Zhonghua Gan Zang Bing Za Zhi [JOURNAL]
Sun
200 papers
[A case of portal hypertensive cholangiopathy].
Zhang RL, Chen CY, Huang L … +3 more , Xu M, Lu LG, Cai XB
Zhonghua Gan Zang Bing Za Zhi · 2025 Nov · PMID 41355133 · Full text
Portal hypertensive biliopathy is a secondary condition of intrahepatic and extrahepatic bile duct abnormalities caused by portal hypertension, especially in extrahepatic portal venous obstruction. Most patients may rema...
Portal hypertensive biliopathy is a secondary condition of intrahepatic and extrahepatic bile duct abnormalities caused by portal hypertension, especially in extrahepatic portal venous obstruction. Most patients may remain asymptomatic for a long time, while a few may present with symptomatic portal hypertensive biliopathy, such as obstructive jaundice, cholelithiasis with or without cholangitis, gastrointestinal bleeding, and others. Such disease is rare in clinical practice and is prone to misdiagnosis and missed diagnosis. Improper treatment can lead to serious adverse consequences. We report a case of unexpected discovery of bile duct dilation due to abdominal pain, which was ultimately diagnosed as portal hypertensive biliopathy based on the medical history, manifestations of portal hypertension, and imaging examinations, especially intraductal ultrasonography.
[Bioinformatics screening and analysis of key genes of ferroptosis and autophagy in alcoholic liver disease and their validation].
Zhang QQ, Zhang QQ, Zhang HY … +2 more , Zhang RX, Liu LX
Zhonghua Gan Zang Bing Za Zhi · 2025 Nov · PMID 41355132 · Full text
To screen and analyze key genes of ferroptosis and autophagy using bioinformatics and to validate them correspondingly in order to provide a basis for identifying key therapeutic targets for alcoholic liver disease (ALD)...
To screen and analyze key genes of ferroptosis and autophagy using bioinformatics and to validate them correspondingly in order to provide a basis for identifying key therapeutic targets for alcoholic liver disease (ALD). Bioinformatics analysis was used to screen key genes of ferroptosis and autophagy in ALD based on the GEO, FerrDb, KEGG, and HAMdb databases. Liver tissues from 12 ALD cases after liver transplantation were collected for immunohistochemistry to verify the expression of key genes. Different concentrations of ethanol were used to intervene in the human liver cell line L02 for 24 hours. Cell counting kit-8 (CCK8), lactate dehydrogenase (LDH), oil red O staining, reactive oxygen species (ROS) levels, real-time fluorescence quantitative PCR, and Western blot were used to detect the expression of key genes. The gene and protein expression changes of key genes were detected after intervention with the ferroptosis inhibitor ferrostatin-1 (Fer-1) or the autophagy inhibitor 3-methyladenine (3-MA).The -test was used for comparison between the two groups, and one-way analysis of variance was used for comparison between multiple groups. Bioinformatics analysis screened out the key ferroptosis gene ACSL4, the key autophagy gene CXCR4, and the key ferroptosis and autophagy genes PRKAA2 and CDKN2A. The expression of the four key genes was significantly upregulated in the liver tissues of ALD patients (ALD . control, =9.132～15.240, <0.01 or <0.001). The LDH release increased (200 mmol/L . conrtol, =10.51, <0.01) at ethanol concentration of 200 mmol/L in the ALD in vitro hepatocyte model. Cell viability was significantly inhibited (100, 200 mmol/L . conrtol, =177.30, <0.001) at ethanol concentration of 100 mmol/L and 200 mmol/L. Lipid deposition and ROS accumulation were observed in the cells (100, 200 mmol/L . conrtol, =27.65～245.40, <0.01 or <0.001). The expression of four key genes and their proteins was significantly upregulated (100, 200 mmol/L . conrtol, =5.092～81.770, <0.05). The gene and protein expressions of long-chain acyl-CoA synthetase 4(ACSL4), protein kinase AMP-activated catalytic subunit alpha 2 (PRKAA2), and cyclin dependent kinase inhibitor 2a (CDKN2A) were significantly downregulated (200 mmol/L+Fer-1 . 200 mmol/L, =6.40～930.10, <0.05) following intervention with the ferroptosis inhibitor Fer-1, while C-X-C chemokine receptor type 4 (CXCR4) protein expression was inhibited (200 mmol/L+Fer-1 . 200 mmol/L, =18.60, <0.01). The expressions of all four key genes and their proteins were significantly downregulated (200 mmol/L+3-MA 200 mmol/L, =10.66～116.40, <0.05) after intervention with the autophagy inhibitor 3-MA. ACSL4 is a key gene in ferroptosis in ALD. CXCR4 is a key gene in autophagy in ALD. PRKAA2 and CDKN2A are key genes to ferroptosis and autophagy in ALD, and they are expected to become therapeutic targets for ALD in the future.
[Changes in hepatic phase Ⅱ detoxification enzymes and their mechanism in metabolic associated steatohepatitis (MASH) induced by MCD diet in mice].
Gao JQ, Zuo B, Pi CQ … +4 more , Xiao M, Wang JX, Tao WJ, He Y
Zhonghua Gan Zang Bing Za Zhi · 2025 Nov · PMID 41355131 · Full text
To investigate the changes in hepatic phase II detoxification enzymes and their mechanism in metabolic associated steatohepatitis (MASH) induced by a methionine-choline-deficient (MCD) diet in mice. Ten C57BL/6J mice we...
To investigate the changes in hepatic phase II detoxification enzymes and their mechanism in metabolic associated steatohepatitis (MASH) induced by a methionine-choline-deficient (MCD) diet in mice. Ten C57BL/6J mice were randomly divided into two groups, with five mice in each group, and fed with a control diet (NCD group) and a methionine-choline-deficient diet (MCD group) for four consecutive weeks to establish the MASH model in mice. Mice body weight was recorded weekly. Mice peripheral blood and liver tissue samples were collected after four weeks. The liver histopathological changes were observed by hematoxylin-eosin staining and Sirius red staining in liver tissue. The levels of plasma alanine aminotransferase (ALT), aspartate aminotransferase (AST) and triglycerides were measured by an automatic biochemical analyzer. Triglyceride and total cholesterol were used to evaluate the lipid accumulation condition in the liver of mice with Oil red O staining. Real-time fluorescence quantitative PCR was used to detect the expression of liver inflammatory factors interleukin (IL)-1β and monocyte chemoattractant protein-1 (MCP-1) condition. Transcriptome sequencing and bioinformatics were used to analyze the changes in gene expression profiles in the liver of mice and screen differentially expressed genes. The expression conditions of phase Ⅱ detoxification enzymes glutathione S-transferase mu 4 (GSTM4), dihydronicotinamide riboside:quinone oxidoreductases (NQO-2), sulfotransferase 1β1 (SULT1β1), and uridine diphosphate glucuronosyltransferase 2 family, polypeptide A3(UGT2A3) were verified by real-time fluorescent quantitative PCR. Plasma malondialdehyde content, total antioxidant capacity (T-AOC), plasma and liver glutathione content were determined using commercial kits. The expression of nuclear factor E2-related factor 2 (Nrf2), GSTM4, and UGT1A6 was examined by Western blotting. The independent sample -test was used for comparison between the groups. The body weight of mice in the MCD group showed a gradual downward trend, while the body weight of mice in the NCD group did not change significantly following four weeks of different dietary feeding. The MCD group mice liver had yellow-white appearance with round edges. The liver/body mass index was significantly lower in the NCD group (=3.216, <0.01). Hematoxylin-eosin staining showed that hepatocytes in the MCD group had an occurrence of fatty degeneration accompanied by inflammatory cell infiltration, with a higher NAFLD activity score (NAS) compared to the NCD group (=7.155, <0.001). Sirius red staining showed that the the liver of the MCD group had mildly increased periportal fibers. Plasma biochemical tests indicated that plasma ALT, AST, and triglyceride levels were significantly higher in the MCD group than those in the NCD group (=8.920, <0.001; =6.696, <0.001; =3.904, <0.01). Oil red O staining showed that a large number of lipid droplets accumulated in the liver tissue of the MCD group and were more severe than those in the NCD group (=7.405, <0.001). The triglyceride content was significantly higher in the liver of the mice in the MCD group than that in the NCD group (=3.559, <0.01), and the expression of inflammatory factors IL-1β and MCP-1 was significantly increased (=2.562 and 2.391, respectively, <0.05). Transcriptome sequencing analysis showed that the expression profile of genes related to lipid metabolism was changed in the liver tissue of the mice in the MCD group. The expression of multiple phase Ⅱ detoxification enzymes was significantly downregulated. Real-time fluorescence quantitative PCR verification demonstrated that the expression of four phase Ⅱ detoxification enzymes GSTM4, NQO2, SUIL1β1, and UGT2A3 were significantly lower in the liver of the mice in the MCD group than those in the NCD group (=2.498, 3.570, 3.768, and 4.166, respectively, <0.05). The detection kit showed that compared with the NCD group, the malondialdehyde content in the liver of mice in the MCD group increased (=3.601, <0.01), while the plasma total glutathione (=11.93, <0.001) and reduced glutathione levels were significantly reduced (=3.635, <0.01). The total antioxidant capacity of the liver decreased (=2.872, <0.05), and the total glutathione and reduced glutathione levels in the liver were significantly increased (=3.175 and 3.064, <0.05). Western blotting showed that the expression of Nrf2, GSTM4, and UGT1A6 proteins was significantly lower in the MCD group than that in the NCD group (=3.385, 2.990, 2.168, <0.05). The expressions of multiple phase Ⅱ detoxification enzymes and antioxidant capacity are reduced in the liver of MASH mice induced by the MCD diet, and its mechanism is related to the down-regulation of the expression of the upstream regulatory factor Nrf2 protein.
[Analysis of the impact of tumor diameter on short-term prognosis in patients with hepatitis B-related hepatocellular carcinoma-inducing acute-on-chronic liver failure].
Peng YH, Chen J, Li C … +7 more , Guan CD, Ning P, Li H, Yan LL, Wang YH, Su HB, Liu XY
Zhonghua Gan Zang Bing Za Zhi · 2025 Nov · PMID 41355130 · Full text
To investigate the impact of the size of the liver tumor diameter on the prognosis of patients with hepatitis B-related hepatocellular carcinoma (HCC)-inducing acute-on-chronic liver failure (HBV-HCC/ACLF). A retrospect...
To investigate the impact of the size of the liver tumor diameter on the prognosis of patients with hepatitis B-related hepatocellular carcinoma (HCC)-inducing acute-on-chronic liver failure (HBV-HCC/ACLF). A retrospective cohort study was conducted. Clinical data of patients with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF) diagnosed according to the Asia-Pacific Association for the Study of the Liver (APASLT) guidelines who were admitted to the Fifth Medical Center of PLA General Hospital between January 2016 and January 2021 were collected. The patients were enrolled in the HBV-HCC/ACLF group (116 cases) and the HBV-ACLF group (348 cases). General information, medical history, biochemical parameters, complications, and liver cancer status were collected. Clinical data and prognoses at 28 days and 12 months of follow-up were compared between the two groups. Factors influencing mortality in the HBV-HCC/ACLF group were analyzed to determine the prognostic significance of tumor diameter. The test, χ test, and multivariate logistic regression analysis were used to analyze factors influencing mortality. Receiver operating characteristic (ROC) curves were used to assess the sensitivity and specificity of tumor diameter for 28-day prognosis, and Kaplan-Meier curves were used for survival analysis. There were statistically significant differences in the 28-day mortality rate [(55.17%, 64/116) . (38.51%, 134/348)] and 12-month mortality rate [(78.45%, 91/116) . (55.75%, 194/348)] between the HBV-HCC/ACLF group and the HBV-ACLF group (<0.05). The area under the ROC curve analysis for HBV-HCC/ACLF patients indicated that the tumor diameter was 0.707 (95%: 0.615-0.788). The survival group (52 cases) and the mortality group (64 cases) were divided into the HBV-HCC/ACLF group based on 28-day mortality. Univariate analysis showed that the levels of aspartate aminotransferase (AST), alkaline phosphatase, creatinine, alpha-fetoprotein, white blood cell count, international normalized ratio, model for end-stage liver disease score, acute kidney injury (AKI), the occurrence of infections and complications, and others were all significantly higher in the mortality group compared to the survival group (<0.05).The mortality group had a larger tumor diameter than the survival group (<0.01). The incidence of portal vein tumor thrombosis and distant liver cancer metastasis was also higher in the survival group (<0.01). The mortality group had a higher rate of HCC-related minimally invasive treatment within three months before ACLF diagnosis than the survival group (<0.01). AST levels, infection, size of tumor diameter, and minimally invasive treatment within three months before onset were independent risk factors for 28-day mortality in the HBV-HCC/ACLF group. The optimal significant value for tumor diameter affecting prognosis was 3.3 cm, with a sensitivity of 67.19% and a specificity of 73.08%. Patients with liver tumor diameters >3.3 cm had significantly lower 28-day survival rates than those with a tumor diameter ≤3.3 cm [(24.56%, 14/57) (64.41%, 38/59)]. Eighty case analyses had the same findings in patients who had not previously received any therapy. Patients with HBV-HCC/ACLF had a high 28-day mortality rate, and the size of the tumor diameter is important in determining the 28-day prognosis.
[Study on the role and mechanism of quercetin promoting autophagy in HCCLM3 cells via STING signaling].
Chen L, Wu GZ, Zhu Y … +1 more , Zhang TT
Zhonghua Gan Zang Bing Za Zhi · 2025 Nov · PMID 41355129 · Full text
To explore the effects of quercetin on autophagy and proliferation in HBV-positive liver cancer HCCLM3 cells based on STING signaling and its underlying mechanism. HCCLM3 cells were treated with quercetin (50 μmol/L or...
To explore the effects of quercetin on autophagy and proliferation in HBV-positive liver cancer HCCLM3 cells based on STING signaling and its underlying mechanism. HCCLM3 cells were treated with quercetin (50 μmol/L or 100 μmol/L), designated as the 50 μmol/L group and 100 μmol/L group, respectively. The inhibitory effect of quercetin on HCCLM3 cells was detected using the CCK-8 method. A scratch assay was conducted to assess the impact of quercetin on the migration ability of HCCLM3 cells. A CCK8 and ROS kit was used to detect the effect of quercetin on the levels of reactive oxygen species in HCCLM3 cells. Western blotting was employed to measure the effect of quercetin on the expression of STING signaling and autophagy-related proteins in HCCLM3 cells. RNA interference technology was used to assess the effects of STING signaling inhibition on the expression of autophagy-related proteins and reactive oxygen species levels in HCCLM3 cells. The combined effects of STING activators and quercetin on HCCLM3 cell proliferation and autophagy were evaluated. The -test was used to detect data differences between two groups, while ANOVA was employed for comparisons among multiple groups, followed by the SNK- test for further pairwise comparisons. Compared with the control group, quercetin (50 μmol/L and 100 μmol/L groups) significantly inhibited HCCLM3 cell survival activity in a dose-dependent manner (control group: 100%; 50 μmol/L group: 75.25%; 100 μmol/L group: 50.36%, <0.01 ). Quercetin inhibited HCCLM3 cell migration in a dose-dependent manner (>2 h, control group: 187.16 μm; 50 μmol/L group: 145.22 μm; 100 μmol/L group: 88.21 μm, <0.01), which significantly increased intracellular reactive oxygen species (ROS) levels in HCCLM3 cells (control group: 1.00; 50 μmol/L group: 1.565; 100 μmol/L group: 2.175, <0.01). The phosphorylation level of STING was significantly increased (<0.01), and the expression of autophagy-related protein microtubule-related protein 1A/1B light chain 3 (LC3) protein was significantly promoted (<0.01). Compared with the quercetin group, the cell viability of the small interfering-STING+quercetin group was increased (quercetin group: 56.3%; small interfering-STING+quercetin group: 85.7%, <0.05), while the expression of autophagy-related protein LC3 was decreased. Compared with the quercetin group, the cell viability of the quercetin+STING activator group was further decreased (quercetin group: 56.7%; quercetin+STING activator group: 35.4%, <0.01), and the expression levels of STING and autophagy protein LC3 were significantly increased (<0.05). STING signaling-regulated cell autophagy mediates the inhibitory effect of quercetin on the proliferation of HCCLM3 cells, and this effect is enhanced after administration of the STING agonist.
[Clinical outcomes of small-size grafts in auxiliary liver transplantation for the treatment of portal hypertension].
Ju HF, Wei L, Sun LY … +7 more , Qu W, Zeng ZG, Zhang HM, Tan YL, Wang J, Xie FX, Zhu ZJ
Zhonghua Gan Zang Bing Za Zhi · 2025 Nov · PMID 41355128 · Full text
To evaluate the safety and efficacy of using small and ultra-small sized grafts for in situ auxiliary liver transplantation in the treatment of portal hypertension. A prospective single-arm cohort study was conducted. P...
To evaluate the safety and efficacy of using small and ultra-small sized grafts for in situ auxiliary liver transplantation in the treatment of portal hypertension. A prospective single-arm cohort study was conducted. Patients who underwent liver transplantation at Beijing Friendship Hospital from December 2014 to July 2025 were included. Intraoperative portal vein pressure was routinely monitored, with the target regulation for portal vein blood flow set at<15 mmHg (1 mmHg=0.133 kPa) and follow-up continued until September 2025. The primary endpoints were the patient's status and graft survival. The secondary endpoints were small-for-size syndrome and perioperative complications. The small-for-size syndrome was graded according to the 2023 International Liver Transplantation Society consensus statement. A total of 33 cases were enrolled. Among them, 22 had ultra-small size grafts, 11 had small-size grafts, 28 had living donor grafts, and five had split grafts. The graft-to-recipient weight ratio in living donor liver transplantation was 0.31%～0.79%, while in split liver transplantation it was 0.45%～1.02%. Intraoperative portal vein pressure of ≥15 mmHg was observed in 11 cases, who underwent portal vein blood flow adjustment via splenic artery ligation (2 cases), partial splenectomy (8 cases), and/or restrictive portocaval shunting (1 case), after which all patients achieved the target portal vein pressure. All cases completed at least one month of follow-up, with 28 cases following for more than one year, and the median follow-up period was 36.5 months. Early-stage postoperative small-for-size syndrome occurred in eight cases (24.2%, 8/33), all classified as grade A, with improvements following supportive treatment. Severe complications (Clavien-Dindo≥Ⅲ) occurred in three cases (9.1%, 3/33). The one-year survival rate was 92.9% (26/28). The overall survival rate at the end of follow-up was 90.9% (30/33). No patients experienced graft loss or death due to small-for-size syndrome. Graft tissue tested negative for hepatitis B core antibody and covalently closed circular DNA, and hepatitis B surface antigen seroconversion was achieved following second-stage residual liver resection and under a combined strategy of potent nucleos(t)ide analogs and hepatitis B immunoglobulin in ten cases of hepatitis B-related disease. With standardized portal vein blood flow monitoring and individualized portal vein blood flow adjustment, in situ auxiliary liver transplantation can safely and effectively use small and even ultra-small sized grafts, thereby significantly expanding graft sources and ensuring donor and recipient safety. These findings warrant further validation and promotion in multicenter controlled studies.
[Advantages and challenges of auxiliary liver transplantation therapeutic strategies for patients with acute liver failure].
Sun LY, Wei L, Qu W … +3 more , Zeng ZG, Zhang HM, Zhu ZJ
Zhonghua Gan Zang Bing Za Zhi · 2025 Nov · PMID 41355127 · Full text
The mortality rates are significantly elevated with the rapid progression of acute liver failure in the absence of timely diagnosis and treatment. Liver transplantation is an effective therapeutic approach that can halt...
The mortality rates are significantly elevated with the rapid progression of acute liver failure in the absence of timely diagnosis and treatment. Liver transplantation is an effective therapeutic approach that can halt disease progression, but transplantation timing is a crucial factor affecting prognosis. Patients with acute liver failure should be promptly transferred to hospitals equipped for liver transplantation while simultaneously preparing for the procedure during the course of treatment to avoid missing the opportunity to save lives when the condition suddenly worsens. Auxiliary liver transplantation preserves the patient's native liver while transplanting a new liver. Therefore, patients are expected to gradually reduce immunosuppressants following the regeneration of the autologous liver, so avoiding the problem of lifelong use of immunosuppressants. This is also a unique advantage, offering benefits to patients undergoing auxiliary liver transplantation therapy for acute liver failure, while simultaneously presenting challenges for clinicians in terms of technical skill and comprehensive management.
[Advances in minimally invasive surgical techniques for liver transplant recipients].
Feng Z, Zhang XF, Lyu Y
Zhonghua Gan Zang Bing Za Zhi · 2025 Nov · PMID 41355126 · Full text
In recent years, minimally invasive surgical techniques, especially laparoscopic and robot-assisted surgery, have fundamentally changed the standard procedure for living donor liver retrieval and are gradually expanding...
In recent years, minimally invasive surgical techniques, especially laparoscopic and robot-assisted surgery, have fundamentally changed the standard procedure for living donor liver retrieval and are gradually expanding into the core area of recipient surgery. This review systematically examines the latest advancements in the application of minimally invasive techniques in surgery for liver transplant recipients, focusing on the current status of the integrated application of innovative technologies such as laparoscopy, robot-assisted surgery, and magnetic anastomosis. In addition, this article delves into the potential and evidence-based basis for improving postoperative recovery and reducing surgical complications, and analyze the technical complexity, ethical considerations, equipment dependence, and training challenges faced in achieving full minimally invasiveness in key stages of donor liver implantation. Lastly, the future development directions are discussed, emphasizing that innovation in technological instruments, establishment of standardized training systems, deep multidisciplinary integration, and assemblage with emerging technologies are key pathways to safely and efficiently advance this field, ultimately aiming to provide optimized surgical treatment options for more patients with end-stage liver disease.
[Novel research horizon for liver transplantation management model in hepatocellular carcinoma based on the tumor-donor liver-recipient].
Xu SJ, Xu YY, Xu X
Zhonghua Gan Zang Bing Za Zhi · 2025 Nov · PMID 41355125 · Full text
Hepatocellular carcinoma (hereinafter referred to as liver cancer) is the main indication for liver transplantation in China, but postoperative tumor recurrence and metastasis severely restrict the efficacy of liver tran...
Hepatocellular carcinoma (hereinafter referred to as liver cancer) is the main indication for liver transplantation in China, but postoperative tumor recurrence and metastasis severely restrict the efficacy of liver transplantation. There exist significant differences between the traditional liver cancer research models due to the long-term immunosuppressive state of transplant recipients and the complex mechanism of tumor recurrence and metastasis, posing enormous challenges to existing theoretical system. Therefore, it is crucial to innovate the scientific research pattern and liver transplantation clinical management model for liver cancer. Herein, the author's team has innovatively proposed a 'Tumor-Donor Liver-Recipient' integrated research horizon for liver transplantation in liver cancer based on prior clinical practice and scientific exploration, with the aim to expand new concepts in basic research, explore new strategies for precise clinical intervention, and establish a refined recipient management system. This paper systematically elaborates on the research general situation and cutting-edge perspectives under the "tumor-donor liver-recipient" so as to classify HCC liver transplantation patients, pre-transplant downstaging therapy, scientific evaluation and application of donor livers, innovations in transplant surgical techniques, and individualized postoperative management.
[Research progresses in ex vivo liver perfusion technology].
Liu QY, Zhao Q, He XS
Zhonghua Gan Zang Bing Za Zhi · 2025 Nov · PMID 41355124 · Full text
Liver transplantation is the standard therapy for end-stage liver disease, but the long-standing shortage of donor livers has constrained its advancement. The use of standard donor criteria expansion partially alleviates...
Liver transplantation is the standard therapy for end-stage liver disease, but the long-standing shortage of donor livers has constrained its advancement. The use of standard donor criteria expansion partially alleviates the supply-demand imbalance but increases postoperative complication risks. Extracorporeal mechanical perfusion mitigates ischemia-reperfusion injury, extends preservation time, and enables functional assessment and partial repair of the liver under ex vivo settings. Current clinical evidence confirms that short-term mechanical perfusion positively improves outcomes, but it still has limitations in terms of functional evaluation and deep repair. Therefore, the exploration of prolonged mechanical perfusion has possibilities for the restoration of organ function. The concept of "organ medicine" has enabled the breakthrough application of mechanical perfusion technology, originating from organ transplantation, to multiple disciplines, such as organ research, education, and therapy. Additionally, advancements in transforming research results and industrial upgrading are anticipated to develop into a strategic technology for a new round of medical revolution and industrial transformation.
[Advances in liver transplantation technology].
Zhu ZJ
Zhonghua Gan Zang Bing Za Zhi · 2025 Nov · PMID 41355123 · Full text
Liver transplantation techniques have made significant advances in recent years in surgical procedures, expanding liver donor sources and perioperative management, leading to markedly improved patient survival rates. Thi...
Liver transplantation techniques have made significant advances in recent years in surgical procedures, expanding liver donor sources and perioperative management, leading to markedly improved patient survival rates. This review focuses on key recent developments in the field of liver transplantation, summarizing practical achievements and technical breakthroughs in areas such as machine perfusion techniques and utilization of marginally viable donors, minimally invasive liver transplantation techniques, and the clinical application of small-and ultra-small-size grafts. Furthermore, it explores the current challenges encountered in clinical practice and analyzes future research priorities and developmental trends.
[Research progress on predictive models of portal vein thrombosis in liver cirrhosis].
Wu ZN, Qi ZQ, Xiao Y … +3 more , Guo TY, Tong H, Wang YD
Zhonghua Gan Zang Bing Za Zhi · 2025 Oct · PMID 41167774 · Full text
The formation of portal vein thrombosis (PVT) is one of the complications of liver cirrhosis, which is easily overlooked but is not uncommon. With the deepening research on PVT in liver cirrhosis, evidence regarding the...
The formation of portal vein thrombosis (PVT) is one of the complications of liver cirrhosis, which is easily overlooked but is not uncommon. With the deepening research on PVT in liver cirrhosis, evidence regarding the assessment of PVT formation, treatment effectiveness, and prognostic outcomes is continually being updated. This article summarizes recent studies on predicting the formation, anticoagulation efficacy, and survival models; analyzes and evaluates the rationality, standardization, and practicality of prediction models; and compares their strengths and weaknesses to provide a reference for clinicians in the individualized management and treatment of PVT in patients with liver cirrhosis.
[Research progress on brucellosis combined with liver injury].
Ibrahim D, Lu XB
Zhonghua Gan Zang Bing Za Zhi · 2025 Oct · PMID 41167773 · Full text
Liver injury, as one of the common clinical manifestations of brucellosis, presents a diversity of pathophysiological mechanisms, pathological manifestations, and clinical features, which may trigger severe organ dysfunc...
Liver injury, as one of the common clinical manifestations of brucellosis, presents a diversity of pathophysiological mechanisms, pathological manifestations, and clinical features, which may trigger severe organ dysfunction and poor prognostic conditions. This article systematically analyzes the research progress on brucellosis combined with liver injury at home and abroad, focusing on discussing its pathophysiological mechanism, pathological and clinical features, as well as prognostic outcomes, with the aim to provide a solid theoretical basis for the clinical diagnosis, therapeutic strategies, and prognostic management.
[Analysis of factors affecting fibrosis reversal in patients with metabolic associated steatohepatitis based on magnetic resonance elastography].
Zhang ZY, Sun CL, Ren H … +12 more , Yang DW, Zhao XY, Zhang MY, Han X, Zhao JJ, Wang QY, Sun YM, Zhao XY, Jia JD, Yang ZH, Tong XF, You H
Zhonghua Gan Zang Bing Za Zhi · 2025 Oct · PMID 41167772 · Full text
To dynamically assess liver fibrosis using magnetic resonance elastography (MRE) and explore factors associated with fibrosis reversal in patients with metabolic dysfunction-associated steatohepatitis (MASH). This study...
To dynamically assess liver fibrosis using magnetic resonance elastography (MRE) and explore factors associated with fibrosis reversal in patients with metabolic dysfunction-associated steatohepatitis (MASH). This study included data from patients diagnosed with MASH by liver biopsy who underwent at least two MRE examinations. Patients were divided into a fibrosis reversal group and a non-reversal group according to whether MRE values decreased by 20% during follow-up. Differences in clinical data between the groups were compared using analysis of variance, the Kruskal-Wallis test, and the chi-square test. Univariate and multivariate logistic regression analyses were used to explore independent risk factors for fibrosis reversal in MASH. A total of 46 cases were included in this study (mean age 50.1±12.3 years, BMI 26.1±3.1 kg/m²). Among them, the reversal group accounted for 26.1%. The rate of decrease in MRI proton density fat fraction (PDFF) was significantly higher in the reversal group (-50.0% vs. -8.1%, =0.001) than in the non-reversal group between the two MRE examinations. The reversal group showed a more significant change rate of decreases in fasting insulin (-37.3% vs. -3.6%, =0.011), insulin resistance index (-38.6% vs. -6.5%, =0.044), and ALP (-24.9% vs. 0, =0.004). Multivariate logistic regression analysis indicated that the rate of change in MRI PDFF was an independent predictor of fibrosis reversal (=0.96, 95% : 0.92-1.00, =0.046). A decrease in MRI proton density fat fraction levels is independently associated with liver fibrosis reversal in MASH, suggesting that intervention targeting liver fat content may be an effective treatment strategy.
[Predictive role of dynamic changes in liver stiffness measurement for liver-related endpoint events in chronic hepatitis B].
Sun CL, Chen SY, Wu XN … +8 more , Zhou JL, Meng TT, Wang BQ, Zhao XY, Ou XJ, Jia JD, Sun YM, You H
Zhonghua Gan Zang Bing Za Zhi · 2025 Oct · PMID 41167771 · Full text
To investigate the role of dynamic changes in liver stiffness measurement (LSM) in predicting liver-related end-point events (LREs) occurrence in patients with chronic hepatitis B (CHB) with liver fibrosis during long-te...
To investigate the role of dynamic changes in liver stiffness measurement (LSM) in predicting liver-related end-point events (LREs) occurrence in patients with chronic hepatitis B (CHB) with liver fibrosis during long-term antiviral therapy. Data were collected from CHB patients whose liver biopsy results showed Metavir fibrosis stage F2～F4 or clinically diagnosed cirrhosis. Entecavir antiviral therapy was mainly administered. Follow-up was conducted once every six months. Clinical data such as demographic information, blood routine tests, liver biochemical parameters, HBV virological and serological test results, and LSM were collected. Dynamic changes in LSM were categorized into four types based on LSM levels before treatment (0y) and following two years of antiviral therapy (2y) : (1) LSM < 10 kPa and LSM < 10 kPa, i.e., LSM persisted < 10 kPa; (2) LSM < 10 kPa and LSM ≥ 10 kPa, i.e., LSM increased to ≥ 10 kPa; (3) LSM ≥ 10 kPa and LSM < 10 kPa, i.e., LSM decreased to < 10 kPa; (4) LSM ≥ 10 kPa and LSM ≥ 10 kPa, i.e., LSM persisted ≥ 10 kPa. The predictive role of the dynamic changes of LSM in the occurrence of LREs was analyzed. The Wilcoxon rank-sum test was used for quantitative data. Fisher's exact test was used for categorical data. Multivariate analysis was performed using the Cox proportional hazards regression model. Survival curves were plotted and compared using the Kaplan-Meier. A total of 713 CHB cases with liver fibrosis were included, among whom 512 had cirrhosis. The cumulative incidence of LREs following two years of antiviral therapy was low in patients with LSM < 10 kPa during follow-up (all patients: LSM persisted < 10 kPa 1.6% vs. LSM increased to ≥ 10 kPa 0%; cirrhosis subgroup: LSM persisted < 10 kPa 0% vs. LSM increased to ≥ 10 kPa 0%). The 5-year cumulative incidence of LREs following two years of antiviral treatment was significantly higher in patients with LSM0y ≥ 10 kPa than in those with LSM persisting ≥ 10 kPa and those with LSM decreasing to < 10 kPa during follow-up (all patients: LSM persisted ≥ 10 kPa 12.4% vs. LSM decreased to < 10 kPa 3.6%; cirrhosis subgroup: LSM persisted ≥ 10 kPa 12.6% vs. LSM decreased to < 10 kPa 4.3%). Patients with LSM persisting at ≥ 10 kPa had a significantly increased risk of LREs following two years of antiviral treatment compared with those whose LSM decreased to <10 kPa during follow-up after adjusting for age, gender, baseline body mass index, platelet count, and alanine aminotransferase (all patients, aHR=2.96, 95% : 1.41～6.24, =0.005; cirrhosis subgroup, aHR=2.74, 95% :1.26～5.95, =0.011). LSM<10 kPa before antiviral treatment had a lower risk of liver-related endpoint events following two years of treatment among CHB patients with liver fibrosis. LSM ≥10 kPa before antiviral treatment and LSM persisted ≥10 kPa two years following treatment had a significantly higher occurrence risk of liver-related endpoints than LSM<10 kPa following treatment among CHB patients with liver fibrosis.
[Recommendations from the European Association for the Study of the Liver and the European Reference Network for Rare Liver Diseases Clinical Practice Guidelines for hepatolenticular degeneration].
Tang S, Hou W, Zheng SJ
Zhonghua Gan Zang Bing Za Zhi · 2025 Oct · PMID 41167770 · Full text
Wilson disease (WD), also known as hepatolenticular degeneration, is an autosomal recessive inherited disorder of copper metabolism that primarily affects the liver, brain, and other organs. The diagnostic criteria inclu...
Wilson disease (WD), also known as hepatolenticular degeneration, is an autosomal recessive inherited disorder of copper metabolism that primarily affects the liver, brain, and other organs. The diagnostic criteria include clinical features, biochemical tests (plasma ceruloplasmin, 24-hour urinary copper, liver copper content), and molecular genetic analysis. The Leipzig scoring system, supplemented by the use of exchangeable copper, is recommended for diagnosis. Pharmacotherapy mainly includes chelating agents (such as penicillamine and trientine) and zinc salts. Chelating agent therapy is recommended only for patients with severe liver disease. Patient monitoring is primarily based on clinical symptoms, liver biochemical indices, and copper metabolism parameters (such as 24-hour urinary copper and exchangeable copper) to identify poor adherence as well as over-treatment or under-treatment situations. The diagnosis and treatment of acute liver failure with WD is extremely challenging, as the diagnosis is difficult and medical treatment cannot save life. The role of liver transplantation has been clearly recognized in the treatment of acute liver failure with WD, and it may also be considered in cases with neurological involvement.
[Chinese expert consensus on clinical practice of chronic hepatitis B functional (clinical) cure].
Author Group of Expert Consensus
Zhonghua Gan Zang Bing Za Zhi · 2025 Oct · PMID 41167769 · Full text
Chronic hepatitis B functional (clinical) cure is currently an important therapeutic endpoint, which significantly reduces the incidence risk of cirrhosis and liver cancer. This expert consensus focuses on key clinical i...
Chronic hepatitis B functional (clinical) cure is currently an important therapeutic endpoint, which significantly reduces the incidence risk of cirrhosis and liver cancer. This expert consensus focuses on key clinical issues on the basis of previous studies, systematically elaborates population stratification and stepwise treatment strategies based on patient characteristics, consolidation therapy, relapse management, long-term monitoring after serum HBsAg clearance, and optimal management for patients who have not achieved the cure goal, and formulates suitable clinical guidance recommendations tailored to the characteristics of Chinese patients, providing scientific evidence and decision-making pathways so as to further standardize and guide the practice of functional (clinical) cure of chronic hepatitis B in China.
[Chinese guidelines for clinical diagnosis, treatment, and management of cirrhosis (2025)].
Chinese Society of Hepatology, Chinese Medical Association
Zhonghua Gan Zang Bing Za Zhi · 2025 Oct · PMID 41167768 · Full text
The Chinese Society of Hepatology of the Chinese Medical Association has invited experts in relevant fields to revise and rename the 2019 "Chinese guidelines on the management of liver cirrhosis" to "Chinese guidelines f...
The Chinese Society of Hepatology of the Chinese Medical Association has invited experts in relevant fields to revise and rename the 2019 "Chinese guidelines on the management of liver cirrhosis" to "Chinese guidelines for clinical diagnosis, treatment, and management of cirrhosis (2025)". The guidelines put forward the recommendations for the clinical diagnosis and management of cirrhosis in the compensation, decompensation, and re-compensation stages, as well as for cirrhosis reversal and related complications.
[How far has non-invasive testing become a surrogate endpoint for the research and development of new drugs for metabolic dysfunction-associated steatohepatitis?].
Sun YM, You H
Zhonghua Gan Zang Bing Za Zhi · 2025 Oct · PMID 41167767 · Full text
The research and development of new drugs for metabolic dysfunction-associated steatohepatitis still leads to a high screening failure rate and low efficiency with the repeated liver biopsy as the primary endpoint. Curre...
The research and development of new drugs for metabolic dysfunction-associated steatohepatitis still leads to a high screening failure rate and low efficiency with the repeated liver biopsy as the primary endpoint. Currently, non-invasive testing has been widely used in early-stage efficacy evaluation and patient screening, and evidence of association with clinical outcomes has gradually been established, and a number of new non-invasive scoring systems are also emerging. With the accumulation of data and the improvement of standards, the research and development of new drugs for metabolic dysfunction-associated steatohepatitis is gradually moving from the "histological era" to the "non-invasive era," which is expected to profoundly change clinical trials and disease management strategies.
[The partial cure represents an intermediate endpoint on the path to a functional cure, not an ideal endpoint].
Zhuang H
Zhonghua Gan Zang Bing Za Zhi · 2025 Oct · PMID 41167766 · Full text
A partial cure, defined as HBsAg <100 IU/mL and HBV DNA below the lower limit of quantification (i.e., <10 IU/mL) at 24 weeks off-treatment, is an intermediate endpoint on the pathway to a functional cure, not a realisti...
A partial cure, defined as HBsAg <100 IU/mL and HBV DNA below the lower limit of quantification (i.e., <10 IU/mL) at 24 weeks off-treatment, is an intermediate endpoint on the pathway to a functional cure, not a realistic goal. Patient with chronic hepatitis B achieved a partial cure have good outcomes. qHBsAg in combination with HBV RNA, hepatitis B core related antigen, LHBs, MHBs and qAnti-HBc may predict virological and clinical relapses of patients with a partial cure. The patients achieved partial cure should be monitored closely. Retreatment is necessary for patients who experience a virus-dominated hepatic flare after discontinuation of therapy, whereas it is not for those with a host-dominated flare.
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