器官移植

Abstract:
Objective To analyze the correlation between the status of the donation after brain and cardiac death (DBCD) donors and postoperative recovery of the organ function in the liver and renal transplant recipients. Methods The assessment data and organ protection measures of 12 DBCD donors admitted to the Organ Transplantation Center in Sichuan Provincial People's Hospital from August 2011 to November 2013 were retrospectively analyzed. The parameters of postoperative recovery of 12 liver and 22 renal transplant recipients were also assessed. The correlation between the parameters of the donors and postoperative recovery of the liver and renal transplant recipients was statistically analyzed. Results Among 12 liver transplant recipients, 1 patient had primary non-function (PNF) (1/12, 8%) and 11 cases developed delayed graft function (DGF) after renal transplantation (11/22, 50%). Intensive care unit (ICU) period, liver function, maintaining systolic blood pressure (SBP), blood coagulation function, blood glucose level and electrolyte (Na⁺/K⁺) were significantly correlated with postoperative recovery of the liver and kidney function in the recipients (all in P < 0.05). Age, cause of brain death, maintaining diastolic blood pressure (DBP), activated partial thromboplastin time (APTT) and pH of arterial blood gas (ABG) were associated with postoperative recovery of the liver function. Total bilirubin and white blood cell count (WBC) were correlated with postoperative recovery of kidney function. Conclusions DBCD donors cater to the specific conditions in China. The incidence of postoperative PNF in liver recipients is relatively low whereas and the incidence of DGF after renal transplantation is relatively high. Assessment of the DBCD donors and organ protection measures should be specifically taken to enhance the clinical efficacy of liver and renal transplantation from DBCD donors.

Short-term clinical efficacy of liver transplantation with organs from donation after Chinese citizens' death in patients with high model for end-stage liver disease score

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

2015, 6(2): 86-92. doi: 10.3969/j.issn.1674-7445.2015.02.004

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Abstract:
Objective To explore the short-term clinical efficacy and safety after liver transplantation with organs from Chinese donation after citizens' death in patients with high model for end-stage liver disease (MELD) score. Methods The clinical data of 34 liver transplantation recipients with organs from donation after citizens' death from November 2011 to June 2014 in the First People's Hospital of Foshan were retrospectively analyzed. All recipients were divided into the high MELD score (MELD score≥25, n=8) and low MELD score groups (MELD score < 25, n=26) according to preoperative MELD score. Preoperative, intraoperative and postoperative status of the patients was statistically compared between two groups. Results Prior to operation, the proportion of patients requiring artificial liver support and the incidence of acute or chronic and acute liver failure in the high MELD score group were significantly higher than those in the low MELD score group (all in P < 0.05). Intraoperatively, there was no significant difference in blood loss, perfusion volume, warm and cold ischemia time, anhepatic period, operative time and approach between two groups (all in P > 0.05). After operation, the length of intensive care unit (ICU) stay in the high MELD score group was significantly longer than that in the low MELD score group (P < 0.05). And there was no significant difference in the length of hospital stay, mortality during hospitalization, incidence of early complications, follow-up time and overall survival rate between two groups (all in P > 0.05). The peak level of aspartate aminotransferase (AST) in the high MELD score group was significantly higher compared with that in the low MELD score group (P < 0.05). The incidence of bile leakage, abdominal abscess and liver dysfunction significantly differed between two groups (all in P < 0.05). Conclusions It is a safe and short-term efficacious approach to perform liver transplantation with organs obtained from Chinese donation after citizens' death in patients with high MELD score liver recipients.

Clinical analysis of 47 cases with mid-and long-term biliary complications after liver transplantation

Jiang Weiwei, Li Jun, Chen Hong, Shen Zhongyang, Cheng Mingliang, Fan Tieyan, Wang Xu, Zhang Qing, Chen Xinguo, Xu Guangxun

2015, 6(2): 93-97. doi: 10.3969/j.issn.1674-7445.2015.02.005

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Abstract:
Objective To investigate the incidence, treatment and outcome of mid-and long-term biliary complications after liver transplantation. Methods Clinical data of 651 patients who underwent liver transplantation at General Hospital of Armed Police Forces from April 2002 to February 2012 were retrospectively studied to analyze the incidence, treatment and outcome of mid-and long-term biliary complications after liver transplantation. Results Among 651 liver transplant cases, 47 patients (7.2%) developed mid-and long-term biliary complications. The mean time of onset was 21 months. Forty seven patients underwent 48 cases of treatment in total. Nine cases received anti-inflammatory therapy alone. Fourteen cases were treated with choledochoscope lithotomy, choledochoscope biliary cast or placing the biliary support tube. And 13 cases underwent endoscopic retrograde cholangiopancreatography(ERCP) nephrolithotomy, expanding the bile duct or placing the biliary support tube, including 1 patient was switched to percutaneous transhepatic cholangial drainage(PTCD) due to ERCP failure. Seven cases received drainage by PTCD and 5 cases were treated with anti-inflammatory therapy combined with choledochoscope or PTCD. The total efficacious rate was 92%. Among 3 invalid patients, two patients were treated with secondary liver transplantation and one died. Conclusions The mid-and long-term biliary complications probably occur after liver transplantation. Individualized therapies should be chosen based upon the types and severity of biliary complications, which yields relatively high efficacious rate. Secondary liver transplantation should be performed as necessary.

Clinical application of thymalfasin in patients with severe pulmonary infection after liver transplantation

Song Jiyong, Du Guosheng, Zhu Zhidong, Zhou Lin, Suo Longlong, Zheng Dehua, Feng Likui, Shi Bingyi

2015, 6(2): 98-101. doi: 10.3969/j.issn.1674-7445.2015.02.006

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Abstract:
Objective To explore the efficacy and safety of thymalfasin in the treatment of severe pulmonary infection after liver transplantation. Methods Twenty seven patients who developed severe lung infection after undergoing liver transplantation in Organ Transplant Institute of the 309^th Hospital of People's Liberation Army from January 2008 to May 2014 were enrolled in this study. According to whether the application of thymalfasin, the patients were divide into thymalfasin group(n=11) and control group(n=16). In the thymalfasin group, thymalfasin was administered via subcutaneous injection at a dose of 1.6 mg once daily for consecutive two weeks. In the control group, conventional anti-infection therapy was delivered. Ventilator time, duration of fever, the length of intensive care unit(ICU) stay and mortality were statistically compared between two groups. And the incidence of acute rejection (AR) was monitored. Results Ventilator time, duration of fever, length of ICU stay of patients in the thymalfasin group were significantly shortened compared with those in the control group (all in P < 0.05). There was no significant difference in the mortality between two groups. No clinical AR was observed in either group. No thymalfasin-related adverse event was found in the thymalfasin group. Conclusions Thymalfasin can improve the curative effect to anti-infection of patients with severe pulmonary infection after liver transplantation without the incidence of AR, which is efficacious and safe in the treatment of severe pulmonary infection.

Observation on safety of renal transplantation in patients with idiopathic thrombocytopenic purpura

Pei Xiangke, Jiang Wei, Liu Yanbin, Yang Qishun, Long Wei, Yang Shuobin

2015, 6(2): 102-104, 115. doi: 10.3969/j.issn.1674-7445.2015.02.007

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Abstract:
Objective To investigate the safety of renal transplantation in patients with idiopathic thrombocytopenic purpura (ITP). Methods Clinical data of two ITP patients undergoing renal transplantation were retrospectively analyzed and pertinent literatures were reviewed. Results Prior to renal transplantation, the platelet count of these two patients was 41×10⁹/L and 34×10⁹/L, respectively. The coagulation function was normal and no active bleeding was observed. They underwent renal transplantation successfully without obvious bleeding intra-or post-operatively. The platelet count of one patient who received hydrocortisone impulse therapy for three days and maintenance treatment with immunosuppressant based on ciclosporin recovered to normal range and kept stable at 7 days after renal transplantation. Though receiving platelet-promoting drugs and platelet infusion, the platelet count of the other patient treated with methylprednisolone impulse therapy for 3 days and maintenance therapy with immunosuppressant based on tacrolimus did not recover to normal range but fluctuated between 10×10⁹/L and 30×10⁹/L after renal transplantation. Renal function was well maintained in both recipients. Conclusions The risk of renal transplantation related bleeding in ITP patients is correlated with whether the preoperative active bleeding or not. Renal transplantation is relatively safe for uremia patients without active bleeding pre-operation.

Experimental Researches

Induction of Schwann cell-like differentiation in bone mesenchymal stem cell of adult rat in vitro

Zhou Lina, Cui Xiaojun, Su Kaixin, Wang Xiaohong, Cai Xueyan, Guo Jinhua, Lei Linzhong

2015, 6(2): 105-110. doi: 10.3969/j.issn.1674-7445.2015.02.008

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Objective To explore the effective method of induction of Schwann cell-like differentiation in bone mesenchymal stem cell (BMSC) of adult rat in vitro. Methods Primary culture of Schwann cell and isolated culture of BMSC were separately conducted. According to different induction methods, the cells were divided into chemical induction group and co-culture induction group. The growth of Schwann cell and BMSC was observed under light microscope. These two kinds of cells were identified by immunofluorescence staining [detecting Schwann cell marker proteins: glial fibrillary acidic protein (GFAP) antibody and S-100 antibody] and flow cytometry. The shape and growth of cells in two groups were dynamically observed by light microscope. The induced differentiation was evaluated with immunofluorescence staining at 3^rd day after co-culture induction in the co-culture induction group and at 4 h and 1^st day after chemical induction in the chemical induction group. Results In the chemical induction group, the BMSC appeared typical Schwann cell-like morphology. The positive expression of GFAP antibody appeared at 4 h after preliminary induction. Meanwhile, the positive expression rate of GFAP and S-100 antibody was (80.9±3.5)% and (59.0±1.1)% at 1^st day after induction. The induced BMSC began to die at 2^nd day after chemical induction and most of the induced BMSC had died at 3^rd day after chemical induction. At 3^rd day after co-culture induction, few induced BMSC showed obvious morphological changes like those in chemical induction group. The positive expression rate of GFAP and S-100 antibody was (89.8±2.4)% and (80.9±1.7)%. The positive expression rate of GFAP and S-100 antibody in the co-culture induction group was higher than those in the chemical induction group and the difference had statistical significance (all in P < 0.01). Conclusions The co-culture induction not only has obvious effect on Schwann cell-like differentiation in BMSC, but also promotes the survival and proliferation of BMSC. Thus, co-culture induction is more safe and effective than chemical induction.

Research on isolation and purification method of pancreatic islets in mice

Yan Dien, Zhou Yingsheng, Gao Xiuying, Zhao Yinan

2015, 6(2): 111-115. doi: 10.3969/j.issn.1674-7445.2015.02.009

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Abstract:
Objective To investigate a method for isolation and purification of pancreatic islets in mice, aiming to enhance the quantity and activity of pancreatic islets. Methods The pancreas were digested by retrograde common bile duct perfusion of collagenase, discontinuous density gradient centrifugation and the islets were selected and purified by manual method. After overnight culture, the pancreatic islets were incubated by static glucose-stimulated insulin secretion (GSIS) and the islet function was assessed. The subcellular structure of islet β cells was observed under transmission electron microscopy. Results Using the modified method, (200±20) islets were collected in each mouse with a mean diameter of (175±22) μm. The insulin levels in the stimulation of low (2.8 mmol/L) and high glucose (16.7 mmol/L) were (0.33±0.07) and (1.36±0.47) ng/(islet·60 min), which were detected by GSIS. Insulin levels in the stimulation of high sugar is 4.12 times of those of low sugar with a statistical significance (P < 0.05). It was revealed by transmission electron microscopy that the pancreatic β cell membrane and mitochondrial membrane was intact and insulin granules of different sizes could be seen within β cells. Conclusions Retrograde common bile duct perfusion of collagenase, discontinuous density gradient centrifugation combined with manual selection in vitro is a convenient, fast and stable method for isolating mouse islets, which can get pancreatic islets with relatively high output, intact cellular morphology, and good reactivity of GSIS.

Research on differential expression of hepatic stress protein after reduced-size liver transplantation in rats

Liu Jing, Li Li, Ran Jianghua, Zhang Shengning, Li Laibang, Zhang Xibing, Chen Yiming, Gao Yang

2015, 6(2): 116-119. doi: 10.3969/j.issn.1674-7445.2015.02.010

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Abstract:
Objective To discuss the differential expression of hepatic stress proteins after reduced-size liver transplantation in rats. Methods The specimens of liver tissues were procured on 1 d, 3 d and 7 d after the improved model of reduced-size liver transplantation in rats. Then, the two-dimensional electrophoresis of these specimens was compared with that of the original liver tissues of normal donors and recipients. The differentially expressed protein spots were selected with the standard of change times greater than 10 or less than 1/10 and then were analyzed and identified by mass-spectrometric technique and data bases. Results Seventy-two differentially expressed protein spots were found in total. And the 32 kinds of proteins were identified with definite function through mass spectrometry and a series of identifications. The expression difference of heat shock protein-8 and hypertrophy agonist reactive protein was larger, amounting 7% (5/72) of all differential proteins. Conclusions This study provides fundamental research data for studying the relation between liver ischemia-reperfusion injury after liver transplant and the above differential proteins of stress reaction in transplant liver which are found after reduced-size liver transplantation in rats.

Review Articles

2015, 6(2): 120-123, 130. doi: 10.3969/j.issn.1674-7445.2015.02.011

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Abstract: