Intractable and dramatic diarrhea in liver transplantation recipient with vasoactive intestinal peptide-producing tumor after split liver transplantation: a case report.

Diarrhea after liver transplantation is a common complication. Vasoactive intestinal peptide-producing tumor (VIPoma) is a rare cause of watery diarrhea; 80% of such tumors occur in the pancreas, but it is rare in liver. Hypersecretion of vasoactive intestinal polypeptide can stimulate intestinal water and electrolyte secretion, and patients with VIPoma present with watery diarrhea, hypokalemia, and dehydration. Here we report on a 50-year-old man who presented with a 7-month history of watery diarrhea. He had undergone an orthotopic split-liver transplantation for hepatocellular carcinoma in November 2011. Two months after the liver transplantation, he presented with watery diarrhea, dehydration, and hypokalemia. Antibiotics, immunosuppressive drugs modification, antidiarrheal agents, antispasmodics, adsorbents, and fasting were alternately used to control the diarrhea, but his symptoms remained unchanged. A chromogranin examination, a marker of pancreatic neuroendocrine neoplasm, was positive in the third month of the diarrhea history and VIPoma was considered. Treatment with somatostatin immediately controlled the diarrhea, but the primary lesion could not be identified even after corresponding examinations were completed. In the ninth month of diarrhea, a 1 × 1-cm lesion was detected in the right liver by ultrasonography. Radiofrequency ablation was performed, and the diarrhea stopped. Seventeen months later, the chromogranin level decreased to normal and the patient was asymptomatic. Neither the recipient sharing the other liver portion nor the donor presented with any symptoms, so we wondered how the tumor occurred. It is possible that a small VIPoma lesion existed in the liver donor before the transplantation, and that the immunosuppressive drugs induced tumor development.

Can liver transplantation achieve similar effects at high altitudes compared with plains: case report.

In orthotopic liver transplantation, particular emphasis must be placed on the unique physiologic, pathologic, and clinical features in residents living in areas at high vs low altitude. Hypobaric hypoxia, hypothermia, heavy radiation, high wind speed, and superevaporation at high altitudes may lead to various diseases. These features have progressive effects on cardiopulmonary and central nervous system functions. A high concentration of red cells in the circulation is likely to result in an increased incidence of hepatic artery and portal vein thrombosis. The immune system is also affected at high altitudes. Exposure to high altitude, which is associated with decreased oxygen pressure, can result in oxidation-reduction stress, enhanced generation of reactive oxygen and nitrogen species, and related oxidative damage to lipids, proteins, and DNA. Our male patient with liver cirrhosis caused by chronic hepatitis B virus infectionunderwent orthotopic liver transplantation in Tibet with a successful outcome and good long-term survival.

Roles of calcium and IP3 in impaired colon contractility of rats following multiple organ dysfunction syndrome

The purpose of the present study was to explore changes in rat colon motility, and determine the roles of calcium and inositol (1,4,5)-triphosphate (IP3) in colon dysmotility induced by multiple organ dysfunction syndrome (MODS) caused by bacteria peritonitis. The number of stools, the contractility of the muscle strips and the length of smooth muscle cells (SMC) in the colon, the concentration of calcium and IP3 in SMC, and serum nitric oxide were measured. Number of stools, fecal weight, IP3 concentration in SMC and serum nitric oxide concentration were 0.77 ± 0.52 pellets, 2.51 ± 0.39 g, 4.14 ± 2.07 pmol/tube, and 113.95 ± 37.89 mumol/L, respectively, for the MODS group (N = 11) vs 1.54 ± 0.64 pellets, 4.32 ± 0.57 g, 8.19 ± 3.11 pmol/tube, and 37.42 ± 19.56 mumol/L for the control group (N = 20; P < 0.05). After treatment with 0.1 mM acetylcholine and 0.1 M potassium chloride, the maximum contraction stress of smooth muscle strips, the length of SMC and the changes of calcium concentration were 593 ± 81 and 458 ± 69 g/cm³, 48.1 ± 11.8 and 69.2 ± 15.7 muM, 250 ± 70 and 167 ± 48 percent, respectively, for the control group vs 321 ± 53 and 284 ± 56 g/cm³, 65.1 ± 18.5 and 87.2 ± 23.7 muM, 127 ± 35 and 112 ± 35 percent for the MODS group (P < 0.05). Thus, colon contractility was decreased in MODS, a result possibly related to reduced calcium concentration and IP3 in SMC.

Roles of calcium and IP3 in impaired colon contractility of rats following multiple organ dysfunction syndrome.

The purpose of the present study was to explore changes in rat colon motility, and determine the roles of calcium and inositol (1,4,5)-triphosphate (IP3) in colon dysmotility induced by multiple organ dysfunction syndrome (MODS) caused by bacteria peritonitis. The number of stools, the contractility of the muscle strips and the length of smooth muscle cells (SMC) in the colon, the concentration of calcium and IP3 in SMC, and serum nitric oxide were measured. Number of stools, fecal weight, IP3 concentration in SMC and serum nitric oxide concentration were 0.77 +/- 0.52 pellets, 2.51 +/- 0.39 g, 4.14 +/- 2.07 pmol/tube, and 113.95 +/- 37.89 micromol/L, respectively, for the MODS group (N = 11) vs 1.54 +/- 0.64 pellets, 4.32 +/- 0.57 g, 8.19 +/- 3.11 pmol/tube, and 37.42 +/- 19.56 micromol/L for the control group (N = 20; P < 0.05). After treatment with 0.1 mM acetylcholine and 0.1 M potassium chloride, the maximum contraction stress of smooth muscle strips, the length of SMC and the changes of calcium concentration were 593 +/- 81 and 458 +/- 69 g/cm(3), 48.1 +/- 11.8 and 69.2 +/- 15.7 microM, 250 +/- 70 and 167 +/- 48%, respectively, for the control group vs 321 +/- 53 and 284 +/- 56 g/cm(3), 65.1 +/- 18.5 and 87.2 +/- 23.7 microM, 127 +/- 35 and 112 +/- 35% for the MODS group (P < 0.05). Thus, colon contractility was decreased in MODS, a result possibly related to reduced calcium concentration and IP3 in SMC.

The early changes of colon motility in the rats after liver transplantation.

The purpose of this study was to explore the early changes of colon motility in rats after liver transplantation. Thirty Wistar rats were divided into a sham operation group (n = 10) and a liver transplantation group (n = 10 pairs). The number of stools, the contractility of muscle strips, the length of smooth muscle cells, the levels of plasma endotoxin, the morphological changes, and the expression of inducible nitric oxide synthase (iNOS) in the colon of the rats were observed in the two groups. N(6)-(iminoethyl)-L-lysine (L-NIL, a selective iNOS antagonist) was used to confirm the activity of iNOS in the contractility of colonic motility. We observed the changes of nitrogen monoxide (NO) in plasma and colon mucosa of the two groups. Results showed that the liver transplantation group compared with the sham operation group showed significantly decreased contractility of the colon with significant differences in the morphological changes in rat colon. The expression of iNOS protein and iNOSmRNA was significantly increased in the liver transplantation group. The concentrations of plasma and colon mucosa NO and the levels of endotoxin were higher among the liver transplantation group than the sham operation group (P < .05). When the strips and cells of smooth muscle from the liver transplantation group were treated with L-NIL, their contractility increased. We concluded that colon motility decreased in the rats after transplantation, which could be related to the levels of plasma endotoxin and iNOS expressing in the colon.

Early changes of small intestine function in rats after liver transplantation.

OBJECTIVE: The aims of this study were to explore the concomitant changes of the barrier function, bacterial translocation, absorption, and small intestinal motility in rats after liver transplantation and to correlate these changes with levels of plasma endotoxin. METHODS: Thirty Wistar rats were divided randomly between a sham operation group (n=10) and a liver transplantation group (n=10 pairs). The intestinal transit function, intestinal permeability, bacterial translocation, absorption function, levels of plasma endotoxin, and nitrogen monoxide (NO) changes in plasma and small intestinal mucosa were monitored in the two groups. The expression of iNOS mRNA in the intestine was investigated by reverse transcriptase-polymerase chain reactions. RESULTS: Significant differences were observed between the liver transplantation group and the sham operation group for aspects of intestinal transit function, intestinal permeability, bacterial translocation, absorption function, and NO changes in both plasma and small intestine. Compared with the sham operation group, the expression of iNOS mRNA was significantly increased (P<.05) in the small intestine of rats that had undergone liver transplantation. CONCLUSION: The functions of motility, barrier, and absorption in the intestine were decreased among rats that had undergone liver transplantation. Reduced motility in the small intestine of the rats following liver transplantation may be related to the enhanced expression of iNOS in the intestine with a negative correlation to plasma levels of endotoxin.