[Analysis of influencing factors of shunt dysfunction after transjugular intrahepatic portosystemic shunt in liver cirrhosis accompanied with portal vein thrombosis]

Objective: To investigate the efficacy of shunt after transjugular intrahepatic portosystemic shunt (TIPS) in liver cirrhosis accompanied with portal vein thrombosis (PVT). Methods: Forty-four cases with liver cirrhosis accompanied with PVT who underwent TIPS treatment from January 2015 to May 2018 were retrospectively analyzed. Clinical baseline data of the patients were collected. Portal vein pressure gradient (PVPG) before and after the surgery was recorded. Shunt patency was observed at 3, 6, 12, 18 and 24 months after the surgery. The influencing factors were determined by univariate and multivariate analysis. Results: Transjugular intrahepatic portosystemic shunt was successfully established in all 44 cases. The postoperative PVPG was lower than preoperative (P < 0.01). The shunt patency rate after TIPS in PVT was 18.2% (n = 8). The cumulative shunt patency rates at 3, 6, 12, 18, and 24 months after surgery were 95.5%, 90.7%, 90.7%, 86.8% and 74.4%, respectively. Univariate analysis showed that diabetes history, platelet level and prothrombin time-international normalized ratio were associated with postoperative shunt dysfunction. Multivariate analysis showed that diabetes history (P = 0.007, OR = 28.606) was an independent risk factor for postoperative shunt dysfunction. Conclusion: TIPS is a safe and feasible procedure, which can effectively reduce the portal pressure in liver cirrhosis accompanied with PVT. Diabetic patients have a higher risk of postoperative shunt dysfunction. Therefore, clinical intervention should be strengthened for high-risk patients.

Suppression of natural killer cell activity in biliary obstruction

Prior studies regarding immune function in bile-duct ligated rats have illustrated blunted immune function. The present study measures natural killer (NK) cell activity. Rats underwent bile duct ligation (BDL) or sham celiotomy (SC) and were sacrificed at 1, 2, and 3 weeks after surgery. Ficoll-Hypaque density centrifugation was used to obtain a purified preparation of splenocytes. NK cell activity was determined by incubating varying concentrations of splenocytes with chromium-labelled YAC-1 tumor cells for 4 hours. Chromium release was measured by a gamma counter and expressed as per cent activity (compared with 100 per cent activity obtained by complete lysis with detergent). The experiments were repeated after preincubation in tissue culture flasks to remove an adherent cell population. NK cell activity was decreased at all spleen cell:target cell ratios studies at 1 week after BDL. At 2 weeks after BDL, NK cell activity was decreased at all but the lowest two concentrations; and 3 weeks after BDL, NK cell activity was decreased only at the highest concentrations used. Separation of an adherent cell fraction restored NK cell activity. This suppression in NK cell activity one week after BDL may account, in part, for the poor response of BDL animals to bacterial and immune challenge. Restoration of activity after removal of an adherent cell fraction suggests that macrophages may be at least partly responsible for this inhibition.

Splenocytes from bile duct ligated rats do not elicit a normal immune response in the intact host

Previous studies have shown impaired immune function in biliary obstruction, and our earlier investigations have demonstrated impaired response to alloantigens in the jaundiced rat host. The present study uses the graft versus host (GVH) popliteal lymph node assay to assess the ability of lymphocytes from bile duct ligated animals to elicit an immune response in normal rats. Female Lewis rats underwent bile duct ligation and transection (BDL) or sham celiotomy. A third group of rats served as normal controls. The animals were killed at intervals from 1 to 6 weeks after surgery, and spleen cell preparations were made. Splenocytes (5 x 10(6) from BDL, sham celiotomy, or normal control rats were injected into the hind footpads of LBNF1 hybrid rats. The contralateral hind footpads were injected with media as controls. The popliteal lymph nodes were removed and weighted 7 days after injection. The BDL rats were clinically jaundiced. GVH response was normal at 1 week and decreased at 2 weeks, remaining depressed through 6 weeks. Contralateral control lymph node weights were similar in all groups. Obstructive jaundice not only impairs host immune defense, but also significantly decreases splenocyte GVH capability.

Impaired response to alloantigens in murine biliary obstruction

Male Lewis strain rats underwent bile duct ligation and division (BDL), selective hepatic duct ligation (SHL), simple ligation and recanalization (RCN), or sham celiotomy (SC). Unoperated rats served as normal controls (NC). At intervals of 1, 2, and 3 weeks postoperatively, the popliteal lymph node assay was used to study host versus graft (HVG) response. LBN-F1 splenocytes (5 x 10(6)) were injected into the hind foot pads, and the contralateral foot pad was injected with medium as a control. The popliteal lymph nodes were removed and weighed 7 days later. In the BDL group, HVG response was significantly impaired at 1 (BDL, 12.9 +/- 5.1 mg; SC, 21.6 +/- 2.6; NC, 22.4 +/- 9.4; P < 0.005, BDL vs SC or NC), 2 (BDL, 12.6 +/- 5.6; SC, 19.1 +/- 3.0; NC, 15.8 +/- 5.8; P < 0.001, BDL vs SC), and 3 weeks (BDL, 8.9 +/- 3.9; SC, 21.7 +/- 6.3; NC, 16.7 +/- 3.8; P < 0.001, BDL vs SC or NC). SHL did not cause hyperbilirubinemia or impair the HVG response at 2 weeks (SHL, 17.2 +/- 4.5; NC, 16.7 +/- 7.4). The serum bilirubin was normal 2 and 3 weeks after RCN, and the HVG response was normal in both groups; however, the HVG response was somewhat lower at 2 weeks (RCN, 12.1 +/- 2.1) than at 3 weeks (RCN, 18.2 +/- 4.4; P < 0.01, RCN 2 weeks vs RCN 3 weeks). BDL causes significant impairment in the murine response to alloantigens as measured by the popliteal lymph node assay.(ABSTRACT TRUNCATED AT 250 WORDS)