器官移植

2014 Vol. 5, No. 3

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2014, 5(3): 131-136. doi: 10.3969/j.issn.1674-7445.2014.03.001

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2014, 5(3): 137-140. doi: 10.3969/j.issn.1674-7445.2014.03.002

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2014, 5(3): 141-144, 173. doi: 10.3969/j.issn.1674-7445.2014.03.003

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2014, 5(3): 145-148. doi: 10.3969/j.issn.1674-7445.2014.03.004

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2014, 5(3): 149-151. doi: 10.3969/j.issn.1674-7445.2014.03.005

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2014, 5(3): 152-155. doi: 10.3969/j.issn.1674-7445.2014.03.006

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Modified technique of renal transplantation model in rats

Li Cai, Zhu Yi, Ye Shaojun, Zhou Wei, Liu Hong, Niu Ying, She Xingguo, Ming Yingzi

2014, 5(3): 156-160. doi: 10.3969/j.issn.1674-7445.2014.03.007

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Objective To investigate modified technique of renal transplantation model in rats. Methods Sprague-Dawley rats were selected as donors (n=21) and Wistar rats as recipients (n=42). Renal allografts of both sides were harvested from the donors for renal transplantation. After resection of left kidney, end-to-end anastomosis of renal arteries between donor and recipient was performed by the assistance of home-made catheter. And end-to-end anastomosis between recipient's renal vein and donor's inferior vena cava was also performed. The donor's ureter with bladder patch was anastomosed to the recipient's bladder. Finally the right kidney was removed, cefminox(10 mg) was injected intraperitoneally, and then the abdominal cavity was closed. The operation data were recorded, including the operation time, artery and vein anastomosis time, cold and warm ischemia time and so on. Living for 3 days after operation was regarded as a success model. The success rate of modeling was calculated and the cause of death was analyzed. Results The operation time of donor was (32.7±5.6) min, and repair time for kidney was (4.2±1.1) min. The operation time of recipient was (42.3±42.3) min, including (10.1±3.2) min of the artery anastomosis time, (13.9±2.5) min of vein anastomosis time, (6.3±1.4) min of urinary tract reconstruction time. Warm ischemia time was (5.4±1.8) s, and cold ischemia time was (56.2±7.3) min. In 42 recipient rats, 40 rats were successful modeling and the success rate was 95.2%. Two rats died. One died of artery anastomosis hemorrhage, and the other died of diffuse peritonitis caused by urine leakage. Conclusions Renal transplantation model in rats with modified vascular end-to-end anastomosis has the characters of simple handling, short operation time and high success rate.

Imaging findings of rare tumors or tumor-like lesions in liver grafts after liver transplantation

Chen Binghui, Xie Peiyi, Quan Li, Xie Sidong, Meng Xiaochun, Shan Hong

2014, 5(3): 161-168. doi: 10.3969/j.issn.1674-7445.2014.03.008

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Objective To investigate the imaging findings of rare tumors or tumor-like lesions in liver grafts after liver transplantation. Methods Imaging data of 4 patients with rare tumors or tumor-like lesions in the liver grafts of patients after liver transplantation from December 2006 to August 2013 in the Third Affiliated Hospital of Sun Yat-sen University were reviewed. Findings of computerized tomography (CT) and (or) magnetic resonance imaging (MRI) plain scan and dynamic enhanced MRI of liver lesions in these patients were analyzed specially. Results In the 4 patients, 3 cases were misdiagnosed, including undifferentiated liver sarcoma, secondary lymphoma and eosinophilic granuloma. One case was diagnosed correctly with hepatic metastases of gallbladder carcinoma. The undifferentiated liver sarcomas appeared as cystic and solid space occupying masses with significant and persistent enhancement in the surrounding solid and separating parts. No enhancement was observed in the cystic parts, which increased rapidly in a short term. No edema area around the lesions was observed, but many calcifications were detected. The secondary hepatic lymphoma appeared as intrahepatic multiple nodules, most of which presented uniform signal intensity with moderate enhancement in every phase. No intrahepatic vascular invasion was observed but extrahepatic lymphadenectasis was detected. Bleeding was observed in a few lesions. The liver eosinophilic granuloma appeared as multiple liver lesions with variable signal intensity and enhancement modes, which suggested that the lesions were consisted of variety of elements and in the different disease stages. Most of the lesions were observed with progressive circled enhancement. The recurrence of gallbladder carcinoma and hepatic metastasis after liver transplantation appeared as a intrahepatic hypodensity lesion with slight enhancement in arterial phase and slight hypodensity in portal phase. Retroperitoneal lymph nodes were observed swelled and fused. Conclusions Rare tumors or tumor-like lesions in liver grafts have distinctive imaging features. Imaging examinations are useful for the early detection of these rare tumors or tumor-like lesions in liver grafts. Imaging findings combining with disease history and clinical manifestations can help to make correct diagnosis.

Analysis of risk factors of developing cardiac arrest in postreperfusion syndrome of orthotopic liver transplantation

Wang Yang, Cao Jinglin, Gao Qingjun, Zeng Qiang, Zhao Xin, Dou Jian

2014, 5(3): 169-173. doi: 10.3969/j.issn.1674-7445.2014.03.009

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Objective To investigate the risk factors of developing cardiac arrest in postreperfusion syndrome(PRS) of orthotopic liver transplantation(OLT). Methods Clinical data of 192 patients who underwent OLT in the Third Hospital of Hebei Medical University from 2003 to 2013 were retrospectively analyzed. Among them, 38 patients developed PRS. According to the occurrence of cardiac arrest or not, the patients were divided into 2 groups, including 7 cases in cardiac arrest group(5 males and 2 females) and 31 cases in non-cardiac arrest group(23 males and 8 females). The probable influence factors of cardiac arrest were selected, including gender, age, preoperative cardiac indexes(electrocardiogram or color doppler ultrasound of heart), preoperative albumin, borderline pH value during opening circulation, borderline temperature, borderline blood potassium level, blood calcium level after opening, degree of donor fatty liver, time of occluding inferior vena cava, and cold ischemia time of donor liver. Comparison of data between two groups was used t-test or Fisher exact probability test. Rick factors with significance differences between two groups were analyzed by unconditional Logistic regression analysis. Results Probable risk factors of developing cardiac arrest in PRS included borderline pH value < 7.35 during opening circulation, borderline temperature < 36℃ during opening circulation, borderline blood potassium level>4 mmol/L during opening circulation and moderate fatty liver (all in P < 0.05). Results of unconditional Logistic regression analysis showed that moderate fatty liver was an independent risk factor of cardiac arrest in PRS. Conclusions Moderate fatty liver is an independent risk factor of cardiac arrest in PRS. The rational application of liver donors and paying more attention to perioperative treatment of recipients have important significance for reducing the incidence of cardiac arrest.

Value of three-dimensional contrast-enhanced ultrasound in diagnosing hepatic artery complications after liver transplantation

Tong Ge, Zheng Bowen, Cao Junyan, Wu Tao, Liao Mei, Lyu Yan, Wu Lili, Ren Jie

2014, 5(3): 174-177, 190. doi: 10.3969/j.issn.1674-7445.2014.03.010

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Objective To investigate the value of three-dimensional contrast-enhanced ultrasound (3D-CEUS) in diagnosing the hepatic artery complications after liver transplantation. Methods A total of 26 liver transplant donors or recipients suspected with hepatic artery complications were examined by color Doppler ultrasound, two-dimensional contrast-enhanced ultrasound (2D-CEUS) and 3D-CEUS. The successful reconstruction rates of 3D-CEUS and the three-dimensional image quality of reconstructed hepatic arteries were evaluated. Results In the 26 patients, 21 hepatic arteries could be visualized with a successful reconstruction rate 81%. The three-dimensional images of hepatic arteries by 3D-CEUS were continuous. The coronal(Z-axle), fine or circuitous branches or tributaries could be visualized well. The segmental hepatic arteries origin could be determined and the spatial relationship of vessels could be visualized definitely. Conclusions The 3D-CEUS images are intuitive, three-dimensional and clear, and have clinical application value in diagnosing of hepatic artery complications after liver transplantation.

Preliminary discussion of ultrasonograms of biliary sludge and its relationship with the prognosis of patients after liver transplantation

Lyu Yan, Liao Mei, Cao Junyan, Wu Tao, Wu Lili, Zheng Rongqin, Ren Jie

2014, 5(3): 178-181. doi: 10.3969/j.issn.1674-7445.2014.03.011

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Objective To investigate the ultrasonograms of biliary sludge and its relationship with the prognosis of patients after liver transplantation. Methods Ultrasonograms of 36 patients with biliary sludge after liver transplantation were retrospectively analyzed. These patients were divided into two groups according to the different treatment outcomes: poor prognosis group and favorable prognosis group. The characteristics of initial ultrasonograms of biliary sludge when they were found at first time compared between two groups. Results Biliary sludge combined with ischemic-type biliary lesions accounted for 95%(19/20) in poor prognosis group while 13%(2/16) in favorable prognosis group. There was significant difference between two groups(P < 0.05). In favorable prognosis group, biliary sludge was found locating in hepatic hilar region in all 16 cases (16/16) and the sludge had clear boundaries dissociated with bile duct walls were observed in 14 cases (14/16). There was no incrassation of bile duct walls in hepatic hilar region, nor dilation of intrahepatic bile ducts observed in 14 cases (14/16). In poor prognosis group, biliary sludge was observed widespread not only in hepatic hilar region but also in intrahepatic biliary ducts in 10 cases (10/20), and the boundaries between sludge and bile duct walls were vague in 15 cases (15/20). Obvious incrassation of bile duct walls in hepatic hilar region was observed in 16 cases (16/20), and dilation of intrahepatic bile ducts was observed in 19 cases (19/20). There were significant differences in the above 4 ultrasound features between two groups (all in P < 0.05). Conclusions There are differences in the ultrasonograms of biliary sludge between different prognosis groups. Biliary sludge combined with ischemic-type biliary lesions suggests a poor prognosis, which may need more active interventional treatments.

Effect evaluation of mechanical perfusion in the application of renal transplantation: a report of 36 cases

Yan Qiang, Wei Xiaolian, Li Fei, Yang Ming, Chen Huaizhou, Xie Shenping, Guo Junjun, Liu Ping, Shi Feng, Sui Weiguo

2014, 5(3): 182-185. doi: 10.3969/j.issn.1674-7445.2014.03.012

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Objective To explore the clinical effect of mechanical perfusion for preserving kidney. Methods From May to October 2013, 36 donors' kidneys were preserved by mechanical perfusion in the Department of Kidney in the 181^st Hospital of Chinese People's Liberation Army. The donors' kidneys were preserved, transported and perfused by the LKT-100 type Lifeport organ transporter and special software. General condition of patients and the relationship between resistance coefficient, flow velocity and occurrence of delayed graft function(DGF) were analyzed. Results None of 36 recipients had graft loss. Thirty cases' (83%) renal function recovered well without DGF. Six cases developed DGF and returned to normal gradually after 3-18 days postoperative treatment. After mechanical renal perfusion for 1 h, 28 recipients with kidneys' resistance coefficient≤0.3 mmHg/(ml·min)hadn't developed DGF after transplantation. Among 8 recipients with kidneys' resistance coefficient>0.3 mmHg/(ml·min), 6 recipients developed DGF. Eight recipients with kidneys' flow velocity>100 ml/min hadn't developed DGF. Among 21 recipients with kidneys' flow velocity 60-100 ml/min, 1 case developed DGF. In 7 recipients with kidneys' flow velocity < 60 ml/min, 5 cases developed DGF. Conclusions Mechanical perfusion for preserving kidney can improve graft quality and reduce the incidence of DGF in recipients.