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Objective To investigate the occurrence and prevention measures of long term complications in long term survival recipients after liver transplantation.Methods In the recipients undergoing liver transplantation from Sept. 2003 to Dec. 2004,by Nov. 30,2011,there were 62 cases with the survival time more than seven years.The clinical data and follow up examination results of these 62 cases were retrospectively,including weight,blood pressure,blood sugar,blood lipids,and liver and kidney functions. The incidence of long-term complications was statistically tested.Results Postoperative metabolic complications including overweight or obese occurred in 21 cases (33.9％), new onset diabetes in18 patients (29％), hyperlipidemia in 17 cases (27.4％),hypertension in 9 cases ( 14.5 ％ ),and kidney dysfunction in 12 patients ( 19.4％ ).The incidence of diabetes and hyperlipidemia in the patients with overweight and diabetes (respectively 52.4％ and 42.9％) was significantly higher than in the normal weight group (respectively 17.1 ％ and 19.5 ％)(P＜0.05).In 58 recipients with primary diseases of hepatitis B-related liver diseases,one case had hepatitis B virus reinfection. In 17 recipients with primary disease of primary liver cancer,tumor recurrence occurred in 2 cases.During the follow up period,4 patients received liver re-transplantation due to hepatic artery stenosis (1 case) or biliary complications-induced loss of the transplanted liver function (3 cases).Conclusion The major complications of the long term survival recipients after liver transplantation are metabolic complications and primary disease relapse. Postoperative long-term follow up and monitoring of recipients is recommended to prevent and treat a variety of long-term complications.
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Objective To investigate immune status changes in liver transplant patients suffering from early developed sepsis.Methods In this study 19 patients undergoing liver transplantation for severe hepatitis from Oct 2008 to Jul 2009 were enrolled.Immune status was compared between patients of severe hepatitis and 20 healthy volunteers.According to whether early sepsis developed or not,patients were divided into sepsis group (HSS) and non-sepsis group (HSNS).T lymphocyte subgroups of the peripheral blood were compared between post-transplant and pre-transplant in these two groups on different stages.Results Comparing to volunteers,T％ and IFN-γ/IL-4 of severe hepatitis patients significantly decreased,CD4 + CD25 + Foxp3 + Treg( ％ ),Foxp3 mRNA and IL-10 significantly increased.Early sepsis developed in 9 patients.Compared with pre-transplant levels,T％ in both groups significantly decreased on the first day post transplant.T％ in HSNS group increased to the level of pretransplant while T％ of HSS group remained at the low level.Treg％ ( t =3.265,P =0.004 ) and Foxp3 mRNA ( t =2.750,P =0.013 ) of HSNS group on day 14 decreased significantly lower than that before transplantation.Those two parameters of HSS group even increased slightly.IFN-γ/IL-4 in HSNS group increased significantly on day 3 (t =2.261,P =0.036),while there was no change in HSS group.The concentration of IL-10 in both groups significantly decreased,and the level in HSNS group remained at a low level,while that in HSS group increased on day 14.Conclusions Patients with severe hepatitis have weakened immune status.The imbalance of immune status recovers gradually since 7-14 days after transplantation in patients uncomplicated with sepsis.However,the immune status of receipients complicated with sepsis fails to improve.
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ObjectiveTo evaluate the effect of mycophenolate mofeil (MMF) combined with dose-decreased calcineurin inhibitors (CNIs) in patients who received liver transplanation with chronic kidney malfunction.Methods28 liver transplant patients with chronic kidney malfunction were prospectively included in this study.MMF was initiated and the dose of the original immunosuppressive drug CNIs decreased.The change in renal function and adverse events were evaluated.ResultsOne patient was discontinued with MMF treatment because of serious myelosuppression.The other 27 patients were treated with MMF with a median of 30.8 months.The basal creatinine values and the basal creatinine clearance were ( 134.26 ± 27.25) μmol/1 and (57.70 ± 16.93) ml/min,respectively.The basal glomerular filtration rate was (53.91±11.63) ml/min.The creatinine values at 1,3,6,12,24 and 36 months were 124.30±28.27 (P=0.006),130.19±29.29 (P=0.174),125.49±38.18 (P=0.194),119.71±31.36 (P=0.010),137.43±42.55 (P＝0.804),and (139.04±39.80) μmol/L (P=0.916).And the creatinine clearance values at 1,3,6,12,24 and 36 months were 62.57±19.29 (P=0.008),61.18± 19.70 (P=0.086),64.27±22.82 (P=0.018),67.48±22.59 (P=0.002),57.18±19.55 (P=0.405),and (54.56±23.48) ml/minute (P=0.708),respectively.The glomerular filtration rate at 1,3,6,12,24 and 36 months were 59.20 ± 14.05 (P=0.006),56.61±14.01 (P=0.04),60.47±17.33 (P=0.016),63.59±17.66 (P=0.002),53.75±13.60 (P=0.369),and (51.70±16.07) ml/min (P＝0.703).One patient (3.7％) had mild acute rejection.5 patients (18.5 ％ ) had mild abdominal distention or diarrhea.2 patients (7.4％) had ischemic cholangitis.No patient had cytomegalo virus infection or tumor recurrence.ConclusionIn liver transplant recipients with chronic renal dysfunction,MMF allowed CNIs dose reduction or discontinuation,improved or stabilized renal function in most patients and it had only mild adverse events.
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[Objective] To investigate the incidence and risk factors for posttransplantation anemia (PTA) following kidney transplantation. [Methods] A retrospective cohort study reviewing the medical records of the patients who received a renal transplant at our center from January 2004 to June 2008 was performed. All possible risk factors for PTA were recorded. Outcomes among the patients with PTA were compared with those without PTA using t-test and chi-square analysis methods. Logistic regression analysis was done to rank the relative risk of potential variables and calculate the 95% CI. [Results] Prevalence of PTA in our center was 31.0% (hemoglobin <120 g/L or Hct< 0.38 for males, < 110 g/L or Hct < 0.35 for males). Univariate and Logistic regression analysis revealed that the risk factors for PTA after kidney transplantation were female (RR=8.738; 95%CI 2.558～29.853; P= 0.001), creatinine level (RR=1.035; 95%CI 1.018～1.052; P<0.001) and acute rejection (RR=19.827; 95%CI 2.056～191.19; P=0.01); [Conclusions] PTA is a frequent complication after kidney transplantation. Great attention should be paid to this complication considering its negative effect on graft function. Female, impaired renal function and acute rejection are risk factors of anemia in kidney transplantation recipients.
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Objective To explore the relationship between hepatitis B virus (HBV) concentration and hepatocellular carcinoma (HCC) recurrence in HCC patients undergoing orthotopic liver transplantation (OLT). Methods 148 HCC patients associated with HBV infection undergoing OLT were enrolled in the study.Survival analysis was performed using the Kaplan-Meier method.Cox multiple regression analysis was performed to determine the parameters predicting HCC recurrence. Results Survival rates at 1,3 and 5 years were 86%,72% and 72%,respectively,and disease-free survival rate were 79%,71% and 54%,respectively.In this series 43 patients suffered from HCC recurrence.The recurrence rate was 29.1%(43/148),with the mean recurrence time being (13.16 ± 14.17) months (1 ～ 54 months).Exceeding Milan criteria (HR = 9.89; 95% CI 2.30 ～ 42.52; P = 0.002) and pretransplant HBV DNA level ＞ 5log10copies/ml (HR = 2.26; 95% CI 1.01 ～ 5.04; P = 0.047) were significant independent predictors for posttransplant HCC recurrence. Conclusion High HBV DNA load before transplantation is statistically associated with recurrence of HCC after liver transplantation.
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16,95% CI 0.074-0.628 ,P<0.05) and diabetes mellitus history(RR=3.023,95% CI 0.998-9.157,P≤0.05).
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Objective To investigate the prevention of gram-positive cocci infection by oral administration of vaBeomvcin after liver transplantation. Methods Eighty patients who underwent liver transplantation from September 2005 to September 2006 were divided into vaneomycin group and control group.All the patients were intravenously infused with piperacillin + tazobatam to prevent infection after liver transplantation.Patients in vancomycin group were given vancomycin orally in the first 7 days after liver transplantation and vancomycin concentration in the blood were measured at the same time.Infection and stool cocci and bacilli ratio of the patients in the 2 groups were observed.Results Seven patients in vancomycin group and 15 patients in control group(including 3 and 10 patients infected with methicillin resistant staphylococcus aureus in each group)were infected with grampositive cocci,respectively,with statistical difference(x2=4.501,P＜0.05).Three patients in vancomycin group and 10 patients in control group presented with imbalance of gastrointestinal flora,with statistical difference (x2=4.501,P＜0.05).No statistical difference was found in the patients infected with gram-negative bacilli or fungi between the 2 groups(x2=0.065,0.251,P＞0.05).The vancomycin concentration was 0 in the blood of patients who simply took vancomycin.Conclusions It is safe and effective to take vancomycin orally to prevent gram-positive cocci infection and imbalance of gastrointestinal flora after liver transplantation.