Objective To analyze the individual immunosuppressive protocol (IP) after liver transplantation (LT) in benign end-stage liver disease. Methods The clinical data of 645 patients with benign end-stage liver disease undergoing LT in our institute from April 2002 to Aug 2010 wen analyzed retrospectively. 146 cases from Apr. 2002 to Dec. 2004 were in stage one, and triple therapy containing tacrolimus (Tac), mycophenolate mofetil (MMF) and methylprednisolone (MP) was used;273 cases from Jan. 2005 to Dec 2007 were in stage two, and the less dose of immunosuppressant than stage one was used; 226 cases from Jan. 2008 to Aug. 2010 were in stage three, and they wen divided into conventional group and severe patient group according to their preoperative model for endstage liver disease (MELD) score and patient condition, the individual IP was used. Results The overall survival rate of patients with MELD score <25 was 88. 9 % in stage one, 94. 2 % in stage two, and 95. 4 % in stage three; The overall survival rate of patients with MELD score ≥25 was 67. 7 % in stage one, 73. 4 % in stage two, and 82. 0 % in stage three. The incidence of rejection ir cases with MELD score <25 had no significant difference (P>0. 05). The incidence of rejection in cases with MELD score ≥25 in stage two and stage three was higher slightly than in stage one (P<0. 05). Conclusion The IP after liver transplantation should be individualized according to recipient conditions, which can increase survival rate.

Objective To explore the treatment of ABO-incompatible orthotopic liver transplantation. Methods Nine cases of ABO-incompatible liver transplantation performed in our hospital were analyzed retrospectively. Plasma exchange was done before the operation in 1 case. Hepatic artery and biliary duct anastomosis were performed by the microvascular technique. Splenectomy was done during operation in 5 cases. The immunosuppressive protocol included a quadruple drug therapy. Blood oxygen saturation was maintained above 95% and anticoagulant therapy was performed after operation.Results Four patients recovered smoothly without complications. Postoperative complications included acute rejection in 3 patients and biliary nonanastomotic stricture in 4. Three patients died. Conclusion ABO-incompatible orthotopic liver transplantation can be used when the graft is scarce, and should manage to decrease the complications.

Objective To investigate the MRI features of pilomyxoid astrocytoma ( PMA ) in children.Methods MRI features of seven children with pathologically proven PMA in 2011-2013 were retrospectively analyzed.The ages of the patients ranged from 10 months to 32 months at initial diagnosis.Results All tumors were well-circumscribed masses.Six tumors were located in the hypothalamic-chiasmatic-third ventricular region , two tumor involved the bilateral temporal lobe , and one tumor was associated with NF-I.One occurred in the basal ganglia region.Four tumors were solid masses , whereas the other three showed cystic components.Six tumors were hypointense and one was isointense on T 1-weighted image.Five tumors were hyperintense and three were isointense on T 2-weighted image.Four tumors were hypointense , one was iso-hypointense and one was isointense on DWI.After contrast administration , four tumors enhanced homogenously and three tumors enhanced heterogeneously , with intratumoral irregular hypointense region in two tumors and rim enhancement in one tumor.Cerebrospinal fluid ( CSF ) dissemination, hydrocephalus and peritumor edema were observed in 2, 4 and 1 of cases, respectively.Proton magnetic resonance spectrum of two PMA showed elevated Cho /Cr ratios and decreased NAA/Cr ratios.Conclusions The imaging features of pilomyxoid astrocytoma include common origination from the midline of the neuroaxis in younger children about 2-3 years old.The CSF dissemination is common.The presence of hemorrhage and peritumor edema is not common.

Objective To investigate the value of susceptibility weighted imaging in grading brain tumors in children.Methods Twenty-eight children with surgically or pathologically proved primary brain tumor were recruited during 2010 to 201 1.All patients were scanned with conventional MRI and SWI sequences on a 1.5T or 3.0T scanner before surgery.The cases of tumors were divid-ed into low grade (9 males and 2 females)and high grade groups (10 males and 7 females),according to the WHO classification of the tumors of the central nervous system in 2007.The low-intense signals within the abnormalities on SWI images were analyzed and classified into the different shapes,including punctuate,tubular,cluster-like,linear signal,irregular patchy signal.As for the num-ber of low-intense signals,we applied the four-score system.The irregular patchy signals were considered to be artifacts of SWI, namely hemorrhage,after exclusion of the isolated veins and calcification.The differences of rate of hemorrhage and scores between the two groups in SWI were analyzed statistically.Results The low-signal scores were significantly different between two groups with higher scores in high grade tumors than in low grade tumors(P <0.001).The rate of intratumor hemorrhage was also signifi-cantly different between two groups.The rate is higher in high-grade group than low-grade group,given the fact that the hemor-rhage was showed in 2 low grade tumors (18.18%),while in 1 1 high grade tumors (76.37%)(P =0.01 5 9<0.001).Conclusion Different grades of pediatric brain tumors manifest significant difference on susceptibility weighted imaging(SWI).It may be helpful in the preoperative classification of brain tumors by analyzing the relevant signals on SWI.

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.

Objective To investigate the clinicopathological characteristics of retransplantation for intrahepatic recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT).Methods In a center hospital of organ transplantation setting,9 patients after primary liver transplantation had intrahepatic recurrence and received retransplantation,and 12 patients in control group were not subjected to LT over the same period.The follow-up period was 10 to 58 months.Results As compared the pathological characteristics of secondary transplanted liver with primary thansplanted liver,there was significant difference in tumor differentiation (grade Ⅱ,Ⅲ and Ⅳ)between primary group (33％,67％ and 0) and secondary group (22％,22％ and 56％) (P＜0.01).After primary liver transplantation,median of tumor free survival was 15.0 months.After secondary liver transplantation,median of survival was 5.8 months,and median of tumor free survival was 2.5 months.In control group,median of tumor free survival was 13.0 months,and total survival survival was 17.6 months.In transplantation group and control group,1-,2-,and 3-year cumulative survival rate was 89％,44％,33％ and 91％,45％,9％ respectively,with the difference being not statistically significant (P ＞ 0.05).Conclusion It is high risk of vascular invasion for tumor recurrence.The differentiation grade of recurrent tumor is lower.The sign of intrahepatic recurrence of HCC after liver transplantation may be early and local clinical characteristics of tumor cell disseminating and metastasis before and during operation,and it is not recommended to perform retransplantation.

Objective To investigate the relationship between HLA antibodies strength and complement-binding ability in sensitized renal patients waiting for renal transplantation.Method Serum samples of 31 sensitized renal patients waiting for renal transplantation were retrospectively analyzed by single-antigen bead array (SAB) to identify HLA antibodies and in parallel by C1q-SAB to determine the complement binding of HLA antibodies.Result C1q-positive HLA antibodies had significantly higher MFI than C1q-negative HLA antibody (for Class Ⅰ,11052 ± 3291 vs.4506 ± 2960,P＜0.05;for Class Ⅱ,13347 ± 4076 vs.4448 ± 3602,P＜0.05).The mean fluorescence intensities (MFI) of IgG-SAB were correlated with the MFI of C1q-SAB for the same antibodies (Spearman correlation; Class Ⅰ,r =0.665,P ＜ 0.01 ; Class Ⅱ,r =0.761,P ＜ 0.01).Receiver operating characteristics (ROC) curve analysis showed that the MFIs of HLA antibodies by IgG-SAB could predict their C1q-binding abilities [area under the curve (AUC)Class Ⅰ =0.917; AUCclass Ⅱ =0.927).Using MFI cut-off value of 8238 and 6754 for HLA Class Ⅰ and Class Ⅱ antibodies,respectively,the sensitivity and specificity for C1q binding were 82.4％ and 87.4％ for Class Ⅰ antibodies,and 90.9％ and 82％ for Class Ⅱ antibodies,respectively.Conclusion The MFI of HLA antibodies by IgG-SAB can predict the C1q binding capability at a certain extent before transplantation.

Objective To establish method of constructing lentiviral vectors to express microRNA (miRNA) ''tough decoy''(TuD)and to detect the effects of the TuD on cellular endogenous miRNA level and cellular phenotypes. Methods Two-step cloning strategy was utilized to first generate a universal miRNA TuD frame vector,followed by con-structing the TuD expression vector specially targeting miR-203. The package of the recombinant lentivirus was per-formed in 293T cells. Then the rat bone marrow mesenchymal stem cells(BM-MSCs)were infected by the miR-203 TuD expression lentivirus. The pSIH1-H1-copGFP vector was also packaged and the BM-MSCs infected by this lentivirus were served as control. Endogenous miR-203 level in BM-MSCs was measured by quantitative RT-PCR,and cellular vi-ability and apoptosis were detected by CCK-8 test and Annexin V-PI staining respectively. Results The miR-203 TuD expression vector was successfully constructed and inserted sequence was validated. At the 3rd,6th and 9th days after in-fected by the miR-203 TuD expression lentivirus,rat BM-MSCs exhibited a repressed endogenous miR-203 level. The miR-203 TuD also promoted viability and inhibited apoptosis of BM-MSCs. All these differences between miR-203 TuD group and control group were statistically significant. Conclusion The two-step cloning method for the construction of miRNA TuD expression vector is simple and efficient. The miRNA TuD can effectively suppress the level of the target miRNA and affect cellular phenotypes.

Objective To analyse our clinical experience in pediatric living donor liver transplantation (PLDLT).Methods The clinical data of 45 patients who underwent PLDLT in our hospital from April 2005 to April 2014 were retrospectively studied and their preoperative,intraoperative and postoperative data were analyzed.Results All donors recovered well.The graft to recipient weight ratio (GRWR) ranged from 1.0％ ～ 6.4％ (2.5％ ± 1.2％).Size reduction of graft were performed in 2 patients.An interposition venous conduit from the confluence of the native right and left portal vein (PV) to the graft PV was carried out in 1 patient,venous grafts for revascularization of the tributaries of the middle hepatic vein from segment Ⅴ and Ⅷ were used in 3 patients,and a venous patch for revascularization of the left hepatic vein was used in 2 patients.Hepatic artery re-reconstruction was performed in 3 patients after hypoperfusion was detected on intraoperative Doppler ultrasound.The postoperative complications included acute rejection (n =2),vascular complications (n =7),biliary complications (n =11),and infectious complications (n =27).The 1-,2-and 5-year survival rates were all 84.4％.Seven of 45 recipients died within one year post transplantation,with 3 patients who died of vascular complications,and 4 patients who died of infection.The differences in age [(50.8 ± 49.8) months vs (12.6 ± 14.9) months],body weight [(16.2 ± 10.5) kg vs (7.3 ± 1.7) kg],serum total bilirubin [(177.0 ± 126.5) μmol/L vs (301.9 ± 110.6)μmol/L],Pediatric end-stage liver disease (PELD) score (16.1 ± 12.1 vs 26.2 ± 11.3) and GRWR (2.2％ ± 0.8％ vs 4.2％ ± 1.6％) between the survival and the dead groups were significant (P ＜ 0.05).Conclusions PLDLT is an effective method to treat children with end-stage liver disease.Using a multidisciplinary approach in the preoperative management,excellent surgical techniques,and proper postoperative management are extremely helpful to improve postoperative survival rate.

Objective To investigate the characteristics of infection and risk factors after pediatric living donor liver transplantation (PLDLT).Method Form April 2005 to April 2014 the clinical data of 45 cases of PLDLT in General Hospital of Chinese People's Armed Police Forces were retrospectively investigated,and the difference between the patients after PLDLT with infection and those without infection was analyzed.Result Eighty-four infections occurred in 27 (60.0％) of 45 patients,including 25 cases of bacterial infections,14 cases of viral infections,and 3 cases of candida albicans infections.Most infections occurring within 3 months after PLDLT have been found to be caused by bacteria,viruses and fungi.The trough level of tacrolimus (Tac) was in target therapeutic window in 16/20 infected patients and more than 10 ng/mL in 4/20 infected patients within 3 months after PLDLT,and there were 12/16 infected patients with the trough level of Tac of more than 10 ng/mL 3 months post-PLDLT,with the difference being significant (P＜0.05).Multivariate analysis revealed that post-transplant infection was significantly related with the factors as weight＜10 kg,age ＜12 months,biliary intestinal anastomosis,pediatric end-stage liver disease (PELD) score,ChildPugh score,total bilirubin,blood loss per kg body weight and graft to recipient weight ratio (GRWR).Logistic regression analysis suggested that PELD score was independent risk factor of infection after PLDLT.Conclusion The infection after PLDLT has their special characteristics.The proper irnmunosuppressive protocol and control of above risk factors are helpful to decrease the incidence of infection after PLDLT.