Objective To investigate the expression and significance of glucogen synthase kinase-3β (GSK-3β) in the pathogenesis of chronic allograft nephropathy (CAN) in rats.Methods Kidneys of Fisher (F344) rats as donors were orthotopically transplanted into Lewis (LEW) rats as recipients.The renal function and histopathological changes were observed at 4,8,12,16,and 24week post-transplantation.Phosphorylated GSK-3β (p-GSK-3β) protein and mRNA expression was determined by using immunohistological assays and RT-PCR respectively.Results Our data showed that 24-h urinary protein excretion in CAN rats was increased significantly at week 16 as compared with F344/LEW controls.Allografts showed markedly increased mononuclear cells infiltration and presented with severe interstitial fibrosis and tubular atrophy at 16 and 24 week post-transplantation.p-GSK-3β expression (protein/mRNA) was down-regulated in rat kidneys with CAN,and the decrease became more significant over time after transplantation.p-GSK-3β expression was correlated significantly with 24-h urinary protein excretion,serum creatinine levels,tubulointerstitial mononuclear cells infiltration,smooth muscle cells migration in vascular wall,and interstitial fibrosis.Conclusion It was concluded that GSK-3β down-regulation was the key event that may be involved in mononuclear cells infiltration and vascular SMCs migration at early stage,and interstitial fibrosis and allograft nephroangiosclerosis at later stage of CAN pathogenesis in rats.

Objective To investigate the clinical application of the distance of biliary duct measured by MRCP in bile duct resection of the donor and biliary reconstruction of recipients in living donor liver transplantation (LDLT) using right lobe graft.Methods Seventy-six living donors received preoperative MRCP after fat meal,who underwent right lobe resection and all had intraoperative cholangiography (IOC) for comparison.The accuracy of preoperative MRCP for biliary types in LDLT donors was analyzed and compared to that of IOC findings.The length of biliary duct between the junction of the right posterior hepatic duct (RPHD) and the junction of the right and left hepatic ducts was measured in MRCP images.The reconstruction of intraoperative data and the length,the diameter were compared,and binary logistic regression and Receiver Operating Characteristic (ROC) curves were calculated.The result included the limitation.Results In comparison to IOC,the accuracy of MRCP after fat meal was 97.4 ％.The length of biliary duct between the junction of RPHD and the junction of the right and left hepatic ducts measured by MRCP and the biliary type were the influencing factor of intraoperative reconstruction of biliary duct; while the diameter of biliary duct had no influence ROC curves showed that when the length of biliary duct of type Ⅰ was smaller or equal to 4.2 mm,or the biliary anatomy had variation,the number of biliary anastomotic stomas was more than one,and plasty was selected in 95 ％ of donors intraoperatively.The corresponding length of biliary duct of type Ⅲ and type Ⅳ was 3.8 mm,which was the limitation whether biliary plasty was done intraoperatively.Conclusion The type of bile duct in MRCP can reflect the biliary anatomy structure accurately.The length of biliary duct between the junction of RPHD and the junction of the right and left hepatic ducts measured by MRCP after fat meal can guide the biliary reconstruction intraoperatively and offer reliable basis for optimizing the clinical operation program in adult LDLT.

Objective To evaluate the applied value of multislice CT (MSCT) in the selection of living donor kidneys and excision methods.Methods Ninety living renal donors underwent MSCT assessment.The nonenhanced,arterial,venous and excretory phase examinations were performed.Using maximum intensity projection and volume rendering techniques for vascular imaging,two blinded radiologists independently analyzed and evaluated all MSCT images.According to the CT reconstructive images,radiologists and physicians selected the left renal or the right renal donors,and chose laparoscopic or open live donor nephrectomy.Results On the 90 cases of donors,78 donors underwent nephrectomy in the left kidney.Seventy-one left kidney donors having no significant variation received the routine laparoscopic live donor nephrectomy.Seven left kidney donors on both sides had relatively obvious anatomical variations such as accessory renal artery,multi-branch renal vein and renal vein in the back of the abdominal aorta,and they were subjected to the left kidney open donor nephre.ctomy.Other 12 donors having significant variation in the left kidney were given nephrectomy in the right kidney,and all of them received hand-assisted laparoscopic live donor nephrectomy.All intraoperative records of urine collection system and renal vascular anatomy were consistent with the preoperative evaluation of MSCT,and the accuracy was 100 ％.Two imaging experts in the evaluation of renal artery,renal vein and urine collection system showed good consistency.Nephrectomy was successfully performed on 90 cases of donors,and.postoperative recipients had no renal vein thrombosis and other vascular complications.Conclusion MSCT can provide accurate and valuable information for the selection of living donor kidneys and excision methods as a “one-stop” technique for the preoperative evaluation of living renal donors.

Objective To summarize the clinical experience of antibody induction therapy in renal re-transplantations and compare the outcomes among different antibodies.Methods We retrospectively investigated 39 recipients after renal re-transplantations in our center.According to the induction agents,patients were divided into three groups as follows:basiliximab (Bax) group (patients treated with Bax,n =12),T lymphocyte polyclonal antibody (ALG) group (patients treated with ALG,n =19) and thymoglobuline (ATG) group (patients treated with ATG,n =8).Incidence of acute rejection,graft loss and cytomegalovirus infection was analyzed,as well as graft survival rate and serum creatinine one year after transplantation.Results Acute rejection occurred in 5 patients of Bax group (5/12,41.7 ％),in 9 patients of ALG group (9/19,47.4 ％) and 1 patient of ATG group (1/8,12.5 ％).The acute rejection rate was similar in Bax and ALG groups,but significantly decreased in ATG group.The 1-year survival rate of re-transplant recipients was 84.6 ％.There were no significant differences in 1-year survival rote between Bax group and ALG group (82.4 ％ vs 80.5 ％),while ATG group showed higher survival rate (90.8 ％).The renal function in ATG group was improved at 1st year after re-transplantation:serum creatinine (121.3 ± 22.6) μmol/L vs (176.8±43.5)μmol/L in Bax group and (195.4 ± 35.2) μmol/L in ALG group respectively.There were 2patients with CMV infection in Bax group,3 patients in ALG group and 2 patients in ATG group.There was no significant increase in infection incidence between ATG group and Bax or ALG groups during the follow-up period.Conclusion Retrospective analysis from monocenter and small samples indicated that ATG induction treatment seems to be effective in decreasing acute rejection risk andachieving better outcomes in the renal re-transplant recipients without increased CMV infection incidence.

Objective To evaluate the impact of cardiac troponin Ⅰ (cTnI) on acute lung injury in pediatric living donor liver transplant children with biliary atresia.Methods The clinical data of 112 pediatric living donor liver transplant recipients with biliary atresia in Tianjin First Central Hospital from February 2011 to September 2015 were retrospectively reviewed.Fifty-five recipients with cTnI ≥0.07 μg/L served as high-cTnI group and 57 recipients with cTnI group ＜0.07μg/L as normalcTnI group.The clinical data between two groups were compared and the association between serum cTnI level and acute lung injury after living-donor liver transplantation was evaluated by logistic regression analysis.Results The percentage of acute lung injury after pediatric living donor liver transplantation in high-cTnI group and normal-cTnI group was 31.6％ and 9.1％,respectively.Intratransplant cTnI ≥0.07μg/L (OR =4.489,confidence interval 1.170-17.226) was the risk factor for acute lung injury after transplantation.The value of cTnI showed the positive correlation with preoperative PELD scores (OR =4.489,confidence interval 1.170-17.226).Conclusions Intratransplant cTnI level was the significant prognostic risk factor in acute lung injury after pediatric living-donor liver transplantation for children with biliary atresia.The cTnI level was associated with preoperative PELD scores.

Objective To analyze and compare the dosage,blood concentration and metabolic characteristics of Tacrolimus (Tac) for pediatric patients who underwent living related liver transplantation (LRLT) or donation after cardiac death liver transplantation (DDLT).Methods The clinical data of 75 liver transplantation pediatric patients from October 2012 to August 2015 were retrospectively analyzed.According to the different source of donors,the recipients were divided into two groups:LRLT group (40 cases) and DDLT group (35 cases).Results (1) Under the condition of same initial Tac dosage,the Tac dosage in LRLT group was less than in DDLT group during the first 28 days post-transplantation (P＞ 0.05).However,the Tac dosage in DDLT group was significantly higher than in LRLT group on the second and third months after sugery (P =0.000).(2) Correlation analysis revealed that graft-recipient body weight ratio (GRWR) was correlated with Tac dosage (mg·kg-1 ·d-1) on the 14th day postoperative (LRLT group:r=0.579,P＜0.05;DDLT group:r =0.583,P＜0.05) and Tac concentration/dosage ratio (LRLT group:r =-0.607,P＜0.05;DDLT group:r=-0.680,P＜0.05).Conclusion Tac has a satisfactory anti-rejection effect on liver transplantation pediatric patients while the metabolism varied with each individual.There is a positive correlation between the early Tac dosage and the GRWR in both groups.It is necessary to set individualized Tac administration regimen according to the metabolic characteristics and GRWR.

Objective To investigate the relationship between hepatic venous outflow obstruction (HVOO) and patterns of the hepatic vein (HV) drainage into inferior vena cava (IVC) in piggyback liver transplantation (PBLT).Methods A retrospective analysis on 202 cases of PBLT (from May 2000 to Aug.2015) was conducted.The recipients' patterns of HV drainage into WC and the angle ∠COB between the reconstructed outflow and IVC in the cross section were recorded by preoperative 3D reconstruction.And the lengths and diameters of recipients' HVs were measured during operations.The relationship between the incidence of HVOO and patterns of HV drainage into IVC was analyzed.Results There were 3 patterns of HV drainage into IVC:type Ⅰ (n =136),trunk of left and middle HVs;type Ⅱ (n=52),trunk of right and middle HVs;type Ⅲ (n=14):trunk of three HVs.There was no statistically significant difference within the HVs of each type,when the lengths and diameters were compared respectively.However,the angle ∠COB of type Ⅰ [(164 ±10.14)°] was significantly bigger than type Ⅱ [(44 ± 12.2)°] and type Ⅲ [(96 ± 13.1) °] (P＜0.05).Accordingly,the highest incidence of HVOO (23.5％) was foundin type Ⅰ,followed by type Ⅱ (9.6％),and type Ⅲ had the lowest incidence (7.1 ％) (P＜0.05).The correlation coefficient Cramer's V =0.765.Conclusion This study demonstrated that there was preferable relativity between the HVOO incidence and the patterns of HV drainage into IVC.Type I is more likely to have HVOO.Type Ⅲ is the most ideal one for PBLT.

Objective To investigate the technique,efficacy,and safety of percutaneous interventional treatments for biliary complications (BC) after liver transplantation (LT).Methods The clinical and imaging data of 127 patients with BC after LT,who received percutaneous interventional treatments in the Third Affiliated Hospital of Sun Yat-sen University from January 2006 to December 2015,were analyzed retrospectively.On the basis of the cholangiographic appearance,patients were classified into 5 groups:biliary leakage group (n =11),anastomotic biliary strictures group (n=28),hilar biliary strictures group (n =30),multifocal biliary strictures group (n =51),and bilomas group (n =7).The modality of interventional treatments was percutanous transhepatic biliary drainage (PTBD),PTBD combined with balloon dilation,PTBD combined with balloon dilation and stent implantation.The methods of biliary drainage included external drainage and external-internal drainage.All the patients were followed up after treatment.The curative effect and operation-correlated complications were observed.Results The first successful rate of PTBD was 97.6％ (124/ 127).The total curative rate,improvement rate and inefficacy rate of interventional treatments were 37.8％ (48/127),44.9％ (57/127) and 17.3％ (22/127) respectively.In biliary leakage group,all the patients were cured by percutaneous interventional treatments with the curative rate being 100％.In anastomotic biliary strictures group,the cure and improvement rates were 64.3％ (18/28) and 35.7％ (10/28) respectively.The efficacy rate was 100％ (28/28).In hilar biliary strictures group,the cure,improvement and inefficacy rates were 40％ (12/30),53.3％ (16/30) and 6.7％ (2/30) respectively.The efficacy rate was 93.3％ (28/30).In multifocal biliary strictures group,the cure,improvement and inefficacy rates were 13.7％ (7/51),54.9％ (28/51) and 31.4％ (16/51) respectively.The efficacy rate was 68.6％ (35/51).In bilomas group,3 cases (3/7) obtained improvement and treatment of 4 cases was inefficative.The efficacy was the best for the patients with bilary leakage,and it was the worst for the patient with bilomas (P＜0.001).The main operation-correlated complication was bile tract infection during drainage.The rates of bile tract infection were 32.4％ (34/105) and 81.8％ (18/22) in patients with external drainage and external-internal drainage,respectively.There was statistically significant difference between these two items (P＜ 0.001).Conclusion PTBD combined with balloon dilation and biliary stent implantation is a safe and effective therapeutic modality for BC after LT,which can improve patients' clinical symptoms,improve patients' quality of life.The patients with bilomas should be treated by retransplantation as soon as possible.The biliary external drainage can decrease the rate of biliary tract infection significantly.

Objective To investigate whether the donor's glomerular filtration rate (GFR) to recipient's weight ratio (Dg/Rw) is a useful tool to predict early clinical outcome in living-related do-nor transplantation.Methods A total number of 108 living donor transplant recipients in the Chinese Military 309th Hospital from Jan.2014 to July 2015 were enrolled in this study.The patients who had multi-organ transplantation or developed grafts rejection,delayed graft function,hydronephrosis or renal vascular stenosis were excluded.The 90 qualified recipients were divided into G1 group (Dg/Rw ≤0.81),G2 group (Dg/Rw 0.81～1.11),and G3 group (Dg/Rw≥1.12).We respectively analyzed the relationship between recipient's serum creatinine Scr and Dg/Rw at 3-,7-,30-day and 1 year after transplantation.Results Scr at 3-,7-,30-day and 1 year after transplantation had linear correlation with Dg/Rw.As compared with G1 and G2 groups,Scr level was significantly reduced in G3 group at different time points (P＜0.05).Conclusion Dg/Rw has a negative relationship with Scr level after renal transplantation.Pre-transplant Dg/Rw is a potential index to predict the early clinical outcome in living-related donor transplantation.

Objective To observe the mental and motor development of children with biliary atresia before and after liver transplantation,and analyze the effect of liver transplantation on neurocognitive functions.Methods Fifty children with biliary atresia who experienced living related liver transplantation were selected from Jan.2016 to Dec.2016 in our hospital,with an average age of 5 to 12 months regardless of gender.All the children were assessed by Bayley Scale of Infant Development (BSID) one day before surgery,to obtain the mental and motor development conditions.The results were indicated with Mental Development Index (MDI) and Psychomotor Development Index (PDI).The levels of preoperative ammonia,bilirubin,albumin and white blood cells were recorded,and their relationship with preoperative neurocognitive development was analyzed.The development indexes were obtained at 2nd week,3rd week and 1st month after surgery by the same method,and the neurocognitive changes were analyzed in children before and after the surgery.The effects of postoperative biliary complications,secondary operations,pneumonia infection and other complications on the postoperative development indexes one month after surgery were assessed.Results The preoperative mental and motor development was both below the standard level in 50 infants with average MDI and PDI in middle and lower state.The correlation analysis among the levels of preoperative blood ammonia,bilirubin and albumin showed statistically significant on development index (P ＜ 0.05).The levels of blood ammonia and bilirubin were negatively correlated with development index,while albumin levels showed a positive correlation.As compared with one day before liver transplantation,MDI and PDI were decreased at 2nd week after operation;the MDI increased,and PDI had no significant change at 3rd week after operation.MDI and PDI were significantly higher at 1 st month after operation than preoperation.As compared with 2nd week after operation,PDI and MDI were significantly increased at 3rd week and 1st month after operation.Postoperative persistent pneumonia infection could affect children's MDI,and biliary complications could affect PDI (P＜0.05).Concision The mental and motor development conditions of children with biliary atresia were in medium/low level,and the levels of preoperative blood ammonia,bilirubin and albumin may have significant influence.Liver transplantation may obviously improve the patient's neurocognitive function.