Living donor liver transplantation (LDLT) is a vital tool to address the growing organ shortage in the United States caused by increasing numbers of patients diagnosed with end‐stage liver disease. ...LDLT still only makes up a very small proportion of all liver transplantations performed each year, but there are many innovations taking place in the field that may increase its acceptance among both transplant programs and patients. These innovations include ways to improve access to LDLT, such as through nondirected donation, paired exchange, transplant chains, transplant of ABO‐incompatible donors, and transplants in patients with high Model for End‐Stage Liver Disease scores. Surgical innovations, such as laparoscopic donor hepatectomy, robotic hepatectomy, and portal flow modulation, are also increasingly being implemented. Policy changes, including decreasing the financial burden associated with LDLT, may make it a more feasible option for a wider range of patients. Lastly, center‐level behavior, such as ensuring surgical expertise and providing culturally competent education, will help toward LDLT expansion. Although it is challenging to know which of these innovations will take hold, we are already seeing LDLT numbers improve within the past 2 years.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
IMPORTANCE: Long-term oncologic outcomes of robotic surgery remain a hotly debated topic in surgical oncology, but sparse data have been published thus far. OBJECTIVE: To analyze short- and long-term ...outcomes of robotic liver resection (RLR) for hepatocellular carcinoma (HCC) from Western high-volume centers to assess the safety, reproducibility, and oncologic efficacy of this technique. DESIGN, SETTING, AND PARTICIPANTS: This cohort study evaluated the outcomes of patients receiving RLR vs open liver resection (OLR) for HCC between 2010 and 2020 in 5 high-volume centers. After 1:1 propensity score matching, a group of patients who underwent RLR was compared with a validation cohort of OLR patients from a high-volume center that did not perform RLR. MAIN OUTCOMES AND MEASURES: A retrospective analysis was performed of prospectively maintained databases at 2 European and 2 US institutions of patients who underwent RLR for HCC between January 1, 2010, and September 30, 2020. The main outcomes were safety and feasibility of RLR for HCC and its oncologic outcomes compared with a European OLR validation cohort. A 2-sided P < .05 was considered significant. RESULTS: The study included 398 patients (RLR group: 125 men, 33 women, median IQR age, 66 58-71 years; OLR group: 315 men, 83 women; median IQR age, 70 64-74 years), and 106 RLR patients were compared with 106 OLR patients after propensity score matching. The RLR patients had a significantly longer operative time (median IQR, 295 190-370 minutes vs 200 165-255 minutes, including docking; P < .001) but a significantly shorter hospital length of stay (median IQR, 4 3-6 days vs 10 7-13 days; P < .001) and a lower number of admissions to the intensive care unit (7 6.6% vs 21 19.8%; P = .002). Incidence of posthepatectomy liver failure was significantly lower in the RLR group (8 7.5% vs 30 28.3%; P = .001), with no cases of grade C failure. The 90-day overall survival rate was comparable between the 2 groups (RLR, 99.1% 95% CI, 93.5%-99.9%; OLR, 97.1% 95% CI, 91.3%-99.1%), as was the cumulative incidence of death related to tumor recurrence (RLR, 8.8% 95% CI, 3.1%-18.3%; OLR, 10.2% 95% CI, 4.9%-17.7%). CONCLUSIONS AND RELEVANCE: This study represents the largest Western experience to date of full RLR for HCC. Compared with OLR, RLR performed in tertiary centers represents a safe treatment strategy for patients with HCC and those with compromised liver function while achieving oncologic efficacy.
Noninvasive means for diagnosing acute rejection in kidney transplants are needed. This study prospectively measured mRNA in urinary cells from kidney-allograft recipients. A three-gene signature ...appeared to be diagnostic and prognostic of acute cellular rejection.
Kidney transplantation is considered the best available treatment for patients with end-stage renal disease (ESRD), but acute rejection, a leading cause of new cases of ESRD, undermines its full benefits.
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Acute rejection is diagnosed by means of needle biopsy. Over time, this invasive procedure has become safer, and biopsy interpretation more standardized.
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Nevertheless, bleeding and subsequent graft loss still occur, and sampling errors and interobserver variability in biopsy reading remain problematic.
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Repeated biopsies to assess the recipient's status pose challenges, including feasibility and cost.
Immunosuppressive drugs effectively treat acute rejection; a noninvasive means of diagnosing this reversible cause of . . .
Minimally invasive donor hepatectomy, systemic review Cho, Hwui-Dong; Samstein, Benjamin; Chaundry, Sulemon ...
International journal of surgery (London, England),
October 2020, 2020-Oct, 2020-10-00, 20201001, Volume:
82
Journal Article
Peer reviewed
Open access
Liver transplantation is a life-saving therapy for patients with end-stage liver disease. Living donation is a critical source of organs throughout the world. Reducing donor morbidity and mortality ...is of utmost importance while maintaining access to liver transplantation for recipients. While laparoscopy was more rapidly utilized in donor nephrectomy, laparoscopy has been slower to develop for living donor hepatectomies due to the concerns about hemostasis, safety of the donor and quality of the graft. Pure minimal invasive approach has become a standard of care for left lateral sectionectomy (LLS) for pediatric recipients. In the past few years, a number of centers with significant laparoscopic and living donor experience have reported fully minimally invasive approach to hemi-hepatectomies. In this manuscript we discuss the experiences, lessons learned and path forward for laparoscopic and minimal invasive surgery(MIS) in donor hepatectomies (DH).
•Because the donor is not a patient with a pathologic condition, donor safety should be fully guaranteed. It is also important to consider quality-of-life parameters, such as postoperative pain or cosmetic outcomes by using Minimally invasive surgical technique.•Pure minimal invasive approach has become a standard of care for left lateral sectionectomy for pediatric recipients.•Laparoscopic major donor hepatectomy is a surgical procedure that requires high proficiency due to anatomic complexity, therefore, it is strongly recommended that the procedure be performed carefully by well experienced surgeons.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Lymphoepithelioma-like intrahepatic cholangiocarcinoma is a rare variant of cholangiocarcinoma that is associated with the Epstein-Barr virus. The intimate relationship between the malignant ...epithelial cells and the numerous lymphoid cells can make the diagnosis challenging on limited tissue samples. We present 2 cases in which the presence of a dense hematolymphoid infiltrate served to mask the diagnosis of carcinoma on initial frozen section and biopsy review, respectively. We bring awareness to this potential diagnostic pitfall and offer morphologic and immunohistochemical clues that may aid in recognition of this unusual and sometimes perplexing carcinoma.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
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