Backgrounds/Aims Primary liver tumors such as hepatocellular carcinoma (HCC), and colorectal cancer liver metastases, can be treated with liver thermal ablation (LTA). Current evidence comparing percutaneous LTA (P-LTA) and laparoscopic LTA (L-LTA) is inconclusive, and data on lesions in the posterosuperior (PS) liver segments are scarce. This study aimed to compare early local recurrence rates between percutaneous and laparoscopic thermal ablation, with a focus on PS liver segments. Methods This single-centre retrospective study included all consecutive patients treated with P-LTA or L-LTA between 2010 and 2024. The primary outcome was early local recurrence (≤ 6 months); secondary outcomes were subgroup analyses of HCC nodules and microwave ablation-treated nodules. Results The study included 101 nodules in 69 patients. Overall morbidity was higher after L-LTA, whereas chronic liver disease was more common among P-LTA patients. Early local recurrence was significantly lower after L-LTA (7% vs. 25%), and this difference was accentuated in the PS liver segments (4% vs. 33%). Multivariable analysis identified the percutaneous approach and a lesion size > 3 cm as predictors of early local recurrence. Conclusions L-LTA appears more effective in reducing early local recurrence, particularly in the PS segments, although P-LTA remains less invasive. Prospective multicentre studies are needed to validate these findings.
Backgrounds/Aims The determinants of bleeding after living donor liver transplantation (LDLT) are difficult to isolate, because the surgeon who achieves final hemostasis varies. We characterized postoperative bleeding and intraoperative transfusion in a cohort with a single final-hemostasis surgeon. Methods We reviewed 156 consecutive adult LDLTs (2016-2019) in which one surgeon performed biliary reconstruction, final hemostasis, and closure. The primary outcome was postoperative bleeding of Clavien-Dindo grade ≥ IIIa; intraoperative red blood cell transfusion was secondary. The source and the operative field of every event were determined from the operative records. Results Bleeding occurred in 16 recipients (10.3%; median postoperative day 1.5). An identifiable source was found in all 16, and none was coagulopathic. Sources were in the recipient hepatectomy field (9), on the graft from vessels divided during donor hepatectomy (2), the closure field (2), a vascular anastomosis (1), and remote (2). No patient who bled died or lost the graft. On Firth penalized logistic regression, the estimates were largest for Model for End-stage Liver Disease (MELD) score (odds ratio 1.072, p = 0.062) and previous hilar surgery (odds ratio 3.133, p = 0.057). Transfusion was associated with MELD score (p < 0.001) and platelet count (p = 0.012), but not with laparoscopic donor hepatectomy (p = 0.954). Conclusions With the final-hemostasis surgeon held constant, bleeding arose from discrete anatomical sources rather than coagulopathy, whereas transfusion reflected recipient severity and thrombocytopenia. Neither was associated with the donor approach, although two events arose from graft-side vessels, and equivalence cannot be established.
Backgrounds/Aims The justification for living donor liver transplantation (LDLT) for acute alcoholic hepatitis (AAH) remains debated, particularly in urgent settings. We compared outcomes of recipients undergoing urgent LDLT for AAH versus other causes and identified predictors of mortality. Methods We analyzed 317 adults in the Korean national registry who underwent urgent LDLT from 2017 to 2021 within seven days of emergency approval. AAH was defined using National Institute on Alcohol Abuse and Alcoholism criteria, excluding coexisting liver disease. Recipient, donor, and perioperative variables were compared between the AAH (n = 114) and non-alcoholic groups (n = 203). Survival was assessed using Kaplan-Meier analysis, and predictors of death using Cox regression. Results AAH recipients had more severe decompensation, particularly hepatorenal syndrome and ascites. One-, two-, and three-year survival rates were 90.1%, 86.5%, and 86.5% in the AAH group versus 83.1%, 79.6%, and 77.9% in the non-alcoholic group (log-rank p = 0.321). Overall, 66 recipients (20. 8%) died. Pretransplant ventilator support (hazard ratio [HR] 1.954), donor age ≥ 55 years (HR 3.134), and chronic kidney disease independently predicted mortality, whereas AAH did not (HR 0.765, 95% confidence interval 0.440-1.329; p = 0.341). Conclusions AAH did not independently predict mortality following urgent LDLT. Instead, outcomes were influenced by the recipient's pre-surgery condition and the characteristics of the donor and graft, suggesting that the procedure is justified when candidates are carefully selected.
