Prognosis analysis of hepatitis B virus recurrence after liver transplantation: a single-center study of 38 cases / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To analyze the prognosis of hepatitis B virus (HBV) recurrence after liver transplantation.</p><p><b>METHODS</b>Thirty-eight patients (37 males; 1 female) with HBV-related end-stage liver disease underwent liver transplantation at our institute between December 1998 and November 2009 and experienced HBV recurrence. Clinical data from pre-transplant and follow-up examinations were retrospectively retrieved from medical records, and included serologic indices of HBV (HBV DNA, markers of liver function) and histological findings from liver biopsy.</p><p><b>RESULTS</b>The median follow-up time was 45.1 months. The median time to HBV recurrence after transplantation was 31.8 months (range: 0.3 to 72.8 months) for histologically benign cases and 13.7 months (range: 0.3 to 66.6 months) for malignant cases. HBV DNA gene mutations were detected in 21% (8/38) of cases. Eighteen patients were treated with entecavir or adefovir, with respect to gene mutations, and HBV DNA fell below 103 copies/ml and liver function became normal. Twenty-two patients died, and causes of death included hepatocellular carcinoma (HCC, n=18), organ failure (n=2), or infection (n=1).</p><p><b>CONCLUSION</b>HBV gene mutations and HCC recurrence were important risk factors for HBV recurrence in our study population. In addition, patients with benign liver diseases who received salvage therapy with adefovir or entecavir achieved a satisfactory prognosis.</p>

Application of eversion embolectomy for portal vein thrombosis on liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the technical improvement of the conventional thrombectomy for portal vein thrombosis (PVT) on liver transplantation.</p><p><b>METHODS</b>The clinical data of 198 cases of liver transplantation with PVT who admitted in Tianjin First Central Hospital were analyzed retrospectively. According to the different treatments for PVT, these cases were divided into group A and group B. The conventional eversion embolectomy were performed in group A (n = 43) and the improved eversion embolectomy were performed in group B (n = 155). The general conditions, blood loss volumes, the achievement ratio of embolectomy, PVT recurrence rate and survival rate between the two groups were compared.</p><p><b>RESULTS</b>No statistical significance on operation time between two groups (P > 0.05); the achievement ratio of embolectomy for Yerdel I-II were 100% in two groups, however, the achievement ratio of embolectomy for Yerdel III in group B was higher than that of group A (100% vs. 45.45%; chi(2) = 12.38, P < 0.01). Blood loss volumes in group B was significantly lower than that of group A [(4315.4 +/- 630.5) ml vs. (3509.2 +/- 862.7) ml, P < 0.05]. No statistical significance on Yerdel I and II PVT recurrence rate between two groups (P > 0.05). While thrombosis recurrent rate of Yerdel III PVT in group B was lower than that of group A(5.6% vs. 2/5; chi(2) = 4.09, P < 0.05). Perioperative mortality of Yerdel I-III patients were both 0 in two groups. 1-year survival rate of Yerdel I-III patients was similar in two groups (86.5% vs. 89.0%, P > 0.05).</p><p><b>CONCLUSIONS</b>Improved eversion embolectomy can simplify the operation procedures, reduce blood loss, expand application range, increase the embolectomy success rate, decrease the PVT relapse rate.</p>

The clinical feature, diagnosis and management of splenic artery aneurysms in liver transplant patients / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical feature of splenic artery aneurysms (SAA) in OLT recipient, and review the experience in diagnosis and management.</p><p><b>METHODS</b>The clinical data, results of four-phase CT scanning and CT angiography of 450 recipients, who underwent OLT from December 2001 to December 2003 were analyzed statistically.</p><p><b>RESULTS</b>Twenty of 450 recipients were diagnosed as SAA, the incidence was about 4.4%. Nineteen of them were diagnosed by four-phase CT scanning. Fifteen patients did not receive any treatment for SAA during OLT, but two of them suffered SAA rupture after OLT, among which one died of hemorrhagic shock although emergency operations were performed. The five patients, who were performed splenectomy with SAA resection during transplantation, recovered successfully after OLT, and their grafts' function was satisfactory.</p><p><b>CONCLUSIONS</b>Morbidity of SAA is higher in patients of liver cirrhosis. Four-phase CT scanning can diagnose SAA exactly. In the early period post-OLT, SAA rupture happens frequently, so SAA resection should be performed during transplantation.</p>

Pediatric liver transplantation in 31 consecutive children / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although liver transplantation has become a standard therapy for end-stage liver diseases, the experience of pediatric liver transplantation is limited in China. In this article we report our experience in pediatric liver transplantation, and summarize its characters in their indications, surgical techniques, and postoperative managements.</p><p><b>METHODS</b>Thirty-one children (< or = 18 years old) underwent liver transplantation in our centers. The mean age at transplantation was 12.4 years old (ranged from 5 months to 18 years) with 7 children being less than 4 years of age at transplantation. The most common diagnosis of patients who underwent liver transplantation were biliary atresia, Wilson's disease, primary biliary cirrhosis, glycogen storage disease, hepatoblastoma, urea cycle defects, fulminant hepatic failure, etc. The surgical procedures included 12 standard (without venovenous bypass), 6 pigyback, 6 reduced-size, 3 split, 3 living donor liver transplantation, and 1 Domino liver transplantation. The triple-drug (FK506, steroid, and mycophenolate mofetil) immunosuppressive regimen was used in most of patients. Patients were followed up for a mean of 21.8 months.</p><p><b>RESULTS</b>Five of the 31 patients died during perioperative time; mortality rate was 16.1%. The reasons of death were infections, primary non-function, heart failure, and hypovolemic shock. Postoperative complications in 10 patients included biliary leakage, acute rejection, abdominal infection, hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, and pulmonary infection. Overall patient cumulative survival rate at 1-, 3-, and 5-year was 78.1%, 62.6%, 62.6%, respectively.</p><p><b>CONCLUSIONS</b>The most common indications of pediatric liver transplantation were congenital end-stage liver diseases. According to patients' age and body weight, standard, piggyback, reduced-size, split, or living donor liver transplantation should be performed. Pediatric liver transplantation especially requires higher surgical skills. The early postoperative management is the key to success. Postoperative bile leak was common, but most patients underwent liver transplantation had a better prognosis.</p>

Pediatric liver transplantation in 20 consecutive children / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical efficacy of pediatric liver transplantation, and investigate the characters of pediatric liver transplantation in their indications, surgical procedures and postoperative management.</p><p><b>METHODS</b>From August 2000 to March 2007, 23 liver transplantations were performed on 20 children, aging from 6 months to 13 years old. The most common indications were biliary atresia, Wilson's disease, glycogen storage disease and urea cycle defects. Surgical procedures included 4 living donor liver transplantations, 1 Domino liver transplantation, 5 split grafts, 10 reduced liver grafts and 3 whole cadaveric grafts. The triple-drug (FK506, steroid and MMF) immunosuppressive regimen was used in 19 children, except one children using cyclosporine.</p><p><b>RESULTS</b>Three children died of primary non-function, heart failure and abdominal infections respectively during peri-operative period, and the mortality was 15.0%. Nine children showed different post-operative complications including 2 hepatic artery thrombosis, 1 portal vein thrombosis, 1 acute rejection, 3 biliary leakage, 2 biliary stricture, 2 intestinal fistula, 3 abdominal infection, 1 pulmonary infection and 1 heart failure. Cumulative patient survival rates at 6-month, 1-and 2-year were 80.0%, 73.9% and 73.9%, respectively.</p><p><b>CONCLUSIONS</b>Liver transplantation is an effective option to cure the liver disease of children with end-stage. Different surgical procedure could be chosen according to the children's age and body weight.</p>

Adult-to-adult living donor liver transplantation using right lobe including middle hepatic vein / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the feasibility and the clinical efficacy of right lobe including middle hepatic vein in adult-to-adult living donor liver transplantation.</p><p><b>METHOD</b>We retrospectively analyzed the clinical data of 30 adult-to-adult living donor liver transplantation using right lobe including middle hepatic vein performed in our hospital from Feb. 2007 to Nov. 2007.</p><p><b>RESULTS</b>The right lobes weighed 540-1058 g (median 708 g). The remnant liver volumes were over 30% of the total liver volume in all donors. No perioperative death was noted for among donors and recipients. Complications were recorded and cured in 4 donors (13.3%) and 7 recipients (23.3%). All the donors and the recipients were followed up for 2-8 months (median 5 months), during which no donor died and 1 recipient died from aspergillus infection 4 months after operation.</p><p><b>CONCLUSION</b>Adult-to-adult living donor liver transplantation using right lobe graft including middle hepatic vein is a safe and effective technique.</p>

Clinical study of Milan criteria for liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the value and deficiency of Milan criteria for liver transplantation in patients with hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>Between December 2001 and November 2005, 125 patients underwent orthotopic liver transplantation ( OLT), who measured up Milan criteria with preoperation computerized tomography (CT) scanning. The results of pre-transplant multidetector CT scan and post-transplant pathology were retrospectively analyzed, and survival rates were compared.</p><p><b>RESULTS</b>Pathology examination demonstrated that 97 cases met Milan criteria (77.6%), 26 cases exceeded Milan criteria,and the other 2 cases were diagnosed as nodular cirrhosis. The 1-,2-,3-,4- and 5-year survival rates for those met pre-transplant multidetector CT scanning pre-transplant met Milan criteria vs. those met post-transplant pathology post-transplant criteria were 92.0% vs. 92.8%, 87.2% vs. 90.7%, 86.4% vs. 89.7%, 86.4% vs. 89.7%, and 86.4% vs. 89.7%, respectively. There was no statistic significant difference (P > 0.05). The 1-,2-,3-,4- and 5-year survival rates were 73.0%, 65.4%, 61.5%, 61.5% and 61.5%, for those pathology exceed Milan criteria respectively. The difference between this group and each of the above two were statistically significant (P < 0.05).</p><p><b>CONCLUSIONS</b>The prognosis of OLT for HCC is good for those met Milan criteria by pre-transplant multidetector CT. Factors leading to poor prognosis such as portal vein tumor thrombi and lymphatic metastasis should be accurately evaluated avoiding for misjudgement.</p>

Clinical study of liver re-transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To report experiences of liver re-transplantation.</p><p><b>METHODS</b>The cause of re-transplantation, the pre-operative MELD score, timing of re-transplantation, technical considerations, 1 year survival rate and the causes of death of the patients receiving liver re-transplantation in First Central Hospital of Tianjin between January 1999 and December 2005 were retrospectively analyzed.</p><p><b>RESULTS</b>One year survival rate of re-transplantation was 71.6%. The most common cause of hepatic graft failure and subsequent re-transplantation was biliary complications (45.5%). The 1 year survival rate of patients with a MELD score less than 20 was higher than patients with a score of 20 approximately 30 and > 30 (83.8% versus 57.1% and 66.7%). The peri-operative survival rate of patients who received re-transplantation 30 days after the initial transplantation was higher than those who received re-transplantation between 8 to 30 days post the first operation (83.8% versus 41.7%). The main cause of peri-operative death was celiac infections (accounted for 54.2% deaths) in the patients.</p><p><b>CONCLUSIONS</b>Proper indication selection, optimum operation time, right surgical procedure, intensified peri-operative monitoring and infection control are all crucial for the improvement of survival rate in patients receiving liver re-transplantation.</p>

Analysis of survival rate and risk factors of liver retransplantation / 中华外科杂志

<p><b>OBJECTIVES</b>To analyze the survival rate of orthotopic liver retransplantation (Re-OLT) and identify the variables predicting the outcome.</p><p><b>METHODS</b>A retrospective analysis of 74 Re-OLT patients from January 1999 to December 2005 was performed. The univariate analysis of Kaplan-Meier model was used to investigate the relativity between the factors and survival rate, and COX regression model was used in multivariate analysis to identify the prognostic factors for survival.</p><p><b>RESULTS</b>The total incidence rate of Re-OLT was 5.7%, and overall patient survival rates at 1 month, 3 month, 1 year and 2 year were 82.4%, 73.8%, 71.9% and 68.5%, respectively. There were 10 factors might influence the survival rate by Kaplan-Meier model, such as the period of Re-OLT, stage of hepatic encephalopathy, prothrombin time, total bilirubin, warm ischemia time, operative surgical procedure, quantity of blood lost during operation, days staying in the intensive care unit (ICU), infection and complications after Re-OLT. And three factors among them were identified as independent prognostic factors for survival by multivariate model: operative surgical procedure, days staying in the ICU and complications after Re-OLT.</p><p><b>CONCLUSION</b>The surgical procedure, duration in ICU and complications after Re-OLT are strong predictors for survival after Re-OLT.</p>

Liver retransplantation: report of 80 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To sum up the clinical experience of liver retransplantation.</p><p><b>METHODS</b>The clinical data of patients receiving liver retransplantation in our department between Jan. 1999 and July 2005 were retrospectively analyzed, the cause of retransplantation, timing of retransplantation, technical considerations and the causes of death.</p><p><b>RESULTS</b>The most common causes of hepatic graft loss and subsequent retransplantation are biliary complications (45.0%). Patients who received retransplantation more than 30 days after their initial transplant fared better than those who received retransplants between 8 and 30 days after receiving their first one (intraoperative mortality rates 19.6% versus 70.0%). The development of sepsis (54.5%) and multiorgan failure (18.2%) accounts for the majority of deaths in retransplanted patients.</p><p><b>CONCLUSIONS</b>Proper indication and optimum operation time, surgical procedure, perioperative monitoring and proper treatment post operation contribute to the increase of the survival rate of the patients receiving liver retransplantation.</p>