In-Situ Hemodynamics and Oxygen Utilization in Right Lobe Grafts During Living Donor Hepatectomy.

Background: Several studies have examined liver graft hemodynamics during living donor liver transplants; however, to the best of our knowledge, the hemodynamics of the partial graft during donor hepatectomy have not been thoroughly explored. We analyzed intraoperative graft hemodynamics and oxygen utilization data following parenchymal dissection during living donor hepatectomy.

Methods: The following parameters were measured intraoperatively in 63 right hepatic lobe living donor hepatectomy cases: right portal vein (RPV) and right hepatic artery (RHA) blood flow after parenchymal transection, along with blood gas analysis from the RPV, RHA, and right hepatic vein.

Association Between Psychiatric Illness and Short-Term Outcomes Among Patients With Hepatobiliary and Pancreatic Cancer.

Introduction: The association between psychiatric illness (PI) and outcomes after hepatobiliary and pancreatic (HPB) surgery remains unknown. Our study aimed to assess the association between psychiatric diseases and outcomes after surgery for malignant HPB diseases.

Methods: We performed a retrospective review of the 2016-2019 National Inpatient Sample (NIS) of patients undergoing HPB surgery.

Expanding pediatric liver transplants: the role of split grafts, allocation policies, and machine perfusion.

Purpose Of Review: Pediatric liver transplant waitlist mortality remains disproportionately high, particularly among infants under one year old. Despite the success of split liver transplantation (SLT) in improving pediatric access to transplants, its utilization remains limited. This review examines barriers to SLT adoption, explores the impact of pediatric-focused allocation policies, and evaluates the potential of machine perfusion technology in expanding the pediatric donor pool.

ABO Incompatible Grafts Are Associated With Excellent Outcomes in Pediatric Liver Transplant Recipients: An Important Resource to Reduce Waitlist Mortality.

Background: Liver transplant (LT) waitlist mortality occurs in 10% of children; innovative strategies to expand access to LT can be lifesaving.

Methods: Outcomes of ABO incompatible (ABOi) LT performed between 1999 and 2023 at a high-volume center were compared to ABO compatible (ABOc) LT.

Results: 25 ABOi LT were performed among 270 LT; 72% were listed with status 1/1A/1B or a median pediatric end-stage liver disease/model for end-stage liver disease of 40 (IQR 32,41).

Outcomes of pediatric candidates for liver retransplantation in the modern era: Strategies are needed to avoid waitlist mortality in the United States.

Pediatric liver retransplantation (rLT) has historically shown poorer outcomes compared to primary liver transplantation (pLT). Comprehensive studies assessing outcomes for pediatric candidates for rLT under the modern allocation policy are lacking. Organ Procurement and Transplantation Network data from January 1, 2010, to December 31, 2022, were obtained; exclusion criteria included candidates ≥18 years of age and those listed or transplanted for multiple organs.

Pushing the Limits of In Situ Split Liver Procurement to Overcome Donor Distance and Graft Size Challenges for 8-Week-Old Pediatric Recipient.

Background: Pediatric liver transplantation for small recipients presents significant challenges, particularly in securing suitably sized donor organs. This case report illustrates the feasibility of performing an in situ split procurement in an 18.5-kg toddler, the smallest recorded case in the OPTN database to date, for a critically ill 8-week-old infant recipient.

Optimizing pediatric liver transplantation: Evaluating the impact of donor age and graft type on patient survival outcome.

Background: We examined the combined effects of donor age and graft type on pediatric liver transplantation outcomes with an aim to offer insights into the strategic utilization of these donor and graft options.

Methods: A retrospective analysis was conducted using a national database on 0-2-year-old (N = 2714) and 3-17-year-old (N = 2263) pediatric recipients. These recipients were categorized based on donor age (≥40 vs <40 years) and graft type.

Liver transplant versus liver resection in patients with multifocal hepatocellular carcinoma.

Background: The optimal surgical option in patients with multifocal hepatocellular carcinoma (MHCC) is an area of active research. The preference varies based on geographic variations and institutional policies. We sought to determine long-term outcomes in patients with MHCC based on surgical treatment-liver transplant (LT) vs resection (LR).

Small-for-size syndrome in a 9.7 kg pediatric recipient with a whole liver graft.

Background: Small-for-size syndrome (SFSS) in pediatric liver transplant recipients, particularly those weighing less than 10 kg, is rare. This report describes a case of a 15-month-old whole liver transplant recipient who suffered SFSS, and systematic literature review was performed to identify outcomes of such cases and potential risk factors for SFSS.

Case Presentation: A 15-month-old toddler with a history of biliary atresia underwent a deceased donor whole liver transplant.

Liver resection is superior to tumor ablation in patients with multifocal hepatocellular carcinoma.

Introduction: The management of T2 multifocal hepatocellular carcinoma (MHCC) is controversial, and the comparative impact of liver resection (LR) versus tumor ablation (TA) on survival continues to be debated. The aim of our study was to examine short- and long-term survival for LR and TA in a nationally representative cohort. We hypothesized that patients who underwent LR would have improved survival.

Outcomes in elderly patients undergoing hepatic resection compared to liver transplant for hepatocellular carcinoma.

Background: Hepatic resection (HR) is an excellent option for patients with hepatocellular carcinoma (HCC). For patients meeting the Milan criteria, a liver transplant (LT) is also a viable option for patients with HCC, especially those with end-stage liver disease. With increasing rates of LTs amongst the elderly, we sought to determine long-term outcomes in patients who underwent HR compared to LTs in this patient population.

Association Between Preoperative Angioembolization and Bleeding Complications in Patients With Benign Liver Tumors: Analysis of a National Database.

Introduction: The role of angioembolization (AE) in patients with benign liver diseases is an area of active research. This study aims to assess any difference in liver resection outcomes in patients with benign tumors dependent on utilization of preoperative AE.

Methods: A retrospective cohort study of patients undergoing elective liver resections for benign liver tumors was performed using the National Surgical Quality Improvement Program database (2014-2019).

Living donor liver paired exchange between pediatric and adult recipients due to donor graft size mismatch.

Living donor liver transplantation is an effective means to decrease organ shortage. However, many potential living donors are currently being denied due to ABO incompatibility or inadequate donor liver volume. Liver paired exchange (LPE) provides a practical solution to overcome these obstacles, and yet the first case of LPE in the United States was only recently reported in 2020.

Perceptions and Early Outcomes of the Acuity Circles Allocation Policy Among Liver Transplant Centers in the United States.

Unlabelled: Recently, a new liver allocation policy called the acuity circles (AC) framework was implemented to decrease geographic disparities in transplant metrics across donor service areas. Early analyses have examined the changes in outcomes because of the AC policy. However, perceptions among transplant surgeons and staff regarding the new policy remain unknown.

Critical Appraisal of the Quality of Publications in Hepatobiliary and Pancreatic Surgery Research Using the American College of Surgeons NSQIP Database.

Background: The use of the American College of Surgeons (ACS) NSQIP has increased in hepatobiliary and pancreatic surgery (HPB) research as it provides access to high-quality surgical outcome data on a national scale. Using the ACS NSQIP database, this study examined the methodologic reporting of HPB publications.

Study Design: Web of Science core collection (all editions) was queried for all HPB studies using the ACS NSQIP database published between 2004 and 2022.

Does Chronic Use of Steroids Affect Outcomes After Liver Resection? Analysis of a National Database.

Introduction: With the increasing age of patients, more patients on chronic preoperative steroids are undergoing liver resections. Our study aimed to assess the relationship between preoperative steroids and outcomes.

Methods: We performed a retrospective review of the 2014-2019 NSQIP database of all patients undergoing liver resections.

Liver Transplantation as a Curative Approach for Patients With Nonresectable Colorectal Liver Metastases.

Objectives: Liver transplant is emerging as a potential treatment option for patients with isolated colorectal liver metastasis. In this review article, we analyzed the published literature on liver transplant outcomes in such patients.

Materials And Methods: Four prospective studies documenting the clinical outcomes in patients with colorectal liver metastasis who underwent liver transplant were analyzed to study the feasibility of liver transplant in such patients.

Living Donor Versus Deceased Donor Pediatric Liver Transplantation: A Systematic Review and Meta-analysis.

Unlabelled: Reduced-size deceased donors and living donor liver transplantation (LDLT) can address the organ shortage for pediatric liver transplant candidates, but concerns regarding technical challenges and the risk of complications using these grafts have been raised. The aim of this study was to compare outcomes for pediatric LDLT and deceased donor liver transplantation (DDLT) via systematic review.

Methods: A systematic literature search was performed to identify studies reporting outcomes of pediatric (<18 y) LDLT and DDLT published between 2005 and 2019.

Effects of Coronavirus Disease 2019 on Solid Organ Transplantation.

Background: As the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged as a viral pandemic, data on the clinical characteristics and outcomes of patients with SARS-CoV-2 infection undergoing solid organ transplant are emerging. The objective of this systematic review was to assess currently published literature relating to the management, clinical course, and outcome of SARS-CoV-2 infection in liver, kidney, and heart solid organ transplant recipients.

Methods: We conducted a systematic review to assess currently published literature relating to the management, clinical course, and outcome of SARS-CoV-2 infection in liver, kidney, and heart solid organ transplant recipients.

Biliary Internal Stents and Biliary Complications in Adult Liver Transplantation.

Background: Biliary complications in liver transplantation (LT) can cause significant morbidity or even lead to a potential graft loss and patient mortality. Oftentimes biliary internal stents (ISs) are used at the time of LT to lower the risk for or prevent these biliary complications; however, their efficacy and outcomes remain controversial.

Methods: A retrospective cohort study was conducted on all of the adult patients who underwent a deceased-donor LT (DDLT) with an end-to-end choledococholedocostomy.

Review of COVID-19 Outcomes in Surgical Patients.

Unlabelled: COVID-19 emerged as a viral pandemic in the year 2019. The practice and scope of surgery and medicine transformed radicially as the virus spread across the world. There is an urgent need to understand the outcomes of COVID-19 infected patients who undergo surgery.

Current state of kidney utilization in multiorgan transplants.

Purpose Of Review: In the United States, the leading indication for kidney transplant is primary kidney dysfunction arising from chronic hypertension and diabetes. However, an increasing indication for kidney transplantation is secondary kidney dysfunction in the setting of another severe organ dysfunction, including pancreas, liver, heart, and lung disease. In these settings, multiorgan transplantation is now commonly performed.