Background: Hypophosphatemia appears to be a universal event after right hepatic lobectomy for live-donor adult liver transplantation according to one report. Because hypophosphatemia appears to contribute to increased postoperative complications, routine hyperalimentation with supratherapeutic levels of phosphorus was advocated.
Methods: From July 2000 to May 2002, we performed 95 right-lobe living-donor hepatectomies for 95 adult liver-transplant recipients, the largest single institutional experience. We reviewed our data that were collected prospectively.
Results: We did not find profound hypophosphatemia (<1.0 mg/dL) to be prevalent in our donors. At least six (6.3%) donors did not have postoperative hypophosphatemia. In addition, there appears to be no increased morbidity related to hypophosphatemia when aggressively corrected with intravenous or oral phosphates in our group of donors that underwent right-lobe hepatectomies.
Conclusions: We, therefore, cannot endorse the routine administration of hyperalimentation with supratherapeutic phosphorus because of its potential morbidity.
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http://dx.doi.org/10.1097/01.TP.0000085652.47821.8A | DOI Listing |
J Clin Exp Hepatol
November 2024
The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India.
Living donor liver transplantation (LDLT) constitutes the majority of liver transplants in Asia and advancements in LDLT techniques have expanded the range of allografts beyond the commonly used right lobe (RL). This review provides a comprehensive overview of lesser-known variants of allografts and LDLT techniques which include right posterior sector grafts (RPSG), dual-lobe liver transplantation (DLLT), auxiliary partial orthotopic liver transplantation (APOLT), and extended left lobe grafts with caudate concentrating on the technical aspects, current evidence, and their indications in contemporary practice of LDLT. The first section examines RPSGs, focussing on their potential as an alternative to RL grafts particularly when volumetric studies indicate a larger right posterior sector in donors.
View Article and Find Full Text PDFAnn Surg
December 2024
Department of Liver Transplantation & GI Surgery, Amritha Institute of Medical Sciences, Kochi, India.
Objective: To compare early patency and outcomes of single outflow (SOT) and double outflow (DOT) reconstruction in right lobe living donor liver transplantation (RtLDLT) in a multicenter open-labelled randomized controlled trial.
Summary Background Data: Optimum graft venous outflow is a key factor in determining outcomes of RtLDLT. There is no data directly comparing SOT and DOT technique of graft outflow reconstruction.
Transplant Proc
December 2024
Department of General Surgery, Istinye University Training and Research Hospital, Istanbul, Turkey. Electronic address:
Background: In countries with low rates of deceased donor solid organ transplantations, live-donor liver transplantation is the preferred definitive treatment for children and adults with end-stage liver disease. However, it is known that a remarkable number of potential living liver donors are rejected due to ABO incompatibility, suboptimal liver mass, or anatomical features. Paired exchange liver transplantation (PELT) practice emerged to overcome these obstacles.
View Article and Find Full Text PDFTransplant Proc
December 2024
Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
Background: Biliary stricture is a common complication after living-donor liver transplantation (LDLT), but its management is challenging. We herein report a case of successful internal drainage achieved through combination of the gun-sight technique and dual hepatic vascular embolization (DHVE).
Case Presentation: A 54-year-old woman with primary biliary cholangitis underwent ABO-incompatible LDLT with the right lobe.
Exp Clin Transplant
October 2024
From the Department of Transplantation and Pediatric Surgery, Kumamoto University, Kumamoto, Japan and the Department of Hepatobiliary Pancreatic and Transplantation/Pediatric Surgery, Kyoto University, Kyoto, Japan.
Objectives: The right posterior segment graft can be selected in cases where neither the right nor left lobe graft satisfies the selection criteria for adult living donor liver transplant. However, vascular and biliary anatomy may cause technical difficulties in procurement of posterior segments in donors of living donor liver transplant and may require specific attention in vascular and biliary reconstruction in the recipient. In this study, we examined the feasibility of right posterior segment grafts in adult living donor liver transplants through donor safety and recipient outcomes and clarified the anatomic points of the surgical technique.
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