Objective To investigate the clinical experience of patients with novel coronavirus (2019-ncov) infection after kidney transplantation. Method Clinical data of two patients with 2019-nCoV infection after renal transplantationin Jan 2020 Renmin Hospital of Wuhan Universiyt were retrospectively analyzed.Case 1 was a 48-year-old male with CMV pneumonia secondary to 2019-nCoV infection at 4 months after transplantation. CT imaging showed multiple patchy ground-glass images of both lungs. Case 2 was a 59-year-old male, who was screened positive for 2019-nCoV nucleic acid due to fever at 9 days after renal transplantation and showed no clinical manifestations of pneumonia. After diagnosis, case 1 was transferred to a designated hospital for isolation. Treatment regimens: cefoperazone sulbactam sodium + linezolid to resist infection, gamma globulin to enhance immunity function, methylprednisolone to control inflammatory response, antiviral regimens including arbidol tablets + lopina-velitonavir tablets. Case 2 was treated with isolated treatment in a single room. The treatment plan included anti-infection (cefoperazone sulbactam sodium), enhancing immunity function (gamma globulin), antivirus therapy with arbidol and other symptomatic treatment. Result Follow up with 3 weeks, case 1 recovered with renal dysfunction, nucleic acid test with nasopharyngeal swabs turned negative, and pulmonary imaging improved. Case 2 showed no obvious clinical symptoms, and the nucleic acid test of nasopharyngeal swabs turned negative for 3 times. Conclusion Renal transplant recipients should receive fine protection to avoid exposure to high-risk environments. Diagnosis should be defined with combination of clinical manifestations, nucleic acid test and pulmonary imaging. At present, there are no antiviral drugs and symptomatic treatment is the main choice. Key words: 2019-nCov; NCP; Kidney transplant; Level III Protection
Objective:To explore the clinical evaluation outcomes of COVID-19 risk assessment scale on organ donation and procurement during the pandemic of novel coronavirus pneumonia (NCP) and reduce the incidence of donor-derived infection and medical staff infection.Methods:From January 20 to February 29 in 2020, the organ procurement team adopted the COVID-19 risk assessment scale for evaluating 8 potential donors. They were classified into the levels of high/low/uncertain risk by analyzing the risk levels of donation hospitals, clinical characteristics and exposure history. The coordinators, organ evaluators and ward medical staff adopted essential protective measures. The infection status of 2019-nCoV in the above mentioned staff was examined and graft function in the corresponding recipients were observed.Results:Based upon the COVID-19 risk assessment results, the risk level was high (n=8), low (n=5) and uncertain (n=2) and underwent organ procurement. A total of 19 grafts including liver, kidney, pancreas and heart were harvested and successfully utilized for organ transplantation. During the observation period of 14 days, there was no suspected or confirmed infection of 2019-nCoV among coordinators and medical staff. No graft dysfunction or acute rejection was observed during a follow-up period of 4 to 30 days. No recipient was suspected or confirmed to be infected with 2019-nCoV and 6 of them were negative for 2019-nCoV nucleic acid testing after organ transplantation.Conclusions:During the COVID-19 pandemic, it is safe to proceed with donor organ evaluations and procurements according to the result with the COVID-19 risk assessment scale. Low-risk donor organ donation may be carried out, uncertain risk donor organ donation should be performed cautiously and high-risk donations discouraged.
胰岛移植作为β细胞替代治疗手段之一，近年来已成为治疗糖尿病的有效手段，但还面临包括供体胰腺短缺、移植胰岛术后早期大量死亡/凋亡、长期功能不确切等问题。最近研究显示通过提高胰岛分离纯化率、提高移植胰岛的定植率等手段有望改善胰岛移植效果。此外随着干细胞、异种移植、基因编辑技术的发展，有望提供"不限量"的β细胞，实现"按需"细胞移植治疗糖尿病。
Objective To explore the risk factors, diagnosis and treatment of early portal vein complications after liver transplantation. Methods From January 2016 to December 2018, clinical data of 616 adult patients undergoing liver transplantation were retrospectively analyzed. Nine cases (1.5%) had early portal vein complications. By comparing the general status of recipients and donors and the intraoperative findings, the risk factors of early portal vein complications were analyzed. Results No statistically significant differences existed in recipient age, gender, donor/recipient blood type, donor liver cold ischemia time, transplant operative duration, intraoperative non-hepatic period, intraoperative blood loss or intraoperative red blood cell transfusion (P>0.05). However, preoperative recipients had portal vein thrombosis, splenectomy, retransplantation and portal vein anastomosis. Statistical differences existed and all were risk factors for early portal vein complications (P<0.05). Binary logistic regression showed that preoperative patients had portal vein thrombosis [OR=16.922, 95% CI(1.859-154.059), P=0.012] and retransplantation [OR=64.871, 95% CI(8.293-507.435), P<0.001] was an independent risk factor for early portal vein complications. Nine cases of early portal vein complications were confirmed by ultrasound and/or computed tomography (CT) angiography. Three patients with portal vein thrombosis type 1 received oral medication while another three with portal vein thrombosis type 2 underwent abdominal portal vein incision, thrombectomy and large omental portal vein pump implantation. During a follow-up period of (22±14.8) months, portal vein blood flow remained patent. One patient with portal vein stenosis underwent portal vein balloon dilation and stent implantation. During a follow-up period of 17 months, portal vein blood flow remained patent. Two patients with abnormal portal vein blood flow underwent liver re-transplantation and died postoperatively. Conclusions Preoperative portal vein thrombosis and splenectomy, re-transplantation of liver and end-to-end anastomosis of non-donor recipient portal vein are risk factors for early portal vein complications after liver transplantation. Individualized treatments of portal vein thrombosis may be provided according to the type of thrombus and liver function. And the prognosis is decent. Because of a higher mortality rate, attention should be paid to patients with abnormal portal vein blood flow immediately after re-transplantation. Key words: Liver transplantation; Portal complications; Risk factors; Diagnosis; Treatment; Prognosis
Objective To summarize the computed tomographic (CT) manifestations of pulmonary aspergillosis after organ transplantation and compare different signs between pulmonary aspergillosis and bacterial pneumonia.Methods CT images of pulmonary aspergillosis (n =62) and bacterial pneumonia (n =68) in post-transplantation patients were reviewed.The signs were categorized with consolidation,mass,large nodule (≥1crn),small nodule and bud-in-tree pattern.Some detailed useful differentiating signs such as halo sign,air bronchogram sign,reversed halo sign,hypodensity sign and cavitation were also analyzed.Results CT patterns of pulmonary aspergillosis included consolidation,mass,large nodule,small nodule and bud-in-tree pattern.The most common was large nodule (75.8％),followed by consolidation (48.4％)and mass (29.0％).And small nodule (16.1 ％) and bud-in-tree (12.9％) patterns were concurrent.For consolidation pattern,the proportion of bacterial pneumonia (69.1％) was the larger;For mass pattern,the proportion of pulmonary aspergillosis (29.0％) was the larger.For large nodule pattern,there was no difference.The detail sign of large nodule in two groups had no difference In detailed signs of consolidation pattern,air bronchogram sign was more often seen in bacterial pneumonia while cavitation was more frequently found in pulmonary aspergillosis.In detailed signs of mass pattern,pulmonary aspergillosis often has single lesion (66.7％),cavitation (83.3％)and air crescent sign (77.8％) is more common.The proportion of halo sign was 30.7％.Conclusions CT manifestations of pulmonary aspergillosis are diverse after organ transplantation.There is some difference and yet overlap with bacterial pneumonia.
Objective To analyze the clinical significance of early lymphocyte recovery after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in acute myeloid leukemia.Methods The clinical data of 89 patients with acute myeloid leukemia undergoing allo-HSCT were retrospectively analyzed.The absolute lymphocyte count at Day 21 (ALC21) after allo-HSCT was used for representing the recovery rate of lymphocyte.And the effects of ALC21 on disease relapse,overall survival (OS),disease-free survival (DFS) and other parameters were analyzed.Results The recurrent rate of ALC21 ≥0.5 × 109/L group (high ALC21 group) was significantly lower than that of ALC21 ＜0.5× 109/L group (low ALC21 group) (19.6 ％ vs 48.5 ％,P=0.004).The 2-year OS and DFS of high ALC21 group spiked markedly as compared with low ALC21 group [(74.0 ± 6.0 ％ vs (46.5±9.5) ％,P=0.002],[(70.5 ± 6.2) ％ vs (44.9±9.3) ％,P =0.009] while viral infection rate declined markedly (37.5 ％ vs 60.6 ％,P =0.035).However,non-recurrence mortality (NRM),acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD) (P =0.556) were not elevated in high ALC21 group as compared with low ALC21 group (P=0.584,P =0.08,P =0.556).Conclusions Early lymphocyte recovery after in acute myeloid leukemia patients has significant early predictive value for recurrence and long-term prognosis after allo-HSCT.
Objective To investigate the effect of nucleotide-binding oligomerization domaincontaining protein 1 (NOD1) on pyroptosis in hepatic ischemia-reperfusion injury.Methods An animal model of ischemia-reperfusion injury was established.Thirty healthy,male,and clean C57 BL mice were randomly divided into sham operation group (sham group) and ischemia-reperfusion group (IR,including 2 h,6 h,12 h,24 h subgroups),6 per group.Serum ALT and AST levels in each group were measured by blood biochemistry.HE staining and TUNEL were used to observe the pathological changes of liver and hepatocyte apoptosis.Immunohistochemistry was used to detect the expression and distribution of NOD1 in each group.Western blotting was used to detect NOD1,MM2,pro-Caspase-1 and active-Caspase-1 expression.NOD1 siRNA and empty control siRNA were transfected into AML12 cells,then the hypoxia/reoxygenation model was established and cells were collected to detect the expression of NOD1,AIM2 and active-Caspase-1.Results The ALT and AST levels in IR group were significantly higher than those in sham group,and peaked at IR 12-h subgroup (P＜0.05).HE staining showed that hepatic injury was the most severe at 12 h after reperfusion.TUNEL results showed that the number of apoptotic cells was the greated at 12 h after reperfusion.Western blotting showed that NOD1 protein expression was highest at 12 h after reperfusion.With the prolongation of reperfusion time,the expression of AIM2 and active-Caspase-1 gradually increased,and that of pro-Caspase-1 gradually decreased.The expression of NOD1,AIM2 and activeCaspase-1 decreased after transfection of NOD1 siRNA into AML12 cells.Conclusions NOD1 promotes liver ischemia-reperfusion injury,which may be related to NOD1 promoting liver injury by activating pyroptosis.
Objective To reduce the perioperative complications of simultaneous pancreas and kidney transplantation (SPK ) and boost the clinical efficacy by exploring its perioperative management in diabetics with end-stage renal disease .Methods Retrospective analysis was performed for the clinical data of 5 diabetics with end-stage renal disease undergoing SPK since 2017 .Results The cold ischemic time of all allografts was under 8 hours .No surgical complications occurred in recipients post-transplantation .Two patients were complicated with hyperkalemia and their serum potassium levels normalized after treatment .One case of bleeding in abdominal cavity was cured conservatively . Renal functions of two patients with delayed renal function post-transplantation gradually recovered after hematodialysis . One case of peritransplant fluid collection recovered after debridement and drainage .Another case of acute left heart failure and cardiac arrest at 45 days post-transplantation resumed normal heart rhythm after rescue .However ,his consciousness could not be restored and his families gave up subsequent treatments . Transplanted kidneys and pancreases of these 4 patients normalized .Follow-up was conducted until March 20 , 2019 . They became insulin and dialysis independent and serum creatinine and blood glucose normalized .Diabetic complications were relieved and their quality-of-life also improved significantly .Conclusions SPK is an effective treatment for diabetics with end-stage renal disease .While maintaining normal serum creatinine and blood glucose , it may liberate patients from insulin dosing and dialytic maintenance ,lower diabetic complications and improve quality-of-life .
Objective To investigate the clinical features,causes,incidence,high-risk factors and prognosis of central nervous system (CNS)complications after hematopoietic stem cell transplantation (HSCT)in children,and to improve the diagnosis and treatment of CNS complications,hence,to improve the quality of life of children.Methods A retrospective study was conducted to analyze the causes,clinical characteristics,and prognosis of CNS complications after HSCT in 1 13 patients,such as epilepsy,hypertensive encephalopathy,posterior reversible encephalopathy syndrome and transplantation-associated thrombotic microangiopathy.Results CNS complications occurred in 7 out of 1 13 (6.2%) patients after HSCT,and one child died of CAN complication.Among these 7 patients,6 patients were with HLA-mismatching compared to 1 with HLA-identical. All the 7 patients used ATG as the preconditioning regimen.Conclusions HLA-mismatching maybe a high-risk factor of CNS complications after HSCT.Early detection,diagnosis and active treatment of CNS complications can reduce the incidence and mortality,which can effectively improve the quality of life of children.
Objective To summarize the experiences of diagnosing and treating portal vein stenosis (PVS) after pediatric liver transplantation from China donation after citizen 's death (CDCD) grafts .Methods Retrospective analysis was performed for 30 cases of pediatric CDCD liver transplantation recipients with PVS .The screening ,diagnosis ,treatment and prognosis of PVS were analyzed .Results Among 218 pediatric liver transplantation recipients with CDCD grafts ,PVS was diagnosed in 30 cases with an incidence rate of 13 .8％ (30/218) .The initial diagnosis of PVS ranged from 5 days to 27 months post-operation with a median age of 2 .9 months .Ultrasonography indicated that stenotic rate of anastomotic site diameter was (41 .28 ± 12 .93)％ and blood flow velocity ratio (358 .77 ± 117 .82)％ .Intervention examination showed average pressure gradient was (9 .06 ± 5 .34) mmHg between both sides of stenosis . All cases underwent percutaneous intrahepatic balloon dilatation .The recipients were followed up for a median follow-up time of 23(3-63) months .For three cases of restenosis ,percutaneous intrahepatic balloon dilatation was repeated .Two cases underwent stent implantation due to ineffective balloon dilation .After treatment ,the stenotic rate of anastomotic site diameter was (34 .69 ± 8 .82) and blood flow velocity ratio (61 .18 ± 63 .11)％ on ultrasound while the average pressure gradient was (1 .03 ± 0 .85) mmHg .Conclusions PVS is a common vascular complication after pediatric CDCD liver transplantation .Portal vein balloon dilation is both safe and efficacious .However ,some cases require repeated balloon dilation and stent implantation serves as the last option for intractable PVS .Color ultrasound is both convenient and effective for making a primary diagnosis and evaluating outcomes .
Pediatric liver transplantation has long been developed in the western world.Currently,favorable outcomes after liver transplantation have been achieved in pediatric recipients and the postoperative 5-year survival rate reached 80％ in western transplantation centers.In the mainland China,pediatric liver transplantation started quite recently and there is still a big gap compared with western centers.In addition,there is unbalanced development between adult and pediatric recipients due to surgical difficulties and undesirable outcomes following pediatric liver transplantation.The operation methods of pediatric liver transplantation include whole liver transplantation,reduced-size liver transplantation,living donor liver transplantation and split liver transplantation.Perioperative complications of pediatric liver transplantation mainly include portal vein thrombosis,hepatic artery thrombosis,intra-abdominal bleeding,infections,rejection,bile leakage and biliary strictures.While the long-term complications are infections,post-transplantation lymphoproliferative disorders,acute and chronic rejections caused by poor compliance with immunosuppressive therapy.Perioperative complications have been reduced recently thanks to improvement of surgical techniques.With the highly-prolonged survival period,long-term postoperative complications have been playing a significant role in recipients' survival rates.Management of long-term follow-up and compliance has been the next focus of pediatric liver transplantation.
异基因造血干细胞移植是治愈许多血液病的最佳选择。对于成人Ph样急性淋巴细胞白血病，采用综合治疗序贯移植成功治疗4例患者。移植相关并发症的监测一直是临床难题，通过对98例重型再生障碍性贫血患者回顾性研究，发现铁过载导致造血重建明显延迟。免疫重建是移植成功的关键环节，研究发现淋巴细胞的快速恢复，可明显提高移植存活率，降低病毒感染率。复发是移植后最严重的并发症，研究发现脑脊液嵌合度监测可有效预测中枢神经系统复发，受者嵌合率升高可作为早期干预指征。
半个世纪以来，我国肝移植事业取得了令人瞩目的进步，但仍存在诸多瓶颈难题。精准医学和大数据时代下的肝移植研究，应加强临床重大需求为驱动的引领性多中心临床研究，并善于从临床诊治实践中不断总结和凝练新的科学问题，推进科研持续创新发展。进一步以多学科融合研究为孵化器，打造一支年富力强的中青年肝移植临床骨干和医师科学家队伍，涌现一批具有国际影响力的原创性科研成果，推动我国肝移植从世界大国向强国迈进。
Objective To analyze many indicators during perioperative period of liver transplantation in patients with end-stage liver disease ,only to seek related factors that can accurately predict short-term(≤ three months)outcome .Methods We analyzed retrospectively clinical data of consecutive patients with end-stage liver diseases undergone liver transplantation in a single treatment center .Logistic regression analysis was used to analyze the perioperative indicators including recipient gender ,age ,body mass index ,preoperative serum albumin level ,serum sodium concentration ,urea nitrogen level and donor-recipient blood group ,et al .Correlated factors were analyzed by the method of multivariate logistic regression .Statistical processing package was SAS 9 .1 .3 soft .The difference was statistically significant with P< 0 .05 .Results 18/165 patients died within 3 months after transplantation(mortality rate :10 .9 ％ ) .According to the result of univariate analysis ,the indicators correlated with early mortality which were statistically significant were preoperative serum sodium , blood urea nitrogen ,PT-INR ,CTP score ,MELD score and MELD-Na score .On the base of the result of Logistic multiple regression . However ,only MELD-Na score was associated with 3 months prognosis(P=0 .001 ,β=-2 .510 ,OR=0 .088 ,95 ％ CI=0 .037～0 .349) .Conclusions Preoperative MELD-Na score is an independent risk factor for short-term survival in patients with end-stage liver disease .Higher MELD-Na score is ,the early mortality is higher .
Objective To explore the effects of WeChat-based peer supports upon medication adherence and quality-of-life in liver transplant recipients .Methods A total of 63 patients with liver transplantation were conveniently divided into intervention group (n=32) and control group (n=31) depending upon their different follow-up periods .In control group ,routine outpatient health guidance was offered while intervention group received 6-week WeChat-based peer supports . Medication compliance and quality-of-life of two groups were evaluated at Month 3/6/12 post-intervention . Results At Month 3 post-intervention ,as compared with control group ,only non-punctual medication improved significantly in intervention group (P<0 .01);at Month 6 post-intervention ,all aspects of drug adherence improved in intervention group (P< 0 .05) ,at Month 12 post-intervention ,drug adherence ,non-punctual medication and missed dosing improved in intervention group ( P> 0 .05 ) . However , inter-group quality-of-life was not statistically significant at Month 3/6/12 post-intervention .Conclusions WeChat-based peer supports may partially improve the immediate compliance of patients with liver transplantation .However ,long-term outcomes and effects on quality-of-life are worth further researches .
Objective To explore the potential role of BK virus (BKV) in urothelial carcinoma after renal transplantation .Methods From May 2013 to March 2017 , We collected 26 cases of urothelial carcinoma after renal transplantation (study group) and 30 cases of urothelial carcinoma of non-immunosuppressed patients (control group) .Tumor tissues were stained with SV40 T antigen by immunohistochemical assay .Urinary and peripheral blood samples were assayed for BKV-DNA levels by real-time fluorescent quantitative polymerase chain reaction (PCR) .Results There were 7 positive cases of SV40 T-Ag in study group and only 1 weakly positive case in control group .The positive rate of BKV-DNA was 38 .5％ in urinary samples in study group (10 /26 ) and it was significantly higher than that in control group by 10％ (3/30)(P< 0 .05) .And the positive rate of blood BKV-DNA was not different between two groups ( P > 0 .05 ) .Conclusions There is a relatively high prevalence of BKV infection in urothelial carcinoma after renal transplantation .And a ,high level of BKV infection may play a role in urothelial carcinoma after renal transplantation .
Objective To study the function and mechanism of receptor-interacting protein kinase 3 (RIPK3)-mediated necroptosis in liver ischemia-reperfusion injury (IRI) in mice.Methods Sixty mice were randomly divided into four groups using Stata statistical software:Wild-type (WT)-sham group,WT-IRI group,HKO (HKO:RIPK3 liver-specific knockout)-sham group and HKO-IRI group.Sham operation was used as a control in which only the hepatic portal blood vessels were freed after laparotomy,and blood flow was not blocked.In the WT-IRI group and the HKO-IRI group,the hepatic portal vein was freed,and the blood supply of left hepatic lobe and the mid-hepatic lobe wer blocked for 90 min,then the blood vessels were opened for 6 h.Blood and liver tissue samples of each group of mice were taken to detect liver function.Inflammatory infiltration and liver injury were detected by immunohistochemistry and hematoxylin and eosin (HE) staining,and autophagyassociated protein LC3-Ⅱ and P62 were detected by Western blotting.The primary hepatocytes of WT mice and HKO mice were extracted and divided into control group and hypoxia-reoxygenation group (HIR group).After attachment of primary hepatocytes,the HIR group was given hypoxia for 6 h and reoxygenated for 4 h.The supernatant was taken for detecting ALT and AST,and the cell extract protein was used to detect LC3-Ⅱ and P62.Results As compared with the control groups,the liver functions of the IRI groups were significantly impaired,and as compared with the WT-IRI group,the liver damage was significantly aggravated in the HKI-IRI group (P ＜ 0.05),and the LC3-Ⅱ protein content was significantly decreased and the P62 protein content was increased.Similarly,after hepatocytes were were given hypoxia and reoxygenated,HKO-derived hepatocytes were more severely damaged than WT-derived hepatocytes.Conclusions Blocking RIPK3-mediated necroptosis of hepatocytes could induce autophagy inhibition,which aggravates hepatic ischemia-reperfusion injury.
移植免疫是器官移植领域的核心内容之一。移植免疫学的相关研究成果极大地促进了组织配型技术的发展、免疫抑制剂的进步以及移植排斥反应的诊治等，移植受者的预后也得到了极大的改善。但与此同时，如何改善移植物及受者的远期存活是目前制约器官移植发展的一大瓶颈，而这一问题的解决，依然需要移植免疫领域新的突破。因此，本文主要回顾和总结了近年来国际上移植免疫研究的热点问题。
过去30年来，美国已完成胰腺移植超过31 000例，美国以外其他国家和地区胰腺移植累积例数也已超过15 000例。自1982年完成首例胰腺移植以来，截至2016年底，我国共完成400余例胰腺移植。近年来，随着新型强效免疫抑制剂的临床应用及移植术式的日趋成熟，我国胰腺移植再度兴起，2017年和2018年连续两年胰腺移植例数均超过100例，我国新一轮胰腺移植快速发展时期来临。现阶段，胰腺移植主要是以大型单中心研究或零星的小规模研究报告为基础，亟需开展多中心前瞻性、随机、对照研究，以明确我国胰腺移植的疗效、风险和长期获益。希望各移植中心加强学术交流与合作，促进我国临床胰腺移植事业再上新台阶。
Objective To summarize the application experiences and curative efficacies of single lung transplantation assisted by extracorporeal circulation with coated lung ,centrifugal pump and coated pipe .Methods Retrospective analysis was conducted for clinical data of 6 adult patients with respiratory insufficiency undergoing single lung transplantation .The changes of hemodynamics and oxygenation before and after adjuvant treatment were observed ,the effects of adjuvant evaluated and the experiences of application summarized .Results The hemodynamic parameters post-assistance significantly improved as compared with that pre-assistance and pulmonary arterial pressure dropped from (56 ± 15 ) to (45 ± 13 ) mmHg with statistically significant differences . Arterial blood gas parameters significantly improved .PO2 spiked from (47 ± 12) to (68 ± 9) mmHg and PCO2 declined from (65 ± 14) to (55 ± 12)mmHg .And there were statistically significant differences .All patients were discharged successfully .Conclusions The simple extracorporeal membrane oxygenation system of coated lung , centrifugal pump and coated pipe during routine extracorporeal circulation may guarantee the operative safety of single lung transplantation and provide a new therapeutic option .
