Clinical Outcomes Of Liver Transplantation With Different Sources Of Donor Liver

Part I Outcomes of Liver Transplantation with DCD Donor LiverObjective: DCD donor liver is widely used in liver transplantation in China today. However, the complexity of the donor and the damage in the process of organ obtaining may result in high rate of graft infection, organ failure and mortality after liver transplantation. In this study, we analyzed the clinical data of patients with liver transplantation from single center in the past five years to evaluate the safety and reliability of liver transplantation with DCD donor liver.Method: This study collected 112 cases of patients undergoing orthotopic liver transplantation in Organ Transplant Center, Sichuan Provincial People’s Hospital from December 2010 to December 2015. According to the different sources of donor liver, all 112 cases were divided into two groups including DCD group(n=43) and Non-DCD group(n=69). The preoperative related indexes, the incidence rate of postoperative complications and clinical prognosis between the two groups were analyzed in this study.Result: In this study, the preoperative baseline data included age, gender, previous history of disease, MELD score and Child score between the two groups had no significant differences. The warm ischemia time in DCD group was significantly longer than that in the Non-DCD group(P<0.05), while the cold ischemia time in DCD group was significantly shorter than that in the Non-DCD group(P<0.05). Compared with the Non-DCD group, the amount of intraoperative fluid infusion and the actual intraoperative volume during the operation was less in the DCD group(P<0.05), and the amount of intraoperative hemorrhage, blood transfusion, plasma transfusion, urinary volume in the DCD group were also less than that in the Non-DCD group, but there were no significant differences in these indexes(P>0.05). Furthermore, the results of linear correlation analysis showed that there was no significant correlation between the actual intraoperative volume and the use of breathing machine(P>0.05). The anhepatic phase in the DCD group(80.93±27.41 min) was shorter than that in the Non-DCD group(98.30±37.70 min)(P<0.05), and the time of operation of DCD group(533.26±122.28 min) was also shorter than that in the Non-DCD group(588.01±141.66 min). Compare the postoperative liver function indicators, the results showed that the level of GGT and ALP in the DCD group was significantly higher than that in the Non-DCD group(P<0.05). In addition, the 1-year and 3-year survival rate in the DCD group was 79.1%(34/43) and 79.1%(34/43), the Non-DCD group was 84.1%(58/69) and 81.2%(56/69). The 1-year and 3-year survival rate showed no significant difference(P>0.05). Meanwhile, the postoperative complications also had no significant difference between the two groups(P>0.05).Conclusion: The results showed that liver transplantation with different sources of donor livers could achieve similar clinical outcomes, and there were no significant differences in the perioperative indexes, postoperative complications rate and clinical prognosis, which provides a theoretical basis for the safety and reliability of the current liver transplantation with DCD donor liver.Part II The Role of Preoperative Downstaging Treatment in LiverTransplantation with Hepatocellular Carcinoma: Experience from aSingle-CenterObjective: In China, the majority of patients with hepatocellular carcinoma who have willingness to liver transplantation were at the advanced stage. Preoperative downstaging treatment may help delay the tumor development and increase the opportunities of liver transplantation, but how the clinical curative efficacy is has become a hot topic today. Here, this retrospective study was to investigate the clinical outcomes of preoperative downstaging treatment in patients with liver transplantation with hepatocellular carcinoma in the past five years from single center.Method: In this study, 47 patients with hepatocellular carcinoma undergoing liver transplantation were chosen from Organ Transplant Center, Sichuan Provincial People’s Hospital from December 2010 to December 2015. According to whether received preoperative downstaging treatment, all 47 cases were divided into the Downstaging group(n=22) and Non-downstaging group(n=25). And the preoperative related indexes, the incidence rate of postoperative complications and the clinical prognosis between the two groups were analyzed in this study.Result: In this study, the baseline data included age, gender, previous history of disease, MELD score, Child score and TNM staging of the two groups had no statistically significant differences. There were no significant differences in the amount of intraoperative fluid volume, the time of operation and the postoperative liver function between the Downstaging group and the Non-downstaging group(P>0.05). The rate of postoperative complications, including postoperative jaundice, hepatitis B recurrence, tumor recurrence and metastasis, hypertension, diabetes, diarrhea, pneumonia and acute, chronic rejection, also had no significant differences(P>0.05). The 1-year and 3-year survival rate of the Downstaging group was 86.4%(19/22) and 81.8%(18/22), and the Non-downstaging group was 84%(21/25) and 80%(20/25). There was no statistical difference in the 1-year and 3-year survival rate(P>0.05). At the same time, no significant differences existed in the 1-year and 3-year tumor-free survival between the Downstaging group(63.6%(14/22) and 59.1%(13/22)) and the Non-downstaging group(68%(17/25) and 64%(16/25))(P>0.05).Conclusion: The results showed that there were no significant differences in the incidence rate of postoperative complications, the overall survival rate and disease-free survival rate between the two groups. Recipients with hepatocellular carcinoma who received preoperative downstaging treatment could reach similar clinical outcomes like those meet the criteria of liver transplantation.