Abstract:Abstract:Objective:To evaluate the clinical application of adult-to-adult living donor liver transplantation (A-A LDLT).
Methods:The clinical data of 3 cases of A-A LDLT performed in our hospital between February 2007 and July 2007 were retrospectively analyzed.
Results:Of the three grafts, 1 case was a right lobe graft (not including the middle hepatic vein), and 2 cases were left lobe grafts (including the middle hepatic vein and caudate lobe). GV/SLV were all more than 40％. The 3 pairs of recipients and donors recovered uneventfully. No small-for-size syndrome or severe complications occurred. The recovery of hepatic function of left lobe donors was faster than that of the right lobe donor.
Conclusions:If GV/SLV of left lobe graft is more than 40％, the left lobe living donor should be preferably selected. There is no need for placement of drainage tube when the bile duct is reconstructed. A-A LDLT is a safe and effective procedure for treatment of end-stage liver diseases.

Abstract:Abstract:Objective：To summarize the experience of emergency orthotopic liver transplantation (EOLT) for severe hepatitis， and discuss the operative indications.
Methods：The clinical data of 34 patients with severe hepatitis and acute liver failure. who were candidates for liver transplantation was retrospective reviewed.
Results：Among the 34 patients, 11 of them underwent liver transplantation, 14 of them died while waiting for donor liver and 9 cases lost the chance of undergoing transplantation. In the 11 cases with liver transplatation, one case died of pulmonary infection and acute respiratory distress syndrome (ARDS) on postoperative day 7, one case died of primary poor graft function and renal failure on postoperative day 20, and the other 9 cases made a good recovery. At follow up of 6-29 months, 1 case died of chronic rejection 12 months after operation.
Conclusions：Emergency liver transplantation is effective treatment for acute liver failure caused by severe hepatitis. The indications for the operation are: (1) Stage Ⅱ or higher degree of encephalopathy: (2) prolongation of PT>15s; (3) Serum TBIL>300μmol/L(17.5mg/dl) or progressive daily increase of TBIL (>17.1μmol/L).

Abstract:Abstract:Objective：To explore the clinical experience of treating the postoperative complications of orthotopic liver transplantation (OLT) by reoperation.
Methods：A retrospective analysis of the clinical data of over 200 OLT performed in Fuzhou General Hospital from June 2002 to March 2007 was made. Among 14 cases, 17 reoperations (including 1 liver retransplantation) were performed.
Results：All of the 17 reoperations were performed to treat complications after liver transplantation.The reoperation success rate was 100%.Four patients died at 10th,20th,33rd,and 25th day respectively after reoperation.One case with intraabdominal bleeding died of renal failure combined with adult respiratory distress syndrome(ARDS).One case with hemothorax after thoracocentesis died of severe abdominal cavity and lung infection.One case of hepatico stones and cholangitis died of multiple organ failure(MOF). One died of recurrence and metastasis of carcinoma.The other 10 patients survived with good liver function.Survival rate was 71.4%（10/14）.
Conclusions：The key to improve the success rate of liver transplantation and quality of life after thansplantation is to correctly select the opportune time of reoperation for surgical complications after liver transplantation and make active surgical intervention.

Abstract:Abstract:Objective:To seek effective methods for postoperative nutrition support to promote postoperative recovery of liver transplantation.
Methods:Different methods for nutrition support were selected for 48 liver transplantation patients. After recovery of gastrointestinal functions, EN in combination with PN and with infusion of human albumin was begun as early as possible. For patients with serious malnutrition, EN was used in combination with PN+rhGH+Gln, or TPN+rhGH+Gln, and with infusion of human albumin.
Results:There was no occurrence of complications resulting from nutrition support. All patients had a smooth perioperative period and recovered.
Conclusions:Effective postoperative nutrition support plays an important role in improving the survival rate of liver graft and promote postoperative recovery.

Abstract:Abstract:Objective:To investigate the diagnosis and treatment method of fungal infection after orthotopic liver transplantation(OLT).
Methods:A retrospective survey of 29 fungal infection patients in 147 patients who underwent liver transplantation was made.
Results:Twentynine patients(19.73%) had 48 occurrences of invasive fungal infection.Lung fungal infection was found in 16 cases(33.34%),intestine in 11 cases(22.92%), and genitourinary system in 10 cases(20.83%). Pathogens were Candida albicans (52.08%), Candida tropicalis (12.50%), Aspergillus(8.34%) and mold fungus(4.17%).Twelve cases were effectively treated with fluconazole, 8 cases with itraconazole, and 4 cases with caspofungin. 24 cases were cured with the curative rate being 82.76%,and 5 cases died with the mortality being 17.24%.
Conclusions:The rate of fungal infection after liver transplantation is high. Imaging and pathogenic studies should be done to early diagnose fungal infection, which could be timely treated with effective antifungal agents，such as fluconazole, itraconazole and caspofungin.

Abstract:Abstract:Objective: To explore the prophylaxis and treatment strategies for psychic syndrome in patients after piggyback liver transplantation.
Methods:The data on the etiology, treatment outcome and prognosis of psychic syndrome occurring in 45 of 235 patients who had piggyback liver transplantation were retrospectively analyzed.
Results:The incidence of psychic syndrome complication was 19.1%(45/235), 22 cases presented as mania (48.9%), 5 cases as tristimania (11.1%), 3 cases as hallucinosis (6.7%), 1 case as suicidal tendency (2.2%), 1 case as metamorphopsia (2.2%), 8 cases as angst insomnia (17.8%), 2 cases as maladjusted disturbance(4.4%), 3 cases as affective disturbance(6.7%), and the majority presented as delirious alienation. All the cases were cured, except 1 case of coma, who was confirmed by CT to have intracranial hemorrage, died after failure of resuscitation.
Conclusions:The incidence of psychic syndrome in patients after piggyback liver transplantation is relatively high. However，most cases have mild symptoms and the prognosis is fine. When the patients have psychogenic symptoms, the prognosis of patients can be improved by some symptomatic treatment strategies directed to their different clinical manifestations.

Abstract:Abstract:Objective:To study the diagnosis and treatment of tuberculosis infection after liver transplantation.
Methods:The clinical data of 2 cases of tuberculosis infection after liver transplantation in the author′s center and 56 cases in literature from 1988~2006 were reviewed retrospectively.
Results:Mycobacterium tuberculosis infection occurred in 2 of 110(1.8%) cases undergoing liver transplantation between 2001 and 2006 in the author′s center. Combined with data in the literature, the average morbidity is 0.77% (58/7 532). Pyrexia, poor appetite and weight loss were the most common presentations clinically. The diagnosis methods including chest Xray, PPD test, acid fast bacillus and invasive and histological test. There were two major antituberculous strategies: Group A was the usual tetragenous protocol inducing therapies (isoniazid; rifampicin; pyramide ethambutal) and maintaining therapy (isoniazid; rifampicin), Group B included fluoroquinolones (ofloxacin or moxifloxacin) combined with firstline antituberculous drugs. The two groups had similar average treatment time (10m vs 11.5m, P>0.05,ttest). The cure rate, hepatotoxicity incidence and TB correlated case fatality in Group B and A are 76.92% and 58.33%, 46.15% and 70.83%, and 15.83% and 41.67%, but with no statistic significance (P>0.05, Pearson Chisquare Test).
Conclusions:The diagnosis of posttransplant TB infection considerably relies on combined method. Invasive and histological procedure has more and more significance. The classical antituberculosis protocol shows high hepatotoxicity incidence and should be cautiously selected. Fluoroquinolones combined with firstline antituberculous drugs is a new protocol with satisfactory effect and low hepatotoxicity incidence, and therefore might be safer in the treatment of posttransplant tuberculosis.

Abstract:Abstract:Objective:To study the effect of combined immune therapy with anti-CD40L mAb and low-dose cyclosporine (CsA) on the liver graft survival in rats, and Th1/Th2 cytokine profile.
Methods:Recipientswere divided into the following groups. Group A: SD→SD rats, Group B: SD→Wistar rats without any treatment, Group C: SD→Wistar rats with CsA monotherapy from d1 to d5, Group D: SD→Wistar rats with CsA from d1 to d5 and anti-CD40L mAb in d0 and d2. The recipient survival and liver graft pathology observed. On post-transplant d7 ELISA technique was used to detect the level of cytokines in peripheral blood.
Results:The survival period of recipients in Group A and D was significantly longer than that in Group B and C. Mild to severe acute rejection reactions were observed in liver specimens from Group B and C while the degree of tissue injury in specimens from Group D was decreased signiflcantly. The serum levels of IL-2 and IFN-γ in Group B were significantly higher than those in other groups. On the contrary, the serum level of IL-4 and IL-10 in Group D was elevated much more than that in Group B(P<0.05).
Conclusions:The combined immune therapy can prolong graft survival and effectively suppress acute rejection in ROLT. High expression of Th2 cytokines is beneficial to long-term survival of recipients and graft

Abstract:Abstract:Objective:To study the effect of recombinant antibody HBsAg-Fab of hepatitis B virus (HBV) to block hepatitis B reinfection after liver transplantation.
Methods:The functional efficiency of antibody Fab in blocking hepatitis B reinfection after LT was analysis and studied by vitro infection test, complement toxicity assay and virus infection test, calculated the antibody absorption rate and cell death rate and cell infection rate,
Results:When the group with and the group without recombinant antibody Fab were compared, the antibody absorption rate, cell death rate and cell infection rate between the 2 groups showed sigificant defference (P<0.05). The tese data had significant statistical defference.
Conclusions:Recombinant antibody Fab can block antibody absorption by the target cell, can induce complement-dependent toxic death and damage of target cells, and decrease the HBV infection rate of primary human hepatocytes. The in vitro efficacy test of recombinant gene antibody Fab can be a basis for its use clinically in vivo.

Abstract:Abstract:Objective:To summarise the perioperative features of orthotopic liver transplantations(OLTs) in miniature porcine, to establish mature、stable OLT models.
Methods:In order to observe hemodynamics and blood changes and improved perioperative management and summarise the perioperative characteristics, 8 preliminary experiments (group A) and 18 experiments (group B) of OLTs were performed without veno-venous bypass(VVB) in Chinese inbred miniature porcine.
Results:The mean operation time was （179.6±14.3）min in our 18 OLTs, and the mean anhepatic phase time was（27.3±3.4）min. Dramatic hemodynamic and metabolic changes were identified during anhepatic phase. The one- week survival rate was 88.9% in group B, but all the 8 pigs in group A died. The experiment group pigs urinated after 3～5hours and had normal diet after 3days.
Conclusions:Decreasing the operation time and stability of hemodynamics in anhepatic phase are the keys for success in OLTs without VVB.

Abstract:Abstract:Objective:To observe the number，location,type and caliber of the major hepatic veins and short hepatic veins（SHVs）.
Methods:The SHVs were divided into 3 rows that drained into the left wall, front wall and right wall of the inferior vena cava (IVC) respectively.The extrahepatic length and caliber of the major hepatic veins, the number,location, caliber and the relationship between the major hepatic veins and SHVs were observed and measured in 60 adult cadavers.
Results:The left, middle and right hepatic veins drained into the upper 1/4 segment of the retrohepatic IVC. The left and middle hepatic veins formed a common trunk in 44 cases (73.3%), the 3 major hepatic veins formed a common trunk in 1 case (1.7%), and the 3 major hepatic veins had separate inflow into IVC in 15 cases (25.0%). Three to thirty five branches of SHVs with a mean diameter of 1.5～17.8（5.4±1.4）mm had inflow into the IVC from different directions and locations.There was marked negative correlation between the diameter of the right hepatic vein and that of SHVs.There has marked negative correlation between the diameter of the left hepatic vein and the right hepatic vein with the number of SHVs.The incidence rate of inferior right hepatic veins was 83.3% with an average diameter of 2.6～8.0（4.3±1.2）mm.
Conclusions:The SHVs have much variations but few of them are of large diameter. The diameter and number of SHVs and those of the major hepatic veins are correlated, so that the larger the diameter of the right or left hepatic veins the smaller is the diameter of the SHVs, and vice-versa.

Abstract:Abstract:Objective:To evaluate the safety and efficacy of combining radiofrequency ablation(RFA) with arsenious acid(AA) locally to treat liver VX2 tumor in rabbits,and to explore its mechanism.
Methods:Twentyeight New Zealand White rabbits with implanted liver VX2 tumors were randomly divided into four groups: control group(n= 7), AA group (n=7), RFA group (n=7), and combination(RFA+AA) group (n=7). ALT was measured before treatment and on the day 0, day 3, day 7 and day 14 after treatment, meanwhile ultrasonic(US) examination was performed. All rabbits were killed 14 days after treatment. Vascular endothelial growth factor (VEGF) was examined by immunohistochemistry,and the relationship of VEGF and gross tumor volume was analyzed.
Results:Combination (RAF+AA) therapy caused little damage to hepatic function but had better inhibited tumor growth.The level of VEGF in AA,RFA and RAF+AA group was lower than that of the control group（P<0.05）, The level of VEGF in the RFA group were lower than the AA group（P<0.05） while in the RAF+AA group it was the lowest,
Conclusions:Combined (RAF+AA) therapy can inhibit VEGF expression which can inhibit tumor growth and with no significant liver damage.

Abstract:Abstract:Objective:To investigate the effect of PSUPER-siRNA-IGFIR plasmid in inhibiting the growth of human liver cancer cell SMMC7721.
Methods:Cancer xenograft was established by transplanting SMMC7721 cell to nude mice, and the PSUPER-siRNA-IGFIR plasmid was constructed and the graft cancer was treated with PSUPER-siRNA-IGFIR plasmid. The effect on tumor growth was monitored.
Results:PSUPER-siRNA-IGFIR plasmid can inhibit the growth of human liver cancer cell SMMC7721. The expression of IGFIR and MVD in human liver cancer cell SMMC7721 was decreased significantly in the gene transfected group as compared to that of control group.
Conclusions:The PSUPER-siRNA-IGFIR plasmid can inhibit the growth of human transfected liver-cancer in nude mice.

Abstract:Abstract:Objective:To study the relationship between Ephrin-A1 and its receptor with angiogenesis in hepatocellular carcinoma(HCC).
Methods:Immunohistochemistry staining method (S P methods)and reverse transcription polymerase chain reaction (RT-PCR) were used to determine the protein and mRNA expression of Ephrin-A1 and its receptor EphA1、EphA2 in tumor tissues and their corresponding adjacent liver tissues from 52 HCC patients; then, analyse of the relationship between Ephrin-A1 and clinicopathologyfactor and microvessel density(MVD) in HCC was made.
Results:The protein expression rate of Ephrin-A1 and EphA1, EphA2 in HCC was 59.6%(31/52), 53.8%(28/52)and 17.3%(9/52), respectively, but in the paired liver tissues adjacent to HCC the expression rate was 23.1%(12/52), and 21.2%(11/52), respectively. The protein expression rate of Ephrin-A1 and EphA1 was significantly higher than that in the paired liver tissues adjacent to HCC(P<0.05), The protein expression rate of EphA2 was not significant in HCC compared to the paired liver tissues adjacent to HCC（P>0.05）. The mRNA express rate of Ephrin-A1 and EphA1 in HCC ［67.3%(35/52) and 73.7%(38/52)］ were prominently higher than those in the paired liver tissues adjacent to HCC ［42.3%(22/52) and 48.1%(25/52)］ (P<0.05), The mRNA express rate of EphA2 was no significant in HCC compare to the paired liver tissues adjacent to HCC（P>0.05）. The higher expression of Ephrin-A1 was correlated with the AFP level and thrombus in the portal vein(P<0.05) in patients with HCC. Spearman′s rank correlation analysis indicatied the expression of Ephrin-A1 was correlated with EphA1(r=0.671，P<0.01), but was not correlated with EphA2 in HCC; and the expression of Ephrin-A1 was correlated with MVD in HCC(r=0.826，P<0.01).
Conclusions:Ephrin-A1 can be combination with its receptor EphA1 but not with EphA2 in HCC, and can improve angiogenesis of HCC, then enhanced its growth, invasiveness and metastasis. Ephrin-A1 and EphA1 can become the new targets for the antiangiogenesis treatment of HCC.

Abstract:Abstract:Objective: To study the effect of ischemia and reperfusion injury to hepatocarcinoma and normal liver tissues.
Methods:The hepatocarcinoma animal models were established by the ultrasonography-guided implantation of VX2 tumor tissue suspension into the left-middle lobe of liver of rabbits. Two weeks later, the established hepotocarcinoma animal modal and the control group animal were subjected to 60 minutes clamp of the left-middle lobe artery branch followed by reperfusion at 0 min, 1 h, 1 d, 3 d and 7 d respectively. Apoptotic changes in the hepatocarcinoma and normal hepatic tissues were observed by means of HE staining and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL).
Results:The result of HE staining indicated that the number of apoptotic cells in hepatocarcinoma and normal liver tissues increased to the highest point 1 d following reperfusion（23%,10%）, but even though the positive cell count decreased to a certain extent until 7 d after reperfusion, it was still more obvious than that before the reperfusion. The positive apoptosis ratio of hepatocarcinoma tissue retained a higher level than that of normal liver tissues at all time points. The result of TUNEL showed that the number of the apoptotic cells in hepatocarcinoma tissues(5%) was larger than that of normal liver tissues before ischemia(1%). The apoptotic characteristics of hepatocarcinoma and normal liver tissues after reperfusion were similar to those of HE staining and their apoptotic ratio was 25%, 15% and 8%, 2% after reperfusion for 1 d and 7 d respectively.
Conclusions:Ischemia and reperfusion can cause more intense injury and apoptosis in hepatocarcinoma tissue than in normal hepatic tissues.

Abstract:Abstract:Objective:To evaluate the effect of application of pringle maneuver combined with hepatic veins occlusion in the process of hepatectomy.
Methods:The clinical data of 37 cases of tumours that involved the second portal hepatis and underwent liver resection were surveyed retrospectively.Pringle maneuver combined with hepatic veins occlusion was used during the resections.
Results:In this series,there were 27 cases of hepatocelluar carcinoma,2 cases of metastatic liver tumor, and 8 giant haemangioma. The average size of the tumors was 12.7cm(6cm to 35cm) in diameter.One main hepatic vein was invaded by tumor in 6 cases,2 main hepatic veins were invaded by tumor in 20 cases and 3 main hepatic veins were invaded in 11 cases.Among the 37 hepatectomies,extended right hepatectomy was performed in 11 patients,right hemihepatectomy in 5,middle lobe hepatectomy in 9，extended left hepatectomy in 5，resection of segment Ⅷ in 4 and caudate lobectomy in 3 cases.The mean occlusion time of the first porta hepatis was 29min(17min～48min)，and occlusion time of the hepatic veins was 21min（8min～32min）.The average blood loss was 950ml（200ml～4000ml）. Postoperative complications occurred on 18 occasions, and all recovered after treatment. There was no mortality in this series.
Conclusions:Pringle maneuver combined with hepatic veins occlusion for complicated hepatectomy is safe， and is effective to prevent dangerous bleeding and air embolism with less disturbance of systemic hemodynamics.

Abstract:Abstract:Objective:To evaluate the value of color Doppler flow imaging (CDFI) in detecting the blood supply of primary hepatic carcinoma in comparison with DSA.
Methods:Fiftytwo hepatic carcinoma patients with 64 tumors were studied. All patients were examined by CDFI within three days before transarterial chemotherapy embolization (TACE) treatment. The artery supply of 64 tumors was graded into four degrees: 0,Ⅰ,Ⅱand Ⅲ. The diameter, peak systolic velocity (PS), and resist index (RI) of proper hepatic artery were measured. Meanwhile the blood flow volume of portal vein and proper hepatic arteria was calculated. In the procedure of TACE, blood supply of tumors was graded into three degrees: grade1, 2, and 3 by DSA. Thirty tumors in 30 patients were followed up with CDFI within 7 days after TACE. The changes of the gradations of blood supply and hemodynamics of proper hepatic arteria, portal flow and tumors were analyzed by CDFI.
Results:(1)The gradation of CDFI in the blood supply of HCC had positive correlation rank compared to that of DSA (rs＝0.644，P<0.01). Grade 0,GradeⅠ and Ⅱ,Grade Ⅲ in CDFI closely corresponded to Grade 1,Grade 2,Grade 3 in DSA respectively. (2)After TACE, the gradations of the blood supplies decreased. The diameters of proper hepatic arteries became slightly narrow and their blood flow volumes decreased. But portal flow volumes increased.
Conclusions:The gradation in impulse blood of HCC with CDFI has positive correlation rank, Grade 0,GradeⅠ and Ⅱ,Grade Ⅲ in CDFI correspond to Grade 1,Grade 2,Grade 3 in DSA respectively. and CDFI can reflect indirectly the changes of hemodynamics before and after TACE.

Abstract:Abstract:Objective:To study the value of BCSG1 on evaluating the curative effect of neoadjuvant chemotherapy (NC) for breast cancer.
Methods:The expression of BCSG1 in cancer tissue was assayed by immunohistochemistry and RTPCR in 36 cases of breast cancer patients before and after receiving NC of CEF (cyclophosphamide, epirubicin and fluorouracil) regimen. The therapeutic response of NC was evaluated by morphological and pathological observation. The relationship between expression of BCSG1 and morphological response to NC was analyzed.
Results:Among the studied cases, the diameter of tumor significantly decreased（P<0.01）and the improvment rate of the treatment effect (CR+PR) was 85.6%. The expression of BCSG1 mRNA （P<0.05）and the high expression rate of BCSG1（P<0.01）were decreased significantly after receiving NC than that before NC.
Conclusions:After NC,the expression of BCSG1 mRNA and protein was decreased significantly,which had negative relation to the therapeutic effect of NC. BCSG1 can be a prognosticate gene to evaluate the effect of NC in breast cancer patients.