Research progress on the role of exosome in rejection after lung transplantation / 器官移植

Rejection after lung transplantation, including acute rejection (AR) and chronic rejection manifested with chronic lung allograft dysfunction (CLAD), is the main factor affecting the long-term survival of allografts. Exosome, a type of extracellular nanovesicle for intercellular communication among eukaryotic cells, could carry complex biological information and participate in various physiological and pathological processes. Exosome has become a critical immune medium in rejection, regulates the incidence and development of rejection through multiple pathways, and also plays a key role in the monitoring and management of rejection. In this article, the type of rejection after lung transplantation, the mechanism underlying the role of exosome in regulating rejection, exosome acting as biomarkers and the application in rejection treatment were reviewed, aiming to provide a novel direction for comprehensive diagnosis and treatment of rejection following lung transplantation.

Clinical research progress on pediatric lung transplantation / 器官移植

Lung transplantation is an efficacious treatment for end-stage lung diseases in children. Shortage of donor lungs, poor donor-recipient matching, difficult postoperative management, multiple postoperative complications and high fatality jointly restrict the development of pediatric lung transplantation. However, significant progress has been achieved in each transplantation center along with the popularization of organ donation after citizen' s death, advancement of medical science and technology and accumulation of lung transplantation experience. In recent years, clinical application of donor lung from donation after brain death and marginal donor lung repair, maturity of perioperative life support technology and surgical transplantation procedure and reference of management experience after adult lung transplantation have accelerated rapid development of pediatric lung transplantation. In this article, current status and progress on primary diseases, utilization and allocation of donor lungs, selection of surgical techniques, management of postoperative complications and clinical prognosis of pediatric lung transplantation were elucidated, aiming to provide reference for clinical diagnosis and treatment.

Risk factors analysis of central airway stenosis after lung transplantation / 器官移植

Objective To investigate the risk factors of central airway stenosis after lung transplantation. Methods Clinical data of 155 recipients undergoing lung transplantation in Wuxi People's Hospital Affiliated to Nanjing Medical University from July 2016 to December 2017 were retrospectively analyzed. According to the incidence of central airway stenosis following lung transplantation, all recipients were divided into the stenosis group (n=36) and control group (n=119). The incidence of central airway stenosis after lung transplantation was summarized. The risk factors of central airway stenosis after lung transplantation were assessed by univariate and multivariate logistic regression analyses. Results Among 155 lung transplant recipients, 36 cases (23.2%) developed central airway stenosis. The average incidence time was (53±13) d after lung transplantation. Univariate analysis demonstrated that bilateral lung transplantation, grade 3 primary graft dysfunction (PGD), airway fungal infection, long cold ischemia time, long mechanical ventilation time and long intensive care unit (ICU) stay were the risk factors for central airway stenosis after lung transplantation (all P < 0.05). Multivariate analysis showed that airway fungal infection, long cold ischemia time and long mechanical ventilation time were the independent risk factors for central airway stenosis after lung transplantation (all P < 0.05). Conclusions Airway fungal infection after lung transplantation, long cold ischemia time and long mechanical ventilation time probably lead to central airway stenosis after lung transplantation. Active preventive measures and intimate monitoring should be taken to improve the quality of life of the recipients after lung transplantation.

Research progress on posttransplant lymphoproliferative disease after lung transplantation / 器官移植

Posttransplant lymphoproliferative disease (PTLD) is a fatal complication after lung transplantation, which is intimately associated with age, immunosuppression level and Epstein-Barr virus (EBV) infection, etc. Reducing immunosuppression level, rituximab therapy and T cell immunotherapy are common treatments for PTLD. With the rapid development of lung transplantation in China, PTLD after lung transplantation has attracted widespread attention. This article reviews the risk factors, pathological types, clinical manifestations, diagnosis, treatment, prognosis and prevention of PTLD after lung transplantation, aiming to provide reference for early monitoring and management of the incidence and progression of PTLD.

Multi-disciplinary team of the treatment of bilateral lung transplantation for pediatric cystic fibrosis / 器官移植

Objective To improve the surgical efficacy of bilateral lung transplantation for pediatric cystic fibrosis through multi-disciplinary team (MDT). Methods Preoperative MDT consultation was delivered for a 10-year-old child with rare end-stage cystic fibrosis to establish the corresponding treatment protocol. Results The child was diagnosed with cystic fibrosis for 5 years, and the indication of lung transplantation were confirmed. After preoperative MDT consultation, bilateral lung transplantation via a Clam-shell incision was determined. The vital signs were maintained stable during operation. Postoperatively, ventilator-assisted ventilation, anti-infection, immunosuppression, acid suppression, prevention of stress ulceration and other treatments were delivered. Individualized treatment was given according to the characteristics of the child, and the child was well recovered. Conclusions Through preoperative MDT consultation, lung transplantation yields satisfactory surgical efficacy in treating pediatric cystic fibrosis and lowers the risk of postoperative complications, which deserves application in clinical practice.

Discussion on Management of Epidemic Prevention Consumables in Response to COVID-19 in Our Hospital / 中国医疗器械杂志

Compared with normal medical consumables, the management of epidemic prevention consumables in response to COVID-19 is special. Based on the practical management experience of a hospital in Shanghai, this article expounds through various aspects such as classified protection requirements, interpretation of domestic and foreign standards for epidemic prevention consumables, targeted use countermeasures, material supply of Hubei medical teams, and the management of inbound and outbound of epidemic prevention consumables, covering the whole process of epidemic prevention consumables management. The purpose of this paper is to provide ideas and references for the management of epidemic prevention materials.

Influence factors cause prolonged ICU stay in cardiac rupture patients after operations / 中华急诊医学杂志

Objective To investigate the influence factors on length of ICU stay in cardiac rupture patients after surgical repair.Methods A retrospective study was conducted and enrolled survived cardiac rupture patients admitted to ICU of Wuxi People's Hospital from January 2009 to January 2017.Clinical data of patients were recorded including age,causes,complications,blood transfusion,duration of mechanical ventilation,duration of vasoactive agent employment,and length of ICU stay.At the same time,the laboratory findings were documented including hemoglobin(Hb),hematocrit (Hot),serum creatinine,blood lactic acid and creatine kinase muscle b(CK-MB).Patients were divided into two groups according to length of ICU stay(A group ＞3 d,B group ≤ 3 d).Data were analyzed using SPSS20.0 and MedCalc software.Pearson correlation test and ROC curve were taken to analyze the predicting factors for the prognosis.Results Twenty-two patients were referred to ICU after operation and survived.The length of ICU stay varied from 2 to 12 d.The statistical analysis showed the levels of Hb and Hct in group A were lower than those in group B (P＜0.05);the levels of CK-MB and lactic acid in group A were higher than those in group B (P＜0.05);and larger volume of blood transfusion (P=0.002),higher complications (P=0.024),longer duration of mechanical ventilation (P=0.001) and longer duration of vasopressor application (P=0.003) were found in group A.Pearson correlation test showed Hb and Hct had negative correlation with duration of mechanical ventilation,duration of vasoactive agent application and length of ICU stay (P＜0.05),whereas the CK-MB and lactic acid had positive correlation with duration of mechanical ventilation,duration of vasoactive agent employment and length of ICU stay (P＜0.05).ROC curve showed lactic acid,Hct,and CK-MB all had significance in prediction of prolonged ICU stay,and there were no statistically significant differences in areas under the curve(AUC) among these three biomarkers (P＞0.05).With the employment of ROC curve,the optimal cut-off points of three biomarkers for clinical diagnosis were lactic acid ≥ 3.4 mmol/L,Hct ≤ 39％,CK-MB ≥ 58 U/L.Conclusion Hb,Hct,lactic acid,CK-MB,blood transfusion,complications,duration of mechanical ventilation,duration of vasoactive agent employment were factors influencing on length of ICU stay in cardiac rupture patients after operations.The levels of lactic acid,Hct,and CK-MB had significance in prediction of prolonged ICU stay.

Influence of pulmonary hypertension on patients with advanced chronic obstrnctive pulmonary disease prior to lung transplantation / 中华器官移植杂志

Objective To study the influence of pulmonary artery hypertension (PAH) on survival of patients with advanced chronic obstructive pulmonary disease (COPD) on the waiting list of lung transplantation.Methods The characteristics of 143 patients with COPD receiving lung transplantation evaluation from January 2014 to August 2016 were queried.Mild PAH was defined as mean pulmonary artery pressure (mPAP) ≥25 mmHg and severe ≥35 mrnHg by right heart catheterization measurements.The incidence of PAH was studied,and the patients were divided to different groups to determine the effect of PAH on survival prior to transplantation on the basis of different definitions of PAH.Kaplan Meier method was used to draw survival curves,and a log-rank test was used to analyze the effect of PAH on survival of COPD patients on the waiting list of pulmonary transplantation.Univariate and multivariate Cox proportional hazard models were performed to test the relationship between each main covariate and the hazard of mortality.The waiting time was tracked from wait list entry date until death or censoring,and the censoring issues were as follows:receiving lung transplantation,removing from the waiting list without transplant,and still wating for donor until the last follow-up day (2016-08-30).Results Of 143 COPD patients,there were 119 males and 24 males,with mean age of 61.73 years old;46 patients received lung transplantation,and the remaining 97 not;50 had mPAP ≥25 mmHg and 21 had mPAP ≥35 mmHg.A total of 23 cases (22.88％) died on the waiting list.Thirty-eight patients were removed from the list prior to transplantation,and 36 were still on the waiting list.Kaplan-Meier survival function showed suvival of patients with mild PAH or severe PAH was significantly shorter than that of patients without PAH (P＜0.001).Using Cox proportional hazards models,univariate analysis revealed significant differences in survival for mild PAH (HR =2.147,95％CI 1.429-3.157,P＜ 0.001) and severe PAH (HR =3.458,95 ％ CI 2.518-4.859,P＜0.001).Multivariate Cox models identified significant risk for death for mild PAH (HR=2.518,95％CI 1.728-3.364,P＜0.001) and severePAH HR=4.027,95％ CI 3.257-4.703,P＜0.001).Conclusion The incidence of PAH among COPD patients waiting for lung transplantation was high.PAH is associated with significantly increased risk of death among COPD patients waiting for lung transplantation.

Extracorporeal membrane oxygenation as a bridge to lung transplantation / 中华危重病急救医学

Objective To evaluate the effect of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (LTx). Methods The clinical data of 18 patients with end-stage lung diseases was retrospectively reviewed, using ECMO as a bridge to LTx in intensive care unit of Affiliated Wuxi People's Hospital from January 2015 to December 2017. Clinical parameters were obtained from these patients, including gender, age, primary disease, preoperative lactate level, preoperative leukocyte, operation modality (unilateral or bilateral), type of ECMO, ECMO support time as a bridge to LTx, ECMO support time after operation, total usage time of ECMO, ECMO associated complications, primary graft dysfunction (PGD), successful ECMO weaning, and survival. Patients were divided according to type of ECMO, whether successfully weaned from ECMO or not, and primary disease. Clinical data was compared, and the Kaplan-Meier survival of 180-day was studied. Results ① The overall situation showed: A total of 18 patients were enrolled, with 14 males and 4 females, age ranged from 23 to 78 years old. Primary disease included 6 cases of idiopathic pulmonary fibrosis (IPF), 3 cases of idiopathic pulmonary hypertension (IPAH), 8 cases of interstitial pneumonia and 1 case of silicosis. Nine patients received venous-venous (V-V) ECMO and 9 venous-artery (V-A) ECMO as a bridge to LTx; 15 patients received LTx successfully, and failed in 3 cases. The average bridge time was 57.5 (14.5, 116.5) hours. ECMO associated complications included 6 cases with bleeding, 12 cases with renal failure, 2 cases with thrombosis, 2 cases with oxygenator leak, and 1 case with leg ischemia. There were 7 unilateral (5 right lungs and 2 left lungs) and 8 bilateral LTx. Three patients died before LTx due to septic shock. Nine patients died after LTx, 4 for septic shock, 4 for multiple organ failure, and 1 for sudden cardiac death. Six patients survived after LTx.② Group comparison showed: There was no significant difference in gender, age, ECMO support time as a bridge to LTx, ECMO support time after operation, total ECMO usage time, incidence of PGD, successful weaning from ECMO, and 180-day survival rate between V-V ECMO group (n = 7) and V-A ECMO group (n = 8). There was no significant difference in gender, age, primary disease, type of ECMO, operation modality, preoperative leukocyte count between groups of successfully weaned from ECMO (n = 11) and the failed (n = 7). Lower level of preoperative lactate acid (mmol/L: 3.01±1.51 vs. 8.27±3.49, t = -3.770, P = 0.006), shorter total ECMO usage time (hours: 72.82±40.53 vs. 210.71±107.10, t = -3.907, P = 0.001), and higher 180-day survival rate (54.5% vs. 0, P = 0.038) were found in the group of successfully weaned from ECMO, when compared with the failed group. ③ Kaplan-Meier survival analysis showed that postoperative survival rates of 7, 30, 60, and 180 days of 18 patients was 72.2%, 38.9%, 33.3%, and 33.3%, respectively. Among them, the postoperative survival rates of 7, 30, 60, and 180 days in the group of successfully weaned from ECMO (n = 11) were higher than those in group of failed (n = 7; 81.8% vs. 57.1%, 63.6 % vs. 0, 54.5% vs. 0, 54.5% vs. 0, respectively; log-rank test: χ2= 8.009, P = 0.005). The postoperative survival rates of 7, 30, 60, and 180 days in IPF group (n = 6) were lower than those in non-IPF group (n = 12; 33.3% vs. 83.3%, 16.7% vs. 50.0%, 16.7% vs. 41.7%, 16.7% vs. 41.7%; log-rank test: χ2= 4.161, P = 0.041). Conclusions The use of ECMO as a bridge to LTx may provide survival benefit for LTx recipients. V-V ECMO provides effective life support for patients without severe heart failure, and V-A ECMO for patients with unstable hemodynamics. Preoperative lactate level and total ECMO duration time were closely related to ECMO weaning rate. Primary diagnosis may affect prognosis.

Long-term survival of bilateral lung transplantation combined with Nuss operation on treatment of bronchiolitis obliterans syndrome complicated with thoracic deformity after hematopoietic stem cell transplantation: report of one case / 器官移植

Objective To evaluate the clinical efficacy of bilateral lung transplantation combined with Nuss operation on the treatment of bronchiolitis obliterans syndrome (BOS) complicated with pectus excavatum after hematopoietic stem cell transplantation. Methods On March 24, 2015, one patient presenting with BOS complicated with pectus excavatum after hematopoietic stem cell transplantation underwent extracorporeal membrane oxygenation (ECMO)-assisted bilateral lung transplantation in the Department of Thoracic Surgery and Lung Transplantation Center of Wuxi People's Hospital affiliated to Nanjing Medical University. Simutaneously, Nuss operation was successfully performed to treat pectus excavatum. After anti-inflammation and anti-fungal treatment, a triple immunosuppressive regimen consisting of tacrolimus + mycophenolate mofetil + adrenocortical hormone was implemented. Results The patient was properly recovered and discharged on 25 d after operation. The Nuss steel plate was removed from the chest at postoperative 2 years. The thoracic deformity was corrected. The patient received long-term postoperative follow-up. Until submission date, the patient survived for more than 3 years. The lung function was well restored and the quality of life was satisfactory. Conclusions Bilateral lung transplantation combined with Nuss operation is an effective approach in the treatment of end-stage BOS complicated thoracic deformity.

Relationship between menstrual disorder and ovarian morphology of adolescent women / 西安交通大学学报(医学版)

Objective To study the relationship between menstrual disorder and ovarian morphology of adolescent women in order to provide basis for diagnosis of adolescent polycystic ovary syndrome (PCOS).Methods We analyzed the clinical data of 212 patients with adolescent menstrual disorders 2 years after menstruation collected from the Department of Gynecology and Women's Health of First Affiliated Hospital of Xi'an Jiaotong University between September 2014 and September 2015.Results ① Oligomenorrhea was the most common in the 212 adolescent women (33.96 ％),followed by amenorrhea (16.51％).There was a significant difference in F-G score and acne score among patients with different types of menstrual disorder (F=1.39,1.77,all P＜0.05),the highest in those with oligomenorrhea.② The volume of the ovary,number of sinusoidal follicles,maximum area of the ovary in women with oligomenorrhea were significantly higher than those in non-oligomenorrhea women (t =2.89,5.76,6.23,all P＜ 0.05).③ Clinical manifestations differed significantly among normal ovarian group,MFO group and PCO group (x2=43.25,P＜0.05).Incidence rate of oligomenorrhea ranked the top in polycystic ovary group (49.30％),followed by multiple ovarian follicles group (42.59％),and there were significant differences in blood LH,T,and LH/FSH (F=3.45,2.43,2.76,all P＜0.05) was found in PCO group.There was significant difference in diagnosis of puberty PCOS (x2=26.58,P＜0.05).④ Among these 212 adolescent women,45 ones had puberty PCOS (21.23％).The ovary volume,number of sinus follicles,and the largest area in the obese patients were significantly higher than those in non-obese group (t =3.42,7.89,4.02,all P＜0.05);HOMA IR was also significantly higher than that in non-obese group (t =8.89,10.62,all P ＜ 0.05).Conclusion Oligomenorrhea is the most common menstrual disorder in adolescent women.Ovarian morphological abnormalities occur in most women with oligomenorrhea and obesity,who should be followed up regularly.

Lung transplantation for end-stage pulmonary diseases using donation after death of citizens: report of 242 cases / 中华器官移植杂志

Objective To summarize the lung transplant program using donation after death of citizens (DCD).Methods Retrospective characteristics of 242 patients with end-stage lung diseases receiving lung transplantation in our hospital were reviewed between January 2015 and December 2016.The data about evaluation and collection of all donors were analyzed.The survival rate,causes of deaths,and postoperative complications were reviewed.Kaplan Meier survival curves and a logrank test of differences in survival functions were used to assess the effect of lung transplant type and extracorporeal membrane oxygenation (ECMO) on survival post transplant.Results A total of 231 patients donated their lungs,including China type three (135 cases),China type two (19 cases),and China type one (77 cases).242 lung transplantations were successfully performed.The 3-month,6-month and 1-year survival rate after lung transplantation was 80.6％,80.6％,and 77.8％,respectively.There were 47 deaths during perioperative period,including 22 cases of primary graft dysfunction,14 cases of sepsis,6 cases of multiple organ failure,3 cases of heart failure,and 2 cases of stomal leak.One hundred and thirty-two patients received bilateral lung transplantation,with 3-month,6-month,and 1-year survival rate being 78.6％,78.6％,and 75.6％ respectively.110 underwent single lung transplantation with 3-month,6-month,and 1-year survival rate being 82.7 ％,82.7 ％,and 80.1％,respectively.No significant difference in survival rate was observed between single and bilateral lung transplantation (P＞0.05).One hundred and twenty-nine cases of lung transplants were conducted under ECMO support,with the 3-month,6-month and 1-year survival rate being 72.5％,72.5％,and 70.5％ respectively,which was significantly higher in those without ECMO with the 3-month,6-month and 1-year survival rate being 90.2％,90.2％ and 86.6％ respectively (n =113) (P ＜ 0.05).Conclusion DCD may facilitate the development of lung transplantation in China with long-term survival.

Analysis of clinical outcomes of bilateral lung transplantation with simultaneous lung volume reduction surgery on end-stage lung disease / 中华胸心血管外科杂志

Objective To investigate the effectiveness and safety of bilateral lung transplantation with simultaneous lung volume reduction surgery in the treatment on end-stage lung disease and analysis its prognosis.Methods Clinical data of 79 patients with end-stage 1ung diseases receiving BLTx in our hospital were retrospectively analyzed between Sept.2002 to Dec.2012.Bilateral lung transplantations were performed on 48 male and 31 female patients, with a mean age of(57.0 ± 6.3) years (ranging from 15 to 75 years).Amongst them 56 patients received LTx under circulation support,including 1 cases of cardiopulmonary bypass(CPB) support and 55 cases of extracorporeal membrane oxygenation(ECMO) support.34 patients accepted lung volume reduction surgery, other 45 patients receive standard BLTx.The Patients were divided into lung volume reduction group(group Ⅰ)and control group(group Ⅱ).Differences in various clinical parameters such as Pulmonary function, postoperative complications, and prognosis between the two groups were compared.Results The 1、2、3 and 5-year survival rate after LTx was 80.5％ 、71.4％ 、58.2％ and 43.5％.The mean survival time post-transplant in size reduction group and control group were(38.54 ±4.72) months and(42.19 ±6.64) months repectively.The main causes of mortality included primary graft dysfunction(PGD) ,acute rejection(AR) , multiple organ failure(MOF) , bronchiolitis obliterans(BOS) and sepsis.No tendency of increase in mechanical ventilation, chest tube drainage time, volume of chest drainage were observed.Compared clinical parameters between the two groups, none had significant differences(P ＞0.05).Lung function test was performed on 63 cases after transplantation.There was no significant difference in FEV1 improvement after lung transplantation between the two groups[(74.23 ±4.86)％, (72.0 ±3.64)％, P ＞0.05].Conclusion This study demonstrates that BLTx with simultaneous lung volume reduction surgery is safe and effective, which have the same outcome and prognosis compare with standardbilateral lung transplantation.

Clinical analysis of bilateral lobar lung transplantation on end-stage lung disease in patients with size mismatching thoracic cavity / 中华器官移植杂志

Objective To investigate the effectiveness and safety of bilateral lobar lung transplantations (LLTx) in thoracic cavity size mismatching patients with end-stage lung diseases and analyze its prognosis.Method Clinical data of 34 patients receiving LLTx in our hospital were retrospectively analyzed between Sept.2002 to Dec.2012.LLTx were performed on 14 male and 20 female patients,with a mean age of 37.0 ± 6.3 years (ranging from 15 to 56 years).Indications for LLTx were idiopathic pulmonary fibrosis (n =24),idiopathic pulmonary hypertension (n =2),Eisenmenger syndrome (n =3),bronchiectasis (n =2) and lymphangiomyomatosis (n =3).Amongst them 26 patients received LLTx under extracorporeal membrane oxygenation (ECMO) support and 3 on ECMO as a bridge to transplantation.Twenty-four middle/lower right lobes with left lower LLT,4 bilateral lower LLT,2 bilateral superior LLT and 4 split left lung LLT were performed.Ischemic time was 4.4± 1.2 h for the first lobe and 6.3 ± 1.4 h for the second.Result The mortality in postoperative prophase (30 days) was 23.5％.The 1-,2-,3-and 5-year survival rate after LLTx was 70.9％,60.8％,50.6％ and 36.2％ respectively.The main causes of mortality included primary graft dysfunction,acute rejection,multiple organ failure,bronchiolitis obliterans and sepsis.Lung function test was performed on 23 cases after transplantation and forced expiratory volume in first second,maximal voluntary ventilation accounting for the predicted value was (74.23 ± 4.86)％ and (72.0 ± 3.64)％,respectively.Conclusion This study demonstrates that for thoracic cavity size mismatching patients,LLTx are safe and effective in the treatment of end-stage lung diseases,which can ameliorate the lung function and prognosis.

Curative effect and prognosis analysis of lung transplantation for patients over 65 years old with end- stage lung diseases / 器官移植

Objective To investigate the curative effect and prognosis of lung transplantation for patients over 65 years old with end-stage lung diseases.Methods Clinical data of 24 elderly patients (≥65 years old)undergoing lung transplantation in Affiliated Wuxi People's Hospital of Nanjing Medical University from September 2002 to December 201 1 were retrospectively analyzed.The survival conditions of elderly patients undergoing lung transplantation were studied and the survival conditions of unilateral lung transplantation and bilateral lung transplantation were compared.The complications after lung transplantation were observed and the death causes of patients died during the follow-up period was analyzed.Results All patients completed the lung transplantation successfully.The 1 ,3,5 and 7-year cumulative survival rate of the 24 patients were respectively 75.0%,62.5%,33.3% and 1 2.5%,and those of patients undergoing unilateral lung transplantation were respectively 68.8%,50.0%,31 .3% and 1 2.5% and those of the patients undergoing bilateral lung transplantation were respectively 87.5%,87.5%,37.5% and 1 2.5%.The median survival time of the patients undergoing unilateral lung transplantation and bilateral lung transplantation was respectively 35 months and 51 months,and there was no significant difference (P >0.05 ).The primary postoperative complication was infection with the incidence of 46% (1 1 /24).Seventeen patients died during the long-term follow-up.Among them,9 died of severe infection,1 died of primary graft dysfunction (PGD), 1 died of acute rejection (AR),4 died of bronchiolitis obliterans syndrome (BOS),1 died of heart failure and 1 died of tumor.Conclusions Unilateral lung transplantation and bilateral lung transplantation are both effective methods to treat elderly patients with end-stage lung diseases.Infection is the primary postoperative complication and the cause of death of elderly patients.

Experience of donation after citizens death for lung transplant: report of 19 cases / 中华器官移植杂志

Objective To summarize the experience of harvesting and using the lungs from donation after citizens death.Method From November 2007 to December 2013,19 cases of potential donation after brain death (DBD) and donation after cardiac death (DCD) were evaluated,including 9 cases of DCD and 10 cases of DBD.All the patients received the tests of sputum culture,bedside bronchoscopes,chest X rays,and blood gas analysis.After clear evaluation,3 cases of DCD and 3 cases of DBD were discharged from the group for bilateral inflammatory infiltration and poor oxygenation index,and the rest one case of DCD was precluded due to long warm ischemic time (＞60 min).The donor lungs from remaining 12 cases were harvested successfully after the declaration of brain death or cardiac death.The donors suitable for the transplant procedure were transported to our transplant center.Result Twelve lung transplants were performed successfully,including 10 cases of bilateral lung transplantation and 2 cases of right single lung transplantation.Two patients was complicated with severe infection and died of sepsis postoperatively,and the remaining 10 patients all recovered uneventfully with dramatic improvement of pulmonary function.During the follow-up period,all the patients lived an active life style with high quality of life.The mean survival time was 34.7 months (4-60 months).Conclusion Lung transplantation using DCD and DBD can be successfully performed after adequate preoperative evaluation of donor lung and abundant preparation for donor harvesting.

Posttransplant immunosuppression regimens in 100 lung transplant recipients / 中华器官移植杂志

Objective To evaluate the safety and effectiveness of immunosuppression regimens,postoperative complications,dead causes and risk factors of lung transplantation (LTx).Methods The immunosuppression regimens and clinical data of 100 patients with end-stage lung diseases receiving LTx in our hospital were retrospectively analyzed between Sept.2002 to Dec.2010.There were 72 patients subject to single LTx and 28 patients to bilateral LTx,amongst them 61 patients received LTx under circulation support,including 5 cases of cardopulmonary bypass (CPB) support and 56 cases of extracorporeal membrane oxygenation (ECMO) support.The immunosuppression regimens including Cyclosporin,mycophemolate Mofeil and corticosteroids were utilized in 53 recipients before the year of 2007,and Cyclosporin was switched to Tacrolimus in 47 patients after 2007.All the patients received Daclizumab or Basiliximab as immunosuppression induction regimens.Results The 1-,2-,3-and 5-year survival rate after LTx was 73.3％,61.6％,53.5％ and 40.7％ respectively.The mean survival time post-transplant in the patients who received Cyclosporin-based regimens and Tacrolimus-based regimens were (36.57 ± 3.44) months and (35.00 ± 2.33) months,repectively,with no significant differences (P＞0.05).The main causes of mortality included primary graft dysfunction (PGD),acute rejection (AR),bronchiolitis obliterans (BOS) and sepsis.The incidence of AR and BOS in Tacrolimus group was significantly lower than that in Cyclosporin grou (P ＜0.05),but the incidence of diabetes mellitus was significantly higher in Tacrolimus group.Analysis of Spearman rank correlation revealed that there was a direct correlation between the incidence of AR and BOS (r =0.340,P＜0.01).The use of circulation support,diagnosis of IPF,postoperative complications such as AR,BOS and infection were associated with decreased survival time postoperatively,in both univariate and multivariate proportional hazards regression models (P＜0.05).Conclusion Cyclosporin-and Tacrolimus-based regimens were both effective immunosuppression strategies postoperatively,Consummate follow-up surveillance and prompt treatment of complications were the key points in prolongation of survival time and improving quality of life after LTx.

Lung transplantation from donor of cardiac death and donation after brain death in one centre Ⅲ: 4 cases report / 中华器官移植杂志

Objective To summarize the clinical experience ot harvesting and using the lungs from donation after brain death (DBD) and donation after cardiac death (DCD,Maastricht category Ⅳ) in China.Methods Eleven potential DBDs and DCDs were evaluated by our transplant group preoperatively,including 6 cases of DCDs and 5 cases of DBDs,and all of them received the tests of sputum culture bedside bronchoscopy,chest X rays,and blood gas analysis.After clear evaluation,1 case of DCD and 2 cases of DBD were discharged from the group for bilateral inflammatory infiltration and poor oxygenation index,and one case of DCD was precluded due to long warm ischemic time (＞60min).The donor lungs from remaining 7 cases were harvested successfully after the declaration of brain death or cardiac death.The preoperative lymphocytotoxic cross match test was negative,ABO blood types were compatible,and the donors were all suitable for the transplant procedure.Results Seven lung transplants were performed successfully under ECMO support,including 5 cases of bilateral lung transplantation and 2 cases of single lung transplantation.One patient was complicated with severe infection and died of sepsis on postoperative day (POD) 39,and one was succumbed to multiple organ failure.Two patients suffered of acute rejection on POD 30 and POD 19,respectively,and obtained improvements by bolus steroid therapy.The remaining 3 patients all recovered uneventfully.During a follow up period,all the patients lived an active life style with high quality of life.The mean survival time was 23.3 months (3-51 months).Conclusion The DCD and DBD may be one of the available donor resources for lung transplantation after efficient management of the potential donors and detailed preoperative evaluation in China.

Raffinose-low potassium dextran solution in clinical lung transplantation: a retrospective study / 中华器官移植杂志

ObjectiveTo evaluate the security and effectiveness of raffinose-low potassium dextran solution (RLPDs) for donor lung preservation.MethodsFrom Sep.2002 to Dec.2011,131patients underwent lung transplantation in our institution,including 81cases of single lung transplantation and 50 cases of bilateral lung transplantation.There were 95 males and 36 females.A total of 129 donors were used for organ harvest.Two donors denoted their lungs to four patients receiving single lung transplantation. All the donors were flushed, perfused antegradely and retrogradely,and preserved with hypothermal RLPDs.The repeated reperfusion was necessary when the cold ischemic time was fairly long and the function of donor was poor.During operation,the blood gas analysis,mean pulmonary artery pressure (mPAP) and breathing mechanics were monitored.Postoperatively,all the recipients received re-examination of cardiac ultrasonography,pulmonary function,blood gas analysis and chest imaging.ResultsAll lung transplantations were performed successfully,with a mean cold ischemic time of (193±21) min (range,65-630 min).There was a significant relationship between postoperative pneumonedema and donor lung cold ischernic time (P＜0.05),which was also observed between postoperative pneumonedema and primary graft dysfunction (P＜0.01). The blood gas analysis and oxygenation index were significantly improved postoperatively,with the mPAP and parameters of breathing mechanics being descended to a normal level.There were 24 early deaths in the first month post-transplant,with a mortality of 18.3％ (24/131),including 11cases of sepsis,7 cases of primary graft dysfunction,3 cases of heart failure,1case of bronchial stomal leak,1case of acute rejection,and 1case of pulmonary infarction.The pulmonary function was improved significantly 3 months postoperatively.Conclusion RLPDs is efficient in the preservation of donor lung,with the ability to alleviate ischemic reperfusion injury and improve pulmonary function.

Study on the relativity among the attachment type, alexitymia and defense style of depression patients / 中华行为医学与脑科学杂志

ObjectiveTo evaluate the attachment type,the level of alexitymia and the defense style of depression patients and their relativity.Methods 32 depression patients were assessed with the adult attachment scale (AAS-1996 Revised Edition),toronto alexithymia scale (TAS) and defense style questionnaire( DSQ),and 80 healthy people were involved as controls.Results The depression patients showed significantly different attachment type from the control group( x2 =47.6,P ＜ 0.01 ).Compare with the control group,the depression patients showed higher scores in immature defense style( (5.47 ± 1.13 ) vs (3.79 ± 1.09 ) ) and neurotic defense style( (4.93 ±0.56) vs (4.20 ± 1.00),(P＜0.01) ).Compared with controls,the depression patients showed higher scores in TAS total score( (76.88 ± 8.94) vs (65.70 ± 7.98 ) ) factor Ⅰ ( ( 3.34 ± 0.77 ) vs ( 2.41 ±0.78)) and factor Ⅱ ((3.64 ±0.51) vs (2.65 ±0.55),P＜0.01),and lower scores in factor Ⅲ((2.51 ±0.78) vs (3.14 ± 1.03 ),P ＜ 0.01 ).The depression patients' adult attachment was significantly correlative with their scores of alexithymia.The depression patients' adult attachment was also significantly correlative with their scores of defense style.ConclusionThe attachment of depression patients may lead to depression via their defense style.Depression leads to alexitymia.Depression patients with different features of attachment show different level of alexitymia.