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.
【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.
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 explore the diagnostic and treating scheme of primary sclerotic cholangitis. Methods 24 cases of primary sclerotic cholangitis identified by radiological and pathological examinations from 1972 to 1998 were analysed retrospectively. According to Thompson, 1 case was classified as type Ⅰ, 5 cases were type Ⅱ, 10 cases were type Ⅲ and 8 cases were type Ⅳ. The operation were as follows,resection of gallbladder plus T tube drainage in 8 cases, plus Roux-en-Y anastomosis of bile duct and jejunum in 12 cases, plus U tube stent and drainage in 4 cases. Results The total mortality rate was 25% (6/24) in 2～18 years follow-up after operation. Conclusion Early diagnosis and operation may resolve the drainage of bile into the jejunum. When serious lesions and worse liver functions exist, liver transplantation should be considered.
Objective To discuss the differentiation between transient intrahepatic cholestasis (TIHC) and acute rejection (AR) after liver transplantation． Methods Characteristics and the changes (before and within 21 d after transplantation) of alanine aminotransferase (ALT) and direct bilirubin (DBIL) in 30 patients undergone liver transplantation were observed. These patients were divided into TIHC group and AR group following the diagnosis criteria, and the serum levels of ALT and DBIL were compared respectively on day 1 before liver transplantation, day 3, 7 and 21 after liver transplantation． Results Compared with day 3 after transplantation in the TIHC group， DBIL significantly ascended while ALT was changeless on day 7 after transplantation. But in the AR group， DBIL ascended significantly and ALT showed an increasing tendency on day 7 after transplantation． After appropriate therapy, DBIL and ALT of two groups both descended significantly on day 21 after transplantation． Conclusion The changes of DBIL and ALT are available for the differentiation between TIHC and AR after transplantation.
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 investigate the effect of pre-infusion with allogeneic lymphocytes treated by 5-FU on inducting immune tolerance of liver transplantation in rats. Methods Wistar and SD rats were used as liver transplantation donors and recipients, respectively. They were divided into 4 groups as following: control group: liver was transplanted from Wistar to SD rats without any other treatment; lymphocytes group: recipient was pre-infused lymphocytes （5×106 cell/ml, 1 ml） from Wistar rat 7 d and 4 d separately before transplantation; low concentration of 5-FU with lymphocytes group: lymphocytes were treated by 5-FU (7.5 μg) before pre-infusion; high concentration of 5-FU with lymphocytes group: lymphocytes were treated by 5-FU (15 μg) before pre-infusion. Pathological changes were observed on day 7 after liver transplantation. Results Acute slight rejection was observed in low concentration of 5-FU with lymphocytes group: liver cell cords were well-arranged basically, hepatic lobules structures could be observed, a few inflammatory cells infiltrated around central veins, and a few lymphocytes infiltrated around portal area. Acute severe rejection was observed in control group, and acute moderate rejection was observed in high concentration of 5-FU with lymphocytes group and lymphocytes group. Conclusion Pre-infusion of lymphocytes treated with low level 5-FU can induce immune tolerance better in recipients after liver transplantation.
Objective To explore the methods of hepatic artery reconst ruction with iliac arterial interpositiongraf t in orthotopic liver t ransplantation (OL T) and influential factor of relevant complications postoperatively.Methods Analyzed ret rospectively 8 OL T , the hepatic artery reconst ruction with arterial inflow based on recipientinf rarenal aorta using donor iliac artery graf t tunneled through the t ransverse mesocolon and pancreas. Results Thetime required for hepatic artery reconst ruction with iliac arterial interposition graf t was 52 - 126 minutes. Amongthe 8 patient s , 2 patient s developed postoperative bililary t ract complications , 1 with biliary fistula , 1 with int rahepatic biloma , the others were recovered smoothly and liver function returned to normal about one week af ter livert ransplantation. No complications of hepatic artery were observed. Conclusion Iliac arterial interpositional graft is aneffective and reliable method of revascularization in liver transplantation when the use of hepatic artery is not possible.
ObjectiveTo summary the progress and status of downstaging therapy in treating hepatocellular carcinoma. MethodsThe related literatures were reviewed and analyzed by searching PubMed and MEDLINE. ResultsAlthough the clinical prognosis of advanced hepatocellular carcinoma was poor, the liver resection or liver transplantation after downstaging therapy could significantly improve the prognosis of patients. However, differences were existed if different downstaging therapies and selections of standard were used. ConclusionTo improve the prognosis of patients with advanced hepatocellular carcinoma, the downstaging therapy should be ingeniously selected based on the situation of the patients.