Quality of Life Status and Influencing Factors Among Patients with Deep Vein Thrombosis.

Objective: The objective of the study was to describe the quality of life (QoL) status and investigate the influencing factors of QoL among patients with deep vein thrombosis (DVT). Methods: A retrospective analysis at a single center was performed, and the clinical data of 161 patients with DVT admitted to West China Hospital of Sichuan University from June 2019 to June 2020 were collected with the Villalta scale, Hospital Anxiety and Depression Scale (HADS), and Chronic Venous Insufficiency Questionnaire (CIVIQ). The relationship between QoL and influencing factors, including characteristics, course of DVT, postthrombotic syndrome (PTS), psychological status, and behaviors, was analyzed by Student's t-test, analysis of variance and multiple linear regression. Results: A total of 161 patients who completed all the questionnaires between 2019 and 2020 were included, and 110 patients (68%) were male. The mean QoL score acquired by the CIVIQ scale was 74.18±8.44, and the results showed significant differences between patients of different ages, genders, behaviors and psychological statuses (P < 0.05). Multiple regression analysis showed that age (P = 0.024), negative mood (P < 0.001), CCI index (P < 0.001), PTS (P < 0.001) and regular exercise (P = 0.002) influenced the CIVIQ scale evaluation model, in which exercise regularly was a protective factor for QoL, and age, negative mood, CCI index and PTS were risk factors for QoL. Conclusion: The QoL of DVT patients was impaired and associated with age, mood, CCI index and PTS. Regular exercise is beneficial for improving the quality of life of DVT patients.

Involvement of dopamine signaling pathway in neurodevelopmental toxicity induced by isoniazid in zebrafish.

AIMS: This study evaluated the neurodevelopmental toxicity of isoniazid (INH) in zebrafish embryos and the underlying mechanism. METHODS: Zebrafish embryos were exposed to different concentrations (2 mM, 4 mM, 8 mM, 16 mM, 32 mM) INH for 120 hpf. During the exposure period, the percentage of embryo/larva mortality, hatching, and morphological malformation were checked every 24 h until 120 hpf. The development of blood vessels in the brain was observed at 72 hpf and 120 hpf, and behavioral capacity and acridine orange (AO) staining were measured at 120 hpf. Alterations in the mRNA expression of apoptosis and dopamine signaling pathway related genes were assessed by real-time quantitative PCR (qPCR). RESULTS: INH considerably inhibited zebrafish embryo hatching and caused zebrafish larval malformation (such as brain malformation, delayed yolk sac absorption, spinal curvature, pericardial edema, and swim bladder defects). High concentration of INH (16 mM, 32 mM) even induced death of zebrafish. In addition, INH exposure markedly restrained the ability of the zebrafish autonomous movement, shortened the length of dopamine neurons and inhibited vascular development in the brain. No obvious apoptotic cells were observed in the control group, whereas considerable numbers of apoptotic cells appeared in the head of INH-treated larvae at 120 hpf. PCR results indicated that INH significantly raised the transcription levels of caspase-3, -8, -9, and bax and significantly decreased bcl-2 and bcl-2/bax in the zebrafish apoptotic signaling pathway. INH also markedly decreased the genes related to dopamine signaling pathway (th1, dat, drd1, drd2a, drd3, and drd4b). CONCLUSIONS: Experimental results indicated that INH had obvious neurodevelopmental toxicity in zebrafish. Persistent exposure to INH for 120 h caused apoptosis, decreased dopaminergic gene expression, altered vasculature, and reduced behaviors.

Risk Factors for Preoperative Anxiety and Depression in Patients Scheduled for Abdominal Aortic Aneurysm Repair.

BACKGROUND: Perioperative emotional disorders of patients underwent abdominal aortic aneurysm (AAA) repair is an emerging area of study, and preoperative mental distress of those patients remains poorly understood. The aim of this study was to investigate the prevalence and identify the risk factors of preoperative anxiety and depression in patients scheduled for AAA repair. METHODS: A total of 189 patients who underwent elective AAA repair between 2015 and 2016 were included in this study. These patients were preoperatively evaluated by Hospital Anxiety and Depression Scale (HADS). Demographics and anxiety and depression scores of the patients were documented. Logistic regression was used to identify the independent risk factors of preoperative anxiety and depression. RESULTS: A total of 150 AAA patients were included in final analysis. Of these 150 patients, 44 patients (29.3%) had borderline anxiety or clinical anxiety, and 42 patients (28.0%) were found to have borderline or clinical depression. Female (odds ratio [OR]: 2.81, 95% confidence interval [CI]: 1.08-7.26), the American Society of Anesthesiologists (ASA) Grade 3/4 (OR: 4.34, 95% CI: 1.13-16.68), higher education (OR: 1.44, 95% CI: 1.02-2.04), and abdominal or back pain (OR: 3.08, 95% CI: 1.20-7.87) were identified as significant independent risk factors of abnormal HADS-anxiety in overall patients; and higher level of education (OR: 1.87, 95% CI: 1.16-3.01) was predictive of anxiety in patients planned for endovascular aortic repair. Besides, higher body mass index (BMI) (OR: 1.18, 95% CI: 1.04-1.33) and abdominal or back pain (OR: 3.93, 95% CI: 1.70-9.11) were predictive of abnormal preoperative HADS-depression in overall patients. CONCLUSION: As for patients scheduled for AAA repair, female, higher ASA, higher level of education, and symptom may be independent risk factors for preoperative anxiety, and symptom and higher BMI may predict preoperative depression.

[Two Methods of Internal Iliac Artery Exclusion in Endovascular Aorta Repair: a Middle-long Term Follow-up Study].

OBJECTIVE: To compare the middle and long term results of two internal iliac artery exclusionmethods (with or without coils) in endovascular aorta repair (EVAR). METHODS: Clinical data of patients who underwent EVAR from January 2006 to December 2013 were analyzed retrospectively. The participants were divided into two group: coils were not used in Group A, but were used in Group B. The patients were followed up from June 2006 to June 2014. RESULTS: A total of 137 patients (74 in Group A, 63 in Group B) were included in this study, with a mean age of 71. 6 years. The majority (124) of participants were men. Postoperative 30-day mortality of the participants was 0. 73%. None of the participants developed pelvic and spinal ischemia. Claudication appeared in 9 patients (3 in Group A and 6 in Group B). Ischemia in lower extremity happened in 5 patients (2 in Group A and 3 in Group B). Gluteal sore was reported by 5 patients (1 in Group A and 4 in Group B). One patient from Group B developed gluteal skin necrosis. No statistical difference in ischemia and stent occlusion was found between the two groups (P=0. 301, P=0. 108). However, patients in Group B stayed in hospitals longer (P<0. 001) than those in group A. One patient in Group B developed severe ischemic complication: skin and gluteus necrosis. CONCLUSION: Internal iliac artery exclusions with and without coilsresult in similar middle and long term outcomes measured by ischemic complications.

Risk factors associated with early and late HAT after adult liver transplantation.

AIM: To identify risk factors that might contribute to hepatic artery thrombosis (HAT) after liver transplantation (LT). METHODS: The perioperative and follow-up data of a total of 744 liver transplants, performed from February 1999 to July 2010, were retrospectively reviewed. HAT developed in 20 patients (2.7%). HAT was classified as early (occurring in fewer than 30 d post LT) or late (occurring more than 30 d post LT). Early HAT developed in 14 patients (1.9%). Late HAT developed in 6 patients (0.8%). Risk factors associated with HAT were analysed using the χ(2) test for univariate analysis and logistic regression for multivariate analysis. RESULTS: Lack of ABO compatibility, recipient/donor weight ratio ≥ 1.15, complex arterial reconstruction, duration time of hepatic artery anastomosis > 80 min, duration time of operation > 10 h, dual grafts, number of units of blood received intraoperatively ≥ 7, number of units of fresh frozen plasma (FFP) received intraoperatively ≥ 6, postoperative blood transfusion and postoperative FFP use were significantly associated with early HAT in the univariate analysis (P < 0.1). After logistic regression, independent risk factors associated with early HAT were recipient/donor weight ratio ≥ 1.15 (OR = 4.499), duration of hepatic artery anastomosis > 80 min (OR = 5.429), number of units of blood received intraoperatively ≥ 7 (OR = 4.059) and postoperative blood transfusion (OR = 6.898). Graft type (whole/living-donor/split), duration of operation > 10 h, retransplantation, rejection reaction, recipients with diabetes preoperatively and recipients with a high level of blood glucose or diabetes postoperatively were significantly associated with late HAT in the univariate analysis (P < 0.1). After logistic regression, the independent risk factors associated with early HAT were duration of operation > 10 h (OR = 6.394), retransplantation (OR = 21.793) and rejection reactions (OR = 16.936). CONCLUSION: Early detection of these risk factors, strict surveillance protocols by Doppler ultrasound and prophylactic anticoagulation for recipients at risk might be determined prospectively.

[Establishment of experimental abdominal aortic aneurysm model in rats].

OBJECTIVE: To establish a new reliable experimental abdominal aortic aneurysm (AAA) rat model that simulates human aneurysms and has high survival rate. METHODS: Twenty-four SD rats were randomly divided equally into two groups (male: female=1: 1). Intraluminal saline infusion was given to rats in group A. Rats in group B were given intraluminal elastase infusion and extraluminal calcium chloride application. The diameter of abdominal aorta was measured and eventually harvested at 4 weeks. Successful AAA formation was defined as a dilation ratio )50%. HE stain was applied to evaluate the histology changes of aorta. RESULTS: Group A had a survival rate, technical success rate and AAA formation rate of 83. 3%, 91. 67%, and 0% respectively, compared with 91. 67%, 100%, and 90. 91% in group B. The AAA formation rate in group B was significantly higher than that in group A (P<0. 05). The dilation ratio during infusion was 50. 82% ±4. 11% in group A and 48. 19% ± 3. 89% in group B. The dilation ratio after infusion was 29. 55% ± 4. 69% in group A and 27. 89% + 4. 28% in group B. The difference of dilation ratio between the two groups was not significant. The post-surgery (28 d) dilation ratio was 27. 89% ± 4. 28%0 in group A and 88. 98% ± 42. 33% in group B (P< 0. 05). Fusiform aneurysms, local adhesion and calcification were found in group B. Rats in group B also had thickening intimal, degenerated matrix in media, loss of elastin fiber, apoptosis of vascular smooth muscle cells and transmural inflammation, none of which was observed in group A. CONCLUSION: With improved operative procedure, intraluminal elastase infusion and extraluminal calcium chloride application can create reliable AAA rat model.

[Surgical vascular by-pass operation of lower limb artery occlusion in patients with diabetic foot].

OBJECTIVE: To document the effectiveness and patient experience of surgical treatment for diabetic lower limb arterial occlusion. METHODS: Out of 290 diabetic patients with lower limb arterial occlusion, 69 received by-pass operation because of severe stenosis below the abdominal aorta and severe ulcers in feet from April 2004 to April 2011. We reviewed the experience and outcome of the 69 diabetic patients who underwent surgical operations on lower limb arterial occlusion. RESULTS: 100% initial surgical success was achieved. The morbidity (excluding death) was 12.3% +/- 4.1% and 15.7% +/- 5.1% at 1 year and 3 years after operations, respectively. Five (7.2%) death cases were recorded, which resulted in a survival rate of 94.2% +/- 2.8% and 92.0% +/- 3.5% at 1 year and 3 years after operations, respectively. About 90.6% +/- 3.6% and 87.2% +/- 4.9% of patients had graft patency 1 year and 3 years after operations, respectively; and 6. 5% + 3. 1% had amputations. Four (5. 8%) patients developed graft thrombosis, in which 2 (2.9%) had amputations because of recurrence of thrombosis after thrombectomy. Two (2.9%) patients had amputations because of graft infection accompanied with graft resection operations. One (1.4%) patient received repeated arterialized operation on great saphenous vein because of popliteal artery occlusion, and obtained a good outcome within two years. One (1.4%) patient developed stomas false aneurysm, but the excision of the false aneurysm resulted in a good outcome in four years. CONCLUSION: Detailed pre-operation assessment, optimal selection of surgical procedure and perioperative management can help improve the outcome of diabetes and decrease amputation rate in patients with diabetic lower limb arterial occlusion.

[Clinical and pathological characteristics and surgical treatment of carotid body tumor with endocrine activity].

OBJECTIVE: To investigate the clinical and pathological characteristics and surgical treatment of carotid body tumor with endocrine activity (CBT). METHODS: Records of seven CBT patients with endocrine activity (Jan, 1991-Aug, 2011) who underwent surgical excision of tumor were retrospectively reviewed. The operations were performed with the careful peroperative preparation on the control of blood pressure, serum potassium and catecholamine. All the tumors were studied with the methods of HE staining, immunohistochemistry of chromogranin A (CgA) and S-100. RESULTS: All the operations were successfully accomplished and the patients recovered quickly. It was confirmed with pathological examination that all the tumors were CBT, coming from paraganglioma. Tumor cells and sertoli cells were found in HE staining, and all were positive of CgA and S-100. All patients were followed up for 12-60 months and no recurrence was found during the follow up. CONCLUSION: CBT with endocrine activity presents with identifiable clinical and pathological characteristics. The recommended treatment is surgical resection, careful perioperative preparation and care is important to avoid the severe complication due to the endocrine activity of tumor.

Impact of graft steatosis on the post-transplantation biliary complications for living donor liver transplant recipients in China.

BACKGROUND/AIMS: After living donor liver transplantation (LDLT), the prevalence of complications related to the biliary system is 6-35%. In spite of great improvements in both surgical techniques and postoperative and long-term medical treatment, the biliary complications are still considered a relatively high risk for LDLT. The aim of this retrospective study was to analyze the incidence of biliary complications and identify predisposing risk factors. METHODOLOGY: The clinical and follow-up data of 175 adult patients receiving LDLT (right lobe or left lobe) between 2002 and December 2008 were collected and retrospectively analyzed. Patients were divided into 2 groups: with biliary complications (n=30) and without biliary complications (n=145). RESULTS: Thirty patients (17.1%) had post-transplantation biliary complications. Eight patients (4.6%) were diagnosed with bile leakage, while 24 patients (13.7%) developed biliary stricture. Percentage of steatosis of the graft and hepatic artery thrombosis after LDLT were two factors upon univariate analysis (p=0.034, p=0.01, respectively). In multivariate logistic analysis, 20-50% macrovesicular steatosis emerged as a new defined risk factor by us (p=0.001). There was no difference in patient survival rate in different groups and sorts of graft steatosis (p>0.05). CONCLUSIONS: We consider that using a graft with macro-vesicular steatosis in 20-50% should be put on the table carefully, balancing both sides of positive and negative.

[Perioperative outcomes after endovascular versus open repair of abdominal aortic aneurysms: a single center experience].

OBJECTIVE: To evaluate the outcomes of endovascular repair (EVAR) versus open repair (OR) in the patients with abdominal aortic aneurysm (AAA) and compare their perioperative rates of morbidity and mortality. METHODS: The clinical data of 371 AAA patients from January 2006 to January 2011 were collected and analyzed. Endovascular (n = 174) and open (n = 197) repairs were performed. The relevant parameters included preoperative status, intraoperative blood loss, procedure time, intensive care unit (ICU) stay length, ventilatory support time, postoperative fasting time and duration of postoperative hospital stay and anesthesia methods. The perioperative rates of morbidity and mortality were presented. RESULTS: The patients of EVAR group were elder than those of OR group [(72 ± 8) vs (60 ± 14) years old, P = 0.000]. The comorbidity rate of chronic obstructive pulmonary disease (COPD) in EVAR group was higher than that in OR group (31.0% vs 21.8%, P = 0.045). As compared with OR group, the EVAR group had less blood loss [(125 ± 43) vs (858 ± 602) ml, P = 0.000], a lower rate of blood transfusion (0 vs 71.1%, P = 0.000), shorter ICU stay length [(15 ± 5) vs (31 ± 11) h, P = 0.000], shorter postoperative fasting time [(7 ± 4) vs (90 ± 32) h, P = 0.000], shorter procedure time [(146 ± 39) vs (210 ± 24) min, P = 0.000] and shorter ventilatory support time [(90 ± 23) vs (220.0 ± 132.0) min, P = 0.000]. In EVAR group, general (88, 50.6%), epidural (52, 30.0%) and local (34, 19.4%) anesthesia were used. General anesthesia was used for all OR group patients. The duration of postoperative hospital stay was similar in two groups (9.1 ± 2.7) d vs (9.2 ± 2.6) d (P = 0.798). The perioperative complication rate was lower in EVAR group (12.6% vs 27.0%, P = 0.001). And the 30-day mortality rate was 1.15% in EVAR group and 2.0% in OR group. CONCLUSION: Endovascular repair is less-invasive in AAA patients and offers significant advantages over open surgery. Especially it is indicated for those patients non-suitable for open surgery. And a long-term survival rate is expected.

Higher tacrolimus blood concentration is related to hyperlipidemia in living donor liver transplantation recipients.

BACKGROUND: The arrival of tacrolimus has drastically improved AALDLT recipients' survival. However, little data of tacrolimus have been reported concerning its effects on lipid metabolism for AALDLT recipients. AIM: Out aim was to investigate the relationship between tacrolimus blood concentration and lipid metabolism in AALDLT recipients. METHODS: The pre and postoperative data of 77 adult patients receiving AALDLT between 2002 and December 2007 were retrospectively reviewed. The postoperative immune suppressive regimen was prednisone with tacrolimus ± mycophenolate mofetil. Prednisone was withdrawn within the first postoperative month. Blood lipids and tacrolimus concentration were detected at the first, third, and sixth month during follow-up. Episodes of acute rejection were diagnosed based on biopsy. RESULTS: Overall prevalence of post-transplantation hyperlipidemia was 29.9% (23/77) at the sixth postoperative month. The patients were divided into two groups, the hyperlipidemia group and the ortholipidemia group. In the 23 patients with hyperlipidemia, 15 (65%) were hypercholesterolemia, five (22%) were hypertriglyceridemia, and three (13%) patients had both hypercholesterolemia and hypertriglyceridemia. In univariate analysis, only tacrolimus blood concentration at the third and sixth post-transplantation months showed significant difference (8.7 ± 2.1 vs. 6.9 ± 3.2, p = 0.013; 9.2 ± 2.7 vs. 7.3 ± 3.8, p = 0.038, respectively). In multivariate logistic analysis, only two factors appear to be risk factors, namely, tacrolimus blood concentration at the third and sixth post-transplantation months (8.7 ± 2.1 vs. 6.9 ± 3.2, p = 0.043; 9.2 ± 2.7 vs. 7.3 ± 3.8 p = 0.035, respectively). CONCLUSIONS: Higher tacrolimus blood concentration was related to hyperlipidemia at an early postoperative period. This indicates that tacrolimus blood concentration should be controlled as low as possible in the premise that there is no risk of rejection to minimize post-transplant hyperlipidemia after AALDLT.

Microsurgical reconstruction of hepatic artery in A-A LDLT: 124 consecutive cases without HAT.

AIM: To retrospectively investigate microsurgical hepatic artery (HA) reconstruction and management of hepatic thrombosis in adult-to-adult living donor liver transplantation (A-A LDLT). METHODS: From January 2001 to September 2009, 182 recipients with end-stage liver disease underwent A-A LDLT. Ten of these patients received dual grafts. The 157 men and 25 women had an age range of 18 to 68 years (mean age, 42 years). Microsurgical techniques and running sutures with back-wall first techniques were performed in all arterial reconstructions under surgical loupes (3.5 x) by a group of vascular surgeons. Intimal dissections were resolved by interposition of the great saphenous vein (GSV) between the donor right hepatic artery (RHA) and recipient common HA (3 cases) or abdominal aorta (AA) (2 cases), by interposition of cryopreserved iliac vessels between the donor RHA and recipient AA (2 cases). RESULTS: In the 58 incipient patients in this series, hepatic arterial thrombosis (HAT) was encountered in 4 patients, and was not observed in 124 consecutive cases (total 192 grafts, major incidence, 2.08%). All cases of HAT were suspected by routine color Doppler ultrasonographic examination and confirmed by contrast-enhanced ultrasound and hepatic angiography. Of these cases of HAT, two occurred on the 1st and 7th d, respectively, following A-A LDLT, and were immediately revascularized with GSV between the graft and recipient AA. HAT in one patient occurred on the 46th postoperative day with no symptoms, and the remaining case of HAT occurred on the 3rd d following A-A LDLT, and was cured by thrombolytic therapy combined with an anticoagulant but died of multiorgan failure on the 36th d after A-A LDLT. No deaths were related to HAT. CONCLUSION: Applying microsurgical techniques and selecting an appropriate anastomotic artery for HA reconstruction are crucial in reducing the high risk of HAT during A-A LDLT.

Donor right hepatectomy in living donor liver transplantation: report of 143 cases.

BACKGROUND/AIMS: To summarize the surgical techniques of liver resection for right hepatic lobe graft in living donor liver transplantation (LDLT). METHODOLOGY: Data of 143 living donors of right hepatic lobe graft from January 2002 to February 2009 were retrospectively studied. The right lobe grafts were obtained by transecting the liver on the right side of the middle hepatic vein. Liver transection was done by using an ultrasonic dissector without inflow vascular occlusion. The standard liver volume (SLV) and the ratio of right lobe volume to SLV were calculated. RESULTS: The weight of right hepatic lobe graft ranged from 310 g to 870 g, accounting for 39.7-69.5% of SLV with the ratio of residual left liver from 30.5% to 60.3%, corresponding to 31.7%-71.6% of the recipient SLV. The mean operative loss of blood was 428 ml. Complications included 2 cases of intraabdominal bleeding, 1 thrombosis of the portal vein, 1 liver function insufficiency, 3 bile leakages, 1 chyle leakage, 2 pleural effusions and 5 wound steatoses. At last, all donors restored to health. CONCLUSIONS: Estimation of the liver volume by CT or formulae and accurate donor hepatectomy is of clinical importance in planning and performing successful living donor liver transplantation.

[Augmented hepatic regeneration of living donor liver graft by intraportal insulin administration].

OBJECTIVE: To evaluate the effect of postoperative intraportally administration of insulin on hepatic regeneration in adult patients underwent living donor right lobe liver transplantation (LDLT). METHODS: From July 2005 to September 2007, 15 right lobe LDLT adult recipients voluntarily receiving posttransplant intraportal insulin administration, without postoperative vascular and bile duct complications, without immune rejection, with more than 1 month survival and complete clinical data were enrolled in this study as intraportal insulin-therapy group (Group I). Another consecutive 15 right lobe LDLT adult recipients meeting the upwards referred criteria were enrolled in as non-insulin-therapy control group (Group NI). Recipients in Group I were treated postoperatively with intraportal insulin infusion, as follows: a 18-gauge catheter was inserted into right gastro-omental vein during surgery, regular insulin was administered just after the operation at the rate of 2 units/hour for 7 days. Liver function and serum insulin level were measured at before-operative day 1, postoperative day (POD) 7 and 30. Graft volume (GV) were measured during operation, and at POD 7 and 30. RESULTS: The rate defined as ratio of POD 7 GV/operation GV in Group I was higher than that of Group NI [(186.1 +/- 35.4)% vs. (160.6 +/- 22.1)%, P < 0.05]. The rate defined as ratio of POD 7 GRWR/operation GRWR was also higher in Group I than Group NI [(179.0 +/- 35.8) % vs. (156.6 +/- 18.5%, P < 0.05], whereas significant differences were not appeared between two groups in terms of regeneration rates at POD 30. Serum levels of total bilirubin, aspartate aminotransferase and alanine aminotransferase in Group I were lower than that in Group NI at POD 7 (P < 0.05). Significant differences were not presented between two groups in terms of post-transplant serum insulin levels and total insulin dosage by subcutaneous administration and venous injection (P > 0.05). CONCLUSIONS: These results suggest that intraportal insulin administration could augment liver graft regeneration during the first postoperative week.

[Reconstruction of hepatic artery in adult to adult living donor liver transplantation in 104 patients].

OBJECTIVE: To report the experience of hepatic artery reconstruction with adult-to-adult living donor liver transplantation (ALDLT) using right lobe liver grafts. METHODS: From January 2002 to August 2007, 104 patients underwent ALDLT using right lobe grafts. Hepatic arteries of donors and recipients were assessed carefully with spiral CT angiography and DSA before ALDLT. All patients underwent reconstruction of hepatic artery between right lobe liver grafts of donor and recipient which included the anastomosis between right hepatic artery of donors and recipients; the reconstruction of right hepatic artery between donor grafts and left hepatic artery of recipients; interpositional bypass using autogenous saphenous vein and cryopreserved iliac artery between right hepatic artery of donors and hepatic artery, common hepatic artery and abdominal aorta of recipients. The microsurgical technique was employed under the magnification of 3.5 times and operative microscope of 5-10 times. RESULTS: In these series, HAT occurred in 2 recipients at Days 1 and 7 post-ALDLT (1.9%). Both were revascularized with autogenous saphenous vein between right hepatic artery of donor and abdominal aorta of recipient. HAT occurred in 1 recipient at Days 90 post-ALDLT, but no symptom was presented. There was no severe complication and mortality related to hepatic artery reconstruction in recipients. No HAT, hepatic artery stenosis and aneurysm occurred during the follow-up period of 2-60 months. The 1, 2 and 3-year survival rates were 89.3%, 76.0% and 69.3% respectively. CONCLUSION: Careful evaluation of hepatic artery condition and using microsurgical techniques are important for safer arterial reconstruction and a long-term patency of hepatic artery in living donor liver transplantation in adults using right lobe liver grafts.

Indicators of prognosis after liver transplantation in Chinese hepatocellular carcinoma patients.

AIM: To identify prognostic factors of patients with hepatocellular carcinoma (HCC), who were treated by orthotopic liver transplantation (OLT). METHODS: From January 2000 to October 2006, 165 patients with HCC underwent OLT. Various clinicopathological risk factors for actuarial and recurrence-free survival were identified using the Kaplan-Meier method with the log-rank test. The Cox proportional hazards model was used to identify independently predictive factors for actuarial and recurrence-free survival, which were used to propose new selection criteria. We compared the outcome of the subgroup patients meeting different criteria. Survival analysis was performed using the Kaplan-Meier method with the log-rank test. RESULTS: The median follow-up was 13.0 mo (2.8-69.5 mo). Overall, 1-, 2-, 3- and 5-year actuarial survival was 73.3%, 45.6%, 35.4% and 32.1%, respectively. One-, 2-, 3- and 5-year overall recurrence-free survival was 67.0%, 44.3%, 34.5% and 34.5%, respectively. In univariate analysis, number of tumors, total tumor size, lobar distribution, differentiation, macrovascular invasion, microvascular invasion, capsulation of the tumor, and lymph node metastasis were found to be associated significantly with actuarial and tumor-free survival. By means of using the multivariate Cox proportional hazards model, total tumor size and macrovascular invasion were found to be independent predictors of actuarial and tumor-free survival. When the selection criteria were expanded into the proposed criteria, there was no significant difference in 1-, 2-, 3- and 5-year actuarial and tumor-free survival of the 49 patients who met the proposed criteria (97.6%, 82.8%, 82.8% and 82.8%, and 90.7%, 82.8%, 68.8% and 68.8%, respectively) compared with that of patients who met the Milan or University of California, San Francisco (UCSF) criteria. CONCLUSION: Macrovascular invasion and total tumor diameter are the strongest prognostic factors. The proposed criteria do not adversely affect the outcome of liver transplantation for HCC, compared with the Milan or UCSF criteria.

Outcomes of adult-to-adult living donor liver transplantation: a single center experience.

BACKGROUND: Since January 2002, adult-to-adult living donor liver transplantation (AALDLT) has gained increasing popularity in China in response to the shortage of cadaveric donor livers. This study presents a detailed analysis of the outcomes of AALDLT in a single center. METHODS: A total of 70 patients underwent AALDLT at our center between January 2002 and January 2007. Among these, 67 patients received a right lobe graft without the middle hepatic vein and 3 patients received dual grafts. Three-dimensional volumetric computed tomography, magnetic resonance imaging with angiography and cholangiography were performed preoperatively. Recipient operation time, intraoperative transfusion requirement, length of intensive care unit stay, length of hospital stay, liver function tests, coagulation tests and surgical outcomes were routinely investigated throughout this study. RESULTS: All donors survived the procedure with an overall complication rate of 15.3%. Overall recipient 1-year survival and complication rates were 87.1% and 34.2%, respectively. Among the 70 cases, average graft recipient weight ratio was 0.94% (0.72% - 1.43%) and average graft volume/standard liver volume ratio was 46.42% (31.74% - 71.68%). All residual liver volumes exceeded 35%. Liver function and coagulation recovered rapidly within the first 7 days after transplantation. CONCLUSIONS: AALDLT is a safe procedure for the donors and an effective therapy for patients with end-stage liver disease. Patient selection and timely decision-making for transplantation are essential in achieving good outcomes. With accumulation of experience in surgery and clinical management, timely feedback and proper modification, we foresee better outcomes in the future.

[Evaluation of the effect of living donor liver transplantation on the treatment of severe hepatitis].

OBJECTIVE: To evaluate the effect of living donor liver transplantation on the treatment of severe hepatitis. METHODS: 18 patients with severe hepatitis received liver transplantation (transplanted severe hepatitis group), 28 patients with sever hepatitis received non surgical treatment (non-transplanted severe hepatitis group), and 30 patients with end stage liver cirrhosis (without cancer) received liver transplantation (transplanted cirrhosis group). The vital sign, blood coagulation, and renal function were monitored during operation. After liver transplantation, patients received immunosuppressive therapy (including tacrolimus or cyclosporine A, mycophenolate, mofetil and corticosteroids), intensive care, antiviral therapy (including lamivudine and HBIg) and other treatments (including restoration of liver function and prevention of blood coagulation). Pre-operation data, operation procedure, liver function, renal function and the operation complications of three groups were compared, and survival rate at 1, 6 and 12 months after operation was followed. RESULTS: There was no significant difference in the operation time, warm ischemia time, hypothermic ischemia time and Graft-to-recipient weight ratio between the two transplantation groups. The blood loss volume and blood transfusion volume in the transplanted severe hepatitis group were higher than that those in the cirrhosis transplantation group (t = 0.001, 0.004). The levels of TBil, ALT and AST at day 7 after operation were (100.5 +/- 96.4)mumol/L, (215.3 +/- 195.7) U/L , (209.8 +/- 188.6) U/L in the transplanted severe hepatitis group, and (53.3 +/- 31.9)mumol/L, (56.3 +/- 22.1) U/L, (51.3 +/- 13.5) U/L in the transplanted cirrhosis group (t = 0.017, 0.021, 0.004). However, there was no significant difference in the levels of Alb and Cr between these two groups (P > 0.05). Survival rate was 88.89%, 83.33% 83.33% in the transplanted severe hepatitis group, and 96.67%, 93.33% 93.33% in the transplanted cirrhosis group at 1, 6 and 12 months after transplantation. CONCLUSION: Living donor liver transplantation is one of effect ways for the treatment of severe hepatitis.