【Abstract】Objective To investigate the surgical technique of orthotopic liver transplantation using two-cuff technique and prevention of operational complications in rats. Methods The model was established with modified cuff technique.Before donor livers were harvested,the portal vein and hepatic artery were interrupted for 10 min,and reflow was initiated for another 10 min.The donor liver was perfused through abdominal aorta and portal vein respectively.The infrahepatic vena vein and portal vein were anastomosed by means of cuff method； the anastomosis of the suprahepatic vena vein was performed with suture method. The anastomosis of the common bile duct was performed with an internal stent. Results One hundred and twenty rats underwent orthotopic liver transplantation using twocuff technique and the successful rate was 90.8%. The average nonhepatic time of recipients was (21.0±3.5) min and the total surgical time was (46.0±4.5) min. The oneweek survival rate of recipients was 87.2%. Conclusion Good exposure of operative field, sophisticated microsurgical technique and delicate surgical manipulation can benefit decreasing nonhepatic and total surgical time of recipients and increasing the survival rate of recipients.
Objective To establish the rat orthotopic liver transplantation model by characterizing the blood supply of hepatic artery with the Cuff skill and the modified arterial sleeve anastomosis, to explore the possible mechanisms of acute rejection and the express of Fractalkine (Fkn) in the early stage after hepatic allograft operation. Methods SD rats were selected as donors and Wistar rats as receptor for the rejection model of orthotopic liver transplantation. Recipient rats were divided into 2 groups randomly after operationand the drugs were given intraperitoneally once a day in each group. In the experimental group, cyclosporine A (CsA) was delivered with 3 mg/kg. In the control group, only normal saline was given with 3 ml/kg. Condition of survivals were observed. The rejection actvity index (RAI) and the expression of Fkn of liver tissue were observed after 3rd, 5th and 7th days in 5 rats. The rest of rats in each group were fed and given drug or normal saline until they were died and the mean survival time were recorded. Results There were 18 survivals in control group, and 19 in experimental group after liver transplantation. Condition of survivals in experimental group was better than that of control group. The mean survival times of experimental group(19.50±4.51 days) was significantly longer than that of control group(7.60±1.60 days), showing statistically significant difference (P＜0.05). After 3rd, 5th and 7th days of transplantation, RAI of control group were 3.80±0.35,5.90±0.87 and 7.50±1.30,respectively;RAI of experimental group were 3.10±0.21,3.90±0.41 and 4.50±0.52.Therewasstatistically significant difference in RAI between 2 groups on the 7th day after transplantation (Plt;0.01). On the 3rd,5th and 7th days after transplantation, the Fkn of control group was 8.20±0.57,21.30±3.30 and 25.70±4.91, and that of experimental group was 8.30±0.56,10.30±0.67 and 11.70±1.23. There were statistically significant differences in Fkn between 2 groups on the 5th, 7th days after transplantation (Plt;0.01). Conclusion Fkn is a participant inacute rejection after the rat orthotopic liver transplantation and can be chosen as a useful target in the diagnosis of acute rejection. CsA has immunosuppressive property in the condition of acute rejection in the rat orthotopic liver transplantation, which may be result from the decreased the level of Fkn.
【Abstract】ObjectiveTo investigate the prophylactic effect of lamivudine monotherapy on the recurrence of hepatitis B after liver transplantation. MethodsThirtyone patients with hepatitis B related benign decompensated cirrhosis who underwent liver transplantation between February 1999 to June 2002 and survived more than 3 months were analyzed retrospectively. Lamivudine was administered to each patient after operation and some patients before operation for the prophylaxis of HBV recurrence. The HBV markers and HBV DNA in serum and bioptic liver tissues in all patients were evaluated before and after operation. ResultsTotal HBV recurrence rate was 19.4％（6/31） during average 38.2 months (3.2-70.2 months) follow up. HBV recurrence rate was 7.1％(2/28), 16.0％(4/25), 26.1％(6/23) and survival rate was 87.1％(27/31), 80.6％(25/31), 66.1％(20.5/31) after 1-, 3-and 5-year, respectively. One hundred milligram lamivudine administration peroral daily for 2 weeks prior to transplantation enable HBeAg 54.5％(6/11) and HBV DNA 50.0％(5/10) positive patients convert to negative respectively. ConclusionPreoperative administration of lamivudine monotherapy can effectively prevent allograft from HBV re-infection after liver transplantation. Lamivudine should be used to convert HBV DNA and HBeAg to negative.
ObjectiveTo study the development of methods assessing donor liver viability in liver transplantation.MethodsThe literature in the recent years on the methods of assessing donor liver viability was reviewed.ResultsFrom donor liver morphology to function,there have being developed many methods which assess donor liver viability,including:①donor liver appearance; ②intraoperative biopsies; ③donor liver microcirculation; ④portal pressure; ⑤enzymes levels in liver; ⑥lidocainemetabolizing activity; ⑦energy metabolism of donor liver; ⑧fat content in donor liver.ConclusionThere are many methods to assess the viability of donor liver. Each has its supericrity and defect respectively. Intraoperative biopsies, 31Pmagnetic resonance spectroscopy and portal pressure have more importance in clinical application.
【 Abstract 】 Objective To investigate the features and risk factors of bacterial infection after orthotopic liver transplantation (OLT) and summarize the experiences for prevention and treatment of infection. Methods The clinical materials of 79 patients underwent OLT from December 2004 to January 2007 were reviewed. The incidence and sites of postoperative bacterial infections as well as species of bacteria and the situation of drug resistance were retrospectively analyzed. Results Thirty-two (40.5%) out of 79 patients developed bacterial infections. Infection mainly occurred in lung, abdominal cavity and blood, which were mainly caused by Escherichia coli, staphylococcus aureus, klebsiella pneumoniae, staphylococcus epidermidis and enterococcus bacteria. The main risk factors included delayed restoration of gastrointestinal function (gt;5 d), poorly preoperative liver function (Child C grade), hypoproteinemia and persistent postoperative hyperglycemia (gt;11.0 mmol/L). Perioperative decontamination in digestive tract was a protective factor in the prevention of bacterial infection. Conclusion Bacterial infection is one of the most severe complications after OLT. Therefore, it is very important to remove those risk factors, make early diagnosis and take effective treatment ．
Objective To summarize the function of Kupffer cell for the ischemia reperfusion injury after liver’s transplatation. Methods The literatures which about the function of Kupffer cell for the ischemia reperfusion injury after liver’s transplatation were reviewed. Results Kupffer cells are the resident macrophages of the liver, which can be activated to generate a range of inflammatory mediators, including cytokines, reactive oxygen intermediates, chemokines, and other factors to startup the ischemia reperfusion injury （IRI）, and to cause the liver graft dysfunction. On the other hand, Kupffer cells can protect the ischemia reperfusion injury by release NO and HO-1. The CO, which is the byproduct of heme degradation by the heme oxygenases （HO-1），has the same function for IRI. Conclusions The Kupffer cells have bidirectional function for the ischemia reperfusion injury of liver’s transpatation. Thus, how to decrease the harmful factors and up-regulate the beneficial substances by Kupffer cells will be the key points in preventing IRI after liver transplantation in future.
Objective To observe the expression of heat shock protein 70 (HSP70) in human liver after hepatic transplantation, and to study its correlation with the occurrence and progression of acute allograft rejection.Methods Fifteen biopsy specimen of allograft liver after transplantation were collected and divided into three groups according to their pathological changes: control group (no rejection), mild acute rejection group, and moderate/serious acute rejection group. The expressions of HSP70 in grafts were detected by using immunohistochemical method and imaging analysis. Results HSP70 was expressed in all 3 groups, and appeared mainly in hepatocellular cytoplasm. The immunohistochemical imaging analysis of HSP70 showed: integral optical density (IOD) which was 30.99±11.14 in the control group was lower than that in the mild acute rejection group (68.84±21.37) and that in the moderate/serious acute rejection group (71.82±19.99), P＜0.01； and the IOD in the moderate/serious acute rejection group was higher than that in the mild acute rejection group (P＜0.05). Conclusion HSP70 plays a role in cellular protection for allograft liver, and the continuously increasing expression of HSP70 in graft maybe closely relates to the occurrence and progression of acute allograft rejection.
Objective To evaluate the outcome of liver transplantation in patients with recurrent liver cancer after resection. Methods Data of 23 patients underwent liver transplantation for recurrent liver cancer from April 2001 to March 2008 were retrospectively collected and analyzed. Results Previous history of liver resection had little negative effect in subsequent liver transplantation in technical aspect. Liver function recovered uneventfully after transplantation in all cases. Alpha fetoprotein (AFP) recovered to normal value in 13 of 17 cases with elevated AFP before transplantation within one month after operation. Five cases (21.74%) had postoperative complications. Nineteen cases (82.61%) were followed up, average follow-up duration were 610 days. There were 5 cases (26.32%) of cancer recurrence and 6 deaths during follow-up, survival rate was 68.42%. Conclusion Liver transplantation is a reasonable treatment for recurrent liver cancer after resection.
Objective To review the advances of livingrelated liver transplantation for children. MethodsOn the basis of the data in Kyoto university, the center of livingrelated liver transplantation in the world, the current situation of livingrelated liver transplantation for children were investigated. ResultsEighty percent of patients who underwent the livingrelated liver transplantation were children with cholestatic liver disease. From the data of 462 cases, the patients’survival rate for 1, 3 and 5 years after livingrelated liver transplantation (79.8%, 77.0% and 77.0% respectively) preceded the survival rate of 129 patients who underwent the whole liver transplantation (76.0%, 70.0% and 65.0% respectively). To the livingrelated liver transplantation, the survival rate was higher for patients who underwent selective operation (85.0%) than emergency surgery (67.0%). The principal causes of death were rejection and infection. Furthermore, a partial orthotopic liver transplantation and livingrelated liver replantation were performed for children. Conclusion Strict indication, optimal health status and perfect postoperative management are the keys to keep patients longterm healthy survival. The curative effect of livingrelated liver transplantation precedes the whole liver transplantation. For children, livingrelated liver transplantation is better than for adults.
Objective To establish a reliable rats model of orthotopic liver transplantation with non-heart beating donors. Methods The model was established with modified double-cuff method. According to obtain pre-liver warm ischemia time experiencing non-heart-beat the rats were divided into 3 groups: 10 min (R10 group), 20 min (R20 group) and 30 min (R30 group), then one week survival after operation was compared in rats. Results The operative time of donor was 30 min approximately except warm ischemia time and the cold preservation time of donor liver was 1 h. The anastomotic time for suprahepatic vena cava was 12-22 min (mean 15 min). The anastomotic time for portal vein and infrahepatic vena cava was about 2 min and 1 min, respectively. The anhepatic phase sustained 14-24 min (mean 19 min). The operative time of receptor was 50-65 min (mean 60 min). Twelve rats died at 24 h after operation, which was considered as operative failure. The success rates of operation in R10 group, R20 group, and R30 group were 95% (19/20), 80% (16/20), and 65% (13/20), respectively. After one week the survival rate was 95% (18/19), 81% (13/16), and 54% (7/13), respectively. Conclusions Improved non-heart donor liver transplantation model of rat on the basis of Kamada’s “twocuff technique” acts as a good simulation in clinical non-heart-donor liver transplantation. This study showes that rat liver can tolerate warm ischemia time less than 30 min, the short-term survival after transplantation can reach satisfactory results. However, long-term survival requires further study.