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超声造影早期检出联合间充质干细胞治疗改善肝移植术后胆道缺血预后的初步探讨

林跃君 郑博文 吴涛 周慧超 廖梅 吕艳 何玉婷 任杰

林跃君, 郑博文, 吴涛, 等. 超声造影早期检出联合间充质干细胞治疗改善肝移植术后胆道缺血预后的初步探讨[J]. 器官移植, 2021, 12(3): 324-328. doi: 10.3969/j.issn.1674-7445.2021.03.011
引用本文: 林跃君, 郑博文, 吴涛, 等. 超声造影早期检出联合间充质干细胞治疗改善肝移植术后胆道缺血预后的初步探讨[J]. 器官移植, 2021, 12(3): 324-328. doi: 10.3969/j.issn.1674-7445.2021.03.011
Lin Yuejun, Zheng Bowen, Wu Tao, et al. Preliminary study of early diagnosis by contrast-enhanced ultrasound combined with mesenchymal stem cell therapy in improving prognosis of biliary ischemia after liver transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(3): 324-328. doi: 10.3969/j.issn.1674-7445.2021.03.011
Citation: Lin Yuejun, Zheng Bowen, Wu Tao, et al. Preliminary study of early diagnosis by contrast-enhanced ultrasound combined with mesenchymal stem cell therapy in improving prognosis of biliary ischemia after liver transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(3): 324-328. doi: 10.3969/j.issn.1674-7445.2021.03.011

超声造影早期检出联合间充质干细胞治疗改善肝移植术后胆道缺血预后的初步探讨

doi: 10.3969/j.issn.1674-7445.2021.03.011
基金项目: 

国家自然科学基金面上项目 81971632

广东省自然科学基金面上项目 2020A1515010425

广东省重点领域研发计划项目 2019B020235002

详细信息
    通讯作者:

    任杰,Email: renj@mail.sysu.edu.cn

  • 中图分类号: R617, R445, R329.2

Preliminary study of early diagnosis by contrast-enhanced ultrasound combined with mesenchymal stem cell therapy in improving prognosis of biliary ischemia after liver transplantation

More Information
  • 摘要:   目的  探讨超声造影(CEUS)早期检出联合间充质干细胞(MSC)治疗肝移植术后胆道缺血的疗效。  方法  回顾性分析9例肝移植术后4周内CEUS提示胆道缺血且术后1年内确诊为非吻合口胆管狭窄(NAS)受者的临床资料。常规治疗组4例,行常规治疗,治疗方式包括护肝、利胆、介入治疗等; MSC治疗组5例,在常规治疗的基础上,分别于CEUS提示胆道缺血后1、2、4、8、12和16周接受MSC静脉输注。分析两组受者肝移植术后1年内介入治疗情况和预后。  结果  MSC治疗组2例受者需接受介入治疗,首次治疗时间为肝移植术后7~9个月,治疗次数1~2次; 常规治疗组所有受者均需接受介入治疗,首次治疗时间早于MSC治疗组,为术后1~3个月,治疗次数2~6次。肝移植术后1年内,MSC治疗组2例受者发生弥漫性胆管损伤,未发生移植物失功; 常规治疗组所有受者均发生弥漫性胆管损伤,2例受者发生移植物失功。  结论  应用CEUS早期检出肝移植术后胆道缺血并进行MSC治疗可延缓并减少NAS介入治疗需求,改善受者预后。

     

  • 图  1  1例肝移植术后CEUS提示胆道缺血接受常规治疗受者的超声表现

    注:A图示肝移植术后4周复查,彩色多普勒超声见肝动脉形态正常; B图示肝移植术后4周CEUS见胆管壁动脉期无增强,提示胆道缺血(箭头处为胆管壁,*为肝实质); C、D图示肝移植术后2个月,二维超声见肝动脉形态正常,肝门区积液(红色箭头),介入治疗中确诊积液为胆漏; E图示肝移植术后11个月,PTCD见以稀疏胆管树及多发肝内胆管狭窄为特点的弥漫性严重胆管损伤(红色箭头处为中心胆管狭窄)。

    Figure  1.  Ultrasonic findings of 1 recipient received conventional treatment with biliary ischemia determined by CEUS after liver transplantation

    图  2  1例肝移植术后CEUS提示胆道缺血且接受MSC治疗受者的超声表现

    注:A图示肝移植术后4周复查,彩色多普勒超声见肝动脉形态正常; B图示肝移植术后4周CEUS见胆管壁动脉期无增强,提示胆道缺血(箭头处为胆管壁,*为肝实质),此时开始MSC治疗; C图示肝移植术后5个月,受者出现轻中度肝功能异常,行MRCP确诊NAS,此时肝动脉形态正常; D图示肝移植术后1年,MRCP未见肝内胆管(白色箭头)及中心胆管(红色箭头)狭窄。

    Figure  2.  Ultrasonic findings of 1 recipient received MSC treatment with biliary ischemia determined by CEUS after liver transplantation

  • [1] BOEVA I, KARAGYOZOV PI, TISHKOV I. Post-liver transplant biliary complications: current knowledge and therapeutic advances[J]. World J Hepatol, 2021, 13(1): 66-79. DOI: 10.4254/wjh.v13.i1.66.
    [2] MAGRO B, TACELLI M, MAZZOLA A, et al. Biliary complications after liver transplantation: current perspectives and future strategies[J]. Hepatobiliary Surg Nutr, 2021, 10(1): 76-92. DOI: 10.21037/hbsn.2019.09.01.
    [3] KEANE MG, DEVLIN J, HARRISON P, et al. Diagnosis and management of benign biliary strictures post liver transplantation in adults[J]. Transplant Rev (Orlando), 2021, 35(1): 100593. DOI: 10.1016/j.trre.2020.100593.
    [4] KOHLI DR, DESAI MV, KENNEDY KF, et al. Patients with post-transplant biliary strictures have significantly higher rates of liver transplant failure and rejection: a nationwide inpatient analysis[J]. J Gastroenterol Hepatol, 2020, DOI: 10.1111/jgh.15388[Epubahead of print].
    [5] SHARMA S, GURAKAR A, JABBOUR N. Biliary strictures following liver transplantation: past, present and preventive strategies[J]. Liver Transpl, 2008, 14(6): 759-769. DOI: 10.1002/lt.21509.
    [6] VERDONK RC, BUIS CI, VAN DER JAGT EJ, et al. Nonanastomotic biliary strictures after liver transplantation, part 2: management, outcome, and risk factors for disease progression[J]. Liver Transpl, 2007, 13(5): 725-732. DOI: 10.1002/lt.21165.
    [7] OP DEN DRIES S, WESTERKAMP AC, KARIMIAN N, et al. Injury to peribiliary glands and vascular plexus before liver transplantation predicts formation of non-anastomotic biliary strictures[J]. J Hepatol, 2014, 60(6): 1172-1179. DOI: 10.1016/j.jhep.2014.02.010.
    [8] FRANCHITTO A, OVERI D, MANCINELLI R, et al. Peribiliary gland damage due to liver transplantation involves peribiliary vascular plexus and vascular endothelial growth factor[J]. Eur J Histochem, 2019, 63(2): 3022. DOI: 10.4081/ejh.2019.3022.
    [9] REN J, LU MD, ZHENG RQ, et al. Evaluation of the microcirculatory disturbance of biliary ischemia after liver transplantation with contrast-enhanced ultrasound: preliminary experience[J]. Liver Transpl, 2009, 15(12): 1703-1708. DOI: 10.1002/lt.21910.
    [10] ZHANG YC, LIU W, FU BS, et al. Therapeutic potentials of umbilical cord-derived mesenchymal stromal cells for ischemic-type biliary lesions following liver transplantation[J]. Cytotherapy, 2017, 19(2): 194-199. DOI: 10.1016/j.jcyt.2016.11.005.
    [11] ABDELRAZIK H, GIORDANO E, BARBANTI BRODANO G, et al. Substantial overview on mesenchymal stem cell biological and physical properties as an opportunity in translational medicine[J]. Int J Mol Sci, 2019, 20(21): 5386. DOI: 10.3390/ijms20215386.
    [12] CHOI JR, YONG KW, NAM HY. Current status and perspectives of human mesenchymal stem cell therapy[J]. Stem Cells Int, 2019: 4762634. DOI: 10.1155/2019/4762634.
    [13] MAEDA S, MIYAGAWA S, KAWAMURA T, et al. Notch signaling-modified mesenchymal stem cells improve tissue perfusion by induction of arteriogenesis in a rat hindlimb ischemia model[J]. Sci Rep, 2021, 11(1): 2543. DOI: 10.1038/s41598-021-82284-3.
    [14] 张英才, 姚嘉, 邓宜南, 等. 联合间充质干细胞简化方案在ABO血型不符肝移植患者中的应用[J/CD]. 中华肝脏外科手术学电子杂志, 2016, 5(6): 380-384. DOI: 10.3877/cma.j.issn.2095-3232.2016.06.009.

    ZHANG YC, YAO J, DENG YN, et al. Application of simplified protocol combining with mesenchymal stem cell in ABO-incompatible liver transplant patients[J/CD]. Chin J Hepatic Surg (Electr Edit), 2016, 5(6): 380-384. DOI: 10.3877/cma.j.issn.2095-3232.2016.06.009.
    [15] 任杰, 吕艳, 廖梅, 等. 超声造影定性诊断肝移植缺血性胆道病变及评估预后的临床研究[J]. 中华超声影像学杂志, 2013, 22(9): 784-787. DOI:10.3760/cma.j.issn. 1004-4477.2013.09.014.

    REN J, LYU Y, LIAO M, et al. Clinical study on diagnosis and prognosis assessment of ischemic-type biliary lesion in liver transplantation by contrast-enhanced ultrasound[J]. Chin J Ultrason, 2013, 22(9): 784-787. DOI: 10.3760/cma.j.issn.1004-4477.2013.09.014.
    [16] DENG Y, YI S, WANG G, et al. Umbilical cord-derived mesenchymal stem cells instruct dendritic cells to acquire tolerogenic phenotypes through the IL-6-mediated upregulation of SOCS1[J]. Stem Cells Dev, 2014, 23(17): 2080-2092. DOI: 10.1089/scd.2013.0559.
    [17] DE VRIES Y, VON MEIJENFELDT FA, PORTE RJ. Post-transplant cholangiopathy: classification, pathogenesis, and preventive strategies[J]. Biochim Biophys Acta Mol Basis Dis, 2018, 1864(4 Pt B): 1507-1515. DOI: 10.1016/j.bbadis.2017.06.013.
    [18] 蔡晓波, 朱峰, 翁坚军, 等. 肝移植术后胆管吻合口狭窄和非吻合口狭窄内镜治疗的比较[J]. 中华消化内镜杂志, 2012, 29(7): 389-392. DOI: 10.3760/cma.j.issn. 1007-5232.2012.07.008.

    CAI XB, ZHU F, WENG JJ, et al. Therapeutic effect of endoscopy for anastomotic and nonanastomotic biliary strictures after liver transplantation[J]. Chin J Dig Endosc, 2012, 29(7): 389-392. DOI: 10.3760/cma.j.issn.1007-5232.2012.07.008.
    [19] 汪邵平, 郑于剑, 李鹏, 等. 肝移植术后胆道非吻合口狭窄的诊治[J]. 中华肝胆外科杂志, 2014, 20(8): 577-581. DOI: 10.3760/cma.j.issn.1007-8118.2014.08.007.

    WANG SP, ZHENG YJ, LI P, et al. Diagnosis and management of non-anastomotic biliary stricture after liver transplantation[J]. Chin J Hepatobiliary Surg, 2014, 20(8): 577-581. DOI: 10.3760/cma.j.issn.1007-8118. 2014.08.007.
    [20] VILLA NA, HARRISON ME. Management of biliary strictures after liver transplantation[J]. Gastroenterol Hepatol (N Y), 2015, 11(5): 316-328.
    [21] BORTOLASI L, VIOLI P, CARRARO A, et al. Complications and outcomes of endoscopic treatment in a cohort of patients with biliary stenosis after orthotopic liver transplant: a retrospective observational study[J]. Exp Clin Transplant, 2019, 17(4): 513-521. DOI: 10.6002/ect.2018.0167.
    [22] GRAZIADEI IW, SCHWAIGHOFER H, KOCH R, et al. Long-term outcome of endoscopic treatment of biliary strictures after liver transplantation[J]. Liver Transpl, 2006, 12(5): 718-725. DOI: 10.1002/lt.20644.
    [23] BARBARO F, TRINGALI A, LARGHI A, et al. Endoscopic management of non-anastomotic biliary strictures following liver transplantation: long-term results from a single-center experience[J]. Dig Endosc, 2020, DOI: 10.1111/den.13879[Epubahead of print].
    [24] HANSEN T, HOLLEMANN D, PITTON MB, et al. Histological examination and evaluation of donor bile ducts received during orthotopic liver transplantation--a morphological clue to ischemic-type biliary lesion?[J]. Virchows Arch, 2012, 461(1): 41-48. DOI: 10.1007/s00428-012-1245-8.
    [25] BRUNNER SM, JUNGER H, RUEMMELE P, et al. Bile duct damage after cold storage of deceased donor livers predicts biliary complications after liver transplantation[J]. J Hepatol, 2013, 58(6): 1133-1139. DOI: 10.1016/j.jhep.2012.12.022.
    [26] MALHOTRA P, SHUKLA M, MEENA P, et al. Mesenchymal stem cells are prospective novel off-the-shelf wound management tools[J]. Drug Deliv Transl Res, 2021, DOI: 10.1007/s13346-021-00925-6[Epubahead of print].
    [27] MICELI V, BULATI M, IANNOLO G, et al. Therapeutic properties of mesenchymal stromal/stem cells: the need of cell priming for cell-free therapies in regenerative medicine[J]. Int J Mol Sci, 2021, 22(2): 763. DOI: 10.3390/ijms22020763.
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出版历程
  • 收稿日期:  2021-01-11
  • 网络出版日期:  2021-05-19
  • 刊出日期:  2021-05-15

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