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As a mature organ transplantation, liver transplantation has become the optimal treatment for end-stage liver disease, which can improve the quality of life of recipients. However, liver transplantation still faces multiple challenges, such as rejection, infection, biliary complications, delayed graft function, ischemia-reperfusion injury, recurrence of hepatocellular carcinoma after liver transplantation, kidney-related diseases after transplantation, and donor shortage, etc., which remain to be improved and urgently resolved. With persistent attempts and experience accumulated by Chinese experts and scholars, these problems related to liver transplantation have been gradually resolved year by year. In 2023, liver transplantation teams in China have achieved a series of significant progresses in the field of clinical research. In this article, clinical frontiers and novel technological progresses in the field of liver transplantation in 2023 were reviewed, and the achievements of clinical liver transplantation in China in 2023 were summarized, aiming to provide novel ideas for promoting further development of liver transplantation in China. [ABSTRACT FROM AUTHOR]

Portal vein thrombosis is one of the common complications of liver cirrhosis. The incidence of portal vein thrombosis is increased with the progression of diseases. The incidence and progression of portal vein thrombosis are associated with multiple factors. The indications of anticoagulant therapy remain to be investigated. At present, portal vein thrombosis is no longer considered as a contraindication for liver transplantation. Nevertheless, complicated portal vein thrombosis will increase perioperative risk of liver transplantation. How to restore the blood flow of portal vein system is a challenge for surgical decision-making in clinical practice. Rational preoperative typing, surgical planning and portal vein reconstruction are the keys to ensure favorable long-term prognosis of liver transplant recipients. In this article, epidemiological status, risk factors, typing and identification of portal vein thrombosis, preoperative and intraoperative management of portal vein thrombosis in liver transplantation, and the impact of portal vein thrombosis on the outcomes of liver transplantation were reviewed, aiming to provide reference for perioperative management of portal vein thrombosis throughout liver transplantation. [ABSTRACT FROM AUTHOR]

Liver transplantation is the optimal treatment for end-stage liver disease and hepatocellular carcinoma, which can significantly improve clinical prognosis and quality of life of patients. However, multiple challenges, such as rejection, immune tolerance, shortage of donor liver, preservation of donor liver, ischemia-reperfusion injury and postoperative complications, etc., limit the efficacy of liver transplantation in clinical practice. Research teams in China have made significant contributions to the basic research related to liver transplantation by making continuous efforts and combining the development of emerging technologies, interdisciplinary integration and other emerging fields. In this article, the frontier progress in the basic research of liver transplantation in 2023 was reviewed, highlighting the progress made by Chinese research teams in the basic research of liver transplantation, aiming to provide reference for promoting the integration of Chinese characteristics into the research of liver transplantation, accelerate the integration of Chinese liver transplantation research with international community, and promote further advancement of liver transplantation in China. [ABSTRACT FROM AUTHOR]

器官移植受者术后常规使用免疫抑制剂治疗，如何选择合理的免疫抑制方案，既能避免免疫抑制不 足引起的移植物排斥反应，又可减少因免疫过度导致的感染、药物中毒和恶性肿瘤是器官移植术后治疗的一大难题。 由于目前没有一种快速有效的方法评估受者的免疫状态，因而无法快速准确地判断免疫抑制方案的使用是否合理。 本文从血药浓度监测和免疫状态评估两方面综述了国内外对器官移植术后受者免疫监测应用的最新研究进展，为 实体器官移植后免疫监测提供另一种全新思路和选择。 [ABSTRACT FROM AUTHOR]

Rejection and adverse reactions caused by long-term use of immunosuppressants severely affect the survival rate and quality of life of organ transplant recipients. Immune tolerance induction plays a key role in improving the survival rate and quality of life of organ transplant recipients. In recent years, tremendous progress has been achieved in adoptive re-transfusion of regulatory cells. In this article, research progress in regulatory T cell (Treg), myeloid-derived suppressor cell (MDSC) and regulatory B cell (Breg) in animal experiment and clinical application was reviewed, and the main clinical problems of adoptive re-transfusion of regulatory cells, the application of chimeric antigen receptor Treg and the concept of cell therapy in immune evaluation were summarized, aiming to deepen the understanding of regulatory cell therapy, promote the application of regulatory cells in immune tolerance of organ transplantation, and improve clinical efficacy of organ transplantation and the quality of life of recipients. [ABSTRACT FROM AUTHOR]

Trogocytosis is a process of exchanging part of the membrane fragment or cytoplasmic content of cells through direct contact, and it's an interaction mechanism that exists between cells. Immune cell can obtain some characteristics of other cells through trogocytosis, and the new cells generated through trogocytosis may play an important role in the induction of graft immune tolerance. In this article, the origin and development of research on cell trogocytosis, mechanism of cell trogocytosis and biological significance of trogocytosis of immune cell were reviewed. [ABSTRACT FROM AUTHOR]

Dendritic cell (DC) is professional antigen presenting cell with specific functions. DC can specifically phagocytize antigen, and process and deliver to effector T cell, which play an important role in immune tolerance and immune response. Tolerance DC (tol-DC) is a group of DC with negative immune regulatory function, which can induce immune tolerance of organ transplantation through central and peripheral mechanism. In this article, the phenotype and functional characteristics of DC, mechanism of immune tolerance induced by DC, and the application of tol-DC in organ transplantation of DC were summarized, aiming to provide basic theoretical support for clinical translational medicine research. [ABSTRACT FROM AUTHOR]

Liver transplantation is an effective treatment of severe liver disease. However, the pathophysiological changes of patients with severe liver disease are complicated, which significantly increase the difficulty of perioperative management of liver transplantation. Therefore, it is of great significance to strengthen postoperative management of the recipients with severe liver disease after liver transplantation. In this article, the pathophysiological characteristics of severe liver disease, the selection of immunosuppressant after liver transplantation, and the prevention and treatment of infection after liver transplantation in patients with severe liver disease were summarized [ABSTRACT FROM AUTHOR]

Objective To investigate the guiding role of quantitative evaluation system of immune status in the individualized management of immunosuppressants for the recipients after liver transplantation. Methods Clinical data of 239 liver transplant recipients were retrospectively analyzed. MingDao Immune Cell Analysis (MICA) was established. All recipients were divided into two groups according to the adjustment regimens of immunosuppressants. The immunosuppressant regimen was adjusted according to MingDao Immune System Score (MISS) in the MISS group (n=84), and the medication plan was empirically adjusted during the same period in the control group (n=155). According to the time of postoperative detection (t), the recipients in the MISS group were divided into subgroup A (t ≤ 28 d, n=78), subgroup B (28 d< t ≤ 6 months, n=68), subgroup C (6 months < t ≤ 12 months, n=18), subgroup D (12 months < t ≤ 24 months, n=18) and subgroup E (t >24 months, n=19). In the MISS group, postoperative MISS scores of recipients in subgroups A-E were analyzed. The incidence of acute rejection and opportunistic infection and the overall survival rate were statistically compared between the MISS and control groups. Results The MISS scores in subgroups A-E were -7.0 (-13.2, -2.0), -2.0 (-5.8, 1.8), -0.5 (-7.3, 2.8), -2.0 (-4.5, 3.3) and -3.0 (-6.0, 1.0), respectively. The immune status of the recipients was gradually improved over postoperative time, and the difference between two groups was statistically significant (P<0.05). In the MISS group, 15% (13/84) of the recipients developed acute rejection, and 27% (42/155) in the control group, and the difference was statistically significant (P<0.05). In the MISS group, the MISS score of the recipients with acute rejection was 0 (-2.5, 3.5), and -5.0 (-12.0, -1.0) for their counterparts without acute rejection, and the difference was statistically significant (P<0.05). In the MISS group, 2% (2/84) of the recipients presented with postoperative opportunistic infection, and 9% (14/155) in the control group, and the difference was statistically significant (P<0.05). In the MISS group, the 1- and 3-year overall survival rates were 86.9% and 79.8%, and 83.2% and 76.8% in the control group, and no significant difference was observed between two groups (P>0.05). Conclusions MICA and MISS score may reflect the immune status of liver transplant recipients, and guide the individualized management of administration of immunosuppressants after liver transplantation. [ABSTRACT FROM AUTHOR]

Objective To evaluate the changes and significance of lymphocyte subsets in the recipients with acute rejection after liver transplantation. Methods The recipients presenting with acute rejection after liver transplantation were assigned into the rejection group (n=17), and their counterparts with stable liver function were allocated into the control group (n=17) according to the ratio of 1∶1 by propensity score matching method. The incidence of acute rejection after liver transplantation was analyzed, and the concentration of tacrolimus in the recipients was compared between two groups. The absolute value and proportion of lymphocyte subsets in peripheral blood were compared between two groups. The diagnostic value of lymphocyte subsets for acute rejection after liver transplantation was assessed by the receiver operating characteristic (ROC) curve. The absolute value and proportion of lymphocyte subsets in the rejection group were compared before and after treatment. Results Among 17 recipients in the rejection group, 4 cases developed acute rejection within postoperative 28 d, and 13 cases had acute rejection within postoperative 29-180 d. No significant difference was noted in the tacrolimus concentration between two groups (P=0.295). Compared with the control group, the proportions of peripheral blood T cells, CD4+ T cells, B cells and natural killer (NK) T cells were significantly increased in the rejection group (all P<0.05). The elevated proportion of NKT cells in the early stage after liver transplantation was an independent risk factor for acute rejection following liver transplantation[odds ratio (OR) 1.774，95% confidence interval (CI) 1.059-2.971，P=0.029]. ROC curve analysis showed that the area under curve (AUC) of CD4+ T cells, B cells and NKT cells was 0.76, 0.73 and 0.77, respectively. The AUC of combined use of CD4+ T cells, B cells and NKT cells was 0.89, with a cut-off value of 0.69, sensitivity of 0.706 and specificity of 0.941. After corresponding treatment, all recipients were gradually recovered, and liver functions were eventually restored to normal in the rejection group. After treatment, the proportion of T cells, CD4+ T cells, CD8+ T cells and NK cells was significantly decreased (all P<0.05). Conclusions The elevated proportion of NKT cells indicates an increased risk of acute rejection after liver transplantation. Combined use of CD4+ T cells, B cells and NKT cells may deliver early detection and diagnosis of acute rejection after liver transplantation. [ABSTRACT FROM AUTHOR]

Objective To investigate the role of tolerogenic dendritic cell (tolDC) in inducing immune tolerance in liver transplantation. Methods Liver transplantation rat models of spontaneous tolerance [Brown Norway (BN)→Lewis, tolerance group, n=6] and acute rejection (AR) (Lewis → BN) were established. In AR rat models, tolDC transfusion was performed in the study group (tolDC group, n=6) and no intervention was given in the control group (AR group, n=6). The survival time of rats in each group was observed. The transplant liver tissues of rats were prepared for pathological examination in each group. The expression of myeloid dendritic cell (mDC) and plasmacytoid dendritic cell (pDC) in rat peripheral blood, transplant liver, spleen and lymph nodes in each group was detected by flow cytometry. The expression levels of serum interleukin (IL)-10 and interferon (IFN)-γ in each group were measured by enzyme-linked immune absorbent assay. Results Pathological manifestations of rats in the AR group mainly included inflammatory cell infiltration and tissue structural disorder in transplant liver, and the survival time was 7-14 d. In the tolDC and tolerance groups, the transplant liver tissues were almost normal, and the longest survival time exceeded 100 d. Compared with the AR group, the expression levels of CD11+ mDC in peripheral blood, transplant liver, spleen and lymph nodes of rats were significantly down-regulated in the tolerance and tolDC groups (all P<0.05), and those of CD86 and major histocompatibility complex (MHC) Ⅱ on the surface of CD11+ mDC were also significantly down-regulated (all P<0.05). Compared with the AR group, the expression levels of pDC in peripheral blood, transplant liver, spleen and lymph nodes of rats were significantly up-regulated in the tolerance and tolDC groups (all P<0.05), whereas those of MHC Ⅱ on the surface of pDC were all significantly down-regulated (all P<0.05). Compared with the AR group, the expression levels of serum IL-10 were significantly up-regulated, and IFN-γ were significantly down-regulated in the tolerance and tolDC groups (all P<0.05). Conclusions As tolDC subsets, mDC and pDC play a positive role in regulating the incidence of graft immune tolerance in rats after liver transplantation. [ABSTRACT FROM AUTHOR]

Objective To investigate the role of CD4+ CD45RClow regulatory T cell (Treg) in the immune tolerance induction of rats undergoing liver transplantation. Methods Liver transplantation rat models of acute rejection (AR) [Lewis → Brown Norway (BN), AR group] and spontaneous tolerance (BN → Lewis, tolerance group) were established, with 6 rats in each group. Moreover, 3 Lewis rats and 3 BN rats were assigned into the sham operation group (control group). The liver tissues of rats in each group were subject to pathological staining. The expression of T cell subsets and plasmacytoid dendritic cells (pDC) in the peripheral blood, liver graft and spleen of rats was detected in each group. The correlation between pDC and CD4+ CD45RClowTreg was analyzed. The expression levels of CD4, CD45RC and CD103 in the liver graft and spleen of rats were quantitatively measured in each group. Results In the AR group, pathological manifestations mainly consisted of inflammatory cell infiltration and structure disorders of transplant liver. Compared with the AR group, the expression levels of CD4+ CD25+ Treg and CD8+ Treg in the peripheral blood were significantly upregulated in the tolerance group (all P<0.05). In the peripheral blood, the expression level of CD4+ CD25+ Treg was positively correlated with that of CD8+ Treg (r=0.742, P=0.022). In the AR group, the expression level of CD4+ CD45RChighT cell in the peripheral blood was significantly higher than those in the tolerance and control groups (both P<0.05). Compared with the AR group, the expression level of CD4+ CD45RClowTreg in the spleen, and the expression levels of CD8+ CD45RClowTreg in the peripheral blood, transplant liver and spleen were significantly up-regulated in the tolerance group (all P<0.05). Compared with the control and AR groups, the ratio of CD8+ CD45RClowTreg/CD8+ T in the peripheral blood and the expression levels of pDC in the peripheral blood, transplant liver and spleen were all significantly up-regulated in the tolerance group (all P<0.05). The expression level of CD4+ CD45RClowTreg was positively correlated with the changes of pDC (r=0.506, P=0.016). The expression levels of CD4, CD45RC and CD103 in the transplant liver and spleen of rats were up-regulated in the tolerance group. In the AR group, the expression levels of CD4 and CD45RC were up-regulated, whereas that of CD103 was down-regulated. Conclusions CD4+ CD45RClowTreg is a cell subgroup with negative immune regulation, which may construct a regulatory cell network of immune tolerance induction along with CD8+ CD45RClowTreg and pDC, [ABSTRACT FROM AUTHOR]

Objective To explore the clinical efficacy of liver transplantation for severe liver disease. Methods The clinical data of 51 patients who underwent liver transplantation for severe liver disease were retrospectively analyzed. The general intraoperative conditions were observed, including operation duration, warm ischemia time, cold ischemia time, anhepatic phase, bleeding volume, blood transfusion volume, plasma transfusion volume and so on. The changes in indexes such as total bilirubin (TB), prothrombin time activity (PTA), and prothrombin time international normalized ratio (PT-INR) were observed before operation and at 3 d, 1 week and 2 weeks after operation. The postoperative survival and occurrence of complications were analyzed. The indexes that might affect the prognosis of patients with severe liver disease were analyzed by Cox regression analysis. Results For the 51 patients, operation duration, warm ischemia time and cold ischemia time was 8 (7, 9) h, 3 (2, 3) min and 6 (5, 8) h respectively, intraoperative anhepatic phase was 80 (70, 100) min, intraoperative bleeding volume was 1 000 (550, 1 500) mL, and intraoperative blood transfusion volume was 1 200 (200, 1 600) mL. Postoperative TB, PTA, PT-INR and other indexes improved significantly compared to those preoperatively. Among the 51 patients, 10 cases died, with the death causes of multiple organ failure and severe infection (7 cases), renal insufficiency (2 cases), and cardiovascular complications (1 case). Survival rates at 1 month and 1 year post-transplantation for patients with severe liver disease were 82% and 80%, respectively. Cox regression analysis suggested that abnormal preoperative PTA and PT-INR were the risk factors for post-transplantation death in patients with severe liver disease. Conclusions Liver transplantation significantly improves the survival rate for patients with severe liver disease, perioperative infection prevention and treatment as well as multiple organ function management play key roles in improving post-transplantation survival rate in patients with severe liver disease. [ABSTRACT FROM AUTHOR]

Liver transplantation, although recognized as the only effective radical treatment for severe liver disease, might be accompanied by high surgical risks, high perioperative mortality and high postoperative complications. Considering the shortage of donor liver and related surgical risks, it is necessary to strictly control the indication of operation and the opportunity of transplantation. Therefore, accurate diagnosis and comprehensive evaluation of the condition of patients with severe liver disease to be treated by liver transplantation is an important part in determining the treatment plan. At present, there are many evaluation criteria for severe liver disease. In addition to the classic ChildTurcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) score, many other evaluation criteria have also been developed. All transplant centers have their own choices and thus there is no uniform diagnostic criterion, with disputes among various criteria, which is exactly what this paper aims to summarize. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between immune tolerance and the changes of helper T cell (Th), regulatory T cell (Treg) cytokines, related signaling pathway proteins during immune tolerance process in rat models of liver transplantation. Methods The orthotopic liver transplantation rat models were established by double-cuff technique. All rats were divided into 3 groups. In the operative control group (n=6), sham operation was performed without liver transplantation. In the short-term group (n=10), the rats survived for 10 d after liver transplantation. In the immune tolerance group (n=10), the rats survived for 100 d after operation and the function of the transplanted liver was restored to normal. The expression levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), Th1 cytokines [interferon (IFN)-γ, interleukin (IL)-2 and tumor necrosis factor (TNF)-α], Th2 cytokines (IL-4, IL-5, IL-6 and IL-13), Th17 cytokines [granulocyte-macrophage colony-stimulating factor (GM-CSF) and IL-17A], Treg cytokines [IL-10, transforming growth factor (TGF)-β and IL-12p] were quantitatively measured. The serum sample of rats in each group was detected by protein chip analysis. Results Compared with the operative control group, the AST level in the short-term group was significantly down-regulated, whereas the ALT level was significantly up-regulated (both P<0.05). However, the AST and ALT levels did not significantly differ between the immune tolerance group and operative control group (both P>0.05). In the liver tissues of rats in each group, the expression levels of Th1 cytokines IFN-γ and IL-2 in the shortterm group were significantly higher than those in the operative control group (both P<0.05). The expression level of Th2 cytokine IL-4 in the immune tolerance group was significantly lower than that in the operative control group (P<0.05). The expression levels of Th2 cytokines IL-5, IL-6 and IL-13 in the short-term group were significantly lower than those in the operative control group (all P<0.05). The expression level of IL-17A in the immune tolerance group was significantly higher than that in the operative control group (P<0.05). In the immune tolerance group, the expression levels of IL-10 and IL-12p were significantly higher than those in the operative control group (both P<0.05). The expression level of TGF-β in the short-term group was significantly higher than that in the operative control group (P<0.05). Compared with the operative control group, the expression levels of intercellular adhesion molecule (ICAM)-1, pro-platelet basic protein (Ppbp), Neuropilin-2, Notch-2 protein in the short-term group were significantly up-regulated (all P<0.05). The expression levels of CXC chemokine ligand 17 (CXCL17), ICAM-1 and Neuroleptin-2 protein were markedly up-regulated (all P<0.05), whereas that of B7-1 protein was significantly down-regulated (P<0.05) in the immune tolerance group. Conclusions Treg cytokines (IL-10, TGF-β and IL-12p), IL-6, IL-17 and trans-membrane signaling pathway molecules (ICAM-1, Neuropilin-2, B7-1 proteins) play a pivotal role in the natural immune tolerance process of rat models of liver transplantation. [ABSTRACT FROM AUTHOR]

肝移植已成为治疗终末期肝病的主要手段，然而术后的肿瘤复发、代谢性疾病、肾功能不全等严 重影响了受体的生活质量及长期生存率。这些疾病的发生发展与免疫抑制剂的方案有着密切的关系。本文主要针 对肾上腺皮质激素（激素）和钙神经蛋白抑制剂（CNI）这两类药物在原发性肝脏恶性肿瘤术后、肝移植术后预 防代谢性疾病以及预防肾损伤的减药方案及联合应用其他免疫抑制剂三方面进行综述，以期对术后免疫抑制剂管 理提供参考。 [ABSTRACT FROM AUTHOR]

Objective To analyse the clinical efficacy of liver transplantation and summarize the clinical experience of perioperative management in patients with hepatic coma. Methods Clinical data of 22 patients with hepatic coma undergoing liver transplantation were retrospectively analyzed. The perioperative conditions of the recipients were observed, including operation time, warm/cold ischemia time of donor liver, intraoperative anhepatic phase of the recipients, intraoperative blood loss, intraoperative blood transfusion, early postoperative blood drug concentration and incidence of postoperative complications. The survival situation of the recipients and the influencing factors of clinical prognosis were analyzed. Results The operation time of 22 recipients was 8 (6-12) h, the warm ischemia time of donor liver was 4 (2-6) min, the cold ischemia time was 7 (5-10) h, intraoperative anhepatic phase of recipients was 80 (55- 120) min, intraoperative blood loss was 1 139 (400-4 000) mL and intraoperative blood transfusion was 1 440 (0-3 600) mL. The blood concentration of tacrolimus (FK506) fluctuated between 6 and 11 ng/mL at postoperative one week. Six recipients died after liver transplantation including 1 case of primary graft liver failure, 2 cases of severe infection, 1 case of severe cerebral edema caused by cerebral hemorrhage and 2 cases of multiple organ failure. The postoperative 1 month and 1 year survival rates of hepatic coma recipients were 82% and 77%. Conclusions Liver transplantation can significantly improve the survival rate of patients with hepatic coma. Preoperative decreasing blood ammonia, controlling postoperative infection, improving renal function and formulating precise individualized immunosuppression therapy according to immune status play a pivotal role in enhancing the survival rate. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of Immutol on inducing the immune tolerance of cardiac grafts in rat models. Methods A rat model of heterotopic abdominal heart transplantation was established. The recipient rats were divided into 5 groups: blank control group (n=6); dimethyl sulfoxide (DMSO) group (n=6), in which DMSO was administered until the cardiac graft arrest; Immutol group (n=6), in which Immutol was administered until the cardiac graft arrest; ciclosporin (CsA) group (n=10), in which CsA was administered for 20 d； combined group (n=13), in which Immutol was given for 60 d combined with CsA for 20 d. The survival time and pathological changes of cardiac grafts in each group were observed. The contents of serum interleukin (IL)-10 and interferon (IFN)-γ were detected. The expression levels of indoleamine 2,3-dioxygenase (IDO) and fibrinogen-like protein 2(Fgl2) messenger RNA(mRNA) in heart tissues of rats in each group were measured. Results In the combined group, the cardiac grafts survived for >180 d and immune tolerance was induced. The pathological score of cardiac grafts in the combined group was significantly lower than that in the CsA group at postoperative 39 d (P<0.05). The levels of serum IL-10 and IFN-γ in the combined group were significantly higher than those in the CsA group at 9 d and 39 d after operation (both P<0.05). The content of serum IL-10 and IFN-γ in the combined group were gradually increased over time. At postoperative 39 d, the expression levels of IDO and Fgl2 mRNA in the combined group were significantly higher than those in the CsA group (both P<0.05). The expression level of IDO mRNA in the combined group tended to gradually elevate after operation. In the combined group, the expression level of Fgl2 mRNA at postoperative 180 d was significantly higher than those at 9 d and 39 d after operation (both P<0.05). Conclusions Combined administration of Immutol and CsA can effectively inhibit the incidence of acute rejection, and maintain the long-term survival of the cardiac grafts and induce immune tolerance after drug withdrawal [ABSTRACT FROM AUTHOR]

肝移植是目前公认的治疗终末期肝病的最有效措施，而如何让移植受者获得免疫耐受状态则是肝 移植科医师追求的最终目标。了解最新的国际多中心临床经验以及相关基础研究结果，有助于我们更深入地认识 免疫耐受，从而为移植受者制定更加妥善的治疗方案。本文综合国际核心期刊报道的内容，从临床免疫耐受的可 行性、免疫耐受的诱导和维持、免疫耐受诱导方案的制定及寻找合理的免疫状态的相关监测指标等方面作一综述， 并对今后的研究方向作出展望。 [ABSTRACT FROM AUTHOR]

Objective To analyze the application effect of non-penetrating vascular closure system in portal vein reconstruction of allogenic liver transplantation in adults. Methods Clinical data of 222 patients undergoing allogeneic liver transplantation were retrospectively analyzed. According to whether vascular closure system was used in portal vein reconstruction during operation, all patients were divided into vascular clip group (n=137) and traditional suture group (n=85). Perioperative conditions, clinical prognosis and complications were statistically compared between two groups. Results All patients successfully completed the surgery. The success rate of one-time portal vein anastomosis was 93.4% (128/137) in the vascular clip group. A total of 14 patients died during perioperative period in this study with a mortality rate of 6.3% (14/222). No portal vein-related complications occurred during perioperative period in both groups. The time of portal vein anastomosis in the vascular clip group was (5.6±1.7) min, which was significantly shorter than (10.7±3.6) min in the traditional suture group (P<0.05). The incidence and grade of perioperative complications did not significantly differ between two groups (all P>0.05). Conclusions It is safe and feasible to utilize vascular closure system to reconstruct the portal vein during liver transplantation. Compared with traditional suture, it can effectively shorten the time of portal vein anastomosis. [ABSTRACT FROM AUTHOR]

Objective To systematic evaluation the therapeutic effects on patients with ABO-incompatibility liver transplantation (ILT), and compare the curative effect with ABO-compatible liver transplantation (CLT). Methods The literatures of comparison in clinical efficacy between ILT and CLT were collected at home and abroad by computer search in PubMed database, Embase database, Cochrane database, Medline database, Web of science database, CNKI, Wanfang database, VIP database, et al, and the quality of literatures were accessed. Meta analysis was carried out by fixed effect model and random effect model with RevMan5.3 software. Results A total of 18 papers were included. The results of Meta analysis showed that there was no significant difference in the survival rates of recipient between ILT group and CLT group at 1, 3 and 5 years after operation (all P>0.05 ). Compared with CLT group, the survival rates of grafts were significantly decreased in ILT group at 1 , 3 and 5 years after operation, and the difference was statistically significant (all P<0.05 ). The incidences of postoperative biliary complication and acute rejection in ILT group were significantly higher than those in CLT group, the difference was statistically significant (both P<0.05 ). Conclusions Compared with CLT, the curative effect of ILT is weaker but still can be used as a new choice for critical condition of the recipient or waiting for the donor liver for a long time. [ABSTRACT FROM AUTHOR]

CD40-CD40L 信号通路在特异性免疫中是一条重要的细胞信号传导通路，它参与体液免疫和细胞免疫的调节。动物实验表明抗 CD40L 单克隆抗体（mAb）阻断 CD40与 CD40L 的结合，从而阻断 CD40-CD40L信号的传导，具有抑制器官移植排斥反应的作用。近年来抗 CD40LmAb 在临床试验中出现的血栓并发症导致其应用受到了质疑。随着人们对 CD40-CD40L 信号通路的认识不断深入，尤其是新的抗 CD40mAb 的应用，使得克服与之相关的血栓并发症成为可能，加之其在动物器官移植模型中表现出良好的应用前景，相信这将会进一步推动器官移植免疫耐受及免疫抑制剂方案的发展。本文就 CD40-CD40L 信号通路在器官移植方面取得的进展进行综述。 [ABSTRACT FROM AUTHOR]