BACKGROUND:The incidence of intestinal necrosis during liver transplantation is low, and most of them abandon transplantation and thus leading to death. OBJECTIVE:To retrospectively analyze the reasons which result in smal intestinal necrosis during liver transplantation, and to explore the viable treatment options. METHODS:The clinical data of 207 patients were reviewed, two patients complicated with smal intestinal necrosis during liver transplantation. Case 1 underwent liver transplantation combined with necrotic smal bowel resection. Case 2 abandoned liver transplantation, and received conservative treatment. RESULTS AND CONCLUSION:Both of the two patients had preoperative portal system thrombosis. In Case 1, there was upper gastrointestinal bleeding before transplantation, and repeated application of hemostatic drugs could increase the thrombosis and thus resulting smal intestinal necrosis. At 10 days after liver transplantation, the patients complicated with intestinal fistula and were treated with fistulation. After fistulation, the patient suffered from abdominal cavity and lung infections. At 7 days after anti-infection treatment and immunosuppressant stopped, the infections were cured. At 40 days after fistulation, the intestinal fistula was healed and the patient was discharged after rehabilitation. After fol owed-up for 2 years, the patient was stil healthy living. The Case 2 suffered with mass ascites which lead to abdominal compartment syndrome, the intestinal venous disorders lead to extensive smal bowel necrosis. At 2 days after abandon the liver transplantation, the patient was dead because of multiple organ failure. The patients who waiting for liver transplantation had preoperative portal system thrombosis, abdominal pain and abdominal distention, should be pay attention to intestinal necrosis. Patients with smal bowel necrosis during liver transplantation can be cured with liver transplantation combined with necrotic smal bowel resection.

Objective To analyze the clinical efficacy and outcomes of adult patients who underwent ABO-incompatible living donor liver transplantation.Methods The clinical data of 7 patients who underwent ABO-incompatible living donor liver transplantation at the Henan Provincial People's Hospital and Zhengzhou People's Hospital from January 2013 to December 2015 were analyzed retrospectively.Age,gender,primary disease,blood type antibody level,graft volume/standard liver volume (GV/SLV),postoperative complications and prognosis were analyzed.Results The recipients' average GV/SLV was 52.0％.There were 4 recipients who underwent splenectomy,including 3 patients who underwent the procedure concurrently,and one patient who underwent the procedure a few years before,the liver transplantation.Seven recipients were treated with plasmapheresis,Rituximab and Basiliximab.No patients experienced acute rejection during the perioperative period,and the 1-year survival rate was 85.7％ (6/7).Conclusion ABOincompatible liver transplantation in adult living donor can have favorable clinical outcomes using appropriate preoperative evaluation for recipients,optimized surgical procedures,pretransplant plasmapheresis,and perioperative Rituximab,Basiliximab injection and intravenous immunoglobulin administration.

Objective To investigate the clinical value of sorafenib in preventing tumor recurrence in patients with hepatocellular carcinoma (HCC) after liver transplantation (LT). Methods A total of 41 patients with HCC beyond University of California, San Francisco (UCSF) criteria receiving LT in Department of Hepatobiliary Pancreatic Surgery, People's Hospital of Zhengzhou from March 2010 to July 2012 were enrolled in this prospective study. The informed consents of all patients were obtained and the ethical committee approval was received. There were 35 males and 6 females with age ranging from 34 to 61 years old and the median age of 49 years old. According to whether the patients chose sorafenib for  Objective To investigate the clinical value of sorafenib in preventing tumor recurrence in patients with hepatocellular carcinoma (HCC) after liver transplantation (LT). Methods A total of 41 patients with HCC beyond University of California, San Francisco (UCSF) criteria receiving LT in Department of Hepatobiliary Pancreatic Surgery, People's Hospital of Zhengzhou from March 2010 to July 2012 were enrolled in this prospective study. The informed consents of all patients were obtained and the ethical committee approval was received. There were 35 males and 6 females with age ranging from 34 to 61 years old and the median age of 49 years old. According to whether the patients chose sorafenib for treatment after operation, they were divided into sorafenib group (n=9) and control group (n=32). Patients were treated with sorafenib orally (400 mg) twice daily in sorafenib group, and half dose (200 mg) was given twice daily when the patients were intolerant to the adverse reactions. In control group, patients did not take sorafenib or changed to take sorafenib after tumor recurrence. Patients received follow-up after operation, and tumor recurrence and survival were recorded during the follow-up. The tumor recurrence rates after operation of two groups were compared using Chi-squane test. The postoperative 1-, 2-year disease-free survival and cumulative survival rates were compared using Kaplan-Meier method and Log-rank test. Results The tumor recurrence rate was 3/9 in sorafenib group including 2 cases of taking half dose sorafenib. The tumor recurrence rate was 47%(15/32) in control group including 3 cases with liver metastasis underwent radiofrequency ablation, 2 cases with pulmonary metastases underwent radiation therapy, 2 cases with pulmonary metastases took sorafenib, the other 8 cases with multiple metastases received no treatments. No signiifcant difference was observed in tumor recurrence rates between two groups (χ2=0.523, P>0.05). No death was observed in sorafenib group, while in control group, 12 cases died of tumor recurrence or metastasis. The postoperative 2-year disease-free survival rates were 67%, 53%in sorafenib group and control group respectively and no signiifcant difference was observed (χ2=2.226, P>0.05). The postoperative 2-year cumulative survival rates were 100%, 63%in sorafenib group and control group respectively and signiifcant difference was observed (χ2=5.126, P<0.05). Conclusion For patients with HCC beyond UCSF criteria after LT, sorafenib can improve the 2-year cumulative survival rate and has a certain value in preventing tumor recurrence after operation.