Background: Bridging strategies are necessary for patients with HCC, who are on a liver transplant waiting list. Few centers have started using TARE as a bridging strategy and Yttrium 90 (Y90) has been approved for use in HCC, however, it is very expensive and not practical to use as standard of care in countries, where there is no universal insurance coverage. 188 Rhenium (188Re) radio labeled lipiodol for the treatment of HCC is an alternative isotope with very similar properties to Y90. Methods: We did a retrospective review of 3 patients who were treated with 188Re radio labeled lipiodol as a bridging modality and then later on underwent cadaveric orthotopic liver transplant (OLT). Radiological, histopathological (HPE), alpha-feto protein (AFP) levels, survival and recurrence outcomes were analyzed. Results: First patient had 2 tumors and was transplanted 1 month after TARE. He developed recurrence 8 months post transplant. Second patient had single HCC and had a complete radiological response post TARE. He underwent OLT, 2 months post TARE and HPE also showed complete tumor necrosis. Third patient had 3 lesions and underwent TARE and had a partial radiological response. He underwent OLT, 9 months post TARE. There was a partial response on HPE. Second and third patients are doing well 15 and 11 months post transplant respectively. Conclusion: 188Re radio labeled lipiodol is a very effective bridging strategy for maintaining or down staging HCC in appropriately selected liver transplant waiting list patients.
Background: Prevalence of hepatolithiasis is common in South-East Asia, which mainly presented as recurrent pyogenic cholangitis, acute cholangitis and accredited a risk factor for cholangiocarcinoma. Hepatectomy is an acknowledged therapeutic option for hepatolithiasis. Methods: From January 2005 to December 2014, 124 patients, whom received hepatectomy for hepatolithiasis at Kaohsiung Chang Gung Memorial Hospital, had been reviewed and analyzed. Results: The presentation included left sided stones in 69%, right sided stones in 18% and bilateral in 13% of patients. Immediate stone clearance after operation was 95.2%. Hospital mortality rate was 3.2%, including one patient with post-operative liver failure and 3 with severe sepsis. Stone recurrence rate was 15.3%. Only one patient developed cholangiocarcinoma during the seventh year of follow-up. In comparison with other series of non-operative management, hepatectomy had higher stone clearance and reduced recurrence of stone and cholangitis, and reduced the risk of cholangiocarcinoma. Our incidence of de-novo cholangiocarcinoma was lowest among other hepatectomy series, with comparable rate of stone clearance and recurrent cholangitis. Conclusion: Hepatectomy for hepatolithiasis has highest stone clearance and lowest recurrent cholangitis rates. Low 5-year risk of cholangiocarcinoma can be achieved by early hepatectomy, including complete resection of the bile duct segment from the bifurcation, complete stone clearance and resection of strictures.
Background: Simultaneous kidney-pancreas transplantation for patients with type 1 diabetes and end-stage chronic renal disease is widely performed. However, the rate of surgical morbidity from pancreatic complications remains high. The aim of this study was to describe the development of a new program. Methods: We analyzed 53 simultaneous pancreas-kidney transplants performed over a period of seven years, from 2009 to 2016, with a median follow up of 39 months (range: 1-86 months). Results: Two patients have died, one patient because of a cardiac arrest immediately after surgery and another patient due to traffic accident complicated with a pneumonia. Among the 51 patients alive two grafts were lost, one due to chronic rejection four years after transplantation and the other one due to arterial thrombosis 20 days after transplantation, being this case the only requiring a transplantectomy. In ten patients one or more surgical reinterventions have been necessary due to the following diagnosis: graft pancreatitis (n=4), small intestinal occlusions (n=4), arterial thrombosis (n=1), abscess (n=1) and hemoperitoneum (n=1). Patient and graft overall survival rates at 1, 3 and 5 years were 98%, 95% and 95% and 96, 93 and 89%; respectively Conclusion: This study has shown that the Results of new pancreatic transplant program, which rely on previous experience of other groups, do not reflect a learning curve. Adequate personal education and learning, the use of standardized and adequate techniques, should assure optimal results
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