Objective To summary the operative technique of liver retransplantation （RLT）. Methods The clinical data of 62 cases who had received RLT in our institute from Jan. 2003 to Jun. 2012 were analyzed retrospectively， and the experience about RLT was summaried too. Results The operative time 〔（12.7±3.5） h vs. （10.5±3.0） h〕， bleeding volume （3 431 mL vs. 2 211 mL）， and blood volume transfused during operation （3 229 mL vs. 1 910 mL） in 62 cases who had underwent RLT were longer or higher than that of 38 patients who had underwent the first liver transplantation （LT） in our hospital （P＜0.05）， but there was no significant difference on the model for end-stage liver disease （MELD） score between the 2 groups （P＞0.05）. All cases were followed up for 1-104 months （average 31 months）. Twenty case died within 1 month after RLT， including sever lung or abdominal infection in 13 cases， multiple organ failure in 4 cases， hepatic artery complication in 2 cases， and portal vein complication in 1 case. Eight cases died of tumor recu-rrence during 14-69 months （average 27 months） after RLT. The cumulative survival rate of 1-， 2-， and 5-year of 62 cases of RLT were 67.7%， 59.7%， and 56.4%， respectively. The 34 patients had survived for 3-104 months （average 49 months）， of them， there were biliary stenosis in 3 cases who were cured by interventional radiology treatment， biliary stenosis in 2 cases who were cured by a third RLT， infection in 10 cases who were cured by anti-infective therapy and immunosuppressant adjustment， light rejection in 2 cases who were relieved by dosage increase of oral immunosuppressant， other 17 cases suffered no complications and all in good condition. Conclusions RLT is an effective method for irreversible graft failure after LT. Proper surgical procedure contributes to the increase of survival rate of patients who has received RLT.
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 review the literature reports on research progress of Heme oxygenase 1 (HO-1) modified mesenchymal stem cells (MSCs). Methods The significance, effects, and related mechanism of HO-1 modification of MSCs were summarized by consulting the related literatures and reports of HO-1 modification of MSCs. Results HO-1 modification of MSCs has important research value. It can effectively enhance the anti-oxidative stress and anti-apoptotic properties of MSCs in complex internal environment after transplantation into vivo. It can also effectively enhance the immune regulation function of MSCs. It can improve the anti-injury, repair, and immune regulation effect of MSCs in various disease models and research fields. Conclusion The basic research of HO-1 modified MSCs has made remarkable progress, which is expected to be applied in clinical trials and provide theoretical basis and reference value for stem cell therapy.
Objective To explore the causes and prognosis of liver retransplantation. Methods The clinical data of 215 cases who had underwent liver retransplantation in Tianjin First Central Hospital between Nov. 26th 2003 and May. 26th 2012 were analyzed retrospectively for its causes and prognosis. Results Two hundreds and fifteen cases were enrolled， including 200 cases of 2 times liver transplantation， 14 cases of 3 times liver transplantation， and 1 case of 4 times liver transplantation. The major causes of the second liver transplantation were biliary complication （53.5%， 115/215） and primary non-function or dysfunction of liver graft （8.4%， 18/215）， and the major causes of the third liver transplantation were biliary complication （5/14） and hepatocellular carcinoma recurrence （2/14）. The liver graft survival rate of late liver retransplantation （at least 1 month after operation） was significantly higher than that of early liver retrans-plantation （less than 1 month after operation） for the second liver transplantation （P=0.005）. The liver graft survival rate of the second liver transplantation was significantly higher than that of the third liver transplantation （P=0.043）. Compared with biliary complication， cases of hepatocellular carcinoma recurrence （P=0.001） and primary non-function or dysfunction of liver graft （P=0.033） had lower graft survival rates， while cases of chronic failure of liver graft had a higher survival rate （P=0.037）. Conclusions Biliary complication is the main cause of liver retransplantation. The liver retransplantations which are performed less than 1 month after prior liver transplantation result in a relative low survival rate in reason of the increase of perioperative death. The prognosis of liver retransplantation for hepatocellular carcinoma recurrence is unacceptable， while cases of chronic failure of liver graft have optimal prognosis.
Objective To discuss the criteria of recipient selection，surgical approach，and complications and its theray by using of pediatric donation after cardiac death liver graft in adult recipient. Methods The clinical data of one case of pediatric donation after cardiac death liver to adult recipient was analyzed retrospectively and the literatures were reviewed. Results A 6-year-old girl pronounced brain death due to drowning and on the basis of cardiopulmonary criteria donated the organ．The liver graft weight was 598 g and the warm ischemic time was 10 min. The liver donor was transplanted to a 64-year-old woman，the graft to recipient weight ratio was 1.09%，the graft volume/estimated standard liver volume was 61.8%．The classic orthotopic liver transplantation without bypass was underwent，the postoperative recovery was smooth after the liver transplantation．The CT scan showed that the liver graft volume was 1 003cm3 on day 14 after operation．The patient was discharged on 45 d after orthotopic liver transplantation and the liver function was normal when followed-up 3 months after the operation. Conclusions Pediatric donation after cardiac death liver graft can be successfully utilized to adult recipient．Recipient selection and surgical approach should be decided by conditions of both donor and graft．
Objective To report our experience in living donor liver harvesting of right lobe grafts. MethodsThe data of 76 living donors of right lobe grafts hepatectomy between August 2007 and December 2008 were studied. Before operation, the graft size, remnant liver volume rate, fatty liver, middle hepatic vein type, and the level of portal hypertension of recipient were comprehensive assessed to determine whether harvested middle hepatic vein. The graft was harvested depending on the port vein and hepatic artery ischemia-line. B-ultrasound was used to definite the structure and branch of middle hepatic vein, and intraoperative cholangiography was performed to definite the structure and variation of bile duct. Donor operative time, intraoperative blood loss, postoperative hospital stay, levels of bilirubin, international normalized ratio （INR）, and ALT, and complications after operation were recorded. Results All the operations were successful. The operative time was (8.3±1.3) h, the blood loss was (325±127) ml without blood transfusion in operation. The ALT, INR, and bilirubin recovered on the 12th day. The most common complication in early post-operation was wound infection in 5 cases, 4 cases had cholestasis, 4 cases occurred cross-section bile leakage, and 11 cases occurred varying degrees of delayed gastric emptying in 4～7 d after operation, who were all alleviated by corresponding treatments. The hospital stay was 9～21 d (median: 14 d) after operation. Conclusion Preoperative evaluation of the hepatic anatomy and precise surgical procedure are crucial, which will help the development of graft harvesting and rehabilitation of donor.
Objective To investigate the diagnosis of organized thrombus in portal vein (PVOT) in liver transplantation. Methods The clinical data of 32 patients with PVOT who took the orthotopic liver transplantation (OLT) from January 2005 to January 2006 (271 cases) in this institute were retrospectively analyzed. Color doppler imaging (CDI), double helical CT plus three dimensional CT angiography (CTA) were taken before operation. CDI was performed during operation to look for the varicose vein, it was also used to reconstruct portal vein and measure the blood velocity in the portal vein. Results 23/32 (71.8%) cases had taken surgical treatment or interventional therapy before OLT. The grades of thrombus were as follows: gradeⅠ, 14/32; grade Ⅱ, 11/32; grade Ⅲ, 1/32; grade Ⅳ, 6/32. Twenty-eight cases of PVOT were diagnosed before operation, with accuracy of 87.5%. CDI was performed in 20 cases during operation, and 17 cases of collateral shunts were ligated with the monitor of ultrasound after the reconstruction of portal vein. The mean velocity of portal vein was (30.13±16.41) cm/s before the ligation of shunting veins, and the mean velocity was (46.36±19.82) cm/s after ligating the shunt veins. Conclusion Posibility of having PVOT for patients who had surgical treatment before OLT were much higher than who did not. CT and CTA could evaluate the portal vein system before operation, and performing CDI during operation may be important for the optimal reconstruction of portal vein.