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Problems in adult living donor liver transplantation using the right hepatic lobe

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Hepatobiliary & Pancreatic Diseases International 2006年第3期5卷 345-349页

作者： GuangDong Pan lunan yan Department of General Surgery West China Hospital Sichuan University Chengdu 610041 China. pgdhx@***

BACKGROUND: Adult living donor liver transplantation (LDLT) is now widely applied to patients, children or adults, and the graft extends from the left hepatic lobe to the right hepatic lobe. Harvesting the right hepatic lobe would mean putting the donor at high risk. The congestion of a graft may cause small-for-size syndrome. The safety of the donor and its evaluation, which are related to the outcome for the recipient,play an important role in LDLT. How to decrease the congestion of the graft is another challenge to transplant experts. DATA SOURCES: A literature search from MEDLINE about adult LDLT in recent years was made to analyze the safety of the living donor and the innovation of surgical techniques for preventing small-for-size syndrome. RESULTS: The top priority for adult LDLT is donor safety. Preoperative donor evaluation consists of three stages: phase 1 for general evaluation, phase 2 for laboratory tests, and phase 3 for radiological evaluation of graft volume and vessel anatomy. The potential pathogenic mechanisms of small-for-size syndrome seem to be related to persistent portal hypertension and portal overperfusion. Improved surgical techniques for decreasing portal hypertension and preventing congestion of a graft may reduce the incidence of small-for-size syndrome. The improved techniques include reconstruction of the tributaries of the middle hepatic vein, end-to-side portocaval shunting, ligation of the splenic artery, dual-graft transplantation, and modified reconstruction of hepatic veins. CONCLUSION: With the careful preoperative assessment and the safety of the living donor, as well as improved surgical techniques, adult LDLT using the right lobe is safe.

关键词： living donor liver transplantation small-for-size syndrome prevention

Impact of anatomical resection for hepatocellular carcinoma with microportal invasion (vp1)

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Hepatobiliary Surgery and Nutrition 2019年第3期8卷 274-276页

作者： Yifei Tan Wei Zhang lunan yan Liver Transplantation Center Department of Liver SurgeryWest China Hospital of Sichuan UniversityChengdu 610041China

Hepatocellular carcinoma(HCC)is one of the most common cancers worldwide(1),with an upward trend in most countries over the last 20 *** surgical resection remains as the first-line therapy for HCC,the relevant high postoperative recurrence rate is still the major concern,responding for poor survival in most cases(2).The comparison between anatomic resection(AR)and non-anatomic partial resection(NAR)has been discussed for several decades,making it more clear of their application based on tumor features and underlying liver disease,but yet much needs to be completed.

关键词： resection invasion carcinoma

Orthotopic liver transplantation for patients with Caroli’s disease

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Hepatobiliary & Pancreatic Diseases International 2008年第1期7卷 97-100页

作者： ZhenXia Wang lunan yan Bo Li Yong Zeng TianFu Wen WenTao Wang Liver Transplantation Division Department of General Surgery West China Hospital Sichuan University Chengdu 610041 China.

BACKGROUND:Caroli’s disease, a rare congenital hepatic disease, has a poor prognosis, especially in patients with diffuse dilatation of the bile ducts. But liver transplantation has been a curative option. The aim of this study was to investigate the feasibility and rationality of orthotopic liver transplantation as an indication for patients with diffuse Caroli’s disease. METHODS:The data from 3 patients with diffuse Caroli’s disease who had undergone orthotopic liver transplantation in our unit were analyzed retrospectively. RESULTS:On postoperative day 7, patient 1 had acute rejection which was relieved after pulse treatment with methyprednisolone. He was discharged from hospital on postoperative day 27 and has been in good health for 82 months. Patient 2 had no acute rejection or severe complications, but died of chronic graft dysfunction 34 months postoperatively. Patient 3 had acute rejection on postoperative days 10 and 35, complicated with pulmonary infection, pleural effusion and opportunistic infection. After successful treatment, she resumed work and has been followed up for 47 months. Her condition is good. CONCLUSION:Liver transplantation can offer an effective therapy for patients with diffuse Caroli’s disease, and can provide satisfactory long-term results.

关键词： liver transplantation Caroli’s disease prognosis

Construction of recombinant adenoviral vector carrying human tissue inhibitor of metalloproteinase-1 gene and its expression in vitro

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Hepatobiliary & Pancreatic Diseases International 2005年第2期4卷 259-264页

作者： Dong Xia lunan yan Yu Tong XinPing Wang MingMan Zhang LanYing Zhao Department of General Surgery West China Hospital Sichuan University Chengdu 610041 China.

BACKGROUND:Overexpression of human tissue inhibitors of metalloproteinase-1 (TIMP-1) may play an antitumor role in inhibiting hepatocellular carcinoma (HCC) growth and progression. The aim of the study was to construct a recombinant adenovirus vector carrying hTIMP-1 cDNA for liver gene therapy and observe its expression in vitro.;METHODS:The full-length cDNA of hTIMP-1 was positively cloned into the adenoviral shuttle vector pAdTrack-CMV, and then cotransformed into competent BJ5183 cells with the adenoviral backbone plasmid pAdEasy-1. Thus, a recombinant adenovirus AdhTIMP-1 containing full-length cDNA of hTIMP-1 was generated by homologous recombination in E. coli. AdhTIMP-1 was then packaged and amplified in adenoviral packaging cells, or human embryonic kidney 293 cells. The viral titer was checked by green fluorescent protein (GFP), and the expression of hTIMP-1 in vitro was detected by the techniques of Western blot and RT-PCR.;RESULTS:The recombinant adenovirus vector carrying hTIMP-1 was constructed and confirmed by restriction endonuclease analysis and DNA sequence analysis. The transcription of TIMP-1 mRNA in 293 cells was checked by RT-PCR and TIMP-1 protein could be detected in the culture by Western blot analysis.;CONCLUSIONS:The successful construction of recombinant adenoviral vector carrying human TIMP-1 and the effective expression in vitro has laid a foundation for further study of its antitumor function and may pave the way for future application in liver gene therapy.

关键词： tissue inhibitor of metalloproteinase hepatocellular carcinoma recombinant adenoviral vector gene therapy

Overexpression of TIMP-1 mediated by recombinant adenovirus in hepatocellular carcinoma cells inhibits proliferation and invasion in vitro

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Hepatobiliary & Pancreatic Diseases International 2006年第3期5卷 409-415页

作者： Dong Xia lunan yan JianGuo Xie Yu Tong MaoLin yan XinPing Wang MingMan Zhang LanYing Zhao Department of General Surgery West China Hospital Sichuan University Chengdu 610041 China.

BACKGROUND: Matrix metalloproteinases (MMPs) and its natural tissue inhibitors of metalloproteinases (TIMPs) are involved in cancer progression. This study was undertaken to determine the effects of overexpression of TIMP-1 on human hepatocellular carcinoma (HCC) cell growth, proliferation,and invasion. METHODS: Employing the efficient AdEasy?system, recombinant adenovirus AdTIMP-1 containing full-length cDNA of TIMP-1 was generated by homologous recombination and amplified in 293 cells. Then, human HCC cell line (HepG2) underwent gene transfection to overexpress TIMP-1 (so-called HepG-T cells). The mRNA and protein expressions of TIMP-1 were detected with RTPCR and Western blotting, respectively. The ultrastructure was observed with a transmission electron microscope and the proliferation of HepG-T cells was determined by MTT assay and growth curve. The potential of in vitro invasion was measured with Millicell Chamber. RESULTS: The resulting AdTIMP-1 and HepG-T cells were generated and the expression of TIMP-1 was detected in vitro. The cell proliferation curves and MTT assay showed HepG-T cells’ growth, and proliferation were obviously inhibited. The invasion across Matrigel-coated filters was significantly decreased compared with controls. The suppression rate of HepG-2 cells with AdhTIMP-1 transfection was 50%, and AdhTIMP-1 transfection inhibited by more than 91.6% of the invasion into the Matrigel-coated filter (P<0.01). CONCLUSIONS: TIMP-1 overexpression results in the suppression of proliferative and invasive potential of HepG2 cells in vitro. This study demonstrates the potential role of TIMP-1 as a target for liver cancer gene therapy and has laid a foundation for further study on its anticancer function.

关键词： tissue inhibitor of metalloproteinase hepatocellular carcinoma proliferation invasion gene therapy

Reducing biliary complications in adult-to-adult living donor liver transplantation using right lobe graft:experience of 124 cases

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Frontiers of Medicine 2008年第2期2卷 130-133页

作者： lunan yan Tianfu WEN Wentao WANG Jiayin yanG Mingqing XU Zheyu CHEN Hong WU Liver Transplantation Division Department of SurgeryWest China HospitalSichuan University Medical SchoolChengdu 610041China

The aim of this paper is to summarize our experience of using right lobe liver grafts to reduce biliary complications in adult-to-adult(A-A)living donor liver transplantation(LDLT).From January 2002 to October 2007,124 adult patients underwent living donor liver transplantation using right lobe grafts at the West China Hospital,Sichuan University Medical School,*** was no death in all *** reconstruction for 178 hepatic duct orifices from 124 donor grafts was performed which included 106 reconstructions of duct-to-duct anastomoses and 72 *** recipients had biliary complications including six bile lea-kages(four from the anastomotic site and two from the cut surface of the liver graft)and three biliary *** the improved techniques for biliary reconstruction,we have achieved good results in 124 recipients of A-A *** ascribe our success to the introduction of microsurgical techniques and the use of fixed operators which help in decreasing the biliary complications of LDLT.

关键词： living donor liver transplantation adult-to adult right lobe graft surgical technique biliary com-plication

Comparison of the outcomes of patients who underwent deceased-or living-donor liver transplantation after successful down-staging therapy

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Comparison of the outcomes of patients who underwent decease...

The Morbidity and Survival of 196 Consecutive Cases In A Single Center from China's mainland:Ten-Year Experience

2013中国器官移植大会

作者： Jianyong Lei lunan yan Liver Transplantation Center West China Hospital of Sichuan University

Objectives We aimed to determine the difference in outcomes between patients who underwent deceaseddonor or livingdonor right-lobe liver transplantation after successful down-staging therapy. Patients and methods From July 2002 to August 2009,83 adult patients were diagnosed with advanced HCC and received a liver transplantation(LT)after various successful down-staging *** of the patients met the UCSF *** these patients,3 1 patients(Group 1)underwent living-donor,right-lobe liver transplantation,and 52 patients(Group 2)underwent deceased-donor liver *** compared the two groups by evaluating the differences in post-operative complications,tumor recurrence,survival rate and hepatitis B virus recurrence.

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The Morbidity and Survival of 196 Consecutive Cases In A Sin...

Preliminary experience in adult-to-adult living donor liver transplantation in a single center in China

2013中国器官移植大会

作者： Peixian Chen Wang Wentao yan lunan Department of Liver and Vascular Surgery of WestChina Hospital of Sichuan University

Aim Right lobar living donor living transplantation(LDLT)has been controversial because of widely diverse repots of recipient ***,we presented our nearly 10-year experience and identified factors that potentially could be modified to improve the recipient outcome. Methods The Clavien 5-tier grading system was applied retrospectively in 196 consecutive adult right lobar *** incidence was determined of potentially life threatening(GradeⅢ),actually life threatening(Grade V)or lethal(Grade V)complications during the first post-transplant *** most serious and seminal complication was considered ff simultaneous or multiple complications appeared. Results One year recipient/graft survival was 82%/82%.Within the year,68,34,69%of the 196 recipients had GradeⅢ(n=3 1),

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Frontiers of Medicine 2007年第2期1卷 136-141页

作者： yan lunan LI Bo ZENG Yong WEN Tianfu ZHAO Jichun WANG Wentao yanG Jiayin XU Mingqing MA Yukui CHEN Zheyu LIU Jiangwen WU Hong Liver Transplantation Division Department of SurgeryWest China HospitalSichun University Medical SchoolChengdu 610041China

The aim of this paper is to report the authors’experience in performing adult-to-adult living donor liver transplantation(LDLT)by using a modified technique in using grafts of the right lobe of the *** January 2002 to September 2006,56 adult patients underwent LDLT using right lobe grafts at the West China Hospital,Sichuan University Medical School,*** patients underwent a modified operation designed to improve the reconstruction of the right hepatic vein(RHV)and the tributariers of the middle hepatic vein(MHV)by interposing a vessel graft,and by anastomosing the hepatic arteries and bile *** were no severe complications or deaths in all ***-two(92.8%)recipients survived the *** the 56 recipients,complications were seen in 15 recipients(26.8%),including hepatic vein stricture(one case),small-for-size syndrome(one case),hepatic artery thrombosis(two cases),intestinal bleeding(one case),bile leakage(two cases),left subphrenic abscess(one case),renal failure(two cases)and pulmonary infection(five cases).Within three months after transplantation,four recipients(7.14%)died due to smallfor-size syndrome(one case),renal failure(one case)and multiple organ failure(two cases).All patients underwent direct anastomoses of the RHV and the inferior vena cava(IVC),and in 23 cases,reconstruction of the right inferior hepatic vein was also *** 24 patients,the reconstruction of the tributaries of the MHV was also done by interposing a vessel graft to provide sufficient venous *** of the portal vein was seen in nine ***,veno-plasty or separate anastomoses were *** graft and recipient body weight ratios(GRWR)were between 0.72%and 1.43%,and in three cases it was<0.8%.The graft weight to recipient standard liver volume ratios(GV/SLV)were between 31.86%and 71.68%,among which four cases had<40%.No“small-for-size syndrome”*** modification of the surgical technique,especially in the reconstruction of

关键词： living donors liver transplantation