The systemic cytokine response during surgery has been reported to be stimulated by the molecules released from damaged cells, called damage-associated molecular patterns (DAMPs). The relationship between DAMPs and liver transplantation has not been reported. We aimed to clarify the relationship between the plasma levels of DAMPs and the short-term post-transplant outcomes, including mortality and postoperative multi-organ dysfunction syndrome (MODS). This retrospective cohort study enrolled 61 patients who underwent liver transplantation. Mitochondrial DNA fragments, as mitochondria-derived DAMPs (mtDAMPs), were isolated from frozen plasma obtained at the start and the end of transplantation and were quantified by polymerase chain reaction. The short-term post-transplant outcomes were compared among the groups categorized based on the median value of the intraoperative fluctuation of mtDAMPs levels. The mtDAMPs levels were increased from the start to the end of transplantation in 52 recipients (85.2%, n = 61). Regarding mortality, no significant differences were noted between the high group (n = 30) and the low group (n = 31). The higher plasma levels of mtDAMPs were correlated with the longer duration of postoperative vasopressor support (P < 0.05). Importantly, the rate of MODS on postoperative day 1 was significantly higher in the high group (high vs. low group: 21 patients [70%] vs. 11 patients [35.1%], P < 0.01). In conclusion, mtDAMPs were increased in plasma during liver transplantation in most recipients. This elevation was not associated with mortality, but associated with the post-transplant recovery. Measuring plasma mtDAMPs may be helpful for predicting posttransplant recovery among livertransplant recipients.

We report herein our experience with bilateral inguinal hernia surgery for a patient who had previously undergone a Y-shaped vascular graft for an abdominal aortic aneurysm and then right axillary-bilateral femoral artery bypass surgery. Preoperative physical examination and imaging revealed a subcutaneous vascular graft passing from the right axilla through the right flank region and branching at the lower abdomen to reach the femoral areas on both sides. As repair surgery by inguinal incision was considered difficult, we performed laparoscopic surgery. Bilateral direct hernia was observed on intraperitoneal observation. Essentially no intraperitoneal organ adhesion to the abdominal wall was present, and the previous surgery was also confirmed not to have reached the inguinal preperitoneal space. Transabdominal preperitoneal repair was therefore performed, yielding favorable results.

Background/Aims: The effect of splenectomy on the liver regeneration of a partial graft after living donor liver transplantation (LDLT) is controversial. In recent years, some studies have shown that platelets have strong effects on promoting liver regeneration, but not with a smallfor-size liver graft. This study aimed to validate the effects of splenectomy on liver regeneration rate after LDLT with extended left lobe graft with the middle hepatic vein. Methodology: Of 312 LDLT to date, 32 adult patients at Nagasaki University Hospital (Nagasaki, Japan) transplanted with an extended left lobe graft with middle hepatic vein between April 2013 and April 2019 were retrospectively assessed. In our department, the preoperative platelet count indicated for splenectomy is 50,000/ L. Overall, 13 and 19 patients were included in the splenectomy and without splenectomy groups, respectively. We examined the relations hip between splenectomy and liver volume increase, and postoperative platelet count on the 1st, 3rd, 5th, and 7th postoperative day. The liver volume 1 month (1MVol) after LDLT was estimated using a 3D image analysis system. Results: ROC curve analysis showed the spleen volume threshold for significant volume increase (1MVol/graft weight 2) was 440ml. With regard to 1MVol, no significant difference was observed between the splenectomy and without splenectomy groups. However, in the splenectomy group, recipients with a large spleen (more than 440 ml) led to higher liver volume increase than in those with a small spleen. Platelet count significantly increased from postoperative day 14 in the splenectomy group regardless of the size of the spleen. Conclusions: Simultaneous splenectomy does not always have an effect on liver regeneration in extended left lobe graft LDLT. However, for LDLT recipients with large spleen volume, graft volume increase was affected, probably through vigorous portal venous blood flow but not plateletderived factors.

Introduction The aim of this study was to analyze changes in characteristics of HCC and the modes of LR over 20 years in order to show the impact of those changes in the outcome of LR. In addition, BCLC staging was used to assess the limitations of this classification system and changes over the decade. Patients and methods In our department, 500 liver resections (LR) were performed for hepatocellular carcinoma (HCC) over the 20 years between January 2000 and February 2020. The 208 cases performed through 2009 were designated as Era 1, and the 292 cases between 2010 and February 2020 were termed Era 2. We analyzed changes in the characteristics of HCC and mode of LR (Study 1), and final outcomes of LR are shown according to the BCLC staging classifications and eras using data from the 5 years after LR (Study 2). Results In Era 1, the mean age of the patients was 68, while in Era 2 the mean age was 71, which was significantly older than the patients in Era 1. HCC that developed from non‐B, non‐C liver cirrhosis was significantly increased in Era 2 (45%) as compared to that in Era 1 (34%). Laboratory data were all comparable between the eras in patients undergoing LR for HCC. The size and numbers of the HCC as well as tumor markers were similar between the eras. As to the mode of LR, although the extent of LR was similar between the eras, the laparoscopic method was significantly increased in Era 2. Blood loss was significantly lower in Era 2 (mean 519 g) than in Era 1 (1,085 g). Patient survival and recurrence‐free survival (RFS) were similar between the two eras, while RFS at 5 years after LR was better in Era 2. Even in the BCLC A category, only patients with a single HCC less than 5 cm showed best results, while patients with HCC within the rest of BCLC A and BCLC B showed a dismal outcome. There was no difference in OS and RFS between the eras after stratification by BCLC. Conclusion There are conspicuous changes in the baseline characteristics and mode of LR over 20 years, which should be taken into account for patient care and informed consent for patients undergoing LR going forward.

No abstract