Objective To investigate the diagnosis of organized thrombus in portal vein (PVOT) in liver transplantation. Methods The clinical data of 32 patients with PVOT who took the orthotopic liver transplantation (OLT) from January 2005 to January 2006 (271 cases) in this institute were retrospectively analyzed. Color doppler imaging (CDI), double helical CT plus three dimensional CT angiography (CTA) were taken before operation. CDI was performed during operation to look for the varicose vein, it was also used to reconstruct portal vein and measure the blood velocity in the portal vein. Results 23/32 (71.8%) cases had taken surgical treatment or interventional therapy before OLT. The grades of thrombus were as follows: gradeⅠ, 14/32; grade Ⅱ, 11/32; grade Ⅲ, 1/32; grade Ⅳ, 6/32. Twenty-eight cases of PVOT were diagnosed before operation, with accuracy of 87.5%. CDI was performed in 20 cases during operation, and 17 cases of collateral shunts were ligated with the monitor of ultrasound after the reconstruction of portal vein. The mean velocity of portal vein was (30.13±16.41) cm/s before the ligation of shunting veins, and the mean velocity was (46.36±19.82) cm/s after ligating the shunt veins. Conclusion Posibility of having PVOT for patients who had surgical treatment before OLT were much higher than who did not. CT and CTA could evaluate the portal vein system before operation, and performing CDI during operation may be important for the optimal reconstruction of portal vein.
Objective To approach the questions of donation after cardiac death （DCD） and transplantation through analyzing the DCD cases in this hospital. Methods The organs were obtained from 4 DCD from 2010 to 2011 in this hospital， the clinical data of DCD were analyzed retrospectively. Results Seven renal transplantations and 3 liver transplantations were performed. Donor warm ischemic time was 10-40 min. The liver and left kidney of the first DCD donator （Maastricht categoryⅣ） were eliminated through biopsy. One patient exhibited delayed graft function of kidney from the first DCD，the nephrectomy had to be done on day 7 after operation due to renal allograft rupture. Nine patients received 3 livers and 6 kidneys from the other 3 DCD donators （Maastricht categoryⅢ），whose patients were alive with excellent graft function. Conclusions The use of controlled DCD （Maastricht categoryⅢ） might be an effective way to increase the number of organs available for transplantation because that it might obtain satisfactory transplant outcomes and acceptable postoperative complications. The widespread implementation of controlled DCD in China should be encouraged.
【Abstract】Objective The injury induced by hepatic artery ischemia (HAI) in the liver transplantation procedure and the protective effects of using hepatic artery bridge-conduit (HABC) technique were studied. Methods Thirtytwo dogs were randomly divided into 4 groups: control, HAI 30 min, HAI 2 h and HABC groups. We observed the pathological changes of hepatocytes and biliary tract tissues and the microstructure of chondriosome, which were based on the model of auto-orthotopic liver transplantation in dogs. Biochemical and spectrophotometric methodswere used to evaluate the content of MDA and SOD, SDH activities in the graft liver tissue respectively. Results The pathologic and electrical microscopic changes of hepatocytes and epithelial cells of bile ducts were found in HAI 30 min and HAI 2 h groups,while the content of MDA increased to （1.652±0.222） nmol/mg prot and (2.379±0.526) nmol/mg prot, and SOD activity decreased to (11.15±3.9) U/mg prot and (9.47±3.4) U/mg prot. At the same time, SDH activity was also down-regulated to 0.362±0.019 and 0.281±0.029. Compared with control group, the differences were significant (Plt;0.05, Plt;0.01). But these changes of functional index caused by HAI injury were not significant in HABC group. Conclusion The HABC technique can not only avoid HAI injury during operation but also alleviate the occurrence of complication after transplantation, especially the biliary tract complication.
Living donor liver transplantation is one of the main solutions to the organ supply-demand discrepancy at present. However, there was a risk of the recipient developing small-for-size syndrome due to insufficient graft volume, while an excessively large graft volume for donation might lead to postoperative liver failure for the donor. In this context, the dual-graft liver transplantation had emerged, which could minimize the volume of liver resection from the each donor to ensure the donor’s safety and provide the adequate volume of liver for the recipient. Yet, this procedure is less commonly performed in our country. In order to promote the steady implementation of dual-graft liver transplantation in China and serve as an important supplement to the donor pool, the West China Hospital of Sichuan University organized relevant experts and draw on the mature experiences of advanced countries in the field of transplantation jointly formulated the “Expert consensus on dual-graft liver transplantation”. The consensus had been developed around aspects such as donor evaluation and selection, surgical methods, and postoperative complications.
ObjectiveTo approach the role of CD4+CD25+ regulatory T cells in the maintenance of immunotolerance in mouse liver allograft. MethodsThe mouse orthotopic liver transplantation was performed. After the liver transplantation immunotolerance induction, antiCD25 monoclonal antibody (PC61) was injected into the recipients with a delayed timing to remove the CD4+CD25+ T cells. The percentage of CD4+CD25+ T cells and the expression of forkhead/winged helix transcription factor (Foxp3) in the recipients were examined. Furthermore, the survival time of the recipient was observed. ResultsC3H/HeJ recipients receiving DBA/2 hepatic allografts survived over 70 d as in the syngeneic liver transplantation (C3H/HeJ recipients receiving C3H/HeJ hepatic grafts). With various protocols of the delayed PC61 treatment, the CD4+CD25+ T cell was completely disappeared as observed. However, the removal of CD4+CD25+ regulatory T cells after the induction of transplantation immunotolerance did not affect the survival of hepatic allografts. ConclusionCD4+CD25+ regulatory T cells are not essential for the maintenance of spontaneous mouse liver transplantation immunotolerance.
Portal vein blood flow is very important for the normal function of transplanted liver. The author reviewed the management methods of different portal vein thrombosis classification in the liver transplantation (LT). The prognosis of LT in the patients with Yerdel 1–3 thrombosis is similar to that the patients without thrombosis. The portal vein reconstruction of the patients with Yerdel 4 thrombosis can be realized by varicose vein to portal anastomosis, renoportal anastomosis or cavoportal hemitransposition. When anastomosis is made at the proximal side of a spontaneous shunt between the portal and cava system, the blood shunted from portal system can be reintroduced into the donor liver, which is crucial for the management of Yerdel 4 thrombosis. The establishments of artificial shunt by distal splenic vein, mesenteric vein or “multiple to one” anastomosis are effective attempts to drain the blood from portal system to the donor liver. For more severe diffuse thrombosis of portal vein system, multivisceral transplantation, including liver and small intestine, should be considered. The cases of LT in the patients with complex portal vein thrombosis are increasing, however the prognosis remains to be determined after accumulation of the cases.
中国的肝脏移植事业在过去10年中取得不菲成绩，在21世纪依然保持蓬勃发展的势头。作为目前治疗肝脏终末期疾病的唯一有效手段，肝脏移植围手术期死亡率已降至5%以下，受体术后1年生存率已超过80%。然而，与国际水准相比，在术后并发症防治方面尚未形成系统化的认识,有待进一步总结经验，从而提高受体生存率和生活质量。其中血管并发症是一个常见和不应忽视的问题。尽管目前外科技术和器官保存技术屡经改良，血管并发症的发生率仍超过10%，尤其是活体部分和劈裂式肝脏移植的血管并发症发生率仍居高不下，其中具有较高死亡率的肝动脉并发症的存在尤为突出，应引起移植外科医师的足够重视并采取有效对策。
Objective To summarize clinical application status of auxiliary heterotopic liver transplantation. Methods Reviewed relevant literatures and made a summary. Indications, contraindications, surgical treatment, therapeutic efficacy, and existing problems of auxiliary heterotopic liver transplantation were summed up. Results Main indication of auxiliary heterotopic liver transplantation is fulminant liver failure, and with no absolute contraindications. Partial liver transplantation is more popular. The therapeutic efficacy of auxiliary heterotopic liver transplantation is confirmed, but there are still some problems needed to be solved. Conclusion Auxiliary heterotopic liver transplantation is an effective method and replacement therapy for acute and chronic liver failure.
目的 总结肝移植治疗慢性重症肝炎急性肝衰竭的经验，以期改善预后。 方法 回顾性分析我院施行的3例慢性重症肝炎急性肝衰竭肝移植临床资料。结果 2例男性，1例女性，术前均诊断为慢性重症肝炎急性肝衰竭，肝功能Child分级均为C级，MELD评分分别为56.72、31.90及52.83，肝性脑病Ⅱ°～Ⅳ°，均合并肺部、腹腔感染，术前人工肝治疗1～3次，均行背驮式肝移植，术后病例3停用免疫抑制剂11 d，病例2和病例3痊愈出院，病例1因严重感染继发多器官功能衰竭死亡。结论 术前、术后人工肝支持改善内环境、术中及时补充凝血物质和术后有效控制感染是保证肝移植治疗慢性重症肝炎急性肝衰竭良好预后的关键措施。