What Happens When Adequate Vascular Access Cannot Be Provided for Major Surgery (Liver Transplantation)?

2019 ◽  
Vol 24 (1) ◽  
pp. 52-54 ◽  
Author(s):  
Zoka Milan ◽  
Sanjay Agrawal ◽  
Katyayani Katyayani ◽  
Nikhil Sharma
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Vascular Access ◽  
Early Stage ◽  
Major Surgery ◽  
Early Age ◽  
Large Vein ◽  
Central Access

Highlights Although not traditionally accepted as a viable central access during liver transplant, this case illustrates that in certain situations femoral central access can be successful When dealing with patients who require constant vascular access from a very early age, potential large vein thromboses should be considered Thromboprophylaxis initiation should be considered at a very early stage

Liver Transplantation for Locally Advanced Hepatocellular Carcinoma

2020 ◽  
Vol 04 (01) ◽  
pp. 003-012
Author(s):  
Norio Kawamura ◽  
Akinobu Taketomi
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Early Stage ◽  
Locally Advanced ◽  
Tumor Biology ◽  
Locoregional Therapy ◽  
Milan Criteria ◽  
Advanced Hepatocellular Carcinoma ◽  
Advanced Hcc

AbstractSince the Milan criteria were accepted as the gold standard, liver transplantation has been widely performed as a curative treatment for early-stage hepatocellular carcinoma (HCC). The outcome of liver transplantation in early-stage HCC is excellent; however, the Milan criteria are strict, and therefore, only limited numbers of patients can benefit from liver transplantation. Many HCC patients are diagnosed at an advanced stage, which falls outside the Milan criteria, so it has been proposed over the last two decades that liver transplant surgeons should perform liver transplantation in locally advanced HCC, when presenting without recurrence. Several trials exploring the upper limits of liver transplantation have been performed, and extensive research on tumor biology has enabled the expansion of liver transplant indication for HCC. Simultaneously, locoregional therapy for advanced HCC was found to be an effective procedure when used to distinguish potentially transplantable patients. This treatment approach, known as a downstaging strategy, has been developed over the last two decades and became an essential treatment option for locally advanced HCC. In this article, the current strategies of liver transplantation for the treatment of locally advanced HCC are reviewed.

I need to gain vascular access: ultrasound-guided techniques

Ultrasound ◽  
2012 ◽  
Vol 20 (2) ◽  
pp. 120-124
Author(s):  
John Sloan
Keyword(s):  
Vascular Access ◽  
Ultrasound Guided ◽  
Femoral Access ◽  
General Terms ◽  
Line Placement ◽  
Vein Access ◽  
Large Vein ◽  
Central Access ◽  
Time Critical ◽  
Critical Intervention

Ultrasound has been used to assist line placement for many years, and it is known that ultrasound aids the placement of central and peripheral lines, both in terms of speed of access and reduction of complications. The indications for the use of ultrasound in vascular access vary. In central access, ultrasound should be used at all times unless time-critical intervention mandates otherwise, e.g. in cardiac arrest. In femoral access, it is a very useful adjunct and can be used for reliable, rapid large vein access. In peripheral access, it has a use when conventional access fails. In general terms ultrasound can be used to identify relevant anatomy prior to cannulation, or to guide the process of cannulation. This paper outlines the approaches available.

scholarly journals Through Mothers' Eyes: The Lived Experience of Caring for a Child who has Undergone and Recovered from a Liver Transplantation

2021 ◽  
Author(s):  
◽  
Sandra Elisabeth Ebbeling Murphy
Keyword(s):  
Liver Transplantation ◽  
New Zealand ◽  
Liver Transplant ◽  
Lived Experience ◽  
Health Professionals ◽  
Survival Rates ◽  
Hospital Setting ◽  
Major Surgery ◽  
Paediatric Liver Transplantation ◽  
Emerging Themes

<p>Paediatric liver transplantation is a complicated and costly procedure. It also has the potential to be life-changing for the child and family.  Paediatric liver transplantation commenced in New Zealand in July 2001. Approximately six to eight New Zealand children require liver transplantation annually. International survival rates of children receiving a liver transplant have increased in association with effective drug therapy and technological advances, though the children experience varying levels of wellbeing. Children are discharged relatively quickly following their major surgery. Upon discharge the child is assessed to be well, exhibits satisfactory liver function and the social situation at home is assessed to be conducive to their ongoing care. On discharge the child remains under the spotlight of health care workers. Monitoring reduces as the child's condition improves. The child is only seen by health professionals in outpatient appointments or if admitted back to the ward. The close engagement in the hospital setting is untangled. The child, mother and family regain their autonomy. The long term implications of caring for a child recovering from a life-threatening condition to relative normalcy are largely unobserved. Mothers, whose children had undergone a liver transplant more than one year ago at time of interview and whose children were outpatients of Starship Children's Hospital, were invited to participate in this research. Mothers are generally the most common primary caregiver of children. In caring for their transplanted child following recovery, mothers are relied upon to provide information about their child's wellbeing and functioning. A Heideggerian hermeneutic phenomenological approach, informed by the work of van Manen (1990) was used. Three mothers of children who had received a liver transplant were interviewed to reveal the meanings of the phenomenon - what is the meaning of lived experience of mothers in caring for their child who has undergone and recovered following liver transplantation? Little previous study regarding mothers' lived experience of caring for their child, who had recovered from a liver transplant, was found in the literature. The emerging themes were punctuated with stress being a consistent feature. Utilising Ruddick's (1983) concepts of maternal thinking, the emerging themes were merged within the three interests governing maternal practice; preservation, growth and acceptability. The absolute capacity for attentive love draws the experience together. An essential theme identified out of the analysis was the concept of survival relating to the unique features of liver transplantation and the consequences of liver rejection and failure. The findings contribute to the understanding of the phenomenon, emphasising the need for good support systems for families of children who have undergone transplantation; assistance in the establishment of maternal coping strategies and regular feedback on the children's progress  acknowledging the role and care provided by mothers. Health professionals might develop new understandings of the dynamic and evolving issues arising out of the provision of care by mothers. There may be a greater empathy and understanding of the experiences of mothers in their roles of caring. The findings provide glimpses of the life of children who have  undergone and recovered from a liver transplant.</p>

scholarly journals Through Mothers' Eyes: The Lived Experience of Caring for a Child who has Undergone and Recovered from a Liver Transplantation

2021 ◽  
Author(s):  
◽  
Sandra Elisabeth Ebbeling Murphy
Keyword(s):  
Liver Transplantation ◽  
New Zealand ◽  
Liver Transplant ◽  
Lived Experience ◽  
Health Professionals ◽  
Survival Rates ◽  
Hospital Setting ◽  
Major Surgery ◽  
Paediatric Liver Transplantation ◽  
Emerging Themes

<p>Paediatric liver transplantation is a complicated and costly procedure. It also has the potential to be life-changing for the child and family.  Paediatric liver transplantation commenced in New Zealand in July 2001. Approximately six to eight New Zealand children require liver transplantation annually. International survival rates of children receiving a liver transplant have increased in association with effective drug therapy and technological advances, though the children experience varying levels of wellbeing. Children are discharged relatively quickly following their major surgery. Upon discharge the child is assessed to be well, exhibits satisfactory liver function and the social situation at home is assessed to be conducive to their ongoing care. On discharge the child remains under the spotlight of health care workers. Monitoring reduces as the child's condition improves. The child is only seen by health professionals in outpatient appointments or if admitted back to the ward. The close engagement in the hospital setting is untangled. The child, mother and family regain their autonomy. The long term implications of caring for a child recovering from a life-threatening condition to relative normalcy are largely unobserved. Mothers, whose children had undergone a liver transplant more than one year ago at time of interview and whose children were outpatients of Starship Children's Hospital, were invited to participate in this research. Mothers are generally the most common primary caregiver of children. In caring for their transplanted child following recovery, mothers are relied upon to provide information about their child's wellbeing and functioning. A Heideggerian hermeneutic phenomenological approach, informed by the work of van Manen (1990) was used. Three mothers of children who had received a liver transplant were interviewed to reveal the meanings of the phenomenon - what is the meaning of lived experience of mothers in caring for their child who has undergone and recovered following liver transplantation? Little previous study regarding mothers' lived experience of caring for their child, who had recovered from a liver transplant, was found in the literature. The emerging themes were punctuated with stress being a consistent feature. Utilising Ruddick's (1983) concepts of maternal thinking, the emerging themes were merged within the three interests governing maternal practice; preservation, growth and acceptability. The absolute capacity for attentive love draws the experience together. An essential theme identified out of the analysis was the concept of survival relating to the unique features of liver transplantation and the consequences of liver rejection and failure. The findings contribute to the understanding of the phenomenon, emphasising the need for good support systems for families of children who have undergone transplantation; assistance in the establishment of maternal coping strategies and regular feedback on the children's progress  acknowledging the role and care provided by mothers. Health professionals might develop new understandings of the dynamic and evolving issues arising out of the provision of care by mothers. There may be a greater empathy and understanding of the experiences of mothers in their roles of caring. The findings provide glimpses of the life of children who have  undergone and recovered from a liver transplant.</p>

scholarly journals The Treatment Effect of Liver Transplantation versus Liver Resection for HCC: A Review and Future Perspectives

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3730
Author(s):  
Berend R. Beumer ◽  
Roeland F. de Wilde ◽  
Herold J. Metselaar ◽  
Robert A. de Man ◽  
Wojciech G. Polak ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Liver Resection ◽  
Early Stage ◽  
Disease Free Survival ◽  
Milan Criteria ◽  
Term Survival ◽  
Equal Distribution ◽  
Intention To Treat ◽  
Treat Analysis

For patients presenting with hepatocellular carcinoma within the Milan criteria, either liver resection or liver transplantation can be performed. However, to what extent either of these treatment options is superior in terms of long-term survival is unknown. Obviously, the comparison of these treatments is complicated by several selection processes. In this article, we comprehensively review the current literature with a focus on factors accounting for selection bias. Thus far, studies that did not perform an intention-to-treat analysis conclude that liver transplantation is superior to liver resection for early-stage hepatocellular carcinoma. In contrast, studies performing an intention-to-treat analysis state that survival is comparable between both modalities. Furthermore, all studies demonstrate that disease-free survival is longer after liver transplantation compared to liver resection. With respect to the latter, implications of recurrences for survival are rarely discussed. Heterogeneous treatment effects and logical inconsistencies indicate that studies with a higher level of evidence are needed to determine if liver transplantation offers a survival benefit over liver resection. However, randomised controlled trials, as the golden standard, are believed to be infeasible. Therefore, we suggest an alternative research design from the causal inference literature. The rationale for a regression discontinuity design that exploits the natural experiment created by the widely adopted Milan criteria will be discussed. In this type of study, the analysis is focused on liver transplantation patients just within the Milan criteria and liver resection patients just outside, hereby ensuring equal distribution of confounders.

scholarly journals Peritoneal Dialysis After Liver Transplantation: A Systematic Review

2021 ◽  
Vol 8 ◽  
pp. 205435812110297
Author(s):  
Jean Maxime Côté ◽  
Isabelle Ethier ◽  
Héloïse Cardinal ◽  
Marie-Noëlle Pépin
Keyword(s):  
Systematic Review ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Kidney Failure ◽  
Liver Graft ◽  
Transplant Recipients ◽  
Technique Survival ◽  
Liver Transplant Recipients

Background: Chronic kidney disease following liver transplantation is a major long-term complication. Most liver transplant recipients with kidney failure will be treated with dialysis instead of kidney transplantation due to noneligibility and shortage in organ availability. In this population, the role of peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) remains unclear. Objective: To determine the feasibility regarding safety, technique survival, and dialysis efficiency of PD in liver transplant recipients requiring KRT for maintenance dialysis. Design: Systematic review. Setting: Interventional and observational studies reporting the use of PD after liver transplantation. Patients: Adult liver transplant recipients with kidney failure treated with maintenance KRT. Measurements: Extracted data included eligibility criteria, study design, demographics, and PD modality. The following outcomes of interest were extracted: rate of peritonitis and microorganisms involved, noninfectious peritoneal complications, technique survival, and kidney transplantation-censored technique survival. Non-PD complications included overall survival, liver graft dysfunction, and hospitalization rate. Methods: The following databases were searched until July 2020: MedLine/PubMed, EMBASE, CINAHL, and Cochrane Library. Two reviewers independently screening all titles and abstracts of all identified articles. Due to the limited sample size, observational designs and study heterogeneity expected, no meta-analysis was pre-planned. Descriptive statistics were used to report all results. Results: From the 5263 identified studies, 4 were included in the analysis as they reported at least 1 outcome of interest on a total of 21 liver transplant recipients, with an overall follow-up duration on PD of 19.0 (Interquartile range [IQR]: 9.5-29.5) months. Fifteen episodes of peritonitis occurred in a total cumulative PD follow-up of 514 patient-months, representing an incidence rate of 0.35 per year. These episodes did not result in PD technique failure, mortality, or impairment of liver graft function. Limitations: Limitations include the paucity of studies in the field and the small number of patients included in each report, a risk of publication bias and the impossibility to directly compare hemodialysis to PD in this population. These results, therefore, must be interpreted with caution. Conclusions: Based on limited data reporting the feasibility of PD in liver transplant recipients with kidney failure, no signal was associated with an increased risk of infectious complications. Long-term studies evaluating this modality need to be performed. Registration (PROSPERO): CRD42020218374.

scholarly journals Risk factors predicting Cytomegalovirus infection in post liver transplant recipients

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M G Abdelrahman ◽  
H A Mahmoud ◽  
M K Mohsen ◽  
M O Ali ◽  
A M N Mohamed
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Organ Transplantation ◽  
Chronic Rejection ◽  
Cytomegalovirus Infection ◽  
Transplant Recipients ◽  
Cmv Infection ◽  
Donor Liver Transplantation ◽  
Liver Transplant Recipients

Abstract Background Liver transplantation is considered to be the only curative treatment for patients with end stage liver disease. Postoperative infection remains to be one of the most common causes of morbidity and mortality throughout the past years. Cytomegalovirus (CMV) infection although considered to be a weak viral infection that usually passes asymptomatic in immunocompetent patients, however, it is considered one of the most common pathogens causing morbidities and mortality in liver transplant recipients. Multiple studies have been done to assess the risk factors for developing CMV infection. Objective Identification of risk factors predicting Cytomegalovirus infection in liver transplant recipients following transplantation. Methods This retrospective study was conducted on 194 patients and their donors who underwent living donor liver transplantation operation at Ain Shams centre for organ transplantation (ASCOT) at Ain Shams specialized hospital in the period between January 2010 and December 2016 with at least one year follow up period after operation for the recipient group. Results In our study, 194 patients undergoing liver transplantation at Ain shams centre for organ transplantation over seven years from January 2010 to December 2016 have been followed to assess risk factors affecting CMV infection development. Chronic rejection was found to be the most common factor associated with CMV infection followed by Cyclosporin (Neoral) as main postoperative immunosuppressant following liver transplantation. Other factors that were found to carry risk for CMV infection included younger age, advanced MELD score, positive CMV IgM status of the donors and recipients. Conclusion Differentiation of Cytomegalovirus disease from Cytomegalovirus infection isn’t always available as it requires tissue invasive techniques. Multiple risk factors have been attributed to cause Cytomegalovirus infection (viremia) . In our study, rejection (chronic rejection) was the factor that carries highest risk for Cytomegalovirus infection development followed by Cyclosporin .

scholarly journals HIV and Liver transplantation: The British Columbia Experience, 2004 to 2013

2014 ◽  
Vol 25 (3) ◽  
pp. 159-162 ◽  
Author(s):  
Clara Tan-Tam ◽  
Pamela Liao ◽  
Julio S Montaner ◽  
Mark W Hull ◽  
Charles H Scudamore ◽  
...  
Keyword(s):  
British Columbia ◽  
Liver Transplantation ◽  
Hepatitis C Virus ◽  
Liver Disease ◽  
Hepatitis C ◽  
Liver Transplant ◽  
Clinical Outcomes ◽  
Disease Status ◽  
Transplant Program ◽  
End Stage

BACKGROUND: The demand for definitive management of end-stage organ disease in HIV-infected Canadians is growing. Until recently, despite international evidence of good clinical outcomes, HIV-infected Canadians with end-stage liver disease were ineligible for transplantation, except in British Columbia (BC), where the liver transplant program of BC Transplant has accepted these patients for referral, assessment, listing and provision of liver allograft. There is a need to evaluate the experience in BC to determine the issues surrounding liver transplantation in HIV-infected patients.METHODS: The present study was a chart review of 28 HIV-infected patients who were referred to BC Transplant for liver transplantation between 2004 and 2013. Data regarding HIV and liver disease status, initial transplant assessment and clinical outcomes were collected.RESULTS: Most patients were BC residents and were assessed by the multidisciplinary team at the BC clinic. The majority had undetectable HIV viral loads, were receiving antiretroviral treatments and were infected with hepatitis C virus (n=16). The most common comorbidities were anxiety and mood disorders (n=4), and hemophilia (n=4). Of the patients eligible for transplantation, four were transplanted for autoimmune hepatitis (5.67 years post-transplant), nonalcoholic steatohepatitis (2.33 years), hepatitis C virus (2.25 years) and hepatitis B-delta virus coinfection (recent transplant). One patient died from acute renal failure while waiting for transplantation. Ten patients died during preassessment and 10 were unsuitable transplant candidates. The most common reason for unsuitability was stable disease not requiring transplantation (n=4).CONCLUSIONS: To date, interdisciplinary care and careful selection of patients have resulted in successful outcomes including the longest living HIV-infected post-liver transplant recipient in Canada.

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