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2. Optimal anesthetic conduct regarding immediate and short‐term outcomes after liver transplantation – Systematic review of the literature and expert panel recommendations

Author

Chadha, Ryan, Patel, Dhupal, Bhangui, Pooja, Blasi, Annabel, Xia, Victor, Parotto, Matteo, Wray, Christopher, Findlay, James, Spiro, Michael, Raptis, Dimitri Aristotle, Niemann, Claus, Pollok, Joerg‐Matthias, Berenguer, Marina, Tinguely, Pascale, Fan, Ka Hay, and Farrer, Giselle

Subjects
Liver Disease, Transplantation, Clinical Research, Clinical Trials and Supportive Activities, Digestive Diseases, Patient Safety, Evaluation of treatments and therapeutic interventions, 6.4 Surgery, Good Health and Well Being, Humans, Liver Transplantation, Prospective Studies, Retrospective Studies, Anesthetics, Anesthesia, General, bispectral index, depth of anesthesia, liver transplantation, minimum alveolar concentration, oxygen management, positive end-expiratory pressure, total intravenous anesthesia, ventilation, volatile or inhalational anesthesia, ERAS4OLT.org Working Group, Clinical Sciences, Surgery
Abstract

BackgroundIn the era of enhanced recovery after surgery, there is significant discussion regarding the impact of intraoperative anesthetic management on short-term outcomes following liver transplantation (LT), with no clear consensus in the literature.ObjectivesTo identify whether or not intraoperative anesthetic management affects short-term outcomes after liver transplantation.Data sourcesOvid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.MethodsA systematic review following PRISMA guidelines was undertaken. The systematic review was registered on PROSPERO (CRD42021239758). An international expert panel made recommendations for clinical practice using the GRADE approach.ResultsAfter screening, 14 studies were eligible for inclusion in this systematic review. Six were prospective randomized clinical trials, three were prospective nonrandomized clinical trials, and five were retrospective studies. These manuscripts were reviewed to look at five questions regarding anesthetic care and its impact on short term outcomes following liver transplant. After review of the literature, the quality of evidence according to the following outcomes was as follows: intraoperative and postoperative morbidity and mortality (low), early allograft dysfunction (low), and hospital and ICU length of stay (moderate).ConclusionsFor optimal short term outcomes after liver transplantation, the panel recommends the use of volatile anesthetics in preference to total intravenous anesthesia (TIVA) (Level of Evidence: Very low; Strength of Recommendation: Weak) and minimum alveolar concentration (MAC) versus bispectral index (BIS) for depth of anesthesia monitoring (Level of Evidence: Very low; Strength of Recommendation: Weak). Regarding ventilation and oxygenation, the panel recommends a restrictive oxygenation strategy targeting a PaO2 of 70-120 mmHg (10-14 kPa), a tidal volume of 6-8 ml/kg ideal body weight (IBW), administration of positive end expiratory pressure (PEEP) tailored to patient intraoperative physiology, and recruitment maneuvers. (Level of evidence: Very low; Strength of Recommendation: Strong). Finally, the panel recommends the routine use of antiemetic prophylaxis. (Level of evidence: low; Strength of Recommendation: Strong).

Published
2022

3. Development and validation of an artificial intelligence model for predicting post‐transplant hepatocellular cancer recurrence

Author

Quirino Lai, Carmine De Stefano, Jean Emond, Prashant Bhangui, Toru Ikegami, Benedikt Schaefer, Maria Hoppe‐Lotichius, Anna Mrzljak, Takashi Ito, Marco Vivarelli, Giuseppe Tisone, Salvatore Agnes, Giuseppe Maria Ettorre, Massimo Rossi, Emmanuel Tsochatzis, Chung Mau Lo, Chao‐Long Chen, Umberto Cillo, Matteo Ravaioli, Jan Paul Lerut, and the EurHeCaLT and the West‐East LT Study Group

Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Published
2023
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4. Minimizing Incision in Living Donor Liver Transplantation: Initial Experience and Comparative Analysis of Upper Midline Incision in 115 Recipients

Author

Amit Rastogi, Ankur A. Gupta, Raghav Bansal, Fysal Kollanta Valappil, Kamal S. Yadav, Suchet Chaudhary, Prashant Bhangui, Swapnil Dhampalvar, Narendra S. Choudhary, Neeraj Saraf, and Arvinder S. Soin

Subjects
living donor liver transplantation, recipient surgery, upper midline incision, wound complications, incision scar, Specialties of internal medicine, RC581-951
Abstract

Living donor liver transplantation (LDLT) needs “Mercedes Benz” or “J-shaped” incision, causing short and long-term complications. An upper midline incision (UMI) is less invasive alternative but technically challenging. Reporting UMI for recipients in LDLT vs. conventional J-shaped incision. Retrospective analysis, July 2021 to December 2022. Peri-operative details and post-transplant outcomes of 115 consecutive adult LDLT recipients transplanted with UMI compared with 140 recipients with J-shaped incision. Cohorts had similar preoperative and intraoperative variables. The UMI group had significant shorter time to ambulation (3 ± 1.6 vs. 3.6 ± 1.3 days, p = 0.001), ICU stay (3.8 ± 1.3 vs. 4.4 ± 1.5 days, p = 0.001), but a similar hospital stay (15.6±7.6 vs. 16.1±10.9 days, p = 0.677), lower incidence of pleural effusion (11.3% vs. 27.1% p = 0.002), and post-operative ileus (1.7% vs. 9.3% p = 0.011). The rates of graft dysfunction (4.3% vs. 8.5% p = 0.412), biliary complications (6.1% vs. 12.1% p = 0.099), 90-day mortality (7.8% vs. 12.1% p = 0.598) were similar. UMI-LDLT afforded benefits such as reduced pleuropulmonary complications, better early post-operative recovery and reduction in scar-related complaints in the medium-term. This is a safe, non-inferior and reproducible technique for LDLT.

Published
2024
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5. Hepatic Duct Division During Robotic Living Donor Hepatectomy: A Comparison Between the Novel Triple C (Clip–Clamp–Cut) and the Cut–Suture Techniques

Author

Arvinder S. Soin, Kamal S. Yadav, Fysal Valappil, Nikhitha Shetty, Raghav Bansal, Suchet Chaudhary, Ankur Gupta, Amit Rastogi, and Prashant Bhangui

Subjects
Surgery, RD1-811
Abstract

Conclusions: Our simple yet novel triple C technique enables clean, precise, bloodless HDD resulting in lower donor and potentially recipient biliary complication rates. The ease and reproducibility make it ideal for widespread adoption.

Published
2024
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7. Fast tracking in adult living donor liver transplantation: A case series of 15 patients

Author

Pooja Bhangui, Prashant Bhangui, Nikunj Gupta, Annu Sarin Jolly, Seema Bhalotra, Nishant Sharma, A S Soin, and Vijay Vohra

Subjects
Fast tracking, feasibility, living donor liver transplantation, outcomes, criteria for fast tracking, Anesthesiology, RD78.3-87.3
Abstract

Background and Aims: Fast tracking (FT) for more efficacious use of resources may be difficult after living donor liver transplantation (LDLT) due to a partial liver graft, complex vascular anastomoses and longer operating time. Our study was aimed at reporting our experience with FT (on table extubation) in LDLT recipients. A secondary objective of our study was to look at defining a subgroup of patients who could be prospectively planned for FT. Methods: We studied the demographics and outcomes of 15 LDLT recipients extubated immediately in the operating suite based on an uneventful intraoperative course, haemodynamic stability after graft reperfusion and improvement of metabolic parameters post-implantation and vascular anastomoses. Results: Twelve recipients were males, and mean age, body mass index (BMI) and Model for End Stage Liver Disease (MELD) score were 43 ± 12 years, 23 ± 3 kg/m2 and 15.5 ± 6, respectively, most were Child–Turcotte–Pugh Class B. Diabetes and hypothyroidism were present in 1 and 2 patients, respectively. Post-extubation, none required immediate re-intubation and one patient needed non-invasive ventilation for 2 h. Conclusion: Fast tracked recipients were young, with a low BMI, low MELD scores, minimal comorbidities and good immediate graft function post-reperfusion.

Published
2018
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9. Liver transplantation and resection in patients with hepatocellular cancer and portal vein tumor thrombosis: Feasible and effective?

Author

Bhangui, Prashant

Abstract

Patients with locally advanced hepatocellular cancer (HCC) and portal vein tumor thrombosis (PVTT) have a dismal prognosis since limited treatment options are available for them. In recent years, effective systemic therapy, and advances in the understanding of technicalities and effectiveness of ablative therapies especially radiotherapy, have given some hope to prolong survival in them. This review summarized recent evidence in literature regarding the possible role of liver resection (LR) and liver transplantation (LT) in patients with locally advanced HCC and PVTT with no extrahepatic disease. Downstaging therapies have helped make curative resection or LT a reality in selected patients. This review emphasizes on the key points to focus on when considering surgery in these patients, who are usually relegated to palliative systemic therapy alone. Meticulous patient selection based on tumor biology, documented downstaging based on imaging and decrease in tumor marker levels, and an adequate waiting period to demonstrate stable disease, may help obtain satisfactory long-term outcomes post LR or LT in an intention to treat strategy in patients with HCC and PVTT.

Published
2024
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16. Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference

Author

Pollok, Joerg M, Tinguely, Pascale, Berenguer, Marina, Niemann, Claus U, Raptis, Dimitri A, Spiro, Michael, Mayr, Andreas, Dominguez, Beatriz, Muller, Elmi, Rando, Karina, Enoch, Mary Anne, Tamir, Noam, Healy, Pamela, Manser, Tanja, Briggs, Tim, Chaudhary, Abhideep, Humar, Abhinav, Jafarian, Ali, Soin, Arvinder Singh, Eghtesad, Bijan, Miller, Charles, Cherqui, Daniel, Samuel, Didier, Broering, Dieter, Pomfret, Elizabeth, Villamil, Federico, Durand, Francois, Berlakovich, Gabriela, McCaughan, Geoffrey, Auzinger, Georg, Testa, Giuliano, Klintmalm, Goran, Belghiti, Jacques, Findlay, James, Lai, Jennifer, Fung, John, Klinck, John, Roberts, John, Liu, Linda, Cattral, Mark, Ghobrial, Mark, Selzner, Markus, Ramsay, Michael, Rela, Mohamed, Ascher, Nancy, Man, Nancy Kwan, Selzner, Nazia, Burra, Patrizia, Friend, Peter, Busuttil, Ronald, Hwang, Shin, McCluskey, Stuart, Mas, Valeria, Vohra, Vijay, Vij, Vivek, Merritt, William, Tokat, Yaman, Kang, Yoogoo, Chan, Albert, Mazzola, Alessandra, Hessheimer, Amelia, Rammohan, Ashwin, Hogan, Brian, Vinaixa, Carmen, Nasralla, David, Victor, David, De Martin, Eleonora, Alconchel, Felipe, Roll, Garrett, Kabacam, Gokhan, Sapisochin, Gonzalo, Campos-Varela, Isabel, Liu, Jiang, Patel, Madhukar S., Izzy, Manhal, Kalisvaart, Marit, Adams, Megan, Goldaracena, Nicholas, Tinguely, Pascale, Hernandez-Alejandro, Roberto, Chadha, Ryan, Shaker, Tamer Mahmoud, Klair, Tarunjeet S., Pan, Terry, Tanaka, Tomohiro, Yoon, Uzung, Kirchner, Varvara, Hannon, Vivienne, Cheah, Yee Lee, Frola, Carlo, Morkane, Clare, Milliken, Don, Lurje, Georg, Potts, Jonathan, Fernandez, Thomas, Badenoch, Adam, Mukhtar, Ahmed, Zanetto, Alberto, Montano-Loza, Aldo, Chieh, Alfred Kow Wei, Shetty, Amol, DeWolf, Andre, Olmos, Andrea, Mrzljak, Anna, Blasi, Annabel, Berzigotti, Annalisa, Malik, Ashish, Rajakumar, Akila, Davidson, Brian, O'Farrell, Bryan, Kotton, Camille, Imber, Charles, Kwon, Choon Hyuck David, Wray, Christopher, Ahn, Chul-Soo, Morkane, Clare, Krenn, Claus, Quintini, Cristiano, Maluf, Daniel, Mina, Daniel Santa, Sellers, Daniel, Balci, Deniz, Patel, Dhupal, Rudow, Dianne LaPointe, Monbaliu, Diethard, Bezinover, Dmitri, Krzanicki, Dominik, Milliken, Don, Kim, Dong-Sik, Brombosz, Elizabeth, Blumberg, Emily, Weiss, Emmanuel, Wey, Emmanuel, Kaldas, Fady, Saliba, Faouzi, Pittau, Gabriella, Wagener, Gebhard, Song, Gi-Won, Biancofiore, Gianni, Testa, Giuliano, Crespo, Gonzalo, Rodríguez, Gonzalo, Palli, Graciela Martinez, McKenna, Gregory, Petrowsky, Henrik, Egawa, Hiroto, Montasser, Iman, Pirenne, Jacques, Eason, James, Guarrera, James, Pomposelli, James, Lerut, Jan, Emond, Jean, Boehly, Jennifer, Towey, Jennifer, Hillingsø, Jens G, de Jonge, Jeroen, Potts, Jonathan, Caicedo, Juan, Heimbach, Julie, Emamaullee, Juliet Ann, Bartoszko, Justyna, Ma, Ka Wing, Kronish, Kate, Forkin, Katherine T., Chok, Kenneth Siu Ho, Olthoff, Kim, Reyntjens, Koen, Lee, Kwang-Woong, Suh, Kyung-Suk, Denehy, Linda, van der Laan, Luc J.W., McCormack, Lucas, Gorvin, Lucy, Ruffolo, Luis, Bhat, Mamatha, Ramírez, María Amalia Matamoros, Londoño, Maria-Carlota, Gitman, Marina, Levstik, Mark, Selzner, Markus, de Santibañes, Martin, Lindsay, Martine, Parotto, Matteo, Armstrong, Matthew, Kasahara, Mureo, Schofield, Nick, Rizkalla, Nicole, Akamatsu, Nobuhisa, Scatton, Olivier, Keskin, Onur, Imventarza, Oscar, Andacoglu, Oya, Muiesan, Paolo, Giorgio, Patricia, Northup, Patrick, Matins, Paulo, Abt, Peter, Newsome, Philip N, Dutkowski, Philipp, Bhangui, Pooja, Bhangui, Prashant, Tandon, Puneeta, Brustia, Raffaele, Planinsic, Raymond, Brown, Robert, Porte, Robert, Barth, Rolf, Ciria, Rubén, Florman, Sander, Dharancy, Sebastien, Pai, Sher-Lu, Yagi, Shintaro, Nadalin, Silvio, Chinnakotla, Srinath, Forbes, Stuart J, Rahman, Suehana, Hong, Suk Kyun, Liying, Sun, Orloff, Susan, Rubman, Susan, Eguchi, Susumu, Ikegami, Toru, Reichman, Trevor, Settmacher, Utz, Aluvihare, Varuna, Xia, Victor, Yoon, Young-In, Soejima, Yuji, Genyk, Yuri, Jalal, Arif, Borakati, Aditya, Gustar, Adrian, Mohamed, Ahmed, Ramirez, Alejandro, Rothnie, Alex, Scott, Aneya, Sharma, Anika, Munro, Annalise, Mahay, Arun, Liew, Belle, Hidalgo, Camila, Crouch, Cara, Yan, Cheung Tsz, Tschuor, Christoph, Shaw, Conrad, Schizas, Dimitrios, Fritche, Dominic, Huda, Fabia Ferdousi, Wells, Gemma, Farrer, Giselle, Kwok, Hiu Tat, Kostakis, Ioannis, Mestre-Costa, Joao, Fan, Ka Hay, Fan, Ka Siu, Fraser, Kyra, Jeilani, Lelia, Pang, Li, Lenti, Lorenzo, Kathirvel, Manikandan, Zachiotis, Marinos, Vailas, Michail, Milan, Michele Mazza, Elnagar, Mohamed, Alradhawi, Mohammad, Dimitrokallis, Nikolaos, Machairas, Nikolaos, Morare, Nolitha, Yeung, Oscar, Khanal, Pragalva, Satish, Pranav, Ghani, Shahi Abdul, Makhdoom, Shahroo, Arulrajan, Sithhipratha, Bogan, Stephanie, Pericleous, Stephanos, Blakemore, Timon, Otti, Vanessa, Lam, Walter, Jackson, Whitney, and Abdi, Zakee

Abstract

There is much controversy regarding enhanced recovery for recipients of liver transplants from deceased and living donors. The objectives of this Review were to summarise current knowledge on individual enhanced recovery elements on short-term outcomes, identify key components for comprehensive pathways, and create internationally accepted guidelines on enhanced recovery for liver-transplant recipients. The ERAS4OLT.org collaborative partnered by the International Liver Transplantation Society performed systematic literature reviews on the effect of 32 relevant enhanced perioperative recovery elements on short-term outcomes, and global specialists prepared expert statements on deceased and living donor liver transplantation. The Grading Recommendations, Assessment, Development and Evaluations approach was used for rating of quality of evidence and grading of recommendations. A virtual international consensus conference was held in January, 2022, in which results were presented, voted on by the audience, and discussed by an independent international jury of eight members, applying the Danish model of consensus. 273 liver transplantation specialists from 30 countries prepared expert statements on elements of enhanced recovery for liver transplantation based on the systematic literature reviews. The consensus conference yielded 80 final recommendations, covering aspects of enhanced recovery for preoperative assessment and optimisation, intraoperative surgical and anaesthetic conduct, and postoperative management for the recipients of liver transplants from both deceased and living donors, and for the living donor. The recommendations represent a comprehensive overview of the relevant elements and areas of enhanced recovery for liver transplantation. These internationally established guidelines could direct the development of enhanced recovery programmes worldwide, allowing adjustments according to local resources and practices.

Published
2023
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18. Development and validation of a deep learning model for the prediction of hepatocellular cancer recurrence after transplantation: an international study

Author

Lai, Q., primary, De Stefano, C., additional, Halazun, K., additional, Bhangui, P., additional, Soejima, Y., additional, Finkenstedt, A., additional, Hoppe-Lotichius, M., additional, Mrzljak, A., additional, Uemoto, S., additional, Vivarelli, M., additional, Tisone, G., additional, Agnes, S., additional, Ettorre, G.M., additional, Rossi, M., additional, Tsochatzis, E., additional, Lo, C.M., additional, Chen, C.L., additional, Cillo, U., additional, and Lerut, J.P., additional

Published
2022
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19. De Novo Malignancy After Liver Transplantation: Risk Assessment, Prevention, and Management-Guidelines From the ILTS-SETH Consensus Conference

Author

Colmenero J, Tabrizian P, Bhangui P, Pinato D, Rodriguez-Peralvarez M, Sapisochin G, Bhoori S, Pascual S, Senzolo M, Al-Adra D, Herrero J, Petrowsky H, Dawson L, Hosni A, Kutzke J, Gastaca M, and Watt K

Abstract

De novo malignancies (DNMs) following liver transplantation (LT) have been reported as 1 of the major causes of late mortality, being the most common cause of death in the second decade after LT. The overall incidence of DNMs is reported to be in the range of 3.1% to 14.4%, and the incidence is 2- to 3-fold higher in transplant recipients than in age- and sex-matched healthy controls. Long-term immunosuppressive therapy, which is the key in maintaining host tolerance and achieving good long-term outcomes, is known to contribute to a higher risk of DNMs. However, the incidence and type of DNM also depends on different risk factors, including patient demographics, cause of the underlying chronic liver disease, behavior (smoking and alcohol abuse), and pre-existing premalignant conditions. The estimated standardized incidence ratio for different DNMs is also variable. The International Liver Transplantation Society-Spanish Society of Liver Transplantation Consensus Conference working group on DNM has summarized and discussed the current available literature on epidemiology, risk factors, management, and survival after DNMs. Recommendations for screening and surveillance for specific tumors, as well as immunosuppression and cancer-specific management in patients with DNM, are summarized.

Published
2022

29. Proceedings of the 25th Annual Congress of the International Liver Transplantation Society

Author

Chadha R, De Martin E, Kabacam G, Kirchner V, Kalisvaart M, Goldaracena N, Tanaka T, Spiro M, Sapisochin G, Vinaixa C, Hessheimer A, Varela IC, Rammohan A, Yoon YI, Victor D, Scalera I, Chan A, and Bhangui P

Subjects
surgical procedures, operative
Abstract

The 25th Annual Congress of the International Liver Transplantation Society (ILTS) was held in Toronto, Canada from May 15 to 18, 2019. Surgeons, hepatologists, anesthesiologists, critical care intensivists, radiologists, pathologists, and research scientists from all over the world came together with the common aim of improving care and outcomes for liver transplant recipients and living donors. Some of the featured topics at this year's conference included multidisciplinary perioperative care in liver transplantation, worldwide approaches to organ allocation, donor steatosis, and updates in pediatrics, immunology, and radiology. This report presents excerpts and highlights from invited lectures and select abstracts, reviewed and compiled by the Vanguard Committee of ILTS. This will hopefully contribute to further advances in clinical practice and research in liver transplantation.

Published
2020

30. Proceedings of the 26th Annual Virtual Congress of the International Liver Transplantation Society

Author

Kalisvaart, Marit, Chadha, Ryan, De Martin, Eleonora, Alconchel, Felipe, Goldaracena, Nicolas, Keskin, Onur, Liu, Jiang, Nasralla, David, Mazzola, Alessandra, Rammohan, Ashwin, Spiro, Michael, Tanaka, Tomohiro, Campos-Varela, Isabel, Victor, David, Vinaixa, Carmen, Yoon, Uzung, Yoon, Young-in, Hessheimer, Amelia, Kabacam, Gokhan, Sapisochin, Gonzalo, Shaker, Tamer, Bhangui, Prashant, Chan, Albert, and Kirchner, Varvara

Abstract

After a 1-y absence due to the coronavirus disease 2019 pandemic, the 26th Annual Congress of the International Liver Transplantation Society was held from May 15 to 18, 2021, in a virtual format. Clinicians and researchers from all over the world came together to share their knowledge on all the aspects of liver transplantation (LT). Apart from a focus on LT in times of coronavirus disease 2019, featured topics of this year’s conference included infectious diseases in LT, living donation, machine perfusion, oncology, predictive scoring systems and updates in anesthesia/critical care, immunology, radiology, pathology, and pediatrics. This report presents highlights from invited lectures and a review of the select abstracts. The aim of this report, generated by the Vanguard Committee of International Liver Transplantation Society, is to provide a summary of the most recent developments in clinical practice and research in LT.

Published
2022
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33. An intention-to-treat competing-risk model for candidates with hepatocellular cancer waiting for liver transplantation

Author

Lai, Q., primary, Cucchetti, A., additional, Vitale, A., additional, Halazun, K., additional, Iesari, S., additional, Lehner, K., additional, Bhangui, P., additional, Mennini, G., additional, Wong, T., additional, Kaido, T., additional, Lin, C.C., additional, Hoppe-Lotichius, M., additional, Ikegami, T., additional, Xie, Q.F., additional, Zhe, Y., additional, Zheng, S.S., additional, Soejima, Y., additional, Otto, G., additional, Chen, C.L., additional, Uemoto, S., additional, Lo, C.M., additional, Rossi, M., additional, Soin, A.S., additional, Finkenstedt, A., additional, Emond, J.C., additional, Cillo, U., additional, and Lerut, J., additional

Published
2019
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34. Launch of the International Living Donor Liver Transplantation Outcomes Registry

Author

Staubli, Sebastian, Grover, Alexander Steen, Turner, Benedict R H, Raptis, Dimitri A, Spiro, Michael, Tinguely, Pascale, Berenguer, Marina, Rela, Mohamed, Raptis, Dimitri A., Berenguer, Marina, Rela, Mohamed, Spiro, Michael, Pomfret, Elizabeth, Egawa, Hiroto, Kim, Ki-Hun, Bhangui, Prashant, Yi, Nam J., Chaudhary, Abhideep, Humar, Abhinav, Shaked, Abraham, Chan, Albert, Chieh, Alfred K.W., Jafarian, Ali, Soin, Arvinder S., Chen, Chao-Long, Miller, Charles, Wang, Chih-Chi, Azoulay, Daniel, Cherqui, Daniel, Balci, Deniz, Joo, Dong J., Testa, Giulano, Kabacam, Gokhan, Sapisochin, Gonzalo, Eilers, Helge, Ozden, Ilgin, Lerut, Jan, Roberts, John P., Dong, Jia-Hong, Liu, Jiang, Olthoff, Kim, Hasegawa, Kiyoshi, Man, Kwan, Patel, Madhukar S., Cattral, Mark, Malago, Massimo, Kasahara, Mureo, Ascher, Nancy, Selzner-Malekkiani, Nazia, Bhangui, Pooja, Jalan, Rajiv, Kamel, Refaat, Adam, Rene, Troisi, Roberto I., Nadalin, Silvio, Asthana, Sonal, McCluskey, Stuart A., Gupta, Subhash, Eguchi, Susumu, Pan, Terry, Wong, Tiffany C.L., Vohra, Vijay, Vij, Vivek, Andraus, Wellington, Tokat, Yaman, Soejima, Yuji, Mayr, Andreas, Dominguez, Beatriz, Muller, Elmi, Rando, Karina, Rammoha, Ashwin, Roll, Garrett, Izzy, Manhal, De Santibanes, Martin, Andacoglu, Oya, Kirchner, Varvara A., De Martin, Eleonora, Fernandez, Thomas, Turner, Benedict R.H., Chikkala, Bhargava, Hidalgo-Salina, Camila, Mellul, Emmanuel, Syeda, Gulbahar, Kantsedikas, Ilya, Patel, Krishnakumure, Zachiotis, Marinos, Raja, Meera, Reji, Nidhi, Machairas, Nikolaos, Tinguely, Pascale, Staubli, Sebastian, Ghani, Shahi A., Grover, Steen, Bousi, Stelios-Elion, and Oberkofler, Christian E.

Published
2023
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35. Current status of liver transplantation in Asia.

Author

Hibi, Taizo, Wei Chieh, Alfred Kow, Chi-Yan Chan, Albert, and Bhangui, Prashant

Abstract

In spite of early adoption of the brain death legislation, and all efforts at promoting deceased donation, various social, economic and cultural factors have acted as road blocks to the furthering of deceased donor liver transplantation (DDLT) in most Asian societies. On the other hand, Asian liver transplant centers have been the pioneers, innovators, and technical advancement catalysts for the world to follow, especially with regards to living donor liver transplantation (LDLT). With some high volume centers performing more than 200 LDLTs a year with good outcomes in the donor and recipient, techniques to expand the living donor pool have also been adopted like ABO-incompatible, paired exchange and dual lobe living donor liver transplants. Although large multicenter, and registry data as regards safety and outcomes of minimally invasive donor hepatectomy are awaited, expert centers have pioneered, and now regularly perform purely laparoscopic and robotic living donor hepatectomies, especially in Korea. [ABSTRACT FROM AUTHOR]

Published
2020
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36. Biliary reconstruction and complications in living donor liver transplantation.

Author

Jung, Dong-Hwan, Ikegami, Toru, Balci, Deniz, and Bhangui, Prashant

Abstract

For a technically successful liver transplant (LT), secure bile duct anastomosis to prevent biliary complications (BC's) like biliary anastomotic stricture (BAS) and bile leak (BL) is mandatory. BC's after living donor liver transplantation (LDLT) are relatively more common compared to deceased donor LT (DDLT), particularly owing to surgical factors (small diameter, and/or multiple bile duct openings on the graft), and non-surgical factors (immunologic reactions). Adequate blood supply to the bile duct both in donor and recipient, meticulous anastomotic technique, mucosal eversion for better approximation thus avoiding lesser fibrosis, proper use of internal or external stent drainage, and tension-free anastomosis, may contribute to the decrease of BC's after LDLT. Further, if BC's are not dealt with in a timely manner, these could progressively lead to severe morbidities and even mortality. While the endoscopic approach is preferred initially to deal with biliary leaks or strictures, the more invasive percutaneous approach may be required in case of endoscopic failure. Dedicated and experienced endoscopists, and interventional radiologists are key members of the multidisciplinary team in a successful LDLT program. In this review, we have tried to summarize current concepts in surgical techniques of biliary reconstruction in LDLT, incidence and risk factors for BC's, and principles followed to try and reduce the incidence of the same. [ABSTRACT FROM AUTHOR]

Published
2020
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37. Current management of portal vein thrombosis in liver transplantation.

Author

Bhangui, Prashant, Fernandes, Eduardo S.M., Di Benedetto, Fabrizio, Joo, Dong-Jin, and Nadalin, Silvio

Abstract

Nontumoral portal vein thrombosis (PVT) is present at liver transplantation (LT) in 5-26% of cirrhotic patients, and is known to affect post LT outcomes. Up to 31% of patients who are found to have PVT at the time of LT, would have had PVT at the time of initial listing, but others develop PVT during the waiting period. Adequate screening and treatment of the PVT on the waiting list for LT is thus essential so that a portoportal anastomoses can be performed at the time of LT. Early PVT (Yerdel Grade I/II) can be usually managed by thrombectomy, whereas Grade III PVT may require a jump graft from the superior mesenteric vein to the graft PV. Complete portomesenteric thrombosis is a huge challenge, and sometimes a cause for denying a LT in these patients, with multivisceral transplant being the only alternative. The presence of spontaneous, or previously surgically created portosytemic shunts like the leinorenal shunt, may serve as a good inflow option (renoportal anastomosis) in these patients to establish a physiological reconstruction. Although challenging, good outcomes are possible in patients with complex PVT if the appropriate surgical technique is chosen to ensure portal inflow and resolution of PHT post LT. [ABSTRACT FROM AUTHOR]

Published
2020
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41. Liver Transplantation for Hepatocellular Carcinoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference

Author

Mehta, Neil, Bhangui, Prashant, Yao, Francis Y., Mazzaferro, Vincenzo, Toso, Christian, Akamatsu, Nobuhisa, Durand, Francois, Ijzermans, Jan, Polak, Wojciech, Zheng, Shusen, Roberts, John P., Sapisochin, Gonzalo, Hibi, Taizo, Kwan, Nancy Man, Ghobrial, Mark, and Soin, Avi

Abstract

Liver transplantation (LT) offers excellent long-term outcome for certain patients with hepatocellular carcinoma (HCC), with a push to not simply rely on tumor size and number. Selection criteria should also consider tumor biology (including alpha-fetoprotein), probability of waitlist and post-LT survival (ie, transplant benefit), organ availability, and waitlist composition. These criteria may be expanded for live donor LT (LDLT) compared to deceased donor LT though this should not adversely affect the double equipoise in LDLT, namely ensuring both acceptable recipient outcomes and donor safety. HCC patients with compensated liver disease and minimal tumor burden have low urgency for LT, especially after local-regional therapy with complete response, and do not appear to derive the same benefit from LT as other waitlist candidates. These guidelines were developed to assist in selecting appropriate HCC patients for both deceased donor LT and LDLT.

Published
2020
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44. Living or Brain-dead Donor Liver Transplantation for Hepatocellular Carcinoma: A Multicenter, Western, Intent-to-treat Cohort Study.

Author

Azoulay, Daniel, Audureau, Etienne, Bhangui, Prashant, Belghiti, Jacques, Boillot, Olivier, Andreani, Paola, Castaing, Denis, Cherqui, Daniel, Irtan, Sabine, Calmus, Yvon, Chazouillères, Olivier, Soubrane, Olivier, Luciani, Alain, and Feray, Cyrille

Abstract

Objective: An intent-to-treat analysis of overall survival (ITT-OS) of cirrhotic patients with hepatocellular carcinoma (HCC) listed for living donor liver transplantation (LDLT) or brain-dead donor liver transplantation (BDLT) across 5 French liver transplant (LT) centers. Background: Comparisons of HCC outcomes after LDLT and BDLT measured from time of transplantation have yielded conflicting results. Methods: Records from 861 cirrhotic patients with HCC consecutively listed for either LDLT (n = 79) or BDLT (n = 782) from 2000 to 2009 were analyzed for ITT-OS using a Cox model; and tumor recurrence using 2 competitive risk models. Results: Tumor staging was similar between groups. In total, 162 patients dropped out (20.7%), all from Group BDLT (P < 0.0001). The postoperative mortality rate and the retransplantation rate were similar between LDLT and BDLT. At 5 years, no statistically significant difference was found in ITT-OS between LDLT and BDLT groups (73.2% vs 66.7%; P = 0.062). LDLT waitlist inclusion (hazard ratio: 0.61 (0.39–0.96); P = 0.034) and a time-of-listing MELD score ≥ 25 (hazard ratio: 1.93 (1.15–3.26); P = 0.014) were independent predictors of ITT-OS. Similar 5-year post-LT OS rates (73.2% and 73.0% for Group LDLT and Group BDLT, respectively; P = 0.407) and HCC recurrence rates (10.9% and 11.2% for Group LDLT and Group BDLT, respectively; P = 0.753) were found. Upon explant analysis, tumors exceeding the Milan criteria, macroscopic vascular invasion, and AFP score>2 were independent predictors of recurrence, whereas LT type was not. Conclusions: LDLT improves ITT-OS, and it is not a risk factor for tumor recurrence. Therefore, LDLT and BDLT should be equally encouraged in countries where both are available. [ABSTRACT FROM AUTHOR]

Published
2017
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45. Report of the 24th Annual Congress of the International Liver Transplantation Society

Author

De Martin, Eleonora, Hessheimer, Amelia, Chadha, Ryan, Kabacam, Gokhan, Rajanayagam, Jeremy, Kirchner, Varvara, Kalisvaart, Marit, Scalera, Irene, Bhat, Mamatha, Contreras, Alan, and Bhangui, Prashant

Abstract

The 24th Joint Annual Congress of the International Liver Transplantation Society in association with European Liver and Intestine Transplant Association and Liver Intensive Care Group of Europe was held in Lisbon, Portugal from May 23 to 26, 2018. More than 1200 participants from over 60 countries including surgeons, hepatologists, anesthesiologists and critical care intensivists, radiologists, pathologists, organ procurement personnel, and research scientists came together with the common aim of improving care and outcomes for liver transplant recipients. Over 600 scientific abstracts were presented. The principal themes were living donation, use of marginal liver donors, machine preservation, disease-specific immunosuppressive regimen, malignancies, and advances in pediatric liver transplantation and liver transplant anesthesia. This report presents excerpts from invited lectures and select abstracts from scientific sessions, which add to current knowledge, and will drive clinical practice and future research.

Published
2019
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48. Liver Transplantation in India–Where are we? Single Team Experience of 131 Pediatric Living Related Liver Transplants

Author

Mujeeb, Athar, primary, Mohan, Neelam, additional, Karkra, Sakshi, additional, Dhaliwal, M., additional, Raghunathan, V., additional, Goyal, D., additional, Mohanka, R., additional, Rastogi, A., additional, Balachandran, M., additional, Goja, S., additional, Kolar, S., additional, Bhangui, P., additional, Vohra, V., additional, Gupta, N., additional, Jolly, A., additional, Kumar, P., additional, and Soin, A.S., additional

Published
2014
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50. The use of ABO-incompatible grafts in living donor liver transplantation—First report from India

Author

Soin, A. S., primary, Raut, V., additional, Mohanka, R., additional, Rastogi, A., additional, Goja, S., additional, Balachandran, M., additional, Saigal, S., additional, Saraf, N., additional, Bhangui, P., additional, Sumana, K. R., additional, Singla, P., additional, Srinivasan, T., additional, Choudhary, N., additional, Tiwari, A., additional, Raina, V., additional, Govil, D., additional, Mohan, N., additional, and Vohra, V., additional

Published
2013
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