Donor safety in adult living donor liver transplantation using the right lobe: single center experience in China.

AIM: To evaluate the safety of donors in adult living donor liver transplantation (LDLT) using the right lobe in a single liver transplantation center in China. METHODS: We investigated retrospectively 52 living donor liver resections performed from October 2003 to July 2006. All patients were evaluated by blood tests and abdominal CT. The mean donor age was 28.2 +/- 7.4 years. Residual liver volume was 42.1% +/- 4.7%. Mean operative time was 420 +/- 76.2 min; mean ICU stay, less than 36 h; mean hospital stay, 16.4 +/- 8.6 d; and mean follow-up period, 6 mo. RESULTS: There was no mortality. The overall complication rate was 40% (21 donors). Major complications included biliary leak in two, and pneumonia in 2 donors. Minor complications included mild pleural effusion in 12 donors, transient ascites in 6, mild depression in 4, intra-abdominal collections in 2, and wound infections in 1 donor. Residual liver volume did not affect the complication rate. None required re-operation. Return to pre-donation activity occurred within 5-8 wk. CONCLUSION: Right hemi-hepatectomy can be performed safely with minimal risk in cases of careful donor selection. Major complications occurred in only 7.7% of our series.

[Investigation on the alteration of hepatitis B virus (HBV) markers in liver allograft of HBV related recipients in perioperative period].

OBJECTIVE: To investigate the alteration of HBV markers in liver allograft of HBV related recipients pre and post liver transplantation under Lamivudine or combination of Lamivudine with HBIG prophylaxis and explore the mechanism of HBV de nova infection in liver allograft after orthotopic liver transplantation, as well as seek to establish a optimal prophylactic protocol. METHODS: The serial liver biopsy specimens of 90 liver allograft and sera of 78 liver transplant recipients during operation and after 1 week, 1 month, 3 months, 6 months, 12 months, 24 months post transplantation have been collected and detected for HBV markers with enzyme-linked radioimmunoassay, fluorescent quantitative assay for HBV-DNA in serology and with immunohistochemistry stain, HBV-DNA in situ hybridization in histology for detection of HBV markers in liver allograft samples. RESULTS: Whether recipients with active replicative or inactive replicative HBV preoperatively, none of positive HBV-DNA, HBsAg and HBcAg in 100% liver biopsy specimens with HBV-DNA hybridization in situ and immunohistochemistry stains in histology within 2 hours after reperfusion. CONCLUSION: Whatever HBV replicative status the recipients have before surgery, no evidence of HBV particles direct invasion to the liver allograft from HBV related cirrhotics during operation under current prophylactic measures. However, the further supposed mechanism and its significance in HBV de nova infection of liver allograft remained to be disclosed further.

[Reversal of multidrug resistance gene MDR1 and MRP of drug-resistant human hepatocellular carcinoma cells SMMC-7721/ADM with antisense phosphorothioate oligonucleotides].

OBJECTIVES: To investigate the reversal effect of gene MDR1 and MRP with combinational antisense phosphorothioate oligonucleotide on Drug-resistant human hepatocellular carcinoma cells SMMC-7721/ADM. METHODS: SMMC-7721/ADM was transfected with synthetic antisense phosphorothioate oligonucleotides complementary to gene MDR1 and MRP mediated by Lipofectamine. Drug sensitivity was measured by MTT assay, Fluorescence intensity of cells was determined by flow cytometric analysis, RH123 and DNR retention was assayed by confocal scanning laser microscopy. RESULTS: ASODN of MDR1+MRP increased the sensitivity of SMMC-7721/ADM to chemotherapeutic drug more significantly than that any of MDR1 and MRP did separately. But they did not enhance the inhibition expression of protein of p190 or p170. CONCLUSION: Drug-resistance could be reversed significantly when antisense phosphorothioate oligonucleotide of MDR1+MRP were transfected into drug-resistant human hepatocellular carcinoma cells SMMC-7721/ADM together.

Venovenous bypass ahead of mobilization of the liver in orthotopic liver transplantation.

BACKGROUND: To evaluate feasibility and safety of venovenous bypass prior to mobilization of the liver during orthotopic liver transplantation (OLT). METHODS: Fifty-four patients were classified into two groups. Group A consisted of 23 patients receiving OLT with classical venovenous bypass. Group B consisted of 31 patients who received a modified-procedure: venovenous bypass ahead of the mobilization of the liver during OLT. The blood loss, duration of venovenous bypass, cold ischemia time, anhepatic phase, and transfusion during operation in the two groups were compared. Complications after the operation were also compared between the two groups. RESULTS: The duration of venovenous bypass and cold ischemia time in group A were longer than those in group B [(99.78+/-21.36 min) vs (96.32+/-22.25 min) and (484.78+/-134.01 min) vs (443.15+/- 85.27 min)]. The anhepatic phase lasted for about 100 min averagely in the two groups. The volumes of blood loss and transfusion during the operation were larger in group A than in group B [(5096+/-4243 ml) vs (1726+/-1125 ml) and (3676+/-2938.74 ml) vs (1217.69+/-829.72 ml)]. Postoperative complications occurred in 26 patients of group A and in 19 patients of group B. CONCLUSION: This modified-procedure or venovenous bypass ahead of mobilization of the liver in OLT can reduce the blood loss during OLT and the incidence of postoperative complications without prolongation of the anhepatic phase and duration of venovenous bypass.

Dynamic alteration of HBV markers on active HBV replicative recipients after liver transplantation: a preliminary report.

OBJECTIVE: To investigate the dynamic alternations of HBV markers of active HBV replication recipients receiving lamivudine prophylaxis after liver transplantation. METHODS: Serial liver biopsy samples and sera were obtained from 15 recipients and examined with enzyme-linked radioimmunoassay for HBsAg, HBeAg, HBsAb, HBcAb and HBeAb, and fluorescent quantitative assay for quantitation of HBV DNA in serum. Immunohistochemical staining of HBsAg, HBcAg and HBV DNA hybridization in situ were used to detect HBV markers in liver biopsy samples. RESULTS: 100 mg lamivudine taken orally every day for 2 weeks before transplantation enabled 12 (80%) of 15 active viral replication recipients (HBV DNA positive) to converse to HBV DNA negative. HBsAb, HBcAb and HBeAb in serum emerged in 1-2 weeks after liver transplantation, and disappeared gradually within 6 months; HBV DNA fluorescent quantitative assay showed constant negativity in serum. Immunohistochemical staining of HBsAg, HBcAg and HBV DNA hybridization in situ in liver biopsy samples showed negative results synchorously. Eight of the 15 HBV active replication recipients lost HBV markers thoroughly both in serology and tissue staining as well as HBV DNA hybridization in situ of serial liver biopsy samples from 12 to 44 weeks after liver transplantation. Should any of HBsAg, HBeAg in serology and HBsAg, HBcAg in immunohistochemical staining was positive, or HBV DNA detectable in serum, or HBV DNA hybridization in situ in liver tissue positive, allograft HBV reinfection or De novo liver allograft infection could be diagnosed. Furthermore, if associated with elevation of ALT and bilirubin, the diagnosis of HBV hepatitis recurrence could be established. CONCLUSION: Allograft HBV reinfection or De novo liver allograft infection in active viral replication recipients could be prevented with lamivudine regimen, and further clearance of HBV may be possible if proper measures are taken.

Single-dose daclizumab induction therapy in patients with liver transplantation.

AIM: To investigate the efficacy and safety of a single-dose daclizumab induction therapy in orthotopic liver transplantation (OLTx). METHODS: A retrospective study was made for 54 cases of OLTx in recent three years. The daclizumab group consisted of 23 cases of OLTx who received single-dose of 2 mg/kg intravenously after postoperative 24 hours. The control group consisted of the remaining 31 patients. Additional immunosuppressors included steroids, mycomphenolate mofetil, facrolimus or microemulsion cyclosporine used in all patients. Meta-statistical analysis was made for general data, incidence of acute rejection and infection, postoperative clinical course, complications and prognosis between two groups. RESULTS: Pretransplant demographies were not significantly different between two groups. In the induction group there were significantly less acute rejection episodes (5 of 23, 21.74 %) than those in the control group (12 of 31, 38.71 %), which were proved by pathologic diagnosis (P<0.05). The incidence of infection at the early stage was not significantly different between two groups. CONCLUSION: Induction therapy with single-dose of daclizumab is safe and effective and appears to be able to reduce the incidence of acute rejection.

[Diagnosis and treatment of lung aspergillosis after liver transplantation].

OBJECTIVE: To assess the diagnosis and treatment of invasive lung aspergillosis after liver transplantation. METHODS: Routine sputum culture was performed. Itraconazole and fluconazole were used to prevent fungal infection prophylactically. Amphyotericin B was only used on aspergillosis. In 54 patients receiving, liver transplantation, 3 patients with lung aspergillosis were reviewed. RESULTS: Of the 3 patients 2 died and 1 recovered. CONCLUSIONS: Over-immunosuppression is a main risk factor for aspergillosis. Amphotericin B is still the best choice for the treatment of aspergillosis and its gradual, interrupted, low concentration administration, cooperated with itraconazole can ease the side effects.

Subcellular daunorubicin distribution and its relation to multidrug resistance phenotype in drug-resistant cell line SMMC-7721/R.

AIM: To investigate the correlation between subcellular daunorubicin distribution and the multidrug resistance phenotype in drug-resistant cell line SMMC-7721/R. METHODS: The multidrug resistant cell line SMMC-7721/R, a human hepatocellular carcinoma cell line, was established. Antisense oligonucleotides (AS-ODN) were used to obtain different multidrug resistance phenotypes by inhibiting the expression of mdr1 gene and/or multidrug resistance-related protein gene(mrp) using Lipofectamine as delivery agent. Expression of mdr1 and mrp genes was evaluated by RT-PCR and Western blotting. Intracellular daunorubicin (DNR) concentration was measured by flow cytometry. Subcellular DNR distribution was analyzed by confocal laser scanning microscopy. Adriamycin (ADM) and DNR sensitivity was examined by MTT method. RESULTS: Low level expression of mdr1 and mrp mRNAs and no expression of P-Glycoprotein(P-gp) and multidrug resistance-related protein (P(190)) were detected in parental sensitive cells SMMC-7721/S, but over-expression of these two genes was observed in drug-resistant cell SMMC-7721/R. The expression of mdr1 and mrp genes in SMMC-7721/R cells was down-regulated to the level in the SMMC-7721/S cells by AS-ODN. Intracellular DNR concentration in SMMC-7721/S cells was 10 times higher than that in SMMC-7721/R cells. In SMMC7721/S cells intracellular DNR distributed evenly in the nucleus and cytoplasm, while in SMMC-7721/R cells DNR distributed in a punctate pattern in the cytoplasm and was reduced in the nucleus. DNR concentration in SMMC-7721/R cells co-transfected with AS-ODNs targeting to mdr1 and mrp mRNAs recovered to 25 percent of that in SMMC7721/Scells. Intracellular DNR distribution pattern in drug-resistant cells treated by AS-ODN was similar to drug-sensitive cell, and the cells resistance index (RI) to DNR and ADM decreased at most from 88.0 and 116.0 to 4.0 and 2.3, respectively. Co-Transfection of two AS-ODNs showed a stronger synergistic effect than separate transfection. CONCLUSIONS: P-gp and P(190) are two members mediating MDR in cell line SMMC7721/R. Intracellular drug concentration increase and subcellular distribution change are two important factors in multidrug resistance (MDR) formation. The second factor, drugs transport by P-gp and P(190) from cell nucleus to organell in cytoplasm, may play a more important role.

Liver transplantation in patients with intrahepatic stones: report of two cases.

AIM: To investigate the feasibility and rationality of liver transplantation as an indication for patients with intrahepatic stones. METHODS: Liver transplantation was successfully performed for a 28-year-old man and a 42-year-old woman, both with intrahepatic stones. RESULTS: Patient 1 had digestive tract bleeding on the postoperative day 6 and he was discharged from the hospital on the postoperative day 25. He is in good health 14 months after operation. Patient 2 also had hemorrhage from the digestive tract on the postoperative day 44 and a leakage of end-to-side intestinal anastomosis on the postoperative day 47. She has resumed her work and is in good health from the postoperative month 12. CONCLUSION: Liver transplantation is safe and effective for patients with intrahepatic stones.

Effect of apolipoprotein E gene Hha I restricting fragment length polymorphism on serum lipids in cholecystolithiasis.

AIM:To investigate the role of apolipoprotein E (apoE) polymorphism in the lithogenesis of gallstone and the hereditary pathogenesis of the disease.METHODS: Polymerase chain reaction (PCR) was used to study apoE phenotypes and allele frequencies in patients with gallstones and control, and the fasting serum lipids of subjects were also measured by enzymatic methods.RESULTS:The levels of triglyceride (TG) and very low density lipoprotein cholesterol (VLDL-C) were much higher in E(2/3) patients than that in E(2/3) control. E(3/3) patients were accompanied with remarkably low levels of high density lipoprotein cholesterol (HDL-C) and its subforms.But in E(3/4) patients there were only slight changes in levels of VLDL-C and low density lipoprotein cholesterol (LDL-C).CONCLUSION:Different apoE phenotype patients with gallstones have different cheracteristics of dyslipidemia and the average level of serum lipids in patients with gallstones are higher than subjects without gallstones in the same apoE gene phenotype.epsilon2 allele is possibly one of the dangerous factors in the lithogenesis of cholecystolithiasis.