| China has high incidence of viral hepatitis, especially the hepatitis B. Posthepatitic cirrhosis, portal hypertension and hepatic functional decompensation, which were caused by chronic active hepatitis, are the critical causes of patients' death. Hepatocarcinoma may arise during a long term of posthepatitic cirrhosis. Liver transplantation, as one of the most efficient theraputic methods of end-stage hepatobiliary diseases, has been developed more than 10 years in China. Liver transplantation techniques in china still lagged behind the international level by several years now. We are desperately calling for summarization of experience and standardization of clinic implements. The integrity and complexity of liver transplantation technologies and techniques are preponderate over that of other hepatobiliary diseases, and a lot of basic researches are needed to extend. Furthermore, Liver transplantation is closely related to ethic, medication system and social-economic efficiency. Nowadays, there have no rules to regulate and manage the performance of liver transplantation. So the relative tasks including case selection, rational application of graft and improvements of techniques are achieved by analyzing the clinical data in time, besides the clinical therapeutic implements.The application of database systems is more and more wildly adopted in the field of medicine. Collection and management information of liver transplantation with databasesystem could help to analyze the data in real time and support to make the clinical decision. The usage of a large mount of cases information united in multi-centers could also avail to reduce the deviation and repetition of clinical research, and also improve the social-economic efficiency. It is required to construct an efficacious distributed database system that could support clinical research and offer the proofs to establish managing policy.According to characters of liver transplantation, the present study attempt to design and construct the liver transplantation application database system, which is propitious to the reality of our country, and expand it to clinical research. And also ulteriorly discuss the feasibility and prospect of using this database system to fulfill the collection and transmission of liver transplantation information united multi-centers. There are two parts included in this study. First, the design and construction of liver transplantation database system. Second, the clinical research on liver transplantation for hepatocellular carcinoma based on data collected by present database system.Part 1. Design and construction of three-tier database application system for liver transplantationObjective: To design and construct a three-tiered database application system for liver transplantation and the feasibility and prospect of the management of liver transplantation date, teledata gathering and clinical application with this system. Methods: Analyzed requirements and feasibility of the liver transplantation database, Blueprint of the data structure was designed and accomplished based on the resolution of data flow of liver transplantation. Microsoft SQL Server system was used as the background database. Delphi was adopted for programming. Performance test and analysis was carried out for clinical application. Results: So as to the relevant data transforming and user defined querying utilities, the database and the application were finished and applied to clinic usage. The teledata collection module was developed. Conclusions: The system, which can provide support for clinical real-time decision, remarkably increase the efficiency ofdata management and analysis. If combined with web services it could fulfill the function of multi-center applications and Internet follow-up. The system would have important clinical application significance and have a prosperous future.Part 2. Analysis of prognosis prediction factors of liver transplantation for hepatocellular carcinomaObjective: To evaluate the risk factors affecting survival rate and recurrence-free survival rate of orthotopic liver transplantation(OLT) for hepatocellular carcinoma(HCC), and to discuss the selection criteria for liver transplantation within HCC patients in China. Methods: The data of 67 consecutive patients undergoing OLT for HCC at our center were retrospectively reviewed including CHILD grade, MELD score, pre-transplant serum alphafetoprotein(AFP), pre-transplant adjuvant treatment and tumor size, number, pTNM stage, pathologic tumor stage etc. Results: On univariate analysis, the factors found to be significantly associated with long-term survival rate were CHILD grade(MELD score) and extrahepatic vascular invasion. The factors that affect post-transplant recurrence survival rate were serum AFP level, pathologic tumor stage, tumor size and macro-vascular invasion. Multivariate analysis suggested that pathologic tumor stage, tumor size and macro-vascular invasion can significantly influent recurrence-free survival rate. Conclusions: The liver function status was the main factor that affects the survival rate of HCC post liver transplantation. Liver transplantation should be strict selected for those HCC patients with macro-vascular invasion. For the non-vascular invasion HCC patients, tumor size should not be a strict recruitment criterion as UNOS.
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