肝衰竭患者血浆置换治疗前后细胞因子的变化与预后的关系

目的探讨肝衰竭患者人工肝治疗（血浆置换）术前与术后72 h细胞因子变化与预后的关系。方法选择2011年4月至2012年4月在兰州市第二人民医院感染科住院并经血浆置换治疗的58例肝衰竭患者,根据临床转归情况,分为好转组和未愈组。测定治疗前及术后72 h血清中白细胞介素（IL）-4、IL-6、IL-10、肿瘤坏死因子（TNF）α以及干扰素（IFN）γ的水平,观察其变化和预后的关系。数据以均数±标准差（x±s）表示,治疗前后比较采用配对t检验,组间比较采用组间t检验。结果经血浆置换治疗后,患者好转率为67.24%（39/58）,未愈率为32.75%（19/58）。好转组血浆置换治疗术前和术后72h血清IL-4、IL-6、IL-10、TNFα以及IFNγ差异有统计学意义（t=2.048～5.163,P〈0.05）,其中IL-4、IL-6、TNFα、IFNγ的下降程度较未愈组患者更为明显,IL-10水平提升程度较未愈组明显。术前IL-6、TNFα水平未愈组较好转组明显偏高,差异有统计学意义（t=2.024～2.174,P〈0.05）。结论血浆置换能有效清除血清中炎性细胞因子TNFα、IL-4、IL-6、IFNγ,提升IL-10水平,是治疗肝衰竭的有效措施。肝衰竭患者发生的免疫损伤过程中,IL-6、TNFα较其他细胞因子似乎起着更为重要的作用。     

原发性胆汁性肝硬化患者外周血淋巴细胞亚群和细胞因子水平及药物对其的影响

目的 研究原发性胆汁性肝硬化(PBC)患者外周血淋巴细胞亚群、细胞因子特点及药物对其的影响.方法 82例初诊PBC患者随机分为熊去氧胆酸组(28例)、熊去氧胆酸联合泼尼松龙组(27例)、熊去氧胆酸联合硫唑嘌呤组(27例),检测治疗前和治疗3、6个月时外周血淋巴细胞亚群和细胞因子水平.另设健康对照组20例.结果 与健康对照组相比,PBC患者外周血CD_4~+T细胞比例升高[42.10±0.97)%比(36.40±2.18)%],IFN7[(36.40±1.49)ng/L比(25.70±2.50)ns/L]、IL-2[(68.30±3.14)ng/L比(37.10±3.72)ns/L]、IL-4[(53.30±2.49)ns/L比(40.70±3.78)ns/L]、IL-6[(41.30±2.91)ng/L比(31.20±3.14)ng/L]、TNFα[(30.10±0.94)ng/L比(23.50±1.68)ng/L]、IL一1β[(55.80±2.38)ng/L比(42.40±3.03)ns/L]、转化生长因子β(TGFβ)[(68.10±2.63)ng/L比(59.10±2.29)ng/L]水平升高;外周血TNFα水平与AIJT、AST、总胆红素(TBil)、直接胆红素(DBil)、Mayo危险评分呈正相关(r分别为0.355、0.390、0.409、0.397、0.293,P<0.05).治疗后,熊去氧胆酸组外周血CD~+_4T细胞比例下降;熊去氧胆酸组IFNγ、IL-4、IL-6水平在治疗3个月后降低,而6个月后升高;熊去氧胆酸联合泼尼松龙组、熊去氧胆酸联合硫唑嘌呤组IFNγ、IL-4、IL-6均较治疗前降低.3组PBC患者治疗后IL-2、TNFα均较治疗前降低.结论 PBC患者外周血同时存在Th1型和Th2型细胞因子异常,且以Th1型细胞因子异常为主,提示PBC是以细胞免疫为主的自身免疫病.IFNγ、TNFα与病情相关.三种治疗方案对免疫系统的调节不完全相同.     

血浆置换联合血浆灌流治疗肝衰竭患者临床疗效分析

目的探讨血浆置换(PE)联合血浆灌流(PP)治疗肝衰竭患者的临床疗效。方法选择2012年6月~2015年7月我科治疗的肝衰竭患者46例为观察组,行PE联合PP治疗;以2007年1月~2008年5月治疗的肝衰竭患者46例为对照组,行单纯PE治疗。采用日本OLYMPUS AU5400全自动生化分析仪检测肝功能指标;采用酶联免疫吸附法检测CRP、TNF-α、IL-6水平。结果观察组显效率和总有效率(分别为41.3%和93.47%)均明显高于单纯PE组(21.74%和78.26%,P0.05);治疗后,观察组患者血清TBIL、INR、NH3、CRP、TNF-α和IL-6水平分别为(308.3±35.3)μmol/L、(1.6±0.2)、(214.3±22.7)μmol/L、(7.4±1.1)mg/L、(1128.3±345.3)ng/L和(115.5±12.0)ng/L,明显低于对照组【分别为(326.1±38.4)μmol/L、(1.9±0.8)、(267.5±26.1)μmol/L、(10.3±1.3)mg/L、(2012.3±318.4)ng/L和(184.3±20.1)ng/L,P0.05】;观察组ALB水平为(34.3±4.9)g/L,明显高于对照组【(31.4±3.9)g/L,P0.05】;观察组并发症发生率为19.6%,显著低于对照组的36.1%(P0.05)。结论血浆置换联合血浆灌流治疗肝衰竭患者有助于清除炎性因子,改善肝功能,提高治疗效果。     

心力衰竭患者血浆细胞因子变化与心功能的关系

目的:分析心力衰竭患者血浆细胞因子变化与心功能的关系。方法:选择2011年8月至2013年8月我院收治的58例心力衰竭患者为心衰组,另选同期来我院进行体检的58名健康人群作为健康对照组,运用酶联免疫吸附试验(ELISA)检测其C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、Th1/Th2细胞因子干扰素-γ(IFN-γ)、白介素-4(IL-4)水平,并进行比较。结果:与健康对照组比较,心衰组NYHAⅡ级、NYHAⅢ级、Ⅳ级患者的CRP[(3.57±1.15)mg/L比(6.21±1.89)mg/L、(6.89±2.02)mg/L、(7.57±2.11)mg/L]、TNF-α[(4.31±2.09)ng/L比(13.97±3.24)ng/L、(16.23±3.59)ng/L、(18.55±3.61)ng/L]、IL-6[(8.25±1.2)ng/L比(19.27±4.26)ng/L、(25.78±4.89)ng/L、(34.44±6.12)ng/L]水平均明显升高;外周血IFN-γ水平[(48.21±7.52)pg/ml比(68.63±8.24)pg/ml、(73.91±10.14)pg/ml、(82.44±11.58)pg/ml]、IFN-γ/IL-4[(1.07±0.12)比(1.73±1.26)、(2.09±1.31)、(2.38±1.40)]均显著升高(P均0.05);NYHAⅢ级、Ⅳ级患者的外周血IL-4[(45.11±6.97)pgl/ml比(35.31±5.47)pgl/ml、(34.56±4.92)pgl/ml]水平显著降低(P均0.05)。NYHAⅢ级、Ⅳ级患者的外周血IFN-γ、IFN-γ/IL-4显著高于NYHAⅡ级组患者,且NYHAⅣ级组患者又显著高于Ⅲ级组的(P均0.05)。结论:心力衰竭患者血浆细胞因子与心功能密切相关。     

白细胞介素7和15对肺结核患者Th1/Th2平衡的调节作用

目的探讨白细胞介素7(IL7)、IL15对肺结核病患者外周血单个核细胞(PBMC)分泌Th1型细胞因子γ干扰素(IFNγ)、肿瘤坏死因子α(TNFα)和Th2型细胞因子IL4、IL10的影响。方法选择2003年1至9月入院的60例肺结核患者和25名健康对照者,用葡聚糖泛影葡胺密度梯度离心法分离PBMC。按加入刺激物的不同,将每份标本分为6组:RPMI1640组、纯化蛋白衍生物(PPD组)、PPD+IL7组、PPD+IL7抗体组、PPD+IL15组、PPD+IL15抗体组。加入相应刺激物后培养72h,收集上清液,采用酶联免疫吸附法(ELISA)检测各组培养上清液中IFNγ、TNFα、IL4、IL10的水平。结果与PPD组相比,加入IL7的患者组PBMC分泌IFNγ和TNFα显著增高,分别为(107±42)～(157±74)ng/L、(460±128)～(887±242)ng/L;显著抑制IL4和IL10的合成,分别为(58±15)～(31±9)ng/L、(153±40)～(112±32)ng/L。健康对照组PBMC分泌IFNγ和TNFα显著增高,分别为(211±57)～(292±92)ng/L、(1203±390)～(1722±503)ng/L;显著抑制IL4和IL10的合成,分别为(43±13)～(36±11)ng/L、(135±37)～(96±36)ng/L。加入IL15患者组PBMC分泌IFNγ和TNFα显著增高,分别为(107±42)～(231±62)ng/L、(460±128)～(843±208)ng/L;显著抑制IL4和IL10的合成,分别为(58±15)～(37±9)ng/L、(153±40)～(116±41)ng/L。健康对照组PBMC分泌IFNγ和TNFα显著增高,分别为(211±57)～(343±108)ng/L、(1203±390)～(1468±235)ng/L;显著抑制IL4和IL10的合成,分别为(43±13)～(36±8)ng/L、(135±37)～(90±35)ng/L。加入IL7抗体或IL15抗体均可抑制IFNγ和TNFα的分泌,促进IL4和IL10的合成。肺结核患者各组IFNγ、TNFα水平均低于健康对照各组,而IL4、IL10水平比较差异无统计学意义。结论IL7和IL15可作为免疫调节剂,诱导IFNγ及TNFα分泌,抑制IL4及IL10合成,从而调节Th1/Th2平衡,发挥对结核分枝杆菌感染患者的免疫保护作用。     

重型再生障碍性贫血患者树突细胞刺激异体淋巴细胞增殖的功能

目的 了解重型再生障碍性贫血(SAA)患者树突细胞(DC)刺激异体淋巴细胞增殖的功能,探讨SAA的免疫病理机制.方法 以25例SAA患者和12例正常对照者为研究对象,以重组人白介素-4(rhIL-4)、重组人粒-巨噬细胞集落刺激因子(rhGM-CSF)和重组人肿瘤坏死因子(rhTNF)体外诱导骨髓单核细胞分化为成熟髓细胞样DC(mDC),与正常淋巴细胞按1:100、1:50作混合淋巴细胞培养(MLR),噻唑兰(MTT)比色法计算淋巴细胞增殖率.ELISA法检测MLR培养上清IL-12、干扰素γ(IFNγ)浓度.分析MLR上清液IL-4、IFNγ水平与淋巴细胞增殖率相关性.结果 SAA初治组、恢复组和对照组mDC与淋巴细胞1:100混合培养时,淋巴细胞增殖率分别为(219.8 ±94.0)%、(159.1 ±66.0)%、(160.1 ±91.9)%,培养上清IL-12水平分别为(8.2±3.6)ng/L、(6.5±2.8)ng/L、(6.1±2.6)ng/L,IFNγ,水平分别为(21.8 ±8.7)ng/L、(25.5±9.1)ng/L和(22.6±7.8)ng/L3组差异均无统计学意义(P值均>0.05).初治组、恢复组和对照组mDC与淋巴细胞1:50混合培养时,淋巴细胞增殖率分别为(322.1±171.1)%、(180.9±79.1)%、(192.3 ±91.9)%,培养上清IL-12水平分别为(12.6 ±4.4)ng/L、(9.4 ±3.3)ng/L、(8.5 ±3.7)ng/L,IFNγ,水平分别为(32.3 ±9.2)ng/L、(27.4 ±6.5)ng/L、(24.4 ±7.4)ng/L,3项指标初治组均高于对照组(P<0.05),恢复组与对照组比较差异无统计学意义(P>0.05).MLR上清液IL-12水平与淋巴细胞增殖率呈正相关(r=0.529,P<0.01);MLR上清液IFNγ水平与淋巴细胞增殖率旱正相关(r=0.381,P<0.05).结论 SAA患者mDC刺激淋巴细胞增殖功能增强,在SAA发病中起重要作用.     

中医辨证运用重肝汤剂结合组合型人工肝对早期肝衰竭患者细胞因子水平及转归的影响

目的:探讨中医辨证运用重肝汤剂结合组合型人工肝对早期肝衰竭患者细胞因子水平及转归的影响。方法:2019年5月至2021年5月收治住院的乙型肝炎慢加急性/亚急性肝衰竭并接受人工肝治疗的病例共120例，经随机数字表法分为研究组和对照组，各60例。研究组患者采用重肝汤剂联合组合型人工肝，即半量血浆置换(PE)联合双重血浆分子吸附系统(DPMAS),平均每人治疗2～5(3.46±1.03)次。对照组患者采用单纯PE,平均每人治疗2～5(3.51±0.89)次。比较两组患者治疗前后肝功能指标、INR水平、细胞因子水平及MELD评分变化，收集治疗期间患者不良反应发生情况，并进行为期6个月的跟踪随访，统计两组患者3、6个月存活率，综合分析两组临床疗效差异。结果:研究组患者治疗有效率为95.83%,显著高于对照组(81.25%,P<0.05)。治疗后，两组患者的TBil、Cr、TBA及INR均显著下降(P<0.05),研究组患者改善程度显著优于对照组(P<0.05);两组患者的TNF-α、IL-6、IL-8水平及MELD评分均降低(P<0.05),研究组患者降幅大于对照组(P&...     

慢性特发性血小板减少性紫癜CD_4~+T细胞亚群变化的特点

目的 测定慢性特发性血小板减少性紫癜(ITP)患者CD_4~+T细胞亚群[Th1、Th2、Th17和调节性T细胞(Treg)]和相应血浆细胞因子水平,探索其在ITP发病机制中的作用.方法 将35例成人慢性ITP患者分为疾病活动组、未缓解组、缓解组,18例体检正常者设为对照组.应用流式细胞仪检测表达细胞内因子干扰素(IFN)γ~+、白细胞介素(IL)-4~+、IL-17~+细胞及表达CD_(25)~+Foxp3~+细胞分别占CD_4~+细胞的百分率.应用ELISA检测血浆中IFNγ、IL-4、IL-17和IL-10的水平,分析活动组患者血浆细胞因子水平与血小板、骨髓巨核细胞计数间的相关性.结果 Th1、Th17细胞百分率及Th1/Th17比例在各组间比较差异均无统计学意义;Th2细胞百分率:活动组[(1.01±0.88)%]、未缓解组[(1.22±1.04)%]与对照组[(1.86±0.59)%]比较明显下降(P<0.05);Th1/Th2比例:活动组(15.04±9.67)、未缓解组(11.65±9.32)与对照组(7.02±3.01)比较明显增高(P<0.05); Treg细胞百分率:活动组[(0.89±0.58)%]、未缓解组[(1.46±1.27)%]与对照组[(5.73±0.71)%]比较明显下降(P<0.01).IFNγ、IL-17水平在各组间比较差异无统计学意义;IL-4水平:活动组[(2.25±2.05)ng/L]、未缓解组[(2.33±2.14)ng/L]与对照组[(5.54±4.00)ng/L]比较明显下降(P<0.05);IL-10水平:活动组[(5.07±4.10)ng/L]、未缓解组[(5.66±4.35)ng/L]与对照组[(14.21 ±7.31)ng/L]比较明显下降(P<0.01).上述各参数(Th2、Treg细胞百分率、IL-4、IL-10水平)在缓解组与对照组间比较差异无统计学意义.活动组患者血浆IL-10水平与血小板计数呈正相关(r=0.16,P=0.03),与骨髓巨核细胞数间无相关性(r=0.41,P=0.06).结论 慢性ITP患者疾病活动组Th1/Th2比值升高,这是由Th2细胞的百分率下降所致.Treg细胞百分率下降可能与慢性ITP发病机制有关,但Th17细胞百分率可能与慢性ITP疾病状态无关.     

异甘草酸镁治疗慢性乙肝及对患者Th1/Th2型细胞因子的影响

目的探讨异甘草酸镁治疗慢性乙肝及对患者Th1/Th2型细胞因子的影响。方法选取2013年12月至2014年12月我院收治的慢性乙肝患者80例作为研究对象,将其随机分为对照组和观察组。对照组给予常规治疗,观察组患者给予异甘草酸镁治疗。结果观察组治疗总有效率(77.50%)高于对照组的(55.00%)(P0.05)。治疗后,两组ALT、AST水平与治疗前相比均有所降低,且观察组患者AST水平(42.2±6.1)U/L、ALT水平(41.7±6.6)U/L均低于对照组AST水平(52.9±7.2)U/L、ALT水平(51.5±8.3)U/L(P0.01)。治疗后,两组IFNγ、IL-2、IL-4、IL-10水平与治疗前相比均有所改善,且观察组治疗后IFNγ水平(29.29±10.07)pg/m L、IL-2水平(196.36±10.53)pg/m L、IL-4水平(45.78±11.04)pg/m L、IL-10水平(8.47±6.14)pg/m L改善程度均优对照组IFNγ水平(18.33±9.14)pg/m L、IL-2水平(143.21±12.74)pg/m L、IL-4水平(75.23±12.75)pg/m L、IL-10水平(13.91±6.42)pg/m L,差异具有统计学意义(P0.01)。结论异甘草酸镁治疗慢性乙肝能有效提高患者的治疗效果,促进肝功能的恢复,改善机体免疫紊乱状态,减轻机体炎症反应。     

血浆置换联合血液滤过对乙型肝炎相关慢加急性肝衰竭患者血清IL-17和IL-6的影响

目的探讨血浆置换联合血液滤过对乙型肝炎相关肝衰竭血清白细胞介素(IL)-17、IL-6的影响。方法 30例乙型肝炎慢加急性肝衰竭患者在内科治疗的基础上采用血浆置换联合血液滤过单次治疗。用ELISA检测各组血清IL-17、IL-6浓度,同时记录血清ALT、TBil等值并进行统计分析。结果肝衰竭组患者血清IL-17、IL-6水平分别为(123.5±23.0)pg/ml、(110.0±18.5)pg/ml,高于慢性乙型肝炎患者(48.5±6.3)pg/ml、(27.8±5.9)pg/ml和正常对照组(34.7±3.3)pg/ml、(12.1±5.1)pg/ml,P均<0.001;治疗后血清IL-17、IL-6水平分别为(84.7±21.4)pg/ml、(75.8±16.6)pg/ml,较治疗前下降(t=35.1,P<0.001;t=33.4,P<0.001);与好转组相比,人工肝对恶化组血清IL-17、IL-6清除效率降低(t=3.8,P<0.05;t=3.9,P<0.05);人工肝对血清IL-17、IL-6清除效率均与MELD评分呈负相关(r=-0.53、P=0.003;r=-0.43,P=0.015)。结论血浆置换联合血液滤过能有效降低肝衰竭患者血清IL-17、IL-6水平,其对IL-17、IL-6的清除效率可能与患者预后有关。     

Ultrasound liver elastography beyond liver fibrosis assessment

Several guidelines have indicated that liver stiffness(LS) assessed by means of shear wave elastography(SWE) can safely replace liver biopsy in several clinical scenarios, particularly in patients with chronic viral hepatitis. However, an increase of LS may be due to some other clinical conditions not related to fibrosis,such as liver inflammation, acute hepatitis, obstructive cholestasis, liver congestion, infiltrative liver diseases. This review analyzes the role that SWE can play in cases of liver congestion due to right-sided heart failure, congenital heart diseases or valvular diseases. In patients with heart failure LS seems directly influenced by central venous pressure and can be used as a prognostic marker to predict cardiac events. The potential role of LS in evaluating liver disease beyond the stage of liver fibrosis has been investigated also in the hepatic sinusoidal obstruction syndrome(SOS) and in the Budd-Chiari syndrome. In the hepatic SOS, an increase of LS is observed some days before the clinical manifestations;therefore, it could allow an early diagnosis to timely start an effective treatment.Moreover, it has been reported that patients that were successfully treated showed a LS decrease, that reached pre-transplantation value within two to four weeks. It has been reported that, in patients with Budd-Chiari syndrome, LS values can be used to monitor short and long-term outcome after angioplasty.     

Recurrent nonviral liver disease following liver transplantation

Recurrent disease after liver transplantation is well recognized and remains a potential cause of premature graft loss. The rates of recurrence are difficult to establish because of the lack of consistency in diagnostic criteria and approaches to diagnosis. Owing to the fact that recurrent parenchymal disease may occur in the presence of normal liver tests, those centers that use protocol biopsies will report greater rates of recurrence. It is important to recognize that rates of recurrence vary according to indication and show little correlation with rates of graft loss from recurrent disease. Recurrance rates are greatest for primary sclerosing cholangitis and autoimmune hepatitis, and low reccurrance rates are reported for alcoholic liver disease and recurrent primary biliary cirrhosis. The impact of recurrent nonalcoholic fatty liver disease is not yet clear. Patients and clinicians need to be aware of the possibility of recurrent disease in the differential diagnosis of abnormal liver tests, and management stategies may require alteration to reduce the impact of disease recurrence on outcome. Finally, an understanding of which diseases do recur after transplantation and identification of the risk factors may lead to a better understanding of the pathogenetic mechanisms of these conditions.     

脂肪性肝病与原发性肝癌

脂肪性肝病是隐原性肝硬化的主要原因之一,其经过肝硬化进展至原发性肝癌的过程已被认可,但是近年来越来越多的研究证实脂肪性肝病本身存在有促肿瘤形成的机制,它可以不经过肝硬化而直接进展成原发性肝癌,两者之间的具体机制还未明确.此文就脂肪性肝病向原发性肝癌进展的可能机制作一综述.     

Auxiliary liver transplantation for acute liver failure

BACKGROUND: In patients with acute liver failure (ALF) who fulfil criteria, liver transplantation is the only effective treatment which can substitute metabolic and excretory function of the liver. Auxiliary liver transplantation was developed because a significant minority of patients with ALF who fulfil transplant criteria can have a complete morphological and functional recovery of their liver. The favourable outcome reported in European series using auxiliary partial orthotopic liver transplantation (APOLT), the greater experience as well as the lessons from split liver and from living related donors have revived interest in this approach. In selected patients aged <40 years without haemodynamic instability, the use of ABO-compatible, non-steatotic grafts harvested from young donors with normal liver function can restore liver function and prevent the occurrence of irreversible brain damage. In the majority of cases the auxiliary graft is a right graft which is placed orthotopically after a right hepatectomy in the recipient. After standard immunosuppression, the recovery of the native liver is assessed by biopsies, hepatobiliary scintigraphy and computed tomography. When, on the basis of histological, scintigraphical and morphological data, there is evidence of sufficient regeneration of the native liver, immunosuppression can be discontinued progressively. Complete regeneration of the native liver can be observed in >50% of patients, who can be withdrawn from immunosuppression. Therefore the advantages of auxiliary transplantation seem to balance favourably with the potential inconvenience of this technique in selected patients.     

非酒精性脂肪性肝病与肝硬化

非酒精性脂肪性肝病（Nonalcoholic fatty liver disease, NAFLD）发病与胰岛素抵抗（Insulin resistance, IR） 和遗传易感性密切相关,病理学改变与酒精性肝病（Alcoholic liver disease, ALD）相似,但无过量饮酒史^[1]。在此要强调NAFL与NASH的不同,NAFL是指病理活检显示肝脏脂肪变性,但是不具有肝纤维化或气球样变性的肝细胞损伤。NASH指在肝脏脂肪变基础上出现气球样肝细胞损伤伴或不伴肝纤维化^[2],NASH发生肝纤维化、肝硬化、肝细胞癌风险明显增高,而NAFL则很低^[2],NASH是NAFL发生肝硬化的必经阶段^[3]。     

中国肝癌肝移植的现状与展望

肝癌行肝移植治疗的指征、效果和相关问题一直存在争论,国际上已经有数个通用的肝癌肝移植标准,如Milan标准、Pittsburgh标准、UCSF标准等等,中国的移植学家们也在纷纷探讨适合中国的肝癌肝移植标准.本文收集并分析近年来国内外的文献,结合本移植中心460例肝移植的病例,对肝癌的分期标准、晚期肝癌行肝移植的指征进行了探讨,笔者认为影响我国肝癌肝移植的主要因素有:供肝的来源、术后乙肝及肿瘤的复发及相关社会因素等.     

Chronic liver diseases as liver tumor precursors

Liver cancer is a major global health problem and hepatocellular carcinoma (HCC) accounts for 75% of all liver carcinoma. HCC occurs more often in men than in women and mostly in people 50 to 60 years old. The disease is more common in parts of sub-Saharan Africa and Asia than in North and South America and Europe. Nevertheless its incidence increased over the past 4 decades in some Western countries. Worldwide, liver carcinoma is the 5th most common cancer and 3rd most common cause of cancer mortality (behind only lung and colorectal cancer) with approximately 680,000 annual deaths. Unlike most of the other malignancies, HCC almost entirely develops in the context of inflammation and organ injury and is related to cirrhosis in about 85% of the cases. Among underlying etiologies of liver cirrhosis, most frequent are viral infection and toxic substances, mostly alcohol. The main HCC risk factor in Eastern Asia and Africa is hepatitis B virus infection. Hepatitis C virus infection is the main risk factor in Western countries. Hereditary hemochromatosis is not a very frequent cause of liver cirrhosis, but these patients are at higher risk for HCC compared with other etiologies of cirrhosis. Aflatoxins, cancer-causing substances made by a type of plant mold, can play a role in some countries in Asia and Africa, and can have a synergistic effect with hepatitis B infection.     

Fatty liver in liver transplantation and surgery

Steatosis of the liver is common in Western countries, affecting about 25% of donors for liver transplantation and 20% of patients undergoing liver resection. Transplantation of livers with severe steatosis (> 60%) is associated with a high risk of primary nonfunction, and these livers should not be used for organ donation. In contrast, transplantation with livers containing mild steatosis (< 30%) yields results similar to those of transplantation performed with nonfatty livers. The outcome of livers with moderate steatosis (30 to 60%) are varying, and the use of these organs depends on the existence of additional risk factors. Similarly, liver resection in patients with steatosis is associated with a risk of postoperative mortality when compared with patients with nonfatty livers (14% versus 2%). Although hepatic steatosis is an important risk factor for surgery, little is known about the mechanisms of injury. In animal experiments, steatosis is associated with decreased ATP production and a disturbance of sinusoidal flow. Further contributing factors may include Kupffer cell dysfunction and leukocyte adhesion. Fatty hepatocytes have reduced tolerance against ischemic injury with a predominant necrotic form of cell death. In addition, the ability of hepatocytes to regenerate after major tissue loss is impaired in the steatotic liver. Very few protective strategies are known. Ischemic preconditioning and intermittent clamping protect the human liver against prolonged periods of ischemia. These techniques appear to be particularly protective in the steatotic liver. New insights into the mechanisms of liver failure in steatotic organs are needed to decrease the risk of surgery and increase the pool of organ donors.