The relevant clinical data were reviewed for a recipient of grade 4 portal vein thrombus undergoing reno-portal anastomosis liver transplantation on May 19, 2022. Liver function transaminase and bilirubin gradually normalized within 2 weeks after operation. An elevation of creatinine showed mild functional impairment at Day 5-7 post-operation and then recovered quickly. No portal vein thrombosis, gastrointestinal hemorrhage, ascites and other complications occurred within 2 years post-operation. The survival was excellent during 2-year follow-ups.

Allografts ; COVID-19 ; China/epidemiology* ; Disease Outbreaks ; Humans ; Kidney Transplantation/adverse effects* ; SARS-CoV-2

Hepatic ischemia-reperfusion injury is an inevitable clinical phenomenon during the liver transplantation. The mechanism of hepatic ischemia-reperfusion injury is complex, with reactive oxygen species, inflammatory factors, calcium overload, neutrophils and Kupffer cells involved. If injury continues to getting worsen, liver cells will undergo necrosis, apoptosis, and autophagy. Interventions for hepatic ischemia-reperfusion injury mainly include ischemic preconditioning, drug pretreatment, chemical pretreatment, mild hypothermia pretreatment, and machine perfusion and gene-targeted therapy in recent years. With the indepth research of injury mechanism, new intervention methods continue to emerge, which will bring new ideas for clinical prevention and treatment of liver ischemia-reperfusion injury.

With the rapid development of organ transplantation in China,the donation after cardiac death (DCD) donor organs are widely used.However,the quality of these organs is relatively poor,so the way to preserve and maintain organ still remains a severe problem.Among them,ischemic reperfusion injury (IRI) impairs the organs severely.Acetaldehyde dehydrogenase 2 (ALDH2) protects organs from stress conditions,including ischemia-reperfusion injury,and the activation and autophagy inhibition also protects the organs from stress conditions as well.Recent studies showed that ALDH2 can regulate autophagy to inhibit the organ injury during ischemia-reperfusion.Our study aims to discuss the new findings in this mechanism.

Objective To investigate the diagnosis and treatment of antibody-mediated rejection after liver transplantation.Methods The clinical data of 1 case of antibody-mediated rejection after liver transplantation were collected.The patient had autoimmune liver disease (de-compensated stage) and received a liver transplantation with ABO-compatible.Triple immunosuppressive regimen of tacrolimus + mycophenolate mofetil + prednisone was used after operation.The valley of tacrolimus concentration was maintained at 8-10 μg/L.One month after transplantation,the liver function recovered to normal.Alanine aminotransferase was 16 U/L,aspartate aminotransferase was 37 U/L and total bilirubin was 17.3 U/L.Results Three months after operation,the liver function index increased sharply (total bilirubin was 186.3 U/L).The first pathological examination of liver biopsy at 14th week after operation showed the histological findings of acute rejection.Combining the data of clinical features,steroid pulse therapy was given,but the effect was poor.The biopsy of the retransplanted liver at 18th week after operation showed necrosis of minority hepatic cells and obvious attachment of lymphocytes in the central venous branch wall.Panel reactive antibodies test revealed that the HLA_ Ⅱ antibodies were intensively positive,suggesting the diagnosis of AMR.After treatment with plasma exchange and adjusting the immunosuppressant dosage,the function of the transplanted liver recovered gradually.Conclusion For liver transplantation with compatible blood type and recipient with autoimmune liver disease,we should alert the occurrence of acute AMR.Timely liver biopsy and PRA detection should be performed for definite diagnosis.Plasmapheresis is effective in treating acute AMR after liver transplantation.

Primary hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and has a relatively high mortality rate.Liver transplantation has become an effective treatment for HCCs,but tumor recurrences after liver transplantation and donor shortages are the major limitations.The Milan criterion was the first standard and has been widely applied to liver transplantation of HCCs.Then,there are new emerging standards,namely University of California,San Francisco criterion (UCSF),Hangzhou and Shanghai criteria.Meanwhile,the comparison among these criteria laid the foundation for early prediction and prevention of post-transplantation tumor recurrence.In this review,clinical effect prediction and tumor recurrence after liver transplantation are also heated issues.

Objective To investigate the protective effect of glycyrrhizin against renal ischemiareperfusion injury in mice and its mechanisms.Methods Male C57BL/6 mice were divided into three groups of six.Bilateral flank incisions were made,the right kidney was removed and the left kidney was subjected to ischemia using a microvascular clamp,which was removed after 30 min.In the shamoperated group,the mice underwent anesthesia,bilateral flank incisions and a right nephrectomy.In the glycyrrhizin-treated group,the mice were injected with 60 mg/ kg glycyrrhizin 1 h prior to ischemia.In the saline-treated group,the mice were administered with 60 mg/ kg saline.The mice were sacrificed 6 h after reperfusion and the blood and kidney samples were immediately collected for kidney function,inflammatory response and signal pathway test.Results As compared with those in the saline-treated group,the mice in glycyrrhizin0-treated group exhibited notably decreased serum levels of creatine and blood urea nitrogen at 6 h following reperfusion (P＜0.01),the SOA level was significantly reduced (P＜0.01) and the SOD activity was increased.The activity of MPO (P＜0.01)in the glycyrrhizin-treated group was significantly reduced as compared with the saline-treated group,also the serum level of pro-inflammatory TNF-α (P＜0.05),IFN-γ (P＜0.05),IL-1β (P＜0.01) and IL-6 (P＜0.01).Furthermore,the phosphorylated-p38 protein level in the glycyrrhizin-treated group was notably as reduced compared with that in the saline-treated group.Conclusion Pretreatment with glycyrrhizin attenuates renal ischemia-reperfusion injury via inhibition of tissue inflammation by downregulating p38 mitogen-activated protein kinase signaling.

Chinese donation after citizen's death (CDCD) is an important way to solve the donor shortage problem,but if we can't effectively control warm ischemia time of CDCD donor,it's easy to cause grafts primary nonfunction,early grafts dysfunction and biliary complications.Nowadays,with the development of surgical techniques,the definition of warm ischemia continues has been continuously updated.The understanding on different definitions may lay the foundation for improving the survival rate of liver and kidney and effectively protect liver and kidney function after transplantation.This paper overviewed the significance of different definitions of warm ischemia and its effect on liver and renal function,which could provide a reference for further experimental study and clinical practice.

Objective To sum up the experiences in liver transplantations from donation after brain death (DBD),and compare the clinical effect,complications and influential factors with international situation.Methods The retrospective descriptive study was adopted.All the data of 66 DBD liver donors and the matched recipients from authors' affiliations during June 2010 and June 2013 were collected.Original articles,meta-analysis and data reports with high academic influence were read and data were analyzed with SPSS 22.0.Results The incidence of serious complications,vascular complications and biliary complications during the first year among 66 recipients was 21.2％,10.6％,and 6.1％,respectively.Compared to international situation,graft 1-,3-,and 5-year survival rate was similar (P＞0.05) (83％,80％ and 73％ respectively),similar to that of recipients.There was no statistically significant difference in primary nonfunction and vascular complications between our center and other centers.As for biliary complications,morbidity was lower in our center (P＜0.05).The 3-and 5-year survival rate of recipients was also similar (P＞0.05),though the 1-year survival rate was slightly lower (P＜ 0.05).Conclusion These findings provide evidence that patient's prognosis under DBD liver transplantation in our center is acceptable,and long-term survival rate has reached international level.Still,1-year survival rate of recipients is unsatisfactory.In order to achieve a good clinical efficacy,we need to find out disadvantages during donor maintenance,recipient selection,surgical procedure and postoperative management.

Objective To compare three different types of donor livers (C-Ⅰ,C-Ⅱ,C-Ⅲ) in clinical efficacy,complications and survival rate of liver transplantation.Methods Using the retrospective descriptive study method,the clinical data of 422 patients undergoing liver transplantation,including 124 cases of C-Ⅰ,81 cases of C-Ⅱ and 81 cases of C-Ⅲ in recent 6 years (from June 2010 to June 2016) were analyzed.The same surgical method was performed with piggyback liver transplantation.Observation indicators contained (1) recipient postoperative liver function;(2) the postoperative complications;(3) the recipient survival rate.SPSS 19.0 statistical software was used for analysis.Results (1) The curative effect was evaluated by the changes of ALT and TBIL among three groups of recipients postoperatively.As compared with C-Ⅰ transplantation group and CⅢ transplantation group,the level of ALT in C-Ⅱ transplantation group was significantly increased (P ＜0.05),the clinical efficacy was poorer.(2) The incidence of PNF was 3.23％ in C-Ⅰ group,9.88％ in C-Ⅱ group and 9.88％ in C-Ⅲ group (P＜0.05).The incidence of acute rejection was respectively 9.68％ in C-Ⅰ group,38.27％ in C-Ⅱ group and 38.27％ in C-Ⅲ group (P＜0.001).The incidence of SIRS was respectively 5.65％ in C-Ⅰ group,39.50％ in C-Ⅱ group and 39.50％ in C-Ⅲ group (P＜ 0.001).There were significant differences in the incidence of other complications among the three groups.(3) There were 14 deaths within 3 months,accounting for 17.28％,and the survival rate was 82.72％ in C-Ⅱ group,the 1-,3-,and 5-year survival rate was 76.55％,74.18％ and 76.55％ respectively in C-Ⅰ group,and that was 88.02％,85.72％ and 81.11％ respectively in C-Ⅲ group.Conclusion Since June 2015,C-Ⅰ donors grow up more quickly on year-on-year basis than C-Ⅱ.Simultaneously,the sort-term and long-term clinical efficacy is better in C-Ⅰ transplantation group than in C-Ⅱ transplantation group.How to repair the three types of Chinese standard donor organs and optimize the quality is still a hot point to ensure the healthy development of organ transplantation in China,which needs further investigation.