The existence of causal relationship between dietary factors and respiratory diseases is uncertain. We comprehensively investigated the association between dietary factors and respiratory diseases by using Mendelian randomization (MR). Genetic variants linked to dietary factors were selected as instrumental variables with genome-wide significance. These instrumental variables were obtained from large GWAS databases. These databases include Biobank, the FinnGen study, and other large consortia. We used multivariate MR analyses to control the effects of smoking and education. Median analysis was conducted to evaluate whether body mass index (BMI) played a role in dietary factors in respiratory diseases. Dried fruit intake was found to be associated with a decreased risk of chronic obstructive pulmonary disease (COPD) (OR: 0.211; 95% CI 0.117–0.378; P < 0.001) and asthma (OR: 0.539; 95% CI 0.357–0.815; P = 0.003). Conversely, pork intake was associated with an increased risk of idiopathic pulmonary fibrosis (IPF) (OR: 1.051*10 2 , 95% CI 4.354–2.56*10 3 , P = 0.004). However, no significant associations were observed between the 20 dietary factors and obstructive sleep apnea (OSA). In addition, multivariate MR analyses showed that the above results were unchanged in smoking and nonsmoking populations, while the effect of dried fruit intake on asthma was significantly attenuated after corrective education. The results of the mediator variable analysis indicated that BMI could serve as a mediator of the above results. This study found that dried fruits slowed the progression of COPD and asthma, while pork promoted IPF. However, no effect of dietary factors on OSA was found. Meanwhile, we showed that the above results were unchanged in smoking and non-smoking populations. In contrast, education could influence the role of diet on asthma, and BMI could be used as a mediating variable to influence the above results.

Common bile duct (CBD) exploration and T-tube drainage are the main surgical methods for the removal of bile duct stones (BDSs), which can now be completed by laparoscopy. However, the feasibility and safety of primary closure of the CBD (PCCBD) in laparoscopic CBD exploration (LCBDE) without biliary drainage are still uncertain. From January 1, 2021, to June 30, 2022, patients who were diagnosed with BDSs and underwent LCBDE and primary closure of the CBD without biliary drainage in our hospital were included. The clinical and prognostic data of the patients were retrospectively analyzed to determine the feasibility and safety of PCCBD in LCBDE without biliary drainage. Forty-nine patients successfully underwent PCCBD in LCBDE without biliary drainage. The operation time was 158.8 ± 50.3 (90–315,150) minutes, the bile duct suture time was 17.6 ± 4.46 (10–26, 18) minutes, the intraoperative blood loss volume was 70.4 ± 52.6 (5–200, 80) ml, the hospitalization cost was 28,141.2 ± 7011.3 (15,005.45–52,959.34, 26,815.14) CNY Yuan, the hospitalization time was 13.22 ± 5.16 (8–32, 12) days, and the postoperative hospitalization time was 7.31 ± 1.94 (3–15, 7) days. There were 3 cases of postoperative bile leakage (3/49, 6.12%), all of them healed by nonsurgical treatment. During the follow-up of 17.2 ± 11.01 (10–26, 17) months, no residual BDSs, biliary stricture or other complications classified as Clavien-Dindo grade I or higher occurred. For some selected patients who meet certain criteria, PCCBD in LCBDE without biliary drainage is feasible and safe and is more conducive to the rapid postoperative recovery of patients.

目的 探究受体肝动脉重建位点的选择对肝移植术后早期缺血性胆道病(ischemic-type biliary lesion,ITBL)的影响.方法 回顾性收集2015年1月至2020年1月期间于四川大学华西医院肝移植中心及华中科技大学附属同济医院器官移植研究所接受公民逝世后捐献肝移植的656例患者的临床病理资料.按照受体动脉吻合位点进行分组:远端组采用肝左、右动脉或肝固有动脉进行吻合;近端组采用胃十二指肠动脉、肝总动脉或肝总动脉-胃十二指肠动脉分叉处进行吻合.探究2组术后早期并发症的差异和移植术后1年内ITBL发生的影响因素.结果 656例患者中,远端组262例,近端组394例.近端组的肝动脉血栓发生率低于远端组(x2=5.675,P=0.017),而2组的肝动脉出血、ITBL、原发性移植物无功能、胆道相关性和排斥相关性移植物功能衰竭的发生率比较差异均无统计学意义(均P＞0.05).多因素logistic回归结果显示:肝动脉血栓形成[OR=4.453,95％CI(1.318,15.050),P=0.016]及冷缺血时间＞6 h[OR=1.844,95％CI(1.014,3.353),P=0.045]是肝移植患者术后早期ITBL的危险因素,而肝动脉的重建类型不是ITBL的危险因素[OR=1.166,95％CI(0.630,2.157),P=0.625].结论 以受体肝总动脉、胃十二指肠动脉及肝总动脉-胃十二指肠动脉分叉处Carrel瓣进行肝动脉吻合重建可一定程度降低吻合难度且不增加术后早期ITBL的发生风险.

BACKGROUND:Mirizzi syndrome (MS) remains a challenging biliary disease, and its low rate of preoperative diagnosis should be resolved. Moreover, technological advances have not resulted in decisive improvements in the surgical treatment of MS. Complex bile duct lesions due to MS make surgery difficult, especially when the laparoscopic approach is adopted. The safety and long-term effect of MS treatment need to be guaranteed in terms of preoperative diagnosis and surgical strategy.AIM:To analyze preoperative diagnostic methods and the safety, effectiveness, prognosis and related factors of surgical strategies for different types of MS.METHODS:The clinical data of MS patients who received surgical treatment from January 1, 2010 to December 31, 2020 were retrospectively reviewed. Patients with malignancies, choledochojejunal fistula, lack of data and lost to follow-up were excluded. According to preoperative imaging examination records and documented intraoperative findings, the clinical types of MS were determined using the Csendes classification. The safety, effectiveness and long-term prognosis of surgical treatment in different types of MS, and their interactions with the clinical characteristics of patients were summarized.RESULTS:Sixty-six patients with MS were included (34 males and 32 females). Magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) showed specific imaging features of MS in 58 cases (87.9%), which was superior to ultrasound scan (USS) in the diagnosis of MS and more sensitive to subtle biliary lesions than USS. The overall laparoscopic surgery completion rate was 53.03% (35/66), where the completion rates of MS type I, II and III were 69.05% (29/42), 42.86% (6/14) and zero (0/10), respectively. Thirty-one patients (46.97%) underwent laparotomy or conversion to laparotomy including 11 cases of iatrogenic bile duct injury which occurred in type I patients, and 25 of these patients underwent bile duct exploration, repair and T-tube drainage. In addition, 25 patients underwent intraoperative choledochoscopy and T-tube cholangiography. Overall, 21 cases (31.8%) were repaired by simple suturing, and 14 cases (21.2%) were repaired using the remaining gallbladder wall patch in the subtotal cholecystectomy. The ascendant of the Csendes classification types led to an increase in surgical complexity reflected by increased operation time, bleeding volume and cost. Gender, acute abdominal pain and measurable stone size had no effect on Csendes type of MS or final surgical approach. Age had no effect on the classification of MS, but it influenced the final surgical approach, hospital stay and cost. A total of 66 patients obtained a relatively high preoperative diagnostic rate and underwent surgery safely without serious complications, and no mortality was observed during the follow-up period of 36.5 ± 26.5 mo (range 13-76, median 22 mo).CONCLUSION:MRI/MRCP can improve the preoperative diagnosis of MS. The Csendes classification can reflect the difficulty of treatment. The surgical strategies including laparoscopic surgery for MS should be formulated based on full evaluation and selection.

This retrospective study was conducted to examine the development and current status of pediatric liver transplantation (LT) in western China. Clinical, demographic, morbidity, and mortality data were collected to analyze. It included 260 consecutive pediatric LTs performed at three centers in western China between January 2000 and May 2019. Kaplan-Meier graft survival rates at 1, 3, 5, and 10 years were 82.1%, 77.2%, 76.6%, and 76.6%, respectively; corresponding patient survival rates were 84.7%, 80.7%, 80.0%, and 80.0%, respectively. More patients underwent living donor liver transplantation (LDLT; n = 188 (73.4%)) than deceased-donor liver transplantation (DDLT; n = 68 (26.6%)). Survival was better after LDLT (91.5%, 86.6%, and 80.6% at 1, 3, and 5 years, respectively) than after DDLT (80.9%, 72.4%, and 63.9%, respectively;P < .05). Biliary atresia was the leading LT indication (n = 141 (55.1%)), followed by metabolic disease (n = 36 (14.1%)), which was associated with the best recipient survival (88.5% at 5 years). The transplant era and graft-to-recipient body weight ratio (GRWR) also significantly predicted overall survival. Survival rates at 5 years were worst in 2000-2005 (54.5%) and best for GRWRs of 0.8%-4% (80.4%). The development of pediatric LT in western China began slowly, but the quantity and quality of pediatric LT has progressed in recent years. This procedure is now a promising and reliable treatment for children with end-stage liver disease in western China.

Liver transplantation can lead to post-traumatic stress disorder (PTSD) in recipients, but the risk factors associated with PTSD in living donors are unknown. To investigate this progression in pediatric living donors, a cross-sectional investigation was carried out. All participants completed 2 questionnaires: a PTSD self-rating scale (PTSD-SS) and a validated Chinese version of the Medical Outcomes Study Short Form-36 (SF-36). Clinical and demographic data were collected from medical records and self-report questionnaires. Univariate analysis was conducted to identify statistical differences. The prevalence of full PTSD (all symptom clusters) and partial PTSD (2 out of 3 symptom clusters) was 12.1% and 31.1%, respectively. Those with an educational status of elementary school ( P = .001), who were donors to their children ( P = .008), who were in the first 6 months after transplant ( P < .001), or were involved in transplants where the recipients had severe complications ( P = .02) were more likely to have higher PTSD-SS scores than other groups. The non-PTSD group had a higher health-related quality-of-life score compared with the full and partial PTSD groups in the domains of physical function, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. In addition, the occurrence of PTSD was related to a poorer quality of life. The occurrence of PTSD was common in living donors after pediatric liver transplantation. Those with a lower educational status, who were donors to their children, were in the first 6 months after transplant, or were involved in transplants where the recipients had severe complications were most likely to experience PTSD. Post-traumatic stress symptom severity was significantly associated with a poorer quality of life after transplant.

Objective To explore the health-related quality-of-life of pediatric liver transplant donors and examine the principal influencing factors of quality-of-life.Methods A total of 86consecutive pediatric liver transplant donors undergoing hepatectomy were recruited from West China Hospital of Sichuan University and Children's Hospital,Chongqing Medical University between January 2005 and December 2014.Health-related quality-of-life was measured with the Chinese version of Medical Outcomes Study Short Form-36 (SF-36).All participants fulfilled the criteria of left hepatic resection without middle hepatic vein involvement or left lateral lobectomy,no severe medical complications and communicating influent Chinese.The survey results were compared with those of general population.And the influencing factors of quality-of-life were also explored.Results A total of 80 questionnaires were distributed in accordance with the selection criteria and 71 (88.7％)returned.There were 24 males and 47 females with an average age of 29.4-± 8.0 years.The recipients had biliary atresia (BA,n =35),metabolic liver disease (n =15),primary hepatocirrhosis (n =11) and hepatic tumors (n =10).Most donors were recipients' parents.In general,all dimensions of healthrelated quality-of-life in donors were favorable as compared with general population (P ＞0.05).Mental health scores in donors donated to BA were better than those to non-BA (P =0.029).General health scores were lower in donors without recipients' medical insurance than those with recipients'medical insurance (P =0.033).Regarding physical functioning (P =0.038) and bodily pain (P =0.040),donors ＞2 years after surgery scored higher than those ＜2 years.Based upon principal component analysis,8 dimensions of SF-36 were integrated into one single dimension.The Results indicated that time since surgery was a principal influencing factor of donors' quality-of-life (P =0.037).Conclusions The outcomes of health-related quality-of-life are favorable for pediatric liver transplant donors.Time since surgery,recipients primary disease and medical insurance may impact the donors' postoperative quality-of-life significantly.

ObjectiveTo summarize the operative experiences and postoperative complications of pediatric liver transplantation (LT).MethodsClinical data of 88 child patients undergoing LT in West China Hospital, Sichuan University between January 2000 and October 2015 were retrospectively analyzed. Among the patients, 38 were males and 50 were females, with the age ranging from 3 months to 17 years and 7 months old and the median of 2 years and 3 months old. Seventy-seven cases underwent living donor LT and 11 underwent cadaver LT. Thirty-nine cases underwent left lobe transplantation and 49 underwent left lateral lobe transplantation. The main immunosuppressive regimen after operation was adrenocortical hormone + tacrolimus (FK506) or cyclosporin. And heparin was used after operation for anticoagulation. The informed consents of all patients and their families were obtained and the local ethical committee approval was received. The intraoperative conditions and postoperative complications of the patients were observed.ResultsThe average operation time was (7.5±2.4) h, the median intraoperative blood loss was 475(100-2 000) ml, the transfusion of red blood cells was 1.8(0-6.5) U, the warm ischemia time was 2.5(1.0-10.0) min, the cold ischemia time was 188(110-590) min and the inferior vena cava occlusion time was 75(35-170) min. Forty-nine cases developed early complications after operation, and the incidence of vascular complications was 11%(10/88), including 4 cases of hepatic artery thrombosis, 5 of portal vein thrombosis and 1 of hepatic vein stenosis. Sixteen cases developed late complications, and the incidence of biliary complications was 12% (11/88), including 9 cases of cholangitis, 1 of bile leakage and 1 of bile duct stricture. The 1-, 3-year survival rate after LT was respectively 81% and 75%.Conclusions The success rate and postoperative survival rate of pediatric LT have increased signiifcantly in recent years. However, the incidence of postoperative vascular and biliary complications are still high. Thus, the operation procedures should be kept improving, and the immunosuppressant and anticoagulant therapy should be individually adjusted in order to obtain better efifcacy.

OBJECTIVE To determine the changing patterns of 4 liver fibrosis markers pre and post splenectomy (combined with pericardial devascularization [PCDV]) and to examine the short-term effects of splenectomy on liver fibrosis. METHODS Four liver fibrosis markers of 39 liver cirrhosis patients were examined pre, immediately post, 2 days post, and 1 week post (15 cases) splenectomy (combined with PCDV). RESULTS The laminin (LN) level decreased immediately post surgery compared with the preoperative LN level (P < 0.05). The type IV collagen level decreased immediately post surgery compared with that pre surgery (P < 0.05), it significantly increased (P < 0.05) 2 days post surgery and significantly decreased 1 week post surgery (P < 0.05). Hyaluronic acid and the procollagen III N-terminal peptide levels increased significantly 2 days post surgery compared with that pre and immediately post surgery, they significantly decreased 1 week post surgery compared to 2 days post surgery (P < 0.05). CONCLUSIONS In the short-term, the 4 liver fibrosis markers and the FibroScans post splenectomy showed characteristic changes, splenectomy may transiently initiate the degradation process of liver fibrosis.

To investigate the levels of hepatitis B virus total DNA (HBV DNA) and covalently closed circular (ccc) DNA in liver transplant recipients who received hepatitis B vaccination, including responders and non-responders, following liver transplantation due to hepatitis B-related diseases and to investigate the efficacy of hepatitis B immune reconstitution against HBV reinfection. Twenty responders and 34 non-responders were enrolled in the present study. The levels of HBV total DNA and ccc DNA in peripheral blood mononuclear cells (PBMCs) and the liver and plasma were detected by real-time polymerase chain reaction (PCR). Fifty-three blood samples and 38 liver allograft tissues were acquired. For the responders, the mean serum titer for anti-HBs (antibodies against hepatitis B surface antigen) was 289 (46.64-1000) IU/ml. Also for the responders, HBV total DNA was detected in PBMCs for one recipient and in the liver for another recipient, but ccc DNA was not detected in either of those 2 recipients. For the non-responders, HBV total DNA was detected in PBMCS for 2 recipients, neither of whom had ccc DNA. Also for the non-responders, HBV total DNA was detected in the livers of 3 recipients, 2 of whom also had ccc DNA. All responders had discontinued hepatitis B immunoglobulin (HBIG), and 13 responders had discontinued antiviral agents. One responder experienced HBV recurrence during the follow-up period. For the majority of liver transplant recipients, no HBV total DNA or ccc DNA was detected in the blood or liver. The lack of HBV total DNA and ccc DNA both in PBMCs and the liver in liver transplant recipients who received hepatitis B vaccination to prevent HBV reinfection should be a prerequisite for the withdrawal of HBIG and/or antiviral agents.

We present a female patient with preterm labor, severe viral hepatitis B of acute phase, hepatic encephalopathy stage III and coma. After delivery, the illness was exacerbated and the patient presented with clinical signs of vital organ dysfunctions such as acute respiratory distress syndrome, cerebral edema and hypoxemia that needed mechanical ventilation. Emergency liver transplantation was recommended after multidisciplinary panel consultations. The donor, her mother, consented to donate her right liver. Auxiliary partial orthotopic living donor liver transplantion (APOLDLT) was performed. After operation, the patient was on triple medication of tacrolimus plus mofetil mycophenolate and prednisone for immunosuppression. The combination of anti-hepatitis B virus (HBV) immunoglobulin and entecavir was initiated for anti-HBV therapy. Both the patient and the donor recovered well without any complications. The patient was followed up regularly. Her liver function, clinical signs and symptoms improved significantly. Until now, the recipient has been living for more than 78 mo free of any complications. The APOLDLT is a life-saving modality for rescuing patients with high-risk acute liver failure following HBV infection without available donor and hence is recommended under standardized antiviral therapy coverage as stated above.

OBJECTIVE:To evaluate the influence of sirolimus on the long-term survival of patients after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC).METHODS:Clinic data of 165 consecutive patients who underwent OLT for HCC from February 2005 to March 2012 was analyzed retrospectively. Among them, 94 patients were treated with a sirolimus-based immunosuppressive protocol after OLT, while the other 71 patients with a FK506-based protocol. Postoperative survival time, survival, disease-free survival (DFS) and tumor recurrence rates between the two groups were compared.RESULTS:The 2 groups were comparable in all clinicopathologic parameters. The sirolimus-based group had higher patient survival rates than the control group at 1-year (87% vs. 97%, P = 0.03), 2-year (80% vs. 88%), 3-year (76% vs. 85%) and 5-year (63% vs. 75%). The 1-year, 2-year, 3-year and 5-year recurrence rates were 12% vs. 3%, 17% vs. 9%, 21% vs. 9% (P = 0.04) and 31% vs. 16% (P = 0.03). Early and mid-HCC (I - II stage) of 131 cases (control group 61 cases, sirolimus-based group of 70 patients). The 1-year, 2-year, 3-year and 5-year survival rates were 90% vs. 97% , 80% vs. 90%, 78% vs. 86% and 65% vs. 82% (P = 0.04) and recurrence rates were 10% vs. 3%, 16% vs. 8%, 18% vs. 8% and 29% vs. 11% (P = 0.01).CONCLUSION:The sirolimus-based immunosuppressive protocol reduce long-term postoperative recurrence rate and improve the survival rate of patients after OLT for HCC significantly (especially early-mid HCC).

Hilar cholangiocarcinoma (HCC) is a rare tumor with a poor prognosis.With the development of high definition imaging technology,improvement of surgical instruments,optimization of perioperative surgical strategies and accumulation of surgical experiences,the radical resection rate of HCC is significantly improved.Operation is the main method of treatment for HCC,and radical resection is important for a long-term survival of HCC patients.The clinical data of 66 patients with HCC who were admitted to the Beijing Youan Hospital from April 2004 to April 2012 were retrospectively analyzed.The key points in surgical procedure and prognosis of patients were investigated.

OBJECTIVE:To investigate the pathogenesis of ischemic-type biliary lesions (ITBLs) in post-liver transplant patients and the possible therapeutic mechanisms of sirolimus.METHODS:The clinic data of 32 post-liver transplant patients with ITBLs from May 2004 to December 2010 was analyzed. There were including 25 male and 7 female patients with a median age of 46 years (ranging from 19 to 61 years). Patients were divided into those who received sirolimus (sirolimus group) and those who did not (control group). The expression of IL-2, FoxP3, and IL-10 in the portal area, liver function indexes, and bile duct injury score were assessed pre-ITBL, when ITBLs were identified, and after 6 months of sirolimus treatment.RESULTS:Compared with pre-ITBL optical density (OD) values, there was a significantly increase in IL-2 OD(0.138 ± 0.050 in control group and 0.141 ± 0.052 in sirolimus group), but not FoxP3 and IL-10 OD in both groups at the time ITBLs were diagnosed. After 6 months of treatment, the IL-2, FoxP3, and IL-10 OD values in the control group were not different from those when ITBLs were diagnosed. There was a significant reduction in post-therapy IL-2 OD(0.107 ± 0.043, t = 2.087, P = 0.044), and a significant elevation in FoxP3(0.213 ± 0.039) and IL-10 OD(0.187 ± 0.048) in sirolimus group as compared with those when ITBLs were diagnosed(t = -3.822 and -4.350, both P < 0.01). There was a significant increase in serum levels of ALT, AST, total bilirubin, γ-glutamyl transpeptidase and ALP at the time ITBLs were diagnosed compared with pre-ITBL levels in both groups. After 6 months of treatment, the above indexes had not changed in the control group, but significantly improved in the sirolimus group, and the bile duct injury score in the sirolimus group had significantly decreased(4.4 ± 2.4, Z = -2.568, P = 0.010). The 1-year and 3-year graft survival rates in the control group were 6/13 and 5/13, respectively, and 17/19 and 13/19, respectively, in the sirolimus group (χ(2) = 7.166, P = 0.007; χ(2) = 5.398, P = 0.020, respectively).CONCLUSIONS:Sirolimus can downregulate IL-2 expression and upregulate FoxP3 and IL-10 expression, thereby stimulating FoxP3+ Treg cells, suppressing immunopathological damage, and promoting epithelial repair in bile ducts.

Objective To investigate the indication,clinical outcomes and prognosis of liver retransplantation.Method The clinical data of 612 patients who underwent liver transplantation (LT)from Apr.2004 to Apr.2013 in our center were retrospectively reviewed and analyzed.Results There were 16 cases of liver retransplantation.The rate of liver retransplantation was 2.6％ (16/612).The interval of primary transplantation and retransplantation was (16.2 ± 18.3)months (10 days～64 months,median 9.5 months).The cumulative death rate after retransplantation was 50％ (8/16) and the perioperative mortality was 18.8％ (3/16).An interval of beyond 6 months between the two transplantations was helpful in reducing the perioperative mortality of liver retransplantation.The survival time of the second liver graft was (37.4±34.3)months (3 days～94 months,me dian 39.5 months),the recipients' survival time (53.6±33.9)months (10 days～94 months,median 57 months) and the 5 years survival 48.3％.Conclusions Liver retransplantation is a reasonable,necessary and feasible treatment for patients who suffered from severe complications after primary liver transplantation.Liver retransplantation carried out 6 months after primary liver transplantation had a lower perioperative mortality.

Objective To learn the clinical outcomes of hepatic artery bypass reconstruction of liver transplantation(LT) using allogenic iliac artery on special occasions.Methods The clinical data of 427 patients who received LT from 2004 to 2010 in our liver transplantation center were reviewed retrospectively and the methods and clinical outcomes of hepatic artery bypass reconstruction of LT using allogenic iliac artery were analyzed.Results Hepatic artery bypass reconstruction were successfully performed 13 times in 12 cases by using allogenic iliac artery;11 times were allogenic iliac artery-recipient's abdominal aorta bypass,1 time was allogenic iliac artery-recipient's splenetic artery bypass,1 time was allogenic iliac artery-recipient's left common iliac artery bypass;4 times of hepatic artery bypass reconstruction were performed because of the second LT,9 times of the reconstruction were performed because of useless of recipients' hepatic artery(including one living donor LT,LDLT).Time consumption of hepatic artery bypass construction was ranged from 90 to 120 minutes.The grafts survival time was(511.8±573.9) days(range from 2 to 1 577 days,median 270 days),the recipients survival time was(554.5±606.1) days(range from 2 to 1 577days,median time 317 days).There were no complications related to hepatic artery bypass reconstruction in the follow-up period.Conclusion Hepatic artery bypass reconstruction of LT using allogenic iliac artery on special occasions is a safe and effective method,but the preexisting comorbidities and poor situations of recipient may lead to poor survival after LT.

Figure 1 (A) A schematic representation of the five-stage differentiation protocol from hESCs to mature hepatocytes.ES, hESCs; DE, definitive endoderm; VF, ventral foregut;

我院近年来有4例肝移植受者术后发生移植物抗宿主病(GVHD),其中1例以术后2周起不明原因的发热伴渐进性低氧血症为主要表现,经过治疗后好转,现报告如下.临床资料患者为女性,60岁,因原发性胆汁性肝硬变、肝功能衰竭于2011年1月接受肝移植.术后第1天和第4天给予巴利昔单抗,并持续给予他克莫司4mg/d.术后10 d,受者的肝功能即恢复正常.

Obsjective To investigate the clinical data,and to summarize the clinical experience of diagnosis and treatment of graft-versus-host-disease (GVHD) after liver transplantation.Methods 4 of 480 recipients undergone liver transplantation developed GVHD from Apr.2005 to Sep.2011.The 4 recipients'clinical courses and laboratory tests were recorded.Results The diagnosis of GVHD depended on clinical syndrome involved skin rash,bone marrow depression and diarrhea.Skin biopsy and STR-PCR were matched.Among them,2 with successful treatment have been surviving for 7 and 24 months,and 2 died from infection.One recipient had the donor T lymphocyte microchimerism detected by STR-PCR.Conclusions GVHD after liver transplantation can cause high mortality due to bone marrow depression.A reasonable treatment can be to reduce immunosuppressant and glucocorticoids and IVIG.

To evaluate the role of host IL28B (interleukin 28B; interferon lambda 3) single nucleotide polymorphisms (SNPs) in predicting hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) susceptibility, three SNPs in the IL28B gene (rs12979860C/T, rs8099917G/T and rs12980275G/A) were examined in 330 subjects (including 154 HBV-related HCC patients, 86 non-HCC patients with chronic hepatitis B (CHB), 43 HBV self-limited infections and 47 healthy controls). Notably, the frequency of CC homozygosity was 91.5% in healthy controls and 72.9% in CHB, the difference being statistically significant (χ 2 = 6.40, P = 0.01). The statistically difference was seen between healthy controls (91.5%) and HCC (74.7%) (χ 2 = 6.05, P = 0.01). However, this significant finding was not seen between HBV self-limited and healthy controls. Carriers of the minor T allele in rs12979860 had a higher risk of HCC compared with non-carriers (χ 2 = 4.44, P = 0.04). Haplotype analyses revealed significant association between haplotype C–T–A and healthy controls, but not with the HCC group (96.6 vs. 82.0%, χ 2 = 6.08, P = 0.01). Analyses of genotype combination and gene–gene interaction showed that there was a positive interaction between rs12979860 and rs12980275, with an OR rate of 11.79 (likelihood test, P = 0.04). Our results suggest that the IL28B rs12979860 C/T polymorphism might affect susceptibility to the chronic HBV infection and progression of HCC. Of note, the T allele and non-CC genotypes have strong predictive effect of increasing susceptibility of chronic HBV infection and HCC.