Objective To explore improvement of orthotopic liver transplantation model in rhesus monkey. Methods Healthy rhesus monkeys were chosen to perform orthotopic liver transplantation for 10 cases. The model was established by drawing on a variety of animal model methods, and the portal vein cuff method was used to establish stable model of orthotopic liver transplantation in rhesus monkeys. Results Ten orthotopic liver transplantation models in rhesus were performed, and the achievement ratio of operation was 10/10. The time of donor hepatectomy and donor preparation was (20±5) min and (30±7) min, respectively. The operation time of recipient and anhepatic phase were (180±35) min and (17±4) min, respectively. After 24 h of operation 9 cases survived, one case died of intra-abdominal hemorrhage after 9 h of operation. After 72 h of operation 8 cases survived, and one case died of upper gastrointestinal bleeding after 38 h of operation. After one week of operation 5 cases survived, and 3 cases died of rejection after 9, 11, and 11 d of operation, respectively. The longest survival time was 32 d, but all of them also died of rejection. No portal vein thrombosis and biliary complications were found in all recipients.Conclusion The improved rhesus monkey model of orthotopic liver transplantation is easy to perform with high achievement ratio of operation. It is an ideal animal model for pre-clinical studies of 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 explore perioperative management model of ABO-incompatible liver transplantation. MethodsThe clinical data of ABO-incompatible caderveric liver transplantions without urgency performed in our center from July 2006 to May 2010 were analyzed retrospectively. Four patients had received an ABO-incompatible graft: AB to O in three, AB to A in one. All the cases were diagnosed as end-stage liver disese, one of them was primary hepatocellular carcinoma. ResultsFour survived to now （11 to 19 months） without severe infections and acute rejections. Two experienced coagulative disturbance and one of them had a second exploration. One developed acute renal failure and recovered with help under continuous veno-venous hemofiltration. All the cases were given 20 mg basiliximab two hours before revascularization and on day 4 after operation respectively. Splenectomy was performed in three, intravenous immunoglobulin was given in all more than seven days. Isohemagglutinin titers were basically stable and not relevant to the clinical manifestations. Antibiotic prophylaxis and immunosuppression protocol was same as the ABO compatible transplants except a 3-month-delay for steroid withdrawal. ConclusionABO-incompatible liver transplantation could be performed with appropriate perioperative management, such as basiliximab induction, splenectomy, intravenous immunoglobulin administration, and routine immunosuppression.