Hemodynamic Changes During the Anhepatic Phase in Pediatric Patient With Biliary Atresia Versus Glycogen Storage Disease Undergoing Living Donor Liver Transplantation

Huang, Hung-Yu; Lu, Hung-Yi; Chiang, Min Hsien; Chen, C.-L.; Wang, C.-H.; Cheng, K.-W.; Jawan, Bruno; Huang, Chun-Chieh; Wu, Shao-Chun

doi:10.1016/j.transproceed.2011.12.062

Cited by 9 publications

(5 citation statements)

References 8 publications

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“…Why this should occur is unclear given that those with liver disease were measurably more ill, being more likely to be hospitalized or to receive intensive care at the time of transplant. Those with portal hypertension are known to develop adaptive splanchnic vascular changes, which, ironically, may protect against the acute hemodynamic challenges encountered during the anhepatic phase of transplantation . Those without liver diseases will be more vulnerable to acute metabolic decompensation due to the transplant procedure itself, which, in turn, may impact early allograft function.…”

Section: Discussionmentioning

confidence: 99%

“…Those with portal hypertension are known to develop adaptive splanchnic vascular changes, which, ironically, may protect against the acute hemodynamic challenges encountered during the anhepatic phase of transplantation. (9) Those without liver diseases will be more vulnerable to acute metabolic decompensation due to the transplant procedure itself, which, in turn, may impact early allograft function. Higher rates of early graft dysfunction, hepatic artery thrombosis, and perioperative systemic complications are recognized in those with nonstructural disease.…”

Section: Original Article | 919mentioning

confidence: 99%

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Evolving Trends in Liver Transplant for Metabolic Liver Disease in the United States

et al. 2019

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Indications for liver transplantation (LT) in metabolic disease are evolving. We reviewed the US experience with primary LT for metabolic disease in the Scientific Registry for Transplant Recipients (October 1987 to June 2017) to determine the following: temporal changes in indications, longterm outcomes, and factors predicting survival. Patients were grouped by the presence of structural liver disease (SLD) and whether the defect was confined to the liver. There were 5996 patients who underwent LT for metabolic disease, 2354 (39.3%) being children. LT for metabolic disease increased in children but not in adults. Children experienced a 6‐fold increase in LT for metabolic disease without SLD. Indications for LT remained stable in adults. Living donor liver transplantation increased between era 1 and era 3 from 5.6% to 7.6% in children and 0% to 4.5% in adults. Patient and graft survival improved with time. The latest 5‐year patient survival rates were 94.5% and 81.5% in children and adults, respectively. Outcomes were worse in adults and in those with extrahepatic disease (P < 0.01), whereas SLD did not affect outcomes. Survival improved with younger age at LT until age <2 years. On multivariate analysis, diagnostic category, inpatient status, age at LT, and transplant era significantly predicted outcomes in all ages with male sex predicting survival in childhood only. Children without structural disease were less likely to die awaiting LT and had improved post‐LT survival compared with children with chronic liver disease. In conclusion, LT for metabolic disease is increasingly used for phenotypic correction in children; extrahepatic manifestations significantly impact survival at all ages; where indicated, transplantation should not be unnecessarily delayed; and the development of new allocation models may be required.

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Section: Discussionmentioning

confidence: 99%

Section: Original Article | 919mentioning

confidence: 99%

Evolving Trends in Liver Transplant for Metabolic Liver Disease in the United States

et al. 2019

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“…Despite the theoretical arguments in favor of the systematic use of portocaval shunts for pediatric candidates, their clinical benefit remains the subject of controversy. However, a previous report showed that in pediatric recipients of LT with either cholestatic liver disease or liver‐based metabolic defects, the hemodynamic changes caused by IVC and portal vein clamping between these groups were significantly different. The total clamping of the IVC and portal vein decreased the CVP in both groups, but it decreased it significantly more in the liver‐based metabolic defect group without portosystemic collaterals, indicating that the venous return from the lower part of the body to the heart was more dramatically affected.…”

Section: Discussionmentioning

confidence: 90%

“…Clamping of the portal vein during the anhepatic phase when portosystemic collaterals have not developed can lead to hemodynamic instability and splanchnic venous congestion with associated hemorrhage and intestinal edema [1][2][3][4][5][6][7][8][9][18][19][20][21][22][23]. To decompress the portal venous system during total hepatectomy, two principal shunting techniques have been established: a spontaneous ex situ shunt, usually using a VVB, and in situ portal venous shunting by a temporary end-to-side anastomosis of the PV to the infrahepatic vena cava.…”

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confidence: 99%

Recanalized umbilico‐caval anastomosis as a temporary portosystemic shunt in pediatric living donor liver transplantation: the crossed fingers method

Urahashi

Ihara

Sanada

et al. 2016

Clinical Transplantation

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A temporary portocaval shunt (TPCS) associated with retrohepatic vena cava preservation prevents the edema caused by splanchnic congestion during liver transplantation (LT), especially for non-cirrhotic cases. We herein report a modified TPCS technique using the recanalized umbilical vein and an end-to-side recanalized umbilico-caval anastomosis for use during pediatric living donor liver transplantation (LDLT). This work evaluated a group of pediatric patients who underwent LDLT between 2001 and 2014 with the conventional TPCS (n=16) vs the recanalized umbilico-caval shunt (the crossed fingers method, n=10). The crossed fingers method was performed by suturing an end-to-side anastomosis of the patent or recanalized umbilical vein to the vena cava using a continuous monofilament suture like "crossing the fingers," that is, placing the left portal vein across the portal vein trunk next to it. The preoperative, surgical, and postoperative characteristics were similar in both groups except for the significantly shorter portal vein clamping time for the crossed fingers method. This method can allow the portal circulation to be totally decompressed before and after implanting the graft and while maintaining the hemodynamic stability throughout all stages of pediatric LDLT.

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“…A long anhepatic term may affect the hepatic venous reflux leading to internal environment disorder, intoxicants accumulation and hemodynamic changes (54). Shorten the anhepatic term is significant for reducing complications such as pulmonary thromboembolism and post-reperfusion syndrome (55).…”

Section: Surgical Proceduresmentioning

confidence: 99%

Current status of ex-vivo liver resection and autologous liver transplantation for end-stage hepatic alveolar echinococcosis

Yang

Deng

et al. 2020

Ann Palliat Med

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Hepatic alveolar echinococcosis (HAE) is a cosmopolitan zoonosis distribute widely in the northern hemisphere with high estimated 10-year mortality. Radical resection combined with oral albendazole administration are the major methods for HAE treatment, whereas most patients delayed diagnosis and treatment because which was considered as benign disease. For the cases with end-stage HAE could not be treated through conventional hepatectomy, allograft liver transplantation (LT) was regarded as a life-saving technique previously. However, graft shortage, high recurrence rate and long-term immunosuppressive therapy limited its utilization. Since the ex-vivo liver resection and autotransplantation (ERAT) procedure was first used in treating for end-stage HAE in 2011, there are more than 120 HAE cases patients were reported treating in this method up to now. Comparing with LT, ERAT needs neither an organ donor nor long term immunosuppressive therapy, and provide preferable overall survival rates. Based on the conventional ERAT procedure, some modification such as auxiliary partial autologous LT were introduced in the high selected end-stage HAE patients presently. However, the standard procedures for ERAT including surgical details and perioperative management have not been established because of limited reported cases. Also, the present ERAT experience for end-stage HAE treatment are all summarizes by the Chinese surgeon groups. For summarizing the knowledge and experience details, we reviewed present opinions about ERAT for end-stage HAE patients, and presented the future perspectives about this topic in this manuscript. We aimed at discussing the feasibility, indications, preparation, technical details, and postoperative outcomes of ERAT for HAE patients.

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Hemodynamic Changes During the Anhepatic Phase in Pediatric Patient With Biliary Atresia Versus Glycogen Storage Disease Undergoing Living Donor Liver Transplantation

Cited by 9 publications

References 8 publications

Evolving Trends in Liver Transplant for Metabolic Liver Disease in the United States

Evolving Trends in Liver Transplant for Metabolic Liver Disease in the United States

Recanalized umbilico‐caval anastomosis as a temporary portosystemic shunt in pediatric living donor liver transplantation: the crossed fingers method

Current status of ex-vivo liver resection and autologous liver transplantation for end-stage hepatic alveolar echinococcosis

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