期刊文献+
共找到30,574篇文章
< 1 2 250 >
每页显示 20 50 100
Tacrolimus dosage requirements in living donor liver transplant recipients with small-for-size grafts 被引量:5
1
作者 Fei Liu Ya Li +8 位作者 Xiang Lan Yong-Gang Wei Bo Li Lv-Nan Yan Tian-Fu Wen Ji-Chun Zhao Ming-Qing Xu Wen-Tao Wang Jia-Yin Yang 《World Journal of Gastroenterology》 SCIE CAS CSCD 2009年第31期3931-3936,共6页
AIM: To investigate the tacrolimus dosage requirements and blood concentrations in adult-to-adult right lobe living donor liver transplantation (AALDLT) recipients with small-for-size (SFS) grafts. METHODS: Duri... AIM: To investigate the tacrolimus dosage requirements and blood concentrations in adult-to-adult right lobe living donor liver transplantation (AALDLT) recipients with small-for-size (SFS) grafts. METHODS: During January 2007 and October 2008, a total of 54 cases of AALDLT with an observation period of 6 mo were enrolled in this study. The 54 patients were divided into two groups according to graftrecipient body weight ratio (GRBW): SFS grafts group (Group S, GRBW 〈 0.8%, n = 8) and non-SFS grafts group (Group N, GRBW ≥ 0.8%, n = 46). Tacrolimus 12-hour blood levels and doses were recorded during weeks 1, 2, 3 and 4 and months 2, 3, 4, 5 and 6 in group S and group N. Meanwhile, acute rejection rates, liver and renal function test results, and the number of potentially interacting medications were determined at each interval in the two groups. A comparison of tacrolimus dosage requirements and blood levels were made weekly in the first month post-surgery, and monthly from months 2 to 6. RESULTS: There were no differences in the demo-graphic characteristics, acute rejection rates, liver and renal function test results, or the number of potentially interacting medications administered between the two groups. The tacrolimus dosage requirements in group S were significantly lower than group N at 2 wk (2.8 ± 0.4 mg/d vs 3.6 ± 0.7 mg/d, P = 0.006), 3 wk (2.9± 0.7 mg/d vs 3.9±0.8 rag/d, P = 0.008), 4 wk (2.9 ± 0.8 mg/d vs 3.9 ± 1.0 mg/d, P = 0.023) and 2 mo (2.8 ±0.7 mg/d vs 3.8±1.1 mg/d, P = 0.033). Tacrolimus 12-h trough concentrations were similar between the two groups at all times except for 2 wk post-transplantation, when the concentrations were significantly greater in group S recipients than in group N recipients (11.3 ± 4.8 ng/mL vs 7.0 ± 3.8 ng/mL, P = 0.026). CONCLUSION: SFS grafts recipients have significantly decreased tacrolimus dosage requirements compared with non-SFS grafts recipients in AALDLT during the first 2 mo post-surgery. 展开更多
关键词 Blood concentration Liver transplantation Living donor small-for-size graft TACROLIMUS
下载PDF
Outcome of patients undergoing right lobe living donor liver transplantation with small-for-size grafts 被引量:5
2
作者 Pei-Xian Chen Lu-Nan Yan Wen-Tao Wang 《World Journal of Gastroenterology》 SCIE CAS 2014年第1期282-289,共8页
AIM: To investigate the outcome of living donor liver transplantation (LDLT) recipients transplanted with small-for-size grafts (SFSGs). METHODS: Between November 2001 and December 2010, 196 patients underwent LDLT wi... AIM: To investigate the outcome of living donor liver transplantation (LDLT) recipients transplanted with small-for-size grafts (SFSGs). METHODS: Between November 2001 and December 2010, 196 patients underwent LDLT with right lobe liver grafts at our center. Recipients were divided into 2 treatment groups: group A with an actuarial graft-to-recipient weight ratio (aGRWR) < 0.8% (n = 45) and group B with an aGRWR = 0.8% (n = 151). We evaluated serum liver function markers within 4 wk after transplantation. We also retrospectively evaluated the outcomes of these patients for potential effects related to the recipients, the donors and the transplantation procedures based upon a review of their medical records. RESULTS: Small-for-size syndrome (SFSS) developed in 7 of 45 patients (15.56%) in group A and 9 of 151 patients (5.96%) in group B (P = 0.080). The levels of alanine aminotransferase and aspartate aminotransferase in group A were higher than those in group B during early period after transplantation, albeit not sig-nificantly. The cumulative 1-, 3-and 5-year liver graft survival rates were 82.22%, 71.11% and 71.11% for group A and 81.46%, 76.82%, and 75.50% for group B patients, respectively (P = 0.623). However, univariate analysis of risk factors associated with graft survival in group A demonstrated that the occurrence of SFSS after LDLT was the only significant risk factor affecting graft survival (P < 0.001). Furthermore, multivariate analysis of our data did not identify any additional significant risk factors accounting for poor graft survival. CONCLUSION: Our study suggests that LDLT recipients with an aGRWR < 0.8% may have liver graft outcomes comparable to those who received larger size grafts. Further studies are required to ascertain the safety of using SFSGs. (c) 2014 Baishideng Publishing Group Co., Limited. All rights reserved. 展开更多
关键词 Living donor liver transplantation Right lobe Actuarial graft-to-recipient weight ratio small-for-size graft small-for-size syndrome
下载PDF
Outcomes of adult patients adopting small-for-size grafts in living donor liver transplantation: A systematic review and meta-analysis 被引量:1
3
作者 Yue Yan Dao-Feng Zheng +1 位作者 Jun-Liang Pu Zhong-Jun Wu 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2019年第3期206-213,共8页
Background: Small-for-size graft(SFSG) has emerged as one of the very contentions in adult-to-adult living donor liver transplantation(LDLT) as a certain graft size is related to recipients’ prognosis. Graftto-recipi... Background: Small-for-size graft(SFSG) has emerged as one of the very contentions in adult-to-adult living donor liver transplantation(LDLT) as a certain graft size is related to recipients’ prognosis. Graftto-recipient weight ratio(GRWR)≥0.8% was considered as a threshold to conduct LDLT. However, this also has been challenged over decades as a result of technique refinements. For a better understanding of SFSG in practice, we conducted this meta-analysis to compare the perioperative outcomes and long-term outcomes between patients adopting the grafts with a lower volume(GRWR < 0.8%, SFSG group) and sufficient volume(GRWR ≥ 0.8%, non-SFSG group) in adult-to-adult LDLT. Data sources: The studies comparing recipients adopting graft with a GRWR < 0.8% and ≥ 0.8% were searched by three authors independently in Pub Med, Web of Science, Embase, the Cochrane Library, MEDLINE and Google Scholar databases until September 2018 and data were analyzed by RevMan 5.3.5. Results: Sixteen studies with a total of 3272 subjects were included in this meta-analysis. In terms of small-for-size syndrome(SFSS), no significant difference was found in subjects enrolled after year 2010(before 2010, OR = 3.00, 95% CI: 1.69–5.35, P = 0.0002;after 2010, OR = 1.23, 95% CI: 0.79–1.90, P = 0.36;P for interaction: 0.02). There was no significant difference in operative duration, blood loss, cold ischemia time, biliary complications, acute rejection, postoperative bleeding, hospitalization time, perioperative mortality, and 1-, 3-and 5-year overall survival rates between two groups. Conclusions: This meta-analysis suggested that adopting SFSG in adult LDLT has comparable outcomes to those with non-SFSG counterparts since 2010. 展开更多
关键词 LIVING DONOR liver TRANSPLANTATION graft-to-recipient weight ratio small-for-size graft
下载PDF
Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts 被引量:4
4
作者 Wong Hoi She Kenneth SH Chok +2 位作者 James YY Fung Albert CY Chan Chung Mau Lo 《World Journal of Gastroenterology》 SCIE CAS 2017年第23期4270-4277,共8页
AIM To analyze the outcomes of living-donor liver transplantation(LDLT) using left-lobe(LL) or right-lobe(RL) small-for-size(SFS) grafts.METHODS Prospectively collected data of adult patients who underwent LDLT at our... AIM To analyze the outcomes of living-donor liver transplantation(LDLT) using left-lobe(LL) or right-lobe(RL) small-for-size(SFS) grafts.METHODS Prospectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short-and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight(GW) to recipient standard liver volume(RSLV)(GW/RSLV) of < 50%. The Urata formula was used to estimate RSLV.RESULTS Totally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age(median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, P = 0.997) but had significantly different ratios of men to women(165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, P < 0.0001). The two groups were also significantly different in GW(P < 0.0001), GW/RSLV(P < 0.0001), and graft cold ischemic time(P = 0.007). When it comes to postoperative complication, the groups were comparable(P = 0.105). Five patients died in hospital,4(2%) in the RL-LDLT group and 1(5.3%) in the LLLDLT group(P = 0.918). There were 38 graft losses, 33(16.6%) in the RL-LDLT group and 5(26.3%) in the LL-LDLT group(P = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group(95.2% vs 89.5%, P = 0.049). The two groups had similar 5-year patient survival rates(RL-LDLT: 86.8%, LL-LDLT: 89.5%, P = 0.476).CONCLUSION The use of SFS graft in LDLT requires careful tailormade surgical planning and meticulous operation. LLLDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed in order to validate the use of LL graft. 展开更多
关键词 Small for size liver graft Right lobe graft Left lobe graft Living donor liver transplantation
下载PDF
Liver transplantation in rats using 3 methods of small-for-size grafts
5
作者 李江 《外科研究与新技术》 2011年第4期274-274,共1页
Objective To explore a simple and effective way of establishing a 30 % small - for-size liver transplantation in rats. Methods SD rats were selected as donors and recipients. Smallfor - size orthotopic live transplant... Objective To explore a simple and effective way of establishing a 30 % small - for-size liver transplantation in rats. Methods SD rats were selected as donors and recipients. Smallfor - size orthotopic live transplantation was performed using Kamada’s two - cuff method. 展开更多
关键词 ORTHOTOPIC graft establishing RECIPIENT donor HEPATECTOMY STRICTURE shorter BLEEDING AORTA
下载PDF
Impact of small-for-size liver grafts on medium-term and long-term graft survival in living donor liver transplantation: A meta-analysis 被引量:4
6
作者 Ka Wing Ma Kelly Hiu Ching Wong +6 位作者 Albert Chi Yan Chan Tan To Cheung Wing Chiu Dai James Yan Yue Fung Wong Hoi She Chung Mau Lo Kenneth Siu Ho Chok 《World Journal of Gastroenterology》 SCIE CAS 2019年第36期5559-5568,共10页
BACKGROUND Small-for-size grafts (SFSGs) in living donor liver transplantation (LDLT) could optimize donor postoperative outcomes and also expand the potential donor pool. Evidence on whether SFSGs would affect medium... BACKGROUND Small-for-size grafts (SFSGs) in living donor liver transplantation (LDLT) could optimize donor postoperative outcomes and also expand the potential donor pool. Evidence on whether SFSGs would affect medium-term and long-term recipient graft survival is lacking. AIM To evaluate the impact of small-for-size liver grafts on medium-term and longterm graft survival in adult to adult LDLT. METHODS A systematic review and meta-analysis were performed by searching eligible studies published before January 24, 2019 on PubMed, EMBASE, and Web of Science databases. The primary outcomes were 3-year and 5-year graft survival. Incidence of small-for-size syndrome and short term mortality were also extracted. RESULTS This meta-analysis is reported according to the guidelines of the PRISMA 2009 Statement. Seven retrospective observational studies with a total of 1821 LDLT recipients were included in the meta-analysis. SFSG is associated with significantly poorer medium-term graft survival. The pooled odds ratio for 3-year graft survival was 1.58 [95% confidence interval 1.10-2.29, P = 0.014]. On the other hand, pooled results of the studies showed that SFSG had no significant discriminatory effect on 5-year graft survival with an odds ratio of 1.31 (95% confidence interval 0.87-1.97, P = 0.199). Furthermore, incidence of small-for-size syndrome detected in recipients of SFSG ranged from 0-11.4% in the included studies. CONCLUSION SFSG is associated with inferior medium-term but not long-term graft survival. Comparable long-term graft survival based on liver graft size shows that smaller grafts could be accepted for LDLT with appropriate flow modulatory measures. Close follow-up for graft function is warranted within 3 years after liver transplantation. 展开更多
关键词 Living DONOR liver TRANSPLANTATION small-for-size graftS small-for-size syndrome graft survival
下载PDF
Hemi-portocaval shunt: A simple salvage maneuver for small-for-size graft during living donor liver transplantation: a case report 被引量:5
7
作者 HUANG Ji-wei YAN Lu-nan CHEN Zhe-yu WU Hong LU Qiang XU Ying-long Pankaj Prasoon ZENG Yong 《Chinese Medical Journal》 SCIE CAS CSCD 2011年第14期2231-2233,共3页
Since the fast expansion of living donor liver transplantation (LDLT) over last few decades, small-for-size syndrome (SFSS) has emerged as a tough problem. Herein the first case of LDLT combined hemi-portocaval sh... Since the fast expansion of living donor liver transplantation (LDLT) over last few decades, small-for-size syndrome (SFSS) has emerged as a tough problem. Herein the first case of LDLT combined hemi-portocaval shunt in the mainland of China was reported. Portal venous overperfusion was well modulated and the recipient recovered uneventfully. LDLT combined hemi-portocaval shunt was a feasible procedure for preventing SFSS in LDLT. 展开更多
关键词 liver transplantation small-for-size syndrome hepatocellular carcinoma
原文传递
Excessive portal flow causes graft failure in extremely small-for-size liver transplantation in pigs 被引量:8
8
作者 Hong-Sheng Wang Nobuhiro Ohkohchi +13 位作者 Yoshitaka Enomoto Masahiro Usuda Shigehito Miyagi Takeshi Asakura Hiroo Masuoka Takashi Aiso Keisuke Fukushima Tomohiro Narita Hideyuki Yamaya Atsushi Nakamura Satoshi Sekiguchi Naoki Kawagishi Akira Sato Susumu Satomi 《World Journal of Gastroenterology》 SCIE CAS CSCD 2005年第44期6954-6959,共6页
AIM: To evaluate the effects of a portocaval shunt on the decrease of excessive portal flow for the prevention of sinusoidal microcirculatory injury in extremely smallfor-size liver transplantation in pigs. METHODS:... AIM: To evaluate the effects of a portocaval shunt on the decrease of excessive portal flow for the prevention of sinusoidal microcirculatory injury in extremely smallfor-size liver transplantation in pigs. METHODS: The right lateral lobe of pigs, i.e. the 25% of the liver, was transplanted orthotopically. The pigs were divided into two groups: graft without portocaval shunt (n = 11) and graft with portocaval shunt (n = 11). Survival rate, portal flow, hepatic arterial flow, and histological findings were investigated. RESULTS: In the group without portocaval shunt, all pigs except one died of liver dysfunction within 24 h afcer transplantation. In the group with portocaval shunt, eight pigs survived for more than 4 d. The portal flow volumes before and after transplantation in the group without portocaval shunt were 118.2±26.9 mL/min/100 g liver tissue and 270.5±72.9 ml./min/100 g liver tissue, respectively. On the other hand, in the group with portocaval shunt, those volumes were 124.2±27.8 ml./ min/100 g liver tissue and 42.7±32.3 mL/min/100 g liver tissue, respectively (P〈0.01). As for histological findings in the group without portocaval shunt, destruction of the sinusoidal lining and bleeding in the peri-portal areas were observed afl:er reperfusion, but these findings were not recognized in the group with portocaval shunt. CONCLUSION: These results suggest that excessive portal flow is attributed to post transplant liver dysfunction after extreme small-for-size liver transplantation caused by sinusoidal microcirculatory injury. 展开更多
关键词 Hyperperfusion syndrome Liver regeneration Portocaval shunt Postoperative liver dysfunction Sinusoidal microcirculatory injury small-for-size liver transplantation
下载PDF
Future of non-invasive graft evaluation:A systematic review of proteomics in kidney transplantation
9
作者 Eleni Avramidou Konstantina Psatha +2 位作者 Kallisti St John Georgios Tsoulfas Michalis Aivaliotis 《World Journal of Transplantation》 2025年第1期135-149,共15页
BACKGROUND Despite the developments in the field of kidney transplantation,the already existing diagnostic techniques for patient monitoring are considered insufficient.Protein biomarkers that can be derived from mode... BACKGROUND Despite the developments in the field of kidney transplantation,the already existing diagnostic techniques for patient monitoring are considered insufficient.Protein biomarkers that can be derived from modern approaches of proteomic analysis of liquid biopsies(serum,urine)represent a promising innovation in the monitoring of kidney transplant recipients.AIM To investigate the diagnostic utility of protein biomarkers derived from proteomics approaches in renal allograft assessment.METHODS A systematic review was conducted in accordance with PRISMA guidelines,based on research results from the PubMed and Scopus databases.The primary focus was on evaluating the role of biomarkers in the non-invasive diagnosis of transplant-related com-plications.Eligibility criteria included protein biomarkers and urine and blood samples,while exclusion criteria were language other than English and the use of low resolution and sensitivity methods.The selected research articles,were categorized based on the biological sample,condition and methodology and the significantly and reproducibly differentiated proteins were manually selected and extracted.Functional and network analysis of the selected proteins was performed.RESULTS In 17 included studies,58 proteins were studied,with the cytokine CXCL10 being the most investigated.Biological pathways related to immune response and fibrosis have shown to be enriched.Applications of biomarkers for the assessment of renal damage as well as the prediction of short-term and long-term function of the graft were reported.Overall,all studies have shown satisfactory diagnostic accuracy of proteins alone or in combination with conventional methods,as far as renal graft assessment is concerned.CONCLUSION Our review suggests that protein biomarkers,evaluated in specific biological fluids,can make a significant contribution to the timely,valid and non-invasive assessment of kidney graft. 展开更多
关键词 PROTEOMICS Kidney transplantation graft evaluation Non-invasive diagnosis Kidney graft function
下载PDF
Acellular fish skin grafts in diabetic foot ulcer care:Advances and clinical insights
10
作者 Yu Zhao Quan-Quan Shen 《World Journal of Diabetes》 SCIE 2025年第1期34-38,共5页
Diabetic foot ulcers(DFUs)represents a significant public health issue,with a rising global prevalence and severe potential complications including amputation.Traditional treatments often fall short due to various lim... Diabetic foot ulcers(DFUs)represents a significant public health issue,with a rising global prevalence and severe potential complications including amputation.Traditional treatments often fall short due to various limitations such as high recurrence rates and extensive resource utilization.This editorial explores the innovative use of acellular fish skin grafts as a transformative approach in DFU management.Recent studies and a detailed case report highlight the efficacy of acellular fish skin grafts in accelerating wound closure,reducing dressing changes,and enhancing patient outcomes with a lower socio-economic burden.Despite their promise,challenges such as limited availability,patient acceptance,and the need for further research persist.Addressing these through more extensive randomized controlled trials and fostering a multidisciplinary treatment approach may optimize DFU care and reduce the global health burden associated with these complex wounds. 展开更多
关键词 Diabetic foot ulcer Acellular matrix tissues Acellular fish skin grafts Wound healing Bioengineered materials
下载PDF
Staged ligation of large portosystemic collaterals in living donor liver transplantation using a small-for-size graft
11
作者 Chao-Long Chen Chee-Chien Yong +4 位作者 Jeffrey Samuel Co Chih-Yi Chen Aldwin Ong Chih-Che Lin Yu-Fan Cheng 《Hepatobiliary Surgery and Nutrition》 SCIE 2020年第4期555-557,共3页
The success of using a partial graft for liver transplantation depends highly on portal venous flow as it is the primary determinant of graft regeneration.Portosystemic collaterals(PSCs)are not uncommon,with an incide... The success of using a partial graft for liver transplantation depends highly on portal venous flow as it is the primary determinant of graft regeneration.Portosystemic collaterals(PSCs)are not uncommon,with an incidence reported to be as high as 40%amongst liver transplant candidates(1). 展开更多
关键词 COLLATERAL graft DONOR
原文传递
Brachioradialis tendon transfer and palmaris longus tendon graft for thumb avulsion:A case report and review of literature
12
作者 Pierre Curings Sonia Ramos-Pascual +4 位作者 Kinga Michalewska Nicolas Gibert Lionel Erhard Mo Saffarini AlexisNogier 《World Journal of Clinical Cases》 SCIE 2025年第4期48-55,共8页
BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of t... BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft. 展开更多
关键词 Brachioradialis tendon transfer Flexor pollicis longus Palmaris longus tendon graft REPLANTATION Thumb amputation Thumb avulsion Case report
下载PDF
Small-for-size syndrome in liver transplantation:Definition,pathophysiology and management 被引量:19
13
作者 Yuichi Masuda Kazuki Yoshizawa +3 位作者 Yasunari Ohno Atsuyoshi Mita Akira Shimizu Yuji Soejima 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2020年第4期334-341,共8页
Background:Since the first success in an adult patient,living donor liver transplantation(LDLT)has become an universally used procedure.Small-for-size syndrome(SFSS)is a well-known complication after partial LT,especi... Background:Since the first success in an adult patient,living donor liver transplantation(LDLT)has become an universally used procedure.Small-for-size syndrome(SFSS)is a well-known complication after partial LT,especially in cases of adult-to-adult LDLT.The definition of SFSS slightly varies among transplant physicians.The use of a partial liver graft has risks of SFSS development.Persistent portal vein(PV)hypertension and PV hyper-perfusion after LT were identified as the main factors.Hence,various approaches were explored to modulate PV flow and decrease PV pressure in order to alleviate this syndrome.Herein,the definition,clinical symptoms,pathophysiology,basic research,as well as preventive and treatment strategies for SFSS are reviewed based on an extensive review of the literature and on our own experiences.Data sources:The articles were collected through PubMed using search terms“liver transplantation”,“living donor liver transplantation”,“living liver donation”,“partial graft”,“small-for-size graft”,“small-forsize syndrome”,“graft volume”,“remnant liver”,“standard liver volume”,“graft to recipient body weight ratio”,“sarcopenia”,“porcine”,“swine”,and“rat”.English publications published before March 31,2020 were included in this review.Results:Many transplant surgeons performed PV flow modulation,including portocaval shunt,splenic artery ligation and splenectomy.With these techniques,patient outcome has been improved even when using a"small"graft.Other factors,such as preoperative recipients’nutritional and skeletal muscle status,graft congestion,and donor factors,were also identified as risk factors which all have been addressed using various strategies.Conclusions:The surgical approach controlling PV flow and pressure could help to prevent SFSS especially in severely ill recipients.In the absence of efficacious medications to resolve SFSS,conservative treatments,including aggressive fluid balance correction for massive ascites,anti-microbiological therapy to prevent or control sepsis and intensive nutritional therapy,are all required if SFSS could not be prevented. 展开更多
关键词 Liver transplantation Living donor liver transplantation small-for-size graft small-for-size syndrome
下载PDF
Expression of iNOS in early injury in a rat model of small-for-size liver transplantation 被引量:5
14
作者 Jiang, Wei-Wei Kong, Lian-Bao +1 位作者 Li, Guo-Qiang Wang, Xue-Hao 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2009年第2期146-151,共6页
BACKGROUND: Living donor liver transplantation has been widely accepted as the treatment of choice for end-stage liver disease. Large amounts of nitric oxide generated by inducible nitric oxide synthase (iNOS) have be... BACKGROUND: Living donor liver transplantation has been widely accepted as the treatment of choice for end-stage liver disease. Large amounts of nitric oxide generated by inducible nitric oxide synthase (iNOS) have been shown to play an important role in many inflammatory and immune reactions, but expression of iNOS in small-for-size liver transplantation is unknown. The aims of this study were to determine the time course of iNOS mRNA and protein as well as the redox state of liver biopsies in a rat model of small-for-size liver transplantation. METHODS: Male Sprague-Dawley rats were divided into a control group, a warm ischemia-reperfusion (IR) group, and a small-for-size liver graft group. Real-time RT-PCR and Western blotting were used to characterize the time course of the expression of iNOS mRNA and protein, respectively. Malondialdehyde (MDA) and superoxide dismutase (SOD) were used as markers to characterize the redox state of liver tissues, and the time courses of MDA and SOD levels were also measured. RESULTS: The expression of iNOS mRNA and protein levels in the warm IR and small-for-size graft groups both significantly increased after reperfusion, and peaked at 3 hours. Moreover, the increase in MDA was accompanied by increased iNOS in the period of 1-24 hours after reperfusion. The MDA levels in the warm IR and small-for-size graft groups significantly increased after reperfusion, peaked at 3 hours, and decreased thereafter. The direction of change in SOD was opposite that of the change in MDA. CONCLUSIONS: The expression of iNOS mRNA and protein is activated after reperfusion both in hepatic warm IR injury and small-for-size liver graft. Furthermore, the results of this study suggest that iNOS contributes to the damage in warm IR injury and small-for-size grafts via free oxygen radicals. 展开更多
关键词 inducible nitric oxide synthase small-for-size graft ischemia-reperfusion injury liver transplantation
下载PDF
Small-for-size syndrome in adult-to-adult living-related liver transplantation 被引量:15
15
作者 Salvatore Gruttadauria Duilio Pagano +1 位作者 Angelo Luca Bruno Gridelli 《World Journal of Gastroenterology》 SCIE CAS CSCD 2010年第40期5011-5015,共5页
Small-for-size syndrome (SFSS) in adult-to-adult living-related donor liver transplantation (LRLT) remains the greatest limiting factor for the expansion of segmental liver transplantation from either cadaveric or liv... Small-for-size syndrome (SFSS) in adult-to-adult living-related donor liver transplantation (LRLT) remains the greatest limiting factor for the expansion of segmental liver transplantation from either cadaveric or living donors. Portal hyperperfusion, venous pathology, and the arterial buffer response signif icantly contribute to clinical and histopathological manifestations of SFSS. Here, we review the technical aspects of surgical and radiological procedures developed to treat SFSS in LRLT, along with the pathophysiology of this condition. 展开更多
关键词 Adult-to-adult living-related liver transplantation small-for-size syndrome Liver resection Liver transplantation
下载PDF
Should temporary extracorporeal continuous portal diversion replace meso/porta-caval shunts in “small-for-size” syndrome in porcine hepatectomy? 被引量:3
16
作者 Da-Dong Wang Yong Xu +4 位作者 Zi-Man Zhu Xiang-Long Tan Yu-Liang Tu Ming-Ming Han Jing-Wang Tan 《World Journal of Gastroenterology》 SCIE CAS 2015年第3期888-896,共9页
AIM:To investigate the feasibility of temporary extracorporeal continuous porta-caval diversion(ECPD) to relieve portal hyperperfusion in "small-for-size" syndrome following massive hepatectomy in pigs.METHO... AIM:To investigate the feasibility of temporary extracorporeal continuous porta-caval diversion(ECPD) to relieve portal hyperperfusion in "small-for-size" syndrome following massive hepatectomy in pigs.METHODS:Fourteen pigs underwent 85%-90% liver resection and were then randomly divided into thecontrol group(n = 7) and diversion group(n = 7).In the diversion group,portal venous blood was aspirated through the portal catheter and into a tube connected to a centrifugal pump.After filtration,the blood was returned to the pig through a double-lumen catheter inserted into the internal jugular or subclavian vein.With the conversion pump,portal venous inflow was partially diverted to the inferior vena cava through a catheter inserted via the gastroduodenal vein at 100-130 m L/min.Portal hemodynamics,injury,and regeneration in the liver remnant were compared between the two groups.RESULTS:Compared to the control group,porta-caval diversion via ECPD significantly mitigated excessive portal venous flow and portal vein pressure(PVP); the portal vein flow(PVF),hepatic artery flow(HAF),and PVP in the two groups were not significantly different at baseline; however,the PVF(431.8 ± 36.6 vs 238.8 ± 29.3,P < 0.01; 210.3 ± 23.4 vs 122.3 ± 20.6,P < 0.01) and PVP(13.8 ± 2.6 vs 8.7 ± 1.4,P < 0.01; 15.6 ± 2.1 vs 10.1 ± 1.3,P < 0.05) in the control group were significantly higher than those in the diversion group,respectively.The HAF in the control group was significantly lower than that in the diversion group at 2 h and 48 h post hepatectomy,and ECPD significantly attenuated injury to the sinusoidal lining and hepatocytes,increased the regeneration index of the liver remnant,and relieved damage that the liver remnant suffered due to endotoxin and bacterial translocation.CONCLUSION:ECPD,which can dynamically modulate portal inflow,can reduce injury to the liver remnant and facilitate liver regeneration,and therefore should replace permanent meso/porta-caval shunts in "smallfor-size" syndrome. 展开更多
关键词 small-for-size syndrome EXTRACORPOREAL CONTINUOUS
下载PDF
Small-for-size syndrome in living donor liver transplantation 被引量:5
17
作者 Shintaro Yagi Shinji Uemoto 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2012年第6期570-576,共7页
When the graft volume is too small to satisfy the recipient’s metabolic demand, the recipient may thus experience small-for-size syndrome (SFSS). Because the occurrence of SFSS is determined by not only the liver gra... When the graft volume is too small to satisfy the recipient’s metabolic demand, the recipient may thus experience small-for-size syndrome (SFSS). Because the occurrence of SFSS is determined by not only the liver graft volume but also a combination of multiple negative factors, the definitions of small-for-size graft (SFSG) and SFSS are different in each institute and at each time. In the clinical setting, surgical inflow modulation and maximizing the graft outflow are keys to overcoming SFSS. Accordingly, relatively smaller-sized grafts can be used with surgical modification and pharmacological manipulation targeting portal circulation and liver graft quality. Therefore, the focus of the SFSG issue is now shifting from how to obtain a larger graft from the living donor to how to manage the use of a smaller graft to save the recipient, considering donor safety to be a priority. 展开更多
关键词 living donor liver transplantation small-for-size syndrome
下载PDF
Extracorporeal continuous portal diversion plus temporal plasmapheresis for “small-for-size” syndrome 被引量:4
18
作者 Peng Hou Chao Chen +2 位作者 Yu-Liang Tu Zi-Man Zhu Jing-Wang Tan 《World Journal of Gastroenterology》 SCIE CAS 2013年第33期5464-5472,共9页
AIM:To investigate the effect of plasmapheresis via the portal vein for"small-for-size"syndrome(SFSS)aided by extracorporeal continuous portal diversion(ECPD).METHODS:Extensive or total hepatectomy in the pi... AIM:To investigate the effect of plasmapheresis via the portal vein for"small-for-size"syndrome(SFSS)aided by extracorporeal continuous portal diversion(ECPD).METHODS:Extensive or total hepatectomy in the pig is usually adopted as a postoperative liver failure(PLF)or SFSS model.In this study,animals which underwent85%-90%hepatectomy were randomized into either the Systemic group(n=7)or the Portal group(n=7).In the Systemic group,all pigs received temporal plasmapheresis(PP)via the extracorporeal catheter circuit(systemic to systemic circulation)from 24 to 30 h posthepatectomy(PH);in the Portal group,all pigs received ECPD to divert partial portal vein flow(PVF)to the systemic circulation after hepatectomy,then converted to temporal PP from 24 to 30 h PH,and subsequently converted to ECPD again until 48 h PH.In the Portal group,the PVF was preserved at 3.0-3.3 times that of the baseline value,similar to that following 70%hepatectomy,which was regarded as the optimal PVF to the hypertrophic liver remnant.At 48 h PH,all pigs were re-opened and the portal vein pressure(PVP),PVF,and HAF(hepatic artery flow)were measured,and then diversion of the portal venous flow was terminated.After1 h the PVP,PVF,and HAF were re-measured.The portal hemodynamic changes,liver injury,liver regeneration and bacterial/lipopolysaccharide(LPS)translocation were evaluated in the two groups.RESULTS:The PVP in the Portal group was significantly lower than that in the Systemic group during the time period from 2 to 49 h PH(P<0.05).Serum alanine aminotransferase(ALT),total bilirubin(TB)and ammonia were significantly reduced in the Portal group compared with the Systemic group from 24 to 48 h PH(P<0.05).The Portal group may have attenuated sinusoidal endothelial injury and decreased the level of HA compared with the Systemic group.In the Systemic group,there was significant sinusoidal dilation,hydropic changes in hepatocytes and hemorrhage into the hepatic parenchyma,and the sinusoidal endothelial lining was partially destroyed and detached into the sinusoidal space.CD31immunostaining revealed significant destruction of the endothelial lining.In the Portal group,there was no intraparenchymal hemorrhage and the sinusoidal endothelial cells and hepatocytes were well preserved.CD31immunostaining was mild which indicated less destruction of the endothelial lining.HA was significantly decreased in the Portal group compared with the Systemic group from 2 to 48 h PH.The rate of liver remnant regeneration was elevated,while apoptosis was attenuated in the Portal group compared with the Systemic group.Thymidine kinase activity was much higher in the Portal group than in the Systemic group at 48 h PH.The PCNA index was significantly increased and the apoptotic index was significantly decreased in the Portal group compared with the Systemic group.Bacterial translocation and endotoxin,as well as the inflammatory response,were significantly attenuated in the Portal group compared with the Systemic group.LPS,tumor necrosis factor-and interleukin-6 levels were all significantly decreased in the Portal group compared with the Systemic group from 24 to48 h PH,while bacterial DNA level was significantly decreased from 2 to 48 h PH.CONCLUSION:PP plus ECPD via the portal vein can attenuate toxic load and hyperperfusion injury,and should be undertaken instead of PP via the systemic circulation in SFSS or PLF. 展开更多
关键词 small-for-size syndrome POSTOPERATIVE liver failure EXTRACORPOREAL PORTAL DIVERSION PLASMAPHERESIS HEPATECTOMY
下载PDF
Minimizing the risk of small-for-size syndrome after liver surgery 被引量:3
19
作者 Michail Papamichail Michail Pizanias NigelD Heaton 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2022年第2期113-133,共21页
Background: Primary and secondary liver tumors are not always amenable to resection due to location and size. Inadequate future liver remnant(FLR) may prevent patients from having a curative resection or may result in... Background: Primary and secondary liver tumors are not always amenable to resection due to location and size. Inadequate future liver remnant(FLR) may prevent patients from having a curative resection or may result in increased postoperative morbidity and mortality from complications related to small-forsize syndrome(SFSS). Data sources: This comprehensive review analyzed the principles, mechanism and risk factors associated with SFSS and presented current available options in the evaluation of FLR when planning liver surgery. In addition, it provided a detailed description of specifc modalities that can be used before, during or after surgery, in order to optimize the conditions for a safe resection and minimize the risk of SFSS. Results: Several methods which aim to reduce tumor burden, preserve healthy liver parenchyma, induce hypertrophy of FLR or prevent postoperative complications help minimize the risk of SFSS. Conclusions: With those techniques the indications of radical treatment for patients with liver tumors have signifcantly expanded. The successful outcome depends on appropriate patient selection, the individualization and modifcation of interventions and the right timing of surgery. 展开更多
关键词 small-for-size syndrome Liver resection Future liver remnant
下载PDF
Extended hepatectomy with segments Ⅰand Ⅶ as resection remnant:a simple model for small-for-size injuries in pigs 被引量:3
20
作者 Qiang Xia,Tian-Fei Lu,Zhi-Hua Zhou,Ling-Xiang Hu,Jun Ying,De-Zhong Ding, Xiao-Song Chen and Jian-Jun Zhang Transplantation Center and Department of Clinical Laboratory ,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China Tyco Clinical Institute,Shanghai 200040,China 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2008年第6期601-607,共7页
BACKGROUND:Small-for-size(SFS)syndrome is an important clinical problem after living donor liver transplantation,split liver transplantation or extended hepatectomy.The uncertainty of the mechanisms and treatments of ... BACKGROUND:Small-for-size(SFS)syndrome is an important clinical problem after living donor liver transplantation,split liver transplantation or extended hepatectomy.The uncertainty of the mechanisms and treatments of SFS syndrome urges surgeons to establish effective models for SFS syndrome. METHODS:A new porcine model for SFS syndrome based on extended hepatectomy was established.Portal pressure gradient was observed before and after the surgery,and venous sampling for estimation of alanine aminotransferase, total bilirubin,and international normalized ratio was continued on a daily basis. RESULTS:Although the external morphology of the porcine liver differs from that of human being,segmental anatomy is remarkably similar in term of its vascularity and biliary tree.Extended hepatectomy with segmentsⅠand Ⅶas resection remnant(about 20%of total liver volume) resulted in similar survival rates,blood liver function tests,and elevated portal pressure gradient as clinical SFS syndrome. CONCLUSIONS:The extended hepatectomy based new model can easily be reproduced,with few costs and surgical complications.Clinical SFS syndrome can easily be simulated by this new model,which is a useful tool for studying SFS syndrome-related liver injuries,especially portal overperfusion and hypertension. 展开更多
关键词 HEPATECTOMY small-for-size syndrome
下载PDF
上一页 1 2 250 下一页 到第
使用帮助 返回顶部