器官移植

Abstract:
Objective To evaluate whether sofosbuvir (SOF)-based direct-acting antiviral agents (DAAs) combined with ribavirin (RBV) (combined RBV) can yield benefits to the recipients infected with hepatitis C virus (HCV) genotype 1 (GT1) after liver transplantation through systematic evaluation and Meta-analysis. Methods Multiple databases at home and abroad were systematically searched, the literature screening was conducted according to relevant standards, the quality of literatures was evaluated and data extraction was performed. The literature was divided into two groups according to the recipients with HCV-GT1 hepatitis after liver transplantation who received the treatment combined RBV or SOF-based DAAs alone without RBV (not combined RBV). Meta-analysis of the data was carried out using Rev Man 5.3 and R3.4.3 software. The incidence of sustained virological response 12 weeks (SVR12) after therapy was evaluated. Results A total of 2 195 articles were retrieved, and 6 articles published in English were eventually included according to the inclusion criteria. The Meta-analysis results demonstrated that the incidence of SVR12 did not significantly differ between the combined RBV and not combined RBV groups (P=0.28). However, the incidence of anemia in the combined RBV group was significantly higher than that in the other group (P < 0.01). Both combined RBV and not combined RBV therapies were efficacious in treating HCV-GT1a and HCV-GT1b subtypes after liver transplantation with similar clinical efficacy (P=0.33). The incidence of SVR in HCV-GT1 recipients did not significantly differ after receiving 12- and 24-weeks therapy after liver transplantation (P=0.95). Conclusions When SOF-based DAAs regimen is adopted to treat HCV-GT1 in recipients after liver transplantation, combination with RBV not only fails to improve the virus clearance rate and bring clinical benefits, but also increases the risk of anemia in the recipients.

Application of retrobulbar nerve block combined with general anesthesia in corneal transplantation

Lai Aihua, Zhang Huang, You Shan, Sun Tao, Liu Xian, Zhou Wentian

2019, 10(5): 578-583. doi: 10.3969/j.issn.1674-7445.2019.05.018

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Abstract:
Objective To explore the application value of retrobulbar nerve block combined with general anesthesia in the penetrating keratoplasty (PKP). Methods A total of 100 recipients undergoing PKP from January 2017 to January 2019 were recruited in this study. All recipients were divided into the observation group (n=50) and control group (n=50) by random number table method. In the control group, patients received laryngeal mask airway under general anesthesia, and in the observation group, patients received laryngeal mask airway under general anesthesia combined with retrobulbar nerve block. Hemodynamic changes of the PKP recipients before and after operation were observed in two groups. The dosage of analgesic drugs and the incidence of complications were observed in two groups. The degree of pain at postoperative 2-, 6- and 24-h was evaluated by visual analogue scale (VAS) in two groups. The awakening situation of the recipients in two groups was observed. The levels of inflammatory cytokines at 1 d before and after operation were statistically compared in two groups. Results The average arterial pressure and heart rate at intraoperative 15 min and after the surgery in the observation group were significantly higher than those in the control group (both P < 0.05). In the observation group, the dosage of remifentanil and propofol were (1.0±0.4) mg and (299±40) mg, significantly lower than (1.3±0.6) mg and (365±42) mg in the control group (both P < 0.05). The incidence of complications did not significantly differ between two groups (P > 0.05). In the observation group, the VAS scores at 2-, 6- and 12-h after operation were remarkably lower than those in the control group (all P < 0.01). The respiratory recovery time, eye opening time, directional force recovery time and extubation time of the recipients in the observation group were significantly shorter than those in the control group (all P < 0.05). The expression levels of including interleukin (IL)-1, IL-6 and tumor necrosis factor-α (TNF-α) at postoperative 1 d in the observation group were considerably lower than those in the control group (all P < 0.05). Conclusions Retrobulbar nerve block combined with general anesthesia can maintain hemodynamic stability during PKP, reduce the dosage of remifentanil and propofol and alleviate the degree of postoperative pain and inflammatory responses of the recipients.

Analysis of the management and clinical effect of accessory renal artery in the living-related donor renal, transplantation

Pan Guozheng, Zhai Fengxian, Li Shihui, Dai Shuai, Liu Hongtao

2019, 10(5): 584-588. doi: 10.3969/j.issn.1674-7445.2019.05.019

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Abstract:
Objective To investigate the management and clinical effect of accessory renal artery in living-related donor renal transplantation. Methods Clinical data of 277 donors and recipients undergoing living-related donor renal transplantation were retrospectively analyzed. According to the results of preoperative CT angiography (CTA), the donor kidney was selected and the accessory renal artery of the renal graft was treated intraoperatively. Intraoperative status of the donors, and intraoperative management, postoperative complications, clinical prognosis of the recipients were summarized. Results Among 277 cases of renal transplantation, accessory renal arteries were detected in 83 donors by preoperative CTA examination with an accuracy rate of 95%. Fifty-eight donor kidneys with accessory renal arteries were obtained. Twenty-five donor kidneys with accessory renal arteries were reconstructed and anastomized by vascular repairing. Among them, 1 patient presented with anastomotic thrombosis during abdominal closure, whereas the other 24 cases were successfully anastomized with excellent blood flow. No complications, such as hemorrhage, renal graft embolism, ureteral necrosis and urinary fistula, occurred after renal transplantation. The 1-year survival rates of the recipients and renal grafts were 94% and 91%. The clinical efficacy did not significantly differ between the recipients with single renal artery and their counterparts with accessory renal artery (P > 0.05). Conclusions It can be obtained good clinical efficacy of renal transplantation by selecting a suitable donor kidney and reconstructing and anastomizing the accessory renal artery of the renal graft through vascular repair.

Experience summary of complex hepatic artery reconstruction in orthotopic liver transplantation

Ye Zhenghui, Zhao Hongchuan, Geng Xiaoping, Huang Fan, Wang Guobin, Yu Xiaojun, Wu Ruolin, Hou Liujin

2019, 10(5): 589-593, 611. doi: 10.3969/j.issn.1674-7445.2019.05.020

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Abstract:
Objective To summarize the experience of complex hepatic artery reconstruction in orthotopic liver transplantation. Methods Clinical data of 7 liver transplantation recipients who underwent complex hepatic artery reconstruction from January 2015 to March 2019 were retrospectively analyzed. Among them, 4 recipients received classical liver transplantation and 3 cases underwent piggyback liver transplantation. Intraoperative general conditions including anhepatic phase, intraoperative blood loss, hepatic artery anastomosis time and operation time of the recipients were recorded. The clinical prognosis and complications were observed. Results In two donors, variant right hepatic artery was used for vascular reconstruction. The celiac trunk or the common hepatic artery of the donors was anastomosed with the common hepatic artery of the recipients. Iliac artery bypass was employed in 2 cases, and then the hepatic artery of the donors was anastomosed with the abdominal aorta of the recipients. The superior mesenteric artery of 1 donor was end-to-end anastomosed with the common hepatic artery of the recipient. The celiac trunk of 1 donor was anastomosed with the splenic artery of the recipient. Only 1 case was required to undergo secondary liver transplantation due to acute hepatic artery thrombosis after hepatic artery anastomosis. All the 6 recipients successfully completed the liver transplantation. No perioperative death was observed. The anhepatic phase endured from 49 to 77 min. The intraoperative blood loss was ranged from 300 to 1 500 mL. The anastomosis time of hepatic artery was 23-56 min. The operation time was ranged from 5.3 to 11.1 h. The length of postoperative hospital stay was 23-56 d. Neither hepatic artery thrombosis nor stenosis occurred. The liver function of all recipients was basically restored to normal within postoperative 2 weeks. No severe surgical complications occurred. The liver graft achieved excellent function. Conclusions Appropriate identification of the hepatic artery variation, proper management of liver artery of the donors and recipients and reconstructing the blood supply of liver graft are the crucial procedures of liver transplantation.

Clinical application of ECMO in protecting donor liver in organ donation after citizen's death

Ding Limin, Li Xinchang, Xu Zhidan, Yang Xiaogang, Huang Xiaomei, Luo Wenfeng

2019, 10(5): 594-598. doi: 10.3969/j.issn.1674-7445.2019.05.021

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Abstract:
Objective To explore the feasibility of extracorporeal membrane oxygenation (ECMO) in protecting the donor liver in donation after citizen's death. Methods Clinical data of 16 donors and recipients undergoing liver transplantation using ECMO to protect the donor liver were retrospectively analyzed. The effect of ECMO on different indicators of the donors was evaluated. The liver function and clinical prognosis of the recipients after liver transplantation were observed. Results Compared with the time before ECMO, the heart rate, total bilirubin (TB), alanine transaminase (ALT) and aspartate transaminase (AST) of the donors after ECMO were significantly reduced, whereas the systolic blood pressure, diastolic blood pressure and partial pressure of arterial oxygen (PaO₂) were remarkably increased (all P < 0.05). The liver function of the recipients was properly recovered after liver transplantation, and gradually restored normal at postoperative 7 to 28 d. Postoperative complications occurred in 3 recipients, including delayed liver function recovery in 1 case, biliary tract stenosis in 1 case and portal vein thrombosis in 1 case. Among them, the patient with portal vein thrombosis died after secondary operation, and the other 2 patients were recovered and discharged after symptomatic treatment. Conclusions The hemodynamics, liver function and other indicators of donors from donation after citizen's death are significantly improved after ECMO, and the liver function of the recipients also recover well.

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