Objective To investigate the clinical efficacy of liver transplantation for liver cirrhosis and portal hypertension.Methods The clinical data of 181 patients with liver cirrhosis and portal hypertension who were admitted to the People's Hospital of Peking University from January 2000 to January 2012 were retrospectively analyzed.The efficacy of liver transplantation for liver cirrhosis and portal hypertension was investigated.The indications of liver transplantation included repeated upper gastrointestinal hemorrhage,failure of medication,surgical treatment and interventional therapy,and portal hypertension combined with hepatic functional decompensation.Orthotropic liver transplantation or piggyback liver transplantation was selected according to the condition of the patients.The pressures of the portal vein were detected before and after the transplantation of the liver graft by the manometer tube.The incidence of postoperative complications was detected.Patients were followed up regularly till December 2012.The varices and rebleeding of the esophageal veins and the survival of the patients were monitored.The survival rates was calculated using the Kaplan-Meier method,and the measurement data were analyzed using the t test.Results Of the 181 patients,65 received orthotropic liver transplantation,and 116 received piggyback liver transplantation.The operation time,volume of blood loss and anhepatic phase were (485 ± 97) minutes,(4 380 ± 1 993) mL and (56 ± 24) minutes,respectively.T tube was placed in 157 patients.The portal vein pressure was detected in 102 patients.The portal vein pressures before and after liver transplantation were (32 ± 11) cmH2O (1 cmH2O =0.098 kPa) and (21 ± 6) cmH2O,respectively.There was significant difference in the portal vein pressure before and after liver transplantation (t =2.412,P ＜ 0.05).Severe infection was detected in 23 patients,acute renal failure in 20 patients,severe abdominal bleeding in 6 patients,vascular complications in 5 patients and primary graft non-function in 2 patients after liver transplantation.A total of 181 patients were followed up for 6-131 months.One hundred and thirty-eight patients received endoscopy or upper gastrointestinal imaging at 1 year after liver transplantation.The varices were disappeared in 112 patients and alleviated in 26 patients,with the overall alleviation rate of 85.71％ (138/161).Four patients were complicated with upper gastrointestinal rebleeding within 1 year after liver transplantation,and the rebleeding rate was 3.70％ (4/108).The condition of 3 patients was alleviated by haemostatics and endoscopic treatment,and 1 patient died of liver failure caused by rebleeding.The 1-month,1-,5-year survival rates were 86.8％,84.9％ and 77.4％,respectively.Twenty-three patients died.Fifteen patients died of multi-organ dysfunction syndrome,5 died of vascular complications (2 died of hepatic artery thrombosis,2 died of portal vein thrombosis and 1 died of anastomotic stricture of vena cava),2 died of primary graft non-function,and 1 died of respiratory complications.Conclusion Liver transplantation is an efficient method for the treatment of liver cirrhosis and portal hypertension with the advantages of low rebleeding rate and ideal efficacy of reducing portal vein pressure.

ObjectiveTo investigate the incidence of de novo malignancies in liver transplantation recipients.MethodsWe retrospectively assessed data of 475 patients undergoing liver transplantation from May 2000 to December 2008. ResultsAmong the 475 recipients followed-up for 6 months at minimum,5 patients developed de novo malignancy and the total incidence rate was 1.1％.The median elapsed time from transplant to the diagnosis of de novo malignancy was 14 months (range 6 to 72).The patients were all males,including one of rectal cancer which was cured by radical resection,2 of hepatocellular carcinoma who died 6 and 14 months respectively after the diagnosis,1 of neuroendocrine carcinoma of the lung dying after 16 months,1 of Bukitt lymphoma who died within 2 months.Conclusions De novo malignancy is an uncommon event in liver transplantation recipients,but the outome is very poor.

Objective:To investigate the outcome of liver transplantation(LT) for end stage liver disease with portal vein thrombosis(PVT) in different processes.Methods: Data from 308 patients who underwent LT from July 2004 to February 2008 were retrospectively assessed.The processes of varies grades of PVT during LT were analyzed and estimated for whether the outcome of LT was different between patients with or without PVT.Results: There were 46 patients with PVT,including 11 of grade 1,14 of grade 2,18 of grade 3 and 3 of grade 4.LT performed in grade 1 and 2 PVT patients without special intervention.LT was performed in 16 patients with grade 3 PVT after simple thrombectomy or thrombus-extraction.The other 2 patients with grade 3 PVT received the donor superior mesenteric vein to act as a bridge between the donor portal vein and host superior mesenteric vein.Two cases with grade 4 PVT received a cavo-portal hemitransposition,and the other one anastomosis between graft portal vein and varicose coronary vein.The postoperative 1-year survival rates of patients without PVT and patients with PVT were 91.6%(240/262),80.5%(211/262)vs 86.9%(40/46),76.1%(35/46),respectively.The patients with PVT had a recurrence rate of 4.3%(2/46).Conclusion: Most patients suffering from end stage liver disease with PVT can be successfully treated by LT.However,the result of the patients with diffused PVT undergoing LT is relatively poor.

Objective To discuss the clinical presentation and management of pancreatic arteriovenous malformation.Methods The data pool for the analysis was collected from pancreatic arteriovenous malformation cases encountered by our hospital and sporadic case reports in the literature.Results A total of 95 cases were collected,including 83 males (87.37％) and 12 females (12.63％).The most common presenting symptom was epigastric pain (45.26％),followed by melena (17.89％),epigastric pain accompanied melena (14.74％) and haematemesis (8.42％).The most commonly associated complications were gastrointestinal bleeding (48.42％),pancreatitis (23.16％),duodenal ulcer (16.84％),portal hypertension (11.58％),pseudocyst (4.21％) and hemobilia (3.16％).Most cases were of singular lesion,located in the pancreatic head (61.05 ％) in 58 cases and in the pancreatic body-tail (20％) in 19 cases.Surgery (51.58％) was the most common treatment for pancreatic arteriovenous malformation cases,followed by transarterial embolization (17.89％),a combination of surgery and transarterial embolization (7.37％) and radiotherapy (4.21％).Watchful conservation was adopted in 20％ cases.Conclusions Pancreatic arteriovenous malformation occurs most commonly in males.Epigastric pain and gastrointestinal bleeding are the main clinical presentations.Surgical resection is indicated in symptomatic patients.

Objective To evaluate the feasibility of OX40L gene silence in dentritic cells by RNAi through lentiviral vector, so that to explore the influence of CD4 + CD25 + T regulatory cells by blocking OX40/OX40L costimulation signals. Methods Serial plasmids were constructed, consisting of lentiviral vector framework, containing different OX40L siRNA sequences. The most effective packaged one by 293T cells to be the operating siRNA vector named OX4OL-RNAi-LV was chosen. The negative comparing vector was NC-GFP-LV. DCs isolated from C57BL/6 mice by magnetic selecting system were cultured in vitro and divided into 3 groups. Experimental group and negative control group were transfected with OX40L-RNAi-LV and NC-GFP-LV, respectively, and the blank control group was given the same volume culture solution. The MOI was 25. The status of transfection and GFP expression was monitored by GFP fluorescence. 6 days later, CD86 positive DCs were isolated and were co-cultured with CD4 + CD25 + T regulatory cells isolated from na(y)ve BALB/C. 6 days later, the proliferation and apoptosis of Tregs were evaluated by flow cytometry.Results The most effective siRNA sequence targeted the C,CTCATACAAGAATGAGTA episode of OX40L gene. The suppressive ratio of the OX40L protein expression was 73.1%. While the MOI was 25, the DCs transfected ratio by lentiviral vectors was at the level of 86. 4%. After co-cultured for 6 days, the CD4+CD25 +T regulatory cells of experimental group have a higher proliferation index (respectively, 38.3% vs.24.5 % ,22. 9%, F = 95.40, P = 0. 000) and lower apoptosis percentage ( respectively, 8.7 % vs. 20. 1%,19.8%, F=244.22,P=0. 000) than negative group and blank group. Conclusions The OX40L siRNA lentiviral vetor was constructed. This vector could effectively transfect DCs and block OX40/OX40L pathway, so to promote CD4 + CD25 + T regulatory cells proliferation in vitro.

Objective To optimize the condition of converting murine naive CD4+ CD25-T cells ( effector T cells,Teffs) to CD4-CD8-double negative regulatory T cells ( DN Tregs) in vitro.Methods Naive Teffs from C57BL/6 mouse were isolated with magnetic activated cell sorting( MACS)and co-cultured with DBA/2 mature dendritic cells (mDCs) with different doses of recombinant murine interleukin-2 (IL-2).The percentage of converted DN Tregs was examined by flow cytometry after 6 days.Purified DN Tregs were co-cultured with CFSE labeled Teffs.The proliferation rate of Teffs were evaluated by flow cytometry.Results Without IL-2,the percentage of CD4-CD8-T cells was 6.21％ ± 2.03％.With IL-2,the percentage was 14.77％ ± 2.15％ ( 25 ng/ml),21.29％ ± 2.68％ (50 ng/ml),43.45％ ±4.45％ (75 ng/ml),and 28.59％ ±3.05％ ( 100 ng/ml) respectively.The IL-2 concentration of 75 ng/ml signilicantly enhanced the conversion of Teffs to DN Tregs ( separately t =10.700,8.288,6.158,3.932,all P ＜ 0.05).Highly purified DN Trega significantly suppress the proliferation of Teffs in vitro.Conclusions Teffs are converted to DN Trega in vitro with the LPS-activated allogeneic mDCs and that 75 ng/ml of IL-2 is the optimal concentration for the conversion of Teffs to DN Trogs in vitro.

Objective To investigate the clinical effectiveness of oral ganciclovir on prevention and treatment of cytomegalovirus (CMV) infections after liver transplantation.Method We tested archival peripheral blood of 69 kidney recipients for CYP3A5 genotyping by polymerase chain reaction sequence-specific primer.The dose,blood concentrations and dose-normalized blood concentrations of tacrolimus were measured at 1 st and 2nd month after the renal transplantation.Result pp65 antigen of CMV was negative in all the patients before liver transplantation.In 72 patients subject to acyclovir,9 cases (12.5％) were infected by CMV.By using oral ganciclovir to prevent CMV infection after 1iver transplantation in 376 patients,pp65 antigen of CMV was detected in 17 patients (4.5％).Fifteen patients received intravenous ganciclovir for treatment of CMV infection or CMV pneumonia,and 6 patients (40％) suffered from granulocytopenia because of the use of intravenous ganciclovir.Forty-six patients (12.2％) suffered from granulocytopenia because of the use of oral ganciclovir.Conclusion Oral ganciclovir is a safe and effective drug for prevention and treatment of CMV infection.

Objective To study the risk factors of hepatitis B virus re-infection after liver transplantation. Methods We retrospectively analyze the data of 285 patients who underwent liver transplantation for hepatitis B related diseases basing on data collected during a follow-up of at least 6 months. Results The postoperative follow-up ranges from 6 to 59 months of all the 285 cases after liver transplantation. There were 10 patients diagnosed as hepatitis B virus re-infection after liver transplantation leading to a 3.5% re-infection rate. There were 9 patients being diagnosed as HCC recurrence before HBV re-infection was identified. Patients with HCC recurrence suffered from higher HBV re-infection rate than other patients, and HBsAg and HBcAg was detected in one of the 13 metastatic HCC specimens.Conclusions HBIg combined with nucleotide analogue can effectively prevent HBV re-infention. HCCrecurrence is an important risk factor to HBV re-infection after liver transplantation.

Objective To study clinical characteristics of postoperative recurrence of liver malignant tumor after liver transplantation,the postoperative standard evaluation,and treatment for recurrent tumor. Methods We retrospectively analyzed the data of 81 recurrent cases among 215 patients undergoing liver transplantation for malignant liver tumors,focusing on the recurrent time and location and the result oftreatment.Results The follow-up time ranged from 6 to 108 months of all the 81 patients after liver transplantation.The time of tumor recurrence ranged from 3 to 20 months after transplantation.and lung,abdominal cavity,new liver and bone were among the most common places of recurrence.Local therapy was the mainstay of therapy,including liver lobectomy in 6 cases and gamma knife treatment for pulmonary metastasis in 74 cases;Resection for abdominal mass Was performed in 10 cases.Gamma knife treatment for abdominal lymph node metastasis in 8 eases,resection of hepatic metastatic tumor in 6 cases,ablation therapy in 5 cases,gamma knife treatment in 15 cases,33 cases underwent repeated TACE and 3 cases received re-transplantation for liver metastasis;For bone metastasis 15 cages underwent resection,16 cases did gamma knife treatment and 3 cases underwent internal fixation for bone fracture caused by bone metastasis;For intracranial metastasis 4 cnses received gamma knife treatment.3 cases were cured,6 cases were still alive with recurrent tumor for 21～56 months respectively and the mean survival time was 39 months;72 cnses died with a mean survival time of 15 months.Conclusion The regular and standard close follow-up for liver transplantation recipients suffering from primary liver malignant tumors and aggressive therapy for the recurrent tumors help prolong patient's survival.

Objective To investigate the timing, target and method for the treatment of preoperative coagulopathy in patients undergoing orthotopic liver transplantation. Methods We retrospectively assessed 168 adult patients undergoing orthotopic liver transplantation from 2002 to 2004. Preoperative prothrombin time(PT) , prothrombin activity (PTA) , international normalizing ratio(INR) , activated partial thromboplastin time(APTT) , fibrinogen (FIB) , and platelet count (PLT) were assessed. The relationship between PTA and intraoperative blood loss or use of blood product, preoperative plasma exchange and intraoperative blood loss or use of blood product were analysed. Results Preoperative normocoagulation significantly decreased intraoperative blood loss and blood product' s requirement. PTA level was in negative correlation with intraoperative blood loss and blood transfusion. Preoperative plasma exchange effectively reduced intraoperative bleeding and blood product's requirement. Conclusion Aggressive coagulatory therapy should be adopted to improve coagulation condition in order to reduce intraoperative blood loss and blood product's requirement.