Objective To observe the dynamic histopathologic changes of acute rejection in rat orthotopic liver transplantation (OLT) model after tacrolimus discontinued and provide some prediction and evaluation data for clinical acute rejection after liver transplantation. Methods Kamada two-cuff technique was used to establish 60 rat OLT model， and male DA rats, male Lewis rats were used as donors and recipients respectively. Therapeutic amount of tacrolimus (0.05 mg/kg, twice per day, continued for 8 d, 1 d before operation and 7 d after operation, intragastric administrated) was administrated to recipients, then continuously half dose was decreased every day beginning from day 8 after operation and tacrolimus administration was stopped on day 13. Liver tissues were collected on day 7, 14, 21, and 28 after liver transplantation. Histopathologic changes and rejection activity index (RAI) of liver tissues were observed, survival time of recipients was calculated. Results Owing to protection effects of tacrolimus, liver tissues displayed no significant histopathologic changes of acute rejection in 7 d after OLT, while typical acute rejection histopathologic changes began to be observed on day 14 after OLT due to tacrolimus discontinuation. On day 14, 21, and 28, RAI were 3.7±0.9, 6.3±0.9, and 8.1±0.7 respectively. Survival time of recipients was (20.85±0.71) d with a median of 21 d. Conclusion Acute rejection could be induced in rat OLT model after tacrolimus discontinuation, and data collected from this model shows some extent of predictive value and assessment value for clinical liver acute rejection.
Piggyback allogeneic orthotopic liver transplantation was performed successfully in a patient with primary biliary cirrhosis on July 26,1996. Topographic study of hepatic veins and short hepatic veins were made in 17 adult cadavers. The majority of short hepatic veins were found in the middle and lower portion of inferior vena cava (IVC) behind liver, but two of 17 cases had a big accessory middle hepatic vein and the right hepatic vein (1 case) divided four branchs into IVC in the area. The lengths of the main trunk of left, middle and right hepatic vein were 22.8±8.80 mm, 50.98±23.94 mm and 22.80±9.50 mm and the diameters were 10.74±2.86 mm, 9.50±3.75 mm and 15.60±4.05 mm respectively. The right hepatic vein in all cases, except one drained into IVC as one vessel. The middle and left hepatic vein drained into IVC in different forms: ①joining as one vessel longer than 1cm before entering IVC (23.5%);②joining right before entering IVC (70.6%); ③draining into IVC separately (5.9%). The distance between right and middle hepatic vein was 7-23 mm. Topography of hepatic veinous flow related with the technique of piggyback operation and removing of diseased liver is discussed.
Objective To observe the changes of blood biochemistry during orthotopic liver transplantation in pigs. Methods Fourteen healthy pigs were anesthetized and intubated, the right carotic artery was cannulated for blood pressure monitoring and blood biochemical sampling. The right internal jugular vein was cannulated for central venous pressure monitoring. No exogenous glucose was administrated during operation, the donor liver was perfused with Collin’s solution. During the anhepatic stage, the veno-venous bypass was established, blood was pumped from the portal and femoral veins using an extracorporeal circuit, and returned to the axillary vein. The arterial blood was sampled for monitoring arterial blood gas tensions, Na＋,K＋,Ca2＋, and blood glucose levels.Results During preanhepatic stage, blood glucose levels increased progressively, blood electrolytes and acidbase balance were stable. During anhepatic stage, pH was decreased, base deficit was increased significantly, blood glucose levels were significantly decreased, blood electrolytes were stable. During neohepatic stage, acidosis became more severe, blood potassium increased abruptly on reperfusin of the grafted liver, blood glucose was higher than that in prehepatic and anhepatic stage. Conclusion During operation of liver transplantation, metabolic acidosis developed progressively, blood glucose decreased in anhepatic stage, blood glucose and potassium increased significantly on reperfusion of the grafted liver.
ObjectiveTo evaluate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) for biliary strictures post-orthotopic liver transplantation (OLT). MethodsA systematic review was performed by searching electronic bibliographic databases, including the Cochrane Library, Medline, EMbase, CNKI, and WanFang from 1994 to 2014. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were used to describe the diagnostic value. Summary receiver operating characteristic (SROC) curve with area under the SROC curve (AUC) were used to summarize overall diagnostic performance. ResultsSix studies involving 261 subjects were eligible for the analysis. The summary estimates of pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and AUC of MRCP for the diagnosis of biliary strictures after OLT were 89% (95% CI:0.83-0.94), 94% (95% CI:0.88-0.98), 8.04 (95% CI:2.83-22.85), 0.11 (95% CI:0.04-0.37), and 0.961, respectively. ConclusionMRCP is a sensitive and specific technique to diagnose biliary strictures after OLT.
ObjectiveTo evaluate and discuss the various surgical methods for hepatic echinococcosis. MethodsFour hundred and two patients with hepatic echinococcosis were treated in West China Hospital of Sichuan University from 2009 to 2014 and 271 of them were undergone surgical treatment. The cystic echinococcosis was in 195 patients, including 80 cases performed classic endocystectomy or subtotal cystectomy, 109 performed total cystectomy or hepatectomy, 6 cases performed palliative surgery. The alveolar echinococcosis was in 76 patients, including 7 cases performed palliative surgery, 54 cases performed hepatectomy, 12 cases performed liver allotransplantation, and 3 cases performed liver autotransplantation. Results①The draining time, the rate of postoperative complications, and the recurrence was (18.6±2.7) d, 21.2% (17/80), and 15.0%(12/80) respectively in the cases of cystic echinococcosis underwent classic endocystectomy or subtotal cystectomy, which were significantly higher than those cases of cystic echinococcosis underwent total cystectomy or hepatectomy〔(5.4±0.6) d, 7.3% (8/109), and 0.9% (1/109), respectively, P < 0.05〕.②The draining time and the recurrence was (5.9±0.7) d and 1.8% (1/54) respectively in the cases of alveolar echinococcosis underwent hepatectomy, which were significantly lower than those in the cases of alveolar echinococcosis took palliative surgery〔(9.7±1.4) d and 57.1% (4/7), respectively, P < 0.01〕. The 12 patients underwent liver transplantation were complete rehabilitation, while the rest 3 were death. Conclusions①Total cystectomy or hepatectomy should be the first choice for cystic echinococcosis; Palliative treatment could improve the symptoms of unresectable patients with cystic echinococcosis.②Hepatectomy should be the first choice for alveolar echinococcosis, palliative surgery could only be used to alleviate symptoms and physical signs, delay the progression of this disease.③Liver transplantation might be an alternative for advanced hepatic echinococcosis.
ObjectiveTo discuss various surgical methods for hepatic alveolar echinococcosis. MethodsThe clinical data of 98 patients with hepatic alveolar echinococcosis treated in West China Hospital of Sichuan University from 2004 to 2015 were analyzed retrospectively. Palliative surgeries were performed in 9 cases, radical hepatectomies were performed in 69 cases, liver transplantations were performed in 20 cases, in which 12 cases were performed by liver allotransplantation, and 8 cases were performed by liver autotransplantation. ResultsThere was no death case during perioperative period. The rate of postoperative complications of the radical hepatectomy (11.6%, 8/69) was significantly lower than that of the palliative surgery (44.4%, 4/9), which had statistically significant difference (P<0.05). The followup time was from 4 months to 6 years, the average time was 36 months. The postoperative recurrence rate in the radical hepatectomy (1.4%, 1/69) was significantly lower than that in the palliative surgery (55.6%, 5/9), which had statistically significant difference (P<0.05). During follow-up period, the mortality of the palliative surgery (33.33%, 3/9) was also significantly higher than that of the radical hepatectomy (0, 0/69), which had statistically significant difference (P<0.05). Four patients underwent liver transplantation were death within 3 months (20.0%). ConclusionsRadical hepatectomy should be the first choice for alveolar echinococcosis. In this research, although the rates of postoperative complications and recurrence in palliative surgery are higher than those in radical hepatectomy, palliative surgery, for the patients who had lose the opportunity to perform radical hepatectomy, could be used to alleviate symptoms and physical signs, improve quality of life, delay progression of this disease. Although risk of liver transplantation is high, this might be an alternative for advanced hepatic alveolar echinococcosis.
Objective To summarize the methods, safety, and efficacy of the ex vivo liver resection followed by autotransplantation in the treatment of advanced hepatic alveolar echinococcosis (HAE). Method A retrospective analysis of clinical data and follow-up data in 21 cases who received ex vivo liver resection followed by autotransplantation in the treatment of HAE from February 2014 to December 2016 in West China Hospital was performed. Results All the patients successfully underwent ex vivo liver resection followed by autotransplantation and no death happened during operation. The median weight of remnant liver was 701.4 g (360–1 300 g), the average operation time were 13.6 h (9.4–19.5 h), the anhepatic phase time were 180–455 min with median of 314 min. The average of intraoperative blood loss were 2 379 mL (1 200–6 000 mL). The average of patients entered red blood cell suspension were 10.6 u (0–39.5 u), the average of fresh frozen plasma were 1 377 mL (0–6 050 mL) , of which 7 patients received autologous blood transfusion, with average of 1 578 mL (500–3 700 mL). The average of postoperative hospital stay were 23.5 days (4–51 days). Postoperative complications occurred in 12 patients during hospitalization, and 4 cases of postoperative complications were in grade Clavien-Dindo Ⅲ or above, 2 cases of grade Ⅴ (died). During the follow-up period, 19 patients were followed for a median of 16.2 months (3–38 months), no HAE recurrence or metastasis was found, only 1 patient were lost follow-up after surgery for 12 months. Massive ascites and hyponatremia were found in 1 patient who was diagnosis as left hepatic vein stenosis at the end of the 3 months after operation. The patient was cured after interventional treatment of hepatic vein stent implantation and angioplasty. Conclusions The ex vivo liver resection followed by autotransplantation provides radical treatment for patients with advanced HAE, but the surgery is difficult and has high risk of postoperative complications. The detailed preoperative evaluation, intraoperative pipeline reconstruction reasonably, and fine postoperative management can improve the patient’s survival, and reduce the rate of complications.
Objective To explore the correlations between the time of tracheal extubation and the intraoperative basic factors of ex vivo liver resection followed by autotransplantation in patients with advanced hepatic alveolar echinococcosis (HAE), and analyze the change trend of blood gas analysis during operation. Methods The data of 24 patients with advanced HAE who underwent ex vivo liver resection followed by autotransplantation in West China Hospital of Sichuan University between February 2014 and August 2017 were retrospectively analyzed. Results There were significant correlations between the extubation time and the duration of anesthesia (r=0.472, P=0.031), the amount of bleeding (r=0.524, P=0.015), the amount of erythrocyte suspensions infusion (r=0.627, P=0.002), and the amount of plasma infusion (r=0.617, P=0.003). There was no statistical difference in extubation time between patients with and without pulmonary complications in 3 months postoperatively [(23.74±15.84), (15.52±19.40) h, P=0.327]. Compared with those arterial blood gas results before the interruption, the pH value, blood glucose, lactic acid and base excess were statistically significantly different (P<0.05) at each time point after the interruption. Blood potassium increased at the end of operation compared with that before interruption (P<0.05); and the free calcium after blocking and opening increased with a temporary decrease (P<0.05); the hemoglobin decreased significantly after interruption and clamping (P<0.05). Conclusions Anesthesia length and bleeding should be reduced in ex vivo liver resection followed by autotransplantation, thus the extubation time would be shortened and the prognosis of the patients might be improved. Because of the longer anhepatic phase, the blood gas analysis varies largely. During operation, blood gas analysis and monitoring should be strengthened, and the acid-base balance and electrolytes should be maintained in time.