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Hepatocellular carcinoma recurrence in living and deceased donor liver transplantation:a systematic review and meta-analysis

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Chinese Medical Journal 2019年第13期132卷 1599-1609页

作者： Hai-Ming Zhang Yue-Xian Shi Li-Ying Sun Zhi-Jun Zhu Liver Transplantation Center National Clinical Research Center for Digestive Diseases and Beijing Key Laboratory of Tolerance Induction and Organ Protection in TransplantationBeijing Friendship HospitalCapital Medical UniversityBeijing 100050China Peking University School of Nursing Beijing 100191China

Background:Although a number of technical problems and donor safety issues associated with living donor liver transplantation(LDLT)have been resolved,some initial clinical studies showed an increased risk of hepatocellular car cinoma(HCC)recurrence in *** meta-analysis was conducted to assess differences in tumor recurrence between LDLT and deceased donor liver transplantation(DDLT).Methods:After systematic retrievals of studies about LDLT and DDLT for HCC,articles were selected with a rationale of emphasizing inter-group *** from multivariate analyses were combined and discussed together with univariate *** subgroup analysis,the impact of organ allocation policy was taken into ***:Seven articles were included in the ***,a salient result that emerged from the seven studies was a significant increased risk of HCC recurrence in the LDLT group than in the DDLT group(P=0.01).The most significant increase in hazard ratio was found in studies where organs tended to be allocated to non-tumor ***:An increased risk for HCC recurrence in LDLT as compared with DDLT patients was *** relatively shorter preoperative observation windows in LDLT may lead to fewer cases of HCC with invasive features being screened out,which may provide a possible explanation for the high rates of HCC recurrence.

关键词： Living donor liver transplantation deceased donor liver transplantation Hepatocellular car cinoma Meta-analysis

Comparison of “Normal” Craniocerebral Computed Tomography of deceased and Living Individuals

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Journal of Forensic Science and Medicine 2020年第4期6卷 111-116页

作者： Xiaofei Liu Wenju Jin Zhiyuan Xia Lan Du Chunsheng Li Qing Chen Li Liu Department of Forensic Pathology Criminal Investigation Corps of Beijing Public Security BureauBeijingChina Dian Research Center for Postmortem Imaging and Angiography Zhejiang Dian Institute of Forensic SciencesHangzhouChina Haidian Division of Beijing Public Security Bureau BeijingChina

To compare“normal”craniocerebral computed tomography(CT)of deceased and living *** parameters of craniocerebral CT scans of 50 deceased and 50 living individuals that met specific filtering criteria were measured separately:The intensity(CT value)ratio of gray matter to white matter(GM/WM),maximum and minimum length of frontal horn of ventricle,transverse diameter of cerebral parenchyma,length of choroid plexus,maximum external diameter of body of lateral ventricle,maximum internal transverse diameter of cranium,length of cerebral longitudinal fissure,length between two calvarium,transverse and longitudinal diameter of the third and fourth ventricle,length of the cerebral longitudinal fissure,Hackman value,ventricular index(D/A),index of the somatic part of lateral ventricle(F/E),lateral ventricular body index(G/E),frontal horn index(G/A),and ventriculocranial ratio(VCR).The values of these 19 parameters for the deceased and living individuals were performed using statistical *** were significant statistic differences between deceased and living individuals in terms of eight craniocerebral CT parameters,including GM/WM,D/A,transverse diameter of the fourth ventricle,and length of the cerebral longitudinal *** craniocerebral CT findings differ between deceased and living *** of the normal postmortem craniocerebral CT parameters is key to correct postmortem craniocerebral radiopathological diagnosis.

关键词： Craniocerebral deceased living individual postmortem computed tomography postmortem cross-sectional imaging

Lobar lung transplantation from deceased donors: A systematic review

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World Journal of Transplantation 2017年第1期7卷 70-80页

作者： Michael Eberlein Robert M Reed Mayy Chahla Servet Bolukbas Amy Blevins Dirk Van Raemdonck Alessia Stanzi Ilhan Inci Silvana Marasco Norihisa Shigemura Clemens Aigner Tobias Deuse Division of Pulmonary Critical Care and Occupational Medicine University of Iowa Hospitals and Clinics Department of Medicine University of Iowa Hospitals and Clinics University of Iowa Hospitals and Clinics Division of Pulmonary and Critical Care Medicine University of Maryland Department of Thoracic Surgery Helios Klinikum Wuppertal - University Hospital Witten/Herdecke Hardin Library for the Health Sciences University of Iowa Hospitals and Clinics Department of Thoracic Surgery and Lung Transplant Unit University Hospitals Leuven Department of Thoracic Surgery Zurich University Hospital Cardiothoracic Surgery Unit The Alfred Hospital Department of Cardiothoracic Surgery University of Pittsburgh Medical Center Department of Thoracic Surgery Medical University of Vienna Department of Thoracic Surgery and Surgical Endoscopy Ruhrlandklinik University Clinic Essen Tueschener Weg Department of Cardiovascular Surgery University Heart Center Hamburg

AIM To systematically review reports on deceased-donor-lobar lung transplantation(dd LLTx) and uniformly describe sizematching using the donor-to-recipient predicted-total lung-capacity(pT LC) ratio. METHODS We set out to systematically review reports on ddL LTx and uniformly describe size matching using the donorto-recipient pT LC ratio and to summarize reported oneyear survival data of ddL LTx and conventional-LTx. We searched in Pub Med, CINAHL via EBSCO, Cochrane Database of Systematic Reviews via Wiley(CDSR),Database of Abstracts of Reviews of Effects via Wiley(DARE), Cochrane Central Register of Controlled Trials via Wiley(CENTRAL), Scopus(which includes EMBASE abstracts), and Web of Science for original reports on ddL LTx. RESULTS Nine observational cohort studies reporting on 301 ddL LTx met our inclusion criteria for systematic review of size matching, and eight for describing one-year-survival. The dd LLTx-group was often characterized by high acuity;however there was heterogeneity in transplant indications and pre-operative characteristics between studies. Data to calculate the pT LC ratio was available for 242 ddL LTx(80%). The mean pT LCratio before lobar resection was1.25 ± 0.3 and the transplanted pT LCratio after lobar resection was 0.76 ± 0.2. One-year survival in the ddL LTxgroup ranged from 50%-100%, compared to 72%-88%in the conventional-LTx group. In the largest study ddL LTx(n = 138) was associated with a lower one-year-survival compared to conventional-LTx(n = 539)(65.1% vs84.1%, P < 0.001). CONCLUSION Further investigations of optimal donor-to-recipient size matching parameters for ddL LTx could improve outcomes of this important surgical option.

关键词： Lobar lung transplantation from deceased donors Cadaveric lobar lung transplantation Lung size matching Primary graft dysfunction Survival

Stabilization of estimated glomerular filtration rate in kidney transplantation from deceased donors with acute kidney injuries

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World Journal of Transplantation 2016年第4期6卷 712-718页

作者： Punlop Wiwattanathum Atiporn Ingsathit Surasak Kantachuvesiri Nuttapon Arpornsujaritkun Wiwat Tirapanich Vasant Sumethkul Division of Nephrology Department of Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University Section for Clinical Epidemiology and Biostatistics Faculty of Medicine Ramathibodi Hospital Mahidol University Vascular and Transplant unit Department of Surgery Faculty of Medicine Ramathibodi Hospital Mahidol University

AIM To evaluate and compare the outcomes of kidney transplant(KT) from deceased donors among standard criteria, acute kidney injury(AKI) and expanded criteria donors(ECDs). METHODS This retrospective study included 111 deceased donor kidney transplant recipients(DDKT). deceased donors were classified as standard criteria donor(SCD), AKI donor and ECD. AKI was diagnosed and classified based on change of serum Cr by acute kidney injury network(AKIN) criteria. Primary outcome was one-year estimated glomerular filtration rate(eG FR) calculated from Cr by CKD-EPI. Multivariate regression analysis was done by adjusting factors such as type of DDKT, %Panel-reactive antibodies, cold ischemic time, the presence of delayed graft function and the use of induction therapy. Significantfactors that can affect the primary outcomes were then identified. RESULTS ECD group had a significantly lower eG FR at one year(33.9 ± 17.3 mL /min) when compared with AKI group(56.6 ± 23.9) and SCD group(63.6 ± 19.9)(P deceased donors with variable stage of acute kidney injuries were associated with favorable two-year allograft function. The outcomes were comparable with KT from SCD. This information supports the option that deceased donors with AKI are an important source of organ for kidney transplantation even in the presence of stage 3 AKI.

关键词： Acute kidney injury donor Rising of terminal serum creatinine Acute kidney injury network stage deceased donor Estimated glomerular filtration rate stabilization Stabilize allograft function

Living donor liver transplantation does not increase tumor recurrence of hepatocellular carcinoma compared to deceased donor transplantation

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World Journal of Gastroenterology 2014年第31期20卷 10953-10959页

作者： Guang-qin Xiao Jiu-lin Song Shu Shen Jia-yin yang lu-nan yan Liver Transplantation Center West China Hospital of Sichuan University

AIM: To compare the recurrence-free survival(RFS) and overall survival(OS) of hepatitis B virus(HBV)-positive hepatocellular carcinoma(HCC) after living donor liver transplantation(lDlT) and deceased donor liver transplantation(DDlT).METHODS: We retrospectively collected clinical data from 408 liver cancer patients from February 1999 to September 2012. We used the chi-squared test or Fisher's exact test to analyze the characteristics of lDlT and DDlT. Kaplan-Meier analysis was used to compare the RFS and OS in ***: Three hundred sixty HBV-positive patients(276 DDlT and 84 lDlT) were included in this *** mean follow-up time was 27.1 mo(range 1.1-130.8 mo). One hundred eighty-five(51.2%) patients died during follow-up. The 1-, 3-, and 5-year RFS rates for lDlT were 85.2%, 55.7%, and 52.9%, respectively; for DDlT, the RFS rates were 73.2%, 49.1%, and 45.3%(P = 0.115). The OS rates were similar between the lDlT and DDlT recipients, with 1-, 3-, and 5-year survival rates of 81.8%, 49.5%, and 43.0% vs 69.5%, 43.0%, and 38.3%, respectively(P = 0.30). The outcomes of HCC according to the Milan criteria after lDlT and DDlT were not significantly different(for lDlT: 1-, 3-, and 5-year RFS: 94.7%, 78.7%, and 78.7% vs 89.2%, 77.5%, and 74.5%, P = 0.50; for DDlT: 86.1%, 68.8%, and 68.8% vs 80.5%, 62.2%, and 59.8% P = 0.53).CONCLUSION: The outcomes of lDlT for HCC are not worse compared to the outcomes of DDlT. lDlT does not increase tumor recurrence of HCC compared to DDlT.

关键词： Hepatocellular carcinoma living donor deceased don

Living-donor vs deceased-donor liver transplantation for patients with hepatocellular carcinoma

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World Journal of Hepatology 2014年第9期6卷 626-631页

作者： Nobuhisa Akamatsu Yasuhiko Sugawara Norihiro Kokudo Artificial Organ and Transplantation Division Department of SurgeryGraduate School of MedicineUniversity of Tokyo

With the increasing prevalence of living-donor liver transplantation(LDLT) for patients with hepatocellular carcinoma(HCC),some authors have reported a potential increase in the HCC recurrence rates among LDLT recipients compared to deceased-donor liver transplantation(DDLT) *** aim of this review is to encompass current opinions and clinical reports regarding differences in the outcome,especially the recurrence of HCC,between LDLT and *** some studies report impaired recurrence- free survival and increased recurrence rates among LDLT recipients,others,including large database studies,report comparable recurrence- free survival and recurrence rates between LDLT and *** supporting the increased recurrence in LDLT have linked graft regeneration to tumor progression,but we found no association between graft regeneration/initial graft volume and tumor recurrence among our 125 consecutive LDLTs for HCC *** the absence of a prospective study regarding the use of LDLT vs DDLT for HCC patients,there is no evidence to support the higher HCC recurrence after LDLT than DDLT,and LDLT remains a reasonable treatment option for HCC patients with cirrhosis.

关键词： deceased donor liver transplantation Hepatocellular carcinoma Living donors Living-donor liver transplantation Recurrence

deceased donor organ procurement injuries in the United States

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World Journal of Transplantation 2016年第2期6卷 423-428页

作者： Tim E Taber Nikole A Neidlinger Muhammad A Mujtaba Elling E Eidbo Roxane L Cauwels Elizabeth M Hannan Jennifer R Miller Anil S Paramesh Indiana Donor Network Donor Network West Department of Nephrology University of Texas Medical Branch Association of Organ Procurement Organi- zations Tulane Transplant Institute Louisiana Organ Procurement Association

AIM: To determine the incidence of surgical injury during deceased donor organ procurements. METHODS: Organ damage was classified into three tiers, from 1-3, with the latter rendering the organ nontransplantable. For 12 consecutive months starting in January of 2014, 36 of 58 organ procurement organization's(OPO)'s prospectively submitted quality data regarding organ damage(as reported by the transplanting surgeon and confirmed by the OPO medical director) seen on the procured ***: These 36 OPOs recovered 5401 of the nations' s 8504 deceased donors for calendar year 2014.A total of 19043 organs procured were prospectively analyzed. Of this total, 59 organs sustained damage making them non-transplantable(0 intestines; 4 pancreata; 5 lungs; 6 livers; 43 kidneys). The class 3 damage was spread over 22(of 36) reporting OPO'***: While damage to the procured organ is rare with organ loss being approximately 0.3% of procured organs, loss of potential transplantable organs does occur during procurement.

关键词： Organ procurement deceased donations Organ procurement organization Organ injury Organ transplantation

State of deceased donor transplantation in India:A model for developing countries around the world

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World Journal of Transplantation 2016年第2期6卷 331-335页

作者： Georgi Abraham Madhusudan Vijayan Natarajan Gopalakrishnan Sunil Shroff Joseph Amalorpavanathan Anand Yuvaraj Sanjeev Nair Saravanan Sundarrajan Madras Medical Mission Hospital Kilpauk Medical College Madras Medical College and Government General Hospital

Renal replacement therapy(RRT) resources are scarce in India, with wide urban-rural and interstate disparities. The burden of end-stage renal disease is expected to increase further due to increasing prevalence of risk factors like diabetes mellitus. Renal transplantation, the best RRT modality, is increasing in popularity, due to improvements made in public education, the deceased donor transplantation(DDT) programme and the availability of free and affordable transplant services in government hospitals and certain non-governmental philanthropic organizations. There are about 120000 haemodialysis patients and 10000 chronic peritoneal dialysis patients in India, the majority of them waiting for a donor kidney. Shortage of organs, lack of transplant facilities and high cost of transplant in private facilities are major barriers for renal transplantation in India. The DDT rate in India is now 0.34 per million population, among the lowest in the world. Infrastructural development in its infancy and road traffic rules not being strictly implemented by the authorities, have led to road traffic accidents being very common in urban and rural India. Many patients are declared brain dead on arrival and can serve as potential organ donors. The DDT programme in the state of Tamil Nadu has met with considerable success and has brought down the incidence of organ trade. Government hospitals in Tamil Nadu, with a population of 72 million, provide free transplantation facilities for the underprivileged. Public private partnership has played an important role in improving organ procurement rates, with the help of trained transplant coordinators in government hospitals. The DDT programmes in the southern states of India(Tamil Nadu, Kerala, Pondicherry) are advancing rapidly with mutual sharing due to public private partnership providing vital organs to needy patients. Various health insurance programmes rolled out by the governments in the southern states are effective in alleviatin

关键词： deceased donor transplantation Kidney India Developing countries

Risk factors and outcomes of delayed graft function in renal transplant recipients receiving a steroid sparing immunosuppression protocol

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World Journal of Transplantation 2017年第1期7卷 34-42页

作者： Michelle Willicombe Anna Rizzello Dawn Goodall Vassilios Papalois Adam G Mc Lean David Taube Imperial College Kidney and Transplant Centre Hammersmith Hospital

AIM To analyse the risk factors and outcomes of delayed graft function(DGF) in patients receiving a steroid sparing protocol. METHODS Four hundred and twenty-seven recipients of deceased donor kidney transplants were studied of which 135(31.6%) experienced DGF. All patients received monoclonal antibody induction with a tacrolimus based, steroid sparing immunosuppression *** Five year patient survival was 87.2% and 94.9% in the DGF and primary graft function(PGF) group respectively, P = 0.047. Allograft survival was 77.9% and 90.2% in the DGF and PGF group respectively, P < 0.001. Overall rejection free survival was no different between the DGF and PGF groups with a 1 and 5 year rejection free survival in the DGF group of 77.7% and 67.8% compared with 81.3% and 75.3% in the PGF group, P = 0.19. Patients with DGF who received IL2 receptor antibody induction were at significantly higher risk of rejection in the early post-transplant period than the group with DGF who received alemtuzumab induction. On multivariate analysis, risk factors for DGF were male recipients, recipients of black ethnicity, circulatory death donation, preformed DSA, increasing cold ischaemic time, older donor age and dialysis *** Alemtuzumab induction may be of benefit in preventing early rejection episodes associated with DGF. Prospective trials are required to determine optimal immunotherapy protocols for patients at high risk of DGF.

关键词： Allograft failure deceased donors Delayed graft function Cold ischaemic time Rejection Steroid sparing Alemtuzumab