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Ischemia-reperfusion injury is one of the main causes of complications related to liver transplantation, hepatectomy, trauma and hemorrhagic shock. The cells of ischemia and hypoxic injury release of injury-related molecular patterns, lead to the activation of immune cells and cytokine, which further aggravates the inflammatory response and enlarges the injury. It ' s indicated that injury-related molecular patterns, liver resident immune cells and cytokines play a key role in promoting inflammation and liver ischemia-reperfusion injury. However, recent studies suggested that the ischemia cells and cytokines played acomplex role in this process. Relevant progresses were reviewed in this article.
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Ischemia-reperfusion injury is one of the main causes of complications related to liver transplantation, hepatectomy, trauma and hemorrhagic shock. The cells of ischemia and hypoxic injury release of injury-related molecular patterns, lead to the activation of immune cells and cytokine, which further aggravates the inflammatory response and enlarges the injury. It’s indicated that injury-related molecular patterns, liver resident immune cells and cytokines play a key role in promoting inflammation and liver ischemia-reperfusion injury. However, recent studies suggested that the ischemia cells and cytokines played acomplex role in this process. Relevant progresses were reviewed in this article.
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Objective To investigate the effect of regulatory dendritic cells treated by extracorporeal photochemotherapy on T cell proliferation. Methods Human peripheral blood mononuclear cells (PBMCs) were obtained and the immature dendritic cells (imDCs) were induced by recombinant human granulocyte and macrophage colony stimulating factors. SPDCs were obtained by PUVA treatment, and ECDCs were co-cultured with imDCs and PUVA-SP to obtain immunoprecipitated dendritic cells. In vitro, imDCs were co-cultured with SPDCs to obtain SPDCs; imDCs were added to 10ng/ml of LPS, and cultured for 1 day to obtain DCs. The expressions of CD11c, CD83 and CD86 on the surface of the cells were detected. The effect of imDCs on the proliferation of recipient T cells was detected by mixed lymphocyte culture method. Results The early apoptosis rate of PUVA-treated cells was 91.33%. The positive expression rates of CD83 and CD86 in ecpDCs were 22.83%±5.26% and 22.06%±4.37%, respectively, which were similar to those of imDCs (15.06%±0.59%, 15.19%±1.83% (P<0.01), but significantly lower than those in DCs (99.79%±0.36%, 99.85%±0.19%, respectively), the difference was statistically significant (P<0.01). The recipient imDC cells phagocyting the appoptotic splenic lymphocytes from the donor significantly inhibited the proliferation of recipient T cells. Conclusion Apoptosis of splenic lymphocytes induced by extracorporeal photochemotherapy can inhibit the maturation of dendritic cells and inhibit the proliferation of T lymphocytes.
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Objective To summarize the clinical experience of immunosuppressive therapy for recipients suffering from psoriasis after liver transplantation. Methods Five patients diagnosed with cirrhosis or hepatocellular carcinoma (HCC)complicated with psoriasis after liver transplantation were recruited in this clinical trial. All participants were positive for serum biomarkers of hepatitis B virus (HBV). Induction therapy was adopted before surgery. Immunosuppressive regime of tacrolimus (FK506),mycophenolate mofetil (MMF)and adrenal cortical hormone (hormone) was implemented early after surgery. The hormone use was terminated within 1 week. Three cases of cirrhosis complicated with HCC due to chronic HBV infection were gradually switched to sirolimus substitution treatment within 1 month after liver transplantation. Two patients with cirrhosis were administered with FK506 with or without MMF following liver transplantation. All patients received anti-HBV therapy. Baseline data,changes in psoriasis area and severity index (PASI)score and adjustment of postoperative immunosuppressive agents were analyzed. Results Five patients undergoing transplantation were followed up until the submission date with a mean duration of (8. 3 ±1 . 5 )years and survived. Compared with preoperative values,PASI score was significantly reduced at postoperative 6 months (P<0. 05 ). Two patients with cirrhosis had recurrent psoriasis at 2 years after liver transplantation. PASI score was significantly increased and steadily declined after sirolimus substitution therapy. These patients remained physically stable and did not progress at postoperative 3 years. Three patients suffering from cirrhosis complicated with HCC presented with no recurrence of psoriasis postoperatively. Conclusions Sirolimus-based immunosuppressive therapy can effectively control the progression of psoriasis in liver transplantation recipients. Anti-HBV treatment should be simultaneously implemented for HBV positive patients.
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Objective To analyze the correlation of tumor recurrence after liver transplantation for hepatocellular carcinoma (HCC)with the expression levels of regulatory T cell (Treg)and cytokines in peripheral blood. Methods A total of 56 patients who underwent liver transplantation in the 309th Hospital of People's Liberation Army from 2010 to 2014 were studied. According to the postoperative pathological data,all the patients were divided into the group of liver transplantation for HCC (HCC group,n=28)and group of liver transplantation for cirrhosis (liver cirrhosis group,n=28), of which the HCC group was further divided into non-recurrence group (n=8)and recurrence group (n=20)according to the situation of postoperative tumor recurrence. The expression levels of Treg and cytokines [vascular endothelial growth factor (VEGF),interleukin (IL)-2,IL-10,IL-12,transformation growth factor (TGF)-βand interferon (IFN)-γ]in peripheral blood of the patients in various groups were compared. Results Compared with the liver cirrhosis group,levels of IFN-γand IL-12 in the non-recurrence group increased significantly (both P<0.05);levels of Treg%,VEGF,IFN-γ, IL-10 and TGF-βin the recurrence group increased significantly,while levels of IL-2 and IL-12 decreased significantly (all P<0.05). Compared with the non-recurrence group,levels of Treg%,VEGF,IL-10 and TGF-βin the recurrence group increased significantly,while levels of IFN-γ,IL-2 and IL-12 decreased significantly (all P<0.05 ). Conclusions Levels of Treg and cytokines can be used to predict the tumor recurrence after liver transplantation for HCC.
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Objective To discuss the relationship between Foxp3 +regulatory T cell (Treg)and tumor recurrence of patients after liver transplantation for primary hepatocellular carcinoma (HCC) over University of California,San Francisco (UCSF)criteria.Methods Clinical data of 24 patients with HCC undergoing liver transplantation in the Organ Transplantation Research Institute of the 309 th Hospital of People's Liberation Army from January 2010 to December 2013 were retrospectively studied.During the follow-up,4 patients recurred (tumor recurrence group)and other 20 patients did not recur (tumor non-recurrence group).The blood samples of healthy people was selected as control group at the same period.The levels of alpha-fetoprotein (AFP)were compared at different time points of the recurrence group and the non-recurrent group before and after transplantation.The levels of Foxp3 +Treg (Foxp3 +Treg%)were compared at different time points of the tumor recurrence group,the tumor non-recurrence group and the control group before and after transplantation.The relations between expression of Foxp3 +Treg and the levels of AFP,CD3 + and CD8 +T before and after transplantation were analyzed by correlation analysis.Results Compared with the level of Foxp3 +Treg before transplantation and the normal level,the expression of Foxp3 +Treg of patients in tumor non-recurrence group after transplantation firstly decreased,then gradually increased and finally stabilized at a low level.Compared with patients in tumor non-recurrence group,the levels of AFP and Foxp3 +Treg of patients in tumor recurrence group increased obviously and were significantly higher than the normal levels (both in P <0.01).Moreover,abnormal increase of Foxp3 +Treg at early stage was prior to AFP among the patients in tumor recurrence group.Correlation analysis indicated that the change of Foxp3 +Treg was consistent with the changes of AFP,which was positively correlated (P <0.01).But the change of Foxp3 +Treg was contrary to the change of effector T cells (CD3 +T cells and CD8 + T cells),which was negatively correlated (P <0.05-0.01).Conclusions Foxp3 +Treg is closely associated with tumor recurrence after liver transplantation for HCC.In the patients after liver transplantation for HCC over UCSF criteria,the higher Foxp3 +Treg is,the higher the recurrence risk is.Joint detection of AFP is beneficial to find tumor recurrence.
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Objective To evaluate the efficacy and security of splenic artery ligation for severe hypersplenism during liver transplantation.Method Thirty-two liver transplant patients with preoperative hypersplenism were selected,including 17 cases (ligation group) treated by splenic artery ligation during liver transplantation,and rest 15 patients as non-ligation group.The fluctuation of white blood cells,platelets and volume of spleen were compared between these two groups.At the same time,splenic infarction,postoperative infection,recurrent gastrointestinal bleeding,splenic artery steal syndrome and other complications were observed in these two groups.Result All recipients were followed up for over 6 months.One recipient in ligation group died of multiple organ dysfunction caused by delayed recovery of liver donor with the survival rate being 94.1％ (16/17).The survival rate in non-ligation group was 93.3 ％ (14/15) (one recipient died of respiratory failure caused by pulmonary infection).There was no statistically significant difference in survival rate between these two groups (P＞0.05).Splenic necrosis wasn't detected in the ligation group.The splenic volume in ligation group was significantly less than that in non-ligation group (P＜0.01).The products of splenic maximum length and wide diameter shrunk 33.17-± 8.26 cm2 and 22.47 ± 7.25 cm2 in ligation group and non-ligation group,respectively.The platelet counts of ligation group were significantly greater than those of non-ligation group in all the observation points within 6 postoperative months (P＜0.01).The white blood cell counts of ligation group were greater than those of non-ligation group at the first week postoperatively (P＜0.01),whereas,there was no statistically significant difference between these two groups from then on (P＞0.05).The infection incidence of ligation group was lower than that of non-ligation group within 6 postoperative months (P ＜0.05).Statistically significant differences in recurrent gastrointestinal bleeding and splenic artery steal syndrome weren't found between these two groups (P＞0.05).Conclusion Splenic artery ligation in liver transplantation is safe and effective.It can rapidly increase the counts of platelet and white blood cell in the earlier postoperative time,which is beneficial to patient's recovery.Besides,it adds no correlative complication.
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Objective To explore the efficacy and safety of thymalfasin in the treatment of severe pulmonary infection after liver transplantation.Methods Twenty seven patients who developed severe lung infection after undergoing liver transplantation in Organ Transplant Institute of the 309 th Hospital of People’s Liberation Army from January 2008 to May 2014 were enrolled in this study.According to whether the application of thymalfasin,the patients were divide into thymalfasin group (n =11)and control group (n =16).In the thymalfasin group,thymalfasin was administered via subcutaneous injection at a dose of 1.6 mg once daily for consecutive two weeks.In the control group,conventional anti-infection therapy was delivered. Ventilator time,duration of fever,the length of intensive care unit (ICU)stay and mortality were statistically compared between two groups.And the incidence of acute rejection (AR)was monitored.Results Ventilator time,duration of fever,length of ICU stay of patients in the thymalfasin group were significantly shortened compared with those in the control group (all in P <0.05).There was no significant difference in the mortality between two groups.No clinical AR was observed in either group.No thymalfasin-related adverse event was found in the thymalfasin group.Conclusions Thymalfasin can improve the curative effect to anti-infection of patients with severe pulmonary infection after liver transplantation without the incidence of AR,which is efficacious and safe in the treatment of severe pulmonary infection.
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BACKGROUND:Previous studies have reported the cause and treatment of biliary complication. However, how to improve operative technique for preventing the complication is rarely reported. OBJECTIVE:To explore the effect of operational skil s during liver transplantation on biliary complications. METHODS:Biliary complications in 475 patients who underwent liver transplantation were retrospectively analyzed. The relationship between operational skil s and biliary complications after liver transplantation was observed. The potential risk factors about operative technique were summarized. Some preventive interventions for biliary complications were suggested. RESULTS AND CONCLUSION:Biliary complication was diagnosed in 36 (7.6%) of 475 patients who underwent liver transplantation. They were nonanastomotic biliary stricture (n=19, 4.0%), anastomotic biliary stricture (n=7, 1.5%), biliary leakage (n=3, 0.6%), twisted common biliary duct (n=3, 0.6%), residual common duct stone (n=1, 0.2%), and neoformative common duct stone (n=3, 0.6%). There was no difference in the incidence of nonanastomotic biliary stricture among the three biliary anastomotic styles. The possibility of anastomotic biliary stricture in placing T-drainage tube group was lower than the other two groups according to clinical data. Nevertheless, there was no statistical difference between these three groups. Infusing UW into the liver from cranial mesenteric vein and douching the biliary duct immediately while taking the donor could decrease the incidence of biliary complication after liver transplantation (P=0.013 and P=0.018, OR=0.26 and OR=0.28), the later factor could also decrease the incidence of nonanastomotic biliary stricture (P=0.001, OR=0.09). Meanwhile, some operational skil s also decrease the incidence of biliary complications, such as protecting the artery around the biliary duct, and elevating the liver when suturing the common biliary duct.
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Objective To explore the influence of triple anti-tumor therapy which bases on sirolimus combined huaier granule and thymosin α-1 on T lymphocyte of rat model with liver cancer recurrence after transplantation.Methods Seventy-two Sprague-Dawley(SD)rats were randomly divided into triple therapy group,sirolimus group,huaier-granule group,thymosin α-1 group,positive-control group and blank group (n=1 2 in each group).Except the blank group,rats in all the other groups were established the simulation animal model of liver cancer recurrence after liver transplantation by chemical-induced method.After the model was established,rats in the positive control group were executed to appraise whether the model was successful.The proportion of regulatory T cells (Treg)of CD4 + T lymphocytes in peripheral blood (Treg%),the percentage of CD4 + T lymphocyte of total lymphocyte(CD4 +T%)and the percentage of CD8 + T lymphocyte of total lymphocyte (CD8 +T%),were detected by the flow cytometry respectively.The relationship between Treg% and CD4 + T %,CD8 + T %,the ratio of CD4 +/CD8 + T lymphocytes(CD4 +/CD8 +)was analyzed by the method of Spearman rank correlation.Results Pathological section of rat liver tissue suggested that the rat model was established successfully.Treg % of positive control group was higher than that of blank group,the difference had statistical significance(P <0.05).Treg% of triple therapy group was significantly lower than that of the positive control group,huaier-granule group,thymosin α-1 group,and significantly higher than the blank group (all in P <0.05 ).Compared with positive-control group,CD4 +T% and CD8 +T% of triple therapy group,sirolimus group and thymosin α-1 group were significantly higher (all in P <0.05).CD4 +T%and CD8 +T% of triple therapy group were significantly higher than those of thymosin α-1 group,sirolimus group and huaier-granule group(all in P <0.05).The relationship between Treg% and CD4 +T%,CD8 +T%, CD4 +/CD8 + in peripheral blood were negatively correlated for rats in each group.In addition,the triple anti-tumor therapy decreased the negative correlation between Treg% and CD4 +/CD8 +.Conclusions Sirolimus based triple anti-tumor therapy can decrease the peripheral blood Treg level of the liver cancer rat,increase the number of T lymphocyte and CD4 +/CD8 +,and play the role of anti tumor cell growth and proliferation.
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Objective To investigate the diagnosis and treatment of hepatic artery pseudoaneurysm (HAPA) after liver transplantation.Methods The clinical data of 4 patients who had HAPA after liver transplantation at the No.309 Hospital of PLA from April 2002 to April 2010 were retrospectively analyzed.All the 4 patients had abdominal massive hemorrhage,and 2 of them were complicated by bile leakage and bile duct bleeding.Peritoneal effusion was observed in the 4 patients,and 3 of them were complicated by peritoneal infection.All the patients were diagnosed and treated by angiography and exploratory laparotomy.Results The mean time of hemorrhage of ruptured HAPA was 24.6 days (range,14-35 days).One of the patients was diagnosed by exploratory laparotomy,and the other 3 patients were diagnosed by angiography.Hemostasis of HAPA was successed in 1 patient by hepatic artery ligation,2 patients by interventional embolization + endovascular covered coronary stent grafts implantation guided by digital subtraction angiography (DSA),1 patient by interventional embolization.1 patients died of hepatic failure and 1 died of multiple organ disfunction syndrome.Conclusions Early diagnosis of HAPA after liver transplantation is difficult and the mortality is high.Interventional embolization + endovascular covered coronary stent grafts implantation guided by DSA is the first choice for the diagnosis and treatment of HAPA.
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BACKGROUND: Hepatic myelopathy results from liver disease, which lacks of effective cure method. Liver transplantation has attempted to cure this disease; however, the long-term therapeutic effect is rarely reported. OBJECTIVE: To explore the long-term therapeutic effect of liver transplantation in patients with hepatic myelopathy. METHODS: The clinical data of 2 patients with hepatic myelopathy, who underwent orthotopic liver transplantation, in August 2002 and November 2004, at the 309 Hospital of Chinese PLA, were analyzed retrospectively. The time of follow-up was 18 and 43 months, respectively. The muscle strength of double lower limbs in 2 patients was assessed prior to and after operation. RESULTS AND CONCLUSION: Two patients recovered well at 4 weeks after transplantation, the clinical symptom and physical signs of patients were improved obviously, the blood routine examination and other biochemical index were normal,and the function of transplanted kidney was normal. Two patients discharged at 6 weeks after transplantation. Patient 1 could stand for a long time at months 6 after transplantation, walked slowly with the supporter after 12 months and without the supporter at 43 months. The muscular strength of two lower limbs was grade 4. And the liver function was normal. Patients 2 could move his lower limbs in bed at months 6 after transplantation, walked with the supporter at 18 months. The muscular strength of two lower limbs was grade 3. The liver function was normal. It demonstrated that liver transplantation is beneficial to control hepatic myelopathy and recover muscular strength of two lower limbs. It is a newly developed, effective curing method for treating hepatic myelopathy. However, the numbers were small with short time observation, thus, the long-term therapeutic effect still need to be explored.
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Objective To explore the roles of B lymphocyte and plasma cell in liver allograft re-jection to find the evidences of humoral factor participating in the rejection. Methods Immunohisto-chemical inspection of C4d, CD20+ B lymphocytes and CD138+ plasma cells were performed in 34 liver biopsy specimens from 25 patients with hepatic injury and their preoperative specimens. Then we ob-served the variances of the above parameters in the liver biopsy specimens and the differences of them with different hepatic injuries. We further observed the relation of the presence of CD20+ B lympho-cytes and CD138+ plasma cells to C4d positivity. Meanwhile, we compared the difficulties of clinical therapy with different presences of CD20+ B lymphocytes and CD138+ plasma cells in the liver biopsy specimens. Results The positive ratios of CD20+B lymphocytes and CD138+ plasma cells were signif-icantly higher in the acute rejection group than in the non-rejection group(P<0. 05 and P<0. 01).The positive ratios of CD20+ B lymphocytes were markedly higher in the chronic rejection group than in the non-rejection group(P<0. 05). There was no difference in CD138+ plasma cells between the 2 groups. The degrees of hepatic injury could not influence the positive ratioes of CD138+ plasma, but the positive ratioes of CD20+ B lymphocytes in the heavy hepatic injury groups was higher than in the slight hepatic injury groups(P<0. 05). CD20+ B lymphocytes and CD138+ plasma cells presented fol-lowing C4d(P<0. 01 and P<0. 05). The effective power of steroid in the all-positive group was obvi-ously lower than in the all-negative group(P<0. 05). Conclusion Humoral immune may participate in some liver allograft rejection. It would be more favorable for observing and prewarning the humoral re-jection by finding CD20, CD138 and C4d by immunohistochemical staining in liver biopsy specimens with hepatic injury after liver transplantation. It would be helpful for choosing the therapeutic regi-mens of liver allograft rejection.
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Objective To investigate the expression of IL-23 and IL-23 mRNA in allograft and peripheral blood of mice receiving skin transplantation under different immune states. Methods Mice skin allograft models were established and divided into 3 groups: synergeneic transplant group (BALB/c→BALB/c), allogeneic transplant group (C57BL/6→BALB/c), donor spleen cells infusion group (C57BL/6→BALB/c). Peripheral blood plasma concentration of IL-23 was measured by ELISA. RT-PCR was used to detect the expression of IL-23 mRNA in the skin allograft. Results There was no significant difference in the IL-23 and IL-23 mRNA expression among all three groups one day after skin transplantation (P＞0. 05). On the day 3, 5, and 7 after skin transplantation, there was significant difference in the IL-23 and IL-23 mRNA expression levels between synergeneic transplant group, donor spleen cells infusion group and allogeneic transplant group (P ＜ 0. 01 ), but there was no significant difference between synergeneic transplant group and donor spleen cells infusion group (P＞0. 05). Conclusion The high expression levels of IL-23 and IL-23 mRNA were detected when early acute rejection took place in recipient mice. IL-23 could serve as a predictable and prognostic marker for the acute rejection. Infusion of donor spleen cells can significantly prolong the allograft survival.
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This study raised the necessity of developing performance indicators for measuring the management efficiency and effectiveness of school food service, and as a means of helping its implementation, a balanced score card (BSC) approach developed by Norton and Kaplan was adopted. This study established BSC in seven phases through literature: Phase 1 Defining a school food service and the scope of working activities, Phase 2 Establishing the vision of a school food service, Phase 3 Setting strategic goals, Phase 4 Identifying critical success factors (CSFs), Phase 5 Developing Key Performance Indicators (KPIs), Phase 6 Extracting cause and effect relationship, and Phase 7 Completing a preliminary BSC. The preliminary BSC was turned into a survey, which was administered to food service related people working at the Office of Education and School Food Service including 16 offices, 209 dietitians, 48 school administrators both from self-operated and contract-managed, and 9 experts in areas related to school food service. They were asked questions about strategics from 4 different perspectives, 12 CSFs, 39 KPIs, and the cause and effect relationships among them. As a result, among the CSFs based on 4 different perspectives, all factors other than "zero sum on profit/loss" from the financial perspective turned out to be valid. In terms of KPIs, manufacturing cost percentages, casualty loss count/reduction rates, school foodervice participation rates, and sales goal achievement rates were found to be valid from the financial perspective, while student satisfaction index, faculty satisfaction index, leftover ratio, nutrition educational performance count, index of evaluating nutrition education, customer claim count/reduction rate, handling customer claim count/reduction rate, and parent satisfaction index were found to be valid from the customers' perspective. Besides, nutritional requirement sufficient ratio, nutritional management score, food poisoning outbreak count, employee safety accident count, sanitary inspection assessment index, meals per labor hour (productivity index), computerization ratio, operational management index, and purchase management assessment index were also found to be valid from the perspective of internal business processes. From the perspective of innovation and learning, employee turnover ratio/rate of absenteeism, annual education and training count, employee satisfaction index, human resource management assessment index, annual menu-related customer feedback, food service information index for employees and parents/schools were also found to be valid. The significance of this study is to present indices for measuring overall performance of school lunch food service operations without putting any limitation on types of school food service management, and to help correctly assess the contribution of the current types of school food service management to schools and students.
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Humanos , Absentismo , Personal Administrativo , Comercio , Educación , Servicios de Alimentación , Enfermedades Transmitidas por los Alimentos , Aprendizaje , Almuerzo , Comidas , Necesidades Nutricionales , Nutricionistas , Padres , Reorganización del PersonalRESUMEN
Objective To discuss the long-term effect of orthotopic liver transplantation to patients with hepatic myelopathy. Methods The clinical data of 2 patients with hepatic myelopathy undergoing liver transplantation were analyzed retrospectively. The condition of recovery of muscle strength of the patient's double lower limbs was carefully observed both pre-and post operatively. Results The patient's clinical symptoms were well improved and liver function recovered to normal. Hepatic myelopathy was controlled. The follow-up duration of 2 cases was 18 and 43 months respectively. The muscle strength of lower limbs was recovered from 1 degree to 3 and 4 degree respectively. Conclusion Liver transplantation can effectively control the development of hepatic myelopathy and it is obviously useful for recovery of double lower limbs.
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Objective To explore causative factors, and prevention and treatment of nonanastomotic biliary stricture (NABS) after orthotopic liver transplantation. Methods The donor’s liver together with celiac artery and its branches were havvested rapidly without injury to reduce heat ischemia time and artery loss, then the bilinary duct was flushed to clean out residual bile. During operation, when the portal vein was opened, the hepatic artery of the donor liver was flushed with heparin saline. Post-operatively, acute or chronic rejection and cytomegalovirus infection should be prevented. When NABS occurred, it was treated with bilinary balloon dilatation. Results Of 36 patients with liver transplantation, 4 patients (11.1%, 4/36) were found to suffer from NABS. Two patients were cured, in one patient it was improved after dilatation, and one patient died. Conclusion NABS is mainly related to artery loss, cold/warm ischemia injury, ischemia/reperfusion injury, bile toxicity injury, immune injury and cytomegalovirus infection etc. Biliary balloon dilatation is the major treatment for NABS. Retransplantation is necessary for some severe cases.
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Objective To evaluate the application of artificial liver support system (ALSS) in severe hepatitis patients before liver transplantation. Methods Double lumen catheters were inserted into the femoralvein to construct the blood conduit in patients receiving ALSS. The blood purification apparatus was applied for plasma replacement and blood perfusion with PIS separator and HA hemoperfusion apparatus. The plasma replacement capacity was 3000ml-4000ml (average 3200 ml) with albumin 20g. The average dosages of both heparin and protamine were 25 mg. The separation speed was 26 ml/min. The replacement blood flow was 100-150 ml/min, and the average treatment time was 120 min. Results The liver function markers, including TB, DB, ALT, AST and NH 3, were improved in patients with ALSS. Conclusion ALSS could correct the imbalance of homeostasis of the patients, eliminate the toxic substances effectively and provide valuable support for liver transplantation.
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Objective To explore a new therapeutic method to intractable rejection after liver transplantation.Methods Low dose prograft and rapamycin were given to 2 patients with intractable acute rejection and 2 patients with intractable chronic rejection confirmed by biopsy after liver transplantation, which had no response to normal treatment. The blood concentration of prograft was controlled in 3～5 ?g/L and rapamycin in 6～12 ?g/L. Rapamycin was withdrawn and prograft was increased to normal dose while the rejections were rectified.Results Four allograft rejections were all reversed in the end with this method. In the course of this therapy, one of the 4 patients had CMV pneumonia and cured with antiviral therapy. One had diabetes and another's diabetes got more critical. The blood glucose recovered to the primary level after the withdrawal of rapamycin.Conclusion The intractable acute and chronic rejection which has no response to normal treatment can be reversed by combined use of low dose prograft and rapamycin.
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Objective To explore the evidences of the humoral factor involved in the liver allograft rejection, and to explore better monitoring methods and therapy of the humoral liver rejection. Methods After the humoral liver rejection, liver puncture biopsies were performed. Immunohistochemical examinations of C4d, CD20+ B lymphocytes and CD138+ plasma cells were performed to judge whether humoral factor was involved in liver rejection. The dosage of tacrolimus was increased first when rejection was identified. The patients with severe liver function damage were treated with methyllprednisolone, and the steroid-insensitive cases were treated with antithymocyte globulins (ATG) and rapamycin. Results 25 biopsies were performed in 16 patients. Humoral rejection was diagnosed for 15 times in 10 patients, cellular rejection was diagnosed for 6 times in 4 patients, and the both kinds of rejection occurred in the last 2 patients. The effect of methylprednisolone was obviously lower in the humoral rejection cases (29.4%, 5/17) than that of the cellular rejection cases (7/8). Steroid-insensitive humoral rejections were diagnosed in 12 biopsies from 7 patients receiving liver transplantation. One patient was cured with ATG and 5 patients were cured with addition of rapamycin. The case whose blood type was AB receiving a liver transplant from the donor of O blood type died of liver function failure even after an extensive treatment. Conclusions Humoral immune factors maybe involved in some acute and chronic liver allograft rejection. ATG and rapamycin are more effective for the patients with humoral liver rejection.