To investigate the clinical value of shear wave elastography (SWE) combined with conventional ultrasound in the evaluation of donor liver quality.

From February 2014 to October 2017, 121 cases of donation after citizens′ death for liver transplantation were performed in Calmette Hospital Affiliated to Kunming Medical University, and all the donors were performed with ultrasound and SWE before the graft harvest. The donors were divided into normal group and abnormal group according to the intraoperative rapid pathological results. The abnormal group included fatty liver, liver fibrosis, liver congestion and liver necrosis. The group t test was used to compare the Young′s modulus between abnormal group, fatty liver group, liver fibrosis group and normal group. The area under the ROC curve was calculated. The Young′s modulus at the highest Youden index was used as the cut-off value to distinguish between normal and abnormal donor livers, and the corresponding sensitivity and specificity were calculated.

There were 73 cases in normal group and 48 cases in abnormal group (21 cases of fatty liver, 18 cases of liver congestion, 5 cases of liver fibrosis, and 4 cases of liver necrosis) according to the results of intraoperative rapid pathological examination. The Young′s modulus of donor livers in abnormal group and normal group were (5.55±1.56) kPa and (3.64±0.70) kPa, respectively, with significant difference (t=7.964, P<0.05). When the cut-off value was 4.07 kPa, the Youden index was 0.628, which was the highest, and the sensitivity and specificity of SWE in the diagnosis of donor liver lesions were 83.3% and 79.5%, respectively. The Young′s modulus of fatty liver group and liver fibrosis group were (5.56±1.43) and (6.67±1.36) kPa, both of them were higher than that of normal group (t=5.974 and 4.933, P all<0.05). The range of Young′s modulus was (2.46-7.11) kPa and (5.62-9.11) kPa in liver congestion group and liver necrosis group, respectively.

SWE can quantitatively evaluate the hardness of liver tissue, and has a high specificity in the differentiation of abnormal and normal donor livers. SWE combined with conventional ultrasound can evaluate the quality of donor liver noninvasively and quantitatively, which has high clinical application value.

To explore the clinical value of indocyanine green (ICG) test combined with two-dimensional shear wave elastography (2D SWE) in evaluating the quality of donor liver.

A retrospective analysis of 21 brain-dead donors from the Organ Transplantation Center of the Affiliated Hospital of Qingdao University from May 2018 to November 2018 was conducted. All the donor livers were evaluated by ICG and 2D SWE test in ICU before donor liver acquisition. According to the early recovery of liver function, 21 recipients were divided into observation group (6 cases, recipients with early graft dysfunction after transplantation) and control group (15 cases). The age and modle for end-stage liver disease scores (last time before transplantation) of the recipients, and the cold ischemia time, ICG-R15, ICG-PDR and Young′s modulus of the donor liver between the 2 groups were compared by two independent samples t test. The Child-Pugh scores (last time before transplantation) and anhepatic stage between the 2 groups were compared by Wilcoxon signed-rank test. Receiver operator characteristic (ROC) was used to compare the predictive effect of different parameters on early allograft dysfunction after liver transplantation. P<0.05 was considered statistically significant.

The age of recipients of observation group and control group were (38±13) years and (54±6) years, respectively, the difference was statistically significant (t=2.840, P<0.05). The ICG-R15 of donor liver of observation group and control group were (5.5±3.0)% and (3.2±1.4)%, respectively, the difference was statistically significant (t=-2.386, P<0.05); the ICG-PDR of donor liver of observation group and control group were (21±5) %/min and (24±4) %/min, respectively, Young′s modulus of donor liver of observation group and control group were (5.0±1.3) kPa and (3.9±2.6) kPa, respectively, and there was no significant difference (t=1.655 and -0.930, P all>0.05). The area under ROC of ICG-R15 on predication of early graft dysfunction after liver transplantation was 0.767 (95%CI: 0.490-1.000, P>0.05), the area under ROC of ICG-PDR was 0.789 (95%CI: 0.513-1.000, P<0.05), the area under ROC of 2D SWE was 0.756 (95%CI: 0.5392-0.9719, P>0.05), the area under ROC of ICG-R15 and ICG-PDR was 0.767 (95%CI: 0.490-1.000, P>0.05). The area under ROC of ICG-R15, ICG-PDR and 2D SWE was 0.822 (95%CI: 0.608-1.000, P<0.05), the best cut-off for the prediction of early graft dysfunction were ICG-R15=4.15%, ICG-PDR=21.7 %/min, Young′s modulus=3.00 kPa, with a sensitivity of 83.3% and a specificity of 86.7%.

The prediction on early graft dysfunction after liver transplantation by ICG test combined with 2D SWE test was better than that by 2D SWE or ICG, with the advantage of non-invasive, simple and quantitative evaluation.

肝移植作为各种类型不可逆急、慢性肝病的有效治疗手段，已被广泛接受。经过几十年稳步持续的发展，肝移植技术逐渐成熟。随着肝移植技术的发展、新型免疫抑制剂的应用以及围手术期管理的进步，肝移植适应证和禁忌证也在发生变化。详细的术前检查和准备是保证肝移植预后的重要环节。为进一步规范我国肝移植受者选择以及术前评估和准备，中华医学会器官移植学分会组织肝移植专家，总结国内外相关研究最新进展，结合国际指南和临床实践，从肝移植适应证和禁忌证、受者术前检查、术前准备以及常见并发症处理等方面，制订《中国肝移植受者选择与术前评估技术规范(2019版)》。

受者筛选是肺移植成功的重要决定因素之一，严格的术前评估及充分准备是获得满意疗效的关键。为了进一步规范我国肺移植受者选择以及术前评估和准备，中华医学会器官移植学分会根据我国近20年肺移植临床实践经验，并结合国际心肺移植协会肺移植受者选择指南，从肺移植适应证和禁忌证、各种终末期肺疾病手术时间选择以及术前检查内容等方面，制订中国肺移植受者选择与术前评估技术规范(2019版)。

由于供心资源稀缺，必须对心脏移植候选者进行严格选择，仔细衡量风险和获益，评估其是否适合接受心脏移植。入选心脏移植等待名单的候选者需进行全面的术前评估，最大限度改善心功能和各器官功能状态；同时，接受详细的术前检查，以确保心脏以外器官功能可耐受心脏移植手术及术后免疫抑制治疗。为了进一步规范心脏移植受者选择以及术前评估和准备，中华医学会器官移植学分会组织心脏移植专家，总结相关国内外最新进展，结合国际指南和临床实践，从心脏移植适应证、禁忌证、移植候选者筛选和评估以及术前检查和准备等方面，制订中国心脏移植受者术前评估与准备技术规范(2019版)。

To evaluate and rank the efficacy of seven interventionson on recurrent hepatocellular carcinoma after liver transplantation: surgical resection, retransplantation, radiofrequency ablation (RFA), transcatheter arterial chemoembolization (TACE), sorafenib, sorafenib plus TACE and conservative treatment. Hoping to evidence-based medical evidence for clinical treatment.

Databases including Cochrane library, Embase, PubMed, Web of Science, Wan Fang Data, CNKI, VIP and SinoMed were searched to collect randomized controlled trials, as well as cohort studies about the seven interventions on recurrent hepatocellular carcinoma after liver transplantation from inception to 1 Jan 2018. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then network meta-analysis was performed using Stata 12.0 and WinBUGS 1.4.3 statistical softwares.

A total of 20 retrospective cohort studies was collected in the study, including 604 patients. The 8 articles in the Newcastle-Ottawa scale scored 6 points and 12 in 7 points, all of which were high quality literature. Predicting the efficacy of interventions under the cumulative ranking probability plot. On the 6-month overall survival (OS) rate, the efficacy was ranked: sorafenib+ TACE>RFA>TACE>surgical resection>retransplantation>sorafenib>conservative treatment. On the 1-year OS rate, the efficacy was ranked: sorafenib+ TACE>surgical resection>sorafenib>RFA>TACE=retransplantation>conservative treatment. On the 2-year OS rate, the efficacy was ranked: sorafenib+ TACE>surgical resection>RFA>sorafenib>TACE>conservative treatment.

For the treatment of recurrent hepatocellular carcinoma after liver transplantation, the efficacy of sorafenib plus TACE is likely to be the best treatment and the surgical resection and RFA is relatively effective. The efficacy of retransplantation, TACE and sorafenib are relatively poor, conservative treatment may be the worst.

To preliminarily analyze the value of ultrasonography on liver grafts in in-suit split liver transplantation (ISSLT).

The ultrasonography data of 5 cases of donation after brain death were analyzed retrospectively. All the donors received routine two-dimensional ultrasonography, color doppler ultrasound (CDFI) and shear wave elastography (SWE) before transplantation, and contrast enhanced ultrasound (CEUS) was performed depending upon the situation.

Test result of two-dimensional ultrasonography showed that liver echo was low in 2 cases, slightly enhanced in 2 cases, and remarkably enhanced in 1 case. No abnormality was found in hepatic artery, portal vein, middle hepatic vein or their branches using CDFI. The shear wave velocity of right hepatic anterior of 5 donors was 2.67-4.35 kPa. CEUS was performed in 2 donors, and 1 case had anatomical variation in hepatic artery. The vascular assessment results of ultrasonography were consistent with intraoperative findings. Pathologic findings showed no hepatic adipose infiltration in all five cases.

Ultrasonography can serve as the preferred imaging examanation for preoperative liver evaluation of ISSLT donor. It can accurately evaluate the size, quality, existence of adipose infiltration, and vascular variation of donor livers. SWE and CEUS can serve as effective supplements for the traditional ultrasonographic method by hardness and microcirculation perfusion detection, respectively.

To compare the value of different diagnostic methods on transplant renal artery stenosis (TRAS) and summarize the treatment experience of interventional therapy on TRAS.

The clinical data of 25 recipients who suffered TRAS after renal transpantation in Renmin Hospital of Wuhan University from January 2010 to June 2017 were analysed. All recipients accepted color doppler flowing image (CDFI), magnetic resonance angiography (MRA) and digital subtraction angiography (DSA). Recipients received interventional therapy immediately after they were diagnosed with TRAS by DSA, mild stenosis recipients were treated with balloon dilatation, moderate stenosis and severe stenosis recipients were treated with balloon dilatation and artery stent. TRAS recipients were divided into fast blood flow group and slow blood flow group, the media peak systolic velocity (PSV) of transplant artery and resistance index between the 2 groups were compared. Diagnosis rate of CDFI and MRA on TRAS were compared with Fisher′s exact test. The indexes like 24 hour urine volume, mean arterial pressure, serum creatinine and glomerular filtration rate (GFR) before and after operation were compared with paired t test; the media PSV and resistance index of fast blood flow group and slow blood flow group were also compared with paired t test. P<0.05 was considered statitically significant.

Diagnosis rate of CDFI and MRA on TRAS were 68% (17/25) and 84.0% (21/25), which had no statitical significance (P=0.57). The test results of DSA showed that there were 7 cases of mild stenosis recipients, 13 cases of moderate stenosis recipients and 5 cases of severe stenosis recipients. All the mild stenosis recipients received balloon dilatation, other recipients received balloon dilatation and artery stent. Twenty-four hour urine volume, mean arterial pressure, serum creatinine and GFR of fast blood flow group and slow blood flow group before and after operation were (1 956±615) and (2 752±729) mL, (117±13) and (96±8) mmHg, (190±50) and (109±22) μmol/L, (39±12) and (66±8) mL/min, all of them had statitical significance (t=4.17, 6.59, 7.35, 9.48, P all<0.05). Media PSV and resistance index of fast blood flow group (n=17) before and after operation were (151±27) and (87±28) cm/s, 0.77±0.05 and 0.56±0.06, all of them had statitical significance (t=6.35, 4.38, P all<0.05). Media PSV and resistance index of slow blood flow group (n=8) before and after operation were (39±9) and (80±16) cm/s, (0.56±0.06) and (0.66±0.04), all of them had statitical significance (t=6.33, 3.92, P all<0.05). Postoperative follow-up time of 25 TRAS recipients was 4-36 months up to October 2017, complications like artery thrombosis and restenosis were not observed; gastrointestinal bleeding (n=1) and vena iliaca externa thrombosis (n=1) were observed after interventional therapy; 1 case catched pulmonary infection on the third day after interventional therapy and died of respiratory failure 1 month later.

MRA and CDFI perform similar value in diagnosing TRAS. Interventional therapycould rectify the clinical symptoms and renal function by restoring transplant renal blood filtration.

To evaluate the clinical efficacy of salvage liver transplantation (SLT) for hepatocellular carcinoma.

Information up to August 31th 2016 was retrieved from Cochrane library, Pubmed, EMbase, CBM, CNKI, CSPD and VIP without linguistic constraints. Collected publications were all about case-control study of SLT or primary liver transplantation for hepatocellular carcinoma. All the included articles were performed with data extraction and quality assessment and then analyzed with RevMan 5.3.

A total of 17 articles including 9 335 patients were enrolled. There was no statistic difference between SLT and PLT on 1-year survival rate, 1-year disease-free survival rate (RR=0.93, 95%CI: 0.80-1.08, P=0.36; RR=0.94, 95%CI: 0.81-1.08, P=0.40). However, 3-year survival rate and 5-year disease-free survival rate of PLT were higher than SLT(RR=0.88, 95%CI: 0.77-1.00, P=0.04; RR=0.86, 95%CI: 0.76-0.98, P=0.02; RR=0.83, 95%CI: 0.73-0.94, P=0.005; RR=0.77, 95%CI: 0.67-0.88, P=0.001).

Long-term efficacy of PLT was better than SLT.

Accurate assessment of the kidney from donation after citizen′s death, can avoid the waste of the donor kidney, reduce the incidence of postoperative delayed graft function or renal allograft primary nonfunction. Naturally, donor kidney will be examined through visual observation, donor risk score, selective renal biopsy, parameters of hypothermic machine pefusion, as well as comprehensive judgement on molecular diagnosis, and biomarker detection for blood, urine and perfusion solution. However, accurate quality assessment of donor kidney has get to be improved. At present, organ donation after citizen′s death in China is growing rapidly. It is very necessary to formulate unified quality assessment standards to guide the national organ donation, and promote the more standardized, effective and safe clinical application.

To compare the effectiveness and advantage of living donor liver transplantation (LDLT) for postresection recurrent hepatocellular carcinoma (HCC) with primary LDLT for HCC patients.

Acccording to the including criteria, 4 retrospective studies involving 639 patients were included. RevMan 5.3 software was used for data analysis.

We conducted subgroup analysis based on outcome measures and interventions. Comparing with LDLT for postresection recurrent HCC, primary LDLT had a lower incidence rate of postoperative bleeding (RR=0.36, 95%CI: 0.19-0.68, P<0.05). The incidence rates of vascular complication and biliary complication were similar (RR=0.41, 95%CI: 0.13-1.36, P>0.05; RR=0.80, 95%CI: 0.47-1.36, P>0.05). Likewise, perioperative mortalities did not significantly differ between them (RR=1.24, 95%CI: 0.40-3.88, P>0.05). However, 3-year survival rate was higher among patients who underwent primary living donor liver transplantation (RR=1.28, 95%CI: 1.02-1.61, P<0.05). The 5-year survival rate and 3, 5-year disease-free survival rates showed no statistically significant difference between them (RR=1.10, 95%CI: 0.92-1.33, P>0.05; RR=1.23, 95%CI: 0.91-1.68, P>0.05; RR=1.21, 95%CI: 0.89-1.64, P>0.05).

The long-term effect of LDLT for postresection recurrent HCC is equivalent to primary LDLT, and this therapeutic method is safe and reliable.