器官移植

2017 Vol. 8, No. 1

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Editorials
Expert Forum
Academic Summary
Laws and Regulations
Experimental Research
Clinical Research
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Editorials

2017, 8(1): 1-4. doi: 10.3969/j.issn.1674-7445.2017.01.001

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2017, 8(1): 5-9. doi: 10.3969/j.issn.1674-7445.2017.01.002

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Expert Forum

2017, 8(1): 10-14. doi: 10.3969/j.issn.1674-7445.2017.01.003

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Academic Summary

2017, 8(1): 15-21. doi: 10.3969/j.issn.1674-7445.2017.01.004

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Laws and Regulations

2017, 8(1): 22-26. doi: 10.3969/j.issn.1674-7445.2017.01.005

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Experimental Research

Study of antibacterial effect of mononuclear cells in liver lavage solution

Cao Weiwei, Li Xiao, Xu Jiru

2017, 8(1): 27-33. doi: 10.3969/j.issn.1674-7445.2017.01.006

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Objective To evaluate the antibacterial effect of mononuclear cells (MCs) in the liver lavage solution. Methods For in vitro experiment, MCs were collected from the liver lavage solution of SD rats and divided into the supplement of interleukin (IL)-15 and non-supplement groups. The MCs were co-cultured with Pseudomonas aeruginosa (P. aeruginosa) for 4 h and then the supernatant was collected and MCs were lysed. The bacterial load in the lysate was detected after LB plate culture. The levels of interferon (IFN)-γ and tumor necrosis factor (TNF)-α in the supernatant were measured by enzyme-linked immune absorbent assay (ELISA). For in vivo experiment, 40 SD rats were administered via tracheal injection of P. aeruginosa solution at a dose of 1×10⁹ CFU/mL and randomly divided into four groups (n=10). In the control group, physiological saline was given via gavage. In the immunosuppression group, tacrolimus (FK506) was delivered via gavage. In the MC group, MCs at a dose of 1.0×10⁸ was given via intravenous injection after use of FK506. In the IL-15 pretreated-MC group, IL-15 pretreated-MCs at a dose of 1.0×10⁸ were administered via intravenous injection after application of FK506. The lavage solution of pulmonary alveolus and the rat lung tissue were collected. The bacterial load was detected after LB plate culture. The expression of IFN-γ and TNF-α in the pulmonary alveolus and lung tissue were measured by ELISA and Western blot. Results Compared with MCs alone, IL-15 pretreated-MCs exhibited significantly higher antibacterial capability in vitro. The CFU was 35% of untreated MCs. The synthesis and release capabilities of IFN-γ and TNF-α were significantly enhanced. Compared with the control group, the quantity of immune cells in the lung tissue was decreased and the bacterial load in the lung tissue and the lavage solution of pulmonary alveolus was significantly increased, whereas the expression levels of IFN-γ and TNF-α tended to decline in the immunosuppression group. Administration of IL-15 pretreated-MCs significantly enhanced the quantity of immune cells in the lung tissue, decreased the bacterial load and increased the secretion of IFN-γ and TNF-α. Conclusions MCs in the liver lavage solution exhibit favorable antibacterial activity. Under immunosuppression condition, the defense capability of the host against the opportunistic pathogenic bacteria is significantly enhanced.

Clinical Research

Analysis and management of critical value in renal transplantation recipients during perioperative period

Sui Yuying, Yu Lixin, Deng Wenfeng, Qiu Chunyan, Miao Yun, Liu Rumin, Ye Guirong

2017, 8(1): 34-39. doi: 10.3969/j.issn.1674-7445.2017.01.007

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Objective To analyze and summarize the and charcteristics and processing methods of critical value in renal transplantation recipients during perioperative period. Methods Clinical data including gender, age, critical value, primary disease, clinical diagnosis and corresponding management at the presence of critical value in 273 cases with renal transplantation were collected and analyzed during perioperative period. Results and conclusions During perioperative period, the critical values of water, electrolyte and acid-base disorders were observed in 43.2% (118/273) of renal transplantation cases. The hyperpotassemia was found in 24.9% (68/273) of cases, which was the most common critical value. The percentage of male patients presenting with critical value was 76.9%, significantly higher compared with 23.1% in female counterparts, especially in those aged 35 to 54 years. For patients with critical value of hyperpotassemia, calcium gluconate or calcium chloride was administered to stabilize myocardium cell membrane. Insulin, glucose and sodium bicarbonate were administered via intravenous drip to accelerate intracellular transportation of K⁺ and diuretics were used to promote the excretion of K⁺. Hemodialysis therapy was used if the treatment is ineffective. The serum level of potassium restored to normal range after treatment in all cases. For those presenting with critical values of other parameters, individualized treatment was adopted based upon different conditions. Understanding of common critical values during perioperative period, characteristics and causes of distribution of critical values in renal transplant recipients of different age and gender offers guidance for clinical monitoring and treatment.

Clinical analysis on hyperpotassemia induced by pharmacologic interaction between tacrolimus and other drugs in 10 renal transplant recipients

Qiu Chunyan, Sui Yuying, Yu Lixin, Deng Wenfeng, Miao Yun, Liu Rumin, Ye Guirong

2017, 8(1): 40-43. doi: 10.3969/j.issn.1674-7445.2017.01.008

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Objective To investigate the therapeutic methods of hyperpotassemia induced by excessively high blood concentration of tacrolimus (FK506) caused by drug use after renal transplantation. Methods Clinical data of 10 patients diagnosed with hyperpotassemia induced by excessively high blood concentration of FK506 after administration of antifungal medication following renal transplantation were collected and retrospectively analyzed. Results At 1-2 months after renal transplantation, 10 patients suffered from pulmonary infection or pneumonia complicated with pulmonary fungal infection. An appropriate dose of compound sulfamethoxazole, micafungin, cefoperazone sodium-sulbactam sodium and moxifloxacin was administered for antifungal infection. After potassium-lowering therapy, termination of antifungal medication and FK506 dose adjustment (replaced by cyclosporin for certain cases), the serum level of potassium was declined and maintained within normal range for 10 cases. The serum concentration of FK506 was within normal range. No sign of excessively high level of potassium was observed without any potassium-lowering intervention. Conclusions Postoperative administration of drugs is likely to cause excessively high level of FK506 and hyperpotassemia. Potassium-lowering therapy, termination of drug use and adjustment of immunosuppressive agents should be adopted to avoid the incidence of adverse pharmacologic interaction.

Clinical study of chronic hyponatremia after liver transplantation

Sui Yuying, Yu Lixin, Deng Wenfeng, Zhou Jie, Liu Rumin, Miao Yun

2017, 8(1): 44-48. doi: 10.3969/j.issn.1674-7445.2017.01.009

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Objective To summarize clinical characteristics, prevention and treatment of postoperative chronic hyponatremia after liver transplantation (LT). Methods Clinical data of 26 patients presenting with chronic hyponatremia after LT were retrospectively analyzed. Baseline data and main complications of patients with hyponatremia after LT were recorded. The correlation between postoperative length of hospital stay and the duration of hyponatremia was analyzed. Clinical treatment and prognosis were summarized. Results Among 26 patients, the median blood sodium concentration was 131 mmol/L (range 125 to 133 mmol/L). All patients were diagnosed with mild or moderate degree of hyponatremia. Main complications included pulmonary infection (n=13, 50%), acute rejection of liver graft (n=7, 27%) and digestive tract hemorrhage (n=7, 27%). Postoperative length of hospital stay was correlated with the duration of hyponatremia. After full evaluation of patient's condition and excluding the potential inducers, a portion of 3% of hypertonic saline was administered via gastro-intestinal tract and/or vein. After positive treatment, 23 cases (88%) were healed and 3 (12%) died from infection complicated with multiple organ failure. Conclusions After LT, the incidence of chronic hyponatremia is low with mild severity. Postoperative length of hospital stay is correlated with the duration of hyponatremia. The key of treatment is to timely exclude the inducers, correct the low level of sodium based upon the individual principles and prevent the incidence of postoperative complications.

Preliminary observation of clinical efficacy and safety of direct-acting antiviral agents for hepatitis C virus following renal transplantation

Niu Ying, Ming Yingzi, She Xingguo, Liu Hong

2017, 8(1): 49-53. doi: 10.3969/j.issn.1674-7445.2017.01.010

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Objective To observe the clinical efficacy and safety of direct-acting antiviral agents (DAAs) in the treatment of hepatitis C after renal transplantation. Methods Six patients were complicated with hepatitis C virus (HCV) at 8 to 43 months after renal transplantation with a median time of 19 months. Prior to treatment, the virus load was detected from 4.03×10³ to 8.18×10⁷ IU/mL. Four cases were administered with tacrolimus (FK506) + mycophenolate mofetil (MMF) + prednisone (Pred), and the remaining 2 received cyclosporin (CsA) + MMF + Pred. The serum creatinine level was lower than 200 μmol/L. The amount of urine and body weight remained stable. No severe mental irritation or trauma history was reported within 6 months before antiviral therapy. Six patients did not receive genotype test of HCV before DAAs therapy. Four patients were administered with sofosbuvir, 1 with sofosbuvir + ledipavir and 1 with sofosbuvir + daclatasvir for 12 weeks. The complete blood cell count, serum transaminase level, creatinine level and blood concentration of immunosuppressive agents were measured each week and serum HCV RNA level was quantitatively detected every 4 weeks. Results Among 6 patients, 5 were negative for HCV at 4 weeks after DAAs therapy and obtained sustained virological response (SVR) after DAAs treatment. One case administered with sofosbuvir alone was positive for HCV after DAAs therapy. The patient was infected with genotype 5 HCV. After 12-week administration of sofosbuvir + daclatasvir, the patient was negative for HCV and obtained SVR. No significant changes were observed in complete blood cell count, serum transaminase level, creatinine level and blood concentration of immunosuppressive agents. Adverse reactions included evanescent eruption in 1 case and mild dizziness in 1 case. Conclusions DAAs treatment is an effective and safe approach for patients with stable renal function after renal transplantation. Combined use of sofosbuvir+ daclatasvir is recommended as the optimal therapy.

Determination of optimal threshold for hepatic artery stenosis on Doppler ultrasonography and its effect for clinical decision of treatment for patients with tardus parvus waveform after liver transplantation

Lian Yufan, Zheng Bowen, Tan Yingyi, Tong Ge, Wu Tao, Zheng Rongqin, Ren Jie

2017, 8(1): 54-58. doi: 10.3969/j.issn.1674-7445.2017.01.011

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Objective To analyze the optimal threshold of Doppler ultrasonography (DUS) in the diagnosis of hepatic artery stenosis (HAS) after liver transplantation and propose the diagnostic criteria of CT angiography (CTA) or digital subtraction angiography (DSA) for patients with tardus parvus waveform (TPW) in combination with liver dysfunction. Methods Clinical data of 171 patients undergoing liver transplantation, postoperative conventional DUS, liver function test, CTA or DSA were collected. The optimal threshold of resistance index (RI) and systolic acceleration time (SAT) for the diagnosis of HAS were determined by multi-level likelihood ratio (MLR). Different diagnostic criteria were established and the diagnostic efficacy was statistically compared. Positive TPW was defined as the diagnostic criterion with low confidence, positive TPW + liver dysfunction as the moderate confidences, and positive TPW + liver dysfunction or positive TPW + optimal threshold as the high confidence. Results MLR revealed that RI < 0.4 and SAT>0.12 s were the optimal threshold for the diagnosis of HAS. The specificity of diagnostic criteria with moderate and high confidence was significantly higher compared with that of the low confidence (P < 0.05). Moreover, the false-positive rate was significantly decreased (P < 0.05). The sensitivity of diagnostic criterion with moderate confidence was significantly lower than those of low and high confidence (both P < 0.05), whereas the sensitivity did not significantly differ between the diagnostic criteria with low and high confidence (P>0.05). Conclusions For patients with positive TPW detected by DUS after liver transplantation, the optimal threshold of diagnostic criteria combined with liver dysfunction contribute to appropriate clinical decision-making for clinicians.

Orthotopic liver transplantation for treatment of hepatic epithelioid hemangioendothelioma: report of two cases and literature review

Zhang Quanbao, Tao Yifeng, Li Ruidong, Zou Liping, Ma Zhenyu, Zhang Xiaofei, Wang Zhengxin

2017, 8(1): 59-65. doi: 10.3969/j.issn.1674-7445.2017.01.012

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Objective To investigate the clinical efficacy and therapeutic progress of orthotopic liver transplantation for the treatment of hepatic epithelioid hemangioendothelioma (EHE). Methods Clinical data of 2 patients diagnosed with hepatic EHE were retrospectively analyzed. One patient (case 1) was diagnosed with multiple hepatic EHE complicated with multiple infarction lesions of the spleen, and underwent orthotopic liver transplantation combined with splenectomy. The other case (case 2) was diagnosed with multiple hepatic EHE and received orthotopic liver transplantation alone. Literature review was performed. Pathological characteristics, clinical efficacy of liver transplantation and clinical prognosis of hepatic EHE patients were analyzed. Results Two patients successfully underwent surgery and were discharged postoperatively. The diagnosis of hepatic EHE was confirmed by pathological examination and case 1 was complicated with EHE of the spleen. For case 1, tacrolimus was replaced by sirolimus at postoperative 1 month. At postoperative 4 months, capecitabine was orally administered (chemotherapy) for EHE recurrence. At 6 months after surgery, the patient was diagnosed with recurrent hepatic EHE complicated with multiple bone metastases, and was orally administered with sorafenib. At postoperative 7 months, the patient died from cachexia and liver failure. Case 2 was followed up until the submission date (8 months after surgery). No postoperative complications and tumor recurrence were observed. Previous studies had demonstrated that surgical resection was the primary therapy of hepatic EHE. Liver transplantation was highly recommended for patients with multiple unresectable hepatic EHE and extra-hepatic lesions. Moreover, chemotherapy, percutaneous puncture combined with transcatheter arterial chemoembolization and anti-angiogenesis treatment exerted certain clinical efficacy. Conclusions Surgical resection remains the primary therapy of hepatic EHE. For patients with multiple intrahepatic EHE, liver transplantation is considered as the optimal treatment. Much attention should be diverted to the prevention and treatment of recurrent hepatic EHE following liver transplantation, aiming to improve the clinical efficacy.

Clinical observation of hepatitis B virus carriers after renal transplantation

Zhuang Jie, Dai Bo, Wu Lijuan, Zhou Ying, Lu Xiaojun, Ying Binwu, Lin Tao

2017, 8(1): 66-72. doi: 10.3969/j.issn.1674-7445.2017.01.013

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Objective To observe the changes of liver and kidney function in hepatitis B virus (HBV) carriers after renal transplantation. Methods A total of 116 patients with HBV infection undergoing renal transplantation and 348 counterparts without HBV infection were recruited in this clinical trial. The liver function parameters including alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels and renal function parameter including serum creatinine (Scr) level were measured before and at 1, 3, 6, 12, 18, 24, 36 and 60 months after renal transplantation. Preoperative and postoperative changes of liver and kidney function were statistically compared between the hepatitis B surface antigen (HBsAg) (+) and HBsAg (-) groups. According to the results of preoperative HBV serology, preoperative quantitative detection of HBV DNA and preoperative liver function test, 116 HBsAg (+) patients undergoing renal transplantation were divided into (HBsAg, HBeAg and anti-HBc all positive) and (HBsAg, anti-HBe and anti-HBc all positive) groups, HBV DNA (+) and HBV DNA (-) groups, and normal and abnormal liver function groups. Preoperative and postoperative changes of liver and kidney function were statistically compared between different subgroups. Results (1) Preoperative ALT and AST levels in HBsAg (+) patients were significantly higher compared with those in their HBsAg (-) counterparts. In 36 months after renal transplantation, liver function parameters significantly differed between two groups (all P < 0.05), whereas no statistical significance was noted at postoperative 60 months (all P>0.05). Before and in 60 months after renal transplantation, no statistical significance was observed in the Scr levels between the HBsAg (+) and HBsAg (-) groups (all P>0.05). (2) Before and in 60 months after renal transplantation, no statistical significance was observed in the liver and kidney function parameters between the (HBsAg, HBeAg and anti-HBc all positive) and (HBsAg, anti-HBe and anti-HBc all positive) groups, and HBV DNA (+) and HBV DNA (-) groups (all P>0.05). (3) The ALT levels before and at 1, 3, 6 and 12 months after renal transplantation significantly differed between the normal and abnormal liver function groups (all P < 0.05), whereas no statistical significance was observed at other time points (all P>0.05). The AST levels before and at 1 month after renal transplantation significantly differed between two groups (both P < 0.05), whereas did not significantly differ at alternative postoperative time points (all P>0.05). No statistical significance was observed in the kidney function parameters before and at 60 months following renal transplantation between two groups (all P>0.05). Conclusions HBV infection cannot exert significant effect upon kidney function within 5 years after renal transplantation, whereas it can affect short-term postoperative liver function.

Review Articles

2017, 8(1): 73-77. doi: 10.3969/j.issn.1674-7445.2017.01.014

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2017, 8(1): 78-81. doi: 10.3969/j.issn.1674-7445.2017.01.0015

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