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New insights in the management of the middle hepatic vein dilemma

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Hepatobiliary & Pancreatic Diseases International 2019年第2期18卷 101-102页

作者： Quirino Lai Fabio MelANDro Gianluca Mennini Massimo Rossi Hepato-Bilio-Pancreatic and Liver transplant unit Department of General Surgery and Organ Transplantation Sapienza University of Rome Umberto I Policlinic of Rome

When the first series of adult-to-adult living donor liver transplantation(A2A-LDLT)were performed in Hong Kong[1],it was immediately clear that great technical challenges existed,mainly concerning the middle hepatic ... 详细信息

关键词： New insights middle hepatic vein dilemma

Liver transplantation as an alternative for the treatment of non-resectable liver colorectal cancer: Advancing the therapeutic algorithm

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Hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 154-159页

作者： Badi Rawashdeh Richard Bell Abdul Hakeem Raj Prasad Division of transplant surgery Department of General SurgeryMedical College of WisconsinMilwaukeeWI53226USA Leeds Teaching Hospital LeedsUK

Colorectal cancer is a leading cause of cancerrelated mortality,with nearly half of the affected patients developing liver *** three decades,liver resection(LR)has been the primary curative strategy,yet its applicability is limited to about 20%of *** transplantation(LT)for unresectable metastases was attempted unsuccessfully in the 1990s,with high rates of perioperative death and *** is now more interest in this strategy due to improvements in systemic therapies and surgical techniques.A significant study conducted by the Oslo group showed that patients receiving liver transplants had a 60%chance of survival after five *** better results have been achieved by using advanced imaging for risk stratification and further refining selection criteria,especially in the Norvegian SECA *** review carefully charts the development and history of LT as a treatment option for colorectal cancer liver *** revolutionary path from the early days of exploratory surgery to the current situation of cautious optimism is traced,highlighting the critical clinical developments and improved patient selection standards that have made LT a potentially curative treatment for such challenging very well selected cases.

关键词： Liver transplantation Colorectal cancer liver metastases Non-resectable liver metastases

Potentially fatal haemobilia due to inappropriate use of an expanding biliary stent

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World Journal of Gastroenterology 2003年第10期9卷 2377-2378页

作者： Rakesh Rai John Rose Derek Manas Hepatobiliary surgery and Liver transplant unit Freeman HospitalNewcastleUK Department of Interventional Radiology Freeman HospitalNewcastleUK Hepatobiliary surgery and Liver transplant unit.Freeman Hospital.Newcastle.UK

AIM: To highlight the fatal complication caused by expanding biliary stents and the importance of avoiding use of expanding stent in potentially curable ***: Arteriobiliary fistula is an uncommon cause of haemobilia. We describe a case of right hepatic artery pseudoaneurysm causing arteriobiliary fistula and presenting as severe malena and cholangitis, in a patient with a mesh metal biliary stent. The patient had lymphoma causing bile duct ***: Gastroduodenoscopy failed to establish the exact source of bleeding and hepatic artery angiography and selective embolisation of the pseudo aneurysm successfully controlled the ***: Bleeding from the pseudo aneurysm of the hepatic artery can be fatal. Mesh metal stents in biliary tree can cause this complication as demonstrated in this *** mesh metal stent insertion should be avoided in potentially benign or in curable conditions. Difficulty in diagnosis and management is discussed along with the review of the literature.

关键词： Aneurysm, False Biliary Fistula Female Hemobilia Hemorrhage Humans Middle Aged Stents

Hepatitis C virus related cirrhosis decreased as indication to liver transplantation since the introduction of direct-acting antivirals: A single-center study

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World Journal of Gastroenterology 2018年第38期24卷 4403-4411页

作者： Alberto Ferrarese Giacomo Germani Martina Gambato Francesco Paolo Russo Marco Senzolo Alberto Zanetto Sarah Shalaby Umberto Cillo Giacomo Zanus Paolo Angeli Patrizia Burra Multivisceral transplant unit Department of Surgery Oncology and Gastroenterology Padua University Hospital Hepatobiliary surgery and Liver transplant unit Department of Surgery Oncology and Gastroenterology Padua University Hospital Internal Medicine Department of Medicine Padua University Hospital

AIM To evaluate waiting list(WL) registration and liver transplantation(LT) rates in patients with hepatitis C virus(HCV)-related cirrhosis since the introduction of direct-acting antivirals(DAAs).METHODS All adult patients with cirrhosis listed for LT at Padua University Hospital between 2006-2017 were retrospectively collected using a prospectivelyupdated database; patients with HCV-related cirrhosis were divided by indication for LT [dec-HCV vs HCV/hepatocellular carcinoma(HCC)] and into two interval times(2006-2013 and 2014-2017) according to the introduction of DAAs. For each patient, indications to LT, severity of liver dysfunction and the outcome in the WL were assessed and compared between the two different time periods. For patients receiving DAA-based regimens, the achievement of viral eradication and the outcome were also evaluated. RESULTS One thousand one hundred and ninty-four [male(M)/female(F): 925/269] patients were included. Considering the whole cohort, HCV-related cirrhosis was the main etiology at the time of WL registration(490/1194 patients, 41%). HCV-related cirrhosis significantly decreased as indication to WL registration after DAA introduction(from 43.3% in 2006-2013 to 37.2% in 2014-2017, P = 0.05), especially amongst decHCV(from 24.2% in 2006-2013 to 15.9% in 2014-2017, P = 0.007). Even HCV remained the most common indication to LT over time(289/666, 43.4%), there was a trend towards a decrease after DAAs introduction(from 46.3% in 2006-2013 to 39% in 2014-2017, P = 0.06). HCV patients(M/F: 43/11, mean age: 57.7 ± 8 years) who achieved viral eradication in the WL had better transplant-free survival(log-rank test P = 0.02) and delisting rate(P = 0.002) than untreated HCV patients. CONCLUSION Introduction of DAAs significantly reduced WL registrations for HCV related cirrhosis, especially in the setting of decompensated cirrhosis.

关键词： Liver transplantation Hepatitis C Cirrhosis Sustained virological response

Influence of hepatitis viruses on clinico-pathological profiles and long-term outcome in patients undergoing surgery for hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2014年第2期13卷 162-172页

作者： Anna-Maria Tanase Traian Dumitrascu Simona Dima Razvan Grigorie Agnes Marchio Pascal Pineau Irinel Popescu Center of general surgery and Liver transplant Fundeni Clinical Institute unité "Organisation nucléaire et oncogenèse" INSERM U993Institut

BACKGROUND: The global risk of hepatocellular carcinoma(HCC) is largely due to hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. In recent years, however, an increased prevalence of non-viral HCC has been noted. The clinical impact of the presence/absence of viral infections in HCC remains controversial. The present study aimed to assess the effect of hepatitis viruses on demographics, clinical and pathological features and long-term outcome in a large cohort of Romanian patients who underwent surgery for HCC. METHODS: The study included 404 patients with HCC who had undergone resection, transplantation or radiofrequency ablation at a single institution between 2001 and 2010. The patients were divided into four groups: 85 patients with hepatitis B virus infection (HBV group), 164 patients with hepatitis C virus infection (HCV group), 39 patients with hepatitis B and C virus co-infection (HBCV group), and 116 patients without viral infection (non-BC group). RESULTS: The patients of both HBV (56.0±11.3 years) and HBCV groups (56.0±9.9 years) were significantly younger than those of the HCV (61.0±8.5 years, P=0.001) and non-BC groups(61.0±13.0 years, P=0.002). Interestingly, the prevalence of liver cirrhosis was significantly lower in the non-BC group (47%)than in any other subsets (72%-90%, Punity practice. The presence of viral infections does not appear to impair the longterm prognosis after surgical treatm

关键词： hepatitis B virus hepatitis Cvirus hepatocellular carcinoma recurrence prognosis

Laparoscopic staging in hilar cholangiocarcinoma:Is it still justified?

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World Journal of Gastrointestinal Oncology 2013年第7期5卷 127-131页

作者： Fernando Rotellar Fernando Pardo HPB and Liver transplant unit Department of General and Abdominal SurgeryUniversity Clinic of NavarreUniversity of Navarre31008 PamplonaSpain

Radical resection remains the only potential curative therapy for hilar cholangiocarcinoma(HCCA).The aim of staging laparoscopic(SL) is to identify patients with previously undetected advanced disease who will not benefit from surgical palliation and therefore avoid unnecessary *** accuracy of non-invasive imaging techniques has significantly improved during the last *** a consequence,the diagnostic yield of SL of biliary tract malignancy should have decreased *** the same time,some authors have recently questioned the value of laparoscopic ultrasound(LUS) as a complement of *** this setting,the precise role of SL and LUS in the preoperative workup of HCCA remains *** it seems undoubtedly clear that its efficacy has decreased in the last decades,there is a general consensus that the universal use of SL shouldn't be recommended anymore;SL should be performed only in selected patients with higher risk of holding unresectable disease(T2/T3 or Bismuth type 3/4 and patients with suspicion of metastases).It would also be recommended in patients with potentially resectable disease who would need preoperative invasive ***,SL should be performed preceding laparotomy in one *** studies on the benefit of SL and LUS in this subset of HCCA patients are warranted.

关键词： Hilar cholangiocarcinoma Laparoscopy Staging laparoscopy Laparoscopic ultrasound

Therapeutic approaches for portal biliopathy: A systematic review

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World Journal of Gastroenterology 2016年第45期22卷 9909-9920页

作者： Irene Franceschet Alberto Zanetto Alberto Ferrarese Patrizia Burra Marco Senzolo Gastroenterology unit Department of Surgery Oncology and Gastroenterology University Hospital of Padua Multivisceral transplant unit Department of Surgery Oncology and Gastroenterology University Hospital of Padua

Portal biliopathy(PB) is defined as the presence of biliary abnormalities in patients with non-cirrhotic/nonneoplastic extrahepatic portal vein obstruction(EHPVO) and portal cavernoma(PC). The pathogenesis of PB is due to ab extrinseco compression of bile ducts by PC and/or to ischemic damage secondary to an altered biliary vascularization in EHPVO and PC. Although asymptomatic biliary abnormalities can be frequently seen by magnetic resonance cholangiopancreatography in patients with PC(77%-100%), only a part of these(5%-38%) are symptomatic. Clinical presentation includes jaundice, cholangitis, cholecystitis, abdominal pain, and cholelithiasis. In this subset of patients is required a specific treatment. Different therapeutic approaches aimed to diminish portal hypertension and treat biliary strictures are available. In order to decompress PC, surgical porto-systemic shunt or transjugular intrahepatic porto-systemic shunt can be performed, and treatment on the biliary stenosis includes endoscopic(Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy, balloon dilation, stone extraction, stent placement) and surgical(bilioenteric anastomosis, cholecystectomy) approaches. Definitive treatment of PB often requires multiple and combined interventions both on vascular and biliary system. Liver transplantation can be considered in patients with secondary biliary cirrhosis, recurrent cholangitis or unsuccessful control of portal hypertension.

关键词： Portal biliopathy Portal cavernoma Magnetic resonance cholangiopancreatography Endoscopic retrograde cholangiopancreatography Porto-systemic shunt

Treatment modalities for hypersplenism in liver transplant recipients with recurrent hepatitis C

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World Journal of Gastroenterology 2009年第40期15卷 5010-5013页

作者： Lena Sibulesky Justin H Nguyen Ricardo Paz-Fumagalli C Burcin Taner Rolland C Dickson Division of transplant surgery and transplant Hepatology Division of Interventional Radiology

Hepatitis C is the most common indication for orthotopic liver transplantation in the united States. Unfortunately, hepatitis C recurs universally in the transplanted liver and is the major cause of decreased graft and patient survival. The combination therapy of interferon and ribavirin has been shown to be the most effective therapy for recurrent hepatitis C. However, pre-and post-transplant hypersplenism often precludes patients from receiving the antiviral therapy. Splenectomy and partial splenic embolization are the two invasive modalities that can correct the cytopenia associated with hypersplenism. In this report we review the two treatment options, their associated outcomes and complications.

关键词： Hypersplenism Leukopenia Recurrenthepatitis C Thrombocytopenia Liver transplant

Perioperative thrombotic complications in liver transplantation

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World Journal of Gastroenterology 2015年第26期21卷 8004-8013页

作者： Paolo Feltracco Stefania Barbieri Umberto Cillo Giacomo Zanus Marco Senzolo Carlo Ori Department of Medicine UO Anaesthesia and Intensive CarePadua University Hospital Hepatobiliary surgery and Liver transplant unit Department of SurgeryOncology and GastroenterologyUniversity Hospital of Padua Multivisceral transplant unit Department of SurgeryOncology and GastroenterologyUniversity Hospital of Padua

Although the perioperative bleeding complications and the major side effects of blood transfusion have always been the primary concern in liver transplantation(OLT),the possible cohesion of an underestimated intrinsic hypercoagulative state during and after the transplant procedure may pose a major threat to both patient and graft *** during OLT is characterized not only by a complex aetiology,but also by unpredictable onset and evolution of the *** initiation of a procoagulant process may be triggered by various factors,such as inflammation,venous stasis,ischemia-reperfusion injury,vascular clamping,anatomical and technical abnormalities,genetic factors,deficiency of profibrinolytic activity,and platelet *** involvement of the arterial system,intracardiac thrombosis,pulmonary emboli,portal vein thrombosis,and deep vein thrombosis,are among the most serious thrombotic events in the perioperative *** rapid detection of occlusive vascular events is of paramount importance as it heavily influences the prognosis,particularly when these events occur intraoperatively or early after *** of the lack of studies and guidelines on anticoagulant prophylaxis in this setting,many institutions recommend such an approach especially in the subset of patients at high ***,the decision of when,how and in what doses to use the various chemical anticoagulants is still a difficult task,since there is no common consensus,even for highrisk *** risk of postoperative thromboembolism causing severe hemodynamic events,or even loss of graft function,must be weighed and compared with the risk of an important *** this article we briefly review the risk factors and the possible predictors of major thrombotic complications occurringin the perioperative period,as well as their incidence and clinical ***,the indications to pharmacological prophylaxis and the current treatment strategies are also summarized.

关键词： Vascular complications Thromboembolicphenomena Liver transplantation Hepatic arteryocclusion Postoperative complications Pulmonaryemboli