With the development of immunosuppressant and surgical technique,both the survival rate of liver transplant patients and grafts improve significantly. Meanwhile,infection has become one of the most common complication and main reason of death.The knowledge of the characteristics of infection after liver transplantation is helpful for early diagnosis and treatment,which may decrease the mortality.As the clinical manifestation becomes atypical for the usage of immunosuppressant, it's reasonable to combine some specific biomarkers for early diagnosis.Pathogen varies according to the time post transplant,and it can be divided into three stages.Low immune status and the application of broad-spectrum antibiotic are the reason of opportunistic infection and super infection. Epidemiological survey found that new type of fungus and multi-drug resistance bacterium increase.It's important to pay attention to the management and standardized usage of antibiotic,as well as to establish relative guideline,which may decrease the drug resistance and improve outcome.

Objective To compare the antiviral efficacy and economics between lamivudine and entecavir in patients with low preoperative HBV replication after liver transplantation. Methods Liver transplantation patients from 2006 July to 2013 July were selected for being studied prospectively. Statistically evaluated between entecavir and lamivudine efficacy by the analysis of postoperative follow-up of seroconversion and HBV reinfection. Results The cumulative overcast rate of entecavir group was 98.04% one month after transplatation. And 3 of 51 cases were reinfected with average turn time of 9.73 days. Meanwhile , the cumulative overcast rate of Lamivudine group was 100% and 3 of 26 cases were reinfected with average turn time of 5.11 days. There are no statistical differences between the two groups accumulation rate , reinfection rates , as well as cumulative infection rates. Conclusion In the cases of low hepatitis B virus replication before liver transplantation, Entecavir and Lamivudine have the similar effect of preventing HBV reinfection after operation. Compared with the cost of Entecavir group, Lamivudine is more economy.

Objective To assess the effects of liposomal prostaglandin E1 (Lipo PGE1) on hepatic arterial and portal vein inflow early after orthotopic liver transplantation (OLT).Methods Fifty-six patients were divided randomly into two groups who received a primary liver transplant: normal control group and PGE1-treated group. Lipo PGE1 was infused by 20??g/d from day 1 to 14 after OLT in the PGE1-treated group. Measurements of hepatic arterial and portal vein inflow were taken on post-operative day 1, 3, 5, 7, 9 and 14 by color Doppler image (CDI).Results In control and PGE1-treated groups, hepatic artery velocity (HAV) was gradually increased during postoperative 2 weeks, but portal vein flow volume (PVFV) showed a decreased trend. HAV in PGE1-treated group was higher than normal control group during postoperative 5 days, but there was no significant difference in PVFV between two groups.Conclusion Lipo PGE1 can improve hepatic arterial inflow early after OLT, but not significantly influence portal vein inflow.

ObjectiveTo establish early diagnosis of vascular complications following orthotopic liver transplantation (OLT).MethodsThe surveillance and diagnosis making of vascular complications in 53 cases of OLT patients from April 1990 to June 2000 were carried out by color Doppler imaging (CDI), selective-angiography and analyzing relevant clinical features.ResultsThe incidence of vascular complication after OLT is 15%(8/53) including 3 cases of hepatic artery thrombosis, 2 of hepatic artery stenosis, 1 of celiac artery stenosis, and 2 of inferior vena cava stenosis. Diagnosis was confirmed by selective angiography in 7 cases and by autopsy in one. The sensitivity and specificity of CDI were 100%(8/8) and 98% (45/46) respectively. Conclusions Clinical feature of vascular complications following OLT lacks specificity. Continuous monitoring using CDI is a sensitive and specific method in the detection and diagnosis of vascular complications.Duration of surveillance should be no less than 2 months.

Objective To study the clinical feature and treatment of cytomegalovirus(CMV) pneumonia in the orthotopic liver transplantation(OLT) recipients.Methods The clinical data of 451 patients after OLT in our hospital from Oct.2003 to June 2005 were retrospectively analyzed.The prevention,clinical feature and treatment of CMV pneumonia were discussed.Results Seven patients((1.66 %)) developed CMV pneumonia after OLT.The symptoms presented much earlier than signs.All patients had high fever,and followed with cough,polypnea,dyspnea one week later.Blood-gas analysis showed hypoxemia.CMV pp65 antigen detection was helpful for early diagnosis.All the infected patients received ganciclovir and foscarnet treatment.At the same time,immunosuppressive drugs were withdrawn and complex treatment including high dose immunoglobulin,low does thymulin and broad-spectrum antibiotec were given.Six patients((85.7 %)) were cured.Conclusions The early onset of CMV pneumonia is not specific but still regular.CMV pp65 antigen detection is specific and sensitive.Ganciclovir and foscarnet treatment is effective and complex therapy necessary for CMV pneumonia.

Objective To analyze the high risk factors of blood infection in Chinese citizens' organ donation,provide the basic evidence for early protection,increase the success rate of donor distribution,and expand the Chinese organ donation pool.Methods A retrospective study was performed on 70 cases of donation recruited during October 2014 to January 2016.The incidence of blood infection in these donors was analyzed.The univariate analysis and multivariate logistic regression analysis were used to find out the high risk factors influencing the donor blood infection.Finally,the donor blood infection assessment model and the receiver operating characteristic (ROC) curve were established to assess the sensitivity and specificity.Results The overall infection rate was 64.3％ (45/70).The pulmonary,blood,and urinary tract infection rate was 42.9％,31.4％ and 1.4％ respectively.The total length of hospital stay (＞10 days) (P =0.017),oxygenation index (＜ 233.5 ± 107.0) (P =0.046),aspartate aminotransferase (＞196.9 ± 329.1 U/L) (P =0.044),and valley alanine aminotransferase (＞95.0 ± 78.1 U/L) (P =0.026) were four risk factors for predicting the donor blood infection.The multivariate logistic regression analysis revealed that the total length of stay ＞10 days along with the donors' oxygenation index (＜233.5 ± 107.0) was independent risk factor for predicting the blood infection.The donor blood infection model was:0.193 + 1.753 hospital stay (＞10 days)-0.007 oxygenation index.The sensitivity and specificity were 0.682 and 0.75 (P ＜0.001) respectively.Conclusion For a long-term stay in ICU,the rate of blood infection for donors was much higher,at this time,the most effective antibiotics should be chosen.Besides,improving donor oxygenation index and liver function can reduce the incidence of infection.

0.05 ). Conclusion Individual immunosuppression regime can prolong the survival of the recipients with high risk factors and is proved to be more safe and reliable.

Objective To explore the value of color Doppler image (CDI) in monitoring of portal vein (PV) complications following orthotopic liver transplantation (OLT).Methods Pre and post operative CDI examinations were performed on 107 orthotopic liver transplants. Monitoring parameters of CDI included: portal vein diameter (PVD), portal vein velocity (PVV), portal vein flow volume (PVFv), wave form and spectrum of PV, the presence of collaterals and ascites. Results A total of 4 ( 3.7% ) PV complications were identified by PV angiography in 107 recipients, including 2 cases of portal vein stenosis (PVS), 1 PVS combined portal vein thrombosis (PVT), 1 right portal vein (RPV) occlusion. Diagnostic sensitivity and specificity for PV complications of CDI were 100 % (4/4) and 98.1% (101/103), respectively. We performed percautaneous transluminal angioplasty (PTA) in 2 patients with PVFv remarkably reduced, and conservative treatment in 2 patients without PVFv reduced.Conclusion CDI is a sensitive and specific way of monitoring portal vein complications following OLT and also contributes to the treatment of portal vein complications. The conservative treatment might be effective for the patients with PVFv reduced unremarkably and the presence of collaterals, if not, PTA should be performed as early as possible.

ObjectiveTo evaluate the effect of mycophenolate mofeil (MMF) combined with dose-decreased calcineurin inhibitors (CNIs) in patients who received liver transplanation with chronic kidney malfunction.Methods28 liver transplant patients with chronic kidney malfunction were prospectively included in this study.MMF was initiated and the dose of the original immunosuppressive drug CNIs decreased.The change in renal function and adverse events were evaluated.ResultsOne patient was discontinued with MMF treatment because of serious myelosuppression.The other 27 patients were treated with MMF with a median of 30.8 months.The basal creatinine values and the basal creatinine clearance were ( 134.26 ± 27.25) μmol/1 and (57.70 ± 16.93) ml/min,respectively.The basal glomerular filtration rate was (53.91±11.63) ml/min.The creatinine values at 1,3,6,12,24 and 36 months were 124.30±28.27 (P=0.006),130.19±29.29 (P=0.174),125.49±38.18 (P=0.194),119.71±31.36 (P=0.010),137.43±42.55 (P＝0.804),and (139.04±39.80) μmol/L (P=0.916).And the creatinine clearance values at 1,3,6,12,24 and 36 months were 62.57±19.29 (P=0.008),61.18± 19.70 (P=0.086),64.27±22.82 (P=0.018),67.48±22.59 (P=0.002),57.18±19.55 (P=0.405),and (54.56±23.48) ml/minute (P=0.708),respectively.The glomerular filtration rate at 1,3,6,12,24 and 36 months were 59.20 ± 14.05 (P=0.006),56.61±14.01 (P=0.04),60.47±17.33 (P=0.016),63.59±17.66 (P=0.002),53.75±13.60 (P=0.369),and (51.70±16.07) ml/min (P＝0.703).One patient (3.7％) had mild acute rejection.5 patients (18.5 ％ ) had mild abdominal distention or diarrhea.2 patients (7.4％) had ischemic cholangitis.No patient had cytomegalo virus infection or tumor recurrence.ConclusionIn liver transplant recipients with chronic renal dysfunction,MMF allowed CNIs dose reduction or discontinuation,improved or stabilized renal function in most patients and it had only mild adverse events.

Objective To evaluate the efficacy and indications of salvage liver transplantation for patients with recurrent hepatecellular carcinoma(HCC)after liver resection.MethodsThe clinical data of 35 HCC patients who received salvage liver transplantation after liver resection at the Third Affiliated Hospital of Sun Yatsen University from October 2003 to March 2006 were retrospectively analyzed.All patients were divided into the salvage liver transplantation(SLT)group(n = 19)and extended SLT group(n = 16).Perioperative condition,postoperative complications and prognosis of the 2 groups were compared.The survival rate was analyzed and compared by the Kaplan-Meier method and Log-rank test,respectively.Results The anhepatic phase,ischaemic time,operation time,intraoperative blood loss,packed red blood cell transfusion,fresh frozen plasms transfusion,mobidity and retransplantation rate were(32 ± 9)minutes,(8.0 ± 2.1)hours,(7.6 ± 1.5)hours,2300 ml,8 U,23 U,6/19 and 2/19 in the SLT group,and(34 ± 7)minutes,(7.4 ± 2.3)hours,(7.4 ± 2.0)hours,2750 ml,12 U,20 U,4/16,1/16 in the extended SLT group,respectively,with no significant difference between the 2 groups(t=0.726,-0.804,-0.366,Z=-0.348,-0.549,-0.149,x2 =0.184,0.203,P＞0.05).The perioperative mortality,tumor recurrence rate were 0 and 2/19 in the SLT group,and 4/16 and 9/16 in the extended SLT group,with significant differences between the 2 groups(x2 = 5.363,8.426,P ＜ 0.05).The 1-,3-,5-year cumulative survival rates were 100%,84% and 84% in the SLT group,and 75%,33% and 33% in the extended SLT group.The 1-,3-,5-year tumor-free survival rates were 100%,89% and 89% in the SLT group,and 48%,29% and 19% in the extended SLT group.There were significant differences in the cumulative and tumor-free survival rates between the2 groups(x2 =11.58,19.31,P＜0.05).Conclusions The efficacy of SLT is satisfactory in the treatment of recurrent HCC.The optimal indication for SLT is Milan criteria.