1.Autoimmune Liver Diseases and Liver Transplantation
Chinese Journal of Gastroenterology 2018;23(5):300-304
Liver transplantation is a well accepted treatment for patients with end-stage liver disease. The indications of liver transplantation for autoimmune liver diseases such as autoimmune hepatitis,primary biliary cholangitis,and primary sclerosing cholangitis are similar to that with other acute or chronic liver diseases. Despite liver transplantation has a favorable overall outcome in these patients,the recurrence of autoimmune liver diseases is relatively common and challenges remain in terms of the management and survival of graft. It should be noted that de novo autoimmune hepatitis can arise in patients transplanted for non-autoimmune liver diseases. In this article,the indications and outcomes of liver transplantation in patients with autoimmune liver diseases were discussed for the better understanding of liver transplantation in this setting.
2.Development and application of resection and partial liver transplantation with delayed total hepatectomy
Wei GENG ; Chengpeng ZHONG ; Hanyong SUN ; Lei XIA
Chinese Journal of Digestive Surgery 2023;22(11):1378-1384
Liver is a common site for distant metastasis of colorectal cancer and a large proportion of patients with colorectal liver metastasis cannot receive the radical hepatectomy. Liver transplantation has been proven to bring a survival benefit in highly selected unresectable colorectal liver metastasis (u-CRLM) patients, but the shortage of donor liver severely restricts its application. Resection and partial liver transplantation with delayed total hepatectomy (RAPID) is a newly deve-loped liver transplantation procedure, which innovatively combined auxiliary liver transplantation and associating liver partition and portal vein ligation for staged hepatectomy. With the small and partial liver graft, RAPID can cure u-CRLM safely and effectively. In RAPID, the reconstruction of portal vein and hepatic vein is the key point, while the control of portal vein pressure and flow is the difficulty and also the key for success. Thereafter, living donor-RAPID is created by combing RAPID with living donor liver transplantation. Besides, the application of RAPID also extends to other primary liver diseases, including liver cirrhosis and liver cancer. RAPID is difficult, complex and under an exploratory stage at present. In this paper, based on the developing process of RAPID, the authors give a comprehensive overview of its surgical procedures and key points, and discuss its potential application area.