Objective To analyze the effects of different perfusion and different superior hepatic vena cava anastomosis methods on the establishment of rat orthotopic liver transplantation model. Methods Eighty SD rats were randomly grouped with donor group and recipient group with 40 rats in each group. Ten rats in the donor liver acquisition group received abdominal aorta infusion set drip irrigation (1 drop/s); 10 rats received abdominal aorta micro-pump perfusion method (6 mL/min); and then received recipient liver transplantation (corresponding to 10 rats in each group). The donor liver perfusion time and donor liver acquisition time of rats in the 2 groups were collected. HE staining was performed on liver tissues after perfusion and 24 h after liver transplantation. Ten rats in the recipient liver transplantation group received continuous anastomosis, and 10 rats received tension-reducing half-needle anastomosis. We collected the anastomosis time of superior and inferior hepatic vena cava, the time of anhepatic stage and the incidence of postoperative complications of the recipient. Results Contrasted with abdominal aorta infusion group, the perfusion time and acquisition time of donor liver were shorter in the abdominal aorta micro-pump perfusion group (P＜0.05). HE staining showed that the morphology of hepatocytes, portal vein and bile duct in the abdominal aorta micro-pump perfusion group did not change obviously, only a few lymphocytes infiltrated. Contrasted with continuous anastomosis group, the anastomosis time, anhepatic stage of the superior hepatic vena cava, incidences of postoperative anastomotic bleeding and incomplete perfusion of donor liver in the reduced tension half-needle anastomosis group were shorter or lower (P＜0.05). Conclusions Compared with abdominal aorta infusion set drip method, the quality of donor liver was improved by abdominal aorta micropump perfusion. Compared with continuous anastomosis method, the tension-reducing half-needle anastomosis can shorten the suture time of superior hepatic vena cava and anhepatic stage, and the incidence of anastomotic bleeding was reduced.
【Abstract】Objective To discuss the application of endoscopic diagnosis and treatment of biliary stone with choledochofiberscope after orthotopic liver transplantation.Methods Five patients with repeated infection of bile duct and obstructive jaundice were treated with choledochofiberscope through T tube sinus, combining with the plasma shock wave lithotripsy, the eyewinker clam and the basket extraction. Results We could efficiently extract the biliary tract stone through choledochofiberscope combining with plasma shock wave lithotripsy, eyewinker clam and basket extraction; and observe the healing appearance, and blood circulation of the biliary tract. Conclusion The choledochofiberscope can be used to diagnose and treat biliary tract stone of orthotopic liver transplantation. The choledochofiberscope and T tube will be important in diagnosis and treatment of biliary tract stone following orthotopic liver transplantation.
【Abstract】Objective To investigate the result of liver transplantation for end stage liver disease. Methods A retrospective analysis was made for 7 cases orthotopic liver transplantation(OLT) and 4 cases living related liver transplantation (5 patients with hepatitis B cirrhosis and 6 with Wilson’s disease),cirrhosis group was treated with lamivudine plus low dose anti-HBV-Ig. Results Ten patients were completely recovered discharged(including 4 cases LRLT) and only 1 died of ARDS.The complications after operation were: 2 cases of abdominal hemorrhage,3 cases of acute respiratory distress syndrome; and 4 cases of hepatitis B cirrhosis were HBV-DNA(-) after operation.Copperoxidase in all with Wilson’s disease became normal. Conclusion Liver transplantation is effective measure for end stage liver disease and living related liver transplantation is suitable for the present medical condition in China.Surgical technique is crucial for reducing perioperative complications.
ObjectiveTo evaluate the application of portosystemic shunt after subcutaneous transposition of the spleen (STS) to orthotopic liver transplantation (OLT) in the rat. MethodsOne hundred and eighty Wistar rats were randomly divided into the group of orthotopic liver transplantation after portosystemic shunts by subcutaneous transposition of the spleen (STS+OLT group) and the group of orthotopic liver transplantation (OLT group). The two groups were further divided into A, B, C subgroups in the light of duration of anhepatic phase (phases were respectively less than 25 min, around 35 min and 45 min).There were fifteen rats in each subgroup. At the described intervals, blood samples were collected from the peripheral and portal vein for testing ALT, pH and endotoxin levels. The survival rates were also observed. Results The ALT value of all animals basically returned to normal levels on the 7th postoperative day in the STS+OLT group and the OLT A subgroup, but in OLT B subgroup, ALT was still remarkably elevated on the 7th postoperative day (P＜0.01), and returned to normal levels on the 30th postoperative day. The pH values and endotoxin levels from the portal vein of all animals in STS+OLT groups and OLT A subgroup had no significant difference (Pgt;0.05) at the beginning, the end of the anhepatic phase and at the time of reperfusion for 30 min. But in the OLT B and C groups, the pH values and endotoxin levels were significantly higher at the end of anhepatic phase and reperfusion for 30 min than those in the beginning of anhepatic phase (P＜0.01). The survival rates at postoperative different time points in both B and C subgroup of the OLT group were significantly lower than those in STS+OLT group animals (P＜0.05).Conclusion The portosystemic shunt by subcutaneous transposition of the spleen can notably improve both the success rate of the OLT procedure and the postoperative survival rate in the rat.
ObjectiveTo explore the application of extracorporeal venovenous bypass in orthotopic liver transplantation in pigs and to compare hemodynamic changes during operation of two different bypass ways. MethodsTwentyfive porcine orthotopic liver transplantations were performed and extracorporeal venovenous bypass was established during anhepatic phase through a catheter in portal vein (group A,n=16) or in splenic vein (group B,n=9).Hemodynamic changes were monitored continuously.ResultsFourteen recipients survived two days after operation (14/16) in group A while all survived in group B (9/9).Transient hemodynamic disturbance (MAP and CVP decreased,and HR increased) was monitored at both the beginning and the end of anhepatic stage in group A,while these parameters kept stable in group B (P＜0.05).ConclusionApplying venovenous bypass may stabilize recipients’ hemodynamics in porcines orthotopic liver transplantation,and splenic vein draining way has more advantages than portal vein.
ObjectiveTo evaluate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) for biliary strictures post-orthotopic liver transplantation (OLT). MethodsA systematic review was performed by searching electronic bibliographic databases, including the Cochrane Library, Medline, EMbase, CNKI, and WanFang from 1994 to 2014. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were used to describe the diagnostic value. Summary receiver operating characteristic (SROC) curve with area under the SROC curve (AUC) were used to summarize overall diagnostic performance. ResultsSix studies involving 261 subjects were eligible for the analysis. The summary estimates of pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and AUC of MRCP for the diagnosis of biliary strictures after OLT were 89% (95% CI:0.83-0.94), 94% (95% CI:0.88-0.98), 8.04 (95% CI:2.83-22.85), 0.11 (95% CI:0.04-0.37), and 0.961, respectively. ConclusionMRCP is a sensitive and specific technique to diagnose biliary strictures after OLT.
Objective To investigate the expression of transcription factor Foxp3 in the orthotopic liver transplantation by using the inbred rats with spontaneous immune tolerance. Methods The model of orthotopic liver transplantation was established on inbred rats according to double-sleeve technique. The total RNA that was isolated from liver was reversely transcribed into cDNA. The method of real-time fluorescence quantitative PCR (RFQ-PCR) was used to analyze the expression level of Foxp3 mRNA in tolerance group and syngeneic group, respectively. The expression of Scurfin in hepatic tissue was assayed by Western blot and then was analyzed by computer imaging system. Results The expression levels of Foxp3 mRNA and Scurfin in the transplanted liver were significantly lower than those of normal liver within the first week after transplantation. The level of Foxp3 mRNA began to increase on day 7 and reached the peak point on day 14. The expression level of Foxp3 mRNA began to decrease on day 30 but was still higher than the normal value (P＜0.05). The Western blot showed resemble changes on that of Scurfin. Conclusion Transcription factor Foxp3 may play an important role in the spontaneous immune tolerance in the orthotopic liver transplantation of inbred rat.
Objective To observe the dynamic histopathologic changes of acute rejection in rat orthotopic liver transplantation (OLT) model after tacrolimus discontinued and provide some prediction and evaluation data for clinical acute rejection after liver transplantation. Methods Kamada two-cuff technique was used to establish 60 rat OLT model， and male DA rats, male Lewis rats were used as donors and recipients respectively. Therapeutic amount of tacrolimus (0.05 mg/kg, twice per day, continued for 8 d, 1 d before operation and 7 d after operation, intragastric administrated) was administrated to recipients, then continuously half dose was decreased every day beginning from day 8 after operation and tacrolimus administration was stopped on day 13. Liver tissues were collected on day 7, 14, 21, and 28 after liver transplantation. Histopathologic changes and rejection activity index (RAI) of liver tissues were observed, survival time of recipients was calculated. Results Owing to protection effects of tacrolimus, liver tissues displayed no significant histopathologic changes of acute rejection in 7 d after OLT, while typical acute rejection histopathologic changes began to be observed on day 14 after OLT due to tacrolimus discontinuation. On day 14, 21, and 28, RAI were 3.7±0.9, 6.3±0.9, and 8.1±0.7 respectively. Survival time of recipients was (20.85±0.71) d with a median of 21 d. Conclusion Acute rejection could be induced in rat OLT model after tacrolimus discontinuation, and data collected from this model shows some extent of predictive value and assessment value for clinical liver acute rejection.
Objective To investigate the significance of three dimensional (3D) visualization and virtual surgery system in liver transplantation surgery. Methods Two patients suffered from cholangiolithiasis were scanned by 64 slice helical-CT on livers and the data were collected. Man-made segmentation and true up on the image from the data were carried out. 3D moulds of the liver and the intrahepatic vessels were reconstructed by VTK software respectively. And then, the moulds were imported to the FreeForm Modeling System for modifying. At last, auxiliary partial orthotopic liver transplantation was simulated with the force-feedback equipment (PHANTOM). Results ①It had greatly verisimilar image for the reconstructed 3D liver moulds with artery, vein, portal vein and bile duct; By liver seeing through, it had high fidelity and b 3D effect for the intrahepatic artery, vein, portal vein and bile duct, and their spatial disposition and course and correlationship were shown clearly. ②In the virtual surgery system, the virtual scalpel could be manipulated on 3D liver mould with PHANTOM. The simulating effect was the same as the clinic operation for auxiliary partial orthotopic liver transplantation. Plane visualization of hepatic resection and intrahepatic vessel cutting was achieved by adjusting the transparency of the resection part. Life-like could be felt and power feeling could be touched during virtul operation. Conclusion ①The visualized liver mould reconstructed is 3D and verisimilar, and it is helpful to design reasonable scheme for liver transplantation. ②It not only can improve the surgical effect and decrease the surgical risk, but also can reduce the complications and enhance the communication between doctor and patient through designing surgical plan and demonstrating visualized operation before surgery. ③Visualized liver transplantation surgery is helpful for medical workers to train and study.