Anand Ramamurthy

Initial Poor Function and Primary Nonfunction in Deceased-Donor Orthotopic Liver Transplantation Maintaining Short Cold Ischemic Time What Is the Influence of Poor Donor Maintenance? Notes From a Single Indian Center

Background: Nations with emerging deceased-donor liver transplantation programs, such as India, face problems associated with poor donor maintenance. Cold ischemic time (CIT) is typically maintained short by matching donor organ recovery and recipient hepatectomy to achieve maximum favorable outcome. We analyzed different extended criteria donor factors including donor acidosis, which may act as a surrogate marker of poor donor maintenance, to quantify the risk of primary nonfunction (PNF) or initial poor function (IPF). Methods: A single-center retrospective outcome analysis of prospectively collected data of patients undergoing deceased-donor liver transplantation over 2 years to determine the impact of different extended criteria donor factors on IPF and PNF. Results: From March 2013 to February 2015, a total of 84 patients underwent deceased-donor liver transplantation. None developed PNF. Thirteen (15.5%) patients developed IPF. Graft macrosteatosis and donor acidosis were only related to IPF (P = .002 and P = .032, respectively). Cold ischemic time was maintained short (81 cases ≤8 hours, maximum 11 hours) in all cases. Conclusion: Poor donor maintenance as evidenced by donor acidosis and graft macrosteatosis had significant impact in developing IPF when CIT is kept short. Similar study with larger sample size is required to establish extended criteria cutoff values.

Incidental Ventricular Septal Defect (VSD) in the Donor of a Live Donor Liver Transplant: Tackle and Proceed

Live Donor Liver Transplantation (LDLT) is an act of selflessness on the part of the donor who is subjected to a major hepatectomy. Ensuring safety and long-term well being of the donor is of utmost priority. We describe a 21-year-old otherwise healthy donor with perimembranous Ventricular Septal Defect (VSD) who successfully underwent donor hepatectomy after closure of the VSD. There is no literature available to guide regarding course of action in such a condition neither any study to substantiate the risk involved. Optimum anticoagulation, endocarditis prophylaxis and optimum interval between the two procedures are areas to be defined as our experience with similar cases increases. Our case emphasizes the importance of multidisciplinary approach and management of such patient at high volume centers.

Inferior vena cava obstruction as a rare manifestation of bronchopulmonary sequestration: Inferior vena cava obstruction

Bronchopulmonary sequestration (BPS) is a rare congenital problem with anomalous vascular supply and absence of tracheobronchial communication. Continued inflammation consequent to sequestration can, in rare cases, lead to atherosclerotic damage to the feeding artery and resultant aneurysm formation. We present a case of BPS presenting with partial inferior vena cava obstruction caused by aneurysmal dilatation of the feeding artery.

Hepatic infarction from portal vein thrombosis: A fatal consequence of acute pancreatitis: Hepatic infarction in acute pancreatitis

Acute pancreatitis is potentially fatal and its severe form is often associated with pancreatic necrosis and high mortality. The inflammatory response of the disease causes peripancreatic and pancreatic necrosis, and in severe cases results in multi organ damage through vascular insult in the form of either arterial spasm, arterial thrombosis or splanchnic thrombosis. Hepatic infarction from acute pancreatitis is rare as the liver has a dual blood supply. We reported a patient with severe acute pancreatitis (SAP) who presented with hepatic infarction due to splanchnic thrombosis.