Articles in press have been peer-reviewed and accepted, which are not yet assigned to volumes /issues, but are citable by Digital Object Identifier (DOI).
Display Method:
Editorial
Discussion on the on-site audit management of practicing qualification certification of human organ transplantation
Ma Xudong
2021, 12(5): 503-505.   doi: 10.3969/j.issn.1674-7445.2021.05.001
Abstract(40) HTML(4) PDF 2032KB()
Abstract:
Human organ transplantation is an effective method to treat organ failure and save the life of patients. The practicing qualification certification of human organ transplantation is recognized as an administrative examination and approval item of the national health authority. National health authorities shall organize experts to conduct on-site audit of medical institutions that have applied for practicing qualification certification and have passed preliminary supervision at the provincial level. In this article, the management of on-site audit on the practicing qualification certification of human organ transplantation was illustrated and discussed from the practical significance, principles and highlights of on-site audit, and key points during on-site audit, aiming to provide reference for ensuring high-quality development of organ transplantation and strengthening the management of practicing qualification certification of human organ transplantation in medical institutions.
Development and prospect of clinical research on lung transplantation in post-COVID-19 era
Jiao Guohui, Chen Jingyu
2021, 12(5): 506-511.   doi: 10.3969/j.issn.1674-7445.2021.05.002
Abstract(11) HTML(5) PDF 3986KB()
Abstract:
Lung transplantation has been advanced for nearly half a century around the globe, and it has been developed rapidly for over 20 years in China. The field of lung transplantation in China has been gradually integrated into the international community. The outbreak of novel coronavirus pneumonia (COVID-19) in 2020 brought big challenges, as well as diverted the worldwide attention to the development of lung transplantation in China, accelerating international communication and cooperation. With the steadily deepening of clinical and basic research on lung transplantation for severe cases of COVID-19, organ transplant physicians have deepened the understanding and thinking of the maintenance of donors, selection of elderly and pediatric candidates, and perioperative management of recipients, as the future perspective of lung transplantation in China. For interdisciplinary research related to lung transplantation, it is necessary to carry out multi-center clinical trials with qualified study design and constantly promote the theoretic and practical innovation.
Banff Allograft Pathology
Banff classification and progress on liver allograft pathology
Guo Hui, Wang Zhenglu, Cong Wenming, Chen Zhishui
2021, 12(5): 512-524.   doi: 10.3969/j.issn.1674-7445.2021.05.003
Abstract(17) HTML(8) PDF 12553KB()
Abstract:
The pathology of liver allograft biopsy is not only essential for the evaluation of liver donor, but also for the diagnosis and differential diagnosis of posttransplantation complications. With the development of liver transplantation in clinical practice, relevant studies of the pathological diagnosis of liver allograft complications have been deepened. Banff classification on liver allograft pathology have been gradually established within the international community. In China, pathological studies related to liver allograft pathology have been steadily carried out, and the pathological diagnostic basis of liver allograft pathology suitable for the clinical practice of liver transplantation in China has been gradually formed. This article reviews the history of Banff liver allograft pathology and major pathological lesions of liver allograft complications, aiming to provide reference for implementing pathological diagnosis of liver allograft pathology in China, assisting clinical diagnosis and targeted treatment of complications after liver transplantation, and further improving the survival of liver allograft and recipients.
Expert Forum
Current status of diagnosis and treatment of chronic lung allograft dysfunction
Huang Heng, Tian Dong
2021, 12(5): 525-532.   doi: 10.3969/j.issn.1674-7445.2021.05.004
Abstract(7) HTML(7) PDF 4317KB()
Abstract:
Chronic lung allograft dysfunction (CLAD) is the largest obstacle to the long-term survival of lung transplant recipients, which represents a series of complicated clinical manifestations of significant and persistent deterioration of lung allograft function after surgery. Due to lack of effective strategies for early diagnosis and prevention, over half of lung transplant recipients will develop CLAD within postoperative 5 years, which is likely to increase to 75% within postoperative 10 years. At present, no drug can be administered to completely prevent or reverse the progression of CLAD. In recent years, since the definition, diagnosis and treatment of CLAD have been updated by International Society of Heart and Lung Transplantation (ISHLT) in 2019, the understanding of CLAD has been significantly deepened within the international community. In this article, comprehensive diagnostic methods and potential treatment strategies of CLAD were explicitly illustrated, aiming to provide theoretical reference and insights for early monitoring and management of the incidence and progression of CLAD.
Transplantation Forefront
Diagnosis and treatment progress on airway anastomotic stenosis after lung transplantation
Liu Mingzhao, Shi Lingzhi, Yang Hang, Wei Dong, Fan Li, Wu Bo, Chen Jingyu
2021, 12(5): 533-538.   doi: 10.3969/j.issn.1674-7445.2021.05.005
Abstract(8) HTML(5) PDF 5049KB()
Abstract:
Lung transplantation is the only effective treatment of most end-stage lung diseases. Airway anastomotic complications are the main obstacles affecting the postoperative survival and quality of life of lung transplant recipients. Airway anastomotic stenosis is the most common airway anastomotic complication after lung transplantation. In recent years, improvements in the recipient selection, organ preservation, surgical techniques, postoperative intensive care management, immunosuppression, antifungal and endoscopic treatment have decreased the incidence of airway anastomotic stenosis and improved the surgical efficacy of lung transplantation and the survival of the recipients. In this article, the pathogenesis, risk factors, diagnosis and treatment of airway anastomotic stenosis after lung transplantation were reviewed, aiming to provide novel ideas for clinical research, diagnosis and treatment of airway anastomotic stenosis following lung transplantation.
Progress in clinical application of urgent lung transplantation
Li Haoxuan, Huang Heng, Yan Haoji, Tang Hongtao, Zheng Xiangyun, Zhang Han, Qian Qinchun, Jiang Kaiyuan, Tian Dong
2021, 12(5): 539-543.   doi: 10.3969/j.issn.1674-7445.2021.05.006
Abstract(6) HTML(5) PDF 874KB()
Abstract:
Lung transplantation is the only effective treatment of end-stage lung diseases. Nevertheless, shortage of donor lungs has become increasingly prominent worldwide. A large quantity of patients died while waiting for lung transplantation. Urgent lung transplantation is a prioritized allocation strategy for donor lung transplantation according to the urgency of diseases, aiming to shorten the waiting time for donor lungs and reduce the fatality of patients on the waiting list for lung transplantation. However, no consensus has been reached worldwide on the definition, criteria and application of the terminology of urgent lung transplantation. In addition, the survival and net benefits of lung transplant recipients based on this allocation system are still controversial. On the basis of previous clinical research on urgent lung transplantation, the definition criteria, risk factors, survival outcomes, limitations and optimization measures were explicitly elucidated in this article, aiming to provide theoretical reference for comprehensive evaluation of the feasibility of urgent lung transplantation and further optimizing the allocation system of donor lungs.
Current status and prospect of imaging examination methods for rejection after lung transplantation
Xu Lin, Yan Haoji, Wang Junjie, Tang Hongtao, Li Caihan, Chen Tingting, Zhang Han, Fu Siyi, Tian Dong
2021, 12(5): 544-549.   doi: 10.3969/j.issn.1674-7445.2021.05.007
Abstract(8) HTML(5) PDF 883KB()
Abstract:
Lung transplantation is the only effective therapeutic option for end-stage lung diseases, and postoperative rejection is the main factor affecting clinical prognosis of the recipients. Imaging examination can be utilized as a noninvasive tool to assist other examinations in monitoring rejection after lung transplantation. At present, multiple imaging examination methods have been reported. The advantages and disadvantages of various imaging examinations have been clarified, which may promote early diagnosis of rejection, deliver timely treatment for lung transplant recipients and improve the quality of life and clinical prognosis. In this article, the advantages, disadvantages and research progress upon different imaging examinations for rejection after lung transplantation were reviewed, aiming to provide reference for identifying the optimal noninvasive examination approach for rejection after lung transplantation and enhance the long-term survival of the recipients.
Application of dual hypothermic oxygenated machine perfusion in ex vivo split liver transplantation
Ren Junkai, Zhang Tong
2021, 12(5): 550-555.   doi: 10.3969/j.issn.1674-7445.2021.05.008
Abstract(14) HTML(6) PDF 899KB()
Abstract:
The technology of split liver transplantation is becoming increasingly mature with rapid development. During ex vivo splitting, the depletion of intracellular energy sources [such as adenosine triphosphate (ATP)] and other metabolic disorders may lead to cell damage and dysfunction, which will be aggravated by reperfusion injury of liver transplantation, clinically manifested as postoperative complications and transplantation failure. To further improve the quality of donor liver in ex vivo split liver transplantation, research teams at home and abroad apply machine perfusion to enhance the quality of donor liver. In this article, the research progresses worldwide on machine perfusion of donor liver in ex vivo split liver transplantation were reviewed, and the application and prospect of dual hypothermic oxygenated machine perfusion (D-HOPE) in ex vivo split liver transplantation were elucidated, aiming to provide reference for increasing the source of donor liver for ex vivo split liver transplantation and further resolving the current status of donorliver shortage.
Original Article
Learning curve and key procedures analysis of modified rat models of orthotopic left lung transplantation
Tang Hongtao, Li Caihan, Wang Junjie, Huang Heng, Xu Lin, Chen Tingting, Liu Meihan, Fu Siyi, Tian Dong
2021, 12(5): 556-562.   doi: 10.3969/j.issn.1674-7445.2021.05.009
Abstract(10) HTML(4) PDF 11445KB()
Abstract:
  Objective  To summarize and analyze the key procedures of the modified rat model of orthotopic left lung transplantation, aiming to provide more experience for the establishment of rat models of lung transplantation.  Methods  Two surgeons (A and B) performed complete transplantation in consecutive 15 rat models, and every 5 surgeries were divided into 1 practice stage. The operating time of each transplantation procedure was recorded. The differences of overall success rate and 1-week survival rate were calculated among different practice stages. The learning curve was delineated by the cumulative sum method.  Results  For surgeons A and B, the number of the first successful transplantation was the 5th and 6th time, the overall success rates of transplantation were 80% and 87% respectively, and the 1-week survival rates of rats both were 92%. Along with the increasing number of surgeries, the entire cardiopulmonary procurement, cannula preparation, cold ischemia, warm ischemia, transplantation and total operation time by two surgeons showed a significantly downward trend (all P < 0.05). For surgeons A and B, 3 and 2 rats died of heart failure due to overdose anesthesia, and 1 rat died of vein distortion at postoperative 1 d and 1 died of atelectasis at postoperative 7 d, respectively. The goodness of fit (R2) of cumulative sum method was 0.992 8 and 0.976 6. The turning point of learning curve was achieved in the 7th and 8th transplantation for surgeons A and B.  Conclusions  The modified rat model of orthotopic left lung transplantation yields high operability and repeatability both theoretically and technologically, and has multiple advantages of short learning curve, short operation time, high survival rate of the recipients and few complications, which is worthy of application in the basic research of lung transplantation.
Effect of bone marrow mesenchymal stem cell on the expression of IL-10 and TNF-α in mice with ischemia-reperfusion acute kidney injury
Lin Chenyu, Chen Wen, Ma Xihui, Kong Xiangrui, Fan Wenmei, Han Yong, Xiao Li, Shi Bingyi
2021, 12(5): 563-570.   doi: 10.3969/j.issn.1674-7445.2021.05.010
Abstract(3) HTML(4) PDF 35145KB()
Abstract:
  Objective  To evaluate the effect of bone marrow mesenchymal stem cell (BMSC) on the expression of interleukin (IL)-10 and tumor necrosis factor (TNF)-α in mice with ischemia-reperfusion acute kidney injury (IR-AKI).  Methods  All mice were randomly divided into the sham operation group (control group), ischemia-reperfusion injury group (IRI group) and BMSC treatment group (BMSC group), with 6 mice in each group, respectively. The renal function and pathological changes of mice were detected. The cell apoptosis of renal tissues of mice was determined. The expression levels of serum IL-10 and TNF-α of mice were quantitatively measured. The mouse BMSC was randomly divided into the control and hypoxia-reoxygenation groups (IRI group), and the expression levels of IL-10 and TNF-α in cell supernatant were determined.  Results  The renal structure of mice was normal in the control group, severe damage was observed in the IRI group, and mild damage occurred in the BMSC group. Compared with the control group, the renal tissue injury scores were significantly higher in the IRI and BMSC groups (both P < 0.05). Compared with the IRI group, the renal tissue injury score was significantly lower in the BMSC group (P < 0.05). Compared with the control group, the levels of serum creatinine (Scr) and blood urea nitrogen (BUN) were remarkably up-regulated in the IRI group, and the level of BUN was significantly up-regulated in the BMSC group (all P < 0.05). Compared with the IRI group, the levels of Scr and BUN were significantly down-regulated in the BMSC group (both P < 0.05). In the IRI group, the quantity of apoptotic cells in the renal tissues was considerably higher than those in the BMSC and control groups, and the quantity of apoptotic cells in the BMSC group was significantly higher than that in the control group (all P < 0.05). Compared with the control group, the levels of serum IL-10 and TNF-α were significantly up-regulated in the IRI group, whereas the level of serum TNF-α was significantly down-regulated and the level of serum IL-10 was significantly up-regulated in the BMSC group (all P < 0.05). Compared with the IRI group, the levels of serum IL-10 and TNF-α were significantly down-regulated in the BMSC group (both P < 0.05). The levels of IL-10 and TNF-α in the cell supernatant did not significantly differ between the IRI and control groups (P=0.080、0.627).  Conclusions  BMSC infusion may reduce the incidence of renal IRI and inflammation, probably via the mechanism of down-regulating TNF-α expression rather than up-regulating IL-10 expression.
Mild hypothermia alleviates renal ischemia-reperfusion injury by up-regulating the expression of cold-shock protein RBM3
Song Keqin, Xiao Qi, Xiao Jiansheng, Luo Kaifeng
2021, 12(5): 571-578.   doi: 10.3969/j.issn.1674-7445.2021.05.011
Abstract(6) HTML(2) PDF 9633KB()
Abstract:
  Objective  To evaluate the effect of mild hypothermia on the renal ischemia-reperfusion injury (IRI), and the expression profile of RNA-binding motif protein 3(RBM3) and its downstream effector molecules during this process.  Methods  Eighteen healthy SD male rats were randomly divided into the normal control (NC) group, IRI group and mild hypothermia pretreat (MHP) group, with 6 rats in each group. Serum creatinine level was measured to evaluate the renal function. Hematoxylin-eosin (HE) staining was performed to assess the renal tissue injury. Western blot was used to determine the relative expression levels of RBM3, Yes-associated protein 1(YAP1), nuclear factor E2-related factor 2(Nrf2), B cell-lymphoma-2(Bcl-2) and Bcl-2-associated X protein (Bax) in the kidney tissues. Immunohistochemical staining was employed to further detect the expression levels of RBM3 and YAP1 proteins. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay was adopted to detect the cell apoptosis of kidney tissues. Malondialdehyde (MDA) content and superoxide dismutase (SOD) activity were evaluated to determine the oxidative stress level of kidney tissues.  Results  Compared with the NC group, the serum creatinine level, the pathological injury score of kidney tissues and the expression levels of RBM3, YAP1 and Nrf2 proteins were significantly up-regulated, the Bcl-2/Bax ratio was considerably lower, the apoptosis rate was remarkably elevated, the MDA content was significantly increased and the SOD activity was dramatically reduced in the IRI and MHP groups (all P < 0.05). Compared with the IRI group, the serum creatinine level and the pathological injury score of kidney tissues were significantly decreased, the expression levels of RBM3, YAP1 and Nrf2 proteins were significantly up-regulated, the Bcl-2/Bax ratio was considerably higher, the apoptosis rate was significantly decreased, the MDA content was significantly decreased and the SOD activity was considerably elevated in the MHP group (all P < 0.05).  Conclusions  Mild hypothermia may exert protective effect upon renal IRI and it could alleviate cell apoptosis and oxidative stress injury induced by IRI, probably by up-regulating the expression level of RBM3 and its downstream effector molecules of YAP1 and Nrf2.
Study of the role of CD4+CD45RClowTreg in regulating immune tolerance of rats undergoing liver transplantation
Zhou Lin, Li Han, Zhao Yang, Wang Jing, Jia Yanan, Zhang Xinxue, Li Xianliang, Lang Ren, He Qiang
2021, 12(5): 579-587.   doi: 10.3969/j.issn.1674-7445.2021.05.012
Abstract(13) HTML(1) PDF 13611KB()
Abstract:
  Objective  To investigate the role of CD4+CD45RClow regulatory T cell (Treg) in the immune tolerance induction of rats undergoing liver transplantation.  Methods  Liver transplantation rat models of acute rejection (AR) [Lewis→Brown Norway (BN), AR group] and spontaneous tolerance (BN→Lewis, tolerance group) were established, with 6 rats in each group. Moreover, 3 Lewis rats and 3 BN rats were assigned into the sham operation group (control group). The liver tissues of rats in each group were subject to pathological staining. The expression of T cell subsets and plasmacytoid dendritic cells (pDC) in the peripheral blood, liver graft and spleen of rats was detected in each group. The correlation between pDC and CD4+CD45RClowTreg was analyzed. The expression levels of CD4, CD45RC and CD103 in the liver graft and spleen of rats were quantitatively measured in each group.  Results  In the AR group, pathological manifestations mainly consisted of inflammatory cell infiltration and structure disorders of transplant liver. Compared with the AR group, the expression levels of CD4+CD25+Treg and CD8+Treg in the peripheral blood were significantly up-regulated in the tolerance group (all P < 0.05). In the peripheral blood, the expression level of CD4+CD25+Treg was positively correlated with that of CD8+Treg (r=0.742, P=0.022). In the AR group, the expression level of CD4+CD45RChighT cell in the peripheral blood was significantly higher than those in the tolerance and control groups (both P < 0.05). Compared with the AR group, the expression level of CD4+CD45RClowTreg in the spleen, and the expression levels of CD8+CD45RClowTreg in the peripheral blood, transplant liver and spleen were significantly up-regulated in the tolerance group (all P < 0.05). Compared with the control and AR groups, the ratio of CD8+CD45RClowTreg/CD8+T in the peripheral blood and the expression levels of pDC in the peripheral blood, transplant liver and spleen were all significantly up-regulated in the tolerance group (all P < 0.05). The expression level of CD4+CD45RClowTreg was positively correlated with the changes of pDC (r=0.506, P=0.016). The expression levels of CD4, CD45RC and CD103 in the transplant liver and spleen of rats were up-regulated in the tolerance group. In the AR group, the expression levels of CD4 and CD45RC were up-regulated, whereas that of CD103 was down-regulated.  Conclusions  CD4+CD45RClowTreg is a cell subgroup with negative immune regulation, which may construct a regulatory cell network of immune tolerance induction along with CD8+CD45RClowTreg and pDC.
Heterozygous living donor liver transplantation for pediatric maple syrup urine disease with new compound mutation of BCKDHB gene: a case report and literature review
Wu Yue, Gu Guangxiang, Xia Qiang
2021, 12(5): 588-594.   doi: 10.3969/j.issn.1674-7445.2021.05.013
Abstract(6) HTML(3) PDF 1067KB()
Abstract:
  Objective  To evaluate the clinical efficacy of heterozygous living donor liver transplantation for pediatric maple syrup urine disease.  Methods  A 3-year-old boy was admitted to the hospital on July 5, 2017 due to maple syrup urine disease for half a year. The child presented with paroxysmal dysarthria and motor dysfunction of the lower limbs under fasting status for half a year, accompanied with obvious maple syrup urine odor and slow language development. No other growth abnormality or mental defects were observed. Serum branched chain amino acid (BCAA) assay detected that the level of leucine was 684 μmol/L and 559 μmol/L for the valine. The child was diagnosed with maple syrup urine disease type b based on gene detection combined with BCAA assay. Living donor liver transplantation from his biological father was performed. Postoperatively, routine immunosuppression, anti-virus, anti-infection therapies, maintenance of fluid, electrolyte, and acid-base balance and other necessary nutritional support were given. The dose of tacrolimus was adjusted according to biochemical parameters and cytochrome P450(CYP)3A5 genotype of the recipient. Glucocorticoid administration was terminated at approximately 6 months after operation.  Results  The liver function of the recipient was recovered to normal range at postoperative 1 month, and basically stabilized at 3 years after surgery. The amino acid level was decreased to normal level immediately after operation, and BCAA was continually declined after normal diet for postoperative 1 month. As of the submission date, the recipient grew well in a stable condition and achieved high quality of life.  Conclusions  Heterozygous living donor liver transplantation is a safe and effective treatment of maple syrup urine disease, which reduces the possibility of sudden acute metabolic events, significantly improves the quality of life of the recipient and provides a novel idea for surgical treatment of maple syrup urine disease.
Establishment of a blood concentration detection system for everolimus in recipients after liver transplantation
Tao Simei, Huang Jiwei, Li Haibo, Zhang Yingcai, Yang Yang
2021, 12(5): 595-600.   doi: 10.3969/j.issn.1674-7445.2021.05.014
Abstract(7) HTML(4) PDF 1008KB()
Abstract:
  Objective  To establish a detection system of ultra high performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) for everolimus concentration in whole blood of liver transplant recipients.  Methods  The proteins of samples were precipitated with methanol and zinc sulfate, and everolimus-D4 was used as the internal standard. Phenomenex Kinetex PFP column was used. The mobile phase A was water (containing 2 mmol/Lammonium formate and 0.1% formic acid), and the mobile phase B was methanol (containing 2 mmol/L ammonium formate and 0.1% formic acid). The gradient elution was performed with the flow rate of 1 mL/min, the column temperature of 50 ℃ and the injection volume of 1 μL. The multi-reaction monitoring mode was used to quantitatively analyze with electrospray positive ionization. The UPLC-MS/MS detection system required only 100 μL of whole blood, and could achieve a sufficient lower limit of quantification without complicated sample preparation. The total running time was within 4.5 min. Linear regression (1/x2) analysis was performed using peak area of everolimus / peak area of everolimus-D4 (y) and concentration of everolimus/concentration of everolimus-D4 (x) to calculate the calibration function and analyze its accuracy and linear relationship. UPLC-MS/MS was used to detect the trough blood concentration of everolimus in blood samples of 5 recipients after liver transplantation.  Results  The accuracy of quality control was within 15%, and the linear relationship of everolimus was good in the blood concentration range of 1-100 ng /mL(R2 > 0.990). Trough blood concentration of everolimus measured in blood samples of 5 liver transplant recipients ranged from 3.77 to 9.27 ng/mL.  Conclusions  The detection system of UPLC-MS/MS in this study is suitable for monitoring the concentration of everolimus in whole blood of liver transplant recipients because of its high accuracy, simple sample processing method and short detection time.
Clinical efficacy of adult kidney transplantation from unilateral pediatric donor kidney
Liu Kepu, Li Zhibin, Wang Huilong, Han Shichao, Zhang Geng
2021, 12(5): 601-606.   doi: 10.3969/j.issn.1674-7445.2021.05.015
Abstract(8) HTML(3) PDF 1305KB()
Abstract:
  Objective  To evaluate the clinical efficacy of adult kidney transplantation from unilateral pediatric donor kidney.  Methods  Clinical data of pediatric donors (n=10) and adult recipients (n=19) undergoing kidney transplantation were retrospectively analyzed. The changes of renal function, liver function and the maximal diameters of the kidney allografts were compared at 1, 7, 14, 28, 60 d after operation. The short-term survival and incidence of postoperative complications of the recipients were analyzed.  Results  Ten donors included 6 males and 4 females, aged (7±3) years old, with a body mass index (BMI) of (16.3±3.8) kg/m2. All donors were donation after brain death followed by cardiac death. Among 19 recipients, 12 were males and 7 were females, aged (34±12) years old, with a BMI of (20.3±1.3) kg/m2.An oblique incision was created in the lower right abdomen of the recipients. The arteries and veins of donor kidney were anastomosed with the external iliac arteries and veins of the recipients. The ureter of donor kidney was anastomosed with the bladder of the recipients. After anastomosis, the kidney was placed and fixed in the right iliac fossa. The serum creatinine and blood urea nitrogen levels of the recipients were decreased at 1 week after kidney transplantation, and restored to normal range at postoperative 2 weeks. All parameters related to liver function were normal after operation. At postoperative 1 month, the maximal diameters of the kidney allografts were (9.5±0.3) cm on average, which basically reached those of normal adults. The 1-year survival rate of 19 recipients was 95%. One recipient died from pulmonary infection after ineffective treatment. Two recipients developed rejection, and 1 recipient experienced urinary system infection, who were healed after corresponding treatment.  Conclusions  Adult kidney transplantation from unilateral pediatric donor kidney is safe, feasible and effective, which can be utilized to enlarge the source of donor kidneys.
Review Article
Research progress on posttransplant lymphoproliferative disease after lung transplantation
Ban Le, Zhang Ji, Zhou Min, Wang Hongmei, Mao Wenjun, Chen Jingyu
2021, 12(5): 607-613.   doi: 10.3969/j.issn.1674-7445.2021.05.016
Abstract(5) HTML(2) PDF 892KB()
Abstract:
Posttransplant lymphoproliferative disease (PTLD) is a fatal complication after lung transplantation, which is intimately associated with age, immunosuppression level and Epstein-Barr virus (EBV) infection, etc. Reducing immunosuppression level, rituximab therapy and T cell immunotherapy are common treatments for PTLD. With the rapid development of lung transplantation in China, PTLD after lung transplantation has attracted widespread attention. This article reviews the risk factors, pathological types, clinical manifestations, diagnosis, treatment, prognosis and prevention of PTLD after lung transplantation, aiming to provide reference for early monitoring and management of the incidence and progression of PTLD.
New progress on diagnosis and treatment of acute cellular rejection after lung transplantation
Xu Yu, Lian Qiaoyan, Chen Ao, Zhang Jianheng, Xu Xin, Wei Bing, Cai Yuhang, Huang Danxia, Kuang Minting, He Jianxing, Ju Chunrong
2021, 12(5): 614-618.   doi: 10.3969/j.issn.1674-7445.2021.05.017
Abstract(8) HTML(4) PDF 877KB()
Abstract:
Acute cellular rejection (ACR) is a common complication after lung transplantation, which is mainly caused by the immune response of T lymphocytes recognizing the major histocompatibility complex on the cellular surface of grafts. It is currently considered as the main pattern of acute rejection. ACR is not only a direct cause of death of recipients, but also a high-risk factor for chronic rejection after lung transplantation. Nevertheless, it is a challenging task to deliver the diagnosis and treatment of ACR following lung transplantation. In this article, new progresses on the risk factors, pathogenesis, diagnosis and treatment of ACR in lung transplant recipients were summarized, aiming to improve the diagnostic and treatment efficiency of ACR and prolong the survival of recipients.
CT manifestations and application progress of airway complications after lung transplantation
Li Dan, Xie Mingran, Ke Li
2021, 12(5): 619-623.   doi: 10.3969/j.issn.1674-7445.2021.05.018
Abstract(2) HTML(3) PDF 874KB()
Abstract:
With the continuous improvement of surgical techniques and perioperative management, the success rate of lung transplantation has gradually increased, but airway complications after lung transplantation are still common. Airway complications after lung transplantation may reduce the quality of life, increase medical costs, and even threaten the lives of the recipients. In 2018, the International Society for Heart and Lung Transplantation (ISHLT) consensus proposed that airway complications included ischemic necrosis, anastomotic dehiscence, airway stenosis and tracheobronchomalacia. Bronchoscopy remains the gold standard for the diagnosis of airway complications. However, during the follow-up of lung transplant recipients, use of end-inspiratory CT scan combined with end-expiratory or dynamic expiratory CT scan may contribute to identifying a variety of airway complications, evaluating the location and degree of airway complications and providing beneficial supplement for the selection of clinical treatment.
Research progress on malignant tumor after lung transplantation
Li Caihan, Tang Hongtao, Xu Lin, Wang Junjie, Jiang Kaiyuan, Yan Haoji, Li Haoxuan, Zheng Xiangyun, Chen Tingting, Fu Siyi, Tian Dong
2021, 12(5): 624-629.   doi: 10.3969/j.issn.1674-7445.2021.05.019
Abstract(3) HTML(3) PDF 848KB()
Abstract:
Lung transplantation has become the most effective treatment of end-stage lung diseases. Along with persistent optimization of lung transplantation technique and perioperative management, the short-term clinical efficacy after lung transplantation has been significantly improved, whereas the long-term clinical prognosis remains unoptimistic. Besides chronic lung allograft dysfunction, postoperative malignant tumors also threaten the long-term survival of the recipients. Common malignant tumors following lung transplantation include nonmelanoma skin cancer, posttransplant lymphoproliferative disease and lung cancer. After solid organ transplantation, a large majority of the recipients require lifelong immunosuppressive therapy. The intensity of immunosuppressive therapy for the lung transplant recipients is generally higher than other organ transplant recipients. Immunosuppression is the main factor which leads to the impairment of anti-tumor immune monitoring function and promotes the incidence and development of malignant tumors. In this article, the risk factors, prevention and treatment of the most common malignant tumors after lung transplantation were reviewed, aiming to provide reference for comprehensive diagnosis and treatment of malignant tumors following lung transplantation.
Recent progress on diabetes mellitus after liver transplantation
Xiao Zhengnan, Li Junhui, Jiang Jie, Zhou Zhaoqin, Zhang Yu, Guo Chen, Wang Meng, Ming Yingzi
2021, 12(5): 630-636.   doi: 10.3969/j.issn.1674-7445.2021.05.020
Abstract(7) HTML(3) PDF 892KB()
Abstract:
Diabetes mellitus is one of the most common complications after liver transplantation. The survival rate of recipients after liver transplantation with diabetes mellitus and the long-term survival rate of grafts are significantly lower than those of their counterparts without diabetes mellitus. In recent years, diabetes mellitus after liver transplantation has attracted widespread attention along with the rapid development of liver transplantation in China. Although post-transplantation diabetes mellitus (PTDM) has been extensively investigated in the past two decades, multiple problems remain to be further resolved. The study was designed to review the latest research progress upon diabetes mellitus after liver transplantation, covering the definition and diagnostic criteria of PTDM, risk factors, prevention and treatment of diabetes mellitus after liver transplantation, aiming to deepen the understanding of diabetes mellitus following liver transplantation, deliver effective prevention and management, improve the long-term survival rate and enhance the quality of life of the recipients.
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(160) HTML(77) PDF 201KB(28)
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(163) HTML(126) PDF 886KB(24)
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(162) HTML(122) PDF 323KB(16)
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(168) HTML(145) PDF 1076KB(50)
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(137) HTML(77) PDF 1280KB(1)
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。
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(131) HTML(91) PDF 264KB(9)
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(240) HTML(148) PDF 5080KB(19)
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)。
2017, 8(4): 251-259.   doi: 10.3969/j.issn.1674-7445.2017.04.001
Abstract(122) HTML(74) PDF 871KB(3)
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。
2019, 10(2): 142-148.   doi: 10.3969/j.issn.1674-7445.2019.02.005
Abstract(180) HTML(116) PDF 7197KB(20)
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(2)
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(420) HTML(165) PDF 1734KB(165)
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.
Experimental research progress on immunology of organ transplantation in 2020
Tian Qianchuan, Wu Changhong, Xu Yanan, Zhao Yong
2021, 12(2): 143-154.   doi: 10.3969/j.issn.1674-7445.2021.02.004
Abstract(310) HTML(156) PDF 901KB(156)
Abstract:
Despite the rapid development of organ transplantation technique, the long-term survival and functional maintenance of transplant organs still depend on the massive use of immunosuppressants.At present, the rejection and infection after organ transplantation remain the major problem facing transplant surgeons and recipients. The basic research in the field of organ transplantation is still steadily advancing to further explore the basic biological principle of rejection and immune tolerance, resolve multiple pathophysiological questions in the process of clinical organ transplantation and provide basic theoretical basis and clinical intervention guidance for wider and more effective application of organ transplantation.In 2020, researchers have achieved significant progresses on a wide range of basic researches of organ transplantation, such as the fundamental principle of immune response, overcoming transplantation rejection and inducing transplantation immune tolerance, etc.In this article, novel attempts and progresses upon inducing transplantation immune tolerance in 2020 were reviewed from two perspectives including inhibition of immune cell function and suppression of immune signaling pathway, and the main development direction of immunology of organ transplantation in the future was prospected.

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