器官移植

Abstract:
Objective To explore the feasibility of ultra-long distance transport of lung from donation after cardiac death (DCD) or donation after brain death (DBD) by civil aviation for lung transplantation. Methods Clinical data of 6 cases with lung transplantation through ultra-long distance transport of lung from donors by civil aviation in Wuxi People's Hospital Affiliated to Nanjing Medical University from February to March in 2015 were analyzed retrospectively. Results There were 6 donors who were DBD or DCD. It spent 5.0~8.5 h from lung removal, transport to lung transplantation in the operation room, including 2.0~3.0 h (mileage>1 500 km) for flight. Five cases received sequential double lung transplantation. One case received right single lung transplantation. The operation was conducted successfully, with the lung's cold ischemia time of 7-12 h. After operation, all patients received ventilator assisted breathing, and suspended after 2-4 d. As of the date of submission, 6 cases recovered well. Conclusions Long distance transport is feasible in the case of conducting sequential double lung transplantation with donor lung from DCD or DBD, if there are direct flights between the two cities of the donor and recipient, and the flight time is within 3 h.

Sepsis after liver transplantation: a report of one case and interpretation of International Guidelines for Management of Severe Sepsis and Septic Shock

Yi Huimin, Wei Xuxia, Li Lijuan, An Yuling, Lyu Haijin, Yi Xiaomeng, Liu Jianrong, Xiong Liang, Zhou Mi, Lu Pinglan, Guo Yu

2015, 6(6): 378-381. doi: 10.3969/j.issn.1674-7445.2015.06.006

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Abstract:
Objective To summarize the treatment experience of sepsis after liver transplantation. Methods The clinical features and treatment methods of 1 patient developing sepsis after liver transplantation, who was admitted and treated in the Surgical Intensive Care Unit of the Third Affiliated Hospital of Sun Yat-sen University in September 2014, were retrospectively studied. The interpretation of International Guidelines for Management of Severe Sepsis and Septic Shock (SSC Guidelines) and relevant literature were reviewed. Results One male patient at the age of 50 years old developed high fever and decrease of blood pressure at 1 d after liver transplantation, and was diagnosed as septic shock. The symptoms were relieved after the appropriate treatment like goal-directed fluid resuscitation, anti-infection and blood purification, etc. And the patient was discharged in stable conditions. Conclusions It is easy to develop infection after liver transplantation and the fatality rate of sepsis caused by infection is high. Once the sepsis occurs, clinicians must perform early goal-directed therapy and bundle therapy according to the SSC Guidelines positively, and select the appropriate drugs according to the pathogen culture results in order to reduce the fatality rate.

Curative effect and prognosis analysis of lung transplantation for patients over 65 years old with end-stage lung diseases

Xia Wei, Yan Jie, Mao Wenjun, Chen Jingyu

2015, 6(6): 382-387. doi: 10.3969/j.issn.1674-7445.2015.06.007

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Abstract:
Objective To investigate the curative effect and prognosis of lung transplantation for patients over 65 years old with end-stage lung diseases. Methods Clinical data of 24 elderly patients (≥65 years old) undergoing lung transplantation in Affiliated Wuxi People's Hospital of Nanjing Medical University from September 2002 to December 2011 were retrospectively analyzed. The survival conditions of elderly patients undergoing lung transplantation were studied and the survival conditions of unilateral lung transplantation and bilateral lung transplantation were compared. The complications after lung transplantation were observed and the death causes of patients died during the follow-up period was analyzed. Results All patients completed the lung transplantation successfully. The 1, 3, 5 and 7-year cumulative survival rate of the 24 patients were respectively 75.0%, 62.5%, 33.3% and 12.5%, and those of patients undergoing unilateral lung transplantation were respectively 68.8%, 50.0%, 31.3% and 12.5% and those of the patients undergoing bilateral lung transplantation were respectively 87.5%, 87.5%, 37.5% and 12.5%. The median survival time of the patients undergoing unilateral lung transplantation and bilateral lung transplantation was respectively 35 months and 51 months, and there was no significant difference (P>0.05). The primary postoperative complication was infection with the incidence of 46% (11/24). Seventeen patients died during the long-term follow-up. Among them, 9 died of severe infection, 1 died of primary graft dysfunction (PGD), 1 died of acute rejection (AR), 4 died of bronchiolitis obliterans syndrome (BOS), 1 died of heart failure and 1 died of tumor. Conclusions Unilateral lung transplantation and bilateral lung transplantation are both effective methods to treat elderly patients with end-stage lung diseases. Infection is the primary postoperative complication and the cause of death of elderly patients.

Treatment of liver transplantation on acute liver failure of pregnancy: a report of two cases and literature review

Tang Hui, Fu Binsheng, Yi Huimin, Wang Guoying, Zhang Yingcai, Yi Shuhong, Zhang Jian, Wang Genshu, Li Hua, Yang Yang, Chen Guihua

2015, 6(6): 388-391. doi: 10.3969/j.issn.1674-7445.2015.06.008

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Abstract:
Objective To investigate the curative effect of liver transplantation on acute liver failure of pregnancy. Methods Clinical data of 2 patients with acute liver failure of pregnancy undergoing liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University from March 2004 to June 2015 were retrospectively studied. Results The patient of case 1 developed subacute liver failure and underwent emergency liver transplantation, because chronic viral hepatitis B (HBV) progressed quickly after natural delivery. The patient of case 2 developed acute liver failure with unknown etiology, and underwent subtotal hysterectomy by the obstetrician on the following day of emergency liver transplantation because the intrauterine fetus was dead. The two patients were given tacrolimus (FK506) and adrenocortical hormone as the postoperative early immunosuppressive regimen. Anti-HBV treatment was enhanced for the patient of case 1 with the antivirus regimen of entecavir combined with hepatitis B immune globulin. The patient of case 1 was willing to continue pregnancy, so the minimal dose of a single immunosuppressant was used when the graft function was stable. The patient of case 2 had no ability of pregnancy and underwent routine postoperative management. The two patients were followed up till the date of submission and they recovered well. The patient of case 1 had no recurrence of HBV and delivered a baby boy successfully. Conclusions Liver transplantation on acute liver failure of pregnancy may obtain good curative effect.

Therapeutic effect and safety of acipimox combined with small-dose atorvastatin on combined hyperlipidemia after renal transplantation

Wei Xing, Cai Ming, Li Xiang, Jin Hailong, Zhang Dawei

2015, 6(6): 392-396, 414. doi: 10.3969/j.issn.1674-7445.2015.06.009

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Abstract:
Objective To assess the therapeutic effect and safety of acipimox combined with small-dose atorvastatin on combined hyperlipidemia after renal transplantation. Methods Fifty-six patients complicated with combined hyperlipidemia after renal transplantation were randomized into the combined small-dose group [n=28, acipimox (250 mg, twice a day)+atorvastatin (10 mg, once a day)] and normal dose group [n=28, atorvastatin (20-40 mg, once a day)]. Total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterin (HDL-C), low density lipoprotein cholesterin (LDL-C), aspartate aminotransaminase (AST), alanine aminotransferase (ALT), serum creatinine (Scr), blood urea nitrogen (BUN), uric acid (UA) and creatine kinase (CK) were observed before treatment and 1, 2 and 3 months after treatment. Adverse drug reaction was recorded. Results Compared with those before treatment, TC, TG and LDL-C of the normal dose group and the combined small-dose group decreased after treatment, but HDL-C increased, and the difference had statistical significance (all in P < 0.01). Compared with the normal dose group, TG and LDL-C of the combined small-dose group were lower and HDL-C was higher, and the difference had statistical significance (all in P < 0.01). At each time point before and after treatment, ALT, AST, Scr, BUN, UA and CK of the normal dose group and the combined small-dose group showed no statistically significant difference (all in P>0.05). There was significant difference in the incidence of adverse reactions in the digestive system, nervous system, musculoskeletal system and skin/vascular of the normal dose group and the combined small-dose group (all in P < 0.05). Conclusions Acipimox combined with small-dose atorvastatin can treat combined hyperlipidemia after renal transplantation safely and effectively.

Analysis of risk factors of hemorrhage after ultrasound-guided liver graft biopsy

Guo Guanghui, Xu Erjiao, Zheng Rongqin, Zeng Qingjin, Li Kai

2015, 6(6): 397-400. doi: 10.3969/j.issn.1674-7445.2015.06.010

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Objective To investigate the risk factors of hemorrhage after ultrasound-guided liver graft biopsy. Methods Clinical data of 51 liver transplant patients undergoing ultrasound-guided liver graft biopsy in the Third Affiliated Hospital, Sun Yat-sen University between February 2013 and April 2014 were retrospectively studied. Hemorrhage after biopsy was taken the dependent variable. Age, gender, coagulation, duration of biopsy, frequency of biopsy, number of biopsy tissues, medication of anticoagulant or not and cooperation in breathing and breath holding or not were taken as the independent variables. Multivariate non-conditional Logistic regression analysis was performed for all independent variables to screen out the risk factors associated with hemorrhage after ultrasound-guided liver graft biopsy. Results Fifty-one patients underwent 84 biopsies in total and 5 cases (6%) had hemorrhage after biopsy. The multivariate non-conditional Logistic regression analysis showed that obvious hemorrhagic tendency, medication of anticoagulant and poor cooperation in breathing were independent risk factors of hemorrhage after liver graft biopsy (OR was respectively 8.71, 3.16 and 2.03, all in P < 0.05). Conclusions Obvious hemorrhagic tendency, medication of anticoagulant and poor cooperation in breathing are independent risk factors of hemorrhage after ultrasound-guided liver graft biopsy.

Effect of body mass index on short-term prognosis of renal transplantation: a report of 1 041 cases in a single center

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

2015, 6(6): 401-404, 433. doi: 10.3969/j.issn.1674-7445.2015.06.011

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Abstract:
Objective To investigate the effect of body mass index (BMI) on short-term prognosis of patients after renal transplantation. Methods Clinical data of 1 041 adult patients undergoing the first renal transplantation in the Institute of Organ Transplantation of the 309^th Hospital of People's Liberation Army from March 2009 to March 2013 were retrospectively studied. According to the Adult Obesity and Overweight Standard commonly used in China, these patients were divided into 4 groups: 112 patients in BMI < 18.5 kg/m² group (emaciation group), 606 patients in BMI 18.5-23.9 kg/m² group (normal group), 250 patients in BMI 24.0-27.9 kg/m² group (overweight group) and 73 patients in BMI≥28.0 kg/m² group (obesity group). The incidence of delayed graft function (DGF) and acute rejection (AR) of the 4 groups one year after renal transplantation were observed and compared. One-year patient and graft survival rates were calculated. The relationship between BMI and DGF was studied by univariate and multivariate Logistic regression analysis to investigate the effect of different BMI on DGF. Results After the follow-up for one year, the incidence of DGF in the obesity group was significantly higher than that in the emaciation group and the normal group(both in P < 0.05). The difference in the incidence of acute rejection one year after renal transplantation as well as one-year patient or graft survival rate had no statistical significance (all in P>0.05). Univariate analysis showed that obesity increased the risk of DGF after renal transplantation (OR was 1.33, P < 0.05). Multivariate analysis showed that both overweight and obesity were independent risk factors of DGF after renal transplantation (OR was respectively 1.56 and 1.37, both in P < 0.05). Conclusions Overweight and obesity increases the risk of DGF after renal transplantation, but do not increase the incidence of AR after renal transplantation and do no influence short-term patient and graft survival rates after renal transplantation.

Curative effect and safety of haploidentical allogeneic cytokine-induced killer in treatment of advanced hepatocellular carcinoma

Yang Fan, Zheng Xiaofang, Liu Chang, Chen Wenjie, Cheng Jintao, Yang Li, Lu Jianxi, Zhang Qi

2015, 6(6): 405-409. doi: 10.3969/j.issn.1674-7445.2015.06.012

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Abstract:
Objective To investigate the curative effect and safety of haploidentical allogeneic cytokine-induced killer (CIK) in treatment of advanced hepatocellular carcinoma. Methods The peripheral blood mononuclear cell (PBMC) of the healthy immediate family members of 21 patients with advanced hepatocellular carcinoma (HCC) were collected, induced into haploidentical allogeneic CIK in vitro and transfused to the patients for 4 cycles. The curative effect and safety were assessed. Results The 21 patients were followed up for half a year. The survival rate was 81% (17/21). Among the 21 patients, 11 cases were with stable disease and 10 cases were with progressive disease(including 4 dead cases). Six patients developed fever of different degrees during the treatment and one patient developed rash. The platelet counts of the patients at the fourth cycle after the treatment decreased compared with that before the treatment, with significance difference (P < 0.05). The difference in leukocytes, neutrophils, lymphocytes, hemoglobin, liver function and renal function at the first and fourth cycle after the treatment had no statistical significance (all in P>0.05). Conclusions Haploidentical allogeneic CIK in treatment of advanced HCC may effectively improve the quality of life and the adverse reactions are tolerable, which is a relatively safe therapy.

Application of dexmedetomidine in anesthesia for recipients in living related renal transplantation

Wei Xin, Zhou Susu, Gao Wei, Mao Jiali, Shu Shuhua, Chai Xiaoqing

2015, 6(6): 410-414. doi: 10.3969/j.issn.1674-7445.2015.06.013

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Abstract:
Objective To assess the effectiveness and safety of dexmedetomidine (Dex) in anesthesia for end-stage renal disease (ESRD) recipients in living related renal transplantation. Methods Forty ESRD patients undergoing living related renal transplantation in the Affiliated Provincial Hospital of Anhui Medical University from October 2013 to December 2014 were randomized into the Dex group and the control group, 20 patients in each group. In the Dex group, the patients were pumped with the loading dose of Dex at 0.6 μg/kg before anesthesia induction and the procedure was completed within 20 min. Then, the patients were pumped at 0.2 μg/(kg·h) for 1 h and underwent general anesthesia induction. In the control group, the patients were pumped with equivalent normal saline. The anesthesia induction and the maintenance drug of the two groups were the same. The mean arterial pressure(MAP), heart rate(HR) and bispectral index (BIS) before administration (T₀), 20 min after administration (T₁), before laryngeal mask placement (T₂) and after laryngeal mask placement (T₃) of the two groups were observed and recorded. Delayed recovery and emergence delirium were also observed. Urine output during transplantation, 4, 8, 12, 24 h after transplantation, as well as endogenous creatinine clearance rate(Ccr) before transplantation and 12, 24 h after transplantation were recorded. Results Compared with T₀, the MAP, HR and BIS of the two groups at T₂ decreased significantly (all in P < 0.05). As for the comparison between two groups, the HR and BIS of the Dex group decreased significantly(both in P < 0.05), but the MAP didn't decrease significantly (P>0.05). The emergence delirium in the Dex group was all mild with the incidence of 15% (3/20), which significantly deceased in comparison with that in the control group (30%, 6/20) (P < 0.05). The urine outputs of Dex group during transplantation, and 4 h and 8 h after transplantation were significantly higher than those of the control group (all in P < 0.05). The Ccr of the two groups at 12 h and 24 h after transplantation significantly increased, compared with that before transplantation (all in P < 0.01). Conclusions Dex may reduce the incidence of emergence delirium of recipient in living related renal transplantation, increase urine output after transplantation and cause no delayed recovery, which may be used in ESRD patients safely.

Long-term remission of leukemia after failure of cord blood stem cell transplantation for high-risk childhood acute lymphoblastic leukemia: a report of one case and literature review

Zhang Jingwen, Lu Ying, Li Xudong

2015, 6(6): 415-419. doi: 10.3969/j.issn.1674-7445.2015.06.014

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Abstract:
Objective To analyze the reasons for long-term remission of leukemia after failure of cord blood stem cell transplantation for high-risk childhood acute lymphoblastic leukemia. Methods Clinical data of 1 child with high-risk acute lymphoblastic leukemia undergoing cord blood stem cell transplantation in the Department of Hematology of the Third Affiliated Hospital of Sun Yat-sen University in September 2013 were collected. The treatment course and prognosis of the child were analyzed. In combination with literatures, the possible reasons for the good treatment effect on leukemia after transplantation failure were analyzed. Results The hematopoietic recovery of the child after the first cord blood stem cell transplantation was poor. The child underwent cord blood infusion in November 2013 and did not undergo further treatment for the primary disease due to economic reasons. However, the hematopoietic function recovered 15 months after cord blood transplantation. Till September 2015, 2-year disease free survival after cord blood transplantation was obtained. Conclusions Cord blood transplantation or infusion may repair the function of hematopoietic system and immune system, and may take effect with no need of successful transplantation. The failure of cord blood transplantation for childhood high-risk leukemia does not mean treatment failure. Children patients may obtain long-term disease free survival.

Clinical study on treatment of high-risk acute leukemia with unrelated cord blood transplantation

Sun Yanling, Li Xudong, Lin Dongjun, Fang Zhigang

2015, 6(6): 420-424. doi: 10.3969/j.issn.1674-7445.2015.06.015

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Objective To investigate the effect of unrelated cord blood transplantation (UCBT) on the treatment of high-risk childhood and adult acute leukemia. Methods Ten patients with high-risk acute leukemia underwent UCBT. Among the 10 patients, 3 were children and 7 were adults with the median age of 29 years old (11-41 years old). Six patients underwent one-unit cord blood transplantation and four patients underwent two-unit cord blood transplantation. The myeloablative conditioning regimen without antithymocyte globulin (ATG) was adopted. Cytarabine (Ara-C), fludarabine (Flu) or total body irradiation (TBI) was added on the basis of busulfan(Bu) and cyclophosphamide (Cy). Ciclosporin and mycophenolate mofetil were used to prevent graft-versus-host disease (GVHD). Results The transplantation was successful in 8 (80%) patients. The median implant-time of leukocytes was 19 d(14-25 d)and that of platelets was 40 d(33-60 d). Three patients developed acute GVHD and no patient developed chronic GVHD. The median follow-up time was 24 months (1-29 months). Seven patients remained in disease-free survival. Both the 2-year overall survival and disease-free survival rates were 66.7%. Conclusions UCBT is feasible in the treatment of high-risk acute leukemia. UCBT is the preferred option for the high-risk patients without HLA-identical sibling donors, which is characterized by low incidence of GVHD and low recurrence rate. It may make patients with acute leukemia remain long-term survival.

Experimental Researches

Effect of magnetic nanocomposites on proliferation ability of human hepatoma carcinoma cells

Wang Zizhen, Hu Gang, Wu Xinhuai

2015, 6(6): 425-428, 437. doi: 10.3969/j.issn.1674-7445.2015.06.016

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Objective To investigate the effect of magnetic nanocomposites on proliferation ability of human hepatoma carcinoma (HCC) cells(HepG2 cell line). Methods Leucine-rich repeat-containing G protein-coupled receptor (LGR) 5-small interfering ribonucleic acid (siRNA) was composited with polyethylenimine wrapped superparamagnetic iron oxide nanoparticle (PEI-SPIO) as the gene vector. PEI group was established by transfecting HepG2 cells when cell fusion reached 60% and SI group was established by transfecting HepG2 cells with equivalent simple LGR5-siRNA. Control(Ctrl) group was also established without transfecting. The efficiency of nanocomposites entering cells was scanned with MRI T2. The inhibition rate of cell proliferation was detected by (cell count kit, CCK)-8 assay. The expression level of messenger ribonucleic acid (mRNA) in LGR5 of cells was detected by reverse transcriptase polymerase chain reaction (RT-PCR) and the protein expressions of LGR5 and cyclin D1 were detected by western blotting. Results MRI T2 signal of HepG2 cells in PEI group decreased significantly. Compared with Ctrl group, the inhibition rate of cell proliferation of HepG2 cells in PEI group was significantly increased. The relative expression of LGR5 mRNA and the relative expression of LGR5 and cyclin D1 protein were both significantly decreased (all in P < 0.05), while the corresponding indexes of the cells in SI group had no statistical significance (all in P>0.05). Conclusions Magnetic nanocomposites PEI-SPIO composited with LGR5-siRNA may effectively transfect HepG2 cells. Its mechanism may take effect through down-regulating the expression of cyclin D1 to inhibit the proliferation ability of hepatocellular carcinoma HepG2 cells.

Application of ImmuKnow immune cell function assay in monitoring of immune function after renal transplantation

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

2015, 6(6): 429-433. doi: 10.3969/j.issn.1674-7445.2015.06.017

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Objective To investigate the application value of ImmuKnow immune cell function assay in monitoring of immune function changes after renal transplantation. Methods One hundred and six patients with uraemia undergoing renal transplantation in the Department of Organ Transplantation of the Second Affiliated Hospital of Guangzhou Medical University from January 2013 to December 2014 were included. Blood specimens were collected before transplantation and at the occurrence of infection or acute rejection during 12 months after transplantation. ImmoKnow was used to determine the adenosine triphosphate(ATP) content in CD4⁺T cells. The ATP content of patients with renal transplantation at different clinical conditions were observed and compared, including periopreative group, stable group, acute rejection group and infecticn group(including severe pneumonia). The ratio of T cell subsets (CD4⁺T cells, CD8⁺T cells) and natural killer (NK) cells in peripheral blood were detected. Pearson correlation analysis was used to detect the association between ATP and the blood trough concentration of tacrolimus (FK506) and ciclosporin (CsA). Results The ATP content of the patients in the infection group was lower than that of the patients in the stable group (P < 0.001). The ATP content of patients with severe pneumonia was lower than that of patients with other infections (P < 0.05). The percentage of CD4⁺T cells of the patients in the infection group was lower than that of the patients in the postoperative stable group (P < 0.05). The ATP content was not associated with the postoperative blood trough concentration of FK506 and CsA. Conclusions ImmuKnow assay may be used to monitor the postoperative immune function of patients after renal transplantation. The detection of ATP content in CD4⁺T cells has hinting and pre-warning function for postoperative infection, especially for severe pneumonia.

Review Article

2015, 6(6): 434-437. doi: 10.3969/j.issn.1674-7445.2015.06.018

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Abstract: