Humans ; Liver Transplantation ; standards ; trends

Liver transplantation is the only cure for end stage liver diseases. Although liver transplantation started lately in China, it has evolved rapidly during the last decade. The graft and patient survival have increased significantly, and the long-term curative effect has been promisingly improved. In some large transplantation centers in China, liver transplantation has been a routine operation. However, liver transplantation in China has not yet formed its own characteristics, and its basic research, cross-discipline development, long-term survival rate, and post-operational management still drop behind the international advanced levels. It is important to summarize our experience, standardize its rule, and innovate its technique, so as to improve the outcomes of liver transplantation in China in the future. This article briefly overviews the status quo, existing problems, and further development of liver transplantation in China.
China ; Humans ; Liver Neoplasms ; surgery ; Liver Transplantation ; standards ; Tissue Donors ; supply & distribution ; Treatment Outcome

Pediatric liver transplantation (PLT) is an effective strategy of treating various acute or chronic end-stage liver diseases and inherited metabolic diseases in children.PLT has been applied in many transplant centers nationwide and has achieved satisfactory results.However,the development of transplant centers is uneven,and there is a lack of consensus and standards within the industry.In order to reduce post-operative complications,accelerate post-operative recovery,and improve the short-and long-term quality of life of children,the Enhanced Recovery After Surgery Committee of Chinese Research Hospital Association organized multidisciplinary experts to summarize the progress of domestic and international research,and formulated a perioperative consensus on PLT based on the principles of evidence-based medicine.The consensus provides recommendations for perioperative PLT from three aspects:preoperative assessment and preparation,intraoperative management and postoperative management,in order to provide reference guidelines for centers that are conducting or preparing to conduct PLT.
Child ; Consensus ; End Stage Liver Disease/therapy* ; Enhanced Recovery After Surgery/standards* ; Humans ; Liver Transplantation/standards* ; Metabolism, Inborn Errors/therapy* ; Perioperative Care/standards* ; Practice Guidelines as Topic

Acute Disease ; Bacterial Infections ; prevention & control ; Brain Edema ; drug therapy ; etiology ; Critical Care ; Hepatic Encephalopathy ; etiology ; therapy ; Humans ; Intracranial Hypertension ; etiology ; therapy ; Liver Failure, Acute ; etiology ; nursing ; therapy ; Liver Transplantation ; nursing ; standards

OBJECTIVETo investigate the value and deficiency of Milan criteria for liver transplantation in patients with hepatocellular carcinoma (HCC).

METHODSBetween December 2001 and November 2005, 125 patients underwent orthotopic liver transplantation ( OLT), who measured up Milan criteria with preoperation computerized tomography (CT) scanning. The results of pre-transplant multidetector CT scan and post-transplant pathology were retrospectively analyzed, and survival rates were compared.

RESULTSPathology examination demonstrated that 97 cases met Milan criteria (77.6%), 26 cases exceeded Milan criteria,and the other 2 cases were diagnosed as nodular cirrhosis. The 1-,2-,3-,4- and 5-year survival rates for those met pre-transplant multidetector CT scanning pre-transplant met Milan criteria vs. those met post-transplant pathology post-transplant criteria were 92.0% vs. 92.8%, 87.2% vs. 90.7%, 86.4% vs. 89.7%, 86.4% vs. 89.7%, and 86.4% vs. 89.7%, respectively. There was no statistic significant difference (P > 0.05). The 1-,2-,3-,4- and 5-year survival rates were 73.0%, 65.4%, 61.5%, 61.5% and 61.5%, for those pathology exceed Milan criteria respectively. The difference between this group and each of the above two were statistically significant (P < 0.05).

CONCLUSIONSThe prognosis of OLT for HCC is good for those met Milan criteria by pre-transplant multidetector CT. Factors leading to poor prognosis such as portal vein tumor thrombi and lymphatic metastasis should be accurately evaluated avoiding for misjudgement.

Adult ; Aged ; Carcinoma, Hepatocellular ; diagnostic imaging ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; diagnostic imaging ; pathology ; surgery ; Liver Transplantation ; methods ; mortality ; standards ; Male ; Middle Aged ; Retrospective Studies ; Survival Analysis ; Survival Rate ; Tomography, Spiral Computed

Carcinoma, Hepatocellular ; complications ; pathology ; surgery ; Embolism ; etiology ; surgery ; Female ; Hepatectomy ; methods ; standards ; Humans ; Hypertension, Portal ; etiology ; surgery ; Laparoscopy ; Liver Cirrhosis ; etiology ; surgery ; Liver Neoplasms ; complications ; pathology ; surgery ; Liver Transplantation ; Male ; Neoplasm Recurrence, Local ; surgery ; Neoplasm Staging ; Portal Vein ; pathology ; Practice Guidelines as Topic ; Prognosis ; Tomography, X-Ray Computed

OBJECTIVETo investigate the anti-cancer effects of crude extract from Melia toosendan Sieb. et Zucc and its possible molecular mechanisms in vitro and in vivo.

METHODSTransonic alcohol-chloroform extraction method was used to extract toosendanin from the bark of Melia toosendan Sieb. et Zucc, and the content of toosendanin in the crude extract was measured by high performance liquid chromatography (HPLC). Anti-cancer effects of crude extract from Melia toosendan Sieb. et Zucc were investigated in in vivo and in vitro studies. In the in vitro experiment, human hepatocellular carcinoma cell lines SMMC-7721 and Hep3B were co-incubated with toosendanin crude extract of different concentrations, respectively. In the in vivo experiment, BALB/c mice were subcutaneously inoculated with mouse hepatocellular carcinoma H22 cells and treated with crude extract.

RESULTSHPLC revealed the content of toosendanin was about 15%. Crude extract from Melia toosendan Sieb. et Zucc inhibited cancer cells growth in a dose- and time-dependent manner. The 50% inhibitory concentration (IC50, 72 h) was 0.6 mg/L for SMMC-7721 cells and 0.8 mg/L for Hep3B cells. Both high-dose [0.69 mg/(kg d)] and low-dose [0.138 mg/(kg d)] crude extract could markedly suppress cancer growth, and the inhibition rate was greater than 50%. Hematoxylin and eosin staining showed necrotic area in cancers and transmission electron microscopy displayed necrotic and apoptotic cancer cells with apoptotic bodies. Immunohistochemistry showed that the expression of Bax and Fas increased and the expression of Bcl-2 reduced.

CONCLUSIONSToosendanin extract has potent anti-cancer effects via suppressing proliferation and inducing apoptosis of cancer cells in vivo and in vitro. The mechanism of apoptosis involves in mitochondrial pathway and death receptor pathway.

Animals ; Antineoplastic Agents ; pharmacology ; therapeutic use ; Apoptosis ; drug effects ; Carcinoma, Hepatocellular ; drug therapy ; pathology ; ultrastructure ; Cell Proliferation ; drug effects ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; therapeutic use ; Female ; Immunohistochemistry ; Liver Neoplasms ; drug therapy ; pathology ; ultrastructure ; Male ; Melia ; chemistry ; Mice, Inbred BALB C ; Mitochondria ; drug effects ; metabolism ; Neoplasm Transplantation ; Plant Extracts ; therapeutic use ; Reference Standards ; bcl-2-Associated X Protein ; metabolism ; fas Receptor ; metabolism