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:Because of the shortage of deceased donors with livers fit for transplantation,living donor liver transplantation(LDLT)is becoming an attractive alternative.Attention should be paid to the donors,especially...BACKGROUND:Because of the shortage of deceased donors with livers fit for transplantation,living donor liver transplantation(LDLT)is becoming an attractive alternative.Attention should be paid to the donors,especially to those of the right lobe.In this study,we evaluated the risks faced by donors of the right lobe for adult-to-adult LDLT.METHODS:The perioperative data from 105 consecutive living donors of the right lobe performed in West China Hospital from January 2002 to December 2007 were retrospectively studied.Preoperative evaluation included CT,MRCP,and intraoperative cholangiography,showing liver volume,hepatic vasculature and the biliary system.The standard liver volume(SLV)and the ratio of left lobe volume to SLV were calculated.The right lobe grafts were obtained by transecting the liver on the right side of the middle hepatic vein without inflow vascular occlusion,using an ultrasonic dissector.After operation the donors were monitored in the Intensive Care Unit for about three days.Each donor was followed up for at least 6 months.RESULTS:There was no donor mortality.Major complications occurred in 14 donors(13.3%),of whom 3 received conservative treatment,8 required invasive paracentesis,and 3 required further surgery.All donors were recovered well and resumed their previous occupations.CONCLUSIONS:Donors of the right lobe face low risks.The preoperative evaluation,especially evaluation of the volume of the remnant liver,should be exact.During the operation,the patency of the remnant hepatic vasculature and bile duct must be preserved,and the extent of injury to the remnant liver should be limited as much as possible.The detection and treatment of postoperative complications should be diligently performed.展开更多
Background: The efficacy and necessity of middle hepatic vein(MHV) reconstruction in adult-to-adult right lobe living donor liver transplantation(LDLT) remain controversial. The present study aimed to evaluate the sur...Background: The efficacy and necessity of middle hepatic vein(MHV) reconstruction in adult-to-adult right lobe living donor liver transplantation(LDLT) remain controversial. The present study aimed to evaluate the survival beneficiary of MHV reconstructions in LDLT. Methods: We compared the clinical outcomes of liver recipients with MHV reconstruction( n = 101) and without MHV reconstruction( n = 43) who underwent LDLT using right lobe grafts at our institution from January 2006 to May 2017. Results: The overall survival(OS) rate of recipients with MHV reconstruction was significantly higher than that of those without MHV reconstruction in liver transplantation( P = 0.022; 5-yr OS: 76.2% vs 58.1%). The survival of two segments(segments 5 and 8) hepatic vein reconstruction was better than that of the only one segment(segment 5 or segment 8) hepatic vein reconstruction( P = 0.034; 5-yr OS: 83.6% vs 67.4%). The survival of using two straight vascular reconstructions was better than that using Y-shaped vascular reconstruction in liver transplantation with two segments hepatic vein reconstruction( P = 0.020; 5-yr OS: 100% vs 75.0%). The multivariate analysis demonstrated that MHV tributary reconstructions were an independent beneficiary prognostic factor for OS(hazard ratio = 0.519, 95% CI: 0.282–0.954, P = 0.035). Biliary complications were significantly increased in recipients with MHV reconstruction(28.7% vs 11.6%, P = 0.027). Conclusions: MHV reconstruction ensured excellent outflow drainage and favored recipient outcome. The MHV tributaries(segments 5 and 8) should be reconstructed as much as possible to enlarge the hepatic vein anastomosis and reduce congestion.展开更多
Objective: To review the experience of donor selec-tion and right lobe hepatectomy in adult-to-adult livedonor liver transplantation.Methods: From May 1996 to December 2001, 89 livedonor liver transplants using right ...Objective: To review the experience of donor selec-tion and right lobe hepatectomy in adult-to-adult livedonor liver transplantation.Methods: From May 1996 to December 2001, 89 livedonor liver transplants using right lobe grafts wereperformed at Queen Mary Hospital, Hong Kong. Alldonors had received psychological counseling beforedonor operations. They were screened by laboratorytests including complete blood cell count, liver andrenal biochemistry, and viral serology studies. Com-puted tomography (CT), CT volumetry and hepaticarteriography were routinely performed. All donorsunderwent the operations using the method designedby us.Results: The median duration of the operations was8.8 hours. The median blood loss recorded 466 ml.The median intensive care unit and hospital stayswere 2 and 10 days, respectively. There was no do-nor mortality. Complications of donor operations in-cluded wound infection, urinary tract infection, bili-ary stricture, cholestasis, subphrenic collection,bowel obstruction and incision hernia, etc. All do-nors have recovered and returned to their previousoccupations.Conclusions: Live donation of right lobe grafts for a-dult-to-adult liver transplantation is safe, providedthat donor selection is strict and utmost care is exer-cised during the operation.展开更多
AIM:To investigate the outcome of living donor liver transplantation(LDLT)recipients transplanted with small-for-size grafts(SFSGs).METHODS:Between November 2001 and December2010,196 patients underwent LDLT with right...AIM:To investigate the outcome of living donor liver transplantation(LDLT)recipients transplanted with small-for-size grafts(SFSGs).METHODS:Between November 2001 and December2010,196 patients underwent LDLT with right lobe liver grafts at our center.Recipients were divided into 2 treatment groups:group A with an actuarial graft-to-recipient weight ratio(aGRWR)<0.8%(n=45)and group B with an aGRWR≥0.8%(n=151).We evaluated serum liver function markers within 4 wk after transplantation.We also retrospectively evaluated the outcomes of these patients for potential effects related to the recipients,the donors and the transplantation procedures based upon a review of their medical records.RESULTS:Small-for-size syndrome(SFSS)developed in 7 of 45 patients(15.56%)in group A and 9 of 151patients(5.96%)in group B(P=0.080).The levels of alanine aminotransferase and aspartate aminotransferase in group A were higher than those in group B during early period after transplantation,albeit not significantly.The cumulative 1-,3-and 5-year liver graft survival rates were 82.22%,71.11%and 71.11%for group A and 81.46%,76.82%,and 75.50%for group B patients,respectively(P=0.623).However,univariate analysis of risk factors associated with graft survival in group A demonstrated that the occurrence of SFSS after LDLT was the only significant risk factor affecting graft survival(P<0.001).Furthermore,multivariate analysis of our data did not identify any additional significant risk factors accounting for poor graft survival.CONCLUSION:Our study suggests that LDLT recipients with an aGRWR<0.8%may have liver graft outcomes comparable to those who received larger size grafts.Further studies are required to ascertain the safety of using SFSGs.展开更多
BACKGROUND:The right lobe of the liver is generally preferred for living donor liver transplantation in adult patients with end-stage liver disease.It is important to know the preoperative factors relating to the majo...BACKGROUND:The right lobe of the liver is generally preferred for living donor liver transplantation in adult patients with end-stage liver disease.It is important to know the preoperative factors relating to the major postoperative complications.We therefore evaluated the possible risk factors for predicting postoperative complications in right lobe liver donors.METHODS:Data from 378 donors who had undergone展开更多
BACKGROUND: The safety of donors in living donor liver transplantation (LDLT) should be the primary consideration. The aim of this study was to report our experience in increasing the safety of donors in LDLTs using r...BACKGROUND: The safety of donors in living donor liver transplantation (LDLT) should be the primary consideration. The aim of this study was to report our experience in increasing the safety of donors in LDLTs using right lobe grafts. METHODS: We retrospectively studied 37 living donors of right lobe grafts from January 2002 to March 2006. The measures for increasing the safety of donors in LDLT included carefully selected donors, preoperative evaluation by ultrasonography, angiography and computed tomography; and necessary intraoperative cholangiography and ultrasonography. Right lobe grafts were obtained using an ultrasonic dissector without inflow vascular occlusion on the right side of the middle hepatic vein. The standard liver volume and the ratio of left lobe volume to standard liver volume were calculated. RESULTS: There was no donor mortality in our group. Postoperative complications only included bile leakage (1 donor), biliary stricture (1) and portal vein thrombosis (1). All donors recovered well and resumed their previous occupations. In recipients, complications included acute rejection (2 patients), hepatic artery thrombosis (1), bile leakage (1), intestinal bleeding (1), left subphrenic abscess (1) and pulmonary infection (1). The mortality rate of recipients was 5.4% (2/37); one recipient with pulmonary infection died from multiple organ failure and another from occurrence of primary disease.CONCLUSIONS: The first consideration in adult-to-adult LDLT is the safety of donors. The donation of a right lobe graft is safe for adults if the remnant hepatic vasculature and bile duct are ensured, and the volume of the remnant liver exceeds 35% of the total liver volume.展开更多
The aim of this paper is to summarize our experience of using right lobe liver grafts to reduce biliary complications in adult-to-adult(A-A)living donor liver transplantation(LDLT).From January 2002 to October 2007,12...The aim of this paper is to summarize our experience of using right lobe liver grafts to reduce biliary complications in adult-to-adult(A-A)living donor liver transplantation(LDLT).From January 2002 to October 2007,124 adult patients underwent living donor liver transplantation using right lobe grafts at the West China Hospital,Sichuan University Medical School,China.There was no death in all donors.Biliary reconstruction for 178 hepatic duct orifices from 124 donor grafts was performed which included 106 reconstructions of duct-to-duct anastomoses and 72 cholangiojejunostomy.Nine recipients had biliary complications including six bile lea-kages(four from the anastomotic site and two from the cut surface of the liver graft)and three biliary strictures.With the improved techniques for biliary reconstruction,we have achieved good results in 124 recipients of A-A LDLT.We ascribe our success to the introduction of microsurgical techniques and the use of fixed operators which help in decreasing the biliary complications of LDLT.展开更多
BACKGROUND: Controversy exists over whether living donor liver transplantation (LDLT) should be offered to patients with high Model for End-stage Liver Disease (MELD) scores. This study tried to determine whether a hi...BACKGROUND: Controversy exists over whether living donor liver transplantation (LDLT) should be offered to patients with high Model for End-stage Liver Disease (MELD) scores. This study tried to determine whether a high MELD score would result in inferior outcomes of right-lobe LDLT. METHODS: Among 411 consecutive patients who received right-lobe LDLT at our center, 143 were included in this study. The patients were divided into two groups according to their MELD scores: a high-score group (MELD score ≥25; n=75) and a low-score group (MELD score <25; n=68). Their demographic data and perioperative conditions were compared. Univariable and multivariable analyses were performed to identify risk factors affecting patient survival. RESULTS: In the high-score group, more patients required preoperative intensive care unit admission (49.3% vs 2.9%; P<0.001), mechanical ventilation (21.3% vs 0%; P<0.001), or hemodialysis (13.3% vs 0%; P=0.005); the waiting time before LDLT was shorter (4 vs 66 days; P<0.001); more blood was transfused during operation (7 vs 2 units; P<0.001); patients stayed longer in the intensive care unit (6 vs 3 days; P<0.001) and hospital (21 vs 15 days; P=0.015) after transplantation;more patients developed early postoperative complications (69.3% vs 50.0%; P=0.018); and values of postoperative peak blood parameters were higher. However, the two groups had comparable hospital mortality. Graft survival and patient overall survival at one year (94.7% vs 95.6%; 95.9% vs 96.9%), three years (91.9% vs 92.6%; 93.2% vs 95.3%), and five years (90.2% vs 90.2%; 93.2% vs 95.3%) were also similar between the groups. CONCLUSIONS: Although the high-score group had signifi-cantly more early postoperative complications, the two groups had comparable hospital mortality and similar satisfactory rates of graft survival and patient overall survival. Therefore, a high MELD score should not be a contraindication to right-lobe LDLT if donor risk and recipient benefit are taken into full account.展开更多
AIM To analyze the outcomes of living-donor liver transplantation(LDLT) using left-lobe(LL) or right-lobe(RL) small-for-size(SFS) grafts.METHODS Prospectively collected data of adult patients who underwent LDLT at our...AIM To analyze the outcomes of living-donor liver transplantation(LDLT) using left-lobe(LL) or right-lobe(RL) small-for-size(SFS) grafts.METHODS Prospectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short-and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight(GW) to recipient standard liver volume(RSLV)(GW/RSLV) of < 50%. The Urata formula was used to estimate RSLV.RESULTS Totally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age(median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, P = 0.997) but had significantly different ratios of men to women(165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, P < 0.0001). The two groups were also significantly different in GW(P < 0.0001), GW/RSLV(P < 0.0001), and graft cold ischemic time(P = 0.007). When it comes to postoperative complication, the groups were comparable(P = 0.105). Five patients died in hospital,4(2%) in the RL-LDLT group and 1(5.3%) in the LLLDLT group(P = 0.918). There were 38 graft losses, 33(16.6%) in the RL-LDLT group and 5(26.3%) in the LL-LDLT group(P = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group(95.2% vs 89.5%, P = 0.049). The two groups had similar 5-year patient survival rates(RL-LDLT: 86.8%, LL-LDLT: 89.5%, P = 0.476).CONCLUSION The use of SFS graft in LDLT requires careful tailormade surgical planning and meticulous operation. LLLDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed in order to validate the use of LL graft.展开更多
Three male patients were diagnosed with new cortical infarctions of the right parietal lobe on the basis of head magnetic resonance imaging;high-intensity signals indicating lesions in the right parietal lobe were not...Three male patients were diagnosed with new cortical infarctions of the right parietal lobe on the basis of head magnetic resonance imaging;high-intensity signals indicating lesions in the right parietal lobe were noted on diffusion-weighted images at admission.Two of them presented with left hand weakness,and one exhibited left upper limb weakness.Treatment for improving blood supply to the brain was administered.One patient died suddenly because of ventricular fibrillation 3 days after admission.The other two patients had increased troponin levels and abnormal electrocardiograms,and were diagnosed with acute myocardial infarction half a month after admission.When lesions exist in field 7 of the parietal cortex (resulting in paralysis of the contralateral hand),the sympathetic center of the posterior lateral nucleus of the hypothalamus demonstrates compensatory excitement,which easily causes tachyarrhythmia and sudden death.Our experimental findings indicate that close electrocardiograph monitoring and cerebral infarction treatment should be standard procedures to predict and help prevent heart disease in patients with cerebral infarction in the right parietal lobe and left upper limb weakness as the main complaint.展开更多
Background: Some studies have suggested that among all cases of lung cancer, the outcome of lung cancer located in the right middle lobe (RML) is the worst. However, with the advances in the diagnosis and treatment me...Background: Some studies have suggested that among all cases of lung cancer, the outcome of lung cancer located in the right middle lobe (RML) is the worst. However, with the advances in the diagnosis and treatment methods of lung cancer over the last couple of decades, we investigated whether the prognosis of primary lung cancer located in the RML still remains inferior to that of lung cancer arising from other lobes. Methods: Between July 2003 and December 2011, 505 consecutive patients with non-small cell lung cancer (NSCLC) underwent surgical resection at our institution. Of these, 32 patients (6.3%) had tumors arising from the RML. Results: The rate of incomplete resection was higher for cancer located in the RML than that for cancer arising from other lobes. Significant associations were noted between cancer located in the RML and the rate of lymph node metastasis and initial locoregional recurrence. Multivariate analysis identified lymph node metastasis and location in the RML as independent risk factors influencing the recurrence-free survival (p = 0.006), although location in the RML was not extracted as an independent risk factor influenceing the overall survival (p = 0.060). Conclusion: Despite the recent advances in the treatment of lung cancer, evaluation of complete resection revealed that the outcome of cancer located in the RML is still the worst among cancer of all the lobes. Further early diagnosis and adjuvant therapy are needed for improving the prognosis of cancer located in the RML.展开更多
During a 12-year period, 44 patients were surgically treated for stage- Ⅲ peripheral squamous cell car-cinoma of the right upper lobe. The mean time from the discovery of the shadow in the right upper lobe tothe conf...During a 12-year period, 44 patients were surgically treated for stage- Ⅲ peripheral squamous cell car-cinoma of the right upper lobe. The mean time from the discovery of the shadow in the right upper lobe tothe confirmation of the diagnosis was 2 months. All patients underwent the resection of the right upperlobe with the dissection of the right mediastinal lymph nodes, among them, 4 patients had sleeve lobectomy of the right upper lobe. P-TNM staging: 23 cases were in stage- Ⅲ a, 21 cases in stage- Ⅲ b. The fre-quency of the postoperative complications was 20- 4 % (9/44 cases). The 1-year survival rate of all patientswas 61 % (27/44 cases). None of stage - Ⅲ b patients lived longer than 3 years. The postoperative 3-and 5-year survival rates of stage- Ⅲ a cases were 65. 2 % (15/23cases) and 21. 7 % (5/23 cases) respectively. Inthis article, the patients clinical features, the causes of delayed-diagnosis, the operative and postoperativemanagement were discussed. We suggest that the stage- Ⅲ a patients should be given surgical treatment,whereas, for the patients of stage- Ⅲ b, palliative operation was given just for the purpose of reliving thesymptoms.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.
文摘BACKGROUND:Because of the shortage of deceased donors with livers fit for transplantation,living donor liver transplantation(LDLT)is becoming an attractive alternative.Attention should be paid to the donors,especially to those of the right lobe.In this study,we evaluated the risks faced by donors of the right lobe for adult-to-adult LDLT.METHODS:The perioperative data from 105 consecutive living donors of the right lobe performed in West China Hospital from January 2002 to December 2007 were retrospectively studied.Preoperative evaluation included CT,MRCP,and intraoperative cholangiography,showing liver volume,hepatic vasculature and the biliary system.The standard liver volume(SLV)and the ratio of left lobe volume to SLV were calculated.The right lobe grafts were obtained by transecting the liver on the right side of the middle hepatic vein without inflow vascular occlusion,using an ultrasonic dissector.After operation the donors were monitored in the Intensive Care Unit for about three days.Each donor was followed up for at least 6 months.RESULTS:There was no donor mortality.Major complications occurred in 14 donors(13.3%),of whom 3 received conservative treatment,8 required invasive paracentesis,and 3 required further surgery.All donors were recovered well and resumed their previous occupations.CONCLUSIONS:Donors of the right lobe face low risks.The preoperative evaluation,especially evaluation of the volume of the remnant liver,should be exact.During the operation,the patency of the remnant hepatic vasculature and bile duct must be preserved,and the extent of injury to the remnant liver should be limited as much as possible.The detection and treatment of postoperative complications should be diligently performed.
基金supported by a grant from the National Science and Technology Major Project of China(2017ZX100203205)
文摘Background: The efficacy and necessity of middle hepatic vein(MHV) reconstruction in adult-to-adult right lobe living donor liver transplantation(LDLT) remain controversial. The present study aimed to evaluate the survival beneficiary of MHV reconstructions in LDLT. Methods: We compared the clinical outcomes of liver recipients with MHV reconstruction( n = 101) and without MHV reconstruction( n = 43) who underwent LDLT using right lobe grafts at our institution from January 2006 to May 2017. Results: The overall survival(OS) rate of recipients with MHV reconstruction was significantly higher than that of those without MHV reconstruction in liver transplantation( P = 0.022; 5-yr OS: 76.2% vs 58.1%). The survival of two segments(segments 5 and 8) hepatic vein reconstruction was better than that of the only one segment(segment 5 or segment 8) hepatic vein reconstruction( P = 0.034; 5-yr OS: 83.6% vs 67.4%). The survival of using two straight vascular reconstructions was better than that using Y-shaped vascular reconstruction in liver transplantation with two segments hepatic vein reconstruction( P = 0.020; 5-yr OS: 100% vs 75.0%). The multivariate analysis demonstrated that MHV tributary reconstructions were an independent beneficiary prognostic factor for OS(hazard ratio = 0.519, 95% CI: 0.282–0.954, P = 0.035). Biliary complications were significantly increased in recipients with MHV reconstruction(28.7% vs 11.6%, P = 0.027). Conclusions: MHV reconstruction ensured excellent outflow drainage and favored recipient outcome. The MHV tributaries(segments 5 and 8) should be reconstructed as much as possible to enlarge the hepatic vein anastomosis and reduce congestion.
文摘Objective: To review the experience of donor selec-tion and right lobe hepatectomy in adult-to-adult livedonor liver transplantation.Methods: From May 1996 to December 2001, 89 livedonor liver transplants using right lobe grafts wereperformed at Queen Mary Hospital, Hong Kong. Alldonors had received psychological counseling beforedonor operations. They were screened by laboratorytests including complete blood cell count, liver andrenal biochemistry, and viral serology studies. Com-puted tomography (CT), CT volumetry and hepaticarteriography were routinely performed. All donorsunderwent the operations using the method designedby us.Results: The median duration of the operations was8.8 hours. The median blood loss recorded 466 ml.The median intensive care unit and hospital stayswere 2 and 10 days, respectively. There was no do-nor mortality. Complications of donor operations in-cluded wound infection, urinary tract infection, bili-ary stricture, cholestasis, subphrenic collection,bowel obstruction and incision hernia, etc. All do-nors have recovered and returned to their previousoccupations.Conclusions: Live donation of right lobe grafts for a-dult-to-adult liver transplantation is safe, providedthat donor selection is strict and utmost care is exer-cised during the operation.
基金Supported by National Science and Technology Major Project of China,No.2008ZX10002-025 and No.2008ZX10002-026
文摘AIM:To investigate the outcome of living donor liver transplantation(LDLT)recipients transplanted with small-for-size grafts(SFSGs).METHODS:Between November 2001 and December2010,196 patients underwent LDLT with right lobe liver grafts at our center.Recipients were divided into 2 treatment groups:group A with an actuarial graft-to-recipient weight ratio(aGRWR)<0.8%(n=45)and group B with an aGRWR≥0.8%(n=151).We evaluated serum liver function markers within 4 wk after transplantation.We also retrospectively evaluated the outcomes of these patients for potential effects related to the recipients,the donors and the transplantation procedures based upon a review of their medical records.RESULTS:Small-for-size syndrome(SFSS)developed in 7 of 45 patients(15.56%)in group A and 9 of 151patients(5.96%)in group B(P=0.080).The levels of alanine aminotransferase and aspartate aminotransferase in group A were higher than those in group B during early period after transplantation,albeit not significantly.The cumulative 1-,3-and 5-year liver graft survival rates were 82.22%,71.11%and 71.11%for group A and 81.46%,76.82%,and 75.50%for group B patients,respectively(P=0.623).However,univariate analysis of risk factors associated with graft survival in group A demonstrated that the occurrence of SFSS after LDLT was the only significant risk factor affecting graft survival(P<0.001).Furthermore,multivariate analysis of our data did not identify any additional significant risk factors accounting for poor graft survival.CONCLUSION:Our study suggests that LDLT recipients with an aGRWR<0.8%may have liver graft outcomes comparable to those who received larger size grafts.Further studies are required to ascertain the safety of using SFSGs.
文摘BACKGROUND:The right lobe of the liver is generally preferred for living donor liver transplantation in adult patients with end-stage liver disease.It is important to know the preoperative factors relating to the major postoperative complications.We therefore evaluated the possible risk factors for predicting postoperative complications in right lobe liver donors.METHODS:Data from 378 donors who had undergone
文摘BACKGROUND: The safety of donors in living donor liver transplantation (LDLT) should be the primary consideration. The aim of this study was to report our experience in increasing the safety of donors in LDLTs using right lobe grafts. METHODS: We retrospectively studied 37 living donors of right lobe grafts from January 2002 to March 2006. The measures for increasing the safety of donors in LDLT included carefully selected donors, preoperative evaluation by ultrasonography, angiography and computed tomography; and necessary intraoperative cholangiography and ultrasonography. Right lobe grafts were obtained using an ultrasonic dissector without inflow vascular occlusion on the right side of the middle hepatic vein. The standard liver volume and the ratio of left lobe volume to standard liver volume were calculated. RESULTS: There was no donor mortality in our group. Postoperative complications only included bile leakage (1 donor), biliary stricture (1) and portal vein thrombosis (1). All donors recovered well and resumed their previous occupations. In recipients, complications included acute rejection (2 patients), hepatic artery thrombosis (1), bile leakage (1), intestinal bleeding (1), left subphrenic abscess (1) and pulmonary infection (1). The mortality rate of recipients was 5.4% (2/37); one recipient with pulmonary infection died from multiple organ failure and another from occurrence of primary disease.CONCLUSIONS: The first consideration in adult-to-adult LDLT is the safety of donors. The donation of a right lobe graft is safe for adults if the remnant hepatic vasculature and bile duct are ensured, and the volume of the remnant liver exceeds 35% of the total liver volume.
文摘The aim of this paper is to summarize our experience of using right lobe liver grafts to reduce biliary complications in adult-to-adult(A-A)living donor liver transplantation(LDLT).From January 2002 to October 2007,124 adult patients underwent living donor liver transplantation using right lobe grafts at the West China Hospital,Sichuan University Medical School,China.There was no death in all donors.Biliary reconstruction for 178 hepatic duct orifices from 124 donor grafts was performed which included 106 reconstructions of duct-to-duct anastomoses and 72 cholangiojejunostomy.Nine recipients had biliary complications including six bile lea-kages(four from the anastomotic site and two from the cut surface of the liver graft)and three biliary strictures.With the improved techniques for biliary reconstruction,we have achieved good results in 124 recipients of A-A LDLT.We ascribe our success to the introduction of microsurgical techniques and the use of fixed operators which help in decreasing the biliary complications of LDLT.
文摘BACKGROUND: Controversy exists over whether living donor liver transplantation (LDLT) should be offered to patients with high Model for End-stage Liver Disease (MELD) scores. This study tried to determine whether a high MELD score would result in inferior outcomes of right-lobe LDLT. METHODS: Among 411 consecutive patients who received right-lobe LDLT at our center, 143 were included in this study. The patients were divided into two groups according to their MELD scores: a high-score group (MELD score ≥25; n=75) and a low-score group (MELD score <25; n=68). Their demographic data and perioperative conditions were compared. Univariable and multivariable analyses were performed to identify risk factors affecting patient survival. RESULTS: In the high-score group, more patients required preoperative intensive care unit admission (49.3% vs 2.9%; P<0.001), mechanical ventilation (21.3% vs 0%; P<0.001), or hemodialysis (13.3% vs 0%; P=0.005); the waiting time before LDLT was shorter (4 vs 66 days; P<0.001); more blood was transfused during operation (7 vs 2 units; P<0.001); patients stayed longer in the intensive care unit (6 vs 3 days; P<0.001) and hospital (21 vs 15 days; P=0.015) after transplantation;more patients developed early postoperative complications (69.3% vs 50.0%; P=0.018); and values of postoperative peak blood parameters were higher. However, the two groups had comparable hospital mortality. Graft survival and patient overall survival at one year (94.7% vs 95.6%; 95.9% vs 96.9%), three years (91.9% vs 92.6%; 93.2% vs 95.3%), and five years (90.2% vs 90.2%; 93.2% vs 95.3%) were also similar between the groups. CONCLUSIONS: Although the high-score group had signifi-cantly more early postoperative complications, the two groups had comparable hospital mortality and similar satisfactory rates of graft survival and patient overall survival. Therefore, a high MELD score should not be a contraindication to right-lobe LDLT if donor risk and recipient benefit are taken into full account.
文摘AIM To analyze the outcomes of living-donor liver transplantation(LDLT) using left-lobe(LL) or right-lobe(RL) small-for-size(SFS) grafts.METHODS Prospectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short-and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight(GW) to recipient standard liver volume(RSLV)(GW/RSLV) of < 50%. The Urata formula was used to estimate RSLV.RESULTS Totally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age(median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, P = 0.997) but had significantly different ratios of men to women(165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, P < 0.0001). The two groups were also significantly different in GW(P < 0.0001), GW/RSLV(P < 0.0001), and graft cold ischemic time(P = 0.007). When it comes to postoperative complication, the groups were comparable(P = 0.105). Five patients died in hospital,4(2%) in the RL-LDLT group and 1(5.3%) in the LLLDLT group(P = 0.918). There were 38 graft losses, 33(16.6%) in the RL-LDLT group and 5(26.3%) in the LL-LDLT group(P = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group(95.2% vs 89.5%, P = 0.049). The two groups had similar 5-year patient survival rates(RL-LDLT: 86.8%, LL-LDLT: 89.5%, P = 0.476).CONCLUSION The use of SFS graft in LDLT requires careful tailormade surgical planning and meticulous operation. LLLDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed in order to validate the use of LL graft.
文摘Three male patients were diagnosed with new cortical infarctions of the right parietal lobe on the basis of head magnetic resonance imaging;high-intensity signals indicating lesions in the right parietal lobe were noted on diffusion-weighted images at admission.Two of them presented with left hand weakness,and one exhibited left upper limb weakness.Treatment for improving blood supply to the brain was administered.One patient died suddenly because of ventricular fibrillation 3 days after admission.The other two patients had increased troponin levels and abnormal electrocardiograms,and were diagnosed with acute myocardial infarction half a month after admission.When lesions exist in field 7 of the parietal cortex (resulting in paralysis of the contralateral hand),the sympathetic center of the posterior lateral nucleus of the hypothalamus demonstrates compensatory excitement,which easily causes tachyarrhythmia and sudden death.Our experimental findings indicate that close electrocardiograph monitoring and cerebral infarction treatment should be standard procedures to predict and help prevent heart disease in patients with cerebral infarction in the right parietal lobe and left upper limb weakness as the main complaint.
文摘Background: Some studies have suggested that among all cases of lung cancer, the outcome of lung cancer located in the right middle lobe (RML) is the worst. However, with the advances in the diagnosis and treatment methods of lung cancer over the last couple of decades, we investigated whether the prognosis of primary lung cancer located in the RML still remains inferior to that of lung cancer arising from other lobes. Methods: Between July 2003 and December 2011, 505 consecutive patients with non-small cell lung cancer (NSCLC) underwent surgical resection at our institution. Of these, 32 patients (6.3%) had tumors arising from the RML. Results: The rate of incomplete resection was higher for cancer located in the RML than that for cancer arising from other lobes. Significant associations were noted between cancer located in the RML and the rate of lymph node metastasis and initial locoregional recurrence. Multivariate analysis identified lymph node metastasis and location in the RML as independent risk factors influencing the recurrence-free survival (p = 0.006), although location in the RML was not extracted as an independent risk factor influenceing the overall survival (p = 0.060). Conclusion: Despite the recent advances in the treatment of lung cancer, evaluation of complete resection revealed that the outcome of cancer located in the RML is still the worst among cancer of all the lobes. Further early diagnosis and adjuvant therapy are needed for improving the prognosis of cancer located in the RML.
文摘During a 12-year period, 44 patients were surgically treated for stage- Ⅲ peripheral squamous cell car-cinoma of the right upper lobe. The mean time from the discovery of the shadow in the right upper lobe tothe confirmation of the diagnosis was 2 months. All patients underwent the resection of the right upperlobe with the dissection of the right mediastinal lymph nodes, among them, 4 patients had sleeve lobectomy of the right upper lobe. P-TNM staging: 23 cases were in stage- Ⅲ a, 21 cases in stage- Ⅲ b. The fre-quency of the postoperative complications was 20- 4 % (9/44 cases). The 1-year survival rate of all patientswas 61 % (27/44 cases). None of stage - Ⅲ b patients lived longer than 3 years. The postoperative 3-and 5-year survival rates of stage- Ⅲ a cases were 65. 2 % (15/23cases) and 21. 7 % (5/23 cases) respectively. Inthis article, the patients clinical features, the causes of delayed-diagnosis, the operative and postoperativemanagement were discussed. We suggest that the stage- Ⅲ a patients should be given surgical treatment,whereas, for the patients of stage- Ⅲ b, palliative operation was given just for the purpose of reliving thesymptoms.
