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.

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 explore the risk factors and prevention measures for anastomotic leakage after rectal radical resection.Methods The clinical data of 404 patients with rectal radical resection were analyzed retrospectively and the risk factors for anastomotic leakage were analyzed.Results Thirty-one patients (7.67％,31/404) were subjected to anastomotic leakage.The mean leakage time was 6.5 (3-14) d postoperatively.The muhivariate Logistic regression analysis showed that preoperative hemoglobin (OR =3.023,95％ CI:1.101-8.303,P=0.031 8),tumor size (OR =2.543,95％ CI:1.075-6.018,P=0.033 7) and tumor distance from anal verge (OR =3.160,95％ CI:1.387-7.199,P=0.006 2) were the risk factors for anastomotic leakage.Conclusions Preoperative hemoglobin,tumor size and tumor distance from anal verge are significant factors for anastomotic leakage.Therefore correction of anemia,improvement of surgical technique and suitable use of preventive diversion stoma ane all benefit for prevention of anastomotic leakage after rectal radical resection.

Objective To evaluate the influence of L-ornithine-L-aspartate (LOLA) on model for end stage liver disease(MELD) score and liver function of patients with chronic liver failure (CLF). Methods Sixty patients consecutively admitted to our hospital from May, 2002 and November, 2008 were enrolled into the study and randomly divided into low dose group (LD group, LOLA:10 g/d) and high dose group (HD group, LOLA :20 g/d)After treatment of LOLA, the clinical data ( serum NH3 , MELD score and liver function ) were compared between the two groups. Results Compared to serum NH3 level before treatment, serum NH3 decreased ( 62.59 + 27.87 )μmoL/L in the HD group and (49.36 + 27.34 ) μmol/L in the LD group, and both decreasements were statistical significant (Ps ＜ 0. 05 ). Compared to MELD before treatment, MELD score decreased ( 8.38 ± 2. 24 ) and ( 14.57 + 7.68), respectively ( Ps ＜ 0.05 ). Compared to LD group, all indices of liver function in the HD group improved more compared to those of the LD group ( Ps ＜ 0.05 ). Conclusions LOLA could significantly decrease serum NH3 and MELD score and improve liver function in CLF patients.

ObjectiveTo study the impact of allocation of organ arteries and their reconstruction for donor livers on arterial complications after liver transplantation from organ clusters obtained by combined liver,kidney,pancreas and duodenum harvesting.The aim is to guide future use of donor organs more safely and rationally with a decrease in postoperative complications.MethodWe studied 11 patients.ResultsThere was no hepatic artery anomaly.A Carrol artery patch was obtained at the bifurcation of the proper hepatic artery and the gastroduodenal artery in these donor livers.In one patient,an arterial graft was used because of inadequate arterial length,and arterial thrombosis developed which required re-transplantation.The hepatic arterial reconstruction was successful for the remaining 10 patients.One patient died of pulmonary infection 5 months post transplantation.ConclusionWhen combined liver,kidney,pancreas and duodenum harvesting was used,enough arterial length of the recipient must be preserved.There should be adequate and prompt communication between the teams carrying out the donor operation and the recipient operation.A Carrol arterial patch of the proper hepatic artery and the gastroduodenal artery for the donor liver,and the use of microsurgical vascular anastomosis in the operation are the keys to prevent hepatic arterial complications after liver transplantation.Multi-organ harvesting can be used for obtaining donor livers in liver transplantation.

Objective To evaluate the value of intraoperative ultrasound on recipient with living donor liver transplantation.Methods Forty-five recipients with living donor liver transplantation were performed intraoperative ultrasound using Mylab 30 after the blood vessels were anatomized.Results Three cases of hepatic artery thrombosis,two cases of outflow occlusion,four cases of abnormal increasing of portal vein blood flow velocity and hemodynamics,and one case of portal vein anastomosis stenosis were found by intraoperative ultrasound.Conclusions Intraoperative ultrasound plays an important role for recipient in living donor liver transplantation.

Objective To discuss the application value of contrast-enhanced uhrasound(CEUS)in diagnosis of hepatic artery thrombosis(HAT)after liver transplantation.Methods Four hundred and seventy-five liver transplantation patients were performed routine exam by color Doppler uhrasound,11patients suspected of HAT were examined by CEUS.Results All cases were confirmed bv DSA or CTA.Of them,6 cases were thrombotic by CEUS,and 3 cases out of the 6 cases HAT were founded infarction.The other 5 cases were nonthrombotic,but the diameter of hepatic artery showed narrow,3 Datients were accompanied by severe fatty liver. Conclusions CEUS is equally effective as DSA or CTA in diagnosing HAT after liver transplantation.

Objective To investigate the effect of normothermic machine perfusion (NMP) in alleviating the ischemia reperfusion injury of DCD grafts.Methods Twenty-four Bama miniature pigs were randomly divided into two groups.The donor livers were harvested after 40-min cardiac arrest and preserved for 6 h by NMP preservation in the group A,or with cold UW solution in the group B,respectively.Then,liver transplantation was performed in both groups.Choleresis and the perfusate biochemical markers in the group A were detected during NMP.The recipient survival rate,the serum biochemical markers as well as the histopathological changes of the donor livers were compared between these two groups.Results The levels of ALT,AST and LDH in the perfusate were slightly elevated at the beginning of NMP and maintained at a stable level thereafter.The average choleresis rate was 10.3 ± 3.61 mL/h.The histological structures of the donor livers were normal after 6-h NMP preservation.The survival rate of the recipient pigs was 100％ and 0 in the group A and group B,respectively.After reperfusion,the levels of serum ALT,AST,LDH and lactic acid in the group A were significantly lower than those in the group B (P ＜ 0.05).The pathological examination demonstrated that the hepatocyte injury in group A was slighter than that in group B after 6-h preservation and reperfusion.Conclusion NMP storage could significantly alleviate the ischemia reperfusion injury of pig DCD livers and improve the prognosis of liver transplantation.

Objective To evaluate the safety and clinical effect of ABO-incompatible (ILT) pediatric living donor liver transplantation.Method We analyzed 169 pediatric living donor liver transplantation recipients from Sept.20,2006 to Dec.31,2014.There were 16 ABO-incompatible liver transplantation cases.The median age was 6 months.The blood agglutitin titer was monitored.The titer was controlled lower or equal to 1 ∶ 16.The method to decrease blood agglutitin titer included IVIG and plasma exchange.The patients were treated with Tacrolimus combined with methylprednisolone.Basiliximab for injection was used.The patients were followed-up for 9-26months.The survival rate,acute rejection,vascular and biliary tract complications,and infection were monitored.Result All the patients survived.There was once case of acute rejection,1 case of bile duct dilatation,2 cases of portal vein stenosis,8 cases of EBV viremia,5 cases of CMV viremia,and 6 cases of lung infection.The liver functions of all the 16 recipients were recovered within 3 weeks.Conclusion ABO-incompatible liver grafts can be used safely in pediatric patients.