Objective To study the principle of chemokine stromal-dirived factors-1(SDF-1)in acute rejection,we test the expression of CXCR4 which is the receptor of SDF-1 in acute rejection following liver transplantation. Methods needle-biopsy specimens after liver transplantation were divided into four groups according to Banff schema.We analyzed the mRNA level of CXCR4 in each group by RT-PCR.Results In non-rejection group and control group,all samples expressed CXCR4 in small and medium dose.In rejection group,high level expression of CXCR4 related to high degree of acute rejection were found.Conclusion The CXCR4 plays an important role in acute allograft rejection of human liver after transplantation.To restrain the expression of CXCR4 may be au effective method of anti-acute rejection.

ObjectiveTo explore the application and significance of assisted laparoscopic hepatectomy (ALH) in living-donor-hepatectomy.MethodsWe successfully performed 7 cases of ALH of right hepatectomy on living donor from 30/5/2011 to 1/9/2011.ResultsThe donors recovered well with ratio of remnant lver:32.10％ ～38.31 ％,good liver fuction,little pain and no surgical complications.All the wound sutured intracuteneously was taken out stitches 7 days after operation and healed perfectly.Liver function got normal 2 weeks after operation.Conclusions ALH,which gives the consideration to both the minimal invasion of laparoscopic surgery and safe of open surgery,can be applied safely in hepatectomy of living donor and highly acceptible for donor and receptor.

Objective To evaluate the effects of portoenterostomy (Kasai surgery) on living donor liver transplantation (LDLT) for children with biliary atresia (BA). Methods A total of 150 children with BA, who were treated with LDLT in our center from September 2006 to September 2014, were retrospectively analysed. The children were categorized into Kasai group (90 cases, 60%) and non-Kasai (60 cases, 40%) group, based on whether they had previously undergone Kasai procedure pre-LDLT. Clinical data, incidence of complications and accumulated survival rates were compared between two groups. Results The ages of pediatric patients were 4.9-87.0 months. The patient age and height were significantly higher in Kasai group than those of non-Kasai group (P<0.05). The serum bilirubin level was lower before surgery in Kasai group than that of non-Kasai group (P<0.05). There were no significant differences in body weight, pediatric end stage of liver disease (PELD) score, graft to recipient body weight ratio (GRWR), operation time and blood loss between two groups ( P>0.05). Similarly, there were no significant differences in pulmonary infection, acute rejection, portal vein thrombosis, hepatic artery occlusion and biliary complications between the two groups (P>0.05). The overall complication rate of post-LDLT was 61.1%in Kasai group, which was higher than that in non-Kasai group (43.3%,χ2=4.580, P=0.032). Totally, there were 7 cases (4.7%) died on post-LDLT, in which there were 6 cases (4.0%) in Kasai group including 5 cases of multiple organ
failure and 1 case of severe pulmonary infection, and 1 case (0.7%) in non-Kasai group, who died of multiple organ failure due to preoperative gastrointestinal bleeding for emergency surgery. There were no serious complications and death in donors. The overall cumulative survival rates were 98.6%, 96.6%, 94.9%and 92.7%in 1 month, 1 year, 3 years and 5 years after LDLT, respectively. And there were no significant differences in survival rates in 1 month, 1 year, 3 years and 5 years between two groups (χ2=1.490, P=0.222) with the rates of 98.9%, 96.5%, 93.8%, 91.3%in Kasai group and 98.3%, 96.6%, 96.4%, 95.5% in non-Kasai group. Conclusion Performing Kasai procedure can acquire satisfied results to pediatric patients with BA pre-LDLT, without increasing the incidence of major complications and mortality post-LDLT. And the accumulated survival rate is not different in pediatric patients received Kasai surgery compared with that in non-Kasai patient. Besides that, Kasai surgery might postpone the time of receiving LDLT, benefit to the growth of children and reduce the jaundice of pre-LDLT.

Objective To summarize the clinical experience in pediatric split liver transplantation (SLT) recipients.Methods A retrospective analysis was conducted on 38 cases of pediatric recipients using split donors during February 2007 to December 2015.The ex situ splitting technique was used for 22 grafts and in situ splitting technique was used for the rest 16 grafts.The survival rate of patients,recovery of liver function,re-transplantation rate,incidence of vascular complications and biliary complications were Observed,and the causes of death were analyzed.Results The median follow-up time of all the patients was 30.65 months (0.1-96.6 months).The 1-and 3-year cumulative survival rate was 81.6％ and 76.3％ respectively.The re-transplantation rate was 13.16％,the incidence of vessel complications was 31.58％,and biliary complication rate was 31.58％.There were 9 deaths,including 5 deaths which were related to surgical complications.Conclusion SLT can expand the resource of 1iver donors for pediatric recipients.Comparing to ex situ split liver grafts,in situ split liver grafts can reduce morbidity and mortality of children after liver transplantation.

Objective To explore the clinical efficacy of pediatric blood type incompatible living donor liver transplantation. Methods The clinical data from 242 cases of pediatric living donor liver transplantation recipients were retrospectively analyzed. Recipients were assigned to group A (ABO-identical group, n=165), group B (ABO-compatible group, n=42) and group C (ABO-incompatible group, n=35) according to the blood type compatibility between the recipients and the donors. The occurrence of postoperative complications and development of postoperative donor specific antibody (DSA) among the 3 groups were observed and compared. And the blood type distribution of donors and recipients and development of erythrocyte antibodies in group C were analyzed. The survival situation of recipients after liver transplantation was compared among the 3 groups. Results There was no significant difference in the incidence of complications among the 3 groups(all P > 0.05). DSA was dominated by human leukocyte antigen (HLA) Ⅱ antibodies after liver transplantation, mostly anti-HLA-DR and anti-HLA-DQ. The postoperative erythrocyte antibodies for liver transplant recipients in group C were dominated by IgM, with titers ≤1:2 for all. The differences in postoperative survival rates were not statistically significant among 3 groups(all P > 0.05). Conclusions Pediatric blood type incompatible living donor liver transplantation is a safe and effective treatment, which can effectively expand the source of liver transplant donors and save the children's lives.

Objective To evaluate the feasibility and safety of using pediatric donation after brain death donors during split liver transplantation .Methods The clinical data were retrospectively reviewed for 8 pediatric recipients undergoing split liver transplantation with a donor age of 2 .7-7 years .The clinical characteristics of donors/recipients ,perioperative course ,postoperative recovery and complications along with graft and recipient survival rate were analyzed .Results The split procedure was performed ex situ (n=3) and in situ (n=1) ,all liver grafts were split into left lateral lobes and extended right lobes . The recipients were children aged 4 .7-105 .5 months . The mean follow-up period was (8 .1 ± 0 .6) months and the graft/recipient survival rates approached 100％ . Graft functions remained normal in all recipients at the end of follow-ups .Two recipients undergoing liver grafting with long cold ischemia time exhibited slower recovery of graft function .Pathological examination of graft biopsy indicated ischemic and hypoxic changes .Portal vein stenosis occurred in one recipient .Percutaneous transhepatic portal vein balloon dilatation was performed and the recipient recovered well .Cytomegalovirus infection occurred in 5/8 recipients and serum virological marker returned to normal after ganciclovir therapy . The youngest donor age was 2 .7 years and both recipients of donor liver recovered well .Conclusions Split liver transplantation with a donor age of 2 .7-7 .0 years may achieve ideal clinical outcomes in well-matched donors and recipients .

Objective To summarize the experiences of diagnosing and treating portal vein stenosis (PVS) after pediatric liver transplantation from China donation after citizen 's death (CDCD) grafts .Methods Retrospective analysis was performed for 30 cases of pediatric CDCD liver transplantation recipients with PVS .The screening ,diagnosis ,treatment and prognosis of PVS were analyzed .Results Among 218 pediatric liver transplantation recipients with CDCD grafts ,PVS was diagnosed in 30 cases with an incidence rate of 13 .8％ (30/218) .The initial diagnosis of PVS ranged from 5 days to 27 months post-operation with a median age of 2 .9 months .Ultrasonography indicated that stenotic rate of anastomotic site diameter was (41 .28 ± 12 .93)％ and blood flow velocity ratio (358 .77 ± 117 .82)％ .Intervention examination showed average pressure gradient was (9 .06 ± 5 .34) mmHg between both sides of stenosis . All cases underwent percutaneous intrahepatic balloon dilatation .The recipients were followed up for a median follow-up time of 23(3-63) months .For three cases of restenosis ,percutaneous intrahepatic balloon dilatation was repeated .Two cases underwent stent implantation due to ineffective balloon dilation .After treatment ,the stenotic rate of anastomotic site diameter was (34 .69 ± 8 .82) and blood flow velocity ratio (61 .18 ± 63 .11)％ on ultrasound while the average pressure gradient was (1 .03 ± 0 .85) mmHg .Conclusions PVS is a common vascular complication after pediatric CDCD liver transplantation .Portal vein balloon dilation is both safe and efficacious .However ,some cases require repeated balloon dilation and stent implantation serves as the last option for intractable PVS .Color ultrasound is both convenient and effective for making a primary diagnosis and evaluating outcomes .

Objective To explore the diagnosis and treatment of diaphragmatic hernia (DH)secondary to living donor liver transplantation (LDLT) in pediatrics.Methods The primary disease was biliary atresia and all of the 4 patients underwent LDLT using a donor's left lateral graft.The ages of recipients were 5-7 months at LDLT and the onset of DH were 1.5-16 months after LDLT.There were 3 right DH and 1 left DH,and 3 were emergency cases.Results The graft weight and graft to recipient body weight ratio (GRWR) were respectively between 170-290 g and between 2.7％-5.0％.Clinical symptoms included urgent respiratory distress,dyspepsia or gastrointestinal obstruction.DH was diagnosed by computed tomography scan or X-ray of the chest.Laparotomy were performed successfully to repair the DH including emergency laparotomy in three patients.Herniated organs were partial intestines or colon and partial stomach.All cases recovered without major complications.Conclusions DH post-LDLT is an unusual complication,often calls for emergent management.

Objective To summary the diagnosis and therapy of antibody-mediated rejection (AMR) caused by donor specific antibody (DSA) in pediatrics after living donor liver transplantation.Methods The clinical data of total 4 pediatric recipients with biliary atresia after liver transplantation were retrospectively analyzed.Liver biopsy was performed and HLA antibodies were detected by Luminex.The abnormal graft function was found.Results The concentrations of immunosuppressant were very low pre-AMR-diagnosed.DSA was detected in total 4 patients with the most DSA at HLA-Ⅱ antibodies.Staining of C4d was positive in liver biopsies in 3 of 4 recipients.The patients were gvien plasmapheresis,intravenous immunoglobulin,mycophenolate mofetil and rituximab postdiagnosis.However,only 1 patient was cured with normal graft function and negative DSA.The rest of patients received re-transplantation because of ineffective treatment and showed a well graft function during the follow-up period.Conclusion AMR induced by DSA was rare complaint after pediatric liver transplantation,with serious consequence and poor prognosis.AMR in some patients can be cured by conservative therapies as being diagnosed definitely.However,re-transplantation was oneof the valid therapies to AMR.

Objective:To explore the application of extracorporeal membrane oxygenation (ECMO)for severe acute respiratory distress syndrome(ARDS)in children after liver transplantation.Methods:The clinical data were retrospectively analyzed for two ECMO-supported children with severe ARDS after liver transplantation. There were suspected pneumocystis carinii pneumonia(n=1)and identified pneumocystis carinii pneumonia(n=1).Results:Veno-arterial ECMO(VA-ECMO)was performed and oxygen saturation index(OSI)before an initiation of ECMO was 31.8 and 23.9 respectively. Both were successfully separated from ECMO after 219 h and 168 h support respectively, and both were weaned from ventilator after 342 h and 232 h invasive mechanical ventilation respectively. The length of ICU stay was 31 and 18 days and the length of hospital stay 57 and 33 days respectively. During ECMO support, liver function remained stable and there was no new onset of organ dysfunction or life-threatening complications.Conclusions:ECMO is a potential therapy for children with severe ADRS after liver transplantation and the assessment and management of complications with ECMO support should be further studied.