Surgery, Gastroenterology and Oncology

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 University, Nagasaki, Japan are addressing the role of inflammatory response in LT. They postulate that most complications in LT can be explained in a unified manner by abnormal inflammatory responses. Although inflammation is a unitary system in LT, it has multifactorial effects that affect the prognosis of the graft and the recipient. The conclusion is that controlling inflammation can enhance the results of LT.

In a review paper from Portugal, the country that is championing the domino LT, Ines Barros et al. from Lisbons's Central Hospitals and University Center and Nova Medical School present the current status of the implementation of this technique worldwide, and their own experience with this procedure. The authors emphasize that the benefit of expanding the donor pool must be balanced against the risk of disease transmission.

Massimo Malago et al. from UCL, London, UK, are discussing the multimodal treatment of HCC. The authors show that surgical treatments remain the only potential curative treatments for selected patients with early stage HCC. Liver resection remains a reliable curative method for HCC. Meta-analyses have shown that clinical outcomes of surgical resection are superior to ablative treatments in early stage HCC. Thus, they argue that LT is still the standard treatment for patients with early stage HCC.

Luciano de Carlis et al. from Niguarda Hospital, Milan, Italy, present their experience with LT during the COVID-19 pandemic in the most affected area of Europe, Northern Italy and especially Lombardia. LT activity continued despite the heavy pandemic burden without being stopped a priori, but evaluating each organ offer based on the resources available. Preserving LT activity was possible and safe with specific precautions, strong team motivation, and cooperation.

Florin Botea et al. are presenting a 1,000 LT experience (including retransplantations) over 20 years in one program (Fundeni Hospital, Bucharest, Romania). On the way to becoming a high-volume center, the Fundeni team started with ortothopic LT from cadaveric donors and gradually introduced the split and domino LT, the living donor liver transplantation (LDLT) for adults and children, and the dual graft.

By analyzing biliary complications after 417 cadaveric and 3 living LT, Octavio Gil et al. from National University, Cordoba, Argentina show that the majority of these complications must be treated today by minimally invasive approach. However, when those fail, surgical reconstruction remains the only solution. Early recognition and adequate treatment are pivotal to reducing morbidity and mortality, improving patient and graft survival.

Four papers approach the LDLT from various perspectives. Mohammed Abdel Wahab et al. describe the experience of a high-volume center (Mansoura University, Mansoura, Egypt). Preoperative MELD score, blood transfusion, pulmonary complications, and vascular complications were identified as significant predictors of early mortality in multivariate analysis. The authors conclude that reduction of perioperative transfusions together with early detection and management of vascular and respiratory complications are essential to reduce early mortality after LDLT.

Shashwat Sarin, from Mahatma Ghandi Hospital and University, Jaipur, India, Ramazan Donmez from Yeditepte University, Istanbul, Turkey and Yaman Tokat, from International Liver Center, Istanbul, Turkey are summarizing technical advancements in LDLT. The authors describe outflow reconstruction, portal vein reconstruction and arterial reconstruction; a special part is dedicated to inflow modulation. In addition, the methods of biliary reconstruction are described.

Ender Dulundu, from Marmara University (Istanbul, Turkey) is addressing the outflow reconstruction techniques in LDLT. These techniques are presented for right liver, left liver and left liver with caudate lobe; a special part is devoted to IVC resection and reconstruction using synthetic graft.

Finally, the paper by Hae Won Lee, Ho-Seong Han and Jai Young Cho is dedicated to laparoscopic harvesting of the right hemiliver for LDLT, based on a large experience in Seoul National University, Bundang Hospital, Seoul, Korea. Special emphasis is on timing to initiate totally laparoscopic donor right hepatectomy and learning curve. The article provides a detailed description of the procedure.

In conclusion, this special issue of the SGO presents important and timely experiences from major centers in Asia, Europe, Africa and South America, from a multidisciplinary perspective, and provides a critical analysis of the most significant advances made in LT over the last decades.

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