Since Shaw et al,first reported the first case successfully treated by veno-venous bypass (VVB),there has been great controversy on the routine application of VVB during conventional liver transplantation and piggyback liver transplantation in recent decades.With the improvements on the surgical skills,surgical techniques and anesthesiology,only a small portion of patients have the indications for VVB in liver transplantation routinely.This article reviews the current publications in this topic,which may provide new insight into the liver transplantation in clinical practice.

Objective To explore the application of steatosis liver donor (SLD) in piggyback liver transplantation (PBLT). Methods Sixty-four cases of SLD were subjected to PBLT and classified into light steatosis liver (S1,22 cases),moderate steatosis liver (S2,25 cases),and severe steatosis liver (S3,17 cases) groups.Eighty cases of non fatty liver selected randomly in the same period served as controls. The liver and renal function at the day of surgery,postoperative liver function recovery,complications one month after surgery,and the death of recipients were recorded.Results There was no significant difference in the liver and renal function between steatosis liver groups and control group at the day of surgery (P＞0.05). At 21st day after surgery,the liver function of 95％ recipients in control group returned to the normal level,and the liver function recovery rate in S1,S2 and S3 groups was 90.9％,80.0％,and 70.6％ respectively.Graft primary nonfunction occurred in 2 cases (11.8％) of S3 group. The incidence of complications such as bleeding,infection,hepatic artery thrombosis,ascites,sepsis in S1,S2 and S3 groups was higher than in control group (P＜0.05).One year after operation,there were two deaths in control group,one in S1 group,one in S2 group,and 5 in S3 group,respectively.Conclusion SLD can be used for transplantation,but for the transplantation with severe steatosis liver,it should be carried out carefully.

Objectives To investigate the results of liver transplantation using steatosis liver donors in order to provide a scientific basis for the use of marginal donors.Methods From 2002 to 2011,80 of 407 were steatosis liver donors.There were 69 males and 11 females.Their age ranged from 20-54 years old.Sixteen donor livers with severe fatty liver and reperfusion injury were not used.The remaining 64 livers were divided into a S1 group (mild steatosis,n=22),a S2 group (moderate steatosis,n=25),and a S3 group (severe steatosis,n=17).A S0 group was used as a control (randomly selected fat-free liver,n=80).Results The occurrence rates of delayed graft function (DGF) in the S0,S1,S2,S3 groups were 5％,9.1％,20％,29.41％,respectively.Primary nonfunctioning occurred in 2 cases of the S3 group,which represented a 11.76％ of the S3 group (2/17),and 3.12％ of the total 64 cases (2/64).Conclusions Although the incidence rate of DGF was higher in the steatosis liver donor groups than the S0 group,there was no correlation in the mortality rate of the S1-S3 group within one year of transplantation.Attentions should be paid to the treatment of complications after steatosis liver transplantation.By minimizing ischemia-reperfusion injury,improving microcirculation,strengthening routine therapy and reducing the amount of immunosuppression,the same results could be achieved using steatosis donor liver and normal liver for transplantation.

Patients who suffer from HBV-related endstage liver disease are the majority of liver transplantation (LT) recipients,and hence HBV recurrence post-LT is the key for the treatment success.HBIG was no longer solely used in clinical practice because of high cost and unavoidable drug-resistance.Nowadays,the standard prophylaxis regimen is the combination of low-dose HBIG and nucleoside analogues (NAs).Recently,the necessity of HBIG usage has been often questioned,and the novel prophylaxis of HBIG-withdrawn and HBIG-free regimen have been carried out in several transplant centers with encouraging results.In this review,we summarized the application of HBIG in the prophylaxis of HBV recurrence,and then evaluated the prospect of the prophylaxis of HBIG-withdrawn and HBIG-free regimen.

Auto liver transplantation (ALT) has been tremendously popular in hepatic surgery for the liver masses due to lack of enough donor for allogeneic transplantation of liver.But ALT remains stagnant because it is technically more difficult than liver transplantation.Much difficulties in this field lying ahead.Related surgical technical requirements for surgeons operating ALT,complications,difficult liver resection,hypothermic liver perfusion,veno-venous bypass,ex vivo ECMO perfusion and liver trim,assess the quality and volume of autoplast,autoplast implant and vascular anastomosis.On the other hand,the therapeutic effect largely depends on the intraoperative vascular separating range,the location and size of the tumor,the scope of lymphoid infiltrates by neoplast,the intubation site for perfusion and the sequence of opening the occlusion vessel.Thus,it's necessary to set up a scientific,normative ALT procedure to improve the therapeutic effect and prognosis.

Objective To determine the risk factors of urinary tract infection (UTI) after renal transplantation,so as to provide a theoretical basis of reducing the rate of postoperative UTI effectively.Method Such databases as CNKI,VIP,Wanfang,Pubmed,Embase,Ovid,and EBSCO were searched from January 1995 to December 2015 for collecting the studies about UTI after renal transplantation.The search keywords were renal transplantation,kidney transplantation,urinary tract infection and risk factors.Meta-analysis was performed by using the RevMan 5.2 software.Result Fifteen studies were identified,including 1 236 patients in UTI group and 2 729 patients in the control group (non UTI group).The two groups had no significant differences in recipient age,diabetes mellitus history,peritoneal dialysis,cytomegaovirus infection,acute rejection,usage of MMF,usage of Tacrolimus,usage of CsA and retransplantation.The incidence of UTI after renal transplantation was significantly higher in female patients than male patients (OR:2.69;95％ CI:1.92-3.77;P＜0.000 01).The incidence of UTI of cadaveric renal transplantation was higher than living donor renal transplantation (OR:1.51;95％ CI:1.71-1.95;P=0.002).Using D-J tube for urinary reconstruction significantly increased the incidence of UTI (OR:1.51;95 ％ CI:1.07-2.13;P =0.02).Patients in the UTI group had a significantly longer preoperative dialysis time (WMD:1.48;95％ CI:0.22-2.74;P =0.02).Conclusion The female recipients,cadaveric renal transplantation,using D-J tube and prolonged preoperative dialysis time were factors affecting the risk of UTI.UTI after renal transplantation had no relationship with recipient age,diabetes mellitus history,peritoneal dialysis,cytomegaovirus infection,acute rejection,usage of MMF,Tacrolimus and CsA,and retransplantation.

Liver transplantation is a standard life-saving procedure for end-stage liver diseases.The therapeutic potential of this procedure may be limited by post-operative infectious complications.A better understanding on the common important infectious complications may improve the life quality and survival rate after liver transplantation.In this article,we review the progress on infectious complications after liver transplantation,with particular emphasis on risk factors,clinical manifestations,diagnostic methods,prevention measures and specific treatments for bacterial,fungal,cytomegalovirus infections.

Objective To study the intraoperative and postoperative complications of autologous liver transplantation (ALT),and their prevention and treatment.Methods From October 2005 to December 2011,our center carried out 36 cases of ALT for malignant (n=23) and benign diseases (n=13).Intraoperative and postoperative complications and treatment methods were analysed.Results Of the 36 patients,2 patients developed small liver syndrome in the perioperative period.Allogeneic liver transplantation was carried out for 1 of these two patients for acute liver failure.Another patient died of lung infection 16 days after the surgery.Among 36 ALT recipients and 23 patients suffering from malignant tumor,1,2,3-year survival rates were.75％,71％,68％ and 65％,59％,54％ respectively.Conclusions With adequate preoperative assessment,the incidence of serious complications after ALT should be low.Prompt prevention and treatment of intraoperative and postoperative serious complications could cut down perioperative mortality,and provide long-term survival after ALT.

Objective To sum up the experiences in liver transplantations from donation after brain death (DBD),and compare the clinical effect,complications and influential factors with international situation.Methods The retrospective descriptive study was adopted.All the data of 66 DBD liver donors and the matched recipients from authors' affiliations during June 2010 and June 2013 were collected.Original articles,meta-analysis and data reports with high academic influence were read and data were analyzed with SPSS 22.0.Results The incidence of serious complications,vascular complications and biliary complications during the first year among 66 recipients was 21.2％,10.6％,and 6.1％,respectively.Compared to international situation,graft 1-,3-,and 5-year survival rate was similar (P＞0.05) (83％,80％ and 73％ respectively),similar to that of recipients.There was no statistically significant difference in primary nonfunction and vascular complications between our center and other centers.As for biliary complications,morbidity was lower in our center (P＜0.05).The 3-and 5-year survival rate of recipients was also similar (P＞0.05),though the 1-year survival rate was slightly lower (P＜ 0.05).Conclusion These findings provide evidence that patient's prognosis under DBD liver transplantation in our center is acceptable,and long-term survival rate has reached international level.Still,1-year survival rate of recipients is unsatisfactory.In order to achieve a good clinical efficacy,we need to find out disadvantages during donor maintenance,recipient selection,surgical procedure and postoperative management.

Objective To compare three different types of donor livers (C-Ⅰ,C-Ⅱ,C-Ⅲ) in clinical efficacy,complications and survival rate of liver transplantation.Methods Using the retrospective descriptive study method,the clinical data of 422 patients undergoing liver transplantation,including 124 cases of C-Ⅰ,81 cases of C-Ⅱ and 81 cases of C-Ⅲ in recent 6 years (from June 2010 to June 2016) were analyzed.The same surgical method was performed with piggyback liver transplantation.Observation indicators contained (1) recipient postoperative liver function;(2) the postoperative complications;(3) the recipient survival rate.SPSS 19.0 statistical software was used for analysis.Results (1) The curative effect was evaluated by the changes of ALT and TBIL among three groups of recipients postoperatively.As compared with C-Ⅰ transplantation group and CⅢ transplantation group,the level of ALT in C-Ⅱ transplantation group was significantly increased (P ＜0.05),the clinical efficacy was poorer.(2) The incidence of PNF was 3.23％ in C-Ⅰ group,9.88％ in C-Ⅱ group and 9.88％ in C-Ⅲ group (P＜0.05).The incidence of acute rejection was respectively 9.68％ in C-Ⅰ group,38.27％ in C-Ⅱ group and 38.27％ in C-Ⅲ group (P＜0.001).The incidence of SIRS was respectively 5.65％ in C-Ⅰ group,39.50％ in C-Ⅱ group and 39.50％ in C-Ⅲ group (P＜ 0.001).There were significant differences in the incidence of other complications among the three groups.(3) There were 14 deaths within 3 months,accounting for 17.28％,and the survival rate was 82.72％ in C-Ⅱ group,the 1-,3-,and 5-year survival rate was 76.55％,74.18％ and 76.55％ respectively in C-Ⅰ group,and that was 88.02％,85.72％ and 81.11％ respectively in C-Ⅲ group.Conclusion Since June 2015,C-Ⅰ donors grow up more quickly on year-on-year basis than C-Ⅱ.Simultaneously,the sort-term and long-term clinical efficacy is better in C-Ⅰ transplantation group than in C-Ⅱ transplantation group.How to repair the three types of Chinese standard donor organs and optimize the quality is still a hot point to ensure the healthy development of organ transplantation in China,which needs further investigation.