Objective To study the effect of simultaneously combined liver and kidney transplantation (SLKT) on end-stage liver and kidney diseases. Methods Thirteen cases subject to SLKT from 1996 to 2004 were reviewed in The First Affiliated Hospital of Sun Yat-sen University. Among them, there were 4 cases of polycystic liver and kidney, 4 cases of hepatic cirrhosis and renal failure, and 5 cases of fulminant heptic failure and hepatorenal syndrome. Ten were males and 3 females with an average age of 45.5 years old.Results Four cases of polycystic liver and kidney have all survived for more than one year after SLKT, and one of them has survived for 4 years. The 3 of 4 patients with hepatic cirrhosis and renal failure have survived more than one year, and one of them died perioperatively. The 2 of 5 patients with fulminant hepatic failure and hepatorenal syndrome have survived for one year, and 3 of them died perioperatively.Conclusion SLKT has been the effective therapy for end-stage liver and kindney diseases; The indications of SLKT for hepato-renal syndrome were discussed. SLKT may immunologically protect the renal graft.

Objective To evaluate the epidemiology, prophylaxis and treatment of bacterial infections after orthotopic liver retransplantation.Methods A retrospective study on bacterial infections in 22 patients undergoing othotopic liver retransplantation was carried out.Results Bacterial infections were confirmed in 8 of 22 preoperation and in 20 of 22 (90.9 %) postoperation. The median time of bacterial infections was 7 days after liver retransplantation. Fifty-one pathogenic organisms including 25 types were separated. The most commonly seen infected sites were biliary tract (50.0 %, 11/22), abdomen (45.4 %, 10/22), respiratory tract (36.4 %, 8/22), blood (31.7 %, 7/22), incision ((9.1) %, 2/22), bowel (4.5 %, 1/22), veins with venipuncture (4.5 %, 1/22). Seven cases of sepsis died.Conclusion The infectious rate after liver retransplantation is high and the types of bacterial disseminating loosely on organs are varied. The mortality will be increased if the patients develop sepsis. Reasonable use of immunosuppressants, selection of antibiotics and the supporting therapy are the keys to prevent and treat infections following liver retransplantation.

Hepatic ischemia/reperfusion injury (HIRI) exists in lots of process of clinical pathology and operation. Apoptosis is an active process controlled by some gene and factors such as Fas/FasL, Caspases and Bcl-2 families. More and more studies suggest that HIRI is associated with apoptosis. This article summarized the mechanisms and gene modulation of apoptosis during HIRI and the significance of suppressing apoptosis in preventing HIRI.

5 cases of orthotopic live transplantation (OLTX) were performed in unresectable hepatic cellular carcinoma(3),Wilson's disease(1)and hepatitis B(1).The donor livers were harvested by the technique of rapid multiple organ harvesting,flushed and preserved with UW solution.The veno-venous bypass was introduced during the anhepatic phase in the operation.The double or triple-drug immunosuppressive regimen was used and three episodes of acute rejection were controlled in two patients.One patient died of CMV infection and another,of upper gastrointestinal hemorrhage on the 92nd and 58th postoperative day respectively.The other three are still alive for 35,150 and 210 days.

Objective:To investigate the techniques of establishment of abdominal heart transplantation model in rats and modify the procedure to make it more stable and improve the success rate.Methods: Heterotopic abdominal heart transplantations of Wistar and SD rats were performed by using Ono's method with modification of preparation of recipients,donor cardiectomy and donor transplantations.Results: One hundred heart transplantations were performed,among which 90 were successful.The success rate was 90%.Conclusion: This modified Ono's method can shorten the ischemia time and recipient abdominal aorta occlusion time,make vessel anastomosis easier and increase the success rate of operation.It is a stable and reliable model of heart transplantations in rats.

Objective To investigate the surgical technique of establishing a reliable rat model of orthotopic liver transplantation and prevention of operational complication. Methods The model was established with modified cuff technique.The donor was perfused through the abdominal aorta with 20ml cold perfusate.The anastomosis of the suprahepatic vena cave(VC)was sutured end-to-end with 8-0 nylon line,and the continuity of infrahepatic VC and portal vein (PV)were established by means of cuff method respectively.The bile duct anastomosis was performed by internal stent. Results Three hundred and sixty case of rat orthotopic liver transplantation were performed and the successful rate of the mode was 91.3%.In non-intervention group,the survival rat was satisfactory,with a 86.5%of 1 week survival and a 80.7% of long-term survival (longer than 3 months). Conclusions The sophisticated microsurgical technique and the delicate surgical manipulation is the prerequisite of preventing operational complication,and shortening the anhepatic phase of recipient as soon as possible is the key to animal survival.

Objective To sum up the clinical experience of liver retransplantation (ReTx).Methods All recipients were male. The average age was 50 years old (43-55). The indications included primary nonfunction (PNF) (1 case), acute rejection (1 case), chronic rejection and biliary infection (1 cases) and ischemic type billiary lesion and biliary infection (2 cases). The blood types of recipients and donors were identical. All donors were heart arrest. The immunosuppressive protocols included Zenapax and methylpredinisone (MP) and FK506. MMF was added if necessary.Results Three patients were cured. Two patients died at 8th and 10th day. One died of serious infection and failure of multiple organs and another died of heart failure. Complications included multiple organ infection (1 case) and biliary infection (1 case) and wound infection (1 case).Conclusion Liver retransplantation is an effective treatment for graft failure after liver transplantation. Proper indication and optimum operation time, intensive perioperative supervision and proper treatment were very important for improved effect of liver retransplantation.

Objective To evaluate the surgical technique and outcome of the extended radical resections for hilar cholangiocarcinoma.Methods A patient with Bismuth-Corlette type Ⅳ Klatskin's tumor, which invaded the secondary intrahepatic bile duct and the pancreatic portion along the common bile duct, underwent the HPLT_ X . And then, the digest cannel was reconstructed according to the Child's methods. By using immunohistochemistry, the expression of cytokeratin9, 17, CEA and hepatocyte protein was detected. After operation, the immunosuppressive agents consisting of Tacrolimus and steroids were given; lamivudine and HBIg were used to prevent HBV from recurrence.Results Pathologic examination revealed low differentiated adenocarcinoma and immunohistochemistry stains confirmed the positive expression of cytokeratin9 and 17, carcinoembryonic antigen, and the negative expression of hepatocyte protein. Neither the margins of resection nor periductal lymph nodes were pathologically involved. She was currently alive for 17 months after the operation, the liver graft function was within normal range, and the patient was back to the previous work without any evidence of recurrent cancer. The tumor marker in plasma was decreased to the controllable level.Conclusion The HPLT_ X may be the treatment choice for unresectable Klatskin's tumor and provide the higher rate of radical resection and better prognosis.

Micro-implant anchorage was used for orthodontic intervention of 3 patients with buccal impacted maxillary canine,good clinical outcome was obtained.The micro-implant anchorage may provided a new approach for the treatment of this kind of teeth.

Objective Partial hepatectomy, liver transplantation, and radio frequency ablation for hepatocellular carcinoma (HCC) were compared to select the most suitable method for HCC. Methods 1198 patients with HCC in 3 hospitals in Guangzhou were divided into 3 groups: group Ⅰ , small HCC; group Ⅱ > HCC without vascular invasions and group Ⅲ , HCC with vascular invasion. The patients either received partial hepatectomy, transplantation or ablation. The 1-, 2- or 3-year survival rates, the 3-year recurrent rates and Child-Pugh grades in the 3 groups were compared. Results For small HCC, there was a significant increase in the 3-year survival rate (P<0. 05) and a significant decease in the recurrent rate (P<0. 05) in patients who received transplantation, compared with those who received hepatic resection. Patients who received ablation had a higher 3-year survival rate and a lower recurrence (P<0. 05) in comparison with those who received hepatectomy. There was no significant difference(P<0. 05) between transplantation and ablation, but there were more Child A patients who received hepatectomy and ablation, and more Child B and C patients who received transplantation. For advanced HCC, there was no significant different in the 3-year survival rates for the 3 therapies, but the 3-year recurrence was lower (P<0. 05) in the transplantation group. Conclusions For small HCC, superiority of transplantation versus resection was obvious. Ablation (diameter <3 cm) was also superior to resection, whereas ablation was as effective as transplantation. There were more Child B and C patients in the transplantation group than the ablation and resection groups. Therefore, small HCC with hepatic decompensation should receive liver transplantation. Transplantation was advantageous in having less tumor recurrent but there was no difference in the 3 therapies for advanced HCC.