The Research On Related Supporting Treatment In Perioperational Period Of Liver Transplantation

Objectives:To study the integrity and function of hepatocytes during extended suspension culture at mild hypothermia. Methods:Isolated hepatocytes were suspended a bicarbonate buffered saline medium supplemented with glucose and bovine serum albumin(BSA) for 48 hours at 30℃, during and after which, the integrity and function of hepatocytes were assessed. Results:Under the up-mentioned condition there was no significant decline in cell viability, albumin synthesis and phase I drug detoxification activity of these cells during 48h post isolation. Conclusions:These observation demonstrate the robust nature of mildly hypothermia isolated hepatocytes in suspension and encourage further studies re-examing the feasibility of using this cell preparation in bioartificial liver. Objectives:To analyse the preoperational risks on liver transplant recipients with acute renal failure and assess the value of treating them with renal replacement therapy as a common bridge to liver transplant. Methods:Review the liver transplant recipients with acute renal failure treated with renal replacement therapy inrecent years in our group. To compare the difference of clinical characteristics of the liver transplant recipients with different prognosis; To compare the difference of clinical characteristics of the liver transplant recipients received diffent kinds of RRT; Logistic regression was applied to investigate the parameters that can forecast the motality of the liver transplant recipients with acute renal failure. Results:Of patients who received RRT,30% survived to liver transplant or discharge,67.5% died in the waiting for liver transplant, the dead had a higher Multiple Organ Dysfunction Score (MODS), lower mean arterial pressure than those survived to liver transplant or discharge. There was no significant difference on the duration of RRT between CRRT patients and hemodialysis patients. CRRT patients had a higher Multiple Organ Dysfunction Score (MODS), lower mean arterial pressure, lower serum creatinine than hemodialysis patients. Lower mean arterial pressure was statistically associated with a higher risk of mortality. Conclusions:RRT is acceptable for liver transplant recipients with ARF. Though mortality was high, RRT helped part (30%) of patients survived to liver transplant, which is OK considering the high mortality without transplantation. Purpose:Orthotopic liver transplanttion (OLT) is an accepted mode of therapy for selected patients with advanced liver disease, however, the early mortality after OLT remains relatively high due to the poor selection of candidates with serious conditions. The aim of this study is to assess the value of pretransplantation artificial liver support in reducing the pre-operation risk factors relating to early mortality after OLT. Methods:50 adult patients with various stages and various etiologies undergoing OLT procedures were treated with MARS preoperation liver support therapy. The study was designed into two parts, the first one is to evaluate the medical effectiveness of single MARS therapy with some clinical and laboratory parameters which was supposed to be the therapeutical pretransplantation risk factors, the second part is to study the patients undergoing OLT by using the regression analysis on preoperation risk factors relating to early mortality (30 days) after OLT. Results:In the 50 patients, a statistically significant improvement(P<0.05) in the biochemical parameters was observed (pretreatment vs post treatment).8 patients avoided the scheduled Ltx due to significant relief of clinical condition or recovery of failing liver function,8 patients died,34 patients were successfully bridged to Ltx, the immediate outcome of this 34 patients within 30 days observation was: 28 kept alive and 6 patient died. Conclusions:Pre-operation SOFA, level of creatinine, INR, TNF-a, IL-10 are the main preoperative risk factors that causes early death after operation, MARS treatment before transplant operation can relieve these factors significantly, hence improve survival rate of liver transplantation or even avoid transplantation.Purposes:To study the clinical value of MARS applied in the intra-operational period of PBLT assisted with simplified venous-venous bypass. Methods:In the experimental groop, MARS was applied in the intra-operational phase of PBLT assisted with simplified venous-venous bypass. In the control groop, PBLTs were performed traditionally. Compare the related parameters of the two groops. Results:The time length of operation, ahepatic phase, the amount of blood transfusion, the time length of hospitalization in ICU, the 1 month survival rate, the 1 year survival rate in the experimental groop were significantly better than the control groop. Conclusions:MARS applied in the intra-operational phase of PBLT assisted with simplified venous-venous bypass can improve the prognosis of the operation.