Biomedical subjects

Sheung-Tat Fan

Publications and source records attributed to Sheung-Tat Fan.

113 records · Page 7Linked to original sources

PubMed2002

Live donor liver transplantation in adults: graft size, related anatomical anomaly and imaging evaluation of donor.

The shortage of cadaveric livers has sparked an interest in adult live donor liver transplantation. Right lobe donor hepatectomy is frequently required to obtain a graft of adequate size for adult recipients. This procedure requires not only a precise understanding of liver anatomy and anatomic anomaly, but also the means of assessing them. This review focuses on the key points in adult live donor liver transplantation using the right lobe combined with our own experience in 81 cases including graft size, related anatomical anomaly and imaging evaluation of donor.

Adult↗

PubMed2002

Experience of donor right lobe hepatectomy in adult-to-adult live donor liver transplantation: clinical analysis of 89 cases.

OBJECTIVE: To review the experience of donor selection and right lobe hepatectomy in adult-to-adult live donor liver transplantation. METHODS: From May 1996 to December 2001, 89 live donor liver transplants using right lobe grafts were performed at Queen Mary Hospital, Hong Kong. All donors had received psychological counseling before donor operations. They were screened by laboratory tests including complete blood cell count, liver and renal biochemistry, and viral serology studies. Computed tomography (CT), CT volumetry and hepatic arteriography were routinely performed. All donors underwent the operations using the method designed by us. RESULTS: The median duration of the operations was 8.8 hours. The median blood loss recorded 466 ml. The median intensive care unit and hospital stays were 2 and 10 days, respectively. There was no donor mortality. Complications of donor operations included wound infection, urinary tract infection, biliary stricture, cholestasis, subphrenic collection, bowel obstruction and incision hernia, etc. All donors have recovered and returned to their previous occupations. CONCLUSIONS: Live donation of right lobe grafts for adult-to-adult liver transplantation is safe, provided that donor selection is strict and utmost care is exercised during the operation.

Adult↗

PubMed2002

Hepatic stress gene expression and ultrastructural features under intermittent Pringle manoeuvre.

BACKGROUND: Intermittent Pringle manoeuvre resulted in less blood loss and better preservation of liver function when it was applied for fewer than 120 minutes. The mechanism of better preservation of liver function under intermittent Pringle manoeuvre at molecular level remains unclear. Furthermore, the ultrastructural features in the liver with chronic diseases under intermittent Pringle manoeuvre have not been studied. The aim of the study is to investigate the expression of stress genes and ultrastructural change of the liver under intermittent Pringle manoeuvre. METHODS: From July 1995 to February 1998, 131 patients underwent hepatectomy for liver tumours (61 patients without Pringle manoeuvre and 70 patients with intermittent Pringle manoeuvre). Twenty-five patients (15 with Pringle manoeuvre and 10 without Pringle manoeuvre) were included in the study of hepatic stress gene expression during hepatectomy. Twenty-two patients (18 patients with intermittent Pringle manoeuvre and four patients without Pringle manoeuvre) were randomly assigned for electron microscopic examination. RESULTS: For the expression of stress genes, both the heat shock genes (HSP 70A and HSC 70) and acute phase genes (TNF-alpha and interleukin-6) were detected simultaneously in the patients with or without intermittent Pringle manoeuvre. The patients under intermittent Pringle manoeuvre had relatively higher mRNA levels of heat shock gene 70 family, which is related to intracellular repair and protection. Induction of TNF-alpha and interleukin-6 genes, which contributed to ischaemia-reperfusion injury and postoperative complication, was not found in the patients under intermittent Pringle manoeuvre. Under the electron microscopy, the hepatic ultrastructure was well maintained under intermittent Pringle manoeuvre whatever the liver status, even when the accumulated ischaemic duration was extended to 120 min. CONCLUSION: Intermittent Pringle manoeuvre induced relatively higher expression of heat shock genes, which are related to intracellular homeostasis, and is consistent with the well maintenance of liver ultrastructure.

Gene Expression↗

PubMedDate not supplied

Methods and related drawbacks in the estimation of surgical risks in cirrhotic patients undergoing hepatectomy.

There has been a dramatic improvement in recent results of hepatectomy for hepatocellular carcinoma in cirrhotic patients. Hospital mortality rates of less than 5% are frequently reported. The improvement is largely a result of better techniques and performance of surgeons in hepatectomy, and reduction in blood loss and transfusion requirement. Better selection of patients is perhaps a more significant contributory factor. Careful identification of risk factors related to the medical condition of the patient, functional reserve of the liver and volume of the remnant liver is essential for the prevention of postoperative liver failure. Indocyanine green clearance test is the most accurate test for assessment of liver function reserve. An indocyanine green retention rate of 14% at 15 minutes is the safety limit for major hepatectomy for cirrhotic patients. A maximum of 60% of the nontumorous liver can be resected safely. Computed tomography is therefore an important assessment parameter. The liver function reserve also reveals the suitability for hepatectomy. Liver enzymes, alanine aminotransferase or aspartate aminotransferase can reflect the hepatic activity, which could be responsible for the impaired liver function. Steatosis is another factor that influences hepatic function reserve. Age is also an important risk factor in hepatectomy because elderly patients may harbor occult heart disease, reduced respiratory and liver function reserves. After recognizing the risk factors, surgeons should eliminate operative morbidity and mortality by making appropriate decisions based on the assessments. In conclusion, preoperative risk assessment involves evaluation of hepatic function reserve, remnant liver volume, liver status, age and the medical condition of the patient. A 0% hospital mortality rate is considered the objective.

Age Factors↗

PubMedDate not supplied

Split liver transplantation for two adult recipients.

We report a case of split liver transplantation for two adult recipients. The liver graft (1285 g) was split on the backtable into a right lobe graft (900 g, containing the inferior vena cava and middle hepatic vein) and a left lobe graft (385 g). The right lobe graft was implanted into a patient with hepatitis B cirrhosis uneventfully. The left lobe graft was implanted into a patient with familial amyloid polyneuropathy, but was met with massive bleeding from the transection surface and congestion of segment 4. The dusky appearance of segment 4 disappeared after hepatic artery anastomosis, but Doppler ultrasonography showed reverse blood flow in the segment 4 portal vein. Both patients survived the operation. The case illustrated that a left lobe graft without the middle hepatic vein could be problematic. To benefit two adults with chronic liver diseases, a better design of hepatic vein drainage of segment 4 in the left lobe graft and segment 5 and 8 in the right lobe graft is required.

Adult↗