Ischemia reperfusion injury (IRI) is a multistep pathophysiological process involving a complex of multi-factors.To alleviate the IRI is of great importance in clinical liver transplantation,especially for marginal donor livers.This article overviewed the protective strategies and the latest progress for alleviation of IRI in three stages of liver transplantation,which includes liver procurement,preservation and reperfusion.

Objective To summarize the experience of establishing a split liver transplantation pig model using extracorporeal normothermic machine perfusion (NMP).Methods Twenty miniature pigs were purchased with ten as donors and another ten as receptors.The graft was spliced along Taira line and the right half was reserved for transplantation.Hemodynamics and bile production volume were monitored,and blood biochemical and blood gas analysis indicators were detected during machine perfusion.Pathological change was observed by HE stain.Hemodynamics during liver transplantation,5-day survival rate and the cause of death were recorded.Results Hemodynamic,biochemical and blood gas analysis indicators remained stable during NMP.All receptor pigs were successfully extubated and awake after surgery.Two receptors died on the second day after the operation.The 5-day survival rate was 80％.Conclusion The split liver transplantation pig model using extracorporeal normothermic machine perfusion is feasible and appropriate,and it lays the foundation for further investigation.

OBJECTIVE:To comprehend the causes for adverse drug reactions (ADR)associated with the traditional Chinese medicine injections in order to improve therapeutic safety.METHODS:Through tracking visits and retrospective study of patient cases,100 control cases and 93 ADR cases are analyzed in terms of medicine,patient,prescribing and nursing,both by single-factor and multi-factor approach.RESULTS:The main causes of ADR associated with traditional Chinese medicine injections are:overdosing,combined administration of drugs,longer-than-required time gap between dispensing and transfusion,failure to do pre-dosing liver or kidney function checkup,irrelevance of indication,lack of detailed instruction about way of administration and dosing,and lack of remarks on pharmacological action.CONCLUSION:It’s vitally important to improve prescribing and nursing behaviors for the sake of enhanced safety of clinical use of drugs.

OBJECTIVE:To investigate the characteristics and the prevention of traditional Chinese medicine-induced death. METHODS: The traditional Chinese medicine-induced death cases from 1994 to 2006 collected by retrieving full-text data base of CHKD were analyzed statistically. RESULTS: Of the total traditional Chinese medicine-induced death cases, drugs were chiefly administered by intravenous drip and oral administration, and allergic shock was the chief death causes. CONCLUSION: Clinicians and pharmacists should attach great importance on the ADRs induced by traditional Chinese medicines to ensure safe and effective drug use.

Objective To summarize the experience of orthotopic liver transplantation in pigs without veno-venous bypass.Method In general,Bama miniature pigs were used as both the donors and the recipients.Suprahepatic inferior vena cava and portal vein anastomosis was performed with running prolene sutures.After completion of the portal vein anastomosis,the graft was reperfused.Infrahepatic inferior vena cava anastomosis and hepatic artery anastomosis were performed in a similar fashion.Finally,the common bile duct was reconstructed.Result For all of the transplant procedures,the average cold ischemic time was 356.3 ± 66.4 min and anhepatic time 22.5 ± 2.6 min,and the average operative time was 185.7 ± 24.8 min.During the anhepatic phase,the central venous pressure (CVP) and the mean arterial pressure (MAP) were significantly lower than those at baseline (P＜ 0.05).Heart rate (HR),on the other hand,was increased significantly during the anhepatic phase (P＜0.05).By the time the portal vein and the hepatic artery were reperfused,and CVP and MAP were gradually elevated,and HR gradually reduced.All receptors were successfully extubated and awake after surgeries.On the third postoperative day they began to eat.All receptors survived during the intraoperative period,and the survival rate was 93.8％ (15/16) on the fifth postoperative day.One receptor was died on the third postoperative day due to abdominal infection.Conclusion This model has satisfactory stability and reproducibility.Without using any vasoactive substances,to maintain the MAP beyond 50 mmHg in the anhepatic phase and the short anhepatic time are important to perform successful liver transplantation.

Objective To summarize the experience of treating the end stage of liver disease complicated with renal failure using combined liver-kidney transplantation.Methods The clinical data of 28 cases receiving combined liver-kidney transplantation were retrospectively analyzed, including the inclusion criteria of surgical indications, modus operandi, protocol of immunosuppression and the prognosis post-operation.Results Among these 28 cases in our study, 22 cases suffered from liver and renal failure, accounting for 78.6%; 4 cases were diagnosed as having hepatorenal syndrome, accounting for 14.3%; and 1 case had hyperoxaluria and polycystic liver with polycystic kidney. As for the modus operandi we used, piggy-back procedure was adopted for 4 patients and classic procedure without bypass was used for the rest. Donor kidneys were all put in the right iliac fossa. During the follow-up period of 5 months to 7 years, one-and 3-year survival rate of the recipients was 92.9% and 78.3% respectively. Among these 28 recipients, 4 cases had the graft renal dysfunction early post-operation: One died and 3 recovered through consecutive therapy. One case received re-transplantation of the liver 3 months after the first due to the relevant complications and then recovered. During this period, no impact on the renal function occurred. Eleven cases had pulmonary infection post-operation, and 1 died. No acute rejection occurred.Conclusion Combined liver-kidney transplantation is the effective treatment to the patients with end stage liver disease complicated with renal dysfunction. Suitable case selection and perfect operation timing were the key points to the success of combined liver-kidney transplantation.

ObjectiveTo study the impact of allocation of organ arteries and their reconstruction for donor livers on arterial complications after liver transplantation from organ clusters obtained by combined liver,kidney,pancreas and duodenum harvesting.The aim is to guide future use of donor organs more safely and rationally with a decrease in postoperative complications.MethodWe studied 11 patients.ResultsThere was no hepatic artery anomaly.A Carrol artery patch was obtained at the bifurcation of the proper hepatic artery and the gastroduodenal artery in these donor livers.In one patient,an arterial graft was used because of inadequate arterial length,and arterial thrombosis developed which required re-transplantation.The hepatic arterial reconstruction was successful for the remaining 10 patients.One patient died of pulmonary infection 5 months post transplantation.ConclusionWhen combined liver,kidney,pancreas and duodenum harvesting was used,enough arterial length of the recipient must be preserved.There should be adequate and prompt communication between the teams carrying out the donor operation and the recipient operation.A Carrol arterial patch of the proper hepatic artery and the gastroduodenal artery for the donor liver,and the use of microsurgical vascular anastomosis in the operation are the keys to prevent hepatic arterial complications after liver transplantation.Multi-organ harvesting can be used for obtaining donor livers in liver transplantation.

OBJECTIVE:To investigate the incidence of adverse drug reactions(ADRs),the ratio of irrational drug use and the average daily drug costs after the initiation of clinical pharmacists' intervention on the combined use of antibiotic injections in the outpatient department.METHODS:By a controlled prospective study,500 patients in the intravenous center in outpatient department whose records were in line with inclusion criteria were included before intervention as controls,and after the initiation of clinical pharmacists' intervention on the combined use of antibiotic injection in the outpatient department,500 patients meeting the inclusion criteria were enrolled as trial group.A database was established and the results were analyzed statistically.RESULTS:The irrational drug use was noted in 52 cases in the control group versus 21 cases in the trial group and the ADRs or adverse drug events were noted in 18 cases for the control group versus 9 cases for the trial group.The daily mean drug cost reduced by 29.84 yuan after intervention.CONCLUSION:The intervention measures contributed to the reduction in incidences of irrational drug use and ADRs and drug costs.

OBJECTIVE:To improve the safety of antibiotic injections in outpatient department. METHODS:In a prospective randomized control study,outpatients treated with antibiotic injections in 2007 were chosen to be the subjects. The subjects were randomized into control group and intervention group. Education,administration intervention and inspection were adopted in clinical intervention considering the factor of drug combination. The rationality of drug combination and the incidence of ADR before and after intervention were observed. RESULTS:As compared with control group,the rationality of drug combination in intervention group was improved obviously(P