scholarly journals Medium-term outcomes after laparoscopic revision of laparoscopic Kasai portoenterostomy in patients with biliary atresia

2020 ◽  
Author(s):  
Yi Ji ◽  
Xuepeng Zhang ◽  
Siyuan Chen ◽  
Yanan Li ◽  
Kaiying Yang ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Biliary Atresia ◽  
Kasai Portoenterostomy ◽  
Medium Term ◽  
Conversion To Open Surgery ◽  
Bile Drainage ◽  
Group A ◽  
Survival With Native Liver ◽  
Group B ◽  
Viable Treatment

Abstract Objective: To determine whether revision laparoscopic Kasai portoenterostomy (RLKPE) is a viable treatment option for patients with biliary atresia (BA) who underwent initially successful laparoscopic Kasai portoenterostomy (ILKPE).Methods: The medical records of 312 patients with nonsyndromic BA who underwent ILKPE between May 2009 and May 2017 were retrospectively reviewed. The patients were divided into three groups according to their outcomes after ILKPE: group A: 25 patients who underwent RLKPE; group B: 203 patients who underwent ILKPE and required no further surgical intervention; and group C: 84 patients with failed ILKPE who either died or required liver transplantation for survival. The 3-year and 5-year survival with native liver (SNL) rates were compared between groups A and B C. Among the 25 patients in group A, the perioperative data of RLKPE were compared with those of ILKPE.Results: Of the 312 patients who underwent ILKPE, 228 reached the normal bilirubin concentration range within 6 months postoperatively. Among them, 25 patients with a sudden cessation of bile flow underwent RLKPE. Adequate biliary drainage evidenced by normalized conjugated bilirubin levels was achieved in 80% of the patients who underwent RLKPE. The perioperative variables, including operative time, blood loss, rate of conversion to open surgery and complications of RLKPE, were not significantly different between RLKPE and ILKPE. The 3-year and 5-year SNL rates in patients after RLKPE were 64.0% and 52.0%, respectively, which were not significantly different from the corresponding 86.2% and 73.9% in patients after unrevised ILKPE (P>0.05).Conclusion: Our data demonstrated that RPLKE can be a viable and effective treatment opinion in patients who experience sudden cessation of bile drainage after ILKPE. RPLKE can delay the need for liver transplantation, yielding encouraging medium-term patient outcomes.

scholarly journals Medium-term outcomes after laparoscopic revision of laparoscopic Kasai portoenterostomy in patients with biliary atresia

2020 ◽  
Author(s):  
Yi Ji ◽  
Xuepeng Zhang ◽  
Siyuan Chen ◽  
Yanan Li ◽  
Kaiying Yang ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Biliary Atresia ◽  
Kasai Portoenterostomy ◽  
Medium Term ◽  
Conversion To Open Surgery ◽  
Bile Drainage ◽  
Group A ◽  
Survival With Native Liver ◽  
Group B ◽  
Better Than

Abstract Objective To determine whether revision laparoscopic Kasai portoenterostomy (RLKPE) is a viable treatment option for patients with biliary atresia (BA) who underwent initially successful laparoscopic Kasai portoenterostomy (ILKPE). Methods The medical records of 312 patients with nonsyndromic BA who underwent ILKPE between May 2009 and May 2017 were retrospectively reviewed. The patients were divided into three groups according to their outcomes after ILKPE: group A: 25 patients who underwent RLKPE; group B: 203 patients who underwent ILKPE and required no further surgical intervention; and group C: 84 patients with failed ILKPE who either died or required liver transplantation for survival. The 3-year and 5-year survival with native liver (SNL) rates were compared between groups A and B and between groups A and C. Among the 25 patients in group A, the perioperative data of RLKPE were compared with those of ILKPE. Results Of the 312 patients who underwent ILKPE, 228 reached the normal bilirubin concentration range within 6 months postoperatively. Among them, 25 patients with a sudden cessation of bile flow underwent RLKPE. Adequate biliary drainage evidenced by normalized conjugated bilirubin levels was achieved in 80% of the patients who underwent RLKPE. The perioperative variables, including operative time, blood loss, rate of conversion to open surgery and complications of RLKPE, were not significantly different between RLKPE and ILKPE. The 3-year and 5-year SNL rates in patients after RLKPE were 64.0% and 52.0%, respectively, which were not significantly different from the corresponding 86.2% and 73.9% in patients after unrevised ILKPE (P > 0.05) but were significantly better than the corresponding values of group C (P < 0.01). Conclusion Our data demonstrated that with appropriate patient selection, RPLKE can be a viable and effective treatment opinion in patients who experience sudden cessation of bile drainage after ILKPE. RPLKE can delay the need for liver transplantation, yielding encouraging medium-term patient outcomes.

scholarly journals Medium-term outcomes after laparoscopic revision of laparoscopic Kasai portoenterostomy in patients with biliary atresia

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yi Ji ◽  
Xuepeng Zhang ◽  
Siyuan Chen ◽  
Yanan Li ◽  
Kaiying Yang ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Biliary Atresia ◽  
Treatment Option ◽  
Intervention Group ◽  
Kasai Portoenterostomy ◽  
Medium Term ◽  
Effective Treatment Option ◽  
Conversion To Open Surgery ◽  
Group A ◽  
Group B

Abstract Objective To determine whether revision laparoscopic Kasai portoenterostomy (RLKPE) is a viable treatment option for patients with biliary atresia (BA) who had undergone initially successful laparoscopic Kasai portoenterostomy (ILKPE). Methods The medical records of 312 patients with nonsyndromic BA who had undergone ILKPE between May 2009 and May 2017 were retrospectively reviewed. The patients were divided into three groups according to their outcomes after ILKPE: group A: 25 patients who had undergone RLKPE; group B: 203 patients who had undergone ILKPE and required no further surgical intervention; group C: 84 patients with failed ILKPE who had either died or required liver transplantation for survival. The 3-year and 5-year survival with native liver (SNL) rates were compared between groups A and B and between groups A and C. Among the 25 patients in group A, the perioperative data of RLKPE were compared with those of ILKPE. Results Of the 312 patients who had undergone ILKPE, 228 reached the normal bilirubin concentration range within 6 months postoperatively. Among them, 25 patients with a sudden cessation of bile flow had undergone RLKPE. Adequate biliary drainage, as evidenced by normalized conjugated bilirubin levels, was achieved in 80% of patients who had undergone RLKPE. The perioperative variables, including the operative time, blood loss, rate of conversion to open surgery and complications of RLKPE, were not significantly different between RLKPE and ILKPE. The 3-year and 5-year SNL rates in patients after RLKPE were 64.0% and 52.0%, respectively, which were not significantly different from the corresponding rates of 86.2% and 73.9%, respectively, in patients after unrevised ILKPE (P > 0.05). Conclusion Our data demonstrated that RPLKE is a viable and effective treatment option in patients with sudden cessation of bile drainage after ILKPE. RPLKE can delay the need for liver transplantation, yielding encouraging medium-term patient outcomes.

scholarly journals Predictors of Successful Kasai Portoenterostomy and Survival with Native Liver at 2 Years in Infants with Biliary Atresia

2019 ◽  
Vol 9 (4) ◽  
pp. 453-459 ◽  
Author(s):  
Ruchika Kumar ◽  
Bikrant B. Lal ◽  
Vikrant Sood ◽  
Rajeev Khanna ◽  
Senthil Kumar ◽  
...  
Keyword(s):  
Biliary Atresia ◽  
Kasai Portoenterostomy ◽  
Native Liver ◽  
Survival With Native Liver

scholarly journals Association of Hematuria with Renal Progression and Survival in Patients Who Underwent Living Donor Liver Transplant

2021 ◽  
Vol 10 (19) ◽  
pp. 4345
Author(s):  
Kai-Chieh Chang ◽  
Yao-Peng Hsieh ◽  
Huan-Nung Chao ◽  
Chien-Ming Lin ◽  
Kuo-Hua Lin ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Living Donor ◽  
Donor Liver ◽  
Living Donor Liver Transplant ◽  
Group A ◽  
Renal Progression ◽  
Group B ◽  
Donor Liver Transplant

Background: This study aimed to determine the association between episodic or persistent hematuria after liver transplantation and long-term renal outcomes. Methods: Patients who underwent living donor liver transplantation between July 2005 and June 2019 were recruited and divided into two groups based on the finding of microscopic or gross hematuria after transplantation. All patients were followed up from the index date until the end date in May 2020. The risks of chronic kidney disease, death, and 30% and 50% declines in estimated glomerular filtration rate (eGFR) were compared between groups. Results: A total of 295 patients underwent urinalysis for various reasons after undergoing transplantation. Hematuria was detected in 100 patients (group A) but was not present in 195 patients (group B). Compared with group B, group A had a higher risk of renal progression, including eGFR decline >50% [aHR = 3.447 (95%CI: 2.24~5.30), p < 0.001] and worse survival. In addition, patients who took non-steroidal anti-inflammatory drugs (NSAIDs) continuously for over seven days within six months before transplant surgery had high risks of rapid renal progression, including a >30% decline in eGFR [aHR = 1.572 (95%CI: 1.12~2.21), p = 0.009)]. Conclusion: Development of hematuria after surgery in patients who underwent living donor liver transplant and were exposed to NSAIDs before surgery were associated with worse long-term renal dysfunction and survival.

scholarly journals Liver stiffness measurement predicts the difficulty of Kasai procedure in biliary atresia: a single center retrospective analysis of 199 patients

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Qiulong Shen ◽  
Yajun Chen ◽  
Chunhui Peng ◽  
Wenbo Pang ◽  
Zengmeng Wang ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Biliary Atresia ◽  
Liver Stiffness ◽  
Porta Hepatis ◽  
Liver Stiffness Measurement ◽  
Stiffness Measurement ◽  
Kasai Procedure ◽  
Group A ◽  
Group B ◽  
Sensitivity Specificity

Abstract Background Kasai procedure is the standard initial treatment of infants with biliary atresia. The key to perform a successful surgery is to accurately remove the fibrous portal plate near the liver hilum. Yet how to estimate surgical difficulty pre-operatively remains unclear. This study aims to design an algorithm that predicts the difficulty of Kasai procedure using liver stiffness measurement (LSM). Methods One hundred ninety-nine patients were included from April 2012 to December 2016. The patients were all surgically diagnosed with biliary atresia. Group A comprised of patients with porta hepatis retraction (the angle between the plane of the fibrous porta plate and the plane of the medial liver closest to the plate was equal to or smaller than 90°), group B comprised of patients without porta hepatis retraction (the angle between the plane of the fibrous porta plate and the plane of the medial liver closest to the plate was greater than 90°). Liver function measurements and LSM were measured for all patients within three days before surgery. Results Our study included 19 cases in group A (9 males, 10 females) and 180 cases in group B (87 males, 93 females). LSM had statistical differences between the two groups, 28.10(14.90) kPa VS 10.89(7.10) kPa, P = 0.000. There was a significant relationship between LSM and operative age, TBA, AST, GGT (P = 0.000, 0.003, 0.003, 0.012, correlation coefficient = 0.323, 0.213, 0.207, 0.179). The AUROC of LSM was 0.919. When the cutoff value was 15.15 kPa(OR = 3.989; P = 0.000), the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 0.947, 0.750, 0.285, 0.992 and 0.768, respectively. When the value was 23.75 kPa(OR = 3.483; P = 0.000), the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 0.631, 0.950, 0.571, 0.960 and 0.919, respectively. Conclusions LSM can be used to predict the difficulty in dissecting fibrous portal plate, and in turn, the difficulty of Kasai procedure. LSM > 23.75 kPa suggests a more complicated surgery.

scholarly journals Living with biliary atresia: From Kasai portoenterostomy to liver transplantation

2016 ◽  
Vol 45 (2) ◽  
pp. 116
Author(s):  
Naresh P Shanmugam ◽  
Gomathy Narasimhan ◽  
Shaman Rajindrajith
Keyword(s):  
Liver Transplantation ◽  
Biliary Atresia ◽  
Kasai Portoenterostomy

scholarly journals Clinical Relevance of Isoagglutinin Rebound in Adult ABO-Incompatible Living Donor Liver Transplantation

2021 ◽  
Vol 11 (12) ◽  
pp. 1300
Author(s):  
Wei-Chen Lee ◽  
Chen-Fang Lee ◽  
Tsung-Han Wu ◽  
Hao-Chien Hung ◽  
Jin-Chiao Lee ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Graft Loss ◽  
Initial Assessment ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Antibody Mediated Rejection ◽  
Group A ◽  
Group B

ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) can be performed successfully. However, anti-ABO isoagglutinin rebound may cause antibody-mediated rejection (AMR) and graft loss. The risk threshold of isoagglutinin rebound is still not defined. 76 ABO-I LDLT recipients were divided into group A (n = 56) with low isoagglutinin titers (<1:256), and group B (n = 20) with high isoagglutinin titers (≥1:256), at initial assessment for liver transplantation. The last 12 patients in group B received a modified desensitization regimen by adding bortezomib to deplete plasma cells. Six (10.7%) patients in group A and 10 (50.0%) patients in group B had postoperative isoagglutinin rebound (p < 0.001). Three patients (5.54%) in group A and two patients (10%) in group B developed clinical AMR (p = 0.602). The cutoff value of postoperative isoagglutinin rebound to cause clinical AMR was ≥1:1024. Among the 12 patients in group B with bortezomib administration, isoagglutinin rebounded up to 1:128 only, and no clinical AMR occurred. In conclusion, the patients with high isoagglutinin titers had a higher rate of postoperative isoagglutinin rebound. Isoagglutinin rebound ≥1:1024 is risky for developing clinical AMR. Adding bortezomib into the desensitization regimen may mitigate isoagglutinin rebound, and avoid clinical AMR.

scholarly journals Significance of Hepatitis B Recurrence in Liver Transplantation Recipients

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Hong-Shiue Chou ◽  
Chih-Hsien Cheng ◽  
Hao-Chien Hung ◽  
Jin-Chiao Lee ◽  
Yu-Chao Wang ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatitis B ◽  
Liver Function ◽  
Survival Rates ◽  
Clinical Manifestations ◽  
Antiviral Agent ◽  
Close Monitoring ◽  
Group A ◽  
Group B ◽  
Hcc Recurrence

Background. A combination of antihepatitis B immunoglobulin and antiviral agents is the most common regimen for prophylaxis of hepatitis B recurrence after liver transplantation. However, hepatitis B recurrence still happens. The significance of hepatitis B recurrence is less mentioned. Materials. Forty-eight of the 313 hepatitis B liver transplant recipients having hepatitis B recurrence were included in this study. The patients were divided into group A, the patients transplanted for hepatitis B-related liver failure, and group B, the patients transplanted for hepatitis B-related cirrhosis and HCC. The clinical manifestations after hepatitis B recurrence were recorded. Results. Among the 48 patients with hepatitis B recurrence, 23 patients were in group A and 25 patients in group B. The age was 51.6±9.4 years in group A and 52.8±6.4 in group B (p=0.869). The MELD score prior to transplantation was 23.1±9.9 in group A patients and 12.9±5.6 in group B patients (p<0.001). The median (interquartile) interval from transplantation to hepatitis B recurrence was 10 (2-19) months for group A patients and 13 (8.5-35) months for group B patients (p=0.051). After hepatitis B recurrence, the liver function was almost normal in both groups. In group B patients, 10 patients had HCC recurrence with 7 of 10 patients having hepatitis B recurrence earlier than HCC recurrence. The interval between hepatitis B and HCC recurrence was 1 to 15 months. The 1-, 3-, and 5-year survival rates were 82.6%, 73.9%, and 69.0%, respectively, for group A patients and 96%, 76%, and 68%, respectively, for group B patients (p=0.713). Conclusion. The patients have uneventful liver function under antiviral agent while hepatitis B recurred. For the patients having HCC prior to transplantation, close monitoring of HCC recurrence is necessary if hepatitis B recurs.

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