The quality and function of the donor liver is one of the main factors which influence the success and prognosis of liver transplantation.At present,the major source of donor liver for transplantation is Donor of Brain Death (DBD) all over the world,which has unstable circulation.When the brain death occurs,a series of serious physiological function changes will be induced within a few minutes and affect the hemodynamics and homeostasis of the body,which will greatly influence the liver quality and function,and consequently the success and prognosis of liver transplantation,finally leading to the loss of potential donor organs.Therefore,it is necessary to identify the physiological function changes induced by the process of brain death and its injury to liver and take immediate proper protective measures,which can effectively reduce the organ injury,improve liver function and enhance the organ utilization and liver transplantation success.In this paper,the changes and maintenance measures of liver physiological function in DBD will be reviewed.

Objective To explore the effect of meditation training on postoperative pain, anxiety and reduce the incidence of constipation in patients with lower limb fracture. Methods The enrolled 106 patients with lower extremity fractures were randomly divided into the observation group and control group 53 cases respectively according to the odd even method. The control group was implemented with fracture surgery routine care, while the observation group was implemented with meditation training on the basis of the control group, the two groups were compared by postoperative pain score, anxiety, constipation, and satisfaction. Results Before intervention, the postoperative pain Visual Analogue Scale (VAS) scores and anxiety scores of the two groups were not significantly different (P>0.05). After intervention, the postoperative pain scores of observation group and control group were (2.06 ± 0.85) points and (4.15 ± 0.62) points respectively, the difference was statistically significant (t = 4.103, P <0.05). The anxiety scores of observation group and control group were (28.95 ± 3.83) points and (56.13 ± 3.52) points respectively, the difference was statistically significant (t= 2.353, P < 0.05). The first defecation time and the cases number of observation group patients were as follows:day 1st:20.75%(11/53), day 2nd: 52.83% (28/53), day 3rd: 18.87% (10/53), day 4th: 7.55% (4/53). While the data of the control group were day 1st: 1.89% (1/53), day 2nd: 26.42% (14/53), day 3rd 37.74% (20/53), day 4th:33.96%(18/53), the difference between the two groups was statistically significant (χ2=4.022-5.629, P<0.05). The satisfaction of observation group and control group patients were 94.34%(50/53), 77.36%(41/53) respectively, the difference was statistically significant (χ2=4.543, P < 0.05). Conclusions Meditation training can effectively reduce postoperative pain, reduce the incidence of anxiety and constipation, and improve the satisfaction of patients to nursing service, and promote the recovery of patients after surgery.

China donation after Citizen's death (CDCD) has been organized since 2010,and now has been synchronized with the international organ transplantation.At present,liver transplantation has become the only safe and curative treatment for the end-stage liver diseases.Nevertheless,there is much restriction over further exploration of this technique.This article will mainly focus on donation after brain death (DBD),and summarize the four dominating injuries of donor liver,including the donor's primary injury,cut and perfusion injury,graft preservation injury,and ischemia-reperfusion injury.

Hypoxia-inducible factors 1α (HIF-1α) is the key cellular oxygen-sensitive transcription factors that could activate diverse pathways in regulating cellular metabolism,angiogenesis,proliferation and migration,enabling a cell to generate adaptive responses to a low oxygen or hypoxic environment.HIF-1 α has been shown to play an important role in the pathogenesis of multiple liver diseases.This review explores the impact of HIF1α on liver ischemia-reperfusion injury and liver transplantation as well as its mechanism.

Liver transplantation has become the most effective treatment option for end-stage liver diseases.The liver donation after cardiac death (DCD) had been increasingly used in clinical practice.Nevertheless,the DCD donated livers inevitably exposed to long-term ischemia and hypoxia makes the implanted organs with decreased function and more postoperative complications.Different from the conventional static cold storage,machine perfusion (MP) can be continuously used in vitro liver perfusion,which could simulate the in vivo liver status.Through the observation of ischemia injury status,we could evaluate the quality of donated liver,and thus reduce ischemia related complications.This review provides an overview and evaluation on the markers that have been investigated for the assessment of graft quality and viability testing during different types of MP.

Objective To investigate the repair function of extracorporeal membrane oxygenation (ECMO) in vivo for the liver after cardiac death with warm ischemia injury for 30 min from cardiac death swinc.Method Ten landraces,30 to 40 kg,randomized to experimental group and control group,were used to make 30-min cardiac death models through clamping trachea after deep anesthesia.An intravenous cannula was placed through right iliac arteries and veins,and connected to ECMO extracorporeal circulation pipes in experimental group.The balloon catheter was placed to diaphragm plane through left femoral artery.The ECMO was performed to infuse abdominal organs,and pH and electrolyte were adjusted.The circulation flow rate,intraperitoneal organ perfusion pressure,venous blood gas,electrolyte,transaminase,and bile product,etc.were monitored and recorded.The livers of control group were retrieved after 30-min cardiac arrest and stored in cold UW for 4 h.Pathological tissue was sliced and stained by HE.Result After 30-min cardiac arrest,the liver showed obvious congestion appearance; pathologically,there were hepatic sinus expansion,blood cells clog,and erythrocyte aggregation.Circulating blood gas analysis revealed severe acidosis.After the ECMO recirculation started,circulation flow rate maintained to 1 L/min,the liver gradually restored bright red,pathological biopsy showed that hepatic sinus expansion disappeared,and clogged blood cells dispelled.AST was markedly increased to (226.0 ± 28.0) U/L after 30-min cardiac arrest and reduced to (150.0 ± 30.0) U/L 4 h after the ECMO recirculation.Average bile production was 7.75 ml/h.Conclusion ECMO recirculation in vivo can repair the injured livers from cardiac death donor with 30-min cardiac arrest.

Objective To explore the differential proteins between livers of control and brain dead grups,and to provide an experimental basis for the assessment of liver quality in brain dead rabbits.Methods 60 healthy male New Zealand rabbits were divided into two groups.The brain dead group (n=30) contained rabbits 2 hours (B1),6 hours (B2),and 8 hours(B3) after brain death.The sham group (n=30) contained groups of 2 hours (C1),6 hours (C2),and 8 hours (C3).At the end of the relevant experiments,blood samples and liver tissues were collected.The level of ALT and AST were determined by an automatic biochemistry analyzer and the morphologic changes of the livers were detected by HE staining.The differentially expressed proteins were screened and identified by two-dimensional gel electrophoresis,PDQuest software,matrix-assisted laser desorption ionization time of flight mass spectrometry,and the NCBI database.Results In 8 hour brain dead group,the level of ALT increased comparing with 6 h (P＜0.05),but there was no significant statistical difference in the other groups.Under real time observation with the light microscope,the livers of the brain dead groups had increased edema and infiltration of lymphocytes in the portal area,especially in the 8 hour group.However,infiltration of neutrophils also appeared in the 8 hour control group and all groups had no damage in the liver cell.There were 10 kinds of differentially expressed proteins through the two-dimensional gel electrophoresis,mass spectrometry analysis,and database query.One protein of interest was ALDH2,which showed a gradually decreasing expression in the liver when the braid dead time increased.Conclusion Brain death could lead to no damage of liver function and little damage to liver morphology.The identified protein ALDH2 may be related with liver injury after brain death and could be a new indicator in the assessment of liver quality in brain dead rabbits.

Objective To explore the way to establish the brain death model for rabbits and pathophysiological changes before and after brain death.Methods 80 healthy male New Zealand rabbits were divided into brain death group (n =60) and sham operation group (n =20),The 60 brain death rabbits were established by increasing intracranial pressure in a modified,slow,and intermittent way.The sham operation rabbits were only maintained with anesthesia.Results The 56 brain death rabbits were established successfully and maintained for 10 h with the respiration and circulation supports.2 rabbits died due to anesthetic accident,the other 2 died because of improper pressure.The surgical success rate is 93.3％ (56/60).The changes of mean artery pressure (MAP) and heart rate (HR) in brain death group were more significant than in sham operation group:MAP and HR fluctuated and showed the increased tendency.The mean MAP and HR during increasing intracranial pressure were (400.24±18.36) mm Hg (1 mm Hg=0.133 kPa) and (258.00 ± 25.70) beats/min respectively,which was significantly higher than before and after increasing intracranial pressure (P＜0.05).Conclusions The brain death model for rabbits could be established by increasing intracranial pressure in a modified,slow,and intermittent way successfully and maintained 10 h.the MAP and HR before and after brain death showed characteristic changes.The model is helpful to the further observation of organ changes in brain dead state.

With the increasing demand for liver transplantation,some previously abandoned donors,called marginal donor,started to be involved in clinical liver transplantation,which raises higher requirement on the organ preservation methods.Normothermic perfusion is regarded to be superior to the currently adopted hypothermic perfusion,and plays an important role in the organ preservation of marginal donors.This review will summarize the clinical applications of liver normothermic perfusion in transplantation and repair,as well as its roles in basic research.

Objective To investigate the effect of the genotypic analysis of donor from cardiac death donation on the initial dose of Tac for liver transplant recipients and provide individualized administration for the early use of Tac in liver transplantation patients.Method Thirty recipients with a different genotype of CYP3A5 from cardiac death donors were collected from March 2010 to February 2013.The matched recipients were randomly divided into experiment group and control group.There was an adjustment of initial doses of Tac according to the donors' different CYP3A5 genotypes in experiment group but not in control group.Result In experiment and control groups,the average Tac blood concentrations at the 7th day after operation were (7.47 ± 1.83) and (8.68 ± 5.14) ng/mL,and the percent of recipeints reaching the optimal Tac concentrations was 72.2％ and 38.9％,respectively (P＜0.05).In experiment and control groups,22.2％ and 55.6％ recipients needed adjustments of Tac concentrations respectively (P＜0.05).Conclusion Individualized adjustment of Tac initial doses of recipients according to cardiac death donors' different CYP3A5 genotypes was benefit for reaching optimal concentrations as soon as possible and could decrease the rate of rejection,and reduce the side effects of Tac.