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Objective To evaluate the role of preoperative serological indexes in predicting long-term survival and tumor recurrence of hepatocellular carcinoma (HCC) patients after liver transplantation, aiming to explore its significance in expanding the Milan criteria. Methods Clinical data of 669 recipients undergoing liver transplantation for HCC were retrospectively analyzed. The optimal cut-off value was calculated by the receiver operating characteristic (ROC) curve. The risk factors affecting the overall survival and recurrence-free survival rates of HCC patients after liver transplantation were identified by univariate and multivariate regression analyses. The correlation between preoperative serum liver enzymes and pathological characteristics in HCC patients was analyzed. The predictive values of alpha-fetoprotein (AFP) combined with γ -glutamyl transferase (GGT) and different liver transplant criteria for the survival and recurrence of HCC patients after liver transplantation were compared. Results Exceeded Milan criteria, total tumor diameter (TTD) > 8 cm, AFP > 200 ng/mL and GGT > 84 U/L were the independent risk factors for the overall survival and recurrence-free survival rates of HCC patients after liver transplantation (all P < 0.05). Correlation analysis showed that preoperative serum GGT level was correlated with TTD, number of tumor, venous invasion, microsatellite lesions, capsular invasion, tumor, node, metastasis (TNM) stage, Child-Pugh score and exceeded Milan criteria (all P < 0.05). Milan-AFP-GGT-TTD (M-AGT) criteria were proposed by combining Milan criteria, TTD with serum liver enzyme indexes (AFP and GGT). The 5-year overall survival and recurrence-free survival rates of HCC recipients who met the M-AGT criteria (111 cases of exceeded Milan criteria) were significantly higher than those who met Hangzhou criteria (both P < 0.05), whereas had no significant difference from their counterparts who met the University of California at San Francisco (UCSF) criteria (both P > 0.05). Conclusions Preoperative serological indexes of AFP and GGT could effectively predict the long-term survival and tumor recurrence of HCC patients after liver transplantation. Establishing the M-AGT criteria based on serological indexes contributes to expanding the Milan criteria, which is convenient and feasible.
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Liver transplantation is an effective approach to treat intrahepatic cholangiocarcinoma (ICC). It is necessary to strictly control surgical indications of ICC because of its high invasiveness, lymph node metastasis and recurrence rate after liver transplantation. Liver transplantation yields high efficacy for single ICC with a diameterof ≤2 cm. For advanced ICC, neoadjuvant therapies including locoregional treatment and systemic chemotherapy should be initially delivered. According to the response of these neoadjuvant therapies, whether liver transplantation should be performed can be determined, and individualized adjuvant therapy should be delivered after operation. At present, multiple gene mutation targets and targeted therapeutic drugs for cholangiocarcinoma have been identified. Comprehensive treatment before and after liver transplantation may expand surgical indications of liver transplantation for ICC and improve clinical prognosis of the recipients. In this article, liver transplantation for ICC, neoadjuvant therapy before liver transplantation, postoperative adjuvant therapy and targeted therapy for ICC were reviewed.
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Objective To investigate the safety and efficacy of radiofrequency ablation (RFA) combined with extracting blood from hemangiomas guided with CEUS for treating hepatic cavernous hemangiomas (HCH).Methods Data of 55 patients with 77 lesions of HCH underwent CEUS guided RFA combined with extracting blood from hemangiomas during January 2010 to December 2016 were retrospectively analyzed.Conventional ultrasound and CEUS were performed before therapy,in order to obtain the size and blood supply information of lesions,also performed immediately after treatment and 3 months later to calculate the volume of hemangiomas and the rate of hemangiomas after the treatment,as well as the rate of non-blood supply 3 months after the treatment.Then statistical analysis was done.Results The mean operation time was (31.53±15.89)min,and the blood extracting from hemangiomas was (135.36± 68.13)ml.There was positive correlation between the volume of hemangiomas before treatment and the blood extracting from hemangiomas (r=0.722,P＜0.05).No serious complication occurred among 55 cases,while mild complications happened in 9 cases (9/55,16.36 ％).The volume of hemangiomas decreased immediately and 3 months after treatment (both P＜0.05),and the rate of hemangiomas reducing was (48.76±32.58) ％ and (22.37±35.73) ％,respectively.The rate of non-blood supply 3 months after treatment was 96.10％ (74/77).Conclusion CEUS-guided RFA combined with extracting blood from hemangiomas is an effective and safe method,which has potential to become a first-line therapy.
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Objective To assess the effects of the risk factors of grafts from donors after cardiac death (DCD) on the prognosis of liver transplantation (LT).Methods In this retrospectively study,215 cases of LT using DCD donor grafts were performed at our institution from September 2013 to January 2017.Due to the loss to follow-up in 4 cases,211 cases were enrolled in the study.The following DCD donor data were collected:gender,age,primary disease,ABO blood type,body mass index (BMI),medical history (fatty liver,hypertension),ICU hospitalization time,mechanical ventilation time,warm ischemia time,cold ischemia time,and indexes of routine laboratory test before donation.Statistical analyses using the Kaplan-Meier method,log-rank test,multivariate step-wise Cox regression were performed.Results Of the 211 donors,univariate analysis showed that the overall 6-month,1-,and 3-year survival rate after DCD LT was 88％,84％,and 82％,respectively.Univariate analysis showed that donor serum sodium level ＜136 mmol/L (P =0.018) and cold ischemia time ＞9 h (P =0.013) were all significant risk factors affecting overall survival after DCD LT.Additionally,donor BMI ＞30 kg/m2 (P =0.011) and donor age ＞60 years (P =0.025) were significantly associated with postoperative complications.Multivariate analysis showed that donor serum sodium level (P=0.025) was an independent risk factor of survival after DCD LT.Conclusion To select suitable DCD liver allografts and control risk factors of donor can help to improve outcomes of recipients.
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Objective To investigate the characteristics of infection and risk factors after pediatric living donor liver transplantation (PLDLT).Method Form April 2005 to April 2014 the clinical data of 45 cases of PLDLT in General Hospital of Chinese People's Armed Police Forces were retrospectively investigated,and the difference between the patients after PLDLT with infection and those without infection was analyzed.Result Eighty-four infections occurred in 27 (60.0％) of 45 patients,including 25 cases of bacterial infections,14 cases of viral infections,and 3 cases of candida albicans infections.Most infections occurring within 3 months after PLDLT have been found to be caused by bacteria,viruses and fungi.The trough level of tacrolimus (Tac) was in target therapeutic window in 16/20 infected patients and more than 10 ng/mL in 4/20 infected patients within 3 months after PLDLT,and there were 12/16 infected patients with the trough level of Tac of more than 10 ng/mL 3 months post-PLDLT,with the difference being significant (P＜0.05).Multivariate analysis revealed that post-transplant infection was significantly related with the factors as weight＜10 kg,age ＜12 months,biliary intestinal anastomosis,pediatric end-stage liver disease (PELD) score,ChildPugh score,total bilirubin,blood loss per kg body weight and graft to recipient weight ratio (GRWR).Logistic regression analysis suggested that PELD score was independent risk factor of infection after PLDLT.Conclusion The infection after PLDLT has their special characteristics.The proper irnmunosuppressive protocol and control of above risk factors are helpful to decrease the incidence of infection after PLDLT.
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Objective To analyse our clinical experience in pediatric living donor liver transplantation (PLDLT).Methods The clinical data of 45 patients who underwent PLDLT in our hospital from April 2005 to April 2014 were retrospectively studied and their preoperative,intraoperative and postoperative data were analyzed.Results All donors recovered well.The graft to recipient weight ratio (GRWR) ranged from 1.0％ ～ 6.4％ (2.5％ ± 1.2％).Size reduction of graft were performed in 2 patients.An interposition venous conduit from the confluence of the native right and left portal vein (PV) to the graft PV was carried out in 1 patient,venous grafts for revascularization of the tributaries of the middle hepatic vein from segment Ⅴ and Ⅷ were used in 3 patients,and a venous patch for revascularization of the left hepatic vein was used in 2 patients.Hepatic artery re-reconstruction was performed in 3 patients after hypoperfusion was detected on intraoperative Doppler ultrasound.The postoperative complications included acute rejection (n =2),vascular complications (n =7),biliary complications (n =11),and infectious complications (n =27).The 1-,2-and 5-year survival rates were all 84.4％.Seven of 45 recipients died within one year post transplantation,with 3 patients who died of vascular complications,and 4 patients who died of infection.The differences in age [(50.8 ± 49.8) months vs (12.6 ± 14.9) months],body weight [(16.2 ± 10.5) kg vs (7.3 ± 1.7) kg],serum total bilirubin [(177.0 ± 126.5) μmol/L vs (301.9 ± 110.6)μmol/L],Pediatric end-stage liver disease (PELD) score (16.1 ± 12.1 vs 26.2 ± 11.3) and GRWR (2.2％ ± 0.8％ vs 4.2％ ± 1.6％) between the survival and the dead groups were significant (P ＜ 0.05).Conclusions PLDLT is an effective method to treat children with end-stage liver disease.Using a multidisciplinary approach in the preoperative management,excellent surgical techniques,and proper postoperative management are extremely helpful to improve postoperative survival rate.
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Objective TostudythevalueofordinarycolorDopplerflowimaging(CDFI)inthe diagnosis of hepatic artery thrombosis (HAT)in early stage after pediatric liver transplantation (PLT).Methods Clinicaldataof55childrenundergoingPLTintheGeneralHospitalofChinesePeople'sArmed Police Forces from April 2005 to May 2014 were analyzed retrospectively. Conventional hemodynamic monitoring was performed in all cases in the early stage after operation by CDFI. No intrahepatic arterial blood flow signal was observed by CDFI multi-angle examination and HAT was suspected. Computed tomography angiography (CTA)and surgical exploration were performed in the suspected HAT patients. The sensitivity and specificityofordinaryCDFIindiagnosingHATwerecalculatedbyChissstatisticalsoftware.Results Among the 55 PLT recipients,3 cases were suspected as HAT by CDFI,including 2 cases of HAT in the main hepatic artery,1 cases of HAT in the right hepatic artery. All cases were confirmed by CTA or surgical exploration.The incidence of HAT was 5% (3/55 ). The sensitivity and the specificity of CDFI in diagnosing HAT after PLTwereboth1.0,andfalsepositiveratewas0.Conclusions OrdinaryCDFIisthepreferredandmain method for hemodynamic examination after PLT. The experienced sonographer for transplantation can improve the accuracy in diagnosing HAT.
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Objective To analyze the individual immunosuppressive protocol (IP) after liver transplantation (LT) in benign end-stage liver disease. Methods The clinical data of 645 patients with benign end-stage liver disease undergoing LT in our institute from April 2002 to Aug 2010 wen analyzed retrospectively. 146 cases from Apr. 2002 to Dec. 2004 were in stage one, and triple therapy containing tacrolimus (Tac), mycophenolate mofetil (MMF) and methylprednisolone (MP) was used;273 cases from Jan. 2005 to Dec 2007 were in stage two, and the less dose of immunosuppressant than stage one was used; 226 cases from Jan. 2008 to Aug. 2010 were in stage three, and they wen divided into conventional group and severe patient group according to their preoperative model for endstage liver disease (MELD) score and patient condition, the individual IP was used. Results The overall survival rate of patients with MELD score 0. 05). The incidence of rejection in cases with MELD score ≥25 in stage two and stage three was higher slightly than in stage one (P<0. 05). Conclusion The IP after liver transplantation should be individualized according to recipient conditions, which can increase survival rate.
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Objective To explore the treatment of ABO-incompatible orthotopic liver transplantation. Methods Nine cases of ABO-incompatible liver transplantation performed in our hospital were analyzed retrospectively. Plasma exchange was done before the operation in 1 case. Hepatic artery and biliary duct anastomosis were performed by the microvascular technique. Splenectomy was done during operation in 5 cases. The immunosuppressive protocol included a quadruple drug therapy. Blood oxygen saturation was maintained above 95% and anticoagulant therapy was performed after operation.Results Four patients recovered smoothly without complications. Postoperative complications included acute rejection in 3 patients and biliary nonanastomotic stricture in 4. Three patients died. Conclusion ABO-incompatible orthotopic liver transplantation can be used when the graft is scarce, and should manage to decrease the complications.
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Objective:To explore the treatment and effect of ABO-different orthotopic liver transplantation(OLT).Methods:Fifteen cases of ABO-different OLT were analyzed retrospectively.Six cases of ABO-different but compatible OLT were treated routinely.In 9 cases of ABO-incompatible OLT,plasma exchange was done in 1 case before operation,splenectomy was done in 5 cases during operation,the hepatic artery and biliary duct anastomosis were performed by the microvascular technique.The immuno suppressive protocol included a quadruple drug therapy,and anticoagulant therapy were performed postoperation.Results:No complications were found in 6 cases of ABO-different but compatible OLT.Of the 9 cases of ABO-incompatible OLT,4 patients recovered smoothly without complications.Postoperative complications included acute rejection in 3 patients,biliary nonanastomotic stricture in 4 patients,and 3 cases died.Conclusion:The effect of ABO-different but compatible OLT is good.ABO-incompatible OLT can be used when the graft is scarce,but we should manage to decrease the complications.
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Objective: To study the surgical strategy of portal vein organized thrombosis ( PVOT ) during liver transplantation ( LT ) . Methods: The clinical data of 41 patients with PVOT performed LT from January 2005 to June 2006 ( 359 cases ) in our institute was retrospectively analyzed . The reconstruction of portal vein ( PV ) were removing thrombosis in 22 cases , throm- boendovenectomy in 10 cases , PV to splanchnic varicose vein in 8 cases , cavoportal hemitranspo- sition in 1 case . Results: 1 case died of multiple organ failure , 1 case died of hepatic artery bleeding . Retransplantation and portosystemic shunt vein ligation were performed in 1 case 14 days after LT because of its insufficient PV flow 2 cases were found anastomotic stenosis and they were cured by balloon angioplasty and stent placement via hepatic vein . Other patients were followed up 6 to 20 months , all of them had normal PV flow . Conclusion: Thromboen- dovenectomy or removing thrombosis is applicable to manage PVOT during LT .
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Objective:To investigate the renal injury of portal hypertensive rat after one hour of occlusion of portal vein and inferior vena cava.Methods:Healthy male Wistar rats were taken randomly as normal control、portal hypertensive control and trial group.The recoverable portal hypertensive model was induced firstly.Three weeks later ,15 model rats were taken randomly as portal hypertensive control group,others had another operation and were divided randomly into 0,6h,12h,24h,48h,72h,7d group according to different reperfusion time after 1 hour of occlusion of portal vein and inferior vena cava.At the corresponding time points after reperfusion,the examinations below were done:serum ALT,TBIL,BUN,Cr concentrations;mor-phological changes of liver and kidney,the ultrastructure of renal tissue.Results:Serum and Cr in trail group reached their peak value 12~24 hours after reperfusion,then decreased gradually,and returned to normal 72 hours after reperfusion.The main injury of kidney was located in proximal tubular epithelial cell ,it peaked at 12 hours and 24 hours after reperfusion,the sporadic karyopyknosis and karyorrhexis could be seen,but the basement membrane preserved well.48 hours later,the restoration could be seen.7 days later it restored obviously.Conclusion:There are obvious injury in tubular epithelial cell in the portal hypertensive rat after 1 hour of occlusion of portal vein and inferior vena cava.But the injury of kidney is reversible.
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Objective:To investigate the management in patients with complete portal vein (PV) and superior mesenteric vein (SMV) thrombosis during liver transplantation (LT). Methods:Seven patients with complete PV and SMV thrombosis undergone LT, The reconstruction of PV were the anastomosis PV to varicose coronary vein in 3 cases, PV to varicose vein near hilus of spleen in 2 case, PV to varicose vein in front of common bile duct in 1 case, PV to varicose right gastro-epiploic vein in 1 case. Results:All patients undergone successful LT. One case died 7 days after the transplantation of multi-organic nonfunction, but the PV was patent. One case was found stenosis at the anastomosis 6 months after LT, and he was cured by percutaneous transhepatic portography and stent placement. Other patients were followed-up12~22 months, the PVs were patent, and had sufficient blood supply, and they have normal liver and kidney functions now. Conclusion :The anastomosis between graft portal vein and the splanchnic varicose vein may be a applicable choice for the patients with complete PV and SMV thrombosis during LT.