In liver transplantation,hepatic sinusoidal obstruction syndrome (HSOS) is rare,which results in misdiagnosis and mistreatment.The prognosis of HSOS after liver transplantation is related to the implementation of early specific treatment.No systematic review has been reported on HSOS after liver transplantation.To raise awareness of HSOS after liver transplantation,this review summarizes the aetiology,pathology,clinical manifestations,laboratory findings,imaging features,diagnosis,differential diagnosis,treatment and prognosis of the condition.

Objective To evaluate the outcome of patients with alcoholic liver disease (ALD) after orthotopic liver transplantation (OLT) and to study the prognostic factors.Methods The data of 17 patients who underwent OLT for ALD from January 2010 to March 2013 were analyzed retrospectively.The data on age,gender,history of gastrointestinal bleeding,history of splenectomy,Child-Pugh score,Maddrey' s discriminant function and MELD score were evaluated using the Kaplan-Meier method for univariate analysis.The log-rank test was applied to compare the survival rates.Results The overall survival rate at 100 weeks in patients less than 55 years old was 90％ (9/10),while that in patients more than 55 years old was 28.57％ (2/7).There was a significant difference between the two groups (P ＜ 0.05).There were no statistically significant differences between female and male patients,between patients with or without a history of gastrointestinal bleeding or splenectomy (P ＞ 0.05).There was no significant difference on survival rates after liver transplantation between patients with Child-Pugh B and Child-Pugh C,patients with Maddrey' s scores ＜ 70 and ≥70,and patients with a MELD score ＜ 30 and ≥ 30 (P ＞ 0.05).Conclusions Better survival rates were observed in ALD patients who were ＜ 55 years old after liver transplantation.The Child-Pugh score,Maddrey' s discriminant function and MELD score were of no prognostic significance.These findings still need to be verified by prospective large-scale studies.

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 imaging findings of rare tumors or tumor-like lesions in liver grafts after liver transplantation.Methods Imaging data of 4 patients with rare tumors or tumor-like lesions in the liver grafts of patients after liver transplantation from December 2006 to August 2013 in the Third Affiliated Hospital of Sun Yat-sen University were reviewed.Findings of computerized tomography ( CT ) and ( or ) magnetic resonance imaging ( MRI) plain scan and dynamic enhanced MRI of liver lesions in these patients were analyzed specially.Results In the 4 patients, 3 cases were misdiagnosed , including undifferentiated liver sarcoma , secondary lymphoma and eosinophilic granuloma.One case was diagnosed correctly with hepatic metastases of gallbladder carcinoma.The undifferentiated liver sarcomas appeared as cystic and solid space occupying masses with significant and persistent enhancement in the surrounding solid and separating parts .No enhancement was observed in the cystic parts , which increased rapidly in a short term.No edema area around the lesions was observed , but many calcifications were detected.The secondary hepatic lymphoma appeared as intrahepatic multiple nodules , most of which presented uniform signal intensity with moderate enhancement in every phase.No intrahepatic vascular invasion was observed but extrahepatic lymphadenectasis was detected .Bleeding was observed in a few lesions.The liver eosinophilic granuloma appeared as multiple liver lesions with variable signal intensity and enhancement modes , which suggested that the lesions were consisted of variety of elements and in the different disease stages.Most of the lesions were observed with progressive circled enhancement.The recurrence of gallbladder carcinoma and hepatic metastasis after liver transplantation appeared as a intrahepatic hypodensity lesion with slight enhancement in arterial phase and slight hypodensity in portal phase.Retroperitoneal lymph nodes were observed swelled and fused.Conclusions Rare tumors or tumor-like lesions in liver grafts have distinctive imaging features.Imaging examinations are useful for the early detection of these rare tumors or tumor-like lesions in liver grafts.Imaging findings combining with disease history and clinical manifestations can help to make correct diagnosis.

Objective: To compare the clinical effects between laparoscopic cholecystectomy and choledochotomy versus traditional open cholecystectomy plus choledochotomy. Methods: One hundred and sixty-eight elderly patients with gallbladder and choledocholithiasis were divided into a laparoscopy group(n=75, receiving laparoscopic cholecystectomy and choledochotomy)and an open abdominal group(n=93, undergoing traditional open cholecystectomy and common bile duct exploration). The surgical incision length, operation time, intraoperative blood loss, anal exhaust time, hospital stay and postoperative complications were compared between the two groups. Results: The surgical incision length, operation time, intraoperative blood loss, anal exhaust time, hospital stay were lower in the laparoscopic group than in the open abdominal group(P<0.05). The incidence of postoperative complications was lower in the laparoscopic group than in the open group(P<0.05). Conclusions Laparoscopic cholecystectomy and choledochotomy can obviously improve the clinical efficacy and reduce complications in elderly patients with gallbladder and choledocholithiasis, and it is worthy of clinical application.

Objective:To report on 3 patients who presented with rupture of hepatic artery pseudoaneurysm after liver transplantation.Methods:From April 2010 to April 2019, 3 patients with hepatic artery pseudoaneurysm rupture after liver transplantation treated at the Department of Hepatobiliary and Pancreatic Surgery, Henan Provincial People's Hospital were studied. The possible causes, clinical manifestations, diagnosis and treatment were retrospectively analyzed.Results:Rupture of hepatic artery pseudoaneurysm occurred on the19th, 28th and 63th days after transplantation. The 3 patients all presented with hematochezia and abdominal pain, while 2 patients presented with hematemesis. Two patients had bile leakage and abdominal infection. All the 3 patients presented with fever. Patient 1 who was diagnosed by laparotomy died of liver failure. Patient 2 underwent interventional embolization of hepatic artery and died of liver failure also. Patient 3 underwent surgical resection of the pseudoaneurysm followed by hepatic artery reconstruction, but died of repeat abdominal hemorrhage.Conclusion:Hepatic artery pseudoaneurysm after liver transplantation has a long latent period and is difficult to diagnose at an early stage. Early detection of this life-threatening complication is the key to improve survival. Early treatment of biliary leakage, abdominal infection and other complications help to prevent development of pseudoaneurysms.

Objective:To explore the diagnostic value of virtual monoenergetic image (VMI) and electron density map (EDM) generated by non-contrast dual-layer spectral detector CT in acute pulmonary embolism(APE).Methods:The clinical and imaging data of 27 patients (41 lesions) who underwent CT pulmonary angiography (CTPA) using dual-layer spectral detector CT and were diagnosed with APE in the Third Affiliated Hospital of Sun Yat-sen University from October 2022 to May 2023 were retrospectively analyzed. All patients received a dual-layer spectral detector CT non-contrast scan. Based on the non-contrast scan data, conventional 120 kVp polyenergetic images (PI), virtual monoenergetic images (40, 70, 100 keV VMI), electron density maps (EDM), and effective atomic number maps (Z eff) were respectively reconstructed. Taking CTPA as the gold standard, the detection rate of APE in different reconstruction images of non-contrast scan were evaluated. The vascular lesion was used as the pulmonary embolism group and the corresponding position of the normal vessel at the same level of the diseased vessel as the control group, and the Wilcoxon rank-sum test was used to compare the differences of CT values on PI and 40, 70, and 100 keV VMI (CT PI, CT 40 keV, CT 70 keV, CT 100 keV) as well as the ED values on the EDM, and the Z eff value on the Z eff images between the 2 groups. Parameters with statistically significant differences were included in a multifactor logistic regression, resulting in the construction of a logistic regression model. Receiver operator characteristic curve and area under curve (AUC) were applied to evaluate the diagnostic efficiency of different spectral quantitative parameters and logistic regression model in identifying pulmonary embolism group from normal control group. Results:The detection rates of APE on PI, EDM, Z eff map, and EDM and Z eff map fusion images were 14.6% (6/41), 82.9% (34/41), 51.2% (21/41), and 97.6% (40/41), respectively. CT PI, ED, CT 40 keV, CT 70 keV and CT 100 keV in pulmonary embolism group were statistically higher than those in control group ( Z values were 1 009.00, 1 024.50, 1 038.00, 1 079.00 and 1 076.00, respectively, P<0.05). Finally, CT PI, CT 40 keV, and CT 100 keV were selected to construct the logistic regression model. The AUC, sensitivity, specificity, and accuracy of the logistic regression model for distinguishing the embolism group from the control group were 0.771, 0.769, 0.744, and 0.756, respectively. Conclusion:Non-contrast images of dual-layer spectral detector CT VMI and EDM have some clinical value in detecting and diagnosing APE.

Objective:To analyze the influencing factors of low liver regeneration in patients with hilar cholangiocarcinoma (HCCA) after portal vein embolization (PVE).Method:Clinical data of 62 patients with HCCA undergoing PVE at Henan Provincial People's Hospital (People's Hospital of Zhengzhou University) from January 2019 to March 2024 were retrospectively analyzed, including 33 males and 29 females, aged (59.1±10.3) years. Patients were divided into two groups based on the median regeneration rate of remnant liver volume (28.6%) three weeks after PVE: low regeneration ( n=31, <28.6%) and high regeneration group ( n=31, ≥28.6%). The proportion of lymph node metastasis, history of alcohol consumption, liver fibrosis, biliary tract infection, alkaline phosphatase (ALP), and tumor necrosis factor-α (TNF-α) were compared between two groups. Multivariate logistic regression analysis was used to indentify the influencing factors of low liver regeneration in patients with HCCA after PVE surgery. Results:The proportion of lymph node metastasis, history of alcohol consumption, liver fibrosis, biliary tract infection, ALP, and level of TNF-α were higher in the low regeneration group than those in the high regeneration group (all P<0.05). Multivariate logistic regression analysis showed that patients with regional lymph node metastasis ( OR=2.561, 95% CI: 1.265-5.185), history of alcohol consumption ( OR=2.616, 95% CI: 1.321-5.181), liver fibrosis ( OR=2.351, 95% CI: 1.265-4.369), biliary tract infection ( OR=2.461, 95% CI: 1.226-4.940), elevated level of ALP ( OR=2.687, 95% CI: 1.351-5.344), and elevated level of TNF-α ( OR=2.781, 95% CI: 1.452-5.326) had an increased risk of low liver regeneration after PVE (all P<0.05). Conclusion:Regional lymph node metastasis, history of alcohol consumption, liver fibrosis, biliary tract infection, and elevated ALP and TNF-α are risk factors for low liver regeneration in patients with HCCA after PVE surgery, which should be noted in clinical practice.

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.