Pub Date : 2019-08-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.08.009
H. Ren, W. Shang, Xiaohan Ma, Yongri Cui, L. Ming
Objective To summarize the experiences of diagnosing and treating acute pancreatitis (AP) after kidney transplantation. Methods From September 2007 to December 2017, clinical data were retrospectively analyzed for 12 AP patients after kidney transplantation. Results They were diagnosed as AP within 72 h after an onset of abdominal pain. Among 4 recurrent cases within 1 week post-transplantation, the curative interventions included non-operative therapy (n=2) and peripancreatic puncture & drainage (n=2). AP occurred at 1 year post-transplantation (n=8). Three cases were cured non-surgically while another 5 cases underwent surgery. The procedures included laparoscopic cholecystectomy (n=1), endoscopic retrograde cholangiopancreatography (ERCP) for cholelithiasis (n=1) and peripancreatic puncture & drainage (n=2). One patient died after surgical debridement for adjacent pancreatic tissue. Conclusions After kidney transplantation, the occurrence of AP may be associated with immunosuppressants interfering with triglyceride metabolism and pancreatic microcirculation. For those with cholelithiasis-related pancreatitis, surgical removal of precipitating factor is required. Mini-invasive puncture and drainage are preferred for severe non-gallstone pancreatitis while surgery is performed whenever necessary. Key words: Kidney transplantation; Complication; Acute pancreatitis; Immunosuppressant
{"title":"Management of acute pancreatitis after kidney transplantation: our experiences of 12 patients","authors":"H. Ren, W. Shang, Xiaohan Ma, Yongri Cui, L. Ming","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.08.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.08.009","url":null,"abstract":"Objective \u0000To summarize the experiences of diagnosing and treating acute pancreatitis (AP) after kidney transplantation. \u0000 \u0000 \u0000Methods \u0000From September 2007 to December 2017, clinical data were retrospectively analyzed for 12 AP patients after kidney transplantation. \u0000 \u0000 \u0000Results \u0000They were diagnosed as AP within 72 h after an onset of abdominal pain. Among 4 recurrent cases within 1 week post-transplantation, the curative interventions included non-operative therapy (n=2) and peripancreatic puncture & drainage (n=2). AP occurred at 1 year post-transplantation (n=8). Three cases were cured non-surgically while another 5 cases underwent surgery. The procedures included laparoscopic cholecystectomy (n=1), endoscopic retrograde cholangiopancreatography (ERCP) for cholelithiasis (n=1) and peripancreatic puncture & drainage (n=2). One patient died after surgical debridement for adjacent pancreatic tissue. \u0000 \u0000 \u0000Conclusions \u0000After kidney transplantation, the occurrence of AP may be associated with immunosuppressants interfering with triglyceride metabolism and pancreatic microcirculation. For those with cholelithiasis-related pancreatitis, surgical removal of precipitating factor is required. Mini-invasive puncture and drainage are preferred for severe non-gallstone pancreatitis while surgery is performed whenever necessary. \u0000 \u0000 \u0000Key words: \u0000Kidney transplantation; Complication; Acute pancreatitis; Immunosuppressant","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":"89374418","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 : 2019-07-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.07.007
P. Wan, B. Qiu, M. Feng, F. Xue, Lei-Lei Xia, Yi Luo, L. Gu, Yong-bing Qian, Jianjun Zhang, Q. Xia
Objective To explore the diagnosis and treatment of parvovirus B19 infection-associated anemia after pediatric liver transplantation (LT). Methods The clinical data were retrospectively reviewed for 2 children with severe anemia caused by parvovirus B19 infection after LT. Case 1 was a 2-year-old girl with a weight of 10.7 kg. Classical orthotopic LT was performed due to ornithine carbamoyltransferase deficiency. Hemoglobin level began to progressively decline since Day 2 post-transplantation. And case 2 was a 5-month-old girl with an age of 5 months and a weight of 7.2 kg. She underwent classic orthotopic LT for biliary atresia and decompensated liver cirrhosis. Hemoglobin level progressively declined at nearly 2 months post-transplantation. Results In case 1, bone marrow aspiration was performed at Day 54 post-transplantation. There was pure red cell aplasia and the detection of microvirus B19 nucleic acid was positive. Intravenous immunoglobulin was prescribed at a dose of 2.5 g/day for 10 days, tacrolimus was switched to cyclosporine and hemoglobin level spiked from 62 to 105 g/L after one-month treatment. In case 2, hemoglobin decreased to 44 g/L at 2.5 months post-transplantation and the result of polymerase chain reaction of parvovirus B19 was 9.7×107copies/ml. Then intravenous immunoglobulin was dosed at 2.5 g/day for 10 days and hemoglobin level rose to 122 g/L at 25 days after treatment. Hemoglobin level decreased to 63 g/L again at 4.5 months post-transplantation. Anemia was corrected by intravenous immunoglobulin injection plus a temporary discontinuation of tacrolimus and a reduced dose of tacrolimus. Conclusions Infection of parvovirus B19 can cause pure red cell aplasia after LT in children. Early diagnosis with intravenous immunoglobulin and modification of immunosuppressive regimen can obtain excellent therapeutic efficacies. Key words: liver transplantation; children; parvovirus B19; pure red cell aplasia
{"title":"Two cases of human parvovirus B19 infection-associated anemia after pediatric liver transplantation","authors":"P. Wan, B. Qiu, M. Feng, F. Xue, Lei-Lei Xia, Yi Luo, L. Gu, Yong-bing Qian, Jianjun Zhang, Q. Xia","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.07.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.07.007","url":null,"abstract":"Objective \u0000To explore the diagnosis and treatment of parvovirus B19 infection-associated anemia after pediatric liver transplantation (LT). \u0000 \u0000 \u0000Methods \u0000The clinical data were retrospectively reviewed for 2 children with severe anemia caused by parvovirus B19 infection after LT. Case 1 was a 2-year-old girl with a weight of 10.7 kg. Classical orthotopic LT was performed due to ornithine carbamoyltransferase deficiency. Hemoglobin level began to progressively decline since Day 2 post-transplantation. And case 2 was a 5-month-old girl with an age of 5 months and a weight of 7.2 kg. She underwent classic orthotopic LT for biliary atresia and decompensated liver cirrhosis. Hemoglobin level progressively declined at nearly 2 months post-transplantation. \u0000 \u0000 \u0000Results \u0000In case 1, bone marrow aspiration was performed at Day 54 post-transplantation. There was pure red cell aplasia and the detection of microvirus B19 nucleic acid was positive. Intravenous immunoglobulin was prescribed at a dose of 2.5 g/day for 10 days, tacrolimus was switched to cyclosporine and hemoglobin level spiked from 62 to 105 g/L after one-month treatment. In case 2, hemoglobin decreased to 44 g/L at 2.5 months post-transplantation and the result of polymerase chain reaction of parvovirus B19 was 9.7×107copies/ml. Then intravenous immunoglobulin was dosed at 2.5 g/day for 10 days and hemoglobin level rose to 122 g/L at 25 days after treatment. Hemoglobin level decreased to 63 g/L again at 4.5 months post-transplantation. Anemia was corrected by intravenous immunoglobulin injection plus a temporary discontinuation of tacrolimus and a reduced dose of tacrolimus. \u0000 \u0000 \u0000Conclusions \u0000Infection of parvovirus B19 can cause pure red cell aplasia after LT in children. Early diagnosis with intravenous immunoglobulin and modification of immunosuppressive regimen can obtain excellent therapeutic efficacies. \u0000 \u0000 \u0000Key words: \u0000liver transplantation; children; parvovirus B19; pure red cell aplasia","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80501376","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 : 2019-07-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.07.003
S. Yi, Tong Zhang, B. Fu, Yingcai Zhang, Qing Yang, H. Tang, Laien Song, Ziming Liang, Yang Yang
Objective To explore the clinical and technical essentials of hepatic arterial segmentation and reconstruction during split liver transplantation using pediatric deceased donor. Methods The clinical data were retrospectively analyzed for 15 pediatric deceased donor aged 4.6-16.3 years undergoing split liver transplantation from July 2017 to March 2019. The donors were DBD (donation after brain death, n=13) and DCD(donor after cardiac death, n=2). Thirty split liver transplantations were performed using these 15 pediatric deceased donors. The receptors were adult + child (n=5) and child + child recipients (n=10). According to the Michels’ classification, the clinical types were I (n=13), V (n=1) and VI (n=1). Hepatic arterial segmentation: In type I hepatic arterial type donor liver, proper hepatic artery was retained in right trilobar liver (n=8), low-age (< 7 years) donor liver (n=5), retaining proper hepatic artery in left liver & reconstructing right trilobe directly using right hepatic artery trunk (n=4). Methods of hepatic artery reconstruction: 8-0 Prolene string was utilized under 4.5 times magnifying glass for reconstructing hepatic artery in recipients aged under 4 years. Results Hepatic arterial segmentation and reconstruction were successfully completed. Hepatic arterial thrombosis occurred in 2./25 ecipients. The overall incidence of hepatic arterial complications was 6.67%. Conclusions For reducing the occurrence of arterial complications, arterial segmentation and reconstruction in pediatric deceased donor should be performed according to the size of donor liver and the characteristics of hepatic arterial classification. Key words: Liver transplantation; Hepatic artery; Complication
{"title":"Hepatic arterial segmentation and reconstruction during split liver transplantation using pediatric deceased donor","authors":"S. Yi, Tong Zhang, B. Fu, Yingcai Zhang, Qing Yang, H. Tang, Laien Song, Ziming Liang, Yang Yang","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.07.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.07.003","url":null,"abstract":"Objective \u0000To explore the clinical and technical essentials of hepatic arterial segmentation and reconstruction during split liver transplantation using pediatric deceased donor. \u0000 \u0000 \u0000Methods \u0000The clinical data were retrospectively analyzed for 15 pediatric deceased donor aged 4.6-16.3 years undergoing split liver transplantation from July 2017 to March 2019. The donors were DBD (donation after brain death, n=13) and DCD(donor after cardiac death, n=2). Thirty split liver transplantations were performed using these 15 pediatric deceased donors. The receptors were adult + child (n=5) and child + child recipients (n=10). According to the Michels’ classification, the clinical types were I (n=13), V (n=1) and VI (n=1). Hepatic arterial segmentation: In type I hepatic arterial type donor liver, proper hepatic artery was retained in right trilobar liver (n=8), low-age (< 7 years) donor liver (n=5), retaining proper hepatic artery in left liver & reconstructing right trilobe directly using right hepatic artery trunk (n=4). Methods of hepatic artery reconstruction: 8-0 Prolene string was utilized under 4.5 times magnifying glass for reconstructing hepatic artery in recipients aged under 4 years. \u0000 \u0000 \u0000Results \u0000Hepatic arterial segmentation and reconstruction were successfully completed. Hepatic arterial thrombosis occurred in 2./25 ecipients. The overall incidence of hepatic arterial complications was 6.67%. \u0000 \u0000 \u0000Conclusions \u0000For reducing the occurrence of arterial complications, arterial segmentation and reconstruction in pediatric deceased donor should be performed according to the size of donor liver and the characteristics of hepatic arterial classification. \u0000 \u0000 \u0000Key words: \u0000Liver transplantation; Hepatic artery; Complication","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78913438","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 : 2019-07-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.07.011
Z. Jiao, W. Xue, Maozhu An, Q. Fan, Yang Li, Fenglou Li, Zuohua Zhang
Objective To explore the function and survival of islet grafts during co-transplantation with adipose mesenchymal stem cells (AMSCs) in diabetic mice. Methods After human AMSCs and islet cells were isolated, purified and then subcutaneously co-transplanted into nude mice with diabetes mellitus. Four groups of AMSCs + islet co-transplantation, islet transplantation alone, phosphate buffered solution (PBS) and normal control mice were designated. Islet cell activity and apoptosis/revascularization degree of islet grafts were observed by immunohistochemical double staining of insulin, factor associated suicide (Fas) and CD31 antibody. The blood glucose and serum insulin levels of mice and the survival time of islet grafts were compared. Results The blood glucose and serum insulin levels of diabetic mice analyzed by multivariate analysis in AMSCs + islet co-transplantation group were better than those in islet transplantation alone group (P<0.05). The mean survival time (MST) of islet grafts was longer in AMSCs + islet co-transplantation group than that in islet transplantation alone group [(81.33±7.58) vs. (58.17±6.91) days] (P<0.05). At Day 7 post-transplantation, insulin staining intensity of islet grafts was higher in AMSCs + islet co-transplantation group than that in islet transplantation alone group while Fas staining intensity of islet grafts was lower. And mean microvascular density (MVD) of islet grafts per square millimeter was higher in AMSCs + islet co-transplantation group than that in islet transplantation alone group [(21.8±5.6) vs. (14.6±4.1)] (P<0.05). Conclusions Co-transplantation with AMSCs may improve the function of islet grafts, prolong its survival and promote its revascularization. Key words: Islet of Langerhans transplantation; Adipose mesenchymal stem cells; Diabetes mellitus
{"title":"Adipose mesenchymal stem cells promote the function and survival of islet graft during co-transplantation","authors":"Z. Jiao, W. Xue, Maozhu An, Q. Fan, Yang Li, Fenglou Li, Zuohua Zhang","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.07.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.07.011","url":null,"abstract":"Objective \u0000To explore the function and survival of islet grafts during co-transplantation with adipose mesenchymal stem cells (AMSCs) in diabetic mice. \u0000 \u0000 \u0000Methods \u0000After human AMSCs and islet cells were isolated, purified and then subcutaneously co-transplanted into nude mice with diabetes mellitus. Four groups of AMSCs + islet co-transplantation, islet transplantation alone, phosphate buffered solution (PBS) and normal control mice were designated. Islet cell activity and apoptosis/revascularization degree of islet grafts were observed by immunohistochemical double staining of insulin, factor associated suicide (Fas) and CD31 antibody. The blood glucose and serum insulin levels of mice and the survival time of islet grafts were compared. \u0000 \u0000 \u0000Results \u0000The blood glucose and serum insulin levels of diabetic mice analyzed by multivariate analysis in AMSCs + islet co-transplantation group were better than those in islet transplantation alone group (P<0.05). The mean survival time (MST) of islet grafts was longer in AMSCs + islet co-transplantation group than that in islet transplantation alone group [(81.33±7.58) vs. (58.17±6.91) days] (P<0.05). At Day 7 post-transplantation, insulin staining intensity of islet grafts was higher in AMSCs + islet co-transplantation group than that in islet transplantation alone group while Fas staining intensity of islet grafts was lower. And mean microvascular density (MVD) of islet grafts per square millimeter was higher in AMSCs + islet co-transplantation group than that in islet transplantation alone group [(21.8±5.6) vs. (14.6±4.1)] (P<0.05). \u0000 \u0000 \u0000Conclusions \u0000Co-transplantation with AMSCs may improve the function of islet grafts, prolong its survival and promote its revascularization. \u0000 \u0000 \u0000Key words: \u0000Islet of Langerhans transplantation; Adipose mesenchymal stem cells; Diabetes mellitus","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90267232","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 : 2019-07-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.07.010
Yushan Kong, Zao-Xuan Wu, K. Tian, G. Gu, Lijuan Li
Objective To explore the clinical characteristics, diagnosis, treatment and prognosis of parainfluenza virus (PIV) pneumonia after lung transplantation. Methods One case of PIV pneumonia after lung transplantation was retrospectively analyzed. The relevant domestic and foreign cases and literature review were summarized. Results The recipient underwent sequential bilateral lung transplantation for chronic obstructive pulmonary disease, bullae and respiratory failure. Donor lung was sourced from donation after cardiac death. Routine anti-rejection therapy was prescribed postoperatively. At 14 months, cough and shortness of breath lead to hospitalization for over 1 month. At 15 months, sputum/fungal smear and culture showed that nucleic acid of PIV was positive. The definite diagnosis was PIV pneumonia after lung transplantation. After ribavirin antiviral therapy, tracheal intubation and invasive ventilation, followed by imipenem plus doxycycline plus anti-infective therapy, ganciclovir antiviral therapy, repeated bronchoscopic sputum aspiration and lavage treatment, the patient's condition deteriorated and died from breathing failure and septic shock at 16 months. Conclusions Preventing PIV infection after lung transplantation is of vital importance. PCR is essential for a rapid detection of virus infection. However, there is no curative treatment of PIV infection. Specific parainfluenza immunoglobulin and DAS181 aerosol inhalation may be applied for future treatment of PIV infection in lung transplant recipients. Key words: Lung transplantation; Parainfluenza virus; Pneumonia
{"title":"Parainfluenza virus pneumonia after lung transplantation: a case report and literature review","authors":"Yushan Kong, Zao-Xuan Wu, K. Tian, G. Gu, Lijuan Li","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.07.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.07.010","url":null,"abstract":"Objective \u0000To explore the clinical characteristics, diagnosis, treatment and prognosis of parainfluenza virus (PIV) pneumonia after lung transplantation. \u0000 \u0000 \u0000Methods \u0000One case of PIV pneumonia after lung transplantation was retrospectively analyzed. The relevant domestic and foreign cases and literature review were summarized. \u0000 \u0000 \u0000Results \u0000The recipient underwent sequential bilateral lung transplantation for chronic obstructive pulmonary disease, bullae and respiratory failure. Donor lung was sourced from donation after cardiac death. Routine anti-rejection therapy was prescribed postoperatively. At 14 months, cough and shortness of breath lead to hospitalization for over 1 month. At 15 months, sputum/fungal smear and culture showed that nucleic acid of PIV was positive. The definite diagnosis was PIV pneumonia after lung transplantation. After ribavirin antiviral therapy, tracheal intubation and invasive ventilation, followed by imipenem plus doxycycline plus anti-infective therapy, ganciclovir antiviral therapy, repeated bronchoscopic sputum aspiration and lavage treatment, the patient's condition deteriorated and died from breathing failure and septic shock at 16 months. \u0000 \u0000 \u0000Conclusions \u0000Preventing PIV infection after lung transplantation is of vital importance. PCR is essential for a rapid detection of virus infection. However, there is no curative treatment of PIV infection. Specific parainfluenza immunoglobulin and DAS181 aerosol inhalation may be applied for future treatment of PIV infection in lung transplant recipients. \u0000 \u0000 \u0000Key words: \u0000Lung transplantation; Parainfluenza virus; Pneumonia","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76738171","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 : 2019-07-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.07.002
Zhuolun Song, N. Ma, C. Dong, Xing-chu Meng, Chao Sun, H. Qin, C. Han, Yang Yang, Fubo Zhang, Weiping Zheng
Objective To evaluate the feasibility and safety of using pediatric donation after brain death donors during split liver transplantation. Methods The clinical data were retrospectively reviewed for 8 pediatric recipients undergoing split liver transplantation with a donor age of 2.7-7 years. The clinical characteristics of donors/recipients, perioperative course, postoperative recovery and complications along with graft and recipient survival rate were analyzed. Results The split procedure was performed ex situ (n=3) and in situ (n=1), all liver grafts were split into left lateral lobes and extended right lobes. The recipients were children aged 4.7-105.5 months. The mean follow-up period was (8.1±0.6) months and the graft/recipient survival rates approached 100%. Graft functions remained normal in all recipients at the end of follow-ups. Two recipients undergoing liver grafting with long cold ischemia time exhibited slower recovery of graft function. Pathological examination of graft biopsy indicated ischemic and hypoxic changes. Portal vein stenosis occurred in one recipient. Percutaneous transhepatic portal vein balloon dilatation was performed and the recipient recovered well. Cytomegalovirus infection occurred in 5/8 recipients and serum virological marker returned to normal after ganciclovir therapy. The youngest donor age was 2.7 years and both recipients of donor liver recovered well. Conclusions Split liver transplantation with a donor age of 2.7-7.0 years may achieve ideal clinical outcomes in well-matched donors and recipients. Key words: Liver transplantation; Brain death; Child
{"title":"Application of pediatric donation after brain death donors during split liver transplantation: an analysis of 8 cases","authors":"Zhuolun Song, N. Ma, C. Dong, Xing-chu Meng, Chao Sun, H. Qin, C. Han, Yang Yang, Fubo Zhang, Weiping Zheng","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.07.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.07.002","url":null,"abstract":"Objective \u0000To evaluate the feasibility and safety of using pediatric donation after brain death donors during split liver transplantation. \u0000 \u0000 \u0000Methods \u0000The clinical data were retrospectively reviewed for 8 pediatric recipients undergoing split liver transplantation with a donor age of 2.7-7 years. The clinical characteristics of donors/recipients, perioperative course, postoperative recovery and complications along with graft and recipient survival rate were analyzed. \u0000 \u0000 \u0000Results \u0000The split procedure was performed ex situ (n=3) and in situ (n=1), all liver grafts were split into left lateral lobes and extended right lobes. The recipients were children aged 4.7-105.5 months. The mean follow-up period was (8.1±0.6) months and the graft/recipient survival rates approached 100%. Graft functions remained normal in all recipients at the end of follow-ups. Two recipients undergoing liver grafting with long cold ischemia time exhibited slower recovery of graft function. Pathological examination of graft biopsy indicated ischemic and hypoxic changes. Portal vein stenosis occurred in one recipient. Percutaneous transhepatic portal vein balloon dilatation was performed and the recipient recovered well. Cytomegalovirus infection occurred in 5/8 recipients and serum virological marker returned to normal after ganciclovir therapy. The youngest donor age was 2.7 years and both recipients of donor liver recovered well. \u0000 \u0000 \u0000Conclusions \u0000Split liver transplantation with a donor age of 2.7-7.0 years may achieve ideal clinical outcomes in well-matched donors and recipients. \u0000 \u0000 \u0000Key words: \u0000Liver transplantation; Brain death; Child","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79701059","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 : 2019-07-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.07.004
M. Feng, Chengpeng Zhong, B. Qiu, P. Wan, Lei-Lei Xia, Yi Luo, L. Gu, J. Chi, Ye-feng Lu, Jianjun Zhang, Q. Xia
Objective To explore the experience of infantile liver transplantation, reconstructing portal vein (PV) and avoid the higher incidence of portal vein low flow and complications. Methods The clinical data were reviewed for 152 infantile liver transplantations performed by a single surgery group. And 114 cases with PV risk factors underwent customized PV reconstructions. All of them were diagnosed as cholestatic liver diseases and 106 (93%) belonged to biliary atresia. Forty-two cases (36%) had 2 or more risk factors. Results Most cases (n=106, 93%) underwent living donor transplantations using lateral left graft while another 8 cases had deceased donor transplantations. Four types of PV reconstructions were adopted based upon individual conditions: left/right branch of PV trunk (n=103), autogenous patch PV venoplastic reconstruction (n=3), duct-to-duct of PV trunk (n=5) and donor PV duct-to-recipient confluence of SMV/CV and SV (n=3). Graft size reduction was performed when GRWR>4.5% (n=16). During a median follow-up period of 6.5 (1.5-13) months, there were 3 LPVF (2.6%), 2PVS (1.7%) and 1 PVT (0.8%). Three LPVF cases was corrected by PV stenting, two cases of PVS were stable after anticoagulation therapy while one PVT case undergoing thromboectomy plus PV stenting resumed a normal PV flow. Conclusions PV reconstruction of high-risk infants require comprehensive risk evaluations, precise surgical skills and customized strategies. For PV complications, stenting is both safe and feasible. Key words: Liver transplantation; Portal vein; Anastomosis, surgical
{"title":"Portal vein reconstruction in high risk infantile liver transplantation","authors":"M. Feng, Chengpeng Zhong, B. Qiu, P. Wan, Lei-Lei Xia, Yi Luo, L. Gu, J. Chi, Ye-feng Lu, Jianjun Zhang, Q. Xia","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.07.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.07.004","url":null,"abstract":"Objective \u0000To explore the experience of infantile liver transplantation, reconstructing portal vein (PV) and avoid the higher incidence of portal vein low flow and complications. \u0000 \u0000 \u0000Methods \u0000The clinical data were reviewed for 152 infantile liver transplantations performed by a single surgery group. And 114 cases with PV risk factors underwent customized PV reconstructions. All of them were diagnosed as cholestatic liver diseases and 106 (93%) belonged to biliary atresia. Forty-two cases (36%) had 2 or more risk factors. \u0000 \u0000 \u0000Results \u0000Most cases (n=106, 93%) underwent living donor transplantations using lateral left graft while another 8 cases had deceased donor transplantations. Four types of PV reconstructions were adopted based upon individual conditions: left/right branch of PV trunk (n=103), autogenous patch PV venoplastic reconstruction (n=3), duct-to-duct of PV trunk (n=5) and donor PV duct-to-recipient confluence of SMV/CV and SV (n=3). Graft size reduction was performed when GRWR>4.5% (n=16). During a median follow-up period of 6.5 (1.5-13) months, there were 3 LPVF (2.6%), 2PVS (1.7%) and 1 PVT (0.8%). Three LPVF cases was corrected by PV stenting, two cases of PVS were stable after anticoagulation therapy while one PVT case undergoing thromboectomy plus PV stenting resumed a normal PV flow. \u0000 \u0000 \u0000Conclusions \u0000PV reconstruction of high-risk infants require comprehensive risk evaluations, precise surgical skills and customized strategies. For PV complications, stenting is both safe and feasible. \u0000 \u0000 \u0000Key words: \u0000Liver transplantation; Portal vein; Anastomosis, surgical","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86164178","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 : 2019-07-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.07.008
Dawei Zhou, J. Liang, Yanfeng Wang, G. Peng, Shaojun Ye, Z. Xia, Xiaoyan Hu
Objective To explore the effects of donor/recipients’ gender on delayed graft function (DGF). Methods A retrospective analysis was performed for clinical data of donors (n=174) and recipients (n=265) during renal transplantation between May 1, 2012 and December 31, 2017. Types of China donation after citizen's death, age, last creatinine level, height, weight, body mass index (BMI) and protopathy of donors were collected. And pre-dialysis method, dialysis time, HLA mismatch, post-creatine at Day 7, whether dialysis after transplantation, height, weight and BMI of recipients were analyzed. The data were checked by t and chi square tests and P<0.05 was deemed as statistically significant. Results Donor gender had no correlation with DGF occurrence rate (P=0.689) while DGF occurrence rate among female recipients was evidently lower than that among males (P=0.036); Female recipients selected peritoneal dialysis therapy more than male recipients (P=0.023); Cerebral hemorrhage female donors were more than male donors (P=0.034); BMI (P<0.001) and postoperative creatinine (P=0.001) among female recipients were evidently lower than that among males. Conclusions DGF occurrence rate is significantly lower among female receptors than that among males after kidney transplantation. Key words: Kidney transplantation; Gender; Estrogen
{"title":"Clinical retrospective analysis in delayed graft function morbidity of kidney transplantation recipients and gender factors in both donors and recipients","authors":"Dawei Zhou, J. Liang, Yanfeng Wang, G. Peng, Shaojun Ye, Z. Xia, Xiaoyan Hu","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.07.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.07.008","url":null,"abstract":"Objective \u0000To explore the effects of donor/recipients’ gender on delayed graft function (DGF). \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was performed for clinical data of donors (n=174) and recipients (n=265) during renal transplantation between May 1, 2012 and December 31, 2017. Types of China donation after citizen's death, age, last creatinine level, height, weight, body mass index (BMI) and protopathy of donors were collected. And pre-dialysis method, dialysis time, HLA mismatch, post-creatine at Day 7, whether dialysis after transplantation, height, weight and BMI of recipients were analyzed. The data were checked by t and chi square tests and P<0.05 was deemed as statistically significant. \u0000 \u0000 \u0000Results \u0000Donor gender had no correlation with DGF occurrence rate (P=0.689) while DGF occurrence rate among female recipients was evidently lower than that among males (P=0.036); Female recipients selected peritoneal dialysis therapy more than male recipients (P=0.023); Cerebral hemorrhage female donors were more than male donors (P=0.034); BMI (P<0.001) and postoperative creatinine (P=0.001) among female recipients were evidently lower than that among males. \u0000 \u0000 \u0000Conclusions \u0000DGF occurrence rate is significantly lower among female receptors than that among males after kidney transplantation. \u0000 \u0000 \u0000Key words: \u0000Kidney transplantation; Gender; Estrogen","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77873717","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 : 2019-07-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.07.006
Jing-Yi Liu, Liying Sun, Zhi-jun Zhu, Lin Wei, Y. Liu, Z. Zeng, W. Qu, E. He, R. Xu
Objective To retrospectively explore the clinical symptoms, diagnosis, treatment and prognosis of posttransplant lymphoproliferative disorder (PTLD) after pediatric liver transplantation. Methods The diagnosis and treatment of PTLD were reviewed for 3 children recipient with living donor liver transplantation. Their primary diseases were biliary atresia, glycogen storage disease type III and ornithine-transcarbamylase deficiency. All of them received FK506 for immunosuppression therapy. They were diagnosed as PTLD at 7, 8, 6 months post-operation respectively. Their major clinical manifestations were non-specific, including fever, diarrhea and anemia. Positron emission tomography/computed tomography (PET/CT) and ultrasound revealed enlarged mesenteric lymph nodes with neck lymphoadenopathy (n=2). Pathological examinations of resected enlarged lymph nodes indicated post-transplantation lymphoproliferative disorder. One case was diffuse large B cell lymphoma and two of them belonged to preliminary EBER+ . Results After a definite diagnosis, there was one cycle of R-CHOP regimen (rituximab, cyclophosphamide, pirarubicin, vincristine, dexamethasone) or 2 cycles of rituximab along with a. reduction of anti-rejection drug and they stayed in remission. Three were followed up for 37, 39 and 20 months respectively from May 31, 2019. Currently transplanted liver function was stable and EBV viral load remained negative persistently. Conclusions This case highlights the complexity of clinical presentations and co-morbidities of PTLD. Reducing immunosuppressive agents and using rituximab plus chemotherapy can achieve a satisfactory efficacy for Epstein-Barr virus-related PTLD patients after pediatric liver transplantation. Key words: Liver transplantation; Lymphoproliferative disorder; Epstein-Barr virus
{"title":"Diagnosis and treatment of posttransplant lymphoproliferative disorder after pediatric liver transplantation","authors":"Jing-Yi Liu, Liying Sun, Zhi-jun Zhu, Lin Wei, Y. Liu, Z. Zeng, W. Qu, E. He, R. Xu","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.07.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.07.006","url":null,"abstract":"Objective \u0000To retrospectively explore the clinical symptoms, diagnosis, treatment and prognosis of posttransplant lymphoproliferative disorder (PTLD) after pediatric liver transplantation. \u0000 \u0000 \u0000Methods \u0000The diagnosis and treatment of PTLD were reviewed for 3 children recipient with living donor liver transplantation. Their primary diseases were biliary atresia, glycogen storage disease type III and ornithine-transcarbamylase deficiency. All of them received FK506 for immunosuppression therapy. They were diagnosed as PTLD at 7, 8, 6 months post-operation respectively. Their major clinical manifestations were non-specific, including fever, diarrhea and anemia. Positron emission tomography/computed tomography (PET/CT) and ultrasound revealed enlarged mesenteric lymph nodes with neck lymphoadenopathy (n=2). Pathological examinations of resected enlarged lymph nodes indicated post-transplantation lymphoproliferative disorder. One case was diffuse large B cell lymphoma and two of them belonged to preliminary EBER+ . \u0000 \u0000 \u0000Results \u0000After a definite diagnosis, there was one cycle of R-CHOP regimen (rituximab, cyclophosphamide, pirarubicin, vincristine, dexamethasone) or 2 cycles of rituximab along with a. reduction of anti-rejection drug and they stayed in remission. Three were followed up for 37, 39 and 20 months respectively from May 31, 2019. Currently transplanted liver function was stable and EBV viral load remained negative persistently. \u0000 \u0000 \u0000Conclusions \u0000This case highlights the complexity of clinical presentations and co-morbidities of PTLD. Reducing immunosuppressive agents and using rituximab plus chemotherapy can achieve a satisfactory efficacy for Epstein-Barr virus-related PTLD patients after pediatric liver transplantation. \u0000 \u0000 \u0000Key words: \u0000Liver transplantation; Lymphoproliferative disorder; Epstein-Barr virus","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80502704","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 : 2019-07-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.07.009
Z. Guan, Jien-Wei Liu, L. Qian, L. Yin, Yan Tian
Objective To explore the efficacy and safety of two antibody induction therapies during donor after cardiac death (DCD) kidney transplantation. Methods Retrospective analysis was performed for the clinical data of DCD kidney patients in 2016. Patients using basiliximab monoclonal or thymoglobulin (ATG) polyclonal antibody were divided into two groups. Early postoperative biopsy proven, acute rejection rate, creatinine level and patient/graft survival rate were compared between two groups at 1, 3 or 6 month post-operation. Results Basiliximab (n=44) and ATG (n=60) was used as induction. No significant inter-group difference existed in donor age, primary disease, creatinine pre-donation, recipient age or cause of renal failure. And recipient male ratio and body weight were greater in ATG group than those in basiliximab group [87% vs. 55%; (70±13) vs. (64±12) kg]. Outcomes of basiliximab group showed acute rejection rate was 9%, average creatinine 112.4 at 1 month, 127.0 at 3 months and 107.8 at 6 months and total infection rate 16%. Graft/patient 6-month survival rates were 95%(42/44)and 98%(43/44). Outcomes of ATG group showed that acute rejection rate was 3%, average creatinine 135.6 at 1 month, 119.0 at 3 months and 118.0 at 6 months and total infection rate 22%. Graft/patient 6-month survival rates were both 100% (60/60). Conclusions During DCD kidney transplantation, both induction therapies may prevent acute rejection immediately post-operation. No difference exists in acute rejection rate, infection rate, graft/recipient 6-month survival rate or graft function. These two inductions have an excellent early prognosis. Key words: Kidney transplantation; Monoclonal antibody; Acute rejection
{"title":"Comparative study of induction therapy during kidney transplantation","authors":"Z. Guan, Jien-Wei Liu, L. Qian, L. Yin, Yan Tian","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.07.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.07.009","url":null,"abstract":"Objective \u0000To explore the efficacy and safety of two antibody induction therapies during donor after cardiac death (DCD) kidney transplantation. \u0000 \u0000 \u0000Methods \u0000Retrospective analysis was performed for the clinical data of DCD kidney patients in 2016. Patients using basiliximab monoclonal or thymoglobulin (ATG) polyclonal antibody were divided into two groups. Early postoperative biopsy proven, acute rejection rate, creatinine level and patient/graft survival rate were compared between two groups at 1, 3 or 6 month post-operation. \u0000 \u0000 \u0000Results \u0000Basiliximab (n=44) and ATG (n=60) was used as induction. No significant inter-group difference existed in donor age, primary disease, creatinine pre-donation, recipient age or cause of renal failure. And recipient male ratio and body weight were greater in ATG group than those in basiliximab group [87% vs. 55%; (70±13) vs. (64±12) kg]. Outcomes of basiliximab group showed acute rejection rate was 9%, average creatinine 112.4 at 1 month, 127.0 at 3 months and 107.8 at 6 months and total infection rate 16%. Graft/patient 6-month survival rates were 95%(42/44)and 98%(43/44). Outcomes of ATG group showed that acute rejection rate was 3%, average creatinine 135.6 at 1 month, 119.0 at 3 months and 118.0 at 6 months and total infection rate 22%. Graft/patient 6-month survival rates were both 100% (60/60). \u0000 \u0000 \u0000Conclusions \u0000During DCD kidney transplantation, both induction therapies may prevent acute rejection immediately post-operation. No difference exists in acute rejection rate, infection rate, graft/recipient 6-month survival rate or graft function. These two inductions have an excellent early prognosis. \u0000 \u0000 \u0000Key words: \u0000Kidney transplantation; Monoclonal antibody; Acute rejection","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77154102","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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