Clin Transpl. 2005 ;:221-3 17424740
Zhongyang Shen, Zhijun Zhu, Yamin Zhang, Weiping Zheng, Hong Zheng, Yonglin Deng, Cheng Pan, Wenli Song
Tianjin First Central Hospital, Tianjin, China.
Liver transplantation has expanded rapidly in China. The Tianjin First Central hospital is currently the largest liver transplant center in China. During 2005, this center performed 647 liver transplants and 436 kidney transplants. Since the liver transplantation program began in 1998, this center has performed 1,803 liver transplants and 1,233 kidney transplants. Significant progress has been made during the past 5 years in surgical technique, immunosuppression and patient care after transplantation. Graft survival rates have also improved significantly. The one-year graft survival rate for 843 patients who received a liver transplant between 2001 and 2004 was 87.3%. About half of these patients suffered from hepatocellular carcinoma. We will continue to evaluate donor and recipient factors to maximize outcomes of liver and kidney transplantation.
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Effect of steatosis donor liver transplantation on hepatocellular carcinoma recurrence: experience at a single institution.
Da Hong Teng, Zhi Jun Zhu, Hong Zheng, Yong Lin Deng, Li Ying Sun, Cheng Pan, Yi He Liu, Hong Li Song, Zhong Yang Shen
Background/Aims: The increasing demand for transplantation has led application of steatotic liver as the graft. The aim of this study was to determine the effect of donor graft steatosis on overall outcome and tumor recurrence after liver transplantation for hepatocellular carcinoma. Methodology: 131 patients that underwent liver transplantation for hepatocellular carcinoma between 2007 and 2008 were included. Donor steatosis was categorized as non-steatosis group (0%-10%, n=101) and steatosis group (>10%, n=30). The Kaplan-Meier method and Cox proportional hazard regression model was used for data analysis. Results: Postoperative recipient survival rate was 81% and 66.6% at 1 and 3 years, respectively, for non-steatotic graft; 87.5% and 58.3% for mild steatosis; 83.3% and 41.7% for moderate to severe steatosis (p=0.303). Postoperative tumor recurrence rate was 15.8% and 28.7% at 1 and 3 years, respectively, for grafts with no steatosis; 8.3% and 20.8% for those with mild steatosis; 33.3% and 50% for those with moderate to severe steatosis,(p>0.05). Conclusions: Steatotic donor was not associated with a worse prognosis in early stage postoperative and mild fatty liver did not increase tumor recurrence risks. The moderate to severe status of fatty liver had some effect on tumor recurrence.
Hepatol Res. 2012 Mar ;42 (3):280-7 22176205
Protective hepatitis B surface antibodies in blood and ascites fluid in the early stage after liver transplantation for hepatitis B diseases.
Department of Transplant Surgery, First Center Hospital Clinic Institute, Tianjin Medical University, Tianjin, China.
Aim: The aim of this study is to identify the titres of protective hepatitis B surface antibodies (anti-HBs) in the blood and their effective factors in the early stage after liver transplantation (LT) for hepatitis B virus (HBV) related diseases. The condition of anti-HBs lost in ascites fluid was also investigated. Methods: Twenty-six patients who received LT were administered prophylaxis of lamivudine combining intravenous hepatitis B immunoglobulin (HBIG) post-LT. The titres of anti-HBs were recorded and analyzed daily in blood and ascites fluid within the first week post-LT. Results: In the first 5 days post-LT, the titres of anti-HBs in HBV DNA positive groups, high hepatitis B surface antigen (HBsAg) groups, hepatitis B e antigen (HBeAg) positive groups were lower than that in the parallel HBV DNA negative groups, low HBsAg groups and HBeAg negative groups. The mean titre level of anti-HBs in ascites fluid is 224.89 IU/L and fluctuated from 0.00 IU/L to 968.50 IU/L, which is also correlated with anti-HBs titres in blood drawn at the same time (r = 0.927, P = 0.000). The level of anit-HBs in ascites fluid was very high; however, it fluctuated in a wide range (from 0.00 IU to 908.55 IU). Conclusions: Patients in high risk groups should receive a higher level of HBIG to maintain sufficient amounts of anti-HBs in the early stage post-LT, while the patients in low risk groups need a lower level of HBIG administration. Furthermore, the lost amount of anti-HBs in ascitic fluid post-LT has minimum impact on the anti-HBs titres in blood.
Clinical values of AFP, GPC3 mRNA in peripheral blood for prediction of hepatocellular carcinoma recurrence following OLT: AFP, GPC3 mRNA for prediction of HCC.
Orient Organ Transplant Center, First Central Clinic Institute of Tianjin Medical University, Key Lab for Critical Care Medicine of the Ministry of Health, Tianjin, China.
BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Annually, about 200,000 patients died of HCC in China. Liver transplantation (LT) holds great theoretical appeal in treating HCC. However, the high recurrence rate after transplantation is the most important limiting factor for long-term survival. OBJECTIVES: To assess the value of alpha-fetoprotein (AFP) messenger RNA (mRNA), Glypican-3 (GPC3) mRNA-expressing cells in the peripheral blood (PB) for prediction of HCC recurrence following orthotopic liver transplantation (OLT). PATIENTS AND METHODS: 29 patients with HCC who underwent OLT with a minimum clinical follow-up of 12 months were included in this retrospective study. We detected AFP mRNA, GPC3 mRNA-expressing cells in the PB by TaqMan real-time reverse transcriptase-polymerase chain reaction (RT-PCR), pre-, intra- and post-operatively. The early recurrence of patients was evaluated. RESULTS: 8 (28%), 15 (52%), and 9 (31%) patients had AFP mRNA detected pre-, intra-, and post-operatively, respectively. With 12 months of follow-up, HCC recurred in 7 (24%) patients. Univariate analysis revealed that positive pre- and post-operative AFP mRNA, TNM stage as well as vascular invasion were significant predictors for the HCC recurrence. Multivariate analysis revealed that being positive for AFP mRNA pre-operatively remained a significant risk factor for HCC recurrence after OLT. GPC3 mRNA was expressed in all PB samples. There was no significant difference in the expression levels of GPC3 mRNA between the HCC and control groups. There were no significant differences in GPC3 mRNA expression values between those patients with and without tumor recurrence. CONCLUSIONS: The pre-operative detection of circulating AFP mRNA-expressing cells could be a useful predictor for HCC recurrence following OLT. GPC3 mRNA-expressing cells in PB seem to have no diagnostic value.
PLoS One. 2011 ;6 (10):e24900 21998633
Dazhi Wang, Zhengwen Jiang, Zhongyang Shen, Hui Wang, Beilan Wang, Weihua Shou, Hong Zheng, Xun Chu, Jinxiu Shi, Wei Huang
Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Variations in the activities of Cytochrome P450s are one of the major factors responsible for inter-individual differences in drug clearance rates, which may cause serious toxicity or inefficacy of therapeutic drugs. Various mRNA level is one of the key factors for different activity of the major P450 genes. Although both genetic and environmental regulators of P450 gene expression have been widely investigated, few studies have evaluated the functional importance of cis- and trans-regulatory factors and environmental factors in the modulation of inter-individual expression variations of the P450 genes. In this study, we measured the mRNA levels of seven major P450 genes (CYP1A1, CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4 and CYP3A5) in 96 liver biopsy samples from Chinese population. Both trans-acting (mRNA levels and non-synonymous SNPs of putative regulator genes) and cis-acting (gene copy number and functional SNPs) factors were investigated to identify the determinants of the expression variations of these seven P450 genes. We found that expression variations of most P450 genes, regulator genes and housekeeping genes were positively correlated at the mRNA level. After partial correlation analysis using ACTB and GAPDH expression to eliminate the effect of global regulators, a UPGMA (Unweighted Pair Group Method with Arithmetic Mean) tree was constructed to reveal the effects of specific regulation networks potentially masked by global regulators. Combined with the functional analysis of regulators, our results suggested that expression variation at the mRNA level was mediated by several factors in a gene-specific manner. Cis-acting genetic variants might play key roles in the expression variation of CYP2D6 and CYP3A5, environmental inducers might play key roles in CYP1A1 and CYP1A2 variation and global regulators might play key roles in CYP2C9 variation. In addition, the functions of regulators that play less important roles in controlling expression variation for each P450 gene were determined.
Department of Transplant Surgery, Tianjin First Central Hospital, Tianjin 300192, China. email@example.com
OBJECTIVE To discuss the technical improvement of the conventional thrombectomy for portal vein thrombosis (PVT) on liver transplantation. METHODS The clinical data of 198 cases of liver transplantation with PVT who admitted in Tianjin First Central Hospital were analyzed retrospectively. According to the different treatments for PVT, these cases were divided into group A and group B. The conventional eversion embolectomy were performed in group A (n = 43) and the improved eversion embolectomy were performed in group B (n = 155). The general conditions, blood loss volumes, the achievement ratio of embolectomy, PVT recurrence rate and survival rate between the two groups were compared. RESULTS No statistical significance on operation time between two groups (P > 0.05); the achievement ratio of embolectomy for Yerdel I-II were 100% in two groups, however, the achievement ratio of embolectomy for Yerdel III in group B was higher than that of group A (100% vs. 45.45%; chi(2)= 12.38, P < 0.01). Blood loss volumes in group B was significantly lower than that of group A [(4315.4 +/- 630.5) ml vs.(3509.2 +/- 862.7) ml, P < 0.05]. No statistical significance on Yerdel I and II PVT recurrence rate between two groups (P > 0.05). While thrombosis recurrent rate of Yerdel III PVT in group B was lower than that of group A(5.6% vs. 2/5; chi(2)= 4.09, P < 0.05). Perioperative mortality of Yerdel I-III patients were both 0 in two groups. 1-year survival rate of Yerdel I-III patients was similar in two groups (86.5% vs. 89.0%, P > 0.05). CONCLUSIONS Improved eversion embolectomy can simplify the operation procedures, reduce blood loss, expand application range, increase the embolectomy success rate, decrease the PVT relapse rate.
[The clinical feature, diagnosis and management of splenic artery aneurysms in liver transplant patients].
Department of Transplant Surgery, Tianjin First Central Hospital, Tianjin 300192, China.
OBJECTIVE To summarize the clinical feature of splenic artery aneurysms (SAA) in OLT recipient, and review the experience in diagnosis and management. METHODS The clinical data, results of four-phase CT scanning and CT angiography of 450 recipients, who underwent OLT from December 2001 to December 2003 were analyzed statistically. RESULTS Twenty of 450 recipients were diagnosed as SAA, the incidence was about 4.4%. Nineteen of them were diagnosed by four-phase CT scanning. Fifteen patients did not receive any treatment for SAA during OLT, but two of them suffered SAA rupture after OLT, among which one died of hemorrhagic shock although emergency operations were performed. The five patients, who were performed splenectomy with SAA resection during transplantation, recovered successfully after OLT, and their grafts' function was satisfactory. CONCLUSIONS Morbidity of SAA is higher in patients of liver cirrhosis. Four-phase CT scanning can diagnose SAA exactly. In the early period post-OLT, SAA rupture happens frequently, so SAA resection should be performed during transplantation.
Monitoring of CD95 and CD38 expression in peripheral blood T lymphocytes during active human cytomegalovirus infection after orthotopic liver transplantation.
Yuliang Wang, Yawu Liu, Ruifa Han, Qiang Li, Zhi Yao, Wenyan Niu, Yuhua Yuan, Zhiqin Tang, Zhijun Zhu, Zhongyang Shen
Tianjin Institute of Urology, Tianjin Medical University, Hexi District, Tianjin, China.
AIM The aim of the present study was to quantitatively monitor the response of CD95 molecules expressed on CD3(+) T cells (CD95(+)CD3(+) cells) and CD38 molecules expressed on CD8(+) T cells (CD38(+)CD8(+) cells) to ganciclovir treatment after orthotopic liver transplant (OLT) in recipients with active human cytomegalovirus (HCMV) infection. METHODS Blood samples were collected from 20 liver transplanted recipients with active HCMV infection and 24 recipients without HCMV infection. CD95(+)CD3(+) cells and CD38(+)CD8(+) cells were quantitatively detected with QuantiBRITE bead methods by dual-color flow cytometry analysis during the post-transplantation period. RESULTS CD95(+)CD3(+) cells and CD38(+)CD8(+) cells were not significantly different among different ages of healthy adults (P > 0.05). CD95(+)CD3(+) cells and CD38(+)CD8(+) cells were drastically increased in the active HCMV infection group compared with that in the stable group or in the healthy group (P < 0.001), and then they were gradually decreased within the next several weeks after ganciclovir treatment when compared with active HCMV infection recipients (P < 0.001). CONCLUSIONS The present study showed that CD38(+)CD8(+) T cells can be an appropriate immunological marker for early detection and antiviral therapeutic monitoring of HCMV infection. The evaluation of CD95 molecule levels may be used routinely in clinical practice to assess the level of immunosuppression.
Zhong-yang Shen, Zi-fa Wang, Zhi-jun Zhu, Yun-jin Zang, Hong Zheng, Yong-lin Deng, Cheng Pan, Xin-guo Chen
Liver Transplantation Institute, General Hospital of Chinese People's Armed Police Force, Beijing 100039, China.
BACKGROUND Although liver transplantation has become a standard therapy for end-stage liver diseases, the experience of pediatric liver transplantation is limited in China. In this article we report our experience in pediatric liver transplantation, and summarize its characters in their indications, surgical techniques, and postoperative managements. METHODS Thirty-one children (< or = 18 years old) underwent liver transplantation in our centers. The mean age at transplantation was 12.4 years old (ranged from 5 months to 18 years) with 7 children being less than 4 years of age at transplantation. The most common diagnosis of patients who underwent liver transplantation were biliary atresia, Wilson's disease, primary biliary cirrhosis, glycogen storage disease, hepatoblastoma, urea cycle defects, fulminant hepatic failure, etc. The surgical procedures included 12 standard (without venovenous bypass), 6 pigyback, 6 reduced-size, 3 split, 3 living donor liver transplantation, and 1 Domino liver transplantation. The triple-drug (FK506, steroid, and mycophenolate mofetil) immunosuppressive regimen was used in most of patients. Patients were followed up for a mean of 21.8 months. RESULTS Five of the 31 patients died during perioperative time; mortality rate was 16.1%. The reasons of death were infections, primary non-function, heart failure, and hypovolemic shock. Postoperative complications in 10 patients included biliary leakage, acute rejection, abdominal infection, hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, and pulmonary infection. Overall patient cumulative survival rate at 1-, 3-, and 5-year was 78.1%, 62.6%, 62.6%, respectively. CONCLUSIONS The most common indications of pediatric liver transplantation were congenital end-stage liver diseases. According to patients' age and body weight, standard, piggyback, reduced-size, split, or living donor liver transplantation should be performed. Pediatric liver transplantation especially requires higher surgical skills. The early postoperative management is the key to success. Postoperative bile leak was common, but most patients underwent liver transplantation had a better prognosis.
Zhong-yang Shen, Wen-tao Jiang, Zhi-jun Zhu, Cheng Pan, Yong-lin Deng, Hong Zheng, Hong-hai Wang, Jun-jie Li
Tianjin First Central Hospital, Tianjin 300192, China. firstname.lastname@example.org
OBJECTIVE To investigate the feasibility and the clinical efficacy of right lobe including middle hepatic vein in adult-to-adult living donor liver transplantation. METHOD We retrospectively analyzed the clinical data of 30 adult-to-adult living donor liver transplantation using right lobe including middle hepatic vein performed in our hospital from Feb. 2007 to Nov. 2007. RESULTS The right lobes weighed 540-1058 g (median 708 g). The remnant liver volumes were over 30% of the total liver volume in all donors. No perioperative death was noted for among donors and recipients. Complications were recorded and cured in 4 donors (13.3%) and 7 recipients (23.3%). All the donors and the recipients were followed up for 2-8 months (median 5 months), during which no donor died and 1 recipient died from aspergillus infection 4 months after operation. CONCLUSION Adult-to-adult living donor liver transplantation using right lobe graft including middle hepatic vein is a safe and effective technique.
Zhong-Yang Shen, Zhi-Jun Zhu, Yun-Jin Zang, Hong Zheng, Yong-Lin Deng, Cheng Pan, Xin-Guo Chen, Zi-Fa Wang, Wei-Ping Zheng
Oriental Organ Transplant Center, Tianjin First Central Hospital, Tianjin 300192, China.
OBJECTIVE To summarize the clinical efficacy of pediatric liver transplantation, and investigate the characters of pediatric liver transplantation in their indications, surgical procedures and postoperative management. METHODS From August 2000 to March 2007, 23 liver transplantations were performed on 20 children, aging from 6 months to 13 years old. The most common indications were biliary atresia, Wilson's disease, glycogen storage disease and urea cycle defects. Surgical procedures included 4 living donor liver transplantations, 1 Domino liver transplantation, 5 split grafts, 10 reduced liver grafts and 3 whole cadaveric grafts. The triple-drug (FK506, steroid and MMF) immunosuppressive regimen was used in 19 children, except one children using cyclosporine. RESULTS Three children died of primary non-function, heart failure and abdominal infections respectively during peri-operative period, and the mortality was 15.0%. Nine children showed different post-operative complications including 2 hepatic artery thrombosis, 1 portal vein thrombosis, 1 acute rejection, 3 biliary leakage, 2 biliary stricture, 2 intestinal fistula, 3 abdominal infection, 1 pulmonary infection and 1 heart failure. Cumulative patient survival rates at 6-month, 1-and 2-year were 80.0%, 73.9% and 73.9%, respectively. CONCLUSIONS Liver transplantation is an effective option to cure the liver disease of children with end-stage. Different surgical procedure could be chosen according to the children's age and body weight.
Latest similar papers:
Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA. email@example.com
Kidney transplantation in pediatric patients has become a routinely successful procedure, with 1- and 5-year patient survival rates of 98% and 94%, and 1- and 5-year graft survival rates of 93% to 95% and 77% to 85%(the range takes into account differences between living and deceased donors). These good outcomes represent the cumulative effect of improvements in pre- and posttransplant patient care, operative techniques, immunosuppression, and infection prophylaxis, diagnosis, and treatment. This article provides a brief historical overview, discusses the indications for transplantation, describes the evaluation process for the recipient and the potential donor, outlines the operative details, reviews the various causes of and risk factors for graft dysfunction, and analyzes outcomes.
Clinical outcomes for Saudi and Egyptian patients receiving deceased donor liver transplantation in China.
N Allam, M Al Saghier, Y El Sheikh, M Al Sofayan, H Khalaf, M Al Sebayel, A Helmy, Y Kamel, A Aljedai, H Abdel-Dayem, N M Kenetman, A Al Saghier, W Al Hamoudi, A A Abdo
Department of Hepatology, Menofeya University, Egypt.
Long waiting list times in liver transplant programs in Saudi Arabia and unavailability of deceased donor transplantation in Egypt have led several patients to seek transplantation in China. All patients who received transplants in China and followed in three centers from January 2003-January 2007 were included. All patients' charts were reviewed. Mortality and morbidity were compared to those transplanted in King Faisal Specialist Hospital & Research Centre (KFSH&RC) during the same period. Seventy-four adult patients were included (46 Saudi nationals; 28 Egyptians). One-year and 3-year cumulative patient survival rates were 83% and 62%, respectively compared to 92% and 84% in KFSH&RC. One-year and 3-year cumulative graft survival rates were 81% and 59%, respectively compared to 90% and 84% in KFSH&RC. Compared to KFSH&RC, the incidence of complications was significantly higher especially biliary complications, sepsis, metastasis and acquired HBV infection posttransplant. Requirements of postoperative interventions and hospital admissions were also significantly greater. Our data show high mortality and morbidity rates in Saudi and Egyptian patients receiving transplants in China. This could be related to more liberal selection criteria, use of donation after cardiac death (DCD) donors or possibly more limited posttransplant care.
Outcome of foreign residents undergoing deceased donor liver transplantation in China: a single-center experience in Taiwan.
Wei-Ting Kuo, Cheng-Yuan Hsia, Che-Chuan Loong, Chin-Su Liu, Hsin-Lin Tsai, Hsiou-Shan Tseng, Rheun-Chuan Lee, Mei-Yung Tsou, Chew-Wun Wu, Wing-Yiu Lui
Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taiwan.
Foreign residents seeking liver transplantation in China are not uncommon. The outcomes of these people have not been well reported, and the results remain unclear. A total of 64 adults [26 with end-stage liver disease (ESLD) and 38 with hepatocellular carcinoma (HCC)] who underwent donation after cardiac death (DCD) liver transplantation in China during a 5-year period were reviewed. The median follow-up period was 15.6 months. The estimated 3-month mortality rate was 4.7%. The overall survival (OS) rate of the entire patient group at 1 and 3 years was 80.3% and 63.6%, respectively. The 1- and 3-year graft survival rates were 78.5% and 64.4%, respectively. For ESLD, the 1- and 3-year OS rates were 82.5% and 82.5%, respectively. For HCC, the 1- and 3-year survival rates were 78.3% and 50.8%, respectively. The 1- and 3-year OS rates for the HCC patients who were beyond the Milan criteria (MC; n = 24) versus those who met the MC (n = 14) were 69.8% and 28.2% versus 92.9% and 92.9%(P = 0.0032). The 1- and 3-year disease-free survival rates for those beyond the MC versus those who met the MC were 56.8% and 39.0% versus 92.3% and 92.3%(P = 0.0089). The incidence of complications was 59.4%. Biliary complications (n = 24, 37.5%), vascular complications (n = 24, 37.5%), and infection (n = 16, 25%) were the 3 most frequent transplant-related complications. There were 10 patients with unsolved biliary complications, and a total of 5 patients died of posttransplant infections. In conclusion, patients with ESLD or HCC within the MC seeking DCD liver transplants in China obtained survival results comparable to those of other major cohorts from Western countries. However, a considerably high incidence of biliary complications, vascular complications, and infection substantially threatening the lives of patients is notable. Furthermore, the associated cost impact on medical resource utilization should not be overlooked.
Is short term outcome of Iranian renal transplant recipients affected by mean first 6 months C2 level?
Medicine and Health Promotion Institute, Tehran; Clinical Research Unit, Baqiyatallah Medical Sciences University, Tehran, Iran. firstname.lastname@example.org
International Consensus Conference (ICC) has suggested that the whole blood level of Cyclosporine (CsA) be kept strictly at a certain level. However, it is not well understood whether failing to maintain these levels will affect the short term outcome in different patient populations or not. We aimed to assess if the short term outcome of Iranian renal transplant recipients will be affected by first 6 months C2 level. In a retrospective cohort, 265 consecutive kidney transplant recipients were categorized as group with mean C2 lower than recommended range (mean C2 levels in the first 6 month after transplantation lower than the recommended ranges; n=213) and group with mean C2 within recommended range (mean C2 levels in the first 6 month after transplantation within the recommended range; n=52). All recipients were negative for panel reactive antibody, and had received their first (living unrelated) kidney transplantation in Baqiyatallah hospital, between 2002 and 2003. The groups were similar in characteristics and 6 months, 1, 2, and 3 years patient and graft survival rates were considered as outcome. No significant difference was observed in patient and graft survival rates between the two groups (P > 0.05). The patient survival rate in group with mean C2 lower than recommended range and group with mean C2 within recommended range were: 6 months: 98% vs. 98, 1 year: 97% vs. 98%, 2 years: 97% vs. 98% and 3 years: 97% vs. 98%. The graft survival rate in the above groups were as follows: 6 months: 93% vs. 91%, 1 year: 92% vs. 91%, 2 years: 92% vs. 77% and 3 years: 89% vs. 69%, respectively. The result of our study showed that lower mean C2 levels was not necessarily accompanied with a worse short term outcome in our patients. This finding suggests that the optimal level of C2 may be different in ethnic populations.
Department of Surgery, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
Orthotopic liver transplantation (OLT) is the best treatment option for selected patients with hepatocellular carcinoma (HCC) with the background of cirrhosis since this treatment modality can cure both diseases at once. Over the years, the applicability of OLT for HCC has evolved. In Asia, including Hong Kong, a shortage of deceased donor liver grafts is a universal problem having to be faced in all transplant centers. Living-donor liver transplant (LDLT) has therefore been developed to counteract organ shortage and the high prevalence of HCC. The application of LDLT for HCC is a complex process involving donor voluntarism, selection criteria for the recipient and justification with respect to long-term survival in comparison to the result of deceased donor liver transplant. This article reviews the authors' experience with OLT for HCC patients in Hong Kong, with emphasis on the applicability and outcome of LDLT for HCC. Donor voluntarism has a significant impact on the application of LDLT."Fast-track" LDLT in the setting of recurrence following curative treatment carries a high risk of recurrence even though the tumor stage fulfills the standard criteria. Although the survival outcome may be worse following LDLT than DDLT for HCC, LDLT is still the main treatment option for patients with transplantable HCC in Hong Kong, and a reasonable survival outcome can be achieved in selected patients with extended indications. It is particularly true that LDLT provides the only hope for patients with advanced HCC under the constricting problem of organ shortage.
Intention to treat survival following liver transplantation for hepatocellular carcinoma within a donor service area.
Division of Transplant Surgery, Rhode Island Hospital, Providence, RI 02903, USA. email@example.com
BACKGROUND This study aimed to assess the impact of wait times on patient survival following liver transplantation for hepatocellular carcinoma (HCC) in a single donor service area. PATIENTS AND METHODS Patients listed in the New England Organ Bank (NEOB) from 1996 to 2005 for liver transplantation with a diagnosis of HCC were identified from the United Network for Organ Sharing database. The following data were extracted: date of listing, date removed from the wait list, indication for wait list removal, patient death and date of last known follow-up. Kaplan-Meier survival estimates were calculated from the time of listing for transplant (intention to treat liver transplant survival, ITT OLT) and compared to those calculated from the date of transplant (liver transplant, OLT). RESULTS There were 63 new registrations to the transplant list during the study period. Sixty-one patients were removed from the waiting list: transplanted 41 (65%), death seven (11%), candidate condition deteriorated/too sick to transplant eight (13%), medically unsuitable one (2%), other one (2%), transferred to another center two (3%), and transplanted at another center one (2%). Three-year survival following liver transplantation for primary liver cancer was 85%. When the results were analyzed using an intention to treat analysis there was a 10-20% decrease in survival rate at every time point due to wait list drop-out. CONCLUSION Wait list drop-out adversely affects liver transplant survival in transplant centers served by the NEOB. These data should be considered when recommending transplant versus resection as first line therapy for stage I or II HCC in our region.
K Sakai, M Okamoto, T Suzuki, A Yoshizawa, S Nobori, H Ushigome, S Sakamoto, K Akioka, S Kaihara, N Yoshimura
Department of Transplantation and Regenerative Surgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan. firstname.lastname@example.org
In coping with the shortage of deceased kidney donors, living donor kidney transplantation is mainly performed in Japan. We started our living unrelated spousal kidney transplantation program in 1989. In this analysis, we compared the results of 64 spousal transplantations performed between September 1989 and May 2007 with those of living related and deceased donor grafts. Despite the older age of the recipients and the lower HLA matching, the graft survival rates of spousal transplants were as good as those from living related donors and better than those from deceased donors,(P <.01). The graft survival rate of spousal kidney transplantation is improving with advances in immunosuppression, so spouses are considered important donors in Japan, which lacks deceased donors.
Nephrology and Renal Transplantation Department, Alkramah Hospital, Baghdad, Iraq. email@example.com
Kidney transplantation remains the optimal therapy for patients with end-stage renal failure. The kidney transplantation program in Iraq has finished its third decade, and this study was performed to assess the characteristics of this program. This study was performed, from early 2004 to mid-2005, on all patients who underwent renal transplantation and were residing in Baghdad. All the subjects were subjected to full examination and detailed investigations at the Al-Karamah Hospital, Baghdad. A total of 512 patients (males, 69.7%), all of whom were residing in Baghdad, underwent kidney transplantation from 1979 to 2005. The donor source was living donors in 55.7% of these patients, living unrelated donors in 42.6% and emotionally related donors in 1.7%. The recipients' age range was from 7 to 64 years with a mean age of 41 years. The patient survival rates at 6, 12 and 18 months were 91, 91 and 89% respectively, while the graft survival rates in the same periods were 89, 89 and 82% respectively. The annual incidence of renal transplant in our study was 15.4 per million people. About 55% of the transplants were performed in private hospitals and 41% in Government hospitals; the others (3.5%) were performed abroad. We conclude that this study is an initial step to assess the renal transplant activities in Iraq, and we hope that this will act as a launching pad for future studies.
Department of Internal Medicine, Division of Digestive Disease, University of Cincinnati, Cincinnati, OH 45267-0595, USA.
Long-term allograft and patient survival following liver transplantation continues to improve with the development of new surgical techniques and immunosuppressive agents. Complications such as primary nonfunction (PNF) have not been well characterized in terms of long-term allograft and patient survival. The aim of this study was to determine the incidence of PNF in liver transplant recipients and patient and graft survival, in addition to identifying temporal trends in these parameters. METHOD: Data were obtained from the United Network for Organ Sharing/Organ Procurement and Transplant Network for all adults (>18 years old) who received a deceased donor liver transplant between January 1990 and December 2004. RESULTS: Of the 58,576 liver transplant recipients, 2061 had PNF, an overall incidence of 3.5%. There was a 30% annual increase in the incidence of PNF between 1990 and 2000; the incidence of PNF peaked at 7%, and then decreased by 20% annually thereafter. No differences in donor and perioperative variables were identified to account for this variation. One-, 3-, and 5-year patient and graft survival for patients with PNF who underwent retransplant were significantly lower than those with primary liver transplant. In conclusion, there has been decreased incidence of PNF among liver transplant recipients in the last decade.
Outcome of kidney transplantation using organs from executed prisoners: is it justified beyond the ethical issue?
Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan, ROC. firstname.lastname@example.org
BACKGROUND Kidney transplantation using organs from executed prisoners is a subject of controversy from the viewpoint of ethics. However, few reports have addressed the clinical outcome beyond the ethical issue. METHODS Between January 1990 and September 2004, a total of 435 kidney transplant recipients (group M) who underwent transplantation in 26 different hospitals in China were followed up at our hospital. It is believed that all the organs came from executed prisoners. The clinical data were retrieved and compared to those of 200 kidney transplant recipients (group T) who underwent transplantation in our hospital during the same period. RESULTS There was no significant difference between these 2 groups (T vs. M) in terms of hepatitis B virus infection (10.5% vs. 12.1%) or surgical complication rate (6.5% vs. 5.6%). The 1st-year acute rejection rate was significantly lower in group M (31.1% vs. 24.5%, p=0.015). The 1-year, 5-year, and 10-year patient survival rates were 94.3%, 89.5%, and 85.2%, respectively, for group T and 92.6%, 83.6%, and 76.7%, respectively, for group M (p>0.05); the corresponding graft survival rates were 91.4%, 82.6%, and 66.9%, respectively, for group T and 91.6%, 80.0%, and 61.4%, respectively, for group M (p>0.05). When patients were stratified according to the year of transplantation, patients who underwent transplantation between 2000 and 2004 had significantly better graft survival rates in both groups. CONCLUSION We conclude that kidney transplantation using organs from executed prisoners had a clinical outcome similar to that of transplantation performed in our hospital during the same period.