Objective To study the method of preparation of donor liver in liver transplantation. Methods The methods and skills of donor liver preparation and the anomaly artery reconstruction of graft in 64 cases of orthotopic liver transplantation (OLT) were retrospectively analyzed. Results All allografts had preparation and were suitable for clinical transplantation. Thirteen cases with hepatic artery anatomy variation were found. Among the 13 cases, 5 cases were reconstructed. Splenic artery (3/5) and gastro-duodenal artery (2/5) were typically used for anastomosis of the variant hepatic arteries. No complications resulted from donor liver preparation. Conclusions Correct preparation of the donor hepatic artery and biliary tracts, can decrease the incidence of hepatic artery and biliary tract complications after liver transplantation, and is the key to ensure successful donor liver preparation.

Objective To study the MTHFR gene (677 gene loci and 1298 gene loci) mutations in Chinese patients with keloid. Methods The tissue DNA was extracted from 20 samples of keloids. and peripheral blood samples from the same patients were employed as the control. Polymerase chain reaction(PCR) was used to amplify the Mthfr 677 gene loci and Mthfr 1298 gene loci from the keloid tissue DNA and peripheral blood DNA. and the PCR products were sequenced directly and then compared with the GenBank data. Results Mutations were detected in 17 out of 20 keloids on Mthfr 677 gene loci, the mutation incidence was 85.0 %. Mutations were detected in 13 out of 20 keloids on Mthfr 1298 gene loci, and the mutation incidence was 65.0 %. The mutation involved point mutation, deletion and insetion as well as multisite and multitype. No MTHFR gene mutation was detected in all peripheral blood samples . Conclusion There is a strong correlation between the MTHFR gene (677 gene loci and 1298 gene loci) mutation and keloid.

Objective To explore the related prognostic factors of the patients with thyroid microcarcinoma.Methods Clinical data,including clinical,pathologic,and therapeutic factor of 203 patients with thyroid microcarcinoma admitted were analyzed retrospectively.Results The cause specific survival and locoregional failure free survival rates at 10 years were 100.0% and 91.4% , respectively.Univariate analysis showed that multifocality, cervical lymph node metastasis and radioiodine treatment was associated with prognosis.Multivariate analysis revealed that cervical lymph node metastasis was the only independent prognostic factor for locoregional failure free survival.The risk of locoregional recurrence increased 2.5 folds when lymph nodes metastasis occurred at presentation.Conclusion The ratio of thyroid microcarcinoma to thyroid carcinoma increased yearly and the overall survival rate of thyroid microcarcinoma was excellent.Of all the prognostic factors,lymph node metastasis was the most important one related to survival.

Objective To investigate the application of molecular absorbent recycling system (MARS) in auto liver transplantation (ALT).Methods The clinical data of 46 patients who underwent ALT in Zhongnan Hospital of Wuhan University from September 2014 to August 2015 were retrospectively studied.The patients were randomly divided into the MARS group (n =30) and the hemodialysis group (n =16).In the MARS group,20 patients were male and 10 were female with an average age of (15 ±67) years,and the median age was 46.In the hemodialysis group,8 were male and 8 were female with an average age of (22 ± 54) years.A heparinized left iliac vein was linked to a centrifugal pump of a MARS and an output tube was linked to a left jugular vein.Before the anhepatic phase,physical pretreatment was carried out by ligating the porta hepatis and inferior vena cava (IVC) to adapt the patient to the anhepatic phase.Subsequently,a bypass was established followed by ligation of the IVC.The duration of operation,length of stay in ICU after operation,one-year survival rate and hepatorenal function were studied.Results The duration of operation in the MRAS group and in the hemodialysis group was not significantly different (P ＞0.05).The length of stay in ICU after operation in the MARS group was (12.0 ±3.0) d,which was significantly shorter than that of the hemodialysis group (20.0 ± 2.0) d (P ＜ 0.05).The one-year survival rate in the MARS group was (100％),which was significantly higher than that of the hemodialysis group (93.8％,P ＜0.05).Conclusion The application of MARS in ALT shortened the length of stay in hospital and improved one-year survival rate,resulting in better outcomes than the conventional method.

Objective: To explore the characteristics of external iliac artery vascular complications atfer renal transplantation and the diagnosis and treatment. Methods: We reviewed the clinical data of 6 patients with of external iliac artery vascular complications atfer renal transplantation from more than 2000 renal transplantation patients in the Transplantation Center of the Third Xiangya Hospital of Central South University from 2001 to 2013, and analyzed the clinical characteristics, diagnosis and treatment. Results: hTe renal allogratf was removed in 5 of the 6 patients due to repeated external iliac arteryhemorrhage: 2 patients were replaced the external iliac artery with reversed autogenous great saphenous vein, 2 patients underwent the bilateral femoral artery bypass surgery, and 1 was repaired the external iliac artery directly. The other 1 was resected the renal allograft and the involved external iliac arteries due to fungal mass in the external iliac artery. Among the 6 patients, except 1 patient died atfer the surgery of the repair of the external iliac artery, the other 5 are all alive. Conclusion: Vascular replacement and artery bypass are effective methods for patients with external iliac artery vascular complications atfer kidney transplantation.

As one of the commonest postoperative complications after liver transplantation,fungal infection has a high incidence and mortality.Nowadays,the development of the organ transplantation technique in China has already entered into the era of donation after citizen's death (DCD).Donors of DCD are mainly derived from the patients after brain death,cardiac death or death of both brain and cardiac.These donors usually suffer from long-term hypotension,ischemia,anoxia and secondary recessive or dominant infections during emergency treatment.Hence,preventing the fungal infections in donor organs and recipients after transplantation plays an important role in improving the success rate of liver transplantation.This review focuses on the clinical significance of preventing fungal infection in DCD of liver transplantation.

Objective To investigate the risk factors of bloodstream infection-related death after liver transplantation.Methods The retrospective case-control study was adopted.The clinical data of the 107 patients with bloodstream infection from 365 liver transplantation patients who were admitted to the Third Xiangya Hospital of Central South University (220 patients) and South Central Hospital Affiliated to Wuhan University (145 patients) from January 1,2002 to December 31,2015 were collected.The patients received modified piggyback liver transplantation.The second or third generation celphalosporin or carbapenems antibiotics were preventively used against infection according to the bacterial culture results before surgery,and the immune inhibitor basic program after surgery was FK506 + prednisone.The observation indicators included:(1) the bloodstream infection status after liver transplantation:incidence of bloodstream infection,frequency of bloodstream infection,inadequate antiinfection treatment,primary infection position,microorganism infection type,bacterial culture results and bloodstream infection-related mortality.(2) The risk factors of blood stream infection-related death after liver transplantation in univariate and multivariate analyses in cluded:the gender,age,resource of donor,usage of immune inhibitor,time between infection and liver transplantation,infection temperature,primary infection position(intraperitoneal or biliary infection),pathogenic microorganism type,nosocomial infection,inadequate antibiotic usage,serum creatinine level,serum albumin (Alb) level,white blood cell (WBC) in peripheral blood,lymphocyte in peripheral blood,platelet (PLT) in peripheral blood and septic shock indexes.The patients were followed up by outpatient examination and telephone interview up to January 31,2016,the follow-up contents included the survival status of the patients,vital signs,using status of immune inhibitor,immune inhibitor concentration,blood routine,biochemical indexes,surgery,other infection-related complications and acute rejection.Continuous variables with normal distribution were represented as ~ ± s.The univariate analysis was done by the Chi-square test.The multivariate analysis was done by the Logistic regression model.Results (1) The bloodstream infection status after liver transplantation:186 bloodstream infections were happened in 107 patients undergoing liver transplantation,with a total incidence of bloodstream infection of 29.32％ (107/365).The incidence of bloodstream infection was 28.18％ (62/220) in the Third Xiangya Hospital of Central South University and 31.03％ (45/145) in the South Central Hospital Affiliated to Wuhan University,with no statistical difference (x2=0.186,P ＞0.05).Of 107 patients,56 patients had once bloodstream infection,31 had twice bloodstream infection and 20 had three times or more bloodstream infection (frequency of the most bloodstream infection was 6).The inadequate anti-infection treatment was applied to the 41.12％ (44/107)of patients with liver transplantation and bloodstream infection.The number of patients with primary infection positions in abdomen,lung,urethra,intravascular catheter and unknown sites were 40,39,3,1 and 24,respectively.The Gram positive bacteria,Gram negative bacteria,fungus and mixed infection of microorganism infection type were detected in 28,24,4 and 51 patients,respectively.There were 102 patients with nosocomial infection.Bacteria culture results in 186 strains of blood sample illustrated:84 strains were Gram positive bacteria as major pathogenic bacteria,among which enterococcus (31 strains) and staphylococcus aureus (23 strains) were dominant strains.The bloodstream infection-related mortality was 37.38％ (40/107),including 35 patients dying of septic shock.(2) The univariate analysis showed that the gender,resource of the donor,infection temperature,type of microorganism,serum creatinine level,serum Alb level,WBC in peripheral blood,PLT in peripheral blood and septic shock were the risk factors affecting bloodstream infection-related death after liver transplantation (x2=5.801,5.920,13.047,12.776,11.366,7.976,25.173,9.289,51.905,P ＜0.05).The multivariate analysis showed that serum Alb level ＜ 30 mg/L and septic shock were the independent risk factors affecting bloodstream infection-related death after liver transplantation (OR =5.839,44.983,95 ％ confidence interval:1.145-29.767,12.606-160.514,P ＜ 0.05).Conclusion It is prone to happen bloodstream infection after liver transplantation,and serum Alb level ＜ 30mg/L and septic shock are the independent risk factors affecting bloodstream infection-related death after liver transplantation.

BACKGROUND: Liver cells are regulated by proliferation and apoptosis following ischemia/reperfusion injury, and the liver regeneration is obvious inhabited after ischemia/reperfusion injury, which can be relieved by ischemic preconditioning. However, the mechanism is still poorly understood.OBJECTIVE: To explore the effects of ischemic preconditioning on remained liver cell apoptosis and proliferation following autologous liver transplantation.DESIGN, TIME AND SETTING: The randomized controlled animal experiment was performed at the experimental animal center of Xiangya Medical College of Central South University from September 2006 to July 2007.MATERIALS: Totally 144 male Sprague Daweley rats were randomly divided into hepatic resection, auto-transplantation, ischemic preconditioning groups, with 48 animals in each group.METHODS: Rats in the hepatic resection group were underwent left hepatic lobe and median lobe resection without blocking blood current at the right hepatic lobe and caudal lobe. In the auto-transplantation group Venous traffic branches of rats were broke, with liberating caudate lobe, first porta hepatis, and inferior vena cava, followed by blocking and continuous hypothermical perfusion preservative fluid via porta hepatic, simultaneously, anemia hepatectomy was performed (left hepatic lobe and median lobe was resected). The liver was washed and preserved in cold preservation solution for 15 minutes. At the end, portal triad clamping was removed and underwent abdominal closure. The procedure of rats in the ischemic preconditioning group was identical to auto-transplantation group except 10 minutes blocking and 10 minutes recover the blood flow at right hepatic lobe and caudal lobe prior to portal vein perfusion. Liver tissues were harvested at hours 0, 1, 3, 6, 12, 24, 48 and 72 after hepatic resection in 3 groups. MAIN OUTCOME MEASURES: Contents of aspartate aminotransferase and alanine aminotransferase were calculated by biochemical analyzer. The index of cell apoptosis was detected by flow cytometry. In addition, proliferation of liver cells was measured by Ki-67 expression. RESULTS: Compared to the auto-transplantation group, the levels of alanine aminotransferase and aspartate aminotransferase were dramatically decreased in hepatic resection and ischemic preconditioning groups at each time point exception with 0 hour after operation (P < 0.05). Few apoptosis cells existed in each group at 0 hour after operation. The index of cell apoptosis increased slightly after resection in the hepatic resection group, which was sharp increased in the auto-transplantation group after reperfusion, reached a peak at 12 hour, and then gradually decreased. Compared auto-transplantation group, the index of cell apoptosis in ischemic preconditioning group was significantly decreased (P < 0.05). The expression of Ki-67 in 3 groups increased after hepatic resection, peaked at 24 hour after hepatic resection, then decreased lower and lower. Compared to the hepatic resection group, the expression of Ki-67 in auto-transplantation group was significantly lower after hepatic resection (P < 0.05). Compared to the auto-transplantation group, the expression of Ki-67 in ischemic preconditioning group was significantly increased after hepatic resection (P < 0.05).CONCLUSION: Ischemic preconditioning can decrease cell apoptosis and promote cell proliferation after rat's liver auto-transplantation, which may be one mechanisms of ischemic preconditioning in promoting liver regeneration.

Objective To sum up the experiences in liver transplantations from donation after brain death (DBD),and compare the clinical effect,complications and influential factors with international situation.Methods The retrospective descriptive study was adopted.All the data of 66 DBD liver donors and the matched recipients from authors' affiliations during June 2010 and June 2013 were collected.Original articles,meta-analysis and data reports with high academic influence were read and data were analyzed with SPSS 22.0.Results The incidence of serious complications,vascular complications and biliary complications during the first year among 66 recipients was 21.2％,10.6％,and 6.1％,respectively.Compared to international situation,graft 1-,3-,and 5-year survival rate was similar (P＞0.05) (83％,80％ and 73％ respectively),similar to that of recipients.There was no statistically significant difference in primary nonfunction and vascular complications between our center and other centers.As for biliary complications,morbidity was lower in our center (P＜0.05).The 3-and 5-year survival rate of recipients was also similar (P＞0.05),though the 1-year survival rate was slightly lower (P＜ 0.05).Conclusion These findings provide evidence that patient's prognosis under DBD liver transplantation in our center is acceptable,and long-term survival rate has reached international level.Still,1-year survival rate of recipients is unsatisfactory.In order to achieve a good clinical efficacy,we need to find out disadvantages during donor maintenance,recipient selection,surgical procedure and postoperative management.

Objective:To identify the polymorphisms of cytochrome P450 3A5 gene (CYP3A5) and multidrug resistance gene 1 (MDR-1) and their distributions in Hans renal transplant recipients in Hunan province, we analyzed the difference of the gene polymorphisms and distributions between Hunan province and 11 other provinces of China.
Methods:We collected 598 Hans renal transplant recipients who had operation or follow-up examination in 3rd Xiangya Hospital from Hunan province. We examined the gene polymorphisms of CYP3A5 and MDR-1 and compared their distributions with the data from 11 other provinces of China by chi-square test.
Results:hTere were CYP3A5*1/*1 genotype in 58 cases (9.7%), CYP3A5*1/*3 genotype in 251 cases (42.0%), CYP3A5*3/*3 genotype in 289 cases (48.3%);MDR-1 3435CC genotype in 238 cases (39.8%), MDR-1 3435CT genotype in 263 cases (44.0%), MDR-1 3435TT genotype in 97 cases (16.2%). Frequency of CYP3A5*1/*1 and*1/*3 genotypes of Hunan province was higher than the that from the 11 other provinces of China and the frequency of mutator*3 was lower. Frequency of MDR-1 3435CC and 3435CT genotypes of Hunan province was higher and the frequency of mutator T was lower than that from the 11 other provinces of China.
Conclusions:There were significant difference in gene polymorphisms and distributions of CYP3A5 and MDR-1 between Hunan province and the 11 other provinces of China. It may be a guideline for us to use calcineurin inhibitor drugs in the early stage atfer renal transplantation.