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AFP level and histologic differentiation predict the survival of patients with liver transplantation for hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2012年第3期11卷 256-261页

作者： Onur Yaprak Murat Akyildiz Murat Dayangac baha tolga demirbas Necdet Guler Gulen Bulbul Dogusoy Yildiray Yuzer Yaman Tokat Organ Transplantation Center Sisli Florence Nightingale Hospital

BACKGROUND: In liver transplantation or resection for hepatocellular carcinoma (HCC), patient selection depends on morphological features. In patients with HCC, we performed a clinicopathological analysis of risk factors that affected survival after liver transplantation. METHODS: In 389 liver transplantations performed from 2004 to 2010, 102 were for HCC patients. Data were collected retrospectively from the Organ Transplantation Center Database. Variables were as follows: age, gender, preoperative alpha-fetoprotein (AFP) levels, Child-Pugh and MELD scores, prognostic staging criteria (Milan and UCSF), etiology, number of tumors, the largest tumor size, total tumor size, multifocality, intrahepatic portal vein tumor thrombosis, bilobarity, and histological differentiation. RESULTS: One hundred and two patients were evaluated. The 5-year overall survival rate was 56.5%. According to the UCSF criteria, 63% of the patients were within and 37% were beyond UCSF (P=0.03). Ten patients were excluded (one with fibrolamellary HCC and 9 because of early postoperative death without HCC recurrence), and 92 patients were assessed. The mean age of the patients was 56.5±6.9 years. Sixty-two patients underwent living donor liver transplantations. The mean follow-up time was 29.4±22.6 months. Fifteen patients (16.3%) died in the follow-up period due to HCC recurrence. Univariate analysis showed that AFP level, intrahepatic portal vein tumor thrombosis, histologic differentiation and UCSF criteria were significant factors related to survival and tumor recurrence. The 5-year estimated overall survival rate was 62.2% in allpatients. According to the UCSF criteria, and the 5-year overall survival rate was 66.7% within and 52.7% beyond the criteria (P=0.04). Multivariate analysis showed that AFP level and poor differentiation were independent factors. CONCLUSIONS: For proper patient selection in liver trans- plantation for HCC, prognostic criteria related to tumor biology (especially AF

关键词： liver transplantation hepatocellular carcinoma alpha-fetoprotein

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Living donor liver hilar variations: surgical approaches and implications

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Hepatobiliary & Pancreatic Diseases International 2011年第5期10卷 474-479页

作者： Onur Yaprak tolga demirbas Cihan Duran Murat Dayangac Murat Akyildiz Yaman Tokat Yildiray Yuzer Hepatobiliary and Organ Transplant Center Florence Nightingale Hospital Istanbul Turkey

BACKGROUND: Varied vascular and biliary anatomies are common in the liver. Living donor hepatectomy requires precise recognition of the hilar anatomy. This study was undertaken to study donor vascular and biliary tract variations, surgical approaches and implications in living liver transplant patients. METHODS: Two hundred living donor liver transplantations were performed at our institution between 2004 and 2009. All donors were evaluated by volumetric computerized tomography (CT), CT angiography and magnetic resonance cholangiography in the preoperative period. Intraoperative ultrasonography and cholangiography were carried out. Arterial, portal and biliary anatomies were classified according to the Michels, Cheng and Huang criteria. RESULTS: Classical hepatic arterial anatomy was observed in 129 (64.5%) of the 200 donors. Fifteen percent of the donors had variation in the portal vein. Normal biliary anatomy was found in 126 (63%) donors, and biliary tract variation in 70% of donors with portal vein variations. In recipients with single duct biliary anastomosis, 16 (14.4%) developed biliary leak, and 9 (8.1%) developed biliary stricture; however more than one biliary anastomosis increased recipient biliary complications. Donor vascular variations did not increase recipient vascular complications. Variant anatomy was not associated with an increase in donor morbidity. CONCLUSIONS: Living donor liver transplantation provides information about variant hilar anatomy. The success of the procedure depends on a careful approach to anatomical variations. When the deceased donor supply is inadequate, living donor transplantation is a life-saving alternative and is safe for the donor and recipient, even if the donor has variant hilar anatomy.

关键词： living donor liver transplantation anatomical variation

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A new technique for the reconstruction of complex portal vein anomalies in right lobe living liver donors

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Hepatobiliary & Pancreatic Diseases International 2012年第4期11卷 438-441页

作者： Onur Yaprak Necdet Guler N Cem Balci Murat Dayangac tolga demirbas Refik Killi Yaman Tokat Yildiray Yuzer Hepatobiliary and Organ Transplant Center Florence Nightingale HospitalIstanbulTurkey Department of Radiology Bilim UniversityIstanbulTurkey

Living donor liver right lobe transplantation using donors with variation of the right sectorial portal vein is considered a challenging procedure in terms of the donor’s safety and the complexity of reconstruction in the *** describe an innovative technique to reconstruct double portal vein orifices via a deceased donor iliac vein *** postoperative course of the recipient was *** ultrasound on the fourth postoperative month revealed equivalent flow in both portal vein *** of double right portal vein branches using a cryopreserved iliac vein is a valuable technique for utilizing right lobe grafts with challenging portal vein anatomy.

关键词： liver transplantation living donor portal vein variations venous plasty

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