[Two Methods of Internal Iliac Artery Exclusion in Endovascular Aorta Repair: a Middle-long Term Follow-up Study].

OBJECTIVE: To compare the middle and long term results of two internal iliac artery exclusionmethods (with or without coils) in endovascular aorta repair (EVAR). METHODS: Clinical data of patients who underwent EVAR from January 2006 to December 2013 were analyzed retrospectively. The participants were divided into two group: coils were not used in Group A, but were used in Group B. The patients were followed up from June 2006 to June 2014. RESULTS: A total of 137 patients (74 in Group A, 63 in Group B) were included in this study, with a mean age of 71. 6 years. The majority (124) of participants were men. Postoperative 30-day mortality of the participants was 0. 73%. None of the participants developed pelvic and spinal ischemia. Claudication appeared in 9 patients (3 in Group A and 6 in Group B). Ischemia in lower extremity happened in 5 patients (2 in Group A and 3 in Group B). Gluteal sore was reported by 5 patients (1 in Group A and 4 in Group B). One patient from Group B developed gluteal skin necrosis. No statistical difference in ischemia and stent occlusion was found between the two groups (P=0. 301, P=0. 108). However, patients in Group B stayed in hospitals longer (P<0. 001) than those in group A. One patient in Group B developed severe ischemic complication: skin and gluteus necrosis. CONCLUSION: Internal iliac artery exclusions with and without coilsresult in similar middle and long term outcomes measured by ischemic complications.

[Establishment of experimental abdominal aortic aneurysm model in rats].

OBJECTIVE: To establish a new reliable experimental abdominal aortic aneurysm (AAA) rat model that simulates human aneurysms and has high survival rate. METHODS: Twenty-four SD rats were randomly divided equally into two groups (male: female=1: 1). Intraluminal saline infusion was given to rats in group A. Rats in group B were given intraluminal elastase infusion and extraluminal calcium chloride application. The diameter of abdominal aorta was measured and eventually harvested at 4 weeks. Successful AAA formation was defined as a dilation ratio )50%. HE stain was applied to evaluate the histology changes of aorta. RESULTS: Group A had a survival rate, technical success rate and AAA formation rate of 83. 3%, 91. 67%, and 0% respectively, compared with 91. 67%, 100%, and 90. 91% in group B. The AAA formation rate in group B was significantly higher than that in group A (P<0. 05). The dilation ratio during infusion was 50. 82% ±4. 11% in group A and 48. 19% ± 3. 89% in group B. The dilation ratio after infusion was 29. 55% ± 4. 69% in group A and 27. 89% + 4. 28% in group B. The difference of dilation ratio between the two groups was not significant. The post-surgery (28 d) dilation ratio was 27. 89% ± 4. 28%0 in group A and 88. 98% ± 42. 33% in group B (P< 0. 05). Fusiform aneurysms, local adhesion and calcification were found in group B. Rats in group B also had thickening intimal, degenerated matrix in media, loss of elastin fiber, apoptosis of vascular smooth muscle cells and transmural inflammation, none of which was observed in group A. CONCLUSION: With improved operative procedure, intraluminal elastase infusion and extraluminal calcium chloride application can create reliable AAA rat model.

Higher tacrolimus blood concentration is related to hyperlipidemia in living donor liver transplantation recipients.

BACKGROUND: The arrival of tacrolimus has drastically improved AALDLT recipients' survival. However, little data of tacrolimus have been reported concerning its effects on lipid metabolism for AALDLT recipients. AIM: Out aim was to investigate the relationship between tacrolimus blood concentration and lipid metabolism in AALDLT recipients. METHODS: The pre and postoperative data of 77 adult patients receiving AALDLT between 2002 and December 2007 were retrospectively reviewed. The postoperative immune suppressive regimen was prednisone with tacrolimus ± mycophenolate mofetil. Prednisone was withdrawn within the first postoperative month. Blood lipids and tacrolimus concentration were detected at the first, third, and sixth month during follow-up. Episodes of acute rejection were diagnosed based on biopsy. RESULTS: Overall prevalence of post-transplantation hyperlipidemia was 29.9% (23/77) at the sixth postoperative month. The patients were divided into two groups, the hyperlipidemia group and the ortholipidemia group. In the 23 patients with hyperlipidemia, 15 (65%) were hypercholesterolemia, five (22%) were hypertriglyceridemia, and three (13%) patients had both hypercholesterolemia and hypertriglyceridemia. In univariate analysis, only tacrolimus blood concentration at the third and sixth post-transplantation months showed significant difference (8.7 ± 2.1 vs. 6.9 ± 3.2, p = 0.013; 9.2 ± 2.7 vs. 7.3 ± 3.8, p = 0.038, respectively). In multivariate logistic analysis, only two factors appear to be risk factors, namely, tacrolimus blood concentration at the third and sixth post-transplantation months (8.7 ± 2.1 vs. 6.9 ± 3.2, p = 0.043; 9.2 ± 2.7 vs. 7.3 ± 3.8 p = 0.035, respectively). CONCLUSIONS: Higher tacrolimus blood concentration was related to hyperlipidemia at an early postoperative period. This indicates that tacrolimus blood concentration should be controlled as low as possible in the premise that there is no risk of rejection to minimize post-transplant hyperlipidemia after AALDLT.

Impact of graft steatosis on the post-transplantation biliary complications for living donor liver transplant recipients in China.

BACKGROUND/AIMS: After living donor liver transplantation (LDLT), the prevalence of complications related to the biliary system is 6-35%. In spite of great improvements in both surgical techniques and postoperative and long-term medical treatment, the biliary complications are still considered a relatively high risk for LDLT. The aim of this retrospective study was to analyze the incidence of biliary complications and identify predisposing risk factors. METHODOLOGY: The clinical and follow-up data of 175 adult patients receiving LDLT (right lobe or left lobe) between 2002 and December 2008 were collected and retrospectively analyzed. Patients were divided into 2 groups: with biliary complications (n=30) and without biliary complications (n=145). RESULTS: Thirty patients (17.1%) had post-transplantation biliary complications. Eight patients (4.6%) were diagnosed with bile leakage, while 24 patients (13.7%) developed biliary stricture. Percentage of steatosis of the graft and hepatic artery thrombosis after LDLT were two factors upon univariate analysis (p=0.034, p=0.01, respectively). In multivariate logistic analysis, 20-50% macrovesicular steatosis emerged as a new defined risk factor by us (p=0.001). There was no difference in patient survival rate in different groups and sorts of graft steatosis (p>0.05). CONCLUSIONS: We consider that using a graft with macro-vesicular steatosis in 20-50% should be put on the table carefully, balancing both sides of positive and negative.

[Perioperative outcomes after endovascular versus open repair of abdominal aortic aneurysms: a single center experience].

OBJECTIVE: To evaluate the outcomes of endovascular repair (EVAR) versus open repair (OR) in the patients with abdominal aortic aneurysm (AAA) and compare their perioperative rates of morbidity and mortality. METHODS: The clinical data of 371 AAA patients from January 2006 to January 2011 were collected and analyzed. Endovascular (n = 174) and open (n = 197) repairs were performed. The relevant parameters included preoperative status, intraoperative blood loss, procedure time, intensive care unit (ICU) stay length, ventilatory support time, postoperative fasting time and duration of postoperative hospital stay and anesthesia methods. The perioperative rates of morbidity and mortality were presented. RESULTS: The patients of EVAR group were elder than those of OR group [(72 ± 8) vs (60 ± 14) years old, P = 0.000]. The comorbidity rate of chronic obstructive pulmonary disease (COPD) in EVAR group was higher than that in OR group (31.0% vs 21.8%, P = 0.045). As compared with OR group, the EVAR group had less blood loss [(125 ± 43) vs (858 ± 602) ml, P = 0.000], a lower rate of blood transfusion (0 vs 71.1%, P = 0.000), shorter ICU stay length [(15 ± 5) vs (31 ± 11) h, P = 0.000], shorter postoperative fasting time [(7 ± 4) vs (90 ± 32) h, P = 0.000], shorter procedure time [(146 ± 39) vs (210 ± 24) min, P = 0.000] and shorter ventilatory support time [(90 ± 23) vs (220.0 ± 132.0) min, P = 0.000]. In EVAR group, general (88, 50.6%), epidural (52, 30.0%) and local (34, 19.4%) anesthesia were used. General anesthesia was used for all OR group patients. The duration of postoperative hospital stay was similar in two groups (9.1 ± 2.7) d vs (9.2 ± 2.6) d (P = 0.798). The perioperative complication rate was lower in EVAR group (12.6% vs 27.0%, P = 0.001). And the 30-day mortality rate was 1.15% in EVAR group and 2.0% in OR group. CONCLUSION: Endovascular repair is less-invasive in AAA patients and offers significant advantages over open surgery. Especially it is indicated for those patients non-suitable for open surgery. And a long-term survival rate is expected.

[Surgical vascular by-pass operation of lower limb artery occlusion in patients with diabetic foot].

OBJECTIVE: To document the effectiveness and patient experience of surgical treatment for diabetic lower limb arterial occlusion. METHODS: Out of 290 diabetic patients with lower limb arterial occlusion, 69 received by-pass operation because of severe stenosis below the abdominal aorta and severe ulcers in feet from April 2004 to April 2011. We reviewed the experience and outcome of the 69 diabetic patients who underwent surgical operations on lower limb arterial occlusion. RESULTS: 100% initial surgical success was achieved. The morbidity (excluding death) was 12.3% +/- 4.1% and 15.7% +/- 5.1% at 1 year and 3 years after operations, respectively. Five (7.2%) death cases were recorded, which resulted in a survival rate of 94.2% +/- 2.8% and 92.0% +/- 3.5% at 1 year and 3 years after operations, respectively. About 90.6% +/- 3.6% and 87.2% +/- 4.9% of patients had graft patency 1 year and 3 years after operations, respectively; and 6. 5% + 3. 1% had amputations. Four (5. 8%) patients developed graft thrombosis, in which 2 (2.9%) had amputations because of recurrence of thrombosis after thrombectomy. Two (2.9%) patients had amputations because of graft infection accompanied with graft resection operations. One (1.4%) patient received repeated arterialized operation on great saphenous vein because of popliteal artery occlusion, and obtained a good outcome within two years. One (1.4%) patient developed stomas false aneurysm, but the excision of the false aneurysm resulted in a good outcome in four years. CONCLUSION: Detailed pre-operation assessment, optimal selection of surgical procedure and perioperative management can help improve the outcome of diabetes and decrease amputation rate in patients with diabetic lower limb arterial occlusion.

[Clinical and pathological characteristics and surgical treatment of carotid body tumor with endocrine activity].

OBJECTIVE: To investigate the clinical and pathological characteristics and surgical treatment of carotid body tumor with endocrine activity (CBT). METHODS: Records of seven CBT patients with endocrine activity (Jan, 1991-Aug, 2011) who underwent surgical excision of tumor were retrospectively reviewed. The operations were performed with the careful peroperative preparation on the control of blood pressure, serum potassium and catecholamine. All the tumors were studied with the methods of HE staining, immunohistochemistry of chromogranin A (CgA) and S-100. RESULTS: All the operations were successfully accomplished and the patients recovered quickly. It was confirmed with pathological examination that all the tumors were CBT, coming from paraganglioma. Tumor cells and sertoli cells were found in HE staining, and all were positive of CgA and S-100. All patients were followed up for 12-60 months and no recurrence was found during the follow up. CONCLUSION: CBT with endocrine activity presents with identifiable clinical and pathological characteristics. The recommended treatment is surgical resection, careful perioperative preparation and care is important to avoid the severe complication due to the endocrine activity of tumor.

Quality of Life Status and Influencing Factors Among Patients with Deep Vein Thrombosis.

Objective: The objective of the study was to describe the quality of life (QoL) status and investigate the influencing factors of QoL among patients with deep vein thrombosis (DVT). Methods: A retrospective analysis at a single center was performed, and the clinical data of 161 patients with DVT admitted to West China Hospital of Sichuan University from June 2019 to June 2020 were collected with the Villalta scale, Hospital Anxiety and Depression Scale (HADS), and Chronic Venous Insufficiency Questionnaire (CIVIQ). The relationship between QoL and influencing factors, including characteristics, course of DVT, postthrombotic syndrome (PTS), psychological status, and behaviors, was analyzed by Student's t-test, analysis of variance and multiple linear regression. Results: A total of 161 patients who completed all the questionnaires between 2019 and 2020 were included, and 110 patients (68%) were male. The mean QoL score acquired by the CIVIQ scale was 74.18±8.44, and the results showed significant differences between patients of different ages, genders, behaviors and psychological statuses (P < 0.05). Multiple regression analysis showed that age (P = 0.024), negative mood (P < 0.001), CCI index (P < 0.001), PTS (P < 0.001) and regular exercise (P = 0.002) influenced the CIVIQ scale evaluation model, in which exercise regularly was a protective factor for QoL, and age, negative mood, CCI index and PTS were risk factors for QoL. Conclusion: The QoL of DVT patients was impaired and associated with age, mood, CCI index and PTS. Regular exercise is beneficial for improving the quality of life of DVT patients.

Involvement of dopamine signaling pathway in neurodevelopmental toxicity induced by isoniazid in zebrafish.

AIMS: This study evaluated the neurodevelopmental toxicity of isoniazid (INH) in zebrafish embryos and the underlying mechanism. METHODS: Zebrafish embryos were exposed to different concentrations (2 mM, 4 mM, 8 mM, 16 mM, 32 mM) INH for 120 hpf. During the exposure period, the percentage of embryo/larva mortality, hatching, and morphological malformation were checked every 24 h until 120 hpf. The development of blood vessels in the brain was observed at 72 hpf and 120 hpf, and behavioral capacity and acridine orange (AO) staining were measured at 120 hpf. Alterations in the mRNA expression of apoptosis and dopamine signaling pathway related genes were assessed by real-time quantitative PCR (qPCR). RESULTS: INH considerably inhibited zebrafish embryo hatching and caused zebrafish larval malformation (such as brain malformation, delayed yolk sac absorption, spinal curvature, pericardial edema, and swim bladder defects). High concentration of INH (16 mM, 32 mM) even induced death of zebrafish. In addition, INH exposure markedly restrained the ability of the zebrafish autonomous movement, shortened the length of dopamine neurons and inhibited vascular development in the brain. No obvious apoptotic cells were observed in the control group, whereas considerable numbers of apoptotic cells appeared in the head of INH-treated larvae at 120 hpf. PCR results indicated that INH significantly raised the transcription levels of caspase-3, -8, -9, and bax and significantly decreased bcl-2 and bcl-2/bax in the zebrafish apoptotic signaling pathway. INH also markedly decreased the genes related to dopamine signaling pathway (th1, dat, drd1, drd2a, drd3, and drd4b). CONCLUSIONS: Experimental results indicated that INH had obvious neurodevelopmental toxicity in zebrafish. Persistent exposure to INH for 120 h caused apoptosis, decreased dopaminergic gene expression, altered vasculature, and reduced behaviors.

Donor right hepatectomy in living donor liver transplantation: report of 143 cases.

BACKGROUND/AIMS: To summarize the surgical techniques of liver resection for right hepatic lobe graft in living donor liver transplantation (LDLT). METHODOLOGY: Data of 143 living donors of right hepatic lobe graft from January 2002 to February 2009 were retrospectively studied. The right lobe grafts were obtained by transecting the liver on the right side of the middle hepatic vein. Liver transection was done by using an ultrasonic dissector without inflow vascular occlusion. The standard liver volume (SLV) and the ratio of right lobe volume to SLV were calculated. RESULTS: The weight of right hepatic lobe graft ranged from 310 g to 870 g, accounting for 39.7-69.5% of SLV with the ratio of residual left liver from 30.5% to 60.3%, corresponding to 31.7%-71.6% of the recipient SLV. The mean operative loss of blood was 428 ml. Complications included 2 cases of intraabdominal bleeding, 1 thrombosis of the portal vein, 1 liver function insufficiency, 3 bile leakages, 1 chyle leakage, 2 pleural effusions and 5 wound steatoses. At last, all donors restored to health. CONCLUSIONS: Estimation of the liver volume by CT or formulae and accurate donor hepatectomy is of clinical importance in planning and performing successful living donor liver transplantation.

[Reconstruction of hepatic artery in adult to adult living donor liver transplantation in 104 patients].

OBJECTIVE: To report the experience of hepatic artery reconstruction with adult-to-adult living donor liver transplantation (ALDLT) using right lobe liver grafts. METHODS: From January 2002 to August 2007, 104 patients underwent ALDLT using right lobe grafts. Hepatic arteries of donors and recipients were assessed carefully with spiral CT angiography and DSA before ALDLT. All patients underwent reconstruction of hepatic artery between right lobe liver grafts of donor and recipient which included the anastomosis between right hepatic artery of donors and recipients; the reconstruction of right hepatic artery between donor grafts and left hepatic artery of recipients; interpositional bypass using autogenous saphenous vein and cryopreserved iliac artery between right hepatic artery of donors and hepatic artery, common hepatic artery and abdominal aorta of recipients. The microsurgical technique was employed under the magnification of 3.5 times and operative microscope of 5-10 times. RESULTS: In these series, HAT occurred in 2 recipients at Days 1 and 7 post-ALDLT (1.9%). Both were revascularized with autogenous saphenous vein between right hepatic artery of donor and abdominal aorta of recipient. HAT occurred in 1 recipient at Days 90 post-ALDLT, but no symptom was presented. There was no severe complication and mortality related to hepatic artery reconstruction in recipients. No HAT, hepatic artery stenosis and aneurysm occurred during the follow-up period of 2-60 months. The 1, 2 and 3-year survival rates were 89.3%, 76.0% and 69.3% respectively. CONCLUSION: Careful evaluation of hepatic artery condition and using microsurgical techniques are important for safer arterial reconstruction and a long-term patency of hepatic artery in living donor liver transplantation in adults using right lobe liver grafts.

[Evaluation of the effect of living donor liver transplantation on the treatment of severe hepatitis].

OBJECTIVE: To evaluate the effect of living donor liver transplantation on the treatment of severe hepatitis. METHODS: 18 patients with severe hepatitis received liver transplantation (transplanted severe hepatitis group), 28 patients with sever hepatitis received non surgical treatment (non-transplanted severe hepatitis group), and 30 patients with end stage liver cirrhosis (without cancer) received liver transplantation (transplanted cirrhosis group). The vital sign, blood coagulation, and renal function were monitored during operation. After liver transplantation, patients received immunosuppressive therapy (including tacrolimus or cyclosporine A, mycophenolate, mofetil and corticosteroids), intensive care, antiviral therapy (including lamivudine and HBIg) and other treatments (including restoration of liver function and prevention of blood coagulation). Pre-operation data, operation procedure, liver function, renal function and the operation complications of three groups were compared, and survival rate at 1, 6 and 12 months after operation was followed. RESULTS: There was no significant difference in the operation time, warm ischemia time, hypothermic ischemia time and Graft-to-recipient weight ratio between the two transplantation groups. The blood loss volume and blood transfusion volume in the transplanted severe hepatitis group were higher than that those in the cirrhosis transplantation group (t = 0.001, 0.004). The levels of TBil, ALT and AST at day 7 after operation were (100.5 +/- 96.4)mumol/L, (215.3 +/- 195.7) U/L , (209.8 +/- 188.6) U/L in the transplanted severe hepatitis group, and (53.3 +/- 31.9)mumol/L, (56.3 +/- 22.1) U/L, (51.3 +/- 13.5) U/L in the transplanted cirrhosis group (t = 0.017, 0.021, 0.004). However, there was no significant difference in the levels of Alb and Cr between these two groups (P > 0.05). Survival rate was 88.89%, 83.33% 83.33% in the transplanted severe hepatitis group, and 96.67%, 93.33% 93.33% in the transplanted cirrhosis group at 1, 6 and 12 months after transplantation. CONCLUSION: Living donor liver transplantation is one of effect ways for the treatment of severe hepatitis.

[Augmented hepatic regeneration of living donor liver graft by intraportal insulin administration].

OBJECTIVE: To evaluate the effect of postoperative intraportally administration of insulin on hepatic regeneration in adult patients underwent living donor right lobe liver transplantation (LDLT). METHODS: From July 2005 to September 2007, 15 right lobe LDLT adult recipients voluntarily receiving posttransplant intraportal insulin administration, without postoperative vascular and bile duct complications, without immune rejection, with more than 1 month survival and complete clinical data were enrolled in this study as intraportal insulin-therapy group (Group I). Another consecutive 15 right lobe LDLT adult recipients meeting the upwards referred criteria were enrolled in as non-insulin-therapy control group (Group NI). Recipients in Group I were treated postoperatively with intraportal insulin infusion, as follows: a 18-gauge catheter was inserted into right gastro-omental vein during surgery, regular insulin was administered just after the operation at the rate of 2 units/hour for 7 days. Liver function and serum insulin level were measured at before-operative day 1, postoperative day (POD) 7 and 30. Graft volume (GV) were measured during operation, and at POD 7 and 30. RESULTS: The rate defined as ratio of POD 7 GV/operation GV in Group I was higher than that of Group NI [(186.1 +/- 35.4)% vs. (160.6 +/- 22.1)%, P < 0.05]. The rate defined as ratio of POD 7 GRWR/operation GRWR was also higher in Group I than Group NI [(179.0 +/- 35.8) % vs. (156.6 +/- 18.5%, P < 0.05], whereas significant differences were not appeared between two groups in terms of regeneration rates at POD 30. Serum levels of total bilirubin, aspartate aminotransferase and alanine aminotransferase in Group I were lower than that in Group NI at POD 7 (P < 0.05). Significant differences were not presented between two groups in terms of post-transplant serum insulin levels and total insulin dosage by subcutaneous administration and venous injection (P > 0.05). CONCLUSIONS: These results suggest that intraportal insulin administration could augment liver graft regeneration during the first postoperative week.

Development of a survival evaluation model for liver transplant recipients with hepatocellular carcinoma secondary to hepatitis B.

AIM: To develop a model using easily obtainable, objective, verifiable preoperative parameters, to help evaluate post transplant survival probability for hepatocellular carcinoma (HCC) patients with hepatitis B. METHODS: We retrospectively examined a cohort of 150 consecutive primary cadaveric liver transplants with HCC in our center over 6 years. Thirteen preoperative biochemical parameters and six tumor-related factors were analyzed to identify their correlation with post transplant survival using the Cox proportional-hazards regression model. The predictive power of a new model and the model for end stage liver disease was compared by the receiver operating characteristic curve. RESULTS: In univariate analysis, the factors significantly associated with post transplant survival were serum concentrations of albumin, total bilirubin, alkaline phosphatase, alpha-fetoprotein, gamma-glutamyltransferase, aspartate aminotransferase, sodium, tumor diameter and the number of tumor nodules. Multivariate analysis showed alpha-fetoprotein, serum sodium, alkaline phosphatase and the number of tumor nodules were significantly associated with the post transplant outcome. Based on the four variables, we established a new model with a c-statistic of 0.72 which was significantly greater than 0.50 (P = 0.001), and the c-statistic of MELD was 0.59 (P = 0.146). CONCLUSION: The new model based on four objective tumor-related parameters has the capacity to evaluate the risk of post transplant mortality for HCC patients with hepatitis B.

[Prevention and treatment of biliary tract complications following adult living donor liver transplantation].

OBJECTIVE: To investigate the prevention and treatment of biliary tract complications following adult-adult living donor liver transplantation (A-A LDLT). METHODS: One hundred and eight patients, aged 38 (18 - 63), underwent A-A LDLT, including transplantation of the right liver graft without middle hepatic vein (MHV) in 102 cases and dual graft transplantation in 6 cases (of left lobe from relative in 1 case, of right lobe+left lobe from relative in 3 cases, of right lobe from relative + cadaveric left lobe in 2 cases). Preoperative 3-dimensional computerized tomography (3D CT) and intra-operative cholangiography were employed to reveal the state of the liver, caution was exercised to protect the peripheral vasculature of the right hepatic duct during resection. The bile duct was reconstructed by duct-to-duct (D-D) biliary anastomosis or Roux-en-Y anastomosis of the hepatic duct and jejunum (H-J). RESULTS: Twenty-four of the 108 patients (22.2%) suffered from complications, including bile leakage (n = 4), cutting surface bile leakage (n = 1), and anastomotic biliary stricture (n = 3), etc. Seven donors (6.3%) suffered from complications too, including 2 cases of bile leakage from the remnant cut surface. All the biliary tract complications were properly managed with good outcomes, except for 1 case of recipient death. CONCLUSION: Measures such as improvement of pre- and intra-surgical examinations and assessments, choice of appropriate approach of biliary tract reconstruction, employment of subtle operations of microscopic procedures, and timely detection and management of complications may reduce the incidence and mortality of biliary tract complications following A-A LDLT.

[Evaluation of living donor liver transplantation for patients with hepatocellular carcinoma].

OBJECTIVE: To evaluate the donor risks and potential recipient benefits of living donor liver transplantation (LDLT) for adult patients with hepatocellular carcinoma (HCC). METHODS: From January 2002 to December 2006, a total of 27 LDLT for HCC patients were performed in our center, of which 25 received right lobe grafts and 2 received dual grafts. The clinical and follow-up data of these 27 recipients and 29 donors were analyzed retrospectively. RESULTS: Of the 29 donors, the overall complication rate was 17.24% (5 cases). Two cases (6.90%) experienced major complications (one with intra-abdominal bleeding and one with portal vein thrombosis) and three cases (10.34%) experienced minor ones (fat necrosis and infection of the surgical skin wound in one, pleural effusion in another and transient chyle leakage in the third). All donors were fully recovered and returned to their previous work. No recipients developed small-for-size syndrome. The overall HCC patients survival rate at 1- and 3-years was 84.01% and 71.40%, respectively, similar to that of patients undergoing LDLT for various nonmalignant diseases during the same period (P > 0.05). CONCLUSION: Although further study is needed to fully assess the risks and benefits of LDLT for the HCC patients and donors, our present results preliminarily suggest that LDLT offers an acceptable chance and duration of survival in patients with HCC, and it is a relatively safe procedure.

[Hepatic arterial reconstruction and complications management in adult-to-adult living donor liver transplantation].

OBJECTIVE: To explore the experience of hepatic arterial reconstruction and its management of complications in adult-to-adult living donor liver transplantation (A-A LDLT) using right lobe liver grafts. METHODS: From January 2002 to July 2006, 50 of A-A LDLT using right lobe liver grafts were performed. All arterial anastomosis were performed to protect the donor hepatic arterial supply, in which donor right hepatic artery was sutured to recipient right hepatic artery in 24 patients, to recipient proper hepatic artery in 12 patients, to recipient left hepatic artery in 3 patients, to recipient common hepatic artery in 2 patients, to recipient aberrant right hepatic artery arising from superior mesenteric artery in 2 patients. Interpositional bypass using autogenous saphenous vein was performed between donor right hepatic artery and recipient common hepatic artery in 2 patients. Bypass was done between donor right hepatic artery and recipient abdominal aorta using autogenous saphenous vein in 2 patients and using stored cadaveric iliac vessels in 2 patients respectively. The diameter of donor right hepatic artery is between 1.5-2.5 mm, microsurgical technique was used under the magnified lobe of 3.5 times and operative microscope of 5-10 times. RESULTS: In these series, hepatic artery thrombosis (HAT) occurred in 2 recipients on 1st and 7th days following A-A LDLT (4%), which were revascularized with autogenous saphenous vein between donor right hepatic artery and recipient abdominal aorta immediately, HAT in 1 recipient occurred one and a half month following A-A LDLT, but no symptom was presented. No hepatic artery stenosis and aneurysm occurred during follow-up period. No death related to hepatic artery complications occurred. All recipients were followed up from 2 to 52 months (mean follow-up 9 months). 1-year survival rate was 92%. CONCLUSIONS: Proper anastomotic vessel choose and use of microsurgical technique in hepatic arterial reconstruction would reduce significantly the incidence of hepatic artery complications and provide an excellent graft survival following A-A LDLT.

[Excision and reconstruction of anomalous portal venous branching in adult-to-adult right lobe living donor liver transplantation].

OBJECTIVE: To discuss the techniques for excision and reconstruction of anomalous portal venous branches (APVB) in adult-to-adult right lobe living donor liver transplantation (A-A RL LDLT). METHODS: From February 2002 to April 2007, 70 cases of A-A RL LDLT were performed. Preoperative three-dimensional computed tomography of the donor revealed the configurations of hepatic artery, portal vein and hepatic vein. Nine donors had anomalous portal venous branching (APVB). The APVB were type II (trifurcation) in 7 cases and type III in two. Except the excision of APVB with a common opening by a narrow bridge of main portal vein tissue in one type II donor, all the right APVB were transected on the principal of donor priority: right APVB being excised approximately 2-3 mm from the confluence while leaving the donor's portal vein intact. In type II APVB, the donor portal venous branches were transected with separate two openings and reconstructed as double anastomoses in 4 cases, with separate two openings joined as a common orifice at the back table and reconstructed as single anastomoses in 2 cases, and with one common opening with narrow-bridge of tissue and reconstructed as single anastomoses in 1 case. In type III APVB, the APVB were transected with separate two openings and were reconstructed by double anastomoses in 1 case and by a new technique named U-shaped vein graft interposition in the another one. RESULTS: There were no vascular complications such as portal vein stricture or thrombosis, hepatic artery stricture or thrombosis and hepatic vein outflow stricture in all 9 recipients transplanted with grafts with APVB. Only the type II APVB donor undergoing a excision of APVB with a common opening by a narrow bridge of main portal vein tissue developed portal vein thrombosis on the third postoperative day and underwent thrombectomy followed by repair with vein patch plasty. The velocity of blood flow in the U-graft was normal. CONCLUSIONS: It is feasible and safe of APVB excision on the principal of donor priority and reconstruction including double anastomoses and the novel U-graft interposition in A-A RL LDLT, and has a good outcome without increasing the management difficulty.

Risk Factors for Preoperative Anxiety and Depression in Patients Scheduled for Abdominal Aortic Aneurysm Repair.

BACKGROUND: Perioperative emotional disorders of patients underwent abdominal aortic aneurysm (AAA) repair is an emerging area of study, and preoperative mental distress of those patients remains poorly understood. The aim of this study was to investigate the prevalence and identify the risk factors of preoperative anxiety and depression in patients scheduled for AAA repair. METHODS: A total of 189 patients who underwent elective AAA repair between 2015 and 2016 were included in this study. These patients were preoperatively evaluated by Hospital Anxiety and Depression Scale (HADS). Demographics and anxiety and depression scores of the patients were documented. Logistic regression was used to identify the independent risk factors of preoperative anxiety and depression. RESULTS: A total of 150 AAA patients were included in final analysis. Of these 150 patients, 44 patients (29.3%) had borderline anxiety or clinical anxiety, and 42 patients (28.0%) were found to have borderline or clinical depression. Female (odds ratio [OR]: 2.81, 95% confidence interval [CI]: 1.08-7.26), the American Society of Anesthesiologists (ASA) Grade 3/4 (OR: 4.34, 95% CI: 1.13-16.68), higher education (OR: 1.44, 95% CI: 1.02-2.04), and abdominal or back pain (OR: 3.08, 95% CI: 1.20-7.87) were identified as significant independent risk factors of abnormal HADS-anxiety in overall patients; and higher level of education (OR: 1.87, 95% CI: 1.16-3.01) was predictive of anxiety in patients planned for endovascular aortic repair. Besides, higher body mass index (BMI) (OR: 1.18, 95% CI: 1.04-1.33) and abdominal or back pain (OR: 3.93, 95% CI: 1.70-9.11) were predictive of abnormal preoperative HADS-depression in overall patients. CONCLUSION: As for patients scheduled for AAA repair, female, higher ASA, higher level of education, and symptom may be independent risk factors for preoperative anxiety, and symptom and higher BMI may predict preoperative depression.

Clinical study on safety of adult-to-adult living donor liver transplantation in both donors and recipients.

AIM: To investigate the safety of adult-to-adult living donor liver transplantation (A-A LDLT) in both donors and recipients. METHODS: From January 2002 to July 2006, 50 cases of A-A LDLT were performed at West China Hospital, Sichuan University, consisting of 47 cases using right lobe graft without middle hepatic vein (MHV), and 3 cases using dual grafts (one case using two left lobe, 2 using one right lobe and one left lobe). The most common diagnoses were hepatitis B liver cirrosis, 30 (60%) cases; and hepatocellular carcinoma, 15 (30%) cases in adult recipients. Among them, 10 cases had the model of end-stage liver disease (MELD) with a score of more than 25. Donor screening consisted of reconstruction of the hepatic blood vessels and biliary system with 3-dimension computed tomography and volumetry of whole liver and right liver volume. Various improved surgical techniques were adopted in the procedures for both donors and recipients. RESULTS: Forty-nine right lobes and 3 left lobes (2 left lobe grafts for 1 recipient, 1 left lobe graft for 1 recipient who had received right lobe graft donated by relative living donor) were obtained from 52 living donors. The 49 right lobe grafts, without MHV, weighed 400 g-850 g (media 550 g), and the ratio of graft volume to recipient standard liver volume (GV/SLV) ranged from 31.74% to 71.68% (mean 45.35%). All donors' remnant liver volume was over 35% of the whole liver volume. There was no donor mortality. With a follow-up of 2-52 mo (media 9 mo), among 50 adult recipients, complications occurred in 13 (26%) cases and 4 (8%) died postoperatively within 3 mo. Their 1-year actual survival rate was 92%. CONCLUSION: When preoperative CT volumetry shows volume of remnant liver is more than 35%, the ratio of right lobe graft to recipients standard liver volume exceeding 40%, A-A LDLT using right lobe graft without MHV should be a very safe procedure for both donors and recipients, otherwise dual grafts liver transplantation should be considered.