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To increase the utilization rate of expanded criteria donor (ECD) kidney, the kidney preservation methods have been ever advancing in recent years. The application of normothermic machine perfusion (NMP) promotes the preservation, evaluation and repair of ex vivo donor kidneys and accelerates the innovation of surgical approaches of kidney transplantation. Ischemia-free kidney transplantation (IFKT), which initiated by Organ Transplantation Center of the First Affiliated Hospital of Sun Yat-sen University, keeps the blood flow and oxygen supply of the donor kidney with NMP machine during the entire process of acquisition, preservation and transplantation, thereby fundamentally avoiding ischemia-reperfusion injury (IRI) of the donor kidney and reducing the risk of delayed graft function (DGF) and acute rejection after surgery. In this article, recent progresses upon the kidney NMP, surgical procedures and short-term outcomes of IFKT were reviewed, aiming to provide reference for enhancing the utilization rate of ECD donor kidney and resolving the issue of organ shortage.
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Objective:To explore the long-term preservation value and repair effect of normothermic machine perfusion (NMP) on clinically discarded kidneys.Methods:A case of clinical discarded donor kidney was collected, and NMP was carried out in vitro for 9 hours with recovered blood. The dynamic changes of renal appearance, blood gas and biochemistry analysis of perfusate and renal pathology were recorded. Results:In the second to fifth hour of NMP, the appearance of renal was pink and ex vivo normothermic perfusion assessment score (EVNP) was grade Ⅰ. While, the sixth hour and beyond of NMP, the appearance of kidney turned to dark red and EVNP was grade Ⅲ. The renal perfusion blood flow maintained above 150 ml/min in the first 6 hours and decreased significantly after that, and at the end, was only 50 ml/min. During the whole process of perfusion, urine output was maintained at about 100 ml/h. PO 2 remained above 100 mmHg in the first 5 hours of perfusion and from the 6th hour, was lower than 80 mmHg and continued to decline, and was close to 0 at the end of perfusion. The results showed that although the K + concentration changes in blood and urine in the first 5 hours of NMP had a good consistency, the lactic acid level had been rising. In addition, there was no significant change in the histopathology at the fourth hour of perfusion compared with that before zero-point puncture, and the fibrinous thrombus in glomeruli was improved compared with that before perfusion. However, at the sixth hour after perfusion and before the end of perfusion, the pathological changes of renal tissue were significantly worse. There were a large of thrombosis in glomerular blood vessels, renal tubular atrophy and acute tubular necrosis. Conclusions:NMP can realize the evaluation of extended criteria donors before transplantation, and it proves the feasibility and repair potential of NMP in kidney to a certain extent. At the same time, NMP also provides a new way to expand the source of donor kidney and to pre-treat organ in vitro.
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Objective To establish and evaluate a novel and non-invasive diagnostic model using routine laboratory serological indexes in cirrhotic patients.Methods A retrospective study was conducted on 1044 consecutive patients with hepatocellular carcinoma (HCC) treated by hepatectomy in the Affiliated Tumor Hospital of Guangxi Medical University from September 2013 to December 2016.These patients were divided into a training cohort (n =783) and a validation cohort (n =261) using the 3 ∶ 1 matching principle.Logistic regression analysis was used to identify independent risk factors related to occurrence of cirrhosis in the training cohort,and then a PPH score was established.The accuracy of the model in predicting cirrhosis in two groups was evaluated respectively by the area under the receiver operating characteristic curve (AUC) and goodness of fit,and compared with the following commonly used predictive systems:the model for endstage liver disease (MELD) score,fibrosis index based on 4 factor score (FIB-4),Forns score and aspartate aminotransferase to platelet ratio index score (APRI).Results Univariate and multivariate Logistic regression analysis in the training cohort showed prothrombin time,platelet count and hepatitis B surface antigen positivity were closely related to occurrence of cirrhosis.The accuracy of the PPH score (AUC =0.705) in diagnosing cirrhosis in the training cohort was significantly better than the MELD score (AUC =0.557),APRI score (AUC =0.598),FIB-4 score (AUC =0.597) and Forns score (AUC =0.665).Similar results were obtained in the validation cohort (AUC:0.702 vs 0.554 vs 0.624 vs 0.634 vs 0.580).The goodness of fit indicated that there was no significant difference between the actual and predicted values of cirrhosis in the two cohorts,and the model was in good agreement.Conclusions A novel and non-invasive model for the diagnosis of cirrhosis was successfully established.The accuracy of this model in diagnosing cirrhosis was better than the MELD,APRI,Fib-4 and Forns scores.This model has significance in guiding clinical treatment decision in HCC patients with cirrhosis.
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Objective To study the value of serum prealbumin-bilirubin score (PALBI) in predicting posthepatectomy liver failure (PHLF) for patients with HBV related hepatocellular carcinoma (HCC).Methods A retrospective study was conducted on 919 HBV-related HCC patients who underwent hepatectomy from September 2013 to December 2016 at the Affiliated Tumor Hospital of Guangxi Medical University.These patients were divided into a training cohort (n =689) and a validation cohort (n =230) using the 3 ∶ 1 matching principle.The training cohort was divided into the control group (n=546) and the PHLF group (n=143) according to whether PHLF occurred.The multivariate logistic regression model was used to analyze the factors related to PHLF in the training cohort,and then the PALBI score was established.The ability of the PALBI score to predict PHLF was evaluated by the area under the receiver operating characteristic curve (AUC) and compared with the Child-Pugh,model for end-stage liver disease (MELD),and albumin-bilirubin (ALBI) scores.Results Univariate and multivariate logistic regression analyses showed the factors including HBV-DNA≥ 103 IU/ml,total bilirubin,prealbumin,platelet count,AST,prothrombin time,intraoperative blood loss ≥400 ml and major liver resection were closely related to PHLF.The ability of the PALBI score (AUC =0.733) to predict PHLF preoperatively was superior to the ChildPugh score (AUC =0.562),the MELD score (AUC =0.652) and the ALBI score (AUC =0.683) in the entire training cohort.Similar results were obtained in the entire validation cohort (AUC:0.752 vs.0.599 vs.0.641 vs.0.678).To eliminate the effect of a small residual liver volume on PHLF,the ability of each of these scores in the training and validation cohorts to predict PHLF was calculated respectively in these 2 cohorts of patients who underwent only minor liver resection,and similar results were obtained.Conclusion The PALBI score was significantly superior to the Child-Pugh,MELD and ALBI scores in predicting PHLF in patients with HBV-related HCC who underwent liver resection.The PALBI score is a simple,non-invasive and reliable novel model in predicting PHLF.
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Objective To study the effect of psychological intervention combined with the analysis of Budesonide and Formoterol Fumarate Powder for Inhalation in treatment of chronic obstructive pulmonary disease. Methods 100 patients with chronic obstructive pulmonary disease treated in our hospital from February 2015 to March 2016 were selected and randomly divided into the control group and the experimental group, with 50 patients in each group. The control group was treated with the Budesonide and Formoterol Fumarate Powder for Inhalation treatment,the experimental group on the basis of psychological intervention on the mental status of patients and patients,strengthen communication and exchanges, increase confidence in the treatment and the treatment compliance of patients. Results After treatment, the SGRQ score of the experimental group was (57.33±16.81), and the score of the control group was (43.86±12.68) points, with statistical difference (P<0.05). The scores of depression and anxiety in the experimental group were significantly better than those in the control group,with statistical difference(P<0.05). Conclusion Budesonide and Formoterol Fumarate Powder for Inhalation combined with mental intervention in the treatment of chronic obstructive pulmonary disease can significantly improve the patients, improve the quality of life, help patients recover as soon as possible, has clinical significance.