Objective To observe the recovery of recipients with complex portal vein thrombosis (CPVT) underwent “multiple to one” anastomosis and patency of portal vein blood flow during liver transplantation, and to ensure the reliability of this method. MethodsThe clinicopathologic data of the recipients with CPVT underwent “multiple to one” anastomosis in the Beijing Friendship Hospital, Capital Medical University were collected retrospectively. The “multiple to one” portal vein reconstruction was defined as the anastomosis of multiple vessels of portal venous system with the portal vein of graft, or the anastomosis that connected the blood vessel of portal venous system and the left renal vein/inferior vena cava to the portal vein of graft. ResultsA total of 5 patients were collected, including 1 patient with Yerdel grade 3 thrombosis and 4 patients with Yerdel grade 4 thrombosis. In 3 cases, the left renal vein, inferior vena cava, left renal vein were combined with the parabiliary vein, respectively, in the anastomosis to the donor portal vein. In another 2 cases, portal vein and left renal vein were combined with gastric coronary vein, respectively, in the anastomosis to the donor portal vein. During the follow-up period of 162–865 d, all patients had the stable portal vein blood flow without any symptom of portal hypertension. One patient had thrombosis at the anastomosis with varicose vein, while the anastomosis with left renal vein was unobstructed, which did not affect the donor liver function. ConclusionMultiple blood supply of portal vein is established after “multiple to one” anastomosis, and stability of portal vein blood flow can be maintained after a blood redistribution of portal venous system following liver transplantation.
Objective To report our experience in living donor liver harvesting of right lobe grafts. MethodsThe data of 76 living donors of right lobe grafts hepatectomy between August 2007 and December 2008 were studied. Before operation, the graft size, remnant liver volume rate, fatty liver, middle hepatic vein type, and the level of portal hypertension of recipient were comprehensive assessed to determine whether harvested middle hepatic vein. The graft was harvested depending on the port vein and hepatic artery ischemia-line. B-ultrasound was used to definite the structure and branch of middle hepatic vein, and intraoperative cholangiography was performed to definite the structure and variation of bile duct. Donor operative time, intraoperative blood loss, postoperative hospital stay, levels of bilirubin, international normalized ratio （INR）, and ALT, and complications after operation were recorded. Results All the operations were successful. The operative time was (8.3±1.3) h, the blood loss was (325±127) ml without blood transfusion in operation. The ALT, INR, and bilirubin recovered on the 12th day. The most common complication in early post-operation was wound infection in 5 cases, 4 cases had cholestasis, 4 cases occurred cross-section bile leakage, and 11 cases occurred varying degrees of delayed gastric emptying in 4～7 d after operation, who were all alleviated by corresponding treatments. The hospital stay was 9～21 d (median: 14 d) after operation. Conclusion Preoperative evaluation of the hepatic anatomy and precise surgical procedure are crucial, which will help the development of graft harvesting and rehabilitation of donor.
ObjectiveTo observe the clinical effect of Rituximab combined with intravenous immunoglobulin (IVIG) in preventing blood group antibody mediated rejection (AMR) in pediatric ABO incompatible living donor liver transplantation (ABOi-LDLT).MethodsA total of 503 cases of pediatric living donor liver transplantation in Beijing Friendship Hospital Affiliated to Capital Medical University from June 2013 to December 2020 were retrospectively collected; the overall survival of recipient and graft were compared between ABOi-LDLT and ABO compatible living donor liver transplantation (ABOc-LDLT), and we summarized the data of AMR in 7 cases received Rituximab+IVIG protocol.ResultsThere were 53 cases of ABOi-LDLT and 450 cases of ABOc-LDLT in our study. The 5-year cumulative survival rate of recipients and grafts was 98.0% and 96.0% in the ABOi-LDLT group respectively, and in ABOc-LDLT group was 92.2% and 89.1% respectively, there was no significant difference between the two groups (P=0.232, P=0.381）. Seven children with blood group antibody titer >1∶64 were included in the study. On the basis of classical intensive immunosuppressive therapy, all patients were treated with Rituximab+IVIG. The blood group antibody titer of 6 patients remained stable, and no rejection occurred; one patient developed severe AMR and graft failure, and recovered after salvage treatment of ABOc-LDLT.ConclusionRituximab+IVIG can be used as an effective therapeutic option to prevent blood group AMR after ABOi-LDLT.
ObjectiveTo investigate the effect of perioperative intravenous immunoglobulin (IVIG) on the reduction of blood group antibody titer and prognosis in children with ABO incompatible (ABO-I) liver transplantation.MethodsA retrospective study was conducted in 20 children undergoing ABO-I liver transplantation in Beijing Friendship Hospital Affiliated to Capital Medical University from July 2017 to March 2020. The changes of blood group antibody titer, alanine aminotransferase, and total bilirubin before and after operation, as well as survival rate were analyzed after intravenous IVIG during perioperative period.ResultsAfter ABO-I liver transplantation, the 1-year survival rate of 20 patients was 100%, and 1 case (5%) developed immune rejection. Compared with before operation, on the day of operation, IgM blood group antibody titer did not change in 4 cases (20%), increased in 1 case (5%), and decreased in 15 cases (75%); in one week after operation: 12 cases (60%) decreased, 5 cases (25%) increased, and 3 cases (15%) remained unchanged; in one month after operation: 18 cases (90%) decreased , 2 cases (10%) remained unchanged. Compared with before operation, the titer of IgG blood group antibody increased in 2 cases (10%), remained unchanged in 6 cases (30%), and decreased in 12 cases (60%); in one week after operation: 4 cases (20%) increased, 4 cases (20%) remained unchanged, and 12 cases (60%) decreased; in one month after operation: 3 cases (15%) increased, 4 cases (20%) remained unchanged, and 13 cases (65%) decreased. The levels of alanine aminotransferase and total bilirubin in 1 month after operation were lower than those on the day of operation.ConclusionThe effect of IVIG on reducing blood group antibody titer in children after ABO-I liver transplantation is not obvious, and its actual clinical effect needs to befurther confirmed.