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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 study the feasibility and efficacy of prevention and treatment of rethrombosis with an implantable pump of the portal veinafter liver transplantation.Methods The clinical data of adult patients who underwent orthotopic liver transplantation from Feb.1999 to Dec.2007 were analyzed retrospectively.Results The 404 orthotopic liver transplantation (LT) patients were divided into three groups:PVT patients with an implantable pump (PVT + implantable pump,n =28),PVT patients without an implantable pump (PVT,n =20),and patients without pre-existing PVT (non-PVT,n =356).The following parameters in the 3 groups of patients were compared:(1) pre-operative parameters including baseline data of the donors,recipients,and duration of graft ischemia;(2) intra-operative and postoperative parameters including operative time,red blood cell and plasma transfusion,platelet concentrate transfusion,amount of bleeding,primary graft malfunction,and durations of hospitalization and intensive care unit (ICU) stay;and (3) follow-up data on patency of portal vein,rethrombosis rate,stenosis and reoperation (relaparotomy or retransplantation),in-hospital mortality,and actuarial one-year survival rate.Results among the 3 groups of recipients,there were no significant differences detected in the pre-operative and intra-operative parameters.However,when compared to PVT patients without an implantable pump,PVT patients with an implantable pump showed a remarkable reduction (P ＜ 0.05) in post-operative hospital stay [(21.7 ±8.9) vs.(26.5 ± 6.1)],rethrombosis rate (7.14％ vs.30％),reoperation rate (0 vs.25％),and in-hospital mortality (3.57％ vs.25％).Conclusions Patients with pre-existing PVT had a higher risk of rethrombosis following liver transplantation which was significantly prevented and/or treated with an implantable pump.Implantable pump placement should be considered for PVT patients undergoing liver transplantation.
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Based on the pathogenetic occurrence of the tumor,multinodular hepatocellular carcinoma can be classified into multicentric occurrence and intrahepatic metastasis.Different diagnostic strategies from genomics,transcriptomics and proteomics can be used to define the clonal origin of tumors and provide advisable method to cure the disease.Pathomorphological test wasgold standard in cancer diagnosis at one time.Currently,from the respect of molecular diagnosis,including HBV DNA intergration,p53 mutation,selective X chromosome inactivation,loss of heteozygosity of chromosomal DNA,mtDNA-Loop,transcriptional sequence,and comparative proteomics,we could accurately differentiate the clonal origin of tumors.Intrahepatic metastasis was demonstrated with a high early recurrence rate and low survival rate comparing to the multicentric occurrence from the review of the previous study.
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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.