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Current status and perspectives in split liver transplantation

World Journal of Gastroenterology 2015年第39期21卷 11003-11015页

作者： Andrea Lauterio Stefano Di Sandro Giacomo Concone Riccardo De Carlis alessandro giacomoni Luciano De Carlis Transplant Center Department of General Surgery and Abdominal Transplantation Niguarda Cà Granda Hospital Department of General Surgery University of Pavia Medical School

Growing experience with the liver splitting technique and favorable results equivalent to those of whole liver transplant have led to wider application of split liver transplantation(SLT) for adult and pediatric recipients in the last decade. Conversely, SLT for two adult recipients remains a challenging surgical procedure and outcomes have yet to improve. Differences in organ shortages together with religious and ethical issues related to cadaveric organ donation have had an impact on the worldwide distribution of SLT. Despite technical refinements and a better understanding of the complex liver anatomy, SLT remains a technically and logistically demanding surgical procedure. This article reviews the surgical and clinical advances in this field of liver transplantation focusing on the role of SLT and the issues that may lead a further expansion of this complex surgical procedure.

关键词： Liver transplantation Split liver Segmental liver

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Major liver resections,perioperative issues and posthepatectomy liver failure:A comprehensive update for the anesthesiologist

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World Journal of Critical Care Medicine 2024年第2期13卷 49-71页

作者： Andrea De Gasperi Laura Petrò Ombretta Amici Ilenia Scaffidi Pietro Molinari Caterina Barbaglio Eva Cibelli Beatrice Penzo Elena Roselli Andrea Brunetti Maxim Neganov alessandro giacomoni Paolo Aseni Elena Guffanti Former Head Anesthesia and Critical Care Service 2Grande Ospedale Metropolitano Niguarda ASST GOM NiguardaMilan 20163Italy AR1 Ospedale Papa Giovanni 23Bergamo 24100Italy Anesthesia and Critical Care Service 2 Grande Ospedale Metropolitano Niguarda AR2ASST GOM NiguardaMilan 20163Italy Anestesia e Terapia Intensiva Generale Istituto Clinico HumanitasRozzano 20089Italy Chirurgia Oncologica Miniinvasiva Grande Ospedale Metropolitano Niguarda ASST GOM NiguardaMilan 20163Italy Dipartimento di Medicina d’Urgenza ed Emergenza Grande Ospedale Metropolitano Niguarda ASST GOM NiguardaMilano 20163MIItaly

Significant advances in surgical techniques and relevant medium-and long-term outcomes over the past two decades have led to a substantial expansion in the indications for major liver *** support these outstanding results and to reduce perioperative complications,anesthesiologists must address and master key perioperative issues(preoperative assessment,proactive intraoperative anesthesia strategies,and implementation of the Enhanced Recovery After Surgery approach).Intensive care unit monitoring immediately following liver surgery remains a subject of active and often unresolved *** postoperative complications,posthepatectomy liver failure(PHLF)occurs in different grades of severity(A-C)and frequency(9%-30%),and it is the main cause of 90-d postoperative ***,recently redefined with pragmatic clinical criteria and perioperative scores,can be predicted,prevented,or *** review highlights:(1)The systemic consequences of surgical manipulations anesthesiologistsmust respond to or prevent,to positively impact PHLF(a proactive approach);and(2)the maximal intensivetreatment of PHLF,including artificial options,mainly based,so far,on Acute Liver Failure treatment(s),to buytime waiting for the recovery of the native liver or,when appropriate and in very selected cases,toward *** a clinical context requires a strong commitment to surgeons,anesthesiologists,and intensivists towork together,for a fruitful collaboration in a mandatory clinical continuum.

关键词： Liver resection Chronic liver disease Preoperative assessment Vascular clamping Intraoperative hemodynamic monitoring Postoperative intensive care unit Posthepatectomy liver failure Artificial liver support

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