器官移植

2017 Vol. 8, No. 6

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Editorial
Original Articles·Clinical Researches
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Editorial

2017, 8(6): 413-416. doi: 10.3969/j.issn.1674-7445.2017.06.001

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Original Articles·Clinical Researches

Comparison of clinical efficacy between ABO-incompatible and ABO-compatible liver transplantation in children: a Meta-analysis

Tian Wei, Li Wentao, Zhu Shikai, Yang Hongji

2017, 8(6): 417-423. doi: 10.3969/j.issn.1674-7445.2017.06.002

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Objective To compare the clinical efficacy between pediatric ABO-incompatible liver transplantation (ILT) and ABO-compatible liver transplantation (CLT) by Meta-analysis. Methods Relevant studies published until May 2017 were electronically retrieved from PubMed, Embase, Cochrane library, China national knowledge internet (CNKI), Wanfang and VIP databases. According to the inclusion and exclusion criteria, the publications eligible were screened and clinical data were extracted. Meta-analysis was performed using the random or fixed effect model analyses with Review Manager 5.3 statistical software. Results Eleven retrospective cohort studies in English were selected. Meta-analysis demonstrated that the postoperative 1-year survival rate of the recipients in the ILT group was significantly lower than that in the CLT group [odds ratio (OR)=0.64, 95% confidence interval (CI) 0.49-0.83, P=0.0007)]. In the ILT group, the incidence of postoperative rejection reactions was considerably higher compared with that in the CLT group (OR=1.96, 95% CI 1.03-3.72, P=0.04). No statistical significance was observed in the postoperative 3-and 10-year survival rate of the recipients, 1-, 3-and 10-year survival rate of the graft and the incidence of postoperative biliary tract complications between two groups (all P > 0.05). Conclusions Compared with their CLT counterparts, the 1-year survival rate of the ILT recipients is lower, whereas the incidence of rejection reactions is higher. However, the long-term survival rate of both the recipient and graft and the incidence of biliary tract complications do not significantly differ between CLT and ILT. ILT is a relatively ideal option for emergent patients or those lacking of liver graft with compatible blood group for a long period of time.

Experience of clinical efficacy of renal transplantation from donors of donation after brain death complicated with acute kidney injury

Wang Hongyu, Jiao Xianfa, Niu Xingguo, Dong Huijun, Liang Shaofeng, Qu Qingshan

2017, 8(6): 424-429. doi: 10.3969/j.issn.1674-7445.2017.06.003

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Objective To summarize the clinical efficacy of renal transplantation from donors of donation after brain death (DBD) complicated with acute kidney injury (AKI). Methods Fifty-nine DBD donors successfully undergoing renal transplantation were recruited in this investigation. According to the Scr level upon admission of intensive care unit (ICU), DBD donors were divided into the AKI group (n=14) and control group (n=45). A total of 101 recipients were assigned into the AKI group (n=23) and control group (n=78) correspondingly. The organ donation conditions of 59 donors were summarized. Main parameters of the donors before organ procurement were statistically compared between two groups. Postoperative kidney function, hospitalization condition and clinical outcomes of the recipients were statistically compared between two groups. Results Among 59 donors, 14 cases (24%) suffered from AKI. Two donors received continuous renal replacement therapy during organ maintenance. Compared with the donors in the control group, the APACHE Ⅱ score of the donors was significantly higher (P < 0.05), the incidence of central diabetes insipidus was considerably higher (P < 0.01), the Scr levels at admission of ICU and before organ procurement were significantly higher (both P < 0.01) and the amount of urine at 24 h before organ procurement was dramatically less in the AKI group (P < 0.01). Compared with the recipients in the control group, the Scr levels at postoperative 2 and 3 d were significantly higher (both P < 0.05), the length of hospital stay was considerably longer (P < 0.01) and the hospitalization expanse was significantly higher in the AKI group (P < 0.05). No statistical significance was observed in the postoperative delayed recovery of renal graft function, incidence of acute rejection, infection and rehabilitation dialysis in the recipients between two groups (all P > 0.05). At 3 months after transplantation, the recipients in two groups were discharged and the graft survival rate was 100%. Conclusions For renal transplantation from DBD donors complicated with AKI, active measures should be taken to maintain the organ and relieve the AKI, which yields similar clinical efficacy to renal transplantation from non-AKI donors and widens the origin of kidney graft.

Clinical analysis on donor liver protection and function evaluation for organ donation after citizen's death

Ding Limin, Xu Zhidan, Li Xinchang, Luo Wenfeng, Long Chengmei, Luo Laibang

2017, 8(6): 430-434. doi: 10.3969/j.issn.1674-7445.2017.06.004

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Objective To summarize the preliminary experience of donor liver protection and function evaluation for organ donation after citizen's death. Methods Clinical data of 35 donors from organ donation after citizen's death and 33 recipients were retrospectively analyzed. Donor liver procurement and clinical prognosis of the recipients were summarized. According to serum level of sodium ion (serum sodium) before organ procurement, all recipients were divided into the serum sodium < 155 mmol/L, 155-160 mmol/L and 161-180 mmol/L groups. The incidence of liver graft dysfunction early after liver transplantation was statistically compared among three groups. Results In 35 donors, 27 cases were Chinese type Ⅱ and 8 cases were Chinese type Ⅲ. Thirty-three donor livers were used for liver transplantation, and the remaining 2 cases of donor livers were excluded due to congestive cirrhosis. In 33 liver transplantation recipients, 30 cases were successfully recovered. The liver function was gradually restored at postoperative 7-14 d, and normal liver function was obtained during long-term follow-up. Postoperatively, 3 recipients died including 2 cases dying from portal vein thrombosis and 1 case from pulmonary infection complicated with multiple organ failure. The incidence of early liver graft dysfunction of the recipients after liver transplantation was 18%, 23% and 4/5 in the serum sodium < 155 mmol/L, 155-160 mmol/Land 161-180 mmol/L groups, respectively. Statistical significance was observed between the 161-180 mmol/L and < 155 mmol/L groups (P < 0.05). Conclusions Timely protection of donor liver, accurate evaluation and maintenance of liver function play a pivotal role in enhancing the utilization rate of donor liver, maintaining liver function and yielding good efficacy for transplantation.

Liver transplantation from donor liver of organ donation after citizen's death: a single center experience

Deng Feiwen, Chen Huanwei, Zhen Zuojun

2017, 8(6): 435-439. doi: 10.3969/j.issn.1674-7445.2017.06.005

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Objective To evaluate the application value of donor liver from organ donation after citizen's death (organ donation) in clinical liver transplantation. Methods Clinical data of 75 pairs of donors and recipients undergoing liver transplantation from organ donation in the First People's Hospital of Foshan from October 2011 to December 2016 were retrospectively analyzed. The conditions of the donors were strictly evaluated. Clinical prognosis and the incidence of postoperative complications of the recipients were summarized. Results The 1-year and 3-year accumulated survival rates of 75 liver transplantation recipients were 88% and 78%. Four recipients died from the recurrence and metastasis of liver cancer, 1 case from graft-versus-host disease, 1 case from severe pulmonary infection, 1 case from recurrence of virus B hepatitis (hepatitis B) and liver failure, 1 case from postoperative multiple organ failure and 1 case from massive hemorrhage of the upper digestive tract. Thirteen recipients suffered from biliary tract stenosis. One case was mitigated spontaneously and 1 recipient was healed after percutaneous transhepatic biliary drainage (PTBD). Eleven cases were treated with endoscopic retrograde cholangiopancreatography (ERCP). Among them, 5 cases were healed, 2 recipients were switched to choledochojejunostomy and 4 cases were still monitored in clinical practice. Conclusions Liver transplantation from organ donation yields high clinical efficacy. Strict evaluation of donor conditions, standard perioperative management of the recipients, maintenance immunosuppressive therapy without adrenocortical hormone, timely and effective treatment of complications, regular postoperative follow-up are pivotal measures to guarantee the success of liver transplantation from organ donation and long-term survival of the recipients.

Application value of contrast enhanced ultrasound for postoperative monitoring after split liver transplantation

Wang Jianhong, Zhao Yang, Li Zhiqiang, Wu Xiaodong, Guo Yuan, Zang Yunjin

2017, 8(6): 440-444, 449. doi: 10.3969/j.issn.1674-7445.2017.06.006

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Objective To investigate the application value of contrast enhanced ultrasound (CEUS) for postoperative monitoring after split liver transplantation. Methods Ten recipients undergoing split liver transplantation received conventional two-dimensional ultrasonography, color Doppler ultrasound (CDU) and CEUS. Clinical prognosis of 10 recipients undergoing split liver transplantation was summarized. The findings of postoperative conventional two-dimensional ultrasonography, CDU and CEUS were analyzed. Results Among 10 recipients, 8 cases obtained favorable clinical prognosis, one died from the recurrence and metastasis of malignant tumors and multiple organ failure, and one died from sudden cardiac arrest. CDU detected the hepatic artery in 8 of 10 recipients(80%). CEUS revealed hepatic artery embolism in one recipient and normal hepatic artery in the other case. Conventional two-dimensional ultrasonography demonstrated abnormality of the hepatic parenchyma in 5 recipients including hyperecho in S5 segment in 1 case, hypoecho in S7 segment in 1 case, hyperecho in S4 segment in 1 case, hypoecho followed by hyperecho in S5 and S6 segments in 1 case and multiple hypoecho and slight hyperecho in 1 case. CEUS revealed significant asynchrony in the microcirculation blood perfusion between the normal and abnormal echo regions, manifested with imaging features of early perfusion and early regression, which was considered to be associated with hepatic venous back-flow obstruction. Evident asynchrony in microcirculation blood perfusion between the normal and abnormal echo regions was observed in 1 case, manifested with the imaging features of early perfusion and synchronous regression, suggesting that congestion and edema on the hepatic resection surface caused by hepatic venous back-flow obstruction and myocardial infarction. Multiple intrahepatic abnormal blood perfusion region of 'fast-in and fast-out' echo was noted in 1 case, which was probably correlated with postoperative recurrence of malignant tumors. Conclusions CEUS isan effective supplement of conventional two-dimensional ultrasonography and CDU for postoperative monitoring after split liver transplantation, which contributes to understanding of hepatic blood flow and blood perfusion and identifying early postoperative complications after split liver transplantation.

Clinical analysis of 18 patients with portal vein stenosis after liver transplantation

Zhang Mei, Zhang Xiaogang, Tian Min, Shi Jianhua, Wang Rongfeng, Liu Xuemin, Wang Bo, Lyu Yi

2017, 8(6): 445-449. doi: 10.3969/j.issn.1674-7445.2017.06.007

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Objective To summarize the experience of clinical diagnosis and treatment of portal vein stenosis after liver transplantation. Methods Clinical data of 18 patients presenting with portal vein stenosis after undergoing liver transplantation were retrospectively analyzed. The incidence, treatment and prognosis of portal vein stenosis were summarized. Results Seventeen patients had a medical history of liver cirrhosis before liver transplantation, 7 cases with a medical history of portal vein thrombosis and 8 cases with a medical history of devascularization or shunt with splenectomy. Three cases received the pediatric liver grafts. Eighteen patients suffered from portal vein stenosis from postoperative 23 d to 24 months with a median time of 2.2 months, which was detected by color Doppler ultrasound (CDU) and diagnosed by CT angiography (CTA) of the portal vein or interventional therapy. After the diagnosis was confirmed, all cases received anticoagulant treatment by warfarin. Five patients with portal hypertension underwent balloon dilatation, and one of them received endovascular stent implantation simultaneously. The remaining 13 patients received conservative therapy. After corresponding treatment, 9 cases were mitigated, 7 patients remained unchanged and 2 cases were aggravated. Conclusions For the recipients with a medical history of liver cirrhosis before liver transplantation, portal vein stenosis should be monitored by conventional CDU and diagnosed by CTA or interventional therapy after transplantation. Patients without clinical symptoms can receive conservative treatment. Those complicated with portal hypertension can undergo interventional therapy. Favorable clinical prognosis is obtained in most cases.

Clinical efficacy of application of hepatitis B surface antigen-positive donor liver in liver transplantation

Liu Rongqiang, Zhang Yingcai, Yao Jia, Deng Yinan, Zhu Shuguang, Yang Qing, Tang Hui, Wang Guoying, Yang Yang, Chen Guihua

2017, 8(6): 450-454, 471. doi: 10.3969/j.issn.1674-7445.2017.06.008

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Objective To evaluate the clinical efficacy of application of hepatitis B surface antigen (HBsAg)-positive donor liver in adult liver transplantation. Methods Clinical efficacy of 28 recipients with liver diseases induced by virus B hepatitis (hepatitis B) undergoing liver transplantation using HBsAg-positive donor liver from July 2012 to October 2015 was retrospectively analyzed. Clinical prognosis and postoperative complications of the recipients were summarized. The changing features of serum levels of HBsAg and hepatitis B virus (HBV) DNA was investigated. Results After liver transplantation, 28 recipients were orally administered with entecavir to prevent the recurrence of hepatitis B. During perioperative period, 2 recipients died from sepsis and acute heart failure. During postoperative follow-up, 2 cases died from the recurrence of hepatocellular carcinoma (liver cancer). The remaining 24 patients were followed up for 12-26 months. Throughout the follow-up, 24 recipients were positive for serum HBsAg. After treatment, the titre of HBV DNA was significantly declined to < 1×10² copies/mL at postoperative 12 months. No graft dysfunction induced by hepatitis B recurrence occurred in 24 recipients alive. Conclusions As a marginal donor liver, HBsAg-positive liver graft is safe for liver transplantation in the recipients with hepatitis B-related liver diseases. Postoperatively, anti-HBV treatment should be strengthened and intimate follow-up should be delivered.

Clinical observation on the removal of donor specific antibody by double filtration plasmapheresis in renal transplant recipients

Liao Qi, Jiang Qiuyan, Xiong Yan, Wang Fengying, Yan Qiang, Zou Guimian, Sui Weiguo

2017, 8(6): 455-459. doi: 10.3969/j.issn.1674-7445.2017.06.009

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Objective To investigate the effect of double filtration plasmapheresis (DFPP) upon the removal of donor specific antibody (DSA) in highly sensitized recipients with renal transplantation. Methods Four highly sensitized recipients undergoing renal transplantation received 7 cycles of DFPP. Luminex technology was adopted to monitor the changes of DSA. Clinical efficacy, incidence of acute rejection and adverse reactions were observed. Results After DFPP, the DSA MFI [1 036 (0-4 113)] was significantly declined than that before treatment [6 446 (2 999-12 905), Z=-2.503, P=0.012]. No hyperacute rejections occurred in four highly sensitized recipients undergoing renal transplantation. Acute rejection was noted in one case, which was mitigated by postoperative DFPP and adjustment of immunosuppressive agents. During postoperative follow-up, the function of transplant kidney was normal and no rejection reactions occurred. The level of albumin was decreased after DFPP. Conclusions DFPP can effectively remove the DSA in the recipients. It is an efficacious and safe approach to prevent the incidence of acute rejections in highly sensitized recipients after renal transplantation.

Investigation and analysis on current status of organ donation willingness and death attitudes of medical students majoring in nursing

Dang Wen, Jiang He

2017, 8(6): 460-464. doi: 10.3969/j.issn.1674-7445.2017.06.010

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Objective To investigate the status quo of knowledge-attitude-behavior about organ donation willingness and death attitudes of medical students majoring in nursing (nursing students). Methods A total of 409 nursing students from 3 medical colleges in Tianjin were recruited as study subjects by convenient sampling method. A cross-sectional survey was carried out using organ donation scale and Chinese version of death attitude scale. Questionnaire input was performed by Epidata 3.1 software. The general situation of 409 nursing students was sumed up. The status quo of the knowledge-attitude-behavior about organ donation among nursing students and the correlation between the attitude towards death and the willingness to donate organs was analyzed. Results The nursing students lacked of comprehensive understanding of organ donation knowledge. A majority of nursing students held neutral or slightly positive attitudes towards organ donation. Only 10.5% of nursing students were willing to donate organs. Nursing students were inclined to death natural acceptance. Organ donation willingness was correlated with death attitudes. The fear of death was the primary factor affecting the organ donation willingness of nursing students (P < 0.05). Conclusions At present, a small proportion of nursing students are willing to donate organs and they are affected by the fear of death. Social and medical colleges should strengthen the death education for nursing students to establish positive death attitudes and promote the development of organ donation.

Original Articles·Experimental Researches

Effect and mechanism of all-trans retinoic acid on cyclosporin-induced proliferation and apoptosis of glomerular mesangial cells

Chen Xu, Wu Jianhua, Guo Naifeng, Fan Yaping, Chen Xiaolan

2017, 8(6): 465-471. doi: 10.3969/j.issn.1674-7445.2017.06.011

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Objective To investigate the effect and mechanism of all-trans retinoic acid (ATRA) on the cyclosporin (CsA)-induced proliferation and apoptosis of glomerular mesangial cells in rat models. Methods The glomerular mesangial cells induced by different doses of CsA were treated with different doses of ATRA. MTT assay was carried out to detect cell proliferation. Hoechst 33258 fluorescent staining was adopted to observe the morphology of the apoptotic cells. Flow cytometry was conducted to detect the cellular apoptosis rate. Immunofluorescent staining was employed to quantitatively measure the expression level of mitochondria-derived pro-apoptotic Smac protein. Results Compared with the control group, administration of CsA at a dose of 0.5 μg/mL and above could suppress cellular proliferation, and use of CsA at a dose of 1.0 μg/mL and above could induce cellular apoptosis. The expression level of Smac protein was significantly up-regulated by CsA administration with a dose and time dependence (all P < 0.05).Compared with the CsA group, combined administration of CsA and ATRA exerted a more significant inhibitory effect on cellular proliferation. Supplement of ATRA could significantly inhibit glomerular mesangial cellular apoptosis induced by CsA and down-regulate the expression of Smac protein with a dose dependence (both P < 0.05). Conclusions CsA can inhibit cellular proliferation, induce cellular apoptosis and up-regulate the expression of Smac protein of glomerular mesangial cells. ATRA is capable of suppressing glomerular mesangial cellular apoptosis induced by CsA, which is probably mediated by the Smac signaling pathway.