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Humans , Tacrolimus , Living Donors , End Stage Liver Disease , Postoperative Complications , NeuropsychologyABSTRACT
ObjectiveTo investigate the incidence of early postoperative complications in living donor liver transplantation.MethodsPostoperative data of 170 living liver donors were retrospectively collected from January 2002 to August 2009 and the collected data were divided into two groups according to the type of donors (right-lobe graft,R group and left lobe graft,L group). Early postoperative complications were analyzed using Clavien classification system.ResultsThe difference between two groups was no statistically significant in donor's age,body mass index,operation time and other characters (P＞0.05).R group had a bigger actual cut weight of donor liver (P＜0.05),smaller residual liver weight (P＜0.05) which also smaller than standard liver weight (P＜0.05),and a longer hospital stay (P＜0.05) than L group.During hospitalization,62 complications occurred in 55 cases with the total complication rate being 32.35％ (55/170). In detail,the incidence of complications was 34.39％ (54/157) in R group,and 7.69％ (1/13) in L group (chi-square value =2.787,P＞0.05).Among these 62 complications,there were 39 times of Ⅰ grade,5 times of Ⅱ grade,16 times of Ⅲ grade,2 times of Ⅳ a grade. All the complications were cured by active treatment and all donors survived well.Conclusion Although the security of living donor liver transplantation is better,the risk of serious complications must be faced.We must strictly select and assess the donor before the operation,very carefully carry out surgical operation,and pay more attention to postoperative management in order to avoid postoperative complications of donors.
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Objective To investigate the liver function injury and the rate of complications in living liver transplantation donors in different graft type transplantation.Methods Postoperative data of 154 living liver donors satisfying our inclusion criteria were prospectively collected and registered from Jan 2002 to May 2009 in our hospital.We divided the donors into two groups (right-lobe graft, R group and left-lobe graft, L group), and made comparison on the liver function and complications.Results Remnant liver weight in R group were smaller than those in L group (t = 11.418, P ＜ 0.05).the ratio of remnant liver weight to standard liver weight in R group were smaller than those in L group (t = - 5.040, P ＜ 0.05 ) .Peaks of ALT, AST and INR in both groups appeared on the first day after operation, while the peak of TB in R group appeared on the third day after operation.All the index values returned to a normal baseline after reaching its peak.Mean values of TB in R group were higher than those in L group on the 1st, 3rd, 7th day after operation (seperately t1 = 5.285, t3 = 3.747, t7 = 2.729, all P ＜ 0.05).Mean values of INR in R group were higher than those in L group on the 1st, 3rd, 7th day after operation (seperately t1 = 5.260, t3 = 5.035, t7 = 2.267, all P ＜ 0.05).The level of TB in both groups returned to normal range on the 7th postoperative day, while the level of ALT and AST remained twice the upper limits of the normal.There were no deaths; Complications occurred in 53 of 154 donors (34.42% ) , 52/141 (36.88% ) in R group and 1/13 (7.69% ) in L group (x2 = 3.292, P ＞ 0.05).Conclusions Ramnant liver function of R group during early postoperative period was poorer than that of the L group.Donors were safe, though suffering from comparatively high complication rate.
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Objective To evaluate the efficacy and safety of simulect (basiliximab) after orthotopic liver transplantation (OLT). Methods Forty adult recipients with benign end-stage liver disease between November 2003 to November 2004 were assigned randomly in a 1∶1 ratio to receive either two doses of simulect or matching placebo. The patients in the two groups received baseline triple immunosuppression with the calcineurin inhibitor (CsA or FK506), MMF and steroids. A total of 40 mg simulect was given in two doses of 20 mg each on the day 0 before inferior vena was opened and the day 4 after transplantation respectively. Acute rejection, infection and serum ALT, AST, TBIL, DBIL and ALP in both groups were observed in the first 30 days after OLT. Results In Simulect group had less frequent incidence of acute refection during the first 30 days after OLT. In Simulect group and matching placebo, incidence of acute refection was 10 % (2/20) abd 45 % (9/20) respectively (P= 0.034), and that of infection was 40 % (8/20) and 45 % (9/20) respectively (P= 0.749). Bilirub and aminopherase in both groups were declined gradually and ALP increased. There were significant difference in ALT and TBIL between two groups. Conclusion The application of simulect in combination with CsA/FK506, MMF and prednisone is safe and well tolerated, and can effectively reduce the incidence of acute refection, and does not lead to increased opportunistic infections.
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Objective To evaluate the outcome of liver transplantation in patients with recurrent liver cancer after resection.Methods Data of 23 patients underwent liver transplantation for recurrent liver cancer from April 2001 to March 2008 were retrospectively collected and analyzed.Results Previous history of liver resection had little negative effect in subsequent liver transplantation in technical aspect.Liver function recovered uneventfully after transplantation in all cases.Alpha fetoprotein(AFP) recovered to normal value in 13 of 17 cases with elevated AFP before transplantation within one month after operation.Five cases(21.74%) had postoperative complications.Nineteen cases(82.61%) were followed up,average follow-up duration were 610 days.There were 5 cases(26.32%) of cancer recurrence and 6 deaths during follow-up,survival rate was 68.42%.Conclusion Liver transplantation is a reasonable treatment for recurrent liver cancer after resection.
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Objective To explore the correlation between liver volume variation of posthepatitic cirrhosis patients and the severity of the disease. Methods One hundred and eleven patients with normal livers and 74 posthepatitic cirrhosis patients underwent volume CT scan. The relation between normal liver volume and body height, body weight and body surface area was studied by linear regression and correlation method, the standard liver volume equation was deduced. The change ratio of liver volume in cirrhotic patients was calculated and compared with Child classification. Results The mean normal liver volume of Chinese adults was (1 225.15?216.23) cm~3, there was a positive correlation between liver volume and body height, body weight 〔liver volume (cm~3)=12.712?body weight (kg)+450.44〕 and body surface area 〔liver volume (cm~3)=876.02?body surface area (m~2)-297.17〕. The mean liver volume of Child A, B and C patients were (1 077.77?347.01) cm~3, (1 016.35?348.60) cm~3 and (805.73?208.85) cm~3 respectively. The liver volume and liver volume index was significantly smaller in Child C patients than those in Child A and B patients (P
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Objective To explore the effect of perioperative risk factors on post-liver transplantation acute renal failure ( ARF). Methods Clinical data of 89 cases undergoing liver transplantation between 1999 and 2002 in our centre were retrospectively analyzed. Univariate logistic regression analysis was used to determine relative risk factors leading to post-liver transplantation ARF. Significant factors were then entered into a multivariate logistic regression to identiy factors independently associated with post-liver transplantation ARF. Result In univariate analysis, intraoprative volume of blood transfusion (P - 0. 041) and duration of operation (P = 0. 005) are with statistical significance. ARF is associated with a poor prognosis ( P