The Clinical Analysis Of 92 Orthotopic Liver Transplantations

Objective To investigate the relations of biliary complications and the factors of cold ischemia time, reconstraction of biliary tract. And explore the diagnosis and the managements of biliary complications.Methods Reviewed the clinical datas of 92 patients that received orthotopic liver transplantions between 2003 and Jan. 2007 (include 15 patients in Qilu Hospital(between 2003 and 2004), 77 patients in Shandong Provincial Hospital(between 2005 and Jan. 2007)) . To analysis the relations between biliary tract complications and the factors of cold ischemia time and biliary reconstraction. Checking up the index of ALT, AST, GGT, ALP and using ultrasounds MRCP to investigate the biliary tract of the liver.Results1 , Of all 92 patients,the ischemia time was more than 11 hours in 7 patients,and 2 of those suffered sludge. The others were less than 11 hours, only 9 suffered biliary tract complications of biliary stenosis or biliary leak.2, All patients were well diagnosed by MRCP or ERCP and the symptoms and excluded acute rejection, HBV recurrence.3, All patients were treated with interventional radiology procedure. We placed ENBD by ERCP to cure biliary leak, and balloon dilatation to biliary stenosis. And we used endoscope to drainage the biliary in sludge, and appeared sound affective.Conclusions1, Cold ischemia time and biliary tract reconstraction influenced biliary complications.2, The diagnosis of biliary complications should considered the cilinical symptom and other checks and exclude acute rejecton and HBV recurrence.3, The treatments to biliary complications should consider the biliary type. Intervetional radiology is effective to cure biliary tract complications. Objective To anlysis the factors affecting HBV recurrence of OLT , and investigate the prophylaxis and treatments to HBV recurrence of OLT.Methods Analysising the clinical datas of 68 patients combined HBV infection of 92 liver transplantation patients ( include 15 patients in Qilu Hospital(between 2003 and 2004), 77 patients in Shandong Provincial Hospital(between 2005 and Jan. 2007)). All 68 patients were given lamivudine(100mg/d) or adefovir(10mg/d), Checking up indexis of HBV DNA, HBsAg, HBeAg, HBsAb, HBeAb, HBcAb pre-transplantation. Given 2000 IU HBIG i.m in ahepatic time, and keeping on using lamivudine(100mg/d) or adefovir(10mg/d) combined HBIG to prevent HBV recurrencepost-transplantation. Checking up index HBV DNA, HBsAg, HBeAg termly.Results1, All serum index of HBV DNA, HBsAg, HBeAg, HBeAb, HBcAb converted negative after operation.2, 10 patients suffered HBV recurrence after OLT, we checked HBV DNA, HBsAg, HBeAg converting positive, and investigated YMDD mutations of HBV in 6 patients. 3, After change lamivudine to adefovir,all 6 patients got serum conversion again.Conclusions1, Lamivudine combined HBIG can prevent the HBV recurrence after liver transplantation.2, Resistant YMDD mutations might emerge in patients after prolonged use of LAM.3, Adefovir dipidoxil approved as the rescue therapy for patients resistant to lamivudine due to YMDD mutations.