Objective To investigate the clinical choice on graft size and the type of donor’s hepatectomy in adult living related partial liver transplantation. Methods The literatures in recent years on the donor’s evaluation, the size of liver grafts, the types of donor hepatectomy and safety of donor in adult living related partial liver transplantation were reviewed.Results The size of liver graft is a crucial factor related to the safety of donor and the prognosis of the recipient. GW/ESLW≥30%, GW/BW≥0.8% may be the lowest limits. Left lobe contained middle hepatic vein, extended left lobe with leftside caudle lobe, right lobe or extended right lobe contained middle hepatic vein may be the practical choice.Conclusion It is important to make a reasonable choice of liver graft according to the estimation of GW/ESLW or GW/BW, and the anatomy of liver in adult living related partial liver transplantation.
Objective To analyze the effect of monitoring and modulating the portal vein pressure and blood flow during living donor liver transplantation （LDLT） on preventing small-for-size-syndrome (SFSS). Methods Data of forty-four LDLT recipients between Oct.2007 and Oct.2008 were reviewed. Actual graft-to-recipient weight ratio（GRWR）, portal vein flow and pressure during operation and syndrome of SFSS after operation were recorded. The patients received splenectomy or splenic artery ligation according to actual GRWR, portal vein flow and pressure and WBC. Relationships between patients’ GRWR, portal vein flow, portal vein pressure and occurrence of SFSS were analyzed. Results Six patients received splenectomy and 7 patients received splenic artery ligation to decrease the portal vein flow and pressure during the operation. The portal vein flow and pressure decreased after splenectomy （Plt;0.05）. The portal vein pressure decreased （Plt;0.05） and the portal vein flow had no significant change after splenic artery ligation （P＞0.05）. No SFSS occurred after operation. Conclusion Modulation of portal vein flow and pressure by splenectomy or splenic artery ligation during LDLT operation can decrease the portal vein flow and pressure, and which can prevent the incidence of SFSS.
【Abstract】Objective To review the recent advances in the use of marginal liver in liver transplantation. Methods The literatures of recent years on the use of marginal liver for liver transplantation were reviewed and summarized.Results The donors with older age, hemodynamic instability, long stay in the intensive care unit and fatty liver are significantly clinical marginal liver donors.Conclusion Though the use of marginal liver donors negatively influences the results of liver transplantation, marginal liver expands the liver source for liver transplantation with a good result.
Objective To summarize the experience of the prevention of early arterial compl ications after hepatic artery (HA) reconstruction in adult-to-adult l iving donor l iver transplantation (A-A LDLT). Methods Between January 2002and March 2008, 127 patients underwent A-A LDLT. Of the 131 donors (127 cases of right lobe graft, 4 cases of left lobe graft), there were 69 males and 62 females with a mean age of 36.2 years (range, 19-65 years); in 127 recipients, there were 109 males and 18 females with a mean age of 41.9 years (range, 18-64 years). All patients underwent microsurgical reconstruction of HA between grafts and recipients. The artery of graft was anastomosed to the right HA in 62 cases, to the proper HA in 34 cases, to the left HA in 7 cases, to the common HA in 6 cases, and aberrant right HA rising from superior mesenteric artery in 8 cases. Interposition bypass using great saphenous vein (GSV) was performed between the donor right HA and recipient common HA in 5 cases. Bypass was performed between the donor right HA and recipient abdominal aorta using GSV in 2 cases, or using cryopreserved cadaveric il iac vessels in 3 cases. Results Of these 127 cases, hepatic artery thrombosis (HAT) occurred in 2 recipients (1.6%) at 1 day and 7 days following A-A LDLT, which were successfully revascularized with GSV between right HA of donor and abdominal aorta of recipient, HAT in 1 patient occurred on the 46th postoperative day with no symptom. No other arterial compl ication such as HA stenosis and aneurysm occurred in recipients. All patients were followed up 9-67 months. At 1, 2, and 3 years, actual survival rateswere 82.2%, 64.7%, and 59.2%. No death was related to HA compl ication in peri-operative period. Conclusion The anatomic structure and variation of HA, the pathological changes, as well as surgical technique in HA reconstruction, have direct impact on the risk of postoperative compl ications of HA reconstruction.
Objective To discuss venous drainage types of median hepatic lobe and their guiding significances on the selection of grafts. Methods Between April 2005 and March 2009, 109 potential living donors underwent 3-dimensional reconstruction of computed tomography (CT) and the volume of graft was determined in the center of organ transplantation of Ruijin Hospital. The venous drainage types of median hepatic lobe of each donor were analyzed by the computer-based liver operation-planning system in detail to assign middle hepatic vein (MHV) types according to Marcos classification and venous types of Ⅳb segment according to Nakamura classification. Results The branching pattern of MHV was divided into 3 types: Type Ⅰ and Ⅱwere relatively more accounting for 44.0% （48/109）, 37.6% （41/109）, and type Ⅲ was fewest 〔18.3% （20/109）〕. There were no significant differences in volume of whole liver, volume of left liver or left liver/total liver volume ratio among various types of MHV of the donor (Pgt;0.05). Ⅳb vein was also divided into 3 types: The most common was type Ⅰ, accounting for 72.4% (79/109); Type Ⅱ 〔12.8% （14/109）〕, type Ⅲ 〔14.7% （16/109）〕 were relatively fewer. At last, 37 donors provided right liver, for Marcos Ⅰ, Ⅱ, and Ⅲ type of donors, donors remained with MHV was 12/17, 8/11, and 5/9; for Nakamura Ⅰ, Ⅱ, and Ⅲ type of donors, those number were 16/26, 4/6, and 5/5. Conclusion In adult-to-adult living donor liver transplantation, there may be great significances in accordance with Marcos and Nakamura typing results to harvest right lobe liver graft with or without MHV.
Minimally invasive surgery played a crucial role in modern medicine. With advantages such as less trauma, precise operation, minimal bleeding, and rapid postoperative recovery, minimally invasive procedures had been increasingly applied in the field of liver transplantation in recent years. This included techniques such as small incision living donor hepatectomy through an upper abdominal midline incision, laparoscopic-assisted living donor hepatectomy, pure laparoscopic living donor hepatectomy, and robotic living donor hepatectomy. Since Professor Cherqui from France firstly reported the total laparoscopic left lateral sectionectomy in living donors in 2002, the application of minimally invasive technology in living donor liver transplantation had become increasingly widespread. Based on this, so as to guide the more standardized, effective, and safe implementation of minimally invasive liver donor hepatectomy across the country, in August 2023, the Branch of Organ Transplant of Chinese Medical Association and the Branch of Organ Transplant Physicians of Chinese Medical Doctor Association organized national liver transplantation experts to jointly formulate the “Chinese guidelines for minimally invasive surgical techniques in living donor liver transplantation (2024 edition)”. This is to provide scientific guidance and reference for surgeons performing minimally invasive surgery on living liver donors in China.
Objective To investigate quality of life of pediatric living donor liver transplantation recipient (PLDLTR) and analyze it’s influencing factors. Methods The convenient sampling method was adopted. Fifty-three PLDLTRs from May 2012 to January 2017 in the West China Hospital of Sichuan University were selected. At the same time, 56 children who participated in the physical examination and had no abnormality results were selected as reference (control group), their age and gender matched with the PLDLTRs. A general data inventory and a self-assessment scale for children’s quality of life (Pediatric Quality of Life Inventory 4 Generic Core Scales, PedsQL4.0) were used to evaluate the quality of life of the 53 PLDLTRs. Results A total of 53 questionnaires were distributed to all the 2 groups, all of them were effectively recovered. The points of quality of life of the physiological function, emotional function, social function, and school performance for the PLDLTRs were significantly higher than those of the control group (P<0.050), which for the PLDLTRs with male and more than 3 years after the operation were significantly higher than those of the PLDLTRs with female and within 1 year after the operation (P<0.050). For the PLDLTRs with age >4 years old, the points of the emotional function, social function, and school performance were significantly higher than those of the PLDLTRs with age ≤4 years old. For the PLDLTRs without postoperative complications, the points of quality of life of the physiological function, emotional function, and school performance were significantly higher than those of the PLDLTRs with Ⅱ grade of postoperative complications (P<0.050). Conclusions Life quality of PLDLTR is poorer than that of normal children. Postoperative time, postoperative complications, age, and gender are certainly associated with quality of life for PLDLTR.
ObjectiveTo explore modified methods and outcomes of collection of donor blood from donation after citizen death (DCD). MethodThe clinicopathologic data of 26 DCD donors underwent phase Ⅰ clinical trials and 6 patients who received donor blood by modified collection technique from May 2020 to November 2021 in the West China Hospital of Sichuan University were collected retrospectively. ResultsCompared with the data of 26 DCD donors at phase Ⅰ clinical trials, after the modified collection technique, the blood collection volume, the concentrated red blood cells following filtration, centrifugation, and the amount of concentrated red blood cell/kg body mass were more (P<0.05). In addition, compared with the components of stored red blood cell suspension, the pH value, sodium and chloride ions concentrations of the red blood cell suspension obtained after modified collection technique were higher (P<0.05), the potassium ion concentration was <1 mmol/L, and the lactic acid concentration of none of blood was >15 mmol/L. ConclusionThe adoption of the modified collection technique increases the amount of donor red blood collected, and its biochemical and electrolyte indicators are more in line with physiological requirements than those of stored blood.
Lung transplantation is the only treatment for patients with end-stage lung diseases. And this field is also a research hotspot in the international field at presen. Relevant researches not only promote the progress and development of lung transplantation, but also improve the life quality of patients after transplantation. With the development of lung transplantation technology, the guidelines for identifying candidates are constantly being revised, and the source of donor lungs has always been an urgent problem for all transplantation centers. The standardized management during transplantation period involves anesthesia induction, intraoperative fluid management, airway management, management of important operative steps and postoperative pain management. Extracorporeal life support (ECLS) includes cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO). With the progress and development of ECLS technology, the advantages of ECMO as a bridge for lung transplantation, intraoperative and postoperative circulatory support are becoming more and more prominent, enabling recipient patients to successfully pass the period of lung transplantation. Although lung transplantation in basic science and clinical researches has got a lot of progress, to improve the survival rate after transplantation, we must overcome many challenges including how to successfully perform lung transplantation, expand lung donor library, induce tolerance, and prevent complications after transplantation, primary graft dysfunction (PGD), cell and antibody mediated rejection and infection.
ObjectiveTo observe the clinical effect of Rituximab combined with intravenous immunoglobulin (IVIG) in preventing blood group antibody mediated rejection (AMR) in pediatric ABO incompatible living donor liver transplantation (ABOi-LDLT).MethodsA total of 503 cases of pediatric living donor liver transplantation in Beijing Friendship Hospital Affiliated to Capital Medical University from June 2013 to December 2020 were retrospectively collected; the overall survival of recipient and graft were compared between ABOi-LDLT and ABO compatible living donor liver transplantation (ABOc-LDLT), and we summarized the data of AMR in 7 cases received Rituximab+IVIG protocol.ResultsThere were 53 cases of ABOi-LDLT and 450 cases of ABOc-LDLT in our study. The 5-year cumulative survival rate of recipients and grafts was 98.0% and 96.0% in the ABOi-LDLT group respectively, and in ABOc-LDLT group was 92.2% and 89.1% respectively, there was no significant difference between the two groups (P=0.232, P=0.381）. Seven children with blood group antibody titer >1∶64 were included in the study. On the basis of classical intensive immunosuppressive therapy, all patients were treated with Rituximab+IVIG. The blood group antibody titer of 6 patients remained stable, and no rejection occurred; one patient developed severe AMR and graft failure, and recovered after salvage treatment of ABOc-LDLT.ConclusionRituximab+IVIG can be used as an effective therapeutic option to prevent blood group AMR after ABOi-LDLT.