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Liver transplantation
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Caroline Lemoine, Riccardo A. Superina
Hepatic artery thrombosis (4–8% of cases) can be devastating. It is more common in smaller pediatric recipients. Various prophylactic agents, such as perioperative low-dose heparin and/or acetylsalicylic acid, are used and the packed cell volume should initially be maintained below 35%. Hepatic artery thrombosis may present in several ways: An acute deterioration in liver function progressing to fatal hepatic necrosis, an insidious onset with biliary complications or sepsis, or an absent arterial signal on routine Doppler US scan. If hepatic artery thrombosis is suspected within days of the transplant, urgent arterial computed tomodensitometry and/or laparotomy are warranted; if revascularization is not possible or unsuccessful, urgent retransplantation is usually required.
Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Biliary strictures, mostly secondary to ischaemia, can occur in up to 30% of patients and it is a late complication of transplant. Hepatic artery thrombosis is the most common and serious early vascular complication post transplant. A tardus parvus wave form is not normal and indicates hepatic artery stenosis.
Transplant Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
David van Dellen, Zia Moinuddin, Hussein Khambalia, Brian KP Goh
A patient 1-week post-liver transplant for primary sclerosing cholangitis has a sudden rise in transaminases. What are the possible causes?Hepatic artery thrombosisFulminant acute rejection
Does Arterialization of Portal Vein Have Any Effects in Large-for-Size Liver Transplantation? Hemodynamic, Histological, and Biomolecular Experimental Studies
Published in Journal of Investigative Surgery, 2022
Rafael Rodrigues Torres, Ana Cristina Aoun Tannuri, Suellen Serafini, Alessandro Belon, Josiane Oliveira Gonçalves, Celso di Loreto, Uenis Tannuri
When a large graft mass is transplanted into a small child, insufficient portal flow (mL/min/graft weight) might induce severe IRI, resulting in allograft dysfunction. An association between portal flow changes, IRI, and graft outcome has been previously reported. Portal flow has been shown to play an important role in early graft outcomes after liver transplantation [18]. In the hepatic microcirculation there is a complex interdependence between the portal vein flow and the hepatic artery flow. A recent study found that liver transplant recipients with high portal flow had milder IRI, but had lower intraoperative hepatic artery flow with a higher incidence of hepatic artery thrombosis [19]. There are many unanswered questions regarding the role of portal vein pressure and how much portal flow can affect the hepatic microcirculation and IRI, which we tried to address in the present study.
Endoscopic management of high-grade biliary strictures complicating living donor liver transplantation using soehendra stent retrievers
Published in Scandinavian Journal of Gastroenterology, 2021
Harshavardhan B. Rao, Anoop K. Koshy, Krishna Priya, Priya Nair, S. Sudhindran, Rama P. Venu
A total of 10 patients were diagnosed with HGBS during the study period (Group 1) and were treated with SSR dilatation. Mean age of patients in group 1 was 46.7 ± 12.6 years and all the patients belonged to the male gender. The donor characteristics are given in Table 1. The pre-operative mean MELD score was 22 ± 9.17 and half of them (5/10(50%)) had non-identical blood group donors. Group 2 included a total of 14 patients with HGBS who had had a PTC-R with the subsequent placement of a stent. There were no significant differences between the two groups in terms of all demographic variables like mean age, gender distribution and donor characteristics (Table 1). Vascular complications like hepatic artery thrombosis (HAT) was seen in 3 patients (60%) in Group 1 as opposed to 2 patients (40%) in Group 2 (p value =0.618). Patients in Group 1 presented later in their post-transplant course (median = 545.5) as compared to Group 2 (median = 169) and also, required a lower number of procedures (2.70 ± 2.05 vs 4 ± 2.35). All patients initially had a 5 Fr plastic stent placed across the stricture. Serial dilatation in subsequent sessions enabled the placement of a 10 Fr stent in all patients of the study. The baseline characteristics of both groups are given in Table 1.
Cost-utility analysis of normothermic liver perfusion with the OrganOx metra compared to static cold storage in the United Kingdom
Published in Journal of Medical Economics, 2020
Mehdi Javanbakht, Atefeh Mashayekhi, Miranda Trevor, Michael Branagan-Harris, Jowan Atkinson
Our economic analysis was largely informed by the results from a single clinical study5 with a sample size of 334 livers. The study showed very promising results with fewer discard, EAD, PRS, and AE rates for the NMP group compared to the SCS group. Other complications such as primary non-function, hepatic artery thrombosis, and ischemic cholangiopathy are quite common in liver transplantation and have a detrimental effect on the outcome of the transplanted liver requiring immediate re-transplantation. In that study, only a few events of these complications occurred, leading to non-statistically significant results; thus these complications as well as the possibility of re-transplantation were not considered in our model. The study on which this analysis was based was not primarily designed to assess discard rate, which emerges as one driver of the ICER. The study was open label and it is therefore possible that the decision to discard a liver was in some part dependent on whether NMP or SCS was being used. However, results from our deterministic sensitivity analysis show that a 25% increase or decrease in discard rate would not have changed the overall conclusion. In an extreme scenario, we also modelled an increase in the discard rate by 50% in the OrganOx metra arm (i.e. from 12% to 18%). This increased the estimated ICER from €7,905 to €11,202 per QALY, still well below any conventional WTP threshold.