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The role of liver transplantation for hilar cholangiocarcinoma

Hepatobiliary & Pancreatic Diseases International 2007年第3期6卷 248-253页

作者： Durgatosh Pandey Kang-Hoe Lee Kai-Chah Tan Hepatobiliary Surgery & liver transplantation Asian Centre for Liver Disease and Transplantation Gleneagles Hospital Singapore

BACKGROUND: Hilar cholangiocarcinoma is a devastating disease. Surgery is the only potentially curative modality. However, the results of surgical resection for hilar cholangiocarcinomas are disappointing. The introduction of liver transplantation for this condition has brought new hope for the management of this disease. The aim of this review is to discuss the role of liver transplantation in this disease. DATA SOURCES: A MEDLINE search was conducted for the articles on liver transplantation for hilar cholangiocarcinoma. Their results have been compiled and compared with the existing literature on resection for this disease. RESULTS: The earlier series on liver transplantation for hilar cholangiocarcinoma were not encouraging because of poor patient selection. The Mayo Clinic protocol of neoadjuvant chemoradiation followed by liver transplantation has shown remarkable success (survival at 1-, 3-, and 5-year post-transplantation being 92%, 82%, and 82%, respectively). With better patient selection and integration of neoadjuvant chemoradiation, the long-term survival is superior to that of the patients who undergo resection, as shown by the published literature on resection. The limitations of organ availability can be overcome by the living donor liver transplantation programme. This review article discusses the rationale, pros and cons of liver transplantation vis-à-vis resection for hilar ***: liver transplantation, especially living donor liver transplantation, is a new and exciting alternative to resection for hilar cholangiocarcinoma. Integration of neoadjuvant chemoradiation has the potential to further improve the curative potential of liver transplantation. The strategy of combining neoadjuvant chemoradiation and liver transplantation brings new hope for the treatment of this difficult disease.

关键词： liver transplantation hilar cholangiocarcinoma neoadjuvant chemoradiation.

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Outcomes following liver transplantation in intensive care unit patients

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World Journal of Hepatology 2013年第1期5卷 26-32页

作者： Lena Sibulesky Michael G Heckman C Burcin Taner Juan M Canabal Nancy N Diehl Dana K Perry Darren L Willingham Surakit Pungpapong Barry G Rosser David J Kramer Justin H Nguyen Department of transplantation Mayo ClinicJacksonvilleFL 32225United States Biostatistics unit Mayo ClinicJacksonvilleFL 32225United States Departments of transplantation and Critical Care Medicine Mayo ClinicJacksonvilleFL 32225United States Department of Critical Care Medicine and Internal Medicine Aurora Health CareMilwaukeeWI 53204United States

AIM:To determine feasibility of liver transplantation in patients from the intensive care unit (ICU) by estimating graft and patient ***:This single center retrospective study included 39 patients who had their first liver transplant directly from the intensive care unit and 927 non-ICU patients who were transplanted from hospital ward or home between January 2005 and December ***:In comparison to non-ICU patients,ICU patients had a higher model for end-stage liver disease (MELD) at transplant (median:37 vs 20,P liver transplantation (LT) with 6 patients (15%) requiring both vasopressin and *** ICU patients (41%) were ventilator dependent immediately prior to LT with 9 patients undergoing percutaneous tracheostomy prior to ***-five ICU patients (64%) required dialysis *** 1,3 and 5 years after LT,graft survival was 76%,68% and 62% in ICU patients vs 90%,81% and 75% in non-ICU *** survival at 1,3 and 5 years after LT was 78%,70% and 65% in ICU patients vs 94%,85% and 79% in non-ICU *** formally comparing graft survival and patient survival between ICU and nonICU patients using Cox proportional hazards regression models,both graft survival [relative risk (RR):1.94,95%CI:1.09-3.48,P=0.026] and patient survival (RR:2.32,95%CI:1.26-4.27,P=0.007) were lower in ICU patients vs non-ICU patients in single variable *** findings were consistent in multivariable *** not statistically significant,graft survival was worse in both patients with cryptogenic cirrhosis (RR:3.29,P=0.056) and patients who received donor after cardiac death (DCD) grafts (RR:3.38,P=0.060).These findings reached statistical significance when considering patient survival,which was worse for patients with cryptogenic cirrhosis (RR:3.97,P=0.031) and patients who were transplanted with DCD livers (

关键词： Donor pool Donor outcomes Onor after cardiac death grafts liver graft survival Patient survival

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

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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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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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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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Malaria after living donor liver transplantation:report of two cases

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Hepatobiliary & Pancreatic Diseases International 2008年第2期7卷 210-213页

作者： Durgatosh Pandey Kan-Hoe Lee Sin-Yew Wong Kai-Chah Tan Department of Hepatobiliary Surgery and liver transplantation Asian Centre for liver Diseases and transplantation Gleneagles Hospital Singapore Department of Respiratory Medicine and Intensive Care Asian Centre for liver Diseases and transplantation Gleneagles Hospital Singapore Department of Infectious Diseases Asian Centre for liver Diseases and transplantation Gleneagles Hospital Singapore

BACKGROUND:Infectious complications are common during the postoperative course of a liver transplant recipient. Malaria, however, is a rare complication in such a setting. METHOD:We report post-transplantation malaria causing elevation of liver enzymes in two recipients. RESULTS:Both patients who had undergone living donor liver transplantation showed elevated levels of liver enzymes and fever during the postoperative course. Investigations (including liver biopsy in one patient) were initially inconclusive in determining the cause of liver dysfunction. The diagnosis of malaria was established in both cases by peripheral blood smear. liver function transiently worsened with antimalarial treatment but subsequently became normal. CONCLUSION:This report highlights the importance of excluding such uncommon causes of post-transplantation liver dysfunction, especially when either the recipient or the donor comes from a region endemic for malaria.

关键词： liver transplantation malaria recipient

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Strategies to optimize the use of marginal donors in liver transplantation

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World Journal of Hepatology 2015年第26期7卷 2636-2647页

作者： Daniele Pezzati Davide Ghinolfi Paolo De Simone Emanuele Balzano Franco Filipponi Hepatobiliary Surgery and liver transplantation unit University of Pisa Medical School Hospital

liver transplantation is the treatment of choice for end stage liver disease, but availability of liver grafts is still the main limitation to its wider use. Extended criteria donors(ECD) are considered not ideal for several reasons but their use has dramatically grown in the last decades in order to augment the donor liver pool. Due to improvement in surgical and medical strategies, results using grafts from these donors have become acceptable in terms of survival and complications; nevertheless a big debate still exists regarding their selection, discharge criteria and allocation policies. Many studies analyzed the use of these grafts from many points of view producing different or contradictory results so that accepted guidelines do not exist and the use of these grafts is still related to non-standardized policies changing from center to center. The aim of this review is to analyze every step of the donationtransplantation process emphasizing all those strategies, both clinical and experimental, that can optimize results using ECD.

关键词： liver transplantation Extended criteria donors Mar

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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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Comparison of hepatitis B prophylactic outcomes in living donor liver transplantation recipients who meet the Milan or UCSF criteria

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Hepatobiliary & Pancreatic Diseases International 2013年第5期12卷 494-499页

作者： Li Jiang Lu-Nan Yan Tian-Fu Wen Bo Li Jia-Yin Yang liver transplantation Center Department of Liver SurgeryWest China HospitalSichuan University

BACKGROUND:The tumor burden before liver transplantation indicates that hepatitis B virus(HBV) may hide in the extrahepatic and micrometastatic sites which serve as a source of HBV ***,many liver transplant centers,especially in Western countries,use the Milan or UCSF criteria to select patients with hepatocellular carcinoma for liver *** study was undertaken to compare the HBV prophylactic outcomes in two groups of living donor liver transplantation(LDLT) *** in group A met the Milan criteria and those in group B exceeded the Milan criteria but were within the UCSF ***:A database of adult-to-adult right-lobe LDLT performed at our institution for HBV-related hepatocellular carcinoma within the Milan or UCSF criteria between June 2002 and May 2012 was used to compare the HBV prophylactic outcomes between patients within the Milan criteria(group A,41 patients) and those exceeding the Milan criteria but within the UCSF criteria(group B,19 patients).RESULTS:The 1-,3-,and 5-year survival rates were similar between groups A and B(87.8%,85.1% and 74.0% vs 73.3%,61.1% and 61.1%,respectively,P=0.067).HBV recurred in 1 patient in 3.1 months after LDLT in group A and in 2 patients in group B(1 in 11.9 months and 1 in 24.1 months after LDLT).The 1-,3-,and 5-year HBV recurrence rates were 2.6%,2.6% and 2.6% in group A,and 7.3%,17.9% and 17.9% in group B,respectively(P=0.118).CONCLUSION:LDLT recipients who exceed the Milan criteria but remain within the UCSF criteria may have post-transplant HBV prophylactic outcomes similar to those who meet the Milan criteria.

关键词： living donor liver transplantation hepatitis B virus hepatocellular carcinoma antiviral therapy

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Risk factors for hepatocellular carcinoma recurrence after liver transplantation

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Hepatoma Research 2020年第8期6卷 46-66页

作者： Pierluigi Toniutto Ezio Fornasiere Elisa Fumolo Davide Bitetto Hepatology and liver transplantation unit Azienda Sanitaria Universitaria IntegrataUdine 33100Italy

liver transplantation(LT)provides an excellent option for the long-term survival of patients with unresectable hepatocellular carcinoma(HCC)based on the Milan *** careful selection of patients,HCC may still recur after LT,which represents the most important negative predictor of post-transplant *** growing demand for LT in HCC has led to the expansion of patient selection criteria,with a resultant increase in the risk of post-transplant HCC *** tumor and host factors predict HCC *** morphological,histological,and serological characteristics of tumors in predicting HCC recurrence have been extensively ***,the type and duration of anticancer response before LT has also been considered a surrogate marker of tumor aggressiveness and is associated with the risk of *** demographic and clinical characteristics of recipients,as well as the type and duration of exposure to immunosuppressive therapy,represent the main host-related risk *** studies have attempted to describe predictive models for the risk of HCC recurrence,considering evaluable parameters both before and after *** many models have been proposed,relatively few have been externally validated on different patient *** paper aims to comprehensively summarize the available data on the predictive factors of HCC recurrence after LT,and to examine and discuss those that have been externally validated.

关键词： liver transplantation hepatocellular carcinoma tumor recurrence risk predictive model

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