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ABSTRACT: Precise evaluation of the live donor's liver is the most important factor for the donor's safety and the recipient's prognosis in living donor liver transplantation (LDLT). Our study assessed the clinical value of computer-assisted three-dimensional quantitative assessment and a surgical planning tool for donor evaluation in LDLT.
Computer-assisted three-dimensional (3D) quantitative assessment was used to prospectively provide quantitative assessment of the graft volume for 123 consecutive donors of LDLT and its accuracy and efficiency were compared with that of the standard manual-traced method. A case of reduced monosegmental LDLT was also assessed and a surgical planning tool displayed the precise surgical plan to avoid large-for-size syndrome.
There was no statistically significant difference between the detected graft volumes with computer-assisted 3D quantitative assessment and manual-traced approaches ((856.76 ± 162.18) cm(3) vs. (870.64 ± 172.54) cm(3), P = 0.796). Estimated volumes by either method had good correlation with the actual graft weight (r-manual-traced method: 0.921, r-3D quantitative assessment method: 0.896, both P < 0.001). However, the computer-assisted 3D quantitative assessment approach was significantly more efficient taking half the time of the manual-traced method ((16.91 ± 1.375) minutes vs. (39.27 ± 2.102) minutes, P < 0.01) to estimate graft volume. We performed the reduced monosegmental LDLT, a pediatric case, with the surgical planning tool (188 g graft in the operation, which was estimated at 208 cm(3) pre-operation). The recipient recovered without large-for-size syndrome.
Computer-assisted 3D quantitative assessment provided precise evaluation of the graft volume. It also assisted surgeons with a better understanding of the hepatic 3D anatomy and was useful for the individual surgical planning tool.
Chinese medical journal 04/2013; 126(7):1288-91. · 0.86 Impact Factor
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Li-Ying Sun,
Yun-Sheng Yang, Zhi-Jun Zhu,
Wei Gao,
Lin Wei,
Xiao-Ye Sun,
Wei Qu,
Wei Rao,
Zhi-Gui Zeng,
Chong Dong,
Jin-Peng Tu,
Jian Wang,
Yi-He Liu,
Yuan Liu,
Li-Xin Yu,
Yu Wang,
Jing Li,
Zhong-Yang Shen
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ABSTRACT: Congenital biliary atresia is a rare condition characterized by idiopathic dysgenesis of the bile ducts. If untreated, congenital biliary atresia leads to liver cirrhosis, liver failure and premature death. The present study aimed to evaluate the outcomes of orthotopic liver transplantation in children with biliary atresia.
We retrospectively analyzed 45 patients with biliary atresia who had undergone orthotopic liver transplantation from September 2006 to August 2012.
The median age of the patients was 11.0 months (5-102). Of the 45 patients, 41 were younger than 3 years old. Their median weight was 9.0 kg (4.5-29.0), 34 of the 45 patients were less than 10 kg. Thirty-one patients had undergone Kasai portoenterostomy prior to orthotopic liver transplantation. We performed 30 living donor liver transplants and 15 split liver transplants. Six patients died during a follow-up. The median follow-up time of surviving patients was 11.4 months (1.4-73.7). The overall 1-, 2- and 3-year survival rates were 88.9%, 84.4% and 84.4%, respectively.
With advances in surgical techniques and management, children with biliary atresia after liver transplantation can achieve satisfactory survival in China, although there remains a high risk of complications in the early postoperative period.
Hepatobiliary & pancreatic diseases international: HBPD INT 04/2013; 12(2):143-8. · 1.08 Impact Factor
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ABSTRACT: AIM: Whether percutaneous transluminal balloon dilatation (PTBD) or stent placement should be used in children with hepatic venous outflow obstruction (HVOO) is still controversial. The aim of the present study was to retrospectively describe experience in diagnosis and treatment of HVOO and to evaluate the outcome of PTBD in HVOO patients after pediatric liver transplantation (P-LT). METHODS: From January 2001 to January 2011, 54 children received P-LT at our center. The clinical features of children with HVOO analyzed included demography, type of donor and liver transplant, the new-onset symptoms, liver function test, interventional examination, and treatment and outcome. RESULTS: Three children were treated successfully with PTBD without stenting. All patients received percutaneous interventional management successfully. In the total of eight episodes of PTBD across the stenosis, the mean pressure gradient ± standard deviation was 16.6 ± 7.90 mmHg before PTBD and 6.8 ± 2.27 mmHg after PTBD. The difference was significant (P < 0.05). All of the three HVOO patients were still surviving with primary graft functioning normally until the last follow up. CONCLUSION: HVOO after P-LT should be taken seriously. PTBD is an effective and safe treatment for HVOO in younger patients subjected to P-LT and re-venoplasty is recommended even in patients with recurrent HVOO.
Hepatology Research 03/2013; · 2.20 Impact Factor
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ABSTRACT: Acute rejection remains an important cause of renal allograft dysfunction and the need for accurate diagnosis is essential to successfully treat transplant recipients. The purpose of this study was to determine the costimulatory molecules OX40 and OX40L messenger RNA (mRNA) levels in peripheral blood mononuclear cells (PBMCs) to predict acute renal transplant rejection.
The whole blood samples from 20 recipients with biopsy-confirmed acute rejection (rejection group), 20 recipients with stable graft function and normal biopsy results (stable group) after kidney transplantation, and 20 healthy volunteers (control group) were collected. The mRNA levels of OX40 and OX40L were analyzed with TaqMan real-time reverse transcriptase polymerase chain reaction (RT-PCR). The association of OX40 and OX40L mRNA levels with disease severity was investigated.
There was no significant difference of OX40, OX40L mRNA levels in PBMCs between the stable group and control group (P > 0.05). The levels of OX40 and OX40L mRNA were significantly higher in the rejection group than in the control group (P < 0.01 and P < 0.05, respectively). Non-significantly higher OX40L mRNA and significantly higher OX40 mRNA in PBMCs were observed in subjects in the rejection group compared with the stable group (P > 0.05 and P < 0.01, respectively). Receiver operating characteristic (ROC) curve analysis demonstrated that OX40 mRNA levels could discriminate recipients who subsequently suffered acute allograft rejection (area under the curve, 0.908). OX40 and OX40L mRNA levels did not significantly correlate with serum creatinine levels in the rejection group (P > 0.05). Levels of OX40 mRNA after anti-rejection therapy were lower than those at the time of protocol biopsy in the rejection group (P < 0.05).
Our data suggest that measurement of OX40 mRNA levels after transplant might offer a noninvasive means for recognizing recipients at risk of acute renal allograft rejection.
Chinese medical journal 11/2012; 125(21):3786-90. · 0.86 Impact Factor
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ABSTRACT: To investigate the diagnostic value of glypican-3 (GPC3) and its relationship with hepatocellular carcinoma (HCC) recurrence after liver transplantation.
HCC tissue samples (n = 31) obtained from patients who had undergone liver transplantation were analyzed. GPC3 mRNA and protein expression were analyzed by TaqMan real-time reverse transcription-polymerase chain reaction and immunohistochemistry. Correlation between the GPC3 expression and clinicopathological features was analyzed. The potential prognostic value of GPC3 was investigated by comparing recurrence-free survival between HCC patients with and without GPC3 expression.
Using a cutoff value of 3.5 × 10⁻², 20 of 31 cancerous tissues had expression values of > 3.5 × 10⁻², whereas 3 of 31 adjacent non-neoplastic parenchyma and 0 of 20 control liver tissues had expression values of > 3.5 × 10⁻² (P < 0.001). GPC3 protein was immunoexpressed in 68% of cancerous tissues, but not in adjacent non-neoplastic parenchyma and control liver tissues. Vascular invasion was significantly related to GPC3 expression (P < 0.05). Recurrence-free survival was significantly longer for patients without GPC3 mRNA overexpression (> 3.5 × 10⁻²) and those without vascular invasion (P < 0.05 for both).
GPC3 expression may serve as a valuable diagnostic marker for HCC. GPC3 mRNA overexpression may be an adverse indicator for HCC patients after liver transplantation.
World Journal of Gastroenterology 05/2012; 18(19):2408-14. · 2.47 Impact Factor
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ABSTRACT: ObjectiveTo analyze the expression and levels of serum proinflammatory cytokines including tumor necrosis factor alpha (TNF-α), and interleukin (IL)-6 in patients with hepatocellular carcinoma (HCC), who received orthotopic liver transplantation (OLT).
MethodsThe blood samples of 20 consecutive HCC patients who underwent liver transplantation were detected and analyzed for the clinical
serum biochemical parameters, TNF-α and IL-6. Blood samples were drawn from the radial artery at planned time points: preoperatively, intraoperatively, and postoperatively.
Levels of serum TNF-α and IL-6 were detected with enzyme-linked immunosorbent assay (ELISA).
ResultsThe levels of serum TNF-α and IL-6 increased significantly at reperfusion phase compared with those detected preoperatively (P < 0.01), and the level of serum IL-6 remained significantly higher until the third day after the liver transplantation. There
was a significant correlation between TNF-α and IL-6 (P < 0.001).
ConclusionThis research into the effects of the proinflammatory cytokines on liver transplantation has provided new insights into the
mechanisms of ischemia and reperfusion injury to OLT.
Key Wordsliver transplantation–carcinoma–hepatocellular–reperfusion–cytokines
Clinical Oncology and Cancer Research 04/2012; 8(1):38-41.
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ABSTRACT: The increasing demand for transplantation has led application of steatotic liver as the graft. The aim of this study was to determine the effect of donor graft steatosis on overall outcome and tumor recurrence after liver transplantation for hepatocellular carcinoma.
131 patients that underwent liver transplantation for hepatocellular carcinoma between 2007 and 2008 were included. Donor steatosis was categorized as non-steatosis group (0%-10%, n=101) and steatosis group (>10%, n=30). The Kaplan-Meier method and Cox proportional hazard regression model was used for data analysis.
Postoperative recipient survival rate was 81% and 66.6% at 1 and 3 years, respectively, for non-steatotic graft; 87.5% and 58.3% for mild steatosis; 83.3% and 41.7% for moderate to severe steatosis (p=0.303). Postoperative tumor recurrence rate was 15.8% and 28.7% at 1 and 3 years, respectively, for grafts with no steatosis; 8.3% and 20.8% for those with mild steatosis; 33.3% and 50% for those with moderate to severe steatosis, (p>0.05).
Steatotic donor was not associated with a worse prognosis in early stage postoperative and mild fatty liver did not increase tumor recurrence risks. The moderate to severe status of fatty liver had some effect on tumor recurrence.
Hepato-gastroenterology 03/2012; 59(115):858-62. · 0.66 Impact Factor
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Wei Qu,
Li-ying Sun, Zhi-jun Zhu,
Yong-lin Deng,
Xiao-ye Sun,
Wei Rao,
Ya-min Zhang,
Jian-jun Zhang,
Wen-tao Jiang,
Wei Gao,
Zhong-yang Shen
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ABSTRACT: To analyze the prognosis of hepatitis B virus (HBV) recurrence after liver transplantation.
Thirty-eight patients (37 males; 1 female) with HBV-related end-stage liver disease underwent liver transplantation at our institute between December 1998 and November 2009 and experienced HBV recurrence. Clinical data from pre-transplant and follow-up examinations were retrospectively retrieved from medical records, and included serologic indices of HBV (HBV DNA, markers of liver function) and histological findings from liver biopsy.
The median follow-up time was 45.1 months. The median time to HBV recurrence after transplantation was 31.8 months (range: 0.3 to 72.8 months) for histologically benign cases and 13.7 months (range: 0.3 to 66.6 months) for malignant cases. HBV DNA gene mutations were detected in 21% (8/38) of cases. Eighteen patients were treated with entecavir or adefovir, with respect to gene mutations, and HBV DNA fell below 103 copies/ml and liver function became normal. Twenty-two patients died, and causes of death included hepatocelluar carcinoma (HCC, n=18), organ failure (n=2), or infection (n=1).
HBV gene mutations and HCC recurrence were important risk factors for HBV recurrence in our study population. In addition, patients with benign liver diseases who received salvage therapy with adefovir or entecavir achieved a satisfactory prognosis.
Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 01/2012; 20(1):10-3.
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ABSTRACT: Aim: The aim of this study is to identify the titres of protective hepatitis B surface antibodies (anti-HBs) in the blood and their effective factors in the early stage after liver transplantation (LT) for hepatitis B virus (HBV) related diseases. The condition of anti-HBs lost in ascites fluid was also investigated. Methods: Twenty-six patients who received LT were administered prophylaxis of lamivudine combining intravenous hepatitis B immunoglobulin (HBIG) post-LT. The titres of anti-HBs were recorded and analyzed daily in blood and ascites fluid within the first week post-LT. Results: In the first 5 days post-LT, the titres of anti-HBs in HBV DNA positive groups, high hepatitis B surface antigen (HBsAg) groups, hepatitis B e antigen (HBeAg) positive groups were lower than that in the parallel HBV DNA negative groups, low HBsAg groups and HBeAg negative groups. The mean titre level of anti-HBs in ascites fluid is 224.89 IU/L and fluctuated from 0.00 IU/L to 968.50 IU/L, which is also correlated with anti-HBs titres in blood drawn at the same time (r = 0.927, P = 0.000). The level of anit-HBs in ascites fluid was very high; however, it fluctuated in a wide range (from 0.00 IU to 908.55 IU). Conclusions: Patients in high risk groups should receive a higher level of HBIG to maintain sufficient amounts of anti-HBs in the early stage post-LT, while the patients in low risk groups need a lower level of HBIG administration. Furthermore, the lost amount of anti-HBs in ascitic fluid post-LT has minimum impact on the anti-HBs titres in blood.
Hepatology Research 12/2011; 42(3):280-7. · 2.20 Impact Factor
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Zhi-jun Zhu,
Li-wei Zhu,
Wei Gao,
Wen-tao Jiang,
Ya-min Zhang,
Jian-jun Zhang,
Ming-sheng Huai,
Tao Yang,
Li-ying Sun,
Lin Wei,
Zhi-gui Zeng,
Jun-jie Li,
Zhong-yang Shen
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ABSTRACT: To investigate the donor evaluation, surgical protocol, and the complication for the adult-to-adult living donor liver transplantation (AALDLT).
There were 94 cases of AALDLT were performed by the same surgical team from January 2007 to August 2010. Patients aged from 18 to 74 years. Donors aged from 19 to 60 years. All the 94 cases' operation protocol as following, 2 cases with left lobe liver graft, 92 cases with right lobe graft, 44 cases with middle hepatic vein (MHV) harvested, and 48 cases without MHV. Assessment methods of donors, postoperative complications and the current survival were analyzed.
All the donors were discharged with good recovery, complication incidence of donor was 7.4%. Median time of follow-up was 37 months. Eight patients were died during follow-up, 1-year patient survival rate was 95.7%, and graft survival rate was 94.4%. One case complicated with small-for-size syndrome, 1 case was performed re-tranplantation for acute hepatic necrosis, 24 patients (25.5%) showed biliary anastomotic stenosis defined cholangiography or magnetic resonance cholangiopancreatography examination, and 9 patients (9.6%) showed abnormal liver function.
Living donor liver transplantation is an effective treatment method for end-stage liver disease, with accurate evaluation preoperative, a reasonable surgical approach, whether using the left or right lobe liver graft, with or without middle hepatic vein in AALDLT can effectively ensure the donor and recipient safety.
Zhonghua wai ke za zhi [Chinese journal of surgery] 12/2011; 49(12):1100-4.
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ABSTRACT: Use of livers infected with Clonorchis sinensis as donor organs for transplantation is controversial because of the potential associated risks. The low availability of donor livers at Tianjin First Center Hospital since 2003 prompted us to undertake cadaveric liver transplantation in 14 patients using donor livers infected with C. sinensis. None of the donors had been diagnosed with liver fluke infection before organ procurement, and in none of them was there laboratory evidence of abnormal liver function. After livers had been harvested and preserved, dead liver flukes were found in the bile of each donor; subsequent pathological examination of the flukes confirmed the diagnosis of clonorchiasis. Conventional orthotopic liver transplantation, with insertion of a T- tube, was undertaken in all 14 patients. Praziquantel, 25 mg/kg three times daily for two days, was administrated to the recipients starting on postoperative day 2. Results of tests of liver function improved rapidly after the operation in all of the patients. The median duration of follow-up was 31 months. The 1- and 3-year survival rates of the grafts were 85.7% and 78.6%, respectively. Postoperative biliary complications occurred in 2 patients (14.3%). No ova were detected in the bile or feces of any of the patients postoperatively. These findings suggest that livers infested with C. sinensis can be used as donor organs for liver transplantation. Further studies are required to establish definitive criteria for determining whether such donor organs may be used in a liver transplantation program.
Liver Transplantation 12/2010; 16(12):1440-2. · 3.39 Impact Factor
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Chinese medical journal 05/2010; 123(10):1353-5. · 0.86 Impact Factor
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Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 04/2010; 22(4):242-3.
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ABSTRACT: To discuss the technical improvement of the conventional thrombectomy for portal vein thrombosis (PVT) on liver transplantation.
The clinical data of 198 cases of liver transplantation with PVT who admitted in Tianjin First Central Hospital were analyzed retrospectively. According to the different treatments for PVT, these cases were divided into group A and group B. The conventional eversion embolectomy were performed in group A (n = 43) and the improved eversion embolectomy were performed in group B (n = 155). The general conditions, blood loss volumes, the achievement ratio of embolectomy, PVT recurrence rate and survival rate between the two groups were compared.
No statistical significance on operation time between two groups (P > 0.05); the achievement ratio of embolectomy for Yerdel I-II were 100% in two groups, however, the achievement ratio of embolectomy for Yerdel III in group B was higher than that of group A (100% vs. 45.45%; chi(2) = 12.38, P < 0.01). Blood loss volumes in group B was significantly lower than that of group A [(4315.4 +/- 630.5) ml vs. (3509.2 +/- 862.7) ml, P < 0.05]. No statistical significance on Yerdel I and II PVT recurrence rate between two groups (P > 0.05). While thrombosis recurrent rate of Yerdel III PVT in group B was lower than that of group A(5.6% vs. 2/5; chi(2) = 4.09, P < 0.05). Perioperative mortality of Yerdel I-III patients were both 0 in two groups. 1-year survival rate of Yerdel I-III patients was similar in two groups (86.5% vs. 89.0%, P > 0.05).
Improved eversion embolectomy can simplify the operation procedures, reduce blood loss, expand application range, increase the embolectomy success rate, decrease the PVT relapse rate.
Zhonghua wai ke za zhi [Chinese journal of surgery] 11/2009; 47(22):1681-4.
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ABSTRACT: To evaluate the living donor selection, donor hepatectomy technique, and surgical complication in living donor liver transplantation.
From June 2007 to July 2008, 74 consecutive cases living donor hepatectomy were performed by the same surgical team. Seventy-four donors (64 males and 10 females) with a mean age of 29.2 years old passed the donor liver assessment and evaluation program successfully. The hepatectomy procedure types contained right liver resection (n = 72), of which 27 cases harvested the middle hepatic vein and 45 cases not, left liver resection contain middle hepatic vein (n = 1) and left lateral resection (n = 1).
Of all the donors, operation time was (6.5 +/- 6.2) hours, the mean blood loss was 300 ml (100 - 500 ml) and didn't accept foreign blood transfusion. The maximum alanine aminotransferase (ALT) level was (229.5 +/- 108.6) U/L, the ALT returned to normal time was (12.7 +/- 4.8) d, the maximum total bilirubin (TB) level was (78.7 +/- 44.3) micromol/L, the TB returned to normal time was (8.8 +/- 2.7) d, and the mean hospital stay time was 14 days (7 - 28 d). The complications included bile leak (n = 1), cut surface hemorrhage (n = 1) and anaphylactoid purpura (n = 1). All the donors returned to normal work and life finally.
Precisely evaluating donor blood vascular and biliary anatomy before operation, keeping the blood vascular and bile duct integrity during operation and monitoring complication to solve it immediately after operation is crucial to ensure donor safety and recovering successfully.
Zhonghua wai ke za zhi [Chinese journal of surgery] 09/2009; 47(17):1309-11.
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ABSTRACT: The treatment algorithm of donor middle hepatic vein (MHV) was made depending on the remnant liver volume of the total donor liver volume as calculated by computer tomography, estimated graft-to-recipient weight ratio and also anatomy. The present study was to analyze the influence of this algorithm upon the safety of donors and recipients in right lobe living donor liver transplantation (LDLT) and to provide references for our future clinical practices.
Data of 73 consecutive LDLT cases, operated and managed by the same surgical team according to the pre-operation MHV treatment algorithm, were analyzed. MHV was harvested in 28 cases and not in 45 cases. Donor and recipient gender, age, weight, operation time, blood loss volume, graft weight, non-hepatic phase, graft cold preservation time, perioperative survival rate and the incidence of small-for-size syndrome were compared, and also the peak post-operative values of ALT, AST, T-bilirubin and D-bilirubin.
No donor needed blood transfusion and suffered small-for-size syndrome. One recipient recovered from small-for-size syndrome successfully by medical interventions. One recipient had acute hepatic necrosis at Day 6 post-operation and was converted into cadaveric liver transplantation. At Day 30 post-operation, one recipient died from disseminated infections and respiratory failure, but his liver function was normal. There was significant difference in donor and recipient age, actual GRWR, graft cold preservation time and recipient's ALT peak value between the MHV harvest group and the MHV non-harvest group.
The MHV treatment algorithm is safe to both donors and recipients.
Zhonghua yi xue za zhi 07/2009; 89(26):1825-9.
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ABSTRACT: To summarize the clinical feature of splenic artery aneurysms (SAA) in OLT recipient, and review the experience in diagnosis and management.
The clinical data, results of four-phase CT scanning and CT angiography of 450 recipients, who underwent OLT from December 2001 to December 2003 were analyzed statistically.
Twenty of 450 recipients were diagnosed as SAA, the incidence was about 4.4%. Nineteen of them were diagnosed by four-phase CT scanning. Fifteen patients did not receive any treatment for SAA during OLT, but two of them suffered SAA rupture after OLT, among which one died of hemorrhagic shock although emergency operations were performed. The five patients, who were performed splenectomy with SAA resection during transplantation, recovered successfully after OLT, and their grafts' function was satisfactory.
Morbidity of SAA is higher in patients of liver cirrhosis. Four-phase CT scanning can diagnose SAA exactly. In the early period post-OLT, SAA rupture happens frequently, so SAA resection should be performed during transplantation.
Zhonghua wai ke za zhi [Chinese journal of surgery] 06/2009; 47(11):818-20.
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Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 03/2009; 21(2):117-8.
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ABSTRACT: Although liver transplantation has become a standard therapy for end-stage liver diseases, the experience of pediatric liver transplantation is limited in China. In this article we report our experience in pediatric liver transplantation, and summarize its characters in their indications, surgical techniques, and postoperative managements.
Thirty-one children (< or = 18 years old) underwent liver transplantation in our centers. The mean age at transplantation was 12.4 years old (ranged from 5 months to 18 years) with 7 children being less than 4 years of age at transplantation. The most common diagnosis of patients who underwent liver transplantation were biliary atresia, Wilson's disease, primary biliary cirrhosis, glycogen storage disease, hepatoblastoma, urea cycle defects, fulminant hepatic failure, etc. The surgical procedures included 12 standard (without venovenous bypass), 6 pigyback, 6 reduced-size, 3 split, 3 living donor liver transplantation, and 1 Domino liver transplantation. The triple-drug (FK506, steroid, and mycophenolate mofetil) immunosuppressive regimen was used in most of patients. Patients were followed up for a mean of 21.8 months.
Five of the 31 patients died during perioperative time; mortality rate was 16.1%. The reasons of death were infections, primary non-function, heart failure, and hypovolemic shock. Postoperative complications in 10 patients included biliary leakage, acute rejection, abdominal infection, hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, and pulmonary infection. Overall patient cumulative survival rate at 1-, 3-, and 5-year was 78.1%, 62.6%, 62.6%, respectively.
The most common indications of pediatric liver transplantation were congenital end-stage liver diseases. According to patients' age and body weight, standard, piggyback, reduced-size, split, or living donor liver transplantation should be performed. Pediatric liver transplantation especially requires higher surgical skills. The early postoperative management is the key to success. Postoperative bile leak was common, but most patients underwent liver transplantation had a better prognosis.
Chinese medical journal 11/2008; 121(20):2001-3. · 0.86 Impact Factor
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Zhi-Jun Zhu,
Wei Rao,
Ji-San Sun,
Jin-Zhen Cai,
Yong-Lin Deng,
Hong Zheng,
Ya-Min Zhang,
Wen-Tao Jiang,
Jian-Jun Zhang,
Wei Gao,
Zhong-Yang Shen
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ABSTRACT: Ischemic-type biliary lesions (ITBLs) play an extremely important role in influencing the long-term survival and quality of life of recipients after orthotopic liver transplantation (OLT). Some patients can be cured by interventional therapies, however others lose their grafts at last and receive liver retransplantation (re-OLT). The aim of this study was to analyze the data of 66 patients who had received re-OLT at our center because of ITBL and to discuss the treatment of ITBL after OLT.
We retrospectively analyzed 66 re-OLT cases due to ITBL from September 2001 to February 2007 at our center. The Kaplan-Meier method and the Cox-Mantel test were used to identify factors associated with mortality for univariate analysis and multivariate analysis, respectively.
Fifty-five of 66 ITBL cases underwent interventional therapies before re-OLT. The actuarial survival at 1 month and 1 year for these patients was 83% and 74%, respectively. Prognostic factors for mortality in univariate analysis were model of end-stage liver disease score (MELD) >16.5 (Chi(2)=5.856, P=0.016), cold ischemia time >8 hours (Chi(2)=6.539, P=0.011), infections (Chi(2)=5.550, P=0.018) and complications (Chi(2)=12.168, P=0.002) after re-OLT. In the multivariate analysis (Cox regression), the risk factors independently associated with mortality were MELD score >16.5 (RR: 3.140; P=0.035), cold ischemia time >8.2 hours (RR: 0.192; P=0.016) and complications (RR: 3.896, P=0.003).
The incidence of ITBL in China is higher than in other countries. Based on our experience, MELD score, cold ischemia time and complications after re-OLT are risk factors independently associated with mortality in retransplanted ITBL patients.
Hepatobiliary & pancreatic diseases international: HBPD INT 10/2008; 7(5):471-5. · 1.08 Impact Factor
