Received Liver Grafts Research Articles

The Effect of Pringle Maneuver Applied during Living Donor Hepatectomy on the Ischemia-Reperfusion Injury Observed in the Donors and Recipients.

Background and Objectives: The aim of this study is to evaluate the clinical and laboratory changes of ischemia and reperfusion injury in the remnant livers of donors with and without Pringle maneuver. Furthermore, we evaluated the recipients who have been transplanted with liver grafts from these donors. Methods and Materials: A total of 108 patients (54 living liver donors and 54 liver recipients) who underwent donor hepatectomy and recipients who living donor liver transplantation, were included in this randomized double-blind study between February 2021 and June 2021. The donors were divided into two groups: Pringle maneuver applied (n = 27) and Pringle maneuver not applied (n = 27). Similarly, recipients with implanted liver obtained from these donors were divided into two groups as the Pringle maneuver was performed (n = 27) and not performed (n = 27). Blood samples from donors and recipients were obtained on pre-operative, post-operative 0 h day (day of surgery), post-operative 1st day, post-operative 2nd day, post-operative 3rd day, post-operative 4th day, post-operative 5th day, and liver tissue was taken from the graft during the back table procedures. Liver function tests and complete blood count, coagulation tests, IL-1, IL-2, IL-6, TNF-α, and β-galactosidase measurements, and histopathological findings were examined. Results: There was no statistically significant difference in the parameters of biochemical analyses for ischemia-reperfusion injury at all periods in the donors with and without the Pringle maneuver. Similarly, there was no statistically significant difference between in the recipients in who received liver grafts harvested with and without the Pringle maneuver. There was no statistically significant difference between the two recipient groups in terms of perioperative bleeding and early bile duct complications (p = 0.685). In the histopathological examinations, hepatocyte damage was significantly higher in the Pringle maneuver group (p = 0.001). Conclusions: Although the histological scoring of hepatocyte damage was found to be higher in the Pringle maneuver group, the Pringle maneuver did not augment ischemia-reperfusion injury in donors and recipients that was evaluated by clinical and laboratory analyses.

Utilization of older deceased donors for pediatric liver transplant may negatively impact long-term survival.

Multiple adult studies have investigated the role of older donors (ODs) in expanding the donor pool. However, the impact of donor age on pediatric liver transplantation (LT)has not been fully elucidated. UNOS database was used to identify pediatric (≤18 years) LTs performed in the United States during 2002-22. Donors ≥40 years at donation were classified as older donors (ODs). Propensity analysis was performed with 1:1 matching for potentially confounding variables. A total of 10,024 pediatric liver transplantation (PLT) patients met inclusion criteria; 669 received liver grafts from ODs. Candidates receiving OD liver grafts were more likely to be transplanted for acute liver failure, have higher Model End-Stage Liver Disease/Pediatric End-Stage Liver Disease (MELD/PELD) scores at LT, listed as Status 1/1A at LT, and be in the intensive care unit(ICU) at time of LT (all p < 0.001). Kaplan-Meier (KM) analyses showed that recipients of OD grafts had worse patient and graft survival (p < 0.001)compared to recipients of younger donor (YD)grafts. KM analyses performed on candidates matched for acuity at LT revealed inferior patient and graft survival in recipients of deceased donor grafts (p < 0.001), but not living donor grafts (p > 0.1)from ODs. Cox regression analysis demonstrated that living donor LT, diagnosis of biliary atresia and first liver transplant were favorable predictors of recipient outcomes, whereas ICU stay before LT and transplantation during 2002-12 were unfavorable. Livers from ODs were used for candidates with higher acuity. Pediatric recipients of livers from ODs had worse outcome compared to YDs; however, living donor LT from ODs had the least negative impact on recipient outcomes.

Liver transplant in patients with primary sclerosing cholangitis: A retrospective cohort from Northeastern Brazil.

Primary sclerosing cholangitis (PSC) manifests within a broad ethnic and racial spectrum, reflecting different levels of access to health care. To evaluate the clinical profile, complications and survival rates of patients with PSC undergoing liver transplantation (LTx) at a Brazilian reference center. All patients diagnosed with PSC before or after LTx were included. The medical records were reviewed for demographic and clinical variables, including outcomes and survival. The level of statistical significance was set at P < 0.05. Our cohort represented 1.6% (n = 34) of the 2113 patients receiving liver grafts at our service over the past two decades. Most were male (n = 19; 56%). The average age (40 ± 14 years) was similar for men and women (P = 0.347). The mean follow-up time from diagnosis to LTx was 68 mo. Most patients had the classic form of PSC. Three women had PSC/autoimmune hepatitis overlap syndrome, and one patient had small-duct PSC. Alkaline phosphatase levels at diagnosis and pre-LTx model for end-stage liver disease. scores were significantly higher in males. Inflammatory bowel research (IBD) was investigated by colonoscopy in 26/34 (76%) and was present in most cases (18/26; 69%). IBD was less common in women than in men (44.4% vs. 55.6%) (P = 0.692). Cholangiocarcinoma (CCA) was diagnosed in 2/34 (5.9%) patients by histopathology of the explant (survival: 3 years 6 mo, and 4 years 11 mo). Two patients had complications requiring a second LTx (one after 7 d due to hepatic artery thrombosis and one after 17 d due to primary graft dysfunction). Five patients (14.7%) developed biliary stricture. The overall median post-LTx survival was 66 mo. Most deaths occurred in the first year (infection n = 2, primary liver graft dysfunction n = 3, unknown cause n = 1). The 1-year and 5-year survival rates of this cohort were 82.3% and 70.6%, respectively, matching the mean overall survival rates of LTx patients at our center (87.1% and 69.43%, respectively) (P = 0.83). Survival after 1 and 5 years was similar to that of other LTx indications. The observed CCA survival rate suggests CCA may be an indication for LTx in selected cases.

Predictive value of portal fibrosis and inflammation in transplanted liver grafts treated with hypothermic oxygenated perfusion.

Hypothermic oxygenated perfusion (HOPE) has become widespread for the preservation of liver grafts, making tangled the relationship among the use of extended criteria donors (ECD), graft histology and transplant outcome. To prospectively validate the impact of the graft histology on transplant outcome in recipient receiving liver grafts from ECD after HOPE. Ninety-three ECD grafts were prospectively enrolled; 49 (52.7 %) were perfused with HOPE according to our protocols. All clinical, histological and follow-up data were collected. Grafts with portal fibrosis stage ≥3 according to Ishak's (evaluated with Reticulin stain) had a significantly higher incidence of early allograft dysfunction (EAD) and 6-month-dysfunction (p=0.026 and p=0.049), with more days in Intensive Care Unit (p=0.050). Lobular fibrosis correlated with post-liver transplant kidney function (p=0.019). Moderate-to-severe chronic portal inflammation was correlated with graft survival on both multivariate and univariate analyses (p<0.001), but this risk factor is sensibly reduced by the execution of HOPE. The use of liver grafts with portal fibrosis stage ≥3 implies a higher risk of post-transplant complications. Portal inflammation represents an important prognostic factor as well, but the execution of HOPE represents a valid tool to improve graft survival.

A Single Center Experience of the Prognosis After Liver Transplantation From Discarded Graft Due to Poor Graft Conditions in Prioritized Centers

Liver transplantation (LT) has the limitation of graft shortage. Therefore, to increase the donor pool, even marginal grafts are being transplanted depending on the recipient's condition. This study was conducted to analyze the post-LT prognosis using discarded liver grafts. From January 2010 to September 2020, deceased-donor LT was performed in 160 patients in our center. Among them, 121 patients (allocated group) were preferentially allocated to our center, and the remaining 39 patients (24.4%, discarded group) received liver grafts that were discarded by prioritized centers. The preoperative model for end-stage liver disease score were 27.0 ± 10.41 and 27.0 ±11.79 for each group (P=.99). There were no differences between the 2 groups in operation time (P=.06) and intraoperative packed red cell transfusion (P=.90). There were no differences between the 2 groups in early allograft dysfunction (P=.48) and hospital stay (P=.26) after deceased-donor LT. In-hospital mortality occurred in 10 patients (8.3%) in the allocated group and 4 patients (10.3%) in the discarded group. Only the length of intensive care unit stay was significantly longer in the discarded group (P=0.04). The 5-year survival rate was 73.8% in the allocated group and 72.2% in the discarded group. The outcome of the discarded group is never worse than that of the allocated group. deceased-donor LT from the discarded graft can be acceptable. As a result, the number of discarded grafts can be reduced.

Cerebrolysin Prevents Brain Injury in a Mouse Model of Liver Damage.

Liver damage can lead to secondary organ damage by toxic substances and catabolic products accumulation which can increase the permeability of blood-brain barrier, leading to cognitive impairment. The only real treatment for end stage liver failure is grafting. With some, but not all, neurological symptoms subsiding after transplantation, the presence of brain damage can impair both the short and long-term outcome. We tested if Cerebrolysin can prevent brain injury in an experimental model of non-viral liver damage in mice. Behavior, abdominal ultrasound evaluation and immunohistochemistry were used to evaluate the animals. No ultrasound or behavior differences were found between the control and treated animals, with both groups displaying more anxiety and no short-term memory benefit compared to sham mice. Cerebrolysin treatment was able to maintain a normal level of cortical NeuN+ cells and induced an increase in the area occupied by BrdU+ cells. Surprisingly, no difference was observed when investigating Iba1+ cells. With neurological complications of end-stage liver disease impacting the rehabilitation of patients receiving liver grafts, a neuroprotective treatment of patients on the waiting lists might improve their rehabilitation outcome by ensuring a minimal cerebral damage.

Association Between ACOX1 and NRF1 Gene Expression and Hepatitis B and C Virus Infections and Hepatocellular Carcinoma in Liver Transplant Patients (Shiraz, Iran).

Liver transplantation is used to treat both patients with end-stage liver diseases and those with hepatocellular carcinoma; in Iran, these patients are commonly infected with hepatitis B and C viruses. In the present study, for the first time, we investigated the association between ACOX1 and NRF1 gene and protein expression and presence of hepatitis B virus, hepatitis C virus, and hepatocellular carcinoma in liver transplant patients in South-Central Iran. In this cross-sectional study, we included 200 patients who were seen between 2008 and 2017 for liver transplant at the Namazi Hospital, Shiraz University of Medical Sciences (Shiraz, Iran). All patients received liver grafts from brain dead donors. Donors and recipients were unrelated. ABO compatibility blood group analyses for donor-recipient pairs were conducted. Liver transplant recipients were divided into 3 different groups: hepatitis B virus infected, hepatitis C virus infected, and presence of hepatocellular carcinoma. We also had a control group that included 30 healthy individuals. NRF1 and ACOX1 gene expression levels were evaluated using the SYBER green real-time polymerase chain reaction method. NRF1 and ACOX1 protein expression levels were evaluated using enzymelinked immunosorbent analyses. We used SPSS software for statistical analyses (version 19.0). NRF1 gene expression was increased in all 3 liver transplant recipient groups compared with the control group (not significant, P > .05). Furthermore, ACOX1 gene expression was decreased in all patients compared with control (P > .05). However, we found ACOX1 and NRF1 protein expression to be significantly decreased in all 3 liver transplant recipients groups compared with the control group (P < .05). NRF1 and ACOX1 genes and their protein expressions could affect the development of chronic liver disease.

Clinical analysis of the outcomes after receiving a liver graft that abandoned transplantation due to poor graft conditions in the centers allocated as a priority

Depending on the recipient's condition and lack of donors, even liver grafts with poor conditions may need to be transplanted. This study was conducted to analyze the outcomes after receiving a liver graft that abandoned transplantation due to poor graft conditions at the preceding centers. From January 2010 to September 2020, deceased-donor liver transplantation (DDLT) was performed in 161 patients in our center. Among them, 127 patients (allocated group) were preferentially allocated to our center by KONOS and the remaining 34 patients (abandoned group) received liver grafts that were abandoned by other transplant centers due to poor organ conditions. Various perioperative factors and postoperative outcomes were compared. There was no difference in recipient factors before transplantation, and the donor had a longer stay in the ICU in the abandoned group. The operation time was less in the abandoned group, but there was no statistical difference (p = 0.06), and there was no difference in ischemic time or transfusion between the two groups. Postoperative ICU hospital stay was longer in the abandoned group (p = 0.04), but postoperative in-hospital mortality was not different between the two groups. There was no difference between the two groups in long term survival after transplantation. Even if the graft that was abandoned due to poor condition, good results can be obtained if the transplant is carried out according to the recipient state. And as a result, it is expected that the discarded graft can be reduced.

Clinical analysis of the prognosis after receiving a liver graft that abandoned transplantation due to poor graft conditions in the centers allocated as a priority

Background: Liver transplantation (LT) has the limitation of lack of donors compared to those waiting for a transplant. Depend ing on the recipient’s condition, even liver grafts with poor conditions may need to be transplanted. This study was conducted to analyze the prognosis after LT that abandoned transplantation due to poor graft conditions at the preceding centers. Methods: From January 2010 to September 2020, deceased-donor LT was performed in 161 patients in Seoul St. Mary’s Hospi tal. Among them, 127 patients (allocated group) were preferentially allocated to our center by Korean Network for Organ Sharing and the remaining 34 patients (21.1%, abandoned group) received liver grafts that were abandoned by other transplant centers due to poor organ conditions. To compare and analyze the clinical prognosis of the allocated group and the abandoned group, various perioperative factors and postoperative outcomes were evaluated. Results: The average ages of the allocated and abandoned groups were 52.3 and 51.6 years, respectively (P=0.65). The preop erative Model for End-stage Liver Disease score was 27.3±10.6 in the allocation group and 25.8±11.3 in the abandoned group (P=0.49). There was no difference between the two groups in operation time (P=0.14) and intraoperative PRC transfusion (P=0.94). There was no difference between the two groups in intensive care unit stay (P=0.91) and hospital stay (P=0.86). In-hospital mor tality occurred in 17 patients (13.4%) in the allocated group and three patients (8.8%) in the abandoned group, so there was no dif ference between the two groups (P=0.47). The 5-year survival rate was 72.4% in the allocated group and 78.2% in the abandoned group, with no difference between the two groups (P=0.25). Conclusions: Even if the graft that was abandoned due to poor condition, good results can be obtained if the transplant is carried out according to the recipient state. And as a result, it is expected that the discarded graft can be reduced.

PP2Ac upregulates PI3K-Akt signaling and induces hepatocyte apoptosis in liver donor after brain death

Multiple research groups have demonstrated that the outcome of patients receiving liver grafts from brain death donors (DBD) is poorer when compared with patients receiving grafts from living donors. This might be due to an increased hepatocyte apoptosis induced after brain death (BD). In this work, we found that the activity of PP2A-Akt pathway is significantly increased in clinical donor ex vivo hepatocytes after BD by iTRAQ protein quantification analysis. The same results were confirmed in animal models. A time-dependent promotion of apoptosis was also found in DBD rabbit liver, as demonstrated by the increased levels of cleaved Caspase 3 and the decreased of Bcl-2. To further investigate the roles of PP2A and Akt in regulating apoptosis of hepatocytes after BD, we cultivated human liver cell line L02 with serum deprivation and hypoxia, to simulate the ischemic and hypoxic conditions of hepatocytes in DBD. Increased apoptosis and decreased viability were observed during the time in this model. Meanwhile PP2A activity and Akt activity were respectively increased and decreased. Notably, the proportion of Akt phosphorylation at Ser473 decreased, while other known targets of PP2A (p38, JNK and ERK) were not affected in terms of protein levels or phosphorylation. These results suggested that PP2A is involved in apoptotic induction of hepatocytes after brain death by specific suppression of Akt. This discovery was further confirmed with pharmaceutical and genetic methods. Our work implied potential targets for reducing liver cell apoptosis and improving organ donor quality after BD.

Long-term outcomes using uncontrolled donors after circulatory death (DCD) for liver transplantation. A 10-year single center experience

Introduction: Number of liver grafts is not enough to attend all patients who need an OLT. Many OLT teams have proposed to expand the number of available grafts using livers from donors after circulatory death (DCD). We aim to analyse the use of liver grafts from type 2 uDCD donors for OLT, comparing with a group of patients who received liver grafts from donors after brain death (DBD). Patients and methods: Between January 2006 and December 2016 we performed 783 OLT in adult recipients. 75 of these transplants were DCD (Maastricht type II). We compared thus 75 DCD with 265 optimal donors OLT. Results: We present 75 DCD with a mean age 58.8 ± 8 vs 54.7 ± 10; p = 0,000, no different has found according to gender, body mass index, Child, MELD neither OLT indication. Donor age was 41.7 ± 10 vs 47.8 ± 15;p = 0.001; No different has found in Esteatosis, neither preservation injury, or cold ischemia time. Warm ischemia time was faster in DCD 62 min ± 14 vs 70 ± 36 (p = 0,010). Transfusion rate was significally higer in DCD in RBC, FFP, platelets and fibrinogen. Primary graft failure was higher in DCD 8.1% vs 2.1% (p = 0,031), also retransplant rate 12% vs 4.6% (0,028) and ischemic cholangiopathy 31,1% vs 5,6% (p = 0,000). Patient survival at 1, 3 and 5 years was in DCD: 81,3%, 70,2% and 68,6% vs DBD 89%, 83,7% and 78,8% p = 0,070. Conclusion: Even with a higher risk of primary graft failure and ischemic cholangiopathy, DCD type II is a safe source of donor for liver transplantation.

Donor-Transmitted Bacterial Infection in Deceased Donor Liver Transplantation: Experience of Southern Taiwan Medical Center

BackgroundBacterial Infection is the most important source of mortality and morbidity in liver transplantation recipients. Donor transmitted bacterial infection is rare but one of the most important infection sources. This kind of infection is difficult to identify, causing treatment dilemma. Patients and MethodsIn this article, we retrospectively reviewed our deceased donor liver transplants performed from January 2014 to December 2016. Forty-two recipients in Kaohsiung Chang Gung Memorial Hospital receiving liver grafts from 35 deceased liver donors were evaluated. The demography, donor transmitted infection, and outcomes were evaluated. ResultTwo patients had probable donor transmitted bacterial infection and 1 patient died of suspected transmitted infection. ConclusionEarly identification of donor infection and adequate antibiotic treatment for the donor and recipient are the keys to preventing donor transmitted bacterial infection. Donor infection is not an absolute contraindication for organ donation in the area of organ shortage. Organ procurement organizations or similar authorities may establish the platform for sharing the data about donor and recipient infections.

Utilization of hepatitis B core antibody positive grafts in living donor liver transplantation.

Utilization of liver grafts from hepatitis B core antibody (anti-HBc) positive donors carries the risk of reactivation of hepatitis B virus (HBV) in recipients because of post-transplant immunosuppressive therapy. This was a retrospective study of patients who had received liver grafts from anti-HBc positive live donors between 2006 and 2016 at our institute. Out of 22 recipients [all males, mean age 45.4years (range 18-64years)], four patients were hepatitis B surface antigen (HBsAg) positive preoperatively and received entecavir post-transplantation. One among these patients who temporarily stopped entecavir had a recurrence of hepatitis B 39months post-transplantation. Among the 13 non-immune [hepatitis B surface antibody (anti-HBs) < 10mIU/mL] recipients, eight were prescribed lamivudine (100mg daily) as monoprophylaxis. Four compliant patients remain negative for HBV so far. Out of the remaining four, two died secondary to sepsis unrelated to hepatitis B; two were non-compliant and developed reactivation of hepatitis B. Lamivudine was missed out in five non-immune patients; three of them developed hepatitis B reactivation while two remain negative. Anti-HBs titer was immune in five patients. Over a period of 4 to 8years follow up, three remain immune without prophylaxis, while two expired due to causes unrelated to hepatitis B. Following the detection of hepatitis B infection, five patients have been started on tenofovir 300mg once daily. Anti-HBc positive liver grafts can be safely used for live donor liver transplantation. If the recipients are immune preoperatively, they can be merely followed up without HBV prophylaxis. However, it is extremely important to prophylactically treat the non-immune recipients with an antiviral agent lifelong.

EFFECTS OF COLD ISCHEMIA TIME ON HEPATIC ALLOGRAFT FUNCTION.

ABSTRACT Background : Cold ischemia time is related to success of liver transplantation. Aim : To compare the impact of cold ischemia time on allografts locally collected to those collected distantly. Methods : Were evaluated 83 transplantations. The patients were divided in two groups: those who received liver grafts collected from cities out of Curitiba (n=42) and locally (n=41). From the donors were compared: cause of death, days at ICU, cardiac arrest, vasoactive drugs, lab exams, gender, age, and BMI. Were compared the subsequent information of receptors: cold ischemia time, warm ischemia time, length of surgery, lab exams, etiology of cirrhosis, MELD score, age, gender, histology of graft, use of vasoactive drugs, and blood components transfusion. Were evaluated the correlation between cold ischemia time and lab results. Results : The liver grafts collected from other cities were submitted to a longer cold ischemia time (500±145 min) compared to those locally collected (317,85±105 min). Donors from other cities showed a higher serum sodium level at donation (154±16 mEq/dl) compared to those from Curitiba (144±10 mEq/dl). The length of cold ischemia time was related to serum levels of ALT and total bilirubin. Conclusion : Liver grafts distantly collected underwent longer cold ischemia times, although it caused neither histologic injuries nor higher transfusion demands. There is a correlation between cold ischemia time and hepatic injury, translated by elevation of serum ALT and total bilirubin levels.

Application of active immunization in the prevention of de novo hepatitis B virus infection after pediatric liver transplantation with HBcAb positive donor liver

To investigate the effect of active immunization on prevention of post-transplantation de novo hepatitis B virus (HBV) infection in patients receiving liver grafts from hepatitis B core antibody (HBcAb) positive donors. A retrospective analysis was conducted. Eighty-seven children undergoing liver transplantation from HBcAb positive donors admitted to Tianjin First Center Hospital from October 2012 to December 2016 were enrolled, and the data of donors and recipients were collected. The hepatitis B vaccine was given before operation for hepatitis B surface antibody (HBsAb) > 1 000 U/L; hepatitis B immunoglobulin (HBIG) 100 U/kg was given during the operation, in order to prevent children from HBV infected by obtaining passive immunity quickly, children with HBsAb < 200 U/L after operation were injected with hepatitis B vaccine for booster immunization. HBV markers and liver function of recipients were determined before liver transplantation and during the follow-up, which up to April 2017. According to the children got de novo HBV infection after operation or not, the preventive effect of active immunization before and after transplantation operation on HBV infection was analyzed and compared. In 87 children who received HBcAb positive donor livers, 9 (10.3%) developed de novo HBV infection, which occurred in 16 (10, 25) months after liver transplantation. Among the 9 children with HBV infection, 7 children had HBsAb < 1 000 U/L before the operation, the ratio was statistically increased as compared with the children without HBV infection [77.8% (7/9) vs. 37.2% (29/78), P < 0.05]. After the transplantation, 62 children of 78 without HBV infection showed a good response to hepatitis B vaccination, 1 child after inoculation of hepatitis B vaccine, the titer of HBsAb was still less than 200 U/L, 15 children without administration of hepatitis B vaccine, only with HBIG injection for prevention. The HBsAb of children with de nove HBV infection were less than 200 U/L after operation, the ratio was significantly increased as compared with children without HBV infection [100.0% (9/9) vs. 20.5% (16/78), P < 0.01]. The establishment of active immunization method can effectively prevent children with de novo HBV infection occurred in pediatric recipients from HBcAb positive donors with preventive treatment.

Octogenarian donors in liver transplantation grant an equivalent perioperative course to ideal young donors

BackgroundUse of grafts from very old donors for liver transplantation is controversial. AimTo compare the perioperative course of patients receiving liver grafts from young ideal vs octogenarian donors. MethodsAnalysis of the perioperative course of patients receiving liver grafts from young, ideal (18–39 years) vs octogenarian (≥80years) deceased donors between 2001 and 2014. Results346 patients were studied: 179 (51.7%) received grafts aged 18–39 years whereas 167 (48.3%) received a graft from a donor aged ≥80years. Intra-operative cardiovascular (p=0.2), coagulopathy (p=0.5) and respiratory (p=1.0) complications and incidence of reperfusion syndrome (p=0.3) were similar. Patients receiving a young graft required more fresh frozen plasma units (p≤0.03) but did not differ for the need of packed red cells (p=0.2) and platelet (p=0.3) transfusions. Median ICU stay was identical (p=0.4). Patients receiving octogenarian vs young grafts did not differ in terms of death or re-transplant (p=1.0) during the ICU stay. Similar cardiovascular, respiratory, renal, infectious and neurological postoperative complication rates were observed in the two groups. ConclusionsOctogenarian donors in liver transplantation grant an equivalent perioperative course to ideal young donors.

Clinical efficacy of liver transplantation using aged liver grafts from donation after citizen′s death

Objective : To explore the clinical efficacy of liver transplantation using aged liver grafts from donation after citizen′s death (DCD). Methods The retrospective case-control study was adopted. The clinico-pathological data of 146 patients who underwent liver transplatation using liver grafts from DCD at the Tongji Hospital of Huazhong University of Science and Technology from January 2011 to December 2015 were collected. Of 146 patients, forty-six recipients who received liver grafts from donors≥60 years were allocated into the donor age≥60 years group and 100 who received liver grafts from donor age<60 years were allocated into the donor age<60 years group. Observed indicators included: (1) the incidence of primary liver graft nonfunction (PNF) and initial poor function (IPF) of transplanted liver, (2) liver function recovery in the first postoperative month, (3) the postoperative complications, including reoperation because of bleeding, acute rejection, thrombosis of hepatic artery, thrombosis of portal vein, biliary complications, neurological complications, bacterial infection, cytomegalovirus infection and adverse reaction of calcineurin inhibitors, (4) postoperative survival rate in liver transplant recipients. The regular follow-up using outpatient examination was performed to detect indexes of laboratory examination and postoperative complications and survival of patients till January 2016. Measurement data with normal distribution were represented as ±s and comparison between groups was evaluated with the independent t test. Measurement data with skewed distribution were represented as M(Qn) and analyzed by Mann-Whitney test. Count data were analyzed using the chi-square test. Results (1) The incidences of PNF and IPF of transplanted liver: two patients in the donor age≥60 years group and 1 patient in the donor age 0.05). Eight patients in the donor age≥60 years group and 6 patients in the donor age 0.05). Nine patients had adverse reaction of calcineurin inhibitors in the donor age≥60 years group and 6 patients in the donor age 0.05). Conclusion Using liver grafts from donor age≥60 years after strict selection can achieve good therapeutic effects in liver transplantation. Key words: Liver diseases; Aged liver graft; Donation after citizen′s death; Liver transplantation

The impact of donor liver graft quality on postoperative outcome in liver transplant recipients. A single centre experience.

The Donor Risk Index (DRI) has become a universal score for organ allocation in liver transplantation (LT) worldwide. The aim of this study was to evaluate the impact of liver graft quality measured by DRI, CIT, WIT and donor age on intraoperative hemodynamics (reperfusion syndrome) and early postoperative outcome, defined as initial graft poor function (within 3 days of LT), of deceased donor liver transplant (DDLT) recipients. Secondary end-points were the assessment of the impact of graft quality on the intraoperative and postoperative day 1 hemostasis (evaluated using ROTEM assay). We retrospectively analyzed 135 patients who underwent deceased-donor LT between January 2013 and December 2014. Patient demographic data (age, sex, cause of End-Stage Liver Disease), preoperative paraclinical data (total bilirubin, creatinine, serum sodium), severity of liver disease scores (Model for End-Stage Liver Disease - MELD and MELD-sodium), intraoperative blood loss and blood products transfusion, incidence of post reperfusion syndrome, postoperative biochemical data (including total bilirubin, hepatic transaminases, lactate levels) and outcome (initial graft poor function diagnosis) were noted. Donor characteristics including DRI, CIT, WIT and donor age were noted. Coagulation was assessed by rotational thromboelastometry (ROTEM) after reperfusion of the graft and on postoperative day 1 in order to determine the effects of liver graft quality on hemostasis. Donor age has significantly correlated with decreased derived ROTEM parameters time to the maximum velocity of clot formation - MaxVt (p = 0.000), area under the curve (AUC) (p = 0.008) and maximum clot elasticity (MCE) (p = 0.018) although no difference in transfusion requirements has been observed. A longer CIT was associated with an increase in AST and ALT observed during the early postoperative period: day 1 ALT (p = 0.032) and AST (p = 0.008), day 2 ALT (p = 0.001) and AST (p = 0.001) and day 3 AST (p = 0.010) and ALT (p = 0.001). Higher DRI correlated with higher bilirubin levels measured on postoperative day 1 (p = 0.027) and 2 (p = 0.001). Patients who developed initial graft poor function received liver grafts from older donors (p = 0.05) with a higher DRI (p = 0.002). Our results suggest a significant impact of donor age and DRI on perioperative coagulation kinetics that may be a result of initial graft poor function. Although CIT and DRI correlated with a more severe cholestasis and hepatocitolysis during the early postoperative period these seems to be short-lived.

Ultrasonic integrated backscatter in assessing liver steatosis before and after liver transplantation

Liver steatosis affects 20%-30% of adults. Because of the increasing gap between graft supplies and demands, livers with steatosis are frequently used in liver transplantation. But severely steatotic liver grafts are associated with a high risk of intraoperative and postoperative complications. Accurate assessment of fat content of donor livers and monitoring of the extent of steatosis in recipients are required for liver transplantation. The present study aimed to determine the correlation between liver echogenicity and fat content, and to evaluate the use of an ultrasonic integrated backscatter system (IBS) in the assessment of changes in fat content after liver transplantation. Seventy-nine consecutive patients receiving liver grafts from living donors were evaluated in our center. Of these recipients, 67 survived for more than two years and were included in this study. Each liver graft was evaluated with IBS and ultrasound before operation and the fat content was estimated. The fat content of the grafts in the recipients was again assessed with ultrasound at 18 months after surgery. A correlation was detected between each graft's IBS value and its fat content (P=0.001). The IBS value in fatty grafts with various degrees of steatosis was significantly decreased in 3 (P=0.02), 12, 15 and 18 (P=0.001) months after orthotopic liver transplantation. The IBS value returned to normal in all patients in 18 months after liver transplantation. Decreased fat content in steatotic grafts can be observed in all recipients. Ultrasonic IBS is useful in determining the steatotic degree of grafts in donors as well as in monitoring the grafts after liver transplantation.

Successful Active Immunization Using a Hepatitis B Virus Vaccination Protocol for a Recipient With Hepatitis B Core Antibody–Positive Liver Graft

IntroductionDonor shortages occasionally necessitate the use of hepatic allografts from hepatitis B core antibody–positive (HBcAb+) donors, with an attendant risk of post-transplantation hepatitis B virus (HBV) infection. The aim of the present study was to develop and evaluate a protocol of active immunization for prevention of post-transplantation de novo HBV infection in patients receiving liver grafts from HBcAb+ donors. Patients and MethodsTen patients who had received HBcAb+ liver grafts at Shinshu University Hospital between October 1996 and December 2012 were enrolled. All the recipients were negative for HBV serological tests, and HBV-DNA. Hepatitis B immunoglobulin (HBIG) was given routinely in the peritransplantation and post-transplantation periods, without antiviral drugs. Subcutaneous vaccination with recombinant HBV was given at a dosage of 20 μg in adults and 5 μg in children concomitant with HBIG until acquisition of active immunization. The timing to start HBV vaccination was dependent on the condition of the patient. ResultsThe median follow-up period after liver transplantation was 140 months, and the median period after transplantation until the start of vaccination was 7.0 months. Nine patients (90%) acquired active immunity after a median number of 4 (range, 2–13) vaccinations (hepatitis B surface antibody >300 mIU/mL for 1 year, or >100 mIU/mL thereafter), and did not require HBIG administration thereafter. None had any side effects of HBV vaccination or developed hepatitis B infection during the study period. Four fast responders who achieved antibody high titers by active immunization within 9 months received pretransplantation vaccinations, whereas 5 slow responders did not. ConclusionsOur vaccination protocol provides a new effective strategy for prevention of de novo hepatitis B infection after liver transplantation in recipients with HBcAb+ liver grafts. Pretransplantation HBV vaccination was helpful for the post-transplantation vaccine response.