Ex vivo liver resection followed by autotransplantation for end-stage hepatic alveolar echinococcosis

Background For patients with end-stage hepatic alveolar echinococcosis （AE）, in vivo resection of the involved parts of the liver is usually very difficult, therefore, allogenic liver transplantation is indicated. However, we hypothesize that for selected patents, ex vivo liver resection for thorough elimination of the involved tissues and liver autotransplantation may offer a chance for clinical cure. Methods We presented a 24-year-old women with a giant hepatic AE lesion who was treated with hepatectomy, ex vivo resection of the involved tissue and hepatic autotransplantation. The patient had moderate jaundice and advanced hepatic AE lesion which involved segments I, IV, V, VI, VII, VIII and retrohepatic inferior vena cava. The lateral segments （II and III） of the left liver remained normal with over 1000 ml in its volume. No extrahepatic metastases （such as to the lung or brain） could be found. As the first step of treatment, X-ray guided percutaneous transhepatic cholangiodrainage （PTCD） was performed twice for bile drainage in segment III and II separately until her serum total bilirubin decreased gradually from 236 to 88 umol/L. Total liver resection was then performed, followed by extended right hepatic trisegmentectomy and the entire retrohepatic vena cava was surgically removed en bloc while her hemodynamics parameters were stable. Neither veino-veinous bypass nor temporary intracorporeal cavo-caval or porto-caval shunt was used during the 5.7-hour anhepatic phase. The remained AE-free lateral segments of the-left liver were re-implanted in situ. The left hepatic vein was directly anastomosed end-to-end to the suprahepatic inferior vena cava due to the lack of the retrohepatic inferior vena cava with AE total infiltration. Because compensatory retroperitoneal porto-caval collateral circulation developed, we enclosed remained infrahepatic inferior vena cava at renal vein level without any haemodynamics problems. Results During a 60-day following-up after operation, the patient had a good recovery except for a mildly elevated serum total bilirubin. Conclusions As a radical approach, ex vivo liver resection and liver autotransptantation in a case has shown a optimal potential for treatment of the end-stage hepatic AE. Strict compliance with its indications, evaluation of vessels of patients pre-operatively, and precise surgical techniques are the keys to improve the prognosis of patients.

Delayed graft function is correlated with graft loss in recipients of expanded-criteria rather than standard-criteria donor kidneys:a retrospective,multicenter,observation cohort study

Background:Although the use of expanded-criteria donors(ECDs)alleviates the problem of organ shortage,it significantly increases the incidence of delayed graft function(DGF).DGF is a common complication after kidney transplantation;however,the effect of DGF on graft loss is uncertain based on the published literature.Hence,the aim of this study was to determine the relationship between DGF and allograft survival.Methods:We conducted a retrospective,multicenter,observation cohort study.A total of 284 deceased donors and 541 recipients between February 2012 and March 2017 were included.We used logistic regression analysis to verify the association between clinical parameters and DGF,and Cox proportional hazards models were applied to quantify the hazard ratios of DGF for kidney graft loss.Results:Among the 284 deceased donors,65(22.8%)donors were ECD.Of the 541 recipients,107(19.8%)recipients developed DGF,and this rate was higher with ECD kidneys than with standard-criteria donor(SCD)kidneys(29.2%vs.17.1%;P=0.003).The 5-year graft survival rate was not significantly different between SCD kidney recipients with and without DGF(95.8%vs.95.4%;P=0.580).However,there was a significant difference between ECD kidney recipients with and without DGF(71.4%vs.97.6%;P=0.001),and the adjusted hazard ratio(HR)for graft loss for recipients with DGF was 1.885(95%confidence interval[CI]=1.305–7.630;P=0.024).Results showed that induction therapy with anti-thymocyte globulin was protective against DGF(odds ratio=0.359;95%CI=0.197–0.652;P=0.001)with all donor kidneys and a protective factor for graft survival(HR=0.308;95%CI=0.130–0.728;P=0.007)with ECD kidneys.Conclusion:DGF is an independent risk factor for graft survival in recipients with ECD kidneys,but not SCD kidneys.

COVID-19 in the immunocompromised population:data from renal allograft recipients throughout full cycle of the outbreak in Hubei province,China

Coronavirus disease 2019(COVID-19)is an infectious disease caused by a newly discovered coronavirus and has rapidly spread to most of the world and resulted in a global pandemic.However,there is a paucity of information available to characterize the immunodeficient population in the COVID-19 pandemic,especially information that focuses on patients after renal transplantation as the typical representative of this population.