Pathological characteristics of liver allografts from donation after brain death followed by cardiac death in pigs

Donation after brain death followed by circulatory death (DBCD) is a unique practice in China. The aim of this study was to define the pathologic characteristics of DBCD liver allografts in a porcine model. Fifteen male pigs (25-30 kg) were allocated randomly into donation after brain death (DBD), donation after circulatory death (DCD) and DBCD groups. Brain death was induced by augmenting intracranial pressure. Circulatory death was induced by withdrawal of life support in DBCD group and by venous injection of 40 mL 10% potassium chloride in DCD group. The donor livers were perfused in situ and kept in cold storage for 4 h. Liver tissue and common bile duct samples were collected for hematoxylin and eosin staining, TUNEL testing and electron microscopic examination. Spot necrosis was found in hepatic parenchyma of DBD and DBCD groups, while a large area of necrosis was shown in DCD group. The apoptosis rate of hepatocytes in DBD [(0.56±0.30)%] and DBCD [(0.50 ± 0.11)%] groups was much lower than that in DCD group [(3.78±0.33)%] (P<0.05). And there was no significant difference between DBD group and DBCD group (P>0.05)). The structures of bile duct were intact in both DBD and DBCD groups, while the biliary epithelium was totally damaged in DCD group. Under electron microscope, the DBD hepatocytes were characterized by intact cell membrane, well-organized endoplasmic reticulum, mild mitochondria edema and abundant glycogens. Broken cell membrane, mild inflammatory cell infiltration and sinusoidal epithelium edema, as well as reduced glycogen volume, were found in the DBCD hepatocytes. The DCD hepatocytes had more profound cell organelle injury and much less glycogen storage. In conclusion, the preservation injury of DBCD liver allografts is much less severe than that of un-controlled DCD, but more severe than that of DBD liver allografts under electron microscope, which might reflect post-transplant liver function to some extent.

Liver transplantation using organs from deceased organ donors: a single organ transplant center experience

BACKGROUND

In 2011, a pilot program for deceased organ donation was initiated in China. We describe the first successful series of liver transplants in the pilot program.

METHODS

From July 2011 to August 2012, our center performed 26 liver transplants from a pool of 29 deceased donors. All organ donation and allograft procurement were conducted according to the national protocol. The clinical data of donors and recipients were collected and summarized retrospectively.

RESULTS

Among the 29 donors, 24 were China Category II donors (organ donation after cardiac death), and five were China Category III donors (organ donation after brain death followed by cardiac death). The recipients were mainly the patients with hepatocellular carcinoma. The one-year patient survival rate was 80.8% with a median follow-up of 422 (2-696) days. Among the five mortalities during the follow-up, three died of tumor recurrence. In terms of post-transplant complications, 9 recipients (34.6%) experienced early allograft dysfunction, 1 (3.8%) had non-anastomotic biliary stricture, and 1 (3.8%) was complicated with hepatic arterial thrombosis. None of these complications resulted in patient death. Notably, primary non-function was not observed in any of the grafts.

CONCLUSION

With careful donor selection, liver transplant from deceased donors can be performed safely and plays a critical role in overcoming the extreme organ shortage in China.

[Study on safety of Tibetan medicine zuotai and preliminary study on clinical safety of its compound dangzuo]

Zuotai (gTso thal) is a typical representative of Tibetan medicines containing heavy metals, but there is still lack of modem safety evaluation data so far. In this study, acute toxicity test, sub-acute toxicity test, one-time administration mercury distribution experiment, long-term mercury accumulative toxicity experiment and preliminary study on clinical safety of Compound Dangzuo were conducted in the hope of obtain the medicinal safety data of Zuotai. In the acute toxicity test, half of KM mice given the lethal dose of Zuotai were not died or poisoned, and LD50 was not found. The maximum tolerated dose of Zuotai was 80 g x kg(-1). In the subacute toxicity test, Zuotai could reduce ALT, AST, Crea levels in serums under low dose (13.34 mg x kg(-1) x d(-1)) and medium dose (53.36 mg x kg(-1) x d(-1)), with significant difference under low dose, and increase the levels of ALT, AST, MDA, Crea in serums under high dose (2 000 mg x kg(-1) x d(-1)); besides, the levels of BUN and GSH in serums reduced with the increase in dose of Zuotai, indicating a significant dose-effect relationship. In the one-time administration distribution experiment, the content of mercury in rat kidney, liver and lung increased after the one-time administration with Zuotai, with a significant dose-dependent relationship in kidney. In the long-term mercury accumulative toxicity experiment, KM mice were administered with equivalent doses of Zuotai for 4.5 months and then stopped drug administration for 1.5 months. Since the 2.5th month, they showed significant mercury accumulation in kidney, which gradually reduced after drug withdrawal, without significant change in mercury content in liver, spleen and brain and ALT, AST, TBIL, BUN and Crea in serum. At the 4.5th month after drug administration, KM mice showed slight structural changes in kidney, liver and spleen tissues, and gradually recovered to normal after drug withdrawal. Besides, no significant difference in weight gain was found between the Zuotai group and the control group. According to the findings of the clinical safety study of Dangzuo, after subjects administered Dangzuo under clinical dose for one month, their serum biochemical indicators, blood routine indicators and urine routine indicators showed no significant adverse change. This study proved that traditional Tibetan medicine Zuotai was slightly toxic, with a better safety in clinical combined administration and no adverse effects on bodies under the clinical dose and clinical medication cycle. However, long-term high-dose administration of Zuotai may have a certain effect on kidney.

[Impact of hepatitis B virus infection on liver function after hematopoietic stem cell transplantation]

To analyze the impact of hepatitis B virus (HBV) infection on liver function of patients after hematopoietic stem cell transplantation (HSCT), the transplantation outcome of 48 patients infected with HBV prior to transplantation among 185 patients received HSCT was investigated retrospectively. The results showed that during a follow-up for 6 months after HSCT, the alanine aminotransferase (ALT) peak average values of the patients with HBsAg(+), HBsAb(+) and control groups were (281.6 ± 414.6), (95.4 ± 79.9) and (65.1 ± 44.2) U/L, respectively. The incidences of abnormal liver function of the patients with HBsAg(+), HBsAb(+) and control groups were 61.54%, 40.00% and 30.23% respectively. There were no significant differences between any two groups (P > 0.05). The lethality of those patients at late period after transplantation was not related to HBV infection. The hepatocirrhosis and hepatocarcinoma caused by HBV infection have not become major problems in long-term survivors. It is concluded that in HBsAg(+) patients received HSCT, the damage of liver function is more severe than control group, possibly increasing the development of abnormal liver function. The measures against the liver function damage should be taken. The prophylactic administration of ganciclovir for virus may be effective to prevent the activation of HBV.

Evolution of the Macondo well blowout: simulating the effects of the circulation and synthetic dispersants on the subsea oil transport

During the Deepwater Horizon incident, crude oil flowed into the Gulf of Mexico from 1522 m underwater. In an effort to prevent the oil from rising to the surface, synthetic dispersants were applied at the wellhead. However, uncertainties in the formation of oil droplets and difficulties in measuring their size in the water column, complicated further assessment of the potential effect of the dispersant on the subsea-to-surface oil partition. We adapted a coupled hydrodynamic and stochastic buoyant particle-tracking model to the transport and fate of hydrocarbon fractions and simulated the far-field transport of the oil from the intrusion depth. The evaluated model represented a baseline for numerical experiments where we varied the distributions of particle sizes and thus oil mass. The experiments allowed to quantify the relative effects of chemical dispersion, vertical currents, and inertial buoyancy motion on oil rise velocities. We present a plausible model scenario, where some oil is trapped at depth through shear emulsification due to the particular conditions of the Macondo blowout. Assuming effective mixing of the synthetic dispersants at the wellhead, the model indicates that the submerged oil mass is shifted deeper, decreasing only marginally the amount of oil surfacing. In this scenario, the oil rises slowly to the surface or stays immersed. This suggests that other mechanisms may have contributed to the rapid surfacing of oil-gas mixture observed initially. The study also reveals local topographic and hydrodynamic processes that influence the oil transport in eddies and multiple layers. This numerical approach provides novel insights on oil transport mechanisms from deep blowouts and on gauging the subsea use of synthetic dispersant in mitigating coastal damage.

Adenovirus-mediated bone morphogenetic protein-2 gene transfection of bone marrow mesenchymal stem cells combined with nano-hydroxyapatite to construct bone graft material in vitro

To study the adhesion, proliferation and expression of bone marrow mesenchymal stem cells (BMSCs) on nano-hydroxyapatite (Nano-HA) bone graft material after transfection of adenovirus-mediated human bone morphogenetic protein-2 expression vector (Ad-BMP-2). BMSCs were transfected using Ad-BMP-2. Immunohistochemistry and Western blot were used to detect BMP-2 expression in transfected cells. After transfection, BMP-2 protein was highly expressed in BMSCs; MTT test assay showed that the Nano-HA bone graft material could not inhibit in vitro proliferation of BMSCs. Ad-BMP-2-transfected BMSCs are well biocompatible with Nano-HA bone graft material, the transfected cells in material can secrete BMP-2 stably for a long time.

A novel approach for normalizing the photoreflectance spectrum by using polymer-dispersed liquid crystal

This study developed a novel type of normalization procedure for modulation reflectance spectroscopy experiments to obtain the relative change in the reflectance spectrum, ΔR/R. This technique uses a polymer-dispersed liquid crystal to ensure that the dc component of the signal from the detector remained constant by varying the intensity of the light striking the sample. This method is particularly useful for photoreflectance measurement, which may encounter background problems because of scattered pump light and/or photoluminescence. It does not require a change in the gain of the detector or the use of a variable neutral density filter mounted on a servo-motor.

[Efficacy and safety of sorafenib in the prevention and treatment of hepatocellular carcinoma recurrences after liver transplantation]

OBJECTIVE

To evaluate the efficacy and safety of sorafenib in the prevention and treatment of hepatocellular carcinoma (HCC) relapse after liver transplantation.

METHODS

A retrospective cohort study was performed to assess the efficacy and safety of sorafenib for HCC. Forty-four patients who underwent liver transplant for HCC beyond Milan criteria form July 2007 to May 2010 were included study group (sorafenib, n = 22) and control group (without sorafenib, n = 22). The primary endpoints of the study were disease-free survival (DFS), overall survival (OS). Secondary outcomes included the rates of acute rejection and graft survival.

RESULTS

The clinical data of 44 patients were completely collected. There were significantly differences between sorafenib group and control group in 1-year DFS (81.8% (n = 18) vs 63.6% (n = 14), P < 0.05) and OS (90.9% (n = 20) vs 72.7% (n = 16), P < 0.05) respectively. The acute rejection rates in Sorafenib were 13.6% (3/22), compared with 18.2% (4/22) in control group (P = 0.524) and 1-year graft survival in Sorafenib group were 86.4% (19/22), compared with 72.7% (16/22) in control group (P = 0.086). The overall incidence of treatment-related adverse events was 68.1% (n = 15) in sorafenib group and 31.8% (n = 7) in the control group (P < 0.01). Adverse events that were reported for patients receiving sorafenib were predominantly grade 1 or 2 in severity including diarrhea (45.5%, n = 10), liver dysfunction (40.9%, n = 9), hand-foot skin reaction (31.8%, n = 7) and pains of head and four limbs (22.7%, n = 5). Two patients with grade 3 adverse events in study group were stopped continuing to use the sorafenib. Three patients with the dose of 400 mg twice daily and 17 patients with the dose reduction of sorafenib continued to the study endpoint.

CONCLUSION

Patients with HCC undergoing liver transplantation could get the benefits of Sorafenib in reducing the incidence of tumor recurrence and extending disease-free and overall survival time.

Steroid elimination within 24 hours after orthotopic liver transplantation: effectiveness and tolerability

BACKGROUND

Steroids have been the mainstay of immunosuppressive regimen in liver transplantation. However, the use of steroids is associated with various post-transplant complications. This study evaluated the efficacy and safety of reduced immunosuppressive regimen with steroids (steroid elimination within 24 hours post-transplant) in a cohort of Chinese liver transplant recipients.

METHODS

Seventy-six patients in line with the selection criteria were enrolled in this prospective study. All patients received anti-IL-2 receptor antibody induction and tacrolimus-based maintenance therapy. The recipients were divided into two groups according to the duration of steroid use: 40 transplant in a 3-month withdrawal group and the remaining 36 in a 24-hour elimination group. Recipient survival, post-operative infections, biopsy-proven acute rejection and steroid-resistant acute rejection, non-healing wound, recurrence of hepatitis B virus (HBV) and hepatocellular carcinoma (HCC), de novo diabetes, hyperlipidemia and hypertension were assessed in the two groups.

RESULTS

There was no significant difference in patient survival, incidence of acute rejection episodes and hyperlipidemia, and recurrence of HBV and HCC between the two groups. However, the incidence rates of post-transplant infection, non-healing wound, de novo diabetes and hypertension were significantly lower in the 24-hour elimination group than in the 3-month withdrawal group (all P values <0.05).

CONCLUSION

Under anti-IL-2 receptor antibody induction and tacrolimus-based maintainance, steroid elimination within 24 hours post-transplant is associated with reduced steroid-related complications without increasing the risk of rejection.

An improved polymerase chain reaction method for genetic testing of spinocerebellar ataxia type 3

The development of a reliable PCR assay for genetic testing of spinocerebellar ataxia type 3. Touchdown PCR conditions were tested and different primer sets were evaluated with genomic DNA from blood sample of patients suffering from spinocerebellar ataxia type 3 (SCA3). An improved PCR assay was developed with a new set of primers and using the optimized touchdown PCR protocol. This new assay had been successfully employed in the screening of one identificated SCA3 family. Results from the present study document a simple and reliable PCR assay for genetic testing of SCA3. Strategies used in the present study may find applications in the optimization of PCR assay for triplet expansion with GC rich in the sequence context.

[Clinical efficacies of ABO-incompatible adult liver transplantation]

OBJECTIVE

To evaluate the efficacy and safety of ABO-incompatible liver transplantation in adult patients with fulminant hepatitis B.

METHODS

The clinical data of 97 cases of adult liver transplantation for fulminant hepatitis B were retrospectively analyzed. The patients were grouped as ABO-identical (ABO-Id, n = 58), ABO-compatible (ABO-C, n = 19) and ABO-incompatible (ABO-In, n = 20). The rates of rejection, infection, biliary tract complications, vascular complications, and patient and graft survivals were compared among 3 groups.

RESULTS

The 3-month, 1-year and 3-year graft survival rates were 87.9%/77.6%/65.3% in ABO-Id group, 84.2%/73.7%/66.5% in ABO-C group and 50.0%/35.0%/33.3% in ABO-In group respectively. There were significant differences between ABO-Id and ABO-In (P < 0.05). The incidences of rejection, infection, vascular complications and biliary tract complications were 8.6%, 20.7%, 3.4% and 6.9% in ABO-Id group, 35%, 60%, 20% and 30% in ABO-In group (P < 0.05) and 10.5%, 26.3%, 5.3% and 10.5% respectively in ABO-C group (P > 0.05).

CONCLUSION

ABO-C liver transplantation is an important therapeutic option in adult patients with acute liver failure awaiting an emergency procedure. ABO-In transplantation can be used only for life-rescuing in patients with fulminant hepatitis since it is associated with a higher risk of rejection, infection, vascular thrombosis, ischemic bile duct complications and poor patient and graft survival.

[Analysis on treatment outcomes in five patients with combined en bloc liver and pancreas transplantation]

OBJECTIVE

To summarize the treatment outcomes after combined en bloc liver and pancreas transplantation.

METHODS

Five patients with end-stage liver disease and type 2 diabetes mellitus received combined en bloc liver and pancreas transplantation after hepatectomy.

RESULTS

Five operations were performed successfully. The operative time ranged from 9 to 16 hours and blood loss from 1600 to 3000 ml. Postoperatively, one patients developed pulmonary infection, one died of graft-versus-host disease(GVHD), and one experienced acute renal failure. No intestinal fistula, anastomotic leakage, biliary complications, chronic and acute rejection and pancreatitis were seen. Liver function index including alanine aminotransferase, aspartate aminotransferase and total bilirubin returned to normal levels a week after surgery, while levels of C peptide and blood glucose resumed within 1 to 2 weeks. Apart from 1 case died of GVHD, the other 4 maintained normal liver function during the follow up ranging from 2 to 23 months and no insulin was required for the diabetes.

CONCLUSION

Combined en bloc liver and pancreas transplantation is technically feasible and an effective treatment for multi-organ diseases.

[Effect of Campath-1H induction on immunosuppression in small intestine transplantation]

OBJECTIVE

To investigate the effect of Campath-1H induction on immunosuppression in small intestine transplantation.

METHODS

Clinical data of a patient who underwent small intestine transplantation were retrospectively summarized.

RESULTS

Intraoperative Campath-1H induction by intravenous injection was administered. Triple immunosuppression(FK506, MMF and methylprednisolone) was used postoperatively. The lymphocyte and leukocyte decreased significantly following Campath-1H induction, and returned to normal after adjusting the dose of immunosuppressant and use of colony stimulating factor. There were no acute rejection, graft versus host disease, or severe infection during the immediate postoperative period. The patient recovered and discharged.

CONCLUSION

Intraoperative Campath-1H induction and postoperative triple immunosuppression using FK506, MMF, and methylprednisolone may prevent rejection and graft versus host disease in the early stage after small intestine transplantation.

[Clinical analysis on multivisceral transplantation]

OBJECTIVE

To assess the indication, surgical and post-operative complications of the multivisceral transplantation.

METHODS

The post-transplant complications of 8 patients who underwent multivisceral transplantation between May 2004 and May 2010 were analyzed. There were 7 male and 1 female, aged from 28 to 65 years. Five patients who suffered from non-resectable advanced upper abdominal malignancy experienced the liver, stomach, spleen, pancreas, duodenum, omentum and variable amounts of the colon resection, and then underwent standard multivisceral transplantation (included liver, stomach, pancreaticoduodenal and small bowel). After underwent hepatectomy while retaining the native pancreas and entire gastrointestinal, three recipients with end-stage liver cirrhosis and type 2 insulin-dependent diabetes mellitus (IDDM) was performed combined en bloc liver/pancreaticoduodenal transplantation.

RESULTS

Since the third day post-operation, all recipients no longer needed exogenous insulin and had normal blood glucose concentrations. Two weeks after transplantation, their liver function almost became normal. For the 5 recipients who suffered abdominal malignancy, the longest survival period was 326 days. Cause of death are recurrent tumor (n = 2), multiple organ failure (n = 3). All the 5 patients experienced infection. For 3 patients suffered cirrhosis and IDDM, the longest survival was over 18 month. Excepting the case 8 died of graft versus host disease, all were still living without apparently post-transplant complication.

CONCLUSIONS

Multivisceral transplantation is an alternative in the treatment of the patients with benign massive abdominal pathologies. Careful patient selection and technical modification are crucial to improve the outcome of these patients.

[Etiology and management of postoperative gastrointestinal bleeding after orthotopic liver transplantation]

OBJECTIVE

To investigate the causes and treatment of postoperative gastrointestinal bleeding after orthotopic liver transplantation (OLT).

METHODS

Clinical data of 776 patients after OLT between January 2000 and December 2006 were analyzed retrospectively.The experiences in diagnosis and treatment of postoperative gastrointestinal bleeding after OLT were reviewed.

RESULTS

Gastrointestinal bleeding occurred in 18 patients (2.3%) after OLT, among whom 8 (44.5%) were from peptic ulcer, 3 (16.7%) from gastric and esophageal varices, 3 (16.7%) from gastroduodenitis, 3 (16.7%) from hemobilia, and 1 (5.6%) had diverticular bleeding in the jejunum. These 18 patients with gastrointestinal bleeding were managed with conservative treatment, endoscopic treatment, radiological interventional embolism,or exploratory laparotomy. Five patients died of gastrointestinal bleeding and the gastrointestinal bleeding-related mortality rate was 27.8%. After a mean follow up of 3.5 years, only 1 patient died of recurrence of hepatic cellular carcinoma while others survived disease-free.

CONCLUSIONS

Gastrointestinal bleeding may occur from different sites after OLT and the mortality is high. Prompt identification of the source of bleeding and correct management are required to improve the prognosis.

Strontium borate glass: potential biomaterial for bone regeneration

Boron plays important roles in many life processes including embryogenesis, bone growth and maintenance, immune function and psychomotor skills. Thus, the delivery of boron by the degradation of borate glass is of special interest in biomedical applications. However, the cytotoxicity of borate glass which arises with the rapid release of boron has to be carefully considered. In this study, it was found that the incorporation of strontium into borate glass can not only moderate the rapid release of boron, but also induce the adhesion of osteoblast-like cells, SaOS-2, thus significantly increasing the cyto-compatibility of borate glass. The formation of multilayers of apatite with porous structure indicates that complete degradation is optimistic, and the spread of SaOS-2 covered by apatite to form a sandwich structure may induce bone-like tissue formation at earlier stages. Therefore, such novel strontium-incorporated borosilicate may act as a new generation of biomaterial for bone regeneration, which not only renders boron as a nutritious element for bone health, but also delivers strontium to stimulate formation of new bones.

Graft-verse-host disease after liver transplantation: A report of two cases and review of literature

Graft-verse-host disease (GVHD) is an uncommon fatal complication following liver transplantation (LTx). In mainland China, only six cases have been reported with a morbidity rate up to 1%-2%. Definitive diagnosis was achieved by molecular techniques (HLA typing or PCR-STR) in only two cases and the remaining cases were diagnosed based on typical clinical features with exclusion of other possible causes. All patients died of septic shock or multiple organ failure even after administration of increased corticosteroids and supportive therapy, and reduced immunosuppressive agents. In our center, two cases of GVHD were found among 128 (1.56%) patients. One case was diagnosed by detecting lymphocyte macrochimerism through DNA-STR. Both of them died even after aggressive treatment. In China, the incidence of GVHD is similar to that reported by foreign centers except for an extremely bad prognosis. Rapid diagnosis is crucial for a better prognosis. In China, only 37.5% of cases are diagnosed by molecular methods. We recommend detecting lymphocyte macrochimerism through DNA-STR to get a rapid diagnosis, and interleukin 2-receptor antibody (basiliximab or daclizumab) therapy seems to be a good choice for the disease.

[The analysis of portal vein thrombosis following orthotopic liver transplantation]

OBJECTIVE

To investigate and summarize the experience in clinical presentation, diagnosis and treatment of portal vein thrombosis after orthotopic liver transplantation (OLT).

METHODS

The clinical data of 402 patients who underwent OLT from January 2003 to February 2007 were reviewed. A retrospective study was performed on etiology, prognosis and treatment in 9 cases of portal vein thrombosis after OLT.

RESULTS

All of the 9 cases received anticoagulant and antiaggregation therapy, within whom one underwent percutaneous transluminal angioplasty and stent placement, one underwent retransplantation after failure of thrombolysis therapy, and one received surgical embolectomy. Six patients died of multiple organ failure on 9th, 30th, 34th, 40th, 48th, 6 2nd days, respectively, while 3 patients survived.

CONCLUSIONS

The major risk factors of portal vein thrombosis after OLT were pathological changes in portal vein, abnormal blood stream dynamics, hypercoagulable status and improper surgical technique. Prophylactic intervention to patients with high risk factors, early diagnosis and aggressive comprehensive therapy on portal vein thrombosis patients are essential to improve prognosis.

[The etiology and management of postoperative hyperbilirubinemia after orthotopic liver transplantation]

OBJECTIVE

To investigate the causes and treatment of postoperative hyperbilirubinemia after orthotopic liver transplantation.

METHODS

Clinical data of 368 cases of orthotopic liver transplantation patients from the First Affiliated Hospital of Sun Yat-sen University between 2004 and 2005 were analyzed retrospectively.

RESULTS

Three hundred and sixty-eight patients experienced 396 incidents of hyperbilirubinemia, including 183 incidents of preoperative hyperbilirubinemia (46.2%), 46 incidents of ischemia-reperfusion injury (11.6%), 36 incidents of acute rejection (9.1%), 78 incidents of biliary complications (19.7%), 24 incidents of blood vessel complications (6.1%), 23 incidents of recurrence of the primary disease (5.8%) and 6 incidents of tacrolimus (FK506) toxicity (1.5%). The comprehensive management targeted to the etiology and symptoms were applied to all patients with hyperbilirubinemia.

CONCLUSION

Hyperbilirubinemia is a common clinical manifestation after liver transplantation with multiple and complicated causes. The key point for successful treatment is to identify the causes. To reach the aim of treatment and obtain long-term survival of the recipients, it is very important to make a correct diagnosis and give reasonable therapeutic regimens as soon as possible.

[Prophylaxis and management of biliary complications after orthotopic liver transplantation]

OBJECTIVE

To investigate the risk factors of biliary complications after orthotopic liver transplantation (OLTx) and the relevant prevention and management strategies.

METHODS

The clinical data of 368 patients undergoing allograft orthotopic liver transplantation, 282 males and 86 females, aged 47.5 (8 - 73), were collected and analyzed retrospectively.

RESULTS

Of the 368 OLTx patients, 36 (9.8%) experienced biliary complications, including simple anastomosis biliary leakage (7 cases), biliary leakage due to injury and omission of accessory hepatic duct (1 case), anastomosis stricture (5 cases), intrahepatic bile duct stricture (3 cases), bile duct stricture secondary to bile duct twist (1 case), calculus of intrahepatic duct (2 cases), bile duct stricture secondary to biliary leakage (2 cases), bile duct stricture combined with intrahepatic biloma (2 cases), bile duct stricture combined with biliary sludge (2 cases), biliary cast syndrome (5 cases), hemobilia (1 case), intrahepatic abscess (3 cases) and Oddi's sphincter dysfunction (2 cases). Among the 36 patients with biliary complications, 23 were cured by nonsurgical therapies; and 13 patients needed abdominal surgical interventions, including retransplantation in 7 cases.

CONCLUSION

Biliary complications after OLT are difficult to treat. Most of these complications can be cured conservatively, such as radiological intervention and endoscopic treatment. When the patients are unresponsive to nonsurgical therapies, or when they suffer from hepatic arterial embolism or arterial stricture simultaneously, surgical interventions, even retransplantation should be considered.