Search

Pancreatic transplantation is the only treatment for insulin‐dependent diabetes resulting in long‐term euglycemia without exogenous insulin. However, pancreatic transplantation has become debatable following the improvements in the results of islet transplantation and artificial pancreas. Therefore, surgeons who perform pancreas transplants require the best surgical technique that can minimize technical failure. We aimed to report our experiences with pancreatic transplantations. We transplanted 65 pancreatic grafts between 2015 and 2020. Except for one death due to hypoxic brain damage after surgery, no postoperative technical failure was observed. We usually perform duodeno‐duodenal anastomosis using the transperitoneal approach, with retrocolic placement of the graft pancreas. There was no leakage from the duodenum even after immunologic graft failure. To prevent venous thrombosis, which is the most common cause of technical failure, we used the inferior vena cava for anastomosis and added graft venoplasty with a patch of donor vena cava or aortic interposition graft to the bench procedure; subsequently, there were no cases of technical failure due to thrombosis post‐transplantation. Therefore, the 1‐year graft survival (insulin‐free) rate was more than 95%. The improving the surgical technique will maintain pancreatic transplantation as the best treatment for insulin‐dependent diabetes. [ABSTRACT FROM AUTHOR]

Serum pancreatic enzymes (serum amylase and lipase) are sensitive markers for monitoring acute rejection in pancreatic transplant recipients. However, those enzymes are not specific, as their levels are elevated in other conditions. We evaluated the eosinophil‐to‐monocyte ratio (EMR) in peripheral blood as a biomarker of acute rejection in the clinical setting in recipients of pancreatic transplant alone. We performed 32 cases of pancreatic transplantation alone since 2015. Nine patients were diagnosed with rejection. Serum amylase and lipase levels and eosinophil and monocytes counts were analyzed and compared retrospectively between the non‐rejection and rejection groups. The serum eosinophil count, eosinophil fraction of the complete blood count, and serum amylase and lipase levels were significant predictors of rejection according to the receiver operation characteristic (ROC) curve. However, the EMR was the best indicator of rejection based on the ROC curve (area under the curve 0.918, sensitivity 100%, specificity 76.2% at the cutoff value 0.80, P <.001). The combination of EMR and the lipase level had 100% sensitivity and 90.5% specificity. The EMR is a simple and excellent predictor of acute rejection in recipients of pancreatic transplant alone. [ABSTRACT FROM AUTHOR]

Abstract: Background & Aims: No consensus has been reached regarding optimal treatment strategies for ABO‐incompatible (ABO‐I) living donor liver transplantation (LDLT). We introduce a simplified protocol using rituximab and intravenous immunoglobulin (IVIG). Methods: Data were analysed on adult patients who underwent ABO‐I LDLT of which protocol added rituximab (300 mg/m2) before surgery and IVIG (0.8 g/kg) on post‐operative days 1 and 4 to the conventional immunosuppressive regimen used in ABO‐compatible (ABO‐C) LDLT, without plasmapheresis, splenectomy or graft local infusion. The outcomes were compared with those of ABO‐C LDLT by 1:2 propensity score‐matched analysis. Results: Consecutive 43 ABO‐I LDLT patients were identified between 2014 and 2016. Before desensitization, the median isoagglutinin titre was 1:8 (range, 1:2‐1:64). The titre was reduced to 4 (range, 0‐16) at the time of LDLT. None showed a rebound rise of isoagglutinin titres. No antibody‐mediated rejection occurred. Biliary stricture was the most common complication with an incidence of 30.2%. A comparator group of 86 ABO‐C LDLT patients were selected. There was no statistical difference in the overall complication rate including acute cellular rejection, biliary complications and infection between ABO‐I and ABO‐C groups. The 3‐year cumulative patient survival rates in the ABO‐I and ABO‐C groups were 82.4% and 85.9% respectively (P = .115). Conclusions: A simplified protocol using rituximab and IVIG for ABO‐I LDLT was safe and effective in achieving sufficient desensitization and comparable outcomes in patients with the titre no higher than 1:64. [ABSTRACT FROM AUTHOR]

Abstract: Background and Aim: In most patients with perihilar cholangiocarcinoma (PHCC), major hepatectomy and extrahepatic bile duct resection are needed for surgical radicality, and a high risk of hepatic insufficiency exists. This study aims to develop a prediction model for post‐hepatectomy liver failure (PHLF) in patients with PHCC. Methods: A total of 143 patients who underwent major liver resection and extrahepatic bile duct resection for PHCC between October 2001 and December 2013 were included. Clinically relevant PHLF was defined as liver failure corresponding to grade B or C of the International Study Group of Liver Surgery criteria. Multivariate logistic regression was used to develop the PHLF risk model. Model performance was evaluated internally using the area under the curve analysis (discrimination) after 1000 bootstrap resampling and the Hosmer–Lemeshow goodness‐of‐fit test (calibration). Results: Post‐hepatectomy liver failure occurred in 43.4% of patients (n = 62). In multivariate analysis, PHLF was significantly associated with future liver remnant ratio (odds ratio [OR] per 10% = 0.68, 95% confidence interval [CI] 0.51–0.88), intraoperative blood loss (OR per 1 L = 1.82, 95% CI 1.11–3.17), and preoperative prothrombin time > 1.20 (OR = 3.22, 95% CI 1.15–9.97). The PHLF risk score model showed good discrimination (area under the curve = 0.708, 95% CI 0.623–0.793) and calibration (P = 0.227). Conclusions: The risk model proposed in this study accurately predicted PHLF in patients with PHCC. This offers surgeons a practical guide to quantitative risk assessment of hepatic insufficiency and aids decision‐making in surgical treatment and perioperative management. [ABSTRACT FROM AUTHOR]