Pub Date : 2019-09-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.09.009
Aierken Yiliyaer, Lingxiang Kong, Lei Li, Bo Li
Objective To explore the indications and clinical value of orthotropic liver transplantation(OLT)in patients with advanced hepatic alveolar echinococcosis(HAE). Methods The clinical data of 12 patients with advanced HAE who received OLT from January 2001 to December 2017 were retrospectively analyzed. Among them, there were 7 males and 5 females, the age ranged from 16~58 years(median 42 years). The preoperative hepatic functions of 12 patients were 2 Child-Pugh class A, 3 class B and 7 class C, and the median model for end-stage liver disease(MELD)score was 19.5(8~23). Results The mean time of OLT procedure and anhepatic phase in 12 patients were 456.25(456.25±44.98)min and 79.17(79.17±10.01)min respectively. The median intraoperative blood loss and hospital stay times were 1000 ml(600~4000 ml), and 29.5(15±58)days respectively. All the patients were followed-up for 0 months to 207 months. Among the 12 patients who underwent OLT, 2 recipients died of incurable infection of pulmonary infection on day 23 post-OLT, and multiple organ failure on day 32 post-OLT, respectively. One case developed lung metastasis 2 years after operation, and brain metastasis was found in the same patient after 4 years. The recurrence occurred 3 years after OLT in another patient, no evidence of HAE recurrence or extrahepatic metastasis was found in the remaining 8 patients. Conclusions OLT can provide patients with advanced HAE the best chance for long term disease-free and overall survival who lost the opportunity for radical hepatectomy. Key words: Liver transplantation; Hepatic alveolar echinococcosis; Relapse
{"title":"Clinical efficiency of orthotopic liver transplantation for advanced hepatic alveolar echinococcosis","authors":"Aierken Yiliyaer, Lingxiang Kong, Lei Li, Bo Li","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.09.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.09.009","url":null,"abstract":"Objective \u0000To explore the indications and clinical value of orthotropic liver transplantation(OLT)in patients with advanced hepatic alveolar echinococcosis(HAE). \u0000 \u0000 \u0000Methods \u0000The clinical data of 12 patients with advanced HAE who received OLT from January 2001 to December 2017 were retrospectively analyzed. Among them, there were 7 males and 5 females, the age ranged from 16~58 years(median 42 years). The preoperative hepatic functions of 12 patients were 2 Child-Pugh class A, 3 class B and 7 class C, and the median model for end-stage liver disease(MELD)score was 19.5(8~23). \u0000 \u0000 \u0000Results \u0000The mean time of OLT procedure and anhepatic phase in 12 patients were 456.25(456.25±44.98)min and 79.17(79.17±10.01)min respectively. The median intraoperative blood loss and hospital stay times were 1000 ml(600~4000 ml), and 29.5(15±58)days respectively. All the patients were followed-up for 0 months to 207 months. Among the 12 patients who underwent OLT, 2 recipients died of incurable infection of pulmonary infection on day 23 post-OLT, and multiple organ failure on day 32 post-OLT, respectively. One case developed lung metastasis 2 years after operation, and brain metastasis was found in the same patient after 4 years. The recurrence occurred 3 years after OLT in another patient, no evidence of HAE recurrence or extrahepatic metastasis was found in the remaining 8 patients. \u0000 \u0000 \u0000Conclusions \u0000OLT can provide patients with advanced HAE the best chance for long term disease-free and overall survival who lost the opportunity for radical hepatectomy. \u0000 \u0000 \u0000Key words: \u0000Liver transplantation; Hepatic alveolar echinococcosis; Relapse","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89456668","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 : 2019-09-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.09.010
Shao-hua Song, W. Yanling, Hao Liu, Junfeng Dong, Ke-Yan Sun, Jia-Yong Dong, F. Teng, Wen-Yuan Guo, Xiao-min Shi, Guoshan Ding
Objective To explore the safety of liver transplantation recipients with Rh blood group mismatchming. Methods From May 2005 to December 2018, 1 546 cases of liver transplantation in our hospital were retrospectively analyzed. Among these cases, 5 cases of Rh blood group mismatched were Rh(-) recipients receiving Rh(+ ) donor liver. For each Rh blood group mismatched liver transplantation, 5 patients received the same Rh blood group liver allograft were matched according to a certain principle and were defined as Rh-mismatch group and Rh-match group respectively. The serum alanine aminotransferase (ALT), aspartate aminotransferase(AST)and creatinine(SCr)were compared between two groups at Days 7 & 14 post-operation. Serum total bilirubin(TB), gamma-glutamyl transpeptidase(GGT)were compared between two groups at Month 1, 6 & 12 post-operation. Hemoglobin (Hb)were compared between two groups Month 1, 3 & 6 post-operation. The rates of infection, vascular complications and acute rejection was also compared. Indirect antiglobulin test (IAT)was used for detecting the production of anti-RhD antibody in patients in Rh-mismatch group at Month 1, 6 & 12 post-operation. Results At the mentioned time, no significant inter-group difference existed in serum ALT, AST, SCr, TB, GGT and blood Hb levels(all P>0.05); Also, no significant difference existed in the incidence of infection, vascular complications or acute rejection(all P>0.05). In Rhmismatch group, 4 recipients received Rh(+ )RBC transfusion during perioperative period and no hemolytic anemia occurred after operation. Rh(D) antibody was negative at all timepoints. Conclusions Taking into account the rarity of Rh-negative blood group in Chinese, it is safe and feasible to carry out Rh blood group mismatched liver transplantation when donor or recipient with the same Rh blood group is not available. Key words: Rh blood group system; Mismatching; Liver transplantation; Safety; Recipient
{"title":"Preliminary study on the safety of liver transplantation recipients with Rh blood group mismatching","authors":"Shao-hua Song, W. Yanling, Hao Liu, Junfeng Dong, Ke-Yan Sun, Jia-Yong Dong, F. Teng, Wen-Yuan Guo, Xiao-min Shi, Guoshan Ding","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.09.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.09.010","url":null,"abstract":"Objective \u0000To explore the safety of liver transplantation recipients with Rh blood group mismatchming. \u0000 \u0000 \u0000Methods \u0000From May 2005 to December 2018, 1 546 cases of liver transplantation in our hospital were retrospectively analyzed. Among these cases, 5 cases of Rh blood group mismatched were Rh(-) recipients receiving Rh(+ ) donor liver. For each Rh blood group mismatched liver transplantation, 5 patients received the same Rh blood group liver allograft were matched according to a certain principle and were defined as Rh-mismatch group and Rh-match group respectively. The serum alanine aminotransferase (ALT), aspartate aminotransferase(AST)and creatinine(SCr)were compared between two groups at Days 7 & 14 post-operation. Serum total bilirubin(TB), gamma-glutamyl transpeptidase(GGT)were compared between two groups at Month 1, 6 & 12 post-operation. Hemoglobin (Hb)were compared between two groups Month 1, 3 & 6 post-operation. The rates of infection, vascular complications and acute rejection was also compared. Indirect antiglobulin test (IAT)was used for detecting the production of anti-RhD antibody in patients in Rh-mismatch group at Month 1, 6 & 12 post-operation. \u0000 \u0000 \u0000Results \u0000At the mentioned time, no significant inter-group difference existed in serum ALT, AST, SCr, TB, GGT and blood Hb levels(all P>0.05); Also, no significant difference existed in the incidence of infection, vascular complications or acute rejection(all P>0.05). In Rhmismatch group, 4 recipients received Rh(+ )RBC transfusion during perioperative period and no hemolytic anemia occurred after operation. Rh(D) antibody was negative at all timepoints. \u0000 \u0000 \u0000Conclusions \u0000Taking into account the rarity of Rh-negative blood group in Chinese, it is safe and feasible to carry out Rh blood group mismatched liver transplantation when donor or recipient with the same Rh blood group is not available. \u0000 \u0000 \u0000Key words: \u0000Rh blood group system; Mismatching; Liver transplantation; Safety; Recipient","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80948674","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 : 2019-08-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.08.006
Lan Zhu, H. Feng, Yu Zhang, J. Jia, Xinyue Hu, Zheng-bin Lin, L. Qiu, Jianhua Zhou, Gang Chen
Objective To explore the feasibility and safety of kidney transplantation for pre-sensitized infants using deceased donors and summarize the relevant literature reports. Methods A second kidney transplantation was successfully performed for an 8-month-old pre-sensitized girl in July 2017. She had a low level of donor specific antibody (DSA) against human leucocyte antigen (HLA) B62 due to severe acute rejection (AR) after her first kidney transplantation. For desensitization, plasmapheresis and intravenous immunoglobulin plus anti-CD20 antibodies were offered on operative day. Clinical data and outcomes were retrospectively analyzed. Results Renal graft regained immediate function after transplantation. Preformed DSA could be detected at 1 week. However, there was no de novo DSA. At 1 year post-transplantation, preformed DSA turned negative. During a follow-up period of 2 years, renal graft showed an excellent function with a serum creatinine of 31 μmol/l and eGFR of 110 ml/min/1.73m2. No AR episode or proteinuria occurred. DSA stayed negative. Simultaneously physical development also caught up. Her height of 93 cm tall and weight of 13.5 kg at month 24 & 8 months corresponded to normal growth curve of her age. Conclusions Pre-sensitized infant could tolerate desensitization therapy well and achieve satisfactory outcomes. With surgical precisions and optimized managements, kidney transplantation provides excellent renal functions and survivals for infants with organs from deceased donors. Key words: Infant; Kidney transplantation; Pre-sensitization; Human leucocyte antigen; Donor specific antibodies
{"title":"Renal re-transplantation in a pre-sensitized small infant and literature review","authors":"Lan Zhu, H. Feng, Yu Zhang, J. Jia, Xinyue Hu, Zheng-bin Lin, L. Qiu, Jianhua Zhou, Gang Chen","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.08.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.08.006","url":null,"abstract":"Objective \u0000To explore the feasibility and safety of kidney transplantation for pre-sensitized infants using deceased donors and summarize the relevant literature reports. \u0000 \u0000 \u0000Methods \u0000A second kidney transplantation was successfully performed for an 8-month-old pre-sensitized girl in July 2017. She had a low level of donor specific antibody (DSA) against human leucocyte antigen (HLA) B62 due to severe acute rejection (AR) after her first kidney transplantation. For desensitization, plasmapheresis and intravenous immunoglobulin plus anti-CD20 antibodies were offered on operative day. Clinical data and outcomes were retrospectively analyzed. \u0000 \u0000 \u0000Results \u0000Renal graft regained immediate function after transplantation. Preformed DSA could be detected at 1 week. However, there was no de novo DSA. At 1 year post-transplantation, preformed DSA turned negative. During a follow-up period of 2 years, renal graft showed an excellent function with a serum creatinine of 31 μmol/l and eGFR of 110 ml/min/1.73m2. No AR episode or proteinuria occurred. DSA stayed negative. Simultaneously physical development also caught up. Her height of 93 cm tall and weight of 13.5 kg at month 24 & 8 months corresponded to normal growth curve of her age. \u0000 \u0000 \u0000Conclusions \u0000Pre-sensitized infant could tolerate desensitization therapy well and achieve satisfactory outcomes. With surgical precisions and optimized managements, kidney transplantation provides excellent renal functions and survivals for infants with organs from deceased donors. \u0000 \u0000 \u0000Key words: \u0000Infant; Kidney transplantation; Pre-sensitization; Human leucocyte antigen; Donor specific antibodies","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81684704","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}
{"title":"Antibody mediated rejections: fighting an uphill battle","authors":"Changxi Wang","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.08.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.08.001","url":null,"abstract":"抗体介导的排斥反应(AMR)是影响移植肾远期存活的重要疾病，其发病机理较明确但疾病异质性高，临床表型多，尚缺乏有效的治疗手段，特别是迟发或慢性AMR。细化AMR分型有助于实施针对性治疗和预估疗效。病理诊断标准和抗体检测技术有待进一步优化，分子病理和无创监测(如供者游离DNA)能辅助提高AMR的诊断和治疗。基于HLA Eplets错配建立免疫风险分层有助于指导个体化免疫抑制方案，降低新生供者特异性抗体(DSA)风险。","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73960568","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 : 2019-08-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.08.007
J. Qiu, Guo-dong Chen, Hehuan Ruan, C. Deng, Jun Li, S. Deng, Gang Huang, Longshan Liu, Q. Fu, Changxi Wang, Lizhong Chen
Objective To explore the strategies of desensitization treatment for ABO incompatible (ABOi) related living-donor kidney transplantation. Methods A retrospective analysis was performed for 14 recipients undergoing ABOi related living kidney transplantation from July 2015 to December 2018. The clinical outcomes and expenditures of desensitization treatment before and after optimizing desensitization were compared. Results After desensitization treatment, 14 recipients successfully underwent ABOi-kidney transplantation. Within 2 weeks post-transplantation, blood group antibody rebounded to 1: 64 in only 1 recipient. Within 1 week post-transplantation, the serum creatinine levels decreased to 85-165 μmol/L in 14 recipients. Thirteen patients stabilized after 1 week while another patient had an elevated level of serum creatinine at Day 12 post-operation and renal allograft function recovered after treatment. Two cases of rejection were diagnosed by clinical manifestations and 1 case was confirmed by pathological biopsy. Five cases of programmed renal allograft biopsy indicated critical or suspected acute T-lymphocytic rejection within 1 year. Thirteen cases (92.6%) demonstrated varying degrees of peritubular capillary deposition of C4d. One case developed BK viral uropathy within 1 year and four patients of pulmonary infections requiring hospitalization were cured after treatment. During an early stage, the incidence of postoperative infection was 57.14% and declined to 14.29% after optimized desensitization. The expenditure of early desensitization treatment was (27004.86±10719.85) yuan and (10612.29±8143.05) yuan after optimization. And the expenditure of optimized desensitization was significantly lowered (P<0.05). During follow-ups, renal allograft function of 14 recipients remained decent. And the survival rate of recipient/allograft was 100% up to the statistical cut-off point. Conclusions Both desensitization strategies may achieve the goal of desensitization for ABOi kidney transplantation and the outcomes are excellent. The expenditure of desensitization treatment is significantly lowered after optimization. Key words: Kidney transplantation; Lving donor; ABO incompatibility; Blood group antibody; Desensitization therapy; Antibody-mediated rejection
{"title":"Desensitization strategies for ABO-incompatible living related kidney transplantation","authors":"J. Qiu, Guo-dong Chen, Hehuan Ruan, C. Deng, Jun Li, S. Deng, Gang Huang, Longshan Liu, Q. Fu, Changxi Wang, Lizhong Chen","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.08.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.08.007","url":null,"abstract":"Objective \u0000To explore the strategies of desensitization treatment for ABO incompatible (ABOi) related living-donor kidney transplantation. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was performed for 14 recipients undergoing ABOi related living kidney transplantation from July 2015 to December 2018. The clinical outcomes and expenditures of desensitization treatment before and after optimizing desensitization were compared. \u0000 \u0000 \u0000Results \u0000After desensitization treatment, 14 recipients successfully underwent ABOi-kidney transplantation. Within 2 weeks post-transplantation, blood group antibody rebounded to 1: 64 in only 1 recipient. Within 1 week post-transplantation, the serum creatinine levels decreased to 85-165 μmol/L in 14 recipients. Thirteen patients stabilized after 1 week while another patient had an elevated level of serum creatinine at Day 12 post-operation and renal allograft function recovered after treatment. Two cases of rejection were diagnosed by clinical manifestations and 1 case was confirmed by pathological biopsy. Five cases of programmed renal allograft biopsy indicated critical or suspected acute T-lymphocytic rejection within 1 year. Thirteen cases (92.6%) demonstrated varying degrees of peritubular capillary deposition of C4d. One case developed BK viral uropathy within 1 year and four patients of pulmonary infections requiring hospitalization were cured after treatment. During an early stage, the incidence of postoperative infection was 57.14% and declined to 14.29% after optimized desensitization. The expenditure of early desensitization treatment was (27004.86±10719.85) yuan and (10612.29±8143.05) yuan after optimization. And the expenditure of optimized desensitization was significantly lowered (P<0.05). During follow-ups, renal allograft function of 14 recipients remained decent. And the survival rate of recipient/allograft was 100% up to the statistical cut-off point. \u0000 \u0000 \u0000Conclusions \u0000Both desensitization strategies may achieve the goal of desensitization for ABOi kidney transplantation and the outcomes are excellent. The expenditure of desensitization treatment is significantly lowered after optimization. \u0000 \u0000 \u0000Key words: \u0000Kidney transplantation; Lving donor; ABO incompatibility; Blood group antibody; Desensitization therapy; Antibody-mediated rejection","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84269939","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 : 2019-08-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2014.00.011
Yaqi Huang, Yuexian Shi, Yue Zhao
Objective To explore the life experiences of donors undergoing pediatric living related liver transplantation and elucidate it’s the influencing factors of quality-of-life. Methods A qualitative study was performed with a phenomenological-hermeneutic approach. Twelve living related liver transplantation donors were face-to-face interviewed by a semi-structured interview and 7-step Colaizzi method was applied for data analysis. Results Four domains and 9 sub-domains were summarized as follows: body disturbance (pain, discomfort & physical changes), sense of uncertainty (recipient-dependent sensitive, self-doubt & confusion under family pressure), role conflict (patient-carer & family-social) and contentment & gratitude (willing to sacrifice, living in the present & benefiting from social funds). Conclusions The levels of quality-of-life vary greatly in different donors. Body disturbance, sense of uncertainty, role conflict, contentment and gratitude are the major influencing factors of quality-of-life for donors undergoing pediatric living related transplantation. Key words: Child; Liver transplantation; Lving donor; Quality of life
{"title":"Influencing factors of quality-of-life for donors undergoing pediatric living related liver transplantation: a qualitative approach","authors":"Yaqi Huang, Yuexian Shi, Yue Zhao","doi":"10.3760/CMA.J.ISSN.0254-1785.2014.00.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2014.00.011","url":null,"abstract":"Objective \u0000To explore the life experiences of donors undergoing pediatric living related liver transplantation and elucidate it’s the influencing factors of quality-of-life. \u0000 \u0000 \u0000Methods \u0000A qualitative study was performed with a phenomenological-hermeneutic approach. Twelve living related liver transplantation donors were face-to-face interviewed by a semi-structured interview and 7-step Colaizzi method was applied for data analysis. \u0000 \u0000 \u0000Results \u0000Four domains and 9 sub-domains were summarized as follows: body disturbance (pain, discomfort & physical changes), sense of uncertainty (recipient-dependent sensitive, self-doubt & confusion under family pressure), role conflict (patient-carer & family-social) and contentment & gratitude (willing to sacrifice, living in the present & benefiting from social funds). \u0000 \u0000 \u0000Conclusions \u0000The levels of quality-of-life vary greatly in different donors. Body disturbance, sense of uncertainty, role conflict, contentment and gratitude are the major influencing factors of quality-of-life for donors undergoing pediatric living related transplantation. \u0000 \u0000 \u0000Key words: \u0000Child; Liver transplantation; Lving donor; Quality of life","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85691417","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 evaluate the outcome of 1iver transplantation for acute-on-chronic liver failure (ACLF) patients. Methods We included 453 consecutive patients with previously cirrhosis who underwent liver transplantation between January 2013 and December 2017. Patients were categorized as no ACLF (n=294) and ACLF(n=159) according to EASL-CLIF consortium criteria. Furthermore, we used ACLF grades to categorize the ACLF patients. Their clinical data were reviewed and their 90-days survival outcomes were compared. Results Compared with the no ACLF group, the length of stay in the ICU was significantly prolonged for all patients with ACLF, and the 90-days survival rate after transplantation was significantly reduced in ACLF group. The length of stay in the ICU was shorter in Grade 1 and Grade 2 group when compared to Grade 3 group. The 90-days survival rate of no ACLF, Grade 1, Grade 2 and Grade 3 group were 93.20%, 92.59%, 93.33% and 73.68%, respectively. There were no statistically significant differences in 90-days survival rate among the no ACLF, Grade 1 and Grade 2 group. However, the 90-days survive rate of Grade 3 group was lower than that of other groups. Conclusions Liver transplantation has been shown to be safe and effective with good outcome in patients with ACLF and should be offered in early course of ACLF before onset of multi-organ failure. Key words: Acute-on-chronic liver failure; Liver transplantation; Outcome; Diagnosis criteria; Prognostic Score
{"title":"Liver transplantation in acute-on-chronic liver failure patients: a single center experience of 159 consecutive cases","authors":"Jiequn Li, Zhen‐jie Zhou, Yangyang Bin, Guangshun Chen, Qiang Li, Haizhi Qi","doi":"10.3760/CMA.J.ISSN.0254-1785.2014.00.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2014.00.010","url":null,"abstract":"Objective \u0000To evaluate the outcome of 1iver transplantation for acute-on-chronic liver failure (ACLF) patients. \u0000 \u0000 \u0000Methods \u0000We included 453 consecutive patients with previously cirrhosis who underwent liver transplantation between January 2013 and December 2017. Patients were categorized as no ACLF (n=294) and ACLF(n=159) according to EASL-CLIF consortium criteria. Furthermore, we used ACLF grades to categorize the ACLF patients. Their clinical data were reviewed and their 90-days survival outcomes were compared. \u0000 \u0000 \u0000Results \u0000Compared with the no ACLF group, the length of stay in the ICU was significantly prolonged for all patients with ACLF, and the 90-days survival rate after transplantation was significantly reduced in ACLF group. The length of stay in the ICU was shorter in Grade 1 and Grade 2 group when compared to Grade 3 group. The 90-days survival rate of no ACLF, Grade 1, Grade 2 and Grade 3 group were 93.20%, 92.59%, 93.33% and 73.68%, respectively. There were no statistically significant differences in 90-days survival rate among the no ACLF, Grade 1 and Grade 2 group. However, the 90-days survive rate of Grade 3 group was lower than that of other groups. \u0000 \u0000 \u0000Conclusions \u0000Liver transplantation has been shown to be safe and effective with good outcome in patients with ACLF and should be offered in early course of ACLF before onset of multi-organ failure. \u0000 \u0000 \u0000Key words: \u0000Acute-on-chronic liver failure; Liver transplantation; Outcome; Diagnosis criteria; Prognostic Score","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90631345","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 : 2019-08-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.08.008
Jia Liu, Jianfei Xie, Lifang Liu, Ying Niu, Y. Ming, Ke Chen
Objective To explore the effects of WeChat-based peer supports upon medication adherence and quality-of-life in liver transplant recipients. Methods A total of 63 patients with liver transplantation were conveniently divided into intervention group (n=32) and control group (n=31) depending upon their different follow-up periods. In control group, routine outpatient health guidance was offered while intervention group received 6-week WeChat-based peer supports. Medication compliance and quality-of-life of two groups were evaluated at Month 3/6/12 post-intervention. Results At Month 3 post-intervention, as compared with control group, only non-punctual medication improved significantly in intervention group (P 0.05). However, inter-group quality-of-life was not statistically significant at Month 3/6/12 post-intervention. Conclusions WeChat-based peer supports may partially improve the immediate compliance of patients with liver transplantation. However, long-term outcomes and effects on quality-of-life are worth further researches. Key words: Liver transplantation; Medication; Adherence; WeChat; Peer supports; Quality of life
{"title":"Effects ofWeChat-based peer supports upon medication adherence in liver transplant recipients","authors":"Jia Liu, Jianfei Xie, Lifang Liu, Ying Niu, Y. Ming, Ke Chen","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.08.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.08.008","url":null,"abstract":"Objective \u0000To explore the effects of WeChat-based peer supports upon medication adherence and quality-of-life in liver transplant recipients. \u0000 \u0000 \u0000Methods \u0000A total of 63 patients with liver transplantation were conveniently divided into intervention group (n=32) and control group (n=31) depending upon their different follow-up periods. In control group, routine outpatient health guidance was offered while intervention group received 6-week WeChat-based peer supports. Medication compliance and quality-of-life of two groups were evaluated at Month 3/6/12 post-intervention. \u0000 \u0000 \u0000Results \u0000At Month 3 post-intervention, as compared with control group, only non-punctual medication improved significantly in intervention group (P 0.05). However, inter-group quality-of-life was not statistically significant at Month 3/6/12 post-intervention. \u0000 \u0000 \u0000Conclusions \u0000WeChat-based peer supports may partially improve the immediate compliance of patients with liver transplantation. However, long-term outcomes and effects on quality-of-life are worth further researches. \u0000 \u0000 \u0000Key words: \u0000Liver transplantation; Medication; Adherence; WeChat; Peer supports; Quality of life","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88909690","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 : 2019-08-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.08.005
Lixiang Zhao, Z. Huang, Jinfeng Li, Lei Liu, Keke Zhang, Hongchang Xie, Yong-hua Feng, X. Pang, G. Feng
Objective To compare the therapeutic efficacy of plasmapheresis (PP) and intravenous immunoglobulin (IVIG) plus Rituximab for antibody-mediated rejection (AMR) after kidney transplantation. Methods From May 2015 to November 2018, a single-center retrospective cohort study was conducted for 540 recipients with high-resolution HLA undergoing kidney transplantation. According to the criteria of diagnosing AMR and patient selection, 20 patients were selected for PP+ IVIG (group A, n=12), PP+ IVIG+ Rituximab (group B, n=8). The efficacies and outcomes of two groups were compared. Results During a follow-up period of (12.0±5.8) months, no significant inter-group differences existed in basic profiles (P>0.05). After AMR treatment, serum creatinine levels decreased significantly from 283.4 to 226.4 μmol/L in group A (P=0.001) and from 289.4 to 166.6 μmol/L in group B (P=0.049). And the magnitude of decline was more marked in group B (P=0.023). Meanwhile, antibody MFI (log10) decreased from 3.73 to 3.62 in group A (P=0.012) and from 3.57 to 3.02 in group B (P=0.043). At months 3 and 6, serum creatinine level was lower in group B than that in group A (125.0 vs. 166.1 μmol/L, P=0.03; 127.0 vs. 169.0 μmol/L, P=0.048). The serum creatinine levels of AMR patients were 249.8 and 233.8 μmol/L respectively (P=0.182). Serum creatinine levels were 176.1 and 120.3 μmol/L (P=0.045) and 180.2 and 114.8 μmol/L at months 3 and 6 (P=0.044) respectively. Serum creatinine levels were 202.8 and 122.5 μmol/L (P=0.049) in group A and 142.7 and 107.0 μmol/L (P=0.046) in group B respectively. Four recipients developed allograft failure. At month 6 post-operation, AMR occurred in group A (n=3, 25%) and group B (n=1, 12.5%). And the incidence of leucopenia was 37.5% and 0 (P=0.049) in groups A and B respectively. Conclusions PP and IVIG plus rituximab is more efficacious for AMR. The earlier occurring time, the better prognosis. Key words: Kidney transplantation; Antibody-mediated rejection; Plasmapheresis; Intravenous immunoglobulin; Rituximab
{"title":"Therapeutic efficacy of plasmapheresis and intravenous immunoglobulin plus Rituximab for antibody-mediated rejection after kidney transplantation","authors":"Lixiang Zhao, Z. Huang, Jinfeng Li, Lei Liu, Keke Zhang, Hongchang Xie, Yong-hua Feng, X. Pang, G. Feng","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.08.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.08.005","url":null,"abstract":"Objective \u0000To compare the therapeutic efficacy of plasmapheresis (PP) and intravenous immunoglobulin (IVIG) plus Rituximab for antibody-mediated rejection (AMR) after kidney transplantation. \u0000 \u0000 \u0000Methods \u0000From May 2015 to November 2018, a single-center retrospective cohort study was conducted for 540 recipients with high-resolution HLA undergoing kidney transplantation. According to the criteria of diagnosing AMR and patient selection, 20 patients were selected for PP+ IVIG (group A, n=12), PP+ IVIG+ Rituximab (group B, n=8). The efficacies and outcomes of two groups were compared. \u0000 \u0000 \u0000Results \u0000During a follow-up period of (12.0±5.8) months, no significant inter-group differences existed in basic profiles (P>0.05). After AMR treatment, serum creatinine levels decreased significantly from 283.4 to 226.4 μmol/L in group A (P=0.001) and from 289.4 to 166.6 μmol/L in group B (P=0.049). And the magnitude of decline was more marked in group B (P=0.023). Meanwhile, antibody MFI (log10) decreased from 3.73 to 3.62 in group A (P=0.012) and from 3.57 to 3.02 in group B (P=0.043). At months 3 and 6, serum creatinine level was lower in group B than that in group A (125.0 vs. 166.1 μmol/L, P=0.03; 127.0 vs. 169.0 μmol/L, P=0.048). The serum creatinine levels of AMR patients were 249.8 and 233.8 μmol/L respectively (P=0.182). Serum creatinine levels were 176.1 and 120.3 μmol/L (P=0.045) and 180.2 and 114.8 μmol/L at months 3 and 6 (P=0.044) respectively. Serum creatinine levels were 202.8 and 122.5 μmol/L (P=0.049) in group A and 142.7 and 107.0 μmol/L (P=0.046) in group B respectively. Four recipients developed allograft failure. At month 6 post-operation, AMR occurred in group A (n=3, 25%) and group B (n=1, 12.5%). And the incidence of leucopenia was 37.5% and 0 (P=0.049) in groups A and B respectively. \u0000 \u0000 \u0000Conclusions \u0000PP and IVIG plus rituximab is more efficacious for AMR. The earlier occurring time, the better prognosis. \u0000 \u0000 \u0000Key words: \u0000Kidney transplantation; Antibody-mediated rejection; Plasmapheresis; Intravenous immunoglobulin; Rituximab","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86818457","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 relationship between positive rate of de novo donor specific antibody (dnDSA) and human leukocyte antigen (HLA) mismatch after kidney transplantation and explore the impact of dnDSA upon long-term graft survival and rejection. Methods Retrospective analysis was conducted for clinical data of 101 kidney transplant recipients. Based upon HLA antibody and dnDSA, they were divided into three groups of HLA- (n=70), dnDSA- (n=23) and dnDSA+ (n=8). Rejection and graft survival were recorded for evaluating the impact of dnDSA on rejection and graft survival and observing the differences among all groups. Results The mismatchs of HLA-A/B and HLA-DR were more frequent than HLA- and dnDSA- groups(P=0.047, P=0.010)and graft survival was lower in dnDSA+ group than HLA- and dnDSA- groups (P=0.001). The rejection rate was higher in dnDSA+ group (62.5%) than HLA- group (8.57%) and dnDSA- group (8.69%). The difference was statistically significant (P=0.013). Pathological examination indicated microcirculatory inflammation (glomerulonephritis & trichodangiitis) and damage (multilayer change of capillary basement membrane) occurred frequently in dnDSA+ group and C4d remained positive. However, scar, arterial fibrosis or tubulointerstitial inflammation was not correlated with dnDSA. Conclusions HLA mismatch is correlated with dnDSA positivity. And dnDSA may reduce graft survival and enhance rejection rate. Rejection mediated by dnDSA is often accompanied by microcirculatory inflammation and C4d positivity. Key words: Kidney transplantation; Donor specific antibody; Rejection; Graft Survival
目的探讨肾移植术后新生供体特异性抗体(dnDSA)阳性率与人白细胞抗原(HLA)错配的关系，并探讨dnDSA对移植体长期存活和排斥反应的影响。方法对101例肾移植受者的临床资料进行回顾性分析。根据HLA抗体和dnDSA分为HLA-组(n=70)、dnDSA-组(n=23)和dnDSA+组(n=8)。记录排斥反应和移植物存活，评价dnDSA对排斥反应和移植物存活的影响，观察各组间差异。结果HLA- a /B和HLA- dr错配发生率高于HLA-组和dnDSA-组(P=0.047, P=0.010)，且dnDSA+组移植物存活率低于HLA-组和dnDSA-组(P=0.001)。dnDSA+组的排异率(62.5%)高于HLA-组(8.57%)和dnDSA-组(8.69%)。差异有统计学意义(P=0.013)。病理检查显示dnDSA+组微循环炎症(肾小球肾炎、毛纤支炎)及损伤(毛细血管基底膜多层改变)多发，C4d阳性。然而，疤痕、动脉纤维化或小管间质炎症与dnDSA无关。结论HLA错配与dnDSA阳性相关。dnDSA可能降低移植物存活率，提高排异率。dnDSA介导的排斥反应常伴有微循环炎症和C4d阳性。关键词:肾移植;供体特异性抗体;拒绝;移植物存活率
{"title":"De novo donor specific antibody affect the prognosis of kidney transplant recipients: retrospective study","authors":"Z. Sun, Xiaodong Zhang, Xinuo Zhang, Peng Cao, Xing-han Li, Xiang Zheng, Baozhong Yu","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.08.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.08.003","url":null,"abstract":"Objective \u0000To explore the relationship between positive rate of de novo donor specific antibody (dnDSA) and human leukocyte antigen (HLA) mismatch after kidney transplantation and explore the impact of dnDSA upon long-term graft survival and rejection. \u0000 \u0000 \u0000Methods \u0000Retrospective analysis was conducted for clinical data of 101 kidney transplant recipients. Based upon HLA antibody and dnDSA, they were divided into three groups of HLA- (n=70), dnDSA- (n=23) and dnDSA+ (n=8). Rejection and graft survival were recorded for evaluating the impact of dnDSA on rejection and graft survival and observing the differences among all groups. \u0000 \u0000 \u0000Results \u0000The mismatchs of HLA-A/B and HLA-DR were more frequent than HLA- and dnDSA- groups(P=0.047, P=0.010)and graft survival was lower in dnDSA+ group than HLA- and dnDSA- groups (P=0.001). The rejection rate was higher in dnDSA+ group (62.5%) than HLA- group (8.57%) and dnDSA- group (8.69%). The difference was statistically significant (P=0.013). Pathological examination indicated microcirculatory inflammation (glomerulonephritis & trichodangiitis) and damage (multilayer change of capillary basement membrane) occurred frequently in dnDSA+ group and C4d remained positive. However, scar, arterial fibrosis or tubulointerstitial inflammation was not correlated with dnDSA. \u0000 \u0000 \u0000Conclusions \u0000HLA mismatch is correlated with dnDSA positivity. And dnDSA may reduce graft survival and enhance rejection rate. Rejection mediated by dnDSA is often accompanied by microcirculatory inflammation and C4d positivity. \u0000 \u0000 \u0000Key words: \u0000Kidney transplantation; Donor specific antibody; Rejection; Graft Survival","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75759666","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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