Objective To summarize the experience of complex hepatic artery reconstruction in orthotopic liver transplantation. Methods Clinical data of 7 liver transplantation recipients who underwent complex hepatic artery reconstruction from January 2015 to March 2019 were retrospectively analyzed. Among them, 4 recipients received classical liver transplantation and 3 cases underwent piggyback liver transplantation. Intraoperative general conditions including anhepatic phase, intraoperative blood loss, hepatic artery anastomosis time and operation time of the recipients were recorded. The clinical prognosis and complications were observed. Results In two donors, variant right hepatic artery was used for vascular reconstruction. The celiac trunk or the common hepatic artery of the donors was anastomosed with the common hepatic artery of the recipients. Iliac artery bypass was employed in 2 cases, and then the hepatic artery of the donors was anastomosed with the abdominal aorta of the recipients. The superior mesenteric artery of 1 donor was end-to-end anastomosed with the common hepatic artery of the recipient. The celiac trunk of 1 donor was anastomosed with the splenic artery of the recipient. Only 1 case was required to undergo secondary liver transplantation due to acute hepatic artery thrombosis after hepatic artery anastomosis. All the 6 recipients successfully completed the liver transplantation. No perioperative death was observed. The anhepatic phase endured from 49 to 77 min. The intraoperative blood loss was ranged from 300 to 1 500 mL. The anastomosis time of hepatic artery was 23-56 min. The operation time was ranged from 5.3 to 11.1 h. The length of postoperative hospital stay was 23-56 d. Neither hepatic artery thrombosis nor stenosis occurred. The liver function of all recipients was basically restored to normal within postoperative 2 weeks. No severe surgical complications occurred. The liver graft achieved excellent function. Conclusions Appropriate identification of the hepatic artery variation, proper management of liver artery of the donors and recipients and reconstructing the blood supply of liver graft are the crucial procedures of liver transplantation.

Objective To summarize the clinical experience of small-for-size graft of pediatric donor liver transplantation in the treatment of acute liver failure in an adult recipient. Methods Clinical data of application of small-for-size graft of pediatric donor liver transplantation in an adult recipient was retrospectively analyzed and literature review was performed. Results The pediatric donor was aged 4.5 years old and the weight of donor liver from donation after brain death was 544.6 g. The body mass of recipient was 52 kg. The graft-to-recipient weight ratio was 1.05%. The classic orthotopic liver transplantation was performed. Postoperative recovery was not satisfying. The recipient suffered from brain edema, stress gastrointestinal bleeding, acute kidney injury, small-for-size liver syndrome, atelectasis, lung infection, fungal infection, abdominal infection, pleural effusion and other postoperative complications. After symptomatic and comprehensive treatment, the function of liver graft was gradually restored and regenerated to the normal size of adult liver at postoperative 2 to 3 weeks. The patient was discharged after 102 d hospitalization. During the follow-up at postoperative 10 months, the liver function was evaluated normal and the quality of life was favorable. Conclusions Pediatric small-for-size donor livers can be successfully transplanted to the adult recipients. Nevertheless, it is necessary to select the appropriate recipients, surgical methods and fine perioperative management according to the conditions of the donor livers.

Objective To analyze the risk factors of multi-drug resistant organism (MDRO) infection after liver transplantation. Methods The clinical data of 77 recipients undergoing liver transplantation were retrospectively analyzed. According to the incidence of MDRO infection, all recipients were divided into the non-MDRO infection group (n=51) and MDRO infection group (n=26). The infection rate and strain distribution of MDRO in liver transplant recipients were summarized. The risk factors of MDRO infection in liver transplant recipients were identified. Clinical prognosis of all recipients was statistically compared between two groups. Results The infection rate of MDRO after liver transplantation was 34% (26/77), mainly carbapenem-resistant MDRO infection. The main sites of infection included lung, abdominal cavity and incision. Univariate analysis showed that postoperative tracheal intubation ≥48 h, length of intensive care unit (ICU) stay ≥72 h, length of hospital stay ≥30 d, re-operation, continuous renal replacement therapy (CRRT) and tacrolimus (Tac) blood concentration ≥15 ng/mL were the risk factors for MDRO infection after liver transplantation. Cox regression analysis indicated that postoperative tracheal intubation≥48 h, re-operation, CRRT and Tac blood concentration ≥15 ng/mL were the independent risk factors for MDRO infection after liver transplantation. The fatality in the MDRO infection group was significantly higher than that in the non-MDRO infection group [31%(8/26) vs. 10%(5/51), P=0.01]. Conclusions Postoperative tracheal intubation ≥48 h, re-operation, CRRT and Tac blood concentration ≥15 ng/mL may increase the risk of MDRO infection after liver transplantation and affect clinical prognosis of the recipients.

Objective To evaluate the effect of different techniques of hepatic artery reconstruction on postoperative hepatic artery complications and clinical prognosis in liver transplantation. Methods Clinical data of 140 liver transplant recipients were retrospectively analyzed. All recipients were divided into the conventional hepatic artery reconstruction group (n=123) and special hepatic artery reconstruction group (n=17) according to hepatic artery reconstruction methods. Intraoperative and postoperative clinical indexes, the incidence of postoperative hepatic artery complications and survival rate were compared between two groups. Results The alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels at postoperative 1 d, total bilirubin (TB) at postoperative 7 d and prothrombin time international normalized ratio (PT-INR) at postoperative 30 d in special hepatic artery reconstruction group were higher than those in conventional hepatic artery reconstruction group, and the differences were statistically significant (all P < 0.05). There were no significant differences in the operation time, anhepatic phase, intraoperative blood loss, intraoperative transfusion volume of red blood cells, cold or warm ischemia time, the length of intensive care unit (ICU) stay, the length of hospital stay and postoperative blood flow of liver allograft between two groups (all P > 0.05). In the conventional hepatic artery reconstruction group, 5 recipients developed hepatic artery complications, whereas no hepatic artery complications occurred in the special hepatic artery reconstruction group, with no significant difference between two groups (P > 0.05). In the special hepatic artery reconstruction group, the 1-, 3- and 5-year cumulative survival rates were equally 82.4%, compared with 85.0%, 78.9% and 75.6% in the conventional hepatic artery reconstruction group, respectively. There was no significant difference between two groups (all P > 0.05). Conclusions When hepatic artery variations and (or) lesions are detected in donors and recipients, use of special hepatic artery reconstruction may effectively restore the hepatic arterial blood flow of liver allograft after liver transplantation, and will not affect the incidence of hepatic artery complications and survival rate of the recipients following liver transplantation.

Objective To summarize clinical experience of transabdominal pericardial anastomosis of suprahepatic vena cava of the donor and right atrium of the recipient in liver transplantation for Budd-Chiari syndrome (BCS) complicated with liver cancer. Methods Clinical data of a BCS patient complicated with liver cancer undergoing transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium in liver transplantation were retrospectively analyzed. Results The hepatic vein and suprahepatic vena cava were partially occluded in the patient. Liver transplantation was completed by transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium with beating-heart. In addition, due to pathological changes of the recipient's hepatic artery, splenic artery of the recipient was cut off, distal ligation was performed, and the proximal end was reversed and anastomosed with the common hepatic artery of the donor liver, and the reconstruction of hepatic artery was completed. The surgery was successfully performed. At approximately postoperative 1 week, the function of the liver allograft was gradually restored to normal, and no major complications occurred. The patient was discharged at postoperative 25 d. No signs of BCS recurrence was reported after 8-month follow-up. Conclusions It is safe and feasible to treat BCS by liver transplantation with transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium. BCS patients complicated with liver cancer obtain favorable prognosis.