器官移植

Expert consensus on perioperative management of liver transplantation in adults with acute-on-chronic liver failure

Transplantation Immunology Committee of Branch of Organ Transplantation Physician of Chinese Medical Doctor Association, Enhanced Recovery of Liver Transplantation Group of Enhanced Recovery after Surgery Committee of Chinese Research Hospital Society

2020, 11(5): 533-542. doi: 10.3969/j.issn.1674-7445.2020.05.001

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Abstract:
Acute-on-chronic liver failure (ACLF) is a syndrome of acute liver failure complicated by other organ failure on the basis of chronic liver disease. Liver transplantation is the only effective treatment for ACLF. There is still discussion space on the optimal operation timing of ACLF, how to reduce postoperative infection rate, improvement of nutrition and body function. Transplantation Immunology Committee of Branch of Organ Transplantation Physician of Chinese Medical Doctor Association and Enhanced Recovery of Liver Transplantation Group of Enhanced Recovery after Surgery Committee of Chinese Research Hospital Society organized relevant experts to discuss the perioperative management of ACLF liver transplantation from the operation timing, organ protection, nutritional support, infection prevention and control, rehabilitation exercise and regulation of the internal environment, etc. And the expert consensus was developed for the reference of clinicians.

Supercooling organ preservation technology and its application

Lu Qiang, Zhang Wei, Yang Lifei, Lyu Yi

2020, 11(5): 543-546. doi: 10.3969/j.issn.1674-7445.2020.05.002

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The main purpose of organ preservation in organ transplantation is to maintain tissue and cell activity of donor organs so as to gain time for allocation and transportation of the organ, preparation of the recipient and organization of staff and facilities. The main principles of organ preservation can be divided into normothermic mechanical perfusion and cryopreservation. Cryopreservation is the favourite organ preservation method in clinical practice currently. However, the metabolic activity still exists in donor organs preserved with current cryopreservation technique, which makes the long-term preservation of organs extremely difficult. The supercooling organ preservation is a new type of cryopreservation technology, which greatly prolongs the preservation time of organs. It is expected to become an important organ preservation technique in the future, and it will provide technical support for the establishment of "organ bank".

Application of chimeric antigen receptor-regulatory T cell immunotherapy in organ transplantation

Wu Yu, Li Peilu, Ge Jun, Jiang Tingya

2020, 11(5): 547-552. doi: 10.3969/j.issn.1674-7445.2020.05.003

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Regulatory T cell (Treg) is a subset of T cells that negatively regulates immunity and has the function of inhibiting rejection. The specific modification of Treg by chimeric antigen receptor (CAR) technology can successfully chime donor-specific antigen onto the surface of Treg, thus regulating the immune function of the body in a real-time manner. It provides a novel and promising therapeutic option for inducing immune tolerance. In this article, research progresses on Treg in immune related diseases, main difficulties in the realization of CAR-Treg technology and its role in inducing transplantation immune tolerance were reviewed, and the opportunities and challenges of CAR-Treg application in the field of organ transplantation are prospected.

Exploration and practice of organ donation prevention and control management under COVID-19 epidemic

Liu Yuan, Zhi Yuna, Zhang Bin, Sun Chen, Wang Lu, Li Guangming

2020, 11(5): 553-558. doi: 10.3969/j.issn.1674-7445.2020.05.004

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Novel coronavirus pneumonia (COVID-19) is currently raging worldwide, and the prevention and control situation is very grim. Gratifying achievements of organ donation have been made in China since its implementation. Due to the characteristics of potential donors, such as complicated personnel structure, sudden onset and critical illness, it is necessary for multi-department to contact with the donors and their families during the work link of donor evaluation, family communication, donor transportation, organ function maintenance and organ procurement, which raises higher requirement for the screening and management of potential donors under COVID-19 epidemic. During the outbreak, Beijing Youan Hospital, Capital Medical University has completed 9 cases of organ donation, formulated the relevant screening process, established the prevention and control requirements, and gained certain experience and effects, which benefits the orderly and smooth development of organ donation under the COVID-19 epidemic.

Dynamic changes of lymphocyte subsets and their correlation with renal function in recipients with stable graft status after renal transplantation

Ma Xihui, Han Yong, Li Binyu, Kong Xiangrui, Sun Yujie, Xiao Li

2020, 11(5): 559-565. doi: 10.3969/j.issn.1674-7445.2020.05.005

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Objective To investigate the dynamic changes of peripheral blood lymphocyte subsets and their correlation with renal function in recipients with stable graft status after renal transplantation. Methods Forty-five recipients who underwent renal transplantation for the first time and had stable graft function within postoperative 6 months were selected. The proportion and absolute value of lymphocyte subsets were detected by flow cytometry (FCM) in 180 peripheral blood samples from recipients at 15 d, 1, 3 and 6 months after renal transplantation. The dynamic changes of lymphocyte subsets with the extension of postoperative time and their correlation with serum creatinine (Scr) and blood urea nitrogen (BUN) were analyzed. Results The Scr levels did not significantly differ at 4 time points after renal transplantation (all P > 0.05). The BUN levels significantly differed between 15 d and 1 month after renal transplantation, and between 1 and 3 months after renal transplantation (P=0.002, P=0.001). The proportion of CD3⁺CD8⁺T cells, CD3⁺CD4⁺T cells, natural killer (NK) cells and CD4/CD8 ratio at postoperative 15 d significantly differed from those at 1 month after operation (P=0.009, P=0.004, P < 0.001, P=0.004). The proportion of B cells significantly differed between 15 d and 1 month, and between 1 and 3 months after renal transplantation (both P < 0.001). The absolute values of CD3⁺T cells, CD3⁺CD8⁺T cells, CD3⁺CD4⁺T cells and NK cells at postoperative 15 d significantly differed from those at 1 month after renal transplantation (P=0.001, P=0.002, P=0.003, P < 0.001). The absolute values of CD3⁺CD8⁺T cells significantly differed between 3 and 6 months after operation (P=0.015). The absolute value of B cells at 1 month after renal transplantation significantly differed from that at 3 months after renal transplantation (P=0.001). The proportion and absolute value of lymphocyte subsets were not significantly correlated with the Scr level (both P > 0.05). The proportion and absolute value of CD3⁺CD8⁺T cells and NK cells were negatively correlated with BUN (P < 0.001-0.05), whereas the proportion of CD3⁺CD4⁺T cells and B cells was positively correlated with the BUN level (P < 0.001-0.05). The absolute value of CD3⁺T cells was negatively associated with the BUN level (P < 0.05). Conclusions T cells and NK cells in the lymphocyte subsets of stable recipients raise to the stable state within 1 month after renal transplantation, whereas B cells decrease to stable state within 3 months renal transplantation. The dynamic changes of lymphocyte subsets are correlated with the BUN level.

Efficacy analysis of T lymphocyte polyclonal antibody in renal transplantation from donor kidney of organ donation after citizen's death

Li Yang, Hu Xiaoyun, Ding Chenguang, Liu Zunwei, Ding Xiaoming, Xiang Heli, Tian Puxun, Zheng Jin, Xue Wujun

2020, 11(5): 566-571. doi: 10.3969/j.issn.1674-7445.2020.05.006

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Abstract:
Objective To compare the clinical efficacy of different T lymphocyte polyclonal antibodies in renal transplantation from donor kidney of organ donation after citizen's death. Methods Clinical data of 691 donors and recipients undergoing renal transplantation from donor kidney of organ donation after citizen's death were retrospectively analyzed. According to different T lymphocyte polyclonal antibodies used for induction, all recipients were divided into the rabbit anti human T lymphocyte immunoglobulin (rALG) group (n=414) and rabbit anti human thymocyte immunoglobulin (rATG) group (n=277). The recovery of renal graft function in recipients of the two groups were collected, including the incidence of delayed graft function (DGF) and acute rejection (AR), and the changes of serum creatinine level after renal transplantation. The 1-year survival rate of the recipients and renal grafts was collected. The incidence of adverse effects within 1 year after operation was calculated. According to the DGF risk score of donors, all recipients were divided into 5 groups. The use proportion of rALG and rATG in the recipients of each group was calculated. Results The incidence of DGF in the recipients of rALG and rATG groups was 14.5% (60/414) and 11.9% (33/277), respectively. The duration of DGF in the recipients of rALG and rATG groups was (7±4) d and (12±7) d respectively, with no statistically significant difference between two groups (P > 0.05). The incidence of AR in the rALG group was 7.5% (31/414), significantly higher than 4.0% (11/277) in the rATG group (P < 0.05). The serum creatinine levels of recipients within 6 months after renal transplantation tended to gradually decline in both groups. In renal transplantation for donor kidney with a DGF risk score of 0-15, the use proportion of rALG was significantly higher than that of rATG. However, the use proportion of rATG was significantly higher than that of rALG in renal transplantation for donor kidney with a DGF risk score over 16 (P < 0.05). The 1-year survival rates of the recipients and renal grafts in the rALG and rATG groups were 99.8% and 99.6%, 98.1% and 98.2%, respectively. There was no significant difference between two groups (both P > 0.05). The incidence of acute pulmonary edema and leukopenia in the recipients of rATG group was significantly higher than that in the rALG group (both P < 0.05). Conclusions Both rALG and rATG can effectively reduce the incidence of DGF and AR and achieve good clinical efficacy after renal transplantation from donor kidney of organ donation after citizen's death. The incidence of leukopenia and acute pulmonary edema induced by rATG is higher than that by rALG in the renal transplant recipients.

Experimental study of a modified extraction method of mouse islets

Zeng Wen, Liu Kunying, Lin Chuwen, Lin Shuo, Peng Hangya, Li Haicheng, Zeng Longyi

2020, 11(5): 572-577. doi: 10.3969/j.issn.1674-7445.2020.05.007

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Objective To investigate the improvement and effect of the method of islet extraction in mice. Methods According to different islet extraction methods, all mice were randomly divided into the common bile duct puncture group (n=100) and common bile duct puncture combined with in situ pancreatic injection group (combined injection group, n=100). Common bile duct puncture combined with in situ pancreatic injection was utilized as the modified method. The islets were selected and purified under stereomicroscope. The morphology and purification of islets were identified. The islet yield and success rate of islet extraction were statistically compared between two groups. The survival of islets after 1 week culture in vitro was analyzed, and the insulin secretion function of islets after 24 h and 4 d culture in vitro was evaluated. Results Compared with the common bile duct puncture group, the islet yield in the combined injection group was significantly increased (P < 0.001). The success rate of islet extraction in both groups was 83% with no statistical significance (P > 0.05). The islets extracted by common bile duct puncture combined with in situ pancreatic injection had intact morphology, high purity and high activity. The survival rate of newly isolated islets was nearly 100% after 24 h culture in vitro. After 1~5 d culture in vitro, the islet cells survived well. After 6 d culture in vitro, the islets showed central death. After culture in vitro for 24 h and 4 d, the islet function of the mice was normal after high glucose stimulation. Conclusions Common bile duct puncture combined with in situ pancreatic injection can increase the islet yield, and the obtained islet cells have high activity and proper function.

Effect of cold ischemia time on early graft function and acute rejection after liver transplantation

Liu Hao, Dong Jiayong, Fu Zhiren, Yang Jinghui

2020, 11(5): 578-583. doi: 10.3969/j.issn.1674-7445.2020.05.008

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Objective To evaluate the effect of different cold ischemia time (CIT) on early graft function and acute rejection (AR) after liver transplantation. Methods Clinical data of 218 donors and recipients undergoing liver transplantation were collected and analyzed. All patients were divided into three groups according to the CIT of donor liver: group A (CIT≤6 h, n=60), group B (6 h < CIT≤10 h, n=89) and group C (CIT > 10 h, n=69). Blood samples were collected on the 1, 7 and 14 d after liver transplantation. The changes of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and adenosine triphosphate (ATP) in CD4⁺T cells were detected. The incidence of AR and the positive rate of C4d deposition were analyzed. Results The ALT, AST and LDH levels in each group reached the peak on the 1 d after operation, and then gradually decreased. The indexes in each group were almost equivalent on the 14 d. An interaction effect existed between postoperative time and group. After liver transplantation, ATP levels in CD4⁺T cells were gradually increased in each group, peaked at postoperative 7 d, and then decreased gradually. An interaction effect was noted between postoperative time and group. The incidence of AR in groups A, B and C was 10%, 12% and 28%. Compared with group C, the incidence of AR in groups A and B was decreased significantly (both P < 0.05/3). The positive rate of C4d deposition in AR recipients of groups A, B and C was 1/3, 45% and 89% respectively. Compared with group C, the positive rate of C4d deposition in group A was decreased significantly (P=0.015). Conclusions The prolongation of CIT may lead to aggravation of early-stage liver function injury after liver transplantation, which is more easily to induce humoral AR.

Difference of clinical efficacy between surgical magnifying glass and surgical microscope assisted hepatic artery reconstruction in living donor liver transplantation

Yang Jian, Xie Yan, Tian Dazhi, Sun Xiaoye, Jiang Wentao

2020, 11(5): 584-588. doi: 10.3969/j.issn.1674-7445.2020.05.009

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Objective To compare the difference of clinical efficacy between surgical magnifying glass and surgical microscope assisted hepatic artery reconstruction in living donor liver transplantation (LDLT). Methods Clinical data of 272 donors and recipients undergoing LDLT were retrospectively analyzed. According to different patterns of hepatic artery reconstruction, all recipients were divided into the magnifying glass group (n=189) and microscope group (n=83). The operation time, intraoperative blood loss, hepatic artery reconstruction site, diameter of anastomosis, incidence of postoperative complications and survival rate of recipients were statistically compared between two groups. Results Compared with the microscope group, the operation time, hepatic artery reconstruction time and intraoperative blood loss were significantly less in the magnifying glass group (all P < 0.001). The most common site of hepatic artery reconstruction was the right hepatic artery in two groups, and the diameter of anastomosis was (2.1±0.9) mm in the magnifying glass group and (2.1±0.8) mm in the microscope group, with no statistical significance between two groups (P > 0.05). The 1-, 2- and 3-year survival rates of recipients in the magnifying glass group were 88%, 86% and 85%, which did not significantly differ from 89%, 87% and 86% in the microscope group (all P > 0.05). The incidence of postoperative complications did not significantly differ between two groups (all P > 0.05). Conclusions The efficacy and safety of hepatic artery reconstruction in LDLT under surgical magnifying glass are equivalent to those under surgical microscope, with less operation workload and intraoperative blood loss. For experienced transplantation surgeons, it is recommended to perform hepatic artery reconstruction assisted by surgical magnifying glass.

Clinical value of virtual touch tissue quantification technique in diagnosing acute rejection of transplant kidney at different stages

Fan Yunling, Yang Ping, Yang Cheng, Ji Zhengbiao, He Wanyuan, Wang Wenping

2020, 11(5): 589-593. doi: 10.3969/j.issn.1674-7445.2020.05.010

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Objective To explore the clinical value of virtual touch tissue quantification (VTQ) technique in the diagnosis of acute rejection of transplant kidney at different stages. Methods Clinical data of 170 renal transplant recipients were retrospectively analyzed. According to the time of VTQ examination and the occurrence of acute rejection after renal transplantation, the recipients within 4 weeks and after 4 weeks post-renal transplantation were assigned into the normal renal function group (n=41, 51) and acute rejection group (n=22, 56). Clinical ultrasound parameters at different stages after renal transplantation were compared between two groups. The diagnostic value of ultrasound parameters in acute rejection at different stages after renal transplantation was evaluated. Results Within 4 weeks post-renal transplantation, the resistance index (RI) and shear wave velocity (SWV) in the acute rejection group were significantly higher than those in the normal renal function group (both P < 0.001). After 4 weeks post-renal transplantation, the SWV in the acute rejection group was significantly higher than that in the normal renal function group (P < 0.001). The area under curve (AUC) of RI and SWV in the diagnosis of acute rejection were 0.729 and 0.803 respectively within 4 weeks post-renal transplantation, which were 0.478 and 0.794 respectively after 4 weeks post-renal transplantation. The diagnostic value of SWV was higher than RI (P < 0.05). The cutoff value of SWV in the diagnosis of acute rejection within 4 weeks post-renal transplantation was considerably higher than that after 4 weeks post-renal transplantation. Conclusions VTQ technique can effectively assist in diagnosing acute rejection of transplant kidney at different stages.

Clinical analysis of hepatic arterial thrombolysis combined with splenic arterial embolization in treatment of hepatic arterial thrombosis after liver transplantation

Zhang Xiwu, Kuang Yue

2020, 11(5): 594-598. doi: 10.3969/j.issn.1674-7445.2020.05.011

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Objective To analyze the clinical efficacy of transcatheter hepatic arterial thrombolysis combined with splenic arterial embolization in the treatment of hepatic artery thrombosis (HAT) after liver transplantation. Methods Clinical data of 9 patients diagnosed with HAT after liver transplantation undergoing transcatheter hepatic arterial thrombolysis combined with splenic arterial embolization were retrospectively analyzed. The incidence of HAT and clinical efficacy of thrombolytic therapy were summarized. The incidence of thrombolysis related complications and clinical prognosis were evaluated. The thrombolytic therapy procedures of typical cases were analyzed. Results HAT was diagnosed at 1-66 d after liver transplantation with a median time of 10 d. The formation site of HAT was found at the anastomosis of the main hepatic artery in 8 cases and at the right branch in 1 case. Upon diagnosis, 9 patients received transcatheter hepatic arterial thrombolysis combined with splenic arterial embolization in emergency. The hepatic artery was open during operation in 4 cases and treated with postoperative thrombolytic therapy with indwelling catheter in 3 cases. The opening time for inwelling catheter was 72-96 h. The total successful rate was 7/9. The thrombolysis related complication of abdominal hemorrhage occurred in 1 case after surgery. Three cases died, including 2 cases of liver failure and infection, and 1 case of biliary ischemia and systemic infection at 70 d after interventional therapy. Conclusions Hepatic arterial thrombolysis combined with splenic arterial embolization is an efficacious treatment for HAT after liver transplantation, which can serve as the optimal therapy for patients who are unable to undergo secondary liver transplantation.

Single-center data analysis of organ donation and utilization after citizen's death

Qian Gongtao, Li Xiaoshan, Zhou Jianmei, Zhang Lihua, Hu Chunxiao

2020, 11(5): 599-604. doi: 10.3969/j.issn.1674-7445.2020.05.012

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Objective To get a knowledge of the current status of organ donation and utilization after citizen's death in Wuxi District, and thereby provide ideas and basis for further development of organ donation work in local areas. Methods Clinical data from 151 organ donors, included 37 successful donors and 114 potential donors, were retrospectively analyzed. The reasons for donation failure of potential donors were analyzed. The general information for successful donors was collected. And the information on organ donation and organ utilization in successful donors were analyzed. Results Among the 151 organ donors, 37 were successful donors, with the conversion rate reaching 24.5%. For the 114 donors with failed organ donation, the reasons for failure included family disagreement, failure to meet donation status criteria, insufficient evaluation time, and unresolved work injury disputes. The categories for organ donation included 34 cases of donation after brain death followed by cardiac death (DBCD), 3 cases of donation after brain death (DBD), and no case of donation after cardiac death (DCD). The reasons for death of donors includes 19 cases of craniocerebral trauma, 14 cases of stroke and 4 cases of others. Among the 37 cases of successful donors, the majority were floating population. A total of 154 major organs and tissues were donated, of which 124 were major organs. The number of major organs and tissues donated per citizen was (4.2± 1.6) and the number of major organs donated per citizen was (3.4± 1.1). The utilization rate of the 154 donated organs reached 96.7% (149/154), with Nanjing, Wuxi, Suzhou and Changzhou ranking the top 4 of organ distribution. Conclusions The rate for successful organ donation and conversion after citizen's death is low in Wuxi District. The organ donation work networks in local areas should be established. And organ donation promotion efforts and skills training for coordinators should be developed.

Diagnostic value of lymphocyte subset classification for active pulmonary tuberculosis in renal transplant recipients

Yi Wang, Cheng Ke

2020, 11(5): 605-609. doi: 10.3969/j.issn.1674-7445.2020.05.013

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Objective ;To evaluate the clinical value of lymphocyte subset classification in the diagnosis of active pulmonary tuberculosis in renal transplant recipients. Methods Clinical data of 52 recipients undergoing renal transplantation were retrospectively analyzed. According to the results of imaging and etiological examination, 52 recipients were divided into the stable group(n=19), tuberculosis group (n=9), bacteria group (n=12) and fungi group (n=12), respectively. The renal function of recipients was compared, and the proportion and absolute value of lymphocyte subset were analyzed and compared among four groups. The diagnostic value of lymphocyte subset classification for active pulmonary tuberculosis after renal transplantation was evaluated. Results Compared with the stable group, the levels of blood urea nitrogen and serum creatinine in the tuberculosis group, bacteria group and fungi group were significantly increased (all P < 0.05). The proportion of CD3⁺, CD8⁺, CD4⁺, natural killer (NK) cells and CD19⁺ lymphocyte subsets were not significantly different (all P>0.05). And the absolute values of CD3⁺, CD8⁺, CD4⁺, NK cells and CD19⁺ lymphocyte subsets were significantly decreased (all P < 0.05). The proportion of CD8⁺ lymphocyte subset in the tuberculosis group and fungi group was significantly higher than that in the bacteria group (both P < 0.05). The optimal cut-off value of CD8⁺ lymphocyte subset ratio in the differential diagnosis of active pulmonary tuberculosis and bacterial pneumonia was 33.27%, and the sensitivity and specificity were 0.889 and 0.833, respectively. The area under the curve (AUC) was 0.880. Conclusions The classification of lymphocyte subset can provide auxiliary diagnostic basis for differential diagnosis and individualized treatment of active pulmonary tuberculosis and bacterial pneumonia in renal transplant recipients.

Application value of quantitative parameters of contrast-enhanced ultrasound in evaluating donor liver from donation after brain death

Ren Xiuyun, Gao Nong, Pan Yipeng, Lyu Faqin, Li Wei

2020, 11(5): 610-613. doi: 10.3969/j.issn.1674-7445.2020.05.014

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Objective To evaluate the application value of quantitative parameters of contrast-enhanced ultrasound (CEUS) in evaluating the donor liver from donation after brain death (DBD). Methods Clinical data of 25 DBD donor livers and 10 healthy adult livers were retrospectively analyzed. CEUS examinations of DBD donor livers and healthy livers were collected. Quantitative parameters included the area under curve (AUC), maximum intensity (I_max), time to peak (TTP) and mean transit time (mTT), etc. Results Among 25 cases of DBD donor livers, 23 cases showed normal enhancement pattern, and the other 2 cases presented with abnormal enhancement pattern. Compared with the control group, the AUC, I_max and mTT values of DBD donor livers were significantly decreased (all P < 0.05). Conclusions CEUS quantitative parameters can be effective means to evaluate the micro-perfusion of DBD donor livers.

Organ donation: a novel discipline created by multi-disciplinary integration in the new era of China

Society of Organ & Tissue Donation of China Association for Promotion of Health Science and Technology

2020, 11(5): 614-621. doi: 10.3969/j.issn.1674-7445.2020.05.015

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The pilot work of organ donation after citizen's death has been implemented in China for 10 years. The number of organ donations was significantly increased from 34 cases in 2010 to more than 6 300 cases in 2018, accounting for over 15% of the global quantity of organ donations. China has established an organ donation and transplantation system that follows the international ethical standards, and conforms to our own social development stage and cultural tradition. Organ donation is a novel discipline created by multi-disciplinary integration in the new era of China, the process of which was reviewed from the perspectives of legal supervision, workflow, management mode, training and education mode, quality management and control system, organ donation in the epidemic of noval coronavirus pneumonia and application of innovative technologies, etc.

Analysis on application of regulatory dendritic cell in renal transplantation

Xu Haiyan, Xu Renfang, He Xiaozhou

2020, 11(5): 622-628. doi: 10.3969/j.issn.1674-7445.2020.05.016

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How to reduce the use of immunosuppressant is one of the difficult problems to be solved in the field of organ transplantation. Cell therapy is considered as an effective solution to replace immunosuppressant with a promising clinical application. Regulatory dendritic cell (DCreg) has attracted widespread attention due to its ability to induce immune tolerance. Kidney is a solid and non-immune organ. Whether the particularity of body and the local microenvironment of recipients after renal transplantation affects the application of DCreg is the focus of research. In this article, the application of DCreg in renal transplantation was analyzed from the perspective of renal immunity.

Research progress on dendritic cell in immune tolerance of organ transplantation

Xu Junming, Zhou Lin, He Qiang

2020, 11(5): 629-634. doi: 10.3969/j.issn.1674-7445.2020.05.017

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Dendritic cell (DC) is professional antigen presenting cell with specific functions. DC can specifically phagocytize antigen, and process and deliver to effector T cell, which play an important role in immune tolerance and immune response. Tolerance DC (tol-DC) is a group of DC with negative immune regulatory function, which can induce immune tolerance of organ transplantation through central and peripheral mechanism. In this article, the phenotype and functional characteristics of DC, mechanism of immune tolerance induced by DC, and the application of tol-DC in organ transplantation of DC were summarized, aiming to provide basic theoretical support for clinical translational medicine research.

Research progress on pharmacokinetics of mycophenolic acid drugs in organ transplant recipients

Cao Yirui, Jia Yichen

2020, 11(5): 635-645. doi: 10.3969/j.issn.1674-7445.2020.05.018

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Mycophenolic acid (MPA) drugs are common immunosuppressant for organ transplant recipients, which possesses high immunosuppressive effect. However, insufficient or excessive dosage of MPA is not conducive to clinical prognosis of the recipients. Hence, it is necessary to accurately control the dosage of MPA. The metabolism of MPA significantly differs among individuals. The metabolic pattern and monitoring method of these drugs are of important significance in clinic. In this article, the research progresses on the metabolism of MPA drugs in organ transplant recipients in recent five years were reviewed, the main results and direction of drug metabolism and monitoring methods were summarized, and the researches on the metabolism of MPA drugs in organ transplantation were briefly reviewed and prospected.

Research progress on risk factors of de novo malignancy after liver transplantation

Meng Lingzhan, Liu Zhenwen, Zhu Zhenyu

2020, 11(5): 646-650. doi: 10.3969/j.issn.1674-7445.2020.05.019

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De novo malignancy after liver transplantation is an important factor that affecting the long-term survival of recipient. The main risk factors for de novo malignancy include immunosuppression and many factors of recipients, such as age, gender, race, primary disease, preoperative tumor history and precancerous lesion, carcinogenic virus infection, smoking and drinking, etc. Currently, there is no standardized monitoring scheme after liver transplantation, but planned monitoring is required for high-risk recipients, thus to achieve early diagnosis and improve the survival rate. This article summarized the incidence, prognosis and related risk factors of de novo malignancy after liver transplantation, which provided reference for improving long-term survival rate of recipients after liver transplantation.

2020 Vol. 11, No. 5