Probing into indication of living-related liver transplantation for Wilson's disease / 中华外科杂志

<p><b>OBJECTIVE</b>To probe into indication of living-related liver transplantation (LRLT) for Wilson's Disease.</p><p><b>METHODS</b>From January 2001 to February 2007, thirty-seven living-related liver transplants were performed. A retrospective analysis was carried on outcome of those patients. The indications for LRLT were acute hepatic failure in 3 patients and chronic advanced liver disease in 32 patients including 13 patients with Wilsonian neurological manifestations. Two patients presented with severe Wilsonian neurological manifestations even though their liver functions were stable. According to the scoring system for evaluation of the neurological impairment in Wilson disease based on neurological signs and functions (total score was 30), the pre-transplantation score of those patients with neurological manifestations was 15.9 +/- 4.3 (n = 15).</p><p><b>RESULTS</b>Thirty-seven patients were followed up for 20 - 93 months. The survival rates of post-transplant patients and grafts at 1, 3, and 5 year were 91.9%, 83.8%, 75.7%, and 86.5%, 78.4%, 75.7%, respectively. Postoperative surgical complications occurred in 2 donors with bile leakage required drainage, in 2 recipients with hepatic thrombosis underwent retransplantation of cadaveric liver and in 1 recipient with hepatic stenosis required balloon dilatation. Neurological function was improved in all recipients and the score of posttransplantation at 6, 12, 18, 24, and 30 month was 17.5 +/- 3.7 (n = 13); 21.0 +/- 4.3 (n = 12); 23.9 +/- 3.9 (n = 10); 26.6 +/- 2.2 (n = 10) and 28.1 +/- 1.9 (n = 7) respectively.</p><p><b>CONCLUSIONS</b>Patients with acute hepatic failure or patients with severe liver disease unresponsive to chelation treatment should be treated with LRLT. Early transplantation in patients with an unsatisfactory response medical treatment may prevent irreversible neurological deterioration even though their liver function is stable.</p>

Inhibitory effect of lentivirus transduced anti-telomerase siRNA therapy on hepatocellular carcinoma in nude mice / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the efficacy of anti-telomerase siRNA in hepatocellular carcinoma both in vitro and in vivo.</p><p><b>METHODS</b>Lentvirus vectors contained anti-telomerase siRNA were conducted with a high performance homologous recombination system, and then were transduced into human hepatocellular carcinoma HepG2 cells. The telomerase activity was detected by RT-PCR, HepG2 cell proliferation was determined by MTT assay, and apoptosis was detected by TUNEL assay. The in vivo experiment was carried out by inoculation of HepG2 cells into nude mice and the tumor growth was measured and analyzed.</p><p><b>RESULTS</b>The growth of transfected HepG2 cells was significantly inhibited and the inhibition rate was 57.5% at the 8th day after transfection. The telomerase activity was significantly suppressed in vitro. The growth of transfected human hepatocellular HepG2 tumor in the nude mice was also significantly inhibited.</p><p><b>CONCLUSION</b>The results of this study demonstrate that the growth of hepatocellular carcinoma cells is effectively inhibited by transfection of anti-telomerase siRNA both in vitro and in vivo.</p>

Mechanism of enhancement of the CTL activity in mice co-expressing CD80, CD86 and CD137L genes / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the mechanism of enhancement of the CTL activity in mice co-expressing of CD80, CD86 and CD137L genes.</p><p><b>METHODS</b>The mice were randomly divided into five groups, named A, B, C, D and E. The group A and B were control groups (CG). H22-BAL B/c HCC mouse model was established by subcutaneous injection with hepatocellular carcinoma cells of cell line H22-Wt (group A), H22-neo (group B), H22-CD80/CD86(+) (group C), H22-CD137L(+) (group D) and H22-CD80/CD86/CD137L(+) (group E), respectively. On the 14th, 35th, 56th and 84th day after the first inoculation of tumor cells, TUNEL staining and DNA ladder examination were used to detect apoptosis of splenic T lymphocytes in all groups at each post-inoculation time point. Electrophoretic mobility-shift assay (EMSA) method was used to detect the activity of nuclear factor kappaB (NF-kappaB) in splenic T lymphocytes in each group at each time point post-inoculation.</p><p><b>RESULTS</b>Apoptosis was found in a great number of T lymphocytes in CG on the 14th day, much more than that in group C and E. The number of apoptotic T cells in group C had a significant difference compared with that in the group E from 14th to 84th day (P = 0.003). DNA ladder analysis showed typical positive results in group C and E. The significant apoptosis fragments were found in group C on 21st, 35th and 84th days. NF-kappaB activity of T cells in groups C and E was remarkably higher than that of groups CG and D, with higher in group D than that of CG (P = 0.002), and with no significant difference between group C and E on 14th day. The activity in group E was stable and remarkably higher than that of group C on 56th and 84th days after the first inoculation.</p><p><b>CONCLUSION</b>H22-CD80/CD86/CD137L(+) induces higher NF-kappaB activity of the host T cells by synergistic action of CD28 and CD137, which may be one of the mechanisms of enhancement of the host CTL activity induced by co-expression of CD80, CD86 and CD137L genes.</p>

Adult living donor liver transplantation using right lobe for severe hepatitis in emergency: a report of 9 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the outcome of emergency adult right lobe living donor liver transplantation for fulminant hepatitis.</p><p><b>METHODS</b>Nine cases of adult right lobe living donor liver transplantation were performed from September 2002 to August 2005, the clinical and follow-up data was analyzed.</p><p><b>RESULTS</b>According to Child Pugh Turcotte (CPT) classification, 9 patients were classified as grade C before transplant. The Model for End-Stage Liver Disease (MELD) scores of these patients were 26.7 +/- 8.8. The principal pre-transplant complications included hepatic encephalopathy (5 cases), electrolyte disturbance (3 cases), renal failure (2 cases), gastrointestinal bleeding (1 case). The operations in donors and recipients were all successful. The post-transplant complications induced pulmonary infection in 2 patients, acute renal failure in 3 and transplantation related encephalopathy in 1. There were no primary graft non-function and no blood vessel and bile tract complications occurred. One-year survival rate was 55.6%. No serious complication or death found in donors.</p><p><b>CONCLUSIONS</b>Emergency adult to adult living donor liver transplantation is an effective treatment for fulminant hepatitis but the safety of the donors should be assessed strictly preoperation.</p>

Surgical methods in living donor liver transplantation: with report of 50 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate and evaluate different surgical methods applied in living-donor liver transplantation (LDLT).</p><p><b>METHODS</b>Fifty patients with end-stage liver disease received LDLT in our department between January 1995 and March 2006. The data were analyzed on a retrospective basis. The choice of different surgical methods, strategies applied to ensure the safety of donors and indications of LDLT in the series were reviewed.</p><p><b>RESULTS</b>All donors recovered uneventfully. Among the 50 patients, 47 recipients presented with end-stage cirrhosis, 3 patients suffered from malignant tumor. To date, 6 recipients died after LDLT, among them, 3 recipients died of the operation and the other 3 recipients died of long-term complications. Resected donor livers included 9 cases of segments V, VI, VII and VIII (not including the middle hepatic veins) and 1 case of segments V, VI, VII and VIII (including the middle hepatic veins), 36 cases of segments II, III and IV (including the middle hepatic veins) and 4 cases of segments II, III, and part of IV (not including middle hepatic veins).</p><p><b>CONCLUSIONS</b>LDLT helps tackle the problem of donor shortage in the world. The process is complicated, and it is very important to choose appropriate surgical methods for the improvement of surgical achievement and donor safety.</p>

Early experiences on living donor liver transplantation in China: multicenter report / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Because of the lack of brain death laws in China, the proportion of cadaveric organ donation is low. Many patients with end-stage liver disease die waiting for a suitable donor. Living donor liver transplantation (LDLT) would reduce the current discrepancy between the number of patients on the transplant waiting list and the number of available organ donors. We describe the early experience of LDLT in the mainland of China based on data from five liver transplant centers.</p><p><b>METHODS</b>Between January 2001 and October 2003, 45 patients with end-stage liver disease received LDLT at five centers in China. The indication and timing, surgical techniques and complications, nonsurgical issues including rejection, infection, and advantages of LDLT in the series were reviewed. Actuarial patient and graft survival rates were calculated by using the Kaplan-Meier product-limit estimate. Statistical analysis was completed by using SPSS 10.0.</p><p><b>RESULTS</b>All LDLT recipients were cirrhotic patients, except for one man with fulminant hepatic failure. Among the 45 cases of LDLT, 35 (77.8%) were performed in one center (the First Affiliated Hospital of Nanjing Medical University). The overall 1 and 3 year survival rate of the recipients was 93.1% and 92.0%, respectively. Of the 45 LDLT donors, there were 3 cases of biliary leakage, 2 subphrenic collections, 1 fat liquefaction around the incision and 1 biliary peritonitis after T tube removal. All donors recovered completely.</p><p><b>CONCLUSIONS</b>LDLT provides an excellent approach to addressing the problem of donor shortage in China even though the operation is complicated, uncompromising and difficult with respect to the safety of the donors and receptors. Despite early technical hurdles having been overcome, perfection of technique is still necessarily. At present, LDLT is a good choice for the patients with irreversible liver disease.</p>

Impact of co-expression of CD80, CD86 and CD137L genes on tumor immunogenicity in HCC H22-BAL b/c mouse model / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To understand the influence of co-expression of CD80, CD86 and CD137L genes on tumor immunogenicity in hepatocellular carcinoma H22-BAL B/c mouse models.</p><p><b>METHODS</b>The mice were randomly divided into five groups, named A, B, C, D and E, and control groups A and B, 20 mice in each group. Hepatocellular carcinoma H22-BAL B/c mouse model was established by subcutaneous injection of cells H22-Wt, H22-neo, H22-CD80/CD86+, H22-CD137L+ and H22-CD80/CD86/CD137L+, respectively. The rate and incubation period of tumor development, survival rate, and the tumor growth in vivo were observed and recorded. The effects of gene transduction on immunogenicity of the tumor and antitumor immunity of the animals were assessed by re-innoculation of wild type H22 cells.</p><p><b>RESULTS</b>The rate of tumor development in group E was only 50%, much lower than that in other four groups (P < 0. 01). The tumor growth in group C was reduced with complete tumor regression in two hosts (20%, 2/10). In group E, there was more pronounced reduction of tumor size. The maximal tumor sizes were remarkably smaller than those of group C, and there was complete tumor regression in three mice (60%, 3/5). No tumor regression was found in the other three groups. Survival rates of group C and E were significantly higher than that of animals in groups A, B and D (P < 0. 01), but no significant difference was seen between group C and E. The results of re-inoculation test showed that tumor formation rate was 40% (4/10) in group C, 100% (8/8) in group D, and 0 (0/5) in group E. There were significant differences between groups C and E and control group, between group E and C, but not between C and D. After the third time of re-inoculation with H22-Wt cells at the 56th day, tumor occurred in 6/6 mice (100%) of group C, but 0 (0/5) in group E. The difference was very significant. Five animals without tumor formation after the first inoculation in group E, were re-inoculated with H22-Wt cells on the 21st day and the third re-inoculation on the 56th day, no tumor was found (0/5).</p><p><b>CONCLUSION</b>Both co-expression and solo-expression of CD80+ CD86 and CD137L genes reduce the tumorigenicity of wild type H22 cells, but co-expression of CD80, CD86 and CD137L genes can more significantly improve the immunogenicity of H22-CD80/CD86/CD137L+ cells.</p>

Some principal surgical techniques for living donor liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate some principal surgical techniques of living donor liver transplantation (LDLT).</p><p><b>METHODS</b>Eleven patients of LDLT have been performed at our department from January 2001 to March 2002. The left lobe (segments II, III, IV, including the middle hepatic veins) was transplanted in 8 patients, the left lateral lobe (segments II, III) in one and the right lobe (segments V, VI, VII, VIII, not including the middle hepatic veins) in 2. The plane of liver resection was determined on the basis of donor liver volumetry using CT scan and the anatomic analysis of vascular structure of the hepatic vein, portal vein and hepatic artery using intraoperative ultrasound. The hepatic parenchyma was transected using ultrasound aspirator without blood vessel clamping or graft manipulation. The isolated graft was perfused in situ through the portal vein branch. The liver graft was transplanted into the recipients who underwent total hepatectomy with preservation of the inferior vena cava. The hepatic vein reconstruction was performed in end to end fashion or end to side to the vena cava after venoplasty. Arterial anastomoses were performed using microsurgical technique. Biliary reconstruction was made by using duct-to-duct anastomosis and placement of a T tube.</p><p><b>RESULTS</b>All the 11 donors are uneventfully discharged after operation. In the 11 recipients, an 8-year-old girl needed retransplantation because of hepatic artery thrombosis, one case died of serious chronic rejection on the postoperative day 72. Ten recipients recovered and were discharged from hospital, whose liver function and cuprum oxidase had returned to normal.</p><p><b>CONCLUSIONS</b>The procedure of LDLT is relatively safe for the donor. Reconstruction of vessels is a key step in the procedure. Comprehending anatomical variation of vessels pre- and intra-operatively and correct surgical management might reduce the incidence of complications.</p>