Liver transplantation is the most effective treatment for end-stage liver diseases.To expand the donor source,the Ministry of Health (MOH) initiated a new national program called Donation of Citizen's Deceased (DCD) to address the need for organ transplantation in 2010.However,it has been proven that DCD liver transplantation has the poorer graft function in short-and long-term outcome compared to live donor liver transplantation.In order to improve the effect of DCD liver transplantation,the preconditioning of DCD liver,as an effective measure,is gaining more and more attention.This review summarizes the recent research progress on the application of preconditioning in DCD liver transplantation during perioperative period.

With the increasing demand for liver transplantation,some previously abandoned donors,called marginal donor,started to be involved in clinical liver transplantation,which raises higher requirement on the organ preservation methods.Normothermic perfusion is regarded to be superior to the currently adopted hypothermic perfusion,and plays an important role in the organ preservation of marginal donors.This review will summarize the clinical applications of liver normothermic perfusion in transplantation and repair,as well as its roles in basic research.

Vascular complications after liver transplantation can seriously threaten the survival of patients.In the preoperative assessment and postoperative monitoring of patients' vascular conditions,although the digital subtraction angiography (DSA) is the golden standard for vascular lesion diagnosis,but not the first choice due to traumatic lesions.In some clinical circumstances,DSA can only be used when Doppler ultrasound,spiral CT,and MRI are not applicable,and in most cases DSA is used for treatment rather than diagnosis.This article reviewed the current interventional treatment of vascular complications to stress the important role of DSA in diagnosis and treatment of related complications after liver transplantation.

Objective To investigate the relationship between hepatic venous outflow obstruction (HVOO) and patterns of the hepatic vein (HV) drainage into inferior vena cava (IVC) in piggyback liver transplantation (PBLT).Methods A retrospective analysis on 202 cases of PBLT (from May 2000 to Aug.2015) was conducted.The recipients' patterns of HV drainage into WC and the angle ∠COB between the reconstructed outflow and IVC in the cross section were recorded by preoperative 3D reconstruction.And the lengths and diameters of recipients' HVs were measured during operations.The relationship between the incidence of HVOO and patterns of HV drainage into IVC was analyzed.Results There were 3 patterns of HV drainage into IVC:type Ⅰ (n =136),trunk of left and middle HVs;type Ⅱ (n=52),trunk of right and middle HVs;type Ⅲ (n=14):trunk of three HVs.There was no statistically significant difference within the HVs of each type,when the lengths and diameters were compared respectively.However,the angle ∠COB of type Ⅰ [(164 ±10.14)°] was significantly bigger than type Ⅱ [(44 ± 12.2)°] and type Ⅲ [(96 ± 13.1) °] (P＜0.05).Accordingly,the highest incidence of HVOO (23.5％) was foundin type Ⅰ,followed by type Ⅱ (9.6％),and type Ⅲ had the lowest incidence (7.1 ％) (P＜0.05).The correlation coefficient Cramer's V =0.765.Conclusion This study demonstrated that there was preferable relativity between the HVOO incidence and the patterns of HV drainage into IVC.Type I is more likely to have HVOO.Type Ⅲ is the most ideal one for PBLT.

Objective To systematically review the effect of donor ischaemic preconditioning in liver transplantation.Methods Databases including the Cochrane Library,PubMed,EMbase,CNKI,VIP and WanFang database were searched up to June 2016 for studies which involved donor ischaemic preconditioning (IPC) in liver transplantation.The data retrieved included 1-year mortality,incidence of Primary Graft Non-Functioning (PGNF),intensive therapy unit (ICU) hospitalization and liver function tests which were used to evaluate the treatment outcomes.The data were analyzed using both the fixed-effect and the random-effects models.For categorical outcomes,risk ratio (RR) with 95％ confidence intervals (CI) were calculated.For continuous outcomes,the mean difference (MD) with 95％ CI were calculated.The metaanalysis was performed using Review Manager 5.2 software.Results Six clinical studies with 322 patients were qualified for this meta-analysis.There were no significant differences in the 1-year mortality (OR =0.51,95％ CI 0.24 ～ 1.05,P ＞ 0.05),PGNF (OR =0.33,95％ CI 0.08 ～ 1.40,P ＞ 0.05) and ICU hospitalization (OR =-0.17,95 ％ CI-2.72 ～ 2.38,P ＞ 0.05) between the donor ischaemic preconditioning and the control groups.There were also no significant differences in the transaminase and bilirubin levels on postoperative day 1,3 and 7 between the two groups.Conclusion There is currently not enough evidence in evidenced based medicine to recommend the routine use of ischaemic preconditioning in donor liver retrieval.

Liver transplantation is a standard life-saving procedure for end-stage liver diseases.The therapeutic potential of this procedure may be limited by post-operative infectious complications.A better understanding on the common important infectious complications may improve the life quality and survival rate after liver transplantation.In this article,we review the progress on infectious complications after liver transplantation,with particular emphasis on risk factors,clinical manifestations,diagnostic methods,prevention measures and specific treatments for bacterial,fungal,cytomegalovirus infections.

Objective To examine the metabolic variations in liver after 30 min warm ischemic injury,and the effect of hypothermic machine perfusion on the metabolism in rats.Methods 40 SD male rats were randomly divided into 4 groups:Group A,the liver underwent warm ischemia for 0 min and cold storage (CS) for5 h; Group B,the liver was treated by warm ischemia for0 min,CS for4 h and then machine perfusion (MP) for 1 h; Group C,the liver suffered from warm ischemia for 30 min and CS for 5 h; and Group D,the liver was treated by warm ischemia for 30 min plus CS for 4 h plus MP for 1 h.During the MP process,the perfusion resistance index was recorded every 10 min,and the liver glycogen content and malondialdehyde (MDA) value were also detected.Results The hepatic glycogen content decreased after MP treatment,but there was no statistical significance (P ＞ 0.05).No differences on MDA contents was found between Group A and B (P ＞ 0.05),while MDA in Group D was significantly higher than that in Group C (P ＜ 0.05).After hypothermic MP treatment,the liver resistance index value was significantly reduced.Conclusion MP could reduce the resistance index but increase metabolic rate in liver undergoing warm ischemic injury,thus producing more lipid peroxides.

Objective To explore the effect of moderate hypothermia (MH) in liver ischemiareperfusion (IR) injury.Methods Male BALB/c mice (8 weeks old,n =15) were randomly divided into three groups:IR group:five mice subjected to 70％ hepatic IR (hepatic vascular triad above the bifurcation occlusion for 35 min before 24 h reperfusion) in normal temperature condition (37 ±0.5 ℃);MH + IR group:five mice were treated with MH (32 ±0.5 ℃) for 2 h before 70％ hepatic IR was performed;sham group:the other five mice were subjected to laparotomy and liver manipulations without vascular occlusion.AST and ALT in plasma were detected in all mice,and the morphological changes,cell apoptosis and the cold-inducible RNA-binding protein (CIRP) expression after MH in liver tissues were detected.Results Compared with IR group,the ALT and AST levels in MH + IR group were significantly decreased.In IR group,the liver morphology deteriorated with more severe hydropic degeneration and more cell apoptosis.In MH + IR group,the expression of CIRP began to increase after MH preconditioning.Conclusion MH preconditioning could protect against the liver ischemia-reperfusion injury.

Liver transplantation is the main treatment for end-stage liver diseases and liver tumor.To solve the problem of the insufficient donor liver,autologous liver transplantation (ALT) is becoming widely acknowledged,which could serve as a complementary technique for treating unresectable liver space-occupying lesions in routine operation.However,compared with allogeneic liver transplantation,the long anhepatic phase during ALT may influence the outcome of such patients.Veno-venous bypass (VVB) as a technology which can maintain the stability of hemodynamics and internal environment in the anhepatic phase is routinely used in ALT.In this paper,the application of VVB in the ALT was mainly discussed.

Objective To investigate the effects of sevoflurane on HIF-1α/epithelial mesenchymal transition (EMT)pathway activity and invasion of lung cancer in rats undergoing one lung ventilation (OLV). Methods Lung cancer model of SD rats was established. Rats were randomly divided into 4 groups:group control(group C), group two lungs ventilation(TLV)(group T),group one lungs ventilation(group O),and group sevoflurane +one lungs ventilation(group SO). Two lung ventilation was performed after endotracheal intubation for 2.5 h in group T. OLV was performed after endotracheal intubation for 2 h in group O and SO. The end-expiratory concentration of sevoflurane of rats in group SO was maintained 2.6% during OLV period. Left lung cancer tissues were harvested at 0.5 h of TLV. The protein levels of HIF-1α,Vimentin and Fibronectin in lung cancer were determined by Western blot. The mRNA levels of MMP-2 and MMP-9 in lung cancer were evaluated by RT-PCR. Results The expres-sions of HIF-1α,Vimentin,Fibronectin,MMP-2,and MMP-9 in group O and group SO were significantly higher than those in group C and group T(P<0.05). The expressions of HIF-1α,Vimentin,Fibronectin,MMP-2,and MMP-9 were decreased significantly in group SO as compared with group O(P<0.05). Conclusion Sevoflurane inhibits the elevation of HIF-1α/EMT pathway activity and invasion ability induced by OLV.