器官移植

Abstract:
Objective To evaluate the effect of Lifeport and static cold storage (CS) on preservation of donor kidney. Methods Medline, Embase, Cochrane library, CBMdisc, China National Knowledge Infrastructure, Wanfang database and VIP database were searched by computer, and relevant clinical studies on the effect of Lifeport and CS on preservation of transplant kidney were collected, with the search period from database construction to December 31, 2015. According to the inclusion and exclusion criteria, relevant references were selected, quality was evaluated, information was extracted, and risk of bias in the study was evaluated. In addition, Meta analysis was conducted using software Stata 12. Results A total of 16 studies were included with 5 randomized controlled trials (RCT) and 11 retrospective cohort studies (RCS). The results of Meta analysis showed that: compared with Group CS, (1) for total deceased donor (TDD), incidence of delayed graft function (DGF) decreased in Group Lifeport after transplantation, duration of DGF and average length of stay decreased, and 1-year survival rate of kidney increased after operation. The incidence of postoperative acute rejection (AR) and 1-year survival rate of patients were similar in two groups. (2) for donor after cardiac death(DCD): postoperative incidence of DGF and average length of stay decreased in Group Lifeport; there was no statistical significance in incidence of primary nonfunction(PNF) and AR, 1-year survival rate of kidneys and patients between two groups. (3) for expanded criteria donor (ECD): postoperative incidence of PNF decreased and 1-year survival rate of kidney increased in Group Lifeport; there was no statistical significance in postoperative incidence of DGF and AR and 1-year survival rate of kidney between two groups. Conclusion Application of Lifeport in preservation of donor kidney has certain advantages. However, more high-quality studies should be further conducted to verify the study findings due to limited quantity and quality of the study.

Robot-assisted laparoscopic living donor nephrectomy: report of 31 cases

Ruan Dongli, Zhang Geng, Li Zhibin, Ma Shuaijun, Liu Kepu, Gao Long, Qin Weijun, Wang Yanzhu, Yang Xiaojian, Yuan Jianlin

2016, 7(4): 275-278. doi: 10.3969/j.issn.1674-7445.2016.04.005

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Objective To evaluate the safety and efficacy of robot-assisted laparoscopic living donor nephrectomy. Methods Clinical data of 31 donors and recipients undergoing robot-assisted laparoscopic living donor nephrectomy in Xijing Hospital of the Fourth Military Medical University from November 2013 to August 2015 were retrospectively analyzed. Results Donor nephrectomy was successfully performed in 31 cases. The operation time ranged from 110 to 190 min. Intraoperative hemorrhage volume was measured as 20-100 ml. The warm ischemia time of the donor kidney was 100 to 160 s. The retained length of renal vein was between 1.8 and 3.0 cm and the length of renal artery was 1.4 to 2.3 cm. In 2 cases, spleen injury occurred during the kidney extraction and was treated with splenorrhaphy. One donor had postoperative hemorrhage, which was treated with hemostasis and anemia correction. Thirty one donors received postoperative follow-up for over 6 months. No long-term complications were observed. Among 31 recipients, one patient had delayed recovery of renal graft function and the serum creatinine level returned to normal range after treatment at postoperative 1 month. The survival rate of kidney grafts was up to 100%. Conclusion Robot-assisted laparoscopic living donor nephrectomy is a safe and efficacious surgical procedure for kidney resection, which possesses the advantages of small trauma, rapid recovery and no influence upon renal function.

Clinical analysis of retroperitoneal living donor nephrectomy under 3D laparoscopy

Guo Jia, Liu Xiuheng, Zhou Jiangqiao

2016, 7(4): 279-282. doi: 10.3969/j.issn.1674-7445.2016.04.006

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Abstract:
Objective To summarize the experience in retroperitoneal living donor nephrectomy under 3D laparoscopy and to investigate its clinical effect and safety. Methods The clinical data of 19 cases who underwent retroperitoneal living donor nephrectomy under 3D laparoscopy were collected. Operation duration, intraoperative blood loss, renal warm ischemia time, length of renal artery, renal vein and ureter, incision size and operative complications were recorded. Postoperative renal function of donors and recipients was observed. Results Nineteen cases of living donor nephrectomy were successfully completed under the 3D laparoscopy, and there were no conversion into conventional laparoscopy and open surgery. The operation duration of living donor nephrectomy under 3D laparoscopy was 80.5-125.2 (with an average of 102.3) min; intraoperative blood loss was 40.6-90.4 (60.8) ml; renal warm ischemia time was 100-230 (161) s. Length of renal artery, renal vein and ureter was 2.6-3.2 (2.9) cm, 2.2-3.0 (2.6) cm and 8-13 (10) cm, respectively. The incision size was about 5-6 cm, and the wound healed. Urine volume of the donors at 24 h after operation was 2 000-2 500 ml. Serum creatinine increased slightly in 1 case at 3 d after operation, and returned to normal through reexamination after 7 d and 1 month. The donors stayed in the hospital 5-7 (6) d after operation. All transplant operations were performed successfully, and delayed graft function did not occurred. Conclusion Accuracy of operation can be improved effectively by 3D laparoscopic surgery system. It is safe and feasible to perform retroperitoneal living donor nephrectomy under 3D laparoscopy.

Application of double filtration plasmapheresis in ABO-incompatible liver transplantation

Zhou Jing, Lei Lianhui, Tian Eryun, Yang Yang, Yin Lihua

2016, 7(4): 283-286. doi: 10.3969/j.issn.1674-7445.2016.04.007

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Objective To observe the clinical efficacy and safety of double filtration plasmapheresis (DFPP) in eliminating blood group antibody in ABO-incompatible patients undergoing liver transplantation. Methods Eighteen recipients with ABO-incompatible liver transplantation in the General Hospital of Chinese People's Armed Police from January 2012 to December 2014 were selected in the ABO-incompatibility group. The recipients with an antibody titer of anti-A or anti-B blood group>1∶16 were scheduled to undergo DFPP. Another 20 recipients eligible for blood transfusion were chosen into the control group. The changes in the antibody titer, blood biochemical parameters and the incidence of complications were observed in recipients with ABO-incompatible liver transplantation. The incidence of acute rejection and mortality rate between the ABO incompatibility group and control group were statistically compared. Results Among 18 patients, 15 with an antibody titer of anti-A or anti-B blood group>1∶16 received DFPP. After DFPP, the mean antibody titer was significantly declined. Detection of blood biochemical parameters indicated that the level of fibrinogen was significantly decreased following DFPP (P=0.0001). Among 20 cases receiving DFPP, 3 cases presented with hypotension, 3 with hemorrhage, 1 with nausea and vomiting, and 1 with coagulation in pipeline. All symptoms were alleviated after effective treatment. The incidence of acute rejection and mortality rate did not significantly differ between the ABO-incompatibility group and control group after DFPP (both P>0.05). Conclusion DFPP can safely and effectively reduce the level of blood group antibody, decrease the incidence of acute rejection after liver transplantation and enhance the success rate of liver transplantation.

Clinical experience analysis of liver transplantation from donation after citizen's death in 78 cases

Lan Chuan, Zhang Ming, Yan Lyunan, Li Bo, Zeng Yong, Wen Tianfu, Xu Mingqing, Wang Wentao, Yang Jiayin

2016, 7(4): 287-291. doi: 10.3969/j.issn.1674-7445.2016.04.008

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Objective To summarize the clinical experience and effect analysis of liver transplantation from donation after citizen's death. Methods Clinical data of 76 donors and 78 recipients of liver transplantation from donation after citizen's death completed in Liver Transplantation Center of West China Hospital, Sichuan University from March 2012 to November 2015 were analyzed retrospectively. The functional recovery of early allografts in liver transplant recipients was observed and the risk factors causing early allograft dysfunction (EAD) were analyzed. In addition, long-term survival of allografts and recipient as well as complications was observed. Results The incidence of postoperative EAD was 36% (28/78) in 78 recipients. High total bilirubin (TB) and long cold ischemia time constituted the risk factors of EAD. Survival rate of the recipients was 92% (72/78) during perioperation, and 6 cases died, of which 4 cases died of primary graft dysfunction, 1 case of upper gastrointestinal hemorrhage and 1 case of pulmonary infection. Postoperative abdominal infection occurred in 5 cases, with biliary stricture in 3 cases and vascular thrombosis in 2 cases. One case died, and the rest were improved after corresponding treatment. The 1-year survival rate of the recipients was 84.2% and 2-year survival rate was 80% after operation. Conclusion Liver transplantation from donation after citizen's death realizes favorable short and long-term effects, which can be regarded as a good source of donor livers. Important measures such as controlling the preoperative quality of donor liver and shortening the cold ischemia time can improve the clinical effect.

Effect of puncture needles with different diameter on percutaneous biopsy for transplant kidney under ultrasound guidance

Chen Qiumei, Ye Xiaolou, Deng Ronghai, Xian Changhui, Yang Siguang, Ouyang Xiaoguang

2016, 7(4): 292-295. doi: 10.3969/j.issn.1674-7445.2016.04.009

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Objective To compare the effect of puncture needles with different diameter on percutaneous biopsy for transplant kidney under ultrasound guidance. Methods A total of 82 cases underwent percutaneous renal biopsy for transplant kidney under ultrasound guidance, and were divided into two groups based on the diameters of puncture needles, Group 18 G (n=31) and Group 16 G (n=51). The effect of biopsy and complications were compared between the two groups. Results Compared with Group18 G, Group16 G used less puncture needles and obtained more glomeruli (both P＜0.01). The qualified rate of renal specimens in Group 16 G was significantly higher than that of Group 18 G(P＜0.05). There was no significant difference in postoperative complications between the two groups (P＞0.05). Further stratified comparison was conducted, and the results showed that complications of the two groups were not statistically significant in case of puncture with 2 needles or 3 needles (both P＞0.05). Conclusions There is similar safety of 16 G puncture needle and 18 G puncture needle to perform renal biopsies under ultrasound guidance. Under the allowable condition of patients, 16 G puncture needle is superior to 18 G puncture needle and realizes high quality of renal specimens.

Relationship between the mid-term hepatic hemodynamics and abnormal liver function after liver transplantation

Hu Weiyu, Wang Jianhong, Hu Xiao, Fu Xiaoyue, Wu Xiaodong, Zhang Shun, Zang Yunjin

2016, 7(4): 296-300. doi: 10.3969/j.issn.1674-7445.2016.04.010

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Objective To analyze the law of the mid-term hepatic hemodynamics after liver transplantation and to investigate its relationship with liver function. Methods A total of 56 recipients underwent liver transplantation in the Affiliated Hospital of Qingdao University from February 2014 to October 2015 were studied, and divided into normal group (n=24) and abnormal group (n=32) according to the liver function. General information and liver function of both groups were recorded. Furthermore, hepatic artery peak velocity (HAP), portal vein peak velocity (PVP) and portal vein flow (PVF) before the liver transplantation and on postoperative day 1, 30 and 90 were measured through ultrasonic detection; hepatic arterial buffer capacity (BC) and adjustment BC were calculated. The univariable and multivariable analysis were performed to analyze the relationship between hepatic hemodynamics and liver function in two groups, and the receiver operating curve (ROC) was drawn. Results The PVP and PVF on postoperative day 30 in abnormal group were significantly higher than those of normal group (P=0.014, 0.049). The BC and adjustment BC in normal group were significantly higher than those of abnormal group (P=0.048, 0.011). The multivariable analysis showed that adjustment BC was the independent risk factor (P=0.047), with the area under the curve (AUC) of ROC of 0.705, sensitivity of 0.652 and specificity of 0.750. Conclusion PVP, PVF, BC and adjustment BC on postoperative day 30 may be related to abnormal liver function, of which adjustment BC can be used as one of the indicators for diagnosis and intervention of abnormal liver function.

Experience in diagnosis and treatment of donor bile leakage after living donor liver transplantation

Li Canming, Zhu Zhijun, Sun Liying, Wei Lin, Qu Wei, Zeng Zhigui, Liu Ying

2016, 7(4): 301-304. doi: 10.3969/j.issn.1674-7445.2016.04.011

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Objective To summarize the experience in diagnosis and treatment of donor bile leakage after living donor liver transplantation. Methods Clinical data of 95 donors underwent living donor liver transplantation were retrospectively analyzed. Postoperative complications of bile leakage were observed, and clinical performance, treatment methods and therapeutic effects were analyzed. Results Bile leakage occurred in 9 donors of 95 donors with liver transplantation, and the incidence was 9%. The location of donor liver was left lateral lobe in 9 cases with bile leakage, all of which were delayed bile leakage of liver section. The clinical performance showed no typical bile peritonitis with increased serum bilirubin. All patients were cured after treatment of percutaneous puncture drainage or drainage tube retention, and there were no cases underwent second operation and death cases. Conclusion Changes in donor liver function and hepatic artery hemodynamics shall be monitored after living donor liver transplantation, and the donors with bile leakage shall be treated actively and will achieve favorable prognosis.

Short Article

2016, 7(4): 305-307. doi: 10.3969/j.issn.1674-7445.2016.04.012

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Review Articles

2016, 7(4): 308-311. doi: 10.3969/j.issn.1674-7445.2016.04.013

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2016, 7(4): 312-314. doi: 10.3969/j.issn.1674-7445.2016.04.014

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2016, 7(4): 315-319. doi: 10.3969/j.issn.1674-7445.2016.04.015