Jai Young Cho

Thrombosis confined to the portal vein is not a contraindication for living donor liver transplantation

BackgroundThere is a lack of agreement regarding preexisting portal vein thrombosis (PVT) in patients undergoing living donor liver transplantation (LDLT). We report the results of a single-center study to determine the impact of PVT on outcomes of adult LDLT recipients.MethodsOf 133 cases of adult LDLT performed between January 2000 and December 2004, a thrombectomy was performed on 22 patients (16.5%) with PVT during the transplant procedure. One hundred eleven patients without PVT (group 1) were compared with those with a thrombosis confined to the portal vein (group 2; nxa0=xa015) and patients with the thrombosis beyond the portal vein (group 3; nxa0=xa07).ResultsThe sensitivities of Doppler ultrasound and CT in detecting PVT were 50 and 63.6%. A prior history of variceal bleeding (ORxa0=xa010.6, pxa0=xa00.002) and surgical shunt surgery (ORxa0=xa028.1, pxa0=xa00.044) were found to be an independent risk factors for PVT. The rate of postoperative PVT was significantly higher in patients with PVT than in those without (18.2 vs. 2.7%; pxa0=xa00.014). In particular, the rethrombosis rate in group 3 was 28.6%. The actuarial 3-year patient survival rate in PVT patients (73.6%) was similar to that of the non-PVT patients (85.3%; pxa0=xa00.351). However, the actuarial 3-year patient survival rate in group 3 was 38.1%, which was significantly lower than that in groups 1 and 2 (pxa0=xa00.006).ConclusionA thrombosis confined to the portal vein per se should not be considered a contraindication for LDLT.

The Right Small-for-Size Graft Results in Better Outcomes than the Left Small-for-Size Graft in Adult-to-Adult Living Donor Liver Transplantation

BackgroundThe recent outcome of adult-to-adult living donor liver transplantation (ALDLT) using small-for-size grafts (SFSGs; GRWR <0.8%) has been excellent after right grafts were exclusively used in large-volume ALDLT centers.MethodsWe compared the outcome of ALDLTs using 11 right SFSGs (group R) with that using 18 left SFSGs (group L) of our center. The dysfunction of graft was defined dysfunction as hyperbilirubinemia (>5xa0mg/dl), prolonged prothrombin time (>2 INR), or uncontrolled ascites (>1,000xa0ml/day) on 3 consecutive days in posttransplant 7xa0days, and the dysfunction score (DS; the sum of points given per each sign) of the graft was used to describe the SFSG dysfunction severity.ResultsThe pretransplant recipient status was similar between the groups, but the 1-year mortality rate was 0% in group R and 33.3% (nxa0=xa06) in group L (pxa0=xa00.038). The ICU stay was longer in group L (20xa0days) than in group R (11xa0days; pxa0=xa00.004). Hyperbilirubinemia in group R vs. L was noted in 54.5% vs. 50%, prolonged prothrombin time in 18.2% vs. 50%, and uncontrolled ascites in 54.5% vs. 100%. The DS was lower in group R than in group L (1.3 vs. 2; pxa0=xa00.007). The DS was zero in four right liver recipients. On multivariate analysis, the only factor affecting DS was the graft side.ConclusionThe clinical signs of SFSG dysfunction were less arduous and there was no 1-year mortality in cases in group R. Therefore, the right SFSG may be used for ALDLT in the future base on the transplant center’s experience.

ABO-incompatible living donor liver transplantation in a patient with a history of platelet transfusion- related anaphylaxis

Anaphylaxis and severe allergic transfusion reactions (ATR) are uncommon complications after blood transfusion. Nevertheless, these complications are associated with very severe outcomes, such as dyspnea, shock, and death. Patients with end-stage liver disease who require liver transplantation have a high tendency for bleeding because of splenomegaly-induced thrombocytopenia and decreased production of coagulation factors in the liver. Liver transplantation is a very long procedure and a significant perioperative blood loss is highly likely. Therefore, transfusion of platelets and other blood products is often necessary. We report a successful ABO-incompatible living donor liver transplantation in a patient with hepatitis B virus-related liver cirrhosis and hepatocellular carcinoma who had a history of platelet transfusion-related anaphylaxis. coagulation factors. Accordingly, these patients have much a higher risk of bleeding during their illness and blood transfusion is frequently required in their resuscitation. Furthermore, liver transplantation is a complicated procedure that is expected to cause significant blood loss [6], even when the surgeon uses many approaches and techniques to minimize this loss. Therefore, transfusion of multiple units of blood products is necessary during liver transplantation. Here, we report a patient with hepatitis B virus-induced liver cirrhosis and HCC who experienced platelet transfusion-related anaphylaxis after successful ABO-incompatible living donor liver transplantation (LDLT). Case Presentation