Objective To research anesthetic management, pathophysiologic variation of adult-to-adult living donor liver transplantation (A-ALDLT) and to probe how to improve anesthetic quality of A-ALDLT. Methods The clinical data of 47 donors from Sep. 2005 to Jan. 2007 in West China Hospital were reviewed. Intraoperative vital signs, anesthetic management, perioperative serum levels of HGB， Alb， ALT， AST, TBIL， APTT， PT were measured， and complications were assessed. Results The physical condition of all donors were good before operations and were all in grade Ⅰaccording to ASA. Under general anesthesia of intravenous and inhalation, electrocardiogram, O2 saturation, blood pressure and body temperature were continuously monitored. A radial arterial catheter and a central venous catheter were placed. Blood lavement was utilized intraoperatively in all patients. All donors maintained stable life signs intraoperatively. The average intraoperative blood losses was （603.13±317.00） ml, and donors were transfused with autologous blood 〔(381.25±171.15) ml〕, with only 4 donors required homologous blood transfusion. HR and mean arterial blood pressure (MAP) showed no significantly variations intraoperatively (Pgt;0.05). Compared with controlled central venous pressure (CVP) before and right after hepatectomy, CVP increased significantly (P＜0.05) when intubation and abdomen-closing were carried. After hepatectomy and on the first day after operation, HGB and Alb decreased significantly (P＜0.05); ALT, AST and TBIL increased significantly (P＜0.05). Right after hepatectomy, PT increased instantly and significantly (P＜0.05); On the first day after operation, APTT began to increase significantly (P＜0.05). All donors came around completely and were extubated in the liver transplantation intensive care unit on the first day after operation. There were 3 cases (6.38%) of postoperative complication, which were biliary leakage, portal vein thrombosis and serious pleural effusion. Those 3 donors were cured after treatment. Conclusion Inhalation and intravenous general anesthesia of propofol, remifen-tanil and isoflurane can maintain stable life signs and reduce liver injury. Steady anesthesia, sufficient oxygenation and effective blood protection measures, for example, by decreasing CVP to prevent bleeding and by reclaiming autologous blood to avoid transfusing homologous blood, are keys for the safety of the donor and the prevention of complications.
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.
Liver transplantation；Imaging evaluation；Donor；Recipient
目的总结心脏移植和双肺移植供体心肺同时摘取的经验。 方法解放军第一八一医院心脏中心2012年完成3例同一供体心肺同时摘取，分别完成心脏移植和双肺移植各3例。3例供体为脑死亡，阻断供体升主动脉和主肺动脉后，同时灌注保护液，心脏保护应用组氨酸-色氨酸-酮戊二酸心脏停搏液（HTK液），肺保护应用低钾右旋糖酐液（LPD液）；供体心肺热缺血时间为5 min，供心冷缺血时间分别为252 min、323 min和375 min，供体肺冷缺血时间分别为610 min、679 min和738 min；3例心脏移植均采用双腔静脉吻合法，3例肺移植均采用序贯式双肺移植。 结果3例心脏移植均存活；肺移植2例存活，1例死亡。存活患者出院后生活质量良好，随访8～13个月未出现感染、急性排斥反应等并发症。 结论供体心肺同时摘取，同时灌注后分别修剪并再次灌注，分别保存运输，心脏移植和双肺移植可取得满意效果。
Objective To investigate the effectiveness of free vascularized fibula grafting with unilateral fibula as donor in treatment of bilateral avascular necrosis of femoral head (ANFH). Methods Between June 2007 and January 2008, 14 patients with bilateral ANFH were treated with free vascularized fibula grafting with unilateral fibula as donor. There were 12males and 2 females with an average age of 36.6 years (range, 17-57 years). The necrosis was caused by use of steroids in 3 cases, consumption of alcohol in 4 cases, and idiopathic condition in 7 cases. According to Steinberg system, 16 hips were classified as stage II, 10 hips as stage III, and 2 hips as stage IV. The preoperative Harris hip scores were 77.50 ± 4.19, 69.70 ± 2.76, 59.50 ± 0.50 in patients at stages II, III, and IV, respectively. The duration of operation and the bleeding volume were recorded. The X-ray examination, the Harris hip score, and the compl ications were used to evaluate the effectiveness. Results The duration of the fibula osteotomy was 10-32 minutes (mean, 20 minutes). The duration of the total operation was 100-240 minutes (mean, 140 minutes). The bleeding volume was 200-500 mL (mean, 280 mL). All patients achieved heal ing of incision by first intention. The patients were followed up 12-40 months (mean, 24 months). One case had numbness and hyperthesia of the anterolateral thigh; 1 case had abnormal sensation of the dorsal foot; 1 case had discomfort of the ankle; and they restored to normal at 1 year after operation. According to X-ray films 1 year after operation, the improvement was achieved in 23 hi ps (82.1%) and no deterioration in 5 hips (17.9%). At 1 year after operation, the Harris hip scores were 93.90 ± 4.84, 88.50 ± 8.13, and 78.00 ± 0.00 inpatients at stages II, III, and IV, respectively, showing significant differences when compared with preoperative ones (P lt; 0.05). Conclusion Unilateral free vascularized fibula grafting has lots of virtues, such as short surgical time, less bleeding volume, l ittle injury, and good results of function recovery. It could be an effective and safe method in treating bilateral ANFH.
Objective To summarize the research progress on the source and selection of donor cells in the field of islet replacement therapy for diabetes mellitus. Methods Domestic and abroad literature concerning islet replacement therapy for diabetes mellitus, as well as donor source and donor selection was reviewed and analyzed thoroughly. Results The shortage of donor supply is still a major obstacle for the widely clinical application of pancreatic islet transplantation (PIT). Currently, in addition to the progress on the allogeneic/autologous donor islet supply, some remarkable achievements have been also attained in the application of xenogeneic islet (from pig donor), as well as islet like cells derived from stem cells and islet cell line, potentially enlarging the source of implantable cells. Conclusion Adequate and suitable donor cell supply is an essential prerequisite for widely clinical application of PIT therapy for type 1 diabetes mellitus (T1DM). Further perfection of organ donation system, together with development of immune-tolerance induction, gene and bioengineering technology etc. will possibly solve the problem of donor cell shortage and provide a basis for clinical application of cellular replacement therapy for T1DM.
Living donor liver transplantation is one of the main solutions to the organ supply-demand discrepancy at present. However, there was a risk of the recipient developing small-for-size syndrome due to insufficient graft volume, while an excessively large graft volume for donation might lead to postoperative liver failure for the donor. In this context, the dual-graft liver transplantation had emerged, which could minimize the volume of liver resection from the each donor to ensure the donor’s safety and provide the adequate volume of liver for the recipient. Yet, this procedure is less commonly performed in our country. In order to promote the steady implementation of dual-graft liver transplantation in China and serve as an important supplement to the donor pool, the West China Hospital of Sichuan University organized relevant experts and draw on the mature experiences of advanced countries in the field of transplantation jointly formulated the “Expert consensus on dual-graft liver transplantation”. The consensus had been developed around aspects such as donor evaluation and selection, surgical methods, and postoperative complications.
【Abstract】ObjectiveThe growing gap between the number of patients waiting for transplantation and available organs has continued to be the number one issue facing the transplant community. The major limitation of adult-to-adult living donor liver transplantation (LDLT) is the adequacy of the graft size. But donor safety is the major concern in LDLT. Methods Two patients with end-stage liver disease were successfully performed adult-to-adult LDLT using dual grafts in our division. One patient’s donors are left lobe and left lobe from his two old sisters , respectively. The other graft are right lobe from his 56 years-old mother and left lobe splitting from a cadaveric organ donor (the other part of split-liver transplants from the the cadaveric organ donor offer to another adult donor ). Results Both recipients and three donors display good graft function and normal triangularshape regeneration of their liver grafts after liver transplantation. There was neither a mortality nor a serious complications in the donors. Conclusion The critical issue of LDLT is donor morbidity. Dual grafts from two living donors can help to alleviate the problem of small-for-size grafts and yet secure the safety of the donor. But the complicated surgical technique give a great challenge for liver transplant surgeons.