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Risk factors associated with early and late HAT after adult liver transplantation

World Journal of Gastroenterology 2014年第30期20卷 10545-10552页

作者： Yi Yang Ji-Chun Zhao Lu-Nan Yan Yu-Kui Ma Bin Huang Ding Yuan Bo Li Tian-Fu Wen Wen-Tao Wang Ming-Qing Xu Jia-Yin Yang Department of Vascular Surgery Liver Transplantation CenterWest China HospitalSichuan University liver transplantation Center Department of Liver SurgeryWest China HospitalSichuan University

AIM: To identify risk factors that might contribute to hepatic artery thrombosis (HAT) after liver transplantation (LT). METHODS: The perioperative and follow-up data of a total of 744 liver transplants, performed from February 1999 to July 2010, were retrospectively reviewed. HAT developed in 20 patients (2.7%). HAT was classified as early (occurring in fewer than 30 d post LT) or late (occurring more than 30 d post LT). Early HAT devel-oped in 14 patients (1.9%). Late HAT developed in 6 patients (0.8%). Risk factors associated with HAT were analysed using the chi(2) test for univariate analysis and logistic regression for multivariate analysis. RESULTS: Lack of ABO compatibility, recipient/donor weight ratio >= 1.15, complex arterial reconstruction, duration time of hepatic artery anastomosis > 80 min, duration time of operation > 10 h, dual grafts, number of units of blood received intraoperatively >= 7, number of units of fresh frozen plasma (FFP) received intraoperatively >= 6, postoperative blood transfusion and postoperative FFP use were significantly associated with early HAT in the univariate analysis (P = 1.15 (OR = 4.499), duration of hepatic artery anastomosis > 80 min (OR = 5.429), number of units of blood received intraoperatively >= 7 (OR = 4.059) and postoperative blood transfusion (OR = 6.898). Graft type (whole/living-donor/split), duration of operation > 10 h, retransplantation, rejection reaction, recipients with diabetes preoperatively and recipients with a high level of blood glucose or diabetes postoperatively were significantly associated with late HAT in the univariate analysis (P 10 h (OR = 6.394), retransplantation (OR = 21.793) and rejection reactions (OR = 16.936). CONCLUSION: Early detection of these

关键词： liver transplantation Hepatic artery thrombosis Risk factors Complication Blood transfusion

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liver resection in hepatitis B related-hepatocellular carcinoma: Clinical outcomes and safety in elderly patients

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World Journal of Gastroenterology 2014年第21期20卷 6620-6625页

作者： Hai-Qing Wang Jian Yang Lu-Nan Yan Xiao-Wu Zhang Jia-Yin Yang Department of liver Surgery Liver Transplantation CenterWest China Hospital of Sichuan University

AIM: To compare the morbidity and mortality in young and elderly hepatocellular carcinoma (HCC) patients undergoing liver resection. METHODS: We retrospectively enrolled 1543 consecutive hepatitis B (HBV)-related HCC patients undergoing elective hepatic resection in our cohort, including 207 elderly patients (>= 65 years) and 1336 younger patients (liver resection were compared between the two groups. RESULTS: Elderly patients had more preoperative comorbidities and lower alanine aminotransferase and aspartate aminotransferase levels. Positive rates for hepatitis B surface antigen (P liver resection with expected higher complication and mortality rates. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

关键词： Elderly Hepatocellular carcinoma Hepatectomy Complication Hepatitis B

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Effects of multimodal fast-track surgery on liver transplantation outcomes

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Hepatobiliary & Pancreatic diseases International 2017年第4期16卷 364-369页

作者： Jian-Hua Rao Feng Zhang Hao Lu Xin-Zheng Dai Chuan-Yong Zhang Xiao-Feng Qian Xue-Hao Wang Ling Lu liver transplantation Center First Affiliated Hospital of Nanjing Medical University Key Laboratory of Living Donor liver transplantation of Ministry of Public Health Nanjing 210029China

BACKGROUND: Fast-track surgery and enhanced recovery after surgery have been applied to many surgical procedures; however, data on fast-track surgery and enhanced recovery after surgery following liver transplantation is limited. This study aimed to conduct a prospective study to determine the effects of fast-track surgery on prognosis after liver transplantation. METHODS: This was a prospective, single-blinded, randomized study. One hundred twenty-eight patients undergoing liver transplantation were selected for the fast-track (FT group, n=54) or conventional process (NFT group, n=74). The primary endpoints were intensive care unit (ICU) stay and hospital stay. The secondary endpoints were as follows: operative time, anhepatic phase time, intraoperative blood loss, intraoperative blood transfusion volume, postoperative complications, readmission rate, and postoperative mortality. RESULTS: There was no significant difference in preoperative demographics between the two groups. The median ICU stay was 2 days (range 1-7 days) in the FT group and 5 days (range 3-12 days) in the NFT group (Pliver transplantation.

关键词： fast-track surgery liver transplantation surgical drainage ICU days hospital stay

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Rapamycin combined with allogenic immature dendritic cells selectively expands CD4^+CD25^+Foxp3^+ regulatory T cells in rats

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Hepatobiliary & Pancreatic diseases International 2012年第2期11卷 203-208页

作者： Guo-Ying Wang Qi Zhang Yang Yang Wen-Jie Chen Wei Liu Nan Jiang Gui-Hua Chen chgh1955@*** liver transplantation Center Third Affiliated Hospital Transplantation Research Institute Sun Yat-Sen University Organ Transplantation Research Center of Guangdong Province Guangzhou 510630 China

ReferencesReferencesBackgroundDendritic cells (DCs) can initiate the expansion of regulatory T cells (Tregs), which play an indispensable role in inducing transplantation tolerance. Some studies have investigated the effect of the immunosuppressant rapamycin (Rapa) on Tregs in vitro. However, the in vivo effect of Rapa combined with immature DCs (iDCs) on Tregs is unknown. This study was undertaken to determine whether allogenic iDCs combined with a short course of Rapa have the ability to selectively expand the CD4+CD25+Foxp3+ Tregs in a rat *** Norway rats were injected intravenously with 2×106 Lewis iDCs followed by 1 mg/kg per day Rapa intraperitoneally for 7 consecutive days. On day 8, the levels of CD4+CD25+Foxp3+ Treg cells in peripheral blood and spleen cells were analyzed by flow cytometry. IL-2, IL-4, TGF-β1, and IFN-γ levels in serum were assessed by ELISA. The experimental animals were divided into four groups: control, Rapa-treated, iDC-treated, and ***4+CD25+Foxp3+ Tregs comprised 7%-8%of CD4+ T cells in control rats. Rapa combined with iDCs enhanced this percentage in the peripheral blood and spleen. However, the levels of Tregs did not significantly change after treatment with Rapa or iDCs alone. The levels of CD4+CD25?/sup>Foxp3+ T cells and CD4+ CD25+Foxp3?/sup> T cells in CD4+ T cells did not significantly change in the combined group. The TGF-β1 level in serum from the combined group increased significantly compared with the other *** significantly higher percentage of CD4+ CD25+ Foxp3+ Tregs was found in rats treated with allogenic iDCs and a short course of Rapa, along with an increase in the TGF-β1 level in serum. This improved protocol may be a promising therapeutic strategy to increase Tregs, which are beneficial to the induction of peritransplant tolerance.

关键词： dendritic cells regulatory T cells rapamycin

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Mesohepatectomy versus extended hemihepatectomy for centrally located hepatocellular carcinoma

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Hepatobiliary & Pancreatic diseases International 2014年第3期13卷 264-270页

作者： Xi Chen Bo Li Wei He Yong-Gang Wei Zheng-Gui Du Li Jiang Department of liver Surgery and liver transplantation Center West China Hospital Sichuan University

BACKGROUND: Extended hemihepatectomy is usually recommended to treat large centrally located hepatocellular carcinoma (HCC). However, the morbidity and mortality are high because of the postoperative liver failure. Mesohepatectomy is seldom used because of its technical complexity This study aimed to evaluate the short-term and long-term curative effect of mesohepatectomy. METHODS: From January 2002 to September 2008, a total of 198 consecutive patients with centrally located HCC underwent hepatectomy in our department. According to the surgical procedures, they were divided into mesohepatectomy (group M, n=118), extended right hemihepatectomy (group RE, n=47) and extended left hemihepatectomy (group LE, n=33) groups. The surgical techniques, clinical pathological characteristics and outcomes were compared between group M, group RE and group LE. RESULTS: The operative time of group M was significantly longer than that of the other two groups (P0.05). The morbidity rate in group M was significantly lower than that in group RE (37.3% vs 55.3%, P=0.034), but not in group LE (37.3% vs 24.2%, P=0.163). The biliary leakage tended to be more common in group M (10.2%, P>0.05). The incidence of postoperative liver failure in group M was significantly lower than that in group RE (1.7% vs 10.6%, P=0.032), but not in group LE (1.7% vs 6.1%, P=0.208). The 1-, 3- and 5-year tumor-free survival rates and the overall survival rates after mesohepatectomy were 53.4%, 30.5% and 16.9% and 67.8%, 45.5% and 28.9%, respectively. CONCLUSIONS: Mesohepatectomy is a safe and effective technique for centrally located HCC patients. Compared with extende

关键词： hepatocellular carcinoma mesohepatectomy extended hemihepatectomy complication survival

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Anterior vs conventional approach hepatectomy for large liver cancer:A meta-analysis

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World Journal of Gastroenterology 2014年第45期20卷 17235-17243页

作者： Lei Li Hai-Qing Wang Qing Wang Jian Yang Jia-Yin Yang Department of liver Surgery Liver Transplantation Center West China Hospital of Sichuan University

AIM: To evaluate the clinical outcomes and safety of anterior-and conventional-approach hepatectomy for patients with large liver tumors. METHODS: PubMed, EMBASE, Google Scholar and the Cochrane Library databases were searched for randomized controlled trials (RCTs) and controlled clinical trials comparing anterior-approach hepatectomy (AAH) and conventional-approach hepatectomy (CAH). Two observers independently extracted the data using a spreadsheet and assessed the studies for inclusion. Studies that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were further assessed using either fixed effects or random effects models. RESULTS: Two RCTs and six controlled clinical trials involving 807 patients met the predefined inclusion criteria. A total of 363 patients underwent AAH and 444 underwent CAH. Meta-analysis indicated that the AAH group had fewer requirements for transfusion (OR = 0.37, 95%CI: 0.21-0.63), less recurrence (OR = 0.57, 95%CI: 0.37-0.87), and lower mortality (OR = 0.29, 95%CI: 0.13-0.63). There were no significant differences between AAH and CAH with regard to perioperative complications (OR = 0.94, 95%CI: 0.58-1.51), intraoperative tumor rupture (OR = 0.98, 95%CI: 0.40-2.40), or length of hospital stay (weighted mean difference = -0.17, 95%CI: -2.36-2.02). CONCLUSION: AAH has advantages of decreased transfusion, mortality and recurrence compared to CAH. It is a safe and effective method for large cancers requiring right hepatectomy. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

关键词： Anterior approach Conventional approach Hepatectomy liver tumor Meta-analysis

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Prophylaxis against hepatitis B virus recurrence after liver transplantation: A registry study

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World Journal of Gastroenterology 2015年第2期21卷 584-592页

作者： Shu Shen Li Jiang Guang-Qin Xiao Lu-Nan Yan Jia-Yin Yang Tian-Fu Wen Bo Li Wen-Tao Wang Ming-Qing Xu Yong-Gang Wei liver transplantation Center Department of Liver SurgeryWest China Hospital of Sichuan University

AIM: To evaluate the prophylactic efficacy of hepatitis B immunoglobulin(HBIG) in combination with different nucleos(t)ide ***: A total of 5333 hepatitis B surface antigenpositive patients from the China liver Transplant Registry database were enrolled between January 2000 and December 2009. Low-dose intramuscular(im) HBIG combined with one nucleos(t)ide analogue has been shown to be very cost-effective in recent reports. Hepatitis B virus(HBV) prophylactic outcomes were compared based on their posttransplant prophylactic protocols [group A(n = 4684): im HBIG plus lamivudine; group B(n = 491): im HBIG plus entecavir; group C(n = 158): im HBIG plus adefovir dipivoxil]. We compared the related baseline characteristics among the three groups, including the age, male sex, Meld score at the time of transplantation, Child-Pugh score at the time of transplantation, HCC, pre-transplantation hepatitis B e antigen positivity, pre-transplantation HBV deoxyribonucleic acid(HBV DNA) positivity, HBV DNA at the time of transplantation, pre-transplantation antiviral therapy, and the duration of antiviral therapy before transplantation of the patients. We also calculated the 1-, 3- and 5-year survival rates and HBV recurrence rates according to the different groups. All potential risk factors were analyzed using univariate and multivariate ***: The mean follow-up duration was 42.1 ± 30.3 mo. The 1-, 3- and 5-year survival rates were lower in group A than in groups B(86.2% vs 94.4%, 76.9% vs 86.6%, 73.7% vs 82.4%, respectively, P < 0.001) and C(86.2% vs 92.5%, 76.9% vs 73.7%, 87.0% vs 81.6%, respectively, P < 0.001). The 1-, 3-and 5-year posttransplant HBV recurrence rates were significantly higher in group A than in group B(1.7% vs 0.5%, 3.5% vs 1.5%, 4.7% vs 1.5%, respectively, P = 0.023). No significant difference existed between groups A and C and between groups B and C with respect to the 1-, 3- and 5-year HBV recurrence rates. Pretransplant hepatocell

关键词： Viral hepatitis Recurrence Hepatitis B immunoglobu

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Synchronous splenectomy and hepatectomy for patients with hepatocellular carcinoma and hypersplenism:A casecontrol study

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World Journal of Gastroenterology 2015年第8期21卷 2358-2366页

作者： Xiao-Yun Zhang Chuan Li Tian-Fu Wen Lu-Nan Yan Bo Li Jia-Yin Yang Wen-Tao Wang Li Jiang Department of liver Surgery and liver transplantation Centre West China Hospital of Sichuan University

AIM:To investigate whether the use of synchronoushepatectomy and splenectomy(HS)is more effective than hepatectomy alone(HA)for patients with hepatocellular carcinoma(HCC)and ***:From January 2007 to March 2013,84consecutive patients with HCC and hypersplenism who underwent synchronous hepatectomy and splenectomy in our center were compared with 84 well-matched patients from a pool of 268 patients who underwent hepatectomy *** short-term and longterm outcomes of the two groups were analyzed and ***:The mean time to recurrence was 21.11±12.04 mo in the HS group and 11.23±8.73 mo in the HA group,and these values were significantly different(P=0.001).The 1-,3-,5-,and 7-year disease-free survival rates for the patients in the HS group and the HA group were 86.7%,70.9%,52.7%,and 45.9%and 88.1%,59.4%,43.3%,and 39.5%,respectively(P=0.008).Platelet and white blood cell counts in the HS group were significantly increased compared with the HA group one day,one week,one month and one year postoperatively(Pdisease-free ***,tumor number,and recurrence were independent prognostic factors for overall ***:Synchronous hepatectomy and hepatectomy potentially improves disease-free survival rates and alleviates hypersplenism without increasing the surgical risks for patients with HCC and hypersplenism.

关键词： Hepatocellular carcinoma Hypersplenism Splenectomy

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An accurate predictor of liver failure and death after hepatectomy:A single institution's experience with 478 consecutive cases

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World Journal of Gastroenterology 2014年第1期20卷 274-281页

作者： Zheng-Gui Du Yong-Gang Wei Ke-Fei Chen Bo Li Department of liver Surgery Liver Transplantation CenterWest China HospitalSichuan University

AIM:To establish a reliable definition of postoperative liver failure(PLF)and allow the prediction of outcomes after ***:The clinical data of 478 consecutive patients who underwent hepatectomy were retrospectively *** examined prognostic factors included the ratio of total bilirubin(TBIL)on postoperative day(POD)X to TBIL on POD 1(TBIL-r1)and the ratio of the international normalized ratio(INR)on POD X to the INR on POD 1(INR-r1)for PODs 3,5 and ***’s t test,theχ2test,logistic regression,survival analysis and receiver operating curve analysis were used to evaluate risk factors and establish the definition of postoperative liver failure(PLF).RESULTS:Fourteen patients(2.9%)died of liver failure within 3 mo of *** differences were found between patients who died of liver failure and the remaining patients in terms of TBIL-r1 and INR-r1on PODs 3,5 and *** combination of TBIL-r1 and INR-r1 on POD 5 showed strong predictive power for liver failure-related death(sensitivity 92.9%and specificity 90.1%).The hepatic damage score(HDs),which was derived from TBIL-r1 and INR-r1,was used to define the degree of metabolic functional impairment after resection as mild(HDs=0),reversible hepatic"dysfunction"(HDs=1)or fatal hepatic failure(HDs=2).Furthermore,the indocyanine green retention rate at 15 min(ICG-R15)and the number of resected segments(RSs)were identified as independent predictors of the HDs.A linear relationship was found between ICG-R15 and RSs in the HDs=2 *** regression equation was:RSs=-0.168×ICG-R15+5.625(r2=0.613,F=14.257,P=0.004).CONCLUSION:PLF can be defined by the HDs,which accurately predicts liver failure-related death after liver ***,the ICG-R15 and RSs can be used as selection criteria for hepatectomy.

关键词： liver failure Hepatectomy Mortality Morbidity Hepatic dysfunction

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Low immediate postoperative platelet count is associated with hepatic insufficiency after hepatectomy

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World Journal of Gastroenterology 2014年第33期20卷 11871-11877页

作者： Hai-Qing Wang Jian Yang Jia-Yin Yang Wen-Tao Wang Lu-Nan Yan Department of liver Surgery Liver Transplantation Center West China Hospital of Sichuan University

AIM: To investigate the relationship between low immediate postoperative platelet count and perioperative outcome after liver resection in patients with hepatocellular carcinoma (HCC). METHODS: In a cohort of 565 consecutive hepatitis B-related HCC patients who underwent major liver resection, the characteristics and clinical outcomes after liver resection were compared between patients with immediate postoperative platelet count = 100 x 10(9)/L. Risk factors for postoperative hepatic insufficiency were evaluated by multivariate analysis. RESULTS: Patients with a low immediate postoperative platelet count (liver failure (6.8% vs 2.6%, P = 0.02), hepatic insufficiency (31.5% vs 21.2%, P = 100 x 10(9)/L. The alanine aminotransferase levels on postoperative days 3 and 5, and bilirubin on postoperative days 1, 3 and 5 were higher in patients with immediate postoperative low platelet count. Multivariate analysis revealed that immediate postoperative low platelet count, rather than preoperative low platelet count, was a significant independent risk factor for hepatic insufficiency. CONCLUSION: A low immediate postoperative platelet count is an independent risk factor for hepatic insufficiency. Platelets can mediate liver regeneration in the cirrhotic liver. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

关键词： Thrombocytopenia Hepatic insufficiency Hepatocellular carcinoma Hepatectomy Hepatitis B

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