Gastroesophageal variceal bleeding is one of the major causes of death for patients with portal hypertension.The treatment of portal hypertension has evolved from surgery being the only option to the wide range of options currently available,including endoscopic sclerotherapy of varietals ligation,interventional radiology and surgery.Given the shortage of liver transplantation donors,devascularization would be one of the major treatments for portal hypertension for a considerable time.Based on the clinical experience of the People's Hospital of Peking University,we think that peraesophagogastric devascularization without splenectomy is a better option for the treatment of portal hypertension,with less operation time,less intraoperative blood loss and fewer postoperative complications,and better short-and long-term hemostatic effect.

Liver transplantation is the only curative treatment for cirrhotic portal hypertension, especially for the patients with end-stage liver failure. In the era of liver transplantation, when drugs, endoscopy and interventional treatments fail, surgery (not including liver transplantation) is an irreplaceable treatment option for esophagogastric variceal bleeding, which should be individualized, in order not to increase the risk and difficulty of liver transplantation in the future.

Objective:To analyze the long-term cumulative survival and tumor-free survival of hepatocellular carcinoma (HCC) patients after liver transplantation, as well as the influencing factors.Methods:We conducted a retrospective study on 228 HCC patients receiving liver transplantation from May 1, 2000 to May 1, 2012 at the Department of Hepatobiliary Surgery, Peking University People's Hospital. A total of 166 patients met the recruit criteria. The patients' perioperative data and follow-up data were collected. We analyzed the cumulative survival and tumor-free survival of the recipients, as well as the influencing factors.Results:The 1-, 5- and 10-year cumulative survival of the 166 HCC patients were 80.7%, 52.4% and 45.8%, respectively, while the 1-, 5- and 10-year tumor-free survival of these patients were 60.2%, 47.6% and 44.0%, respectively. Among these patients,a total of 96 recipients met the University of California, San Francisco (UCSF) criteria, whose 1-, 5- and 10-year cumulative survival were 83.3%, 66.7%, and 59.4%, respectively, and tumor-free survival were 74.0%, 62.5% and 57.3%, respectively. Multivariate analysis showed that beyond the UCSF criteria, alpha fetoprotein (AFP) ≥ 400 ng/ml before transplantation and poorly differentiated carcinoma were independent factors affecting cumulative survival and tumor-free survival ( P < 0.05). Conclusions:Liver transplantation is an effective treatment of HCC. Besides the size and the number of the tumors, AFP ≥ 400 ng/ml before transplantation and poorly differentiated tumors are independent factors affecting the long-term cumulative survival and tumor-free survival of HCC patients.

In July 2024， the European Association for the Study of the Liver released the latest edition of EASL Clinical Practice Guidelines on liver transplantation. The purpose of the EASL guidelines presented here is not to cover all aspects of liver transplantation， but to focus on important advances since the release of the 2016 edition of EASL guidelines. This article gives an excerpt of the recommendations in the guidelines.

Objective To investigate the expression of EpCAM (epithelial cell adhesion molecule) in patients undergoing liver transplantation for hepatocellular carcinoma (HCC),and to explore the relationship between EpCAM expression level and HCC recurrence.Methods 83 HCC tissue samples were collected and analyzed retrospectively.EpCAM was detected by immunohistochemistry staining and the correlation between EpCAM and clinicopathological features,prognosis and recurrence were analyzed retrospectively from patients undergoing liver transplantation in Peking University People's Hospital from 2000 to 2010.Results Log-rank univariate survival analysis showed that the 5-year overall survival (41.2％ vs.73.3％,x2 =4.935,P =0.026) and 5-year disease free survival (41.2％ vs.73.3％,x2 =4.634,P =0.031)of HCC patients with high EpCAM expression level was significantly lower than that with low expression level of EpCAM.COX multivariate survival analysis showed patients with high EpCAM expression had a higher risk of recurrence(HR =2.860,95％ CI:1.012-8.083) and death (HR =2.909,95％ CI:1.030-8.217)after liver transplantation than those with low EpCAM expression,which was an independent predictor of 5-year overall survival and 5-year disease free survival recurrence (P =0.044).Furthermore,EpCAM expression level was highly related to tumor distant metastasis (P =0.01).Conclusion There was positive relation between high expression of EpCAM and high HCC recurrence after liver transplantation,suggesting that EpCAM can be a predictor for HCC recurrence and long-term survival of patients with HCC after transplantation.

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