Living-Donor Liver Transplantation Using Segment 2 Monosegment Graft: A Single-Center Experience

Sakuma, Yoshiki; Sasanuma, Hideki; Miki, Atsushi; Shimizu, Atsushi; Sata, Naohiro; Yasuda, Yoshikazu; Lefor, Alan Kawarai; Hirata, Yuta; Yamada, Naoya; Okada, Noriki; Sanada, Yukihiro; Ihara, Yoshiyuki; Urahashi, Taizen; Mizuta, Koichi

doi:10.1016/j.transproceed.2015.12.119

Cited by 15 publications

(17 citation statements)

References 11 publications

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“…Studies investigating living donor liver transplantation and pediatric patients are more common. 23,26 The main limitation of this study was the retrospective design. The investigation of the occurrence of large-for-size allografts was impaired, as complete data were unavailable in the medical records selected.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Liver Transplantation

Oliveira

Mancero²,

Faria³

et al. 2019

Prog Transpl

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Background: Surgical site infection is an important complication in the postoperative period among liver transplant recipients. However, little is known about the risk factors in this patient group. Therefore, the objective of this study was to analyze the incidence and risk factors for surgical site infections among adult liver transplant recipients. Methods: Medical records of adult liver transplant recipients from January 1, 2009, to December 31, 2015, were analyzed in this retrospective cohort study. Results: We enrolled 156 recipients' medical records. Forty-two (26.9%) cases of surgical site infections were identified. The main isolated microorganisms were methicillin-resistant Staphylococcus species, extended spectrum b-lactamase-producing Klebsiella species, carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Acinetobacter baumannii, and vancomycin-susceptible Enterococcus faecalis. We found that long operative times (487 minutes) and differences in body mass index between donor and recipient (1.3 kg/m 2) increased the risk for surgical site infections by approximately 5 times (odds ratio [OR], 5.5; 95% confidence interval [CI], 2.5-11.8), and capillary glycemia 175 mg/dL in the first 96 postoperative hours increased the risk by approximately 3 times (OR, 2.97; 95% CI, 1.43-6.17). Conclusions: There was a high incidence of surgical site infections among the studied population and that some risk factors identified differ from those reported in the scientific literature.

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Section: Discussionmentioning

confidence: 99%

A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Liver Transplantation

Oliveira

Mancero²,

Faria³

et al. 2019

Prog Transpl

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“…Except for posterior grafts, the early relaparotomy rates for left lobe grafts (16.1%) or monosegment grafts (38.5%) were higher than for left lateral segment grafts (9.2%). The recipients who needed to undergo LDLT using monosegment grafts had small and fragile vessels and tissues . Left lobe grafts and monosegment grafts have been reported to be risk factors for postoperative intra‐abdominal infection .…”

Section: Discussionmentioning

confidence: 99%

“…The recipients who needed to undergo LDLT using monosegment grafts had small and fragile vessels and tissues. (16,17) Left lobe grafts and monosegment grafts have been reported to be risk factors for postoperative intra-abdominal infection. (18) In that study, (18) the transection sites in the left lobe and the S2 monosegment grafts were larger than the left lateral segment grafts.…”

Section: Discussionmentioning

confidence: 99%

The Causes and Outcomes of Early Relaparotomy Following Pediatric Living Donor Liver Transplantation

et al. 2019

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Early relaparotomy of adult recipients after living donor liver transplantation (LDLT) is significantly associated with poor prognosis. However, there are few reports focusing on pediatric recipients after LDLT. The aim of this study is to clarify the causes and outcomes of early relaparotomy after pediatric LDLT. A total of 265 pediatric recipients (272 LDLTs) transplanted from May 2001 to October 2015 were retrospectively analyzed. Early relaparotomy was defined as surgical intervention performed within 3 months after LDLT. Early relaparotomy was performed 49 times for 33 recipients (12.5%). The recipient and graft survival rates in the early relaparotomy group were significantly lower than those in the nonearly relaparotomy group, respectively (75.0% and 63.6% versus 96.6% and 95.8%; both P < 0.001). Left lateral segment grafts were used significantly more frequently in the nonrelaparotomy group (P = 0.01). According to the multivariate analysis, the preoperative Pediatric End‐Stage Liver Disease (PELD)/Model for End‐Stage Liver Disease (MELD) score of the early relaparotomy group was significantly higher than that of the nonearly relaparotomy group (13.7 versus 6.3; P = 0.04). According to the receiver operating characteristic curve, the preoperative PELD/MELD score cutoff point was 17.2. Early relaparotomy due to infectious causes led to significantly poorer graft survival than that due to noninfectious causes (P = 0.04). In conclusion, the recipient and graft survival rates of the early relaparotomy group were significantly lower than those of the nonearly relaparotomy group. A high preoperative PELD/MELD score was a risk factor for early relaparotomy. In particular, early relaparotomy due to infection showed a poor prognosis.

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“…A precise knowledge of the number and the location of the different venous branches for segments II and III is also mandatory for surgeons performing pediatric LDLT. In fact, the volume of the left lateral segment has to be reduced to prevent large‐for‐size syndrome in small infants (Yamada et al, ); reduced left lateral segment or monosegment grafts, either segment II or segment III, are usually used (Shehata et al, ; Sakuma et al, ). A clear demarcation between the two segments can be obtained by an injection of sterile blue solution into the portal vein of the segment to be resected.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, modern liver surgery and transplantation have reached a level of complexity that requires an accurate description of the vascular anatomy of the liver. Recent years have witnessed the emergence of new surgical procedures such as modified Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS; Tanaka et al, ), pediatric living donor liver transplantation (LDLT) using monosegmental graft (Yamada et al, ; Sakuma et al, ), and meso Rex shunt (di Francesco et al, ). Therefore, a detailed knowledge of the segmental anatomy of the liver in general, and of the LPV in particular has become imperative.…”

Section: Introductionmentioning

confidence: 99%

Segmental branching pattern of the left portal vein: Anatomical characteristics and clinical implications

Najah

Ammar²,

Gupta

et al. 2017

Clinical Anatomy

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The existing knowledge on anatomy of segmental branches of left portal vein (LPV) is limited. This study aims to describe the surgical anatomy and variations of LPV and its segmental branching pattern. Forty fresh cadaveric liver dissections were performed. The dissection of LPV was carried out from its emergence at the level of the portal vein bifurcation to its segmental branches penetrating the left hemiliver. LPV characteristics, the number, and situation of its segmental branches were recorded. LPV comprises two portions: a 28 ± 6.7 mm-long transverse portion (TPLPV) and a 34.9 ± 4.4 mm-long umbilical portion (UPLPV). Mean number of LPV branches to segments I, II, III, and IV was 2 ± 1 (1-6), 2 ± 1 (1-4), 2 ± 1 (1-5), and 8 ± 2 (4-14), respectively. A single large vein supplied segment II in 90% of the cases. Segment III constantly had one vein arising from the left horn of UPLPV with mean diameter of 5.9 ± 1.6 mm. Most of the veins to segment IV took origin from the right horn of UPLPV with a mean number of 5 ± 2 (2-8). Segmental veins arising from UPLPV and TPLPV and supplying segment IV were present in 90 and 45% of the cases respectively. Segmental veins arising from LPV are often multiple and variable in position. Detailed knowledge of these veins is mandatory in order successfully perform anatomical liver resections or monosegment graft harvest for pediatric liver transplantation. Clin. Anat, 2017. © 2017 Wiley Periodicals, Inc.

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Living-Donor Liver Transplantation Using Segment 2 Monosegment Graft: A Single-Center Experience

Cited by 15 publications

References 11 publications

A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Liver Transplantation

A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Liver Transplantation

The Causes and Outcomes of Early Relaparotomy Following Pediatric Living Donor Liver Transplantation

Segmental branching pattern of the left portal vein: Anatomical characteristics and clinical implications

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