ABSTRACT
Objective To investigate the clinical value of argon plasma coagulation (APC)trans-choledochoscopy in biliary tract complications following liver transplantation. Methods All 27 patients underwent T-tube-choledochoscopy or percutaneous transhepatic cholangioscope (PTCS).APC was used to burn the hyperplasia of bile duct stenosis and then expended the stenosis with bougienage. The bile duct foreign bodies were burnt by APC and then eliminated. The granulation tissues of bile duct were burnt by APC after biopsied. The sutures of anastomoses were burnt by APC and then eliminated. Results In general, the therapeutic achievement ratio of stenosis of bile duct in 25 cases of 28 locations was 78. 6% (22/28). The clearance ratio of bile duct foreign bodies was 85. 7% (6/7). The elimination ratio of granulation tissues was 100% (5/5), the same as the elimination ratio of sutures of anastomoses. There were no treatment-related complications about APC. The recurrence ratio of bile duct stenosis was respectively 4.5% (1/22) and 13. 6% (3/22)after follow-up for 3 and 6 months respectively. All the recurrent stenosis was non-anastomotic. The recurrence ratio of bile duct foreign bodies was respectively 16. 7% (1/6) and 33.3% (2/6) after follow-up for 3 and 6 months respectively. Conclusion APC trans-choledochoscopy in treatment of biliary anastomotic stenosis, mural foreign bodies, mural biliary cast, granulation tissues of bile duct and sutures of anastomoses following liver transplantion has a high success ratio and a sure long-term efficacy without treatment-related complications.
ABSTRACT
<p><b>OBJECTIVE</b>To study the prevention and treatment of HBV reinfection after liver transplantation.</p><p><b>METHODS</b>Total 19 cases of chronic fulminant hepatitis B, the end-stage of liver cirrhosis and liver carcinoma complicated with HBV cirrhosis. Were performed liver transplantation and given anti-viral drugs pre and post transplantation. Famciclovir was administered in 4 cases, lamivudine in 13 cases and lamivudine+HBIG in 2 cases. The serum HBVM and liver biopsy immunohistochemistry were performed.</p><p><b>RESULTS</b>Four cases given famciclovir developed reinfection. Serum HBsAg, HBeAg and HBV DNA were positive in 3 cases. Liver biopsy immunohistochemistry showed HBsAg and HBeAg phenotype. Classical viral hepatitis in 1 case occurred, three cases died. In the lamivudin group 7 cases showed positive for HBsAg, 2 cases positive for HBV DNA, 4 cases HBsAg or HBcAg phenotype. One case showed positive for serum anti-HBc the other negative for HBVM, and liver biopsy immunohistochemistry was negative too.</p><p><b>CONCLUSIONS</b>These date suggest that anti-virus prevention and treatment in pre and post liver transplantation with HBV infected correlative disease is necessary, feasible and effective.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , 2-Aminopurine , Therapeutic Uses , Antiviral Agents , Biopsy , Methods , DNA, Viral , Drug Combinations , Hepatitis B , Hepatitis B Surface Antigens , Blood , Hepatitis B e Antigens , Blood , Immunoglobulins , Therapeutic Uses , Lamivudine , Therapeutic Uses , Liver Transplantation , Postoperative Care , Methods , Preoperative Care , Methods , RecurrenceABSTRACT
Objective To study the influence factors for HBV reinfection following liver transplantation.Methods 92 cases of liver transplantation were enrolled for open non-randomized clinical study.Given conventional OLTx and immunosuppressive agents and antibiotics to prevent infection etc,patients are divided into lamivudine alone and HBIG combined with lamivudine group.Observation of postoperative liver function,HBV serum markers,HBV DNA in PBMC,YMDD and HBV S gene mutation,liver tissue IH etc.Results In 92 cases of liver transplantation with HBV-related liver disease,hepatitis B recurrence rate was 4.35%(4/92).In lamivudine group the HBV infection rate was 35%(7/20);In combined therapy group the HBV infection rate was 6.94%(5/72).With preoperatively negative HBV DNA negative the hepatitis B recurrence rate was 0;With preoperatively positive HBV DNA,the postoperative HBV infection rate was 17.39%(12/69),which had cases with S gene or YMDD mutation.In patients with negative HBV DNA before and after operation,the HBV re-infection rate was 11.11%(1/9);In 5 cases with preoperative HBV DNA positive,the HBV infection rate was 4/5 after LTx;before and after operation HBV DNA are positive,the HBV infection rate was 100%(3/3);the preoperative HBV DNA positive and postoperative HBV DNA negative,the HBV infection rate was 50%(1/2).Conclusion To prevent HBV infection after LTx,lamivudine group easily leads to HBV re-infection than HBIG combined with lamivudine group.Preoperative serum HBV DNA positive,preoperative and postoperative HBV YMDD and S gene mutation are the primary factors affecting the HBV re-infection after operation.HBV DNA positive in PBMC is the source of HBV re-infection,but also the factor of recurrence of hepatitis B.