Short-term Results of Liver Transplantation With Octogenarian Donors.

BACKGROUND: There are increasingly more patients awaiting liver transplantation while the number of donors has remained stable. It has been proven that grafts from donors older than 60 years have comparable results with those from younger donors. It is unclear whether this is so with donors older than 80 years old. MATERIAL AND METHODS: This was a retrospective study of all adult liver transplantations at our institution between March 2011 and December 2015. We compared 1-, 3-, 6-, and 12-month graft survival rates from donors <80 years and ≥80 years. We also compared postoperative complications: infections, acute kidney injury, need for readmission in the intensive care unit, length of stay, mechanical ventilation, and specific graft complications. We considered differences in each age group regarding the presence of hepatitis C virus (HCV). RESULTS: Of 177 recipients, 38 received grafts from octogenarian donors (21.5%). Survival rates were very similar in the groups (97%, 93%, 91%, and 87% for donors <80 years and 95%, 92%, 87%, and 76% for donors ≥80 years). Although for younger grafts, 1-year survival rates were slightly lower for HCV+ patients (80% vs 89%; log-rank 0.205), this difference does not exist for elderly donors. The incidence of postoperative complications was similar in both groups. CONCLUSIONS: Livers from octogenarian donors are acceptable for liver transplantation provided that thorough assessment and selection is made by avoiding other known poor prognosis factors. The presence of HCV did not affect survival rates.

Portal vein arterialization in liver transplantation: an option to restore arterial flow: a case report.

We report a 66-year-old woman who underwent emergency orthotopic liver transplantation due to acute liver failure. The donor's liver graft displayed extensive arteriosclerosis, involving the celiac trunk and hepatic artery. Arterial revascularization of the graft could not be achieved, requiring an arterioportal shunt between the gastroduodenal artery and the portal vein of the recipient. During the early postoperative period, the patient's clinical condition and liver function tests improved rapidly; the patient was discharged on postoperative day 30. Two months later, she developed acute cholangitis. Ischemic-type stenosis of the intrahepatic biliary tree was present, so successful elective retransplantation was undertaken at the ninth postoperative month. In our experience, portal vein arterialization may be useful as a bridging therapy in extreme situations.

[Hepatic hydatidosis. Radical vs. conservative surgery: 22 years of experience]. / Hidatidosis hepática. Cirugía radical vs. no radical: 22 años de experiencia.

OBJECTIVES: the incidence of hepatic hydatidosis has remarkably decreased in the last years due to the preventive measures adopted to stop the transmission of the parasite. However, surgery carries on being the treatment of choice, although the surgical procedure is still a matter of controversy. The aim of the study was to evaluate the results obtained with the treatment of this condition after two decades according to surgical procedure type. MATERIAL AND METHODS: from 1983 to 2005, 372 patients were operated on for hepatic hydatidic cyst in Hospital Ramón y Cajal. Radical surgery was performed for 162 (43.5%) and conservative surgery for 210 (56.5%). RESULTS: average postoperative hospital stay (8.65 vs. 14.9 days), morbidity (13.3 vs. 31.4%, p < 0.001), and mortality (0 vs. 3.8%, p < 0.01) were lower in the radical surgery group. Recurrence rate was 1.85% after radical surgery versus 11.9% in the conservative surgery group (p < 0.0001). CONCLUSION: radical surgery is associated with lower morbidity, mortality, postoperative hospital stay, and recurrence rates, and represents the treatment of choice for hepatic hydatidosis. However, its indication must depend on the patient characteristics, cyst anatomy, and surgical team experience.

Hidatidosis hepática. Cirugía radical vs. no radical: 22 años de experiencia / No disponible

Introducción: la incidencia de la hidatidosis hepática ha disminuidonotablemente en los últimos años gracias a las medidasde prevención adoptadas para interrumpir la transmisión del parásito.Con todo, la cirugía continúa siendo el tratamiento de elección,si bien su modalidad es todavía motivo de controversia.Objetivos: el objetivo de este trabajo es evaluar los resultadosobtenidos en el tratamiento de esta patología a lo largo de más dedos décadas, atendiendo a la modalidad quirúrgica empleada yafuese cirugía radical o no radical.Material y métodos: se analizaron un total de 372 pacientesintervenidos por quiste hepático hidatídico (QHH) entre 1983-2005 en el Hospital Ramón y Cajal. En162 se efectúa una cirugíaradical (43,5%) y en 210 una no radical (56,5%).Resultados: tanto la estancia media hospitalaria (8,65 días vs.14,9 días) como la morbilidad (13,3 vs. 31,4 %, p < 0,001) y lamortalidad (0 vs. 3,8%, p < 0,01) fueron menores en el grupo decirugía radical. La tasa de recidiva fue del 1,85% tras un abordajeradical frente al 11,9% en los abordajes no radicales (p < 0,0001).Conclusión: la cirugía radical se asocia con una menor morbimortalidad,menor estancia hospitalaria y menor recidiva, constituyendola técnica de elección en la hidatidosis hepática. Sin embargo,su aplicación debe atenerse a las características delpaciente, la anatomía del quiste y el grado de experiencia del equipoquirúrgico

Objectives: the incidence of hepatic hydatidosis has remarkablydecreased in the last years due to the preventive measuresadopted to stop the transmission of the parasite. However, surgerycarries on being the treatment of choice, although the surgical procedureis still a matter of controversy. The aim of the study was toevaluate the results obtained with the treatment of this conditionafter two decades according to surgical procedure type.Material and methods: from 1983 to 2005, 372 patientswere operated on for hepatic hydatidic cyst in Hospital Ramón yCajal. Radical surgery was performed for 162 (43.5%) and conservativesurgery for 210 (56.5%).Results: average postoperative hospital stay (8.65 vs. 14.9days), morbidity (13.3 vs. 31.4%, p < 0.001), and mortality (0 vs.3.8%, p < 0.01) were lower in the radical surgery group. Recurrencerate was 1.85% after radical surgery versus 11.9% in theconservative surgery group (p < 0.0001).Conclusion: radical surgery is associated with lower morbidity,mortality, postoperative hospital stay, and recurrence rates,and represents the treatment of choice for hepatic hydatidosis.However, its indication must depend on the patient characteristics,cyst anatomy, and surgical team experience

[Renal cell carcinoma with liver extension: a report of a new case and literature review]. / Tumor renal con invasión hepática: aportación de un nuevo caso y revisión de la literatura.

Locally advanced renal cell carcinoma (RCC) with involvement to adjacent organs is uncommon and the prognosis is poor. Radical surgery remains the only effective treatment. We report the case of a woman with RCC and direct liver extension who was surgically treated. A literature review is made.

Tumor renal con invasión hepática: aportación de un nuevo caso y revisión de la literatura / Renal cell carcinoma with liver extension: a report of a new case and literature review

El carcinoma de células renales (CCR) con invasión directa de órganos adyacentes es un hallazgo infrecuente y de mal pronóstico en el que el único tratamiento potencialmente efectivo es la cirugía radical. Se presenta el caso de una mujer con gran masa renal y afectación hepática y diafragmática sometida a tratamiento quirúrgico, y se realiza revisión de la literatura

Locally advanced renal cell carcinoma (RCC) with involvement to adjacent organs is uncommon and the prognosis is poor. Radical surgery remains the only effective treatment. We report the case of a woman with RCC and direct liver extension who was surgically treated. A literature review is made

Donor age as a risk factor for patient survival in the liver transplant.

OBJECTIVES: Our aims were to establish whether there is a relationship between donor age and patient and graft survival among liver transplant recipients and to determine the age at which this relationship emerges. PATIENTS AND METHODS: We reviewed 254 consecutive liver transplants performed at the Hospital Ramón y Cajal, Madrid in 206 patients over a 79-month period. Survival rates were determined using Kaplan-Meier curves analyzed by the log-rank method. RESULTS: The mean donors age was 42.08+/-17.89 years (range 8-79 years). The minimum and mean patient follow-up times were 6 months and 29.48+/-23.37 months. Mean patient and graft survival rates, along with their standard errors and 95% confidence intervals were 62.47+/-2.42(57.72-67.21) and 57.30+/-2.40(52.59-62.01) months, respectively. Mean survival was lower (P=.047) among patients who received a graft from a donor of 30 or more years (58.24+/-3.05[52.28-64.21] months) versus from a younger donor (66.19+/-3.55[59.23-73.15] months). Graft survival was also significantly different (P=.037) for donors older versus younger than 25 years (53.04+/-2.83[47.50-58.58] and 64.72+/-4.11[56.67-72.77] months, respectively). CONCLUSIONS: Patients undergoing liver transplant show lower survival when the donor is older than 30 and the survival of the implanted graft is also lower when the donor is over 25.

Impact of donor, recipient, and graft features on the development of primary dysfunction in liver transplants.

OBJECTIVES: To establish the utility of eight anatomic/pathologic suboptimal and 9 others graft features, versus in 20 donor versus 14 recipient characteristics to predict primary transplant dysfunction. PATIENTS AND METHODS: We reviewed 248 consecutive liver transplants performed at the Hospital Ramón y Cajal, Madrid, in 206 patients over a 79-month period. At least one biopsy specimen was obtained from 169 grafts (68.1%). Recipients were classified as showing primary function or dysfunction, the latter group being subdivided into primary failure and inadequate initial function. The primary function and inadequate initial function groups were defined in terms of transaminases less or more than 2000 IU and prothrombin activity over or under 50%, respectively during posttransplant days 2 to 7. RESULTS: The following graft-related rates were recorded: arteriopathy 6.5%, steatosis 29.4% (macrovesicular 26.4%, microvesicular 4.7%, or both 1.7%), hepatocyte vacuolization 14.2%, sinusoidal ectasia 12.4%, hepatocellular necrosis 44.7%, and neutrophilic infiltration 24.4%. The only significant factors in the multivariate analysis were cause of donor death other than cranioencephalic trauma (P=.032) and moderate steatosis (30%-60% affected hepatocytes); (P=.012). CONCLUSIONS: The only factors that seem to influence the development of primary liver dysfunction were a moderate degree of graft steatosis and a cause of brain death other than cranioencephalic trauma.

Survival and complication rates in liver transplant patients showing primary dysfunction versus normofunction.

AIMS: To determine rates of vascular and biliary duct complications, acute rejection, and graft and patient survival according to function status following liver transplantation. METHODS: We classified 248 consecutive liver transplants performed at the Hospital Ramón y Cajal, Madrid, over a 79-month period according to initial function as primary function (NP) versus dysfunction (PD). The latter group was subdivided into grafts showing primary failure (PF) or inadequate function (IPF). The classes NP and IPF were distinguished according to whether transaminase (GOT or GPT) levels and prothrombin activity were above or below 2000 IU and 50%, respectively. RESULTS: There were 23 (9.3%) patients with PD, of whom 12 (4.8%) showed PF. The incidence of vascular and biliary duct complications was similar in both groups, although acute rejection showed a significant difference (PD 3/23 versus NP 98/225; odds ratio =.18). In contrast, the mean survival rates of the grafts (NP 60.37 versus IPF 39.90 months) or patients (NP 63.02 versus PD 47.10 months) were not significantly different. Only 1- and 3-month graft survival rates significantly differed between the NP and IPF groups (NP 95% versus IPF 63%; P=.03 and NP 89% versus IPF 58%; P=.02, respectively). CONCLUSIONS: Recipients with PD or NP after liver transplant showed no differences in the incidence of vascular or biliary duct complications. These groups did vary, however, in terms of rates of acute rejection episodes. No differences in graft and patient survival rates were observed except a significantly lower graft survival at 1 and 3 months, among patients with inadequate primary function.

Influence of ischemia and surgery times on development of primary dysfunction liver transplant in patients.

OBJECTIVE: (1) To determine the incidences of primary failure and primary dysfunction of liver transplants performed at our center. (2) To evaluate the effects of mean cold and warm ischemia times as well as the length of five stages of surgery on the development of primary dysfunction. PATIENTS AND METHODS: We reviewed 248 liver transplants consecutively performed in 206 patients at the Hospital Ramón y Cajal, Madrid over 79 months. Six cases were excluded because the patients died within 24 hours of transplant, it was therefore not possible to establish the postoperative liver function. Recipients were classified according to their posttransplant liver function as showing normal primary function (NP) or primary dysfunction (PD), which included patients with primary failure (PF) and inadequate primary function (IPF). The NP and IPF groups were defined in terms of transaminase levels and prothrombin activity from posttransplant days 2 to 7. The following factors were analyzed: graft cold (CIT) and warm (WIT) ischemia times; graft arterial (AIT) and venous (VIT) ischemia times; and times of surgery (ST), arterial anastomosis (AAT), and anhepatic phase (APT). RESULTS: Twenty-three (9.3%) patients were classified as showing PD, 12 (4.8%) of whom suffered an episode of PF. The mean values (and standard deviations) of the times (in minutes) were ST = 308.19 +/- 109.78; CIT = 411.08 +/- 140.62; WIT = 46.51 +/- 37.70; AIT = 510.95 +/- 165.95; VIT = 458.68 +/- 151.98; AAT = 54.12 +/- 31.84; and APT = 58.53 +/- 90.07. No significant differences were detected in the mean times of patients showing NP or PD. Neither were any differences observed between the two patient groups according to the variables CIT longer than 10 hours and WIT longer than 60 minutes. CONCLUSIONS: Our times of surgery and cold ischemia are shorter than those reported by other transplant teams, mostly North American surgeons who quote figures of around 7 and 12 hours, respectively. These relatively low values may account for the lack of effect shown by the times of ischemia or surgery stages on the appearance of primary dysfunction in patients undergoing liver transplant.

Hematoma subcapsular hepático sintomático tras litotricia renal extracorpórea mediante ondas de choque / Symptomatic hepatic subcapsular hematoma following extracorporeal real shock wave lithotripsy

La presentación de un hematoma subcapsular hepático como complicación tras la realización de litotricia renal extracorpórea mediante ondas de choque es bastante infrecuente. Describimos el caso de un enfermo que presentó sintomatología abdominal intensa post-litotricia renal extracorpórea y en el que se descartó la presencia de patología hepática previa, alteraciones en el sistema de coagulación sanguínea así como anomalías en la ejecución de la litotricia extracorpórea como mecanismos etiológicos. Realizamos una revisión bibliográfica debido a la rareza del proceso descrito (AU)

[Symptomatic subcapsular hepatic hematoma after renal extracorporeal shock wave lithotripsy]. / Hematoma subcapsular hepático sintomático tras litotricia renal extracorpórea mediante ondas de choque.

The presentation of a hepatic subcapsular hematoma as a complication following the carrying out of an extracorporeal renal shock wave lithotripsy is fairly uncommon. We would like to describe the case of a patient who showed after extracorporeal renal post-lithotripsy intense abdominal symptoms and in which the presence of any prior hepatic pathology was ruled out, alterations in the blood coagulation system as well as anomalies in the execution of the extracorporeal lithotripsy as etiological mechanisms. We carried out a bibliographical review due to the rarity of the process described.

Cirugía mínimamente invasiva radiodirigida en el hiperparatiroidismo primario. resultados preliminares / Radioguided minimally invasive surgery in primary hyperparathyroidism. Preliminary results

Introducción. La mayoría de los cirujanos endocrinos utilizan una exploración cervical bilateral en los pacientes con hiperparatiroidismo primario, debido a la falta de un método preciso de localización preoperatoria. La experiencia reciente con los modernos radiotrazadores, junto con la detección intraoperatoria de un mapa nuclear y la determinación de hormona paratiroidea intacta (PTHi) durante la operación, nos ha permitido realizar una cirugía de mínimo acceso en los pacientes con sospecha de un adenoma único. Pacientes y métodos. En 6 pacientes consecutivas con diagnóstico de hiperparatiroidismo primario realizamos un estudio gammagráfico con tecnecio -99m sestamibi, a las 3 h se realizó un mapa nuclear intraoperatorio con sonda gamma detectora de 10 mm; en el punto de máxima emisión se realizó una incisión de 2-3 cm. Ex vivo se midió la radiactividad de la glándula extirpada y del lecho de resección. En todas se realizó determinación de la PTHi antes y durante la cirugía. Las muestras fueron estudiadas por cortes en congelación. Resultados. En las 6 pacientes fue posible localizar el adenoma a través de una pequeña incisión, aunque en un caso era doble y fue necesario realizar cervicotomía bilateral. La extirpación produjo una disminución de la radiactividad residual y un descenso de los valores de PTHi, a los 30 min, mayor del 75 por ciento respecto de los valores basales. La medición ex vivo determinó la mayor emisión de los adenomas. El diagnóstico anatomopatológico fue de adenoma único de paratiroides, excepto en una paciente con adenoma doble. Las pacientes fueron dadas de alta al día siguiente de la operación. Conclusiones. La localización preoperatoria, junto con el mapa nuclear intraoperatorio y la medición de PTHi intraoperatoria, nos permite realizar un abordaje cervical unilateral mínimamente invasivo en pacientes seleccionados con sospecha de adenoma único de paratiroides (AU)