V. Scuderi

No evidence of in vitro and in vivo porcine endogenous retrovirus infection after plasmapheresis through the AMC-bioartificial liver

Abstract:u2002 Background:u2002 Currently a number of bioartificial livers (BAL) based on porcine liver cells have been developed as a treatment to bridge acute liver failure patients to orthotopic liver transplantation or liver regeneration. These xenotransplantation related treatments hold the risk of infection of treated patients by porcine endogenous retrovirus (PERV) released from the porcine cells, as in vitro infection experiments and transplantations in immunocompromised mice have shown that PERV is able to infect human cells. The Academic Medical Center (AMC)‐BAL, unlike other BALs, is characterized by direct contact between porcine liver cells and human plasma, and might therefore be permissive for PERV transfer.

Hepatitis B Prophylaxis in Hepatitis B–Negative Recipients Transplanted With Donor Grafts Positive for Hepatitis B Core Antibodies

BACKGROUND AND AIMSnUse of grafts from hepatitis B (HBV) core antibody (HBcAb(+)) individuals is a routine transplant practice. Herein, we have reported the results of 20 HBV-negative patients transplanted with a HBcAb-positive liver grafts in order to access the efficacy of HBV prophylaxis using immunoglobulin (IE) and antiviral drugs.nnnMETHODSnFrom January 2004 to December 2009, we performed 168 liver transplantations including 38 HBcAb-positive grafts (22.6%) in 18 cases of HBV-positive recipients and 20 HBV-negative recipients. Histological data obtained from these last 20 grafts during retrieval showed an Ishak 1 score in three and no fibrosis in the other cases. HBV prophylaxis included infusion of 10,000 UI IG during the anhepatic phase and every 24 hours for the first 7 days irrespective of the antibody titer as well as lamivudin (100 mg) administered daily. Once discharged, outpatient management provided modulated IG infusions according to when the antibody titer was lower than 400 UI.nnnRESULTSnNo patient displayed an HBV infection. The overall survival was 80%. Two patients died within the first month after transplantation due to septic complications; one patient succumbed at 24 months after transplantation because of a lymphoproliferative malignancy and another died due to an aggressive hepatitis C virus recurrence at 6 months post transplant.nnnCONCLUSIONnBy using appropriate anti-HBV prophylaxis, HBcAb-positive grafts can be used safely for HBcAb-negative recipients.

Left Hepatectomy: Laparoscopic Approach

Since the first laparoscopic anatomical hepatectomy, reported by Azagra et al. in 1996 [1], major laparoscopic hepatectomies have become increasingly frequent: in a 2009 world review of almost 3,000 laparoscopic liver resections (LLR), 7% were left hepatectomies [2]. Several studies show the safety and feasibility of major LLR in the hands of surgeons who are expert in both liver and laparoscopic surgery [3, 4]. The Louisville Conference in 2008 established that there is no formal contraindication to minimally invasive surgery of the liver (MISL), even for major hepatectomies, provided that established guidelines are attentively followed [5].

Encircling the Pedicle for the Pringle Maneuver

Although some liver resections may now be safely performed without vascular clamping, blood saving remains an important concern in hepatobiliary surgery, especially in patients with liver tumors, as blood loss seems to directly affect early and late outcome.

Treating the Resected Surface

Postoperative complications directly due to liver resection are hepatic failure and abdominal fluid collections due to bleeding or biliary leaks from the resection plane. The decrease in complication rates is due to technological advances and the widespread use of anatomically oriented resection techniques that significantly minimize liver-tissue necrosis. Hepatic parenchyma has in fact a complex, high-density framework of vascular and biliary structures, and even the most meticulous and appropriate approach to resection does not exclude the risk of postoperative bleeding and/or biliary leaks.