Objective To summary the operative technique of liver retransplantation （RLT）. Methods The clinical data of 62 cases who had received RLT in our institute from Jan. 2003 to Jun. 2012 were analyzed retrospectively， and the experience about RLT was summaried too. Results The operative time 〔（12.7±3.5） h vs. （10.5±3.0） h〕， bleeding volume （3 431 mL vs. 2 211 mL）， and blood volume transfused during operation （3 229 mL vs. 1 910 mL） in 62 cases who had underwent RLT were longer or higher than that of 38 patients who had underwent the first liver transplantation （LT） in our hospital （P＜0.05）， but there was no significant difference on the model for end-stage liver disease （MELD） score between the 2 groups （P＞0.05）. All cases were followed up for 1-104 months （average 31 months）. Twenty case died within 1 month after RLT， including sever lung or abdominal infection in 13 cases， multiple organ failure in 4 cases， hepatic artery complication in 2 cases， and portal vein complication in 1 case. Eight cases died of tumor recu-rrence during 14-69 months （average 27 months） after RLT. The cumulative survival rate of 1-， 2-， and 5-year of 62 cases of RLT were 67.7%， 59.7%， and 56.4%， respectively. The 34 patients had survived for 3-104 months （average 49 months）， of them， there were biliary stenosis in 3 cases who were cured by interventional radiology treatment， biliary stenosis in 2 cases who were cured by a third RLT， infection in 10 cases who were cured by anti-infective therapy and immunosuppressant adjustment， light rejection in 2 cases who were relieved by dosage increase of oral immunosuppressant， other 17 cases suffered no complications and all in good condition. Conclusions RLT is an effective method for irreversible graft failure after LT. Proper surgical procedure contributes to the increase of survival rate of patients who has received RLT.
Objective To review the literature reports on research progress of Heme oxygenase 1 (HO-1) modified mesenchymal stem cells (MSCs). Methods The significance, effects, and related mechanism of HO-1 modification of MSCs were summarized by consulting the related literatures and reports of HO-1 modification of MSCs. Results HO-1 modification of MSCs has important research value. It can effectively enhance the anti-oxidative stress and anti-apoptotic properties of MSCs in complex internal environment after transplantation into vivo. It can also effectively enhance the immune regulation function of MSCs. It can improve the anti-injury, repair, and immune regulation effect of MSCs in various disease models and research fields. Conclusion The basic research of HO-1 modified MSCs has made remarkable progress, which is expected to be applied in clinical trials and provide theoretical basis and reference value for stem cell therapy.
Objective To summary the clinical experience of liver retransplantation （RLT）， and to improve the effect. Methods The clinical data of 62 cases who had received RLT in our institute from Jan. 2003 to Jun. 2012 were analyzed retrospectively. The survival rates of patients with different interval between two liver transplantation （LT） were calculated， and the data of patients who died and survived during perioperative period after operation were compared and analyzed. Results The 1-， 2-， and 5-year cumulative survival rates of 62 patients were 67.7%， 59.7%， and 56.4%， of early stage RLT patients were 38.5%， 38.5%， and 30.8%， of later stage RLT patients were 75.5%， 65.3%， and 63.3%， respectively. There were 28 patients died after operation， and 20 patients （71.4%） died during perioperative period， whose major cause of death were infection （65.0%， 13/20）， in addition， 4 cases （20.0%） died of multiple organ failure， 2 cased （10.0%） died of hepatic artery complication， 1 case （5.0%） died of portal vein complication. Eight cases （28.6%） died after perioperative period in reason of tumor recurrence. The model for end-stage liver disease （MELD） score 〔（26.95±9.28） score vs. （14.23±9.06） score〕， creatinine （Cr） level 〔（157.3±88.0） μmol/L vs.（69.8±35.9） μmol/L〕， international normalized ratio （INR） value 〔（1.676±0.744） vs.（1.124±0.286）〕， and total bilirubin （TBiL） value 〔431.8 μmol/L vs. 248.2 μmol/L〕 of patients died during perioperative period were higher than that of patients survived after perioperative period （P＜0.05）. The ratio of abnormal Cr of patients died during perioperativeperiod and survived after perioperative period were 60.0% （12/20） and 7.1% （3/42）， respectively. The 34 patients who had survived after perioperative period were all got followed-up for 3-104 months （average 49 months）. There were no tumor recurrence during the followed-up， and liver function of them were normal. Conclusions RLT is an effective method for irreversible graft failure after LT. Optimum operative time and reasonable individual immunosuppressive regimen to decrease the infection rate are all contribute to the increase of the survival rate.
Objective To summarize the experience of l iving donor l iver transplantation using cryopreserved il iac vein for middle hepatic vein reconstruction. Methods Between July 2006 and June 2009, right l iver transplantation without middle hepatic vein was performed in 37 cases of 85 patients undergoing l iving donor l iver transplantation; of 37 cases, 30 received middle hepatic vein reconstruction using cryopreserved il iac vein. There were 27 males and 3 females, aged from 10 to 57 years (median, 44 years). Thirty cases included 11 hepatocellular carcinoma, 10 hepatic cirrhosis, 2 Wilson’ sdisease, 1 cholangiocarcinoma, 1 hepatoblastoma, 1 congenital hepatic fibrosis, 1 chronic severe hepatitis, and 1 congenital bil iary atresia. Il iac veins harvested from donors were put into 0-4℃ mixed antibiotics sal ine and transported to the operating room. The il iac veins were trimmed, placed into sterile bags (containing RMPI 1640 + 20% DMSO + 10% calf protein solution) and frozen at —70 . In l iving donor l iver transplantation process, the veins were melt and used for middle hepatic vein reconstruction. After operation, the patency of veins was monitored by regular Doppler ultrasound examination or enhanced CT for 3 months. Results In 30 patients, 30 il iac veins were used. The average cryopreserve time was 14 days (range, 3-44 days). Anastomosis were all successful; after cryopreservation, the blood vessels texture and elasticity were fit for surgery. No easily tearing or severe suture bleeding was observed. In 30 patients, 6 had segment V veins reconstruction; 3 had segment VIII; and 21 had both segments V and VIII. The patency rate of reconstructed vessels was 93% at 1 week, 90% at 2 weeks, 90% at 1 month, and 67% at 3 months. No serious compl ication was observed in donors. The prognosis was good with no small-for-size syndrome. Conclusion Cryopreserved il iac vein is an ideal material for the right hepatic l iving donor l iver transplantation in the reconstruction of middle hepatic vein.
Objective To report our experience in living donor liver harvesting of right lobe grafts. MethodsThe data of 76 living donors of right lobe grafts hepatectomy between August 2007 and December 2008 were studied. Before operation, the graft size, remnant liver volume rate, fatty liver, middle hepatic vein type, and the level of portal hypertension of recipient were comprehensive assessed to determine whether harvested middle hepatic vein. The graft was harvested depending on the port vein and hepatic artery ischemia-line. B-ultrasound was used to definite the structure and branch of middle hepatic vein, and intraoperative cholangiography was performed to definite the structure and variation of bile duct. Donor operative time, intraoperative blood loss, postoperative hospital stay, levels of bilirubin, international normalized ratio （INR）, and ALT, and complications after operation were recorded. Results All the operations were successful. The operative time was (8.3±1.3) h, the blood loss was (325±127) ml without blood transfusion in operation. The ALT, INR, and bilirubin recovered on the 12th day. The most common complication in early post-operation was wound infection in 5 cases, 4 cases had cholestasis, 4 cases occurred cross-section bile leakage, and 11 cases occurred varying degrees of delayed gastric emptying in 4～7 d after operation, who were all alleviated by corresponding treatments. The hospital stay was 9～21 d (median: 14 d) after operation. Conclusion Preoperative evaluation of the hepatic anatomy and precise surgical procedure are crucial, which will help the development of graft harvesting and rehabilitation of donor.
ObjectiveTo investigate the value of computer assisted radiology and surgery solutions system (IQQA-Liver) in surgical planning for precise hepatectomy. MethodsThe clinical data of 95 cases performed precise hepatec-tomy from January 1, 2012 to June 30, 2013 in our hospital were retrospectively analyzed, and the computer assisted radiology and surgery solutions system was used for three dimensional quantitative analysis, volume measurement and designing for liver resection in all the cases before operation. ResultsThe intuitive and clear three dimensional images of all the 95 cases were obtained by using the computer assisted radiology and surgery solutions system, which could show the precise anatomical relationship of the liver, tumor, and main hepatic vascular.The three dimensional images could be observed at any angle and rotated freely, and could show the involved and needed to be resected vascular away from the tumor margin for 2 mm, 5 mm, 10 mm, and 20 mm and the liver volume dominated by this vascular.Of all the 95 cases, the total liver volume was (1 776.4±998.5) cm3, the proposed removed liver volume was (1 026.2±811.5) cm3, the functional residual liver volume was (795.3±522.6) cm3.The ratio of functional residual liver volume to the standard total liver volume was (58.2±25.1)%, which the ratio of patients without cirrhosis was > 30% and with cirrhosis was > 40%.All the 95 cases were implemented precise operation.The operation plan was designed based on a combination of factors such as the amount of functional residual liver volume and function.The surgery programs were changed for 13 cases, in which 9 cases were narrowed the scope of resection and 4 cases were expanded the scope of resection.No patients died perioperation. ConclusionBy using the computer assisted radiology and surgery solutions system (IQQA-Liver), we could precisely locate liver tumor, calculate the functional residual liver volume, identify the relationship between tumor and adjacent vascular, and ultimately help to design the optimal surgical plan.
Objective To explore the causes and prognosis of liver retransplantation. Methods The clinical data of 215 cases who had underwent liver retransplantation in Tianjin First Central Hospital between Nov. 26th 2003 and May. 26th 2012 were analyzed retrospectively for its causes and prognosis. Results Two hundreds and fifteen cases were enrolled， including 200 cases of 2 times liver transplantation， 14 cases of 3 times liver transplantation， and 1 case of 4 times liver transplantation. The major causes of the second liver transplantation were biliary complication （53.5%， 115/215） and primary non-function or dysfunction of liver graft （8.4%， 18/215）， and the major causes of the third liver transplantation were biliary complication （5/14） and hepatocellular carcinoma recurrence （2/14）. The liver graft survival rate of late liver retransplantation （at least 1 month after operation） was significantly higher than that of early liver retrans-plantation （less than 1 month after operation） for the second liver transplantation （P=0.005）. The liver graft survival rate of the second liver transplantation was significantly higher than that of the third liver transplantation （P=0.043）. Compared with biliary complication， cases of hepatocellular carcinoma recurrence （P=0.001） and primary non-function or dysfunction of liver graft （P=0.033） had lower graft survival rates， while cases of chronic failure of liver graft had a higher survival rate （P=0.037）. Conclusions Biliary complication is the main cause of liver retransplantation. The liver retransplantations which are performed less than 1 month after prior liver transplantation result in a relative low survival rate in reason of the increase of perioperative death. The prognosis of liver retransplantation for hepatocellular carcinoma recurrence is unacceptable， while cases of chronic failure of liver graft have optimal prognosis.
Objective To investigate the diagnosis of organized thrombus in portal vein (PVOT) in liver transplantation. Methods The clinical data of 32 patients with PVOT who took the orthotopic liver transplantation (OLT) from January 2005 to January 2006 (271 cases) in this institute were retrospectively analyzed. Color doppler imaging (CDI), double helical CT plus three dimensional CT angiography (CTA) were taken before operation. CDI was performed during operation to look for the varicose vein, it was also used to reconstruct portal vein and measure the blood velocity in the portal vein. Results 23/32 (71.8%) cases had taken surgical treatment or interventional therapy before OLT. The grades of thrombus were as follows: gradeⅠ, 14/32; grade Ⅱ, 11/32; grade Ⅲ, 1/32; grade Ⅳ, 6/32. Twenty-eight cases of PVOT were diagnosed before operation, with accuracy of 87.5%. CDI was performed in 20 cases during operation, and 17 cases of collateral shunts were ligated with the monitor of ultrasound after the reconstruction of portal vein. The mean velocity of portal vein was (30.13±16.41) cm/s before the ligation of shunting veins, and the mean velocity was (46.36±19.82) cm/s after ligating the shunt veins. Conclusion Posibility of having PVOT for patients who had surgical treatment before OLT were much higher than who did not. CT and CTA could evaluate the portal vein system before operation, and performing CDI during operation may be important for the optimal reconstruction of portal vein.
Objective To discuss the criteria of recipient selection，surgical approach，and complications and its theray by using of pediatric donation after cardiac death liver graft in adult recipient. Methods The clinical data of one case of pediatric donation after cardiac death liver to adult recipient was analyzed retrospectively and the literatures were reviewed. Results A 6-year-old girl pronounced brain death due to drowning and on the basis of cardiopulmonary criteria donated the organ．The liver graft weight was 598 g and the warm ischemic time was 10 min. The liver donor was transplanted to a 64-year-old woman，the graft to recipient weight ratio was 1.09%，the graft volume/estimated standard liver volume was 61.8%．The classic orthotopic liver transplantation without bypass was underwent，the postoperative recovery was smooth after the liver transplantation．The CT scan showed that the liver graft volume was 1 003cm3 on day 14 after operation．The patient was discharged on 45 d after orthotopic liver transplantation and the liver function was normal when followed-up 3 months after the operation. Conclusions Pediatric donation after cardiac death liver graft can be successfully utilized to adult recipient．Recipient selection and surgical approach should be decided by conditions of both donor and graft．
【摘要】目的 探讨肝移植术后肝动脉血栓的防治方法，以降低其发生率。方法 对52例（53例次）肝移植手术后发生肝动脉血栓的2例患者的临床资料进行回顾性总结。结果 该2例患者均为乙肝肝硬变合并巨块型肝癌，术中发现受体肝动脉内膜及外膜管壁硬化，血管弹性差，内外膜间隙较大，供、受体肝动脉直径稍有差距，致血管内膜对合不好，造成吻合口扭曲、皱折等，从而导致术后肝动脉血栓形成，2例患者术后均经彩超检查确诊。结论 对肝移植术后肝动脉血栓的形成应以预防为主，肝移植术后应常规用彩超监测肝动脉血流，一旦发现肝动脉血栓，应立即行肝动脉溶栓、取栓和重新吻合术。