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| 1 | Graft-to-recipient weight ratio lower to 0.7% is safe without portal pressure modulation in right-lobe living donor liver transplantation with favorable conditions显示文摘BACKGROUND: The low graft-to-recipient weight ratio(GRWR) in adult-to-adult living donor liver transplantation(LDLT) is one of the major risk factors affecting graft survival. The goal of this study was to evaluate whether the lower limit of the GRWR can be safely reduced without portal pressure modulation in right-lobe LDLT. METHODS: From 2005 to 2011, 317 consecutive patients from a single institute underwent LDLT with right-lobe grafts without portal pressure modulation. Of these, 23 had a GRWR of less than 0.7%(group A), 27 had a GRWR of ≥0.7%, <0.8%(group B), and 267 had a GRWR of more than and equal to 0.8%(group C). Medical records, including recipient, donor, operation factors, laboratory findings and complications were reviewed retrospectively. RESULTS: The baseline demographics showed low model for end-stage liver disease score(mean 16.3±8.9) and high percentage of hepatocellular carcinoma(231 patients, 72.9%). Three groups by GRWR demonstrated similar characteristics except recipient body mass index and donor gender. For smallforsize syndrome, there were 3(13.0%) in group A, 1(3.7%) in group B, and 2 patients(0.7%) in group C(P<0.001). Hepatic artery thrombosis was more frequently observed in group A than in groups B and C(8.7% vs 3.7% vs 1.9%, P=0.047). However, among the three groups, graft survival rates at 1 year(100% vs 96.3% vs 93.6%) and 3 years(91.7% vs 73.2% vs 88.1%) were not different(P=0.539). In laboratory measurements,there was no group difference in total bilirubin and albumin. However, prothrombin time was longer in group A within postoperative 1 week and platelet count was lower in groups A and B within postoperative 1 month. CONCLUSION: A GRWR lower to 0.7% is safe and does not need to modulate portal pressure in adult-to-adult LDLT using the right-lobe in favorable conditions including low model for end-stage liver disease score. | Seung Duk Lee Seong Hoon Kim Young-Kyu Kim Soon-Ae Lee Sang-Jae Park | 2014 | Hepatobiliary & Pancreatic Diseases International2014，13，1： | 8 |
| 2 | Portal inflow preservation during portal diversion in small-for-size syndrome显示文摘AIM:To investigate the impact of portal inflow on liver remnants in a stable pig model of small-for-size syndrome.METHODS:Twenty pigs underwent mesocaval shunt(MCS)surgery followed by 85%-90%hepatectomy.The control group had no shunt placement;the S1group had portal flow maintained at an average of 2.0times the baseline values;and the S2group had portal flow maintained at an average of 3.2 times the baseline flow.The effect of portal functional competition on the liver remnant was investigated for 48 h postoperatively.Data were presented as mean±SD.Statistical significance was determined using Student’s t test(SPSS,Chicago,IL,United States).Values of P<0.05 were considered statistically significant.RESULTS:At 24 h after hepatectomy,biochemical and histological changes were not significantly different between the S1and S2groups,but changes in both sets of variables were significantly less than in the control group.At 48 h,biochemical and histological changes were significantly less in the S2group than in the S1or control group.The regeneration index was significantly higher in the S2group than in the S1group,and was similar to that in the control group.Apoptosis index,serum lipopolysaccharide,and bacterial DNA levels were significantly lower in the S2group than in the other two groups.CONCLUSION:Diversion of portal inflow using MCS reduces portal overflow injury.Excessive diversion of portal inflow inhibits liver regeneration following major hepatectomy.Maintaining portal inflow at an average of 3.2 times above baseline helps promote hypertrophy of the liver remnant and reduce apoptosis. | Xian-Qiang Wang Yue-Fang Xu Jing-Wang Tan Wen-Ping Lv Zhe Liu Jian-Ping Zeng Jia-Hong Dong | 2014 | World Journal of Gastroenterology2014，20，4： | 0 |
| 3 | Gut-liver axis improves with meloxicam treatment after cirrhotic liver resection显示文摘AIM:To investigate the effect of meloxicam on the gut-liver axis after cirrhotic liver resection.METHODS:Forty-four male Wistar rats were assigned to three groups:(1)control group(CG);(2)bile duct ligation with meloxicam treatment(BDL+M);and(3)bile duct ligation without meloxicam treatment(BDL).Secondary biliary liver cirrhosis was induced via ligatureof the bile duct in the BDL+M and BDL groups.After 2wk,the animals underwent a 50%hepatectomy.In the BDL+M group 15 min prior to the hepatectomy,one single dose of meloxicam was administered.Parameters measured included:microcirculation of the liver and small bowel;portal venous flow(PVF);gastrointestinal(GI)transit;alanine aminotransferase(ALT);malondialdehyde;interleukin 6(IL-6),transforming growth factor beta 1(TGF-β1)and hypoxia-inducible factor 1 alpha(HIF-1α)levels;mRNA expression of cyclooxigenase-2(COX-2),IL-6 and TGF-β1;liver and small bowel histology;immunohistochemical evaluation of hepatocyte and enterocyte proliferation with Ki-67 and COX-2 liver expression.RESULTS:Proliferative activity of hepatocytes after liver resection,liver flow and PVF were significantly higher in CG vs BDL+M and CG vs BDL group(P<0.05),whereas one single dose of meloxicam ameliorated liver flow and proliferative activity of hepatocytes in BDL+M vs BDL group.COX-2 liver expression at 24h observation time(OT),IL-6 concentration and mRNA IL-6 expression in the liver especially at 3 h OT,were significantly higher in BDL group when compared with the BDL+M and CG groups(P<0.01,P<0.001,P<0.01,respectively).Liver and small bowel histology,according to a semi quantitative scoring system,showed better integrity in BDL+M and CG as compared to BDL group.ALT release and HIF-1αlevels at 1 h OT were significantly higher in BDL+M compared to CG and BDL group(P<0.001 and P<0.01,respectively).Moreover,ALT release levels at 3 and 24 h OT were significantly higher in BDL group compared to CG,P<0.01.GI transit,enterocyte proliferative activity and number of goblet cells were in favor of meloxicam treatment vs BDL group(P<0.05,P<0.001,P<0.01,respectively).Additionally,villus length were higher in BDL+M as compared to BDL group.CONCLUSION:One single dose of meloxicam admin-istered after cirrhotic liver resection was able to cause better function and integrity of the remaining liver and small bowel. | Astrit R Hamza Avdyl S Krasniqi Pramod Kadaba Srinivasan Mamdouh Afify Christian Bleilevens Uwe Klinge René H Tolba | 2014 | World Journal of Gastroenterology2014，20，40： | 0 |
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