No abstract

Multivisceral transplantation is now an effective treatment of patients with complex abdominal pathology. The incidences of serious acute rejection and patient survival have improved in the most recent experience. Our results show that the multivisceral graft seems to facilitate engraftment of transplanted organs and raises the possibility that there is a degree of immunologic protection afforded by this procedure.

The subset of PVT patients requiring nonphysiological portal vein reconstruction was associated with higher complication rates and suffered diminished long-term prognoses. For the most severe PVT cases, a comprehensive approach is critical to further improve outcomes.

Itx in children still is a high-risk procedure but has now become a viable option for children who otherwise have no hope for survival. Control of respiratory infection is of particular importance in the younger children.

A selective protocol based on donor and recipient risk factors for post-liver transplant HBV infection can prevent hepatitis-B infection and avoid unnecessary administration of antiviral prophylaxis in recipients of HBsAg(-), anti-HBc(+) liver allografts.

The use of a nonvascularized FoRM is a novel and simple surgical option to resolve complex abdominal wall defects in liver/intestinal/multivisceral transplant recipients when it can be covered with the recipient skin.

Porto-caval hemitransposition (PCH) in liver transplantation allows revascularization of the liver when the porto-mesenteric axis is thrombosed. We, here, review our experience over an 11-year period. A total of 23 patients underwent liver transplantation using PCH. Immunosuppression was based on tacrolimus, with sirolimus used in case of renal insufficiency. Most common diagnoses were hepatitis C, Laennec's, BuddChiari and cryptogenic cirrhosis. Six patients needed splenectomy prior to transplant, 5 during transplant, 1 post-transplant, 11 had no splenectomy. Overall survival was 60% at 1 year and 38% at 3 years, with 10 of 23 patients currently alive and the longest survivor at 9.3 years. Most common cause of death was sepsis/multisystem organ failure, followed by pulmonary embolism. A total of 7/23 patients experienced postoperative gastrointestinal bleeding episodes, 6/23 patients developed thrombosis of the vena cava (median 162 days post-op). Post-operative ascites was noted in almost all patients. Renal dysfunction was commonly seen even after the first month post-transplant. PCH offers a feasible option for liver transplantation in those patients with complex thrombosis of the mesenteric and portal circulation.

Objective To compare outcomes for patients with hepatocellular carcinoma (HCC) treated with either liver resection or transplantation. Methods A retrospective, single institution analysis of 413 HCC patients from 1999–2009. Results 413 patients with HCC underwent surgical resection (n=106), transplantation (n=270), or were listed without receiving transplantation (n=37). Excluding transplanted patients with incidental tumors (n=50), 257 patients with suspected HCC were listed with the intent to transplant (ITT). The median diameter of the largest tumor by radiography was 6.0 cm in resected, 3.0 cm in transplanted, and 3.4 cm in the listed-but-not-transplanted patients. Median time to transplant was 48 days. Recurrence rates were 19.8% for resection and 12.1% for all ITT patients. Overall, patient survival for resection vs. ITT patients was similar (5-year survival of 53.0% vs. 52.0%, NS). However, for HCC patients with MELD scores <10 and who radiologically met Milan or UCSF criteria, 1-year and 5-year survival rates were significantly improved in resected patients. For patients with MELD <10 and who met Milan criteria, 1-year and 5-year survival were 92.0% and 63.0% for resection (n=26) vs. 83.0% and 41.0% for ITT (n=73, p=0.036). For those with MELD <10 and met UCSF criteria, 1-year and 5-year survival was 94.0% and 62.0% for resection (n=33) vs. 81.0% and 40.0% for ITT (n=78, p=0.027). Conclusions Among known HCC patients with preserved liver function, resection was associated with superior patient survival versus transplantation. These results suggest surgical resection should remain the first line therapy for patients with HCC and compensated liver function who are candidates for resection.