器官移植

Abstract:
Objective To analysis the cause of primary graft failure of unrelated cord blood transplantation with high-dose of CD34⁺ cells in treatment of acute myelocytic leukemia(AML)/myelodysplastic syndrome (MDS[). Methods A 4-year-old girl was diagnosed AML/MDS at the Department of Pediatric Hematology and Oncology of West China Second University Hospital of Sichuan University. She presented completely remission after induction and consolidation chemotherapy. She received unrelated partially human leukocyte antigen(HLA)-mismatched cord blood transplantation. We investigated the treatment outcomes of UCBT and associated complications. Results The patient suffered primary graft failure and then received secondary haploidentical hematopoietic stem cell transplantation(HSCT) from her mother. However, she suffered fatal multiresistant Acinetobacter spp septicemia. She died due to respiratory failure on 7 d after the second transplantation. Conclusions In this case, hematopoietic stem cells with high dose of CD34⁺ cells could not overcome the risk of primary graft failure and HLA disparity. The patient's primary graft failure was associated with platelet transfusion refractoriness and potent immunologic dysfunction, especially the anti-HLA donor specific antibodies before unrelated cord blood transplantation.

Application value of fast-track surgery on liver transplantation

Fan Ye, Zhuang Lin, Lu Hao, Li Guoqiang, Zhang Chuanyong, Zhang Feng, Wang Xuehao, Lyu Ling, Qian Xiaofeng

2014, 5(6): 348-351, 376. doi: 10.3969/j.issn.1674-7445.2014.06.004

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Abstract:
Objective To explore the impact of fast-track surgery (FTS) on prognosis of liver transplant patients. Methods Inclusion criterias: (1) primary disease was cirrhosis or primary liver cancer meeting Milan criteria; (2) surgical method was modified piggyback orthotopic liver transplantation (OLT); (3) no liver transplantation operation was performed before. Exclusion criterias: (1) age≤16 years old; (2) receiving OLT more than 1 time; (3) transcatheter hepatic arterial chemoembolization or radiofrequency ablation was performed before or during operation. From January 2011 to December 2013 in First Affiliated Hospital of Nanjing Medical University, 52 patients meeting the criteria above were enrolled into this prospective random single-blinded study(all operations were performed by same team). According to different peri-operative managements, they were divided into FTS group (n=21) and non-FTS (NFTS) group (n=31). Protocol of FTS included comprehensive pre-operative education, no bowel preparation, no usage of nasogastric tube pre-operation and surgical drainage post-operation, prevention of hypothermic during operation, smaller incision, early exercise and enhanced oral nutrition. Intra-and post-operative parameters were compared between 2 groups. Step-by-step Logistic regression was used to evaluate relationship between FTS and clinical parameters, in order to analyze the impact of FTS on the prognosis of liver transplantation. Results Compared with NFTS group, operation time and anhepatic phase time decreased significantly in FTS group, as well as intra-operative bleeding and transfusion (all in P<0.05). Besides, intensive care unit(ICU) days and total length of stay in FTS group were shorter than those in NFTS group, which indicated a better prognosis of patients in FTS group(both in P<0.05). Logistic regression suggested that FTS management was a favorable factor of shortening ICU days (odds ratio: 0.301, 95% confidence interval: 0.184-0.494, P=0.000) and total length of stay (odds ratio: 0.148, 95% confidence interval: 0.085-0.257, P=0.000). Conclusions Application of FTS in perioperative period can improve the prognosis of liver transplant patients.

Preliminary study of real-time three-dimensional contrast-enhanced ultrasound for evaluating hepatic artery complications after liver transplantation

Zhang Aohua, Xu Jing, Cao Junyan, Wu Tao, Wu Lili, Liao Mei, Zheng Rongqin, Ren Jie

2014, 5(6): 352-355, 388. doi: 10.3969/j.issn.1674-7445.2014.06.005

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Abstract:
Objective To study preliminarily on the value of real-time three-dimensional contrast-enhanced ultrasound (RT-3D-CEUS) for the diagnosis of hepatic artery complications after liver transplantation. Methods From April to July in 2014, a total of 18 liver transplant recipients were examined 29 times, by color doppler ultrasound, contrast-enhanced ultrasound (2D-CEUS) and RT-3D-CEUS. The successful rate of RT-3D-CEUS was calculated. And the image quality and the diagnosis of hepatic artery complications were evaluated. Results In the 29 times of RT-3D-CEUS examination, the successful rate was 93%(27/29). The image quality of RT-3D-CEUS got 3 points for 14 times, 2 points for 13 times and 1 point for 2 times. In 6 cases who were diagnosed hepatic artery stenosis by RT-3D-CEUS, 4 cases were first diagnosed by RT-3D-CEUS and confirmed by CTA, and 2 cases were diagnosed by CTA or DSA before RT-3D-CEUS. Conclusions The RT-3D-CEUS examination can get intuitive and clear images, which has clinical application value in evaluating hepatic artery complications after liver transplantation.

Retroperitoneal laparoscopic living donor nephrectomy: a report of 22 cases

Chen Lizhong, Wang Daohu, Qiu Jiang, Chen Guodong, Wang Changxi

2014, 5(6): 356-359. doi: 10.3969/j.issn.1674-7445.2014.06.006

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Abstract:
Objective To summarize the experience of retroperitoneal laparoscopic living donor nephrectomy. Methods Clinical data of 22 donors undergoing retroperitoneal laparoscopic living donor nephrectomy in the First Affiliated Hospital of Sun Yat-sen University from January 2012 to May 2014 were analyzed retrospectively. The ureter, renal vessel and perirenal fat were dissected by laparoscopic approach. Then the renal vessels were cut off and the kidney was extracted by hand through superomedial inguinal parallel incision. The surgical process and the postoperative follow-up of the donors were recorded. Results One right kidney and 21 left kidneys were extracted. The operations in 22 cases were performed successfully without conversion to laparotomy. The operation time was (123±31) min. The length of kidney extracting incision was (7.2±0.5) cm. The intraoperative blood loss was 15-80 ml and the warm ischemia time was 60-150 s. The length of donor renal arteries was 2.0-3.2 cm. The length of renal veins was 1.0-3.5 cm. The donors were followed up for 1-21 months. The serum creatinine (Scr) levels at 1 d, 1 week and 1 month after operation were (120±57), (95±25), (90±21) μmol/L respectively. Two cases suffered from renal fossa hematoma and poor wound healing after operation respectively. The pain score of the donors was 0-5 at 1 week after operation and 0-1 at 1 month after operation. No donor had the perception that donating kidney had obvious impacts on the general health, but 1 donor felt it had some influence on physical strength. Conclusions It is safe to perform retroperitoneal laparoscopic living donor nephrectomy on the basis of strict donor selection. It has little impacts on the donor's quality of life with small surgical incision and mild postoperative pain.

Study on the relationship between panel reactive antibody and long-term prognosis of transplant renal function

Jia Baoxiang, Zhang Dong, Wu Junjie, Xu Xiuhong

2014, 5(6): 360-363. doi: 10.3969/j.issn.1674-7445.2014.06.007

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Abstract:
Objective To study the impact of panel reactive antibody (PRA) on the long-term prognosis of transplant renal function after renal transplantation. Methods The objects of this study were 224 patients, who underwent renal transplantation, received PRA test about 2 weeks after operation and followed up in Affiliated Beijing Friendship Hospital of Capital Medical University from January 1994 to December 2004. According to the PRA test results, the patients were divided into two groups: negative group (n=195) and positive group(n=29). PRA of patients in negative group were tested again in 2007. Serum creatinine (Scr) of patients in both groups were tested recently (from October 2013 to April 2014) to know about the renal function. The rates of long-term normal transplant renal function between PRA positive patients (including PRA re-test positive patients) and PRA negative patients were compared. Results In 29 cases of positive group, the re-test result in April 2014 showed that 18 cases were observed with loss(n=17) or decline(n=1) of renal function, and 11 cases were observed with normal renal function. In 195 cases of negative group, a total of 153 cases were re-tested with PRA negative in 2007, 148 cases were re-tested with normal renal function in April 2014, and 5 cases were observed with decline or loss of renal function. A total of 42 cases were re-tested with PRA positive in 2007 and the transplant renal function was observed decline or loss by varying degrees. There were a total of 71 cases with PRA positive before 2004 and when re-tested in 2007, and 11 cases were re-tested with normal renal function in April 2014. The rate of long-term normal transplant renal function was 15.5%. There were 153 cases with PRA negative and 148 cases were re-tested with normal renal function in April 2014. The rate of long-term normal transplant renal function was 96.7%. Significant difference was observed in the rates of long-term normal transplant renal function between PRA positive patients and PRA negative patients (P<0.005). Conclusions PRA after renal transplantation has obvious impacts on the long-term prognosis of transplant renal function.

Follow-up observation on the safety of donors for living donor renal transplantation

Liu Jian, , Sang Xiaohong

2014, 5(6): 364-367. doi: 10.3969/j.issn.1674-7445.2014.06.008

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Abstract:
Objective To explore the influence of living donor renal transplantation on the safety of donors. Methods Sixty-two donors who underwent living donor renal transplantation in the First Affiliated Hospital of Xinjiang Medical University from April 2003 to April 2007 were selected as research objects. The operation time and length of stay of donors were recorded. The occurrence of postoperative complication and prognosis were observed. Postoperative follow up included serum creatinine(Scr), blood urea nitrogen(BUN), glomerular filtration rate(GFR), plasma albumin, hemoglobin, blood pressure and the influence of kidney donation on life and work. Results The operations of 62 donors were successful. One case developed pneumothorax during open nephrectomy and another case developed fat liquefaction and necrosis of incision. Both of them were cured after symptomatic treatment. Two cases developed pulmonary infection postoperation and were cured after the treatment of sensitive antibiotics and aerosol inhalation. The other cases recovered smoothly after operation. In 62 donors, the average postoperative length of stay was (8.2±2.6) d, and the follow-up time was (3.2±1.1) years. All of the donors survived without influence on life and work. No significant difference was observed in the changes of Scr, BUN, GFR, plasma albumin, hemoglobin, blood pressure of the donors before operation and 7 d, 3 months, 1 year, 3 years, 5 years after operation(all in P>0.05). Conclusions The living donor nephrectomy is safe and feasible. It is very important for assuring the safety of donors to examine living donor perfectly before operation, be careful during operation, and closely follow up after operation.

Experimental Researc

Influence of sirolimus based triple anti-tumor therapy on T lymphocyte of rat model with liver cancer recurrence after transplantation

Zhou Lin, Suo Longlong, Song Jiyong, Zhu Zhidong, Du Guosheng, Zheng Dehua, Feng Likui, Fu Xiaoqian, Xiao Wei, Li Zaigao

2014, 5(6): 368-373. doi: 10.3969/j.issn.1674-7445.2014.06.009

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Abstract:
Objective To explore the influence of triple anti-tumor therapy which bases on sirolimus combined huaier granule and thymosin α-1 on T lymphocyte of rat model with liver cancer recurrence after transplantation. Methods Seventy-two Sprague-Dawley(SD)rats were randomly divided into triple therapy group, sirolimus group, huaier-granule group, thymosin α-1 group, positive-control group and blank group(n=12 in each group). Except the blank group, rats in all the other groups were established the simulation animal model of liver cancer recurrence after liver transplantation by chemical-induced method. After the model was established, rats in the positive control group were executed to appraise whether the model was successful. The proportion of regulatory T cells (Treg) of CD4⁺ T lymphocytes in peripheral blood (Treg%), the percentage of CD4⁺ T lymphocyte of total lymphocyte(CD4⁺T%)and the percentage of CD8⁺ T lymphocyte of total lymphocyte (CD8⁺T%), were detected by the flow cytometry respectively. The relationship between Treg% and CD4⁺ T%, CD8⁺ T%, the ratio of CD4⁺/CD8⁺ T lymphocytes(CD4⁺/CD8⁺)was analyzed by the method of Spearman rank correlation. Results Pathological section of rat liver tissue suggested that the rat model was established successfully. Treg% of positive control group was higher than that of blank group, the difference had statistical significance(P<0.05). Treg% of triple therapy group was significantly lower than that of the positive control group, huaier-granule group, thymosin α-1 group, and significantly higher than the blank group(all in P<0.05). Compared with positive-control group, CD4⁺T% and CD8⁺T% of triple therapy group, sirolimus group and thymosin α-1 group were significantly higher (all in P<0.05). CD4⁺T% and CD8⁺T% of triple therapy group were significantly higher than those of thymosin α-1 group, sirolimus group and huaier-granule group (all in P<0.05). The relationship between Treg% and CD4⁺T%, CD8⁺T%, CD4⁺/CD8⁺ in peripheral blood were negatively correlated for rats in each group. In addition, the triple anti-tumor therapy decreased the negative correlation between Treg% and CD4⁺/CD8⁺. Conclusions Sirolimus based triple anti-tumor therapy can decrease the peripheral blood Treg level of the liver cancer rat, increase the number of T lymphocyte and CD4⁺/CD8⁺, and play the role of anti tumor cell growth and proliferation.

Short Articl

2014, 5(6): 374-376. doi: 10.3969/j.issn.1674-7445.2014.06.010

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Abstract:

Case repor

2014, 5(6): 377-379. doi: 10.3969/j.issn.1674-7445.2014.06.011

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Abstract:

Learning Garde

2014, 5(6): 380-382. doi: 10.3969/j.issn.1674-7445.2014.06.012

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Abstract:

Review Articles

Retinoid X receptor signaling pathway in leukemia

Lu Xiaoxi, Ma Zhigui, Gao Ju, Zhu Yiping

2014, 5(6): 383-388. doi: 10.3969/j.issn.1674-7445.2014.06.013

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Abstract:
Retinoid X receptor (RXR) acts as ligand-dependent transcription factors playing an important role in regulating a serial of physiological processes, such as embryo development and organ homeostasis. At the molecular level, RXRs exert their functions by inter-activating with multiple signal pathways to regulate target gene expression which control cell growth, differentiation, survival and death. The interference in the network of RXR and other signal pathways has turned RXR into an attractive drug target.