The Clinical And Pathological Analysis Of Postoperative Liver Transplantation And Clinical Significance Of GranzymeB/Fas-L Expression And Measurement Of SIL-2R Levels

As the effective method of treating terminal hepatic and biliary disease , chronic metabolism hepatopathy and liver tumor ,liver transplantation has developed quickly. Disposal concerning perioperative treatment especially acute and chronic rejective reaction has become the key of restricting short and long-term effect.Up to now,immunosurppressive agent is still main measurement of preventing and treating rejection when there are not good immunologic tolerance method introduced in clinical practice.Although experienced continuous changes , there are still high rate of 50%-90% rejective incidence as practising immunosurppressive agent in clinical practice.The issue must be solved concerning how to early diagnose and differential diagnose rejection as well as how to prevent and treat rejection.There are lots of factors affecting occurrence and therapeutic efficacy.Grasping these factors will obtain reasonable and individual treatment.Liver biopy is named for "gold standard"in diagonose and differential diagnose rejection of liver transplantation.But for many cases pathological examination cannot work.So seeking specific diadynamic criteria is necessary. Granzyme B and Fas-L expression detecting in transplanted liver rejection posseses important significance as generally accepted effect marker.On the other hand, IL-2 is important cytokine leading to immunologic cell activation and producing rejection. Dynamic monitoring sIL-2R levels poseses important significance for postoperative liver transplantation rejection.[Objective] This topic will be separated 2 parts.The first part will begin with clinical aspect to observe and analyse clinical diagonosis and treatment during perioperation of transplantation. As well as to analyse and investigage affecting factors related to preventing and treating rejection.The second part is experiment.lt is formed by 3 parts.Firstly, rejective type and degree will be differenced by RAI scoring and Banff grading to 16 cases(26 times) HE staining pathological results of liver biopsy.Secondly, granzyme B and Fas-L expression detecting by immuno - histochemistry method and dynamic monitoring sIL-2R levels in postoperative blood by ELISA method will be performed.Finally, both expressions and levels under different rejective circumstance will get comprehensive assessment for the aim to find laws and provide experimental foundation for more reasonably and individually preventing and treating postoperative rejection.[Methods] 1.Through a retrospective analysis of clinical data in 61 liver transplantation cases collecting from Hepabiliary Surgery of General Hospital of PLA from June,2002 to December,2003.and analyse these aspects such as immunosuppression agent program, cross matching -, primary disease -, preoperative liver function sex and age, etc. to try to find affecting factors of occurrence and effect of postoperative rejection of liver transplantation. 2.Sixteen cases(26 times) liver biopsy sample were collected to perform HE staining and detect granzyme B and Fas-L expression by immnohistochemistry method. 3.Blood of liver transplantation patients involving 1 day of preoperation, l,3,5,7, 10, 14, 18,21 day of postoperation were collected to detect sIL-2R content by ELISA method. 4.A11 HE Staining sections were scored by RAI standard and Banff demiquantu grading scheme to difference acute or chronic type and mikU moderate or severe degree; Results of granzyme B and Fas-L expression and sIL-2R levels according to different circumstance of rejection were analysed comprehensivly.Data was disposed by statistical method.[ Results ] 1 .Thirty-eight cases(70.4%) of acute rejection were occurrenced in 61 cases(totaol 54 cases besides 7 cases of earlier period deadth) of liver transplantation. Of which 37 cases(68.5%) was acute rejection and 1 case(1.9%) was chronic rejection.Immunosuppression scheme was dominated by 3 combining of "FK506+MMF+Pred". It was more excellent than CsA group. The usage period of Pred was fairly longer. The probability of infection , tumor relapse and hypergl...