Objective:To compare the effect of in situ and ex situ liver splitting techniques on the short-term outcomes of complete split liver transplantation.Methods:A retrospective analysis was conducted on the perioperative and follow-up data of 81 adult split liver transplant recipients and 42 donors at Ningbo University's Affiliated Lihuili Hospital from Mar 2021 to Dec 2023. Patients were divided into the ex situ and in situ splitting groups, and short-term complications were compared.Results:As of Dec 2023, the follow-up duration ranged from 1 to 30 months, with a median of 19 months. Cold and warm ischemia times were significantly shorter in the in situ splitting group compared to the ex situ group ( P<0.001). Postoperative peak levels of AST and ALT were also lower in the in situ splitting group ( P<0.01). However, the incidence of biliary complications was higher in the in situ splitting group (13 cases vs. 1 case, P=0.028). Conclusions:Compared to ex situ splitting, in situ splitting significantly reduces cold and warm ischemia times and results in less hepatocellular injury. However, it is associated with a higher incidence of biliary complications.

Donation after circulatory death liver transplantation(DCD-LT)remains a curative treatment for end-stage liver disease.Variant hepatic arteries are frequently encountered during transplantation,and inadequate management may result in localized ischemia and graft dysfunction.Precise handling of these variations remains a critical determinant of surgical success.This review summarizes anatomical classifications based on Michels' typology,highlights the value of imaging modalities in preoperative evaluation and intraoperative decision-making,and outlines current surgical approaches.Particular emphasis is placed on standardized strategies for arterial reconstruction in complex variations.Future research perspectives are also proposed,aiming to optimize assessment and management of variant hepatic arteries in DCD-LT.

Donation after circulatory death liver transplantation(DCD-LT)remains a curative treatment for end-stage liver disease.Variant hepatic arteries are frequently encountered during transplantation,and inadequate management may result in localized ischemia and graft dysfunction.Precise handling of these variations remains a critical determinant of surgical success.This review summarizes anatomical classifications based on Michels' typology,highlights the value of imaging modalities in preoperative evaluation and intraoperative decision-making,and outlines current surgical approaches.Particular emphasis is placed on standardized strategies for arterial reconstruction in complex variations.Future research perspectives are also proposed,aiming to optimize assessment and management of variant hepatic arteries in DCD-LT.

Objective:To compare the effect of in situ and ex situ liver splitting techniques on the short-term outcomes of complete split liver transplantation.Methods:A retrospective analysis was conducted on the perioperative and follow-up data of 81 adult split liver transplant recipients and 42 donors at Ningbo University's Affiliated Lihuili Hospital from Mar 2021 to Dec 2023. Patients were divided into the ex situ and in situ splitting groups, and short-term complications were compared.Results:As of Dec 2023, the follow-up duration ranged from 1 to 30 months, with a median of 19 months. Cold and warm ischemia times were significantly shorter in the in situ splitting group compared to the ex situ group ( P<0.001). Postoperative peak levels of AST and ALT were also lower in the in situ splitting group ( P<0.01). However, the incidence of biliary complications was higher in the in situ splitting group (13 cases vs. 1 case, P=0.028). Conclusions:Compared to ex situ splitting, in situ splitting significantly reduces cold and warm ischemia times and results in less hepatocellular injury. However, it is associated with a higher incidence of biliary complications.

Objective:To evaluate the reoperation of abdominal metastasis after liver resection for hepatocellular carcinoma (HCC).Methods:The data of 2748 patients with liver cancer undergoing surgical resection at the Department of Hepatobiliary and Pancreatic Surgery of Li Huili Hospital of Ningbo Medical Center from January 2010 to January 2022 were retrospectively screened. A total of 19 patients with abdominal metastases after liver resection undergoing reoperation were enrolled, which were all males with a median age of 53 years (27 to 68). The surgical procedures and diagnosis for abdominal metastases were recorded, and the recurrence and survival of patients were followed up.Results:During the follow-ups of initial resection of HCC, 10 patients were diagnosed with postoperative abdominal metastasis by enhanced CT, and seven patients were diagnosed by MRI. MRI and PET/CT were negative in two patients. Abdominal metastasis was found during reoperation in one case and liver transplantation in the other case due to postoperative liver recurrence. All 19 patients successfully underwent radical resection of abdominal metastases. Eighteen patients underwent open surgery and one underwent laparoscopic surgery. Among them, nine cases underwent simple metastases resection, six combined liver resection, one combined liver resection and right hemicolectomy, one combined partial rectal resection, one combined partial small bowel resection, and one combined liver transplantation. The 1-year, 3-year, and 5-year disease-free survival rates were 26.3%, 15.8%, 10.5%, respectively. The 1-year, 3-year, and 5-year overall survival rates were 94.7%, 26.3%, 15.8%, respectively. Three patients are currently surviving disease-free for 154.3 months, 67.3 months, and 33.4 months, respectively. These three patients all had single abdominal metastase and did not receive any targeted or immune treatments after surgery.Conclusion:For patients with localized or single abdominal metastases after HCC surgery, reoperation for metastases can bring survival benefits.

Objective:To investigate the factors influencing recipient liver regeneration after full-size split liver transplantation (fSLT).Methods:The clinical data of patients undergoing split liver transplantation in the Affiliated Li Huili Hospital of Ningbo University from May 2019 to Sep 2023 were retrospectively collected. Graft volume (GV) and initial graft volume (IGV) at (30±7) days after operation were measured, and postoperative liver regeneration rate (LRR) was calculated. The patients undergoing fSLT were divided into high regeneration group and low regeneration group with LRR=30% as boundary. The differences of donor and recipient data and perioperative data between the two groups were compared.Results:A total of 52 patients were included. The low fSLT regeneration group (16 cases) was compared with the high fSLT regeneration group (36 cases), and in high fSLT regeneration group donor age was lower, the donor liver steatosis was less, GRWR was lower, the incidence of hepatitis B virus-related liver disease was lower, the postoperative diagnosis of malignant liver disease was lower, the intraoperative blood loss was less, and the postoperative platelet count was higher. The levels of liver enzyme and total bilirubin (TBiL) were higher than those in high regeneration group ( P<0.05). Conclusions:Donor age, donor liver steatosis, GRWR, hepatitis B virus associated liver disease, and recipient pathogenesis are important factors affecting liver regeneration after fSLT. Postoperative platelet and liver enzyme levels are important indicators for monitoring liver regeneration after fSLT.

Objective:To investigate the risk factors for postoperative early recurrence of patients with single large hepatocellular carcinoma (HCC) (tumor diameter≥5cm).Methods:Clinical data of 135 single large HCC patients who underwent radical resection from Jan 2015 to Sep 2020 in Ningbo Medical Centre Lihuili Hospital were analyzed.Results:Seventy-five HCC patients suffered recurrence,among those 42 patients had early recurrence(within 12 months). Multivariate analysis showed that alpha-fetoprotein (AFP)≥400 ng/ml ( OR=3.510,95% CI: 1.528-8.064; P=0.003) and tumor microvascular invasion (MVI) ( OR=2.769,95% CI: 1.143-6.706; P=0.024) were independent risk factors for early recurrence of single large hepatocellular carcinoma. Survival analysis showed that early recurrence risk factors significantly reduced recurrence free survival (RFS)(AFP≥400 ng/ml, χ 2=23.038, P<0.001; MVI positive , χ 2=10.554, P=0.001) and overall survival (OS) (AFP≥400 ng/ml, χ 2=14.336, P<0.001; MVI positive, χ 2=10.481, P=0.001) in single large hepatocellular carcinoma patients. Conclusion:AFP≥400 ng/ml and MVI positive are independent risk factors for postoperative early recurrence in single large hepatocellular carcinoma patients.

Objective:To evaluate the short-term efficacy of split liver transplantation (SLT) in patients with acute-on-chronic liver failure (ACLF).Methods:The clinical data of 9 ACLF patients receiving SLT in our center from Mar 2021 to May 2022 were retrospectively analyzed to evaluate its safety and efficacy.Results:The preoperative APASL ACLF Research consortium (AARC) score of the 9 ACLF patients was 8 points in 1 case, 9 points in 3 cases, 10 points in 3 cases, 11 points in 1 case and 12 points in 1 case, 7 cases were in AARC-ACLF grade 2, and 2 cases in grade 3.In-situ liver splitting was performed in 9 deceased donors, including 4 classical split cases, 5 full size split cases. Among these 9 ACLF patients, 2 received left half liver transplantation, 3 received right half liver transplantation, and 4 received extended right lobe liver transplantation. After transplantation, all 9 recipients were discharged fully recovered, 1 case developed Clavien grade Ⅳa complication and 2 cases developed Clavien grade Ⅲb complication.After SLT treatment the median postoperative hospital stay was 27 days, the 1-year survival rate was 100%, and the organ survival rate was 88.9%.Conclusion:Split liver transplantation is a safe and feasible treatment method for ACLF patients.

Objective:To analyze the prognostic factors affecting salvage liver transplantation (SLT).Methods:The clinical data of 97 patients undergoing liver transplantation in the Ningbo Medical Centre Lihuili Hospital from January 2012 to May 2022 were retrospectively analyzed, including 84 males and 13 females, aged (53.6±7.4) years. Among them, 33 patients underwent primary liver transplantation (PLT) and 64 underwent SLT. SLT patients were subdivided into the groups within the Milan criteria (SLT-A, n=35) and beyond the Milan criteria (SLT-B, n=29), according to whether the Milan criteria were met at first hepatectomy. Clinicopathological and prognostic data were subsequently analyzed. Results:The tumor number ( χ2=16.03, P<0.001), microvascular invasion (MVI) ( χ2=10.97, P=0.004), recurrence rate ( χ2=9.31, P=0.010), recurrence-free survival (RFS, F=14.05, P=0.001) and overall survival (OS, F=17.27, P<0.001) were significantly different among the three groups. RFS ( P=0.047) and OS ( P=0.012) in PLT group were better than those in SLT-B group. RFS ( P=0.007) and OS ( P=0.024) in SLT-A group were also better than those in SLT-B group. The multivariate analysis indicated that beyond the Milan criteria at first hepatectomy was an independent risk factor for RFS ( HR=4.378, 95% CI: 1.393-13.756, P=0.011) and OS ( HR=5.391, 95% CI: 1.428-20.352, P=0.013) in patients undergoing SLT, and MVI positive ( HR=4.042, 95% CI: 1.137-14.368, P=0.031) was an independent risk factor for RFS in patients undergoing SLT. Conclusion:Patients beyond the Milan criteria at first hepatectomy and MVI positive showed a poorer prognosis after SLT. Whether the Milan criteria should be the gold standard for SLT as well as for PLT needs further study.

Objective:To analyse the risk factors of biliary leakage after surgical resection in patients with perihilar cholangiocarcinoma (PHCC).Methods:The medical data on 179 patients who underwent surgical resection for PHCC at the Department of Hepatopancreatobiliary Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo University from April 2000 to April 2020 were collected, and 160 patients were finally enrolled into this study. There were 86 males and 74 females, aged (63.4±10.8) years. The 44 patients with class B biliary leakage and the 5 patients with class C biliary leakage were classified into the biliary leakage group, while the remaining 111 patients were classified into the control group. Risk factors of biliary leakage were analysed by univariate and multivariate logistic regression analyses.Results:Operation time ≥360 min, resection and reconstruction of hepatic hilar vessels on the preserved side of liver and number of bile duct openings of >3 in remnant liver were significantly higher in the biliary leakage than the control group (all P<0.05). Multivariate analysis showed that resection and reconstruction of hepatic hilar vessels on the preserved side ( OR=2.322, 95% CI: 1.078-5.002, P=0.028) and 3 or more bile duct openings in the remnant liver ( OR=2.656, 95% CI: 1.198-5.892, P=0.016) were significantly associated with biliary leakage. Conclusion:Resection and reconstruction of hepatic hilar vessels on the preserved side of liver and 3 or more bile duct openings in remnant liver were independent risk factors for biliary leakage after PHCC resection.