Good news | The core index of Organ Transplantation reached a new high
2023-01-13Good news | Tian Dong and Wu Jiajia won the excellent reviewer and excellent editor of Guangdong Science and Technology Journal in 2022
2023-01-11Announcement on the key themes of the 3rd issue of
2022-12-20Good news丨The liver transplantation team of the Third Affiliated Hospital of Sun Yat-sen University won the first prize of the 4th Guangdong Medical Science and Technology Award
2023-01-13Organ Transplantation was once again selected as the 2022 China Science and Technology Core Journal and the Science and Technology Journals World Impact Index (WJCI) Report (2022 Edition)
2022-12-30Diagnosis and treatment specification for postoperative complications after liver transplantation in China (2019 edition)
Clinical technical operation specification of pancreatic islet transplantation (2019 edition)
Technical operation specification for ABO-incompatible kidney transplantation from relative living donor (2019 edition)
The spread, prevention and control of novel coronavirus infection and the potential risks and uncertainties of novel coronavirus transmission from donor to recipient have brought serious impacts and great challenges to organ donation and transplantation. There is increasing evidence that the use of non-pulmonary organs (kidney, liver and heart) from novel coronavirus infected donors carries a low risk of transmission, regardless of whether they were symptomatic at the time of acquisition. Delaying organ donation after the death of those who are positive for novel coronavirus antigen or nucleic acid testing, and then waiting until turns negative, will result in the discarding of a significant number of organs that are medically suitable for transplantation. In order to maximally meet the demand for transplantation in patients with end-stage organ failure, Branch of Organ Transplantation of Chinese Medical Association organized relevant experts formulated the "Expert consensus on organ donation from patients infected with novel coronavirus in China" after citizen' s death by taking into account the epidemic situation of novel coronavirus infection in China and the clinical practice of organ donation and transplantation, and by referring to relevant research results and clinical research evidence at home and abroad. It aims to provide recommendations and references for the procurement and application of donor organs from patients infected with novel coronavirus.
The quality of solid organ transplantation has been improved significantly in China in recent years. However, surgical site infection (SSI) is still a main factor affecting the survival of solid organ transplantation recipients. With the joint efforts of experts in fields of organ transplantation, infectious diseases, critical care medicine, laboratory medicine and clinical pharmacy, this expert consensus systematically summarizes the experiences of SSI management in solid organ transplantation in China, focusing on basic management principles, epidemiology, risk factors, special pathogen infection and diagnostic techniques of SSI. It aims to standardize the prevention measures of SSI in transplantation centers to reduce the incidence and mortality of SSI in solid organ transplantation recipients.
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease and one of the most common causes for end-stage renal disease (ESRD). Kidney transplantation is the optimal renal replacement therapy for ADPKD patients complicated with ESRD. Currently, scholars at home and abroad have a certain controversy about whether polycystic kidney resection is necessary in ADPKD patients before kidney transplantation, and the criteria and methods for polycystic nephrectomy also differ. To further standardize the clinical technical operation of kidney transplantation in ADPKD patients, experts in organ transplantation organized by Branch of Organ Transplantation of Chinese Medical Association formulated this specification from the aspects of diagnosis of ADPKD, indications and contraindications of kidney transplantation for ADPKD, preoperative evaluation and treatment, polycystic nephrectomy, and postoperative management, etc.
Heart transplantation is the primary therapeutic option for patients with end-stage heart failure. The shortage of donors has been the main limiting factor for the increasing quantity of heart transplantation. With persistent updating and introduction of novel technologies, the donor pool has been increasingly expanded, such as using the heart from older donors, donors infected with hepatitis C virus, donors dying from drug overdose or donation after cardiac death (DCD) donors, etc. Meantime, the proportion of recipients with advanced age, multiple organ dysfunction, mechanical circulatory support and human leukocyte antigen antibody sensitization has been significantly increased in recent years. The shortage of donors, complication of recipients' conditions, individualized management of immunosuppressive therapy and prevention and treatment of long-term cardiac allograft vasculopathy are all challenges in the field of heart transplantation. In this article, novel progresses on donor pool expansion, improving the quality of recipients, strengthening the diagnosis and treatment of rejection, and preventing cardiac allograft vasculopathy were reviewed, aiming to prolong the survival and enhance the quality of life of patients with end-stage heart failure on the waiting list or underwent heart transplantation.
At present, the heart of donor from donation after brain death are the primary organ sources for heart transplantation. After brain death, severe hemodynamic changes and a series of organ functional changes will occur, thereby leading to the functional damage or even loss of tissues and organs, especially the heart. Intimate relationship and interaction have been found in the physiology and pathophysiology between nervous and cardiovascular systems. After stroke, autonomic nervous disorder, neuroendocrine disorder and intense and persistent inflammatory reaction could be caused by the brain-heart axis reaction, leading to stroke-induced cardiac injuries, such as sympathetic storm, catecholamine storm, inflammatory storm, etc. In this article, research progresses on the mechanism of myocardial injury in heart from donors with stroke and the effect on clinical efficacy and prognosis after heart transplantation were reviewed, aiming to provide reference for clinical practice and subsequent research.
Extracorporeal membrane oxygenation (ECMO) could pump the blood from human veins to the outside of the body, oxygenate the red blood cells in an artificial environment and then return them back into the body. ECMO could replace the heart and lungs to complete gas exchange and systemic blood perfusion in patients with severe cardiopulmonary insufficiency, which also plays an important role in the field of heart transplantation. Besides circulatory support treatment after heart transplantation, ECMO may also be used to prolong the waiting time for heart transplantation in patients with respiratory and circulatory failure before operation, as a bridging therapy for heart transplantation. However, at present, the application of ECMO in pediatric heart transplantation still exist challenges, such as high perioperative mortality and difficulty in determining the timing of treatment, etc. In this article, the development history of ECMO application in pediatric heart transplantation, use of ECMO before and after pediatric heart transplantation, ECMO-related complications in children, and application of ventricular assist device (VAD) in pediatric heart transplantation were briefly reviewed, aiming to provide reference for promoting the application of ECMO in pediatric heart transplantation.
Pediatric heart transplantation is the standard treatment for children complicated with refractory heart failure which is difficult to be treated by conventional surgery or drugs. At present, an increasing quantity of pediatric heart transplantation is being performed worldwide, whereas relevant experience is still lacking in China. In recent 10 years, significant progress has been achieved in pediatric heart transplantation. On one hand, the number of pediatric heart transplantation has been increased year by year. On the other hand, ABO-incompatible heart transplantation, application of ventricular assist device in children, and recipient-donor weight mismatch transplantation have been widely employed to resolve the shortage of donor heart in pediatric heart transplantation. However, relevant experience of pediatric heart transplantation is lacking in China, especially in understanding the indications of pediatric heart transplantation and the application of specific strategies for pediatric heart transplantation, etc. In this article, the development history, advances in therapeutic strategy and clinical prognosis of pediatric heart transplantation were reviewed.
At present, heart transplantation is the most effective treatment for end-stage heart failure. Nevertheless, the shortage of donors is becoming an increasingly severe challenge. In recent years, rapid development of mechanical circulatory support technologies has provided multiple therapeutic options for patients with end-stage heart failure. As an important mechanical circulatory support device, ventricular assist device (VAD) are divided into durable VAD (dVAD) and temporary VAD (tVAD) according to the duration of assistance. dVAD shows application potential in bridging heart transplantation, destination therapy and bridge to decision. With technological progress and experience accumulation in clinical application, VAD is evolving towards the direction of more biocompatible, lighter, more bionic and intelligent. In this article, the development of VAD, application status at home and abroad and the overall application of VAD in our hospital were reviewed, aiming to provide reference for promoting the clinical application of VAD in China.
Thrombotic microangiopathy (TMA) is a severe complication after kidney transplantation, mainly characterized by thrombocytopenia, microvascular hemolytic anemia and acute kidney injury, which may lead to kidney allograft failure or even death of the recipients. With the increasing quantity of solid organ transplantation in China and deeper understanding of TMA, relevant in-depth studies have been gradually carried out. Kidney transplantation-associated TMA is characterized with different causes and clinical manifestations. Non-invasive specific detection approach is still lacking. The diagnosis of TMA mainly depends on renal biopsy. However, most TMA patients are complicated with significant thrombocytopenia. Hence, renal puncture is a risky procedure. It is difficult to make a definite diagnosis. For kidney transplantation-associated TMA, plasma exchange, intravenous immunoglobulin and withdrawal of potential risk drugs are commonly employed. Nevertheless, the overall prognosis is poor. In this article, the classification of TMA after kidney transplantation, diagnosis and treatment of kidney transplantation-associated TMA were reviewed, aiming to provide reference for clinical diagnosis and treatment of kidney transplantation-associated TMA.
Due to long-term use of immunosuppressant, poor immune function and a higher risk of critical diseases after novel coronavirus pneumonia in kidney transplant recipients, it is of significance to deliver prophylactic vaccination for this high-risk population. Studies have shown that the immune reaction of kidney transplant recipients to novel coronavirus vaccine is significantly lower than that of healthy counterparts. Standard vaccination program in the United States, such as 2 doses of messenger RNA (mRNA) vaccine, fails to provide sufficient protection for kidney transplant recipients. Many studies have proven that increasing the frequency of vaccination for kidney transplant recipients may enhance the vaccine efficacy. Nevertheless, the role of adjusting immunosuppressive therapy in increasing vaccine efficacy remains to be elucidated. In this article, the importance, effectiveness and particularity of novel coronavirus vaccine for kidney transplant recipients and the effect of immunosuppressive therapy on the efficacy of novel coronavirus vaccine were reviewed, aiming to provide reference on the vaccination for kidney transplant recipients.
With persistent advancement of surgical instruments, methods and techniques, clinical efficacy of liver transplantation has been steadily enhanced. However, the length of anhepatic phase is still an important factor affecting the efficacy of liver transplantation. Rat is one of the major animal models for liver transplantation-related basic research. In this article, multiple approaches for prolonging the anhepatic phase and shortening the operation time during anhepatic phase in rat liver transplantation were reviewed, which consisted of sevoflurane inhalation anesthesia, intravenous infusion via jugular vein indwelling needle, clamping of the abdominal aorta before anhepatic phase, injection of normal saline into portal vein before anhepatic phase, subcutaneous transposition of the spleen, electrocoagulation of hepatic esophageal artery, magnetic ring anastomosis of the superior and inferior hepatic vena cava, cannula anastomosis of the superior and inferior hepatic vena cava, stent anastomosis of the superior and inferior hepatic vena cava, rapid connection device and cannula of portal vein, and ring-shaped cannula of hepatic tissue-preserving inferior hepatic vena cava, aiming to add evidence for prolonging the duration of anhepatic phase, improving the operation efficiency during anhepatic phase and elevating the success rate of rat liver transplantation.
Kidney is a highly vascularized organ and peritubular capillary network constitutes the critical component of its microvascular system. Peritubular capillaries, as the main vessels for blood supply in renal tubules and renal interstitium, involve in important physiological processes in renal tubules such as energy metabolism, substance secretion and reabsorption. In recent years, it has been demonstrated that ischemia-reperfusion injury, rejection and renal fibrosis during kidney transplantation would result in compromised structural integrity and decreased number in peritubular capillaries, thus leading to interstitial fibrosis in renal allograft, which would seriously affect the long-term stability of renal function in the renal allograft. Therefore, we reviewed the structure and function of peritubular capillary, peritubular capillary and ischemia-reperfusion injury, rejection and renal allograft fibrosis, focusing on the mechanism for peritubular capillary injury in kidney transplantation and the specific changes manifested, with the aim of providing a reference for preventing and treating perioperative complications in kidney transplantation and improving the long-term prognosis of grafts.
Hepatic venous pressure gradient (HVPG) is the "gold standard" for the diagnosis of portal hypertension, which could be applied in the evaluation of liver cirrhosis. Combined use of HVPG with model for end-stage liver disease (MELD) scoring system may more accurately match the donors and recipients undergoing liver transplantation for liver cirrhosis, select the appropriate timing of surgery, and provide guidance for bridging treatment for patients on the waiting list for liver transplantation. Besides, HVPG may also predict clinical prognosis of liver transplant recipients, and provide evidence for early detection and intervention of potential complications. Therefore, the value of HVPG in preoperative evaluation and prognosis prediction of liver transplant recipients was reviewed, aiming to provide guidance for clinical diagnosis and treatment of liver transplant recipients before and after surgery.
为提高临床医师对肾移植受者免疫抑制治疗的认识, 规范国内肾移植受者管理, 帮助医师在肾移植临床实践中做出合理决策, 我们组织专家制订了《中国肾移植受者免疫抑制治疗指南(2016版)》。该指南以《2009版改善全球肾病预后组织(KDIGO)肾移植受者管理指南》为主要参考, 结合我国的临床实践经验, 希望能为相关临床科室提供工作指引。
我国的器官移植事业正处于由数量规模型发展向高质量和高科技含量提升、由移植大国向移植强国冲刺的历史关键时期。在2018年中华医学会器官移植学年会上,主任委员石炳毅教授从中国器官捐献与移植体系建设、中国器官移植发展现状两大方面,作了“继往开来,中国器官移植的发展现状”的报告。新的历史时期赋予我们新的历史使命,器官移植学分会要主动作为,推动科学发展,为贯彻新理念、拓宽新视野、实现新愿景而努力奋斗。
为了进一步规范器官移植免疫抑制剂的临床应用,中华医学会器官移植学分会组织全国31家移植中心的器官移植专家,从器官移植免疫诱导药物应用技术规范、器官移植维持期免疫抑制剂应用技术规范、器官移植常用免疫抑制方案技术规范、器官移植免疫抑制剂血药浓度监测技术规范、器官移植药物性肝肾损伤治疗技术规范等方面,制订本规范,以帮助器官移植工作者规范和优化器官移植免疫抑制剂的临床应用。
活体供肾移植经历半个多世纪的发展,已成为终末期肾病患者的重要治疗手段。在我国,亲属活体器官捐献肾移植作为家庭自救的方式之一,近年来已成为肾脏供体来源的重要补充部分。本指南以世界卫生组织《人体器官移植指导原则》(1991)、中华人民共和国国务院《人体器官移植条例》(2007)以及国家卫生部《关于规范活体器官移植的若干规定》(2010)为法律依据,在《中国活体供肾移植指南》(2009)的基础上进行更新。内容包括活体供肾移植的伦理学、供者与受者的医学评估、活体供肾摘取原则与手术方式、供者近期与远期并发症以及供者的长期随访等。
为了进一步规范中国公民逝世后器官捐献的流程,中华医学会器官移植学分会组织器官移植和器官捐献相关专家,从报名登记、捐献评估、捐献确认、器官获取、器官分配、遗体处理、人道救助、捐献文书归档等8个环节,制定中国公民逝世后器官捐献流程和规范(2019版)。
为了进一步规范中国实体器官移植(SOT)受者巨细胞病毒(CMV)感染的诊断和治疗,中华医学会器官移植学分会组织器官移植专家、感染病学专家及呼吸内科专家,在《实体器官移植受者巨细胞病毒感染诊疗指南(2017版)》的基础上,从CMV感染的主要危险因素、实验室诊断、临床类型、预防方案,CMV病的治疗,儿童SOT术后CMV感染或CMV病的防治,CMV肺炎合并伊氏肺孢子菌肺炎的防治等方面,制订本规范,以期为我国SOT术后CMV感染的规范化防治提供指导意见。
为了进一步规范肾移植排斥反应的临床诊断与治疗, 中华医学会器官移植学分会组织器官移植学专家, 总结各移植中心的肾移植临床经验, 在《中国肾脏移植排斥反应临床诊疗指南(2016版)》的基础上, 并依据Banff标准, 从超急性排斥反应、急性加速性排斥反应、急性排斥反应、慢性排斥反应等方面, 制订本规范。
为了更好地将加速康复外科(ERAS)的理念用于优化重型肝炎肝移植围手术期管理,达到减少并发症、促进患者快速康复的目的,中国医师协会器官移植分会移植免疫学组、中华医学会外科学分会手术学组、广东省医师协会器官移植医师分会组织专家制订了《加速康复外科优化重型肝炎肝移植围手术期管理临床实践的专家共识》。该共识从ERAS优化重型肝炎肝移植术前、术中、术后治疗策略3个方面,总结各移植中心的临床经验,提出相应的专家共识,希望为临床优化重型肝炎肝移植围手术期管理提供参考方案。
排斥反应是影响移植肾长期存活的首要独立危险因素,是亟待解决的瓶颈问题。中华医学会器官移植学分会和中国医师协会器官移植医师分会组织国内专家,总结各中心肾移植的临床经验,依据Banff 2013标准,编写了本部指南,希望能为相关临床科室提供工作指引。
肝移植是目前公认的治疗终末期肝病的最有效措施。经过超过50年的发展,肝移植患者术后存活时间不断延长,并发症的发生率亦有所降低。但是,如何改善供肝短缺的现状、减轻供肝缺血-再灌注损伤,减少并发症的发生率以及进一步提高肝移植患者的远期疗效仍然是困扰肝移植科医师的难题。因此,了解最新的外科技术、多中心临床经验以及相关基础研究结果,将帮助我们更深入地认识疾病本质,为患者制定更妥善的治疗方案。本文综合国际核心期刊报道的内容,对2017年度肝移植相关领域的研究热点及最新进展作一综述,并对今后的研究方向作出展望。
Competent Authorities: Ministry of Education of the People's Republic of China
Sponsored by: Sun Yat-sen University
Presented by: The Third Affiliated Hospital of Sun Yat-sen University
Editor-in-Chief: Gui-Hua Chen
Publisher: Editorial Office of Organ Transplantation
Address: The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou
Postcode: 510630
Tel: 020-38736410
Email: organtranspl@163.com
Postal Code: 46-35
Website: http://www.organtranspl.com
Journal: bimonthly
Price: 20 yuan for each period and 120 yuan for the whole year
CN 44-1665/R
ISSN 1674-7445
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Development status and new challenges of heart transplantation
Clinical research progress and mechanism on myocardial injury in hearts from donors with stroke
Application of robot assisted surgical system in kidney transplantation
Current status analysis and development strategy of united Organ Procurement Organization