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

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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MicroRNAs in Common Human diseases

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Genomics, Proteomics & Bioinformatics 2012年第5期10卷 246-253页

作者： Yu Li Kris V.Kowdley Benaroya Research Institute and center for liver disease Digestive Disease InstituteVirginia Mason Medical Center

MicroRNAs （miRNAs） are a class of short non-coding RNA molecules that have attracted tremendous attention from the biological and biomedical research communities over the past decade. With over 1900 miRNAs discovered in humans to date, many of them have already been implicated in common human disorders. Facilitated by high-throughput genomics and bioinformatics in conjunction with traditional molecular biology techniques and animal models, miRNA research is now positioned to make the transition from laboratories to clinics to deliver profound benefits to public health. Herein, we overview the progress of miRNA research related to human diseases, as well as the potential for miRNA to becoming the next generation of diagnostics and therapeutics.

关键词： MicroRNA Human diseases Diagnostics Therapeutics Biomarker

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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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Implications of the immunoregulatory functions of mesenchymal stem cells in the treatment of human liver diseases

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Cellular & Molecular Immunology 2011年第1期8卷 19-22页

作者： Hu Lin Ruonan Xu Zheng Zhang Liming Chen Ming Shi Fu-Sheng Wang liver disease Research center for Biological Therapy Beijing 302 HospitalBeijingChina

Transplantation of mesenchymal stem cells(MSCs)has been recently studied in animal models,and in clinical trials of patients with fulminant hepatic failure,end-stage liver diseases and inherited metabolic *** cytokines produced by MSCs can inhibit immunocyte proliferation and migration to the liver,thereby attenuating inflammatory injury and reducing hepatocyte *** addition,MSCs play an important role in regressing liver fibrosis and in supporting the function,proliferation and differentiation of endogenous hepatocytes under appropriate *** remarkable progress has been achieved in basic and clinical MSC studies,optimal therapeutic regimens for the clinical application of MSCs,such as optimal doses,transplantation routine and interval period for transplantation,need to be elucidated in ***,the long-term safety and therapeutic efficacy of MSC transplantation should be evaluated in future clinical *** review summarizes our current understanding of the immunomodulatory effects of MSC therapies on human liver diseases.

关键词： immunomodulation liver diseases mesenchymal stem cells transplantation

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Herb-Induced liver Injury: A Global Concern

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Chinese Journal of Integrative Medicine 2018年第9期24卷 643-644页

作者： Neil Kaplowitz USC Research center for liver disease USC Keck School of Medicine

Chinese medicine and herb medicine though used to treat liver diseases are an important cause of liver injury. Many phytochemicals have the potential to injure the liver, some in a dose-related fashion and more often in an idiosyncratic fashion, meaning occurrence is uncommon to rare in the population using these treatments. As is the case with pharmaceuticals, the phytochemicals are usually tolerated despite either no or mild transient subclinical injury but rarely in some susceptible patients cause moderate to severe liver injury which is likely mediated by the adaptive immune system.

关键词： herb-induced liver injury diagnosis and management guideline Chinese medicine

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Development and Validation of a Metabolic-related Prognostic Model for Hepatocellular Carcinoma

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Journal of Clinical and Translational Hepatology 2021年第2期9卷 169-179页

作者： Junyu Huo Liqun Wu Yunjin Zang liver disease center The Affiliated Hospital of Qingdao UniversityQingdaoShandongChina

Background and Aims:Growing evidence suggests that metabolic-related genes have a significant impact on the occurrence and development of hepatocellular carcinoma(HCC).However,the prognostic value of metabolic-related genes for HCC has not been fully ***:mRNA sequencing and clinical data were obtained from The Cancer Genome Atlas and the GTEx Genotype-Tissue Expression comprehensive *** expressed metabolic-related genes in tumor tissues(n=374)and normal tissues(n=160)were identified by the Wilcoxon ***-dependent receiver operating characteristic curve analysis,univariate multivariate Cox regression analysis and Kaplan-Meier survival analysis were used to evaluate the predictive effectiveness and independence of the prognostic *** independent cohorts(International Cancer Genome Consortiums and GSE14520)were applied to verify the prognostic ***:Our study included a total of 793 patients with *** constructed a risk score consisting of five metabolic-genes(BDH1,RRM2,CYP2C9,PLA2G7,and TXNRD1).For the overall survival rate,the low-risk group had a considerably higher rate than the high-risk *** and multivariate Cox regression analyses indicated that the risk score was an independent predictor for the prognosis of ***:We constructed and validated a novel prognostic model,which may provide support for the precise treatment of HCC.

关键词： Hepatocellular carcinoma Metabolic Prognostic Signature

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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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An extended treatment protocol with pegylated interferon and ribavirin for hepatitis C recurrence after liver transplantation

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World Journal of Hepatology 2011年第7期3卷 198-204页

作者： Nikroo Hashemi Victor Araya Kashif Tufail Laxmi Thummalakunta Eyob Feyssa Ashaur Azhar Mumtaz Niazi Jorge Ortiz Division of Hepatology Center for Liver Disease and TransplantationAlbert Einstein Medical Center Division of Transplant Surgery Center for Liver Disease and TransplantationAlbert Einstein Medical Center

AIM: To evaluate the efflicacy and tolerability of an extended treatment protocol and to determine the predictors of sustained virological response (SVR) after liver transplantation (LT).METHODS: Between August 2005 and November 2008, patients with recurrent hepatitis C virus (HCV) after LT were selected for treatment if liver biopsy showed at least grade 2 inflammation and/or stage 2 flibrosis. All patients were to receive pegylated interferon (PEG)/regimens combining ribavirin (RBV) for an additional 48 wk after HCV ***: Extended protocol treatment was initiated in thirty patients. Overall, 73% had end of treatmentresponse and 60% had SVR. Nineteen patients completed treatment per protocol, of them, sixteen (84%) had end of treatment response, and fourteen (74%) achieved SVR. Both early virological response and 24-week virological response were individually associated with SVR but this association was not signif icant on multivariate analysis. Eleven patients (37%) discontinued therapy due to adverse effects. Cytopenias were the most common and most severe adverse effect, and required frquent growth factor use, dose adjustments and treatment cessations. The risk of rejection was not ***: Recurrent HCV after LT can be safely treated with extended virological responseguided therpy using PEG/RBV, but requires close monitoring for treatment-related adverse effects, particularly cytopenias.

关键词： Hepatitis C virus liver transplantation Extended treatment protocol

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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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A single center analysis of long-term outcomes and survival related risk factors in liver retransplantation

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Hepatobiliary Surgery and Nutrition 2024年第3期13卷 425-443,I0011页

作者： Zhihao Li Yi Ping Sng Chao-Long Chen Chih-Che Lin Shih-Ho Wang Chee-Chien Yong liver Transplantation center and Department of Surgery Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung

Background:liver retransplant is the only option to save a patient with liver graft ***,it is controversial due to its poor survival outcome compared to primary *** deceased organ donation in Taiwan leads to high waitlist ***,living-donor grafts offer a valuable alternative for *** study aims to analyze the single center’s outcome in living donor liver retransplantation(re-LDLT)and deceased donor liver retransplantation(re-DDLT)as well as the survival related confounding risk ***:This is a single center retrospective study including 32 adults who underwent liver retransplantation(re-LT)from June 2002 to April *** cohort was divided into a re-LDLT and a re-DDLT group and survival outcomes were *** outcomes over different periods,the effect of timing on survival,and multivariate analysis for risk factors were also demonstrated Results:Of the 32 retransplantations,the re-LDLT group(n=11)received grafts from younger donors(31.3 vs.43.75 years,P=0.016),with lower graft weights(688 vs.1,457.2 g,P<0.001)and shorter cold ischemia time(CIT)(45 vs.313 min,P<0.001).The 5-year survival was significantly better in the re-LDLT group than in the re-DDLT group(100%vs.70.8%,P=0.02).This difference was adjusted when only retransplantation after 2010 was *** analysis showed that the timing of retransplantation(early ***)did not affect patient *** analysis revealed that prolonged warm ischemia time(WIT)and intraoperative blood transfusion were related to poor long-term ***:Retransplantation with living donor graft demonstrated good long-term outcomes with acceptable complications to both recipient and *** may serve as a choice in areas lacking deceased *** timing of retransplantation did not affect the long-term *** effort should be made to reduce WIT and massive blood transfusion as they contributed to poor survi

关键词： Retransplantation living donor liver retransplantation(re-LDLT) deceased donor liver retransplantation(re-DDLT) timing of retransplantation long-term outcome

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