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Major complications of adult right lobe living liver donors

Hepatobiliary & Pancreatic Diseases International 2015年第2期14卷 150-156页

作者： Necdet Guler Onur Yaprak Yusuf Gunay Murat Dayangac Murat Akyildiz Fisun Yuzer Yildiray Yuzer Yaman Tokat Liver transplantation center Florence Nightingale Hospital

BACKGROUND：The right lobe of the liver is generally preferred for living donor liver transplantation in adult patients with end-stage liver *** is important to know the preoperative factors relating to the major postoperative *** therefore evaluated the possible risk factors for predicting postoperative complications in right lobe liver ***：Data from 378 donors who had undergone right lobe hepatectomy at our center were evaluated retrospectively. The factors we evaluated induded donor age, gender, body mass index （BMI）, remnant liver volume, operation time, history of previous abdominal surgery, inclusion of the middle hepatic vein and variations in the portal and bile systems. RESUEI＇S： Of the 378 donors, 219 were male and 159 female. None of the donors died, but 124 （32.8%） donors experienced complications including major complications （Clavien scores III and IV） in 27 （7.1%）. Univariate analysis showed that complica- tions were significantly associated with male gender and higher BMI （P〈0.05）, but not with donor age, remnant liver volume, operation time, graft with middle hepatic vein, variations in the portal and bile systems and previous abdominal surgery （P〉0.05）. Multivariate logistic regression analysis showed that major complications were significantly associated with male gender （P=0.005） and higher BMI （P=0.029）. Moreover, the Chi- square test showed that there were significant relationships between major complications and male gender （P=0.010,Z2=6.614, df=l） and BMI 〉25 kg/m2 （P=-0.031, Z2=8.562, df-1）. Of the 96 male donors with BMI 〉25 kg/m2, 14 （14.6%） with major complications had significantly smaller mean remnant liver volume than those （82, 85.4%） without major complications （32.50%± 4.45% vs 34.63%±3.11%, P=0.029）.CONCLUSION： Male donors with BMI 〉25 kg/m2 and a remnant liver volume 〈32.50% had a significantly increased risk for major complications.

关键词： living donor right lobe liver donor major complications risk factors

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Future directions for research on tissue-engineered trachea

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Bio-Design and Manufacturing 2022年第3期5卷 627-632页

作者： Hai Tang Weiyan Sun Yi Chen Yunlang She Chang Chen Department of Thoracic Surgery Shanghai Pulmonary HospitalTongji University School of MedicineShanghai 200433China Shanghai Engineering Research center of lung transplantation Shanghai 200433China

As the only way for air to enter the lungs,the trachea plays an indispensable role in conducting,cleaning,and humidifying ***,trauma,and congenital disease of the trachea are serious threats to patients[1].Local tracheal disease can be treated with a balloon or stent,but for extensive tracheal disease,tracheal reconstruction after surgical resection is the only treatment[2–4].However,the tension of the anastomotic site also increases with expansion of the resection range,which causes a series of complications,such as poor anastomotic healing,anastomotic fistulae,and tracheal rupture,and even life-threatening complications in severe cases[5].

关键词： balloon healing congenital

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Simultaneous liver and kidney transplantation： analysis of a single-center experience

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Chinese Medical Journal 2010年第10期123卷 1259-1263页

作者： MA Yi WANG Guo-dong HE Xiao-shun LI Qiang LI Jun-liang ZHU Xiao-feng WANG Chang-xi Organ transplantation center the First Affiliated Hospital Sun Yat-Sen University Guangzhou Guangdong 510080 China

Background Simultaneous liver and kidney transplantation （SLKT） has been proven to be a favorable treatment for combined renal and hepatic end-stage disease. However, recipients receiving SLKT have a long medical history, poor general condition that is often accompanied by anemia, hypoalbuminemia, coagulopathy, water-electrolyte imbalance and acid-base disorders. This study aimed to explore the indications, surgical techniques, therapeutic experience, prevention and treatment of postoperative complications of SLKT. Methods The clinical data of 22 SLKTs cases performed at the First Affiliated Hospital of Sun Yat-sen University from January 2001 to December 2008 were retrospectively studied. Indications for SLKT, surgical techniques, perioperative fluid management, immunosuppressive regimen and experience in prevention and treatment of postoperative complications were analyzed. Results All operations were successfully performed. Postoperative complications occurred in 13 cases （59.1%）, including pleural effusions （7）, intra-abdominal bleeding （2）, biliary complications （2）, repeated upper gastrointestinal bleeding （1）, and acute liver graft rejection （1）. All complications were treated conservatively. In this study, there were five deaths during follow-up, in which three perioperative deaths occurred due to serious conditions. Mortality at 3 months was 13.6%. The one and three year patient survival rate was 81.3% and 73.9% respectively. Conclusions SLKT is an effective therapy for end-stage liver disease with chronic renal failure or severe damage to renal function. It is a complex surgical procedure, causing a large disturbance of circulation and fluid balance, and more postoperative complications. The SLKT surgical techniques selected are based on the experience of surgeons, the anatomy of the recipient and primary diseases. It is essential to use the correct perioperative fluid management, reasonable immunosuppressive regimen, and prevention and treatment of postop

关键词： liver transplantation kidney transplantation treatment

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Application of nucleoside analogues to liver transplant recipients with hepatitis B

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World Journal of Gastroenterology 2015年第42期21卷 12091-12100页

作者： Zhuo-Lun Song Yu-Jun Cui Wei-Ping Zheng Da-Hong Teng Hong Zheng Organ transplantation center Tianjin Key Laboratory of Organ Transplantation Tianjin First Center Hospital Swiss Hepato-Pancreato-Biliary center Department of Visceral and Transplantation Surgery University Hospital Zurich

Hepatitis B is a common yet serious infectious disease of the liver, affecting millions of people worldwide. Liver transplantation is the only possible treatment for those who advance to end-stage liver disease. Donors positive for hepatitis B virus(HBV) core antibody(HBc Ab) have previously been considered unsuitable for transplants. However, those who test negative for the more serious hepatitis B surface antigen can now be used as liver donors, thereby reducing organ shortages. Remarkable improvements have been made in the treatment against HBV, most notably with the development of nucleoside analogues(NAs), which markedly lessen cirrhosis and reduce post-transplantation HBV recurrence. However, HBV recurrence still occurs in many patients following liver transplantation due to the development of drug resistance and poor compliance with therapy. Optimized prophylactic treatment with appropriate NA usage is crucial prior to liver transplantation, and undetectable HBV DNA at the time of transplantation should be achieved. NA-based and hepatitis B immune globulin-based treatment regimens can differ between patients depending on the patients' condition, virus status, and presence of drug resistance. This review focuses on the current progress in applying NAs during the perioperative period of liver transplantation and the prophylactic strategies using NAs to prevent de novo HBV infection in recipients of HBc Ab-positive liver grafts.

关键词： Nucleoside analogues Liver transplantation Hepatit

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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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Up-to-seven criteria for hepatocellular carcinoma liver transplantation:a single center analysis

Up-to-seven criteria for hepatocellular carcinoma liver tran...

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2013中国器官移植大会

作者： Jianyong Lei Lunan Yan Bo Li Tianfu Wen Wentao Wang Mingqing Xu Jiaying Yang Yonggang Wei Liver transplantation center West China Hospital of Sichuan University

Aim The aim of our study was to detect whether the up—to—seven should be used as inclusion criteria for liver transplantation for hepatocelluar carcinoma. Patients and methods Between April 2002 and July 2008,220 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-to-seven group(Group 3).Then,we compared long-term survival and tumor recurrence of these three groups. Results The baseline characteristics of transplant recipients were comparable among these three groups,except for the type of

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Recurrent hepatitis C after liver transplant

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World Journal of Gastroenterology 2014年第31期20卷 10668-10681页

作者： Andrew S deLemos Paul A Schmeltzer Mark W Russo Department of Medicine Center for Liver Diseases and Transplantation Carolinas Medical Center

End stage liver disease from hepatitis C is the most common indication for liver transplantation in many parts of the world accounting for up to 40% of liver transplants. Antiviral therapy either before or after liver transplantation is challenging due to side effects and lower efficacy in patients with cirrhosis and liver transplant recipients, as well as from drug interactions with immunosuppressants. Factors that may affect recurrent hepatitis C include donor age, immunosuppression, IL28 B genotype, cytomegalovirus infection, and metabolic syndrome. Older donor age has persistently been shown to have the greatest impact on recurrent hepatitis C. After liver transplantation, distinguishing recurrent hepatitis C from acute cellular rejection may be difficult, although the development of molecular markers may help in making the correct diagnosis. The advent of interferon free regimens with direct acting antiviral agents that include NS3/4A protease inhibitors, NS5 B polymerase inhibitors and NS5 A inhibitors holds great promise in improving outcomes for liver transplant candidates and recipients.

关键词： Hepatitis C Liver transplant Donor risk factors Immunosuppression Protease inhibitors Fibrosing cholestatic hepatitis C Acute cellular rejection Cytomegalovirus

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Short-term postoperative bacteriobilia or fungibilia in liver transplantation patients with donation after circulatory death allografts associated with a longer hospital stay:A single-center retrospective observational study in China

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Hepatobiliary & Pancreatic Diseases International 2024年第6期23卷 566-572页

作者： Chen-Xue Guo Jian-Hua Li Zheng-Xin Wang Wan-Zhen Li Jing Zhang Hao Xing Su Liu Tian Wei Li Li Rui-Dong Li Institute of Antibiotics Huashan HospitalFudan UniversityShanghai 200040China Key Laboratory of Clinical Pharmacology of Antibiotics Shanghai 200040China National Clinical Research center for Aging and Medicine Huashan HospitalFudan UniversityShanghai 200040China Liver transplantation center Department of General SurgeryHuashan HospitalFudan UniversityShanghai 200040China Institute of Organ transplantation Fudan UniversityShanghai 200040China Clinical Pharmacology Research center Huashan HospitalFudan UniversityShanghai 200040China Department of Biostatistics School of Public HealthFudan UniversityShanghai 200040China NHC Key Laboratory of Health Technology Assessment Fudan UniversityShanghai 200040China Department of Critical Care Medicine Huashan HospitalFudan UniversityShanghai 200040China

Background:Normal bile is *** have shown that cholangitis after liver transplantation(LT)was associated with a relatively poor *** remains unclear whether the bacteriobilia or fungibilia impact the patient outcomes in LT recipients,especially with donation after circulatory death(DCD)allografts,which was correlated with a higher risk of allograft ***:This retrospective study included 139 LT recipients of DCD grafts from 2019 to *** patients were divided into two groups according to the presence or absence of bacteriobilia or *** prevalence and microbial spectrum of postoperative bacteriobilia or fungibilia and its possible association with outcomes,especially hospital stay were ***:Totally 135 and 171 organisms were isolated at weeks 1 and 2,*** all patients included in this analysis,83(59.7%)developed bacteriobilia or fungibilia within 2 weeks *** occurrence of bacteriobilia or fungibilia[β=7.43,95%CI(confidence interval):0.02 to 14.82,P=0.049],particularly the detection of Pseudomonas(β=18.84,95%CI:6.51 to 31.07,P=0.003)within 2 weeks post-transplantation was associated with a longer hospital ***,it did not affect the graft and patient ***:The occurrence of bacteriobilia or fungibilia,particularly Pseudomonas within 2 weeks posttransplantation,could influence the recovery of liver function and was associated with prolonged hospital stay but not the graft and patient survival.

关键词： Pseudomonas spp. Early allograft dysfunction Donor creatinine Perioperative bleeding Intraoperative blood transfusion

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A single-center experience of venous thromboembolism after adult lung transplantation

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China Medical Abstracts(Internal Medicine) 2019年第4期36卷 215-216页

作者： ZHAO Li lung Transplant center China-Japan Friendship HospBeijing 100029

Objective To investigate the incidence of venous thromboembolism(VTE)in lung transplant(LT)*** The clinical data on 124 consecutive patients who underwent lung transplant at lung transplantation center of China-Japan Friendship Hospital from March 2017 to September 2018 were retrospectively *** venous thrombosis(DVT)was ascertained by vascular *** embolism(PE)was diagnosed by either chest computed tomography pulmonary angiogram or ventilation/perfusion *** risk factors in those patients with postoperative VTE were studied.

关键词： VTE DVT lung

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"Metroticket" predictor for assessing liver transplantation to treat hepatocellular carcinoma:A single-center analysis in China's mainland

"Metroticket" predictor for assessing liver transplantation ...

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2013中国器官移植大会

作者： Jianyong Lei Lunan Yan Bo Li Tianfu Wen wentao Wang Mingqing Xu jiaying Yang Yonggang Wei Liver transplantation center West China Hospital of Sichuan University

Background and Aims The"Metroticket"prognostic model for survival after liver transplantation(LT)for hepatocellular carcinoma(HCC)treatment has been implemented for several *** aim of our study was to validate the"Metroticket"predictor using alarge cohort of LT patients with HCC in China. Patients and Methods In total,230 cases of LT for HCC treatment at our center,from July 2000 to August 2008,were included in the present *** predictive 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 analyzed.

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