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Splenectomy in living donor liver transplantation and risk factors of portal vein thrombosis

Hepatobiliary & Pancreatic Diseases International 2019年第4期18卷 337-342页

作者： nobuhiko kurata Yasuhiro Ogura Satoshi Ogiso Yasuharu Onishi Hideya Kamei Yasuhiro Kodera Department of Transplantation and Endocrine Surgery(Surgery II) Nagoya University Graduate School of MedicineNagoyaJapan Department of Transplantation Surgery Nagoya University Hospital65 Tsurumai-choShowa-kuNagoya 466-8560Japan Department of Gastroenterological Surgery(Surgery II) Nagoya University Graduate School of MedicineNagoyaJapan

Background:Graft inflow modulation(GIM)during adult-to-adult living donor liver transplantation(LDLT)is a common strategy to avoid small-for-size syndrome,and some transplant surgeons attempt small size graft strategy with frequent GIM procedures,which are mostly performed by splenectomy,in ***,splenectomy can cause serious complications such as portal vein thrombosis and overwhelming postsplenectomy ***:Forty-eight adult-to-adult LDLT recipients were enrolled in this study and retrospectively *** applied the graft selection criteria,which routinely fulfill graft-to-recipient weight ratio≥0.8%,and consider GIM as a backup strategy for high portal venous pressure(PVP).Results:In our current strategy of LDLT,splenectomy was performed mostly due to hepatitis C and splenic arterial aneurysms,but splenectomy for GIM was intended to only one patient(2.1%).The final PVP values≤20 mmHg were achieved in all recipients,and no significant difference was observed in patient survival or postoperative clinical course based on whether splenectomy was performed or ***,6 of 18 patients with splenectomy(33.3%)developed postsplenectomy portal vein thrombosis(PVT),while none of the 30 patients without splenectomy developed PVT after *** was identified as a risk factor of PVT in this study(P<0.001).Our study revealed that a lower final PVP could be risk factor of postsplenectomy ***:Using sufficient size grafts was one of the direct solutions to control PVP,and allowed GIM to be reserved as a backup *** should be avoided as much as possible during LDLT because splenectomy was found to be a definite risk factor of *** splenectomy cases with a lower final PVP,a close follow-up is required for early detection and treatment of PVT.

关键词： Living donor liver transplantation Splenectomy Portal venous pressure Graft-to-recipient weight ratio Portal vein thrombosis

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Risk of alcohol use relapse after liver transplantation for alcoholic liver disease

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World Journal of Gastroenterology 2017年第5期23卷 869-875页

作者： Yasuharu Onishi Hiroyuki Kimura Tomohide Hori Shinichi Kishi Hideya Kamei nobuhiko kurata Chisato Tsuboi Naoko Yamaguchi Mayu Takahashi Saki Sunada Mitsuaki Hirano Hiroshige Fujishiro Takashi Okada Masatoshi Ishigami Hidemi Goto Norio Ozaki Yasuhiro Ogura Department of Transplantation Surgery Nagoya University Hospital Department of Psychiatry Nagoya University Hospital Transplant Coordination Service Nagoya University Hospital Department of Gastro-enterology and Hepatology Nagoya University Graduate School of Medicine

AIMTo investigate factors, including psychosocial factors, associated with alcoholic use relapse after liver transplantation (LT) for alcoholic liver disease (ALD).METHODSThe clinical records of 102 patients with ALD who were referred to Nagoya University Hospital for LT between May 2003 and March 2015 were retrospectively evaluated. History of alcohol intake was obtained from their clinical records and scored according to the High-Risk Alcoholism Relapse scale, which includes duration of heavy drinking, types and amount of alcohol usually consumed, and previous inpatient treatment history for alcoholism. All patients were assessed for eligibility for LT according to comprehensive criteria, including Child-Pugh score, Model for End-Stage Liver Disease score, and psychosocial *** the 102 patients with ALD referred for LT, seven (6.9%) underwent LT. One (14.3%) of these seven patients returned to heavy drinking, but that patient was able to successfully quit drinking following an immediate intervention, consisting of psychotherapeutic education and supportive psychotherapy, by a psychiatrist. A comparison between the transplantation/registration (T/R) group, consisting of the seven patients who underwent LT and 10 patients listed for deceased donor LT, and 50 patients who did not undergo LT and were not listed for deceased donor LT (non-T/R group), showed statistically significant differences in duration of abstinence period (P < 0.01), duration of heavy drinking (P < 0.05), adherence to medical treatment (P < 0.01), and declaration of abstinence (P < 0.05).CONCLUSIONPatients with ALD referred for LT require comprehensive evaluation, including evaluation of psychosocial criteria, to prevent alcoholic recidivism.

关键词： Liver transplantation Risk assessment Alcoholic liver disease Psychosocial evaluation criteria Liaison psychiatry Alcohol use relapse

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Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation

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World Journal of Hepatology 2016年第25期8卷 1047-1060页

作者： Tomohide Hori Yasuhiro Ogura Yasuharu Onishi Hideya Kamei nobuhiko kurata Motoshi Kainuma Hideo Takahashi Shogo Suzuki Takashi Ichikawa Shoko Mizuno Tadashi Aoyama Yuki Ishida Takahiro Hirai Tomoko Hayashi Kazuko Hasegawa Hiromu Takeichi Atsunobu Ota Yasuhiro Kodera Hiroyuki Sugimoto Taku Iida Shintaro Yagi Kentaro Taniguchi Shinji Uemoto Department of Transplant Surgery Nagoya University Hospital Department of Intensive Care Unit Nagoya University Hospital Second Department of Surgery Nagoya University Hospital Department of Transplant Surgery Kyoto University Hospital First Department of Surgery Mie University Hospital

Advanced liver cirrhosis is usually accompanied by portal hypertension. Long-term portal hypertension results in various vascular alterations. The systemic hemodynamic state in patients with cirrhosis is termed a hyperdynamic state. This peculiar hemodynamic state is characterized by an expanded blood volume, high cardiac output, and low total peripheral resistance. Vascular alterations do not disappear even long after liver transplantation(LT), and recipients with cirrhosis exhibit a persistent systemic hyperdynamic state even after LT. Stability of optimal systemic hemodynamics is indispensable for adequate portal venous flow(PVF) and successful LT, and reliable parameters for optimal systemic hemodynamics and adequate PVF are required. Even a subtle disorder in systemic hemodynamics is precisely indicated by the balance between cardiac output and blood volume. The indocyanine green(ICG) kinetics reflect the patient's functional hepatocytes and effective PVF, and PVF is a major determinant of the ICG elimination constant(kICG) in the well-preserved allograft. The kICG value is useful to set the optimal PVF during living-donor LT and to evaluate adequate PVF after LT. Perioperative management has a large influence on the postoperative course and outcome; therefore, key points and unexpected pitfalls for intensive management are herein summarized. Transplant physicians should fully understand the peculiar systemic hemodynamic behavior in LT recipients with cirrhosis and recognize the critical importance of PVF after LT.

关键词： Liver cirrhosis Portal hypertension Liver transplantation Indocyanine green Hyperdynamic

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