Comments for Surgery for Surgeons http://forsurgeons.net surgery blog for surgeons Tue, 22 Mar 2011 12:31:14 -0700 http://wordpress.org/?v=2.8.1 hourly 1 Comment on Hyperacute rejection in liver transplantation? by boston plastic surgeon http://forsurgeons.net/cases/hyperacute-rejection-in-liver-transplantation/comment-page-1#comment-101 boston plastic surgeon Tue, 22 Mar 2011 12:31:14 +0000 http://forsurgeons.net/?p=135#comment-101 This is really a great story.The liver is not as antigenic as other solid organs, assessment for rejection of the transplanted liver is a major focus of patient care. The liver has immune characteristics (ie, Kupffer cells, vascular and sinusoidal endothelial cells, and portal dendritic and inflammatory cells) that logically should promote graft rejection. This is really a great story.The liver is not as antigenic as other solid organs, assessment for rejection of the transplanted liver is a major focus of patient care. The liver has immune characteristics (ie, Kupffer cells, vascular and sinusoidal endothelial cells, and portal dendritic and inflammatory cells) that logically should promote graft rejection.

]]> Comment on The process of organ procurement: Liver – the warm dissection by Ivo Mitsiev http://forsurgeons.net/transplant-surgery/the-process-of-organ-procurement-liver-the-warm-dissection/comment-page-1#comment-62 Ivo Mitsiev Fri, 21 Jan 2011 19:50:55 +0000 http://forsurgeons.net/?p=53#comment-62 Thank you for your comment! There are multiple techniques for organ procurement and I believe that every procuring surgeon makes something different. It is e.g. the experience of many transplant surgeons that prolonged cold ischemia time should be generally avoided and this also by reducing the cold dissection during organ procurement. The liver/pancreas division is only a matter of preference if it should be performed in-situ or on the back table. I have never witnessed any kind of liver dysfunction which I could relate to any kind of dissection during the procurement surgery. Thank you for your comment!

There are multiple techniques for organ procurement and I believe that every procuring surgeon makes something different.
It is e.g. the experience of many transplant surgeons that prolonged cold ischemia time should be generally avoided and this also by reducing the cold dissection during organ procurement.
The liver/pancreas division is only a matter of preference if it should be performed in-situ or on the back table.

I have never witnessed any kind of liver dysfunction which I could relate to any kind of dissection during the procurement surgery.

]]> Comment on The process of organ procurement: Liver – the warm dissection by nose huggie http://forsurgeons.net/transplant-surgery/the-process-of-organ-procurement-liver-the-warm-dissection/comment-page-1#comment-60 nose huggie Sat, 08 Jan 2011 21:02:18 +0000 http://forsurgeons.net/?p=53#comment-60 It is our experience that warm dissection in the porta hepatis as well as extensive organ mobilization during combined pancreas-liver procurements may cause posttransplant dysfunction of the liver. To avoid this, we recently utilized a rapid en bloc procurement technique with minimal warm dissection and division of the liver and pancreas ex vivo It is our experience that warm dissection in the porta hepatis as well as extensive organ mobilization during combined pancreas-liver procurements may cause posttransplant dysfunction of the liver. To avoid this, we recently utilized a rapid en bloc procurement technique with minimal warm dissection and division of the liver and pancreas ex vivo

]]> Comment on Hyperacute rejection in liver transplantation? by Joe http://forsurgeons.net/cases/hyperacute-rejection-in-liver-transplantation/comment-page-1#comment-48 Joe Fri, 21 May 2010 11:06:22 +0000 http://forsurgeons.net/?p=135#comment-48 Thanks for sharing this case. Thanks for sharing this case.

]]> Comment on Hyperacute rejection in liver transplantation? by I. Mitsiev http://forsurgeons.net/cases/hyperacute-rejection-in-liver-transplantation/comment-page-1#comment-47 I. Mitsiev Sun, 09 May 2010 22:16:01 +0000 http://forsurgeons.net/?p=135#comment-47 Thank you for you comment and the very reasonable question, Amit! The cold ischemia time (CIT) plays a significant role in the delayed graft function (DGF) in kidney transplantation. 11.5 hours shouldn't be the time a liver dies completely when appropriately preserved, like in this case. In a good meta-analysis about the role of CIT in primary non-function (PNF) of liver allografts by a mixed (MGH and Pittsburgh) group (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430537/?tool=pubmed) from about 2 years ago, the authors show that there is not a linear dependency between the CIT and the PNF. Furthermore, the graft survival was excellent in the CIT-group of 10–12.5 hrs. There is no doubt that a prolonged CIT does not help. But I just don't believe that the role of the CIT in the PFN of this liver was crucial. The liver was also not really fatty. Much fattier livers have been transplanted without any significant problems. The common sense would tell that a prolonged CIT would result in DGF prior to a PNF. But there was no DGF here! There must have been something else that killed the liver in this case, Amit... but I don't know what. Thank you for you comment and the very reasonable question, Amit!
The cold ischemia time (CIT) plays a significant role in the delayed graft function (DGF) in kidney transplantation. 11.5 hours shouldn’t be the time a liver dies completely when appropriately preserved, like in this case.
In a good meta-analysis about the role of CIT in primary non-function (PNF) of liver allografts by a mixed (MGH and Pittsburgh) group (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430537/?tool=pubmed) from about 2 years ago, the authors show that there is not a linear dependency between the CIT and the PNF. Furthermore, the graft survival was excellent in the CIT-group of 10–12.5 hrs.

There is no doubt that a prolonged CIT does not help. But I just don’t believe that the role of the CIT in the PFN of this liver was crucial. The liver was also not really fatty. Much fattier livers have been transplanted without any significant problems.

The common sense would tell that a prolonged CIT would result in DGF prior to a PNF. But there was no DGF here!
There must have been something else that killed the liver in this case, Amit… but I don’t know what.

]]> Comment on Hyperacute rejection in liver transplantation? by Amit Jain http://forsurgeons.net/cases/hyperacute-rejection-in-liver-transplantation/comment-page-1#comment-46 Amit Jain Sun, 09 May 2010 20:02:35 +0000 http://forsurgeons.net/?p=135#comment-46 Thanks a lot for sharing this case. What are your thoughts on - if the cold ischemia time of 11.5 hr had to play a part in the primary non function of this fatty liver ? Thanks a lot for sharing this case. What are your thoughts on – if the cold ischemia time of 11.5 hr had to play a part in the primary non function of this fatty liver ?

]]> Comment on The process of organ procurement: Liver – the warm dissection by Ivo Mitsiev http://forsurgeons.net/transplant-surgery/the-process-of-organ-procurement-liver-the-warm-dissection/comment-page-1#comment-43 Ivo Mitsiev Tue, 12 Jan 2010 00:41:55 +0000 http://forsurgeons.net/?p=53#comment-43 Alger: Thank you very much for your comment! You (should) know that a significant portion of this particular knowledge I have gained because of you! You probably recognize situations and comments in this text, that we both discussed while I tried to learn from your experience. I will not forget your support and manner of teaching which helped me a lot especially in the hard initial time. Thank you so much! Keep up your great work, my friend! :) Alger:
Thank you very much for your comment!
You (should) know that a significant portion of this particular knowledge I have gained because of you! You probably recognize situations and comments in this text, that we both discussed while I tried to learn from your experience.
I will not forget your support and manner of teaching which helped me a lot especially in the hard initial time. Thank you so much!
Keep up your great work, my friend! :)

]]> Comment on The process of organ procurement: Liver – the warm dissection by alger http://forsurgeons.net/transplant-surgery/the-process-of-organ-procurement-liver-the-warm-dissection/comment-page-1#comment-42 alger Tue, 12 Jan 2010 00:27:36 +0000 http://forsurgeons.net/?p=53#comment-42 Ivo: Found your website surfing for some information, want to complement you on a great job!! Ivo:
Found your website surfing for some information, want to complement you on a great job!!

]]> Comment on Metastasis dependancy on the primary tumor? by bouazza http://forsurgeons.net/general-surgery/metastasis-dependancy-on-the-primary-tumor/comment-page-1#comment-36 bouazza Tue, 10 Nov 2009 19:42:20 +0000 http://forsurgeons.net/general-surgery/metastasis-dependancy-on-the-primary-tumor#comment-36 In Africa the surgeons put Silvadene inside a deep wound of a diabetic foot to help it heel better. Does this make any sense? Thanks ! In Africa the surgeons put Silvadene inside a deep wound of a diabetic foot to help it heel better.
Does this make any sense?
Thanks !

]]> Comment on Metastasis dependancy on the primary tumor? by bouazza http://forsurgeons.net/general-surgery/metastasis-dependancy-on-the-primary-tumor/comment-page-1#comment-35 bouazza Tue, 10 Nov 2009 19:40:14 +0000 http://forsurgeons.net/general-surgery/metastasis-dependancy-on-the-primary-tumor#comment-35 Do you guys evacuate a hematoma that collects into a subcutaneous chemotherapy reservoir area ? Do you guys evacuate a hematoma that collects into a subcutaneous chemotherapy reservoir area ?

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