ObjectiveTo summerize the experiences of using molecular adsorbent recycling system(MARS) in perioperative period of orthotopic liver transplantation (OLT). MethodsThe effects of MARS-artificial liver treatments in 19 cases were reviewed. ResultsThe levels of serum total bilirubin, BUN, Cr, urine acid and blood ammonia were greatly reduced by using MARS. Fifteen patients were bridged to transplantation, 1 patient was relieved in symptoms of hepatic encephalopathy after MARS treatment, died 2 weeks after leaving hospital, 1 patient died of severe gastrointestinal bleeding before transplantation. The survival rate is 89.5%.ConclusionMARS artificial liver now is a safe and effective assistant device. It can help to gain more chance of undergoing OLT for the patients.
【Abstract】ObjectiveTo investigate the protective effects and the impact on the expression of Bcl-2 and Caspase-3 mRNA by Panax notoginseng saponins (PNS) preconditioning in rat liver transplantation. MethodsMale Sprague-Dawley rats were used as donors and recipients of orthotopic liver transplantation (OLT) and were divided into PNS preconditioning group (PNS group) and NS control group (NS group) randomly according to whether PNS was injected by venous (50 mg/kg) 1 h before liver grafts harvesting. The animals were respectively killed 2 h, 6 h and 24 h after reperfusion. Plasma samples were collected for ALT and AST test. Liver tissues were collected to detect histological changes, apoptosis and the expression of Bcl-2, Caspase-3 mRNA. ResultsThe serum levels of ALT and AST and the apoptosis index (AI) of liver tissue in PNS group were lower than those in NS group’s significantly (P＜0.05) at 2 h, 6 h and 24 h after reperfusion. The expression of Bcl-2 mRNA was enhanced significantly in PNS group at 6 h, 24 h after reperfusion and the expression of Caspase-3 mRNA was decreased significantly in PNS group at 2 h, 6 h after reperfusion as compared with NS group’s(P＜0.05). ConclusionPNS preconditioning can attenuate liver grafts ischemia/reperfusion injury and apoptosis of hepatocytes. Affecting expression of Bcl-2 and Caspase-3 genes may be one of the mechanisms of PNS antiapoptotic effects.
【Abstract】Objective To explore the effect and indication of splenectomy in liver transplantation. Methods From January 2001 to April 2006, 260 patients underwent piggyback orthotopic liver transplantation (PBOLT), and 28 patients had undergone combined PBOLT and splenectomy (splenectomy group). These patients were compared to 56 randomly selected non-splenectomy patients from the same transplant period, meaningly two controls were selected for every non-splenectomy case. Two groups were analyzed with respect to rate of infection and survival rate, as well as biopsy-proven acute allograft rejection within 30 days after transplantation. Results Rate of infection in the splenectomy group was higher than that in the non-splenectomy patients (85.7% vs 55.4%, P＜0.05). Acute rejection and survival rates in the splenectomy group were lower than those in the non-splenectomy patients (3.6% vs 14.3%, P＜0.05; 46.4% vs 82.1%, P＜0.05). Conclusion Concomitant splenectomy with PBOLT has a significantly higher patient mortality rate; it is mainly due to its septic complications. At present, unless there is a certain indication for splenectomy, this procedure is not recommended.