As the only effective way for the treatment of end- stage liver disease, liver transplantation has been developed rapidly in China over recent years. The latest developments of liver transplantation in China are reviewed, including establishment of selection criteria for the liver cancer recipients of liver transplantation——Hangzhou Criteria; latest application of salvage liver transplantation and downstaging therapy in liver transplantation for liver cancer; progress in liver transplantation combined with artificial liver support system for treatment of severe acute liver failure; breakthrough in technology innovation of living donor liver transplantation and organ donation and transplantation after cardiac death in China. Facing the problem of organ shortage, a scientific and standardized organ donation system should be established in line with the national conditions of China, so as to benefit the people and further improve the reputation of China in the international organ transplant community.

Objective To compared the prognosis between infants with biliary atresia ( BA) who underwent living donor liver transplantation ( LDLT) during 2006- 2009 and 2010- 2012 in the Department of Liver Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine and to evaluate the prognos is of LDLT performed during different periods. Methods A retrospective analysis was performed on the clinical data of 101 infants with BA who underwent LDLT from October 2006 to December 2012. These patients were divided into 2006- 2009 group and 2010- 2012 group according to the year the procedure was performed. The two groups were compared in terms of preoperative general data, intraoperative status, and treatment outcome. The Kaplan- Meier method was used for survival analysis; measurement data were analyzed by t test, and enumeration data were analyzed by Fisher exact probability test and chi- square test. Results The preoperative general data showed no significant difference between the two groups. Compared with the 2006- 2009 group, the 2010- 2012 group had significantly less intraoperative blood loss ( t = 2. 05, P = 0. 04) , a significantly shorter cold ischemia time of donor liver ( t = 3. 25, P < 0. 01) , and significantly lower incidence of postoperative biliary complications ( χ2= 4. 27, P = 0. 04) , pulmonary infection ( χ2= 4. 47, P = 0. 03) , and acute rejection ( P = 0. 03) . The 2010- 2012 group had significantly improved survival compared with the 2006- 2009 group; the 1 and 2 year cumulative survival rates for the 2010- 2012 group were 88. 4% and 88. 4%, respectively, versus 84. 4% and 75% for the 2006- 2009 group. Conclusion The development of surgical techniques, improvement in perioperative management, and standardized follow- up can significantly increase the success rate of surgery and survival rate and reduce postoperative complications in BA patients.

Objective To analyze the rationality of delivery method for hepatitis B immune globulin ( HBIG) in patients with chronic hepatitis B virus ( HBV) infection after liver transplantation and to investigate the guiding principle for medication. Methods Forty- four cases of hepatitis B- related liver transplantation who participated in the phase IV clinical trial of HBIG for intravenous injection from August 2008 to December 2010 were analyzed. These patients were divided into severe liver disease group, liver cancer group, and liver cirrhosis group. The positive rates of HBV DNA and HBeAg were compared between groups by chi- square test. The HBV DNA level was compared by analysis of variance. The correlation between blood concentration and half- life of HBIG at different doses and dosing intervals was analyzed by Pearson's correlation test. The titer of anti- HBs at one week after operation was compared between HBeAg- negative group and HBeAg-positive group and between high- HBV DNA group and low- HBV DNA group by t test. Cases of reinfection were also monitored. Results There were no significant differences in the positive rates of HBV DNA and HBeAg between the severe liver disease group, liver cancer group, and liver cirrhosis group ( χ2= 4. 871, P = 0. 088; χ2= 1. 079, P = 0. 583) . No significant differences in mean HBV DNA level were found between these groups ( F = 0. 895, P = 0. 418) . The Pearson's correlation analysis revealed a significant negative correlation between the blood concentration and half- life of HBIG ( r = 0. 988, P = 0. 012) . The tier of anti- HBs showed no significant differences between HBeAg- negative group and HBeAg- positive group and between high- HBV DNA group and low- HBV DNA group one week after operation ( t = 1. 757, P = 0. 087) . No cases of reinfection were found during the observation period. Conclusion It is necessary to give HBIG 4000 IU during operation and 2000 IU daily for 6 days after operation, and the dose should be increased appropriately when the patients have relatively high viral load in serum. For the patients whose serological markers of hepatitis B become negative, the antibody level can be maintained at about 100 IU / L until the next administration if 600 IU of HBIG is given once a month by intramuscular injection.

Objective To perform antiviral therapy in patients with recurrent hepatitis C after liver transplantation and to study the efficacy of antiviral therapy and its effect on the progression of liver fibrosis. Methods Twenty- three patients with recurrent hepatitis C after liver transplantation who were admitted to our hospital from June 2005 to December 2012 were treated with interferon plus ribavirin. Virological response, adverse reactions, and liver pathology were observed before and after treatment. Enumeration data were expressed as number of cases and constituent ratio; comparison of anti- fibrotic effect between the groups with different responses to antiviral therapy was made by rank sum test. Results Twelve patients discontinued treatment due to adverse reactions. Eighteen patients achieved end- of- treatment virological response ( ETVR) ; 6 of the 18 patients achieved sustained virological response ( SVR) , and 12 relapsed after treatment. Nineteen patients underwent liver biopsy before and after treatment. In the SVR group, liver fibrosis was improved in 3 cases, stable in 1 case, and worse in 0 case; in the relapse group, liver fibrosis was improved in 2 cases, stable in 3 cases, and worse in 5 cases; in the patients without response, liver fibrosis was improved in 0 case, stable in 1 case, and worse in 4 cases. There were significant differences in anti- fibrotic effect between the three groups ( χ2= 7. 330, P = 0. 026) . Conclusion SVR rate is low in patients who receive antiviral therapy for recurrent hepatitis C after liver transplantation. Effective antiviral therapy can delay the progression of liver fibrosis, and patients with SVR have the most improvement in liver fibrosis.

Objective To analyze the prognostic factors in patients with hepatitis B- related primary liver cancer treated with transcatheter arterial chemoembolization ( TACE) and to provide a basis for properly selecting indications and treatment regimen in clinical practice. Methods A total of 140 patients with hepatitis B- related primary liver cancer, who underwent TACE in our hospital from January to December 2010, were enrolled in this study. Follow- up was continued until December 2011 to observe the patients' survival within 12 months after treatment. The Kaplan- Meier method and log- rank ( Mantel- Cox) test were used for univariate and multivariate analyses to identify the prognostic factors in patients with hepatitis B- related primary liver cancer treated with TACE. Results The univariate analysis showed that age, portal vein metastasis, peritoneal metastasis, pleural metastasis, Child- Pugh classification, bilirubin, alanine aminotransferase, number of interventional therapies, and antiviral therapy were prognostic factors in patients with hepatitis B- related primary liver cancer treated with TACE. There was significant difference in 12- month survival curve between patients treated with TACE plus antiviral therapy and those who did not receive antiviral therapy ( P < 0. 05) . The multivariate analysis showed that portal vein metastasis ( P = 0. 004) , peritoneal metastasis ( P = 0. 009) , bilirubin level ( P = 0. 017) , antiviral therapy ( P = 0. 000) , and number of TACE therapies ( P = 0. 000) were prognostic factors in patients with hepatitis B- related primary liver cancer treated with TACE. Conclusion Portal vein metastasis, peritoneal metastasis, and bilirubin level may be independent risk factors in patients with hepatitis B- related primary liver cancer treated with TACE, and antiviral therapy and number of interventional therapies may be protective factors for these patients.

Objective To evaluate the clinical effect of transcatheter arterial chemoembolization ( TACE) alone or combined with tegafur, gimeracil, and oteracil potassium ( S- 1) in the treatment of advanced hepatocellular carcinoma ( HCC) . Methods Sixty patients with unresectable advanced HCC, who were admitted to our hospital from August 2009 to October 2010, were randomly divided into treatment group ( n =30) and control group ( n =30) . The treatment group was treated with TACE combined with oral S-1, and the control group with TACE alone. The response rates, disease control rates, survival rates, and adverse reactions of both groups were evaluated. Categorical data were analyzed by chi- square test; survival analysis was performed by Log- rank test. Results Compared with the control group, the treatment group had a significantly higher response rate ( 63. 3% vs 33. 3%, χ2= 5. 406, P = 0. 020) , a significantly higher disease control rate ( 86. 7% vs 43. 3%, χ2= 12. 308, P = 0. 000) , a significantly higher 1- year survival rate ( 77. 3% vs 51. 5%, χ2= 4. 593, P = 0. 032) , and a significantly higher 2- year survival rate ( 34. 8% vs 10. 4%, χ2= 4. 812, P = 0. 028) . Mild adverse reactions ( grade Ⅰ or Ⅱ) were seen in the two groups, including nausea, vomiting, diarrhea, and bone marrow suppression. These adverse reactions could be reduced by symptomatic treatment and showed no significant differences between the two groups ( P > 0. 05) . Conclusion The combination therapy with S- 1 plus TACE is effective in the treatment of advanced HCC and is worth further study.

Objective To analyze the clinical data, laboratory parameters, infection rate, and serum procalcitonin ( PCT) and ET- 1 levels of patients with cirrhotic ascites and type 1 hepatorenal syndrome ( HRS) and to investigate the roles of endotoxin and ET- 1 in the development of HRS. Methods Between January 2009 and October 2012, 56 inpatients with cirrhotic ascites and type 1 HRS ( HRS group) and 60 inpatients with cirrhotic ascites who had normal renal function ( non- HRS group) were included in the study. Their general data, causes of liver cirrhosis, infection rates and types, Child- Pugh classification, systemic inflammatory response syndrome ( SIRS) score, and mean arterial pressure ( MAP) were recorded; blood samples were collected to evaluate liver and renal function and measure serum electrolyte, PCT, and ET- 1 levels. The clinical data and laboratory parameters were compared between the two groups. Categorical data were analyzed by chi-square test; comparison of normally distributed continuous data between the two groups was made by independent- samples t test, and comparison of non- normally distributed continuous data between the two groups was made by Wilcoxon rank sum test. Results The infection rate of HRS group ( 75. 0%) was significantly higher than that of non- HRS group ( 28. 4%) ( χ2= 11. 91, P < 0. 05) . The PCT and ET- 1 levels and SIRS score of HRS group [8. 72 ( 3. 14, 31. 68) ng / L, 13. 04 ± 2. 82 pg / ml, and 2. 1 ± 1. 1]were significantly higher than those of non-HRS group [0. 11 ( 0. 04, 0. 45) ng / L, 5. 76 ± 1. 68 pg / ml, and 0. 6 ± 0. 6] ( P < 0. 05) . In addition, the HRS group had significantly higher serum urea, creatine, cystatin C, and K levels than the non- HRS group ( P < 0. 05) , while the HRS group had significantly lower Na and Cl levels than the non- HRS group ( P < 0. 05) . There were no significant differences in ALT and AST levels between the two groups ( P > 0. 05) . Conclusion Endotoxin causes elevated expression of ET- 1, and ET- 1 induces renal perfusion deficiency by intense renal vasoconstriction, thus leading to type 1 HRS. Endotoxin and ET- 1 are closely associated with the development of type 1 HRS.

Objective To investigate and assess prognostic factors for survival in patients with primary biliary cirrhosis ( PBC) by receiver operating characteristics ( ROC) curves and Kaplan- Meier methods. Methods A total of 155 patients were identified and followed. Terminal events were death and / or liver transplantation. The optimal thresholds for continuous variables were established by ROC curves and cumulative proportions of patients developing an event were estimated using the Kaplan- Meier method. Results During a median follow- up period of 50 months ( range: 6- 316) , 36 patients died or underwent liver transplantation. Age 55 years or older, Total Bilirubin ( TBil) > 1. 8mg / dl, serum IgG > 17. 2 g / L, and Mayo risk score ( MRS) > 6. 11 were associated with mortality. With four markers in series test, their sensitivity was 99. 18%, specificity was 5. 56%, the total coincidence rate was 79. 23%; With four markers in parallel test, their sensitivity was 100%, specificity was 24. 51%, the total coincidence rate was 40. 77%. Age 55 years or older ( P = 0. 001) , TBil > 1. 8mg / dl ( P = 0. 005) , serum IgG > 17. 2 g / L ( P = 0. 001) , and MRS > 6. 11 ( P < 0. 000 1) were significantly associated with mortality. Conclusion Age 55 years or older, TBil > 1. 8mg / dL, serum IgG > 17. 2 g / L, and MRS > 6. 11 might predict survival for PBC patients with liver cirrhosis.