In liver transplantation, the primary concern is to ensure an adequate future liver remnant (FLR) volume for the donor, while selecting a graft of sufficient size for the recipient. The living donor–resection and partial liver segment 2−3 transplantation with delayed total hepatectomy (LD−RAPID) procedure offers a potential solution to expand the donor pool for living donor liver transplantation (LDLT).We report the first case involving a cirrhotic patient with autoimmune hepatitis and hepatocellular carcinoma, who underwent left lobe LDLT using the LD−RAPID procedure. The living liver donor (LLD) underwent a laparoscopic left hepatectomy, including middle hepatic vein. The resection on the recipient side was an extended left hepatectomy, including the middle hepatic vein orifice and caudate lobe. At postoperative day 7, a computed tomography scan showed hypertrophy of the left graft from 320 g to 465 mL (i.e., a 45.3% increase in graft volume body weight ratio from 0.60% to 0.77%). After a 7-day interval, the diseased right lobe was removed in the second stage surgery. The LD−RAPID procedure using left lobe graft allows for the use of a small liver graft or small FLR volume in LLD in LDLT, which expands the donor pool to minimize the risk to LLD by enabling the donation of a smaller liver portion.

In liver transplantation, the primary concern is to ensure an adequate future liver remnant (FLR) volume for the donor, while selecting a graft of sufficient size for the recipient. The living donor–resection and partial liver segment 2−3 transplantation with delayed total hepatectomy (LD−RAPID) procedure offers a potential solution to expand the donor pool for living donor liver transplantation (LDLT).We report the first case involving a cirrhotic patient with autoimmune hepatitis and hepatocellular carcinoma, who underwent left lobe LDLT using the LD−RAPID procedure. The living liver donor (LLD) underwent a laparoscopic left hepatectomy, including middle hepatic vein. The resection on the recipient side was an extended left hepatectomy, including the middle hepatic vein orifice and caudate lobe. At postoperative day 7, a computed tomography scan showed hypertrophy of the left graft from 320 g to 465 mL (i.e., a 45.3% increase in graft volume body weight ratio from 0.60% to 0.77%). After a 7-day interval, the diseased right lobe was removed in the second stage surgery. The LD−RAPID procedure using left lobe graft allows for the use of a small liver graft or small FLR volume in LLD in LDLT, which expands the donor pool to minimize the risk to LLD by enabling the donation of a smaller liver portion.

In liver transplantation, the primary concern is to ensure an adequate future liver remnant (FLR) volume for the donor, while selecting a graft of sufficient size for the recipient. The living donor–resection and partial liver segment 2−3 transplantation with delayed total hepatectomy (LD−RAPID) procedure offers a potential solution to expand the donor pool for living donor liver transplantation (LDLT).We report the first case involving a cirrhotic patient with autoimmune hepatitis and hepatocellular carcinoma, who underwent left lobe LDLT using the LD−RAPID procedure. The living liver donor (LLD) underwent a laparoscopic left hepatectomy, including middle hepatic vein. The resection on the recipient side was an extended left hepatectomy, including the middle hepatic vein orifice and caudate lobe. At postoperative day 7, a computed tomography scan showed hypertrophy of the left graft from 320 g to 465 mL (i.e., a 45.3% increase in graft volume body weight ratio from 0.60% to 0.77%). After a 7-day interval, the diseased right lobe was removed in the second stage surgery. The LD−RAPID procedure using left lobe graft allows for the use of a small liver graft or small FLR volume in LLD in LDLT, which expands the donor pool to minimize the risk to LLD by enabling the donation of a smaller liver portion.

In liver transplantation, the primary concern is to ensure an adequate future liver remnant (FLR) volume for the donor, while selecting a graft of sufficient size for the recipient. The living donor–resection and partial liver segment 2−3 transplantation with delayed total hepatectomy (LD−RAPID) procedure offers a potential solution to expand the donor pool for living donor liver transplantation (LDLT).We report the first case involving a cirrhotic patient with autoimmune hepatitis and hepatocellular carcinoma, who underwent left lobe LDLT using the LD−RAPID procedure. The living liver donor (LLD) underwent a laparoscopic left hepatectomy, including middle hepatic vein. The resection on the recipient side was an extended left hepatectomy, including the middle hepatic vein orifice and caudate lobe. At postoperative day 7, a computed tomography scan showed hypertrophy of the left graft from 320 g to 465 mL (i.e., a 45.3% increase in graft volume body weight ratio from 0.60% to 0.77%). After a 7-day interval, the diseased right lobe was removed in the second stage surgery. The LD−RAPID procedure using left lobe graft allows for the use of a small liver graft or small FLR volume in LLD in LDLT, which expands the donor pool to minimize the risk to LLD by enabling the donation of a smaller liver portion.

This report examines a patient with pulmonary adenocarcinoma that developed on a previous lesion from microscopic polyangiitis. A 59-year-old woman had been diagnosed with microscopic polyangiitis in October of 1988 based on her clinical symptoms and serological tests, which were positive for anti-neutrophil cytoplasmic antibodies. Her glomerulonephritis had been well controlled with low-dose prednisolone. She presented in October of 2005 with vague chest discomfort and dyspnea on exertion. Physical examination was unremarkable. A non-contrast computed tomography (CT) scan of the chest showed patch ground-glass opacity at the right lower lobe of the lung. Because we did not believe the lesion to be a definite malignancy, we decided to follow up with chest images over a short interval. During the 18 months following the images, the lesion did not change. However, the opacity of the lesion increased slightly over the last two months, and a non-contrast CT scan of the chest was therefore performed. A CT scan showed persistent ground-glass opacity with a slightly solid portion. To diagnose the previous finding and possibly to provide treatment, a right lower lobectomy of the lung via video-assisted thoracoscopic surgery was performed. The pathologic review of the resected lung revealed an adenocarcinoma, stage pT1N0. After one year, fluorodeoxyglucose positron emission tomography was performed, and no evidence of a recurrent malignancy was found.
Adenocarcinoma ; Antibodies, Antineutrophil Cytoplasmic ; Dyspnea ; Female ; Follow-Up Studies ; Glomerulonephritis ; Humans ; Lung ; Microscopic Polyangiitis ; Middle Aged ; Physical Examination ; Positron-Emission Tomography ; Prednisolone ; Serologic Tests ; Thoracic Surgery, Video-Assisted ; Thorax

Purpose: In the latest staging system of the American Joint Committee on Cancer for intrahepatic cholangiocarcinoma (IHCCC), solitary tumors with vascular invasion and multiple tumors are grouped together as T2. However, recent studies report that multifocal IHCCC has a worse prognosis than a single lesion. This study aimed to investigate the risk factors for IHCCC and explore the prognostic significance of multiplicity after surgical resection. Materials and Methods: A total of 257 patients underwent surgery for IHCCC from 2010 to 2019 and the clinicopathological data were retrospectively reviewed. Risk factor analysis was performed to identify variables associated with survival after resection. Survival outcomes were compared between patients with solitary and multiple tumors. Results: In multivariable analysis, the presence of preoperative symptoms, tumor size, lymph node ratio, multiplicity, and tumor differentiation were identified as risk factors for survival. Among 82 patients with T2, overall survival was significantly longer in patients with solitary tumors (sT2) than in those with multiple tumors (mT2) (p=0.017). Survival was compared among patients with stage II-sT2, stage II-mT2, and stage III. The stage II-sT2 group showed prolonged survival when compared with stage II-mT2 or stage III. Survivals of stage II-mT2 and stage III patients were not statistically different. Conclusion Tumor multiplicity was an independent risk factor for overall survival of IHCCC after surgical resection. Patients with multiple tumors showed poorer survival than patients with a single tumor. The oncologic significance of multiplicity in IHCCC should be reappraised and reflected in the next staging system update.