A Case Report of Modified Pancreatic Transplantation With a Limited Splenic Arteriovenous Fistula to Elude Thrombosis.

In classic pancreatic transplantation, the splenic artery and vein are ligated at the tail of the pancreas graft. This leads to slowed blood flow in the splenic vein and may cause thrombosis and graft loss. In this study, a patient received a pancreas after kidney transplantation. A modified surgical technique was used in the pancreatic graft preparation. The donor splenic artery and vein were anastomosed end to end at the tail of the pancreas. The splenic artery near the anastomosis was partially ligated, and an effective diameter of 2 mm was reserved to limit arterial blood pressure and flow. The patient recovered very well. Contrasted computed tomography scans on days 11 and 88 after pancreas transplantation indicated sufficient backflow of the splenic vein. We believe that this procedure may avoid the risk of splenic vein thrombosis after pancreas transplantation. This modified technique has not been reported in clinical cases previously and may help reduce the risk of thrombosis after pancreas transplantation.

Noninvasive Assessment of Interstitial Fibrosis and Tubular Atrophy in Renal Transplant by Combining Point-Shear Wave Elastography and Estimated Glomerular Filtration Rate.

The purpose of this study was to evaluate the feasibility of the combination of point-shear wave elastography (p-SWE) and estimated glomerular filtration rate (eGFR) for assessing different stages of interstitial fibrosis and tubular atrophy (IF/TA) in patients with chronic renal allograft dysfunction (CAD). From September 2020 to August 2021, 47 patients who underwent renal biopsy and p-SWE examinations were consecutively enrolled in this study. The areas under the receiver operating characteristic curves (AUCs) were calculated to evaluate overall accuracy and to identify the optimal cutoff values for different IF/TA stages. A total of 43 patients were enrolled in this study. The renal cortical stiffness and eGFR showed a significant difference between IF/TA Grade 0-1 and Grade 2-3 (p < 0.001). Additionally, renal stiffness and eGFR were independent predictors for moderate-to-severe IF/TA (Grade ≥ 2) according to multiple logistic regression analysis. The combination of p-SWE and eGFR, with an optimal cutoff value of -1.63, was superior to eGFR alone in assessing moderate-to-severe interstitial fibrosis (AUC, 0.86 vs. 0.72, p = 0.02) or tubular atrophy (AUC, 0.88 vs. 0.74, p = 0.02). There was no difference between p-SWE and eGFR in assessing moderate-to-severe IF/TA (AUC, 0.85 vs. 0.79, p = 0.61). Therefore, combining p-SWE and eGFR is worthy of clinical popularization and application.

Factors Influencing Health-Related Quality of Life of Living-Donor Kidney Transplant Recipients: A Population-Based Study.

OBJECTIVES: Our objective was to explore factors influencing health-related quality of life in living-donor kidney transplant recipients. MATERIALS AND METHODS: A total of 140 kidney transplant recipients, enrolled between December 2014 and April 2015, were administered questionnaires on medical outcomes, 36-item Short Form Health Survey, medical coping modes, cognitive appraisal of health scale, and adverse effects of medications. Path analysis was employed to verify the hypothesized model. RESULTS: Increased serum creatinine level and high economic burden had direct positive effects on negative appraisal (ß = 0.18, P < .05 and ß = 0.46, P < .01). Adverse effects of medication had direct positive effects on confrontation; whereas negative appraisal had direct positive effect on acceptance-resignation (ß = 0.21, P < .05) and direct negative effect on physical component summary (ß = -0.43, P < .001) and mental component summary (ß = -0.51, P < .001). In addition, confrontation directly affected mental component summary (ß = -0.15, P < .05). The enrolled variables accounted for 25.0% of physical component summary variance and 35.4% of mental component summary variance. CONCLUSIONS: In this study, economic burden, serum creatinine levels, and adverse effects of immunosuppressive therapy were the key external factors, whereas patients' cognitive appraisal and coping strategies were the main internal factors affecting patients' health-related quality of life. Medical care providers attending to transplant recipients should be able to identify patients developing negative coping strategies in response to stressors and plan individualized counseling programs for these patients.

Pilot feasibility research of Chinese version of kidney transplant questionnaire in recipients of living donor kidney transplantation.

OBJECTIVE: To explore the feasibility of the Chinese version of Kidney Transplant Questionnaire (KTQ) by evaluating the health-related quality of life (HRQoL) in Chinese recipients of living donor kidney transplantation. METHODS: The English version of KTQ was translated into Chinese and underwent cultural adaptation to obtain the Chinese version of KTQ. HRQoL of 136 Chinese recipients of living donor kidney transplantation that met the inclusion criteria were evaluated to assess the validity and reliability of the questionnaire. RESULTS: One hundred and thirty-six recipients (98 males and 38 females) of living donor kidney transplantation were included. The mean age of the recipients was 43.91 years. For each dimension of the questionnaire, the Cronbach's alpha coefficient was 0.7-0.9, test-retest reliability coefficient ≥0.7, goodness of fit index (GFI) >0.9, and comparative fitness index (CFI) >0.9. CONCLUSION: The validity and reliability of the Chinese version of KTQ is similar to the English version, suggesting that the Chinese version of KTQ could be applied as a disease-specific questionnaire to evaluate the HRQoL of the recipients of living donor kidney transplantation in China.

[Cryopreserved iliac vein for reconstruction of middle hepatic vein in living donor right liver transplantation].

OBJECTIVE: To summarize the experience of living donor liver transplantation using cryopreserved iliac vein for middle hepatic vein reconstruction. METHODS: Between July 2006 and June 2009, right liver transplantation without middle hepatic vein was performed in 37 cases of 85 patients undergoing living donor liver transplantation; of 37 cases, 30 received middle hepatic vein reconstruction using cryopreserved iliac vein. There were 27 males and 3 females, aged from 10 to 57 years (median, 44 years). Thirty cases included 11 hepatocellular carcinoma, 10 hepatic cirrhosis, 2 Wilson's disease, 1 cholangiocarcinoma, 1 hepatoblastoma, 1 congenital hepatic fibrosis, 1 chronic severe hepatitis, and 1 congenital biliary atresia. Iliac veins harvested from donors were put into 0-4 degrees C mixed antibiotics saline and transported to the operating room. The iliac veins were trimmed, placed into sterile bags (containing RMPI 1640 + 20% DMSO + 10% calf protein solution) and frozen at -70 degrees C. In living donor liver transplantation process, the veins were melt and used for middle hepatic vein reconstruction. After operation, the patency of veins was monitored by regular Doppler ultrasound examination or enhanced CT for 3 months. RESULTS: In 30 patients, 30 iliac veins were used. The average cryopreserve time was 14 days (range, 3-44 days). Anastomosis were all successful; after cryopreservation, the blood vessels texture and elasticity were fit for surgery. No easily tearing or severe suture bleeding was observed. In 30 patients, 6 had segment V veins reconstruction; 3 had segment VIII; and 21 had both segments V and VIII. The patency rate of reconstructed vessels was 93% at 1 week, 90% at 2 weeks, 90% at 1 month, and 67% at 3 months. No serious complication was observed in donors. The prognosis was good with no small-for-size syndrome. CONCLUSION: Cryopreserved iliac vein is an ideal material for the right hepatic living donor liver transplantation in the reconstruction of middle hepatic vein.

[Liver transplantation for the treatment of hepatocellular carcinoma].

OBJECTIVE: To retrospectively evaluate the clinical outcomes of liver transplantation for patients with hepatocellular carcinoma (HCC). METHODS: The clinical data of 88 consecutive HCC patients who underwent orthotopic liver transplantation between 2002. 4 and 2004. 7 were retrospectively reviewed. HCC stage of those patients were defined according to the pTNM classification system of UICC. All patients were followed up for more than 12 months after liver transplantation. The recurrence and overall survival rate were evaluated by univariate and multivariate analysis with SAS software. RESULTS: The cumulative 1-year recurrence rate of stage I, II, III and IV after liver transplantation was 0%, 4.8%, 40.0% and 71.3%, respectively (P < 0.01). The cumulative 1-year overall survival rate of stage I, II, III and IV was 100%, 95.2%, 71.5% and 41.7%, respectively (P < 0.01). CONCLUSION: Liver transplantation may be suitable for stage I or II hepatocellular cancer patients and improve their prognosis, while it is not suitable for stage IV HCC patients.

[Application of sleeve anastomosis in development of cervical heart transplantation in rats].

OBJECTIVE: To simplify surgical technique and increase postoperative survival rate, sleeve anastomosis technique combined cuff technique was used in developing the model of cervical heart transplantation in rats. METHODS: In this model, the hearts from 25 male SD rats were transplanted into the neck of Wistar rats by anastomosing the donor innominate artery to the recipient right common carotid artery by use of sleeve technique, and the donor pulmonary artery to the recipient right external jugular vein by use of cuff technique. After operation, the rats were treated with cyclosporine A (1.5 mg/kg, q.d.), transplanted hearts were followed by daily inspection or palpation and the allograft survival time was more than 3 days as the standard of successful operation. RESULTS: The mean operative time was (48.7 +/- 3.4) min, with a successful rate of 88% (22/25). Complications were anastomotic hemorrhage (1 case) and thrombosis(2 cases). During the follow-up period, 6 rats died of pulmonary infection, abscess in the neck, liver or bladder tumor. The remaining 16 transplanted hearts survived more than 3 months. CONCLUSION: The modified operation have advantages of less operative procedure, shorter operation and ischemia time and easier monitoring of graft function.