Objective To discuss venous drainage types of median hepatic lobe and their guiding significances on the selection of grafts. Methods Between April 2005 and March 2009, 109 potential living donors underwent 3-dimensional reconstruction of computed tomography (CT) and the volume of graft was determined in the center of organ transplantation of Ruijin Hospital. The venous drainage types of median hepatic lobe of each donor were analyzed by the computer-based liver operation-planning system in detail to assign middle hepatic vein (MHV) types according to Marcos classification and venous types of Ⅳb segment according to Nakamura classification. Results The branching pattern of MHV was divided into 3 types: Type Ⅰ and Ⅱwere relatively more accounting for 44.0% （48/109）, 37.6% （41/109）, and type Ⅲ was fewest 〔18.3% （20/109）〕. There were no significant differences in volume of whole liver, volume of left liver or left liver/total liver volume ratio among various types of MHV of the donor (Pgt;0.05). Ⅳb vein was also divided into 3 types: The most common was type Ⅰ, accounting for 72.4% (79/109); Type Ⅱ 〔12.8% （14/109）〕, type Ⅲ 〔14.7% （16/109）〕 were relatively fewer. At last, 37 donors provided right liver, for Marcos Ⅰ, Ⅱ, and Ⅲ type of donors, donors remained with MHV was 12/17, 8/11, and 5/9; for Nakamura Ⅰ, Ⅱ, and Ⅲ type of donors, those number were 16/26, 4/6, and 5/5. Conclusion In adult-to-adult living donor liver transplantation, there may be great significances in accordance with Marcos and Nakamura typing results to harvest right lobe liver graft with or without MHV.
Portal vein blood flow is very important for the normal function of transplanted liver. The author reviewed the management methods of different portal vein thrombosis classification in the liver transplantation (LT). The prognosis of LT in the patients with Yerdel 1–3 thrombosis is similar to that the patients without thrombosis. The portal vein reconstruction of the patients with Yerdel 4 thrombosis can be realized by varicose vein to portal anastomosis, renoportal anastomosis or cavoportal hemitransposition. When anastomosis is made at the proximal side of a spontaneous shunt between the portal and cava system, the blood shunted from portal system can be reintroduced into the donor liver, which is crucial for the management of Yerdel 4 thrombosis. The establishments of artificial shunt by distal splenic vein, mesenteric vein or “multiple to one” anastomosis are effective attempts to drain the blood from portal system to the donor liver. For more severe diffuse thrombosis of portal vein system, multivisceral transplantation, including liver and small intestine, should be considered. The cases of LT in the patients with complex portal vein thrombosis are increasing, however the prognosis remains to be determined after accumulation of the cases.
Objective To investigate the factors influencing the occurrence of postoperative pulmonary complications (PPCs) in liver transplant recipients and to construct Nomogram model to identify high-risk patients. Methods The clinical data of 189 recipients who underwent liver transplantation at the General Hospital of Eastern Theater Command from November 1, 2019 to November 1, 2022 were retrospective collected, and divided into PPCs group (n=61) and non-PPCs group (n=128) based on the occurrence of PPCs. Univariate and multivariate logistic regression analyses were used to determine the risk factors for PPCs, and the predictive effect of the Nomogram model was evaluated by receiver operator characteristic curve (ROC) and calibration curve. Results Sixty-one of 189 liver transplant patients developed PPCs, with an incidence of 32.28%. Univariate analysis results showed that PPCs were significantly associated with age, smoking, Child-Pugh score, combined chronic obstructive pulmonary disease (COPD), combined diabetes mellitus, prognostic nutritional index (PNI), time to surgery, amount of bleeding during surgery, and whether or not to diuretic intraoperatively (P<0.05). Multivariate logistic regression analysis showed that age [OR=1.092, 95%CI (1.034, 1.153), P=0.002], Child-Pugh score [OR=1.575, 95%CI (1.215, 2.041), P=0.001], combined COPD [OR=4.578, 95%CI (1.832, 11.442), P=0.001], combined diabetes mellitus [OR=2.548, 95%CI (1.024, 6.342), P=0.044], preoperative platelet count (PLT) [OR=1.076, 95%CI (1.017, 1.138), P=0.011], and operative time [OR=1.061, 95%CI (1.012, 1.113), P=0.014] were independent risk factors for PPCs. The prediction model for PPCs which constructed by using the above six independent risk factors in Nomogram had an area under the ROC curve of 0.806. Hosmer and Lemeshow goodness of fit test (P=0.129), calibration curve, and decision curve analysis showed good agreement with Nomogram model. Conclusion The Nomogram model constructed based on age, Child-Pugh score, combined COPD, combined diabetes mellitus, preoperative PLT, and time of surgery can better identify patients at high risk of developing PPCs after liver transplantation.
Objective To investigate the surgical technique of reduced sized liver transplantation. Methods A reduced size liver transplantation was successfully performed on a 11-year old girl with incurable caroli′s disease. Results The recovery of liver graft function was good after the operation in this patients without complications. Conclusion Reduced size liver transplantation is a safe and effective technique for pediatric liver transplantation to provide liver graft. Authors introduced their experiences of surgical technique in this patient.
ObjectiveTo explore the application of extracorporeal venovenous bypass in orthotopic liver transplantation in pigs and to compare hemodynamic changes during operation of two different bypass ways. MethodsTwentyfive porcine orthotopic liver transplantations were performed and extracorporeal venovenous bypass was established during anhepatic phase through a catheter in portal vein (group A,n=16) or in splenic vein (group B,n=9).Hemodynamic changes were monitored continuously.ResultsFourteen recipients survived two days after operation (14/16) in group A while all survived in group B (9/9).Transient hemodynamic disturbance (MAP and CVP decreased,and HR increased) was monitored at both the beginning and the end of anhepatic stage in group A,while these parameters kept stable in group B (P＜0.05).ConclusionApplying venovenous bypass may stabilize recipients’ hemodynamics in porcines orthotopic liver transplantation,and splenic vein draining way has more advantages than portal vein.
Objective To report our experience in living donor liver harvesting of right lobe grafts. MethodsThe data of 76 living donors of right lobe grafts hepatectomy between August 2007 and December 2008 were studied. Before operation, the graft size, remnant liver volume rate, fatty liver, middle hepatic vein type, and the level of portal hypertension of recipient were comprehensive assessed to determine whether harvested middle hepatic vein. The graft was harvested depending on the port vein and hepatic artery ischemia-line. B-ultrasound was used to definite the structure and branch of middle hepatic vein, and intraoperative cholangiography was performed to definite the structure and variation of bile duct. Donor operative time, intraoperative blood loss, postoperative hospital stay, levels of bilirubin, international normalized ratio （INR）, and ALT, and complications after operation were recorded. Results All the operations were successful. The operative time was (8.3±1.3) h, the blood loss was (325±127) ml without blood transfusion in operation. The ALT, INR, and bilirubin recovered on the 12th day. The most common complication in early post-operation was wound infection in 5 cases, 4 cases had cholestasis, 4 cases occurred cross-section bile leakage, and 11 cases occurred varying degrees of delayed gastric emptying in 4～7 d after operation, who were all alleviated by corresponding treatments. The hospital stay was 9～21 d (median: 14 d) after operation. Conclusion Preoperative evaluation of the hepatic anatomy and precise surgical procedure are crucial, which will help the development of graft harvesting and rehabilitation of donor.
ObjectiveTo analyze the prevalence and risk factors of metabolic syndrome (MS) after adult liver transplantation (LT) recipients. MethodsThe clinicopathologic data of patients with survival time ≥1 year underwent LT in the People’s Hospital of Zhongshan City from January 1, 2015 to August 31, 2020 were analyzed retrospectively. The logistic regression model was used to analyze the risk factors affecting MS occurrence after LT, and the receiver operating characteristic (ROC) curve was used to evaluate the optimal cutoff value of the index of predicting MS occurrence and its corresponding evaluation effect. ResultsA total of 107 patients who met the inclusion criteria were collected in this study. Based on the diagnostic criteria of MS of Chinese Medical Association Diabetes Association, the occurrence rate of MS after LT was 32.7% (35/107). Multivariate logistic regression analysis showed that the increased age of the recipient [OR (95%CI)=1.106 (1.020, 1.199), P=0.014], preoperative increased body mass index [OR (95%CI)=1.439 (1.106, 1.872), P=0.007] and blood glucose level [OR (95%CI)=1.708 (1.317, 2.213), P<0.001], and with preoperative smoking history [OR (95%CI)=5.814 (1.640, 20.610), P=0.006] and drinking history [OR (95%CI)=5.390 (1.454, 19.984), P=0.012] increased the probability of MS after LT. The areas under the ROC curve (AUC) corresponding to these five indexes were 0.666, 0.669, 0.769, 0.682, and 0.612, respectively. The corresponding optimal cutoff values of three continuous variables (recipient’s age, preoperative body mass index, and blood glucose level) were 53 years old, 23.1 kg/m2, and 6.8 mmol/L, respectively. The AUC of combination of the above five indexes in predicting occurrence of MS was 0.903 [95%CI (0.831, 0.952)], and the sensitivity and specificity were 80.0% and 90.3%, respectively. ConclusionsIncidence of MS after adult LT recipient is not low. For recipients with preoperative hyperglycemia, obese, elderly, histories of drinking and smoking before LT need to pay attention to the early detection and early intervention of MS.
【Abstract】Objective To study the anatomy of the hepatic arteries and imitate the way to deal with the hepatic arteries in the living liver transplantation of the left lateral lobe.Methods Thirty normal adult livers were anatomyzed and 30 casting models of livers were observed. The lengths, diameters and distributaries of the hepatic arteries were described.Results The blood supply of the left lateral region came from proper hepatic artery, left hepatic artery and middle hepatic artery. The aberrant arteries included left inferior phrenic artery, left gastric artery and right gastric artery. They branched to supply the upper segment and the inferior segment.Conclusion There are five types of hepatic arteries to supply the left liver lobe. The anatomy of hepatic arteries should be studied and a reasonable approach to gain a liver graft should be designed before transplantation. The hepatic arteries should be dealt with so as to anastomose with recipient hepatic arteries.
ObjectiveTo elucidate the mechanism of evolimus (EVR) and its application, efficacy and common adverse reactions in hepatocellular carcinoma (HCC) patients after liver transplantation.MethodRelevant literatures in recent years were searched through websites such as Wanfang, CNKI and PubMed, and the results were read, analyzed and summarized.ResultsCurrently, there are a wide variety of immunosuppressive agents for HCC patients after liver transplantation, and immunosuppressive treatment options are also diverse and there is no unified standard. Today is more widely used clinically used for transplantation immune inhibitors of calcineurin inhibitors (CNIs), but because of its renal toxicity and side effects and recurrence of HCC risk increases, CNIs in HCC patients after liver transplantation using gradually is restricted, and mammalian target of rapamycin (mTOR) inhibitors are valued, gradually into clinical immunosuppression after liver transplantation for treatment provides a new way of thinking. As an mTOR inhibitor, EVR is gradually being applied to HCC patients after liver transplantation.ConclusionAs an mTOR inhibitor only approved for use in HCC patients after liver transplantation in recent years, relevant literature studies have shown that EVR plays an important role in improving the success rate of transplantation, protecting renal function and inhibiting HCC recurrence.
ObjectiveTo compare the effect and safety of basiliximab in ABO incompatible pediatric liver transplant recipients.MethodsABO incompatible pediatric liver transplantation operated between January 2019 and August 2020 were studied. The patients were allocated randomized into two groups. Patients in experimental group were treated with basiliximab as immune induction therapy, but basiliximab was not used in patients of control group. Tacrolimus combined methylprednisolone were used after liver transplantation. The clinical characteristics, graft and recipient survival rate, rejection, infectious complications, and kidney functions after liver transplantation were observed. Donor specific antibody (DSA) was tested in 3 months after liver transplantation. The growth and development were assessed too after liver transplant.ResultsFourty-four patients were enrolled in the study, including 19 patients in the experimental group and 25 patients in the control group. The median follow-up time was 16.6 months (3.8–25.4 months), and there were no statistically differences between the two groups in terms of age, sex, weight, pediatric end-stage liver disease (PELD) score, and other basic conditions. There were no significant differences between the two groups in tacrolimus dose, tacrolimus trough concentration, kidney functions, height and weight growth after liver transplantation. There were no statistical differences in lung infection, blood stream infection within 3 months after liver transplantation, cytomegalovirus, EBV infection, graft/patient survival rate after liver transplantation (P>0.05). However, the acute rejection rate was lower and the DSA positive rate in 3 months after liver transplantation was lower in the experimental group (P<0.05).ConclusionsBasiliximab can be safely used in ABO incompatible pediatric liver transplant recipients. Acute rejection rate and DSA positive rate after transplantation can be decreased with the useof basiliximab.
