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Objective To evaluate the efficacy of perioperative use of tigecycline in preventing infection and the incidence of hypofibrinogenemia in liver transplant recipients. Methods Clinical data of 40 liver transplant recipients given with tigecycline to prevent infection were retrospectively analyzed. The incidence of infection in recipients and donor-derived infection were analyzed. The changes of clinical indexes in recipients during, upon the completion and (7±2) d after tigecycline treatment were analyzed, respectively. The incidence and treatment of hypofibrinogenemia were summarized. Results Among 40 liver transplant recipients, 2 cases were infected by aspergillus niger and cytomegalovirus, out of the antibacterial spectrum of tigecycline. After adjusting the anti-infection regimen, the infection was properly controlled. Liver allografts were positive for relevant culture in 9 cases, whereas none of them progressed into donor-derived infection. Approximately at postoperative 2 weeks, all 40 recipients restored liver function and were discharged from hospital. Among them, 6 recipients developed hypofibrinogenemia complicated with coagulation disorder at postoperative 2-4 d, whereas transaminase level, bilirubin level and infection-related indexes were gradually decreased after liver transplantation, and albumin level was stable. After supplemented with human fibrinogen and prothrombin complex, coagulation function was improved, but fibrinogen level persistently declined. After terminating use of tigecycline, fibrinogen level was gradually restored to normal range, which might be an adverse drug reaction induced by tigecycline. Conclusions Perioperative anti-infection regimen including tigecycline may reduce the incidence of infection caused by sensitive bacteria in liver transplant recipients. Nevertheless, the incidence of hypofibrinogenemia should be intimately monitored throughout the use of tigecycline.
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Objective:To summarize the incidence of acute rejection (AR) after pediatric kidney transplantation (KT) at a single center and examine its impact on graft/patient survival and risk factors for AR.Methods:This is a retrospective cohort study including pediatric recipients who underwent kidney transplantation in past 8 years.After excluding recipients of graft thrombosis within a week post-transplant and lost to follow-ups, a total of 143 cases were ultimately recruited and assigned into two groups of AR (n=29) and non-AR (n=114).Basic profiles of both donors and recipients and graft/patient survival rate were compared between two groups.Relative risk factors for AR episodes were also examined by Logistic regression.Results:Renal grafts for 130/143 cases (90.9%) were harvested from deceased donors and 120(83.9%) cases from children.Twenty-seven transplants (18.9%) were performed in infants and young recipients aged < 3 years.During a median follow-up of 33 months, 34 AR episodes occurred in 29(20.3%) patients.Rate of re-transplantation (27.6% vs. 7.9%), pediatric donor (96.5% vs. 80.7%) and rabbit anti-human thymocyte globulin (rATG) induction (79.3% vs. 36%) were significantly higher in AR group than non-AR group ( P=0.007, P=0.046, P<0.001).Multivariate regression analysis indicated that basiliximab induction caused a significant reduction in the risk of AR incidence as compared with rATG induction (odds ratio 0.13, 95% confidence interval 0.04-0.43, P<0.001).The median time of AR incidence was 1.3 months post-transplantation and 23 episodes (67.6%) were confirmed by biopsy.After anti-rejection treatment, 52.9%(n=18) of the cases achieved a full recovery and 38.3% (n=13) had improved graft function.However, 3 cases (8.8%) developed irreversible graft failure.The 1/3-year graft survival rates were significantly lower in AR group than those in non-AR group (75.3% vs. 95.2%, 68.4% vs. 90.4%, P=0.01), and there was no significant difference in 1-and 3-year patient survival rates between two groups. Conclusions:The incidence of AR is relatively high in pediatric renal transplantation, which has an impact on graft survival.Basiliximab induction can effectively reduce the risk of AR.
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In recent years, although the quantity of organ donation after citizen's death has been constantly increased, a large number of patients with end-stage renal diseases are waiting for kidney transplantation every year. The imbalance between donor and recipient is still one of the main problems affecting kidney transplantation in clinical practice. Therefore, it is of clinical significance to accurately evaluate the quality of donor kidney and fully utilize the expanded criteria donor kidney. Contrast-enhanced ultrasound has been gradually applied in the detection of multiple solid organs due to its safety, portability, real-time detection, quantification and other characteristics, and it also has promising application prospect in the evaluation of donor kidney quality. In this article, the advantages and limitations of current evaluation methods for donor kidney and current status and advantages of contrast-enhanced ultrasound in donor kidney evaluation were reviewed, and the application prospect of contrast-enhanced ultrasound in the evaluation of donor kidney quality was discussed, aiming to increase the methods and enhance the accuracy for donor kidney evaluation, and provide reference for rational use of expanded criteria donor kidney.
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Intestinal transplantation has become the most ideal treatment for intestinal failure. Modern clinical intestinal transplantation includes three types: isolated intestinal transplantation, combined liver-intestinal transplantation and abdominal multivisceral transplantation. The immunological, anatomical and physiological characteristics of intestinal grafts significantly differ from those of other solid transplant organs. Consequently, intestinal grafts could develop specific and severe complications, such as acute rejection, chronic rejection, graft-versus-host disease (GVHD), infection and posttransplant lymphoproliferative disease (PTLD), among which acute rejection and infection are extremely challenging. Endoscopic examination and intestinal mucosal biopsy of intestinal grafts could be performed to make timely diagnosis and differentiation of these complications, then deliver targeted treatment and guarantee the long-term survival of recipients and intestinal grafts.
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Objective:To explore a new model of Total Quality Management in project management of National Natural Science Foundation of China (NSFC).Methods:The theory of Total Quality Management is applied to the management of NSFC funded project, that is, a complete and comprehensive process formed which covered the different stages of project cultivation, application, identification, implementation, completion and post-completion tracking; and the management concepts of whole process personnel engagement and comprehensive quality management are penetrated into those different stages, furthermore, corresponding key points should be focused are also analyzed.Results:The hospital has made great achievements in scientific research management, project quantity, outputs, and discipline construction.Conclusions:The introduction of Total Quality Management theory into NSFC management is conducive to continuously improve the level of fund management, and enhance the scientific and technological innovation capacity building of the hospital.
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Objective:To explore the efficacy of sirolimus-based immunosuppressive protocol on tumor recurrence and tumor-free survival after liver transplantation(LT)in hepatocellular carcinoma (HCC)patients.Methods:From January 1, 2016 to December 31, 2018, a total of 114 HCC patients undergoing LT were recruited and divided into two groups of sirolimus(SRL)and tacrolimus. Univariate and multivariant analyses were performed for evaluating the risk factors of recurrence after LT. Tumor-free survival were compared using Cox logistic regression analysis.Results:Tumor recurrence and/or metastasis occurred in 45 patients. Univariate and multivariate regression analysis indicated that sirolimus was an independent protective factor for preventing tumor recurrence( P=0.005, HR=0.38, 95% CI 0.193~0.748). The median tumor-free survival time was 5(4~19)months in tacrolimus group and 23(13~31)months in sirolimus group. No inter-group statistical difference existed in incidence of infection or rejection complications( P>0.05). Conclusions:HCC patients benefit from sirolimus-based immunosuppressive protocol after LT. And sirolimus may reduce tumor recurrence rate and prolong tumor-free survival time.
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Objective:To explore the outcome of kidney transplantation from donation after cadaveric death(DCD)with high pathological Remuzzi score.Methods:From January, 2019 to December, 2019, 31 recipients of kidney allograft transplantation from marginal donors with Remuzzi score≥4 in preimplantation biopsy were retrospectively enrolled. They were divided into two groups of dual kidney transplantation(DKT, 14 cases)and single kidney transplantation(SKT, 17 cases). Median Remuzzi score of left kidney(5.05 in DKT group vs 4.92 in SKT group)or right kidney(5.26 vs. 4.58)was comparable. Dual donor kidneys were implanted into ipsilateral iliac fossa. Survival outcomes, kidney function, acute rejection episodes, incidence of delayed graft function(DGF)and proteinuria were recorded within Year 1 post-operation.Results:Proportion of male(92.9% vs. 52.9%, P<0.05)and recipient's body mass index(BMI, 23.93 vs. 21.09)were significant higher in DKT group than those in SKT group. One graft failure occurred in DKT group at Month 11 post-operation. The 1-year graft survival rate was 92.9% in DKT group and 1-year recipient survival rate both 100% in two groups. Mean 12-month serum creatinine[SCr, (164±37.7)μmol/L vs. (154.92±96.2)μmol/L]and estimated glomerular filtration rate[eGFR, (41.84±9.01) vs. (44.8±18.16)ml/(min·1.73m 2)]were comparable between two groups(both P>0.05). There was no occurrence of thrombosis resulting in graft loss. One-year incidence of acute rejection, rate of DGF(42.9% vs 41.2%)and proteinuria(57.1% vs. 41.2%)were comparable between two groups(both P>0.05). Conclusions:Through donor-recipient matching and dual kidney transplant allocation, short-term survival outcome of kidney allograft from marginal donors with high Remuzzi score≥4 is encouraging. However, long-term outcomes should be further examined.
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Objective:To observe the safety and efficacy of early conversion into a simplified once-daily immunosuppressive regimen of sirolimus plus low-dose extended-release tacrolimus in kidney transplant recipients.Methods:From April 2019 to August 2020, clinical data were collected from 44 recipients (22 pairs) of kidney transplantation. Two kidneys from the same donor were randomly divided into observed and control groups. The immunosuppressive regimen of two groups was the same within 1 month post-transplantation, i. e. tacrolimus plus mycophenolatemofetil (or mycophenolate sodium) and prednisone. Then the immunosuppressive regimen of observed group was switched into a simplified once-daily regimen of sirolimus plus low-dose extended-release tacrolimus and prednisone while control group remained unchanged. The changes of graft function, proteinuria and the incidence of related adverse events were recorded.Results:No inter-group difference existed in serum level of creatinine at Month 1 post-transplantation (163.40±51.57 vs 166.10±49.48 μmol/L). After regimen conversion, serum level of creatinine was slightly lower in observed group than that in control group at Months 3 and 6 post-transplantation (130.10±30.10 vs 134.90±28.97, 121.50±24.96 vs 136.30±27.06). However, there was no statistic difference. The 24-hour urinary total trace protein was slightly higher in observed group than that in control group (331.20±84.21 vs 279.50±80.91 and 209.60±66.02 vs 179.50±37.60 mg/24 h) at Months 3 and 6 post-transplantation. However, there was no statistic difference. No inter-group difference existed in the incidence of drug side effects or other adverse events.Conclusions:In kidney transplant recipients at Month 1 post-transplantation, a conversion of immunosuppressive regimen into a simplified once-daily of sirolimus plus low-dose extended-release tacrolimus can significantly boost patient compliance without an elevated risk of drug side effects or adverse events and offer an advantage of reducing nephrotoxicity.
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Objective:To improve the level of detection method and quality control at different transplant centers in China and comprehensively analyze the data of tacrolimus(Tac)detection in multiple transplant centers and provide data supports.Methods:Low, medium and high concentration commercial quality control products in triplicate samples were delivered to 34 domestic organ transplantation centers and testing repeated for 2~3 times during different time periods. The detection results of 240 quality control samples were summarized. The methods, accuracy and stability of Tac detection results were analyzed.Results:In international standard laboratories, mean±standard deviation(SD)of Tac detection results of low/medium/high concentration commercial quality control products was(4.70±0.325), (8.46±0.548)and(13.50±0.966)respectively. Here the results were (4.79±0.605), (8.49±0.948)and(13.99±1.604)respectively. In contrast, SD and degree of variation of international standard data were smaller, indicating that the accuracy and stability of international standard laboratories in detecting Tac were higher. SD of Tac concentrations detected by international standard laboratory for low/medium/high concentrations was approximately 0.3, 0.5 and 1.0 respectively, i.e.International first-class level. Here SD was approximately 0.5, 1.0 and 1.5 respectively, i.e. Chinese industry level.Conclusions:The "Chinese industry level" is recommended. Before using a new batch of "testing reagents" , "standard control samples" must be employed for calibrating the calculated curve. The calculated curve should be re-calibrated at least once per month. And clinicians should be consulted frequently.
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The pathology of liver allograft biopsy is not only essential for the evaluation of liver donor, but also for the diagnosis and differential diagnosis of posttransplantation complications. With the development of liver transplantation in clinical practice, relevant studies of the pathological diagnosis of liver allograft complications have been deepened. Banff classification on liver allograft pathology have been gradually established within the international community. In China, pathological studies related to liver allograft pathology have been steadily carried out, and the pathological diagnostic basis of liver allograft pathology suitable for the clinical practice of liver transplantation in China has been gradually formed. This article reviews the history of Banff liver allograft pathology and major pathological lesions of liver allograft complications, aiming to provide reference for implementing pathological diagnosis of liver allograft pathology in China, assisting clinical diagnosis and targeted treatment of complications after liver transplantation, and further improving the survival of liver allograft and recipients.
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Objective:To explore the early warning value of carbapenem-resistant Klebsiella pneumoniae (CRKP) positivity in liver transplantation recipients with rectal swabs, examine the risk factors of CRKP bloodstream infection and provide the relevant treatments.Methods:From June 2018 to December 2019 in Organ Transplantation Research Institute Affiliated Tongji Hospital Tongji Medical College Huazhong University of Science & Technology, 148 cases of liver transplantation recipients with positive CRKP rectal swabbing were recruited. Clinical data were retrospectively analyzed. And the risk factors of CRKP bloodstream infections were examined for intervention and non-intervention groups to observe the effect of interventions of CRKP bloodstream infections.Results:Among them, 23 cases (15.5%) were positive for CRKP and 5 cases (21.7%) were infected with CRKP bloodstream. Rectal swab culture was negative in 125 cases and no bloodstream infection occurred. Long-term use of broad-spectrum antimicrobial agents, severe basic diseases (severe hepatitis), postoperative delayed graft liver function recovery, acute renal failure requiring renal replacement therapy (RRT) and postoperative anti-thymocyte globulin (ATG) induction were risk factors. In intervention group, there were 2 cases (11.1%) of 18 patients with positive CRKP in rectal swab culture in late stage. Among 5 CRKP-positive recipients without intervention, 3 cases (60%) developed later CRKP bloodstream infection. The incidence of bloodstream infection was significantly lower in intervention group than that in non-intervention group ( P<0.05). Conclusions:Rectal swab culture for liver transplantation recipients provides early warning for CRKP bloodstream infection. Interventions for CRKP positive high-risk recipients with rectal swab culture may reduce the occurrence of CRKP bloodstream infection and lower the risk of CRKP bloodstream infection in liver transplantation recipients.
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Objective To analyze the clinical efficacy of different anti-tumor therapies for recurrence and metastasis after liver transplantation for primary liver cancer (liver cancer). Methods Clinical data of 145 recipients undergoing liver transplantation for liver cancer were retrospectively analyzed. The overall survival and recurrence and metastasis after liver transplantation for liver cancer were analyzed. The clinical efficacy of different anti-tumor therapies for recipients with recurrence and metastasis were compared. Results Sixty-five recipients (44.8%) developed recurrence and metastasis. The median recurrence time was 6 months. Among them, 1 case underwent secondary liver transplantation after recurrence and died of intestinal perforation. Twenty-four recipients (37%) received targeted drug therapy with a median tumor-bearing survival of 22 months. Eleven recipients (17%) received radiotherapy or chemotherapy with a median tumor-bearing survival of 11 months. Nine recipients (14%) received local treatment (surgical resection or radiofrequency ablation), and the median tumor-bearing survival was 8 months. Twenty recipients (31%) abandoned anti-tumor therapy, and the median tumor-bearing survival was 3 months. The tumor-bearing survival of recipients receiving anti-tumor therapy was significantly longer than that of recipients without anti-tumor therapy (P < 0.001). The tumor-bearing survival of recipients receiving targeted drug therapy was significantly longer than that of those receiving other anti-tumor therapies (P=0.03). The tumor-bearing survival of recipients receiving local treatment, radiotherapy and chemotherapy was considerably longer than that of those who abandoned anti-tumor therapy (P=0.004). Conclusions Surgical resection and radiofrequency ablation are the optimal therapies for recipients with recurrence and metastasis after liver transplantation for liver cancer. For recipients with multi-focal tumors who fail to receive local treatment, those receiving targeted drug therapy obtain the longest survival. In addition, radiotherapy and chemotherapy can also prolong the survival of recipients with recurrence and metastasis.
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Objective@#To analyze the clinical characteristics of one living-related kidney transplant recipient infected with 2019 coronavirus disease (COVID-19) .@*Method@#The clinical diagnosis and treatment of one relative renal transplant recipient after the occurrence of COVID-19 were analyzed retrospectively, including the course of onset, clinical manifestations, blood routine test, renal function, lung CT scan, nucleic acid detection, outpatient and inpatient therapies and outcomes.@*Result@#The case was diagnosed as COVID-19 (severe type) with influenza A virus infection. The clinical symptoms were gradually relieved and the lung lesions were absorbed through the treatment of reduce and stop taking immunosuppressant, antiviral therapy of abidol/oseltamivir, prevention of bacterial infection, hormone anti-inflammatory, oxygen inhalation, nutritional support and adequate rest.@*Conclusion@#This case present typical characteristics of COVID-19 in epidemiological investigation, clinical manifestation, examination, pulmonary imaging and etiology. After comprehensive treatment including reduce and stop immunosuppressive therapy, clinical cure was achieved. The long-term effect of COVID-19 on this immunosuppressive patient remains follow-up.
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In the second half of 2019, the last four sessions of Transplant Cloud College jointly established by Chinese Research Hospital Association and Medical Neighbor Network were successfully held. During the courses in the second half of this year, the lecturers from each institution mainly focused upon four topics including management of hyperuricemia (HUA) after kidney transplantation, renal graft pathology, diagnosis and treatment of acute antibody-mediated rejection (AMR) after kidney transplantation and pulmonary infection after liver transplantation. All participants delivered discussions and exchanges in kidney and liver transplantation from multiple perspectives.
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Objective To provide a system for warning, preventing and controlling emerging infectious diseases from a macroscopic perspective, using the COVID-19 epidemic data and effective distance model. Methods The dates of hospitalization/isolation treatment of the first confirmed cases of COVID-19 and the cumulative numbers of confirmed cases in different provinces in China reported as of 23 February, 2020 were collected. The Location Based Service (LBS) big data platform of 'Baidu Migration' was employed to obtain the data of the proportion of the floating population from Wuhan to all parts of the country. Effective distance models and linear regression models were established to analyze the relationship between the effective distance and the arrival time of the epidemic as well as the number of cumulative confirmed cases at provincial and municipal levels. Results The arrival time of the epidemic and the cumulative number of confirmed cases of COVID-19 had significant linear relationship at both provincial and municipal levels in China, and the regression coefficients of each linear model were significant ( P <0.001). At the provincial level, the effective distance could explain about 71% of the variation of the model with arrival time along with around 90% of the variation for the model in the cumulative confirmed case magnitude; at the municipal level, the effective distance could explain about 66% of the variation for the model in arrival time, and about 85% of the variation of the model with the cumulative confirmed case magnitude. Conclusions The fitting degree of the models are good. The LBS big data and effective distance model can be used to estimate the track, time and extent of epidemic spread to provide useful reference for early warning, prevention and control of emerging infectious diseases.
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Objective:To explore the clinical characteristics of one living-related kidney transplant recipient infected with 2019 coronavirus disease(COVID-19).Methods:The clinical diagnosis and treatment of one living-related kidney transplant recipient after the occurrence of COVID-19 were analyzed retrospectively. Course of onset, clinical manifestations, laboratory and image enamination, outpatient and inpatient therapies and outcomes.Results:The renal transplant recipient was diagnosed as COVID-19(severe) with influenza A virus infection based upon epidemiological survey, clinical manifestations, laboratory examinations, imaging findings and etiological tests. The clinical symptoms were gradually relieved and lung lesions became absorbed after tapering and withdrawing immunosuppressants, antiviral therapy of abidol/oseltamivir, antibiotic therapy, hormonal anti-inflammation, oxygen inhalation, nutritional supports and adequate rest.Conclusions:Living-related kidney transplant recipients have specific immunosuppressive states.The long-term effect of covid-19 on recipients should be determined through long-term follow-ups.
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Objective:To summarize the transplant outcomes of pediatric kidney transplantation at a single center and discuss probable measures of improving the outcomes.Methods:A total of 111 pediatric renal transplantation were performed from September 2002 to September 2019. They were divided into adult-donor group ( n=41) and pediatric-donor group ( n=70). Adult-donor group consisted of two subgroups based upon donor sources: living-donor group ( n=19) and deceased-donor group ( n=22). Pediatric-donor group consisted of two subgroups based upon surgical types: single kidney group ( n=48) and en bloc kidney group ( n=22). Clinical data and outcomes of grafts and recipients were retrospectively analyzed. Results:The average age of recipients was (15.6±1.9) years in adult-donor group. None developed delayed graft function (DGF) in living-donor group whereas 6 patients (27.3%) had DGF in deceased-donor group ( P<0.05). During a follow-up period of 22-181 months, 1-year and 5-year graft survivals were 100% vs 94.1% and 93.8% vs 94.1% in living-donor and deceased-donor groups respectively. There were no statistical differences. In pediatric-donor group, the age of donors was significantly lower in en bloc subgroup than that in single kidney subgroup (median: 0.5 vs 6 months, P<0.05). The age of recipients was similar between two subgroups: (9.5±5.3) years in single kidney group vs. 11.5± 1.8 years in en bloc kidney group. In addition, 7 cases of single kidney were transplanted for infant recipients aged under 1 year. Vascular thrombosis occurred in 3 patients (6.3%) of single kidney group, less than that in 5 patients (22.7%) of en bloc kidney group ( P=0.06). During a follow-up period of 4-54 months, 1-year and 2-year graft survivals were 85% and 80% in single kidney group whereas 75% and 70% in en bloc kidney group. However, there was no statistically significant difference. One-year survival was 98% in single kidney group and 95% in en bloc kidney group. Conclusions:For elder pediatric recipients, excellent kidney transplant outcomes may be achieved with grafts from adult donors. For pediatric kidney recipients, transplant outcomes can be further improved with careful assessments and cautious usage of small grafts, particularly those form neonatal donors.
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Objective To explore the influencing factors and treatment strategies of long-term survival after simultaneous pancreas and kidney transplantation (SPK ) .Methods One case of long-term post-SPK survival was reviewed and its influencing factors were analyzed along with the relevant literature .Results At 10 years post-SPK ,the patient lost transplanted kidney due to rejection and underwent secondary kidney transplantation . The transplanted pancreas functioned well and has survived for more than 18 years .Conclusions Strict preoperative screening ,adopting mature surgical approaches ,aggressive managements of various perioperative complications ,strengthening of health education of recipients ,improving of compliance and long-term regular follow-ups are conducive for enhancing long-term survival of recipients and grafts of SPK .
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Objective To investigate the diagnosis and treatment of graft-versus-host-disease (GVHD) after solid organ transplant (SOT) and the possible mechanism.Methods In this study,we retrospectively reported a rare case of GHVD after kidney transplantation and performed a literature review.This 51 year old male patient presented with over 10-day history of sporadic skin rash on postoperative day 50.Skin biopsy examination revealed GVHD.For further clear diagnosis,patient's peripheral blood was collected immediately for short tandem repeats (STR) enriched for CD3+ cells and we also performed immunofluorescent staining for patient's skin with specific HLA-A11 antibody,one of donor specific HLA sites.Meanwhile,the decreased immunosuppression was used for treatment.Results In our report,chimerism analysis by STR revealed no chimerism in patient's peripheral blood.However,immunofluorescent staining of patient's skin demonstrated abundant donor-derived lymphocytic infiltration existed.GVHD was definitely made in this case.After treatment with decreased immunosuppression and a low dose of methylprednisolone (MP),his clinical symptom was quickly alleviated.Now the patient was discharged and the renal function was normal.Conclusion Combined with literature review and our case report,we thought that chimerism analysis by STR and immunofluorescent staining by donor-specific HLA antibody were very useful for diagnosis of GVHD after SOT.Furthermore,GVHD referred to over-immunosuppression and prognosis of GVHD after kidney transplantation is usually satisfactory.
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Objective To summarize the effect of professional organ procurement team at Tongji Hospital in Chinese donation after citizen's death.Methods A retrospective analysis was done on the clinical data of 335 cases of organ acquisition by the professional organ procurement team of Tongji Hospital,including 27 infant donors and the efficiency of the team was assessed.Results Retrospective analysis on the clinical data of 335 cases of organ acquisition by the professional organ procurement team of Tongji Hospital,including cases of 27 infant donors and assessment on the efficiency of the team.Conclusion The establishment of a professional organ procurement team is to standardize the procurement procedure and shorten the time in pre-surgical preparation and operation,decreasing the errors and deviations caused by human factors in the procurement process.