Objective To investigate the dynamic changes of postoperative liver reserve function and laboratory liver function as well as liver volume regeneration, and their potential relationship with short-term clinical outcomes after adult-to-adult living donor liver transplantation (LDLT). Methods The data of 30 recipients underwent LDLT were prospectively collected. The plasma clearance (K) by indocyanine green (ICG) excretive test, liver function test by laboratory methods, liver volume by CT and shortterm (lt;3 months) complications were analyzed. Results The graft recipient body weight ratio (GRBW) was 0.63%-1.43%. The hepatic volume of the recipients in the operation was (638±103) ml, which was smaller than that day 7, 30, and 90 after operation (Plt;0.001), but the hepatic volume at subsequent time point was not different from that at the former time point (Pgt;0.05). The KICG values of recipients among the day 3 〔(0.177±0.056)/min〕, 7 〔(0.183±0.061)/min〕, 30 〔(0.200±0.049)/min〕, and 90 〔(0.209±0.050)/min〕 after operation gradually increased, which was respectively higher than that of recipients before operation (P=0.006, P=0.002, Plt;0.001, and Plt;0.001). Compared with the baseline KICG 〔(0.228±0.036)/min〕 of the donors, the KICG of recipients showed significant variation on day 3 and 7 after operation (P=0.004 and P=0.015), and the KICG of recipients on day 30 and 90 after operation approached the baseline KICG (P=0.355 and P=0.915). The recipients were divided into good liver function group (n=23) and poor liver function group (n=7) according to total serum bilirubin on day 14 after operation. The KICG significantly dropped compared with the recipients of good liver function group on day 3 after operation (P=0.001). Conclusions The liver volume regenerates dramatically on day 7 after operation for the recipients. The ICG excretivetest shows that volume recovery occurs much more gradually than the recovery of function in the recipients. The ICG excretive test is a more reliable indicator of graft function and subsequent graft outcome early after LDLT.
【Abstract】Objective To look for a feasible way to evaluate hepatic reserve function completely by retention rate of indocyanine green at 15 minutes （ICGR15）and Child-Pugh classification supplemented by hepatic clearance of D-sorbitol (CLh-s). Methods The ICGR15, Child-Pugh classification and CLh-s were examined in 186 patients with liver cirrhosis. Relations between CLh-s and operative complications were further studied when ICGR15 and Child-Pugh classification was superposed. ResultsThe superpositions of ICGR15 (40% being boundary) and Child-Pugh classification was centralized between Child-Pugh B and C. ICGR15 of 17 examples were higher than 40% in 63 examples of Child-Pugh B. Eight examples of them had some complications, CLh-s=(584.52±98.27) ml/min (CLh-s＜700 ml/min), while 9 examples of them had no complications, CLh-s=(801.25±75.04) ml/min (CLh-s＞700 ml/min). Conclusion The CLh-s could be interrelated with operative complication, and it is considered as an effective supplement to ICGR15 and Child-Pugh classification for the evaluation of hepatic reserve function, CLh-s (700 ml/min being boundary) could be used to predict operative complication, to evaluate hepatic reserve function effectively, and to provide the basis for choosing the right time for operation.
ObjectiveTo explore the relationship between the levels of transferrin (TRF), prealbumin (PAB) and total bile acids (TBA) in serum and the loss of the hepatic reserve function in primary liver cancer (PHC) patients and the importance of the former factors for diagnosis of PHC. MethodsA total of 154 patients with PHC collected between March 2010 and February 2013 were included in our study. Based on the information of hepatic reserve function and the Child-Pugh classification standard, the patients were divided into Child-Pugh-A, B, and C groups with 67, 55 and 42 patients respectively. Another 58 healthy subjects were selected as the control group. Serum TRF, PAB and TBA levels were measured by automated chemiluminescence immunoassay, immune turbidimetric assay and enzymatic cycling respectively, and they were compared among the groups. ResultsTRF level of patients in the control group and Child-Pugh-A, B, and C groups was respectively (2.574±0.214), (1.618±0.135), (0.988±0.121), and (0.314±0.107) g/L, with significant differences among the groups (P<0.05). PAB level of patients in four groups was respectively (269.32±37.29), (165.22±21.01), (123.24±31.15), and (83.66±19.74) mg/L, with significant differences among the groups (P<0.05). TBA level in the above four groups was respectively (9.16±2.48), (65.13±4.25), (133.62±8.44), and (250.73±21.59) μmol/L, and there was also significant differences among the groups. A positive correlation between serum TRF and PAB was found (r=0.927, P<0.001), and negative correlations between serum TBA level and serum TRF and between TBA and PAB were found (r=-0.454, P<0.001; r=-0.432, P<0.001, respectively). ConclusionSerum TRF, PAB and TBA levels are closely related to the hepatic reserve function in PHC patients, and they can be used as an important indicator for PHC diagnosis.