Objective To explore the application strategies of immunosuppression scheme after different types of liver transplantation for liver diseases. Methods According to the published literatures and the practical experiences in organ transplant center of Tianjin First Center Hospital,the immunosuppression schemes used after liver transplantation,the liver transplantation in patients with hepatitis C or liver cancer,patients after liver re-transplantation or with concurrent infection or with renal injury were summarized,and the spontaneous controllable tolerance (SOT) and the dosage reduction or elimination of immunosuppressor were approached. Results① Dose reduction and combined drugs therapy were the important strategies to adjust immunosuppressor after liver transplantation.②Maintaining low level immunosuppression,avoiding the repeat of cell rejection reaction and actively implementing antiviral therapy could slow down the progress of fibrosis after liver transplantation in HCV patients with recurrent hepatitis.③The induction therapy using anti CD25 monoclonal antibody and based on sirolimus(SRL) maintaining immune inhibition were the related factors to improve the survival rate of liver transplantation in patients with liver cancer. ④ We needed to strengthen the immune inhibitor concentration detection and timely adjust the dosage of calcineurin inhibitors(CNIs)or SRL after liver re-transplantation or when there was infectious complication. In severe cases with infection,we could consider to remove them.⑤We could reduce the progression of renal injury after transplantation by decreasing the CNIs or converting to SRL.⑥Inducing stable and durable immune tolerance and designedly withdrawing the immunosuppressor after liver transplantation in relatively stable patients,we might expect 20% patients achieving SOT. Conclusions The progress of immunosuppression scheme after liver transplantation on the one hand depends on the successive development of new types of immunosuppressor with lower adverse effect, and on the other hand,the more accurate genomics,pharmacogenetics and pharmacokinetic methods for monitoring the transplanted liver damage are necessary. We also need to look for specific immune monitoring methods to accurately assess the effectiveness and toxicity of immunosuppressive agents to gradually withdraw or stop the immunity inhibitors.

OBJECTIVE:To study the postoperative use of anti-infectives inpatients undergoing liver transplantation and its rationality.METHODS:50 inpatients who had undergone liver transplantation were randomly collected from center of organ transplantation for the analysis of the use of anti-infective agents within 1 month after operation in respect of utilization frequency(cases/times),duration of medication,drug utilization index(DUI) as well the conformity between drug combination and etiology so as to derive the rationality of drug use.RESULTS:Among the top 10 anti-infectives in terms of utilization frequency in patients undergone liver transplantation,9 had their DUI less than 1,and 1 had its DUI above 1.The perioperative application rate of anti-infective agents was 100%.In terms of drug combination,2 cases(4%) used one kind of anti-infectives,17(34%) two kinds,21(42%) tree kinds,10(20%) four kinds concomitantly.CONCLUSION:The doses and the proportion of anti-infectives used in combination for inpatients undergoing liver transplantation were on the high side,which should be controlled urgently.

Ischemia reperfusion injury (IRI) is a multistep pathophysiological process involving a complex of multi-factors.To alleviate the IRI is of great importance in clinical liver transplantation,especially for marginal donor livers.This article overviewed the protective strategies and the latest progress for alleviation of IRI in three stages of liver transplantation,which includes liver procurement,preservation and reperfusion.

Objective To summarize the experience of establishing a split liver transplantation pig model using extracorporeal normothermic machine perfusion (NMP).Methods Twenty miniature pigs were purchased with ten as donors and another ten as receptors.The graft was spliced along Taira line and the right half was reserved for transplantation.Hemodynamics and bile production volume were monitored,and blood biochemical and blood gas analysis indicators were detected during machine perfusion.Pathological change was observed by HE stain.Hemodynamics during liver transplantation,5-day survival rate and the cause of death were recorded.Results Hemodynamic,biochemical and blood gas analysis indicators remained stable during NMP.All receptor pigs were successfully extubated and awake after surgery.Two receptors died on the second day after the operation.The 5-day survival rate was 80％.Conclusion The split liver transplantation pig model using extracorporeal normothermic machine perfusion is feasible and appropriate,and it lays the foundation for further investigation.

Objective To investigate effects of microRNA-506 (miR-506) on malignant phenotypes of hepatocellular carcinoma (HCC) cells, including cellular viability, proliferation and invasion. Methods HCC cell lines HepG2 and QGY-7703 were served as model. Five experimental groups were established in this study, including cell control, pcDNA 3 blank vector control, miR-506 over-expression, pSIH1 blank vector control and miR-506 suppression groups. Real-time reverse transcription PCR assay was performed to measure miR-506 level. CCK-8, colony formation and Transwell assays were performed to detect viability, colony formation activity and invasion activity of HCC cell lines, respectively. Effects of miR-506 on these indexes were evaluated. Results In HepG2 and QGY-7703 cell lines, miR-506 level increased in the miR-506 over-expression group (P<0.01), and its level decreased in the miR-506 suppression group (P<0.05) compared with the related blank vector control groups. In the miR-506 over-expression group, cellular viability was significantly reduced (P<0.01), cell colony number decreased, and number of cell penetrating Transwell microporous membrane was also decreased (P<0.01). In the miR-506 suppression group, cellular viability significantly increased (P<0.01), and both colony number and penetrating cell number increased (P<0.05). Also, there were no effects on the above indexes in pcDNA3 and pSIH1 blank vector control groups compared with those of cell control group (P>0.05). Conclusion miR-506 plays a tumor suppressor role in HCC cells by inhibiting cell viability, colony formation and invasion.

Partial hepatectomy (PH) is widely used and the preferred method for the surgical treatment of hepatocellular carcinoma,and liver regeneration is directly related to the prognosis of the patients after the operation.Therefore,the specific mechanism and cytokines related to liver regeneration have become a hot topic in recent years.Currently,there is a wide variation of reported gene expressions and signal transduction pathways in the literature,but the mechanism and interactions are still unclear,especially for postoperative liver regeneration with hepatitis or cirrhosis.This review summarizes current research on the liver regeneration process,the mechanism of liver regeneration after partial hepatectomy,and the different mechanisms of hepatocirrhosis.

Objective To analyze the individual immunosuppressive protocol (IP) after liver transplantation (LT) in benign end-stage liver disease. Methods The clinical data of 645 patients with benign end-stage liver disease undergoing LT in our institute from April 2002 to Aug 2010 wen analyzed retrospectively. 146 cases from Apr. 2002 to Dec. 2004 were in stage one, and triple therapy containing tacrolimus (Tac), mycophenolate mofetil (MMF) and methylprednisolone (MP) was used;273 cases from Jan. 2005 to Dec 2007 were in stage two, and the less dose of immunosuppressant than stage one was used; 226 cases from Jan. 2008 to Aug. 2010 were in stage three, and they wen divided into conventional group and severe patient group according to their preoperative model for endstage liver disease (MELD) score and patient condition, the individual IP was used. Results The overall survival rate of patients with MELD score <25 was 88. 9 % in stage one, 94. 2 % in stage two, and 95. 4 % in stage three; The overall survival rate of patients with MELD score ≥25 was 67. 7 % in stage one, 73. 4 % in stage two, and 82. 0 % in stage three. The incidence of rejection ir cases with MELD score <25 had no significant difference (P>0. 05). The incidence of rejection in cases with MELD score ≥25 in stage two and stage three was higher slightly than in stage one (P<0. 05). Conclusion The IP after liver transplantation should be individualized according to recipient conditions, which can increase survival rate.

Objective To discuss the causes of acute hematogenesis disorder after liver trans-plantation. Methods A retrospective analysis was performed to identify 6 patients with high fever,skin rash and acute haematogenesis disorder during 2005-2006 in our center. Results The 6 patients had viral infection, immunity damage, intake of marrow toxicity medicine and multiple organ dysfunc-tion syndrome after the operation. These might cause the disorder. Conclusion Infection, virus,drugs, graft versus host disease and immunity damage are the main reasons for acute hematogenesis disorder after liver transplantation.

Objective To investigate the risk factor for new-onset diabetes after transplantation (NODAT) and the relationship between NODAT and arterial stiffness. Methods Oral glucose tolerance test (OGTT) was performed on 195 patients with renal transplantation. The degree of arterial stiffness, which was determined by brachial ankle pulse wave velocity (baPWV), anklebrachial blood pressure index (ABPI) and intima-media thickness (IMT) of the carotid artery, was evaluated. Results Twenty-nine patients diagnosed as NODAT had significantly higher fasting plasma glucose before transplantation, blood pressure and incidence of hepatitis C virus (HCV) infection than in patients without NODAT. Multivariate regression analysis revealed that the risk factor of NODAT was fasting plasma glucose pre-transplantation, HCV infection and systolic blood pressure.The independent determinant of the advanced arterial stiffness on NODAT was the statement of hypertension and age. Conclusions High fasting plasma glucose prior to transplantation, HCV infection and high blood pressure are risk factors for NODAT in patients after renal transplantation.Strict control of blood pressure is the key way to prevent the NODAT and atherosclerosis.

Objective To investigate the clinical significance of ligating the portasystemic shunt confirmed by preoperative CT evaluation during orthotopic liver transplantation. Methods From January 2007 to August 2008, 35 patients in Tianjin First Central Hospital underwent preoperative three-dimensional CT scan, among them 23 patients had spontaneous major portasystemic shunts, the other 12 patients did not have portasystemic shunts. 16 out of the 23 cases with significant shunts underwent shunt ligation based on portal blood flow volume measured by intraoperative portal vein flowmetry. The shunt of the other 7 patients were left untreated. Results The portal blood flow in the 12 patients without portasystemic shunt as judged by preoperative CT scanning were (1101±70) ml/min. The shunts in 7 patients with portal blood flow greater than 1000 ml/min were not ligated, that of the 16 patients with portal blood flow volume lower than 1000 mL/min were ligated. The portal blood flow volume in those 16 patients before and after ligating the shunt were (657±112) m//min and (1136±161) ml/min, respectively (P<0.05). Postoperatively 2 patients suffered from portal vein thrombosis, among them 1 patient suffered from intermittent disturbance of consciousness, 2 patients died within 3 months, with one dying of respiratory failure from pulmonary aspergillus infection one dying of hepatic failure in 2 months after operation because of graft dysfunction.The other 19 patients with normal blood flow and well-functioning graft were alive. Conclusion The ligation of portasystemic shunt is mandatory in patients when pretransplant CT evaluation showing a major porto-systemic shunts and portal blood flow volume was less than 1000 ml/min.