器官移植

Abstract:
Objective To compare the preservation quality of intestinal grafts from donors of donation after cardiac death (DCD) and cadaveric donors. Methods Quality of intestinal grafts from 7 cadaveric donors(group N) and 7 DCD donors(group DCD) in Beijing from 2013 to 2014 was evaluated. The grafts were preserved after perfusion and resection, and then intestinal tissue was collected 30 min and 6 h later. Meanwhile, histopathological examination and intestinal graft injury score (Chiu's integral method) were performed. The content of malondialdehyde (MDA) in intestinal tissue was detected by thiobarbituric acid assay, and the apoptosis of intestinal mucosa cells was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) method. Results Intestinal graft injury scores for group N and DCD were (1.46±0.81) and (1.76±0.21) respectively at 30 min after preservation, and (3.86±0.42) and(4.17±0.71), respectively at 6 h after preservation(both in P > 0.05). Compared with the preservation of 30 min, intestinal graft injury scores increased significantly in both groups at 6 h after preservation (both in P < 0.05). The contents of MDA in intestinal tissue of the small intestinal graft in group N and DCD were(100±10)pmol/mg and (110±13) pmol/mg, respectively at 30 min after preservation (P > 0.05), and (170±18) pmol/mg and (310±29) pmol/ mg, respectively at 6 h after preservation, of which the difference was statistically significant between the two groups at the same time(P < 0.05). Compared with the preservation of 30 min, the contents of MDA increased significantly in both groups at 6 h after preservation (both in P < 0.05). The number of apoptotic intestinal mucosal cells in small intestinal grafts for group N and DCD was (9.78±2.56) and (15.78±2.84), respectively at 30 min after preservation (P > 0.05), and (31.32±1.38) and (53.42±1.95), respectively at 6 h after preservation, of which the difference was statistically significant between the two groups (P < 0.05). Compared with the preservation of 30 min, the number of apoptotic intestinal mucosal cells in small intestinal grafts increased significantly in both groups at 6 h after preservation(P < 0.05). Conclusions Preservation quality of small intestinal grafts in DCD donors is roughly equivalent to that in traditional cadaveric donors, which suggests that small intestinal grafts in DCD donors may be used in clinical intestinal transplantation.

Manufacture and comparison of chronic rejection model of orthotopic and heterotopic intestinal transplantation in rats

Li Fuxin, Li Chuan, Liu Tong, Wang Pengzhi

2016, 7(1): 32-38. doi: 10.3969/j.issn.1674-7445.2016.01.006

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Abstract:
Objective To compare the modeling effect of chronic rejection following orthotopic and heterotopic intestinal transplantation in rats. Methods F344 (RT1^1vr) rats were used as the donors and Lewis (RT1¹) rats were used as the recipients. Models of allogeneic heterotopic and orthotopic intestinal transplantation in rats (8 rats in each model) were established, and subcutaneous injection of ciclosporin was given at 0~14 d after operation. Changes in body weight and survival time of the recipients were observed after operation. In addition, pathological changes in intestinal tissue were observed by hematoxylin-eosin (HE) staining. Changes in collagenous fibers and elastic fibers in intestinal tissue were observed after alcohol and hematoxylin staining. Finally, success rate of modeling of recipients in two groups was calculated. Results Rats in heterotopic and orthotopic intestinal transplantation groups were able to survive for a long time, most of which were more than 90 d. For the rats in orthotopic intestinal transplantation group, normal diet could be recovered at the 3^rd d after operation. Their body weight could recover preoperative level at about the 14^th d after operation, and then grew slowly. However, most of the rats in orthotopic intestinal transplantation group continued weight loss from the 150^th d after operation, which could not be reversed with ciclosporin. For the rats in heterotopic intestinal transplantation group, normal diet could be recovered at the 1^st d after operation, and their body weight could recover preoperative level within 25-30 d after operation and gradually rose and remained at a high level within 30-90 d after operation. No pathological changes of chronic rejection and obvious mesangial fibrosis in intestinal tissue were observed at the 90^th d after operation, but intestinal tissue developed chronic rejection and obvious mesangial fibrosis at the 163^rd d and 200^th d after operation in orthotopic intestinal transplantation group. Typical pathological changes of chronic rejection and mesangial fibrosis in intestinal tissue were observed at the 90^th d and 200^th d after operation for rats in heterotopic intestinal transplantation group. All the rats in heterotopic intestinal transplantation group showed characteristic pathological changes. The success rate of modeling was 100% in heterotopic intestinal transplantation group, which was not of statistical significance, compared with the success rate of modeling of 75% in the orthotopic intestinal transplantation group(P > 0.05). Conclusions Chronic rejection will occur at different time points with small dose of ciclosporin after operation if models of orthotopic and heterotopic intestinal transplantation are established in combination of F344→Lewis rats. Compared with orthotopic intestinal transplantation, the rat model of heterotopic intestinal transplantation holds the advantages of simple modeling, shorter chronic rejection and relatively consistent degree of pathological changes, which is more suitable for experimental study.

Study on effects of curcumin pretreatment on intestinal ischemia-reperfusion injury

Zhu Lei, Zhang Li

2016, 7(1): 39-43,60. doi: 10.3969/j.issn.1674-7445.2016.01.007

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Abstract:
Objective To explore the effects and mechanism of curcumin pretreatment on intestinal ischemia-reperfusion injury (IRI) in rats. Methods Thirty SD rats were randomly divided into sham operation group (Sham group), IRI group and curcumin pretreatment group (Cur group), with 10 rats in each group. Intraperitoneal injection with curcumin (5 mg/kg) was given to rats in Cur group at 1 h before operation; intraperitoneal injection with normal saline of same volume was given to rats in Sham group and IRI group. Rats in IRI group and Cur group received intestinal IRI operation. Pathological changes in intestinal tissues of the rats in 3 groups were observed. Messenger RNA (mRNA) levels of interleukin (IL)-6, IL-8 and tumor necrosis factor (TNF)-α in intestinal tissue were detected by reverse transcription polymerase chain reaction, and protein expression levels of IL-6, IL-8 and TNF-α in serum were detected by enzyme linked immunosorbent assay (ELISA). Malondialdehyde(MDA) in intestinal tissue was detected by thiobarbituric acid reactive substance assay, as well as contents of catalase(CAT), glutathione peroxidase(GPx) and superoxide dismutase(SOD) in intestinal tissue were detected by ELISA. Protein expression levels of phosphatidylinositol 3-kinase (PI3K), protein kinase (AKT) and mammalian target of rapamycin (mTOR) in intestinal tissue were detected by Western blotting. Results Compared with Sham group, the injury degree of intestinal tissue as well as the expression levels of IL-6, IL-8, TNF-α, MDA, PI3K, AKT and mTOR in intestinal tissue and serum increased significantly, while the contents of CAT, GPx and SOD in intestinal tissue decreased significantly in IRI group. Compared with IRI group, the injury degree of intestinal tissue as well as the expression levels of IL-6, IL-8, TNF-α, MDA, PI3K, AKT and mTOR in intestinal tissue and serum decreased significantly, while the contents of CAT, GPx and SOD in intestinal tissue increased significantly in Cur group (all in P<0.05). Conclusions Curcumin presents protective effect on intestinal tissue with IRI in rats, which may be related to the inhibition of oxidative stress and inflammation mediated by PI3K/AKT/mTOR signaling pathway.

Clinical Researches

Programmed death receptor(PD)-1 monoclonal antibody-induced acute immune hepatitis in the treatment of recurrent hepatocellular carcinoma after liver transplantation: a case report

Wang Guoying, Tang Hui, Zhang Yingcai, Li Hua, Yi Shuhong, Jiang Nan, Wang Genshu, Zhang Jian, Zhang Qi, Yang Yang, Chen Guihua

2016, 7(1): 44-47. doi: 10.3969/j.issn.1674-7445.2016.01.008

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Abstract:
Objective To explore the safety of programmed death receptor (PD)-1 monoclonal antibody for treatment of hepatocellular carcinoma (HCC) recurrence after liver transplantation. Methods Clinical data of 1 case with acute immune hepatitis induced by PD-1 monoclonal antibody(pembrolizumab) therapy for recurrent HCC after liver transplantation was retrospectively analyzed. Results The patient who received liver transplantation for primary HCC was diagnosed with lung metastasis at 4 months after the transplantation, and treated with the pembrolizumab (150 mg intravenous infusion of once) at 12 months after transplantation. Liver dysfunction was found at 5^th d after treatment, and liver biopsy was conducted which showed pathological changes of mild to moderate acute rejection. It was diagnosed to be acute immune hepatitis based on the patient's clinical manifestations, laboratory examination and pembrolizumab drug instructions. After adrenal cortical hormone and intensive immunosuppressive therapy, the patient was followed up for 8 months, which showed that the patient survived with tumor, but the liver function remained abnormal. Conclusions PD-1 monoclonal antibody and other immune checkpoint inhibitors are not suitable for the immunologic suppression after liver transplantation due to the risk of inducing immune hepatitis.

Experience with the application of leflunomide in rescuing therapy of BK virus nephropathy after renal transplantation in the case of ineffective treatment with reduction of immunosuppressant: report of 4 cases

Fan Yu, Li Jigang, Qian Yeyong, Shi Bingyi, Xie Junjie

2016, 7(1): 48-52,71. doi: 10.3969/j.issn.1674-7445.2016.01.009

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Abstract:
Objective To explore the clinical application experience of leflunomide in rescuing therapy of BK virus nephropathy (BKVN) after renal transplantation in the case of ineffective treatment with reduction of immunosuppressant. Methods Four recipients with BKVN after renal transplantation were diagnosed at 135^th-737^th day after operation, with the pathological staging as following: 2 cases in stage A1, 1 case in stage B1 and 1 case in stage B2. For all recipients, leflunomide was used for rescuing therapy due to ineffective treatment with reduction of immunosuppressant for 0.5-3.0 months. Initially, 50 mg/d of leflunomide was given continuously for 3 days, so as to reach therapeutic serum concentration, and then 20 mg/d of leflunomide was given for maintaining. The efficacy and safety were observed. Results After a follow-up for an average of 6 months (5-7 months), 3 recipients with development of BKVN were controlled effectively, 1 recipient (stage B2) with ineffective treatment. No obvious adverse reactions occurred during medication. Conclusions It is possible to slow down the development of BKVN and reduce the incidence of renal allograft loss by using leflunomide to conduct rescuing therapy of BKVN after renal transplantation in the case of ineffective treatment with reduction of immunosuppressant. Better effect can be achieved if early detection and diagnosis of BKVN are conducted as well as effective measures are taken timely in the early pathological stage.

Investigation on the willingness of organ donation of the floating population in Guangdong Province and its influence factors

Wu Zhen, Gao Lingling, Chen Xuelian, Hu Ailing, Sun Qiquan

2016, 7(1): 53-56. doi: 10.3969/j.issn.1674-7445.2016.01.010

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Abstract:
Objective To investigate the current status of the willingness of organ donation among floating population in Guangdong Province and explore its influence factors. Methods The questionnaire survey was conducted to investigate general information of the floating population and their willingness of organ donation, knowledge of organ donation, attitude towards organ donation and death as well as the willingness of family discussion (organ donation), etc. The correlation analysis of variables and the willingness of organ donation in floating population was conducted by Spearman rank correlation, and the multivariate analysis was conducted by multiple linear regression model. Results Among the floating population, the people who were female, from city, owned an average monthly household income per capita of RMB 4 001-5 000 yuan, got acquaintance with the organ donors or their families, got acquaintance with accepted the organ donors or their families had higher willingness of organ donation (all in P<0.05). Scores of the willingness of organ donation, knowledge of organ donation, attitude towards organ donation and the willingness of family discussion were 1.95±0.91, 5.02±2.40, 92.00±16.78 and 3.98±1.28 respectively. The willingness of family discussion, knowledge of organ donation and recognition of the value of organ donation showed positive correlation with the willingness of organ donation (P<0.05-0.01). The cause hindering organ donation and fear of death showed negative correlation with the willingness of organ donation (all in P<0.01). Five variables were integrated into the multiple linear regression analysis model, including willingness of family discussion, knowledge of organ donation, recognition of the value of organ donation, cause hindering organ donation and fear of death. Conclusions The willingness of organ donation among the floating population in Guangdong Province is on or below the medium level, and its influence factors include willingness of family discussion, knowledge of organ donation, recognition of the value of organ donation, cause hindering organ donation and fear of death.

Treatment and effect of donor kidney with single calculus in living renal transplantation

Chen Zheng, Zhang Lei, Ma Junjie, Fang Jiali, Li Guanghui, Xu Lu, Lai Xingqiang, Pan Guanghui

2016, 7(1): 57-60. doi: 10.3969/j.issn.1674-7445.2016.01.011

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Abstract:
Objective To explore treatment methods of donor kidney with single calculus in living renal transplantation and their effect. Methods The treatment experience of donor kidneys with unilateral renal calculus in living renal transplantation of 3 cases was summarized, which were diagnosed before operation. The kidney with renal calculus was excised as the donor kidney; ureteroscopic lithotomy was conducted in vitro, and then renal transplantation was performed by routine operation. Results There was no early complication such as delayed graft function and acute rejection in 3 recipients after operation. Three pairs of donors and recipients were followed up for 34, 45 and 62 months respectively. The color Doppler ultrasound examination of urinary system after renal transplantation showed that, new renal calculus and urinary tract obstruction did not occur in donor's preserved kidneys and recipient's transplant kidneys. Renal function of all donors and recipients was good. Three donors were followed up until now, and no abnormal urine routine was discovered. One recipient developed IgA nephropathy, which was considered to be recurrent nephropathy and had nothing to do with renal calculus. Conclusions The donor kidney with single calculus in living renal transplantation can be treated effectively by ureteroscopic lithotomy in vitro after donor kidneys are excised.

Short Article

2016, 7(1): 61-63. doi: 10.3969/j.issn.1674-7445.2016.01.012

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Abstract:

Case Report

2016, 7(1): 64-66. doi: 10.3969/j.issn.1674-7445.2016.01.013

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Abstract:

Review Article

2016, 7(1): 67-71. doi: 10.3969/j.issn.1674-7445.2016.01.014

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Abstract: