器官移植

Abstract:
Objective To analyze the necessity of anti-human leukocyte antigen (HLA) antibody monitoring and graft biopsy on early diagnosis of antibody-mediated rejection (AMR). Methods Fifty-one recipients with de novo donor specific antibody (dnDSA) were screened and chosen. Donor specific antibody (DSA) and its ability to bind with C1q were evaluated. Pathological biopsy of the kidney graft was performed. The recipients diagnosed with AMR were divided into the unstable and stable kidney function groups. Type of DSA, binding ability of the complement and Banff score were statistically compared between two groups. Kaplan-Meier survival analysis of the kidney graft in the recipients from non-rejection, unstable and stable kidney function groups was performed. Results Type of HLA antibody, mean fluorescent intensity (MFI) of DSA, C1q binding ability and C4d deposition in peritubular capillary did not significantly differ between the unstable and stable groups (all P>0.05). Histomorphologically, the Banff score of microvasculitis, endarteritis, renal tubule-interstitial nephritis, transplantation glomerulopathy and renal tubular atrophy-stroma fibrosis did not significantly differ between two groups (all P>0.05). In the unstable group, the accumulated survival rate of the kidney graft was significantly lower compared with that in the stable group, which was significantly lower than that of their counterparts who were ineligible for pathological diagnosis (P=0.002). Conclusions It is necessary to perform regular anti-HLA antibody monitoring and pathological puncture examination after renal transplantation, which contributes to early detection and diagnosis of AMR.

Experience of clinical treatment on patients on cirrhosis or liver cancer complicated with psoriasis after liver transplantation

Du Guosheng, Zhou Lin, Zheng Yonggen, Pan Lichao, Shi Haida, Zhu Zhidong, Song Jiyong, Feng Likui

2016, 7(6): 438-443. doi: 10.3969/j.issn.1674-7445.2016.06.005

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Abstract:
Objective To summarize the clinical experience of immunosuppressive therapy for recipients suffering from psoriasis after liver transplantation. Methods Five patients diagnosed with cirrhosis or hepatocellular carcinoma(HCC) complicated with psoriasis after liver transplantation were recruited in this clinical trial. All participants were positive for serum biomarkers of hepatitis B virus (HBV). Induction therapy was adopted before surgery. Immunosuppressive regime of tacrolimus (FK506), mycophenolate mofetil (MMF) and adrenal cortical hormone (hormone)was implemented early after surgery. The hormone use was terminated within 1 week. Three cases of cirrhosis complicated with HCC due to chronic HBV infection were gradually switched to sirolimus substitution treatment within 1 month after liver transplantation. Two patients with cirrhosis were administered with FK506 with or without MMF following liver transplantation. All patients received anti-HBV therapy. Baseline data, changes in psoriasis area and severity index (PASI) score and adjustment of postoperative immunosuppressive agents were analyzed. Results Five patients undergoing transplantation were followed up until the submission date with a mean duration of (8.3±1.5) years and survived. Compared with preoperative values, PASI score was significantly reduced at postoperative 6 months (P＜0.05). Two patients with cirrhosis had recurrent psoriasis at 2 years after liver transplantation. PASI score was significantly increased and steadily declined after sirolimus substitution therapy. These patients remained physically stable and did not progress at postoperative 3 years. Three patients suffering from cirrhosis complicated with HCC presented with no recurrence of psoriasis postoperatively. Conclusions Sirolimus-based immunosuppressive therapy can effectively control the progression of psoriasis in liver transplantation recipients. Anti-HBV treatment should be simultaneously implemented for HBV positive patients.

Analysis of risk factors of initial poor graft function after living donor liver transplantation

Cai Zhenxing, Chen Xiaobo, Yan Lyunan, Li Bo, Zeng Yong, Wen Tianfu, Xu Mingqing, Wang Wentao, Yang Jiayin

2016, 7(6): 444-448. doi: 10.3969/j.issn.1674-7445.2016.06.006

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Abstract:
Objective To identify the risk factors of the incidence rate of initial poor graft function (IPGF) in recipients after living donor liver transplantation. Methods Clinical data of 309 patients undergoing living donor liver transplantation were retrospectively analyzed. Candidate risk factors: (1) donor factors included age, gender and body mass index (BMI); (2) recipient factors included age, gender, BMI and preoperative Child-Pugh classification, model for end-stage liver disease (MELD) grading, preoperative renal insufficiency, serum total bilirubin elevation, hyponatremia and hypopotassaemia; (3) graft factors included graft cold ischemia time, graft recipient weight ratio (GRWR); (4) recipient surgery factors included total operation time, blood loss volume, blood transfusion volume, platelet transfusion and anhepatic phase≥100 min. Single factor analysis was performed to identify the potential risk factors of IPGF. Logistic regression analysis was conducted to explore independent risk factors. Results and Conclusions Child-Pugh C of preoperative recipient liver function, MELD score≥20, serum total bilirubin elevation(>68.4 μmol/L), hyponatremia(＜135 mmol/L), hypopotassaemia (＜3.5 mmol/L) and anhepatic phase≥100 min were potential risk factors of IPGF (all P＜0.05). Child-Pugh C of preoperative recipient liver function was an independent risk factor of the incidence rate of IPGF following living donor liver transplantation (P=0.019).

Analysis of postoperative complications after autologous liver transplantation in hepatic alveolar echinococcosis patients from plateau area

Gao Chao, Ye Chengjie, Guo Yamin, Wu Gang

2016, 7(6): 449-453. doi: 10.3969/j.issn.1674-7445.2016.06.007

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Abstract:
Objective To analyze common postoperative complications after autologous liver transplantation in patients diagnosed with hepatic alveolar echinococcosis (HAE) from plateau area. Methods Clinical data of 6 patients with advanced HAE undergoing ex-situ or partially ex-situ hepatectomy combined with autologous liver transplantation were retrospectively analyzed. Clinical characteristics of postoperative complications were analyzed. Results Postoperative complications mainly included biliary tract complications (n=4), intra-abdominal hemorrhage (n=1), infection (n=3). Two cases presented with bile leakage complicated with intra-abdominal infection and died from infectious shock and multiple organ dysfunction syndrome. One patient had intra-abdominal hemorrhage and died from hemorrhagic shock and disseminated inravascular coagulation. Biliary tract complication and intra-abdominal hemorrhage were primary causes of mortality. Conclusions Biliary tract complication, intra-abdominal hemorrhage and infection are the main prognostic factors for HAE patients undergoing autologous liver transplantation.

Effect of living-related donor renal transplantation with mild renal arterial stenosis on early renal function and postoperative complication in recipients

Sun Dong, Wang Zhenpu, Gu Dongfeng, Jiang Xin, Wang Kai, Qu Qingshan

2016, 7(6): 454-458. doi: 10.3969/j.issn.1674-7445.2016.06.008

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Abstract:
Objective To evaluate the effect of living-related donor renal transplantation with mild renal arterial stenosis upon the early renal function and postoperative complications of the recipients. Methods Clinical data of 14 donors and recipients undergoing living-related donor renal transplantation with mild renal arterial stenosis and 50 donors and recipients receiving standard living donor renal transplantation from healthy relatives were retrospectively analyzed. The levels of serum creatinine (Scr) in the donors were statistically compared between two groups. The serum levels of Scr at postoperative 1, 3 and 6 months in the recipients were statistically compared between two groups. The survival rate of kidney graft, and the incidences of delayed graft function (DGF), acute rejection and pulmonary infection were compared between two groups. Results Postoperative Scr levels of the donors did not significantly differ between two groups(all P>0.05). The Scr levels of the recipients at postoperative 1, 3 and 6 months did not significantly differ between two groups (all P>0.05). The survival rate of kidney graft, and the incidences of DGF, acute rejection and pulmonary infection in the recipients did not significantly differ between two groups (all P>0.05). Conclusions Living-related donor renal transplantation with mild renal arterial stenosis exerts no significant effect upon renal function and postoperative complication in the recipients, who are eligible for the donors for renal transplantation.

Clinical efficacy of umbilical cord-derived menchymal stem cell treatment of refractory chronic graft-versus-host disease

Zhang Ling, Zhang Xiangzhong, Li Xiaoqing, Long Bing, Lin Dongjun, Li Xudong

2016, 7(6): 459-462. doi: 10.3969/j.issn.1674-7445.2016.06.009

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Abstract:
Objective To evaluate the clinical efficacy and safety of umbilical cord-derived mesenchymal stem cell (MSC) treatment of refractory chronic graft-versus-host disease (cGVHD) after allogene hematopoietic stem cell transplantation. Methods Seven patients developed with cGVHD following allogene hematopoietic stem cell transplantation. Conventional immunosuppressive agent treatment yielded no efficacy. Based upon immunosuppressive agent therapy, umbilical cord-derived MSC treatment was supplemented with a cell density of 1×10⁶/kg, once a week for consecutive 4 times. Clinical efficacy, safety and survival of the patients were observed. Results Among 7 patients receiving MSC injection, 2 obtained complete response (CR) and 3 had partial response (PR) with an overall response rate of 5/7, and the remaining 2 cases achieved no response (NR). No adverse reactions were induced by MSC injection. No patient had primary disease recurrence. One patient developed secondary cytomegalovirus pneumonia after PR and died from severe pneumonia. The remaining patients survived. Conclusions Umbilical cord -derived MSC injection is an efficacious and safe therapy of cGVHD.

Analysis on cause, prevention and treatment of intra-abdominal hemorrhage after liver transplantation: a report of 82 cases

Xiong Liang, Li Lijuan, An Yuling, Wei Xuxia, Yi Huimin

2016, 7(6): 463-466. doi: 10.3969/j.issn.1674-7445.2016.06.010

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Abstract:
Objective To investigate the cause, prevention and treatment of intra-abdominal hemorrhage after liver transplantation. Methods Clinical data of 82 patients undergoing liver transplantation were retrospectively analyzed. All participants were divided into the intra-abdominal hemorrhage (n=12) and control groups (n=70). Preoperative parameters including age, model for end-stage liver disease (MELD) score, prothrombin time (PT), prothrombin time international normalized ratio (PT-INR), fibrinogen (FIB), activated partial thromboplastin time (APTT), platelet (Plt) were statistically compared between two groups. Intraoperative hemorrhage volume, cold ischemia time of donor liver, anhepatic phase time and operation time were also compared between two groups. Postoperatively, the mortality rate was compared between two groups. Results Among 82 patients, 12 (15%) presented with intra-abdominal hemorrhage and required twice surgical hemostasis. In the intra-abdominal hemorrhage group, 4 cases (33%) died, and 8 (11%) died in the control group. No statistical significance was documented between two groups (P>0.05). Age, MELD score, PT-INR, FIB, APTT and PLT did not significantly differ between two groups (all P>0.05). Compared with patients in the control group, those in the intra-abdominal hemorrhage group yielded significantly more blood loss intraoperatively, longer operation time and longer cold ischemia time of donor liver (all P＜0.05). Anhepatic phase time did not significantly differ between two groups (P>0.05). Conclusions After liver transplantation, intra-abdominal hemorrhage is associated with longer cold ischemia time of donor liver, more intraoperative blood loss and longer operation time. In order to decrease the incidence of postoperative intra-abdominal hemorrhage, coagulation function should be completely corrected prior to surgery and the surgical skills should also be enhanced.

Experimental Researche

Induction of long-term heart survival after secondary transplantation by anti-RANTES monoclonal antibody combined with ciclosporin in mouse models

Huang Jian, Luo Zengrong, Zhuang Jiawei, Shan Zhonggui, Lin Lianfeng

2016, 7(6): 467-472. doi: 10.3969/j.issn.1674-7445.2016.06.011

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Abstract:
Objective To evaluate the effect of anti-RANTES monoclonal antibody in combination with ciclosporin (CsA) upon inhibiting the rejection response during secondary heart transplantation in mouse models. Methods BALB/c mouse models were used as the donors and C57BL/6 mice were utilized to establish secondary heart transplantation recipient models. The animals were randomly divided into the control (physiological saline, n=6), A (anti-RANTES monoclonal antibody treatment, n=6), B (CsA treatment, n=6) and C groups (anti-RANTES monoclonal antibody combined with CsA treatment, n=6). The survival time of heart after secondary transplantation was observed. The degree of acute heart rejection was assessed by histopathological analysis. The relative expression levels of RANTES, interleukin(IL)-2, IL-10, interferon(IFN)-γ and transcription growth factor(TGF)-β messenger ribonucleic acid (mRNA) in the heart grafts were quantitatively measured by real-time fluorescent quantitative polymerase chain reaction (qRT-PCR). The serum levels of RANTES, IFN-γ, IL-2, IL-10 and TGF-β were detected by enzyme-linked immune absorbent assay (ELISA). Results The heart grafts of all mice survived after secondary cardiac transplantation. Compared with the controlgroup, the survival time of hearts in group A, B and C was significantly prolonged (all P＜0.01). Pathological staining revealed that the quantity of infiltrated inflammatory cells in group C was significantly decreased than those in the other groups. The expression levels of heart RANTES, IFN-γ and IL-2 mRNA in group C were significantly down-regulated, whereas the expression levels of IL-10 and TGF-β mRNA were considerably up-regulated compared with those in the other three groups (all P＜0.05). The serum levels of RANTES, IL-2 and IFN-γ in group C were significantly down-regulated, whereas the serum contents of IL-10 and TGF-β were considerably up-regulated compared with those in the other three groups (all P＜0.05). Conclusions Combined application of anti-RANTES monoclonal antibody and CsA can effectively induce the immune tolerance to secondary cardiac transplantation and prolong the survival time of the cardiac grafts in mouse models.

Changes of erythrocytes surface molecule CD35, CD58 and CD59 expression in recipients infected with cytomegalovirus after renal transplantation Kong

Kong Xiangrui, Xiao Li, Chen Wen, Fan Wenmei, Bai Jian, Gao Yu, Ma Xihui, Bi Lili, Shi Bingyi

2016, 7(6): 473-478. doi: 10.3969/j.issn.1674-7445.2016.06.012

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Abstract:
Objective To investigate the change rules and its significance of erythrocytes surface molecule CD35, CD58 and CD59 expression in recipients infected with cytomegalovirus (CMV) after renal transplantation. Methods Eighty-two recipients undergoing allogeneic renal transplantation were selected and divided into the negative (n=21) and positive CMV groups (n=61) based on the qualitative detection of CMV-pp65 antigen in peripheral blood. According to the results of CMV-pp65 (+) leucocyte count, all 61 patients in positive CMV group were further divided into low (n=55) and high active infection subgroups (n=6). Healthy adults were recruited into the normal control group (n=30). The expression levels of CMV-pp65 antigen, erythrocytes surface molecule CD35, CD58 and CD59 were measured by flow cytometry. Results Compared with normal control group, the expression levels of erythrocytes surface molecule CD35, CD58 and CD59 in the positive CMV group were significantly down-regulated, and the CD35 and CD59 expression in the negative CMV group were considerably down-regulated (all P＜0.05). Compared with negative CMV group, the expression levels of CD58 and CD59 in the positive CMV group were significantly down-regulated (both P＜0.05). The expression levels of CD35 and CD59 in the high active infection subgroup were significantly lower than those in the low active infection subgroup (both P＜0.05). Conclusions The more severe active CMV infection after renal transplantation, the lower expression of erythrocytes surface molecule CD35, CD58 and CD59, hinting that red cell immune dysfunction is probably involved with active CMV infection.