The analysis of pancreatic fistula in middle segmental pancreatic resection / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the influence of pancreatic fistula in middle segmental pancreatic resection and summarize the experience in dealing with the stump.</p><p><b>METHODS</b>The data of 40 cases undergoing middle pancreatectomy were reviewed retrospectively to analyze the curative effect and pancreatic fistula between April 2003 and December 2009. Of these, 36 patients with benign cases outcomes were compared with 2 separate control groups, 44 pancreaticoduodenectomy (PD) and 26 extended distal pancreatectomy (EDP).</p><p><b>RESULTS</b>The mean operating time of group MSP was 222 min, which was significantly shorter than that of group PD. The mean blood loss of group MSP was 316 ml, which was less than that of others. Otherwise, the postoperative nutritional status and blood sugar control in group MSP was superior to the other 2 groups. Through long-term follow-up, the patients in group MSP retained endocrine and exocrine function better. Only 1 patient developed new-onset diabetes mellitus after operation, and no patient required enzyme substitution. No lesion recurred. The rate of pancreatic fistula was highest (42%), but didn't result in the significant deference of overall discharge time with group PD and EDP. The pancreatic fistula level and the mean postoperative time in hospital didn't differ significantly from the other 2 groups.</p><p><b>CONCLUSIONS</b>Middle segmental pancreatectomy is a safe and feasible technique that is indicated for selected patients with benign or low malignant lesion in the neck and body of the pancreas. Though the rate of pancreatic fistula is higher, the risk of which is reduced by the marked curative effect. It is very important to deal with the stump reasonably.</p>

Operative techniques and common complications of modified orthotopic intestinal transplantation in rats / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate operative techniques, treatment and precaution of common complications of orthotopic intestinal transplantation in the rats.</p><p><b>METHODS</b>Orthotopic intestinal transplantation was performed in 120 rats by modified three cuffs method. The causes, treatment and precaution of common complications were analyzed retrospectively.</p><p><b>RESULTS</b>The 7-day survival rate of recipients was 82.5% and the 30-day survival rate was 68.3%. The average volume of bleeding in the recipient operation was less than 1 ml. The result obtained from the above 99 recipients was satisfactory. The main reasons of final failure and death were as follows: anastomotic bleeding(5 rats), portal vein thrombus(2 rats), arterial thrombus(4 rats), air embolism(1 rat), infection of abdominal cavity(4 rats), aspiration pneumonitis (2 rats), anesthetic accident(2 rats) and kinking of graft intestine(1 rat).</p><p><b>CONCLUSIONS</b>The sophisticated surgical technique and the delicate surgical manipulation are the prerequisite of preventing operational complication. Improving operative techniques and being familiar with the common complications can reduce the occurrence of complications and increase operative successful rate.</p>

Diagnosis and treatment of multiple endocrine neoplasia type 1 related pancreatic endocrine tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience on diagnosis and treatment of multiple endocrine neoplasia type 1 (MEN-1) related pancreatic endocrine tumors (PET).</p><p><b>METHODS</b>From January 2004 to December 2007, there were 10 patients of MEN-1 related PET were treated in Shanghai Jiaotong University School of Medicine Affiliated Ruijin Hospital. There were 2 males and 8 females, aged from 11- to 49-years-old. They were diagnosed by laboratory tests, imaging examinations and genes sequencing. Drug therapy, surgery and follow-up were applied on the patients.</p><p><b>RESULTS</b>There were 9 patients having insulinomas including 2 cases of multiple insulinomas and 1 case presenting an insulinoma, multiple nonfunctional PET and malignant duodenum gastrinoma with liver metastasis. The other patient was diagnosed as glucagonoma clinically. Five cases had family history and MEN-1 gene mutation was detected in 9 patients. Seven patients accepted nine operations. Twelve insulinomas, four nonfunctional PET and one duodenum gastrinoma were found in the operations. All patients were followed up from 1 month to 11 years, and 9 patients with good conditions and 1 patient died.</p><p><b>CONCLUSIONS</b>Well recognizing PET and MEN-1, early diagnosing MEN-1 related PET, appropriately surgical intervention will prove patients' life quality and will help for prolonging patients' survival time.</p>

A clinical study on splanchnic hemodynamic changes after orthotopic liver transplantation for patients with portal hypertension / 中华外科杂志

<p><b>OBJECTIVE</b>To study the regularity of splanchnic hemodynamic changes after orthotopic liver transplantation (OLT) for patients with portal hypertension. At the same time, effect of such changes on splenomegaly, hypersplenism, collateral circulation and the postoperative liver function was discussed.</p><p><b>METHODS</b>Between June 2002 and October 2005, 173 liver transplantations were performed. In 38 patients with portal hypertension undergoing OLT, the following parameters were measured before surgery and subsequently at 1, 3, 5, 7 days, 1, 6 months and 1, 2, 3 years after operation by using Color Doppler sonography: portal blood flow mean velocity (PBV), portal blood flow volume (PBF), hepatic artery resistance indexes (HA-RI) and spleen size. The same parameters were measured in 8 patients with acute liver failure and 20 healthy controls. Meanwhile to observe liver function and varicose vein of esophagus.</p><p><b>RESULTS</b>In cirrhotics, PBV and PBF increased immediately after transplantation [from (13.7 +/- 4.2) cm/s to (58.4 +/- 25.2) cm/s and from (958 +/- 445) ml/min to (3024 +/- 1207) ml/min respectively, P < 0.05]. HA-RI also augmented [from (0.65 +/- 0.11) to (0.74 +/- 0.12), P < 0.05]. PBV returned to normal values after 6 months, PBF returned to normal value after 2 years. Spleen size decreased significantly, but splenomegaly persisted after 3 years. In addition the esophagogastric varix ameliorated significantly.</p><p><b>CONCLUSIONS</b>Abnormal splanchnic hemodynamic changes for patients with portal hypertension still will long-term exist after OLT, but does not effect recovery of hypersplenism, esophagogastric varix and liver function.</p>

Correlation between liver stem cell activation and histopathologic changes in liver with hepatic failure / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the correlation between liver stem cell activation and histopathologic changes in liver transplant recipients with hepatic failure.</p><p><b>METHODS</b>A total of 33 cases of hepatic failure were enrolled into the study. Donor liver tissues were used as normal controls. Histopathologic changes, presence of hepatotropic virus antigens, history of artificial liver therapy and number of c-kit positive cells were analyzed.</p><p><b>RESULTS</b>There were a total of 25 males and 8 females. The age of patients ranged from 21 to 64 years. Among the 33 patients studied, 6 suffered from acute liver failure, 5 from subacute liver failure and the remaining from acute-on-chronic liver failure (associated with cirrhosis). Thirteen patients had a history of artificial liver therapy. Activated liver stem cells expressed c-kit monoclonal antibody but were negative for toluidine blue stain. The number of c-kit-positive cells in acute liver failure, subacute liver failure and acute-on-chronic liver failure were 3.50 +/- 2.66 (0 to 8) per mm(2), 11.47 +/- 8.85 (3 to 30) per mm(2) and 15.50 +/- 10.95 (5 to 45) per mm(2), respectively (P < 0.05). The number of c-kit-positive cells in cases with or without artificial liver therapy showed no statistically significant difference.</p><p><b>CONCLUSIONS</b>The poor prognosis of acute liver failure is mainly due to massive liver necrosis and insufficient stem cell activation. Liver stem cell level is increased whenever there is progression into subacute liver failure and chronic liver failure. Actively treating acute liver failure with stimulation of the self-regeneration system in liver is thus useful.</p>

Primary non-Hodgkin lymphoma of small bowel: a clinical analysis of 34 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics,treatment and prognosis of primary non-Hodgkin's lymphoma of small bowel.</p><p><b>METHODS</b>The records of 34 patients with a confirmed diagnosis of primary non-Hodgkin's lymphoma of small bowel, registered between Jan. 1996 and Dec. 2005 at our hospital, were retrieved and analysed retrospectively.</p><p><b>RESULTS</b>Twenty-seven patients had B-cell lymphoma and 7 had T-cell lymphoma of the small bowel. The major symptoms included abdominal pain and intestinal obstruction. According to Ann Arbor staging classification, 22 patients belonged to stage I~II, including 20 cases of B-cell lymphoma and 2 cases of T-cell lymphoma, and 12 patients belonged to stage III~IV, including 7 cases of B-cell lymphoma and 5 cases of T-cell lymphoma. Compared with T-cell lymphoma patients, B-cell lymphoma patients had lower lymphoma stages (P<0.05). Twenty-seven patients were treated with surgical resection. Fourteen patients were treated with six cycles of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy, and 8 patients were treated with Rituximab at the same time. T-cell lymphoma patients were more often treated with emergent operation than B-cell lymphoma patients would (P<0.05). It happened more frequently that B-cell lymphoma patients reached complete remission and their accumulative survival rate was longer than T-cell lymphoma patients did (P<0.05).</p><p><b>CONCLUSION</b>Patients with stages I and II B-cell lymphoma of small bowel respond well to surgery and chemotherapy, and the treatment and prognosis of patients with T-cell lymphoma of small bowel are unsatisfactory.</p>

Clinical analysis of infectious complications following abdominal cluster transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the characteristic and management of postoperative infection in abdominal cluster transplantation.</p><p><b>METHODS</b>Preliminary experience of two cases of abdominal cluster transplantation including small intestine was reviewed.</p><p><b>RESULTS</b>Combination of five immunosuppressive agents based on tacrolimus was used. Severe Gram-negative bacillus infections occurred. The majority of invasive fungal infections was due to Candida species. Cytomegalovirus (CMV) infection increased monocytes and caused eosinopenia and an inversion of the CD4(+) to CD8(+) cell ratio in recipient I, and human CMV matrix proteins pp71 (CMV-pp71) was detected and identified in bile by PCR. Microabscesses in liver transplant biopsies were presented.</p><p><b>CONCLUSIONS</b>Infectious complications after cluster transplantation were complicated. Strategies to optimize the immunity suppression protocol and early diagnosis and treatment will be important to reduce infection after abdominal cluster transplantation.</p>

Primary diffuse large B-cell non-Hodgkin's lymphoma of the small intestine: clinicopathologic features, management, and prognosis in 24 patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological features of primary diffuse large B-cell lymphomas (DLBCLs) of the small intestine, CD10 expression, and their relationship to prognosis.</p><p><b>METHODS</b>Twenty-four cases of small intestinal DLBCLs were studied clinically and pathologically. All cases were staged according to the Ann Arbor classification of lymphoma.</p><p><b>RESULTS</b>Fifteen cases (62.5%) were at stages I and II, and nine cases (37.5%) at stages III and IV. The Karnofsky performance status ranged from 40% to 100% (mean 75.5%). Twenty cases (83.3%) received surgical resection, sixteen cases (66.7%) received chemotherapy, and no patient received radiotherapy. Seven of 19 cases (36.8%) were CD10+. Although there was no statistically significant difference(P = 0.28) in therapy result between the CD10+ and CDO1--groups, patients with CD10+ lymphoma more frequently presented with stages I compared with those with CD10 - lymphoma (P = 0.013). Follow-up information was available in 19 cases ranging from 1 to 111 months (mean 32.7 months). Five cases died of the disease. The mortality rate was 26.3%. The analysis of survival rate showed a longer overall survival duration in the stage I and II group compared with that of the stage III and IV group ( P = 0.0197 ) , but there was no significant difference between CD10+ and CD1- groups.</p><p><b>CONCLUSION</b>The primary small intestnal diffuse large B cell lymphoma patients at stage I and II respond better to therapy including surgical resection and chemotherapy than those at stage III and IV. CD10+ expression is more common in stage I lymphomas.</p>

Prognostic factors of retroperitoneal soft tissue sarcomas: analysis of 132 cases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Retroperitoneal sarcoma is a rare disease with poor prognosis. The aim of this study was to investigate the prognostic factors of the disease.</p><p><b>METHODS</b>Between January 1988 and December 2003, 132 patients with retroperitoneal sarcoma were surgically treated in our hospital, 79 of them were followed up for 1 - 122 months (median: 19 months). Their clinicopathological data including tumor size, histological subtype, grade and resection margin status, were studied. The Kaplan-Meier method and log-rank test were used to analyze the disease-specific survival rates after the resection.</p><p><b>RESULTS</b>Among the 132 patients, 98 (74.2%) received macroscopic complete resection, 29 (22.0%) incomplete resection, and 5 (3.8%) surgical biopsy. In the 79 patients who were followed up, macroscopic clear resection of retroperitoneal sarcoma (n = 49) was associated with a significantly higher survival rate compared with unclear resection (n = 30, P < 0.001). The median survival period was 31 months (95% CI, 20.09 - 41.91; actuarial 1-year survival, 85.7%) in the patients with the tumor completely resected and 11 months (95% CI, 6.71 - 15.29; actuarial 1-year survival, 46.7%) in those with incomplete resection. Patients with high-grade sarcomas had a significantly shorter survival time (n = 39; median: 24, 95% CI: 5.71 - 42.29) than those with low-grade sarcomas (n = 40; median: 15; 95% CI: 8.80 - 21.20; P < 0.01). Moreover, compared with the patients with the tumor sized < 15 cm in diameter (n = 53), the survival rate was lower in those with a sarcoma sized > 15 cm (n = 26). (Median: 12, 95% CI: 8.26 - 15.74 vs median: 24, 95% CI: 17.25 - 30.75; P < 0.05). Furthermore, the survival of the patients with liposarcomas (n = 29, median: 29, 95% CI: 12.84 - 45.16), leiomyosarcomas (n = 14, median: 11, 95% CI: 6.11 - 15.89), and others (n = 36, median: 22, 95% CI: 14.95 - 29.05) varied significantly (P < 0.05).</p><p><b>CONCLUSION</b>Completeness of resection, tumor volume, grade, and subtype are prognostic factors of retroperitoneal soft tissue sarcomas.</p>

Steroid Withdrawal in Liver Transplantation / 上海第二医科大学学报

Recently a great number of new immunodepressants have emerged due to the side effects of steroids.Therefore,relatively more perfect steroid withdrawl regimens have been studied by many researchers at home and abroad.This article reviews the course of steroid withdrawal in liver transplantation,introduces and compares different protocols of steroid withdrawal.

Cytokine Gene Polymorphism and Organ Transplantation / 上海第二医科大学学报

The cytokines have close relationship with the rejection and infection in organ transplantation.The cytokine gene polymorphism influences the secretion of cytokines.The relationship between the rejection and infection in organ transplantation and some cytokines gene polymorphism is reviewed in this article.

Advances in cell components of bioartificial liver / 上海第二医科大学学报

The biological artificial liver(BAL) can offer reliable artificial liver support for the patients with hepatic failure.All BAL devices contain hepatocytes as their biological component,whose specific biological characteristics contribute to the function of the BAL.During the past two decades,various cells including human hepatocytes,heterogeneous hepatocytes and liver cell lines have been used and different culture methods have been studied to optimize the activity of the biological component.However,both functionality and safety of these cells should be improved before successful use in BAL. This paper summarizes the latest progress on it.

Advances of Abdominal Multivisceral Transplantation / 上海第二医科大学学报

Abdominal multivisceral transplantation is a new and proved effective therapeutic methods for two or more terminal abdominal organs. Upper abdominal exenteration(resection of the liver,stomach,spleen,pancreaticoduodenal complex,and part of the colon) for the treatment of otherwise unresectable tumors is one of the more radical operations in oncology.Some new surgical methods such as liver-intestinal,liver-kidney,pancreas-kidney and multivisceral cluster transplantation have emerged recently.These new advance surgical approache improve the curative effect of abdominal organ transplantation.

Clinical Experience of Liver Retransplantation in 8 Patients / 上海第二医科大学学报

Objective To summarize the clinical experience in liver retransplantation. Methods From June 2002 to December 2005,a total of 185 cases of liver transplantation were performed in our hospital,including 8 cases of retransplantation.Those clinical data were analyzed retrospectively. Results The rate of liver retransplantation was 4.32%.The average MELD scores before primary transplantation and retransplantation were 15.6 and 23.9,respectively.The average interval between primary transplantation and retransplantation was 316 days(78~725 days).Causes of retransplantation included 3 cases of biliary complications,2 cases of chronic rejection,1 case of hepatic artery thrombosis,1 case of acute rejection and 1 case of recurrence of hepatitis B.The former 3 cases died of severe infection combined with multiple organ failure 101,16 and 28 days after retransplantation.The latter 5 cases recovered smoothly,and have survived 27,12,8,4 and 3 months up to now. Conclusion Liver retransplantation is an effective way to save the patient with hepatic allograft failure.Good knowledge of the indications of retransplantation,careful selection of the operation time,excellent surgical skills and meticulous postoperative management will contribute to the success of liver retransplantation.

The protective effect of heat shock protein 72 by Doxorubicin in cold ischemia-reperfusion injury of the rat liver / 中华外科杂志

<p><b>OBJECTIVE</b>To observe induction of heat shock reaction by pretreatment of Doxorubicin (DXR) in long-term cold preservation-reperfusion injury of the rat liver.</p><p><b>METHODS</b>The rats were administered intravenously by DXR at a dose of 1 mg/kg body weight in DXR group and by saline in control group. After 48 hours, the rat liver was perfused by using cold University of Wisconsin (UW) solutions and was preserved in UW solution at 4 degrees C for 48 hours. Recipient liver was perfused for 1 and 3 hours after orthotopic liver transplantation. Tumor necrosis factor-alpha (TNF-alpha) mRNA, cytokine-induced neutrophil chemoattractant (CINC) mRNA, macrophage inflammatory protein (MIP-2) mRNA was measured by RT-PCR and heat shock protein 72 (HSP72), nuclear factor-kappaB (NF-kappaB) by Western blot. The serum levels of TNF-alpha, CINC, MIP-2 by ELISA and AST were measured. The survival rate of 7 days was observed.</p><p><b>RESULTS</b>The expression of TNF-alpha mRNA, CINC mRNA and MIP-2 mRNA was stronger in control group than in DXR group. HSP72 was expressed in SA group but not in control group and oppositely NF-kappaB was expressed in control group but not in DXR group. Serum AST, TNF-alpha, CINC and MIP-2 concentrations were significantly lower in DXR group than in control group (P < 0.05). The survival rate of 7 days was significantly higher in DXR group than in control group (50% vs. 0%, P < 0.05).</p><p><b>CONCLUSIONS</b>These data suggested that long-term cold ischemia-reperfusion injury was attenuated in liver graft with pretreatment of DXR. The induction of HSP72 may offer protection to hepatocytes by restraining the activation of NF-kappaB and inflammation.</p>

Clinical degree of the superior mesenteric vein involvement with the surgery in the pancreas uncinate process carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To create the clinical degree of the superior mesenteric vein (SMV) involvement in pancreas uncinate process carcinoma (PUPC) and its clinical significance to be discussed.</p><p><b>METHODS</b>According to the contiguous relationship between the SMV and the PUPC, the clinical degree of SMV involvement in PUPC are as followings four grades, 1 grade, the grade of clear boundary. 2 grade, the grade of fuzzy boundary. 3 grade, the grade of dissolved boundary. 4 grade, the grade of SMV infringed. The coherence between the type under the CT scan (Tx) and the type under the inoperative judgement (Sx) were analyzed with Kappa-test.</p><p><b>RESULTS</b>There is a significant difference between the grade of SMV involvement and the surgery. The resection rate is 100% in 1st grade, 97.4% in 2nd grade, 65.8% in 3rd grade and 21.7% in 4th grade. There is coherent in the degree judgement between the CT scan and the inoperative inspection (U = 15.96, P < 0.01).</p><p><b>CONCLUSIONS</b>There is clinical significance to establish the degree of SMV involvement in PUPC. It is helpful for clinician to accurately know its anatomic characteristic and decide more reasonable surgical strategy.</p>

Clinical misdiagnosis of solid pseudopapillary tumour of pancreas / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Since being reclassified by WHO in 1996, solid pseudopapillary tumour (SPT) of pancreas has been recognized as the internationally accepted name. Clinicians are lacking in knowledge of this rare disease so the misdiagnosis and inappropriate therapy are hard to avoid. The clinic data on 22 patients were summarized to study the misdiagnosis and treatment of a sample of SPTs.</p><p><b>METHODS</b>Twenty-two female patients with SPT were studied retrospectively and divided into two groups, the misdiagnosed group and the correctly diagnosed one. The analyses were performed with Fisher test with accurate probability for categorical data, and Kruskal-Wallis test for ranked data.</p><p><b>RESULTS</b>The rate of misdiagnosis in this sample was 45.5%. The misdiagnosed SPTs were apt to be the incomplete capsule ones (P = 0.020), which resulted in obvious difficulties during operation (P = 0.024). In the misdiagnosed SPT group, the medical expenses increased significantly (P = 0.042), and the number of days in hospital greater than in correctly diagnosed group (P = 0.041).</p><p><b>CONCLUSIONS</b>Although SPT has low malignancy with excellent prognosis after surgical treatment in most patients, the misdiagnosis of SPT increases the social and economic burdens on patients. It is important to analyse the causes of misdiagnosis.</p>

Retrospective analysis of 47 cases with hilar cholangiocarcinoma using T-staging system / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical value of T-staging system for hilar cholangiocarcinoma which was adopted in memorial Sloan-Kettering cancer center of New York.</p><p><b>METHODS</b>The image data of these 47 patients were analyzed retrospectively from December 1997 to December 2002 whose data were according with our demand, and they were staged into three-stage according to the criteria of the T-staging system. The difference of respectability, ratio of tumor-free resection margin and actuarial survival rate were analyzed for different T-staging. And the coincident ratio of three different kinds of imaging methods was also analyzed.</p><p><b>RESULTS</b>Twenty patients had T(1) tumors, twenty three had T(2) tumors and four had T(3) tumors. The resectability of the three stage was 60%, 39% and 0% respectively, and the difference was significant (P = 0.013). The likelihood of achieving tumor-free margin decreased progressively with increasing T stage (P = 0.018). The cumulative 1-year survival rates of T(1), T(2) and T(3) patients were 60%, 39% and 0% respectively, and the cumulative 3-year survival rate was 35%, 9% and 0% respectively, the survival of different stage patients differed markedly (P = 0.0103). The coincident ratio of combined using MRCP and color Doppler-ultrasonography was higher than that of combined using MRCP and B-ultrasonography or combined using CT/SCT and color Doppler-ultrasonography (P = 0.007).</p><p><b>CONCLUSIONS</b>The T-staging system has a better value for preoperative assessment, and can be used to judge resectability and survival of hilar cholangiocarcinoma. It will be helpful to use MRCP and color Doppler-Ultrasonography combined to verdict the coverage of the tumor and the T-staging preoperatively.</p>

The surgical treatment of the solid-pseudopapillary tumor of pancreas: report of 21 cases / 中华外科杂志

<p><b>OBJECTIVE</b>The surgical therapies and prognoses on 21 solid-pseudopapillary tumors (SPT) of pancreas were summarized in our center.</p><p><b>METHODS</b>Twenty-one SPTs were retrospectively studied and divided into two groups, the complete capsular group and the incomplete one. The analyses were performed by SAS6.12 Stat. software.</p><p><b>RESULTS</b>There are no tumor recurrences in all patients. There are significant difference between operative types in radical resection and the tumor position of the pancreas (P = 0.038). There are also significant differences between the capsular integrity and the course of the diseases (P = 0.029), and the possible malignant cells by the frozen section examination (P = 0.001), and the size of the tumor (P = 0.0004). The judgement on the capsular integrity of the tumor could directly effect the adoptable operative types (P = 0.001).</p><p><b>CONCLUSIONS</b>The surgical resection is good treatment for the SPT, which has satisfying prognosis.</p>

Sensitivity and specificity of granzyme B and perforin in diagnosing acute rejection after liver transplantation / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the roles of granzyme B and perforin in diagnosing acute rejection after liver transplantation, and the relationship between their activity index (AI) and Banff's histological grading criteria.</p><p><b>METHODS</b>Liver biopsies were processed as for routine surgical specimens and labeled with granzyme B and perforin monoclonal antibodies. The number of positive cells/mm(2) was determined as activity index (AI) by IPP image analysis software. Histologic findings were used as the "gold standard" in diagnosing acute rejection.</p><p><b>RESULTS</b>Of 41 liver biopsy samples studied, acute rejection was noted in 21 cases, the remaining 20 cases showed no evidence of rejection. The AI of granzyme B and perforin in the acute rejection group was significantly higher than that in the non-acute rejection group (< 0.001). In the acute rejection group, the AI in moderate to severe acute rejection was higher than that in mild to indeterminate acute rejection (< 0.001). Compared with the "golden" histologic criteria, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of granzyme B in diagnosing acute rejection were 90.0%, 95.2%, 94.7%, 90.9% and 92.7% respectively. The values of these parameters for perforin were also above 80%.</p><p><b>CONCLUSIONS</b>Granzyme B and perforin are key markers of activated immune cells in acute rejection and highly expressed during acute liver rejection episodes. As ancillary investigations, these parameters demonstrated high sensitivity and specificity in diagnosing acute rejection in allograft post-transplant liver biopsies.</p>