Living donor liver transplantation: early single-center experience.

Adult living donor liver transplantation (ALDLT) is an accepted procedure to overcome the organ shortage. The advantages of ALDLT must be balanced against the first concern of donor safety. We analyzed the results of our early experience among a series of eight ALDLT performed between April 2001 and October 2003. All patients were listed as United Network for Organ Sharing UNOS status 2b and 3. Transplant recipients consisted of four men and four women. The living donors included four sons, three daughters, and one son-in-law (ages 20 to 45 years). One donor was anti-HBc-positive and negative for hepatitis B virus-DNA by polymerase chain reaction analysis in serum and in liver tissue. GR/WR >0.8 and fatty liver <10% were considered suitable for the hepatectomy. Residual left lobe volume was at least 33%. No exogenous blood and blood products were transfused into the donors and a cell-saver device was used in all donors (blood loss 490 +/- 160 mL). All procedures were right lobe hepatectomy; in one case the middle hepatic vein was withdrawn with the right graft. The mean ischemia time was 1.5 +/- 0.5 hours. All donors survived the procedure. Median hospital stay was 8.5 +/- 2.1 days in all donors but one who had a long stay because of drug-related hepatitis. One graft was lost and one donor aborted because of preoperative overestimated volumetry. Complications were experienced by two donors (25%). Five recipients (62.5%) experienced major complications; one patient underwent retransplantation because of donor graft loss. Two biliary and two vascular complications (33.3%) occurred in three patients. No perioperative death occurred. Two patients died at 9 and 10 months after transplant because of heart and respiratory failure in the first case and tumor recurrence in the second. One-year actuarial survival is 75%. ALDLT using right lobe has gained acceptance to overcome the organ shortage. Donor selection criteria must be stringent with respect to residual donor hepatic volume, steatosis, and liver function.

[Hepatic splenosis diagnosed by fine-needle cytology]. / Splenosi epatica diagnosticata con citologia con ago sottile.

A case of hepatic splenosis, diagnosed by FNA cytology, in a 56 years old cirrhotic man is reported. The cytologic material, aspirated from a 4.8 cm "suspicious for hepatocarcinoma" nodule, showed, within a hematic background, small-medium sized lymphoid cells, neutrophils and eosinophils granulocytes, histiocytes with large cytoplasm, plasma cells; mixtures of these cells, within a reticular network, were often aggregated in large structures, in which endothelial cells organized in vascular-like structures were also visible. The cell block, showed sinusoidal structures, lymphoid follicular aggregates and fibrous septa, strongly suggesting the micromorphology of the normal spleen. Splenosis is an autotransplant of splenic tissue, morphologically organized in non-capsulated, functioning, self-limited nodules, secondary to a post-traumatic splenectomy. Usual presentation of this condition is the presence of several bluish nodules on the peritoneal surface. Nevertheless, sporadic cases in other organs have been reported. To the best of our review of the Medical Literature, a hepatic splenosis is an exceptional even and the present is the first case in this location diagnosed by FNA cytology. The present one is also the case with the largest latency between the splenectomy and the splenosis detection (43 years).