Indocyanine green clearance test and model for end-stage liver disease score of patients with liver cirrhosis

BACKGROUND:The indocyanine green(ICG)clearance test(clearance rate(K)and retention rate at 15 minutes (R15))is a sensitive indicator to evaluate liver function. The model for end-stage liver disease(MELD)score has emerged as a useful tool for estimating the mortality of patients awaiting liver transplantation and has recently been validated on patients with liver diseases of various etiologies and severity.In this study,we investigated the correlation between the ICG clearance test and MELD score of patients with liver cirrhosis. METHODS:From June 2007 to March 2008,52 patients with liver cirrhosis admitted to our center were classified into Child-Pugh class A(8 patients),B(14)and C(30).The ICG clearance test(K value and R15)was performed by ICG pulse spectrophotometry(DDG-3300K),and the MELD scores of patients were calculated. RESULTS:As the Child-Pugh classification of liver function gradually deteriorated,the K value decreased, while R15 and MELD score increased.There were significant statistical differences in K value,R15 and MELD score in patients with different Child-Pugh classifications. Significant correlations were found between the parameters of the ICG clearance test(K value and R15)and MELD score.A negative correlation was observed between K value and MELD score(r=-0.892,P<0.05),while a positive correlation was observed between R15 and MELD score(r=0.804,P<0.05).CONCLUSIONS:The ICG clearance test and MELD score are good parameters for evaluating liver function.Moreover, K value and R15 have significant correlations with MELD score,especially the K value,which may be a convenient and appropriate indicator to evaluate liver function of patients with liver cirrhosis.

Targeted IL-24 gene therapy inhibits cancer recurrence after liver tumor resection by inducing tumor cell apoptosis in nude mice

BACKGROUND:Interleukin-24(IL-24)is a novel candi-date tumor suppressor that induces tumor cell apoptosis experimentally in a variety of human malignant cells including liver cancer cells.The present study was conducted to investigate the potential effect of recombinant adeno-associated virus(rAAV)-mediated IL-24 gene therapy on tumor recurrence and metastasis by inducing tumor cell apoptosis in a hepatocellular carcinoma(HCC)model in nude mice.METHODS:We established a recurrent and metastatic HCC model in nude mice and constructed an rAAV vector carrying alpha-fetoprotein(AFP)promoter for expressing the IL-24 gene(rAVV/AFP/IL-24).The vector was administered by regional injection(liver incisal margin).AFP was detected by radiation immunoassay.Histological evaluation of tumor recurrence and metastasis was performed for the liver and lung.The effect of tumor cell apoptosis was confirmed by TUNEL analysis.RESULTS:IL-24 gene therapy prevented tumor recurrence and metastasis,as evidenced by marked decreases in the number of metastatic tumor nodules and tumor volume in the liver and lung.At the same time,serum AFP concentration decreased markedly in the IL-24 group compared with the control or rAAV groups(P【0.05).IL-24 gene therapy inhibited tumor recurrence and metastasis as evidenced by the induction of tumor cell apoptosis.CONCLUSION:The results demonstrated that targeted IL-24 gene therapy was effective in the prevention of postoperative recurrence and metastasis in an HCC nude mice model by induction of tumor cells apoptosis with potential minimum tumor burden.

Sirolimus as primary immunosuppressant for calcineurin inhibitor-related renal insufficiency after liver transplantation

BACKGROUND:Calcineurin inhibitor-related renal toxicity affects patient and graft survival in transplant recipients. This study aimed to determine whether sirolimus is effective and safe in treating renal insufficiency related to tacrolimus after liver transplantation. METHODS:Tacrolimus for primary immunosuppression was used in 16 patients after liver transplantation. Patients with a creatinine level higher than 132.6 μmol/L were eligible for conversion to sirolimus. Simultaneously,the dose of tacrolimus was decreased to half. Blood urea nitrogen,creatinine,tacrolimus level,liver function and rejection episodes were monitored dynamically. RESULTS:All patients showed improvement of renal function after conversion to sirolimus. Blood creatinine level was reduced from 146.8±92.4 to 105.3±71.3 μmol/L(P<0.05). One patient had an acute rejection episode that was successfully treated with pulsed corticosteroids and low-dose tacrolimus. The side-effects of sirolimus included hyperlipidemia(4 patients) and leukocytopenia(2). CONCLUSION:Sirolimus can be safely used in liver transplant recipients suffering from tacrolimus-related renal insufficiency.