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In early stage after liver transplantation(LT), coagulation function of recipients stays in a fragile balance. Affected by a variety of complex mechanisms, blood is usually hypercoagulable. An imbalance between coagulation factors and physiological anticoagulants, elevated level of vWF, an occurrence of fibrinolysis inhibition and dosing of immunosuppressive agents cause a hypercoagulable state in an early stage after LT. Blood hypercoagulability may lead to such thrombotic complications as hepatic artery, portal vein and deep vein thromboses. Some studies have demonstrated that postoperative prophylactic anticoagulation has some effect in reducing the risks of early postoperative thrombosis. However, there is still a great lack of high-quality evidence. This review summarized the latest researches on early coagulation dysfunction, thrombosis and preventive anticoagulation after LT.
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Objective:To identify the risk factors for massive blood transfusion in pediatric living donor liver transplantation.Methods:The medical data of children underwent living donor liver transplantation in our hospital from April 2006 to April 2019 were retrospectively collected.Massive transfusion was defined as the administration of red blood cells > 1 fold of the total blood volume (70 ml/kg) during operation.Patients were assigned to massive transfusion group and non-massive transfusion group according to the volume of blood transfused during operation.Binary logistic regression analysis was used to identify the risk factors for massive blood transfusion during living liver transplantation.Results:A total of 95 pediatric patients were enrolled in this study, with 18 cases in massive transfusion group and 77 cases in non-massive transfusion group.The incidence of massive blood transfusion was 19% during operation.The results of logistic regression analysis showed that preoperative survival status of " hospitalization" ( OR=49.816, 95% CI 2.945-842.59, P=0.007), increased serum Cr concentrations ( OR=1.046, 95% CI 1.007-1.086, P=0.021), increased Pediatric End-Stage Liver Disease (PELD) or Model for End-Stage Liver Disease (MELD) score ( OR=1.215, 95% CI 1.046-1.411, P=0.011) and prolonged operation time( OR=1.623, 95% CI 1.133-2.327, P=0.008) were the independent risk factors for intraoperative massive blood transfusion in living donor liver transplantation, while increased recipient weight ( OR=0.856, 95% CI 0.761-0.962, P=0.009) was a protective factor for intraoperative massive blood transfusion. Conclusions:Preoperative survival status of " hospitalization", increased PELD or MELD score and prolonged operation time are independent risk factors, while increased pediatric weight is a protective factor for massive blood transfusion in pediatric living donor liver transplantation.
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Objective:To evaluate the long-term prognosis and recurrence of young liver transplant recipients with hepatocellular carcinoma(HCC).Methods:Based upon the database of liver transplantation center, clinical data were retrospectively reviewed for 39 young recipients(18~40 years)and 158 middle-aged and elderly recipients(over 40 years)from 2013 to 2017. The parameters of overall survival(OS), recurrence-free survival(RFS)and disease-specific survival(DSS)were compared between two groups.Cox's proportional hazard model was utilized for evaluating the prognostic factors.Results:Significant inter-group difference existed in recurrence rate of HCC. Kaplan-Meier analysis revealed no significant difference in OS rate(1/3-year OS, 82.1%, 66.7% and 86.1%, 74.7%, P>0.05)and DSS rate(1/3-year DSS, 94.9%, 82.1% and 99.4%, 91.1%, P=0.053); RFS rate(1/3-year RFS, 51.3%, 41.0% and 73.0%, 62.7%, P=0.008)showed significant differences; Cox multivariate analysis revealed that AFP>400 μg/L was an independent risk factor for OS, DSS and RFS; poorly differentiated tumors and positive micro-vascular invasion(MVI)were independent risk factor for DSS; poorly differentiated tumors and total tumor size >5 cm were independent risk factors for RFS. Conclusions:Although RFS of young adult group is worse than that in middle-aged and elderly group after LT, no significant inter-group difference exists in OS or DSS. And LT is still a quite effective treatment for young HCC patients.
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Objective:To investigate the application value of dual-graft living donor liver transplantation of right segment from an adult living donor combined with a left lateral segment from donation after brain death for hepatocellular carcinoma (HCC).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of a male 46-year-old patient with HCC who underwent dual-graft living donor liver transplantation of right segment from an adult living donor combined with a left lateral segment from donation after brain death at the West China Hospital of Sichuan University in October 2019 were collected. He weighed 66 kg and was 171 cm in height. His blood type was A Rh-positive. Graft one was from a female 23-year-old living donor who had a bodyweight of 50 kg, a height of 150 cm, and blood type of A Rh-positive; graft two was from a male 44-year-old brain death donor with the blood type of A Rh-positive. The surgery was performed in three operating rooms, graft one and graft two were obtained simultaneously in two operating rooms, and the recipient′s liver was dissected in the third operating room. When the in vitro splicing of the liver was almost completed, surgeons entirely removed the recipient′s liver and started to transplant the new one. Observation indicators: (1) surgical situations and postoperative recovery of the living donor and the recipient; (2) postoperative pathological examination of the recipient′s liver; (3) follow-up. Follow-up was conducted by outpatient examinations, including monitoring of HCC recurrence, monitoring of new liver function, monitoring and adjustment of immunosuppressive agents, detection of biliary vascular complications, rejection and adverse drug reactions. Regular lifelong follow-up was required for recipients, with the latest follow-up on December 4, 2019. Count data were expressed as absolute numbers or percentages.Results:(1) Surgical situations and postoperative recovery of the living donor and the recipient: operation time, volume of intraoperative blood loss, volume of intraoperative infusion of autologous blood of the living donor were 315 minutes, 200 mL, 200 mL, respectively. The living donor was discharged from hospital on the sixth day after surgery without any complications. The recipient underwent modified piggyback liver transplantation successfully. Graft one was from the right segment free of the middle hepatic vein in the living donor, with a weight of 410 g. Graft two was from the left lateral segment in the donor after brain death, with a weight of 400 g. The graft from donors to recipient weight ratio was 1.2% after splicing. The operation time, duration of anhepatic phase, volume of intraoperative blood loss, volume of intraoperative blood transfusion were 815 minutes, 60 minutes, 1 500 mL, 1 800 mL, respectively. The recipient′s temperature was normal during hospitalization. On the first postoperative day, the level of white blood cell and neutrophilic granulocyte percentage of the recipient reached a peak (17.15×10 9/L and 91.7%, respectively) and then gradually decreased. After anti-infective treatment with piperacillin sodium and sulbactam sodium, both of the two indicators returned to normal on the seventh day after surgery (7.90×10 9/L and 70.9%, respectively), and the antibiotic was discontinued. During the hospitalization, the level of albumin of the recipient fluctuated in 31.0-41.4 g/L, the liver function parameters including total bilirubin, alanine aminotransferase, aspartate aminotransferase, prothrombin time and international normalized ratio gradually returned to normal levels, and the renal function parameters including creatinine and estimated glomerular filtration rate remained within the normal range. On the tenth day after surgery, the recipient was in good condition and discharged from the hospital. (2) Postoperative pathological examination of the recipient′s liver: ① results of the pathological examination showed moderately differentiated HCC with incomplete tumour capsule and no invasion of the liver capsule. The surrounding liver tissues showed hepatitis B-related nodular cirrhosis, and no tumor involvement was detected at the broken end of the hilum. ② The gallbladder presented chronic cholecystitis accompanied by cholesterol deposition, and one abdominal lymph node showed reactive hyperplasia. The immunohistochemical staining showed 10% positive HBsAg and negative HBcAg. (3) Follow-up: the tumor markers of the recipient were tested on November 19, 2019, including α-fetoprotein (2.92 μg/L) and abnormal prothrombin (16 AU/L). Together with the negative result of abdominal colour doppler ultrasound, they collectively indicated no HCC recurrence in the recipient. The liver function parameters including total bilirubin (8.6 μmol/L), alanine aminotransferase (23 IU/L), aspartate aminotransferase (28 IU/L) and albumin (44.0 g/L) of the recipient tested on December 3, 2019, were all in normal levels. Blood concentration of tacrolimus was 4.2 μg/L . The drug dose of mycophenolate mofetil dispersible tablets was adjusted to 250 mg given twice daily, and the drug dose of others was unchanged (tacrolimus 2 mg, once daily; sirolimus 1mg, once daily). No symptoms, signs or examination results indicated biliary vascular complications, rejection or adverse drug reactions. Conclusion:Dual-graft living donor liver transplantation of right segment from an adult living donor combined with a left lateral segment from donation after brain death is safe and effective, which can be used as a suboptimal treatment for patients with HCC beyond Milan criteria.
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Objective@#To investigate the application and effect of clinical pathway in practice teaching of hepatic surgery.@*Methods@#The 64 clinical interns who had an internship in our department between February 2018 and May 2019 were divided randomly into two groups: the experimental group (n=32) and the control group (n=32). The clinical pathway teaching method was used in the experimental group and the traditional teaching method was used in the control group. At the end of their internship, the examination and the satisfaction survey were requested to finish in the both groups. The statistical software SPSS 17.0 was used. Continuous variables were analyzed through the t-test. Categorical data were compared through Pearson chi-square.@*Results@#The examination results included theoretical knowledge (P=0.033), operating skill (P=0.021), case analysis (P=0.006) and medical record writing (P=0.017), which were significantly better in the experimental group than in the control group, and the satisfaction of interns was also significantly better in the experimental than in the control group (P<0.05).@*Conclusion@#The clinical pathway teaching method is effective in practice teaching of hepatic surgery, and can improve the results of practice teaching quality obviously.
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Objective@#To explore the indications and clinical value of orthotropic liver transplantation(OLT)in patients with advanced hepatic alveolar echinococcosis(HAE).@*Methods@#The clinical data of 12 patients with advanced HAE who received OLT from January 2001 to December 2017 were retrospectively analyzed. Among them, there were 7 males and 5 females, the age ranged from 16~58 years(median 42 years). The preoperative hepatic functions of 12 patients were 2 Child-Pugh class A, 3 class B and 7 class C, and the median model for end-stage liver disease(MELD)score was 19.5(8~23).@*Results@#The mean time of OLT procedure and anhepatic phase in 12 patients were 456.25(456.25±44.98)min and 79.17(79.17±10.01)min respectively. The median intraoperative blood loss and hospital stay times were 1000 ml(600~4000 ml), and 29.5(15±58)days respectively. All the patients were followed-up for 0 months to 207 months. Among the 12 patients who underwent OLT, 2 recipients died of incurable infection of pulmonary infection on day 23 post-OLT, and multiple organ failure on day 32 post-OLT, respectively. One case developed lung metastasis 2 years after operation, and brain metastasis was found in the same patient after 4 years. The recurrence occurred 3 years after OLT in another patient, no evidence of HAE recurrence or extrahepatic metastasis was found in the remaining 8 patients.@*Conclusions@#OLT can provide patients with advanced HAE the best chance for long term disease-free and overall survival who lost the opportunity for radical hepatectomy.
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Objective To explore the indications and clinical value of orthotropic liver transplantation(OLT)in patients with advanced hepatic alveolar echinococcosis (HAE) .Methods The clinical data of 12 patients with advanced HAE who received OLT from January 2001 to December 2017 were retrospectively analyzed .Among them ,there were 7 males and 5 females ,the age ranged from 16～58 years(median 42 years) .The preoperative hepatic functions of 12 patients were 2 Child-Pugh class A ,3 class B and 7 class C ,and the median model for end-stage liver disease(MELD)score was 19 .5(8～23) .Results The mean time of OLT procedure and anhepatic phase in 12 patients were 456 .25(456 .25 ± 44 .98)min and 79 .17(79 .17 ± 10 .01)min respectively .The median intraoperative blood loss and hospital stay times were 1000 ml(600～4000 ml) ,and 29 .5(15 ± 58)days respectively . All the patients were followed-up for 0 months to 207 months .Among the 12 patients who underwent OLT ,2 recipients died of incurable infection of pulmonary infection on day 23 post-OLT ,and multiple organ failure on day 32 post-OLT ,respectively .One case developed lung metastasis 2 years after operation ,and brain metastasis was found in the same patient after 4 years .The recurrence occurred 3 years after OLT in another patient ,no evidence of HAE recurrence or extrahepatic metastasis was found in the remaining 8 patients .Conclusions OLT can provide patients with advanced HAE the best chance for long term disease-free and overall survival who lost the opportunity for radical hepatectomy .
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Objective To investigate the application and effect of clinical pathway in practice teaching of hepatic surgery.Methods The 64 clinical interns who had an internship in our department between February 2018 and May 2019 were divided randomly into two groups: the experimental group(n=32)and the control group(n=32).The clinical pathway teaching method was used in the experimental group and the traditional teaching method was used in the control group.At the end of their internship,the examination and the satisfaction survey were requested to finish in the both groups.The statistical software SPSS 17.0 was used.Continuous variables were analyzed through the t-test.Categorical data were compared through Pearson chi-square.Results The examination results included theoretical knowledge(P=0.033),operating skill(P=0.021),case analysis(P=0.006)and medical record writing(P=0.017),which were significantly better in the experimental group than in the control group,and the satisfaction of interns was also significantly better in the experimental than in the control group(P＜0.05).Conclusion The clinical pathway teaching method is effective in practice teaching of hepatic surgery,and can improve the results of practice teaching quality obviously.
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The recurrence rate of hepatocellular carcinoma (HCC) after liver transplantation is still high, seriously affecting the long-term survival rate. The current research results show that the mechanism of postoperative recurrence of liver cancer is mainly related to residual micro-lesions, hepatitis, regeneration and immunosuppression. Milan criteria for liver transplantation, tumor vascular invasion, degree of differentiation, surgical procedures, and the use of calcineurin immunosuppressive agents are risk factors for recurrence of HCC after liver transplantation, and biomarkers such as genes and miRNAs that respond to biological characteristics of the tumor have been gradually used in HCC recurrence risk stratification and predicting prognosis. The use of mTOR inhibitors, preoperative interventional treatment before liver transplantation and non -tumor ablation technique are the main effective methods to prevent the recurrence of HCC. Hepatectomy is still the most effective treatment for patients with recurrent HCC after transplantation, and intervention with sorafenib in combination with mTOR inhibitors can benefit the survival of most patients.
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Objective To explore the application of bundle management in enhanced recovery after surgery (ERAS) on liver transplantation.Methods The multidisciplinary team of West China Hospital of Sichuan University discussed the program of ERAS on liver transplantation in 2016,and implemented this program in July 2016.A retrospective analysis was made on 220 liver transplant patients who were admitted to West China Hospital of Sichuan University in the period from Jan.2015 to Mar.2017.According to the inclusion and exclusion criteria,there were 104 patients in traditional group and 92 patients in ERAS group.The clinical indicators during and after surgery were compared between the two groups,and the applied value of ERAS on liver transplantation was analyzed.Results As compared with the traditional group,the patients in ERAS group had advantages in operative time,blood loss,postoperative stay in intensive care unit (ICU),transfusion volume in ICU,endotracheal intubation time and total hospitalization time,with significant difference between the two groups (P＜0.05).Meanwhile readmission and mortality rate after one month in ERAS group was not increased.Conclusion The bundle management in ERAS on liver transplantation of West China Hospital of Sichuan University can improve the prognosis of liver transplant patients.
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Objective To explore the relationship between the serum gamma glutamyl transpeptidase (GGT) level and the prognosis of liver cancer patients undergoing living dornor liver transplantation.Methods A retrospective analysis was made on 139 liver cancer cases receiving living donor liver Tx from Apri 2005 to Oct 2015 in Sichuan University Huaxi Hospital.GGT cut-off value of 71 U/L was calculated from the ROC curve method (sensitivity was 72.2％,specificity was 59.0％).According to the values of the cut-off patients were divided into high GGT group (73 cases) and low GGT group (66 cases),chi-square test was used to judge its correlation with capillary tumor emboli and Kaplan Meier method to determine the overall survival rate difference.Results The tumor vascular invasion,AFP level,tumor size were in disfavour for higher GGT group (P ＜0.05).The 1,3,5 year's survival rates were 59.0％,44.5％,39.7％,for high GGT group,and in low GGT group it was 78.6％,63.6％,63.6％,P =0.010).Conclusions The liver cancer patients with high preoperative serum GGT values have poor long-term prognosis after receiving living donor liver transplantation.
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BACKGROUND/AIMS: Solitary hepatocellular carcinoma (HCC) is a subgroup of HCCs. We aimed to establish nomograms for predicting the survival of solitary HCC patients after hepatectomy. METHODS: A total of 538 solitary HCC patients were randomly classified into training and validation sets. A Cox model was used to identify predictors of overall survival (OS) in the training set. A nomogram was generated based on these predictors and was validated using the validation set. RESULTS: Tumor size, microvascular invasion, and major vascular invasion were significantly associated with OS in the training set. Nomograms were developed based on these predictors in the multivariate analysis. The C-index was 0.75 for the OS nomogram and 0.72 for the recurrence-free survival nomogram. Compared to the index of conventional staging systems for predicting survival (0.71 for Barcelona Clinic Liver Cancer, 0.66 for the seventh American Joint Committee on Cancer, 0.68 for Cancer of the Liver Italian Program, and 0.70 for Hong Kong Liver Cancer), the index of the OS nomogram was significantly higher. Moreover, the calibration curve fitted well between the predicted and observed survival rate. Similarly, in the validation set, the nomogram discrimination was superior to those of the four staging systems (p<0.001). CONCLUSIONS: The nomograms demonstrated good discrimination performance in predicting 3- and 5-year survival rates for solitary HCCs after hepatectomy.
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Humans , Calibration , Carcinoma, Hepatocellular , Discrimination, Psychological , Hepatectomy , Hong Kong , Joints , Liver , Liver Neoplasms , Multivariate Analysis , Nomograms , Prognosis , Survival RateABSTRACT
Objective To identify the risk factors of the incidence rate of initial poor graft function (IPGF)in recipients after living donor liver transplantation. Methods Clinical data of 309 patients undergoing living donor liver transplantation were retrospectively analyzed. Candidate risk factors:(1 )donor factors included age,gender and body mass index (BMI);(2)recipient factors included age,gender,BMI and preoperative Child-Pugh classification,model for end-stage liver disease (MELD)grading,preoperative renal insufficiency,serum total bilirubin elevation,hyponatremia and hypopotassaemia;(3)graft factors included graft cold ischemia time,graft recipient weight ratio (GRWR);(4)recipient surgery factors included total operation time,blood loss volume,blood transfusion volume,platelet transfusion and anhepatic phase≥1 00 min. Single factor analysis was performed to identify the potential risk factors of IPGF. Logistic regression analysis was conducted to explore independent risk factors. Results and Conclusions Child-Pugh C of preoperative recipient liver function,MELD score≥20,serum total bilirubin elevation(>68. 4μmol/L),hyponatremia(<1 35 mmol/L), hypopotassaemia (<3. 5 mmol/L)and anhepatic phase≥1 00 min were potential risk factors of IPGF (all P<0. 05 ). Child-Pugh C of preoperative recipient liver function was an independent risk factor of the incidence rate of IPGF following living donor liver transplantation (P=0. 01 9).
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Objective To summarize the clinical experience and effect analysis of liver transplantation from donation after citizen’s death. Methods Clinical data of 76 donors and 78 recipients of liver transplantation from donation after citizen’s death completed in Liver Transplantation Center of West China Hospital,Sichuan University from March 2012 to November 2015 were analyzed retrospectively.The functional recovery of early allografts in liver transplant recipients was observed and the risk factors causing early allograft dysfunction (EAD)were analyzed.In addition,long﹣term survival of allografts and recipient as well as complications was observed. Results The incidence of postoperative EAD was 36%(28 /78)in 78 recipients.High total bilirubin (TB)and long cold ischemia time constituted the risk factors of EAD. Survival rate of the recipients was 92% (72 /78)during perioperation,and 6 cases died,of which 4 cases died of primary graft dysfunction,1 case of upper gastrointestinal hemorrhage and 1 case of pulmonary infection.Postoperative abdominal infection occurred in 5 cases,with biliary stricture in 3 cases and vascular thrombosis in 2 cases.One case died,and the rest were improved after corresponding treatment.The 1﹣year survival rate of the recipients was 84.2% and 2﹣year survival rate was 80% after operation. Conclusions Liver transplantation from donation after citizen’s death realizes favorable short and long﹣term effects,which can be regarded as a good source of donor livers.Important measures such as controlling the preoperative quality of donor liver and shortening the cold ischemia time can improve the clinical effect.
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Objective The aim of this study is to analyze the long-time outcome of hepatocellular carcinoma(HCC)patients with micro-vascular invasion underwent liver resection combined with transarterial chemoembolization(TACE).Methods Our database of surgical re-section from January 2009 to September 2015 was retrospectively analyzed.This study was conducted on 296 HCC patients with MVI.Patients were divided into two groups:one group underwent liver resection (n =159)and another for liver resection combined with TACE (n =137). The 5-year overall survival rate (OS)and disease free survival (DFR)were compared.A multivariate Cox proportional hazards regression a-nalysis was performed to assess the prognostic risk factors associated with overall survival rate.Results The 5-year OS and 5-year DFR see significant difference (OS:18% vs.8%,P =0.001;TRF:15% vs.8%,P =0.008).Multivariate analysis revealed that HBsAg(HR 1.596, P =0.002,95% CI 1.194 ~2.131),tumor size >5 cm(HR 0.729,P =0.042,95% CI 0.539 ~0.989)as well as multiple tumors(HR 1.480,P =0.049,95% CI 1.002 ~2.186)were correlated to poor overall survival rate.Conclusion Surgical resection combined TACE for HCC patients with MVI realized a better prognosis than patients merely underwent therapy of resection.
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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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A decade has passed since the terrorist attack of the World Trade Center on September 11, 2001. Tragedies such as that caused either by human or the Mother Nature result in damages not only to our physical health, but also our mental health. Although mental problems is generally not as tangible as physical ones, they do put a threat to our society especially in forms of long-term disorders such as post-traumatic stress symptoms [PTSD], depression and generalized anxiety disorder [GAD] and should not be ignored
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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 discuss the influence of anatomical variations of the cystic duct on preoperative diagnosis and operational scheme for cholecystectomy. Methods A 47-year-old woman was admitted to our hospital with diagnosis of cholecystolithiasis. Ultrasonography suggested minimal intra- and extrahepatic ductal dilatation. Laboratory tests showed that serum levels of alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase were 189 IU/L, 366 IU/L and 144 IU/L, respectively. In order to make a certain diagnosis, the patient received both magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). Results MRCP showed the bile duct slightly dilated with a shuttle shape figure and a lower signal with a strip form in it. MRCP could not confirm the quality of this signal and was doubtful of choledochus diaphragma. Subsequently, ERCP was applied to demonstrate that the cystic duct was collateral with the common hepatic duct when arriving into its left side and converged into the bile duct with a lower position, which was the reason for why MRCP misjudged the formation of choledochus diaphragma in the bile duct. Finally, the patient underwent open cholecystectomy. Conclusion There are some kinds of variations in the cystic duct including course, appearance and location of confluence. Combing MRCP with ERCP can significantly elevate the diagnostic accuracy of the cystic duct before operation, especially in those patients with doubtful diagnosis upon admission. To avoid biliary injury as much as possible, open cholecystectomy is superior to the laparoscopic cholecystectomy (LC)with regard to the patients suffering from cholecystolithiasis complicated with variation of the cystic duct.
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Objective To investigate the clinical effects of liver transplantation including living related liver transplantation for Caroli's disease (CD). Methods Seven consecutive patients with diffused type of Caroli's disease had undergone liver transplantation (LT) from September 1999 to February 2007 in our single center. The clinical characteristics and survival of these patients were retrospectively reviewed. Results All 7 patients were diagnosed as Caroli's disease with diffused type which manifested recurrent cholangitis in clinical symptoms. Among them, 4 were female and 3 male.The mean age was 16 years old (ranging from 10 to 31 years old). Six patients were subjected to conservative therapy and only one patient had previously undergone cholecystectomy and T tube drainage before transplantation. In types of surgery, 4 patients accepted split liver transplantation with right liver lobe, two got whole liver transplantation and only one underwent living related liver transplantation. In two patients venovenous bypass was done during the operation. The mean duration of surgery was 9. 1 h. Post-transplant complications included pulmonary infection (3 cases), acute rejection (2 cases), pleural effusion (2 cases) and biliary leakage in the split section of donor liver (1 case). One patient died within 19 days caused by acute renal failure and multiple organs dysfunction.The rest six patients are alive without any signs of recurrence of protopathy and the longest survival time is 7 years. Conclusion Liver transplantation is a valuable treatment to Caroli's disease with diffused type. Due to the organ shortage, living related liver transplantation may own identical effects on LT.