Transplantation proceedings
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Patients with hepatocellular carcinoma (HCC) exceeding the University of California, San Francisco (UCSF) criteria are normally rejected for cadaveric liver transplants. However, whether they should be allowed to undergo living donor liver transplantation (LDLT) has been controversial. We reviewed the outcome of patients with advanced HCC who underwent LDLT at our center. ⋯ In HCC patients exceeding UCSF criteria, a reasonable 5-year overall survival of 55% post-LDLT can be obtained. Patients with HCC exceeding the UCSF criteria, especially in the older age group with no portal vein invasion and lower AFP level, should be actively considered for LDLT.
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Comparative Study
Stroke volume variation derived by arterial pulse contour analysis is a good indicator for preload estimation during liver transplantation.
Accurate determination of preload during liver transplantation is essential. Continuous right ventricular end diastolic volume index (RVEDVI) has been shown to be a better preload indicator during liver transplantation than the filling pressures. However, recent evidence has shown that dynamic variables, in this case stroke volume variation (SVV), are also good indicators of preload responsiveness. In this study, we evaluated the correlation between SVV, which we derived from arterial pulse contour analysis and RVEDVI. ⋯ We conclude that SVV is a good indicator for preload estimation during liver transplantation. A higher SVV value is associated with a more hypovolemic fluid status.
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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.
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In Korea, living donor transplantation is increasing steadily as a life-saving alternative. It is essential to provide living donors the mental and physical care they need throughout their lives including postoperative period. Therefore, this study explored postoperative pain among living liver donors. ⋯ This study of postoperative pain among living liver donors may contribute to developing the safest, most effective strategy to relieve postoperative pain after living liver donation.
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Due to the organ shortage, many patients die without transplantation, even before completing an evaluation for candidacy. We analyzed outcomes after patient referral and factors associated with mortality both before and after listing for cadaveric donor liver transplantation. ⋯ Patients with a higher MELD, higher MELD-Na, and higher CPT score at referral were at greater risk for death without transplantation, especially before listing. Evaluation for transplantation candidacy is a time-consuming process. Therefore, earlier referral is mandatory to achieve successful listing for transplantation.