Good news | The core index of Organ Transplantation reached a new high
2023-01-13Good news | Tian Dong and Wu Jiajia won the excellent reviewer and excellent editor of Guangdong Science and Technology Journal in 2022
2023-01-11Announcement on the key themes of the 3rd issue of
2022-12-20Good news丨The liver transplantation team of the Third Affiliated Hospital of Sun Yat-sen University won the first prize of the 4th Guangdong Medical Science and Technology Award
2023-01-13Organ Transplantation was once again selected as the 2022 China Science and Technology Core Journal and the Science and Technology Journals World Impact Index (WJCI) Report (2022 Edition)
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Management of immunosuppression and immune tolerance in organ transplantation
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Organ transplantation and infection Guideline
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Liver transplantation treatment for rare diseases
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Long-term management strategy after kidney trasnplantation
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Development and Innovation of Organ Donation
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Immune cells and solid organ transplantation
Diagnosis and treatment specification for postoperative complications after liver transplantation in China (2019 edition)
Clinical technical operation specification of pancreatic islet transplantation (2019 edition)
Technical operation specification for ABO-incompatible kidney transplantation from relative living donor (2019 edition)
In order to further standardize the diagnosis and treatment of long-term systemic complications in kidney transplant recipients, Branch of Organ Transplantation of Chinese Medical Association initiated the formulation of “Clinical Diagnosis and Treatment Guidelines for Long-term Systemic Complications in Kidney Transplant Recipients in China”. Experts on organ transplantation were organized to summarize and integrate the latest progress in this field based on existing clinical guidelines, systematic evaluations, case studies, expert consensus. The guideline was formed after multiple rounds of discussion and reaching a consensus which included complications of hematological system, central nervous system, cardiovascular system, ocular, cutaneous and osteoporosis disorders. The full text focuses on 27 clinical problems and forms 40 recommendations, mainly involving the risk factors, classification, diagnosis, treatment and prevention of various complications. This guideline graded the quality of evidence and the strength of recommendation for each clinical issue using 2009 Oxford Centre for Evidence-Based Medicine (OCEBM) Grading and Strength of Recommendation criteria, so as to provide reference for the diagnosis and treatment of late complications, comprehensively improve the management capacity of clinicians to benefit kidney transplant recipients.
The diagnosis and treatment of digestive system complications of kidney transplant recipients is related to the long-term survival and quality of life of patients, which needs great attention. In order to further standardize its diagnosis and treatment, Branch of Organ Transplantation of Chinese Medical Association initiated the formulation of “Clinical Diagnosis and Treatment Guidelines for Digestive System Complications in Kidney Transplant Recipients in China”, and organized experts in organ transplantation and related disciplines to summarize the new progress in diagnosis and treatment of digestive system complications of kidney transplant recipients at home and abroad in recent years based on existing clinical research, systematic evaluation, case study, expert consensus and existing guidelines, and reached a consensus after many discussions. This paper focuses on 11 clinical problems, forming 16 recommendations, and grading the evidence quality and recommendation strength of each clinical problem by the evidence grading and recommendation strength standard of Oxford University Evidence-based Medicine Center in 2009, in order to provide reference for the diagnosis and treatment of digestive system complications of kidney transplant recipients, comprehensively improve the management ability of digestive system complications of clinicians in an all-round way and benefit transplant recipients.
To further standardize the diagnosis and treatment of hypertension after kidney transplantation in China, Branch of Organ Transplantation of Chinese Medical Association organized experts in kidney transplantation and cardiovascular diseases to formulate “Guidelines for Clinical Diagnosis and Treatment of Hypertension in Kidney Transplant Recipients in China” based on “Diagnosis and Treatment Specification for Hypertension after Solid Organ Transplantation in China (2019 edition)” in combination with clinical status of hypertension after organ transplantation in China, and referring to the latest guidelines for diagnosis and treatment of hypertension at home and abroad. This guideline was formulated to provide theoretical reference for medical practitioners in the field of kidney transplantation in China, aiming to better control adult hypertension after kidney transplantation, mitigate adverse outcomes and improve the quality of life.
Combined liver and kidney transplantation has been steadily applied in major transplantation centers, saving the lives of many patients with end-stage liver and renal failure. However, there are still multiple unresolved problems in the clinical diagnosis, treatment and long-term prognosis of combined liver and kidney transplantation. By referring to "Technical Operating Standards for Combined Liver and Kidney Transplantation (2019 Edition)" and the latest published literature and guidelines at home and abroad, "Guidelines for Clinical Diagnosis and Treatment of Combined Liver and Kidney Transplantation" was formulated. Recommendations and suggestions were delivered regarding the surgical indications and contraindications, preoperative preparation and evaluation, the timing of transplantation for end-stage liver and kidney diseases, the selection of surgical approaches and postoperative follow-up, specific pathophysiology, surgical techniques, complication management and immunosuppressive treatment of combined live and kidney transplantation, aiming to enhance the utilization rate of grafts and improve the survival and prognosis of combined liver and kidney transplant recipients.
The immune system is the important guarantee for maintaining the health of organ function and preventing diseases. The goal of immune health management and immune treatment is to restore the normal function of the immune system. The technical problems of how to inhibit or enhance the immune status has been solved in the field of immunology, but how to comprehensively detect and quantitatively evaluate the immune status is still a challenge. There is no mature solution at present. The quantification detection and visualization evaluation of immune status are of great significance for disease prevention and control, sub-health status management, and immune treatment. This expert consensus has carried out preliminary discussions on the definition of normal immune status and the comprehensive quantitative evaluation and visual scoring techniques of immune cell function status (immune function), put forward the basic concepts and thinking related to normal immune status, discussed the direction and principles of quantitative detection and evaluation of immune cell function status, and taken this as an opportunity to promote the decoding of immunity and the study of basic and clinical trials in the field of immune health.
With the maturity and development of surgical techniques, as well as the improvement of perioperative management level, the success rate of kidney transplantation has been significantly improved. However, due to evident differences in heredity and antigenicity between donors and recipients, rejection will occur after kidney transplantation, which will affect the survival of renal grafts. Immunosuppression is an important treatment for rejection, which is of significance to reduce the risk of rejection and enhance graft survival rate. Nevertheless, immunosuppressants may cause multiple complications while lowering the incidence of rejection, such as infection, cardiovascular diseases and tumors, etc., which seriously affect the quality of life of patients and may even lead to their death. Reasonable selection of immunosuppressants and continuous optimization of immunosuppressive regimen for recipients play a critical role in improving the survival of recipients and renal grafts. In this article, the development history of organ transplantation, immune induction therapy and immune maintenance therapy was reviewed, and the progress in the optimization of immunosuppressive regimens for kidney transplant recipients was discussed, aiming to provide reference for improving clinical prognosis of kidney transplant recipients.
Liver retransplantation is the final option for graft failure after liver transplantation. The interval between the first and second liver transplantation will directly affect surgical indications, technical difficulties and treatment outcomes of adult liver retransplantation. Previous studies have shown that the overall survival of liver allografts and recipients after liver retransplantation is significantly lower than that after the first liver transplantation. However, with comprehensive progress in organ preservation methods, anesthesia management concepts, intensive care strategies, surgical techniques and new immunosuppressive drugs, clinical efficacy of adult liver retransplantation has been significantly improved. In this article, the changes of indications, timing of operation, long-term efficacy and its influencing factors, technical difficulties, selection of immunosuppressive regimens and the implementation of living donor liver retransplantation were reviewed, and the achievements, challenges and potential solutions of adult liver retransplantation were summarized, aiming to provide reference for enhancing clinical efficacy of adult liver retransplantation.
The application of combination antiretroviral therapy (cART) has significantly prolonged the life expectancy of patients infected with human immunodeficiency virus (HIV). However, viral infection and adverse reactions of cART drugs make patients more prone to organ failure. Solid organ transplantation has become a standard treatment for HIV-infected patients with end-stage organ failure. Nevertheless, among HIV-positive soild organ transplant recipients, multiple problems remain to be resolved, such as increased incidence of graft rejection, increased infection risk, drug toxicity and drug interaction between cART therapy and immunosuppressive drugs, etc. It is extremely challenging to deliver appropriate management for HIV-positive soild organ transplant recipients. Therefore, the application of immune induction therapy, calcineurin inhibitors, mammalian target of rapamycin (mTOR) inhibitors and other immunosuppressive drugs in HIV-positive soild organ transplant recipients was reviewed, aiming to provide reference for subsequent management of immunosuppression in HIV-positive soild organ transplant recipients.
Rejection after liver transplantation severely affects the survival of recipients. Long-term use of immunosuppressants is an important approach to prevent rejection, whereas it may cause toxic effects and increase the risk of adverse events such as systemic infection and tumor recurrence, etc. Therefore, before successful liver transplantation, how to induce individual immune tolerance of recipients and achieve complete or early withdrawal of postoperative immunosuppressants remains to be investigated by practitioners of organ transplantation. In recent years, certain progresses have been made in the mechanism of immune tolerance induced by tolerogenic dendritic cells in liver transplantation, and preliminary outcomes have been obtained in clinical trials. In this article, basic research and clinical application progress in the characteristics of tolerogenic dendritic cells, the mechanism underlying participating in liver immune microenvironment remodeling, and inducing immune tolerance in liver transplantation were reviewed, aiming to provide reference for the application of tolerogenic dendritic cells in immune tolerance of liver transplantation.
Surgical technique of lung transplantation exerts significant impact on clinical prognosis of the recipients. Choosing an appropriate surgical incision determines the exposure of intraoperative visual field, which is the first step of surgical success and directly affects subsequent surgical procedures. Lung transplantation incision is usually considered as primary closure. Nevertheless, for patients with high-risk factors such as oversized lung allografts and primary graft failure after lung transplantation, primary closure cannot be achieved. Hence, delayed chest closure is an effective strategy. The selection of incisions and the adoption of delayed chest closure of lung transplantation exert profound impact upon perioperative prognosis, long-term quality of life and surgical complications of the recipients. Therefore, the development and research status of Clamshell incision, anterolateral incision, posterolateral incision and median sternal incision in lung transplantation were reviewed, highlighting the effect of incision patterns on clinical prognosis of lung transplantation and providing reference for the selection of incisions in clinical lung transplantation.
Dopamine is the precursor of biosynthesis of norepinephrine. Low-dose dopamine mainly excites dopamine receptors, which may dilate renal and mesenteric vessels, increase renal blood flow and improve the microcirculation. In recent years, low-dose dopamine has been widely applied in the field of kidney transplantation due to its vasoactive effect. However, with the development of evidence-based medicine, the role of dopamine in protecting the perfusion function of renal allograft in kidney transplantation has been questioned. Multiple studies have shown that dopamine brings no significant benefit to renal and cardiac function in kidney transplantation, exerts low pressor effect, and may even increase the risk of perioperative complications. Norepinephrine may be used as a safe substitute. In this article, recent progress in the effect of dopamine upon renal and cardiac function and hemodynamics during kidney transplantation was reviewed, aiming to provide reference for clinical application of dopamine in kidney transplantation.
As a cation with abundant intracellular contents and extensive functions, magnesium plays an active role in immune function and captivates widespread attention. Under the influence of multiple factors, such as use of calcineurin inhibitors, hypomagnesemia post-kidney transplantation is not uncommon. Infection is a common complication post-kidney transplantation and one of the main causes of death of kidney transplant recipients. Recent clinical studies have shown that hypomagnesemia post-kidney transplantation is closely associated with the risk of infection post-transplantation. Emphasizing and monitoring magnesium concentration in kidney transplant recipients may help prevent infection and improve clinical prognosis of both recipients and grafts. Therefore, research progress in magnesium and immune response, the causes of hypomagnesemia post-kidney transplantation and hypomagnesemia and infection post-kidney transplantation was reviewed, aiming to provide reference for the prevention and treatment of infection post-kidney transplantation.
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。
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。
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。
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。
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)。
为了进一步规范肾移植排斥反应的临床诊断与治疗, 中华医学会器官移植学分会组织器官移植学专家, 总结各移植中心的肾移植临床经验, 在《中国肾脏移植排斥反应临床诊疗指南(2016版)》的基础上, 并依据Banff标准, 从超急性排斥反应、急性加速性排斥反应、急性排斥反应、慢性排斥反应等方面, 制订本规范。
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。
为了进一步规范中国移植后糖尿病(PTDM)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和糖尿病专家, 总结器官移植后血糖异常的国内外最新进展, 在《中国器官移植术后糖尿病诊疗指南(2016版)》的基础上, 结合临床实践, 从PTDM的定义和诊断标准、流行病学、危险因素和发病机制、对移植受者和移植物预后的影响、预防及治疗策略等方面, 制定PTDM诊疗技术规范(2019版)。
肺移植是治疗多种终末期肺疾病的唯一有效方法,体外膜肺氧合(ECMO)在肺移植围手术期起到重要的桥接和支持作用。本指南从肺移植术前ECMO的桥接治疗、术中的心肺支持及术后功能维持等方面,总结肺移植临床实践经验,以期为我国肺移植相关临床科室提供工作指引。
为了进一步规范实体器官移植(SOT)受者侵袭性真菌病(IFD)的诊断和治疗,中华医学会器官移植学分会结合近期国内外临床证据,从SOT受者IFD的流行病学特点、诊断、预防、治疗等方面,在2017年版《器官移植受者侵袭性真菌病临床诊疗指南》的基础上制定本规范,以期为器官移植和相关学科的同道提供帮助。
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
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Optimization of immunosuppressive regimen for kidney transplant recipients
The question of death criteria in human organ donation
Hepatitis E virus infection in liver transplant recipients
Research progress in adult liver retransplantation