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Objective To develop a new model for predicting recurrence after liver transplantation for hepatocellular carcinoma (HCC) beyond Milan criteria based on related preoperative and postoperative indicators. Methods A retrospective analysis was performed for the clinical data of the patients with HCC beyond Milan criteria who underwent orthotopic liver transplantation for the first time in Tianjin First Central Hospital from August 2014 to July 2018, and according to the presence or absence of recurrence during follow-up, the patients were divided into recurrence group and no-recurrence group. The t -test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison of survival curves. Univariate and multivariate Cox proportional hazards regression analyses were used to identify the risk factors for recurrence-free survival after surgery. A new model was developed for recurrence after liver transplantation in the patients with HCC beyond Milan criteria based on the risk factors identified. The area under the receiver operating characteristic curve (AUC) was used to evaluate predictive performance, and the Hosmer-Lemeshow test was used to assess the goodness of fit of the model. Results A total of 117 patients with HCC beyond Milan criteria were enrolled in this study, with a median follow-up time of 24 (1-74) months. A total of 53 patients (45.3%) experienced recurrence after surgery, among whom 52 (98.1%) had recurrence within 3 years after surgery, with a median time to recurrence of 6 (1-52) months. The Cox proportional hazards regression analysis showed that preoperative serum alpha-fetoprotein (AFP) >769 ng/mL, neutrophil-lymphocyte ratio (NLR) >3.75, and ki67 index >0.25 were independent risk factors for recurrence-free survival after liver transplantation. The model established based on these three risk factors had an AUC of 0.843, with good sensitivity (88.7%) and specificity (70.3%). The optimal cut-off value was selected according to the maximization of Youden index, and then the patients were divided into low-risk group (0-1 point) and high-risk group (1.5-4 points). The log-rank test showed that the low-risk group had significantly higher 3-and 5-year recurrence-free survival rates than the high-risk group (84.1%/72.0% vs 10.9%/10.9%, χ 2 =29.425, P < 0.001). Conclusion Liver transplantation for HCC beyond Milan criteria should be performed with caution, and the predictive model established based on preoperative AFP, NLR, and ki67 index can accurately assess the indication for liver transplantation in such patients.
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Objective:To evaluate the efficacy of comprehensive anti-cancer treatment for lung metastases after liver transplantation (LT) for hepatocellular carcinoma (HCC).Methods:From March 2012 to July 2016, A total of 36 patients with lung metastasis after LT were divided into comprehensive anti-cancer treatment group (rapamycin + radioactive I 125 seed implantation + pulmonary artery infusion chemotherapy + sorafenib, n=22) and maintenance supportive care group ( n=14). The survival profiles of two groups were evaluated. Results:No significant inter-group differences existed in preoperative basic data, tumor pathology, time of pulmonary metastatic tumor after operation and lung metastasis tumor burden.In comprehensive anti-cancer treatment group, there were partial remission ( n=3), disease stability ( n=12) and disease progression after treatment ( n=7). In maintenance supportive care group, there were disease stability ( n=3) and disease progression after treatment ( n=11). And comprehensive anti-cancer treatment was superior to maintenance supportive care ( χ2=7.901, P=0.019). The median survival time after metastasis was 23 months (95%CI: 19.68-26.32) in comprehensive anti-cancer treatment group and 7 months (95%CI: 3.33-10.67) in maintenance supportive care group; 1-year survival rate 91% and 9%, 2-year survival rate 45% and 0% and 3-year survival rate 10% and 0% respectively.The survival rate of comprehensive anti-cancer treatment group was significantly better than that of maintenance supportive care group ( P<0.001). Conclusions:Comprehensive anti-cancer treatment (rapamycin + radioactive I 125 seed implantation + pulmonary artery infusion chemotherapy + sorafenib) can improve the survival time of patients with lung metastasis after liver transplantation for HCC.
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Objective To explore the early prognosis and the risk factors of delayed graft function (DGF) of the recipients undergoing liver transplantation from donor liver with moderate-to-severe steatosis. Methods Clinical data of 475 donors and 475 recipients undergoing liver transplantation from donor liver of organ donation after citizen's death were retrospectively analyzed. According to the classification criteria of steatosis proposed by Australia National Liver Transplantation Unit (ANLTU), all recipients were divided into the S0 group (no steatosis, n=308), S1 group (mild steatosis, n=97), S2 group (moderate steatosis, n=52) and S3 group (severe steatosis, n=18), respectively. The early postoperative death and incidence of postoperative complications were statistically compared among each group. The risk factors from donors, recipients and operation leading to DGF were analyzed by univariate and multivariate logistic regression models. Results The incidence of postoperative DGF in the S2 and S3 groups was significantly higher than that in the S1 and S0 groups (all P < 0.05). The incidence of postoperative DGF in the S3 group was remarkably higher than that in the S2 group (P < 0.05). The early postoperative fatality, the incidence of primary nonfunction (PNF) of the transplant liver, postoperative bleeding, infection, biliary complications and vascular complications did not significantly differ among each group (all P > 0.05). Univariate regression analysis showed that severe steatosis of donor liver, long cold ischemia time, high model for end-stage liver disease (MELD) score and tumors of the recipients before operation were the risk factors of DGF (all P < 0.05). Multivariate logistic regression analysis demonstrated that moderate-to-severe steatosis of donor liver, cold ischemia time > 8 h and MELD score > 30 of the recipients were the independent risk factors for early postoperative DGF. Conclusions The early-stage incidence of DGF after adult liver transplantation from donor liver with moderate-to-severe steatosis is high, whereas it does not affect the early survival rate of the recipients. The selection of donor liver with moderate-to-severe steatosis should be considered in combination with cold ischemia time of the donors and MELD score of the recipients before operation, etc.
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Objective To employ image post-processing technique measuring splenic volume for evaluating the mitigation effect of end-stage liver disease patients complicated with different degrees of hypersplenism undergoing orthotopic liver transplantation .Methods For 55 end-stage liver disease patients with hypersplenism undergoing orthotopic liver transplantation ,the changes in splenic volume were measured before and after transplantation by image post-processing system Advantage Workstation 46 (AW46) and the changes of splenic thickness ,portal flow velocity and platelet counts observed during perioperative period .Results Postoperative splenic volumes of 55 recipients were (562 .90 ± 49 .16) cm3 ,significantly decreased than preoperative (850 .50 ± 77 .99) cm3 (P< 0 .05) and reduction ratio was (31 .70 ± 2 .76 )％ . Splenic thickness at different postoperative timepoints was significantly lower than that pre-operation (P< 0 .05) and stabilized at 1 month post-transplantation ; Splenic volume was positively correlated with splenic thickness ( r = 0 .78 , P < 0 .05 ) . Portal flow velocity at different postoperative timepoints increased significantly as compared with preoperative ( P < 0 .05) ,peaked at (380 .70 ± 21 .80) mm/s at 1 month post-transplantation ,declined and stabilized at 3 months post-transplantation . Platelet counts (PLT ) at different postoperative timepoints were significantly higher than those at pre-operation ( P < 0 .05 ) ,peaked (193 .40 ± 10 .36 ) × 109 /L at 2 weeks post-transplantation ,dropped and remained at 2 months post-transplantation ;Splenic volume was negatively correlated with PLT ( r = -0 .44 , P < 0 .05 ) . And hypersplenism recovery rate and recurrence rate within 10 months post-transplantation was (78 .79 ± 2 .29 )％ and (17 .75 ± 2 .31 )％ respectively .Conclusions Orthotopic liver transplantation can effectively alleviate hypersplenism for most end-stage liver diseases .Using image post-processing system ,splenic volume may be calculated and blood routine and ultrasound are simultaneously used for assessing the outcomes of liver transplantation on hypersplenism .
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Objective To discuss the modified eversion thrombectomy for portal vein thrombosis (PVT) in liver transplantation and the curative effectiveness.Methods All 613 cases complicated with PVT preoperation were given modified eversion thrombectomy,and there were 179,236,182 and 16 cases of PVT Yerdel grade Ⅰ,Ⅱ,Ⅲ and Ⅳ respectively.Results All 415 PVT patients of grade Ⅰ and Ⅱ received modified eversion thrombectomy and success rate was 100％.Among 182 PVT patients of grade Ⅲ received modified eversion thrombectomy (success in 176 cases,and failure in 6 cases).Sixteen PVT patients of grade Ⅳ received modified eversion thrombectomy (success in 13 cases and failure in 3 cases).The 1-year survival rate of PVT patients after surgical operation was 93.6％,and that of non-PVT patients was 94.6％ (P＞0.05).Conclusion Modified eversion thrombectomy could be adopted in PVT patients regarding to different Yerdel grades.
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Objective To study long-term post-liver-transplantation hyperuricemia (HUA) and the influence of urate-lowering therapyon renal functions of adult patients.Methods Among 428 cases undergoing liver transplantations during March 2011 to December 2013,206 patients,whose followup periods were above 1 year,were selected as the objects of study.Those whose two-time serum uric acid (SUA) levels tested not in the same day one year after operation ＞420 μmol/L (male),or female ＞360 μmol/L (female) were divided into HUA group,and non-HUA group.The serum creatinine (SCr) concentrations and glomerular filtration rate (eGFR) were analyzedin the two groups at their peak SUA to find whether there was any difference between the two groups.Meanwhile,27 HUA patients with abnormal renal function were given urate-lowering therapy and the differences in SCr and eGFR after the therapy were observed.Results 49.5％ patients sufferedlong-term HUA after liver transplantations.As compared with non-HUA group,SCrconcentrations were increased statistically (P＜0.05),and eGFR was reduced statistically in HUA group (P＜0.05).After 8-week uratelowering therapy among 27 patients,SUA level in 24 cases (88.9％,24/27) returned to the normal standard and SCr concentrations in 21 cases (77.8％,21/27) decreased for a certain degree.SUA levels were decreased to (349.93 ± 22.85)μmol/L from (532.94 ± 93.91) μmol/L (P＜0.001).SCr concentrations were decreased to (129.52 ± 19.06)μmol/L from (144.95 ± 13.51) μmol/L (P =0.016).The eGFR increased to (56.30 ± 11.46) ml · min-1 · 1.73 m-2 from (46.46 ± 8.11) ml·min-1 ·1.73 m-2(P =0.012),which showed a certain degree of improvement in their renal functions.Conclusion HUA is a long-term common complication in liver transplanted adult patients,which has a negative influence on patients' renal functions,so we need to pay enough attention to this.Urate-lowing therapy has a positive influence on the improvement of renal function if other factors were excluded from the treatment.