2019 Vol. 10, No. 6

Diagnosis and Treatment Specifications
Clinical technical operation specification of pancreatic islet transplantation (2019 edition)
Branch of Organ Transplantation of Chinese Medical Association
2019, 10(6): 621-627. doi: 10.3969/j.issn.1674-7445.2019.06.001
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Clinical operation specification for pancreas allograft pathology (2019 edition)
Branch of Organ Transplantation of Chinese Medical Association
2019, 10(6): 628-637. doi: 10.3969/j.issn.1674-7445.2019.06.002
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Technical operation specification for combined multiple organ transplantation in the upper abdomen (2019 edition)
Branch of Organ Transplantation of Chinese Medical Association
2019, 10(6): 638-652. doi: 10.3969/j.issn.1674-7445.2019.06.003
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Technical operation specification for treatment of surgical complications after renal transplantation (2019 edition)
Branch of Organ Transplantation of Chinese Medical Association
2019, 10(6): 653-660. doi: 10.3969/j.issn.1674-7445.2019.06.004
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Technical specification for diagnosis and treatment of long-term complications of renal transplantation (2019 edition)
Branch of Organ Transplantation of Chinese Medical Association
2019, 10(6): 661-666, 671. doi: 10.3969/j.issn.1674-7445.2019.06.005
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Specification for follow-up after renal transplantation (2019 edition)
Branch of Organ Transplantation of Chinese Medical Association
2019, 10(6): 667-671. doi: 10.3969/j.issn.1674-7445.2019.06.006
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Guideline and Consensus
Experts consensus on islet xenotransplantation clinical trial (2019 expert advice edition)
Xenotransplantation Group in Branch of Organ Transplantation of Chinese Medical Association, Wang Wei, Dou Kefeng, Wang Guiqiang, Cheng Ying, Zhao Jiajun, Luo Minhua, Lu Yanrong, He Zhengming, Yi Shounan, Shi Bingyi, Liu Yongfeng
2019, 10(6): 672-677. doi: 10.3969/j.issn.1674-7445.2019.06.007
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Editorial
The latest research progress and prospect of islet transplantation
Yin Hao
2019, 10(6): 678-683. doi: 10.3969/j.issn.1674-7445.2019.06.008
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Original Articles Experimental Researches
Comparison of blood glucose-lowering function of transplant islets between subcutaneous adipose tissues of inguinal region and renal capsule in mice
Peng Yuanzheng, Zou Zhicheng, Chen Jiao, Lu Ying, Zhang Hancheng, Cai Zhiming, Mou Lisha
2019, 10(6): 684-689. doi: 10.3969/j.issn.1674-7445.2019.06.009
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  Objective  To compare the effect of transplant islets between the subcutaneous inguinal white adipose tissues and renal capsule in the treatment of type 1 diabetes mellitus in mouse models.  Methods  The mice with type 1 diabetes mellitus undergoing islet transplantation were divided into the white adipose group (n=10) and renal capsule group (n=10). The islets were isolated, purified and transplanted to the subcutaneous white adipose tissues of inguinal region and renal capsule. The random blood glucose level and glucose tolerance function of the recipient mice in two groups were continuously monitored after operation. Islet grafts of the surviving recipient mice were harvested at postoperative 100 d for histopathological examination.  Results  In the white adipose group, the blood glucose levels of 6 recipient mice were restored to normal at 1 month after transplantation, whereas the blood glucose levels of the other 4 recipient mice were high, which died before the end of monitoring. In the renal capsule group, the blood glucose levels of 10 recipient mice returned to normal within 10 d after transplantation. Islet grafts of the recipient mice in two groups could lower the blood glucose levels, whereas the islet grafts in the white adipose group required a longer time to exert the effect. The glucose tolerance function of the mice in the renal capsule group was significantly better than that of those in white adipose group (P < 0.05). Histopathological examination demonstrated that the insulin of the islet grafts was normally expressed in two groups.  Conclusions   The islets transplanted into the subcutaneous white adipose tissues of inguinal region can play an effective role in regulating the changes of blood glucose level. Although the blood glucose-lowering function is slightly weaker than that of the islets graft in the renal capsule, it has multiple advantages resembling the ideal islet transplantation sites, which is a promising replacement site for islet transplantation.
Effect of adoptive reinfusion of Treg on immune rejection of islet allografts in mice
Li Junhui, Zhao Yuanyu, Guo Meng, Ji Junsong, Yuan Hang, Wang Hui, Lu Qi, Fu Zhiren, Ding Guoshan, Yin Hao
2019, 10(6): 690-695. doi: 10.3969/j.issn.1674-7445.2019.06.010
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  Objective  To investigate the effects of adoptive reinfusion of regulatory T cell (Treg) on the recovery of islet function and graft survival time after islet allograft transplantation.  Methods  The diabetic model was established using C57BL/6 mice as recipients, and Balb/c mice were chosen as donors for islet allografts transplantation beneath the renal capsule. The recipient mice were divided into 3 groups and 3 mice in each group according to different processing Methods: Treg experiment group (Treg group, 1×106 Treg cells were injected via tail vein at 1 d before operation), positive control group [sirolimus (SRL) group, SRL at a dose of 300 μg/(kg·d) was intragastrically given every day from 1 d before operation] and blank control group (control group, an equivalent volume of normal saline was intragastrically given every day from 1 d before operation). Enzyme-linked immune absorbent assay (ELISA) was used to detect the changes of blood glucose and C-peptide in mice within 14 days after transplantation. In vivo imaging technique was used to dynamically monitor the survival of mice within 14 days after transplantation.  Results  In each group, the blood glucose levels at postoperative 3 d were significantly decreased compared with those before transplantation (all P < 0.001). At postoperative 1 d, the C-peptide levels showed an explosive rise to varying degree in each group. At postoperative 3 d, the C-peptide levels in each group were significantly higher than that before operation (all P < 0.001). At the end of the observation period at 14 d after operation, the C-peptide levels in the SRL and Treg groups were (427±50) pmol/L and (833±57) pmol/L, relatively higher than that in the control group. But the blood glucose levels were (14.5±0.5) mmol/L and (12.1±0.6) mmol/L, significantly lower than that in the control group (all P < 0.001). Compared with the SRL group, the explosive release amount of C-peptide was significantly lower, the declining trend was more remarkably stable, and the C-peptide level was considerably higher in the Treg group at the end of the observation period (all P < 0.001). At postoperative 14 d, the grafts were almost completely apoptotic in the control group, over 50% of the grafts survived in the SRL group, and over 80% of the grafts survived in the Treg group.  Conclusions   Adoptive reinfusion of Treg cells can effectively protect islet grafts, prolong the survival time of grafts, and maintain the normal levels of blood glucose and C-peptide in the recipient mice.
Original Articles Clinical Researches
Next generation sequencing screening for human parvovirus B19 infection after liver transplantation and the analysis of related risk factors
Chen Tuo, Li Ruidong, Ying Yue, Tao Yifeng, Shen Conghuan, Jin Yanting, Wang Zhengxin
2019, 10(6): 696-701. doi: 10.3969/j.issn.1674-7445.2019.06.011
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  Objective  To summarize the screening Methods for human parvovirus (HPV) B19 infection after liver transplantation and analyze the related risk factors.  Methods  Clinical data of 86 recipients were retrospectively analyzed. According to the Results of next generation sequencing (NGS), all recipients were divided into the HPV B19 infection group and control group. Clinical characteristics, treatment regime and clinical prognosis of patients infected with HPV B19 were analyzed. The risk factors of HPV B19 infection were analyzed using univariate and multivariate Logistic regression model by forward LR step method.  Results  Nine of the 86 recipients developed fever and progressive anemia with unexplained reasons at approximately 2 weeks after liver transplantation. NGS detection demonstrated that HPV B19 was positive and they were diagnosed with pure red cell aplasia (PRCA) caused by HPV B19 infection. After intravenous immunoglobulins (IVIG) was given and the immunosuppressant therapy was adjusted, the hemoglobin levels in all patients were significantly increased. The Results of multivariate analysis revealed that low serum globulin level in peripheral blood at postoperative 7 d [odds ratio (OR) =0.749, P=0.040] and young age (OR=0.937, P=0.038) were the independent risk factors of HPV B19 infection after liver transplantation.  Conclusions   HPV B19 infection should be considered in relatively young patients with unexplained hemoglobin decline early after liver transplantation. NGS screening is an effective method for early diagnosis of HPV B19 infection. Low serum globulin level in peripheral blood at postoperative 7 d and young age may be independent risk factors of the incidence of HPV B19 infection.
Safety application of organs from infectious donors
He Li, Li Guangming, Lin Dongdong, Liu Jinning, Wang Xin, Xu Ying
2019, 10(6): 702-707. doi: 10.3969/j.issn.1674-7445.2019.06.012
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  Objective  To explore the safety application of organs from infectious donors.  Methods  Clinical data of 67 donors and recipients undergoing orthotopic liver transplantation were retrospectively analyzed. According to the occurrence of infections and infection sites in donors, all recipients were divided into the bloodstream infection group (n=16, donors with non-drug resistant bacterial infections), non-bloodstream infection group (n=20, donors with other site infections) and non-infection group (n=31). Perioperative clinical parameters including preoperative model for end-stage liver disease (MELD) score, operative time, anhepatic phase, intraoperative blood loss and intraoperative blood transfusion were statistically compared among three groups. The recovery of liver function and coagulation function in the recipients was observed at postoperative 1, 3, 7, 14 and 21 d. The incidence rate of complications and mortality rate in the recipients were recorded within 1 month after liver transplantation. The recovery of postoperative infection-related parameters including white blood cell (WBC), neutrophil pet (NE%) and procalcitonin (PCT) level in the recipients was observed. The application rate and application time of restricted antibiotics were recorded.  Results  Perioperative clinical parameters in the recipients did not significantly differ among three groups (all P > 0.05). At each time point after liver transplantation, the liver function, coagulation function, incidence rate of complications and mortality rate in the recipients did not significantly differ among three groups (all P > 0.05). The NE% of recipients at postoperative 3 and 7 d in the bloodstream infection group was significantly higher than those in non-bloodstream infection and non-infection groups (all P < 0.05). The PCT levels of recipients at postoperative 3, 7 and 14 d in the bloodstream infection group were significantly higher than those in the non-bloodstream infection and non-infection groups (all P < 0.05). The application rate and application time of restricted antibiotics in the recipients with bloodstream infections were significantly higher or longer than their counterparts in the non-bloodstream infection and non-infection groups (all P < 0.05).  Conclusions   It is safe to apply liver grafts from donors with bloodstream infection of non-drug resistant bacteria or other site infections when antibiotics are applied as early as possible.
Clinical Researches
Effect of donor-derived infection on prognosis of liver transplant recipients
Song Wei, Sun Liying, Zhu Zhijun, Wei Lin, Qu Wei, Zeng Zhigui, Liu Ying, Zhang Haiming, He Enhui, Xu Ruifang, Tan Yule
2019, 10(6): 708-712. doi: 10.3969/j.issn.1674-7445.2019.06.013
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  Objective  To evaluate the effect of donor-derived infection on the clinical prognosis of the recipients undergoing liver transplantation.  Methods  Clinical data of 75 donors and recipients undergoing liver transplantation were retrospectively analyzed. According to the culture results of donor organ lavage fluid, all recipients were divided into the positive group (n=26) and negative group (n=49). Clinical parameters of the recipients during perioperative period were observed in the positive and negative groups. The sputum and peritoneal drainage fluid of the recipients undergoing liver transplantation were cultured. The incidence of postoperative infection of the recipients was observed. The 1.5-year survival curve of the recipients was analyzed by Kaplan-Meier method.  Results  In the positive group, the incidence of portal vein stenosis and thrombosis was significantly higher than that in the negative group (P < 0.05). Among 75 recipients undergoing liver transplantation, 33 cases (44%) developed postoperative infection mainly in the lung and abdominal cavity. The infection rate significantly differed between the positive group (77%) and negative group (27%, P < 0.05). In the positive group, sputum culture was positive in 10 recipients and peritoneal drainage culture was positive in 11 recipients. The sputum culture outcomes of 4 recipients were consistent with those of the organ lavage fluid culture of their donors. The peritoneal drainage culture results of 6 recipients were consistent with those of the organ lavage fluid culture of their donors. After anti-infection treatment, 2 recipients in the positive group died at postoperative 5 and 12 d, and the culture results of the remaining recipients were negative. In the negative group, 7 recipients were positive for sputum culture and 6 recipients were positive for peritoneal drainage culture. The culture results of all recipients were negative following anti-infection therapy. Two recipients died from graft failure at postoperative 1 month and 1 year. The 1.5-year survival rate did not significantly differ between the positive and negative groups (P > 0.05).  Conclusions  The effect of donor-derived infection on the early prognosis of liver transplant recipients cannot be neglected, whereas it exerts mild impact on the intermediate- and long-term clinical prognosis of the recipients.
Distribution characteristics of pathogenic bacteria in infectious donors from organ donation after citizen's death and preventive strategies for renal transplant recipients: a single center experience
Lai Xingqiang, Chen Li, Zhang Lei, Fang Jiali, Li Guanghui, Xu Lu, He Jingwen, Ma Junjie, Chen Zheng
2019, 10(6): 713-718. doi: 10.3969/j.issn.1674-7445.2019.06.014
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  Objective  To investigate the distribution characteristics of pathogenic bacteria in infectious donors from organ donation after citizen's death and preventive strategies for renal transplant recipients.  Methods  Clinical data of 412 donors and 803 recipients from organ donation after citizen's death were retrospectively analyzed. All donors underwent culture of airway secretions, urine, blood and renal lavage fluid. The incidence rate of infection, distribution and composition ratio of pathogenic bacteria of donors from organ donation after citizen's death were observed. The scores of all donors were evaluated according to the length of intensive care unit (ICU) stay for donors, the situation of abdominal trauma and the results of body fluid culture, etc. According to the score, the recipients received different infection prevention regimes. The incidence rate of donor-derived infection (DDI) and clinical prognosis of the recipients were analyzed.  Results  A total of 243 donors were diagnosed with infection in 412 donors from organ donation after citizen's death with an infection rate of 59.0%. In total, 456 strains of pathogenic bacteria were isolated, mainly derived from the airway secretions (71.7%). Gram-negative bacteria dominantly consisted of Klebsiella pneumoniae and acinetobacter baumannii. Gram-positive bacteria mainly included staphylococcus aureus and fungus mainly included yeast-type fungus. Three recipients (kidneys from 2 donors respectively) developed DDI with an incidence rate of 0.4%.  Conclusions  The infection rate of donors from organ donation after citizen's death is relatively high. It is effective to prevent the incidence of DDI by grading the risk of infection of donors and adopting rational preventive plan according to the score.
Review Articles
Pancreatic islet cells derived from pluripotent stem cells and their application in the treatment of diabetes
Fu Tianlong, Nie Tengfei, Yin Hao, Cheng Xin
2019, 10(6): 719-723. doi: 10.3969/j.issn.1674-7445.2019.06.015
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Research progress of regulatory B cell secreting granzyme B in immunoregulation after organ transplantation
Liu Zixi, Li Xianliang, He Qiang, Zhu Jiqiao
2019, 10(6): 724-726, 734. doi: 10.3969/j.issn.1674-7445.2019.06.016
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Research progress of vascular factors affecting recurrence after liver transplantation in patients with hepatocellular carcinoma
Shi Xinlin, Wang Jizhou, Jiang Hongchi, Lu Chaoyang, Liu Lianxin
2019, 10(6): 727-730. doi: 10.3969/j.issn.1674-7445.2019.06.017
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To optimize the clinical management strategy of donor, to promote the scientific research of donor
Sun Xuyong, Dong Jianhui, Qin Ke, Wu Xianrong, Wang Bing, Yang Chuan, Huang Yeqing, Cen Maoliang, Li Fei, Zhang Hongbin, Liao Jixiang, Liu Xuyang, Jiang Wenshi
2019, 10(6): 731-734. doi: 10.3969/j.issn.1674-7445.2019.06.018
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Transplantation Cloud College
The mid-year collection of transplantation cloud college
Shi Bingyi, Zhang Xiaodong, Hu Xiaopeng, Chen Zhishui, Chen Gang, Wang Changxi, Huang Gang, Yan Tianzhong, Wu Xiaoqiang
2019, 10(6): 735-738. doi: 10.3969/j.issn.1674-7445.2019.06.019
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