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Objective@#The aim of this study was to summarize and analyze the clinical features and characteristics of de novo HBV infection after liver transplantation in non-HBV-related liver disease. @*Methods@#We retrospectively analyzed the clinical data of 13 patients with new HBV infection in 376 cases of liver transplantation patients with non-HBV related liver diseases from April 2002 to December 2013 in our hospital. @*Results@#Among 376 patients with non-HBV-related liver disease after liver transplantation, 13 patients developed new HBV infection, and the rate of new HBV infection was 3.46%. Of the 13 cases, 5 were males and 8 were females. The follow-up time was 14.7 -128.7 months, and the average time from surgery to new HBV infection was 19.06 months. The primary diseases were as follows: 5 cases of primary biliary cholangitis, 3 cases of alcoholic liver disease, 2 cases of drug-induced liver damage, 1 cases of post-hepatitis C cirrhosis, congenital biliary atresia and congenital liver fibrosis. All patients were positive for HBsAg, HBeAg, anti-HBc, 11 were positive for HBV DNA, and 2 were negative for HBV DNA. 6 cases had abnormal liver function and 7 cases had normal liver function. All patients were treated with antiviral therapy with nucleoside (acid) analogues. HBsAg was negative in 6 patients; HBsAg remained positive in 7 cases, including HBsAg, HBeAg, anti-HBc positive in 6 cases, HBsAg, anti-HBe, anti- HBc was positive in 1 case, HBV DNA was still positive in 1 patient, and HBV DNA was negative in 6 patients; liver function was normal in all patients. @*Conclusion@#Non-HBV- related liver transplantation are high-risk group of new HBV infection, with the highest incidence of autoimmune liver disease. It is speculated that it may be related to the long-term use of hormones after the transplantation. The prognosis of newly diagnosed HBV infection after liver transplantation is fine as long as it can be found and treated early.
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Objective To investigate the incidence,treatment and outcome of mid-and long-term biliary complications after liver transplantation.Methods Clinical data of 651 patients who underwent liver transplantation at General Hospital of Armed Police Forces from April 2002 to February 2012 were retrospectively studied to analyze the incidence, treatment and outcome of mid-and long-term biliary complications after liver transplantation.Results Among 651 liver transplant cases,47 patients (7.2%) developed mid-and long-term biliary complications.The mean time of onset was 21 months.Forty seven patients underwent 48 cases of treatment in total.Nine cases received anti-inflammatory therapy alone.Fourteen cases were treated with choledochoscope lithotomy,choledochoscope biliary cast or placing the biliary support tube.And 13 cases underwent endoscopic retrograde cholangiopancreatography (ERCP)nephrolithotomy, expanding the bile duct or placing the biliary support tube,including 1 patient was switched to percutaneous transhepatic cholangial drainage (PTCD)due to ERCP failure.Seven cases received drainage by PTCD and 5 cases were treated with anti-inflammatory therapy combined with choledochoscope or PTCD. The total efficacious rate was 92% . Among 3 invalid patients, two patients were treated with secondary liver transplantation and one died.Conclusions The mid-and long-term biliary complications probably occur after liver transplantation.Individualized therapies should be chosen based upon the types and severity of biliary complications,which yields relatively high efficacious rate.Secondary liver transplantation should be performed as necessary.
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Objective To analyze the HBV recurrence and summarize the experiences in treatment of HBV recurrence after liver transplantation for HBV related liver diseases.Method A total of 650 patients subject to liver transplantation for HBV related liver diseases from September 2002 to February 2007 were included,and the clinical data were retrospectively analyzed.Result Twenty-five (3.85％) of 650 patients experienced HBV recurrence.All liver functions recovered to normal after nucleoside or nucleotide analogs treatment.Two cases lost to follow-up,2 cases were died of tumor recurrence,and 1 case died of tumor recurrence after re-transplantation.Eleven cases were positive for serum HBsAg,and HBV DNA was converted to undetectable levels in 10 cases.One case developed to decompensated liver cirrhosis,and HBsAg was negative after re-transplantation.In 7 cases,after nucleos(t)ide analogs treatment,HBsAg titer was decreased gradually to a lower level,and continuous intravenous drip of large doses of HBIG for 3 to 5 days achieved anti-HBs seroconversion.Conclusion Nucleos(t) ide analogs can effectively suppress viral replication of HBV recurrence after liver transplantation.When the HBsAg titer is decreased to a lower level,large doses of HBIG can achieve anti-HBs seroconversion.
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Objective To investigate the efficacy of tertiary liver transplantation.Methods The clinical data of 4 patients with hepatobiliary disease who were admitted to the General Hospital of Chinese People's Armed Police Forces from April 2002 to December 2012 were retrospectively analyzed.All the patients received orthotopic liver transplantation,and received tacrolimus + mycophenolate mofetil (MMF) + hormone after operation.All the patients were followed up till May 2014,and their prognosis was learned.The measurement data were analyzed using the t test.Results Three patients with benign hepatic disease received tertiary liver transplantation due to biliary complications and chronic rejection,and 1 patient with hepatic cancer received tertiary liver transplantation because of hepatic cancer recurrence.The average interval between the primary and secondary liver transplantation was 16.0 months,which was shorter than 22.5 months of the interval between the secondary and tertiary liver transplantation.The mean operation time in the secondary liver transplantation was (11.4 ± 1.0)hours,which was significantly shorter than (14.1 ± 2.2) hours in the tertiary liver transplantation (t =3.644,P ＜ 0.05).The median volumes of blood loss in the secondary and tertiary liver transplantation were 1 300 mL and 1 800 mL,and the median volumes of blood transfusion were 1 400 mL and 3 100 mL.The hepatic function of the 4 patients recovered smoothly at the early time after liver transplantation.Two patients (3 cases) were complicated with infection postoperatively (1 patient was infected by pseudomonas aeruginosa within 30 days after liver transplantation,and was cured by active antimicrobial treatment),and they were cured after anti-infectional treatment.One patient died of hepatic failure at the 80th month after the primary liver transplantation,1 died of hepatic cancer recurrence complicated by pulmonary,bone and retroperitoneal lymph node metastasis at the 107th month after the primary liver transplantation,and the other 2 patients survived for 104 months and 26 months after the primary liver transplantation,respectively.Conclusion Tertiary liver transplantation is effective for the treatment of biliary complications and chronic rejection after liver transplantation,and it can extend the life span of patients with hepatic cancer recurrence if there are insufficient donor resources.
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BACKGROUND:Cytomegalovirus is relatively common condition pathogenic virus after liver transplantation. It has many direct or indirect effects on the body, and seriously affects the long-term survival of patients. It should be paid more attention. OBJECTIVE:To analyze and summarize the outcomes of the epidemiology, risk factors, effects on the body, clinical manifestation, diagnosis, treatment and prevention for cytomegalovirus infection after liver transplantation. METHODS:Fitness database, PubMed database and China National Knowledge Infrastructure database were retrieved by computer for articles on cytomegalovirus infection after liver transplantation published from January 2006 to December 2013, and through manual refer to books. Articles were searched with the key words of“liver transplantation, cytomegalovirus infection, risk factors”in Chinese and English. A total of more than 200 articles were retrieved. Forty articles directly related to cytomegalovirus infection after liver transplantation and those published in authoritative magazines were included to review with good representativeness. RESULTS AND CONCLUSION:The positive rate of serum cytomegalovirus-IgG is high in the population. Risk factors of cytomegalovirus infection after liver transplantation include donor-recipient cytomegalovirus serologic status, low serum creatinine clearance, female patients, graft rejection, the use of immunosuppressant and donor-recipient MBL-2 and FCN-2 gene polymorphism. There are direct and indirect effects of this posttransplant opportunistic infection, such as cytomegalovirus syndrome, organ invasion lesions, graft loss, accelerated recurrence of hepatitis C, an increased risk of acute or chronic rejection, predisposition to other opportunistic infections, compromised immunity, accelerated atherosclerosis and the interaction between beta herpes virus. Therefore, prevention and early treatment are very crucial. A combination of pp65 antigen assay for screening and real-time RT-PCR methods for confirmation provides an optimal, low-cost diagnostic regimen for cytomegalovirus infection. Ganciclovir is the first selection for antiviral treatment after liver transplantation, but oral valganciclovir and intravenous ganciclovir are safe, feasible options for preemptive treatment of cytomegalovirus infection after liver transplantation. The plasma levels of CXCL16, PTX3 and von Wil ebrand factor at the start of treatment are independently associated with virologic and clinical treatment failure during anti-cytomegalovirus therapy in solid organ transplant recipients. We should choose different prevention programs for the patients of different donor-recipient cytomegalovirus serologic status.
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BACKGROUND:The causes for abnormal liver function after liver transplantation is complex, and it is important for the treatment to clarify the causes of abnormal liver function. OBJECTIVE:To analyze the cause of abnormal liver function after liver transplantation, and to use it in clinical diagnosis and treatment. METHODS:The CNKI database and FMJS database were retrieved by computer for articles published from January 1991 to July 2012. Articles were searched with the key words of“liver transplantation, abnormal liver function, transaminase abnormalities, bilirubin increased, causes”in Chinese and English. A total of 98 articles were retrieved. Thirty-five articles directly related to abnormal liver function after liver transplantation and those published in authoritative magazines were included to review.RESULTS AND CONCLUSION:Many reasons can lead to abnormal liver function after liver transplantation, with complex clinical manifestations. The most common causes were acute rejection, biliary complications and virus infection. When the abnormal liver function occurred in the early postoperative period, especial y in one month after liver transplantation, the smal size syndrome and primary graft non-function should be vigilant. The transaminase and bilirubin levels were different for different causes. Transaminase increased more significantly than bilirubin in acute rejection, autoimmune hepatitis, viral infection, ischemia-reperfusion injury, portal vein and hepatic vein stenosis. However, obstruction enzyme such as alkaline phosphatase, glutamyltransferase, total bilirubin and direct bilirubin was increased more significantly in chronic rejection, biliary complications, hepatic artery, primary biliary cirrhosis and primary sclerosing cholangitis;transaminase increasing mainly and bilirubin increasing mainly can both appear in the patients with tumor, and which one wil happen depending on the size and oppression of the tumor. In addition, col ecting the medical history careful y can help to diagnose early as each patient have his special medical history. In a word, It’s important to col ect medical history careful y in clinical work, and the common cause of abnormal liver function should be consider firstly according to the increasing of transaminase and bilirubin, and other relatively uncommon causes should be considered after remove the common causes through clinical proven. It can help to diagnose and treat as soon as possible to make ful use of examinations, such as laboratory tests, imaging studies and liver puncture biopsy.
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Objective To study the efficacy of peg-interferon plus ribavirin treatment for hepatitis C recurrence after liver transplantation.Methods The clinical data of 16 patients with hepatitis C recurrence after liver transplantation were collected from June 2002 to March 2012 in our hospital.Results There were 1620 patients receiving liver transplantation.66 of these patients received the treatment because of hepatitis C related diseases.16 of the 66 patients received peg-interferon plus ribavirin treatment after liver transplantation.The hepatitis C virus (HCV) RNA concentrations of all the 16 patients were detected.Twelve of the 16 patients were negative for HCV RNA,and the HCV RNA concentration was reduced by more than 2 log after treatment for 12 weeks in 2 cases.The early viral response (EVR) was 87.5％.The HCV RNA of all the 16 patients became negative after treatment for 24 weeks.Conclusion The EVR was high (87.5％) among patients who received peg-interferon plus ribavirin treatment after liver transplantation,and the combination therapy with interferon plus ribavirin was safe and effective for hepatitis C recurrence after liver transplantation.
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ObjectiveTo analyze the etiologies and diagnosis of jaundice after liver transplantation during mid later stage and summarize the experience of clinical practice.Methods822 liver transplantation patients were collected from the Department of Internal Medicine, Organ Transplantation Institute in General Hospital of Chinese People's Armed Police Forces between June 2005 and Dec.2008.The clinical data of these cases were analyzed retrospectively.ResultsAmongst 822 patients,129 experienced jaundice after liver transplantation and the occurrence of jaundice ranged from 43 days to 39 months postoperation.Total bilirubin levels were from 27.4 to 503 μmol/L.The etiologies of jaundice and its percentage were as follow:59 cases of biliary complications (45.7％),36 of rejection (27.8％ ),11 cases of virus infection (8.5％),5 cases of drug-induced hepatic injury (3.9％),4 cases of tumor recurrence (3.1％),4 cases of Gilbert syndrome (3.1％),3.cases of dysfunction of papillary muscle (2.3％),2 cases of vascellum complication (1.6％),2 cases of radiation hepatitis (1.6％),1 case of hepatapostema (0.8％),2 cases of unknown reasons (1.6％),respectively.The jaundice of most patients (93％) got released while small part of patients (7％)failed to treatment,of whom 5 cases received liver re-transplantation and 4 cases died of disease progression.ConclusionThe etiologies of jaundice after liver transplantation during mid-later stage are diversiform and complex.And the etiological diagnosis is the premise to treat effectively.
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Portal vein stricture complicated with superior mesenteric venous thrombosis is rarely seen in clinical practice. On December 26, 2009, a 51-year-old male patient who had a liver transplantation history was admitted to The General Hospital of Chinese People's Armed Police Forces with the chief complaint of intermittent abdominal pain and diarrhea.A plain and enhanced CT scan showed that the portal vein was constrictive and thrombosis had formed in the main trunk of the superior mesenteric vein, and varicose veins were seen in surrounding tissues of the esophagus. Edema was observed at the end of the ileum and cecum. The results of colonoscopy showed inflammatory changes and varicose veins of the colon. The patient received medical treatment. The thrombosis was dissolved 9 days later, and all symptoms disappeared 12 days later.