ObjectiveTo compare the effect and safety of basiliximab in ABO incompatible pediatric liver transplant recipients.MethodsABO incompatible pediatric liver transplantation operated between January 2019 and August 2020 were studied. The patients were allocated randomized into two groups. Patients in experimental group were treated with basiliximab as immune induction therapy, but basiliximab was not used in patients of control group. Tacrolimus combined methylprednisolone were used after liver transplantation. The clinical characteristics, graft and recipient survival rate, rejection, infectious complications, and kidney functions after liver transplantation were observed. Donor specific antibody (DSA) was tested in 3 months after liver transplantation. The growth and development were assessed too after liver transplant.ResultsFourty-four patients were enrolled in the study, including 19 patients in the experimental group and 25 patients in the control group. The median follow-up time was 16.6 months (3.8–25.4 months), and there were no statistically differences between the two groups in terms of age, sex, weight, pediatric end-stage liver disease (PELD) score, and other basic conditions. There were no significant differences between the two groups in tacrolimus dose, tacrolimus trough concentration, kidney functions, height and weight growth after liver transplantation. There were no statistical differences in lung infection, blood stream infection within 3 months after liver transplantation, cytomegalovirus, EBV infection, graft/patient survival rate after liver transplantation (P>0.05). However, the acute rejection rate was lower and the DSA positive rate in 3 months after liver transplantation was lower in the experimental group (P<0.05).ConclusionsBasiliximab can be safely used in ABO incompatible pediatric liver transplant recipients. Acute rejection rate and DSA positive rate after transplantation can be decreased with the useof basiliximab.
ObjectiveTo study the development of methods assessing donor liver viability in liver transplantation.MethodsThe literature in the recent years on the methods of assessing donor liver viability was reviewed.ResultsFrom donor liver morphology to function,there have being developed many methods which assess donor liver viability,including:①donor liver appearance; ②intraoperative biopsies; ③donor liver microcirculation; ④portal pressure; ⑤enzymes levels in liver; ⑥lidocainemetabolizing activity; ⑦energy metabolism of donor liver; ⑧fat content in donor liver.ConclusionThere are many methods to assess the viability of donor liver. Each has its supericrity and defect respectively. Intraoperative biopsies, 31Pmagnetic resonance spectroscopy and portal pressure have more importance in clinical application.
ObjectiveTo explore risk factors of blood transfusion during liver transplantation and construct its prediction model. MethodsThe patients underwent liver transplantation who met the inclusion and exclusion criteria of this study from March 2020 to December 2020 in the Beijing Youan Hospital of Capital Medical University were retrospectively collected. The univariate and logistic multivariate analysis were used to evaluate the risk factors of blood transfusion during liver transplantation and construct the prediction model for intraoperative blood transfusion. ResultsA total of 151 eligible liver transplantation patients were collected in this study, including 51 non-transfusion patients and 100 transfusion patients. The univariate analysis results showed that the differences of primary diagnosis, preoperative hemoglobin (Hb), platelet count, prothrombin time, international normalized ratio, Child-Turcotte-Pugh score, and end-stage liver disease (MELD) score were statistically different between them (P<0.05). The above variables selected by the univariate analysis were selected by stepwise method, then the preoperative Hb and MELD score were selected into the multivariate logistic regression analysis, the results showed that the preoperative Hb≤113 g/L and MELD score ＞14 increased the risk of blood transfusion during liver transplantation [Hb: OR=6.652, 95%CI (2.282, 19.392), P<0.001; MELD score: OR=16.037, 95%CI (6.336, 40.592), P<0.001]. The logistic regression model predicted the area under receiver operating characteristic curve was 0.873 [95%CI (0.808, 0.919), P<0.001], the sensitivity and specificity were 91.0% and 67.5%, respectively, Youden index was 0.674, the accuracy was 86.1%. ConclusionsResults of this study suggest that preoperative Hb ≤113 g/L and MELD score＞14 increase risk of blood transfusion during liver transplantation. Logistic regression model constructed according to preoperative Hb and MELD score has a better sensitivity and specificity of intraoperative blood transfusion.
ObjectiveTo summarize clinical applications of inferior right hepatic vein (IRHV) in liver surgery and to provide a basis for clinical applications of IRHV.MethodThe relevant literatures about clinical applications of IRHV in liver surgery in recent years were reviewed.ResultsAs a kind of short hepatic veins, the IRHV directly flowed into the inferior vena cava, often accompanied by the portal vein of the segment Ⅵ. The occurrence rate of IRHV was 80%–90% by the autopsy examination, while which was 10%–30% by the imaging examination. The caliber of IRHV was 0.22–0.95 cm, and its caliber was negatively correlated with the caliber of right hepatic vein. The IRHV played a great role in the classification and treatment of the Budd-Chiari syndrome. According to the Couinaud liver classification method, the IRHV mainly drained the blood of segment Ⅵ. The existence of IRHV expanded the indications of hepatectomy. The reconstruction of IRHV in the liver transplantation could not only reserve the function of donor liver, but could compensatively drain the corresponding liver areas if the acute occlusion of other major hepatic veins happened.ConclusionsIRHV has some important clinical significances in liver surgery. Fully studying course characters and adjacent relationship of IRHV can not only avoid injury during surgery, but also provide a new treatment idea for related liver diseases.
【Abstract】ObjectiveTo evaluate the value of MR imaging with a contrast-enhanced multi-phasic isotropic volumetric interpolated breath-hold examination (VIBE) in diagnosis of primary liver carcinoma. MethodsThirty-two consecutive patients with surgical-pathologically confirmed 42 foci of primary carcinoma of liver underwent comprehensive MR examination of the upper abdomen, routine two-dimensional (2D) T1WI and T2WI images were acquired before administration of Gd-DTPA for contrast enhancement. Then, contrast-enhanced multi-phasic VIBE was acquired followed by 2D T1WI images. The lesion appearances on hepatic arterial, portal venous and equilibrium phases of VIBE sequence were carefully observed along with delineation of hepatic arterial and portal venous structures. The lesion detection rates and lesion characterization ability were compared among various MR sequences. Results33(78.6%), 30(71.4%), 38(90.5%) and 42(100%) foci were displayed respectively on T2WI, non-enhanced T1WI, enhanced T1WI and enhanced 3D-VIBE images (P＜0.05). The hepatic arterial anatomy of 30 patients （93.8%） and the portal venous structure of 31 patients （96.9%） were clearly depicted on enhanced 3D-VIBE images. Using MIP and MPR reconstruction techniques, the feeding arteries of 14 foci and draining vein of 12 foci were clearly displayed.ConclusionHigh-quality 3D-VIBE images are not only better than 2D images in lesion detection and characterization for primary liver carcinoma, but also able to provide much more information about hepatic vascular anatomy.
ObjectiveTo investigate the clinical manifestations, imaging manifestations, etiology, histological origin, pathological characteristics, diagnosis and differential diagnosis, selection of treatment methods, and prognosis of primary diffuse large B cell lymphoma of livers (PDLBCLL), so as to improve understanding and reasonable diagnosis and treatment of this kind of disease.MethodThe clinicopathologic data of a case of PDLBCLL diagnosed in the West China Hospital of Sichuan University in June 2019 were analyzed retrospectively.ResultsIt was very difficult to diagnose PDLBCLL preoperatively and to distinguish PDLBCLL from primary liver cancer and other liver space occupying lesions. It was also easy to ignore the possibility of invasion of liver by lymphopoietic tissue tumor, which was often diagnosed by postoperative pathological diagnosis or puncture biopsy, and after the elimination of hematological diseases by various examinations. This patient was admitted to the hospital as a space occupying in right liver. Preoperative imaging examination considered that may be a tumor. After MDT discussion, considering that the nature of the tumor should be confirmed by surgical resection, and then go to the Department of Oncology. Irregular right hemihepatectomy + cholecystectomy + hilar lymphadenectomy + diaphragmatic repair was performed after MDT discussion. The diagnosis of PDLBCLL was confirmed by postoperative pathological examination. The operation duration was about 230 min, and the intraoperative blood loss was about 200 mL. The patient recovered well without complications and was discharged on the 10th day after operation. The patient was followed up for 9 months. The liver and kidney function, electrolytes and abdominal Doppler ultrasound examination were regularly reviewed every month. No obvious abnormality was found in these results.ConclusionsAt present, there is no unified treatment principle, most of them will undergo surgery, chemotherapy, radiotherapy or combined treatment. Due to its unknown etiology and unclear mechanism, clinicians can only implement individualized treatment according to the characteristics of patients’ conditions.
Objective To understand the role and mechanism of tumor associated macrophages (TAM) on the occurrence and development of primary liver cancer, and its application in the treatment. MethodThe related literatures about the researches of relation between TAM and primary liver cancer at home and abroad in recent years were collected, sorted out, and made a review. Results Under different stimulating factors, TAM could be polarized to anti-tumor type 1 TAMs or tumor-promoting type 2 TAMs, and type 2 TAMs was the main part in the tumor microenvironment. Through some mechanisms such as vascularity-promoting, invasion-promoting, and immunosuppression to promote the occurrence and development of tumors, and potential treatment plans for primary liver cancer could be found by targeting TAM from different perspectives. Conclusion TAM has a wide range of effects on primary liver cancer, and their mechanisms are complex, understanding the relation between them and make an effective control of TAM could provide new therapeutic ideas and plans for clinical treatment of primary liver cancer.
Objective To study the potential of a bioderived material combined with Pluronic F-127 in vitro as a delivery vehicle for WO-1 in the bone repair therapy. Methods Bio-derived materials were fabricated and loaded with WO-1 by Pluronic F-127. Micromorphology and porosity were detected by the scanning electron microscope and the digital image analysis system respectively. The WO-1 release from the system in vitro was studied by the high performance liquid chromatography. Results Bio-derived material-WO-1 drug delivery systems were created with the interconnected pore network. Theporosity and pore size of the system were 55% and 522.43±16.75 μm respectively, compared with those of bio-derived materials, which were 75% and 623.67±12.31 μm respectively. And the main composition of the system was HA. The in vitrorelease kinetics of WO-1 revealedthat an effective therapeutic concentration(0.2-0.8 μg/ml) of WO-1 was maintained for 6 days after a high initial burst release. Conclusion The bio-derived material-WO-1 drug delivery system can be used in the bone repair therapy. However, the in vivostudy on it is still needed.
OBJECTIVE To manufacture adriamycin-porous tricalcium phosphate (A-PTCP) ceramic drug delivery system (DDS) as a possible method for bone defect treatment after bone tumor operation. METHODS A-PTCP DDS was made from putting adriamycin into PTCP. Thirty rabbits were divided randomly into group A(24 rabbits) and group B(6 rabbits). A-PTCP was implanted in the greater trochanter of the right femur in group A. Adriamycin were injected into veins in group B. Muscle around A-PTCP and plasma were taken out at different period. Adriamycin concentrations in muscle and plasma were measured by high performance liquid chromatography (HPLC). RESULTS A-PTCP could gradually release adriamycin over 10 weeks. Adriamycin concentrations in the muscle were higher than that in plasma. CONCLUSION A-PTCP may be a new method for repairing bone defects after bone tumor operation.
Objective To establish a reliable rats model of orthotopic liver transplantation with non-heart beating donors. Methods The model was established with modified double-cuff method. According to obtain pre-liver warm ischemia time experiencing non-heart-beat the rats were divided into 3 groups: 10 min (R10 group), 20 min (R20 group) and 30 min (R30 group), then one week survival after operation was compared in rats. Results The operative time of donor was 30 min approximately except warm ischemia time and the cold preservation time of donor liver was 1 h. The anastomotic time for suprahepatic vena cava was 12-22 min (mean 15 min). The anastomotic time for portal vein and infrahepatic vena cava was about 2 min and 1 min, respectively. The anhepatic phase sustained 14-24 min (mean 19 min). The operative time of receptor was 50-65 min (mean 60 min). Twelve rats died at 24 h after operation, which was considered as operative failure. The success rates of operation in R10 group, R20 group, and R30 group were 95% (19/20), 80% (16/20), and 65% (13/20), respectively. After one week the survival rate was 95% (18/19), 81% (13/16), and 54% (7/13), respectively. Conclusions Improved non-heart donor liver transplantation model of rat on the basis of Kamada’s “twocuff technique” acts as a good simulation in clinical non-heart-donor liver transplantation. This study showes that rat liver can tolerate warm ischemia time less than 30 min, the short-term survival after transplantation can reach satisfactory results. However, long-term survival requires further study.