Child ; Humans ; Liver Failure, Acute/therapy* ; Liver Transplantation/adverse effects*

Female ; Humans ; Liver Transplantation ; adverse effects ; Male ; Mycoses ; diagnosis

Cholestasis, Intrahepatic ; etiology ; prevention & control ; Humans ; Liver Transplantation ; adverse effects

To investigate the postoperative serum triglyceride (TG) levels in predicting the risk of new-onset diabetes mellitus (NODM) in patients following allogeneic liver transplantation. One hundred and forty three patients undergoing allogeneic liver transplantation in Shanghai General Hospital from July 2007 to July 2014 were enrolled in this study. The NODM developed in 33 patients after liver transplantation. The curve of dynamic TG levels in the early period after liver transplantation was generated. Independent risk factors of NODM were determined by univariate and multivariant logistic regression analyses. The clinical value of TG in predicting NODM was analyzed by area under the ROC curve (AUC). Serum TG levels were gradually rising in the first week and then reached the plateau phase (stable TG, sTG) in patients after surgery. The sTG in NODM group were significantly higher than that in non-NODM group (=-2.31, <0.05). Glucocorticoid therapy (=4.054, <0.01), FK506 drug concentration in the first week after operation (=3.482, <0.05) and sTG (=3.156, <0.05) were independent risk factors of NODM. ROC curve analysis showed that the AUC of sTG in predicting NODM was 0.72. TG shows a gradual recovery process in the early period after liver transplantation, and the higher TG level in stable phase may significantly increase the risk of NODM in patients.
China/epidemiology* ; Diabetes Mellitus/etiology* ; Humans ; Liver Transplantation/adverse effects* ; Risk Factors ; Tacrolimus/adverse effects* ; Triglycerides

Humans ; Hepatopulmonary Syndrome/surgery* ; Liver Transplantation/adverse effects* ; Extracorporeal Membrane Oxygenation/adverse effects* ; Postoperative Complications ; Patients

OBJECTIVETo summarize the features of pulmonary infection (PI) in kidney transplant (Ktx) and liver transplant (Ltx) recipients for effective control measures.

METHODSA retrospective analysis was conducted among Ktx recipients and Ltx recipients with PI during the period from Jan 2004 to Dec 2008. The clinical data concerning the infection was compared.

RESULTSForty-five Ktx recipients and 23 Ltx recipients developed PI after the transplantation. The incidence of PI was 7.4% and 56.1% in (P<0.001), respectively, with severe PI occurring in 2.6% and 46.3% of the recipients (P<0.001). The median time from PI diagnosis to transplant was 230 days (29-1080 days) and 4 days (2-104 days) (P<0.001), the case-fatality rate for PI was 6.7% and 17.4% (P=NS), and the mortality rate was 0.5% and 9.8% (P<0.001) in Ktx and Ltx recipients, respectively; Gram-negative organisms were the most common in both Ktx and Ltx recipients, but Ltx recipients had significantly higher incidence of multidrug-resistant bacteria (12.9% vs 37.0%, P=0.005).

CONCLUSIONThe knowledge of PI after the transplantation will benefit appropriate prophylactic and empirical treatment to improve the survival of Ktx and Ltx recipients.

Adult ; Female ; Humans ; Kidney Transplantation ; adverse effects ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Pneumonia ; epidemiology ; microbiology ; virology ; Retrospective Studies

Fontan-associated liver disease (FALD) is one of the main complications after the Fontan procedure, manifesting mostly as liver fibrosis and even cirrhosis, with a high incidence rate and a lack of typical clinical symptoms that seriously affect patient prognosis. The specific cause is unknown, although it is considered to be associated with long-term elevated central venous pressure, impaired hepatic artery blood flow, and other relevant factors. The absence of association between laboratory tests, imaging data, and the severity of liver fibrosis makes clinical diagnosis and monitoring difficult. A liver biopsy is the gold standard for diagnosing and staging liver fibrosis. The most important risk factor for FALD is time following the Fontan procedure; therefore, it is recommended to do a liver biopsy 10 years after the Fontan procedure and to be cautious for the presence of hepatocellular carcinoma. Combined heart-liver transplantation is a recommended choice with favorable outcomes for patients with Fontan circulatory failure and severe hepatic fibrosis.
Humans ; Liver Diseases/pathology* ; Liver Cirrhosis/pathology* ; Liver/pathology* ; Carcinoma, Hepatocellular/pathology* ; Liver Transplantation/adverse effects* ; Fontan Procedure/adverse effects* ; Postoperative Complications/pathology* ; Liver Neoplasms/pathology*

Cell Transplantation ; adverse effects ; Graft Rejection ; prevention & control ; Hepatocytes ; transplantation ; Humans ; Liver Failure ; surgery

The indications for living donor liver transplantation (LDLT) were successfully expanded from pediatric to adult cases last 15 years. During this process, graft type has been shifted from left side liver to right side liver. Although the introduction of right lobe graft can successfully increase the actual graft size in LDLT, problem related to "small-for-size grafts" have gradually come to light. "Small-for-size syndrome", such as poor bile production, delayed synthetic function, prolonged cholestasis, and intractable ascites, leading to septic complications and higher mortality, are neither specific nor inevitable in low-weight liver grafts. Many factors other than actual graft weight contribute to the occurrence of "small-for-size syndrome". In the clinical setting, surgical modification targeting portal hemodynamics and tissue congestion is a key to overcome "small-for-size syndrome". Until now, several therapeutic options were reported, but further elucidation of the pathogenesis in "small-for-size syndrome" will be a solution for improving the outcomes in adult-to-adult LDLT.
Humans ; Liver/*pathology/*physiopathology ; Liver Transplantation/*adverse effects ; *Living Donors ; Organ Size ; Transplants

OBJECTIVETo investigate the anatomical variations of donor hepatic artery and explore the measures that can be taken to avoid accidental hepatic artery injury during graft procurement and reconstruction.

METHODSThe data of totally 843 consecutive patients undergoing orthotopic liver transplantation (OLT) during the period from April 2001 to July 2006 was reviewed in relation to anatomical variation of the donor hepatic arteries. The variations of the hepatic artery, the relationship between the anomalous hepatic artery and accidental injury of the hepatic artery were analyzed.

RESULTSIn the 843 cases of OLT, the total anatomical variation rate of the donor hepatic arteries was 20.4% (172/843). The common variations included replaced or accessory right hepatic arteries originated from superior mesenteric artery (6.67%, 57/843), replaced or accessory left hepatic arteries originated from the left gastric artery (6.41%, 54/843) or from the celiac trunk and gastro-duodenal artery (1.66%, 14/843), replaced or accessory right hepatic arteries originated from the celiac trunk, common hepatic artery and gastro-duodenal artery (1.54%,13/843), replaced or accessory right hepatic arteries and left hepatic arteries coexistence (0.83%, 7/843), variation of the common hepatic artery from the superior mesenteric artery (1.54%, 13/843) or from the abdominal aorta (0.95%, 8/843).

CONCLUSIONDuring graft procurement and reconstruction, accidental injury of the hepatic artery is more likely in the presence of hepatic arterial variation, which can be a common clinical entity. Acquaintance with hepatic arterial variation and maintenance of the integrity of the superior mesenteric artery and celiac trunk are key to reducing potential hepatic artery injuries.

Arteries ; anatomy & histology ; pathology ; Humans ; Liver ; blood supply ; Liver Transplantation ; adverse effects ; Retrospective Studies