August 23rd, after the smooth implementation of living donor liver transplantation for Yuan Yuan (pseudonym) who is a six-month-old female baby from Henan suffering from congenital biliary atresia, Qiang Xia’s team from Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine announced that: they have successfully completed 1000 cases of liver transplantation in children, with the number accounting for about one-half of the total number of liver transplantation in children in rural areas. Renji Hospital has thus become the hospital which has completed the most number of liver transplant surgeries in children in the past nearly six years all over the world. After the press conference, Professor Qiang Xia rushed to the operating table for the 1001st case of liver transplantation in children.

Yuan Yuan, a baby girl of six and a half months old, was found jaundice after the fourth day of birth. The jaundice has been incurable after medication, and she was thereafter diagnosed with congenital biliary atresia in the local hospital. Because she had missed the best time for Gusi surgery and she was suffering from concurrent cirrhosis at that time, only liver transplantation could save the baby. Yuan Yuan’s parents was attracted to find Professor Qiang Xia of Renji Hospital. After the inspection, it was found that although the typing of the mother and her daughter is successful, the living of the family consisting of five people was extremely poor. The grandmother was disabled; the father could not work because of cervical injury, so the whole family could not afford all the cost of surgery. Fortunately, funded by the SMIC project of the China Soong Ching Ling Foundation for poverty-stricken children with biliary atresia, Yuan Yuan finally had the opportunity of liver transplant surgery. August 23rd, a piece of 220 grams of liver from the left side of the mother’s live was successfully "planting" to Yuan Yuan's body, and yuan yuan got a new life.

 

According to Director Qiang Xia, Director of Department of Liver Surgery of Renji Hospital, the surgery lasted nearly 4 hours, which is 40 minutes longer than expected. During the surgery it was found that the child’s portal vein was narrow due to recurrent cholangitis caused by stenosis, leading to poor vascular conditions and lack of portal venous blood flow. The direct transplantation of donor liver may lead to failure due to lack of blood flow. The medical group immediately adjusted the surgical program. They used the unuseful blood vessels in the child’s autologous liver to perform the portal vein patch plastic surgery, so that the portal vein blood flow returned to the best condition. The surgery was a complete success, with less than 50 ml bleeding for both the mother and the child.

Qiang Xia also introduced, since the first case of liver transplant surgery in children has been successfully carried out at Renji Hospital in October 2006, the team has spent nearly a decade to complete the 500 cases of liver transplantation in children. In order to allow more and more children not to lose the final treatment opportunities because of donor shortages, the team members perform surgeries day and night, with surgery and surgery again and actually have completed the other 500 cases of liver transplantation in children in less than two years’ time. About 80% of the 1000 cases of liver transplantation in children are pediatric living liver transplantation, more than 70% are from poor areas, and about 60% are funded by various types of funding to complete the operation.

 

During the interview, Head Nurse of Department of Liver Surgery Mingzhu Huang had some feeling. "Because the patients' condition suddenly worsened, two children who are still less than a year old left in the ward yesterday. When a child is gone, several families are in despair. When looking at their sincere needing to receive liver transplantation, we not only have no holidays, and once the appropriate source of liver appeared, it is necessary to work overtime at any time into combat.

It is reported that each year about three thousand children in China suffer from infant end-stage cirrhosis due to various congenital diseases, and the mortality rate is more than 90%. Among them, the most common is congenital biliary atresia, in which bile cannot be discharged due to the "solid" bile duct, resulting in irreversible liver injury in children. If there is not active and effective treatment, 90% of them will die within 1 year due to liver failure.

For more than a decade, in order to break through the related technologies of liver transplantation to achieve the change leap of Chinese liver transplantation from quantitative to qualitative, Qiang Xia’s team have successively carried out living liver transplantation, split liver transplantation, auxiliary partial liver transplantation, DCD (heart death donation) liver transplantation and other technologies. The latest statistics show that Renji Hospital has completed 1000 cases of liver transplantation in children, covering more than 20 kinds of liver and genetic metabolic diseases in children. The operation time has been shortened from the initial 13 hours to 5-6 hours. The age of patients is from less than 5 months to 15 years old. The success rate of liver transplantation is more than 98%, with 1-year and 5-year overall survival rate at 90% and 80% respectively, which were more than 10% higher than the national average level.