器官移植

Abstract:
Objective To evaluate the effect of different doses of D-galactosamine (D-Gal) on non-human primate cynomolgus monkey and to establish a monkey model with different degree of acute liver failure (ALF). Methods Twelve cynomolgus monkeys were evenly divided into the low-, medium- and high-dose groups (n=4) with a dosage of 0.23, 0.25 and 0.27 g/kg, respectively. In each group, the corresponding dose of D-Gal solution was injected into the monkeys through the forearm vein at one time in a sober state (without anesthesia). The survival time of the cynomolgus monkeys was recorded. Digestive tract and hepatic encephalopathy symptoms were observed. Vital signs were measured at 0 h before and 12, 24, 36, 48, 60, 72, 96, 120 and 144 h after D-Gal administration. Alanine transaminase (ALT), total bilirubin (TB), prothrombin time (PT), blood ammonia and other parameters were detected from the blood samples. The liver tissues were prepared for hematoxylin-eosin (HE) staining to observe the pathological changes. Results All cynomolgus monkeys in the low-dose group survived and transient liver injury was noted without the hepatic encephalopathy symptoms. At 60 h after D-Gal administration, the liver function and coagulation indexes reached the peak, gradually recovered and then basically returned to the normal range at 120 h. In the medium-dose group, the course of disease was relatively slow and gradually recovered after the appearance of severe liver damage and hepatic encephalopathy symptoms and only one animal died. All cynomolgus monkeys in the high-dose group died after developing hepatic encephalopathy symptoms and severe liver damage with a mean survival time of (72±13) h. Pathological examination of liver tissue demonstrated that scattered liver cell necrosis and inflammatory cell infiltration were observed in the liver tissues of the low-dose group. In the medium- and high-dose groups, the hepatic lobule structure was not clear, and the liver cell necrosis in flakes accompanied by evident hemorrhage were documented. Conclusions The D-Gal dosage in the medium- and high-dose groups meet the standards of the ALF model. The degree of ALF in the medium-dose group is relatively slight, which is beneficial to the implementation of liver transplantation. ALF in the high-dose group is relatively severe, which is suitable for the evaluation of the clinical efficacy of therapeutic options.

Establishment of a non-venous bypass orthotopic liver transplantation model in Bama miniature pigs

Su Qiao, Yu Zhenyu, Li Wenwen, Ye Linsen, Dai Tianxing, Liang Rongpu, Liu Rongqiang, Lin Guozhen, Zhao Guangyin, Li Wuguo, Wang Guoying, Chen Guihua

2019, 10(1): 55-60. doi: 10.3969/j.issn.1674-7445.2019.01.008

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Abstract:
Objective To establish a non-venous bypass orthotopic liver transplantation model in Bama miniature pigs with high repeatability and stability. Methods Twelve Bama miniature pigs were randomly divided into the donor group (n=6) and recipient group (n=6). Pigs underwent non-venous bypass orthotopic liver transplantation. The time of anhepatic phase during operation was shortened, blood pressure during anhepatic phase was stably maintained, and management of anesthesia and body fluid during operation were strengthened. The operation time, anhepatic phase and survival status of the recipients were observed and recorded. The intraoperative heart rate, mean arterial pressure (MAP) and changes in arterial blood gas analysis were monitored. The perioperative liver function was evaluated. Results Among 6 Bama miniature pigs, 1 died from transplantation failure intraoperatively. The operation time of the remaining 5 pigs was (247±27) min and the time of anhepatic phase was (46±4) min. Three animals survived for more than 2 weeks. Compared with the preanhepatic phase, the heart rate of the animals was significantly faster, MAP was considerably reduced to (46±6) mmHg, blood pH value, base excess (BE) and HCO₃^- level were all significantly decreased and serum level of K⁺ was significantly elevated during the anhepatic phase (all P < 0.05). In the neohepatic phase, MAP of Bama miniature pigs was significantly increased, heart rate was dramatically slower.Blood pH value, BE, HCO₃^- level were significantly increased and serum level of K⁺ was significantly declined (all P < 0.05). During abdominal closure, MAP, blood gas indexes and serum level of K⁺ were almost recovered to those in the preanhepatic phase. Compared with preoperative levels, the levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), lactate dehydrogenase(LDH)and alkaline phosphatase(ALP)were significantly increased after operation (all P < 0.05), the change in AST was the most obvious, and it gradually decreased at postoperative 2 d. The level of γ-gutamyl transferase(GGT) did not significantly elevated. The level of total bilirubin (TB) was evidently elevated at postoperative 5 d. Compared with the preoperative levels, the levels of total protein (TP) and albumin (ALB) were significantly decreased after operation (both P < 0.05), and began to gradually increase at postoperative 1 d. Conclusions The non-venous bypass orthotopic liver transplantation model of Bama miniature pig is convenient, with highly reproducible and survival rate, which can be utilized as a standardized liver transplantation model.

Clinical Researches

Survey of current status and influencing factors analysis of attitude and willingness of ICU nurses towards organ donation in Chongqing

Dong He, Xu Xia, Zhang Jiasi, Yang Qin, Luo Chunmei, Deng Jing, Luo Yu

2019, 10(1): 61-66. doi: 10.3969/j.issn.1674-7445.2019.01.009

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Abstract:
Objective To investigate the attitude and willingness of nurses from intensive care unit (ICU) in Chongqing towards organ donation and analyze the influencing factors. Methods In this study, 4 Grade 3A hospitals with organ transplantation qualifications in Chongqing were selected by cluster sampling, and 321 nurses in ICU from these 4 hospitals were chosen by convenient sampling method to complete the questionnaire survey. The scores of ICU nurses' attitude and willingness towards organ donation were calculated. Spearman's correlation analysis was adopted to analyze the correlation between the attitude and willingness to donate organs. Multiple linear regression analysis was performed to identify the influencing factors of attitude and willingness towards organ donation. Results The average score of ICU nurses' attitude toward organ donation was (3.5±0.9) and the median score of willingness to donate organs was 2 (2-3). The attitude of ICU nurses towards organ donation was positively correlated with their willingness (P < 0.001). The experience of voluntary blood donation, the attitude of family members towards organ donation and the experience of organ donation persuasion were the influencing factors of ICU nurses' willingness to donate organs (all P < 0.05), among which the experience of voluntary blood donation and the attitude of family members towards organ donation were also the influencing factors of ICU nurses' attitude towards organ donation (both P < 0.05). Conclusions ICU nurses hold neutral attitude towards organ donation and show low willingness to donate organs. The experience of voluntary blood donation, the attitude of family members towards organ donation and the experience of organ donation persuasion are the main influencing factors.

Analysis of survival and influencing factors of patients with recurrent and de novo nephritis of renal allograft

Huang Yuanhang, Fan Liming, Deng Suxiong, Shen Meng, Zhang Wei, Chen Shujuan

2019, 10(1): 67-73. doi: 10.3969/j.issn.1674-7445.2019.01.010

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Abstract:
Objective To analyze the survival and influencing factors of patients with recurrent and de novo nephritis of the renal allograft. Methods Clinical data of 95 patients undergoing pathological puncture (biopsy) of the renal allograft were retrospectively analyzed. According to the biopsy results, all recipients were assigned into the recurrent group (n=28), de novo group(n=33) and non-nephritis group (n=34). The 1-, 3- and 5-year survival was statistically analyzed and the survival rates were calculated in three groups. Kaplan-Meier survival curve was adopted to analyze the 5-year survival. Clinical data of patients with recurrent and de novo nephritis were analyzed by univariate analysis. Logistic regression analysis was utilized to analyze the influencing factors of clinical prognosis of patients with recurrent and de novo nephritis. Results The 1-year survival rate did not significantly differ among three groups (all P > 0.05). The 3-year survival rates in the de novo group and non-nephritis group were 97% and 100%, significantly higher than 86% in the recurrent group (both P < 0.05). The 5-year survival rates in the de novo group and non-nephritis group were 82% and 91%, considerably higher than 61% in the recurrent group (both P < 0.05). Logistic regression analysis demonstrated that the survival rate of patients with recurrent renal nephritis was significantly correlated with the times of renal transplantation, cold ischemia time (≥12 h), immunosuppressive regime, recovery time of postoperative serum creatinine (Scr) (≥14 d), complications at postoperative 1 month (acute renal tubular necrosis, ultra-acute rejection and acute rejection) and type of nephritis (IgA nephropathy, focal segmental glomerular sclerosis and hemolytic-uremic syndrome) (all P < 0.05). In patients with de novo nephritis, the survival rate was significantly associated with cold ischemia time (≥12 h), immunosuppressive regime, recovery time of postoperative Scr (≥14 d) and complications at postoperative 1 month (acute renal tubular necrosis, ultra-acute rejection and acute rejection) (all P < 0.05). Conclusions The survival rate of patients with recurrent renal nephritis is lower than those in their counterparts with de novo nephritis and without nephritis. Cold ischemia time, immunosuppressive regime, recovery time of postoperative Scr and complications at postoperative 1 month are pivotal influencing factors of the clinical prognosis of patients with recurrent and de novo nephritis of the renal allograft.

Experience of perioperative treatment of lung transplantation: report of 7 cases

Lin Ting, Wu Qifei, Ye Chunjuan, Fu Junke, Zhang Guangjian, Zhang Yong, Wang Zhe, Wang Zheng, Liu Chang

2019, 10(1): 74-78. doi: 10.3969/j.issn.1674-7445.2019.01.011

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Abstract:
Objective To summarize the experience of perioperative treatment of lung transplantation for end-stage lung disease. Methods Perioperative clinical data of 7 recipients undergoing lung transplantation were retrospectively analyzed, including 3 cases with bilateral lung transplantation and 4 cases with unilateral lung transplantation. The perioperative status and clinical prognosis of lung transplantation recipients were observed. Results The operation time of 7 lung transplantation recipients was (344±133) min. Cold ischemia time was (236±74) min in 4 cases of single-lung transplantation and (480±120) min in 3 cases of bilateral-lung transplantation. The length of Intensive care unit(ICU) stay was 21 (13-25) d and the length of hospital stay was 101 (64-117) d. In the first 3 d after surgery, the daily fluid output was significantly larger than the fluid input (all P < 0.05). The arterial oxygen partial pressure (PaO₂) of lung transplantation recipients in the first 3 d after surgery was significantly elevated than preoperative level (all P < 0.05), whereas the arterial carbon dioxide pressure (PaCO₂) did not significantly change (all P > 0.05). All recipients had pulmonary bacterial infection after lung transplantation, including 3 cases complicated with fungal infection. One recipient underwent exploratory thoracotomy for hemostasis due to active thoracic bleeding after operation, 1 recipient suffered from primary graft dysfunction (PGD) and 4 recipients received secondary endotracheal intubation. Two cases died after operation, 1 case died of septicemia caused by multidrug-resistant acinetobacter baumannii, the other case died of rejection reaction after self-terminating use of immunosuppressive agents. The remaining 5 cases were successfully discharged and recovered well. The longest survival period was 3.1 years. Conclusions In the perioperative management of lung transplantation, it has great significance to hold the surgical indications, monitor and manage postoperative refined fluid and hemodynamics, implement the strategy of protective pulmonary ventilation, and early diagnose and treat severe postoperative complications for the recipients of lung transplantation to safety through the perioperative period.

Application of telemedicine robot in follow-up after liver transplantation from donation after cardiac death

Tian Boyan, Lu Huapeng, Zhang Jiaoqiong, Ding Hongfan, Liu Wenyuan, Tian Min, Lyu Yi, Yang Qinling

2019, 10(1): 79-83. doi: 10.3969/j.issn.1674-7445.2019.01.012

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Abstract:
Objective To evaluate the application effect of telemedicine robot on the postoperative follow-up of liver transplantation recipients from donation after cardiac death (DCD). Methods A total of 100 recipients undergoing liver transplantation from DCD in the First Affiliated Hospital of Xi 'an Jiaotong University from January 2014 to December 2017 were recruited in this investigation. According to differnt follow-up patterns, all recipients were divided into the research group (n=50, follow-up by telemedicine robot) and control group (n=50, follow-up by traditional telephone). The compliance (medication compliance, self-monitoring, life compliance and follow-up compliance), follow-up time and follow-up satisfaction at postoperative 3 months of all DCD liver transplantation recipients were analyzed and statistically compared between research group and control group. Results The scores of medication compliance, self-monitoring, life compliance, follow-up compliance and the total score of compliance in the research group were significantly higher than those in the control group (all P < 0.05). The each follow-up time of liver transplantation recipients in the research group was (9±4) min, significantly shorter than (13±4) min in the control group (t=-4.452, P < 0.001). The score of satisfaction during postoperative follow-up in the research group was 19.8±2.6, significantly higher than 16.2±3.1 in the control group (t=6.234, P < 0.001). Conclusions The application effect of telemedicine robot on the postoperative follow-up of liver transplantation recipients from DCD is satisfactory, deserves widespread application in clinical practice. It is expected to become an indispensable part of the postoperative follow-up of liver transplantation recipients from DCD.

Review Articles

The use of psychological crisis intervention to alleviate the cultural sensitivity of organ donation in China

Zhang Xiaoman, Feng Lei

2019, 10(1): 84-87. doi: 10.3969/j.issn.1674-7445.2019.01.013

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Abstract:

Prevention and treatment strategy of cytomegalovirus pneumonia after solid organ transplantation: interpretation of the diagnosis and treatment of ATS cytomegalovirus pneumonia