Personal experience with the procurement of 132 liver allografts

Yanaga, Katsuhiko; Tzakis, Andreas G.; Starzl, Thomas E.

doi:10.1111/j.1432-2277.1989.tb01857.x

Cited by 29 publications

(12 citation statements)

References 19 publications

(16 reference statements)

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“…The aberrant HA should. therefore, be preserved during procurement of the liver [11]. If it is injured or interrupted.…”

Section: Discussionmentioning

confidence: 99%

“…The arterial blood supply of the liver is extremely variable, and the interruption of the hepatic artery is a feared complication in hepatobiliary or pancreatic surgical procedures, as well as in liver transplantation [2,7,10,11]. Although the clinical consequences of complete dearterialization of an allograft in orthotopic liver transplantation (OLTx) are well documented [10], little is known about the behavior of a partially dearterialized liver graft.…”

Section: Abstract: Liver Transplantation Partial Dearterialization mentioning

confidence: 99%

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Partial dearterialization of the liver allograft

Yanaga¹,

Tzakis²,

Starzl³

1990

Transplant Int

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Abstract. The clinical course of five patients with partial dearterialization of their hepatic allografts is described. One patient died and three others suffered serious morbidity as a direct or indirect result of this complication. Partial dearterialization of the liver allograft is a serious and potentially life-threatening complication for which preservation of the complete hepatic arterial supply is important' even if this requires reconstruction of the aberrant vessels. Key words: Liver transplantation, partial dearterialization -Arterial supply, in liver transplantationThe arterial blood supply of the liver is extremely variable, and the interruption of the hepatic artery is a feared complication in hepatobiliary or pancreatic surgical procedures, as well as in liver transplantation [2,7,10,11]. Although the clinical consequences of complete dearterialization of an allograft in orthotopic liver transplantation (OLTx) are well documented [10], little is known about the behavior of a partially dearterialized liver graft. We studied the clinical course of five patients who were known to have had this complication in order to clarify its significance. Patients and results Case JA 20-year-old male underwent OLTx for sclerosing cholangitis. The graft had an aberrant left hepatic artery (HA) originating from the left gastric artery (LGA) and a properHA that supplied the right hepatic lobe. Figure 1 demonstrates the postoperative course. On day 7 post-transplantation, he underwent Doppler ultrasonography of the graft, which failed to demonstrate arterial flow. Emergency

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“…The aberrant HA should. therefore, be preserved during procurement of the liver [11]. If it is injured or interrupted.…”

Section: Discussionmentioning

confidence: 99%

Section: Abstract: Liver Transplantation Partial Dearterialization mentioning

confidence: 99%

Partial dearterialization of the liver allograft

Yanaga¹,

Tzakis²,

Starzl³

1990

Transplant Int

Self Cite

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“…However, the dose used Plasma octreotide concentrations were determined by should be seriously questioned. In a previous study, 2 radioimmunoassay (Sandoz Laboratory, Rueil Malmaiwe indeed observed early rebleeding when octreotide son, France). Data are shown in Fig.…”

Section: Subcutaneous Octreotide For the Prevention Of Early Varicealmentioning

confidence: 99%

“…In our article, 2 we defined primary graft nonfunction (PGNF) as the inabilWe thank Dr. Yanaga for his letter. Dr. Yanaga's ity of the graft to sustain the metabolic homeostasis of report covered a period during which he performed doa recipient during the first postoperative week, with nor procedures at the University of Pittsburgh.…”

Section: Referencesmentioning

confidence: 99%

Subcutaneous octreotide for the prevention of early variceal rebleeding

DeLedinghen¹

1996

Hepatology

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Section: Introductionmentioning

confidence: 99%

Partial dearterialization of the liver allograft

1990

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The clinical course of five patients with partial dearterialization of their hepatic allografts is described. One patient died and three others suffered serious morbidity as a direct or indirect result of this complication. Partial dearterialization of the liver allograft is a serious and potentially lifethreatening complication for which preservation of the complete hepatic arterial supply is important, even if this requires reconstruction of the aberrant vessels. KeywordsLiver transplantation; partial dearterialization; Arterial supply; in liver transplantationThe arterial blood supply of the liver is extremely variable, and the interruption of the hepatic artery is a feared complication in hepatobiliary or pancreatic surgical procedures, as well as in liver transplantation [2,7,10,11]. Although the clinical consequences of complete dearterialization of an allograft in orthotopic liver transplantation (OLTx) are well documented [10], little is known about the behavior of a partially dearterialized liver graft. We studied the clinical course of five patients who were known to have had this complication in order to clarify its significance. Patients and results Case 1A 20-year-old male underwent OLTx for sclerosing cholangitis. The graft had an aberrant left hepatic artery (HA) originating from the left gastric artery (LGA) and a proper HA that supplied the right hepatic lobe. Figure 1 demonstrates the postoperative course. On day 7 post-transplantation, he underwent Doppler ultrasonography of the graft, which failed to demonstrate arterial flow. Emergency hepatic arteriography revealed thrombosis of the proper HA, which was reconstituted through intrahepatic collaterals from the aberrant left HA (Fig. 2). A needle liver biopsy at that time revealed acute cellular rejection, for which OKT3 was administered for 2 weeks. The patient developed cytomegalovirus (CMV) hepatitis and subsequently required retransplantation. The failed allograft revealed no evidence of hepatic abscesses or lobar ischemia. The patient was discharged 3 months after the initial transplant and is doing well. A 62-year-old male with postnecrotic cirrhosis underwent OLTx. The aberrant left HA of the allograft originating from the LGA was erroneously injured during organ procurement and was ligated. His postoperative course was complicated by systemic bacterial and CMV infection. At 6 months post-transplantation, he developed a fever. Computed tomography revealed a 6.0 × 6.0 cm collection with an air-fluid level in the left lateral segment of the hepatic graft (Fig. 3), which was drained. The aspirate grew enterococcus and diphtheloids, for which appropriate antibiotics were given. The main HA was patent on Doppler ultrasonographs, and a percutaneous transhepatic cholangiogram was normal. The drainage catheter was removed 47 days later, when the cavity collapsed completely. He remains alive and well 13 months later. Case 3A 31-year-old male underwent uneventful OLTx for postnecrotic cirrhosis due to hepatitis B. The allograft had a smal...

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Personal experience with the procurement of 132 liver allografts

Cited by 29 publications

References 19 publications

Partial dearterialization of the liver allograft

Partial dearterialization of the liver allograft

Subcutaneous octreotide for the prevention of early variceal rebleeding

Partial dearterialization of the liver allograft

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