Objective To summarize the significance of CYP3A5 in individualized immunosuppressive treatment with tacrolimus (FK506) after liver transplantation. Methods Relevant literatures about the effect of CYP3A5 polymorphisms on the pharmacokinetics of tacrolimus in liver transplant recipients, which were published recently domestic and abroad, were reviewed and analyzed. Results Tacrolimus was used effectively to prevent allograft rejection after liver transplantation. Narrow therapeutic range and individual variation in pharmacokinetics made it difficultly to establish a fixed dosage for all patients. Genetic polymorphism in drug metabolizing enzymes and in transporters influenced the plasma concentration of tacrolimus. CYP3A5 genotype had an effect on the tacrolimus dose requirement in liver transplant recipients.Conclusion Genotyping for CYP3A5 may help optimal individualization of immunosuppressive drug therapy for patients undergoing liver transplantation
Objective Ｔo summarize the advancement of ABO-incompatible liver transplantation. Methods Relevant literatures about ABO-incompatible liver transplantation, which were published recently domestic and abroad were reviewed and analyzed. Results Owing to various treatments recent years, outcomes of ABO-incompatible liver transplantation have been improved dramatically. Conclusion With effective immnosuppressive protocols and effective perioperative management, ABO-incompatible liver transplantation is feasible.
目的 探討多層螺旋CT血管造影（CTA）在主動脈夾層中的診斷價值及臨床應用。 方法 回顧性分析2010年2月－2011年4月35例行CTA檢查的主動脈夾層患者，所有患者原始數據在圖像后處理工作站采用多平面重建、容積再重建、最大密度投影等方法進行主動脈成像。由2名有經驗的放射科副主任醫師進行診斷。 結果 35例均可明確顯示主動脈夾層的真假腔、內膜片及破裂口部位。Ⅰ型12例，Ⅱ型3例，Ⅲ型20例；累及左鎖骨下動脈5例，左頸總動脈2例，無名動脈2例，腹腔干3例，腸系膜上動脈4例，左腎動脈3例，右腎動脈2例，右髂總動脈受累6例，左髂總動脈受累8例，其中雙側髂總動脈均受累4例；合并動脈瘤3例；壁內血腫4例；所有患者均顯示了單一或多發破口。 結論 CTA及圖像后處理技術能快速、準確地診斷主動脈夾層，為臨床治療方案選擇提供重要的影像學依據。
Objective To establish a rat model of pancreas-duodenal transplantation for pancreas transplantation research. Methods A rat model of pancreas-duodenal transplantation was established by using dual cuff technique. The graft affiliated portal vein and abdominal aorta were anastomosed to recipient’s left renal vein and left renal artery by using dual cuff technique without clamping the systemic circulation in order to minimize hemodynamic instability. Simultaneously the graft duodenum was anastomosed to the host jejunum in an end-to-side fashion to reestablish drainage of pancreatic secretion. Fluid replacement, warm keeping and anticoagulation were maintained during perioperative period. Results The average donor operation time was (68.4±7.2) min and recipient operation time was (26.1±3.3) min. Moreover, it took (5.0±1.1) min for cuff preparation in vitro and (9.6±3.5) min for vessel reconstruction in vivo, respectively. Intestinal anastomosis took (7.2±2.3) min. The operation successful rate was about 91.7%. Conclusion This pancreas-duodenal transplantation model avoids systemic circulation clamping. It is simple and stable, with the value in pancreas transplantation research.
Objective To investigate the pathogenesis of acute lung injury in rats induced by intra-peritoneally injection of perforative peritonitis ascitic fluids（PPAF） and the role of L-arginine （L-Arg） in acute lung injury in this model. Methods Perforative peritonitis （PP） models were established in 60 rats and PPAF were collected. Forty-eight rats were randomly divided equally into NS group，PPAF group, and L-Arg group. Rats were randomly subjected to death at 7 h and 12 h. Peripheral blood WBC were counted，levels of NO and malondialdehyde （MDA） in serum were examined. Lung injury score and wet/dry ratio were evaluated， and level of myeloperoxidase （MPO） in lung tissues and lung cell apoptosis were tested. Results WBC count of peripheral blood, levels of NO and MDA in serum， level of MPO in lung tissue, lung injury score， wet/dry ratio， and lung cell apoptosis rate in PPAF group were significantly higher than that in NS group at each time point（P＜0.01）. Level of NO in serum in L-Arg group was higher than that in PPAF group （P＜0.01）， but lower level of MDA in serum， lower level of MPO in lung tissue and lung injury score，lower wet/dry ratio， and lung cell apoptosis rate were observed in L-Arg group（P＜0.05）. In PPAF group and L-Arg group， level of NO in serum， wet/dry ratio, and lung cell apoptosis rate were higher at 12 h than that at 7 h（P=0.000）. Serum NO level was in negative correlation with serum MDA level （r=-0.257，P=0.021）， MPO level in lung tissue（r=-0.444， P=0.011），and lung cell apoptosis（r=-0.351， P =0.010） in PPAF group and L-Arg group， but serum MDA level was in positive correlation with cell apoptosis（r=0.969， P＜0.001） in each group. Conclusions Acute lung injury rats model can be established by intra-peritoneally injection of PPAF. Enhanced oxidizing reaction and cell apoptosis take part in the occurrence of acute lung injury. L-Arg plays a protective role in acute lung injury.
Objective To summarize the clinical experience of liver retransplantation. Methods Six liver retransplantations were performed. The indications consisted of primary non-function (PNF, 2 cases), acute or chronic rejection (2 cases), stomas stenosis of biliary tract (1 case) and primary sclerosing cholangitis (1 case). The immunosuppressive protocols included tacrolimus, methylprednisolone (MP) and mycophenolate mofetil (MMF). Results Five patients were cured. One patient died on day 4 after liver retransplantation because of multiple organ failure. Postoperative complications included deep fungal infection and wound infection. Conclusions Liver retransplantation is an effective method for graft failure after liver transplantation. Proper indication and optimum operative time, intensive perioperative supervision and proper treatment are very important to improv effect of liver retransplantation.