Liver transplantation has been associated with massive blood loss and considerable transfusion requirements. Bleeding in orthotopic liver transplantation is multifactorial. Technical difficulties inherent to this complex surgical procedure and pre operative derangements of the primary and secondary coagulation system are thought to be the principal causes of perioperative hemorrhage. Intraoperative practices such as massive fluid resuscitation and resulting hypothermia and hypocalcemia secondary to citrate toxicity further aggravate the preexisting coagulopathy and worsen the perioperative bleeding. Excessive blood loss and transfusion during orthotopic liver transplant are correlated with diminished graft survival and increased septic episodes and prolonged ICU stay. With improvements in surgical skills, anesthetic technique, graft preservation, use of intraoperative cell savers and overall perioperative management, orthotopic liver transplant is now associated with decreased intra operative blood losses. The purpose of this review is to discuss the risk factors predictive of increased intra operative bleeding in patients undergoing orthotopic liver transplant.
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http://dx.doi.org/10.4240/wjgs.v7.i6.86 | DOI Listing |
Ann Surg Open
December 2024
From the Department of Visceral, Transplant, Thoracic and Vascular Surgery, Division of Hepatobiliary Surgery and Visceral Transplant Surgery, University Clinic Leipzig, Germany.
Objective: This study explored the novel application of hyperspectral imaging (HSI) for in vivo allograft perfusion assessment during liver transplantation (LT) and its potential value for predicting early allograft dysfunction (EAD), graft, and overall survival (OS).
Background: LT is a well-established therapy for acute and chronic liver diseases, with excellent outcomes. However, a significant proportion of recipients experience EAD, which affects graft and OS.
Biomaterials
December 2024
Institute of Precision Medicine, Peking University Shenzhen Hospital, 518036, Shenzhen, China. Electronic address:
Radiotherapy, employing high-energy rays to precisely target and eradicate tumor cells, plays a pivotal role in the treatment of various malignancies. Despite its therapeutic potential, the effectiveness of radiotherapy is hindered by the tumor's inherent low radiosensitivity and the immunosuppressive microenvironment. Here we present an innovative approach that integrates peroxynitrite (ONOO)-mediated radiosensitization with the tumor-associated neutrophils (TANs) polarization for the reversal of immunosuppressive tumor microenvironment (TME), greatly amplifying the potency of radiotherapy.
View Article and Find Full Text PDFBest Pract Res Clin Gastroenterol
December 2024
Liver Intensive Care Unit, Centre Hépato-Biliaire, AP-HP, Hôpital Paul-Brousse, Université Paris-Saclay, Inserm research unit 1193, Villejuif, F-94800, France. Electronic address:
ABO-compatible Orthotopic Liver Transplantation (OLT) is the standard treatment for patients with acute liver failure (ALF) who meet the criteria for poor prognosis. Contraindications to liver transplantation may be related to the presence of severe medical or psychiatric comorbidities, or to an unstable clinical state incompatible with transplantation. Early mortality predictive scores and factors have been developed to identify futile transplantations that exacerbate organ shortage.
View Article and Find Full Text PDFSurg Endosc
December 2024
Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy.
Background And Aims: The most common adverse event (AE) of orthotopic liver transplantation (OLT) is anastomotic biliary stricture (ABS). Management varies widely between centers, and it is not clear whether a combination of endoscopic dilation of the stenosis followed by multiple plastic stents (MPS) or placement of a fully covered self-expandable metal stent (fcSEMS) is better for the management of post-OLT ABS. This systematic review and meta-analysis aimed to compare the efficacy, safety, and cost of fcSEMS versus MPS in the treatment of post-OLT ABS.
View Article and Find Full Text PDFACS Pharmacol Transl Sci
December 2024
Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China.
Hepatocellular carcinoma (HCC) represents the predominant form of primary liver cancer, yet early, precise, and noninvasive detection continues to pose a considerable clinical challenge. Glypican-3 (GPC3), a membrane-bound proteoglycan, is markedly overexpressed in most HCC cases, while exhibiting low expression in normal and hepatitis-affected liver tissues. Given its crucial role in malignant transformation and tumor progression, GPC3 emerges as a compelling target for imaging.
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