TRANSPLANTATION ——Liver

The management of lamivudine resistance in immunocompromised chronic hepatitis B liver transplantation recipient under immunosuppressant therapy,Management of hepatic HBV reinfection after liver transplantation,Prophylaxis and treatment of acute renal failure following orthotopic liver transplantation,Long-term effect of orthotopic liver transplantation to patients with hepatic myelopathy, An initially clinical study of pneumocystis carinii pnemnonia during early stage after orthotopic liver transplantation[第一段]     

Liver

Alleviation of ischemia-reperfusion injury in rat liver donors by induction of exogenous hTERT gene;Effects of surgical technique on acute renal failure after orthotopic liver transplantation in patients with end-stage liver disease at high risk： a report of 90 eases;Timing for liver transplantation for chronic severe hepatitis;Analysis of bacterial variance and drug resistance after orthotopic liver transplantation;The influence of splenectomy on orthotopic liver transplantation and its management     

TRANSPLANTATION——Liver

Mutation of X region nucleotide sequence of hepatitis B virus DNA in patients with HBV reinfection after liver transplantation; Clinical manifestation and patho-typing of biliary cast syndrome in patients after othotopic liver transplantation; Interventional therapy of portal vein occlusion after liver transplantation.     

TRANSPLANTATION——Liver

Relationship between intra-abdominal hypertension and acute renal failure after liver transplantation; Liver transplantation in the presence of portal vein thrombosis： report of 21 cases;Application of MR imaging in the diagnosis of complications following liver transplantation;Blood-conservation techniques during ortho. topic liver transplantation; Effect of regulative CD4 T-cell on spontaneous immune tolerance of liver transplantation in rats; Acute rejection after orthotopic liver transplantation in recipients with hepatitis B related liver diseases;Observation on three dimensional reconstruction of peribiliary blood plexus in rat＇ s hepatohilar bile duct after losing liver artery supply entirely;     

TRANSPLANTATION —— Liver

Surgical techniques of hepatic artery reconstitution in orthotopic liver transplantation, Impact of core hypothermia during reperfusion on acute pulmonary edema after liver transplantation in patients with chrome severe hepatitis,Risk factors for development of early acute renal failure after liver transplantation in patients with normal renal function     

TRANSPLANTATION：Liver

Effect of progtaglandin E1 on renal blood flow and serum endothelin in early stage after liver transplantation;Diagnosis and treatment of biliary stricture after orthotopic liver transplantation; Clinical application of interventional therapy liver in orthotopic hepatic venous outflow obstruction following liver transplantation     

FIRST HETEROTOPIC LIVER TRANSPLANTATION PERFORMED SUCCESSFULLY IN CHINA

The first heterotopic liver transplatation in China was successfully performed in Xiangya Hospital Affiliated to Hunan Medical University. Liver transplantation is an extremely difficult point in organ transplantations. This transplantation is divided into two types: orthotopic and heterotopic. In orthotopic transplantation, the patient's liver is totally extracted and a new one implanted; while in heterotopic transplantation, the primitive liver is reserved and a healthy one implanted besides. Heterotopic liver transplantation has many advantages, such as ability to successfully treat late nonmalignant liver lesions, low expenses, surgical safety, avoidence of the systemic affect on patients during liver-free period and easy rehabilitation; but great surgical difficulty. At present, no re-     

Liver transplantation at the Sun Yat-Sen University of Medical Sciences in China

Objectives To summarize the results of liver transplantation for various end-stage liver d iseases at the Sun Yat-Sen University of Medical Sciences (SUMS), define the ro le of liver transplantation in the treatment of hepatocellular carcinoma and ful minant hepatitis B, and assess the efficiency of lamivudine on preventing HBV re currence.Methods Seventy liver transplants performed at the SUMS between April 1993 and December 2000 were retrospectively analyzed. The main indications for liver transplant w ere hepatocellular carcinoma (26 cases), liver cirrhosis (21 cases), fulminant h epatitis B (12 cases), sclerosing cholangitis (4 cases) and other terminal liver diseases (7 cases). Lamivudine was used in twelve patients suffering from fulm inant hepatitis B. Logistic multivariate regression analysis was applied to det ermine the risk factors predicting liver transplantation outcomes.Results Fifty-four patients survived for more than one month, and 16 patients died with in 30 days after orthotopic liver transplantation (OLT). The overall hospital s urvival rate was 77.1%. The hospital survival rates in the Child’s A and B pat ients were 87.5% and 83.3%, respectively. Those rates were superior to those of the Child’s C patients (P<0.05). The outcome of patients with small hep atocellular carcinoma (HCC) was superior to that of patients with large HCC. Pr eoperative APACE Ⅲ scores, the severity of ascites and serum creatine level had independent influence on outcome. Of the patients with fulminant HBV infection , 9 recipients survived for a follow-up period of 2-24 months. Treatment with lamivudine monotherapy was both well tolerated and efficacious in patients with fulminant hepatitis B.Conclusions The results indicate that orthotopic liver transplantation could provide long-t erm cure and palliation for patients with HCC, and that patient selection is ext remely important in predicting outcome. The results support the continued appli cation of liver transplantation as a therapeutic modality for various end-stage liver diseases and that lamivudine is an effective and safe monotherapy in OLT for patients with HBV infection.     

Transdiaphragmatic Exposure for Direct Atrioatrial Anastomosis in Liver Transplantation

Background Liver transplantation in Budd-Chiari syndrome remains controversial; however, some improved techniques lead to better results. We report medium-term follow-up results of liver transplantation with atrioatrial anastomosis for Budd-Chiari syndrome and explore the indications of liver transplantation with atrioatrial anastomosis for patients with end stage liver disease.Methods Nine patients （six Budd-Chiari syndromes, one end stage hepatolithiasis, one hepatocellular carcinoma and one incurable alveolar echinococcosis） underwent liver transplantation with atrioatrial anastomosis in West China Hospital of Sichuan University from 1999 to 2006. Eight liver transplants used cadaveric orthotopic livers and one a living donor liver. The operative technique was transdiaphragmatic exposure for direct atrioatrial anastomosis and replacement of inferior vena cava by cryopreserved vena cava graft with the help of venovenous bypass.Results All liver transplantations were successful. Two patients contracted pulmonary infection and acute rejection took place in another case. With proper treatment, all patients recovered well and had good quality of life. To date, they have been followed up for more than 24 months. The only death followed recurrence of hepatic carcinoma three years after liver transplantation.Conclusions Transdiaphragmatic exposure for direct atrioatrial anastomosis and the cryopreserved vena cava graftreplacement of inferior vena cava are possible for patients with end stage liver disease thus extending the indications of liver transplantation.     

Liver

208557 Mutation of X region nucleotide sequence of hepatitis B virus DNA in patients with HBV reinfection after liver transplantation /Shen Zhongyang(沈中阳, Dept Organ Transplant, Tianjin 1st Centr Hosp, Tianjin 300192)…∥Chin J Gen Surg.-2008,23(5).-368～371Objective To analyze the mutation of HBV X region nucleotide sequence in patients with HBV reinfection after liver transplantation. Methods In this study 320     

Anesthesia

Effects of hydroxyethyl starch on leukocyte activation and vascular permeability in endotoxic rats; Effects of adenosine preconditioning on expression of myocardial TNF-α mRNA and ICAM-1 mRNA in patients undergoing off-pump coronary artery bypass graft operation; The changes in cognitive function and beta amyloid protein after partial hepatectomy in rats; Relationship between tolblike receptor 2 on polymorphonuclear neutrophil and postoperative systemic inflammatory response syndrome in patients undergoing orthotopic liver transplantation; Effect of microglia inhibition on GABAs receptor expression in the spinal cord in a rat model of neuropathic pain……     

GENERAL ASPECIS——Infection

Characteristics and management of fungal infection in severely burn patients; Burned infants combplicated with rotavirus diarrhea：an analysis diagnosis and therapy of of 12 cases;JOLLYCOME^TM irrigation on incision and wound surface： a clinical report; Secondary lung infection in oatients of postoperative cranio-cerebral trauma： a clinical study; Postoperative infections of CNS： a retrospective study;Nosocomial infection after intubating central vein in patients with liver transplantation compared to other operated patients： investigation and analysis;206158 Effect of silver sulfadiazine-impregnated hydrocolloid dressing on wound care of nail extraction;……     

Combined liver-kidney transplantation and orthotopic liver transplantation in the treatment of severe hepatitis B

Objective To compare orthotopic liver transplantation ( OLT ) and combined liver-kidney transplantation ( CLKT) in the treatment of severe hepatitis. Methods In this study 52 patients of severe hepatitis B were allocated to OLT ( 40 cases) or CLKT( 12 csaes) at our deparment from Jan. 2001 to Sep. 2005. Results     

肝移植术后急性排斥反应的临床与病理分析

Background Acute rejection is one of the most important factors for prognosis following liver transplantation. With the use of potent immunosuppressants, acute rejection does not always present typical manifestations. Moreover, other complications often occur concomitantly after liver transplantation, which makes early diagnosis of acute rejection more difficult. Acute rejection is best diagnosed by liver biopsy. Differentiation of clinical manifestations and pathological features plays an important role in achieving individualized immunosuppressive treatment and prolonging long term survival of patients given orthotopic liver transplants. Methods From January 2004 to December 2006, 516 orthotopic liver transplantations were performed at the First Affiliated Hospital, Sun Yat-sen University. For patients who suffered acute rejection, clinical manifestations, histopathological features, diagnosis and anti-rejection treatment were summarized and analyzed. Results In 86 cases （16.7%）, of the 516 recipients, 106 episodes of acute rejection occurred, which included 9 with histopathological borderline changes, 36 Banff I rejections, 48 Banff II and 13 Banff III. Among these, 36 were cured by adjusting the dose of immunosuppressant and 65 were reversed by methylprednisolone pulse treatment. Five were methylprednisolone resistant, 3 of whom were given OKT3 treatment and 2 underwent liver retransplantation. Conclusions Due to potent immunosuppressive agents, acute rejection following an orthotopic liver transplantation lacks typical clinical manifestations and pathological features. Acute rejection is best diagnosed by liver biopsy. Designing rational individualized immunosuppressive regimen based on clinical and pathological features of acute rejection plays an important role in prolonging long term survival of patients.     

Pediatric liver transplantation in 31 consecutive children

Background Although liver transplantation has become a standard therapy for end-stage liver diseases, the experience of pediatric liver transplantation is limited in China. In this article we report our experience in pediatric liver transplantation, and summarize its characters in their indications, surgical techniques, and postoperative managements.
Methods Thirty-one children （≤18 years old） underwent liver transplantation in our centers. The mean age at transplantation was 12.4 years old （ranged from 5 months to 18 years） with 7 children being less than 4 years of age at transplantation. The most common diagnosis of patients who underwent liver transplantation were biliary atresia, Wilson＇s disease, primary biliary cirrhosis, glycogen storage disease, hepatoblastoma, urea cycle defects, fulminant hepatic failure, etc. The surgical procedures included 12 standard （without venovenous bypass）, 6 pigyback, 6 reduced-size, 3 split, 3 living donor liver transplantation, and 1 Domino liver transplantation. The triple-drug （FK506, steroid, and mycophenolate mofetil） immunosuppressive regimen was used in most of patients. Patients were followed up for a mean of 21.8 months.
Results Five of the 31 patients died during perioperative time; mortality rate was 16.1%. The reasons of death were infections, primary non-function, heart failure, and hypovolemic shock. Postoperative complications in 10 patients included biliary leakage, acute rejection, abdominal infection, hepatitis B virus （HBV） or hepatitis C virus （HCV） infection, and pulmonary infection. Overall patient cumulative survival rate at 1-, 3-, and 5-year was 78.1%, 62.6%, 62.6%, respectively.
Conclusions The most common indications of pediatric liver transplantation were congenital end-stage liver diseases. According to patients＇ age and body weight, standard, piggyback, reduced-size, split, or living donor liver transplantation should be performed. Pediatric liver transplantation especially requires higher surgical skills. The     

Pregnancy and delivery after liver transplantation: the first successful case in China

Severe liver diseases usually cause menstrual dysfunction and infertility in women of reproductive age. Liver transplantation is one of the treatment choices for patients with liver diseases. Among patients receiving liver transplantation, 11% are women of reproductive age. Successful liver transplantation,     

Liver support therapy with molecular adsorbents recirculating system in liver failure: a summary of 252 cases from 14 centers in China

Background A liver support therapy, named molecular adsorbents recirculating system （MARS）, has been used for more than 700 liver failure patients in China. We made here a summary to evaluate the effects of MARS treatment in different applications with emphasis on hepatitis B virus （HBV） based liver failure.
Methods This report analyzed data of 252 patients （mean age （44.9±12.7） years） in three groups： acute severe hepatitis （ASH）, subacute severe hepatitis （SSH） and chronic severe hepatitis （CSH）. The largest group was CSH （156 patients, 61.9%）, and 188 patients （74.6%, 188/252） were infected with HBV.
Results MARS treatments were associated with significant reduction of albumin bound toxins and water-soluble toxins. Most of the patients showed a positive response with a significant improvement of multiple organ function substantiated by a significant increase in prothrombin time activity （PTA） and median arterial pressure （MAP）. There was a decrease in hepatic encephalopathy （HE） grade and Child-Turcotte-Pugh （CTP） scale. Thirty-nine of 188 HBV patients （20.7%） dropped out of the commendatory consecutive therapy ending with lower survival of 43.6% while the rest of the 149 patients had a survival rate of 62.4%. Survival within the ASH and SSH groups were 81.2% and 75.0%, respectively. In the CSH group, end stage patients were predominant （65/151,43%）, whereas the early and middle stage patients had a better prognosis： early stage survival, including orthotopic liver transplantation （OLT） survival of 91.7%, middle stage survival of 75%, end stage survival of 33.8%.
Conclusions MARS continues to be the most favorable extracorporeal treatment for liver support therapy in China for a wide range of conditions, including the majority of hepatitis B related liver failure conditions. The appropriate application of MARS for the right indications and stage of hepatic failure, as well as the fulfillment of prescribed treatments, will lead to the o     

Posttransplant non-anastomotic biliary stricture in consecutive 381 liver transplantations at a single center

Objective To investigate the causes of non-anastomotic biliary stricture （NABS） after orthotopic liver transplantation （OLT）. Methods Between May 2000 and December 2005,381 liver transplantations were performed in consecutively admitted 373 patients. Data were retrospectively analyzed for the incidence, risk factors and clinical pictures of NABS. Results There were altogether 20 NABS cases divided into diffused type of 6 cases and localized type of 14 cases clinically with an overall incidence of 5.25%.     

Clinicopathological analysis of HBV recurrence in post-liver transplantation patients

<正>Objective To describe the technique,efficacy, and safety of percutaneous interventional therapy for anastomotic biliary strictures after orthotopic liver transplantation ( OLT) . Methods From May 2004 to December 2009,25 patients with anastomotic biliary stric-     

GENERAL ASPECTS--Infection

Nosocomial infection in pancreas surgery： an investigation and analysis; Prevention and treatment of pulmonary infection after liver transplantation;Rational use of antibacterials and drug sensitivity analysis in neurosurgery; Risk factors of lower respiratory tract infection in neurosurgery ward patients with tracheotomy： a survey; Correlation factors of nosocomiai infection in patients after receiving craniocerebral operation……