Li-Ying Sun

Salvage liver transplantation for hepatocellular carcinoma recurrence after primary liver resection

OBJECTIVE To evaluate the clinical efficacy and prognostic factors for salvage liver transplantation (SLT) for hepatocellular carcinoma (HCC) recurrence after primary liver resection. METHODS One hundred and eleven patients underwent SLT for HCC recurrence after primary liver resection from April 2000 to June 2011. We analyzed statistically the operative characteristics, survival rate, and effect of pathological characteristics on prognosis of SLT. RESULTS The overall survival rates at 6 months, and 1, 3 and 5 years after SLT were 87.9%, 75.5%, 56.3% and 49.1%, respectively. The mean age of the patients receiving SLT was 53.5 ± 9.6 years (range: 26.8-76.4 years), with a median follow-up of 28.8 months. The mean operating time was 10.34 ± 3.05 hours, and mean blood loss was 2925.0 ± 2373.51 ml. However, factors such as Edmondson grade, TNM stage, and invasion of hepatic and portal veins significantly affected the prognosis of SLT. CONCLUSIONS SLT for HCC recurrence after primary liver resection does not show increased surgery-related risks or reduced long-term survival rate, and thus SLT is an effective treatment for patients with HCC recurrence after primary liver resection.

Reconstruction of the Outflow Tract in Cross-Auxiliary Double-Domino Donor Liver Transplantation

BACKGROUND Auxiliary liver transplantation is accepted as an effective manner to expand the liver donor pool. A difficult surgical technical challenge of the procedure is hepatic vein reconstruction of the graft. METHODS To resolve this problem, complex techniques are used to perform an innovative outflow tract reconstruction in the worlds first cross-auxiliary double-domino donor liver transplantation with two whole liver grafts. The inferior vena cava-sparing hepatectomy technique was applied at harvest in the two domino liver donors. For each donor, the three major hepatic veins (right, middle, and left) were joined together to create one single orifice, but there was no sufficient tissue to perform a direct anastomosis. RESULTS The hepatic vein was reconstructed with the use of a longitudinally opened iliac vein graft from a cadaveric donor to prolong the outflow tract for the piggyback suturing. CONCLUSIONS This new technique might provide an innovative surgical approach for reconstructing the complex outflow tract of domino transplantation.

Normothermic Machine Perfusion versus Cold Storage of Liver in Pig Model: A Meta-Analysis

Background Normothermic machine perfusion (NMP) is a novel strategy used for organ preservation. We aimed to determine the overall efficacy of NMP for liver preservation versus traditional static cold storage (CS). Material/Methods We performed a meta-analysis of the literature to evaluate the efficacy of NMP in experimental pig models of liver preservation. We use the standardized mean difference and 95% confidence intervals (CI) to calculate statistics and used the random effects model for the combined analysis of the results. Results A total of 16 studies from 12 published articles were included. The combined results showed that NMP significantly decreased alanine aminotransferase (ALT), aspartate aminotransferase (AST), and hyaluronic acid levels in serum or perfusate, significantly increased bile production, and had a similar 5–7-days survival rate after liver transplantation compared with the CS group. Conclusions NMP provides superior graft preservation compared with CS in the pig model.

Correlation Between Survival Interval and CD4+ T-Cell Intracellular ATP Levels in Liver Transplant Recipients

OBJECTIVE The objectives of this study were to analyze the potential correlation between post-liver transplantation survival interval and CD4+ T-cell intracellular ATP (iATP) levels, and to describe the distribution of CD4+ T-cell iATP levels in liver transplant recipients. METHODS This was a retrospective analysis of clinical data of 273 patients who underwent liver transplantation from July 2010 to October 2012 in our center and achieved long-term stable survival. CD4+ T-cell iATP level was detected using Cylex ImmuKnow assay. Post-liver transplantation survival was analyzed. RESULTS CD4+ T-cell iATP level significantly differed among patients with different post-liver transplantation survival intervals. The peak CD4+ T-cell iATP levels typically occurred within the first 3 postoperative months. CONCLUSIONS Post-liver transplantation survival interval is correlated with CD4+ T-cell iATP levels.

Gut microbiota of liver transplantation recipients

The characteristics of intestinal microbial communities may be affected by changes in the pathophysiology of patients with end-stage liver disease. Here, we focused on the characteristics of intestinal fecal microbial communities in post-liver transplantation (LT) patients in comparison with those in the same individuals pre-LT and in healthy individuals. The fecal microbial communities were analyzed via MiSeq-PE250 sequencing of the V4 region of 16S ribosomal RNA and were then compared between groups. We found that the gut microbiota of patients with severe liver disease who were awaiting LT was significantly different from that of healthy controls, as represented by the first principal component (p = 0.0066). Additionally, the second principal component represented a significant difference in the gut microbiota of patients between pre-LT and post-LT surgery (p = 0.03125). After LT, there was a significant decrease in the abundance of certain microbial species, such as Actinobacillus, Escherichia, and Shigella, and a significant increase in the abundance of other microbial species, such as Micromonosporaceae, Desulfobacterales, the Sarcina genus of Eubacteriaceae, and Akkermansia. Based on KEGG profiles, 15 functional modules were enriched and 21 functional modules were less represented in the post-LT samples compared with the pre-LT samples. Our study demonstrates that fecal microbial communities were significantly altered by LT.

Outcomes of Liver Transplantation Using Pediatric Deceased Donor Livers: A Single-Center Analysis of 102 Donors

Background: The outcome of pediatric deceased donor liver transplantation (LT) has not been well studied, especially pediatric deceased donor livers used in adult transplantation. This study aimed to evaluate the efficacy of LT using pediatric deceased donor livers and compare the outcomes between pediatric-to-pediatric LT and pediatric-to-adult LT. Methods: A retrospective review of LT using pediatric deceased donor livers from June 2013 to August 2016 was performed. The patients were divided into the pediatric-to-pediatric LT group and pediatric-to-adult LT group based on the ages of the recipients. The survival and incidence of early vascular complications (VCs) were observed between the two groups. We also analyzed the risk factors of early VCs in pediatric LT and the effect of donor hypernatremia on the prognosis of recipients. Results: There were 102 cases of LT using pediatric deceased donor livers in our hospital from June 2013 to August 2016, 83 pediatric-to-pediatric LT (recipients’ age ⩽13 years) and 19 pediatric-to-adult LT (recipients’ age ≥19 years). The ratio of early VC was similar in the two groups (19.3% vs. 10.6%, P = 0.514). Low body weight of recipient was an independent risk factor of early VC in pediatric LT (odds ratio: 0.856, 95% confidence interval: 0.752–0.975, P = 0.019). The 1-year cumulative survival rates of grafts and patients were 89.16% and 91.57% in pediatric-to-pediatric LT and 89.47% and 94.74% in pediatric-to-adult LT, respectively (all P > 0.05). In all cases, patients using donors with hypernatremia (serum sodium levels ≥150 mmol/L) had worse graft survival (&khgr;2=4.330, P = 0.037). Conclusions: Pediatric-to-pediatric LT group has similar graft and patient survival rates with those of pediatric-to-adult LT group. Low body weight of recipients is an independent risk factor of early VC in pediatric LT. Patients using donors with hypernatremia have worse graft survival.

Paediatric liver re-transplantation after primary partial liver graft transplantation: a report of four cases

To discuss rules of anatomic shifting of the porta hepatis structures of the original graft and dissection techniques for the portal vein (pull‐out technique) in pediatric liver re‐transplantation.