BACKGROUND:The potential effect of graft steatosis on the postoperative liver function is discussed controversially. The present study aimed to evaluate the effect of the donor liver microvesicular steatosis on the po...BACKGROUND:The potential effect of graft steatosis on the postoperative liver function is discussed controversially. The present study aimed to evaluate the effect of the donor liver microvesicular steatosis on the postoperative outcome after liver transplantation.METHODS:Ninety-four patients undergoing liver transplantation at the University Hospital Aachen were included in this study. The patient cohort was divided into three groups according to the grade of microvesicular steatosis(MiS):MiS <30%(n=27), MiS 30%-60%(n=41) and MiS >60%(n=26).The outcomes after liver transplantation were evaluated, including the 30-day and 1-year patient and graft survival rates and the incidences of early allograft dysfunction(EAD) and primary nonfunction(PNF). RESULTS:The incidences of EAD and PNF did not differ significantly between the groups. We observed 5 cases of PNF,one occurred in the MiS <30% group and 4 in the MiS 30%-60% group. The 30-day and 1-year graft survivals did not differ significantly between groups. The 30-day patient survival rates were 100% in all groups. The 1-year patient survival rates were 94.4% in the MiS <30% group, 87.9% in the MiS 30%-60% group and 90.9% in the MiS >60% group.CONCLUSION:Microvesicular steatosis of donor livers has no negative effect on the postoperative outcome after liver transplantation.展开更多
BACKGROUND: Post-hepatectomy liver failure as a result of insufficient liver remnant is a feared complication in liver surgery. Efforts have been made to find new strategies to support liver regeneration. The aim of t...BACKGROUND: Post-hepatectomy liver failure as a result of insufficient liver remnant is a feared complication in liver surgery. Efforts have been made to find new strategies to support liver regeneration. The aim of this study was to investigate the effects of terlipressin versus splenectomy on postoperative liver function and liver regeneration in rats undergoing 70%partial hepatectomy. METHODS: Seventy-two male Wistar rats were randomly assigned into three groups(n=24 in each group): 70% partial hepatectomy as control(PHC), 70% partial hepatectomy with splenectomy(PHS) or 70% partial hepatectomy with a micropump for terlipressin administration(PHT). Eight rats in each group were sacrificed on postoperative day(POD) 1,3 and 7. To assess liver regeneration, immunohistochemical analysis of liver tissue using bromodeoxyuridine(BrdU) and Ki-67 labeling was performed. Portal venous pressure, serum concentrations of creatinine, urea, albumin, bilirubin and prothrombin time as well as liver-, body-weight and their ratio were determined on POD 1, 3 and 7.RESULTS: The liver-, body-weight and their ratio were not statistically different among the groups. On POD 1, 3 and 7 portal venous pressure in the intervention groups(PHT:8.13 ±1.55, 10.38±1.30, 6.25±0.89 cm H2O and PHS: 7.50±0.93,8.88 ±2.42, 5.75±1.04 cm H2O) was lower compared to the control group(PHC: 8.63±2.06, 10.50±2.45, 6.50±2.67 cmH2O). Hepatocyte proliferation in the intervention groups was delayed, especially after splenectomy on POD 1(Brd U: PHS vs PHC, 20.85% ±13.05% vs 28.11%±10.10%; Ki-67, 20.14%±14.10% vs 23.96% ±11.69%). However, none of the differences were statistically significant.CONCLUSIONS: Neither the administration of terlipressin nor splenectomy improved liver regeneration after 70% partial hepatectomy in rats. Further studies assessing the regulation of portal venous pressure as well as extended hepatectomy animal models and liver function tests will help to further investigate mechanisms of liver regeneration.展开更多
Background: Liver transplantation remains the main curative treatment option for hepatocellular carcinoma(HCC) patients. In the Eurotransplant area Milan criteria are used to assign priority extra points(exceptional M...Background: Liver transplantation remains the main curative treatment option for hepatocellular carcinoma(HCC) patients. In the Eurotransplant area Milan criteria are used to assign priority extra points(exceptional MELD, ex MELD) for patients on the waiting list. To prevent patients from tumor progression, loco-regional(neoadjuvant) treatment(LRT) is used. For patients unlikely to timely receive an organ via primary allocation,“extended critera donor(ECD) organs” are used. The present study aimed to investigate the survival after LT with a strategy of minimizing waiting list dropouts by using LRT for bridging and transplanting ECD organs if possible and necessary. Methods: Between October 2010 and May 2015, 50 liver transplants for HCC were included in this retrospective study. Of those, 42(84%) met the Milan criteria according to the preoperative radiological examination. Forty-one patients(82%) received LRT. The waiting time was analyzed according to LRT. Kaplan-Meier curves with log-rank statistics were used for survival analyses. Results: One-and five-year overall survival within Milan criteria was 94.3% and 83.7% compared with 91.7% and 67.9% beyond Milan criteria, though statistical significance was not reached( P = 0.487). LRT had no impact on overall survival( P = 0.629). Median waiting time was shorter if no LRT was performed(4.6 months vs. 1.5 months, P = 0.006) and there were no cases of waiting list dropouts. Using ECD organs had no impact on overall survival( P = 0.663). Conclusions: Patients with an expected waiting time to transplantation of > 6 months could be successfully treated with LRT as a bridge to transplant. Overall and disease-free survival for patients within and beyond Milan criteria was comparable and the use of ECD organs in this cohort of HCC patients proved to be a safe option.展开更多
BACKGROUND Laparoscopic liver surgery is currently considered the standard of care for various liver malignancies.However,studies focusing on perioperative outcome after laparoscopic hepatectomy(LH)in overweight patie...BACKGROUND Laparoscopic liver surgery is currently considered the standard of care for various liver malignancies.However,studies focusing on perioperative outcome after laparoscopic hepatectomy(LH)in overweight patients are still sparse and its benefit compared to open hepatectomy(OH)is a matter of debate.AIM To analyze postoperative outcomes in overweight[body mass index(BMI)over 25 kg/m²]and obese(BMI over 30 kg/m²)patients undergoing LH and compare postoperative outcome with patients undergoing OH.METHODS Perioperative data of 68 overweight(BMI over 25 kg/m²)including a subcohort of obese(BMI over 30 kg/m²)patients(n=27)who underwent LH at our institution between 2015 and 2019 were retrospectively analyzed regarding surgical outcome and compared to an equal number of patients undergoing OH.RESULTS The mean BMI was 29.8±4.9 kg/m2 in the LH group and 29.7±3.6 kg/m2 in the OH group with major resections performed in 20.6%(LH)and 26.5%(OH)of cases,respectively.Operative time(194±88 min vs 275±131 min;P<0.001)as well as intensive care(0.8±0.7 d vs 1.1±0.8 d;P=0.031)and hospital stay(7.3±3.6 d vs 15.7±13.5 d;P<0.001)were significant shorter in the LH group.Also,overall complications(20.6%vs 45.6%;P=0.005)and major complications(1.5%vs 14.7%,P=0.002)were observed less frequently after LH.An additional investigation analyzing the subgroup of obese patients who underwent LH(n=27)and OH(n=29)showed a shorter operative time(194±81 min vs 260±137 min;P=0.009)and a reduced length of hospitalization(7.7±4.3 d vs 17.2±17 d;P<0.001)but no difference in postoperative complications or overall cost.CONCLUSION LH is safe and cost-effective in overweight and obese patients.Furthermore,LH is significantly associated with fewer postoperative complications and reduced hospital stay compared to OH in these patients.展开更多
文摘BACKGROUND:The potential effect of graft steatosis on the postoperative liver function is discussed controversially. The present study aimed to evaluate the effect of the donor liver microvesicular steatosis on the postoperative outcome after liver transplantation.METHODS:Ninety-four patients undergoing liver transplantation at the University Hospital Aachen were included in this study. The patient cohort was divided into three groups according to the grade of microvesicular steatosis(MiS):MiS <30%(n=27), MiS 30%-60%(n=41) and MiS >60%(n=26).The outcomes after liver transplantation were evaluated, including the 30-day and 1-year patient and graft survival rates and the incidences of early allograft dysfunction(EAD) and primary nonfunction(PNF). RESULTS:The incidences of EAD and PNF did not differ significantly between the groups. We observed 5 cases of PNF,one occurred in the MiS <30% group and 4 in the MiS 30%-60% group. The 30-day and 1-year graft survivals did not differ significantly between groups. The 30-day patient survival rates were 100% in all groups. The 1-year patient survival rates were 94.4% in the MiS <30% group, 87.9% in the MiS 30%-60% group and 90.9% in the MiS >60% group.CONCLUSION:Microvesicular steatosis of donor livers has no negative effect on the postoperative outcome after liver transplantation.
文摘BACKGROUND: Post-hepatectomy liver failure as a result of insufficient liver remnant is a feared complication in liver surgery. Efforts have been made to find new strategies to support liver regeneration. The aim of this study was to investigate the effects of terlipressin versus splenectomy on postoperative liver function and liver regeneration in rats undergoing 70%partial hepatectomy. METHODS: Seventy-two male Wistar rats were randomly assigned into three groups(n=24 in each group): 70% partial hepatectomy as control(PHC), 70% partial hepatectomy with splenectomy(PHS) or 70% partial hepatectomy with a micropump for terlipressin administration(PHT). Eight rats in each group were sacrificed on postoperative day(POD) 1,3 and 7. To assess liver regeneration, immunohistochemical analysis of liver tissue using bromodeoxyuridine(BrdU) and Ki-67 labeling was performed. Portal venous pressure, serum concentrations of creatinine, urea, albumin, bilirubin and prothrombin time as well as liver-, body-weight and their ratio were determined on POD 1, 3 and 7.RESULTS: The liver-, body-weight and their ratio were not statistically different among the groups. On POD 1, 3 and 7 portal venous pressure in the intervention groups(PHT:8.13 ±1.55, 10.38±1.30, 6.25±0.89 cm H2O and PHS: 7.50±0.93,8.88 ±2.42, 5.75±1.04 cm H2O) was lower compared to the control group(PHC: 8.63±2.06, 10.50±2.45, 6.50±2.67 cmH2O). Hepatocyte proliferation in the intervention groups was delayed, especially after splenectomy on POD 1(Brd U: PHS vs PHC, 20.85% ±13.05% vs 28.11%±10.10%; Ki-67, 20.14%±14.10% vs 23.96% ±11.69%). However, none of the differences were statistically significant.CONCLUSIONS: Neither the administration of terlipressin nor splenectomy improved liver regeneration after 70% partial hepatectomy in rats. Further studies assessing the regulation of portal venous pressure as well as extended hepatectomy animal models and liver function tests will help to further investigate mechanisms of liver regeneration.
文摘Background: Liver transplantation remains the main curative treatment option for hepatocellular carcinoma(HCC) patients. In the Eurotransplant area Milan criteria are used to assign priority extra points(exceptional MELD, ex MELD) for patients on the waiting list. To prevent patients from tumor progression, loco-regional(neoadjuvant) treatment(LRT) is used. For patients unlikely to timely receive an organ via primary allocation,“extended critera donor(ECD) organs” are used. The present study aimed to investigate the survival after LT with a strategy of minimizing waiting list dropouts by using LRT for bridging and transplanting ECD organs if possible and necessary. Methods: Between October 2010 and May 2015, 50 liver transplants for HCC were included in this retrospective study. Of those, 42(84%) met the Milan criteria according to the preoperative radiological examination. Forty-one patients(82%) received LRT. The waiting time was analyzed according to LRT. Kaplan-Meier curves with log-rank statistics were used for survival analyses. Results: One-and five-year overall survival within Milan criteria was 94.3% and 83.7% compared with 91.7% and 67.9% beyond Milan criteria, though statistical significance was not reached( P = 0.487). LRT had no impact on overall survival( P = 0.629). Median waiting time was shorter if no LRT was performed(4.6 months vs. 1.5 months, P = 0.006) and there were no cases of waiting list dropouts. Using ECD organs had no impact on overall survival( P = 0.663). Conclusions: Patients with an expected waiting time to transplantation of > 6 months could be successfully treated with LRT as a bridge to transplant. Overall and disease-free survival for patients within and beyond Milan criteria was comparable and the use of ECD organs in this cohort of HCC patients proved to be a safe option.
文摘BACKGROUND Laparoscopic liver surgery is currently considered the standard of care for various liver malignancies.However,studies focusing on perioperative outcome after laparoscopic hepatectomy(LH)in overweight patients are still sparse and its benefit compared to open hepatectomy(OH)is a matter of debate.AIM To analyze postoperative outcomes in overweight[body mass index(BMI)over 25 kg/m²]and obese(BMI over 30 kg/m²)patients undergoing LH and compare postoperative outcome with patients undergoing OH.METHODS Perioperative data of 68 overweight(BMI over 25 kg/m²)including a subcohort of obese(BMI over 30 kg/m²)patients(n=27)who underwent LH at our institution between 2015 and 2019 were retrospectively analyzed regarding surgical outcome and compared to an equal number of patients undergoing OH.RESULTS The mean BMI was 29.8±4.9 kg/m2 in the LH group and 29.7±3.6 kg/m2 in the OH group with major resections performed in 20.6%(LH)and 26.5%(OH)of cases,respectively.Operative time(194±88 min vs 275±131 min;P<0.001)as well as intensive care(0.8±0.7 d vs 1.1±0.8 d;P=0.031)and hospital stay(7.3±3.6 d vs 15.7±13.5 d;P<0.001)were significant shorter in the LH group.Also,overall complications(20.6%vs 45.6%;P=0.005)and major complications(1.5%vs 14.7%,P=0.002)were observed less frequently after LH.An additional investigation analyzing the subgroup of obese patients who underwent LH(n=27)and OH(n=29)showed a shorter operative time(194±81 min vs 260±137 min;P=0.009)and a reduced length of hospitalization(7.7±4.3 d vs 17.2±17 d;P<0.001)but no difference in postoperative complications or overall cost.CONCLUSION LH is safe and cost-effective in overweight and obese patients.Furthermore,LH is significantly associated with fewer postoperative complications and reduced hospital stay compared to OH in these patients.
