器官移植

2014 Vol. 5, No. 1

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Editorial
Experimental Researches
CIinical Researches
Learning Garden
Review Articles
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Editorial

2014, 5(1): 1-3. doi: 10.3969/j.issn.1674-7445.2014.01.001

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Experimental Researches

Time limit of human uterine tissue tolerating cold ischemic injury

Lyu Xiaogang, Wang Yifeng, Chen Gaowen, Yu Ping, Zhu Ying

2014, 5(1): 4-7. doi: 10.3969/j.issn.1674-7445.2014.01.002

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Objective To investigate the time limit of human uterine tissue tolerating cold ischemic injury. Method The uterus in this study were from 10 patients undergoing panhysterectomy or subtotal hysterectomy for hysteromyoma. The informed consents of all patients were obtained and the ethical committee approval was received. According to different preservation solutions, the uterine tissues were divided into University of Wisconsin (UW)solution group (group UW, n=5) and Ringer acetate (RIN) solution group (group RIN, n=5) at 0-4℃. The histological changes of the uterine tissues were observed by optical microscope and electron microscope when time for preservation was up. The autonomic contraction of myometrium and the response of myometrium to oxytocin were observed to judge the cold ischemic injury of the preserved tissues. Result No change in the endometrium and myometrium of all preserved tissues was observed by optical microscope. Compared with the normal uterine tissues, no ultrastructure change of the uterine tissues was observed after 6 h and 24 h storage in UW solution and 6 h storage in RIN solution by electron microscope. But irreversible degenerative changes of the tissues were observed after 24 h storage in RIN solution. Severe degenerative changes of the uterine tissues occurred. Different degree of swelling was observed in the mitochondria and change was also observed in the cell nucleus (thickening chromatin). Compared with normal uterine tissues, all the contraction of myometrium mildly weakened in 2 groups. Autonomic contraction or contraction after applying small dose of oxytocin of all the uterine tissue samples were observed after 6 h and 24 h storage in group UW and 6 h storage in group RIN, while no contraction was observed in samples after 24 h storage in group RIN. Conclusion The human uterine tissue can tolerate cold ischemic injury for at least 6 h and preserve for 24 h in UW solution at low temperature.

Effect of therapeutic hypercapnia on the early inflammatory factors after ischemia-reperfusion injury of lung transplantation

Wang Ling, La Budanbaila

2014, 5(1): 8-11. doi: 10.3969/j.issn.1674-7445.2014.01.003

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Objective To investigate the effect of therapeutic hypercapnia on the early inflammatory factors after ischemia-reperfusion of lung transplantation. Method Seventy-two male Wistar rats were randomly divided into model group (n=36) and therapy group (n=36). Rats on the baseline in model group and therapy group were ventilated with 50% N₂ and 50% O₂. Rats in model group were continuously ventilated with 50% N₂ and 50% O₂ after successful transplantation. Rats in therapy group were ventilated with mixed gases after successful transplantation, which included 50% O₂, 8% CO₂, and 42% N₂ to keep arterial partial pressure of carbon dioxide(PaCO₂) in the range of 80~100 mmHg(10 mmHg=1.33 kPa). The mean arterial pressure (MAP)、PaCO₂ and arterial partial pressure of oxygen (PaO₂) of recipient rats were recorded as baseline value after mechanical ventilation for 1 minute. Then the data were recorded once every 30 minutes during reperfusion period until the end. The inferior lobes of left lung sample were taken at 1, 2,4 h after reperfusion respectively. The levels of tumor necrosis factor(TNF)-α and interleukin(IL)-1β in lung tissues were measured by enzyme-linked immunosorbent assay. Result Compared with model group, MAP and PaO₂ were significantly higher in therapy group at different time points after reperfusion (all in P<0.05). Compared with model group, the levels of TNF-α and IL-1β of transplant lung tissues were significantly lower in therapy group at different time points after reperfusion(all in P<0.05). Conclusion The therapeutic hypercapnia plays an inhibitive role on the release of early inflammatory factors after the ischemia-reperfusion injury of lung transplantation.

CIinical Researches

Research on the establishment of competency evaluation system of organ donation coordinator

Luo Aijing, Xie Wenzhao, Ming Yingzi, Cui Qiaoling, Wang Fuzhi

2014, 5(1): 12-17,34. doi: 10.3969/j.issn.1674-7445.2014.01.004

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Objective To establish the competency evaluation system of organ donation coordinator. Method The original framework of competency model of organ donation coordinator was established by McClelland competency dictionary law. Then, combining behavioral event interview, 10 coordinators with rich experience from Hunan、Guangdong and other pilot regions were interviewed, whose competence indicators were extracted. And 15 experts screened the competency indicators by professional survey. Finally, the weight of competency indicators was determined by analytic hierarchy process, and the competency evaluation system of organ donation coordinator was established. Result The competency evaluation system of organ donation coordinator was successfully established, including 6 dimensionalities(first level indicator) and 21 items of competency(second level indicator). Conclusion This system can evaluate the competency of organ donation coordinator from many dimensionalities and has important reference value on the recruitment, performance assessment and training of organ donation coordinator.

Impacts of spleen volume and collateral circulation on the biliary complications in patients with hepatic cirrhosis after liver transplantation

Liang Yingying, Yan Ronghua, Wang Jin, Liu Jingjing, Ren Linglan, Hu Bing, He Bingjun, Jiang Zaibo, Shan Hong

2014, 5(1): 18-23. doi: 10.3969/j.issn.1674-7445.2014.01.005

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Objective To investigate the impacts of spleen volume and collateral circulation on the biliary complications in patients with end-stage hepatic cirrhosis after liver transplantation(LT). Method Seventy-four patients who underwent LT in the Third Affiliated Hospital of Sun Yat-sen University from April 2005 to February 2013 were enrolled in this study. All the patients received computed tomography (CT) and/or magnetic resonance imaging (MRI) before and after LT. The patients were divided into 3 groups according to the changes of spleen volume after LT: group A (the volume reduced to the normal range), group B (the volume reduced but still exceeded the normal range), group C (the volume increased). Twenty healthy people were enrolled in the study as the normal control group. The spleen form and diameter changes of splenic vein, portal vein before and after operation in 3 groups were counted and compared with that in normal control group. The establishment of collateral circulation before and after operation and postoperative follow-up of patients in 3 groups were recorded. Result There were 18 cases(24%) in group A, 39 cases (53%) in group B, 17 cases(23%)in group C. The collateral circulation was obviously relieved after operation for patients in group A and group B, but it was not relieved and became worse for patients in group C. Six cases (33%) in group A suffered from mild vascular complications after LT and 1 case (6%) suffered from mild ischemic cholangitis after LT. Seventeen cases (44%) in group B suffered from mild vascular complications after LT and 6 cases(15%) suffered from mild ischemic cholangitis after LT. Seventeen cases (100%) in group C suffered from severe vascular complications after LT with biliary complications of different degrees and granulation tissues were found in hepatic hilar area of 5 cases. Conclusion The incidence of biliary complications in patients with end stage hepatic cirrhosis and portal hypertension after LT is comparatively high. The abnormal hemodynamics caused by severe vascular complications after LT is one of the influences.

Analysis of curative effect of pulmonary lobectomy on atelectasis after lung transplantation

Li Huixing, Mao Wenjun, Chen Jingyu, Zheng Mingfeng, Ye Shugao, He Yijun, Liu Feng

2014, 5(1): 24-27,31. doi: 10.3969/j.issn.1674-7445.2014.01.006

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Objective To investigate the curative effect of pulmonary lobectomy on lobe atelectasis after lung transplantation. Method Clinical data of two patients with lobe atelectasis after lung transplantation were retrospectively analyzed in July 2013. One case developed severe infection of right middle lobe and lobe atelectasis after double lung transplantation for cystic fibrosis. The other case developed lobe atelectasis of right middle and lower lobe after double lung transplantation for bronchiectasis and pneumonectasis. Before pulmonary lobectomy, both of them suffered from pulmonary infection. Two cases underwent pulmonary lobectomy of middle lobe or middle and lower lobe of right transplant lung respectively. Result Pulmonary infection was controlled in two cases after pulmonary lobectomy. They were discharged from the hospital and had good quality of life. Conclusion Pulmonary lobectomy can be performed aggressively for pulmonary atelectasis after lung transplantation due to severe lung infection or bronchostenosis. Removal of diseased region can control the postoperative complication effectively.

Analysis of predictive factors associated with the reversibility of post-transplantation diabetes mellitus

Xu Xiaodong, Xie Ruying, Lin Shuo, Shu Jiong, Wang Manman, Mu Panwei, Yang Yang, Chen Guihua, Zeng Longyi

2014, 5(1): 28-31. doi: 10.3969/j.issn.1674-7445.2014.01.007

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Objective To investigate the predictive factors associated with the reversibility of post-transplantation diabetes mellitus(PTDM). Method Clinical data of 618 patients who underwent liver transplantation from April 2004 to June 2009 in the Liver Transplantation Center of the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed, in which 190 patients were included in the study. According to the persistence of hyperglycemia, patients were divided into two groups: reversible PTDM group and irreversible PTDM group. Preoperative data (age, gender, body mass index, pre-transplantation fasting plasma glucose, liver cirrhosis history, hypertension history) and postoperative data (rejection, dose of glucocorticoid, choice of calcineurin inhibitor) which might affect the glycometabolism of patients between two groups were analyzed by univariate factor analysis. Result PTDM in 102 patients (69.9%) was reversible. Compared with irreversible PTDM group, age of patients was younger in reversible PTDM group[(43±11)years old vs. (52±10)years old, P<0.05]. And there was no significant difference in the other factors(all in P>0.05). Conclusion Age of patients received organ transplantation is the predictive factor associated with the reversibility of PTDM.

Replacement of external iliac artery by reversed great saphenous vein for the treatment of vascular complications after renal transplantation: a report of 2 cases

Ming Yingzi, Zhou Wei, Ye Shaojun, She Xingguo, Liu Hong, Niu Ying, Zhu Yi, Li Cai, Shao Mingjie, Ye Qifa

2014, 5(1): 32-34. doi: 10.3969/j.issn.1674-7445.2014.01.008

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Objective To investigate the treatment of vascular complications after renal transplantation and the replacement therapy of blood vessels in an emergency. Method Two patients with repeated external iliac artery bleeding after renal transplantation received treatment in Transplantation Center of the Third Xiangya Hospital of Central South University from December 2009 to March 2012. After surgical exploration, the reason of bleeding was burst of the anastomotic external iliac artery in two cases. Then anastomotic external iliac artery was removed and the ipsilateral autologous limb's great saphenous vein was taken for reversed replacement of external iliac artery. Result Both patients recovered well after the operation with normal lower limb blood supply and free walk. One patient survived for four years with no postoperative bleeding again. Another patient had recovered for more than one year with normal the lower limb blood supply. Conclusion Repeated external iliac artery rupture hemorrhage after renal transplantation is one of the serious complications which results in death. Emergency treatment is very important and autologous vascular reconstruction may be a more effective and convenient treatment.

Analysis of the causes of death and preventive measures in renal transplant recipients

Liao Guiyi, Ruan Houxin, Tang Liang, Fang Weihua

2014, 5(1): 35-37,53. doi: 10.3969/j.issn.1674-7445.2014.01.009

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Objective To analyze the cause of death in renal transplant recipients and to investigate the preventive measures. Method Clinical data of 6 death cases were retrospectively analyzed, who underwent renal transplantation in the Department of Urinary Surgery of the First Affiliated Hospital of Anhui Medical University from August 2007 to March 2013. The causes of death were analyzed combined with associated literatures. Result In 6 dead cases, the causes of death were abandoning treatment for graft failure or repeated complication in 3 cases, acute cardiovascular event in 1 case, pulmonary infection in 1 case, and fulminant hepatic failure in 1 case. Conclusion Abandoning treatment, pulmonary infection, acute cardiovascular event and fulminant hepatic failure are the important reasons for death of renal transplant recipients. The reason of abandoning treatment is graft failure or repeated complication after transplantation. It is an important preventing measure that physicians cooperate with family members to strengthen the psychological counseling with patients and prompt them to comply the treatments.

Learning Garden

2014, 5(1): 38-40. doi: 10.3969/j.issn.1674-7445.2014.01.010

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Review Articles

2014, 5(1): 41-44. doi: 10.3969/j.issn.1674-7445.2014.01.011

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2014, 5(1): 45-48. doi: 10.3969/j.issn.1674-7445.2014.01.012

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2014, 5(1): 49-53. doi: 10.3969/j.issn.1674-7445.2014.01.013