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Background: In small infants, left lateral segment grafts are sometimes too large to overcome the problems of large-for-size grafts in the abdominal compartment. To address this problem, we have developed a safe living donor graftectomy for neonates, a so-called "S2 monosegment graft" to minimize graft thickness. We reviewed our single-center experience to evaluate the feasibility of this technique for reducing graft size., Methods: Eleven living-donor liver transplants using S2 monosegment grafts were performed between October 2008 and September 2014 at our institution. Medical records of both donors and recipients were reviewed and data collected retrospectively., Results: The mean age of recipients at the time of transplantation was 125.3 days, including 3 neonates. The average S2 monosegment graft weight was 127.4 g, and the graft-to-recipient body weight ratio was successfully reduced to 3.5%. The graft livers were reduced to 4.1 cm in thickness. Two recipients with grafts larger than 5 cm could not undergo primary abdominal closure. Portal vein stenosis and biliary stenosis was observed in 1 recipient, and hepatic artery complications were seen in 2 recipients; the clinical course for all donors were uneventful. Liver regeneration was seen in every patient. The graft and patient 1-year survival rate was 100%., Conclusions: Living-donor liver transplantation using S2 monosegment grafts offers a safe and useful option for treating smaller infants. Here, we introduce our method of S2 monosegment graft emphasizing the donor harvest and graft thickness., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: Opportunistic pulmonary infections frequently occur after liver transplantation, and affect mortality and morbidity significantly. The purpose of this study was to define the incidence, types, and imaging characteristics of pulmonary infections in liver transplant recipients with multidetector CT (MDCT) evaluation., Methods: Thirty-five adult transplant recipients diagnosed with a pulmonary infection within the first 45 days posttransplantation were reviewed retrospectively from March 2002 to December 2013. MDCT features were evaluated retrospectively by 2 radiologists in consensus. All diagnoses were made by sputum analysis, cultures, biopsies, and postmortem histopathologic evaluation., Results: Pneumococcus pneumonia was found in 7 patients. Five patients had nonspecific pneumonia, Candidiasis, Klebsiella, and Aspergillosis separately. S aureus pneumonia was detected in 2 patients and the other 2 patients had Escherichia coli pneumonia. Two patients had active tuberculosis and 1 patient had Acinetobacter pneumonia also. Four main MDCT patterns were identified: patchy infiltrations (10%), tree-in-bud pattern (9.5%), ground-glass opacity (8.5%), and nodules with halo sign (6%). One patient had a cavitary lesion owing to tuberculosis., Conclusion: Although the incidence of pulmonary complications in liver recipients was relatively low, mortality from serious infections was high. Care must be taken with pulmonary infectious complications in the posttransplant period. For any suspicious case, MDCT evaluation for specific patterns of early accurate diagnosis is very important., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Coronary artery disease (CAD) is a common cause of morbidity and mortality in liver transplant (LT) recipients. To date there is no consensus on the preferred screening tests to detect CAD in the pre-LT population. Therefore the aim of this study was to: 1) evaluate the utility of a noninvasive tool (cardiac computerized tomography [CT] scan); and 2) determine the prevalence of CAD in low-risk LT candidates., Methods: Using our transplant database we identified all LT candidates classified as low risk for CAD. All low-risk candidates underwent cardiac CT scan for coronary calcium score (CCS) estimation. Those with CCS >100 underwent coronary angiogram, and those with <100 underwent stress test and if stress test was positive then coronary angiography was performed. The Agatston calcium score was classified as: normal (0), mild (1-100), moderate (101-400), severe (401-1,000), or extensive (>1,000)., Results: Eighty-five LT candidates were classified as low risk and underwent cardiac CT scan. The mean calcium score was 325 (range, 0-3,707). In our study cohort, 21% had normal CCS score, 43% mild, 13% moderate, 11% severe, and 12% extensive. A calcium score >400 was significantly associated with CAD on angiography (P = .02). Although male sex was significantly associated with the presence of CAD (P = .006), there was no correlation with age, ethnicity, liver diagnosis, or Model for End-Stage Liver Disease score., Conclusions: Prevalence of asymptomatic CAD in this low-risk population is relatively high. Cardiac CT is well tolerated and is a useful noninvasive screening tool in LT candidates. Future studies to determine its utility as a prognostic tool after LT will be invaluable., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Liver transplantation is the treatment of choice for patients with end-stage liver disease (ESLD) and early hepatocellular carcinoma (HCC), Routine laparoscopy with intraoperative ultrasound was employed in an attempt to improve patient selection for transplantation. Our aim was to assess whether laparoscopy improved the patient selection with ESLD and HCC being considered for transplantation., Methods: We retrospectively reviewed the clinical notes and transplant database of all patients with ESLD complicated by HCC, being assessed for liver transplantation, from January 2000 to April 2005., Results: Twenty-five patients with ESLD and HCC underwent assessment for liver transplantation. Eight were deemed untransplantable on cross-sectional imaging alone. Sixteen patients underwent laparoscopy and intraoperative ultrasound. One patient had undergone a previous segmental hepatectomy and laparoscopy was not technically feasible. At laparoscopy, all 16 patients were found to be free from extrahepatic disease and major vascular involvement. All 16 patients were listed for transplantation. At transplantation, one patient was found to have extrahepatic disease; the procedure was abandoned. One patient was found to have lesser curvature lymphadenopathy, Two patients had major vascular involvement noted in the explanted liver. All these findings were missed on pretransplant imaging and at laparoscopy., Conclusions: As an additional investigation, laparoscopy did not improve staging or alter the management of patients with HCC being assessed for liver transplantation. Since July 2005, we have ceased routine laparoscopic assessment of patients prior to listing. The decision use laparoscopy on patients is now being taken on a more selective basis.

Unlabelled: The clinical course of patients with fulminant hepatic failure (FHF) is often worsened by the presence of cerebral edema and endocranial hypertension. In spite of the multiple studies using Transcranial Doppler Sonography (TCDS), few have shown the cerebral blood flow (CBF) pattern among patients with encephalopathy resulting from FHF., Objective: Our objective was to characterize the CBF pattern in these patients through the use of TCDS to provide therapeutic strategies., Method: The TCDS pattern was assessed in five patients diagnosed with FHF and compared with a control group who displayed critical neurologic conditions not associated with FHF. Pulsatile index, systolic, diastolic, and mean velocity of the middle cerebral artery were measured., Results: The mean age of patients with FHF was 45.4 years. One hundred percent were women, with viral hepatitis as the predominant etiology. A cerebral hypoperfusion pattern was found in 80% of the FHF group and 40% of the control group. In the former group there was no evidence of hyperemia, as there was among 20% of the control group. The mean values of velocity and pulsatile index were 36.6 cm/sec and 2.4, respectively, in the FHF group and 47.8 cm/s and 1.8 in the control group (P=0.268, P=0.402)., Conclusions: FHF patients show a predominance of cerebral hypoperfusion pattern with mean velocities lower than normal values and an increased pulsatile index. We recommend that clinicians take appropriate measures to improve cerebral perfusion and avoid hypoxia. Hyperventilation as a first level measure is contraindicated.