ABSTRACT
Acute-on-chronic liver failure (ACLF) is a fatal condition, and liver transplantation (LT) is a vital option for these patients. However, the result of living donor LT (LDLT) for ACLF is not well investigated. This study investigated the outcomes of LDLT in patients with ACLF compared with patients without ACLF. This was a single-center, retrospective, matched case-control study. From July 2002 to March 2017, a total of 112 patients with ACLF who underwent LDLT were enrolled according to the consensus of the Asian Pacific Association for the Study of the Liver. A total of 224 patients were selected for control comparison (non-ACLF) with demographic factors (sex, age, and body mass index) matched (1:2). Patients with ACLF were stratified into ACLF 1, 2, and 3 categories according to the number of organ failures based on the Chronic Liver Failure-Sequential Organ Failure Assessment score. Survival and surgical outcomes after LDLT were analyzed. The Model for End-Stage Liver Disease and Child-Turcotte-Pugh scores in the ACLF group were significantly higher than those in the non-ACLF group (P < 0.001). The 90-day, 3-year, and 5-year survival rates in the ACLF and non-ACLF groups were 97.3%, 95.5%, 92.9%, respectively, and 96.9%, 94.2%, and 91.1%, respectively (P = 0.58). There was more intraoperative blood loss in the ACLF group than in the non-ACLF group (P < 0.001). The other postoperative complications were not significantly different between the groups. A total of 20 patients (17.9%) in the ACLF group presented with 3 or more organ system dysfunctions (ACLF 3), and the 90-day, 3-year, and 5-year survival rates were comparable with those of ACLF 1 and ACLF 2 (P = 0.25). In carefully selected patients, LDLT gives excellent outcomes in patients with ACLF regardless of the number of organs involved. Comprehensive perioperative care and timely transplantation play crucial roles in saving the lives of patients with ACLF.
Subject(s)
Acute-On-Chronic Liver Failure , End Stage Liver Disease , Liver Transplantation , Acute-On-Chronic Liver Failure/diagnosis , Acute-On-Chronic Liver Failure/surgery , Case-Control Studies , End Stage Liver Disease/complications , End Stage Liver Disease/diagnosis , End Stage Liver Disease/surgery , Humans , Liver Transplantation/adverse effects , Living Donors , Retrospective Studies , Severity of Illness IndexABSTRACT
BACKGROUND: Bile duct complications hamper patient recovery from a transplant, curtail patient quality of life, and may impair the function and persistent survival of the allograft. The aim of this study is to compare the results of biliary reconstruction using 6-0 polypropylene and 6-0 polydioxanone. METHODS: A single-center retrospective study was performed on 133 patients who underwent microsurgical biliary reconstruction during living donor liver transplantation between November 2014 and December 2015. 6-0 polypropylene (Prolene) and 6-0 polydioxanone suture (PDS) were used for biliary reconstruction in 80 and 53 cases, respectively. The factors of age, sex, disease, and comorbidity were evenly distributed in these 2 groups. The average follow-up time was 43 months (36-50 months). There were 49 right lobe grafts and 31 left lobe grafts in the polypropylene group and 27 right lobe grafts, 25 left lobe grafts, and 1 left lateral segment in the polydioxanone group. RESULTS: The overall biliary complication rate was 11.25% in the polypropylene group. The overall biliary complication rate was 11.32% in the polydioxanone group. All biliary complications were managed successfully, and no mortality was observed. There was no statistically significant difference between complication rates with the use of different suture material (P = .990). CONCLUSION: The theoretical advantages of polydioxanone over polypropylene in biliary reconstruction could not be explained with this study.
Subject(s)
Bile Ducts/surgery , Liver Transplantation/methods , Plastic Surgery Procedures/methods , Sutures , Adult , Female , Humans , Living Donors , Male , Middle Aged , Polydioxanone , Polypropylenes , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective StudiesABSTRACT
OBJECTIVE: To compare the length of hospital stay and return of bowel movement using the conventional management versus 'enhanced recovery after surgery' protocol. METHODS: This study was conducted at the Civil Hospital, Karachi, from June 2014 to May 2015, and comprised patients undergoing stoma reversal. Patients were randomly allocated in two equal groups, i.e. A (treated with conventional peri-operative management) and B (with 'enhanced recovery after surgery' protocol). Prolonged ileus, wound infection and length of hospital stay between the two groups were compared. SPSS 20 was used for statistical analysis. RESULTS: There were 60 participants who were divided into two groups of 30(50%) each. Overall, 39(65%) patients were males and 21(35%) were females. The mean age was 27.80±9.99 years in group A and 23.87±4.56 years in group B. Besides, 25(83%) patients in group A had prolonged ileus compared to 3(10.7%) in group B (p=0.00). Moreover, 14(46.7%) patients in group A and 8(26.7%) patients in group B had wound infection (p=0.10). The mean duration of hospital stay was also less in group B compared to group A (p<0.05). CONCLUSIONS: The application of 'enhanced recovery after surgery' protocol was found to be safe.
