Objective To study long-term post-liver-transplantation hyperuricemia (HUA) and the influence of urate-lowering therapyon renal functions of adult patients.Methods Among 428 cases undergoing liver transplantations during March 2011 to December 2013,206 patients,whose followup periods were above 1 year,were selected as the objects of study.Those whose two-time serum uric acid (SUA) levels tested not in the same day one year after operation ＞420 μmol/L (male),or female ＞360 μmol/L (female) were divided into HUA group,and non-HUA group.The serum creatinine (SCr) concentrations and glomerular filtration rate (eGFR) were analyzedin the two groups at their peak SUA to find whether there was any difference between the two groups.Meanwhile,27 HUA patients with abnormal renal function were given urate-lowering therapy and the differences in SCr and eGFR after the therapy were observed.Results 49.5％ patients sufferedlong-term HUA after liver transplantations.As compared with non-HUA group,SCrconcentrations were increased statistically (P＜0.05),and eGFR was reduced statistically in HUA group (P＜0.05).After 8-week uratelowering therapy among 27 patients,SUA level in 24 cases (88.9％,24/27) returned to the normal standard and SCr concentrations in 21 cases (77.8％,21/27) decreased for a certain degree.SUA levels were decreased to (349.93 ± 22.85)μmol/L from (532.94 ± 93.91) μmol/L (P＜0.001).SCr concentrations were decreased to (129.52 ± 19.06)μmol/L from (144.95 ± 13.51) μmol/L (P =0.016).The eGFR increased to (56.30 ± 11.46) ml · min-1 · 1.73 m-2 from (46.46 ± 8.11) ml·min-1 ·1.73 m-2(P =0.012),which showed a certain degree of improvement in their renal functions.Conclusion HUA is a long-term common complication in liver transplanted adult patients,which has a negative influence on patients' renal functions,so we need to pay enough attention to this.Urate-lowing therapy has a positive influence on the improvement of renal function if other factors were excluded from the treatment.

Objective To explore the early prognosis and the risk factors of delayed graft function (DGF) of the recipients undergoing liver transplantation from donor liver with moderate-to-severe steatosis. Methods Clinical data of 475 donors and 475 recipients undergoing liver transplantation from donor liver of organ donation after citizen's death were retrospectively analyzed. According to the classification criteria of steatosis proposed by Australia National Liver Transplantation Unit (ANLTU), all recipients were divided into the S0 group (no steatosis, n=308), S1 group (mild steatosis, n=97), S2 group (moderate steatosis, n=52) and S3 group (severe steatosis, n=18), respectively. The early postoperative death and incidence of postoperative complications were statistically compared among each group. The risk factors from donors, recipients and operation leading to DGF were analyzed by univariate and multivariate logistic regression models. Results The incidence of postoperative DGF in the S2 and S3 groups was significantly higher than that in the S1 and S0 groups (all P < 0.05). The incidence of postoperative DGF in the S3 group was remarkably higher than that in the S2 group (P < 0.05). The early postoperative fatality, the incidence of primary nonfunction (PNF) of the transplant liver, postoperative bleeding, infection, biliary complications and vascular complications did not significantly differ among each group (all P > 0.05). Univariate regression analysis showed that severe steatosis of donor liver, long cold ischemia time, high model for end-stage liver disease (MELD) score and tumors of the recipients before operation were the risk factors of DGF (all P < 0.05). Multivariate logistic regression analysis demonstrated that moderate-to-severe steatosis of donor liver, cold ischemia time > 8 h and MELD score > 30 of the recipients were the independent risk factors for early postoperative DGF. Conclusions The early-stage incidence of DGF after adult liver transplantation from donor liver with moderate-to-severe steatosis is high, whereas it does not affect the early survival rate of the recipients. The selection of donor liver with moderate-to-severe steatosis should be considered in combination with cold ischemia time of the donors and MELD score of the recipients before operation, etc.

Human herpesvirus-6 (HHV-6) is a ubiquitous virus. The incidence of HHV-6 after liver transplantation is estimated to be 22% ? 54%; it may present with fever, hepatitis, pneumonia, encephalitis, and myelosuppression and has a poor prognosis. HHV-6(+) recipients had a mortality rate of 29%, significantly higher than that of HHV-6(?) recipients (6%). Since most infections are asymptomatic, HHV-6 monitoring is not routinely performed in clinical practice, which means clinicians often ignore the diagnosis of HHV-6 and eventually delay diagnosis and treatment. In this paper, a case of human herpesvirus 6B encephalitis after liver transplantation was retrospectively analyzed, and the literature related to this disease was reviewed to improve the understanding of this disease.

Objective To employ image post-processing technique measuring splenic volume for evaluating the mitigation effect of end-stage liver disease patients complicated with different degrees of hypersplenism undergoing orthotopic liver transplantation .Methods For 55 end-stage liver disease patients with hypersplenism undergoing orthotopic liver transplantation ,the changes in splenic volume were measured before and after transplantation by image post-processing system Advantage Workstation 46 (AW46) and the changes of splenic thickness ,portal flow velocity and platelet counts observed during perioperative period .Results Postoperative splenic volumes of 55 recipients were (562 .90 ± 49 .16) cm3 ,significantly decreased than preoperative (850 .50 ± 77 .99) cm3 (P< 0 .05) and reduction ratio was (31 .70 ± 2 .76 )％ . Splenic thickness at different postoperative timepoints was significantly lower than that pre-operation (P< 0 .05) and stabilized at 1 month post-transplantation ; Splenic volume was positively correlated with splenic thickness ( r = 0 .78 , P < 0 .05 ) . Portal flow velocity at different postoperative timepoints increased significantly as compared with preoperative ( P < 0 .05) ,peaked at (380 .70 ± 21 .80) mm/s at 1 month post-transplantation ,declined and stabilized at 3 months post-transplantation . Platelet counts (PLT ) at different postoperative timepoints were significantly higher than those at pre-operation ( P < 0 .05 ) ,peaked (193 .40 ± 10 .36 ) × 109 /L at 2 weeks post-transplantation ,dropped and remained at 2 months post-transplantation ;Splenic volume was negatively correlated with PLT ( r = -0 .44 , P < 0 .05 ) . And hypersplenism recovery rate and recurrence rate within 10 months post-transplantation was (78 .79 ± 2 .29 )％ and (17 .75 ± 2 .31 )％ respectively .Conclusions Orthotopic liver transplantation can effectively alleviate hypersplenism for most end-stage liver diseases .Using image post-processing system ,splenic volume may be calculated and blood routine and ultrasound are simultaneously used for assessing the outcomes of liver transplantation on hypersplenism .

Objective To discuss the modified eversion thrombectomy for portal vein thrombosis (PVT) in liver transplantation and the curative effectiveness.Methods All 613 cases complicated with PVT preoperation were given modified eversion thrombectomy,and there were 179,236,182 and 16 cases of PVT Yerdel grade Ⅰ,Ⅱ,Ⅲ and Ⅳ respectively.Results All 415 PVT patients of grade Ⅰ and Ⅱ received modified eversion thrombectomy and success rate was 100％.Among 182 PVT patients of grade Ⅲ received modified eversion thrombectomy (success in 176 cases,and failure in 6 cases).Sixteen PVT patients of grade Ⅳ received modified eversion thrombectomy (success in 13 cases and failure in 3 cases).The 1-year survival rate of PVT patients after surgical operation was 93.6％,and that of non-PVT patients was 94.6％ (P＞0.05).Conclusion Modified eversion thrombectomy could be adopted in PVT patients regarding to different Yerdel grades.

Objective:To summarize the clinical characteristics of single-center children with low and intermediate-risk neuroblastoma (NB), report the long-term follow-up results of the growth and survival quality, and provide a basis for further clinical research.Methods:Clinical characteristics, including the sex, age, stage, risk of disease, and metastatic site of 370 newly treated children with low and intermediate-risk NB admitted to Hematology Oncology Center, Beijing Children′s Hospital from March 2007 to June 2019 were retrospectively analyzed.Kaplan-Meier method was used for survival analysis.WHO Anthro Plus was used for calculating Z score.Results:A total of 370 eligible children with low and intermediate-risk NB were included, with the mean age at onset of 16.8 months (1-191 months). Among them, 148 cases (40%) were younger than 12 months old.Mediastinal region was the most common primary site of NB (47.8%, 177 cases), followed by retroperitoneum/adrenal gland (41.4%, 153 cases). The median follow-up time of 370 patients was 31 months (0.3-157.0 months), the 5-years event free survival (EFS) and 5-year overall survival (OS) were 86.2% and 96.9%, respectively.Thirty-seven cases had growth and deve-lopment problems, of which 22 cases had stunted growth, 6 cases had low body mass, 9 cases had wasting, and 7.3%(27/370 cases) had scoliosis.5.5% of them had heart damage and 5.0%(18/357 cases) had kidney damage, involving 12 cases related to the primary tumor and 6 cases were surgically related.30.2%(95/315 cases) of them had hair changed after chemotherapy, and curly hair was the most common change.Compared with before treatment, 14.9% of the children had a personality change, with an impatient being the most common.Conclusions:The 5-year overall survival rate of the single-center large sample of low and intermediate-risk NB was high, mediastinal was the most common primary site of tumor, and the long-term quality of life is good, but there were still treatment-related side effects, and further clinical monitoring and long-term follow-up were needed.

Objective:To evaluate the efficacy of comprehensive anti-cancer treatment for lung metastases after liver transplantation (LT) for hepatocellular carcinoma (HCC).Methods:From March 2012 to July 2016, A total of 36 patients with lung metastasis after LT were divided into comprehensive anti-cancer treatment group (rapamycin + radioactive I 125 seed implantation + pulmonary artery infusion chemotherapy + sorafenib, n=22) and maintenance supportive care group ( n=14). The survival profiles of two groups were evaluated. Results:No significant inter-group differences existed in preoperative basic data, tumor pathology, time of pulmonary metastatic tumor after operation and lung metastasis tumor burden.In comprehensive anti-cancer treatment group, there were partial remission ( n=3), disease stability ( n=12) and disease progression after treatment ( n=7). In maintenance supportive care group, there were disease stability ( n=3) and disease progression after treatment ( n=11). And comprehensive anti-cancer treatment was superior to maintenance supportive care ( χ2=7.901, P=0.019). The median survival time after metastasis was 23 months (95%CI: 19.68-26.32) in comprehensive anti-cancer treatment group and 7 months (95%CI: 3.33-10.67) in maintenance supportive care group; 1-year survival rate 91% and 9%, 2-year survival rate 45% and 0% and 3-year survival rate 10% and 0% respectively.The survival rate of comprehensive anti-cancer treatment group was significantly better than that of maintenance supportive care group ( P<0.001). Conclusions:Comprehensive anti-cancer treatment (rapamycin + radioactive I 125 seed implantation + pulmonary artery infusion chemotherapy + sorafenib) can improve the survival time of patients with lung metastasis after liver transplantation for HCC.

Objective To develop a new model for predicting recurrence after liver transplantation for hepatocellular carcinoma (HCC) beyond Milan criteria based on related preoperative and postoperative indicators. Methods A retrospective analysis was performed for the clinical data of the patients with HCC beyond Milan criteria who underwent orthotopic liver transplantation for the first time in Tianjin First Central Hospital from August 2014 to July 2018, and according to the presence or absence of recurrence during follow-up, the patients were divided into recurrence group and no-recurrence group. The t -test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison of survival curves. Univariate and multivariate Cox proportional hazards regression analyses were used to identify the risk factors for recurrence-free survival after surgery. A new model was developed for recurrence after liver transplantation in the patients with HCC beyond Milan criteria based on the risk factors identified. The area under the receiver operating characteristic curve (AUC) was used to evaluate predictive performance, and the Hosmer-Lemeshow test was used to assess the goodness of fit of the model. Results A total of 117 patients with HCC beyond Milan criteria were enrolled in this study, with a median follow-up time of 24 (1-74) months. A total of 53 patients (45.3%) experienced recurrence after surgery, among whom 52 (98.1%) had recurrence within 3 years after surgery, with a median time to recurrence of 6 (1-52) months. The Cox proportional hazards regression analysis showed that preoperative serum alpha-fetoprotein (AFP) >769 ng/mL, neutrophil-lymphocyte ratio (NLR) >3.75, and ki67 index >0.25 were independent risk factors for recurrence-free survival after liver transplantation. The model established based on these three risk factors had an AUC of 0.843, with good sensitivity (88.7%) and specificity (70.3%). The optimal cut-off value was selected according to the maximization of Youden index, and then the patients were divided into low-risk group (0-1 point) and high-risk group (1.5-4 points). The log-rank test showed that the low-risk group had significantly higher 3-and 5-year recurrence-free survival rates than the high-risk group (84.1%/72.0% vs 10.9%/10.9%, χ 2 =29.425, P < 0.001). Conclusion Liver transplantation for HCC beyond Milan criteria should be performed with caution, and the predictive model established based on preoperative AFP, NLR, and ki67 index can accurately assess the indication for liver transplantation in such patients.

Objective: To analyze the clinical characteristics of children with neuroblastoma (NB) complica-ted with lung or pleural metastasis, further to explore the correlation between characteristics and short-term outcome of NB, so as to provide a basis for clinical diagnosis and treatment. Methods: A retrospective analysis was performed concerning the age of onset, clinical features, treatment and outcome of 36 patients with NB who were admitted at Blood Tumor Center, Beijing Children′s Hospital of Capital Medical University from December 2007 to December 2017.The diagnostic criteria, therapeutic regimen and therapeutic efficacy criteria of the enrolled children were all based on the NB protocol of Beijing Children′s Hospital of Capital Medical University (BCH-NB-2007), the clinical stage was based on international clinical stage of neuroblastoma (INSS stage), and stratified treatment was conducted according to the BCH-NB risk grouping standard.The follow-up period lasted till October 31, 2018. Results: (1)The common clinical features of grouped children: 36 patients were selected into the group, accounted for 5.99% (36/601 cases) in total hospitalized NB children, they were less than 10 years old, 10 cases under 18 months, and the median age was 29.5 months (9-105 months); 20 cases were male, and 16 cases were female; the primary tumor was located in the retroperitoneal site in 19 cases, accounting for 52.78%, 9 cases in adrenal site, accounting for 25.00%, and 8 cases in mediastinal site, accounting for 22.22%.Risk groups: 29 cases were in high-risk group, 6 cases were in medium-risk group and 1 case was in low-risk group.The main symptoms were of pain onset in 8 cases, fever in 6 cases, local mass in 6 cases, abdominal mass in 4 cases, mediastinal mass in 3 cases, paleness in 3 cases, subcutaneous nodules in 2 cases, abdominal distension in 2 cases, lower limb swelling in 1 case, and diarrhea in 1 case. Among them, 16 cases had respiratory system symptoms first, accounting for 44.4%.(2)Laboratory examination: there were 35 patients of neuron-specific enolase (NSE) ≥25 μg/L on the initial diagnosis, of which 11 cases were more than 370 μg/L, the value of serum lactate dehydrogenase (LDH) ≥717.5 U/L in 25 patients, accounting for 69.44%, and 10 cases were accompanied by N-myc gene amplification.(3)Imaging examination: on the first diagnosis, chest/abdomen CT showed 75.75%(24/33 cases) of pleural or lung involvement, PET-CT showed 81.8% (27/33 cases) of pleural or lung involvement, B-ultrasound showed 41.67%(5/12 cases) of pleural or lung involvement; 3 imaging examinations showed: 1 positive in 16 cases, 2 positive in 16 cases, and 3 positive in 4 cases.(4)Comparison of clinical features of pleural and pulmonary involvement: among the 30 children with pleural involvement, 6 cases had respiratory symptoms, 3 cases had respiratory symptoms on the 6 cases with pulmonary involvement only, and 4 cases with pleural and pulmonary involvement had no respiratory symptoms at first diagnosis.(5)Treatment and outcome: 2 cases died because of critical condition after diagnosis, 5 cases didn′t receive the law treatment, 29 cases accepted law stratification treatment, among them, 1 case in low risk group, INSS-Ⅳ, alleviate current (CR); 4 cases in the moderate group, INSS-Ⅳ, CR in 2 cases, partial response (PR) in 1 case, progress in 1 case, new tumor foci occurring after chemotherapy discontinuation for 13 months. Twenty-four cases were in the high-risk group, event occurred in 7 cases (29.17%) of them, 1 case had progression by postoperative evaluation, 4 cases of progression at 1.5, 2.0, 3.0 and 6.0 months after cessation of chemotherapy, and 2 cases had recurrence at 11 and 17 months after cessation of chemotherapy.Overall survival rate (OS) was 41.4% for all children analyzed by Kaplan-Merier, and 32.9% of them were predicted to have 3-year event-free survival. Conclusions Children with pulmonary or pleural metastasis of neuroblastoma have no specific respiratory symptoms.CT scan might be a useful method for diagnosing the group Ⅳ children with pulmonary or pleural metastasis of neuroblastoma.Moreover, there seemed to be no significant correlation between the N-myc gene expression and survival prognosis of these children.