Liver transplantation from donor liver of organ donation after citizen's death: a single center experience / 器官移植

Objective To evaluate the application value of donor liver from organ donation after citizen's death (organ donation) in clinical liver transplantation. Methods Clinical data of 75 pairs of donors and recipients undergoing liver transplantation from organ donation in the First People's Hospital of Foshan from October 2011 to December 2016 were retrospectively analyzed. The conditions of the donors were strictly evaluated. Clinical prognosis and the incidence of postoperative complications of the recipients were summarized. Results The 1-year and 3-year accumulated survival rates of 75 liver transplantation recipients were 88% and 78%. Four recipients died from the recurrence and metastasis of liver cancer, 1 case from graft-versus-host disease, 1 case from severe pulmonary infection, 1 case from recurrence of virus B hepatitis (hepatitis B) and liver failure, 1 case from postoperative multiple organ failure and 1 case from massive hemorrhage of the upper digestive tract. Thirteen recipients suffered from biliary tract stenosis. One case was mitigated spontaneously and 1 recipient was healed after percutaneous transhepatic biliary drainage (PTBD). Eleven cases were treated with endoscopic retrograde cholangiopancreatography (ERCP). Among them, 5 cases were healed,2 recipients were switched to choledochojejunostomy and 4 cases were still monitored in clinical practice. Conclusions Liver transplantation from organ donation yields high clinical efficacy. Strict evaluation of donor conditions, standard perioperative management of the recipients, maintenance immunosuppressive therapy without adrenocortical hormone,timely and effective treatment of complications, regular postoperative follow-up are pivotal measures to guarantee the success of liver transplantation from organ donation and long-term survival of the recipients.

Effects of Liver Function in Patients with Liver Cirrhosis and Virus B Hepatitis on Drug Half-life and An-algesic Effect of Target Controlled Infusion of Remifentanil / 中国药房

OBJECTIVE:To explore the safety and effects of liver function in patients with liver cirrhosis following virus B hepatitis(called“hepatitis B”for short)on drug half-life and analgesic effect of target controlled infusion of remifentanil. METH-ODS:100 patients with liver cirrhosis following hepatitis B underwent liver and gallbladder surgery under selective general anesthe-sia were collected from our hospital and divided into group A(mild abnormal liver function)and group B(severe abnormal liver function,3 cases withdrew from the test and 47 cases completed the test),with 50 cases in each group,according to Child-Pugh grading of liver function. Both group were given phenobarbital sodium 0.1 g+scopolamine 0.3 mg intramuscularly 0.5 h before oper-ation;midazolam 0.04 mg/kg+propofol 1.5 mg/kg+atracurium 0.6 mg/kg intravenously;target controlled infusion of Remifentanil hydrochloride for injection during operation with 0.125-0.250 μg/(kg·min). The distribution half-life and the elimination half-life of remifentanil were determined, and temperature pain perception threshold (tPDT) and electrical pain perception threshold (ePDT) were measured immediately after the operation;the occurrence of ADR was observed. RESULTS:The distribution and elimination half-life of remifentanil were (4.52 ± 1.25)min and(24.64 ± 1.30)min in group A and (4.68 ± 1.31)min and(25.45 ± 2.08)min in group B respectively,there was no statistical significance between 2 groups(P>0.05). tPDT and ePDT of group A were(8.88± 1.66)mA and(1.54±0.09)mA respectively,and those of group B were(9.16±1.58)mA and(1.34±0.15)mA,there was no sta-tistical significance between 2 groups (P>0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:The abnormal liver function of patients with liver cirrhosis following hepatitis B have no significant effect on drug half-life and analgesic effect of remi-fentanil with good safety.

Virus B e interferón / Virus B and interferon

La aparición de nuevas drogas y formas de diagnóstico, han transformado la hepatitis crónica B de una enfermedad fatal a una manejable y aún curable. Se distinguen dos tipos de enfermedad crónica por virus B, la que se desarrolla con antígeno e positivo y la que cursa con antígeno e negativo. La enfermedad crónica puede presentarse con ALT normal, ALT en continua elevación, fluctuaciones de ALT sin llegar a ser normales o elevaciones intermitentes. El éxito de la terapia antiviral para el virus B incluye, suprimir la replicación viral al nivel más bajo posible, lograr mejoría bioquímica e histológica y prevenir el desarrollo de complicaciones. Existen dos estrategias de tratamiento para el virus B, una de duración limitada (interferones) y otra de largo plazo (análogos nucleós(t)idos). Existen factores que influencian favorablemente la respuesta al tratamiento con interferón: niveles bajos de HBV DNA, niveles altos de ALT, niveles bajos de HBeAg y genotipos A y B. En el manejo de la enfermedad crónica tanto por virus B e ( + ) y e ( - ) se han utilizado interferón αlfa y actualmente el interferón pegilado α-2a. El interferón pegylado también ha mostrado ser superior al interferón simple en cuanto a normalización de ALT, pérdida del HBe y pérdida sostenida del HBV DNA. El interferón pegylado también ha mostrado ser superior a la terapia combinada o a la lamivudina sola en cuanto a rangos de respuesta y seroconversión en e (+) y e (-). En los pacientes e (-) sigue existiendo controversia por ameritar tratamiento a largo plazo el uso de interferón o iniciar con análogos nucleósidos.

The appearance of new drugs and new forms of diagnosing has transformed chronic hepatitis B from being a lethal disease to becoming a treatable and even curable disease. There are two kinds of chronic hepatitis B, one that develops with antigen e positive and the other one with antigen e negative. This chronic disease can appear with normal ALT, ALT continuous elevation, and ALT fluctuations without becoming normal or intermittent elevations. The success of the antiviral therapy for HBVincludes, suppressing the replicative state to the lowest level possible, getting biochemical and histological amelioration; and preventing the development of complications. There are two strategies for HBV treatment, one with limited duration (interferon) and the other long term treatment (nucleotide analogue). There are factors that influence satisfactorily, the response to the treatment with interferon: low levels of HBV DNA, high levels of ALT, long levels of HBeAg and A & B genotypes. Alpha interferon and more recently Pegylated α-2a have been used for the management of HBVe (+) and HBVe (-). The Pegylated interferon has shown to be more effective than conventional interferon, in terms of ALT normalization, HBe loss, and sustainable loss of HBV DNA. The Pegylated interferon has also shown to be superior to the combined therapy or only to lamivudine, in terms of range response and seroconversion in e (+) and e (-). There is still controversy when treating patients with e (-) who need long term usage of interferon or those who need to start nucleoside analogue.