fulminant liver failure(FLF)is a rapid onset life-threatening emerency in which liver dysfunction,liver failure and hepatic encephalopathy occur within 8 weeks in previouslv norillal person.It has been confirmed by available clinical experience and literatures during the past decades that FLF patients are ideal recipients of liver transplantation.However,the prognosis of the FLF patients who accepted liver transplantation differed greatly according to the available reports because of the differences of supportive treatment during waiting period,the criterion for recipient assessment,the determination of operation chance,the use of critical techniques during operation and postoperative management between different transplantation centers.We probe the standardized clinical use of the aspects above mentioned in liver transplantation for FLF,particularly discuss the treatment of complications resulting from coagulopathy,determination of operation chance,significance of standardized etiological treatment and the indication of the use of veno-venous bypass technique during transplantation to provide better treatment strategy and improve the prognosis of FLF patients.

With the worldwide increase in adult-to-adult live donor liver transplantation, more profound basic and clinical medical research has ensued to solve the key problem of graft failure following liver transplantation. The present status of the study of small-for-size liver syndrome was summarized. Its definition, risk factors, pathogenesis,clinical manifestations, prevention and treatment were included.

Non-coding RNAs mainly include microRNAs and long non-coding RNAs (LncRNAs),which work as a kind of RNA to regulate the expression of gene at the levels of transcription,post-transcription and epigenetics.Recent studies have shown that many non-coding RNAs are dysregulated during liver regeneration after partial hepatectomy.This review summarized the biological characteristics and regulatory mechanisms of non-coding RNAs in liver regeneration after partial hepatectomy.

Objective To evaluate the value of IL15mRNA determination in the early diagnosis and differential diagnosis of acute rejection(AR) after liver transplantation.Methods RT-PCR was used to detect the mRNA of IL-15 in serum and bile on the 30th day after liver transplantation in 43 patients subject to orthotopic piggy-back liver transplantation.Serum and bile of the patients were cultured for bacteria.The acute rejection was confirmed pathologically. Results Acute rejection(occurred) in 16 out of 43 cases as the AR group and bacterial infection(BI) in 12 cases as the BI group.The (remaining) 15 patients were uneventful as the control group.Before diagnosis of AR and BI,the gene expression rate of IL-5 in bile was significantly higher in AR group((62.5 %)) than in BI group((16.7 %)) and control group((13.3 %))(P

Autologous liver transplantation,a type of ex situ liver surgery along with hypothermic organ preservation,a venovenous bypass and complicated vascular reconstructions,allows better access to unresectable tumor and is considered as an effective strategy to overcome the shortage of donors.However,the high complication incidence and mortality related with the technique limit its wide application.To popularize this technique,based on our current experience,we review the key parts of the surgery and the treatment strategy for the complications.

Objective A classification for hepatic venous outflow obstruction after piggyback liver transplantation (PBLT) and its clinical significance.Methods We conducted a retrospective study on 248 patients who underwent liver transplantation from May 2000 to August 2006.The aims were to elucidate the causes and treatment of postoperative venous outflow obstruction.Results Venous outflow obstruction occurred in 38 patients after transplantation.Among those,2 (5.26％) had superior hepatic inferior vena cava (IVC) stenosis,13 (34,21％) had the hepatic vein anastomosis twisted at an angle,7 (18.42％) had IVC stenosis at the posthepatic segment,and 16 (42.10％) had outflow obstruction at the hepatic veins.In these 38 patients,34 underwent PBLT,2 underwent APBLT,and 2 COLT.Most patients with hepatic venous outflow obstruction improved with surgical treatment and interventional therapy.Conclusions Hepatic vein outflow obstruction was associated with the technique of hepatic vein anastomosis,the type of cavocaval anastomosis and graft size mismatch between the donor and the recipient.Performing piggyback liver transplantation according to the classification of hepatic vein and appropriate treatments could improve the prognosis of venous outflow obstruction in clinical practice.

Objective To summerize the experiences of using molecular adsorbent recycling system(MARS) in perioperative period of orthotopic liver transplantation (OLT). Methods The effects of MARS artificial liver treatments in 19 cases were reviewed. Results The levels of serum total bilirubin, BUN, Cr, urine acid and blood ammonia were greatly reduced by using MARS. Fifteen patients were bridged to transplantation, 1 patient was relieved in symptoms of hepatic encephalopathy after MARS treatment, died 2 weeks after leaving hospital, 1 patient died of severe gastro intestinal bleeding before transplantation. The survival rate is 89.5%.Conclusion MARS artificial liver now is a safe and effective assistant device. It can help to gain more chance of undergoing OLT for the patients.

Classical piggyback liver transplantation (CPBLT) is an advanced technique based on standard orthotopic liver transplantation (SOLT),which has more advantages compared to the SOLT.However,there are still some problems with CPBLT to be solved,such as complicated surgical procedures,postoperative hepatic venous outflow obstruction and thrombosis.Recently,in order to solve these problems,modifications have been made,being named ameliorated piggyback liver transplantation (APBLT).The APBLT solved above-mentioned problems,and expanded the application of PBLT.Therefore,this article describes the technique of these ameliorations,and discusses their individual characteristics.

Objective To investigate the relationship between wound suture and incision complications in acute gastrointesti -nal tract incision .Methods Patients with abdominal surgery ( acute digestive tract perforation , and acute intestinal obstruction ) were divided into two groups .The differences between two suture methods were compared with the indicators such as operative time , incision complications, and hospital stay, etc.Results There were no significant differences between two groups (12.5%vs 20%) in incision complications ( P >0.05 );while there were differences in the postoperative hospital stay between two groups .The hospital stay of the intradermalsubcutaneoussuturegroup(13.54±7.32)dweresignificantlyshorterthanthatoftraditionalgroup(18.11±11.67)d(P<0.05 ) .Conclusions Wound intradermal subcutaneous suture was superior to traditional suture in acute gastrointestinal tract inci -sion.No significant difference was found between two groups in incision complications , but wound intradermal subcutaneous suture had significantly shorter postoperative hospital stay .

The hospital have to arrange discussions about carrying out or giving up life-support treatment such as gastrostomy artificial feeding on critical ill patients with patients themselves or their family members.In this article,we expatiate on the present ethical situation,problems,value assessment,recommendations on this treatment.