Diabetes mellitus may affect the long-term survival of hepatitis B virus-related hepatocellular carcinoma patients after liver transplantation.

AIM: To determine whether diabetes mellitus (DM) affects prognosis/recurrence after liver transplantation (LT) for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). METHODS: A retrospective study was conducted between January 2000 and August 2013 on 1631 patients with HBV-related HCC who underwent LT with antiviral prophylaxis. Patient data were obtained from the China Liver Transplant Registry (https://www.cltr.org/). To compare the outcomes and tumor recurrence in the HBV-related HCC patients with or without DM, statistical analyses were conducted using χ2 tests, Mann-Whitney tests, the Kaplan-Meier method, log-rank tests and multivariate step-wise Cox regression analysis. RESULTS: Univariate analysis of 1631 patients who underwent LT found overall 1-, 3- and 5-year survival rates of 79%, 73% and 71% respectively in the DM patients, and 84%, 78% and 76% in the non-DM patients respectively. Overall survival rate differences after LT between the two groups were significant (P = 0.041), but recurrence-free survival rates were not (P = 0.096). By stratified analysis, the overall survival rates in DM patients for age > 50 years (P = 0.002), the presence of vascular invasion (P = 0.096), tumors ≤ 3 cm (P = 0.047), two to three tumor nodules (P = 0.007), Child-Pugh grade B (P = 0.018), and pre-LT alanine aminotransferase levels between 40 and 80 IU/L (P = 0.017) were significantly lower than in non-DM patients. Additionally, serum α-fetoprotein level > 2000 ng/mL (P = 0.052) was associated with a significant survival difference trend between DM and non-DM patients. Multivariate analysis showed that the presence of DM (P < 0.001, HR = 1.591; 95%CI: 1.239-2.041) was an independent predictor associated with poor survival after LT. CONCLUSION: HBV-related HCC patients with DM have decreased long-term overall survival and poor LT outcomes. Prevention strategies for HCC patients with DM are recommended.

Gallstones in liver transplant recipients: A single-center study in China.

BACKGROUND/AIMS: Liver transplant recipients include patients who present with almost all kinds of end-stage liver disease. Studying the relationship between gallstones and end-stage liver disease among liver transplant recipients is becoming important. MATERIALS AND METHODS: Multiple logistic regression analysis was applied to assess 1640 liver transplant recipients. Multiple factors were involved in the analysis, including age, sex, total bilirubin and total cholesterol levels, Child score, hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, alcoholic cirrhosis, and hepatocellular carcinoma (HCC). RESULTS: Age and Child score are independent risk factors for the development of gallstone disease (GD). The average age of the recipients in the GD group was 49.22±9.96 years, which was significantly higher than that in the GD-free group (48.23±9.79 years). The Child score of the recipients in the GD group was 9.21±2.47, which was significantly lower than that of the recipients in the GD-free group, which was 8.79±2.48 (t=3.23, p<0.001). We also found that hepatitis B is an influential factor in GD. CONCLUSION: The prevalence of gallstones among liver transplant recipients is related to the Child score and patient age. The prevalence of GD is lower in patients with HCC and in those who are HBV positive and is relatively higher in HCV-positive patients and in those with alcoholic cirrhosis, although no significant differences were found.

Effect of liver transplantation in combined hepatocellular and cholangiocellular carcinoma: a case series.

BACKGROUND: Liver transplantation is a treatment option for combined hepatocellular and cholangiocellular carcinoma (cHCC-CC) but its prognostic significance remains unclear. The present study aimed to evaluate the therapeutic effects of liver transplantation on cHCC-CC and analyze the clinicopathological factors affecting prognosis. METHODS: Retrospective analysis of the clinicopathological data of a case series of 21 patients with cHCC-CC who underwent orthotopic liver transplantation from April 2000 to April 2011 was performed. Cumulative survival rate and tumor-free survival rate were calculated using the Kaplan-Meier method followed by the log-rank test. RESULTS: The operative survival rate of the 21 patients was 100%; the 30 day mortality was 4.8% (1/21) and 90-day mortality was 9.5% (2/21); 1-, 2-, 3-, and 5-year overall cumulative survival rates were 64%, 47%, 39%, and 39%, respectively; and the corresponding cumulative tumor-free survival rates were 64%, 37%, 30%, and 30%, respectively. Cumulative tumor diameter, lymph node metastasis, macroscopic portal vein tumor thrombus, and mixed states according to Allen typing were identified as the primary influencing factors of poor prognosis (all P < 0.05). CONCLUSION: Liver transplantation may be an effective therapeutic method for the treatment of cHCC-CC. Strict screening of potential liver transplantation candidates with cHCC-CC can help reduce the risks of tumor recurrence and metastasis.

Magnetic ring anastomosis of suprahepatic vena cava: novel technique for liver transplantation in rat.

To improve the technique of suprahepatic vena cava (SHVC) reconstruction in rat OLT, novel magnetic rings were designed and manufactured to facilitate reconstruction of SHVC and shorten the anhepatic time. One-hundred and twenty adult male Wistar rats were randomly divided into two groups: rings group (n = 30), using magnetic rings for SHVC reconstruction; suture group (n = 30), 7/0 prolene suture was used for SHVC running anastomosis as control. Cuff techniques were used for portal vein and infrahepatic vena cava reconstruction as Kamada and Calne described. The bile duct was reconnected with a stent. The hepatic re-arterialization was omitted. In the rings group, the SHVC reconstruction took 0.91 ± 0.24 (mean ± SD) min; the anhepatic phase and the recipient operation time were 5.63 ± 0.65 min and 36.02 ± 8.02 min, respectively. In suture group, the anastomotic time of SHVC was 10.40 ± 2.11 min; the anhepatic phase and the recipient operation time were 17.76 ± 2.51 and 49.38 ± 12.06 min, respectively, and there was statistically significant difference between the two groups. The ALT levels reached peak at 24 h post-OLT (186.2 ± 32.5 IU/l) and restored to normal level at 96 h gradually. In the rings group, 29 of 30 rats survived at day 7 and 28 of 30 rats survived at day 30. In contrast, only 25 of 30 recipients in suture group remained alive at day 7 and 22 of 30 remained alive at day 30 (P < 0.05). Better anastomotic healing was founded in rings group by pathology and scanning electron microscope. The magnetic rings technique provides a novel, simple method for SHVC reconstruction of OLT in rat. It significantly shortens anhepatic phase, while the success rate of the operation is satisfactory.

Synchronous splenectomy and hepatectomy in patients with hepatocellular carcinoma, hypersplenism and liver cirrhosis.

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) mainly arises from underlying liver disease. Complicated liver cirrhosis and secondary hypersplenism are the most risk factors preventing surgical treatment of patients with HCC. The present study aimed at investigating the safety and long term outcome of patients with HCC and liver cirrhosis undergoing synchronous hepatectomy and splenectomy. METHODOLOGY: The clinical data of 306 cases of patients with HCC and liver cirrhosis undergoing curative hepatectomy were reviewed. 18 cases underwent synchronous hepatectomy and splenectomy. The rest 288 cases of HCC with hepatectomy only were compared in aspects of clinicopathological and surgical variables and surgical outcomes. RESULTS: Preoperative hemoglobin and platelet count were significantly lower in splenectomy than non-splenectomy group (p<0.01, respectively). Patients undergoing combined splenectomy and hepatectomy needed longer surgery time and hospital stay time, and transfused much more blood intraoperatively (p=0.07, 0.03, and 0.02), and also experienced more portal vein thrombosis (p<0.01). The level of hemoglobin and platelet increased after splenectomy and finally to normal level one month postoperatively. There was no statistical difference of overall and disease-free survival of patients in splenectomy and non-splenectomy groups (p>0.05). CONCLUSIONS: With strict selection, patients with HCC and hypersplenism could undergo combined splenectomy and hepatectomy safely.

Tacrolimus-related seizure after pediatric liver transplantation--a single-center experience.

To identify the risk factors for new-onset seizures after pediatric LT and to assess their clinical implications and long-term prognosis. The clinical and laboratory data of 27 consecutive children who underwent LT from January 2007 to December 2010 in our center were analyzed retrospectively. Patients were divided into seizures group and a non-seizures group. Pre-operative, intra-operative, and post-operative data were collected. Seizures occurred in four children, an incidence of 14.8%. All exhibited generalized tonic-clonic seizures within the first two wk after LT. Univariate analysis showed that the risk factors associated with seizures after pediatric LT included gender, pediatric end-stage liver disease score before surgery, Child-Pugh score before surgery, serum total bilirubin after surgery, and trough TAC level. Multivariate analysis showed that trough TAC level was the only independent risk factor associated with the seizures. All children who experienced seizures survived with good graft function and remained seizure-free without anti-epileptic drugs over a mean follow-up period of 33.7 ± 14.6 months. High trough TAC level was the predominant factor that contributed to seizures in the early post-operative period after pediatric LT. High PELD and Child-Pugh scores before LT and high post-operative serum Tbil may be contributory risk factors for TAC-related seizures.

Variations in the S and P regions of the hepatitis B virus genome under immunosuppression in vitro and in vivo.

To provide a basis for improved prevention and treatment of hepatitis B virus (HBV) re-infection after liver transplantation, variations in the S and P genes of HBV under immunosuppression in vitro and their association with patient prognosis were investigated. For the in vitro study, HepG2.2.15 hepatocellular carcinoma cells stably producing HBV particles were treated with the immunosuppressants methylprednisolone (MP) and tacrolimus (FK506) at doses found to be non-toxic by the methylthiazolyl tetrazolium (MTT) cell viability assay. MP dose-dependently inhibited HBV DNA expression in HepG2.2.15 cells, while FK506 did not, as determined by quantitative real-time PCR (qRT-PCR). By gene sequencing, both MP and FK506 were found to cause variations in HBV S, P, and S/P overlapping regions. MP- but not FK506-induced mutations were common in the glucocorticoid response element of the P region, while both immunosuppressants caused mutations outside the nucleoside analogue resistance sites. For the in vivo study, 14 patients with HBV-related end-stage liver disease re-infected after liver transplantation, and 20 cases without HBV re-infection as controls, were studied. Seventy-five percent of re-infected recipients showed multi-loci amino acid mutations at different sites besides lamivudine (LAM)-resistant loci in the P region, including in the glucocorticoid response element. Fifty percent of re-infected recipients had mutations in the "a" determinant region and flanking sequences. Re-infection was associated with negative serum hepatitis B immunoglobulin (HBIG), as measured by a microparticle capture enzyme immunoassay. Nucleotide mutations in the S region caused missense or synonymous mutations, which caused synonymous mutations in the overlapping P region. These results showed that effects of immunosuppressants on HBV genes in vitro were different from those in clinical recipients. Positive HBV DNA and gene mutations pre-transplantation were factors affecting re-infection post-transplantation. Multiple mutations found in the P and S genes suggest that the formation of quasispecies contributes to HBV re-infection after liver transplantation.

[Prognosis analysis of hepatitis B virus recurrence after liver transplantation: a single-center study of 38 cases].

OBJECTIVE: To analyze the prognosis of hepatitis B virus (HBV) recurrence after liver transplantation. METHODS: Thirty-eight patients (37 males; 1 female) with HBV-related end-stage liver disease underwent liver transplantation at our institute between December 1998 and November 2009 and experienced HBV recurrence. Clinical data from pre-transplant and follow-up examinations were retrospectively retrieved from medical records, and included serologic indices of HBV (HBV DNA, markers of liver function) and histological findings from liver biopsy. RESULTS: The median follow-up time was 45.1 months. The median time to HBV recurrence after transplantation was 31.8 months (range: 0.3 to 72.8 months) for histologically benign cases and 13.7 months (range: 0.3 to 66.6 months) for malignant cases. HBV DNA gene mutations were detected in 21% (8/38) of cases. Eighteen patients were treated with entecavir or adefovir, with respect to gene mutations, and HBV DNA fell below 103 copies/ml and liver function became normal. Twenty-two patients died, and causes of death included hepatocellular carcinoma (HCC, n=18), organ failure (n=2), or infection (n=1). CONCLUSION: HBV gene mutations and HCC recurrence were important risk factors for HBV recurrence in our study population. In addition, patients with benign liver diseases who received salvage therapy with adefovir or entecavir achieved a satisfactory prognosis.

Effect of steatosis donor liver transplantation on hepatocellular carcinoma recurrence: experience at a single institution.

BACKGROUND/AIMS: The increasing demand for transplantation has led application of steatotic liver as the graft. The aim of this study was to determine the effect of donor graft steatosis on overall outcome and tumor recurrence after liver transplantation for hepatocellular carcinoma. METHODOLOGY: 131 patients that underwent liver transplantation for hepatocellular carcinoma between 2007 and 2008 were included. Donor steatosis was categorized as non-steatosis group (0%-10%, n=101) and steatosis group (>10%, n=30). The Kaplan-Meier method and Cox proportional hazard regression model was used for data analysis. RESULTS: Postoperative recipient survival rate was 81% and 66.6% at 1 and 3 years, respectively, for non-steatotic graft; 87.5% and 58.3% for mild steatosis; 83.3% and 41.7% for moderate to severe steatosis (p=0.303). Postoperative tumor recurrence rate was 15.8% and 28.7% at 1 and 3 years, respectively, for grafts with no steatosis; 8.3% and 20.8% for those with mild steatosis; 33.3% and 50% for those with moderate to severe steatosis, (p>0.05). CONCLUSIONS: Steatotic donor was not associated with a worse prognosis in early stage postoperative and mild fatty liver did not increase tumor recurrence risks. The moderate to severe status of fatty liver had some effect on tumor recurrence.

Feasibility of using a liver infected with Clonorchis sinensis for liver transplantation: fourteen cases.

Use of livers infected with Clonorchis sinensis as donor organs for transplantation is controversial because of the potential associated risks. The low availability of donor livers at Tianjin First Center Hospital since 2003 prompted us to undertake cadaveric liver transplantation in 14 patients using donor livers infected with C. sinensis. None of the donors had been diagnosed with liver fluke infection before organ procurement, and in none of them was there laboratory evidence of abnormal liver function. After livers had been harvested and preserved, dead liver flukes were found in the bile of each donor; subsequent pathological examination of the flukes confirmed the diagnosis of clonorchiasis. Conventional orthotopic liver transplantation, with insertion of a T- tube, was undertaken in all 14 patients. Praziquantel, 25 mg/kg three times daily for two days, was administrated to the recipients starting on postoperative day 2. Results of tests of liver function improved rapidly after the operation in all of the patients. The median duration of follow-up was 31 months. The 1- and 3-year survival rates of the grafts were 85.7% and 78.6%, respectively. Postoperative biliary complications occurred in 2 patients (14.3%). No ova were detected in the bile or feces of any of the patients postoperatively. These findings suggest that livers infested with C. sinensis can be used as donor organs for liver transplantation. Further studies are required to establish definitive criteria for determining whether such donor organs may be used in a liver transplantation program.

[The clinical feature, diagnosis and management of splenic artery aneurysms in liver transplant patients].

OBJECTIVE: To summarize the clinical feature of splenic artery aneurysms (SAA) in OLT recipient, and review the experience in diagnosis and management. METHODS: The clinical data, results of four-phase CT scanning and CT angiography of 450 recipients, who underwent OLT from December 2001 to December 2003 were analyzed statistically. RESULTS: Twenty of 450 recipients were diagnosed as SAA, the incidence was about 4.4%. Nineteen of them were diagnosed by four-phase CT scanning. Fifteen patients did not receive any treatment for SAA during OLT, but two of them suffered SAA rupture after OLT, among which one died of hemorrhagic shock although emergency operations were performed. The five patients, who were performed splenectomy with SAA resection during transplantation, recovered successfully after OLT, and their grafts' function was satisfactory. CONCLUSIONS: Morbidity of SAA is higher in patients of liver cirrhosis. Four-phase CT scanning can diagnose SAA exactly. In the early period post-OLT, SAA rupture happens frequently, so SAA resection should be performed during transplantation.

[Application of eversion embolectomy for portal vein thrombosis on liver transplantation].

OBJECTIVE: To discuss the technical improvement of the conventional thrombectomy for portal vein thrombosis (PVT) on liver transplantation. METHODS: The clinical data of 198 cases of liver transplantation with PVT who admitted in Tianjin First Central Hospital were analyzed retrospectively. According to the different treatments for PVT, these cases were divided into group A and group B. The conventional eversion embolectomy were performed in group A (n = 43) and the improved eversion embolectomy were performed in group B (n = 155). The general conditions, blood loss volumes, the achievement ratio of embolectomy, PVT recurrence rate and survival rate between the two groups were compared. RESULTS: No statistical significance on operation time between two groups (P > 0.05); the achievement ratio of embolectomy for Yerdel I-II were 100% in two groups, however, the achievement ratio of embolectomy for Yerdel III in group B was higher than that of group A (100% vs. 45.45%; chi(2) = 12.38, P < 0.01). Blood loss volumes in group B was significantly lower than that of group A [(4315.4 +/- 630.5) ml vs. (3509.2 +/- 862.7) ml, P < 0.05]. No statistical significance on Yerdel I and II PVT recurrence rate between two groups (P > 0.05). While thrombosis recurrent rate of Yerdel III PVT in group B was lower than that of group A(5.6% vs. 2/5; chi(2) = 4.09, P < 0.05). Perioperative mortality of Yerdel I-III patients were both 0 in two groups. 1-year survival rate of Yerdel I-III patients was similar in two groups (86.5% vs. 89.0%, P > 0.05). CONCLUSIONS: Improved eversion embolectomy can simplify the operation procedures, reduce blood loss, expand application range, increase the embolectomy success rate, decrease the PVT relapse rate.

Pediatric liver transplantation in 31 consecutive children.

BACKGROUND: Although liver transplantation has become a standard therapy for end-stage liver diseases, the experience of pediatric liver transplantation is limited in China. In this article we report our experience in pediatric liver transplantation, and summarize its characters in their indications, surgical techniques, and postoperative managements. METHODS: Thirty-one children (< or = 18 years old) underwent liver transplantation in our centers. The mean age at transplantation was 12.4 years old (ranged from 5 months to 18 years) with 7 children being less than 4 years of age at transplantation. The most common diagnosis of patients who underwent liver transplantation were biliary atresia, Wilson's disease, primary biliary cirrhosis, glycogen storage disease, hepatoblastoma, urea cycle defects, fulminant hepatic failure, etc. The surgical procedures included 12 standard (without venovenous bypass), 6 pigyback, 6 reduced-size, 3 split, 3 living donor liver transplantation, and 1 Domino liver transplantation. The triple-drug (FK506, steroid, and mycophenolate mofetil) immunosuppressive regimen was used in most of patients. Patients were followed up for a mean of 21.8 months. RESULTS: Five of the 31 patients died during perioperative time; mortality rate was 16.1%. The reasons of death were infections, primary non-function, heart failure, and hypovolemic shock. Postoperative complications in 10 patients included biliary leakage, acute rejection, abdominal infection, hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, and pulmonary infection. Overall patient cumulative survival rate at 1-, 3-, and 5-year was 78.1%, 62.6%, 62.6%, respectively. CONCLUSIONS: The most common indications of pediatric liver transplantation were congenital end-stage liver diseases. According to patients' age and body weight, standard, piggyback, reduced-size, split, or living donor liver transplantation should be performed. Pediatric liver transplantation especially requires higher surgical skills. The early postoperative management is the key to success. Postoperative bile leak was common, but most patients underwent liver transplantation had a better prognosis.

[Pediatric liver transplantation in 20 consecutive children].

OBJECTIVE: To summarize the clinical efficacy of pediatric liver transplantation, and investigate the characters of pediatric liver transplantation in their indications, surgical procedures and postoperative management. METHODS: From August 2000 to March 2007, 23 liver transplantations were performed on 20 children, aging from 6 months to 13 years old. The most common indications were biliary atresia, Wilson's disease, glycogen storage disease and urea cycle defects. Surgical procedures included 4 living donor liver transplantations, 1 Domino liver transplantation, 5 split grafts, 10 reduced liver grafts and 3 whole cadaveric grafts. The triple-drug (FK506, steroid and MMF) immunosuppressive regimen was used in 19 children, except one children using cyclosporine. RESULTS: Three children died of primary non-function, heart failure and abdominal infections respectively during peri-operative period, and the mortality was 15.0%. Nine children showed different post-operative complications including 2 hepatic artery thrombosis, 1 portal vein thrombosis, 1 acute rejection, 3 biliary leakage, 2 biliary stricture, 2 intestinal fistula, 3 abdominal infection, 1 pulmonary infection and 1 heart failure. Cumulative patient survival rates at 6-month, 1-and 2-year were 80.0%, 73.9% and 73.9%, respectively. CONCLUSIONS: Liver transplantation is an effective option to cure the liver disease of children with end-stage. Different surgical procedure could be chosen according to the children's age and body weight.

[Analysis of survival rate and risk factors of liver retransplantation].

OBJECTIVES: To analyze the survival rate of orthotopic liver retransplantation (Re-OLT) and identify the variables predicting the outcome. METHODS: A retrospective analysis of 74 Re-OLT patients from January 1999 to December 2005 was performed. The univariate analysis of Kaplan-Meier model was used to investigate the relativity between the factors and survival rate, and COX regression model was used in multivariate analysis to identify the prognostic factors for survival. RESULTS: The total incidence rate of Re-OLT was 5.7%, and overall patient survival rates at 1 month, 3 month, 1 year and 2 year were 82.4%, 73.8%, 71.9% and 68.5%, respectively. There were 10 factors might influence the survival rate by Kaplan-Meier model, such as the period of Re-OLT, stage of hepatic encephalopathy, prothrombin time, total bilirubin, warm ischemia time, operative surgical procedure, quantity of blood lost during operation, days staying in the intensive care unit (ICU), infection and complications after Re-OLT. And three factors among them were identified as independent prognostic factors for survival by multivariate model: operative surgical procedure, days staying in the ICU and complications after Re-OLT. CONCLUSION: The surgical procedure, duration in ICU and complications after Re-OLT are strong predictors for survival after Re-OLT.

[Clinical study of liver re-transplantation].

OBJECTIVE: To report experiences of liver re-transplantation. METHODS: The cause of re-transplantation, the pre-operative MELD score, timing of re-transplantation, technical considerations, 1 year survival rate and the causes of death of the patients receiving liver re-transplantation in First Central Hospital of Tianjin between January 1999 and December 2005 were retrospectively analyzed. RESULTS: One year survival rate of re-transplantation was 71.6%. The most common cause of hepatic graft failure and subsequent re-transplantation was biliary complications (45.5%). The 1 year survival rate of patients with a MELD score less than 20 was higher than patients with a score of 20 approximately 30 and > 30 (83.8% versus 57.1% and 66.7%). The peri-operative survival rate of patients who received re-transplantation 30 days after the initial transplantation was higher than those who received re-transplantation between 8 to 30 days post the first operation (83.8% versus 41.7%). The main cause of peri-operative death was celiac infections (accounted for 54.2% deaths) in the patients. CONCLUSIONS: Proper indication selection, optimum operation time, right surgical procedure, intensified peri-operative monitoring and infection control are all crucial for the improvement of survival rate in patients receiving liver re-transplantation.

[Clinical study of Milan criteria for liver transplantation].

OBJECTIVE: To investigate the value and deficiency of Milan criteria for liver transplantation in patients with hepatocellular carcinoma (HCC). METHODS: Between December 2001 and November 2005, 125 patients underwent orthotopic liver transplantation ( OLT), who measured up Milan criteria with preoperation computerized tomography (CT) scanning. The results of pre-transplant multidetector CT scan and post-transplant pathology were retrospectively analyzed, and survival rates were compared. RESULTS: Pathology examination demonstrated that 97 cases met Milan criteria (77.6%), 26 cases exceeded Milan criteria,and the other 2 cases were diagnosed as nodular cirrhosis. The 1-,2-,3-,4- and 5-year survival rates for those met pre-transplant multidetector CT scanning pre-transplant met Milan criteria vs. those met post-transplant pathology post-transplant criteria were 92.0% vs. 92.8%, 87.2% vs. 90.7%, 86.4% vs. 89.7%, 86.4% vs. 89.7%, and 86.4% vs. 89.7%, respectively. There was no statistic significant difference (P > 0.05). The 1-,2-,3-,4- and 5-year survival rates were 73.0%, 65.4%, 61.5%, 61.5% and 61.5%, for those pathology exceed Milan criteria respectively. The difference between this group and each of the above two were statistically significant (P < 0.05). CONCLUSIONS: The prognosis of OLT for HCC is good for those met Milan criteria by pre-transplant multidetector CT. Factors leading to poor prognosis such as portal vein tumor thrombi and lymphatic metastasis should be accurately evaluated avoiding for misjudgement.

Liver retransplantation: report of 80 cases and review of literature.

BACKGROUND: Because the orthotopic liver transplantation (OLT) was performed widely in recent 5 years throughout China, the proportion of recipients whose graft function deteriorated to be retransplantation candidates increased gradually. This study was undertaken to analyze clinical experience of orthotopic liver retransplantation (re-OLT) at our center. METHODS: The medical records of 80 patients who had undergone liver retransplantation at our center from January 1999 to July 2005 were analyzed retrospectively, including indications and timing of retransplantation, surgical techniques, and the causes of death. RESULTS: The commonest cause leading to hepatic graft loss and subsequent retransplantation was biliary complications in 36 patients (45%). The patients underwent retransplantation more than 30 days after their primary transplant recovered better than those who underwent retransplantation within 8-30 days after primary transplantation (perioperative mortality 19.6% versus 70%). Sepsis (12 of 22 patients, 54.5%) and multiple organ failure (4 of 22 patients, 18.2%) were leading causes of re-OLT recipient deaths. CONCLUSIONS: Proper indications and optimal operative time, surgical procedures, perioperative monitoring and appropriate postoperative treatment contribute to the improvement of the survival rate of patients after liver retransplantation.

[Liver retransplantation: report of 80 cases].

OBJECTIVE: To sum up the clinical experience of liver retransplantation. METHODS: The clinical data of patients receiving liver retransplantation in our department between Jan. 1999 and July 2005 were retrospectively analyzed, the cause of retransplantation, timing of retransplantation, technical considerations and the causes of death. RESULTS: The most common causes of hepatic graft loss and subsequent retransplantation are biliary complications (45.0%). Patients who received retransplantation more than 30 days after their initial transplant fared better than those who received retransplants between 8 and 30 days after receiving their first one (intraoperative mortality rates 19.6% versus 70.0%). The development of sepsis (54.5%) and multiorgan failure (18.2%) accounts for the majority of deaths in retransplanted patients. CONCLUSIONS: Proper indication and optimum operation time, surgical procedure, perioperative monitoring and proper treatment post operation contribute to the increase of the survival rate of the patients receiving liver retransplantation.