Zhi-Jun Zhu

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.

Association Between Flushed Fluid Potassium Concentration and Severe Postreperfusion Syndrome in Deceased Donor Liver Transplantation.

Backgrounds Predicting the occurrence of severe postreperfusion syndrome (PRS) is clinically challenging. We investigated whether the flushed fluid potassium concentration (FFK) was associated with severe PRS in deceased donor liver transplantation (DDLT). Material/Methods Forty adult DDLT recipients were enrolled in this retrospective study. Effluent solution samples were collected at the end of the portal vein flush, and the FFK was determined using a point-of-care blood gas analyzer. The risk factors associated with severe PRS and the clinical outcomes in 2 groups were compared. Results Severe PRS occurred in 22 out of 40 patients (55.0%). The FFK of the severe PRS group was significantly higher than that of the non-severe PRS group (median, 9.6 vs. 5.8, P<0.001). Other variables associated with severe PRS included the donor risk index (DRI), Child-Turcotte-Pugh score, donor type, donor warm ischemia time, and Model for End-stage Liver Disease score. The area under the receiver operator characteristic curve for the FFK was 0.982, and the best cut-off value of the FFK for predicting severe PRS was 6.75 mmol/L (100.0% sensitivity and 88.9% specificity). A significant positive correlation was observed between the FFK and DRI (R=0.714). Patients who experienced severe PRS had a higher early allograft dysfunction rate (63.6% vs. 22.2%, P=0.019) and a longer hospital stay (median, 33.0 vs. 24.0, P=0.034). Conclusions Both the severity of the recipient’s liver disease and the donor graft factors play an important role in the development of severe PRS in DDLT. An FFK of more than 6.75 mmol/L was associated with severe PRS after reperfusion.

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.