Objective To discuss venous drainage types of median hepatic lobe and their guiding significances on the selection of grafts. Methods Between April 2005 and March 2009, 109 potential living donors underwent 3-dimensional reconstruction of computed tomography (CT) and the volume of graft was determined in the center of organ transplantation of Ruijin Hospital. The venous drainage types of median hepatic lobe of each donor were analyzed by the computer-based liver operation-planning system in detail to assign middle hepatic vein (MHV) types according to Marcos classification and venous types of Ⅳb segment according to Nakamura classification. Results The branching pattern of MHV was divided into 3 types: Type Ⅰ and Ⅱwere relatively more accounting for 44.0% （48/109）, 37.6% （41/109）, and type Ⅲ was fewest 〔18.3% （20/109）〕. There were no significant differences in volume of whole liver, volume of left liver or left liver/total liver volume ratio among various types of MHV of the donor (Pgt;0.05). Ⅳb vein was also divided into 3 types: The most common was type Ⅰ, accounting for 72.4% (79/109); Type Ⅱ 〔12.8% （14/109）〕, type Ⅲ 〔14.7% （16/109）〕 were relatively fewer. At last, 37 donors provided right liver, for Marcos Ⅰ, Ⅱ, and Ⅲ type of donors, donors remained with MHV was 12/17, 8/11, and 5/9; for Nakamura Ⅰ, Ⅱ, and Ⅲ type of donors, those number were 16/26, 4/6, and 5/5. Conclusion In adult-to-adult living donor liver transplantation, there may be great significances in accordance with Marcos and Nakamura typing results to harvest right lobe liver graft with or without MHV.
Objective To investigate quality of life of pediatric living donor liver transplantation recipient (PLDLTR) and analyze it’s influencing factors. Methods The convenient sampling method was adopted. Fifty-three PLDLTRs from May 2012 to January 2017 in the West China Hospital of Sichuan University were selected. At the same time, 56 children who participated in the physical examination and had no abnormality results were selected as reference (control group), their age and gender matched with the PLDLTRs. A general data inventory and a self-assessment scale for children’s quality of life (Pediatric Quality of Life Inventory 4 Generic Core Scales, PedsQL4.0) were used to evaluate the quality of life of the 53 PLDLTRs. Results A total of 53 questionnaires were distributed to all the 2 groups, all of them were effectively recovered. The points of quality of life of the physiological function, emotional function, social function, and school performance for the PLDLTRs were significantly higher than those of the control group (P<0.050), which for the PLDLTRs with male and more than 3 years after the operation were significantly higher than those of the PLDLTRs with female and within 1 year after the operation (P<0.050). For the PLDLTRs with age >4 years old, the points of the emotional function, social function, and school performance were significantly higher than those of the PLDLTRs with age ≤4 years old. For the PLDLTRs without postoperative complications, the points of quality of life of the physiological function, emotional function, and school performance were significantly higher than those of the PLDLTRs with Ⅱ grade of postoperative complications (P<0.050). Conclusions Life quality of PLDLTR is poorer than that of normal children. Postoperative time, postoperative complications, age, and gender are certainly associated with quality of life for PLDLTR.
ObjectiveTo observe the clinical effect of Rituximab combined with intravenous immunoglobulin (IVIG) in preventing blood group antibody mediated rejection (AMR) in pediatric ABO incompatible living donor liver transplantation (ABOi-LDLT).MethodsA total of 503 cases of pediatric living donor liver transplantation in Beijing Friendship Hospital Affiliated to Capital Medical University from June 2013 to December 2020 were retrospectively collected; the overall survival of recipient and graft were compared between ABOi-LDLT and ABO compatible living donor liver transplantation (ABOc-LDLT), and we summarized the data of AMR in 7 cases received Rituximab+IVIG protocol.ResultsThere were 53 cases of ABOi-LDLT and 450 cases of ABOc-LDLT in our study. The 5-year cumulative survival rate of recipients and grafts was 98.0% and 96.0% in the ABOi-LDLT group respectively, and in ABOc-LDLT group was 92.2% and 89.1% respectively, there was no significant difference between the two groups (P=0.232, P=0.381）. Seven children with blood group antibody titer >1∶64 were included in the study. On the basis of classical intensive immunosuppressive therapy, all patients were treated with Rituximab+IVIG. The blood group antibody titer of 6 patients remained stable, and no rejection occurred; one patient developed severe AMR and graft failure, and recovered after salvage treatment of ABOc-LDLT.ConclusionRituximab+IVIG can be used as an effective therapeutic option to prevent blood group AMR after ABOi-LDLT.
Minimally invasive surgery played a crucial role in modern medicine. With advantages such as less trauma, precise operation, minimal bleeding, and rapid postoperative recovery, minimally invasive procedures had been increasingly applied in the field of liver transplantation in recent years. This included techniques such as small incision living donor hepatectomy through an upper abdominal midline incision, laparoscopic-assisted living donor hepatectomy, pure laparoscopic living donor hepatectomy, and robotic living donor hepatectomy. Since Professor Cherqui from France firstly reported the total laparoscopic left lateral sectionectomy in living donors in 2002, the application of minimally invasive technology in living donor liver transplantation had become increasingly widespread. Based on this, so as to guide the more standardized, effective, and safe implementation of minimally invasive liver donor hepatectomy across the country, in August 2023, the Branch of Organ Transplant of Chinese Medical Association and the Branch of Organ Transplant Physicians of Chinese Medical Doctor Association organized national liver transplantation experts to jointly formulate the “Chinese guidelines for minimally invasive surgical techniques in living donor liver transplantation (2024 edition)”. This is to provide scientific guidance and reference for surgeons performing minimally invasive surgery on living liver donors in China.