Objective To summarize the clinical experience of liver retransplantation. Methods Six liver retransplantations were performed. The indications consisted of primary non-function (PNF, 2 cases), acute or chronic rejection (2 cases), stomas stenosis of biliary tract (1 case) and primary sclerosing cholangitis (1 case). The immunosuppressive protocols included tacrolimus, methylprednisolone (MP) and mycophenolate mofetil (MMF). Results Five patients were cured. One patient died on day 4 after liver retransplantation because of multiple organ failure. Postoperative complications included deep fungal infection and wound infection. Conclusions Liver retransplantation is an effective method for graft failure after liver transplantation. Proper indication and optimum operative time, intensive perioperative supervision and proper treatment are very important to improv effect of liver retransplantation.
Objective To investigate the clinical choice on graft size and the type of donor’s hepatectomy in adult living related partial liver transplantation. Methods The literatures in recent years on the donor’s evaluation, the size of liver grafts, the types of donor hepatectomy and safety of donor in adult living related partial liver transplantation were reviewed.Results The size of liver graft is a crucial factor related to the safety of donor and the prognosis of the recipient. GW/ESLW≥30%, GW/BW≥0.8% may be the lowest limits. Left lobe contained middle hepatic vein, extended left lobe with leftside caudle lobe, right lobe or extended right lobe contained middle hepatic vein may be the practical choice.Conclusion It is important to make a reasonable choice of liver graft according to the estimation of GW/ESLW or GW/BW, and the anatomy of liver in adult living related partial liver transplantation.
Objective To study the interaction and mechanism of prostaglandin I2 (PGI2) receptor/thromboxane A2 (TxA2) receptor (IP/TP) and cyclooxygenase-2 (COX-2) in ischemia reperfusion injury after liver transplantation of rat. Methods Rats were randomly divided into three groups: control group （n=16), orthotropic liver transplantation group （n=32) and nimesulide intervention group （n=32). The samples were obtained at 3 h, 6 h, 12 h and 24 h after operation. The expressions of COX-2, IP and TP mRNA were detected by RT-PCR. Immunohistochemistry was used to detect the localization and expression of COX-2. Hematoxylin Eosin staining was used to classify the injury extent of liver. Serum ALT and AST levels were detected to evaluate the changes of liver enzyme. Results COX-2 protein expression detected by immunohistochemistry in orthotropic liver transplantation group mainly distributed in the district of liver sinusoidal endothelial cells, liver cells and macrophage cells, which was significantly higher than control group and nimesulide intervention group. Expressions of IP mRNA, TP mRNA and COX-2 mRNA in the orthotropic liver transplantation group were significantly increased than those in control group (P＜0.05), and the ratio of IP/TP increased (P＜0.05). Expressions of IP mRNA and TP mRNA in nimesulide intervention group were significantly lower than that in the orthotropic liver transplantation group at 6 h and 12 h after operation (P＜0.05), and the ratio of IP/TP decreased at 3 h, 6 h and 24 h after operation (P＜0.05). The expression of COX-2 mRNA in nimesulide intervention group was significantly lower than that in the orthotropic liver transplantation group at 6 h, 12 h and 24 h after operation. In orthotropic liver transplantation group liver injury was obvious by HE staining, and more severve than that in nimesulide intervention group. Serum AST (each time) and ALT (3 h, 6 h and 12 h) levels in the orthotropic liver transplantation group were significantly higher than that in control group and nimesulide intervention group (P＜0.05) and peaked at 6 h after operation. Conclusion The balance of IP/TP takes part in and plays an important role in the ischemia reperfusion injury of liver transplantation. Changing imbalance of IP/TP may reduce liver transplantation ischemia reperfusion injury by inhibiting COX-2 expression.
Objective To review the value of imaging assessment for perioperative period of liver transplantation. Methods The related literatures in recent years were reviewed, and the applications of various kinds of radiological techniques in perioperative period of liver transplantation and radiological strategies of major complications after liver transplantation were summarized. Results Transplantation has become an effective option for treatment of patients with irreversible severe liver dysfunction. Radiological assessment supplies prompt and accurate information for clinic to increase the success rate and reduce the complications. So it plays an irreplaceable role. Conclusions Radiology assessment is important for screening donors and recipients before liver transplantation， following up and monitoring the complications. The doctor of imaging department could grasp the different imaging appearance in perioperative period of liver transplantation.
ObjectiveTo summarize experience of clinical diagnosis and treatment for liver posttransplant lymphoproliferative disorder(PTLD). Method The clinical diagnosis and treatment processes of 3 patients with live PTLD in this hospital were retrospectively analyzed and the relevant literatures were reviewed. ResultsThe EB virus was negative and CD20 was positive for these 3 patients with liver PTLD, the time of onset was 10 to 12 years after liver transplantation, and the tacrolimus was given for anti-immune following liver transplantation. The pathological diagnosis was diffuse large B cell lymphoma for all the patients. ConclusionsWith use of large quantities of immunosuppressive drugs following liver transplantation, incidence of liver PTLD gradually rises. Meanwhile, prognosis is poor and early diagnosis is difficult. Currently, diagnosis and classification is still dependent on pathological examination. EB virus positive patients show earlier onset, while EB negative patients show later onset with a poorer prognosis. Therefore, a long-term follow-up should be conducted for early detection, and rituximab should be administrated to patients with CD20(+).
Objective To investigate the protection on the intrahepatic cholangiocyte mediated by hypoxic preconditioning (HP) after liver transplantation and the role of vascular endothelial growth factor (VEGF). Methods The model of autologous liver transplantation was established, and the rats were divided into 3 groups: autologous liver transplantation group, hypoxic preconditioning before operation group (HP group) and sham operation group. At 6, 12, 24, 48 h after operation, blood samples were collected for examination of the serum total bilirubin (TBIL), direct bilirubin (DBIL) and alkaline phosphatase (ALP), and the expression of VEGF was detected by immunohistochemical method. The pathological changes of cholangiocytes were observed by light microscope. Results As compared with autologous liver transplantation group, the levels of seurm TBIL, DBIL and ALP in HP group were lower (P＜0.05), while the expression of VEGF in HP group was higher at the whole process (P＜0.05). The degrees of billiary epithelium damage and inflammatory infiltration in autologous liver transplantation group were more severe than those in HP group. Conclusion HP has protective effect on cholangiocytes after liver transplantation, in which VEGF may play an important role.
【Abstract】Objective To evaluate the value of pTNM classification in predicting the prognosis of hepatic cell carcinoma after liver transplantation. Methods Fifty-nine HCC cases undergoing liver transplantation between April 1993 and January 2003 were retrospectively reviewed. Fiftynine cases were staged by using the pTNM classification. Results The 1-year survival rates were 66.67%, 66.67%, 40.91% and 31.75% for Ⅰ，Ⅱ，Ⅲa and Ⅳa stages，2-year survival rates were 66.67%, 66.67%, 21.29% and 31.75%, the difference was not statistically significant. Conclusion The pTNM classification is not good enough to predict the prognosis of hepatic cell carcinoma after liver transplantation.
Objective To investigate the risk factors of early allograft dysfunction (EAD) following C-Ⅱ donation after cardiac death (DCD) liver transplantation. Methods The data of 46 donors and recipients of C-ⅡDCD liver transplantation between March 2012 and August 2015 were retrospectively analyzed. The baseline data such as democracy, death cause, donor warm ischemic time (DWIT) and cold ischemic time (CIT) in EAD group and the non-EAD group (control group) was compared, and whether these factors were risk factors of EAD was investigated by univariate and multivariate analyses. Statistical cut-off values for significant factors of the unfavorable analysis were defined by receiver operating characteristics (ROC) analysis. The 6-month and 1-year graft survival rate were compared. Results The EAD group had a longer DWIT compared with the group [(17.6±4.7) and (12.7±6.2) minutes, P=0.009]; meanwhile, the EAD group had a longer CIT compared with the control group [(13.7±4.7) and (11.0±3.5) hours, P=0.020]. The other factors in both groups showed no statistical significance (P>0.05). The ROC curve revealed the cut-off values of DWIT and CIT were 17.50 minutes [area under the curve (AUC)=0.713, P=0.020] and 9.85 hours (AUC=0.723, P=0.015), respectively. The multivariate logistic regression analysis showed the DWIT [odds ratios (OR)=1.340, 95% confidence interval (CI)(1.042, 1.654), P=0.008] and CIT [OR=1.396, 95% CI (1.075, 1.698), P=0.015] were all independent risk factors of EAD. The 6-month and 1-year graft survival rate of the EAD group and the control group was 85.7% vs. 92.3% (P=0.607) and 71.4% vs. 84.6% (P=0.587), respectively. Conclusions EAD may occured in C-Ⅱ donors with DWIT≥17.50 minutes or CIT≥9.85 hours in DCD liver transplantation. The livers can be used as a resource for clinical use and also have a good outcome.
ObjectiveTo discuss the relation between bile duct anastomotic stricture and bile duct injury by endo-scopic observation following liver transplantation and it, s efficacy of endoscopic treatment. Method The clinical data of 24 cases of bile duct anastomotic stricture following liver transplantation diagnosed by cholangiography were analyzed retro-spectively. Results①Twenty-four cases of bile duct anastomotic strictures were included in 3 cases of typeⅠa, 2 cases of typeⅠb, 4 cases of typeⅡ, 1 case of typeⅢa, 5 cases of typeⅢb, and 9 cases of typeⅢc.②The redness of intrahepatic bile duct mucosa, banding erosion, ulcer and fusion of anastomotic stricture mucosa could be seen in typeⅠa andⅢa. The redness of intrahepatic bile duct and anastomotic stricture mucosa could be seen in typeⅡwithout ulcer and fusion. The extensive erosion and ulcer of intrahepatic bile duct and redness of anastomotic stricture mucosa could be seen in typeⅢb. The extensive erosion, ulcer and partial necrosis of intrahepatic bile duct and anastomotic stricture mucosa could be seen in typeⅠb andⅢc.③Seventeen cases were cured by choledochoscopy through T tube, the biliary casts were moved out and the anastomotic strictures were relieved by balloon dilatation and placement of plastic stenting for 2 to 6 months, no recurrence happened. One case of typeⅠb treated by percutaneous transhepatic cholangial drainage(PTCD) and percuta-neous transhepatic cholangioscopy(PTCS) was developed into the stricture of typeⅡduring following-up for 19 months. Two cases of typeⅠa were treated by ERCP, the biliary casts were moved, one of which was cured, another 1 case was developed into the stricture of typeⅡduring following-up for 5 months. Two cases of typeⅡwere treated by ERCP, the biliary casts were moved, balloon dilatation and placement of plastic stent were performed, one of which was cured, another 1 case was recurrent during following-up for 1 months. The strictures were not relieved by multiple plastic stents for 4 to 6 months in 3 patients with recurrence and progress, but which was relieved by full-covered self-expanding removable metal stents for 4 to 7 months, there was no recurrence during following-up. One case of typeⅢb and one case of typeⅢc received the secondary open operation or choledochoscopy and placement of plastic stent for biliary infection and jaundice after the treatment of ERCP were cured. ConclusionsBiliary stricture following liver transplantation accompanies different degree biliary injury. The slightest is typeⅡand typeⅠa, typeⅢa is the second, typeⅢb is more serious, and typeⅠb and typeⅢc are the worst. Choledochoscopy is a better choose for anastomotic strictures. ERCP is not a better choose for anastomotic strictures of typeⅠb, Ⅲb, andⅢc.
Objective To study the mechanism of immune hyporesponsiveness of allograft rejection induced by transfusion nonpufsed allopeptide syngeneic immature dendritic cell (imDC) generated from recipient bone marrow progenitors and to explore a possible strategy for liver allograft protection in clinic. Methods Forty experimental rats were randomly divided into 4 group: control group, cyclosporine A (CsA) group, mature DC (mDC) group and imDC group. In control group, Wistar rats only received liver transplantation. In CsA group, Wistar rats underwent liver transplantation plus CsA treatment 〔10 mg/（kg·d)〕. In mDC group, recipient-derived mDC 1×106 were infused intravenously through the penile vein to Wistar rats. In imDC group, ImDC with the dose of 1×106 were injected into Wistar rats via the dorsum vein of penile. In each group, five recipients were killed on the 10th day after transplantation, the other five recipients were left to observe survival time. The levels of ALT, AST, TBIL, IL-2, IFN-γ, IL-4 and IL-10 were detected. The acute rejection and the expression of FasL/Fas in the grafts were detected by HE and immunohistochemical staining. Western blot was used to detect Scurfin protein expression of CD4+ CD25+ T cells. Results The median survival time of the liver allografts in CsA group and imDC group were significantly longer than that in control group and mDC group ( P ＜ 0.05). The levels of ALT and TBIL in control group and mDC group were significantly higher than those in CsA group and imDC group ( P ＜ 0.05). Compared with CsA group and imDC group, the levels of IL-2 and IFN-γ were higher but the levels of IL-4 and IL-10 were lower in control group and mDC group ( P ＜ 0.01). Slightly or no rejection reaction was found in CsA group and imDC group ( P ＜ 0.05). The Scurfin protein expressions of CD4+ CD25+ T cells of imDC group were significantly higher than those of other three groups. Conclusion Application of nonpufsed allopeptide syngeneic recipient-derived imDC is an effective way to induce immune hyporesponsiveness by blocking indirect recognition in rat liver transplantation model. Survival span is significantly prolonged by its protective effect. The mechanism of immune hyporesponsiveness induced by imDC transfusion might be involved in some aspects: T cell apoptosis, immune deviation of Thl/Th2 cytokine net and inhibition of T lymphocytes responsiveness by regulatory T cells.