ABSTRACT
INTRODUCTION: Liver transplantation (LT) remains the best treatment option for hepatocellular carcinoma (HCC). Patient selection is crucial and debated ever since the emerging of the Milan criteria in 1996. As live-donor LT is being more routinely performed worldwide, numerous new and/or expansions of the original criteria have been suggested to allow more patients to benefit from this superior treatment modality. This study aims to contribute to the ever-growing data in search for better coverage of patients with acceptable outcomes. METHODS: Medical recordings of 187 adult patients who underwent LT for HCC in a 6-year period were retrospectively collected. Patients were classified by Milan and University of California, San Francisco, criteria. Survival times as well as tumor, liver disease, and recurrence-related data were recorded for each patient and the outcomes were statistically analyzed. RESULTS: Factors significantly affecting recurrence and survival were histologic differentiation, number and the size of the tumor, and the presence of vascular invasion. Serum alpha-fetoprotein levels did not significantly affect outcomes. Among the patients exceeding both of the criteria, having a total tumor size of less than 160 mm was significantly associated with better outcomes (P = .007). CONCLUSION: HCC patients having tumors with vascular invasion, poor differentiation, exceeding 6 in number and 160 mm in total diameter demonstrate higher recurrence rates and worse outcomes.
Subject(s)
Carcinoma, Hepatocellular/surgery , Liver Neoplasms/surgery , Liver Transplantation , Neoplasm Recurrence, Local , Patient Selection , Adult , Aged , Carcinoma, Hepatocellular/pathology , Female , Humans , Liver Neoplasms/pathology , Liver Transplantation/adverse effects , Liver Transplantation/mortality , Living Donors , Male , Middle Aged , Neoplasm Recurrence, Local/etiology , Retrospective StudiesABSTRACT
BACKGROUND: Venous reconstruction in living-donor liver transplantation for Budd-Chiari syndrome (BCS) has challenges because the grafts from living donors lack vena cava, and hepatic venous anastomosis must be performed on an already-thrombosed and/or stenosed inferior vena cava. Several techniques are described to overcome this problem, and we represent our experience with 22 patients. METHODS: Medical recordings of 22 patients were retrospectively collected, and disease-specific data as well as recordings about surgical technique were analyzed. RESULTS: Creation of a wide, triangular de novo orifice was the main method used for venous drainage, which was used in 19 patients. The remaining 3 patients had totally thrombosed vena cava; thus, direct anastomosis to the supra-hepatic portion of the vena cava was used in 2 patients and an anastomosis to the right atrium was used in 1 patient. CONCLUSIONS: Venous reconstruction in BCS can be achieved without the use of patch-plasty, and the inferior vena cava can be safely resected in selected patients. Living-donor liver transplantation is a feasible option for the treatment of BCS, considering the scarcity of cavaderic donors.
Subject(s)
Budd-Chiari Syndrome/surgery , Liver Transplantation/methods , Living Donors , Adolescent , Adult , Child , Child, Preschool , Constriction, Pathologic/surgery , Female , Hepatic Veins/surgery , Humans , Male , Middle Aged , Plastic Surgery Procedures/methods , Retrospective Studies , Vascular Surgical Procedures/methods , Vena Cava, Inferior/surgery , Young AdultABSTRACT
Mucormycosis is a rare lethal complication of organ transplantation that progresses rapidly, and the prognosis is dismal if diagnosed late. We present a surviving liver transplant recipient in whom severe rhino-orbita-maxillary mucormycosis developed 1 month after liver transplantation. Prompt diagnosis with tissue biopsy, local control of the underlying condition with aggressive surgical debridement, and appropriate administration of systemic antifungal therapies are essential to improve prognosis and survival.
