ABSTRACT
Objective To study the effects of ischemia-reperfusion in liver transplantation on the pathophysiological changes of the lung and mechanisms of lung injury. Methods We studied 23 patients who received liver transplantation at Fuzhou General Hospital of PLA. We cut a small piece of the right lung for pathological study and for L-1β and TNF-a immunohistochemistry studies at 5 minutes after the beginning of operation (Ta), 5 minutes before the portal vein was opened (Tb) and three hours after the new liver was transplanted (Tc). We also collected peripheral blood to study the concentration of IL-1β and TNF-a in the plasma at the beginning of operation (T1), the portal vein 5 minutes before opening, the portal vein (T2) ten minutes after the opening (T3) , and one hour after the new liver was transplanted (T4), three hours after the new liver was transplanted (T5), and 12 hours after operation (T6). Results The cytokines TNF-a and IL-1β in peripheral blood were not obviously increased in the portal vein before it was opened, but were significantly increased after the portal vein was opened. Comparison of T1 and T2 separately with T3, T4 and T5 showed significant differences (P<0. 01). In light and electron microscopy, the structures of the lung tissues were normal at Ta and did not change significantly at Tb. There were significant abnormalities at Tc. The average positive points of TNF-a and IL-1β expressions in the lung tissues at Tc were significantly higher than Ta and Tb(P<0. 01). Conclusion Ischemia-reperfusion in liver transplantation led to a serious systemic inflammatory syndrome,and acute lung injury. TNF-a and IL-1β were involved in acute lung injury.
ABSTRACT
Objective To investigate the efficiency of model for end-stage liver disease(MELD)score,serum sodium concentration and aseites condition in the evaluation of short-term survival rate of patients with benign end-stage hepatopathy after liver transplantation.Methods The clinical data of 98 patients with benign end-stage hepatopathy who had undergone liver transplantation in Fuzhou General Hospital from January 1999 to February 2007 were retrospectively analyzed.The relationship between serum sodium concentration.ascites condition and the prognosis of patients with the same MELD score was analyzed.Kaplan-Meier survival curve was drawn.The 1-year survival rate of the patients was analyzed by chi-square test.The mortality of patients with the same MELD score at the end of the third month after operation was analyzed by Fisher's exact test.Results MELD score of aIJ patients was 15-25 or＞25.The postoperatire 3-month mortality rates of patients with serum sodium concentration≥130 mmol/L were 5%and 15%.which were significantly lower than 33%and 55%of those with serum sodium concentration＜1 30 mmol/L.The difference upon 1-year survival rates between them had statistical significance(x2:12.88,P＜0.05).The postoperative 3-month mortality rates of patients without ascites were 5%and 8%.which were lower than 35%and 57%of those with aseites.and the difference upon 1-year survival rates between them had statistical significance(X2=15.26.P＜0.05).Conclusions It is more accurate to evaluate the short-term survival rate after liver transplantation for benign end-stage hepatopathy by combining the MELD score with serum sodium concentration and ascites condition.