Middle hepatic vein reconstruction in adult right lobe living donor liver transplantation improves recipient survival

BackgroundThe efficacy and necessity of middle hepatic vein (MHV) reconstruction in adult-to-adult right lobe living donor liver transplantation (LDLT) remain controversial. The present study aimed to evaluate the survival beneficiary of MHV reconstructions in LDLT.MethodsWe compared the clinical outcomes of liver recipients with MHV reconstruction (n = 101) and without MHV reconstruction (n = 43) who underwent LDLT using right lobe grafts at our institution from January 2006 to May 2017.ResultsThe overall survival (OS) rate of recipients with MHV reconstruction was significantly higher than that of those without MHV reconstruction in liver transplantation (P = 0.022; 5-yr OS: 76.2% vs 58.1%). The survival of two segments (segments 5 and 8) hepatic vein reconstruction was better than that of the only one segment (segment 5 or segment 8) hepatic vein reconstruction (P = 0.034; 5-yr OS: 83.6% vs 67.4%). The survival of using two straight vascular reconstructions was better than that using Y-shaped vascular reconstruction in liver transplantation with two segments hepatic vein reconstruction (P = 0.020; 5-yr OS: 100% vs 75.0%). The multivariate analysis demonstrated that MHV tributary reconstructions were an independent beneficiary prognostic factor for OS (hazard ratio=0.519, 95% CI: 0.282–0.954, P = 0.035). Biliary complications were significantly increased in recipients with MHV reconstruction (28.7% vs 11.6%, P = 0.027).ConclusionsMHV reconstruction ensured excellent outflow drainage and favored recipient outcome. The MHV tributaries (segments 5 and 8) should be reconstructed as much as possible to enlarge the hepatic vein anastomosis and reduce congestion.     

萸连巴布剂体外释放和透皮行为的研究

目的:考察萸连巴布膏的体外释放和透皮行为和规律.方法:试验采用改良Franz扩散装置,用HPLC法使用1种流动相测定接收液中吴茱萸碱、吴茱萸次碱、巴马汀、小檗碱4种指标成分的含量.结果:吴茱萸碱、吴茱萸次碱、巴马汀、小檗碱释放速率分别为0.023 9,0.015 6,0.072 5,0.819 1 mg·cm~(-2)·h~(-1/2);透皮速率分别为1.256,1.030 2,2.802 9,20.919μg·cm~(-2)·h~(-1).结论:萸连巴布剂的体外释放符合Higuchi方程,透皮行为为零级过程.