ObjectiveTo investigate the clinical value of small-for-size left lobe liver auxiliary partial orthotopic liver transplantation (APOLT) in the treatment of decompensated cirrhosis. MethodThe preoperative and postoperative clinical data of 4 patients who received small-for-size left lobe liver APOLT in 2023 were retrospectively described and analyzed. ResultsOne patient suffered metabolic liver disease cirrhosis and the other three suffered hepatitis B cirrhosis, all of whom presented with decompensated cirrhosis. Preoperative evaluation showed that the graft-to-recipient weight ratio was less than 0.6%. All recipients underwent left hemihepatectomy. The grafts were derived from living donors in 3 cases, from donation after citizen death in 1 case. After APOLT treatment, 4 patients and grafts survived, 1 patient experienced transplantation rejection and recovered after modified anti-rejection therapy. Three patients with hepatitis B cirrhosis were treated with nucleoside analogues and hepatitis B immunoglobulin, the hepatitis B virus DNA was negative at the end of follow-up, one of three patients with hepatitis B cirrhosis showed negative results for hepatitis B virus in the graft biopsy at month one after surgery. ConclusionsFrom the summary results of these cases, small-for-size left lobe liver APOLT can be used to treat decompensated cirrhosis. The application and popularization of this treatment regimen is expected to expand the donor pool and benefit more decompensated cirrhosis patients with lower Model for End-stage Liver Disease score.
ObjectiveTo summarize the current status of research in the correlation between the liver diseases and oral microbiota, to provide the scientific basis for the prevention and treatment of oral diseases in the patients with liver diseases, and to provide the guidance for further research on the biomarkers for the noninvasive diagnosis of liver diseases.MethodThe related literatures about the studies of correlation between liver diseases and oral microbiota were reviewed by searching the databases such as the PubMed, Web of Science, CNKI, and Wanfang, etc.ResultsAs the second richest microbiota, the oral flora closely interacted with the hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, cirrhosis, liver cancer, etc. Meanwhile, the prognosis of patients underwent liver transplantation was also closely correlated to oral flora.ConclusionsSpecific oral flora in patients with different liver diseases may be a potential non-invasive diagnostic biomarker. At the same time, it is necessary to pay attention to oral health and maintain oral microbiota balance for preventing and treating of liver diseases.
Liver transplantation plays a pivotal role in the field of treating end-stage liver diseases. It is currently the only treatment method that can effectively save patients’ lives and has been fully verified as effective in clinical practice. However, the problem of postoperative infection has become one of the key factors impeding the favorable prognosis of patients. Among them, donor-derived infections, due to their uniqueness and complexity, are gradually becoming a research hotspot in both clinical and scientific research fields. Through a systematic and comprehensive analysis of a large number of existing studies, we deeply analyzed the overall current situation of infections after liver transplantation, clarified the specific types of donor-derived infections and their respective characteristics. On this basis, the potential risks of such infections were thoroughly explored, and preventive strategies such as the prophylactic use of antibiotics and vaccination were put forward in a targeted manner, aiming to improve the prognosis of patients after liver transplantation to the greatest extent and enhance the quality of life of patients.
Liver transplantation is a complex medical procedure with extremely high technical requirements. It demands rigorous expertises from the transplant surgeons, particularly in the vascular and biliary reconstruction using microsurgical techniques. In China, organ transplantation training started relatively late, and current training for liver transplantation surgeons faces deficiencies in the practical opportunities, simulation training combined with hands-on experience, and scientific evaluation standards, etc. Improving the teaching quality primarily depends on addressing challenges in microsurgical training. Therefore, it is imperative to establish a systematic and standardized microsurgical training system. The Liver Transplant Center of West China Hospital, Sichuan University, had proposed a comprehensive microsurgical training program that integrated various training methods, including non-biological models, virtual reality systems, biological models, and clinical mentorship, alongside objective evaluation criteria to ensure trainees acquire essential microsurgical skills for liver transplantation. By implementing a phased and progressive training approach, combining theoretical knowledge with practical application, and adhering to standardized operational protocols and assessment mechanisms, this program effectively enhances surgeons’ technical proficiency and decision-making abilities. This innovative solution addresses critical challenges in current training, driving the implementation and continuous improvement of liver transplantation training systems.
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.
Organ transplantation is a critical treatment for end-stage organ diseases, yet postoperative infections significantly affect patient outcomes. Traditional diagnostic methods for infections often fall short in meeting the demands of precise prevention and treatment due to limitations in sensitivity, specificity, and speed. Targeted nanopore pathogen sequencing technology, characterized by its long-read capability, real-time detection, and adaptability, has shown unique potential in pathogen identification, structural variation analysis, and antimicrobial resistance gene profiling. This offers new insights into the prevention and management of postoperative infections. This expert consensus focuses on the standardized application of this technology in managing infections following organ transplantation, addressing its principles, clinical recommendations, and diagnostic workflows. By exploring its features and value in infectious disease diagnosis, the expert consensus provides standardized guidance on sample processing and result interpretation. The development of this consensus aims to promote the rational use of nanopore sequencing in diagnosing and treating post-transplant infections, enhance diagnostic accuracy and efficiency, improve patient outcomes, and facilitate the widespread adoption of this technology.