Liver transplantation for patients with pulmonary tuberculosis.

BACKGROUND: Tuberculosis (TB) infection in a liver transplantation candidate is not rare in China. There is little experience on how to manage the pre-existing TB infection in liver transplantation recipients. Aim. Patients with pre-existing pulmonary TB who received liver transplantation are described and the perioperative treatment is discussed. METHODS: The treatment of 3 patients with pre-existing pulmonary TB infection who received liver transplantation was reviewed. RESULTS: The patients were given nonstandard antituberculous therapy according to their reaction to the drugs. No evidence of TB infection relapse was discovered. CONCLUSION: Pre-existing TB infection should not be an absolute contraindication to orthotopic liver transplantation. The use of second-line antituberculous therapy is safe and effective for the treatment of TB infection in liver transplantation recipients.

Prognostic factors after liver resection for hepatocellular carcinoma with hepatitis B virus-related cirrhosis: surgeon's role in survival.

AIMS: Little is known in judging significant factors that affect the outcome of hepatocellular carcinoma (HCC) patients with hepatitis B virus (HBV)-related cirrhosis undergoing liver resection. The aim of the present study is to investigate the controllable and uncontrollable poor prognostic factors for hepatectomy in patients with HBV-related cirrhosis. METHODS: Clinical and pathological data of 412 HCC patients with HBV-related cirrhosis undergoing liver resection from October 1996 to October 2006 were retrospectively reviewed and the prognostic risk factors were analyzed by univariate and multivariate analyses. Cumulative survival was calculated with respect to the number of prognostic risk factors. RESULTS: The significant risk factors for decreasing both the overall and disease-free survival of patients were: (1) ascites volume of more than 500 ml; (2) prothrombin time of more than 4s; (3) serum AFP of more than 400 ng/ml; (4) tumor distribution in two lobes; (5) vascular invasion; (6) capsule absence; and (7) blood transfusion of more than 600 ml. Moreover, female gender and operation time of more than 5h are risk factors of tumor recurrence but not for the patients' overall survival. The 3-year survival rate decreased from 100% to 0 as the number of risk factors in the patients increased from zero to four or more. Patients who had two or more preoperative risk factors were poor candidates for liver resection, with a 3-year survival rate of 8.5%. CONCLUSIONS: The survival of HCC patients with HBV-related cirrhosis after liver resection depends on preoperative liver reserve, tumor status and blood transfusion. Tumor status cannot be altered; however, the surgeon can do a great favor to the prognosis of patients by minimizing bleeding and blood transfusion. Patients with two or more preoperative risk factors should be cautiously selected for liver resection.

The suppressive effect of resveratrol on protein kinase C theta in peripheral blood T lymphocytes in a rat liver transplantation model.

UNLABELLED: Our aim was to study the effect of resveratrol on the expressions of protein kinase C isotypes (PKC alpha, theta) in peripheral blood lymphocytes and on the expression of IkappaB kinase-beta (IKK beta) in lymphocytes in allografts in a rat liver transplantation model. METHODS: Orthotopic liver transplantations (OLT) were performed from Sprague Dawley rats to Wistar rats. The recipients were divided into two groups after OLT. In the RES group, resveratrol was given intraperitoneally once a day (100 mg kg(-1)) after OLT, whereas in the control group vehicle buffer was given. The expressions of PKC alpha, theta in peripheral blood lymphocytes, expression of IKK beta in lymphocytes in allograft, and survival periods were compared between the groups. RESULTS: The mean survival period after OLT in the RES group was significantly longer than that in control group (P < .05). On posttransplant day 7, the expression of PKC theta in peripheral blood lymphocytes in the RES group was significantly decreased compared with that in the control group (P < .05), whereas there was no obvious difference in the expressions of PKC alpha between the two groups (P > .05), and the positive rate of IKK beta protein in lymphocytes in allografts in RES group was significantly decreased compared with that in the control group (P < .05). CONCLUSION: Resveratrol showed an immunosuppressive effect on lymphocytes for allograft rejection in the rat. Down-regulation of the expression of PKC theta in peripheral blood lymphocytes may be part of the mechanism.

Novel magnetic rings for rapid vascular reconstruction in canine liver transplantation model.

OBJECTIVE: Magnetic rings were used for rapid vascular reconstruction in a canine liver transplantation model. MATERIALS AND METHODS: Thirty-two adult mongrel dogs weighing 13 to 16 kg were randomly selected as donors or recipients of transplantations. The recipients were randomly divided into two groups: group A (n = 10) had magnetic rings used for vascular reconstruction without venovenous bypass; group B (n = 6) had vascular reconstruction performed by continuous suturing with splenojugular venovenous bypass. RESULTS: In group A, the entire operative period was 3.24 +/- 0.49 hours, the durations of clamping the portal vein and the infrahepatic vena cava of the recipient were 5.89 +/- 2.27 minutes and 3.89 +/- 0.73 minutes, respectively. In group B, the entire operative period was 4.12 +/- 0.51 hours with the duration of clamping portal vein and infrahepatic vena cava, 28.33 +/- 6.04 minutes and 12.16 +/- 3.72 minutes (P < .01 vs group A). In group A, mean arterial pressure dropped during the anhepatic phase but recovered quickly after reperfusion. The fluid infusion was about 730.56 +/- 50.56 mL in the group A and a pressor agent was unnecessary. In group B, blood pressure dropped during the anhepatic phase and slowly recovered. The fluid infusion was about 2241.67 +/- 390.78 mL and a pressor agent was used to maintain the blood pressure of the recipient. No twist or thrombus was discovered in the anastomoses group A and the endothelium at the site of anastomosis was entire. In group B, errhysis was common in the anastomotic stomas. Nine of 10 dogs in group A survived more than 3 days, the longest being 8 days, whereas four of the six dogs in group B survived less than 3 days. CONCLUSION: The results showed that the anhepatic time was significantly shortened (about 5.89 +/- 2.27 minutes) in group A compared with group B and venovenous bypass was unnecessary. Magnetic rings could be used for rapid vascular reconstruction in canine liver transplantation model. The long-term results of this procedure should be clarified before it is applied in clinical practice in the future.

Immunosuppression by combined use of cyclosporine and resveratrol in a rat liver transplantation model.

INTRODUCTION: Despite continued progress in the development of immunosuppressive agents, allograft rejection remains an important cause of morbidity and mortality after liver transplantation. We examined the effect of intraperitoneal injection of cyclosporine (CsA) and resveratrol (Res) on allograft rejection after liver transplantation in rats. METHODS: Male Sprague-Dawley rats were selected as donors and male Wistar rats as recipients for a rejection model. The recipients were divided into three groups after orthotopic liver transplantation (OLTx): in the combination group both Res (100 mg/kg) and CsA (20 mg/kg) were given by intraperitoneal route once a day, whereas in the CsA group or control group CsA (20 mg/kg) or vehicle buffer was given. The survival period, serum chemistry, production of some cytokines, activation of transcription factor NF- kappaB, and histopathological findings were then compared among them. RESULTS: The mean survival period after OLTx in the combination group was significantly longer than that in the CsA group or control group (P < .05 and P < .01). On posttransplant day 7, the serum albumin level significantly improved, the serum total bile acid and alanine aminotransferase levels were significantly lower, the serum interleukin-2 and interferon-gamma levels were significantly lower, and the activation of transcription factor NF-kappaB in peripheral blood T lymphocytes was significantly suppressed in the combination group in comparison with those in the CsA group (all P < .05) or control group (all P < .01), and a histological examination revealed apparent difference in the severity of rejection between the combination group and CsA group (P < .05) or control group (P < .01). CONCLUSION: The combined use of CsA and Res has a stronger immunosuppressive effect on hepatocytes under allograft rejection in comparison with the sole use of CsA. Res might serve as a novel supplementary immunosuppressive agent for reducing the severity of hepatic allograft rejection in rats.

A new cardiac concordant xenotransplantation model.

OBJECTIVE: A simplified method of heterotopic abdominal cardiac xenotransplantation and its technique problems are described. METHODS: Hamster-to-rat cardiac xenotransplantation was performed by means of "sleeve and cuff" method. The left common carotid artery of the donor heart was anastomosed to the left renal artery of the recipient with a "sleeve" anastomosis, and the "cuffed" right pulmonary artery was anastamosed to the left renal vein of the rat. The viability of the donor heart was examined daily by palpating the left abdominal wall of the rat. RESULTS: Among 105 rats that underwent heterotopic cardiac xenotransplantation, 95 were completed successfully. The xenograft survived for 3 to 4 days after the procedure suffering typical acute vascular rejection. CONCLUSIONS: A useful, easy model to investigate the mechanisms of concordant xenotransplantation was established.

Serologic prevalence of Toxoplasma gondii in field mice, Microtus fortis, from Yuanjiang, Hunan Province, People's Republic of China.

Antibodies to Toxoplasma gondii were investigated in serum samples of field mice, Microtus fortis, from Yuanjiang, Hunan Province, People's Republic of China. The modified agglutination test (MAT) incorporating formalin-fixed whole tachyzoites and mercaptoethanol was used to determine antibodies. Antibodies to T. gondii (MAT > or = 1:20) were found in 36 (29%) of 124 trapped mice. The antibody titers of positive sera (percentage in parentheses) were 1:20 (8.9), 1:40 (3.2), 1:80 (3.2), 1:160 (1.6), 1:320 (1.6), 1:640 (1.6), 1:1,280 (1.6), 1: 2,560 (0.8), and > 1:2,560 (6.5). No antibody to T. gondii was found in 104 sera of laboratory-bred M. fortis infected with Schistosoma japonicum between 1 and 45 days after infection.

[Sequential hepatic artery and portal vein embolization using lipiodol-adriamycin for primary liver cancer].

Despite recent advances in hepatic surgery, management of unresectable carcinoma of the liver is still a challenging problem. From September 1988 through March 1989, 10 primary liver cancer patients were treated by hepatic artery embolization (HAE) using lipiodol-adriamycin with or without hepatic artery ligation (HAL). One of them received HAE twice in seven weeks. In two of these patients, following right HAE and HAL, right portal vein embolization (PVE) by catheterization via the ileac vein was performed. Transcatheter portal vein embolization via the ileac vein was simple, easy and safe even it was impossible to expose the hepatic hilum. All patients are alive from 7 to 12 months after operation except one who died of hepatic failure after having survived for 54 days. There was marked alleviation of symptoms and tumor shrinkage was observed in 9 out of 10 patients. HAE and PVE using lipiodol-adriamycin may have the potential of improving the therapeutic effect in patients with hepatocellular carcinoma.

[Indirect immunoperoxidase staining technique with frozen sections of schistosome for serodiagnosis of latent schistosomiasis].

Indirect immunoperoxidase staining technique using frozen sections of adult worm as antigen (IIP-AWA) was carried out to detect antibodies against schistosome antigens (AWAb) for the diagnosis of existing infection of schistosomiasis in COPT positive cases. Sera from 229 COPT positive and 135 COPT negative cases in Shanghai County, where schistosomiasis had been eradicated for more than 5 years, were tested. Sera from 122 patients with positive stool hatching from an endemic area were served as positive controls. The positive rates of the three groups were 96.9%, 5.2%, and 100% respectively. The staining pattern of the worm sections was mainly diffused at serum dilutions 1:4 to 1:16. 149 sero-positive cases were treated with pyquiton (60 mg/kg.2d) and re-examined 1, 1.5, and 2.5 years post-treatment. The negative conversion rate of IIP-AWA was considerably higher than that of COPT (80% vs. 61.1%) at the first year, but no significant difference was observed after 2.5 years (85.5% vs. 83.6%). With the decreasing antibody titer, the staining pattern of worm sections changed from diffused to focal pattern, mostly in the gut. The results suggest that the presence of detectable AWAb in untreated patients or patients treated 2 years ago with pyquiton possibly indicate latent schistosomiasis. IIP-AWA is of practical value in screening populations for latent schistosomiasis in areas where the disease had been under control.

Hormonal and enzymatic parameters of hepatic regeneration in patients undergoing major liver resections.

Thirteen patients who underwent 40% to 80% removal of their livers had blood samples drawn initially and daily on postoperative days 1 to 7. The enzyme marker of heightened polyamine metabolism, ornithine decarboxylase, and the indicator of DNA synthesis, thymidine kinase, were measured. In addition, the hormones (insulin, glucagon, estradiol and androgen), which in animals are known to reflect and possibly modulate regeneration, were measured. Changes in all these indices followed the same pattern as in rats, dogs and swine but at a slower rate. Ornithine decarboxylase and estradiol increased within 24 hr, but thymidine kinase and insulin rises did not become statistically significant until 3 to 5 days. Using these plasma or serum indices as surrogate measures of biochemical events in the liver itself, regeneration reached a maximum after 4 or 5 days. By computed tomography scan analysis, restoration of hepatic cell mass was not complete until 3 wk.

Renal artery reconstruction for harvesting injuries in kidney transplantation with particular reference to the use of vascular allografts.

At the University of Pittsburgh during the calendar year 1986, an arterial injury occurred during harvesting in 20 (7.5%) of the 270 grafts used to perform kidney transplantation (KTx). Four cases required reconstruction, using extension iliac arterial allografts from cadaveric donors of the same blood type; 6 patients, remodelling of the aortic patch in multiple arteries; 4 cases, repairs for injuries to the smaller segmental/polar arteries; 6 cases, a combination of the above techniques. These ex vivo arterial reconstructions are described and the use of donor arterial homografts is emphasized. No deaths have occurred at an average follow-up of 19 months. The postoperative acute tubular necrosis (ATN) rate was significantly higher (90%) compared with non-reconstructed kidneys during the same year (30%). The 1-year graft survival of kidneys undergoing arterial reconstruction (75%) was statistically no different than the overall kidney-transplant survival. Whenever extension iliac allografts were utilized, the cyclosporin-steroid immunosuppression required to control the kidney rejection contributed to the long-term patency rate of the graft. Since the number of organs available for grafting is limited, reconstruction of injured renal vessels has become justified, allowing valuable kidneys to be used that would otherwise be lost.

Effect of 15-deoxyspergualin on experimental organ transplantation.

DSPG had a definite but relatively feeble immunosuppressive effect in rats undergoing heterotopic heart transplantation and in dogs after renal transplantation. The drug was toxic in both species, although less so in rats. In dogs, synergistic interactions with cyclosporine and steroids were not evident.

Orthotopic liver transplantation in dogs receiving FK-506.

Ten dogs that survived the perioperative events of liver transplantation were treated with 1 mg/kg/d oral FK. Eight of the recipients lived for at least 1 month postoperatively, and seven are still alive with normal hepatic function after 35 to 65 days. The consistency and good quality of results with this difficult transplant preparation using FK, in spite of its rumored great toxicity in dogs, have highlighted the importance of further developing the drug.