Zhi-Gui Zeng

Outcomes in children with biliary atresia following liver transplantation

BACKGROUND 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. METHOD We retrospectively analyzed 45 patients with biliary atresia who had undergone orthotopic liver transplantation from September 2006 to August 2012. RESULTS 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. CONCLUSION 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.

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.

Feasibility of using a liver infected with Clonorchis sinensis for liver transplantation: Fourteen cases

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 Transpl 16:1440–1442, 2010.

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.

First case of cross-auxiliary double domino donor liver transplantation

We report a case of double domino liver transplantation in a 32-year-old woman who was diagnosed with familial amyloid polyneuropathy (FAP) and liver dysfunction. A two-stage surgical plan was designed, and one domino graft was implanted during each stage. During the first stage, an auxiliary domino liver transplantation was conducted using a domino graft from a 4-year-old female child with Wilson’s disease. After removing the right lobe of the FAP patient’s liver, the graft was rotated 90 degrees counterclockwise and placed along the right side of the inferior vena cava (IVC). The orifices of the left, middle, and right hepatic veins were reconstructed using an iliac vein patch and then anastomosed to the right side of the IVC. Thirty days later, a second domino liver graft was implanted. The second domino graft was from a 3-year-old female child with an ornithine carbamyl enzyme defect, and it replaced the residual native liver (left lobe). To balance the function and blood flow between the two grafts, a percutaneous transcatheter selective portal vein embolization was performed, and “the left portal vein” of the first graft was blocked 9 mo after the second transplantation. The liver function indices, blood ammonia, and 24-h urinary copper levels were normal at the end of a 3-year follow-up. These two domino donor grafts from donors with different metabolic disorders restored normal liver function. Our experience demonstrated a new approach for resolving metabolic disorders with domino grafts and utilizing explanted livers from children.

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.

Complication Follow-up With Ultrasonographic Analyses of 91 Cases With Donor Gallbladder Preservation in Living Donor Liver Transplantation of Left Lateral Sectionectomies

BACKGROUND Preserving the donors gallbladder during living donor liver transplantation (LDLT) is a better method for liver transplantation surgery, but not enough is known about gallbladder complications after the operation. METHODS We retrospectively investigated postsurgical donor gallbladder complications in clinical LDLT with gallbladder preservation. The feasibility of retaining the gallbladder during liver graft procurement is discussed. Ninety-one donors with retained gallbladder after LDLT with the hepatic left lateral sectionectomy (from June 2013 to October 2015) were retrospectively analyzed. Donors were followed for 12.6 to 40.7 months after surgery (median 26.1 months). Sonography was used to evaluate gallbladder characteristics before and after surgery. RESULTS Gallbladder function had recovered to almost normal 1 month after transplantation. Four donors (4.40%) experienced gallbladder enlargement that resolved after 3 days. Thickening of the gallbladder wall in 31 donors (34.07%) was restored within 2 to 75 days. Biliary sludge appeared in 9 donors (9.89%); 6 of them recovered within 3 to 34 days. Three (3.30%) and 1 donor (1.10%) suffered gallstone and gallbladder polyps, respectively, which persisted until the last follow-up. CONCLUSION The rate of postoperative complications of the gallbladder in donors was relative low. Preserving the gallbladder in liver transplantation donors during liver graft procurement is feasible and safe.

Posttransplant Lymphoproliferative Disorder in Liver Transplant Recipients

Objective This study was conducted to analyze the clinical characteristics, treatment and outcome of posttransplant lymphoproliferative disorder(PTLD) in liver transplant recipients. Methods: This study includes a retrospective data analysis of nine liver transplant recipients with PTLD who were treated at the Liver Transplant Center, Beijing Friendship Hospital, China, from 2013 to 2017. One patient was adult, and the others were children. Demographic, clinical, treatment data and outcome were collected. Results The incidence of PTLD in our liver transplant center was 7/634(1.1%),whereas the incidence of PTLD in pediatric liver transplant recipients in our liver transplant center was 6/403(1.5%).All the patients were diagnosed by pathology. Three cases were classified as early lesions of PTLD,2 cases were polymorphic PTLD, two cases were burkitt lymphoma, one case was diffuse large B cell lymphoma and one case was classical Hodgkin lymphoma-like PTLD.The mean onset time was 15months after liver transplantation (from 5 to 32 months. The paitents had different clinical manifestations mainly including fever, anemia, diarrhea, enlargement of lymph nodes or hepatosplenomegaly, jaundice, intestinal obstruction and even intestinal perforation. All the patients had positive EB-DNA in serum. After the diagnosis,immunosuppressants were reduced or discontinued.All the patients received anti-CD20(Rituximab) theraphy.Four cases were treated combined with chemotheraphy(R-CHOP,ABVD,COPP/ABV).Two cases were treated combined with radiotherapy.Two cases received surgical treatment due to intestinal obstruction.Seven patients achieved complete response and were alive at the time of review. One patient died of graft failure,and another patient died of relapse of PTLD. Conclusion PTLD is one of the most serious and fatal complications after liver transplantation.The detection of EB-DNA load and imaging examination can provide clues for diagnosis.Definite diagnosis can be made based on histopathology.Treatment varies according to differet classifications,and basically including immunosuppression reduction,anti-CD20 antibody,operation, radiotherapy and chemotherapy.Early detection and early-stage treatment are needed to rescue patients who have suffered from PTLD.