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1.
T.-H. Shih Y.-H. Tsou C.-J. Huang C.-L. Chen K.-W. Cheng S.-C. Wu S.-C. Yang S.-E. Juang C.-E. Huang Y.-E. Lee B. Jawan C.-H. Wang K.-A. Chang 《Transplantation proceedings》2018,50(9):2661-2663
Background
Blood loss during liver surgery is found to be correlated with central venous pressure (CVP). The aim of the current retrospective study is to find out the cutoff value of CVP and stroke volume variation (SVV), which may increase the risk of having intraoperative blood loss of more than 100 mL during living liver donor hepatectomies.Method and Patients
Twenty-seven adult living liver donors were divided into 2 groups according to whether they had intraoperative blood loss of less (G1) or more than 100 mL (G2). The mean values of the patients' CVP and SVV at the beginning of the transaction of the liver parenchyma was used as the cutoff point. Its correlation to intraoperative blood loss was evaluated using the χ2 test; P?<?.001 was regarded as significant.Results
The cutoff points of CVP and SVV were 8 mm Hg and 13% respectively. The odds ratio of having blood loss exceeding 100 mL was 91.25 (P?<?.001) and 0.36 (P?<?.001) for CVP and SVV, respectively.Conclusion
CVP less than 5 mm Hg, as suggested by most authors, is not always clinical achievable. Our results show that a value of less than 8 mm Hg or SVV 13% is able to achieve a minimal blood loss of 100 mL during parenchyma transaction during a living donor hepatectomy. Measurements used to lower the CVP or increased SVV in our serial were intravenous fluids restriction and the use of a diuretic. 相似文献2.
C.-E. Huang H.F. Lu C.-L. Chen C.-H. Wang C.-J. Huang K.-W. Cheng S.-C. Wu T.-H. Shih S.-C. Yang S.-E. Juang B. Jawan Y.-E. Lee H.-Y. Lee 《Transplantation proceedings》2018,50(9):2648-2650
Objectives
The aims of this study were to compare the core temperature changes between pediatric patients lying on regular operating room linen drapes and a water-repellent sheepskin rug during living donor liver transplantation (LDLT) and to evaluate the effectiveness of using a water-repellent sheepskin rug in preventing profound hypothermia due to fluid overflow from the abdominal cavity during LDLT.Patients and Methods
The operative records of pediatric patients who underwent LDLT from June 1994-September 2003 were reviewed retrospectively. The nasopharyngeal temperature (NT) changes during the LDLT procedure between patients lying on regular operating room drapes (GI) and water-repellent sheepskin rug (GII) were compared and analyzed using the Mann-Whitney U test. A P value <.05 was regarded as significant.Results
Thirty-two patients were included in GI and 56 in GII. Profound hypothermia was not observed in any recipients lying on a water-repellent sheepskin rug (GII). The NT after induction and the following 4 hours into the LT procedure were significantly higher in GII than GI.Conclusion
Pediatric patients lying on water-repellent sheepskin preserved their core temperature better in comparison to patients lying on linen drapes. The use of a water-repellent sheepskin rug seems to be effective in preventing profound hypothermia related to physical contact with abdominal fluid overflow during the LDLT. 相似文献3.
T.-L. Huang T.-Y. Chen L.-C. Tsang H.-Y. Ou C.-Y. Yu H.-W. Hsu W.-X. Lim Y.-F. Cheng C.-L. Chen 《Transplantation proceedings》2018,50(9):2695-2698
Objective
The aim of the study was to evaluate the efficacy of liver fibrosis (LF) with acoustic radiation force impulse (ARFI) elastography for post-transplant (post-LT) HCV recurrence.Patients and methods
We enrolled 89 adult recipients of living donor liver transplantation (LDLT) who had HCV, with or without post-LT HCV recurrence and treated or not treated. The post-LT HCV recurrence was diagnosed on the basis of RNA viral load present. ARFI examination was performed every 3 months for all patients, with shear wave velocity (SWV) obtained quantitatively in m/s and correlated with histopathologic fibrosis scoring of liver biopsy (LB).Results
There were 50 (50 of 89) patients without HCV recurrence and 39 (39 of 89) with post-LT recurrence in the 89 patients studied. The recurrent group had significantly higher median SWVs (1.87 ± 0.52 vs 1.37 ± 0.52 m/s, P < .0001), in which 18 (18 of 39) patients had antiviral drug treatment and obtained significant improvement with SWVs from 1.83 ± 0.49 to 1.68 ± 0.56 m/s, P = .043. The correlations of LF staging between ARFI elastography and Ishak histopathologic LF scores showed great significance, P = .045. The HCV RNA titer after antiviral treatment decreased from 3,831,750 to 0, P < .0001, but the RNA titer of nontreated patients remained high and the median SWV increased. The Ishak LF staging in the nontreated group progressed from stage 1 to 2, P = .012 and SWV increased from 1.69 ± 0.54 to 1.91 ± 0.66 m/s, P = .085 at 1-year follow-up.Conclusion
ARFI elastography has efficient quantitative LF monitoring correlated with histopathologic staging for post-LT HCV recurrence. It could be an alternative, noninvasive method for frequent LB in the disease follow-up. 相似文献4.
L.-M. Lin S.-C. Kuo Y.-C. Chiu H.-F. Lin M.-L. Kuo A.M. Elsarawy C.-L. Chen C.-C. Lin 《Transplantation proceedings》2018,50(9):2601-2605
Background
Liver transplantation (LT) has become established therapy for end-stage liver disease and small-cell hepatocellular carcinoma (HCC), relying mainly on living donor LT (LDLT) in Taiwan. The cost of LDLT varies in different countries depending on the insurance system, the costs of the facility, and staff. In this study we aimed to investigate cost outcomes and determinants of LDLT in Taiwan.Methods
From January 2014 to December 2015, 184 LDLT patients were enrolled in a study performed at the Kaohsiung Chang Gung Memorial Hospital. Patients' transplantation costs were defined as expense from immediately after surgery to discharge during hospitalization for LDLT. Antiviral therapy and hepatitis B immunoglobulin (HBIG) for prevention of hepatitis B virus (HBV) were included, but direct-acting antiviral (DAA) therapy for hepatitis C (HCV) was excluded.Results
The median total, intensive care unit (ICU), and ward costs of LT were US$64,250, $43,357, and $16,138 (currency ratio 1:30), respectively. HBV significantly increased the total cost of LT, followed by postoperative reintubation and bile duct complications.Conclusion
The charges associated with anti-HBV viral therapy and HBIG increase the cost of LDLT. Disease severity of liver cirrhosis showed less importance in predicting cost. Postoperative complications such as reintubation or bile duct complications should be avoided to reduce the cost of LT. 相似文献5.
C.-J. Huang C.-H. Chang K.-W. Cheng C.-L. Chen S.-C. Wu T.-H. Shih S.-C. Yang Y.-E. Lee C.-E. Huang B. Jawan C.-H. Wang S.-E. Juang 《Transplantation proceedings》2018,50(9):2645-2647
Background
To evaluate the effect of dextrose contained in banked blood products on the changes of blood glucose levels in adult living donor liver transplantation patients retrospectively.Methods
Four hundred seventy-seven patients were divided into a non–blood transfusion (BT) group (G1) and a BT group (G2). The changes in blood glucose levels during the operation were compared using a Mann-Whitney U test, and a P value less than .05 was regarded as significant.Results
No significant changes were detected in blood glucose levels after anesthesia, during dissection phase, in the anhepatic phase, or after reperfusion between the groups. Estimated blood loss for G1 (n = 89) and G2 (n = 388) were 718 ± 514 and 5804 ± 877 mL respectively, G1 had no blood transfusion but G2 had received 4350 ± 6230 mL leukocyte-poor red blood cell transfusion, the pre- and end operation hemoglobin for G1 and G2 were 13.2 ± 2.0, 10.2 ± 1.9 and 10.1 ± 1.6, 10.2 ± 1.9 mg/dL respectively, indicating that they were not under or over transfused.Conclusion
When banked blood products are used to replace ongoing blood loss, the dextrose contained in citrate-phosphate-dextrose-adenine seems to have no effect on the changes in the blood glucose levels of the recipients. 相似文献6.
H.-W. Hsu L.L. Tsang H.-Y. Ou T.-L. Huang T.-Y. Chen C.-Y. Yu W.-X. Lim Y.-S. Tong C.-L. Chen Y.-F. Cheng 《Transplantation proceedings》2018,50(9):2588-2592
Objectives
This study aims to investigate postdonation outcomes of adult living donor liver transplantation donors and remnant liver regeneration in different graft types.Methods
A total of 236 adult living donor liver transplantation donors were classified into different groups: donors with <35% remnant liver volume (group A; n = 56) and donors with remnant liver volume ≥35% (group B, n = 180); left lobe grafts (LLG group; n = 98) including middle hepatic vein (MHV) and right lobe grafts (RLG group; n = 138) without MHV. The 98 LLG group donors were further classified into 2 subgroups based on hepatic venous drainage patterns: MHV-dominant (n = 20) and non-MHV-dominant (n = 78). The demographic data, postoperative laboratory data, complications, graft weight, remnant liver volume, remnant liver growth rate, and remnant liver regeneration rate (RLRR) after partial liver donation were analyzed.Results
The postoperative aspartate aminotransferase, alanine aminotransferase, total bilirubin, intensive care unit stays, and hospitalization stays were higher in A and RLG group donors. All the donor complications in our series were minor complications. The postoperative complication rate was higher in the A and RLG group, but failed to reach statistical significance. There was no significant difference in RLRR between the RLG/LLG and A/B groups. However, the MHV-dominant group had significantly lower RLRR than the non-MHV-dominant group (P < .05).Conclusions
Small remnant liver volume donors (<35% remnant liver) have higher risks of developing postdonation minor complications. Left lobe liver donation in MHV-dominant donor candidates are a major concern. 相似文献7.
K.-T. Lu Y.-F. Cheng T.-Y. Chen L.-C. Tsang H.-Y. Ou C.-Y. Yu H.-W. Hsu W.-X. Lim Y.-S. Tong T.-L. Huang 《Transplantation proceedings》2018,50(9):2715-2717
Background
Our aim in this study was to evaluate long-term efficiency of hepatic venous balloon angioplasty (BA) and stent placement (SP) for hepatic venous outflow obstruction (HVOO) in pediatric liver transplantation (LT).Methods
From January 1999 to September 2016, 262 pediatric patients underwent LT at our hospital. Ten were diagnosed with HVOO, which included 8 living donor grafts and 2 split liver grafts. BA and SP were used in management of these 10 patients with HVOO. After intervention, Doppler ultrasound (DUS) was the major follow-up modality for comparing efficiency of BA and SP.Results
The incidence of HVOO was 3.8% (10 of 262) in our pediatric LTs. Of the 10 HVOO cases, 5 had SP, 3 had BA once, 1 had BA twice, and 1 had BA twice along with SP. The patent hepatic vein was maintained after a mean follow-up of 7.4 (range, 0.04–17) years. Recurrent rate of HVOO after BA was 42%. Neither recurrent HVOO nor stent migration occurred after SP and throughout long-term follow-up.Conclusion
Hepatic venous SP was found to be more effective and safe than BA for treatment of HVOO in pediatric LT for long-term follow-up. 相似文献8.
S.-C. Yang H.-Y. Lee C.-L. Chen C.-J. Huang C.-H. Wang K.-W. Cheng S.-C. Wu T.-H. Shih C.-E. Huang Y.-E. Lee B. Jawan S.-E. Juang H.-F. Lu 《Transplantation proceedings》2018,50(9):2651-2653
Background
Opsite (Smith & Nephew, Hull, UK) is widely used in wound care but its use in eye protection against corneal abrasion during major surgery is rarely reported. The purpose of the current study is to compare the effectiveness of using Opsite in eye protection with either wet gauze alone or with wet gauze following application of eye ointment in patients undergoing living donor liver transplantation (LDLT).Methods
This is a prospective, double-blinded, randomized controlled trial. Forty-one patients undergoing liver transplantation were enrolled. One eye of each patient was protected with sterile gauze soaked with normal saline solution and covered with Opsite. Duratears (ALCON, Fort Worth, Tex, United States) ointment was applied to the other eye before covering it with sterile wet gauze and Opsite (ointment group). The corneal examination was carried out after fluorescein staining before and at the end of surgery by the same doctor. A Student t-test and a χ2 test were used for the statistical analyses.Results
Forty-one patients with 82 eyes were observed in this study. No corneal epithelial defects were found in either the normal saline group or the ointment group.Conclusion
Opsite combined with wet gauze with or without additional eye ointment provided 100% protection against corneal abrasion in patients undergoing LDLT. 相似文献9.
H.L. Luo Y.T. Chen S.C. Huang T.C. Chen P.H. Chiang S.S. Lin Y.T. Cheng 《Transplantation proceedings》2017,49(5):1064-1067
Objectives
Polyomavirus has been reported to be oncogenic due to viral integration into the human genome. A relatively high prevalence of upper urinary tract urothelial carcinoma (UTUC) was noted after kidney transplantation (KT) in Taiwan. However, little was known about the impact of polyomavirus on the urothelial cancer behavior. Therefore, the aim of this study is to analyze the characteristics of polyomavirus-related UTUC after KT.Methods
From 2005 to 2014, 27 patients were found to have UTUCs after KT. All the patients underwent standard nephroureterectomy. Detailed perioperative parameters were obtained from chart records. A qualified pathologist who is blinded to the clinical outcome examined large T antigen expression and pathological features. All the patients were divided into two groups according to positive or negative expression of large T antigen.Results
In the patient demography, a significantly younger median age was found in patients with large T antigen–positive UTUCs compared with the negative control group (48.1 ± 8.3 years versus 54.6 ± 4.1 years, respectively, P = .013). As for the pathological features and oncologic outcome, there were no obvious differences between these two groups. Non–organ-confined status and positive lymphovascular invasion are prognostic factors associated with systemic disease recurrence (P = .017 and .001, respectively).Conclusions
Although UTUC commonly develops in the elderly, earlier onset of post-KT UTUCs was observed especially in patients with positive large T antigen expression in our cohort. This preliminary result provides valuable experience suggesting more frequent upper urinary tract screening for polyomavirus infected patients after KT in Taiwan. 相似文献10.
Objectives
Kidney transplantation (KT) is an important renal replacement therapy for end-stage renal disease (ESRD). The incidence of upper urinary tract urothelial carcinoma (UTUC) is relatively higher in Taiwan. According to our institutional database, early onset of post-KT UTUC is not uncommon. Early detection of post-KT UTUC is an important issue to improve oncologic outcome. Because painless hematuria is a common symptom for UTUC, this study analyzes whether using hematuria as post-KT UTUC screening delayed cancer diagnosis or not.Methods
From 2005 to 2012, 128 ESRD patients were found to have UTUCs. There were 28 patients who underwent KT and were regularly followed up at our institution. All the patients underwent standard nephroureterectomy.Results
In ESRD patients with UTUC, the post-KT group revealed significantly less gross hematuria and microscopic hematuria at presentation compared with the non-KT group (43% versus 76%, P = .001 and 64% versus 86%, P = .011). For those patients with gross hematuria, non–organ-confined UTUC occurred more in the post-KT group compared with the non-KT group (42% versus 12%, P = .009). For those patients with microscopic hematuria, non–organ-confined UTUC occurred more in the post-KT group compared with the non-KT group with borderline significance (33% versus 16%, P = .085).Conclusions
According to our observation, using gross or microscopic hematuria as detection of post-KT UTUC is associated with delayed diagnosis of cancer occurrence. Closer upper urinary tract image study such as sonography may help earlier cancer screening. 相似文献11.
S.-C. Kuo C.-C. Lin A. Elsarawy Y.-H. Lin S.-H. Wang Y.-J. Wu C.-L. Chen 《Transplantation proceedings》2017,49(8):1870-1874
Background
Ventral incisional hernia (VIH) is not uncommon following liver transplantation. Open repair was traditionally adopted for its management. Laparoscopic repair of VIH has been performed successfully in nontransplant patients with evidence of reduced recurrence rates and hospital stay. However, the application of VIH in post-transplantation patients has not been well established. Herein, we provide our initial experience with laparoscopic repair of post-transplantation VIH.Methods
From March 2015 to March 2016, 18 cases of post-transplantation VIH were subjected to laparoscopic repair (laparoscopy group). A historical control group of 17 patients who underwent conventional open repair (open group) from January 2013 to January 2015 were identified for comparison. The demographics and clinical outcomes were retrospectively compared.Results
There were no significant differences among basic demographics between the 2 groups. No conversion was recorded in the laparoscopy group. Recurrence of VIH up to the end of the study period was not noted. In the laparoscopy group, the minor complications were lower (16.7% vs 52.9%; P = .035), the length of hospital stay was shorter (3 d vs 7 d, P = .007), but the median operative time was longer (137.5 min vs 106 min; P = .003).Conclusions
Laparoscopic repair of post-transplantation VIH is a safe and feasible procedure with shorter length of hospital stay. 相似文献12.
Y.S. Tong T.L. Huang T.Y. Chen L.L.C. Tsang H.Y. Ou C.Y. Yu H.W. Hsu L.W. Xiong C.C. Liao H.L. Eng C.L. Chen Y.F. Cheng 《Transplantation proceedings》2018,50(9):2622-2625
Objective
The aim of this study is to determine whether post-transarterial chemoembolization imaging (computed tomography or magnetic resonance imaging) could accurately predict the tumors' necrosis on pathologic specimens.Background
Transarterial chemoembolization with drug-eluting beads has been proven to be an effective way to bridge patients with hepatocellular carcinomas to liver transplantation.Materials and methods
From September 2012 to June 2017, 59 patients with a total of 78 hepatocellular carcinomas, who received transarterial chemoembolization with drug-eluting beads before liver transplantation in Kaohsiung Chang Gung Memorial Hospital, were included in the study. All patients and hepatocellular carcinomas have pre-transarterial chemoembolization and post-transarterial chemoembolization images (computed tomography or magnetic resonance imaging) and pathological findings for correlation. Tumor response was evaluated according to modified Response Evaluation Criteria in Solid Tumors. The ranges of necrotic percentage are 100%, 91-99%, 51-90%, and <50%.Results
The accuracy rate between the imaging and pathology correlation was 40% for computed tomography and 42% for magnetic resonance imaging. The recurrent rate of the complete respond group is 11.5%, the partial respond group is 16.0%, and the stationary group is 28.6%.Conclusion
Computed tomography and magnetic resonance imaging sensitivity is not satisfactory for microscopic evaluation of residual tumors after transarterial chemoembolization with drug-eluting beads. However, survival is good after liver transplantation no matter what the microscopic findings were. 相似文献13.
T.-L. Lin S.-C. Kuo C.-H. Yeh Y.-C. Chan Y.-H. Lin W.-F. Li C.-C. Yong Y.-W. Liu S.-H. Wang C.-C. Lin C.-C. Wang C.-L. Chen 《Transplantation proceedings》2018,50(9):2711-2714
Background
Bacterial Infection is the most important source of mortality and morbidity in liver transplantation recipients. Donor transmitted bacterial infection is rare but one of the most important infection sources. This kind of infection is difficult to identify, causing treatment dilemma.Patients and Methods
In this article, we retrospectively reviewed our deceased donor liver transplants performed from January 2014 to December 2016. Forty-two recipients in Kaohsiung Chang Gung Memorial Hospital receiving liver grafts from 35 deceased liver donors were evaluated. The demography, donor transmitted infection, and outcomes were evaluated.Result
Two patients had probable donor transmitted bacterial infection and 1 patient died of suspected transmitted infection.Conclusion
Early identification of donor infection and adequate antibiotic treatment for the donor and recipient are the keys to preventing donor transmitted bacterial infection. Donor infection is not an absolute contraindication for organ donation in the area of organ shortage. Organ procurement organizations or similar authorities may establish the platform for sharing the data about donor and recipient infections. 相似文献14.
C.-Y. Hsieh C.-H. Chien K.-L. Liu H.-H. Wang K.-J. Lin Y.-J. Chiang 《Transplantation proceedings》2017,49(9):2036-2039
Objective
This study aimed to identify the factors influencing the positive and negative affects and the health-related quality of life (HRQOL) of living kidney donors.Methods
With the use of a cross-sectional study design and a structured questionnaire, information on the basic characteristics, positive affect, negative affect, and HRQOL of 41 living kidney donors were compared.Results
The negative affect in living kidney donors was similar to that of the general population, but the positive affect was slightly lower. The physical HRQOL of living kidney donors was slightly higher than that of the general population, and the mental HRQOL was similar. Female donors showed a greater positive affect than male donors. The donors who were siblings of the recipients showed a more negative affect. Donors without chronic disease and with good perceived physical health showed improved positive affect, negative affect, and mental HRQOL. Furthermore, living kidney donors with better positive and negative affects showed improved physical and mental HRQOLs.Conclusions
Clinical health providers should evaluate and determine the positive affect, negative affect, and quality of life of living kidney donors, especially in men, siblings of the recipients, those with chronic disease, and those with poorer perceived physical health. Moreover, psychosocial interventions should be provided to improve these factors. 相似文献15.
N.M. Abdelhamid Y.-C. Chen Y.-C. Wang C.-H. Cheng T.-J. Wu C.-F. Lee T.-H. Wu H.-S. Chou K.-M. Chan W.-C. Lee R.-S. Soong 《Transplantation proceedings》2017,49(1):92-97
Background
The prognosis of patients after liver transplantation (LTx) with high Model of End-Stage Liver Disease (MELD) score (>30) is predicted, but patients with lower MELD scores (<30) have no conclusive studies of pre- and post-transplant risk factors that influence the long-term outcome.Methods
This retrospective study reviewed 268 recipients with MELD score <30, from 2008 to 2013 in our institution, for evaluation of pre-transplant risk factors including patients' clinical background data, pre-transplant lymphocyte subpopulation, and early post-transplant infection complication as predictors for long-term survival after LTx.Results
The post-transplant patients' survival estimates were 90.7%, 85.1%, and 83.6% at 1, 3, and 5 years, respectively. In multivariate analysis, age >55years, presence of ascites, cluster of differentiation (CD)3 < 93.2 (count/μL), CD4/CD8 <2.4, fungal infection, and more than one site of fungal colonization significantly influenced survival (P = .0003, P = .002, P = .04, P = .004, P < .0001, and P > .0001, respectively). We also noticed that these five factors accumulatively influence the long-term survival rate; this means that in the presence of any two risk factors, the 5-year survival can still be 88.4%, whereas in the presence of any three risk factors, the survival rate dropped to only 57.1%.Conclusions
Older patients in the presence of pre-transplant low immune cell number and ascites in association with post-transplant fungal infection are the independent risk factors in MELD scores <30 LTx groups for long-term survival. Patients in these groups with any of the three factors had inferior long-term survival results. 相似文献16.
Background
Tacrolimus is widely used in renal transplantation to help prevent acute and chronic rejection, but the nephrotoxicity of tacrolimus may compromise renal function. This study investigates the safety and efficacy in delayed initiation of tacrolimus after antilymphocyte induction therapy in kidney transplant recipients.Methods
This retrospective cohort analysis involved data from 68 kidney transplant recipients receiving standard induction therapy (basiliximab [Simulect] or thymoglobulin) combined with tacrolimus. The patients were divided into 2 groups according to whether the start time of tacrolimus therapy was before or after 24 hours posttransplantation. Acute rejection, common complications of immunosuppression, and graft survival were compared.Results
The mean (SD) timing of tacrolimus administered in the Delayed group was 4 (1.9) days after transplantation. The Delayed group patients had a higher percentage of slow graft function and delayed graft function than the No-delay group. Compared with the No-delay group, delayed initiation of tacrolimus did not increase risk of biopsy-proven acute rejection, infection, posttransplant diabetes mellitus, graft survival, and patient survival.Conclusions
Our study confirmed delayed initiation of tacrolimus after antilymphocyte induction therapy is safe and effective in renal transplant recipients with slow or delayed graft function. 相似文献17.
活体右半肝供肝切取的经验 总被引：1，自引：0，他引：1
目的对活体右半肝供肝切取手术经验进行总结。方法回顾性分析我中心单一外科小组2007年8月至2008年12月期间连续实施右半肝切取的76例供者资料。术前综合考虑移植物大小、残肝比例、有无脂肪肝、肝中静脉类型及受体术前门静脉高压情况,以确定是否带肝中静脉。术中以缺血线确定肝切平面,以术中B超了解肝中静脉的走向及分支,肝切线在肝中静脉左或右侧紧贴肝中静脉。行术中胆道造影,了解胆道结构及变异。记录手术时间,术中失血量,术后住院时间,术后住院期间总胆红素、国际标准化比值(INR)和ALT水平变化情况以及术后各种并发症发生情况。结果 76例供体均顺利完成手术,手术时间(8.3±1.3)h,术中失血量(325±127)ml,术中均未输血。总胆红素、INR和ALT水平于术后第12天恢复正常。本组供体术后住院期间最常见并发症是伤口感染(共5例),胆汁郁积4例,断面漏胆4例;11例患者于术后4～7d出现不同程度的胃排空障碍;均经相应处理后好转。术后住院9～21d,中位时间14d。结论充分的术前评估以及精准的术中操作能够保证供肝的顺利切取并有利于供体的术后恢复。 相似文献
18.
Young Hye Kim Ui Jin Park Hyun Sik Chung Sang Hyun Hong Chul Soo Park Jong Ho Choi Ho Joong Choi Joon-Yong Jung Min Suk Chae 《Transplantation proceedings》2019,51(6):1853-1860
ObjectiveThe development of sarcopenia leads to adverse postoperative outcomes. However, no study has investigated perioperative loss in core muscle and the correlation between core muscle and residual liver volume in living donors for liver transplant.Patients and MethodsA total of 457 adult healthy donors who underwent a right lobe hepatectomy without the middle hepatic vein for elective liver transplant were retrospectively analyzed. Abdominal computed tomography was performed within 1 month before surgery and the first week and 3 months after the surgery. The average psoas muscle area between lumbar vertebrae 3 and 4 was measured and normalized by height squared (psoas muscle index [PMI] = psoas muscle area/height2). The initial whole liver volume and remnant left lobe volume were measured on computed tomography images.ResultsThe study cohort included 279 men (61.1%) and 178 women (38.9%). The median preoperative PMIs were 420.9 mm2/m2 (interquartile range, 360.6–487.0 mm2/m2) in men and 280.9 mm2/m2 (interquartile range, 243.5–318.7 mm2/m2) in women. The PMIs in men and women significantly decreased during the first week after surgery, and gradually recovered to preoperative levels during the first 3 months after surgery. Based on the ratio between the remnant left lobe and initial whole liver volume (≥30%), the increase in remnant left lobe volume was not correlated with the decrease in PMI on postoperative day 7. A postoperative U-shaped recovery in the core muscles was present in both male and female donors, independent of the remnant liver ratio.ConclusionsDespite the requirements of partial liver regeneration and surgical wound repair, healthy donors did not suffer from sustained core muscle loss after surgery. 相似文献
19.
K.-M. Chan C.-H. Cheng T.-H. Wu C.-F. Lee T.-J. Wu H.-S. Chou W.-C. Lee 《Transplantation proceedings》2017,49(10):2324-2326
Background
Currently, pancreas transplantation has been a promising strategy to restore long-term normoglycemia as well as to improve life quality for patients with insulin-dependent diabetes mellitus (DM). However, the discrepancy between the number of organs needed and the number donated for transplantation is always enormous. Under a setting of scarce organ donations, we examined our limited experience of pancreas transplantation.Methods
A retrospective review of pancreas transplantations was performed with the use of data from the Taiwan Organ Registry and Sharing Center and the Ministry of Health and Welfare. Pancreas transplantations in the Organ Transplantation Institute of Chang Gung Memorial Hospital also were reviewed.Results
At present, there are 5 medical centers approved for pancreas transplantation in Taiwan. Overall, a total of 156 pancreas transplantations were performed from 2005 to the end of 2016; only 9 of them were performed in the Organ Transplantation Institute of Chang Gung Memorial Hospital. Although the number of organ donations is rising, pancreas transplantation numbers remain low. More than 20 pancreas transplantations were performed in 2016, yet there remained a total of 111 patients registered on the wait list for pancreas transplantation at the end of this study. Thus the gap between organ donation and transplantation is still vast.Conclusions
With continuing improvements in Taiwanese health policies and public education regarding organ transplantation, organ donation rates have risen steadily in recent years. Moreover, quality control and continuing evolution in organ transplantation is crucial to ameliorate the difficult situation of pancreas transplantation and other solid organ transplantation in the context of low levels of donation. 相似文献20.
J. Briceno R. Ciria P. López A. Luque A. Arjona-Sanchez J.M. Sánchez-Hidalgo M.D. Ayllón I. Gómez-Luque J. Gomez 《Transplantation proceedings》2019,51(1):56-57
Herein we report on laparoscopic donor hepatectomy (left lateral sectionectomy) for pediatric living donor liver transplantation by using a pure laparoscopic approach. Seven laparoscopic living donor procedures were performed during the period March 2016 to February 2017 at our institution. The average age of donors was 33.3 years. Preoperative liver function was normal in all donors. Four donors required 1 or more Pringle maneuver(s). The etiology was biliary atresia (n = 3), metabolic disorders (n = 2) (OTC deficiency), Alagille syndrome (n = 1), and neonatal ductopenia (n = 1). The graft was implanted orthotopically in 6 patients; we performed an auxilliary transplantation in a patient with an OTC deficiency. The time of donor surgery was 363 minutes. Dindo-Clavien complications among donors were type I (n = 1), type IIa (n = 1), and type IIb (n = 2). The mean hospital stay for the recipients was 14 days. The mean donor stay was 3.7 days. Perioperative donor and recipient mortality was 0%. Graft survival was 87.5% with 1 graft loss secondary to inadequate venous outflow. In conclusion, we can propose the laparoscopic approach in experienced centers as a “standard of practice” due to its minimal complication rate and short hospital stay. 相似文献