Design, synthesis of novel purin-6-one derivatives as phosphodiesterase 2 (PDE2) inhibitors: The neuroprotective and anxiolytic-like effects.

Phosphodiesterase 2 (PDE2) has received much attention for the potential treatment of the central nervous system (CNS) disorders. Herein, based on the existing PDE2 inhibitors and their binding modes, a series of purin-6-one derivatives were designed, synthesized and evaluated for PDE2 inhibitory activities, which led to the discovery of the best compounds 6p and 6s with significant inhibitory potency (IC50: 72 and 81 nM, respectively). Docking simulation was performed to insert compound 6s into the crystal structure of PDE2 at the active site to determine the binding mode. Furthermore, compound 6s significantly protected HT-22 cells against corticosterone-induced cytotoxicity and rescued corticosterone-induced decreases in cAMP and cGMP levels. It also produced anxiolytic-like effect in the elevated plus-maze test and exhibited favorable pharmacokinetic properties in vivo. These results might bring significant instruction for further development of potent PDE2 inhibitors.

Posterior reversible encephalopathy syndrome and graft-versus-host disease after liver transplantation: a case report and review of the literature.

Case (description): A 52-year-old male patient presented with seizures on the 16th day post liver transplantation suggesting tacrolimus-associated posterior reversible encephalopathy syndrome (PRES). On the 18th day, the patient was diagnosed with graft-versus-host disease (GVHD). Calcineurin inhibitor (CNI) was stopped and the patient received 1 g methylprednisolone and 25 g immunoglobulin. However, on the 21st day, the patient's clinical condition progressively worsened and he died of multi-organ failure. GVHD could have occurred with PRES because the CNI dose was reduced. The best treatment for patients with PRES and GVHD is using immunosuppressants other than CNI. Antibody preparations and steroids could be a standard treatment.

Effect of donor age on graft function and long-term survival of recipients undergoing living donor liver transplantation.

BACKGROUND: Donor shortage is the biggest obstacle in organ transplantation. Living donor liver transplantation (LDLT) has been considered as a valuable approach to shortening waiting time. The objectives of this study were to investigate the feasibility of utilizing donors older than 50 years in LDLT and to evaluate the graft function and recipient survival. METHODS: All LDLT cases (n=159) were divided into the older (donor age≥50 years, n=10) and younger (donor age<50 years, n=149) donor groups. Donor graft and recipient condition pre-, intra- and post-operation were compared between the two groups. In particular, graft functions and recipient survivals were analyzed. RESULTS: The median donor age was 58.5 (52.5-60.0) years in the older donor group and 25.0 (23.0-32.0) in the younger donor group. There was no significant difference in cold ischemic time, anhepatic phase and operation time between the older and younger donor groups (P>0.05). However, the volume of red blood cell transfused in operation was greater in the older donor group than in the younger donor group (1900 vs 1200 mL, P=0.023). The 1-, 3- and 5-year graft survival rates were 90%, 80% and 80% for the older donor group, and 92%, 87% and 87% for the younger donor group, respectively (P=0.459). The 1-, 3- and 5-year survival rates were 100%, 90% and 90% for recipients with older grafts, and 93%, 87% and 87% for those with younger grafts, respectively (P=0.811). CONCLUSION: It is safe for a LDLT recipient to receive liver from donors older than 50 years, and there is no significant adverse effect on graft function and long-term patients' survival.

Association between gaming disorder and regional homogeneity in highly involved male adult gamers: A pilot resting-state fMRI study.

BACKGROUND: Gaming behavior can induce cerebral changes that may be related to the neurobiological features of gaming disorder (GD). Additionally, individuals with higher levels of depression or impulsivity are more likely to experience GD. Therefore, the present pilot study explored potential neurobiological correlates of GD in the context of depression and impulsivity, after accounting for video gaming behavior. METHODS: Using resting-state functional magnetic resonance imaging (fMRI), a cross-sectional study was conducted with 35 highly involved male adult gamers to examine potential associations between GD severity and regional homogeneity (ReHo) in the entire brain. A mediation model was used to test the role of ReHo in the possible links between depression/impulsivity and GD severity. RESULTS: Individuals with greater GD severity showed increased ReHo in the right Heschl's gyrus and decreased ReHo in the right hippocampus (rHip). Furthermore, depression and impulsivity were negatively correlated with ReHo in the rHip, respectively. More importantly, ReHo in the rHip was found to mediate the associations between depression/impulsivity and GD. CONCLUSIONS: These preliminary findings suggest that GD severity is related to ReHo in brain regions associated with learning/memory/mood and auditory function. Higher levels of depression or impulsivity may potentiate GD through the functional activity of the hippocampus. Our findings advance our understanding of the neurobiological differences behind GD symptoms in highly involved gamers.

Comparison of the long-term outcomes of patients with hepatocellular carcinoma within the Milan criteria treated by ablation, resection, or transplantation.

BACKGROUND: Liver transplantation (LT), resection (LR), and ablation (LA) are three curative-intent treatment options for patients with early hepatocellular carcinoma (HCC). We aimed to develop a prognostic calculator to compare the long-term outcomes following each of these therapies. METHODS: A total of 976 patients with HCC within the Milan criteria who underwent LT, LR, and LA between 2009 and 2019 from four institutions were evaluated. Multistate competing risks prediction models for recurrence-free survival (RFS), recurrence within the Milan criteria (RWM), and HCC-specific survival (HSS) were derived to develop a prognostic calculator. RESULTS: During a median follow-up of 51 months, 420 (43%) patients developed recurrence. In the multivariate analysis, larger tumor size, multinodularity, older age, male, higher alpha-fetoprotein (AFP), higher albumin-bilirubin (ALBI) grade, and the presence of portal hypertension were significantly associated with higher recurrence and decreased survival rates. The RFS and HSS were both significantly higher among patients treated by LT than by LR or LA and significantly higher between patients treated by LR than by LA (all p < 0.001). For multinodular HCC ≤3 cm, although LT had better RFS and HSS than LR or LA, LA was noninferior to LR. An online prognostic calculator was then developed based on the preoperative clinical factors that were independently associated with outcomes to evaluate RFS, RWM, and HSS at different time intervals for all three treatment options. CONCLUSIONS: Although LT resulted in the best recurrence and survival outcomes, LR and LA also offered durable long-term alternatives. This prognostic calculator is a useful tool for clinicians to guide an informed and personalized discussion with patients based on their tumor biology and liver function.

[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.

A Novel Nomogram Model to Predict the Recurrence-Free Survival and Overall Survival of Hepatocellular Carcinoma.

Background: Treatments for patients with early-stage hepatocellular carcinoma (HCC) include liver transplantation (LT), liver resection (LR), radiofrequency ablation (RFA), and microwave ablation (MWA), are critical for their long-term survival. However, a computational model predicting treatment-independent prognosis of patients with HCC, such as overall survival (OS) and recurrence-free survival (RFS), is yet to be developed, to our best knowledge. The goal of this study is to identify prognostic factors associated with OS and RFS in patients with HCC and develop nomograms to predict them, respectively. Methods: We retrospectively retrieved 730 patients with HCC from three hospitals in China and followed them up for 3 and 5 years after invasive treatment. All enrolled patients were randomly divided into the training cohort and the validation cohort with a 7:3 ratio, respectively. Independent prognostic factors associated with OS and RFS were determined by the multivariate Cox regression analysis. Two nomogram prognostic models were built and evaluated by concordance index (C-index), calibration curves, area under the receiver operating characteristics (ROC) curve, time-dependent area under the ROC curve (AUC), the Kaplan-Meier survival curve, and decision curve analyses (DCAs), respectively. Results: Prognostic factors for OS and RFS were identified, and nomograms were successfully built. Calibration discrimination was good for both the OS and RFS nomogram prediction models (C-index: 0.750 and 0.746, respectively). For both nomograms, the AUC demonstrated outstanding predictive performance; the DCA shows that the model has good decision ability; and the calibration curve demonstrated strong predictive power. The nomograms successfully discriminated high-risk and low-risk patients with HCC associated with OS and RFS. Conclusions: We developed nomogram survival prediction models to predict the prognosis of HCC after invasive treatment with acceptable accuracies in both training and independent testing cohorts. The models may have clinical values in guiding the selection of clinical treatment strategies.

Tricyclo-hex-yl(3,5-dibromo-2-hy-droxy-benzoato-κO)tin(IV).

In the title compound, [Sn(C(6)H(11))(3)(C(7)H(3)Br(2)O(3))], the Sn atom is four-coordinate and possesses a distorted Sn(C(3)O) tetra-hedral geometry, with Sn-C bond lengths in the range 2.132 (6)-2.144 (6) Šand with Sn-O = 2.086 (4) Å. The uncoordinated carboxyl-ate O atom forms a weak contact with the Sn atom, with an Sn⋯O separation of 2.962 (2) Å.

[Adult-to-adult living donor liver transplantation with 94 cases report].

OBJECTIVE: To investigate the donor evaluation, surgical protocol, and the complication for the adult-to-adult living donor liver transplantation (AALDLT). METHODS: There were 94 cases of AALDLT were performed by the same surgical team from January 2007 to August 2010. Patients aged from 18 to 74 years. Donors aged from 19 to 60 years. All the 94 cases' operation protocol as following, 2 cases with left lobe liver graft, 92 cases with right lobe graft, 44 cases with middle hepatic vein (MHV) harvested, and 48 cases without MHV. Assessment methods of donors, postoperative complications and the current survival were analyzed. RESULTS: All the donors were discharged with good recovery, complication incidence of donor was 7.4%. Median time of follow-up was 37 months. Eight patients were died during follow-up, 1-year patient survival rate was 95.7%, and graft survival rate was 94.4%. One case complicated with small-for-size syndrome, 1 case was performed re-transplantation for acute hepatic necrosis, 24 patients (25.5%) showed biliary anastomotic stenosis defined cholangiography or magnetic resonance cholangiopancreatography examination, and 9 patients (9.6%) showed abnormal liver function. CONCLUSIONS: Living donor liver transplantation is an effective treatment method for end-stage liver disease, with accurate evaluation preoperative, a reasonable surgical approach, whether using the left or right lobe liver graft, with or without middle hepatic vein in AALDLT can effectively ensure the donor and recipient safety.

Clinical progress of auxiliary liver transplantation.

After half a century of development, auxiliary liver transplantation (ALT) technology gradually matured and major indications of ALT have been gradually expanded. This review summarized the history of ALT and introduced indications for ALT which including metabolic liver disease, fulminant hepatic failure, highly sensitized kidney transplantation, prevention of hepatic resection of small hepatic syndrome, etc.; at the same time, the hot issues related to ALT were discussed, including the regulation of hepatic portal blood flow of transplanted liver and residual liver, how to treat the graft liver and remaining liver on second stage. Additionally, the expansion of indications for ALT which included the implementation of ALT for patients with liver cancer and ALT for patients with liver cirrhosis was discussed. It was believed that ALT can greatly alleviate the contradiction of insufficient source of graft liver.

Value of the controlling nutritional status score and psoas muscle thickness per height in predicting prognosis in liver transplantation.

BACKGROUND: Patients with end-stage liver disease usually have varying degrees of malnutrition, and severe malnutrition may affect the prognosis of patients after liver transplantation (LT). However, there is no recommended standard for the nutrition assessment of patients waiting for LT, and it is unknown whether malnutrition has an impact on the occurrence of postoperative complications. AIM: The study aim was to investigate the value of the controlling nutritional status (CONUT) score and psoas muscle thickness per height (PMTH) in predicting prognosis in LT. METHODS: We retrospectively analyzed the clinical data of 313 patients who underwent classic orthotopic LT from January 2016 to December 2018 in Tianjin First Central Hospital affiliated with Tianjin Medical University. The CONUT score is derived from the preoperative serum albumin and total cholesterol levels, and total lymphocyte count. Patients were divided into low (≤ 4), medium (5-8), and high (9-12) CONUT score groups perioperative characteristics, Clavien-Dindo grade III/IV/V postoperative complications, graft loss and infection, and cumulative postoperative survival in the three groups were compared 3 mo after LT. PMTH was calculated as the ratio of the transverse thickness of the psoas muscle in the umbilical plane to the height of the patient. The cutoff values of receiver operating characteristic curves were determined separately for men and women. The values were 14.1 cm/m2 for women and 17.9 cm/m2 for men. The patients were then divided into low and high PMTH groups by the cutoff values. The comparison of data between the two groups was the same as above. RESULTS: Patients with medium and high CONUT scores had lower preoperative serum hemoglobin, more intraoperative red blood cell (RBC) transfusions, longer postoperative intensive care unit stay and hospital stays, higher 7 and 14 preoperative-day serum bilirubin levels, and a higher incidence of postoperative grade III/IV complications and infections than patients with low CONUT scores. Differences in the 3-mo cumulative survival among the three groups were not significant. Patients with a low PMTH had higher preoperative serum urea nitrogen, more intraoperative packed RBC and frozen plasma transfusions, longer times to postoperative ventilator extubation, higher incidence of total postoperative complications, and a lower 3-mo cumulative survival than those with a high PMTH. CONCLUSION: A CONUT score ≥ 5 and a low PMTH were both associated with poor prognosis in LT. The CONUT score had no predictive value for short-term patient survival after LT, but the PMTH was predictive of short-term patient survival after LT.

[Effects of antimicrobial peptide GH12 on the morphology and composition of cariogenic three-species biofilm].

OBJECTIVES: To evaluate the effects of antimicrobial peptide GH12 designed de novo on the structure, morphology, and composition of a cariogenic three-species biofilm. METHODS: The cariogenic three-species biofilm consis-ted of the cariogenic Streptococcus mutans (S. mutans) and commensal bacteria Streptococcus sanguinis (S. sanguinis) and Streptococcus gordonii (S. gordonii). The biofilm was treated using GH12 (2, 4, and 8 mg·L-1), and untreated biofilm was used as the control. Changes in the morphology and structure of the three-species biofilm were evaluated through crystal violet staining, scanning electron microscopy (SEM), and fluorescent in situ hybridization (FISH). Moreover, S. mutans in the biofilm was selectively cultured, and its colony-forming units were counted. RESULTS: The biomass and density of the cariogenic three-species biofilm treated with GH12 decreased compared with those of the control. The number of S. mutans decreased gradually and eventually became undetectable, whereas the number of S. gordonii and S. sanguinis increased and became predominant in the biofilm. CONCLUSIONS: GH12 can reduce the number of S. mutans within the cariogenic three-species biofilm, destroys its integrity, and consequently makes the biofilm easy to remove.

Non-amputated limb muscle coordination of unilateral transfemoral amputees.

Unilateral transfemoral amputees rely heavily on non-amputated limb muscles to regulate the prosthetic gait. In this study, we compared the non-amputated limb muscle coordination of eight unilateral transfemoral amputees to eight able-bodied controls. Inverse dynamics approach was conducted via a musculoskeletal model to obtain lower limb joint moments and muscle forces. In addition to the muscle forces at the instants of peak joint moments and the maximum muscle forces, the peak joint moments of the lower limbs were also investigated. The results showed that there were significant differences of muscle forces between the non-amputated limbs and the controls at the instant of peak hip extension moment, although the peak hip extension moments themselves were not significantly different between the two groups. The non-amputated limbs had significantly smaller peak hip flexion moment and peak knee extension moment, with significant differences between the muscle forces of non-amputated limbs and controls at the two instants. There was no significant difference between the muscle forces of the non-amputated limbs and controls at the peak knee flexion moment instant, despite the fact that the non-amputated limbs had significantly higher peak knee flexion moments. In addition, the non-amputated limbs had significantly smaller maximum muscle forces than the controls. These results demonstrate that amputees modify their muscle coordination to adapt to the specific joint requirements of the prosthetic gait. Our findings suggest the possibility of non-amputated limb muscle atrophy due to the decrease in the peak muscle forces during walking.

Simultaneous partial splenectomy during liver transplantation for advanced cirrhosis patients combined with severe splenomegaly and hypersplenism.

BACKGROUND: The most effective treatment for advanced cirrhosis and portal hypertension is liver transplantation (LT). However, splenomegaly and hypersplenism can persist even after LT in patients with massive splenomegaly. AIM: To examine the feasibility of performing partial splenectomy during LT in patients with advanced cirrhosis combined with severe splenomegaly and hypersplenism. METHODS: Between October 2015 and February 2019, 762 orthotopic LTs were performed for patients with end-stage liver diseases in Tianjin First Center Hospital. Eighty-four cases had advanced cirrhosis combined with severe splenomegaly and hypersplenism. Among these patients, 41 received partial splenectomy during LT (PSLT group), and 43 received only LT (LT group). Patient characteristics, intraoperative parameters, and postoperative outcomes were retrospectively analyzed and compared between the two groups. RESULTS: The incidence of postoperative hypersplenism (2/41, 4.8%) and recurrent ascites (1/41, 2.4%) in the PSLT group was significantly lower than that in the LT group (22/43, 51.2%; 8/43, 18.6%, respectively). Seventeen patients (17/43, 39.5%) in the LT group required two-stage splenic embolization, and further splenectomy was required in 6 of them. The operation time and intraoperative blood loss in the PSLT group (8.6 ± 1.3 h; 640.8 ± 347.3 mL) were relatively increased compared with the LT group (6.8 ± 0.9 h; 349.4 ± 116.1 mL). The incidence of postoperative bleeding, pulmonary infection, thrombosis and splenic arterial steal syndrome in the PSLT group was not different to that in the LT group, respectively. CONCLUSION: Simultaneous PSLT is an effective treatment and should be performed in patients with advanced cirrhosis combined with severe splenomegaly and hypersplenism to prevent postoperative persistent hypersplenism.

Comparison of Liver Transplantation and Liver Resection for Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombus Type I and Type II.

PURPOSE: The aim of this study was to compare the efficacy of liver transplantation (LT) and liver resection (LR) for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) and to investigate risk factors affecting prognosis. MATERIALS AND METHODS: A total of 94 HCC patients with PVTT type I (segmental PVTT) and PVTT type II (lobar PVTT) were involved and divided into LR (n=47) and LT groups (n=47). Recurrence-free survival (RFS) and overall survival (OS) were compared before and after inverse probability of treatment weighting (IPTW). Prognostic factors for RFS and OS were explored. RESULTS: Two treatment groups were well-balanced using IPTW. In the entire cohort, LT provided a better prognosis than LR. Among patients with PVTT type I, RFS was better with LT (p=0.039); OS was not different significantly between LT and LR (p=0.093). In subgroup analysis of PVTT type I patients with α-fetoprotein (AFP) levels >200 ng/mL, LT elicited significantly longer median RFS (18.0 months vs. 2.1 months, p=0.022) and relatively longer median OS time (23.6 months vs. 9.8 months, p=0.065). Among patients with PVTT type II, no significant differences in RFS and OS were found between LT and LR (p=0.115 and 0.335, respectively). Multivariate analyses showed treatment allocation (LR), tumor size (>5 cm), AFP and aspartate aminotransferase (AST) levels to be risk factors of RFS and treatment allocation (LR), AFP and AST as risk factors for OS. CONCLUSION: LT appeared to afford a better prognosis for HCC with PVTT type I than LR, especially in patients with AFP levels >200 ng/mL.

Complex liver retransplantation to treat graft loss due to long-term biliary tract complication after liver transplantation: A case report.

BACKGROUND: Loss of graft function after liver transplantation (LT) inevitably requires liver retransplant. Retransplantation of the liver (ReLT) remains controversial because of inferior outcomes compared with the primary orthotopic LT (OLT). Meanwhile, if accompanied by vascular complications such as arterial and portal vein (PV) stenosis or thrombosis, it will increase difficulties of surgery. We hereby introduce our center's experience in ReLT through a complicated case of ReLT. CASE SUMMARY: We report a patient who suffered from hepatitis B-associated cirrhosis and underwent LT in December 2012. Early postoperative recovery was uneventful. Four months after LT, the patient's bilirubin increased significantly and he was diagnosed with an ischemic-type biliary lesion caused by hepatic artery occlusion. The patient underwent percutaneous transhepatic cholangial drainage and repeatedly replaced intrahepatic biliary drainage tube regularly for 5 years. The patient developed progressive deterioration of liver function and underwent liver re-transplant in January 2019. The operation was performed in a classic OLT manner without venous bypass. Both the hepatic artery and PV were occluded and could not be used for anastomosis. The donor PV was anastomosed with the recipient's left renal vein. The donor hepatic artery was connected to the recipient's abdominal aorta. The bile duct reconstruction was performed in an end-to-end manner. The postoperative process was very uneventful and the patient was discharged 1 mo after retransplantation. CONCLUSION: With the development of surgical techniques, portal thrombosis and arterial occlusion are no longer contraindications for ReLT.

[Middle hepatic treatment algorithm in right lobe living donor liver transplantation for donor recipient safety].

OBJECTIVE: The treatment algorithm of donor middle hepatic vein (MHV) was made depending on the remnant liver volume of the total donor liver volume as calculated by computer tomography, estimated graft-to-recipient weight ratio and also anatomy. The present study was to analyze the influence of this algorithm upon the safety of donors and recipients in right lobe living donor liver transplantation (LDLT) and to provide references for our future clinical practices. METHODS: Data of 73 consecutive LDLT cases, operated and managed by the same surgical team according to the pre-operation MHV treatment algorithm, were analyzed. MHV was harvested in 28 cases and not in 45 cases. Donor and recipient gender, age, weight, operation time, blood loss volume, graft weight, non-hepatic phase, graft cold preservation time, perioperative survival rate and the incidence of small-for-size syndrome were compared, and also the peak post-operative values of ALT, AST, T-bilirubin and D-bilirubin. RESULTS: No donor needed blood transfusion and suffered small-for-size syndrome. One recipient recovered from small-for-size syndrome successfully by medical interventions. One recipient had acute hepatic necrosis at Day 6 post-operation and was converted into cadaveric liver transplantation. At Day 30 post-operation, one recipient died from disseminated infections and respiratory failure, but his liver function was normal. There was significant difference in donor and recipient age, actual GRWR, graft cold preservation time and recipient's ALT peak value between the MHV harvest group and the MHV non-harvest group. CONCLUSION: The MHV treatment algorithm is safe to both donors and recipients.

[Clinical analysis of donor hepatectomy in living donor liver transplantation: report of 74 cases].

OBJECTIVE: To evaluate the living donor selection, donor hepatectomy technique, and surgical complication in living donor liver transplantation. METHODS: From June 2007 to July 2008, 74 consecutive cases living donor hepatectomy were performed by the same surgical team. Seventy-four donors (64 males and 10 females) with a mean age of 29.2 years old passed the donor liver assessment and evaluation program successfully. The hepatectomy procedure types contained right liver resection (n = 72), of which 27 cases harvested the middle hepatic vein and 45 cases not, left liver resection contain middle hepatic vein (n = 1) and left lateral resection (n = 1). RESULTS: Of all the donors, operation time was (6.5 +/- 6.2) hours, the mean blood loss was 300 ml (100 - 500 ml) and didn't accept foreign blood transfusion. The maximum alanine aminotransferase (ALT) level was (229.5 +/- 108.6) U/L, the ALT returned to normal time was (12.7 +/- 4.8) d, the maximum total bilirubin (TB) level was (78.7 +/- 44.3) micromol/L, the TB returned to normal time was (8.8 +/- 2.7) d, and the mean hospital stay time was 14 days (7 - 28 d). The complications included bile leak (n = 1), cut surface hemorrhage (n = 1) and anaphylactoid purpura (n = 1). All the donors returned to normal work and life finally. CONCLUSIONS: Precisely evaluating donor blood vascular and biliary anatomy before operation, keeping the blood vascular and bile duct integrity during operation and monitoring complication to solve it immediately after operation is crucial to ensure donor safety and recovering successfully.

Liver retransplantation for ischemic-type biliary lesions after orthotopic liver transplantation: a clinical report of 66 cases.

BACKGROUND: Ischemic-type biliary lesions (ITBLs) play an extremely important role in influencing the long-term survival and quality of life of recipients after orthotopic liver transplantation (OLT). Some patients can be cured by interventional therapies, however others lose their grafts at last and receive liver retransplantation (re-OLT). The aim of this study was to analyze the data of 66 patients who had received re-OLT at our center because of ITBL and to discuss the treatment of ITBL after OLT. METHODS: We retrospectively analyzed 66 re-OLT cases due to ITBL from September 2001 to February 2007 at our center. The Kaplan-Meier method and the Cox-Mantel test were used to identify factors associated with mortality for univariate analysis and multivariate analysis, respectively. RESULTS: Fifty-five of 66 ITBL cases underwent interventional therapies before re-OLT. The actuarial survival at 1 month and 1 year for these patients was 83% and 74%, respectively. Prognostic factors for mortality in univariate analysis were model of end-stage liver disease score (MELD) >16.5 (Chi(2)=5.856, P=0.016), cold ischemia time >8 hours (Chi(2)=6.539, P=0.011), infections (Chi(2)=5.550, P=0.018) and complications (Chi(2)=12.168, P=0.002) after re-OLT. In the multivariate analysis (Cox regression), the risk factors independently associated with mortality were MELD score >16.5 (RR: 3.140; P=0.035), cold ischemia time >8.2 hours (RR: 0.192; P=0.016) and complications (RR: 3.896, P=0.003). CONCLUSIONS: The incidence of ITBL in China is higher than in other countries. Based on our experience, MELD score, cold ischemia time and complications after re-OLT are risk factors independently associated with mortality in retransplanted ITBL patients.

[Adult-to-adult living donor liver transplantation using right lobe including middle hepatic vein].

OBJECTIVE: To investigate the feasibility and the clinical efficacy of right lobe including middle hepatic vein in adult-to-adult living donor liver transplantation. METHOD: We retrospectively analyzed the clinical data of 30 adult-to-adult living donor liver transplantation using right lobe including middle hepatic vein performed in our hospital from Feb. 2007 to Nov. 2007. RESULTS: The right lobes weighed 540-1058 g (median 708 g). The remnant liver volumes were over 30% of the total liver volume in all donors. No perioperative death was noted for among donors and recipients. Complications were recorded and cured in 4 donors (13.3%) and 7 recipients (23.3%). All the donors and the recipients were followed up for 2-8 months (median 5 months), during which no donor died and 1 recipient died from aspergillus infection 4 months after operation. CONCLUSION: Adult-to-adult living donor liver transplantation using right lobe graft including middle hepatic vein is a safe and effective technique.