LIVER TRANSPLANTATION – TECHNICAL ISSUES AND COMPLICATIONS Edited by Hesham Abdeldayem and Naglaa Allam Liver Transplantation – Technical Issues and Complications Edited by Hesham Abdeldayem and Naglaa Allam Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Romana Vukelic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published February, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Liver Transplantation – Technical Issues and Complications, Edited by Hesham Abdeldayem and Naglaa Allam p. cm. ISBN 978-953-51-0015-7 Contents Preface IX Part 1 Living Donor Liver Transplantation 1 Chapter 1 Living Donor Liver Transplantation 3 Hesham Abdeldayem Chapter 2 Arterial Anastomosis in Living Donor Liver Transplantation 43 Mirela Patricia Sirbu Boeti, Vladislav Brašoveanu, Sadiq Shoaib and Irinel Popescu Chapter 3 Microvascular Hepatic Artery Reconstruction in Living Donor Liver Transplantation 65 Hideaki Uchiyama, Ken Shirabe, Akinobu Taketomi, Yuji Soejima, Tomoharu Yoshizumi, Toru Ikegami, Noboru Harada, Hiroto Kayashima and Yoshihiko Maehara Chapter 4 Small-for-Size Syndrome After Living Donor Liver Transplantation 83 Yuzo Umeda, Takahito Yagi, Hiroshi Sadamori and Toshiyoshi Fujiwara Part 2 Deceased Donor Liver Transplantation: Surgical Techniques 95 Chapter 5 Vascular and Biliary Anastomoses in Deceased Donor Orthotopic Liver Transplantation 97 Steven Cohn, Julie Stein, Alan Koffron and Vandad Raofi Chapter 6 The Routinely Use of “Piggyback” Technique in Adult Orthotopic Liver Transplantation 119 Luis Herrera, Federico Castillo, Marcos Gómez, Gonzalo Gutiérrez, Roberto Fernández, Elena García, Antonio López, Mónica González, Juan Carlos Rodríguez, Francisco González, Fernando Casafont and Manuel G. Fleitas VI Contents Part 3 Cell and Experimental Liver Transplantation 141 Chapter 7 Cell Transplantation – A Possible Alternative to Orthotopic Liver Transplant (OLT) 143 Kristen J. Skvorak, Roberto Gramignoli, Marc C. Hansel, Suleyman Uraz, Veysel Tahan, Kenneth Dorko, Fabio Marongiu and Stephen C. Strom Chapter 8 Experimental Liver Transplantation 173 Mirela Patricia Sîrbu Boeti, Sadiq Shoaib, Alaa Elshorbagy, Catalin Iulian Efrimescu and Irinel Popescu Part 4 Surgical Complications 189 Chapter 9 Biliary Complications After Liver Transplantation 191 Julius Špičák and Renáta Bartáková Chapter 10 Biliary Complications in Liver Transplantation 211 Ilka de Fatima Santana Ferreira Boin, Fernando Romani de Araujo, Elaine Cristina de Ataide, Anaisa Portes Ramos and Ciro Garcia Montes Chapter 11 Ischemic Type Biliary Lesions 225 Dennis Eurich, Daniel Seehofer and Peter Neuhaus Chapter 12 Minimal Invasive (Endovascular and Percutaneous) Treatment of Post Liver Transplantation Complications in Pediatrics 243 Ghazwan Kroma, Jorge Lopera and Rajeev Suri Part 5 Nonsurgical Complications 271 Chapter 13 Renal Dysfunction and Liver Transplantation 273 Naglaa Allam Chapter 14 Post Transplant Lymphoproliferative Disorders After Liver Transplantation 309 Dario Marino, Savina Maria Aversa, Silvia Stragliotto, Fabio Canova and Caterina Boso Chapter 15 Post-Transplant Lymphoproliferative Disease – PTLD 331 Julio Cesar Wiederkehr and Barbara de Aguiar Wiederkehr Chapter 16 Metabolic Syndrome After Liver Transplantation 349 Rocío González Grande, Miguel Jiménez Pérez, Ana Belen Sáez Gómez and Juan Miguel Rodrigo López Contents VII Chapter 17 Autoimmune Hepatitis After Liver Transplantation 361 Pierpaolo Di Cocco, Giuseppe Orlando, Katia Clemente, Lauren Corona, Vinicio Rizza, Linda De Luca, Maurizio DAngelo, Federica Delreno, Francesco Pisani and Antonio Famulari Chapter 18 Bone Disease After Organ Transplantation with Special Regard of Post Transplantation-Osteoporosis After Liver Transplantation 383 Daniel Kaemmerer and Gabriele Lehmann Chapter 19 Betaherpesviruses in Adult Liver Transplant Recipients 393 Ronaldo Luis Thomasini, Fernanda Costa, Ana Maria Sampaio, Sandra Helena Alves Bonon, Paula Durante, Ilka de Fátima Santana Ferreira Boin, Fabiana Souza Maximo Pereira and Sandra Cecília Botelho Costa Chapter 20 Donor-Derived Infectious Complications and Disease Transmission 411 Kun-Ming Chan and Wei-Chen Lee Part 6 Miscellaneous 443 Chapter 21 Physiotherapy in Liver Transplantation 445 Meriç Senduran and S. Ufuk Yurdalan Preface Although the basic principles of liver transplantation have not changed, the field of liver transplantation is still young, evolving, and dynamic. In this book, the authors are pioneers in different aspects of liver transplantation and come from many centers across the world. The contributions resulted in a valuable reference to anyone interested in developing a global view on liver transplantation, including medical students, residents, fellows, nurses, and practicing physicians and surgeons, as well as researchers in the field of liver transplantation. This book covers a wide spectrum of topics including, but not limited to, the technical issues in living and deceased donor liver transplant procedures, cell and experimental liver transplantation, as well as the complications of liver transplantation. Some of the very important topics such as the arterial reconstruction in living donor liver transplantation, biliary complications, and the post-transplant-lymphoprolifrative disorders (PTLD), have been covered in more than one chapter. As the editor, I wish to thank all of the authors for their co-operation and desire to share their precious experience with the medical community. On their behalf, I wish to express hope that our publication will facilitate access to the latest scientific achievements in the field of liver transplantation all across the world. To all my colleagues at the National Liver Institute in Egypt who supported and embraced me with their warm feelings: I love you all. To all my professors who so generously guided me by their example, wisdom, and insights: thank you. Finally, to Ms. Romana Vukelic, the publishing manager, with whom editing this book was a real pleasure: thank you. Hesham Abdeldayem, MD. Professor of Surgery National Liver Institute Menoufeyia University Egypt [...]... life, e.g employment, and insurability, and expenses to be borne by the donor 6 5 6 7 Liver Transplantation – Technical Issues and Complications Expected outcome of transplantation for the recipient Any alternative therapies available to the recipient The specific experience and statistics of the transplant centre 4.2.1 Informed understanding The donor must demonstrate informed understanding This is best... planned line of liver transection and to provide the most accurate assessment of graft volume (Hill MJ, et al., 2009) 18 Liver Transplantation – Technical Issues and Complications Two formulas are used to assess graft size adequacy: (1) graft-recipient body weight ratio (GRBWR) and (2) graft weight as a percentage of standard liver mass There is an excellent linear correlation between the two, and either... alone or in combination with HBIG after transplantation Both the donor and the recipient should receive regular and lifelong follow-up Any episode of liver dysfunction should be investigated for HBV reactivation with serological and virological testing (Suehiro T et al., 2005; Fontana R; Merion R, 2003) 22 Liver Transplantation – Technical Issues and Complications 9 Technical aspects of LDLT Timing of... support Patients cannot and should not undergo stressful LT without considerable social support Depending on the severity of the patient’s illness at the time of LT evaluation, many family 10 Liver Transplantation – Technical Issues and Complications members and/ or close friends may already have assumed care giving duties, including overseeing medication and dietary regimens and coordinating the patient’s... worker, and transplant coordinator (Marcos A et al., 2000) 14 Liver Transplantation – Technical Issues and Complications Guidelines for evaluating potential living liver donors are not standardized There is a great deal of variability among individual centers regarding components of their living donor evaluation protocols Variability exists in the performance of some diagnostic studies, such as liver. .. Leiden and prothrombin gene mutations (Ogawa H, et al., 2011) 7.5 Psychosocial evaluation This part of the evaluation assesses the donor’s mental fitness and willingness to donate, ensuring that consent is obtained in a voluntary manner with the absence of coercion A 20 Liver Transplantation – Technical Issues and Complications trained transplant psychiatrist, psychologist, clinical social worker, and. .. LDLT procedure in Africa and the Middle East at the National Liver Institute, in Egypt They reported the success of their first case in 1993 (Habib et al, 1993) In the same year, Haberal et al extended LDLT to adult recipients In their series, they transplanted left -liver grafts to eight patients In 1994, Yamaoka et al reported 4 Liver Transplantation – Technical Issues and Complications unplanned adult-to-child... junction Smaller draining veins are ligated or 26 Liver Transplantation – Technical Issues and Complications clipped as the entire left lobe and caudate lobe are retracted to the LHV, MHV and RHV are isolated as they drain into the cava (Humar A et al., 2006; Tanaka K et al., 2010) 9.4.4 Hilar time Hilar dissection is confined to the left side to free the LHA and LPV Attention should be paid to the caudate... limited by religious and cultural beliefs, as in Japan, Egypt, Korea, and India (Abdeldayem H, 2010) This chapter outlines the advantages and disadvantages of LDLT, addresses the moral and ethical issues surrounding this procedure, reviews the evaluation process of the recipient and the donor candidates, highlights controversial indication for LDLT, outlines technical aspects of LDLT, and the middle hepatic... specific to replace liver biopsy in most situations (Iwasaki et al, 2004) 7.1.1.4 Liver biopsy Liver biopsy is the gold standard for the assessment of hepatic parenchymal disease, including steatosis In general, liver biopsy is a safe procedure with a low risk for serious complications Liver biopsy also is useful in excluding occult chronic liver disease The appropriate use of liver biopsy in the . LIVER TRANSPLANTATION – TECHNICAL ISSUES AND COMPLICATIONS Edited by Hesham Abdeldayem and Naglaa Allam Liver Transplantation – Technical Issues and Complications. limited to, the technical issues in living and deceased donor liver transplant procedures, cell and experimental liver transplantation, as well as the complications of liver transplantation. Some. transplanted left -liver grafts to eight patients. In 1994, Yamaoka et al. reported Liver Transplantation – Technical Issues and Complications 4 unplanned adult-to-child LDLT using right liver .In