Role of the criteria based on preoperative serological indexes of AFP and GGT in predicting long-term survival of patients with hepatocellular carcinoma after liver transplantation / 器官移植

Objective To evaluate the role of preoperative serological indexes in predicting long-term survival and tumor recurrence of hepatocellular carcinoma (HCC) patients after liver transplantation, aiming to explore its significance in expanding the Milan criteria. Methods Clinical data of 669 recipients undergoing liver transplantation for HCC were retrospectively analyzed. The optimal cut-off value was calculated by the receiver operating characteristic (ROC) curve. The risk factors affecting the overall survival and recurrence-free survival rates of HCC patients after liver transplantation were identified by univariate and multivariate regression analyses. The correlation between preoperative serum liver enzymes and pathological characteristics in HCC patients was analyzed. The predictive values of alpha-fetoprotein (AFP) combined with γ -glutamyl transferase (GGT) and different liver transplant criteria for the survival and recurrence of HCC patients after liver transplantation were compared. Results Exceeded Milan criteria, total tumor diameter (TTD) > 8 cm, AFP > 200 ng/mL and GGT > 84 U/L were the independent risk factors for the overall survival and recurrence-free survival rates of HCC patients after liver transplantation (all P < 0.05). Correlation analysis showed that preoperative serum GGT level was correlated with TTD, number of tumor, venous invasion, microsatellite lesions, capsular invasion, tumor, node, metastasis (TNM) stage, Child-Pugh score and exceeded Milan criteria (all P < 0.05). Milan-AFP-GGT-TTD (M-AGT) criteria were proposed by combining Milan criteria, TTD with serum liver enzyme indexes (AFP and GGT). The 5-year overall survival and recurrence-free survival rates of HCC recipients who met the M-AGT criteria (111 cases of exceeded Milan criteria) were significantly higher than those who met Hangzhou criteria (both P < 0.05), whereas had no significant difference from their counterparts who met the University of California at San Francisco (UCSF) criteria (both P > 0.05). Conclusions Preoperative serological indexes of AFP and GGT could effectively predict the long-term survival and tumor recurrence of HCC patients after liver transplantation. Establishing the M-AGT criteria based on serological indexes contributes to expanding the Milan criteria, which is convenient and feasible.

Current status and prospect of immunotherapy for cholangiocarcinoma / 中华消化外科杂志

Cholangiocarcinoma (CCA) is a category of highly heterogeneous and aggressive malignancy mainly originating from bile duct epithelial cells. The median survival time of untreated CCA patients is approximately 12?24 months, and the effectiveness and durability of surgical resection and neoadjuvant chemotherapy are limited. Results of the next-generation sequencing show that dysregulation of the immune system plays an important role in the pathogenesis of CCA. It has opened up new possibilities for the study of therapies targeting the natural course of aggressive CCA, such as immune checkpoint inhibitors, adoptive cell therapy, and tumor vaccines. Based on the current status of immunotherapy for CCA, the authors review the efficacy and dilemmas of current CCA immunotherapy strategies and look forward to the future treatment prospects of CCA.

Risk assessment of outcomes using grafts from donors after cardiac death / 中华器官移植杂志

Objective To assess the effects of the risk factors of grafts from donors after cardiac death (DCD) on the prognosis of liver transplantation (LT).Methods In this retrospectively study,215 cases of LT using DCD donor grafts were performed at our institution from September 2013 to January 2017.Due to the loss to follow-up in 4 cases,211 cases were enrolled in the study.The following DCD donor data were collected:gender,age,primary disease,ABO blood type,body mass index (BMI),medical history (fatty liver,hypertension),ICU hospitalization time,mechanical ventilation time,warm ischemia time,cold ischemia time,and indexes of routine laboratory test before donation.Statistical analyses using the Kaplan-Meier method,log-rank test,multivariate step-wise Cox regression were performed.Results Of the 211 donors,univariate analysis showed that the overall 6-month,1-,and 3-year survival rate after DCD LT was 88％,84％,and 82％,respectively.Univariate analysis showed that donor serum sodium level ＜136 mmol/L (P =0.018) and cold ischemia time ＞9 h (P =0.013) were all significant risk factors affecting overall survival after DCD LT.Additionally,donor BMI ＞30 kg/m2 (P =0.011) and donor age ＞60 years (P =0.025) were significantly associated with postoperative complications.Multivariate analysis showed that donor serum sodium level (P=0.025) was an independent risk factor of survival after DCD LT.Conclusion To select suitable DCD liver allografts and control risk factors of donor can help to improve outcomes of recipients.

Diagnosis, prophylaxis and treatment of splenic arterial steal syndrome after orthotopic liver transplantation / 中华肝胆外科杂志

Objective To study the diagnosis,prophylaxis and treatment of splenic artery steal syndrome (SASS),and to evaluate their clinical outcomes in recipients who underwent orthotopic liver transplantation (OLT).Methods 1 385 consecutive patients who suffered from liver cirrhosis and had undergone OLT in our hospital between Jan,2004 and Dec,2013 were studied.We hypothesized that patients were at risk of SASS when the calibre of the splenic artery (SA) was 1.5 times larger than the common hepatic artery (CHA) together with splenomegaly (318 patients,23.0％).Further surveillance with Doppler ultrasound (DUS) was carried out immediately at CHA reperfusion during operation.When a sluggish peak systolic velocity (PSV) ＜ 30 cm/s or no flow was detected in a patent hepatic artery,prophylactic SA banding (SAB) was considered.127 patients (39.9％) who fulfilled these criteria were recruited to the intervention group to undergo SAB.Eventually,patients who developed SASS were treated with coil-embolization of the SA (SAE),re-anastomosis of the HA to aorta (HTA),ligation of SA (SAL) or splenectomy (SPT),or retransplantation.Results SAB resulted in immediately increase in the mean PSV of the HA from 19.3 ±5.5 cm/s to 45.9 ± 9.1 cm/s (P ＜ 0.05),and resistance index (RI) of the HA rehabilitated to reasonable levels (0.5 ～0.8),without any HA or biliary related complication in all the 127 patients.17 patients in the control group were identified to have SASS (8.9％).5 of these 17 patients required emergency treatment by coil-embolization.Of the remaining 12 patients,11 who developed hepatic artery thrombosis secondary to SASS required to undergo embolectomy or thrombolysis followed by HTA (4 patients),SAL (3 patients),SPT (5 patients).Three of these patients finally required re-OLT.All these patients obtained acceptable results by these salvage strategies,except 2 out of the 12 patients who died from liver failure.Conclusions SASS is an important but it is often and under-diagnosed cause of graft ischemia after OLT.Prophylactic SAB should be introduced to patients at risk of developing SASS in order to obtain satisfactory results.Coil-embolization of SA shortly after diagnosis is an effective salvage intervention to prevent further progression to develop devastating consequences.

Effects of portal vein thrombosis on parameters in recipients of orthotopic liver transplantation / 中华肝胆外科杂志

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.

Influence of L-ornithine-L-aspartate on MELD score of patients with chronic liver failure / 中国综合临床

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.

Impact of core hypothermia during reperfusion on acute pulmonary edema after liver transplantation in patients with chronic severe hepatitis / 中华普通外科杂志

Objective To investigate the influence of hypothermia during reperfusion on acute pulmonary edema(APE)after liver transplantation in patients with chronic severe hepatitis. Methods Between February 2002 and December 2006,108 consecutive patients of chronic severe hepatitis underwent liver transplantation. Patients suffering from postoperative APE(APE group)were compared with those without APE(NAPE group)on hypothermia during reperfusion. We evaluated the impact of hypothermia on requirement of red blood cells and/or fresh-frozen plasma, and prothrombin time in neo-liver phase. Results Forty-one out of these 108(37.96%)cases were complicated with APE. Compared with NAPE group, patients in APE group have significant lower core hypothermia(t=2.413,P=0.018),longer hypothermia duration(＞5 min)(39.02%,x2=143.40).Longer pmthrombin time(t=2.884,P=0.005)and larger amount of blood transfnsion were observed in APE group. Patients with hypothermia were prone to accompanied with longer PT in neo-liver phase(28.03±8.45)min vs (24.12±5.89)min, t=2.553,P=0.012),larger requiting of RBC transfusion(2786.96±1266.47)ml vs(2129.41±805.90) ml, t=2.364,P=0.026)and fresh-frozen plasma(2121.74±676.19)ml vs (1768.24±685.08) ml, t=2.201,P=0.030).Conclusions Low core hypothermia during neo-liver reperfusion contributes to the development of APE in patients with chronic severe hepatitis undergoing liver transplantation. Prolonged PT and large amount of blood transfusion may be involved in this complication.

Clinical significance of spontaneous shunt of omentorenopexy in the treatment of portal hypertension / 中国普通外科杂志

0.05 ). The rate of hypertensive gastropathy, compared with PCDV (66.74%), was significantly attenuated in patiens who underwent PCDV+ORP (22.78%, P

Relationship Between Plasma Insulin,Serum Lipids and Cholelithiasis in Patients With Type 2 Diabetes / 中国医师杂志

Objective To investigate the level changes of plasma insulin,serum lipids in type 2 diabetes with cholelithiasis.Methods 159 cases of types 2 diabetic patients was studied during recently 3 years in our department of endocrinology,the levels of blood glucose,plasma insulin and insulin sensitivity index(ISI),serum lipids,apolipoproteins(ApoA 1,B) were measured both fasting and post-prandial,and investigated their correlation between type 2 diabetic patients with cholelithiasis(n=103) and without cholelithiasis(n=56).Results Female was predominated in fifty-six diabetic with cholelithiasis,they had higher triglyceride(TG),fasting or post-prandial insulins,ApoA 1,ApoB,the top body weight index and lower ISI than 103 diabetics without cholelithiasis.There were no significant differences in total cholesterol(CH),HDL-Ch,LDL-Ch,blood glucose concentrations between the groups.Conclusions Obesity,insulin resistance and lipids metabolic disturbance might be related to the development of cholelithiasis in type 2 diabetic patients.

Effect of exogenous prostaglandin E_1 on expression of platelet-derived growth factor B and its receptor ? in rabbits with schistosomia japonicum / 中国普通外科杂志

Objective To investigate the effects of exogenous prostaglandin E 1 (PGE 1) on expression of platelet derived growth factor B (PDGF-B) mRNA and its receptor ? protein in rabbit with schistosomiasis. Methods In this study, 14 rabbits were infected with cercaria of S. japonicum percutaneously. PGE 1 ( 2.5 ?g/kg?d -1 ) was given intravenously to 7 rabbits from the 60th day to day 120. The expressions of PDGF-B mRNA, PDGFR ? protein and ?-SMA were detected by RT-PCR, Western blotting and immunohistochemistry, respectively. Endogenous IFN-? was measured by in situ hybridization. Results Up-regulated expressions of PDGF-B mRNA, receptor ? protein as well as ?-SMA were observed in rabbits with Schistosome hepatic fibrosis. The increased expressions of PDGF mRNA and receptor ? were suppressed in rabbits treated with exogenous PGE 1 (29.42?5.05 vs 41.37?7.23, P

Prophylaxis and treatment of biliary cast syndrome after orthotopic liver transplantation / 中华器官移植杂志

Objective To evaluate the preventive effect of different portal vein flush solutions in no heart beating donor harvest on biliary cast syndrome (BCS) after orthotopic liver transplantation (OLT), and the application of choledochoscopy in treating BCS. Methods The incidence of biliary complications in 137 consecutive recipients undergoing OLT in our liver transplant center from May. 2002 to Dec. 2003 was retrospectively analyzed. The incidence and risk factors of BCS were compared in 2 groups with different types of portal vein flush solution in no heart beating donor liver harvest: group 1 (n = 65). University of Wisconsin (UW) solution; and group 2 (n = 72), hypertonic citrate adenine ( HCA) solution combined with UW solution. Therapeutic experience and clinical value of choledochoscopy for BCS were summarized. Results Seventeen out of 137 cases (12.4 %) developed BCS in the first three months after operation. In the group 1, the incidence of BCS was 20. 0 % (13/ 65), while that in the group 2 5. 56 % (4/72) with the difference being significant (P