Background: Following liver transplantation (LT), bacterial infections occur in over 70% of recipients leading to significant morbidity and mortality. While synbiotics have been reported to decrease infectious complications in various surgical procedures, the evidence of their benefits following LT remains limited.
Methods:In this 18-month double-blinded, investigator-initiated, placebocontrolled trial, 100 recipients of live donor liver transplant (LDLT) were randomized to receive either the synbiotic drug Prowel® (Prepro arm) or a placebo, starting 2 days pretransplant and continued for 2 weeks. The primary endpoint was culture-proven bacterial infection in blood, urine or drain fluid within 30 days. Secondary endpoints were hospital stay, noninfectious complications, antibiotic usage and 30-day mortality.Results: Overall infectious complications were significantly lower in the Prepro arm in comparison to the Placebo arm (44% vs 22%, P = .019, OR 0.359; CI: 0.150-0.858). Blood stream infections were significantly less in the study arm (21.7% vs 53.3%, P = .020, OR 0.243; CI: 0.072-0.826), whereas urinary tract and intraabdominal infections were similar. Length of hospital stay, noninfectious complications, deviation from protocol antibiotics and 30-day mortality were comparable.
Conclusion:Synbiotics administered for 2 weeks following LDLT significantly reduced overall and blood stream infectious complications in the early postoperative period. However, there was no difference in hospital stay, noninfectious complications, antibiotic usage and mortality.Clinical Trial Registry of India registration number -CTRI/2017/09/009869.
Background: This study intended to assess incidence, risk factors and treatment of PV complication after living donor right hepatectomy (LDRH). Methods: This study analyzed 2979 cases of LDRH from July 1997 to December 2014 at Asan Medical Center regarding on PV complication. Results: Male and female were 2055 (69.0%) and 924 (31.0%), respectively. Mean donor age was 27.5 AE 8.1 years old. Mean body mass index was 22.70 AE 2.70. Type 1, 2, 3, and other PV anomalies were 2727 (91.6%), 113 (3.8%), 132 (4.4%), and 6 (0.2%), respectively. PV stenosis (>50% narrowing of PV diameter) occurred 47 cases (1.5%). PV reconstruction (odds ratio 7.949; p=0.012), anomalous PV anatomy (OR 4.536; p< 0.001), acute angulation between main and Left PV (60-90 OR 2.214; p=0.041, < 60 OR 7.690; p< 0.001), and no fixation of falciform ligament (OR 2.213; p=0.010) were significant risk factors for PV stenosis. Among 47 PV stenosis donors, PV stent insertion was performed in 9 cases (0.3%) which occurred 1 in type 1 (0.1%), 2 in type 2 (1.8%), 6 in type 3 (4.5%), and 0 in other types (P< 0.001). All PV complication donors had no long-term sequelae. Conclusions: PV reconstruction and no fixation of falciform ligament should be avoided to prevent PV complication during LDRH. Because donors with anomalous PV anatomy or acute angulation between main and left PV have a higher tendency to occur PV complication after LDRH, those donors require meticulous surgical techniques during operation and periodic image studies after operation.
p=0.04), total bilirubin (p=0.03), TNF-alpha (p< 0.01), IL-10 (p< 0.01); and IL-6 (p< 0.01). Mitochondrial calcium retention capacity and respiration confirmed preservation of mitochondrial function in Group II. Histopathological evaluation of hepatocyte viability showed minimal ischemic changes in Group II; however, a significant degree of hepatocyte necrosis was observed the other groups. Conclusion: Ex Vivo subnormothermic regulated hepatic reperfusion mitigates IRI, preserves mitochondrial function and facilitates liver function recovery after donation after cardiac death. This novel strategy has potential applicability to human liver transplantation.
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