Pathological characteristics of liver allografts from donation after brain death followed by cardiac death in pigs / 华中科技大学学报（医学）（英德文版）

Donation after brain death followed by circulatory death (DBCD) is a unique practice in China. The aim of this study was to define the pathologic characteristics of DBCD liver allografts in a porcine model. Fifteen male pigs (25-30 kg) were allocated randomly into donation after brain death (DBD), donation after circulatory death (DCD) and DBCD groups. Brain death was induced by augmenting intracranial pressure. Circulatory death was induced by withdrawal of life support in DBCD group and by venous injection of 40 mL 10% potassium chloride in DCD group. The donor livers were perfused in situ and kept in cold storage for 4 h. Liver tissue and common bile duct samples were collected for hematoxylin and eosin staining, TUNEL testing and electron microscopic examination. Spot necrosis was found in hepatic parenchyma of DBD and DBCD groups, while a large area of necrosis was shown in DCD group. The apoptosis rate of hepatocytes in DBD [(0.56±0.30)%] and DBCD [(0.50 ± 0.11)%] groups was much lower than that in DCD group [(3.78±0.33)%] (P0.05)). The structures of bile duct were intact in both DBD and DBCD groups, while the biliary epithelium was totally damaged in DCD group. Under electron microscope, the DBD hepatocytes were characterized by intact cell membrane, well-organized endoplasmic reticulum, mild mitochondria edema and abundant glycogens. Broken cell membrane, mild inflammatory cell infiltration and sinusoidal epithelium edema, as well as reduced glycogen volume, were found in the DBCD hepatocytes. The DCD hepatocytes had more profound cell organelle injury and much less glycogen storage. In conclusion, the preservation injury of DBCD liver allografts is much less severe than that of un-controlled DCD, but more severe than that of DBD liver allografts under electron microscope, which might reflect post-transplant liver function to some extent.

Pathological characteristics of liver allografts from donation after brain death followed by cardiac death in pigs / 华中科技大学学报（医学）（英德文版）

Donation after brain death followed by circulatory death (DBCD) is a unique practice in China. The aim of this study was to define the pathologic characteristics of DBCD liver allografts in a porcine model. Fifteen male pigs (25-30 kg) were allocated randomly into donation after brain death (DBD), donation after circulatory death (DCD) and DBCD groups. Brain death was induced by augmenting intracranial pressure. Circulatory death was induced by withdrawal of life support in DBCD group and by venous injection of 40 mL 10% potassium chloride in DCD group. The donor livers were perfused in situ and kept in cold storage for 4 h. Liver tissue and common bile duct samples were collected for hematoxylin and eosin staining, TUNEL testing and electron microscopic examination. Spot necrosis was found in hepatic parenchyma of DBD and DBCD groups, while a large area of necrosis was shown in DCD group. The apoptosis rate of hepatocytes in DBD [(0.56±0.30)%] and DBCD [(0.50 ± 0.11)%] groups was much lower than that in DCD group [(3.78±0.33)%] (P<0.05). And there was no significant difference between DBD group and DBCD group (P>0.05)). The structures of bile duct were intact in both DBD and DBCD groups, while the biliary epithelium was totally damaged in DCD group. Under electron microscope, the DBD hepatocytes were characterized by intact cell membrane, well-organized endoplasmic reticulum, mild mitochondria edema and abundant glycogens. Broken cell membrane, mild inflammatory cell infiltration and sinusoidal epithelium edema, as well as reduced glycogen volume, were found in the DBCD hepatocytes. The DCD hepatocytes had more profound cell organelle injury and much less glycogen storage. In conclusion, the preservation injury of DBCD liver allografts is much less severe than that of un-controlled DCD, but more severe than that of DBD liver allografts under electron microscope, which might reflect post-transplant liver function to some extent.

A study of the efficacy and safety of using hepatitis B surface antigen-positive donors for liver transplantation / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate the outcomes of liver transplant recipients who received liver allografts from hepatitis B surface antigen (HBsAg)-positive donors.</p><p><b>METHODS</b>The medical records of 23 male patients (median age, 42.5 years; range: 29-61) who received HBsAg-(+) liver allografts in our organ transplant center were retrospectively analyzed. All patients had confirmed diagnosis of end-stage liver disease (ESLD) secondary to hepatitis B virus (HBV) infection, including 13 HBsAg(+)/HBeAg(-)/HBcAb(+) cases and 10 HBsAg(+)/HBeAb(+)/HBcAb(+) cases. After transplantation, all patients were administered oral entecavir and intravenous anti-hepatitis B immunoglobulin (HBIG) (2000 IU/d during the first week), along with a steroid-free immune suppression regimen. HBV-related antigen and antibody and HBV DNA were detected on post-transplantation days 1, 7, 14, 21, and 30. The liver allografts were monitored by ultrasound imaging. After discharge, monthly follow-up recorded liver function, renal function, acute rejection, infections, vascular complications, biliary complications, HBV recurrence, cancer recurrence, and patient survival.</p><p><b>RESULTS</b>Two of the recipients died from severe perioperative pneumonia. The remaining 21 recipients were followed-up for 10 to 38 months, and all 21 patients remained HBsAg(+). One recipient developed biliary ischemia and required a second liver transplantation at five months after the primary transplantation. Three recipients (all primary) died from tumor recurrence at 9, 14, and 18 months post-transplantation, respectively. All other recipients survived and had acceptably low HBV DNA copy levels. Color Doppler imaging showed good graft function and normal texture. The patient and graft survival rates were 78.3% (18/23) and 73.9% (17/23), respectively. The recurrence rate of HBV infection was 100% (23/23). In surviving patients, no liver function abnormality, graft loss, or death was found to be related to the recurrence of HBV infection.</p><p><b>CONCLUSION</b>Liver transplantation using HBsAg(+) liver grafts was safe for patients with ESLD secondary to HBV infection.</p>

Clinical characteristics, diagnosis and treatment of digestive tract leakage after orthotopic liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics, diagnosis and treatment of digestive tract leakage after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>Sixty-one recipients had digestive tract leakage in early stage after OLT among 1173 cases from January 2000 to December 2010. There were 55 male and 6 female patients, aging from 36 to 61 years, with a median of 45 years. Digestive tract leakage included bile leakage (46 cases), gastric leakage (5 cases), duodenal leakage (1 case), jejunal leakage (4 cases), ileal leakage (1 case) and colon transversum leakage (4 cases). Ten of recipients with gastrointestinal leakage had 1 to 3 times of abdominal surgery before OLT. Abdominal drainage was used in 28 cases with bile leakage, and additionally, endoscopic retrograde cholangiopancreatography, endoscopic nasobiliary drainage and stenting were performed for 8 of them, and surgical neoplasty for another 18 patients with bile leakage. Simple surgical neoplasty of perforation was performed for 13 patients with gastrointestinal leakage, and diverticulectomy and neoplasty for 1 case with duodenal leakage, and partial jejunostomy for one severe jejunal leakage. Nutritional support was administered for all of cases.</p><p><b>RESULTS</b>The incidence rate of digestive tract leakage in early stage after OLT was 5.20% (61/1173). Intra-operative iatrogenic injury of gastrointestinal tract was occurred in 6 cases with gastrointestinal leakage. After treatment, 11 cases died of multiple organ failure resulted from severe infection, with mortality of 18.0% (11/61), including 4 cases with bile leakage, with the mortality of 8.6% (4/46), and 7 cases with gastrointestinal tract leakage, with the mortality of 46.6% (7/15). The remanent 50 cases through comprehensive treatment with a span of 1 to 3 months recovered and discharged healthily. No digestive tract leakage reoccurred in the follow-up of 6 to 84 months.</p><p><b>CONCLUSIONS</b>The morbidity of digestive tract leakage in early stage after OLT is low, but its mortality is high, especially for gastrointestinal tract leakage. High dose corticosteroids therapy, history of abdominal operation and intra-operative iatrogenic injury may be high risk factor. Comprehensive treatment is crucial for improving prognosis.</p>

Effect of Campath-1H induction on immunosuppression in small intestine transplantation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of Campath-1H induction on immunosuppression in small intestine transplantation.</p><p><b>METHODS</b>Clinical data of a patient who underwent small intestine transplantation were retrospectively summarized.</p><p><b>RESULTS</b>Intraoperative Campath-1H induction by intravenous injection was administered. Triple immunosuppression(FK506, MMF and methylprednisolone) was used postoperatively. The lymphocyte and leukocyte decreased significantly following Campath-1H induction, and returned to normal after adjusting the dose of immunosuppressant and use of colony stimulating factor. There were no acute rejection, graft versus host disease, or severe infection during the immediate postoperative period. The patient recovered and discharged.</p><p><b>CONCLUSION</b>Intraoperative Campath-1H induction and postoperative triple immunosuppression using FK506, MMF, and methylprednisolone may prevent rejection and graft versus host disease in the early stage after small intestine transplantation.</p>

Analysis on treatment outcomes in five patients with combined en bloc liver and pancreas transplantation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the treatment outcomes after combined en bloc liver and pancreas transplantation.</p><p><b>METHODS</b>Five patients with end-stage liver disease and type 2 diabetes mellitus received combined en bloc liver and pancreas transplantation after hepatectomy.</p><p><b>RESULTS</b>Five operations were performed successfully. The operative time ranged from 9 to 16 hours and blood loss from 1600 to 3000 ml. Postoperatively, one patients developed pulmonary infection, one died of graft-versus-host disease(GVHD), and one experienced acute renal failure. No intestinal fistula, anastomotic leakage, biliary complications, chronic and acute rejection and pancreatitis were seen. Liver function index including alanine aminotransferase, aspartate aminotransferase and total bilirubin returned to normal levels a week after surgery, while levels of C peptide and blood glucose resumed within 1 to 2 weeks. Apart from 1 case died of GVHD, the other 4 maintained normal liver function during the follow up ranging from 2 to 23 months and no insulin was required for the diabetes.</p><p><b>CONCLUSION</b>Combined en bloc liver and pancreas transplantation is technically feasible and an effective treatment for multi-organ diseases.</p>

Application of steroids minimization immunosuppressive regimen in liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the safety and feasibility of steroids minimization immunosuppressive regimen in liver transplantation.</p><p><b>METHODS</b>One hundred and sixteen patients in line with the selecting criteria from January 2005 to June 2008 were divided into three groups according to the withdrawal of steroids: 40 cases in 3 months withdrawal group, 40 cases in 7 d withdrawal group and the other 36 cases in 24 h withdrawal group. The difference of recipients' survival, infection, acute rejection and steroids resistant acute rejection, wound healing, recurrence of HBV and hepatocellular cell (HCC), new on-set of diabetes, hyperlipidemia and hypertension between the three groups were compared.</p><p><b>RESULTS</b>The difference of recipients' survival, acute rejection including steroids resistant acute rejection, recurrence of HBV and HCC, hyperlipidemia between the three groups were not significant (P > 0.05), the incidence of wound un-healing and hypertension in 24 h withdrawal group was significantly lower than that in the other 2 groups (P < 0.05), the incidence of infection and new on-set diabetes in 24 h withdrawal group and 7 d withdrawal group was significantly lower than that in 3 months withdrawal group (P < 0.05).</p><p><b>CONCLUSION</b>Steroids minimization immunosuppressive strategy is safe and feasible in liver transplantation field, it will significantly reduce the steroids related complications without increasing the risk of rejection.</p>

Etiology and management of postoperative gastrointestinal bleeding after orthotopic liver transplantation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the causes and treatment of postoperative gastrointestinal bleeding after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>Clinical data of 776 patients after OLT between January 2000 and December 2006 were analyzed retrospectively.The experiences in diagnosis and treatment of postoperative gastrointestinal bleeding after OLT were reviewed.</p><p><b>RESULTS</b>Gastrointestinal bleeding occurred in 18 patients (2.3%) after OLT, among whom 8 (44.5%) were from peptic ulcer, 3 (16.7%) from gastric and esophageal varices, 3 (16.7%) from gastroduodenitis, 3 (16.7%) from hemobilia, and 1 (5.6%) had diverticular bleeding in the jejunum. These 18 patients with gastrointestinal bleeding were managed with conservative treatment, endoscopic treatment, radiological interventional embolism,or exploratory laparotomy. Five patients died of gastrointestinal bleeding and the gastrointestinal bleeding-related mortality rate was 27.8%. After a mean follow up of 3.5 years, only 1 patient died of recurrence of hepatic cellular carcinoma while others survived disease-free.</p><p><b>CONCLUSIONS</b>Gastrointestinal bleeding may occur from different sites after OLT and the mortality is high. Prompt identification of the source of bleeding and correct management are required to improve the prognosis.</p>

Evaluation of quality of life after simultaneous pancreas-kidney transplantation / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the influence of simultaneous pancreas-kidney (SPK) transplantation on the quality of life of diabetic recipients with end-stage renal disease.</p><p><b>METHODS</b>We performed a retrospective analysis of the data of diabetic patients with end-stage renal disease and evaluated the quality of life of the recipients using SF-36 health survey.</p><p><b>RESULTS</b>One patient died of cerebrovascular accident, and 7 patients recovered smoothly. During the follow-up lasting for a mean of 23.3 months, the blood glucose, C-peptide and creatine levels of the patients remained stable. The score of 8 domains of SF-36 of the diabetic recipient at 2 years after SPK transplantation showed a significant improvement compared with that before the operation, similar to that of Chinese normal population(P > 0.05).</p><p><b>CONCLUSIONS</b>SPK transplantation can achieve a significant improvement of the quality of life of diabetic patients with end-stage renal disease.</p>

Clinical analysis on multivisceral transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the indication, surgical and post-operative complications of the multivisceral transplantation.</p><p><b>METHODS</b>The post-transplant complications of 8 patients who underwent multivisceral transplantation between May 2004 and May 2010 were analyzed. There were 7 male and 1 female, aged from 28 to 65 years. Five patients who suffered from non-resectable advanced upper abdominal malignancy experienced the liver, stomach, spleen, pancreas, duodenum, omentum and variable amounts of the colon resection, and then underwent standard multivisceral transplantation (included liver, stomach, pancreaticoduodenal and small bowel). After underwent hepatectomy while retaining the native pancreas and entire gastrointestinal, three recipients with end-stage liver cirrhosis and type 2 insulin-dependent diabetes mellitus (IDDM) was performed combined en bloc liver/pancreaticoduodenal transplantation.</p><p><b>RESULTS</b>Since the third day post-operation, all recipients no longer needed exogenous insulin and had normal blood glucose concentrations. Two weeks after transplantation, their liver function almost became normal. For the 5 recipients who suffered abdominal malignancy, the longest survival period was 326 days. Cause of death are recurrent tumor (n = 2), multiple organ failure (n = 3). All the 5 patients experienced infection. For 3 patients suffered cirrhosis and IDDM, the longest survival was over 18 month. Excepting the case 8 died of graft versus host disease, all were still living without apparently post-transplant complication.</p><p><b>CONCLUSIONS</b>Multivisceral transplantation is an alternative in the treatment of the patients with benign massive abdominal pathologies. Careful patient selection and technical modification are crucial to improve the outcome of these patients.</p>

Two-dose steroid combined with two-dose daclizumab and tacrolimus regimen in liver transplant recipients / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the efficiency and safety of two-dose steroid combined with two-dose daclizumab and tacrolimus (FK506) regimen in liver transplant recipients.</p><p><b>METHODS</b>There were 74 patients who treated in the First Affiliated Hospital of Sun Yat-Sen University from September 2006 to March 2008. Expect for 7 patients who didn't measure up, 67 adult liver transplant recipients were randomized into two groups: conventional protocol group (n = 35) in which steroid was withdrawn in 3 months after operation, and two-dose steroid group (n = 32). Comparison of rejection, infection (bacteria, fungal and cytomegalovirus) and metabolic complications rates were studied between two groups.</p><p><b>RESULTS</b>There were significant differences between two groups in the rate of early postoperation hyperglycemia, the average dosage of insulin consumption among hyperglycemia recipients as well as the rate of diabetes mellitus, hypertension and infection during the follow-up period (P < 0.05). The rate of hypertension in early postoperation period, hyperlipemia and rejection rate during the follow-up period were similar in two groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Two-dose steroid combined with two-dose daclizumab and tacrolimus would be a safe and efficient immunosuppression strategy without increase the acute rejection rate hazard, that could reduce post-transplant infection and other complications from side-effect of long-term usage of steroid.</p>

The etiology and management of postoperative hyperbilirubinemia after orthotopic liver transplantation / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the causes and treatment of postoperative hyperbilirubinemia after orthotopic liver transplantation.</p><p><b>METHODS</b>Clinical data of 368 cases of orthotopic liver transplantation patients from the First Affiliated Hospital of Sun Yat-sen University between 2004 and 2005 were analyzed retrospectively.</p><p><b>RESULTS</b>Three hundred and sixty-eight patients experienced 396 incidents of hyperbilirubinemia, including 183 incidents of preoperative hyperbilirubinemia (46.2%), 46 incidents of ischemia-reperfusion injury (11.6%), 36 incidents of acute rejection (9.1%), 78 incidents of biliary complications (19.7%), 24 incidents of blood vessel complications (6.1%), 23 incidents of recurrence of the primary disease (5.8%) and 6 incidents of tacrolimus (FK506) toxicity (1.5%). The comprehensive management targeted to the etiology and symptoms were applied to all patients with hyperbilirubinemia.</p><p><b>CONCLUSION</b>Hyperbilirubinemia is a common clinical manifestation after liver transplantation with multiple and complicated causes. The key point for successful treatment is to identify the causes. To reach the aim of treatment and obtain long-term survival of the recipients, it is very important to make a correct diagnosis and give reasonable therapeutic regimens as soon as possible.</p>

The analysis of portal vein thrombosis following orthotopic liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate and summarize the experience in clinical presentation, diagnosis and treatment of portal vein thrombosis after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>The clinical data of 402 patients who underwent OLT from January 2003 to February 2007 were reviewed. A retrospective study was performed on etiology, prognosis and treatment in 9 cases of portal vein thrombosis after OLT.</p><p><b>RESULTS</b>All of the 9 cases received anticoagulant and antiaggregation therapy, within whom one underwent percutaneous transluminal angioplasty and stent placement, one underwent retransplantation after failure of thrombolysis therapy, and one received surgical embolectomy. Six patients died of multiple organ failure on 9th, 30th, 34th, 40th, 48th, 6 2nd days, respectively, while 3 patients survived.</p><p><b>CONCLUSIONS</b>The major risk factors of portal vein thrombosis after OLT were pathological changes in portal vein, abnormal blood stream dynamics, hypercoagulable status and improper surgical technique. Prophylactic intervention to patients with high risk factors, early diagnosis and aggressive comprehensive therapy on portal vein thrombosis patients are essential to improve prognosis.</p>

Comparison of the short-term outcomes of liver transplant recipients receiving liver grafts from brain-death and non-heart-beating donors / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the short-term outcomes of liver transplantation recipients receiving liver grafts from brain-death and non-heart-beating donors and evaluate the safety of liver grafts from brain-death donors.</p><p><b>METHODS</b>A total of 130 patients receiving liver transplantation between January, 2006 and December, 2007 were retrospectively analyzed, including 9 patients receiving liver graft from brain-death donors and 121 with grafts from non-heart-beating donors. The operative time, anhepatic time, bleeding volume, postoperative complications and short-term survival were compared between the two groups.</p><p><b>RESULTS</b>The operative time, anhepatic time, bleeding volume, postoperative complications and short-term survival showed no significant differences between the two groups.</p><p><b>CONCLUSION</b>The short-term outcome of recipients receiving liver grafts from brain-death donors is similar to that of recipients receiving grafts from non-heart-beating donors, indicating the safety of clinical use of the liver grafts from brain-death donors.</p>

Evaluation of efficacy and safety on steroid withdraw at the seventh day after liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate efficacy and safety on steroid withdrawal at the seventh day after liver transplantation.</p><p><b>METHODS</b>Seventy-six adult patients undergoing first cadaveric liver transplantation from October 2005 to October 2007 were randomly divided into 7 day (n = 40) and 3 month (n = 36) steroid withdrawal groups. All patients received FK506 3 mg and intravenous methylprednisolone 1000 mg during intra-operation and FK506 thereafter was adjusted to predefined 8 - 12 microg/L from day 1 to month 6. Patients in 7 day steroid withdrawal group received 500, 240, 200, 160, 80, 40 and 20 mg intravenous methylprednisolone tapered daily from postoperative day 1 to day 7. In 3 month steroid withdrawal group, patients received the same protocol as 7 day steroid withdrawal group for intravenous methylprednisolone tapered daily from postoperative day 1 to day 7 and thereafter received oral prednisone 48, 40, 32, 24, 16, 8, 4 mg tapered every 3 days and maintained 4 mg to the 3(rd) month. All patients were followed up for 6 months. The incidence of treated acute rejection and side effects were evaluated between two groups.</p><p><b>RESULTS</b>A total of 69 cases were fully followed up, and 7 cases were discontinued including death (n = 2), server infection (n = 2), protocol violation (n = 2) and retransplantation (n = 1). There were no statistical difference between 2 groups concerning the incidence of acute rejection, hypertension, hyperlipemia and other adverse events (P > 0.05), but significant difference in incidence of diabetes (17.5% vs. 38.9%, P = 0.047).</p><p><b>CONCLUSION</b>Steroid withdrawal strategy at day 7 is same safety and efficacy as steroid withdrawal at 3 month.</p>

The cause and management of postoperative venous outflow obstruction after orthotopic liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the causes and treatment of postoperative venous outflow obstruction after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>Clinical data of 776 patients after OLT were analyzed retrospectively between January 2000 and December 2006. The accumulated experiences in diagnosis and treatment of postoperative outflow obstruction after OLT were reviewed.</p><p><b>RESULTS</b>Venous outflow obstruction occurred in 10 patients (1.29%) after OLT, among those 6 had supra-hepatic inferior vena cava (IVC) stenosis, 2 had IVC stenosis of the post-hepatic segment, and 2 had outflow obstruction of hepatic vein. The diagnosis was confirmed by inferior vena cavography in all the patients. Of the 10 patients, 8 received percutaneous transluminal angioplasty (PTA) or metallic stent replacement, and 2 underwent liver retransplantation (re-LT) when interventional therapy failed. Three patients died from outflow obstruction, so the outflow obstruction related mortality was 30% in the patients.</p><p><b>CONCLUSIONS</b>Complications of outflow obstruction after OLT were associated with surgical technique like vascular anastomosis, various types of cavo-caval anastomosis and graft size mismatch between donor and recipient. Making an early diagnosis and giving timely treatment including interventional therapy or re-LT is the key to improve the prognosis of outflow obstruction.</p>

Selection of four surgical techniques in orthotopic liver transplantation / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the advantages and disadvantages of four surgical techniques in orthotopic liver transplantation.</p><p><b>METHODS</b>A total of 135 adult recipients receiving cadaveric whole liver grafts were divided into four groups according to the surgeries they received: group A (n=22) underwent classic orthotopic liver transplantation, group B (n=79) underwent modified piggyback liver transplantation, group C (n=18) underwent classical piggyback liver transplantation, and group D (n=16) underwent modified classic orthotopic liver transplantation. The clinical data of these recipients were retrospectively analyzed.</p><p><b>RESULTS</b>The operation time, anhepatic time, and intra-operation bleeding volume among these four groups were significantly different (P < 0.05). The incidence of transient renal damage in group C was significantly lower than that in other groups (P < 0.05), while the complication rates and survival rates were not significantly different in the early stage after the operation.</p><p><b>CONCLUSIONS</b>Surgery techniques should be carefully selected based on the individual patients's pre-operative condition. The modified classic orthotopic liver transplantation is a preferred technique for tumor patients or patients with surgical history of upper abdomen.</p>

Orthotopic liver transplantation in patients over 60 years old / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the outcome and relative problems of patients over 60 years old underwent orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>Data of patients over 60 years old (>or= 60 years old group, n = 59) patients recipients who were 18 to 59 years old (< 60 years old group, n = 500) were reviewed retrospectively.</p><p><b>RESULTS</b>Overall patients survival at 1 year was not significantly different among >or= 60 years old group (66%) and < 60 years group (76%). There were no differences in the operation time, the quantity of blood lost during operation, the days of hospitalization and the incidence of hepatic artery thrombosis between the two groups. The incidence rate of acute rejection reaction in >or= 60 years old group was lower. Both the duration of staying in intensive care unit and the time of using ventilator in >or= 60 years old group were longer than the other group. Moreover, the incidence rates of infection and intracerebral hemorrhage were higher in >or= 60 years old group, which were the primary causes of death in this group.</p><p><b>CONCLUSION</b>Even though the complications were higher, recipients over 60 years old underwent OLT have more excellent 1 year survival.</p>

Adult-to-adult living donor liver transplantation in treating acute liver failure using extended right lobe graft / 中华外科杂志

<p><b>OBJECTIVE</b>To report experience in adult-to-adult living donor liver transplantation for acute liver failure using extended right lobe graft.</p><p><b>METHODS</b>A 42-year-old male with acute liver failure received adult-to-adult living donor liver transplantation using extended right lobe graft. Volumetric analysis with computed tomography (CT) revealed that the volume of donor's extended right liver with medial hepatic vein (MHV) amounted to approximately 1.3% of the recipient's body weight. The donor hepatic vein and recipient inferior vena cava were reconstructed and then anastomosed end to side. The portal veins, hepatic arteries and bile ducts were anastomosed end-to-end, respectively.</p><p><b>RESULTS</b>The operations in donor and recipient were all successful. The donor recovered uneventfully. The recipient regained consciousness in 8 hours and got normal liver function 14 days after transplantation. On day 16 after transplantation, transaminases such as alanine transaminase, aspartate transaminase increased expeditiously in the recipient and was controlled effectively with methylprednisolone (1000 mg). The recipient and donor has survived for 8 months healthily without vascular and bile duct complications.</p><p><b>CONCLUSIONS</b>Adult-to-adult living donor liver transplantation for acute liver failure using extended right lobe graft can achieve superior results when performed by an experienced team in hepatectomy and transplantation. This technique extends the success of living donor liver transplantation and opens a new donor pool for adults to receive a timely graft of adequate function.</p>

Study of surgical procedures of abdominal organ cluster transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the surgical procedures and therapeutic effect of organ cluster transplantation in treating abdominal multiple organ malignant tumors.</p><p><b>METHODS</b>Two patients with abdominal multiple organ malignant tumors received organ cluster transplantation in May and August 2004. The excised specimen included liver, pancreas, duodenum, stomach, spleen, mesenteric and epigastric lymph nodes. The transplanted organs included liver, pancreas, duodenum. Superior mesenteric artery was involved in the malignancy in one case and was transected and anastomosed to right common iliac artery.</p><p><b>RESULTS</b>The patients waked up 4 and 5 hours post operation and began recovering 3 and 5 days after. Dynamic examinations showed that the functions of grafted liver, pancreas and duodenum obtained normal function in 10 days post the transplantation. One patient survived for 12 months postoperatively and died of recurrence of cancer; The other recovered uneventfully after transplantation, and discharged automatically 20 days after.</p><p><b>CONCLUSIONS</b>Abdominal organ cluster transplantation is technically feasible and effective for patients with abdominal multiple organ malignant tumors.</p>