Objective To analyze and compare the clinical effects of comprehensive treatment and liver transplantation for hepatocellular carcinomas (HCC)exceeding Milan criteria.Methods A retrospective analysis was performed on the clinical data of 157 patients with HCC (exceeding Milan criteria)who received comprehensive treatment (99 patients,including 48 cases meeting Shanghai criteria)and liv-er transplantation (58 patients,including 26 cases meeting Shanghai criteria)in our hospital from January 2006 to January 2010.The medi-an survival times and 1 -,2-,and 3-year survival rates were calculated by the Kaplan-Meier method,and the log-rank test was used for survival difference analysis.Results For all patients,the median survival times of the comprehensive treatment group and liver trans-plantation group were 18.00 ±1.15 and 23.40 ±4.44 months,respectively,and their 3 -year survival rates were(18.2 ±3.9)% and (39.7 ±6.4)%,respectively;the survival was significantly improved by the treatment of liver transplantation (P=0.009).For patients meeting Shanghai criteria,the median survival times of the comprehensive treatment group and liver transplantation group were 20.00 ±1.17 and 36.00 ±0.00 months,respectively,and their 3-year survival rates were (25.0 ±6.3)% and (57.7 ±9.7)%,respectively;there was significant survival difference between the two groups (P=0.008).For patients exceeding Shanghai criteria,the median survival times of the comprehensive treatment group and liver transplantation group were 16.00 ±1.78 and 16.00 ±1.69 months,respectively,and their 3-year survival rates were (11.8 ±4.5)% and (25.0 ±7.7)%,respectively;there was no significant survival difference between the two groups (P=0.221).Conclusion Compared with comprehensive treatment,liver transplantation leads to a significant higher long-term survival rate in HCC patients exceeding Milan criteria but meeting Shanghai criteria.However,the two therapies cause no significant survival difference in HCC patients exceeding Shanghai criteria.

Objective To explore a better method for establishing rat model of simultaneous (liver)-kidney transplantation and the prevention of complications after transplantation.Methods In the donor operation, the liver and the right kidney were flushed with 0-4 ℃ sodium lactate Ringer’s (injection) through aorta, and en bloc resection of organs of right kidney, liver, pancreas, intestines, and spleen were done. Preparation was performed in the preservation solution. During the recipient (operation), all the blood vessels were reconstructed with cuff methods. The bile duct was anastomosed using a simple inside bracket. Operation of connecting ureter attached part of bladder with the bladder was conducted.Results One hundred and ten simultaneous liver-kidney transplantations including 50 (preliminary) experiments were carried out. Eighteen recipient rats died in the preliminary experiments. Five recipient rats died in the formal experiments and all the remaining had survived for more than 30 days. The successful rate of formal transplantations was 91.7 %.Conclusion This kind of rat model of simultaneous liver-kidney transplantation is simple. The time for blood vessel anastomosis and (anhepatic) stage was reduced. Complications such as stenosis were avoided. Preparation before operation, manipulation after operation and management after operation can affect the establishment of the model.

Objective To investigate the efficiency of model for end-stage liver disease(MELD)score,serum sodium concentration and aseites condition in the evaluation of short-term survival rate of patients with benign end-stage hepatopathy after liver transplantation.Methods The clinical data of 98 patients with benign end-stage hepatopathy who had undergone liver transplantation in Fuzhou General Hospital from January 1999 to February 2007 were retrospectively analyzed.The relationship between serum sodium concentration.ascites condition and the prognosis of patients with the same MELD score was analyzed.Kaplan-Meier survival curve was drawn.The 1-year survival rate of the patients was analyzed by chi-square test.The mortality of patients with the same MELD score at the end of the third month after operation was analyzed by Fisher's exact test.Results MELD score of aIJ patients was 15-25 or＞25.The postoperatire 3-month mortality rates of patients with serum sodium concentration≥130 mmol/L were 5%and 15%.which were significantly lower than 33%and 55%of those with serum sodium concentration＜1 30 mmol/L.The difference upon 1-year survival rates between them had statistical significance(x2:12.88,P＜0.05).The postoperative 3-month mortality rates of patients without ascites were 5%and 8%.which were lower than 35%and 57%of those with aseites.and the difference upon 1-year survival rates between them had statistical significance(X2=15.26.P＜0.05).Conclusions It is more accurate to evaluate the short-term survival rate after liver transplantation for benign end-stage hepatopathy by combining the MELD score with serum sodium concentration and ascites condition.

Objective To study the effects of ischemia-reperfusion in liver transplantation on the pathophysiological changes of the lung and mechanisms of lung injury. Methods We studied 23 patients who received liver transplantation at Fuzhou General Hospital of PLA. We cut a small piece of the right lung for pathological study and for L-1β and TNF-a immunohistochemistry studies at 5 minutes after the beginning of operation (Ta), 5 minutes before the portal vein was opened (Tb) and three hours after the new liver was transplanted (Tc). We also collected peripheral blood to study the concentration of IL-1β and TNF-a in the plasma at the beginning of operation (T1), the portal vein 5 minutes before opening, the portal vein (T2) ten minutes after the opening (T3) , and one hour after the new liver was transplanted (T4), three hours after the new liver was transplanted (T5), and 12 hours after operation (T6). Results The cytokines TNF-a and IL-1β in peripheral blood were not obviously increased in the portal vein before it was opened, but were significantly increased after the portal vein was opened. Comparison of T1 and T2 separately with T3, T4 and T5 showed significant differences (P<0. 01). In light and electron microscopy, the structures of the lung tissues were normal at Ta and did not change significantly at Tb. There were significant abnormalities at Tc. The average positive points of TNF-a and IL-1β expressions in the lung tissues at Tc were significantly higher than Ta and Tb(P<0. 01). Conclusion Ischemia-reperfusion in liver transplantation led to a serious systemic inflammatory syndrome,and acute lung injury. TNF-a and IL-1β were involved in acute lung injury.

BACKGROUND: Hepatitis B virus (HBV) recurrence following liver transplantation has been difficultly treated, and antiviral therapy following HBV recurrence has been less reported yet.OBJECTIVE: To investigate the antiviral therapy using Adefovir + Lamivudine + anti-hepatis B immunoglobulin on liver functional improvement following liver transplantation.METHODS: A total of 208 cases with hepatitis B-related end-stage liver disease following liver transplantation were selected from Liver Transplantation Center of Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from January 2005 to October 2008. All patients were treated with Lamivudine + anti-hepatis B immunoglobulin so as to prevent from HBV recurrence. At 6-43 months after following up, HBV recurrence was found in 19 cases, including 13 with positive HBeAg and 8 with YMDD mutation. The 19 patients were treated with Adefovir based on the application of Lamivudine + anti-hepatis B immunoglobulin.RESULTS AND CONCLUSION: At 12, 24, and 48 weeks after treatment, DNA and glutamic-pyruvic transaminase of 19 cases were significantly decreased (P < 0.01). After 48-week treatment, recovery rate of glutamic-pyruvic transaminase, negativity rate of HBeAg, and negativity rate of HBV DNA were 84.1 %, 76.92%, and 78.9%, respectively. The results demonstrated that the application of Adefovir + Lamivudine + anti-hepatis B immunoglobulin effectively inhibited viral replication and prevented HBV recurrence following liver transplantation.

Objective To investigate the effective strategies to prevent and treat biliary complications after orthotopic liver transplantation.Methods The clinical data of 316 patients who received orthotopic liver transplantation at the Fuzhou General Hospital of Nanjing Military Command from November 2001 to March 2012 were retrospectively analyzed.Cold perfusion with HTK + UW solution was applied when obtaining the liver graft,and then the liver graft was preserved in the UW solution.The bile duct was perfused with UW solution thereafter.Orthotopic liver transplantation or piggyback liver transplantation were adopted in the cadaver liver transplantation.Left liver transplantation and right liver transplantation were adopted in the living donor liver transplantation.Choledochojejunal Roux-en-Y anastomosis or duct-to-duct choledochostomy were used for biliary reconstruction.Ordinary T tubes were used for drainage before 2006,and then 6 F pediatric suction catheter or epidural catheter were applied for drainage thereafter.The Ttube was pulled out 3-6 months after the operation.Enteral nutrition was applied to patients at the early phase after operation.The immunosuppressive agents used including tacrolimus + mycophenolatemofetil + adrenal cortical hormone,and for some patients,tacrolimus + mycophenolatemofetil + sirolimus + hormone were used.Patients were followed up for 2 years to learn the incidence of biliary complications and guide the medication.The difference in the incidence of bile leakage between patients who wcrc admitted before 2006 and those admitted after 2006 were compared using the chi-square test.Results The warm ischemia time was 2-6 minutes,and the cold ischemia time was 3-10 hours.For patients who received cadaver liver transplantation,orthotopic liver transplantation was carried out for 291 times and piggyback liver transplantation for 24 times; biliojejunal Roux-en-Y anastomosis was carried out for 5 times and bile duct end-to-end anastomosis for 310 times.For patients who received living donor liver transplantation,1 received left liver transplantation and 1 received right liver transplantation,and they received bile duct end-to-end anastomosis.A total of 311 patients received immunosuppressive treatment with tacrolimus + mycophenolatemofetil + adrenal cortical hormone,and 5 patients reveived tacrolimus + mycophenolatemofetil + sirolimus + hormone.Of the 316 patients who received orthotopic liver transplantation,38 had biliary complications after the operation,including bile leakage in 18 patients,intra-and extra-hepatic bile duct stricture in 6 patients,anastomotic stricture in 6 patients,biliarycomplications included cholangitis in the portal area and cholestasis in 4 patients,choledocholithiasis and cholangitis in 2 patients and biliary infection in 2 patients.The incidence of bile leakage before 2006 was 14.00％ (7/50),which was significantly higher than 4.12％ (11/267) of bile leakage after 2006 (x2-7.676,P ＜ 0.05).Of the 38 patients with biliary complications,the condition of 35 patients was improved,and 3 patients died.Of the 18 patients with bile leakage,15 was cured by conservative treatment,3 received surgical treatment (the condition of 1 patient was improved by drainage,anti-infection treatment and nutritional support,but died of peritoneal hemorrhage at postoperative 1 month; 2 patients received peritoneal drainage,1 was cured and 1 died of peritoneal infection).For the 6 patients with intra-and extra-hepatic bile duct stricture,1 was cured by liver retransplantation and 5 were cured by conservative treatment,endoscopic retrograde cholangio-pancreatography (ERCP) or balloon dilation.For the 6 patients with anastomotic stricture,the condition of 3 patients was improved by conservative treatment,balloon dilation or stent implantation,1 gave up treatment due to hepatic cancer recurrence and died thereafter,1 received anastomosis + T tube drainage,1 was cured by recurrent tumor resection and choledochojejunostomy.Four patients with cholangitis in the portal area and cholestasis were cured by conservative treatment.For the 2 patients with choledocholithiasis and cholangitis,1 was cured by stent implantation with ERCP,and 1 received conservative treatment,and the level of total bilirubin was decreased.Two patients with biliary infection were cured by anti-infection treatment.Conclusions Most of the biliary complications could be treated by non-surgical treatments.For patients with severe biliary complications or those could not be treated by non-surgical treatment,re-exploration of the bile duct is effective.Liver re-transplantation is the only choice for patients with dysfunction of liver graft caused by severe ischemic biliary injury.

BACKGROUND: The affected liver can be completely removed by liver transplantation,long-term efficacy is superior to liver resection,the 5-year survival rate reaches 70% H1.In addition,liver transplantation can avoid a serious risk for incomplete liver function caused by hepatic resection in the case of liver dysfunction.OBJECTIVE: To retrospectively analyze the treatment effects and importance of orthotoplc liver transplantation for primary hepatic cancer patients.METHODS: A total of 75 patients with primary hepatic cancer treated by orthotopic liver transplantation in Department of Hepatobiliary Surgery,Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from March 1980 to December 2008 were involved in the analysis for the postoperative survival rates and recurrence of tumors.RESULTS AND CONCLUSION: For all the patients,the total postoperative survival rate in the 1st,2nd and 3rd year was 86.6%,66.7% and 53.3% respectively,the disease free survival rate was 65.2%,53.9%,34.1%.Their mean survival time is 25 months.For the patients in line with Milan standard,the postoperative survival rate in the 1st,2nd and 3rd year was 88.4%,72.5% and57.9% respectively,the disease free survival rate was 77.6%,62.3%,51.8%.Their mean survival time is 39 months.Tumor recurrence occurred within one year in all six patients who were beyond Milan standard.Two patients died in one year after operation,the survival rate at postoperative one year was 66.7% and the remanent four patients all died in the 2nd year after operation.Orthotopic liver transplantation was one of the effective treatments for pdmary hepatic cancer patients.The patients which were measured up to Milan standard would have the best curative effects.

Objective To compare the efficacies of hepatectomy and liver transplantation for patients with hepatocellular carcinoma (HCC) fulfilling the Milan criteria.Methods From July 2002 to February 2009,121 patients with HCC combined with hepatic cirrhosis fulfilling the Milan criteria were admitted to the Fuzhou General Hospital.Eighty-nine patients who received hepatectomy were in the hepatectomy group,and 32 patients who received liver transplantation were in the liver transplantation group.There were no significant difference in the age,gender,etiology of liver disease,the size of the largest tumor,number of tumors,microscopic venous invasion,microsatellite lesion and tumor differentiation between the 2 groups.The clinical data of the patients in the 2 groups were retrospectively analyzed.The overall survival and disease-free survival were evaluated by Kaplan-Meier method,and differences in survival rates between the 2 groups were determined by Log-rank test.COX proportional hazard was used for univariate and multivariate analysis to evaluate the risk factors for prognosis.Results The median period of follow-up was 37 months.The 1-,3-,5-year survival rates were 86％,63％ and 44％ in the hepatectomy group,and 87％,70％ and 62％ in the liver transplantation group.There was no significant difference in the overall survival rate between the 2 groups (x2 =1.092,P ＞ 0.05).The 1-,3-,5-year disease-free survival rates were 68％,44％ and 26％ in the hepatectomy group,and 80％,65％ and 52％ in the liver transplantation group.There was a significant difference in the disease-free survival rate between the 2 groups (x2 =4.712,P ＜ 0.05).The result of univariate analysis revealed that microscopic venous invasion and microsatellite lesion were significantly correlated with the survival (Wald =9.625,7.340,P ＜ 0.05),and the result of multivariate analysis indicated that microscopic venous invasion was the independent risk factor influencing the survival (Wald =5.008,P ＜ 0.05).Conclusions As for patients with HCC fulfilling the Milan criteria,the overall survival rate of patients who received hepatectomy is not different from those who received liver transplantation,but the disease-free survival rate of patients who received liver transplantation is higher than those who received hepatectomy.Microscopic venous invasion is an independent risk factor influencing the survival.

Objective To investigate the clinical effect of cryosurgery in the preoperative preparation of liver transplantation in treating liver cancer.Method This study reviewed retrospectively clinical data from 74 patients who underwent cryosurgery of liver cancer before liver transplantation.According to the differences between transplantation programs,74 patients were divided into 2 groups:26 patients in Argon-helium cryoablation group (AHC group) and 48 patients in transcatheter arterial chemoembolization group (TACE group).Whether the patients in two groups met the standard of Milan after treatment,as well as the incidence rate of complication,waiting time for transplantation and MELD score before transplantation were compared between two groups after preoperative therapy.What's more,operation time,no liver time,amount of bleeding,PT and serum level of aminotransferase at 1st,3rd,and 5th day after transplantation were analyzed.Abdominal drainage fluid volume,the incidence of infection,acute rejection,kidney failure,biliary complication,and vascular complication in two groups were also compared.Disease free survival rate was counted after two years by outpatient follow-up.Result Only 3 cases in two groups exceeded Milan standard after treatment,one in AHC group and two in TACE group.The complication incidence and waiting time in two groups had no statistically significant differences.The MELD score in AHC group was significantly lower than in TACE group before transplantation.The operation time,amount of bleeding and transfusion requirements in AHC group were also significantly lower than in TACE group.The time without liver in two groups had no statistically significant difference.The speed of liver function recover was faster in ACH group,and the abdominal drainage fluid volume was less.There were no significant differences in incidence of postoperative complications between two groups (P＞0.05).Conclusion Cryosurgery therapy has little effect on liver functions after treatment.It is a good therapy for liver cancer patients before liver transplantation.

Objective To investigate the role of preoperative peripheral blood neutrophil to lymphocyte ratio (NLR),platelet to lymphocyte ratio (PLR),prognostic nutritional index (PNI) in the prognosis of patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after radical operation.Methods This is a retrospective study,involving 426 surgically resected hepatitis B related hepatocellular carcinoma cases in a single center from 2003 to 2012.Results Kaplan-Meier analysis showed patients in NLR ≤ 1.62 group achieve higher rate of recurrence-free and overall survival than that in the NLR ＞ 1.62 group,the difference was statistically significant (P ＜ 0.005);Also PNI ＞ 49.42 group showed higher rate of overall survival significantly than PNI≤49.42 group (P ＜ 0.005).The results of Cox regression multivariate analysis further suggested that both NLR ＞ 1.62 (HR 1.74,P =0.007) and PNI ≤49.42 (HR 0.70,P =0.021) were independent risk factors for overall survival,NLR ＞ 1.62 (HR 1.45,P =0.03) was also an independent risk factor for recurrence-free survival.Conclusion The preoperative NLR and PNI may be independent risk factors for prognosis of patients with HBV-related HCC after radical operation.