Resection Details, Donor Segment Volume, and Adjuvant Chemotherapy in Patients With Colorectal Cancer and Liver Transplant —Reply

In Reply We thank Chen and Wei for their comments on our study. The report included all patients who underwent transplant in various prospective trails at our institution. Three of 61 patients were included in the Resection and Partial Liver Segment 2/3 Transplantation With Delayed Total Hepatectomy (RAPID) study with transplant of segment 2  + 3 grafts and 2-stage hepatectomy. The technical characteristics of the RAPID protocol have been published. Chen and Wei question whether 3 weeks between the first-stage transplant and second-stage liver remnant hepatectomy was sufficient time for donor graft survival without liver failure for the recipients. The 1-year outcomes of 22 RAPID operations from 7 European centers have been published, and no signs of posthepatectomy liver failure was observed after an median interval of 14 days. In our own experience, the donor grafts increased in volume by 110% to 183%, resulting in a ratio o f graft to recipient body weight of 0.75% to 0.97%. None of the 3 patients had liver failure after resection of segments 4 through 8 (the second part of the hepatectomy). Excluding the RAPID study patient who died of postoperative hepatic artery thrombosis 1.4 months after transplant, maximum intern ational normalized ratio (INR) and bilirubin levels after resection of segments 4 through 8 were 1.5 to 1.8 (upper normal limit, 1.2) and 32 to 35 μmol/L (upper normal limit 25, μmol/L), respectively, at 2 to 10 days after resection. The INR and biliru...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research