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Liver transplantation for polycystic liver and massive hepatomegaly

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World Journal of Gastroenterology 2010年第11期16卷 1425-1426页

作者： Salvatore Gruttadauria Fabrizio di Francesco bruno gridelli Mediterranean Institute for Transplant and Advanced Specialized Therapies University of Pittsburgh Medical Center in Italy bruno gridelli Department of SurgeryUniversity of Pittsburgh

Liver tumor and other benign liver diseases such as polycystic liver disease can cause massive hepatomegaly and may represent an indication for liver transplantation(LT)in some *** this setting,LT can be extremely difficult and challenging due to its decreased mobility and access to vascular *** from either a right or a left partial liver resection during the transplant procedure has been advocated to safely accomplish the hepatectomy of the native *** we believe that partial hepatectomy adds some risk to intra-operative bleeding,we alternatively advise a different *** have a successful experience with LT in 6 massive hepatomegaly patients due to giant liver *** the transplant procedures were performed without intermediate partial liver resection,showing that selective use of veno-venous bypass can play a significant role in the treatment of massive hepatomegaly.

关键词： Liver transplantation Massive hepatomegaly Polycystic liver

Clinical applications of hepatocyte transplantation

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World Journal of Gastroenterology 2009年第17期15卷 2074-2077页

作者： Giada Pietrosi Giovanni Battista Vizzini Salvatore Gruttadauria bruno gridelli Department of Gastroenterology and Hepatology Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT) University of Pittsburgh Medical Center Palermo 90127 Italy Department of Surgery Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT) University of Pittsburgh Medical Center Palermo 90127 Italy

The shortage of organ donors is a problem worldwide, with approximately 15% of adult patients with lifethreatening liver diseases dying while on the waiting list. The use of cell transplantation for liver disease is an attempt to correct metabolic defects, or to support liver function as a bridge to liver transplantation and, as such, has raised a number of expectations. Most of the available studies briefly reported here focus on adult hepatocyte transplantation (HT), and the results are neither reproducible nor comparable, because the means of infusion, amount of injected cells and clinical variability differ among the studies. To better understand the specif ic role of HT in the management of end-stage liver disease, it is important that controlled studies, designed on the principles of evidence-based medicine, be done in order to guarantee the reproducibility of results.

关键词： Hepatocyte transplantation Metabolic dis-eases Chronic liver disease Liver failure Stem cells

Pediatric liver transplantation

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World Journal of Gastroenterology 2009年第6期15卷 648-674页

作者： Marco Spada Silvia Riva Giuseppe Maggiore Davide Cintorino bruno gridelli Istituto Mediterraneo peri Trapiantie Terapie ad alta specializzazione-IsMeTT University of Pittsburgh Medical Center90127 PalermoItaly Department of Reproductive Medicine and Child Development University of Pisa56100 PisaItaly

In previous decades,pediatric liver transplantation has become a state-of-the-art operation with excellent success and limited *** and patient survival have continued to improve as a result of improvements in medical,surgical and anesthetic management,organ availability,immunosuppression,and identification and treatment of postoperative *** utilization of split-liver grafts and living-related donors has provided more organs for pediatric *** immunosuppression regimens,including induction therapy,have had a significant impact on graft and patient *** developments of pediatric liver transplantation will deal with long-term followup,with prevention of immunosuppression-related complications and promotion of as normal growth as *** review describes the state-of-the-art in pediatric liver transplantation.

关键词： Pediatric liver transplantation Indications Surgical techniques Complications

Imaging in liver transplantation

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World Journal of Gastroenterology 2009年第6期15卷 675-683页

作者： Settimo Caruso Roberto Miraglia Luigi Maruzzelli Salvatore Gruttadauria Angelo Luca bruno gridelli Department of Diagnostic and Interventional Radiology Mediterranean Institute for Transplantation and Advanced Specialized Therapies(IsMeTT)University of Pittsburgh Medical Center ItalyVia Tricomi 1Palermo 90127Italy Department of Transplantation Surgery Mediterranean Institute for Transplantation and Advanced Specialized Therapies(IsMeTT) University of Pittsburgh Medical Center ItalyVia Tricomi 1 Palermo 90127Italy

The aim of this study was to illustrate the role of noninvasive imaging tools such as ultrasonography,multidetector row computed tomography,and magnetic resonance imaging in the evaluation of pediatric and adult liver recipients and potential liver donors,and in the detection of potential complications arising from liver transplantation.

关键词： Complications Liver donor Liver transplantation Magnetic resonance Multi detector computed tomography

Endoscopic treatment of biliary complications after liver transplantation

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World Journal of Gastroenterology 2008年第26期14卷 4185-4189页

作者： Ilaria Tarantino Luca Barresi Ioannis Petridis Riccardo Volpes Mario Traina bruno gridelli Department of Gastroenterology Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT)University of Pittsburgh Medical Center (UPMC)Palermo 90100Italy Department of Surgery Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT)University of Pittsburgh Medical CenterPalermo 90100Italy

AIM： To evaluate the efficacy of endoscopic treatment in patients who undergo OLTx or LRLTx and develop biliary complications. METHODS： This is a prospective, observational study of patients who developed biliary complications, after OLTx and LRLTx, with duct-to-duct anastomosis performed between June 2003 and June 2007. Endoscopic Retrograde Cholangiopancreatography （ERCP） was considered unsuccessful when there was evidence of continuous bile leakage despite endoscopic stent placement, or persistence of stenosis after i year, despite multiple dilatation and stent placement. When the ERCP failed, a percutaneous trans-hepatic approach （PTC） or surgery was adopted. RESULTS： From June 2003 to June 2007, 261 adult patients were transplanted in our institute, 68 from living donors and 193 from cadaveric donors. In the OLTx group the rate of complications was 37.3%, while in the LRLTx group was 64.7%. The rate of ERCP failure was 19.4% in the OLTx group and 38.6% in LRLTx group. In OLTx group, i patient was retransplanted and 8 patients died. In the LRLTx group, 2 patients underwent OLTx and 8 patients died. The follow-up was 23.3±13.13 mo and 21.02± 14.10 mo, ***： Albhough ERCP is quite an effective mode of managing post-transplant bile duct complications, a significant number of patients need other types of approach. Further prospective studies are necessary in order to establish whebher obher endoscopic protocols or new devices, could improve bhe current results.

关键词： Endoscopic retrograde cholangiopancreatography Biliary complication Liver transplant Benignstenosis Biliary leak

Different modalities of arterial reconstruction in hepatic retransplantation using right partial graft

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World Journal of Gastroenterology 2009年第26期15卷 3322-3323页

作者： Salvatore Gruttadauria Fabrizio di Francesco Marco Spada Mariapina Milazzo bruno gridelli Mediterranean Institute for Transplant and Advanced Specialized Therapies University of Pittsburgh Medical Center in Italy

Though split-liver and living-related transplantation are routinely performed,they are done almost exclusively for primary liver transplantation because of potential surgical *** difficulties are generally related to arterial revascularization,particularly if there is hepatic artery *** to UNOS data,of the hepatic retransplantations performed between 1996 and 2007,only 8.7% were done using right or extended right grafts from deceased donors,and 14.3% using right grafts from live *** we report our experience with 5 hepatic retransplantations in which right partial grafts resulting from conventional in situ splits,and one right lobe resulting from an adult-toadult living-related transplant,were successfully used with different modalities of graft arterialization.

关键词： Hepatic artery Liver transplantation Split liver Living related transplantation Hepatic retransplantation

Transjugular intrahepatic portosystemic shunt with accidental diagnosis of persistence of the left superior vena cava

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World Journal of Gastroenterology 2010年第9期16卷 1158-1160页

作者： Ioannis Petridis Roberto Miraglia Gianluca Marrone Salvatore Gruttadauria Angelo Luca Giovanni Battista Vizzini bruno gridelli Department of Gastroenterology and Hepatology Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT)University of Pittsburgh Medical Center Department of Diagnostic and Interventional Radiology Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT)University of Pittsburgh Medical Center Department of Abdominal Surgery and Organ Transplantation Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT)University of Pittsburgh Medical Center

Transjugular intrahepatic portosystemic shunt (TIPSS) is considered a valid therapeutic option for the treatment of portal hypertension and its *** guidelines for this procedure have already been established on the basis of the normal vascular anatomy and of various technical radiological *** some few rare cases,diagnosis of a congenital vascular anomaly can be made accidentally by interventional radiologists,making the procedure of the TIPSS placement extremely difficult or in some cases technically *** report describes a rare vascular malformation characterized by the absence of the right superior vena cava and persistence of the left superior vena cava in a patient with a diagnosis of advanced liver cirrhosis who needed a TIPSS placement in order to control refractory ascites.

关键词： Left superior vena cava persistence Liver cirrhosis Refractory ascites Transjugular intrahepatic portosystemic shunt

Analysis of surgical and perioperative complications in seventy-five right hepatectomies for living donor liver transplantation

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World Journal of Gastroenterology 2008年第20期14卷 3159-3164页

作者： Salvatore Gruttadauria James Wallis Marsh Giovan Battista Vizzini Fabrizio di Francesco Angelo Luca Riccardo Volpes Amadeo Marcos bruno gridelli Department of Abdominal Transplant Surgery Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione Department of Abdominal Transplant Surgery University of Pittsburgh Medical Center

AIM: To present an analysis of the surgical and perioperative complications in a series of seventy- five right hepatectomies for living-donation (RHLD) performed in our center. METHODS: From January 2002 to September 2007, we performed 75 RHLD, defined as removal of a portion of the liver corresponding to Couinaud segments 5-8, in order to obtain a graft for adult to adult living-related liver transplantation (ALRLT). Surgical complications were stratified according to the most recent version of the Clavien classification of postoperative surgical complications. The perioperative period was defined as within 90 d of surgery. RESULTS: No living donor mortality was present in this series, no donor operation was aborted and no donors received any blood transfusion. Twenty- three (30.6%) living donors presented one or more episodes of complication in the perioperative period. Seven patients (9.33%) out of 75 developed biliary complications, which were the most common complications in our ***: The need to define, categorize and record complications when healthy individuals, such as living donors, undergo a major surgical procedure, such as a right hepatectomy, reflects the need for prompt and detailed reports of complications arising in this particular category of patient. Perioperative complications and post resection liver regeneration are not influenced by anatomic variations or patient demographic.

关键词： Right hepatectomy Surgery Living-relatedliver transplantation Surgical complications

Multidisciplinary imaging of liver hydatidosis

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World Journal of Gastroenterology 2012年第13期18卷 1438-1447页

作者： Gianluca Marrone Francesca Crino' Settimo Caruso Giuseppe Mamone Vincenzo Carollo Mariapina Milazzo Salvatore Gruttadauria Angelo Luca bruno gridelli Department of Diagnostic and Interventional Radiology Mediterranean Institute for Transplantation and Advanced Specialized TherapiesUniversity of Pittsburgh Medical Center Italy90127 PalermoItaly Department of Transplantation Surgery Mediterranean Institute for Transplantation and Advanced Specialized TherapiesUniversity of Pittsburgh Medical Center Italy90127 PalermoItaly

Liver hydatidosis is a parasitic endemic disease affecting extensive areas in our planet, a significant stigma within medicine to manage because of its incidence, possible complications, and diagnostic involvements. The diagnosis of liver hydatidosis should be as fast as possible because of the relevant complications that may arise with disease progression, involving multiple organs and neighboring structures causing disruption, migration, contamination. The aim of this essay is to illustrate the role of imaging as ultrasonography （US）, multi detector row computed tomography, and magnetic resonance imaging （MRI） in the evaluation of liver hydatidosis： the diagnosis, the assessment of extension, the identification of possible complications and the monitoring the response to therapy. US is the screening method of choice. Computed tomography （CT） is indi-cated in cases in which US is inadequate and has high sensitivity and specificity for calcified hydatid cysts. Magnetic resonance is the best imaging procedure to demonstrate a cystic component and to show a biliary tree involvement. Diagnostic tests such as CT and MRI are mandatory in liver hydatidosis because they allow thorough knowledge regarding lesion size, location, and relations to intrahepatic vascular and biliary structures, providing useful information for effective treatment and decrease in post-operative morbidity. Hydatid disease is classified into four types on the basis of their radiologic appearance.

关键词： Liver hydatidosis Hepatic cyst Daughtercysts Calcified cyst Pericyst