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Objective@#To analyze many indicators during perioperative period of liver transplantation in patients with end-stage liver disease, only to seek related factors that can accurately predict short-term(≤three months)outcome.@*Methods@#We analyzed retrospectively clinical data of consecutive patients with end-stage liver diseases undergone liver transplantation in a single treatment center. Logistic regression analysis was used to analyze the perioperative indicators including recipient gender, age, body mass index, preoperative serum albumin level, serum sodium concentration, urea nitrogen level and donor-recipient blood group, et al. Correlated factors were analyzed by the method of multivariate logistic regression. Statistical processing package was SAS 9.1.3 soft. The difference was statistically significant with P<0.05.@*Results@#18/165 patients died within 3 months after transplantation(mortality rate: 10.9 %). According to the result of univariate analysis, the indicators correlated with early mortality which were statistically significant were preoperative serum sodium, blood urea nitrogen, PT-INR, CTP score, MELD score and MELD-Na score. On the base of the result of Logistic multiple regression. However, only MELD-Na score was associated with 3 months prognosis(P=0.001, β=-2.510, OR=0.088, 95 % CI=0.037~0.349).@*Conclusions@#Preoperative MELD-Na score is an independent risk factor for short-term survival in patients with end-stage liver disease. Higher MELD-Na score is, the early mortality is higher.
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Objective To analyze many indicators during perioperative period of liver transplantation in patients with end-stage liver disease ,only to seek related factors that can accurately predict short-term(≤ three months)outcome .Methods We analyzed retrospectively clinical data of consecutive patients with end-stage liver diseases undergone liver transplantation in a single treatment center .Logistic regression analysis was used to analyze the perioperative indicators including recipient gender ,age ,body mass index ,preoperative serum albumin level ,serum sodium concentration ,urea nitrogen level and donor-recipient blood group ,et al .Correlated factors were analyzed by the method of multivariate logistic regression .Statistical processing package was SAS 9 .1 .3 soft .The difference was statistically significant with P< 0 .05 .Results 18/165 patients died within 3 months after transplantation(mortality rate :10 .9 ％ ) .According to the result of univariate analysis ,the indicators correlated with early mortality which were statistically significant were preoperative serum sodium , blood urea nitrogen ,PT-INR ,CTP score ,MELD score and MELD-Na score .On the base of the result of Logistic multiple regression . However ,only MELD-Na score was associated with 3 months prognosis(P=0 .001 ,β=-2 .510 ,OR=0 .088 ,95 ％ CI=0 .037～0 .349) .Conclusions Preoperative MELD-Na score is an independent risk factor for short-term survival in patients with end-stage liver disease .Higher MELD-Na score is ,the early mortality is higher .
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Objective A meta-analysis was conducted to evaluate the correlation between hepatitis C virus (HCV) infection and the incidence of intrahepatic cholangiocarcinoma (ICC).Methods EMBASE,MEDLINE,Web of Science,CNKI,Weipu and Wanfang databases were retrieved to identify eligible studies which were published between January 2000 and May 2015.Pooled odds ratios (OR) with 95％ confidence interval (95％ CI) were calculated using RevMAN 5.3.Results 14 case-control studies and 2 cohort studies were included in this study.As there was great heterogeneity among these 16 studies (Chi2 =53.18,df =15,I2 =72％,P ＜0.05),the random-effect model was employed.The combined risk estimates of all the studies showed a significant increase in ICC incidence with HCV infection (OR =3.96,95％ CI 2.63-5.95,P ＜ 0.05).The Begg funnel plot showed no evidence of publication bias.Conclusion HCV infection is related to an increased risk of ICC incidence.
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Objective To evaluate the predictive effect of preoperative CTP score,MELD score and MELD-Na score on short-term prognosis (≤ 3 months) after liver transplantation,to analyze factors which correlated with survival,and to seek indicators that accurately predicted short-term outcomes.Methods The clinical data of 73 consecutive patients with end-stage liver diseases who underwent liver transplantation in a single center were retrospectively analyzed.The area under the ROC curve (AUC) was used to determine the predictive power.Correlated factors were analyzed by multivariate logistic regression.The statistical processing package used was SAS 9.1.3 software.Results 11 (15.1％) of 73 patients died within 3 months after liver transplantation.The areas under the ROC curve of the preoperative CTP score,MELD score and MELD-Na score for predicting short-term survival were 0.817,0.839 and 0.860 respectively.There was no significant difference among these 3 scoring systems.On univariate analysis,indicators significantly correlated with early mortality were preoperative serum sodium,serum urea,PT-INR,CTP score,MELD score and MELD-Na score.On logistic multiple regression,only MELD-Na score remained as a significant indicator (P =0.001,β =-2.496,OR =0.085,95％ CI:0.019 ～ 0.370).Conclusions The MELD-Na scoring system showed superior predictability of early mortality in patients who underwent liver transplantation.The preoperative MELD-Na score was an independent risk factor of short-term survival.The higher the MELD-Na score,the higher was the early mortality.
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Currently,there is a worldwide increase in the incidence and mortality of intrahepatic cholangiocarcinoma (ICC),but the etiology of ICC remains unclear.Recent efforts suggest an etiological role of hepatitis B virus (HBV)infection in ICC,and this article reviews the relationship between chronic HBV infection and the risk and prognosis of ICC.
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Objective To investigate the expression of MTSS1 in cholangiocarcinoma tissue and its relationship with the prognosis of patients.Methods The specimens of bile duct of 49 patients with hilar cholangiocarcinoma who received surgical excision at the Eastern Hepatobiliary Surgery Hospital from January 2003 to December 2005 were collected.Tissue microarrays of the 49 samples of hilar cholangiocarcinomas and the 10samples of adjancent normal bile duct epithelial tissue were constructed.The expression of MTSS1 was detected by the immunohistochemical staining.The pcDNA3.1-MTSS1 was transferred into the RBE cells and the abilities of proliferation of REB cells were measured by MTT assay.The patients were followed up via out-patient examination and telephone till May 2012.The measurement data were analyzed using the t test,and the count data were analyzed using the chi-square test,the survival curve was drawn by the Kaplan-Meier method,the survival was analyzed using the Log-rank test,and multivariate analysis was done using the COX regression model.Results The results of immunohistochemical staining showed that the expression rate of MTSS1 was 10/10 in the adjacent normal epithelial tissue of bile duct,while 59.2％ (29/49) in the cholangiocarcinoma tissues.The proliferative rate of cholangiocarcinoma cells transfected with MTSS1 was 1.55 ±0.05,which was significantly lower than 2.32 ±0.08 of cholangiocarcinoma cells without transfection of MTSS1 (t =4.454,P ＜ 0.05).Gender,age,TNM stage,T stage,differentiation,neural invasion and diameter of tumor did not influence the expression of MTSS1 (x2=0.211,3.471,0.507,0.507,0.368,0.882,0.660,P ＜ 0.05),while lymph node metastasis influenced the expression of MTSS1 (x2=10.436,P ＜ 0.05).All the patients were followed up for 1-59 months,and the median time for follow-up was 16 months.The median tumor-free survival time was 17.9 months in patients with positive expression of MTSSI,and 11.3 months of patients with negative expression of MTSS1,with no significant difference (Log-rank value =3.707,P ＞ 0.05).The median survival time was 34.9 months in patients with positive expression of MTSS1,which was significantly longer than 18.7 months of patients with negative expression of MTSS1 (Log-rank value =5.671,P ＜0.05).Multivariate analysis showed that MTSS1 was not the independent risk factor influencing the prognosis of patients (x2 =0.406,P ＞ 0.05).Conclusions The expression of MTSS1 is decreased in cholangiocarcinoma tissue,which negatively correlates with lymph node metastasis.MTSS1 could be used as a biomarker in predicting the prognosis of patients with cholangiocarcinoma.
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Objective To retrospectively study the high risk factors for biliary complication (BC) and the application of the Clavien system to classify BC in a large cohorts of subjects undergoing liver transplantations (LT).Methods The clinical data of 181 patients who received LT from Jan.2004 to Dec.2008 were studied.BC was classified using the Clavien system.The risk factors of biliary complication were evaluated by using a binary forward stepwise logistic regression analysis.Results 14.4％ (26/181) recipients developed BC (BC group).In 84.6％ (22/26) patients the BC was above the Clavien Ⅲ b.Regression analysis of BC revealed that the placement of a T tube (P =0.0090,OR=31.177),RIld (P=0.0094,OR＜0.001).RI1w (P=0.0013,OR＞999.999) were significantly associated with the development of BC.Regression analysis of BC above Clavien Ⅲ b revealed that RIld (P=0.0065,OR＜0.001,RI1w (P=0.0022,OR＞999.999) were significantly associated with the development of BC above Clavien Ⅲ b.Conclusions The Clavien classification system was useful to classify BC.The placement of a T tube was an independent risk factor to predict BC,it was not a factor for BC above Clavien Ⅲ b.Hepatic arterial insufficiency (HAI) was an independent risk factor for BC and BC above Clavien Ⅲ b.
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Objective To investigate the role and the mechanism of Apr-1 gene on cholangiocarcinoma QBC939 cell lines proliferation and cell cycle regulation. Methods Apr-1 gene was transfected into QBC939 cells by using liposomes to establish a QBC939 cell model ( QBC939-Apr-1 ) stably expressing Apr-1 gene. Apr-1 mRNA expression and the changes in cell cycle and cell growth of QBC939 cells were analyzed by RT-PCR, flow cytometry ( FCM ) and growth curve before and after transfection. The regulatory effect of Apr-1 gene on the expression of cell cycle-related genes was investigated in QBC939 cells before and after Apr-1 transfection using cell cycle gene microarrays. Results Significant suppression of cell growth was observed with the cell model stably expressing Apr-1 gene. Apr-1 over-expression caused cell arrest from 9% to 13% (P ＜0. 01 ) increase in G2 population. Cell cycle gene microarrays demonstrated that the expression of Skp2 、UBE1 was up-regulated, while the expression of MRE11A 、CKS2 、CDK8 、CDC45 was down-regulated by more than 3 folds. Conclusions Apr-1 gene suppresses QBC939 cell proliferation in vitro, QBC939 cells presented with differences in the expression of cell cycle-related genes after Apr-1 gene transfection.
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Objective To establish small-for-size (SFS) graft injury models in miniature pigs with high standardization, reproducibility and similarity to clinical situation. Methods Ba-Ma miniature pigs were introduced in this study and orthotopic liver transplantations (OLTs) were performed in 12 pigs with 30% liver volume allogeneil grafts (small portion of right paramedian lobe, right lateral lobe and caudate lobe) without veno-venous bypass. The profiles of intra-operational hemodynamics and metabolism were investigated. Animals were observed for 7 days with daily serum biochemistry and coagulation function exam. The survival rate related to operation itself and the SFS grafts were respectively calculated as well as the graft regenerative ratio at post-operational day (POD) 7. Results Graft weight as a percentage of the recipient's native liver weight (GW/RLW) and the total body weight (GW/BW) were (28. 63±4. 42)% and (0. 73±0.06)%. The mean operation time, anhepatic phase, and the time of blockage of infra-hepatic IVC were (191. 7±14. 2) min, (28. 3±3. 6) min, and (45. 0±5. 8) min. The survival rate related to the operation itself and the SFS graft were 83. 33% (10/12) and 40% (4/10), and the graft regenerative ratio at POD7 was (278. 06±42. 95) %. Contrast to the remarkable increase of heart rate and serum potassium during anhepatic phase, the mean arterial pressure, central venous pressure, rectal temperature, PH value and buffer excess had a significant decrease (P<0.01) with a gradual recovery after reperfusioa Serum ALT, AST, PT, Cr, and TB were significantly increased with a peak level at POD1 for the former 4 and POD2 for TB, and then began to decrease and favorably recovered at POD7, but TB, PT, and AST levels were still high when compared to those of prereperfusion (P<0. 05). Conclusion This model of OLT performed with 30% liver volume graft without veno-venous bypass was an ideal large animal model for series studies related to SFS graft injury.
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ObjectiveTo evaluate the efficacy and safety of Sirolimus (SRL) in immunosuppression following liver transplantation. Methods SRL was applied in 21 patients totally.Indication for adoption was Tac-related nephrotoxicity (4/21), suspiciously Tac-related hepatoxicity (8/21), Tac overdose (3/21), renal insufficiency pre-operation (2/21), or cancer (4/21). Median follow-up was 25. 4 months. Results SRL provided an adequate prophylaxis against rejection in all study patients, with one case of acute rejection. Sirolimus was Withdrawn in 2 cases due to its sideeffect. Tat-induced hepatoxicity in 6 cases and nephrotoxicity in 3 cases were relieved significantly.Conclusions SRL given alone appears to be an effective primary immunosuppressant regimen fororthotopic liver transplantation patients. Early conversion contributes to significant improvement of Tac-related hepatoxicity and nephrotoxicity.
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Objective This study was to detect the expression and level of vascular endothelial growth factor(VEGF)in the acute rejection reaction of orthotopic liver transplantation in rats,which attempted to prove whether VEGF is the key molecule mediating the inter-permeate and inter-enhancement mediated by cells between Angiogenesis and inflammation reaction Methods Expressions of VEGF in plasm in liver and spleen were detected using immunohistochemical staining.The levels of VEGF were measured with enzyme linked immunosorbent assay(ELISA).Results The expression of VEGF in liver,spleen and the level of VEGF in plasma in experiment group were higher than that in the control group(P＜0.05),which were the highest in two days after operation.Conclusion VEGF may play a significant role in the acute rejection reaction of orthotopic liver transplantation in rats.There was a close relation between the expression and level of VEGF in liver,spleen and survival time of graft.VEGF was a kind factor which is expressed in early stage.
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<p><b>OBJECTIVE</b>To evaluate postoperative transcatheter hepatic arterial chemoembolization (TACE) for improving the disease-free survival of HCC patients after hepatectomy.</p><p><b>METHODS</b>1 725 HCC patients were followed up after hepatectomy retrospectively. Of 1 457 patients who were followed-up completely, 209 had postoperative TACE. The 1 457 patients were divided into ten groups according to tumor thrombus, small HCC, capsular invasion, vascular invasion and cirrhosis. The disease-free survival was analyzed between subgroups of weather postoperative TACE was performed in every group. Software SAS 6.12 and EGRET package were used. Kaplan-Meier estimation was used to calculate the disease-free survival rates.</p><p><b>RESULTS</b>There were no difference of the disease-free survival between the subgroups in no capsular invasion and in no hepatic cirrhosis groups.</p><p><b>CONCLUSION</b>Postoperative TACE is helpful in improving the disease-free survival of HCC patients after hepatectomy except those with integrated tumor envelope or no hepatocirrhosis. It is important to prolong the long-term results of operation.</p>
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Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Carcinoma, Hepatocellular , General Surgery , Therapeutics , Catheterization , Disease-Free Survival , Embolization, Therapeutic , Hepatectomy , Hepatic Artery , Liver Neoplasms , General Surgery , Therapeutics , Postoperative Care , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To observe the in vivo antitumor activity of murine liver tumor vaccine expressing MIP-1alpha mediated by recombinant adenoviral vector.</p><p><b>METHODS</b>The infection efficacy was measured by GFP expression 48 hours after infection of Hepa1-6, and the number of cells was counted daily for 14 days. 5 x 10(6) modified Hepa1-6 cells were inoculated subcutaneously to C57BL/6 mice and the tumor-free animals were rechallenged by 2 x 10(6) wild-type Hepa1-6 cells or syngenic EL4 cells four weeks later. The tumor volume was measured twice a week.</p><p><b>RESULTS</b>Adenoviral vectors could efficiently infect Hepa1-6 cells in vitro, and the in vitro growth rate of AdmMIP-1alpha modified Hepa1-6 cells was not affected; however the in vivo tumorigenicity was significantly decreased, compared with that of control vector modified Hepa1-6. Rechallenge of the tumor-free mice four weeks after administration of AdmMIP-1alpha with the parental Hepa1-6 cells resulted in significant inhibition of tumor growth, but there was no significant difference when rechallenged with EL4.</p><p><b>CONCLUSIONS</b>The liver cancer cells expressing mMIP-1alpha mediated by recombinant adenoviral vector decrease tumorigenicity and elicit specific immunological protection, and could be used as an effective liver tumor vaccine.</p>
Subject(s)
Animals , Mice , Adenoviridae , Genetics , Cancer Vaccines , Allergy and Immunology , Chemokine CCL3 , Chemokine CCL4 , Genetic Therapy , Liver Neoplasms, Experimental , Therapeutics , Macrophage Inflammatory Proteins , Genetics , Mice, Inbred C57BL , Vaccines, Synthetic , Allergy and ImmunologyABSTRACT
Objective To observe the manifestations and judgement methods of acute rejection reaction of orthotopic liver transplantation in Wistar-SD rats.Methods The survival conditions after operation in rats was observed,and liver function tests and histopathology examination were used to study the manifestations of acute rejection reaction of orthotopic liver transplantation in Wistar-SD rats.Results Wistar-SD experiment group had moderate to severe acute rejection reaction after OLT.Alanine aminotransferase,aspartate aminotransferase,total bilirubin io clood serum after orthotopic liver transplantation in rats was obviously elevated on 1-3 d and 7 d after OLT,which are significantly different from every corresponding time point of control group(P
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Objective:To explore the effect of L-glutamine(Gln) on liver Bcl-2mRNA expres sion and apoptosis after total hepatic inflow occlusion in rats.Methods:Male Wistar rats were assigned randomly to three groups(n=40):Group A sham-operation group,group B control group,rats were pretreated with 4 ml 0.9% saline intraperitonally twice per day on 5 consecutive days,group C,rats were pretreated with Gln dissolved in 4 ml 0.9% saline intraperitoneally twice per day on 5 consecutive days.The rats from group B and C underwent total hepatic inflow occlusion for 35min by the pringle's manoeuvre.Ten rats from each group were randomly chosen and killed before the initiation of occlusion at 2 h,4 h,24 h after reperfusion respectively.The levels of MDA,GSH in liver tissue were measured.The serum concentrations of ALT,AST,LDH were assayed on a standard biochemistry autoanalyser.The expression levels of Bcl-2 mRNA in liver were assessed by RT-PCR.The apoptosis of liver were observed by DUTP method.The percentage of apoptosis was analyzed.Results:Compared with group B,the levels of GSH in group C increased after reperfusion(P
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Objectives:To explore the effect of L-glutamine(Gln) on intestinal injury following total hepatic inflow occlusion.Methods:Male Wistar rats were assigned randomly to three groups(n=40) :Group A,sham-operation;Group B,control group,rats were pretreated with 4 ml 0.9% saline intraperitonally twice per day on 5 consecutive days;Group C,rats were pretreated with Gln dissolved in 4 ml 0.9% saline intraperitoneally twice per day on 5 consecutive days.The rats in group B and C underwent total hepatic inflow occlusion for 35min by the pringle' s manoeuvre.Ten rats from each group were randomly sacrificed before occlusion and at 2,4,24h after reperfusion respectively.The levels of MDA,SOD,GSH in intestine tissue were measured.The levels of serum TNF-? and portal vein endotoxin were detected.Results:Compared with group A,the levels of GSH and SOD decreased after reperfusion(P
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Objective To evaluate the effects of different surgical treatments on severe polycystic liver disease (SPLD). Methods A total of 22 patients with SPLD were surgically treated in our Department from December 1989 to July 1999. Of the patients, 5 were treated with the partial hepatic resection in combination with cyst fenestration (group A), 7 with laparotomic fenestration (group B), 4 with laparoscopic fenestration (group C) and 6 with puncture under the guidance of ultrasonography B (group D). The surgical outcome and long term follow up results were retrospectively analyzed. Results After the treatments, all the patients experienced immediate relief of symptoms. However, the follow up for an average of 3 years showed that 10 patients developed recurrence of the disease. The recurring rates were 0, 28.5%, 65.5% and 100% in groups A, B, C and D, respectively. Conclusions The approach of partial hepatic resection in combination with cyst fenestration is the most effective treatment for SPLD. Laparoscopic fenestration may not be an appropriate surgical way for treatment of SPLD.