Organ transplantation is the effective method to replace the function of the patient failed organ. But it is very disappoint that recipients have to receive the long-term immunosuppression regimens for prevention of allograft rejection. To induce allograft immune tolerance without immunosuppressant is in great demand. Although several tolerance strategies for organ transplant have been proposed, even some has already been tested in the 1st clinical trial, these strategies haven ' t approached to ideal efficacy. Helminths are remarkably successful parasites to achieve immunological tolerance to host immune response. It is now well established that the parasites′ success is the result of active immunomodulation of their hosts ' immune response. We suggest that injecting B cells from donor spleen and helminth soluble antigens, recipient might become tolerance to donor organ, but not tolerated to other antigens. Research based on this approach has great translated value for future clinic practice.

Objective To investigate the etiology of early postoperative hyperbilirubinemia after liver transplantation.Methods The clinical data of 87 cases of liver transplantation and the etiology of early postoperative hyperbilirubinemia after liver transplantation were analyzed.Results The incidence of early postoperative hyperbilirubinemia after liver transplantation was(52.87 %).In 21 postoperative complications,17((80.95 %)) were associated with hyperbilirubinemia.The causes of hyperbilirubinemia were as follows in turn: ischemic-reperfusion injury(n=(25,28.73 %)),complications of(common) bile duct(n=23,(26.44 %));acute rejection(n=19,(21.84 %));others(n=13,(14.94 %)).(Conclusions) The early postoperative hyperbilirubinemia is the most common clinical manifestation in(patients) undergoing liver transplantation and can be taken as a reliable clinical mark for the postoperative complications and liver functions.The etiology of early postoperative hyperbilirubinemia after liver transplantation is very complicated.Early diagnosis and treatment is helpful to improve the survival of patients undergoing liver transplantation.

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.

Objective To investigate the protective effects of Ginkgo Biloba leaves(EGb) preconditioning on liver graft in rat liver transplantation.Methods Male Sprague-Dawley rats were used as donors and(recipients) of orthotopic liver transplantation(OLT).The rats were randomly divided into EGb group,normal saline(NS) control group and sham operation(SO) group.The animals were killed at 2h,6h,24h after graft reperfusion.Plasma samples were collected for ALT and AST test.Liver tissues were collected to detect the expression of TNF-?mRNA and Bcl-2mRNA by RT-PCR.Also,liver tissues were used to detect rat(liver) histological change and apoptosis by TUNEL.Results The serum levels of ALT in EGb group were(significantly) lower than the NS group(P

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 molecular adsorbent recycling system (MARS) in the treatment of patients with acute liver failure waiting for liver transplantation. Methods The effects of MARS artificial liver treatments in 16 cases were reviewed. Results There was a remarkable improvement in clinical symptoms and physical signs after MARS treatment, including significant decrease in prothrombin time, total bile acid, level of alanine aminotransferase, aspartate aminotransferase, creatinine, and blood ammonia (P＜0.05＝;There was no statistical change in NO,TNF-α and IL-10(P＞0.05).Sequential organ failure assessment(SOFA)score decreased from 9.91±1.09 to 6.64±1.76 and Glascow coma score increased from 7.29±2.06 to 13.26±2.14.Fourteen patients were tided over to liver transplantation among them 13 patients survived and were successfully discharged from the hospital. The survival rate was 89.5%.Conclusion MARS is a safe and effective assistant device in bridging acute liver failure patients to liver transplantation.

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.

Objectives To investigate the results of liver transplantation using steatosis liver donors in order to provide a scientific basis for the use of marginal donors.Methods From 2002 to 2011,80 of 407 were steatosis liver donors.There were 69 males and 11 females.Their age ranged from 20-54 years old.Sixteen donor livers with severe fatty liver and reperfusion injury were not used.The remaining 64 livers were divided into a S1 group (mild steatosis,n=22),a S2 group (moderate steatosis,n=25),and a S3 group (severe steatosis,n=17).A S0 group was used as a control (randomly selected fat-free liver,n=80).Results The occurrence rates of delayed graft function (DGF) in the S0,S1,S2,S3 groups were 5％,9.1％,20％,29.41％,respectively.Primary nonfunctioning occurred in 2 cases of the S3 group,which represented a 11.76％ of the S3 group (2/17),and 3.12％ of the total 64 cases (2/64).Conclusions Although the incidence rate of DGF was higher in the steatosis liver donor groups than the S0 group,there was no correlation in the mortality rate of the S1-S3 group within one year of transplantation.Attentions should be paid to the treatment of complications after steatosis liver transplantation.By minimizing ischemia-reperfusion injury,improving microcirculation,strengthening routine therapy and reducing the amount of immunosuppression,the same results could be achieved using steatosis donor liver and normal liver for transplantation.

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 investigate the protective function of panax notoginseng saponins(PNS) on grafted liver during ischemia-reperfusion in rat with orthotopic liver transplantation.Methods After establishing rat orthotopic liver transplantation model,the rats were randomly divided into three groups:the experimental group(P),the control group(N),and sham operation group(S).The levels of serum ALT and AST were(determined),the hepatic pathohistological changes were observed,the expression of caspase-3 and TNF-? were examined by immunohistochemistry,and the apoptotic hepatocytes in grafted liver were detected by TUNEL method.Results The levels of ALT,AST,and the expression of caspase-3 and TNF-?,and apoptotic cells in grafted liver were significantly higher in the control group than that in the experimental group.(Conclusions) PNS can protect the grafted liver from injury during ischemia-reperfusion in rat orthotopic liver transplantation.