The shortage of organ donors mandates the use of liver allograft from anti-HBc(+) donors, especially in areas highly endemic for hepatitis B virus(HBV) infection. Theincidence of de novo hepatitis B infection(DNH) is ...The shortage of organ donors mandates the use of liver allograft from anti-HBc(+) donors, especially in areas highly endemic for hepatitis B virus(HBV) infection. Theincidence of de novo hepatitis B infection(DNH) is over 30%-70% among recipients of hepatitis B core antibody(HBcA b)(+) grafts without any prophylaxis after liver transplantation(LT). Systematic reviews showed that prophylactic therapy [lamivudine and/or hepatitits B immunoglobulin(HBIG)] dramatically reduces the probability of DNH. However, there are limited studies regarding the effects of active immunization to prevent DNH, and the role of active vaccination is not welldefined. This review focuses on the feasibility and efficacy of pre- and post-LT HBV vaccination to prevent DNH in HBsA g(-) recipient using HBcA b(+) grafts. The presence of HBs Ab in combination with lamivudine or HBIG results in lower incidence of DNH and may reduce the requirement of HBIG. There was a trend towards decreasing incidence of DNH with higher titers of HBs Ab. High titers of HBs Ab(> 1000 IU/L) achieved after repeated vaccination could eliminate the necessity for additional antiviral prophylaxis in pediatric recipients. In summary, active vaccination with adequate HBsA b titer is a feasible, cost-effective strategy to prevent DNH in recipients of HBc Ab(+) grafts. HBV vaccination is advised for candidates on waiting list and for recipients after withdrawal of steroids and onset of low dose immunosuppression after transplantation.展开更多
The shortage of deceased donor liver grafts led to the use of living donor liver transplant(LDLT).Patients who un-dergo LDLT have a higher risk of complications than those who undergo deceased donor liver transplantat...The shortage of deceased donor liver grafts led to the use of living donor liver transplant(LDLT).Patients who un-dergo LDLT have a higher risk of complications than those who undergo deceased donor liver transplantation(LT).Interventional radiology has acquired a key role in every LT program by treating the majority of vascular and nonvascular post-transplant complications,improving graft and patient survival and avoiding,in the majority of cases,surgical revision and/or re-transplant.The aim of this paper is to review indications,diagnostic modalities,technical considerations,achievements and potential complications of interventional radiology procedures after LDLT.展开更多
AIM: Hyperglycemia commonly seen in liver transplantation (LT) has often been attributed to the dextrose in the storage solution of blood transfusion products. The purpose of the study is to compare the changes of the...AIM: Hyperglycemia commonly seen in liver transplantation (LT) has often been attributed to the dextrose in the storage solution of blood transfusion products. The purpose of the study is to compare the changes of the blood glucose levels in transfused and non-transfused patients during LT. METHODS: A retrospective study on 60 biliary pediatric patients and 16 adult patients undergoing LT was carried out. Transfused pediatric patients were included in Group Ⅰ (GⅠ), those not transfused in Group Ⅱ (GⅡ). Twelve adult patients were not given transfusion and assigned to Group Ⅲ(GⅢ); whereas, four adult patients who received massive transfusion were assigned to Group Ⅳ (GⅣ). The blood glucose levels, volume of blood transfused, and the volume of crystalloid infused were recorded, compared and analyzed. RESULTS: Results showed that the changes in blood glucose levels during LT for both non-transfused and minimally transfused pediatric groups and non-transfused and massively-transfused adult groups were almost the same. CONCLUSION: We conclude that blood transfusion does not cause significant changes in the blood glucose levels in this study.展开更多
AIM： Autologous blood donation （ABD） is mainly used to reduce the use of banked blood. In fact, ABD can be regarded as acute blood loss. Would ABD 2-3 d before operation affect the CVP level and subsequently result...AIM： Autologous blood donation （ABD） is mainly used to reduce the use of banked blood. In fact, ABD can be regarded as acute blood loss. Would ABD 2-3 d before operation affect the CVP level and subsequently result in less blood loss during liver resection was to be determined.METHODS： Eighty-four patients undergoing living donor left hepatectomy were retrospectively divided as group Ⅰ （GⅠ） and group Ⅱ （GⅡ） according to have donated 250-300 mL blood 2-3 d before living donor hepatectomy or not. The changes of the intraoperative CVP, surgical blood loss,blood products used and the changes of perioperative hemoglobin （Hb） between groups were analyzed and compared by using Mann-Whitney Utest.RESULTS： The results show that the intraoperative CVP changes between GⅠ （n = 35） and GⅡ （n = 49） up to graft procurement were the same, subsequently the blood loss,but ABD resulted in significantly lower perioperative Hb levels in GI.CONCLUSION： Since none of the patients required any blood products perioperatively, all the predonated bloods were discarded after the patients were discharged from the hospital. It indicates that ABD in current series had no any beneficial effects, in term of cost, lowering the CVP, blood loss and reduce the use of banked blood products, but resulted in significant lower Hb in perioperative period.展开更多
Objective: Coagulation factor VII(FVII) triggers the extrinsic pathway of blood coagulation. In our previous study, we showed that FVII plays an important role in tumorigenesis of hepatocellular carcinoma(HCC). Howeve...Objective: Coagulation factor VII(FVII) triggers the extrinsic pathway of blood coagulation. In our previous study, we showed that FVII plays an important role in tumorigenesis of hepatocellular carcinoma(HCC). However, the role of FVII polymorphism in HCC is still unknown. The present study aimed to investigate the relationship between HCC carcinogenesis and single nucleotide polymorphism of FVII.Methods: Thirty-seven HCC patients and 30 healthy donors were recruited in this study. Four common FVII gene polymorphisms– a decanucleotide insertion at position –323(–323 ins10-bp), a G to T substitution at position –401(–401 G/T), a G to A substitution at position –402(–402 G/A), and a T to C substitution at position –122(–122 T/C) – were analyzed by sequencing or commercialized assays using genomic DNA isolated from blood samples. Clinicopathological parameters between control and HCC subjects were compared according to the specific genotypes.Results: The most common nucleotide variation was –402 G/A. However, no statistically significant difference was observed between healthy controls and HCC subjects for all four polymorphisms in terms of genotype distribution and allele frequencies,indicating that these polymorphisms may not affect HCC tumorigenesis. Furthermore, no association was found between–402 G/A polymorphisms and tumor stage, recurrence, and overall survival.Conclusions: Our results indicate that FVII polymorphisms may not be a key factor that clinically impact tumorigenesis and outcomes of HCC, although further investigations should be conducted to confirm our findings.展开更多
An innovative 3-phase AC (Alternative Current) drive circuit for the seismic disc in micro-gyroscopes is designed and verified by computer simulations and experiments. The in-plane dynamic model of the seismic disc wi...An innovative 3-phase AC (Alternative Current) drive circuit for the seismic disc in micro-gyroscopes is designed and verified by computer simulations and experiments. The in-plane dynamic model of the seismic disc with mass eccentricity and air gap against the centre bearing and the mathematic expression of two sinusoidal magnetic fields are developed respectively. In order to prevent the seismic disc from collision with the centre bearing and the EM (Electromagnetic) poles, an anti-collision controller is established by employing two Look-up tables which define the intensity of the applied current to the EM poles. Self-sensing technique is included to measure the real-time offset of the disc by two orthogonal pairs of EM poles, without any additional sensors. The drive circuit under SPWM (Sinusoidal Pulse Width Modulation) operation and the anti-collision strategy are verified by intensive computer simulations via commercial software, OrCAD 9, and experiments.展开更多
Background:Barcelona clinic liver cancer(BCLC)stage B(intermediate stage)hepatocellular carcinoma(HCC)is highly heterogeneous;thus,identifying the most effective treatment for individual patients represents a signific...Background:Barcelona clinic liver cancer(BCLC)stage B(intermediate stage)hepatocellular carcinoma(HCC)is highly heterogeneous;thus,identifying the most effective treatment for individual patients represents a significant clinical challenge.However,transarterial chemoembolization(TACE)is the only recommended treatment option.Therefore,we aimed to investigate the patient characteristics and outcomes of living donor liver transplantation(LDLT)for BCLC stage B HCC.Methods:A total of 516 patients with BCLC stage B HCC who underwent LDLT(n=104)or did not undergo LDLT(non-LDLT;n=412)between 2004 to 2018 were analyzed by propensity score matching(PSM;1:4)analysis.Factors influencing overall survival(OS)and recurrence were analyzed using Cox’s proportional hazards models.Results:Patients treated with LDLT achieved better OS than the non-LDLT group,including liver-and non-liver related survival(all P<0.001).Multivariate Cox regression analysis showed age>60 years(P=0.006),a neutrophil-lymphocyte ratio(NLR)>4(P=0.016)and>3 locoregional therapies(LRT)before LDLT(P<0.001)were independent risk factors for HCC recurrence.In addition,age>60 years(P<0.001)and>3 LRT before LDLT(P=0.001)were independent risk factors for OS.Using a combination of age,NLR,and LRT before liver transplantation(LT),the patients can be divided into low-risk(none of risk),intermediate-risk(one of risk),and high risk(more than two of risk)groups.There were significant differences in the cumulative HCC recurrence(P<0.001)and mortality(P<0.001)rates among the three groups.Conclusions:LDLT may represent a valuable therapeutic option for selected patients with BCLC stage B HCC.展开更多
Introduction Within the last decade,progress in transplant and surgical oncology has been tremendous.In liver oncology alone,there has been concurrent technological innovation across the different adjunct fields and t...Introduction Within the last decade,progress in transplant and surgical oncology has been tremendous.In liver oncology alone,there has been concurrent technological innovation across the different adjunct fields and tiers of oncology related to hepatocellular carcinoma(HCC),progressing in quite an unprecedented rate.Significant improvements in our capacity to diagnose and prognosticate HCC with increasing sensitivity,specificity,and predictability is being witnessed.We now better understand that staging,treatment and prognostication cannot be determined on a static basis of tumor burden(i.e.,tumor size and number)alone and a“one size fits all”management.Careful individualized assessment is now mandatory in consideration of intra-and intertumoral heterogeneity and tumor biology in order to more precisely guide diagnostics and treatment options(1).展开更多
Background:Although left-lobe donation is considered safer,right-sided donor hepatectomy predominatesin adult living donor liver transplantation(LDLT).We hypothesized that bilateral proficiency with donorhepatectomy r...Background:Although left-lobe donation is considered safer,right-sided donor hepatectomy predominatesin adult living donor liver transplantation(LDLT).We hypothesized that bilateral proficiency with donorhepatectomy reduces overall donor complications.Methods:A retrospective review of 834 adult LDLT donors(221 left lobes)from January 2004 toDecember 2014 was performed,dividing cases into two eras based on left-graft experience.Donorcomplications within 6 months were investigated,focusing on graft side and surgical era.Results:The overall complication rate was 17.6%,and was higher in right-lobe donors.In Era 2,duringwhich left-lobe donation rates were three times higher,total complications decreased(14.7%vs.20.9%,P=0.02).A significant reduction in postoperative ascites accounted for the lower overall complication rate.The proportion of major biliary complications(BCs)was halved from 62.5%to 25.0%.Right-lobe donorcomplications also decreased significantly(15.8%vs.22.9%,P=0.032),demonstrating that it was not onlyincreased left-lobe donations leading to lowered complication rates,but also greater experience with donorhepatectomy in general.Conclusions:Accumulating experience with bilateral donor hepatectomy leads to decreased donormorbidity and comparable outcomes for right and left lobes,further enhancing the goal of donor safety whilebalancing recipient needs.展开更多
Background:Liver retransplant is the only option to save a patient with liver graft failure.However,it is controversial due to its poor survival outcome compared to primary transplantation.Insufficient deceased organ ...Background:Liver retransplant is the only option to save a patient with liver graft failure.However,it is controversial due to its poor survival outcome compared to primary transplantation.Insufficient deceased organ donation in Taiwan leads to high waitlist mortality.Hence,living-donor grafts offer a valuable alternative for retransplantation.This study aims to analyze the single center’s outcome in living donor liver retransplantation(re-LDLT)and deceased donor liver retransplantation(re-DDLT)as well as the survival related confounding risk factors.Methods:This is a single center retrospective study including 32 adults who underwent liver retransplantation(re-LT)from June 2002 to April 2020.The cohort was divided into a re-LDLT and a re-DDLT group and survival outcomes were analyzed.Patient outcomes over different periods,the effect of timing on survival,and multivariate analysis for risk factors were also demonstrated Results:Of the 32 retransplantations,the re-LDLT group(n=11)received grafts from younger donors(31.3 vs.43.75 years,P=0.016),with lower graft weights(688 vs.1,457.2 g,P<0.001)and shorter cold ischemia time(CIT)(45 vs.313 min,P<0.001).The 5-year survival was significantly better in the re-LDLT group than in the re-DDLT group(100%vs.70.8%,P=0.02).This difference was adjusted when only retransplantation after 2010 was analyzed.Further analysis showed that the timing of retransplantation(early vs.late)did not affect patient survival.Multivariate analysis revealed that prolonged warm ischemia time(WIT)and intraoperative blood transfusion were related to poor long-term survival.Conclusions:Retransplantation with living donor graft demonstrated good long-term outcomes with acceptable complications to both recipient and donor.It may serve as a choice in areas lacking deceased donors.The timing of retransplantation did not affect the long-term survival.Further effort should be made to reduce WIT and massive blood transfusion as they contributed to poor survival after retransplantation.展开更多
The success of using a partial graft for liver transplantation depends highly on portal venous flow as it is the primary determinant of graft regeneration.Portosystemic collaterals(PSCs)are not uncommon,with an incide...The success of using a partial graft for liver transplantation depends highly on portal venous flow as it is the primary determinant of graft regeneration.Portosystemic collaterals(PSCs)are not uncommon,with an incidence reported to be as high as 40%amongst liver transplant candidates(1).展开更多
IntroductionLiving donor liver transplantation(LDLT)is a durable treatment for end-stage liver disease due to biliary atresia(BA)with excellent graft and patient survivals as shown in our previous study(1).Vascular co...IntroductionLiving donor liver transplantation(LDLT)is a durable treatment for end-stage liver disease due to biliary atresia(BA)with excellent graft and patient survivals as shown in our previous study(1).Vascular complications are a major cause of graft failure in LDLT,particularly in children,where size disparity between donor and recipient vessels is often unavoidable.展开更多
文摘The shortage of organ donors mandates the use of liver allograft from anti-HBc(+) donors, especially in areas highly endemic for hepatitis B virus(HBV) infection. Theincidence of de novo hepatitis B infection(DNH) is over 30%-70% among recipients of hepatitis B core antibody(HBcA b)(+) grafts without any prophylaxis after liver transplantation(LT). Systematic reviews showed that prophylactic therapy [lamivudine and/or hepatitits B immunoglobulin(HBIG)] dramatically reduces the probability of DNH. However, there are limited studies regarding the effects of active immunization to prevent DNH, and the role of active vaccination is not welldefined. This review focuses on the feasibility and efficacy of pre- and post-LT HBV vaccination to prevent DNH in HBsA g(-) recipient using HBcA b(+) grafts. The presence of HBs Ab in combination with lamivudine or HBIG results in lower incidence of DNH and may reduce the requirement of HBIG. There was a trend towards decreasing incidence of DNH with higher titers of HBs Ab. High titers of HBs Ab(> 1000 IU/L) achieved after repeated vaccination could eliminate the necessity for additional antiviral prophylaxis in pediatric recipients. In summary, active vaccination with adequate HBsA b titer is a feasible, cost-effective strategy to prevent DNH in recipients of HBc Ab(+) grafts. HBV vaccination is advised for candidates on waiting list and for recipients after withdrawal of steroids and onset of low dose immunosuppression after transplantation.
基金Supported by Grant NSC 96-231-B-182A-009 and NSC 94-231-B-182A-009 from the National Science Council,Taiwan
文摘The shortage of deceased donor liver grafts led to the use of living donor liver transplant(LDLT).Patients who un-dergo LDLT have a higher risk of complications than those who undergo deceased donor liver transplantation(LT).Interventional radiology has acquired a key role in every LT program by treating the majority of vascular and nonvascular post-transplant complications,improving graft and patient survival and avoiding,in the majority of cases,surgical revision and/or re-transplant.The aim of this paper is to review indications,diagnostic modalities,technical considerations,achievements and potential complications of interventional radiology procedures after LDLT.
文摘AIM: Hyperglycemia commonly seen in liver transplantation (LT) has often been attributed to the dextrose in the storage solution of blood transfusion products. The purpose of the study is to compare the changes of the blood glucose levels in transfused and non-transfused patients during LT. METHODS: A retrospective study on 60 biliary pediatric patients and 16 adult patients undergoing LT was carried out. Transfused pediatric patients were included in Group Ⅰ (GⅠ), those not transfused in Group Ⅱ (GⅡ). Twelve adult patients were not given transfusion and assigned to Group Ⅲ(GⅢ); whereas, four adult patients who received massive transfusion were assigned to Group Ⅳ (GⅣ). The blood glucose levels, volume of blood transfused, and the volume of crystalloid infused were recorded, compared and analyzed. RESULTS: Results showed that the changes in blood glucose levels during LT for both non-transfused and minimally transfused pediatric groups and non-transfused and massively-transfused adult groups were almost the same. CONCLUSION: We conclude that blood transfusion does not cause significant changes in the blood glucose levels in this study.
文摘AIM： Autologous blood donation （ABD） is mainly used to reduce the use of banked blood. In fact, ABD can be regarded as acute blood loss. Would ABD 2-3 d before operation affect the CVP level and subsequently result in less blood loss during liver resection was to be determined.METHODS： Eighty-four patients undergoing living donor left hepatectomy were retrospectively divided as group Ⅰ （GⅠ） and group Ⅱ （GⅡ） according to have donated 250-300 mL blood 2-3 d before living donor hepatectomy or not. The changes of the intraoperative CVP, surgical blood loss,blood products used and the changes of perioperative hemoglobin （Hb） between groups were analyzed and compared by using Mann-Whitney Utest.RESULTS： The results show that the intraoperative CVP changes between GⅠ （n = 35） and GⅡ （n = 49） up to graft procurement were the same, subsequently the blood loss,but ABD resulted in significantly lower perioperative Hb levels in GI.CONCLUSION： Since none of the patients required any blood products perioperatively, all the predonated bloods were discarded after the patients were discharged from the hospital. It indicates that ABD in current series had no any beneficial effects, in term of cost, lowering the CVP, blood loss and reduce the use of banked blood products, but resulted in significant lower Hb in perioperative period.
文摘Objective: Coagulation factor VII(FVII) triggers the extrinsic pathway of blood coagulation. In our previous study, we showed that FVII plays an important role in tumorigenesis of hepatocellular carcinoma(HCC). However, the role of FVII polymorphism in HCC is still unknown. The present study aimed to investigate the relationship between HCC carcinogenesis and single nucleotide polymorphism of FVII.Methods: Thirty-seven HCC patients and 30 healthy donors were recruited in this study. Four common FVII gene polymorphisms– a decanucleotide insertion at position –323(–323 ins10-bp), a G to T substitution at position –401(–401 G/T), a G to A substitution at position –402(–402 G/A), and a T to C substitution at position –122(–122 T/C) – were analyzed by sequencing or commercialized assays using genomic DNA isolated from blood samples. Clinicopathological parameters between control and HCC subjects were compared according to the specific genotypes.Results: The most common nucleotide variation was –402 G/A. However, no statistically significant difference was observed between healthy controls and HCC subjects for all four polymorphisms in terms of genotype distribution and allele frequencies,indicating that these polymorphisms may not affect HCC tumorigenesis. Furthermore, no association was found between–402 G/A polymorphisms and tumor stage, recurrence, and overall survival.Conclusions: Our results indicate that FVII polymorphisms may not be a key factor that clinically impact tumorigenesis and outcomes of HCC, although further investigations should be conducted to confirm our findings.
文摘An innovative 3-phase AC (Alternative Current) drive circuit for the seismic disc in micro-gyroscopes is designed and verified by computer simulations and experiments. The in-plane dynamic model of the seismic disc with mass eccentricity and air gap against the centre bearing and the mathematic expression of two sinusoidal magnetic fields are developed respectively. In order to prevent the seismic disc from collision with the centre bearing and the EM (Electromagnetic) poles, an anti-collision controller is established by employing two Look-up tables which define the intensity of the applied current to the EM poles. Self-sensing technique is included to measure the real-time offset of the disc by two orthogonal pairs of EM poles, without any additional sensors. The drive circuit under SPWM (Sinusoidal Pulse Width Modulation) operation and the anti-collision strategy are verified by intensive computer simulations via commercial software, OrCAD 9, and experiments.
基金This work was supported by grants from the Health and Welfare Surcharge of Tobacco Products,Ministry of Health and Welfare,Taiwan(Nos.MOHW107-TDU-B-212-114022,MOHW108-TDU-B-212-124022,MOHW109-TDU-B-212-134022 to Chen CL).
文摘Background:Barcelona clinic liver cancer(BCLC)stage B(intermediate stage)hepatocellular carcinoma(HCC)is highly heterogeneous;thus,identifying the most effective treatment for individual patients represents a significant clinical challenge.However,transarterial chemoembolization(TACE)is the only recommended treatment option.Therefore,we aimed to investigate the patient characteristics and outcomes of living donor liver transplantation(LDLT)for BCLC stage B HCC.Methods:A total of 516 patients with BCLC stage B HCC who underwent LDLT(n=104)or did not undergo LDLT(non-LDLT;n=412)between 2004 to 2018 were analyzed by propensity score matching(PSM;1:4)analysis.Factors influencing overall survival(OS)and recurrence were analyzed using Cox’s proportional hazards models.Results:Patients treated with LDLT achieved better OS than the non-LDLT group,including liver-and non-liver related survival(all P<0.001).Multivariate Cox regression analysis showed age>60 years(P=0.006),a neutrophil-lymphocyte ratio(NLR)>4(P=0.016)and>3 locoregional therapies(LRT)before LDLT(P<0.001)were independent risk factors for HCC recurrence.In addition,age>60 years(P<0.001)and>3 LRT before LDLT(P=0.001)were independent risk factors for OS.Using a combination of age,NLR,and LRT before liver transplantation(LT),the patients can be divided into low-risk(none of risk),intermediate-risk(one of risk),and high risk(more than two of risk)groups.There were significant differences in the cumulative HCC recurrence(P<0.001)and mortality(P<0.001)rates among the three groups.Conclusions:LDLT may represent a valuable therapeutic option for selected patients with BCLC stage B HCC.
文摘Introduction Within the last decade,progress in transplant and surgical oncology has been tremendous.In liver oncology alone,there has been concurrent technological innovation across the different adjunct fields and tiers of oncology related to hepatocellular carcinoma(HCC),progressing in quite an unprecedented rate.Significant improvements in our capacity to diagnose and prognosticate HCC with increasing sensitivity,specificity,and predictability is being witnessed.We now better understand that staging,treatment and prognostication cannot be determined on a static basis of tumor burden(i.e.,tumor size and number)alone and a“one size fits all”management.Careful individualized assessment is now mandatory in consideration of intra-and intertumoral heterogeneity and tumor biology in order to more precisely guide diagnostics and treatment options(1).
文摘Background:Although left-lobe donation is considered safer,right-sided donor hepatectomy predominatesin adult living donor liver transplantation(LDLT).We hypothesized that bilateral proficiency with donorhepatectomy reduces overall donor complications.Methods:A retrospective review of 834 adult LDLT donors(221 left lobes)from January 2004 toDecember 2014 was performed,dividing cases into two eras based on left-graft experience.Donorcomplications within 6 months were investigated,focusing on graft side and surgical era.Results:The overall complication rate was 17.6%,and was higher in right-lobe donors.In Era 2,duringwhich left-lobe donation rates were three times higher,total complications decreased(14.7%vs.20.9%,P=0.02).A significant reduction in postoperative ascites accounted for the lower overall complication rate.The proportion of major biliary complications(BCs)was halved from 62.5%to 25.0%.Right-lobe donorcomplications also decreased significantly(15.8%vs.22.9%,P=0.032),demonstrating that it was not onlyincreased left-lobe donations leading to lowered complication rates,but also greater experience with donorhepatectomy in general.Conclusions:Accumulating experience with bilateral donor hepatectomy leads to decreased donormorbidity and comparable outcomes for right and left lobes,further enhancing the goal of donor safety whilebalancing recipient needs.
文摘Background:Liver retransplant is the only option to save a patient with liver graft failure.However,it is controversial due to its poor survival outcome compared to primary transplantation.Insufficient deceased organ donation in Taiwan leads to high waitlist mortality.Hence,living-donor grafts offer a valuable alternative for retransplantation.This study aims to analyze the single center’s outcome in living donor liver retransplantation(re-LDLT)and deceased donor liver retransplantation(re-DDLT)as well as the survival related confounding risk factors.Methods:This is a single center retrospective study including 32 adults who underwent liver retransplantation(re-LT)from June 2002 to April 2020.The cohort was divided into a re-LDLT and a re-DDLT group and survival outcomes were analyzed.Patient outcomes over different periods,the effect of timing on survival,and multivariate analysis for risk factors were also demonstrated Results:Of the 32 retransplantations,the re-LDLT group(n=11)received grafts from younger donors(31.3 vs.43.75 years,P=0.016),with lower graft weights(688 vs.1,457.2 g,P<0.001)and shorter cold ischemia time(CIT)(45 vs.313 min,P<0.001).The 5-year survival was significantly better in the re-LDLT group than in the re-DDLT group(100%vs.70.8%,P=0.02).This difference was adjusted when only retransplantation after 2010 was analyzed.Further analysis showed that the timing of retransplantation(early vs.late)did not affect patient survival.Multivariate analysis revealed that prolonged warm ischemia time(WIT)and intraoperative blood transfusion were related to poor long-term survival.Conclusions:Retransplantation with living donor graft demonstrated good long-term outcomes with acceptable complications to both recipient and donor.It may serve as a choice in areas lacking deceased donors.The timing of retransplantation did not affect the long-term survival.Further effort should be made to reduce WIT and massive blood transfusion as they contributed to poor survival after retransplantation.
文摘The success of using a partial graft for liver transplantation depends highly on portal venous flow as it is the primary determinant of graft regeneration.Portosystemic collaterals(PSCs)are not uncommon,with an incidence reported to be as high as 40%amongst liver transplant candidates(1).
文摘IntroductionLiving donor liver transplantation(LDLT)is a durable treatment for end-stage liver disease due to biliary atresia(BA)with excellent graft and patient survivals as shown in our previous study(1).Vascular complications are a major cause of graft failure in LDLT,particularly in children,where size disparity between donor and recipient vessels is often unavoidable.
