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Effect of donor age on graft function and longterm survival of recipients undergoing living donor liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2015年第1期14卷 50-55页

作者： Kai Wang Wen-Tao Jiang Yong-Lin Deng Cheng Pan Zhong-Yang Shen Department of Transplant surgery Tianjin First Center Hospital Key Laboratory of Organ Transplantation of Tianjin

BACKGROUND： Donor shortage is the biggest obstacle in organ transplantation. Living donor liver transplantation（LDLT） has been considered as a valuable approach to shortening waiting time. The objectives of this study were to investigate the feasibility of utilizing donors older than 50 years in LDLT and to evaluate the graft function and recipient ***： All LDLT cases（n=159） were divided into the older（donor age ≥50 years, n=10） and younger（donor age 〈50 years,n=149） donor groups. Donor graft and recipient condition pre-,intra- and post-operation were compared between the two *** particular, graft functions and recipient survivals were ***： The median donor age was 58.5（52.5-60.0） years in the older donor group and 25.0（23.0-32.0） in the younger donor group. There was no significant difference in cold ischemic time, anhepatic phase and operation time between the older and younger donor groups（P〉0.05）. However, the volume of red blood cell transfused in operation was greater in the older donor group than in the younger donor group（1900 vs 1200 m L, P=0.023）. The 1-, 3- and 5-year graft survival rates were 90%, 80% and 80% for the older donor group, and 92%, 87% and 87% for the younger donor group, respectively（P=0.459）.The 1-, 3- and 5-year survival rates were 100%, 90% and 90% for recipients with older grafts, and 93%, 87% and 87% for those with younger grafts, respectively（P=0.811）.CONCLUSION： It is safe for a LDLT recipient to receive liver from donors older than 50 years, and there is no significant adverse effect on graft function and long-term patients’ survival.

关键词： living donor liver transplantation donor age graft liver function long-term survival

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Outcomes of liver transplantation Using Pediatric Deceased Donor livers： A Single-Center Analysis of 102 Donors

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Chinese Medical Journal 2018年第6期131卷 677-683页

作者： Rui Zhang Zhi-Jun Zhu Li-Ying Sun Lin Wei Wei Qu liver transplantation Center National Clinical Research Center for Digestive Disease Beijing Friendship Hospital Capital Medical University Beijing 100050 China Department of Hepatobiliary and Pancreatic surgery Shanxi Provincial People's Hospital Taiyuan Shanxi 030012 China

Background： The outcome of pediatric deceased donor liver transplantation （LT） has not been well studied, especially pediatric deceased donor livers used in adult transplantation. This study aimed to evaluate the efficacy of LT using pediatric deceased donor livers and compare the outcomes between pediatric-to-pediatric LT and pediatric-to-adult LT. Methods： A retrospective review of LT using pediatric deceased donor livers from June 2013 to August 2016 was performed. The patients were divided into the pediatric-to-pediatric LT group and pediatric-to-adult LT group based on the ages of the recipients. The survival and incidence of early vascular complications （VCs） were observed between the two groups. We also analyzed the risk factors of early VCs in pediatric LT and the effect of donor hypernatremia on the prognosis of recipients. Results： There were 102 cases of LT using pediatric deceased donor livers in our hospital from June 2013 to August 2016. 83 pediatric-to-pediatric LT （recipients＇ age ≤13 years） and 19 pediatric-to-adult LT （recipients＇ age≥19 years）. The ratio of early VC was similar in the two groups （19.3% vs. 10.6%, P = 0.514）. Low body weight of recipient was an independent risk factor of early VC in pediatric LT （odds ratio： 0.856, 95% confidence interval： 0.752-0.975, P = 0.019）. The 1-year cumulative survival rates of grafts and patients were 89.16% and 91.57% in pediatric-to-pediatric LT and 89.47% and 94.74% in pediatric-to-adult LT, respectively （all P 〉 0.05）. In all cases. patients using donors with hypernatremia （serum sodium levels ≥ 150mmol/L） had worse graft survival （χ2=4.330, P = 0.037）. Conclusions： Pediatric-to-pediatric LT group has similar graft and patient survival rates with those of pediatric-to-adult LT group. Low body weight of recipients is an independent risk factor of early VC in pediatric LT. Patients using donors with hypernatremia have worse graft survival.

关键词： liver transplantation Pediatric Deceased Donors Vascular Complications

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Enhanced recovery after surgery programs in patients undergoing hepatectomy:A meta-analysis

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World Journal of Gastroenterology 2015年第30期21卷 9209-9216页

作者： Tian-Gen Ni Han-Teng Yang Hao Zhang Hai-Peng Meng Bo Li Department of liver surgery Liver Transplantation CenterWest China Hospital of Sichuan University

AIM:To evaluate the impact of enhanced recovery after surgery(ERAS) programs in comparison with traditional care on liver surgery ***:The Pub Med,EMBASE,CNKI and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials(RCTs) comparing the ERAS program with traditional care in patients undergoing liver surgery. Studies selected for the meta-analysis met all of the following inclusion criteria:(1) evaluation of ERAS in comparison to traditional care in adult patients undergoing elective open or laparoscopic liver surgery;(2) outcome measures including complications,recovery of bowel function,and hospital length of stay; and(3) RCTs. The following exclusion criteria were applied:(1) the study was not an RCT;(2) the study did not compare ERAS with traditional care;(3) the study reported on emergency,non-elective or transplantation surgery; and(4) the study consisted of unpublished studies with only the abstract presented at a national or international meeting. The primary outcomes were complications. Secondary outcomes were length of hospital stay and time to first ***:Five RCTs containing 723 patients were included in the meta-analysis. In 10/723 cases,patients presented with benign diseases,while the remaining 713 cases had liver cancer. Of the five studies,three were published in English and two were published in Chinese. Three hundred and fifty-four patients were in the ERAS group,while 369 patients were in the traditional care group. Compared with traditional care,ERAS programs were associated with significantly decreased overall complications(RR = 0.66; 95%CI:0.49-0.88; P = 0.005),grade?Ⅰ?complications(RR = 0.51; 95%CI:0.33-0.79; P = 0.003),and hospitallength of stay [WMD =-2.77 d,95%CI:-3.87-(-1.66); P programs were associated with decreased time to first flatus [WMD =-19.69 h,95%CI:-34.63-(-4.74); P < 0.0001]. There was no statistically significant difference in gra

关键词： Enhanced recovery after surgery liversurgery Complications Hospital length of stay Metaanalysis

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Minimizing tacrolimus decreases the risk of new-onset diabetes mellitus after liver transplantation

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World Journal of Gastroenterology 2016年第6期22卷 2133-2141页

作者： Jiu-Lin Song Wei Gao Yan Zhong 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 Li Jiang Jian Yang Department of liver surgery Liver Transplantation CenterWest China Hospital of Sichuan University

AbstractAIM： To investigate the impact of minimum tacrolimus（TAC） on new-onset diabetes mellitus （NODM） afterliver transplantation （LT）.METHODS： We retrospectively analyzed the data of973 liver transplant recipients between March 1999and September 2014 in West China Hospital livertransplantation Center. Following the exclusion ofineligible recipients, 528 recipients with a TAC-dominantregimen were included in our study. We calculatedand determined the mean trough concentration ofTAC （cTAC） in the year of diabetes diagnosis in NODMrecipients or in the last year of the follow-up in non-NODM recipients. A cutoff of mean cTAC value forpredicting NODM 6 mo after LT was identified usinga receptor operating characteristic curve. TAC-relatedcomplications after LT was evaluated by χ^2 test, andthe overall and allograft survival was evaluated usingthe Kaplan-Meier method. Risk factors for NODM afterLT were examined by univariate and multivariate Cox ***： Of the 528 transplant recipients, 131（24.8%） developed NODM after 6 mo after LT, andthe cumulative incidence of NODM progressivelyincreased. The mean cTAC of NODM group recipientswas significantly higher than that of recipients in thenon-NODM group （7.66 ± 3.41 ng/mL vs 4.47 ± 2.22ng/mL, P 〈 0.05）. Furthermore, NODM group recipientshad lower 1-, 5-, 10-year overall survival rates （86.7%,71.3%, and 61.1% vs 94.7%, 86.1%, and 83.7%, P 〈0.05） and allograft survival rates （92.8%, 84.6%, and75.7% vs 96.1%, 91%, and 86.1%, P 〈 0.05） thanthe others. The best cutoff of mean cTAC for predictingNODM was 5.89 ng/mL after 6 mo after LT. Multivariateanalysis showed that old age at the time of LT （〉 50years）, hypertension pre-LT, and high mean cTAC （≥5.89 ng/mL） after 6 mo after LT were independent riskfactors for developing NODM. Concurrently, recipientswith a low cTAC （〈 5.89 ng/mL） were less likely tobecome obese （21.3% vs 30.2%, P 〈 0.05） or todevelop dyslipidemia （27.5% vs 44.8%, P 〈0.05）,chronic kidney dysfunction （14.

关键词： liver transplantation Minimum tacrolimus New-onset diabetes mellitus Immunosuppressants Allografts failure

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Novel organoid model in drug screening: Past, present, and future

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liver Research 2021年第2期5卷 72-78页

作者： Xialin Nie Zhixing Liang Kun Li Haoyuan Yu Yuhan Huang Linsen Ye Yang Yang Guangdong Provincial Key Laboratory of liver Disease Research GuangzhouChina School of Foreign Languages Sun Yat-sen UniversityGuangzhouChina Department of Hepatic surgery and liver transplantation Center The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina

Advances in the field of stem cells have led to the development of a technology called *** are cell cluster structures formed by the cultivation of stem cells in a three-dimensional environment in vitro,and they can simulate the living environment of cells in *** play an important role in the screening of drugs for tumor *** with traditional drug screening models,tumor organoid models derived from patient tumors have higher sensitivity,heterogeneity,and stability and can restore the real situation of tumors more *** have conducted a number of researches on the feasibility of using organoid technology in drug *** testing and comparing the effects of antitumor drugs in organoids and primary tumors,we can select the most appropriate treatment drugs for *** the past ten years,organoids from dozens of tissues and biological sample banks from several main organs have been established,and a large number of anticancer drugs have been screened *** article summarizes the advantages and disadvantages of traditional drug screening models,discusses the development history of organoid technology,and reviews the research results on organoids from tumor drug *** addition,the combination of organoid technology and other modern biotechnologies is put forward to further promote the role of organoid technology in the medical ***,this article reviews the history,progress,and prospect on organoids from the view of antitumor drug screening.

关键词： Organoid Drug screening Patient-derived cancer cell line(PDC)model Patient-derived xenograft(PDX)model Patient-derived organoid(PDO)model

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Platelets:A review of their function and effects in liver diseases

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liver Research 2020年第3期4卷 129-135页

作者： Haoqi Chen Xiaolong Chen Genshu Wang Department of Hepatic surgery Liver TransplantationThe Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina Guangdong Key Laboratory of liver Disease Research The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina

Platelets are small fragments of the cytoplasm and are detached from the cytoplasm of mature *** play an important role in the function of blood coagulation in *** studies have shown that in addition to participating in hemostasis,platelets play a critical role in liver regeneration,liver inflammation,liver tumors,injury,and other liver diseases by regulating the activation of stellate cells and the interaction between Kupffer cells and sinusoidal endothelial *** platelets and their related molecules is a promising treatment strategy in the management of liver ***,we review the role of platelets and their related molecules in the development of liver diseases and the application of targeted drugs.

关键词： Platelets Hepatic fibrosis Hepatic ischemia-reperfusion injury liver regeneration liver diseases

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Hangzhou criteria as downstaging criteria in hepatocellular ca

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Hepatobiliary & Pancreatic Diseases International 2020年第4期19卷 349-357页

作者： Qi-Fan Zhan Sun-Bin Ling Yi-Nan Deng Qiao-Nan Shan Qian-Wei Ye Sheng-Jun Xu Guang-Jiang Jiang Di Lu Xu-Yong Wei Li Zhuang Wu Zhang Tian Shen Bei-Ni Cen Hai-Yang Xie Ji-Min Liu Jian Wu Shu-Sen Zheng Yang Yang Xiao Xu Department of Hepatobiliary and Pancreatic surgery the First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China NHC Key Laboratory of Combined Multi-organ transplantation Key Laboratory of the Diagnosis and Treatment of Organ TransplantationCAMSHangzhou 310003China Department of Hepatic surgery and liver transplantation Center the Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510630China Department of Hepatobiliary and Pancreatic surgery Shulan(Hangzhou)HospitalHangzhou 310000China Department of Pathology and Molecular Medicine Faculty of Health SciencesMcMaster UniversityHamiltonOntario L8S 4K1Canada

Background:The downstaging of hepatocellular carcinoma(HCC)has been confirmed to benefit liver transplantation(LT)patients whose tumors are beyond the transplantation *** criteria(MC),a tumor size and number-based assessment,is currently used as the endpoint in these ***,many studies believe that tumor biological behavior should be added to the evaluation criteria for downstaging ***,this study aimed to explore the feasibility of Hangzhou criteria(HC),which introduced tumor grading and alpha-fetoprotein in addition to tumor size and number,as an endpoint of ***:We performed a multicenter and retrospective study of 206 patients accepted locoregional therapy(LRT)as downstaging/bridge treatment prior to LT in three centers of ***:Recipients were divided into four groups:failed downstaging to the HC(group A,n=46),successful downstaging to the HC(group B,n=30),remained within the HC all the time(group C,n=113),and tumor progressed(group D,n=17).The 3-year HCC recurrence probabilities of groups B and C were not significantly different(10.3%vs.11.6%,P=0.87).The HCC recurrent rate was significantly higher in group A(52.3%)compared with that in group B/C(P<0.05).Seven patients(7/76,9.2%)whose tumor exceeded the the HC were successfully downstaged to the MC,and 39.5%(30/76)to the the *** group B,23 patients remained beyond the MC and their survivals were as well as those of patients within the ***:Compared to the MC,HC downstaging criteria can give more HCC patients access to LT and furthermore,the outcome of these patients is the same as those matching MC downstaging *** downstaging criteria therefore is applicable in clinical practice.

关键词： Hepatocellular carcinoma liver transplantation Downstaging

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Ex vivo liver resection followed by autotransplantation for end-stage hepatic alveolar echinococcosis

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Chinese Medical Journal 2011年第18期124卷 2813-2817页

作者： WEN Hao DONG Jia-hong ZHANG Jin-hui ZHAO Jin-ming SHAO Ying-mei DUAN Wei-dong LIANG Yu-rong JI Xue-wen TAI Qin-wen Tuerganali Aji LI Tao State Key Lab Breeding Base of Xinjiang Major Disease Research and Department of liver and Laparoscopic surgery First Affiliated Hospital of Xinjiang Medical University Xinjiang Organ Transplantation Research Institute Urumqi Xinjiang 830054 China Department of Hepatobiliary surgery General Hospital of People'sLiberation Army Beijing 100853 China

Background For patients with end-stage hepatic alveolar echinococcosis （AE）, in vivo resection of the involved parts of the liver is usually very difficult, therefore, allogenic liver transplantation is indicated. However, we hypothesize that for selected patents, ex vivo liver resection for thorough elimination of the involved tissues and liver autotransplantation may offer a chance for clinical cure. Methods We presented a 24-year-old women with a giant hepatic AE lesion who was treated with hepatectomy, ex vivo resection of the involved tissue and hepatic autotransplantation. The patient had moderate jaundice and advanced hepatic AE lesion which involved segments I, IV, V, VI, VII, VIII and retrohepatic inferior vena cava. The lateral segments （II and III） of the left liver remained normal with over 1000 ml in its volume. No extrahepatic metastases （such as to the lung or brain） could be found. As the first step of treatment, X-ray guided percutaneous transhepatic cholangiodrainage （PTCD） was performed twice for bile drainage in segment III and II separately until her serum total bilirubin decreased gradually from 236 to 88 umol/L. Total liver resection was then performed, followed by extended right hepatic trisegmentectomy and the entire retrohepatic vena cava was surgically removed en bloc while her hemodynamics parameters were stable. Neither veino-veinous bypass nor temporary intracorporeal cavo-caval or porto-caval shunt was used during the 5.7-hour anhepatic phase. The remained AE-free lateral segments of the-left liver were re-implanted in situ. The left hepatic vein was directly anastomosed end-to-end to the suprahepatic inferior vena cava due to the lack of the retrohepatic inferior vena cava with AE total infiltration. Because compensatory retroperitoneal porto-caval collateral circulation developed, we enclosed remained infrahepatic inferior vena cava at renal vein level without any haemodynamics problems. Results During a 60-day following-up after ope

关键词： liver autotransplantation alveolar echinococcosis ex vivo liver resection liposomal albendazole

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Toripalimab combined with lenvatinib and GEMOX is a promising regimen as first-line treatment for advanced intrahepatic cholangiocarcinoma:a single-center,single-arm,phase 2 study

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Signal Transduction and Targeted Therapy 2023年第4期8卷 1983-1992页

作者： Guo-Ming Shi Xiao-Yong Huang Dong Wu Hui-Chuan Sun Fei Liang Yuan Ji Yi Chen Guo-Huan Yang Jia-Cheng Lu Xian-Long Meng Xin-Ying Wang Lei Sun Ning-Ling Ge Xiao-Wu Huang Shuang-Jian Qiu Xin-Rong Yang Qiang Gao Yi-Feng He Yang Xu Jian Sun Zheng-Gang Ren Jia Fan Jian Zhou Department of liver surgery and transplantation Liver Cancer InstituteZhongshan HospitalFudan UniversityShanghaiChina Department of Radiology Zhongshan HospitalFudan UniversityShanghaiChina Department of Statistics Zhongshan HospitalFudan UniversityShanghaiChina Department of Pathology Zhongshan HospitalFudan UniversityShanghaiChina Department of Hepatic Oncology Liver Cancer InstituteZhongshan HospitalFudan UniversityShanghaiChina Tianjin Medical Laboratory BGI-TianjinBGI ShenzhenTianjinChina

Advanced intrahepatic cholangiocarcinoma(ICC)has a dismal ***,we report the efficacy and safety of combining toripalimab,lenvatinib,and gemcitabine plus oxaliplatin(GEMOX)as first-line therapy for advanced *** patients with pathologically confirmed advanced ICC received intravenous gemcitabine(1 g/m2)on Days 1 and 8 and oxaliplatin(85 mg/m2)Q3W for six cycles along with intravenous toripalimab(240 mg)Q3W and oral lenvatinib(8 mg)once daily for one *** expression of programmed death-ligand 1(PD-L1)and genetic status was investigated in paraffin-embedded tissues using immunohistochemistry and whole-exome sequencing(WES)*** primary endpoint was the objective response rate(ORR).Secondary outcomes included safety,overall survival(OS),progression-free survival(PFS),disease control rate(DCR)and duration of response(DoR).As of July 1,2022,the median follow-up time was 23.5 months,and the ORR was 80%.Twenty-three patients achieved partial response,and one achieved complete ***(21/30)with DNA damage response(DDR)-related gene mutations showed a higher ORR,while patients(14/30)with tumor area positivity≥1(PD-L1 staining)showed a trend of high ORR,but without significant *** median OS,PFS,and DoR were 22.5,10.2,and 11.0 months,*** DCR was 93.3%.Further,56.7%of patients experienced manageable grade≥3 adverse events(AEs),commonly neutropenia(40.0%)and leukocytopenia(23.3%).In conclusion,toripalimab plus lenvatinib and GEMOX are promising first-line regimens for the treatment of advanced ICC.A phase-III,multicenter,double-blinded,randomized study to validate our findings was approved by the National Medical Products Administration(NMPA,No.2021LP01825).

关键词： regimen intrahepatic treatment

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Prof. Henrik Petrowsky: complex hepatobiliary and pancreatic surgery

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Hepatobiliary surgery and Nutrition 2020年第1期9卷 124-125页

作者：无 Henrik Petrowsky HBSN the Department of surgery and transplantation at the University of Zürich Switzerland

Expert’s introduction *** Petrowsky(Figure 1)is a Professor of surgery and Vice-Chair of the Department of surgery and transplantation at the University of Zürich,*** serves as program Director of the HPB surgery and liver Transplant Fellowship at the Swiss HPB and Transplant Center *** is heading the liver and Pancreas Tumor Center,which is embedded in the Comprehensive Cancer Center Zurich at the University Hospital *** current practice consists of liver transplantation and HPB *** research interests have mirrored his clinical work mainly focusing on translational and outcome research in liver transplantation and hepatobiliary surgery.

关键词： surgery surgery hepato

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