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Editorial
Establishment and management of clinical use price of donation after citizen's death based on cost accounting
Li Yushu, Yang Shunliang
2021, 12(2): 123-128.   doi: 10.3969/j.issn.1674-7445.2021.02.001
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Abstract:
In recent years, the fields of donation after citizen's death and organ transplantation in China have developed rapidly with remarkable achievements and revolutionary changes in the source of transplant organs.How to transform the development of organ donation and transplantation from high-speed to high-quality growth mode?It is extremely urgent to establish the expenditure and management system of organ donation and transplantation.In this article, the establishment and management of clinical use price of organs from donation after citizen's death were investigated from the perspectives of policy basis, accounting items, accounting methods, price formation and price management, aiming to provide reference for resolving the problem of cost accounting and price determination of clinical use of donated organs.
Diagnosis and Treatment Specification
Diagnosis and treatment specification for postoperative complications after liver transplantation in China (2019 edition)
Branch of Organ Transplantation of Chinese Medical Association
2021, 12(2): 129-133.   doi: 10.3969/j.issn.1674-7445.2021.02.002
Abstract(51) HTML(30) PDF 870KB()
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The surgical techniques of liver transplantation are increasingly sophisticated with the definite effect.However, postoperative complications, such as liver graft nonfunction, postoperative bleeding and biliary tract complication may still occur, which may affect the long-term survival of the recipients.To further standardize the diagnosis and treatment of postoperative complications after liver transplantation, Branch of Organ Transplantation of Chinese Medical Association organized liver transplant experts to summarize the latest research progress at home and abroad, integrate international guidelines and clinical practice and formulate the"Diagnosis and treatment specification for postoperative complications after liver transplantation in China (2019 Edition)"based upon the diagnosis and treatment of postoperative complications after liver transplantation.
Banff Allograft Pathology
Pathology of T cell-mediated rejection in renal allograft
Guo Hui
2021, 12(2): 134-142.   doi: 10.3969/j.issn.1674-7445.2021.02.003
Abstract(61) HTML(25) PDF 2472KB()
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T cell-mediated rejection (TCMR) is one of the main mechanisms of rejection in organ transplantation, which is also the most common type of acute rejection.Based on Banff classification on allograft pathology (Banff classification) in 2019, TCMR can be divided into acute TCMR (aTCMR) and chronic active TCMR (caTCMR) according to the characteristics of immune lesions.In this article, the basic definition of TCMR, the research progress on TCMR pathology according to Banff classification for renal allograft, and the basic pathological changes and diagnostic grading of TCMR were reviewed, aiming to provide evidence for early identification, diagnosis and treatment of TCMR and prevent the progression of TCMR into caTCMR, thereby guarantying the long-term survival of both the renal allograft and recipient.
Academic Summary
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(66) HTML(30) PDF 901KB()
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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.
Highlights of international frontier hot spots and new progress on renal transplantation in 2020
Shao kun, Wang Xianghui
2021, 12(2): 155-168.   doi: 10.3969/j.issn.1674-7445.2021.02.005
Abstract(47) HTML(13) PDF 953KB()
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A large quantity of studies related to renal transplantation were reviewed to extract and summarize the international frontier hot spots and difficulties, new transplantation technologies, new methods, new visions and new progress on renal transplantation in 2020.The main contents included rejection, optimization application and regulation of immunosuppression, transplant infection, malignancy after transplantation, non-invasive detection and biomarkers, donor organ preservation, repair and utilization, recurrence of renal disease after renal transplantation, multi-factors affecting long-term survival of transplant kidney, computer and artificial intelligence, etc.Strengthening the reading and thinking of literatures in the field of renal transplantation and broadening horizons in higher starting piont, combined with clinical practice of renal transplantation in China, help to promote the long-term efficacy of renal transplantation.
Research highlights of renal transplantation in 2020: voice from China
Luo Zihuan, Sun Qiquan
2021, 12(2): 169-176.   doi: 10.3969/j.issn.1674-7445.2021.02.006
Abstract(37) HTML(16) PDF 906KB()
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Renal transplantation is the optimal approach to improve the quality of life and restore normal life for patients with end-stage renal diseases.With the development of medical techniques and immunosuppressants, the shortterm survival of renal graft has been significantly prolonged, whereas the long-term survival remains to be urgently solved.Renal ischemia-reperfusion injury (IRI), acute rejection, chronic renal allograft dysfunction, renal fibrosis and other factors are still the major problems affecting the survival of renal graft.Relevant researches have always been hot spots in the field of renal transplantation.Meantime, 2020 is an extraordinary year.The novel coronavirus pneumonia (COVID-19) pandemic severely affects the development of all walks of life.Researches related to renal transplantation have also sprung up.In this article, the frontier hotspots of clinical and basic studies related to renal transplantation and the COVID-19 related researches in the field of renal transplantation in China were reviewed, aiming to provide novel therapeutic ideas and strategies.
Transplantation Forefront
Role of NLRP3 inflammasome and related inflammatory signaling pathways in renal ischemia-reperfusion injury
Yuan Qiang, Shen Kaiwen, Zhang Ruibo, Shen Jun
2021, 12(2): 177-183.   doi: 10.3969/j.issn.1674-7445.2021.02.007
Abstract(36) HTML(10) PDF 1592KB()
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Renal ischemia-reperfusion injury (IRI) commonly occurs in renal transplantation, which is an important pathophysiological process that causes acute renal failure and severely affects clinical prognosis of the recipients. Inflammatory response plays a critical role in the pathogenesis and pathological process of IRI. Activated NOD-like receptor protein 3(NLRP3) inflammasome can mediate the maturation and release of various pro-inflammatory cytokines, thereby regulating the inflammatory response and relevant cell functions. In this article, the mechanism underlying NLRP3 inflammasome and its related inflammatory signaling pathway in renal IRI were reviewed, aiming to provide novel ideas for clinical prevention and treatment of renal IRI.
Original Article
Multi-disciplinary team of the treatment of bilateral lung transplantation for pediatric cystic fibrosis
Wang Shengfei, Chen Jingyu, Liu Yi, Zheng Mingfeng, Mao Wenjun
2021, 12(2): 184-190.   doi: 10.3969/j.issn.1674-7445.2021.02.008
Abstract(36) HTML(9) PDF 1337KB()
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  Objective  To improve the surgical efficacy of bilateral lung transplantation for pediatric cystic fibrosis through multi-disciplinary team (MDT).  Methods  Preoperative MDT consultation was delivered for a 10-year-old child with rare end-stage cystic fibrosis to establish the corresponding treatment protocol.  Results  The child was diagnosed with cystic fibrosis for 5 years, and the indication of lung transplantation were confirmed. After preoperative MDT consultation, bilateral lung transplantation via a Clam-shell incision was determined. The vital signs were maintained stable during operation. Postoperatively, ventilator-assisted ventilation, anti-infection, immunosuppression, acid suppression, prevention of stress ulceration and other treatments were delivered. Individualized treatment was given according to the characteristics of the child, and the child was well recovered.  Conclusions  Through preoperative MDT consultation, lung transplantation yields satisfactory surgical efficacy in treating pediatric cystic fibrosis and lowers the risk of postoperative complications, which deserves application in clinical practice.
Rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models using magnetic compression anastomosis technique
Liu Shiqi, Ci Hongbo, Lei Peng, Lyu Yi, Wang Shanpei, Bai Jigang
2021, 12(2): 191-196.   doi: 10.3969/j.issn.1674-7445.2021.02.009
Abstract(30) HTML(8) PDF 1679KB()
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  Objective  To explore the feasibility of rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models using magnetic compression anastomosis (MCA) technique.  Methods  Twelve healthy adult crossbred dogs were evenly divided into the MCA and hand suturing (HS) groups according to the anastomosis method between abdominal aorta and artificial blood vessels. The intraoperative duration of abdominal aorta occlusion, intraoperative condition of anastomotic stoma and postoperative imaging examination of anastomotic stoma were compared between two groups.  Results  The intraoperative duration of abdominal aorta occlusion in the MCA group was significantly shorter than that in the HS group [(5.2±2.3) min vs. (24.4±4.3) min, P < 0.001]. No anastomotic leakage of blood or anastomotic stenosis occurred in the MCA group during the operation. Intraoperative anastomotic leakage of blood occurred in all of the 6 dogs in the HS group. Among them, 1 dog died of excessive blood loss, and 2 dogs experienced mild anastomotic stenosis due to repeated repair. Postoperative color Doppler ultrasound and angiography showed smooth blood flow at the anastomotic stoma without stenosis or thrombosis in the MCA group. In the HS group, 4 dogs presented with anastomotic stenosis on angiography at postoperative 4 weeks.  Conclusions  MCA technique may achieve rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models, which reduces the incidence of anastomotic complications and accelerates postoperative recovery.
Risk factors of multi-drug resistant organism infection after liver transplantation: a single-center clinical trial
Fang Yitian, Wu Ruolin, Huang Fan, Wang Guobin, Feng Lijuan, Yu Xiaojun, Hou Liujin, Ye Zhenghui, Geng Xiaoping, Zhao Hongchuan
2021, 12(2): 197-202.   doi: 10.3969/j.issn.1674-7445.2021.02.010
Abstract(30) HTML(21) PDF 939KB()
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  Objective  To analyze the risk factors of multi-drug resistant organism (MDRO) infection after liver transplantation.  Methods  The clinical data of 77 recipients undergoing liver transplantation were retrospectively analyzed. According to the incidence of MDRO infection, all recipients were divided into the non-MDRO infection group (n=51) and MDRO infection group (n=26). The infection rate and strain distribution of MDRO in liver transplant recipients were summarized. The risk factors of MDRO infection in liver transplant recipients were identified. Clinical prognosis of all recipients was statistically compared between two groups.  Results  The infection rate of MDRO after liver transplantation was 34% (26/77), mainly carbapenem-resistant MDRO infection. The main sites of infection included lung, abdominal cavity and incision. Univariate analysis showed that postoperative tracheal intubation ≥48 h, length of intensive care unit (ICU) stay ≥72 h, length of hospital stay ≥30 d, re-operation, continuous renal replacement therapy (CRRT) and tacrolimus (Tac) blood concentration ≥15 ng/mL were the risk factors for MDRO infection after liver transplantation. Cox regression analysis indicated that postoperative tracheal intubation≥48 h, re-operation, CRRT and Tac blood concentration ≥15 ng/mL were the independent risk factors for MDRO infection after liver transplantation. The fatality in the MDRO infection group was significantly higher than that in the non-MDRO infection group [31%(8/26) vs. 10%(5/51), P=0.01].  Conclusions  Postoperative tracheal intubation ≥48 h, re-operation, CRRT and Tac blood concentration ≥15 ng/mL may increase the risk of MDRO infection after liver transplantation and affect clinical prognosis of the recipients.
Analysis of risk factors and clinical prognosis of massive blood transfusion during perioperative period of lung transplantation
Wen Huanshun, Hao Yang, Chen Jingyu, Liang Chaoyang
2021, 12(2): 203-208.   doi: 10.3969/j.issn.1674-7445.2021.02.011
Abstract(17) HTML(20) PDF 918KB()
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  Objective  To investigate the risk factors and clinical prognosis of massive blood transfusion during the perioperative period of lung transplantation.  Methods  Clinical data of 159 lung transplant recipients were retrospectively analyzed. According to the quantity of perioperative blood transfusion, all recipients were divided into the massive blood transfusion group (n=20) and non-massive blood transfusion group (n=139). Clinical data of lung transplant recipients were statistically compared between two groups. The risk factors of perioperative massive blood transfusion were analyzed. Clinical prognosis of the recipients was observed in two groups.  Results  There were significant differences between the two groups in preoperative data including anticoagulant therapy, hemoglobin content, the number of recipents with idiopathic pulmonary fibrosis or idiopathic pulmonary hypertension, and intraoperative data including the number of recipents presenting with intraoperative intrathoracic adhesion, operation time and the amount of various component transfusion(all P < 0.05). Preoperative anticoagulant therapy, incidence of intraoperative intrathoracic adhesion, use of extracorporeal membrane oxygenation (ECMO) and long operation time were the risk factors of massive blood transfusion during perioperative period of lung transplantation(all P < 0.05). In the massive blood transfusion group, the incidence rate of grade Ⅲ primary graft dysfunction (PGD) and the fatality within postoperative 30 d were higher compared with those in the non-massive blood transfusion group(both P < 0.01). Low body mass index (BMI) and massive blood transfusion were the risk factors for death within postoperative 30 d(P=0.048、P < 0.001). The 1-year survival rate in the massive blood transfusion group was lower than that in the non-massive blood transfusion group(P < 0.001).  Conclusions  Preoperative anticoagulant therapy, incidence of intraoperative intrathoracic adhesion, use of ECMO and long operation time are the risk factors for massive blood transfusion during perioperative period of lung transplantation. Massive blood transfusion negatively affects the clinical prognosis of the recipients undergoing lung transplantation.
Clinical application of biomarkers in DCD donor kidney perfusate for predicting delayed graft function after renal transplantation
Li Xin, Sun Zejia, Cai Jifei, Wang Wei
2021, 12(2): 209-214.   doi: 10.3969/j.issn.1674-7445.2021.02.012
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  Objective  To explore the feasibility of biomarkers in static cold storage (SCS) perfusate of donor kidney from donation after cardiac death (DCD) for predicting delayed graft function (DGF) after renal transplantation.  Methods  Clinical data of 64 recipients and 47 donors undergoing DCD renal transplantation were retrospectively analyzed. All recipients were divided into the DGF group (n=7) and immediate graft function (IGF) group (n=57) according to the incidence of postoperative DGF in the recipients. The levels of neutrophil gelatinase-associated lipocalin (NGAL), liver-type fatty acid-binding protein (L-FABP), interleukin -18(IL-18) and kidney injury molecule-1 (KIM-1) in the SCS perfusate were statistically compared between two groups, and the correlation with DGF was analyzed. The predictive value of each biomarker in the occurrence of DGF in recipients after renal transplantation was analyzed.  Results  The incidence of DGF in the recipients undergoing DCD renal transplantation was 11% (7/64). The NGAL level in the donor kidney perfusate of the DGF group was significantly higher than that in the IGF group (P=0.009). The NGAL level in the donor kidney perfusate was positively correlated with the incidence of DGF in recipients after renal transplantation (r=0.430, P < 0.001). The receiver operating characteristic (ROC) curve analysis showed that the increased levels of NGAL and KIM-1 in the perfusate yielded certain predictive value for DGF in recipients after renal transplantation (both P < 0.05). The area under the curve (AUC) of combined detection of NGAL and KIM-1 for predicting DGF in recipients after renal transplantation was 0.932 [95% confidence interval (CI) 0.850-1.000]. The sensitivity was calculated as 1.000 and 0.754 for the specificity (P < 0.05).  Conclusions  The NGAL level in the SCS perfusate of DCD donor kidney is associated with the occurrence of DGF in recipients after renal transplantation. Combined detection of NGAL and KIM-1 levels in the perfusate may accurately predict the occurrence of DGF in recipients after renal transplantation.
Clinical analysis of percutaneous transluminal angioplasty combined with stent implantation in the treatment of transplant renal artery stenosis
Gu Shijie, Chen Qiuyuan, Cui Ruiwen, Ma Qing, Ma Lin, Shi Xiaohong, Meng Fanhang, Cao Ronghua
2021, 12(2): 215-219.   doi: 10.3969/j.issn.1674-7445.2021.02.013
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  Objective  To evaluate the clinical efficacy of percutaneous transluminal angioplasty (PTA) combined with stent implantation in the treatment of transplant renal artery stenosis (TRAS) after renal transplantation.  Methods  Clinical data of 21 patients with TRAS after renal transplantation undergoing PTA combined with stent implantation were retrospectively analyzed. The incidence of TRAS in renal transplant recipients was summarized. The changes of relevant indexes in patients with TRAS were statistically compared before and after interventional treatment. Clinical prognosis of patients with TRAS was evaluated.  Results  The incidence of TRAS in renal transplant recipients was 4.1%(21/507). TRAS was diagnosed at postoperative 5 (4, 7) months, and 67% (14/21) of patients developed TRAS within postoperative 6 months. Compared with the values before interventional therapy, the serum creatinine level, systolic and diastolic blood pressure and peak flow velocity of transplant renal artery of patients with TRAS were significantly decreased, and the estimated glomerular filtration rate (eGFR) and interlobar arterial resistance index were significantly increased at 1 week and 1 month after interventional therapy (all P < 0.05). During postoperative follow-up after PTA combined with stent implantation, 1 patient suffered re-stenosis of the transplant renal artery, which was improved after simple balloon dilatation. One patient developed pseudoaneurysm formation at the puncture site of the right femoral artery. One patient presented with renal atrophy and loss of function due to atresia of the transplant renal artery. All the remaining 18 patients were well recovered after surgery.  Conclusions  PTA combined with stent implantation is the optimal treatment of TRAS after renal transplantation, which can significantly improve the function of transplant kidney and considerably prolong the survival time of transplant kidney.
Analysis of risk factors and clinical prognosis of acute kidney injury early after lung transplantation
Chen Ao, Lian Qiaoyan, Zhang Jianheng, Xu Xin, Wei Bing, Cai Yuhang, Huang Danxia, He Jianxing, Ju Chunrong
2021, 12(2): 220-225, 231.   doi: 10.3969/j.issn.1674-7445.2021.02.014
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  Objective  To analyze the risk factors and clinical prognosis of acute kidney injury (AKI) early after lung transplantation.  Methods  Clinical data of 155 recipients undergoing lung transplantation or combined heart-lung transplantation were retrospectively analyzed, and they were divided into the AKI group (n=104) and non-AKI group (n=51) according to the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline. The incidence of AKI early after lung transplantation was summarized. The main indexes of recipients were collected. The risk factors of the occurrence of AKI early after lung transplantation were subjected to univariate and multivariate analysis. The clinical prognosis of lung transplant recipients was evaluated and the survival curve was delineated.  Results  The incidence of AKI early after lung transplantation was 67.1%(104/155), including 47 recipients with stage 1 AKI, 34 recipients with stage2 AKI and 23 recipients with stage 3 AKI, respectively. Sixteen recipients required continuous renal replacement therapy (CRRT) early after lung transplantation. Preoperative complication with diabetes mellitus, preoperative complication with pulmonary hypertension, intraoperative mean arterial pressure (MAP) < 60 mmHg, intraoperative massive blood transfusion, and treatment with excessive therapeutic concentration of tacrolimus (Tac) within postoperative 1 week were the independent risk factors for the occurrence of AKI early after lung transplantation. Up to the end of follow-up, 66 recipients (42.6%) died, including 50 recipients in the AKI group and 16 recipients in the non-AKI group. The cumulative survival rate in the AKI group was significantly lower than that in the non-AKI group (40% vs. 66%, P < 0.05). With the increase of AKI severity, the cumulative survival rate of lung transplant recipients was decreased.  Conclusions  AKI develops early after lung transplantation with high incidence and poor clinical prognosis. Preoperative complication with diabetes mellitus and pulmonary hypertension, intraoperative MAP < 60 mmHg and massive blood transfusion, and treatment with excessive therapeutic concentration of Tac within postoperative 1 week are the independent risk factors for the occurrence of AKI early after lung transplantation.
Review Article
Effect of the regulation of mitochondrial dynamics on renal ischemia-reperfusion injury
Yan Xiaodong, Wang Qiang
2021, 12(2): 226-231.   doi: 10.3969/j.issn.1674-7445.2021.02.015
Abstract(41) HTML(10) PDF 1359KB()
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Ischemia-reperfusion injury (IRI) is one of the main causes of early graft dysfunction after renal transplantation. In China, organ transplantation has entered into the era of organ donation after citizen's death. The increased risk of cardiopulmonary resuscitation, prolonged hypoperfusion time and warm ischemia time of donors may lead to IRI of the graft, and affect the short- and long-term clinical prognosis of the recipient and graft. Under IRI and other stress conditions, the mechanism of mitochondrial dynamics, mainly manifested by dynamic regulation of mitochondrial division and fusion, exert critical effect upon the biological function of mitochondria. Cell apoptosis caused by mitochondrial injury is the key event leading to acute kidney injury, which is mainly manifested by the imbalance of the regulatory mechanism of mitochondrial dynamics. In this article, the research progress on the regulatory mechanism of mitochondrial dynamics on renal IRI was reviewed, aiming to provide reference for improving the clinical outcomes of renal transplantation.
Clinical application and progress on adult donor dual kidney transplantation
Zhang Man, Liu Bin
2021, 12(2): 232-238.   doi: 10.3969/j.issn.1674-7445.2021.02.016
Abstract(39) HTML(21) PDF 1195KB()
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Full application of marginal donor organs is a critical method to expand donor pool and alleviate organ shortage. After accurate donor evaluation, allocation and recipient selection, adult donor dual kidney transplantation (DKT) can not only achieve equivalent clinical efficacy to single kidney transplantation (SKT), but also effectively reduce the discard rate of marginal donor kidney. In this article, the clinical application and progress on adult donor DKT were reviewed from the perspectives of the development situation, allocation standard, recipient selection, surgical methods and complications as well as clinical efficacy of DKT, aiming to provide reference and guidance for subsequent development of marginal donor DKT.
Discussion on heart transplantation indications in patients with end-stage heart failure complicated with reversible pulmonary artery hypertension
Zheng Shanshan, Liu Sheng
2021, 12(2): 239-243.   doi: 10.3969/j.issn.1674-7445.2021.02.017
Abstract(28) HTML(23) PDF 851KB()
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Heart transplantation can save the life and improve the quality of life of patients with end-stage heart failure. Nevertheless, it is not suitable for all patients with end-stage heart failure. As a common complication of end-stage heart failure, pulmonary artery hypertension may increase the incidence of right heart failure after heart transplantation, which is associated with the short- and long-term fatality risk in the recipients after heart transplantation. In clinical practice, different transplant centers have different criteria for heart transplantation indications in patients with end-stage heart failure complicated with pulmonary artery hypertension. Accurate preoperative evaluation of surgical indications plays a critical role in determining the success of heart transplantation. In this article, the definition, pathogenesis and effects on heart transplantation, diagnostic methods and reversibility judgment of pulmonary artery hypertension, diagnostic treatment of reversible pulmonary artery hypertension and indications of heart transplantation in patients with end-stage heart failure complicated with reversible pulmonary hypertension were reviewed.
Intracapsular infection of polycystic kidney disease and renal transplantation
Li Xuelin, Miao Yun
2021, 12(2): 244-248.   doi: 10.3969/j.issn.1674-7445.2021.02.018
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Autosomal dominant polycystic kidney disease (ADPKD) is a common monogenic hereditary kidney disease, which can progress into end-stage renal disease (ESRD). Patients with ADPKD constantly suffer from recurrent intracapsular infection. The drug resistance caused by antibiotic treatment is becoming increasingly prominent. The pattern of renal transplantation should be selected according to the infection of polycystic kidney disease. In this article, the origin of renal cyst, classification and source of cystic fluid, type and drug resistance of bacteria in the cystic fluid, and intracapsular infection of patients with renal transplantation- associated ADPKD were reviewed, aiming to provide reference for the diagnosis and treatment of intracapsular infection of patients with ADPKD.
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(31) HTML(12) PDF 0KB(0)
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(10) HTML(20) PDF 887KB(2)
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(14) HTML(16) PDF 0KB(0)
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(27) HTML(11) PDF 1076KB(2)
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(36) HTML(10) PDF 0KB(0)
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(20) HTML(7) PDF 0KB(0)
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(14) HTML(8) PDF 5081KB(0)
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(6) HTML(2) PDF 0KB(0)
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。
2016, 7(2): 159-162.   doi: 10.3969/j.issn.1674-7445.2016.02.016
Abstract(12) HTML(2) PDF 0KB(1)
摘要:
中国器官移植发展起步较晚, 相关法律制度建立较为滞后。随着器官移植外科技术的提高以及新型免疫抑制剂的临床应用, 从上世纪90年代起器官移植在全球范围内快速发展, 中国器官移植事业也得到了蓬勃发展。但是, 中国肝、肾、心、肺等器官功能衰竭患者基数庞大, 加之国人传统观念影响, 器官捐献不足, 供体相对严重短缺。以德国为例的欧美国家在器官移植技术水平、法律制度建立、操作流程的完善等方面的发展远远早于且优于中国。本文拟从组织机构、法律基础、供体器官来源、供体死亡标准、器官获取与分配、移植机构等方面对中国和德国的器官移植现状进行对比, 以期为中国器官移植事业的发展提供参考。
Guideline on the standard of lung transplantation donors and the acquisition and transshipment in China
Branch of Organ Transplantation of Chinese Medical Association, National Quality Management and Control Center for Lung Transplantation
2018, 9(5): 325-333.   doi: 10.3969/j.issn.1674-7445.2018.05.001
Abstract(16) HTML(4) PDF 1533KB(0)
摘要:
2015年我国供肺利用率仅约5%。从器官获取组织(OPO)进行供肺协调、初步评估和维护,到供肺获取直至最后经民航、高速公路、高铁转运完成肺移植,每一环节都相当艰难。许多初评合格的供肺,由于缺乏有效的维护而无法用于移植。因此,我们组织专家制订我国肺移植供体标准及获取转运指南,从我国肺移植供肺捐献的分类、供肺选择标准、供肺维护策略、供肺获取流程、供肺转运流程等方面,总结我国肺移植的临床实践经验,希望能为肺移植相关临床科室提供工作指引。
Attaching importance to mechanical perfusion of donor liver and promoting high-quality development of liver transplantation
Ouyang Qing, Tan Xiaoyu, Huo Feng
2021, 12(1): 1-7.   doi: 10.3969/j.issn.1674-7445.2021.01.001
Abstract(62) HTML(38) PDF 868KB(38)
Abstract:
With the increasing quantity of organ donors and the continual expansion of the definition of extended criteria donor (ECD) livers, the quality of donor liver has become a prominent issue affecting the high-quality development of liver transplantation, which is also the study focus in related fields. Resolving the shortage of organs to the maximal extent and promoting the high-quality development of organ transplantation lead the development direction of organ donation and transplantation in China. In recent years, the application of mechanical perfusion (MP) for the perfusion, preservation, evaluation and repair of donor liver has become a hot topic to improve the quality of liver transplantation within the international community. In this article, according to different conditions of the application of ECD livers in liver transplantation at home and abroad in combination with the research progress on MP in the international community and relevant research experience of our center, the feasibility of establishing an organ intensive care unit (ICU) with integrated organ protection techniques was discussed, aiming to promote the high-quality development of organ transplantation in China and further expand the technical connotation of the "Chinese model" of organ donation and transplantation.
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(66) HTML(30) PDF 901KB(30)
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