Background: Living donor liver transplantation (LDLT) is the only treatment option for patients with end-stage liver disease (ESLD) where cadaveric donors are not available. In developing countries, the inception of LDLT programs remains a challenge. The first successful liver transplantation in Vietnam underwent in 2004. The objective of this study was to report outcomes of 140 LDLT recipients in a developing country and to highlight the challenges encountered by a new LDLT program in a resource-limited setting in highest-volume center in Vietnam. Methods: We retrospectively reviewed recipients who underwent LDLT between October 2017 and August 2022 in 108 Military Central Hospital. Demographics, etiology, graft characteristics, and operative variables were assessed. Outcome was assessed on the basis of morbidity and mortality. All complications of three on the Clavien-Dindo grading system were included as morbidity. Estimated 1-year, 3-year, 5-year survival was calculated using Kaplan-Meier curves, and a log-rank test was used to determine the significance. Outcomes between the first 80 LDLTs (group 1) and latter 60 LDLTs (group 2) were also compared. Results: Median age was 48.5 (11-80) years, whereas the median MELD score was 24 (7-37). The male to female ratio was 4:1. ACLF to hepatitis B virus was the most common indication (40% patients). There were 43 patients significant (grade 3) complications. The most common morbidities were bile leaks in eight and biliary strictures in 21 patients. Overall mortality in patients who underwent LDLT for ACLF was 15.7%. Estimated 1-year survival was 91%, 3 years 85%. Patients who underwent transplantation in the latter period had a significantly lower overall complication rate (36% vs. 68%; P=0.01). Conclusions: Comparable outcomes can be achieved in a new LDLT program in a developing country. Outcomes improve as experience increases.

Background: Liver transplantation is now one of established therapeutic options for patients with hepatocellular carcinoma (HCC). The aim of study is to describe the current practice of living donor liver transplantation (LDLT) for HCC, including the patient selection criteria, surgical techniques, management of small-for-size syndrome, postoperative complications, and the results of our center. Methods: We prospectively analyzed the data on all right lobe LT adult patients for HCC, consecutively performed from October 2017 to June 2022 in Military Central Hospital 108. Our center practices careful selection for HCC patients using the Milan and University of California San Francisco (UCSF) criteria, supplemented by alpha-fetoprotein level and the model for end-stage liver disease (MELD) score. We pioneered in using the extended right lobe graft and the novel hepatic venoplasty technique, which lessen the risk of hyperperfusion and small-for-size syndrome with improved overall recipient survival. When the remnant and total liver volume ratio less than 35%, we used modified right lobe graft. We conjoined the middle hepatic vein and right hepatic vein as a single orifice hepatic vein. Data were collected prospectively and presented as the mean values and ranges, or the number of patients in proportion of total patient population. Results: A total of 57 cases of adult-to-adult LDLT using right lobe graft for HCC treatment were collected. Of our patients, and 50,8% met the Milan and UCSF criteria. Regarding the Milan and UCSF criteria, the 2-year recurrence rate was significantly lower in patients who met Milan than in patients who exceeded the Milan criteria (1.75% vs. 14%). A 5-year overall and disease-free survival rate of 73.5% and 70.3% were achieved. Seventy-three point six percent of the complications were rated as Clavien I. Conclusions: LDLT is an ideal treatment for HCC in Vietnam with regard to the critical organ shortage and high demand for transplantation.

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Background: Laparoscopic common bile duct (CBD) exploration using the cholangioscope has become a standardized technique within the last years. However, this technique often becomes a time-consuming, difficult part of the operation and increases the risk of intra-abdominal and surgical site infections due to intraoperative leakage of bile and stone fragments. A new instrument was developed on the basis of using Hi-Lo endotracheal tubes with various manipulative channels included one-way closed suction system, pilot balloon which allows to keep the canal stable in the CBD and available in a wide range of diameters to provide better fit for the different dilatations of the common bile duct. The cholangioscope will be inserted through this canal to remove stones. Methods: We describe the step-by-step technique using the new instrument under laparoscopic guidance, in patients with hepatolithiasis combined with choledocholithiasis. Main outcomes were complete stone clearance rate, single-session stone clearance rate, number of endoscopic sessions needed for stone clearance, and adverse events. Results: A total of 29 patients with hepatolithiasis with choledocholithiasis underwent laparoscopic CBD exploration to remove stones using cholangioscopy through the new instrument from June 2019 to June 2022. 30% of patients had a history of laparotomy, in which 23.8% had a history of CBD exploration. The complete stone clearance rate was 85.7%. Single-sesion stone clearance was achieved in 71.4%. There were no intraoperative complications occurred; 2 cases of postoperative complication of minor bile leakage, no treatment were necessary. The average operative time and tube insertion time was 126 ± 36 minutes and 5 ± 2 minutes, respectively. Postoperative hospital stay was 8.5 ± 2.6 (days). Conclusions: The laparoscopic CBD exploration using the cholangioscope and the new instrument is a feasible, safe, and effective technique, and may be considered as a standard approach of the treatment for hepatolithiasis combined with choledocholithiasis.