Application of intraoperative cine-portogram to detect spontaneous portosystemic collaterals missed by intraoperative doppler exam in adult living donor liver transplantation.

Adequate portal inflow is essential to the regeneration of a partial liver graft after adult living donor liver transplantation (LDLT). A recipient having large spontaneous portosystemic collaterals with or without portal vein (PV) stenosis would require surgical interruption of large collaterals and/or correction of PV stenosis to prevent postoperative "portal flow steal phenomenon." Intraoperative Doppler ultrasound (IOUS) has been used to estimate the adequacy of portal inflow, but it has a limitation to identify the correct anatomical and hemodynamic parameters of portosystemic collaterals.

Retroduodenal resection of ampullary carcinoid tumor in a patient with cavernous transformation of the portal vein.

Although pancreatoduodenectomy is the standard treatment for periampullary neoplasms, limited pancreas-preserving resections are sometimes performed. This report describes a carcinoid tumor of the ampulla of Vater for which pancreatoduodenectomy was not feasible because of diffuse cavernous transformation of the portal vein (PV) secondary to main PV obliteration of unknown cause. We performed retroduodenal resection of the ampullary carcinoid with total preservation of the pancreas.

Neurologic complications in adult living donor liver transplant recipients.

Background: Neurologic complications (NC) after liver transplantation are not uncommon, with serious complications such as central pontine myelinolysis (CPM), often causing disability.

Objective: We investigated the incidence and features of NC following liver transplantation in adult recipients.

Patients And Methods: We retrospectively reviewed the medical records of 319 adult patients who underwent liver transplantation between January 2004 and May 2005 at the Asan Medical Center.

Unenhanced CT for assessment of macrovesicular hepatic steatosis in living liver donors: comparison of visual grading with liver attenuation index.

Purpose: To retrospectively compare the accuracy of visual grading and the liver attenuation index in the computed tomographic (CT) diagnosis of 30% or higher macrovesicular steatosis in living hepatic donors, by using histologic analysis as the reference standard.

Materials And Methods: Institutional review board approval was obtained with waiver of informed consent. Of 703 consecutive hepatic donor candidates, 24 patients (22 men and two women; mean age +/- standard deviation, 36.

Delayed-onset isolated injury of the right posterior segment duct after laparoscopic cholecystectomy: a report of hepatic segmental atrophy induction.

Laparoscopic cholecystectomy resulted in various bile duct injuries. We present an unusual case of right posterior segment (RPS) duct injury detected 35 days after laparoscopic cholecystectomy. Imaging studies revealed that RPS duct was severed probably because of thermal damage from electrocautery.

Intraoperative biliary exploration through the left hepatic duct orifice during left hepatectomy in patients with left-sided hepatolithiasis.

Background And Aims: Left-sided hepatolithiasis often requires left hepatectomy and exploration of the common bile duct and right hepatic duct. The aim of this study was to assess the feasibility of alternative method of bile duct exploration other than choledochotomy.

Materials And Methods: A prospective study involving 50 cases of left hepatectomy for left or bilateral intrahepatic stone was performed.

Portal vein stenting for portal hypertension caused by local recurrence after pancreatoduodenectomy for periampullary cancer.

Portal hypertension after extensive abdominal surgery is an unusual cause of repetitive gastrointestinal bleeding. We report on a 68-year-old male patient with intermittent gastrointestinal bleeding secondary to portal vein stenosis caused by local recurrence of the distal bile duct cancer after pancreatoduodenectomy. Severe portal vein stenosis without sufficient development of portal venous collaterals was detected 25 months after pancreatoduodenectomy.

Salvage living donor liver transplantation after prior liver resection for hepatocellular carcinoma.

Salvage liver transplantation has been performed for recurrent hepatocellular carcinoma (HCC) or deterioration of liver function after primary liver resection. Because prior liver resection per se is an unfavorable condition for living donor liver transplantation (LDLT), we assessed the technical feasibility of LDLT after prior hepatectomy, and we compared the outcome of salvage LDLT with that of primary LDLT in HCC patients. Of 342 patients with HCC, 17 (5%) underwent salvage LDLT, with 5 having undergone prior major liver resection and 12 prior minor resection.

Portal vein interposition using homologous iliac vein graft during extensive resection for hilar bile duct cancer.

Although autologous vein grafts have been used for portal vein (PV) reconstruction after long-segment portal vein resection during surgery for hilar bile duct cancer, their procurement prolongs operation time and increases morbidity. Less is known regarding the use of homologous vein grafts. The feasibility of homografts for PV reconstruction was preliminarily evaluated in two patients who underwent curative resection for hilar cholangiocarcinoma.

Early posttransplantation portal vein stenosis following living donor liver transplantation: percutaneous transhepatic primary stent placement.

Surgical treatments have usually been preferred for early posttransplantation portal inflow abnormalities. However, these treatments are limited due to their technical difficulty and multiple complicating factors. The present study reports the efficacy and safety of percutaneous transhepatic primary stent placement to treat early posttransplantation ( View Article and Find Full Text PDF

Preoperative evaluation of biliary anatomy of donor in living donor liver transplantation by conventional nonenhanced magnetic resonance cholangiography.

Detailed preoperative evaluation of the biliary anatomy of the donor in living donor liver transplantation (LDLT) can minimize postoperative morbidity in the recipient and maximize safety for the donor. We prospectively evaluated the diagnostic accuracy and clinical usefulness of nonenhanced conventional magnetic resonance cholangiography (MRC) for depicting the biliary anatomy of LDLT donors. MRC and intraoperative cholangiography (IOC) examinations of 111 donors were performed between August 2005 and February 2006.

Reappraisal of plasmapheresis as a supportive measure in a patient with hepatic failure after major hepatectomy.

Major resection of cirrhotic livers can result in hepatic failure, but no supportive treatment has been found to be generally effective. We successfully treated a 63-year-old woman with post-hepatectomy liver failure with plasmapheresis. Following right hepatectomy, the initial postoperative recovery of liver function was favorable, except for ascites.

Ligation of left renal vein for large spontaneous splenorenal shunt to prevent portal flow steal in adult living donor liver transplantation.

Persistance of a large spontaneous splenorenal shunt (SRS) may result in graft failure in adult living donor liver transplantation (LDLT) because it reduces the effective portal perfusion to the partial liver graft by diversion of hepatotrophic portal flow into this hepatofugal pathway. We performed a prospective study to evaluate the efficacy of ligation of left renal vein (LRV) to prevent portal flow steal and the safety of this procedure to the renal function in adult LDLT patients with SRS. Between October 2001 and January 2005, 44 cirrhotic patients with large SRS underwent LDLT with ligation of LRV.

Feasibility assessment for tailoring preservation of segment VIII hepatic vein during left liver graft procurement.

Background/aims: Procurement of left lobe (LL) graft occasionally induces large-sized hepatic venous congestion (HVC) at the remnant right liver. Isolated preservation of segment VIII vein (V8) could reduce this HVC, but it has been applied to only a small number of living donor operations to date.

Methodology: We investigated the indication of tailoring V8 preservation through the anatomical analyses and computer simulation in a large-volume donor pool.

Tailoring transection of segment V vein for optimal sharing of middle hepatic vein in right-lobe living donor liver transplantation.

Background/aims: Separate reconstruction of multiple V5s (segment V hepatic vein) often resulted in incomplete resolution of hepatic venous congestion (HVC) in the right lobe (RL) grafts. This study intended to obtain single large V5 orifice suitable for middle hepatic vein (MHV) reconstruction.

Methodology: We tried tailoring V5 transection in 3 of 39 RL donors, in whom MHV anatomy would reveal multiple sizable V5 orifices along the classical transection plane.

Postoperative changes in remnant medial segment parenchyma of living donor livers after procurement of left lateral segment graft.

Background/aims: Procurement of left lateral segment (LLS) graft usually resulted in uneventful atrophy of the remnant medial segment parenchyma (RMSP) in living donors, but duct dilatation was often detected in the RMSP. We tried to clarify the postoperative atrophic sequences of the RMSP.

Methodology: We analyzed clinical profiles of 33 LLS graft donors out of 362 living donors from January 2002 to December 2003.

[Surgical treatment of sclerosing hepatocellular carcinoma].

Background/aims: Sclerosing hepatocellular carcinoma (HCC) is an unusual subtype of HCC that is characterized by an embedded dense fibrous stroma in the tubular neoplastic structures. We aimed to assess the surgical approaches and outcomes of sclerosing HCC.

Methods: We retrospectively analyzed the clinicopathologic features of 6 patients with sclerosing HCC who underwent surgical treatment at Asan Medical Center between July 1989 and December 2005.

Management of subcapsular hematoma of the graft after living donor liver transplantation.

Subcapsular hematoma of the graft is a serious complication of liver transplantation (LT), and there has been no discussion in the literature about optimal management except in sporadic case reports. The aim of this work is to review our experience of subcapsular hematoma in living donor liver transplantation (LDLT) and to introduce our management strategy. Among the 818 cases of adult-to-adult LDLT between February 1997 and November 2005, there have been 4 cases of subcapsular hematoma.

Resolution of severe graft steatosis following dual-graft living donor liver transplantation.

Although severely steatotic liver grafts are not suitable for transplantation, they have been used when other, more optimal donors were not available, especially for living donor liver transplantation (LDLT) using two liver grafts. Here we present two cases of dual-graft LDLT in which the recipients showed rapid and complete clearing of fat from livers with previously severe steatosis. In the first case, two left lateral segment grafts were used, one of which was 70% steatotic.

Lessons learned from 1,000 living donor liver transplantations in a single center: how to make living donations safe.

Serious complications have occurred in a considerable proportion of living donors of liver transplants, but data from a single high-volume center has rarely been available. We analyzed the medical records of donors and recipients of the first 1,000 living donor liver transplants, performed at Asan Medical Center from December 1994 to June 2005, with a focus on donor safety. There were 107 pediatric and 893 adult transplants.

Five-year follow-up of a hepatitis B virus-positive recipient of hepatitis B surface antigen-positive living donor liver graft.

The shortage of cadaveric donor organs has led to the use of living donors and marginal cadaveric donors. To date, there have been only 2 reports on the use of hepatitis B surface antigen (HBsAg)-positive liver grafts. Here we describe the 5-yr posttransplantation sequence of a hepatitis B virus (HBV)-positive recipient who received an HBsAg-positive living donor liver graft.

Asian contribution to living donor liver transplantation.

Although the shortage of brain-dead donor organs is a worldwide problem, the situation is especially serious in Asia because of various cultural and social reasons, and cadaveric organ donation remains below 5 per million population per year. Living donor liver transplantation (LDLT) could provide an alternative for liver graft for patients with acute and chronic end-stage liver disease. This article introduces the important contributions to the development of LDLT by the leading Asian liver transplantation centers.

Techniques of reconstruction of hepatic veins in living-donor liver transplantation, especially for right hepatic vein and major short hepatic veins of right-lobe graft.

Living-donor liver transplantation (LDLT) is now widely accepted as a therapeutic option for adult patients with acute and chronic end-stage liver disease. In the early period, the left lobe was the major liver graft used in adult LDLT to ensure donor safety, especially in Eastern countries. However, the frequent extremes of graft-size insufficiency in left-lobe LDLT represented a greater risk of small-for-size graft syndrome in the recipient, which has focused attention on transplantation of the right lobe from a living donor.