Jiulin Song

Objective: To compare the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) and the Frey procedure in the treatment of pediatric pancreatic duct stones (PDS). Methods: A retrospective analysis was conducted on 65 pediatric patients treated for pancreatic duct stones in the Department of Pediatric Surgery, West China Hospital of Sichuan University, between February 2018 and May 2025. Demographic data, perioperative clinical parameters, postoperative recovery, and complications were collected. The efficacy and complications of ERCP and the Frey procedure were evaluated. Results: Of the 65 patients, 37 (56.92%) were male and 28 (43.08%) were female, with a median surgical age of 14 (11, 16) years. 32 patients (49.23%) underwent ERCP, and 33 patients (50.77%) underwent the Frey procedure. Significant differences were observed between the two groups in the degree of main pancreatic duct dilation (6.45 vs. 9.11, p < 0.001), postoperative stone recurrence (13 vs. 3, p = 0.003), and number of reinterventions (3.98 vs. 1.27, p < 0.001). The 5-year intervention-free survival rate was 57.75% in the ERCP group and 88.86% in the Frey group, with a statistically significant difference between groups (p = 0.024). Conclusions: Both ERCP and the Frey procedure are effective for pediatric PDS. ERCP is preferred for patients with mild ductal dilation and first-onset stones. However, for those with significant ductal dilation or recurrent stones with suboptimal ERCP outcomes, the Frey procedure is recommended.

To analyze and compare the efficacy of two treatment strategies for biliary atresia (BA) sequential treatment of Kasai hepatoportoenterostomy-liver transplantation and primary liver transplantation. A retrospective analysis was conducted on the clinical data of 300 patients with BA who underwent LT in our center. Among these patients, 225 underwent Kasai hepatoportoenterostomy - liver transplantation sequential treatment (Kasai-LT group), while 75 received primary liver transplantation (pLT group). Data on demographic characteristics, perioperative conditions, postoperative recovery, and complications were collected to analyze the efficacy, complication rates, and survival outcomes of the two treatment approaches. After propensity score matching analysis, there were no differences in postoperative liver function recovery between two groups. However, the Kasai-LT group had lower APRI, lower γ-GT level, and lower PELD scores when liver transplantation. The Kasai-LT group had shorter operative time, shorter PICU stay, shorter hospital stay with lower hospitalization cost. The incidence of hepatic artery complications and thoracoabdominal infections after LT was significantly higher in the pLT group compared to the Kasai-LT group. The 5-year recipient cumulative survival rate was 94.40% in the Kasai-LT group compared to 88.10% in the pLT group. Furthermore, the 5-year cumulative graft survival rate was 89.30% in the Kasai-LT group and 86.80% in the pLT group. The treatment of BA should follow Kasai-LT sequential treatment combined with individualized treatment plans to achieve better pre-transplantation general condition and reduce the incidence of postoperative complications.

Objective: T cell-mediated rejection (TCMR) is a major concern following liver transplantation (LT), and identifying its predictors could help improve post-transplant prognosis. This study aimed to develop a model to predict the risk of TCMR in children and adults after LT. Method: Pre-transplant demographic characteristics, intraoperative parameters, and especially early post-transplant laboratory data for 1221 LT recipients (1096 adults and 125 children) were obtained from the Hospital, University, between 1 January 2015, and 1 January 2022. These data were analyzed to develop the prediction model. Result: The incidence of TCMR was higher in pediatric LT recipients than in adults (17.6% vs. 6.4%, P < 0.001). In adult recipients, seven predictors were identified: donor sex, recipient age, recipient height, and post-transplant levels of serum direct bilirubin, urea, platelets, and neutrophil-to-lymphocyte ratio. In pediatric recipients, four predictors were identified: post-transplant levels of serum monocyte percentage, direct bilirubin, albumin, and gamma-glutamyl transferase. The area under the model’s curve incorporating these variables for predicting TCMR after LT was 0.713 (95% confidence interval, CI: 0.655–0.770) in adults and 0.786 (95% CI: 0.675–0.896) in children. Decision curve analyses demonstrated the clinical significance of the model. Conclusion: This study developed a prediction model that may be useful in identifying high-TCMR-risk populations in both adult and pediatric LT recipients.

Background: Ex vivo liver resection combined with autotransplantation is an effective therapeutic strategy for unresectable end-stage hepatic alveolar echinococcosis (HAE). However, ex vivo liver resection combined with autotransplantation is a technically demanding and time-consuming procedure associated with significant morbidity and mortality. The authors aimed to present our novel remnant liver-first strategy of in vivo liver resection combined with autotransplantation (IRAT) technique for treating patients with end-stage HAE. Methods: This retrospective study included patients who underwent IRAT between January 2014 and December 2020 at two institutions. Patients with end-stage HAE were carefully assessed for IRAT by a multidisciplinary team. The safety, feasibility, and outcomes of this novel technique were analyzed. Results: IRAT was successfully performed in six patients, with no perioperative deaths. The median operative time was 537.5 min (range, 501.3–580.0), the median anhepatic time was 59.0 min (range, 54.0–65.5), and the median cold ischemia time was 165.0 min (range, 153.8–201.5). The median intraoperative blood loss was 700.0 ml (range, 475.0–950.0). In-hospital complications occurred in two patients. No Clavien–Dindo grade III or higher complications were observed. At a median follow-up of 18.6 months (range, 15.4–76.0) , all patients were alive. No recurrence of HAE was observed. Conclusion: The remnant liver-first strategy of IRAT is feasible and safe for selected patients with end-stage HAE. The widespread adoption of this novel technique requires further studies to standardize the operative procedure and identify patients who are most likely to benefit from it.