In search of a pathogenesis for impaired liver regeneration after major hepatectomy with extrahepatic bile duct resection: The plot thickens!

Pravisani, Riccardo; Baccarani, Umberto; Eguchi, Susumu

doi:10.1111/hepr.13414

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…In liver resection setting, Otao et al [ 11 ] have shown that patients who underwent major hepatectomy with biliary resection and external biliary drainage not only had significantly lower serum levels of bile acids compared to patients without external biliary drainage, but also had a significantly lower volumetric regeneration of the remnant liver on POD 7. Similar results, although not directly correlated with bile acids deprivation, were reported by Maeda et al [ 23 ] who showed a significantly lower liver remnant regeneration in patients who underwent major hepatectomy with biliary resection and external biliary drainage, compared to those without biliary resection [ 24 ]. In experimental models, the bile acids’ (BAs) depletion after major hepatectomy by a bile salt-sequestering resin or by external drainage resulted in reduced liver regrowth [ 5 , 6 ].…”

Section: Discussionsupporting

confidence: 86%

Re-thinking of T-tube use in whole liver transplantation: an analysis on the risk of delayed graft function

et al. 2022

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The liver–gut axis has been identified as crucial mediator of liver regeneration. Thus, the use of a T-tube in liver transplantation (LT), which interrupts the enterohepatic bile circulation, may potentially have a detrimental effect on the early allograft functional recovery. We retrospectively analyzed a cohort of 261 patients transplanted with a whole liver graft, with a duct-to-duct biliary anastomosis, who did not develop any surgical complication within postoperative day 14. Early allograft dysfunction (EAD) was defined according to the criteria of Olthoff et al. (EAD-O), and graded according to the Model for Early Allograft Function (MEAF) score. EAD-O developed in 24.7% of recipients and the median MEAF score was 4.0 [interquartile range 2.9–5.5]. Both MEAF and EAD predicted 90-day post-LT mortality. A T-tube was used in 49.4% of cases (n = 129). After a propensity score matching for donor age, cold and warm ischemia time, donor risk index, balance of risk score, Child–Pugh class C, and MELD score, the T-tube group showed a significantly higher prevalence of EAD-O and value of MEAF than the no-T-tube group (EAD-O: 29 [34.1%] vs 16 [19.0%], p = 0.027; MEAF 4.5 [3.5–5.7] vs 3.7 [2.9–5.0], p = 0.014). In conclusion, T-tube use in LT may be a risk factor for EAD and higher MEAF, irrespective of graft quality and severity of pre-LT liver disease.

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Section: Discussionsupporting

confidence: 86%

Re-thinking of T-tube use in whole liver transplantation: an analysis on the risk of delayed graft function

et al. 2022

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“…Liver resection remains the curative for various liver malignancies [2]. Currently the extent of liver resection/ future liver remnants volume has been shown to most consistently and decisively determine the liver regeneration [3]. Truly some centers for radiation segmentectomy has also shown the encouraging results using selective internal radiation therapy(SIRT) as an alternative to curative therapies, but it is not supported by guidelines due to a lack of solid evidence.…”

Section: Case Presentationmentioning

confidence: 99%

Synchronous hepatocellular carcinoma and gallbladder adenocarcinoma with neuroendocrine differentiation: a case report and literature review

Chen

Wang

et al. 2020

BMC Surg

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Background Double primary cancers have a low incidence rate, and synchronous hepatocellular carcinoma and gallbladder adenocarcinoma are rarely reported. Here, we report such a case— the 12th case of synchronous double primary cancers featuring HCC and GC, but the first case of neuroendocrine differentiation in the gallbladder. Case presentation A 77-year-old female was admitted to the hospital complaining of weakness and inappetence for six months. Contrast-enhanced computed tomography (CT) of the abdomen indicated an 11 cm space-occupying lesion in the right lobe of the liver. Later, magnetic resonance imaging showed a high possibility of a massive hepatoma, and multiple gallstones were also seen. After transhepatic arterial chemoembolization, a repeat abdominal CT showed obvious local nodular thickening in the gallbladder wall. Finally, resection of the right lobe of the liver and cholecystectomy were performed. During an approximately 2-year follow-up, the patient recovered uneventfully without recurrence or metastasis. Conclusion The disease in this case is rare and lacked typical radiological features. More precise and advanced diagnostic techniques are needed to obtain a clear diagnosis and refine treatment strategies. The management strategy should always be curative, even in the presence of multiple malignancies.

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“…Besides, the T-tube itself may cause biliary obstruction or leak and its removal may be associated with some degree of morbidity [ 4 , 5 ]. Furthermore, bile deprivation due to external biliary drainage as well as the presence of an indwelling device in the biliary tree may be associated with other pathogenic effects, such as chronic inflammation, changes in intestinal microbiota, malabsorption and interruption of the enterohepatic cycle [ 7 – 9 ]. However, this latter evidence is so far based mainly on experimental data from animal models.…”

Section: Introductionmentioning

confidence: 99%

An Italian survey on the use of T-tube in liver transplantation: old habits die hard!

et al. 2021

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There is enough clinical evidence that a T-tube use in biliary reconstruction at adult liver transplantation (LT) does not significantly modify the risk of biliary stricture/leak, and it may even sustain infective and metabolic complications. Thus, the policy on T-tube use has been globally changing, with progressive application of more restrictive selection criteria. However, there are no currently standardized indications in such change, and many LT Centers rely only on own experience and routine. A nation-wide survey was conducted among all the 20 Italian adult LT Centers to investigate the current policy on T-tube use. It was found that 20% of Centers completely discontinued the T-tube use, while 25% Centers used it routinely in all LT cases. The remaining 55% of Centers applied a selective policy, based on criteria of technical complexity of biliary reconstruction (72.7%), followed by low-quality graft (63.6%) and high-risk recipient (36.4%). A T-tube use > 50% of annual caseload was not associated with high-volume Center status (> 70 LT per year), an active pediatric or living-donor transplant program, or use of DCD grafts. Only 10/20 (50%) Centers identified T-tube as a potential risk factor for complications other than biliary stricture/leak. In these cases, the suspected pathogenic mechanism comprised bacterial colonization (70%), malabsorption (70%), interruption of the entero-hepatic bile-acid cycle (50%), biliary inflammation due to an indwelling catheter (40%) and gut microbiota changes (40%). In conclusion, the prevalence of T-tube use among the Italian LT Centers is still relatively high, compared to the European trend (33%), and the potential detrimental effect of T-tube, beyond biliary stricture/leak, seems to be somehow underestimated.

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In search of a pathogenesis for impaired liver regeneration after major hepatectomy with extrahepatic bile duct resection: The plot thickens!

Cited by 3 publications

References 22 publications

Re-thinking of T-tube use in whole liver transplantation: an analysis on the risk of delayed graft function

Re-thinking of T-tube use in whole liver transplantation: an analysis on the risk of delayed graft function

Synchronous hepatocellular carcinoma and gallbladder adenocarcinoma with neuroendocrine differentiation: a case report and literature review

An Italian survey on the use of T-tube in liver transplantation: old habits die hard!

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