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Objective:To construct the prediction model of SAP complicated with intra-abdominal hypertension (IAH), and evaluate the prediction efficiency of the model.Methods:The clinical data of 322 SAP patients admitted to the emergency department of Cangzhou Hospital of Integrated Chinese and Western Medicine in Hebei Province from January 2017 to December 2021 were retrospectively analyzed. They were divided into IAH group ( n=153) and control group ( n=169) according to whether they had IAH complications or not. The clinical characteristics and laboratory test results of the two groups were compared. Multifactor logistic step-up regression was used to analyze the risk factors of SAP patients complicated with IAH. A nomogram model for predicting SAP complicated with IAH was established by using R software. The receiver operating characteristic curve (ROC) of the model was plotted, and the area under the curve (AUC) was calculated to evaluate its prediction efficiency. Calibration chart, Hosmer-Lemesshow test and decision curve analysis were used to evaluate the prediction accuracy and clinical application value of the model. The Bootstrap method was applied to verify the model internally. Results:In IAH group, cases with body mass index, CRP, procalcitonin (PCT), WBC, acute physiological and chronic health assessmentⅡ (APACHEⅡ) score, modified CT Severity Index score (MCTSI), incidence of complications (abdominal effusion, abdominal infection, gastrointestinal dysfunction, shock, multiple organ dysfunction syndrome), mechanical ventilation, the number of high-volume fluid reactivation (24 h≥4 L) were more than those in control group; serum albumin and serum calcium in IAH group were lower than those in control group, and the differences were statistically significant (all P value <0.05). Multivariate logistic regression analysis showed that serum albumin ( OR=0.815, 95% CI 0.710-0.937), CRP ( OR=1.005, 95% CI 1.002-1.008), MCTSI ( OR=2.043, 95% CI 1.695-2.463), complication of gastrointestinal dysfunction ( OR=4.179, 95% CI 2.170-8.049), and high-volume fluid resuscitation ( OR=4.265, 95% CI 2.269-8.015) were independent risk factors for IAH in SAP.The Nomogram prediction model was established using the five factors above as parameters, and the AUC value for predicting IAH complication was 0.886. The Hosmer-Lemesshow test showed a high consistency between the prediction results and the actual clinical observation results ( P=0.189). The results of decision curve analysis showed that the prediction probability of the model was between 10% and 85%, which could bring more benefits to patients. Conclusions:The early prediction model of SAP with concurrent IAH is successfully established, which can better predict the risk of SAP with concurrent IAH.
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Objective:To explore the safety and clinical efficacy of orthotopic liver transplantation after treatment with gelatin sponge microparticles by transcatheter arterial chemoembolization (GSMs-TACE) for hepatocellular carcinoma with type II/III portal vein tumor thrombus.Methods:For this retrospective study, patients with hepatocellular carcinoma with portal vein tumor thrombosis undergoing GSMs-TACE before liver transplantation from January 2018 to June 2018. The clinical efficacy and safety were evaluated by alpha feto-protein (AFP), imaging changes, postoperative complications and survival time.Results:The median follow-up period was 24 months. The average number of GSMs-TACE was 1.5. No postoperative complications such as biliary fistula, abdominal hemorrhage, liver and kidney failure, arterial stenosis and biliary stricture occurred. After GSMs-TACE, there were varying degrees of tumor necrosis or thrombus, AFP decreased (n=5) and PIVKAII declined (n=7). The 1-year survival rate was 100% and the 1-year disease-free survival rate 71.4%. For two cases of lung metastasis, the recurrent time was 4 and 10 months respectively.Conclusions:GSMs-TACE plus liver transplantation offer good safety and clinical efficacy for hepatocellular carcinoma patients with portal vein cancer thrombus.
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Objective To analyze the clinical features and definitive repair strategies of bile duct strictures after hepatectomy.Methods The clinical data of patients undergoing definite repair for bile duct strictures after hepatectomy in the PLA General Hospital from 2000 to 2014 and Beijing Tsinghua Changgung Hospital from 2014 to 2017 were retrospectively collected.Results Twenty-one patients with bile duct stricture after hepatectomy were treated with reoperation.Among them,13 cases showed continuous bile leakage after operation.The types of hepatectomy include 10 cases of left or extended left hemihepatectomy,7 cases of right or extended right hemihepatectomy,2 cases of mesohepatectomy,and 2 cases of hepatic caudate labectomy.According to classification formulated by the Biliary Surgery Group of Chinese Medical Association,the types of injuries of the patients included four of Ⅱ 2,twelve of Ⅱ 3,and five of Ⅱ 4 respectively.19 of 21 patients underwent definitive repair with hepaticojejunostomy.The long-term follow-up success rate was 89.0％.Conclusions Biliary injury after hepatectomy in which the injury affects the secondary or below hepatic ducts requires surgical repair.Hepaticjejunostomy is an effective definitive repair method.Hepaticjejunostomy for bile duct stenosis after right hemihepatectomy always need to dissect the left intrahepatic bile duct by a hilar plate approach or UPV approach,due to the effect of hepatic portal transposition.Surgical repair for bile duct stenosis after the left hepatectomy,always need the incision of the right anterior and right posterior hepatic duct,due to extensive injuries of hepatic duct.
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Objective To investigate the application value of artery approach in the lower colon region combined with portal vein (PV) resection and allograft vascular grafts in radical pancreaticoduodenectomy for pancreatic cancer combined with vascular invasion.Methods The retrospective descriptive study was conducted.The clinicopathological data of 13 patients with pancreatic cancer involving in PV,splenic vein or junction who were admitted to the Beijing Chao Yang Hospital of Capital Medical University from March 2014 to June 2015 were collected.The superior mesenteric artery (SMA),tumors and soft tissues (including involved vessels) in the right of the celiac trunk were resected after exploring SMA and evaluating resectability of tumors.Patients underwent PV-splenic vein resection and reconstruction with allogenic vein.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor recurrence and metastasis up to April 2016.Measurement data with normal distribution were represented as (x)±s.Results (1) Surgical situations:13 patients successfully underwent radical pancreaticoduodenectomy via artery approach in the lower colon region combined with PV,splenic vein resection and allograft vascular grafts.Operation time and volume of intraoperative blood loss were respectively (489 ± 31) minutes and (407 ± 96) mL,without intra-and post-operative deaths.(2)Postoperative situations:of 13 patients,3 and 1 patients were respectively complicated with pancreatic fistula (2 in grade A and 1 in grade B) and gastroplegia,and cured by conservative treatment.There was no occurrence of bleeding,intraperitoneal infection,diarrhea,anastomotic stenosis and thrombus.The median duration of postoperative hospital stay was 12 days.Results of postoperative pathological examination:of 13 patients,high-,moderate-and low-differentiated adenocarcinoma was detected in 2,7 and 4 patients respectively.Three patients had negative vascular margin,2 had tunica intima invasion and 8 had tumor cell invasion in vascular adventitia.One,2,6,4 patients were detected in Ⅰ B,Ⅱ A,Ⅱ B and Ⅲ staging,respectively.The negative margin rate by postoperative pathological examination was 11/13.(3) Follow-up situation:13 patients were followed up 10 months postoperatively,with good survival and without tumor recurrence or metastasis.Conclusion The radical pancreaticoduodenectomy via artery approach in the lower colon region combined with PV/SMV resection and allograft vascular grafts is safe and feasible for pancreatic cancer involving in PV,splenic vein or junction,it can also evaluate early resectability of tumors,with good operative efficacy.
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Objective To investigate the application value of artery approach in the lower colon region combined with portal vein (PV) resection and allograft vascular grafts in radical pancreaticoduodenectomy for pancreatic cancer combined with vascular invasion.Methods The retrospective descriptive study was conducted.The clinicopathological data of 13 patients with pancreatic cancer involving in PV,splenic vein or junction who were admitted to the Beijing Chao Yang Hospital of Capital Medical University from March 2014 to June 2015 were collected.The superior mesenteric artery (SMA),tumors and soft tissues (including involved vessels) in the right of the celiac trunk were resected after exploring SMA and evaluating resectability of tumors.Patients underwent PV-splenic vein resection and reconstruction with allogenic vein.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor recurrence and metastasis up to April 2016.Measurement data with normal distribution were represented as (x)±s.Results (1) Surgical situations:13 patients successfully underwent radical pancreaticoduodenectomy via artery approach in the lower colon region combined with PV,splenic vein resection and allograft vascular grafts.Operation time and volume of intraoperative blood loss were respectively (489 ± 31) minutes and (407 ± 96) mL,without intra-and post-operative deaths.(2)Postoperative situations:of 13 patients,3 and 1 patients were respectively complicated with pancreatic fistula (2 in grade A and 1 in grade B) and gastroplegia,and cured by conservative treatment.There was no occurrence of bleeding,intraperitoneal infection,diarrhea,anastomotic stenosis and thrombus.The median duration of postoperative hospital stay was 12 days.Results of postoperative pathological examination:of 13 patients,high-,moderate-and low-differentiated adenocarcinoma was detected in 2,7 and 4 patients respectively.Three patients had negative vascular margin,2 had tunica intima invasion and 8 had tumor cell invasion in vascular adventitia.One,2,6,4 patients were detected in Ⅰ B,Ⅱ A,Ⅱ B and Ⅲ staging,respectively.The negative margin rate by postoperative pathological examination was 11/13.(3) Follow-up situation:13 patients were followed up 10 months postoperatively,with good survival and without tumor recurrence or metastasis.Conclusion The radical pancreaticoduodenectomy via artery approach in the lower colon region combined with PV/SMV resection and allograft vascular grafts is safe and feasible for pancreatic cancer involving in PV,splenic vein or junction,it can also evaluate early resectability of tumors,with good operative efficacy.
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Objective To investigate the risk factors of postoperative infection in patients with liver transplantation.Methods Clinical data and laboratory findings of 1 1 3 patients undergoing liver transplantation admitted in Beijing Chaoyang Hospital,Capital Medical University during January 201 1 and December 201 4 were retrospectively analyzed.Among 1 1 3 patients,postoperative infection occurred in 35 patients,multivariate Logistic regression analysis was performed to identify the risk factors of postoperative infection.Results Univariate analysis showed that length of hospital stay,model for end-stage liver disease (MELD)score,preoperative use of antibiotics,duration of postoperative respirator use,length of ICU stay, dosage of albumin,days of parenteral nutrition,intra-abdominal hemorrhage,fasting blood glucose,blood concentration of immunosuppressant (FK506 ),the duration of prophylactic use of antibiotics and pleural effusion were associated with postoperative infection (t =2.56,3.1 9,2.71 and 5.05;χ2 =3.87,5.75,4.66 and 5.46;Z =4.88,3.69,5.86 and 3.90;P <0.05 or <0.01 ).Multivariable logistic regression analysis showed that preoperative use of antibiotics (OR =35.03,95% CI:6.48 -94.64,P <0.01 ),duration of postoperative respirator use (OR =1 .02,95%CI:1 .01 -1 .04,P <0.01 ),days of parenteral nutrition (OR =1 .20,95%CI:1 .07 -1 .35,P <0.01 ),postoperative fasting plasma glucose(OR =1 .46,95%CI:1 .1 0 -2.1 6,P <0.05),the duration of prophylactic antibiotics use (OR =1 .1 0,95%CI:1 .33 -1 .86, P <0.05),and pleural effusion(OR =5.70,95%CI:1 .02 -31 .84,P <0.05 )were independent risk factors of postoperative infection.Conclusion Taken account of possible risk factors,effective prevention and control measures should be taken to prevent postoperative infection after liver transplantation.
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Acute rejection is one of the serious early postoperative complications after liver transplantation.Many studies have shown that acute rejection was mainly mediated by T cells,while humoral factors were responsible for chronic rejection.However,accumulating evidences have demonstrated that humoral immune factors also played an important role in early acute rejection and usually resulted in severe adverse events.Here we clarify the role of humoral immunity in liver transplant rejection,which may help guide the clinical management of such patients with humoral rejection after liver transplantation.
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Objective To study the clinical significance of CD39 on regulatory T (Treg) cells in the peripheral blood (PB) of patients following liver transplantation and to evaluate the relationship between the levels of CD39+ Treg cells in the PB and acute rejection.Methods A prospective study was conducted to compare the CD39+ Treg cells from 76 liver transplant patients with those coming from 20 age-matched healthy individuals.The PB samples were collected within one year at different time points post-transplant.Blood samples and liver biopsies were collected at the time when acute rejection was diagnosed.The percentages of CD39 within the CD4+ CD25+ T cells were measured by using flow cytometry.The liver transplant patients were classified into two groups:the rejection group which consisted of 17 patients who an episode of acute rejection,and the non-rejection group consisted of the remaining 59 patients who had no acute rejection episodes.The percentages of CD39 within the CD4 + CD25 + T cells and the inhibition function of the CD39+ Treg cells were compared between the two liver transplant groups.Results The percentages of CD39 within the CD4+ CD25+ cells were significantly lower in the rejection group during acute rejection as compared to the non-rejection group (P ＜ 0.05).The percentages of CD39 within the CD4 + CD25 + cells were negatively correlated with the Rejection Activity Index (r =-0.86,P ＜ 0.05).The inhibition rate regarding the CD4+ CD25+ CD39+ Treg cells in patients with acute rejection was significantly lower than those without rejection (P ＜ 0.05).Conclusions The percentages of CD39 within the CD4+ CD25+ T cells were significantly lower in the rejection group during acute rejection and were negatively correlated with the RAI.The inhibition rate regarding the CD4+ CD25+ CD39+ Treg cells in patients with acute rejection was significantly lower than those without rejection.
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<p><b>OBJECTIVE</b>To investigate the clinical predictors of cytomegalovirus (CMV) infection after liver transplantation.</p><p><b>METHODS</b>The clinical data of 182 patients (146 male and 36 female with a mean age of (50 ± 7) years) receiving liver transplantation in Beijing Chaoyang Hospital between January 2004 and December 2008 were retrospectively analyzed.All patients were divided into two groups, namely the CMV infection group (n=24) and the control group (n=158). Logistic regression was used to identify the predictive factors of postoperative CMV infection.</p><p><b>RESULTS</b>According to univariate analysis results, the factors for CMV infection were acute liver failure (P=0.032), MELD score ≥ 30 (P=0.001), liver retransplantation (P=0.002), acute rejection (P=0.000) and delayed graft function (P=0.022). According to multi-analysis results, MELD score ≥ 30 (P=0.037, 95%CI:1.194-271.461) and acute rejection (P=0.033, 95%CI:1.179-51.863) were proved to be independent predictors by multivariate analysis.</p><p><b>CONCLUSION</b>The study indicates that MELD score ≥ 30 and acute rejection are the independent predictors of CMV infection.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Beijing , Cytomegalovirus Infections , Diagnosis , End Stage Liver Disease , Diagnosis , Graft Rejection , Liver Transplantation , Logistic Models , Multivariate Analysis , Postoperative Complications , Virology , Reoperation , Retrospective Studies , Severity of Illness IndexABSTRACT
To study the relationship between T helper (Th) 17 cell [CD4 +interleukin (IL)-17 +T lymphocytes]in peripheral blood and acute rejection in patients after liver transplantation.Methods A total of 76 patients receiving orthotopic liver transplantation (OLT)for benign end-stage liver diseases in Department of Hepatobiliary and Pancreas-Spleen Surgery,Affiliated Beijing Chaoyang Hospital of Capital Medical University from June 2008 to December 2012 were included in this study. According to whether the acute rejection occurred after operation,the patients were divided into rejection group (n=17)and non-rejection group (n=59). All the patients were followed up regularly by routine. The incidence of rejection and the treatment of patients were recorded. Patients in the rejection group received liver biopsy when suffered acute rejection to decide the severity. The percentage of CD4 +IL-17 +T lymphocytes to CD4 +T lymphocytes (CD4 +IL-17 +T%)in peripheral blood in all patients was measured at different time points:pre-OLT,at regular intervals (3-6 months)within 1 year after hospital discharge or before the treatment of acute rejection and after the remission (3-6 months). The CD4 +IL-17 +T% of every time point were compared between two groups.The correlations of CD4 +IL-17 +T% with the rejection activity index (RAI ), blood concentration of immunosuppressor were analyzed.Results The acute rejection occurred in 0.7-12.0 (median:2.5 ) months after OLT. The CD4 +IL-17 +T% in the rejection group increased significantly compared with that in the non-rejection group after OLT [(2.56 ±0.43)%vs. (1.79 ±0.44)%,P<0.001]. In the rejection group,the CD4 +IL-17 +T% increased significantly when acute rejection occurred compared with that when acute rejection had not occurred [(2.56 ±0.43)%vs. (1.50 ±0.25)%,P<0.001)]. The variation of CD4 +IL-17 +T%was not obvious at different time points in non-rejection group (P >0.05 ). The CD4 +IL-17 +T% was positively correlated with RAI when acute rejection occurred in the rejection group (r=0.72,P=0.001 ).The blood concentration of tacrolimus,cyclosporin in rejection and non-rejection group were not correlated with CD4 +IL-17 +T% (r=0.21,-0.13;both in P>0.05). Conclusions CD4 +IL-17 +T%in peripheral blood can be used as a monitoring index for deciding and assessing severity of acute rejection after OLT. The increase of CD4 +IL-17 +T% in peripheral blood indicates a severe acute rejection.
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Objective To investigate the curative effect of percutaneous transhepatic cholangial drainage(PTCD) on patients with non-anastomotic stricture after liver transplantation when treated with endoscopic retrograde cholangio-pancreatography(ERCP) unsuccessfully.Method The clinical data of 29 patients with non-anastomotic biliary stricture after liver transplantation were retrospectively analyzed,who failed to respond to ERCP and underwent PTCD from January 2005 to December 2007.Result All patients were performed PTCD successfully including cholangiography in 141 cases,drainage tube replacement in 115 cases,and balloon dilation of bile duct stricture in 39cases.The intubation time ranged from 2 months to 65 months.The mean levels (x ± SD) of alanine aminotransferase,aspartate aminotransferase and total bilirubin were 68.0 ± 29.1 U/L,52.6 ± 34.8 U/L,63.2 ± 33.3 μmol/L after treatment in comparison to 178.3 ± 63.3 U/L,144.0 ± 59.1 U/L,154.2 ± 92.0 μmol/L before treatment.Conclusion PTCD,which could improve the symptoms and prolong the survival time of both grafts and patients in spite of inconvenience of intubation,is suggested for patients with non-anastomotic biliary stricture if they are not suitable for liver retransplantation.
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ObjectiveTo evaluate the feasibility and efficacy of ex-vivo liver resection combined liver autotransplantation for patients with massive primary liver cancer who underwent complex liver resection.Methods The clinical data of 4 patients suffering from massive primary liver cancer who were admitted to the Beijing Chaoyang Hospital from January 2008 to May 2010 were retrospectively analyzed.Regular liver resection could not be carried out because the first,second and third hepatic hilum of the 4 patients were invaded by the tumors,so ex-vivo liver resection combined liver autotransplantation were performed.ResultsThe operation was successfully carried out for the 4 patients.The operation time,the duration of anhepatic phase and the volume of operative blood loss were 690-840 minutes,250-300 minutes and 400-1400 ml,respectively.Portacaval bypass operation was not performed.After ex-vivo liver resection,the inferior vena eava or hepatic vein and portal vein of the 4patients were repaired,and the allogenous blood vessels were kept to extend the superior vena cava of the remnant liver so as to facilitate the anastomosis of blood vessels and reconstruction of the first hepatic hilum. After operation,the hepatic function of 1 patient was back to normal; 1 patient who stfffered from abdominal hemorrhage received reoperation for hemostasia; 1 patient was found with hepatic dysfunction; 1 patient died of hepatorenal dysfunction at postoperative day 5.Compensatory hypertrophy was observed in the 3 patients who survived at postoperative months 1-2.Of the 3 patients,2 were found with multiple pulmonary metastases at postoperative months 8 and 9,and they died at postoperative mouths 13 and 15.Until April 2012,1 patient survived for 37 months with no tumor recurrence or metastasis. ConclusionsEx-vivo liver resection combined liver autotransplantation provides the technical feasibility for performing complex liver resection for patients. The incomplete compensation of liver function and the short-term recurrence of tumors after operation are still the main issues which hinder the development of this technique.
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Objective To investigate the use of laparoscopic ultrasound to exclude cystic duct obstruction and its related risk factors in laparoscopic cholecystectomy.Methods The data of 28 patients who underwent laparoscopic cholecystectomy in our department for cystic duct obstruction from February 2008 to April 2010 were analyzed.Subtotal resection of gallbladder and exclusion of cysticduct were carried out when the gallbladder triangle anatomy was not clear.An abdominal drain was used.Results All the patients were cured and there was no bleeding,abdominal infection,or jaundice.On univariate analysis,risk factors for cystic duct obstruction were adhesions in Calot triangle,gallbladder atrophy,acute cholecystitis,cystic duct stone incarceration,gallbladder wall thickening and white bile.Adhesion in Calot triangle,acute cholecystitis and white bile were independent risk factors on multivariate analysis.Conclusion Excluding cystic duct obstruction by laparoscopic ultrasound for patients who underwent laparoscopic cholecystectomy for cystic duct obstruction is safe and effective.
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Objective To investigate the expression of peripheral blood (PB) CD4+ CD25+ Foxp3+ regulatory T cells (Tregs) in patients with benign end-stage liver disease after liver transplantation and the relationship between levels of PB Tregs and acute rejection. Methods A prospective analysis was performed on 55 consecutive patients who underwent liver transplantation.Fourteen out of 55 cases suffered from acute rejection after liver transplantation were defined as rejection group,while the rest patients were classified into no acute rejection group. PB was obtained from liver transplant patients at different time points longitudinally: pre-transplant, post-transplant within one year and acute rejection. The circulating CD4+ CD25+ Foxp3+ Tregs in PB were measured by flow cytometry. Blood samples were drawn during acute rejection, at the same time, liver biopsies were performed. The circulating CD4+ CD25+ Foxp3+ Tregs were compared between two groups.Results There was no difference between two groups in levels of circulating CD4+ CD25+ Foxp3 + Tregs cells pre-transplant. However, the levels of circulating CD4+ CD25+ Foxp3+ Tregs in rejection group were decreased significantly as compared with no-rejection group (2. 23 % ± 0. 54 % vs. 2. 99 % ±0. 86 %,P＜0.01). The frequency of CD4+ CD25+ Foxp3+ T cells was negatively correlated with rejection activity index (RAI) (r = - 0. 80, P＜0. 01 ). Conclusion Monitoring PB CD4+ CD25+ Foxp3+ Tregs levels may be helpful in evaluating the immune state and act as a more sensitive marker for acute rejection diagnosis in the patients following liver transplantation.
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Objective To probe the indication of biliary tract reconstruction without T-tube in orthotopic liver transplantation.Methods We put forward indications of biliary tract reconstruction without T-tube in orthotopic liver transplantation since January 2004 and there were 102 patients who underwent liver transplantation in our hospital without a T-tube in place after biliary tract reconstruction.The incidence of biliary tract complication was observed in these patients.Results All patients were followed up for more than 6 months.The incidence of biliary tract complication was 4.9 percent(5/102)in this group with 3 patients of intrahepatic difluse bile duct stenosis necessitating liver re-transplantation.The other 2 patients with common hepatic duct nonanastomotic stenosis were healed by ERCP plus stent placement.Conclusions Biliary tract reconstruction without T-tube placement helps to decrease the incidence of biliary tract complications resulting from the T-tube removal.
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0 05), respectively The 5 year survival rate was 38 7%( n =750) The 5 year survival rate of patients undergoing radical resection A and B ( n =561) was 49 9%, that of palliative resection was 5 3% The 5 year survival rate of D 0/D 1、D 2 and D 3/D + 3 lymph node dissection were 30 4% ( n =286), 59 9%( n =197) and 31 8%( n =267), respectively Of stage Ⅲ patients, the 5 year survival rate of D 2 and D 3/D + 3 lymph node dissection were 42 3% ( n =52), and 59 2% ( n =98), respectively ( P
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Objective To explore causes leading to and the timing of liver retransplantation. Methods Among 164 cases of liver transplantation from Jul. 1999 to Dec. 2004, 6 cases underwent retransplantation with an incidence of 3. 65%. Causes included multiple intrahepatic bile duct stricture by ischemic reperfusion injury in 3 cases, hepatic artery stricture and thrombosis, hepatitis B recurrence, outflow obstruction of hepatic veins in one each. Results Clinical symptom improved in 4 cases, and failed to improve in 2 cases. Two cases suffered from intraabdominal bleeding, one biliary leak, one bacterial infection, two mold infection. Two patients died from bacterial and mold infection in four months. Conclusion Ischemic reperfusion injury is main cause resulting in intrahepatic bile duct stricture, liver retransplantation should be performed when the function of graft deteriorates significantly and conservative therapy fails.