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1.
Article in Chinese | WPRIM | ID: wpr-911206

ABSTRACT

Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on perioperative anxiety and postoperative pain in living kidney donors (LKDs).Methods:Seventy-two American Society of Anesthesiologists physical status Ⅰ or Ⅱ LKDs, aged 18-64 yr, with body mass index of 18-28 kg/m 2, undergoing living kidney transplantation, were selected, and divided into 2 groups ( n=36 each) using a random number table method: TEAS group (group T) and sham stimulation group (group S). In group T, TEAS was performed on the forenoon at 1 day before surgery (T 0), at 30 min before anesthesia induction on the morning of the operation day (T 1) and on the forenoon at 1 day after surgery (T 2) at bilateral Neiguan, Taichong and Yintang with a frequency 2-100 Hz, disperse-dense waves and current intensity 6-15 mA, and each TEAS lasted for 30 min.Only electrode patches were applied at the same acupoint and at the same time point, but no stimulation was applied in group S. In T and S groups, brachial venous blood samples were collected before each stimulation for measurement of the plasma 5-hydroxytryptamine (5-HT) concentration.The Hospital Anxiety Depression Scale-Anxiety subscale (HADS-A) scores at T 0, T 1, T 2, on day 3 after surgery (T 3) and before discharge (T 4) in the 2 groups were recorded.The consumption of anesthetics during operation, laryngeal mask airway removal time, requirement for rescue analgesia within 72 h after surgery and the development of postoperative complications were recorded.The LKDs were followed up by telephone at 3 months after surgery (T 5) to record the scores of HADS-A and Leeds Assessment of Neuropathic Symptoms and Sign (LANSS) scale. Results:Compared to group S, the incidence of anxiety was significantly decreased T 1, T 2 and T 3, the incidence of rescue analgesia within 72 h after surgery was decreased, plasma concentration of 5-HT was increased at T 1 and T 2, the incidence of postoperative nausea and vomiting was decreased, and the time to first flatus was shortened in group T ( P<0.05). There was no significant difference in the consumption of anesthetics during operation, laryngeal mask airway removal time, and the incidence of anxiety and neuropathic pain within 3 months after surgery between the 2 groups ( P>0.05). Conclusion:TEAS can relieve early preoperative and postoperative anxiety and alleviate postoperative pain in LKDs.

2.
International Journal of Surgery ; (12): 456-460, 2021.
Article in Chinese | WPRIM | ID: wpr-907462

ABSTRACT

Objective:To investigate the clinical effect of liver transplantation from organ donors in elderly patients.Methods:The clinical data of 346 patients who underwent liver transplantation in the general surgery center of Beijing You′an Hospital Affiliated to Capital Medical University from January 2018 to November 2020 were retrospectively analyzed. After screening, they were divided into the elderly donor group (30 cases) aged 60-70 years and the non elderly donor group (60 cases) aged < 60 years. The observation indexes were operation time, anhepatic phase time and operation bleeding. The prognosis indexes were: postoperative ICU stay, length of hospital stay, primary graft nonfunction (PNF), delayed graft function recovery (DGF) and in-hospital mortality. The measurement data in accordance with normal distribution are expressed as ( Mean± SD). The comparison between the two groups was analyzed by t-test. The measurement data that did not conform to the normal distribution were expressed as median (range). Mann Whitney U test was used for comparison between the two groups. The counting data were collected by the computer χ2 test or Fisher′s exact test analysis. Results:The operation time, anhepatic period and blood loss in the elderly group were (444.33±72.44) min, 56.0 (30-170) min, 1 992.1(400-9 000) mL, respectively and the non elderly group were (460.88±91.32) min, 58.45 (35-140) min, 1 885.8(400-12 000) mL, respectively, there were no significant difference between the two groups ( P>0.05); Among the prognostic indicators, the length of stay in ICU, the length of stay in hospital and the in-hospital mortality of the elderly group were 4.9 (2-21) d, 20.4 (3-40) d and 10% respectively, while the length of stay in ICU, the length of stay in hospital and the in-hospital mortality of the non elderly group were 5.3(1-32) d, 22.1(3-61) d and 10% respectively, with no significant difference between the two groups ( P>0.05); No PNF occurred in the two groups, but the incidence rate of DGF in the elderly group was 13.33%(4/30), and the non elderly group was 1.67%(1/60). There was a significant difference between the two groups ( P<0.05). Conclusion:Under strict preoperative donor evaluation and accurate recipient selection, 60-70 years old donors can achieve similar short-term effect as non elderly donors, but the long-term effect needs further observation.

3.
Rev. Col. Bras. Cir ; 48: e20213042, 2021. tab
Article in English | LILACS | ID: biblio-1340670

ABSTRACT

ABSTRACT The intense use of resources to combat COVID-19 causes concern in the entire transplant community because, in addition to physical limitations such as ICU beds, lack of homogeneous treatment protocols and uncertainties about the effects of immunosuppression on viral progression have significant impact on transplant surgeries. The aim of the present study is to comparatively assess the number of solid organ transplants performed in 2019 and 2020, as well as the impact of the COVID-19 pandemic on organ donation and transplant surgeries in Brazil. The last 10 years have shown increasing trend in the number of solid organ transplants, which have significantly decreased in 2020. Lung transplantations were mostly affected by the pandemic; these surgeries have been carried out only in Rio Grande do Sul and São Paulo states. Liver transplantations were the least affected ones, since the number of surgeries have only decreased by 10.8% in the first three quarters of 2020, in comparison to 2019. The number of active patients on the waiting list for heart and kidney transplantation has increased in 2020. Therefore, it is necessary developing strategies to keep the structure necessary for organ transplantation processes active and, consequently, to reduce the impacts of the pandemic on these patients.


RESUMO A utilização intensa dos recursos para o combate da COVID-19 causa preocupação em toda comunidade de transplantes, pois além das limitações físicas, como leitos de UTI, a falta de protocolos homogêneos para tratamentos e as incertezas dos efeitos da imunossupressão na progressão do vírus, resultam em um impacto significativo nas cirurgias de transplantes. O objetivo do presente estudo é avaliar comparativamente o número de transplantes de órgãos sólidos realizados nos anos de 2019 e 2020, e o impacto da pandemia na doação e transplantes de órgãos no Brasil. Considerando os últimos 10 anos, é possível observar uma tendência de aumento no número de transplantes de órgãos sólidos, com queda expressiva no ano de 2020. O transplante pulmonar foi o mais atingido pela pandemia, sendo realizado apenas nos estados do Rio Grande do Sul e São Paulo. O transplante hepático foi o menos afetado, apresentando uma diminuição de apenas 10,8% nos três primeiros trimestres de 2020, quando comparados com 2019. Sobre os pacientes ativos em lista de espera, houve um aumento em 2020 para transplante de coração e rim. Portanto, estratégias devem ser desenvolvidas para que a estrutura necessária ao processo de transplantes de órgãos se mantenha ativa, reduzindo assim os impactos da pandemia sobre estes pacientes.


Subject(s)
Humans , Tissue and Organ Procurement , COVID-19 , Brazil/epidemiology , Pandemics , SARS-CoV-2
4.
Rev. bras. anestesiol ; 70(3): 271-277, May-June 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137178

ABSTRACT

Abstract Background and objectives: It is suggested that 38-45% of patients experience preoperative anxiety. We observe that patients undergoing living donor nephrectomy suffer from anxiety. Preoperative anxiety may complicate a patient's recovery from anesthesia and postoperative pain control. This study investigates the preoperative anxiety rate and its effect on anesthetic recovery and postoperative pain in patients undergoing donor nephrectomy. Methods: Forty-eight individuals undergoing living-related renal donor nephrectomy were included in this analytic prospective observational cohort study. Their preoperative anxiety was measured with the STAI-I and STAI-II inventories. The relationships between anxiety scores with data regarding demographics, recovery from anesthesia, and postoperative pain scores were investigated. Results: The findings were remarkable in that the anxiety scores of living renal donors were significantly correlated with their recovery variables, which are spontaneous respiration time, sufficient respiration time, extubation time, and PACU discharge time (p < 0.01). Anxiety scores were significantly positively correlated with the pain scores of the 30th minute, 1st, 2nd, 4th, 8th, 12th, 24th hours, and the total amounts of analgesic administered in 24 hours (p < 0.05). A significantly negative correlation was also determined between anxiety scores and patients' satisfaction. Conclusion: Our study showed that patients undergoing living-related donor nephrectomy with high anxiety levels had late recovery times and high postoperative pain scores. Thus, determining those patients with high preoperative anxiety level is crucial to providing patients with satisfactory emerging from anesthesia and the control of their postoperative pain during donor nephrectomy.


Resumo Justificativa e objetivos: Estima-se que 38-45% dos pacientes apresentem ansiedade pré-operatória. Observamos que doadores vivos submetidos à nefrectomia para doação apresentam ansiedade. A ansiedade pré-operatória pode complicar a recuperação anestésica e controle pós-operatório de dor do paciente. O presente estudo mediu as taxas de ansiedade no pré-operatório e seus efeitos na recuperação anestésica e dor pós-operatória em pacientes doadores submetidos a nefrectomia. Método: Quarenta e oito doadores vivos submetidos a nefrectomia para doação de rim foram incluídos neste estudo de coorte prospectivo observacional. A ansiedade pré-operatória foi medida usando os inventários IDATE-I e IDATE-II. As relações entre os escores de ansiedade e dados relacionados a demografia, recuperação da anestesia e escores de dor no pós-operatório foram estudadas. Resultados: Os achados foram notáveis porque os escores de ansiedade de doadores renais vivos se correlacionaram de maneira significante com as variáveis de recuperação, a saber, tempo para respiração espontânea, tempo para respiração adequada, tempo para extubação e tempo para alta da RPA (p < 0,01). Os escores de ansiedade apresentaram correlação significantemente positiva com os escores de dor do 30o minuto e horas 1, 2, 4, 8, 12 e 24, e a quantidade total de analgésicos administrada nas 24 horas (p < 0,05). Foi observada também correlação significantemente negativa entre os escores de ansiedade e satisfação dos pacientes. Conclusão: Nosso estudo mostrou que doadores vivos submetidos a nefrectomia para doação com altos níveis de ansiedade apresentaram tempos de recuperação tardios e altos escores de dor no pós-operatório. Assim, a identificação dos pacientes com alto nível de ansiedade no pré-operatório é crucial para propiciar recuperação da anestesia e controle da dor no pós-operatório satisfatórios durante a nefrectomia para doação de órgão.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Anxiety/complications , Pain, Postoperative/etiology , Pain, Postoperative/epidemiology , Anesthesia Recovery Period , Living Donors/psychology , Nephrectomy , Prospective Studies , Preoperative Period , Middle Aged
5.
Article | IMSEAR | ID: sea-205482

ABSTRACT

Background: With increasing renal transplantation surgeries, the living donor renal transplant is being promoted, majorly due to the shortage of renal graft from deceased persons and potential benefits of living kidney donation itself. It is a complex phenomenon, better studied by the qualitative analysis which allows a complementary in-depth exploration of complex human experiences in such cases. This study adds to the existing literature of qualitative research covering the analysis of decision-making, perioperative, and post-operative period. Objectives: Our aim was to explore the donation process of a heterogeneous group of genetically and non-genetically related living kidney donors, to know their perception during the decision and quality of life after kidney donation. The objectives were to know the factors involved in decision-making process, the psychological status after committing for donation and to explore the changes in individual’s life post-donation. Materials and Methods: It is a thematic study with descriptive approach, with non-probability, purposive sampling of participants. In-depth interviews were analyzed by interpretative phenomenological analysis. Results were created through a comprehensive range of constituent themes and master themes after analysis of transcripts. Results: The decision-making is a rapid, rational, and altruist process. Reassurance and better management of psychological experience during the pre-operation period is helpful to a great extent. The increase in self-esteem is almost universal except a few cases of negative impact after donation. Conclusion: This study will not only help in better understanding of pre-surgical preparation but also for the better management of post-operative and follow-up period.

6.
Article in English | WPRIM | ID: wpr-765799

ABSTRACT

Liver transplantation from living donors is a potential treatment for end-stage liver disease. With advancement of laparoscopic techniques and development of surgical devices, laparoscopic liver resection is becoming increasingly popular because of the minimal invasiveness and excellent cosmetic outcomes. However, owing to technical difficulties, pure laparoscopic donor hepatectomy develops relatively slowly. Pure laparoscopic donor hepatectomy has the great advantage of reducing morbidity, minimizing tissue trauma, and improving postoperative pain and cosmetic outcome. However, pure laparoscopic donor hepatectomy may result in a longer operation time and increased risk of bile duct injury. With continuous technical development and building experience for standardization of the technique, pure laparoscopic donor hepatectomy is expected to be further expanded in the future.


Subject(s)
Bile Ducts , Hepatectomy , Humans , Laparoscopy , Liver , Liver Diseases , Liver Transplantation , Living Donors , Pain, Postoperative , Tissue Donors
7.
Article in English | WPRIM | ID: wpr-718766

ABSTRACT

Antibody-mediated rejection (AMR) is a major complication after ABO-incompatible liver transplantation. According to the 2016 Banff Working Group on Liver Allograft Criteria for the diagnosis of acute AMR, a positive serum donor specific antibody (DSA) is needed. On the other hand, the clinical significance of the histological findings of AMR in the absence of DSA is unclear. This paper describes a 57-year-old man (blood type, O+) who suffered from hepatitis B virus cirrhosis with hepatocellular carcinoma. Pre-operative DSA and cross-matching were negative. After transplantation, despite the improvement of the liver function, acute AMR was observed in the protocol biopsy on postoperative day 7; the cluster of differentiation 19+ (CD19+) count was 0% and anti-ABO antibody titers were 1:2. This paper presents the allograft injury like AMR in the absence of DSA after ABOi living donor liver transplantation with low titers of anti-ABO antibody and depleted serum CD19+ B cells.


Subject(s)
Allografts , Antibody-Dependent Cell Cytotoxicity , B-Lymphocytes , Biopsy , Carcinoma, Hepatocellular , Diagnosis , Fibrosis , Hand , Hepatitis B virus , HLA Antigens , Humans , Liver Transplantation , Liver , Living Donors , Middle Aged , Tissue Donors
8.
Article in Korean | WPRIM | ID: wpr-718173

ABSTRACT

PURPOSE: This study was performed to investigate the factors affecting postoperative pain and length of hospital stay of liver transplantation donors. METHODS: This is a retrospective study using the Electronic Medical Records (EMR) of 91 patients operated on at a tertiary hospital in Seoul, Korea in 2016. The collected data were analyzed using descriptive statistics, t-test, Mann-Whitney U test and Kruskal-Wallis test, Spearman's rank correlation, and multiple regression analysis. RESULTS: The average age of the donors was 35.7±12.2 years, and all donors were family members. PCA was applied for control pain in all patients, and 40.7% of PCA-related side effects were observed. The average length of hospital stay was 9.24±2.52 days. The factors influencing the length of hospital stay were operative methods, pain control methods, and postoperative complications. The length of hospital stay was 1.29 days shorter if donors had no complication, 1.43 days shorter when only PCA was used, and 1.19 days shorter when laparoscopic resection was performed (Adjusted R2=0.17, F=4.67, p < .05). CONCLUSION: The results of this study can be used as basic data for practical and effective postoperative nursing education and intervention of living liver donors.


Subject(s)
Education, Nursing , Electronic Health Records , Humans , Korea , Length of Stay , Liver Transplantation , Liver , Living Donors , Pain, Postoperative , Passive Cutaneous Anaphylaxis , Postoperative Complications , Retrospective Studies , Seoul , Tertiary Care Centers , Tissue Donors
9.
Article in English | WPRIM | ID: wpr-717842

ABSTRACT

PURPOSE: This study aimed to report intraoperative abortion of adult living donor liver transplantation (LDLT). METHODS: From June 1997 to December 2016, 1,179 adult LDLT cases were performed. 15 cases (1.3%) of intraoperative abortions in LDLT were described. RESULTS: Among 15 cases, 5 intraoperative abortions were donor-related, and remaining 10 cases were recipient-related. All donor-related abortions were due to unexpected steatohepatitis. Among remaining 10 recipient-related intraoperative abortions, unexpected extension of hepatocellular carcinoma was related in 5 cases. Two cases of intraoperative abortions were related to bowel inflammation, and 2 cases were associated with severe adhesion related to previous treatment. One recipient with severe pulmonary hypertension was also aborted. CONCLUSION: Complete prevention of aborted LDLT is still not feasible. In this regard, further efforts to minimize intraoperative abortion are required.


Subject(s)
Adult , Carcinoma, Hepatocellular , Fatty Liver , Humans , Hypertension, Pulmonary , Inflammation , Liver Transplantation , Liver , Living Donors , Postoperative Care
10.
Article in English | WPRIM | ID: wpr-713536

ABSTRACT

BACKGROUND/AIMS: Kidney transplantation (KT) reportedly provides a significant survival advantage over dialysis in diabetic patients. However, KT outcome in diabetic patients compared with that in non-diabetic patients remains controversial. In addition, owing to recent improvements in the outcomes of KT and management of cardiovascular diseases, it is necessary to analyze outcomes of recently performed KT in diabetic patients. METHODS: We reviewed all diabetic patients who received living donor KT between January 2008 and December 2011. Each patient was age- and sex-matched with two non-diabetic patients who received living donor KT during the same period. The outcomes of living donor KT were compared between diabetic and non-diabetic patients. RESULTS: Among 887 patients, 89 diabetic patients were compared with 178 non-diabetic patients. The incidence of acute rejection was not different between the diabetic and non-diabetic patients. Urinary tract infection and other infections as well as cardiovascular events occurred more frequently in diabetic patients. However, diabetes, cardiovascular disease, and infection were not significant risk factors of graft failure. Late rejection (acute rejection after 1 year of transplantation) was the most important risk factor for graft failure after adjusting for diabetes mellitus (DM), human leukocyte antigen mismatch, rejection and infection (hazard ratio, 56.082; 95% confidence interval, 7.169 to 438.702; p < 0.001). Mortality was not significantly different between diabetic and non-diabetic patients (0 vs. 2, p = 0.344 by log-rank test). CONCLUSIONS: End-stage renal disease patients with DM had favorable outcomes with living donor kidney transplantation.


Subject(s)
Cardiovascular Diseases , Diabetes Mellitus , Dialysis , Humans , Incidence , Kidney Failure, Chronic , Kidney Transplantation , Kidney , Leukocytes , Living Donors , Mortality , Risk Factors , Transplants , Urinary Tract Infections
11.
Article in English | WPRIM | ID: wpr-713311

ABSTRACT

BACKGROUND/AIMS: Computed tomography (CT) hepatic volumetry is currently accepted as the most reliable method for preoperative estimation of graft weight in living donor liver transplantation (LDLT). However, several factors can cause inaccuracies in CT volumetry compared to real graft weight. The purpose of this study was to determine the frequency and degree of resection plane-dependent error in CT volumetry of the right hepatic lobe in LDLT. METHODS: Forty-six living liver donors underwent CT before donor surgery and on postoperative day 7. Prospective CT volumetry (VP) was measured via the assumptive hepatectomy plane. Retrospective liver volume (VR) was measured using the actual plane by comparing preoperative and postoperative CT. Compared with intraoperatively measured weight (W), errors in percentage (%) VP and VR were evaluated. Plane-dependent error in VP was defined as the absolute difference between VP and VR. % plane-dependent error was defined as follows: |VP–VR|/W∙100. RESULTS: Mean VP, VR, and W were 761.9 mL, 755.0 mL, and 696.9 g. Mean and % errors in VP were 73.3 mL and 10.7%. Mean error and % error in VR were 64.4 mL and 9.3%. Mean plane-dependent error in VP was 32.4 mL. Mean % plane-dependent error was 4.7%. Plane-dependent error in VP exceeded 10% of W in approximately 10% of the subjects in our study. CONCLUSIONS: There was approximately 5% plane-dependent error in liver VP on CT volumetry. Plane-dependent error in VP exceeded 10% of W in approximately 10% of LDLT donors in our study. This error should be considered, especially when CT volumetry is performed by a less experienced operator who is not well acquainted with the donor hepatectomy plane.


Subject(s)
Cone-Beam Computed Tomography , Hepatectomy , Humans , Liver Transplantation , Liver , Living Donors , Methods , Organ Size , Prospective Studies , Retrospective Studies , Tissue Donors , Transplants
12.
Chinese Journal of Geriatrics ; (12): 1009-1012, 2018.
Article in Chinese | WPRIM | ID: wpr-709406

ABSTRACT

Objective To investigate the clinical significance of serum and urinary levels of neutrophil gelatinase-associated lipocalin (NGAL ) for evaluating changes of residual renal function after living donor kidney resection under different operation model in young versus elderly patients. Methods The clinical data of renal transplants were retrospectively analyzed by successfully using 66 living-related donors at the First Affiliated Hospital of Zhengzhou University from September 2016 to October 2017. According to the operation model and age ,renal donors were divided into 4 groups :group A (young/open) ,group B (young/laparoscopic) ,group C (aged/open) ,and group D (aged/laparoscopic).Blood and urinary NGAL and serum levels of creatinine ,cystatin C ,and other indices of renal function were assayed and collected before and at 1 ,3 ,7 days after operation. Results Both blood NGAL levels and urinary NGAL levels showed no statistically significant difference (all P>0.05) among four groups both before and after operation ,except that urinary NGAL was higher in group C (aged/open) than other groups ,at 1 day after operation ,(P = 0.03).The post-vs.pre-operation level dynamic changes of renal function were four or three times higher in urine or serum NGAL level than in serum creatinine or cystatin C level at 1 day after operation ,which showed an important role for predicting an early residual renal damage and relative treatment. Conclusions NGAL can be used as indices in evaluating changes of residual renal function after living donor kidney resection ,especially in the elderly receiving open kidney resection.

13.
Article in Chinese | WPRIM | ID: wpr-706445

ABSTRACT

Purpose To discuss the value of longitudinal assessment of the remaining kidney of the donor and kidney blood oxygen level changes after receiving kidney transplantation by applying blood oxygen level-dependent (BOLD) MRI. Materials and Methods Sixty patients underwent parental kidney transplantation from Jul. 2015 to Feb. 2017 in Tianjin First Center Hospital were prospectively collected, including 30 healthy kidney transplant donors and 30 recipients corresponding to them. The donors received renal BOLD examination 3 days before and 2 weeks after unilateral nephrectomy. Recipients received renal BOLD examination 2 weeks after kidney transplantation, of which, 15 pairs of patients underwent parental kidney transplantation received renal BOLD examination again six months after surgery. The apparent transverse relaxation rate (R2*) values of the cortex and medulla at different times before and after transplantation were measured and recorded. The differences of R2* values between 30 donors' cortex and medulla in both kidneys before surgery were compared; the differences of R2* values between 30 pairs of subjects' cortex and medulla in remaining and donated kidney within 2 weeks before and after surgery were compared; variance gained through single factor repeated measurement was applied to analyze and compared the difference of R2* values between 15 pairs of follow-up subjects' cortex and medulla in remaining and donated kidney at different time points before and after surgery. Results All 60 subjects received MRI scan, and there was no statistical difference in R2* values between 30 subjects' cortex and medulla in both kidney before surgery (P>0.05). The difference between the cortex and medulla was statistically significant, with R2* value of medulla higher than that of cortex (P<0.01). R2* values of cortex and medulla of the remaining kidney in 30 subjects two weeks after receiving unilateral nephrectomy were lower than those before surgery. R2* value of cortex and medulla of donated kidney were both lowered before surgery, the difference of which was statistically significant (P<0.01). R2*values of cortex and medulla in remaining and donated kidney of 15 pairs of subjects who have received half a year's follow up were both evidently reduced two weeks after surgery, and R2* values six months after surgery were raised compared with two weeks after surgery, but were still lower than that before surgery, the difference of which were both statistically significant (P<0.05). Conclusion BOLD MRI can be used for longitudinal monitor of changes in blood oxygen levels in remaining and donated kidney after receiving parental kidney transplantation.

14.
Chinese Journal of General Surgery ; (12): 1038-1041, 2018.
Article in Chinese | WPRIM | ID: wpr-734795

ABSTRACT

Objective To explore the diagnosis and treatment of diaphragmatic hernia (DH)secondary to living donor liver transplantation (LDLT) in pediatrics.Methods The primary disease was biliary atresia and all of the 4 patients underwent LDLT using a donor's left lateral graft.The ages of recipients were 5-7 months at LDLT and the onset of DH were 1.5-16 months after LDLT.There were 3 right DH and 1 left DH,and 3 were emergency cases.Results The graft weight and graft to recipient body weight ratio (GRWR) were respectively between 170-290 g and between 2.7%-5.0%.Clinical symptoms included urgent respiratory distress,dyspepsia or gastrointestinal obstruction.DH was diagnosed by computed tomography scan or X-ray of the chest.Laparotomy were performed successfully to repair the DH including emergency laparotomy in three patients.Herniated organs were partial intestines or colon and partial stomach.All cases recovered without major complications.Conclusions DH post-LDLT is an unusual complication,often calls for emergent management.

15.
ABCD arq. bras. cir. dig ; 30(1): 38-41, Jan.-Mar. 2017. tab, graf
Article in English | LILACS | ID: biblio-837572

ABSTRACT

ABSTRACT Background: Computed tomography volumetry (CTV) is a useful tool for predicting graft weights (GW) for living donor liver transplantation (LDLT). Few studies have examined the correlation between CTV and GW in normal liver parenchyma. Aim: To analyze the correlation between CTV and GW in an adult LDLT population and provide a systematic review of the existing mathematical models to calculate partial liver graft weight. Methods: Between January 2009 and January 2013, 28 consecutive donors undergoing right hepatectomy for LDLT were retrospectively reviewed. All grafts were perfused with HTK solution. Estimated graft volume was estimated by CTV and these values were compared to the actual graft weight, which was measured after liver harvesting and perfusion. Results: Median actual GW was 782.5 g, averaged 791.43±136 g and ranged from 520-1185 g. Median estimated graft volume was 927.5 ml, averaged 944.86±200.74 ml and ranged from 600-1477 ml. Linear regression of estimated graft volume and actual GW was significantly linear (GW=0.82 estimated graft volume, r2=0.98, slope=0.47, standard deviation of 0.024 and p<0.0001). Spearman Linear correlation was 0.65 with 95% CI of 0.45 - 0.99 (p<0.0001). Conclusion: The one-to-one rule did not applied in patients with normal liver parenchyma. A better estimation of graft weight could be reached by multiplying estimated graft volume by 0.82.


RESUMO Racional: A volumetria por tomografia computadorizada (VTC) é uma ferramenta útil para a previsão do peso do enxerto (PE) para o transplante hepático com doador vivo (TFDV). Poucos estudos examinaram a correlação entre o VTC e PE no parênquima hepático normal. Objetivo: Analisar a correlação entre VTC e PE em uma população adulta de doadores para o TFDV e realização de revisão sistemática dos modelos matemáticos existentes para calcular o peso de enxertos hepáticos parciais. Métodos: Foram revisados retrospectivamente 28 doadores consecutivos submetidos à hepatectomia direita para o TFDV entre janeiro de 2009 a janeiro de 2013. Todos os doadores eram adultos saudáveis ​​com VTC pré-operatório. Os enxertos foram perfundidos com solução de preservação HTK. O volume estimado foi obtido por VTC e estes valores foram comparados com o peso real do enxerto, o qual foi aferido depois da hepatectomia e perfusão do enxerto. Resultados: A mediana do PE real foi de 782,5 g, média de 791,43±136 g, variando de 520-1185 g. A mediana do volume estimado do enxerto foi de 927,5 ml, média de 944,86±200,74 ml e variou de 600-1477 ml. A regressão linear volume estimado do enxerto e PE real foi significativamente linear (PE=0.82 do volume estimado do enxerto, r2=0,98, declive=0,47, desvio-padrão de 0,024 e p<0,0001). Correlação linear de Spearman foi de 0,65, com IC de 95% do 0,45-0,99 (p<0,0001). Conclusão: A regra de "um-para-um" não deve ser empregada em pacientes com parênquima hepático normal. A melhor estimativa do peso do enxerto hepático de doador vivo pode ser alcançado através da multiplicação do VTC por 0,82.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Preoperative Care , Tomography, X-Ray Computed , Liver Transplantation , Liver/anatomy & histology , Liver/diagnostic imaging , Organ Size , Retrospective Studies , Living Donors , Models, Theoretical
16.
Article in English | WPRIM | ID: wpr-169997

ABSTRACT

PURPOSE: Liver volumetry is a vital component in living donor liver transplantation to determine an adequate graft volume that meets the metabolic demands of the recipient and at the same time ensures donor safety. Most institutions use preoperative contrast-enhanced CT image-based software programs to estimate graft volume. The objective of this study was to evaluate the accuracy of 2 liver volumetry programs (Rapidia vs. Dr. Liver) in preoperative right liver graft estimation compared with real graft weight. METHODS: Data from 215 consecutive right lobe living donors between October 2013 and August 2015 were retrospectively reviewed. One hundred seven patients were enrolled in Rapidia group and 108 patients were included in the Dr. Liver group. Estimated graft volumes generated by both software programs were compared with real graft weight measured during surgery, and further classified into minimal difference (≤15%) and big difference (>15%). Correlation coefficients and degree of difference were determined. Linear regressions were calculated and results depicted as scatterplots. RESULTS: Minimal difference was observed in 69.4% of cases from Dr. Liver group and big difference was seen in 44.9% of cases from Rapidia group (P = 0.035). Linear regression analysis showed positive correlation in both groups (P < 0.01). However, the correlation coefficient was better for the Dr. Liver group (R² = 0.719), than for the Rapidia group (R² = 0.688). CONCLUSION: Dr. Liver can accurately predict right liver graft size better and faster than Rapidia, and can facilitate preoperative planning in living donor liver transplantation.


Subject(s)
Donor Selection , Humans , Linear Models , Liver , Liver Transplantation , Living Donors , Organ Size , Retrospective Studies , Tissue Donors , Tomography, X-Ray Computed , Transplants
17.
Article in English | WPRIM | ID: wpr-134101

ABSTRACT

PURPOSE: There is no consensus regarding the difference in outcomes of HCV in patients who receive living donor liver transplantation (LDLT) or compared to deceased donor liver transplantation (DDLT). The aims of this study were to compare characteristics between LDLT and DDLT groups and to identify risk factors affecting patient survival. METHODS: We retrospectively reviewed the multicenter records of 192 HCV RNA-positive patients who underwent liver transplantation. RESULTS: Thirty-five patients underwent DDLT, and 146 underwent LDLT. The 1-, 3-, and 5-year patient survival rates were 66.7%, 63.0%, and 63.0% in the DDLT group and 86.1%, 82.3%, and 79.5% in the LDLT group (P = 0.024), respectively. After propensity matching, the patient survival curve of the LDLT group was higher than that of the DDLT group. However, there was no statistically significant difference in patient survival between the 2 groups (P = 0.061). Recipient age ≥ 60 years, LDLT, and use of tacrolimus were positively associated with patient survival in multivariate analyses. CONCLUSION: LDLT appears to be suitable for HCV-infected patients if appropriate living donor is available.


Subject(s)
Case-Control Studies , Consensus , Hepacivirus , Hepatitis C , Hepatitis , Humans , Immunosuppression , Liver Transplantation , Liver , Living Donors , Multivariate Analysis , Propensity Score , Retrospective Studies , Risk Factors , Survival Rate , Tacrolimus , Tissue Donors
18.
Article in English | WPRIM | ID: wpr-134100

ABSTRACT

PURPOSE: There is no consensus regarding the difference in outcomes of HCV in patients who receive living donor liver transplantation (LDLT) or compared to deceased donor liver transplantation (DDLT). The aims of this study were to compare characteristics between LDLT and DDLT groups and to identify risk factors affecting patient survival. METHODS: We retrospectively reviewed the multicenter records of 192 HCV RNA-positive patients who underwent liver transplantation. RESULTS: Thirty-five patients underwent DDLT, and 146 underwent LDLT. The 1-, 3-, and 5-year patient survival rates were 66.7%, 63.0%, and 63.0% in the DDLT group and 86.1%, 82.3%, and 79.5% in the LDLT group (P = 0.024), respectively. After propensity matching, the patient survival curve of the LDLT group was higher than that of the DDLT group. However, there was no statistically significant difference in patient survival between the 2 groups (P = 0.061). Recipient age ≥ 60 years, LDLT, and use of tacrolimus were positively associated with patient survival in multivariate analyses. CONCLUSION: LDLT appears to be suitable for HCV-infected patients if appropriate living donor is available.


Subject(s)
Case-Control Studies , Consensus , Hepacivirus , Hepatitis C , Hepatitis , Humans , Immunosuppression , Liver Transplantation , Liver , Living Donors , Multivariate Analysis , Propensity Score , Retrospective Studies , Risk Factors , Survival Rate , Tacrolimus , Tissue Donors
19.
Tianjin Medical Journal ; (12): 588-592, 2017.
Article in Chinese | WPRIM | ID: wpr-612369

ABSTRACT

Objective To investigate the effect of edaravone on the JAK2/STAT3 signaling pathway after ischemia-reperfusion injury in donor rat liver under different cold ischemia times. Methods A total of 102 SD rats were randomly divided into sham operation group,control group and experimental group. Six rats were in sham operation group with free liver operation and no transplantation. Forty-eight rats were in control group and experimental group respectively, and divided into subgroups according to the different cold ischemia times (30 min, 6 h, 12 h and 18 h). There were 6 donors and 6 recipients in each group. The rat model of orthotopic liver transplantation was established by modifiedtwo cuff method. All the donors were perfused by abdominal aorta and the warm ischemia time was 3-5 min. After different cold ischemia times, the experimental group was treated with edaravone (3 mg/kg) at 5 min before the opening of the new hepatic artery, and control group was injected with 3 mg/kg saline. Recipients of each group were sacrificed after 6 h. Finally, real-time fluorescence quantitative PCR was used to analyze the relative expression of JAK2/STAT3 mRNA of donor liver. Results The GAPDH gene and JAK2/STAT3 were well amplified. Under the same cold ischemia time, compared with the control group, the relative expression of JAK2/STAT3 was significantly decreased in the experimental group (P<0.05). With the prolongation of cold ischemia time, the relative expressions of JAK2 and STAT3 mRNA showed a decreasing trend in control group and experimental group, while the relative expression of JAK2 mRNA increased first and then decreased in the experimental group (P<0.05). Conclusion Edaravone has a protective effect on transplanted donor liver during different cold ischemia times, and extends the cold ischemia time for 18 h, which may be related to the inhibition of JAK2/STAT3 signal transduction pathway.

20.
Article in Chinese | WPRIM | ID: wpr-668893

ABSTRACT

Objective:To summarize our experience of retroperitoneal laparoscopic living donor nephrectomy,our continuous technical improvements and refinement of this skill and standardization of each procedure of this operation.Methods:Having approved by hospital ethical committee and local government administration,a total of 193 living donors underwent retroperitoneal laparoscopic living donor nephrectomy from Dec.2003 to Feb.2016 in our department.Under general anaesthesia,the operation was performed through 3 lumbar ports.After the kidney was liberated fully and the ureter was severed 7-8 cm under the lower pole of the kidney,the renal artery and vein were blocked with endo-cut or hem-o-lok separately and then severed.Then the kidney was taken out quickly and flushed with 4 ℃ kidney preserving fluid immediately,the donor kidneys were then preserved in iced saline until kidney transplantation.Clinical data about operation time,volume of blood loss,perioperative complications,renal function of both donors and recipients before and after operation were collected.Results:The 193 retroperitoneal laparoscopic living donor nephrectomy operations were successful with only one operation was converted to open living donor nephrectomy because of hemorrhage and unclear operation field during the operation.The average operation time was 85 min (55-135 min),the average blood loss was 60 mL (20-200 mL),and no donor needed blood transfusion during or after operation.Three donors were found to have hematoma of renal fossa after operation and none of them required further treatment.The average hospital stay after operation was 5.7 days (4-9 days).In the study,162 donors were followed up for an average of 42 months (1-58 months) and they were all healthy.Two kidney recipients had urinary bladder anastomosis leakage after operation and both needed surgical repair,a new anastomosis of ureter and bladder were made.Three kidney recipients had kidney subcapsular hematoma but required no further treatment.One kidney recipient had delayed graft function and recovered finally and the renal function of other recipients were all normal.Renal function of both donors and recipients during the follow up period were normal.Conclusion:Retroperitoneal laparoscopic living donor nephrectomy is a safe and reliable technique,it may become a standardized operation for living kidney transplantation after continuous technical improvement.Precautions must be taken to avoid complications and a skilled hand is necessary for success.

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