The aim of the investigation was to assess the immediate and long-term results of the liver transplantation in patients with unresectable hepatic alveolar echinococcosis.Materials and Methods. 22 liver transplantations were performed in the Center for Surgery and Transplantology of the A.I. Burnazyan Federal Medical and Biophysical Center between January 2011 and December 2016 for unresectable liver disease. Liver segments (the right liver lobe in all cases) from living related donors were transplanted to 21 patients, a posmortal donor liver was transplanted to 1 female patient. 16 patients (72.7%) had parasitic invasion of the inferior vena cava. All operations were done in R0 variant. Reconstruction of the great vessels was performed by synthetic PTFE-conduits if autoplasty was not feasible.Results. The duration of surgery was 430 (390-480) min. The intraoperative blood loss amounted to 1,500 (1,300-2,200) ml, cold ischemia lasted 30 (25-45) min. The morbidity rate of postoperative complications made up 45.4%. Biliary complications (Grade A, B, ISGLS, 2011) prevailed. Mortality rate was equal to 4.5%. The length of postoperative hospital stay averaged out to 20 (15-23.5) bed days. Long-term survival rate comprised 100%. Maximal follow-up period was 58 months.Conclusion. Liver transplantation with resection and reconstruction of the great vessels, including resection of the inferior vena cava and even the right atrium, may be the only radical method of treating unresectable hepatic alveolar echinococcosis, making it possible to provide satisfactory immediate and long-term results of surgical treatment of the patients seemingly doomed to death. These interventions should be performed only in highly specialized centers with a developed program of surgical hepatology and liver transplantation.
On February 7, 2019, a one-day Consensus Conference of the International Liver Transplantation Society was held to discuss oncology issues. Representatives of world's leading clinics gathered in Rotterdam (Netherlands). The presentations made on that day covered the following topics: hepatocellular cancer, bile duct cancer, immunotherapy and its place in the treatment of liver tumors, the possibility of liver transplantation in patients with metastatic liver disease, world trends in pediatric oncohepatology. A separate session in the working groups was allocated to discuss the most actual topics. The Conference identified the main global trends and the most crucial issues in the field of liver transplantation in patients with oncological diagnosis. It is likely that these presentations will “set the tone” for the large Transplantationt Congress in Toronto in May 2019.
Aim. To describe new data and to complement the existing information about the anatomic features of the hepatic vein structure in the donor of the right hepatic lobe, to formulate the principles of donor selection proceeding from vascular anatomy.Materials and methods. 306 liver transplantations from living related donors were performed at A.I. Burnazyan Federal Medical Biophysical Center of Federal Medical and Biological Agency of Russia from 2009 to 2021. The vascular anatomy of 518 potential donors was analyzed. The prevalence of different vein structures of the right hepatic lobe was assessed.Results. The authors identified 14 subtypes of anatomy of efferent vessels. They were classified into 3 types depending on the contribution of the median vein to the blood outflow from the right hepatic lobe: caval (67.3%), cava medial (semi-separate, 29%), and separate (3.6%).Conclusion. The anatomy of the efferent vessels of the right lobe graft is characterized by variability and complexity. It requires accurate assessment at the preoperative stage (CT scanning) to be ready for reconstruction of any complexity.
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