With improvements in survival, liver trans- plant recipients now suffer more morbidity from long-term immunosuppression. Considerations were given to develop individualized immunosuppression based on their risk of re-...With improvements in survival, liver trans- plant recipients now suffer more morbidity from long-term immunosuppression. Considerations were given to develop individualized immunosuppression based on their risk of re- jection. METHOD： We retrospectively analyzed the data of 788 liver transplants performed during the period from October 1991 to December 2011 to study the relationship between acute cel- lular rejection （ACR） and various clinical factors. RESULTS： Multivariate analysis showed that older age （P=0.04, OR=0.982）, chronic hepatitis B virus infection （P=0.005, OR= 0.574）, living donor liver transplantation （P=0.02, OR=0.648） and use of interleukin-2 receptor antagonist on induction （P〈0.001, OR=0.401） were associated with fewer ACRs. Patients with fulminant liver failure （P=.004, OR=4.05） were more likely to develop moderate to severe grade ACR. CONCLUSIONS： Liver transplant recipients with older age, chronic hepatitis B virus infection, living donor liver trans- plantation and use of interleukin-2 receptor antagonist on in- duction have fewer ACR. Patients transplanted for fulminant liver failure are at higher risk of moderate to severe grade ACR. These results provide theoretical framework for developing individualized immunosuppression.展开更多
Including the middle hepatic vein in the right lobe liver graft has the advantage of providing direct venous drainage of the right anterior segment. To allow unimpeded passage of blood flow, we previously designed ven...Including the middle hepatic vein in the right lobe liver graft has the advantage of providing direct venous drainage of the right anterior segment. To allow unimpeded passage of blood flow, we previously designed venoplasty of the middle and right hepatic veins. We found that venoplasty is also feasible when the inferior right hepatic vein is near to the right hepatic vein, or when multiple segment 8 hepatic vein orifices are exposed adjacent to the middle hepatic vein at the graft transection surface. By joining the hepatic vein orifices into a single opening, the anastomosis into the inferior vena cava is much facilitated. The technique is simple, yet versatile , and able to cope with variation of the configurations of the hepatic vein.展开更多
ABSTRACT: Fulminant hepatic failure is a medical emer-gency. When this condition declared itself irreversible, atimely liver transplantation is the only effective treatment.A 34-year-old Chinese with fulminant hepatic...ABSTRACT: Fulminant hepatic failure is a medical emer-gency. When this condition declared itself irreversible, atimely liver transplantation is the only effective treatment.A 34-year-old Chinese with fulminant hepatic failure wasevaluated as a potential liver transplantation candidate. Onthe erect chest radiograph, Chilaiditi' s sign has developedover a very short period of a week due to rapid shrinkage ofthe liver. Awareness of Chilaiditi' s sign facilitated distin-guishing the condition of free gas under the diaphragm dueto bowel perforation and subphrenic abscess by gas formingmicro-organisms. Rapidity of onset of this sign parallels thedeterioration of liver function and reflects the urgency ofcondition.展开更多
文摘With improvements in survival, liver trans- plant recipients now suffer more morbidity from long-term immunosuppression. Considerations were given to develop individualized immunosuppression based on their risk of re- jection. METHOD： We retrospectively analyzed the data of 788 liver transplants performed during the period from October 1991 to December 2011 to study the relationship between acute cel- lular rejection （ACR） and various clinical factors. RESULTS： Multivariate analysis showed that older age （P=0.04, OR=0.982）, chronic hepatitis B virus infection （P=0.005, OR= 0.574）, living donor liver transplantation （P=0.02, OR=0.648） and use of interleukin-2 receptor antagonist on induction （P〈0.001, OR=0.401） were associated with fewer ACRs. Patients with fulminant liver failure （P=.004, OR=4.05） were more likely to develop moderate to severe grade ACR. CONCLUSIONS： Liver transplant recipients with older age, chronic hepatitis B virus infection, living donor liver trans- plantation and use of interleukin-2 receptor antagonist on in- duction have fewer ACR. Patients transplanted for fulminant liver failure are at higher risk of moderate to severe grade ACR. These results provide theoretical framework for developing individualized immunosuppression.
基金This study was supported by Sun C. Y. Research Foundation for Hepatobiliary and Pancreatic Surgery ot the Uni- versity of Hong Kong.
文摘Including the middle hepatic vein in the right lobe liver graft has the advantage of providing direct venous drainage of the right anterior segment. To allow unimpeded passage of blood flow, we previously designed venoplasty of the middle and right hepatic veins. We found that venoplasty is also feasible when the inferior right hepatic vein is near to the right hepatic vein, or when multiple segment 8 hepatic vein orifices are exposed adjacent to the middle hepatic vein at the graft transection surface. By joining the hepatic vein orifices into a single opening, the anastomosis into the inferior vena cava is much facilitated. The technique is simple, yet versatile , and able to cope with variation of the configurations of the hepatic vein.
文摘ABSTRACT: Fulminant hepatic failure is a medical emer-gency. When this condition declared itself irreversible, atimely liver transplantation is the only effective treatment.A 34-year-old Chinese with fulminant hepatic failure wasevaluated as a potential liver transplantation candidate. Onthe erect chest radiograph, Chilaiditi' s sign has developedover a very short period of a week due to rapid shrinkage ofthe liver. Awareness of Chilaiditi' s sign facilitated distin-guishing the condition of free gas under the diaphragm dueto bowel perforation and subphrenic abscess by gas formingmicro-organisms. Rapidity of onset of this sign parallels thedeterioration of liver function and reflects the urgency ofcondition.
