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Over nearly 70-year development, organ transplantation has become an effective treatment for multiple end-stage diseases. However, postoperative administration of immunosuppressants should be given for the recipients, which leads to low immune function and high incidence rate of infection, including viral, bacterial and fungal infections. Among them, the occurrence of fungal infection is hidden, and it is difficult to deliver prompt diagnosis. Candida, Aspergillus, Cryptococcus and Pneumocystis infection are common fungal infections in solid organ transplantation. High-risk factors of fungal infection after solid organ transplantation should be identified and prevented in advance, and prompt diagnosis and treatment should be carried out by combining the results of (1, 3)-β-D-glucan assay (fungal G-test), imaging examination and related body fluid culture. These interventions are of clinical significance to reduce the incidence of fungal infection and fatality after solid organ transplantation. In this article, common fungal infections after organ transplantation were reviewed, aiming to provide reference for the prevention and treatment of fungal infections after organ transplantation.
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Objective@#To explore the safety and efficacy of totally laparoscopic right posterior liver resection for hepatocellular carcinoma (HCC).@*Methods@#The clinical data of 16 HCC patients undergoing laparoscopic right posterior liver resection at the First People′s Hospital of Foshan between Apr 2014 and Sep 2018 was retrospectively analyzed.@*Results@#14 out of the 16 cases, underwent totally laparoscopic right posterior liver resection by right hepatic Glisson pedicle transection, 2 were converted to open surgery.The operation time was (378±65) min, blood loss was (500±287) ml. There was no transfusion except for 2 cases. The median hospital stay after operation was 8 days . There was no mortality . With the median follow up period of 22 months (range 1 to 54 months). Tumor recurrence was found in one case.@*Conclusion@#Laparoscopic Glisson′s pedicle transection for right posterior liver resection for hepatocellular carcinoma was safe and effective.
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Objective To explore the safety and efficacy of totally laparoscopic right posterior liver resection for hepatocellular carcinoma (HCC).Methods The clinical data of 16 HCC patients undergoing laparoscopic right posterior liver resection at the First People's Hospital of Foshan between Apr 2014 and Sep 2018 was retrospectively analyzed.Results 14 out of the 16 cases,underwent totally laparoscopic right posterior liver resection by right hepatic Glisson pedicle transection,2 were converted to open surgery.The operation time was (378 ±65) min,blood loss was (500 ±287) ml.There was no transfusion except for 2 cases.The median hospital stay after operation was 8 days.There was no mortality.With the median follow up period of 22 months (range 1 to 54 months).Tumor recurrence was found in one case.Conclusion Laparoscopic Glisson's pedicle transection for right posterior liver resection for hepatocellular carcinoma was safe and effective.
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Objective To evaluate the application value of donor liver from organ donation after citizen's death (organ donation) in clinical liver transplantation. Methods Clinical data of 75 pairs of donors and recipients undergoing liver transplantation from organ donation in the First People's Hospital of Foshan from October 2011 to December 2016 were retrospectively analyzed. The conditions of the donors were strictly evaluated. Clinical prognosis and the incidence of postoperative complications of the recipients were summarized. Results The 1-year and 3-year accumulated survival rates of 75 liver transplantation recipients were 88% and 78%. Four recipients died from the recurrence and metastasis of liver cancer, 1 case from graft-versus-host disease, 1 case from severe pulmonary infection, 1 case from recurrence of virus B hepatitis (hepatitis B) and liver failure, 1 case from postoperative multiple organ failure and 1 case from massive hemorrhage of the upper digestive tract. Thirteen recipients suffered from biliary tract stenosis. One case was mitigated spontaneously and 1 recipient was healed after percutaneous transhepatic biliary drainage (PTBD). Eleven cases were treated with endoscopic retrograde cholangiopancreatography (ERCP). Among them, 5 cases were healed,2 recipients were switched to choledochojejunostomy and 4 cases were still monitored in clinical practice. Conclusions Liver transplantation from organ donation yields high clinical efficacy. Strict evaluation of donor conditions, standard perioperative management of the recipients, maintenance immunosuppressive therapy without adrenocortical hormone,timely and effective treatment of complications, regular postoperative follow-up are pivotal measures to guarantee the success of liver transplantation from organ donation and long-term survival of the recipients.
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Objective To summarize the clinical experience of combined liver and kidney procurement from pediatric organ donation. Methods Clinical data of 6 pediatric donors undergoing combined liver and kidney procurement in the First People's Hospital of Foshan from October 2011 to December 2016 were collected and relevant clinical experience was summarized. Results According to the diagnostic criteria for brain death (for children) established by Brain Injury Evaluation Quality Control Center of National Health and Family Planning Commission, 6 pediatric donors received combined liver and kidney procurement for organ donation under the status of brain death. Modified liver-kidney perfusion was performed by external iliac arterial intubation using No.7 suction catheter, or arteria iliaca communis intubation using 24 F catheter for the perfusion of portal vein and abdominal aorta, thoracic aorta occlusion. The operation time was 55-60 min. A total of 6 liver grafts and 12 renal grafts were harvested, which were successfully applied in clinical liver and renal transplantation. No primary nonfunction was observed in the liver or renal grafts. Conclusions Timely assessment of brain death, rigorous and cautious measures for organ maintenance and modified techniques for combined liver and kidney procurement play a key role in the success of combined liver and kidney procurement from pediatric organ donation.
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Objective To study the feasibility and safety of pure laparoscopic right hemihepatectomy for hepatocellular carcinoma via the anterior approach.Methods The data of five patients with hepatocellular carcinoma who underwent pure laparoscopic right hemihepatectomy at the First People's Hospital of Foshan between December 2013 and December 2016 were retrospectively analyzed.Patients'operation time,blood loss,blood transfusion rate,surgical margins,hospital stay,complication and short term outcomes were reviewed.Results All the five patients completed pure laparoscopic right hemihepatectomy without conversion to open surgery.The average (range) operation time was 6.0 (5 ～ 8) h.The average blood loss was 340 (110 ～ 600) ml.No patient received blood transfusion.The average surgical margin was 2.4 (1 ～4.5) cm.The average postoperative hospital stay was 7 (4 ～ 15) d.The average follow-up was 22 (2 ～38) months.Three patients experienced postoperative complications,which included ascites,pleural effusion,and ascites accompanied by biliary leakage,respectively.The last patient recovered well from drainage.No liver failure,cancer recurrence or death was noted.Conclusions This study demonstrated that pure laparoscopic right hemihepatotectomy via the anterior approach is a minimally invasive procedure which has the advantage of fast postoperative recovery.It was feasible and safe to treat hepatocellular carcinoma with favorable short-term outcomes.
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Objective To study the feasibility and safety of laparoscopic hepatic caudate lobe resec tion.Methods The clinical data of seven patients who underwent laparoscopic hepatic caudate lobe resection in our hospital were retrospective analyzed.There were 3 male and 4 female patients.The mean age was 45.3 years.The primary diseases included hepatic haemangioma (n =2),metastatic liver cancer (n =2),hepatocellular carcinoma (n =1),recurrent hepatocellular carcinoma (n =1) and hepatic adenoma (n =1).The total blood loss,operation time,hospital stay after surgery and complication were analyzed.Results The surgery was successful in all these 7 patients and no patients required any conversion to open surgery.Five patients underwent partial caudate lobe resection,and the remaining 2 underwent combined left hemi hepatectomy with partial caudate lobe resection.The operation time ranged from 200 to 250 minutes with a mean of 235 minutes.The intraoperative blood loss ranged from 40 to 600 ml with a mean of 188 ml.There was no postoperative bleeding and bile leakage.The resections were all R0 resections.Conclusions Laparoscopic hepatic caudate lobe resection was safe and feasible in appropriate patients.Familiarity with anatomy of the liver caudate lobe and skilled laparoscopic techniques are important to carry out this surgery.
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Objective To observe the effect of acute normovolemic hemodilution(ANH)combined with enhanced recovery after surgery(ERAS)on immune function in patients undergoing hepatic lobectomy. Methods 80 patients were divided into two groups:ERAS group(group E),ANH combined with ERAS group(group AE). bleeding volume,blood transfusion,infused fluid volume,urine output during operation and clinical index after surgery were recorded. Exhaust and defecation time ,fluid intake time and hospitalization duration were also record-ed. Blood samples were obtained from the patients at 30 min before anesthesia induction(T1),immediately(T2), 24 h(T3),3 d(T4)and 7 d(T5)after the end of operation for determination of the expression of CD3+,CD4+, CD8+ on T cells and natural killer cell. Results In group E ,CD3+,CD4+ T-lymphocytes and NK cells at T2-3 decreased as compared with T0. Compared with group E ,no allogeneic blood transfusion cases were found and clinical index duration was shorter in group AE. CD3+,CD4+T-lymphocytes and NK cells at T2-3 increased in group AE as compared with those in Group E. The difference is significant (P < 0.05). Conclusion ANH combined with ERAS can decrease allogenic blood transfusion and increase post-operation immunologic function ,shorten the postoperative hospitalization time.
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group was significantly longer than that in the low MELD score group (P <0.05).And there was no significant difference in the length of hospital stay,mortality during hospitalization,incidence of early complications, follow-up time and overall survival rate between two groups (all in P >0.05).The peak level of aspartate aminotransferase (AST)in the high MELD score group was significantly higher compared with that in the low MELD score group (P <0.05 ).The incidence of bile leakage,abdominal abscess and liver dysfunction significantly differed between two groups (all in P <0.05 ).Conclusions It is a safe and short-term efficacious approach to perform liver transplantation with organs obtained from Chinese donation after citizens’ death in patients with high MELD score liver recipients.
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Objective To summarize the feasibility and safety of fast perfusion through abdominal aorta and portal vein in combined liver and kidney procurement from organ donation. Methods Clinical data of 43 donors of donation after cardiac death (DCD)undergoing combined liver and kidney procurement in the First People’s Hospital of Foshan from September 201 1 to June 2014 were analyzed retrospectively. Among the 43 donors,15 cases were China DCD donor category Ⅰ (donor after brain death) (C-Ⅰ),1 case was category Ⅱ (donor after cardiac death) (C-Ⅱ)and 27 cases were categoryⅢ(C-Ⅲ). Combined abdominal aorta and portal vein perfusion with fast cannulation were performed. Results The time from abdomen incision to abdominal aorta cannulation was 1.5-2.0 min. Forty-three livers and eighty-six kidneys were procured from 43 donors. The warm ischemia time (WIT)was 0 for C-Ⅰ donors,and was 3-21 min for the other donors (mean:10 min). Two liver grafts were discarded for major injury of the porta hepatis and severe fatty liver respectively. Eighteen kidney grafts were discarded for kidney stones, kidney atrophy, high level of preoperative serum creatinine,severe renal atherosclerosis,renal microvessel thrombosis,multiple renal cyst, kidney traumatic rupture,etc. The total discard rate of donor organs was 16%. Conclusions Fast perfusion through abdominal aorta and portal vein is a simple and safe method in combined procurement liver and kidney from organ donation.
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Objective To investigate the safety and feasibility of modified hand-assisted laparoscopic surgery (MHALS) in the abdominal surgery.Methods The clinical data of 8 patients who underwent long-sleeved MHALS at the First People's Hospital of Foshan between September 2014 and January 2015 were retrospectively analyzed.Among the 8 patients,right liver cancer with intrahepatic metastasis was found in 2 patients,left liver cancer in 1 patient,hepatic peripheral nerve sheath tumor in 1 patient,left retroperitoneal leiomyosarcoma in 1 patient,extra-and intra-hepatic cholangiolithiasis in 1 patient,choledochocyst in 1 patient and ampulla cancer in 1 patient.Laparoscopic protection sleeve went through the middle of incision-retractor,and then wrapped around it about 10 cm.Incision-retractor was fixed at the abdominal incision firstly,laparoscopic procedures were performed when the wrist of assisted hand was bound and fixed by the distal of sleeve.The patients were followed up by outpatient examination and telephone interview till March 2015.Results All the 8 patients underwent successful MHALS,including 1 of right hemihepatectomy in situ,1 of ligation of right portal vein + left liver split (the patient gave up two-stage operation due to intractable ascites and elevated bilirubin),1 of hepatic left lateral lobectomy (the patient underwent hemostatic sutures in open surgery due to hemorrhage of liver's cutting surface),1 of hepatic peripheral nerve sheath tumor resection,1 of left retroperitoneal leiomyosarcoma resection,1 of choledocholithotomy + left hepatectomy + cholecystectomy + T tube drainage,1 of choledochocyst + biliary enteric drainage and 1 of pancreaticoduodenectomy.Four patients had assisted incision of 4 cm,and another 4 patients of 7 cm.Eight patients were followed up for a median time of 3 months (range,2-7 months).The patient who received ligation of right portal vein + left liver split died at postoperative month 3,and the others didn't have recurrence of tumor or lithiasis.Conclusion The MHALS is safe and feasible in the abdominal surgery.
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Objective To explore the efficacy and safety of the oralnucle osideanalogues monotherapy in the prevention of hepatitis B recurrence of patients after liver transplantation (LT). Methods Clinical data of 32 patients with hepatitis B-related disease undergoing LT in the First People's Hospital of Foshan in Guangdong Province from October 1999 to April 2014 were retrospectively analyzed. The patients were divided into two phase groups according to the source of donors. Phase 1 was from October 1999 to September 2007 when 6 patients receiving LT of non-heart-beating donors. The serum hepatitis B virus (HBV) markers of 6 donor livers were all negative. The serum hepatitis B surface antigen (HBsAg)and hepatitis B core antibody (anti-HBc)of the recipients before operation were all positive,including 2 cases combined with Hepatitis Be antigen (HBeAg ) positive,1 case combined with hepatitis B viruse antibody (anti-HBe )positive. The serum HBV deoxyribonucleic acid (DNA)of 5 recipients before LT were over 1000 copies/ml and 1 case were below 1000 copies/ml. All the patients in phase 1 group were given lamivudine (100mg/d) monotherapy orally for the prevention of hepatitis B recurrence after LT. Phase 2 was from November 2011 to April 2014 when 26 patients receiving LT of donation after cardiac death including 1 case of combined liver-kidney transplantation. Six of the donor livers were with serum HBsAg positive and 20 cases negative. Fifteen cases were with hepatitis B surface antibody (anti-HBs)positive and 2 cases with HBeAg positive,14 cases with anti-HBc positive and 5 with anti-HBe positive. The serum HBV DNA of 11 recipients before LT were over 500 copies/ml and 15 cases below 500 copies/ml. Twenty-five cases were given entecarvir 0.5 mg/d and 1 casetelbivudine 600mg/d monotherapy or all for the prevention of hepatitis Brecurrence.Results The median follow-up time of the recipients in group phase 1 was 104 months. The serum HBsAg and HBV DNA were both negative in all recipients and no hepatitis B recurrence was observed till now. The median follow-up time of the recipients in group phase 2 was 50 weeks. Twenty cases received donor livers of negative HBsAg,in which 1 case had transient positive HBsAg 39 weeks after LT and became negative later. The patient receiving combined liver-kidney transplantation suffered hepatitis B recurrence 28 weeks after LT but HBV DNA was observed negative. No hepatitis B recurrence was observed in the 15 cases receiving donor livers of positive anti-HBc. Six cases receiving donor livers of positive HBsAg failed to become negative HBsAg after LT. All the follow-up recipients survived. No HBV DNA replication was observed in the recipients after LT. No adverse reaction of related nucleoside analogues was observed.Conclusions It is effective and safe tousenucleoside analogues monotherapy for the prevention of hepatitis B recurrence in patients after LT.
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Associating liver partition and portal vein ligation for two-staged hepatectomy(ALPPS) is a novel approach for hepatectomy.The case we reported was a 68 years old male patient diagnosed with hilar cholangiocellular carcinoma and obstructive jaundice.ALPPS surgery was operated.Since the patient's left lateral lobe volume was less than 40％ of the whole liver volume (merely 33.91％),the ligation of the right portal vein,plus in situ split of the junction zone between left medial and left lateral liver lobe and the dissection of portal lymph nodes as the first stage operation was conducted.Abdominal CT on the 8th day after the operation reported an increase on the volume of left lateral lobe by 32％ to 41.5％ of the whole liver volume.On the 12th day after the first stage operation,an extended right trilobate hepatectomy combined with left hepatic duct intra-jejunum drainage was performed as the second operation.The patient completely recovered and was discharged three weeks after the second stage operation.
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The shortage of liver organ donor is the barrier to the development of liver transplantation.In the past recent years,the usefulness of the donation after cardiac death donor has increased significantly.So the donor after cardiac death may be the important way to expand the liver organ donor pool.The high incidence of the biliary complication,primary non function and the arterial thrombosis may the most important effectors on the survival outcome of the recipients accepted liver after cardiac death.Reducing warm ischemia time,extracorporeal membrane oxygenation and ex vivo hypothermic machine perfusion may be the ways to improve the life quality of the liver donor after cardiac death and the survival outcome of the recipients.
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Although the organ transplantation had a rapid development in the last 50 years due to the immunosuppression application,the side effect of the immunosppression is one factor affecting the recipient' s long term survival.Immune tolerance induction can solve this problem.Some studies had found a few operational tolerance organ recipients in clinical practice.The regulatory T cells and some gene's expression in the peripheral blood can be used as the potential immune tolerance biomarkers in the operational tolerance kidney and liver recipient.The dentritic cells,and the γδTCR + T cells' number differences were also found in the operational tolerance liver recipient,and B lymphocyte number difference was also found in the peripheral blood of the operational tolerance kidney recipient.All these markers may be the potential biomarker of immune tolerance.As the important role of MicroRNA in the immune system,it may also be the potential immune tolerance biomarker of the organ transplantation.
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Objective To compare the effects of combined ‘en bloc' liver-pancreas transplantation (LPT) with portal vein drainage and simultaneous combined kidney-pancreas transplantation (KPT) with systemic venous drainage on the pancreatic endocrine function and related metabolism.Methods Four LPT patients and 6 KPT ones with normal hepato-renal function, good quality of life and periodic follow-up received measurement of serum insulin, insulin provocation test, fasting glucose, oral glucose tolerance test, C-peptide, glycated hemoglobin, triglyceride and total cholesterol; and their laboratory test parameters were compared and analyzed.Results In KPT group, 2-h insulin level, C-peptide level and total cholesterol level were significantly higher at 6th month, 3rd and 6th month postoperation (all P<0.05). But there was no significant difference in other parameters between the two groups at 6th month after operation.Conclusion Either KPT or LPT can achieve excellent endocrine function, carbohydrate and lipid metabolism; and the results show that portal venous drainage does not offer major metabolic advantages within 6 months after operation.