器官移植

Abstract:
Objective To investigate the impacts of sirolimus (SRL) on the survival time of graft and the differentiation and proliferation of regulatory T cell (Treg) of spleen in mouse heterotopic heart transplantation model. Methods Male BALB/c→C57BL/6 mice cervical heterotopic heart transplantation model was established by Cuff method. The mice were divided into 3 groups randomly with 10 mice in each group. The control group received no treatment of special medicine after operation. Mice in SRL group were gavaged with SRL 10 mg/(kg·d) at 1-14 d after operation. Mice in ciclosporin (CsA) group were gavaged with CsA 30 mg/(kg·d)at 1-14 d after operation. The survival time of cardiac grafts were recorded. The spleen was procured after asystole of cardiac graft or 14 d after operation. Mononuclear cells were isolated and the proportion of CD4⁺CD25⁺Treg in CD4⁺ T cell(CD4⁺ CD25⁺ Treg%) were detected by flow cytometry and reverse transcription polymerase chain reaction (RT-PCR) was used to examine the expression of Foxp3 messenger ribonucleic acid (mRNA) semi-quantitatively. Results Compared with the control group, the survival time of cardiac grafts prolonged significantly in SRL and CsA group (all in P < 0.01), but no significant difference was observed between SRL and CsA group(P> 0.05). Compared with the control group, CD4⁺CD25⁺ Treg% significantly decreased in the spleen of CsA group and significantly increased in SRL group (all in P < 0.01). And significant difference was observed between SRL and CsA group (P < 0.01). Expression of Foxp3 mRNA of T lymphocyte in the spleen of SRL group was significantly higher than those in control and CsA group (P < 0.01). And expression of Foxp3 mRNA in control group was significantly higher than that in CsA group (P < 0.01). Conclusions In mouse heart transplantation model, SRL can prolong the survival time of graft and promote the proliferation and growth of CD4⁺ CD25⁺ Treg to facilitate the establishment of immune tolerance.

Clinical Researches

Interventional treatment for ischemic-type biliary lesion after liver transplantation

Li Ming'an, Huang Mingsheng, Jiang Zaibo, Qian Jiesheng, Li Zhengran, Zhang Youyong, Pang Pengfei, Shan Hong

2015, 6(1): 31-36. doi: 10.3969/j.issn.1674-7445.2015.01.007

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Abstract:
Objective To investigate the safety and efficacy of interventional treatment for ischemic-type biliary lesion(ITBL) after liver transplantation(LT). Methods The clinical and imaging data of 76 patients with ITBL after LT, who received interventional treatment in the Department of Interventional Vascular Radiology of the Third Affiliated Hospital of Sun Yat-sen University from January 2006 to February 2014, were retrospectively analyzed. On the basis of the cholangiographic appearance, patients were classified into 3 groups:hilar biliary stricture group(n=28), multifocal biliary stricture group(n=42), and biloma group (n=6). The modalities of interventional treatment were percutanous transhepatic biliary drainage(PTBD), PTBD combined with balloon dilation, PTBD combined with balloon dilation and plastic stent implantation. The methods of biliary drainage included external drainage and external-internal drainage. All the patients were followed up after treatment. The curative effect and biliary complication was observed. Results The first successful rate of PTBD was 97%(74/76). The total curative rate, improvement rate and ineffective rate of interventional treatment were 21%(16/76), 51%(39/76) and 28%(21/76). In hilar biliary stricture group, the cure, improvement and inefficacy rates were 36%(10/28), 57%(16/28)and 7%(2/28). The efficacy rate was 93%(22/28). In multifocal biliary stricture group, the cure, improvement and inefficacy rates were 14%(6/42), 50%(21/42)and 36%(15/42). The efficacy rate was 64%(27/42). In biloma group, 2 cases(2/6) were cured and treatment of 4 cases was ineffective. The efficacy of hilar biliary stricture group was better than that of multifocal biliary stricture group(P < 0.05). The efficacy of multifocal biliary stricture group was better than that of biloma group(P < 0.001). The main biliary complication was biliary tract infection during drainage. The rates of bile tract infections were 20%(13/64)and 67%(8/12) in patients with external drainage and external-internal drainage, respectively. There was significant difference between these two items (P < 0.001). Conclusions PTBD is a safe and effective therapeutic modality for ITBL after LT, which combined with balloon dilation and biliary stent implantation can improve patients' clinical symptoms, elevate patients' quality of life. The biliary external drainage can decrease the rate of biliary tract infection significantly.

Ultrasonographic diagnosis of splenic artery steal syndrome after liver transplantation

Zhu Xiansheng, Wang Shasha, Cheng Qi, Wang Hong, Fan Li, Ling Yin

2015, 6(1): 37-40. doi: 10.3969/j.issn.1674-7445.2015.01.008

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Abstract:
Objective To evaluate the value of ultrasonography in the diagnosis of splenic artery steal syndrome(SASS) after liver transplantation. Methods Routine ultrasonography and contrast enhanced ultrasound(CEUS) were performed in 10 cases with SASS(SASS group) and 8 cases of control patients with normal liver function after liver transplantation. The ultrasonographic findings of SASS were summed up. The diagnostic efficacy of CEUS was compared with that of digital subtraction angiography(DSA). Results In the SASS group, 2D ultrasonography showed that the hepatic parenchyma was normal or there were some tiny necrosis foci in it, and color Doppler flow imaging (CDFI) showed that the blood flow signal of the hepatic artery was sparse or punctiform. CEUS showed the delayed and weak contrast-enhanced signals in hepatic artery after transplantation. The internal diameter of the splenic artery increased while that of the hepatic artery decreased. There was no significant difference between CEUS and DSA. Conclusions The routine ultrasonography and CEUS have a high value on the detection of suspected abnormal vascular system of transplant liver after liver transplantation as the noninvasive diagnostic tools.

Application value of contrast-enhanced ultrasound in vascular complications of transplanted kidney

Peng Chuan, Lin Manxia, Wang Yan, Wang Changxi, Xie Xiaoyan, Xu Zuofeng

2015, 6(1): 41-45. doi: 10.3969/j.issn.1674-7445.2015.01.009

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Abstract:
Objective To evaluate the application value of contrast-enhanced ultrasound(CEUS)in the diagnosis of vascular complication(VC)of transplanted kidney. Methods Imaging data of conventional ultrasound and CEUS in 28 patients suspected with VC of transplanted kidney were analyzed retrospectively. The results of computed tomography angiography (CTA) or digital subtraction angiography (DSA) were served as the diagnostic standard. The value of CEUS in diagnosing VC of transplanted kidney was analyzed. Results No adverse reaction related to contrast agent was observed in 28 patients during the CEUS examination. And 22 cases with VC were confirmed. VCs were detected correctly by CEUS in 17 cases, but 5 cases with transplant renal artery stenosis(TRAS)were missed and 1 case with focal infarction in transplanted kidney was misdiagnosed. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CEUS for VC of transplanted kidney were 0.77, 1.00, 1.00, 0.55 and 0.82, respectively. The diagnostic sensitivity, specificity, PPV, NPV and accuracy of conventional ultrasound and CEUS for TRAS were 0.37 and 0.74, 0.89 and 1.00, 0.88 and 1.00, 0.40 and 0.64, 0.54 and 0.82, respectively. There were significant differences in the sensitivity and accuracy between conventional ultrasound and CEUS (both in P < 0.05). Conclusions CEUS is an effective method for detecting VC of transplanted kidney.

Early change of echocardiography after orthotopic heart transplantation

Liu Shaozhong, Liu Xiaozhen, Ye Muqi

2015, 6(1): 46-50. doi: 10.3969/j.issn.1674-7445.2015.01.010

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Abstract:
Objective To investigate the early application value of echocardiography(UCG) after orthotopic heart transplantation(OHT). Methods A total of 29 patients were monitored by UCG early after OHT. On the 1^st, 7^th, 14^th, 30^th day after operation, the left ventricular end-diastolic diameter (LVDd) and right ventricular end-diastolic diameter (RVDd), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT) and the tricuspid regurgitation area (TRA) were measured, and the left ventricular ejection fraction (LVEF) and left ventricle Tei index(LV-Tei) were calculated. The blood pressures (BP), central venous pressure (CVP) of the patients were recorded simultaneously. Results The LVDd were larger on the 7^th, 14^th and 30^th day after operation, while the RVDd were smaller, compared with those on the 1^st day after operation (all in P < 0.05). The IVST, LVPWT were lower on the 1^th, 14^th and 30^th day after operation, compared with those on the 7th day after operation (all in P < 0.05). The BP, CVP, LV-Tei were all significantly lower on the 1^st, 14^th and 30^th day after operation, compared with those on the 7th day after operation (P < 0.05). There was no significant difference in LVEF between each time points(P>0.05). The tricuspid regurgitation was detected in 3-4 d after operation by UCG, and the TRA reached the peak value[(9.2±2.5)cm²] in 5-8 d after operation, then gradually decreased to (4.7±2.4)cm² at 1 month after operation. Conclusions Early phase after OHT, the structure and function of transplanted heart can be monitored effectively by echocardiography, and it can timely provide multiple parameters as the basis of diagnosis and treatment for clinical doctors.

Application of fast perfusion through abdominal aorta and portal vein in combined liver and kidney procurement from organ donation

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

2015, 6(1): 51-54, 58. doi: 10.3969/j.issn.1674-7445.2015.01.011

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Abstract:
Objective To summarize the feasibility and safety of fast perfusion through abdominal aorta and portal vein in combined liver and kidney procurement from organ donation. Methods Clinical data of 43 donors of donation after cardiac death (DCD) undergoing combined liver and kidney procurement in the First People's Hospital of Foshan from September 2011 to June 2014 were analyzed retrospectively. Among the 43 donors, 15 cases were China DCD donor category Ⅰ(donor after brain death)(C-Ⅰ), 1 case was category Ⅱ (donor after cardiac death)(C-Ⅱ) and 27 cases were category Ⅲ (C-Ⅲ). Combined abdominal aorta and portal vein perfusion with fast cannulation were performed. Results The time from abdomen incision to abdominal aorta cannulation was 1.5-2.0 min. Forty-three livers and eighty-six kidneys were procured from 43 donors. The warm ischemia time (WIT) was 0 for C-Ⅰ donors, and was 3-21 min for the other donors (mean:10 min). Two liver grafts were discarded for major injury of the porta hepatis and severe fatty liver respectively. Eighteen kidney grafts were discarded for kidney stones, kidney atrophy, high level of preoperative serum creatinine, severe renal atherosclerosis, renal microvessel thrombosis, multiple renal cyst, kidney traumatic rupture, etc. The total discard rate of donor organs was 16%. Conclusions Fast perfusion through abdominal aorta and portal vein is a simple and safe method in combined procurement liver and kidney from organ donation.

Short Article

2015, 6(1): 55-58. doi: 10.3969/j.issn.1674-7445.2015.01.012

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Abstract: