改良法构建大鼠减体积肝移植模型

背景:目前有关活体肝移植后肝脏再生的研究较少。在大鼠肝移植实验中不断改进手术方法和技术,提高肝移植成功率是进行大鼠肝移植研究和获得可靠实验数据的基础。目的:验证以改良方法构建减体积肝移植大鼠模型的有效性。方法:选用健康SD大鼠,70对制备减体积肝移植改良前模型,100对制备减体积肝移植改良后模型。供体为雌性,受体为雄性,供体体质量比受体轻10g左右。改良前方案采用取下全肝后在修肝盆中进行减体积肝移植。改良后方案如下:供体采用单人裸眼操作,在取肝的过程中即进行减体积操作;修肝时将套管柄置于门静脉和肝下下腔静脉的正前方,将幽门静脉结扎点外翻于套管外并置于套管柄的左侧,即肝脏的左侧;将右肾静脉结扎点外翻于套管外并置于套管柄的右侧,即肝脏的右侧;供肝套管完成后用灌注液对门静脉和肝下下腔静脉进行冲洗;然后以左膈静脉为标识点进行7/0无损伤血管缝线吊线;受体采用双人裸眼配合操作,肝上下腔静脉吻合时,左右固定位点采用"8"字形外翻缝合,后壁和前壁分别采用连续吻合,门静脉和肝下下腔静脉采用改良的双袖套法,胆管支撑管法建立大鼠减体积的稳定模型。结果与结论:改良后供体手术时间为(32±2)min,修肝时间为(6±2)min,受体手术时间为(40±3)min,无肝期时间为(14±3)min。移植成功率为92%,移植后3d生存率为85%,移植后2周生存率83%。与改良前比较,移植后并发症发生率降低(P0.05),供肝的冷保存时间缩短(P0.05)。提示改良后的大鼠减体积肝移植模型比较稳定、可靠,移植成功率较高,移植后并发症发生率较低,为研究减体积肝移植后肝脏再生提供了有效的改良手段。     

构建大鼠减体积肝移植模型的肝脏信号转导差异蛋白表达

背景:蛋白质组学是目前医学界比较热门的科学研究技术,已经在肝移植的相关研究中得到初步应用,但未曾报道有在大鼠减体积肝移植相关研究中的应用。目的:利用蛋白质组学相关技术探讨大鼠减体积肝移植后与肝脏信号转导蛋白相关的差异蛋白。方法:在成功建立大鼠减体积肝移植模型的基础上,分别于移植后1,3,7 d获取移植肝脏组织,然后与预先获取冻存的供体和受体肝脏组织采用固相p H梯度双向凝胶电泳技术,建立双向凝胶电泳图谱,再利用串联质谱(MS-MS)分析及数据库对差异表达的蛋白质点进行鉴定。结果与结论:实验中以变化倍数大于10倍为标准进行差异蛋白点的选择,总共发现了72个差异点,最终鉴定到了功能比较明确的32个蛋白,其中有4个蛋白参与了信号转导的过程,其分布于肝移植后的第3天和第7天,占6%。结果显示在大鼠减体积肝移植模型的成功和稳定建立的基础上,利用蛋白组学的相关技术,研究了大鼠减体积肝移植后参与肝脏信号转导的差异蛋白,为下一步深入研究调控这些蛋白的Micro RNA提供了有力的前期基础研究数据。     

大环内酯类抗生素对大鼠肝移植后缺血再灌注损伤的保护作用

文题释义： 原位肝移植：又称正位肝移植，指在术中阻断受体肝的下腔静脉，并切除受体肝和下腔静脉，并利用供体肝的肝上、肝下下腔静脉重建和恢复肝脏的流出道与下腔静脉的连续性。 缺血再灌注损伤：指缺血组织或器官再次恢复血液供应后，会导致自由基过量生成，且过量的自由基会对再灌注组织或器官造成氧化应激损伤。 背景：肝移植是终末期肝病和肝衰竭的标准治疗方法，而缺血再灌注损伤能影响肝移植成功率。当有限的肝脏供体可供移植时，如何降低肝缺血再灌注损伤成了肝移植的首要问题。 目的：探究大环内酯类抗生素对大鼠肝移植后肝缺血再灌注损伤的作用及机制。 方法：构建自体原位肝移植大鼠模型，将Wistar大鼠随机分为大环内酯类抗生素组和对照组。大环内酯类抗生素组大鼠在肝切除前30 min，采用大环内酯类抗生素(含60 mg/kg罗红霉素、20 mg/kg克拉霉素和40 mg/kg红霉素)混合液预处理供体肝脏，在原位肝移植时向门静脉中推注上述大环内酯类抗生素混合液；对照组大鼠在肝切除前30 min，同体积生理盐水预处理供体肝脏，在原位肝移植时向门静脉中推注同体积的生理盐水。肝移植后连续7 d观察大鼠存活率；检测肝移植后48，72 h大鼠血清天冬氨酸氨基转移酶和丙氨酸氨基转移酶活性；苏木精-伊红染色和免疫组化检测大鼠肝组织形态学改变和Ki-67阳性细胞数；TUNEL法和蛋白质免疫印迹分别检测大鼠肝细胞凋亡数量和caspase-3、cleaved caspase-3蛋白表达水平；免疫荧光和ELISA法分别检测肝移植后大鼠肝组织中Kupffer细胞数量改变和白细胞介素6、肿瘤坏死因子α和白细胞介素1β水平。结果与结论：大环内酯类抗生素提高了肝移植大鼠的整体存活率，改善了移植肝脏的功能失调，减轻了肝移植后缺血再灌注的损伤程度，提高了移植肝脏的再生能力，降低了移植肝组织中凋亡细胞数和凋亡蛋白cleaved caspase-3/ caspase-3比值，降低了移植肝组织中Kupffer细胞数量和白细胞介素6、肿瘤坏死因子α和白细胞介素1β水平。以上结果提示，大环内酯类抗生素对大鼠肝移植后的肝缺血再灌注损伤起保护作用。 ORCID: 0000-0002-5646-1426(杨峰) 中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程     

两袖套法大鼠同种异体减体积肝移植模型的建立

目的探讨建立稳定大鼠减体积原位肝移植模型的方法。方法利用两袖套法连接肝下下腔静脉及门静脉,单线连续吻合肝上下腔静脉。共完成120例大鼠减体积原位肝移植模型。结果顺利完成模型建立,移植术后大鼠均能自由活动,进食活跃。其2d和7d存活率分别为85.8%和83.3%。结论利用改进的两袖套法,可以建立稳定的大鼠同种异体减体积原位肝脏移植模型。     

大鼠"二袖套"法双重灌注全血供肝移植模型的建立

目的：建立一个供肝灌注良好受体无肝期明显缩短及移植肝全血供稳定的肝移植动物模型。方法：“二袖套”法在Kamada吻合血管基础上改良,供肝分别经腹主动脉和门静脉双重全肝脏灌注;受体肝脏分步切除,肝上下腔静脉采用缝合法吻合,门静脉和肝下下腔静脉分别用袖套法吻合。移植肝脏动脉重建采用单纯血管套入式吻合或血管缝合的方法,胆总管采用单管内支架胆管端端吻合法。结果：共施行全血供大鼠原位肝脏移植76例（不包括预试验）,手术成功率93．406,1周存活率86．8％。结论：娴熟的显微外科技术、有效改良措施和注重手术细节是手术成功的保障,良好的灌注、受体无肝期的缩短及重建移植肝脏动脉血供能有效提高动物模型的稳定性。     

大鼠原位肝移植模型的建立*☆

背景：“二袖套法”原位肝移植模型的建立缩短了无肝期的时间,并且显著提高了老鼠肝移植后的存活率。 目的：在“二袖套法”的基础上,结合一些相关文献,建立稳定大鼠原位肝移植模型。 方法：用改进的二袖套法对75对SD大鼠行原位肝移植,移植中门静脉、肝下下腔静脉用袖套法进行吻合,肝上下腔静脉用缝合法吻合,胆道采用支架法进行胆道重建。 结果与结论：受体大鼠移植后一般状况良好,50例正式实验移植后1 d存活率94%,1周存活率为90%。供肝热缺血时间均接近0,供体手术时间(34.44±3.25) min,受体手术时间(49.07±4.93) min,无肝期(17.26±2.51) min,下腔静脉平均阻断时间约为20 min。说明只有熟练地掌握手术技巧,细致耐心的操作,最大程度减少各种并发症的发生,才能获得稳定的原位肝移植模型。     

原位肝移植模型的建立技巧与改进

背景：目前肝移植是治愈终末期肝病惟一的方法,但是其移植后的并发症仍然是影响移植患者长期存活的重要因素,因此有必要建立稳定的动物移植模型。目的：建立原位肝移植模型大鼠。方法：应用乙醚吸入法对SD大鼠204只行麻醉,2-4 ℃林格液经腹主动脉进行单路灌注,灌注前不翻动肝脏,以减少肝脏热缺血,灌注完毕后沿膈环下切断肝上下腔静脉,修整时不需再修整,以免损伤腔静脉。取下供体肝脏,置入4 ℃淋格液中保存,切下受体肝脏,采用改良的二袖套法行同种异体原位肝移植。移植完毕后,大鼠可自行翻身饮水,存活超过3 d,视为移植成功。结果与结论：204只大鼠共行102次肝移植,最终86例移植后存活超过3 d,移植成功率为84%。结果证实,实验通过改进技术成功建立了原位肝移植模型大鼠。中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程     

大鼠减体积肝移植术中的呼吸停止

背景:大鼠减体积肝移植模型的成功建立是进行相应实验的基础和前提条件,呼吸停止是影响大鼠减体积肝移植模型成功建立的主要因素之一,对呼吸停止的分析和急救有助于提高模型建立的成功率。目的:探讨大鼠减体积肝移植术中呼吸停止的原因及急救处理。方法:实验选用SD大鼠,供体为雌性,受体为雄性,均采用乙醚吸入麻醉;供体采用单人裸眼操作,在取肝的过程中即进行减体积操作;受体采用双人裸眼配合操作,采用改良的门静脉和肝下下腔静脉双袖套法,胆管支撑管法建立大鼠减体积的稳定模型。对受体术中呼吸停止随即分成3组进行抢救:实验组1采用"简易人工呼吸"加胸外按压的急救方法;实验组2采用单纯的"简易人工呼吸"的方法;对照组采用单纯的胸外按压的急救方法。结果与结论:成功实施的270对大鼠减体积肝移植模型中,术中因吸入麻醉导致的呼吸停止50只,其原因主要是麻醉过度42只,大量气体栓塞3只,气胸3只,急性肺水肿2只。实验组1、实验组2、对照组大鼠呼吸停止后急救成功率分别为84.6%(22/26),54.5%(6/11),30.8%(4/13);对于因吸入麻醉过度导致的呼吸停止,实验组1急救的成功率为95.6%(22/23)。实验组2抢救成功率为66.7%(6/9)。对照组复苏成功率为40%(4/10)。结果表明,大鼠减体积肝移植术中呼吸停止的原因主要是麻醉过度,其次是大量气体栓塞、气胸和急性肺水肿;简易的人工呼吸加胸外按压对于因吸入麻醉过度导致的术中呼吸停止的抢救最有效,其次为单纯的人工呼吸和单纯的胸外按压。     

灌注速度对移植肝脏缺血再灌注的损伤

背景：近年来有学者研究发现供体灌注的压力可直接影响移植物的能量代谢从而影响其活力,适当的灌注压力能明显提高供体的质量。 目的：观察不同灌注速度对大鼠移植肝脏再灌注损伤的影响。 方法：采用改良的Kamada双袖套法建立SD→SD原位肝移植模型。供体肝脏获取时分别以50,100,150,200 mL/h进行灌注。检测移植后外周血清肿瘤坏死因子α和谷丙转氨酶水平,观察肝脏组织病理学改变和肝脏组织内皮源性一氧化氮合酶的表达变化。 结果与结论：与低灌注速度相比,供体肝脏制备过程中200 mL/h的灌注速度导致了更加明显的肝脏病理形态学改变,肝细胞变性、肝血窦扩张和炎细胞浸润也更加明显。术后24 h肝功能的检测也发现,150,200 mL/h灌注速度组外周血谷丙转氨酶活性、肿瘤坏死因子水平明显高于50,100 mL/h灌注速度组(P < 0.05,P < 0.01),内皮源性一氧化氮合酶表达明显低于50,100 mL/h灌注速度组(P < 0.01),100 mL/h灌注速度后,随着灌注速度的增加肝功能损伤也明显加重。证实适当的灌注压力和速度是获得高质量供体的保障,能够减轻移植后肝功能损伤,改善受体预后,在大鼠肝移植供体制备过程中    100 mL/h是适宜的灌注速度。     

输注同基因骨髓间充质干细胞联合脾组织移植诱导肝移植大鼠的免疫耐受

背景:有研究显示在免疫抑制剂的作用下,同种脾脏细胞移植可诱导免疫耐受,使移植物长期存活。另有研究还显示异种骨髓间充质干细胞移植可延长移植肝存活时间。目的:观察输注与受体同基因骨髓间充质干细胞联合脾组织移植对诱导大鼠肝移植后免疫耐受的作用。方法:将受体Lewis大鼠以数字表法随机分为4组:急性排斥组行DA-Lewis大鼠原位肝移植;环孢素A组行DA-Lewis大鼠原位肝移植后灌胃给予环孢素A;干细胞组行DA-Lewis大鼠原位肝移植,同期输注异体Lewis大鼠骨髓间充质干细胞;脾组织移植组在干细胞移植组的基础上同期移植DA大鼠脾组织。观察各组生存期,肝功能情况,血清细胞因子水平,嵌合体的形成情况及肝脏病理变化。结果与结论:与其他各组相比,脾组织移植组大鼠存活时间明显延长,术后血清丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素、白细胞介素2、干扰素γ水平明显降低(P0.05),白细胞介素6、白细胞介素10明显升高(P0.05),30d后受体脾脏中供体阳性细胞明显升高(P0.05)。肝脏病理显示,环孢素A组和干细胞组移植肝仅呈急性轻度排斥反应,急性排斥组呈急性重度排斥反应,脾组织移植组未见明显排斥反应。说明大鼠肝脏、脾组织移植后输注同基因骨髓间充质干细胞可减轻移植肝的排斥作用,甚至诱导免疫耐受。     

减体积肝移植模型大鼠肝脏组织miRNAs表达谱变化

BACKGROUND: Liver regeneration is the key factor influencing the prognosis of living donor liver transplantation. There has not been the research on special miRNA of liver regeneration after living donor liver transplantation. OBJECTIVE: To analyze the variation of miRNAs expression profile after rat reduced-size liver transplantation at certain time point, select and verify target miRNA which can provide targeting intervention strategies in liver regeneration after rat reduced-size liver transplantation and provide theoretical evidence for liver regeneration after living donor liver transplantation. METHODS: The reduced-size liver transplantation models were established. miRNAs microarray was used to detect miRNA expression. In differentially expressed microRNAs, real-time quantitative PCR was utilized to detect target miRNAs. The credibility of miRNAs microarray results was verified. RESULTS AND CONCLUSION: Compared with rat liver tissue in the sham operation group, 11 miRNAs up-regulated in reduced-size liver transplantation, including let-7b-5p, let-7c-5p, miR-101a-3p, miR-103-3p, miR-130a-3p, miR-142-5p, miR-186-5p, miR-199a-3p, miR-21-5p, 221-3p and miR-34a-5p. Four miRNAs were down-regulated, including miR-26b-5p, miR-150-5p, miR-19a-3p and rno-miR-146-5p. PCR test further verified that miR-221-3p and miR-199a-3p expression changes approximated the chip results at 24, 48 hours and 1 week, indicating that results of miRNA microarray were believable. These results verified that it exists variation of miRNAs expression profile after rat reduced-size liver transplantation, which picked out and verified the target miRNAs.        

大鼠气管异位移植慢性排斥反应模型的建立及其与白细胞介素17的关系

背景：闭塞性细支气管炎是肺移植远期主要并发症之一,建立稳定可靠的动物模型是研究闭塞性细支气管炎的首要条件。 目的：建立大鼠气管异位移植慢性排斥反应模型,探讨白细胞介素17在该模型中的作用。 方法：按体质量配对,Wistar和SD大鼠随机分为2组(n=30)：Wistar(供体)→SD(受体)组和SD(供体)→SD(受体)组,颈前皮下组织包埋移植气管,不同时间点分别采样行组织病理学分析,对比观察移植气管上皮丢失、淋巴细胞计数、无核软骨细胞/软骨细胞总数及白细胞介素17表达量等指标。 结果与结论：两组受体全部存活。移植后第7,14,28天两组淋巴细胞计数对比差异均有显著性意义(P < 0.05);移植后第14,28天两组无核软骨细胞/软骨细胞总数比值相比差异均有显著性意义(P < 0.05);移植后第7,14,28天Wistar(供体)→SD(受体)组上皮丢失度分别为> 40%,100%,100%,SD(供体)→SD(受体)组未见明显丢失;移植后第28天Wistar(供体)→SD(受体)组闭塞性细支气管炎发生率为100%,SD(供体)→SD(受体)组未发生闭塞。移植后第28天Wistar(供体)→SD(受体)组白细胞介素17表达量显著高于SD(供体)→SD(受体)组(P < 0.05)。以上结果说明实验成功建立了Wistar(供体)→SD(受体)大鼠异位气管移植慢性排斥反应模型,为闭塞性细支气管炎研究提供了平台,白细胞介素17可能在其中发挥重要作用。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程      

Mechanism of Immune Hyporesponsiveness Induced by Recipient-derived Immature Dendritic Cells in Rat Liver Transplantation

Objective: The use of donor-derived immature dendritic cells (imDC) has become a promising approach to induce immune tolerance or immune hyporesponsiveness. However, donor-derived imDC needs to be harvested for a few days and transfused into the recipient in 5-10 days before transplantation, which is practically impossible in a clinical setting where donor organs are mainly harvested from cadavers. Moreover, donor-derived imDC might be cleared by allogeneic reaction offsetting induced immune tolerance or immune hyporesponsiveness. In our study, we further explored the underlying mechanism of immune hyporesponsiveness induced by donor-antigen-unloaded recipient-derived imDC by transfusing these imDC into rats in 1 day before liver transplantation. This paper is to study the mechanism of immune hyporesponsiveness induced by donor-antigen-unloaded recipient-derived imDC and its protection of liver grafts in rats. Methods: 40 SD rats (donor) and 40 male Wistar rats (recipient) were randomly divided into 4 groups: control, cyclosporine A(CsA), mature DC (mDC), and imDC; with 10 SD rats and 10 Wistar rats for each group. Animal models of acute graft rejection were established with these rats. Corresponding treatments were given before or after transplantation. In the control group, Wistar rats received no treatment other than liver transplantation. In the CsA group, Wistar rats underwent liver transplantation plus CsA treatment (10 mg/kg·d) in the starting day 2 after transplantation. For the mDC group, recipient-derived mDC(1×106/rat) were infused intravenously via the dorsal vein of the penis to recipient rats. For the imDC group, imDC (1×106/rat) were injected into recipient rats via the dorsal vein of the penis. In each group, 5 recipients were executed at 10 days after transplantation; the remaining five recipients were kept for the observation of survival time. Blood samples were collected for the measurement of ALT and TBIL; IL-2, IFN-γ, IL-4 and IL-10 and levels were measured with double-antibody sandwich ELISA. Liver tissue was harvested for HE staining and the observation of histological features. Acute rejection was evaluated with Banff classification. Expression levels of Fas-L/Fas in the grafts were detected by immunohistochemical staining; and western blot was used to detect the expression level of Scurfin. Results: The median survival times (MST) of the liver allografts in the CsA and imDC group were significantly longer than those in the control or mDC group (P<0.05). The serum levels of ALT and TBIL in the control and mDC groups were significantly higher than those of the CsA or imDC group(P<0.05). Compared with the CsA and imDC group, the levels of IL-2 and IFN-γ were higher but the levels of IL-4 and IL-10 were lower than those of the control and mDC groups(P<0.01). Slight or no rejection reaction was found in the CsA and imDC groups (P<0.05). The expression level of Scurfin protein in CD4+ CD25+ T cells of the imDC group was significantly higher than that of three other groups(P<0.05). Conclusion: Donor-antigen-unloaded recipient-derived imDC is an effective treatment in inducing immune hyporesponsiveness by blocking indirect recognition in rat liver transplantation model. Survival span was significantly prolonged by its protective effect. The mechanism of immune hyporesponsiveness induced by imDC transfusion may involve the preprocesses of T cell apoptosis induction, immune tolerance or hyporesponsiveness in T cells, induction of the shift in THl/TH2 balance, selection activation of Th2 subset, or induction of regulatory T cell.     

预输注RelB shRNA慢病毒修饰树突细胞诱导大鼠肝移植免疫耐受

背景：肝移植后的排斥反应是威胁患者和移植物长期存活的主要原因。诱导受者产生特异性免疫耐受是解决排斥反应的理想措施。 目的：探讨RNAi RelB树突状细胞预输注诱导大鼠肝移植特异性免疫耐受的可能性。 方法：将近交系雄性清洁级DA(RT1a)大鼠和近交系雄性SPF级Lewis(RT11)大鼠分别作为供、受体,行原位肝移植手术。术前随机配对分为4组：①对照组,受体鼠移植前不做预输注。②治疗组：受体鼠移植前7 d静脉输注供体大鼠RNAi RelB树突状细胞(5×106)。③未成熟树突状细胞组：受体鼠移植前7 d静脉输注供体大鼠未成熟树突状细胞(5×106)。④成熟树突状细胞组：受体鼠移植前7 d静脉输注供体大鼠成熟树突状细胞(5×106)。 结果与结论：与对照组、未成熟树突状细胞组以及成熟树突状细胞组相比,治疗组移植肝的平均生存时间显著延长。移植后第7天,治疗组天冬氨酸转氨酶,总胆红素水平低于对照组、成熟树突状细胞组、未成熟树突状细胞组(P < 0.01),移植后第14天治疗组、未成熟树突状细胞组天冬氨酸转氨酶,总胆红素均有轻微下降,两组比较差异仍有显著性意义(P < 0.01)。移植后第7天,与治疗组比较,对照组、成熟树突状细胞组、未成熟树突状细胞组γ-干扰素、白细胞介素2水平升高(P < 0.01),而白细胞介素4、白细胞介素10下降(P < 0.01);移植后第14天治疗组、未成熟树突状细胞组γ-干扰素、白细胞介素2水平均有下降,白细胞介素4、白细胞介素10水平均有升高,两组比较差异仍有显著性意义(P < 0.01)。对照组、成熟树突状细胞组、未成熟树突状细胞组移植后第7天排斥活动指数为8.0-9.0。未成熟树突状细胞组第14天肝细胞、内皮细胞坏死及汇管区炎性细胞浸润进一步增多。治疗组移植后第7天排斥活动指数为6.0-8.0,第14天时排斥活动指数为4.0-5.0。结果提示RNAi RelB树突状细胞预输注可以减轻移植肝排斥程度,延长移植肝生存时间,这是通过间接途径实现的,其机制可能与T细胞的调节和无能有关。     

供肝NK细胞对肝移植免疫反应中NF-κB 活性和IL-15表达的影响

 目的：观察大鼠移植肝组织内和外周血白细胞介素15（IL-15）的表达水平及脾组织内核因子κB(NF-κB)的表达活性变化,探讨供肝NK细胞减轻肝移植术后急性排斥反应的机制。方法：Lewis大鼠为肝移植供体,BN大鼠为受体,改良“二袖套”法建立大鼠肝移植模型。应用［60Co］射线照射清除供体免疫细胞和经门静脉回输供肝NK细胞等技术,实验设立3组。A组: 急性排斥组;B组: 单纯［60Co］照射排斥组;C组: ［60Co］照射+供肝NK细胞门静脉回输排斥组。移植术后第1、3、7天收集受鼠外周血清,ELISA法检测IL-15分泌水平,同时切取移植肝行病理学检查,Western blotting法检测移植肝组织IL-15蛋白的表达,凝胶电泳迁移实验（EMSA）检测受鼠脾组织NF-κB表达活性。另外每组各设亚组观察移植后大鼠自然生存时间。结果：B组术后大鼠自然存活时间较A、C组明显缩短,术后发生急性排斥反应程度较A、C组严重;术后第3、7天,3组受鼠外周血IL-15水平均较第1天时显著升高;移植术后第3、7天,B组大鼠血清IL-15 浓度均显著高于A、C组;术后第3、7天,移植肝组织中B组IL-15表达也显著高于A、C组,受鼠脾组织中B组NF-κB表达活性亦显著高于A、C组。结论：IL-15可能作为肝移植急性排斥反应的监测指标,对急性排斥反应的早期诊断和移植物的预后估计具有临床指导意义;供肝NK细胞可能通过下调NF-κB的表达活性来调节IL-15的水平,进而减轻肝移植术后急性排斥反应。     

DA至Lewis大鼠肝移植急性排斥反应模型的建立：技术改良分析

背景：国际上研究肝移植免疫耐受的基础动物模型是大鼠肝移植急性排斥反应模型,国际上公认的肝移植急性排斥反应模型鼠种配对方式为DA至Lewis大鼠、DA至BN大鼠及BN至Lewis大鼠,但由于鼠种缺乏和操作技术有待成熟的原因,国内较少引用以上鼠种配对方式进行该模型的建立。 目的：课题组在大量SD大鼠肝移植模型建立训练的基础上,采用DA大鼠为供体,Lewis大鼠为受体,摸索DA至Lewis大鼠肝移植急排模型建立技巧和经验。 方法：通过改良二袖套法,以雄性DA大鼠为供体,雄性Lewis大鼠为受体,建立原位肝移植动物模型60只,受体大鼠术前1 d和术后1周内饲喂治疗剂量的他克莫司,1周后半量递减并停药,记录移植手术时间,观察受体大鼠的术后生存状况、手术成功率及生存期,分别于术后7,14,21,28 d处死受体大鼠,获取肝组织标本,苏木精-伊红染色,观察肝脏大体和镜下的病理学变化,进行急性排斥反应评分。 结果与结论：供肝冷缺血时间30~60 min,供体手术时间(18.5±4.0) min,供肝修整时间(7±3) min,受体手术时间(35.0±  7.3) min,无肝期为(13.0±3.0) min,手术成功率为98%,1周存活率为91.6%。术后2周随着他克莫司撤药,受体大鼠迅速发生急性排斥反应,于术后14~28 d死亡,平均生存时间为(20.85±0.71) d,中位生存时间为21 d。实验建立DA至Lewis大鼠肝移植急性排斥反应动物模型需要以大量SD大鼠肝移植训练为基础进行,通过对二袖套法技术的改良和围手术期短期应用他克莫司有助于该模型的稳定建立。     

The role of graft-resident Kupffer cells and lymphocytes of donor type during the time course after liver transplantation—a clinico-pathological study

Although graft-resident passenger leukocytes are known to mediate acute rejection by triggering direct allorecognition, they may also act in an immunomodulatory fashion and play an important role in tolerance induction. The present study evaluated by non-isotopic in situ hybridization and immunohistochemistry if and during which time period after transplantation Kupffer cells (KC) and lymphocytes of the liver were replaced by recipient cells and if there is any correlation with the occurrence of rejection episodes and the clinical course. A successive re-population of the liver by recipient lymphocytes and KC was observed after transplantation but a smaller portion of lymphocytes and KC with donor genotype was detectable during the whole time course studied. There was no correlation between the portion of recipient-derived KC and donor-derived lymphocytes and histopathological alterations of the liver tissue. The biopsy content of KC with recipient origin has had no prognostic significance for the probability of survival, but patients with a low portion of donor lymphocytes in the liver biopsy obtained during the first week after transplantation have had a better prognosis for survival. The present results indicate that graft-resident KC and lymphocytes are potentially not the main cell types involved in tolerance induction after liver transplantation.The study contains parts of the doctoral thesis of Adriana Bottino.     

De novo infection of hepatitis B virus in patients with orthotopic liver transplantation: analysis by determining complete sequence of the genome

De novo infection of hepatitis B virus (HBV) occurs after liver transplantation from donors with HBV markers that suggest past infection. In the present study, the complete nucleotide sequences of HBV derived from a donor and recipients were determined to determine the clinical and virological characteristics. A total of 57 donor-recipient pairs, which underwent living-related orthotopic liver transplantation, were enrolled in the present study; all were negative for HBsAg before transplantation. HBV DNA was tested in serum, liver tissue, and peripheral blood mononuclear cells (PBMCs) by the polymerase chain reaction (PCR). The nucleotide sequence of HBV was determined based on PCR products and the phylogenetic analysis. De novo infection of HBV was found in 3 of the 57 recipients. Anti-HBc was positive in all donors of 3 recipients with the de novo infection but was positive only in 4 donors of the remaining 54 recipients (P=0.001). HBV DNA was detected in the liver but not in the serum or PBMCs in donor 3 whose recipient developed de novo HBV infection. The nucleotide sequence covering entire genome of HBV (3,215 bases) derived from the liver of donor 3 had a homology of 99.8-100% with that derived from the serum of corresponding recipient 3. The strain of recipient 3 showed the closest association with that of the donor 3 by phylogenetic analysis. Complete sequences from two recipients with de novo HBV infection including recipient 3 conserved the basic organisation of HBV genome. Analysis of the entire nucleotide sequence of HBV genome proved that HBV existed in the liver of the donor with anti-HBc, and it caused de novo infection in the corresponding recipient.     

Establishment of simultaneous pancreas and kidney transplantation (SPK) model with cuff technique and portal venous drainage in rats

Objective: To establish a simultaneous pancreas and kidney transplantation (SPK) model in the rat. Methods: SD rats served as donors and recipients. The donor portal vein and the recipient superior mesenteric vein were anastomosed and the donor renal veins and recipient renal veins were anastomosed by cuff method. Arterial reconstruction was carried out by end to side anastomosis of the donor abdominal aorta to the recipient abdominal aorta. Enteric drainage was performed by side to side anastomosis between donors' duodenum and recipients' jejunum. The donor ureter -bladder valve was anastomosed to the bladder of recipients.Results: Out of 30 cases of SPK transplantation, 24 had normal serum glucose and serum creatinine after operation. The successful rate was 80 %. Conclusion: This model of SPK in rats is stable and reliable, which could be applied for further scientific research.     

Origin of adenocarcinoma in a transplanted liver determined by microsatellite analysis

Inadvertent transmission of neoplastic cells from an organ donor can occur at the time of transplantation. Determination of recipient versus donor origin of a tumor is crucial for patient management. This report illustrates the use of microsatellite (MS) analysis to determine the origin of adenocarcinoma arising in a liver transplant. The study patient was a 42-year-old male who had received a liver transplant for hepatitis C and alcohol-related cirrhosis. At the 1-year follow-up visit, a 1.5-cm liver mass was identified during routine ultrasound of the vascular anastamoses. A liver biopsy showed a moderately differentiated adenocarcinoma. Tumor, donor, and recipient DNA were isolated from the paraffin-embedded liver biopsy, pretransplant donor liver biopsy, and the explant liver tissue, respectively. MS analysis was performed by polymerase chain reaction using 5 markers: D5S346, ACTC, D2S123, D18S34, and TP53. The allelic patterns of tumor DNA were identical to those of donor DNA and were distinct from the DNA profile of the recipient. The use of MS analysis clearly established that the adenocarcinoma was of donor origin.