Active vaccination to prevent de novo hepatitis B virus infection in liver transplantation

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.

Extended central hepatectomy with preservation of segment 6 for patients with centrally located hepatocellular carcinoma

BACKGROUND： In order to preserve functional liver parenchyma, extended central hepatectomy （segments 4, 5, 7 and 8 resection） was proposed for the management of centrally located hepatocellular carcinoma invading the right and middle hepatic veins, reconstructing segment 6 outflow in the absence of the thick inferior right hepatic vein. The present study was to describe our surgical techniques of extended central hepatectomy.METHODS： Between 2008 and 2012, 5 patients with centrally located hepatocellular carcinoma invading or in the vicinity of the right and middle hepatic veins underwent extended central hepatectomy. The thick inferior right hepatic vein was preserved during dissection. Gore-Tex graft was used for segment 6 outflow reconstruction in the absence of the thick inferior right hepatic vein.RESULTS： The mean future remnant liver volume for segments 2 and 3 was 28% versus 45% on segment 6 preservation. The mean tumor diameter was 7.4 cm. The thick inferior right hepatic vein was found in 1 patient. Outflow reconstruction from segment 6 was performed in 4 patients. Postoperative complications included bile leakage （1 patient）, pleural effusion （2） and liver failure （1）. The rate of graft patency was 75%. There was no perioperative mortality.CONCLUSION： Extended central hepatectomy is a safe alternative for extended hepatic resection in selected patients attempting to preserve the functional liver parenchyma.

Interventional radiology in living donor liver transplant

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.

Living donor liver transplantation with body-weight more or less than 10 kilograms

AIM: To compare the outcomes of pediatric patients weighing less than or more than 10 kg who underwent liver transplantation.METHODS: Data for 196 pediatric patients who underwent living donor liver transplantation between June 1994 and February 2011 were reviewed retrospectively.The information for each patient was anonymized and de-identified before analysis. The data included information regarding the pre-transplant conditions, intraoperative fluid replacement and outcomes for each patient. The 196 patients were divided into two groups: those with body weights of less than 10 kg were included in group 1(G1; n =101), while those with body weights of more than 10 kg were included in group 2(G2; n = 95). For each group, the patients' ages, body weights, heights,pediatric end stage liver disease scores, anesthesia times, and warm and cold ischemic times were analyzed. In addition, between-group comparisons were also made. Mann-Whitney U tests were used to compare all the variables except for complications and survival rates, which were analyzed using χ 2 tests and Kaplan-Meier tests, respectively.RESULTS: The general medical conditions of the G1patients were worse than those of the G2 patients, as shown by the higher pediatric end stage liver disease scores and poorer Z-scores. In addition, the preoperative Hb and serum albumin levels were all lower for the G1 patients than for the G2 patients. The G1 patients also had significantly more intraoperative blood loss than the G2 patients. In addition, the intraoperative fluid requirements for the G1 patients,including leukocyte poor red blood cell transfusions,5% albumin infusions and crystalloid infusions, were significantly higher than those for the G2 patients. The risk of intraoperative portal vein thrombosis was higher for the patients in G1 than for those in G2. However,the one-year survival rates(95.9% and 96.8% for G1 and G2, respectively) and three-year survival rates(94.9% and 94.6% for G1 and G2, respectively) for both groups were similar.CONCLUSION: Patients weighing less than 10 kg typically have poorer conditions, but their survival rates are comparable to those of children weighing more than 10 kg.

Optimizing biliary outcomes in living donor liver transplantation:Evolution towards standardization in a high-volume center

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%.

接枝的同类的现象当在生活施主肝移植使用接受者 / 施主特征的不同遗传型时

AIM:To investigate the evidence of homogeneous phenomenon on CYP3A5*3 MDR1-3435 and CYP3A4*18of the liver graft after living donor liver transplantation(LDLT).METHODS:We identified the proportional change of the CYP3A5*3,MDR1-3435 and CYP3A4*18 from the peripheral blood mononuclear cell of 41 pairs recipient/donor with different genotype polymorphisms and 119liver graft biopsy samples used with the pyrosequencing technique after LDLT.Polymerase chain reaction/ligase detection reaction assay and restriction fragment length polymorphism was employed for genotyping the CYP3A5*3 and CYP3A4*18 single nucleotide poly-morphisms(SNPs).All of the recipients and donors expressed with the similar SNP genotype of CYP3A5*3,MDR1-3435 or CYP3A4*18 were excluded.RESULTS:The final genetic polymorphisms of the liver graft biopsy samples of CYP3A5*3,MDR1-3435 and CYP3A4*18 was predominated depends on the donor with restriction fragment length polymorphism and seems to be less related to the recipient.The proportional changes of G to A alleles of the 119 samples of CYP3A5*3(included A】A/G,A/G】A,A/G】G,G】A,G】A/G and A】G),C to T alleles of the 108 samples of MDR1-3435(included C】C/T,C/T】C,C/T】T,T】C/T and T】C),and T to C alleles of 15 samples of CYP3A4*18(included T/C】T and T】C/T)were significant different between the recipients and the liver graft biopsy samples(P【0.0001)and less difference when compared with the donors in the pyrosequencing analysis after LDLT.CONCLUSION:The CYP3A5*3,MDR1-3435 and CYP3A4*18 of the recipient could be modified by the donor so-called homogenous phenomenon when the recipient’s blood drained into the liver graft.

Effect of autologous blood donation on the central venous pressure, blood loss and blood transfusion during living donor left hepatectomy

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.

5th INTERNATIONAL LIVING DONOR LIVER TRANSPLANTATION CONGRESS "EXCELLENCE THROUGH VERSATILITY"

OCTOBER 15-16,2021 WELCOME ADDRESS FROM THE CONGRESS PRESIDENTS Dear Members,Dear Colleagues,Dear Friends,It is our great pleasure and honor to invite you to particpate in the 5th International Congress of the iLDLT Group that will take place in Brussels on Friday October 15 and Saturday 16,2021.This event will be organised in collaboration with the Belgian Section of Hepato-Bilo-Pancreatic Surgery(BSHBPS)of the Royal Belgian Society for Surgery(RBSS).Indeed theⅩⅩⅠst annual,Postgraduate Course of the BHBPS has been officially integrated in the iLDLT Congress.The biennial iLDLT meeting follows the very successful previous ones,which took place twice in Seoul(SKr)and once in Dallas(US)and Kaohsiung(China).As the Western world still hesitates to embrace this therapeutic modality,the iLDLTG council found it opportune to"export"the congress to Europe.

5th INTERNATIONAL LIVING DONOR LIVER TRANSPLANTATION CONGRESS “EXCELLENCE THROUGH VERSATILITY” OCTOBER 15-16, 2021 WELCOME ADDRESS FROM THE CONGRESS PRESIDENTS

Dear Members,Dear Colleagues,Dear Friends,It is our great pleasure and honor to invite you to particpate in the 5th International Congress of the iLDLT Group that will take place in Brussels on Friday October 15 and Saturday 16,2021.This event will be organised in collaboration with the Belgian Section of Hepato-Bilo-Pancreatic Surgery(BSHBPS)of the Royal Belgian Society for Surgery(RBSS).Indeed the XXIst annual,Postgraduate Course of the BHBPS has been officially integrated in the iLDLT Congress.

Anchoring heterometallic cluster on P-doped carbon nitride for efficient photocatalytic nitrogen fixation in water and air ambient

Light-driven nitrogen fixation to produce ammonia is a green and economical technology of nitrogen reduction but is still quite challenging, especially in an air atmosphere without any sacrificial reagents.Herein, we demonstrate efficient photocatalytic nitrogen fixation using water and air directly by loading lanthanide–transition metal(4f–3d) cluster NdCo_(3) on two-dimensional P-doped graphitic carbon nitrides(PCN) material surface. Benefiting from the increase in the number of nitrogen vacancies(NVs) and highly matched band gap structure and excellent hole trapping ability of clusters, the NdCo_(3)/PCN photocatalyst exhibits efficient nitrogen reduction activity with 371(in air) and 825 μmol h^(-1)g^(-1)(in pure nitrogen)without any sacrificial reagents. The introduction of potassium sulfate inhibits hydrogen production and promotes nitrogen reduction activation. This work suggests that anchoring precisely structured clusters on 2D materials may enhance photocatalytic nitrogen reduction under normal temperature and pressure.

Molecular solid solution of lanthanide-titanium-oxo clusters with enhanced photocatalytic hydrogen evolution

Molecular solid solutions of metal clusters containing different metal centers with well-defined structures can accurately regulate the HOMO-LUMO gap,but are rarely available.Herein,a series of colorless lanthanide-titanium-oxo clusters Ln_(2)Ti_4(μ_(2)-O)_(2)(μ_(3)-O)_4(Piv)_(10)(THF)_(2)(Ln_(2)Ti_4,Ln = Eu,Gd,Tb,and Ce,HPiv = pivalic acid) were synthesized by the reaction of pivalic acid with Ln(Ac)_(3) and titanium isopropoxide.The light yellow crystal of cluster solid solutions Eu_(2)Ti_(4-x)Cd_(x),containing a mixture of Eu_(2)Ti_4 and Eu_(2)Ti_(3)Cd,was obtained by in situ doping Cd^(2+) and S^(2–).Eu_(2)Ti_(3.92)Cd_(0.08) displays efficient photocatalytic hydrogen evolution activity without a co-catalyst,which is up to 2.6 times that of Eu_(2)Ti_4.Femtosecond time-resolved transient absorption spectroscopy and spin-polarized density functional calculations showed that the enhanced photocatalytic performance of Eu_(2)Ti_(4-x)Cd_(x) can be attributed to the narrower HOMO-LUMO gap and lower LUMO position than that of Eu_(2)Ti_4.This studyprovides an in situ doping method to realize the simple preparation of cluster solid solution.

Development and validation of an artificial intelligence model for predicting post-transplant hepatocellular cancer recurrence

Dear Editor,In recent years,criteria based on the combinationof morphology and biology have been proposed forimproving the selection of hepatocellular cancer(HCC)patients waiting for liver transplantation(LT)[1,2].Since all the proposed models showed suboptimalresults in predicting the risk of postLT recurrence,aprediction model constructed using artificial intelligence(Al)could be an attractive way to surpass this limit[3,4].Therefore,the Time_Radiological-response_Alpha-fetoproteIN_Artificial-Intelligence(TRAIN-AI)modelwas developed,combining morphology and biology tumorvariables.

Lanthanide-oxo clusters for efficient catalytic reduction of carboxamides

The reduction of carboxamides into high value-added amines is a very interesting but great challenging topic.Herein we demonstrate that polynuclear lanthanide-oxo clusters Ln16(Ln=Eu and Gd)can be used as efficient catalyst to reduce primary and secondary carboxamides to amines with excellent yield of 71%-98%and broad substrates scope.The methodology can extend to the gram-scale synthesis of phenethylamine drug with 93%yield.Based on the isolation and characterization of catalytic intermediates,a catalytic mechanism involving multipath reaction is proposed.This work provides efficient lanthanide cluster catalysts for the reduction of carboxamides to amines.

Living donor liver transplantation for Barcelona clinic liver cancer (BCLC) intermediate-stage hepatocellular carcinoma

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.

Proton beam therapy for downstaging hepatocellular carcinoma with lobar portal vein tumor thrombosis to living donor liver transplantation

Introduction Liver transplantation(LT)is considered as the definitive standard treatment for hepatocellular carcinoma(HCC)with the advantage of addressing both malignancy and the underlying cirrhosis,thus,providing the best overall and recurrence-free survival.Unfortunately,only 20-25%of patients meet the eligibility criteria for LT.

Peri-operative extracorporeal membrane oxygenation in adult and pediatric living donor liver transplantation:a single-center experience

Background:Extracorporeal membrane oxygenation(ECMO)is a potential rescue therapy for patients with acute cardiopulmonary dysfunction refractory to conventional treatment.In this study,we described the clinical profiles and outcomes of adult and pediatric living donor liver transplantation(LDLT)patients who received ECMO support during the peri-operative period.Methods:From June 1994 to December 2020,eleven out of the 1,812 LDLTs performed at Kaohsiung Chang Gung Memorial Hospital required ECMO support:six for respiratory failure,three for cardiogenic shock,and two for refractory septic shock.Comparison between the survivor and non-survivor groups was made.Results:The survival rate for liver transplantation(LT)patients on ECMO support is 36.4%-40%in adults and 33.3%in pediatrics,while the survival rate per indication is as follows:acute respiratory distress syndrome(ARDS)(50%),cardiogenic shock(33.3%),and sepsis(0%).Shorter durations of LT-to-ECMO and pre-ECMO mechanical ventilation were observed in the survivor group.On the other hand,we observed persistently elevated total bilirubin levels in non-survivors,while none of the survivors had aspartate aminotransferase(AST)/alanine aminotransferase(ALT)levels>1,000 U/L.A higher proportion of non-survivors were on concurrent continuous renal replacement therapy(CRRT).Conclusions:Our experience has proven ECMO’s utility during the peri-operative period for both adult and pediatric LDLT patients,more specifically for indications other than septic shock.Further studies are needed to better understand the factors leading to poor outcomes in order to identify patients who will more likely benefit from ECMO.

Proton beam therapy to bridge or downstage locally advanced hepatocellular carcinoma to living donor liver transplantation

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).

What happened in 133 consecutive hepatic artery reconstruction in liver transplantation in 1 year?

Background:The immediate challenges during microvascular reconstruction of hepatic artery(HAR)during liver transplantation(LT)can be many.Hence,in order to give a cross sectional view of these problems this study over a period of 1 year,showing our routine practice,was taken up.Methods:From January 2015 to December 2015,a total of 133 LTs were performed in Kaohsiung Chang Gung Memorial Hospital,Taiwan.All hepatic artery(HA)reconstructions were performed by a microvascular surgeon under an operating microscope.Results:In the 133 patients,one artery was anastomosed in 123(92.5%)patients,two in 9(6.8%)patients and three in 1(0.7%)of the patient.Eleven(8.3%)arteries were less than 2 mm in size(1–1.9 mm).There were intimal dissections(IDs)involving either the donor or the recipient arteries of mild to severe nature in 9(6.8%)patients.Immediately following graft arterial anastomosis,either there was no flow or an intraoperative hepatic artery thrombosis(HAT)was found in nine(7.1%—8 LDLT,4.8%—1 DDLT)patients.Immediate re-do anastomosis was done in all of these patients who did well in the follow-up.The overall post-operative success rate was 99.2%.One patient(0.8%)developed postoperative HAT due to infection during follow up and died due to sepsis.Conclusions:Small vessels or HA injury are the frequently encountered problems by a micro vascular surgeon.The other problems could be ID,need to do multiple reconstructions,immediate HAT and ability to re-do the HAR immediately.

A primary hepatic neuroendocrine tumor disguised as hepatocellular carcinoma

In a 72-year-old female patient,a 2 cm large lesion over liver segment 7(S7)was incidentally diagnosed during a hepatitis C follow-up.The patient was asymptomatic and had an unremarkable physical examination.Her past medical history consists of chronic hepatitis C,diabetes mellitus type 2 and arterial hypertension.

Prevent bile duct injury by indocyanine green guide fluorescent imaging during laparoscopic cholecystectomy in liver transplantation recipient

Cholecystolithiasis with acute cholecystitis is a rare,late biliary complication occurring in liver transplantation(LT)recipients who received the liver graft with preserved donor’s gallbladder.Although laparoscopic cholecystectomy(LC)is not contraindicated after upper abdominal surgery,misunderstanding of the biliary anatomy due to inflammatory phenomena or severe adhesion might increase the risk of bile duct injury(BDI)(1).