【 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 ．
ObjectiveTo summarize the clinical progress on living related liver transplantation (LRLT). MethodsThe latest progress were reviewed based on recent documents and the experience on LRLT in our department. ResultsLRLT made much progress on evaluation of donor, harvesting the graft liver, donor health assessment and outcomes after living donor liver transplantation, and main factors affecting the survival of liver graft and so on. Conclusion Living related liver transplantation has many unsurpassable advantages, which suits the situation of China and has capacious clinical application.
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.
ObjectiveTo evaluate the effect of pre-infusion of allogeneic lymphoyctes treated with 5-FU on the rat liver graft. MethodsRat liver transplant models from Wistar to SD were established. Four groups were designed as following: control group: only liver transplantation without any other intervention; lymphocytes group: 1 ml of untreated lymphocytes (5×106/ml) from Wistar rats were preinfused into SD rats on day 7 and 4 separately before transplantation; lymphocytes with low concentration of 5-FU group: low concentration 5-FU (7.5 μg) treated lymphocytes were preinfused as above; lymphocytes with high concentration of 5-FU group: high concentration 5-FU (15 μg) treated lymphocytes were preinfused as above. Fas-L and CD8 expression were detected by immunohistochemistry method on day 7 after transplantation. ResultsThe integral opticaldensity (IOD) of Fas-L positive lymphocytes in the lobules of liver and portal areas were higher in lymphocytes with low concentration of 5-FU group than in the other groups （Plt;0.05）. There was no difference between lymphocyte group and lymphocytes with high concentration of 5-FU group （Pgt;0.05）. The IOD of CD8+ expression in lobules of liver was not different among all the three lymphocytes treated groups （Pgt;0.05）. But in portal areas, CD8+ expression was lower in the lymphocytes with low concentration of 5-FU group than in the other groups （Plt;0.05）. ConclusionPreinfusion of lymphocytes treated with low concentration 5-FU can induce graft immune tolerance, the probable mecanism of which is the increasing Fas-L expression in graft.
Objective To explore the liver regeneration following partial liver transplantation. MethodsPartial liver transplantation in the rats were established, three experimental groups were: Ⅰ=control, partial liver resection; Ⅱ=orthotopic liver transplantation (OLT); Ⅲ=partial orthotopic liver transplantation (POLT). Liver function test, morphological investigations and liver regeneration were performed in different time after transplantation. The regenerative response of transplanted partial liver graft in rats were evaluated by Flow Cytometry and compared it to liver regeneration following resection.Results The serum concentrations of ALT, BILI increased in one week, but returned gradually to normal level within one month after transplantation. Large numbers of mononuclear cells infiltrating into the portal areas. Hepatocyte necrosis was observed on day 14 after transplantation. On day 30, the parenchyma cell showed a nearly normal appearance, bile duct proliferation was seen in portal areas. In addition, after liver resection and POLT some diploid hepatocytes were found. Dilation of the central veins, adjoining sinusoids and interlobar veins were seen in group Ⅲ. The partial liver graft is capable of regeneration similar to the situation following partial hepatectomy. The peak of liver regeneration was seen on day 1,2,4 following a hepatectomy and POLT and OLT, respectively.Conclusion The transplanted liver shows the same and/or enhanced regeneration compared to controls. There are several possible explanations for the slight delay in achieving the maximal regenerative response in rats undergoing the POLT and OLT. These may include damage that is induced by the operation itself, preservation, and reperfusion injuries. These suggest that this be caused by activation of the immune system and it might be related to the regulation of cytokines and hormone.
【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 investigate an improved large vascular reconstruction method in the canine liver transplantation and see whether it can shorten the anheptic time and thus reduce the harmful effects during the anhepatic phase. Methods Thirty-two mongrel dogs were enrolled and divided into two groups randomly:the donor group (n=16) and the acceptorgroup(n=16). The dogs in the acceptor group were divided into two groups, according to the different reconstruction methods: Group A using the magnetic rings for a large vein reconstruction in the canine liver transplantation (n=10), and Group B using a handsewing large vein reconstruction in the canine liver transplantation (n=6). The operation time, hemodymics change, anastomosis site, and survival were observed. Results The operation time was as follows: In Group A, the total operation time, the inferior vena cava anastomosistime, and the anheptic phase time were significantly shorter than those in Group B (3.24±0.49 h vs 4.12±0.51 h，5.89±2.27 min vs 28.33±6.04 min，3.89±0.73 min vs 12.16±3.72 min),with a significant difference between the two groups (Plt;0.01). The haemodymics changes were as follows: In Group A, MAP dropped during the anhepatic phase, but it soon recovered after reperfusion，and there was only 730.56±150.56 ml of fluid including the donor blood that needed to be transfused, with no pressor agent required. In Group B, blood pressure dropped during the anhepatic phase，but it slowly recovered，and there was 2241.67±390.78 ml of fluid. In Group A, all the stomas had no errhysis, twistor thrombus. The twisted stomas could be corrected by the revolving of the magnetic rings. The endangium at the site of anastomosis was smooth. In Group B, most of the stomas had errthysis. In Group A, 3 dogs survived for more than 7 days, 6dogs survived for 3-6 days, and 1 dog survived for only 12 hours. In Group B, 2 dogs survived for 3-6 days, 3 dogs survived for 1-2 days, and 1 dog survivedfor only 12 hours. Conclusion Using the magnetic rings for a large vascular reconstruction in the canine liver transplantation is an improvedmethod, which can simplify the anastomosis procedures and significantly shortenthe anheptic phase time. However, the magnetic rings have to be placed in the abdomen, so this method remains to be further improved.
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.
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 summary the clinical experience of liver retransplantation （RLT）， and to improve the effect. Methods The clinical data of 62 cases who had received RLT in our institute from Jan. 2003 to Jun. 2012 were analyzed retrospectively. The survival rates of patients with different interval between two liver transplantation （LT） were calculated， and the data of patients who died and survived during perioperative period after operation were compared and analyzed. Results The 1-， 2-， and 5-year cumulative survival rates of 62 patients were 67.7%， 59.7%， and 56.4%， of early stage RLT patients were 38.5%， 38.5%， and 30.8%， of later stage RLT patients were 75.5%， 65.3%， and 63.3%， respectively. There were 28 patients died after operation， and 20 patients （71.4%） died during perioperative period， whose major cause of death were infection （65.0%， 13/20）， in addition， 4 cases （20.0%） died of multiple organ failure， 2 cased （10.0%） died of hepatic artery complication， 1 case （5.0%） died of portal vein complication. Eight cases （28.6%） died after perioperative period in reason of tumor recurrence. The model for end-stage liver disease （MELD） score 〔（26.95±9.28） score vs. （14.23±9.06） score〕， creatinine （Cr） level 〔（157.3±88.0） μmol/L vs.（69.8±35.9） μmol/L〕， international normalized ratio （INR） value 〔（1.676±0.744） vs.（1.124±0.286）〕， and total bilirubin （TBiL） value 〔431.8 μmol/L vs. 248.2 μmol/L〕 of patients died during perioperative period were higher than that of patients survived after perioperative period （P＜0.05）. The ratio of abnormal Cr of patients died during perioperativeperiod and survived after perioperative period were 60.0% （12/20） and 7.1% （3/42）， respectively. The 34 patients who had survived after perioperative period were all got followed-up for 3-104 months （average 49 months）. There were no tumor recurrence during the followed-up， and liver function of them were normal. Conclusions RLT is an effective method for irreversible graft failure after LT. Optimum operative time and reasonable individual immunosuppressive regimen to decrease the infection rate are all contribute to the increase of the survival rate.