ABSTRACT
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.
ABSTRACT
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 .