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After the occurrence of acute rejection following solid organ transplantation, high-dose glucocorticoid (steroid) pulse therapy is commonly used. However, high-dose steroid pulse therapy is ineffective for some patients, leading to steroid resistant acute rejection, which may easily result in graft loss and severely affect patient prognosis. It is currently believed that both cell-mediated rejection and antibody-mediated rejection are involved in the occurrence and development of steroid resistant acute rejection. The diagnosis and treatment of steroid resistant acute rejection after kidney transplantation have become relatively mature, while the focus on steroid resistant acute rejection after liver transplantation has been relatively low in the past in China, and a unified standardized treatment plan has not yet been formed. Therefore, this article reviews the pathogenesis, diagnosis, and treatment of steroid resistant acute rejection after liver transplantation, in order to provide a reference for the diagnosis and treatment of steroid resistant acute rejection after liver transplantation. [ABSTRACT FROM AUTHOR]

Objective To explore the relationship between PANoptosis and hepatic ischemia-reperfusion injury (HIRI), and to screen the key genes of PANoptosis in HIRI. Methods PANoptosis-related differentially expressed genes (PDG) were obtained through the Gene Expression Omnibus database and GeneCards database. Gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Set Enrichment Analysis (GSEA) were used to explore the biological pathways related to PDG. A protein-protein interaction network was constructed. Key genes were selected, and their diagnostic value was assessed and validated in the HIRI mice. Immune cell infiltration analysis was performed based on the cell-type identification by estimating relative subsets of RNA transcripts. Results A total of 16 PDG were identified. GO analysis showed that PDG were closely related to cellular metabolism. KEGG analysis indicated that PDG were mainly enriched in cellular death pathways such as apoptosis and immune-related signaling pathways such as the tumor necrosis factor signaling pathway. GSEA results showed that key genes were mainly enriched in immune-related signaling pathways such as the mitogen-activated protein kinase (MAPK) signaling pathway. Two key genes, DFFB and TNFSF10, were identified with high accuracy in diagnosing HIRI, with areas under the curve of 0.964 and 1.000, respectively. Immune infiltration analysis showed that the control group had more infiltration of resting natural killer cells, M2 macrophages, etc., while the HIRI group had more infiltration of M0 macrophages, neutrophils, and naive B cells. Real-time quantitative polymerase chain reaction results showed that compared with the Sham group, the relative expression of DFFB messenger RNA in liver tissue of HIRI group mice increased, and the relative expression of TNFSF10 messenger RNA decreased. Cibersort analysis showed that the infiltration abundance of naive B cells was positively correlated with DFFB expression (r=0.70, P=0.035), and the infiltration abundance of M2 macrophages was positively correlated with TNFSF10 expression (r=0.68, P=0.045). Conclusions PANoptosis-related genes DFFB and TNFSF10 may be potential biomarkers and therapeutic targets for HIRI. [ABSTRACT FROM AUTHOR]

Objective To explore the technical process and clinical application of laparoscopic combined upper midline incision minimally invasive liver transplantation. Methods A retrospective analysis was conducted on 30 cases of laparoscopic combined upper midline incision minimally invasive liver transplantation. The cases were divided into cirrhosis group (15 cases) and liver failure group (15 cases) based on the primary disease. The surgical and postoperative conditions of the two groups were compared. Results All patients successfully underwent laparoscopic "clockwise" liver resection, with no cases of passive conversion to open surgery or intolerance to pneumoperitoneum. In 6 cases, the right lobe was relatively large, and the right hepatic ligaments could not be completely mobilized. One case required an additional reverse "L" incision during open surgery. All patients successfully completed the liver transplantation, with no major intraoperative bleeding, cardiovascular events, or other occurrences in the 30 patients. The model for end-stage liver disease (MELD) score in the cirrhosis group was lower than that in the liver failure group (P<0.001). There were no statistically significant differences between the two groups in terms of age, surgical time, blood loss, anhepatic phase, or cold ischemia time (all P>0.05). During the perioperative period, there was 1 case of hepatic artery embolism, 1 case of portal vein anastomotic stenosis, no complications of hepatic vein and inferior vena cava, and 3 cases of biliary anastomotic stenosis, all of which occurred in the liver failure group. Conclusions In strictly selected cases, the minimally invasive liver transplantation technique combining laparoscopic hepatectomy with upper midline incision for graft implantation has the advantages of smaller incisions, less bleeding, relatively easier operation, and faster postoperative recovery, which is worthy of clinical promotion and application. [ABSTRACT FROM AUTHOR]

Benign liver lesions mainly include hepatic hemangioma， focal nodular hyperplasia of the liver， hepatocellular adenoma， and hepatic angiomyolipoma. Hepatic alveolar echinococcosis is a type of parasitic disease， and since it mainly occurs in the liver， it is also a benign lesion of the liver. The clinical treatment of benign liver lesions is mainly based on follow-up observation， supplemented by surgical resection. For patients with end-stage diseases， liver transplantation can be performed due to the large volume of the lesion， the invasion of a number of surrounding large vessels， unclear anatomic location， and the possibility of intraoperative rupture and massive hemorrhage. Since patients with poor liver function based on the liver allocation score for organ donation are more likely to get donor liver， it is difficult for patients with benign liver lesions to obtain the corresponding donor liver resources due to the growth pattern of benign liver lesions， thereby leading to the limited application of allogeneic liver transplantation. Since its emergence in the 1980s， ex vivo liver resection and autotransplantation （ELRA） has brought a new way for the treatment of such patients. This article summarizes the current application of ELRA in benign liver lesions， in order to provide a reference for diagnosis and treatment by clinical medical staff. [ABSTRACT FROM AUTHOR]

Metastasis of colorectal cancer is the primary cause of progression and mortality. Although surgical resection is the preferred method for liver metastasis of colorectal cancer, liver transplantation, as a treatment approach, has attracted widespread attention for patients with unresectable colorectal cancer liver metastases. Recently, an increasing number of clinical trials have focused on the indications for liver transplantation in the treatment of unresectable colorectal cancer liver metastases. Therefore, we systematically summarize the progress of liver transplantation in the application of unresectable colorectal cancer liver metastasis from the aspects of indications, contraindications and advantages over traditional treatment methods. [ABSTRACT FROM AUTHOR]

Thrombocytopenia is one of the common complications after liver transplantation, with pathophysiological mechanisms including insufficient platelet production and increased platelet consumption, which severely affects the prognosis of liver transplant recipients. Various factors such as preoperative hepatitis virus infection, intraoperative ischemic injury, and postoperative use of immunosuppressive drugs may lead to thrombocytopenia after liver transplantation. Early detection and effective treatment of thrombocytopenia after liver transplantation are currently hot topics of research. Based on the existing literature, this article reviews the definition, pathophysiological mechanisms, risk factors, treatment, and prevention of thrombocytopenia, and discusses the occurrence and development of thrombocytopenia after liver transplantation and related diagnosis and treatment strategies, aiming to optimize the existing treatment opinions, reduce the risk of thrombocytopenia after transplantation and improve the prognosis of liver transplant recipients. [ABSTRACT FROM AUTHOR]

Objective To systematically analyze the literature on ABO-incompatible (ABOi) organ transplantation and explore the research hotspots and trends in this field. Methods CiteSpace software was used for visual analysis of ABOi organ transplantation literature collected from the China National Knowledge Infrastructure, VIP web, Wanfang Data, and the Web of Science Core Collection database from January 1, 2013 to December 31, 2023 after cleaning, including the volume of literature published, authors, countries, institution and keywords. Results A total of 588 valid foreign-language author publications and 85 valid Chinese-language author publications were included. Since 2021, the volume of foreign literature publications has shown a downward trend, while the volume of domestic literature published has generally shown a upward trend. The top two core Chinese authors are Wang Yi and Zhu Zhijun; the top three core authors in foreign literature are Nakatani Tatsuya, Tanabe Kazunari, and Uchida Junji. The most active institution in China is Huazhong University of Science and Technology, followed by Zhejiang University and Sichuan University, with relatively insufficient closeness in cooperation between related institutions. The institutions with the most publications abroad are Ulsan University, Seoul National University and Tokyo Women's Medical University in Japan. The top three countries in English-language literature publications are Japan, Republic Korea, and the United States, and China ranked 5th. Keyword cluster analysis shows that the research focus of at home and abroad is mainly on nine topic clusters including ABOi organ transplantation, cryoprecipitation, kidney transplantation, liver transplantation, blood type antigen detection technology and post-transplant complications. Conclusions At present, The research in the field of ABOi organ transplantation is mainly concentrated on kidney transplantation and liver transplantation, showing an overall positive development trend. In the future, it is expected to further promote development of this field by strengthening international cooperation, expanding research investment and promoting the application of advanced technologies. [ABSTRACT FROM AUTHOR]

With the advancement of surgical techniques and perioperative management, liver transplantation has become an effective method to save the lives of patients with end-stage liver disease. However, the imbalance between organ supply and demand remains a significant challenge, and the decision-making process for liver transplantation still faces many difficulties. Artificial intelligence can efficiently extract features and establish connections from complex factors, benefiting clinical decision-making in liver transplantation through data-driven approaches. These include optimizing pre-transplant candidate eligibility decisions and donor-recipient matching, predicting the risk factors for disease recurrence and other related complications after transplantation, and guiding the management of liver transplant recipients. Therefore, this article reviews the application of artificial intelligence in organ allocation, donor liver evaluation, post-operative recurrence of hepatocellular carcinoma, and prediction of post-operative complications in liver transplantation, aiming to provide a reference for the research and development of artificial intelligence in the field of liver transplantation. [ABSTRACT FROM AUTHOR]

Objective: To investigate the risk factors for biliary stricture within two years after orthotopic liver transplantation， and analyze the survival. Methods: A retrospective analysis was performed for the data of 495 patients who underwent liver transplantation at Liver Transplantation Center of The First Hospital of Jilin University from January 2014 to January 2022， and according to the presence or absence of biliary stricture within two years after liver transplantation， the 495 patients were divided into stricture group with 89 patients and non-stricture group with 406 patients. The risk factors for biliary stricture and prognosis were analyzed. The independent-samples t-test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate Cox regression analyses were used for the analysis of risk factors， and the Kaplan-Meier method was used for survival analysis. Results: Recipient sex （hazard ratio ［HR］=1.808， 95% confidence interval ［CI］： 1.055‍ ‍—‍ ‍3.098， P=0.031）， preoperative total bilirubin of the recipient （HR=1.002， 95%CI： 1.001 ‍—‍ 1.003， P=0.001）， cold ischemia time （HR=1.003， 95%CI： 1.001 ‍—‍ 1.005， P=0.007）， history of abdominal surgery for the recipient （HR=3.851， 95%CI： 2.273 ‍—‍ 6.524， P<0.001）， and mismatch of donor-recipient bile ducts （HR=1.962， 95%CI： 1.041 ‍—‍ 3.698， P=0.037） were identified as independent risk factors for biliary stricture within two years after transplantation. The median follow-up time was 4.09 years， and the 1-， 3-， and 5-year survival rates were 92.7%， 80.5%， and 75.4%， respectively， after liver transplantation. The onset of biliary stricture within two years after liver transplantation had no significant impact on the survival of patients undergoing orthotopic liver transplantation. Conclusion: Recipient sex， preoperative total bilirubin of the recipient， cold ischemia time， history of abdominal surgery for the recipient， and mismatch of donor-recipient bile ducts are independent risk factors for biliary stricture within two years after transplantation. The onset of biliary stricture within two years after transplantation does not affect the survival time of patients undergoing orthotopic liver transplantation. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship among the quality of life, parenting styles, and family quality in children after liver transplantation. Methods One hundred and thirty-six families of pediatric liver transplantation recipients admitted to the Third Affiliated Hospital of Sun Yat-sen University between April 2023 and February 2024 were enrolled. The study instruments included a general survey, the Pediatric Quality of Life Questionnaire 4.0 (PedsQL4.0), Pediatric Quality of Life Family Impact Module (PedsQL™FIM) 2.0 and the Parenting Styles and Dimensions Questionnaire (PSDQ). The correlation between family function, parental education style, and quality of life was analyzed by Pearson correlation analysis, and mediation effects were analyzed. Results Paternal authoritarian parenting styles were negatively correlated with the overall quality of life of pediatric recipients after liver transplantation (B=-0.93, 95%CI：-1.44 to -0.42) and family quality (B=-0.75, 95%CI: -1.31 to -0.18). Family quality was significantly positively associated with the quality of life in children after liver transplantation (B=0.49, 95%CI: 0.35 to 0.62). Mediating effect analysis revealed that paternal authoritarian parenting style could influence children’s quality of life after liver transplantation through family quality, and the direct effect was significant (direct effect=-0.64, 95%CI: -1.12 to -0.16). Conclusion Improving parenting styles, especially reducing paternal authoritarian parenting styles, and elevating family quality are of significance for enhancing the quality of life in children after liver transplantation. [ABSTRACT FROM AUTHOR]

Objective To explore risk factors of early lung infection after liver transplantation and to construct a prediction model of early lung infection after liver transplantation. Methods The clinical data of 269 patients who underwent orthotopic liver transplantation for the first time were retrospectively analyzed. Patients were divided into the infected group (n=97) and the non-infected group (n=172) according to whether pulmonary infection occurred within 30 days after operation. The preoperative general data, preoperative laboratory examination results, intraoperative and postoperative data of the patients were collected. Multivariate Logistic regression analysis were used to screen risk factors of pulmonary infection. Based on the results of multivariate analysis, the prediction model was constructed and the prediction efficiency of the model was evaluated. Results Univariate and multivariate Logistic regression analysis showed that preoperative PNI ≤ 41.70 (OR=1.972, 95%CI: 1.047-3.714, P=0.036), LMR≤1.52 (OR=2.020, 95%CI: 1.102-3.705, P=0.023), MELD score＞ 10.72（OR=1.985, 95%CI: 1.103-3.573，P=0.022), operative time > 448.00 min (OR=2.676, 95%CI: 1.515-4.727, P=0.001) and intensive care unit (ICU) hospitalization time > 4.0 days (OR=2.623, 95%CI: 1.335-5.154, P=0.005) were independent risk factors for early pulmonary infection after liver transplantation. The ROC area under the curve (AUC) of the prediction model based on the results of multivariate Logistic regression analysis was 0.768, the sensitivity was 80.41% and the specificity was 60.47%. Conclusion The prediction model based on PNI, LMR, MELD score, operation time and ICU hospitalization time can effectively predict the occurrence of early pulmonary infection after liver transplantation. [ABSTRACT FROM AUTHOR]

Background Self-perceived burden, anxiety and depression are among the most important factors affecting quality of life. At present, there is a lack of understanding on the research status and influencing factors of self-perceived burden in liver transplant recipients. Previous studies have shown that self-perceived burden, anxiety, depression and quality of life are correlated in pairs, but the effecting path among the three are not yet clear. Objective To explore the correlation of self-perceived burden and anxiety/depression with quality of life in liver transplant recipients, so as to provide guidance for psychological nursing intervention in clinical patients. Methods A total of 200 patients liver transplant recipients were enrolled from the liver transplantation inpatient and outpatient clinics of Jiangsu Province Hospital and Qinhuai Medical Area, General Hosptial of Eastern Theater Command of People's Liberation Army of China from March 2022 to February 2023. Patients were evaluated using Self- perceived Burden Scale (SPBS), Hospital Anxiety and Depression Scale (HADS) and the Chinese version of Post Liver Transplant Quality of Life Questionnaire (pLTQ). Spearman correlation analysis was used to examine the correlation among the scales. A structural equation model using Mplus 8. 3 was utilized to testify the relationship among self-perceived burden, anxiety/depression and quality of life in liver transplant recipients. Bootstrap method was used to test the effecting pathway. Results There were statistically significant differences in SPBS scores of liver transplant recipients with different levels of education and fannual family income (H=9. 656, 18. 796, P< 0. 05). There were statistically significant differences in HADS scores of liver transplant recipients with different numbers of somatic symptoms (H=9. 859, P<0. 05). There were statistically significant differences in the Chinese version of pLTQ scores of liver transplant recipients with different levels of education, postoperative survival time and numbers of somatic symptoms (H= 6. 892, 8. 023, 16. 099, P<0. 05). The total and each dimension scores in SPBS of liver transplant recipients were positively correlated with the total score and anxiety/depression dimension scores in HADS (r=0. 464~0. 586, 0. 460~0. 593, 0. 286~ 0. 408, 0. 464~0. 583, P<0. 01) and negatively correlated with the total score and each dimension scores in the Chinese version of pLTQ (r=-0. 572~-0. 416, -0. 599~-0. 441, -0. 365~-0. 213, -0. 559~-0. 428, P<0. 01). Structural equation model denoted that self-perceived burden negatively affected quality of life (β =-0. 186, P<0. 01). Anxiety/depression also negatively affected quality of life (β =-0. 679, P<0. 01). The self-perceived burden indirectly affected the quality of life of liver transplant recipients through anxiety and depression, with an effect value of -0. 429, accounting for 69. 76% of the total effect. Conclusion The quality of life in liver transplant recipients may be related to their self-perceived burden and anxiety/depression. Self-perceived burden may affect the quality of life of liver transplant patients through anxiety and depression. [ABSTRACT FROM AUTHOR]

Liver transplantation is one of the standard treatments for end-stage liver disease. With the development of surgical techniques and the optimization of perioperative management, the incidence of complications after liver transplantation has decreased, but perioperative neurological complications are still relatively common. The incidence of stroke varies greatly, with complex causes, as well as insidious onset, rapid progression and high fatality. Early identification and diagnosis of perioperative stroke after liver transplantation and timely effective treatment are of great significance for improving the prognosis of patients. Therefore, this article reviews the concept, occurrence, risk factors, diagnosis, treatment and prevention of perioperative stroke after liver transplantation, and explores the research progress of perioperative stroke after liver transplantation, in order to provide a reference for the diagnosis and treatment of perioperative stroke after liver transplantation. [ABSTRACT FROM AUTHOR]

Objective To identify early Klebsiella pneumoniae (KP) infection after liver transplantation and its impact on prognosis. Methods Clinical data of 171 liver transplant recipients were retrospectively analyzed, and they were divided into the non-infection (n=52) and infection groups (n=119) according to the bacterial culture results at postoperative 2 weeks. In the infection group, KP was not detected in 86 cases (non-KP infection group), and KP was cultured in 33 cases (KP infection group). Preoperative, intraoperative and postoperative data were statistically compared between the non-infection and infection groups, and between the non-KP infection and KP infection groups. The risk factors of early KP infection after liver transplantation and the influencing factors of long-term survival of the recipients were analyzed.Results Compared with the non-infection group, model for end-stage liver disease (MELD) score and total bilirubin level were higher, the operation time was longer, the length of postoperative intensive care unit (ICU) stay and the length of hospital stay were longer, the amount of intraoperative red blood cell transfusion was higher, the hospitalization expense was higher, the incidence of severe complications was higher, white blood cell count, absolute neutrophil cell count and neutrophil-to-lymphocyte ratio at postoperative 14 and 30 d were higher, absolute lymphocyte count at postoperative 14 d was lower and hemoglobin level at postoperative 30 d was lower in the infection group. The differences were statistically significant (all P<0.05). Compared with the non-KP infection group, MELD score, total bilirubin level and aspartate aminotransferase (AST) level were higher, the operation time and the length of postoperative ICU stay were longer, the hospitalization expense was higher, the 90-d fatality was higher, the albumin level at postoperative 14 d was lower, and total bilirubin level at postoperative 30 d was higher in the KP infection group. The differences were statistically significant (all P<0.05). Among 33 recipients with KP infection, 16 cases were resistant to carbapenem antibiotics, and 7 of them died within postoperative 90 d. Seventeen cases were intermediate or sensitive to carbapenem antibiotics, and 4 of them died within postoperative 90 d. Preoperative MELD score ≥17 and operation time≥415 min were the independent risk factors for KP infection after liver transplantation (both P<0.05). The length of postoperative ICU stay ≥44 h and KP infection were the independent risk factors for long-term prognosis of liver transplantation (both P<0.05). Conclusions KP infection is an independent risk factor for death after liver transplantation. High preoperative MELD score and long operation time are the independent risk factors for early KP infection after liver transplantation. [ABSTRACT FROM AUTHOR]

Objective To evaluate the protective effect and underlying mechanism of ulinastatin on hepatic ischemia-reperfusion injury. Methods Twenty-four male SD rats were divided into three groups: sham operation group (Sham group), hepatic ischemia-reperfusion injury group (HIRI group) and hepatic ischemia-reperfusion injury + ulinastatin pretreatment group (HIRI+UTI group), with 8 rats in each group. The HIRI rat models were established by occluding hepatic portal vein and hepatic artery for 1 h. In the HIRI+UTI group, the rats were intraperitoneally injected with ulinastatin at 30 min before model establishment, and an equivalent amount of normal saline was given in the Sham and HIRI groups. The rats were sacrificed at 6 h after model establishment. Serum samples were collected to detect alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Pathological changes of liver tissues were observed by hematoxylin-eosin (HE) staining. Ultrastructural changes of mitochondria in liver tissues were observed by transmission electron microscopy. The expression of glutathione peroxidase 4 (GPX4) was determined by immunofluorescent staining. The contents of malondialdehyde (MDA), glutathione (GSH), Fe, reactive oxygen species (ROS) and GPX4 were detected. The expression levels of GPX4 and acyl-CoA synthetase long-chain family 4 (ACSL4) messenger RNA (mRNA) and proteins in liver tissue were measured. Results Compared with the Sham group, serum ALT and AST levels were up-regulated, pathological changes such as congestion, hepatocyte necrosis and abnormal hepatic lobule structure were observed, pathological score was increased, the mitochondria shrank, the membrane density was increased, the mitochondrial crest was damaged or even absent, the contents of ROS, MDA and Fe were elevated, the GSH content was decreased, the fluorescent intensity of GPX4 was weakened, the relative expression levels of ACSL4 mRNA and protein were up-regulated, and the relative expression levels of GPX4 mRNA and protein were down-regulated in the HIRI group (all P<0.05). Compared with the HIRI group, serum ALT and AST levels were down-regulated, liver tissue injury was alleviated, pathological score was decreased, mitochondrial shrinkage and crest breakage were mitigated, the contents of ROS, MDA and Fe were down-regulated, the GSH content was up-regulated, the fluorescent intensity of GPX4 was enhanced, the relative expression levels of ACSL4 mRNA and protein were down-regulated, and the relative expression levels of GPX4 mRNA and protein were up-regulated in the HIRI+UTI group (all P<0.05). Conclusions Ulinastatin may alleviate hepatic ischemia-reperfusion injury in rats probably through inhibiting ferroptosis. [ABSTRACT FROM AUTHOR]

With the advancement of surgical technologies and the improvement of perioperative management, the survival rates of organ transplant recipients and grafts have been significantly elevated. Shortage of donor organs has become the main obstacle to further development of organ transplantation. Recently, kidney and heart xenotransplantation with genetically modified pigs as donors have entered clinical trials and achieved favorable results. Xenotransplantation has repeatedly become a hot spot in biomedical research. Compared with heart and kidney, the survival time of liver grafts from genetically modified pigs in non-human primates is shorter. Besides, experimental results are dramatically different. Hence, it is not eligible for clinical trials. Consequently, recent research progress in xenotransplantation was reviewed from surgical pattern selection, coagulation dysfunction and acute vascular rejection, advances in liver xenotransplantation were summarized, and the main problems hindering xenotransplantation from entering clinical trials and potential solutions were illustrated, aiming to provide reference for xenotransplantation from scientific research to clinical application. [ABSTRACT FROM AUTHOR]

Over the years of exploration and development, the surgical techniques and prognosis of liver transplantation in China have been significantly improved, resulting in a notable decrease in the prevalence of postoperative complications. However, ischemic-type biliary lesion remain a non-negligible issue. The Third Affiliated Hospital of Sun Yat-sen University formulated and published the "Expert Consensus on the Diagnosis and Treatment of Ischemic-Type Biliary Lesions after Liver Transplantation in Mainland China" in 2015, which has now been updated into a guideline based on current conditions and literature reports. This guideline elaborates in detail on the definition, incidence, pathogenesis, diagnosis, prevention of high-risk factors, and treatment of ischemic-type biliary lesion, aiming to provide standardized and normative guidance for the diagnosis and treatment of ischemic-type biliary lesion after liver transplantation, thereby reducing the rate of re-transplantation and fatality, and to improve the overall quality of life of liver transplant recipients. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of Six Sigma management in prevention of central venous catheter-related bloodstream infections (CLABSI) in children undergoing liver transplantation. Methods From January to September 2021, a total of 216 children with central venous catheter placement were selected as the control group, and 192 children with central venous catheter indwelling from January to September 2022 were selected as the intervention group. The control group received routine nursing management in the maintenance of central venous catheters, while the intervention group adopted Six Sigma management on the basis of routine care measures. The incidence of CLABSI and 1000-day catheter infection rate were compared between the two groups. Results The incidence of CLABSI in the intervention group was 1. 04%, which was lower than 1. 39% in the control group (P＜0. 05). The 1000-day catheter infection rate was 0. 64 ‰ in the intervention group, which was lower than 1. 07 ‰ in the control group (P＜0. 05). Conclusion The Six Sigma management method can effectively reduce the incidence of CLABSI in children undergoing liver transplantation and improve their safety. (目的 探讨六西格玛管理方法在预防肝移植儿童中心静脉导管相关性血流感染(CLABSI)中的应用效果。方法 选取2021年1月—9月留置中心静脉导管的216例患儿为对照组, 2022年1月—9月留置中心静脉导管192例患儿为干预组。针对肝移植儿童中心静脉导管的维护管理, 对照组实施常规护理措施, 干预组在对照组基础上采用六西格玛管理法。对比两组的CLABSI的发生率及千日导管血流感染率。结果 干预组CLABSI发生率为1. 04%, 低于对照组的1. 39%。差异有统计学意义(P＜0. 05); 干预组千日导管血流感染率为0. 64‰, 低于对照组1. 07‰, 差异有统计学意义(P＜0. 05)。结论 西格玛管理方法能有效降低肝移植儿童CLABSI发生率, 提高患儿安全。)

Objective To investigate the efficacy and safety of drug-eluting bead transarterial chemoembolization (DEB- TACE) as neoadjuvant therapy before liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) beyond Milan criteria with microvascular invasion (MVI) and its impact on the prognosis after LT. Methods From May 2016 to December 2022, 141 patients with HCC beyond Milan criteria underwent LT. A total of 55 patients with MVI were enrolled in the study and were divided into DEB-TACE before LT group (n=26) and control group (n=29) that did not receive any treatment before LT. The Kaplan-Meier method was utilized to estimate the overall survival (OS) rate and recurrence-free survival (RFS) rate after LT after potential prognostic factors for RFS and OS were identified. Results The objective response rate after DEB-TACE was 88%, and the main adverse event was embolization syndrome. The 1-, 2- and 3-year RFS rates in DEB-TACE group (88.5%, 79.2% and 73.9%) were higher than control group (69%, 50% and 44.4%). The 3-year RFS rate was significantly different between the two groups (χ²= 4.428, P=0.035). The 1-, 2- and 3-year OS rates in DEB-TACE group (100%, 91.7% and 82.6%) were not significantly (χ²=3.224, P=0.073) higher than control group (96.6%, 82.1% and 59.3%). Conclusion Preoperative DEB-TACE neoadjuvant therapy can improve the prognosis of LT in patients with HCC beyond Milan criteria with MVI. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) and acute kidney injury (AKI) after liver transplantation (LT), to clarify the influencing factors for AKI after liver transplantation, and to provide diagnostic reference indicators for the early prevention of AKI after LT. Methods A retrospective analysis was performed for the medical records of the adult patients who underwent LT in The First Hospital of Jilin University from September 13，2020 to June 30，2022, and according to the presence or absence of AKI after LT, the patients were divided into AKI group and non-AKI group. The propensity score matching (PSM) method was used to match the basic information of the two groups at a ratio of 1∶4. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The multivariate Logistic regression analysis was used to investigate the independent risk factors for AKI after LT. Results A total of 144 patients were included in this study, among whom 22 (15.3%) developed AKI after surgery and 122 (84.7%) did not develop postoperative AKI. A total of 93 patients were included after PSM, with 19 patients in the AKI group and 74 patients in the nonAKI group. The multivariate Logistic regression analysis showed that preoperative NT-proBNP (odds ratio ［OR］=7.692，95% confidence interval ［CI］：1.473—40.159，P=0.016), preoperative fibrinogen level (OR=5.520，95%CI：1.160—26.267，P= 0.032), time of operation (OR=15.802，95%CI：2.418—103.268，P=0.004), and intraoperative blood loss (OR=13.246，95%CI： 2.291—76.594，P=0.004) were independent risk factors for AKI after LT. Conclusion Preoperative NT-proBNP level may be used as a predictive factor for AKI after LT and can provide a certain reference for establishing a risk predictive model for AKI after LT. [ABSTRACT FROM AUTHOR]

Combined liver and kidney transplantation has been steadily applied in major transplantation centers, saving the lives of many patients with end-stage liver and renal failure. However, there are still multiple unresolved problems in the clinical diagnosis, treatment and long-term prognosis of combined liver and kidney transplantation. By referring to "Technical Operating Standards for Combined Liver and Kidney Transplantation (2019 Edition)" and the latest published literature and guidelines at home and abroad, "Guidelines for Clinical Diagnosis and Treatment of Combined Liver and Kidney Transplantation" was formulated. Recommendations and suggestions were delivered regarding the surgical indications and contraindications, preoperative preparation and evaluation, the timing of transplantation for endstage liver and kidney diseases, the selection of surgical approaches and postoperative follow-up, specific pathophysiology, surgical techniques, complication management and immunosuppressive treatment of combined live and kidney transplantation, aiming to enhance the utilization rate of grafts and improve the survival and prognosis of combined liver and kidney transplant recipients. [ABSTRACT FROM AUTHOR]

Rejection after liver transplantation severely affects the survival of recipients. Long-term use of immunosuppressants is an important approach to prevent rejection, whereas it may cause toxic effects and increase the risk of adverse events such as systemic infection and tumor recurrence, etc. Therefore, before successful liver transplantation, how to induce individual immune tolerance of recipients and achieve complete or early withdrawal of postoperative immunosuppressants remains to be investigated by practitioners of organ transplantation. In recent years, certain progresses have been made in the mechanism of immune tolerance induced by tolerogenic dendritic cells in liver transplantation, and preliminary outcomes have been obtained in clinical trials. In this article, basic research and clinical application progress in the characteristics of tolerogenic dendritic cells, the mechanism underlying participating in liver immune microenvironment remodeling, and inducing immune tolerance in liver transplantation were reviewed, aiming to provide reference for the application of tolerogenic dendritic cells in immune tolerance of liver transplantation. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of mesenchymal stem cells (MSCs) combined with immunosuppressants (IS) on immune rejection in a rat model of liver transplantation. Methods F344 rats were divided into Normal group (without any intervention), PS group (injected with an equal volume of normal saline), MSC group (injected with MSC), IS group (injected with IS), and MSC+IS group (injected with MSC and IS), with 8 rats in each group. For all rats except those in the Normal group, the Kamada’s double-cuff method was used to establish a model of orthotopic liver transplantation, without reconstruction of the hepatic artery. HE staining and Masson staining were performed for rat liver tissue, and the degree of liver fibrosis was analyzed; immunohistochemical experiments were used to measure the infiltration of T cells and NK cells, and immunofluorescence assay was used to analyze macrophage M2 polarization. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for survival analysis. Results Compared with the PS group, the MSC+IS group had a significantly prolonged survival time (P< 0.01), and the MSC group, the IS group, and the MSC+IS group had a significant improvement in the histological structure of the liver and a significant reduction in the degree of liver fibrosis (all P<0.000 1), as well as a significant reduction in the infiltration of NK and T cells (all P<0.000 1) and a significant increase in the degree of macrophage M2 polarization (all P< 0.000 1). The MSC+IS group had a significantly better effect than the MSC group and the IS group. Conclusion MSCs combined with IS can improve liver histopathology, reduce inflammatory cell infiltration, promote macrophage M2 polarization, and exert an immunosuppressive effect in rats after liver transplantation. [ABSTRACT FROM AUTHOR]

In recent years, due to the increasingly prominent shortage of liver transplant donors, more and more institutions have begun to use extended criteria donation (ECD) livers for transplantation. However, the incidence of postoperative complications and poor prognosis are higher for ECD liver transplantation. Hypothermic oxygenated machine perfusion (HOPE) is considered a method of preserving liver transplant donors that can improve the transplantation outcomes, especially for ECD livers. The main mechanisms of HOPE include reducing mitochondrial damage, oxidative stress damage, inflammation, and downregulating immune responses. Compared with other perfusion methods, HOPE can protect the function of the transplant, prolong the preservation time of the liver, and reduce postoperative complications. However, although HOPE has many advantages in clinical practice, its application is still in the exploratory stage, and its widespread use is limited by its high economic cost. Further research is needed in the future to fully demonstrate and realize the clinical role of HOPE, so that it can be better applied in clinical practice. [ABSTRACT FROM AUTHOR]

With persistent breakthrough and maturity of surgical procedures and postoperative immunosuppressive therapy, the survival rate of liver transplant recipients and grafts has been significantly increased. The shortage of donor liver has become the main obstacle for clinical development of liver transplantation. How to expand the source of donor liver has become an urgent issue. Groundbreaking progresses have been made in the use of common marginal donor livers in clinical liver transplantation, such as elderly donor liver, steatosis donor liver, viral hepatitis donor liver and liver from donation after cardiac death. Nevertheless, multiple restrictions still exist regarding the use of marginal donor liver. Consequently, the definition of marginal donor liver and research progress in the application of common marginal donor livers were reviewed, and the opportunities and challenges of mariginal donoor liver were illustrated, aiming to provide reference for expanding the donor pool for clinical liver transplantation and bringing benefits to more patients with end-stage liver disease. [ABSTRACT FROM AUTHOR]

Objective To investigate the long-term safety and effectiveness of withdrawal of hepatitis B immuneglobulin (HBIG) and/or nucleos(t)ide analogues (NAs) to prevent hepatitis B virus (HBV) reinfection in liver transplant recipients with hepatitis B-related diseases after successful vaccination. Methods Baseline data of 76 liver transplant recipients undergoing hepatitis B immune reconstitution after receiving hepatitis B vaccines were retrospectively analyzed. The vaccination and response, the follow-up results of respondents with HBIG and/or NAs withdrawal, and the reinfection of HBV after withdrawal of HBIG and/or NAs were analyzed. Results The time interval from liver transplantation to hepatitis B vaccination was 26 (20, 40) months. The time interval from vaccination to response was 15 (8,27) months. Initially, 76 recipients withdrew HBIG, and 36 recipients withdrew HBIG and NAs. During the follow-up, 12 of 76 recipients who withdrew HBIG resumed use of HBIG, and 16 of 36 recipients who withdrew HBIG and NAs resumed use of NAs. The withdrawal time of HBIG and NAs was 135 (98,150) and 133 (34,149) months, respectively. Sixteen respondents did not receive booster, and 36 respondents received boosters on a regular basis. The time interval between the first booster and HBIG withdrawal was 44 (11,87) months. No significant differences were observed in baseline data between the respondents with and without boosters (all P>0.05). During the follow-up, 9 recipients were lost to follow-up, 5 were re-infected with HBV, 3 died, and 1 recipient developed graft loss and underwent secondary liver transplantation. Among 5 recipients re-infected with HBV, 4 cases had virus mutation. Significant differences were found between re-infected and uninfected patients regarding withdrawal of NAs and hepatitis B e antigen (HBeAg) positive before transplantation (both P<0.05). Conclusions Long-term withdrawal of HBIG is feasible and safe for recipients with successful hepatitis B immune reconstitution after liver transplantation for hepatitis B-related diseases. Nevertheless, whether antiviral drugs can be simultaneously withdrawn remains to be validated. [ABSTRACT FROM AUTHOR]

As a mature organ transplantation, liver transplantation has become the optimal treatment for end-stage liver disease, which can improve the quality of life of recipients. However, liver transplantation still faces multiple challenges, such as rejection, infection, biliary complications, delayed graft function, ischemia-reperfusion injury, recurrence of hepatocellular carcinoma after liver transplantation, kidney-related diseases after transplantation, and donor shortage, etc., which remain to be improved and urgently resolved. With persistent attempts and experience accumulated by Chinese experts and scholars, these problems related to liver transplantation have been gradually resolved year by year. In 2023, liver transplantation teams in China have achieved a series of significant progresses in the field of clinical research. In this article, clinical frontiers and novel technological progresses in the field of liver transplantation in 2023 were reviewed, and the achievements of clinical liver transplantation in China in 2023 were summarized, aiming to provide novel ideas for promoting further development of liver transplantation in China. [ABSTRACT FROM AUTHOR]

Liver transplantation is the optimal treatment for end-stage liver disease and hepatocellular carcinoma, which can significantly improve clinical prognosis and quality of life of patients. However, multiple challenges, such as rejection, immune tolerance, shortage of donor liver, preservation of donor liver, ischemia-reperfusion injury and postoperative complications, etc., limit the efficacy of liver transplantation in clinical practice. Research teams in China have made significant contributions to the basic research related to liver transplantation by making continuous efforts and combining the development of emerging technologies, interdisciplinary integration and other emerging fields. In this article, the frontier progress in the basic research of liver transplantation in 2023 was reviewed, highlighting the progress made by Chinese research teams in the basic research of liver transplantation, aiming to provide reference for promoting the integration of Chinese characteristics into the research of liver transplantation, accelerate the integration of Chinese liver transplantation research with international community, and promote further advancement of liver transplantation in China. [ABSTRACT FROM AUTHOR]

Hepatitis E virus infection is a common cause of acute viral hepatitis. In recent years, the incidence of hepatitis E has shown an increasing trend, which has gradually become an important cause of acute viral hepatitis worldwide. Age, sex, intensity of immunosuppression and socio-economic factors are all risk factors for hepatitis E virus infection. Liver transplant recipients require long-term use of immunosuppressive drugs for anti rejection treatment, prone to hepatitis E virus infection and at the risk of liver fibrosis and cirrhosis due to immunosuppression status. Therefore, special attention should be paid to liver transplant recipients in clinical practice. Meantime, related risk factors should be identified to assist diagnosis and take stricter preventive measures. According to literature review, the etiological characteristics of hepatitis E virus and the epidemiological characteristics, clinical manifestations, diagnosis and treatment of hepatitis E virus infection in liver transplant recipients were reviewed, aiming to properly monitor, treat and prevent hepatitis E virus infection in liver transplant recipients in clinical practice, improving the prognosis of liver transplant recipients. [ABSTRACT FROM AUTHOR]

慢性肝病患者通常合并神经系统并发症, 肝性脑病最常见, 脊髓受累相对罕见, 如肝性脊髓病, 通常与广 泛的门静脉系统分流有关, 因此也称为分流性脊髓病, 这种分流可能是手术引起的, 也可能是自发的, 或两者兼有。 肝性脊髓病的主要症状是对称性下肢无力, 并逐渐向痉挛性瘫痪转变, 很少累及上肢。体征主要有双下肢肌张力增 高和反射亢进, 通常无感觉或括约肌功能损害。起病多隐匿, 诊断标准以排除性诊断为主, 在高度怀疑的临床背景 下, 需排除各种结构性和原发性神经系统疾病。降血氨及其他药物保守治疗效果并不理想, 肝移植治疗对早期患者 可完全逆转, 因此早期诊断至关重要。其他治疗方法还包括脾动脉栓塞, 分流阻断术, 分流限制术和粪便菌群移植 等。其中粪便菌群移植（FMT）有望成为一种新的可行方法, 但局限性于没有更多 FMT试验, 尚无法确定这一方法 能否取得更确切的疗效。 [ABSTRACT FROM AUTHOR]

In recent years, with the development of organ preservation, surgical techniques, perioperative management and immunosuppression regimens, the success rate of liver transplantation and survival rate of the recipients have been significantly enhanced. Liver transplantation has become the optimal treatment for patients with end-stage liver disease. However, biliary complications still commonly occur after liver transplantation, especially biliary anastomotic stricture. Severe biliary anastomotic stricture will not only increase the cost of treatment, but also lead to graft loss and even affect the survival rate of recipients. Therefore, timely diagnosis and treatment of biliary anastomotic stricture play a significant role in improving the survival rate of liver transplant recipients. In this article, the risk factors, clinical symptoms, diagnosis and treatment of biliary anastomotic stricture after liver transplantation were reviewed, aiming to provide novel ideas for the research, diagnosis and treatment of biliary anastomotic stricture after liver transplantation, and further enhance clinical efficacy of liver transplantation and the quality of life of recipients. [ABSTRACT FROM AUTHOR]

Situs inversus totalis (SIT) is a rare congenital condition, with an extremely low incidence. There is no difference between SIT individuals without onset of diseases and healthy counterparts. However, when SIT individuals suffer from diseases, the diagnosis and treatment are highly challenging due to insufficient understanding of SIT populations, especially for those complicated with end-stage liver disease and requiring liver transplantation. It is a huge challenge for surgeons whether SIT individuals serve as donors or recipients of liver transplantation. In this article, recent case reports related to liver transplantation in SIT patients were summarized, and the development, key procedures, clinical prognosis and postoperative complications of liver transplantation in SIT patients were reviewed. [ABSTRACT FROM AUTHOR]

Colorectal cancer is one of the common malignant tumors in China. Studies have shown that more than 50% of patients with colorectal cancer will experience metastasis. After systematic treatment, patients with resectable colorectal cancer could obtain favorable 5-year survival rate. However, patients with unresectable colorectal liver metastasis constantly obtain poor prognosis. In spite of the development of medical treatment, patients with unresectable colorectal liver metastasis can be treated by multiple approaches, such as interventional therapy combined with targeted therapy and immunotherapy, clinical efficacy is relatively low. Hence, clinicians divert extensive attention to liver transplantation. Liver transplantation, as an emerging treatment in recent years, is expected to improve clinical prognosis of patients with unresectable colorectal liver metastasis. In this article, research progress in liver transplantation for patients with unresectable colorectal liver metastasis was reviewed, mainly including the historical overview, recent results, prognostic factors, adaptation criteria, relationship with systemic treatment, liver source shortage and donor allocation, aiming to provide reference for liver transplantation for patients with colorectal liver metastasis. [ABSTRACT FROM AUTHOR]

Hepatic echinococcosis is a chronic parasitic disease, which is caused by the larvae of Echinococcus multilocularis. It has a high risk of disability and mortality, which is also known as "parasite cancer". In clinical practice, hepatic echinococcosis can be divided into hepatic alveolar echinococcosis and hepatic cystic echinococcosis. Hepatic echinococcosis is widely prevalent worldwide. It mainly occurs in the populations residing agricultural and pastoral areas in western China, posing significant threats to the quality of life of local residents. At present, surgery is the main treatment for hepatic echinococcosis in clinical settings. With rapid development of surgical diagnosis and treatment technology and deepening understanding of hepatic echinococcosis, diagnosis and treatment regimens have also been constantly improved. In this article, research progresses on the diagnosis and treatment of hepatic alveolar echinococcosis were reviewed, aiming to provide reference for clinicians, deliver early diagnosis and treatment, mitigate adverse effects of this disease upon patients and improve clinical prognosis. [ABSTRACT FROM AUTHOR]

This article summarizes the nursing experience of a child with biliary-enteric anastomotic strictures complicated by intestinal obstruction after liver transplantation. Nursing priorities include timely understanding of the changes in the child's condition during follow-up, and rapid cooperation with interventional treatment; Cooperating with doctors to effectively relieve intestinal obstruction, restoring gastrointestinal function, and improving the feeding compliance of the child's family; Standardizing pipeline and fistula care, monitoring nutritional risks, and reasonably providing nutritional support; Developing a multi-platform practice continuity nursing model to ensure an efficient quality of life for transplanted children. (总结1例肝移植术后并发胆肠吻合口狭窄与肠梗阻患儿的护理经验。护理重点包括: 及时了解患儿随访时病情变化, 迅速配合介入治疗; 配合医生有效解除肠梗阻, 恢复胃肠功能, 提高患儿家属喂养依从性; 规范管路与瘘道护理, 监测营养风险, 合理提供营养支持; 发展多平台实践延续性护理模式, 保证移植患儿的高效生活质量。)

In August 2023, the European Society for Organ Transplantation （ESOT） published the ESOT Consensus Statement on Biomarkers in Liver Transplantation online. The consensus statement focuses on biomarkers in liver transplantation, clinical applicability, and future needs and explores the role of new biomarkers in predicting liver transplantation outcomes by reviewing the literature on primary disease recurrence, development of chronic kidney disease （CKD）, and safe weaning of immunosuppression. This consensus statement conducts studies from the four aspects of recurrent liver disease after liver transplantation, recurrent hepatocellular carcinoma, weaning of immunosuppression, and CKD progression, emphasizes the importance of biomarkers in predicting or detecting disease recurrence, and proposes that large-scale prospective studies are still needed to improve the quality of evidence. The author’s team gives an excerpt of the consensus statement and systematically introduces the four aspects of the consensus statement and related discussions and conclusions, in order to provide more evidence-based medical evidence for identifying and exploring new biomarkers for liver transplantation [ABSTRACT FROM AUTHOR]

Objective: To explore the experience of liver re ⁃ transplantation for chronic graft failure. Methods: A retrospective analysis was conducted on 4 patients who underwent re⁃transplantation for chronic graft dysfunction in our team from January 2019 to December 2020, focusing on surgical time, intraoperative blood transfusion volume, ICU stay, total hospital stay, postoperative complications, and a literature review was conducted to summarize the experience of re⁃transplantation. Results: The surgery of all four patients were successful, using the in situ classic liver transplantation procedure, with an average operation time of 420 min（385-480 min), an average intraoperative infusion of 11.5 U of red blood cells（8⁃16 U), and an average of 1 350 mL of fresh frozen plasma (1 000-2 075 mL) . The average ICU stay after surgery was 3 days（2-4 days), and an average postoperative hospitalization of hospital stay after surgery was 21 days（14-31 days) . Among the 4 patients, 3 had no significant complications during hospitalization. 1 patient developed stenosis of the inferior vena cava and was cured after percutaneous balloon dilation. Regular follow⁃up after discharge has shown stable conditions in 3 cases, while 1 patient died 20 months after surgery due to non⁃ischemic biliary disease. Conclusion: Liver re ⁃ transplantation is the only effective treatment for chronic graft failure after liver transplantation. By selecting suitable cases, improving surgical techniques, and enhancing perioperative management, better therapeutic effects are expected to be achieved. [ABSTRACT FROM AUTHOR]

Organ preservation fluid could mitigate cold ischemia injury and maintain normal function of the grafts. At present, how to reduce a series of injury caused by cold ischemia of donor liver and improve the preservation quality of grafts are the hot and challenging spots in this field. Currently, preservation fluid in clinical practice has not achieved ideal preservation effect, especially for the protection of marginal donor organs. In the context of severe donor shortage, the key solution is still to explore the optimal preservation protocol for donor liver to prevent grafts from cold ischemia injury. In this article, the mechanism of donor liver injury during cold ischemia, the classification and evolution of donor liver preservation fluid were summarized, the development direction and challenges of donor liver preservation fluid were discussed, aiming to provide novel ideas and references for the research and development of donor liver preservation fluid. [ABSTRACT FROM AUTHOR]

Objective To analyze three-dimensional imaging characteristics and advantages for severe portal vein stenosis after liver transplantation, and to evaluate clinical efficacy of portal vein stent implantation. Methods Clinical data of 10 patients who received portal vein stent implantation for severe portal vein stenosis after liver transplantation were retrospectively analyzed. Results Among 10 patients, 3 cases were diagnosed with centripetal stenosis, tortuosity angulation-induced stenosis in 2 cases, compression-induced stenosis in 2 cases, long-segment stenosis and/or vascular occlusion in 3 cases. Three)dimensional reconstruction images possessed advantages in accurate identification of stenosis, identification of stenosis types and measurement of stenosis length. All patients were successfully implanted with portal vein stents. After stent implantation, the diameter of the minimum diameter of portal vein was increased [(6.2±0.9) mm vs. (2.6±1.7) mm, P<0.05], the flow velocity at anastomotic site was decreased [(57±19) cm/s vs. (128±27) cm/s, P<0.05], and the flow velocity at the portal vein adjacent to the liver was increased [(41±6) cm/s vs. (18±6) cm/s, P<0.05]. One patient suffered from intrahepatic hematoma caused by interventional puncture, which was mitigated after conservative observation and treatment. The remaining patients did not experience relevant complications. Conclusions Three-dimensional visualization technique may visually display the location, characteristics and severity of stenosis, which is beneficial for clinicians to make treatment decisions and assist interventional procedures. Timely implantation of portal vein stent may effectively reverse pathological process and improve portal vein blood flow. [ABSTRACT FROM AUTHOR]

Portal vein thrombosis is one of the common complications of liver cirrhosis. The incidence of portal vein thrombosis is increased with the progression of diseases. The incidence and progression of portal vein thrombosis are associated with multiple factors. The indications of anticoagulant therapy remain to be investigated. At present, portal vein thrombosis is no longer considered as a contraindication for liver transplantation. Nevertheless, complicated portal vein thrombosis will increase perioperative risk of liver transplantation. How to restore the blood flow of portal vein system is a challenge for surgical decision-making in clinical practice. Rational preoperative typing, surgical planning and portal vein reconstruction are the keys to ensure favorable long-term prognosis of liver transplant recipients. In this article, epidemiological status, risk factors, typing and identification of portal vein thrombosis, preoperative and intraoperative management of portal vein thrombosis in liver transplantation, and the impact of portal vein thrombosis on the outcomes of liver transplantation were reviewed, aiming to provide reference for perioperative management of portal vein thrombosis throughout liver transplantation. [ABSTRACT FROM AUTHOR]

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This article reports a patient with hepatic coma who underwent artificial liver support therapy and liver transplantation successfully, and the patient recovered well in the later stage after active treatment. This article also discusses the timing of liver transplantation. [ABSTRACT FROM AUTHOR]

Patients with end-stage liver disease after liver transplantation constantly suffer from malnutrition due to primary diseases and transplantation-related factors. Malnutrition will worsen clinical condition of the patients, increase the incidence of complication, length of hospital stay and medical expense after transplantation, and lower the survival rate. Sufficient nutritional support at all stages of liver transplantation is of significance. Accurate assessment of nutritional status and timely intervention are prerequisites for perioperative nutritional treatment in liver transplantation. In this article, the latest nutritional risk screening indexes and evaluation tools, nutritional support methods and other perioperative nutritional intervention measures for liver transplantation were reviewed, aiming to deepen the understanding and cognition of perioperative nutritional therapy for liver transplantation and provide reference for improving nutritional status and clinical prognosis of liver transplant recipients. [ABSTRACT FROM AUTHOR]

Objective To summarize clinical experience of transabdominal pericardial anastomosis of suprahepatic vena cava of the donor and right atrium of the recipient in liver transplantation for Budd-Chiari syndrome (BCS) complicated with liver cancer. Methods Clinical data of a BCS patient complicated with liver cancer undergoing transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium in liver transplantation were retrospectively analyzed. Results The hepatic vein and suprahepatic vena cava were partially occluded in the patient. Liver transplantation was completed by transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium with beating-heart. In addition, due to pathological changes of the recipient's hepatic artery, splenic artery of the recipient was cut off, distal ligation was performed, and the proximal end was reversed and anastomosed with the common hepatic artery of the donor liver, and the reconstruction of hepatic artery was completed. The surgery was successfully performed. At approximately postoperative 1 week, the function of the liver allograft was gradually restored to normal, and no major complications occurred. The patient was discharged at postoperative 25 d. No signs of BCS recurrence was reported after 8-month follow-up. Conclusions It is safe and feasible to treat BCS by liver transplantation with transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium. BCS patients complicated with liver cancer obtain favorable prognosis. [ABSTRACT FROM AUTHOR]

Objective To explore heterogeneous subtypes of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation and the characteristics differences of different types of children after liver transplantation. Methods Seven hundred and forty-one children who underwent living-related liver transplantation were enrolled. The self-designed general information questionnaire, Chinese version of 5-Item World Health Organization Well-Being Index (WHO-5) and the parent-report version of the Strengths and Difficulties Questionnaire (SDQ) were filled out by their guardians. The scores of five dimensions of SDQ were used as the manifest variables of the model. The classification model of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation was constructed by latent profile analysis. The latent categories of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation were analyzed. The influencing factors of latent categories were analyzed by univariate analysis and logistic regression model. Results There were three latent categories of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation, including peer communication problem group (n=302), psychological and behavioral adaptation group (n=145) and psychological and behavioral adjustment difficulty group (n=294). The first two groups were merged into the psychological and behavioral health group (n=447), which had significant differences in the five dimensions and the total score of difficulties of SDQ compared with the psychological and behavioral adjustment difficulty group (n=294) (all P<0.001). Logistic regression analysis showed that age≤5 years old, primary disease of non-cholestatic liver disease, stem family were the risk factors for psychological and behavioral adjustment difficulties in pediatric recipients after liver transplantation. Female gender, high education levels of parents and high WHO-5 score of guardians were the protective factors for psychological and behavioral adjustment difficulties in pediatric recipients after liver transplantation (all P<0.05). Conclusions The psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation are heterogeneous. Medical staff should pay extensive attention to different characteristics of pediatric recipients after liver transplantation with different psychological and behavioral adaptation categories and adopt targeted screening and intervention strategies, aiming to improve psychological and behavioral adaptation outcomes of pediatric recipients after liver transplantation. [ABSTRACT FROM AUTHOR]

The long-term survival and quality of life of liver transplant recipients largely depend on long-term health management and immunosuppression regimen after surgery. Long-term use of immunosuppressants may lead to severe complications, such as kidney injury, metabolic diseases and new malignant tumors, and even increase the risk of liver cancer recurrence after liver transplantation. At present, common immunosuppressive regimens in liver transplant recipients are delivered based on calcineurin inhibitor (CNI). However, renal toxicity, neurotoxicity and increased tumor recurrence caused by CNI have significantly affected clinical prognosis of the recipients. In recent years, the dosage of CNI has been gradually reduced and alternative drugs have been explored. Recently, the use of immunosuppressive regimens based on mammalian target of rapamycin inhibitor (mTORi) has been gradually increased. Multiple domestic and international guidelines have provided guidance on the use of mTORi in liver transplant recipients. China Organ Transplantation Development Foundation organized experienced transplant experts in China, combined with published guidelines, consensus and research progress at home and abroad and solicited extensive opinions to jointly formulate this expert consensus, aiming to provide reference for liver transplant clinicians in China. [ABSTRACT FROM AUTHOR]

Intrahepatic cholangiocarcinoma (ICC) is a primary malignant tumor of the liver, secondary to hepatocellular carcinoma, and its incidence tends to elevate worldwide. Hepatectomy is the optimal surgical regimen for ICC patients. ICC is considered as a contraindication for liver transplantation due to high tumor recurrence rate and poor survival outcome. At present, multiple significant progresses have been made in liver transplantation for ICC. For strictly)selected ICC patients, liver transplantation or liver transplantation after neoadjuvant therapy has achieved encouraging survival outcomes. Meantime, with the improvement of prognostic risk stratification of liver transplantation for ICC, the inclusion criteria of ICC candidates undergoing liver transplantation will be further optimized. In addition, the advancement of modern multi-mode comprehensive treatment of ICC will further guide the selection of neoadjuvant therapy before liver transplantation for ICC. The application of immune checkpoint inhibitors in ICC before liver transplantation is also an important research direction in the future. In this article, clinical prognosis of liver transplantation for ICC, prognostic risk factors and inclusion criteria of ICC candidates undergoing liver transplantation, and the ongoing trials and existing challenges were summarized, aiming to provide reference for liver transplantation for ICC and improve the quality of life for ICC patients. [ABSTRACT FROM AUTHOR]

Objective To explore the value of a preoperative "F-FDG PET/CT metabolic parameter-based model in predicting recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT). Methods Clinical, pathological, and "F- FDG PET/CT imaging characteristics of 86 patients with confirmed HCC before LT were retrospectively analyzed. Metabolic parameters were extracted from the F-FDG PET/CT images. Cox regression analysis was applied to determine the risk factors associated with HCC recurrence. Statistically significant factors were all integrated to build the PET/CT metabolic parameter-based. model, Milan standard model, the University of California, San Francisco standard model, and Hangzhou standard model. The concordance index (C-index) of each model was calculated and compared. Kaplan-Meier curves were plotted to reveal the discrimination ability of models. Clinical practicality of the final model was assessed by decision curve analysis (DCA). Results recurred in 47.7% (41/86). Preoperative alpha-fetoprotein (AFP) level (P<0.001), metabolic tumor volume (MTV, P=0.020), and total lesion glycolysis (TLG, P=0.016) were identified as risk factors for recurrence. The PET/CT metabolic parameter-based model achieved the highest C-index of 0.689 and distinguished LT candidates with different recurrence risk better than other models based on current common criteria. Conclusion The model combining AFP and "F-FDG PET/CT metabolic parameters shows good efficacy in predicting the recurrence of HCC patients after LT. [ABSTRACT FROM AUTHOR]

Prevention and treatment of complications after liver transplantation play a significant role in maintaining liver graft function and improving clinical prognosis of the recipients. Neutrophil extracellular trap (NET) are fibrous net-like structures composed of DNA as the skeleton and histones and granular proteins released by activated neutrophils. Studies have shown that the activation of neutrophils and the release of NET in donor liver after liver transplantation are involved in the incidence of multiple liver transplantation-related complications including ischemia)reperfusion injury, acute rejection, acute liver failure and recurrence of hepatocellular carcinoma, etc. In this article, the effect of NET on the complications after liver transplantation was mainly assessed, and research progress on NET as a potential target for the prevention and treatment of complications after liver transplantation was reviewed, aiming to provide reference for the prevention and treatment of complications after liver transplantation, enhance clinical efficacy of liver transplantation and improve clinical prognosis of the recipients. [ABSTRACT FROM AUTHOR]

Objective To summarize the diagnosis and treatment experience of portal vein aneurysm after liver transplantation. Methods Clinical data of two recipients with portal vein aneurysm after liver transplantation were retrospectively analyzed. Clinical features, diagnosis, treatment and prognosis were summarized based on literature review. Results Both two cases were diagnosed with intrahepatic portal vein aneurysm complicated with portal vein thrombosis and portal hypertension after liver transplantation. Case 1 was given with targeted conservative treatment and he refused to undergo liver retransplantation. Physical condition was worsened after discharge, and the patient eventually died from liver graft failure, kidney failure, lung infection, and septic shock. Case 2 received high-dose glucocorticoid pulse therapy, whereas liver function was not improved, and the patient was recovered successfully after secondary liver transplantation. Conclusions Long-term complication of portal vein aneurysm (especially intrahepatic type) after liver transplantation probably indicates poor prognosis. Correct understanding, intimate follow-up and active treatment should be conducted. Liver retransplantation may be a potential treatment regimen. [ABSTRACT FROM AUTHOR]