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Primary graft dysfunction after liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2014年第2期13卷 125-137页

作者： Xiao-Bo Chen ming-qing xu Department of Liver and Vascular Surgery West China Hospital Sichuan University

BACKGROUND: Primary graft dysfunction (PGD) causes complications in liver transplantation, which result in poor prognosis. Recipients who develop PGD usually experience a longer intensive care unit and hospital stay and have higher mortality and graft loss rates compared with those without graft dysfunction. However, because of the lack of universally accepted definition, early diagnosis of graft dysfunction is difficult. Additionally, numerous factors affect the allograft function after transplantation, making the prediction of PGD more difficult. The present review was to analyze the literature available on PGD and to propose a *** SOURCE: A search of PubMed (up to the end of 2012) for English-language articles relevant to PGD was performed to clarify the characteristics, risk factors, and possible treatments or interventions for ***: There is no pathological diagnostic standard; many documented definitions of PGD are different. Many factors such as donor status, procurement and transplant process and recipient illness may affect the function of graft, and ischemia reperfusion injury is considered the direct cause. Potentia managements which are helpful to improve graft function were investigated. Some of them are ***: Our analyses suggested that the definition of PGD should include one or more of the following variables: (1)bilirubin ≥10 mg/dL on postoperative day 7; (2) internationa normalized ratio ≥1.6 on postoperative day 7; and (3) alanine aminotransferase or aspartate aminotransferase >2000 IU/L within 7 postoperative days. Reducing risk factors may decrease the incidence of PGD. A majority of the recipients could recover from PGD; however, when the graft progresses intoprimary non-function, the patients need to be treated with retransplantation.

关键词： graft function primary graft dysfunction initial poor function primary non-function liver transplantation

Nuclear factor-KB decoy oligodeoxynucleotides attenuates ischemia/reperfusion injury in rat liver graft

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World Journal of Gastroenterology 2005年第44期11卷 6960-6967页

作者： ming-qing xu Xiu-Rong Shuai Mao-Lin Yan ming-Man Zhang Lu-Nan Yan Department of General Surgery West China Hospital Sichuan University Chengdu 610041 Sichuan Province China Department of General Surgery Sichuan Provincial Hospital Chinese People's Armed Police ForcesLeshan 640014 Sichuan Province China

AIM： To evaluate the protective effect of NF-kB decoy oligodeoxynucleotides （ODNs） on ischemia/reperfusion （I/R） injury in rat liver graft. METHODS： Orthotopic syngeneic rat liver transplantation was performed with 3 h of cold preservation of liver graft in University of Wisconsin solution containing phosphorothioated double-stranded NF-kB decoy ODNs or scrambled ODNs. NF-kB decoy ODNs or scrambled ODNs were injected intravenously into donor and recipient rats 6 and 1 h before operation, respectively. Recipients were killed 0 to 16 h after liver graft reperfusion. NF-kB activity in the liver graft was analyzed by electrophoretic mobility shift assay （EMSA）. Hepatic mRNA expression of TNF-α, IFN-γ and intercellular adhesion molecule-1 （ICAM-1） were determined by semiquantitative RT-PCR. Serum levels of TNF-α and IFN-γ were measured by enzyme-linked immunosorbent assays （ELISA）. Serum level of alanine transaminase （ALT） was measured using a diagnostic kit. Liver graft myeloperoxidase （MPO） content was assessed. RESULTS： NF-kB activation in liver graft was induced in a time-dependent manner, and NF-kB remained activated for 16 h after graft reperfusion. NF-kB activation in liver graft was significant at 2 to 8 h and slightly decreased at 16 h after graft reperfusion. Administration of NF-kB decoy ODNs significantly suppressed NF-kB activation as well as mRNA expression of TNF-α, IFN-γ, and ICAM-1 in the liver graft. The hepatic NF-kB DNA binding activity [presented as integral optical density （IOD） value] in the NF-kB decoy ODNs treatment group rat was significantly lower than that of the I/R group rat （2.16±0.78 vs 36.78 ±6.35 and 3.06±0.84 vs 47.62± 8.71 for IOD value after 4 and 8 h of reperfusion, respectively, P〈0.001）. The hepatic mRNA expression level of TNF-α, IFN-γ and ICAM-1 rpresented as percent of β-actin mRNA （%）] in the NF-kB decoy ODNs treatment group rat was significantly lower than that of the I/R group rat （8.31 ±3.48 vs 46.37±10.65 and 7.46± 3.72

关键词： Hepatic ischemia/reperfusion injury NF-kB Liver graft

Combined hepatectomy and radiofrequency ablation versus TACE in improving survival of patients with unresectable BCLC stage B HCC

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Hepatobiliary & Pancreatic Diseases International 2016年第4期15卷 378-385页

作者： Yi-Fu Hou Yong-Gang Wei Jia-Yin Yang Tian-Fu Wen ming-qing xu Lu-Nan Yan Bo Li Department of Hepatic Surgery West China HospitalSichuan University

BACKGROUND： Combined hepatectomy and radiofrequency ablation（RFA） provides an additional treatment for patients with Barcelona Clinic Liver Cancer（BCLC） stage B hepatocellular carcinoma（HCC） who are conventionally deemed unresectable. This study aimed to analyze the outcome of this combination therapy by comparing it with transarterial chemoembolization（TACE）. METHODS： We retrospectively reviewed 51 patients with unresectable BCLC stage B HCC who had received the combination therapy. We compared the survival of these patients with that of 102 patients in the TACE group（control）. Prognostic factors associated with worse survival in the combination group were ***： No differences in tumor status and liver function were observed between the TACE group and combination group. The median survival time for the combination group and TACE group was 38（6-54） and 17（3-48） months, respectively（P〈0.001）. The combination group required longer hospitalization than the TACE group [8（5-14） days vs 4（2-9） days,P〈0.001]. More than two ablations decreased the survival rate in the combination group. CONCLUSIONS： Combined hepatectomy and RFA yielded a better long-term outcome than TACE in patients with unresectable BCLC stage B HCC. Patients with a limited ablated size（≤2 cm）, a limited number of ablations（≤2）, and adequate surgical margin should be considered candidates for combination therapy.

关键词： hepatocellular carcinoma hepatectomy radiofrequency ablation transarterial chemoembolization Barcelona Clinic Liver Cancer system

Analysis on the Variation Expression of Difficult-Dissolved-Proteins of Diapause Eggs After Activating by Acid Treatment

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Agricultural Sciences in China 2008年第12期7卷 1474-1480页

作者： ZHAO Feng LIN Jian-rong HUO Yong-kang MAO Li-ming KONG qing-ming xu Qiu-yun ZHONG Yang-sheng WANG Ye-yuan Department of Silk Science College of Animal Science South China Agricultural University Guangzhou 510640 P.R.China

Using HCl to activate the diapause eggs is a traditional technique of artificial hatching applied in silkworm egg production. Its mechanism has not yet been clarified. This experiment explored the effect of HCl on the termination of diapause of silkworm eggs cold-stored for 45 days from the point of proteomes. Two-dimensional electrophoresis techniques and ESI- MS-MS were used to compare and analyze the variation expression of difficult-dissolved-proteins of diapause eggs coldstored for 45 days before and after acid treatment. Through analysis on the two-dimensional electrophoretogram, there were 296 dots before acid treatment and 302 after the treatment, respectively. Amongst them 265 dots were matchable. The matchability reached 88.6%. There were 31 specific protein dots before acid treatment and 37 after acid treatment, respectively. ESI-MS-MS analysis was conducted for two specific protein-rich dots which disappeared after acid treatment. The results indicated that the sequence of No. 1 protein dot had 55 amino acids＇ peptide matched with those of chorion protein （Bombyx mori）. While the sequence of No. 2 protein dot had only 15 amino acids＇ peptide matched with those of heat shock protein hsp 19.9 （Bombyx mori）, and it was presumed to be an unknown protein. The difficult-dissolvedproteins of diapause eggs have variation expression after acid treatment. Some proteins before and after acid treatment are changed in MW.

关键词： silkworm egg acid treatment protein electrophoresis image analysis

Safety of hepatitis B virus core antibody-positive grafts in liver transplantation: A single-center experience in China

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World Journal of Gastroenterology 2018年第48期24卷 5525-5536页

作者： ming Lei Lu-Nan Yan Jia-Yin Yang Tian-Fu Wen Bo Li Wen-Tao Wang Hong Wu ming-qing xu Zhe-Yu Chen Yong-Gang Wei Department of Liver Surgery Liver Transplantation CenterWest China Hospital of Sichuan University

BACKGROUND Given the shortage of suitable liver grafts for liver transplantation, proper use of hepatitis B core antibody-positive livers might be a possible way to enlarge the donor pool and to save patients with end-stage liver diseases. However, the safety of hepatitis B virus core antibody positive(HBcAb+) donors has been controversial. Initial studies were mainly conducted overseas with relatively small numbers of HBcAb+ liver recipients, and there are few relevant reports in the population of China's Mainland. We hypothesized that the safety of HBcAb+ liver grafts is not *** To evaluate the safety of using hepatitis B virus(HBV) core antibody-positive donors for liver transplantation in Chinese *** We conducted a retrospective study enrolling 1071 patients who underwent liver transplantation consecutively from 2005 to 2016 at West China Hospital Liver Transplantation Center. Given the imbalance in several baseline variables, propensity score matching was used, and the outcomes of all recipients were reviewed in this *** In the whole population, 230 patients received HBcAb+ and 841 patients received HBcAb negative(HBcAb-) liver grafts. The 1-, 3-and 5-year survival rates in patients and grafts between the two groups were similar(patient survival: 85.8% vs 87.2%, 77.4% vs 81.1%, 72.4% vs 76.7%, log-rank test, P = 0.16; graft survival: 83.2% vs 83.6%, 73.8% vs 75.9%, 70.8% vs 74.4%, log-rank test, P = 0.19). After propensity score matching, 210 pairs of patients were generated. The corresponding 1-, 3-and 5-year patient and graft survival rates showed no significant differences. Further studies illustrated that the post-transplant major complication rates and liver function recovery after surgery were also similar. In addition, multivariate regression analysis in the original cohort and propensity score-matched Cox analysis demonstrated that receiving HBcA b+ liver grafts was not a significant risk factor for long-term survival.

关键词： Liver transplantation Long-term outcome Hepatitis B core antibody Hepatitis B virus infection

Value of α-fetoprotein in association with clinicopathological features of hepatocellular carcinoma

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World Journal of Gastroenterology 2013年第11期19卷 1811-1819页

作者： Chang Liu Guang-Qin Xiao Lu-Nan Yan Bo Li Li Jiang Tian-Fu Wen Wen-Tao Wang ming-qing xu Jia-Yin Yang Department of Liver and Vascular Surgery West China HospitalSichuan University

AIM:To explore the relationship between α-fetoprotein(AFP) and various clinicopathological variables and different staging system of hepatocellular carcinoma(HCC) ***:A retrospective cohort study of consecutive patients diagnosed with HCC between January 2008 and December 2009 in West China Hospital was enrolled in our *** association of serum AFP values with the HCC clinicopathological features was analysed by univariate and multivariate analysis,such as status of hepatitis B virus(HBV) infection,tumor size,tumor number,vascular invasion and degree of tumor ***,patients were divided into four groups at the time of enrollment according to different cutoff values for serum value of AFP(≤ 20 μg/L,21-400 μg/L,401-800 μg/L,and ≥ 801 μg/L),to compare the positive rate of patient among four groups stratified by various clinicopathological *** the correlation of different kinds of tumor staging systems,such as TNM,Barcelona Clinic Liver Cancer(BCLC) staging classification and China staging,were compared with the serum concentration of ***:A total of 2304 HCC patients were enrolled in this study totally;the mean serum level of AFP was 555.3 ± 546.6 μg/*** levels were within the normal range(< 20 μg/L) in 27.4%(n = 631) of all the cases.81.4%(n = 1875) patients were infected with HBV,and those patients had much higher serum AFP level compared with non-HBV infection ones(573.9 ± 547.7 μg/L vs 398.4 ± 522.3 μg/L,P < 0.001).The AFP level in tumors ≥ 10 cm(808.4 ± 529.2 μg/L) was significantly higher(P < 0.001) than those with tumor size 5-10 cm(499.5 ± 536.4 μg/L) and with tumor size ≤ 5 cm(444.9 ± 514.2 μg/L).AFP levels increased significantly in patients with vascular invasion(694.1 ± 546.9 μg/L vs 502.1 ± 543.1 μg/L,P < 0.001).Patients with low tumor cell differentiation(559.2 ± 545.7 μg/L) had the significantly(P = 0.007) highest AFP level compared with high differentiation(207.3 ± 420.8 μg/L) and intermediate differ

关键词： α-fetoprotein Hepatocellular carcinoma Tumor markers Clinical features Pathological features

Liver resection for intermediate hepatocellular carcinoma

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World Journal of Hepatology 2016年第14期8卷 607-615页

作者： Peng-Sheng Yi ming Zhang Ji-Tong Zhao ming-qing xu Department of Liver Surgery West China Hospital Sichuan University Department of Gynecology and Obstetrics West China Second Hospital Sichuan University

Hepatocellular carcinoma(HCC) is one of the most common malignant tumors in China. The Barcelona Clinic Liver Cancer(BCLC) staging system is regarded as the gold standard staging system for HCC, classifying HCC as early, intermediate, or advanced. For intermediate HCC, trans-catheter arterial chemoembolization(TACE) is recommended as the optimal strategy by the BCLC guideline. This review investigates whether liver resection is better than TACE for intermediate HCC. Based on published studies, we compare the survival benefits and complications of liver resection and TACE for intermediate HCC. We also compare the survival benefits of liver resection in early and intermediate HCC. We find that liver resection can achieve better or at least comparable survival outcomes compared with TACE for intermediate HCC; however, we do not observe a significant difference between liver resection and TACE in terms of safety and morbidity. We conclude that liver resection may improve the short- and long-term survival of carefully selected intermediate HCC patients, and the procedure may be safely performed in the management of intermediate HCC.

关键词： Trans-catheter arterial chemoembolization Intermediate hepatocellular carcinoma Liver resection Prognostic factor

Zinc finger protein A20 protects rats against chronic liver allograft dysfunction

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World Journal of Gastroenterology 2012年第27期18卷 3537-3550页

作者： Jie Yang ming-qing xu Lu-Nan Yan Xiao-Bo Chen Jiao Liu Department of Liver and Vascular Surgery Liver Transplanta-tion Center West China Hospital Sichuan University Chengdu610041 Sichuan Province China

AIM： To investigate the effect of zinc finger protein A20 on chronic liver allograft dysfunction in rats. METHODS： AIIogeneic liver transplantation from DA rats to Lewis rats was performed. Chronic liver allograft dysfunction was induced in the rats by administering low-dose tacrolimus at postoperative day （POD） 5. Hepatic overexpression of A20 was achieved by recom- binant adenovirus （rAd.）-mediated gene transfer ad- ministered intravenously every 10 d starting from POD 10. The recipient rats were injected with physiologi- cal saline, rAdEasy-A20 （1 × 109 pfu/30 g weight） or rAdEasy （1 × 109 pfu/30 g weight） every 10 d through the tail vein for 3 mo starting from POD 10. Liver tissue samples were harvested on POD 30 and POD 60. RESULTS： Liver-transplanted rats treated with only tacrolimus showed chronic allograft dysfunction with severe hepatic fibrosis. A20 overexpression ameliorated the effects on liver function, attenuated liver allograft fibrosis and prolonged the survival of the recipient rats. Treatment with A20 suppressed hepatic protein pro- duction of tumor growth factor （TGF）-β1, interleukin- 113, caspase-8, CD40, CD40L, intercellular adhesion molecule-i, vascular cell adhesion molecule-1 and E-selectin. A20 treatment suppressed liver cell apopto- sis and inhibited nuclear factor-KB activation of Kupffer cells （KCs）, liver sinusoidal endothelial cells （LSECs） and hepatic stellate cells （HSCs）, and it subsequently decreased cytokine mRNA expression in KCs and LSECs and reduced the production of TGF-β1 in HSCs. CONCLUSION： A20 might prevent chronic liver allogra- ft dysfunction by re-establishing functional homeostasis of KCs, LSECs and HSCs.

关键词： Chronic allograft dysfunction Liver trans-plantation Zinc finger protein A20 Rat

Management of venous stenosis in living donor liver transplant recipients

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World Journal of Gastroenterology 2009年第39期15卷 4969-4973页

作者： Jie Yang ming-qing xu Lu-Nan Yan Wu-Sheng Lu Xiao Li Zheng-Rong Shi Bo Li Tian-Fu Wen Wen-Tao Wang Jia-Ying Yang Department of Liver and Vascular Surgery West China Hospital Sichuan University Chengdu 610041 Sichuan Province China

AIM:To retrospectively evaluate the management and outcome of venous obstruction after living donor liver transplantation(LDLT).METHODS:From February 1999 to May 2009,1 intraoperative hepatic vein(HV) tension induced HV obstruction and 5 postoperative HV anastomotic stenosis occurred in 6 adult male LDLT *** portal vein(PV) anastomotic stenosis occurred in 1 pediatric left lobe *** ranged in age from 9 to 56 years(median,44 years).An air balloon was used to correct the intraoperative HV *** surgical reoperation,transjugular HV balloon dilatation with stent placement and transfemoral venous HV balloon dilatation was performed for HV stenosis on days 3,15,50,55,and 270 after LDLT,*** dilatation followed with stent placement via superior mesenteric vein was performed for the pediatric PV stenosis 168 d after ***:The intraoperative HV tension was corrected with an air *** recipient who underwent emergent reoperation for hepatic stenosis died of hemorrhagic shock and renal failure 2 d *** balloon dilatation via the transjugular and transfemoral venous approach was technically successful in all *** patient with early-onset HV stenosis receiving transjugular balloon dilatation and stent placement on the 15th postoperative day left hospital 1 wk later and disappeared,while the patient receiving the same interventional procedures on the 50th postoperative day died of graft failure and renal failure 2 wk *** patients with late-onset HV stenosis receiving balloon dilatation have survived for 8 and 4 mo without recurrent stenosis and ascites,*** dilatation and stent placement via the superior mesenteric venous approach was technically successful in the pediatric left lobe LDLT,and this patient has survived for 9 mo without recurrent PV stenosis and ***:Intraoperative balloon placement,emergent reoperation,proper interventional balloon dilatation and

关键词： Living donor liver transplantation Venous obstruction Anastomotic stenosis Venoplasty Stent