BACKGROUND: Glycogen storage disease (GSD) is an inherited metabolic disorder in which the concentration and/or structure of glycogen in tissues is abnormal. Essentially, abnormalities in all known enzymes involved in...BACKGROUND: Glycogen storage disease (GSD) is an inherited metabolic disorder in which the concentration and/or structure of glycogen in tissues is abnormal. Essentially, abnormalities in all known enzymes involved in the synthesis or degradation of glycogen and glucose have been found to cause some type of GSD. Liver and muscle have abundant quantities of glycogen and are the most common and seriously affected tissues. This study was to assess reduced-size liver transplantation for the treatment of GSD. METHODS: The clinical data from one case of GSD type I with hepatic adenoma was retrospectively analyzed. The clinical manifestations were hepatomegaly, delayed puberty, growth retardation, sexual immaturity, hypoglycemia, and lactic acidosis, which made the young female patient eligible for reduced-size liver transplantation. RESULTS: The patient recovered uneventfully with satisfactory outcome, including 12 cm growth in height and 5 kg increase in weight during 16 months after successful reduced-size liver transplantation. She has been living a normal life for 4 years so far. CONCLUSIONS: Reduced-size liver transplantation is an effective treatment for GSD with hepatomegaly and hepatic adenoma. Delayed puberty, growth retardation, hypoglycemia and lactic acidosis can be cured by surgery.展开更多
Objective: To establish a stable reduced-size hepatic transplantation model in rats. Methods: Liver transplantation was performed in accordance with Kamada techniques. Many modifications were made including: Surgical ...Objective: To establish a stable reduced-size hepatic transplantation model in rats. Methods: Liver transplantation was performed in accordance with Kamada techniques. Many modifications were made including: Surgical manipulative innovation, adjustment of pre-operative drug administration and removed liver volume. Results: Forty-two rats underwent reduced-size hepatic transplantation; of them 33(84.6%) survived more than 1 week. The causes of postoperative death were peritonitis, inferior vena cava thrombus and unknown complications. Conclusion: Manipulative innovation and proper drug administration can improve the survival rate of rats apparently. Grafts regeneration can be triggered by the removal of left lateral segment and caudate lobe.展开更多
The evolution of multi-visceral and isolated intestinal transplant techniques over the last 3 decades has highlighted the technical challenges related to the closure of the abdomen at the end of the procedure.Two key ...The evolution of multi-visceral and isolated intestinal transplant techniques over the last 3 decades has highlighted the technical challenges related to the closure of the abdomen at the end of the procedure.Two key factors that contribute to this challenge include:(1) Volume/edema of donor graft;and(2) loss of abdominal domain in the recipient.Not being able to close the abdominal wall leads to a variety of complications and morbidity that range from complex ventral hernias to bowel perforation.At the end of the 90's this challenge was overcome by graft reduction during the donor operation or bench table procedure(especially reducing liver and small intestine),as well as techniques to increase the volume of abdominal cavity by pre-operative expansion devices.Recent reports from a few groups have demonstrated the ability of transplanting a full-thickness,vascularized abdominal wall from the same donor.Thus,a spectrum of techniques have co-evolved with multivisceral and intestinal transplantation,ranging from graft reduction to enlarging the volume of the abdominal cavity.None of these techniques are free from complications,however in large-volume centers the combinations of both(graft reduction and abdominal widening,sometimes used in the same patient) could decrease the adverse events related to recipient's closure,allowing a faster recovery.The quest for a solution to this unique challenge has led to the proposal and implementation of innovative solutions to enlarge the abdominal cavity.展开更多
AIM To investigate the effects of heme oxygenase-1(HO-1)-modified bone marrow mesenchymal stem cells(BMMSCs)on the microcirculation and energy metabolism of hepatic sinusoids following reduced-size liver transplantati...AIM To investigate the effects of heme oxygenase-1(HO-1)-modified bone marrow mesenchymal stem cells(BMMSCs)on the microcirculation and energy metabolism of hepatic sinusoids following reduced-size liver transplantation(RLT)in a rat model.METHODS BMMSCs were isolated and cultured in vitro using an adherent method,and then transduced with HO-1-bearing recombinant adenovirus to construct HO-1/BMMSCs.A rat acute rejection model following 50%RLT was established using a two-cuff technique.Recipients were divided into three groups based on the treatment received:normal saline(NS),BMMSCs and HO-1/BMMSCs.Liver function was examined at six time points.The levels of endothelin-1(ET-1),endothelial nitric-oxide synthase(e NOS),inducible nitric-oxide synthase(i NOS),nitric oxide(NO),and hyaluronic acid(HA)were detected using an enzyme-linked immunosorbent assay.The portal vein pressure(PVP)was detected by Power Lab ML880.The expressions of ET-1,i NOS,e NOS,and von Willebrand factor(v WF)protein in the transplanted liver were detected using immunohistochemistry and Western blotting.ATPase in the transplanted liver was detected by chemical colorimetry,and the ultrastructural changes were observed under a transmission electron microscope.RESULTS HO-1/BMMSCs could alleviate the pathological changes and rejection activity index of the transplanted liver,and improve the liver function of rats following 50%RLT,with statistically significant differences compared with those of the NS group and BMMSCs group(P<0.05).In term of the microcirculation of hepatic sinusoids:The PVP on POD7 decreased significantly in the HO-1/BMMSCs and BMMSCs groups compared with that of the NS group(P<0.01);HO-1/BMMSCs could inhibit the expressions of ET-1 and i NOS,increase the expressions of e NOS and inhibit amounts of NO production,and maintain the equilibrium of ET-1/NO(P<0.05);and HO-1/BMMSCs increased the expression of v WF in hepatic sinusoidal endothelial cells(SECs),and promoted the degradation of HA,compared with those of the NS group and BMMSCs group(P<0.05).In term of the energy metabolism of the transplanted liver,HO-1/BMMSCs repaired the damaged mitochondria,and improved the activity of mitochondrial aspartate aminotransferase(ASTm)and ATPase,compared with the other two groups(P<0.05).CONCLUSION HO-1/BMMSCs can improve the microcirculation of hepatic sinusoids significantly,and recover the energy metabolism of damaged hepatocytes in rats following RLT,thus protecting the transplanted liver.展开更多
BACKGROUND： Split liver transplantation increases the number of grafts available for transplantation. Pre-recovery assessment of liver graft volume is essential for selecting suitable recipients. The purpose of this ...BACKGROUND： Split liver transplantation increases the number of grafts available for transplantation. Pre-recovery assessment of liver graft volume is essential for selecting suitable recipients. The purpose of this study was to determine the ability and feasibility of constructing a 3-D model to aid in surgical planning and to predict graft weight prior to an in situ division of the donor liver. METHODS： Over 11 months, 3-D volumetric reconstruction of 4 deceased donors was performed using Pathfinder Scout liver volumetric software. Demographic, laboratory, operative, perioperative and survival data for these patients along with donor demographic data were collected prospectively and analyzed retrospectively. RESULTS： The average predicted weight of the grafts from the adult donors obtained from an in situ split procedure were 1130 g （930-1458 g） for the extended right lobe donors and 312 g （222-396 g） for left lateral segment grafts. Actual adult graft weight was 92% of the predicted weight for both the extended right grafts and the left lateral segment grafts. The predicted and actual graft weights for the pediatric donors were 176 g and 210 g for the left lateral segment grafts and 308 g and 280 g for the extended right lobe grafts,respectively. All grafts were transplanted except for the right lobe from the pediatric donors due to the small graft weight.CONCLUSIONS： On-site volumetric assessment of donors provides useful information for the planning of an in situ split and for selection of recipients. This information may expand the donor pool to recipients previously felt to be unsuitable due to donor and/or recipient weight.展开更多
Partial liver transplantation,including reducedsize liver transplantation,split liver transplantation,and living donor liver transplantation,has been developed with several innovative techniques because of donor short...Partial liver transplantation,including reducedsize liver transplantation,split liver transplantation,and living donor liver transplantation,has been developed with several innovative techniques because of donor shortage.Reduced-size liver transplantation is based on Couinaud’s anatomical classification,benefiting children and small adult recipients but failing to relieve the overall donor shortage.Split liver transplantation provides chances to two or even more recipients when only one liver graft is available.The splitting technique must follow stricter anatomical and physiological criteria either ex situ or in situ to ensure long-term quality.The first and most important issue involving living donor liver transplantation is donor safety.Before surgery,a series of donor evaluations—including anatomical,liver volume,and liver function evaluations—is indispensable,followed by ethnic agreement.At different recipient conditions,auxiliary liver transplantation and auxiliary partial orthotopic liver transplantation,which employ piggyback techniques,are good alternatives.Partial liver transplantation enriches the practice and knowledge of the transplant society.展开更多
文摘BACKGROUND: Glycogen storage disease (GSD) is an inherited metabolic disorder in which the concentration and/or structure of glycogen in tissues is abnormal. Essentially, abnormalities in all known enzymes involved in the synthesis or degradation of glycogen and glucose have been found to cause some type of GSD. Liver and muscle have abundant quantities of glycogen and are the most common and seriously affected tissues. This study was to assess reduced-size liver transplantation for the treatment of GSD. METHODS: The clinical data from one case of GSD type I with hepatic adenoma was retrospectively analyzed. The clinical manifestations were hepatomegaly, delayed puberty, growth retardation, sexual immaturity, hypoglycemia, and lactic acidosis, which made the young female patient eligible for reduced-size liver transplantation. RESULTS: The patient recovered uneventfully with satisfactory outcome, including 12 cm growth in height and 5 kg increase in weight during 16 months after successful reduced-size liver transplantation. She has been living a normal life for 4 years so far. CONCLUSIONS: Reduced-size liver transplantation is an effective treatment for GSD with hepatomegaly and hepatic adenoma. Delayed puberty, growth retardation, hypoglycemia and lactic acidosis can be cured by surgery.
文摘Objective: To establish a stable reduced-size hepatic transplantation model in rats. Methods: Liver transplantation was performed in accordance with Kamada techniques. Many modifications were made including: Surgical manipulative innovation, adjustment of pre-operative drug administration and removed liver volume. Results: Forty-two rats underwent reduced-size hepatic transplantation; of them 33(84.6%) survived more than 1 week. The causes of postoperative death were peritonitis, inferior vena cava thrombus and unknown complications. Conclusion: Manipulative innovation and proper drug administration can improve the survival rate of rats apparently. Grafts regeneration can be triggered by the removal of left lateral segment and caudate lobe.
文摘The evolution of multi-visceral and isolated intestinal transplant techniques over the last 3 decades has highlighted the technical challenges related to the closure of the abdomen at the end of the procedure.Two key factors that contribute to this challenge include:(1) Volume/edema of donor graft;and(2) loss of abdominal domain in the recipient.Not being able to close the abdominal wall leads to a variety of complications and morbidity that range from complex ventral hernias to bowel perforation.At the end of the 90's this challenge was overcome by graft reduction during the donor operation or bench table procedure(especially reducing liver and small intestine),as well as techniques to increase the volume of abdominal cavity by pre-operative expansion devices.Recent reports from a few groups have demonstrated the ability of transplanting a full-thickness,vascularized abdominal wall from the same donor.Thus,a spectrum of techniques have co-evolved with multivisceral and intestinal transplantation,ranging from graft reduction to enlarging the volume of the abdominal cavity.None of these techniques are free from complications,however in large-volume centers the combinations of both(graft reduction and abdominal widening,sometimes used in the same patient) could decrease the adverse events related to recipient's closure,allowing a faster recovery.The quest for a solution to this unique challenge has led to the proposal and implementation of innovative solutions to enlarge the abdominal cavity.
基金Supported by The National Natural Science Foundation of China,No.81670574,No.81441022 and No.81270528The Natural Science Foundation of Tianjin,China,No.08JCYBJC08400,No.11JCZDJC27800,and No.12JCZDJC25200the Technology Foundation of the Health Bureau in Tianjin,China,No.2011KY11
文摘AIM To investigate the effects of heme oxygenase-1(HO-1)-modified bone marrow mesenchymal stem cells(BMMSCs)on the microcirculation and energy metabolism of hepatic sinusoids following reduced-size liver transplantation(RLT)in a rat model.METHODS BMMSCs were isolated and cultured in vitro using an adherent method,and then transduced with HO-1-bearing recombinant adenovirus to construct HO-1/BMMSCs.A rat acute rejection model following 50%RLT was established using a two-cuff technique.Recipients were divided into three groups based on the treatment received:normal saline(NS),BMMSCs and HO-1/BMMSCs.Liver function was examined at six time points.The levels of endothelin-1(ET-1),endothelial nitric-oxide synthase(e NOS),inducible nitric-oxide synthase(i NOS),nitric oxide(NO),and hyaluronic acid(HA)were detected using an enzyme-linked immunosorbent assay.The portal vein pressure(PVP)was detected by Power Lab ML880.The expressions of ET-1,i NOS,e NOS,and von Willebrand factor(v WF)protein in the transplanted liver were detected using immunohistochemistry and Western blotting.ATPase in the transplanted liver was detected by chemical colorimetry,and the ultrastructural changes were observed under a transmission electron microscope.RESULTS HO-1/BMMSCs could alleviate the pathological changes and rejection activity index of the transplanted liver,and improve the liver function of rats following 50%RLT,with statistically significant differences compared with those of the NS group and BMMSCs group(P<0.05).In term of the microcirculation of hepatic sinusoids:The PVP on POD7 decreased significantly in the HO-1/BMMSCs and BMMSCs groups compared with that of the NS group(P<0.01);HO-1/BMMSCs could inhibit the expressions of ET-1 and i NOS,increase the expressions of e NOS and inhibit amounts of NO production,and maintain the equilibrium of ET-1/NO(P<0.05);and HO-1/BMMSCs increased the expression of v WF in hepatic sinusoidal endothelial cells(SECs),and promoted the degradation of HA,compared with those of the NS group and BMMSCs group(P<0.05).In term of the energy metabolism of the transplanted liver,HO-1/BMMSCs repaired the damaged mitochondria,and improved the activity of mitochondrial aspartate aminotransferase(ASTm)and ATPase,compared with the other two groups(P<0.05).CONCLUSION HO-1/BMMSCs can improve the microcirculation of hepatic sinusoids significantly,and recover the energy metabolism of damaged hepatocytes in rats following RLT,thus protecting the transplanted liver.
文摘BACKGROUND： Split liver transplantation increases the number of grafts available for transplantation. Pre-recovery assessment of liver graft volume is essential for selecting suitable recipients. The purpose of this study was to determine the ability and feasibility of constructing a 3-D model to aid in surgical planning and to predict graft weight prior to an in situ division of the donor liver. METHODS： Over 11 months, 3-D volumetric reconstruction of 4 deceased donors was performed using Pathfinder Scout liver volumetric software. Demographic, laboratory, operative, perioperative and survival data for these patients along with donor demographic data were collected prospectively and analyzed retrospectively. RESULTS： The average predicted weight of the grafts from the adult donors obtained from an in situ split procedure were 1130 g （930-1458 g） for the extended right lobe donors and 312 g （222-396 g） for left lateral segment grafts. Actual adult graft weight was 92% of the predicted weight for both the extended right grafts and the left lateral segment grafts. The predicted and actual graft weights for the pediatric donors were 176 g and 210 g for the left lateral segment grafts and 308 g and 280 g for the extended right lobe grafts,respectively. All grafts were transplanted except for the right lobe from the pediatric donors due to the small graft weight.CONCLUSIONS： On-site volumetric assessment of donors provides useful information for the planning of an in situ split and for selection of recipients. This information may expand the donor pool to recipients previously felt to be unsuitable due to donor and/or recipient weight.
文摘Partial liver transplantation,including reducedsize liver transplantation,split liver transplantation,and living donor liver transplantation,has been developed with several innovative techniques because of donor shortage.Reduced-size liver transplantation is based on Couinaud’s anatomical classification,benefiting children and small adult recipients but failing to relieve the overall donor shortage.Split liver transplantation provides chances to two or even more recipients when only one liver graft is available.The splitting technique must follow stricter anatomical and physiological criteria either ex situ or in situ to ensure long-term quality.The first and most important issue involving living donor liver transplantation is donor safety.Before surgery,a series of donor evaluations—including anatomical,liver volume,and liver function evaluations—is indispensable,followed by ethnic agreement.At different recipient conditions,auxiliary liver transplantation and auxiliary partial orthotopic liver transplantation,which employ piggyback techniques,are good alternatives.Partial liver transplantation enriches the practice and knowledge of the transplant society.
