Liver transplantation for primary hepatic leiomyosarcoma: a case report and review of the literatures.

Primary hepatic leiomyosarcoma (PHL), a malignant mesenchymal tumor of myogenic origin, is exceedingly rare. Patients may be afflicted with a wide spectrum of nonspecific symptoms, and most of the laboratory data are unhelpful to diagnosis. Here, we report a 44-year-old woman with anorexia and right upper quadrant pain who was diagnosed as having malignant hepatic tumor within the Milan criteria and treated by orthotopic liver transplantation (OLT), the pathologic diagnosis of PHL was made by postoperative immunohistochemical study. She underwent six courses of intravenous chemotherapy and enjoyed a 14-month tumor recurrence-free survival until the lymph node metastasis was detected, then we switched the tacrolimus to sirolimus and the patient survived for 20 months additionally. Unfortunately, she finally died of extensively lymphatic metastasis and cachexia. The diagnostic and therapeutic features of PHL are also discussed by reviewing the literatures. To our knowledge, this is the second report of administering OLT to PHL patients.

Rapamycin promotes differentiation and proliferation of mouse CD4 +CD25+ regulatory T cells in vitro / 第二军医大学学报

Objective: To observe the influence of rapamycin on the differentiation and proliferation of CD4+ CD25+ Treg cells, so as to lay a foundation for further studying its role in inducing immune tolerance. Methods: The spleens were taken from C57BL/6 mice under sterile condition and the mononuclear cells were isolated. CD4+ T cells were isolated by immunomagnetic beads (negative) and were divide into normal control group, rapamycin (0.1 μmol/L, for 7 days) group and cyclosporine (0.5 μmol/L, for 7 days) group. Flow cytometry was used to determine the proportions of CD4 +CD25+ Treg cells, and RT-PCR was used to examine the expression of Foxp3 mRNA. Results: Compared with the control group, the proportion of CD4+CD25+ Treg cells in the CD4+ T cells was significantly decreased ([7.42±0.82]% vs [3.72±0.74]%, P<0.01) in the cyclosporine group and was significantly increased ([7.42±0.82]% vs [11.47±1.08]%, P<0.01) in the rapamycin group. Expression of Foxp3 mRNA in rapamycin group was significantly higher than that in the other 2 groups (P<0.01), expression of Foxp3 mRNA in the cyclosporine group was significantly lower than that in the control group (P<0.05). Conclusion: Rapamycin can promote the proliferation and growth of CD4 + CD25+ Foxp3+ Treg cells in vitro, and facilitate the development of immune tolerance. It has a different immune suppression mechanism with cyclosporine A.

A meta-analysis of therapeutic effect of cyclosporine microemulsion and tacrolimus for patients undergoing liver transplantation / 第二军医大学学报

Objective:To evaluate the efficacy and safety of microemulsified cyclosporine(Neoral)and tacrolimus(FK506) for immunodepression after Iiver transplantation.Methods:According to the including criteria,fifteen randomized controlled trials were enrolled in this analysis.The data of trial design,characteristics of the subjects,and findings of the studies were reviewed and analyzed by RevMan 4.2.8 software.Results:The patient survival rate,graft survival rate,incidence of nephrotoxicity,and incidence of infection were not significantly different between Neoral and FK506 groups,with the relative risk and(95% CI,P)being 0.99(0.96-1.02,0.37),0.97(0.92-1.03,0.30),0.99(0.87-1.13,0.86)and 1.08(0.97-1.20, 0.16),respectively.The incidences of hypertension(1.34[1.15-1.55,0.000 1])and acute rejection(1.15[1.06-1.25,0.001]) were significantly lower in the FK506 group,with no significant difference found in the degree of acute rejection(1.00[0.92- 1.22],0.98).Interestingly,the incidence of diabetes was significantly higher in the FK506 group within 1 year after the operation,but was similar to that of the Neoral group thereafter,with relative risk(95%CI,P)being 0.72(0.62-0.83,