Effect of splenic artery ligation for hypersplenism during liver transplantation / 中华器官移植杂志

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.

Clinical application of thymalfasin in patients with severe pulmonary infection after liver transplantation / 器官移植

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.

Operative techniques in liver transplantation and biliary complications / 中国组织工程研究

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.

Influence of sirolimus based triple anti-tumor therapy on T lymphocyte of rat model with liver cancer recurrence after transplantation / 器官移植

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.

Dendritic cells phagocytized apoptotic lymphocytes induce the development of regulatory B cells with high secretion of interleukin-10 / 器官移植

Objective To investigate the feasibility of immature dendritic cells (imDC)phagocytized psoralen ultraviolet A (PUVA)-treated splenic lymphocytes (PUVA-SP DC)in mice inducing B lymphocytes to be regulatory B cells (Breg)with high secretion of interleukin (IL)-10 (IL-10 +Breg). Methods Bone marrow-derived DC of mice was cultured. Spleen lymphocytes of mice were isolated and treated by PUVA,and turned to be PUVA-SP. The bone marrow-derived imDC was co-cultured with PUVA-SP in vitro to obtain PUVA-SP DC. Splenic B lymphocytes of mice were separated by anti-CD19 magnetic beads and co-cultured with different kinds of DC for 48 hours. The levels of interferon (IFN )-γ,transforming growth factor (TGF)-β,IL-12p70,and IL-10 in the culture supernatant of B lymphocytes,imDC,imDC+B lymphocytes, PUVA-SP DC and PUVA-SP DC +B lymphocytes were measured by enzyme-linked immune absorbent assay (ELISA). The accounts of IL-10 +Breg in B lymphocytes,imDC+B lymphocytes,mDC+B lymphocytes and PUVA-SP DC+B lymphocytes were detected by flow cytometry. Results Compared with the other 4 groups, the level of IL-10 in cell culture supernatant of PUVA-SP DC+B lymphocytes was significantly higher (all in P<0.05). Compared with the other groups,the account of IL-10 +Breg in PUVA-SP DC+B lymphocytes was significantly higher. Conclusions PUVA-SP DC can induce splenic B lymphocytes to differentiate into IL-10 +Breg.

Diagnosis and treatment of hepatic artery pseudoaneurysm following liver transplantation / 中华消化外科杂志

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.

Expression of IL-23 and IL-23 mRNA in allograft and peripheral blood of mice subject to skin transplantation / 中华器官移植杂志

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.

A modified model of orthotopic liver transplantation in rat / 解放军医学杂志

Objective Based on recent personal experience, we presented a detailed description on how to perform orthotopic liver transplantation in rat with two-cuff technique, including many improvements to the original technique, to facilitate the beginners to acquire this model. Methods 136 male SD rats were randomly divided into 2 groups, i.e. donor group and recipient group. On the basis of Kamada's cuff technique, some modifications were made. The donor liver was first perfused through the abdominal aorta with cold Ringer-lactate solution and then harvested. After removal of the recipient liver, the liver graft was then placed orthotopically in the abdomen. The donor suprahepatic vena cava was anastomosed end-to-end with the recipient suprahepatic vena cava, using a 7-0 running suture. The continuity of infrahepatic vena cava and portal vein was accomplished by cuff technique. The end-to-end bile duct anastomosis was performed by tying the two ducts over a tube stent, with fixation both sides. Recipient survival rate and causes of death were observed after the transplantation. Results The time for liver procurement, graft preparation, anhepatic phase, and bile duct reconstruction were 23-35 minutes, 8-13 minutes, 16-19 minutes, and 2-3 minutes, respectively. 48-hour and one-week survival rate of recipients was 95.5% and 89.7%, respectively. Main cause for death within 48 hours after operation was bleeding. Biliary tract obstruction, bile leakage, and liver lobe necrosis were the main causes for mortality after one week. Conclusion The results show that the modified model is highly reproducible, and it provides a stable and practical experimental model for the basic study on liver transplantation.