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Objective To investigate the expression of follicular helper T (Tfh) cell subsets in peripheral blood of patients with liver transplantation (LT) and relevance to the prognosis. Methods Eleven liver transplant patients with stable liver function were enrolled in this study. The frequencies of Tfh subsets were examined by flow cytometry. The frequencies and the level of alanine aminotransferase (ALT), aspartate transaminase (AST) and total bilirubin (TBIL) were monitored dynamically within one month after LT. Results The frequency of CD4+CXCR5+CXCR3–CCR6– Tfh2 subset in peripheral blood increased significantly after LT as compared with those before transplantation (P

Circulating T follicular helper (cTFH) cells have been demonstrated to be involved in B-cell-mediated alloreactive responses in kidney and liver transplantation; however, whether these cells are involved in acute liver allograft rejection after liver transplantation, and which subsets are involved, remains to be clarified. The present study aimed to investigate the profiles of cTFH cells in acute liver allograft rejection, including the CXC motif receptor 3 (CXCR3)

Objective To determine the expression characteristics of peripheral blood follicular helper T cells (Tfh) and their molecules during pre- and post-transplantation period in liver transplant patients to explore the role of Tfh in alloreactive response after liver transplantation. Methods Twenty liver transplant (LT) patients and 20 healthy individuals as control were enrolled in this study. Thirteen LT patients with stable liver function were included for cross-sectional study. Another seven LT patients with complete clinical data were included for follow-up study. The frequencies of Tfh cells were examined by flow cytometry. For the seven patients, Tfh cells and level of alanine aminotransferase (ALT) were monitored dynamically for one month after LT. Results The frequencies of CD4+CXCR5+Tfh and CD4+CXCR5+PD-1+ cells in peripheral blood increased significantly after liver transplantation as compared with those before liver transplantation (P

Stem cells, including embryonic stem cells and adult stem cells, are multipotent cells that have self-renewing abilities and the potential to differentiate into various types of cells, and to repair various tissue damages. Bone marrow is the major source of adult stem cells, including mainly the bone marrow hematopoietic stem cells and mesenchymal stem cells. End-stage liver disease is a serious clinical systemic syndrome, and the use of stem cells in the treatment of end-stage liver disease has received more and more attention. This review summarizes the research progresses of stem cells, especially adult stem cells, in respect of the treatment of end-stage liver disease in the form of in vitro study, animal experimentation and clinical research, with emphasis on the research progress in the use of stem cells of various sources in clinical application, discussion of possible mechanisms of stem cell therapy for end-stage liver disease, to point out the problems existing in current research, and to look forward to the prospect of future application.

To describe the outcomes and recurrence of autoimmune hepatitis (AIH) after liver transplantation.Clinical data of 16 patients with AIH who underwent liver transplantation were analyzed retrospectively. The postoperative cumulative survival rate of the patients was calculated. The postoperative rejections and AIH recurrence were analyzed. The Kaplan-Meier method was used for statistical analysis of survival.All patients were female, with an average age of 52.6 years (range: 41-66 years), and an average MELD score of 21.4. According serological analysis, 15 patients were AIH type 1 and 1 patient was AIH type 2. Three patients died, including 2 of pulmonary infection and 1 of graft dysfunction.The 1-, 2-and 5-year cumulative survival rates were 93.8%, 87.1% and 79.1%, respectively. Five cases (31.3%) of recurrent AIH were diagnosed based on histological evidence. Acute rejection occurred in 6 (37.5%) patients, and de novo HBV infection occurred in 1 (6.3%) patient.Liver transplantation is an effective treatment for end-stage AIH. Recurrence and rejection were commonly associated with AIH, but did not negatively impact patient survival.

Objective To investigate the characteristics of changes and clinical significance of Th17 cells and CD4+CD25+Foxp3+ regulatory T cells (Treg) in peripheral blood in liver transplant patients suffering from acute transplant rejection. Methods A total of 25 liver transplant patients admitted in 302 Hospital of People's Liberation Army from January to September 2011 underwent needle biopsy for the transplanted hepatic tissue. The patients were divided into two groups: acute rejection group (12 cases) and stable-graft group (13 cases). In addition, 13 healthy people were enlisted in the study and regarded as control. Flow cytometric analysis was used to measure the proportion of Th17 cells and Treg cells in peripheral blood among CD4+ T cells, and to observe the relationship between change in Th17/Treg ratio and liver injury. Results The proportion of Th17/CD4+T in acute rejection group (3.50%±0.86%) after transplantation was higher than that in the stable-graft group (2.10%±0.52%) and control group (1.79%±0.42%, P < 0.01). There was no statistical difference in cell ratio between the stable-graft group and control group (P > 0.05). The Treg/CD4+T cell ratio in the peripheral blood of the patients from acute rejection and stable-graft group (0.90%±0.25% and 1.51%±0.23%, respectively) were significantly lower than that of control group (2.57%±0.79%, P < 0.01), and that of acute rejection group was notably lower than that of stable-graft group (P < 0.05). The Th17/Treg ratio in acute rejection group (4.20±1.69) was significantly higher than that of stable-graft group (1.43±0.47) and control group (0.75±0.28, P < 0.01), and that of stable-graft group was higher than that of control group (P < 0.01). The ratio of Th17/Treg was positively correlated with alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and glutamate transaminase (GGT) levels (r=0.5023, P=0.0105; r=0.4561, P=0.0219; r=0.4393, P=0.0280; and r=0.5516, P=0.0043, respectively). Conclusions Th17/ Treg imbalance exists in liver transplant patients suffering from acute rejection, which may be related to liver injury to a certain degree. Furthermore, Th17/Treg imbalance may be involved at the onset and development of acute rejection after liver transplantation.

Hyperlipidemia is not unusual in liver transplant recipients, but refractory severe hyperlipidemia is unusual. We treated a 39-year-old man who had severe dyslipidemia after liver transplant. The levels of blood lipids, liver enzymes, and essential indicators of liver pathology were monitored. The first serum sample was collected from the liver recipient 56 days after transplant surgery because samples could not be obtained sooner after the transplant. The levels of liver enzymes and blood lipids were improved with symptomatic treatment but had recurrent fluctuations. Tacrolimus and cyclosporine, even at low doses, may have been the dominant factor affecting the blood lipid levels in the recipient.

Liver transplantation (LT) for hepatitis B virus (HBV)-related disease can be complicated by HBV recurrence. The aim of this study was to evaluate the risk factors, prophylaxis treatment, and histological characteristics of HBV recurrence after LT when using long-term, low-dose hepatitis B immunoglobulin (HBIG) plus nucleoside analog (lamivudine [LAM] or entecavir [ETV]).Retrospective data from 253 adult LT patients using long-term, low-dose HBIG plus nucleoside analog after LT, for a mean treatment duration of 1-72 months, were collected from a single center in Beijing, China. Univariate analyses were conducted to determine the association among gender, age, hepatocellular carcinoma, hepatitis B e antigen-positive status, HBV-DNA level and tyrosine-methionine-aspartate-aspartate (YMDD) mutations on HBV recurrence in these patients.Overall, the HBV recurrence rate was 6.32% (16/253). There was no significant difference in the survival rate between the HBV recurrence and non-recurrence groups. Risk factors for HBV recurrence were: hepatitis B e antigen positivity, HBV-DNA 10(5) copies/mL, hepatocellular carcinoma, and YMDD mutation. Sixteen patients receiving LAM had HBV recurrence (16/169; mean treatment duration: 61.8 ± 18.3 months). No HBV recurrence occurred in patients receiving ETV after LT (0/84; mean treatment duration: 57.1 ± 15.9 months). Differences in rate of mortality and HBV recurrence were not significant between the two groups.LT is an effective treatment for HBV-related end-stage liver disease. The combination of ETV and intramuscular HBIG for HBV recurrence prophylaxis after LT was more effective than LAM, especially in Chinese patients with HBV recurrence risk factors.

To assess the clinical features of aspergillosis and its diagnosis, prophylaxis and treatment in patients after orthotopic liver transplantation (OLT), and to improve the prognosis of the recipients.Medical records of consecutive patients who underwent OLT in our liver transplant center from May 2002 to May 2004 were analyzed retrospectively. Those with aspergillus infection complications were studied in detail regarding their infected organs, related factors, treatments and prognoses.17 out of 207 recipients of OLT were detected with aspergillosis. The incidence was 8.21 percent. 5 patients infected with superficial aspergillus survived. Of the 12 cases with deep aspergillus infection, 3 with infection limited to the sites of their incisions survived, 2 of the 3 patients with infection in their lungs, and 1 of the 2 patients with it in their livers died, and 4 recipients with multi-organ aspergillus infection died. Among the 7 cases that died, 5 had severe hepatitis, 1 had post-hepatitis liver cirrhosis and 1 had primary liver carcinoma.Long-term (or = 3 weeks) broad-spectrum antibiotics and immunosupression were involved in aspergillus infection in our OLT patients. Patients with chronic severe hepatitis had a higher risk of having aspergillus infection. Amphotericin B is still the best choice for treating aspergillosis. Prophylactic administration of anti-fungal medicine, surveillance of fungal infections as a routine, and treatment of the infection in time may help to improve the prognosis of OLT recipients with aspergillosis.