BACKGROUND Standard liver weight(SLW)is frequently used in deceased donor liver transplantation to avoid size mismatches with the recipient.However,some deceased donors(DDs)have fatty liver(FL).A few studies have repo...BACKGROUND Standard liver weight(SLW)is frequently used in deceased donor liver transplantation to avoid size mismatches with the recipient.However,some deceased donors(DDs)have fatty liver(FL).A few studies have reported that FL could impact liver size.To the best of our knowledge,there are no relevant SLW models for predicting liver size.AIM To demonstrate the relationship between FL and total liver weight(TLW)in detail and present a related SLW formula.METHODS We prospectively enrolled 212 adult DDs from West China Hospital of Sichuan University from June 2019 to February 2021,recorded their basic information,such as sex,age,body height(BH)and body weight(BW),and performed abdominal ultrasound(US)and pathological biopsy(PB).The chi-square test and kappa consistency score were used to assess the consistency in terms of FL diagnosed by US relative to PB.Simple linear regression analysis was used to explore the variables related to TLW.Multiple linear regression analysis was used to formulate SLW models,and the root mean standard error and interclass correlation coefficient were used to test the fitting efficiency and accuracy of the model,respectively.Furthermore,the optimal formula was compared with previous formulas.RESULTS Approximately 28.8%of DDs had FL.US had a high diagnostic ability(sensitivity and specificity were 86.2%and 92.9%,respectively;kappa value was 0.70,P<0.001)for livers with more than a 5%fatty change.Simple linear regression analysis showed that sex(R2,0.226;P<0.001),BH(R2,0.241;P<0.001),BW(R2,0.441;P<0.001),BMI(R2,0.224;P<0.001),BSA(R2,0.454;P<0.001)and FL(R2,0.130;P<0.001)significantly impacted TLW.In addition,multiple linear regression analysis showed that there was no significant difference in liver weight between the DDs with no steatosis and those with steatosis within 5%.Furthermore,in the context of hepatic steatosis,TLW increased positively(nonlinear);compared with the TLW of the non-FL group,the TLW of the groups with hepatic steatosis within 5%,between 5%and 20%and more than 20%increased by 0 g,90 g,and 340 g,respectively.A novel formula,namely,-348.6+(110.7 x Sex[0=Female,1=Male])+958.0 x BSA+(179.8 x FLUS[0=No,1=Yes]),where FL was diagnosed by US,was more convenient and accurate than any other formula for predicting SLW.CONCLUSION FL is positively correlated with TLW.The novel formula deduced using sex,BSA and FLUS is the optimal formula for predicting SLW in adult DDs.展开更多
Background:Increased risks have been found for patients undergoing liver transplantation due to the blood supply shortage following the ongoing coronavirus disease 2019(COVID-19)pandemic.Hence,exploring a method to al...Background:Increased risks have been found for patients undergoing liver transplantation due to the blood supply shortage following the ongoing coronavirus disease 2019(COVID-19)pandemic.Hence,exploring a method to alleviate this dilemma is urgent.This phase I,nonrandomized,prospective trial aimed to evaluate the safety and feasibility of using donor-specific red blood cell transfusion(DRBCT)as an urgent measurement to alleviate the blood supply shortage in deceased donor liver transplantation(DDLT).Methods:The outcomes of 26 patients who received DRBCT and 37 patients in the control group who only received 3rd party packed red blood cells(pRBCs)transfusion between May 2020 and January 2021 were compared.Results:Patients receiving DRBCT did not develop transfusion-related complications,and the incidence of postoperative infection was similar to that in the control group(23.1%vs.18.9%,P=0.688).Because the patients received the red blood cells from organ donors,the median volume of intraoperative allogeneic red blood cell transfusion from blood bank was 4.0 U(IQR 1.1-8.0 U)in the DRBCT group,which is significantly lower than that(7.5 U,IQR 4.0-10.0 U)in the control group(P=0.018).The peak aspartate aminotransferase(AST)level was significantly lower in the DRBCT group than in the control group(P=0.008)and so were the AST levels in the first two days after the operation(P=0.006 and P=0.033).Conclusions:DRBCT is a safe and effective procedure to lower the need for blood supply and is associated with a reduction in AST levels after transplantation.DRBCT is beneficial to patients receiving life-saving transplantation without sufficient blood supply during the COVID-19 pandemic.展开更多
基金by New Clinical Technology Project,West China Hospital,Sichuan University,No.20HXJS012National Natural Science Foundation of China,No.81770653 and No.82070674.
文摘BACKGROUND Standard liver weight(SLW)is frequently used in deceased donor liver transplantation to avoid size mismatches with the recipient.However,some deceased donors(DDs)have fatty liver(FL).A few studies have reported that FL could impact liver size.To the best of our knowledge,there are no relevant SLW models for predicting liver size.AIM To demonstrate the relationship between FL and total liver weight(TLW)in detail and present a related SLW formula.METHODS We prospectively enrolled 212 adult DDs from West China Hospital of Sichuan University from June 2019 to February 2021,recorded their basic information,such as sex,age,body height(BH)and body weight(BW),and performed abdominal ultrasound(US)and pathological biopsy(PB).The chi-square test and kappa consistency score were used to assess the consistency in terms of FL diagnosed by US relative to PB.Simple linear regression analysis was used to explore the variables related to TLW.Multiple linear regression analysis was used to formulate SLW models,and the root mean standard error and interclass correlation coefficient were used to test the fitting efficiency and accuracy of the model,respectively.Furthermore,the optimal formula was compared with previous formulas.RESULTS Approximately 28.8%of DDs had FL.US had a high diagnostic ability(sensitivity and specificity were 86.2%and 92.9%,respectively;kappa value was 0.70,P<0.001)for livers with more than a 5%fatty change.Simple linear regression analysis showed that sex(R2,0.226;P<0.001),BH(R2,0.241;P<0.001),BW(R2,0.441;P<0.001),BMI(R2,0.224;P<0.001),BSA(R2,0.454;P<0.001)and FL(R2,0.130;P<0.001)significantly impacted TLW.In addition,multiple linear regression analysis showed that there was no significant difference in liver weight between the DDs with no steatosis and those with steatosis within 5%.Furthermore,in the context of hepatic steatosis,TLW increased positively(nonlinear);compared with the TLW of the non-FL group,the TLW of the groups with hepatic steatosis within 5%,between 5%and 20%and more than 20%increased by 0 g,90 g,and 340 g,respectively.A novel formula,namely,-348.6+(110.7 x Sex[0=Female,1=Male])+958.0 x BSA+(179.8 x FLUS[0=No,1=Yes]),where FL was diagnosed by US,was more convenient and accurate than any other formula for predicting SLW.CONCLUSION FL is positively correlated with TLW.The novel formula deduced using sex,BSA and FLUS is the optimal formula for predicting SLW in adult DDs.
基金This study was supported by grants from the New Clinical Technology Project,West China Hospital,Sichuan University(Grant number:20HXJS012)Sichuan Province Key Research and Development Project(Grant number:2020YFS0134)National Clinical Research Center for Geriatrics,West China Hospital,Sichuan University(Grant number:Z2018B23).
文摘Background:Increased risks have been found for patients undergoing liver transplantation due to the blood supply shortage following the ongoing coronavirus disease 2019(COVID-19)pandemic.Hence,exploring a method to alleviate this dilemma is urgent.This phase I,nonrandomized,prospective trial aimed to evaluate the safety and feasibility of using donor-specific red blood cell transfusion(DRBCT)as an urgent measurement to alleviate the blood supply shortage in deceased donor liver transplantation(DDLT).Methods:The outcomes of 26 patients who received DRBCT and 37 patients in the control group who only received 3rd party packed red blood cells(pRBCs)transfusion between May 2020 and January 2021 were compared.Results:Patients receiving DRBCT did not develop transfusion-related complications,and the incidence of postoperative infection was similar to that in the control group(23.1%vs.18.9%,P=0.688).Because the patients received the red blood cells from organ donors,the median volume of intraoperative allogeneic red blood cell transfusion from blood bank was 4.0 U(IQR 1.1-8.0 U)in the DRBCT group,which is significantly lower than that(7.5 U,IQR 4.0-10.0 U)in the control group(P=0.018).The peak aspartate aminotransferase(AST)level was significantly lower in the DRBCT group than in the control group(P=0.008)and so were the AST levels in the first two days after the operation(P=0.006 and P=0.033).Conclusions:DRBCT is a safe and effective procedure to lower the need for blood supply and is associated with a reduction in AST levels after transplantation.DRBCT is beneficial to patients receiving life-saving transplantation without sufficient blood supply during the COVID-19 pandemic.
