OBJECTIVETo summarize the treatment outcomes after combined en bloc liver and pancreas transplantation.

METHODSFive patients with end-stage liver disease and type 2 diabetes mellitus received combined en bloc liver and pancreas transplantation after hepatectomy.

RESULTSFive operations were performed successfully. The operative time ranged from 9 to 16 hours and blood loss from 1600 to 3000 ml. Postoperatively, one patients developed pulmonary infection, one died of graft-versus-host disease(GVHD), and one experienced acute renal failure. No intestinal fistula, anastomotic leakage, biliary complications, chronic and acute rejection and pancreatitis were seen. Liver function index including alanine aminotransferase, aspartate aminotransferase and total bilirubin returned to normal levels a week after surgery, while levels of C peptide and blood glucose resumed within 1 to 2 weeks. Apart from 1 case died of GVHD, the other 4 maintained normal liver function during the follow up ranging from 2 to 23 months and no insulin was required for the diabetes.

CONCLUSIONCombined en bloc liver and pancreas transplantation is technically feasible and an effective treatment for multi-organ diseases.

Adult ; Diabetes Mellitus, Type 2 ; complications ; surgery ; Female ; Humans ; Liver Failure ; complications ; surgery ; Liver Transplantation ; Male ; Middle Aged ; Pancreas Transplantation ; Retrospective Studies

OBJECTIVETo investigate the causes and treatment of postoperative venous outflow obstruction after orthotopic liver transplantation (OLT).

METHODSClinical data of 776 patients after OLT were analyzed retrospectively between January 2000 and December 2006. The accumulated experiences in diagnosis and treatment of postoperative outflow obstruction after OLT were reviewed.

RESULTSVenous outflow obstruction occurred in 10 patients (1.29%) after OLT, among those 6 had supra-hepatic inferior vena cava (IVC) stenosis, 2 had IVC stenosis of the post-hepatic segment, and 2 had outflow obstruction of hepatic vein. The diagnosis was confirmed by inferior vena cavography in all the patients. Of the 10 patients, 8 received percutaneous transluminal angioplasty (PTA) or metallic stent replacement, and 2 underwent liver retransplantation (re-LT) when interventional therapy failed. Three patients died from outflow obstruction, so the outflow obstruction related mortality was 30% in the patients.

CONCLUSIONSComplications of outflow obstruction after OLT were associated with surgical technique like vascular anastomosis, various types of cavo-caval anastomosis and graft size mismatch between donor and recipient. Making an early diagnosis and giving timely treatment including interventional therapy or re-LT is the key to improve the prognosis of outflow obstruction.

Adolescent ; Adult ; Aged ; Budd-Chiari Syndrome ; etiology ; therapy ; Child ; Child, Preschool ; Female ; Humans ; Liver Transplantation ; methods ; Male ; Middle Aged ; Postoperative Complications ; etiology ; therapy ; Retrospective Studies

OBJECTIVETo investigate the causes and treatment of postoperative gastrointestinal bleeding after orthotopic liver transplantation (OLT).

METHODSClinical data of 776 patients after OLT between January 2000 and December 2006 were analyzed retrospectively.The experiences in diagnosis and treatment of postoperative gastrointestinal bleeding after OLT were reviewed.

RESULTSGastrointestinal bleeding occurred in 18 patients (2.3%) after OLT, among whom 8 (44.5%) were from peptic ulcer, 3 (16.7%) from gastric and esophageal varices, 3 (16.7%) from gastroduodenitis, 3 (16.7%) from hemobilia, and 1 (5.6%) had diverticular bleeding in the jejunum. These 18 patients with gastrointestinal bleeding were managed with conservative treatment, endoscopic treatment, radiological interventional embolism,or exploratory laparotomy. Five patients died of gastrointestinal bleeding and the gastrointestinal bleeding-related mortality rate was 27.8%. After a mean follow up of 3.5 years, only 1 patient died of recurrence of hepatic cellular carcinoma while others survived disease-free.

CONCLUSIONSGastrointestinal bleeding may occur from different sites after OLT and the mortality is high. Prompt identification of the source of bleeding and correct management are required to improve the prognosis.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Gastrointestinal Hemorrhage ; etiology ; prevention & control ; Humans ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Postoperative Hemorrhage ; prevention & control ; Retrospective Studies ; Young Adult

OBJECTIVETo compare the advantages and disadvantages of four surgical techniques in orthotopic liver transplantation.

METHODSA total of 135 adult recipients receiving cadaveric whole liver grafts were divided into four groups according to the surgeries they received: group A (n=22) underwent classic orthotopic liver transplantation, group B (n=79) underwent modified piggyback liver transplantation, group C (n=18) underwent classical piggyback liver transplantation, and group D (n=16) underwent modified classic orthotopic liver transplantation. The clinical data of these recipients were retrospectively analyzed.

RESULTSThe operation time, anhepatic time, and intra-operation bleeding volume among these four groups were significantly different (P < 0.05). The incidence of transient renal damage in group C was significantly lower than that in other groups (P < 0.05), while the complication rates and survival rates were not significantly different in the early stage after the operation.

CONCLUSIONSSurgery techniques should be carefully selected based on the individual patients's pre-operative condition. The modified classic orthotopic liver transplantation is a preferred technique for tumor patients or patients with surgical history of upper abdomen.

Adult ; Humans ; Liver Diseases ; mortality ; physiopathology ; surgery ; Liver Transplantation ; adverse effects ; methods ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo investigate the causes and treatment of postoperative hyperbilirubinemia after orthotopic liver transplantation.

METHODSClinical data of 368 cases of orthotopic liver transplantation patients from the First Affiliated Hospital of Sun Yat-sen University between 2004 and 2005 were analyzed retrospectively.

RESULTSThree hundred and sixty-eight patients experienced 396 incidents of hyperbilirubinemia, including 183 incidents of preoperative hyperbilirubinemia (46.2%), 46 incidents of ischemia-reperfusion injury (11.6%), 36 incidents of acute rejection (9.1%), 78 incidents of biliary complications (19.7%), 24 incidents of blood vessel complications (6.1%), 23 incidents of recurrence of the primary disease (5.8%) and 6 incidents of tacrolimus (FK506) toxicity (1.5%). The comprehensive management targeted to the etiology and symptoms were applied to all patients with hyperbilirubinemia.

CONCLUSIONHyperbilirubinemia is a common clinical manifestation after liver transplantation with multiple and complicated causes. The key point for successful treatment is to identify the causes. To reach the aim of treatment and obtain long-term survival of the recipients, it is very important to make a correct diagnosis and give reasonable therapeutic regimens as soon as possible.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Hyperbilirubinemia ; etiology ; therapy ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Postoperative Complications ; therapy ; Retrospective Studies ; Young Adult

Adult ; Graft Rejection ; drug therapy ; Humans ; Immunosuppressive Agents ; therapeutic use ; Liver Transplantation ; Male ; Middle Aged ; Muromonab-CD3 ; therapeutic use

OBJECTIVETo investigate the safety and feasibility of steroids minimization immunosuppressive regimen in liver transplantation.

METHODSOne hundred and sixteen patients in line with the selecting criteria from January 2005 to June 2008 were divided into three groups according to the withdrawal of steroids: 40 cases in 3 months withdrawal group, 40 cases in 7 d withdrawal group and the other 36 cases in 24 h withdrawal group. The difference of recipients' survival, infection, acute rejection and steroids resistant acute rejection, wound healing, recurrence of HBV and hepatocellular cell (HCC), new on-set of diabetes, hyperlipidemia and hypertension between the three groups were compared.

RESULTSThe difference of recipients' survival, acute rejection including steroids resistant acute rejection, recurrence of HBV and HCC, hyperlipidemia between the three groups were not significant (P > 0.05), the incidence of wound un-healing and hypertension in 24 h withdrawal group was significantly lower than that in the other 2 groups (P < 0.05), the incidence of infection and new on-set diabetes in 24 h withdrawal group and 7 d withdrawal group was significantly lower than that in 3 months withdrawal group (P < 0.05).

CONCLUSIONSteroids minimization immunosuppressive strategy is safe and feasible in liver transplantation field, it will significantly reduce the steroids related complications without increasing the risk of rejection.

Adult ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Immunosuppression ; methods ; Immunosuppressive Agents ; administration & dosage ; therapeutic use ; Liver Transplantation ; Male ; Middle Aged ; Postoperative Care ; Prognosis ; Retrospective Studies ; Steroids ; administration & dosage ; therapeutic use ; Young Adult

OBJECTIVETo compare the short-term outcomes of liver transplantation recipients receiving liver grafts from brain-death and non-heart-beating donors and evaluate the safety of liver grafts from brain-death donors.

METHODSA total of 130 patients receiving liver transplantation between January, 2006 and December, 2007 were retrospectively analyzed, including 9 patients receiving liver graft from brain-death donors and 121 with grafts from non-heart-beating donors. The operative time, anhepatic time, bleeding volume, postoperative complications and short-term survival were compared between the two groups.

RESULTSThe operative time, anhepatic time, bleeding volume, postoperative complications and short-term survival showed no significant differences between the two groups.

CONCLUSIONThe short-term outcome of recipients receiving liver grafts from brain-death donors is similar to that of recipients receiving grafts from non-heart-beating donors, indicating the safety of clinical use of the liver grafts from brain-death donors.

Adult ; Brain Death ; Female ; Heart Arrest ; Humans ; Liver Cirrhosis ; surgery ; Liver Neoplasms ; surgery ; Liver Transplantation ; Male ; Middle Aged ; Retrospective Studies ; Tissue Donors ; Treatment Outcome

OBJECTIVETo assess the indication, surgical and post-operative complications of the multivisceral transplantation.

METHODSThe post-transplant complications of 8 patients who underwent multivisceral transplantation between May 2004 and May 2010 were analyzed. There were 7 male and 1 female, aged from 28 to 65 years. Five patients who suffered from non-resectable advanced upper abdominal malignancy experienced the liver, stomach, spleen, pancreas, duodenum, omentum and variable amounts of the colon resection, and then underwent standard multivisceral transplantation (included liver, stomach, pancreaticoduodenal and small bowel). After underwent hepatectomy while retaining the native pancreas and entire gastrointestinal, three recipients with end-stage liver cirrhosis and type 2 insulin-dependent diabetes mellitus (IDDM) was performed combined en bloc liver/pancreaticoduodenal transplantation.

RESULTSSince the third day post-operation, all recipients no longer needed exogenous insulin and had normal blood glucose concentrations. Two weeks after transplantation, their liver function almost became normal. For the 5 recipients who suffered abdominal malignancy, the longest survival period was 326 days. Cause of death are recurrent tumor (n = 2), multiple organ failure (n = 3). All the 5 patients experienced infection. For 3 patients suffered cirrhosis and IDDM, the longest survival was over 18 month. Excepting the case 8 died of graft versus host disease, all were still living without apparently post-transplant complication.

CONCLUSIONSMultivisceral transplantation is an alternative in the treatment of the patients with benign massive abdominal pathologies. Careful patient selection and technical modification are crucial to improve the outcome of these patients.

Abdomen ; surgery ; Adult ; Aged ; Duodenum ; transplantation ; Female ; Follow-Up Studies ; Humans ; Liver Transplantation ; Male ; Middle Aged ; Organ Transplantation ; Pancreas Transplantation ; Retrospective Studies

OBJECTIVETo investigate the efficiency and safety of two-dose steroid combined with two-dose daclizumab and tacrolimus (FK506) regimen in liver transplant recipients.

METHODSThere were 74 patients who treated in the First Affiliated Hospital of Sun Yat-Sen University from September 2006 to March 2008. Expect for 7 patients who didn't measure up, 67 adult liver transplant recipients were randomized into two groups: conventional protocol group (n = 35) in which steroid was withdrawn in 3 months after operation, and two-dose steroid group (n = 32). Comparison of rejection, infection (bacteria, fungal and cytomegalovirus) and metabolic complications rates were studied between two groups.

RESULTSThere were significant differences between two groups in the rate of early postoperation hyperglycemia, the average dosage of insulin consumption among hyperglycemia recipients as well as the rate of diabetes mellitus, hypertension and infection during the follow-up period (P < 0.05). The rate of hypertension in early postoperation period, hyperlipemia and rejection rate during the follow-up period were similar in two groups (P > 0.05).

CONCLUSIONSTwo-dose steroid combined with two-dose daclizumab and tacrolimus would be a safe and efficient immunosuppression strategy without increase the acute rejection rate hazard, that could reduce post-transplant infection and other complications from side-effect of long-term usage of steroid.

Adult ; Aged ; Antibodies, Monoclonal ; administration & dosage ; therapeutic use ; Antibodies, Monoclonal, Humanized ; Female ; Graft Rejection ; prevention & control ; Humans ; Immunoglobulin G ; administration & dosage ; therapeutic use ; Immunosuppression ; methods ; Immunosuppressive Agents ; administration & dosage ; therapeutic use ; Liver Transplantation ; Male ; Methylprednisolone ; administration & dosage ; therapeutic use ; Middle Aged ; Steroids ; administration & dosage ; therapeutic use ; Tacrolimus ; administration & dosage ; therapeutic use