Objective:To early identify the potential brain death donors, a user-friendly and more accurate scale was constructed based on the Glasgow coma scale (GCS), brainstem reflex and spontaneous respiration assessment.Methods:From January 1, 2021 to June 30, 2023, neurocritical patients in coma, admitted to the First Affiliated Hospital of SYSU and determined as brain death ultimately were retrospectively included as the retrospective group (n=175). Based on existing and previous studies of our center, the factors related to the progression to brain death of such patients were recorded, including GCS, brainstem reflexes (such as pupillary light reflex, corneal reflex, and vestibulo-ocular reflex), and spontaneous respiratory status. Brain death determination was according to the current criteria for brain death determination in China, and was completed by specialized doctors in our center. In the retrospective group, the relevant factors of the progression to brain death within 14 d after brain injury were screened, and were utilized to bulid the GCS-pupillary light reflex (P)-spontaneous respiratory (R) scale. From July 1, 2023 to January 31, 2024, the comatose neurocritical patients, admitted to our hospital and determined as brain death ultimately, were prospectively included as the prospectively group (n=51). In the prospectively group, the the efficacy of constructed GCS-P-R scale was verified. The comparison of quantitative data between groups was conducted with group t-test, and Logistic regression was used to analyze the risk factors for the progression of brain death in comatose neurocritical patients within 14 d after brain injury. The sensitivity and specificity of GCS-P-R scale and GCS were caculated in determining the progression to brain death in comatose neurocritical patients within 14 d after brain injury, and compared with chi square test. P<0.05 was indicated statistical significance of the difference.Results:In the retrospective group, statistical analysis showed that GCS=3 (OR=3.86, 95%CI: 1.57-18.21), disappearance of light reflex in unilateral pupil (OR=6.83, 95%CI: 4.35-19.34), and the frequency of spontaneous respiratory less than the set frequency (OR=4.16, 95%CI: 1.63-15.52) were the related factors with the progression to brain death within 14 d after brain injury. The GCS-P-R scale score≤0 can be used for early identification of potential organ donors after brain death. In the prospective group, 41 cases (80.4%) progressed to brain death within 14 d after brain injury. According to the GCS-P-R scale score ≤ 0, the sensitivity and specificity of predicting brain death progression within 14 d after brain injury were 92.7% and 43.5%, respectively. The sensitivity and specificity of predicting brain death within 14 d after brain injury based on GCS ≤ 6 were 100% and 0, respectively, the difference of sensitivity between the two groups was statistically significant (χ2=4.898, P<0.05), indicating that the constructed GCS-P-R scale has better predictive performance than GCS.Conclusions:The GCS-P-R scale which includes pupillary light reflex and spontaneous respiratory assessment, can more accurately predict the progression to brain death within 14 d in comatose neurocritical patients, and can be used for early identification of potential organ donors after brain death.
To enhance clinical physicians′ understanding of the use of mycophenolic acid in liver and kidney transplant recipients, further standardize the clinical use of mycophenolic acid, and establish basic principles for the switch of mycophenolic acids of different brands and formulations in clinical practice.This consensus, grounded in both evidence and clinical experience, has been collaboratively developed by the Branch of Organ Transplant of Chinese Medical Association, Branch of Organ Transplant Physicians of Chinese Medical Doctor Association, and the Shanghai Pharmaceutical Profession Association.The overarching hope is that this document will serve as a foundational reference for the clinical application of mycophenolic acids in liver and kidney transplant scenarios.
肺炎克雷伯菌(Klebsiella pneumoniae，KP)因其在医院内积累多重耐药性，以及导致严重社区相关性感染的风险，已成为一种威胁人类健康的致病菌[1]。KP通常存在于鼻腔、咽喉、皮肤和肠道菌群中，可引起肺炎、败血症以及软组织、手术伤口和泌尿道等一系列感染，尤其当人体处于免疫抑制状态时[2,3]。碳青霉烯类药物是肠杆菌科产广谱β内酰胺酶和头孢菌素酶菌株引起严重感染的一线治疗药物[4]，随着其在临床广泛应用，耐碳青霉烯类肠杆菌科细菌检出率逐年上升，其中耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae，CRKP)增长尤其显著。CRKP因其条件致病及多重耐药性，易感染长期使用广谱抗菌药物和免疫抑制剂的肾移植受者[5]。本研究回顾性分析近年来武汉大学人民医院器官移植科收治的肾移植术后CRKP感染病例，旨在探讨肾移植术后CRKP感染的防治措施。
In January 2015, organ donation after citizens′ death has become the only legal source of organs in China. After 8 years of reform practice and 2 years of special rectification, organ donation and transplantation in our country show fast, leap-forward development on a legal, ethical, scientific and standardized road, and has shown a good trend of high-quality, healthy and sustainable development along the same track as the international community. At present, China′s organ donation and transplantation ranks first in Asia and second in the world, which has been highly praised and supported by the international transplant community. However, the huge quantitative difference between donors and recipients is still a realistic problem that organ transplant doctors have to face. The development of xenotransplantation may be an effective means to alleviate the current situation of organ shortage, and its clinical promotion needs to overcome the serious complications caused by cross-species genetic differences. This paper summarizes the current development status of organ donation and transplantation in China and the progress of clinical research on xenotransplantation.
In recent years, organ transplantation in our country has witnessed significant growth. However, rejection reactions remain the primary complications affecting graft function and survival rates. Long-term immunosuppressive therapy is the most effective method for preventing rejection reactions. Nevertheless, currently used immunosuppressive agents such as mycophenolate mofetil have notable side effects, leading to many patients being unable to tolerate these side effects, thereby necessitating dose reduction or discontinuation. This, in turn, increases the risk of rejection reactions, ultimately resulting in graft failure. Mizoribine is an immunosuppressant that can concurrently inhibit the proliferation and differentiation of both T lymphocytes and B lymphocytes, with relatively fewer side effects. In recent years, it has been widely employed in the maintenance immunosuppressive therapy following kidney, liver, and other organ transplantations. Although Mizoribine has not yet been applied in the lung transplantation, clinical research evidence from the liver and kidney transplantation present some indications for its application in the lung transplantation, which is worthy of clinical attention and further research.
Objective:To evaluate the clinical experience in the diagnosis and treatment of COVID-19 in kidney transplant recipients.Methods:The clinical data of 14 kidney transplant recipients diagnosed with severe or critical COVID-19 were retrospectively analyzed. The demography data, clinical manifestations, and test results of laboratory examination, chest CT and metagenomic next-generation sequencing of the 14 kidney transplant recipients were collected. The paired t-test was used to compare the normally distributed measurement data, the paired sample Wilcoxon rank-sum test was used to compare non-normally distributed measurement data. P<0.05 indicates that the difference is statistically significant.Results:14 recipients had positive results for novel coronavirus nucleic acid detection of throat swabs, and the oxygen saturation levels at rest were all ≤93%. They were diagnosed with severe cases. Among the 14 recipients, case 1 and case 14 had progressive decline in oxygenation index during treatment and developed allograft dysfunction, and both of them required non-invasive ventilator-assisted ventilation as well as dialysis and therefore diagnosed with critical COVID-19. Among the 14 recipients, 10 cases had stable serum creatinine levels during admission; 2 cases had serum creatinine levels that increased by 30% and 50% compared to baseline; 2 cases had progressive increases in serum creatinine levels, which rose to 600 and 700 μmol/L, respectively, and required renal replacement therapy. Chest CT was performed on all recipients upon admission and during treatment. The most common manifestation was multiple subpleural ground-glass opacities in both lungs, with more obvious involvement in the lower lungs and dorsal regions in some recipients. After diagnosis, all recipients received routine electrocardiogram and blood oxygen saturation monitoring, oxygen therapy, symptomatic supportive treatment, antiviral treatment, immunosuppressant adjustment, immunomodulator use, antibacterial drugs therapy, anticoagulant treatment, and other drug treatments. After treatment, the general condition of the 12 recipients diagnosed with severe cases improved compared to before admission. Systemic symptoms and respiratory symptoms were relieved; oxygen saturation levels at rest were all ≥95%; chest CT showed obvious absorption or stabilization. The peripheral blood lymphocyte counts, serum creatinine levels, serum amyloid A levels, C-reactive protein levels, fibrinogen levels, and IL-6 levels showed statistically significant differences between before treatment and before discharge (t=5.74, 3.65, 6.41, 7.86 and 7.40, Z=-2.35, all P<0.05). The two critical cases required regular renal replacement therapy after discharge. The treatment plan was generally well-tolerated by the recipients without any drug withdrawal events due to adverse reactions during treatment. No deaths occurred during the treatment process.Conclusions:Early administration of antiviral agent is critical for improving the prognosis. Treatment of Paxlovid with Baritinib might still be beneficial for kidney recipient with prolonged course and those already developed severe symptoms.
呃逆是指横膈膜和肋间肌的突然不自主、间歇性、痉挛性收缩，导致声门突然关闭，发出特征性的"嗝"声。呃逆大多数是急性发作、有自限性的良性疾病，持续性呃逆和顽固性呃逆分别指持续48 h以上和1个月以上的呃逆。实际上，呃逆持续大于24 h即可被认为是难治性的[1]。顽固性呃逆的病理生理学机制尚不完全清楚，目前认为与呃逆反射弧相关的神经损伤、刺激或炎症有关。导致难治性呃逆的原因包括胃肠道疾病、代谢异常、迷走神经刺激、中枢神经系统疾病、某些药物以及涉及胃或膈肌的手术。然而，在许多情况下，难治性呃逆对临床医师是一个不可预知的挑战，难以找出确切病因。持续性呃逆会导致患者疲惫、睡眠不足、焦虑和体质量下降等，严重影响生活质量[2]。本研究总结苏州大学附属第一医院血液科1例骨髓增生异常综合征(myelodysplastic syndrome，MDS)患者在异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation，allo-HSCT)过程中并发难治性呃逆的诊治过程，现报道如下。
肝移植是治疗终末期肝病最有效的方法。随着外科技术和免疫抑制药物的发展，肝移植受者和移植物生存率已显著提高。根据中国肝移植注册中心(China Liver Transplant Registry，CLTR)数据，2015至2021年我国共实施肝移植35 566例，公民逝世后器官捐献肝移植和活体肝移植受者术后1、3、5年生存率分别为83.7%、74.5%、68.9%和92.4%、89.3%、88.2%[1]。肝移植受者的长期存活和生存质量很大程度上取决于术后中长期健康管理和免疫抑制方案。长期服用免疫抑制剂可导致受者出现肾损伤、代谢性疾病和新发恶性肿瘤等严重并发症，甚至增加肝癌肝移植术后肿瘤复发风险[2]。目前肝移植受者常用的免疫抑制方案以钙调磷酸酶抑制剂(calcineurin inhibition，CNI)为基础，其中以他克莫司+吗替麦考酚酯(mycophenolate mofetil，MMF)+泼尼松方案最为普遍。但是CNI引起的肾脏毒性、神经毒性和促进肿瘤复发等问题极大地影响了受者预后，近年来临床逐渐减少其用量并寻求替代药物。
鲍恩样丘疹病(bowenoid papulosis，BP)是一种较少见的外阴疾病，多发生在性活跃人群，与高危型人乳头瘤病毒(human papilloma virus，HPV)16、18感染密切相关[1]。BP是一种皮肤癌前病变，免疫抑制人群更易患此病。大部分BP患者预后良好，部分病例可自行消退，但有低于1.0%的比例可转化为肿瘤，尤其是伴高危型HPV 16、18阳性者及免疫功能缺陷者可能会发展为浸润性鳞状细胞癌，因此器官移植后BP患者应尽早治疗[2,3]。BP可采用外用药物、激光、冷冻和手术等多种治疗方法，但多只针对可见病变治疗，不能完全清除潜伏或无症状感染的HPV病灶，导致BP复发率较高[4]。复发病例经多次治疗后，也可能因刺激产生不典型增生，加速皮损恶变可能。光动力疗法(photodynamic therapy，PDT)由于其良好的组织选择性及安全性，被越来越广泛应用于原位宫颈鳞状细胞癌、尖锐湿疣和BP等治疗，且复发率较低[5,6,7,8]。本文回顾性分析浙江大学医学院附属第一医院1例肾移植后BP患者行激光联合PDT治疗的临床资料，总结诊治经验，现报道如下。
Post-transplant diabetes mellitus (PTDM) is a common endocrine and metabolic disorder after adult solid organ transplant (SOT), affecting 10% to 40% of recipients. PTDM has been associated with increased mortality, heightened risk of infections, graft-related complications and cardiovascular diseases, all of which seriously threaten the quality of life and long-term survival of recipients. According to recent studies and the domestic healthcare system, this consensus provides a comprehensive overview of the epidemiology, risk factors, pathogenesis, screening and diagnosis, treatments, prevention strategies, cardiovascular risk factor management and microvascular complications associated with PTDM, in order to further standardize the diagnosis and treatment of PTDM. The objective is to standardize the comprehensive management of PTDM with the aim of enhancing the long-term quality of life and clinical outcomes for SOT recipients.
With the development of 5G and artificial intelligence technology, fields related to medical care have been comprehensively upgraded with information technology, stepping into the era of smart medicine. The system adopts Browser/Server architecture and establishes a remote interactive system for the whole process of donor organ procurement in each working node of the organ procurement organization in our center. Medical history information, ethical procedures, donor acquisition surgery, organ evaluation, and case summary can be monitored and digitally managed throughout the whole procedure. The donor-related data and indicators can be structurally stored, which facilitates the staff to read, backtrack, and statistically analyze the historical data. The design and application of the system realize the fine evaluation and comprehensive monitoring and management of organ acquisition tissue. Simultaneously, it can also provide value for scientific research, personnel training, standard designation, and fraternal unit cooperation, which has great significance for clinical promotion.
Objectives:To identify drug-related problems (DRPs) in liver transplant recipients in the intensive care unit (ICU) and determine the potential impact of pharmacist interventions.Methods:A retrospective study was conducted to review the DRPs, interventions, and acceptance identified by pharmacists during pharmaceutical care and consultations in the liver surgery ICU at Zhongshan Hospital, Fudan University, from January 2020 to December 2021. Two pharmacists classified DRPs using the Pharmaceutical Care Network Europe V9.1. Pharmacist interventions were independently assessed using a six-point scale based on the potential impact on the treatment of liver transplant recipients in resolving DRPs. Gephi 0.9.2 network analysis software was used to analyze the relationships between DRPs and causes.Results:During pharmaceutical care, pharmacists identified 97 DRPs, with the most common "adverse drug event (possibly) occurring" (51.5%). Among the types of causes for DRPs, "drug selection" accounted for the highest proportion (61.9%). Pharmacists proposed 220 interventions for the identified DRPs, with 122 interventions at the prescriber level, predominantly involving "intervention proposed to prescriber" . There were 98 interventions at drug level, with "drug paused or stopped" being the most common. The vast majority of interventions were rated as "very significant" (10.3%), "significant" (64.0%), and "somewhat significant" (24.7%). Following pharmacist interventions, 88.7% (86/97) of the DRPs were resolved. In terms of consultations, pharmacists identified 114 DRPs, with 64.0% related to anti-infective drugs. Physicians were more concerned about "treatment effectiveness and safety, " and among the causes for DRPs, "drug selection" had the highest proportion (40.4%). In addition to prescriber-level (n=202) and drug-level (n=83) interventions, pharmacists proposed other interventions or behaviors (n=10) for the DRPs identified during consultations. Except for 17 DRPs where interventions could not be directly evaluated due to the lack of target patients, among the remaining 97 DRPs, the proportions of interventions by pharmacists with "very significant" , "significant" , and "somewhat significant" potential impact were 19.6%, 52.6%, and 26.8%, respectively. Comparing the causes of DRPs identified during pharmaceutical care and consultations, both physicians and pharmacists were concerned about drug combination issues, including drug interactions. Physicians were more prone to seek pharmacist assistance when encountering "dose adjustment of renal or liver insufficiency" , "needing supplementary drug information" , or facing "unavailable prescribed drugs" . Network analysis of the relationships between DRPs and causes revealed that the most diverse causes in pharmaceutical care were "adverse drug event" and "effect of drug treatment not optimal" , with 10 and 8 causes, respectively. In consultations, the most diverse causes were related to "treatment effectiveness and safety" , with 7 causes.Conclusion:Pharmacists can identify and resolve DRPs in liver transplant recipients in the ICU, and targeted pharmaceutical interventions positively impact their treatment. The complementary knowledge systems of physicians and pharmacists within the liver transplant team are conducive to ensuring the safety and reliability of medication.
Novel coronavirus has exerted an important influence on the cause of organ transplantation worldwide. Organ transplants affected by the initial novel coronavirus infection (COVID-19) are gradually recovering, but it is inevitable that more and more potential organ donors will be infected novel coronavirus. As China adjusts the relevant prevention and control policies on COVID-19, the screening rules for organ donors should also be carefully adjusted. In the case of scientific selection and informed consent of transplant recipients, we should consider the possibility of using organs from COVID-19 rehabilitation donors and non-lung organs from novel coronavirus positive donors.
Objective:To explore the effect of " picture-type nursing preparation checklist" used by operating room nurses in improving surgical cooperation ability and satisfaction of surgeons in laparoscopic living donor hepatectomy(LLDH).Methods:One hundred LLDH donors admitted by the same medical team from January 2020 to February 2022 at Beijing Friendship Hospital were selected as the research subjects. Fifty donors who underwent surgery from January 2020 to January 2021 were selected as the control group, and a " literal nursing preparation list" was used before and during the surgery; fifty donors who underwent surgery from February 2021 to February 2022 were selected as the observation group, and a " picture-type nursing preparation checklist" was used before and during the surgery. The preoperative preparation time, intraoperative pause time, and effective surgical time of the above two groups were recorded. A satisfaction survey questionnaire on operating room nursing work was distributed to surgeons after surgery. The measurement data of normal distribution was compared with group t test, and the counting data were compared with chi-square test. P<0.05 was considered as statistically significant.Results:The average preoperative preparation time in the control group was (63.2±11.2) min. Improper preparation of the operating table, improper placement of operation-related equipment and instrument trolley took up a longer time, which were (3.2±0.7), (11.6±1.5), and (7.4±0.8) min, respectively. The average intraoperative pause time was (5.2±2.2) min. The inexperience in connecting the endoscope with an ultrasound suction knife resulted in a low detection pass rate and a longer time for forgetting to prepare the Hem-o-lok clamps for the endoscope, which were (1.9±0.4) and (1.2±0.2) min, respectively. The average effective surgical time was (182.8±20.6) min. After the observation group was managed with a " picture-type nursing preparation checklist" , the preoperative preparation time and intraoperative pause time of LLDH were significantly reduced compared to the control group, which were (48.4±8.4) and (63.2±11.2) min, (3.1±1.7) and (5.2 ± 2.2) min, respectively, the differences were statistically significant (t=7.475 and 5.341, P all <0.05). There was no statistically significant difference in effective surgical time between the two groups (t=1.584, P>0.05). The feedback rates of surgeons in the observation group and the control group were both 100%, and the satisfaction scores for operating room nursing work of the observation group and the control group were (93.4±4.1) and (85.6±5.2) scores, respectively, with a statistically significant difference (t=8.330, P<0.05).Conclusions:The " picture-type nursing preparation checklist" can effectively reduce the preparation time before and during LLDH, improve the satisfaction of surgeons on the nursing work in the operating room, and ensure the safety of surgical patients.
Objective:To investigate the current situation and influencing factors of medication compliance in pediatric liver transplant recipients after discharge.Methods:From January 2010 to January 2020, 1177 pediatric recipients who underwent liver transplantation in Renji Hospital, Shanghai Jiao Tong University School of Medicine and maintained outpatient follow-up were selected to investigate. The general demographic statistics, clinical diagnosis and treatment data were investigated, and Basel immunosuppressive drug compliance assessment scale was used to assess medication compliance, and the related factors affecting medication compliance were statistically analyzed. Enumeration data were expressed as constituent ratio (%), and Chi-square test or Fisher′s exact test was used for comparison between groups.Univariate analysis was performed using logistic regression, and factors with P<0.10 were included in multivariate analysis, and P<0.05 was considered statistically significant.Results:A total of 1 177 questionnaires were sent out and 1 127 were returned, with an effective recovery rate of 95.8%. A total of 637 cases (56.5%) maintained good medication compliance. Among pediatric recipients who had been transplanted for 0 to 2, 3 to 4, 5 to 10, and >10 years, 63.9% (427/668), 50.3% (146/290), 39.0% (62/159), and 20.0% (2/10) had good overall compliance, respectively, and the difference was statistically significant (χ2=44.695, P<0.05). Among the items indicating non-compliance, the incidence of taking medicine 2 h or more earlier or delayed in the past month was the highest (30.0%), followed by missed one dose in the past month (15.9%), and the incidence of not taking the drug according to the prescribed dose in the past month was the lowest (4.0%). Multivariate logistic regression analysis showed that immunosuppressant medication compliance was worse in pediatric liver transplant recipients aged ≥6 years (OR=0.665, 95% CI: 0.477-0.928), with postoperative time ≥3 years (OR=0.542, 95% CI: 0.417-0.704), and without regular return visits (OR=0.460, 95% CI: 0.216-0.979), and immunosuppressant medication compliance was better in pediatric liver transplant recipients with college education and undergraduate or above major caregivers (OR=1.444, 95% CI: 1.122-1.859).Conclusions:The medication compliance of pediatric liver transplant recipients decreases gradually with the prolongation of postoperative time, which may be related to recipient age, family members′ understanding of the disease and drugs and other factors. It is necessary to improve the cognitive level of family members, strengthen the management of pediatric recipients′ behavior and reduce the occurrence of postoperative medication noncompliance.
1989年世界上第1例肝肾联合移植成功实施，2008年中国首例心肝肾联合移植获得成功。随着实体器官联合移植的不断发展，成功延长了不可逆多器官功能衰竭患者的生命周期，同时对免疫抑制治疗认识和实践的不断深入，也进一步改善了器官移植受者的预后。既往不可逆肾功能不全是心脏移植的绝对禁忌证，但随着心肾联合移植的出现和技术改进，此类患者的生存预期被大幅改善。他克莫司和吗替麦考酚酯(mycophenolate mofetil，MMF)等新型免疫抑制剂的应用，为器官移植术后移植物的长期存活提供了重要保障。不断发展的个体化免疫抑制治疗能在维持移植物正常功能的前提下，最大限度减少不良反应，改善受者预后。本文回顾性分析武汉大学人民医院2016年至2021年完成的3例心肾联合移植受者临床资料，观察其术后恢复情况和中远期预后，现报道如下。
Objective:To explore the role of professional organ procurement nurses in organ donation and procurement efforts.Methods:The data of donors who underwent organ donation before and after setting up professional organ procurement nurses in the First Affiliated Hospital of Xi′an Jiaotong University were retrospectively analyzed. The 215 donors who underwent organ donation from September 1, 2021 to August 31, 2022 after setting up professional organ procurement nurses were used as the observation group, and the 203 donors who underwent organ donation from September 1, 2020 to August 31, 2021 before setting up professional organ procurement nurses were used as the control group. The donor sex, age, primary disease, and the organ procurement operation time, organ warm ischemia time and organ transport time were compared between the two groups.Results:There were no statistically differences in sex, age and primary disease between the two groups (all P>0.05). In the control group and the observation group, there were 176 and 185 donors underwent combined liver and kidney procurement, and the operation time was (36±4) and (32±4) min, respectively, and the difference was statistically significant (t=10.21, P<0.05). Among them, there were 124 and 82 Chinese Ⅱ and Chinese Ⅲ organ donations, respectively, and the organ warm ischemia time was (8.6±1.5) and (8.2±1.7) min, and the difference was statistically significant (t=1.99, P<0.05). In the control group and the observation group, 34 and 76 organs were transferred to the external transplantation center, and the organ transfer time was (6.0±0.8) and (5.1±1.0) h, respectively, and the difference was statistically significant (t=5.47, P<0.05).Conclusion:Professional organ procurement nurses play an active role in promoting organ donation and procurement, providing a solid foundation for the quantity and quality assurance of organ donation and transplantation, and providing a practical basis for organ donation specialization, organ procurement organization construction discipline, and transplantation discipline systematization.
Objective:To investigate the impact of different preoperative dialysis modalities and durations on the prognosis of renal transplantation.Methods:The clinical data of 451 recipients who underwent allogeneic renal transplantation at the Remin Hospital of Wuhan University from January 2015 to June 2019, and received dialysis before operation and were followed up regularly after operation were analyzed retrospectively. According to different preoperative dialysis methods, 451 recipients were divided into hemodialysis (HD) group (n=365) and peritoneal dialysis (PD) group (n=86). According to different preoperative dialysis duration, recipients were also divided into dialysis duration ≤1 year group (n=214), dialysis duration >1-<3 years group (n=118), and dialysis duration ≥3 years group (n=119). The follow-up deadline was June 30, 2022. The serum creatinine level, the incidence rate of complications and the survival rate of recipients/transplanted kidneys within 3 years after renal transplantation were compared between the two groups. Measurement data were compared by group t-test or Mann-Whitney U test, enumeration data were compared by χ2 test. Survival curves were plotted using the Kaplan-Meier method and recipient/graft survival was compared using the log-rank test. P<0.05 was considered statistically significant.Results:There were no statistical differences in age, sex, body mass index, length of preoperative dialysis, preoperative complications and primary disease between the PD group and HD group (P>0.05). Renal allograft function recovered well in both groups, there was no statistical difference in serum creatinine level at different time after operation (P>0.05). There were no statistical differences in incidence of delayed graft function (DGF), pulmonary infection, acute rejection (AR), renal allograft vascular complications, cardiovascular disease (CVD) and urinary system complications after operation between the two groups (P>0.05). There were significant differences in the incidence of DGF and AR among the three groups of recipients with preoperative dialysis duration ≤1 year, >1-<3 years and ≥3 years. The incidence of DGF and AR in the group with dialysis duration ≥3 years was higher than that in the group with dialysis duration ≤1 year (χ2=7.13 and 13.962, P<0.0167). The survival rates of recipients at 3 years after operation in the PD group and HD group were 94.2% and 95.3%, respectively, and the survival rates of transplanted kidneys were 91.9% and 91.0%, respectively, and the differences were not statistically significant (χ2=0.029 and 0.112, P>0.05). The 3-year survival rates of recipients in the three groups with preoperative dialysis duration ≤1 year, >1-<3 years and ≥3 years were 96.3%, 94.9% and 93.3%, respectively, and the renal allograft survival rates were 93.0%, 89.8% and 89.1%, respectively, and the differences were not statistically significant (χ2=1.483 and 1.785, P>0.05).Conclusions:Different dialysis methods before renal transplantation have no significant effect on the recovery of renal allograft function, complications, and recipient/renal allograft survival rate, but the prolonged duration of preoperative dialysis will lead to an increase in the incidence of DGF and AR.
Since the end of 2019, the SARS-CoV-2 infection pandemic has swept the world.Although the current SARS-CoV-2 mutants have decreased in pathogenicity and virulence compared with the original strains, and most patients have a good prognosis, the solid organ transplant(SOT)recipients are vulnerable to SARS-CoV-2.And even with vaccination, the risk of hospitalization or death is still high in SOT recipients infected with SARS-CoV-2.What's more, the clinical manifestations, diagnosis and treatment strategy of SOT recipients infected with SARS-CoV-2 has its unique features, which need high attention.At present, there is a lack of guidelines or consensus in the diagnosis and treatment field of SARS-CoV-2 for such a large number of SOT recipients.Therefore, referring to the "Diagnosis and treatment plan of coronavirus(Trial Version 10)" and global published literature, the writing team wrote the "Expert consensus on diagnosis and treatment of COVID-19 in solid organ transplant recipients(2023 edition)". This consensus is evidence-based written and reached by experts after multiple rounds of discussions, forming 21 recommendations, providing reference for the diagnosis and treatment of SOT recipients infected with SARS-CoV-2.
Hepatitis C virus infection is highly prevalent in kidney transplant recipients and is one of the major risk factors for postoperative complications, transplant kidney survival and recipient prognosis. Recent studies have shown that the use of direct-acting antiviral agents(DAAs) in kidney transplant recipients is effective in improving prognosis, reducing the risk of postoperative complications and increasing the survival rate of the transplanted kidney, and has been beneficial in the exploratory treatment of hepatitis C virus-positive donor kidney transplants, but more evidence from high-quality trials and evidence-based medicine is still needed. This review provides an overview of research advances in hepatitis C virus infection and kidney disease, post-transplant complications, post-operative DAAs therapy and the use of hepatitis C virus-positive donor kidneys.
