ObjectiveTo summary clinical character of de novo hepatitis B virus infection after liver transplantation,and explore the strategy of prevention and treatment.MethodsThe clinical data of recipients undergoing liver transplantation and the recipients who developed de novo hepatitis B virus infection after liver transplantation between Jan. 2000 to Dec. 2010 were retrospectively analyzed.Results365 patients who underwent liver transplantation were negative for serum HBsAg before liver transplantation.Among them,11patients were diagnosed as having de novo hepatitis B virus infection after liver transplantation,with the morbidity being 3.0 ％(11/365).Most recipients did not have any clinical presentation.They were just found HBsAg positive during the follow-up period.The liver functions were normal.All 11patients received anti-virus therapy after they were found having positive HBsAg and replicated HBV-DNA.One patient whose primary disease was hepatitis C combined with primary hepatic carcinoma was treated with pegylated interferon,thereafter,he was found having YMDD-mutation of HBV-DNA,and he was treated with entecavir.The rest 10 patients received anti-virus treatment with nucleoside analog.The 10 recipients were injected with hepatitis B immunoglobin during operation.After anti-HBV therapy,one patient died from acute liver failure because of inefficient treatment,and one patient died from tumor recurrence.The remaining nine patients survived:HBeAg of one patient became negative,and HBV-DNA replications of the four patients became negative (＜1×105 copies/L).The liver function of the patients who survived was normal.ConclusionFor recipients who were HBsAg negative before liver transplantation,when they received liver transplantation,,they should be given strict screening of blood product for transfusion.The liver transplantation patient who is HBsAg negative in serum before liver transplantation,and whose donor is HBcAb positive in serum and/or HBV-DNA positive in serum,should be treated with HBIG and/or nucleoside analog during operation or after operation,as we said above is a ideal strategy to prevent de novo hepatitis B virus infection after liver transplantation.The prognosis of de novo hepatitis B virus infection after liver transplantation is mild.

ObjectiveTo observe the dynamic change of mtDNA in rats with lung ischemiareperfusion (IR) injury and the implications.MethodsThe rat model of lung IR injury was made.Thirty-two male SD rats were divided into IR group and control group.Each group was sub-divided into two subgroups.Thirty and 60 min after reperfusion,8 rats of each group were sacrificed; left lungs and whole blood were collected.Histopathological study of lung tissues were performed; wet weight/dry (W/D) weight ratio of the lung was detected; DNA was extracted from whole blood,and mtDNA level in circulation was detected by using real-time PCR; the protein levels of MMP-9 and MCP-1were examined by ELISA.Results(1) As compared with control group,the edema and PMN emigration were more serious in IR group; besides,the W/D ratio was increased progressively in IR groups as compared with control groups respectively (P＜0.01); (2) As compared with control group,the mtDNA in circulation was significantly increased 30 min after reperfusion (P＜0.01),and the same trend was detected 60 min after reperfusion (P＜0.01):(3) There was no significant difference between the two groups in the content of MMP-9 and MCP-1in the lungs 30 min after reperfusion (P＞0.05),but the MMP-9 and MCP-1expression levels were increased 60 min after reperfusion (P＜0.01).ConclusionThe mtDNA expression in circulation was increased in the early stage of lung IR,and the increased expression of mtDNA was earlier than the up-regulation of MMP-9 and MCP-1.Our results indicated that mtDNA may aggravate lung injury through increasing MMP-9 and MCP-1in the lung IR.

ObjectiveTo evaluate the security and effectiveness of raffinose-low potassium dextran solution (RLPDs) for donor lung preservation.MethodsFrom Sep.2002 to Dec.2011,131patients underwent lung transplantation in our institution,including 81cases of single lung transplantation and 50 cases of bilateral lung transplantation.There were 95 males and 36 females.A total of 129 donors were used for organ harvest.Two donors denoted their lungs to four patients receiving single lung transplantation. All the donors were flushed, perfused antegradely and retrogradely,and preserved with hypothermal RLPDs.The repeated reperfusion was necessary when the cold ischemic time was fairly long and the function of donor was poor.During operation,the blood gas analysis,mean pulmonary artery pressure (mPAP) and breathing mechanics were monitored.Postoperatively,all the recipients received re-examination of cardiac ultrasonography,pulmonary function,blood gas analysis and chest imaging.ResultsAll lung transplantations were performed successfully,with a mean cold ischemic time of (193±21) min (range,65-630 min).There was a significant relationship between postoperative pneumonedema and donor lung cold ischernic time (P＜0.05),which was also observed between postoperative pneumonedema and primary graft dysfunction (P＜0.01). The blood gas analysis and oxygenation index were significantly improved postoperatively,with the mPAP and parameters of breathing mechanics being descended to a normal level.There were 24 early deaths in the first month post-transplant,with a mortality of 18.3％ (24/131),including 11cases of sepsis,7 cases of primary graft dysfunction,3 cases of heart failure,1case of bronchial stomal leak,1case of acute rejection,and 1case of pulmonary infarction.The pulmonary function was improved significantly 3 months postoperatively.Conclusion RLPDs is efficient in the preservation of donor lung,with the ability to alleviate ischemic reperfusion injury and improve pulmonary function.

ObjectiveTo evaluate the clinical effect and reliability of basiliximab as immune inducer combined with classic triad resisting immune rejection scheme in preventing immune rejection after heart transplant.MethodsWe continuously collected the clinical information of 214 patients undergoing heart transplantation from June 2004 to January 2011.Basiliximab was used at 1st h before heart transplant and 4 days after the operation by 20 mg each time.Triad resisting immune rejection scheme included methylprednisone,cyclosporine A and mycophenolate mofetil.The endocardial biopsy was done to diagnose rejection postoperatively,and the severity of acute rejection was graded according to the standardized criteria of the International Society for Heart and Lung Transplantation (ISHLT).The recipients were followed up for 1year after the surgery,the data of the endocardial biopsy and rejection were collected,and the postoperative complications and deaths were observed.Results The first time of recipients to accept the endocardial biopsy was 20.1±7.3 days postoperatively,including 63 (29.4％) cases of Grade Ⅰ A,8 (3.7％) cases of grade Ⅰ B,and 12 (5.6％) cases of grade Ⅱ.One year after operation,143 recipients accepted the endocardial biopsy,including 29 (20.3％) cases of grade Ⅰ A,1(0.7％) case of grade Ⅰ B,12 (7.7％) cases of grade Ⅱ.During hospitalization,5 recipients died,including 3 cases due to transplant heart failure,1case due to multiple organ failure and 1due to sudden death.One year after discharge,there were 2 deaths,including one case of serious rejection and 1case of multiple organ failure One month after operation,infection occurred in 7 cases (3.3％),and acute renal insufficiency in 11cases (5.1％).ConclusionCombined use of Basiliximab with triad resisting immune rejection scheme was a kind of safe and effective therapy to prevent early acute rejection after heart transplantation.

ObjectiveTo know the recent status of heart transplantation in Chinese multicenters.MethodsThe retrospectively data from 24 centers before 2010 (438 cases) and the data from China heart transplant Registry database between 2010 (149 cases from 15 centers)-2011(148 cases from 19 centers) were analyzed.Results In 2010,15 centers performed heart transplantation,including one large-scale center (60 transplants per year),3 moderate-scale centers (10 to 30 transplants per year),and 6 small-scale center (2-8 transplants per year).The rest 5 centers had one transplant per year each.In 2011,19 centers performed heart transplantation,including one large-scale center (52 transplants per year),3 moderate-scale centers (10 to 30 transplants per year),and 5 small-scale centers (2-8 transplants).The rest 8 centers had one transplant per year each.In 2010 and 2011,the median ages of heart transplant recipients were 44.6 and 42.9 years,respectively.Nonischemic cardiomyopathy was the leading indication for heart transplantation.The median donor age in 2010 and 2011was 30.2 and 30.8 years respectively.In 2010 and 2011,up to 99.3％ and 97.3％ of patients were treated with immune induction therapy,respectively.In 2010,the mortality at discharge was 10％,and that was 6％ in 2011.ConclusionAlthough total volume of heart transplants is still small in recent years,the discharge survival in China is similar to ISHLT report.

ObjectiveTo investigate the establishment of stable mice orthotopic left lung transplant model MethodsForty male Balb/c mice randomly served as recipients and donors.Each couple had the similar weight. Three-cuff technique was used to establish mice orthotopic lung transplant model.The micro CT of chest and the artery blood analysis were detected at first month after transplantation.ResultsThe achievement ratio was 95％.More than 90％ of the recipients survived after surgery.Cold ischemia time was (35.6±5.9) min,warm ischemia time was (25.3±7.2) min,donor lung back up time was (21.0±5.6) min,and the whole surgery time was (85±15)min.The long-term survival time achieved more than 30 days with functional lung graft.Micro CT showed clear left lung graft field one month after surgery,and left bronchus cuff was still open.The PaO2 of the artery blood was ( 106.9±5.8 ) mmHg before clipping right lung hlium,and after clipping that was (105.0±8.7) mmHg with the difference being not significant between them (P＞0.05).Histologically,the lung graft appeared very similar to the right lung one month after surgery.The pulmonary alveoli were aerated well.ConclusionBased on our experience of the orthotopic lung transplantation model in mice,through practicing,we independently and successfully established orthotopic lung transplantation model in mice.Compared to the method established by the other country,our method is easier to perform and more stable.This will benefit the basic research related to lung transplantation.

ObjectiveTo evaluate the effectiveness of the interventional treatment for portal vein stenosis in patients who had undergone liver transplantation.MethodsFromApr.2004 to Oct.2011,30 patients with portal vein stenosis after liver transplantation were referred for angiographic analysis and interventional treatment. All patients had typical clinical signs and symptoms or surveillance by imaging.After percutaneous transhepatic portography and balloon angioplasty,stents were deployed.Embolization was performed on patients with varices or portal vein flow changes.The therapeutic results were monitored by the follow-up on clinical symptoms,laboratory tests and imaging examinations.ResultsAngiography was performed successfully on all patients.Twenty-four patients received balloon dilation and 26 stents were deployed subsequently.The guide-wire cannot pass through the lesion of portal trunk in 1patient.Four patients received balloon angioplasty only.The technical success rate was 96.7％ (29/30).Stainless steel coils were applied in 7 patients for varices embolization.The complication related to interventional treatment was bleeding in thoracic cavity which happened in 2 patients.Portal vein patency was maintained in all the patients who received interventional treatment for 1-72 months (mean 21.5 months).No re-stenosis was identified.ConclusionInterventional therapy is an effective method for the treatment of portal vein stenosis after liver transplantation and excellent patency can be achieved by this method.

ObjectiveTo surnmarize the experience of tacrolimus or cyclosporine A-based immunosuppression after pediatric living-donor liver transplamation.Methods The clinical data of 30 children undergoing living-donor liver trarsplantation from October 2006 to January 2010 were analyzed retrospectively.In 30 patients,7 were given Tac-based immunosuppression (group A),10 given CsA-based immunosuppression (group B),and 13 switched from CsA to Tac for complications or adverse effects of drugs.Dosages and blood concentrations of immunosuppressants were recorded.Changes of liver and kidney functions were monitored.Incidence of rejection,infection and adverse effects of drugs were observed.ResultsIn the premise of the stable concentration and liver and kidney functions,the weight of children was increased by about 50％ and the per- kilogram dosage of CNIs was decreased significantly 1year postoperatively.There was no case of rejection in group A and 4 cases of rejection in group B(40％,4/10),and the original symptoms were gradually alleviated after the increased dosage in immunosuppressants.During the first 3 months,there was 1case of abdominal infection in group A (1/7) and 3 cases of lung infection in group B (3/10),and the original symptoms were gradually alleviated after anti-infective therapy.There was 1CMV lgM-positive case in group A (1/7) and 2 CMV IgM-positive cases in group B (2/10),and the original symptoms were gradually alleviated after using ganciclovir.The original symptoms of the 13 children switched from CsA to Tac were gradually alleviated.ConclusionThe two CNIs can be safely used in children undergoing pediatric livlng-donor liver transplantation.Both of them show the same effect in promoting the restoration of liver and kidney functions,but tacrolimus has more satisfactory effect in inhibiting the rejection and it has leas adverse effects.

ObjectiveTo demonstrate the efficacy and safety of Hangzhou tacrolimus capsule (Saishi Tac capsule,Hangzhou Zbongmei Huadong Pharmaceutical Co.Ltd,China) in Chinese liver transplant recipients.MethodsMulticenter,randomized open-labeled,prospective controlled clinical trial was performed in de novo Chinese liver transplant recipients.According to inclusive and exclusive criterion,83 liver recipients from 11transplant centers were enrolled.The recipients accepted Saishi Tac capsule,mycopheolate and steroid 48 h post-operation.The initial dose of Tac was 0.1-0.15 mg kg-1day-1and C0 was 8-12 ng/ml in the first 60 days,followed by 5-10 ng/ml until the terminal observation time poiut (12 weeks after transplantation).The efficacy and safety were estimated during the period.The primary efficacy endpoint of the study was the incidence of biopsy-confirmed acute rejection.Graft survival was the secondary endpoint.Safety was assessed by monitoring laboratory parameters and adverse events reported over the course of the study,such as infection,renal damage,hypertension,hyperlipema and diabetes mellitus and other adverse affairs.ResultsThe dose of Tac at 1st,2nd,4th and 8th week post-operation was (4.1±1.9),(4.5±2.1),(4.5±2.1),(4.4±1.8) and (4.1±2.1) mg,and correspondjng values to the C0 were (8.1±4.5),(8.9±4.5),(8.8±4.3),(8.8±4.1) and (8.0±2.8) ng/ml.During 12 weeks of follow-up,the incidence of biopsy-confirmed acute rejection was 4.8％ (4/83),and all of cases were reversed by implosive therapy.The survival rate of graft hver was 100％.The incidence of lung infection and diabetes mellitus was both 6.02％.ConclusionSaishi Tac capsule was safe and effective to Chinese liver transplant recipients.

ObjectiveTo explore the effect and safety of three non-invasive immune rejection monitor techniques including intramyocardial electrogram (IMEG),tissue Doppler imaging (TDI) and multiple rejection relative genes expression detection in the peripheral blood.MethodsTotally 103 well recovered heart transplant cases were recruited The IMEG,TDI and gene expression detection techniques were used to monitor the rejection.The endomyocardial biopsy (EMB) was performed routinely after 1,3,and 12 months,or with clinic severe symptom,or with obvious abnormal noninvasive monitoring results,The patients were divided into different groups and were subjected to the test of TDI and quantitative real-time fluorescent quantitative reverse transcription-polymerase chain reaction(RT-PCR) technique test to observe the expression patterns of 16 immune rejection relative genes after heart transplantation.Results were also compared with those of the normal people.Results The sensitivity of IMEG was 92.9％,the specificity was 99.2％,positive predictive rate was 70.0％,and negative predictable rate was 99.8％.The routine echo can only detect the abnormality in the severe cardiac function impair.The TDI parameters in the grade Ⅰ or Ⅱ rejection group were decreased as compared with the controls (P＜0.05).The parameters Em,Sm and Tem were significantly reduced in grade ≥Ⅱ group as compared with the grade 0 or Ⅰ rejection group (P＜0.05).On the onset of acute rejection,the expression of ITGA4,FKB and IL1R2 was up-regulated,and that of PF4,ITGAM,TGF-β1and RHOU was down-regulated.ConclusionThe high negative prediction of the IMEG could be used as a non-invasive,convenient and safe monitoring technique for rejection reaction without any biopsies.It has a better correlation to use TDI and the Em,Am,Tem,Sm and Tsm could be used as the early sensentive parameters to detect the immune rejection.The real time quantitation RT-PCR methods were constructed successfully to detect the multiple immune relative genes expression and had clinic application value.