Objective:Adverse-risk acute myeloid leukemia(AML)patients should receive allogeneic hematopoietic stem cell transplantation(allo-HSCT)at first complete remission(CR1).However,the influence of prior therapies[i.e.,ven...Objective:Adverse-risk acute myeloid leukemia(AML)patients should receive allogeneic hematopoietic stem cell transplantation(allo-HSCT)at first complete remission(CR1).However,the influence of prior therapies[i.e.,venetoclax plus azacitidine(VEN-AZA)or intensive chemotherapy(IC)]on post-transplant outcomes remains inconclusive.This multicenter,retrospective study compared the post-transplant outcomes between patients receiving VEN-AZA and those receiving IC before allo-HSCT.Methods:This study was based on the transplant database of TROPHY group.Consecutive adverse-risk AML patients receiving allo-HSCT from January 2021 to June 2023 were screened in five Chinese transplant centers.Patients were categorized into VEN-AZA group if they received venetoclax combined with azacitidine as first-line therapy followed by allo-HSCT.Patients who received first-line therapy consisting of a mainstay treatment of cytarabine and anthracycline followed by allo-HSCT were categorized into IC group.Results:In the total cohort,the 3-year probabilities of overall survival,leukemia-free survival,and event-free survival were better in the IC group than VEN-AZA group,particularly for patients with ASXL1 mutations or SF3B1 mutations.However,the survival of the VEN-AZA group was not superior to that of IC group in patients aged≥55 years or those with the hematopoietic cell transplantation-comorbidity index scores≥1 before allo-HSCT.After propensity score matching(median age:VEN-AZA group:57 years;IC group:55 years),only the probability of overall survival for the IC group was better than that of VEN-AZA group(93.6%vs.78.0%,P=0.034)at the 1-year follow-up;however,all of the other clinical outcomes were comparable between the VEN-AZA and IC groups.The TP53 mutation was independently associated with post-transplant relapse and survival.Conclusions:Our results suggest that IC remains the cornerstone of therapy,whereas VEN-AZA may also be used in younger patients and medically fit patients with adverse-risk AML who are receiving allo-HSCT in CR1.展开更多
Objective:Acute myeloid leukemia(AML)patients with internal tandem duplications in the FMS-like tyrosine kinase 3 receptor gene(FLT3-ITD)receiving tyrosine kinase inhibitors maintenance after allogeneic hematopoietic ...Objective:Acute myeloid leukemia(AML)patients with internal tandem duplications in the FMS-like tyrosine kinase 3 receptor gene(FLT3-ITD)receiving tyrosine kinase inhibitors maintenance after allogeneic hematopoietic stem cell transplantation(allo-HSCT)demonstrated improved survival outcomes,however,some still experienced relapse during the maintenance.This study aimed to explore risk factors which might be indicators for poor survival after allo-HSCT in this population.Methods:We consecutively enrolled FLT3-ITD AML patients undergoing transplantation at three centers.By integrating genetic profiles with clinical information,we assessed their impact on transplant outcomes.Results:A total of 196 patient were eligible in the analysis,among whom 14%harbored myelodysplasia-related(MR)mutations,including ASXL1,BCOR,EZH2,RUNX1,SF3B1,SRSF2,STAG2,U2AF1,and ZRSR2.Co-mutant MR was independently associated with poorer overall survival(OS)[hazard ratio(HR):2.4,95%confidence interval(95%CI):1.1-5.3,P=0.030].DNMT3A co-mutations strongly predicted adverse survival and relapse[OS:HR:2.1,95%CI:1.0-4.3,P=0.045;relapse-free survival(RFS):HR:2.2,95%CI:1.1-4.1,P=0.017;cumulative incidence of relapse(CIR):HR:2.3,95%CI:1.1-4.8,P=0.030].Compared to patients with negative measurable residual disease(MRD)complete remission(CR),no significant differences were observed in CR patients with positive MRD,while those without CR exhibited significantly inferior outcomes(P=0.003).Conclusions:Patients with myelodysplasia-related gene mutations(MRmut)and/or DNMT3A mutations experienced inferior outcomes after transplantation,requiring further exploration.Furthermore,similar prognoses among CR patients highlighted the need for monitoring specific molecular residual lesions.展开更多
Objective:Both allogeneic hematopoietic stem cell transplantation(allo-HSCT)and autologous HSCT(ASCT)are important therapies for extranodal natural killer/T-cell lymphoma(ENKTCL);however,no large-scale,multicenter stu...Objective:Both allogeneic hematopoietic stem cell transplantation(allo-HSCT)and autologous HSCT(ASCT)are important therapies for extranodal natural killer/T-cell lymphoma(ENKTCL);however,no large-scale,multicenter study has compared the efficacy and safety between allo-HSCT and ASCT in these patients.Our multicenter,real-world study aimed to evaluate the outcomes of allo-HSCT vs.ASCT as consolidation in ENKTCL patients who had achieved a complete response(CR)or partial response(PR).Methods:This was a multicenter,retrospective study with nine hospitals in China,and 114 patients with ENKTCL were enrolled.Sixty patients received ASCT and 54 received allo-HSCT.The primary outcome was progression-free survival(PFS).In the sensitivity analysis,propensity score matching(PSM)analyses were conducted to adjust for baseline prognostic factors.Landmark analysis were conducted to minimize immortal-time bias.Results:Patients in the allo-HSCT group presented with more adverse prognostic factors.Allo-HSCT group showed a significantly better PFS and a lower disease progression rate compared with ASCT group in patients with Ann Arbor stageⅢ/Ⅳdisease(PFS:100%vs.82.0%,P=0.023;disease progression rate:0 vs.25.4%,P=0.024),those with intermediate/high prognostic index of natural killer lymphoma(PINK)scores(PFS:100%vs.84.4%,P=0.034;disease progression rate:0 vs.22.1%,P=0.034),those with intermediate/high international prognostic index(IPI)scores(PFS:100%vs.82.0%,P=0.038;disease progression rate:0 vs.25.4%,P=0.038),or those receiving HSCT at PR(PFS:100%vs.50%,P=0.046;disease progression rate:0 vs.50%,P=0.046)at the 1.5-4.0 follow-up.In multivariate analysis,receiving ASCT was significantly associated with a poorer PFS[hazard ratio(HR)=2.23,P=0.038]and overall survival(OS)(HR=2.45,P=0.045).In the sensitivity analysis,patients receiving allo-HSCT showed a significantly better PFS(70.3%vs.39.1%,P=0.039),OS(73.9%vs.42.0%,P=0.044),and a lower disease progression rate(22.6%vs.57.0%,P=0.017)compared with those receiving ASCT after propensity score matching.Conclusions:ENKTCL patients with high-risk characteristics could benefit more from allo-HSCT as consolidation.展开更多
AIM:To detect whether the up-to-seven should be used as inclusion criteria for liver transplantation for hepatocellular carcinoma.METHODS:Between April 2002 and July 2008,220hepatocellular carcinoma(HCC)patients who w...AIM:To detect whether the up-to-seven should be used as inclusion criteria for liver transplantation for hepatocellular carcinoma.METHODS:Between April 2002 and July 2008,220hepatocellular carcinoma(HCC)patients who were diagnosed with HCC and underwent liver transplantation(LT)at our liver transplantation center were included.These patients were divided into three groups according to the characteristics of their tumors(tumor diameter,tumor number):the Milan criteria group(Group 1),the in up-to-seven group(Group 2)and the out up-toseven group(Group 3).Then,we compared long-term survival and tumor recurrence of these three groups.RESULTS:The baseline characteristics of transplant recipients were comparable among these three groups,except for the type of liver graft(deceased donor liver transplant or live donor liver transplantation).There were also no significant differences in the pre-operativeα-fetoprotein level.The 1-,3-,and 5-year overall survival and tumor-free survival rate for the Milan criteriagroup were 94.8%,91.4%,89.7%and 91.4%,86.2%,and 86.2%respectively;in the up-to-seven criteria group,these rates were 87.8%,77.8%,and 76.6%and 85.6%,75.6%,and 75.6%respectively(P<0.05).However,the advanced HCC patients’(in the group out of up-to-seven criteria)overall and tumor-free survival rates were much lower,at 75%,53.3%,and 50%and65.8%,42.5%,and 41.7%,respectively(P<0.01).CONCLUSION:Considering that patients in the up-toseven criteria group exhibited a considerable but lower survival rate compared with the Milan criteria group,the up-to-seven criteria should be used carefully and selectively.展开更多
Background:Over the past two decades robotic surgery has been introduced to many areas including liver surgery.Laparoscopic liver surgery is an alternative minimally invasive approach.However,moving on to the complexi...Background:Over the past two decades robotic surgery has been introduced to many areas including liver surgery.Laparoscopic liver surgery is an alternative minimally invasive approach.However,moving on to the complexity of living donor hepatectomies,the advantages of robotic versus laparoscopic approach have convinced us to establish the robotic platform as a standard for living donor hepatectomy.Methods:From November 2018 to January 2022,501 fully robotic donor hepatectomies,including 177 left lateral donor lobes,112 full left lobes and 212 full right lobes were performed.Grafts were donated to 296 adult recipients and 205 pediatric recipients.Donor age,sex,body weight,body mass index(BMI),graft weight,graft to body weight ratio(GBWR),operative time,blood loss,first warm ischemic time,pain score,length of intensive care unit(ICU)stay and hospital stay,and complications were retrospectively analyzed based on a prospectively kept database.Recipients were evaluated for graft and patient survival,age,sex,BMI,body weight,model of end-stage liver disease score,blood loss,transfusions,operative time,cold ischemic time,length of hospital stay and complications.Results:There was no donor mortality.Two cases needed to be converted to open surgery.The median blood loss was 60 mL(range 20-800),median donor operative time was 6.77 h(range 2.93-11.53),median length of hospital stay was 4 days(range 2-22).Complication rate in donors classified following ClavienDindo was 6.4%(n=32)with one grade Ⅲ complication.Three-year actual recipient overall survival was 91.4%;87.5% for adult recipients and 97.1% for pediatric recipients.Three-year actual graft overall survival was 90.6%;87.5% for adult recipients and 95.1% for pediatric recipients.In-hospital mortality was 6%,9.1%(27/296)for adult recipients and 1.4%(3/205)for pediatric recipients.The recipients’morbidity was 19.8%(n=99).Twenty-eight recipients(5.6%)had biliary and 22(4.4%)vascular complications.Six(12.0%)recipients needed to be re-transplanted.Conclusions:With growing experience it is nowadays possible to perform any donor hepatectomy by robotic approach regardless of anatomical variations and graft size.Donor morbidity and quality for life results are encouraging and should motivate other transplant centers with interest in minimally invasive donor surgery to adopt this robotic technique.展开更多
BACKGROUND Given the shortage of suitable liver grafts for liver transplantation, proper use of hepatitis B core antibody-positive livers might be a possible way to enlarge the donor pool and to save patients with end...BACKGROUND Given the shortage of suitable liver grafts for liver transplantation, proper use of hepatitis B core antibody-positive livers might be a possible way to enlarge the donor pool and to save patients with end-stage liver diseases. However, the safety of hepatitis B virus core antibody positive(HBcAb+) donors has been controversial. Initial studies were mainly conducted overseas with relatively small numbers of HBcAb+ liver recipients, and there are few relevant reports in the population of China's Mainland. We hypothesized that the safety of HBcAb+ liver grafts is not suboptimal.AIM To evaluate the safety of using hepatitis B virus(HBV) core antibody-positive donors for liver transplantation in Chinese patients.METHODS We conducted a retrospective study enrolling 1071 patients who underwent liver transplantation consecutively from 2005 to 2016 at West China Hospital Liver Transplantation Center. Given the imbalance in several baseline variables, propensity score matching was used, and the outcomes of all recipients were reviewed in this study.RESULTS In the whole population, 230 patients received HBcAb+ and 841 patients received HBcAb negative(HBcAb-) liver grafts. The 1-, 3-and 5-year survival rates in patients and grafts between the two groups were similar(patient survival: 85.8% vs 87.2%, 77.4% vs 81.1%, 72.4% vs 76.7%, log-rank test, P = 0.16; graft survival: 83.2% vs 83.6%, 73.8% vs 75.9%, 70.8% vs 74.4%, log-rank test, P = 0.19). After propensity score matching, 210 pairs of patients were generated. The corresponding 1-, 3-and 5-year patient and graft survival rates showed no significant differences. Further studies illustrated that the post-transplant major complication rates and liver function recovery after surgery were also similar. In addition, multivariate regression analysis in the original cohort and propensity score-matched Cox analysis demonstrated that receiving HBcA b+ liver grafts was not a significant risk factor for long-term survival. These findings were consistent in both HBV surface antigen-positive(HBsAg+) and HBsA g negative(HBsAg-) patients.Newly diagnosed HBV infection had a relatively higher incidence in HBsAg-patients with HBcAb+ liver grafts(13.23%), in which HBV naive recipients suffered most(31.82%), although this difference did not affect patient and graft survival(P = 0.50 and P = 0.49, respectively). Recipients with a high HBV surface antibody(anti-HBs) titer(more than 100 IU/L) before transplantation and antiviral prophylaxis with nucleos(t)ide antiviral agents post-operation, such as nucleos(t)ide antiviral agents, had lower de novo HBV infection risks. CONCLUSION HBcA b+ liver grafts do not affect the long-term outcome of the recipients. Combined with proper postoperative antiviral prophylaxis, utilization of HBcAb+ grafts is rational and feasible.展开更多
AIM:To validate the"Metroticket"predictor using a large cohort of liver transplantation(LT)patients with hepatocellular carcinoma(HCC)in China.METHODS:In total,230 cases of LT for HCC treatment at our center...AIM:To validate the"Metroticket"predictor using a large cohort of liver transplantation(LT)patients with hepatocellular carcinoma(HCC)in China.METHODS:In total,230 cases of LT for HCC treatment at our center,from July 2000 to August 2008,were included in the present study.The predicted 1-,3-and 5-year post-LT survival rates were calculated using the Metroticket model(http://89.96.76.14/metroticket/calculator/).The predicted and observed long-term survival rates were then compared and analyzed.RESULTS:The predicted survival rates for all 230cases,as calculated by the Metroticket model,were64.7%and 56.2%at 3 and 5 years,respectively,and the observed survival rates for these patients were71.3%and 57.8%,respectively.For the 23 cases with macrovascular invasion,the predicted 5-year survival rate was 43.5%,whereas the observed 5-year survival rate was only 8.7%.For the 42 cases with microvascular invasion but an absence of macrovascular invasion,the predicted 5-year survival rate was 44.9%,and the observed 5-year survival rate was 50%.For the remaining 165 patients without any vascular invasion,the predicted 5-year survival rate was 65.8%,and the observed 5-year survival rate was 66.7%.CONCLUSION:The Metroticket model can be used to accurately predict survival in HCC-related LT cases with an absence of macrovascular invasion.展开更多
BACKGROUND:Marked hemodynamic alteration,commonly referred to as postreperfusion syndrome(PRS),often occurs after revascularization of the donor organ during orthotopic liver transplantation(OLT)and is associated with...BACKGROUND:Marked hemodynamic alteration,commonly referred to as postreperfusion syndrome(PRS),often occurs after revascularization of the donor organ during orthotopic liver transplantation(OLT)and is associated with poor outcomes.This study aimed to investigate the incidence,predictive factors and clinical outcomes of PRS in Chinese patients following OLT at a liver transplantation center in China.METHODS:Over a 5-year period,330 consecutive patients who had undergone OLT for hepatocellular carcinoma or cirrhosis were included in this retrospective study.PRS was defined as a>30%decrease in the mean arterial pressure compared with that before revascularization for more than 1 minute during the first 5 minutes of graft reperfusion.The patients were divided into 2 groups according to the development of PRS:group 1(patients with PRS,n=56)and group 2(patients without PRS,n=274).The demographic characteristics,operative and postoperative courses,and outcomes of the patients were analyzed using SPSS version 18.0.RESULTS:Multivariate regression analysis showed that left ventricular diastolic dysfunction determined by echocardiography and prolonged cold ischemia time were the independent risk factors for PRS.More patients in group 1 showed postoperative renal dysfunction than those in group 2(19.23%vs 8.4%).Moreover,patients in group 1 also had higher intraoperative(7.14%vs 0%)and postoperative mortalities(26.92%vs 12.04%).CONCLUSION:Left ventricular diastolic dysfunction and prolonged cold ischemia time contribute to a high incidence of PRS,which is associated with adverse outcomes in Chinese patients following OLT.展开更多
BACKGROUND:Few studies have been performed to assess health-related quality of life(HRQOL)in liver transplantation(LT)patients in the mainland of China.This study aimed to investigate the HRQOL of post-LT patients in ...BACKGROUND:Few studies have been performed to assess health-related quality of life(HRQOL)in liver transplantation(LT)patients in the mainland of China.This study aimed to investigate the HRQOL of post-LT patients in a single center.METHODS:HRQOL was evaluated by the SF-36(Chinese version)questionnaire in 60 patients(LT group)who had received LT for benign end-stage liver disease(BELD).Fifty-five patients with BELD(BELD group)and 50 healthy volunteers from the general population(GP group)were also evaluated,and the results were compared among the three groups.RESULTS:There was a significant difference among the three groups in terms of the scores of eight domains in the SF-36(P<0.01).Patients in the BELD group had lower scores in each domain of the SF-36 in comparison with those in the GP group(P<0.025).The LT group had mental health scores equivalent to those of the BELD group(P>0.025),but higher scores for the remaining seven domains(P<0.025).Compared with the GP group,the LT group scored equivalently for role physical,body pain,vitality,social function and role emotion(P>0.025),but had lower scores for the remaining three domains(P<0.025).Lower family income was found to be associated with reduced physical function and mental health scores(P<0.05).Better education was associated with increased mental health scores(P<0.05).CONCLUSIONS:LT patients generally have a good HRQOL although some respects of their HRQOL remains to be improved.Lower family income and poor education are important factors relating to the poor HRQOL of LT patients.展开更多
AIM： To discuss the safety of donors during living donor liver transplantation （LDLT） and the authors＇ experience with 50 cases. METHODS： Between January 1995 and March 2006, 50 patients with end-stage liver dise...AIM： To discuss the safety of donors during living donor liver transplantation （LDLT） and the authors＇ experience with 50 cases. METHODS： Between January 1995 and March 2006, 50 patients with end-stage liver disease received LDLT in our department. Donors （at the age of 27-58 years） were healthy and antibody （ABO）-compatible. The protocol of evaluation and selection of donors, choice of surgical methods and strategy applied in the safety evaluation of donors were analyzed. RESULTS： A total of 115 candidate donors were evaluated for LDLT at our center. Of these, 50 underwent successful hepatectomy for living donation. The elimination rate for donors was 43.5%. Positive hepatitis serology and ABO incompatibility were the main factors for excluding candidates. All donors recovered uneventfully. The follow-up time ranged from 3 to 135 too. The incidence of major and minor medical complications was 12.0% and 28.0%, respectively. CONCLUSION： LDLT provides an excellent approach to the problem of donor shortage in China. With a thorough and complete preoperative workup and meticulous intra-and postoperative management, LDLT can be performed with minimal donor morbidity.展开更多
AIM: To study the effects of mesenchymal stem cell (MSC) therapy on the prevention of acute rejection and graft vs host disease following small bowel transplantation.
Biliary complications have always been a dreaded cause of morbidity after living donor liver transplantation.While intrinsic variations in both graft and recipient biliary anatomy remain a significant factor to the di...Biliary complications have always been a dreaded cause of morbidity after living donor liver transplantation.While intrinsic variations in both graft and recipient biliary anatomy remain a significant factor to the difficulty of biliary reconstruction,our institution has taken advantage of its high volume of cases to critically review and evaluate modifiable operative risk factors,in particular,our surgical protocols.We present herein,the evolution of our reconstructive biliary technique from conventional methods to our current standard of microsurgical biliary reconstruction for both graft and recipient ducts.Over this period of transition,our center has created a classification system for biliary reconstruction that decreased the biliary complication rates from 40.0%to 10.2%.展开更多
Objective:Sex-specific differences are observed in various liver diseases,but the influence of sex on the outcomes of hepatocellular carcinoma(HCC)after liver transplantation(LT)remains to be determined.This study is ...Objective:Sex-specific differences are observed in various liver diseases,but the influence of sex on the outcomes of hepatocellular carcinoma(HCC)after liver transplantation(LT)remains to be determined.This study is the first Chinese nationwide investigation of the role of sex in post-LT outcomes in patients with HCC.Methods:Data for recipients with HCC registered in the China Liver Transplant Registry between January 2015 and December 2020 were analyzed.The associations between donor,recipient,or donor-recipient transplant patterns by sex and the post-LT outcomes were studied with propensity score matching(PSM).The survival associated with different sex-based donor-recipient transplant patterns was further studied.Results:Among 3,769 patients enrolled in this study,the 1-,3-,and 5-year overall survival(OS)rates of patients with HCC after LT were 96.1%,86.4%,and 78.5%,respectively,in female recipients,and 95.8%,79.0%,and 70.7%,respectively,in male recipients after PSM(P=0.009).However,the OS was comparable between recipients with female donors and male donors.Multivariate analysis indicated that male recipient sex was a risk factor for post-LT survival(HR=1.381,P=0.046).Among the donor-recipient transplant patterns,the male-male donor-recipient transplant pattern was associated with the poorest post-LT survival(P<0.05).Conclusions:Our findings highlighted that the post-LT outcomes of female recipients were significantly superior to those of male recipients,and the male-male donor-recipient transplant pattern was associated with the poorest post-LT survival.Livers from male donors may provide the most benefit to female recipients.Our results indicate that sex should be considered as a critical factor in organ allocation.展开更多
BACKGROUND:Donor safety has always been a major concern and potential risk to the donor must be balanced against recipient benefit.However,lack of a standardized and uniform evaluation of perioperative complications i...BACKGROUND:Donor safety has always been a major concern and potential risk to the donor must be balanced against recipient benefit.However,lack of a standardized and uniform evaluation of perioperative complications is a serious limitation of the evaluation of donor morbidity.This study was designed to evaluate the outcomes of donors in adult living donor liver transplantation(LDLT)using the newer Clavien classification system in a single center in China.METHODS:We prospectively analyzed the outcomes of 132 consecutive living liver donors from 2005 to 2008 using the newer Clavien classification system.The preoperative,intraoperative and postoperative data of the donors were collected and analyzed Ordinal regression was used to analyze the ordered grades of complications.RESULTS:Ninety-four(71.2%)of the donors developed postoperative complications of grade I(n=45,34.1%),grade II(n=39,29.5%)and grade III(n=10,7.6%).There was no death or grade IV morbidity.Hepatic functional impairment and pleural effusion were the most frequent morbidities for living donors.Fifty-three donors(40.1%)developed hepatic functional impairment of grade I(n=40,31.1%)and grade II(n=13,10.0%).The ICU stay(7.8±1.8 days)and length of hospital stay(17.7±4.6 days)were significantly longer in donors with grade III than others.Furthermore,ordinal logistic regression revealed that donor’s older age(>40 years)and right hepatectomy were associated with morbidity.In addition,only preoperative total bilirubin(within the normal range)and postoperative nadir serum phosphorus were independently associated with hepatic functional impairment.The receiveroperator characteristic curve revealed that preoperative total bilirubin>18.0μmol/L and postoperative nadir of serum phosphorus<1 mg/dL may lead to more severe hepatic functional impairment.CONCLUSIONS:Despite the fact that donors are relatively safe to undergo hepatectomy,many living donors still experience postoperative morbidity.Meticulous technical and preoperative donor evaluation and treatment are sure to reduce the incidence of complications.展开更多
BACKGROUND： In 2011, a pilot program for deceased organ donation was initiated in China. We describe the first successful series of liver transplants in the pilot program.METHODS： From July 2011 to August 2012, our ...BACKGROUND： In 2011, a pilot program for deceased organ donation was initiated in China. We describe the first successful series of liver transplants in the pilot program.METHODS： From July 2011 to August 2012, our center performed 26 liver transplants from a pool of 29 deceased donors. All organ donation and allograft procurement were conducted according to the national protocol. The clinical data of donors and recipients were collected and summarized retrospectively.RESULTS： Among the 29 donors, 24 were China Category II donors（organ donation after cardiac death）, and five were China Category III donors（organ donation after brain death followed by cardiac death）. The recipients were mainly the patients with hepatocellular carcinoma. The one-year patient survival rate was 80.8% with a median follow-up of 422（2-696） days. Among the five mortalities during the follow-up,three died of tumor recurrence. In terms of post-transplant complications, 9 recipients（34.6%） experienced early allograft dysfunction, 1（3.8%） had non-anastomotic biliary stricture,and 1（3.8%） was complicated with hepatic arterial thrombosis.None of these complications resulted in patient death. Notably,primary non-function was not observed in any of the grafts.CONCLUSION： With careful donor selection, liver transplant from deceased donors can be performed safely and plays acritical role in overcoming the extreme organ shortage in China.展开更多
AIM To examine the effect of center size on survival differences between simultaneous liver kidney transplantation(SLKT) and liver transplantation alone(LTA) in SLKT-listed patients.METHODS The United Network of Organ...AIM To examine the effect of center size on survival differences between simultaneous liver kidney transplantation(SLKT) and liver transplantation alone(LTA) in SLKT-listed patients.METHODS The United Network of Organ Sharing database was queried for patients ≥ 18 years of age listed for SLKT between February 2002 and December 2015. Posttransplant survival was evaluated using stratified Cox regression with interaction between transplant type(LTA vs SLKT) and center volume.RESULTS During the study period, 393 of 4580 patients(9%) listed for SLKT underwent a LTA. Overall mortality was higher among LTA recipients(180/393, 46%) than SLKT recipients(1107/4187, 26%). The Cox model predicted a significant survival disadvantage for patients receiving LTA vs SLKT [hazard ratio, hazard ratio(HR) = 2.85; 95%CI: 2.21, 3.66; P < 0.001] in centers performing 30 SLKT over the study period. This disadvantage was modestly attenuated as center SLKT volume increased, with a 3% reduction(HR = 0.97; 95%CI: 0.95, 0.99; P = 0.010) for every 10 SLKs performed.CONCLUSION In conclusion, LTA is associated with increased mortality among patients listed for SLKT. This difference is modestly attenuated at more experienced centers and may explain inconsistencies between smaller-center and larger registry-wide studies comparing SLKT and LTA outcomes.展开更多
Background:Normal bile is sterile.Studies have shown that cholangitis after liver transplantation(LT)was associated with a relatively poor prognosis.It remains unclear whether the bacteriobilia or fungibilia impact th...Background:Normal bile is sterile.Studies have shown that cholangitis after liver transplantation(LT)was associated with a relatively poor prognosis.It remains unclear whether the bacteriobilia or fungibilia impact the patient outcomes in LT recipients,especially with donation after circulatory death(DCD)allografts,which was correlated with a higher risk of allograft failure.Methods:This retrospective study included 139 LT recipients of DCD grafts from 2019 to 2021.All patients were divided into two groups according to the presence or absence of bacteriobilia or fungibilia.The prevalence and microbial spectrum of postoperative bacteriobilia or fungibilia and its possible association with outcomes,especially hospital stay were analyzed.Results:Totally 135 and 171 organisms were isolated at weeks 1 and 2,respectively.Among all patients included in this analysis,83(59.7%)developed bacteriobilia or fungibilia within 2 weeks posttransplantation.The occurrence of bacteriobilia or fungibilia[β=7.43,95%CI(confidence interval):0.02 to 14.82,P=0.049],particularly the detection of Pseudomonas(β=18.84,95%CI:6.51 to 31.07,P=0.003)within 2 weeks post-transplantation was associated with a longer hospital stay.However,it did not affect the graft and patient survival.Conclusions:The occurrence of bacteriobilia or fungibilia,particularly Pseudomonas within 2 weeks posttransplantation,could influence the recovery of liver function and was associated with prolonged hospital stay but not the graft and patient survival.展开更多
Ischemia-reperfusion injury (IRI) is an inherent issue in organ transplantation. Because of the allograft shortage, more and more extended criteria donor (ECD) organs are used, unfortunately these grafts are more susc...Ischemia-reperfusion injury (IRI) is an inherent issue in organ transplantation. Because of the allograft shortage, more and more extended criteria donor (ECD) organs are used, unfortunately these grafts are more susceptible to IRI. Although machine perfusion technology has brought hope to alleviate IRI, this technology is still unable to eradicate IRI-related organ damage. Ischemia-free liver transplantation (IFLT)can completely avoid IRI, thereby improve graft function and recipient outcome, and allow to expand organ pool. This review summarized the latest progresses in IFLT, and speculated the future development of this concept.展开更多
With the advances in transplant oncology in recent years, the role of liver transplantation has expanded to make curative treatment a possibility for a wider patient population. We highlight strategies in Hong Kong, C...With the advances in transplant oncology in recent years, the role of liver transplantation has expanded to make curative treatment a possibility for a wider patient population. We highlight strategies in Hong Kong, China that have enabled preoperative prognostication for judicious patient selection, downstaging therapy to definitive treatment, and postoperative therapies that have provided a growing role for liver transplantation in patients with more advanced hepatocellular carcinoma.展开更多
Background:Liver transplantations(LTs)with extended criteria have produced surgical results comparable to those obtained with traditional standards.However,it is not sufficient to predict hepatocellular carcinoma(HCC)...Background:Liver transplantations(LTs)with extended criteria have produced surgical results comparable to those obtained with traditional standards.However,it is not sufficient to predict hepatocellular carcinoma(HCC)recurrence after LT according to morphological criteria alone.The present study aimed to construct a nomogram for predicting HCC recurrence after LT using extended selection criteria.Methods:Retrospective data on patients with HCC,including pathology,serological markers and followup data,were collected from January 2015 to April 2020 at Huashan Hospital,Fudan University,Shanghai,China.Logistic least absolute shrinkage and selection operator(LASSO)regression and multivariate Cox regression analyses were performed to identify and construct the prognostic nomogram.Receiver operating characteristic(ROC)curves,Kaplan-Meier curves,decision curve analyses(DCAs),calibration diagrams,net reclassification indices(NRIs)and integrated discrimination improvement(IDI)values were used to assess the prognostic capacity of the nomogram.Results:A total of 301 patients with HCC who underwent LT were enrolled in the study.The nomogram was constructed,and the ROC curve showed good performance in predicting survival in both the development set(2/3)and the validation set(1/3)(the area under the curve reached 0.748 and 0.716,respectively).According to the median value of the risk score,the patients were categorized into the high-and low-risk groups,which had significantly different recurrence-free survival(RFS)rates(P<0.01).Compared with the Milan criteria and University of California San Francisco(UCSF)criteria,DCA revealed that the new nomogram model had the best net benefit in predicting 1-,3-and 5-year RFS.The nomogram performed well for calibration,NRI and IDI improvement.Conclusions:The nomogram,based on the Milan criteria and serological markers,showed good accuracy in predicting the recurrence of HCC after LT using extended selection criteria.展开更多
基金supported by the Beijing Natural Science Foundation(No.Z230016)the National Key Research and Development Program of China(No.2022YFC 2502606)+4 种基金the Major Program of the National Natural Science Foundation of China(No.82293630)the Peking University Medicine Fund for the World’s Leading Discipline or Discipline Cluster Development(No.71003Y3035)the Plan Project of Tongzhou Municipal Science and Technology(No.KJ2024CX045)the National Natural Science Foundation of China(No.82170208)the Fundamental Research Funds for the Central Universities。
文摘Objective:Adverse-risk acute myeloid leukemia(AML)patients should receive allogeneic hematopoietic stem cell transplantation(allo-HSCT)at first complete remission(CR1).However,the influence of prior therapies[i.e.,venetoclax plus azacitidine(VEN-AZA)or intensive chemotherapy(IC)]on post-transplant outcomes remains inconclusive.This multicenter,retrospective study compared the post-transplant outcomes between patients receiving VEN-AZA and those receiving IC before allo-HSCT.Methods:This study was based on the transplant database of TROPHY group.Consecutive adverse-risk AML patients receiving allo-HSCT from January 2021 to June 2023 were screened in five Chinese transplant centers.Patients were categorized into VEN-AZA group if they received venetoclax combined with azacitidine as first-line therapy followed by allo-HSCT.Patients who received first-line therapy consisting of a mainstay treatment of cytarabine and anthracycline followed by allo-HSCT were categorized into IC group.Results:In the total cohort,the 3-year probabilities of overall survival,leukemia-free survival,and event-free survival were better in the IC group than VEN-AZA group,particularly for patients with ASXL1 mutations or SF3B1 mutations.However,the survival of the VEN-AZA group was not superior to that of IC group in patients aged≥55 years or those with the hematopoietic cell transplantation-comorbidity index scores≥1 before allo-HSCT.After propensity score matching(median age:VEN-AZA group:57 years;IC group:55 years),only the probability of overall survival for the IC group was better than that of VEN-AZA group(93.6%vs.78.0%,P=0.034)at the 1-year follow-up;however,all of the other clinical outcomes were comparable between the VEN-AZA and IC groups.The TP53 mutation was independently associated with post-transplant relapse and survival.Conclusions:Our results suggest that IC remains the cornerstone of therapy,whereas VEN-AZA may also be used in younger patients and medically fit patients with adverse-risk AML who are receiving allo-HSCT in CR1.
基金supported by grants from the National Key Research and Development Program of China(No.2022YFA1103500)the National Natural Science Foundation of China(No.82170210)。
文摘Objective:Acute myeloid leukemia(AML)patients with internal tandem duplications in the FMS-like tyrosine kinase 3 receptor gene(FLT3-ITD)receiving tyrosine kinase inhibitors maintenance after allogeneic hematopoietic stem cell transplantation(allo-HSCT)demonstrated improved survival outcomes,however,some still experienced relapse during the maintenance.This study aimed to explore risk factors which might be indicators for poor survival after allo-HSCT in this population.Methods:We consecutively enrolled FLT3-ITD AML patients undergoing transplantation at three centers.By integrating genetic profiles with clinical information,we assessed their impact on transplant outcomes.Results:A total of 196 patient were eligible in the analysis,among whom 14%harbored myelodysplasia-related(MR)mutations,including ASXL1,BCOR,EZH2,RUNX1,SF3B1,SRSF2,STAG2,U2AF1,and ZRSR2.Co-mutant MR was independently associated with poorer overall survival(OS)[hazard ratio(HR):2.4,95%confidence interval(95%CI):1.1-5.3,P=0.030].DNMT3A co-mutations strongly predicted adverse survival and relapse[OS:HR:2.1,95%CI:1.0-4.3,P=0.045;relapse-free survival(RFS):HR:2.2,95%CI:1.1-4.1,P=0.017;cumulative incidence of relapse(CIR):HR:2.3,95%CI:1.1-4.8,P=0.030].Compared to patients with negative measurable residual disease(MRD)complete remission(CR),no significant differences were observed in CR patients with positive MRD,while those without CR exhibited significantly inferior outcomes(P=0.003).Conclusions:Patients with myelodysplasia-related gene mutations(MRmut)and/or DNMT3A mutations experienced inferior outcomes after transplantation,requiring further exploration.Furthermore,similar prognoses among CR patients highlighted the need for monitoring specific molecular residual lesions.
基金supported by Talent development plan for the future in Medical-Engineering Integration by BRACDCHE and ZTA,National Key Research and Development Program of China(No.2022YFC2502600,No.2022YFC2502606)the Beijing Natural Science Foundation(No.Z230016)+2 种基金the National Natural Science Foundation of China(No.82570262,No.82170206,and No.82170208)Science and Technology Plan of Tongzhou District(No.KJ2024CX045)Shanghai Municipal Health Commission Project of Disciplines of Excellence(No.20224Z0022).
文摘Objective:Both allogeneic hematopoietic stem cell transplantation(allo-HSCT)and autologous HSCT(ASCT)are important therapies for extranodal natural killer/T-cell lymphoma(ENKTCL);however,no large-scale,multicenter study has compared the efficacy and safety between allo-HSCT and ASCT in these patients.Our multicenter,real-world study aimed to evaluate the outcomes of allo-HSCT vs.ASCT as consolidation in ENKTCL patients who had achieved a complete response(CR)or partial response(PR).Methods:This was a multicenter,retrospective study with nine hospitals in China,and 114 patients with ENKTCL were enrolled.Sixty patients received ASCT and 54 received allo-HSCT.The primary outcome was progression-free survival(PFS).In the sensitivity analysis,propensity score matching(PSM)analyses were conducted to adjust for baseline prognostic factors.Landmark analysis were conducted to minimize immortal-time bias.Results:Patients in the allo-HSCT group presented with more adverse prognostic factors.Allo-HSCT group showed a significantly better PFS and a lower disease progression rate compared with ASCT group in patients with Ann Arbor stageⅢ/Ⅳdisease(PFS:100%vs.82.0%,P=0.023;disease progression rate:0 vs.25.4%,P=0.024),those with intermediate/high prognostic index of natural killer lymphoma(PINK)scores(PFS:100%vs.84.4%,P=0.034;disease progression rate:0 vs.22.1%,P=0.034),those with intermediate/high international prognostic index(IPI)scores(PFS:100%vs.82.0%,P=0.038;disease progression rate:0 vs.25.4%,P=0.038),or those receiving HSCT at PR(PFS:100%vs.50%,P=0.046;disease progression rate:0 vs.50%,P=0.046)at the 1.5-4.0 follow-up.In multivariate analysis,receiving ASCT was significantly associated with a poorer PFS[hazard ratio(HR)=2.23,P=0.038]and overall survival(OS)(HR=2.45,P=0.045).In the sensitivity analysis,patients receiving allo-HSCT showed a significantly better PFS(70.3%vs.39.1%,P=0.039),OS(73.9%vs.42.0%,P=0.044),and a lower disease progression rate(22.6%vs.57.0%,P=0.017)compared with those receiving ASCT after propensity score matching.Conclusions:ENKTCL patients with high-risk characteristics could benefit more from allo-HSCT as consolidation.
文摘AIM:To detect whether the up-to-seven should be used as inclusion criteria for liver transplantation for hepatocellular carcinoma.METHODS:Between April 2002 and July 2008,220hepatocellular carcinoma(HCC)patients who were diagnosed with HCC and underwent liver transplantation(LT)at our liver transplantation center were included.These patients were divided into three groups according to the characteristics of their tumors(tumor diameter,tumor number):the Milan criteria group(Group 1),the in up-to-seven group(Group 2)and the out up-toseven group(Group 3).Then,we compared long-term survival and tumor recurrence of these three groups.RESULTS:The baseline characteristics of transplant recipients were comparable among these three groups,except for the type of liver graft(deceased donor liver transplant or live donor liver transplantation).There were also no significant differences in the pre-operativeα-fetoprotein level.The 1-,3-,and 5-year overall survival and tumor-free survival rate for the Milan criteriagroup were 94.8%,91.4%,89.7%and 91.4%,86.2%,and 86.2%respectively;in the up-to-seven criteria group,these rates were 87.8%,77.8%,and 76.6%and 85.6%,75.6%,and 75.6%respectively(P<0.05).However,the advanced HCC patients’(in the group out of up-to-seven criteria)overall and tumor-free survival rates were much lower,at 75%,53.3%,and 50%and65.8%,42.5%,and 41.7%,respectively(P<0.01).CONCLUSION:Considering that patients in the up-toseven criteria group exhibited a considerable but lower survival rate compared with the Milan criteria group,the up-to-seven criteria should be used carefully and selectively.
文摘Background:Over the past two decades robotic surgery has been introduced to many areas including liver surgery.Laparoscopic liver surgery is an alternative minimally invasive approach.However,moving on to the complexity of living donor hepatectomies,the advantages of robotic versus laparoscopic approach have convinced us to establish the robotic platform as a standard for living donor hepatectomy.Methods:From November 2018 to January 2022,501 fully robotic donor hepatectomies,including 177 left lateral donor lobes,112 full left lobes and 212 full right lobes were performed.Grafts were donated to 296 adult recipients and 205 pediatric recipients.Donor age,sex,body weight,body mass index(BMI),graft weight,graft to body weight ratio(GBWR),operative time,blood loss,first warm ischemic time,pain score,length of intensive care unit(ICU)stay and hospital stay,and complications were retrospectively analyzed based on a prospectively kept database.Recipients were evaluated for graft and patient survival,age,sex,BMI,body weight,model of end-stage liver disease score,blood loss,transfusions,operative time,cold ischemic time,length of hospital stay and complications.Results:There was no donor mortality.Two cases needed to be converted to open surgery.The median blood loss was 60 mL(range 20-800),median donor operative time was 6.77 h(range 2.93-11.53),median length of hospital stay was 4 days(range 2-22).Complication rate in donors classified following ClavienDindo was 6.4%(n=32)with one grade Ⅲ complication.Three-year actual recipient overall survival was 91.4%;87.5% for adult recipients and 97.1% for pediatric recipients.Three-year actual graft overall survival was 90.6%;87.5% for adult recipients and 95.1% for pediatric recipients.In-hospital mortality was 6%,9.1%(27/296)for adult recipients and 1.4%(3/205)for pediatric recipients.The recipients’morbidity was 19.8%(n=99).Twenty-eight recipients(5.6%)had biliary and 22(4.4%)vascular complications.Six(12.0%)recipients needed to be re-transplanted.Conclusions:With growing experience it is nowadays possible to perform any donor hepatectomy by robotic approach regardless of anatomical variations and graft size.Donor morbidity and quality for life results are encouraging and should motivate other transplant centers with interest in minimally invasive donor surgery to adopt this robotic technique.
文摘BACKGROUND Given the shortage of suitable liver grafts for liver transplantation, proper use of hepatitis B core antibody-positive livers might be a possible way to enlarge the donor pool and to save patients with end-stage liver diseases. However, the safety of hepatitis B virus core antibody positive(HBcAb+) donors has been controversial. Initial studies were mainly conducted overseas with relatively small numbers of HBcAb+ liver recipients, and there are few relevant reports in the population of China's Mainland. We hypothesized that the safety of HBcAb+ liver grafts is not suboptimal.AIM To evaluate the safety of using hepatitis B virus(HBV) core antibody-positive donors for liver transplantation in Chinese patients.METHODS We conducted a retrospective study enrolling 1071 patients who underwent liver transplantation consecutively from 2005 to 2016 at West China Hospital Liver Transplantation Center. Given the imbalance in several baseline variables, propensity score matching was used, and the outcomes of all recipients were reviewed in this study.RESULTS In the whole population, 230 patients received HBcAb+ and 841 patients received HBcAb negative(HBcAb-) liver grafts. The 1-, 3-and 5-year survival rates in patients and grafts between the two groups were similar(patient survival: 85.8% vs 87.2%, 77.4% vs 81.1%, 72.4% vs 76.7%, log-rank test, P = 0.16; graft survival: 83.2% vs 83.6%, 73.8% vs 75.9%, 70.8% vs 74.4%, log-rank test, P = 0.19). After propensity score matching, 210 pairs of patients were generated. The corresponding 1-, 3-and 5-year patient and graft survival rates showed no significant differences. Further studies illustrated that the post-transplant major complication rates and liver function recovery after surgery were also similar. In addition, multivariate regression analysis in the original cohort and propensity score-matched Cox analysis demonstrated that receiving HBcA b+ liver grafts was not a significant risk factor for long-term survival. These findings were consistent in both HBV surface antigen-positive(HBsAg+) and HBsA g negative(HBsAg-) patients.Newly diagnosed HBV infection had a relatively higher incidence in HBsAg-patients with HBcAb+ liver grafts(13.23%), in which HBV naive recipients suffered most(31.82%), although this difference did not affect patient and graft survival(P = 0.50 and P = 0.49, respectively). Recipients with a high HBV surface antibody(anti-HBs) titer(more than 100 IU/L) before transplantation and antiviral prophylaxis with nucleos(t)ide antiviral agents post-operation, such as nucleos(t)ide antiviral agents, had lower de novo HBV infection risks. CONCLUSION HBcA b+ liver grafts do not affect the long-term outcome of the recipients. Combined with proper postoperative antiviral prophylaxis, utilization of HBcAb+ grafts is rational and feasible.
文摘AIM:To validate the"Metroticket"predictor using a large cohort of liver transplantation(LT)patients with hepatocellular carcinoma(HCC)in China.METHODS:In total,230 cases of LT for HCC treatment at our center,from July 2000 to August 2008,were included in the present study.The predicted 1-,3-and 5-year post-LT survival rates were calculated using the Metroticket model(http://89.96.76.14/metroticket/calculator/).The predicted and observed long-term survival rates were then compared and analyzed.RESULTS:The predicted survival rates for all 230cases,as calculated by the Metroticket model,were64.7%and 56.2%at 3 and 5 years,respectively,and the observed survival rates for these patients were71.3%and 57.8%,respectively.For the 23 cases with macrovascular invasion,the predicted 5-year survival rate was 43.5%,whereas the observed 5-year survival rate was only 8.7%.For the 42 cases with microvascular invasion but an absence of macrovascular invasion,the predicted 5-year survival rate was 44.9%,and the observed 5-year survival rate was 50%.For the remaining 165 patients without any vascular invasion,the predicted 5-year survival rate was 65.8%,and the observed 5-year survival rate was 66.7%.CONCLUSION:The Metroticket model can be used to accurately predict survival in HCC-related LT cases with an absence of macrovascular invasion.
基金supported by a grant from the Key Programs of STCSM(No.10411951300)
文摘BACKGROUND:Marked hemodynamic alteration,commonly referred to as postreperfusion syndrome(PRS),often occurs after revascularization of the donor organ during orthotopic liver transplantation(OLT)and is associated with poor outcomes.This study aimed to investigate the incidence,predictive factors and clinical outcomes of PRS in Chinese patients following OLT at a liver transplantation center in China.METHODS:Over a 5-year period,330 consecutive patients who had undergone OLT for hepatocellular carcinoma or cirrhosis were included in this retrospective study.PRS was defined as a>30%decrease in the mean arterial pressure compared with that before revascularization for more than 1 minute during the first 5 minutes of graft reperfusion.The patients were divided into 2 groups according to the development of PRS:group 1(patients with PRS,n=56)and group 2(patients without PRS,n=274).The demographic characteristics,operative and postoperative courses,and outcomes of the patients were analyzed using SPSS version 18.0.RESULTS:Multivariate regression analysis showed that left ventricular diastolic dysfunction determined by echocardiography and prolonged cold ischemia time were the independent risk factors for PRS.More patients in group 1 showed postoperative renal dysfunction than those in group 2(19.23%vs 8.4%).Moreover,patients in group 1 also had higher intraoperative(7.14%vs 0%)and postoperative mortalities(26.92%vs 12.04%).CONCLUSION:Left ventricular diastolic dysfunction and prolonged cold ischemia time contribute to a high incidence of PRS,which is associated with adverse outcomes in Chinese patients following OLT.
基金supported by grants from the Major State Basic Research Development Program(973 Program)of China(2009CB522404)Guangdong Province Science and Technology Project(2011B060300002)
文摘BACKGROUND:Few studies have been performed to assess health-related quality of life(HRQOL)in liver transplantation(LT)patients in the mainland of China.This study aimed to investigate the HRQOL of post-LT patients in a single center.METHODS:HRQOL was evaluated by the SF-36(Chinese version)questionnaire in 60 patients(LT group)who had received LT for benign end-stage liver disease(BELD).Fifty-five patients with BELD(BELD group)and 50 healthy volunteers from the general population(GP group)were also evaluated,and the results were compared among the three groups.RESULTS:There was a significant difference among the three groups in terms of the scores of eight domains in the SF-36(P<0.01).Patients in the BELD group had lower scores in each domain of the SF-36 in comparison with those in the GP group(P<0.025).The LT group had mental health scores equivalent to those of the BELD group(P>0.025),but higher scores for the remaining seven domains(P<0.025).Compared with the GP group,the LT group scored equivalently for role physical,body pain,vitality,social function and role emotion(P>0.025),but had lower scores for the remaining three domains(P<0.025).Lower family income was found to be associated with reduced physical function and mental health scores(P<0.05).Better education was associated with increased mental health scores(P<0.05).CONCLUSIONS:LT patients generally have a good HRQOL although some respects of their HRQOL remains to be improved.Lower family income and poor education are important factors relating to the poor HRQOL of LT patients.
文摘AIM： To discuss the safety of donors during living donor liver transplantation （LDLT） and the authors＇ experience with 50 cases. METHODS： Between January 1995 and March 2006, 50 patients with end-stage liver disease received LDLT in our department. Donors （at the age of 27-58 years） were healthy and antibody （ABO）-compatible. The protocol of evaluation and selection of donors, choice of surgical methods and strategy applied in the safety evaluation of donors were analyzed. RESULTS： A total of 115 candidate donors were evaluated for LDLT at our center. Of these, 50 underwent successful hepatectomy for living donation. The elimination rate for donors was 43.5%. Positive hepatitis serology and ABO incompatibility were the main factors for excluding candidates. All donors recovered uneventfully. The follow-up time ranged from 3 to 135 too. The incidence of major and minor medical complications was 12.0% and 28.0%, respectively. CONCLUSION： LDLT provides an excellent approach to the problem of donor shortage in China. With a thorough and complete preoperative workup and meticulous intra-and postoperative management, LDLT can be performed with minimal donor morbidity.
文摘AIM: To study the effects of mesenchymal stem cell (MSC) therapy on the prevention of acute rejection and graft vs host disease following small bowel transplantation.
文摘Biliary complications have always been a dreaded cause of morbidity after living donor liver transplantation.While intrinsic variations in both graft and recipient biliary anatomy remain a significant factor to the difficulty of biliary reconstruction,our institution has taken advantage of its high volume of cases to critically review and evaluate modifiable operative risk factors,in particular,our surgical protocols.We present herein,the evolution of our reconstructive biliary technique from conventional methods to our current standard of microsurgical biliary reconstruction for both graft and recipient ducts.Over this period of transition,our center has created a classification system for biliary reconstruction that decreased the biliary complication rates from 40.0%to 10.2%.
基金supported by funding from the National Key Research and Development Program of China(Grant No.2021 YFA1100500)The Major Research Plan of the National Natural Science Foundation of China(Grant No.92159202)+3 种基金Key Program,National Natural Science Foundation of China(Grant No.81930016)National Natural Science Foundation of China(Grant No.82300743)Zhejiang Provincial Natural Science Foundation of China(Grant No.LQ23H160044)Key Research&Development Program of Zhejiang Province(Grant Nos.2019C03050,2022C03108,and 2021C03118)。
文摘Objective:Sex-specific differences are observed in various liver diseases,but the influence of sex on the outcomes of hepatocellular carcinoma(HCC)after liver transplantation(LT)remains to be determined.This study is the first Chinese nationwide investigation of the role of sex in post-LT outcomes in patients with HCC.Methods:Data for recipients with HCC registered in the China Liver Transplant Registry between January 2015 and December 2020 were analyzed.The associations between donor,recipient,or donor-recipient transplant patterns by sex and the post-LT outcomes were studied with propensity score matching(PSM).The survival associated with different sex-based donor-recipient transplant patterns was further studied.Results:Among 3,769 patients enrolled in this study,the 1-,3-,and 5-year overall survival(OS)rates of patients with HCC after LT were 96.1%,86.4%,and 78.5%,respectively,in female recipients,and 95.8%,79.0%,and 70.7%,respectively,in male recipients after PSM(P=0.009).However,the OS was comparable between recipients with female donors and male donors.Multivariate analysis indicated that male recipient sex was a risk factor for post-LT survival(HR=1.381,P=0.046).Among the donor-recipient transplant patterns,the male-male donor-recipient transplant pattern was associated with the poorest post-LT survival(P<0.05).Conclusions:Our findings highlighted that the post-LT outcomes of female recipients were significantly superior to those of male recipients,and the male-male donor-recipient transplant pattern was associated with the poorest post-LT survival.Livers from male donors may provide the most benefit to female recipients.Our results indicate that sex should be considered as a critical factor in organ allocation.
基金supported by the Planned Science and Technology Project of Sichuan Province, China (2009SZ0133).
文摘BACKGROUND:Donor safety has always been a major concern and potential risk to the donor must be balanced against recipient benefit.However,lack of a standardized and uniform evaluation of perioperative complications is a serious limitation of the evaluation of donor morbidity.This study was designed to evaluate the outcomes of donors in adult living donor liver transplantation(LDLT)using the newer Clavien classification system in a single center in China.METHODS:We prospectively analyzed the outcomes of 132 consecutive living liver donors from 2005 to 2008 using the newer Clavien classification system.The preoperative,intraoperative and postoperative data of the donors were collected and analyzed Ordinal regression was used to analyze the ordered grades of complications.RESULTS:Ninety-four(71.2%)of the donors developed postoperative complications of grade I(n=45,34.1%),grade II(n=39,29.5%)and grade III(n=10,7.6%).There was no death or grade IV morbidity.Hepatic functional impairment and pleural effusion were the most frequent morbidities for living donors.Fifty-three donors(40.1%)developed hepatic functional impairment of grade I(n=40,31.1%)and grade II(n=13,10.0%).The ICU stay(7.8±1.8 days)and length of hospital stay(17.7±4.6 days)were significantly longer in donors with grade III than others.Furthermore,ordinal logistic regression revealed that donor’s older age(>40 years)and right hepatectomy were associated with morbidity.In addition,only preoperative total bilirubin(within the normal range)and postoperative nadir serum phosphorus were independently associated with hepatic functional impairment.The receiveroperator characteristic curve revealed that preoperative total bilirubin>18.0μmol/L and postoperative nadir of serum phosphorus<1 mg/dL may lead to more severe hepatic functional impairment.CONCLUSIONS:Despite the fact that donors are relatively safe to undergo hepatectomy,many living donors still experience postoperative morbidity.Meticulous technical and preoperative donor evaluation and treatment are sure to reduce the incidence of complications.
基金supported by grants from the National High Technology Research and Development Program of China(863 Program)(2012AA021008)the Special Fund for Science Research by Ministry of Health(201302009)
文摘BACKGROUND： In 2011, a pilot program for deceased organ donation was initiated in China. We describe the first successful series of liver transplants in the pilot program.METHODS： From July 2011 to August 2012, our center performed 26 liver transplants from a pool of 29 deceased donors. All organ donation and allograft procurement were conducted according to the national protocol. The clinical data of donors and recipients were collected and summarized retrospectively.RESULTS： Among the 29 donors, 24 were China Category II donors（organ donation after cardiac death）, and five were China Category III donors（organ donation after brain death followed by cardiac death）. The recipients were mainly the patients with hepatocellular carcinoma. The one-year patient survival rate was 80.8% with a median follow-up of 422（2-696） days. Among the five mortalities during the follow-up,three died of tumor recurrence. In terms of post-transplant complications, 9 recipients（34.6%） experienced early allograft dysfunction, 1（3.8%） had non-anastomotic biliary stricture,and 1（3.8%） was complicated with hepatic arterial thrombosis.None of these complications resulted in patient death. Notably,primary non-function was not observed in any of the grafts.CONCLUSION： With careful donor selection, liver transplant from deceased donors can be performed safely and plays acritical role in overcoming the extreme organ shortage in China.
文摘AIM To examine the effect of center size on survival differences between simultaneous liver kidney transplantation(SLKT) and liver transplantation alone(LTA) in SLKT-listed patients.METHODS The United Network of Organ Sharing database was queried for patients ≥ 18 years of age listed for SLKT between February 2002 and December 2015. Posttransplant survival was evaluated using stratified Cox regression with interaction between transplant type(LTA vs SLKT) and center volume.RESULTS During the study period, 393 of 4580 patients(9%) listed for SLKT underwent a LTA. Overall mortality was higher among LTA recipients(180/393, 46%) than SLKT recipients(1107/4187, 26%). The Cox model predicted a significant survival disadvantage for patients receiving LTA vs SLKT [hazard ratio, hazard ratio(HR) = 2.85; 95%CI: 2.21, 3.66; P < 0.001] in centers performing 30 SLKT over the study period. This disadvantage was modestly attenuated as center SLKT volume increased, with a 3% reduction(HR = 0.97; 95%CI: 0.95, 0.99; P = 0.010) for every 10 SLKs performed.CONCLUSION In conclusion, LTA is associated with increased mortality among patients listed for SLKT. This difference is modestly attenuated at more experienced centers and may explain inconsistencies between smaller-center and larger registry-wide studies comparing SLKT and LTA outcomes.
基金supported by grants from Shanghai Municipal Health Commission(201940032)National Key Research and Development Program of China(2023YFC2505900).
文摘Background:Normal bile is sterile.Studies have shown that cholangitis after liver transplantation(LT)was associated with a relatively poor prognosis.It remains unclear whether the bacteriobilia or fungibilia impact the patient outcomes in LT recipients,especially with donation after circulatory death(DCD)allografts,which was correlated with a higher risk of allograft failure.Methods:This retrospective study included 139 LT recipients of DCD grafts from 2019 to 2021.All patients were divided into two groups according to the presence or absence of bacteriobilia or fungibilia.The prevalence and microbial spectrum of postoperative bacteriobilia or fungibilia and its possible association with outcomes,especially hospital stay were analyzed.Results:Totally 135 and 171 organisms were isolated at weeks 1 and 2,respectively.Among all patients included in this analysis,83(59.7%)developed bacteriobilia or fungibilia within 2 weeks posttransplantation.The occurrence of bacteriobilia or fungibilia[β=7.43,95%CI(confidence interval):0.02 to 14.82,P=0.049],particularly the detection of Pseudomonas(β=18.84,95%CI:6.51 to 31.07,P=0.003)within 2 weeks post-transplantation was associated with a longer hospital stay.However,it did not affect the graft and patient survival.Conclusions:The occurrence of bacteriobilia or fungibilia,particularly Pseudomonas within 2 weeks posttransplantation,could influence the recovery of liver function and was associated with prolonged hospital stay but not the graft and patient survival.
基金supported by a grant from the Guangdong Provincial Key Laboratory of Organ Donation and Transplantation Immunity (K0230015)。
文摘Ischemia-reperfusion injury (IRI) is an inherent issue in organ transplantation. Because of the allograft shortage, more and more extended criteria donor (ECD) organs are used, unfortunately these grafts are more susceptible to IRI. Although machine perfusion technology has brought hope to alleviate IRI, this technology is still unable to eradicate IRI-related organ damage. Ischemia-free liver transplantation (IFLT)can completely avoid IRI, thereby improve graft function and recipient outcome, and allow to expand organ pool. This review summarized the latest progresses in IFLT, and speculated the future development of this concept.
文摘With the advances in transplant oncology in recent years, the role of liver transplantation has expanded to make curative treatment a possibility for a wider patient population. We highlight strategies in Hong Kong, China that have enabled preoperative prognostication for judicious patient selection, downstaging therapy to definitive treatment, and postoperative therapies that have provided a growing role for liver transplantation in patients with more advanced hepatocellular carcinoma.
基金supported by grants from the National Key Research and Development Program of China(2023YFC2505900)the National Natural Science Foundation of China(82241225,81873874 and 82071797)。
文摘Background:Liver transplantations(LTs)with extended criteria have produced surgical results comparable to those obtained with traditional standards.However,it is not sufficient to predict hepatocellular carcinoma(HCC)recurrence after LT according to morphological criteria alone.The present study aimed to construct a nomogram for predicting HCC recurrence after LT using extended selection criteria.Methods:Retrospective data on patients with HCC,including pathology,serological markers and followup data,were collected from January 2015 to April 2020 at Huashan Hospital,Fudan University,Shanghai,China.Logistic least absolute shrinkage and selection operator(LASSO)regression and multivariate Cox regression analyses were performed to identify and construct the prognostic nomogram.Receiver operating characteristic(ROC)curves,Kaplan-Meier curves,decision curve analyses(DCAs),calibration diagrams,net reclassification indices(NRIs)and integrated discrimination improvement(IDI)values were used to assess the prognostic capacity of the nomogram.Results:A total of 301 patients with HCC who underwent LT were enrolled in the study.The nomogram was constructed,and the ROC curve showed good performance in predicting survival in both the development set(2/3)and the validation set(1/3)(the area under the curve reached 0.748 and 0.716,respectively).According to the median value of the risk score,the patients were categorized into the high-and low-risk groups,which had significantly different recurrence-free survival(RFS)rates(P<0.01).Compared with the Milan criteria and University of California San Francisco(UCSF)criteria,DCA revealed that the new nomogram model had the best net benefit in predicting 1-,3-and 5-year RFS.The nomogram performed well for calibration,NRI and IDI improvement.Conclusions:The nomogram,based on the Milan criteria and serological markers,showed good accuracy in predicting the recurrence of HCC after LT using extended selection criteria.
