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Objective:To investigate the application value of triangular modal construed for planning approach of laparoscopic local resection of liver tumors located in superior part of central liver lobe.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 10 patients who underwent local laparoscopic resection of liver tumors located in superior part of central liver lobe at the Affiliated Hospital of Qingdao University from January to June 2020 were collected. There were 6 males and 4 females, aged from 41 to 63 years, with a median age of 54 years. Preoperative triangular model was constructed for all patients to plan approach of laparoscopic local resection of liver tumors located in superior part of central liver lobe. Observation indicators: (1) preoperative general situations of patients; (2) surgical situations; (3) follow-up. Follow-up was conducted by outpatient examination or telephone interview to detect tumor recurrence and survival of patients up to February 2021. Measurement data with normal distribution were expressed as Mean± SD. Count data were expressed was absolute numbers. Results:(1) Preoperative general situations of patients: hepatocellular carcinoma was found in 7 cases, inthahepatic cholangiocarcinoma was found in 2 cases and ovarian cancer with liver metastasis was found in 1 case. Three cases had tumors located in S4a segment, 2 cases had tumors located in ventral subsegment of S8 segment, 2 cases had tumors located in dorsal subsegment of S8 segment, and 3 cases had tumors across the ventral segment of S4a+S8. The diameter of tumors was (3.4±1.0)cm. (2) Surgical situation: all the 10 patients underwent R 0 resection successfully, with no intraoperative blood transfusion or conversion to open surgery. The operation time of 10 patients was (149±59)minutes, the volume of intraoperative blood loss was (294±163)mL, the minimum surgical margin of specimen was (1.1±0.2)cm. The alanine aminotransferase was (324±151)U/L on the postoperative first day, the aspartic aminotransferase was (401±113)U/L on the postoperative first day, and the duration of postoperative hospital stay was (9±4)days. No bile leakage, hemorr-hage, reoperation or other complications occurred in all patients. (3) Follow-up: 10 patients were followed up for 7?13 months, with a median follow-up time of 11 months. All patients had no margin recurrence or distant metastasis. Conclusion:It is safe and feasible to construct triangular modal for planning approach of local laparoscopic resection of liver tumors located in superior part of central liver lobe.
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Objective To investigate the value of cytokines in bile combined with clinical indices in predicting the degree of liver injury after liver transplantation. MethodsA total of 16 patients undergoing liver transplantation who were hospitalized in Center of Organ Transplantation, The Affiliated Hospital of Qingdao University, from January to December 2018 were enrolled, and according to the level of alanine aminotransferase (ALT) on day 1 after surgery, the patients were divided into mild liver injury (ALT ＜500 U/L) group with 10 patients and severe liver injury (ALT ＞500 U/L) group with 6 patients. Bile samples were collected on days 1, 3, 5, and 7 after surgery, and MILLIPLEX assay was used to measure the levels of 17 cytokines. R software was used to perform principal component analysis (PCA) of bile cytokines and clinical indices and gene ontology (GO) enrichment analysis of bile cytokines. The two-independent-samples t-test was used for comparison of normally distributed continuous data between two groups; The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. A Spearman correlation analysis was performed to evaluate the correlation between clinical indices and bile cytokines. ROC curve analysis was used to evaluate the predictive value of cytokines in bile and clinical indices for liver injury after liver transplantation. ResultsCompared with the mild liver injury group, the severe liver injury group had significantly higher expression levels of bile Fractalkine (Z=-2.828, P=0.003), soluble CD40 ligand (sCD40L) (Z=-2.850, P=0.008), interleukin-4 (Z=-2.398, P=0.017), CXCL10 (Z=-2.475, P=0.023), and macrophage inflammatory protein-1α (Z=-1844, P=0.043). The correlation analysis showed that on day 1 after liver transplantation, aspartate aminotransferase, ALT, and lactate dehydrogenase were positively correlated with the levels of several cytokines in bile (all P＜0.05). The area under the ROC curve of Fractalkine, sCD40L and AST were 0.933 (0.812-1.000), 0.833 (0.589-1.000) and 0.917 (0.779-1.000), respectively, suggesting that AST and Fractalkine and sCD40L in bile on the first day after liver transplantation have significant predictive value for liver injury. The results of PCA showed that bile cytokines combined with clinical indices on day 1 after liver transplantation could better distinguish the patients with mild liver injury from those with severe liver injury. GO analysis showed that bile cytokines were associated with positive feedback regulation of external stimulus, cell chemotaxis, receptor ligand activity, cytokine activity, and cytokine-cytokine receptor interaction. ConclusionFractalkine and sCD40L in bile can predict the degree of liver injury after liver transplantation.
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Objective ::To investigate the role of trehalose in hepatic ischemia-reperfusion injury and its underlying mechanisms.Methods:C57BL/6J mice were randomly divided into no-ischemia group, ischemia-reperfusion group, trehalose-treated group and normal saline control group. After ischemia for 90 minutes, reperfusion immediately or 6h, blood and liver tissues were collected, and serum was separated. The liver function parameters of ALT, AST, the inflammatory factors of TNF-α, IL-1β and IL-2, and the pathological changes of liver were detected to study the role of trehalose during hepatic ischemia-reperfusion injury. Hypoxia-reoxygenation cell model was established by AML12 mouse hepatocyte line, and divided into experimental group and control group. The experimental group was divided into low dose group and high dose group according to the concentration of trehalose administrated. And the control group had no use of trehalose. The level of apoptosis was measured to study the effect of trehalose on apoptosis induced by hepatic ischemia-reperfusion injury with flow cytometry. Western blot was utilized for detecting the levels of Caspase-3, Cleaved Caspase-3 and Bcl-2 protein to understand the molecular mechanisms of trehalose in apoptosis during hepatic ischemia-reperfusion injury.Results:In vivo animal experiments showed that liver function and such inflammatory factors as ALT, AST, TNF-α, IL-1β and IL-2 increased in ischemia-reperfusion group after hepatic ischemia-reperfusion ( P<0.05), and liver tissue became necrotic. After a treatment of trehalose, the levels of ALT, AST, TNF-α, IL-1β and IL-2 were lower than those of normalsaline control group and the area of liver tissue necrosis also decreased ( P<0.05). In vitro cell experiments showed that the apoptosis level of hepatocytes in the experimental group decreased compared with the control group.And the level of activated pro-apoptotic protein Cleaved Caspase-3 decreased, the level of anti-apoptotic protein Bcl-2 increased. Conclusions:Trehalose has protective effects on hepatic ischemia-reperfusion injury in vivo and in vitro. The mechanism may be involved in inhibiting inflammation induced by hepatic ischemia-reperfusion injury, suppressing the activation of Caspase-3 and promoting the expression of Bcl-2, thus played a protective role by extenuation of hepatocyteapoptosis.
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Objective:To determine the prevalence of Helicobacter pylori (Hp) infection in orthotopic liver transplantation (LT) recipients, and to study the efficacy and safety of Hp eradication therapy.Methods:13C-urea breath test was carried out between July 2018 and October 2019. There were 104 males and 26 females with an average age of 52.1 year for these LT recipients who were regularly followed-up in the Organ Transplant Center, the Affiliated Hospital of Qingdao University. Propensity scoring was used to match age and gender in a ratio of 1∶3. A healthy group of individuals consisting of 299 males and 91 females, with an average age of 51.8 years, were selected as the control group also in a ratio of 1∶3. All patients underwent 13C-urea breath test to evaluate Hp infection and results of quadruple therapy. Results:The prevalence of Hp infection among the LT recipients was 18.5%(24/130) which was significantly lower than the control group 36.4% (142/390) (χ 2=14.400, P<0.001). Among the recipients who received LT and 13C-urea breath test for less than 1 year, 1-3 years and more than 3 years, the prevalences of Hp infection were 14.3% (6/42), 17.8%(8/45) and 23.3%(10/43), respectively. Although the prevalence of Hp showed a gradually increasing trend, no correlation between Hp infection and duration from LT was observed (χ 2=1.321, P=0.517). Seventeen Hp positive recipients underwent Hp eradication therapy. The success rate of Hp eradication was 100.0%(17/17). Immunosuppressant concentration was monitored regularly in 10 patients. During Hp eradication, the blood concentration of immunosuppressant increased from 1.7 to 3.6 times, and the drug dosage was reduced to one half to one third of what it was before Hp eradication. Seven of these 17 recipients suffered from adverse effects caused by increased levels of blood concentration of immunosuppressants, including headache, hypertension, insomnia and irritability. Normal liver and kidney functions were observed during eradication. Conclusion:In this study, the prevalence of Hp infection among liver transplant recipients was 18.5%. The success rate of Hp eradication was 100% using bismuth-containing quadruple therapy. The dosage of immunosuppressant required to be monitored, and if necessary, adjusted during eradication to reduce adverse side effects.
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Objective:To summarize the experience of diagnosing and treating de novo gastric cancer after liver transplantation(LT).Methods:The clinical data were analyzed for 3 LT patients with de novo gastric cancer during follow-ups.Results:The mean diagnostic age was 57(47~67)years, mean time interval between LT and diagnosis of de novo gastric cancer 82(40~122)months and mean follow-up time 23(4~42)months. After surgical resections, 2 survived and another died of recurrence.Conclusions:LT recipients are recommended for regular screening of de novo malignancies. Regular endoscopic screening of gastric tumors contributes to early detection, diagnosis and treatment. It may improve long-term survival outcomes in LT recipients.
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Objective:To explore the value of FibroScan in liver grafts from brain-dead donors (DBD) prior to liver transplantation (LT).Methods:Liver grafts from 52 DBD were examined using ultrasound and FibroScan before LT. The causes of death were cerebral hemorrhage ( n=25), brain trauma ( n=21) and ischemic-hypoxic cerebropathy ( n=6). Blood samples were tested before LT and a biopsy was performed pre- or intra-operation for determining pathology. The diagnostic accuracy of FibroScan results was compared with that of pathological examinations. The latter is a gold standard for evaluating liver grafts. The eligible donors were grouped by stage of liver fibrosis (F0-F4) and steatosis (S0-S3) based upon Kleiner's scoring system of nonalcoholic fatty liver disease. Results:The value of liver stiffness (LS) significantly rose in group F1 as compared with group F0 (8.74±1.32) kPa and (5.93±1.64) kPa respectively ( P<0.01). The value of LS had a significantly positive correlation with liver graft fibrosis stage ( r=0.73, P<0.01). The area under receiver operating characteristic curve (AUROC) was 0.93 for F1 stage fibrosis ( P<0.01). Significant differences existed in controlled attenuation parameter (CAP) among groups S0, S1 and S2 (173.30±38.36), (230.29±23.27) and (250.00±57.01) dB/m respectively ( F=12.41, P<0.01). CAP was correlated with liver graft steatosis stage ( r=0.64, P<0.01). And AUROC for S1/S2 stage steatosis in liver grafts was 0.89 ( P=0.002) and 0.83 ( P=0.007) respectively. Conclusions:With a high diagnostic accuracy, FibroScan quantifies fibrosis and steatosis in liver grafts from DBD and provides further imaging evidence for assessing liver grafts.
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Objective To investigate the incidence of de novo malignant tumors of the digestive system after liver transplantation (LT) in China. Methods Relevant literature review was performed from Wanfang data, China National Knowledge Infrastructure (CNKI) and Chongqing VIP. The retrieval time started from the establishment of each database to May 9, 2019. The Chinese search terms were liver transplantation+ postoperative/de novo+ malignant tumor/cancer. The age distribution, sex composition, time of diagnosis, involved organs, treatment and clinical prognosis of recipients with de novo malignant tumors of the digestive system after LT in China were retrospectively analyzed. Results After literature screening, 16 articles were eventually selected including 47 cases of de novo malignant tumors of the digestive system after LT. A majority of them were male recipients. The age of the recipients was 51 (23-65) years old, most of them were middle age (45-59 years old). The average time of diagnosis of de novo malignant tumors of the digestive system after operation was 43 (2-156) months, with the highest number of cases within postoperative 1-3 years. Colon and stomach were the most common tumor sites. Surgery combined with radiotherapy and chemotherapy remained the main treatment option. However, the overall clinical prognosis of patients with de novo malignant tumors of the digestive system after LT was poor with a mortality rate of 51%. Conclusions In China, colon cancer and gastric cancer are the main de novo malignant tumors of the digestive system after LT. The overall clinical prognosis of patients with de novo malignant tumors of the digestive system is poor. Sufficient attention should be paid to postoperative monitoring and prevention.
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Objective To evaluate the efficacy of in-situ split liver transplantation (ISSLT) in children.Methods From June 2015 to August 2018,10 liver grafts from DBD were split in-situ.All the donors were male,and the median age of the donors was 28.5 year old (18-48 year).One left half graft and 9 left lateral lobe grafts (including 2 reduced size grafts) were transplanted to 10 pediatric recipients.Four grafts were transplanted in our center,and the rest 6 grafts were shared to other two transplant center.The primary diseases of the recipients included biliary atresia (8/10),hepatic sinus obstruction syndrome (1/10) and Alagille syndrome (1/10).The median age of the recipients was 10 month (7 month-11 year),and the mean body weight was 9.8 ± 6.6 kg (5-28 kg).Results All liver grafts were split in-situ.The mean split time of liver grafts was 88.5 ± 18.9 min.The mean weight of split grafts was 336.7-± 85.4 g.All recipients were subjected to piggyback liver transplantation.Operation time was 542.5 ± 112.1 min.Anhepatic time was 52.0 ±-13.5 min.GRWR was (3.98 ±0.96)％.GRWR of two cases was more than 5％,so segment Ⅲ was partially reduced.During the follow-up period,9 cases were alive and 1 case died due to multiple organ failure 1 day after liver transplantation.Conclusions ISSLT can enlarge the graft pool for children and achieve good results.
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Objective To explore the functions of extracorporeal membrane oxygenation (ECMO ) with continuous renal replacement therapy (CRRT ) for potential organ donors with cardiopulmonary failure after brain death and boost the coefficient of utilization of livers .Methods Analysis was conducted for clinical data of 5 donors with cardiopulmonary failure after brain death and their corresponding recipients from July 2015 to May 2017 .Five donors received the treatments of ECMO and CRRT .The relevant data included changes of blood pressure ,dosage of vasoactive agents , liver function ,renal function and urine volume of those treated donors .Also liver functions of liver recipients were observed .Then the clinical data of 18 normal DBD and their liver recipients were compared .Results After ECMO/CRRT ,donor blood pressures rose and the doses of vasoactive agents decreased .Meanwhile urine volume also increased .Finally 4/5 livers could be transplanted . And 10 kidneys were transplanted successfully .There was no significant inter-group difference of liver function .Conclusions The applications of ECMO and CRRT improve liver function of donors with cardiopulmonary failure after brain death and boost the rates of organ donation and utilization .
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Objective To investigate the application value of contrast enhanced ultrasound (CEUS) for postoperative monitoring after split liver transplantation. Methods Ten recipients undergoing split liver transplantation received conventional two-dimensional ultrasonography, color Doppler ultrasound (CDU) and CEUS. Clinical prognosis of 10 recipients undergoing split liver transplantation was summarized. The findings of postoperative conventional two-dimensional ultrasonography, CDU and CEUS were analyzed. Results Among 10 recipients, 8 cases obtained favorable clinical prognosis, one died from the recurrence and metastasis of malignant tumors and multiple organ failure, and one died from sudden cardiac arrest. CDU detected the hepatic artery in 8 of 10 recipients(80%). CEUS revealed hepatic artery embolism in one recipient and normal hepatic artery in the other case. Conventional two-dimensional ultrasonography demonstrated abnormality of the hepatic parenchyma in 5 recipients including hyperecho in S5 segment in 1 case, hypoecho in S7 segment in 1 case, hyperecho in S4 segment in 1 case, hypoecho followed by hyperecho in S5 and S6 segments in 1 case and multiple hypoecho and slight hyperecho in 1 case. CEUS revealed significant asynchrony in the microcirculation blood perfusion between the normal and abnormal echo regions, manifested with imaging features of early perfusion and early regression, which was considered to be associated with hepatic venous back-flow obstruction. Evident asynchrony in microcirculation blood perfusion between the normal and abnormal echo regions was observed in 1 case, manifested with the imaging features of early perfusion and synchronous regression,suggesting that congestion and edema on the hepatic resection surface caused by hepatic venous back-flow obstruction and myocardial infarction. Multiple intrahepatic abnormal blood perfusion region of 'fast-in and fast-out' echo was noted in 1 case, which was probably correlated with postoperative recurrence of malignant tumors. Conclusions CEUS is an effective supplement of conventional two-dimensional ultrasonography and CDU for postoperative monitoring after split liver transplantation, which contributes to understanding of hepatic blood flow and blood perfusion and identifying early postoperative complications after split liver transplantation.
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Objective To study the impact of splenectomy and esophagogastric devascularization on the nutritional status of patients with cirrhosis and portal hypertension.Methods Sixty consecutive patients with cirrhosis and portal hypertension who underwent splenectomy and esophagogastric devascularization at the Beijing YouAn Hospital from April 5,2015 to January 23,2017 were included in this study.The body mass index (BMI),albumin (Alb),prealbumin (PA) and lymphocyte counts were prospectively collected at the end of 1-week,1-month,3-month,6-month and 1-year after surgery.The postoperative results were compared with the preoperative results in these patients.Results The BMI results obtained at 1-week and 1-month after surgery were significantly lower than the preoperative level [(22.14 ± 3.08)kg/m2 vs.(22.85 ± 3.14) kg/m2,(21.72 ± 3.05) kg/m2 vs.(22.86 ± 3.16) kg/m2,P ＜ 0.05].The BMI result at the end of 1-year after surgery was significantly elevated when compared with the preoperative level [(23.24 ± 3.64) kg/m2 vs.(22.68 ± 3.47) kg/m2,P ＜ 0.05].The ALB levels at 1-month and 3-month after surgery were significantly higher than the preoperative level [(39.87 ± 4.22)g/L vs.(35.35 ±5.15) g/L,(39.35 ± 4.75) g/L vs.(34.82 ± 5.50) g/L,P ＜ 0.05].The PA obtained at 1-week after surgery was significantly lower than the preoperative levels [(79.59 26.52)mg/L vs.(121.77 ±39.96)mg/L,P ＜ 0.05].The lymphocyte counts at all the points after surgery were significantly higher than the preoperative level (P ＜ 0.05).Conclusion Short term and long term nutritional status improved in patients with cirrhosis and portal hypertension after splenectomy and esophagogastric devascularization.
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Objective To explore the risk factors,the distribution of etiology and drug resistance status of patients with early infection (3 months) after liver transplantation,and to provide reference for clinical diagnosis and treatment.Methods The clinical data of 112 recipients from February 2014 to December 2015 were collected,and logistic regression analysis was performed on the risk factors of early postoperative infection in liver transplant patients.The independent risk factors of infection after liver transplantation were screened out.At the same time,the results of pathogen culture and drug sensitivity test were statistically described.Results The independent risk factors for infection at 3th month after liver transplantation included the operative time ≥600 min [P =0.003,odds ratio (OR) =9.996,95 ％ confidence interval (95 ％ CI),2.221-44.981],intensive care unit (ICU) ≥6 days (P =0.010,OR =6.306,95％ CI =1.563-25.437),Child-Pugh grade of C (P =0.023,OR =6.298,95％ CI =1.294-30.659).Of the 112 liver transplant recipients,59 had an infection (52.68％),and 168 stains of pathogens were isolated.The positive rate of the specimens was highest in sputum,followed by bile,ascites,drainage and catheter end,blood,deep vein catheter,middle urinary,pleural effusion and peripherally inserted central catheter (PICC).The detectable rate of gram-negative bacteria,gram-positive bacteria,fungi and viruses was 46.43％ (78 strains),29.76％ (50 strains),18.45％ (31 strains),and 5.36％ (9 strains) respectively.Infection occurred mainly within 1 month after surgery,accounting for about 80.36％ (135 strains),especially at 1st week after surgery,accounting for about 34.52％ (58 strains).Gram-positive bacteria had a higher drug resistance rate,including penicillins,macrolides,aminoglycosides,quinolones,linamides,etc.especially in the highest rate of Enterococcus faeciurr.Gram-negative bacteria were individualized based on the different strains of the bacteria,and they were relatively low in the resistance of the carbapene.Conclusion Infection is one of the most common complications after liver transplantation.To reduce the incidence of infection after liver transplantation,efforts should be made to shorten the duration of operation and ICU stay time,improve the basic nutritional status of recipients,and enhance monitoring of the recipient's infection after liver transplantation,to further increase the survival rate of postoperative liver transplantation recipients and improve the quality of life.
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Objective To analyze the law of the mid﹣term hepatic hemodynamics after liver transplantation and to investigate its relationship with liver function. Methods A total of 56 recipients underwent liver transplantation in the Affiliated Hospital of Qingdao University from February 2014 to October 2015 were studied,and divided into normal group (n =24)and abnormal group (n =32)according to the liver function.General information and liver function of both groups were recorded.Furthermore,hepatic artery peak velocity (HAP),portal vein peak velocity (PVP)and portal vein flow (PVF)before the liver transplantation and on postoperative day 1,30 and 90 were measured through ultrasonic detection;hepatic arterial buffer capacity (BC)and adjustment BC were calculated.The univariable and multivariable analysis were performed to analyze the relationship between hepatic hemodynamics and liver function in two groups,and the receiver operating curve (ROC)was drawn. Results The PVP and PVF on postoperative day 30 in abnormal group were significantly higher than those of normal group (P =0.014,0.049).The BC and adjustment BC in normal group were significantly higher than those of abnormal group (P =0.048,0.011).The multivariable analysis showed that adjustment BC was the independent risk factor (P =0.047),with the area under the curve (AUC)of ROC of 0.705,sensitivity of 0.652 and specificity of 0.750. Conclusions PVP,PVF,BC and adjustment BC on postoperative day 30 may be related to abnormal liver function,of which adjustment BC can be used as one of the indicators for diagnosis and intervention of abnormal liver function.
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Objective To analyze the individual immunosuppressive protocol (IP) after liver transplantation (LT) in benign end-stage liver disease. Methods The clinical data of 645 patients with benign end-stage liver disease undergoing LT in our institute from April 2002 to Aug 2010 wen analyzed retrospectively. 146 cases from Apr. 2002 to Dec. 2004 were in stage one, and triple therapy containing tacrolimus (Tac), mycophenolate mofetil (MMF) and methylprednisolone (MP) was used;273 cases from Jan. 2005 to Dec 2007 were in stage two, and the less dose of immunosuppressant than stage one was used; 226 cases from Jan. 2008 to Aug. 2010 were in stage three, and they wen divided into conventional group and severe patient group according to their preoperative model for endstage liver disease (MELD) score and patient condition, the individual IP was used. Results The overall survival rate of patients with MELD score 0. 05). The incidence of rejection in cases with MELD score ≥25 in stage two and stage three was higher slightly than in stage one (P<0. 05). Conclusion The IP after liver transplantation should be individualized according to recipient conditions, which can increase survival rate.
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BACKGROUND: The formation mechanism of biliary cast syndrome following liver transplantation has not been thoroughly illuminated, and it is unclear that whether some proteins correlated to the formation mechanism of biliary cast or prewarning to the formation of biliary cast.OBJECTIVE: To investigate the holoprotein expression in biliary cast syndrome patients following liver transplantation. METHODS: Four patients underwent liver transplantation at Liver Transplantation Institute, General Hospital of Chinese People's Armed Police Force. Three months later, 10 g biliary cast was harvested. Four kinds of biliary cast specimens at different colors and textures were preserved at deep hypothermia, followed by protein abstraction and restriction enzyme digestion, the total protein abstraction solution of biliary cast were analyzed by high definition mass spectrometry and query on MASCOT database. All protein name of biliary cast were list, the conjunct protein was found by comparing 4 specimens. RESULTS AND CONCLUSION: There were totally 208 proteins in 4 biliary cast specimens, 82, 44, 56 and 65, respectively. By comparison, 5 proteins were found to overlay in 2 biliary cast specimens, 7 proteins in 3 specimens and 13 proteins in 4 specimens. Among the latter 13 proteins, 5 unnamed-proteins, as well as 8 named-proteins (termed alpha-fibrinogen precursor, beta-fibrinogen precursor, fibrinogen gamma chain, proapolipoprotein, Chain A of Human Cathepsin G, S100 calcium-binding protein A9, lactoferrin) were included. The proteins exists in biliary cast, the common proteins of 4 biliary cast specimens imply a correlation between the formation of biliary cast and the exudative inflammation following the damage of biliary tract epithelium; Some proteins might be considered as a marker of prewarning the presence of biliary cast syndrome, judging the inflammation severity following the damage of biliary tract epithelium and the prognosis of biliary cast syndrome.
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Objective To investigate the impacts of preoperative portal vein thrombosis (PVT) on intraoperative or postoperative parameters in patients receiving orthotopic liver transplantation (OLT). Methods The clinical data of 836 patients undergoing OLT in our hospital from February 2002 to February 2007 were retrospectively analyzed. Of the 836 patients, 71 had preoperative PVT (PVT group) and the other 765 had not (control group). Intraoperative patameters (operative dura-tion, anhepatic phase duration, blood transfusion volume) and postoperative parameters (ICU stay and hospitalization time, portal rethrombosis posttransplantation, graft function, portal vein flow, death rate in perioperation and 1-, 3-, 5-year survival rate) were compared between the 2 groups. Results The operative duration and anheptic phase duration were significantly higher in the PVT group than in the control (792. 47±62. 29 min vs 516. 18±86. 30 min, P<0. 01, 77. 53±24. 76 min vs 48. 55±31. 20 min, P<0. 05). Perioperative blood transfusion volume, average ICU stay and hospitalization duration were not significantly different between the 2 groups. The incidence of postoperative portal rethrombosis was remarkably higher in PVT group than in the control (9. 86% vs 1. 44% , P<0. 01).No significant differences in the graft function and portal vein flow (PVF) between the 2 groups except for a higher PVF in the PVT group on the 90th d(41. 43±17. 19 vs 19. 85±11. 39, P<0. 05). We noticed slightly higher death rate in perioperative and lower 1-, 3-, 5-year survival rate in the PVT group. Conclusion Preoperative PVT can gain the same favorable outcomes as in those without PVT in spite of readily intraoperative complex.
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Objective To evaluate the influence of L-ornithine-L-aspartate (LOLA) on model for end stage liver disease(MELD) score and liver function of patients with chronic liver failure (CLF). Methods Sixty patients consecutively admitted to our hospital from May, 2002 and November, 2008 were enrolled into the study and randomly divided into low dose group (LD group, LOLA:10 g/d) and high dose group (HD group, LOLA :20 g/d)After treatment of LOLA, the clinical data ( serum NH3 , MELD score and liver function ) were compared between the two groups. Results Compared to serum NH3 level before treatment, serum NH3 decreased ( 62.59 + 27.87 )μmoL/L in the HD group and (49.36 + 27.34 ) μmol/L in the LD group, and both decreasements were statistical significant (Ps ＜ 0. 05 ). Compared to MELD before treatment, MELD score decreased ( 8.38 ± 2. 24 ) and ( 14.57 + 7.68), respectively ( Ps ＜ 0.05 ). Compared to LD group, all indices of liver function in the HD group improved more compared to those of the LD group ( Ps ＜ 0.05 ). Conclusions LOLA could significantly decrease serum NH3 and MELD score and improve liver function in CLF patients.
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Objective To evaluate the value of intraoperative ultrasound on recipient with living donor liver transplantation.Methods Forty-five recipients with living donor liver transplantation were performed intraoperative ultrasound using Mylab 30 after the blood vessels were anatomized.Results Three cases of hepatic artery thrombosis,two cases of outflow occlusion,four cases of abnormal increasing of portal vein blood flow velocity and hemodynamics,and one case of portal vein anastomosis stenosis were found by intraoperative ultrasound.Conclusions Intraoperative ultrasound plays an important role for recipient in living donor liver transplantation.
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Objective To investigate the feasibility of measuring liver volume with Argus methoct Methods Thirty-two healthy liver transplant donor candidates underwent liver MRI on a 3.0 T MR unit.Volume interpolated body examination(VIBE)was performed after the administration of gadobenate dimeglumine.The VIBE data was transferred to the diagnostic workstation,and then multiple planar reconstruction(MPR)images were acquired.Firstly.two observers manually drawn the liver shape and calculated three volumes:the whole liver volume and right lobes volumes include middle hepatic vein (MHV)and exclude MHV,respectively.Secondly,the same data was transferred to Argus software.calculated that three volumes.Each measurement time was recorded.Actual graft volume(the right lobe)wag measured during surgery.The correlation between right lobes volume of two measurements and actual graft volume was analyzed.The time needed for Argus and that needed for manual method were compared with paired t test.Results The right lobe volumes measured by Argus,manually and surgery method were (813±187),(807 ± 181)and(713 ± 137)mm3,respectively.Argus method and manual method showed good correlation with surgery method,and the correlation coefficients were 0.897(Argus method)and 0.884(manual method),respectively.The time for manual method and Argu8 method were(44.3 ±2.7)and(12.2.±1.0)min,respectively.There was significant difference between Argus and manual methods (t=76.39,P＜0.05).Conclusion Compared with manual method,use of the Liver volumetric measurement by Argus software not only correlated well with Actual graft volume,but also saves time.Argus has potential clinical value for volumetric measurement in living liver transplant donors.
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Objective To compare conventional T2-weighted MR cholangiography (T2WI-MRC) with gadobenate dimeglumine enhanced T1-weighted MR cholangiography(CE-MRC) for evalution of biliary anatomy in liver transplant donor candidates. Methods Thirty-two healthy liver transplant donor candidates were examined with two MR cholangiogaphic methods. For T2WI-MRC, a three-dimensional turbo spin-echo sequence and oblique coronal heavily T2-weighted thick-slab turbo spin-echo imaging sequence were performed. For CE-MRC, three-dimensional fat-suppressed spoiled gradient-echo sequences were performed, with a time delay of 60 minutes following the administration of gadobenate dimeglumine. To compare the depiction of biliary duct anatomy and the artifact caused by intestinal liquid and breathing between the two methods. Intraoperative cholangiography was the reference-standard examination. Results The both methods depicted the biliary anatomy correctly in all 9 cases. The both methods showed the third branches of intrahepatic biliary duct clearly. T2WI-MRC showed interhepatic bihary duct before the third branches in 28 cases (87.5%), CE-MRC showed the same finding in 14 cases (43.8% ). T2WI-MRC showed common bile ducts intermitantly in 2 cases, which were normal in CE-MRC and intraoperative cholangiography. Intestinal liquid affected the image quality of biliary duct in 6 cases (18.8%) performed with T2WI-MRC, but none with CE-MRC. The artifacts caused by breathing were not obvious in the either method. Conclusion T2WI-MRC and CE-MRC both can be used to evaluate bihary anatomy of liver transplant donor candidates, but CE-MRC appears to be more accurate than T2WI-MRC.