A new method to predict venous complications in pediatric liver transplantation: Evaluation of splenic parameters by ultrasonography.

BACKGROUND: Venous complications after pediatric liver transplantation seriously affect the survival rate of patients and grafts. At present, the diagnostic indicators have not been unified. Venous complications may cause portal hypertension, which may lead to splenomegaly and splenic vein dilatation. Therefore, the changes in spleen may be closely related to the venous complications. The purpose of this study was to explore the relationship between ultrasonic splenic parameters and venous complications and to study whether these splenic parameters can be used for the diagnosis of venous complications. METHODS: We retrospectively included pediatric patients who underwent liver transplantation and collected ultrasonic spleen parameters before, and then 1-3 days, 1-3 weeks, 1-3 months, and 4-12 months after liver transplantation. We observed whether there were portal vein or hepatic vein complications within 1 year after liver transplantation. RESULTS: Among 109 pediatric patients after liver transplantation included in our study, 11 of them suffered from portal vein complications and nine hepatic vein complications. Spleen transverse diameter, spleen longitudinal diameter, spleen portal vein diameter, spleen index, spleen transverse diameter ratio, spleen longitudinal diameter ratio, and spleen index ratio were independent risk factors of venous complications. The accuracy of spleen transverse diameter (AUROC: 0.73), spleen index (AUROC: 0.70), spleen transverse diameter ratio (AUROC: 0.71), and spleen index ratio (AUROC: 0.72) in predicting venous complications were higher than other ones. CONCLUSIONS: Ultrasonic examination is a common follow-up method for pediatric patients after liver transplantation and the application of ultrasonic spleen parameters may be helpful to monitor venous complications.

Anatomic classification and reconstruction of right intrahepatic bile duct in the donor liver of split liver trans-plantation / 中华消化外科杂志

Objective:To investigate the anatomic classification and reconstruction of right intrahepatic bile duct in the donor liver of split liver transplantation (SLT).Methods:The retrospective and descriptive study was constructed. The clinical data of 85 patients who underwent SLT in the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to January 2022 were collected. There were 65 males and 20 females, aged 45(range, 1-82)years. Observation indicators: (1) surgical conditions; (2) anatomy of right intrahepatic bile duct; (3) bile duct reconstruction; (4) postoperative biliary complications; (5) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range) or M( Q1, Q3).Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Surgical conditions. Of the 85 donor livers, 11 donor livers were split between the left and right hemilivers, and 74 donor livers were split between the classic right trilobe and left lateral lobe. The cold ischemia time of 85 donor livers was 291(273, 354)minutes, and the operation time, anhepatic phase time and volume of intraoperative blood transfusion of 85 recipients were (497±97)minutes, 51(40, 80)minutes and 8(7, 12)U. (2) Anatomy of right intrahepatic bile duct. Of the 85 donor livers, there were 47 donor livers with classic bile duct anatomical model (type 1), of the ratio as 55.3%(47/85), and 38 donor livers with anatomical variants, of the ratio as 44.7%(38/85). Of the 38 donor livers with anatomical variants, 7 donor livers were type 2, 16 donor livers were type 3a, 2 donor livers were type 3b, 2 donor livers were type 3c, 1 donor liver was type 4, 3 donor livers were type 5a, 4 donor livers were type 5b, 3 donor livers were type 6. For bile duct splitting patterns of the 85 donor livers, 84 donor livers were split with the main trunk of common hepatic duct preserving in the right hemiliver or right trilobe, and 1 donor liver were treated with complete left and right hemiliver splitting to preserve the main trunk of the common hepatic duct in the left hemiliver and the right hemiliver in the right hepatic duct (type 1 bile duct anatomical model). There were 84 donor livers with only one bile duct opening, and 1 donor liver with two bile duct openings (type 3c bile duct anatomical model). (3) Bile duct reconstruction. Of the 85 recipients, there were 69 recipients with common bile duct end-to-end anastomosis to common bile duct of donor liver (38 donor livers with type 1 bile duct anatomical model, 5 donor livers with type 2 bile duct anatomical model, 14 donor livers with type 3a bile duct anatomical model, 2 donor livers with type 3b bile duct anatomical model, 1 donor liver with type 4 bile duct anatomical model, 3 donor livers with type 5a bile duct anatomical model, 4 donor livers with type 5b bile duct anatomical model, 2 donor livers with type 6 bile duct anatomical model), 11 recipients with jejunum anastomosis to common bile duct of donor liver (7 donor livers with type 1 bile duct anatomical model, 2 donor livers with type 2 bile duct anatomical model, 1 donor liver with type 3c bile duct anatomical model, 1 donor liver with type 6 bile duct anatomical model), 3 recipients with jejunum anastomosis to common hepatic duct of donor liver (1 donor liver with type 1 bile duct anatomical model, 2 donor livers with type 3a bile duct anatomical model), 1 recipient with jejunum anastomosis to right hepatic duct of donor liver (type 1 bile duct anatomical model), 1 recipient with common hepatic duct end-to-end anastomosis to right posterior branch of donor liver combined with jejunum of the recipient Roux-en-y anastomosis to common hepatic duct of donor liver (type 3c bile duct anatomical model). (4) Postoperative biliary complications. Of the 85 recipients, 6 cases had postoperative biliary complications, with an incidence of 7.1% (6/85). Of the 6 recipients with postoperative biliary complications, there were 5 recipients with donor liver with type 1 bile duct anatomical model, including 3 cases undergoing postoperative biliary stricture with biliary leakage and 2 cases undergoing postoperative biliary anastomotic stricture, 1 recipient with donor liver with type 3b bile duct anatomical model and undergoing postoperative biliary anastomotic stricture and bile leakage in the liver section. Cases with biliary complications were 5 in the 47 recipients with donor liver with classic bile duct anatomical model and 1 in the 38 recipients with donor liver with anato-mical variants, showing no significant difference between them ( P>0.05). (5) Follow-up. There were 83 recipients receiving followed up for 52(12,96)months. During the follow-up period, 2 recipients died due to non-biliary complication factors (1 donor liver with type 1 bile duct anatomical model and 1 donor liver with 3a bile duct anatomical model). Conclusion:The anatomical classification of right intrahepatic bile duct of donor liver in SLT is mainly classical bile duct anatomical model, and the bile duct reconstruction scheme is mainly common bile duct of donor liver end-to-end anasto-mosis to common bile duct of recipient.

Diagnosis and treatment of the portal vein complications for children undergoing spilt liver transplantation / 器官移植

Objective To investigate the diagnosis and treatment strategy of the portal vein complications in children undergoing split liver transplantation. Methods The clinical data of 88 pediatric recipients who underwent split liver transplantation were retrospectively analyzed. Intraoperative anastomosis at the bifurcating site of the portal vein or donor iliac vein bypass anastomosis was performed depending on the internal diameter and development of the recipient's portal vein. A normalized portal venous blood stream monitoring was performed during the perioperative stage. After operation, heparin sodium was used to bridge warfarin for anticoagulation therapy. After portal vein stenosis or thrombosis was identified with enhanced CT or portography, managements including embolectomy, systemic anticoagulation, interventional thrombus removal, balloon dilatation and/or stenting were performed. Results Among the 88 recipients, a total of 10 children were diagnosed with portal vein complications, of which 4 cases were diagnosed with portal vein stenosis at 1 d, 2 months, 8 months, and 11 months after surgery, and 6 cases were diagnosed with portal vein thrombosis at intraoperative, 2 d, 3 d (n=2), 6 d, and 11 months after surgery, respectively. One patient with portal vein stenosis and one patient with portal vein thrombosis died perioperatively. The fatality related to portal vein complications was 2% (2/88). Of the remaining 8 patients, 1 underwent systemic anticoagulation, 2 underwent portal venous embolectomy, 1 underwent interventional balloon dilatation, and 4 underwent interventional balloon dilatation plus stenting. No portal venous related symptoms were detected during postoperative long term follow up, and the retested portal venous blood stream parameters were normal. Conclusions The normalized intra- and post-operative portal venous blood stream monitoring is a useful tool for the early detection of portal vein complications, the early utilization of useful managements such as intraoperative portal venous embolectomy, interventional balloon dilatation and stenting may effectively treat the portal vein complications, thus minimizing the portal vein complication related graft loss and recipient death.

Clinical study of microvascular invasion on prognosis of recipients after liver transplantation for liver cancer / 器官移植

Objective To evaluate the effect of microvascular invasion (MVI) on prognosis of recipients after liver transplantation for primary liver cancer (liver cancer). Methods Clinical data of 177 recipients after liver transplantation for liver cancer were retrospectively analyzed. All patients were divided into the MVI-positive group (n=64) and MVI-negative group (n=113) according to postoperative pathological examination results. Clinical data were statistically compared of all recipients between the negative and positive MVI groups. The prognosis and risk factors of liver transplantation recipients for liver cancer were analyzed. Results Among 177 recipients, 64 cases (36.2%) were positive for MVI and 113 (63.8%) negative for MVI. Compared with the MVI-negative recipients, MVI-positive recipients had significantly lower degree of tumor differentiation, higher preoperative alpha-fetaprotein (AFP) level, larger maximal tumor diameter, a larger quantity of tumors, more satellite lesions and more recipients who did not meet the Milan criteria (all P < 0.05). The 1-, 3- and 5-year overall survival (OS) and recurrence-free survival (RFS) of recipients after liver transplantation for liver cancer were 80.2%, 62.1%, 58.5% and 66.3%, 57.5%, 51.2%, respectively. The 1-, 3- and 5-year OS and RFS of MVI-positive recipients were 70%, 39%, 35% and 53%, 39%, 33%, significantly lower than 86%, 75%, 72% and 73%, 68%, 63% of their counterparts negative for MVI (all P < 0.05). Cox regression analysis showed that the maximal tumor diameter >8 cm, preoperative AFP level ≥20 ng/mL, low degree of tumor differentiation and positive MVI were the independent risk factors for OS of recipients after liver transplantation for liver cancer (all P < 0.05). Positive MVI, low degree of tumor differentiation and preoperative down-staging failure were the independent risk factors for RFS of recipients after liver transplantation for liver cancer (all P < 0.05). Conclusions MVI is of significant clinical value in predicting clinical prognosis of recipients after liver transplantation for liver cancer.

Analysis of clinical effects of elderly donor liver from organ donation after citizen's death in liver transplantation: a single-center experience / 器官移植

Objective To explore the clinical efficacy of marginal liver from elderly donors in liver transplantation. Methods According to the inclusion and exclusion criteria, the clinical data of 127 donors and recipients were retrospectively analyzed. According to the age of donors, 127 donors were divided into the elderly group (n=27) and control group (n=100). The recovery of liver function, the occurrence of postoperative complications and survival rate of the recipients after transplantation were statistically analyzed between two groups. Results The incidence of primary nonfunction (PNF) and initial poor graft function (IPGF) did not significantly differ between the elderly and control groups (both P > 0.05). Within postoperative 2 weeks, the average levels of alanine aminotransferase (ALT) and serum total bilirubin (TB) of liver transplant recipients in the elderly group was not significantly different from those in the control group (both P > 0.05). There was no significant difference in the incidence of postoperative complications in the postoperative elderly group compared with the control group (all P > 0.05). The 1-and 3-year survival rates of the recipients in the elderly group were 84% and 78% respectively, which did not significantly differ from 89% and 79% in the control group (both P > 0.05). Conclusions Strict and sufficient quality evaluation and functional maintenance should be done for elderly donor livers. It can achieve good transplantation results by intraoperative fine operation, reducing bleeding and trauma, shortening the time of cold ischemia and operation, strengthening postoperative monitoring and implementing enhanced recovery after surgery.

Evaluation of clinical prognosis of liver transplant recipients of hepatocellular carcinoma complicated with microvascular invasion / 器官移植

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.

Multidisciplinary cooperation of achieving the optimal clinical efficacy of pediatric liver transplantation / 器官移植

With the maturity of the technique of adult liver transplantation, pediatric liver transplantation has been gradually emerging in major liver transplantation centers throughout China. Pediatric liver transplantation differs from adult liver transplantation in terms of recipient selection, technical details, perioperative management, postoperative treatment and follow-up, etc. Multidisciplinary cooperation is required to continuously improve the clinical efficacy of pediatric liver transplantation. In this article, we reviewed the significance of multidisciplinary cooperation in achieving the optimal clinical efficacy of pediatric liver transplantation, in respect to the recipient selection and extrahepatic organ function evaluation, mastering the technical key points of different types, improving the quality of postoperative follow-up, and formulating clinical diagnosis and treatment strategies, etc.

Hepatic arterial segmentation and reconstruction during split liver transplantation using pediatric deceased donor / 中华器官移植杂志

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 .

Clinical research of deceased-donor split liver transplantation in pediatric recipients / 中华器官移植杂志

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.

Effect of different liver function Child-Pugh classification on clinical prognosis of hepatocellular carcinoma recipients after liver transplantation / 器官移植

Objective To evaluate the effect of the different Child-Pugh classification on the recurrence and survival of hepatocellular carcinoma (HCC) recipients after liver transplantation. Methods Clinical data of 125 HCC recipients undergoing liver transplantation were retrospectively analyzed. The 3-year disease-free survival (DFS) and overall survival (OS) rates were calculated by Kaplan-Meier survival curve. The independent risk factors probably affecting the recurrence and survival of HCC recipients after liver transplantation were identified by using Cox's proportional hazards regression model. Results The median follow-up time was 25.6 months. The 3-year DFS and OS rates were 68.4% and 65.7% for all patients. The 3-year DFS and OS rates in 113 patients with Child-Pugh class A/B HCC were 68.6% and 66.2%, whereas 66.7% and 65.6% for 12 patients with Child-Pugh class C HCC with no statistical significance (all P>0.05). Cox's proportional hazards regression model demonstrated that vascular invasion (P=0.001)and the number of tumors>3 (P=0.025) were the independent risk factors for the postoperative recurrence of HCC in recipients undergoing liver transplantation. Alpha fetoprotein (AFP)>400μg/L (P=0.035), vascular invasion (P=0.031) and number of tumors>3 (P=0.008) were the independent risk factors affecting the survival of HCC patients. Conclusions The postoperative prognosis does not significantly differ between Child-Pugh class C and A/B HCC patients after liver transplantation. AFP, vascular invasion and number of tumors are the risk factors affecting the clinical prognosis of HCC patients after liver transplantation. Liver transplantation is an efficacious treatment for HCC patients with Child-Pugh class C.

High-throughput sequencing analysis of single nucleotide polymorphism loci mutation in genes associated with acute rejection in liver transplantation / 器官移植

Objective To analyze the mutation of single nucleotide polymorphism (SNP) loci in genes most significantly associated with acute rejection after liver transplantation by high-throughput sequencing. Methods Peripheral blood samples were collected from 68 recipients undergoing allogeneic orthotopic liver transplantation. According to the incidence of acute rejection, all patients were divided into the acute rejection group (n=13) and non-rejection group (n=55). Through the literature review, 44 mutant SNP loci associated with acute rejection were finally identified. Using 44 SNP loci as the detection targets, high-throughput sequencing analysis was performed to detect peripheral blood samples in two groups of recipients. Bioinformatics analysis revealed the mutation rate of the SNP loci of genes related to acute rejection. Results The mutation rate of SNP loci of the interleukin(IL)-10 TT genotype,T allele,AA genotype and A allele in the acute rejection group was significantly higher than that in the non-rejection group. The mutation rate of the SNP loci of the cell chemokine receptor(CCR)5 AG genotype in the acute rejection group was significantly lower than that in the non-rejection group,the mutation rate of the SNP loci of the CCR5 GG genotype in the acute rejection group was significantly higher than that in the non-rejection group.The mutation rate of the SNP loci of IL-4 CT genotype in the acute rejection group was significantly higher than that in the non-rejection group,the mutation rate of the SNP loci of IL-4 TT genotype in the acute rejection group was significantly lower than that in the non-rejection group. The mutation rate of the SNP loci of nuclear factor-kappa B inhibitor alpha(NF-κBIA)C allele in the acute rejection group was significantly higher than that in the non-rejection group.The mutation rate of the SNP loci of vitamin D receptor(VDR)CC genotype and C allele in the acute rejection group was significantly lower than that in the non-rejection group. Differences were statistically significant (all P<0.05). Conclusions High-throughput sequencing analysis shows the genes associated with acute rejection after liver transplantation.Among them,the mutation rate of the SNP loci is relatively high in IL-10 TT genotype,T allele, AA genotype,A allele,CCR5 GG genotype,AG genotype,IL-4 CT genotype,TT genotype,NF-κBIA C allele,VDR CC genotype and C allele.

Peripheral blood immune cells in long-term survival patients after liver transplantation / 中华普通外科杂志

Objective To explore the features of peripheral blood immune cells in long-term survival recipients after liver transplantation.Methods The expression of T subsets (Th1,Th2,Th17,Th22,Tregs),NK cells,NKt cells,Bregs,MDSC in long-term survival recipients (postoperative follow-up time ≥5 years,30 cases),short-term survival recipients(postoperative follow-up time ≤1 year,15 cases) and healthy control (15 cases) were determined by flowcytometry.Results Th17 cells were significantly higher in the long-term group compared with short-term group and healthy control group(P ＜0.01).Tregs in long-term group compared with short-term group were significantly higher (P ＜ 0.01),but the difference was not statistically significant compared with healthy control group (P ＞ 0.05).NK cells were significantly higher in long-term group compared with short-term group and healthy control group (P ＜ 0.01).MDSC were significantly higher in long-term group compared with short-term group and healthy control group (P ＜0.01).Conclusions Th17,Tregs,NK cells and MDSC were significantly higher in long-term survival of liver recipients,which may be related to immune tolerance.

Donor-related risk factors of long-term biliary complications after liver transplantation from organ donation by citizens after death / 中华器官移植杂志

Objective To investigate the donor-related risk factors for long-term biliary complications after liver transplantation (LT) from organ donation by citizens after death.Methods The clinical data of 140 donors who donated the organs after death for LT in the Third Affiliated Hospital of Sun Yat-sen University between April 2016 and April 2017 were retrospectively analyzed.The incidence of long-term biliary complications after LT in the recipients was observed,and the relationship between the incidence and the clinical indexes of the donors was analyzed.The influencing factors for long-term biliary complications after LT were analyzed using univariate and multivariate logistic regression analysis.Results The incidence of long-term biliary complications after LT in the recipients was 9.29％ (13/140).The incidence of donation after cardiac death (DCD) group and donation after brain death (DBD) group was 9.68％ (6/62) and 8.97％ (7/78) respectively.There was no significant difference between the two groups.Univariate logistic regression analysis revealed the long-term biliary complications after LT was related with cerebrovascular accident cause,the second warm ischemia time,steatosis of liver,history of cardiopulmonary resuscitation,dosage of dopamine before procurement and hypoproteinemia.Multivariate logistic regression analysis (removing warm ischemia time) revealed the independent influencing factors for long-term biliary complications after LT from organ donation were the second warm ischemia time (OR =1.106,95％ CI:1.034-1.181;P＜0.05),steatosis of liver (OR =5.319,95％ CI:1.020-27.752;P＜0.05) and dosage of dopamine before procurement (OR =1.279,95％ CI:1.021-1.601;P ＜ 0.05).Conclusion Postoperative long-term biliary complication is one of the major complications after LT from organ donation.The independent risk factors should be strictly controlled,as the second warm ischemia time,steatosis of liver and dosage of dopamine before procurement are contributed to the incidence of long-term biliary complications.

Programmed death receptor(PD)-1 monoclonal antibody-induced acute immune hepatitis in the treatment ;of recurrent hepatocellular carcinoma after liver transplantation:a case report / 器官移植

Objective To explore the safety of programmed death receptor (PD)-1 monoclonal antibody for treatment of hepatocellular carcinoma (HCC)recurrence after liver transplantation.Methods Clinical data of 1 case with acute immune hepatitis induced by PD-1 monoclonal antibody (pembrolizumab)therapy for recurrent HCC after liver transplantation was retrospectively analyzed.Results The patient who received liver transplantation for primary HCC was diagnosed with lung metastasis at 4 months after the transplantation,and treated with the pembrolizumab (1 50 mg intravenous infusion of once)at 1 2 months after transplantation.Liver dysfunction was found at 5 th d after treatment,and liver biopsy was conducted which showed pathological changes of mild to moderate acute rejection.It was diagnosed to be acute immune hepatitis based on the patient 's clinical manifestations,laboratory examination and pembrolizumab drug instructions.After adrenal cortical hormone and intensive immunosuppressive therapy,the patient was followed up for 8 months,which showed that the patient survived with tumor,but the liver function remained abnormal.Conclusions PD-1 monoclonal antibody and other immune checkpoint inhibitors are not suitable for the immunologic suppression after liver transplantation due to the risk of inducing immune hepatitis.

Effect of devascularization and shunt on liver transplantation in patients with portal hypertension / 器官移植

Objective To evaluate the influence of devascularization and shunt on liver transplantation in patients diagnosed with portal hypertension. Methods Clinical data of 182 patients diagnosed with cirrhosis,portal hypertension complicated with hemorrhages caused by esophageal and gastric varices rupture undergoing liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University from January 2007 to December 201 1 were retrospectively analyzed. Nineteen patients undergoing splenectomy plus pericardial devascularization were assigned into the devascularization group,5 receiving distal spleen-renal vein shunt into the shunt group,and the remaining 158 cases with no history of devascularization or shunt into the control group. Preoperative incidence of pylethrombosis,operation time,intraoperative hemorrhage volume,the maximal blood flow velocity (Vmax )of portal vein anastomotic stoma at postoperative 1 month,postoperative incidence of pylethrombosis and 3-year survival rate were statistically compared among three groups. Results In the devascularization group,preoperative incidence of pylethrombosis was significantly higher compared with that in the control group(P<0.01).Compared with the control group,operation time of liver transplantation in the devascularization and shunt groups was significantly longer (both P<0.05 ). The incidence of pylethrombosis at postoperative 1 month was considerably enhanced in the devascularization group (P <0.05 ). The 3-year survival rates of devascularization group and shunt group were dramatically decreased compared with that of control group (both P<0.05 ). Intraoperative hemorrhage volume and Vmax of portal vein anastomotic stoma did not significantly differ among three groups (all P>0.05 ). Conclusions The medical history of devascularization or shunt will not cause severe difficulty or surgical risk to subsequent liver transplantation in patients with portal hypertension.

Effect of preoperative portal venous thrombosis on liver transplantation for patients with end-stage liver cirrhosis / 器官移植

Objective To investigate the effect of preoperative portal venous thrombosis on liver transplantation for patients with end-stage liver cirrhosis.Methods Clinical data of 182 patients with end-stage liver cirrhosis undergoing liver transplantation at the Organ Transplantation Center of the Third Affiliated Hospital,Sun Yat-sen University from January 2007 to December 2011 were retrospectively studied.Thirteen patients complicated with portal venous thrombosis (3 patients were in Yerdel gradeⅠ,6 were in grade Ⅱ,2 were in grade Ⅲ and 2 were in grade Ⅳ)were divided into the portal venous thrombosis group.Other 169 patients without portal venous thrombosis were divided into the control group. The intra-operative and postoperative conditions of patients were compared between two groups.Results Compared with the control group,there were longer operation time,more intra-operative blood loss in the portal venous thrombosis group and the patient with Yerdel grade Ⅲ-Ⅳ.There was significant difference (both in P <0.05).At one month after transplantation,one patient (8%)in the portal venous thrombosis group and three patients (2%)in the control group developed portal venous thrombosis,and there was significant difference (P <0.05).Three-year survival rate of the portal venous thrombosis group was 46% (6 /13)and that of the control group was 84%(142 /169),and there was significant difference (P <0.05).Conclusions Portal venous thrombosis of gradeⅢ and Ⅳ may significantly increase the difficulty and risks of liver transplantation.However,the good curative effect may also be obtained only when the portal venous thrombosis is strictly assessed ,and the rational portal venous reconstruction method is used during the operation.

Treatment of liver transplantation on acute liver failure of pregnancy:a report of two cases and literature review / 器官移植

Objective To investigate the curative effect of liver transplantation on acute liver failure of pregnancy.Methods Clinical data of 2 patients with acute liver failure of pregnancy undergoing liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University from March 2004 to June 201 5 were retrospectively studied.Results The patient of case 1 developed subacute liver failure and underwent emergency liver transplantation,because chronic viral hepatitis B (HBV)progressed quickly after natural delivery.The patient of case 2 developed acute liver failure with unknown etiology,and underwent subtotal hysterectomy by the obstetrician on the following day of emergency liver transplantation because the intrauterine fetus was dead. The two patients were given tacrolimus (FK506 ) and adrenocortical hormone as the postoperative early immunosuppressive regimen.Anti-HBV treatment was enhanced for the patient of case 1 with the antivirus regimen of entecavir combined with hepatitis B immune globulin.The patient of case 1 was willing to continue pregnancy,so the minimal dose of a single immunosuppressant was used when the graft function was stable.The patient of case 2 had no ability of pregnancy and underwent routine postoperative management.The two patients were followed up till the date of submission and they recovered well.The patient of case 1 had no recurrence of HBV and delivered a baby boy successfully.Conclusions Liver transplantation on acute liver failure of pregnancy may obtain good curative effect.

Establishing a model of oxidative damage of L02 hepatocytes in vitro / 器官移植

Objective To investigate the method of establishing a model of oxidative damage of L02 hepatocytes. Methods L02 hepatocytes were cultured divided into 3 h damage group,6 h group and 12 h group. Each group was divided into 6 subgroups according to different concentrations of hydrogen peroxide (H2 O2 )added:100,200,300,500,750,1 000 μmol/L. The control group was treated without H2 O2. All groups were tested with cell counting kit (CCK)-8 after incubating for 3 h,6 h or 12 h respectively. The other L02 hepatocytes were cultured and divided into 3 h damage group,6 h group and 12 h group. The 3 h group was divided into 5 subgroups according to different concentrations of H2 O2 added:100,200,300,500 and 750 μmol/L,the 6 h group was divided into 4 subgroups according to different concentrations of H2 O2 added:100,200,300 and 500 μmol/L,and the 12 h group was divided into 3 subgroups according to different concentrations of H2 O2 added:100,200 and 300 μmol/L. The control group was treated without H2 O2. All groups were tested by flow cytometry with Annexin V-fluorescein isothiocyanate(FITC)/propidium iodide(PI) double staining after incubating for 3 h,6 h or 12 h respectively. The model of oxidative damage of L02 hepatocytes was established and identified. The L02 hepatocytes in damage group were treated with 200 μmol/L H2 O2 after culture and L02 hepatocytes in control group were treated without H2 O2 after culture. Indicators such as mitochondrial membrane potential,malondialdehyde (MDA ),oxygen free radical (ROS ),superoxide dismutase (SOD),alanine aminotransferase (ALT),aspartate aminotransferase (AST)were tested after L02 hepatocytes were incubated for 6 h. Results Compared with control group,significant differences were observed in cell survival rates of 200,300,500,750 and 1 000 μmol/L subgroup in 3 h damage group (all in P<0.01). So were in 6 h damage group and 12 h damage group (all in P<0.01). The correlation coefficient between H2 O2 concentration and cell viability was -0.993 in 3 h group,-0.955 in 6 h group,and -0.819 in 12 h group. Flow cytometry with Annexin V-FITC/PI double staining was used to detect the apoptosis/necrosis of L02 hepatocytes when treated with different concentrations and actuation duration of H2 O2. In 3 h, 6 h and 12 h damage group,significant differences were observed between damage subgroups and control groups (all in P<0.01). The correlation coefficients between H2O2 concentration and cell apoptosis/necrosis in 3 h, 6 h and 12 h group were 0.971,0.992 and 0.986 respectively. Compared with control group,significant differences were observed in mitochondrial membrane potential,MDA,ROS,SOD,ALT,and AST in damage group after treated with 200μmol/L H2O2 for 6 h(all in P<0.01). Conclusions L02 hepatocytes treating with 200μmol/L H2 O2 for 6 h is an appropriate model simulating the ischemia-reperfusion or oxidative damage in vitro.

Long-term follow-up and outcome of patients who survived more than 7 years after liver transplantation:a single-center analysis / 中华器官移植杂志

Objective To investigate the occurrence and prevention measures of long term complications in long term survival recipients after liver transplantation.Methods In the recipients undergoing liver transplantation from Sept. 2003 to Dec. 2004,by Nov. 30,2011,there were 62 cases with the survival time more than seven years.The clinical data and follow up examination results of these 62 cases were retrospectively,including weight,blood pressure,blood sugar,blood lipids,and liver and kidney functions. The incidence of long-term complications was statistically tested.Results Postoperative metabolic complications including overweight or obese occurred in 21 cases (33.9％), new onset diabetes in18 patients (29％), hyperlipidemia in 17 cases (27.4％),hypertension in 9 cases ( 14.5 ％ ),and kidney dysfunction in 12 patients ( 19.4％ ).The incidence of diabetes and hyperlipidemia in the patients with overweight and diabetes (respectively 52.4％ and 42.9％) was significantly higher than in the normal weight group (respectively 17.1 ％ and 19.5 ％)(P＜0.05).In 58 recipients with primary diseases of hepatitis B-related liver diseases,one case had hepatitis B virus reinfection. In 17 recipients with primary disease of primary liver cancer,tumor recurrence occurred in 2 cases.During the follow up period,4 patients received liver re-transplantation due to hepatic artery stenosis (1 case) or biliary complications-induced loss of the transplanted liver function (3 cases).Conclusion The major complications of the long term survival recipients after liver transplantation are metabolic complications and primary disease relapse. Postoperative long-term follow up and monitoring of recipients is recommended to prevent and treat a variety of long-term complications.

Comparsion of PTC and ERCP for the treatment of biliary tract stricture after liver transplantation / 中华普通外科杂志

Objective To compare the efficacy of percutaneous and endoscopic treatment for the biliary stricture(BS) after liver transplantation (LT).Methods The result of percutaneous transhepatic cholangiography (PTC) and drainage ( PTC group) and endoscopic retrograde cholangiopancreatography (ERCP group) for the BS in 132 post-LT patients were analyzed retrospectively.Ninety-nine patients received PTC treatment,and 59 patients received ERCP treatment,26 patients converted to PTC treatment because of the poor efficacy or failure of the ERCP treatment.The operation success rate,complication rate,cure rate and remission rate of the two groups were compared with X2 test.Results The BS types of PTC and ERCP group were different significantly( P ＜ 0.01 ),with more non-anostomotic stricture in PTC group and more anostomotic stricture in ERCP group.The operation success rate of PTC group was higher than of ERCP group( 100％ vs 97％ ) (P ＜0.01 ),and the complication rate of PTC group was lower than of ERCP group.The overall cure and remission rate of PTC and ERCP group were not different significantly(32.3％ vs 45.8％,94.9％ vs 88.1％ ) (P ＞0.05).The cure and remission rate of PTC and ERCP treatment for each subtype of BS were not different significantly ( P ＞ 0.05 ).Conclusions The efficacy of PTC treatment for the post-LT BS is equivalent to that of ERCP treatment.PTC can be considered the first-line option for the post-LT BS.