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Current prophylactic strategies against hepatitis B virus recurrence after liver transplantation

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World Journal of Gastroenterology 2009年第20期15卷 2489-2499页

作者： Li Jiang Li-Sheng Jiang nan-Sheng Cheng lu-nan yan Department of Liver and Vascular Surgery Liver Transplantation Center West China Hospital of Sichuan University Chengdu 610041 Sichuan Province China Department ofBiliary Surgery West China Hospital of Sichuan University Chengdu 610041 Sichuan Province China

Prophylactic strategies against hepatitis B virus(HBV) recurrence after liver transplantation(LT) are essential for patients with HBV-related *** LT, lamivudine(LAM) was proposed to be down-graded from first-to second-line *** contrast, adefovir dipivoxil(ADV) has been approved not only as first-line therapy but also as rescue therapy for patients with LAM ***, combination of ADV and LAM may result in lower risk of ADV resistance than ADV *** new drugs such as entecavir, telbivudine and tenofovir, are probably candidates for the treatment of hepatitis-B-surface-antigen-positive patients awaiting *** LT, low-dose intramuscular hepatitis B immunoglobulin(HBIG), in combination with LAM, has been regarded as the most cost-effective regimen for the prevention of post-transplant HBV recurrence in recipients without pretransplant LAM resistance and rapidly accepted in many transplant *** the introduction of new antiviral drugs, new hepatitis B vaccine and its new adjuvants, post-transplant HBIG-free therapeutic regimens with new oral antiviral drug combinations or active HBV vaccination combined with adjuvants will be promising, particularly in those patients with low risk of HBV recurrence.

关键词： Hepatitis B virus Liver transplantation Recurrence Prophylaxis Hepatitis B immunoglobulin

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World Journal of Gastroenterology 2012年第36期18卷 5114-5121页

作者： Pei-Xian Chen lu-nan yan Wen-Tao Wang Department of Liver and Vascular Surgery West China Hospital of Sichuan University Chengdu 610041 Sichuan Province China Department of Liver and Vascular Surgery West China Hospital of Sichuan University Chengdu 610041 Si- chuan Province China

AIM:To investigate health-related quality of life(HRQoL) and psychological outcomes in 256 adults who had undergone liver transplantation(LT).METHODS:A stratified random sampling method was used in this follow-up multicenter study to select a representative sample of recipients undergoing either living donor liver transplantation(LDLT) or deceased donor liver transplantation(DDLT).HRQoL was measured by using the Chinese version of Medical Outcome Study Short Form-36(SF-36),and psychological outcomes by using the beck anxiety inventory(BAI) and the self-rating depression scale(SDS).Clinical and demographic data were collected from the records of the Chinese Liver Transplant Registry and via ***:A total of 256 patients were sampled,including 66(25.8%) receiving LDLT and 190(74.2%) undergoing DDLT;15(5.9%) recipients had anxiety and four(1.6%) developed severe depression after the *** with LDLT recipients,DDLT patients had higher scores in general health(60.33 ± 16.97 vs 66.86 ± 18.42,P = 0.012),role-physical(63.64 ± 42.55 vs 74.47 ± 36.46,P = 0.048),roleemotional(61.11 ± 44.37 vs 78.95 ± 34.31,P = 0.001),social functioning(78.60 ± 22.76 vs 88.16 ± 21.85,P = 0.003),vitality(70.30 ± 15.76 vs 75.95 ± 16.40,P = 0.016),mental health(65.88 ± 12.94 vs 71.85 ± 15.45,P = 0.005),physical component summary scale(PCS,60.07 ± 7.36 vs 62.58 ± 6.88,P = 0.013) and mental component summary scale(MCS,52.65 ± 7.66 vs 55.95 ± 10.14,P = 0.016).Recipients > 45 years old at the time of transplant scored higher in vitality(77.33 ± 15.64 vs 72.52 ± 16.66,P = 0.020),mental health(73.64 ± 15.06 vs 68.00 ± 14.65,P = 0.003) and MCS(56.61 ± 10.00 vs 54.05 ± 9.30,P = 0.037) than those aged ≤ 45 *** was poorer in recipients with than in those without complications(52.92 ± 12.21 vs 56.06 ± 8.16,P = 0.017).Regarding MCS(55.10 ± 9.66 vs 50.0 ± 10.0,P < 0.05) and PCS(61.93 ± 7.08 vs 50.0 ± 10.0,P < 0.05),recipients scored better than the Sichuan general and had im

关键词： Liver transplantation Living donor livertransplantation Deceased donor liver transplantation Psychology Health-related quality of life

Donor safety and remnant liver volume in living donor liver transplantation

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World Journal of Gastroenterology 2012年第48期18卷 7327-7332页

作者： Zheng-Rong Sh lu-nan yan Cheng-You Du Department of Hepatobiliary Surgery The First Affiliated HospitalChongqing Medical University Liver Transplantation Division Department of SurgeryWest China HospitalSichuan University

AIM:To evaluate the relationship between donor safety and remnant liver volume in right lobe living donor liver transplantation(LDLT).METHODS:From July 2001 to January 2009,our liver transplant centers carried out 197 *** clinical data from 151 cases of adult right lobe living donors(not including the middle hepatic vein) were *** conditions of the three groups of donors were well matched in terms of the studied *** donors' preoperative data,intraoperative and postoperative data were calculated for the three groups:Group 1 remnant liver volume(RLV) 40%.Comparisons included the different remnant liver volumes on postoperative liver function recovery and the impact of systemic *** between remnant liver volume and post-operative complications were also ***:The donors' anthroposomatology data,op-eration time,and preoperative donor blood test indicators were calculated for the three *** significant differences were observed between the donors' gender,age,height,weight,and operation *** to the Chengdu standard liver volume formula,the total liver volume of group 1 was 1072.88 ± 131.06 mL,group 2 was 1043.84 ± 97.11 mL,and group 3 was 1065.33 ± 136.02 *** three groups showed no statistically significant *** the volume of the remnant liver was less than 35% of the total liver volume,the volume of the remnant had a significant effect on the recovery of liver function and intensive care unit *** addition,the occurrence of complications was closely related to the remnant liver *** the volume of the remnant liver was more than 35% of the total liver volume,the remnant volume change had no significant effect on donor ***:To ensure donor safety,the remnant liver volume should be greater than the standard liver volume(35%) in right lobe living donor liver transplantation.

关键词： Donor safety Remnant liver volume Living donor Liver transplantation Complications grade

Hemihepatic versus total hepatic inflow occlusion during hepatectomy:A systematic review and meta-analysis

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World Journal of Gastroenterology 2011年第26期17卷 3158-3164页

作者： Hai-Qing Wang Jia-Yin yang lu-nan yan Department of Liver and Vascu-lar Surgery Liver Transplantation Center West China Hospital ofSichuan University Chengdu 610041 Sichuan Province China Liver Transplantation Center West China Hospitalof Sichuan University Chengdu 610041 Sichuan Province China

AIM： To evaluate the clinical outcomes of patients undergoing hepatectomy with hemihepatic vascular occlusion （HHO） compared with total hepatic inflow occlusion （THO）. METHODS： Randomized controlled trials （RCTs） co- mparing hemihepatic vascular occlusion and total he- patic inflow occlusion were included by a systematic literature search. Two authors independently assessed the trials for inclusion and extracted the data. A meta- analysis was conducted to estimate blood loss, transfu- sion requirement, and liver injury based on the levels of aspartate aminotransferase （AST） and alanine arni- notransferase （ALT）. Either the fixed effects model or random effects model was used. RESULTS- Four RCTs including 338 patients met the predefined inclusion criteria. A total of 167 patients were treated with THO and 171 with HHO. Metaanalysis of AST levels on postoperative day 1 indicated higher levels in the THO group with weighted mean dif- ference （WMD） 342.27; 95% confidence intervals （CI） 217.28-467.26; P = 0.00001; I2 = 16%. Meta-analysis showed no significant difference between THO group and HHO group on blood loss, transfusion requirement, mortality, morbidity, operating time, ischemic duration, hospital stay, ALT levels on postoperative day 1, 3 and 7 and AST levels on postoperative day 3 and 7. CONCluSION： Hemihepatic vascular occlusion does not offer satisfying benefit to the patients undergoing hepatic resection. However, they have less liver injury after liver resections.

关键词： Inflow occlusion Hemihepatic Vascular occlusion Hepatectomy Pringle maneuver

Combined Hangzhou criteria with neutrophillymphocyte ratio is superior to other criteria in selecting liver transplantation candidates with HBV-related hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2015年第6期14卷 588-595页

作者： Guang-Qin Xiao Jia-Yin yang lu-nan yan Liver Transplantation Center West China HospitalSichuan University Department of Biliary-Pancreatic Surgery Tongji Hospital of Tongji Medical CollegeHuazhong University of Science and Technology

BACKGROUND： The elevation of neutrophil-lymphocyte ratio （NLR） has adverse effects on the prognosis of patients with hepatocellular carcinoma （HCC） who have received liver transplantation （LT）. The Hangzhou criteria are set for selecting HCC patients for LT. The present study aimed to establish a set of new criteria combining the NLR and Hangzhou crite- ria for selecting HCC patients for LT.

关键词： Hangzhou criteria hepatocellular carcinoma liver transplantation neutrophil-lymphocyte ratio hepatitis B virus biomarker

Cavoportal hemitransposition in liver transplantation: a new technique

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Hepatobiliary & Pancreatic Diseases International 2003年第2期2卷 518-521页

作者： Peng yan lu-nan yan Department of Surgery University of Pittsburgh School of Medicine Pittsburgh PA 15261 USA. yanpeng@***

OBJECTIVE: To introduce a new surgical technique--cavoportal hemitransposition in ***: Since Tzakis first reported liver transplantation with cavoportal hemitransposition in thepresence of diffuse portal vein thrombosis in 1998, five relevant research papers have been published, inwhich a total of 23 cases were ***: Of the 23 cases, 11 underwent conventionally cavoportal anastomosis as an end-to-endanastomosis, 8 renoportal anastomosis, and 4 end-to-side anastomosis preceded by piggyback. Eightpatients died after operation. Fifteen patients are still alive with normal liver and kinase function, with alongest follow-up of 37 months. They enjoy a normal life without dietary or other ***: Portal vein thrombosis is no longer an absolute contraindication to livertransplantation. This new technique is useful and reliable for liver transplantation.

关键词： liver transplantation cavoportal hemitranspsition portal vein thrombosis

Up-to-seven criteria for hepatocellular carcinoma liver transplantation:A single center analysis

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World Journal of Gastroenterology 2013年第36期19卷 6077-6083页

作者： Jian-Yong Lei Wen-Tao Wang lu-nan yan Liver Transplantation Center West China Hospital of Sichuan University

AIM:To detect whether the up-to-seven should be used as inclusion criteria for liver transplantation for hepatocellular ***:Between April 2002 and July 2008,220hepatocellular carcinoma(HCC)patients who were diagnosed with HCC and underwent liver transplantation(LT)at our liver transplantation center were *** patients were divided into three groups according to the characteristics of their tumors(tumor diameter,tumor number):the Milan criteria group(Group 1),the in up-to-seven group(Group 2)and the out up-toseven group(Group 3).Then,we compared long-term survival and tumor recurrence of these three ***:The baseline characteristics of transplant recipients were comparable among these three groups,except for the type of liver graft(deceased donor liver transplant or live donor liver transplantation).There were also no significant differences in the pre-operativeα-fetoprotein *** 1-,3-,and 5-year overall survival and tumor-free survival rate for the Milan criteriagroup were 94.8%,91.4%,89.7%and 91.4%,86.2%,and 86.2%respectively;in the up-to-seven criteria group,these rates were 87.8%,77.8%,and 76.6%and 85.6%,75.6%,and 75.6%respectively(PluSION:Considering that patients in the up-toseven criteria group exhibited a considerable but lower survival rate compared with the Milan criteria group,the up-to-seven criteria should be used carefully and selectively.

关键词： Up-to-seven criteria Liver transplantation Outcome Hepatocellular carcinoma Recurrence

Transplantation vs resection for hepatocellular carcinoma with compensated liver function after downstaging therapy

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World Journal of Gastroenterology 2013年第27期19卷 4400-4408页

作者： Jian-Yong Lei lu-nan yan Wen-Tao Wang Liver Transplantation Center West China Hospital of Sichuan University

AIM:Our study aimed to compare the results of liver transplantation (LT) and liver resection (LR) in patients with hepatocellular carcinoma (HCC) that met the Milan criteria after successful downstaging therapy. METHODS:From February 2004 to August 2010, a consecutive series of 102 patients were diagnosed with advanced-stage HCC that met the modified UCSF down-staging protocol inclusion criteria. All of the patients accepted various down-staging therapies. The types and numbers of treatments were tailored to each patient according to the tumor characteristics, location, liver function and response. After various downstaging therapies, 66 patients had tumor characteristics that met the Milan criteria; 31 patients accepted LT in our center, and 35 patients accepted LR. The baseline characteristics, down-staging protocols, postoperative complications, overall survival and tumor free survival rate, and tumor recurrence rate were compared between the two groups. Kaplan-Meier analyses were used to estimate the long-term overall survival and tumor-free survival rate. Meanwhile, a Cox proportional hazards model was used for the multivariate analyses of overall survival and disease-free survival rate. RESULTS:No significant difference was observed between the LT and LR groups with respect to the downstaging protocol, target tumor characteristics, and baseline patient characteristics. Fifteen patients suffered various complications after LT, and 8 patients had complications after LR. The overall complication rate for the LT group was 48.4%, which was significantly higher than the LR group (22.9%) (P = 0.031). The overall in-hospital mortality in hospital for the LT group was 12.9% vs 2.9% for the LR group (P = 0.172). The overall patient survival rates at 1-, 3and 5-years were 87.1%, 80.6% and 77.4%, respectively, after LT and 91.4%, 77.1% and 68.6%, respectively, after LR (P = 0.498). The overall 1-, 3and 5-year tumor recurrencefree rates were also comparable (P = 0.656). Po

关键词： Liver Resection Transplantation Downstage Survival Complication Recurrence Comparison

“Metroticket” predictor for assessing liver transplantation to treat hepatocellular carcinoma:A single-center analysis in China's Mainland

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World Journal of Gastroenterology 2013年第44期19卷 8093-8098页

作者： Jian-Yong Lei Wen-Tao Wang lu-nan yan Liver Transplantation Center West China Hospital of Sichuan University

AIM:To validate the"Metroticket"predictor using a large cohort of liver transplantation(LT)patients with hepatocellular carcinoma(HCC)in ***:In total,230 cases of LT for HCC treatment at our center,from July 2000 to August 2008,were included in the present *** predicted 1-,3-and 5-year post-LT survival rates were calculated using the Metroticket model(http://89.***.76.14/metroticket/calculator/).The predicted and observed long-term survival rates were then compared and ***:The predicted survival rates for all 230cases,as calculated by the Metroticket model,were64.7%and 56.2%at 3 and 5 years,respectively,and the observed survival rates for these patients were71.3%and 57.8%,*** the 23 cases with macrovascular invasion,the predicted 5-year survival rate was 43.5%,whereas the observed 5-year survival rate was only 8.7%.For the 42 cases with microvascular invasion but an absence of macrovascular invasion,the predicted 5-year survival rate was 44.9%,and the observed 5-year survival rate was 50%.For the remaining 165 patients without any vascular invasion,the predicted 5-year survival rate was 65.8%,and the observed 5-year survival rate was 66.7%.CONCluSION:The Metroticket model can be used to accurately predict survival in HCC-related LT cases with an absence of macrovascular invasion.

关键词： Metroticket Model Survival Hepatocellular carcinoma Liver transplantation