Browsing by Author "Guo, Zhiyong"

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Diagnosis and Treatment of Acute Appendicitis After Orthotopic Liver Transplant in Adults
(Başkent Üniversitesi, 2011-04) Wu, Linwei; Zhu, Xiaofeng; Wang, Dongping; Ju, Weiqiang; He, Xiaoshun; Tai, Qiang; Guo, Zhiyong; Zhang, Jianwei
Objectives: The incidence of acute appendicitis after orthotopic liver transplant is low but difficult to differentiate from other posttransplant complications. We sought to summarize the clinical characteristics, diagnosis, and treatment of acute appendicitis during the early posttransplant stage. Materials and Methods: Data from 4 liver transplant recipients with acute appendicitis immediately after transplant and 4 patients with misdiagnosed appendicitis, between January 2000 and December 2007, were studied retrospectively. Results: The incidence of acute appendicitis immediately after orthotopic liver transplant was 0.49%. Four patients had right lower quadrant abdominal pain with fixed tenderness, rebound tenderness, and fever on the eighth, ninth, 11th, and 13th days after surgery. White blood cells counts were elevated in all patients. Appendectomies were performed on day 1 or 2 after the onset of symptoms. No appendicular perforations were found. All patients recovered well. After an exploratory laparotomy, the 4 patients originally misdiagnosed with appendicitis were correctly diagnosed with a duodenal diverticulum perforation (1 patient), a jejunum perforation (1 patient), and bile leakage (2 patients). Two of these patients died despite aggressive treatment. Conclusions: The incidence of acute appendicitis immediately after orthotopic liver transplant is low and should be differentiated from other surgical complications, such as gastrointestinal perforation and bile leakage. Appendectomy is recommended in these patients as early as possible.
Hepatic Artery Thrombosis After Orthotopic Liver Transplant: A Review of the Same Institute 5 Years Later
(Başkent Üniversitesi, 2011-06) Wu, Linwei; Hu, Anbin; Wang, Guodong; Ma, Yi; Zhu, Xiaofeng; Wang, Dongping; Ju, Weiqiang; He, Xiaoshun; Tai, Qiang; Guo, Zhiyong; Zhang, Jianwei
Objectives: Summarize the experience of managing patients with hepatic artery thrombosis after orthotopic liver transplant in a single center. Materials and Methods: A total of 726 adult patients who received a liver transplant at the Department of Organ Transplantation, the First Affiliated Hospital of Sun Yat-Sen University, between January 2004 and December 2009, were selected. Fourteen patients had hepatic artery thrombosis after the operation, and the clinical data of these patients were analyzed retrospectively. Results: The incidence rate of hepatic artery thrombosis was 1.9% (14/726), and the mean time of onset was 10 days (range, 1 - 41 d) after surgery. Six patients had acute deterioration of liver function, 4 had bile leakage, 1 had hepatic abscess, and 3 had no symptoms. Three patients received urgent rearterialization, 2 received intra-arterial thrombolysis, 3 received combined urgent rearterialization and intra-arterial thrombolysis, and 6 patients received a retransplant. The mortality rate associated with hepatic artery thrombosis was 42.9% (6/14); 2 from biliary necrosis and secondary hepatic failure after urgent rearterialization; 1 from recurrent hepatic artery thrombosis and multiple organ failure after intra-arterial thrombolysis; 1 from renal failure and severe infection after combined urgent rearterialization and intra-arterial thrombolysis, and 2 from severe infection after retransplant. The other patients recovered and were followed for 18 to 66 months. Their liver grafts all functioned well with a patent artery. Two died from tumor recurrence at 18 and 29 months after transplant. Conclusions: Hepatic artery thrombosis is a severe complication after liver transplant, which leads to graft loss and recipient death. Rearterialization as early as possible before irreversible biliary and liver parenchyma damage can avoid retransplant.