Clinical analysis of donor hepatectomy in living donor liver transplantation: report of 74 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the living donor selection, donor hepatectomy technique, and surgical complication in living donor liver transplantation.</p><p><b>METHODS</b>From June 2007 to July 2008, 74 consecutive cases living donor hepatectomy were performed by the same surgical team. Seventy-four donors (64 males and 10 females) with a mean age of 29.2 years old passed the donor liver assessment and evaluation program successfully. The hepatectomy procedure types contained right liver resection (n = 72), of which 27 cases harvested the middle hepatic vein and 45 cases not, left liver resection contain middle hepatic vein (n = 1) and left lateral resection (n = 1).</p><p><b>RESULTS</b>Of all the donors, operation time was (6.5 +/- 6.2) hours, the mean blood loss was 300 ml (100 - 500 ml) and didn't accept foreign blood transfusion. The maximum alanine aminotransferase (ALT) level was (229.5 +/- 108.6) U/L, the ALT returned to normal time was (12.7 +/- 4.8) d, the maximum total bilirubin (TB) level was (78.7 +/- 44.3) micromol/L, the TB returned to normal time was (8.8 +/- 2.7) d, and the mean hospital stay time was 14 days (7 - 28 d). The complications included bile leak (n = 1), cut surface hemorrhage (n = 1) and anaphylactoid purpura (n = 1). All the donors returned to normal work and life finally.</p><p><b>CONCLUSIONS</b>Precisely evaluating donor blood vascular and biliary anatomy before operation, keeping the blood vascular and bile duct integrity during operation and monitoring complication to solve it immediately after operation is crucial to ensure donor safety and recovering successfully.</p>

Clinical study of liver re-transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To report experiences of liver re-transplantation.</p><p><b>METHODS</b>The cause of re-transplantation, the pre-operative MELD score, timing of re-transplantation, technical considerations, 1 year survival rate and the causes of death of the patients receiving liver re-transplantation in First Central Hospital of Tianjin between January 1999 and December 2005 were retrospectively analyzed.</p><p><b>RESULTS</b>One year survival rate of re-transplantation was 71.6%. The most common cause of hepatic graft failure and subsequent re-transplantation was biliary complications (45.5%). The 1 year survival rate of patients with a MELD score less than 20 was higher than patients with a score of 20 approximately 30 and > 30 (83.8% versus 57.1% and 66.7%). The peri-operative survival rate of patients who received re-transplantation 30 days after the initial transplantation was higher than those who received re-transplantation between 8 to 30 days post the first operation (83.8% versus 41.7%). The main cause of peri-operative death was celiac infections (accounted for 54.2% deaths) in the patients.</p><p><b>CONCLUSIONS</b>Proper indication selection, optimum operation time, right surgical procedure, intensified peri-operative monitoring and infection control are all crucial for the improvement of survival rate in patients receiving liver re-transplantation.</p>

Analysis of survival rate and risk factors of liver retransplantation / 中华外科杂志

<p><b>OBJECTIVES</b>To analyze the survival rate of orthotopic liver retransplantation (Re-OLT) and identify the variables predicting the outcome.</p><p><b>METHODS</b>A retrospective analysis of 74 Re-OLT patients from January 1999 to December 2005 was performed. The univariate analysis of Kaplan-Meier model was used to investigate the relativity between the factors and survival rate, and COX regression model was used in multivariate analysis to identify the prognostic factors for survival.</p><p><b>RESULTS</b>The total incidence rate of Re-OLT was 5.7%, and overall patient survival rates at 1 month, 3 month, 1 year and 2 year were 82.4%, 73.8%, 71.9% and 68.5%, respectively. There were 10 factors might influence the survival rate by Kaplan-Meier model, such as the period of Re-OLT, stage of hepatic encephalopathy, prothrombin time, total bilirubin, warm ischemia time, operative surgical procedure, quantity of blood lost during operation, days staying in the intensive care unit (ICU), infection and complications after Re-OLT. And three factors among them were identified as independent prognostic factors for survival by multivariate model: operative surgical procedure, days staying in the ICU and complications after Re-OLT.</p><p><b>CONCLUSION</b>The surgical procedure, duration in ICU and complications after Re-OLT are strong predictors for survival after Re-OLT.</p>

Relationship between pre-transplantation α-fetoprotein messenger RNA expression in peripheral blood with tumor recurrence and survival rate in HCC patients / 第二军医大学学报

Objective: To assess the relationship between pre-transplantation α-fetoprotein messenger (AFP) RNA expression in peripheral blood with tumor recurrence and survival rate in HCC patients. Methods: Thirty-one HCC patients receiving in situ liver transplantation from Feb. 2003 to Feb. 2004 were included in this study. Real-time quantitative RT-PCR was used to determine the expression level of AFP RNA in peripheral blood of all patients. All the cases were followed up for tumor recurrence and survival rate. The SPSS 12.0 software was used to analyze the relationship between AFP mRNA expression with tumor recurrence and survival rate. Results: Ten of the 31 patients were positive of AFP mRNA, with the quantity being 57 to 10 400 copies/μg RNA (median value: 360 copies/ μg RNA). Patients' Child-pugh grade, tumor size, tumor number, and tumor Edmood grade were not related to pre-transplantation AFP mRNA expression. Patients of pTNM III-IV stages had a significantly higher AFP mRNA expression than those of pTNM I-II stages (P=0.001); patients with vascular invasion had a significantly higher expression than those without (P=0.029). Patients who were negative of AFP mRNA before transplantation had a significantly higher survival rate than those positive of AFP mRNA. Conclusion: The results suggest that the pre-transplantation levels of AFP mRNA in peripheral blood may be a risk factor for recurrence and/or metastasis after transplantation in HCC patients; it may also be an indicator for extra-hepatic micrometastasis before transplantation and can be used for predicting prognosis.