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Surgical portosystemic shunts to facilitate major intrabdominal surgery

Hepatobiliary & Pancreatic Diseases International 2019年第5期18卷 488-490页

作者： Michail Pizanias Elissaios Kontis Evangelos Prassas Parthi Srinivasan andreas prachalias Department of Liver Transplantation Hepatobiliary Pancreatic Surgery King’s Healthcare Partners King’s College Hospital NHS FT Institute of Liver Studies

The effective management of patients with chronic liver disease (CLD) and portal hypertension (PHT) has significantly prolonged their survival. Hence, there is an emerging number of patients who will require major ele... 详细信息

关键词： chronic liver disease(CLD) portal hypertension(PHT) patients

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Pancreaticoduodenectomy with radical lymphadenectomy is not contraindicated for patients with established chronic liver disease and portal hypertension

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Hepatobiliary & Pancreatic Diseases International 2008年第1期7卷 82-85页

作者： Harsheet Sethi Parthi Srinivasan Gabriele Marangoni andreas prachalias Mohamed Rela Nigel Heaton Institute of Liver Studies Kings College London School of Medicine at Kings College HospitalDenmark HillLondon SE5 9RSUK

BACKGROUND: hronic liver disease has been considered a contraindication to radical surgery for intra-abdominal tumors because of the risk of decompensation. METHODS: In a retrospective analysis of all patients undergoing pancreaticoduodenectomy for cancer treated from January 2000 to December 2006 at our center, 4 patients were identified with operable pancreatic tumors and well-compensated chronic liver disease. The preoperative staging, decompression of the biliary tree, liver biopsy, Child-Turcot-Pugh and MELD scores were ***: All patients underwent pancreaticoduodenectomy successfully with minimal blood loss, and no peri-operative blood transfusions or liver decompensation. There was no postoperative mortality. Two patients received adjuvant chemotherapy. One patient died with recurrent disease at 18 months, one is alive with disease recurrence, and two are alive and disease ***: Patients with pancreatic cancer and well-compensated chronic liver disease should routinely be considered for radical surgery at specialist hepatobiliary centres with expertise available to manage complex liver disease.

关键词： pancreaticoduodenectomy Whipple's cirrhosis chronic liver disease portal hypertension

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Selective embolization for bleeding visceral artery pseudoaneurysms in patients with pancreatitis

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Hepatobiliary & Pancreatic Diseases International 2010年第6期9卷 634-638页

作者： Harsheet Sethi Praveen Peddu andreas prachalias Pauline Kane John Karani Mohamed Rela Nigel Heaton Department of Hepatobiliary Surgery Institute ofLiver Studies Kings College London School of Medicine at Kings College Hospital Department of Hepatobiliaryand Interventional Radiology Institute ofLiver StudiesKings College London School of Medicine at Kings College Hospital

BACKGROUND:Pancreatitis is associated with arterial complications in 4%-10%of patients,with untreated mortality approaching 90%.Timely intervention at a specialist center can reduce the mortality to 15%.We present a single institution experience of selective embolization as first line management of bleeding pseudoaneurysms in pancreatitis. METHODS:Sixteen patients with pancreatitis and visceral artery pseudoaneurysms were identified from searches of the records of interventional angiography from January 2000 to June *** visceral artery aneurysms and pseudoaneurysms arising as a result of post-operative pancreatic or biliary leak were excluded from the study. RESULTS:In 50%of the patients,bleeding complicated the initial presentation of *** was the offending agent in 10 patients,gallstones in 3,trauma,drug-induced and idiopathic pancreatitis in one *** 16 patients had a contrast CT scan and 15 underwent coeliac axis angiography. The pseudoaneurysms ranging from 0.9 to 9.0 cm affected the splenic artery in 7 patients:hepatic in 3,gastroduodenal and right gastric in 2 each,and left gastric and pancreatico-duodenal in 1 *** patient developed spontaneous thrombosis of the *** patients had effective coil embolization of the *** patient needed surgical exclusion of the pseudoaneurysm following difficulty in accessing the coeliac axis *** were no episodes of re-bleeding and no in-hospital mortality. CONCLUSIONS:Pseudoaneurysms are unrelated to the severity of pancreatitis and major hemorrhage can occur irrespective of their ***-existent portal hypertension and sepsis increase the risk of *** and selective coil embolization is a safe and effective way to arrest the hemorrhage.

关键词： pseudoaneurysm embolization acute pancreatitis chronic pancreatitis vascular complications

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Developing a donation after cardiac death risk index for adult and pediatric liver transplantation

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World Journal of Transplantation 2017年第3期7卷 203-212页

作者： Shirin Elizabeth Khorsandi Emmanouil Giorgakis Hector Vilca-Melendez John O'Grady Michael Heneghan Varuna Aluvihare Abid Suddle Kosh Agarwal Krishna Menon andreas prachalias Parthi Srinivasan Mohamed Rela Wayel Jassem Nigel Heaton Institute of Liver Studies King’s College Hospital

AIM To identify objective predictive factors for donor after cardiac death(DCD) graft loss and using those factors, develop a donor recipient stratification risk predictive model that could be used to calculate a DCD risk index(DCD-RI) to help in prospective decision making on organ *** The model included objective data from a single institute DCD database(2005-2013, n = 261). Univariate survival analysis was followed by adjusted Cox-regressional hazard model. Covariates selected via univariate regression were added to the model via forward selection, significance level P = 0.3. The warm ischemic threshold was clinically set at 30 min. Points were given to each predictor in proportion to their hazard ratio. Using this model, the DCD-RI was calculated. The cohort was stratified to predict graft loss risk and respective graft survival *** DCD graft survival predictors were primary indication for transplant(P = 0.066), retransplantation(P = 0.176), MELD > 25(P = 0.05), cold ischemia > 10 h(P = 0.292) and donor hepatectomy time > 60 min(P = 0.028).According to the calculated DCD-RI score three risk classes could be defined of low(DCD-RI 5) with a 5 years graft survival of 86%, 78% and 34%, *** The DCD-RI score independently predicted graft loss(P < 0.001) and the DCD-RI class predicted graft survival(P < 0.001).

关键词： Liver transplant Donor after cardiac death Pediatric Adult Survival

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