IV segment portal vein reconstruction in split-liver transplantation with extended right grafts

IV segment portal vein reconstruction in split-liver transplantation with extended right grafts | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article IV segment portal vein reconstruction in split-liver transplantation with extended right grafts Dong Wang, Ning Fan, Xin Wang, Yandong Sun, Ge Guan, Jianhong Wang, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1616717/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Liver transplantation is one of the most effective treatment for end-stage liver disease. Split liver transplantation (SLT) can effectively improve the utilization efficiency of grafts . However, split liver transplantation still faces the shortcomings and not widely used in the surgery. How to improve the effective transplantation volume of split liver transplantation and promote the postoperative recovery of patients has important clinical significance. Methods: In our study, the donor liver was split into the extended right graft and left lateral sector, and the IV segment occure ischemia. In order to guarantee the functional graft size, and avoid the complications, we reconstructed the IV segment portal vein and left portal vein. And we analysed the operation time, intraoperative bleeding, liver function and postoperative complications. Results: In our research, 13 patients underwent IV segment portal vein reconstruction, and 8 patients did not undergo vascular reconstruction. We found that the ischemic area of the IV segment decreased significantly after IV segment portal vein reconstruction. We found that there was no significant difference in operation time and postoperative complications between the patients of the groups. There were significant differences in ALT on the first day and albumin on the sixth day after operation. Conclusion: It indicates that IV segment reconstruction in SLT surgery can alleviate the graft ischemic and obviously promote the recovery of liver function after operation. And, IV segment reconstruction as a novel operating procedure may be widely used in SLT. split liver transplantation IV segment ischemia P4 reconstruction Figures Figure 1 Figure 2 1. Background Liver transplantation is an effective treatment method for end-stage liver disease and liver malignant tumor [ 1 ] . With the development of surgery technology, immunosuppressive drugs and perioperative management, the survival rate of liver transplantation has exceeded 75% in 5 years, especially in advanced liver disease. Due to the unbalanced between the number of liver transplantation waiting list and available donor grafts. Therefore, expanding the number of grafts has important clinical significance for patients who had end-stage liver disease [ 2 ] . This severely shortages of grafts have stimulated the split-liver transplation (SLT), which was firstly introduced in late 1980’s and rapid development in recently years [ 3 , 4 ] . SLT based on the theory of liver as a functional segmented organ, and divided the whole liver graft into 2 recipients which an extended right graft (ERG) given to an adult and a smaller left laternl segment to a child [ 5 ] . The emergence of SLT can effectively increase the number of liver grafts in children without reducing the number of adults [ 6 ] . SLT has greatly decreased the wait-list mortality both in the pediatric and adult liver patients [ 7 ] . Up to now, SLT is wodely adopted, current studies have found that the complications, and the long-term effect of SLT is not satisfactory. In contrast to whole liver transplantation, there are many technical challenges in SLT [ 8 , 9 ] . For adult recipients, small liver syndrome is the main cause of death after SLT and it is also the main difficulty to be overcome. After the whole liver graft splited, we would lose more functional graft size (FGS). In the surgery, we had found that the IV segment had obviously ischemia region in extended right grafts (Fig. 2 ). On the one hand, these ischemia area in IV segment could decrease the volume of FGS, on the other hand, the ischemia can promote the reactive oxygen species (ROS) generatation by the hepatocytes, which tigger apoptosis and necrosis in liver tissue [ 10 ] . All those can decrease the volume of FGS, what we can do for the ischemia in the extended right grafts? With the deepening research on small liver syndrome, it has been found that FGS is an independent risk factor for small liver syndrome which can lead severe complications post-operation [ 11 ] . Therefore, eliminating the ischemia in IV-segment can increase the FGS which may promote recovery of patients, decrease the risk of infection and bleeding post-operation. And, increasing FGS as much as possible have great significance in SLT. In our study, we explored the reconstruction of IV portal vein in SLT to eliminate the ischemia and ensure the blood supply of IV segment. Aim to reduce the damage of FGS, promote the patient’s recovery after liver transplantation, and summarize the application value of IV segment portal vein reconstruction in split-liver transplantation with extended right grafts. 2. Methods 2.1 Study population From January 2016 to April 2021, 22 patients underwent SLT, the extended right grafts for the adult patients, left laternl segment to a child patient in the Organ Transplant Center of the Affiliated Hospital of Qingdao University, 14 patients underwent IV segment portal vein reconstruction, and 8 patients did not. And, 22 (21 adult, 1pediatric) received an ERG. In our research, we had not ananysis the child, and just analysis the IV segment reconstruction in adult. All patients signed informed consent, and our study was approved by the Ethics Committee of the Affiliated Hospital of Qingdao University. 2.2 Criteria for donor group SLT donor selection criteria: BMI < 26Kg/m 2 . ICU stay is less than 5 days. The proportion of hepatic steatosis was less than 10%, AST/ALT is less than three times the normal limit. Total bilirubin was 2 times the normal upper limit. Cold ischemia time was less than 10h. Donor no obvious blood vessels, bile duct variation. 2.3 Clinical data and follow-up The age, alanine aminotransferase, aspartate aminotransferase, bilirubin, creatinine, prothrombin time, platelet, ABO blood group, weight, body mass index (BMI), donor-to-recipient weight ratio (DRWR) and other basic clinical data of the recipients before transplantation were collected. We also collected the operation time, intraoperative bleeding, blood transfusion and other clinical data were collected. The clinical data of alanine aminotransferase, aspartate aminotransferase, bilirubin, creatinine, platelet, and prothrombin time within 9 days after operation were collected. 2.4 Operative procedure The liver was splited into an LLS (segments II and III) and an ERG (segments I plus IV-VIII) in vivo, and the liver parenchyma was separated to retain the integrity of portal vein, biliary tract and hepatic artery and liver vein. All the vesseles were separated in vitro. The donor liver was placed in 4 ℃ UW solution. We cut off the portal vein at the root of the left branch of the portal vein, and the main portal vein was left to the right tri-lobe third lobe of the liver. Leave the middle hepatic vein to the right tri-lobe and cut off the left hepatic vein. Trim the portal vein, and ligated the small branches of the portal vein. We trim the common bile duct to the upper edge of the pancreas and appropriate preservation of the surrounding tissue of the common bile duct to ensure blood supply to the biliary tract. We reconstructed the left branch of the portal vein and the segment IV portal vein branch using the donor iliac vein. We splited the graft into left lateral graft (segments II and III) and an extened right fraft (segments I plus IV-VIII), and just as shown in the Fig. 1 , the IV segment portal vein was reconstruction. And then, common hepatic artery, biliary tract and portal vein were separated. Then the hepatic artery and common hepatic duct were separated. The second hepatic portal was anatomically analyzed, and the superior and inferior vena cava were dissociated, and then blocked superior and inferior vena cava, and the diseased liver was completely resected. The donor liver was implanted in situ, and the vessel anastomosis order was the superior and inferior vena cava, inferior vena cava and portal vein, respectively. After the portal vein anastomosis was completed, the vena cava and portal vein were opened. Recipient gastroduodenal and hepatic artery bifurcation and donor gastroduodenal and right hepatic artery bifurcation reconstruction, and open the artery. Trim the donor hepatic duct and suture with the recipient common bile duct. Immune induction was performed with methylprednisolone during the operation. 2.5 Statistical analysis Statistical analyses were performed using Prism software (GraphPad Prism Software, La Jolla, CA) and SPSS 21.0 (SPSS Company, Chicago, IL) for Windows. Quantitative values were analysised by t tests. Categorical variables were compared using the chi-square test or Fisher’s exact test. P < 0.05 was considered statistically significant. 3. Results 3.1 Portal vein reconstruction can significantly eliminate ischemia in IV segment. During the transplation surgery, we found that when the donor liver was split into LLS and an ERG, there was a significant ischemic area in the IV segment ERG (Fig. 2 . A). In order to reduce ischemic areas and increase the volume of functional hepatocytes, just as shown Fig. 2 -B, we used the donor iliac vein to reconstruct the left branch of the portal vein and the IV segment portal vein. We used the donor blood to reconstruction vein between the IV segment and left portal vein. In the surgery, we reconstruction the IV-a segment vein, IV-b segment vein and left portal vein. And, we reconstruction the blood between the IV-a (or IV-b) segment portal vein and left portal vein. After vascular reconstruction, liver ischemia region was significantly alleviated (Fig. 2 -B, 2 -D) After liver transplantation, the hepatic ischemic line was only at the surgery margin, and the blood flow in the reconstructed vessel was unobstructed (Fig. 2 -E, d). In the surgery, we had found that when the liver was splited, the IV segment of ERG (segments I plus IV-VIII) has a obviously areas of ischemia (Fig. 2 -A). The obvious ischemic area in IV segment may lead to the following adverse consequences. Firstly, reduce the volume of the functional liver and lead to liver failure after liver transplantation. Secondly, the ischemic in IV segment may also become the source abdominal cavity infection and seriously affect SLT postoperative recovery. Finally, the IV segment ischemic area may secreted more inflammatory factors, which affects the immune-inflammatory state of the body, and may interferes the postoperative management of patients. What we can do to the ischemic area of stage IV? In our study, we used donor veins to reconstruct the vessels in the IV segment, and after the liver transplatation, we had observed that the ischemic area was significantly reduced. Therefore, it can be concluded that IV segment portal vein reconstruction can effectively reduce the volume of ischemic liver, improve the volume of effective liver, and finally promote the recovery of patients' liver function. IV segment portal vein reconstruction, which an innovative procedure may be widely used in SLT. 3.2 Clinical characteristic of enrolled patients In the process of transplantation, we were surprised to find that the reconstruction of IV segment portal vein could significantly improve the ischemia. Therefore, we included 21 people in this study whom 14 underwent IV segment reconstruction and 7 did not. All patients received extented right part of liver as graft, 1 patient died of multiple organ dysfunction after transplantation, and the remaining 21 patients were successfully discharged. The average age of the patients was (45.67 ± 15.61) years, BMI was (22.53 ± 2.98) Kg/m 2 , and GRWR was (2.92 ± 1.96) %. There were 12 male patients, 9 female patients as shown in Table 1 . Table 1 Recipient Characteristics No. Gender Blood type Age(year) Height (cm) Weight(Kg) BMI(Kg/m 2 ) GRWR (%) IV segment portal vein reconstruction Pitient1 Female B 38 177 63 20.1 1.85% Yes Pitient2 Male O 15 170 43 14.9 2.92% No Pitient3 Female B 42 160 60 23.4 2.40% Yes Pitient4 Male O 52 168 70 24.8 1.99% Yes Pitient5 Male O 43 180 84 25.9 1.24% No Pitient6 Female O 42 163 64 24.1 2.29% No Pitient7 Female A 59 150 40 17.8 2.83% No Pitient8 Male O 39 160 62 24.2 1.25% Yes Pitient9 Female O 59 150 56 24.9 1.91% Yes Pitient10 Male O 32 172 77 26 1.76% No Pitient11 Male A 69 170 77 26.6 1.68% Yes Pitient12 Male A 25 165 59 21.7 1.88% Yes Pitient13 Male B 52 170 70 24.2 1.74% No Pitient14 Male B 45 178 63 19.9 2.21% No Pitient15 Female O 69 160 52 20.3 1.97% Yes Pitient16 Female A 63 158 55 22 1.86% Yes Pitient17 Female O 15 173 58 19.4 2.62% Yes Pitient18 Male B 63 171 74.5 24.5 1.49% Yes Pitient19 Female B 49 165 61 22.4 2.10% Yes Pitient20 Male A 37 170 65 21.5 1.89% Yes Pitient21 Male O 51 178 78 24.6 1.34% No BMI: body mass index, GRWR, Graft Volume/Recipient Body Weight Ratio. As shown table 2, the glutamic-pyruvic transaminase in vascular reconstruction group and non-vascular reconstruction group were (49.69 ± 24.49) U/L, (19 ± 7.75) U/L respectively (P<0.05). The glutamic-oxaloacetic transaminase was (68.62 ± 32.19) U/L, (32.38±29.14) U/L respectively. Total bilirubin was (145.90 ±261.40), (36.16 ± 40.76). There was no significant difference in platelet, creatinine, length of stay, BMI and GRWR between the vascular reconstruction group and the non-vascular reconstruction group(P>0.05). Table 2 The Characteristics in the group of IV segment portal vein reconstruction Characteristics IV segment portal vein reconstruction P-Value Yes(n = 13) No(n = 8) Age, years 47.69 ± 16.89 42.38 ± 13.67 0.46 BMI, Kg/m2 22.75 ± 2.18 22.18 ± 4.13 0.68 Platelet, 10^9/L 142.08 ± 116.66 107.75 ± 53.00 0.45 GRWR, % 1.915 ± 0.35 2.04 ± 0.63 0.57 Hospitalization time, days 46.31 ± 11.15 40.5 ± 14.33 0.31 ALT, U/L 49.69 ± 24.49 19 ± 7.75 0.003 AST, U/L 68.62 ± 32.19 32.38 ± 29.14 0.018 TBil, µmol/L 145.90 ± 261.40 36.16 ± 40.76 0.26 Serum albumin, g/L 32.72 ± 5.90 35.75 ± 7.85 0.33 PT, s 16.04 ± 4.33 16.19 ± 3.75 0.94 GGT, U/L 101.15 ± 93.65 55.38 ± 71.42 0.25 Creatinine, µmol/L 138.09 ± 245.01 70.49 ± 29.12 0.48 Gender Female 7 2 0.37 Male 6 6 Blood type A 4 1 0.51 B 4 2 O 5 5 Cause of disease Liver failure 7 4 1 Tumor 6 4 BMI, body mass index; GRWR, Graft Volume/Recipient Body Weight Ratio; GGT, γ -glutamyltransferase; TBil, total bilirubin; PT, Prothrombin time; ALT, glutamic-pyruvic transaminase; AST, glutamic oxalacetic transaminase. 3.3 Intraoperative data analysis We also collected the patient's operation time, intraoperative bleeding, intraoperative blood transfusion, postoperative ICU monitoring time and other clinical data, we found that the two groups of patients in the operation time, intraoperative bleeding, intraoperative blood transfusion, postoperative ICU monitoring had not statistically significant(P > 0.05)(Table 3 ). It is further proved that IV segment portal vein reconstruction does not increase the operation time and intraoperative bleeding, indicating that vascular reconstruction has high operability and safety. Table 3 The operation characteristics in the two groups Characteristics IV segment portal vein reconstruction P-Value Yes(n = 13) No(n = 8) The weight of graft 1236.38 ± 159.37 1187 ± 200.37 0.56 Total OR time, min 555.63 ± 90.57 590.231 ± 113.24 0.47 Anhepatic phase, min 50.63 ± 8.28 61 ± 20.00 0.18 Hemorrhage, mL 1437.5 ± 821.04 1361.54 ± 818.07 0.84 Red blood cells transfusion volume, u 10.06 ± 6.56 10.5 ± 5.26 0.87 Plasma transfusion volume, mL 987.75 ± 534.99 1164.62 ± 651.86 0.53 ICU hospitalization time, day 6.75 ± 8.24 6.85 ± 4.04 0.97 Hospitalization time of OR, day 33.5 ± 12.35 36.54 ± 8.93 0.52 3.4 Postoperative liver function We collected the liver function after operation. and had found that the alanine aminotransferase of non-vascular reconstruction group and vascular reconstruction group on the first day after operation were (904.13 ± 635.23) U/L and (443.77 ± 232.17), respectively (P < 0.05)(Table 4 ). The serum albumin of IV reconsturction and none IV reconstruction group on the 6-day after operation were (42.22 ± 3.22) g/L and (38.9 ± 3.49) g/L (P < 0.05). It indicated that vascular reconstruction could promote the recovery of liver function, but at same time, there was no significant difference in bilirubin, GGT, PLT between the two groups. Table 4 The liver Function after SLT in two groups Characteristics IV segment portal vein reconstruction P-Value No(n = 8) Yes(n = 13) POD-1 ALT, U/L 904.13 ± 635.23 443.77 ± 232.17 0.03 AST, U/L 740 ± 760.79 676.77 ± 234.22 0.19 Serum albumin, g/L 44.98 ± 8.48 39.92 ± 5.49 0.11 PT, s 19.05 ± 2.27 20.61 ± 6.51 0.53 Platelet, 10^9/L 70.75 ± 27.78 81.38 ± 57.63 0.63 POD-3 ALT, U/L 491 ± 427.65 276.69 ± 177.28 0.12 AST, U/L 110.25 ± 59.56 183.38 ± 169.79 0.26 Serum albumin, g/L 43.09 ± 6.49 39.42 ± 4.75 0.15 PT, s 17.08 ± 2.59 16.75 ± 3.32 0.82 Platelet, 10^9/L 65.13 ± 31.84 74.69 ± 68.35 0.72 POD-5 ALT, U/L 164.75 ± 149.57 143.54 ± 87.61 0.69 AST, U/L 29.5 ± 7.56 50 ± 34.27 0.12 Serum albumin, g/L 40.09 ± 6.35 41.17 ± 4.21 0.64 PT, s 16.33 ± 2.42 15.05 ± 2.44 0.26 Platelet, 10^9/L 86.5 ± 57.5227 64.692 ± 45.3604 0.35 POD-6 ALT, U/L 109.5 ± 65.42 114.62 ± 66.85 0.87 AST, U/L 31.63 ± 23.69 37.77 ± 28.54 0.62 Serum albumin, g/L 38.9 ± 3.49 42.22 ± 3.22 0.04 PT, s 15.53 ± 2.03 14.4 ± 2.27 0.27 Platelet, 10^9/L 96.37 ± 65.73 71 ± 46.88 0.34 POD-7 ALT, U/L 72.25 ± 50.40 95.31 ± 61.20 0.38 AST, U/L 27.75 ± 14.59 46 ± 39.22 0.23 Serum albumin, g/L 37.59 ± 3.97 40.33 ± 4.05 0.15 PT, s 15.08 ± 1.85 14.95 ± 3.36 0.92 Platelet, 10^9/L 94.5 ± 61.63 83.23 ± 59.11 0.68 PT, Prothrombin time; ALT, glutamic-pyruvic transaminase; AST, glutamic oxalacetic transaminase. 4. Discussion With the successful introduction and application of the techniques of SLT waiting times and pretransplant mortality has been reduced [12] . Pro. Rudolf Pichlmayr pioneered split liver transplantation (SLT) in 1988 [13] , enabling the transplantation of one donor liver into two recipients. With the development of SLT, the wait list mortality of recipients had reduced obviously [14, 15] . Split liver transplantation is an ideal method to expand the utilization of grafts and alleviate the shortage of donor liver, which can shorten the waiting time of recipient and reduce the mortality of patients during the waiting period [16] . In recent years, with the development of surgical techniques [17] , postoperative care and immunosuppressive drug, the safety of split liver transplantation has also achieved long-term development [18, 19] . However, split liver transplantation still faces postoperative complications such as small liver syndrome, infection and biliary fistula. Therefore, it is of great clinical significance to explore how to reduce the risk of small liver syndrome after SLT surgery and improve the functional liver transplantation volume. In the process of transplantation, the section which was splited is prone to ischemic (Fig 1), and the ischemic part may lead to insufficient volume of effective liver transplantation and increased perioperative complications. Ensuring adequate blood supply of grafts is important for functional transplantation. What can we do to improve marginal ischemia? In this study, we creatively reconstructed the IV segment portal vein of the graft. After reconstruction of IV segment portal vein, we had intrerestingly found that the part of ischemic was obviously reduced. we may conclude segment portal vein construction can reduced the risk of ischemic and increased the blood supply at the incisal margin. The ischemia region in the IV segment occurs necrosis and may lead to serve complications. On the one hand, necrosis may further aggravate the risk of abdominal infection, biliary fistula and even hemorrhage; on the other hand, in the immunosuppressed state after liver transplation, infection may be difficult to control or even lead to serious consequences, even death, due to the use of immunosuppressive drugs after surgery. We had found that the IV segment reconstruction can eliminate the ischemia obviously and may reduce the incidence of complications associated with IV segment ischemia. During the operation, we found that the ischemia of the IV segment grafts was improved after vascular reconstruction. Whether IV segment vascular reconstruction can promote postoperative recovery of patients? We further analyzed the liver function after graft vascular reconstruction. And, we found that alanine aminotransferase decreased significantly on the post-operation day 1, and albumin increased significantly on the sixth day after operation. We can draw a conclunction that vascular reconstruction can promote the recovery of liver function after operation. IV segment grafts vascular reconstruction promoted the recovery and regeneration of liver cells at the IV segment which was ischemia. At the same times can increase the effective graft volume, prevent the occurrence of small liver syndrome, reduce the occurrence of postoperative liver failure. Whether vascular reconstruction increases the operation complications. And we found that there was no increase in operation time, intraoperative bleeding, postoperative blood transfusion, postoperative hospital stays, and the risk of thoracoabdominal water after the reconstruction. All these results indicating that the reconstruction of the IV segment portal vein did not artificially increase the operation risk, and the occurrence of postoperative complications was of high operability and safety. And We can draw a conclusion that the IV segment portal vein reconstruction can relieving graft ischemia and promoting liver function recovery. In our study, although we found that the reconstruction of IV segment portal veins can promote the recovery of glutamic-pyruvic transaminase and albumin in patients, the number of cases included in this study is small, and multicenter and large samples are needed for further verification in future clinical practice. In addition, no clinical data related to liver supply were included in this study, and the effect of liver supply on liver function recovery after liver transplantation was not considered. Conclusions In our study, we found that extended right part of liver receive IV segment reconstruction in SLT surgery can alleviate the graft ischemic and obviosuly promote the recovery of liver function. Declarations Ethics approval and consent to participate ： All patients signed informed consent, and our study was approved by the Ethics Committee of the Affiliated Hospital of Qingdao University (No.2018052). All methods in our research were carried out in accordance with routine surgical procedures which also approved by the Ethics Committee of the Affiliated Hospital of Qingdao University (No.2018052). Consent for publication ： Not applicable. Availability of data and materials ： The datasets used or analysed during the current study are available from the corresponding author on reasonable request. Competing interests ： The authors declare that they have no potential competing interests in this work. Funding ： This work was supported by the Key Research and Development Program of Shandong Province (No: 2017GSF218098), Natural Science Foundation of Shandong Province (No. ZR202103020004), Clinical Medicine plus X Project of Affiliated Hospital of Qingdao University (202102006). Authors' contributions ： Guo Yuan designed the study and wrote the manuscript. Dong Wang, Ning Fan, Ge Guan, Xin Wang, Xiaodan Zhu, Yandong Sun analysis the data in this study, Jianhong Wang, Yunjin Zang, Jinzhen Cai performed all the figures in this study. Acknowledgements ： We gratefully acknowledge all the authors’ works for this paper and all the patients in our study. Authors' information (optional) ： Acknowledgments We gratefully acknowledge all the authors’ works for this paper and all the patients in our study. This work was supported by the Key Research and Development Program of Shandong Province (No.2017GSF218098), Natural Science Foundation of Shandong Province (No.ZR202103020004), Clinical Medicine plus X Project of Affiliated Hospital of Qingdao University (No.202102006). Conflict of Interest The authors declare that they have no potential competing interests in this work. Author Contributions Guo Yuan designed the study and wrote the manuscript. Dong Wang, Ning Fan, Ge Guan, Xin Wang, Xiaodan Zhu, Yandong Sun analysis the data in this study(Table1-4), Jianhong Wang, Yunjin Zang, Jinzhen Cai performed all the figures in this study(Figure1-2). References Hackl C, Schmidt KM, Süsal C, Döhler B, Zidek M, Schlitt HJ. Split liver transplantation: Current developments. World J Gastroenterol 2018;24:5312–5321. PMID:30598576. doi: 10.3748/wjg.v24.i47.5312 . Lee WC, Chan KM, Chou HS, Wu TJ, Lee CF, Soong RS, et al. Feasibility of split liver transplantation for 2 adults in the model of end-stage liver disease era. Ann Surg 2013;258:306–311. PMID:23108123. doi: 10.1097/SLA.0b013e3182754b8e . Moussaoui D, Toso C, Nowacka A, McLin VA, Bednarkiewicz M, Andres A, et al. Early complications after liver transplantation in children and adults: Are split grafts equal to each other and equal to whole livers? Pediatr Transplant 2017;21. PMID:28261944. doi: 10.1111/petr.12908 . 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1616717","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":104570901,"identity":"fa5aa4b1-a6ff-475d-a697-971a16d5b901","order_by":0,"name":"Dong Wang","email":"","orcid":"","institution":"The Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Dong","middleName":"","lastName":"Wang","suffix":""},{"id":104570902,"identity":"3199090b-0b7e-454c-9334-3caa7fd9f341","order_by":1,"name":"Ning Fan","email":"","orcid":"","institution":"The Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Ning","middleName":"","lastName":"Fan","suffix":""},{"id":104570903,"identity":"bc0d32cd-2e87-4254-8bce-e5ad4c878c0e","order_by":2,"name":"Xin Wang","email":"","orcid":"","institution":"The Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Wang","suffix":""},{"id":104570904,"identity":"ad540ded-8c44-4df0-9f31-23d729fc0261","order_by":3,"name":"Yandong Sun","email":"","orcid":"","institution":"The Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Yandong","middleName":"","lastName":"Sun","suffix":""},{"id":104570905,"identity":"944ad723-724d-4742-9b2a-6a91c150c3f1","order_by":4,"name":"Ge Guan","email":"","orcid":"","institution":"The Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Ge","middleName":"","lastName":"Guan","suffix":""},{"id":104570906,"identity":"98097dfc-da46-43ce-b44a-027235febd11","order_by":5,"name":"Jianhong Wang","email":"","orcid":"","institution":"The Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Jianhong","middleName":"","lastName":"Wang","suffix":""},{"id":104570907,"identity":"d3d1ee85-7a31-436e-991a-f082b2df6180","order_by":6,"name":"Xiaodan Zhu","email":"","orcid":"","institution":"The Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Xiaodan","middleName":"","lastName":"Zhu","suffix":""},{"id":104570908,"identity":"e1e2934f-0095-4f0a-b69b-40529d7b8b40","order_by":7,"name":"Yunjin Zang","email":"","orcid":"","institution":"The Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Yunjin","middleName":"","lastName":"Zang","suffix":""},{"id":104570909,"identity":"1f9fefde-41f7-4bac-b5b0-f97e46b192c3","order_by":8,"name":"Jinzhen Cai","email":"","orcid":"","institution":"The Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Jinzhen","middleName":"","lastName":"Cai","suffix":""},{"id":104570910,"identity":"cf73d404-ba82-4eeb-8f2b-f932d0d7b605","order_by":9,"name":"Yuan Guo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsUlEQVRIiWNgGAWjYBADOTb29gOkaTHm4zmTQJqWxHkSDgbEKZWPSD4mwVB2OL1NgiGB4UfFNsJaDG+kpUkwnDuc2ybdeICx58xtIrTMyDGTYGwDapE5kMDM2EaClnQ2iQQD4rTIS0C0JBCvxYDnWbIFw7l0wzZgIB8kyi/y7ckHbzCUWcvLt7cffPCjghhbDjCwSP9hawZzDhBWD7KlgYH5AwNbHVGKR8EoGAWjYIQCAPlcORDqAbeiAAAAAElFTkSuQmCC","orcid":"","institution":"The Affiliated Hospital of Qingdao University","correspondingAuthor":true,"prefix":"","firstName":"Yuan","middleName":"","lastName":"Guo","suffix":""}],"badges":[],"createdAt":"2022-05-02 13:59:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1616717/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1616717/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":21825811,"identity":"037e2d01-ae07-4bd0-bebd-c5cccd6b7b75","added_by":"auto","created_at":"2022-05-24 14:40:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2270594,"visible":true,"origin":"","legend":"\u003cp\u003eThe IV segment portal vein reconstruction. Fig A：The extended right grafts. The ‘a’ stand for the left portal vein, ‘b’ and ‘c’ mean the IV segment portal vein. Fig B: Iliac vein of dornor. Fig C: the reconstruction of IV-segment and left portal vein by the iliac vein. ‘d ‘stand for the reconstruction vein. Fig D: The reconstruction vein by the color doppler ultrasound.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-1616717/v1/cdb7a9e9e109b2fa6f38b306.png"},{"id":21825812,"identity":"91197a07-d0db-43f7-80f2-5c163b7bcf4b","added_by":"auto","created_at":"2022-05-24 14:40:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":3990262,"visible":true,"origin":"","legend":"\u003cp\u003eThe ischemic of extended right grafts in SLT before and after IV-segment portal vein reconstruction. Fig A: the ischemic region in the ERG and ‘a’ mean the ischemic area. Fig B: The IV segment was reconstructed and we can find that the ischemic region was decreased. ‘b’ stands for the ischemic region. Fig C: the reconstruction vein in the extended right graft, ‘d’ means the reconstruction vein. Fig E: The reconstruction vein was tested by ultrasound, we can see that the blood vessel patency(d).\u0026nbsp;\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-1616717/v1/313082cc3aba67464116c429.png"},{"id":21825813,"identity":"3dba73a8-bbe6-44be-9f98-032913ae5ef6","added_by":"auto","created_at":"2022-05-24 14:40:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":483154,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1616717/v1/ce580a5d-7abe-464f-a9e3-8cf335d9c126.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"IV segment portal vein reconstruction in split-liver transplantation with extended right grafts","fulltext":[{"header":"1. Background","content":"\u003cp\u003eLiver transplantation is an effective treatment method for end-stage liver disease and liver malignant tumor\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. With the development of surgery technology, immunosuppressive drugs and perioperative management, the survival rate of liver transplantation has exceeded 75% in 5 years, especially in advanced liver disease. Due to the unbalanced between the number of liver transplantation waiting list and available donor grafts. Therefore, expanding the number of grafts has important clinical significance for patients who had end-stage liver disease\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis severely shortages of grafts have stimulated the split-liver transplation (SLT), which was firstly introduced in late 1980\u0026rsquo;s and rapid development in recently years\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. SLT based on the theory of liver as a functional segmented organ, and divided the whole liver graft into 2 recipients which an extended right graft (ERG) given to an adult and a smaller left laternl segment to a child\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. The emergence of SLT can effectively increase the number of liver grafts in children without reducing the number of adults\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. SLT has greatly decreased the wait-list mortality both in the pediatric and adult liver patients\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eUp to now, SLT is wodely adopted, current studies have found that the complications, and the long-term effect of SLT is not satisfactory. In contrast to whole liver transplantation, there are many technical challenges in SLT\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. For adult recipients, small liver syndrome is the main cause of death after SLT and it is also the main difficulty to be overcome. After the whole liver graft splited, we would lose more functional graft size (FGS). In the surgery, we had found that the IV segment had obviously ischemia region in extended right grafts (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). On the one hand, these ischemia area in IV segment could decrease the volume of FGS, on the other hand, the ischemia can promote the reactive oxygen species (ROS) generatation by the hepatocytes, which tigger apoptosis and necrosis in liver tissue\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. All those can decrease the volume of FGS, what we can do for the ischemia in the extended right grafts?\u003c/p\u003e \u003cp\u003eWith the deepening research on small liver syndrome, it has been found that FGS is an independent risk factor for small liver syndrome which can lead severe complications post-operation\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Therefore, eliminating the ischemia in IV-segment can increase the FGS which may promote recovery of patients, decrease the risk of infection and bleeding post-operation. And, increasing FGS as much as possible have great significance in SLT. In our study, we explored the reconstruction of IV portal vein in SLT to eliminate the ischemia and ensure the blood supply of IV segment. Aim to reduce the damage of FGS, promote the patient\u0026rsquo;s recovery after liver transplantation, and summarize the application value of IV segment portal vein reconstruction in split-liver transplantation with extended right grafts.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study population\u003c/h2\u003e \u003cp\u003eFrom January 2016 to April 2021, 22 patients underwent SLT, the extended right grafts for the adult patients, left laternl segment to a child patient in the Organ Transplant Center of the Affiliated Hospital of Qingdao University, 14 patients underwent IV segment portal vein reconstruction, and 8 patients did not. And, 22 (21 adult, 1pediatric) received an ERG. In our research, we had not ananysis the child, and just analysis the IV segment reconstruction in adult. All patients signed informed consent, and our study was approved by the Ethics Committee of the Affiliated Hospital of Qingdao University.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Criteria for donor group\u003c/h2\u003e \u003cp\u003eSLT donor selection criteria: BMI\u0026thinsp;\u0026lt;\u0026thinsp;26Kg/m\u003csup\u003e2\u003c/sup\u003e. ICU stay is less than 5 days. The proportion of hepatic steatosis was less than 10%, AST/ALT is less than three times the normal limit. Total bilirubin was 2 times the normal upper limit. Cold ischemia time was less than 10h. Donor no obvious blood vessels, bile duct variation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Clinical data and follow-up\u003c/h2\u003e \u003cp\u003eThe age, alanine aminotransferase, aspartate aminotransferase, bilirubin, creatinine, prothrombin time, platelet, ABO blood group, weight, body mass index (BMI), donor-to-recipient weight ratio (DRWR) and other basic clinical data of the recipients before transplantation were collected. We also collected the operation time, intraoperative bleeding, blood transfusion and other clinical data were collected. The clinical data of alanine aminotransferase, aspartate aminotransferase, bilirubin, creatinine, platelet, and prothrombin time within 9 days after operation were collected.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Operative procedure\u003c/h2\u003e \u003cp\u003eThe liver was splited into an LLS (segments II and III) and an ERG (segments I plus IV-VIII) in vivo, and the liver parenchyma was separated to retain the integrity of portal vein, biliary tract and hepatic artery and liver vein. All the vesseles were separated in vitro. The donor liver was placed in 4 ℃ UW solution. We cut off the portal vein at the root of the left branch of the portal vein, and the main portal vein was left to the right tri-lobe third lobe of the liver. Leave the middle hepatic vein to the right tri-lobe and cut off the left hepatic vein. Trim the portal vein, and ligated the small branches of the portal vein. We trim the common bile duct to the upper edge of the pancreas and appropriate preservation of the surrounding tissue of the common bile duct to ensure blood supply to the biliary tract. We reconstructed the left branch of the portal vein and the segment IV portal vein branch using the donor iliac vein. We splited the graft into left lateral graft (segments II and III) and an extened right fraft (segments I plus IV-VIII), and just as shown in the Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the IV segment portal vein was reconstruction.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAnd then, common hepatic artery, biliary tract and portal vein were separated. Then the hepatic artery and common hepatic duct were separated. The second hepatic portal was anatomically analyzed, and the superior and inferior vena cava were dissociated, and then blocked superior and inferior vena cava, and the diseased liver was completely resected.\u003c/p\u003e \u003cp\u003eThe donor liver was implanted in situ, and the vessel anastomosis order was the superior and inferior vena cava, inferior vena cava and portal vein, respectively. After the portal vein anastomosis was completed, the vena cava and portal vein were opened. Recipient gastroduodenal and hepatic artery bifurcation and donor gastroduodenal and right hepatic artery bifurcation reconstruction, and open the artery. Trim the donor hepatic duct and suture with the recipient common bile duct. Immune induction was performed with methylprednisolone during the operation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Statistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using Prism software (GraphPad Prism Software, La Jolla, CA) and SPSS 21.0 (SPSS Company, Chicago, IL) for Windows. Quantitative values were analysised by t tests. Categorical variables were compared using the chi-square test or Fisher\u0026rsquo;s exact test. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv class=\"Section2\" id=\"Sec9\"\u003e\n \u003ch2\u003e3.1 Portal vein reconstruction can significantly eliminate ischemia in IV segment.\u003c/h2\u003e\n \u003cp\u003eDuring the transplation surgery, we found that when the donor liver was split into LLS and an ERG, there was a significant ischemic area in the IV segment ERG (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. A). In order to reduce ischemic areas and increase the volume of functional hepatocytes, just as shown Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e-B, we used the donor iliac vein to reconstruct the left branch of the portal vein and the IV segment portal vein. We used the donor blood to reconstruction vein between the IV segment and left portal vein. In the surgery, we reconstruction the IV-a segment vein, IV-b segment vein and left portal vein. And, we reconstruction the blood between the IV-a (or IV-b) segment portal vein and left portal vein. After vascular reconstruction, liver ischemia region was significantly alleviated (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e-B, \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e-D) After liver transplantation, the hepatic ischemic line was only at the surgery margin, and the blood flow in the reconstructed vessel was unobstructed (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e-E, d).\u003c/p\u003e\n \u003cp\u003eIn the surgery, we had found that when the liver was splited, the IV segment of ERG (segments I plus IV-VIII) has a obviously areas of ischemia (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e-A). The obvious ischemic area in IV segment may lead to the following adverse consequences. Firstly, reduce the volume of the functional liver and lead to liver failure after liver transplantation. Secondly, the ischemic in IV segment may also become the source abdominal cavity infection and seriously affect SLT postoperative recovery. Finally, the IV segment ischemic area may secreted more inflammatory factors, which affects the immune-inflammatory state of the body, and may interferes the postoperative management of patients.\u003c/p\u003e\n \u003cp\u003eWhat we can do to the ischemic area of stage IV? In our study, we used donor veins to reconstruct the vessels in the IV segment, and after the liver transplatation, we had observed that the ischemic area was significantly reduced. Therefore, it can be concluded that IV segment portal vein reconstruction can effectively reduce the volume of ischemic liver, improve the volume of effective liver, and finally promote the recovery of patients\u0026apos; liver function. IV segment portal vein reconstruction, which an innovative procedure may be widely used in SLT.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec10\"\u003e\n \u003ch2\u003e3.2 Clinical characteristic of enrolled patients\u003c/h2\u003e\n \u003cp\u003eIn the process of transplantation, we were surprised to find that the reconstruction of IV segment portal vein could significantly improve the ischemia. Therefore, we included 21 people in this study whom 14 underwent IV segment reconstruction and 7 did not. All patients received extented right part of liver as graft, 1 patient died of multiple organ dysfunction after transplantation, and the remaining 21 patients were successfully discharged. The average age of the patients was (45.67\u0026thinsp;\u0026plusmn;\u0026thinsp;15.61) years, BMI was (22.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98) Kg/m\u003csup\u003e2\u003c/sup\u003e, and GRWR was (2.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96) %. There were 12 male patients, 9 female patients as shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRecipient Characteristics\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"9\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBlood type\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge(year)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHeight (cm)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWeight(Kg)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBMI(Kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGRWR (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIV segment portal vein reconstruction\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.24%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.83%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.91%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.76%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.68%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.88%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.74%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.21%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.97%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.86%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.62%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.49%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.89%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePitient21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.34%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003eBMI: body mass index, GRWR, Graft Volume/Recipient Body Weight Ratio.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eAs shown table 2, the glutamic-pyruvic transaminase in vascular reconstruction group and non-vascular reconstruction group were (49.69 \u0026plusmn; 24.49) U/L, (19 \u0026plusmn; 7.75) U/L respectively (P\u0026lt;0.05). The glutamic-oxaloacetic transaminase was (68.62 \u0026plusmn; 32.19) U/L, (32.38\u0026plusmn;29.14) U/L respectively. Total bilirubin was (145.90 \u0026plusmn;261.40), (36.16 \u0026plusmn; 40.76). There was no significant difference in platelet, creatinine, length of stay, BMI and GRWR between the vascular reconstruction group and the non-vascular reconstruction group(P\u0026gt;0.05).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe Characteristics in the group of IV segment portal vein reconstruction\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eIV segment portal vein reconstruction\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYes(n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo(n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.69\u0026thinsp;\u0026plusmn;\u0026thinsp;16.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.38\u0026thinsp;\u0026plusmn;\u0026thinsp;13.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI, Kg/m2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.75\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.18\u0026thinsp;\u0026plusmn;\u0026thinsp;4.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePlatelet, 10^9/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e142.08\u0026thinsp;\u0026plusmn;\u0026thinsp;116.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e107.75\u0026thinsp;\u0026plusmn;\u0026thinsp;53.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGRWR, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.915\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHospitalization time, days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.31\u0026thinsp;\u0026plusmn;\u0026thinsp;11.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.5\u0026thinsp;\u0026plusmn;\u0026thinsp;14.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALT, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.69\u0026thinsp;\u0026plusmn;\u0026thinsp;24.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u0026thinsp;\u0026plusmn;\u0026thinsp;7.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAST, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.62\u0026thinsp;\u0026plusmn;\u0026thinsp;32.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.38\u0026thinsp;\u0026plusmn;\u0026thinsp;29.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTBil, \u0026micro;mol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e145.90\u0026thinsp;\u0026plusmn;\u0026thinsp;261.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.16\u0026thinsp;\u0026plusmn;\u0026thinsp;40.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerum albumin, g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.72\u0026thinsp;\u0026plusmn;\u0026thinsp;5.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.75\u0026thinsp;\u0026plusmn;\u0026thinsp;7.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePT, s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.04\u0026thinsp;\u0026plusmn;\u0026thinsp;4.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.19\u0026thinsp;\u0026plusmn;\u0026thinsp;3.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGGT, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101.15\u0026thinsp;\u0026plusmn;\u0026thinsp;93.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.38\u0026thinsp;\u0026plusmn;\u0026thinsp;71.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCreatinine, \u0026micro;mol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e138.09\u0026thinsp;\u0026plusmn;\u0026thinsp;245.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.49\u0026thinsp;\u0026plusmn;\u0026thinsp;29.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlood type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCause of disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiver failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eBMI, body mass index; GRWR, Graft Volume/Recipient Body Weight Ratio; GGT, \u0026gamma; -glutamyltransferase; TBil, total bilirubin; PT, Prothrombin time; ALT, glutamic-pyruvic transaminase; AST, glutamic oxalacetic transaminase.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec11\"\u003e\n \u003ch2\u003e3.3 Intraoperative data analysis\u003c/h2\u003e\n \u003cp\u003eWe also collected the patient\u0026apos;s operation time, intraoperative bleeding, intraoperative blood transfusion, postoperative ICU monitoring time and other clinical data, we found that the two groups of patients in the operation time, intraoperative bleeding, intraoperative blood transfusion, postoperative ICU monitoring had not statistically significant(P\u0026thinsp;\u0026gt;\u0026thinsp;0.05)(Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). It is further proved that IV segment portal vein reconstruction does not increase the operation time and intraoperative bleeding, indicating that vascular reconstruction has high operability and safety.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab3\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe operation characteristics in the two groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eIV segment portal vein reconstruction\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eYes(n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eNo(n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eThe weight of graft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1236.38\u0026thinsp;\u0026plusmn;\u0026thinsp;159.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1187\u0026thinsp;\u0026plusmn;\u0026thinsp;200.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTotal OR time, min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e555.63\u0026thinsp;\u0026plusmn;\u0026thinsp;90.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e590.231\u0026thinsp;\u0026plusmn;\u0026thinsp;113.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAnhepatic phase, min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e50.63\u0026thinsp;\u0026plusmn;\u0026thinsp;8.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61\u0026thinsp;\u0026plusmn;\u0026thinsp;20.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHemorrhage, mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1437.5\u0026thinsp;\u0026plusmn;\u0026thinsp;821.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1361.54\u0026thinsp;\u0026plusmn;\u0026thinsp;818.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eRed blood cells transfusion volume, u\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e10.06\u0026thinsp;\u0026plusmn;\u0026thinsp;6.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePlasma transfusion volume, mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e987.75\u0026thinsp;\u0026plusmn;\u0026thinsp;534.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1164.62\u0026thinsp;\u0026plusmn;\u0026thinsp;651.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eICU hospitalization time, day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e6.75\u0026thinsp;\u0026plusmn;\u0026thinsp;8.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.85\u0026thinsp;\u0026plusmn;\u0026thinsp;4.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHospitalization time of OR, day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e33.5\u0026thinsp;\u0026plusmn;\u0026thinsp;12.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.54\u0026thinsp;\u0026plusmn;\u0026thinsp;8.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec12\"\u003e\n \u003ch2\u003e3.4 Postoperative liver function\u003c/h2\u003e\n \u003cp\u003eWe collected the liver function after operation. and had found that the alanine aminotransferase of non-vascular reconstruction group and vascular reconstruction group on the first day after operation were (904.13\u0026thinsp;\u0026plusmn;\u0026thinsp;635.23) U/L and (443.77\u0026thinsp;\u0026plusmn;\u0026thinsp;232.17), respectively (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05)(Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). The serum albumin of IV reconsturction and none IV reconstruction group on the 6-day after operation were (42.22\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22) g/L and (38.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.49) g/L (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). It indicated that vascular reconstruction could promote the recovery of liver function, but at same time, there was no significant difference in bilirubin, GGT, PLT between the two groups.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab4\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe liver Function after SLT in two groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eIV segment portal vein reconstruction\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo(n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYes(n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePOD-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALT, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e904.13\u0026thinsp;\u0026plusmn;\u0026thinsp;635.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e443.77\u0026thinsp;\u0026plusmn;\u0026thinsp;232.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAST, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e740\u0026thinsp;\u0026plusmn;\u0026thinsp;760.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e676.77\u0026thinsp;\u0026plusmn;\u0026thinsp;234.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerum albumin, g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.98\u0026thinsp;\u0026plusmn;\u0026thinsp;8.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePT, s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.61\u0026thinsp;\u0026plusmn;\u0026thinsp;6.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePlatelet, 10^9/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.75\u0026thinsp;\u0026plusmn;\u0026thinsp;27.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.38\u0026thinsp;\u0026plusmn;\u0026thinsp;57.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePOD-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALT, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e491\u0026thinsp;\u0026plusmn;\u0026thinsp;427.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e276.69\u0026thinsp;\u0026plusmn;\u0026thinsp;177.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAST, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e110.25\u0026thinsp;\u0026plusmn;\u0026thinsp;59.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e183.38\u0026thinsp;\u0026plusmn;\u0026thinsp;169.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerum albumin, g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.09\u0026thinsp;\u0026plusmn;\u0026thinsp;6.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePT, s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.75\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePlatelet, 10^9/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.13\u0026thinsp;\u0026plusmn;\u0026thinsp;31.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.69\u0026thinsp;\u0026plusmn;\u0026thinsp;68.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePOD-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALT, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e164.75\u0026thinsp;\u0026plusmn;\u0026thinsp;149.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e143.54\u0026thinsp;\u0026plusmn;\u0026thinsp;87.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAST, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u0026thinsp;\u0026plusmn;\u0026thinsp;34.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerum albumin, g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.09\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.17\u0026thinsp;\u0026plusmn;\u0026thinsp;4.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePT, s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePlatelet, 10^9/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.5\u0026thinsp;\u0026plusmn;\u0026thinsp;57.5227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.692\u0026thinsp;\u0026plusmn;\u0026thinsp;45.3604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePOD-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALT, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e109.5\u0026thinsp;\u0026plusmn;\u0026thinsp;65.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e114.62\u0026thinsp;\u0026plusmn;\u0026thinsp;66.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAST, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.63\u0026thinsp;\u0026plusmn;\u0026thinsp;23.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.77\u0026thinsp;\u0026plusmn;\u0026thinsp;28.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerum albumin, g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.22\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePT, s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePlatelet, 10^9/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96.37\u0026thinsp;\u0026plusmn;\u0026thinsp;65.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71\u0026thinsp;\u0026plusmn;\u0026thinsp;46.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePOD-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALT, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.25\u0026thinsp;\u0026plusmn;\u0026thinsp;50.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95.31\u0026thinsp;\u0026plusmn;\u0026thinsp;61.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAST, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.75\u0026thinsp;\u0026plusmn;\u0026thinsp;14.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46\u0026thinsp;\u0026plusmn;\u0026thinsp;39.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerum albumin, g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.59\u0026thinsp;\u0026plusmn;\u0026thinsp;3.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePT, s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.95\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePlatelet, 10^9/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94.5\u0026thinsp;\u0026plusmn;\u0026thinsp;61.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83.23\u0026thinsp;\u0026plusmn;\u0026thinsp;59.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003ePT, Prothrombin time; ALT, glutamic-pyruvic transaminase; AST, glutamic oxalacetic transaminase.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eWith the successful introduction and application of the techniques of SLT waiting times and pretransplant mortality has been reduced\u003csup\u003e[12]\u003c/sup\u003e.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ePro. Rudolf Pichlmayr pioneered split liver transplantation (SLT) in 1988\u003csup\u003e[13]\u003c/sup\u003e, enabling the transplantation of one donor liver into two recipients. With the development of SLT, the wait list mortality of recipients had reduced obviously\u003csup\u003e[14, 15]\u003c/sup\u003e. Split liver transplantation is an ideal method to expand the utilization of grafts and alleviate the shortage of donor liver, which can shorten the waiting time of recipient and reduce the mortality of patients during the waiting period\u003csup\u003e[16]\u003c/sup\u003e. In recent years, with the development of surgical techniques\u003csup\u003e[17]\u003c/sup\u003e, postoperative care and immunosuppressive drug, the safety of split liver transplantation has also achieved long-term development\u003csup\u003e[18, 19]\u003c/sup\u003e. However, split liver transplantation still faces postoperative complications such as small liver syndrome, infection and biliary fistula. Therefore, it is of great clinical significance to explore how to reduce the risk of small liver syndrome after SLT surgery and improve the functional liver transplantation volume.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the process of transplantation, the section which was splited is prone to ischemic (Fig 1), and the ischemic part may lead to insufficient volume of effective liver transplantation and increased perioperative complications. Ensuring adequate blood supply of grafts is important for functional transplantation. What can we do to improve marginal ischemia? In this study, we creatively reconstructed the IV segment portal vein of the graft. After reconstruction of IV segment portal vein, we had intrerestingly found that the part of ischemic was obviously reduced. we may conclude segment portal vein construction can reduced the risk of ischemic and increased the blood supply at the incisal margin.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe ischemia region in the IV segment occurs necrosis and may lead to serve complications. On the one hand, necrosis may further aggravate the risk of abdominal infection, biliary fistula and even hemorrhage; on the other hand, in the immunosuppressed state after liver transplation, infection may be difficult to control or even lead to serious consequences, even death, due to the use of immunosuppressive drugs after surgery. We had found that the IV segment reconstruction can eliminate the ischemia obviously and may reduce the incidence of complications associated with IV segment ischemia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDuring the operation, we found that the ischemia of the IV segment grafts was improved after vascular reconstruction. Whether IV segment vascular reconstruction can promote postoperative recovery of patients? We further analyzed the liver function after graft vascular reconstruction. And, we found that alanine aminotransferase decreased significantly on the post-operation day 1, and albumin increased significantly on the sixth day after operation. We can draw a conclunction that vascular reconstruction can promote the recovery of liver function after operation. IV segment grafts vascular reconstruction promoted the recovery and regeneration of liver cells at the IV segment which was ischemia. At the same times can increase the effective graft volume, prevent the occurrence of small liver syndrome, reduce the occurrence of postoperative liver failure.\u003c/p\u003e\n\u003cp\u003eWhether vascular reconstruction increases the operation complications. And we found that there was no increase in operation time, intraoperative bleeding, postoperative blood transfusion, postoperative hospital stays, and the risk of thoracoabdominal water after the reconstruction. All these results indicating that the reconstruction of the IV segment portal vein did not artificially increase the operation risk, and the occurrence of postoperative complications was of high operability and safety. And We can draw a conclusion that the IV segment portal vein reconstruction can relieving graft ischemia and promoting liver function recovery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn our study, although we found that the reconstruction of IV segment portal veins can promote the recovery of glutamic-pyruvic transaminase and albumin in patients, the number of cases included in this study is small, and multicenter and large samples are needed for further verification in future clinical practice. \u0026nbsp; In addition, no clinical data related to liver supply were included in this study, and the effect of liver supply on liver function recovery after liver transplantation was not considered.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn our study, we found that extended right part of liver receive IV segment reconstruction in SLT surgery can alleviate the graft ischemic and obviosuly promote the recovery of liver function.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eAll patients signed informed consent, and our study was approved by the Ethics Committee of the Affiliated Hospital of Qingdao University (No.2018052).\u0026nbsp;All methods\u0026nbsp;in our research\u0026nbsp;were carried out in accordance with routine surgical procedures which also\u0026nbsp;approved by the Ethics Committee of the Affiliated Hospital of Qingdao University (No.2018052).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThe datasets used or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThe authors declare that they have no potential competing interests in this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThis work was supported by the\u0026nbsp;Key Research and Development Program of Shandong Province (No: 2017GSF218098), Natural Science Foundation of Shandong Province (No. ZR202103020004), Clinical Medicine plus X Project of Affiliated Hospital of Qingdao University (202102006).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eGuo Yuan designed the study and wrote the manuscript. Dong Wang,\u0026nbsp;Ning Fan, Ge Guan, Xin Wang, Xiaodan Zhu, Yandong Sun\u0026nbsp;analysis the data in this study, Jianhong Wang, Yunjin Zang, Jinzhen Cai performed all the figures in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eWe gratefully acknowledge all the authors\u0026rsquo; works for this paper and all the patients in our study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information (optional)\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe gratefully acknowledge all the authors\u0026rsquo; works for this paper and all the patients in our study.\u0026nbsp;This work was supported by the\u0026nbsp;Key Research and Development Program of Shandong Province (No.2017GSF218098), Natural Science Foundation of Shandong Province (No.ZR202103020004), Clinical Medicine plus X Project of Affiliated Hospital of Qingdao University (No.202102006).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no potential competing interests in this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGuo Yuan designed the study and wrote the manuscript. Dong Wang, Ning Fan, Ge Guan, Xin Wang, Xiaodan Zhu, Yandong Sun analysis the data in this study(Table1-4), Jianhong Wang, Yunjin Zang, Jinzhen Cai performed all the figures in this study(Figure1-2).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eHackl C, Schmidt KM, S\u0026uuml;sal C, D\u0026ouml;hler B, Zidek M, Schlitt HJ. Split liver transplantation: Current developments. World J Gastroenterol 2018;24:5312\u0026ndash;5321. PMID:30598576. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3748/wjg.v24.i47.5312\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLee WC, Chan KM, Chou HS, Wu TJ, Lee CF, Soong RS, et al. Feasibility of split liver transplantation for 2 adults in the model of end-stage liver disease era. Ann Surg 2013;258:306\u0026ndash;311. 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Small-for-size liver syndrome after auxiliary and split liver transplantation: donor selection. Liver Transpl 2003;9:S26-28. PMID:12942475. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1053/jlts.2003.50197\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eRoss MW, Cescon M, Angelico R, Andorno E, Rossi G, Pinna A, et al. A matched pair analysis of multicenter longterm follow-up after split-liver transplantation with extended right grafts. Liver Transpl 2017;23:1384\u0026ndash;1395. PMID:28650108. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/lt.24808\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePichlmayr R, Ringe B, Gubernatis G, Hauss J, Bunzendahl H. [Transplantation of a donor liver to 2 recipients (splitting transplantation)--a new method in the further development of segmental liver transplantation]. Langenbecks Archiv fur Chirurgie 1988;373:127\u0026ndash;130. PMID:3287073.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePerito ER, Roll G, Dodge JL, Rhee S, Roberts JP. Split Liver Transplantation and Pediatric Waitlist Mortality in the United States: Potential for Improvement. Transplantation 2019;103:552\u0026ndash;557. PMID:29684000. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/TP.0000000000002249\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMalag\u0026oacute; M, Hertl M, Testa G, Rogiers X, Broelsch CE. Split-liver transplantation: future use of scarce donor organs. World J Surg 2002;26:275\u0026ndash;282. PMID:11865359. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00268-001-0216-z\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePerkins JD, Dick AA, Healey PJ, Montenovo MI, Biggins SW, Sibulesky L, et al. New Evidence Supporting Increased Use of Split Liver Transplantation. Transplantation 2020;104:299\u0026ndash;307. PMID:31335771. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/tp.0000000000002853\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eGong N, Chen X. Partial liver transplantation. Front Med 2011;5:1\u0026ndash;7. PMID:21681668. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11684-010-0105-7\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLauterio A, Di Sandro S, Concone G, De Carlis R, Giacomoni A, De Carlis L. Current status and perspectives in split liver transplantation. World J Gastroenterol 2015;21:11003\u0026ndash;11015. PMID:26494957. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3748/wjg.v21.i39.11003\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eCauley RP, Vakili K, Fullington N, Potanos K, Graham DA, Finkelstein JA, et al. Deceased-donor split-liver transplantation in adult recipients: is the learning curve over? J Am Coll Surg 2013;217:672\u0026ndash;684.e671. PMID:23978530. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jamcollsurg.2013.06.005\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"split liver transplantation, IV segment, ischemia, P4 reconstruction","lastPublishedDoi":"10.21203/rs.3.rs-1616717/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1616717/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Liver transplantation is one of the most effective treatment for end-stage liver disease. Split liver transplantation (SLT) can effectively improve the utilization efficiency of grafts . However, split liver transplantation still faces the shortcomings and not widely used in the surgery. How to improve the effective transplantation volume of split liver transplantation and promote the postoperative recovery of patients has important clinical significance.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e In our study, the donor liver was split into the extended right graft and left lateral sector, and the IV segment occure ischemia. In order to guarantee the functional graft size, and avoid the complications, we reconstructed the IV segment portal vein and left portal vein. And we analysed the operation time, intraoperative bleeding, liver function and postoperative complications.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e In our research, 13 patients underwent IV segment portal vein reconstruction, and 8 patients did not undergo vascular reconstruction. We found that the ischemic area of the IV segment decreased significantly after IV segment portal vein reconstruction. We found that there was no significant difference in operation time and postoperative complications between the patients of the groups. There were significant differences in ALT on the first day and albumin on the sixth day after operation.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e It indicates that IV segment reconstruction in SLT surgery can alleviate the graft ischemic and obviously promote the recovery of liver function after operation. And, IV segment reconstruction as a novel operating procedure may be widely used in SLT.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"IV segment portal vein reconstruction in split-liver transplantation with extended right grafts","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-05-24 14:40:46","doi":"10.21203/rs.3.rs-1616717/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-07-01T05:02:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-06-29T07:48:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-06-04T09:14:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2ca00d08-6651-404a-b14c-3bfad1500f7f","date":"2022-05-28T15:10:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"43679dc1-0ea9-4f7c-9513-3b88a93f7526","date":"2022-05-26T14:19:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-05-25T10:38:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-05-25T10:33:32+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-05-09T11:09:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-05-09T11:04:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2022-05-02T13:46:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"79b6ddbe-5a28-4e23-982f-cbf25792f7cd","owner":[],"postedDate":"May 24th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2022-08-03T06:59:20+00:00","versionOfRecord":[],"versionCreatedAt":"2022-05-24 14:40:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1616717","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1616717","identity":"rs-1616717","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}