Atef Bassas

In situ splitting of cadaveric livers. The ultimate expansion of a limited donor pool.

OBJECTIVE The authors evaluate the safety, applicability, and effectiveness of a new technique for split-liver transplantation. SUMMARY BACKGROUND DATA Split-liver transplantation offers an attractive way to increase the donor pool for cadaveric liver transplantation. The application of this concept has been hampered by inferior patient and graft survivals and higher complication rates. Without supportive data, the concern about increasing biliary leakage and poor initial graft function persisted. The authors focused on the causes of these complications by presenting a new technique to eliminate these problems. METHODS Liver splitting was performed in the heart-beating cadaveric organ donor, using the technique described for procurement of the left lateral lobe of a live donor. A detailed description of the technique is presented. A retrospective review of the first 14 transplantations resulting from 7 in situ splitting procedures was collected. The results were compared with 19 conventional split-liver transplants performed during the same period. RESULTS Six-month patient and graft survivals after in situ split-liver transplantation were 92.8% and 85.7%, respectively. Biliary complications were absent. Postoperative courses were mostly uneventful and characterized by lower peak transaminase levels compared with standard techniques. Early graft function of extrahepatic organs procured simultaneously was excellent. CONCLUSIONS In situ split-liver transplantation provides superior results, related mainly to reduction of cold ischemic damage of the grafts and avoidance of biliary complications. In situ split-liver transplantation renders graft reduction alone obsolete and opens a donor pool for adults to receive right lobes safely. It allows for long-distance sharing between pediatric and adult liver transplant units because the procedure abolishes ex situ benching and prolonged ischemia time and provides two anatomically perfect grafts with hemostasis accomplished.

Overcoming the portal steal phenomenon in auxiliary partial orthotopic liver transplantation by modulation of the venous outflow of the native liver.

The main drawback of auxiliary partial orthotopic liver transplantation (APOLT) is the competition of the portal flow between the graft and the native liver, leading to graft failure. In two patients with Crigler‐Najjar syndrome type I, the intrahepatic resistance of the native liver was increased by occluding the recipients middle hepatic vein during parenchymal transection, leading the portal flow towards the graft. This new surgical technique could encourage centers to recommence APOLT. (Liver Transpl 2005;11:1140–1143.)

Anesthesia care for living-related liver transplantation for infants and children with end-stage liver disease: report of our initial experience

STUDY OBJECTIVE To describe our initial experience of the perioperative anesthetic care provided to pediatric recipients during living-related liver transplantation. DESIGN Cohort review of the perioperative anesthetic care for living-related liver transplantation. SETTING Tertiary referral and postgraduate teaching hospital. PATIENTS 27 children (20 males, 7 females) with end-stage hereditary metabolic liver disease requiring living-related liver transplantation. INTERVENTION Perioperative care was administered during living-related liver transplantation. MEASUREMENTS The major intraoperative physiologic events and concerns are described, as well as the anesthesia technique for pediatric living-related liver transplantation anesthesia. Intraoperative changes in physiologic parameters and the intraoperative requirements in our series are also reported. MAIN RESULTS During a 30-month period, 27 children (20 males and 7 females) were scheduled for transplantation with an hepatic graft from a living-related donor. Twenty-six children received a graft from a living-related donor, and one was retransplanted with a cadaveric graft because of graft failure, and one child received a cadaveric graft because of the lack of a suitable donor. All patients received intravenous (IV) anesthesia with fentanyl, midazolam, and cisatracurium, and were ventilated with oxygen/air. Mean induction and presurgical preparation time was 1.18 hours, with a surgical time of 6.55 hours. All but one patient was extubated on the evening of the operating day after receiving a mean dose of 8.67 microg kg(-1) hr(-1) of fentanyl and a mean dose of 0.124 mg kg(-1) hr(-1) midazolam. The need for crystalloid infusion was 24.0 mL kg(-1) hr(-1), fresh frozen plasma (FFP)16.63 mL kg(-1) hr(-1), and red blood cells 7.98 mL kg(-1) hr(-1). There was no mortality and no anesthetic-related morbidity in our series. CONCLUSIONS Total IV anesthesia with fentanyl, midazolam, and cisatracurium, after preoperative optimization, is a well-tolerated approach for children undergoing living-related liver transplantation and offers quick recovery. This anesthetic technique was aimed at minimizing the effects on the cardiovascular system, and also any consequences related to the possible occurrence of a reperfusion syndrome. Fluid balance was aimed at optimizing flow through the hepatic graft and preventing thrombosis of vascular anastomoses.

Living-related liver transplantation for Crigler–Najjar syndrome in Saudi Arabia

Objective: To analyse the outcome of six children with Crigler–Najjar syndrome type I (CNS‐I) and report the first three living‐related liver transplants for this syndrome in Saudi Arabia and the Middle East.