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Editorial
Application of robot assisted surgical system in kidney transplantation
Lin Tao
2022, 13(1): 1-5.   doi: 10.3969/j.issn.1674-7445.2022.01.001
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In recent years, along with the unremitting efforts of clinical practitioners and the innovation of science and technology, minimally invasive technique has developed rapidly, and robot assisted surgical system has been invented. As a minimally invasive and precise technique, robot assisted surgical system can also be used by remote operation, which is the important development direction of surgical technique in modern era. Robot assisted surgical system has been applied extensively in the field of kidney transplantation, which is one of the research hot spots in this field. At present, da Vinci surgical system is more commonly adopted. In this article, the development history and current status of robot assisted surgical system in the field of kidney transplantation were introduced. The main advantages and disadvantages were summarized and the technical key points were discussed. The evaluation scheme and prospect of robot assisted kidney transplantation were predicted, which may promote the application of robot assisted surgical system in kidney transplantation and provide reference for improving clinical prognosis of kidney transplant recipients.
Organ transplantation and vaccination
Chen Song, Zhang Weijie
2022, 13(1): 6-11.   doi: 10.3969/j.issn.1674-7445.2022.01.002
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Organ transplant recipients are at a high risk of infection with high hospitalization rate, critical rate and fatality, due to low immune function caused by taking immunosuppressants for a period of long time after organ transplantation. Currently, vaccination is recognized as an effective approach to prevent infection. Organ transplant recipients may be vaccinated according to individual conditions. However, the sensitivity to vaccines may decline in organ transplant recipients. The types, methods and timing of vaccination have constantly been the hot spots of clinical trials. In this article, the general principles, specific vaccines and SARS-CoV-2 vaccines of vaccination in organ transplant recipients were briefly reviewed, aiming to provide reference for the vaccination of organ transplant recipients. Moreover, current status of SARS-CoV-2 vaccination for organ transplant recipients was illustrated under the global outbreak of novel coronavirus pneumonia pandemic.
Current status analysis and development strategy of united Organ Procurement Organization
Li Yushu, Zhang Hui, Yang Shunliang
2022, 13(1): 12-18.   doi: 10.3969/j.issn.1674-7445.2022.01.003
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With the reform of organ donation and transplantation in China, the establishment of Organ Procurement Organization (OPO) will become more centralized and enlarged in scale, evolving into the united OPO development stage coordinated by multiple hospitals. How to enhance the operation management and scientific development planning of united OPO has become an urgent and novel issue facing the administrators at all levels. At present, certain constraint factors of united OPO still exist in the integrated management, cost control, service homogenization, cultural integration and discipline layout. To give full play to the large-scale benefits and expand the supply of high-quality organ donation services, the development principle of putting connotation construction first and the appropriate direction of public welfare should be upheld. Leading and driving the development of organ donation services of our province are the responsibility, and discipline construction and talent training serve as the core. The overall development plan should be determined in a scientific pattern and homogeneous management should be implemented according to local conditions, aiming to provide successful experience for establishing a provincial unified OPO.
Banff Allograft Pathology
Diagnostic criteria and research progress on lung allograft pathology
Guo Hui
2022, 13(1): 19-31.   doi: 10.3969/j.issn.1674-7445.2022.01.004
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In recent years, the quantity of lung transplantation has been gradually increased in China along with the accumulation of surgical techniques and postoperative management experience of lung transplantation. Multiple lung allograft complications may occur after lung transplantation, mainly including primary graft dysfunction (PGD) caused by ischemia-reperfusion injury (IRI) of the lung allograft, acute and chronic rejection, opportunistic infection or lymphoproliferative disorder of lymphoid tissues induced by the decrease of host immunity due to postoperative use of immunosuppressants, etc. The diagnosis of complications after lung transplantation mainly relies on biopsy of the lung allograft. In this article, the brief history of lung allograft pathology, main approaches and pathological processing techniques of lung allograft biopsy, major complications after lung transplantation and pathological diagnostic criteria were elucidated, aiming to provide reference for targeted management of these complications in clinical practice.
Expert Forum
Normothermic machine perfusion of kidney and ischemia-free kidney transplantation
Wu Guobin, Chen Guodong
2022, 13(1): 32-37.   doi: 10.3969/j.issn.1674-7445.2022.01.005
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To increase the utilization rate of expanded criteria donor (ECD) kidney, the kidney preservation methods have been ever advancing in recent years. The application of normothermic machine perfusion (NMP) promotes the preservation, evaluation and repair of ex vivo donor kidneys and accelerates the innovation of surgical approaches of kidney transplantation. Ischemia-free kidney transplantation (IFKT), which initiated by Organ Transplantation Center of the First Affiliated Hospital of Sun Yat-sen University, keeps the blood flow and oxygen supply of the donor kidney with NMP machine during the entire process of acquisition, preservation and transplantation, thereby fundamentally avoiding ischemia-reperfusion injury (IRI) of the donor kidney and reducing the risk of delayed graft function (DGF) and acute rejection after surgery. In this article, recent progresses upon the kidney NMP, surgical procedures and short-term outcomes of IFKT were reviewed, aiming to provide reference for enhancing the utilization rate of ECD donor kidney and resolving the issue of organ shortage.
Application of minimally invasive technique in kidney transplantation
Zhang Qiming, Hou Xiaofei
2022, 13(1): 38-43.   doi: 10.3969/j.issn.1674-7445.2022.01.006
Abstract(8) HTML(2) PDF 1165KB()
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Since the 21st century, minimally invasive technique has become a main development direction of surgery, which has been widely applied in all branches of surgery. In the field of kidney transplantation, minimally invasive technique has been mainly applied in the procurement of living donor kidney, kidney transplantation and the management of complications after kidney transplantation. It not only increases the resource of donor kidney, but also reduces the incidence of postoperative complications and enhances the quality of life of the recipients. The application of minimally invasive technique has become one of the research hot spots in the field of kidney transplantation. In this article, research progresses on the application of minimally invasive technique in the procurement of living donor kidney, kidney transplantation and management of complications after kidney transplantation were reviewed, aiming to provide reference for increasing the resource of donor kidney, enhancing the success rate of kidney transplantation and improving clinical prognosis of kidney transplant recipients, thereby promoting the development of minimally invasive technique in surgery.
Application progress on right posterior segmental graft for living donor liver transplantation
Tian Dazhi
2022, 13(1): 44-48.   doi: 10.3969/j.issn.1674-7445.2022.01.007
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Along with the development of liver transplant techniques, clinical efficacy of liver transplantation has been significantly improved, and the survival of the recipients and liver grafts has been remarkably prolonged. However, the source of organ donation after citizen' s death still fails to meet the requirement of liver transplantation. The shortage of donor liver limits further development of liver transplantation. In recent years, living donor liver transplantation has been widely used in the treatment of patients with end-stage liver disease as one of the means to resolve organ shortage. As a special type of living donor liver transplantation, right posterior segmental graft liver transplantation provides a novel solution for expanding the potential donor pool for living donor liver transplantation. In this article, the development profile of living donor liver transplantation, donor selection of right posterior segmental graft for living donor liver transplantation, anatomical challenges of right posterior segmental graft procurement and surgical skills of right posterior segmental graft procurement were reviewed. Moreover, the prospect of right posterior segmental graft for living donor liver transplantation was predicted, aiming to promote the development of liver transplantation in clinical practice and bring benefits to more patients with end-stage liver diseases.
Predictive effect of inflammatory biomarkers on prognosis of liver transplantation for hepatocellular carcinoma
Niu Yishan, Zeng Qiang
2022, 13(1): 49-54.   doi: 10.3969/j.issn.1674-7445.2022.01.008
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Tumor recurrence is the main issue that affects the long-term survival of recipients after liver transplantation for hepatocellular carcinoma. Accurate preoperative evaluation and proper selection of transplant recipients are the key factors affecting the long-term prognosis of recipients undergoing liver transplantation for hepatocellular carcinoma. Neutrophil, lymphocyte, C-reactive protein, platelet and fibrinogen (FIB) are major biomarkers that indicate inflammatory response of the host. Multiple studies have found that these biomarkers may not only represent the inflammatory response, but also could be integrated to predict tumor recurrence and long-term survival rate of the recipients following liver transplantation for hepatocellular carcinoma. These biomarkers mainly consist of neutrophil-to-lymphocyte ratio (NLR), Glasgow prognostic score (GPS), FIB, platelet-to-lymphocyte ratio (PLR) and prognostic nutritional index (PNI), etc. In this article, research progresses on predictive effect of inflammatory biomarkers on prognosis of liver transplantation for hepatocellular carcinoma were reviewed.
Original Article
Preliminary exploration of SpyGlass direct visualization system in diagnosis and treatment of biliary stricture after liver transplantation
Zhao Dong, Zhang Zhuo, Huang Yiming, Zhang Yi, Fang Taishi, Jin Xin, Zhang Kangjun, Yan Xu, Zeng Xinchen, Jiang Nan
2022, 13(1): 55-60.   doi: 10.3969/j.issn.1674-7445.2022.01.009
Abstract(5) HTML(1) PDF 3131KB()
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  Objective  To preliminarily evaluate the application value of SpyGlass direct visualization system in the diagnosis and treatment of biliary stricture after liver transplantation.  Methods  Clinical data of 4 patients presenting with biliary stricture after liver transplantation who underwent SpyGlass direct visualization system examination were collected. The examination, treatment and prognosis of biliary stricture were analyzed.  Results  The examination results of color Doppler ultrasound, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in 4 patients suggested biliary anastomotic stricture with intrahepatic biliary dilatation, and 2 of them were complicated with intrahepatic biliary calculi. Repeated placement of biliary stent under ERCP yielded poor effect in 3 cases. SpyGlass direct visualization system examination hinted biliary anastomotic stricture in 4 patients, 3 cases of intrahepatic biliary dilatation, 3 cases of intrahepatic biliary calculi, 2 cases of purulent bile and 3 cases of floccules within the biliary tract, 1 case of congestion and edema of biliary tract wall and 2 cases of local epithelial necrosis and stiffness changes of intrahepatic biliary tract wall. The wire could not be inserted in 1 patient due to severe biliary anastomotic stricture. Four patients were treated with biliary stricture resection + biliary stone removal + biliary end-to-end anastomosis, biliary stricture resection + biliary-intestinal anastomosis, ERCP lithotomy + biliary metal stent implantation, and biliary metal stent implantation + percutaneous transhepatic bile duct lithotomy, respectively. Relevant symptoms were relieved without evident complications. All patients survived during the follow-up until the submission date.  Conclusions  Compared with traditional imaging examination, SpyGlass direct visualization system may more directly display the morphological characteristics of biliary tract wall and structural changes within biliary tract cavity, which is an effective examination tool for biliary stricture after liver transplantation. In addition, individualized treatment methods may be adopted for different biliary tract diseases, which is expected to improve clinical prognosis of patients.
Pediatric liver transplantation for Alagille syndrome: a single-center experience
Tan Yule, Zhu Zhijun, Sun Liying, Wei Lin, Qu Wei, Zeng Zhigui, Zhang Haiming, Liu Ying, Wang Jun, Li Hongyu
2022, 13(1): 61-66.   doi: 10.3969/j.issn.1674-7445.2022.01.010
Abstract(4) HTML(0) PDF 855KB()
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  Objective  To evaluate the clinical efficacy of liver transplantation in children with Alagille syndrome (ALGS).  Methods  Clinical data of 12 children with ALGS were collected and retrospectively analyzed. Clinical characteristics of children with ALGS, pathological characteristics of liver tissues, characteristics of liver transplantation, postoperative complications and follow-up of children with ALGS were analyzed.  Results  JAG1 gene mutation and typical facial features was present in all 12 children. Jaundice was the most common initial symptom, which occurred at 7 (3, 40) d after birth. Upon liver transplantation, the Z scores of height and body weight were calculated as -2.14 (-3.11, -1.83) and -2.32 (-3.12, -1.12). Five children developed severe growth retardation and 4 children with severe malnutrition. Eight of 12 children were diagnosed with cardiovascular abnormalities. Pathological examination showed that the lobular structure of the diseased livers of 4 children was basically maintained, and 8 cases of nodular liver cirrhosis in different sizes including 1 case of single early moderately-differentiated hepatocellular carcinoma. Three children were misdiagnosed with biliary atresia and underwent Kasai portoenterostomy. Eight children underwent living donor liver transplantation, three children underwent cadaveric donor liver transplantation (two cases of split liver transplantation and one case of cadaveric total liver transplantation), and one child underwent domino liver transplantation (donor liver was derived from a patient with maple syrup urine disease). during the follow-up of 30.0(24.5, 41.7) months, the survival rates of the children and liver grafts were both 100%. During postoperative follow-up, the Z scores of height and body weight were calculated as -1.24 (-2.11, 0.60) and -0.83 (-1.65, -0.43), indicating that the growth and development of the children were significantly improved after operation.  Conclusions  Liver transplantation is an efficacious treatment for children with ALGS complicated with decompensated cirrhosis, severe itching and poor quality of life. For children with ALGS complicated with cardiovascular abnormalities, explicit preoperative evaluation should be delivered, and consultation with pediatric cardiologists should be performed if necessary.
Isolation, culture and identification of mouse amniotic fluid-derived mesenchymal stem cells
Wu Hangfei, Wang Kangchun, Pan Qi, Cheng Ying
2022, 13(1): 67-73.   doi: 10.3969/j.issn.1674-7445.2022.01.011
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  Objective  To explore the isolation, culture and identification of mouse amniotic fluid-derived mesenchymal stem cell (AF-MSC).  Methods  The uteruses of pregnant mice were obtained under sterile conditions. The amniotic fluid was collected, filtered and centrifuged, and the precipitated cell mass was cultured and passaged. The morphology of AF-MSC was observed and the proliferation characteristics of AF-MSC were analyzed. The surface markers of AF-MSC were identified by flow cytometry. The osteogenic, chondrogenic and adipogenic differentiation capability of AF-MSC and cell vitality after cryopreservation and resuscitation were evaluated.  Results  The mouse AF-MSC was seen in typical spindle shape, and vortex structure could be observed when the cell confluency exceeded 80%. No evident latency was noted in the passage and culture of mouse AF-MSC. After 2-3 d culture, AF-MSC proliferated in the logarithmic growth stage with the fastest growth rate, which was slowed down and entered into the plateau period. AF-MSC expressed stem cell antigen (Sca)-1, CD29 and CD44 rather than CD34 and CD45. After the osteogenic differentiation of mouse AF-MSC, the mineralized crystals were stained in dark red spots by Alizarin red S staining. After chondrogenic differentiation, the secreted acid mucopolysaccharide was stained in light blue by Alcian blue. After adipogenic differentiation, cytoplasmic lipid droplets were stained in red by oil red O staining. After cryopreservation and resuscitation, the survival rate of AF-MSC exceeded 95%, and the growth status was excellent. The proliferation ability at 6 d was significantly better than that before cryopreservation (P < 0.05), and the proliferation ability at other time points did not significantly differ from that before cryopreservation (all P > 0.05).  Conclusions  Mouse AF-MSC may be successfully isolated with convenient procedure and the low cost. In addition, the isolated AF-MSC may be purified along with the increasing times of passage. Cryopreservation does not affect the proliferation ability of AF-MSC.
Predictive value of kidney injury markers for early DGF in kidney transplant recipients
Li Feng, Pu Jinxian, Huang Yuhua, Xi Qilin, Pan Hao, Zhao Xiaojun, Hu Linkun
2022, 13(1): 74-79.   doi: 10.3969/j.issn.1674-7445.2022.01.012
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  Objective  To evaluate the predictive values of serum neutrophil gelatinase-associated lipocalin (NGAL), urine NGAL, serum cystatin C (Cys-C) and serum creatinine (Scr) for early delayed graft function (DGF) in kidney transplant recipients.  Methods  Clinical data, blood and urine samples of 159 kidney transplant recipients were collected. All recipients were divided into the DGF group (n=42) and immediate graft function (IGF) group (n=117) according to the incidence of DGF. Clinical data of all recipients were analyzed. The changes of serum NGAL, urine NGAL, Cys-C and Scr levels were statistically compared between two groups. The predictive values of different markers for early DGF were assessed.  Results  Among 159 kidney transplant recipients, DGF occurred in 42 cases with an incidence rate of 26.4%. There were statistically significant differences in donor age, cold ischemia time of donor kidney and complement-dependent cytoxicity (CDC) between the two groups(all P < 0.05). Within postoperative 2 weeks, the serum NGAL levels in the DGF group were higher than those in the IGF group (all P < 0.05). The Cys-C, Scr and urine NGAL levels in the DGF group were higher compared with those in the IGF group within 3 weeks after kidney transplantation(all P < 0.001). Serum NGAL, urine NGAL, Cys-C and Scr levels had certain predictive values for early DGF in kidney transplant recipients. Cys-C yielded the highest predictive value with a cut-off value of 4.73 mg/L, sensitivity of 0.833, specificity of 0.812 and area under the curve (AUC) of 0.895.  Conclusions  Cys-C has higher predictive value for early DGF in kidney transplant recipients compared with serum NGAL, urine NGAL and Scr.
Value of dynamic monitoring of absolute value and function of peripheral blood lymphocyte subsets in predicting the risk of early viral infection after kidney transplantation
Zhang Qianqian, Xie Yalong, Wang Feng, Luo Ying, Chen Song, Zhang Weijie, Chang Sheng
2022, 13(1): 80-87.   doi: 10.3969/j.issn.1674-7445.2022.01.013
Abstract(5) HTML(1) PDF 8239KB()
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  Objective  To investigate the predictive and diagnostic value of absolute value and function of different lymphocyte subsets in evaluating the risk of early viral infection after kidney transplantation.  Methods  Ninety-five kidney transplant recipients were enrolled in this prospective observational cohort study, and divided into the stable group (n=77) and infection group (n=18) according to postoperative immune status. Peripheral blood samples were collected for flow cytometry before operation, and 2 weeks, 1 month, 2 months and 6 months after operation. The dynamic changes of the absolute values of CD4+T cells, CD8+T cells and natural killer (NK) cells were compared between two groups. The function of lymphocyte subsets in two groups was evaluated by detecting the proportion of interferon (IFN)-γ+CD4+T cells, IFN-γ+CD8+T cells and IFN-γ+NK cells. The value of the absolute values and function of lymphocyte subsets in predicting and diagnosing viral infection in the early stage after kidney transplantation was evaluated.  Results  During viral infection, the absolute values of CD4+T cells, CD8+T cells and NK cells in the infection group were at a relatively low level. At 2 months after operation, the absolute values of CD4+T cells and NK cells in the infection group were lower than those in the stable group. At 6 months after operation, the absolute values of CD4+T cells and CD8+T cells in the infection group were significantly lower compared with those in the stable group (all P < 0.05). During viral infection, the proportion of IFN-γ+CD4+T cells, IFN-γ+CD8+T cells and IFN-γ+NK cells in the infection group were all at a relatively low level, especially that of IFN-γ+CD8+T cells decreased most significantly. At postoperative 2 months, the proportion of IFN-γ+CD8+T cells and IFN-γ+NK cells in the infection group was significantly higher than those in the stable group. At 6 months after operation, the proportion of IFN-γ+CD4+T cells and IFN-γ+CD8+T cells in the infection group was significantly higher than those in the stable group (all P < 0.05). Logistic regression analysis showed that the increasing proportion of IFN-γ+CD8+T cells and IFN-γ+NK cells was correlated with the increasing risk of viral infection at 2 months after operation (both P < 0.05). The receiver operating characteristic (ROC) curve demonstrated that the diagnostic value of absolute values of lymphocyte subsets combined with IFN-γ secretion function for viral infection in the immunocompromised recipients was significantly higher than that of absolute values of lymphocyte subsets alone (P < 0.05).  Conclusions  Dynamic monitoring of the changes of absolute values and function of lymphocyte subsets provides critical reference value for the prediction, diagnosis and medication guidance of viral infection.
Effect of HMGB1/Caspase-1/GSDMD signaling axis-mediated hepatocyte pyroptosis on liver ischemia-reperfusion injury
Hu Shasha, Liu Yu, Wang Chaoyang, Yang Shuang, Zhang Guoliang, Cai Jinzhen
2022, 13(1): 88-97.   doi: 10.3969/j.issn.1674-7445.2022.01.014
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  Objective  To evaluate the effect of high mobility group box 1 (HMGB1)/ cysteinyl aspartate specific proteinase (Caspase)-1/Gasdermin D (GSDMD) signaling axis-mediated hepatocyte pyroptosis on liver ischemia-reperfusion injury (IRI).  Methods  C57BL/6 mice were randomly divided into the sham operation group (Sham group), IRI 2 h group, IRI 6 h group, IRI 12 h group, glycyrrhizic acid (GA)+Sham group and GA+IRI 12 h group (n=8 in each group). AML12 cells were evenly divided into the Sham group, IRI 12 h group, GA+Sham group and GA+IRI 12 h group. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), interleukin (IL)-1β and IL-6 in each group were detected by enzyme-linked immune absorbent assay(ELISA). The messenger ribonucleic acid (mRNA) levels of IL-1β and IL-6 were detected by reverse transcription polymerase chain reaction(RT-PCR). The pathological score of liver ischemia and cell apoptosis were compared among all groups. The expression level of HMGB1 in the liver tissues of each group was determined by immunohistochemistry. The expression levels of HMGB1, Caspase-1 and GSDMD proteins in the mouse liver tissues and AML12 cells were measured by Western blot.  Results  Compared with the Sham group, the serum levels of ALT, AST, IL-1β and IL-6 and the relative expression levels of IL-1β and IL-6 mRNA in the liver tissues were all significantly up-regulated after IRI in each group (all P < 0.05), and showed significant time-dependent pattern along with the prolongation of reperfusion time. Compared with the Sham group, the pathological score of hepatic ischemia and the apoptosis rate of hepatocytes were significantly increased after IRI in each group (all P < 0.05). Immunohistochemical results showed that the expression level of HMGB1 in the liver tissues was significantly up-regulated after IRI, which showed an increasing trend along with the prolongation within the period of 2-12 h. Western blot showed that compared with the Sham group, the relative expression levels of HMGB1, Caspase-1 and GSDMD proteins in vivo and in vitro were up-regulated in the IRI 12 h group. The relative expression level of HMGB1 protein was significantly up-regulated, whereas those of Caspase-1 and GSDMD proteins were significantly down-regulated in the GA+IRI 12 h group compared with those in the IRI 12 h group (all P < 0.05).  Conclusions  Hepatocytes probably activate the Caspase-1/GSDMD signaling pathway by releasing HMGB1, thereby triggering hepatocyte pyroptosis and leading to liver IRI. Inhibition of extracellular release of HMGB1 by GA may mitigate liver IRI.
Analysis of conversion rate, organ procurement rate and influencing factors of organ donation: a single-center study in Fujian province
Xie Xianyu, Wu Qinde, Yang Huijie, Wei Qin, Wu Yong, Zhang Hui
2022, 13(1): 98-104.   doi: 10.3969/j.issn.1674-7445.2022.01.015
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  Objective  To investigate the conversion rate, organ procurement rate and influencing factors of organ donation in a single center from Fujian province.  Methods  Baseline data of 182 potential organ donors of Fujian Medical University Union Hospital from November 2018 to June 2021 were retrospectively analyzed. The conversion rate of organ donation, baseline data of successful organ donors and the causes of failure of organ donors were identified. The organ procurement rate and the influencing factors of the number of organ donations were analyzed.  Results  Among 182 potential organ donors, 46 cases were successful organ donors with a conversion rate of 25.3%. In addition, 136 cases failed to donate organ. The main causes included disagreement from family members (58.1%), insufficient evaluation time (24.3%) and ineligible for donation criteria (17.6%). A total of 212 large organs and tissues were donated by 46 organ donors, including 88 kidneys, 42 livers, 15 lungs, 19 hearts and 48 corneas, with 4.6 large organs and tissues, and 3.6 large organs for each donor. Age, sex, native place, organ donation area and blood type were the influencing factors of the number of large organ donations. Organ donation area was the influencing factor of the number of tissue donations.  Conclusions  The conversion rate of organ donation is relatively low in a single center from Fujian province. Disagreement from family members is the main cause. Suitable potential organ donors should be selected for organ donation to improve the conversion rate and organ procurement rate of organ donation.
Review Article
Current status and prospect of surgical technique of liver transplantation
Xie Runpeng, Gu Mingqi, Zhang Fengbo, Jiang Hongchi
2022, 13(1): 105-110.   doi: 10.3969/j.issn.1674-7445.2022.01.016
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Along with the increasing quantity of patients with end-stage liver diseases year by year, as an efficacious treatment, the safety and efficacy of liver transplantation are critical issues to be considered. In addition, liver transplant techniques have become a new research hot spot. In recent years, liver transplant techniques are constantly innovating and developing with the unremitting efforts of researchers. Researchers have successively developed multiple liver transplant techniques, such as split liver transplantation, ischemia-free liver transplantation, liver xenotransplantation, domino liver transplantation, delayed total hepatectomy combined with liver resection and segment Ⅱ-Ⅲ liver transplantation, heterotopic auxiliary liver transplantation on splenic fossa and magnetic anastomosis. It has laid a foundation for expanding the donor pool, improving clinical efficacy of liver transplantation and enhancing the quality of life of liver transplant recipients. In this article, the exploration, development, innovation and improvement of liver transplant techniques were reviewed and prospected, aiming to provide reference for clinical application of liver transplantation.
Research status and progress on surgical treatment of postoperative recurrence of hepatocellular carcinoma
Lin Peng, Cai Minqing, Fang Junwei, Liu Jianyong, Jiang Yi
2022, 13(1): 111-119.   doi: 10.3969/j.issn.1674-7445.2022.01.017
Abstract(8) HTML(1) PDF 9815KB()
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Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. At present, hepatectomy is one of the most frequent therapeutic options, whereas the high postoperative recurrence rate severely affects the long-term survival of HCC patients. Therefore, it is urgent to choose appropriate therapeutic regime to treat the recurrence of HCC to improve the long-term survival of HCC patients. Surgical treatment is an efficacious treatment for recurrent HCC, including re-hepatectomy, salvage liver transplantation and radiofrequency ablation. Currently, individualized treatment is recommended for postoperative recurrence of HCC. The selection of treatment should be conducted based on the tumor conditions after the first hepatectomy, the characteristics of recurrent tumors, baseline data of patients and recurrence time, etc., aiming to formulate appropriate treatment regimes for patients. In this article, these surgical regimes were reviewed and compared to explore appropriate surgical schemes for postoperative recurrence of HCC, aiming to provide reference for prolonging the survival of HCC patients.
Research progress on pathogenesis of skin graft-versus-host disease
Li Xiaoyan, Xi Rui, Bai Hai
2022, 13(1): 120-125.   doi: 10.3969/j.issn.1674-7445.2022.01.018
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Graft-versus-host disease (GVHD) is a major cause that prevents widespread application of allogeneic hematopoietic stem cell transplantation. GVHD is a complication that can affect all systems of the body, such as skin, liver, lung and gastrointestinal tract, among which skin is the most vulnerable organ. At present, the pathogenesis of skin GVHD has not been fully elucidated, and no effective treatment has been established. Severe or extensive chronic GVHD significantly affects the quality of life of the recipients. Consequently, it is urgent to unravel the pathogenesis of skin GVHD and explore novel therapeutic treatment. Cytokines, such as interleukin (IL)-22, IL-17, IL-6 and interferon (IFN)-γ, have been proven to play pivotal roles in the progression of skin GVHD. Nevertheless, the specific mechanism remains elusive. In this article, research progresses at home and abroad on the mechanism underlying the roles of these cytokines in skin GVHD were reviewed, aiming to provide novel ideas for the prevention and treatment of skin GVHD.
Research progress on the role of oxidative stress in ischemia-reperfusion injury of marginal donor liver transplantation
Gao Weidong, Yang Longlong, Yin Qingchen
2022, 13(1): 126-131.   doi: 10.3969/j.issn.1674-7445.2022.01.019
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Common marginal donor liver mainly consists of fatty donor liver, elderly donor liver, small volume donor liver and liver graft from donation after cardiac death (DCD), etc. The application of marginal donor liver may resolve the severe shortage of donor liver to certain extent. Nevertheless, marginal donor liver yields a higher risk of ischemia-reperfusion injury (IRI) and causes more severe IRI than normal donor liver, which is a main cause for the failure of transplantation. In addition, oxidative stress is a major risk factor causing IRI of marginal donor liver. Therefore, how to mitigate oxidative stress and alleviate IRI of marginal donor liver has become a hot spot in clinical practice. Reactive oxygen species (ROS)-mediated oxidative stress occurs throughout the whole process of IRI. In this article, the role of oxidative stress in IRI of marginal donor liver transplantation and the ROS-targeted prevention and treatment were reviewed, aiming to provide reference for clinical practice.
Guideline on immunosuppressive therapy of recipients with renal transplantation in China(2016 edition)
2016, 7(5): 327-331.   doi: 10.3969/j.issn.1674-7445.2016.05.001
Abstract(281) HTML(173) PDF 201KB(122)
摘要:
为提高临床医师对肾移植受者免疫抑制治疗的认识, 规范国内肾移植受者管理, 帮助医师在肾移植临床实践中做出合理决策, 我们组织专家制订了《中国肾移植受者免疫抑制治疗指南(2016版)》。该指南以《2009版改善全球肾病预后组织(KDIGO)肾移植受者管理指南》为主要参考, 结合我国的临床实践经验, 希望能为相关临床科室提供工作指引。
Development status of organ transplantation in China: the report on the 2018 Annual Meeting of Organ Transplantation of Chinese Medical Association
Shi Bingyi
2019, 10(1): 32-35.   doi: 10.3969/j.issn.1674-7445.2019.01.004
Abstract(401) HTML(239) PDF 886KB(57)
摘要:
我国的器官移植事业正处于由数量规模型发展向高质量和高科技含量提升、由移植大国向移植强国冲刺的历史关键时期。在2018年中华医学会器官移植学年会上,主任委员石炳毅教授从中国器官捐献与移植体系建设、中国器官移植发展现状两大方面,作了“继往开来,中国器官移植的发展现状”的报告。新的历史时期赋予我们新的历史使命,器官移植学分会要主动作为,推动科学发展,为贯彻新理念、拓宽新视野、实现新愿景而努力奋斗。
Clinical guideline on living donor renal transplantation in China (2016 edition)
2016, 7(6): 417-426.   doi: 10.3969/j.issn.1674-7445.2016.06.002
Abstract(349) HTML(220) PDF 323KB(48)
摘要:
活体供肾移植经历半个多世纪的发展,已成为终末期肾病患者的重要治疗手段。在我国,亲属活体器官捐献肾移植作为家庭自救的方式之一,近年来已成为肾脏供体来源的重要补充部分。本指南以世界卫生组织《人体器官移植指导原则》(1991)、中华人民共和国国务院《人体器官移植条例》(2007)以及国家卫生部《关于规范活体器官移植的若干规定》(2010)为法律依据,在《中国活体供肾移植指南》(2009)的基础上进行更新。内容包括活体供肾移植的伦理学、供者与受者的医学评估、活体供肾摘取原则与手术方式、供者近期与远期并发症以及供者的长期随访等。
Technical specifcation for clinical application of immunosuppressive agents in organ transplantation (2019 edition)
Branch of Organ Transplantation of Chinese Medical Association
2019, 10(3): 213-226.   doi: 10.3969/j.issn.1674-7445.2019.03.001
Abstract(291) HTML(319) PDF 1076KB(96)
摘要:
为了进一步规范器官移植免疫抑制剂的临床应用,中华医学会器官移植学分会组织全国31家移植中心的器官移植专家,从器官移植免疫诱导药物应用技术规范、器官移植维持期免疫抑制剂应用技术规范、器官移植常用免疫抑制方案技术规范、器官移植免疫抑制剂血药浓度监测技术规范、器官移植药物性肝肾损伤治疗技术规范等方面,制订本规范,以帮助器官移植工作者规范和优化器官移植免疫抑制剂的临床应用。
Summary of important research on liver transplantation in 2017
Li Haibo, Fu Hongyuan, Lu Tongyu, Zeng Kaining, Zhang Yingcai, Yang Yang
2018, 9(1): 41-50,82.   doi: 10.3969/j.issn.1674-7445.2018.01.006
Abstract(246) HTML(160) PDF 1280KB(10)
摘要:
肝移植是目前公认的治疗终末期肝病的最有效措施。经过超过50年的发展,肝移植患者术后存活时间不断延长,并发症的发生率亦有所降低。但是,如何改善供肝短缺的现状、减轻供肝缺血-再灌注损伤,减少并发症的发生率以及进一步提高肝移植患者的远期疗效仍然是困扰肝移植科医师的难题。因此,了解最新的外科技术、多中心临床经验以及相关基础研究结果,将帮助我们更深入地认识疾病本质,为患者制定更妥善的治疗方案。本文综合国际核心期刊报道的内容,对2017年度肝移植相关领域的研究热点及最新进展作一综述,并对今后的研究方向作出展望。
2017, 8(4): 251-259.   doi: 10.3969/j.issn.1674-7445.2017.04.001
Abstract(222) HTML(158) PDF 871KB(12)
摘要:
为了更好地将加速康复外科(ERAS)的理念用于优化重型肝炎肝移植围手术期管理,达到减少并发症、促进患者快速康复的目的,中国医师协会器官移植分会移植免疫学组、中华医学会外科学分会手术学组、广东省医师协会器官移植医师分会组织专家制订了《加速康复外科优化重型肝炎肝移植围手术期管理临床实践的专家共识》。该共识从ERAS优化重型肝炎肝移植术前、术中、术后治疗策略3个方面,总结各移植中心的临床经验,提出相应的专家共识,希望为临床优化重型肝炎肝移植围手术期管理提供参考方案。
Guideline on clinical diagnosis and treatment for rejection of renal transplantation in China(2016 edition)
Branch of Organ Transplantation of Chinese Medical Association, Branch of Organ Transplant Physician of Chinese Medical Doctor Association
2016, 7(5): 332-338.   doi: 10.3969/j.issn.1674-7445.2016.05.002
Abstract(228) HTML(172) PDF 264KB(94)
摘要:
排斥反应是影响移植肾长期存活的首要独立危险因素,是亟待解决的瓶颈问题。中华医学会器官移植学分会和中国医师协会器官移植医师分会组织国内专家,总结各中心肾移植的临床经验,依据Banff 2013标准,编写了本部指南,希望能为相关临床科室提供工作指引。
Branch of Organ Transplantation of Chinese Medical Association Process and specification of Chinese donation after citizen′s death (2019 edition)
Branch of Organ Transplantation of Chinese Medical Association
2019, 10(2): 122-127.   doi: 10.3969/j.issn.1674-7445.2019.02.003
Abstract(682) HTML(365) PDF 5080KB(49)
摘要:
为了进一步规范中国公民逝世后器官捐献的流程,中华医学会器官移植学分会组织器官移植和器官捐献相关专家,从报名登记、捐献评估、捐献确认、器官获取、器官分配、遗体处理、人道救助、捐献文书归档等8个环节,制定中国公民逝世后器官捐献流程和规范(2019版)。
2019, 10(2): 142-148.   doi: 10.3969/j.issn.1674-7445.2019.02.005
Abstract(358) HTML(267) PDF 7197KB(65)
摘要:
为了进一步规范中国实体器官移植(SOT)受者巨细胞病毒(CMV)感染的诊断和治疗,中华医学会器官移植学分会组织器官移植专家、感染病学专家及呼吸内科专家,在《实体器官移植受者巨细胞病毒感染诊疗指南(2017版)》的基础上,从CMV感染的主要危险因素、实验室诊断、临床类型、预防方案,CMV病的治疗,儿童SOT术后CMV感染或CMV病的防治,CMV肺炎合并伊氏肺孢子菌肺炎的防治等方面,制订本规范,以期为我国SOT术后CMV感染的规范化防治提供指导意见。
Pathological evaluation of donor kidney in donation after citizen’s death
Guo Hui, Chen Zhishui, Chen Shi
2018, 9(1): 1-8.   doi: 10.3969/j.issn.1674-7445.2018.01.001
Abstract(0) HTML(0) PDF 1191KB(7)
摘要:
肾移植是治疗终末期肾病的最有效方法,但供体器官的严重短缺一直是阻碍肾移植发展的最大障碍。随着2015年以来我国器官移植尸体供体完全转变为公民逝世后器官捐献,移植例数稳步增长,更多的患者得到救治。但公民逝世后器官捐献因供体高龄、原有系统性疾病等因素导致供肾质量存在差异,而移植前的供肾病理学诊断是一项重要评估方法。本文综述了供肾病理学评估的活组织检查时机、活组织检查方法、病理学标本处理技术和目前国际上采用的组织病理学评估标准,以供大家参考,籍此希望我国更多的移植中心针对目前器官移植的实际情况对此展开更深入的研究。
Overview of global organ donation and transplantation in 2020
Jiang Wenshi, Sun Yongkang, Yan Juan, Jiang Feng, Wang Huiying, Ma Qiruo, Xie Ying, He Xiangxiang, Wu Xiaotong
2021, 12(4): 376-383.   doi: 10.3969/j.issn.1674-7445.2021.04.002
Abstract(901) HTML(581) PDF 1734KB(581)
Abstract:
  Objective  At present, the novel coronavirus pneumonia (COVID-19) pandemic is still raging in certain regions around the globe, and the prevention and control of the pandemic should be strengthened. Under the challenges of respective social environment and allocation of medical resources, and support from the inertia and inherent productivity of the system on which the industry depends, extensive attempts are being delivered to push forward the work of organ donation and transplantation in each country. Under the guidance of national experts and committee members, Shanxi Provincial Human Organ Procurement and Allocation Service Center was established on August 28, 2018 approved by the former Shanxi Provincial Health and Family Planning Commission. It is the only independent non-profit medical institution in Shanxi Province. In this article, the system construction of citizen's organ donation and transplantation fitting national and provincial conditions was further explored according to the data analysis of organ donation and transplantation in the United States and Spain during the COVID-19 pandemic combined with the implementation of organ donation work in Shanxi Provincial Human Organ Procurement and Allocation Service Center.
Guideline on immunosuppressive therapy of recipients with renal transplantation in China(2016 edition)
2016, 7(5): 327-331.   doi: 10.3969/j.issn.1674-7445.2016.05.001
Abstract(281) HTML(173) PDF 201KB(173)
Abstract:

Competent Authorities: Ministry of Education of the People's Republic of China

Sponsored by: Sun Yat-sen University

Presented by: The Third Affiliated Hospital of Sun Yat-sen University

Editor-in-Chief: Gui-Hua Chen

Publisher: Editorial Office of Organ Transplantation

Address: The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou

Postcode: 510630

Tel: 020-38736410

Email: organtranspl@163.com

Postal Code: 46-35

Website: http://www.organtranspl.com

Journal: bimonthly

Price: 20 yuan for each period and 120 yuan for the whole year

CN 44-1665/R

ISSN 1674-7445