【Abstract】Objective To review the recent advances in the use of marginal liver in liver transplantation. Methods The literatures of recent years on the use of marginal liver for liver transplantation were reviewed and summarized.Results The donors with older age, hemodynamic instability, long stay in the intensive care unit and fatty liver are significantly clinical marginal liver donors.Conclusion Though the use of marginal liver donors negatively influences the results of liver transplantation, marginal liver expands the liver source for liver transplantation with a good result.
目的探讨肝脏移植术后早期肠内营养支持的价值。方法在术中将鼻肠管放置至屈氏韧带或空肠输出袢下30 cm， 术后第2天开始恒速灌注瑞素，量由500 ml/d逐渐增加到1 200 ml/d，速度由20 ml/h增至100 ml/h。分别于术后第2天及第8天观察患者的白蛋白、前白蛋白、转铁蛋白、尿尿素氮和氮平衡。结果前白蛋白、转铁蛋白和氮平衡均有显著改善，白蛋白无明显变化。结论肝脏移植术后早期肠内营养支持可以有效改善患者的营养状况和促进患者的恢复，并且可以减少患者的营养支持费用。
中国的肝脏移植事业在过去10年中取得不菲成绩，在21世纪依然保持蓬勃发展的势头。作为目前治疗肝脏终末期疾病的唯一有效手段，肝脏移植围手术期死亡率已降至5%以下，受体术后1年生存率已超过80%。然而，与国际水准相比，在术后并发症防治方面尚未形成系统化的认识,有待进一步总结经验，从而提高受体生存率和生活质量。其中血管并发症是一个常见和不应忽视的问题。尽管目前外科技术和器官保存技术屡经改良，血管并发症的发生率仍超过10%，尤其是活体部分和劈裂式肝脏移植的血管并发症发生率仍居高不下，其中具有较高死亡率的肝动脉并发症的存在尤为突出，应引起移植外科医师的足够重视并采取有效对策。
ObjectiveTo provide the reliable model in the rat for the study of liver transplantation.MethodsA surgical experience with one hundred and fifty orthotopic liver transplants in rats was reviewed,meanwhile a simple method with biliary extradrainage as well as bile collection was introduced.Results The operative successful rate was 93.8%（91/97）,the survival rate after one week was 85.9%(55/64),the recipient underwent an anhepatic period of 19 min,the operative time of donor and recipient were 37 min and 56 min,respectively.ConclusionThe result indicates that the model is reliable in the study of liver transplantation.The hard work and meticulous surgical performance are the key to successful operation.
A simple model of canine auto-trasplantation of liver was set up by ourselves, and the effects of hepatic artery ischemia (HAI) on ultrastructure of liver and biliary duct transplanted were observed. The results showed that the liver and biliary cells swelled slightly, mitochondrial matrix was loose and ridges were vague just often perfusion. Afte HAI for 3 hours the edema of hepatic and biliary cells aggravated cytoplasm was loose, mitochondria enlarged and partly vacuolar degenerated, ridges broke or disappeared, flocculent focal densites was seen in the matrix, endoplasmic retculum distended obviously, and the ribosome depolymerizated. So we consider that HAI causes obvious damage to hepatic and biliary cells. These indicate that HAI is one of the important factors of complication after liver transplantation, especially some biliary complications.
Objective To approach the questions of donation after cardiac death （DCD） and transplantation through analyzing the DCD cases in this hospital. Methods The organs were obtained from 4 DCD from 2010 to 2011 in this hospital， the clinical data of DCD were analyzed retrospectively. Results Seven renal transplantations and 3 liver transplantations were performed. Donor warm ischemic time was 10-40 min. The liver and left kidney of the first DCD donator （Maastricht categoryⅣ） were eliminated through biopsy. One patient exhibited delayed graft function of kidney from the first DCD，the nephrectomy had to be done on day 7 after operation due to renal allograft rupture. Nine patients received 3 livers and 6 kidneys from the other 3 DCD donators （Maastricht categoryⅢ），whose patients were alive with excellent graft function. Conclusions The use of controlled DCD （Maastricht categoryⅢ） might be an effective way to increase the number of organs available for transplantation because that it might obtain satisfactory transplant outcomes and acceptable postoperative complications. The widespread implementation of controlled DCD in China should be encouraged.
ObjectiveTo approach the role of CD4+CD25+ regulatory T cells in the maintenance of immunotolerance in mouse liver allograft. MethodsThe mouse orthotopic liver transplantation was performed. After the liver transplantation immunotolerance induction, antiCD25 monoclonal antibody (PC61) was injected into the recipients with a delayed timing to remove the CD4+CD25+ T cells. The percentage of CD4+CD25+ T cells and the expression of forkhead/winged helix transcription factor (Foxp3) in the recipients were examined. Furthermore, the survival time of the recipient was observed. ResultsC3H/HeJ recipients receiving DBA/2 hepatic allografts survived over 70 d as in the syngeneic liver transplantation (C3H/HeJ recipients receiving C3H/HeJ hepatic grafts). With various protocols of the delayed PC61 treatment, the CD4+CD25+ T cell was completely disappeared as observed. However, the removal of CD4+CD25+ regulatory T cells after the induction of transplantation immunotolerance did not affect the survival of hepatic allografts. ConclusionCD4+CD25+ regulatory T cells are not essential for the maintenance of spontaneous mouse liver transplantation immunotolerance.
Objective To summarize clinical application status of auxiliary heterotopic liver transplantation. Methods Reviewed relevant literatures and made a summary. Indications, contraindications, surgical treatment, therapeutic efficacy, and existing problems of auxiliary heterotopic liver transplantation were summed up. Results Main indication of auxiliary heterotopic liver transplantation is fulminant liver failure, and with no absolute contraindications. Partial liver transplantation is more popular. The therapeutic efficacy of auxiliary heterotopic liver transplantation is confirmed, but there are still some problems needed to be solved. Conclusion Auxiliary heterotopic liver transplantation is an effective method and replacement therapy for acute and chronic liver failure.