Objective To investigate quality of life of pediatric living donor liver transplantation recipient (PLDLTR) and analyze it’s influencing factors. Methods The convenient sampling method was adopted. Fifty-three PLDLTRs from May 2012 to January 2017 in the West China Hospital of Sichuan University were selected. At the same time, 56 children who participated in the physical examination and had no abnormality results were selected as reference (control group), their age and gender matched with the PLDLTRs. A general data inventory and a self-assessment scale for children’s quality of life (Pediatric Quality of Life Inventory 4 Generic Core Scales, PedsQL4.0) were used to evaluate the quality of life of the 53 PLDLTRs. Results A total of 53 questionnaires were distributed to all the 2 groups, all of them were effectively recovered. The points of quality of life of the physiological function, emotional function, social function, and school performance for the PLDLTRs were significantly higher than those of the control group (P<0.050), which for the PLDLTRs with male and more than 3 years after the operation were significantly higher than those of the PLDLTRs with female and within 1 year after the operation (P<0.050). For the PLDLTRs with age >4 years old, the points of the emotional function, social function, and school performance were significantly higher than those of the PLDLTRs with age ≤4 years old. For the PLDLTRs without postoperative complications, the points of quality of life of the physiological function, emotional function, and school performance were significantly higher than those of the PLDLTRs with Ⅱ grade of postoperative complications (P<0.050). Conclusions Life quality of PLDLTR is poorer than that of normal children. Postoperative time, postoperative complications, age, and gender are certainly associated with quality of life for PLDLTR.
ObjectiveTo evaluate donor safety in living donor liver transplantation. MethodsThe clinical data of 356 donors underwent living liver donation in our center from January 2001 to September 2015 were retrospectively analyzed. These patients were divided into pre-2008 group(before January 2008) and post-2008 group(after January 2008). The donor safety was evaluated with regard to three aspects, i.e. complications, liver function, and quality of life. Results①There was no donor death in our center.②The overall complications rate was 23.3%(83/356). The proportion of ClavienⅠ, Ⅱ, Ⅲ, andⅣcomplications was 50.6%(42/83), 26.5%(22/83), 21.7%(18/83), and 1.2%(1/83), respectively. In all the donors, the incidence of ClavienⅠ, Ⅱ, Ⅲ, andⅣcomplications was 11.8%(42/356), 6.2%(22/356), 5.1%(18/356), and 0.3%(1/356), respectively. The overall complications rate in the post-2008 group was significantly lower than that in the pre-2008 group〔18.1%(41/227) versus 32.6%(42/129), P < 0.01〕. The most common complication was the biliary complication with an incidence of 8.4%(30/356).③The postoperative liver dysfunction was transient and generally retur-ned to normal level within a week.④The donor's quality of life was generally satisfied as assessed by the SF-36 tool, and 94.8%(239/252) of them would donate again if necessary. ConclusionEver improving surgical and anesthetic techniques, together with strict donor selection and specialized perioperative management, could guarantee a low donor morbidity and a satisfactory long-term prognosis.
【Abstract】Objective To study the anatomy of the hepatic arteries and imitate the way to deal with the hepatic arteries in the living liver transplantation of the left lateral lobe.Methods Thirty normal adult livers were anatomyzed and 30 casting models of livers were observed. The lengths, diameters and distributaries of the hepatic arteries were described.Results The blood supply of the left lateral region came from proper hepatic artery, left hepatic artery and middle hepatic artery. The aberrant arteries included left inferior phrenic artery, left gastric artery and right gastric artery. They branched to supply the upper segment and the inferior segment.Conclusion There are five types of hepatic arteries to supply the left liver lobe. The anatomy of hepatic arteries should be studied and a reasonable approach to gain a liver graft should be designed before transplantation. The hepatic arteries should be dealt with so as to anastomose with recipient hepatic arteries.
Objective To review the vascular anatomy of the donor and the reci pient for the l iving kidney transplantation. Methods The recent l iterature about the vessels of donor and reci pient in cl inical appl ications was extensively reviewed. Results The pertinent vascular anatomy of the donor and recipient was essential for the screening of the proper candidates, surgical planning and long-term outcome. Early branching and accessory renal artery of the donor were particularly important to deciding the side of nephrectomy, surgical technique and anastomosing pattern, and their injuries were the most frequent factor of the conversion from laparoscopic to open surgery. With increase of laparoscopic nephrectomy indonors, accurate venous anatomy was paid more and more attention to because venous bleeding could also lead to conversion to open nephrectomy. Multidetector CT (MDCT) could supplant the conventional excretory urography and renal catheter angiography and could accurately depict the donors’ vessels, vascular variations. In addition, MDCT can excellently evaluate the status of donor kidney, collecting system and other pertinent anatomy details. Conclusion Accurate master of related vascular anatomy can facil iate operation plan and success of operation and can contribute to the rapid development of living donor kidney transplantation. MDCT has become the choice of preoperative one-stop image assessment for living renal donors.
ObjectiveTo summarize the clinical progress on living related liver transplantation (LRLT). MethodsThe latest progress were reviewed based on recent documents and the experience on LRLT in our department. ResultsLRLT made much progress on evaluation of donor, harvesting the graft liver, donor health assessment and outcomes after living donor liver transplantation, and main factors affecting the survival of liver graft and so on. Conclusion Living related liver transplantation has many unsurpassable advantages, which suits the situation of China and has capacious clinical application.
Objective To discuss venous drainage types of median hepatic lobe and their guiding significances on the selection of grafts. Methods Between April 2005 and March 2009, 109 potential living donors underwent 3-dimensional reconstruction of computed tomography (CT) and the volume of graft was determined in the center of organ transplantation of Ruijin Hospital. The venous drainage types of median hepatic lobe of each donor were analyzed by the computer-based liver operation-planning system in detail to assign middle hepatic vein (MHV) types according to Marcos classification and venous types of Ⅳb segment according to Nakamura classification. Results The branching pattern of MHV was divided into 3 types: Type Ⅰ and Ⅱwere relatively more accounting for 44.0% （48/109）, 37.6% （41/109）, and type Ⅲ was fewest 〔18.3% （20/109）〕. There were no significant differences in volume of whole liver, volume of left liver or left liver/total liver volume ratio among various types of MHV of the donor (Pgt;0.05). Ⅳb vein was also divided into 3 types: The most common was type Ⅰ, accounting for 72.4% (79/109); Type Ⅱ 〔12.8% （14/109）〕, type Ⅲ 〔14.7% （16/109）〕 were relatively fewer. At last, 37 donors provided right liver, for Marcos Ⅰ, Ⅱ, and Ⅲ type of donors, donors remained with MHV was 12/17, 8/11, and 5/9; for Nakamura Ⅰ, Ⅱ, and Ⅲ type of donors, those number were 16/26, 4/6, and 5/5. Conclusion In adult-to-adult living donor liver transplantation, there may be great significances in accordance with Marcos and Nakamura typing results to harvest right lobe liver graft with or without MHV.
【Abstract】ObjectiveTo study the advances in use of imaging in the evaluation of living donor liver. Methods The literatures in recent years on the use of imaging in evaluation of living donor liver were reviewed. ResultsPreoperative computed tomography (CT) and magnetic resonance imaging (MRI) in the donor allowed accurate determination of liver volume and rough determination of macrovesicular hepatic steatosis of the liver. CT angiography could assess the anatomy of hepatic artery, portal vein and hepatic veins. Intraoperative cholangiography allowed detection of the anatomy of the biliary tree. ConclusionImaging techniques are widely used in the evaluation of liver volume, vasculature and biliary system in the living donor liver.