Effect of post-liver transplantation administration of ursodeoxycholic acid on serum liver tests and biliary complications: a randomized clinical trial / 中华肝脏病杂志

<p><b>OBJECTIVE</b>Endogenous hydrophobic bile acids may be a pathogenetic factor of biliary complications after orthotopic liver transplantation (OLT).This study was designed to investigate the effects of hydrophilic ursodeoxycholic acid (UDCA), when administered early after OLT, on serum liver tests and on the incidence of biliary complications.</p><p><b>METHODS</b>A total of 112 adult patients undergoing OLT were randomly assigned to one of two groups for receipt of UDCA (13 to 15 mg/kg/d for 4 weeks, n=56) or a placebo (n=56). All patients underwent serum liver testing and measurement of serum bile acids during the 4 weeks following OLT.Patients with T-tube underwent measurement of biliary bile acids during the 4 weeks following OLT.Biliary complications, as well as patient and graft survival rates, were analyzed during the follow-up period (mean of 65.6 months).</p><p><b>RESULTS</b>At post-OLT days 7, 21 and 28, the UDCA-treated patients showed significantly lower levels of alanine aminotransferase, aspartate aminotransferase and gamma glutamyl transpeptidase (all P less than 0.05).In addition, the UDCA-treated patients showed significantly lower incidence of biliary sludge and casts within the first year post-OLT (3.6% vs.14.3%; x2=3.953, P=0.047). However, there were no significant differences for the incidence of other biliary complications at post-OLT years 1, 3 and 5.The graft and patient survival rates were also similar between the two groups.</p><p><b>CONCLUSION</b>UDCA, when administered early after OLT, improves results from serum liver tests and decreases the incidence of biliary sludge and casts within the first postoperative year.</p>

Management of hepatic HBV reinfection after liver transplantation / 中国普通外科杂志

Objective To study the effect of antivirus therapy of HBV reinfection and YMDD mutation after liver transplantation. Methods Fifteen of 317 patients with HBV-related end-stage liver diseases received lamivudine ( LAM ) monothereapy, others received combination low-dose hepatitis B immune globulin( HBIG) and LAM (or adefovir dipivoxil, ADV) therapy, as prophylaxis against HBV reinfection after OLT. Hepatitis serum markers, HBsAg, HBeAg, HBcAb-IgM, and HBcAg were detected every 2 weeks by immunohistochemistry. Serum HBV DNA was examined by PCR every 2 weeks. HBsAg and HBcAg in the liver specimens were examined by immunohistochemistry. YMDD mutation was detected by PCR in those patients with recurrence of positive HBV DNA posttransplantation. Results In LAM monotherapy group, 4 developed HBV reinfection out of 15 patients with pretreatment positve HBV DNA. Sixteen of 302 patients with combination HBIG and LAM therapy suffered from posttransplant HBV reinfection, the difference between the two groups was significant (26.7% vs. 5. 30% ,P