Outcome for Hong Kong residents undergoing cadaveric liver transplantation in mainland China

Objective. To review the outcome for Hong Kong residents undergoing cadaveric liver transplantation in mainland China. Design. Retrospective study. Setting. Liver Transplant Centre, university teaching hospital, Hong Kong. Subjects and methods. A retrospective review of medical records was undertaken for patients at Queen Mary Hospital who underwent cadaveric liver transplantation in China between 1 January 1997 and 31 December 2001. Results. Fifteen patients from Queen Mary Hospital underwent cadaveric liver transplantation in China during the study period. Eleven were men and four were women. Their mean age was 51 years. Disease indications included hepatitis B-related liver cirrhosis (n=7), hepatitis B-related liver cirrhosis with hepatocellular carcinoma (n=5), hepatitis C-related liver cirrhosis (n=1), hepatitis C-related liver cirrhosis with hepatocellular carcinoma (n=1), and polycystic liver and kidney disease (n=1). Nine patients were already waiting for liver transplantation at Queen Mary Hospital, and two of the nine patients were on the 'urgent' list. The overall survival rate was 80.0% at 6 months and 73.3% at 12 months. There were four (27%) deaths, two of which occurred in China. Of the 11 surviving patients, nine (82%) developed complications. Nineteen complications were seen in the 13 patients who were managed in Hong Kong following their return from China. Infective and biliary complications accounted for 58% and 26% of complications, respectively. Major complications necessitated prolonged hospitalisation for four patients and two required further laparotomy. Conclusion. Although cadaveric liver transplantation in China is an option for Hong Kong residents, patients and clinicians should be aware of the possible outcomes and resource implications.published_or_final_versio

The Contribution of Ageing to Hospitalisation Days in Hong Kong: A Decomposition Analysis

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Living donor liver transplantation in adults

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Liver transplantation for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the third commonest cancer in Hong Kong. Up to 80% of patients have inoperable tumour at presentation, either because of underlying cirrhosis or advanced stage of the disease. The present report described a case of orthotopic liver transplantation (OLT) for HCC. Prognostic factors for survival and selection criteria for liver transplantation are discussed. Early referral of selected patients with HCC to a transplant centre can offer a hope of cure. The best candidate for OLT is a young patient with an asymptomatic small HCC in a cirrhotic liver.published_or_final_versio

Living donor liver transplantation without the use of blood products.

We report on two patients who presented with unresectable hepatocellular carcinoma complicating hepatitis B liver cirrhosis. After evaluation, both patients were accepted for liver transplantation. Being aware of the scarce availability of cadaveric liver grafts and the long waiting time, family members volunteered to be donors for the two patients. Living donor liver transplantation using right lobe liver grafts, including the middle hepatic vein, was subsequently performed without the use of blood products in both the donors and recipients. All involved recovered uneventfully from their respective operations.published_or_final_versio

Kinetics of thermal oxidation of 6H silicon carbide in oxygen plus trichloroethylene

In this work, the behaviors of the trichloroethylene (TCE) thermal oxidation of 6H silicon carbide (SiC) are investigated. The oxide growth of 6H SiC under different TCE concentrations (ratios of TCE to O2) follows the linear-parabolic oxidation law derived for silicon oxidation by Deal and Grove, J. Appl. Phys., 36 (1965). The oxidation rate with TCE is much higher than that without TCE and strongly depends on the TCE ratio in addition to oxidation temperature and oxidation time. The increase in oxidation rate induced by TCE is between 2.7 and 67% for a TCE ratio of 0.001-0.2 and a temperature of 1000-1150°C. Generally, the oxidation rate increases quickly with the TCE ratio for a TCE ratio less than 0.05 and then gradually saturates for a ratio larger than 0.05. The activation energy EB/A of the TCE oxidation for the TCE ratio range of 0.001-0.2 is 1.04-1.05 eV, which is a little larger than the 1.02 eV of dry oxidation. A two-step model for the TCE oxidation is also proposed to explain the experimental results. The model points out that in the SiC oxidation with TCE, the products (H2O and Cl2) of the reaction between TCE and O2 can speed up the oxidation, and hence, the oxidation rate is highly sensitive to the TCE ratio. © 2005 The Electrochemical Society. All rights reserved.published_or_final_versio

Inference of expanded Lrp-like feast/famine transcription factor targets in a non-model organism using protein structure-based prediction

© 2014 Ashworth et al. Widespread microbial genome sequencing presents an opportunity to understand the gene regulatory networks of nonmodel organisms. This requires knowledge of the binding sites for transcription factors whose DNA-binding properties are unknown or difficult to infer. We adapted a protein structure-based method to predict the specificities and putative regulons of homologous transcription factors across diverse species. As a proof-of-concept we predicted the specificities and transcriptional target genes of divergent archaeal feast/famine regulatory proteins, several of which are encoded in the genome of Halobacterium salinarum. This was validated by comparison to experimentally determined specificities for transcription factors in distantly related extremophiles, chromatin immunoprecipitation experiments, and cis-regulatory sequence conservation across eighteen related species of halobacteria. Through this analysis we were able to infer that Halobacterium salinarum employs a divergent local trans-regulatory strategy to regulate genes (carA and carB) involved in arginine and pyrimidine metabolism, whereas Escherichia coli employs an operon. The prediction of gene regulatory binding sites using structure-based methods is useful for the inference of gene regulatory relationships in new species that are otherwise difficult to infer

Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma

Background. Resection of hepatocellular carcinoma is associated with high rates of morbidity and mortality. Since intensive nutritional support can reduce the catabolic response and improve protein synthesis and liver regeneration, we performed a prospective study to investigate whether perioperative nutritional support could improve outcome in patients undergoing hepatectomy for hepatocellular carcinoma. Methods. We studied 124 patients undergoing resection of hepatocellular carcinoma. Sixty-four patients (39 with cirrhosis, 18 with chronic active hepatitis, and 7 with no associated liver disease) were randomly assigned to receive perioperative intravenous nutritional support in addition to their oral diet, and 60 patients (33 with cirrhosis, 12 with chronic active hepatitis, and 15 with no associated liver disease) were randomly assigned to a control group. The perioperative nutritional therapy consisted of a solution enriched with 35 percent branched-chain amino acids, dextrose, and lipid emulsion (50 percent medium-chain triglycerides) given intravenously for 14 days perioperatively. Results. There was a reduction in the overall postoperative morbidity rate in the perioperative-nutrition group as compared with the control group (34 percent vs. 55 percent; relative risk, 0.66; 95 percent confidence interval, 0.45 to 0.96), predominantly because of fewer septic complications (17 percent vs. 37 percent; relative risk, 0.57; 95 percent confidence interval, 0.34 to 0.96). There were also a reduction in the requirement for diuretic agents to control ascites (25 percent vs. 50 percent; relative risk, 0.57; 95 percent confidence interval, 0.37 to 0.87), less weight loss after hepatectomy (median loss, 0 kg vs. 1.4 kg; P = 0.01), and less deterioration of liver function as measured by the change in the rate of clearance of indocyanine green (-2.8 percent vs. -4.8 percent at 20 minutes, P = 0.05). These benefits were seen predominantly in the patients with underlying cirrhosis who underwent major hepatectomy. There were five deaths during hospitalization in the perioperative-nutrition group, and nine in the control group (P not significant). Conclusions. Perioperative nutritional support can reduce complications after major hepatectomy for hepatocellular carcinoma associated with cirrhosis.published_or_final_versio

Portal vein embolisation prior to extended right-sided hepatic resection

Objectives. To determine whether preoperative portal vein embolisation improves the operative outcome of patients undergoing extended right-sided hepatic resection for hepatobiliary malignancy. Design. Prospective non-randomised study. Setting. University teaching hospital, Hong Kong. Patients. Ninety-two patients underwent extended right-sided hepatic resection for hepatobiliary malignancy during a 45-month period (January 2000 to September 2003). Among them, 15 (16%) underwent portal vein embolisation via a percutaneous ipsilateral approach (n=9) or through the ileocolic vein with a mini-laparotomy (n=6). The remaining 77 (84%) patients underwent hepatic resection without portal vein embolisation. Main outcome measures. Operative morbidity and mortality. Results. Patients undergoing portal vein embolisation were older (69 years vs 55 years; P=0.009), and had significantly worse preoperative renal function (creatinine, 96 μmol/L vs 86 μmol/L; P=0.039) and liver function (bilirubin, 23 μmol/L vs 12 μmol/L; P<0.001). Portal vein embolisation resulted in an increase in the future liver remnant of 9% (interquartile range, 7-13%) of the estimated standard liver volume. The operating time for patients receiving portal vein embolisation was significantly longer (medium, 660 min vs 420 min; P<0.001) with more complicated surgery performed in terms of concomitant caudate lobectomy and hepaticojejunostomy. There was no hospital mortality in patients who underwent portal vein embolisation whereas five without the treatment died (P=0.587). The operative morbidity of patients who underwent portal vein embolisation and those who did not was 20% and 30%, respectively (P=0.543). Conclusions. In older patients who have worse preoperative liver and renal functions, portal vein embolisation enhances the possibility to perform extended right-sided hepatic resection for hepatobiliary malignancies with potentially lower operative mortality and morbidity.published_or_final_versio

Hepatic resection for colorectal liver metastases: prospective study.

OBJECTIVE: To assess the operative and long-term survival outcomes of hepatic resection for colorectal liver metastases during an 11-year period in a tertiary referral centre in Hong Kong. DESIGN: Prospective study. SETTING: University teaching hospital, Hong Kong. SUBJECTS AND METHODS: Between January 1989 and December 1999, 72 patients underwent hepatic resection for colorectal liver metastases. Clinical, pathological, and outcome data were prospectively collected and analysed. Factors affecting long-term survival were also evaluated. RESULTS: Twenty-five (34.7%) patients were found to have synchronous hepatic metastasis at the time of colorectal resection. Fifty-two (72.2%) patients underwent major hepatic resection. The operative morbidity and hospital mortality rates were 19% and 4%, respectively. The 5-year survival rate after hepatectomy was 31.9%. The median disease-free survival and median overall cumulative survival were 18.5 months and 30.8 months, respectively. On multivariate analysis, a high preoperative serum carcinoembryonic antigen level (>200 ng/mL) and tumour involvement of the resection margin at histology were the two independent risk factors that adversely affected survival outcome. CONCLUSION: Hepatic resection for colorectal liver metastases can be performed safely, with minimal operative mortality and acceptable morbidity, and results in satisfactory survival. High preoperative serum carcinoembryonic antigen level and histological involvement of resection margin by cancer adversely affect the survival outcome.published_or_final_versio