器官移植

Abstract:
Objective To investigate clinicopathologic characteristics, individualized immunotherapy and prognosis of antibody-mediated rejection (AMR) after renal transplantation. Methods Clinical data of 32 patients, who were confirmed as AMR after renal transplantation by pathology and admitted in the Department of Urology and Renal Transplantation of the First Affiliated Hospital of Henan Traditional Medical College from January 2010 to December 2013, were retrospectively studied. The corresponding immunological intervention was adopted according to the clinicopathologic characteristics of different patients. The indicators including renal function, panel reactive antibody (PRA) and serum immunoglobulin (Ig) G, IgA and IgM level before and after treatment were determined, and adverse reactions were observed. Results Of all 32 patients, 18 developed acute antibody-mediated rejection (AAMR) and 14 developed chronic antibody-mediated rejection (CAMR). Of 13 PRA-positive patients, 8 (62%, 8/13) cases were with donor specific antibody and 5 (38%, 5/13) cases were with non-donor specific antibody. The primary pathological manifestations of early AAMR were changes of acute tubular necrosis (ATN), peritubular capillary inflammation, glomerulitis, fibrinoid necrosis of small arteries, linear C4d deposition in peritubular capillaries (PTC) and immunoglobulin or C3 deposition in arterial wall. The pathological manifestations of CAMR were changes of glomerulopathy, splitting of PTC basement membrane, fibrous intimal thickening and diffuse C4d deposition in PTC. After treatment, the renal function of 20 (63%, 20/32) patients returned to normal, the renal function of 7 (22%, 7/32) patients were stable, the serum creatinine (Scr) of 5 (16%, 5/32) patients increased slowly. Of such 5 patients, 2 (2/5) patients continued hemodialysis, 3 (3/5) patients did not need hemodialysis and no patient died. The indicators including blood urea nitrogen (BUN), Scr, PRA and serum IgG, IgA and IgM after treatment decreased significantly when compared with those before treatment (all in P < 0.01). No serious adverse reaction was noted during the treatment. Conclusions AMR may manifest as AAMR or CAMR after renal transplantation. The gold standard for diagnosing AMR is pathologic biopsy of transplant kidney. To adopt effective individualized immunotherapy in time is the critical measure for treatment of AMR.

Comparative study of application of standard double-and single-dose of basiliximab in renal transplantation

Qiu Tao, Zhou Jiangqiao, Liu Xiuheng, Chen Zhiyuan, Ge Minghuan

2015, 6(4): 230-234. doi: 10.3969/j.issn.1674-7445.2015.04.005

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Abstract:
Objective To compare clinical efficacy and safety between standard double-and single-dose of basiliximab in renal transplantation. Methods A total of 121 patients undergoing allogeneic cadaveric renal transplantation in Department of Urology of Renmin Hopsital of Wuhan University from January 2008 to May 2011 were recruited as study subjects. Among them, 53 patients were assigned into the double-dose of basiliximab group and they were intravenously administered with 20 mg of basiliximab before and 4 d after surgery according to product description. Sixty-eight cases were allocated in the single-dose of basiliximab group and they were given with 20 mg of basiliximab before renal transplantation. The changes of immune function in two groups during perioperative period were monitored. The incidence of adverse reactions including delayed graft function (DGF), acute rejection, pulmonary infection and the survival of patients and renal grafts were statistically compared between two groups. Results There was no significant difference in preoperative humoral immune and cellular immune function between two groups. Compared with preoperative period, cellular and humoral immune function in both groups were inhibited by varying degree at 5 d after surgery (both in P < 0.05). Compared with patients in the single-dose group, cellular and humoral immune functions were evidently suppressed in the double-dose group (both in P < 0.05). Compared with the parameters assessed at 5 d after surgery, cellular and humoral immune functions were restored to varying degree at 15 d after surgery, whereas still significantly lower than preoperative levels (CD3, CD4, IgM and IgA). Partial parameters (CD8 and IgG) were persistently inhibited and continued to decline compared with the levels at 5 d after surgery. The incidence of DGF was 8% in the double-dose group, and 7% in the single-dose group. During 1-year follow-up, the rejection rates in the double-and single-dose groups were 13% and 12%, and the incidence of pulmonary infection was 9% and 10%. No statistical significance was noted between two groups in terms of these parameters (all in P>0.05). The 1-year survival of patients in the double-and single-dose groups was 94% and 98%, 93% and 96% for the survival of renal grafts. No statistical significance was found between two groups (both in P>0.05). Conclusions Both double-and single-dose of basiliximab are efficacious in renal transplantation and do not increase the incidence of adverse reaction. The 1-year survival rates of patients and renal grafts between two groups are almost equivalent. Detection of immune function during perioperative period effectively guides individualized immune induction therapy.

Clinical study on growth and development of children after liver transplantation

Song Yuwei, Zhu Zhijun, Sun Liying, Wei Lin, Qu Wei, Zeng Zhigui, Liu Ying

2015, 6(4): 235-239. doi: 10.3969/j.issn.1674-7445.2015.04.006

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Abstract:
Objective To investigate the growth and development of children after liver transplantation. Methods Seventy children who underwent liver transplantation in Beijing Friendship Hospital and Tianjin First Central Hospital from September 2006 to May 2014 were included in the study. Height Z-scores (Z_H) and weight Z-scores (Z_W) of each child were respectively calculated at transplantation and 6 months, 1 year, 2 years, 3 years, 4 years and 5 years after transplantation. The change trends of Z_H and Z_W at each time point were analyzed. Moreover, Z_H and Z_W at each time point were compared with the standardized mean of growth 0 (standardized mean) formulated according to the survey data of children's physical development in nine provinces and municipalities in 2005. Children were divided into Z≥-2 group and Z < -2 group according to Z_H and Z_W at transplantation. And the change trend of Z_H and Z_W of each group was compared. Results The mean of Z_H and Z_W at the time of liver transplantation was -1.63±1.35 and -1.53±1.52 respectively. After liver transplantation, Z_H and Z_W increased gradually. Z_H and Z_W of children before transplantation and 6 months after transplantation were significantly lower than standardized mean (all in P < 0.01). Z_H and Z_W in other postoperative periods had no statistical significance with standardized mean (all in P>0.05). There were significant difference between Z_H≥-2 group and Z_H < -2 group at transplantation and 6 months and 1 year after transplantation (both in P < 0.05). Zw of Zw≥-2 group and Zw < -2 group at transplantation and 6 months, 1 year and 2 years after transplantation had difference with statistical significance (all in P < 0.05). Conclusions The growth and development of children with liver transplantation recover gradually and increase significantly at 1 year after transplantation.

Experience of treatment on delayed graft function complicated with severe pulmonary infection

Chen Weiguo, Zhou Tingting, Li Xiaowei, Zhou Peng, Wang Qingtang, Li Shadan

2015, 6(4): 240-244. doi: 10.3969/j.issn.1674-7445.2015.04.007

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Abstract:
Objective To sum up the experience in the treatment on delayed graft function (DGF) complicated with severe pulmonary infection. Methods Clinical data of 15 patients undergoing renal transplantation and suffering delayed graft function(DGF) complicated with severe pulmonary infection in Chengdu Military General Hospital from January 2008 to November 2014 were retrospectively studied. The treatment course and prognosis were studied. Results Continuous renal replacement therapy was adopted and dosage regimen was adjusted according to the dosage adjustment table for continuous veno-venous hemofiltration. Antibiotic de-escalation therapy was adopted. Immunosuppressive agents were adjusted and low-dose adrenocortical hormone and other comprehensive treatment were applied. Of the 15 patients, 8 cases underwent tracheal intubation, 2 cases underwent mechanical ventilation after tracheotomy and 5 cases underwent noninvasive ventilator-assisted breathing. Through positive rescue treatment, 11 patients were cured and 4 patients died. The cure rate was 73% and the fatality rate was 27%. All died patients were complicated with acute respiratory distress syndrome. Conclusions DGF complicated with severe pulmonary infection after renal transplantation is characterized by severe condition and fast progression. Once cases confirmed, continuous renal replacement therapy shall be‘fully’applied ‘as early as possible’, and dosage regimen shall be adjusted according to the dosage adjustment table for continuous veno-venous hemofiltration. And other comprehensive treatments shall be combined in order to improve the cure rate.

Clinical study of de novo hepatitis B virus infection after pediatric living liver transplantation

Tu Zhiyue, Sun Liying, Zhu Zhijun, Wei Lin, Qu Wei, Zeng Zhigui, Liu Ying, He Enhui, Zhang Liang, Wang Dong, Song Yuwei

2015, 6(4): 245-248, 267. doi: 10.3969/j.issn.1674-7445.2015.04.008

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Abstract:
Objective To investigate the clinical characteristics, prevention and treatment strategy of de novo hepatitis B virus (HBV) infection after pediatric living liver transplantation. Methods In total, 106 pediatric recipients undergoing living liver transplantation in Organ Transplantation Center of Affiliated Beijing Friendship Hospital of Capital Medical University and Organ Transplantation Center of Tianjin First Center Hospital from July 2010 to July 2014 were enrolled in this study. All surgeries were performed by the same surgical team. According to preoperative test outcomes of donor HBV serological markers, all recipients were divided into the positive (n=45) and negative (n=61) antibody to hepatitis B core antigen (anti-HBc) donor liver groups(positive group and negative group), and the prevalence of de novo HBV infection was compared between two groups. The risk factors of de novo HBV infection in the positive group were analyzed to elucidate the clinical characteristics of de novo HBV infection in affected children. Results The incidences of de novo HBV infection in positive and negative group were 18%(8/45) and 2%(1/61) respectively. The risk factors of de novo HBV infection in recipients with positive anti-HBc were negative anti-HBs before transplantation and absence of antiviral therapy post-transplantation in recipients (both in P < 0.05). The median interval between time of onset and time of liver transplantation was 12 months (8-48 months). Seven cases were treated with lamivudine and the remaining two cases were left untreated. All nine recipients survived. Conclusions Application of positive anti-HBc donor liver have a risk of HBV infection in recipients after pediatric liver transplantation. Absence of postoperative nucleoside analogue therapy and negative anti-HBs before transplantation acts as risk factors of de novo HBV infection in the recipients with positive anti-HBc donor liver. After liver transplantation, nucleoside analogue therapy is recommended for the pediatric recipients with positive anti-HBc donor liver to prevent the incidence of de novo HBV infection. Besides, hepatitis B vaccine should be administered prior to liver transplantation.

Original Articles·Clinical Researches

Pure red cell aplasia caused by human parvovirus B19 infection after renal transplantation: a report of 2 cases and literature review

Huang Senlin, Yu Lixin, Deng Wenfeng, Guo Jinming, Miao Yun

2015, 6(4): 249-253. doi: 10.3969/j.issn.1674-7445.2015.04.009

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Abstract:
Objective To investigate the diagnosis and treatment characteristics of pure red cell aplasia (PRCA) caused by human parvovirus (HPV) B19 infection after renal transplantation. Methods Two cases with PRCA caused by HPV B19-induced after renal transplantation, who were treated in the Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, were summarized. Combined with literature review, the clinical characteristics, diagnostic method, course of treatment and prognosis of such disease were investigated. Results Two renal transplant recipients developed severe anemia early after transplantation with progressive deterioration and failed transfusion therapy. Other causes of anemia were ruled out and two patients were diagnosed as PRCA caused by HPV B19 infection according to bone marrow aspiration and biopsy as well as HPV DNA detection by fluorescent polymerase chain reaction (PCR). The symptoms of anemia were improved significantly after adjustment of immunosuppressive treatment protocol and intravenous immunoglobulin (IVIG). Conclusions For patients with unexplained and progressed anemia early after renal transplantation, especially those complicated with reticulocyte deficiency, the possibility of PRCA caused by HPV B19 infection shall be considered. The results of bone marrow aspiration and fluorescent PCR are the main bases for diagnosing PRCA. Immunosuppressive agents reduction and application of IVIG are the major treatment measures. Most of patients have great prognosis after treatment, but this disease is likely to recur.

Correlation between body mass index and early graft function

Dong Liming, Jiang Yan, Reyihan·Xielifu, Li Li, Li Ming, Mikereyi·Aizimaiti

2015, 6(4): 254-257. doi: 10.3969/j.issn.1674-7445.2015.04.010

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Abstract:
Objective To investigate the correlation between body mass index (BMI) and early graft function. Methods Clinical data of 133 recipients underwent renal allograft transplantation in the Department of Nephropathy of the First Affiliated Hospital of Xinjiang Medical University from November 2003 to November 2014 were retrospectively studied. According to BMI before transplantation, the recipients were divided into 3 groups: emaciation group (BMI < 18.5 kg/m²), normal weight group (BMI of 18.5-23.9 kg/m²) and overweight group (BMI>23.9 kg/m²). The laboratory indexes [blood urea nitrogen (BUN), serum creatinine (Scr), hemoglobin, serum albumin, total cholesterol and triglyceride] and the incidence of delayed graft function at 1 week after transplantation were compared among three groups. The correlation between Scr and BMI was analyzed. Results There was significant difference in Scr level among three groups(P < 0.05). In pairwise comparison, Scr level of the overweight group was higher than that of the normal weight group and the difference had statistical significance (Z=-3.408, P=0.01). The hemoglobin, serum albumin and total cholesterol of the three groups showed no difference with statistical significance (all in P>0.05). The Scr level of renal transplant recipients was positively correlated with BMI (r=0.187, P=0.031), and Scr level raised with the increase of BMI. Conclusions BMI influences the recovery of early graft function. To control body weight before transplantation is beneficial to improve graft function.

Vascular complications of transplant renal artery: a report of 29 cases and literature review

Jiang Wei, Gao Jian, Liu Yanbin, Long Wei, Yu Meng, Yang Qishun

2015, 6(4): 258-261. doi: 10.3969/j.issn.1674-7445.2015.04.011

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Abstract:
Objective To summarize the clinical characteristics and treatment experience on vascular complications of transplant renal artery. Methods Of 322 patients undergoing renal transplantation in the 281st Hospital of People's Liberation Army from June 2007 to June 2014, 29 patients developed vascular complications of transplant renal artery after transplantation. Clinical data of such 29 patients were retrospectively studied to summarize the clinical characteristics and treatment experience. Results Two patients developed anastomotic haemorrhage of transplant renal artery, 23 patients developed transplant intrarenal artery spasm, 2 patients developed transplant renal artery thrombosis and 2 patients developed transplant renal artery stenosis. The anastomotic haemorrhage from transplant renal artery was postoperative haemorrhage, and surgical exploration and hemostasis were conducted in time. Patients with transplant intrarenal artery spasm were given antispasmodic treatment during operation. And the dark red and soft renal graft became full and ruddy. Patients with transplant renal artery thrombosis underwent surgical exploration once confirmed. The renal grafts were dark red and did not recover to normal after blood supply recovery, thus the renal grafts were removed. For patients with developed transplant renal artery stenosis, balloon dilatation and stent implantation were adopted. The blood pressure of patients returned to normal and the renal function was normal. Conclusions Vascular complications of transplant renal artery are characterized by quick progression, fast condition changes and serious consequences. In order to reduce the incidence and increase the recovery rate, active prevention and decisive treatment are very important.

Original Articles·Experimental Researches

Effect of melatonin on GRP-78 and CHOP expression in transplant liver tissues of rats

Li Meng, Pan Qi, Cheng Ying, Liu Yongfeng

2015, 6(4): 262-267. doi: 10.3969/j.issn.1674-7445.2015.04.012

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Abstract:
Objective To investigate the function of melatonin (MEL) on liver transplantation by detecting the effect of MEL on glucose regulated protein-78 (GRP-78) and CCAAT enhancer-binding protein homologous protein (CHOP) involved in the endoplasmic reticulum stress (ERS) pathways in livers of rats with liver transplantation. Methods The rat orthotopic liver transplantation model was established by using'magnetic-loop method'. Male SD rats were randomized into 3 groups: the sham operation group (Sham group), the orthotopic liver transplantation group (OLT group) and the orthotopic liver transplantation+MEL treatment group (OLT+MEL group), 8 rats in each group. Serum sample and liver sample were collected at 24 h after operation. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were detected. Liver tissues were stained with hematoxylin-eosin (HE) and pathological changes of liver tissues of each group were observed. The messenger ribonucleic acid (mRNA) and protein expression levels of GRP-78 and CHOP were detected by polymerase chain reaction and Western blot. Results Compared with the Sham group, the serum ALT and AST of the OLT group increased significantly (both in P < 0.01), liver tissues injury was serious, and mRNA and protein expression levels of GRP-78 and CHOP increased significantly (all in P < 0.01). Compared with the OLT group, ALT and AST of the OLT+MEL group decreased significantly (both in P < 0.05), liver tissues injury was alleviated, and mRNA and protein expression levels of GRP-78 and CHOP decreased significantly (all in P < 0.05). Conclusions MEL may reduce mRNA and protein expression levels of GRP-78 and CHOP involved in the ERS pathways of transplant liver, which may be one of its mechanisms to alleviate liver injury after liver transplantation.

Repairment of sciatic nerve defect by Schwann cell of adult rat combined with acellular nerve grafts

Zhou Lina, Cui Xiaojun, Su Kaixin, Wang Xiaohong, Cai Xueyan, Guo Jinhua, Na Qingqing

2015, 6(4): 268-272. doi: 10.3969/j.issn.1674-7445.2015.04.013

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Abstract:
Objective To investigate clinical efficacy of tissue-engineered artificial nerve grafts constructed by acellular nerve grafts combined with adult rat Schwann cell (SC) in the treatment of peripheral nerve injury. Methods SCs were isolated and cultured from the distal nerves of adult Sprague Dawley (SD) rats with 1-week Wallerian degeneration and then combined with acellular nerve grafts to construct tissue-engineered artificial nerve. All rats were divided into acellular nerve graft containing SCs (SC group) and nerve graft containing no cells groups (control group), five animals in each group. At 2-, 4-and 8-week after surgery, sciatic function index (SFI) of the affected side was compared between two groups. At postoperative 8 weeks, nerve conduction of sciatic nerve of the injured side, recovery rate of triceps surae wet weight and other relevant parameters were equally compared between two groups. Results In the SC group, SFI of the affected side at 2-, 4-and 8-week after surgery, nerve conduction of sciatic nerve at the injured side and recovery rate of triceps surae wet weight at postoperative 8 weeks were significantly better compared with those in the control group (all in P < 0.05). Conclusions Combined use of adult rat SCs and acellular nerve grafts effectively repairs peripheral nerve defects and accelerates functional recovery of injured nerves.