Animals ; Cell Transplantation ; Humans ; Liver Diseases ; surgery

Humans ; Liver Diseases ; surgery ; Liver Transplantation ; Treatment Outcome

Biliary tract diseases have always been one of the important indications for liver transplantation. These biliary tract diseases include congenital atresia of biliary duct, biliary diseases with tendency of malignant transformation, malignant biliary diseases, primary biliary cirrhosis, and secondary biliary cirrhosis. The right time to consider liver transplantation for the above biliary diseases includes situations when transplantation is the only approach to treat the disease, the only effective approach to treat the disease, or one of the effective approaches to treat the disease. Currently there is still no commonly accepted pre-operative evaluation standard for biliary disease-related liver transplantation. However, it is important to obey the following principles. First, the diagnosis should be confirmed; secondary, the necessity or urgency of the liver transplantation should be clarified; and third, the patient and his/her family should understand the whole procedure of transplantation the risk and advantage of the surgery, and the potential life-long intake of immunosuppressors. This article will briefly review all these relavant issues based on the authors' personal experience and clinical cases.
Biliary Atresia ; surgery ; Biliary Tract Diseases ; surgery ; Humans ; Liver Cirrhosis, Biliary ; surgery ; Liver Transplantation ; Living Donors

Humans ; Lithiasis ; surgery ; Liver Diseases ; surgery ; Liver Transplantation ; Male ; Middle Aged ; Situs Inversus ; complications ; surgery

Animals ; Hepatocytes ; transplantation ; Humans ; Liver Diseases ; genetics ; surgery ; therapy ; Liver Failure ; surgery

Female ; Humans ; Infant, Newborn ; Liver Diseases ; surgery ; Liver Transplantation ; Pregnancy ; Pregnancy Complications ; surgery ; Pregnancy Outcome

The liver has a complex cellular composition and a remarkable regenerative capacity. The primary cell types in the liver are two parenchymal cell populations, hepatocytes and cholangiocytes, that perform most of the functions of the liver and that are helped through interactions with non-parenchymal cell types comprising stellate cells, endothelia and various hemopoietic cell populations. The regulation of the cells in the liver is mediated by an insoluble complex of proteins and carbohydrates, the extracellular matrix, working synergistically with soluble paracrine and systemic signals. In recent years, with the rapid development of genetic sequencing technologies, research on the liver's cellular composition and its regulatory mechanisms during various conditions has been extensively explored. Meanwhile breakthroughs in strategies for cell transplantation are enabling a future in which there can be a rescue of patients with end-stage liver diseases, offering potential solutions to the chronic shortage of livers and alternatives to liver transplantation. This review will focus on the cellular mechanisms of liver homeostasis and how to select ideal sources of cells to be transplanted to achieve liver regeneration and repair. Recent advances are summarized for promoting the treatment of end-stage liver diseases by forms of cell transplantation that now include grafting strategies.
Humans ; Liver/surgery* ; Hepatocytes/transplantation* ; Stem Cells/metabolism* ; Liver Diseases/surgery*

BACKGROUND AND OBJECTIVES

Hepatobiliarypancreatic tuberculosis (HBPTB) is a less common form of tuberculosis that often presents as malignancy or lithiasis. Advances in diagnostics and minimally invasive procedures have led to the detection of more patients with milder forms of TB requiring surgical management. Due to the low incidence rates and lack of standardized approaches, additional studies are needed to improve patient outcomes. This study examined the risk factors, diagnostic methods, and treatments for HBPTB patients at the University of the Philippines – Philippine General Hospital (UP-PGH) from January 1, 2014 to December 31, 2021.

METHODS

This retrospective descriptive study utilized our institutional database to identify patients who underwent a surgical procedure for HBPTB and their associated risk factors. Inclusion criteria required biopsy or microbiologic proof of tuberculous involvement of the biliary tract or nearby structures.

RESULTS

Among a total of 45 patients, the most common admitting diagnosis were HBP tuberculosis (37.8%) and malignancy (35.6%). 47.6% of patients had a previous or concurrent TB exposure. Sixty percent had subclinical malnutrition indicated by normal weight and low albumin. The liver (37.8%) and the bile ducts (33.3%) were the most common organs involved. The most common surgical procedures done were ultrasound-guided liver biopsy, biliary enteric anastomosis, percutaneous transhepatic biliary drainage (PTBD), and endoscopic retrograde cholangiopancreatography with or without stenting (ERCP).

CONCLUSIONS

This study provides additional data for clinicians to tailor diagnostic and treatment plans accordingly. Striking a balance between surgical procedures and appropriate anti-tuberculous therapy (ATT) is essential for successful treatment. Local data can be useful to help identify tuberculosis patterns unique to Filipinos and highlight socio-economic factors contributing to this rare presentation of TB.

Human ; Tuberculosis, Extrapulmonary ; Biliary Tract Diseases ; General Surgery ; Acute Care Surgery ; Liver Diseases ; Pancreas

Since the first laparoscopic hepatectomy has been reported in 1991, significant improvement has been made in this procedure. Laparoscopic hepatectomy has been applied as an importent procedure for treatment of hepatic diseases. In the paper, we give a review for present advances in the area of laparoscopic hepatectomy based on literature and our own experience, especially in the aspects of indications, surgical technique and the apparatus for hepatectomy.
Hepatectomy ; methods ; Humans ; Laparoscopy ; methods ; Liver Diseases ; surgery

OBJECTIVETo summarize our experience in adult-to-infant living donor liver transplantation (A-ILDLT) and to analyze the efficacy and complications of A-ILDLT.

METHODSThe clinical data, surgical strategies and complications of 28 adult donors and infantile recipients who underwent A-ILDLT from April 2006 to December 2009 were retrospectively analyzed. These 28 patients (14 boys and 14 girls) aged from 80 days to 11.5 months with body weights of 3.08 to 10.3 kg at the time of operation . They suffered from biliary atresia with decompensated cirrhosis. The living donors were 15 mothers, 9 fathers, 3 grandma and 1 elder brother with ABO compatible with the infantile recipients. 27 Donor organs were the left lateral lobe grafts (segment II, III) and 1 graft was segment II. All patients were followed up for 5 to 24 months.

RESULTSThese grafts were orthotopically transplanted into the infantile recipients. The average length of stay was 9.3 days for the donor group without any complications. Postoperative immunosuppression included prednisone, Cyclosporin and mycophenolate mofetil (MMF). A total of 24 postoperative complications occurred in 20 recipients, including 5 vascular complications, 4 bleeding, 7 pneumonia, 2 bowel obstruction, 4 intestinal perforation and 3 rejection. Three recipients died of hepatic arterial thrombosis (HAT). The perioperative mortality rate of recipients was 10.7% (3/28) and the survival rate was 89.3% in peroperative period. One died of stricture of hepatic vein and 1 of accidental asphyxia during follow-up term. At present, 23 cases are still alive.

CONCLUSIONA-ILDLT has become an effective method to infants with end-stage liver disease. The postoperative vascular complication is the predominant cause of death.

Female ; Humans ; Infant ; Liver Diseases ; surgery ; Liver Transplantation ; methods ; Living Donors ; Male ; Retrospective Studies ; Treatment Outcome