Outcomes of Right and Left Hepatic Arterial Anastomosis in Right Lobe Living Donor Liver Transplant.

OBJECTIVES: Living donor liver transplant is a complex surgery with well-known complications. Here, we report the use of the right and left hepatic arteries of the recipient for anastomosis and the effects of each procedure on overall outcomes and any associated short-term or long-term biliary complications. MATERIALS AND METHODS: This was a prospective observational study with long-term follow-up of 200 patients (100 in the right hepatic artery group and 100 in the left hepatic artery group). RESULTS: The average donor age was 28.9 years in the left hepatic artery group and 30.9 years in the right hepatic artery group. Most of the donors (60%) were female. Overall, there was 10.5% mortality in the early postoperative period. Among survivors, there were more late strictures in the right hepatic artery group (29.7% vs 22.7%). Bile leak (P = .42), mortality (P = .71), and incidence of late-onset biliary strictures (P = .83) were less common in the left hepatic artery group. CONCLUSIONS: Left artery anastomosis was found to be technically safe and feasible and did not adversely affect patient outcome compared with right artery anastomosis. Left hepatic artery anastomosis may also reduce the incidence of the biliary complications compared with the right hepatic artery anastomosis.

Cystic duct anastomosis can be a viable option for biliary reconstruction in case of multiple ducts in right lobe living-donor liver transplantation.

BACKGROUNDS/AIMS: Multiple ducts in right lobe living-donor liver transplant (LDLT) pose a technical challenge in biliary reconstruction. In the absence of separate recipient hepatic ducts for duct-to-duct anastomoses and certain demerits of hepaticojejunostomy, duct to duct anastomoses with the recipient cystic duct might be a possible solution. METHODS: A total of 329 recipients of LDLT who underwent two or more separate biliary anastomoses at our centre between January 2014 and November 2019 were studied retrospectively. Records of demographic data, donor and graft characteristics, operative details, postoperative biochemical parameters, and biliary complications were analysed. RESULTS: Of 329 recipients, 236 patients (71.7%) underwent purely duct-to-duct (DD group) anastomoses, 38 patients (11.5%) underwent at least one anastomosis with the cystic duct (CD group), and 55 patients (16.7%) underwent at least one hepaticojejunostomy (HJ group). At one year, biliary complication rates of these three groups were 20.3%, 26.3%, and 20.0%, respectively (p = 0.68). Postoperative intensive care unit and overall hospital stay were similar among the three groups. Grades IIIa, IIIb, IV, and V Clavien-Dindo complications were identical. One-year patient survival and graft survival were also similar among the three groups. CONCLUSIONS: Biliary outcomes using the cystic duct may have acceptable outcomes. Similar postoperative results as other means of biliary reconstruction could be anticipated with the cystic duct anastomoses in case of multiple ducts in the graft.

Protocol to ensure continued pediatric liver transplantation service during the COVID pandemic and the encouraging outcomes.

Coronavirus disease 2019 is a global pandemic, and to deal with the unexpected, enormous burden on healthcare system, liver transplantation (LT) services have been suspended in many centers. Development of robust and successful protocols in preventing the disease among the recipients, donors and healthcare workers would help in re-starting the LT programs. We adapted a protocol at our center, which is predominantly a living donor liver transplant center based in north India, and continued the service as the pandemic unfolded and peaked in India with good results and shared the experience of the same. Between March 24 and June 7, 2020, during the government-enforced public curfew-"lockdown"-7 children received LT. The protocols of infection control were drafted in our team by local customization of published guidelines. The number of pediatric LT done during the lockdown period in 2020 was similar to that done in corresponding pre-COVID period in 2019. The outcomes were of 100% survival, and none of recipients developed COVID. One potential donor was asymptomatic positive for COVID, responded well to conservative treatment, and was later accepted as a donor. LT program during the COVID pandemic can successfully function after putting in place standard protocols for infection control. These can be implemented with minimal extra involvement of healthcare infrastructure, hence without diversion of resources from COVID management. In conclusion, pediatric liver transplantation services can be continued amid COVID-19 pandemic after establishing a properly observed protocol with minimum additional resources.

Living Donor Liver Transplant for Dengue-Related Acute Liver Failure: A Case Report.

Dengue is a common viral infection, especially in tropical countries, and it is a well-known cause of acute liver failure. The effects on the liver range from a mild illness to acute liver failure. Dengue-related acute liver failure has a high mortality rate, and the role of liver transplant in such cases has been less studied, due to the rapid progression and often associated multiorgan dysfunction in severe cases. Here, we report the first living donor liver transplant for an acute liver failure due to dengue. Although liver transplant is not the choice of treatment for sick patients, timely intervention in specific patients may have a role.

Outcome of Pediatric Liver Transplants in Patients With Less Than 10 kg of Body Weight Is Not Worse.

OBJECTIVES: Liver transplant in pediatric patients with body weight < 10 kg poses a challenge to the entire liver transplant team. Many reports have considered 10 kg to be a cutoff pointfor body weightforfavorable posttransplant outcomes. With evolving surgical techniques and postoperative management, there is potential to improve outcomes in this subset of recipients. We compared the outcomes in pediatric patients with body weight < 10 kg with those > 10 kg; also, we studied the factors of influence. MATERIALS AND METHODS: We performed a retrospective analysis to evaluate the outcomes of liver transplants in pediatric patients with < 10 kg body weight. The cohort consisted of 90 children subdivided into the following 2 subgroups: group A (n = 35) with > 10 kg body weight at liver transplant and group B (n = 55) with < 10 kg body weight at liver transplant. We compared the following pretransplant characteristics between the groups: graft weight, graft-to-recipient weightratio, cold ischemia time, warm ischemia times, and liver transplant outcomes. RESULTS: Pediatric End-stage Liver Disease score was significantly higher in group B (score of 24) versus group A (score of 18). Group B had significantly higher graft-to-recipient weight ratio (2.8 in group B vs 1.7 in group A). Graft function showed no significant difference between the 2 groups. Portal vein thrombosis was seen only in group B, whereas biliary leaks were observed among 5 patients in group B and 1 patientin group A. Patient survivalrate was higherin group B (86%) than in group A (77%). CONCLUSIONS: Pediatric patients weighing < 10 kg have similarif not better survivalrates after liver transplant compared with patients > 10 kg. Advancements in surgical techniques and a careful monitoring for complications and timely intervention are important to facilitate these outcomes.

Can cyclo-oxygenase-2 be a useful prognostic and risk stratification marker in breast cancer?

Cyclo-oxygenase-2 (COX-2) is a prostaglandin synthease that catalyses the synthesis of prostaglandin G2 (PGG2) and PGH2 from arachidonic acid. COX-2 plays an important role in tumourigenesis of different carcinoma types and it is thought to take part in breast carcinoma. In this study, the aim was to investigate the relationship of COX-2 with clinical parameters such as menopausal status, tumour size, grade, nodal status, Nottingham prognostic index (NPI), oestrogen receptor(ER), progesterone receptor (PR), human epidermal growth factor receptor type 2 (HER-2/ neu). The patients were divided into two groups, first group (group A) comprised 57 primary breast cancer patients and the second group (group B) comprised control group 27 patients consisting of fibro-adenoma and benign breast disease. In control groups COX-2 (0%) is not over expressed and we observed that high frequency of COX-2 (73.68%) over expressed in breast carcinoma. In high grade, large tumour size and positive lymph node metastasis, COX-2 expression rate was 78.6%, 59.5% and 90.5% respectively. COX-2 expression is directly correlated with ER negative (88.1%, p = 0.001) and also associated with higher NPI value (78.6%, p = 0.006). In invasive ductal carcinoma (IDC) COX-2 over expression had a significant relationship with HER-2/neu over expression (p < 0.001). The results indicated that COX-2 over expression correlates with aggressive phenotypic features, such as high histological grade, large tumour size, higher NPI value, ER negativity and HER-2/neu positivity.