Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.11.009
L. Ding
Objective To explore the causes, diagnosis and treatment of pulmonary mucor infection after kidney transplantation from citizens' death organ donation. Methods A retrospective analysis was performed for the causes, diagnosis and treatment of 4 cases of typical pulmonary mucor infection since the implementation of organ donation and kidney transplantation after death at our hospital from January 2015 to June 2019. Results Among 4 patients with severe clinical symptoms, 3 survived after timely symptomatic treatments and 1 patient died due to mucor invasion of pulmonary blood vessels and hemothorax. Conclusions Pulmonary mucor infection is often rapid, aggressive and even fatal after kidney transplantation from citizens' death organ donation. For saving the life of transplant recipients, it is vital to save to withdraw or lower the dose of immunosuppressive agents timely and use antibacterial agents against mucor alone or jointly according to clinical condition. Key words: Kidney transplantation; Pulmonary infection; Mucor; Diagnosis; Treatment
{"title":"Clinical analysis of pulmonary mucor infection after kidney transplantation from citizens' death organ donation","authors":"L. Ding","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.11.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.11.009","url":null,"abstract":"Objective \u0000To explore the causes, diagnosis and treatment of pulmonary mucor infection after kidney transplantation from citizens' death organ donation. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was performed for the causes, diagnosis and treatment of 4 cases of typical pulmonary mucor infection since the implementation of organ donation and kidney transplantation after death at our hospital from January 2015 to June 2019. \u0000 \u0000 \u0000Results \u0000Among 4 patients with severe clinical symptoms, 3 survived after timely symptomatic treatments and 1 patient died due to mucor invasion of pulmonary blood vessels and hemothorax. \u0000 \u0000 \u0000Conclusions \u0000Pulmonary mucor infection is often rapid, aggressive and even fatal after kidney transplantation from citizens' death organ donation. For saving the life of transplant recipients, it is vital to save to withdraw or lower the dose of immunosuppressive agents timely and use antibacterial agents against mucor alone or jointly according to clinical condition. \u0000 \u0000 \u0000Key words: \u0000Kidney transplantation; Pulmonary infection; Mucor; Diagnosis; Treatment","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83416632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.11.003
Yingjie He, Wen Peihao, Zhang Jiakai, W. Zhihui, Shi Xiaoyi, Yu‐Ting He, Jie Li, Wenzhi Guo
Objective To explore the risk factors, diagnosis and treatment of early portal vein complications after liver transplantation. Methods From January 2016 to December 2018, clinical data of 616 adult patients undergoing liver transplantation were retrospectively analyzed. Nine cases (1.5%) had early portal vein complications. By comparing the general status of recipients and donors and the intraoperative findings, the risk factors of early portal vein complications were analyzed. Results No statistically significant differences existed in recipient age, gender, donor/recipient blood type, donor liver cold ischemia time, transplant operative duration, intraoperative non-hepatic period, intraoperative blood loss or intraoperative red blood cell transfusion (P>0.05). However, preoperative recipients had portal vein thrombosis, splenectomy, retransplantation and portal vein anastomosis. Statistical differences existed and all were risk factors for early portal vein complications (P<0.05). Binary logistic regression showed that preoperative patients had portal vein thrombosis [OR=16.922, 95% CI(1.859-154.059), P=0.012] and retransplantation [OR=64.871, 95% CI(8.293-507.435), P<0.001] was an independent risk factor for early portal vein complications. Nine cases of early portal vein complications were confirmed by ultrasound and/or computed tomography (CT) angiography. Three patients with portal vein thrombosis type 1 received oral medication while another three with portal vein thrombosis type 2 underwent abdominal portal vein incision, thrombectomy and large omental portal vein pump implantation. During a follow-up period of (22±14.8) months, portal vein blood flow remained patent. One patient with portal vein stenosis underwent portal vein balloon dilation and stent implantation. During a follow-up period of 17 months, portal vein blood flow remained patent. Two patients with abnormal portal vein blood flow underwent liver re-transplantation and died postoperatively. Conclusions Preoperative portal vein thrombosis and splenectomy, re-transplantation of liver and end-to-end anastomosis of non-donor recipient portal vein are risk factors for early portal vein complications after liver transplantation. Individualized treatments of portal vein thrombosis may be provided according to the type of thrombus and liver function. And the prognosis is decent. Because of a higher mortality rate, attention should be paid to patients with abnormal portal vein blood flow immediately after re-transplantation. Key words: Liver transplantation; Portal complications; Risk factors; Diagnosis; Treatment; Prognosis
{"title":"Risk factor analysis and diagnosis and treatment of early portal vein complications after liver transplantation","authors":"Yingjie He, Wen Peihao, Zhang Jiakai, W. Zhihui, Shi Xiaoyi, Yu‐Ting He, Jie Li, Wenzhi Guo","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.11.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.11.003","url":null,"abstract":"Objective \u0000To explore the risk factors, diagnosis and treatment of early portal vein complications after liver transplantation. \u0000 \u0000 \u0000Methods \u0000From January 2016 to December 2018, clinical data of 616 adult patients undergoing liver transplantation were retrospectively analyzed. Nine cases (1.5%) had early portal vein complications. By comparing the general status of recipients and donors and the intraoperative findings, the risk factors of early portal vein complications were analyzed. \u0000 \u0000 \u0000Results \u0000No statistically significant differences existed in recipient age, gender, donor/recipient blood type, donor liver cold ischemia time, transplant operative duration, intraoperative non-hepatic period, intraoperative blood loss or intraoperative red blood cell transfusion (P>0.05). However, preoperative recipients had portal vein thrombosis, splenectomy, retransplantation and portal vein anastomosis. Statistical differences existed and all were risk factors for early portal vein complications (P<0.05). Binary logistic regression showed that preoperative patients had portal vein thrombosis [OR=16.922, 95% CI(1.859-154.059), P=0.012] and retransplantation [OR=64.871, 95% CI(8.293-507.435), P<0.001] was an independent risk factor for early portal vein complications. Nine cases of early portal vein complications were confirmed by ultrasound and/or computed tomography (CT) angiography. Three patients with portal vein thrombosis type 1 received oral medication while another three with portal vein thrombosis type 2 underwent abdominal portal vein incision, thrombectomy and large omental portal vein pump implantation. During a follow-up period of (22±14.8) months, portal vein blood flow remained patent. One patient with portal vein stenosis underwent portal vein balloon dilation and stent implantation. During a follow-up period of 17 months, portal vein blood flow remained patent. Two patients with abnormal portal vein blood flow underwent liver re-transplantation and died postoperatively. \u0000 \u0000 \u0000Conclusions \u0000Preoperative portal vein thrombosis and splenectomy, re-transplantation of liver and end-to-end anastomosis of non-donor recipient portal vein are risk factors for early portal vein complications after liver transplantation. Individualized treatments of portal vein thrombosis may be provided according to the type of thrombus and liver function. And the prognosis is decent. Because of a higher mortality rate, attention should be paid to patients with abnormal portal vein blood flow immediately after re-transplantation. \u0000 \u0000 \u0000Key words: \u0000Liver transplantation; Portal complications; Risk factors; Diagnosis; Treatment; Prognosis","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89349535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.11.010
Suxiang Liu, P. Xiao, Shaoyan Hu, H. He, Jie Li, Jun Lu, Yi Wang, Ye Lu
Objective To explore the incidence, clinical characteristics and prognosis of nervous system(NS) complications after hematopoietic stem cell transplantation (HSCT) in children and further evaluate the occurring risk factors of NS complications and category characteristics. Methods From October 2010 to June 2018, retrospective analysis was performed for 330 HSCT children. Results Twenty-six children developed NS complications after HSCT. Risk factor analysis revealed that the incidence of NS complications were 33.3% in Fanconi anemia, 19.2% in myelodysplastic/myeloproliferative neoplasm (MDS/MPN), 7.3% in acute leukemia, 7.0% in aplastic anemia, 3.1% in genetic immunodeficiency disease, none in other disease (P=0.027). The median age of children with NS complications was 9(4.75-12) versus 6(3-10) (P=0.02) those without NS complications. The incidence of NS complications with and without GVHD>2 degree were 24%(6/25) and 6.6%(20/305)(P=0.002). Different types of NS complications were analyzed, including 53.9% immune-mediated encephalopathy, 26.9% cerebrovascular lesion, one case of transplantation associated thrombotic microangiopathy (TA-TMA), 7.7% drug therapy-related toxic encephacopathy, 3.8% metabolic encephalopathy and 7.7% peripheral neuropathy. The mortality of NS complications was 34.6% and those with immune-mediated encephalopathy had the highest mortality (13/19, 68.4%). However, those with drug therapy-related toxic encephacopathy, metabolic encephalopathy and peripheral neuropathy all survived after HSCT. The overall survival rate was higher in children without NS complications than those with NS complications. Conclusions The incidence of NS complications after HSCT is correlated with primary diseases, age and GVHD >2 degree. Children with drug therapy-related toxic encephacopathy, metabolic encephalopathy and peripheral neuropathy have better prognosis than those with immune-mediated encephalopathy and TA-TMA. Reducing NS complications may improve long-term survival of children after HSCT. Key words: Children; Hematopoietic stem cell transplantation; Nervous system complications; Risk factors; Long term survival
{"title":"Clinical analysis of nervous system complications after hematopoietic stem cell transplantation in children","authors":"Suxiang Liu, P. Xiao, Shaoyan Hu, H. He, Jie Li, Jun Lu, Yi Wang, Ye Lu","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.11.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.11.010","url":null,"abstract":"Objective \u0000To explore the incidence, clinical characteristics and prognosis of nervous system(NS) complications after hematopoietic stem cell transplantation (HSCT) in children and further evaluate the occurring risk factors of NS complications and category characteristics. \u0000 \u0000 \u0000Methods \u0000From October 2010 to June 2018, retrospective analysis was performed for 330 HSCT children. \u0000 \u0000 \u0000Results \u0000Twenty-six children developed NS complications after HSCT. Risk factor analysis revealed that the incidence of NS complications were 33.3% in Fanconi anemia, 19.2% in myelodysplastic/myeloproliferative neoplasm (MDS/MPN), 7.3% in acute leukemia, 7.0% in aplastic anemia, 3.1% in genetic immunodeficiency disease, none in other disease (P=0.027). The median age of children with NS complications was 9(4.75-12) versus 6(3-10) (P=0.02) those without NS complications. The incidence of NS complications with and without GVHD>2 degree were 24%(6/25) and 6.6%(20/305)(P=0.002). Different types of NS complications were analyzed, including 53.9% immune-mediated encephalopathy, 26.9% cerebrovascular lesion, one case of transplantation associated thrombotic microangiopathy (TA-TMA), 7.7% drug therapy-related toxic encephacopathy, 3.8% metabolic encephalopathy and 7.7% peripheral neuropathy. The mortality of NS complications was 34.6% and those with immune-mediated encephalopathy had the highest mortality (13/19, 68.4%). However, those with drug therapy-related toxic encephacopathy, metabolic encephalopathy and peripheral neuropathy all survived after HSCT. The overall survival rate was higher in children without NS complications than those with NS complications. \u0000 \u0000 \u0000Conclusions \u0000The incidence of NS complications after HSCT is correlated with primary diseases, age and GVHD >2 degree. Children with drug therapy-related toxic encephacopathy, metabolic encephalopathy and peripheral neuropathy have better prognosis than those with immune-mediated encephalopathy and TA-TMA. Reducing NS complications may improve long-term survival of children after HSCT. \u0000 \u0000 \u0000Key words: \u0000Children; Hematopoietic stem cell transplantation; Nervous system complications; Risk factors; Long term survival","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89156190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.11.007
Xingqiang Wang, Yi-he Liu, Li-xin Yu, Yan Sun
Objective To explore the clinical efficacy and risk factors of mortality for liver transplantation in patients with acute liver failure. Methods From January 2012 to December 2017, retrospective analysis was performed for 31 patients with acute liver failure undergoing orthotopic liver transplantation. Clinical data and follow-up data were recorded. Univariate survival analysis was performed by Kaplan-Meier and Log-rank tests while multivariate survival analysis conducted by proportional hazards model. Results Age ≥55 years, preoperative hepatorenal syndrome, perioperative infection and preoperative non-molecular adsorbent recirculating system (MARS) support were influencing factors of postoperative survival rate by univariate survival analysis (P<0.05). Preoperative infection was an independent risk factor for survival after liver transplantation by multivariate COX regression analysis (P<0.01). Conclusions Liver transplantation is an effective treatment for acute liver failure. And preoperative infection is an independent risk factor for survival after liver transplantation. Key words: Liver failure; Acute; Liver transplantation; Survival analysis
{"title":"Survival analysis of patients with acute liver failure after liver transplantation","authors":"Xingqiang Wang, Yi-he Liu, Li-xin Yu, Yan Sun","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.11.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.11.007","url":null,"abstract":"Objective \u0000To explore the clinical efficacy and risk factors of mortality for liver transplantation in patients with acute liver failure. \u0000 \u0000 \u0000Methods \u0000From January 2012 to December 2017, retrospective analysis was performed for 31 patients with acute liver failure undergoing orthotopic liver transplantation. Clinical data and follow-up data were recorded. Univariate survival analysis was performed by Kaplan-Meier and Log-rank tests while multivariate survival analysis conducted by proportional hazards model. \u0000 \u0000 \u0000Results \u0000Age ≥55 years, preoperative hepatorenal syndrome, perioperative infection and preoperative non-molecular adsorbent recirculating system (MARS) support were influencing factors of postoperative survival rate by univariate survival analysis (P<0.05). Preoperative infection was an independent risk factor for survival after liver transplantation by multivariate COX regression analysis (P<0.01). \u0000 \u0000 \u0000Conclusions \u0000Liver transplantation is an effective treatment for acute liver failure. And preoperative infection is an independent risk factor for survival after liver transplantation. \u0000 \u0000 \u0000Key words: \u0000Liver failure; Acute; Liver transplantation; Survival analysis","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73278627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.11.011
Hengchang Ren, Wenli Yu, R. Xu, M. Sheng
Objective To examine the protective effect of preoperatively oral hydrogen-rich water on attenuating renal ischemia-reperfusion (I/R) injury of kidney transplantation in rats and explore the related mechanism. Methods Orthotopic kidney transplantation was performed in Sprague-Dawley rats (n=6). Pretreatment of hydrogen-rich and conventional water started at 1 week pre-transplantation. Conventional water was provided for both donors and recipients in control (C) group, hydrogen-rich water for recipients and conventional water for donors in hydrogen-water-treated recipient (HWR) group, hydrogen-rich water for donors and common water for recipients in hydrogen-water-treated donor (HWD) group, hydrogen-rich water for both donors and recipients in hydrogen-water-treated donor and recipient (HWDR) group. Renal function, oxidative stress, inflammatory and apoptotic parameters were monitored at 24h post-reperfusion. The phosphorylation of p38 in kidney graft was assayed by Western blot. Results As compared with C group, renal function of recipients became ameliorated in HWR/HWD/HWDR group. Meanwhile, oxidative stress and inflammatory response were mitigated and lessened pathological injury and apoptosis of renal tubular epithelial cells coincided with suppressing apoptosis-related protein's generation and phosphorylation of p38 (P<0.05). Compared with HWR group, the above differences were more significant in HWD and HWDR groups (P<0.05). Conclusions Preoperative intake of hydrogen water attenuates renal I/R injury after kidney transplantation. And suppressing the activation of p38 MAPK may be a potential mechanism. Key words: Hydrogen; Rat; Kidney transplantation; Ischemia-reperfusion injury; Oxidative stress; Apoptosis; p38 MAPK
{"title":"Pretreatment of oral hydrogen-rich water attenuates renal ischemia-reperfusion injury of kidney transplantation in rats","authors":"Hengchang Ren, Wenli Yu, R. Xu, M. Sheng","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.11.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.11.011","url":null,"abstract":"Objective To examine the protective effect of preoperatively oral hydrogen-rich water on attenuating renal ischemia-reperfusion (I/R) injury of kidney transplantation in rats and explore the related mechanism. Methods Orthotopic kidney transplantation was performed in Sprague-Dawley rats (n=6). Pretreatment of hydrogen-rich and conventional water started at 1 week pre-transplantation. Conventional water was provided for both donors and recipients in control (C) group, hydrogen-rich water for recipients and conventional water for donors in hydrogen-water-treated recipient (HWR) group, hydrogen-rich water for donors and common water for recipients in hydrogen-water-treated donor (HWD) group, hydrogen-rich water for both donors and recipients in hydrogen-water-treated donor and recipient (HWDR) group. Renal function, oxidative stress, inflammatory and apoptotic parameters were monitored at 24h post-reperfusion. The phosphorylation of p38 in kidney graft was assayed by Western blot. Results As compared with C group, renal function of recipients became ameliorated in HWR/HWD/HWDR group. Meanwhile, oxidative stress and inflammatory response were mitigated and lessened pathological injury and apoptosis of renal tubular epithelial cells coincided with suppressing apoptosis-related protein's generation and phosphorylation of p38 (P<0.05). Compared with HWR group, the above differences were more significant in HWD and HWDR groups (P<0.05). Conclusions Preoperative intake of hydrogen water attenuates renal I/R injury after kidney transplantation. And suppressing the activation of p38 MAPK may be a potential mechanism. Key words: Hydrogen; Rat; Kidney transplantation; Ischemia-reperfusion injury; Oxidative stress; Apoptosis; p38 MAPK","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83963813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.11.004
Fubo Zhang, Wei Gao, N. Ma, C. Dong, Chao Sun, Xing-chu Meng, Wei Zhang, Kai Wang, H. Qin, C. Han, Bin Wu, Yang Yang, Zhuolun Song, Weiping Zheng
Objective Hepatic artery thrombosis(HAT) is one of serious complications after liver transplantation. This study was intended to explore the effect of HAT on survival rate of patients/grafts and biliary complications early after liver transplantation with controlled donation after circulatory death (CDCD) donors in children. Methods The clinical data of 236 children with CDCD donor liver transplantation (donor age <14 years) were retrospectively analyzed. Among them, 37 patients developed HAT early postoperatively. The survival rate of patients/grafts and the occurrence of biliary complications were compared between two groups. Results The median follow-up period was 23 months. For HAT (n=37) and non-HAT (n=199) group, the median follow-up period was 27 and 22 months respectively. The 1-year and 3-year survival rates of grafts were 88.2%, 88.2% and 93.2%, 92.4% respectively. And no inter-group statistical difference existed (P=0.373). The 1-year and 3-year graft survival rates were 73.9%, 73.9% and 91.8%, 90.5% respectively. And inter-group statistical difference existed (P<0.01). The incidence of biliary leakage and biliary stricture were 13.5% and 2% and 29.7% and 5.5% respectively. Inter-group statistical differences existed. In HAT group, there were liver failure (n=7, 18.9%) and death (n=3, 8.1%) after transplantation. Conclusions HAT is one of the serious complications after liver transplantation. An early onset of HAT increases the incidence of biliary complications and graft loss in children after CDCD donor liver transplantation. For patients with graft failure, liver re-transplantation may be performed at the right time. Key words: Children; Donor; Liver transplantation; Hepatic artery thrombosis; Biliary complication; Survival rate
{"title":"Effect of hepatic artery thrombosis on the prognosis of controlled donation after circulatory death donor liver transplantation during early postoperative period in children","authors":"Fubo Zhang, Wei Gao, N. Ma, C. Dong, Chao Sun, Xing-chu Meng, Wei Zhang, Kai Wang, H. Qin, C. Han, Bin Wu, Yang Yang, Zhuolun Song, Weiping Zheng","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.11.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.11.004","url":null,"abstract":"Objective \u0000Hepatic artery thrombosis(HAT) is one of serious complications after liver transplantation. This study was intended to explore the effect of HAT on survival rate of patients/grafts and biliary complications early after liver transplantation with controlled donation after circulatory death (CDCD) donors in children. \u0000 \u0000 \u0000Methods \u0000The clinical data of 236 children with CDCD donor liver transplantation (donor age <14 years) were retrospectively analyzed. Among them, 37 patients developed HAT early postoperatively. The survival rate of patients/grafts and the occurrence of biliary complications were compared between two groups. \u0000 \u0000 \u0000Results \u0000The median follow-up period was 23 months. For HAT (n=37) and non-HAT (n=199) group, the median follow-up period was 27 and 22 months respectively. The 1-year and 3-year survival rates of grafts were 88.2%, 88.2% and 93.2%, 92.4% respectively. And no inter-group statistical difference existed (P=0.373). The 1-year and 3-year graft survival rates were 73.9%, 73.9% and 91.8%, 90.5% respectively. And inter-group statistical difference existed (P<0.01). The incidence of biliary leakage and biliary stricture were 13.5% and 2% and 29.7% and 5.5% respectively. Inter-group statistical differences existed. In HAT group, there were liver failure (n=7, 18.9%) and death (n=3, 8.1%) after transplantation. \u0000 \u0000 \u0000Conclusions \u0000HAT is one of the serious complications after liver transplantation. An early onset of HAT increases the incidence of biliary complications and graft loss in children after CDCD donor liver transplantation. For patients with graft failure, liver re-transplantation may be performed at the right time. \u0000 \u0000 \u0000Key words: \u0000Children; Donor; Liver transplantation; Hepatic artery thrombosis; Biliary complication; Survival rate","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73449016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To explore the expression and significance of v-domain Ig suppressor of T cell activation (VISTA) in the clinical samples of hepatocellular carcinoma (HCC). Methods Sixty-nine cases of HCC were recruited as research subjects. Tissue microarrays containing tumor and adjacent tissue were prepared. Immunohistochemical staining of VISTA was performed for analyzing the correlation between the expression of VISTA, its clinicopathological factors and the prognosis of HCC. Results The positive rates of VISTA were 8.70%(6/69), 100%(69/69) and 65.22%(45/69) for tumor cells, intratumoral lymphocytes and vascular endothelial cells respectively. The expression of VISTA of intratumoral lymphocytes in adjacent tissues was higher than that in tumor central area (P 0.05). No difference of statistical significance between clinicopathological features and the expression of VISTA in tumor cells (P<0.05). Kaplan-Meier survival curve analysis indicated that the overall survival and recurrence-free survival rates of VISTA low-expression group were markedly higher than those of VISTA high-expression group (P<0.05). Conclusions The expression of VISTA in HCC is predominantly concentrated in intratumoral lymphocytes. It is associated with tumor size. And an elevated expression of VISTA may be a potential marker of poor prognosis in HCC patients. VISTA is expected to be a new therapeutic target for HCC. Key words: Hepatocellular carcinoma; Liver transplantation; VISTA; Tissue microarray
{"title":"Expression of negative immune checkpoint regulator VISTA and its significance in the prognostic evaluation of liver transplantation for hepatocellular carcinoma","authors":"J. Xiang, Yinghao Yu, Zhiyong Zheng, Li-juan Qu, Zai-zeng Wu, Shun-an Hu, Xianhua Liu, Xingfeng Qi","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.11.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.11.005","url":null,"abstract":"Objective \u0000To explore the expression and significance of v-domain Ig suppressor of T cell activation (VISTA) in the clinical samples of hepatocellular carcinoma (HCC). \u0000 \u0000 \u0000Methods \u0000Sixty-nine cases of HCC were recruited as research subjects. Tissue microarrays containing tumor and adjacent tissue were prepared. Immunohistochemical staining of VISTA was performed for analyzing the correlation between the expression of VISTA, its clinicopathological factors and the prognosis of HCC. \u0000 \u0000 \u0000Results \u0000The positive rates of VISTA were 8.70%(6/69), 100%(69/69) and 65.22%(45/69) for tumor cells, intratumoral lymphocytes and vascular endothelial cells respectively. The expression of VISTA of intratumoral lymphocytes in adjacent tissues was higher than that in tumor central area (P 0.05). No difference of statistical significance between clinicopathological features and the expression of VISTA in tumor cells (P<0.05). Kaplan-Meier survival curve analysis indicated that the overall survival and recurrence-free survival rates of VISTA low-expression group were markedly higher than those of VISTA high-expression group (P<0.05). \u0000 \u0000 \u0000Conclusions \u0000The expression of VISTA in HCC is predominantly concentrated in intratumoral lymphocytes. It is associated with tumor size. And an elevated expression of VISTA may be a potential marker of poor prognosis in HCC patients. VISTA is expected to be a new therapeutic target for HCC. \u0000 \u0000 \u0000Key words: \u0000Hepatocellular carcinoma; Liver transplantation; VISTA; Tissue microarray","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89254531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.10.006
Jian Zhang, Jun Lin, Ye Tian, Wen-xue Sun, Yu-wen Guo, Lei Zhang, Yi-chen Zhu
Objective To explore the efficacy and safety of converting from traditional calcineurin inhibitor-based immunosuppressive regimen to sirolimus plus low-dose calcineurin inhibitor after kidney transplantation from expanded criteria donors. Methods For this prospective, open-label, non-randomized controlled clinical trial, 15 recipients of initial transplant from expanded criteria donors received sirolimus plus low-dose calcineurin inhibitor regimen 3 months after transplantation during June 2017 and March 2018. The follow-up period was over 1 year. The allograft survival time, changes in blood creatinine and glomerular filtration rate before and after conversion (0, 1, 3, 6, 12 months), changes in urinary protein before and after conversion, incidence of acute rejection after conversion, BK virus or cytomegalovirus infection and sirolimus-related complications were observed. Results Renal functions of all 15 patients improved after conversion and 1-year allograft survival rate was 100% (15/15). Serum creatinine decreased markedly and glomerular filtration rate increased significantly at 1 month and 3 months after conversion (P<0.05). BK viruria was detected in 5 patients before conversion. After conversion, BK virus turned into negative in 3 patients within 3 months and viral load also decreased in another 2 patients. After conversion, only 2 patients (13.3%) developed de novo proteinuria. Eight patients (53.3%) developed de novo hypertriglyceridemia responding well to medications. None of them experienced acute rejection during follow-ups. Conclusions Sirolimus plus low-dose calcineurin inhibitor is a safe and effective maintenance immunosuppressive regimen for recipients of kidneys from expanded criteria donors, especially for those with abnormal renal function during recovery. But it cannot completely replace the traditional immunosuppressive regimen. Individualized treatment should be chosen properly for recipients. Key words: Kidney transplantation; Sirolimus; Calcineurin inhibitor
{"title":"Clinical study ofsirolimus plus low-dose calcineurin inhibitor after kidney transplantation from expanded criteria donors","authors":"Jian Zhang, Jun Lin, Ye Tian, Wen-xue Sun, Yu-wen Guo, Lei Zhang, Yi-chen Zhu","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.10.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.10.006","url":null,"abstract":"Objective \u0000To explore the efficacy and safety of converting from traditional calcineurin inhibitor-based immunosuppressive regimen to sirolimus plus low-dose calcineurin inhibitor after kidney transplantation from expanded criteria donors. \u0000 \u0000 \u0000Methods \u0000For this prospective, open-label, non-randomized controlled clinical trial, 15 recipients of initial transplant from expanded criteria donors received sirolimus plus low-dose calcineurin inhibitor regimen 3 months after transplantation during June 2017 and March 2018. The follow-up period was over 1 year. The allograft survival time, changes in blood creatinine and glomerular filtration rate before and after conversion (0, 1, 3, 6, 12 months), changes in urinary protein before and after conversion, incidence of acute rejection after conversion, BK virus or cytomegalovirus infection and sirolimus-related complications were observed. \u0000 \u0000 \u0000Results \u0000Renal functions of all 15 patients improved after conversion and 1-year allograft survival rate was 100% (15/15). Serum creatinine decreased markedly and glomerular filtration rate increased significantly at 1 month and 3 months after conversion (P<0.05). BK viruria was detected in 5 patients before conversion. After conversion, BK virus turned into negative in 3 patients within 3 months and viral load also decreased in another 2 patients. After conversion, only 2 patients (13.3%) developed de novo proteinuria. Eight patients (53.3%) developed de novo hypertriglyceridemia responding well to medications. None of them experienced acute rejection during follow-ups. \u0000 \u0000 \u0000Conclusions \u0000Sirolimus plus low-dose calcineurin inhibitor is a safe and effective maintenance immunosuppressive regimen for recipients of kidneys from expanded criteria donors, especially for those with abnormal renal function during recovery. But it cannot completely replace the traditional immunosuppressive regimen. Individualized treatment should be chosen properly for recipients. \u0000 \u0000 \u0000Key words: \u0000Kidney transplantation; Sirolimus; Calcineurin inhibitor","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82913841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.10.004
Zhen-yu Ma, Tuo Chen, Quan-bao Zhang, Yifeng Tao
Objective To explore the clinical efficacies of applying aged marginal donor liver. Methods From January 2015 to June 2018, clinical data were retrospectively analyzed for 199 adult liver transplantation donors and recipients. They were divided into two groups of aged (≥60 years) and appropriate age (<60 years). The prognosis of two groups was compared after a follow-up period of 1 year. And the aged group was further assigned into lower and higher fat infiltration groups according to the degree of fat infiltration in donor liver and compared the prognosis of two groups. Results No significant differences existed in initial, peak value and recovery time of transaminase (AST/ALT), peak value and recovery time of total bilirubin, glutamyl transpeptidase, alkaline phosphatase, international normalized ratio (INR), peak value of lactate, postoperative hospital stay, graft dysfunction, biliary/vascular complications, acute/chronic rejection or graft survival rate between aged and appropriate age groups post-transplantation. The aged group was further divided into lower and higher fat infiltration groups according to the fat infiltration rate (<20%, ≥20%). And significant inter-group differences existed in peak value and recovery time of AST/ALT, peak value of total bilirubin, glutamyl transpeptidase, lactate, postoperative hospital stay and graft dysfunction. The above parameters were significantly worse in higher fat infiltration group. Also the rejection rate was higher in high group at 1 year post-operation and no significant inter-group difference existed in biliary/vascular complications. In higher group, 4 patients showed graft dysfunctions during perioperative period. Two of them were discharged successfully after secondary transplantation and another 2 patients died. Conclusions On the premise of comprehensive evaluations of donor liver status and reasonable matching of recipients, aged marginal donor liver can be safely applied with excellent clinical outcomes. Severe fatty donor liver should be employed with caution. Hypertensive drugs, high serum sodium and long period of cold ischemia are also important influencing factors for aged donors. Key words: Liver transplantation; Fatty liver; Age factors
{"title":"Clinicalapplications of 57 aged marginal donor livers","authors":"Zhen-yu Ma, Tuo Chen, Quan-bao Zhang, Yifeng Tao","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.10.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.10.004","url":null,"abstract":"Objective \u0000To explore the clinical efficacies of applying aged marginal donor liver. \u0000 \u0000 \u0000Methods \u0000From January 2015 to June 2018, clinical data were retrospectively analyzed for 199 adult liver transplantation donors and recipients. They were divided into two groups of aged (≥60 years) and appropriate age (<60 years). The prognosis of two groups was compared after a follow-up period of 1 year. And the aged group was further assigned into lower and higher fat infiltration groups according to the degree of fat infiltration in donor liver and compared the prognosis of two groups. \u0000 \u0000 \u0000Results \u0000No significant differences existed in initial, peak value and recovery time of transaminase (AST/ALT), peak value and recovery time of total bilirubin, glutamyl transpeptidase, alkaline phosphatase, international normalized ratio (INR), peak value of lactate, postoperative hospital stay, graft dysfunction, biliary/vascular complications, acute/chronic rejection or graft survival rate between aged and appropriate age groups post-transplantation. The aged group was further divided into lower and higher fat infiltration groups according to the fat infiltration rate (<20%, ≥20%). And significant inter-group differences existed in peak value and recovery time of AST/ALT, peak value of total bilirubin, glutamyl transpeptidase, lactate, postoperative hospital stay and graft dysfunction. The above parameters were significantly worse in higher fat infiltration group. Also the rejection rate was higher in high group at 1 year post-operation and no significant inter-group difference existed in biliary/vascular complications. In higher group, 4 patients showed graft dysfunctions during perioperative period. Two of them were discharged successfully after secondary transplantation and another 2 patients died. \u0000 \u0000 \u0000Conclusions \u0000On the premise of comprehensive evaluations of donor liver status and reasonable matching of recipients, aged marginal donor liver can be safely applied with excellent clinical outcomes. Severe fatty donor liver should be employed with caution. Hypertensive drugs, high serum sodium and long period of cold ischemia are also important influencing factors for aged donors. \u0000 \u0000 \u0000Key words: \u0000Liver transplantation; Fatty liver; Age factors","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87202281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.10.005
Zhi-gang Wang, Fei Xu, Lei Liu, Jinfeng Li, W. Shang
Objective To explore the evaluations and recipient selection methods of extended criteria donor (ECD) kidney donation in the death of citizens and analyze the transplantation outcomes. Methods From January to September 2019, the clinical data of donor-recipients were retrospectively studied. The recipients of ECD donor kidneys not evaluated for kidney zero puncture assessment from January 2014 to July 2016 were group A1 and those receiving standard donor kidney (SCD) belonged to group A2. From August 2016 to March 2019, all DCD donors were routinely evaluated for kidney zero puncture and those receiving ECD recipients fell into Group B1 and those receiving SCD belonged to Group B2. Analysis was performed for ECD/SCD donor renal zero puncture pathological features and lesion degree and utilization of ECD donor kidney; donor-recipient body surface area (BSA) ratio and lesion degree of ECD donor kidney on recipient selecting and matching. Serum creatinine value, perioperative adverse events and 1-year follow-up of human/kidney survival rate in each group were compared at 1 day, 1 week, 1 month, 3 months, 6 months and 1 year. Results A total of 108, 264, 306 and 416 recipients were recruited into A1, A2, B1 and B2 groups respectively. The ECD donor renal utilization rate was 88.5% vs 93.3% during two time periods. According to the 2016 Banff standard, glomerular sclerosis (GS), renal interstitial fibrosis (Ci) and intimal fibrosis thickening (Cv), small arterial intimal hyalinization (ah), tubular atrophy (ct) and acute tubular injury (ati) accounted for more than B1 group than B2 group (P<0.05). The severity of ECD donor kidney disease, BSA ratio <1.1 group and ≥1.1 group 1 week, 1 month, 3 months postoperative blood creatinine value was lower than the former while declining amplitude of blood creatinine was higher. A significant difference existed in the degree of moderate lesions in donor kidney (P<0.05). After 1 year, serum creatinine value of B1 group was lower than that of A1 group (P<0.05). Conclusions The quality of ECD donor kidney is obviously inferior to that of SCD donor kidney. The Banff donor kidney criterion is an effective mode of evaluating the quality of ECD donor kidney. Based upon the extent of Banff's nephropathy, the ratio of donor/recipient BSA is an important selecting method for ECD donors to receive kidneys and recipients, ultimately improving graft utilization and recipient transplantation. Key words: Kidney transplantation; Renal needle biopsy; Body surface area
{"title":"Evaluations and utilizations of extended criteria donor kidneys","authors":"Zhi-gang Wang, Fei Xu, Lei Liu, Jinfeng Li, W. Shang","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.10.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.10.005","url":null,"abstract":"Objective \u0000To explore the evaluations and recipient selection methods of extended criteria donor (ECD) kidney donation in the death of citizens and analyze the transplantation outcomes. \u0000 \u0000 \u0000Methods \u0000From January to September 2019, the clinical data of donor-recipients were retrospectively studied. The recipients of ECD donor kidneys not evaluated for kidney zero puncture assessment from January 2014 to July 2016 were group A1 and those receiving standard donor kidney (SCD) belonged to group A2. From August 2016 to March 2019, all DCD donors were routinely evaluated for kidney zero puncture and those receiving ECD recipients fell into Group B1 and those receiving SCD belonged to Group B2. Analysis was performed for ECD/SCD donor renal zero puncture pathological features and lesion degree and utilization of ECD donor kidney; donor-recipient body surface area (BSA) ratio and lesion degree of ECD donor kidney on recipient selecting and matching. Serum creatinine value, perioperative adverse events and 1-year follow-up of human/kidney survival rate in each group were compared at 1 day, 1 week, 1 month, 3 months, 6 months and 1 year. \u0000 \u0000 \u0000Results \u0000A total of 108, 264, 306 and 416 recipients were recruited into A1, A2, B1 and B2 groups respectively. The ECD donor renal utilization rate was 88.5% vs 93.3% during two time periods. According to the 2016 Banff standard, glomerular sclerosis (GS), renal interstitial fibrosis (Ci) and intimal fibrosis thickening (Cv), small arterial intimal hyalinization (ah), tubular atrophy (ct) and acute tubular injury (ati) accounted for more than B1 group than B2 group (P<0.05). The severity of ECD donor kidney disease, BSA ratio <1.1 group and ≥1.1 group 1 week, 1 month, 3 months postoperative blood creatinine value was lower than the former while declining amplitude of blood creatinine was higher. A significant difference existed in the degree of moderate lesions in donor kidney (P<0.05). After 1 year, serum creatinine value of B1 group was lower than that of A1 group (P<0.05). \u0000 \u0000 \u0000Conclusions \u0000The quality of ECD donor kidney is obviously inferior to that of SCD donor kidney. The Banff donor kidney criterion is an effective mode of evaluating the quality of ECD donor kidney. Based upon the extent of Banff's nephropathy, the ratio of donor/recipient BSA is an important selecting method for ECD donors to receive kidneys and recipients, ultimately improving graft utilization and recipient transplantation. \u0000 \u0000 \u0000Key words: \u0000Kidney transplantation; Renal needle biopsy; Body surface area","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83287031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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