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Tuerhongjiang Tuxun – 1st expert on this subject based on the ideXlab platform
ex vivo liver resection and Autotransplantation as alternative to allotransplantation for end stage hepatic alveolar echinococcosisJournal of Hepatology, 2018Co-Authors: Jiahong Dong, Tuerhongjiang Tuxun, T Li, Yingmei Shao, Jinming Zhao, Paizula Shalayiadang, Tiemin JiangAbstract:
Background & Aims Radical resection is the best treatment for patients with advanced hepatic alveolar echinococcosis (AE). Liver transplantation is considered for selected advanced cases; however, a shortage of organ donors and the risk of postoperative recurrence are major challenges. The aim of this study was to assess the clinical outcomes of ex vivo liver resection and Autotransplantation for end-stage AE. Methods In this prospective study, 69 consecutive patients with end-stage hepatic AE were treated with ex vivo resection and liver Autotransplantation between January 2010 and February 2017. The feasibility, safety and long-term clinical outcome of this technique were assessed. Results Ex vivo extended hepatectomy with Autotransplantation was successful in all patients without intraoperative mortality. The median weight of the graft and AE lesion were 850 (370–1,600) g and 1,650 (375–5,000) g, respectively. The median duration of the operation and anhepatic phase were 15.9 (8–24) h and 360 (104–879) min, respectively. Six patients did not need any blood transfusion. Complications higher than IIIa according to Clavien classification were observed in 10 patients. The 30-day-mortality and overall mortality (>90 days) were 7.24% (5/69) and 11.5% (8/69), respectively. The mean hospital stay was 34.5 (12–128) days. Patients were followed-up systematically for a median of 22.5 months (14–89) without recurrence. Conclusion This is the largest series assessing ex vivo liver resection and Autotransplantation in end-stage hepatic AE. This technique could be an effective alternative to liver transplantation in patients with end-stage hepatic AE, with the advantage that it does not require an organ nor immunosuppressive agents. Lay summary Ex vivo liver resection and Autotransplantation were performed in a large series of patients with end-stage hepatic alveolar echinococcosis. The results showed that this surgical option was feasible, with acceptable postoperative mortality, but 100% disease-free survival in survivors. Careful patient selection, as well as precise assessment for size and quality of the remnant liver are key to successful surgery.
ex vivo liver resection and Autotransplantation for end stage alveolar echinococcosis a case seriesAmerican Journal of Transplantation, 2016Co-Authors: J H Dong, J H Zhang, W D Duan, J M Zhao, Y R Liang, Y M Shao, X W Ji, T Li, H Gu, Tuerhongjiang TuxunAbstract:
Abstract The role of Autotransplantation in end-stage hepatic alveolar echinococcosis (AE) is unclear. We aimed to present our 15-case experience and propose selection criteria for Autotransplantation. All patients were considered to have unresectable hepatic AE by conventional resection due to critical invasion to retrohepatic vena cava, hepatocaval region along with three hepatic veins, and the tertiary portal and arterial branches. All patients successfully underwent ex vivo extended right hepatectomy and Autotransplantation without intraoperative mortality. The median autograft weight was 706 g (380-1000 g); operative time was 15.5 hours (11.5-20.5 hours); and anhepatic time was 283.8 minutes (180-435 min). Postoperative hospital stay was 32.3 days (12-60 days). Postoperative complication Clavien-Dindo grade IIIa or higher occurred in three patients including one death that occurred 12 days after the surgery due to acute liver failure. One patient was lost to follow-up after the sixth month. Thirteen patients were followed for a median of 21.6 months with no relapse. This is the largest reported series of patients with end-stage hepatic AE treated with liver Autotransplantation. The technique requires neither organ donor nor postoperative immunosuppressant. The early postoperative mortality was low with acceptable morbidity. Preoperative precise assessment and strict patient selection are of utmost importance.
Michael J Reardon – 2nd expert on this subject based on the ideXlab platform
cardiac Autotransplantation for malignant or complex primary left heart tumorsTexas Heart Institute Journal, 2008Co-Authors: Shanda H Blackmon, Brian A Bruckner, Zbigniew Wojciechowski, Ara A Vaporciyan, David C Rice, Ashish R Patel, Erik A Beyer, Arlene M Correa, Michael J ReardonAbstract:
Cardiac Autotransplantation enables complete resection and accurate reconstruction in many primary malignant and complex benign left-heart tumors.
cardiac Autotransplantation for primary cardiac tumorsThe Annals of Thoracic Surgery, 2006Co-Authors: Michael J Reardon, Chris S Malaisrie, Jon Cecil M Walkes, Ara A Vaporciyan, David C Rice, Roy W Smythe, Clement A Defelice, Zbigniew WojciechowskiAbstract:
Background. Complete tumor resection is the optimal treatment of cardiac tumors. Anatomic accessibility and proximity to vital structures complicates resection of tumors involving the left heart. The results of standard resection and resection with orthotopic heart transplantation are dismal. We, therefore, reviewed our series of patients with complex left-sided primary cardiac tumors who underwent tumor resection with cardiac Autotransplantation. Methods. Since April 1998, 11 consecutive patients with complex left atrial or left ventricular intracavitary cardiac tumors underwent 12 resections using cardiac Autotransplantation— cardiac explantation, ex vivo tumor resection with cardiac reconstruction, and cardiac reimplantation. Demographics, tumor histology, operative data, and mortality were analyzed. Follow-up was complete in all patients. Results. Complete resection by cardiac Autotransplantation was used in 7 patients with left atrial sarcoma, 1 patient with left ventricular sarcoma, 2 patients with left atrial paraganglioma, and 1 patient with a complex giant left atrial myxoma. Eight patients had previous resection of their cardiac tumor, and 1 patient had a repeat Autotransplantation for recurrent disease. There were no operative deaths. Median overall survival was 18.5 months in patients with sarcomas. All patients with benign tumors are alive without evidence of recurrence. Conclusions. Cardiac Autotransplantation is a feasible technique for resection of complex left-sided cardiac tumors. Recurrent disease after previous resections can be safely treated with this technique. Operative mortality and overall survival seems favorable in this series of patients. Benefits of this technique include improved accessibility and ability to perform a complete tumor resection with reliable cardiac reconstruction.
David E R Sutherland – 3rd expert on this subject based on the ideXlab platform
outcome after pancreatectomy and islet Autotransplantation in a pediatric populationJournal of Pediatric Gastroenterology and Nutrition, 2008Co-Authors: Melena D Bellin, Annelisa M Carlson, T Kobayashi, Bernhard J Hering, Angelika C Gruessner, Antoinette Moran, David E R SutherlandAbstract:
Objectives: Little is known regarding outcomes after pancreatectomy and islet Autotransplantation for chronic pancreatitis in pediatric patients. In this study, we document pain control and metabolic course after this procedure in a pediatric population. Materials and Methods: We reviewed medical records for 24 patients 18 years old or younger who underwent pancreatectomy with islet Autotransplantation at the University of Minnesota from July 1989 through June 2006. Patients and/or their parents were invited to participate in a follow-up telephone survey. Primary outcome measures were narcotics and insulin use at follow-up. We compared outcomes in patients undergoing surgery as preadolescents ( 2000 islet equivalents per kilogram and lack of prior pancreatic surgery (P = 0.011). Preadolescents were less likely to require chronic narcotic therapy at follow-up (P=0.05) and were more likely to maintain graft function (P = 0.02) compared with adolescents. Conclusions: Pancreatectomy can relieve pain in pediatric patients with chronic pancreatitis and the majority can withdraw from narcotics. Islet Autotransplantation can prevent or reduce the severity of diabetes in about three fourths of patients. Outcome goals were reached in a higher proportion of younger than older children.
the role of total pancreatectomy and islet Autotransplantation for chronic pancreatitisSurgical Clinics of North America, 2007Co-Authors: Juan J Blondet, Annelisa M Carlson, T Kobayashi, Melena D Bellin, Bernhard J Hering, Martin L Freeman, Greg J Beilman, David E R SutherlandAbstract:
Total pancreatectomy and islet Autotransplantation are done for chronic pancreatitis with intractable pain when other treatment measures have failed, allowing insulin secretory capacity to be preserved, minimizing or preventing diabetes, while at the same time removing the root cause of the pain. Since the first case in 1977, several series have been published. Pain relief is obtained in most patients, and insulin independence preserved long term in about a third, with another third having sufficient beta cell function so that the surgical diabetes is mild. Islet Autotransplantation has been done with partial or total pancreatectomy for benign and premalignant conditions. Islet Autotransplantation should be used more widely to preserve beta cell mass in major pancreatic resections.