Surgery Commons^™

A Glimpse Of Liver Resection Profile In An Indonesian Tertiary Hospital: A Retrospective Descriptive Study, Florencia V. Vaniara, Arnetta Nl Lalisang, Toar Jm Lalisang, Yarman Mazni, Agi S. Putranto, Wifanto S. Jeo, Febiansyah Ibrahim, Ridho A. Syaiful, Lam Sihardo, Vania Mg Marbun

The New Ropanasuri Journal of Surgery

Introduction. In-depth liver resection profile is needed for evaluation to improve the procedure’s outcome. This study aims to describe the clinical characteristics and outcomes of liver resection in HCC patients in Cipto Mangunkusumo Tertiary Hospital.

Methods. This study retrospectively analyzed the clinical data of 19 HCC patients who underwent liver resection in Cipto Mangunkusumo Tertiary Hospital from 2021 to 2024. Demographic, clinical, laboratory, operative, and pathological data were collected. Postoperative complications were assessed using the Clavien-Dindo classification system within 30- and 90-day postoperative periods.

Result. Nineteen patients were included, comprising 12 (63.2%) males and 7 (36.8%) females. Sixteen patients (84.2%) …

Management Of Gastrointestinal Tract Arteriovenous Malformations In Adults: A Literature Review, Febiansyah Ibrahim, Angie Beatrice

The New Ropanasuri Journal of Surgery

Introduction. Arteriovenous malformations (AVMs) of the gastrointestinal (GI) tract are rare vascular lesions that can cause significant GI bleeding, posing a diagnostic challenge in clinical practice. This literature review examines the management strategies for AVMs in adults, focusing on identifying optimal treatment approaches and minimizing recurrence, particularly in Indonesia where no standardized treatment guidelines are available.

Method. A literature search was conducted from August 24, 2022, to September 11, 2023, using PUBMED®, Cochrane®, Proquest®, and Scopus® databases. The inclusion criteria were studies published in English or Indonesian within the last 25 years, including case series, cohort studies, or systematic reviews …

The Outcome Of Snare Loop Catheter For Foreign Body Removal In Superior Vena Cava: An Evidence-Based Case Report, Hutomo Rezky Noorsukma, Patrianef Darwis

The New Ropanasuri Journal of Surgery

Introduction. In recent years, the utilization of central venous catheters (CVC) in medical practice has become increasingly common. One of the complications associated with central venous catheterization is embolization of catheter fragments, which arefound in 1% of cases. Currently, endovascular techniques, such as snare loop catheter, have been developed for the extraction of intravascular foreign bodies. However, there is no strong evidence regarding this method. Thisliterature review aims toevaluate the efficacy and safety of snare loop catheters for foreign body removal within the superior vena cava (SVC).

Method. We searched four databases, that is Cochrane, PubMed, EBSCO, and …

Roux-En-Y Duodenojejunostomy As Surgical Treatment For Congenital Duodenal Obstruction: A Case Report, Ahmad Yani, Albireza Ruhimat

The New Ropanasuri Journal of Surgery

Introduction. Congenital duodenal obstruction is an anatomical abnormality in newborns. Various intrinsic and extrinsic etiologies can cause duodenal obstruction. The surgical treatment that is commonly performed on duodenal obstruction in neonates is duodenoduodenostomy. However, several etiological conditions, such as preduodenal portal vein (PDPV) and pancreatic annulare cause duodenoduodenostomy nearly impossible to perform, so an alternative surgery procedure with a good outcome is necessary.

Case Illustration. A female neonate had been suspected congenital duodenal obstruction since pregnancy due to polyhydramnios. An OGT was inserted with greenish yellow residue after the baby was born. Based on abdominal x-ray examination, a …

Whipple Procedure For High-Grade Pediatric Pancreatic Injury After Blunt Trauma: A Case Report, David C. El Gah, Tri H. Rahayatri, Asri D. Rachmawati, Adianto Nugroho

The New Ropanasuri Journal of Surgery

Introduction: Pediatric pancreatic injury isuncommon but carries significant morbidity. While non-operative management is standard for low-grade injuries, the optimal approach for high-grade trauma (AAST grade III–V) remains debated. Pancreaticoduodenectomy (Whipple procedure) is rarely performed due to high procedural risks and is typically reserved for severe pancreatic head injury with concomitant duodenal damage.

Case presentations: A 13-year-old boy presented three days after blunt abdominal trauma with epigastric pain and bilious vomiting. CT imaging revealed free fluid, a large retroperitoneal hematoma, and suspected pancreatic head injury. Despite initial stability and conservative management in the High Care Unit, worsening abdominal distension prompted an …

Locoregional Management In Breast Cancer With Brca1/2 Mutation: Evidence Based Case Report, Adlina Karisyah, Sonar S. Panigoro

The New Ropanasuri Journal of Surgery

Introduction. Breast cancer is still one of the top health issues worldwide. Hereditary predisposition is linked with morbidity and mortality of breast cancer patients. BRCA 1/2 genetic mutation, one of mutations in breast cancer that has been extensively observed, has tremendous effects on the carrier. Studies showed that patients with BRCA1/2 mutation are often associated with poor pathological characteristics. Further research isyet to identify the effect of the mutation with prognosis including locoregional recurrences. This study aims to understand the risk of locoregional recurrences on the patients with breast cancer and BRCA 1/2 genetic mutation who had BCT or …

Navigating Wound Closure Strategies: Primary Closure Vs. Delayed Primary Closure In Digestive Surgery—A Systematic Review And Meta-Analysis On Surgical Site Infections, Lam Sihardo, Arnetta Nl Lalisang, Afid B. Putra, Bagus A. Suryawiditya

The New Ropanasuri Journal of Surgery

Introduction. Surgical site infection (SSI) is a significant concern following digestive surgery, with varying incidence rates based on wound contamination levels. The choice between Primary Closure (PC) and Delayed Primary Closure (DPC) impacts SSI occurrence, making it essential to evaluate their comparative effectiveness. DPC is hypothesized superior to PC to prevent SSI or wound infection after a contaminated abdominal surgery.

Methods. This systematic review study was carried out through PubMed, Scopus, and Cochrane (CENTRAL). Quality was assessed using Risk of Bias (ROB-2) tool. All results were summarized, and quantitative analysis was performed using a random-effect model. This study …

Bacillus Calmette-Guerin (Bcg) As An Intralesional Therapy For Cutaneous Metastatic Malignant Melanoma: A Literature Review, Farisa B. Dina, Ahmad Kurnia

The New Ropanasuri Journal of Surgery

Introduction. Malignant melanoma is the most lethal form of skin cancer and is the third most common cause of death of all malignancies in the world. Cutaneous metastatic lesions are the earliest and the most frequently encountered metastatic lesions in malignant melanoma. The use of Bacillus Calmette-Guerin (BCG) as an intradermal therapy agent has been long debated due to its effectiveness and adverse effects. This literature review aims to provide a comprehensive explanation regarding the use of intralesional BCG in establishing local control and preventing recurrence in cutaneous metastatic malignant melanoma.

Method. A literature search was conducted on various …

Infrarenal Abdominal Aortic Pseudoaneurysm With Suspected Behcet Disease: A Unique Case Report, Harsya D. Gunardi, Danny Pratama, Andrio W. Prabowo, Nanang W. Hidayat, M Aprizal Putera, Grady Krisandi

The New Ropanasuri Journal of Surgery

Introduction. Abdominal aortic pseudoaneurysm caused by autoimmune vasculitis is a rare complication. Clinical presentation of patients is often late with life–threatening complications.

Case Illustration: A 62–year–old male patient with infrarenal abdominal aortic pseudoaneurysm presenting with a 2–week worsening severe abdominal and lumbar pain with a history of uncontrolled hypertension and a history of oral ulcer. He was successfully treated with tube grafting through open surgical repair.

Conclusion: The pseudoaneurysm was successfully removed and replaced with a polyester tube graft with no perioperative complications and was discharged 5 days later

C-Reactive Protein As An Early Predictor Of Anastomosis Leakage After Colorectal Surgery: A Literature Review, Lucky Permana, Ridho A. Syaiful

The New Ropanasuri Journal of Surgery

Introduction. Anastomosis leakage is a defect in the intestinal wall at the anastomosis site after surgery. This condition is a serious complication causing increased morbidity and mortality. CRP is commonly used as an acute postoperative indicator after abdominal surgery. The use of CRP as an early predictor of anastomosis leakage after colorectal surgery is supported by several studies showing its good diagnostic value. However, using CRP as a biomarker is not standard at Cipto Mangunkusumo National Hospital. Therefore, this literature review aims to support the evidence for CRP in the early detection of anastomosis leakage after colorectal surgery.

Method. …

The Role Of Active Surveillance Of Papillary Thyroid Microcarcinoma: A Literature Review, Prasojo Prasojo, I Gusti Ngurah Gunawan Gunawan Wibisana

The New Ropanasuri Journal of Surgery

Introduction: Thyroid cancer is one of the most common cancers in the world, with incidence 144,7: 100.000 population. The incidence has risen up to 211% within the last 30 years, and one–third of thyroid cancer is papillary thyroid microcarcinoma. There are still controversies regarding whether immediate surgery or active surveillance is the better option for treating this condition. This review aims to evaluate the safety and efficacy of active papillary thyroid microcarcinoma surveillance.

Methods: Cochrane, PubMed, EBSCOHost, and ProQuest were searched for relevant studies of active surveillance of papillary thyroid microcarcinoma.

Results: Six publications were selected after a literature search …

Transformation Of Accreditation Of Higher Education In Health In Indonesia: Qualitative Assessment, Yefta Moenadjat, Insan Sosiawan A. Tunru, Sutrisno Soemardjo

The New Ropanasuri Journal of Surgery

Accreditation of higher education in health in Indonesia shifts to the qualitative assessment driven to ensure quality improvement. The method replaces the former quantitative assessment method that has been applied since 2012; it will be effective in January 2025. The driving factors and rationale of transformation are outlined in this article. The rationale of the qualitative assessment that applies principle–based accreditation and the quantitative assessment that applies rule–based accreditation is reviewed here. Information on the accreditation procedure and the goal is presented, aiming for institutions to prepare for this new version of accreditation.

Surgical Treatment For Hepatocellular Carcinoma With Right Atrium Tumor Thrombus: A Literature Review, Mohammad Z. Hazmi, Ridho A. Syaiful

The New Ropanasuri Journal of Surgery

Introduction. The prognosis of patients with hepatocellular carcinoma (HCC) with right atrial tumor thrombus (RATT) is poor, with a mortality rate of 60 to 90%. Along with the development of multimodality management and surgical techniques in cases of HCC, surgery is still an option for curative purposes. This study aims to review the indications, appropriate surgical techniques, and postoperative survival outcomes in HCC with RATT.

Methods. This literature review conducted using online databases, including Cochrane Library, PubMed, ScienceDirect, EBSCOhost, and ProQuest.

Results. Six case reports and four retrospective studies were reviewed. Surgery for HCC with RATT has one, three, and …

Long-Term Patency Of Stent Angioplasty For Aortoiliac Occlusive Disease: A Literature Review, Ira H. Siagian, Alexander J. Utama

The New Ropanasuri Journal of Surgery

Introduction. Surgical revascularization remains a definitive therapy for aortoiliac occlusive disease. Revascularization could be achieved via endovascular treatment using angioplasty or open surgery. A limited number of studies currently assess the long-term patency of stent angioplasty of aortiliac occlusive disease. This study aims to evaluate or find recent evidence regarding the evaluation of the long-term patency of stent angioplasty for the treatment of aortoiliac occlusive disease.

Method. Literature searching was conducted through several online databases, including Cochrane, PubMed, and EBSCOHost. Several cohort and randomized controlled studies assessing long-term patency of stent angioplasty ranging from bare metal stent to balloon angioplasty …

Recurrence Analysis Of Pediatric Thyroid Carcinoma In Dr. Cipto Mangunkusumo General Hospital And Its Associated Factors, Erwin D. Yulian, Marlin Mp Prawirodihardjo

The New Ropanasuri Journal of Surgery

Introduction. Thyroid cancer is the most common endocrine malignancy in children aged 0-14 years, frequently occurring in adolescents and young adults. The global incidence rate stands at 0.54 cases per 100,000 individuals. Pediatric patients exhibit higher recurrence rates compared to adults, although their mortality rates are low. Research exclusively for the pediatric population is still sparse in Indonesia. Thus, This study aimed to provide essential data on recurrence and mortality rates of pediatric thyroid cancer, along with an analysis of contributing factors.

Method. This study is a retrospective cohort focusing on survival analysis. The research sample was drawn from the …

Safety And Efficacy Of Rivaroxaban-Aspirin Combination Compared To Aspirin Monotherapy On Lower Peripheral Artery Disease After Revascularization: Systematic Review And Meta-Analyses, Robby E. Thio, Dedy Pratama

The New Ropanasuri Journal of Surgery

Introduction. Currently, single antiplatelet treatments using aspirin or clopidogrel are recommended for post-revascularization peripheral artery disease (PAD) patients. However, a recent study suggested that a combination of rivaroxaban and aspirin was more favorable to use. We conducted a systematic review to determine the efficacy and safety of rivaroxaban and aspirin combination compared to aspirin alone.

Method. A systematic review conducted based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol. Search using keywords was conducted on Cochrane, PubMed, Scopus, EBSCOHost, and Google Scholar. Inclusion and exclusion criteria were applied. Selected studies were appraised using the Cochrane risk …

Outcome Of Benign Breast Tumor Excision Using Ultrasound-Guided Vacuum Assisted Breast Biopsy: A Literature Review, I Gusti N.G Wibisana, Elisabet L.A Kinanthi

The New Ropanasuri Journal of Surgery

Introduction. Benign breast tumors have a significant incidence among breast diseases that cause anxiety for patients. Surgical management is one of the managements. Vacuum-assisted breast biopsy (VABB) could be applied to tumors with a size of less than 3 cm or multiple lesions. One of its techniques is guided by ultrasonography (USG). In Indonesia, the ultrasound-guided (USG-guided) VABB has already been applied in several healthcare instances. Nevertheless, there are still opinions about tumor recurrence after the procedure. This study’s purpose is to observe the tumor recurrence and patients' satisfaction with benign breast tumor excision with USG-guided VABB.

Method. Literature was …

Methylene Blue As An Adjuvant Analgesic Postoperative Anal Fistula: A Randomized Clinical Trial, Wifanto S. Jeo, Muhammad Fa Irsal, Riana P. Tamba, Yefta Moenadjat, Dewi Friska

The New Ropanasuri Journal of Surgery

Introduction. Anal fistula is a pathological condition that connects the anorectal mucosa to the perianal skin, requiring various types of surgical procedures. However, surgery often causes postoperative pain. The use of methylene blue is being studied as a potential analgetic adjuvant in anal fistula surgery. Previous studies have shown that methylene blue can effectively reduce postoperative pain in various types of anorectal surgery. This study aims to determine methylene blue's clinical efficacy as an analgetic adjuvant.

Methods. A double-blind, randomized controlled trial was conducted. Subjects consisting of subjects with simple anal fistula to undergo fistulectomy were randomly allocated into two …

Evaluation Of Antimicrobial Stewardship Implementation In Elective Surgery In Dr Cipto Mangunkusumo General Hospital Using Gyssens Method, Rhea P. Ulima, Yefta Moenadjat

The New Ropanasuri Journal of Surgery

Introduction. Nowadays, surgical site infections (SSI) remain the most common complication of surgical procedures. In prevention, prophylactic antibiotics are the first option, which leads to the high use of antibiotics. However, antibiotic administration should be based on strategies such as stewardship. Thus, the study aimed to assess the situation using Gyssens' method.

Method. A retrospective cohort study analyzed the antibiotic administration of most major elective surgeries, including thyroidectomy, mastectomy, and cholecystectomy, proceeded in Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, from January to July 2023. Indication, type, dosage, timing, interval, duration, and route of administration were the variables of interest. …

Correlation Between Age, Initial Body Mass Index (Bmi) With Excessive Weight Loss In Very Early Postoperative Period, Fanny Indarto, Jeffrey -, Peter I. Limas

The New Ropanasuri Journal of Surgery

Introduction. As a major outcome of bariatric surgery, weight loss can be affected by many factors, such as sociodemographic, behavioral problems, genetics, patient status, and the surgical technique. However, limited data were available. This research aimed to seek a correlation between age and BMI with excessive weight loss after bariatric surgery.

Method. Cross–sectional study design from 2 bariatric centers in Jakarta, using data from 2018–2022. Percentage Excessive Weight Loss (%EWL) 3 months was an outcome measurement tool.

Results. Of 87 subjects enrolled with male to female ratio was 1:4. Age ranged from 14–62 years (median 39 years). Type 1 obesity, …

Efficacy Of Full Dose And Sandwich Neoadjuvant Chemotherapy In Breast Cancer: A Literature Review, I Gusti Ng Wibisana, Shandy V. Putra

The New Ropanasuri Journal of Surgery

Introduction. Breast cancer is the leading cause of death in productive-age women, and that needs to be addressed with systemic medication. There has been a big-scale success using adjuvant chemotherapy; however, the optimal method of chemotherapy administration has yet to be determined. Two methods have been introduced today: full dose and sandwich methods. In full dose, we administer chemotherapy before surgical intervention, whereas in the sandwich method, we administer chemotherapy before and after surgical intervention. In this literature review, we aim to observe the effectiveness of chemotherapy administration through both full-dose and sandwich methods.

Method. In the initial phase, 51 …

Outcome Of Endovascular Procedure In Chronic Limb Ischemia Femoropopliteal Lesion: A Literature Review, Alexander J. Utama, Robby E. Thio

The New Ropanasuri Journal of Surgery

Introduction. Angioplasty and stenting are the two main endovascular treatments for femoropopliteal lesions associated with chronic limb ischemia. To summarize the research in this area, this article examines the state of these treatments today, diving into clinical subtleties and new trends. The objectives was to thoroughly analyze the body of research, combining knowledge about the results of endovascular angioplasty and stenting.

Methods: Literature was searched in some databases (Cochrane, PubMed, and EBSCO) from June to July 2021.

Results: Five articles that met the inclusion and exclusion criteria were identified. There were two randomized control trials and three cohort …

Open Sympathectomy Effectiveness On Buerger's Disease’S Pain: An Evidence–Based Case Report, Rangga S. Prawiro, Alexander J. Utama

The New Ropanasuri Journal of Surgery

Introduction. Thromboangiitis obliterans, often referred to as Buerger's disease, is a vascular disease that causes chronic inflammatory conditions, edema, and vascular obstruction due to blood clots. In Cipto Mangunkusumo General Hospital (CMGH), sympathectomy is a rarely done procedure. This evidence–based case report aimed to prove the effectiveness of sympathectomy for Buerger's Disease to reduce pain.

Method. We reported a case of 44–year–old male with progressive pain and a history of darkened fingers of left limbs six months before admission. The patient underwent a lumbar sympathectomy, and there was no recurrence of symptoms after one year of follow–up. A systematic literature …

Correlation Of Thyroid Stimulating Hormone (Tsh), T3, And T4 Hormones With Histopathological Characteristics Of Thyroid Cancer At Cipto Mangunkusumo General Hospital, Ahmad Kurnia, Kristaninta Bangun, Fatahillah Muazdhani

The New Ropanasuri Journal of Surgery

Introduction. In a study spanning 2008 to 2012 at Cipto Mangunkusumo General Hospital (CMGH) Jakarta, 668 cases of thyroid cancer were identified among 18,216 cancer cases. Globally, the papillary subtype is prevalent, and prior research indicates a link between thyroid hormone changes and thyroid carcinoma risk. To improve surgical care, this study aims to find the association between thyroid hormone levels and histological subtypes in thyroid carcinoma patients.

Method. This cross-sectional study focused on thyroid cancer patients managed from 2013 to 2017. Despite subjects' characteristics, thyroid hormone levels and histopathological findings were the variables of interest. The findings were analyzed …

D-Dimer And Ultrasonography As The Early-Diagnostic Tools For Lower-Limb Trauma Patients With Deep Vein Thrombosis: A Literature Review, Faranita Muchtar, Akhmadu Muradi

The New Ropanasuri Journal of Surgery

Introduction. The mortality of venous thromboembolism increased among trauma patients. Both the D-dimer test and ultrasonography are selected to diagnose venous thromboembolism due to non-traumatic causes but are rarely utilized in emergency trauma settings.

Objectives. This literature review comprehensively explains the accuracy of the D-dimer test and ultrasonography for deep vein thrombosis (DVT) diagnosis. This study finding might broaden the diagnostic recommendation for traumatic patients with deep vein thrombosis.

Method. This study used articles from four distinct journal databases. Only eight of the 480 articles found during searching proceeded with the screening process. Thus, five articles were included …

Neutrophil-Lymphocyte-Ratio As Predictor Of Morbidity And Mortality In Adults With Gastrointestinal Obstruction, Agi S. Putranto, Bimo D. Pramesta

The New Ropanasuri Journal of Surgery

Introduction. Gastrointestinal (GI) obstruction is a condition that often requires surgery and can lead to severe complications. The neutrophil-to-lymphocyte ratio (NLR) has been used as an inflammation indicator in various medical conditions, but research on the relationship between NLR and GI obstruction is still limited. Therefore, this study aims to evaluate the role of NLR as a cost-effective and simple preoperative predictor of postoperative mortality and morbidity, mainly surgical site infection, in adult patients with GI obstruction.

Method. This cross-sectional study was conducted at Cipto Mangunkusumo General Hospital in Jakarta. The study sample consists of 150 adult patients with GI …

Preoperative Neutrophil–Lymphocyte Ratio And Serum Carcinoembryonic Antigen As Predictive Factors Of Colorectal Cancer Survival, Agi S. Putranto, Jackson Kamaruddin

The New Ropanasuri Journal of Surgery

Introduction. Colorectal cancer is the second leading cause of death worldwide, with a high mortality rate. This study investigates the predictive value of the neutrophil–lymphocyte ratio (NLR) and carcinoembryonic antigen (CEA) in predicting the survival rates of colorectal cancer patients in Indonesia.

Method. This retrospective cohort study enrolled the colorectal cancer stage I–IV patients treated at Cipto Mangunkusumo General Hospital (CMGH). The independent variables are NLR and CEA, while the dependent variable is the five–year survival of colorectal cancer. The log rank test proceeded to find a correlation between NLR and CEA with 5–year survival, and the Cox proportional hazard …

Factors Influencing Ulcer Healing In Chronic Limb Threatening Ischemia Patients After Endovascular Angioplasty At Cipto Mangunkusumo General Hospital, Raden Suhartono, Ghany H. Wijaya, Akhmadu Muradi

The New Ropanasuri Journal of Surgery

Introduction. Chronic limb–threatening ischemia (CLTI) can cause rest pain in the lower extremities and the formation of ulcers or gangrene. Revascularization, which can be done using open surgery or endovascular procedures, is the first line of treatment in CLTI management. CLTI patients at CMGH usually came with advanced conditions and high re–amputation rates even after revascularization. This study aimed to determine factors associated with the outcome of endovascular angioplasty, especially ulcer healing.

Method. A cross–sectional study was conducted at CMGH, enrolling CLTI patients with Rutherford grades 5 and 6 who underwent angioplasty. Age, gender, history of smoking, hypertension, atrial fibrillation, …

Comparative Evaluation Of Scar Tissue From Chest Tube Wound Closure Using Knotless And Conventional Methods Using The Patient And Observer Scar Assessment Scale, Adrian N. Tangkilisan, Mendy H. Oley, Maximillian C. Oley, Claudia Loho, Wega Sukanto, Christha Zenithy Tamburian, Fima L.F.G. Langi

The New Ropanasuri Journal of Surgery

Introduction. Chest tube placement is widely practiced; most medical doctors can do this safely. However, releasing the chest tube can be a painful and challenging experience for the patient. A novel method has been developed with a new suture material that does not need to be knotted. The Patient and Observer Scar Assessment Scale (POSAS) provides objective and subjective scar assessment. This study aimed to compare the scars associated with chest tube release between the conventional and knotless methods.

Methods. The study was a controlled trial in which patients were divided into two groups. The scar assessment was …

Effect Of Everolimus On The Liver Function Of Children Receiving Liver Transplant With Chronic Rejection: An Evidence–Based Case Report, Adi Nd Puruboyo, Tri H. Rahayatri, Marini Stephanie

The New Ropanasuri Journal of Surgery

Introduction. Chronic rejection, a complication after pediatric living donor liver transplantation (LDLT), is challenging to treat as management generally requires retransplantation. However, retransplantation is avoided because of rejection risks, longer operating time, higher mortality, and lower survival rates. Immunosuppressant therapy has potential as an option for nonsurgical treatment. Everolimus, a mammalian target of rapamycin inhibitors (mTOR inhibitors), is a well-known immunosuppressant in treating chronic rejection of LDLT. However, studies in the pediatric field remain minimum.

Method. The discussion was based on evidence found from studies found through a systematic literature search. These three studies showed permanent liver function improvement after …