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OBJECTIVES: To describe a novel animal model for ex-vivo liver perfusion. METHODS: This study was carried out at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, between September 2016 and January 2019. We assembled a perfusion circuit operated by a continuous pressure-driven arterial pump with continuous portal and arterial pressure and volume measurements. We used normothermic oxygenated perfusate. The livers used were retrieved from the sheep. RESULTS: Ex-vivo continuous perfusion of the liver was achieved for up to 9 hours with stable pressure and volume in both hepatic artery and portal vein. In 4 experiments the arterial pressure was kept in a range of 48-52 mmHg with a mean of 51.75±4.31 resulting in arterial volume at steady state of 223.5±48.25 ml/minute (95% confidence level). At steady state the mean portal pressure was 16.25±1.45 mmHg with a mean volume of 854±313.75 ml/minute (95% confidence level). Bile production was observed during the perfusion period. Hemodynamic parameters were similar to the physiological parameters observed in normothermic perfusion model of the porcine liver. CONCLUSION: A normothermic oxygenated ex-vivo perfusion circuit was successfully constructed using the sheep liver. A sustainable functional circuit with physiological hemodynamic parameters was achieved. Further study on sheep model seems to be feasible.
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Trasplante de Hígado , Animales , Hígado , Perfusión , Arabia Saudita , Ovinos , PorcinosRESUMEN
The demand for liver transplantation in the Kingdom of Saudi Arabia (KSA) is associated with the country's high burden of liver disease. Trends in the epidemiology of liver transplantation indications among recipients in KSA have changed over 20 years. Non-alcoholic steatohepatitis has eclipsed the hepatitis C virus in the country due to the effective treatment strategies for HCV. Risk factors for NASH, like type 2 diabetes mellitus, obesity, and hyperlipidemia, are becoming a major concern and a leading indication for liver transplantation in the KSA. There is also a signiï¬cantly increased prevalence and incidence of genetic adult familial liver diseases in KSA. New immunosuppressive agents and preservation solutions, improved surgical capabilities, and early disease recognition and management have increased the success rate of liver transplant outcome but concerns about the side effects of immunosuppressive therapy can jeopardise long-term survival outcomes. Despite this, indications for liver transplantation continue to increase, resulting in ongoing challenges to maximize the number of potential donors and reduce patient mortality rate while expecting to get transplanted. The Saudi Center of Organ Transplant is the recognized National Organ Donation Agency for transplantation, which renders important support for procurement and allocation of organs. This guidance document aims to help healthcare providers in managing patients in the liver transplant setting.
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Diabetes Mellitus Tipo 2 , Trasplante de Hígado , Obtención de Tejidos y Órganos , Adulto , Humanos , Arabia Saudita/epidemiología , Sociedades Médicas , Donantes de TejidosRESUMEN
OBJECTIVES: Hepatocellular carcinoma is among the leading causes of cancer death. The Milan criteria are the first and most widely used criteria for selecting patients with hepatocellular carcinoma for a good transplant outcome. Studies have shown that patients with hepatocellular carcinoma outside the Milan criteria have good outcomes if they are successfully downstaged before transplant. We report our experience with locoregional therapy for hepatocellular carcinoma, either for bridging or for downstaging prior to transplant. MATERIALS AND METHODS: We retrospectively reviewed the electronic charts and our institutional database for adult patients diagnosed with hepatocellular carcinoma between 2001 and 2016. We recorded patient demographics, the type of transplant (living donor or deceased donor), radiologic findings, the type of locoregional intervention, and overall survival. RESULTS: A total of 642 adult liver transplants were performed during the study period (290 living donor and 352 deceased donor), of which 158 (24.6%) were conducted in patients with hepatocellular carcinoma (104 men and 54 women). Hepatocellular carcinoma was associated with hepatitis C in 80 patients (51%), hepatitis B in 44 (28%), and was cryptogenic in 13 (8%). Patients were grouped based on their radiologic staging (within Milan, within and beyond University of California, San Francisco), and subsequently described by whether they received locoregional therapy. Median survival and mortality were noted. Kaplan-Meier survival curves showed no statistically significant difference for patients within the Milan criteria, with or without locoregional therapy (P = .5). When patients within the Milan criteria were combined with patients within the University of California, San Francisco criteria, those who were downstaged from outside the latter criteria had similar survival. CONCLUSIONS: We demonstrate that carefully selected patients beyond the Milan criteria and even beyond the University of California, San Francisco criteria can be bridged and downstaged successfully for liver transplant.
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Carcinoma Hepatocelular/terapia , Ablación por Catéter , Quimioembolización Terapéutica , Neoplasias Hepáticas/terapia , Trasplante de Hígado , Terapia Neoadyuvante , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/patología , Ablación por Catéter/efectos adversos , Ablación por Catéter/mortalidad , Quimioembolización Terapéutica/efectos adversos , Quimioembolización Terapéutica/mortalidad , Quimioterapia Adyuvante , Bases de Datos Factuales , Registros Electrónicos de Salud , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/mortalidad , Donadores Vivos , Masculino , Estadificación de Neoplasias , Selección de Paciente , Estudios Retrospectivos , Factores de Riesgo , Arabia Saudita , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: Organ transplantation is successful. The main challenge in the Kingdom of Saudi Arabia (KSA) and elsewhere continues to be organ shortage. This shortage was not resolved by utilization of living donors. Previous studies indicate that there is underreporting of brain death cases, lack of completion of documentation process, poor medical care in some instances and finally high refusal rate for consent. In order to put this problem in perspective and find a solution, we initiated a collaborative project between 4 hospitals in Riyadh, KSA and The Saudi Center for Organ Transplantation. The initial result of this project is presented in this article. METHODS: A donor team was formed to deal and facilitate the logistical aspect of donation in the 3 main Ministry of Health hospitals in Riyadh. Data with regard to the number of donors reported, documentation and success rate were recorded over 3-months (October 2003 to December 2003) and compared with the preceding 9 months. RESULTS: During the period from January 2003 to September 2003, the total number of case reported to the Saudi Center for Organ Transplantation in Riyadh region, was 94. Only 53% were fully documented. Families were approached in 45 of these 50 cases in terms of donation and consent was obtained in 15. However, the number harvested was only 10 (11% yield from total number reported). During the period from October 2003 until the end of December 2003, the total number of cases reported from 3 hospitals was 19. Seventeen (90%) of them were documented. The families were approached in 16 cases and consent was obtained in 6. All 6 (32%) donors were harvested. CONCLUSION: The above result clearly indicates that a donor team supporting the intensive care unit (ICU) can improve the donation. It is expected that application of a similar project to more ICUs in KSA will have a substantial positive impact on the rate of organ donation.
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Trasplante de Órganos/normas , Obtención de Tejidos y Órganos/organización & administración , Cadáver , Países en Desarrollo , Femenino , Predicción , Encuestas de Atención de la Salud , Humanos , Donadores Vivos , Masculino , Trasplante de Órganos/tendencias , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Medición de Riesgo , Arabia SauditaRESUMEN
OBJECTIVE: Laparoscopic cholecystectomy is now widely applied in hospitals throughout the Kingdom of Saudi Arabia (KSA). Iatrogenic bile duct injury occurs rarely. It is a serious complication with long term consequences on patients. This paper describes our experience in dealing with this complication and the eventual outcome of the patients. METHODS: Between July 1993 and December 1999, 17 patients with high bile duct injury were referred to the Hepatobiliary Unit of King Khalid University Hospital and King Fahad National Guard Hospital, Riyadh, KSA. Their charts were reviewed retrospectively. Once a patient was referred, a clinical evaluation with particular attention to the presence of sepsis was made. The anatomy of biliary duct was then delineated. Corrective surgery was attempted through hepaticojejunostomy. Follow up was at least 3 years in all cases. RESULTS: There were 15 females and 2 males with an average age of 37 years. Eleven patients presented with bile duct injury and 6 had a stricture following an attempted repair. Five patients had Bismuth type E2 injury and the rest were higher (E3, E4, E5). Re-stricture occurred in 7 patients, 3 of them had concomitant arterial injury. All responded to radiological manipulati CONCLUSION: High bile duct injury following laparoscopic cholecystectomy is a devastating complication, with a high rate of recurrence after repair. Care of such patient should be carried out in a specialized unit with a strict follow up to try to avoid end stage liver failure requiring liver transplantation.
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Conductos Biliares/lesiones , Colecistectomía Laparoscópica/efectos adversos , Adulto , Conductos Biliares/cirugía , Femenino , Estudios de Seguimiento , Humanos , Yeyunostomía/métodos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Arabia Saudita/epidemiología , Resultado del Tratamiento , Heridas y Lesiones/epidemiología , Heridas y Lesiones/etiologíaRESUMEN
OBJECTIVE: Organ transplantation programs have been successful in the Kingdom of Saudi Arabia. This success is limited by organ shortage. The aim of this study is to find out the percentage of actual donors out of all potential donors in intensive care units (ICU), and to look at problems related to the donation process, particularly from the logistical point of view. METHODS: The study was conducted prospectively for a one year period, June 2001 through to May 2002, in 4 main Riyadh hospitals. Mortality data was collected by a medical professional in each ICU and analyzed on a weekly basis. Final analysis was made at the end of the year. RESULTS: Five hundred and forty-two deaths occurred in these ICUs. Fifty-four percent occurred in one hospital. The number of brain death cases in all hospitals was 114 cases. Thirty-eight cases were reported to the Saudi Center for Organ Transplantation (33%). Documentation was completed in only 23 cases (60%). In these, there was a significant delay in documentation (second test was carried out in 6-12 hours in 4 cases only). CONCLUSION: We have found that the reporting of brain death cases was low (33%). Dealing with the reported cases is inefficient since only 4 cases were able to become the actual donor out of 38 cases. We found also that there is a gross difference in the number of brain death cases among different hospitals. To improve the efficiency of ICUs in dealing with brain death cases (reporting, documentation, maintenance and consent) will require solving several problems at the medical, administrative, and religious and mass media levels.
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Obtención de Tejidos y Órganos/organización & administración , Adolescente , Adulto , Muerte Encefálica , Niño , Preescolar , Eficiencia Organizacional , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Arabia SauditaRESUMEN
OBJECTIVE: Over the past 2 decades, liver transplantation has became the standard treatment of end stage liver disease. Organ shortage has been the main hindrance against the progress of liver transplantation in the Kingdom of Saudi Arabia. This paper reports the status of organ donation for liver transplantation in the Kingdom of Saudi Arabia and highlights the problems and the suggested solutions in relation to organ shortage. METHODS: All donors reported to the liver transplant program at the King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia, from the Saudi Center of Organ Transplantation from January 1994 through to June 1998 was retrospectively analyzed. Clinical and laboratory data were evaluated to decide on the suitability of organs for liver transplantation. RESULTS: Out of 216 donor offers only 100 were harvested and utilized (46%). Out of the remaining 116, 8 donors were declined based on bad clinical and laboratory data and the remaining 36 donors' livers were harvested but not used based on abnormal liver histology. This resulted in discarding more than 50% of the offered donors. The main reasons were related to poor donor maintenance and logistical delay. CONCLUSION: The number and quality of organs offered for liver transplantation in the Kingdom of Saudi Arabia over the past 6 years has been deteriorating with a negative impact on the liver transplant programs. Adopting new strategies is required to support the donor program in the Kingdom of Saudi Arabia. It is proposed that establishment of donor promotion offices in major hospitals can change the dismal picture of organ donation in the Kingdom of Saudi Arabia even at the current consent rate by better utilization of the available donors.
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Trasplante de Hígado/estadística & datos numéricos , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos/normas , Adolescente , Adulto , Anciano , Cadáver , Niño , Preescolar , Femenino , Humanos , Lactante , Trasplante de Hígado/normas , Masculino , Selección de Paciente , Sistema de Registros , Estudios Retrospectivos , Arabia Saudita , Obtención de Tejidos y Órganos/tendenciasRESUMEN
OBJECTIVE: The risk of transmitting hepatitis B virus from donors who are positive for hepatitis B core antibody but negative for hepatitis B surface antigen has been a major concern in liver transplantation. In the Kingdom of Saudi Arabia the overall prevalence of hepatitis B core antibody among the general population was reported to be very high indeed. The purpose of this study is to establish the prevalence of hepatitis B core antibody positivity among liver donors who are negative for hepatitis B surface antigen and offered for liver transplantation in the Kingdom of Saudi Arabia. METHODS: Hepatitis B serological markers were studied in 145 of 209 donors offered for organ transplantation over a 4-year period in King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. RESULTS: Out of 145 donors, 51 donors tested positive for hepatitis B core antibody but negative for hepatitis B surface antigen with an over all prevalence of 35.2%. The majority of donors were non-Saudi (75.2%), and predominantly from the Indian subcontinent and Far East. The prevalence of hepatitis B core antibody positive donor was significantly higher in non-Saudi (41.3%) compared with Saudi nationals (16.7%). CONCLUSION: In the view of this high prevalence, we believe that all donors considered for liver transplantation in the Kingdom of Saudi Arabia should be tested for hepatitis B core antibody. Furthermore, an algorithmic approach should be developed to minimize the risk of transmitting hepatitis B virus from donors to liver recipients, at the same time not to affect the existing small pool of available donor organs in the Kingdom of Saudi Arabia.