器官移植

Enlightenment of international experience of organ donation related systematic multi-department collaboration to China

Zhao Jie, Huo Feng, Zhao Hongtao, Pu Miao

2022, 13(6): 683-689. doi: 10.3969/j.issn.1674-7445.2022.06.001

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Abstract:
Organ transplantation is an effective treatment for end-stage organ failure. The shortage of donors severely restricts the development of organ transplantation, which is also an unresolved challenge in the reform of organ transplantation in China. To alleviate the shortage of donors, western countries have established the working mechanism of systematic multi-department collaboration (SMDC), which has significantly elevated the level of organ donation by promoting systematic collaboration among relevant departments in all aspects of organ donation. At present, organ donation and transplantation in China have entered the new stage of high-quality development, whereas the level of organ donation remains to be further improved. In this article, the concept of SMDC, the procedures and departments related to SMDC, and the international experience of SMDC were illustrated. Besides, suggestions and proposals were delivered for implementing SMDC in China and constantly developing and modifying the Chinese model of organ donation catering to national conditions.

Cost management of Organ Procurement Organization from the perspective of value chain

Li Yushu, Wang Dong, Yang Shunliang

2022, 13(6): 690-696. doi: 10.3969/j.issn.1674-7445.2022.06.002

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Human organ donation has entered a high-quality development stage in China, which proposes new requirements for the operation and management of Organ Procurement Organization (OPO). Strengthening cost management of OPO contributes to maintaining healthy and sustainable development of organ donation and highlighting the public welfare and social responsibility of OPO. Therefore, in this article, cost management was taken as the breakthrough point and the concept of value chain cost management was introduced to comprehensively analyze the internal and external value activities of OPO from the aspects of excessively high cost hindering the development of organ donation, value chain cost management promoting high-quality development of organ donation and OPO cost management optimization strategies based on value chain theory, aiming to provide reference for lowering internal cost, expanding the range of cost management and improving industry supervision, thereby reasonably controlling the cost of different activities on the organ donation value chain, achieving the goal of restraining excessive increase of organ procurement cost and promoting healthy development of organ donation and transplantation in China.

With a focus on Asia and a global perspective: sustainable development of donation after brain death

Jiang Wenshi

2022, 13(6): 697-710. doi: 10.3969/j.issn.1674-7445.2022.06.003

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Organ shortage is a prevalent problem within the global transplantation community. World Health Organization (WHO) calls on all countries to achieve self-sufficiency in organ transplantation by reducing the burden of diseases and expanding the effective source of organs in line with ethical principles. Donation after brain death (DBD) remains the major source of transplant organs. In recent years, some Asian countries, including China, have actively promoted the development of donation from deceased organs, which are gradually reshaping the situation of living organ donation as the main source of transplant organs in Asia. The outbreak of COVID-19 in 2020 slowed down the growth trend of global organ donation and transplantation in the past decade. On the premise that the burden of disease and the need for transplantation have not been significantly reduced, the work of organ donation and transplantation in China has been steadily carried out under the guidance of the general policy of epidemic prevention and control and relevant policies of "Put people and their lives first, and adhere to the dynamic zero-Covid policy". This proves to a certain extent that under the continuous drive of the people's medical demands and transplant demands, China has formed an organ donation and transplant work system with resilience, pressure resistance, operational inertia and the survival of the industry. Look at Asia from China, and look at the world from Asia. In this article, by compiling relevant data of organ donation and transplantation in Asia and around the world, the changes of the overall pattern of organ donation and transplantation in Asia during the new developmental trend of global organ transplantation were illustrated, the influencing factors of DBD were identified by analyzing the developmental characteristics and practical experience, and corresponding effective strategies were proposed, aiming to provide professional reference for sustainable and healthy development of organ donation and transplantation in China and throughout Asia.

ulti-disciplinary integration promotes the disciplinary system construction and professional development of organ donation

Jiang Wenshi, Ma Liansheng, Shu Jing, Yan Juan, Yang Liming, Ma Yajie, He Xiangxiang, Wu Xiaotong

2022, 13(6): 711-721. doi: 10.3969/j.issn.1674-7445.2022.06.004

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At present, interdisciplinary integration has become a major feature of the development of science and technology, and multi-disciplinary integration will gradually become the norm. Professional and technological multi-disciplinary integration has unpredictable potential, which will produce new disciplinary frontiers, new fields of science and technology and new patterns of innovation. Organ donation is a new discipline in China's new era. Constructing and promoting an organ donation disciplinary system with the overall goal of safeguarding legal and reasonable rights and interests of donors and their families and the health rights and interests of the recipients are in line with the fundamental requirements of maintaining high-quality development of organ donation and transplantation in China. Meantime, organ donation is a complex medical and social behavior, and organs donated by citizens belong to national resources, which also endows organ donation with a social welfare attribute and relevance with all parties in society. In this article, the essence of current problems encountered during organ donation in China, the whole process of organ donation and theoretical knowledge, professional skills and personnel support required by donors in different clinical stages were analyzed to illustrate the necessity and feasibility of establishing an organ donation disciplinary system based on multi-disciplinary integration. Besides, how to integrate organ donation disciplinary construction into the national policy was also investigated. Taking safeguarding the rights and interests of donors, family members and recipients as the core and taking organ donation and transplantation as the main line, cooperative principles of co-creation, co-construction, mutual promotion, sharing and win-win should be upheld, aiming to promote multi-disciplinary integration and comprehensive talent cultivation of organ donation, jointly enhance the recognition rate and donation rate of organ donation, and make organ donation widely recognized by citizens from all walks of life.

Application of machine learning in liver transplantation

Wu Jian, Cao Linping

2022, 13(6): 722-729. doi: 10.3969/j.issn.1674-7445.2022.06.005

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Machine learning can efficiently extract the features and establish associations from complex databases, and better predict changes in clinical diseases by constructing models. Liver transplantation is one of the efficacious therapeutic options for all types of end-stage liver diseases and primary liver cancer. Nevertheless, it also faces multiple challenges. How to more effectively allocate the organs, expand the donor liver pool, evaluate the optimal donor-recipient matching, predict the complications after liver transplantation, disease recurrence and long-term survival have been the hot spots and difficulties. In recent years, certain progress has been made in the application of machine learning in the field of liver transplantation, showcasing promising prospect. In this article, the application status and prospect of machine learning in organ allocation before liver transplantation, donor liver evaluation, prediction of perioperative complications, blood transfusion, postoperative new disease, disease recurrence, acute rejection and long-term survival were reviewed, aiming to provide ideas and direction for subsequent investigations.

Current status and progress on robot living donor liver hepatectomy

Li Xingfei, Luo Xiang, Li Tao

2022, 13(6): 730-735. doi: 10.3969/j.issn.1674-7445.2022.06.006

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With the emergence, development and innovation of minimally invasive surgical and laparoscopic technologies, minimally invasive technology has been gradually applied and promoted in different fields of surgery, and surgical indications have been constantly expanded. Robot-assisted surgical system has become a novel research hotspot due to its precision and minimal invasiveness. At present, robot-assisted surgical system can be applied in complex tumor surgery. How to apply robot-assisted surgery in the field of liver transplantation, especially in the living donor liver hepatectomy, has become a new research direction, which is also a challenge facing multiple scholars. In this article, the advantages of robot-assisted surgery, current status and major difficulties of robot living donor liver hepatectomy were reviewed, and the future of robot living donor liver hepatectomy was predicted, aiming to provide reference for promoting the application of robot-assisted surgery in clinical liver transplantation.

Clinical application progress of laparoscopic living donor liver hepatectomy for liver transplantation

Kong Junjie, Yu Guangsheng

2022, 13(6): 736-741. doi: 10.3969/j.issn.1674-7445.2022.06.007

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The implementation of living donor liver transplantation not only extends the number of donors and effectively alleviates the shortage of organ donation, but also reduces the fatality of patients on the waiting list for liver transplantation. In recent years, with persistent development of laparoscopic techniques and instruments, laparoscopic donor liver hepatectomy has been widely applied in the field of living donor liver transplantation, which is also one of the research hotspots. It has multiple advantages of mild trauma, slight pain, accelerated postoperative recovery for the donors and slight psychological burden, etc. However, due to strict screening criteria for donors, complicated procedures and long learning curve, it has been carried out in a few transplantation centers nationwide. In this article, the development history and current status, specific surgical patterns, the problems and challenges of laparoscopic living donor liver procurement for liver transplantation were introduced, and the development direction of laparoscopic living donor liver procurement was predicted, aiming to provide reference for accelerating the development and enhancing clinical prognosis of living donor liver transplantation.

Research progress on liver transplantation for benign liver tumors

Ni Yuanzhi, Zhang Wu

2022, 13(6): 742-748. doi: 10.3969/j.issn.1674-7445.2022.06.008

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Liver tumors can be divided into benign and malignant types. Benign liver tumors are relatively common, which are mainly treated with follow-up observation and interventional therapy, and surgical resection should be performed for few cases. Liver transplantation can effectively treat end-stage liver diseases, whereas it is seldom applied in the treatment of benign liver tumors. Liver transplantation is only considered for benign liver tumors with huge space-occupying compression, liver failure, the risk of tumor rupture and bleeding or malignant transformation. Compared with malignant tumors and chronic liver failure, liver transplantation yields an equivalent risk for benign liver tumors, favorable clinical prognosis and long-term survival. However, comprehensive evaluation should be delivered before liver transplantation for benign liver tumors, and extensive attention should be paid to the difficulty of donor liver matching in the new situation. In this article, research progress on liver transplantation for benign liver tumors including hepatic hemangioma, polycystic liver, hepatocellular adenoma, hepatic mesenchymal hamartoma was reviewed, aiming to provide reference for liver transplantation in the treatment of benign liver tumors.

Role and mechanism of GDF15 in ischemia-reperfusion injury during kidney transplantation

Zhu Jiefu, Shi Lang, Song Zhixia, Zha Hongchu, Wu Xiongfei

2022, 13(6): 749-756. doi: 10.3969/j.issn.1674-7445.2022.06.009

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Objective To investigate the role and mechanism of growth differentiation factor (GDF) 15 in ischemia-reperfusion injury (IRI) during kidney transplantation. Methods Nine wild type donor mice and 9 wild type recipient mice were selected. The renal graft of 3 recipient mice were harvested at 4, 24 and 72 h after transplantation. GDF family transcriptome analysis was carried out, and the expression of GDF15 in renal tissues of each group were detected. Five wild type donor mice, 5 GDF15 knockout donor mice and 10 wild type recipient mice were selected. According to the experimental scheme, the mice were divided into wild type sham operation group, wild type transplantation group, GDF15 knockout sham operation group and GDF15 knockout transplantation group. Serum and renal tissue samples were extracted 72 h after transplantation. The renal function, renal tubular injury, inflammatory cell infiltration, inflammatory factors, Toll-like receptor 4 (TLR4) and nuclear factor (NF)-κB expression level were compared in each group. Nine wild type donor mice, 9 GDF15 knockout donor mice and 18 wild type recipient mice were selected. According to the experimental scheme, the mice were divided into wild type transplantation group and GDF15 knockout transplantation group, and the survival rate of two group after kidney transplantation was observed. Results Transcriptome sequencing of renal graft tissues indicated that GDF15 was the most up-regulated GDF family gene, which was mainly expressed in renal tubules. Compared with the sham operation group, the renal function of mice was declined in the transplantation group. Compared with the wild type transplantation group, the serum creatinine and blood urea nitrogen levels of mice were significantly up-regulated in the GDF15-knockout transplantation group (both P < 0.05). The 1-week survival rate of mice was 87.6% in the wild type transplantation group and 41.8% in the GDF15 knockout transplantation group. In the GDF15 knockout transplantation group, the expression level of kidney injury molecule (KIM)-1 was up-regulated, and the renal tubule injury score was increased. In the wild type transplantation group, the renal tubules were dissolved or necrotized, and tubular formation was seen in the extramedullary and cortex area, whereas tubular necrosis and tubular formation were more evident in the GDF15 knockout transplantation group. The expression levels of myeloperoxidase (MPO) and F4/80 were up-regulated in the transplantation group, and the inflammatory cell infiltration was aggravated in the GDF15 knockout transplantation group. Compared with the sham operation group, the expression levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1β and IL-6 in the transplantation group were up-regulated. Compared with the wild type transplantation group, the expression levels of TNF-α, IL-1β and IL-6 were also up-regulated in the GDF15 knockout transplantation group (all P < 0.05). In the transplantation group, the expression levels of TLR4 and NF-κB in the renal graft tissues were higher than those in the sham operation group. In the GDF15 knockout transplantation group, the expression levels of TLR4 and NF-κB in the renal graft tissues were higher compared with those in the wild type transplantation group. Conclusions GDF15 may alleviate the IRI of renal graft probably via inhibiting the TLR4-NF-κB signaling pathway.

Effect of united OPO on organ donation and procurement quality control indexes : a study based on single-center data in Fujian province

Xie Xianyu, Wei Qin, Zhang Hui, Wu Yong, Wu Qinde, Huang Fayun, Chen Yanling

2022, 13(6): 757-763. doi: 10.3969/j.issn.1674-7445.2022.06.010

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Objective To evaluate the effect of united Organ Procurement Organization (OPO) on organ donation and procurement quality control indexes. Methods The differences in organ donation workload, work efficiency, organ donation quality control and management indexes in a united OPO-led hospital were retrospectively analyzed before (n=36) and after (n=33) the establishment of united OPO. Results After the establishment of united OPO, the organ donation workload and efficiency were enhanced. The annual donation cases, annual organ procurement cases, average organ procurement cases per day, organ donation rate of per million population (PMP), coordinator work efficiency index and other indexes were further improved. Before the establishment of united OPO, the donation conversion rate was 26.5%, and increased up to 29.0% after the establishment of united OPO. The average organ yield rate remained higher than 3.3 before and after the establishment of united OPO. No significant differences were noted in the utilization rate of procured organs, proportion of marginal donor organs, positive rate for pathogen culture in organ preservation solution, the incidence of primary nonfunction (PNF) and delayed graft function (DGF) before and after the establishment of united OPO (all P > 0.05). The biopsy rates of donated organs were 27.7% and 58.3%, and the organ outflow rates were 83.1% and 47.8% before and after the establishment of united OPO, and the differences were statistically significant (both P < 0.05). Conclusions The establishment of united OPO contributes to promoting efficient development of organ donation and procurement, lowering the cost of organ donation and procurement, and improving the effectiveness, quality control and management levels of organ donation and procurement.

Design and clinical application of simplified "All in one" hepatic vein reconstruction in right split liver transplantation

Yi Shuhong, Yang Qing, Fu Binsheng, Zhang Tong, Yao Jia, Zeng Kaining, Feng Xiao, Chen Guihua, Yang Yang

2022, 13(6): 764-769. doi: 10.3969/j.issn.1674-7445.2022.06.011

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Objective To introduce the simplified "All in one" hepatic vein reconstruction in right split liver transplantation, and to investigate the clinical indications, surgical procedures and clinical prognosis of this technique. Methods Clinical data of 2 recipients undergoing right split liver transplantation were retrospectively analyzed, and the simplified "All in one" hepatic vein reconstruction of right liver lobe was summarized and analyzed. In 2 cases, the right liver lobe was split in vivo. In case 1, the liver parenchyma was split until the first and second porta hepatis, and then the liver was obtained by whole-liver perfusion after cutting off the right hepatic duct, and the hepatic blood vessels were isolated ex vivo. In case 2, the left liver lobe was obtained during splitting in vivo and the right liver lobe was obtained after perfusion in vivo. During donor liver splitting in two cases, the common trunk of the middle hepatic vein was maintained in the left liver lobe, the S5 and S8 hepatic veins of the right liver lobe were reconstructed by the same donor iliac artery, and directly anastomosed with the gap between the left and middle hepatic veins of the inferior vena cava, thus reconstructing the integrity of the posterior inferior vena cava. Results The simplified "All in one" right hepatic vein reconstruction was adopted. The anhepatic phase of two recipients undergoing liver transplantation was 41 and 36 min. After the liver was incised open, the blood flow of the donor liver was normal, the iliac artery bypass was fully filled, liver congestion or swelling was not observed, and liver function was properly recovered after surgery. Two recipients were subject to postoperative follow-up for 23 and 10 months, respectively, No complications related to hepatic venous outflow tracts were noted, such as hepatic vein and inferior vena cava. Conclusions "All in one" hepatic vein reconstruction may simplify the procedures of hepatic venous outflow tract reconstruction, shorten the anhepatic phase and reduce the incidence of postoperative hepatic vein complications in complete right liver split transplantation.

Comparison of clinical efficacy between Clamshell incision and bilateral posterolateral incision for double lung transplantation

Chen Yuan, Xiong Dian, Xu Jian, Cai Hongfei, Ye Shugao, Chen Jingyu

2022, 13(6): 770-775. doi: 10.3969/j.issn.1674-7445.2022.06.012

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Objective To compare the clinical efficacy between Clamshell incision and bilateral posterolateral incision in the sequential double lung transplantation for end-stage lung disease. Methods Clinical data of 120 recipients undergoing double lung transplantation were retrospectively analyzed. All recipients were divided into bilateral posterolateral incision group (n=108) and Clamshell incision group (n=12) according to different surgical methods. Intraoperative parameters were collected and statistically compared between two groups, including operation time, amount of blood loss, amount of blood transfusion, use of extracorporeal membrane oxygenation (ECMO) or not, cold ischemia time on the first side, and cold ischemia time on the second side. Postoperative parameters were also compared between two groups, including the length of hospital stay, length of intensive care unit (ICU) stay, tracheal intubation duration, ECMO duration, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), incidence of anastomotic stenosis, incidence of bronchopleural fistula, perioperative fatality, and 6-minute walk test for the first time after operation. Results In the Clamshell incision group, the amount of blood loss and blood transfusion was significantly higher than those in the bilateral posterolateral incision group (both P < 0.05). The proportion of ECMO and cold ischemia time on the second side in the Clamshell incision group were significantly lower or shorter than those in the bilateral posterolateral incision group (both P < 0.05). In the Clamshell incision group, the tracheal intubation duration and ECMO duration were significantly shorter compared with those in bilateral posterolateral incision group (both P < 0.05). Conclusions Both Clamshell incision and bilateral posterolateral incision are safe and effective in sequential double lung transplantation. Bilateral posterolateral incision approach can significantly reduce the amount of blood loss and blood transfusion of the recipients without significantly prolonging the operation time. Compared with bilateral posterolateral incision approach, the cold ischemia time of lung graft, tracheal intubation duration and ECMO duration are significantly shortened via the Clamshell incision.

Correlation between tacrolimus and diabetes mellitus after kidney transplantation: a single center study

Wang Ziyu, Dong Chen, Wang Hongyang, Wang Qinghai, Guo Chen, Huang Tao, Ji Jianlei, Cao Yanwei, Dong Zhen

2022, 13(6): 776-782. doi: 10.3969/j.issn.1674-7445.2022.06.013

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Objective To explore the major risk factors of post transplantation diabetes mellitus (PTDM) and analyze the correlation between tacrolimus and PTDM after kidney transplantation. Methods Clinical data of 123 kidney transplant recipients were collected. All recipients were divided into the PTDM group (n=19) and non-PTDM group (n=104). Clinical data of all recipients in two groups were analyzed. The risk factors of PTDM were analyzed by binary logistic regression. Twenty-four mice were evenly divided into the control group (normal saline), low-dose tacrolimus (0.1 mg/kg), medium-dose tacrolimus (0.75 mg/kg) and high-dose tacrolimus groups (1.5 mg/kg). The solutions were given twice a day. The effect of tacrolimus on blood glucose metabolism in mice was evaluated. Results The incidence of PTDM was 15.4% (19/123) within 1 year after kidney transplantation. Age≥48 years old and the trough concentration of tacrolimus≥9 ng/mL within 3 months after kidney transplantation were the risk factors for PTDM after kidney transplantation (both P < 0.05). The fasting blood glucose levels of mice after administration in the low-, medium- and high-dose tacrolimus groups were significantly lower than those before administration (all P < 0.05) in a dose-independent manner (P=0.750). In the low-, medium- and high-dose tacrolimus groups, the postprandial blood glucose levels of mice after administration were significantly higher than those before administration (all P < 0.05) in a dose-dependent manner (P=0.012). Conclusions Tacrolimus is intimately correlated with the incidence of PTDM after kidney transplantation. Age≥48 years old and the trough concentration of tacrolimus ≥9 ng/mL within 3 months after kidney transplantation are the independent risk factors of PTDM. Tacrolimus affects the postprandial blood glucose levels of mice in a dose-dependent manner.

Research status analysis and prospect of human organ donation coordinator at home and abroad based on bibliometrics

Wu Jianquan, Wei Qin

2022, 13(6): 783-790. doi: 10.3969/j.issn.1674-7445.2022.06.014

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Objective To systematically analyze the research status of human organ donation coordinator at home and abroad in recent years, aiming to provide novel ideas for subsequent research. Methods Studies related to organ donation coordinator searched from CNKI, VIP, Wanfang and Web of Science (SCI/SSCI/CPCI) core collection databases from January 1, 2009 to December 31, 2021 were collected as samples, and CiteSpace software was used for visual analysis from the aspects of the number of articles, authors, countries, publishing organizations and keywords, etc. Results A total of 47 valid Chinese articles and 43 English articles were included. The number of articles was elevated in a fluctuating pattern in recent 12 years. Eleven core authors published articles in Chinese journals, and the top three authors were Ye Qifa, Huang Wei and Si Jing. Five core authors published articles in English journals and the top three authors were Konaka, Fukushima and Kato. Wuhan University Affiliated Hospital and its research center published the largest number of articles in China, followed by Ningbo Urology & Nephrology Hospital and Human Organ Donation Office, Institute of Hepatobiliary Diseases of Central South Hospital of Wuhan University, and Institute of Hepatobiliary Diseases of Central South Hospital. These institutions were distributed in a disperse pattern and have not formed a cooperative group. International institutions with the highest number of articles were University of Warsaw in Poland, Osaka University in Japan, Children's Hospital of Eastern Ontario in Canada, and Polish Transplant Coordinating Ctr Poltransplant. The top three countries regarding the number of English articles were the United States, Japan and China. Keywords cluster analysis found that the research mainly focused on seven thematic groups including the emergence and development, roles and functions, professional capability and professional identity, team building, current work status, professional training and health management of organ donation coordinators. Conclusions The research related to organ donation coordinators at home and abroad shows a good development trend, whereas the research contents remain to be classified and expanded. Subsequently, different research institutions and countries should establish more extensive exchange and cooperation, and constantly drive the research advancement in related fields.

Classification and reconstruction of bile duct in pediatric split liver transplantation

Wei Jinming, Feng Xiao, Zeng Kaining, Yang Qing, Yao Jia, Fu Binsheng, Zhang Tong, Huang Xinru, Liu Boying, Chen Guihua, Yang Yang, Yi Shuhong

2022, 13(6): 791-796. doi: 10.3969/j.issn.1674-7445.2022.06.015

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Objective To investigate the anatomical classification of left intrahepatic bile duct (LHD) and the pattern of bile duct reconstruction during pediatric split liver transplantation and their relationship with postoperative biliary complications. Methods Clinical data of 75 pediatric recipients undergoing split liver transplantation were analyzed retrospectively. Before splitting the donor liver, iopromide injection was used for retrograde cholangiography through the common bile duct. According to the patterns of intrahepatic bile ducts in the second, third and fourth segments, the anatomical classification of LHD of the donor liver was determined. The biliary reconstruction regimens for different classification types of LHD were summarized. The incidence and treatment of biliary complications after pediatric split liver transplantation were analyzed. Results Among 75 donor livers, the anatomical classification of LHD included 57 cases (76%) of type Ⅰ, 9 cases (12%) of type Ⅱ, 4 cases (5%) of type Ⅲ and 5 cases (7%) of type Ⅳ LHD, respectively. Among 75 pediatric recipients, 69 cases (53 cases of type Ⅰ, 8 type Ⅱ, 4 type Ⅲ and 4 type Ⅳ) underwent the left hepatic duct-jejunum Roux-en-Y anastomosis, 1 case received common bile duct-jejunum Roux-en-Y anastomosis (type Ⅳ), and 5 cases underwent the left hepatic duct-common bile duct end-to-end anastomosis (4 cases of type Ⅰ and 1 type Ⅱ). Postoperative biliary complications occurred in 6 cases (8%), including 3 cases of biliary anastomotic stenosis, 2 cases of biliary anastomotic leakage and 1 case of bile leakage on the hepatic resection surface. Among 6 recipients, 4 cases were classified as type Ⅰ and 2 cases of type Ⅲ LHD. No significant difference was observed in the incidence of biliary complications between typical type and anatomical variant type of LHD (all P > 0.05). Among 3 recipients with biliary anastomotic stenosis, 2 cases underwent percutaneous transhepatic cholangial and drainage (PTCD) and 1 case repeatedly received biliary-intestinal anastomosis. Two cases of biliary anastomotic leakage underwent PTCD and 1 case of bile leakage on the hepatic resection surface received local drainage. All 6 children survived after treatment. Conclusions Anatomical variation of LHD can be observed in 24% of donor livers, and type Ⅱ accounts for the highest proportion of 12%. Prior to donor liver splitting, routine cholangiography and fine biliary anastomosis may effectively lower the incidence of biliary complications. The incidence of postoperative biliary complications is not significantly associated with the anatomical classification of LHD.

Analysis of risk factors of prolonged mechanical ventilation after lung transplantation

Wang Dapeng, Li Xiaoshan, Xuan Chenhao, Hu Chunxiao, Zhang Feng, Wang Yifeng, Xu Hongyang

2022, 13(6): 797-802. doi: 10.3969/j.issn.1674-7445.2022.06.016

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Objective To identify the risk factors of prolonged mechanical ventilation (PMV) after lung transplantation. Methods Clinical data of 90 recipients undergoing lung transplantation were retrospectively analyzed. According to the duration of invasive mechanical ventilation after operation, all recipients were divided into the PMV group (ventilation duration > 48 h, n=30) and control group (ventilation duration≤48 h, n=60). Perioperative parameters were compared between two groups, including preoperative parameters [serum creatinine, estimated glomerular filtration rate (eGFR)], intraoperative parameters (cold ischemia time of donor lung, blood loss), and postoperative parameters [the first red blood cell, white blood cell, platelet count, hemoglobin, C-reactive protein, serum creatinine, total bilirubin, alanine aminotransferase (ALT), oxygenation index, eGFR and the mean arterial pressure in intensive care unit (ICU)]. The risk factors of PMV after lung transplantation were assessed by multivariate logistic regression analysis. Results Preoperative serum creatinine level in the PMV group was 62 (53, 67) μmol/L, significantly higher than 57 (47, 62) μmol/L in the control group. Preoperative eGFR in the PMV group was 97 (93, 107) mL/min, significantly lower than 106 (102, 116) mL/min in the control group. The first postoperative oxygenation index in the PMV group was 196 (157, 286) mmHg, significantly lower than 250 (199, 354) mmHg in the control group (all P < 0.05). Multivariate analysis showed that the first increase of postoperative total bilirubin, the first decrease of postoperative oxygenation index and preoperative eGFR decrease were the independent risk factors for PMV following lung transplantation. Conclusions The first increase of postoperative total bilirubin, the first decrease of postoperative oxygenation index and preoperative eGFR decrease are the independent risk factors for PMV after lung transplantation.

Clinical application investigation of quantitative evaluation system of immune status in guiding individualized management of immunosuppressants after liver transplantation

Jia Yanan, Zhu Jiqiao, Li Han, Xu Wenli, Wang Ruolin, Lyu Shaocheng, Kou Jiantao, Li Xianliang, He Qiang

2022, 13(6): 803-809. doi: 10.3969/j.issn.1674-7445.2022.06.017

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Objective To investigate the guiding role of quantitative evaluation system of immune status in the individualized management of immunosuppressants for the recipients after liver transplantation. Methods Clinical data of 239 liver transplant recipients were retrospectively analyzed. MingDao Immune Cell Analysis (MICA) was established. All recipients were divided into two groups according to the adjustment regimens of immunosuppressants. The immunosuppressant regimen was adjusted according to MingDao Immune System Score (MISS) in the MISS group (n=84), and the medication plan was empirically adjusted during the same period in the control group (n=155). According to the time of postoperative detection (t), the recipients in the MISS group were divided into subgroup A (t ≤ 28 d, n=78), subgroup B (28 d < t ≤ 6 months, n=68), subgroup C (6 months < t ≤ 12 months, n=18), subgroup D (12 months < t ≤ 24 months, n=18) and subgroup E (t > 24 months, n=19). In the MISS group, postoperative MISS scores of recipients in subgroups A-E were analyzed. The incidence of acute rejection and opportunistic infection and the overall survival rate were statistically compared between the MISS and control groups. Results The MISS scores in subgroups A-E were -7.0 (-13.2, -2.0), -2.0 (-5.8, 1.8), -0.5 (-7.3, 2.8), -2.0 (-4.5, 3.3) and -3.0 (-6.0, 1.0), respectively. The immune status of the recipients was gradually improved over postoperative time, and the difference between two groups was statistically significant (P < 0.05). In the MISS group, 15% (13/84) of the recipients developed acute rejection, and 27% (42/155) in the control group, and the difference was statistically significant (P < 0.05). In the MISS group, the MISS score of the recipients with acute rejection was 0 (-2.5, 3.5), and -5.0 (-12.0, -1.0) for their counterparts without acute rejection, and the difference was statistically significant (P < 0.05). In the MISS group, 2% (2/84) of the recipients presented with postoperative opportunistic infection, and 9% (14/155) in the control group, and the difference was statistically significant (P < 0.05). In the MISS group, the 1- and 3-year overall survival rates were 86.9% and 79.8%, and 83.2% and 76.8% in the control group, and no significant difference was observed between two groups (P > 0.05). Conclusions MICA and MISS score may reflect the immune status of liver transplant recipients, and guide the individualized management of administration of immunosuppressants after liver transplantation.

Problems and challenges of genetically modified pig to non-human primate kidney xenotransplantation

Jiang Hongtao, Li Tao, He Songzhe, Yu Yifan, Bai Yunhao, Ma Xiaojie, Wang Yi

2022, 13(6): 810-817. doi: 10.3969/j.issn.1674-7445.2022.06.018

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Abstract:
Xenotransplantation is one of the potential approaches to mitigate the shortage of donor kidneys. With the progress of gene modification techniques and the development of immunosuppressant, significant progress has been made in the preclinical research of genetically modified pig to non-human primate (NHP) xenotransplantation. The longest survival time of recipients exceeds 500 d. However, the number of recipients surviving for over 1 year is extremely low, and most recipients die within postoperative 1-2 months. Therefore, several problems remain to be clarified and resolved. In this article, rejection, refractory coagulation dysfunction, persistent inflammation, the selection of immunosuppressant, the selection of clinical recipients and the risk of cross-infection in genetically modified pig to NHP xenotransplantation were reviewed, and current problems and potential solutions of genetically modified pig to NHP xenotransplantation were summarized, aiming to provide reference for promoting xenotransplantation in clinical settings.

Research progress on diagnosis and surgical treatment of biliary atresia

Li Xiaobin, Fu Binsheng

2022, 13(6): 818-824. doi: 10.3969/j.issn.1674-7445.2022.06.019

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Abstract:
Biliary atresia is a rare congenital disease of children with unknown pathogenesis and biliary obstruction, which is mainly manifested with progressive inflammation and fibrous obstruction of the biliary system inside and outside the liver, and subsequently develop into cholestatic cirrhosis and liver failure. Although biliary atresia is rare, it is the most common cause of cholestasis during the infancy period. If surgical treatment were not performed (such as Kasai operation and liver transplantation), children may die in a short period of time. Kasai operation can improve biliary drainage, whereas it fails to change the outcomes of children with biliary atresia. Most of them will still suffer from persistent liver injury due to cholestasis, and eventually require liver transplantation. At present, there is no consensus on whether Kasai operation should be performed prior to liver transplantation. In this article, research progress on the diagnosis and surgical treatment of biliary atresia was reviewed, aiming to provide reference for clinical diagnosis and treatment of biliary atresia and improve the survival of children with biliary atresia.

2022 Vol. 13, No. 6