Evaluation of standard liver volume formulae for Chinese adults

Dynamic three-dimensional liver volume assessment of liver regeneration in hilar cholangiocarcinoma patients undergoing hemi-hepatectomy

Background

For patients with hilar cholangiocarcinoma (HC) undergoing hemi-hepatectomy, there are controversies regarding the requirement of, indications for, and timing of preoperative biliary drainage (PBD). Dynamic three-dimensional volume reconstruction could effectively evaluate the regeneration of liver after surgery, which may provide assistance for exploring indications for PBD and optimal preoperative bilirubin value. The purpose of this study was to explore the indications for PBD and the optimal preoperative bilirubin value to improve prognosis for HC patients undergoing hemi-hepatectomy.

Methods

We retrospectively analyzed the data of HC patients who underwent hemi-hepatectomy in the First Affiliated Hospital of China Medical University from 2012 to 2023. The liver regeneration rate was calculated using three-dimensional volume reconstruction. We analyzed the factors affecting the liver regeneration rate and occurrence of postoperative liver insufficiency.

Results

This study involved 83 patients with HC, which were divided into PBD group (n=36) and non-PBD group (n=47). The preoperative bilirubin level may be an independent risk factor affecting the liver regeneration rate (P=0.014) and postoperative liver insufficiency (P=0.016, odds ratio=1.016, β=0.016, 95% CI=1.003-1.029). For patients whose initial bilirubin level was >200 μmol/L (n=45), PBD resulted in better liver regeneration in the early stage (P=0.006) and reduced the incidence of postoperative liver insufficiency [P=0.012, odds ratio=0.144, 95% confidence interval (CI)=0.031-0.657]. The cut-off value of bilirubin was 103.15 μmol/L based on the liver regeneration rate. Patients with a preoperative bilirubin level of ≤103.15 μmol/L shown a better liver regeneration (P<0.01) and lower incidence of postoperative hepatic insufficiency (P=0.011, odds ratio=0.067, 95% CI=0.008-0.537).

Conclusion

For HC patients undergoing hemi-hepatectomy whose initial bilirubin level is >200 μmol/L, PBD may result in better liver regeneration and reduce the incidence of postoperative liver insufficiency. Preoperative bilirubin levels ≤103.15 μmol/L maybe recommended for leading to a better liver regeneration and lower incidence of postoperative hepatic insufficiency.

Single-center experience of Ex vivo liver resection and autotransplantation for complex hepatic alveolar echinoccosis

Objective

To summarize the single-centre experience of Ex vivo Liver Resection and Autotransplantation (ELRA) to treat end-stage hepatic alveolar echinococcosis (HAE).

Methods

Retrospective analysis of clinical data and follow-up data of 13 patients admitted to the Affiliated Hospital of Qinghai University from January 2015 to December 1, 2020, with the Ex vivo Liver Resection and Autotransplantation for hepatic alveolar echinococcosis.

Result

13 patients underwent successful total/ semi-ex-vivo liver resection combined with Ex vivo Liver Resection and Autotransplantation with no intra-operative deaths. the median standard liver volume was 1,118 ml (1,085-1,206.5 ml); the median residual liver volume was 634 ml (526.5-1,338 ml); The median weight of the autograft was 845.8 g (619.5-1,020.5 g), the median operation time was 14.5 h (11.5-16.15 h); the median anhepatic period time was 290 min (257-312.5 min). The median intraoperative blood loss was 1,900 ml (1,300-3,500 ml); the median number of erythrocyte suspensions entered was 7.5 u (6-9u). The median length of hospital stay was 32 days (24-40 days). Postoperative complications occurred in 9 patients during hospitalization,with 7 patients graded at grade III or higher by Clavien-Dindo; 4 patients died postoperatively. 1 patient had recurrent abdominal distension with massive thoracoabdominal fluid and coagulation dysfunction 8 months after surgery and was considered to have small liver syndrome. 1 patient developed HAE recurrence during the follow-up, which was considered intraoperative incisional implantation.

Conclusion

ELRA is one of the most valuable therapeutic measures for the treatment of end-stage complicated hepatic alveolar echinococcosis. Precise preoperative assessment of liver function, individualized intraoperative duct reconstruction, and precise management of the postoperative disease can achieve better treatment results.

First Robotic Hepatectomy With Middle Hepatic Vein Reconstruction Using ePTFE Graft for Hepatic Adenoma: A Case Report

Surgical resection remains the best choice for the treatment of liver tumors. Hepatectomy combined with artificial vascular reconstruction has been proven as an alternative to treating tumors involving the main hepatic veins. As the cutting-edge surgical technique, robotic liver surgery is a novel procedure expanding the field of minimally invasive approaches, especially in complex reconstruction. This study reports, for the first time, on a robotic hepatectomy with middle hepatic vein (MHV) reconstruction using an expanded polytetrafluoroethylene (ePTFE) graft for a patient with hepatic adenoma. The tumor, which was located in segment 8, was adjacent to the MHV. Robot-assisted resection of segment 4 and partial segment 8, and MHV reconstruction using a ePTFE graft were performed. During the post-operative examination and follow-up, the blood flow of the ePTFE graft was patent, and liver function recovered well. Thus, robotic hepatectomy with MHV reconstruction is a safe, minimally invasive, and precise surgery that may provide a novel approach for patients with liver tumors that are invading or adjacent to the main hepatic veins.

Physiologically based pharmacokinetic modeling of candesartan related to CYP2C9 genetic polymorphism in adult and pediatric patients

Candesartan cilexetil is an angiotensin II receptor blocker and it is widely used to treat hypertension and heart failure. This drug is a prodrug that rapidly converts to candesartan after oral administration. Candesartan is metabolized by cytochrome P450 2C9 (CYP2C9) enzyme or uridine diphosphate glucurinosyltransferase 1A3, or excreted in an unchanged form through urine, biliary tract and feces. We investigated the effect of genetic polymorphism of CYP2C9 enzyme on drug pharmacokinetics using physiologically based pharmacokinetic (PBPK) modeling. In addition, by introducing the age and ethnicity into the model, we developed a model that can propose an appropriate dosage regimen taking into account the individual characteristics of each patient. To evaluate the suitability of the model, the results of a clinical trial on twenty-two healthy Korean subjects and their CYP2C9 genetic polymorphism data was applied. In this study, PK-Sim® was used to develop the PBPK model of candesartan.

Physiologically based pharmacokinetic (PBPK) modeling of meloxicam in different CYP2C9 genotypes

Meloxicam, a non-steroidal anti-inflammatory drug, is used for the treatment of rheumatoid arthritis and osteoarthritis. Cytochrome P450 (CYP) 2C9 and CYP3A4 are major and minor enzymes involved in the metabolism of meloxicam. Impaired enzyme activity of CYP2C9 variants increases the plasma exposures of meloxicam and the risk of adverse events. The objective of our study is to develop and validate the physiologically based pharmacokinetic (PBPK) model of meloxicam related to CYP2C9 genetic polymorphism using the PK-Sim^® software. In vitro k_cat of CYP2C9 was optimized in different CYP2C9 genotypes. The demographic and pharmacokinetic dataset for the development of the PBPK model was extracted from two previous clinical pharmacokinetic studies. Thirty-one clinical datasets, representing different dose regimens and demographic characteristics, were utilized to validate the PBPK model. The shapes of simulated plasma concentration-time profiles in each CYP2C9 genotype were visually similar to observed profiles. The predicted exposures (AUC_inf) of meloxicam in CYP2C9*1/*3, CYP2C9*1/*13, and CYP2C9*3/*3 genotypes were increased by 1.77-, 2.91-, and 8.35-fold compared to CYP2C9*1/*1 genotype, respectively. In all datasets for the development and validations, fold errors between predicted and observed pharmacokinetic parameters were within the two-fold error criteria. As a result, the PBPK model was appropriately established and properly described the pharmacokinetics of meloxicam in different CYP2C9 genotypes. This study is expected to contribute to reducing the risk of adverse events of meloxicam through optimization of meloxicam dosing in different CYP2C9 genotypes.

Application of ex vivo liver resection and autotransplantation in treating Budd-Chiari syndrome secondary to end-stage hepatic alveolar echinococcosis: A case series

BACKGROUND

Secondary Budd-Chiari syndrome (BCS) occurs due to a blockage in the liver caused by invasion or compression by a large lesion. Conventional treatments for BCS do not solve practical problems, wherease liver transplantation has been only applied as a last-resort therapy and as the only opportunity for a radical cure. We explored the feasibility of applying ex vivo liver resection and autotransplantation (ELRA) for the new indications of treating patients with end-stage hepatic alveolar echinococcosis (HAE). Our center has firstly proposed the idea and successfully treated the 49 patients with HAE. This article for the first time reports the application of ELRA in treating patients with BCS secondary to HAE.

METHODS

According to the degree of lesion invasion and surgical options, 11 patients were divided into 4 types. These 11 patients had large lesions that invaded the second and third hilum of the caudate lobe and involved the confluence of the hepatic vein and the inferior vena cava, suprahepatic vena cava, or at least 2 hepatic veins and led to secondary BCS. The aim of the present work was to report 11 patients with life-threatening diseases who underwent ELRA (ex vivo liver resection and autotransplantation) for secondary BCS, to propose a classification system for secondary BCS, and to suggest that secondary BCS is an indication for ELRA.

RESULTS

Eleven patients successfully underwent ELRA without intraoperative mortality. The median autograft weight was 690 g (440-950 g); operative time was 12.5 hours (9.4-16.5 hours); Postoperative hospital stay was 15 days (7-21 days). Clavien-Dindo grade IIIa or higher postoperative complications occurred in only 5 patients.

CONCLUSIONS

This article for the first time reports the application of ELRA in treating patients with BCS secondary to HAE, not only provides new ideas for alternative treatments of secondary BCS, but also provides a classification system for secondary BCS. This article describes the technical process of outflow tract reconstruction and the experience for expanding the indications for ELRA. Our study demonstrated that ELRA is well feasible for treatment of BCS secondary to advanced HAE.

The short-term efficacy of no-touch radiofrequency ablation in treating cirrhosis-based small hepatocellular carcinoma

Background

Radiofrequency ablation (RFA) for the treatment of small hepatocellular carcinoma (HCC) has a drawback of high recurrence rate. No-touch technique was developed to overcome it. However, it has barely been studied in Chinese populations. The aim of this study is to determine the safety and efficacy of no-touch RFA in the treatment of cirrhosis-based small HCC patients.

Methods

A total of 130 patients of small HCC in Southwest Hospital were enrolled in this study, 46 cases treated by no-touch RFA and 84 cases by conventional RFA. Treatment complications and tumor-free survival rate and overall survival rate were compared and analyzed.

Results

There were no significant differences in baseline confounding factors between the two groups. The ablation volume of no-touch RFA technique was significantly higher than conventional RFA (P = 0.002) but the remaining liver volume and treatment complications of the two techniques were the same (P = 0.702 and P = 0.269, respectively). Cox regression model revealed that conventional RFA was a predictive factor for short-term HCC recurrence (P = 0.041 for 2-year recurrence rate). Kaplan-Meier survival showed that tumor-free survival in no-touch group was significantly higher than conventional group (P = 0.047).

Conclusions

Our data showed that no-touch RFA provided a higher short-term tumor-free survival rate than conventional RFA but was as safe as conventional RFA.

Laparoscopic associating liver tourniquet and portal ligation combined rescue transhepatic arterial embolization for staged hepatectomy: A case report

RATIONALE

Staged hepatectomy is an important surgical method for large hepatocellular carcinoma (HCC). However, the insufficient future liver remnant (FLR) is still the major barrier in stage II hepatectomy. We herein reported a case of laparoscopic associating liver tourniquet and portal ligation combined rescue transhepatic arterial embolization (TAE) for staged hepatectomy.

PATIENT CONCERNS

Laparoscopic associating liver tourniquet and portal ligation for staged hepatectomy (ALTPS) was performed for cirrhotic HCC in stage I. To stimulate the growth of FLR, a "rescue" TAE was initiated before stage II.

DIAGNOSE

HCC with hepatitis B cirrhosis.

OUTCOMES

Two weeks later after TAE, the FLR achieved sufficient hypertrophy and stage II surgery was successfully performed. The patient was discharged 7 days after the second stage without serious complication. During the follow-up at postoperative 6 months, the patient underwent radiofrequency ablation, because contrast-enhanced ultrasonography showed 1 cm tumor recurrence in the remnant liver.

LESSONS

Rescue TAE plays an important role to stimulate the increasing of FLR after ALTPS.

Liver autotransplantation and retrohepatic vena cava reconstruction for alveolar echinococcosis

BACKGROUND

Alveolar echinococcosis (AE) is characterized by a slow-growing infiltrative neoplasm that is often unresectable by traditional methods because of strong adhesions and invasion to adjacent structures. We present our experience with liver autotransplantation and retrohepatic inferior vena cava (RHIVC) reconstruction using autogenous veins in patients with this end-stage parasitic disease.

METHODS

Twelve patients with hepatic AE and extensive RHIVC, hepatic vein, and/or hilar invasion underwent ex vivo liver resection and RHIVC reconstruction using autogenous veins followed by autotransplantation in the West China Hospital of Sichuan University from 2013 to 2016.

RESULTS

The mean weight of the harvested liver graft was 537 g (range: 390-900 g), the mean anhepatic time was 216 min (range, 120-310 min), and the mean operation time was 13.6 h (range, 10.5-19.5 h). The main postoperative complication was bile leakage. The mean postoperative hospital stay was 16.4 d (range, 10.0-37.0 d), and the median follow-up time was 15.5 mo (range, 1.0-32.0 mo). All patients were alive at the latest follow-up. The vascular patency rate was 100%, and no residual disease, recurrence, or metastasis was detected.

CONCLUSIONS

To our knowledge, liver autotransplantation and RHIVC reconstruction using autogenous veins are rarely performed for patients with end-stage hepatic AE. This technique requires no organ donor, allogeneic, or artificial vessel implantation, postoperative immunosuppressive therapy, or long-term postoperative anticoagulant treatment. These benefits may make the treatment of select end-stage hepatic AE patients more affordable and effective.

Donor Safety in Adult-Adult Living Donor Liver Transplantation: A Single-Center Experience of 356 Cases

Background

As an important means to tackle the worldwide shortage of liver grafts, adult-adult living donor liver transplantation (A-ALDLT) is the most massive operation a healthy person could undergo, so donor safety is of prime importance. However, most previous research focused on recipients, while complications in donors have not been fully described or investigated.

Material/Methods

To investigate donor safety in terms of postoperative complications, the clinical data of 356 A-ALDLT donors in our center from January 2002 to September 2015 were retrospectively analyzed. These patients were divided into a pre-2008 group (before January 2008) and a post-2008 group (after January 2008). Donor safety was evaluated with regard to the type, frequency, and severity of postoperative complications.

Results

There were no donor deaths in our center during this period. The overall complication rate was 23.0% (82/356). The proportion of Clavien I, II, III, and IV complications was 51.2% (42/82), 25.6% (21/82), 22.0% (18/82), and 1.2% (1/82), respectively. In all the donors, the incidence of Clavien I, II, III, and IV complications was 11.8% (42/356), 5.9% (21/356), 5.1% (18/356), and 0.3% (1/356), respectively. The overall complication rate in the post-2008 group was significantly lower than that in the pre-2008 group (18.1% (41/227) vs. 32.6% (42/129), P<0.01). Biliary complications were the most common, with an incidence of 8.4% (30/356).

Conclusions

The risk to A-ALDLT donors is controllable and acceptable with improvement in preoperative assessment and liver surgery.

Application of a Three-Dimensional Reconstruction Technique in Liver Autotransplantation for End-Stage Hepatic Alveolar Echinococcosis

BACKGROUND

The purpose of this study was to determine the clinical value of three-dimensional (3D) computer reconstruction technology in pre-operative assessment and surgical planning for liver autotransplantation in patients with end-stage hepatic alveolar echinococcosis (HAE).

STUDY DESIGN

Fifteen end-stage HAE patients received surgical treatment in our hospital between May 2011 and July 2014. 3D reconstruction and virtual surgeries were performed on diseased livers using a 3D reconstruction system for liver (IQQA-Liver). The feasibility and safety of liver autotransplantation were assessed for successful implementation of surgery. The results were compared with intraoperative conditions and computed tomography (CT) to verify the accuracy of pre-operative evaluation.

RESULTS

Fifteen patients underwent liver resections and liver autotransplantation using surgical strategies consistent with pre-operative surgical planning in 3D reconstruction. Furthermore, there was no significant difference between whole-liver volume (2848.26 ± 798.41 vs. 2598.70 ± 822.45 cm(3), t = -4.635, P > 0.05) and lesion volume (1159.09 ± 789.47 vs. 1213.14 ± 813.76 cm(3), t = -1.959, P > 0.05) measured by 3D and traditional two-dimensional (2D) manual tracing from CT. The remaining liver volumes calculated by 3D and 2D CT were 810.47 ± 214.05 and 892.00 ± 262.36 cm(3) (t = -3.275, P > 0.05), with an average error rate of 6.2 and 16.5%, respectively. The pre-operative remaining liver volumes estimated by the two methods were positively correlated with the actual weight (783.67 ± 217.74 g) after the surgery (r three-dimensional = 0.976, r multislice CT = 0.883, P < 0.01).

CONCLUSIONS

An individualized liver reconstruction technique can provide comprehensive anatomic information on livers of patients with end-stage HAE. Pre-operative virtual surgery can effectively improve the success rate of liver autotransplantation and reduce the risks of surgery.

Difference in outcomes between living left lobe donors and noncirrhotic subjects undergoing left lobe resections

OBJECTIVES

The aim of this study was to compare short- and long-term outcomes between the living donors and patients without cirrhosis after left lobe resection.

MATERIAL AND METHODS

We retrospectively collected data from 40 left lobe donors (Group 1) and from 40 patients who had undergone left liver resection for various diseases (Group 2) from 2002 to 2010. In addition to preoperative parameters, we compared intraoperative variables as well as, short- and long-term outcomes, including postoperative complications and laboratory test results. The liver functions included total bilurubin (TB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), international normalized ratio (INR), and albumin (ALB) compared as well as changes in white blood cell (WBC) count and platelet count.

RESULTS

The preoperative parameters of the two groups were comparable. There was significantly more blood loss in Group 2 than Group 1 (422.5 mL vs 318.8 mL; P = .001), leading to more autologous blood transfusions in Group 2 (P = .008). The other intraoperative variables were similar between the two groups. The overall postoperative complication rate was similar: 4% in Group 1 and 8% in Group 2 (P = .213); however, there were longer hospital stays and overall costs in Group 1 (P < .05). The total bilirubin level, AST, and ALT of Group 2 were worse than those in Group 1 during the early postoperative period. Upon long-term follow-up the postoperative platelet count decreased in the two groups compared with the preoperative levels.

CONCLUSION

The type and rate of complications following left hepatectomy were similar between donors and noncirrhotic hepatic patients. Nevertheless, more serious liver dysfunction postoperatively was observed among the patient group.

Intraoperative "no go" donor hepatectomy in living donor liver transplantation

BACKGROUND AND OBJECTIVE

Although there are many reports on donor safety, there are few concerning aborted donations. We sought to analyze the "no go" donor hepatectomies in our liver transplantation center over 10 years' experience.

METHODS

Among 290 living donors brought to the operating room for liver graft harvest from March 2002 to April 2012, we examined the reasons to abandon the procedure, comparing their data with those of successful donors.

RESULTS

The donor operation was aborted in 5 cases various for reasons. The main reason for the abandonment of the operation process was poor liver quality: in single cases there was: poor liver quality due to a massive cirrhotic nodule observed by laparoscopy; serious steatosis of the liver, indicated by an intraoperative biopsy; and an unsuitable biliary anatomy, including 4 branches with 2 small ones. In another case, a biliary duct variation in the intraoperative cholangiogram showed a narrow crotch of the left and right ducts. In the 5th case, the donor would have been left with only a small remaining left lobe (<30%) if the right lobe had been harvested. All 5 donors proceeded to accept a right lobe hepatectomy. Comparison with the 285 successful donors showed no significant differences in preoperative demographic data. All 5 donors recovered without complication and were in good condition over long-term follow-up.

CONCLUSIONS

A low rate of "no go" donor hepatectomy can be achieved. There was no short- or long-term harm to the living donor owing to abandonment of the procedure.

Platelet count reduction and outcomes in living liver donors

BACKGROUND

Platelet count reduction in living donors after graft harvesting is very common. The mechanisms and the subsequent adverse consequences are not clear. The present study was to explore the mechanisms and the consequences of platelet count reduction in living donors.

METHODS

We collected data from 231 living liver donor patients who donated at our transplant center between July 2002 and August 2009. Baseline and post-operative platelet counts were collected and analyzed. Multivariate logistic regression analysis was used to compare the risk factors for the persistent decrease in platelet counts. Complications and other post-operative recovery were compared between the donors.

RESULTS

Platelet count decreased differently at each of the follow-up intervals, and the average reduction from baseline evaluation to year 3 was 18.2%. A concomitant decrease in white blood cells was observed with platelet count reduction. All of the splenic volumes at the post-operative follow-up time points were significantly higher than those at baseline (P<0.01). Multivariate logistic regression analysis indicated that the graft-to-donor weight ratio was a risk factor for low post-operative platelet counts in living donors at the three follow-up time points: one week (P=0.047), one month (P=0.034), and three months (P=0.047). At the one week follow-up time, 77 donor platelet counts were higher (group 1) and 151 donor platelet counts were lower (group 2) than baseline levels. Two hemorrhage events (1.3%) were observed in group 2, while three hemorrhage events (3.9%) were observed in group 1 (P=0.211). The overall complication rate was comparable between the two groups (P=0.972).

CONCLUSION

An increase in harvesting graft may decrease platelet counts, but this reduction does not produce short- or long-term damage in living liver donors.

Prediction factors of postoperative hyperbilirubinemia in living right lobe donor: a single-center analysis of 210 cases

BACKGROUND

Hyperbilirubinemia in living liver donor is very common, but the causes are still unclear.

AIMS

We sought to clarify the risk factors and predictors of nonobstructive hyperbilirubinemia among living donors.

METHODS

We divided 210 consecutive right liver lobe donors into two groups according to the peak total bilirubin postoperatively. We collected data on preoperative, intraoperative, and postoperative biochemical measurements retrospectively, performing multivariate logistic regression analysis adjusting for potential confounders of the risk of hyperbilirubinemia.

RESULTS

There were significant differences between the two groups in donor age, body mass index, operative time, blood loss, macrovescicular steatosis, allogeneic blood transfusion rate, intensive care unit stay, hospital stay and Clavien score after donation (P < .05). Age, graft/donor weight, operative time, and blood loss were significantly associated with the risk of hyperbilirubinemia upon logistic regression analysis.

CONCLUSION

Hyperbilirubinemia, one type of hepatic dysfunction after a living donor procedure, was associated with multiple independent risk factors.

Transplantation vs resection for hepatocellular carcinoma with compensated liver function after downstaging therapy

AIM: Our study aimed to compare the results of liver transplantation (LT) and liver resection (LR) in patients with hepatocellular carcinoma (HCC) that met the Milan criteria after successful downstaging therapy.

METHODS: From February 2004 to August 2010, a consecutive series of 102 patients were diagnosed with advanced-stage HCC that met the modified UCSF down-staging protocol inclusion criteria. All of the patients accepted various down-staging therapies. The types and numbers of treatments were tailored to each patient according to the tumor characteristics, location, liver function and response. After various downstaging therapies, 66 patients had tumor characteristics that met the Milan criteria; 31 patients accepted LT in our center, and 35 patients accepted LR. The baseline characteristics, down-staging protocols, postoperative complications, overall survival and tumor free survival rate, and tumor recurrence rate were compared between the two groups. Kaplan-Meier analyses were used to estimate the long-term overall survival and tumor-free survival rate. Meanwhile, a Cox proportional hazards model was used for the multivariate analyses of overall survival and disease-free survival rate.

RESULTS: No significant difference was observed between the LT and LR groups with respect to the down-staging protocol, target tumor characteristics, and baseline patient characteristics. Fifteen patients suffered various complications after LT, and 8 patients had complications after LR. The overall complication rate for the LT group was 48.4%, which was significantly higher than the LR group (22.9%) (P = 0.031). The overall in-hospital mortality in hospital for the LT group was 12.9% vs 2.9% for the LR group (P = 0.172). The overall patient survival rates at 1-, 3- and 5-years were 87.1%, 80.6% and 77.4%, respectively, after LT and 91.4%, 77.1% and 68.6%, respectively, after LR (P = 0.498). The overall 1-, 3- and 5-year tumor recurrence-free rates were also comparable (P = 0.656). Poorer tumor differentiation (P = 0.041) and a higher post-downstage alpha-fetoprotein (AFP) level (> 400 ng/mL) (P = 0.015) were the two independent risk factors for tumor recurrence in the LT and LR patients who accepted successful down-staging therapy.

CONCLUSION: Due to the higher postoperative morbidity and similar survival and tumor recurrence-free rates, LR might offer better or similar outcome over LT, but a larger number and further randomized studies may be needed in the future for drawing any positive conclusions.

Donor safety in living donor liver transplantation: a single-center analysis of 300 cases

Aim

To evaluate the safety to donors of living-donor liver transplantation.

Methods

This study included 300 consecutive living liver tissue donors who underwent operations at our center from July 2002 to December 2012. We evaluated the safety of donors with regard to three aspects complications were recorded prospectively and stratified by grade according to Clavien’s classification, and the data were compared in two stages (the first 5 years’ experience (pre-January 2008) and the latter 5 years’ experience (post-January 2008); laboratory tests such as liver function and blood biochemistry were performed; and the health-related quality of life was evaluated.

Results

There was no donor mortality at our center, and the overall morbidity rate was 25.3%. Most of the complications of living donors were either grade I or II. There were significantly fewer complications in the latter period of our study than in the initial period (19.9% vs 32.6%, P<0.001), and biliary complications were the most common complications, with an incidence of 9%. All of the liver dysfunction was temporary; however, the post-operative suppression of platelet count lasted for years. Although within the normal range, eight years after operation, 22 donors showed lower platelet levels (189×10⁹/L) compared with the pre-operative levels (267×10⁹/L) (P<0.05). A total of 98.4% of donors had returned to their previous levels of social activity and work, and 99.2% of donors would donate again if it was required and feasible. With the exception of two donors who experienced grade III complications (whose recipients died) and a few cases of abdominal discomfort, fatigue, chronic pain and scar itching, none of the living donors were affected by physical problems.

Conclusion

With careful donor selection and specialized patient care, low morbidity rates and satisfactory long-term recovery can be achieved after hepatectomy for living-donor liver transplantation.

Influence of larger graft weight to recipient weight on the post-liver transplantation course

Size matching between recipient and donor livers is an important factor in organ allocation in the context of liver transplantation (LT). The aim of this study was to determine whether a large graft for recipient size influenced the post-transplant course. One hundred and sixty-two successive LT recipients were included and retrospectively divided into two groups: 25 (15%) had a graft-to-recipient weight ratio (GWRW) ≥ 2.5% and 137 (85%) had a GWRW <2.5%. Postoperative complications and outcomes were recorded. In the GWRW >2.5% group, more end-to-end caval replacement (72% vs. 38%, p = 0.003) and veno-venous bypass (48% vs. 23%, p = 0.01) were used. Peak AST/ALT values were higher in the GWRW >2.5% group (AST: 596 [70-5876] vs. 453 [29-5132] IU/l, p = 0.03; ALT: 773 [101-5025] vs. 383 [36-4921] IU/l, p = 0.02). Among postoperative complications, the rate of respiratory failure was higher in the GWRW >2.5% group (32% vs. 14%, p = 0.04). The rates of other complications did not differ between the two groups. Both groups had similar graft and patient survival rates at one yr. Using large grafts for recipient size did not impair liver function and did not modify graft and patient outcomes at one yr. However, a GWRW >2.5% appeared to be a determining factor for respiratory morbidity following LT.

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, operation 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.