Objective To investigate the indication and possibility of orthotopic liver transplantation for patient with alveolar hydatid disease. Methods An orthotopic liver transplantaion was successfully performed on two cases with unresectable alveolar hydatid disease using the new approach of venovenous bypass first.Results The recovery of liver graft function was good after the operation in these patients. Following up for nine and three months, the patients returned to his work without any complications. Conclusion It suggests that the case with advanced alveolar hydatid disease are an indication for liver transplantation. The new technique of venovenous bypass prior to mobilization of liver is feasible and safe.
Objective To introduce the imaging modalities used for the evaluation of postoperative complications of orthotopic liver transplantation (OLT) and to present the imaging findings of these complications. Methods The literatures related to the imaging methods and imaging manifestations of OLT complications were reviewed. Results Ultrasound was the initial imaging technique used for the detection of complications in the early postoperative period. Spiral CT and MRI yielded more accurate and comprehensive evaluation of postoperative complications in later stage. So far, there had been no specific imaging findings to suggest rejection reaction. The spectrum of imaging manifestations of OLT complications, such as vascular complications, biliary complications, liver parenchymal complications, and so on, were summarized and illustrated. Conclusion Imaging examination (especially ultrasound, spiral CT and MRI ) plays an important role in the evaluation of postoperative complications of OLT.
Objective To investigate an improved large vascular reconstruction method in the canine liver transplantation and see whether it can shorten the anheptic time and thus reduce the harmful effects during the anhepatic phase. Methods Thirty-two mongrel dogs were enrolled and divided into two groups randomly:the donor group (n=16) and the acceptorgroup(n=16). The dogs in the acceptor group were divided into two groups, according to the different reconstruction methods: Group A using the magnetic rings for a large vein reconstruction in the canine liver transplantation (n=10), and Group B using a handsewing large vein reconstruction in the canine liver transplantation (n=6). The operation time, hemodymics change, anastomosis site, and survival were observed. Results The operation time was as follows: In Group A, the total operation time, the inferior vena cava anastomosistime, and the anheptic phase time were significantly shorter than those in Group B (3.24±0.49 h vs 4.12±0.51 h，5.89±2.27 min vs 28.33±6.04 min，3.89±0.73 min vs 12.16±3.72 min),with a significant difference between the two groups (Plt;0.01). The haemodymics changes were as follows: In Group A, MAP dropped during the anhepatic phase, but it soon recovered after reperfusion，and there was only 730.56±150.56 ml of fluid including the donor blood that needed to be transfused, with no pressor agent required. In Group B, blood pressure dropped during the anhepatic phase，but it slowly recovered，and there was 2241.67±390.78 ml of fluid. In Group A, all the stomas had no errhysis, twistor thrombus. The twisted stomas could be corrected by the revolving of the magnetic rings. The endangium at the site of anastomosis was smooth. In Group B, most of the stomas had errthysis. In Group A, 3 dogs survived for more than 7 days, 6dogs survived for 3-6 days, and 1 dog survived for only 12 hours. In Group B, 2 dogs survived for 3-6 days, 3 dogs survived for 1-2 days, and 1 dog survivedfor only 12 hours. Conclusion Using the magnetic rings for a large vascular reconstruction in the canine liver transplantation is an improvedmethod, which can simplify the anastomosis procedures and significantly shortenthe anheptic phase time. However, the magnetic rings have to be placed in the abdomen, so this method remains to be further improved.
Objective To summary the clinical experience of liver retransplantation （RLT）， and to improve the effect. Methods The clinical data of 62 cases who had received RLT in our institute from Jan. 2003 to Jun. 2012 were analyzed retrospectively. The survival rates of patients with different interval between two liver transplantation （LT） were calculated， and the data of patients who died and survived during perioperative period after operation were compared and analyzed. Results The 1-， 2-， and 5-year cumulative survival rates of 62 patients were 67.7%， 59.7%， and 56.4%， of early stage RLT patients were 38.5%， 38.5%， and 30.8%， of later stage RLT patients were 75.5%， 65.3%， and 63.3%， respectively. There were 28 patients died after operation， and 20 patients （71.4%） died during perioperative period， whose major cause of death were infection （65.0%， 13/20）， in addition， 4 cases （20.0%） died of multiple organ failure， 2 cased （10.0%） died of hepatic artery complication， 1 case （5.0%） died of portal vein complication. Eight cases （28.6%） died after perioperative period in reason of tumor recurrence. The model for end-stage liver disease （MELD） score 〔（26.95±9.28） score vs. （14.23±9.06） score〕， creatinine （Cr） level 〔（157.3±88.0） μmol/L vs.（69.8±35.9） μmol/L〕， international normalized ratio （INR） value 〔（1.676±0.744） vs.（1.124±0.286）〕， and total bilirubin （TBiL） value 〔431.8 μmol/L vs. 248.2 μmol/L〕 of patients died during perioperative period were higher than that of patients survived after perioperative period （P＜0.05）. The ratio of abnormal Cr of patients died during perioperativeperiod and survived after perioperative period were 60.0% （12/20） and 7.1% （3/42）， respectively. The 34 patients who had survived after perioperative period were all got followed-up for 3-104 months （average 49 months）. There were no tumor recurrence during the followed-up， and liver function of them were normal. Conclusions RLT is an effective method for irreversible graft failure after LT. Optimum operative time and reasonable individual immunosuppressive regimen to decrease the infection rate are all contribute to the increase of the survival rate.
Objective To explore the changes in the serum Cu2+and the indexes for the liver pathology and biochemistry before and after the copper needle retained in the central veins of the rabbit ears. Methods Fortynine New Zealandrabbits were randomly divided into 5 groups: Group A (copper needles retained for 1 d), Group B (3 d), Group C (5 d), Group D (7 d), and Group E (the control group, without any copper needles retained). In each experimental group, there were 10 rabbits, and in the control group there were 9 rabbits. The rabbits in each group were arranged to have their venous blood drawn for determination of theCu2+concentration, and for observation on the changes in the liver biochemicalindexes for 5 times before and after the copper needles were retained in the central veins of the rabbit ears. At the same time, a piece of the liver tissue ineach rabbit was taken for examination of the pathological changes. All the liver samples were given the basic pathological examination; if the liver sample hadsome extraordinary pathological features, the specific pathological examinationwould be given, even using the transmission electron microscope. Results After the copper needles were retained in the central veins of the rabbit ears, the Cu2+concentration increased with the passing time. The concentrations in the groups were 1.40±0.49 μg/ml in Group A, 1.45±0.53 μg/ml in Group B, 2.01±0.40 μg/ml in Group C, 2.38±0.83 μg/ml in Group D, and 1.34±0.45 μg/mlin Group E, respectively. There was a statistically significant difference between Group D and Group E(P＜0.05). There were no significant changes in the ALT and AST levels when compared with those before the copper needles were retained(P＞0.05); however, there was a considerably positive correlation on 1st day (r=0.686, P＜0.05), 5th day (r=0.712, P＜0.05), and 7th day (r=0.768, P＜0.01) when compared with those after the copper needles were retained. The histological examination showed that aseptic inflammation subsided with the time in part of the liver. The Masson staining and the Ag staining showed that there were no obvious changes in the hepatic lobules, with no fibrosis of the liver tissues found under light microscope. Conclusion There are no obvious toxic and side effects on the rabbit liver after the copper needles are retained in its central veins.
ObjectiveTo explore the relationship between liver transplantation procedure with or without preservation of retrohepatic vena cava and postoperative reinfection of hepatitis B virus.MethodsHepatitis B virus makers of 15 retrohepatic vena cava samples from hepatitis B virus active replicating recipients was detected using immunohistochemistry stain LSAB and HBV DNA hybridization in situ. Hepatitis B virus reinfection rate and survival rate after transplantation in classic group (20 cases) and piggyback group (7 cases) was analyzed retrospectively. ResultsHepatitis B virus makers including HBsAg and HBcAg and HBV DNA of all 15 retrohepatic vena cava samples, 10 from classic group and 5 from piggyback group, was negative. In classic group, 20 recipients were followedup 6-30 months, mean 18 months, only one case of hepatitis B recurrence was confirmed 22 months after operation; In piggyback group,7 recipients were followedup 5-12 months, mean 8 months, none of hepatitis B virus reinfection was encountered. Recurrence rate in classic group and piggyback group was 5.0%(1/20) and 0(0/7), respectively.ConclusionThis preliminary study indicated that the retrohepatic vena cava of hepatitis B virus active replicating recipients don’t have the residence and replication of hepatitis B virus particle. Orthotopic liver transplantation procedure with preservation of retrohepatic vena cava appears not to increase the hepatitis B virus reinfection rate in hepatitis B virus active replicating recipients after transplantation.
Objective To study the effect of recombinant growth hormone (rhGH) on improvement of liver function and liver regeneration in animal and patients after hepatectomy. Methods The liver cirrhosis model of SD species mouse was set up, then the mouse were randomly divided into experiment group and control group, then 30%-40% liver of all the models were resected, rhGH was used by hypodermic injection (0.2-0.4ml/100g) in experimental group, and the equal dose of N.S. were given in control group every day. Then liver function, arterial blood ketone body ratio(AKBR), and the regenerated liver/body weight ratio (RL/W) were determined, histopathology of the cirrhosis with microscope and electron microscope and the mitotic index (MI) of liver cell on 7, 14 and 28th day after operation were observed. Clinically,39 hepatectomized patients were randomly divided into experiment group and control group, liver function, PA， Glu, RI and AKBR were measured preoperatively and on 1, 7,14th day after operation. Postoperative clinical course were also compared between the two groups. Results In the animal experiment group, as compared with the control group, AKBR was obviously higher (P＜0.01), seruim level of total protein and PA were increased faster (P＜0.05), and RL/W was higher. The mitotic index of liver cell was increased faster on 14th day, the numbers of regenerated liver cell with double nucleus and rough endoplasmic reticulum were higher in 14 and 28th day. In the clinical experiment group, as compared with the control group, serum total bilirubin, alanine aminotransferase and aspartate aminotransferase were lower on 7 and 14th postoperative day (P＜0.05). Serum albumin, PA, Glu, RI and AKBR were higher on 7, 14th postoperative day (P＜0.05). Conclusion Both experimental and clinical study show that the rhGH can promote liver regeneration and improve liver function after hepatectomy.
Objective To explore the methods of hepatic artery reconst ruction with iliac arterial interpositiongraf t in orthotopic liver t ransplantation (OL T) and influential factor of relevant complications postoperatively.Methods Analyzed ret rospectively 8 OL T , the hepatic artery reconst ruction with arterial inflow based on recipientinf rarenal aorta using donor iliac artery graf t tunneled through the t ransverse mesocolon and pancreas. Results Thetime required for hepatic artery reconst ruction with iliac arterial interposition graf t was 52 - 126 minutes. Amongthe 8 patient s , 2 patient s developed postoperative bililary t ract complications , 1 with biliary fistula , 1 with int rahepatic biloma , the others were recovered smoothly and liver function returned to normal about one week af ter livert ransplantation. No complications of hepatic artery were observed. Conclusion Iliac arterial interpositional graft is aneffective and reliable method of revascularization in liver transplantation when the use of hepatic artery is not possible.
Objective To reconstruct the blood supply of hepatic artery of therecipient rat by a modified arterial “sleeve” anastomoses. Methods SD-SD and SD-Wistar rats liver transplantation were performed in 30 and 50 cases, respectively. The donor splenic artery, left gastric artery, right gastric artery and gastroduodenal artery were ligated, meanwhile the proper hepatic arteries were reserved. The celiac trunk of donors and the stump of right kidney artery of recipient were anastomosed by using 8-0 suture with “sleeve” technique. Results Themean time of artery anastomoses was 4.00±1.31 min.The rate of success was 96.3％. The longest survival time in the model SD-SD(29 survived) was more than 2months. In SD-Wistar(48 survived), acute rejectiion was observed 3-5 days after operation andthe mean survival time of rat was 9 d. Conclusion The modifiedarterial “sleeve” anastomoses is an effective method to reconstruct blood supply of hepatic artery of rat recipient in rat liver transplantation.
The purpose of this study was to demonstrate the blood viscosity changes in ischemic injury of rabbits liver and the protective effect of ahalysantinfarctasum upon liver. Before and after occlusion of hepatic blood flow, a capollary type viscomiter was used to measure the whole blood viscosity, plasma viccosity, hematocrit and fibrinogen. Both morphological and functional changes of the liver were observed. The results showed that the liver subject to 30 minutes ischemia revealed a significant increaese of whole blood viscosity, plasma viscosity and hematocrit in the ischemic group, at sawm time both marked morphologic and functional xhanges of the liver were ovserved. Never-theless. the change of hemorheologic parameters of the pretreatment group did not show any significant difference compared with that bifore occlusion of hepatic portal, and had minimal changes morphologically. The study proved that blood voscosity increased obviously during liver ischemic injury and indicated the effective protection of ahalysantinfarctasum on liver.