器官移植

2017 Vol. 8, No. 5

column

Editorial
Original Articles
Short Article
Review Articles

Previous Issue | Next Issue

Select articles

Display Method:

Editorial

2017, 8(5): 337-343. doi: 10.3969/j.issn.1674-7445.2017.05.001

Abstract(291) HTML (61) PDF 2030KB($!{article.pdfDownCount})

Abstract:

Original Articles

Training and evaluation of donor lung procurement technique in swine models

Wang Zhe, Chen Manying, Lin Huiqing, Tian Feng, Ye Bo, Liu Mingyao

2017, 8(5): 344-348. doi: 10.3969/j.issn.1674-7445.2017.05.002

Abstract(108) HTML (40) PDF 1547KB($!{article.pdfDownCount})

Abstract:
Objective To investigate the training methods and evaluation parameters for donor lung procurement technique in swine models. Methods The surgical skills of donor lung procurement in 15 swine models were summarized. The operation time, objective evaluation parameters before lung perfusion, gross observation after lung perfusion, the type and frequency of intraoperative errors were assessed. Results All donor lung procurement surgeries were successfully completed in 15 swine models. The mean time interval from skin incision to lung perfusion was 22.6 min. Prior to lung perfusion, the oxygenation index of the donor lung was (501±68) mmHg, (404±100) mL (under the pressure of 15 mmHg) for the tidal volume and (29±4) mL/cmH₂O for the static compliance. Along with the increasing surgical frequency, the oxygenation index and tidal volume were improved. Favorable lung inflation was obtained after lung perfusion in a majority of swine models. Intraoperatively, multiple operating errors occurred including dissection error, pulmonary arterial intubation error and procedure error, etc. As the frequency of operation increased, the frequency of surgical errors was significantly decreased. Conclusions After certain training for donor lung procurement in swine models, the incidence of intraoperative procedure error is significantly reduced and the quality of the donor lung tends to be enhanced. Objective parameters, such as oxygenation index and the gross shape of the donor lung can be utilized to evaluate the levels of surgical techniques.

High-dose sirolimus protects hepatic ischemia-reperfusion injury probably through promoting cellular autophagy in aged mice

Teng Xu, Ding Fan, Chen Wenjie, Xu Chi

2017, 8(5): 349-354. doi: 10.3969/j.issn.1674-7445.2017.05.003

Abstract(73) HTML (56) PDF 1905KB($!{article.pdfDownCount})

Abstract:
Objective To investigate the effect and mechanism of high-dose sirolimus (rapamycin) upon protecting the hepatic ischemia-reperfusion injury (HIRI) in aged mice. Methods Twenty C57BL/6 aged mice were randomly and evenly divided into the ischemia-reperfusion injury group (IRI group), low-dose rapamycin pretreatment group (rpm group), high-dose rapamycin pretreatment group (RPM group) and control group (Sham group) using the random number table method (5 mice in each group). In the Sham group, abdominal cavity was incised and sutured alone. In the other three groups, aged mouse 70% HIRI models were established. The ischemia time was 60 min. At preoperative 1 h, rapamycin at a dose of 1 mg/kg and 5 mg/kg was administered via intraperitoneal injection in the rpm and RPM groups. At 12 h post-reperfusion, hematoxylin-eosin (HE) staining was performed to observe the histological changes in the mouse liver. Suzuki grading method was adopted to evaluate the pathological score. The serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), tumor necrosis factor (TNF)-α and interleukin (IL)-10 and the LC3B-Ⅱ protein level in the liver tissues were quantitatively measured and statistically compared among different groups. Results HE staining of the liver tissues revealed normal liver tissues in the Sham group, severe liver cellular injury accompanied with a large quantity of inflammatory cellular infiltration in the IRI and rpm groups. Mild sinusoidal congestion and slight inflammatory cellular infiltration were observed in the RPM group. The pathological score was 5 (4-6) in the RPM group, significantly lower than 7 (5-8) and 8 (7-10) in the rpm and IRI groups (Z=-2.554 and -2.731, both P < 0.05). In terms of postoperative liver function parameters, the AST level was (691±207) U/L in the RPM group, significantly lower compared with (2 032±575) U/L and (1 817±777) U/L in the IRI and rpm groups (t=4.90 and 3.13, both P < 0.05). In the RPM group, the ALT level was measured as (996±584) U/L, considerably lower than (2 992±992) U/L and (2 373±687) U/L in the IRI and rpm groups (t=3.86 and 3.41, both P < 0.05). The AST and ALT levels did not significantly differ between the IRI and rpm groups (both P > 0.05). No statistical significance was identified in the TNF-α and IL-10 levels among different groups (all P > 0.05). Western blot analysis revealed that the relative expression level of LC3B-Ⅱ protein in the liver tissue of the RPM group was significantly higher than those in the Sham, IRI and rpm groups (all P < 0.05). Conclusions Administration of high-dose rapamycin exerts a protective effect upon HIRI probably through promoting cellular autophagy in aged mice.

Effect of extracorporeal photopheresis on the expression of IL-12p70 and Th1/Th2-like cytokines in mouse models with skin allograft

Wei Yuxiang, Xiao Li, Cai Ming, Qian Yeyong, Yu Tao, Shi Bingyi

2017, 8(5): 355-359. doi: 10.3969/j.issn.1674-7445.2017.05.004

Abstract(172) HTML (131) PDF 1338KB($!{article.pdfDownCount})

Abstract:
Objective To evaluate the effect of extracorporeal photopheresis upon the expression levels of interleukin (IL)-12p70 and T helper cell (Th) 1/Th2-like cytokines in splenic lymphocytes of mouse models undergoing skin transplantation. Methods The C57BL/6 mice were used as the donors and BALB/c mice as the recipients to establish mouse models with skin allograft. The splenic lymphocytes in the C57BL/6 and BALB/c mice (CSP and BSP) were isolated and treated with 8-methoxypsoralen combined long-wave ultraviolet (PUVA-SP). According to the components of intravenous infusion into the recipients, all experimental animals were randomly divided into the PUVA-BSP, PUVA-CSP, BSP, CSP and phosphate buffer solution (PBS) control groups (n=12 for each group). The mice were injected with PUVA-BSP, PUVA-CSP, BSP, CSP or PBS via the caudal vein at preoperative 7 d, upon the day of surgery and at postoperative 7 d, respectively. The apoptosis of the splenic lymphocytes was observed after PUVA treatment. The expression levels of IL-12p70 and Th1/Th2-like cytokines in the peripheral blood of the recipients were quantitatively measured. Results After the skin transplantation, the expression levels of IL-12p70 in the peripheral blood of mice in the PUVA-BSP and PUVA-CSP groups were significantly down-regulated compared with those in the BSP, CSP and PBS control groups (all P < 0.01). In the PUVA-BSP and PUVA-CSP groups, the expression levels of Th1-like cytokine IL-2, interferon (IFN)-γ were dramatically lower than those in the BSP, CSP and PBS control groups (all P < 0.01). The expression levels of Th2-like cytokine IL-10 in the PUVA-BSP and PUVA-CSP groups were significantly up-regulated compared with those in the BSP, CSP and PBS control groups (all P < 0.01). Conclusions Infusion of PUVA-SP at a sufficient dose can induce the low expression level of IL-12p70 and drive the incidence of Th2 immune deviation in the recipient BALB/c mice.

Value of MELD-Na score for prediction of the incidence of acute kidney injury early after orthotopic liver transplantation using retrograde perfusion

Wei Guoqing, Cheng Yuan, Cai Qiucheng, Yang Fang, Jiang Yi

2017, 8(5): 360-364. doi: 10.3969/j.issn.1674-7445.2017.05.005

Abstract(151) HTML (48) PDF 1221KB($!{article.pdfDownCount})

Abstract:
Objective To evaluate the value of preoperative model for end-stage liver disease combined with serum sodium (MELD-Na) score for the prediction of the incidence of acute kidney injury (AKI) early after liver transplantation. Methods Clinical data of 315 recipients undergoing orthotopic liver transplantation by retrograde inferior vena caval perfusion were retrospectively analyzed. According to preoperative MELD-Na score, all patients were divided into group A (MELD-Na score ≤ 10, n=115), group B (10<MELD-Na score ≤ 20, n=118) and group C (MELDNa score>20, n=82). Preoperative and intraoperative parameters of the recipients were statistically compared among three groups. Preoperative parameters included serum creatinine (Scr), blood urea nitrogen (BUN), albumin (Alb), total bilirubin (TB), prothrombin time-international normalized ratio (PT-INR), mean arterial pressure (MAP) and serum Na⁺, etc. Intraoperative parameters included operation time, vena caval occlusion time, hemorrhage volume, quantity of red blood cell infusion, quantity of plasma transfusion and total fluid infusion volume, etc. The incidence and staging of AKI early after liver transplantation in the recipients were statistically compared among three groups. Spearman's rank correlation analysis was performed to analyze the correlation between preoperative MELD-Na score and AKI staging. Results Preoperative BUN, Alb, TB, PT-INR, MAP and Na⁺ in the recipients significantly differed among three groups (all P < 0.05). Intraoperative vena caval occlusion time, hemorrhage volume, quantity of red blood cell infusion and quantity of plasma transfusion significantly differed among three groups (all P < 0.05). In 315 recipients undergoing liver transplantation, the incidence of AKI within postoperative 1 week was 64.8% (204/315), and 43% (49/115), 71% (84/118) and 87% (71/82) in group A, B and C. Statistical significance was identified among three groups (all P < 0.05). Spearman's rank correlation analysis revealed that preoperative MELD-Na score was positively correlated with AKI staging (r=0.442, P=0.000). Conclusions MELD-Na score not only acts as a parameter evaluating preoperative patients' conditions, but also serves as a pivotal parameter predicting postoperative incidence of AKI.

Desensitization treatment with bortezomib in a highly-sensitized patient before secondary renal transplantation:report of one case and literature review

Du Xin, Sun Zejia, Cai Jifei, Li Xin, Liu Hang, Ren Liang, Zhang Xiaodong, Wang Wei

2017, 8(5): 365-370. doi: 10.3969/j.issn.1674-7445.2017.05.006

Abstract(232) HTML (145) PDF 2588KB($!{article.pdfDownCount})

Abstract:
Objective To summarize the clinical experience of the application of bortezomib desensitization regime prior to secondary renal transplantation in a highly-sensitized recipient. Methods At 13, 10 and 6 d prior to secondary renal transplantation, one patient positive for donor specific antibody (DSA) was subcutaneously administered with bortezomib at a dose of 1.3 mg/m² combined with a low dose of immunoglobulin. Postoperatively, immunosuppressive regime of tacrolimus (FK506), mycophenolat sodium and methylprednisolone was adopted. The serum creatinine (Scr), blood urea nitrogen (BUN) levels, FK506 concentration, DSA titre, C3d binding DSA (C3d-DSA) titre, pathological biopsy of the renal graft and adverse reactions were observed. Results During 12-month follow-up after administration of bortezomib, the Scr level was declined and maintained at 130 μmol/L, and the BUN level was remained at 3.9 mmol/L. The DSA level was significantly decreased and the C3d-DSA was negative. At postoperative 4 and 9 months, pathological biopsy of the renal graft revealed that the patient was positive for C4d, prompting the chronic active antibody mediated rejection (AMR). The patient presented with grade Ⅲ peripheral neuropathy. Conclusions Application of preoperative bortezomib desensitization regime can effectively down-regulate the DSA level in the recipient and avert the incidence of acute rejection in highly-sensitized patients undergoing secondary renal transplantation. Comprehensive treatment using bortezomib is recommended for preoperative desensitization in the highly-sensitized transplant recipients.

Investigation of psychological status of organ donation coordinators

Xiong Tianwei, Zhang Ming, Tang Yue'e, Yang Yang

2017, 8(5): 371-375. doi: 10.3969/j.issn.1674-7445.2017.05.007

Abstract(96) HTML (68) PDF 1387KB($!{article.pdfDownCount})

Abstract:
Objective To investigate the psychological status of organ donation coordinators. Methods The anxiety, depression, sleep quality and personality characteristics of 40 organ donation coordinators were assessed by self-rating anxiety scale (SAS), self-rating depressive scale (SDS), Pittsburgh sleep quality index (PSQI) and Eysenck personality questionnaire (EPQ), respectively. Results The SAS and SDS scores of the organ donation coordinators were significantly higher than those of the norm group (t=23.372, 9.743; both P < 0.05). The component scores of sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication and daytime function, and the total score of PSQI of the organ donation coordinators were significantly higher than those in the norm group (t=8.054, 7.274, 6.634, 10.613, 8.376, 19.166, 8.496, 17.372; all P < 0.05). In terms of EPQ score, the N dimension score of male organ donation coordinators were considerably higher than that of the norm group (P < 0.05). No statistical significance was identified in the N dimension score between the female organ donation coordinators and the norm group (P < 0.05). The P, E and L dimension scores of the male and female organ donation coordinators did not significantly differ from those of the norm group (all P < 0.05). Conclusions Organ donation coordinators present with varying degree of anxiety, depression and poor sleep quality, which deserves sufficient attention. Positive measures should be taken to mitigate these symptoms.

Effect of hypothermia status in donors on renal graft function after renal transplantation from donation after citizen's death

Liu Kepu, Zhang Geng, Li Zhibin, Ruan Dongli, Gao Long, Wang Huilong, Zheng Wenfeng, Yuan Jianlin

2017, 8(5): 376-380. doi: 10.3969/j.issn.1674-7445.2017.05.008

Abstract(124) HTML (77) PDF 1233KB($!{article.pdfDownCount})

Abstract:
Objective To evaluate the effect of hypothermia status in the donors upon the renal graft function after renal transplantation from donation after citizen's death. Methods Thirty-six eligible donors were randomly divided into the normal temperature (body temperature 36.5-37.5℃, n=19) and hypothermia groups (body temperature 34.0-35.0℃, n=17). The matched recipients undergoing renal transplantation were also assigned into the normal temperature (n=38) and hypothermia groups (n=34). Perioperative conditions of the donors and recipients were compared between two groups. And postoperative renal graft function of the recipients were statistically compared between two groups, including the incidence of delayed graft function (DGF) and primary nonfunction (PNF). Results No statistical significance was identified in the perioperative amount of urine volume, serum creatinine (Scr), systolic blood pressure, saturation oxygen, warm ischemia time and cold ischemia time of the donors between two groups (all P < 0.05). No statistical significance was noted in terms of the operation time, intraoperative mean blood glucose and intraoperative mean arterial pressure of the recipients between two groups (all P < 0.05). Postoperative incidence of DGF of the recipients in the hypothermia group was 6%, significantly lower than that in the normal temperature group (24%) (χ²=4.393, P=0.036). Postoperative incidence of PNF of the recipients was 3% in both the hypothermia and normal temperature groups with no statistical significance (χ²=0.000, P=1). Conclusions The hypothermia status of the donors can significantly reduce the incidence of DGF, whereas exerts no evident effect upon the incidence of PNF in the recipients.

Experience summary of 182 patients undergoing liver transplantation from donation after cardiac death in a single center

Hu Liangshuo, Shi Jianhua, Tian Min, Sha Huanchen, Zhang Xiaogang, Liu Xuemin, Liu Chang, Yu Liang, Lyu Yi, Wang Bo

2017, 8(5): 381-385. doi: 10.3969/j.issn.1674-7445.2017.05.009

Abstract(83) HTML (24) PDF 1272KB($!{article.pdfDownCount})

Abstract:
Objective To summarize the clinical efficacy of liver transplantation from donation after cardiac death (DCD). Methods Clinical data of both the donors and recipients (n=182) undergoing liver transplantation from DCD were retrospectively analyzed. According to the type of primary diseases, 182 recipients were divided into the benign group (n=135) and hepatocellular carcinoma (liver cancer) group (n=47). Perioperative conditions, 1-and 3-year survival rate of the recipients were statistically compared between two groups. Clinical prognosis and the incidence of postoperative complications of the recipients were summarized. Postoperative complications mainly included early allograft dysfunction (EAD), vascular complications, acute kidney injury (AKI), pulmonary infection, acute rejection, cytomegalovirus (CMV) infection and billiary tract complication. Results No statistical significance was identified in the anhepatic phase, operation time and length of intensive care unit (ICU) stay between two groups (all P < 0.05). The 1-year survival rates of the 182 recipients and grafts were 93.1%, and 84.9% for the 3-year survival rates. In the benign group, the 1-and 3-year survival rates of the recipients were 92.5% and 88.1%. In the liver cancer group, the 1-year survival rate of the recipients was 95%, 91% for the disease-free survival rate, and 78% for the 3-year survival rate, respectively. No statistical significance was noted in the overall survival rate of the recipients between two groups (P=0.879). In terms of postoperative complications, billiary tract complications occurred in 26 patients, vascular complications in 14, AKI in 34, pulmonary infection in 22, acute rejection in 11, EAD in 11 and CMV infection in 10. The incidence of postoperative billiary tract complications in patients with T-tube insertion was significantly lower than that in their counterparts without T-tube insertion (8% vs. 19%, P < 0.05). Conclusions Liver transplantation from DCD is an efficacious treatment for end-stage liver diseases and liver cancer, which yields relatively high short-term clinical efficacy.

Clinical study of early infection of multi-drug resistant organisms after renal transplantation from organ donation after citizen's death

Li Zhibin, Zhang Geng, Liu Kepu, Ruan Dongli, Gao Long, Wang Huilong, Zheng Wenfeng, Ma Shuaijun, Qin Weijun, Yuan Jianlin

2017, 8(5): 386-391. doi: 10.3969/j.issn.1674-7445.2017.05.010

Abstract(99) HTML (80) PDF 1257KB($!{article.pdfDownCount})

Abstract:
Objective To investigate the clinical characteristics, prevention and treatment of multi-drug resistant organisms (MDROs) infection early after renal transplantation from donation after citizen's death. Methods Clinical data of 166 patients undergoing allogeneic renal transplantation and regular follow-up in Xijing Hospital from November 2011 to September 2016 were retrospectively analyzed. General conditions were statistically compared between the recipients undergoing renal transplantation from donation after cardiac death (DCD) and their counterparts receiving living related donor renal transplantation. The incidence of MDROs infection, onset time, course of diseases, complications, infection site and etiological type were observed. The therapeutic methods and clinical prognosis were summarized. Results The incidence of MDROs infection early after renal transplantation in the recipients undergoing DCD renal transplantation was 14%, significantly higher than 2% in those receiving living related donor renal transplantation, and 13% and 2% for the incidence of delayed graft function with statistical significance (both P < 0.05). The incidence of renal graft loss was 8% and 2%, and 5% and 1% for the mortality rate without statistical significance between two groups (both P < 0.05). MDROs infection occurred in 11 patients after DCD renal transplantation. The most common infection site was urinary system (n=6) and the most prevalent pathogenic bacterium was Escherichia coli (n=4). All patients infected with MDROs were treated with a sufficient dosage of effective antibiotics according to the outcomes of bacterial culture and drug sensitivity test. Eight patients obtained favorable clinical prognosis, one underwent nephrectomy and two died. Conclusions The incidence of MDROs infection early after DCD renal transplantation is higher than that after living related-donor renal transplantation. Strict donor screening, early detection, intimate monitoring and timely treatment can effectively reduce the risk of MDROs and enhance clinical prognosis.

Experience summary of combined liver and kidney procurement from pediatric organ donation

Deng Feiwen, Chen Huanwei, Zhen Zuojun, Li Jieyuan, Wang Fengjie, Hu Jianyuan

2017, 8(5): 392-395, 405. doi: 10.3969/j.issn.1674-7445.2017.05.011

Abstract(62) HTML (68) PDF 1213KB($!{article.pdfDownCount})

Abstract:
Objective To summarize the clinical experience of combined liver and kidney procurement from pediatric organ donation. Methods Clinical data of 6 pediatric donors undergoing combined liver and kidney procurement in the First People's Hospital of Foshan from October 2011 to December 2016 were collected and relevant clinical experience was summarized. Results According to the diagnostic criteria for brain death (for children) established by Brain Injury Evaluation Quality Control Center of National Health and Family Planning Commission, 6 pediatric donors received combined liver and kidney procurement for organ donation under the status of brain death. Modified liverkidney perfusion was performed by external iliac arterial intubation using No.7 suction catheter, or arteria iliaca communis intubation using 24 F catheter for the perfusion of portal vein and abdominal aorta, thoracic aorta occlusion. The operation time was 55-60 min. A total of 6 liver grafts and 12 renal grafts were harvested, which were successfully applied in clinical liver and renal transplantation. No primary nonfunction was observed in the liver or renal grafts. Conclusions Timely assessment of brain death, rigorous and cautious measures for organ maintenance and modified techniques for combined liver and kidney procurement play a key role in the success of combined liver and kidney procurement from pediatric organ donation.

Short Article

2017, 8(5): 396-398. doi: 10.3969/j.issn.1674-7445.2017.04.012

Abstract(33) HTML (0) PDF 983KB($!{article.pdfDownCount})

Abstract:

Review Articles

2017, 8(5): 399-401. doi: 10.3969/j.issn.1674-7445.2017.04.012

Abstract(0) HTML (0) PDF 1055KB($!{article.pdfDownCount})

Abstract:

2017, 8(5): 402-405. doi: 10.3969/j.issn.1674-7445.2017.05.014

Abstract(165) HTML (117) PDF 1006KB($!{article.pdfDownCount})

Abstract:

2017, 8(5): 406-409. doi: 10.3969/j.issn.1674-7445.2017.05.015