62 results on '"Mauricio Sainz-Barriga"'
Search Results
2. Case report: Immediate revascularization for symptomatic hepatic artery pseudoaneurysm after orthotopic liver transplantation? A case series and literature review
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An Verena Lerut, Jacques Pirenne, Mauricio Sainz-Barriga, Joris Blondeel, Geert Maleux, and Diethard Monbaliu
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case series ,hepatic artery pseudoaneurysm ,orthotopic liver transplantation ,endovascular treatment ,arterial reconstruction ,Surgery ,RD1-811 - Abstract
IntroductionHepatic artery pseudoaneurysm (HAPA), a rare vascular complication that can develop after liver transplantation, is associated with a high mortality rate and graft loss. To salvage the liver graft, immediate revascularization, either through surgical or endovascular intervention, is required. However, currently there is no consensus on the optimal strategy. Here, we report three cases of liver transplant recipients diagnosed with HAPA and treated with immediate revascularization. In addition, we present an overview of HAPA cases described in the literature and make recommendations on how to treat this rare complication.MethodsAll adults transplanted in our center between 2005 and 2021 were retrospectively reviewed. Literature search was done in PubMed for original studies between 1980 and 2021 reporting early hepatic artery (pseudo) aneurysm after liver transplantation requiring either surgical or endovascular intervention.ResultsFrom a total of 1,172, 3 liver transplant patients were identified with a symptomatic HAPA and treated with immediate revascularization. HAPA occurred 73, 27, and 8 days after liver transplantation and was treated with immediate revascularization (two surgical and one endovascular intervention). Literature review identified 127 cases of HAPA. HAPA was managed with endovascular therapy in 20 cases and by surgical intervention in 89 cases. Overall reported mortality rate was 39.6%, whereas overall graft survival was 45.2%.ConclusionImmediate surgical or radiological interventional excision and prompt revascularization to salvage liver grafts is feasible but still associated with a high mortality.
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- 2023
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3. Age Matching of Elderly Liver Grafts With Elderly Recipients Does Not Have a Synergistic Effect on Long-term Outcomes When Both Are Carefully Selected
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Nicholas Gilbo, MD, Ina Jochmans, PhD, Mauricio Sainz-Barriga, PhD, Frederik Nevens, PhD, Schalk van der Merwe, PhD, Wim Laleman, PhD, Chris Verslype, PhD, David Cassiman, PhD, Len Verbeke, PhD, Hannah van Malenstein, PhD, Tania Roskams, PhD, Jacques Pirenne, PhD, and Diethard Monbaliu, PhD
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Surgery ,RD1-811 - Abstract
Background. Older donors and recipients are increasingly considered for liver transplantation. Both donor and recipient age have a negative impact on outcomes. Large registry analyses show that older donors are frequently matched to older recipients. Whether age-related risks accumulate in a synergic negative effect on outcomes because of donor-recipient age matching is poorly understood. Methods. We investigated the impact of donor-recipient age interaction on patient and death-censored graft survival in multivariate Cox regressions in 849 transplants (January 2000 to December 2015). Results. Donors 70 years or older did not affect long-term patient or graft survival. Recipient age independently increased the risk of death (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.02-1.05, P < 0.0001), but donor-recipient age interaction was noninfluential. The negative impact of recipient age on patient survival was significant as early as 6 months after transplantation (HR, 1.06; 95% CI, 1.03-1.09; P = 0.00008). The adjusted risk of death was significant for patients aged 60 to 69 years (HR, 1.995; 95% CI, 1.40-2.85; P < 0.0001) and 70 years or older (HR, 2.001; 95% CI, 1.10-2.66; P = 0.04). In contrast, the risk of graft loss was not influenced by recipient age (HR, 1.02; 95% CI, 0.996-1.04; P = 0.11) or age interaction. Conclusions. Older livers can be safely used in older recipients without jeopardizing graft and patient survival if other risk factors are minimized.
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- 2019
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4. The inferior mesoiliacal shunt: A novel shunt for refractory rectal variceal bleeding due to splanchnic thrombosis
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Marie Cappelle, MD, Thomas Douchy, MD, Dirk Vanbeckevoort, MD, PhD, Inge Fourneau, MD, PhD, Mauricio Sainz Barriga, MD, PhD, and Jacques Pirenne, MD, PhD
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Splanchnic vein thrombosis ,Polycythemia vera ,Inferior mesoiliacal shunt ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Surgical shunt therapy may be required when pharmacologic, endoscopic, and radiologic treatment of chronic splanchnic vein thrombosis have failed. In this case report, we present a new interposition shunt for the treatment of refractory rectal variceal bleeding: the inferior mesoiliacal shunt between the inferior mesenteric vein and the left common iliac vein using a cryopreserved iliac venous graft. The postoperative course was complicated by shunt thrombosis at day 2, probably owing to inadvertent interruption of anticoagulation and a decrease in the shunt flow rate. Surgical thrombectomy was performed successfully. The patient presented no relapse of rectal bleeding and was asymptomatic and well at the 12-month follow-up.
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- 2020
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5. The effect of IGL-1 preservation solution on outcome after kidney transplantation: A retrospective single-center analysis
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Jacques Pirenne, Mauricio Sainz-Barriga, Julie De Beule, Ben Sprangers, Maarten Naesens, Dirk Kuypers, Ina Jochmans, Steffen Fieuws, and Diethard Monbaliu
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medicine.medical_specialty ,Adenosine ,Allopurinol ,Organ Preservation Solutions ,Urology ,Renal function ,030230 surgery ,Single Center ,Potassium Chloride ,03 medical and health sciences ,Raffinose ,0302 clinical medicine ,Humans ,Insulin ,Immunology and Allergy ,Medicine ,Mannitol ,Pharmacology (medical) ,Viaspan ,Kidney transplantation ,Retrospective Studies ,Transplantation ,Proteinuria ,business.industry ,Confounding ,IGL-1 preservation solution ,Organ Preservation ,medicine.disease ,Glutathione ,Kidney Transplantation ,Glucose ,Double robust ,medicine.symptom ,business - Abstract
Institut Georges Lopez-1 (IGL-1) solution is increasingly used for kidney preservation, although little information on outcomes is available. Outcomes of all deceased donor kidneys preserved by IGL-1, University of Wisconsin solution (UW), or histidine-tryptophan-ketoglutarate (HTK) and transplanted in our center (2000-2018) were analyzed. Multivariable analysis for delayed graft function (DGF), functional DGF, estimated glomerular filtration rate (eGFR, CKD-EPI equation), proteinuria, acute rejection, death-censored graft loss, and patient survival were performed. A double robust approach, consisting of propensity score weighting and correction for confounders, minimized the risk of bias. In total, 1943 transplants were included: 234 with IGL-1, 1046 with UW, and 663 with HTK. As IGL-1 was only introduced in 2014, a prespecified sensitivity analysis of 917 kidneys (2010-2018) was performed using the same statistical approach. After weighting, IGL-1 retained a higher proportion of kidneys donated after circulatory death (DCD). IGL-1 was not independently associated with any of the outcomes when compared to UW or HTK. Sensitivity analysis between 2010 and 2018 showed similar results. In this retrospective analysis, using robust methodology to reduce the risk of bias, IGL-1 preservation results in equal outcomes compared to UW or HTK, despite more DCD transplants in the IGL-1 group. ispartof: American Journal Of Transplantation vol:21 issue:2 pages:830-837 ispartof: location:United States status: published
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- 2021
6. Tacrolimus drug exposure level in the first year after liver transplantation is an independant risk factor for de novo malignancy in patients transplanted for alcohol-related liver disease
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Benedict Vanlerberghe, Hannah Van Malenstein, Mauricio Sainz-Barriga, Diethard Monbaliu, Schalk van der Merwe, Jacques Pirenne, Frederik Nevens, and Jef Verbeek
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Hepatology - Published
- 2022
7. The inferior mesoiliacal shunt: A novel shunt for refractory rectal variceal bleeding due to splanchnic thrombosis
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Mauricio Sainz Barriga, Marie Cappelle, Thomas Douchy, Inge Fourneau, Jacques Pirenne, and Dirk Vanbeckevoort
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lcsh:Diseases of the circulatory (Cardiovascular) system ,Innovative technique ,medicine.medical_specialty ,Variceal bleeding ,business.industry ,Splanchnic vein thrombosis ,lcsh:Surgery ,lcsh:RD1-811 ,medicine.disease ,Thrombosis ,Asymptomatic ,Polycythemia vera ,Surgery ,Shunt (medical) ,lcsh:RC666-701 ,medicine ,Inferior mesenteric vein ,Inferior mesoiliacal shunt ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Splanchnic ,business ,Venous graft - Abstract
Surgical shunt therapy may be required when pharmacologic, endoscopic, and radiologic treatment of chronic splanchnic vein thrombosis have failed. In this case report, we present a new interposition shunt for the treatment of refractory rectal variceal bleeding: the inferior mesoiliacal shunt between the inferior mesenteric vein and the left common iliac vein using a cryopreserved iliac venous graft. The postoperative course was complicated by shunt thrombosis at day 2, probably owing to inadvertent interruption of anticoagulation and a decrease in the shunt flow rate. Surgical thrombectomy was performed successfully. The patient presented no relapse of rectal bleeding and was asymptomatic and well at the 12-month follow-up. ispartof: JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES vol:6 issue:4 pages:562-565 ispartof: location:United States status: published
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- 2020
8. Donor Hepatectomy and Implantation Time Are Associated With Early Complications After Liver Transplantation: A Single-center Retrospective Study
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Diethard Monbaliu, Chris Verslype, Tania Roskams, Nicholas Gilbo, David Cassiman, Hannah van Malenstein, Wim Laleman, Schalk Van der Merwe, Steffen Fieuws, Nicolas Meurisse, Ina Jochmans, Frederik Nevens, Jacques Pirenne, and Mauricio Sainz-Barriga
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,medicine.medical_treatment ,Operative Time ,030230 surgery ,Anastomosis ,Liver transplantation ,Single Center ,Risk Assessment ,Donor Selection ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Cause of Death ,medicine ,Hepatectomy ,Humans ,Risk factor ,Retrospective Studies ,Transplantation ,Cholestasis ,business.industry ,Hazard ratio ,Retrospective cohort study ,Odds ratio ,Middle Aged ,Tissue Donors ,Surgery ,Liver Transplantation ,medicine.anatomical_structure ,Treatment Outcome ,030211 gastroenterology & hepatology ,Female ,business ,Artery - Abstract
BACKGROUND: Donor hepatectomy and liver implantation time reduce long-term graft and patient survival after liver transplantation. It is not known whether these surgical times influence early outcomes after liver transplantation. METHODS: This single-center study evaluated the effect of donor hepatectomy and implantation time on the risk of nonanastomotic biliary strictures occurring within 1 year and of early allograft dysfunction after deceased-donor solitary liver transplantation, adjusting for other donor, recipient, and surgical factors. RESULTS: Of 917 transplants performed between 1/2000 and 12/2016, 106 (11.56%) developed nonanastomotic biliary strictures and 247 (27%) developed early allograft dysfunction. Donor hepatectomy time (median 35 min, IQR: 26-46) was an independent risk factor of nonanastomotic biliary strictures (adjusted hazard ratio (HR): 1.19, 95% CI: 1.04-1.35, p=0.01). Implantation time (median 80 min, IQR: 69-95) was independently associated with early allograft dysfunction (adjusted odds ratio (OR): 1.15, 95% CI:1.07-1.23, p
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- 2020
9. Liver-Related and Cardiovascular Outcome of Patients Transplanted for Nonalcoholic Fatty Liver Disease: A European Single-Center Study
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Jakob Van Herck, Mauricio Sainz-Barriga, Frederik Nevens, Wim Laleman, Jef Verbeek, Schalk Van der Merwe, Diethard Monbaliu, Chris Verslype, David Cassiman, Ina Jochmans, Hannah van Malenstein, and Jacques Pirenne
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Liver transplantation ,Single Center ,Gastroenterology ,Disease-Free Survival ,End Stage Liver Disease ,Non-alcoholic Fatty Liver Disease ,Recurrence ,Risk Factors ,Internal medicine ,Nonalcoholic fatty liver disease ,medicine ,Humans ,Myocardial infarction ,Aged ,Metabolic Syndrome ,Transplantation ,business.industry ,Incidence (epidemiology) ,Incidence ,Metabolic risk ,nutritional and metabolic diseases ,Hepatitis C ,Middle Aged ,medicine.disease ,digestive system diseases ,Liver Transplantation ,Survival Rate ,Treatment Outcome ,Case-Control Studies ,Surgery ,Female ,Metabolic syndrome ,business - Abstract
BACKGROUND The increasing rate of liver transplantation (LT) for nonalcoholic fatty liver disease (NAFLD) raises concerns on cardiovascular morbidity and mortality after LT in these patients. METHODS We collected variables regarding the presence of metabolic risk factors, NAFLD recurrence, cardiovascular morbidity, and overall survival at time of listing and after LT of 112 patients with NAFLD and a control group of 120 patients with hepatitis C (HCV). RESULTS Metabolic syndrome and cardiovascular morbidity component rates (24.1% vs 12.5%) at the time of LT listing were higher in patients with NAFLD compared with patients with HCV (for all, P < .0390). Median follow-up after LT was 5.6 years in patients with NAFLD vs 13.5 years in patients with HCV (P = .0009). There was no difference in 6-weeks postoperative mortality (1.7% vs 2.5%) (P =1.0000). Metabolic syndrome components after LT were more frequent in patients with NAFLD than in patients with HCV (for all, P < .0008). The incidence of NAFLD 5 years after LT was higher in patients transplanted for NAFLD compared with HCV (43.5% vs 4.2%) (P < .0001). Patients with recurrent NAFLD more often had myocardial infarction compared with those without recurrence (8.3% vs 0%) (P = .0313). Five years after LT, cardiovascular morbidity was more frequent in the NAFLD group than in the HCV group (12.8% vs 9.3%) (P = .0256), whereas no difference in overall survival was observed. CONCLUSION LT for NAFLD is associated with satisfactory 5-year outcomes; however, our data underscore the need for close monitoring and aggressive management of cardiovascular risk factors in these patients.
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- 2020
10. The effect of organ preservation solutions on short-term outcomes after liver transplantation: a single-center retrospective study
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Mauricio Sainz-Barriga, Steffen Fieuws, Diethard Monbaliu, Ina Jochmans, Jef Van den Eynde, Nicholas Gilbo, Jannick Achtergaele, and Jacques Pirenne
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medicine.medical_specialty ,preservation solutions ,Adenosine ,medicine.medical_treatment ,Organ Preservation Solutions ,030230 surgery ,Liver transplantation ,Single Center ,Potassium Chloride ,Histidine-tryptophan-ketoglutarate ,03 medical and health sciences ,0302 clinical medicine ,Raffinose ,medicine ,Preservation solutions ,Humans ,Insulin ,Mannitol ,Retrospective Studies ,Transplantation ,liver transplantation ,business.industry ,Incidence (epidemiology) ,Confounding ,Graft Survival ,Retrospective cohort study ,Organ Preservation ,Glutathione ,UW ,Surgery ,Liver Transplantation ,HTK ,Glucose ,Liver ,030211 gastroenterology & hepatology ,business ,IGL-1 - Abstract
The effect of preservation solutions on outcomes has been subject of many debates but the relative benefits of the various solutions remain unclear. We retrospectively compared short-term outcomes of 885 liver transplantations performed between 1/2000 and 12/2017 and preserved with either Histidine-Tryptophan-Ketoglutarate (HTK, n = 190), University of Wisconsin (UW, n = 557), or Institute George Lopez 1 preservation solution (IGL-1, n = 139). Inverse probability of treatment weighting (IPTW) was performed to account for baseline differences between groups and analyses were adjusted for confounders. In the IPTW analyses, peak AST within 7 days was 44% higher (95% CI 15-81%, P
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- 2020
11. Solid organ donation after death from listeria encephalitis: A case report
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Jacques Pirenne, Mauricio Sainz Barriga, Diethard Monbaliu, Katrien Lagrou, Thomas Douchy, Yves Debaveye, and Ina Jochmans
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Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Endoscopic dilatation ,030230 surgery ,Liver transplantation ,Listeria infection ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Bacteremia ,medicine ,030211 gastroenterology & hepatology ,Invasive Listeriosis ,Organ donation ,business ,Kidney transplantation - Abstract
Despite organ shortage, organs from donors with listeria infections have been discarded for transplantation. We present the first-reported case of liver transplantation following listeria encephalitis. The patient was admitted with progressing neurological symptoms after an episode of gastroenteritis. Rhombo-encephalitis was diagnosed, and Listeria monocytogenes was found to be the causative pathogen. Despite proper antibiotic treatment and rapid clearance of bacteremia, he continued to deteriorate and became brain dead, after which organ donation was performed. At procurement, he had been treated with amoxicillin for 9 days. The recipient was treated with pipercillin/tazobactam for 21 days. Besides an anastomotic biliary stricture, necessitating endoscopic dilatation and stenting, further clinical course was uneventful and she is doing well eleven months post-transplant. Our case suggests that listeria encephalitis is not an absolute contra-indication to solid organ donation. We suggest that donors should be treated with adequate antibiotics for at least 48h prior to procurement and advocate confirmation of sterile blood cultures as a prerequisite for donation. According to listeriosis guidelines, we suggest that the recipient should be treated with targeted antibiotics for at least 2 weeks. The risk of transmission should, however, always be balanced carefully against the suspected waiting list mortality.
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- 2020
12. The Histological Picture of Indication Biopsies in the First 2 Weeks after Kidney Transplantation
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Maarten Naesens, Aleksandar Senev, Dirk Kuypers, Jacques Pirenne, Katrien De Vusser, Mauricio Sainz Barriga, Ben Sprangers, Amaryllis H. Van Craenenbroeck, Evelyne Lerut, Elisabet Van Loon, Ina Jochmans, Diethard Monbaliu, Maarten Coemans, and Marie-Paule Emonds
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Graft Rejection ,Male ,Time Factors ,Epidemiology ,Biopsy ,030230 surgery ,Critical Care and Intensive Care Medicine ,Kidney ,Gastroenterology ,0302 clinical medicine ,HLA Antigens ,Risk Factors ,Autografts ,Kidney transplantation ,0303 health sciences ,medicine.diagnostic_test ,Hazard ratio ,Cold Ischemia ,Graft Survival ,Age Factors ,Middle Aged ,medicine.anatomical_structure ,Kidney Tubules ,Nephrology ,Cohort ,Female ,Adult ,medicine.medical_specialty ,Genotype ,Ischemia ,Delayed Graft Function ,Antibodies ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,030304 developmental biology ,Aged ,Proportional Hazards Models ,Inflammation ,Transplantation ,Proportional hazards model ,business.industry ,Original Articles ,medicine.disease ,Kidney Transplantation ,Microvessels ,business - Abstract
Background and objectives In preclinical studies, ischemia-reperfusion injury and older donor age are associated with graft inflammation in the early phase after transplantation. In human kidney transplantation, impaired allograft function in the first days after transplantation is often adjudicated to donor- and procedure-related characteristics, such as donor age, donor type, and ischemia times. Design, setting, participants, & measurements In a cohort of 984 kidney recipients, 329 indication biopsies were performed within the first 14 days after transplantation. The histologic picture of these biopsies and its relationship with alloimmune risk factors and donor- and procedure-related characteristics were studied, as well as the association with graft failure. Multivariable Cox models were applied to quantify the cause-specific hazard ratios for early rejection and early inflammatory scores, adjusted for potential confounders. For quantification of hazard ratios of early events for death-censored graft failure, landmark analyses starting from day 15 were used. Results Early indication biopsy specimens displayed microvascular inflammation score ≥2 in 30% and tubulointerstitial inflammation score ≥2 in 49%. Rejection was diagnosed in 186 of 329 (57%) biopsies and associated with the presence of pretransplant donor-specific HLA antibodies and the number of HLA mismatches, but not nonimmune risk factors in multivariable Cox proportional hazards analysis. In multivariable Cox proportional hazards analysis, delayed graft function, the graft dysfunction that prompted an early indication biopsy, HLA mismatches, and pretransplant donor-specific HLA antibodies were significantly associated with a higher risk for death-censored graft failure, whereas early acute rejection was not. Conclusions Indication biopsies performed early after kidney transplantation display inflammatory changes related to alloimmune risk factors. Nonimmune risk factors for ischemia-reperfusion injury, such as cold and warm ischemia time, older donor age, and donor type, were not identified as strong risk factors for early inflammation after human kidney transplantation.
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- 2020
13. Survival of PatientsWith Liver Transplants Donated After Euthanasia, Circulatory Death, or Brain Death at a Single Center in Belgium
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Daniel Jacobs-Tulleneers-Thevissen, Ina Jochmans, Mauricio Sainz-Barriga, Jacques Pirenne, Albert Wolthuis, Nicholas Gilbo, Diethard Monbaliu, Pathology/molecular and cellular medicine, Basic (bio-) Medical Sciences, Surgical clinical sciences, and Surgery
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Adult ,medicine.medical_specialty ,Brain Death ,medicine.medical_treatment ,health care facilities, manpower, and services ,animal diseases ,Liver transplants ,Liver transplantation ,Single Center ,Belgium ,Liver Transplantation/mortality ,Research Letter ,Medicine ,Humans ,Survival analysis ,Aged ,Retrospective Studies ,business.industry ,Euthanasia ,Graft Survival ,Retrospective cohort study ,General Medicine ,social sciences ,Middle Aged ,Circulatory death ,Survival Analysis ,humanities ,Tissue Donors ,Surgery ,Liver Transplantation ,Transplantation ,surgical procedures, operative ,Graft survival ,business - Abstract
This study compares graft and patient survival rates after transplantation of livers donated after euthanasia vs after circulatory death or brain death at a hospital in Belgium, where euthanasia is legalized. ispartof: JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION vol:322 issue:1 pages:78-80 ispartof: location:United States status: published
- Published
- 2019
14. Somatostatin as Inflow Modulator in Liver-transplant Recipients With Severe Portal Hypertension
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Alexander Croo, Aude Vanlander, Dirk Voet, Jurgen Van Limmen, Anne Hoorens, Giulia Antoniali, Roberto Troisi, Marleen Praet, Gianluca Tell, Mariano Cesare Giglio, Isabelle Colle, Bjorn Heyse, Erika Codarin, Luigia Scudeller, Mauricio Sainz-Barriga, Hendrik Reynaert, Luc De Baerdemaeker, Translational Radiation Oncology and Physics, Basic (bio-) Medical Sciences, Gastroenterology, Laboratory of Molecullar and Cellular Therapy, Liver Cell Biology, Troisi, Roberto, Vanlander, Aude, Giglio, Mariano Cesare, Van Limmen, Jurgen, Scudeller, Luigia, Heyse, Bjorn, De Baerdemaeker, Luc, Croo, Alexander, Voet, Dirk, Praet, Marleen, Hoorens, Anne, Antoniali, Giulia, Codarin, Erika, Tell, Gianluca, Reynaert, Hendrik, Colle, Isabelle, and Sainz-Barriga, Mauricio
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Male ,medicine.medical_specialty ,Cirrhosis ,medicine.medical_treatment ,Portal venous pressure ,Octreotide ,Liver transplantation ,Gastroenterology ,law.invention ,End Stage Liver Disease ,surgery ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,law ,Internal medicine ,Hypertension, Portal ,medicine ,Humans ,Aged ,business.industry ,Middle Aged ,medicine.disease ,Portal Pressure ,Hormones ,Liver Transplantation ,Treatment Outcome ,Somatostatin ,030220 oncology & carcinogenesis ,Portal hypertension ,Female ,030211 gastroenterology & hepatology ,business ,medicine.drug - Abstract
OBJECTIVE: To investigate the safety and efficacy of somatostatin as liver inflow modulator in patients with end-stage liver disease (ESLD) and clinically significant portal hypertension (CSPH) undergoing liver transplantation (LT) (ClinicalTrials.gov number,01290172). BACKGROUND: In LT, portal hyperperfusion can severely impair graft function and survival, mainly in cases of partial LT. METHODS: Thirty-three patients undergoing LT for ESLD and CSPH were randomized double-blindly to receive somatostatin or placebo (2:1). The study drug was administered intraoperatively as 5-mL bolus (somatostatin: 500 μg), followed by a 2.5 mL/h infusion (somatostatin: 250 μg/h) for 5 days. Hepatic and systemic hemodynamics were measured, along with liver function tests and clinical outcomes. The ischemia-reperfusion injury (IRI) was analyzed through histological and protein expression analysis. RESULTS: Twenty-nine patients (18 receiving somatostatin, 11 placebo) were included in the final analysis. Ten patients responded to somatostatin bolus, with a significant decrease in hepatic venous portal gradient (HVPG) and portal flow of -28.3% and -29.1%, respectively. At graft reperfusion, HVPG was lower in patients receiving somatostatin (-81.7% vs -58.8%; P = 0.0084), whereas no difference was observed in the portal flow (P = 0.4185). Somatostatin infusion counteracted the decrease in arterial flow (-10% vs -45%; P = 0.0431). There was no difference between the groups in the severity of IRI, incidence of adverse events, long-term complications, graft, and patient survival. CONCLUSIONS: Somatostatin infusion during LT in patients with CSPH is safe, reduces the HVPG, and preserves the arterial inflow to the graft. This study establishes the efficacy of somatostatin as a liver inflow modulator.
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- 2019
15. Hemodynamic changes in ALPPS influence liver regeneration and function: results from a prospective study
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Yves D'Asseler, Clarisse Lecluyse, Bieke Lambert, Federico Tomassini, Jo Van Dorpe, Mauricio Sainz-Barriga, Karen Geboes, Anne Hoorens, Roberto Troisi, Mariano Cesare Giglio, Tomassini, Federico, D'Asseler, Yve, Giglio, Mariano C, Lecluyse, Clarisse, Lambert, Bieke, Sainz-Barriga, Mauricio, Van Dorpe, Jo, Hoorens, Anne, Geboes, Karen, and Troisi, Roberto I
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Male ,medicine.medical_specialty ,RESECTION ,STAGED HEPATECTOMY ,medicine.medical_treatment ,Operative Time ,Urology ,Hemodynamics ,Portal vein ligation ,PRESSURE ,PORTAL-VEIN LIGATION ,Postoperative Complications ,Liver Function Tests ,Internal medicine ,Medicine ,Hepatectomy ,Humans ,Prospective Studies ,HEPATOBILIARY SCINTIGRAPHY ,Prospective cohort study ,Hemodynamic stress ,Aged ,MAJOR LIVER ,Science & Technology ,Gastroenterology & Hepatology ,Hepatology ,medicine.diagnostic_test ,business.industry ,Portal Vein ,PARTITION ,MORTALITY ,Liver Neoplasms ,Gastroenterology ,Middle Aged ,2-STAGE HEPATECTOMY ,Liver regeneration ,Liver Regeneration ,Liver ,Surgery ,Female ,REMNANT ,business ,Liver function tests ,Life Sciences & Biomedicine - Abstract
BACKGROUND: Excessive increase of portal flow and pressure following extended hepatectomy have been associated to insufficient growth or function of the future liver remnant (FLR), with the risk of post-hepatectomy liver failure (PHLF). We prospectively assess the influence of liver hemodynamics on FLR regeneration and function in Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS). METHODS: Twenty-three patients underwent ALPPS; liver hemodynamics were assessed throughout the procedures. Volume and function of the FLR were evaluated by angio-CT and 99mTc-Mebrofenin-scintigraphy. RESULTS: The portal vein flow at the end of stage-1 correlated with the increase of the FLR volume (p = 0.002). Patients with portal vein pressure (PVP)
- Published
- 2018
16. Pre-operative trans-catheter arterial chemo-embolization increases hepatic artery thrombosis after liver transplantation - a retrospective study
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Laura Van Praet, Nicholas Gilbo, David Cassiman, Geert Maleux, Ina Jochmans, Frederik Nevens, Schalk Van der Merwe, Mauricio Sainz-Barriga, Diethard Monbaliu, Chris Verslype, Jacques Pirenne, and Wim Laleman
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,animal diseases ,030230 surgery ,Liver transplantation ,Gastroenterology ,environment and public health ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Hepatic Artery ,Postoperative Complications ,Belgium ,Risk Factors ,Internal medicine ,parasitic diseases ,medicine ,Humans ,Embolization ,Chemoembolization, Therapeutic ,Retrospective Studies ,Transplantation ,business.industry ,Graft Survival ,Retrospective cohort study ,Thrombosis ,Odds ratio ,Middle Aged ,medicine.disease ,Surgery ,Liver Transplantation ,Hepatic artery thrombosis ,Catheter ,enzymes and coenzymes (carbohydrates) ,embryonic structures ,030211 gastroenterology & hepatology ,Female ,business - Abstract
Little is known about non-surgical risk factors for Hepatic Artery Thrombosis (HAT) after Liver Transplantation (LT). We determined risk factors for HAT occurring within 90 days post-LT and analyzed the effect of HAT on graft and patient survival. Donor and recipient demographics, surgery-related data, and outcome in transplants complicated by thrombosis (HAT+) and their matched controls (HAT-) were compared. Risk factors were assessed by univariate logistic regression. Median (IQR) is given. 25 HAT occurred among 1035 adult LT (1/1997-12/2014) and 50 controls were manually matched. Donor and recipient demographics were similar. Pre-LT Trans-catheter Arterial Chemo Embolization (TACE) was more frequent in HAT+ (HAT+ 20% vs HAT- 4%, p=0.037). HAT+ had longer implantation [HAT+ 88 min (76-108) vs HAT- 77 min (66-93), p=0.028] and surgery times [HAT+ 6.25 h (5.18-7.47) vs HAT- 5.25 h (4.33-6.5), p=0.001]. Early graft dysfunction and sepsis was more frequent in HAT+ and hospitalization longer. TACE had the greatest odds ratio in unadjusted analysis (OR: 6, 95%CI: 1.07-33.53, p=0.03). All but 7 grafts were lost after HAT (HAT+ 72% vs HAT- 36%, p=0.003), however, patient survival was unaffected (HAT+ 79.8% vs HAT- 76%, p=0.75). LT candidates undergoing TACE are at risk of developing HAT early after transplant. This article is protected by copyright. All rights reserved. ispartof: Transplant International vol:31 issue:1 pages:71-81 ispartof: location:Switzerland status: published
- Published
- 2017
17. Graft inflow modulation in adult-to-adult living donor liver transplantation: A systematic review
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Roberto I. Troisi, Giammauro Berardi, Federico Tomassini, and Mauricio Sainz-Barriga
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Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Splenectomy ,Hemodynamics ,Portacaval shunt ,030230 surgery ,Cochrane Library ,Splenic artery ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Living Donors ,Medicine ,Humans ,Embolization ,Female ,Graft Survival ,Liver Circulation ,Liver Transplantation ,Portacaval Shunt, Surgical ,Prognosis ,Survival Rate ,Treatment Outcome ,Survival rate ,Transplantation ,business.industry ,medicine.disease ,Surgery ,Portal hypertension ,030211 gastroenterology & hepatology ,business - Abstract
Introduction Small-for-size syndrome (SFSS) has an incidence between 0 and 43% in small-for-size graft (SFSG) adult living donor liver transplantation (LDLT). Portal hypertension following reperfusion and the hyperdynamic splanchnic state are reported as the major triggering factors of SFSS. Intra- and postoperative strategies to prevent or to reduce its onset are still under debate. We analyzed graft inflow modulation (GIM) during adult LDLT considering the indications, efficacy of the available techniques, changes in hemodynamics and outcomes. Materials and methods A systematic literature search was performed using PubMed, EMBASE, Scopus and the Cochrane Library Central. Treatment outcomes including in-hospital mortality and morbidity, re-transplantation rate, 1-, 3-, and 5-year patient overall survival and 1-, 3-, and 5-year graft survival rates, hepatic artery and portal vein flows and pressures before and after inflow modulation were analyzed. Results From 563 articles, 12 studies dated between 2003 and 2014 fulfilled the selection criteria and were therefore included in the study. These comprised a total of 449 adult patients who underwent inflow modulation during adult-to-adult LDLT. Types of GIM described were splenic artery ligation, splenectomy, meso-caval shunt, spleno-renal shunt, portocaval shunt, and splenic artery embolization. Mortality and morbidity ranged between 0 and 33% and 17% and 70%, respectively. Re-transplantation rates ranged between 0% and 25%. GIM was associated with good survival for both graft and recipients, reaching an 84% actuarial rate at 5 years. Through the use of GIM, irrespective of the technique, a statistically significant reduction of PVF and PVP was obtained. Conclusions GIM is a safe and efficient technique to avoid or limit portal hyperperfusion, especially in cases of SFSG, decreasing overall morbidity and improving outcomes.
- Published
- 2017
18. P1.02: Tacrolimus induced optic neuropathy after multivisceral transplantation
- Author
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Emilio Canovai, Catherine Cassiman, Laurens Ceulemans, Philippe Demaerel, Mauricio Sainz-Barriga, Ina Jochmans, Diethard Monbaliu, Jacques Pirenne, and Tim Vanuytsel
- Subjects
Transplantation - Published
- 2019
19. Infected large pore meshes may be salvaged by topical negative pressure therapy
- Author
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Xavier Rogiers, Frederik Berrevoet, Mauricio Sainz-Barriga, Roberto Troisi, and Aude Vanlander
- Subjects
medicine.medical_specialty ,business.industry ,Incisional hernia ,medicine.medical_treatment ,Topical Negative-Pressure Therapy ,medicine.disease ,Surgery ,Large pore ,Inguinal hernia ,Negative-pressure wound therapy ,Anesthesia ,medicine ,Hernia ,business ,Prospective cohort study ,Abdominal surgery - Abstract
To evaluate the efficacy of negative pressure therapy for superficial and deep mesh infections after ventral and incisional hernia repair by a prospective monocentric observational study. During a 6-year period, 724 consecutive open ventral and incisional hernia repairs were performed. Pre- and intraoperative data as well as postoperative complications were prospectively recorded. In case of wound infection, negative pressure therapy (NPT) was our primary treatment. Sixty-three patients (8.7 %) were treated using negative pressure therapy after primary ventral and incisional hernia repair. Infectious complications needing NPT occurred in 54 patients in the retromuscular group (54/523; 10.3 %), none when laparoscopically treated and in 9 patients (9/143; 6.3 %) treated by an open intraperitoneal mesh technique. Considering outcome, all meshes were completely salvaged in the retromuscular mesh group after a median of 5 dressing changes (range, 2–9), while in the intraperitoneal mesh, group 3 meshes needed complete (n = 2) or partial (n = 1) excision. Mean duration to complete wound closure was 44 days (range, 26–63 days). NPT is a useful adjunct for salvage of deep infected meshes, particularly when large pore monofilament mesh is used.
- Published
- 2012
20. Successful transplantation of small-for-size grafts: A reappraisal
- Author
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Mauricio Sainz-Barriga and Roberto Troisi
- Subjects
Male ,Transplantation ,Small for size syndrome ,Pathology ,medicine.medical_specialty ,Hepatology ,Portal Vein ,business.industry ,medicine.medical_treatment ,Liver transplantation ,Liver Transplantation ,Somatostatin ,Living Donors ,medicine ,Humans ,Female ,Surgery ,business - Published
- 2012
21. Flow Competition between Hepatic Arterial and Portal Venous flow during Hypothermic Machine Perfusion Preservation of Porcine Livers
- Author
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Wim Laleman, Jacques Pirenne, Charlotte Debbaut, Mauricio Sainz-Barriga, Patrick Segers, Wim Hillewaert, and Diethard Monbaliu
- Subjects
Technology ,Time Factors ,Swine ,Medicine (miscellaneous) ,Hemodynamics ,HEART-BEATING DONORS ,Hepatic Artery ,Engineering ,Hypothermia, Induced ,Medicine and Health Sciences ,Infusion Pumps ,Portal Vein ,Equipment Design ,Organ Preservation ,General Medicine ,Cold Temperature ,Perfusion ,medicine.anatomical_structure ,Liver ,HEMODYNAMICS ,Cardiology ,Hepatic flow ,medicine.symptom ,Life Sciences & Biomedicine ,Liver Circulation ,Blood vessel ,Artery ,medicine.medical_specialty ,animal structures ,Organ Preservation Solutions ,Organ preservation ,RAT-LIVER ,CIRCULATION ,Biomedical Engineering ,Cold storage ,Vena Cava, Inferior ,Bioengineering ,MECHANISMS ,Biomaterials ,KIDNEY ,COLD-STORAGE ,Internal medicine ,Pressure ,medicine ,Animals ,TRANSPLANTED LIVER ,Engineering, Biomedical ,Transplantation ,Machine perfusion ,Science & Technology ,BLOOD-FLOW ,business.industry ,72-HOUR PRESERVATION ,Blood flow ,Hypothermia ,Liver Transplantation ,Surgery ,Pump perfusion ,business ,Hypothermic machine perfusion - Abstract
Hypothermic machine perfusion (HMP) is regarded as a better preservation method for donor livers than cold storage. During HMP, livers are perfused through the inlet blood vessels, namely the hepatic artery (HA) and the portal vein (PV). In previous HMP feasibility studies of porcine and human livers, we observed that the PV flow decreased while the HA flow increased. This flow competition restored either spontaneously or by lowering the HA pressure (PHA). Since this phenomenon had never been observed before and because it affects the HMP stability, it is essential to gain more insight into the determinants of flow competition. To this end, we investigated the influence of the HMP boundary conditions on liver flows during controlled experiments. This paper presents the flow effects induced by increasing PHA and by obstructing the outlet blood vessel, which is the vena cava inferior (VCI). Flow competition was evoked by increasing PHA to 55-70 mmHg, as well as by obstructing the VCI. Remarkably, a severe obstruction resulted in a repetitive and alternating tradeoff between the HA and PV flows. These phenomena could be related to intra-sinusoidal pressure alterations. Consequently, a higher PHA is most likely transmitted to the sinusoidal level. This increased sinusoidal pressure reduces the pressure drop between the PV and the sinusoids, leading to a decreased PV perfusion. Flow competition has not been encountered or evoked under physiological conditions and should be taken into account for the design of liver HMP protocols. Nevertheless, more research is necessary to determine the optimal parameters for stable HMP. ispartof: International Journal of Artificial Organs vol:35 issue:2 pages:119-131 ispartof: location:United States status: published
- Published
- 2012
22. Kidney transplantation: perioperative cardiovascular risk and anaesthetic management
- Author
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Giorgio Della Rocca, George Burke, Mauricio Sainz-Barriga, Maria Gabriella Costa, and L. Pompei
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Anaesthetic management ,medicine.medical_specialty ,business.industry ,Anesthesia ,medicine ,Perioperative ,medicine.disease ,Intensive care medicine ,business ,Kidney transplantation - Published
- 2015
23. Lack of a correlation between portal vein flow and pressure: Toward a shared interpretation of hemodynamic stress governing inflow modulation in liver transplantation
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Luigia Scudeller, Bernard de Hemptinne, Maria Gabriella Costa, Mauricio Sainz-Barriga, and Roberto Troisi
- Subjects
Transplantation ,medicine.medical_specialty ,Hepatology ,business.industry ,medicine.medical_treatment ,Portal venous pressure ,Central venous pressure ,Hemodynamics ,macromolecular substances ,Liver transplantation ,Portal vein flow ,medicine.disease ,Surgery ,Internal medicine ,medicine ,Cardiology ,Portal hypertension ,Prospective cohort study ,business ,Hemodynamic stress - Abstract
The portal vein flow (PVF), portal vein pressure (PVP), and hepatic venous pressure gradient (HVPG) were prospectively assessed to explore their relationships and to better define hyperflow and portal hypertension (PHT) during liver transplantation (LT). Eighty-one LT procedures were analyzed. No correlation between PVF and PVP was observed. Increases in the central venous pressure (CVP) were transmitted to the PVP (58%, range = 25%-91%, P = 0.001). Severe PHT (HVPG ≥ 15 mm Hg) showed a significant reciprocal association with high PVF (P = 0.023) and lower graft survival (P = 0.04). According to this initial experience, an HVPG value ≥ 15 mm Hg is a promising tool for the evaluation of hemodynamic stress potentially influencing outcomes. An algorithm for graft inflow modulation based on flows, gradients, and systemic hemodynamics is provided. In conclusion, the evaluation of PHT severity with PVP could be delusive because of the influence of CVP. PVF and PVP do not correlate and should not be used individually to assess hyperflow and PHT during LT.
- Published
- 2011
24. Early Arterial Revascularization After Hepatic Artery Thrombosis May Avoid Graft Loss and Improve Outcomes in Adult Liver Transplantation
- Author
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B. Van Den Bossche, Frederik Berrevoet, Roberto Troisi, Xavier Rogiers, H. Van Vlierberghe, Mauricio Sainz-Barriga, Isabelle Colle, Andrea Scarinci, Anja Geerts, and B. de Hemptinne
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Liver transplantation ,Revascularization ,environment and public health ,Young Adult ,Hepatic Artery ,parasitic diseases ,Humans ,Medicine ,Young adult ,Aged ,Transplantation ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,Graft Survival ,Thrombosis ,Thrombolysis ,Middle Aged ,Tissue Donors ,Liver Transplantation ,Surgery ,Treatment Outcome ,Angiography ,Female ,business ,Complication ,Vascular Surgical Procedures - Abstract
Background Hepatic artery thrombosis (HAT) represents a devastating complication after liver transplantation (LT), occurring in 1.6%–9.2% of adult recipients. Treatments of HAT include thrombectomy and thrombolysis (with or without redo of the arterial anastomosis), percutaneous thrombolysis through an angiogram, liver retransplantation, and clinical observation. Methods We retrospectively analyzed data from 739 adult LTs between January 1992 and September 2009. HAT was classified as early (E-HAT), when occurring within the first 30 days after LT, or late HAT (L-HAT), when diagnosed from the 2nd month onward. HAT suspected clinically was confirmed by Doppler ultrasound and angiography in all cases. Attempted revascularization was defined as early (ER) if performed within the first 2 weeks after LT and late (LR) if performed between 15 and 30 days. Results After a median follow-up (FU) of 62 months (range, 1–227 months), HAT occurred in 31/739 grafts (4.3%). E-HAT was recorded in 25/31 cases (3.4%) and L-HAT in 11/31 cases (0.8%). ER was performed in 20/31 patients (65%) leading to 62% graft salvage; it was 81% when the revascularization was performed within the first week after LT ( P = ns). LR was unsuccessful in all cases ( P = .08). The overall incidence of BC among rescued grafts was 54% without graft loss during FU. Graft survival was 79% versus 71%; and 50% versus 50% at 1 and 3 years for E-HAT and L-HAT, respectively ( P = ns). Conclusions Urgent revascularization in cases of early HAT may decrease graft loss, especially when performed within the first week after LT, with improved overall outcomes.
- Published
- 2010
25. Intraoperative Renal Perfusion in Kidney Transplantation
- Author
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Diethard Monbaliu, Mauricio Sainz Barriga, Jacques Pirenne, Dirk Kuypers, Maarten Naesens, Ina Jochmans, and Nicholas Gilbo
- Subjects
Transplantation ,medicine.medical_specialty ,business.industry ,Urology ,Medicine ,Retrospective cohort study ,business ,Renal perfusion ,medicine.disease ,Kidney transplantation - Published
- 2018
26. Continuous and intermittent cardiac output measurement in hyperdynamic conditions: pulmonary artery catheter vs. lithium dilution technique
- Author
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Maria Gabriella Costa, P. Chiarandini, Paolo Pietropaoli, Livia Pompei, Maurizio Cecconi, Silvia Mattelig, Mauricio Sainz Barriga, Toby Reynolds, and Giorgio Della Rocca
- Subjects
Adult ,Male ,Cardiac output ,Critical Care ,medicine.medical_treatment ,Indicator Dilution Techniques ,Lithium ,Pulmonary Artery ,Critical Care and Intensive Care Medicine ,law.invention ,law ,Intensive care ,medicine.artery ,medicine ,Humans ,Prospective Studies ,Cardiac Output ,Aged ,business.industry ,Pulmonary artery catheter ,Middle Aged ,Intensive care unit ,Liver Transplantation ,Catheter ,medicine.anatomical_structure ,Catheterization, Swan-Ganz ,Anesthesia ,Heart Function Tests ,Pulmonary artery ,Hyperdynamic circulation ,Female ,business ,Artery - Abstract
This study aimed to assess the level of agreement of both intermittent cardiac output monitoring by the lithium dilution technique (CO(Li)) and continuous cardiac output monitoring (PulseCO(Li)) using the arterial pressure waveform with intermittent thermodilution using a pulmonary artery catheter (CO(PAC)).Prospective, single-center evaluation.University Hospital Intensive Care Unit.Patients (n=23) receiving liver transplantation.Pulmonary artery catheters were placed in all patients and CO(PAC) was determined using thermodilution. CO(Li) and PulseCO(Li) measurements were made using the LiDCO system.Data were collected after intensive care unit admission and every 8h until the 48th hour. A total of 151 CO(PAC), CO(Li) and PulseCO(Li) measurements were analysed. Bias and 95% limit of agreement were 0.11lmin(-1) and -1.84 to + 2.05 lmin(-1) for CO(PAC) vs. CO(Li) (r=0.88) resulting in an overall percentage error of 15.6%. Bias and 95% limit of agreement for CO(PAC) vs. PulseCO(Li) were 0.29 lmin(-1) and -1.87 to + 2.46 lmin(-1) (r=0.85) with a percentage error of 16.8%. Subgroup analysis revealed a percentage error of 15.7% for CO(PAC) vs. CO(Li) and 15.1% for CO(PAC) vs. PulseCO(Li) for data pairs less than 8 lmin(-1), and percentage errors of 15.5% and 18.5% respectively for data pairs higher than 8 lmin(-1).In patients with hyperdynamic circulation, intermittent and continuous CO values determined using the LiDCO system showed good agreement with those obtained by intermittent pulmonary artery thermodilution.
- Published
- 2007
27. Implication of stem cell factor in human liver regeneration after transplantation and resection
- Author
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Andrea Risaliti, Vittorio Bresadola, Gianni De Stasio, Dario Lorenzin, Annibale Donini, Antonio Paolo Beltrami, Mauricio Sainz-Barriga, Umberto Baccarani, Gian Luigi Adani, and Fabrizio Bresadola
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pathology ,stem cell ,human liver ,medicine.medical_treatment ,Clinical Biochemistry ,Stem cell factor ,Biology ,Liver transplantation ,Endocrinology ,Internal medicine ,medicine ,Humans ,Liver injury ,Stem Cell Factor ,Cell Biology ,Middle Aged ,medicine.disease ,Liver regeneration ,Liver Regeneration ,Liver Transplantation ,Transplantation ,Haematopoiesis ,Liver ,embryonic structures ,Female ,Stem cell ,Homing (hematopoietic) - Abstract
The stem cell factor (SCF), besides regulating hemopoietic stem cells homing and proliferation, has proliferative effects on hepatocytes and may be involved in liver regeneration. We investigate if liver transplantation (LT) and hepatic resection (HR) modify the concentration of soluble SCF (s-SCF) in peripheral blood of 15 LT and 7 HR. s-SCF was measured by ELISA as ng/ml. s-SCF basal levels were higher in LT that in HR (818 +/- 349 vs. 479 +/- 79, p = 0.005). A significant increase of s-SCF, peaking at postoperative day +3, was seen after LT (from 818 +/- 349 to 1212 +/- 461, p = 0.01) and HR (from 479 +/- 79 to 698 +/- 122, p = 0.004). s-SCF peak levels were higher after LT than HR (p = 0.0008). At day +7 s-SCF concentration returned to baseline values. LT have a higher basal s-SCF level than HR. These data show for the first time that liver injury affects s-SCF level and suggest that SCF may be involved also in clinical liver regeneration.
- Published
- 2006
28. Quality-of-Life Assessment Before and After Liver Transplantation
- Author
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Vittorio Bresadola, Pierluigi Toniutto, Fabrizio Bresadola, M. Ballestrieri, Andrea Risaliti, G.L. Adani, Mauricio Sainz-Barriga, Luigia Scudeller, Dario Lorenzin, Umberto Baccarani, Maria Gabriella Costa, and G. Ramacciatto
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Stress index ,medicine.medical_treatment ,Anxiety ,Liver transplantation ,Liver disease ,Quality of life ,Internal medicine ,Preoperative Care ,medicine ,Humans ,Life Style ,Aged ,Analysis of Variance ,Transplantation ,Marital Status ,business.industry ,Advanced stage ,Psychological distress ,Middle Aged ,medicine.disease ,Liver Transplantation ,Surgery ,Distress ,Quality of Life ,Educational Status ,Regression Analysis ,Female ,business ,Stress, Psychological ,Follow-Up Studies - Abstract
Background Quality-of-life (QoL) assessment includes health status, disability, psychological wellness, and social performance. We sought to evaluate the effect of liver transplantation (OLT) on the QoL of patients awaiting the procedure and its variations up to 8 years afterwards. Methods LEIPAD-perceived QoL and BSI-psychological distress tests were used. Patients were divided in four groups (waiting list patients, 1 to 2 years after LT, 3 to 4 years after LT, 5 to 8 years after LT). Patients were also evaluated for type and severity of liver disease. Results We evaluated 126 patients, 71% male, 29% female, median age 60.7 years (range 40 to 76 years), median follow-up 4 years (range 1 to 8). The patients on the waiting list scored worse both in global stress index (GSI) and total LEIPAD scores than transplanted patients. Upon univariate linear regression analysis, the only dimension associated with time groups was LEIPAD—physical functioning, showing a progressive improvement of perceived physical status with time from transplant. Severity of liver disease showed a protective effect, probably reflecting a better control of stressful events from patients transplanted at advanced stages of liver disease. Protective effects were found for male sex, retired, cohabitant patients, and the degree of education. Housewife and widow patients showed negative associations with BSI and LEIPAD dimensions. No independent predictors of QoL were found in this study. Conclusions OLT improves most, but not all, QoL and psychological distress domains.
- Published
- 2005
29. Portal vein thrombosis after intraportal hepatocytes transplantation in a liver transplant recipient
- Author
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Domenico Montanaro, Andrea Risaliti, Claudio Avellini, Umberto Baccarani, Daniele Gasparini, Gian Luigi Adani, Fabrizio Bresadola, Annibale Donini, Mauricio Sainz-Barriga, Andrea Sanna, and Dario Lorenzin
- Subjects
Male ,Nephrology ,medicine.medical_specialty ,medicine.medical_treatment ,Liver transplantation ,cryopreservation ,hepatocyte ,liver ,portal vein thrombosis ,transplantation ,Postoperative Complications ,Internal medicine ,medicine ,Humans ,Thrombus ,Venous Thrombosis ,Transplantation ,Portal Vein ,Vascular disease ,business.industry ,Middle Aged ,medicine.disease ,Thrombosis ,Portal vein thrombosis ,Surgery ,Venous thrombosis ,Hepatocytes ,business - Abstract
Hepatocytes transplantation is viewed as a possible alternative or as a bridge therapy to liver transplantation for patients affected by acute or chronic liver disorders. Very few data regarding complications of hepatocytes transplantation is available from the literature. Herein we report for the first time a case of portal vein thrombosis after intraportal hepatocytes transplantation in a liver transplant recipient. A patient affected by acute graft dysfunction, not eligible for retransplantation, underwent intraportal infusion of 2 billion viable cryopreserved ABO identical human allogenic hepatocytes over a period of 5 h. Hepatocytes were transplanted at a concentration of 14 million/ml for a total infused volume of 280 ml. Doppler portal vein ultrasound and intraportal pressure were monitored during cell infusion. The procedure was complicated, 8 h after termination, by the development of portal vein thrombosis with liver failure and death of the patient. Autopsy showed occlusive thrombosis of the intrahepatic portal vein branches; cells or large aggregates of epithelial elements (polyclonal CEA positive), suggestive for transplanted hepatocytes, were co-localized inside the thrombus.
- Published
- 2005
30. The Choice of Recipient Does Not Have a Bearing on Early Outcome in Liver Transplant Patients Receiving Grafts From Non–Heart-Beating Donors: A Reappraisal?
- Author
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Frederik Berrevoet, Mauricio Sainz-Barriga, Luc Colenbie, Xavier Rogiers, J. Van Huysse, M.C. Dezza, Marleen Praet, H. Van Vlierberghe, Roberto Troisi, B. de Hemptinne, Anna Rossetto, Isabelle Colle, and Ivo Haentjens
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Liver transplantation ,Single Center ,Cold Ischemia Time ,Body Mass Index ,Cholestasis ,Humans ,Medicine ,education ,Retrospective Studies ,Transplantation ,education.field_of_study ,Warm Ischemia Time ,business.industry ,Bilirubin ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Tissue Donors ,Liver Transplantation ,Surgery ,Death, Sudden, Cardiac ,Treatment Outcome ,Creatinine ,Female ,business - Abstract
Introduction Donation after cardiac death has reemerged as a potential way of increasing the supply of organs for transplantation. We retrospectively reviewed the outcomes of non–heart-beating donor (NHBD) liver transplantation (OLT) experience and compared with standard heart-beating donation (HBD) at a single center. Methods From October 2003 to November 2006, 13/111 liver transplantations were performed in our institution with NHBD. Living donor liver transplantation, splitting procedures, combined, and pediatric liver transplantations were excluded from this analysis. Results Donor population was similar in both groups. The median warm ischemia time was 10 minutes (range 6 to 38). The median cold ischemia times 6 hours and 16 minutes (2.4 to 6.30 hours and 9 hours and 14 minutes (2.15 to 15.35 hours) for NHBD and HBD groups, respectively (P = .0002). In the NHBD groups, 4/13 (31%) grafts were retransplanted within 3 months, due to ischemic biliary lesions with severe cholestasis (n = 3) or due to the occurrence of primary nonfunction (n = 1). The retransplantation rate was significantly lower in the HBD group (11/98, 11%; P = .03). One-year patient and graft survivals were 62% and 54% versus 86% and 79%, respectively, for the NHBD and HBD groups (P = .107 and P = .003). Conclusion Liver grafts procured from donors after cardiac death accounted for a significantly greater retransplantation rates, mainly due to nonanastomotic biliary strictures. This risk must be taken into account when transplanting such grafts. Based upon this experience, NHBD cannot rival HBD to be a comparable source of quality organs for liver transplantation.
- Published
- 2007
31. Superiority of Transplantation Versus Resection for the Treatment of Small Hepatocellular Carcinoma
- Author
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Fabrizio Bresadola, Umberto Baccarani, Vittorio Bresadola, C A Beltrami, Alessandro Uzzau, Andrea Risaliti, Enrico Benzoni, Dario Lorenzin, G.L. Adani, Claudio Avellini, and Mauricio Sainz-Barriga
- Subjects
Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Time Factors ,medicine.medical_treatment ,Milan criteria ,Liver transplantation ,Gastroenterology ,Disease-Free Survival ,Resection ,Internal medicine ,medicine ,Humans ,Survival rate ,Aged ,Transplantation ,business.industry ,Liver Neoplasms ,Middle Aged ,Hepatitis B ,medicine.disease ,Hepatitis C ,Survival Analysis ,Liver Transplantation ,Treatment Outcome ,surgical procedures, operative ,Tumor progression ,Surgical Procedures, Operative ,Hepatocellular carcinoma ,Female ,Surgery ,business ,Liver cancer - Abstract
The best therapy for hepatocellular carcinoma (HCC) is still debated. Hepatic resection (HR) is the treatment of choice for single HCC in Child A patients, whereas liver transplantation (OLT) is usually reserved for Child B and C patients with multiple nodules. The aim of this study was to compare HR and OLT for HCC within the Milan criteria on an intention-to-treat basis. Forty-eight patients were treated by OLT and 38 by HR. Three- and 5-year patient survival rates were significantly higher (P = .0057) in the OLT group (79% and 74%) than after HR (61% and 26%). The 3- and 5-year disease-free survival rate was better (P = .0005) for OLT (74% and 74%) versus HR (41% and 11%). The probability of HCC recurrences after resection was greater (P = .0002) than after transplantation, achieving 31% and 76% for HR and 2% and 2% for OLT at 3 and 5 years after surgery. The median waiting list time was 118 days; two patients dropped out for HCC progression. We concluded that OLT is superior to HR for small HCC in cirrhotic patients assuming that OLT can be performed within 6 to 10 months after listing to reduce dropouts due to tumor progression.
- Published
- 2007
32. Long-Term Results of In Situ Split-Liver Transplantation
- Author
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U Baccarani, Mauricio Sainz-Barriga, Fabrizio Bresadola, A. Risaliti, G.L. Adani, Domenico Montanaro, Dario Lorenzin, G. Della Rocca, P. Chiarandini, and Pierluigi Viale
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,genetic structures ,Organ transplantation ,Hepatectomy ,Humans ,Medicine ,Child ,Retrospective Studies ,Immunosuppression Therapy ,Transplantation ,Adult patients ,business.industry ,Liver Diseases ,Incidence (epidemiology) ,Whole liver ,Long term results ,Middle Aged ,Cadaver donor ,Liver Transplantation ,Surgery ,Treatment Outcome ,Split liver transplantation ,Tissue and Organ Harvesting ,Female ,business - Abstract
Background Split-liver transplantation (SLT) offers immediate expansion of the cadaver donor pool. The principal beneficiaries have been adult and pediatric recipients with excellent outcomes. This study analyzed a single-center experience of adult to adult in situ SLT in adult recipients. Patients and methods Fourteen consecutive adult-to-adult in situ SLT have been performed at our institution since 1998. The extended right lobe comprising segment 1 was transplanted in to adult patients, the left lateral segment, for pediatric transplants. Results Donors of SLT were significantly younger ( P = .03) than those of whole liver transplants. Survival rates of patients receiving a split liver were 83%, 73%, and 73% at 1, 3, and 5 years after the transplant respectively and grafts of 73%, 73%, and 73% for SLT and 76%, 70%, and 66% for whole liver transplants ( P = .44). The rate of biliary complication after SLT was 21%, which was comparable to that after whole organ transplantation (17%). The incidence of hepatic artery thrombosis and primary nonfunction was not significantly different between split liver and whole organ transplantation performed during the same time period (7% versus 4.6% P = .67 and 7% versus 2.6% P = .32, respectively). Conclusion This limited single-center experience confirmed that both early and long-term results of SLT are comparable to those of traditional whole liver organ transplantation.
- Published
- 2005
33. A multicentre, randomized clinical trial comparing the Veriset haemostatic patch with fibrin sealant for the management of bleeding during hepatic surgery
- Author
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Moritz Kleine, Robert Öllinger, Florian W. R. Vondran, Sascha Weiss, Phillip Knebel, Hüseyin Bektas, Johann Pratschke, Mauricio Sainz-Barriga, André L. Mihaljevic, Christoph Schuhmacher, and Roberto Troisi
- Subjects
Male ,Time Factors ,Administration, Topical ,medicine.medical_treatment ,Blood Loss, Surgical ,Fibrin Tissue Adhesive ,Kaplan-Meier Estimate ,Hemostatics ,law.invention ,Randomized controlled trial ,LONG-TERM OUTCOMES ,law ,HEPATOCELLULAR-CARCINOMA ,Single-Blind Method ,Prospective Studies ,Prospective cohort study ,Fixation (histology) ,COMPLICATIONS ,biology ,Gastroenterology ,Hydrogels ,TachoSil ,Middle Aged ,Europe ,LIVER RESECTION ,Treatment Outcome ,SURVIVAL ,Female ,Life Sciences & Biomedicine ,medicine.medical_specialty ,HEPATECTOMY ,Fibrin ,BLOOD-LOSS ,medicine ,Hepatectomy ,Humans ,Cellulose, Oxidized ,RECURRENCE ,Aged ,Science & Technology ,Hepatology ,Gastroenterology & Hepatology ,Hemostatic Techniques ,business.industry ,Original Articles ,Surgery ,biology.protein ,business - Abstract
BACKGROUND: Bleeding during hepatic surgery is associated with prolonged hospitalization and increased morbidity and mortality. The Veriset™ haemostatic patch is a topical haemostat comprised of an absorbable backing made of oxidized cellulose and self-adhesive hydrogel components. It is designed to achieve haemostasis quickly and adhere to tissues without fixation. METHODS: A prospective, randomized, multicentre, single-blinded study (n = 50) was performed to compare the use of a Veriset™ haemostatic patch with a fibrin sealant patch (TachoSil(®) ) (control) in the management of diffuse bleeding after hepatic surgery. Patients were randomized following the confirmation of diffuse bleeding requiring the use of a topical haemostat. Time to haemostasis was assessed at preset intervals until haemostasis was achieved. RESULTS: Both groups were similar in comorbidities and procedural techniques. The median time to haemostasis in the group using the Veriset™ haemostatic patch was 1.0 min compared with 3.0 min in the control group (P < 0.001; 3-min minimum application time for the control patch). This result was independent of bleeding severity and surface area. Both products had similar safety profiles and no statistical differences were observed in the occurrence of adverse or device-related events. CONCLUSIONS: Regardless of bleeding severity or surface area, the Veriset™ haemostatic patch achieved haemostasis in this setting significantly faster than the control device in patients undergoing hepatic resection. It was safe and easy to handle in open hepatic surgery. ispartof: HPB vol:15 issue:7 pages:548-558 ispartof: location:England status: published
- Published
- 2013
34. Single-time kidney transplantation and monolateral nephrectomy for hypertension and antihypertensive therapy in renal transplant recipients
- Author
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Mauricio Sainz-Barriga, U Baccarani, M Groppuzzo, R. Mioni, F Bresadola, D Montanaro, G.L. Adani, G. Mioni, G Boscutti, P. Tulissi, and A. Risaliti
- Subjects
Nephrology ,medicine.medical_specialty ,Time Factors ,Systole ,medicine.medical_treatment ,Urinary system ,Blood Pressure ,Nephrectomy ,Combined treatment ,Diastole ,Internal medicine ,medicine ,Humans ,Antihypertensive Agents ,Kidney transplantation ,Retrospective Studies ,Transplantation ,Kidney ,business.industry ,medicine.disease ,Kidney Transplantation ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Renal transplant ,Hypertension ,business ,Follow-Up Studies - Published
- 2002
35. Lack of a correlation between portal vein flow and pressure: toward a shared interpretation of hemodynamic stress governing inflow modulation in liver transplantation
- Author
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Mauricio, Sainz-Barriga, Luigia, Scudeller, Maria Gabriella, Costa, Bernard, de Hemptinne, and Roberto Ivan, Troisi
- Subjects
Male ,Central Venous Pressure ,Portal Vein ,Hemodynamics ,Middle Aged ,Portal Pressure ,Liver Transplantation ,Treatment Outcome ,Liver ,Hypertension, Portal ,Pressure ,Humans ,Female ,Prospective Studies ,Algorithms ,Aged - Abstract
The portal vein flow (PVF), portal vein pressure (PVP), and hepatic venous pressure gradient (HVPG) were prospectively assessed to explore their relationships and to better define hyperflow and portal hypertension (PHT) during liver transplantation (LT). Eighty-one LT procedures were analyzed. No correlation between PVF and PVP was observed. Increases in the central venous pressure (CVP) were transmitted to the PVP (58%, range = 25%-91%, P = 0.001). Severe PHT (HVPG ≥ 15 mm Hg) showed a significant reciprocal association with high PVF (P = 0.023) and lower graft survival (P = 0.04). According to this initial experience, an HVPG value ≥ 15 mm Hg is a promising tool for the evaluation of hemodynamic stress potentially influencing outcomes. An algorithm for graft inflow modulation based on flows, gradients, and systemic hemodynamics is provided. In conclusion, the evaluation of PHT severity with PVP could be delusive because of the influence of CVP. PVF and PVP do not correlate and should not be used individually to assess hyperflow and PHT during LT.
- Published
- 2011
36. Evolution of laparoscopic left lateral sectionectomy without pringle maneuver: through resection of benign and malignant tumors to living liver donation
- Author
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Salvatore Ricciardi, Frederik Berrevoet, Jacques Van Huysse, Bernard de Hemptinne, Bert Vandenbossche, Roberto Troisi, Alessio Vinci, Xavier Rogiers, Tommaso Bocchetti, and Mauricio Sainz-Barriga
- Subjects
Male ,Laparoscopic surgery ,Organoplatinum Compounds ,medicine.medical_treatment ,Blood Loss, Surgical ,Leucovorin ,Liver transplantation ,Postoperative Complications ,Left lateral sectionectomy ,Antineoplastic Combined Chemotherapy Protocols ,Living Donors ,Laparoscopy ,Melanoma ,Living liver donors ,medicine.diagnostic_test ,Liver Neoplasms ,Middle Aged ,Combined Modality Therapy ,Tissue and Organ Harvesting ,Female ,Fluorouracil ,Adenoma ,Adult ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Gastrointestinal Stromal Tumors ,Adenocarcinoma ,Article ,Disease-Free Survival ,Pringle maneuver ,medicine ,Carcinoma ,Hepatectomy ,Humans ,Repeat hepatectomy ,Aged ,Retrospective Studies ,business.industry ,Length of Stay ,medicine.disease ,Liver Transplantation ,Endoscopy ,Surgery ,Transplantation ,Camptothecin ,business ,Laparoscopic liver surgery ,Follow-Up Studies - Abstract
Background Laparoscopic left lateral sectionectomy (LLS) has gained popularity in its use for benign and malignant tumors. This report describes the evolution of the authors’ experience using laparoscopic LLS for different indications including living liver donation. Methods Between January 2004 and January 2009, 37 consecutive patients underwent laparoscopic LLS for benign, primary, and metastatic liver diseases, and for one case of living liver donation. Resection of malignant tumors was indicated for 19 (51%) of the 37 patients. Results All but three patients (deceased due to metastatic cancer disease) are alive and well after a median follow-up period of 20 months (range, 8–46 months). Liver cell adenomas (72%) were the main indication among benign tumors, and colorectal liver metastases (84%) were the first indication of malignancy. One case of live liver donation was performed. Whereas 16 patients (43%) had undergone a previous abdominal surgery, 3 patients (8%) had LLS combined with bowel resection. The median operation time was of 195 min (range, 115–300 min), and the median blood loss was of 50 ml (range, 0–500 ml). Mild to severe steatosis was noted in 7 patients (19%) and aspecific portal inflammation in 11 patients (30%). A median free margin of 5 mm (range, 5–27 mm) was achieved for all cancer patients. The overall recurrence rate for colorectal liver metastases was of 44% (7 patients), but none recurred at the surgical margin. No conversion to laparotomy was recorded, and the overall morbidity rate was 8.1% (1 grade 1 and 2 grade 2 complications). The median hospital stay was 6 days (range, 2–10 days). Conclusions Laparoscopic LLS without portal clamping can be performed safely for cases of benign and malignant liver disease with minimal blood loss and overall morbidity, free resection margins, and a favorable outcome. As the ultimate step of the learning curve, laparoscopic LLS could be routinely proposed, potentially increasing the donor pool for living-related liver transplantation.
- Published
- 2011
37. Prospective evaluation of intraoperative hemodynamics in liver transplantation with whole, partial and DCD grafts
- Author
-
Koen Reyntjens, Xavier Rogiers, B. de Hemptinne, Roberto Troisi, Luigia Scudeller, Patrick Wouters, Mauricio Sainz-Barriga, Maria Gabriella Costa, and Faculteit Medische Wetenschappen/UMCG
- Subjects
Adult ,Male ,Cardiac output ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Hemodynamics ,Liver transplantation ,Intraoperative Period ,Hepatic Artery ,graft inflow modulation ,Internal medicine ,medicine ,Living Donors ,Journal Article ,DCD ,Immunology and Allergy ,Humans ,Pharmacology (medical) ,Prospective Studies ,Hepatopulmonary syndrome ,Aged ,Transplantation ,Portopulmonary hypertension ,business.industry ,Portal Vein ,hepatic artery trombosis ,portal hypertension ,Blood flow ,Middle Aged ,Liver flows ,medicine.disease ,LDLT ,liver transplantation ,systemic and hepatic hemodynamics ,Surgery ,Liver Transplantation ,Death ,Cardiology ,Portal hypertension ,Female ,business ,Perfusion ,Blood Flow Velocity ,Liver Circulation - Abstract
The interaction of systemic hemodynamics with hepatic flows at the time of liver transplantation (LT) has not been studied in a prospective uniform way for different types of grafts. We prospectively evaluated intraoperative hemodynamics of 103 whole and partial LT. Liver graft hemodynamics were measured using the ultrasound transit time method to obtain portal (PVF) and arterial (HAF) hepatic flow. Measurements were recorded on the native liver, the portocaval shunt, following reperfusion and after biliary anastomosis. After LT HAF and PVF do not immediately return to normal values. Increased PVF was observed after graft implantation. Living donor LT showed the highest compliance to portal hyperperfusion. The amount of liver perfusion seemed to be related to the quality of the graft. A positive correlation for HAF, PVF and total hepatic blood flow with cardiac output was found (p = 0.001). Portal hypertension, macrosteatosis >30%, warm ischemia time and cardiac output, independently influence the hepatic flows. These results highlight the role of systemic hemodynamic management in LT to optimize hepatic perfusion, particularly in LDLT and split LT, where the highest flows were registered.
- Published
- 2010
38. Improved results for adult split liver transplantation with extended right lobe grafts: could we enhance its application?
- Author
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Eva-Line Decoster, Ivo Haentjens, Luc Colenbie, Anja Geerts, Mauricio Sainz-Barriga, H. Van Vlierberghe, B. de Hemptinne, Roberto Troisi, Xavier Rogiers, and Isabelle Colle
- Subjects
Adult ,Brain Death ,medicine.medical_specialty ,Cirrhosis ,Tissue and Organ Procurement ,medicine.medical_treatment ,Liver transplantation ,Single Center ,Liver disease ,Liver Cirrhosis, Alcoholic ,medicine ,Hepatectomy ,Humans ,Transplantation, Homologous ,Survivors ,Child ,Survival analysis ,Aged ,Retrospective Studies ,Hepatitis ,Transplantation ,business.industry ,Patient Selection ,Retrospective cohort study ,Length of Stay ,Liver Failure, Acute ,Middle Aged ,medicine.disease ,Hepatitis C ,Survival Analysis ,Tissue Donors ,Surgery ,Liver Transplantation ,Survival Rate ,Intensive Care Units ,Treatment Outcome ,Tissue and Organ Harvesting ,business - Abstract
Objective. Split liver transplantation (SLT) allows grafting of 2 recipients with 1 allograft. Results of adult SLT have improved since its first introduction. Children benefit most from SLT, while among some adult liver transplanters there are concerns about splitting a liver, turning a good quality graft into a marginal one. We performed a single center retrospective review to address this issue. Patients and Methods. Between June 2001 and August 2008, we performed 22 extended right liver graft (eRLG) transplantations in 21 adult patients. Results. Eleven donors (50%) did not meet the Eurotransplant criteria for optimal donors. Forty-one percent of eRLG donors showed hemodynamic instability at the time of harvest. Eighteen (82%) splitting procedures were performed ex situ. The main indications for transplantation were alcoholic liver cirrhosis (32%), hepatitis C-related cirrhosis (18%), and acute liver failure (18%). Mean recipient age was 54 years (range, 17-69 years); median Model for End-Stage Liver Disease (MELD) score was 15 (range, 7-40). Patients were followed for a median of 16 months (range, 4-92 months) following transplantation. We observed 5 (23%) vascular and 3 (14%) biliary complications. Overall patient survival was 84% at 3 years; overall graft survival was 79%. For the 11 patients who had undergone transplantation after 2007, we observed a 100% patient and graft survival. Conclusion. After an initial learning curve and provided careful selection, exceptions to classical donor criteria for splitting can be accepted with successful outcomes comparable to those after whole liver transplantation.
- Published
- 2009
39. Split liver transplantation with extended right grafts under patient-oriented allocation policy. Single center matched-pair outcome analysis
- Author
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Mauricio, Sainz-Barriga, Salvatore, Ricciardi, Ivo, Haentjens, Luc, Colenbie, Isabelle, Colle, Hans, Van Vlierberghe, Bernard, de Hemptinne, and Roberto, Troisi
- Subjects
Adult ,Male ,Health Care Rationing ,Adolescent ,Liver Diseases ,Matched-Pair Analysis ,Patient Selection ,Middle Aged ,Liver Transplantation ,Resource Allocation ,Young Adult ,Treatment Outcome ,Humans ,Female ,Aged ,Follow-Up Studies - Abstract
Split liver transplantation (SLT) is an established technique developed to optimize the number of available grafts. Few data are available on SLT with extended right liver grafts (eRLG) in the context of patient-oriented allocation policy.Between July 1, 2001 and December 31, 2005, 12 whole liver graft (WLG) recipients were matched with 12 eRLG recipients according to their clinical status, indication and year of liver transplantation.There were no differences according to recipient Model for End-stage Liver Disease score, total serum bilirubin, creatinine levels and international normalized ratio in both groups. Fifty percent of donors in eRLG group presented 2 or more extended criteria. Liver transplantation was performed in UNOS status 1/2A in 58% of cases in both groups. Vascular and biliary complications were observed in three patients in the eRLG group. The median follow-up was 25.3 months (range 0.4-63). Early mortality (or=3 m) was 16.7% in WLG vs. 0% in eRLG, respectively (p = n.s.). Five-yr patient and graft survival rates were 84% and 77%, and 75% and 68%, respectively, for WLG and eRLG.Split liver transplantation with eRLG according to the patient-oriented allocation policy can be performed under emergency or urgent care circumstances with acceptable morbidity and adequate long-term survival.
- Published
- 2008
40. Arterial pulse cardiac output agreement with thermodilution in patients in hyperdynamic conditions
- Author
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Mauricio Sainz-Barriga, Paolo Pietropaoli, Manuela Lugano, Livia Pompei, Gaia Bertossi, Cecilia Coccia, Giorgio Della Rocca, Maria Gabriella Costa, and P. Chiarandini
- Subjects
Adult ,Male ,Cardiac output ,Arterial pulse ,medicine.medical_treatment ,Thermodilution ,cardiac output ,measurement techniques ,arterial pulse contour analysis ,thermodilution ,pulmonary artery catheter ,liver transplantation ,Blood Pressure ,macromolecular substances ,law.invention ,law ,medicine.artery ,medicine ,Humans ,In patient ,Prospective Studies ,Cardiac Output ,Aged ,business.industry ,Pulmonary artery catheter ,Hemodynamics ,Middle Aged ,University hospital ,Intensive care unit ,Liver Transplantation ,Anesthesiology and Pain Medicine ,Anesthesia ,Catheterization, Swan-Ganz ,Pulmonary artery ,Transplant patient ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective: This study aimed to compare continuous cardiac output (CCO) obtained using the arterial pulse wave (APCO) measurement with a simultaneous measurement of the intermittent cardiac output (ICO) and CCO obtained with a pulmonary artery catheter (PAC) in liver transplant patients. Design: A prospective, single-center evaluation. Setting: A university hospital intensive care unit. Patients: Eighteen patients after liver transplantation. Interventions: Pulmonary artery catheters were placed in all patients, and ICO and CCO were determined using thermodilution. APCO measurements were made with the Vigileo System (Edwards Lifesciences, Irvine, CA). Measurements and Main Results: The authors obtained 126 data pairs of ICO and APCO and 864 pairs of CCO and APCO. ICO data were collected after intensive care unit admission and every 8 hours until the 48th postoperative hour. CCO and APCO data were collected every hour from admission until the 48th postoperative hour. Bias and precision were 0.95 ± 1.41 L/min for ICO versus APCO and 1.29 ± 1.28 L/min for CCO and APCO. Bias and precision for cardiac output (CO) data pairs less than 8 L/min were 0.32 ± 1.14 L/min between ICO and APCO and 0.71 ± 0.98 L/min between CCO and APCO. For CO data pairs higher than 8 L/min, bias and precision were 1.79 ± 1.54 L/min between ICO and APCO and 2.25 ± 1.14 L/min between CCO and APCO. Conclusions: APCO enables the assessment of CO with clinically acceptable bias and precision. At higher CO levels, APCO underestimates PAC measurements and it is not as reliable as thermodilution in hyperdynamic liver transplant patients.
- Published
- 2007
41. Comparison of two techniques of arterial anastomosis during adult cadaveric liver transplantation
- Author
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Dino De Anna, Vittorio Bresadola, Mauricio Sainz-Barriga, Andrea Risaliti, G.L. Adani, C. Comuzzi, Enrico Benzoni, Umberto Baccarani, and Dario Lorenzin
- Subjects
Adult ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Aorta, Thoracic ,Liver transplantation ,Anastomosis ,Group B ,Hepatic Artery ,medicine ,Cadaver ,Humans ,Retrospective Studies ,Transplantation ,business.industry ,Mortality rate ,Anastomosis, Surgical ,Thrombosis ,Tissue Donors ,Surgery ,Liver Transplantation ,medicine.anatomical_structure ,Treatment Outcome ,Circulatory system ,Cadaveric spasm ,business ,Artery - Abstract
Arterial complications are a major source of morbidity and mortality after orthotopic liver transplantation (OLT). The incidence of hepatic artery thrombosis (HAT) ranges from 1.6% to 8%, with a mortality rate that ranges from 11% to 35%. We have described herein a technique of arterial anastomosis aiming to perform the anastomosis as straight as possible to avoid any kinking, redundancy, or malposition of the artery when the liver is released in its final position. We compared this technique with the traditional technique of arterial anastomosis using an aortic Carrel patch, namely, 198 OLT (group A) with the traditional technique and 117 OLT (group B) with the modified technique. An aorto-hepatic bypass was necessary in 25% of the cases in group A and in 21% of the cases in group B (P = .33). Vascular anomalies were present in 20% of cases in group A and in 27.5% in group B (P = .14). Fourteen cases (7%) of HAT developed in group A versus 0 cases in group B (P = .003). In group B, we experienced 2 (1.7%) late arterial stenoses that were successfully treated using percutaneous transluminal angioplasty. The 14 cases of HAT occurring in group A were successfully managed using immediate surgical revascularization with graft salvage in 6 cases (43%), whereas the remaining 8 cases needed urgent retransplantation. We suggest that a technique of arterial anastomosis aimed at avoiding kinking, redundancy, or malposition of the artery may be a viable option to reduce the risk of HAT after OLT.
- Published
- 2007
42. Selective bilirubin removal by plasma treatment with Plasorba BR-350 for early cholestatic graft dysfunction
- Author
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Claudio Avellini, Mauricio Sainz-Barriga, Dario Lorenzin, C. Comuzzi, G.L. Adani, Umberto Baccarani, Vittorio Bresadola, and Giuseppe Currò
- Subjects
medicine.medical_specialty ,Graft dysfunction ,Bilirubin ,Plasma treatment ,Gastroenterology ,Absorption ,chemistry.chemical_compound ,Cholestasis ,Reference Values ,Internal medicine ,Blood plasma ,Biopsy ,medicine ,Humans ,Transplantation ,Total plasma ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Surgery ,Liver Transplantation ,chemistry ,business - Abstract
Early cholestatic graft dysfunction is a frequent cause of morbidity after orthotopic liver transplantation (OLT). We analyze the role of selective bilirubin plasma absorption (PAP) using Plasorba BR-350 in 4 OLT patients who had experienced early severe cholestatic graft dysfunction within 15 days after transplantation. Patients were treated with 3 consecutive cycles of PAP with Plasorba BR-350. The median amount of plasma treated was 7500 mL. Median treatment duration was 231 minutes. The average plasma bilirubin level was 37 +/- 1 mg/dL before PAP and decreased to 15 +/- 0.2 mg/dL at the end of the third cycle of PAP; 3 of 4 cases had progressive bilirubin normalization after PAP. The average amount of bilirubin removed from the plasma of the patients during each PAP treatment was 143 +/- 24 mg. At the beginning of each cycle of PAP, the Plasorba BR-350 was able to remove90% of the total plasma bilirubin, a percentage that decreased to 60%, 50%, and 40% after 2 L, 4 L, and 7 L of plasma were treated, respectively. Liver biopsies performed after the third treatment showed reduced cholestasis when compared with the pretreatment biopsy specimen. The preliminary data suggested that PAP selective for bilirubin removal may not only reduce the bilirubin level, but may also improve the histological pattern of the graft in terms of reduced cholestatic signs.
- Published
- 2007
43. The treatment of recurrent symptomatic lymphocele after kidney transplantation with intraperitoneal tenckhoff catheter
- Author
-
Adani, G. L., Baccarani, U., Lorenzin, D., Mauricio Sainz-Barriga, Bresadola, V., Anna, D., and Bresadola, F.
- Published
- 2007
44. The role of hepatic biopsy to detect macrovacuolar steatosis during liver procurement
- Author
-
Fabrizio Bresadola, Andrea Risaliti, A. De Candia, Umberto Baccarani, G.L. Adani, G. Trevisan, Dario Lorenzin, Mauricio Sainz-Barriga, Claudio Avellini, and Vittorio Bresadola
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Liver transplantation ,Gastroenterology ,Monitoring, Intraoperative ,Internal medicine ,Biopsy ,medicine ,Hepatectomy ,Humans ,Aged ,Retrospective Studies ,Ultrasonography ,Transplantation ,medicine.diagnostic_test ,business.industry ,Fatty liver ,Ultrasound ,Anatomical pathology ,Middle Aged ,medicine.disease ,Fatty Liver ,Liver ,Liver biopsy ,Tissue and Organ Harvesting ,Female ,Surgery ,Steatosis ,business - Abstract
The ability to predict graft function before transplantation has proven to be a difficult task, especially for macrovacuolar steatosis that is considered a major cause of posttransplant dysfunction. It is well known that macrovacuolar steatosis greater than 25% influences the short- and long-term outcomes of liver transplantation. We retrospectively analyzed frozen sections from 43 donor livers comparing preoperative laboratory/clinical values, and liver ultrasound of a cohort of donors without (group A, n = 21) versus with steatosis of 25% to 35% (group B, n = 22) upon liver biopsy performed during harvesting. We analyzed the possible correlations between preoperative donor data and the degree of macrovacuolar steatosis. None of the biochemical and clinical parameters were related to the degree of hepatic steatosis. The only difference between the two groups was the echographic pattern, with evidence of 27% fatty liver by ultrasound in group B and 5% in group A (p = .04). The specificity of hepatic ultrasound for macrovacuolar steatosis was 95% and the sensitivity was only 27%, while the positive and negative predictive value were 86% and 55%, respectively. In conclusion, liver biopsy during donor harvesting remains the gold standard to identify macrovacuolar steatosis greater than 25%. Hepatic ultrasound has a role to exclude the presence of steatosis in normal livers due to its high specificity, but it is not useful to make the diagnosis of a fatty liver since it has a low sensitivity and negative predictive value. Thereafter a liver ultrasound positive for hepatic steatosis alone should not be considered a valuable tool to discard an organ from transplantation.
- Published
- 2006
45. Endovascular treatment of aortic pseudoaneurysm after liver transplantation
- Author
-
Dario Lorenzin, Massimo Sponza, Pierluigi Viale, Daniele Gasparini, Andrea Risaliti, Umberto Baccarani, Gian Luigi Adani, Fabrizio Bresadola, Mauricio Sainz-Barriga, Adani GL, Baccarani U, Gasparini D, Sponza M, Sainz-Barriga M, Lorenzin D, Viale P, Risaliti A, and Bresadola F
- Subjects
Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,pseudoaneurysm ,LIVER TRANSPLANTATION ,Liver transplantation ,medicine.disease ,Surgery ,Pseudoaneurysm ,surgical procedures, operative ,medicine ,cardiovascular system ,cardiovascular diseases ,Endovascular treatment ,business ,Aortic pseudoaneurysm - Abstract
We report herein a case of a 59-year-old Caucasian female who experienced noninfected pseudoaneurysm, of the aorto-hepatic anastomosis of the jump graft, after third liver transplantation, that was successfully treated by endovascular aortic repair
- Published
- 2005
46. A single-center experience of late retransplantation of the liver
- Author
-
Fabrizio Bresadola, G Costa, G. Della Rocca, G.L. Adani, Giorgio Soardo, Mauricio Sainz-Barriga, Pierluigi Toniutto, Umberto Baccarani, Domenico Montanaro, Dario Lorenzin, Andrea Risaliti, and Pierluigi Viale
- Subjects
Adult ,Reoperation ,medicine.medical_specialty ,Time Factors ,Cirrhosis ,medicine.medical_treatment ,Liver transplantation ,Single Center ,Medical Records ,law.invention ,Hepatic Artery ,Postoperative Complications ,law ,Humans ,Medicine ,Survival rate ,Retrospective Studies ,Transplantation ,business.industry ,Thrombosis ,Retrospective cohort study ,medicine.disease ,Intensive care unit ,Liver Transplantation ,Surgery ,surgical procedures, operative ,business - Abstract
Liver retransplantation is considered to carry a higher risk than primary transplantation. However, there are an increasing number of retransplant candidates, especially owing to late graft failure. The aim of this study was to analyze a single-center experience in late liver retransplantation. The overall rate of primary retransplantation was 11.4% (28 re-OLT out of 245 primary OLT); the 14 (52%) who underwent retransplantation at more than 3 months after the first transplant were analyzed by a medical record review. Causes of primary graft failure leading to retransplantation were chronic hepatic artery thombosis in five cases (36%); recurrent HCV cirrhosis in four cases (29%); chronic rejection in two cases (14%); veno-occlusive disease; hepatic vein thrombosis or idiopathic graft failure in one case each (7%). UNOS status at re-OLT was always 2A, all patients were hospitalized; three were intensive care unit bound. ICU and total hospital stay had been 7 +/- 5 and 28 +/- 16 days, respectively. One- and 2-year patient and graft survivals were 84% and 62% and 67% and 67%, respectively. Death occurred in four patients. Two out of the three recovered in ICU at the time of retransplantation, at a median interval of 15 +/- 9 days after retransplantation. The survival rate after late retransplantation is improving, and this option should be considered to be a efficient way to save lives, especially by defining the optimal timing for retransplantation.
- Published
- 2005
47. HUMAN HEPATOCYTE ISOLATION FOR LIVER CELL THERAPY: WHOLE MARGINAL LIVERS OR HEALTHY SEGMENTS FROM SPLITTING?
- Author
-
Umberto Baccarani, Mauricio Sainz-Barriga, Gian Luigi Adani, Andrea Risaliti, Fabrizio Bresadola, Annibale Donini, and Andrea Sanna
- Subjects
Transplantation ,Human hepatocyte ,Pathology ,medicine.medical_specialty ,Isolation (health care) ,business.industry ,Liver cell ,Immunology ,Medicine ,business - Published
- 2005
48. Right lobe living related graft loss due to intrahepatic multiple arterio-portal fistulas
- Author
-
Fabrizio Bresadola, A. Risaliti, G.L. Adani, Dario Lorenzin, U. Baccarani, and Mauricio Sainz-Barriga
- Subjects
Adult ,Reoperation ,medicine.medical_specialty ,Fistula ,Ischemia ,Octreotide ,Carcinoid Tumor ,Anastomosis ,Hepatic Artery ,Ascites ,medicine ,Living Donors ,Humans ,Treatment Failure ,Transplantation ,medicine.diagnostic_test ,business.industry ,Portal Vein ,Liver Neoplasms ,medicine.disease ,Primary tumor ,Surgery ,Liver Transplantation ,Ileal Neoplasms ,Liver biopsy ,Arteriovenous Fistula ,Female ,Radiology ,medicine.symptom ,business ,medicine.drug - Abstract
We report a case of a 38-year-old Caucasian female with ileal carcinoid and bilobar hepatic metastases. After resection of the primary tumor, octreotide therapy was prescribed. Carcinoid histology was positive for chromogranin A and sinaptophsine and negative for MIB1. At 1-year, a follow-up computed tomography scan, Octreoscan, and PET scan were negative for extrahepatic involvement. The patient underwent right lobe living related liver transplantation donated by her sister. Acute hepatic artery thrombosis was successfully revascularized 24 hours after transplantation. Extrahepatic biliary ischemia was treated by a bilio-digestive anastomosis. Eight months later, ascites and clinical and serologic signs of liver failure developed; a liver biopsy revealed fibrosis. Spiral computed tomography scan and hepatic angiography showed multiple intrahepatic arterio-portal fistulas resulting in arterialization and inversion of the portal flow in the absence of graft outflow obstruction.
- Published
- 2004
49. Successful minimally invasive management of late portal vein thrombosis after splenectomy due to splenic artery steal syndrome following liver transplantation: a case report
- Author
-
Pierluigi Toniutto, Daniele Gasparini, Fabrizio Bresadola, Andrea Risaliti, Umberto Baccarani, Mauricio Sainz-Barriga, Massimo Sponza, Claudio Avellini, G Ramacciato, and G.L. Adani
- Subjects
medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Arterial Occlusive Diseases ,Splenic artery ,Liver transplantation ,Angioplasty ,medicine.artery ,medicine ,Humans ,Thrombus ,Transplantation ,business.industry ,Portal Vein ,Thrombosis ,Middle Aged ,medicine.disease ,Hepatitis B ,Hepatitis D ,Portal vein thrombosis ,Surgery ,Liver Transplantation ,Venous thrombosis ,surgical procedures, operative ,Treatment Outcome ,Splenectomy ,Female ,Radiology ,business ,Splenic Artery - Abstract
Portal vein thrombosis (PVT) after liver transplantation (OLT), which occurs in 1% to 2.7% of cases, can compromise patient and graft survival. Percutaneous transhepatic portal vein angioplasty offers an option to treat PVT, diminishing surgically related morbidity and the need for retransplantation. We describe a case of late PVT after OLT, which was successfully treated by a minimally invasive percutaneous transhepatic approach using both mechanical fragmentation and pharmacologic lysis of the thrombus followed by anticoagulation. The patient has had a good clinical course with normal graft function and patent portal blood flow at 6-month follow-up. This case report confirms the possibility of successful recanalization of the portal vein in a patient with late PVT after liver transplantation. Sustained anticoagulation/antiaggregation therapy for at least 6 months after the procedure is advisable.
- Published
- 2004
50. Ileosplenic fistula and splenic abscesses caused by migration of biliary stents in a liver transplant recipient
- Author
-
Pierluigi Toniutto, Andrea Risaliti, Annibale Donini, Gian Luigi Adani, Fabrizio Bresadola, Mauricio Sainz-Barriga, and Umberto Baccarani
- Subjects
Male ,medicine.medical_specialty ,Fistula ,medicine.medical_treatment ,Spleen ,Postoperative Complications ,Foreign-Body Migration ,medicine ,Intestinal Fistula ,Humans ,Radiology, Nuclear Medicine and imaging ,Abscess ,Splenic Diseases ,Cholestasis ,business.industry ,Ileal Diseases ,Gastroenterology ,Stent ,Middle Aged ,medicine.disease ,Surgery ,Liver Transplantation ,Transplantation ,medicine.anatomical_structure ,Biliary tract ,Stents ,Bile Ducts ,Splenic disease ,Complication ,business - Published
- 2004
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