Transplantation proceedings
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Comparative Study
Primary versus salvage living donor liver transplantation for patients with hepatocellular carcinoma: impact of microvascular invasion on survival.
Salvage liver transplantation (LT) has been proposed for patients with a small hepatocellular carcinoma (HCC) and preserved liver function. Few reports have been issued on salvage LT in a living-donor (LD) LT setting. Therefore, we performed this study to evaluate differences in tumor invasiveness and other risk factors on survival after salvage versus primary LDLT. ⋯ Five-year overall survival after primary versus salvage LDLT were similar when differences in tumor pathologic features, such as microscopic vascular invasion, were taken into account. Multivariate analysis showed that the treatment itself was not a significant prognostic factor for survival.
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In orthotopic liver transplantation (OLT), the critical shortage of organ donors is the reason for accepting marginal donors. Although the outcome of OLT does not entirely seem to have been affected by the use of such donors identification of predictive risk factors is challenging. This study sought to identify significant risk factors associated with graft outcomes in our institute. ⋯ Although many factors including a high serum sodium level are associated with a marginal liver graft, Last donor alanine aminotransferase level was the only significant factor that predicted the PDF.
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Comparative Study
Which score system can best predict recipient outcomes after living donor liver transplantation?
Many scoring systems have been suggested to predict the outcomes of deceased donor liver transplantations. The aims of this study were to compare the Model for End-Stage Liver Disease (MELD) score with respect to other scores among patients who underwent living donor liver transplantation (LDLT) seeking to evaluate the best system to correlate with postoperative outcomes after LDLT. ⋯ The MELD score most correlated with total bilirubin after LDLT, while the APACHE II and SOFA scores seemed to correlate with mortality after LDLT.
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Randomized Controlled Trial
Tying a slipknot to an intubation stylet for facilitating insertion of a nasogastric tube in liver transplant recipients: a prospective, randomized study.
It is sometimes difficult and harmful to insert a nasogastric tube (NGT) into a patient with a tendency to bleed and anesthetized recipient of liver transplantation. As a "Rusch" intubation stylet tied by a slipknot, Highwayman's hitch, to the NGT, it is easy to introduce the NGT through nasal cavity and oropharyngeal space. We designed this study to evaluate the usage of this novel method in the guidance of NGT insertion in liver transplant recipients. ⋯ The intubation stylet-guided method is reliable, with high success rate of NGT insertion in patients with a tendency to bleed anesthetized recipients of liver transplantation.
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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.