Transplantation proceedings
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Transplantation in Japan still depends on living donors even after the new revised law. We must pay attention to protect living donors. ⋯ We must pay attention to depression and anxiety among living donors. More care should be focused on pain control and sharing of information of postoperative courses.
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To compare the efficacy and dose requirements for intravenous (IV) patient-controlled analgesia (PCA) with morphine only versus morphine with ketorolac for living liver donors after partial hepatectomy. ⋯ Both regimens provided acceptable pain control with daily VAS less than 3. The use of ketorolac in the PCA did not reduce the daily total morphine requirements with a similar incidence of side effects but a significantly reduced requirement for rescue doses, which subsequently reduced the work load of personnel in the pain control service.
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Many patients are diagnosed with hepatocellular carcinoma (HCC) within the Milan criteria. In Korea, these patients are preferentially treated with locoregional therapy (LRT) instead of living donor liver transplantation. We investigated the effectiveness of LRT in liver transplant recipients who met the Milan criteria at the time of HCC diagnosis and investigated risk factors for HCC recurrence. ⋯ Pretransplant LRT for patients with HCC who met the Milan criteria at the time of diagnosis did not provide a clear benefit with respect to HCC recurrence after transplantation. If patients have suitable living donors, those who meet the Milan criteria should undergo a liver transplantation as soon as possible.
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Orthotopic liver transplantation (OLT) is currently considered to be the ultimate form of therapy for most patients with end-stage liver diseases. The identification of recipient and various perioperative factors that may affect the graft outcomes is critical. This study sought to analyze the preoperative and perioperative factors associated with graft outcomes in our institute. ⋯ Prolonged WIT (>45 minutes) was the only significant risk factor among other established parameters for graft function. Nevertheless, reduced operative times and blood loss may improve the outcomes of OLT.
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Decreased inhalational anesthetic requirements during orthotopic liver transplantation (OLT) have been reported according to the severity of the pre-existent disease as well as decreased opioid requirements thereafter. The aim of the present study was to determine the relationship between postoperative opioid requirements and severity of liver disease among OLT patients. ⋯ OLT patients with high MELD scores required less postoperative opioids and experienced less pain than those with low scores. Therefore, postoperative pain control after OLT should be carefully titrated according to the severity of the liver disease.