BACKGROUND:Left liver graft from a small donor will not meet the metabolic demands of a larger adult recipient. To overcome the problem of graft size insufficiency,living donor liver transplantation(LDLT) using the ri...BACKGROUND:Left liver graft from a small donor will not meet the metabolic demands of a larger adult recipient. To overcome the problem of graft size insufficiency,living donor liver transplantation(LDLT) using the right lobe has become a standard method for adult patients. As the drainage of the median sector(segments Ⅴ,Ⅷ and Ⅳ) is mainly by the middle hepatic vein(MHV),the issue of whether the MHV should or should not be taken with the graft or whether the MHV tributaries(Ⅴ5,Ⅴ8) should be reconstructed in the recipient remains to be settled. DATA SOURCES:An English-language literature search was conducted using MEDLINE(1985-2006) on right lobe living donor liver transplantation,middle hepatic vein,vein graft,hepatic venoplasty and other related subjects. RESULTS:Some institutions had proposed their policy for the management of the MHV and its tributaries. Dominancy of the hepatic vein,graft-to-recipient weight ratio,and remnant liver volume as well as the donor-to-recipient body weight ratio,the volume of the donor's right lobe to the recipient's standard liver volume and the size of MHV tributaries are the major elements for the criteria of inclusion of the MHV,while for the policy of MHV tributaries reconstruction,the proportion of congestive area and the diameter of the tributaries are the critical elements. Optimal vein grafts such as recipient's portal vein and hepatic venoplasty technique have been used to obviate hepatic congestion and venous drainage disturbance.CONCLUSIONS:Taking right liver grafts with the MHV trunk(extended right lobe grafts) or performing the MHV tributaries reconstruction in modified right lobe grafts,according to the criteria proposed by the institutions with rich experience,can solve the congestion problem of the right paramedian sector and help to improve the outcomes of the patients. The additional use of optimal vein grafts and hepatic venoplasty also can guarantee excellent venous drainage.展开更多
BACKGROUND:Acute kidney injury(AKI)is a common complication in the early period after liver transplantation(LT),posing an enormous obstacle to treatment efficiency and patient survival.However,the exact influencing fa...BACKGROUND:Acute kidney injury(AKI)is a common complication in the early period after liver transplantation(LT),posing an enormous obstacle to treatment efficiency and patient survival.However,the exact influencing factors of AKI are still unclear and a predictive model is desperately required in the clinic.METHODS:Data of 102 consecutive LTs were reviewed.A model for predicting AKI was established and further validated in a prospective study of 44 patients receiving LT.RESULTS:The incidence of AKI was 32.4%.AKI patients showed a significantly lower survival rate than non-AKI patients.Multivariate analysis demonstrated the independent influencing factors of AKI were preoperative serum creatinine>1.2 mg/dl,intraoperative urine output≤60 ml/h, intraoperative hypotension status,and intraoperative use of noradrenaline.A model was then established and showed a sensitivity of 75.0%,a specificity of 93.8%,and an accuracy of 88.6%in predicting AKI.CONCLUSIONS:High preoperative serum creatinine,low intraoperative urine output,and intraoperative hypotension contribute to the development of AKI,and intraoperative use of noradrenaline serves as a protective factor.The predictive model could potentially facilitate early prediction and surveillance of AKI.展开更多
BACKGROUND:Hepatic artery(HA) reconstruction is one of the key steps for living donor liver transplantation(LDLT).The incidence of HA thrombosis has been reduced by the introduction of microsurgical techniques under a...BACKGROUND:Hepatic artery(HA) reconstruction is one of the key steps for living donor liver transplantation(LDLT).The incidence of HA thrombosis has been reduced by the introduction of microsurgical techniques under a high resolution microscope or loupe.METHODS:We report our experience in 101 cases of HA reconstruction in LDLTs using the graft-artery-unclamp and posterior-wall-first technique.The reconstructions were completed by either a plastic surgeon or a transplant surgeon.RESULTS:The rate of HA thrombosis was 2%(2/101).The risk factors for failed procedures appeared to be reduced by participation of the transplant surgeon compared with the plastic surgeon.For a graft with duplicate arteries,we considered no branches should be discarded even with a positive clamping test.CONCLUSIONS:HA reconstruction without clamping the graft artery is a feasible and simplified technique,which can be mastered by transplant surgeons with considerable microsurgical training.展开更多
BACKGROUND:The discrepancy between available livers and requests for transplantation has forced many centers to use marginal donors in order to expand the donor pool. Many previous studies have demonstrated controvers...BACKGROUND:The discrepancy between available livers and requests for transplantation has forced many centers to use marginal donors in order to expand the donor pool. Many previous studies have demonstrated controversial results of the application of steatotic liver grafts.The aim of the present study was to summarize our experience and evaluate the value of steatotic liver grafts. METHODS:The clinical and follow-up data of 24 adult patients receiving moderately steatotic liver grafts (30%-60%)from May 2003 to June 2005(group 1)were analyzed.After matching for age,gender,model for end- stage liver diseases score and cold ischemia time,another 24 patients receiving liver grafts with steatosis less than 30% were chosen as the control group(group 2).The patient and graft outcomes were compared between the two groups. RESULTS:No difference of liver and kidney functions in the first post-transplant week was found between the two groups(P>0.05).Neither the incidence of early allograft dysfunction and acute kidney injury nor the patient survival rates(3 months,6 months and 1 year)showed differences between groups 1 and 2(P>0.05). CONCLUSION:Moderately steatotic liver grafts provide adequate function in the first phase after transplantation and can be used for transplantation.展开更多
BACKGROUND:Glycogen storage disease(GSD)is an inherited metabolic disorder in which the concentration and/or structure of glycogen in tissues is abnormal. Essentially,abnormalities in all known enzymes involved in the...BACKGROUND:Glycogen storage disease(GSD)is an inherited metabolic disorder in which the concentration and/or structure of glycogen in tissues is abnormal. Essentially,abnormalities in all known enzymes involved in the synthesis or degradation of glycogen and glucose have been found to cause some type of GSD.Liver and muscle have abundant quantities of glycogen and are the most common and seriously affected tissues.This study was to assess reduced-size liver transplantation for the treatment of GSD. METHODS:The clinical data from one case of GSD type Ⅰwith hepatic adenoma was retrospectively analyzed.The clinical manifestations were hepatomegaly,delayed puberty, growth retardation,sexual immaturity,hypoglycemia,and lactic acidosis,which made the young female patient eligible for reduced-size liver transplantation. RESULTS:The patient recovered uneventfully with satisfactory outcome,including 12 cm growth in height and 5 kg increase in weight during 16 months after successful reduced-size liver transplantation.She has been living a normal life for 4 years so far. CONCLUSIONS:Reduced-size liver transplantation is an effective treatment for GSD with hepatomegaly and hepatic adenoma.Delayed puberty,growth retardation, hypoglycemia and lactic acidosis can be cured by surgery.展开更多
BACKGROUND:Liver transplantation(LT)is an effective therapy for end-stage hepatitis B virus(HBV)infection. Recurrence of HBV is one of the frequent complications.In the present study,we investigated whether human leuk...BACKGROUND:Liver transplantation(LT)is an effective therapy for end-stage hepatitis B virus(HBV)infection. Recurrence of HBV is one of the frequent complications.In the present study,we investigated whether human leukocyte antigen(HLA)matching influences the incidence of HBV recurrence,and the time point of HBV recurrence after LT. METHODS:One hundred and two recipients of LT with end-stage chronic HBV infection were reviewed.The triple- drug immunosuppression regimen consisted of tacrolimus,mycophenolate,and prednisone.All patients were subjected to prophylaxis with hepatitis B immunoglobulin and lamivudine. HLA typing was performed using a sequence-specific primer- polymerase chain reaction kit.Serology for hepatitis B and HBV DNA was examined using a commercial kit. RESULTS:The incidence of recurrent HBV infection post-LT was 6.86%.The recurrent infection of HBV was independent of the degree of HLA matching(P>0.05).The time point of HBV recurrence,however,was prolonged in HLA-A matched patients compared with matchless patients(P=0.049).The recurrence of HBV infection was independent of HLA compatibility. CONCLUSIONS:This retrospective analysis showed that more HLA-A locus compatibility is associated with a prolonged time of recurrence of HBV in patients after LT for end-stage HBV infection.The incidence of HBV recurrence is independent of HLA compatibility.展开更多
BACKGROUND:Hepatic artery thrombosis(HAT)is a frequent complication following liver transplantation,but it is rarely caused by arcuate ligament compression of the celiac artery.This article mainly describes our experi...BACKGROUND:Hepatic artery thrombosis(HAT)is a frequent complication following liver transplantation,but it is rarely caused by arcuate ligament compression of the celiac artery.This article mainly describes our experience in managing a patient with celiac artery stenosis and HAT after liver transplantation. METHODS:A 44-year-old man with a 15-year history of hepatitis B was admitted to our hospital for hepatocellular carcinoma.Before the operation,he received trans- arterial chemoembolization once,and pretransplant MR angiography indicated a suspected stenosis at the initiation of the celiac artery,while color Doppler showed normal blood flow in the arterial system.In this case,orthotopic liver transplantation was performed for radical cure of hepatocellular carcinoma.However,B-ultrasonography detected poor blood flow in the intra-and extra-hepatic artery on the first posttransplant day,and during exploratory laparotomy a thrombus was found in the hepatic artery.Thus,re-transplantation was conducted with a bypass between the graft hepatic artery and the recipient abdominal aorta with the donor's splenic artery. RESULTS:The patient made an uneventful recovery and color Doppler showed good blood flow in the artery and portal system.Histology confirmed extensive thrombosis in the left and right hepatic artery of the explanted graft, indicating HAT.CONCLUSIONS:Although HAT caused by celiac trunk compression is rarely reported in liver transplantation, the diagnosis should be considered in patients with pretransplant hepatic artery stenosis on angiography and abnormal blood flow on B-ultrasonography.Once HAT is formed,treatment such as thrombectomy or re- transplantation should be performed as early as possible.展开更多
BACKGROUND:Cardiac output monitoring is important for critical patients. This study aimed to determine the delayed response of continuous cardiac output (CCO) thermodilution measurement, whether CCO and bolus cardiac ...BACKGROUND:Cardiac output monitoring is important for critical patients. This study aimed to determine the delayed response of continuous cardiac output (CCO) thermodilution measurement, whether CCO and bolus cardiac output (BCO) thermodilution agree sufficiently to be used interchangeably, and whether CCO monitoring is reliable for patients undergoing liver transplantation. METHODS: Thirteen patients undergoing liver transplan- tation without veno-venous bypass were studied (37-66 years old, weight 46-75 kg). Continuous and bolus thermodilution measurements were performed at predefined time points using an "Opti-Q" SvO2/CCO monitor (Abbott Laboratories, North Chicago, IL, USA). Bias and 95% limits of agreement were calculated according to Bland and Altman analysis. The limits of agreement by which two methods are judged to be interchangeable were defined in advance as ±(13%× BCOmean) L/min. The repeatability and relative error of CCO, and the differences between CCO and the mean of the two measurements were calculated. RESULTS: Cardiac output measurements yielded 196 data pairs with ranges of 1.9 to 17.9 L/min for CCO and 2.1 to 18.3 L/min for BCO. The response time of CCO was delayed in the early phases after caval clamping and after reperfusion. At most of the measurement points, bias and 95% limits of agreement were -0.18±1.91 L/min. 95% limits of agreement did not fall within the predetermined limits of agreement of ±1.14 L/min. The repeatability coefficient of CCO was 0.36 L/min and the relative error was 4.6±4.7%. The mean difference between CCO and the average of the two methods was -0.09 L/min (0.49 L/min).CONCLUSIONS: In patients undergoing liver transplan- tation, the delayed response of CCO limits its application during the early phases after caval clamping and after reperfusion of the graft. The two methods are not interchangeable even in hemodynamic stability. Continuous thermodilution monitoring, however, is reliable or acceptable for clinical purposes.展开更多
基金This study was supported by a grant from the National Key Basic Research Program (973) of China (No. 2003 CB515501) Important Project from Science and Technology Department of Zhejiang Province (No. 021103699).
文摘BACKGROUND:Left liver graft from a small donor will not meet the metabolic demands of a larger adult recipient. To overcome the problem of graft size insufficiency,living donor liver transplantation(LDLT) using the right lobe has become a standard method for adult patients. As the drainage of the median sector(segments Ⅴ,Ⅷ and Ⅳ) is mainly by the middle hepatic vein(MHV),the issue of whether the MHV should or should not be taken with the graft or whether the MHV tributaries(Ⅴ5,Ⅴ8) should be reconstructed in the recipient remains to be settled. DATA SOURCES:An English-language literature search was conducted using MEDLINE(1985-2006) on right lobe living donor liver transplantation,middle hepatic vein,vein graft,hepatic venoplasty and other related subjects. RESULTS:Some institutions had proposed their policy for the management of the MHV and its tributaries. Dominancy of the hepatic vein,graft-to-recipient weight ratio,and remnant liver volume as well as the donor-to-recipient body weight ratio,the volume of the donor's right lobe to the recipient's standard liver volume and the size of MHV tributaries are the major elements for the criteria of inclusion of the MHV,while for the policy of MHV tributaries reconstruction,the proportion of congestive area and the diameter of the tributaries are the critical elements. Optimal vein grafts such as recipient's portal vein and hepatic venoplasty technique have been used to obviate hepatic congestion and venous drainage disturbance.CONCLUSIONS:Taking right liver grafts with the MHV trunk(extended right lobe grafts) or performing the MHV tributaries reconstruction in modified right lobe grafts,according to the criteria proposed by the institutions with rich experience,can solve the congestion problem of the right paramedian sector and help to improve the outcomes of the patients. The additional use of optimal vein grafts and hepatic venoplasty also can guarantee excellent venous drainage.
基金supported by a grant from the Projects of Ministry of Public Health(No.20082006)
文摘BACKGROUND:Acute kidney injury(AKI)is a common complication in the early period after liver transplantation(LT),posing an enormous obstacle to treatment efficiency and patient survival.However,the exact influencing factors of AKI are still unclear and a predictive model is desperately required in the clinic.METHODS:Data of 102 consecutive LTs were reviewed.A model for predicting AKI was established and further validated in a prospective study of 44 patients receiving LT.RESULTS:The incidence of AKI was 32.4%.AKI patients showed a significantly lower survival rate than non-AKI patients.Multivariate analysis demonstrated the independent influencing factors of AKI were preoperative serum creatinine>1.2 mg/dl,intraoperative urine output≤60 ml/h, intraoperative hypotension status,and intraoperative use of noradrenaline.A model was then established and showed a sensitivity of 75.0%,a specificity of 93.8%,and an accuracy of 88.6%in predicting AKI.CONCLUSIONS:High preoperative serum creatinine,low intraoperative urine output,and intraoperative hypotension contribute to the development of AKI,and intraoperative use of noradrenaline serves as a protective factor.The predictive model could potentially facilitate early prediction and surveillance of AKI.
基金supported by Projects of the Ministry of Public Health(No.200802006)the National Natural Science Foundation of China(No.N10741)the Program of Science and Technology Bureau of Zhejiang Province(No.2008C14028 and No.2006C13020)
文摘BACKGROUND:Hepatic artery(HA) reconstruction is one of the key steps for living donor liver transplantation(LDLT).The incidence of HA thrombosis has been reduced by the introduction of microsurgical techniques under a high resolution microscope or loupe.METHODS:We report our experience in 101 cases of HA reconstruction in LDLTs using the graft-artery-unclamp and posterior-wall-first technique.The reconstructions were completed by either a plastic surgeon or a transplant surgeon.RESULTS:The rate of HA thrombosis was 2%(2/101).The risk factors for failed procedures appeared to be reduced by participation of the transplant surgeon compared with the plastic surgeon.For a graft with duplicate arteries,we considered no branches should be discarded even with a positive clamping test.CONCLUSIONS:HA reconstruction without clamping the graft artery is a feasible and simplified technique,which can be mastered by transplant surgeons with considerable microsurgical training.
基金supported by Projects of Ministry of Public Health(No.20082006)Major Program of Science and Technology Bureau of Zhejiang Province(No.2006C13020)
文摘BACKGROUND:The discrepancy between available livers and requests for transplantation has forced many centers to use marginal donors in order to expand the donor pool. Many previous studies have demonstrated controversial results of the application of steatotic liver grafts.The aim of the present study was to summarize our experience and evaluate the value of steatotic liver grafts. METHODS:The clinical and follow-up data of 24 adult patients receiving moderately steatotic liver grafts (30%-60%)from May 2003 to June 2005(group 1)were analyzed.After matching for age,gender,model for end- stage liver diseases score and cold ischemia time,another 24 patients receiving liver grafts with steatosis less than 30% were chosen as the control group(group 2).The patient and graft outcomes were compared between the two groups. RESULTS:No difference of liver and kidney functions in the first post-transplant week was found between the two groups(P>0.05).Neither the incidence of early allograft dysfunction and acute kidney injury nor the patient survival rates(3 months,6 months and 1 year)showed differences between groups 1 and 2(P>0.05). CONCLUSION:Moderately steatotic liver grafts provide adequate function in the first phase after transplantation and can be used for transplantation.
文摘BACKGROUND:Glycogen storage disease(GSD)is an inherited metabolic disorder in which the concentration and/or structure of glycogen in tissues is abnormal. Essentially,abnormalities in all known enzymes involved in the synthesis or degradation of glycogen and glucose have been found to cause some type of GSD.Liver and muscle have abundant quantities of glycogen and are the most common and seriously affected tissues.This study was to assess reduced-size liver transplantation for the treatment of GSD. METHODS:The clinical data from one case of GSD type Ⅰwith hepatic adenoma was retrospectively analyzed.The clinical manifestations were hepatomegaly,delayed puberty, growth retardation,sexual immaturity,hypoglycemia,and lactic acidosis,which made the young female patient eligible for reduced-size liver transplantation. RESULTS:The patient recovered uneventfully with satisfactory outcome,including 12 cm growth in height and 5 kg increase in weight during 16 months after successful reduced-size liver transplantation.She has been living a normal life for 4 years so far. CONCLUSIONS:Reduced-size liver transplantation is an effective treatment for GSD with hepatomegaly and hepatic adenoma.Delayed puberty,growth retardation, hypoglycemia and lactic acidosis can be cured by surgery.
基金supported by grants from the National Basic Research Program of China(2007CB513005)the NationalNatural Science Foundation of China(30872239)+1 种基金Key Projects in the National Science&Technology Pillar Program in the Eleventh Five-year Plan Period(2008BA160B03)Zhejiang Health Science foundation(2009A083)
文摘BACKGROUND:Liver transplantation(LT)is an effective therapy for end-stage hepatitis B virus(HBV)infection. Recurrence of HBV is one of the frequent complications.In the present study,we investigated whether human leukocyte antigen(HLA)matching influences the incidence of HBV recurrence,and the time point of HBV recurrence after LT. METHODS:One hundred and two recipients of LT with end-stage chronic HBV infection were reviewed.The triple- drug immunosuppression regimen consisted of tacrolimus,mycophenolate,and prednisone.All patients were subjected to prophylaxis with hepatitis B immunoglobulin and lamivudine. HLA typing was performed using a sequence-specific primer- polymerase chain reaction kit.Serology for hepatitis B and HBV DNA was examined using a commercial kit. RESULTS:The incidence of recurrent HBV infection post-LT was 6.86%.The recurrent infection of HBV was independent of the degree of HLA matching(P>0.05).The time point of HBV recurrence,however,was prolonged in HLA-A matched patients compared with matchless patients(P=0.049).The recurrence of HBV infection was independent of HLA compatibility. CONCLUSIONS:This retrospective analysis showed that more HLA-A locus compatibility is associated with a prolonged time of recurrence of HBV in patients after LT for end-stage HBV infection.The incidence of HBV recurrence is independent of HLA compatibility.
文摘BACKGROUND:Hepatic artery thrombosis(HAT)is a frequent complication following liver transplantation,but it is rarely caused by arcuate ligament compression of the celiac artery.This article mainly describes our experience in managing a patient with celiac artery stenosis and HAT after liver transplantation. METHODS:A 44-year-old man with a 15-year history of hepatitis B was admitted to our hospital for hepatocellular carcinoma.Before the operation,he received trans- arterial chemoembolization once,and pretransplant MR angiography indicated a suspected stenosis at the initiation of the celiac artery,while color Doppler showed normal blood flow in the arterial system.In this case,orthotopic liver transplantation was performed for radical cure of hepatocellular carcinoma.However,B-ultrasonography detected poor blood flow in the intra-and extra-hepatic artery on the first posttransplant day,and during exploratory laparotomy a thrombus was found in the hepatic artery.Thus,re-transplantation was conducted with a bypass between the graft hepatic artery and the recipient abdominal aorta with the donor's splenic artery. RESULTS:The patient made an uneventful recovery and color Doppler showed good blood flow in the artery and portal system.Histology confirmed extensive thrombosis in the left and right hepatic artery of the explanted graft, indicating HAT.CONCLUSIONS:Although HAT caused by celiac trunk compression is rarely reported in liver transplantation, the diagnosis should be considered in patients with pretransplant hepatic artery stenosis on angiography and abnormal blood flow on B-ultrasonography.Once HAT is formed,treatment such as thrombectomy or re- transplantation should be performed as early as possible.
文摘BACKGROUND:Cardiac output monitoring is important for critical patients. This study aimed to determine the delayed response of continuous cardiac output (CCO) thermodilution measurement, whether CCO and bolus cardiac output (BCO) thermodilution agree sufficiently to be used interchangeably, and whether CCO monitoring is reliable for patients undergoing liver transplantation. METHODS: Thirteen patients undergoing liver transplan- tation without veno-venous bypass were studied (37-66 years old, weight 46-75 kg). Continuous and bolus thermodilution measurements were performed at predefined time points using an "Opti-Q" SvO2/CCO monitor (Abbott Laboratories, North Chicago, IL, USA). Bias and 95% limits of agreement were calculated according to Bland and Altman analysis. The limits of agreement by which two methods are judged to be interchangeable were defined in advance as ±(13%× BCOmean) L/min. The repeatability and relative error of CCO, and the differences between CCO and the mean of the two measurements were calculated. RESULTS: Cardiac output measurements yielded 196 data pairs with ranges of 1.9 to 17.9 L/min for CCO and 2.1 to 18.3 L/min for BCO. The response time of CCO was delayed in the early phases after caval clamping and after reperfusion. At most of the measurement points, bias and 95% limits of agreement were -0.18±1.91 L/min. 95% limits of agreement did not fall within the predetermined limits of agreement of ±1.14 L/min. The repeatability coefficient of CCO was 0.36 L/min and the relative error was 4.6±4.7%. The mean difference between CCO and the average of the two methods was -0.09 L/min (0.49 L/min).CONCLUSIONS: In patients undergoing liver transplan- tation, the delayed response of CCO limits its application during the early phases after caval clamping and after reperfusion of the graft. The two methods are not interchangeable even in hemodynamic stability. Continuous thermodilution monitoring, however, is reliable or acceptable for clinical purposes.
