ObjectiveTo introduce the basic principles of commonly used assessment methods for liver function reserve, and compare the advantages and disadvantages of various assessment methods, so as to provide a reference for hepatectomy of patients with hepatocellular carcinoma (HCC). MethodThe literature on evaluation methods of liver reserve function in patients with HCC at home and abroad in recent years was searched and summarized. ResultsFrom the results of literature review, the Child‐Pugh score and indocyanine green discharge test were the most commonly used to assess preoperative liver function reserve for patients with HCC. The application value of other examinations such as albumin-bilirubin score, gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI), nuclear medical imaging in predicting post-hepatectomy liver failure was gradually being explored. ConclusionsThe combination of clinical parameters and volumetric studies is used to assess preoperative liver function reserve for patients with HCC. The clinical applications of nuclear medical imaging and Gd-EOB-DTPA-enhanced MRI make up for the deficiency of local liver function reserve evaluation, which are important examinations to assess liver function reserve after conversion therapy in the future. However, more domestic studies are still needed to confirm their values.
Objective
To investigate effect of bone marrow mesenchymal stem cells (BMSCs) via portal vein injection on transforming growth factor-β receptor 1 (TGF-βR1) and TGF-βR2 in rats with acute liver failure (ALF).
Methods
Sixty male SD rats were randomly divided into a normal control group, ALF model group, and BMSCs treatment group, with 20 rats in each group. The rats of normal control group were directly sacrificed without other treatment. The ALF models were made in the rats of BMSCs treatment group and ALF model group, then were treated with BMSCs and equal volume of normal saline respectively. On day 7 after treatment, the 1-week survival situation of rats was observed, the pathological change was observed by HE staining, the apoptosis of liver cells was detected by TUNEL method, and the TGF-βR1 and TGF-βR2 proteins expressions were detected by Western blot method.
Results
① The 1-week survival rate of the BMSCs treatment group was significantly higher than that of the ALF model group (P<0.05). ② In the ALF model group, the liver cells were diffuse necrosis, the lobular structure was indistinct, and a large number of bridging necrosis. In the BMSCs treatment group, the infiltrations of inflammatory cells were decreased, and the structure of hepatic lobules gradually recovered, and the normal hepatocytes were seen around it. ③ The apoptosis indexes of the BMSCs treatment group and the ALF model group were significantly higher than those in the normal control group (P<0.05), which in the BMSCs treatment group was significantly lower than that of the ALF model group (P<0.05). ④ The TGF-βR1 and TGF-βR2 proteins expressions in the liver tissues of the ALF model group were significantly higher than those of the normal control group (P<0.05), which of the BMSCs treatment group were significantly lower than those of the ALF model group (P<0.05).
Conclusion
BMSCs could inhibit apoptosis of hepatocytes in ALF. Its mechanism might be related to expressions of TGF-βR1 and TGF-βR1 proteins, but its specific regulatory pathway needs to be further studied.
ObjectiveTo evaluate the therapeutic effect of transplantation of mesenchymal stem cells(MSCs) through the spleen for acute live failure in rat, and to observe migration of transplanted MSCs in vivo.
MethodsOne male SD rat was sacrificed to collect MSCs, and MSCs were isolated, expanded, and purified by density gradient centrifugation combined with adhere culture method. The surface antigen expressions of MSCs in the fourth generation were detected by immunohistochemistry method. Twenty-four female rats were given D-galactosamine and tumor necrosis factor α(TNF-α) to establish models of acute liver failure, and then divided into experimental group and blank control group, each group enrolled 12 rats. MSCs of male rat were transplanted into the spleen of female acute liver failure rats in experimental group at 24 hours after model establishment, but rats of blank control group were injected saline(0.5 mL). After the MSCs transplantation, blood samples of rats in 2 groups were got to test levels of serum alanine aminotransferase (ALT), total bilirubin(TBIL), and albumin(ALB). PCR method was used to determine the expression of sex determining region Y gene(SRY gene), and HE staining was used to observe the pathological change of liver tissues of rats in 2 groups.
ResultsThe MSCs of the fourth generation expressed CD44 and CD29, but didn't express CD34. There were 5(41.7%) and 3 rats(25.0%) survived at 72 hours, in 1 week and 2 weeks after MSCs transplantation in experimental group and blank control group, respectively, and the survival rate was higher in experimental group(P<0.05). The expression of SRY mRNA was detected in rats of experimental group, as well as the damage of liver tissues in rats of experimental group improved. Compared with blank control group, the levels of ALT and TBIL were lower in experimental group at all time points after MSCs transplantation(P<0.05), but in 1 week and 2 weeks after MSCs transplantation, the levels of ALB in experimental group were higher(P<0.05).
ConclusionMSCs can migrate to liver tissue, settle down, and exert the function of replacing hepatocyte after it has been transplanted into the spleen.
ObjectiveTo systematically evaluate the risk factors for posthepatectomy liver failure (PHLF) of hepatobiliary malignancies in order to provide evidence-based medical basis for preventing and reducing PHLF.MethodsThe case-control studies on the risk factors of PHLF for hepatobiliary malignancy were searched in PubMed, CNKI, etc. domestic and foreign databases from January 2011 to March 2020. The quality evaluation of the literatures was performed by using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.3.ResultsA total of 43 studies were included, involving 13 075 patients after hepatectomy, of which 1 943 (14.86%) had PHLF. Meta-analysis results showed that the male, liver cirrhosis, portal hypertension, hepatectomy range ≥3 segments, vascular tumor thrombus, intraoperative blood transfusion, tumor number ≥2, Child-Pugh grade ≥B, less platelet count, lower albumin, higher total bilirubin, higer indocyanine green retention rate at 15 minutes, longer hepatic hilar occlusion time, longer operation time, more intraoperative blood loss, bigger maximum tumor diameter, smaller residual liver volume, and higer MELD score were the risk factors for the occurrence of PHLF (P<0.05).ConclusionsAccording to the risk factors of PHLF, the basic condition, liver function, and residual liver volume should be fully evaluated before operation. The operation should be accurate anatomy, adequate hemostasis, timely treatment of intraoperative complications. After operation, the fluid infusion, anti-infection, correction of coagulation dysfunction, and protection of liver function should be strengthened. So incidence of PHLF might be reduced minimally.
ObjectiveTo summarize the definitions, risk factors, and preoperative evaluation methods of posthe-patectomy liver failure.
MethodsDomestic and international publications involving posthepatectomy liver failure were retrieved and reviewed.
ResultsThere was no uniform definition of posthepatectomy liver failure, however, the most approbatory definitions were "50-50 criteria" and "International Study Group of Liver Surgery (ISGLS) criteria". Risk factors of posthepatectomy liver failure included patient-related factors, liver-related factors, and surgery-related factors, and preoperative evaluation was mainly based on liver function and liver volume.
ConclusionPosthepatectomy liver failure is the main cause of postoperative death, sufficient preoperative evaluation and effective measures to decrease intraoperative blood loss and shorten surgery duration are helpful to prevent and (or) reduce posthepatectomy liver failure.
Objective
To explore favorable factors of reducing incidence of postoperative liver failure after radical resection of Bismuth-Corlette type Ⅳ hilar cholangiocarcinoma in condition of hyperbilirubinemia.
Methods
All the clinical data of one patient with Bismuth-Corlette type Ⅳ hilar cholangiocarcinoma underwent radical resection in June 2017 in the West China Hospital of Sichuan University were collected. The preoperative total bilirubin level of this patient was 470.3 μmol/L, the patient didn’t receive preoperative biliary drainage. The preoperative jaundice time and cholangitis were calculated accurately. A 3D imaging system for quantitative evaluation of the liver was used to reconstruct the images with contrast-enhanced CT images of this patient. And the total liver volume and the future liver remnant volume (FLRV) were calculated. Finally, 6 months of follow-up were conducted after surgery.
Results
The exact jaundice time was 20 d and there was no preoperative cholangitis. The postoperative FLRV accounted for about 70%. No postoperative liver failure occurred. No recurrence of tumor and death of patient occurred after 6 months of follow-up.
Conclusions
Radical resection of hilar cholangiocarcinoma in condition of hyperbilirubinemia is not an absolute contraindication for surgery, but indications should be strictly controlled. For special patient whose jaundice with short duration, no preoperative cholangitis and a high FLRV may be treated with directly radical surgery to prevent for losting the best time of surgery.
Objective To investigate the immunological rejection after hepatocyte transplantation for acute liver failure （ALF） in mice．Methods The hepatocytes were isolated from pig，BALB/c and C57BL/6 mice livers were conducted and then transplanted into C57BL/6 mice．CCl4 was used to make ALF mice model．The experimental animals were randomly divided into three groups， including syngenic group，allogeneic group，and xenogenic group．The survival statuses of all the mice were recorded. The alteration of T lymphocyte subsets，immune globulin，and cytokine were determined．Results ①The survival ratio was 8/10，6/10， and 3/10 in the syngenic group， allogeneic group， and xenogenic group， respectively．The survival ratio in the syngenic group was significantly higher than that in the other two groups （P＜0.05）．②The CD4+ and CD8+ T cells of the peripheral blood in the syngenic group did not change significantly on week one after transplantation．The CD4+ T cells in the allogeneic group reached the peak on day 3 after hepatocyte transplantation （P＜0.05）， while CD8+ T cells did not change much in one week．The CD4+ and CD8+ T cells in the xenogenic group increased and reached the peak on day 3 after transplantation （P＜0.05）．③There were no significantly differences of IgM and IgG in the syngenic group among 0.5， 1， and 3 d after transplantation. IgM of the allogeneic group and xenogenic group reached the peak on day 1 （P＜0.05） and IgG reached the peak on day 3 （P＜0.05） after transplantation．④The concentrations of IFN-γ， TNF-ɑ， and IL-2 in the allogeneic group and xenogenic group were significantly higher than those in the syngenic group （P＜0.05）．The concentration of IL-6 of the xenogenic group was higher than that of the other two groups （P＜0.05）. Conclusions CD4+ and CD8+ T cells play an important role in immune response to both allogeneic and xenogenic hepatocyte transplantation， as well as induce humoral immune response early after hepatocyte transplantation．
ObjectiveTo identify the risk factors for liver failure in patients with recurrent liver cancer after hepatectomy who underwent transcatheter arterial chemoembolization (TACE) therapy, and to develop a nomogram predictive model. MethodsThe patients who underwent TACE therapy for recurrent liver cancer after hepatectomy at Haian People’s Hospital Affiliated to Nantong University from December 2018 to January 2023 were retrospectively enrolled. The patients were randomly divided into a training set and a validation set in a 7∶3 ratio. The risk factors for liver failure after TACE therapy were identified using univariate and multivariate logistic regression analyses in the training set. A nomogram predictive model was then developed incorporating the identified risk factors. The discriminative ability of the nomogram predictive model was evaluated using the area under the receiver operating characteristic curve (AUC). The calibration curve and decision curve analysis (DCA) were applied to assess calibration performance and clinical utility, respectively. ResultsA total of 458 patients were included (321 in the training set, 137 in the validation set), among them, 108 (23.58%) developed liver failure. The multivariate analysis revealed seven independent predictors associated with an increased risk of liver failure (all P<0.05): diabetes mellitus, liver cirrhosis, preoperative Child-Pugh grade C, intraoperative blood transfusion and prolonged hepatic inflow occlusion, postoperative remnant liver volume <40%, as well as elevated total bilirubin (TBIL) level prior to TACE therapy. The nomogram constructed based on these factors achieved AUCs (95%CI) of 0.887 (0.843, 0.921) in the training set and 0.820 (0.735, 0.880) in the validation set. The calibration curves approximated the ideal line, and the Hosmer-Lemeshow test indicated good agreement between predictions and observations (training set: χ2=8.849, P=0.355; validation set: χ2=8.362, P=0.399). DCA demonstrated a high net clinical benefit within threshold probability ranges of 0.02–0.93 for the training set and 0.02–0.83 for the validation set. ConclusionsThe findings of this study indicate that heightened vigilance is required regarding the risk of liver failure in patients with high-risk factors following TACE therapy for liver cancer. These factors include comorbidities such as diabetes mellitus and liver cirrhosis, preoperative Child-Pugh grade C, intraoperative blood transfusion during hepatectomy and prolonged duration of hepatic inflow occlusion, postoperative small remnant liver volume, or elevated TBIL level prior to TACE therapy. The nomogram predictive model constructed based on these risk factors demonstrates favorable performance in the early prediction of liver failure risk after TACE therapy.
ObjectiveTo summarize the changes and mechanism of related genes induced by stem cell therapy in acute-on-chronic liver failure (ACLF) in recent years, and in order to guide the clinical value of ACLF and curative effect evaluation.
MethodsThrough searching Wanfang med, CNKI, Pubmed database and so on in recent years, the differentially expressed genes induced by stem cell therapy for ACLF in recent years was retrieved and the changes of related genes induced during the treatment process were discussed.
ResultsBoth at home and abroad had reported that stem cell therapy in the process of ACLF caused mir-27b, TRAIL, and Tg737 genetic changes, some genetic changes had an fixed change trend.
ConclusionsStem cells in the treatment of ACLF, cause mir-27b, TRAIL, Tg737 genetic changes, which can provides a new way and method for monitoring stem cell therapy ACLF.
