Major complications of adult right lobe living liver donors

BACKGROUND：The right lobe of the liver is generally preferred for living donor liver transplantation in adult patients with end-stage liver disease.It is important to know the preoperative factors relating to the major postoperative complications.We therefore evaluated the possible risk factors for predicting postoperative complications in right lobe liver donors.METHODS：Data from 378 donors who had undergone right lobe hepatectomy at our center were evaluated retrospectively. The factors we evaluated induded donor age, gender, body mass index （BMI）, remnant liver volume, operation time, history of previous abdominal surgery, inclusion of the middle hepatic vein and variations in the portal and bile systems. RESUEI＇S： Of the 378 donors, 219 were male and 159 female. None of the donors died, but 124 （32.8%） donors experienced complications including major complications （Clavien scores III and IV） in 27 （7.1%）. Univariate analysis showed that complica- tions were significantly associated with male gender and higher BMI （P〈0.05）, but not with donor age, remnant liver volume, operation time, graft with middle hepatic vein, variations in the portal and bile systems and previous abdominal surgery （P〉0.05）. Multivariate logistic regression analysis showed that major complications were significantly associated with male gender （P=0.005） and higher BMI （P=0.029）. Moreover, the Chi- square test showed that there were significant relationships between major complications and male gender （P=0.010,Z2=6.614, df=l） and BMI 〉25 kg/m2 （P=-0.031, Z2=8.562, df-1）. Of the 96 male donors with BMI 〉25 kg/m2, 14 （14.6%） with major complications had significantly smaller mean remnant liver volume than those （82, 85.4%） without major complications （32.50%± 4.45% vs 34.63%±3.11%, P=0.029）.CONCLUSION： Male donors with BMI 〉25 kg/m2 and a remnant liver volume 〈32.50% had a significantly increased risk for major complications.

Early post-operative complications in living donor liver transplantation:prevention,detection and management

Living donor liver transplantation (LDLT) is now performed with high rates of success due to judicious recipient and donor selection,careful preoperative planning, excellent anesthesia management, and prompt detection and treatment of complications. The indications for LDLT for adult and pediatric recipients should be the same as for deceased donor liver transplantation. Early postoperative complications are often defined as complications occurring within the first 3 months

Mechanism of Gegen Qinlian Decoction in Treating Type 2 Diabetes Mellitus Complicated with NAFLD Based on Network Pharmacology

[Objectives]To explore the mechanism of Gegen Qinlian Decoction in treating type 2 diabetes mellitus(T2DM)complicated with non-alcoholic fatty liver disease(NAFLD)by analyzing the effective components of Gegen Qinlian Decoction.[Methods]TCMSP database was used to analyze the active components of Gegen Qinlian Decoction,and pubchem and Swiss ADME databases were also used to predict drug targets,extract T2DM complicated with NAFLD targets from OMIM and Genecards databases.Venny plot was drawn to obtain intersection targets,and finally Cytoscape was used to make core target maps and drug-target-disease network maps.Using DAVID and Metascape database to analyze the intersection targets,the gene ontology information of Go and KEGG was obtained.Microbial informatics technology was used to visualize GO,and Cytoscape was used to make drug-target-disease network map-enrichment pathway map.[Results]The network pharmacological analysis showed that Gegen Qinlian Decoction acted on the key targets of type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease,such as ALB and ALT1,through many components,and achieved the purpose of treating this disease.The chemical constituents of the drug include formononetin,5-hydroxyisomucronulatol-2,5-2-O-glucoside,cholesteryl laurate,isoliquiritigenin,etc.[Conclusions]This study provides a new idea and theoretical support for future drug research and clinical practice.

Post-operative imaging in liver transplantation: State-of-the-art and future perspectives

Orthotopic liver transplantation(OLT)represents a major treatment for end-stage chronic liver disease,as well as selected cases of hepatocellular carcinoma and acute liver failure.The ever-increasing development of imaging modalities significantly contributed,over the last decades,to the management of recipients both in the pre-operative and post-operative period,thus impacting on graft and patients survival.When properly used,imaging modalities such as ultrasound,multidetector computed tomography,magnetic resonance imaging(MRI)and procedures of direct cholangiography are capable to provide rapid and reliable recognition and treatment of vascular and biliary complications occurring after OLT.Less defined is the role for imaging in assessing primary graft dysfunction(including rejection)or chronic allograft disease after OLT,e.g.,hepatitis C virus(HCV)recurrence.This paper:(1)describes specific characteristic of the above imaging modalities and the rationale for their use in clinical practice;(2)illustrates main imaging findings related to post-OLTcomplications in adult patients;and(3)reviews future perspectives emerging in the surveillance of recipients with HCV recurrence,with special emphasis on MRI.

Predisposing factors and surgical outcome of complicated liver hydatid cysts

AIM: To evaluate the predisposing factors for peritoneal perforation and intrabiliary rupture and the effects of these complications on surgical outcome in liver hydatid disease.METHODS: A total of 372 patients with liver hydatid cysts who had undergone surgical treatment were evaluated retrospectively. Twenty eight patients with peritoneal perforation, 93 patients with spontaneous intrabiliary perforation, and 251 patients with noncomplicated hydatid cysts were treated in our clinics.RESULTS: When the predisposing factors for complications were evaluated, younger age, superf icial position, and larger cyst dimensions (P < 0.05; range, 0.0010.017) increased peritoneal perforation rates. It was shown that older age increased cyst dimensions, and presence of multiple and bilobar cysts increased intrabiliary rupture rates (P < 0.05; range, 0.0010.028). Partial pericystectomy and drainage was the most frequent surgical procedure in all groups (71.6%). The incidence of postoperative complications in the peritoneal perforated group, in the intrabiliary ruptured group, and in the noncomplicated group was 25%, 16.1% and 5.5%, respectively. When compared, complication rates were significantly different (P = 0.002). When length of hospital stay was compared, there was no signif icant difference between the groups (P > 0.05). The overall recurrence rate was 3.8% (14 patients), but there was not any statistical difference among the patient groups (P = 0.13). The early postoperative mortality rate was 1.1%. CONCLUSION: In peritoneally perforated and intrabiliary ruptured cases, the most important steps are irrigation of the peritoneal cavity and clearance of the cystic material from the biliary tree.

Effectiveness of surgical resection for complicated liver cancer and its influencing factors: A retrospective study

BACKGROUND Surgical resection is the preferred method for patients with complex liver cancer.But the tumor is in a special position, the surgery is highly risky, postoperative complications can easily occur, and the prognosis is not ideal.AIM To investigate the effectiveness of surgical resection for complex liver cancer and its influencing factors.METHODS Fifty-seven patients who had complicated liver cancer and underwent surgical resection at our hospital from August 2015 to August 2016 were enrolled in this study. All patients were followed for three years, and their postoperative complications, survival, and factors that impacted their survival were analyzed.RESULTS The total incidence of postoperative complications was 45.61%, and the incidence of pleural effusion was the highest at 28.07%. There were no correlations between the 2-year and 3-year survival rates and sex, age, and Hbs Ag of the patients(P >0.05). In terms of pathological parameters, the 2-year and 3-year survival rates were significantly different according to the presence of a tumor capsule, degree of liver cirrhosis, satellite or focal lesions, hepatic vein thrombosis, portal vein tumor thrombus, and intraoperative blood loss(P < 0.05).CONCLUSIONThe effectiveness of surgical resection for complex hepatocellular carcinoma may be affected by factors such as the presence of a tumor capsule, cirrhosis degree,satellite or focal lesions, hepatic vein embolization, portal vein tumor thrombus,and intraoperative blood loss. Therefore, these factors should be controlled and prevented during surgery to help improve patient survival after surgery.

Amebic liver abscess:Clinico-radiological findings and interventional management

In its classic form,amebic liver abscess(ALA)is a mild disease,which responds dramatically to antibiotics and rarely requires drainage.However,the two other forms of the disease,i.e.,acute aggressive and chronic indolent usually require drainage.These forms of ALA are frequently reported in endemic areas.The acute aggressive disease is particularly associated with serious complications,such as ruptures,secondary infections,and biliary communications.Laboratory parameters are deranged,with signs of organ failure often present.This form of disease is also associated with a high mortality rate,and early drainage is often required to control the disease severity.In the chronic form,the disease is characterized by low-grade symptoms,mainly pain in the right upper quadrant.Ultrasound and computed tomography(CT)play an important role not only in the diagnosis but also in the assessment of disease severity and identification of the associated complications.Recently,it has been shown that CT imaging morphology can be classified into three patterns,which seem to correlate with the clinical subtypes.Each pattern depicts its own set of distinctive imaging features.In this review,we briefly outline the clinical and imaging features of the three distinct forms of ALA,and discuss the role of percutaneous drainage in the management of ALA.

Delayed liver laceration following transjugular intrahepatic portosystemic shunt for portal hypertension

The transjugular intrahepatic portosystemic shunt(TIPS) is an acceptable procedure that has proven benefits in the treatment of patients who have complications from portal hypertension due to liver cirrhosis.Delayed liver laceration is a rare complication of the TIPS procedure.We describe a patient with portal hypertension due to liver cirrhosis,who suddenly presented with abdominal hemorrhage and liver laceration 8 d after TIPS.Few reports have described complications after TIPS placement.To the best of our knowledge,this is the first report describing delayed liver laceration.This potential and serious complication appears to be specific and fatal for TIPS in portal hypertension.We advocate careful attention to the technique to avoid this complication,and timely treatment is extremely important.

Donor safety and remnant liver volume in living donor liver transplantation

AIM:To evaluate the relationship between donor safety and remnant liver volume in right lobe living donor liver transplantation(LDLT).METHODS:From July 2001 to January 2009,our liver transplant centers carried out 197 LDLTs.The clinical data from 151 cases of adult right lobe living donors(not including the middle hepatic vein) were analyzed.The conditions of the three groups of donors were well matched in terms of the studied parameters.The donors' preoperative data,intraoperative and postoperative data were calculated for the three groups:Group 1 remnant liver volume(RLV) < 35%,group 2 RLV 36%-40%,and group 3 RLV > 40%.Comparisons included the different remnant liver volumes on postoperative liver function recovery and the impact of systemic conditions.Correlations between remnant liver volume and post-operative complications were also analyzed.RESULTS:The donors' anthroposomatology data,op-eration time,and preoperative donor blood test indicators were calculated for the three groups.No significant differences were observed between the donors' gender,age,height,weight,and operation time.According to the Chengdu standard liver volume formula,the total liver volume of group 1 was 1072.88 ± 131.06 mL,group 2 was 1043.84 ± 97.11 mL,and group 3 was 1065.33 ± 136.02 mL.The three groups showed no statistically significant differences.When the volume of the remnant liver was less than 35% of the total liver volume,the volume of the remnant had a significant effect on the recovery of liver function and intensive care unit time.In addition,the occurrence of complications was closely related to the remnant liver volume.When the volume of the remnant liver was more than 35% of the total liver volume,the remnant volume change had no significant effect on donor recovery.CONCLUSION:To ensure donor safety,the remnant liver volume should be greater than the standard liver volume(35%) in right lobe living donor liver transplantation.

Donation after cardio-circulatory death liver transplantation

The renewed interest in donation after cardio-circulatory death (DCD) started in the 1990s following the limited success of the transplant community to expand the donation after brain-death (DBD) organ supply and following the request of potential DCD families. Since then, DCD organ procurement and transplantation activities have rapidly expanded, particularly for nonvital organs, like kidneys. In liver transplantation (LT), DCD donors are a valuable organ source that helps to decrease the mortality rate on the waiting lists and to increase the availability of organs for transplantation despite a higher risk of early graft dysfunction, more frequent vascular and ischemia-type biliary lesions, higher rates of re-listing and re-transplantation and lower graft survival, which are obviously due to theinevitable warm ischemia occurring during the declaration of death and organ retrieval process. Experimental strategies intervening in both donors and recipients at different phases of the transplantation process have focused on the attenuation of ischemia-reperfusion injury and already gained encouraging results, and some of them have found their way from pre-clinical success into clinical reality. The future of DCD-LT is promising. Concerted efforts should concentrate on the identification of suitable donors (probably Maastricht category Ⅲ DCD donors), better donor and recipient matching (high risk donors to low risk recipients), use of advanced organ preservation techniques (oxygenated hypothermic machine perfusion, normothermic machine perfusion, venous systemic oxygen persufflation), and pharmacological modulation (probably a multi-factorial biologic modulation strategy) so that DCD liver allografts could be safely utilized and attain equivalent results as DBD-LT.

Approach to persistent ascites after liver transplantation

Persistent ascites(PA)after liver transplantation(LT),commonly defined as ascites lasting more than 4 wk after LT,can be expected in up to 7%of patients.Despite being relatively rare,it is associated with worse clinical outcomes,including higher 1-year mortality.The cause of PA can be divided into vascular,hepatic,or extrahepatic.Vascular causes of PA include hepatic outflow and inflow obstructions,which are usually successfully treated.Regarding modifiable hepatic causes,recurrent hepatitis C and acute cellular rejection are the leading ones.Considering predictors for PA,the presence of ascites,refractory ascites,hepatorenal syndrome type 1,spontaneous bacterial peritonitis,hepatic encephalopathy,and prolonged ischemic time significantly influence the development of PA after LT.The initial approach to patients with PA should be to diagnose the treatable cause of PA.The stepwise approach in evaluating PA includes diagnostic paracentesis,ultrasound with Doppler,and an echocardiogram when a cardiac cause is suspected.Finally,a percutaneous or transjugular liver biopsy should be performed in cases where the diagnosis is unclear.PA of unknown cause should be treated with diuretics and paracentesis,while transjugular intrahepatic portosystemic shunt and splenic artery embolization are treatment methods in patients with refractory ascites after LT.

Adult to adult living related liver transplantation: Where do we currently stand?

Adult to adult living donor liver transplantation (AALDLT) was first preformed in the United States in 1997. The procedure was rapidly integrated into clinical practice, but in 2002, possibly due to the first widely publicized donor death, the number of living liver donors plummeted. The number of donors has since reached a steady plateau far below its initial peak. In this review we evaluate the current climate of AALDLT. Specifically, we focus on several issues key to the success of AALDLT: determining the optimal indications for AALDLT, balancing graft size and donor safety, assuring adequate outflow, minimizing biliary complications, and maintaining ethical practices. We conclude by offering suggestions for the future of AALDLT in United States transplantation centers.

Experiences relating to management of biliary tract complications following liver transplantation in 96 cases

To investigate best diagnosing methods and therapy for patients with biliary tract complications after liver transplantation and analyze related factors Methods A review was made of data collected from 96 patients, and confirmed by retrospective case notes examination Results A total of 94 patients (97 grafts) survived more than 2 days after transplantation; of whom, 92 had an end to end biliary anastomosis with a T tube The average follow up was 5 8 months (range: 0 3-10 2 months) Among the 94 patients, eight (8 5%, 8/94) had complications: leakage during T tube removal (2 patients), leakage at an earlier stage (2), simultaneous stricture and leak (2) and just stricture (2) Six patients with biliary tract complications had predisposing factors including hepatic artery stenosis (2 patients, including one hepatic artery stenosis combined with severe rejection, hepatic artery thrombosis (3), and donor recipient bile duct mismatch (1) There was no difference in cold ischemic time With hepatic artery thrombosis and/or stenosis 】50%, five patients were re transplanted; without hepatic artery thrombosis and/or stenosis 【50%, three patients required endoscopic stenting and radiological percutaneous drainage of bile collection with or without balloon dilation All patients survived Conclusions Biliary strictures occur later than leaks after surgery Without hepatic artery thrombosis and/or stricture, there is no need for surgery; with hepatic artery thrombosis and/or stricture 】50%, re transplantation is needed as early as possible