Experiences relating to management of biliary tract complications following liver transplantation in 96 cases / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate best diagnosing methods and therapy for patients with biliary tract complications after liver transplantation and analyze related factors.</p><p><b>METHODS</b>A review was made of data collected from 96 patients, and confirmed by retrospective case notes examination.</p><p><b>RESULTS</b>A total of 94 patients (97 grafts) survived more than 2 days after transplantation; of whom, 92 had an end-to-end biliary anastomosis with a T tube. The average follow-up was 5.8 months (range: 0.3 - 10.2 months). Among the 94 patients, eight (8.5%, 8/94) had complications: leakage during T-tube removal (2 patients), leakage at an earlier stage (2), simultaneous stricture and leak (2) and just stricture (2). Six patients with biliary tract complications had predisposing factors including hepatic artery stenosis (2 patients, including one hepatic artery stenosis combined with severe rejection, hepatic artery thrombosis (3), and donor-recipient bile duct mismatch (1). There was no difference in cold ischemic time. With hepatic artery thrombosis and/or stenosis > 50%, five patients were re-transplanted; without hepatic artery thrombosis and/or stenosis < 50%, three patients required endoscopic stenting and radiological percutaneous drainage of bile collection with or without balloon dilation. All patients survived.</p><p><b>CONCLUSIONS</b>Biliary strictures occur later than leaks after surgery. Without hepatic artery thrombosis and/or stricture, there is no need for surgery; with hepatic artery thrombosis and/or stricture > 50%, re-transplantation is needed as early as possible.</p>

Liver Non-Parenchymal Cells Induce Apoptosis in Activated T Cells in Vitro / 대한이식학회지

PURPOSE: Liver, unlike heart or skin, allografts transplanted between MHC-disparate mouse strains are spontaneously accepted without any immunosuppressive therapy. Despite the allograft acceptance, the recipients continue to exhibit donor-specific immune responses in vitro (MLR and generation of CTL). High levels of CTL apoptosis evident within tolerated liver grafts have been postulated as a mechanism underlying this 'split' tolerance. METHODS and RESULTS: By using radiometric DNA fragmentation test ("JAM" assay) and TUNEL staining, we present the evidence here that liver nonparenchymal cells (NPC) are quite strong inducers of activated T cell apoptotic death in allogeneic mice. This phenomenon occurs the similar level in activated T cells of syngeneic or third-party mice. Liver cells from gld (FasL-deficient) mice exert similar apoptosis-inducing effect on activated T cells from normal mice. Tumor necrosis factor receptor (TNFR): Fc fusion protein, and concanamycin A, an inhibitor of perforin pathway, fail to inhibit the apoptotic activity. CONCLUSION: These data indicate that liver NPC play important role in causing active apoptosis in graft-infiltratingCTL which favors liver graft acceptance, and liver-induced activated T cell apoptosis may not mediated by Fas, TNF or perforin pathways.

Current problems and perspectives of liver transplantation in Pittsburgh: Retransplantation and Split, Reduced size liver transplantation / 한국간담췌외과학회지

No abstract available.

Liver transplantation for chronic viral hepatitis B and C / 中华肝胆外科杂志

Liver transplantation is considered an effective form of therapy for patients with end-stage liver disease.Unfortunately the results of transplantation for patients with chronic viral hepatitis have not been as promising as for other liver disorders.A high rate of hepatitis recurrence in the allograft leading to a higher incidence of graft and patient loss have led many transplant centers to reconsider the use of orthotopic liver transplantation(OLTX)in these groups.Current strategies to prevent hepatitis B infection focus on identifying groups of hepatitis B virus(HBV)patients with lower risks of reinfection,specifically those with lack of markers for active HBV replication.Trials to convert"high risk"HBV patients to a "low risk"group have recently been initiated in the "high risk"group of patients with the aim to convert their HBV status from replicating to nonor low-replicating states.Antiviral agents or immunostimulatory therapy before and/or after OLTX have been proposed as a means to minimize recurrence of hepatitis B in the liver allograft.While the focus has been specific issues related to prevention or treatment of viral hepatitis in OLTX patients,there are still a number of areas for investigation.For example,immunosuppression is considered to play a role in the recurrence and chronicity of HBV and hepatitis C virus(HCV)in the liver allograft,especially since corticosteroids have been demonstrated to have a biologic effect on HBV by inducing HBV antigen synthesis.Moreover,most of the results to date are based on the use of cyclosporin A as the primary agent of immunosuppression.Tacrolimus(FK506)based immunosuppression may also prove to have a beneficial effect for HBV patients undergoing OLTX.By minimizing or eliminating the need for corticosteroids,FK560 based immunosuppression may lessen the risk of recurrence or the severity of hepatitis in the liver allograft in HBV patients,and ultimately improve patient and graft survival.The controversies in the use of OLTX for HBV and HCV have persisted,in spite of an appreciation for the risks associated with selection,prophylaxis and treatment of candidates with HBV,principally dut to the uncertainties associated with OLTX for HCV.The routine application of OLTX to HBV candidates with low or no levels of HBV replication appears justified,however patients with active HBV replication should undergo OLTX only in a setting where new strategies for prevention, prophylaxis or treatment are being tested.Recently,the U.S.Department of Health and Human Services has approved OLTX for HBV,reflecting the improvements made in the clinical arena.However,further advances are needed for HCV prophylaxis and treatment of recurrent hepatitis following OLTX.