器官移植

2015 Vol. 6, No. 5

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Editorial
Expert Forums
Transplantation Forefronts
Experimental Researches
Clinical Researches
Review Articles

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Editorial

2015, 6(5): 283-287. doi: 10.3969/j.issn.1674-7445.2015.05.001

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Expert Forums

2015, 6(5): 288-293. doi: 10.3969/j.issn.1674-7445.2015.05.002

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2015, 6(5): 294-297. doi: 10.3969/j.issn.1674-7445.2015.05.003

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Transplantation Forefronts

2015, 6(5): 298-302. doi: 10.3969/j.issn.1674-7445.2015.05.004

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2015, 6(5): 303-306. doi: 10.3969/j.issn.1674-7445.2015.05.005

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Experimental Researches

Comparative study of effect of mechanical perfusion and simple cold preservation on DCD pancreas in pigs

Fu Dazhi, Cheng Ying, Liu Yongfeng

2015, 6(5): 307-310, 315. doi: 10.3969/j.issn.1674-7445.2015.05.006

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Objective To compare the effect of mechanical perfusion and simple cold preservation on donation after cardiac death (DCD) pancreas in pigs. Methods Ten healthy pigs were randomized into simple cold preservation group and the mechanical perfusion group (5 pigs in each group). DCD model was established in pigs. The pancreas was cut and stored in University of Wisconsin solution (UW solution). The pancreas of the simple cold preservation group was preserved with simple UW solution and that of the mechanical perfusion group was preserved by mechanical perfusion. Specimen was collected from pancreatic tail at 1, 2, 3, 4, 6 and 24 h to prepare tissue section. Then, the tissue section was stained with hematoxylin-eosin (HE). Histopathological examination was conducted and pathological score of the two groups was compared. Results Microthrombus in DCD pancreas of pig was removed at 180 min of mechanical perfusion and injury to pancreas islet caused by excessive perfusion was avoided. The pathological score of the mechanical perfusion group was (4.2±0.8) and that of the simple cold preservation group was (8.4±1.1), and the difference had statistical significance (P < 0.05). Conclusions Mechanical perfusion may effectively remove thrombus in pancreatic vessels. Compared with simple cold preservation, mechanical perfusion may maintain the integrity of pancreas islet better after the preservation of the same period of time.

Research on the relationship between Foxp3⁺ Regulatory T cell and tumor recurrence of patients after liver transplantation for hepatocellular carcinoma

Du Guosheng, Zhou Lin, Zhu Zhidong, Song Jiyong, Feng Likui, Zheng Yonggen, Suo Longlong, Yang Shaozhen

2015, 6(5): 311-315. doi: 10.3969/j.issn.1674-7445.2015.05.007

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Objective To discuss the relationship between Foxp3⁺regulatory T cell(Treg) and tumor recurrence of patients after liver transplantation for primary hepatocellular carcinoma (HCC) over University of California, San Francisco (UCSF) criteria. Methods Clinical data of 24 patients with HCC undergoing liver transplantation in the Organ Transplantation Research Institute of the 309^th Hospital of People's Liberation Army from January 2010 to December 2013 were retrospectively studied. During the follow-up, 4 patients recurred (tumor recurrence group) and other 20 patients did not recur (tumor non-recurrence group). The blood samples of healthy people was selected as control group at the same period. The levels of alpha-fetoprotein (AFP) were compared at different time points of the recurrence group and the non-recurrent group before and after transplantation. The levels of Foxp3⁺Treg (Foxp3⁺Treg%) were compared at different time points of the tumor recurrence group, the tumor non-recurrence group and the control group before and after transplantation. The relations between expression of Foxp3⁺Treg and the levels of AFP, CD3⁺ and CD8⁺T before and after transplantation were analyzed by correlation analysis. Results Compared with the level of Foxp3⁺Treg before transplantation and the normal level, the expression of Foxp3⁺Treg of patients in tumor non-recurrence group after transplantation firstly decreased, then gradually increased and finally stabilized at a low level. Compared with patients in tumor non-recurrence group, the levels of AFP and Foxp3⁺Treg of patients in tumor recurrence group increased obviously and were significantly higher than the normal levels (both in P < 0.01). Moreover, abnormal increase of Foxp3⁺Treg at early stage was prior to AFP among the patients in tumor recurrence group. Correlation analysis indicated that the change of Foxp3⁺Treg was consistent with the changes of AFP, which was positively correlated (P < 0.01). But the change of Foxp3⁺Treg was contrary to the change of effector T cells (CD3⁺T cells and CD8⁺ T cells), which was negatively correlated (P < 0.05-0.01). It indicated that Foxp3⁺Treg was closely associated with tumor recurrence after liver transplantation for HCC. Conclusions Foxp3⁺Treg is closely associated with tumor recurrence after liver transplantation for HCC. In the patients after liver transplantation for HCC over UCSF criteria, the higher Foxp3⁺Treg is, the higher the recurrence risk is. Joint detection of AFP is beneficial to find tumor recurrence.

Clinical Researches

Clinical effect analysis of liver transplantation from donation after citizen's death in 31 cases

Lan Liugen, Qin Ke, Dong Jianhui, Huang Ying, Cao Song, Li Haibin, Li Zhuangjiang, Zhou Jiehui, Sun Xuyong

2015, 6(5): 316-321. doi: 10.3969/j.issn.1674-7445.2015.05.008

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Objective To summarize the clinical experience and curative effect analysis of liver transplantation from donation after citizen's death. Methods Clinical data of 31 cases of liver transplantation from donation after citizen's death in the 303^rd Hospital of People's Liberation Army were retrospectively studied. Results Among the 31 donors, 8 donors met ClassⅠof Chinese Standard, 3 met Class Ⅱ and 20 met Class Ⅲ. The liver graft was obtained according to the standardized organ procurement process. The warm ischemia time of the liver graft was 2-13 min with the average of 9 min and the cold ischemia time was 240-600 min with the average of 350 min. Thirty-one recipients underwent the liver transplantation successfully. Twenty-nine recipients recovered well and the liver function gradually recovered without thrombosis and rejection. Four recipients developed biliary stricture and the drainage was unobstructed after biliary stent placement. The average stay time in intensive care unit (ICU) was 8 d and the average length of stay after transplantation was 21 d. The recipients were discharged when the conditions were stable. The overall survival rate of the recipients was 81%. One recipient died of primary liver dysfunction at 2 d after transplantation, one recipient died of postoperative pulmonary infection and four tumor patients died of tumor recurrence and metastasis. Conclusions Donation after citizen's death may expand the source of liver grafts and the short term effect is good. To gradually improve function protective measures for donor organs, to strictly control indications of donors, to strengthen the assessment of organ function and to shorten warm and cold ischemia time are important measures to improve clinical effect.

Effect of preoperative portal venous thrombosis on liver transplantation for patients with end-stage liver cirrhosis

Meng Wei, Zhao Hui, Yi Shuhong, Zhang Tong, Fu Binsheng, Wang Guoying, Xu Chi, Li Hua, Yang Yang, Chen Guihua

2015, 6(5): 322-325. doi: 10.3969/j.issn.1674-7445.2015.05.009

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Objective To investigate the effect of preoperative portal venous thrombosis on liver transplantation for patients with end-stage liver cirrhosis. Methods Clinical data of 182 patients with end-stage liver cirrhosis undergoing liver transplantation at the Organ Transplantation Center of the Third Affiliated Hospital, Sun Yat-sen University from January 2007 to December 2011 were retrospectively studied. Thirteen patients complicated with portal venous thrombosis (3 patients were in Yerdel gradeⅠ, 6 were in grade Ⅱ, 2 were in grade Ⅲ and 2 were in grade Ⅳ) were divided into the portal venous thrombosis group. Other 169 patients without portal venous thrombosis were divided into the control group. The intra-operative and postoperative conditions of patients were compared between two groups. Results Compared with the control group, there were longer operation time, more intra-operative blood loss in the portal venous thrombosis group and the patient with Yerdel grade Ⅲ-Ⅳ. There was significant difference (both in P < 0.05). At one month after transplantation, one patient (8%) in the portal venous thrombosis group and three patients (2%) in the control group developed portal venous thrombosis, and there was significant difference (P < 0.05). Three-year survival rate of the portal venous thrombosis group was 46% (6/13) and that of the control group was 84% (142/169), and there was significant difference (P < 0.05). Conclusions Portal venous thrombosis of grade Ⅲ and Ⅳ may significantly increase the difficulty and risks of liver transplantation. However, the good curative effect may also be obtained only when the portal venous thrombosis is strictly assessed, and the rational portal venous reconstruction method is used during the operation.

Observation of curative effect of benazepril on polycythemia after kidney transplantation

Luo Yongwen, Qian Yeyong, Fan Yu, Bai Hongwei, Chang Jingyuan, Wang Zhen

2015, 6(5): 326-330. doi: 10.3969/j.issn.1674-7445.2015.05.010

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Objective To observe the curative effect and adverse reaction of benazepril on polycythemia (PTE) after renal transplantation. Methods Twenty-two patients undergoing kidney transplantation for the first time at the Department of Urinary Surgery of the 309^th Hospital of People's Liberation Army and developed PTE after renal transplantation from June 2012 to June 2013 were enrolled as the object of study. The patients were divided into the hypertension group (n=14) and the normal blood pressure group (n=8) according to whether the patients were with hypertension or not. The hypertension group was given benazepril with an initial dose of 10 mg/d and increased to the maximum dose of 40 mg/d according to the changes of patients' conditions. The normal blood pressure group was given benazepril with an initial dose of 5 mg/d and with the maintenance dose of 2.5 mg/d after hemoglobin and hematokrit returning to normal. The patients in two groups were followed up for 6 months. The curative effect and adverse reactions during the follow-up were compared between the two groups. Results After 6 months of treatment, 12 patients had marked effect, 1 had effect and 1 was improved in the hypertension group. Six patients had marked effect, 1 had effect and 1 had no effect in the normal blood pressure group. The difference of efficacy had no statistical significance between the two groups (P > 0.05). During the treatment, the blood pressure of the hypertension group dropped significantly (P < 0.05), while that of the normal blood pressure group had no significant change. Red blood cells, neutrophils, platelets, serum creatinine, uric acid and estimated glomerular filtration rate of the two groups had no obvious abnormality before and after treatment. One patient in the hypertension group developed irritable cough during the treatment and recovered after withdrawal. Conclusions It is safe and effective to take benazepril for patients with PTE after renal transplantation. It is recommended to start with small dose and the dose shall be adjusted according to blood pressure. The blood pressure, blood routine and renal function shall be monitored during the treatment.

Influence of glomerular filtration rate of living donor on recovery of graft function after transplantation

Su Ziting, Li Zhen, Zeng Zhong, Liu Tao, Duan Jian, Huang Hanfei, Lin Jie

2015, 6(5): 331-334, 339. doi: 10.3969/j.issn.1674-7445.2015.05.011

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Objective To investigate the influence of glomerular filtration rate (GFR) of living donor on recovery of graft function after transplantation. Methods Clinical data of 108 pairs of donors and recipients undergoing living donor renal transplantation at the Organ Transplantation Center of First Affiliated Hospital of Kunming Medical University from 2009 to 2013 were retrospectively studied. The objects were divided into G1 group(GFR < 40 ml/min), G2 group(GFR 40~45 ml/min), G3 group(GFR 46~50 ml/min)and G4 group (GFR > 50 ml/min) according to GFR of the donor kidneys. Changes in serum creatinine (Scr) at 1 week, 2 weeks, 3 weeks, 1 month, 3 months, 6 months and 1 year after transplantation as well as survival conditions of patient and kidney within 1 year after transplantation of each group were compared. Results Compared with G1 group, Scr at 2 weeks, 3 weeks, 1 month after transplantation was lower in G2 group, G3 group and G4 group, and the difference had statistical significance (all in P < 0.05). As for survival conditions of patient and kidney within 1 year after transplantation, one patient in G1 group developed graft failure due to hyperacute rejection and one patient in G1 group died of severe pulmonary infection. One patient in G2 group developed graft failure due to acute rejection. One patient in G3 group died of severe pulmonary infection. One patient in G4 group died of severe pulmonary infection. Other patients and grafts survived during the follow-up. Conclusions Low GFR of living kidney donor has certain influence on recovery of graft function in the early stage (within one month) after renal transplantation.

Pathological changes of renal grafts from elderly donor kidney in young recipients

Fang Jiali, Chen Zheng, Ma Junjie, Li Guanghui, Xu Lu, Zhang Lei, Guo Yuhe, Zhang Yirui, Pan Guanghui

2015, 6(5): 335-339. doi: 10.3969/j.issn.1674-7445.2015.05.012

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Objective To study the pathological changes of renal grafts from elderly donor in young recipients and to investigate the safety of kidney transplantation from elderly donors. Methods Fourteen elderly kidney donors (with the age > 55 years old) and fourteen young recipients (with the age < 30 years old) underwent living related donor renal transplantation at the Department of Transplantation of the Second Affiliated Hospital of Guangzhou Medical University from January 2008 to December 2008 were enrolled as the object of study. Every elderly donor kidney was performed time-zero biopsy and every young recipient was performed routine renal graft biopsy 6 months after transplantation. The pathological and structural changes of kidney tissues after renal transplantation from elderly donors were observed. Results The histopathological changes occurred at 6 months after transplantation from elderly kidney donors to young recipients. Compared with those before transplantation, the severity of renal arteriolar lesion and the index of renal arteriolar sclerosis alleviated after transplantation(P < 0.05), and the ratio of glomerulosclerosis did not change after transplantation (P > 0.05). The expression of fibronectin (FN) decreased after transplantation, but the difference had no statistical significance (P > 0.05). The expression of laminin (LN) decreased after transplantation (P < 0.05). Conclusions The histopathological structure of renal graft from elderly donors in young recipients has improved.

Mucor infection in renal grafts from the same donor after renal transplantation

Zhang Shanbin, Xiao Jinzhu, Zhang Guoqing, Che Xianping, Chen Ning, Gu Jun, Fu Shibao, Li Desheng

2015, 6(5): 340-344. doi: 10.3969/j.issn.1674-7445.2015.05.013

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Objective To summarize the diagnosis and treatment experience of mucor infection in renal grafts. Methods Clinical data of two patients with mucor infection in renal grafts from the same kidney donor that finally caused renal graft and renal artery rupture were retrospectively studied, and the relevant domestic and foreign literatures were reviewed. Results and conclusions Mucor infection after renal transplantation has no specific manifestation, thus it lacks of means of early diagnosis and is easy to cause misdiagnosis and missed diagnosis. Mucor infection is easy to cause vascular rupture and the prognosis is poor. Early diagnosis, thorough debridement, timely selection of effective antifungal agent, withdrawal of immunosuppressant and correction of coagulation disorders under the monitor of thrombelastogram may improve the survival rate of such patients.

Review Articles

2015, 6(5): 345-347. doi: 10.3969/j.issn.1674-7445.2015.05.014

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2015, 6(5): 348-350, 358. doi: 10.3969/j.issn.1674-7445.2015.05.015

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2015, 6(5): 351-354. doi: 10.3969/j.issn.1674-7445.2015.05.016

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2015, 6(5): 355-358. doi: 10.3969/j.issn.1674-7445.2015.05.017

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