Hepatic artery complications after orthotopic liver transplantation： interventional treatment or retransplantation？

Background The main therapeutic treatments for hepatic artery complications after orthotopic liver transplantation （OLT） include thrombolysis, percutaneous transluminal angioplasty, stent placement, and liver retransplantation. The prognosis of hepatic artery complications after OLT is not only related to the type, extent, and timing but also closely associated with the selection and timing of the therapeutic methods. However, there is no consensus of opinion regarding the treatment of these complications. The aim of this study was to determine optimal treatment for hepatic artery complications after OLT. Methods The clinical data of 25 patients diagnosed with hepatic artery thrombosis （HAT） and hepatic artery stenosis （HAS） between October 2003 and March 2007 were retrospectively reviewed. Treatments included liver retransplantation and interventions which contain thrombolysis, percutaneous transluminal angioplasty and stent placement. Results Among five patients with HAT, 3 were treated with thrombolysis. One recovered, one died after thrombolysis and another one died of multi-organ failure after retransplantation because of recurrent HAT. The remaining 2 patients underwent successful retransplantation and have survived after that. Among 12 patients presented with HAS within 1 month postoperatively, 2 patients underwent retransplantation due to irreversible liver failure and another 10 patients were treated with interventions. The liver function failed to improve in 3 patients and retransplantations were performed in 4 patients after stent placement because of ischemic cholangitis. Among 6 patients undergoing liver retransplantations, two died of intracranial hemorrhage and infection respectively. Eight patients presented with HAS after 1 month postoperatively, 5 patients were treated with interventional management and recovered after stent placement. Among another 3 patients presented with HAS, 2 patients’ liver function was stable and one patient received late liver retransplantation due to ischemic bile duct lesion. Conclusions Individualized therapeutic regimens should be adopted in treating hepatic artery complications after OLT, according to postoperative periods, types and whether ischemic bile duct lesion exists or not. Liver retransplantation is the best treatment for patients with hepatic artery thrombosis. Interventional treatments of late HAS without irreversible liver failure or bile duct ischemia are appropriate, whereas retransplantation is recommended for early HAS.

Early liver retransplantation versus late liver retransplantation： analysis of a single-center experience

Background Orthotopic liver retransplantation （re-OLT） is the only effective therapy for irreversible failure of a liver graft. Early and late graft failure gives way to two different clinical conditions that should be discussed separately. This study was designed to compare early and late re-OLT for patients with poor graft function after primary transplantation at our center and sum up our clinical experience in re-OLT. Methods The clinical data of 31 re-OLTs at our center from January 2004 to February 2007 were analyzed retrospectively, consisting of the first group with 14 cases of early re-OLT and the second group with 17 cases of late re-OLT.Results Biliary tract complications were the main indications for early re-OLT （57.1%） and late re-OLT （52.9%）. Other common indications were vascular complications in early re-OLT and recurrence of primary diseases in late re-OLT. No significant differences were found between the groups with regard to the volume of bleeding during operation, cold ischemia time, operative duration, and perioperative mortality; except for the model of end-stage liver disease （MELD） score. Outcome was fatal for 7 patients in early re-OLT and 9 patients in late re-OLT. Two deaths were due to multiple organ failure with 3 deaths due to severe sepsis-related disease in early re-OLT, and 4 deaths were due to severe sepsis-related disease with 3 deaths due to recurrence of hepatocellular carcinoma （HCC） in late re-OLT. One and 2-year actuarial survival rates after re-OLT were 55.2% and 36.9%, respectively, for patients in early re-OLT, and 65.1% and 52% respectively, for patients in late re-OLT. No significant differences were found regarding survival rates between the two groups. Conclusions Similar clinical results can be achieved in early and late re-OLT. Proper indications and optimal operation timing, adequate preoperative preparation, experienced surgical procedures, and effective perioperative anti-infection strategy contribute to the improvement of overall survival rates of patients after re-OLT.

Prophylaxis of hepatitis B recurrence in post-liver transplantation patients with lamivudine-resistant YMDD mutant

Background The most frequently used therapy for post-transplantation recurrence of hepatitis B virus （HBV） infection is lamivudine, but this drug is associated with a high resistance rate due to YMDD mutant. In preliminary reports, adefovir dipivoxil （ADV） has been shown to have activity against lamivudine-resistant strains of HBV. However, clinical experience in treatment of HBV infection after liver transplantation （LT） is still not entirely clear. This study was aimed to evaluate the prophylactic efficacy of ADV plus hepatitis B immunoglobulin （HBIG） in patients with YMDD mutant before LT. Methods From March 2004 to March 2006, 16 patients with chronic hepatitis B had lamivudine-resistant YMDD mutants detected prior to liver transplantation and received treatment with ADV plus additional intramuscular HBIG after LT as prophylaxis against graft reinfection. Tests for liver function, serum HBsAg, anti-HBs （HBIG）, HBeAg, anti-HBc, anti-HBe, HBV-DNA, and creatinine were assessed pre- or post-liver transplantation. Results The median follow-up of these patients post-liver transplantation was 19.4 months. Fifteen patients survived and one patient died of recurrence of hepatocellular carcinoma （HCC）. There was significant difference （10.98% vs. 2.26%, P〈0.05） in YMDD mutant rate between the patients with HBV-DNA over 106 copies/ml and those with HBV-DNA less than 106 copies/mi. Fifteen patients （93.8%） had undetectable HBV-DNA at 4 weeks and 1 （6.3%） at 6 months after LT. No hepatitis B recurrence was detected by persistent testing of HBsAg, HBeAg, and HBV-DNA and no increase of serum creatinine level associated with ADV was observed in any of the patients. Conclusion ADV combined with intramuscular HBIG can effectively prevent patients with pre-transplantation YMDD mutant from HBV recurrence after LT.

Monoclonal antibodies as therapeutic agents in oncology and antibody gene therapy

，治疗学的代理人主要在肿瘤学被使用的抗体在淋巴瘤，乳癌或颜色由他们的应用说明了表面的癌症。这评论为癌症治疗提供单音的同种细胞的抗体的发展的一个简短历史的图案并且迄今为止为建立最好的试剂总结最重要的临床的数据。改进抗体治疗的反肿瘤功效也讨论策略，包括抗体基因治疗和骨髓的利用作为抗体基因 transporter 导出主要间充质的干细胞。

Liver transplantation in China： Retrospect and prospect

China＇s liver transplantation, after 3 decades of rises and falls since its first clinical trial in 1978, has now been accepted as an effective treatment for all kinds of end-stage liver diseases. The total number of liver transplantation performed each year is just next to that in the USA and ranks the second in the world. Despite its rapid growth and widespread recognition, many problematic issues in this field still remain unsettled,

Hemophagocytic syndrome： a rare but fatal complication after liver transplantation

Hemophagocytic syndrome （HPS） is recognized as a disorder characterized by a variety of symptomsincluding fever, jaundice, skin rash, lymphadenopathy, and hepatosplenomegaly related to uncontrolled systemic T-cell activation. Two forms of HPS have been characterized： primary/familial hemophagocytic lymphohistiocytosis and secondary/reactive HPS. Reactive HPS was first described in 1979 by Risdall et al.2 Although most patients with HPS are immunocompromised, only a small number of patients with HPS have been reported following liver transplantation （LT）, suggesting a low level of awareness for this hematological disorder after transplantation. We herein report one patient who underwent LT and in whom HPS subsequently developed. The patient had an aggressive clinical course and fatal outcome. The observation of one case of HPS in a cohort of 741 patients who underwent LT in our center raised the possibility that the case of HPS in these immunocompromised patients might be increasing in the future. Because of this,

COVID-19 in the immunocompromised population:data from renal allograft recipients throughout full cycle of the outbreak in Hubei province,China

Coronavirus disease 2019(COVID-19)is an infectious disease caused by a newly discovered coronavirus and has rapidly spread to most of the world and resulted in a global pandemic.However,there is a paucity of information available to characterize the immunodeficient population in the COVID-19 pandemic,especially information that focuses on patients after renal transplantation as the typical representative of this population.