Liver transplantation has been widely accepted as an effective treatment method for various types of irreversible acute and chronic liver diseases. After decades of steady and sustained development,liver transplantation techniques gradually become mature and stable. At present,all major transplantation centers in China can complete liver transplantation with various techniques,but there are still the problems of unbalanced development and uneven technical levels. In order to further standardize the operation of adult liver transplantation in China,Chinese Society of Organ Transplantation,Chinese Medical Association,organized liver transplantation experts to summarize the latest research advances in China and foreign countries and develop Operation standards for liver transplantation in China(version 2019) with reference to international guidelines and clinical practice,with a focus on the standardized operations for donor liver repair,diseased liver resection,donor liver implantation,and re-liver transplantation.

Liver transplantation has been widely accepted as an effective treatment method for various types of irreversible acute and chronic liver diseases. After decades of steady and sustained development,liver transplantation techniques gradually become mature. With the development of liver transplantation techniques,the application of new immunosuppressants,and the improvement in perioperative management,the indications and contraindications of liver transplantation are also changing. Detailed preoperative examination and preparation is an important link to ensure the prognosis of liver transplantation. In order to further standardize the selection and preoperative evaluation and preparation of liver transplantation recipients in China,Chinese Society of Organ Transplantation,Chinese Medical Association,organized liver transplantation experts to summarize the latest research advances in China and foreign countries to develop Technical specifications for selection and preoperative evaluation of liver transplantation recipients in China(version 2019) with reference to international guidelines and clinical practice,from the aspects of indications and contraindications of liver transplantation,preoperative examination of recipients,preoperative preparation,and treatment of common complications.

Objective To investigate the role of hepatitis E virus nucleic acid(HEV RNA),hepatitis E virus antigen(HEV Ag),hepatitis E virus antibodies(HEV IgM antibody and HEV IgG antibody) in the clinical diagnosis of hepatitis E virus infection. Methods A total of13 992 specimens,for which the detection of HEV IgM antibody and HEV IgG antibody were performed in Peking University People's Hospital,were collected,among which 1924 had positive HEV IgM antibody or HEV IgG antibody. Quantitative real-time PCR was used to determine HEV RNA and HEV genotype,and enzyme-linked immunosorbent assay was used to detect HEV Ag,HEV IgM antibody,and HEV IgG antibody and measure the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),and direct bilirubin(DBil). The non-parametric rank sum Mann-Whitney U test was used for comparison of continuous data between groups. Results Among the 1924 specimens with positive HEV IgM antibody or HEV IgG antibody,152(7. 9%) had positive HEV IgM antibody,1897(98. 6%) had positive HEV IgG antibody,62(3. 2%) had positive HEV RNA,and 55(2. 9%) had positive HEV Ag. Among the 152 specimens with positive HEV IgM antibody,62(40. 8%) had positive HEV RNA,and 55(36. 2%) had positive HEV Ag,and among the 62 specimens with positive HEV RNA,55(88. 7%) had positive HEV Ag. The HEV RNA-positive group with 62 specimens had significantly higher levels of ALT,AST,TBil,and DBil than the HEV RNA-negative group with 90 specimens(Z =-7. 609,-6. 942,-5. 815,and-6. 130,all P < 0. 001),and the HEV Ag-positive group with 55 specimens had significantly higher levels of ALT,AST,TBil,and DBil than the HEV Ag-negative group with 97 specimens(Z =-6. 413,-5. 786,-5. 199,and-5. 545,all P < 0. 001). Nested PCR amplification and sequencing showed that in the HEV RNA-positive group with 62 specimens,58 had positive HEV RNA and 4 had negative HEV RNA. The high level of positive HEV IgG antibody significantly reduced the S/CO value of HEV Ag detection and even yielded a negative result.Conclusion Compared with HEV antibodies,HEV Ag can improve the diagnostic level of hepatitis E and has certain clinical significance.High levels of aminotransferases or bilirubin can help with the diagnosis of hepatitis E. The high level of HEV IgG antibody may reduce the detection value of HEV Ag,and attention should be paid to HEV IgG antibody value when HEV Ag is negative.

Neutrophil extracellular traps(NETs) have recently been found to be a new immune mechanism for neutrophils to kill pathogens.The main component of NETs is DNA,with granular proteins of different sizes attached to the surface. NETs play different roles in various liver diseases such as hepatic ischemia-reperfusion injury,chronic hepatitis B,liver cirrhosis,and liver cancer. This article reviews the formation mechanism,structure,and role of NETs in liver diseases.

Hepatic stellate cells(HSCs) are an important target for the treatment of liver fibrosis. Safe and effective targeted delivery of therapeutic agents to HSCs,improvement of drug therapeutic effect,and reduction of toxic and side effects of off-target drugs are important measures for the development of anti-liver fibrosis drugs. A number of protein markers are elevated in activated HSCs,and thus their ligands are used for the specific delivery of anti-fibrotic drugs. This article summarizes the research advances in the treatment of liver fibrosis by targeting HSCs from the aspects of the type of drug carriers and target receptors.

Portopulmonary hypertension(POPH) refers to the increase in pulmonary artery pressure on the basis of portal hypertension,which may lead to progressive right ventricular failure and death with disease progression. POPH has a low incidence rate and is often neglected by clinicians due to a lack of symptoms or the presence of non-specific symptoms in the early stage. This article summarizes the research advances in the pathogenesis,diagnosis,and treatment of POPH in recent years,introduces the noninvasive detection methods currently available for POPH diagnosis,and explores the selection of appropriate treatment methods based on the severity and individualized conditions of patients with POPH,so as to improve the understanding of this disease among clinicians.

Hepatolenticular degeneration(HLD) is an autosomal recessive liver disease associated with copper metabolism disorders. Mutations in the ATP7 B gene on chromosome 13 result in impaired transmembrane transport of copper ions,which in turn leads to excessive deposition of copper in the liver,brain,cornea,kidney,and bone joints(mainly in the liver and the brain). Early diagnosis and treatment can significantly reduce tissue damage and improve the prognosis of patients. American Association for the Study of Liver Diseases issued the guidelines for the diagnosis and treatment of HLD in 2008,and the European Association for the Study of the Liver released such guidelines in 2012. This article summarizes the recent research advances in China and foreign countries to give an overview of the treatment of HLD.

Primary biliary cholangitis(PBC) is a cholestatic liver disease with unclear etiology and pathogenesis. Ursodeoxycholic acid and obeticholic acid are the therapeutic drugs for PBC approved by the US Food and Drug Administration,both of which have the effect of alleviating intrahepatic cholestasis. However,some patients still have poor biochemical response to them,and it is urgent to explore new therapeutic drugs or methods. Fibrates,immunosuppressants,and traditional Chinese medicine have a certain effect in the treatment of patients with PBC,but further studies are needed to analyze their clinical safety and mechanism of action.

Acute pancreatitis is a local pancreatic and systemic inflammatory disease due to various living and environmental factors,such as alcohol,gallstones,high lipids,and smoking,and its pathogenesis remains unclear. Studies have shown that epigenetic regulation mechanisms,such as DNA methylation,histone modification,and non-coding RNA,play an important role in the development and progression of acute pancreatitis. This article introduces the association between the common causes of acute pancreatitis(including alcohol,gallstones,high lipids,and smoking) and epigenetic regulation mechanisms,as well as the association between inflammatory response and epigenetic regulation mechanisms. The preliminary exploration of epigenetic regulation mechanisms in acute pancreatitis provides new thoughts for further understanding the development,progression,and treatment of acute pancreatitis.