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Safety of hepatitis B virus core antibody-positive grafts in liver transplantation: A single-center experience in China

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World Journal of Gastroenterology 2018年第48期24卷 5525-5536页

作者： Ming Lei Lu-Nan Yan Jia-Yin Yang Tian-Fu Wen Bo Li Wen-Tao Wang Hong Wu Ming-Qing Xu Zhe-Yu Chen Yong-Gang Wei Department of liver Surgery Liver Transplantation CenterWest China Hospital of Sichuan University

BACKGROUND Given the shortage of suitable liver grafts for liver transplantation, proper use of hepatitis B core antibody-positive livers might be a possible way to enlarge the donor pool and to save patients with end-stage liver diseases. However, the safety of hepatitis B virus core antibody positive(HBcAb+) donors has been controversial. Initial studies were mainly conducted overseas with relatively small numbers of HBcAb+ liver recipients, and there are few relevant reports in the population of China's Mainland. We hypothesized that the safety of HBcAb+ liver grafts is not *** To evaluate the safety of using hepatitis B virus(HBV) core antibody-positive donors for liver transplantation in Chinese *** We conducted a retrospective study enrolling 1071 patients who underwent liver transplantation consecutively from 2005 to 2016 at West China Hospital liver Transplantation center. Given the imbalance in several baseline variables, propensity score matching was used, and the outcomes of all recipients were reviewed in this *** In the whole population, 230 patients received HBcAb+ and 841 patients received HBcAb negative(HBcAb-) liver grafts. The 1-, 3-and 5-year survival rates in patients and grafts between the two groups were similar(patient survival: 85.8% vs 87.2%, 77.4% vs 81.1%, 72.4% vs 76.7%, log-rank test, P = 0.16; graft survival: 83.2% vs 83.6%, 73.8% vs 75.9%, 70.8% vs 74.4%, log-rank test, P = 0.19). After propensity score matching, 210 pairs of patients were generated. The corresponding 1-, 3-and 5-year patient and graft survival rates showed no significant differences. Further studies illustrated that the post-transplant major complication rates and liver function recovery after surgery were also similar. In addition, multivariate regression analysis in the original cohort and propensity score-matched Cox analysis demonstrated that receiving HBcA b+ liver grafts was not a significant risk factor for long-term survival.

关键词： liver transplantation Long-term outcome Hepatitis B core antibody Hepatitis B virus infection

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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(P<0.05).However,the advanced HCC patients’(in the group out of up-to-seven criteria)overall and tumor-free survival rates were much lower,at 75%,53.3%,and 50%and65.8%,42.5%,and 41.7%,respectively(P<0.01).CONCLUSION: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

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“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

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Clinical management of acute liver failure: Results of an international multi-center survey

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World Journal of Gastroenterology 2016年第33期22卷 7595-7603页

作者： Liane Rabinowich Julia Wendon William Bernal Oren Shibolet liver Unit Department of GastroenterologyTel-Aviv Medical Center and Tel-Aviv University liver Intensive Therapy Unit Institute of Liver StudiesKing’s College Hospital

AIM To assess the practice of caring for acute liver failure(ALF) patients in varying geographic locations and medical *** Members of the European Acute liver Failure Consortium completed an 88-item questionnaire detailing management of ALF. Responses from 22 transplantation centers in 11 countries were analyzed,treating between 300 and 500 ALF cases and performing over 100 liver transplants(LT) for ALF annually. The questions pertained to details of the institution and their clinical activity,standards of care,referral and admission,wardbased care versus intensive care unit(ICU) as well as questions regarding liver transplantation- including criteria,limitations,and perceived performance. Clinical data was also collected from 13 centres over a 3 mo period. RESULTS The interval between referral and admission of ALF patients to specialized units was usually less than 24 h and once admitted,treatment was provided by a multidisciplinary team. Principles of care of patients with ALF were similar among centers,particularly in relation to recognition of severity and care of the more critically ill. centers exhibited similarities in thresholds for ICU admission and management of severe hepatic encephalopathy. Over 80% of centers administered n-acetyl-cysteine to ICU patients for non-paracetamolrelated ALF. There was significant divergence in the use of prophylactic antibiotics and anti-fungals,lactulose,nutritional support and imaging investigations in admitted patients and in the monitoring and treatment of intra-cranial pressure(ICP). ICP monitoring was employed in 12 centers,with the most common indications being papilledema and renal failure. Most patients listed for transplantation underwent surgery within an average waiting time of 1-2 d. Over a period of 3 mo clinical data from 85 ALF patients was collected. Overall patient survival at 90-d was 76%. Thirty six percent of patients underwent emergency LT,with a 90% post transplant survival to hospital disc

关键词： Acute liver failure liver transplantation Intra-cranial pressure Hepatic encephalopathy

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Safety evaluation of donors for living-donor liver transplantation in Chinese mainland:A single-center report

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World Journal of Gastroenterology 2007年第32期13卷 4379-4384页

作者： Guo-Qiang Li Feng Zhang Xiang-Cheng Li Bei-Cheng Sun Feng Cheng Wen-Gang Ge Xue-Hao Wang liver Transplantation center First Affiliated Hospital of Nanjing Medical University Nanjing 210029 Jiangsu Province China

AIM： To discuss the safety of donors during living donor liver transplantation （LDLT） and the authors＇ experience with 50 cases. METHODS： Between January 1995 and March 2006, 50 patients with end-stage liver disease received LDLT in our department. Donors （at the age of 27-58 years） were healthy and antibody （ABO）-compatible. The protocol of evaluation and selection of donors, choice of surgical methods and strategy applied in the safety evaluation of donors were analyzed. RESULTS： A total of 115 candidate donors were evaluated for LDLT at our center. Of these, 50 underwent successful hepatectomy for living donation. The elimination rate for donors was 43.5%. Positive hepatitis serology and ABO incompatibility were the main factors for excluding candidates. All donors recovered uneventfully. The follow-up time ranged from 3 to 135 too. The incidence of major and minor medical complications was 12.0% and 28.0%, respectively. CONCLUSION： LDLT provides an excellent approach to the problem of donor shortage in China. With a thorough and complete preoperative workup and meticulous intra-and postoperative management, LDLT can be performed with minimal donor morbidity.

关键词： liver transplantation Living donor Safety Evaluation

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Donor safety in adult living donor liver transplantation using the right lobe: Single center experience in China

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World Journal of Gastroenterology 2007年第27期13卷 3752-3755页

作者： Fu-Gui Li Lu-Nan Yan Yong Zeng Jia-Yin Yang Qi-Yuan Lin Xiao-Zhong Jiang Bin Liu The center of liver Transplantation the Second Department of General Surgery West China Hospital Sichuan University Chengdu 610041 Sichuan Province China

AIM: To evaluate the safety of donors in adult living donor liver transplantation (LDLT) using the right lobe in a single liver transplantation center in China. METHODS: We investigated retrospectively 52 living donor liver resections performed from October 2003 to July 2006. All patients were evaluated by blood tests and abdominal CT. The mean donor age was 28.2 ± 7.4 years. Residual liver volume was 42.1% ± 4.7%. Mean operative time was 420 ± 76.2 min; mean ICU stay, less than 36 h; mean hospital stay, 16.4 ± 8.6 d; and mean follow-up period, 6 mo. RESULTS: There was no mortality. The overall complication rate was 40% (21 donors). Major complications included biliary leak in two, and pneumonia in 2 donors. Minor complications included mild pleural effusion in 12 donors, transient ascites in 6, mild depression in 4, intra-abdominal collections in 2, and wound infections in 1 donor. Residual liver volume did not affect the complication rate. None required re- operation. Return to pre-donation activity occurred within 5-8 wk. CONCLUSION: Right hemi-hepatectomy can be performed safely with minimal risk in cases of careful donor selection. Major complications occurred in only 7.7% of our series.

关键词： Safety Donor liver transplantation Complication

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Four-year experience with more than 1000 cases of total laparoscopic liver resection in a single center

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World Journal of Gastroenterology 2022年第25期28卷 2968-2980页

作者： Xiang Lan Hai-Li Zhang Hua Zhang Yu-Fu Peng Fei Liu Bo Li Yong-Gang Wei Department of Hepatobiliary Surgery The First Affiliated HospitalChongqing Medical UniversityChongqing 400016China Department of liver Surgery&liver Transplantation center Sichuan University West China HospitalChengdu 610041Sichuan ProvinceChina

BACKGROUND Laparoscopic liver resection(LLR)has become a safe surgical procedure that needs additional *** To review 4 years of total LLR surgeries,exceeding 1000 cases,which were performed at a single *** Patients who underwent LLR at West China Hospital of Sichuan University between January 2015 and December 2018 were *** details,including the interventional year,category of liver disease,and malignant liver tumors prognosis,were *** learning curve for LLR was evaluated using the cumulative sum *** Kaplan-Meier method was used to perform survival *** Ultimately,1098 patients were *** carcinoma(HCC)was the most common disease that led to the need for LLR at the center(n=462,42.08%).The average operation time was 216.94±98.51 *** conversion rate was 1.82%(20/1098).The complication rate was 9.20%(from grade II to V).The 1-year and 3-year overall survival rates of HCC patients were 89.7%and 81.9%,*** learning curve was grouped into two phases for local resection(cases 1-106 and 107-373),three phases for anatomical segmentectomy(cases 1-44,45-74 and 75-120),and three phases for hemihepatectomy(cases 1-17,18-48 and CONCLUSION LLR may be considered a first-line surgical intervention for liver resection that can be performed safely for a variety of primary,secondary,and recurrent liver tumors and for benign diseases once technical competence is proficiently attained.

关键词： Laparoscopic liver resection Single-center experience Learning curve liver

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Hepatobiliary & Pancreatic Diseases International 2012年第3期11卷 262-266页

作者： Gen-Shu Wang, Yang Yang, Hua Li, Nan Jiang, Bin-Sheng Fu, Hai Jin, Jian-Xu Yang and Gui-Hua Chen Department of Hepatic Surgery and liver Transplant center, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China Department of Hepatic Surgery and liver Transplant center Third Affiliated Hospital Sun Yat-Sen University Guangzhou 510630 China

BACKGROUND: Few studies have been performed to assess health-related quality of life (HRQOL) in liver transplantation (LT) patients in the mainland of China. This study aimed to investigate the HRQOL of post-LT patients in a single center. METHODS: HRQOL was evaluated by the SF-36 (Chinese version) questionnaire in 60 patients (LT group) who had received LT for benign end-stage liver disease (BELD). Fifty-five patients with BELD (BELD group) and 50 healthy volunteers from the general population (GP group) were also evaluated, and the results were compared among the three groups. RESULTS: There was a significant difference among the three groups in terms of the scores of eight domains in the SF-36 (P0.025), but higher scores for the remaining seven domains (P0.025), but had lower scores for the remaining three domains (P<0.025). Lower family income was found to be associated with reduced physical function and mental health scores (P<0.05). Better education was associated with increased mental health scores (P<0.05). CONCLUSIONS: LT patients generally have a good HRQOL although some respects of their HRQOL remains to be improved. Lower family income and poor education are important factors relating to the poor HRQOL of LT patients.

关键词： health-related quality of life liver transplantation benign end-stage liver disease

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liver transplantation in Wilson's disease: Single center experience from Saudi Arabia

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World Journal of Hepatology 2013年第3期5卷 127-132页

作者： Musthafa Chalikandy Peedikayil Hamad Ibrahim Al Ashgar Abdullah Al Mousa Mohammed Al Sebayel Khalid Al Kahtani Faisal Aba Alkhail Department of Medicine King Faisal Specialist Hospital and Research Center liver Transplantation and Hepatobiliary Surgery King Faisal Specialist Hospital and Research Center

AIM: To determine liver transplantation outcomes in Wilson's disease (WD) patients, focusing on neurological manifestations. METHODS: This retrospective study assessed data from 16 WD patients (nine males, 56%) who had liver transplants between 1991 and 2007. Survival, graft function, and neurological complications were assessed during a follow-up period of up to 15 years. In addition, each patient's medical record was reviewed in detail to find the type of Wilson's disease (hepatic or hepatic plus neurological WD), indication for liver transplantation, use of chelating agents prior to transplantation, immediate and long term complications following transplantation, the donor details, and the pathology of explanted liver. RESULTS: End-stage liver disease was the indication for transplantation in all 16 WD patients. Four patients displayed WD-related neurological symptoms in addition to liver disease. Living-related liver transplantation was done in three cases. One patient died on postoperative day 6 due to primary graft non-function. Oneyear post liver transplant survival was 94%. Neurological manifestations of all four patients disappeared during their follow-up. Four patients developed acute cellular rejection, but all responded to treatment. One patient developed chronic ductopenic rejection after 15 years post-transplantation and their graft failed; this patient is currently waiting for re-transplantation. Fourteen patients (88%) are still living. The long-term average survival is currently 10.5 years, with a current median survival of 8 years. Long-term graft survival is currently 81%. CONCLUSION: Shortand long-term survival in WD patient liver transplantation was excellent, and neurological and psychological WD manifestations disappeared during long-term follow-up.

关键词： Wilson’s disease liver transplantation Neurological Psychiatric Penicillamine Saudi Arabia Transplantation

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Optimizing biliary outcomes in living donor liver transplantation:Evolution towards standardization in a high-volume center

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Hepatobiliary & Pancreatic Diseases International 2020年第4期19卷 324-327页

作者： Tsan-Shiun Lin Jeffrey Samuel Co Chao-Long Chen Aldwin D.Ong liver Transplantation center Department of SurgeryKaohsiung Chang Gung Memorial Hospital123 Ta-Pei RoadNiao SungKaohsiung 833TaiwanChina

Biliary complications have always been a dreaded cause of morbidity after living donor liver *** intrinsic variations in both graft and recipient biliary anatomy remain a significant factor to the difficulty of biliary reconstruction,our institution has taken advantage of its high volume of cases to critically review and evaluate modifiable operative risk factors,in particular,our surgical *** present herein,the evolution of our reconstructive biliary technique from conventional methods to our current standard of microsurgical biliary reconstruction for both graft and recipient *** this period of transition,our center has created a classification system for biliary reconstruction that decreased the biliary complication rates from 40.0%to 10.2%.

关键词： Living donor liver transplantation Biliary reconstruction Microsurgical biliary reconstruction Biliary classification Biliary complications

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