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Large Riedel’s lobe and atrophic left liver in a donor-Accept for transplant or call off?

World Journal of Transplantation 2020年第5期10卷 129-137页

作者： Yuhki Sakuraoka Rashmi Seth amanda pcs boteon Moira Perrin J Isaac Gowri Subash Paolo Muiesan Andrea Schlegel The Liver Unit Queen Elizabeth University Hospital BirminghamBirmingham B152THUnited Kingdom Second Department of Surgery Dokkyo Medical UniversityTokyo 321-0293Japan NIHR Liver Biomedical Research Unit University Hospitals BirminghamBirmingham B152THUnited Kingdom

BACKGROUND In context of suboptimal liver utilisation,grafts with various risk factors are under consideration *** example,impaired vascularity with severe arterial calcifications and modified liver shapes are no longer contraindications and their use depends on the centre policy and experience of the surgical *** liver lobes represent a tongue-like liver shape with inferior projection in the right liver *** development modifications were initially described when patients developed a lesion and subsequently presented with *** here present the first case report in the literature,where such livers with anatomical variations were used for *** SUMMARY We describe here two cases of adult human liver transplantation,where we have accepted two donor livers with modified *** technical considerations for transplantation of such livers,found with enlarged right lobes,or Riedel shape,and hypo-trophic left lateral segment are *** recipients experienced immediate liver function and overall good outcomes with a minimum follow up of 1 *** also provide detailed pictures and outcome analysis in combination with a literature *** The utilisation of donor livers with modified shape,such as Riedel’s Lobe appears safe and will increase the donor pool.

关键词： Case report Anatomical variations Riedel’s lobe Liver utilization Liver transplantation

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Impact of machine perfusion of the liver on post-transplant biliary complications: A systematic review

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World Journal of Transplantation 2018年第6期8卷 220-231页

作者： Yuri L boteon amanda pcs boteon Joseph Attard Lorraine Wallace Ricky H Bhogal Simon C Afford Liver Unit Queen Elizabeth Hospital University Hospitals Birmingham NHS Foundation Trust Centre for Liver and Gastrointestinal Research Institute of Immunology and Immunotherapy College of Medical and Dental Sciences University of Birmingham National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre University of Birmingham and University Hospitals Birmingham NHS Foundation Trust

AIM To review the clinical impact of machine perfusion(MP) of the liver on biliary complications post-transplantation, particularly ischaemic-type biliary lesions(ITBL). METHODS This systematic review was performed in accordance with the Preferred Reporting Systematic Reviews and MetaAnalysis(PRISMA) protocol. The following databases were searched: PubMed, MEDLINE and Scopus. The keyword "liver transplantation" was used in combination with the free term "machine perfusion". Clinical studies reporting results of transplantation of donor human livers following ex situ or in situ MP were analysed. Details relating to donor characteristics, recipients, technique of MP performed and post-operative biliary complications(ITBL, bile leak and anastomotic strictures) were critically *** Fifteen articles were considered to fit the criteria for this review. Ex situ normothermic MP was used in 6 studies, ex situ hypothermic MP in 5 studies and the other 4 studies investigated in situ normothermic regional perfusion(NRP) and controlled oxygenated rewarming. MP techniques which have per se the potential to alleviate ischaemia-reperfusion injury: Such as hypothermic MP and NRP, have also reported lower rates of ITBL. Other biliary complications, such as biliary leak and anastomotic biliary strictures, are reported with similar incidences with all MP techniques. There is currently less clinical evidence available to support normothermic MP as a mitigator of biliary complications following liver transplantation. On the other hand, restoration of organ to full metabolism during normothermic MP allows assessment of hepatobiliary function before transplantation, although universally accepted criteria have yet to be *** MP of the liver has the potential to have a positive impact on post-transplant biliary complications, specifically ITBL, and expand extended criteria donor livers utilisation.

关键词： Liver transplantation Ex situ machine perfusion of the liver Donation after circulatory death Non-anastomotic intra-hepatic stricture Ischemic-type biliary lesions Extended criteria donors

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