With the worldwide increase in adult-to-adult live donor liver transplantation, more profound basic and clinical medical research has ensued to solve the key problem of graft failure following liver transplantation. The present status of the study of small-for-size liver syndrome was summarized. Its definition, risk factors, pathogenesis,clinical manifestations, prevention and treatment were included.

fulminant liver failure(FLF)is a rapid onset life-threatening emerency in which liver dysfunction,liver failure and hepatic encephalopathy occur within 8 weeks in previouslv norillal person.It has been confirmed by available clinical experience and literatures during the past decades that FLF patients are ideal recipients of liver transplantation.However,the prognosis of the FLF patients who accepted liver transplantation differed greatly according to the available reports because of the differences of supportive treatment during waiting period,the criterion for recipient assessment,the determination of operation chance,the use of critical techniques during operation and postoperative management between different transplantation centers.We probe the standardized clinical use of the aspects above mentioned in liver transplantation for FLF,particularly discuss the treatment of complications resulting from coagulopathy,determination of operation chance,significance of standardized etiological treatment and the indication of the use of veno-venous bypass technique during transplantation to provide better treatment strategy and improve the prognosis of FLF patients.

Objective To evaluate the value of IL15mRNA determination in the early diagnosis and differential diagnosis of acute rejection(AR) after liver transplantation.Methods RT-PCR was used to detect the mRNA of IL-15 in serum and bile on the 30th day after liver transplantation in 43 patients subject to orthotopic piggy-back liver transplantation.Serum and bile of the patients were cultured for bacteria.The acute rejection was confirmed pathologically. Results Acute rejection(occurred) in 16 out of 43 cases as the AR group and bacterial infection(BI) in 12 cases as the BI group.The (remaining) 15 patients were uneventful as the control group.Before diagnosis of AR and BI,the gene expression rate of IL-5 in bile was significantly higher in AR group((62.5 %)) than in BI group((16.7 %)) and control group((13.3 %))(P

Non-coding RNAs mainly include microRNAs and long non-coding RNAs (LncRNAs),which work as a kind of RNA to regulate the expression of gene at the levels of transcription,post-transcription and epigenetics.Recent studies have shown that many non-coding RNAs are dysregulated during liver regeneration after partial hepatectomy.This review summarized the biological characteristics and regulatory mechanisms of non-coding RNAs in liver regeneration after partial hepatectomy.

Autologous liver transplantation,a type of ex situ liver surgery along with hypothermic organ preservation,a venovenous bypass and complicated vascular reconstructions,allows better access to unresectable tumor and is considered as an effective strategy to overcome the shortage of donors.However,the high complication incidence and mortality related with the technique limit its wide application.To popularize this technique,based on our current experience,we review the key parts of the surgery and the treatment strategy for the complications.

Objective To summerize the experiences of using molecular adsorbent recycling system(MARS) in perioperative period of orthotopic liver transplantation (OLT). Methods The effects of MARS artificial liver treatments in 19 cases were reviewed. Results The levels of serum total bilirubin, BUN, Cr, urine acid and blood ammonia were greatly reduced by using MARS. Fifteen patients were bridged to transplantation, 1 patient was relieved in symptoms of hepatic encephalopathy after MARS treatment, died 2 weeks after leaving hospital, 1 patient died of severe gastro intestinal bleeding before transplantation. The survival rate is 89.5%.Conclusion MARS artificial liver now is a safe and effective assistant device. It can help to gain more chance of undergoing OLT for the patients.

Objective To investigate the effects of simultaneous hepatic artery and portal revaseularization on the expression of TNF-α during bile duet ischemia-reperfusion injury in rats liver transplantation.Methods Male Spragne-Dawley rats were used to establish an autologous orthotopic liver transphmtation model.Model rats were random divided two groups,simultaneous revascularization group(sroup P)and portal vein revascularization group(group N).The animals were separately killed at the 2nd hour,6th hour and 24th hour after reperfusion.Plasma samples were collected for ALT,AST,GGT,AKP,TBiL and DBiL test.Bile duct tissues were collected to detect the histolosical changes,MPO activit,and the expression of TNF-α mRNA.Results The serum levels of GGT in group P was significantly lower than that in group N at the 6th hour and 24th hour after reperfusion(P＜0.05).And the serum levels of AKP,TBiL and DBiL and the morphological scores of bile duct in group P were significantly lower than that in group N at the 24th hour after reperfusion(P＜0.05).The activity of MPO in group N was significantly higher than that in group P at the 6th hour after reperfusion(P＜0.05).Compared with group N,the expression of TNF-αmBNA was reduced significantly in group P at the 2nd hour and 6th hour after reperfusion(P＜0.05).Conclusion Simultaneaus hepatic artery and portal revascularization can alleviate I/R induced bile duct injury of rat liver grafts,and the protective mechanism may be asseciated with inhibition the expression of TNF-α and decrease of neutrophil infiltration.

In order to evaluate the applied value of soluble intracellular adhesion molecule-1 (sICAM-1) in acute rejection (AR) following liver transplantation, the expression of sICAM-1 protein was sequentially detected by using ELISA in serum and bile of 43 patients receiving liver transplantation. In AR group, the expression levels of sICAM-1 protein were increased 3 days before and immediately on the establishment of AR diagnosis, and there was significant difference in the expression of bile between AR group and control group (P<0.01). After reversion of AR with hormone intensive therapy, there was significant difference in the sICAM-1 protein expression of serum and bile between AR group and control group. It was concluded that the sequential detection of sICAM-1 protein level in serum and bile was a reliable and noninvasive method for the early diagnosis of AR after liver transplantation and was valuable to observe the curative effects of anti-AR therapy.

Classical piggyback liver transplantation (CPBLT) is an advanced technique based on standard orthotopic liver transplantation (SOLT),which has more advantages compared to the SOLT.However,there are still some problems with CPBLT to be solved,such as complicated surgical procedures,postoperative hepatic venous outflow obstruction and thrombosis.Recently,in order to solve these problems,modifications have been made,being named ameliorated piggyback liver transplantation (APBLT).The APBLT solved above-mentioned problems,and expanded the application of PBLT.Therefore,this article describes the technique of these ameliorations,and discusses their individual characteristics.

Objective To evaluate the therapeutic effects of EN,PN support on postoperative recovery of (patients) with portal hypertension. Methods 135 patients with portal hypertension who underwent (esophagogastric) devasularization were randomly divided into three groups:EN,PN and control group. (Postoperatively), EN and PN nutritional support and routine fluid replacement therapy was respectively given to the 3 groups. Several clinical and laboratory parameters were studied in order to determine the therapeutic effect of the two different forms of nutrition.Results Nutritional status and immunological function of patients were improved in both EN and PN study groups but with no significant difference, while alterations in liver function and incidence of abdominal infection were higher in PN group. Conclusions EN is an optimal form of nutritional support for patients with portal hypertension after operation.