Objective To explore the status and perioperative management of liver transplantation in treatment of portal hypertension. Methods Clinical data of 56 patients with portal hypertension who underwent (orthotropic) liver transplantation (OLT) from February 2000 to April 2004 were studied retrospectively.(Incidence) of complications,and in-hospital mortality and survival rate were analyzed. Platelet count after OLT was measured and liver blood flow was monitored by Doppler. Results Among the 56 OLT patients, 6 cases(10.7%) underwent simultaneous splenectomy. Incidence of complications was 40.3%,and in-hospital mortality and 1-,2-,and 3- year survival rate after OLT were 12.5% and 87.46%,85.19% and 81.58% respectively. Platelet count reached a nadir at post-transplant day 3. Conclusions OLT is an (effective) method for radical treatment of portal hypertension. Perioperative management is of vital importance for success of the operation and patient′s prognosis.

Objective To explore the liver transplantation in end stage liver disease with portal vein thrombosis (PVT). Methods Computer Tomography and color Doppler examinations were performed on the recipients to be subject to liver transplantation. Four male cases were found having PVT, received orthotopic liver transplantation and thrombectomy. Cell Saver auto transfusion blood and venous by-pass was also conventionally used. By reason of one case with residual thrombosis, a catheter with heparin cap was inserted into the branch of superior mesentery vein, followed by perfusion of urokinase for thrombus dissolution. Anti-coagulation treatments with low molecule heparin and Prostaglandtin E1 after operation were carried on in all of the patients. Results Surgical management of PVT were successful only one time in 3 patients. One patient with PVT extending over the entrance of spleen vein and left and right portal vein branches had portal vein residual thrombosis postoperation. After dissolution and anti-coagulation for 28 days, the residual thrombus disappeared. One cured patient with PVT died 48 days after operation from lung infection due to multiocular effusion resulting from chest cavity bleeding after pleuracentesis, and other 3 patients were cured in 2 months. Conclusion The PVT is not an absolute contraindication to liver transplantation; Thrombectomy combined with thrombus dissolution and anticoagulation can cure PVT; Prevention of bleedings in the patients with PVT is very importance postoperation.

Objective To induce islet grafting tolerance by intravenous injection of anti-CD4,anti-CD8 immunotoxins and donor soluble antigen.Methods 14 days or 7 days prior to transplantation,the immunotoxon 200 μg respectively,and donor soluble antigen 500 μg were injected intravenously into the recipients, then 500 donor islets were translanted under the left renal subcapsular space of diabetes reciPients (SD rats).Results The islet grafting survival time that pretreated with immunotoxon and dono soluble antigen was over 60 days(P<0.01).The immunotoxins or donor soluble antigen treatment alone only slightly prolonged the graft survival.Conclusion The anti-CD4,anti-CD8 immunotoxins combined with donor soluble antigen can induce donor specific immune tolerance.

Objective To evaluate the effect of improving microcirculation and preventing cell Ca 2+ overload in preventing the development of acute pancreatitis (AP).Methods 278 AP patients admitted from 1990 to 1994 and from 1995 to 1999 were retrospectively analyzed. Routine conservative managements were performed in the first stage,improving microcirculation and preventing cell Ca 2+ overload were performed in the second stage.Results During the first period,there were 124 patients with AP.The conversion of mild AP to severe AP developed in 28 of 120 patients with mild AP.18 of 32 patients with severe AP developed systemic complications,24 patients developed local complications,there were 9 deaths.During the second period,154 cases were treated ,the conversion of mild AP to severe AP presented in 16 of 149 patients with mild AP. 4 of 21 patients with severe AP presented systemic complications,19 patients presented local complications, 3 patients died.Conclusion Improving pancreatic microcirculation and preventing pancreatic cell Ca 2+ overload are helpful not only to prevent the conversion of mild pancreatitis to severe pancreatitis,but also to prevent progressive pancreatic necrosis, and improve the prognosis of acute pancreatitis.

Objective To investigate the etiology and management of early postoperative hyperbilirubinemia after liver transplantation. Methods The etiology and dynamic alteration of early postoperative hyperbilirubinemia in 50 liver transplants were retrospectively analyzed by a comparative trial of clinical manifestation with serial liver biopsy. Results The total serum bilirubin (TB) level profile presented like a invert "S" curve. At the first week, second week and 4th week after liver transplantation the serum TB levels were in average ( 127.19? 113.15)? ( 135.45? 124.6) and ( 73.1? 49.52)??mol/L respectively. Three months later, the serum TB level approximated to normal TB level ( 29.8? 37.56)??mol/L. The dynamic alternations of total serum bilirubin level were incorporated with the morphological improvement under microscopy of liver allograft following liver transplantation. The initial hyperbilirubinemia of reciepient before liver transplantation (10 cases, 20?%), preservation injury (containing 44 cases of ischemic reperfusion injury, 88?%), acute cellular rejection (13 cases, 26?%) and bile duct leakage (4 cases, 8?%) were 4 essential causes responsible for the early postoperative hyperbilirubinemia. The total serum bilirubin level profile was not characteristic of each catergory. Those 4 casuses mentioned above presented either independently or concomitantly in concrete case. No primary hepatic failure (PHF) occurred and curability of hyperbilirubinemia was about 100?% in our series. Furthermore, the perioperative survival rate of the recipients and liver allograft was 90.6?% and 1-year accumulative survival rate was about 80?%.Conclusions The hyperbilirubinemia is common clinical manifestion within 3 months after liver transplantation. Preservative injury, acute rejection, preoperative hyperbilirubinemina and bile duct leakage are four essential causes. The comprehensive management targeted to etiology can usually achieve a good outcome for the reciepients with hyperbilirubinemia.

Objective To investigate the effect of liver transplantation on extensive intrahepatic duct stones with biliary cirrhosis and unresectable intrahepatic alveolar echinococcosis.Methods Orthotopic liver transplantation was performed on 2 patients with extensive intrahepatic stones with biliary cirrhosis and 4 cases of unresectable alveolar echinococcosis. The pre- and intraoperative condition and postoperative complications were evaluated. All patients were regularly followed up. Results Two patients with intrahepatic stones have survived for more than 2 years after the transplantation. Three of 4 patients with alveolar echinococcosis have survived for 9, 15 months and 2 years respectively, up to now. Another one died of heart failure at the postoperative 3rd month. All survivors have recovered well their normal life and work. Conclusion Liver transplantation could be regarded as effective therapeutic means for extensive intrahepa- tic stones and unresectable alveolar echinococcosis.

Objective To investigate the preventions and managements of hepatic artery reconstructions and its complications. Method Seventy-two patients who underwent the reconstruction of hepatic artery in orthotopic liver transplantation (OLT) and were followed up during recent 3 years after OLT were collected and analyzed retrospectively. Results The overall hepatic artery complications rate was 1.4 % (1/72). A pseudoaneurysm at the side of hepatic artery anastomosis was found by angiography and embolized successfully. The patency of hepatic artery toward donor liver was remained. Postoperative Doppler ultrasonography monitoring showed that no hepatic arterial thrombosis and stenosis occurred during 43 months of follow-up after OLT. Six patients died in the hospital after OLT and 6 patients died during the follow-up period. The overall cumulative 1-, 3-year survival rate was 83.3 % and 83.3 % respectively. No death associated with hepatic artery complications occurred. Conclusion Complete evaluation and prompt management perioperatively of hepatic artery reconstruction and its complications may improve the long-term survival of the recipients and grafts after OLT.

Objective To explore the therapeutic effect of liver transplantation on hepatic alveolar echinococcosis (HAE) in late stage.Methods Five HAE cases in late stage failed to be treated by hepatic lobectomy underwent liver transplantation, in which 4 cases were performed under veno-venous bypass and 1 without bypass. Three cases were subjected to veno-venous bypass prior to mobilization of the liver. The end-to-end anastomosis was made between the hepatic artery and hepatic artery, and between the bile duct and bile duct. Two cases received placement of T tube in the bile duct. The mean duration of surgery was 8.3 h. Results One patient was reoperated because of the T tube falling off on the postoperative day 10, and one because of the bile leakage. Four patients recovered completely in the postoperative period, one died of multiple organ failure (MOF) and septi-caemia caused by pneumonia, acute rejection and embolism of the liver artery. Four patients were followed up for 21 months to 37 months, showing a good quality of their life. Conclusion Liver transplantation can be applied in treatment of hepatic alveolar echinococcosis in end stage, and can ensure a better clinical result.

Objective To investigate the technique of b iliary reconstruction and treatment of biliary complications in orthotopic liver transplantation (OLT). Methods From Feb. 1999 to Jan. 2003, OLT was performed in 103 patients with end-stage l iver disease. OLT was performed with standard techniques with or without a veno -venous bypass. Reconstructions of biliary tract were performed using choledoc hocholedochostomy (CDC) or Roux-en-Y choledochoje- junostomy (RCDJ). CDC was carried out in 94 cases, with T tube (CDCT) in 62 cases and without T tube (CDCO ) in 32 cases respectively. Among the 32 cases without T tube, 11 had a small tu be placed in the common bile duct through the recipient cystic duct. RCDJ was pe rformed in 9 cases without internal stent. Diagnosis of the biliary complication s after OLT was based on the clinical manifestations, ultrasound findings, MRCP and ERCP. All the patients were followed up regularly after discharge for 12 to 48 months. Results The overall incidence of biliary complications in 103 patients after OLT was 7 .8% (8/103). Of the 62 cases of CDCT posttransplant, biliary complications occ urred in 6 cases ( 9.6% ), including 4 cases of bile leaks following OLT and 2 cases of bile leaks following T-tube removed. Of the 32 patients subject to CD CO, 1 ( 3.1% ) had stricture of anastomosis. Of the 9 cases subject to RCDJ, one patient was complicated with bile leaks at the anasto mosis. Two cases of the bile leaks were drained reoperatively, and others were k ept adequate drained. The patient with stricture of CDCO was cured by balloon di latation and stent placed endoscopically. No death associated with biliary compl ications occurred. Conclusions Bile leaks and stricture of anatomosis are the common biliary complications afte r OLT. Good blood supply to biliary tract and surgical technique are the keys to prevent biliary complications after OLT. The timely endoscopical and radiologic al technique is a valuable nonoperative precedure for diagnosis and treatment of biliary complicat ions.

Objective To investigate the characteristics of pulmonary infection and susceptible factors following orthotopic liver transplantation (OLT). Methods Clinical data of 128 patients who underwent OLT from Feb. 1999 to Dec. 2004 were studied retrospectively in order to analyze primary pathogens, infectious time and susceptible factors.Results Forty-eight ( 37.5 %) of 128 patients had pulmonary infections and 27 ( 56.3 %) of them developed within postoperative 7 days. Thirty-four ( 70.8 %) cases suffered from mixed infection and 6 ( 12.5 %) died in the hospital after OLT. The primary pathogenic germs included Pseudomonas aeruginosa, Acinetobacter baumannii/haenolyticus, Golden staphylococcus, Aspergilosis and so on.Conclusion Pulmonary infection can be caused by various pathogens and associated with patients' constitution, mechanical ventilation, immunosuppressive drugs and so on.