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Objective To investigate the clinical prognosis of the liver transplant recipients diagnosed with hepatocellular carcinoma (HCC) complicated with microvascular invasion (MVI). Methods Clinical data of 3 447 HCC recipients undergoing liver transplantation were extracted from Surveillance, Epidemiology, and End Results (SEER) database of American National Cancer Institute. According to the incidence of MVI, all recipients were divided into MVI (n=376) and non-MVI groups (n=3 071). The clinical prognosis of liver transplant recipients was statistically compared between two groups by analyzing the 1-, 3- and 5-year overall survival (OS) and liver cancer specific survival (LCSS). Relevant clinical data including age, gender, race, pathological staging, tumor size, lymph node metastasis, distant metastasis, tumor-node-metastasis (TNM) staging and MVI were recorded in two groups. The independent risk factors of clinical prognosis of HCC recipients undergoing liver transplantation were analyzed by multivariate Cox regression model. The nomogram for predicting the clinical prognosis of the recipients was delineated. The accuracy of the prediction model was evaluated by the consistency index. Results In the non-MVI group, the 1-, 3-, 5-year OS and LCSS were 93.5%, 82.1%, 75.3% and 98.3%, 93.8%, 90.7%, significantly higher than 88.8%, 72.1%, 68.4% and 95.3%, 83.1%, 80.4% in the MVI group (all P < 0.05). Multivariate regression analysis showed that pathological staging, tumor size, lymph node metastasis, distant metastasis, TNM staging and MVI were the independent risk factors of OS and LCSS in HCC recipients undergoing liver transplantation (all P < 0.05). The nomogram consistency index was calculated as 0.624 (0.602-0.648). Conclusions MVI is an independent risk factor of the clinical prognosis of HCC recipients undergoing liver transplantation, which is significantly correlated with poor prognosis of the recipients. The nomogram based on MVI can predict the clinical prognosis of these recipients.
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Objective The use of split liver transplantation (SLT) from deceased donors in children is gradual increasing.This study analyzed the outcomes of SLT in pediatric recipients at a single center in China.Methods From July 2017 to September 2018,42 SLTs in 41 pediatric recipients were performed.There were 24 adult donors with age ranged from 19 to 52 years and 10 pediatric donors with age ranged from 4 years to 16 years.In adult donors,the livers were divided to left lateral segment (LLS) and extended right lobe (ERL) grafts,and 24 LLS and 1 ERL graft were used.Among 10 pediatric donors,the same split technique was used.Further reduction of the grafts was done on 1 ERL and 3 LLS grafts.There were 34 children with biliary atresia,accounting for 82.9％ of the total patients.Twenty-four patients (58.5％) were less than one year old.For pediatric receptor PELD score,5 cases had 0-14 scores,21 cases had 15-29 scores and 16 cases had more than 30 scores.GRWR was 1.65％-4.39％ in children.The cold ischemia time of grafts was 3-13 h.Results The operations were completed successfully in 41 children.During the follow-up period of 2 months to 4 years and 3 months,38 children recovered and discharged.The incidence of complications of hepatic artery,portal vein and biliary tract was 4.8％,7.1％ and 9.5％oo respectively.There were 3 perioperative deaths and 2 recurrent deaths during the follow-up period.The 1-and 2-year survival rates were 90.25％ and 87.8％ respectively,and the graft survival rates were 88.1％ and 85.7％ respectively.Conclusions Under the background of organ donation in China,we should attach importance to the application of splitting technique in pediatric liver transplantation.Grasping the selection criteria of donors and recipients and fine operation can achieve a satisfactory result.
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Objective To explore the clinical and technical essentials of hepatic arterial segmentation and reconstruction during split liver transplantation using pediatric deceased donor .Methods The clinical data were retrospectively analyzed for 15 pediatric deceased donor aged 4 .6-16 .3 years undergoing split liver transplantation from July 2017 to March 2019 .The donors were DBD (donation after brain death ,n=13) and DCD(donor after cardiac death ,n=2) .Thirty split liver transplantations were performed using these 15 pediatric deceased donors .The receptors were adult + child (n=5) and child + child recipients (n=10) . According to the Michels' classification ,the clinical types were I (n= 13) ,V (n= 1) and VI (n= 1) . Hepatic arterial segmentation :In type I hepatic arterial type donor liver ,proper hepatic artery was retained in right trilobar liver (n=8) ,low-age (< 7 years) donor liver (n=5) ,retaining proper hepatic artery in left liver & reconstructing right trilobe directly using right hepatic artery trunk (n= 4) .Methods of hepatic artery reconstruction :8-0 Prolene string was utilized under 4 .5 times magnifying glass for reconstructing hepatic artery in recipients aged under 4 years .Results Hepatic arterial segmentation and reconstruction were successfully completed .Hepatic arterial thrombosis occurred in 2 ./25 ecipients .The overall incidence of hepatic arterial complications was 6 .67％ .Conclusions For reducing the occurrence of arterial complications , arterial segmentation and reconstruction in pediatric deceased donor should be performed according to the size of donor liver and the characteristics of hepatic arterial classification .