ABSTRACT
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.
ABSTRACT
Transplantation acquired food allergy (TAFA) is a rare complication of solid organ transplantation. The pathogenesis of TAFA has not been fully elucidated. There are two possible mechanisms for its occurrence: food allergy mediated by IgE delivery of the donor and food allergy caused by food intolerance after transplantation. At present, there is still insufficient understanding of this complication among transplant physicians. Through systematic review of relevant literature, the authors summarized the research progress of TAFA, which mainly included the pathogenesis, clinical characteristics, treatment and prognosis of TAFA. In order to provide reference for the diagnosis and treatment of TAFA.
ABSTRACT
Objective:To explore the application value of whole-process ultrasound-guided percutaneous portal vein puncture islet transplantation.Methods:From October 2018 to May 2021, 16 diabetics underwent whole-process ultrasound-guided percutaneous portal vein puncture islet transplantation at First Affiliated Hospital of Sun Yat-sen University.The whole process was guided by ultrasound for completing percutaneous portal vein puncture catheterization, islet infusion monitoring, bleeding prevention and ablation hemostasis after bleeding.Results:Ten patients [8 males and 2 females with a mean age of(45.9±21.1)years]underwent 16 islet transplants, including one islet(5 cases), two islets(4 cases)and three islets(1 case). A single puncture was successfully performed without damage to other extrahepatic organs, persistent portal hypertension, portal vein embolism or infection.Bleeding at liver puncture site occurred in 3 cases and ultrasound radiofrequency ablation was performed for immediate hemostasis.Among them, postoperative blood glucose stabilized at 4~12 mmol/l post-operation.And 5 cases(31.3%)achieved insulin independence for>2 months and 10 cases(62.5%)lowered insulin dosage by>50% as compared with preoperative level.The level of fasting C-peptide recovered or was higher than normal in 10 cases(62.5%)and became obviously elevated in the remainders.In 11 cases(68.8%)of them, liver transaminase was briefly and mildly elevated post-operation, and no other complications were observed.Conclusions:The whole-process ultrasound-guided percutaneous portal vein islet transplantation is both safe and feseasible.It avoids the injury of transplanted kidney caused by contrast agent and radiological radiation to operator and patient.It is a method of islet transplantation worth a wider popularization.
ABSTRACT
Objective:To investigate the effectiveness and safety of fully-covered self-expandable metal stent (FCSEMS) with plastic stent over the treatment of post liver transplantation anastomotic biliary stricture (AS).Methods:The clinical data of AS patients after liver transplantation admitted to the First Affiliated Hospital of Sun Yat-sen University from January 2014 to April 2018 was collected for the retrospective study. According to different implanted stents, patients were divided into FCSEMS group and plastic stent group. The general information of the two groups of patients, surgical success rate, postoperative complications, the number of endoscopic retrograde cholangiopancreatography (ERCP), the number of indwelling stents and other indicators were compared and analyzed.Results:A total of 54 patients were enrolled, including 41 males and 13 females, with a median age of 48 (34-65) years. A total of 23 cases were included in the FCSEMS group and 31 cases were included in the plastic stent group. The overall technical success rate of the operation was 98.3% (176/179). In the FCSEMS group, there were 21 patients recovered and 2 patients were relieved; in the plastic stent group, 29 patients were recovered, 1 case was relieved, and 1 case failed. There were no statistically significant differences in the efficacy and complication rate between the two groups (all P>0.05). The median stent indwelling time, ERCP times, and the number of indwelling stents in the FCSEMS group were 5.9 months, 2 times, and 1, respectively, and in the plastic stent group were 9.5 months, 4 times, and 8 respectively. There were statistical differences between the two groups (all P<0.05). Conclusions:FCSEMS for treatment of AS showed less duration of stenting, numbers of stents and endoscopic treatment sessions with the similar efficacy as plastic stents. It’s indicated that it’s necessary to pay attention to the probability of stent migration and pancreatitis.
ABSTRACT
Epithelioid Hemangioendotheliomais a rare, low-grade malignant vascular tumour. It’scalled hepatic epithelioid hemangioendothelioma(HEHE), when it occurs in liver. It can be metastatic and postoperative recurrence. There are few cases have been reported in the literature at home and abroad because of its rarity. The treatment of HEHE is also controversial. With the continuous improvement of surgical techniques of liver transplantation, it is increasingly applied to treat liver failure patients caused by HEHE. Our paper reviews the literature on disease characteristics of HEHE, and liver transplantation for HEHE indications, immunotherapy and prognosis, to illustrate the status and progress of liver transplantation for HEHE.
ABSTRACT
Objective To summarize the perioperative nursing care of a patient with ischemia-free liver transplantation. Methods The nursing measures were developed according to the characteristics of the disease and the individual conditions of the patients: including preoperative psychological care;preoperative preparation; prevention of postoperative infection; meticulous observation of the patient′s conditions, transplanted liver function and postoperative complications; the early guidance of rehabilitation activity, nutritional support treatment and the care of water and electrolyte balance. Results The patient recovered well with careful nursing care and no nursing-related complications occurred, and he was discharged successfully on the 18th day after surgery. Conclusion According to the patient's condition and individual situation, the development of nursing measures can effectively prevent the potential infection, timely discover the changes of the patient′s condition, understand the recovery of the transplanted liver function and observe the related postoperative complications, and help to promote the early recovery of patients.
ABSTRACT
Objective To investigate the effect of expression of Cullin 4B (CUL4B) on the prognosis of patients after liver transplantation for hepatocellular carcinoma (HCC).Methods The retrospective case-control study was conducted.The clinicopathological data of 79 patients who underwent liver transplantation for HCC in the First Affiliated Hospital of Sun Yat-sen University between January 1,2014 and June 30,2015 were collected.The specimens of HCC tissues were collected and embedded in paraffin,and then were detected by immunohistochemistry staining.Observation indicators:(1) expression of CUL4B in HCC tissues;(2) follow-up and survival;(3) prognostic factors analysis after liver transplantation;(4) association between expression of CUL4B and recurrence and metastasis of tumor after liver transplantation.Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence or metastasis and survival up to June 2018.Measurement data with normal distribution were represented as (x)±s.The comparison between groups of count data was done using the chi-square test.The survival curve drawn using the Kaplan-Meier method,and the survival analysis was done by Log-rank test.The univariate and multivariate analysis were respectively done using the COX regression model.The association analysis was done using the Pearson test.Results (1) Expression of CUL4B in HCC tissues:immunohistochemistry staining showed that CUL4B was mainly expressed in the cytoplasm,with a powerful brownish-yellow staining.The high expression and low expression of CUL4B in HCC tissues were detected in 64 and 15 patients,respectively.(2) Follow-up and survival:79 patients were followed up for 38-56 months,with an average time of 46 months.During the follow-up,37 patients had no tumor recurrence and 42 had tumor recurrence (32 with tumor extrahepatic metastasis and 10 with intrahepatic metastasis);36 had survival and 43 died;the 1-and 3-year overall survival rates were respectively 86.84％ and 63.25％,and 1-and 3-year tumorfree survival rates were respectively 62.31％ and 51.27％.(3) Prognostic factors analysis after liver transplantation:① Results of univariate analysis showed that preoperative alpha-fetoprotein (AFP),Child-Pugh score,maximum tumour dimension,capsular invasion,intravascular tumor thrombus,Edmonson pathological grading and expression of CUL4B were related factors affecting the 3-year overall survival rate of patients after liver transplantation for HCC [Hazard Ratio (HR) =2.17,3.36,3.66,2.43,2.19,3.36,2.84,95％ confidence interval(CI):1.17-4.04,1.53-7.42,2.10-6.42,1.33-4.17,1.08-9.04,1.58-7.59,1.17-6.32,P＜ 0.05].The preoperative alpha-fetoprotein (AFP),Child-Pugh score,maximum tumour dimension,capsular invasion,intravascular tumor thrombus,Edmonson pathological grading and expression of CUL4B were related factors affecting the 3-year tumor-free survival rate of patients after liver transplantation for HCC (HR =2.06,3.72,3.16,2.36,2.83,3.21,1.69,95％CI:1.34-4.85,1.72-8.63,1.79-7.31,1.46-4.86,1.19-8.63,1.19-7.92,1.06-4.87,P＜0.05).② Results of multivariate analysis showed that maximum tumour dimension,intravascular tumor thrombus and expression of CUL4B were independent factors affecting the 3-year overall survival rate of patients after liver transplantation for HCC [Odds ratio(OR) =3.43,3.69,2.81,95％CI:1.16-6.02,1.96-9.38,1.04-9.63,P＜0.05].The maximum tumour dimension,intravascular tumor thrombus and expression of CUL4B were independent factors affecting the 3-year tumor-free survival rate of patients after liver transplantation for HCC (OR=2.25,4.72,2.74,95％C1:1.16-4.02,1.98-9.47,1.03-7.10,P＜ 0.05).The 3-year overall survival rate in patients with high-and low-expressions of CUL4B was respectively 66.7％ and 32.8％,with a statistically significant difference (x2 =5.69,P＜0.05).The 3-year tumor-free survival rate in patients with high-and low-expressions of CUL4B was respectively 73.3％ and 18.6％,with a statistically significant difference (x2 =4.63,P＜0.05).(4) Association between expression of CUL4B and recurrence and metastasis of tumor after liver transplantation:results of Pearson test showed that expression of CUL4B was significantly associated with HCC recurrence and metastasis after liver transplantation (r =0.62,P＜0.05).The further analysis showed that expression of CUL4B was significantly associated with extrahepatic metastasis after liver transplantation (r=0.84,P ＜ 0.05).Conclusion The expression of CUL4B is associated with HCC recurrence after liver transplantation,and it can be as a predictor for HCC recurrence and distant metastasis after liver transplantation.
ABSTRACT
Objective The purpose of this study was to improve the success of organ donation and organ quality by analyzing the hemodynamic stability effect of 3-durgs therapy in brain death donor.Methods In this prospective observational study,we collected clinical data of brain death donors,who was admitted in the First Affiliated Hospital,Sun Yet-sen University from October 2015 to December 2016."3-durgs" emphasizes simultaneous use and includes vasopressin,thyroxine and corticosteroids.The assessment of hemodynamics is based on blood pressure,heart rate,blood oxygen,urine volume,and vasoactive drugs.According to the time of admission,included patients were divided into two groups:3-durgs therapy group and conventional therapy group therapy group;the clinical data were compared between two groups to analyze the effect of 3-durgs on hemodynamic stability.Furthermore,we used univariate and multivariable logistic regression analyses to assess associations between 3-durgs therapy and these variables.Results A total of 109 patients were included in the study;following the time sequence,54 cases enter into the conventional therapy group received conventional therapy,32 cases achieved hemodynamic stability;55 cases in 3-durgs group received 3-durgs and conventional therapy,45 cases achieved hemodynamic stability,3-durgs group is better than the conventional group.In the matter of high-does usage,single vasoactive agent can maintain hemodynamic stability rate and norepinephrine usage,3-durgs group is better than the conventional group.The univariate and multivariable analysis showed that the abnormal suprasellar cistern,midline shift,low free T3,axillary temperature more than 36.5 ℃ and central diabetes insipidus are associated with 3-durgs-hormone therapy.Conclusion 3-durgs therapy can contribute to maintain hemodynamic stability in brain death donors and reduce the usage of vasoactive agents,can improve the success rate of donations and improve the quality of occupied organ;meanwhile,the screened validities can predict the effectiveness of 3-durgs therapy.
ABSTRACT
Objective Ischemia reperfusion injury (IRI) is a major limiting factor of graft survival in organ transplantation.We've established a novel procedure called ischemia-free liver transplantation (IFLT) in big animal study.In this report,we aimed to investigate the feasibility and early outcomes of IFLT.Methods We have performed 3 cases of IFLT during July 23,2017 to August 9,2017.We analyzed the surgical methods,normothermic perfusion parameters,blood gas analysis,liver function tests and complications early after liver transplantation.Pathologic studies and immunohistochemical staining of donor liver biopsies were conducted before procurement,at the end of machine perfusion,as well as after re-vascularization for evaluating IRI.Results The surgical procedures of all 3 patients were successful,without stoppage of blood supply for the liver grafts throughout organ procurement,ex vivo preservation and implantation.During normothermic perfusion,the pH value was stable within the normal range and the lactate levels dropped quickly to lower than detected (＜0.3 mmol/L) within 1.5-3 h.The livers continued to produce bile with the volume of 2-6 mL/h.Hematoxylin and eosin (HE) staining evaluation and TdT-mediated dUTP nick end labeling (TUNEL) assay of biopsies taken from liver tissues before procurement,at the end of machine perfusion and after re-vascularization,showed few necrostic and apoptotic hepatocytes in the liver biopsies.The immunohistochemical staining of IL-1β and vWF suggested no inflammatory cytokine release and sinusoidal endothelial cell activation.The three patients recovered smoothly without rejection,vascular and biliary complications.Conclusion IFLT is a feasible and effective procedure,which is able to overcome the major limitations of conventional procedure.The novel IFLT will become one of the mainstream transplant procedures in the future.
ABSTRACT
Objective To investigate the correlation between the elastographic characteristics of liver and postoperative function of liver allografts.Methods Forty-eight cases of liver transplantation from The First Affiliated Hospital of Sun Yat-sen University were analyzed,Shear wave elastography (SWE) was performed before operation or at one week or one month post-operation.Liver function was evaluated by measuring alanine aminotransferase (ALT),aspartate transaminase (AST),total bilirubin (TBIL),γ-glutamine transferase (GGT),albumin (ALB),alkaline phosphatase (ALP),prothrombin time (PT),activated partial thromboplastin time (APTT),and international normalized ratio (INR).Early allograft dysfunction (EAD) was also analyzed with reference to SWE among liver transplant recipients.Results SWE at one week after transplantation was significantly correlated with TBIL (r=0.525 6,P<0.01),APTT (r=0.668 3,P<0.000 1),PT (r=0.593 7,P=0.000 1),INR (r=0.609 6,P<0.000 1) and prealbumin (r=-0.464 1,P<0.01).However,no significant correlation was observed between pre-operative SWE and parameters of post-operative liver function.SWE in EAD patients was higher than that of patients without EAD (17.60±1.09 kPa vs.13.38±0.99 kPa,P<0.01).The optimal cut-off value of SWE at one week post-operation was 14.85 kPa.Conclusion Postoperative SWE is significantly correlated with postoperative liver function tests and EAD,suggesting SWE is a potential test for evaluating the quality of liver allografts.
ABSTRACT
Objective To analyze the incidence of BK virus (BKV) infection after kidney transplantation in our center and to evaluate the efficacy and safety of conversion treatment with Mizoribine (MZR) on BKV infection after kidney transplantation.Methods The information of recipients who received BK virus screening in hospital or outpatient during 2015-02 to 2016-12 in our center was retrospectively analyzed.The recipients positive for BKV were divided into experiment group (given conversion treatment with MZR) and control group (not given MZR conversion) according to the inclusion criteria.The negative rate of BKV,AR,hyperuricemia and the function of renal allograft during the conversion treatment with MZR were observed.Results 182 recipients accepted BKV screening during 2015-02 to 2016-12 and 68 cases were positive.The positive rate of BKV was 38.5 ％.The positive rate of peripheral blood specimens and midstream urine specimens was 7.1％ and 36.8％ respectively.Twelve recipients were positive for BKV in both peripheral blood specimens and midstream urine specimens.There were 27 recipients in experiment group and 36 cases in control group.Fourteen recipients positive for BKV became negative after MZR conversion in experiment group and the negative rate was up to 51.9％.The mean time of negative rate was 3.2 ± 2.7 (1-10) months after MZR conversion.During the conversion treatment with MZR,AR occurred in 1 case and was reversed by the impact therapy with Thymoglobulin in experiment group.The value of serum uric acid was maintained stable before and after MZR conversion under the action of uric-acidlowering drug.The renal function was kept stable in both experiment group and control group after renal transplantation.No deaths and renal allograft failure cases occurred in both groups during the research period.The 2-year survival rate for patients and kidneys was both 100％.Conclusion The incidence of BKV infection after kidney transplantation was high and the treatment scheme of MZR conversion was safe and effective.
ABSTRACT
Objective To investigate the long-term clinical efficacy of simplified multivisceral transplantation in patients with end-stage liver disease and type 2 diabetes.Methods The clinical data of 31 cases of simplified multivisceral transplantations between 2009 to 2017 were retrospectively analyzed.Results Median post-transplant follow-up was currently 13 ± 26 (0-86) months.Two recipients died of multiple organ dysfunction system (MODS) followed by severe sepsis on postoperative day (POD) 15 and 18,respectively.One recipient died from severe pneumonia with pyemia on POD 37.One recipient died of graft versus host disease (GVHD) on POD 40.One recipient died from acute myelogenous leukemia.Two recipients died of tumor recurrence at postoperative month (POM) 9 and 26,respectively.No biliary complication or diabetes recurrence was observed during follow-up.Condusion Donation after citizen's death is becoming the only organic source in China.Our results indicate that combined en-bloc liver-pancreas transplantation is technically feasible and leads to excellent long-term control of glucose metabolism and satisfactory quality of life in recipients with end—stage liver disease and diabetes mellitus.
ABSTRACT
Objective To investigate the past participation and their future intention of donation after citizen death (DCD) work of attendees.Methods A questionnaire study was carried out in the 9th Chinese ICU annual congress and local workshops taken part in difference provinces and cities from May 2015 to July 2015.A 12-multiple self choice questionnaires,collecting the demographic data of attendees and analyzing the ratio of DCD awareness and participation,their attitude towards DCD,and future recommendation of DCD development,were facilitated and immediately collected back.Results A total of 512 questionnaires were collected and 489 were available.97.75％ of the attendees have been awareness of DCD and 62.37％ have ever participated in DCD activity.During the whole survey,85.07％ of them expressed their willingness of future DCD activities participation.The current fierce conflict between medical workers and patients was selected to the main barrier of DCD work.The enforcement of DCD population and organ donation law were most recommended to improve donation success.Conclusion It is the fifth year after DCD programme initiation and full implementation since last year.Despite the obvious raise of DCD recognition among ICU staff,there is still long way to go ahead to the era of satisfactory donation rate.The hostility between medical workers and patients is the main barrier for ICU workers for DCD promotion.
ABSTRACT
Objective To analyze the related immune parameters in liver transplantation recipients to help guide adjusting future immunosuppressants.Methods Fifty-three tolerant recipients after liver transplantation were included in this study.They had normal liver functions and took only one immunosuppressive drug.They were divided into the 3 ～5 years tolerance group (3Y group,n =21) (including 5 years) after transplantation,and the 5 ～ 11 years tolerance group (5Y group,n =32).Another 15 liver transplantation recipients who had twice or more recurrent acute rejections were enrolled as the RJ group and 32 age-matched healthy donors served as the HC group.The natural killer (NK) cells,B cells,memory T cells,regulatory T cells (Tregs) and the subsets were detected by flow cytometry.The plasma TGF-β level was evaluated using ELISA.Results The percentages of NK cells (3Y group 19.00 ± 0.09,5Y group 20.00 ±0.09,HC group 14.00 ±0.07,RJ group 9.00 ±0.03) and total Tregs within the CD4+ cells (3Y group 6.26 ±2.33,5Y group 4.80 ±2.21,HC group 3.04 ± 1.25,RJ group 1.09 ±0.81) in the 3Y,5Y and HC groups were significantly higher than those in the RJ group (P ＜ 0.05).The proportions of resting Tregs (3Y group 0.23 ±0.07,5Y group 0.16 ±0.02,HC group 0.07 ±0.02,RJ group 0.05 ±0.01),active Tregs (3Y group 0.56 ± 0.11,5Y group 0.42 ± 0.15,HC group 0.08 ± 0.02,RJ group 0.05 ± 0.01) and non-suppressive Tregs (3Y group 3.51 ±0.80,5Y group 3.71 ±0.41,HC group 1.44 ±0.14,RJ group 2.15 ± 0.62) increased significantly in the tolerant recipients after liver transplantation when compared with those in the HC and RJ groups (all P ＜ 0.05).No significant differences on B cells,memory T cells and TGF-β level were detected among in four groups.Conclusions The NK cells,total Tregs,resting Tregs,active Tregs and non-suppressive Tregs increased significantly in the tolerant recipients after liver transplantation.These might serve as potential biomarkers for immune tolerance.
ABSTRACT
Objective To investigate the diagnosis and treatment of pure red cell aplasia (PRCA) caused by human parvovirus B19 (HPVB19) after liver transplantation.Method The clinical data of one case of PRCA caused by HPVB19 after liver transplantation,including clinical manifestations,diagnosis and treatment,were retrospectively analyzed,and the related literatures were reviewed.Result The first case of PRCA caused by HPVB19 after liver transplantation in our center with typical clinical manifestations of anemia was diagnosed,including dizziness,fatigue,anhelation and so on.A progressive decrease in erythrocyte count,reticulocyte count and hemoglobin level were observed by blood routine test.Bone marrow aspiration biopsy showed an absence of erythroid cells and the HPVB19 DNA test of blood was positive.Erythrocyte count,reticulocyte count and hemoglobin level were back to normal after the anti-rejection strategy changing from tacrolimus and rapamycin to cyclosporin and rapamycin and a normal human myelogram was observed by bone marrow aspiration biopsy.The DNA concentration of HPVB19 in blood was below the lower test limit.The blood test of HPVB19 DNA showed a positive result again after the anti-rejection strategy changed back to tacrolimus and rapamycin duo to increased blood creatinine level while the reticulocyte count was still in normal scale.This is the first reported case of successfully cured PRCA caused by HPVB19 in liver transplantation patients through changing the anti-rejection strategy and also the first case of HPVB19 re-infection or relapse without PRCA recurrence in liver transplantation patients.Conclusion This case may indicate the importance of immunosuppressive drug changing in the treatment of liver recipients suffering from PRCA caused by HPVB19 infection,and the genotype test may promote the understanding and treatment for this disease.
ABSTRACT
Objective To observe the early effect of organ donation after pancreas-kidney transplantation.Methods Eight cases of diabetic nephropathy received combined pancreas kidney transplantation.There were 8 donors,including 6 males and 2 females,with an average age of (26 10) years old (range from 15 to 42 years).There were 4 cases of donors with China during the transition period of brain heart double death organ donation (C-Ⅲ) standard,3 cases of donors in line with the international standard of brain death organ donation (C-Ⅰ) standard,1 case of international standard of heart death organ donation (C-lⅡ M-Ⅲ) citizen donors.There were 6 men and 2 women for recipients of the same blood type.Results Eight cases were awake 4-6 h postoperation and the ventilator was removed 8-14 h after operation.The rehabilitation therapy began 2 days postoperation from surgery intensive care unit (SICU) to the common wards.Serum C-peptide and insulin levels achieved normal range in 1-2 weeks after transplant.Blood glucose returned to the normal level in 2-3 weeks,and the creatinine level decreased to the normal level in 2 weeks postoperation.Duodenal intramural hematoma occurred in one patient intraoperatively,and the pancreatic graft was removed for safe consideration.Other patients had no serious surgical complications within 2 weeks after transplantation.Conclusion For organ donation after death of pancreas kidney transplantation,early organ function recovered well.Under the strict preoperative evaluation,the young donors can be safely used in combined pancreas and kidney transplantation.
ABSTRACT
<p><b>OBJECTIVE</b>To explore the diagnosis, treatment and long-term outcome of late acute rejection (LAR) following adult orthotropic liver transplantation (OLT).</p><p><b>METHODS</b>A total of 398 consecutive adult patients who underwent OLT in Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University between January 2007 and December 2012 were reviewed retrospectively. There were 48 patients (12. 1%) developed to LAR, including 43 male patients and 5 female patients, with an average age of (52 ± 13) years(18 - 70 years). The mean body mass index was (22.1 ± 4. 5) kg/m2 (15. 4 - 30. 4 kg/m2). The indications of the liver transplantation recipients included 16 cases of end-staged liver cirrhosis after hepatitis B or C(33. 3%), 14 cases with severe hepatitis (29. 2%), 9 cases of primary liver cancer(18. 5%), 5 cases of alcoholic liver cirrhosis (10. 4%), 1 case with autoimmune liver disease (2. 1%) , the other 3 cases (6. 3%). They were followed up by outpatient service, telephone and other means. Survival curves were generated with the Kaplan-Meier method and Cox proportional hazards modeling was used for predictors of mortality. Statistically significant variables found by single factor regression analysis were put into the Cox proportional hazards regression model of multivariate analysis.</p><p><b>RESULTS</b>The time-to-event was 23. 6 months after OLT which were more common in the first year to the third year post-transplant (26/48,52. 4%). Thirty-five cases were assessed as mild, 11 cases were assessed as moderate, and 2 cases were assessed as severe ,based on the Banff schema. After adjustment to the immunosuppressive regimen, the overall recovery rate reached to 81. 3%. The rate of steroid-resistant acute rejection was 11. 8% (4/34). Inadequate immunosuppression and steroid pulsation were two independent risk factors affecting the prognosis of LAR (P = 0. 008, P = 0. 003, respectively).</p><p><b>CONCLUSIONS</b>LAR is an uncommon complication after OLT. Inadequate immunosuppression and steroid pulsation are the major risk factors for prognosis of LAR. Improving patient compliance and strengthening blood concentration surveillance can increase the patient survival.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Acute Disease , Graft Rejection , Diagnosis , Mortality , Therapeutics , Hepatitis B , Immunosuppression Therapy , Liver Cirrhosis , Liver Neoplasms , Liver Transplantation , Mortality , Multivariate Analysis , Prognosis , Proportional Hazards Models , Retrospective Studies , Risk Factors , SteroidsABSTRACT
<p><b>OBJECTIVE</b>To determine whether the miRNA expression profile in peripheral blood mononuclear cells (PBMCs) differs between liver transplant recipients with long-term stable survival and those with acute rejection.</p><p><b>METHODS</b>Twenty-nine liver transplant recipients with long-term stable survival (STA) group, 10 recipients with acute rejection (RJ group), and 17 healthy subjects (control group) were recruited for genome-wide microarray analysis of miRNA expressions in the PBMCs. The differentially expressed miRNAs among the 3 groups were validated by real-time PCR, and the targets of these miRNAs were predicted.</p><p><b>RESULTS</b>Compared with the RJ group, the STA group showed down-regulation of 13 miRNAs in the PBMCs. Of these down-regulated miRNAs, miRNA-18b, miRNA-340 and miRNA-106b were validated by real-time PCR, and the latter two miRNAs were predicted to target the TGF-β pathway.</p><p><b>CONCLUSIONS</b>The differentially expressed miRNAs in liver transplant recipients with long-term stable survival, namely miRNA-18b, miRNA-340 and miRNA-106b, can be potential clinical biomarkers to predict the outcomes of liver transplantation.</p>
Subject(s)
Humans , Biomarkers , Metabolism , Case-Control Studies , Down-Regulation , Graft Rejection , Leukocytes, Mononuclear , Metabolism , Liver Transplantation , MicroRNAs , Metabolism , Oligonucleotide Array Sequence Analysis , Real-Time Polymerase Chain Reaction , Survival Rate , Transforming Growth Factor betaABSTRACT
Objective To explore the effect of kidney transplantation from donation after brain death (DBD) donors with terminal acute renal failure (ARF).Method The clinical data of kidney transplantation from DBD donors with ARF were retrospectively analyzed,and only standard criteria donors (SCD) were included.The results of kidney transplants from ARF donors were compared with those of kidney transplants from DBD donors with normal renal function (serum creatinine ＜ 133μmol/L) performed from January 2012 to March 2014.Result There were 13 donors with ARF and 27 donors with normal renal function (non-ARF donors).The ARF donors had significantly higher terminal serum creatinine than the non-ARF donors (394.9 ± 176.8 vs.75.4 ± 28.6 μmol/L,P＜0.001),but the initial serum creatinine (79.1 ± 17.2 vs.71.0 ± 22.8 μmol/L) and the best creatinine clearance rate (128.3 ± 33.0 vs.129.8 ± 46.8 ml/min) of two groups showed no significant difference (P＞0.05).Twenty-six recipients received kidney transplants from ARF donors (ARF group) and 54recipients received kidney trangplants from donors with normal renal function (non-ARF group).There was no significant difference in the incidence of delayed graft function and acute rejection between ARF and non-ARF kidneys (0 vs.1.9％,and 11.5％ vs.7.4％,respectively).The ARF group had significantly lower estimated glomerular filtration rate (eGFR) at 1st month after transplantation (54.3 ± 16.9 vs.62.5 ± 14.2 mL·min 11.73 m 2,p =0.025),but the eGFRs of two groups were similar at 6th and 12th month after transplantation.During a mean follow-up period of 11.5 months (range 3 to 28 months),actual patient and graft survival rate for both groups were 100％.Conclusion Kidneys from DBD donors with terminal ARF have excellent short-term outcomes and may represent another potential method to safely expand the donor pool.
ABSTRACT
Objective To analyze the risk factors for the outcomes of recipients after orthotopic liver transplantation using donation after cardiac death (DCD) donors.Method A retrospective study was performed to observe the available clinical data of 60 patients who had receiced hepatic allografts of DCD donors from July 2007 to December 2012 in our hospital and a 3-year follow-up was conducted to investigate outcome.In the patients whose ALT and/or AST levels were more than 1500 U/L within 72 h following surgery,early allograft dysfunction (EAD) was defined.Potential risk fators right before surgery included donor and recipient age,donor ALT AST,TBIL and WIT,and recipient creatine,TBIL,INR,albumin,MELD,BMI and recipient CIT.Kaplan-meier method was used to calculate the cumulative survival rate.Log-rank test and Cox regression model were performed to analyze donors and recipients related risk factors by univariate and multivariate analysis respectively.All statistical data were analyzed by using SPSS 19.0.Results The overall cumulative survival rate of 1 and 3 years was 76％ and 62％ respectively.Donor ALT,AST and WIT,and recipient Cre,MELD,CIT and EAD were significant risk fators in univariate analysis.However,the multivariate analysis revealed that donor WIT was the only independent risk factor affecting survival in our study.Conclusion By identifying and controlling certain characteristics,the outcomes of DCD liver transplant recipients could be dramaticly improved.