Surgery, Gastroenterology and Oncology

Read article Since its inception, IASGO and its founders have played a major role in promoting and improving liver transplantation (LT). Thomas Starzl was an Honorary President of IASGO. Henri Bismuth is an Honorary President, Masatoshi Makuuchi is the current President and Sung-Gyu Lee is an Honorary Vice-President of IASGO.

In this special issue, the two editors present a collection of experiences from across the world, leveraging the global reach of the IASGO, a unique organization, open to specialists from all countries.

Kantoku Nagakawa et al. from Nagasaki Univer....[more]

Read article Successful liver transplantation requires proper mitigation of stress responses. Systemic effects caused by liver cirrhosis, invasive surgery, ischemia-reperfusion injury, rejection, and infection, all of which are relevant to liver transplantation, are mediated by inflammatory factors.
Recently, the detailed mechanisms of inflammation have been elucidated. Damageassociated molecular patterns (DAMPs) released from cells damaged by ischemia or injury, or pathogen-associated molecular patterns (PAMPs) released by pathogens, are recognized by internal cell receptors or cell surfac....[more]

Read article Domino Liver transplant (DLT) is a strategy to address organ shortage and expand the liver donor pool for liver transplantation. Despite offering some unique technical challenges, DLT appears to be a safe and reasonable option to be considered for selected patients who would otherwise not benefit from liver transplantation.
However, the benefit of expanding the donor pool must be balanced against the risk of disease transmission.In this review, we present where the DLT currently stands worldwide and our own experience with this procedure.

Read article Hepatocellular carcinoma (HCC) is the second cause of cancer–related deaths worldwide constitutes a major global health problem. Although our understanding of the molecular pathogenesis of hepatocellular HCC has improved, detected driver mutations are not yet sufficiently reliable therapeutic targets.
The modern management of HCC is conceived only within multidisciplinary schemes. Current systemic therapies are not curative and surgical treatments remain the only potential curative treatments for selected patients with early stage HCC.
The role of parenchyma sparing ....[more]

Read article The first wave of coronavirus disease 2019 (COVID-19) pandemic accounted for roughly 35,000 deaths in Italy and was mainly concentrated in the industrial north of the country.
Despite Italy returned to a partial lockdown during December, the number of people dying in the second wave has now surpassed the toll recorded in the first. This report aims to provide a snapshot of the impact of COVID-19 on liver transplantation activity in our Institution, with special regard to the measures put in place to guarantee through the two waves of the pandemic.
LT activity continued in....[more]

Read article Background: The liver transplantation program of Fundeni Clinical Institute reached a milestone (1000 operations performed by the same team in 20 years). It is a program for both adults and children, including cadaveric and living donor liver transplantations. We analyze the indications and results to emphasize the advantages of a combined program.

Methods: Between April 2000 and March 2020, 957 patients received 1,000 LTs at a single institution (Fundeni Clinical Institute, Bucharest, Romania). The demographics of donors and recipients, indications for liver tr....[more]

Read article Background: Biliary complications are the more frequent problem following liver transplantation (LT) and have been considered the "Achile's heel" this procedure.
The aim of this study was to evaluate the rates of biliary complications after LT, the different therapeutic modalities currently available and their outcomes.

Methods: A total of 420 LTs performed up to 2020 were retrospectively analyzed. Evaluation factors included MELD score, images, surgical techniques, type of biliary reconstruction and type of complications. We also analyzed the different th....[more]

Read article Introduction: Living-donor liver transplantation (LDLT) is a complex procedure requiring a special perioperative patients care. Despite the improvements in the operative techniques and perioperative care, early postoperative mortality remains a disappointing event. The current study is conducted to determine the incidence, causes and potential predictive factors of early postoperative mortality after LDLT.

Methods: We reviewed the data of patients who underwent LDLT during the period between May 2004 till October 2020.

Results: During the stud....[more]

Read article Over the past 2 decades, living donor liver transplantation has become a standard and accepted alternative to deceased donor liver transplantation, especially in countries with poor cadaveric donation rates.
Numerous innovations in surgical technique along with improved understanding of post-transplant physiology have led to LDLT having comparable and sometimes exceeding outcomes of DDLT. The importance of venous outflow and adequate anterior sectoral drainage to minimize congestion has been central to improving safety and outcomes in LDLT.
Portal vein thrombosis, once a ....[more]

Read article Liver transplantation is a therapeutic option for acute and chronic end stage liver diseases and certain hepatic malignant tumors.
The growing disparity between the number of liver transplant candidates and the supply of deceased donor organs has led the increase living donor liver transplantation (LDLT).
The provision of an adequate outflow is indispensable for graft function. In order to meet the metabolic demand of the recipient, the majority of the transplant centers switched to a right lobe from the left lobe LDLT which makes hepatic venous reconstruction more compli....[more]

Read article Although laparoscopic donor right hepatectomy (LDRH) is increasingly performed in adult living donor liver transplantation, most experiences have been reported from a limited number of major transplant centers.
This is because LDRH requires high-level surgical skills and a guarantee of donor safety.
Thus, despite its many advantages, this operation program should be performed with caution, especially in less experienced centers.
Various surgical techniques and the know-how have been introduced by several publications in recent years, which include donor's position d....[more]