Bypass during Liver Transplantation: Anachronism or Revival? Liver Transplantation Using a Combined Venovenous/Portal Venous Bypass—Experiences with 163 Liver Transplants in a Newly Established Liver Transplantation Program

Gastroenterology Research and Practice ◽

10.1155/2015/967951 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

Anne Mossdorf ◽

Florian Ulmer ◽

Karsten Junge ◽

Christoph Heidenhain ◽

Marc Hein ◽

...

Keyword(s):

Liver Transplantation ◽

Volume Overload ◽

Median Number ◽

Liver Transplants ◽

Safety Measures ◽

Ischemic Time ◽

Venous Bypass ◽

Transplant Program ◽

Transplantation Program ◽

Marginal Grafts

Introduction. The venovenous/portal venous (VVP) bypass technique has generally become obsolete in liver transplantation (LT) today. We evaluated our experience with 163 consecutive LTs that used a VVP bypass. Patients and Methods. The liver transplant program was started in our center in 2010. LTs were performed using an extracorporal bypass device. Results. Mean operative time was 269 minutes and warm ischemic time 43 minutes. The median number of transfusion of packed cells and plasma was 7 and 14. There was no intraoperative death, and the 30-day mortality was 3%. Severe bypass-induced complications did not occur. Discussion. The introduction of a new LT program requires maximum safety measures for all of the parties involved. Both surgical and anaesthesiological management (reperfusion) can be controlled very reliably using a VVP bypass device. Particularly when using marginal grafts, this approach helps to minimise both surgical and anaesthesiological complications in terms of less volume overload, less use of vasopressive drugs, less myocardial injury, and better peripheral blood circulation. Conclusion. Based on our experiences while establishing a new liver transplantation program, we advocate the reappraisal of the extracorporeal VVP bypass.

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The Scottish Liver Transplant Unit: current and future perspectives

Scottish Medical Journal ◽

10.1258/smj.2011.011162 ◽

2011 ◽

Vol 56 (4) ◽

pp. 223-226

Author(s):

S J Mcnally ◽

S J Wigmore

Keyword(s):

Liver Transplantation ◽

Liver Transplant ◽

Organ Donation ◽

Quality Care ◽

Liver Transplants ◽

Donor Liver Transplantation ◽

Novel Treatments ◽

Split Liver ◽

Marginal Grafts ◽

And Function

The Scottish Liver Transplant Unit (SLTU) opened in 1992 and has now performed over 900 liver transplants. During this time there have been major changes in both organ donation and transplantation. Currently liver transplantation is restricted by limited organ supply. Scotland has one of the lowest rates of organ donation in Europe and one of the most rapidly increasing rates of cirrhosis. The consequent waiting list mortality has driven innovations including increasing use of marginal grafts, organs donated after cardiac death, split-liver transplants and the development of living-donor liver transplantation. To maintain liver transplantation, there is an urgent need to increase organ donation rates and to find novel treatments which optimize outcomes from marginal grafts. This review addresses the surgical aspects of liver transplantation and how these have evolved over the two past decades. Major changes are currently underway in organ donation organization, and there is continuing refinement of organ treatment and storage. A number of measures to maintain and improve organ preservation and function are currently being evaluated in clinical trials, and cell therapy holds significant potential for the future. Scotland has a rising need for liver transplantation and the SLTU continues to provide high-quality care and to be at the forefront of the latest advances in organ transplantation.

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Caval Anastomosis in Liver Transplantation: Prospective Experience of Verona Liver Transplantation Program

Transplantation Proceedings ◽

10.1016/j.transproceed.2005.06.014 ◽

2005 ◽

Vol 37 (6) ◽

pp. 2605-2606 ◽

Cited By ~ 2

Author(s):

M. Donataccio ◽

A. Ruzzenente ◽

S. Pachera ◽

B. Genco ◽

D. Donataccio

Keyword(s):

Liver Transplantation ◽

Transplantation Program

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Incidence, Characteristics, and Prognosis of Incidentally Discovered Hepatocellular Carcinoma after Liver Transplantation

Journal of Transplantation ◽

10.1155/2016/1916387 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Walid El Moghazy ◽

Samy Kashkoush ◽

Glenda Meeberg ◽

Norman Kneteman

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Tumor Recurrence ◽

Patient Survival ◽

Steady Increase ◽

Liver Transplants ◽

Significant Difference ◽

One Year ◽

Over Time

Background. We aimed to assess incidentally discovered hepatocellular carcinoma (iHCC) over time and to compare outcome to preoperatively diagnosed hepatocellular carcinoma (pdHCC) and nontumor liver transplants.Methods.We studied adults transplanted with a follow-up of at least one year. Patients were divided into 3 groups according to diagnosis of hepatocellular carcinoma.Results.Between 1990 and 2010, 887 adults were transplanted. Among them, 121 patients (13.6%) had pdHCC and 32 patients (3.6%) had iHCC; frequency of iHCC decreased markedly over years, in parallel with significant increase in pdHCC. Between 1990 and 1995, 120 patients had liver transplants, 4 (3.3%) of them had iHCC, and only 3 (2.5%) had pdHCC, while in the last 5 years, 263 patients were transplanted, 7 (0.03%) of them had iHCC, and 66 (25.1%) had pdHCC (P<0.001). There was no significant difference between groups regarding patient survival; 5-year survival was 74%, 75.5%, and 77.3% in iHCC, pdHCC, and non-HCC groups, respectively (P=0.702). Patients with iHCC had no recurrences after transplant, while pdHCC patients experienced 17 recurrences (15.3%) (P=0.016).Conclusions.iHCC has significantly decreased despite steady increase in number of transplants for hepatocellular carcinoma. Patients with iHCC had excellent outcomes with no tumor recurrence and survival comparable to pdHCC.

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226Low blood product requirements in a liver transplantation program

Liver Transplantation ◽

10.1016/s1527-6465(05)80252-7 ◽

2000 ◽

Vol 6 (3) ◽

pp. C56-C56

Author(s):

P CHAPCHAP ◽

E CARONE ◽

V PUGLIESE ◽

S BIAGINI ◽

E SILVA ◽

...

Keyword(s):

Liver Transplantation ◽

Blood Product ◽

Transplantation Program

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

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2014/373898 ◽

2014 ◽

Vol 25 (3) ◽

pp. 159-162 ◽

Cited By ~ 5

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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Liver Transplantation and Quality of Life

Canadian Journal of Gastroenterology ◽

10.1155/2000/879658 ◽

2000 ◽

Vol 14 (8) ◽

pp. 693-699 ◽

Cited By ~ 13

Author(s):

J Rodés ◽

M Navasa

Keyword(s):

Quality Of Life ◽

Liver Transplantation ◽

Survival Rate ◽

Late Complications ◽

Liver Transplants ◽

Physical Conditions ◽

The World ◽

Liver Transplantations ◽

Validated Instrument

To date, more than 50,000 liver transplantations have been performed around the world; the survival rate five years after transplantation ranges from 60% to 65%. One of the fundamental objectives for liver transplantation teams is to achieve the best possible quality of life (QOL) for the patients. A concise analysis of the methodology used (15 questionnaires) to measure QOL of patients with liver transplants is described. The authors suggest that now is the time to establish a database so that a validated instrument will be available to compare QOL results from all the liver transplantation programs. Liver transplantation is believed to improve QOL, although there are several problems with some of the papers published on this subject. Some studies are retrospective, whereas in others, patients in bad physical conditions are excluded from the study; in quite a few prospective studies, deaths are not included in the data analysis. Finally, the authors provide a brief, concise analysis of late complications and of recurrence of the disease after liver transplantation, which influence QOL.

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A New Percutaneous Technique for Establishing Venous Bypass Access in Orthotopic Liver Transplantation

Anesthesiology ◽

10.1097/00000542-199209001-00130 ◽

1992 ◽

Vol 77 (Supplement) ◽

pp. A130

Author(s):

A C. Oken ◽

S M. Frank ◽

W. Merritt ◽

A. Klein ◽

J. Burdick ◽

...

Keyword(s):

Liver Transplantation ◽

Orthotopic Liver Transplantation ◽

Percutaneous Technique ◽

Venous Bypass

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Liver Transplantation: Past Accomplishments and Future Challenges

Canadian Journal of Gastroenterology ◽

10.1155/1999/518751 ◽

1999 ◽

Vol 13 (3) ◽

pp. 257-263 ◽

Cited By ~ 4

Author(s):

William J Wall

Keyword(s):

Liver Transplantation ◽

Survival Rates ◽

Alcoholic Cirrhosis ◽

Liver Transplants ◽

Recidivism Rates ◽

Societal Challenges ◽

Therapeutic Value ◽

Future Challenges ◽

Will Force ◽

End Stage

Liver transplantation has evolved from a rare and risky operation of questionable therapeutic value to the preferred treatment for an extensive list of end-stage liver diseases. Superior immunosuppression (cyclosporine), and improvements in surgery and anesthesia brought liver grafting to its current level of success. Nearly 60,000 liver transplants have been performed, and survival rates are very good; however liver grafting faces serious immediate and long term challenges, mainly due to the widening gap between donor supply and recipient demand. Increasing numbers of sick candidates, recurrent disease (especially hepatitis C) and recidivism rates after transplantation for alcoholic cirrhosis will force increasingly difficult decisions on candidate selection and priority listing of potential recipients. Although xenotransplantation may be the ultimate solution, it has its own specific set of biological and societal challenges - the full extent of which should be revealed in the next several years.

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