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Xanthogranulomatous cholecystitis mimicking gallbladder cancer and causing obstructive cholestasis

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Hepatobiliary & Pancreatic Diseases International 2012年第5期11卷 549-552页

作者： paulo n martins Patricia Sheiner Marcelo Facciuto Department of Surgery Transplant DivisionMassachusetts General HospitalHarvard Medical School Department of Surgery Division of Hepatobiliary Surgery and TransplantationNew York Medical College Division of Transplantation Mount Sinai Hospital

BACKGROUnD: Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder that can mimic gallbladder carcinoma. METHODS: We present the case of a 35-year-old Hispanic male complaining of right upper quadrant pain and jaundice for 2 months prior to admission. He denied a history of fever, nausea/ vomiting, and weight loss. The past medical history was relevant only for diabetes. He had no previous history of jaundice or previous operations. RESULTS: CA19-9 was slightly elevated (52 U/mL). Abdominal ultrasonography showed an irregular thickening of the gallbladder wall and no gallstones were detected. CT scan also revealed an irregular thickening of the wall of the gallbladder body suggestive of malignancy. At laparotomy, the mass was adherent to the duodenum and colon, and although the frozen section biopsy was negative, the intraoperative findings were suggestive of malignancy, and the patient underwent left liver trisegmentectomy, resection of the common bile duct and Roux-en-Y hepaticojejunostomy. Pathological examination unexpectedly revealed XGC without malignancy. COnCLUSIOnS: Preoperative and intraoperative differential diagnosis of XGC from gallbladder carcinoma remains a challenge when it is associated with inflammatory involvement of surrounding tissues. Since gallbladder carcinoma and XGC may coexist, radical resection is justified when malignancy cannot be completely ruled out.

关键词： xanthogranulomatous cholecystitis gallbladder cancer obstructive cholestasis

Follicular dendritic cell sarcoma of the liver:unusual presentation of a rare tumor and literature review

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Hepatobiliary & Pancreatic Diseases International 2011年第4期10卷 443-445页

作者： paulo n martins Sanjay Reddy Ann-Britt martins Marcelo Facciuto Department of Surgery Division of Hepatobiliary Surgery and TransplantationNew York Medical CollegeNew YorkUSA Department of Surgery New York Medical CollegeSt.Vincent's Catholic Medical CenterNew YorkUSA

BACKGROUnD:Hepatic follicular dendritic cell (FDC) sarcoma is an extremely rare *** commonly,FDC sarcoma presents as a solitary mass in lymph nodes,however,several extra-nodal locations have been ***:We report a case of a 53-year-old female who presented with symptoms of abdominal pain,fever,anemia,and *** an extensive review of the literature,we have found only 12 cases of hepatic FDC ***:The tumor was 11.5 cm in diameter and composed of spindle and epithelioid cells with ovoid nuclei and associated with mixed inflammatory *** stains were positive for CD35 and *** patient underwent a left hepatic ***:Liver follicular dendritic cell sarcoma is a very rare *** cases present with abdominal pain and weight loss,and most of them can be managed by hepatic resection with excellent short-term outcomes.

关键词： follicular dendritic cell tumor liver neoplasms sarcoma jaundice

Machine perfusion of the liver:Putting the puzzle pieces together

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World Journal of Gastroenterology 2021年第34期27卷 5727-5736页

作者： Yuri L Boteon paulo n martins Paolo Muiesan Andrea Schlegel Liver Unit Hospital Israelita Albert EinsteinSão Paulo 05652-900Brazil Instituto Israelita de Ensino e Pesquisa Albert Einstein Faculdade Israelita de Ciências da Saúde Albert EinsteinSão Paulo 05652-900Brazil Department of Surgery Transplant DivisionUniversity of Massachusetts Medical SchoolWorcesterMA 01655United States Hepatobiliary Unit Careggi University HospitalUniversity of FlorenceFlorence 50134Italy Department of Visceral Surgery and Transplantation University Hospital ZurichSwiss HPB and Transplant CenterZurich 8091Switzerland

The realm of extended criteria liver transplantation created the'adjacent possible'for dynamic organ *** perfusion of the liver greatly expanded donor organ preservation possibilities,reaching before unattainable goals,including the mitigation of ischemia-reperfusion injury,viability assessment,and organ reconditioning prior to ***,current scientific evidence lacks uniformity between studies,perfusion protocols,and acceptance *** of collaborative research networks for sharing knowledge should,therefore,enable the development of high-level evidence and guidelines for machine perfusion utilization,including donor acceptance ***,this approach shall guarantee conditions for further progress to occur.

关键词： Machine perfusion of the liver Liver transplantation Organ donation Extended criteria donors Liver preservation Clinical trials

Therapeutics administered during ex vivo liver machine perfusion:An overview

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World Journal of Transplantation 2020年第1期10卷 1-I0001页

作者： Julianna E Buchwald Jing Xu Adel Bozorgzadeh paulo n martins Division of Transplantation Department of Surgery University of Massachusetts Medical School

Although the use of extended criteria donors has increased the pool of available livers for transplant,it has also introduced the need to develop improved methods of protection against ischemia-reperfusion injury(IRI),as these"marginal"organs are particularly vulnerable to IRI during the process of procurement,preservation,surgery,and *** this review,we explore the current basic science research investigating therapeutics administered during ex vivo liver machine perfusion aimed at mitigating the effects of IRI in the liver transplantation *** various categories of therapeutics are utilized during the perfusion process and include invoking the RnA interference pathway,utilizing defatting cocktails,and administering classes of agents such as vasodilators,anti-inflammatory drugs,human liver stem cell-derived extracellular vesicles,and δ-opioid agonists in order to reduce the damage of *** vivo machine perfusion is an attractive alternative to static cold storage due to its ability to continuously perfuse the organ,effectively deliver substrates and oxygen required for cellular metabolism,therapeutically administer pharmacological or cytoprotective agents,and continuously monitor organ viability during *** use of administered therapeutics during machine liver perfusion has demonstrated promising results in basic science *** novel therapeutic approaches to combat IRI are being developed through basic science research,their use in clinical medicine and treatment in patients for liver transplantation has yet to be explored.

关键词： Therapeutics Liver transplantation Ex vivo machine perfusion Ischemia reperfusion injury Organ preservation Extended criteria donors

Delivery of genetic load during ex situ liver machine perfusion with potential for CRISPR-Cas9 gene editing:An innovative strategy for graft treatment

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Hepatobiliary & Pancreatic Diseases International 2021年第5期20卷 503-505页

作者： Eliano Bonaccorsi-Riani Andrew Gillooly Isabel M.A.Brüggenwirth paulo n.martins Abdominal Transplant Unit Cliniques Universitaires Saint LucUniversitéCatholique de LouvainBrusselsBelgium Pole de Chirurgie Expérimentale et Transplantation UniversitéCatholique de LouvainBrusselsBelgium Department of Surgery Transplant DivisionUniversity of MassachusettsWorcester-MassachusettsUSA Department of Surgery Section of hepatobiliary surgery and liver transplantationUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands

To the Editor:Over the years,the shortage of suitable donor organs has challenged the transplant community in performing life-saving liver transplantation(LT).Recent reports from European and American liver transplant... 详细信息

关键词： organs mortality graft

Successful treatment of complete traumatic transection of the suprahepatic inferior vena cava with veno-venous and cardiopulmonary bypass with hypothermic circulatory arrest

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Hepatobiliary & Pancreatic Diseases International 2021年第6期20卷 601-610页

作者： paulo n.martins Julianna E.Buchwald Babak Movahedi Ulises Torres Timothy Emhoff Jennifer Walker Michael G.DeBusk Adel Bozorgzadeh Department of Surgery Division of TransplantationUniversity of MassachusettsWorcesterMA 01655USA Department of Surgery Division of TraumaUniversity of MassachusettsWorcesterMA 01655USA Department of Surgery Division of Cardiac SurgeryUniversity of MassachusettsWorcesterMA 01655USA

To the Editor:Complete traumatic transection of the suprahepatic inferior vena cava(IVC)has almost invariably a fatal *** are very few cases in the literature of patients that survived this type of *** we presented a case that was approached multidisciplinary(trauma surgeon,liver transplant surgeon,perfusionist,anesthesiologist,and cardiac surgeon)with a successful outcome including early recovery of all body functions and quality of life.

关键词： traumatic hepatic bypass

Potential approaches to improve the outcomes of donation after cardiac death liver grafts

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World Journal of Transplantation 2016年第2期6卷 314-320页

作者： Paria Mahboub Adel Bozorgzadeh paulo n martins Department of Surgery Groningen Transplant CenterUniversity Medical Center GroningenUniversity of Groningen Depart-ment of Surgery Division of TransplantationUniversity of Massachusetts

There is a growing discrepancy between the supply and demand of livers for transplantation resulting in high mortality rates on the waiting list. One of the options to decrease the mortality on the waiting list is to optimize organs with inferior quality that otherwise would be discarded. Livers from donation after cardiac death(DCD) donors are frequently discarded because they are exposed to additional warm ischemia time, and this might lead to primary-non-function, delayed graft function, or severe biliary complications. In order to maximize the usage of DCD livers several new preservation approaches have been proposed. Here, we will review 3 innovative organ preservation methods:(1) different ex vivo perfusion techniques;(2) persufflation with oxygen; and(3) addition of thrombolytic therapy. Improvement of the quality of DCD liver grafts could increase the pool of liver graft's for transplantation, improve the outcomes, and decrease the mortality on the waiting list.

关键词： Biliarycomplications Donation after cardiac death Organ preservation methods

Exercise training as an intervention for frailty in cirrhotic patients on the liver transplant waiting list:A systematic review

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World Journal of Hepatology 2023年第10期15卷 1153-1163页

作者： Thais Mellato Loschi Melline D T A Baccan Bianca Della Guardia paulo n martins Amanda P C S Boteon Yuri L Boteon Transplant Centre Hospital Israelita Albert EinsteinSão Paulo 05652-900Brazil Instituto Israelita de Ensino e Pesquisa Albert Einstein Faculdade Israelita de Ciências da Saúde Albert EinsteinSão Paulo 05652-900Brazil Department of Surgery Transplant DivisionUniversity of Massachusetts Medical SchoolWorcesterMA 01655United States

BACKGROUnD The existing literature suggests that exercise for cirrhotic patients is safe and favours significant improvement to their physical ***,exercise training for this population and how to deliver activities,especially in severe stages of the disease and while waiting for a liver transplant(LT),remain *** To review the existing exercise prescriptions for cirrhotic patients on the waiting list for LT,their results for frailty evolution and their effect on clinical *** A systematic review was performed following the Preferred Reporting Review and Meta-Analysis guidelines and searching the PubMed,MEDLInE,and Scopus *** keyword“liver transplant”was used in combination with the free terms“frailty”and“exercise”for the literature *** studies that evaluated the effect of a regular training program,independent of supervision or the duration or intensity of physical exercise,in cirrhotic patients on the waiting list for LT were *** data on safe physical activity prescriptions following Frequency,Intensity,Time,and Type recommendations were extracted and *** nine articles met the inclusion criteria for this *** instruments for frailty assessment were used,frequently in *** studies prescribed physical activity for patients,one in-person and four to be performed remotely and *** remaining four studies only used a self-report instrument to assess the level of physical *** reported adverse events related to exercise *** exercise frequency mainly varied from daily to a minimum of twice per *** intensity depended on frailty and included increasing levels of *** type of exercise was predominantly a combination of aerobic and resistance *** duration of exercise varied from 4 to 12 *** articles evaluated the effect of the exercise program on clinical outcomes,reporting a reduction in 90-d readmission rates post-tran

关键词： End-stage liver disease Liver transplant Frailty Exercise Rehabilitation Sarcopenia

Delayed referral for liver transplant evaluation worsens outcomes in chronic liver disease patients requiring inpatient transplant evaluation

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World Journal of Transplantation 2023年第4期13卷 169-182页

作者： Katherine M Cooper Alessandro Colletta nicholas J Hathaway Diana Liu Daniella Gonzalez Arslan Talat Curtis Barry Anita Krishnarao Savant Mehta Babak Movahedi paulo n martins Deepika Devuni Department of Medicine UMass Chan Medical SchoolWorcesterMA 01605United States Department of Medicine Division of GastroenterologyUMass Chan Medical SchoolWorcesterMA 01605United States Department of Surgery Transplant DivisionUMass Chan Medical SchoolWorcesterMA 01605United States

BACKGROUnD Indications to refer patients with cirrhosis for liver transplant evaluation(LTE)include hepatic decompensation or a model for end stage liver disease(MELDna)score≥*** studies have evaluated how delaying referral beyond these criteria affects patient *** To evaluate clinical characteristics of patients undergoing inpatient LTE and to assess the effects of delayed LTE on patient outcomes(death,transplantation).METHODS This is a single center retrospective cohort study assessing all patients undergoing inpatient LTE(n=159)at a large quaternary care and liver transplant center between 10/23/2017-7/31/*** referral was defined as having prior indication(decompensation,MELD-na≥15)for LTE without *** referral was defined as referrals made within 3 mo of having an indication based on practice *** regression and Cox Hazard Regression were used to evaluate the relationship between delayed referral and patient *** Many patients who require expedited inpatient LTE had delayed *** regarding transplant candidacy were a leading cause of delayed ***,delayed referrals negatively affected overall patient outcome and an independent predictor of both death and not receiving a *** referral was associated with a 2.5 hazard risk of *** Beyond initial access to an liver transplant(LT)center,delaying LTE increases risk of death and reduces risk of LT in patients with chronic liver *** is substantial opportunity to increase the percentage of patients undergoing LTE when first clinically *** is crucial for providers to remain informed about the latest guidelines on liver transplant candidacy and the transplant referral process.

关键词： Liver transplantation Liver transplant evaluation Liver transplant referral Patient access Equity Patient outcomes