This report described one patient of giant polycystic liver and polycystic kidney involving iliac fossa. Preoperative computed tomography (CT) revealed a large polycystic kidney occupying partially iliac fossa space. A decompression of lower pole of original kidney was planned for placing transplanted kidney. During total liver resection plus orthotopic liver transplantation, right polycystic kidney could move up on its own and iliac fossa space was released for placing transplanted kidney smoothly. Polycystic kidney shrunk markedly post-operation. It provided references for surgical planning of combined liver-kidney transplantation for this type of disease.

Background/Aims: The shortage of donor liver hinders the development of liver transplantation. This study aimed to clarify the poor outcomes of functionally marginal liver grafts (FMLs) and provide evidence for the improvement of ischemia-free liver transplantation (IFLT) after FML transplantation. Methods: Propensity score matching was used to control for confounding factors. The outcomes of the control group and FML group were compared to demonstrate the negative impact of FMLs on liver transplantation patients. We compared the clinical improvements of the different surgical types. To elucidate the underlying mechanism, we conducted bioinformatic analysis based on transcriptome and single-cell profiles. Results: FMLs had a significantly greater hazard ratio (HR: 1.969, P=0.018) than did other marginal livers. A worse 90-day survival (Mortality: 12.3% vs. 5.0%, P=0.007) was observed in patients who underwent FML transplantation. Patients who received FMLs had a significant improvement in overall survival after IFLT (Mortality: 10.4% vs 31.3%, P=0.006). Pyroptosis and inflammation were inhibited in patients who underwent IFLT. The infiltration of natural killer cells was lower in liver grafts from these patients. Bulk transcriptome profiles revealed a positive relationship between IL-32 and Caspase 1 (R=0.73, P=0.01) and between IL-32 and Gasdermin D (R=0.84, P=0.0012). Conclusions FML is a more important negative prognostic parameter than other marginal liver parameters. IFLT might ameliorate liver injury in FMLs by inhibiting the infiltration of NK cells, consequently leading to the abortion of IL-32, which drives pyroptosis in monocytes and macrophages.

Objective:To investigate the effectiveness and safety of fully-covered self-expandable metal stent (FCSEMS) with plastic stent over the treatment of post liver transplantation anastomotic biliary stricture (AS).Methods:The clinical data of AS patients after liver transplantation admitted to the First Affiliated Hospital of Sun Yat-sen University from January 2014 to April 2018 was collected for the retrospective study. According to different implanted stents, patients were divided into FCSEMS group and plastic stent group. The general information of the two groups of patients, surgical success rate, postoperative complications, the number of endoscopic retrograde cholangiopancreatography (ERCP), the number of indwelling stents and other indicators were compared and analyzed.Results:A total of 54 patients were enrolled, including 41 males and 13 females, with a median age of 48 (34-65) years. A total of 23 cases were included in the FCSEMS group and 31 cases were included in the plastic stent group. The overall technical success rate of the operation was 98.3% (176/179). In the FCSEMS group, there were 21 patients recovered and 2 patients were relieved; in the plastic stent group, 29 patients were recovered, 1 case was relieved, and 1 case failed. There were no statistically significant differences in the efficacy and complication rate between the two groups (all P>0.05). The median stent indwelling time, ERCP times, and the number of indwelling stents in the FCSEMS group were 5.9 months, 2 times, and 1, respectively, and in the plastic stent group were 9.5 months, 4 times, and 8 respectively. There were statistical differences between the two groups (all P<0.05). Conclusions:FCSEMS for treatment of AS showed less duration of stenting, numbers of stents and endoscopic treatment sessions with the similar efficacy as plastic stents. It’s indicated that it’s necessary to pay attention to the probability of stent migration and pancreatitis.

Objective To investigate the correlation between the elastographic characteristics of liver and postoperative function of liver allografts.Methods Forty-eight cases of liver transplantation from The First Affiliated Hospital of Sun Yat-sen University were analyzed,Shear wave elastography (SWE) was performed before operation or at one week or one month post-operation.Liver function was evaluated by measuring alanine aminotransferase (ALT),aspartate transaminase (AST),total bilirubin (TBIL),γ-glutamine transferase (GGT),albumin (ALB),alkaline phosphatase (ALP),prothrombin time (PT),activated partial thromboplastin time (APTT),and international normalized ratio (INR).Early allograft dysfunction (EAD) was also analyzed with reference to SWE among liver transplant recipients.Results SWE at one week after transplantation was significantly correlated with TBIL (r=0.525 6,P<0.01),APTT (r=0.668 3,P<0.000 1),PT (r=0.593 7,P=0.000 1),INR (r=0.609 6,P<0.000 1) and prealbumin (r=-0.464 1,P<0.01).However,no significant correlation was observed between pre-operative SWE and parameters of post-operative liver function.SWE in EAD patients was higher than that of patients without EAD (17.60±1.09 kPa vs.13.38±0.99 kPa,P<0.01).The optimal cut-off value of SWE at one week post-operation was 14.85 kPa.Conclusion Postoperative SWE is significantly correlated with postoperative liver function tests and EAD,suggesting SWE is a potential test for evaluating the quality of liver allografts.

Objective Ischemia reperfusion injury (IRI) is a major limiting factor of graft survival in organ transplantation.We've established a novel procedure called ischemia-free liver transplantation (IFLT) in big animal study.In this report,we aimed to investigate the feasibility and early outcomes of IFLT.Methods We have performed 3 cases of IFLT during July 23,2017 to August 9,2017.We analyzed the surgical methods,normothermic perfusion parameters,blood gas analysis,liver function tests and complications early after liver transplantation.Pathologic studies and immunohistochemical staining of donor liver biopsies were conducted before procurement,at the end of machine perfusion,as well as after re-vascularization for evaluating IRI.Results The surgical procedures of all 3 patients were successful,without stoppage of blood supply for the liver grafts throughout organ procurement,ex vivo preservation and implantation.During normothermic perfusion,the pH value was stable within the normal range and the lactate levels dropped quickly to lower than detected (＜0.3 mmol/L) within 1.5-3 h.The livers continued to produce bile with the volume of 2-6 mL/h.Hematoxylin and eosin (HE) staining evaluation and TdT-mediated dUTP nick end labeling (TUNEL) assay of biopsies taken from liver tissues before procurement,at the end of machine perfusion and after re-vascularization,showed few necrostic and apoptotic hepatocytes in the liver biopsies.The immunohistochemical staining of IL-1β and vWF suggested no inflammatory cytokine release and sinusoidal endothelial cell activation.The three patients recovered smoothly without rejection,vascular and biliary complications.Conclusion IFLT is a feasible and effective procedure,which is able to overcome the major limitations of conventional procedure.The novel IFLT will become one of the mainstream transplant procedures in the future.

Objective To report the results of lung transplantation using graft lungs from donation after citizens death.Methods The clinical data of lung transplantation between January 2016 and June 2016 were analyzed retrospectively.Results Totally 20 patients with end stage lung diseases underwent lung transplantation.Of the 20 patients,11 cases (55％) underwent single lung transplantation and 9 cases (45 ％) underwent bilateral lung transplantation.The top two diseases for lung transplantation were pulmonary fibrosis in 11 cases (55％) and emphysema in 6 cases (30％).Four cases (20％) were given intraoperative ECMO support.Median duration of postoperative intubation was 2 days:1 day for single lung transplantation and 4 days for bilateral lung transplantation,respectively.Acute rejections were diagnosed in 9 patients (45％) who were successfully treated with high-dose intravenous methylprednisolone or methylprednisolone combined with anti-human thymocyte globulin.Postoperative pneumonia episodes occurred in 16 cases (80％)and 4 of them were associated fungal pneumonia.Preoperative sputum culture showed positive bacteria in 16 donors (80％) and 17 kinds of strains were identified.Postoperative sputum culture showed positive bacteria in 19 recipients and 4 of them had the same strains as compared with the corresponding donors.One recipient died of primary graft dysfunction in early term (＜ 1 month)postoperatively,two recipients abandoned treatments and died in 1 week after the discharge,and the remaining 17 cases successfully recovered.Median hospital duration was 55 days:35 days for single lung transplantation and 67 days for bilateral lung transplantation,respectively.Conclusion LLung transplantation is an effective treatment for end-stage lung diseases.Carefully selecting donors,well protecting graft lung and proper peri-operative treatment are the key steps leading to successful lung transplantation using grafts from organ procurement organization.

Objective To investigate the long-term clinical efficacy of simplified multivisceral transplantation in patients with end-stage liver disease and type 2 diabetes.Methods The clinical data of 31 cases of simplified multivisceral transplantations between 2009 to 2017 were retrospectively analyzed.Results Median post-transplant follow-up was currently 13 ± 26 (0-86) months.Two recipients died of multiple organ dysfunction system (MODS) followed by severe sepsis on postoperative day (POD) 15 and 18,respectively.One recipient died from severe pneumonia with pyemia on POD 37.One recipient died of graft versus host disease (GVHD) on POD 40.One recipient died from acute myelogenous leukemia.Two recipients died of tumor recurrence at postoperative month (POM) 9 and 26,respectively.No biliary complication or diabetes recurrence was observed during follow-up.Condusion Donation after citizen's death is becoming the only organic source in China.Our results indicate that combined en-bloc liver-pancreas transplantation is technically feasible and leads to excellent long-term control of glucose metabolism and satisfactory quality of life in recipients with end—stage liver disease and diabetes mellitus.

Objective To investigate the diagnosis and treatment of pure red cell aplasia (PRCA) caused by human parvovirus B19 (HPVB19) after liver transplantation.Method The clinical data of one case of PRCA caused by HPVB19 after liver transplantation,including clinical manifestations,diagnosis and treatment,were retrospectively analyzed,and the related literatures were reviewed.Result The first case of PRCA caused by HPVB19 after liver transplantation in our center with typical clinical manifestations of anemia was diagnosed,including dizziness,fatigue,anhelation and so on.A progressive decrease in erythrocyte count,reticulocyte count and hemoglobin level were observed by blood routine test.Bone marrow aspiration biopsy showed an absence of erythroid cells and the HPVB19 DNA test of blood was positive.Erythrocyte count,reticulocyte count and hemoglobin level were back to normal after the anti-rejection strategy changing from tacrolimus and rapamycin to cyclosporin and rapamycin and a normal human myelogram was observed by bone marrow aspiration biopsy.The DNA concentration of HPVB19 in blood was below the lower test limit.The blood test of HPVB19 DNA showed a positive result again after the anti-rejection strategy changed back to tacrolimus and rapamycin duo to increased blood creatinine level while the reticulocyte count was still in normal scale.This is the first reported case of successfully cured PRCA caused by HPVB19 in liver transplantation patients through changing the anti-rejection strategy and also the first case of HPVB19 re-infection or relapse without PRCA recurrence in liver transplantation patients.Conclusion This case may indicate the importance of immunosuppressive drug changing in the treatment of liver recipients suffering from PRCA caused by HPVB19 infection,and the genotype test may promote the understanding and treatment for this disease.

Acute Disease ; Glucocorticoids ; Graft Rejection ; Heart Rate ; Humans ; Hyperglycemic Hyperosmolar Nonketotic Coma ; Liver Transplantation

Objective To investigate the methods and techniques for organ procurement from donation after cardiac death (DCD),and to evaluate post-transplant outcomes.Methods In this retrospective study,clinical data of 26 cases of DCD organ procurements were analyzed through either epigastric multivisceral organ harvesting or solitary organ harvesting.Results Twenty livers,44 kidneys and 2 multivisceral grafts were procured,followed by 24 cases of liver transplantation,42 cases of kidney transplantation,and 2 cases of multivisceral transplantation.The operations were successful and all transplanted organs were satisfactorily recovered with no primary nonfunction or other complications observed.Conclusion Our methods and techniques for organ procurement from DCD donors require experienced surgery skills,while can maximatily shorten donor organ ischemic time,guarantee procurement of high quality of organs and ensure a favourable transplant outcomes.