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Objective To analyze and compare the dosage,blood concentration and metabolic characteristics of Tacrolimus (Tac) for pediatric patients who underwent living related liver transplantation (LRLT) or donation after cardiac death liver transplantation (DDLT).Methods The clinical data of 75 liver transplantation pediatric patients from October 2012 to August 2015 were retrospectively analyzed.According to the different source of donors,the recipients were divided into two groups:LRLT group (40 cases) and DDLT group (35 cases).Results (1) Under the condition of same initial Tac dosage,the Tac dosage in LRLT group was less than in DDLT group during the first 28 days post-transplantation (P＞ 0.05).However,the Tac dosage in DDLT group was significantly higher than in LRLT group on the second and third months after sugery (P =0.000).(2) Correlation analysis revealed that graft-recipient body weight ratio (GRWR) was correlated with Tac dosage (mg·kg-1 ·d-1) on the 14th day postoperative (LRLT group:r=0.579,P＜0.05;DDLT group:r =0.583,P＜0.05) and Tac concentration/dosage ratio (LRLT group:r =-0.607,P＜0.05;DDLT group:r=-0.680,P＜0.05).Conclusion Tac has a satisfactory anti-rejection effect on liver transplantation pediatric patients while the metabolism varied with each individual.There is a positive correlation between the early Tac dosage and the GRWR in both groups.It is necessary to set individualized Tac administration regimen according to the metabolic characteristics and GRWR.
ABSTRACT
Objective To analyze the clinical effectiveness of using marginal donor kidney in living kidney transplant. Methods From November 2005 to June 2011,274 cases of living kidney transplant were performed in the First Affiliated Hospital of Zhengzhou University.The cases were divided into the marginal donors group ( Donor ages over 60 years old,suboptimal renal anatomy or physiology) of 66 cases and standard donors group of 208 cases.The clinical data were retrospectively analyzed.The criteria of marginal donors were as follows:36 cases of donors with age over 60 yrs (6 cases with renal cysts and 1 case with renal calculus),22 cases of renal cysts ( with diameter range from 4 mm to 40 mm ),4 cases of renal calculus (with diameter range from 3 mm to 6 mm),4 cases of low GFR (under 35 ml/min.The mean recipients' serum creatinine before surgery and after surgery on day 3,day 7,month 1,month 3,month 6,month 12,related complications,the rate of acute rejection and delayed graft function,1 year,3 year recipient/kidney survival were compared between the 2 groups,respectively. Results The serum creatinine levels in the marginal donor group and standard donor group were (242.7 ± 132.2 vs 185.6 ± 148.4) and ( 156.7 ±86.8 vs 122.2 ± 136.8 ) on day 3,day 7 respectively ( P ＜ 0.05 ).Nevertheless,there were no significant differences between the 2 groups in recipients' serum creatinines before surgery and after surgery on month 1,month 3,month 6,month 12,peri-operative complications,the rate of acute rejection and delayed graft function,1 year,3 year recipient/kidney survival (P ＞ 0.05). Conclusions Healthy old donors and donors with renal cyst (the diameter of renal cysts under 40mm) should not be the barriers to organ donation.To those living donors with low GFR,we should consider of donor age,donor/recipient body weight,donor/recipient body surface area and whether we could deal with the problem by surgical operation.Donor with renal calculus should be carefully evaluated.
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Objective To analyze the influence of donating kidney of marginal donors on the early prognosis of living-related kidney transplant recipients.Methods Sixty-six cases of living-re-lated kidney transplant patients between February 2004 and September 2007 were divided into the marginal donors group(28 cases)and non-marginal donors group(38 cases).Serum creatinine before and after surgery,creatinine clearance after surgery and perioperation complications were compared respectivelv between the 2 groups.Results The serum creatinine levels in the marginal donors group and non-marginal donors group were 154,131,127μmol/L and 132,117,118 ttmol/L on 7th day,1st month and 3rd month after transplantation respectively,and there were no significant differences between the 2 groups(P＞0.05).The serum creatinine level in parent-child donating kidney of the 2 groups Was 160,131,126μmol/L and 132,129,126μtmol/L on 7th day,1st month and 3rd month after transplantation respectively,and there were no significant differences too(P＞0.05).There was no difference in the rate of perioperation complications and creatinine clearance after kidney transplantation between the 2 groups.Conclusions The early prognosis of marginal donors'recipients is ideal.The marginal donors could be selected as the living-related kidney transplant donors,especially between parent and child,as long as they are evaluated according to stricter criteria.But the long-term prognosis of the recipients should be further observed.
ABSTRACT
It is an obvious contradiction between the shortage of kidney donors and the increasing demand for kidney transplantation.Living- related donor kidney transplantation may be a proper resolution,which has been academically proved to be superior to cadaveric kidney transplantation.However,there are still many ethical problems unsolved.Based on ethical theory and the"Seven Principles",we explore possible solutions to the ethical problems of living - related donor kidney transplantation.