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Machine perfusion and the prevention of ischemic type biliary lesions following liver transplant:What is the evidence?

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World Journal of Gastroenterology 2023年第20期29卷 3066-3083页

作者： Manuel Durán Rafael Calleja Angus Hann George Clarke Ruben Ciria anisa nutu Rebeca Sanabria-Mateos María Dolores Ayllón Pedro López-Cillero Hynek Mergental Javier Briceño M Thamara P R Perera Department of Liver Transplantation Reina Sofía University HospitalCórdoba 14004Spain The Liver Unit Queen Elizabeth Hospital BirminghamBirmingham B152THUnited Kingdom Centre for Liver and Gastrointestinal Research Institute of Immunology and ImmunotherapyUniversity of BirminghamBirmingham B152THUnited Kingdom

The widespread uptake of different machine perfusion(MP)strategies for liver transplant has been driven by an effort to minimize graft injury.Damage to the cholangiocytes during the liver donation,preservation,or early posttransplant period may result in stricturing of the biliary tree and inadequate biliary drainage.This problem continues to trouble clinicians,and may have catastrophic consequences for the graft and patient.Ischemic injury,as a result of compromised hepatic artery flow,is a well-known cause of biliary strictures,sepsis,and graft failure.However,very similar lesions can appear with a patent hepatic artery and these are known as ischemic type biliary lesions(ITBL)that are attributed to microcirculatory dysfunction rather than main hepatic arterial compromise.Both the warm and cold ischemic period duration appear to influence the onset of ITBL.All of the commonly used MP techniques deliver oxygen to the graft cells,and therefore may minimize the cholangiocyte injury and subsequently reduce the incidence of ITBL.As clinical experience and published evidence grows for these modalities,the impact they have on ITBL rates is important to consider.In this review,the evidence for the three commonly used MP strategies(abdominal normothermic regional perfusion[A-NRP],hypothermic oxygenated perfusion[HOPE],and normothermic machine perfusion[NMP])for ITBL prevention has been critically reviewed.Inconsistencies with ITBL definitions used in trials,coupled with variations in techniques of MP,make interpretation challenging.Overall,the evidence suggests that both HOPE and A-NRP prevent ITBL in donated after circulatory death grafts compared to cold storage.The evidence for ITBL prevention in donor after brain death grafts with any MP technique is weak.

关键词： Liver transplant Ischemic type biliary lesions Hypothermic oxygenated machine perfusion Normothermic machine perfusion Abdominal normothermic regional perfusion Donation after circulatory death

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Technical tailoring of pancreaticoduodenectomy in patients with hepatic artery anatomic variants

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Hepatobiliary & Pancreatic Diseases International 2011年第6期10卷 638-643页

作者： Cristian Lupascu Dan Andronic Corina Ursulescu Ciprian Vasiluta nutu Vlad First Surgical Unit "Gr.T.Popa" University of Medicine and Pharmacy Iasi "St.Spiridon" HospitalIndependentei Bld.1700111 IasiRomania Imaging Department "Gr.T.Popa" University of Medicine and Pharmacy Iasi"St.Spiridon" HospitalIndependentei Bld.1700111 IasiRomania Imaging Department "Gr.T.Popa" University of Medicine and Pharmacy Iasi "St.Spiridon" HospitalIndependentei Bld.1700111 IasiRomania

BACKGROUND:Pancreaticoduodenectomy is the treatment of choice for periampullary and pancreatic head tumors.In case of hepatic artery abnormalities,early pancreatic transection during pancreaticoduodenectomy may prove inappropriate Early retroportal lamina dissection improves exposure of the superior mesenteric vessels and anatomic variants of the hepatic artery,where safeguarding is mandatory.METHOD:We describe our early retroportal lamina approach in patients with anatomic variants of the hepatic artery before pancreatic transection.RESULTS:This approach was used during 42 pancreatico duodenectomies with a hepatic artery anatomic variant which was spared in 40 patients.Arterial reconstruction was performed in 2 patients.Five patients with a hepatic artery variant and adenocarcinoma involving the portomesenteric junction required venous resection and reconstruction.CONCLUSIONS:Early retroportal lamina dissection during pancreaticoduodenectomy in patients with hepatic artery anatomic variants enables easier exposure,avoiding injuries that might compromise the liver arterial supply.When the portomesenteric vein is involved,this approach facilitates en bloc 'no touch' venous resection and reconstruction.

关键词： pancreaticoduodenectomy hepatic artery anatomic variants

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Ulcerated intussuscepted jejunal lipoma-uncommon cause of obscure gastrointestinal bleeding: A case report

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World Journal of Clinical Cases 2019年第22期7卷 3765-3771页

作者： Tudor Cuciureanu Laura Huiban Stefan Chiriac Ana-Maria Singeap Mihai Danciu Florin Mihai Carol Stanciu Anca Trifan nutu Vlad Department of Gastroenterology “Grigore T.Popa”University of Medicine and Pharmacy“St.Spiridon”Emergency HospitalIasi 700115Romania Department of Pathology “Grigore T.Popa”University of Medicine and Pharmacy“St.Spiridon”Emergency HospitalIasi 700115Romania Department of Radiology “Grigore T.Popa”University of Medicine and Pharmacy“St.Spiridon”Emergency HospitalIasi 700115Romania Department of General Surgery “Grigore T.Popa”University of Medicine and Pharmacy“St.Spiridon”Emergency HospitalIasi 700115Romania

BACKGROUND Intestinal lipomas are rare benign gastrointestinal(GI)tumors,usually asymptomatic,but may become symptomatic as the result of some complications such as intussusception,intestinal obstruction,volvulus or bleeding.They can occur at any site along the entire GI tract,more frequent in colon and rarely in small intestine.The patient reported here is a very rare case of jejunal lipoma,ulcerated and intussuscepted,diagnosed in an adult investigated for a chronic iron deficiency anemia(IDA),and successfully managed by segmental jejunal resection.CASE SUMMARY A 63-year-old male was referred to“St.Spiridon”Hospital,Institute of Gastroenterology and Hepatology,Iasi,to investigate an obscure GI bleeding with an IDA.After upper GI endoscopy and colonoscopy were performed,excluding potentially bleeding lesions,videocapsule endoscopy was then carried out,revealing fresh blood and a protruding lesion in proximal jejunum,findings confirmed by a single-balloon enteroscopy.Multiple biopsies were taken from the lesion,but histological results were inconclusive.Then,contrast-enhanced computed tomography was performed showing jejunal polypoid mass with homogenous fat density,suggestive for lipoma.A week later a laparotomy was performed revealing the intussuscepted jejunal segment which was resected enbloc,and sent for further histopathologic analysis.The patient made an uneventful recovery and was discharged seven days later,and at six months follow-up he had no complains and his hemoglobin returned to normal value.CONCLUSION Lipomas are very rarely located in the jejunum,usually asymptomatic,but they may lead to complications such as intussusception and bleeding.Surgical resection remains the treatment of choice.

关键词： Lipoma Intussusception Computed tomography Video capsule endoscopy Gastrointestinal bleeding Case report

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