Experience of choice between liver transplantation or combined liver-kidney transplantation to treat acute-on-chronic liver failure patients with renal dysfunction / 中华器官移植杂志

Objective To evaluate the outcome of liver transplantation (LT) or combined liver-kidney transplantation (CLKT) for acute-on-chronic liver failure (ACLF) patients with renal dysfunction.Method From January 2001 to December 2009,133 patients underwent LT for ACLF at our center.Among them,30 had both ACLF and renal dysfunction.Of the 30 patients,12 underwent CLKT for end-stage renal disease (ESRD),and the other 18 with hepatorenal syndrome type 1 (HRS1) underwent LT alone.Their clinical data were reviewed and their survival outcomes were compared.Result The median model for end-stage liver disease scores (MELD) of the patients with ACLF were 28.133 patients received deceased donor liver grafts and 12 patients also received the same deceased donor kidney grafts,The hospital mortality rate was 21.8％ for all patients with ACLF.The 5-year survival rates were 72.8％ for patients without renal dysfunction and 70％ for patients with renal dysfunction.The curative effectiveness of the patients with ESRD who underwent CLKT was better than that of the patients without renal dysfunction or the patients with HRS1 who underwent LT alone.Conclusion LT alone improved renal function in most patients with HRS1.Simultaneous liver-kidney transplantation is an excellent strategy in patients with both ACLF and ESRD.It provides protection to kidney allograft in liver-based metabolic diseases affecting the kidney.

Effect of post-liver transplantation administration of ursodeoxycholic acid on serum liver tests and biliary complications: a randomized clinical trial / 中华肝脏病杂志

<p><b>OBJECTIVE</b>Endogenous hydrophobic bile acids may be a pathogenetic factor of biliary complications after orthotopic liver transplantation (OLT).This study was designed to investigate the effects of hydrophilic ursodeoxycholic acid (UDCA), when administered early after OLT, on serum liver tests and on the incidence of biliary complications.</p><p><b>METHODS</b>A total of 112 adult patients undergoing OLT were randomly assigned to one of two groups for receipt of UDCA (13 to 15 mg/kg/d for 4 weeks, n=56) or a placebo (n=56). All patients underwent serum liver testing and measurement of serum bile acids during the 4 weeks following OLT.Patients with T-tube underwent measurement of biliary bile acids during the 4 weeks following OLT.Biliary complications, as well as patient and graft survival rates, were analyzed during the follow-up period (mean of 65.6 months).</p><p><b>RESULTS</b>At post-OLT days 7, 21 and 28, the UDCA-treated patients showed significantly lower levels of alanine aminotransferase, aspartate aminotransferase and gamma glutamyl transpeptidase (all P less than 0.05).In addition, the UDCA-treated patients showed significantly lower incidence of biliary sludge and casts within the first year post-OLT (3.6% vs.14.3%; x2=3.953, P=0.047). However, there were no significant differences for the incidence of other biliary complications at post-OLT years 1, 3 and 5.The graft and patient survival rates were also similar between the two groups.</p><p><b>CONCLUSION</b>UDCA, when administered early after OLT, improves results from serum liver tests and decreases the incidence of biliary sludge and casts within the first postoperative year.</p>

Single-center experience of steroid-free immunosuppressive therapy after liver transplantation for hepatocellular carcinoma patients / 中华器官移植杂志

Objective To evaluate the efficacy and safety of using basiliximab in place of a corticosteroid for immunosuppression following liver transplantation for hepatocellular carcinoma (HCC) in Chinese patients.Method The records of 178 patients with HCC who underwent orthotopic liver transplantation from January 2003 to December 2009 were retrospectively reviewed.All patients received immunosuppression therapy that contained either basiliximab (n =78) or steroids (n =100) in addition to tacrolimus and mycophenolate mofetil.Assessments included complications related to liver transplantation,occurrence of steroid side effects,recurrence of HCC,and patient and graft survival.Results A smaller proportion of patients receiving basiliximab than steroids experienced de novo diabetes (38.7％ vs.91.0％,respectively) or long-term de novo diabetes mellitus (4.0％ vs.30.3％,respectively) (both,P＜0.0001).The median overall and disease free survival was similar between basiliximab (50.8 months and 19.6 months,respectively) and steroid treated patients (64.2 months and 23.8 months,respectively).The 5-year overall survival and disease free survival rate was also similar between the basiliximab (42.5％ and 38.9％,respectively) and steroid (50.5％ and 39.2％) groups (all,P＞0.730).However,in patients who met the Milan criteria basiliximab was associated with greater 5 year overall survival rate than steroid therapy (88.9％ vs.57.4％,respectively,P =0.022).Conclusion It revealed that the non-steroid treatment does not increase the incidence of acute rejection but also can decrease the incidence of de novo diabetes in the patients with HCC following liver transplantation and prolong the survival time of patients who met the Milan criteria.

The clinical efficacy and safety of intravenous cefmetazon for prevention of postoperative infections and treatment of infectioons in general surgery / 中华普通外科杂志

ObjectiveTo evaluate the clinical efficiency and safety of cefmetazon in the prevention Department of General Surgery,First People's Hospital,Shanghai Jiaotong University,Shanghai 200080,Chinaand or treatment of infections in general surgery. MethodsA multicenter,prospective and open-labeled trial was conducted. In the prevention group,1700 patients were enrolled in clean-infection surgery,cefmetazon was given 1 g iv half an hour before the surgery started,and 1 g iv twice daily after the surgery for 3 days.Clinical response was evaluated in terms of both cure ( disappearance of pre treatment symptoms)and pathogen. In the treatment group,897 patients were diagnosed as peritonitis, cholecystitis and cholangitis,the patients were given cefmetazon 2 g iv twice a day for 7 - 14 days,clinical response and microbiological efficacy were assessed.ResultsIn prophylactic group,1449 patients were finally included.The clinical efficacy was 100％ (1449/1449).In the treatment group,a total of 897 patients were enrolled,and 110 patients failed for assessment of clinical efficacy,787 patients were included in the PPS population,the clinical efficacy was 90.7％ (714/787); Bacterial eradication rate was 92％ (46/50).Adverse reaction rates in prevention group and treatment group were 1.3％ (22/1700) and 1.2％ (11/897),including mild nausea and vomitting.ConclusionsCefmetazon is effective and safe in prevention and treatment of Postoperative infections in general surgery.

Acute renal failure in acute liver failure patients undergoing liver transplantation / 中华普通外科杂志

Objective To investigate the causes of acute renal failure(ARF)after orthtopic liver transplantation(OLT)in patients of acute liver failure(ALF)and the effects of systemic therapy based on continuous renal replacement(CRRT).Methods Clinical data of 412 patients who underwent liver transplantations between January 2001 and June 2006 were analyzed retrospectively (all the cases were followed up to June 2007).According to UNOS grading scale,54 patients were of acute liver failure(UNOS 1 and 2A).Posttransplant ARF developing in 17 cases underwent a systemic therapy based on CRRT as well as anti-rejection,anti-infection and nutrition support.The perioperative courses,complications,causes of death and follow up results were analyzed.Results There were no severe complications during CRRT.Perioperative mortality was 5.4%and 58.8%in patients without ARF and those with ARF respectively.the rate of complications was 35.1%vs 100%.1 year survival rate Was 89.2% vs 41.2%.3 year survival rate was 81.1% vs 41.2%.Condusions The effect of surgery mainly depends on the function of liver and other vital organs.The ALF recipients suffered from a high perioperative mortality,especially those with posttransplant ARL.The systemic therapy based on CRRT benefits patients with postoperative ARF.

STUDY OF CHEMOTHERAPY SENSITIVITY IN TUMOR CELL LINES ASSESSED BY APOPTOSIS / 肿瘤

Objective　To study chemotherapy sensitivity and apoptosis in tumor cell line.Methods　Two different human colon carcinoma cell lines, LoVo and Ls-174-t were incubated with DDP,MMC,5-FU，EPI at various peak plasma concentrations (PPC), 1/10PPC，1/5PPC，5PPC and 10 PPC. Apoptosis was detected by FACScan and TUNEL technique after 24 hours and 48 hous. Cell growth inhibition rates were assessed by MTT, DNA ladder were examined by agarose electrophoresis.Results　At 48 hours, the highest cellular apoptosis rates were observed with PPC which was assessed by FACScan technique. There was a positive linear correlation between apoptosis assessed by TUNEL technique and growth inhibition rates of cells determined by MMT(P＜0.05).Conclusion　Using Annexin-V-Fluos staining FACScan technique to assess apoptosis of tumor cells is an exploring and useful method which can be used to choose both kinds and doses of chemotherapeutic drugs.

Relationship between Fas/FasL expression and apoptosis of colon adenocarcinoma cell lines / 中国癌症杂志

Purpose:To study the relationship between Fas/FasL expression and apoptosis of colon adenocarcinoma cell lines induced by chemotherapeutic drugs and to screen out hypersensitive drugs. Methods:Colon adenocarcinoma cell lines LS174T and LoVo were incubated respectively in cultural media with DDP,MMC,5 FU and EPI at concentrations of PPC(plasma peak concentration),1/10 PPC,1/5 PPC,5 PPC and 10 PPC. Fas/FasL expression and apoptosis were assessed by FACScan, and DNA ladder was examined by agarose gel electrophoresis. Results:In LS174T cells, Fas expression and apoptosis of DDP group, MMC group and EPI group reached their highest peaks at 1/5 PPC or PPC,and Fas expression and apoptosis were positively correlated by relativity analysis. There was no significant correlation between Fas expression and apoptosis in LoVo cells. Conclusions:We could find out hypersensitive drugs and their appropriate dosage according to apoptosis, partly according to Fas expression. The different apoptosis paths between LS174T cells and LoVo cells demonstrate the importance of individualized selection of chemotherapeutic drugs.