The development status and specific problems of liver transplantation in China were analyzed, and the strategies to resolve these problems were discussed in this study. "Hepatitis B related diseases", including cirrhosis and hepatic cancer, were the main indications for liver transplantation in China. Recurrence of hepatitis B and hepatic cancer was found to significantly affect the long term survival of the recipients of liver transplantation. Severe hepatitis and fulminating liver failure were the main causes of death in the perioperative periods of liver transplantation. Nonanastomotic biliary stricture (NABS) and acute rejection often occurred. Lamivudine and anti-Hepatitis B immunoglobulin(HBIg) could effectively protect the recipients from hepatitis B recurrence. The indication of liver transplantation for the patients with the hepatic cancer should be observed strictively, and measures should be taken before and during the operation to prevent the recurrence of the cancer. In the patients with severe hepatitis and fulminating liver failure, therapy to support the liver function should be emphasized and the artificial liver support system (ALSS) should be administered. The prognosis of NABS was found to be poor, and biliary duct dilatation with balloon catheter might be an effective treatment for NABS, but retransplantation was necessary for some of the patients. The rate of biopsy of the liver graft, the quality of the biopsy and the level of pathological diagnosis should be greatly enhanced.

CD4+CD25+FoxP3+Treg may regulate the immune responses and induce tolerance to alloantigen in vivo in organ transplantation. A high expression of CD4+CD25+FoxP3+Treg may be a possible indicator of acute allograft rejection. The patients with renal transplantation showing a high expression of CD4+CD25+FoxP3+Treg might be more prone to the development of acute allograft rejection,and the detection of its expression may contribute to predict allograft acceptance or rejection. It seems plausible that the imbalance between effector T cells and Treg might reflect an immune state. Additional experimentation and clinical studies are needed to investigate the long-term impact of development and function of Treg cells on immunosuppression in allogeneic renal transplantation.

Recent advances in transplantation tolerance were comprehensively reviewed. The contents included the mechanisms and methods of induction and maintenance of transplantation tolerance. Some experimental protocols were introduced including mixed chimerism of allogeneic bone marrow, blockade of co-stimulation signal and transgene technology for transplantation tolerance induction. The problems and the future of clinical transplantation tolerance were objectively evaluated here.

The low-density lipoprotein (LDL) receptor level and endocrine function were studied in 30 cases of non-familial hypercholesterolemia. The results showed that endocrine dysfunction may play a role in the pathogenesis of hyper-cholesterolemia, for example, the elevation of insulin and growth hormone level, the abnormal ratio of estrogen and testosterone. In addition, the increase of TXB2 and 6-ketone prostacyclihe may make the blood hypercoagulative, raise the incidence of myocardial infarction and cerebral thrombosis. Except the physiologic compensation the LDL receptor level in non-familial hypercholesterolemia may also be regulated by insulin and estrogen.

AIM:Anti-hepatis B immunoglobulin in combination with lamivudine is efficient to prevent chronic hepatitis B virus (HBV) reinfection following liver transplantation. However, long-term usage of lamivudine can result in YMDD variation and lead to medicine resistance even HBV relapse. In this study, we investigated etiological factors and prevention and treatment protocol of HBV recurrence and YMDD variation after liver transplantation. METHODS:A computer-based online search of Pubmed database from January 2002 to January 2008 and Chinese Journal Full-text Database from January 2003 and December 2007 was undertaken to identify articles about HBV recurrence and YMDD variation after liver transplantation. The collected articles were firstly selected and the references of each article were looked up. Only articles that involved in HBV recurrence and YMDD variation after liver transplantation were included. The articles published in authoritative journals in recent 5 years were accepted in priority. Repetitive articles and Meta analysis were excluded. RESULTS:HBV recurrence after liver transplantation is associated with hepatitis B DNA loading dose, invasion of hepatitis B into non-liver tissues, immunosuppressive therapy and viral genovariation. The major prevention and treatment protocol of HBV reinfection after liver transplantation is the combination of anti-hepatis B immunoglobulin and lamivudine, which is economical and efficient. However, long-term administration of lamivudine induces YMDD variation in hepatitis B DNA polymerase, leading to drug resistance even HBV recurrence. Now adefovir dipivoxil is regarded as an effective remedy for YMDD variation. CONCLUSION:Virus variation and HBV recurrence can influence prognosis of HBV-related end-stage diseases after liver transplantation. Prevention and cure approaches are developing. It is important to find an economic, safe, convenient and effective therapeutic regimen. In addition, individualized treatment and the evaluation of risk and advantage should be emphasized.

ObjectiveTo introduce an improved implantation for urethral stents in patients with infra-sacral neurogenic voiding dysfunction and to evaluate its outcome.MethodsTwelve patients with infrasacral neurogenic voiding dysfunction were treated by implantation of urethral stent according to an improved method.The following objective parameters were used to evaluate the outcome:voiding diary,urine residue volume(URV),renal hydronephrosis and urodynamic tests.ResultsThese parameters were improved significantly after implantation:detrusor leak point pressure,voiding pressure and URV decreased,voiding volume and urine flow increased.The main complications were incontinence,difficult voiding and hematuria,but these were transient and disappeared during a week.ConclusionsThis procedure is effective with fewer complications,protects the function of upper urinary tract and improves the life quality of the patients with infra-sacral neurogenic voiding dysfunction.

BACKGROUND: Mesenchymal stem cells (MSCs) from adult bone marrow can alter alloimmune response in vitro and vivo. Their potentiality is great in solid organ transplantation.OBJECTIVE: To develop MSC antirejection therapy and identify behind mechanishm of MSCs immunomodulation ability. METHODS: We searched Pubmed (1994-Mar.2009) with the key words of "mesenchymal stem cells, solid organ transplantation, tolerance, immunosuppression, animal model". RESULTS AND CONCLUSION: Totally 262 English articles about influence and mechanism of action of adult bone marrow mesenchymal stem cells on solid organ transplantation were collected. The 49 suitable articles were included without earlier publication time, repeated and analogous study. Human mesenchymal stem cells did not express MHC2 Ⅱ antigen and T cell costimulatory molecules B7. Coculture with allogenic T lymphocytes could not induce T cell proliferation, but inhibited mixed lymphocyte reaction and mitogenstimulated T cell proliferation. Inhibitory effects of mesenchymal stem cells on T cell proliferation were not limited by major histocompatibility complex. Mesenchymal stem cells no matter from donors or recipients had similar immunoloregulation effects. Allogene mesenchymal stem cells could cause immunereaction in vivo, no complete immune privilege. The in vivo effects of mesenchymal stem cells will strongly depend on their localization and migration pattern after injection. Therefore, MSCs are interesting candidate cells for tolerance induction in clinical organ transplantation.

Hepatic myelopathy is a rare disease with high mortality. There has been no report of an effective treatment to date. In order to evaluate the beneficial effect of orthotopic liver transplantation in patient with hepatic myelopathy. One patient, who was suffering from hepatie myelopathy complicating hepatic pathology, underwent liver transplantation in 2002 was studied. The muscle strength of the patient’s extremities was carefully assessed both pre-operatively and postoperatively. It was found that symptoms and signs of hepatic myelopathy were improved, especially the muscle strength recovered from 1-2 degree to 3-4 degree half a year after the operation. Therefore it is our belief that liver transplantation might be beneficial to patients who are suffering from hepatic myelopathy as a complication of the hepatic disease.

Objective To monitor and modulate the coagulation disorder during operation in patients undergiong allogeneic liver transplantation. Methods PT, TT, APTT, FIB, HB, PLT count, sonoclot coagulation and platelet function were measured dynamically in 10 patients during anesthesia and operation. Results After coagulants were used, the above parameters pertaining to coagulation function were improved obviously. All of above coagulation parameters were severely abnormal in the period from 30 minutes before anesthesia to 20 minutes after portal vein recirculation. The hypocoagulability was significantly improved at the end of operation by target supplementation of prothrombin complex, fibrinogen, fresh platelets, and other coagulants, complementing large amount of fresh blood plasma. Notably, severe hemorrhage and thrombosis leading to re-operation did not happen in all the recepients. Conclusion The relationship of the local hypercoagubility at the anastomosis and the systemic hypocoagulation should be concerned to prevent coagulation and thrombosis during operation of liver transplantation.

Objective To evaluate the application of artificial liver support system (ALSS) in severe hepatitis patients before liver transplantation. Methods Double lumen catheters were inserted into the femoralvein to construct the blood conduit in patients receiving ALSS. The blood purification apparatus was applied for plasma replacement and blood perfusion with PIS separator and HA hemoperfusion apparatus. The plasma replacement capacity was 3000ml-4000ml (average 3200 ml) with albumin 20g. The average dosages of both heparin and protamine were 25 mg. The separation speed was 26 ml/min. The replacement blood flow was 100-150 ml/min, and the average treatment time was 120 min. Results The liver function markers, including TB, DB, ALT, AST and NH 3, were improved in patients with ALSS. Conclusion ALSS could correct the imbalance of homeostasis of the patients, eliminate the toxic substances effectively and provide valuable support for liver transplantation.