1 / 46

LIVER TRANSPLANTATION - Romanian Experience -

Center of General Surgery and Liver Transplantation Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation – Bucharest. LIVER TRANSPLANTATION - Romanian Experience -. I. POPESCU, M. IONESCU, D. TULBURE, V. BRASOVEANU, DOINA HREHORET,

sheera
Télécharger la présentation

LIVER TRANSPLANTATION - Romanian Experience -

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Center of General Surgery and Liver Transplantation Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation – Bucharest LIVER TRANSPLANTATION - Romanian Experience - I. POPESCU, M. IONESCU, D. TULBURE, V. BRASOVEANU, DOINA HREHORET, E. MATEI,  B. DOROBANTU,  R. ZAMFIR, S. ALEXANDRESCU, R. GRIGORIE M. VOICULESCU, LIANA GHEORGHE

  2. Starting with April 2000, 252 LTs in 239 patients (13 retransplantations) were performed in the Center of General Surgery and Liver Transplantation

  3. Transplantation Procedures

  4. General data • Sex 97 F / 142 M • Age • Limits 1 – 64years

  5. Indications for transplantation • HBV+/- HDV cirrhosis 77 (1 - pancreas) • HCV cirrhosis 43 (1- islet cell tx) • Hepatocarcinoma + cirrhosis 39 (1 fibrolamellar) • HBV+HCV cirrhosis 4 • Biliary cirrhosis 18 • Wilson’s Disease 13 • Alcoholic cirrhosis 12 • Autoimmune hepatitis 4 • Cryptogenic cirrhosis 3 • Biliary atresia 6 • Hereditary glycogenosis 5 • Liver fibrosis 3 • Intrahepatic ductopenia 2 • Others 10

  6. 191 Cadaver donors • Agebetween6 – 66(average30 years) • Sex: • 121men • 70 women • Blood type • O I 64 B III 29 • A II 79 AB IV 19 • Harvesting: • Multiorgan (kidney, heart, skin, bone, tendon) 188 • Liver3 • Causesof death • CCT (road accident, aggression etc.) 109 • Stroke79 • Brain tumor 2 • Metilic alcohol intoxication 1

  7. Number ofadult patients included in the waiting list for LT * MORTALITY RATE ON THE WL 45% * Data provided by the Center of Gastroenterology and Hepatology

  8. Number of potential/real deceased donors for LT

  9. WHOLE GRAFT LT TECHNIQUE

  10. Classic technique

  11. Caval anastomosis – “pyggy-back” technique

  12. Caval anastomosis - Belghiti technique

  13. Caval anastomosis – cavoplasty technique

  14. Final aspect of anastomoses

  15. ALTERNATIVE LT TECHNIQUES

  16. 1) LIVING-DONOR LT =transplantation of one or more liver segments from a living donor to a child-recipient (more frequently) or to an adult recipient

  17. Liver segments harvested from a living donor transplantedliver segments • In children: • the left lateral sectionectomy (more frequently) • the left hemiliver (segments 2, 3, 4)

  18. 26 children with LD LT • biliary atresia 6 • hereditary glycogenosis 4 • Wilson’s disease 2 • liver cirrhosis 2 • congenital liver fibrosis 2 • intrahepatic ductopenia 2 • biliary hipoplasia 1 • histiocytosis 1 • focal nodular hyperplasia 1 • hereditary fructosemia 1 and reTx • fibrolamellar hepatocarcinoma 1 • primary sclerosing cholangitis 1 • Caroli’s disease 1

  19. ABDOMINAL ORGAN TRANSPLANTATION FROM LIVING DONORS:STATE OF THE ART Gubbio, Italy - June 21-23, 2002 University of Illinois – Chicago, USA; University of Minnesota – Minneapolis, USA “Romanian Journal of Gastroenterology” June 2004, volume 13, number 2, p. 125-127

  20. Biliary atresia Wilson’s disease Biliary atresia

  21. Biliary atresia – 1 yo LDLT – Oct 2000

  22. Biliary atresia – 1 yo LDLT – March 2001

  23. DUCTOPENIA – 9 yo #1 LDLT – Sep 2005 #2 reduced – Sep 2007

  24. Biliary atresia – 1 yo LDLT May 2006

  25. With improvements in surgical instrumentation and techniques and progressively longer waiting times for cadaveric livers, LDLT was extended to adult recipients, utilizing right hemiliver grafts • In adults: • the right hemiliver (segments 5-8)

  26. donor’s operation Diseased liver (cirrhosis) recipient’s operation

  27. 30 adults with LD LTx • Hepatocellular carcinoma + cirrhosis 12 • HBV+/- HDV cirrhosis 10 • HCV Cirrhosis 5 • Wilson disease 1 • Cryptogenetic cirrhosis 1 • Autoimmune cirrhosis 1

  28. 2) SPLIT LT In situ splitting provides two grafts of optimal quality that can be applied to the entire spectrum of transplant recipients: it is the method of choice for expanding the cadaver liver donor pool* *Busuttil RW, Goss JA. Ann Surg. 1999;229:313-321

  29. SPLITTING ON THE “BACK-TABLE”

  30. 3) DOMINO LT • = transplantation of a liver from a marginal donor with hereditary metabolic disease (who receives another LT) to a marginal recipient (i.e. with cirrhosis and hepatocellular carcinoma) • Familial amyloidotic polyneuropathy • Familial oxaluria • Familial hypercholesterolemia

  31. split split Child with glycogenosis Patient with familial hypercholesterolemia Patient with hepatocellular carcinoma and cirrhosis domino The liver of a patient with hereditary familial hypercholesterolemia was transplanted to a marginal recipient with hepatocellular carcinomaandcirrhosis („domino transplantation”)

  32. EARLY LOCAL POSTOPERATIVE COMPLICATIONS • Biliary complications 28 • Biliary leakage 20 • Biliary stenosis 8 • Vascular complications 24 • Vascular thrombosis 18 • hepatic artery 15 • portal vein 3 • Vascular stenosis 6 • hepatic artery 2 • portal vein 4 • Postoperative intraabdominal hemorrhage 23 • Peritonitis/Peritoneal abscess 18 • Intraoperative hemorrhagic shock 4 • “Small-for-size” syndrome 5 • Acute liver failure 3 • Partial necrosis of the liver graft 3 • Intestinal obstruction 4 • Incisional evisceration(blocked) 3 • Primary non-function 1

  33. EARLY GENERAL POSTOPERATIVE COMPLICATIONS • Neurologicalcomplications 35 • Renal complications 20 • Respiratory complications 18 • Cardio-vascularcomplications6 • Upper GI hemorrhage 5 • Ileotyphlitis 1

  34. LATE POSTOPERATIVE COMPLICATIONS • Biliary complications 21 • Biliary stenosis 18 • Biliary leakage 3 • Vascular complications 7 • Vascular stenosis 5 • hepatic artery 2 • portal vein 2 • caval anast 1 • Vascular thrombosis (hepatic artery) 2 • CMV reinfections 5 • Chronic rejection 2

  35. LATE POSTOPERATIVE COMPLICATIONS • Renal complications 6 • Respiratory complications 6 • Hematological complications5 • PTLD 1 • Severeneutropenia 4 • Cardiologicalcomplications 5 • Venooclusive disease 1 • Incisional hernia 5 • Neurologicalcomplications 1 • Duodenal ulcer 1 • Splenic infarctation 1 • Aggravation of diabetes mellitus 1 • Cervix/lung carcinoma 1 • Erisipela of the arm 1

  36. POSTOPERATIVE RECURRENCE OF THE INITIAL DISEASE FOLLOWING LT • HCV 28 • Hepatocarcinoma 7 • Autoimmune liver disease 1 • Alcoholic cirrhosis 1 • Hepatic fibrosis (ductopenia) 1

  37. SURVIVAL • POSTOPERATIVE SURVIVAL 93.3 % -222/238 patients • Patients alive at Dec 2010 177 • < 1 year 47 • 1-2 years 26 • 2-3 years 30 • 3-4 years 19 • 4-5 years 13 • 5-6 years 10 • 6-7 years 9 • 7-8 years 3 • 8-9 years 7 • 9-10 years 9 • >10 years 4

  38. OVERALL PATIENTS SURVIVAL OVERALL GRAFT SURVIVAL

  39. SURVIVAL 92% 81% 80% 85.5% 58%

  40. CONCLUSION • The transplantation program in our center is increasing as number of surgical procedures • It is a complex program with all types of liver transplantation , both in adults and children and combined as well • Along with the increase of liver transplantation procedures and experience of surgical team, the results are continuously improving

More Related