Pub Date : 2019-06-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.06.008
Ping Li, Yiyao Tu, S. Liang, Feng Xu, D. Liang, Jingsong Chen, Zhihong Liu
Objective To summarize the pathological survey of time-zero renal biopsy (T0-RBx). Methods The material qualities and pathological features were analyzed retrospectively for T0-RBx (n=176) between March 2008 and May 2016. According to the source of donor kidney, T0-RBx specimens were divided into living donors (LD) group (n=137) and Deceased donation (DD) group (n=39). Furthermore, the DD group was divided into cerebral hemorrhage group (n=10) and brain trauma group (n=29) according to the causes of death. The inter-group differences of pathological characteristics and the effects of abnormal pathological lesions on allograft function were observed. Results All T0-RBx specimens contained cortical kidney tissue. The average microscopic length of renal tissue was (0.39±0.23) cm and the median glomerular number 11. The abnormal pathological lesions included glomerulosclerosis (GS, 30.7 %), segmental glomerulosclerosis (1.1 %), mesangial increase (MI, 19.3 %), tubular atrophy (TA, 35.2 %), acute tubular necrosis (ATN, 9.1 %), vacuolar degeneration of tubular epithelium (27.3 %), losses in tubule epithelial brush border (97.7 %), protein cast (25 %), interstitial fibrosis (IF, 34.1 %), inflammation (I, 42.6 %), arteriolar hyalinosis (AH) (26.1 %) and vascular fibrous intimal thickening (CV, 23.3 %). Among them, 23.9 %, 1.1 %, 0.55 % and 0.55 % cases were diagnosed as IgA nephropathy, immune complex associated with glomerular disease and focal segmental glomerulosclerosis diabetic nephropathy respectively. And the reminders were of ischemic injury. The incidence rates of TA, IF and I were lower in DD group than those in LD group (P 0.05). Further analysis showed GS was related with allograft function at 6/12 months post-transplantation in both LD and DD groups (P 0.05). Conclusions T0-RBx may detect the abnormal lesions of donor kidney. Some differences exist in types and degree of abnormal lesions among different donor kidneys. LD group has a higher risk for chronic histological injury such as TA and IF while DD group is more susceptible to acute renal tubular interstitial injury. Thus it is valuable for predicting allograft function post-transplantation. Material quality is essential for ensuring the reliability of T0-RBx. Key words: Renal transplantation; Living related donor; Fine-needle aspiration biopsy; Docoased donation
{"title":"Pathological analysis of time-zero renal biopsy in donor kidney","authors":"Ping Li, Yiyao Tu, S. Liang, Feng Xu, D. Liang, Jingsong Chen, Zhihong Liu","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.06.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.06.008","url":null,"abstract":"Objective \u0000To summarize the pathological survey of time-zero renal biopsy (T0-RBx). \u0000 \u0000 \u0000Methods \u0000The material qualities and pathological features were analyzed retrospectively for T0-RBx (n=176) between March 2008 and May 2016. According to the source of donor kidney, T0-RBx specimens were divided into living donors (LD) group (n=137) and Deceased donation (DD) group (n=39). Furthermore, the DD group was divided into cerebral hemorrhage group (n=10) and brain trauma group (n=29) according to the causes of death. The inter-group differences of pathological characteristics and the effects of abnormal pathological lesions on allograft function were observed. \u0000 \u0000 \u0000Results \u0000All T0-RBx specimens contained cortical kidney tissue. The average microscopic length of renal tissue was (0.39±0.23) cm and the median glomerular number 11. The abnormal pathological lesions included glomerulosclerosis (GS, 30.7 %), segmental glomerulosclerosis (1.1 %), mesangial increase (MI, 19.3 %), tubular atrophy (TA, 35.2 %), acute tubular necrosis (ATN, 9.1 %), vacuolar degeneration of tubular epithelium (27.3 %), losses in tubule epithelial brush border (97.7 %), protein cast (25 %), interstitial fibrosis (IF, 34.1 %), inflammation (I, 42.6 %), arteriolar hyalinosis (AH) (26.1 %) and vascular fibrous intimal thickening (CV, 23.3 %). Among them, 23.9 %, 1.1 %, 0.55 % and 0.55 % cases were diagnosed as IgA nephropathy, immune complex associated with glomerular disease and focal segmental glomerulosclerosis diabetic nephropathy respectively. And the reminders were of ischemic injury. The incidence rates of TA, IF and I were lower in DD group than those in LD group (P 0.05). Further analysis showed GS was related with allograft function at 6/12 months post-transplantation in both LD and DD groups (P 0.05). \u0000 \u0000 \u0000Conclusions \u0000T0-RBx may detect the abnormal lesions of donor kidney. Some differences exist in types and degree of abnormal lesions among different donor kidneys. LD group has a higher risk for chronic histological injury such as TA and IF while DD group is more susceptible to acute renal tubular interstitial injury. Thus it is valuable for predicting allograft function post-transplantation. Material quality is essential for ensuring the reliability of T0-RBx. \u0000 \u0000 \u0000Key words: \u0000Renal transplantation; Living related donor; Fine-needle aspiration biopsy; Docoased donation","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":"24 1","pages":"355-360"},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77412289","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 : 2019-05-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.05.005
Xia Lu, N. Gong, F. Zeng, Z. Chen, Zhishui Chen
Objective To explore the influencing factors and treatment strategies of long-term survival after simultaneous pancreas and kidney transplantation (SPK). Methods One case of long-term post-SPK survival was reviewed and its influencing factors were analyzed along with the relevant literature. Results At 10 years post-SPK, the patient lost transplanted kidney due to rejection and underwent secondary kidney transplantation. The transplanted pancreas functioned well and has survived for more than 18 years. Conclusions Strict preoperative screening, adopting mature surgical approaches, aggressive managements of various perioperative complications, strengthening of health education of recipients, improving of compliance and long-term regular follow-ups are conducive for enhancing long-term survival of recipients and grafts of SPK. Key words: Simultaneous pancreas and kidney transplantation; Diabetic nephropathy; Rejection; Regular follow-up
{"title":"A case report of transplanted pancreas survival longer than 18 years after simultaneous pancreas-kidney transplantation and literature review","authors":"Xia Lu, N. Gong, F. Zeng, Z. Chen, Zhishui Chen","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.05.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.05.005","url":null,"abstract":"Objective \u0000To explore the influencing factors and treatment strategies of long-term survival after simultaneous pancreas and kidney transplantation (SPK). \u0000 \u0000 \u0000Methods \u0000One case of long-term post-SPK survival was reviewed and its influencing factors were analyzed along with the relevant literature. \u0000 \u0000 \u0000Results \u0000At 10 years post-SPK, the patient lost transplanted kidney due to rejection and underwent secondary kidney transplantation. The transplanted pancreas functioned well and has survived for more than 18 years. \u0000 \u0000 \u0000Conclusions \u0000Strict preoperative screening, adopting mature surgical approaches, aggressive managements of various perioperative complications, strengthening of health education of recipients, improving of compliance and long-term regular follow-ups are conducive for enhancing long-term survival of recipients and grafts of SPK. \u0000 \u0000 \u0000Key words: \u0000Simultaneous pancreas and kidney transplantation; Diabetic nephropathy; Rejection; Regular follow-up","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":"20 1","pages":"277-279"},"PeriodicalIF":0.0,"publicationDate":"2019-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75225364","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 : 2019-05-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.05.004
Shengsheng Ren, Liangliang Xu, T. Song, Ming Zhang, Tao Lin, Mingqing Xu, Shifeng Li
Objective To reduce the perioperative complications of simultaneous pancreas and kidney transplantation (SPK) and boost the clinical efficacy by exploring its perioperative management in diabetics with end-stage renal disease. Methods Retrospective analysis was performed for the clinical data of 5 diabetics with end-stage renal disease undergoing SPK since 2017. Results The cold ischemic time of all allografts was under 8 hours. No surgical complications occurred in recipients post-transplantation. Two patients were complicated with hyperkalemia and their serum potassium levels normalized after treatment. One case of bleeding in abdominal cavity was cured conservatively. Renal functions of two patients with delayed renal function post-transplantation gradually recovered after hematodialysis. One case of peritransplant fluid collection recovered after debridement and drainage. Another case of acute left heart failure and cardiac arrest at 45 days post-transplantation resumed normal heart rhythm after rescue. However, his consciousness could not be restored and his families gave up subsequent treatments. Transplanted kidneys and pancreases of these 4 patients normalized. Follow-up was conducted until March 20, 2019. They became insulin and dialysis independent and serum creatinine and blood glucose normalized. Diabetic complications were relieved and their quality-of-life also improved significantly. Conclusions SPK is an effective treatment for diabetics with end-stage renal disease. While maintaining normal serum creatinine and blood glucose, it may liberate patients from insulin dosing and dialytic maintenance, lower diabetic complications and improve quality-of-life. Key words: Simultaneous pancreas and kidney transplantation (SPK); Diabetes; End-stage renal disease; Perioperative management.
{"title":"Simultaneous pancreas and kidney transplantation for 5 patients with diabetesplus end-stage renal disease","authors":"Shengsheng Ren, Liangliang Xu, T. Song, Ming Zhang, Tao Lin, Mingqing Xu, Shifeng Li","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.05.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.05.004","url":null,"abstract":"Objective \u0000To reduce the perioperative complications of simultaneous pancreas and kidney transplantation (SPK) and boost the clinical efficacy by exploring its perioperative management in diabetics with end-stage renal disease. \u0000 \u0000 \u0000Methods \u0000Retrospective analysis was performed for the clinical data of 5 diabetics with end-stage renal disease undergoing SPK since 2017. \u0000 \u0000 \u0000Results \u0000The cold ischemic time of all allografts was under 8 hours. No surgical complications occurred in recipients post-transplantation. Two patients were complicated with hyperkalemia and their serum potassium levels normalized after treatment. One case of bleeding in abdominal cavity was cured conservatively. Renal functions of two patients with delayed renal function post-transplantation gradually recovered after hematodialysis. One case of peritransplant fluid collection recovered after debridement and drainage. Another case of acute left heart failure and cardiac arrest at 45 days post-transplantation resumed normal heart rhythm after rescue. However, his consciousness could not be restored and his families gave up subsequent treatments. Transplanted kidneys and pancreases of these 4 patients normalized. Follow-up was conducted until March 20, 2019. They became insulin and dialysis independent and serum creatinine and blood glucose normalized. Diabetic complications were relieved and their quality-of-life also improved significantly. \u0000 \u0000 \u0000Conclusions \u0000SPK is an effective treatment for diabetics with end-stage renal disease. While maintaining normal serum creatinine and blood glucose, it may liberate patients from insulin dosing and dialytic maintenance, lower diabetic complications and improve quality-of-life. \u0000 \u0000 \u0000Key words: \u0000Simultaneous pancreas and kidney transplantation (SPK); Diabetes; End-stage renal disease; Perioperative management.","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":"98 1","pages":"272-276"},"PeriodicalIF":0.0,"publicationDate":"2019-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78384182","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 : 2019-05-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.05.009
Mingkun Zhao, Chuansheng Xu, Feng Wang
Objective To explore the functions of extracorporeal membrane oxygenation (ECMO) with continuous renal replacement therapy (CRRT) for potential organ donors with cardiopulmonary failure after brain death and boost the coefficient of utilization of livers. Methods Analysis was conducted for clinical data of 5 donors with cardiopulmonary failure after brain death and their corresponding recipients from July 2015 to May 2017. Five donors received the treatments of ECMO and CRRT. The relevant data included changes of blood pressure, dosage of vasoactive agents, liver function, renal function and urine volume of those treated donors. Also liver functions of liver recipients were observed. Then the clinical data of 18 normal DBD and their liver recipients were compared. Results After ECMO/CRRT, donor blood pressures rose and the doses of vasoactive agents decreased. Meanwhile urine volume also increased. Finally 4/5 livers could be transplanted. And 10 kidneys were transplanted successfully. There was no significant inter-group difference of liver function. Conclusions The applications of ECMO and CRRT improve liver function of donors with cardiopulmonary failure after brain death and boost the rates of organ donation and utilization. Key words: Extracorporeal membrane oxygenation; Continuous renal replacement therapy; Donation after brain death; Liver transplantation
{"title":"Applications of extracorporeal membrane oxygenation and continuous renal replacement therapy for maintaining organs of potential organ donors with cardiopulmonary failure after brain death","authors":"Mingkun Zhao, Chuansheng Xu, Feng Wang","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.05.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.05.009","url":null,"abstract":"Objective \u0000To explore the functions of extracorporeal membrane oxygenation (ECMO) with continuous renal replacement therapy (CRRT) for potential organ donors with cardiopulmonary failure after brain death and boost the coefficient of utilization of livers. \u0000 \u0000 \u0000Methods \u0000Analysis was conducted for clinical data of 5 donors with cardiopulmonary failure after brain death and their corresponding recipients from July 2015 to May 2017. Five donors received the treatments of ECMO and CRRT. The relevant data included changes of blood pressure, dosage of vasoactive agents, liver function, renal function and urine volume of those treated donors. Also liver functions of liver recipients were observed. Then the clinical data of 18 normal DBD and their liver recipients were compared. \u0000 \u0000 \u0000Results \u0000After ECMO/CRRT, donor blood pressures rose and the doses of vasoactive agents decreased. Meanwhile urine volume also increased. Finally 4/5 livers could be transplanted. And 10 kidneys were transplanted successfully. There was no significant inter-group difference of liver function. \u0000 \u0000 \u0000Conclusions \u0000The applications of ECMO and CRRT improve liver function of donors with cardiopulmonary failure after brain death and boost the rates of organ donation and utilization. \u0000 \u0000 \u0000Key words: \u0000Extracorporeal membrane oxygenation; Continuous renal replacement therapy; Donation after brain death; Liver transplantation","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":"488 1","pages":"293-297"},"PeriodicalIF":0.0,"publicationDate":"2019-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85584229","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 : 2019-05-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.05.011
Xuliang Fang, Zhongyi Jiang, Lei Li, Q. Wo
Objective To assess the quality of donor liver allografts by employing laser scanning confocal microscope (LSCM) and clinical liver function tests. Methods Sprague-Dawley rats were used for establishing cold ischemia models of liver allografts. According to different timepoints of cold ischemia, four groups of CIT1h, CIT6h, CIT12h and CIT24h were designated. At the end of cold ischemia time (CIT) of each group, perfusion and preservation fluids were collected and fluoresceins perfused. After LSCM examinations, tissue samples were harvested for HE examination. Finally a comparison was made between LSCM results and hematoxylin & eosin (HE) examinations. Also some relevant clinical parameters were detected in preserving and flushing fluids. Results Both LSCM examination and pathological examination indicated that the quality of liver allografts decreased significantly with the elapsing of time. Only the difference of LDH was statistically significant (P<0.001). Conclusions LSCM may be used for evaluating the ex vivo qualities of liver allografts. Simple handling and time efficiency re great advantages of LSCM. As compared with alanine transaminase (ALT) and aspartate transaminase (AST), LDH is a better indicator reflecting the quality of liver allografts. Key words: Donor; Liver; Cold ischemia; Laser scanning confocal microscope; Assessment; Liver function; Lactate dehydrogenase
{"title":"Real-time assessments of liver quality in cold ischemia injury based on the technique of laser scanning confocal microscope","authors":"Xuliang Fang, Zhongyi Jiang, Lei Li, Q. Wo","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.05.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.05.011","url":null,"abstract":"Objective \u0000To assess the quality of donor liver allografts by employing laser scanning confocal microscope (LSCM) and clinical liver function tests. \u0000 \u0000 \u0000Methods \u0000Sprague-Dawley rats were used for establishing cold ischemia models of liver allografts. According to different timepoints of cold ischemia, four groups of CIT1h, CIT6h, CIT12h and CIT24h were designated. At the end of cold ischemia time (CIT) of each group, perfusion and preservation fluids were collected and fluoresceins perfused. After LSCM examinations, tissue samples were harvested for HE examination. Finally a comparison was made between LSCM results and hematoxylin & eosin (HE) examinations. Also some relevant clinical parameters were detected in preserving and flushing fluids. \u0000 \u0000 \u0000Results \u0000Both LSCM examination and pathological examination indicated that the quality of liver allografts decreased significantly with the elapsing of time. Only the difference of LDH was statistically significant (P<0.001). \u0000 \u0000 \u0000Conclusions \u0000LSCM may be used for evaluating the ex vivo qualities of liver allografts. Simple handling and time efficiency re great advantages of LSCM. As compared with alanine transaminase (ALT) and aspartate transaminase (AST), LDH is a better indicator reflecting the quality of liver allografts. \u0000 \u0000 \u0000Key words: \u0000Donor; Liver; Cold ischemia; Laser scanning confocal microscope; Assessment; Liver function; Lactate dehydrogenase","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":"13 1","pages":"303-307"},"PeriodicalIF":0.0,"publicationDate":"2019-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78443147","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 : 2019-05-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.05.003
Lei Zhang, Zheng Chen, Jun-jie Ma, Jia-li Fang, Guang-hui Li, Lu Xu, Xingqiang Lai, W. Yin, Y. Xiong, Luhao Liu, Li Li, Rongxin Chen, Peng Zhang, Hailin Xu, Tao Zhang, J. Wan
Objective To preliminarily explore the clinical efficacy of ipsilateral simultaneous pancreas and kidney transplantation (SPK). Methods Ipsilateral SPK was performed in 40 patients from September 2016 to August 2018. During a follow-up period of 6 to 29 months, we summarized the efficacy and complications of the technique. Results Up to now, 38 patients achieved an exceelent clinical efficacy with no major surgical complications. However, two patients died of severe pneumonia. The postoperative serum levels of creatinine at 3, 6, 12, 24 months were 107, 102, 107, 110 umol/L; creatinine clearance rate 64, 67, 64, 63 ml/min; fasting glucose 4.6, 5.1, 4.6, 5.2 mmol/L; glycated hemoglobin 4.8%, 5.4%, 4.9%, 5.2% respectively. And 1/2-year pancrea and kidney graft survival rates both were 92%. Complications included kidney graft rejection (n=11), pancreas graft rejection (n=12), simultaneous renal & pancreas graft rejection (n=6), renal graft DGF (n=1), pulmonary infection (n=14), urinary tract infections (n=18), gastrointestinal bleeding (n=10) diarrhea (n=6), splenic venous thrombosis (n=2), incomplete ureteric obstruction of renal allograft (n=3), urine leakage (n=1) and pancreas allograft dysfunction (n=2). There were no severe surgical complications. After aggressive interventions, all postoperative complications were cured and none required excision of kidney or pancreas. Conclusions Ipsilateral SPK has definite therapeutic efficacy and it is worth wider popularization. Key words: Simultaneous pancreas and kidney transplantation; Ipsilateral; Renal graft function; Pancreas graft function; Operation complications
{"title":"Preliminary clinical experience of ipsilateral simultaneous pancreas and kidney transplantation","authors":"Lei Zhang, Zheng Chen, Jun-jie Ma, Jia-li Fang, Guang-hui Li, Lu Xu, Xingqiang Lai, W. Yin, Y. Xiong, Luhao Liu, Li Li, Rongxin Chen, Peng Zhang, Hailin Xu, Tao Zhang, J. Wan","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.05.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.05.003","url":null,"abstract":"Objective \u0000To preliminarily explore the clinical efficacy of ipsilateral simultaneous pancreas and kidney transplantation (SPK). \u0000 \u0000 \u0000Methods \u0000Ipsilateral SPK was performed in 40 patients from September 2016 to August 2018. During a follow-up period of 6 to 29 months, we summarized the efficacy and complications of the technique. \u0000 \u0000 \u0000Results \u0000Up to now, 38 patients achieved an exceelent clinical efficacy with no major surgical complications. However, two patients died of severe pneumonia. The postoperative serum levels of creatinine at 3, 6, 12, 24 months were 107, 102, 107, 110 umol/L; creatinine clearance rate 64, 67, 64, 63 ml/min; fasting glucose 4.6, 5.1, 4.6, 5.2 mmol/L; glycated hemoglobin 4.8%, 5.4%, 4.9%, 5.2% respectively. And 1/2-year pancrea and kidney graft survival rates both were 92%. Complications included kidney graft rejection (n=11), pancreas graft rejection (n=12), simultaneous renal & pancreas graft rejection (n=6), renal graft DGF (n=1), pulmonary infection (n=14), urinary tract infections (n=18), gastrointestinal bleeding (n=10) diarrhea (n=6), splenic venous thrombosis (n=2), incomplete ureteric obstruction of renal allograft (n=3), urine leakage (n=1) and pancreas allograft dysfunction (n=2). There were no severe surgical complications. After aggressive interventions, all postoperative complications were cured and none required excision of kidney or pancreas. \u0000 \u0000 \u0000Conclusions \u0000Ipsilateral SPK has definite therapeutic efficacy and it is worth wider popularization. \u0000 \u0000 \u0000Key words: \u0000Simultaneous pancreas and kidney transplantation; Ipsilateral; Renal graft function; Pancreas graft function; Operation complications","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":"25 1","pages":"266-271"},"PeriodicalIF":0.0,"publicationDate":"2019-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81433377","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 : 2019-05-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.05.007
Xuanchuan Wang, Linkun Hu, Zheng Wei, Q. Tang, Bi-Le Chen, Zhaochong Zeng, Yuan Ji, Ming Xu, R. Rong, T. Zhu
Objective To explore the efficacy of renal transplantation plus hematopoietic stem cell transplantation on inducing immune tolerance and summarize its long-term follow-up outcomes. Methods From 2009 to 2018, a total of 11 cases of living related donor kidney transplantation plus hematopoietic stem cell transplantation were performed. Two of them were HLA-matched and the remainder were mismatched for one HLA haplotype. The donor hematopoietic stem cells were mobilized using granulocyte colony-stimulating factor at 5 days pre-transplantation and collected at 1 day pre-operation. The recipients received total lymphoid irradiation for 3 days pre-transplantation and received anti-thymocyte globulin induction during transplantation. The donor hematopoietic stem cells were infused at 2, 4 and 6 postoperative day. Postoperative regulatory T cells, chimerism, B cell activating factor and mixed lymphocyte culture and other parameters were detected and long-term follow-up outcomes tracked. Results The immune tolerance-inducible recipients had a significant increase in activated Treg. One HLA-matched recipient achieved 30%-50% of chimerism and lost after 6 months. However, other recipients did not achieve mixed chimerism. The BAFF of recipient spiked sharply after transplantation. Mixed lymphocyte culture indicated that a donor-specific low response was induced. The recipients were followed up for 717 to 3612 days. The first recipient lost renal function and another ten recipients had stable renal function. None of the recipients had myelosuppression or graft-versus-host disease. Allograft biopsy confirmed only one case of mild acute rejection. The dose of immunosuppressive agents was lowered in 5 patients. Conclusions Hematopoietic stem cell transplantation for inducing tolerance is safe during renal transplantation. And chimerism is essential for inducing immune tolerance. Key words: Living donor; Kidney transplantation; Hematopoietic stem cell transplantation; Chimerism; Tolerance
{"title":"Renal transplantationplus hematopoietic stem cell transplantation as Induction therapy: a single-center 10-year experience","authors":"Xuanchuan Wang, Linkun Hu, Zheng Wei, Q. Tang, Bi-Le Chen, Zhaochong Zeng, Yuan Ji, Ming Xu, R. Rong, T. Zhu","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.05.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.05.007","url":null,"abstract":"Objective \u0000To explore the efficacy of renal transplantation plus hematopoietic stem cell transplantation on inducing immune tolerance and summarize its long-term follow-up outcomes. \u0000 \u0000 \u0000Methods \u0000From 2009 to 2018, a total of 11 cases of living related donor kidney transplantation plus hematopoietic stem cell transplantation were performed. Two of them were HLA-matched and the remainder were mismatched for one HLA haplotype. The donor hematopoietic stem cells were mobilized using granulocyte colony-stimulating factor at 5 days pre-transplantation and collected at 1 day pre-operation. The recipients received total lymphoid irradiation for 3 days pre-transplantation and received anti-thymocyte globulin induction during transplantation. The donor hematopoietic stem cells were infused at 2, 4 and 6 postoperative day. Postoperative regulatory T cells, chimerism, B cell activating factor and mixed lymphocyte culture and other parameters were detected and long-term follow-up outcomes tracked. \u0000 \u0000 \u0000Results \u0000The immune tolerance-inducible recipients had a significant increase in activated Treg. One HLA-matched recipient achieved 30%-50% of chimerism and lost after 6 months. However, other recipients did not achieve mixed chimerism. The BAFF of recipient spiked sharply after transplantation. Mixed lymphocyte culture indicated that a donor-specific low response was induced. The recipients were followed up for 717 to 3612 days. The first recipient lost renal function and another ten recipients had stable renal function. None of the recipients had myelosuppression or graft-versus-host disease. Allograft biopsy confirmed only one case of mild acute rejection. The dose of immunosuppressive agents was lowered in 5 patients. \u0000 \u0000 \u0000Conclusions \u0000Hematopoietic stem cell transplantation for inducing tolerance is safe during renal transplantation. And chimerism is essential for inducing immune tolerance. \u0000 \u0000 \u0000Key words: \u0000Living donor; Kidney transplantation; Hematopoietic stem cell transplantation; Chimerism; Tolerance","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":"92 1","pages":"284-288"},"PeriodicalIF":0.0,"publicationDate":"2019-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84070542","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 prognostic role of laminin (LN) as a tumor biological marker in predicting the recurrence of hepatocellular carcinoma (HCC) related with HBV infection after liver transplantation (LT). Methods Tissue samples from 251 HBV-related HCC patients undergoing LT were immunohistochemically stained with anti-LN antibody. The relevant prognostic factors were analyzed using Spearman's rank test, Kaplan-Meier method, log-rank test and multivariate step-wise Cox regression analysis. Results The expressions of LN in tumor tissues were significantly positively correlated with tumor number (P=0.00), microsatellite (P=0.02), venous invasion (P=0.048), pTNM tumor stage (P=0.00), pre-LT serum α-fetoprotein (AFP) level (P=0.00), HBV DNA level (P=0.02), HBeAg level (P=0.02) and tumor recurrence (P=0.00) respectively. Significant differences existed in 1/3/5-year overall survival or tumor recurrence-free survival rate post-LT among LN different expression (-, + , ≥+ + ) in HBV-related HCC patients (P<0.05). Multivariate analysis indicated that LN was a significantly independent predictor in predicting poor tumor recurrence-free survival post-LT (P=0.01). Conclusions LN may be a feasible marker in predicting HCC recurrence post-LT for HBV-related HCC patients. Key words: Hepatocellular carcinoma; Hepatitis B virus; Liver transplantation; Laminin
{"title":"Laminin may be a predictor of recurrence after liver transplantation for HBV -related hepatocellular carcinoma patients","authors":"Chao Feng, Lihong Huang, Peixiao Wang, Ping Sun, Xinguo Chen, Z. Shen, Qing Zhang","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.05.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.05.010","url":null,"abstract":"Objective \u0000To explore the prognostic role of laminin (LN) as a tumor biological marker in predicting the recurrence of hepatocellular carcinoma (HCC) related with HBV infection after liver transplantation (LT). \u0000 \u0000 \u0000Methods \u0000Tissue samples from 251 HBV-related HCC patients undergoing LT were immunohistochemically stained with anti-LN antibody. The relevant prognostic factors were analyzed using Spearman's rank test, Kaplan-Meier method, log-rank test and multivariate step-wise Cox regression analysis. \u0000 \u0000 \u0000Results \u0000The expressions of LN in tumor tissues were significantly positively correlated with tumor number (P=0.00), microsatellite (P=0.02), venous invasion (P=0.048), pTNM tumor stage (P=0.00), pre-LT serum α-fetoprotein (AFP) level (P=0.00), HBV DNA level (P=0.02), HBeAg level (P=0.02) and tumor recurrence (P=0.00) respectively. Significant differences existed in 1/3/5-year overall survival or tumor recurrence-free survival rate post-LT among LN different expression (-, + , ≥+ + ) in HBV-related HCC patients (P<0.05). Multivariate analysis indicated that LN was a significantly independent predictor in predicting poor tumor recurrence-free survival post-LT (P=0.01). \u0000 \u0000 \u0000Conclusions \u0000LN may be a feasible marker in predicting HCC recurrence post-LT for HBV-related HCC patients. \u0000 \u0000 \u0000Key words: \u0000Hepatocellular carcinoma; Hepatitis B virus; Liver transplantation; Laminin","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":"16 1","pages":"298-302"},"PeriodicalIF":0.0,"publicationDate":"2019-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84477987","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":"To summarize the current status of pancreas transplantation, and promote development of clinical pancreas transplantation in China","authors":"Weijie Zhang","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.05.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.05.001","url":null,"abstract":"过去30年来，美国已完成胰腺移植超过31 000例，美国以外其他国家和地区胰腺移植累积例数也已超过15 000例。自1982年完成首例胰腺移植以来，截至2016年底，我国共完成400余例胰腺移植。近年来，随着新型强效免疫抑制剂的临床应用及移植术式的日趋成熟，我国胰腺移植再度兴起，2017年和2018年连续两年胰腺移植例数均超过100例，我国新一轮胰腺移植快速发展时期来临。现阶段，胰腺移植主要是以大型单中心研究或零星的小规模研究报告为基础，亟需开展多中心前瞻性、随机、对照研究，以明确我国胰腺移植的疗效、风险和长期获益。希望各移植中心加强学术交流与合作，促进我国临床胰腺移植事业再上新台阶。","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":"48 1","pages":"257-259"},"PeriodicalIF":0.0,"publicationDate":"2019-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86135416","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 : 2019-05-20DOI: 10.3760/CMA.J.ISSN.0254-1785.2019.05.006
Desheng Li, Shanbin Zhang, F. Zeng, Yi Wang, Jinzhu Xiao, Jian Xu, Houqin Liu, Liang Xu, Peng Cao
Objective To summarize the experience of one case of anastomotic leakage after simultaneous pancreas-kidney transplantation (SPK) with enteric drainage. Methods One case of type 2 diabetes mellitus complicated with end-stage nephropathy undergoing SPK was retrospectively analyzed. Iliac venous systemic circulation was employed for pancreatic venous reflux, transplanted pancreas exocrine via enteric drainage and side-to-side anastomosis between donor pancreaticoduodenum and recipient jejunum. Pancreatoduodenal anastomotic leakage occurred at 12 days post-operation. During re-operation, Roux-en-Y anastomosis was established between donor pancreaticoduodenum and recipient jejunum. And the relevant domestic and foreign literatures were searched. Results The follow-up time was 3 month after a second operation. Recipient pancreas and kidney transplantation survived well. There was no onset of enteric leakage. The incidence of anastomotic leakage varies greatly between different transplantation centers both at home and abroad. The incidence ranged from 3.6% to 11.3%. And the risk of pancreatic loss was as high as 54.6%. Conclusions As a severe postoperative complication, anastomotic fistula after SPK may cuase abdominal infection. Even after reparing enteric fistula, the risk of leakage remains high. Roux-en-Y anastomosis is other therapeutic option. Key words: Simultaneous pancreas and kidney transplantation; Pancreas graft; Duodenum graft; Anastomotic leakage
{"title":"Cure ofpancreaticoduodenal anastomotic leakage after simultaneous pancreas-kidney transplantation with enteric drainage: a case report and literature review","authors":"Desheng Li, Shanbin Zhang, F. Zeng, Yi Wang, Jinzhu Xiao, Jian Xu, Houqin Liu, Liang Xu, Peng Cao","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.05.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.05.006","url":null,"abstract":"Objective \u0000To summarize the experience of one case of anastomotic leakage after simultaneous pancreas-kidney transplantation (SPK) with enteric drainage. \u0000 \u0000 \u0000Methods \u0000One case of type 2 diabetes mellitus complicated with end-stage nephropathy undergoing SPK was retrospectively analyzed. Iliac venous systemic circulation was employed for pancreatic venous reflux, transplanted pancreas exocrine via enteric drainage and side-to-side anastomosis between donor pancreaticoduodenum and recipient jejunum. Pancreatoduodenal anastomotic leakage occurred at 12 days post-operation. During re-operation, Roux-en-Y anastomosis was established between donor pancreaticoduodenum and recipient jejunum. And the relevant domestic and foreign literatures were searched. \u0000 \u0000 \u0000Results \u0000The follow-up time was 3 month after a second operation. Recipient pancreas and kidney transplantation survived well. There was no onset of enteric leakage. The incidence of anastomotic leakage varies greatly between different transplantation centers both at home and abroad. The incidence ranged from 3.6% to 11.3%. And the risk of pancreatic loss was as high as 54.6%. \u0000 \u0000 \u0000Conclusions \u0000As a severe postoperative complication, anastomotic fistula after SPK may cuase abdominal infection. Even after reparing enteric fistula, the risk of leakage remains high. Roux-en-Y anastomosis is other therapeutic option. \u0000 \u0000 \u0000Key words: \u0000Simultaneous pancreas and kidney transplantation; Pancreas graft; Duodenum graft; Anastomotic leakage","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":"40 1","pages":"280-283"},"PeriodicalIF":0.0,"publicationDate":"2019-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87997898","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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