Predictive value of contrast-enhanced ultrasound plus transient elastography for early allograft dysfunction after liver transplantation from C-I donors / 中华器官移植杂志

Objective:Exploring the value of contrast enhanced ultrasound (CEUS) plus transient elastography in evaluating donor livers for C-I donors and predicting the occurrence of early allograft dysfunction (EAD).Methods:Between September 1, 2022 and August 31, 2023, the relevant clinical data were retrospectively reviewed for 75 pairs of donors and recipients. Based upon whether or not there was a postoperative onset of EAD, the recipients were assigned into two groups of EAD (16 cases) and non-EAD (59 cases) . All donors were examined by contrast-enhanced ultrasonography and FibroScan. QLAB analysis software was utilized for analyzing the results of contrast-enhanced ultrasound. Liver parenchyma at 3 cm below liver capsule was selected as a region of interest for plotting the time-intensity curve (TIC) . And the contrast-enhanced ultrasonic parameters of two groups were recorded. FibroScan transient elastography instrument was employed for quantifying liver stiffness 12 times in right lobe of donor liver and recording quantitative parameters of liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) .Results:Inter-group comparison of gender, age, body mass index (BMI) and ICU length of stay showed no statistically significant differences ( P>0. 05) . However, significant differences existed in the levels of platelet [ (122. 44±85. 82) vs (197. 22± 140. 93) ×10 9/L]and cholinesterase [ (3 473. 44±1 368. 54) vs (4 252. 93±1 365. 37) U/L]within the first 24h pre-operation ( P=0. 047, P=0. 047) . Peak intensity (PKI) and area under the curve (AUC) were lower in EAD group than those in non-EAD group [ (16. 44±4. 70) dB vs 19. 85±4. 39 dB, P=0. 009; (1 366. 76±508. 10) dB·s vs (1 675. 23±498. 77) dB·s, P=0. 014]. There were statistically significant differences ( P=0. 009, P=0. 032) . Arterial-portal arrival interval (APAI) and LSM were higher in EAD group than those in non-EAD group[6. 50 (5. 00, 10.75) s vs 5. 00 (4. 00, 7. 00) s, P =0. 24; 8. 60 (6. 32, 11. 65) kPa vs 6. 10 (5. 40, 7. 90) kPa, P=0. 014]. Receiver operating characteristic (ROC) curve analysis revealed that PKI, AUC, APAI and LSM had AUC values of 0. 703, 0. 664, 0. 683 and 0. 702, respectively in predicting postoperative EAD. And combined prediction of EAD occurrence based upon these parameters had an AUC of 0. 776, a Youden index of 0. 508 with cutoff values, sensitivity and specificity of 0. 800, 0. 813 and 0. 695 respectively. Spearman' s correlation analysis revealed a negative correlation between APAI and AUC values ( r= -0. 404, P<0. 001) . Conclusions:The combination of CEUS and transient elastography can comprehensively evaluate the status of microcirculatory perfusion, fibrosis and steatosis of liver grafts from brain death donors. It offers a great predictive value for postoperative occurrence of EAD.

Successful trans-blood liver transplantation after artificial liver support therapy in a patient with hepatic coma： A case report / 临床肝胆病杂志

This article reports a patient with hepatic coma who underwent artificial liver support therapy and liver transplantation successfully， and the patient recovered well in the later stage after active treatment. This article also discusses the timing of liver transplantation.

Diagnosis and treatment of acute kidney injury after liver transplantation / 器官移植

Acute kidney injury is a common complication after liver transplantation, which severely affects clinical prognosis of liver transplant recipients. Multiple factors before, during and after liver transplantation may cause kidney injury. If not properly treated, it may progress into chronic kidney diseases, which significantly increases postoperative fatality and negatively affects clinical efficacy of liver transplantation. Therefore, prevention, diagnosis and treatment of acute kidney injury after liver transplantation is a hot topic for clinicians. In this article, the definition, diagnosis, risk factors, prevention and treatment of acute kidney injury after liver transplantation were reviewed, and potential risk factors and related therapeutic strategies during different stages of acute kidney injury after liver transplantation were analyzed, aiming to lower the risk of acute kidney injury after liver transplantation and further improve clinical prognosis of liver transplant recipients by optimizing treatment regimens.

Value of FibroScan in liver grafts of brain-death donor prior to liver transplantation / 中华器官移植杂志

Objective:To explore the value of FibroScan in liver grafts from brain-dead donors (DBD) prior to liver transplantation (LT).Methods:Liver grafts from 52 DBD were examined using ultrasound and FibroScan before LT. The causes of death were cerebral hemorrhage ( n=25), brain trauma ( n=21) and ischemic-hypoxic cerebropathy ( n=6). Blood samples were tested before LT and a biopsy was performed pre- or intra-operation for determining pathology. The diagnostic accuracy of FibroScan results was compared with that of pathological examinations. The latter is a gold standard for evaluating liver grafts. The eligible donors were grouped by stage of liver fibrosis (F0-F4) and steatosis (S0-S3) based upon Kleiner's scoring system of nonalcoholic fatty liver disease. Results:The value of liver stiffness (LS) significantly rose in group F1 as compared with group F0 (8.74±1.32) kPa and (5.93±1.64) kPa respectively ( P<0.01). The value of LS had a significantly positive correlation with liver graft fibrosis stage ( r=0.73, P<0.01). The area under receiver operating characteristic curve (AUROC) was 0.93 for F1 stage fibrosis ( P<0.01). Significant differences existed in controlled attenuation parameter (CAP) among groups S0, S1 and S2 (173.30±38.36), (230.29±23.27) and (250.00±57.01) dB/m respectively ( F=12.41, P<0.01). CAP was correlated with liver graft steatosis stage ( r=0.64, P<0.01). And AUROC for S1/S2 stage steatosis in liver grafts was 0.89 ( P=0.002) and 0.83 ( P=0.007) respectively. Conclusions:With a high diagnostic accuracy, FibroScan quantifies fibrosis and steatosis in liver grafts from DBD and provides further imaging evidence for assessing liver grafts.

Applications of extracorporeal membrane oxygenation and continuous renal replacement therapy for maintaining organs of potential organ donors with cardiopulmonary failure after brain death / 中华器官移植杂志

Objective To explore the functions of extracorporeal membrane oxygenation (ECMO ) with continuous renal replacement therapy (CRRT ) for potential organ donors with cardiopulmonary failure after brain death and boost the coefficient of utilization of livers .Methods Analysis was conducted for clinical data of 5 donors with cardiopulmonary failure after brain death and their corresponding recipients from July 2015 to May 2017 .Five donors received the treatments of ECMO and CRRT .The relevant data included changes of blood pressure ,dosage of vasoactive agents , liver function ,renal function and urine volume of those treated donors .Also liver functions of liver recipients were observed .Then the clinical data of 18 normal DBD and their liver recipients were compared .Results After ECMO/CRRT ,donor blood pressures rose and the doses of vasoactive agents decreased .Meanwhile urine volume also increased .Finally 4/5 livers could be transplanted . And 10 kidneys were transplanted successfully .There was no significant inter-group difference of liver function .Conclusions The applications of ECMO and CRRT improve liver function of donors with cardiopulmonary failure after brain death and boost the rates of organ donation and utilization .

In-situ split liver transplantation for pediatric recipient: a single-center experience / 中华器官移植杂志

Objective To evaluate the efficacy of in-situ split liver transplantation (ISSLT) in children.Methods From June 2015 to August 2018,10 liver grafts from DBD were split in-situ.All the donors were male,and the median age of the donors was 28.5 year old (18-48 year).One left half graft and 9 left lateral lobe grafts (including 2 reduced size grafts) were transplanted to 10 pediatric recipients.Four grafts were transplanted in our center,and the rest 6 grafts were shared to other two transplant center.The primary diseases of the recipients included biliary atresia (8/10),hepatic sinus obstruction syndrome (1/10) and Alagille syndrome (1/10).The median age of the recipients was 10 month (7 month-11 year),and the mean body weight was 9.8 ± 6.6 kg (5-28 kg).Results All liver grafts were split in-situ.The mean split time of liver grafts was 88.5 ± 18.9 min.The mean weight of split grafts was 336.7-± 85.4 g.All recipients were subjected to piggyback liver transplantation.Operation time was 542.5 ± 112.1 min.Anhepatic time was 52.0 ±-13.5 min.GRWR was (3.98 ±0.96)％.GRWR of two cases was more than 5％,so segment Ⅲ was partially reduced.During the follow-up period,9 cases were alive and 1 case died due to multiple organ failure 1 day after liver transplantation.Conclusions ISSLT can enlarge the graft pool for children and achieve good results.