Liver transplantation in patients with hepatocellular carcinoma: a single-center experience.

OBJECTIVES: Liver transplantation has become one of the best treatment options for early hepatocellular carcinoma in cirrhosis. We sought to study the results of liver transplantation in patients with hepatocellular carcinoma and to evaluate the outcome of the patients. MATERIALS AND METHODS: The medical records of 256 recipients who underwent a liver transplantation from April 2001 to January 2010 were reviewed. One hundred seventy-six patients received their livers from deceased donors, and 80 received their livers from living donors. Fifty-two patients underwent liver transplantation for hepatocellular carcinoma. RESULTS: From April 2001 until now, 52 patients (20.3%) underwent liver transplantation for hepatocellular carcinoma. Eighteen patients (34.6%) were performed from living-related donors, and 34 (65.4%) were from deceased donors. The patients were 37 males and 15 females (median, 55 years old; age range, 5 through 68 years). Model for end-stage liver disease score ranged from 6 to 40 with a median of 14. All patients were within the Milan criteria by the preoperative evaluation. Hospital stay ranged from 6 to 338 days with a median 14 days. Operating time ranged from 4 to 15 hours with a median 7.5 hours. Blood transfusion ranged from 0 to 19 units median 5 units. Thirty-four complications occurred in 23 patients (44.2%). Recurrence of hepatocellular carcinoma in 7 patients (13.5%), of which recurrent cholangiocarcinoma was diagnosed in 3 (5.7%), accidentally discovered in the explant. One deceased donor had hepatitis B core antibody positive. One explant showed macrovascular invasion. Sixteen patients died, 7 of 52 (13.5%) from hepatocellular carcinoma recurrence, including the 3 cases of accidental discovery of cholangiocarcinoma (5.7%). CONCLUSIONS: Apart from the common complications that can occur with any transplantation, liver transplantation remains the most-promising solution for patients with hepatocellular carcinoma among the available ones, and represents a cornerstone in managing hepatocellular carcinoma. It is the only acceptable option for complete eradication of both the disease and the predisposing factor.

A ruptured graft hematoma in the second day after deceased donor liver transplantation: a case report and review.

BACKGROUND: Ruptured liver after transplant is a rare complication. It can lead to graft or patient loss. Few reports are available in literature. CASE REPORT: A 58 y old male patient underwent a deceased donor liver transplant due to hepatitis B virus related cirrhosis. The donor was a 38 y old trauma victim. There were no obvious injuries involving the liver during organ recovery but multiple petechiae appeared on the surface of the right lobe after preservative solution infusion. The transplant procedure was uneventful. The patient recovered quickly. On the second day the patient developed severe hypotension and laparotomy showed a deep laceration in the right lobe separating the anterior and posterior sectors. Massive blood transfusion was needed. Homeostasis was extremely dif fi cult and partial right lobe resection needed to control bleeding. The patient recovered and was discharged two weeks after the transplant. CONCLUSIONS: Hematomas secondary to interventional procedures may be treated conservatively but spontaneous hematomas mostly will need surgery. The presence of petechiae on the surface of the graft may indicate a high energy injury and the possibility of intrahepatic hematoma that may rupture after implantation.

Improving organ donation in Central Saudi Arabia.

OBJECTIVE: Organ transplantation is successful. The main challenge in the Kingdom of Saudi Arabia (KSA) and elsewhere continues to be organ shortage. This shortage was not resolved by utilization of living donors. Previous studies indicate that there is underreporting of brain death cases, lack of completion of documentation process, poor medical care in some instances and finally high refusal rate for consent. In order to put this problem in perspective and find a solution, we initiated a collaborative project between 4 hospitals in Riyadh, KSA and The Saudi Center for Organ Transplantation. The initial result of this project is presented in this article. METHODS: A donor team was formed to deal and facilitate the logistical aspect of donation in the 3 main Ministry of Health hospitals in Riyadh. Data with regard to the number of donors reported, documentation and success rate were recorded over 3-months (October 2003 to December 2003) and compared with the preceding 9 months. RESULTS: During the period from January 2003 to September 2003, the total number of case reported to the Saudi Center for Organ Transplantation in Riyadh region, was 94. Only 53% were fully documented. Families were approached in 45 of these 50 cases in terms of donation and consent was obtained in 15. However, the number harvested was only 10 (11% yield from total number reported). During the period from October 2003 until the end of December 2003, the total number of cases reported from 3 hospitals was 19. Seventeen (90%) of them were documented. The families were approached in 16 cases and consent was obtained in 6. All 6 (32%) donors were harvested. CONCLUSION: The above result clearly indicates that a donor team supporting the intensive care unit (ICU) can improve the donation. It is expected that application of a similar project to more ICUs in KSA will have a substantial positive impact on the rate of organ donation.