Using the Clavien Grading System to Classify the Complications of Right Hepatectomy in Living Donors

Liu, B; Yan, Lü-Nan; Li, J; Li, Bo; Zeng, Yong; Wang, W T; Xu, Meiqing; Yang, Jian; Zhao, Jichun

doi:10.1016/j.transproceed.2008.11.014

Cited by 16 publications

(6 citation statements)

References 11 publications

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“…Based on the classification of donor complications according to the Clavien system (17), during the partial hepatectomy hospitalizations, one donor had a grade 1 complication (wound infection), five donors had grade 2 (gastrointestinal symptoms including nausea, vomiting, and/or epigastric pain), two donors had grade 3b (one had bile leak requiring percutaneous drainage, and one had peptic ulcer disease with gastric outlet obstruction needing surgical correction), one donor had grade 4 with a pneumothorax immediately post‐partial hepatectomy, and none had grade 5 or death. A total of four donors (7%) required five readmissions after partial hepatectomy, and none had grade 5.…”

Section: Resultsmentioning

confidence: 99%

Living donor liver transplantation in children: A single North American center experience over two decades

Karnsakul

Intihar²,

Konewko³

et al. 2012

Pediatric Transplantation

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Little data concerning hospital charges and long-term outcomes of LDLT in North American children according to transplant indications have been published. To compare outcomes of patient and graft survival and healthcare charges for LDLT for those with BA vs. other diagnoses (non-BA). A retrospective review of 52 children receiving 53 LDLT (38 BA and 14 non-BA) from 1992 to 2010 at our institution was performed. One-, five-, and 10-yr patient and graft survival data were comparable to national figures reported to UNOS. Average one-yr charges for recipients and donors were $242 849 for BA patients and $183 614 for non-BA (p = 0.074). BA patients were 1.23 ± 1.20 yr of age vs. 4.25 ± 5.02 for non-BA, p = 0.045. Examination of the total population of patients who were alive in 2010 in five chronological groupings showed that the crude five-yr survival rates were 1992-1995: 9/11 (82%); 1995-1997: 6/10 (60%); 1997-1999: 8/10 (80%); 1999-2001: 9/10 (90%); and 2001-2003: 7/7 (100%). Thus, examination of the clinical and financial data together over the entire period of the transplant program suggests that the dramatic improvement in patient survival was accomplished without a dramatic increase in indexed charges. All 53 donors survived, and only 10% had complications requiring hospitalization. LDLT in children results in excellent outcomes for patients and donors. Ways to lower costs and maximize graft outcome should be investigated.

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Section: Resultsmentioning

confidence: 99%

Living donor liver transplantation in children: A single North American center experience over two decades

Karnsakul

Intihar²,

Konewko³

et al. 2012

Pediatric Transplantation

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“…The clinical outcomes were analyzed according to the following definitions: perioperative mortality, any death within 30 days after the surgery; early complication, occurring within 90 days after cystectomy; late complication, occurring >90 days after cystectomy. Complications were classified according to Clavien classification .…”

Section: Methodsmentioning

confidence: 99%

The role of cystectomy in elderly patients – a multicentre analysis

et al. 2015

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IntroductionLife expectancy in developed countries is continuously increasing. Hence elderly patients are becoming more common in our clinical practice. Currently, one of the greatest challenges of medicine is balancing the life expectancy of elderly patients against aggressive treatments that carry significant risks. ObjectiveTo outline the complications and survival in surgical patients 80 years and over undergoing radical cystectomy for bladder cancer. Patients and MethodsA review of a radical cystectomy in elderly recorded in four different institutional prospective databases during the period between 1991 and 2014. Clinical and pathologic features, complications and survival were evaluated. ResultsA total of 111 patients were available. Median (range) age 82.2 (80-89) years. Seventeen women and 94 men. Regarding the ASA score, 6 patients were ASA I, 47 patients were ASA II, 49 patients ASA III and 9 ASA IV. Prior to surgery, 48 patients had hydronephrosis. The median (range) creatinine series was 1.1 (0.71-11.1) ng/dL. In 88 cases an ileal conduit was performed, 17 a cutaneous ureterostomy diversion, 5 neobladders and 1 ureterosigmoidostomy case. The median (range) operative time was 230 (120-420) min and a total of 97 patients required blood transfusion. The median (range) hospital stay was 14 (7-126) days. The early and late complication rates were 50.4% and 32%, respectively. A total of 14 patients (12.6%) required surgical reintervention. Eight patients (7.2%) died in the immediate postoperative period. The readmission rate of the series was 27.2%. The mean follow-up of the series was 18 (0.27-134.73) months. During this period 66 patients died, 52 of them due to the tumor. Twelve month tumour progression free survival was 83.9% for ≤pT1, 70.2% for pT2 and 36% for ≥pT3, respectively. Twelve month cancer specific survival was 85.6% for ≤pT1, 75.1% for pT2 and 42.5% for ≥pT3, respectively. ConclusionRadical cystectomy in elderly population is an aggressive surgical treatment with a significant complication rate, hospital readmission and perioperative mortality rate. Careful selection of patients is essential in order to minimize the complications of this surgery and balance benefits against risks in the elderly population. Tumour progression and cancer specific survival are poor for patients with ≥pT3 disease. Alternatives such as tri-modality therapy need to be considered within a multidisciplinary approach. More data is required to determine which sub-groups of elderly patients would benefit from a complication, survival and quality of life perspective.

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“…In the second enhancement, when the MHV branch is bypassed, the autologous saphenous vein is anastomosed with the branch opening of the MHV in the preservation container to reduce the anastomosis time on the operating table. Utilizing these surgical improvements, the same research group reported on 160 cases of consecutive living donor right hepatectomy between 2002 to 2008 (25). They used the Clavien grading system to define and grade the severity of donor complications; all donated livers were right lobe grafts without the MHV and all IRHVs > 5 mm in diameter were preserved for subsequent anastomosis to the recipient IVC.…”

Section: Hangzhou Criteria and New Techniquesmentioning

confidence: 99%

Liver transplantation in China: Achievements over the past 30 years and prospects for the future

Jin

Qiu

et al. 2022

BST

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Primary liver cancer is the seventh most common malignant tumor according to the World Health Organization and the fourth leading cause of cancerrelated mortality. It has soared to the second leading cause of cancer-related mortality in China, after lung cancer. In 2020, the number of cases surpassed 410,000, with more than 390,000 deaths, placing a huge burden on China's health system (1). Hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and other uncommon liver cancers are types of primary liver cancer. HCC accounts for a sizable chunk of the total therein. The main etiological factors for HCC are liver cirrhosis, hepatitis, and aflatoxins, while the high incidence of HCC in China is attributed to the high prevalence of the hepatitis B virus. HCC treatment options include hepatectomy, trans arterial chemoembolization (TACE), radiofrequency ablation (RFA), liver transplantation (LT), and conservative therapy. However, only LT can eliminate the tumor and underlying liver disease at the same time. Accordingly, LT is the treatment of choice for end-stage liver disease and early-stage HCC (2).China has seen remarkable progress in orthotopic LT since 1977, when it was first performed on the Chinese mainland. According to the China liver Transplant Registry (CTLR), LT cases in China account for more than a third of all LT cases worldwide (3). As of June 2015, a total of 29,360 cases of LT were performed, about 50% of which were performed to treat HCC (2). With economic and technological advances, LT in China is no longer constrained by the procedure but rather by a scarcity of donors and a high rate of postoperative recurrence. Under such conditions, efforts are being made to address the issue of a donor shortage and to improve the prognosis for transplant patients. The legal framework for government oversight in 2007 was the initial step to regular organ transplantation. However, several ethical and legal issues remained. The pilot

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Using the Clavien Grading System to Classify the Complications of Right Hepatectomy in Living Donors

Cited by 16 publications

References 11 publications

Living donor liver transplantation in children: A single North American center experience over two decades

Living donor liver transplantation in children: A single North American center experience over two decades

The role of cystectomy in elderly patients – a multicentre analysis

Liver transplantation in China: Achievements over the past 30 years and prospects for the future

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