血清α谷胱甘肽-S-转移酶监测移植肝早期功能的临床价值

目的探讨应用血清α-GST监测肝移植术后早期移植肝功能的临床价值。方法采用酶联免疫测定法(EIA)对30例原位肝移植受体移植肝恢复再灌注72h内血清α-GST水平的动态变化进行监测,并与常规肝功能指标(AST、ALT、LDH)比较。结果本组中29例受体术后3d内未发生特殊并发症,其移植肝发生缺血再灌注损伤时血清α-GST水平会较ALT、AST、LDH等指标提前升高至高峰,并且升高速度更快、幅度更大;在再灌注损伤恢复时可很快降至正常,提示损害终止。1例受者术后确诊原发性移植肝无功能;其血清α-GST水平及常规肝功能指标均显示下降后再度上升趋势,而α-GST于再灌注后第8h即出现再次升高,较其余三种指标提前16h以上。结论肝移植术后早期严密监测血清α-GST变化可准确判断移植肝功能状态,血清α-GST水平下降迟缓或降而复升都应警惕PNF等早期移植肝功能损害的发生。     

肝动脉缓冲效应对肝移植术后肝脏血流的影响及临床意义

目的 探讨肝硬化肝功能失代偿期行改良背驮式肝移植术患者的门静脉和肝动脉血流变化规律及肝动脉缓冲效应(HABR)的作用及其临床意义.方法应用彩色多普勒超声对56例肝移植患者术前及术后移植肝门静脉、肝动脉血流及肝动脉阻力系数(RI)进行监测.结果 移植术后1 d门静脉的血流速度较术前明显加快(P＜0.05).而肝动脉血流速度较术前明显减慢(P＜0.05),肝动脉RI增高,门静脉血流速度与肝动脉RI之间有显著的相关性.急性排斥反应时门静脉及肝动脉血流速度变慢,肝动脉RI呈增高趋势,肝动脉血栓及动脉狭窄表现为肝动脉血流速度减慢甚至完全消失,肝动脉RI增高.结论肝移植术后肝脏的血液流变学发生一系列变化,HABR对血液流变学的变化起着重要作用,了解移植后肝脏的血液流变学的变化过程对肝移植术后并发症的防治有一定的指导作用.     

肝动脉缓冲效应对肝移植术后肝脏血流的影响及临床意义

目的探讨肝硬化肝功能失代偿期行改良背驮式肝移植术患者的门静脉和肝动脉血流变化规律及肝动脉缓冲效应（HABR）的作用及其临床意义。方法应用彩色多普勒超声对56例肝移植患者术前及术后移植肝门静脉、肝动脉血流及肝动脉阻力系数（RI）进行监测。结果移植术后1d门静脉的血流速度较术前明显加快（P〈0．05）。而肝动脉血流速度较术前明显减慢（P〈0．05），肝动脉RI增高，门静脉血流速度与肝动脉RI之间有显著的相关性。急性排斥反应时门静脉及肝动脉血流速度变慢，肝动脉RI呈增高趋势，肝动脉血栓及动脉狭窄表现为肝动脉血流速度减慢甚至完全消失，肝动脉RI增高。结论肝移植术后肝脏的血液流变学发生一系列变化，HABR对血液流变学的变化起着重要作用，了解移植后肝脏的血液流变学的变化过程对肝移植术后并发症的防治有一定的指导作用。     

经裁剪供体肺的临床应用研究

目的 观察经裁剪供体肺用于同种异体肺移植的临床效果.方法 回顾性分析4例采用经裁剪供体肺用于同种异体肺移植的临床资料.例1供体肺部分上叶切除后施行左单肺移植并同期行右肺减容术,例2供体肺部分上叶切除后施行右单肺移植,例3供体肺双上叶部分切除后施行序贯式双肺移植,例4切除供体肺右下叶后施行序贯式双肺移植.结果 经裁剪的供体肺均能够顺利工作并渡过围手术期.例1及例2术后移植肺未出现明显并发症并生存;例3术后第5天再次出现短期漏气,经闭式引流而治愈,术后第32天死于曲霉感染导致的呼吸道大出血;例4术后恢复尚顺利,但术后2个月因重症病毒性肺炎死亡.结论 经裁剪供体肺可以用于临床肺移植.     

经裁剪供体肺的临床应用研究

目的 观察经裁剪供体肺用于同种异体肺移植的临床效果.方法 回顾性分析4例采用经裁剪供体肺用于同种异体肺移植的临床资料.例1供体肺部分上叶切除后施行左单肺移植并同期行右肺减容术,例2供体肺部分上叶切除后施行右单肺移植,例3供体肺双上叶部分切除后施行序贯式双肺移植,例4切除供体肺右下叶后施行序贯式双肺移植.结果 经裁剪的供体肺均能够顺利工作并渡过围手术期.例1及例2术后移植肺未出现明显并发症并生存;例3术后第5天再次出现短期漏气,经闭式引流而治愈,术后第32天死于曲霉感染导致的呼吸道大出血;例4术后恢复尚顺利,但术后2个月因重症病毒性肺炎死亡.结论 经裁剪供体肺可以用于临床肺移植.     

信息速递

肝移植的新进展据了解,到2004年8月底为止,上海交通大学附属第一人民医院今年已成功地完成了3例跨血型肝移植手术。患者通过血型不相容的供体进行过渡,最后在移植了相同血型的供体肝后康复出院。暴发性肝功能衰竭是乙肝发展到后期的严重并发症之一,病死率高达60%～80%,肝移植是目前挽救暴发性肝功能衰竭患者生命的唯一有效手段,其关键是寻找血型相匹配的供体。上海交通大学附属第一医院肝脏移植中心彭志海教授大胆提出,先用血型不相容的供体进行过渡,待病情稳定后再主动施行第二次血型相同的肝移植。有关专家认为,跨血型肝移植采用免疫抑制…     

IL-17在大鼠肝移植急性排斥反应模型中的表达及作用研究

目的:探讨IL-17在大鼠肝移植急性排斥反应模型中的表达及作用。方法:选取32对健康状况相同的大鼠,随机分组后建立大鼠肝移植急性排斥反应动物模型。肝移植手术后取受体鼠的血浆标本和肝组织标本,对比两组受体大鼠的急性排斥反应,并测定两组大鼠的IL-17水平。结果:相较于异基因移植组受体大鼠而言,同基因移植组受体大鼠ALT和TBIL的平均含量更接近正常水平,急性排斥反应较弱。同时,同基因移植组受体大鼠术后IL-17水平明显高于异基因移植组,组间比较具有明显差异,P<0.05。结论:IL-17参与到大鼠肝移植急性排斥反应的发生过程,临床上可将IL-17水平作为急性排斥反应的衡量指标,以便及时发现移植受体的急性排斥反应,并及早作出有效应对。     

肝移植大鼠肝细胞凋亡调控基因表达变化

目的 研究肝移植大鼠移植肝再灌注后肝细胞凋亡情况及凋亡调控基因Bcl-2,FasL的表达变化.方法 将72只SD大鼠随机分为肝移植组和假手术组,肝移植组建立异体原位肝移植模型,对供肝灌注并冷保存4 h后置入受体,于移植后1,6,24 h处死大鼠取样,检测血清中谷草转氨酶(AST)、谷丙转氨酶(ALT)水平,移植肝细胞凋亡情况,凋亡相关基因Bcl-2,FasL蛋白表达.结果 再灌注后肝移植组AST、ALT明显高于假手术组;与假手术组比较,肝移植组1,6,24 h肝细胞凋亡指数(34.66±5.04,42.52±6.13,27.66±5.03)明显升高,肝组织中Bcl-2表达量(18.36±2.83,12.59±1.84,21.93±2.28)减少,FasL表达量(22.62±1.88,26.93±1.77,24.19±2.10)增加(P<0.01),以再灌注后6 h变化最为明显.结论 移植术后移植肝细胞凋亡加重,于再灌注早期达到高峰,与抗凋亡基因Bcl-2表达减少、促凋亡基因FasL表达增加有关.     

缺血性脑卒中肠道微生物移植致菌群失调大鼠模型建立

目的 建立一种肠道菌群失调大鼠模型,为脑缺血损伤肠道菌群失调研究提供方法学支持.方法 将SPF级SD大鼠分为正常组、供体组和受体组,对供体组大鼠予以大脑中动脉栓塞术(MCAO),术后72 h取盲肠菌群作为移植物;对受体组大鼠灌胃硫酸链霉素消耗肠道微生物后,将供体组的盲肠菌群灌胃移植给受体组,1次/d,共3d.取3组大鼠...     

边缘供肝在肝移植中的应用研究

边缘供肝一般是指肝移植后存在原发性移植肝无功能或功能低下以及迟发性移植物失活风险的肝移植供体。广泛地讲，边缘供肝主要包括两大类型，第一种是有可能带来高风险的技术性并发症和功能障碍的供肝，如脂肪肝、无心跳供肝、老年供肝、劈裂式供肝以及长缺血时间供肝；第二种类型是有可能给受体传染疾病或肿瘤的供肝，如血清学病毒抗体阳性的供体、患有恶性肿瘤的供体、有细菌感染的供体等。近年来，由于理想供肝的严重短缺，边缘供肝逐渐被人们重视起来。大量的文献研究表明，合理地利用边缘供肝可以得到满意的效果。本文就边缘供肝在肝移植中的作用及效果做一综述。     

肝脏移植术后受体感染性并发症的防治

目的：探讨儿童同种异体肝脏移植术后各种感染类型的防治特点。方法：2000年3月31日我科成功地进行了1例小儿同种异体背驮式肝移植，受体移植；受体为14岁男童，患先天性Carloli病，曾行两次胆道手术，术前患儿胆汁性肝硬化，复发性胆管炎，肝胆管结石，充血性脾肿大伴脾功亢进，为科末期肝病，结果：术后早期曾出现肺部感染等多器官并发症和急性排斥反应，术后17个月出现慢性排斥反应，经积极抗感染，抗病毒及免疫治疗得以控制，至今已存活2年余。结论：各种感染是儿童肝脏移植的主要并发症，根据药敏选择有效的抗生素控制细菌感染，早期应用更昔洛韦和长期服用FK506的免疫治疗，对巨细胞病毒感染的预防非常有效。     

大鼠颈部异位心脏移植模型的改进

目的 探讨大鼠颈部心脏移植模型的改进和研究心脏移植排斥反应。方法 将Chen术式加以改进，采用供心主动脉与受体颈总动脉行端侧吻合，进行40次大鼠颈部心脏移植。结果 新方法使供心总缺血时间缩短至30min，7d存活率提高到93％。结论 改进的术式简单实用，存活率高，值得推广。     

Favorable results of auxiliary heterotopic liver transplantation in patients with end-stage chronic liver insufficiency

Auxiliary heterotopic liver transplantation (HLT), which avoids removal of the host liver, may improve the results of liver transplantation in patients with end-stage chronic liver disease. However, the results of HLT have so far been disappointing. In 1986 a program of HLT was started in the University Hospital Rotterdam-Dijkzigt. Eighteen patients with chronic liver failure underwent HLT. Twelve out of 18 (67%) patients were discharged 25 days after transplantation with normal liver function. Six patients died within 3 months after operation due to septic causes. Three months after transplantation ascites was no longer detectable and oesophageal varices had disappeared in all surviving recipients of HLT. The actuarial 3 and 12 months survival rate was 67%. Hepatitis B virus reinfection was seen in all patients. In two patients cirrhosis of the graft developed within one year. These data suggest that HLT in patients with chronic liver failure gives long-term metabolic support and adequate decompression of portal system, and is associated with a morbidity and mortality comparable to that of orthotopic liver transplantation.     

Liver transplantation with a living donor: the first 3 cases in Rotterdam

Liver transplantation with a part of the liver from a healthy living donor can be life saving for selected patients with end-stage liver failure. The experiences with the first 3 adult patients in the Netherlands were as follows. The first patient was a 56-year-old man with primary sclerosing cholangitis, who received half of the liver from his 53-year-old sister. Postoperatively, the donor developed a urinary tract infection, which was treated with antibiotics. The recipient developed fever and paralytic ileus 6 days after transplantation. Relaparotomy revealed minimal bile leakage from the cut surface of the liver, which was corrected with a suture. Three years after donation, both donor and recipient were doing well. The second patient was a 63-year-old man with hepatic cirrhosis due to hepatitis B, recurrent bleeding from varices, and hepatocellular carcinoma. The carcinoma was treated percutaneously with radiofrequency ablation. He was given a liver transplant from his 28-year-old son. The donor later developed transient ileus and mild liver function disorders. The recipient developed a bacterial infection of the ascites, which was treated with antibiotics, and later Candida-oesophagitis and a herpes simplex infection, which were also treated successfully. More than 2 years after donation and transplantation, both donor and recipient were in good condition. The third patient was a 42-year-old man with a chronic hepatitis B virus infection and 2 hepatocellular carcinomas. The donor was his 34-year-old sister-in-law. The recipient developed prolonged jaundice due to stenosis at the site of the bile duct anastomosis, for which a stent was placed. He was discharged in good condition but died 11 months later of cerebral metastases. One year after the procedure, the donor was doing well. The Rotterdam liver transplantation programme with living donors demonstrates that excellent results can be accomplished with minimal risk for the donor.     

异基因造血干细胞移植后乙型病毒性肝炎防治新进展

 异基因造血干细胞移植（allo-HSCT）是治愈恶性血液病的有效手段,但移植患者因接受感染乙型肝炎病毒（HBV）的移植物、免疫功能严重受损等原因,术后并发乙型病毒性肝炎的风险增加。恩替卡韦和替诺福韦是目前公认用于预防allo-HSCT后乙型病毒性肝炎的有效药物,显著减少移植后患者的肝损伤。移植后患者的免疫重建时间长且重建规律存在异质性,导致术后监测和预防性抗HBV治疗的最佳持续时间尚未能明确。本文对allo-HSCT后HBV再激活的发生机制、乙型病毒性肝炎的特点及防治的最新研究进展进行综述。     

肝移植后曲霉菌感染的危险因素分析

目的归纳分析肝移植后曲霉菌感染的高危因素。方法通过Logistic回归分析276例肝移植后受体曲霉菌感染的危险因素。结果移植后血透、粒细胞减少、机械通气时间过长、胆红素>20mg/dl和再移植是曲霉菌感染独立的预测因素。结论对高危受体及早预防治疗,有助于降低曲霉菌感染的发生率和死亡率。     

Protective role of the L-arginine-nitric oxide synthase pathway on preservation injury after rat liver transplantation

BACKGROUND: A major problem complicating liver transplantation is the preservation injury that results from cold storage and subsequent ischemia/reperfusion injury after organ revascularization. The L-arginine-nitric oxide (NO) pathway has been recognized to play critical roles during infection, inflammation, organ injury, and transplant rejection. Recent data indicates that NO synthesis has beneficial effects in several models of liver injury. The purpose of this study is to examine the role of the L-arginine-NO pathway on preservation injury in an experimental model of rat liver transplantation. METHODS: Orthotopic liver transplantation was performed in syngeneic (LEW to LEW) rats. Liver preservation injury was determined by measuring serum liver function tests 6 to 48 hours after transplantation. In some experiments, rats received L-arginine supplementation 0 to 24 hours after transplantation. In other experiments, NO synthase inhibitors (L-NAME or L-NIL) were injected at the time of isograft revascularization. RESULTS: L-Arginine supplementation decreased hepatic transaminase levels at all time points examined (6-48 hours). L-Arginine produced a significant improvement in liver preservation injury by 12 hours after reperfusion. The NO synthase inhibitor L-NAME caused a significant increase in liver injury 24 hours after injection. The inducible NO synthase (iNOS)-specific inhibitor L-NIL had no significant effect on liver injury. CONCLUSIONS: The results show that L-arginine supplementation and NO synthesis improve hepatic injury and have a protective role in the transplanted liver graft. The protective effect may be mediated by low-level cNOS-derived NO.     

Histocompatibility tests in a transplantation program

The importance of the role of the histocompatibility laboratory in solid organ transplantation is to perform HLA typing and determine the degree of HLA matching between recipient/donor. It is a useful tool to increase graft survival and decrease chronic rejection. HLA matching has a positive effect on kidney transplants and it has variable impact on other organ transplants. The crossmatch procedure is the most important test in a solid organ transplantation to evaluate the presence of recipient antibodies to antigens expressed on donor white cells. This test decreases the risk of hyperacute humoral rejection or early graft loss. Positive crossmatch is a contraindication for transplantation because it represents the existence of IgG recipient antibodies that will reath againts donor antigens. Antibody evaluation is important in donor-recipient selection and the responsability of the histocompatibility laboratory is to identify clinically relevant anti-donor HLA antibodies. This detection is useful to determine the degree of humoral alloimmunization, expressed as a percent panel reactive antibody (%PRA). This test also provides information about the antibody specificity and can be used for evaluate a patient's immune status providing a significant correlation in selecting donors.     

骨髓间充质干细胞对异基因骨髓移植后GVHD和生存率的影响

目的　观察骨髓间充质干细胞 (BMMSC)对急性淋巴细胞白血病 (ALL)小鼠异基因骨髓移植 (allo -BMT)后移植物抗宿主病 (GVHD)和生存率的影响。方法　建立ALL小鼠动物模型 ,对其进行allo -BMT的同时 ,静脉输注体外培养的供鼠BMMSC ,同时设立单纯allo -BMT对照组。流式细胞仪检测受鼠CD4+ 、CD8+ T细胞亚群的差异 ;观察受鼠发生GVHD一般反应及病理学变化 ;记录受鼠存活时间。结果　BMMSC减少受鼠CD4+ T细胞的同时增加CD8+ T细胞 ;推迟GVHD发生的时间 ;明显延长ALL小鼠allo -BMT后的生存时间 (P <0 0 5或P <0 0 1)。结论　BMMSC能抑制ALL小鼠allo -BMT后GVHD的发生 ,但同时具有一定程度的GVL作用。