OBJECTIVES:Drain tube management after liver transplant is controversial. A new peritoneal drainage management protocol was developed to validate clinical characteristics, such as drain characteristics, postoperative complications, duration of postoperative hospital stay, changes in albumin levels, and 30-day readmission rates.MATERIALS AND METHODS:Data from 183 consecutive patients who underwent deceased donor liver transplant at our institution between January 2019 and June 2022 were retrospectively analyzed. A new drain management protocol was implemented on August 1, 2021, which included early removal of the drain tube when the serum albumin level was >3 g/dL and nonchylous fluid drainage was <200 mL/day.RESULTS:When we compared the traditional and new drain management protocol groups (n = 131 vs n = 52), the new management protocol group showed a decrease in the median duration of intraperitoneal drainage. In addition, the median length of postoperative hospital stay decreased from 33 to 27 days and serum albumin levels returned to normal faster at postoperative 3 weeks. No significant differences were found in postoperative hemorrhage, hematoma, hydrops abdominis, infections, biliary complications, orin the rate ofreinterventions and 30-day rehospitalizations.CONCLUSIONS:The new management protocol was associated with fewer postoperative hospital days and faster recovery than traditional management. Our findings may aid in the development of new drain policy recommendations based on preexisting risk factors.

BACKGROUND:Passenger lymphocyte syndrome (PLS) is a rare post solid organ transplantation complication, usually occurring after ABO- or Rh-mismatched transplantation. In general, PLS can lead to severe hemolytic anemia, but it is usually a self-limited disease. Most PLS cases start with a decreased hemoglobin (Hb) level and require donor type RBC transfusion as the only treatment.CASE REPORT:In our case, the allograft was given by an O-type Rh-D(+) donor and received by an A-type Rh-D(+) recipient. The PLS was developed on the post-operative day (POD) 10 with an increased indirect bilirubin (IDBIL) level as the first clinical symptom, while the Hb level did not significantly decrease. The PLS was diagnosed on POD 17 by a direct antiglobulin test (DAT) and a blood group test. The patient quickly became stable on POD 18 after a total of eight units of O-type RBC transfusion. Kidney function was uneventful in the entire PLS period.CONCLUSION:In ABO-mismatched kidney transplantation, an increased level of IDBIL should be considered as the first symptom of PLS even without an Hb decrease. The kidney function may be not affected by the PLS symptoms.

With the maturity of organ transplantation technology, the long-term survival of solid organ grafts has gradually become the primary task after transplantation. The main cause of graft function loss after solid organ transplantation is chronic graft damage. However, its potential mechanism is not clear. Graft pathological biopsy is the gold standard for the diagnosis of graft function, but the routine evaluation of graft function is hindered by the invasiveness of biopsy puncture and the limitation of sampling. Therefore, functional monitoring of micro injury non-invasive samples (such as peripheral blood or urine) is more conducive to the management of grafts after solid organ transplantation. This paper will systematically review the literature on biomarkers of long-term graft survival in solid organ transplantation.

目的 对国内外报道的肾移植术后BK病毒(BKV)激活的危险因素进行荟萃分析,为临床BKV肾病的防治提供参考.方法 通过系统检索PubMed数据库、中国知网、万方数据库以及中国生物医学数据库从建库至2019年7月公开发表的关于肾移植术后BKV激活危险因素的相关研究论文,并通过其参考文献进行手工补充搜索.采用纽卡斯尔-渥太华量表对纳入文献进行质量评价,运用RevMan 5.3软件进行荟萃分析.结果 最终纳入22篇文献,其中英文15篇、中文7篇.结果显示血液中检测到BKV的危险因素为排斥反应(OR=1.91,95％CI:1.30～2.80)、移植肾功能延迟恢复(OR=1.51,95％CI:0.99～2.31)、服用他克莫司(OR=1.50,95％CI:1.22～1.84)、使用抗胸腺细胞球蛋白(ATG)诱导(OR=1.75,95％CI:1.02～2.98)、使用输尿管支架(OR=1.98,95％CI:1.19～3.30)和合并CMV感染(OR=2.23,95％CI:1.61～3.09);而尿液中检测到BKV的危险因素为持续服用糖皮质激素(OR=1.49,95％CI:1.09～2.04).结论 肾移植术后服用他克莫司、合并CMV感染、使用输尿管支架和ATG诱导的受者发生BKV血症的风险更高,长期服用糖皮质激素的肾移植受者发生BKV尿症的风险更高.

当机体生理负荷加重时,肝脏可以额外动员的潜在能力,以及各种致病因子造成肝脏损伤后自我修复且再生的能力,统称为肝脏储备功能[1].目前临床上评估肝脏储备功能的方法有很多种,主要分为肝功能静态检测及肝功能动态检测.肝功能静态检测包括临床上使用最普遍的肝脏血清生化检查,以及肝脏影像学评估和肝功能评分系统.而肝功能动态检测最常用的方法是吲哚菁绿(indocyanine green,ICG)清除试验[2].ICG清除试验主要应用于评估肝脏肿瘤的切除部位及大小,而在肝移植领域中相关报道较少[3].本文就ICG清除试验在肝移植患者中的应用进行综述.

The evaluation of the immunosuppression state in liver transplanted recipients is vital for a correct posttransplantation management and a major step towards the personalized treatment of the immunosuppression.To date,immunological monitoring after liver transplantation relies mainly on clinical judgment and pathological examination of the graft,without a proper assessment of the actual state.Previous studies have ever identified many markers for acute rejection(AR) and immune tolerance after liver transplantation.Many markers for AR are pro-inflammatory or immunoregulatory cytokines and other proteins related to inflammation.However,many markers have been proved to be also able to predict other diseases and only a few of the markers for AR have been validated.Standard liver tests cannot be used as markers for graft rejection due to the low sensitivity and specificity.This review summarized the potential markers for AR and immune tolerance after liver transplantation based on published literatures in recent years and to provide evidence for clinical application.

Objective:To study the effects of collaborative care model of the cognitive level,self-care capability,life quality and long-term survival rate in the renal transplantation patients.Methods:One hundred renal-transplantation patients were paired and divided into two groups for conventional nursing (group A) and collaborative caring (group B).After 50 pairs of patients are defined,group A treats with usual care implementation and group B deals with Collaborative care implementation.After 6 month's treatments,MuIs and ESCA were used to compare the effects.Results:Implementation of collaborative care could highly improve patients' self-care capability,life quality,emotion and the cognition of disease.Conclusion;Collaborative care has significance for improving patients' self-care capability,life quality,the cognition of disease and long-term survival rate.

The application of immunosuppressor dramatically increased the survival rate of organ and tissue transplantation,improved the patients' life quality,and greatly promoted the organ and tissue transplant work.Fornow,mycophenolic acid (MPA),as the first-line antiproliferative immunosuppressants after transplantation,has those characteristics,such as narrow therapeutic window and individual variation,as same as other common immunosuppressors,like Ciclosporin A,Tacrolimus,etc.Due to the great variation of drug administration in different patients,the dosage should be frequently adjusted according to the plasma concentration.This article would review the development of therapeutic drug monitoring (TDM) for MPA's plasma concentration.

Objective To summarize the dietary guidance for patients who are undergoing follow-up after liver transplantation.Methods Dietary guidance were conducted in a total of82 cases of liver transplantation patients with postoperative follow-up dietary guidance, diet principle is the low salt, low sugar, low fat, high vitamin and right amount of high-quality protein(animal protein), eating little but often throughout the day. Through the exercise along with that kind of diet, the increasing range of weight should be controlled within 10 kg.Results The quality of life of patients undergoing follow-up has greatly been improved, the increasing range of weight were controlled within10 kg and the blood concentrations of immunosuppressants were within the relatively ideal scope.Conclusion The effective health education and the right dietary guidance, which help maintain the physical and mental health of patients who are undergoing follow-up after liver transplantation, reduce the rates of patients' infection and complications and protect the function of transplanted livers are important parts of the treatment after liver transplantation.

股骨头坏死是肾移植术后一种严重的并发症，威胁着患者的生活质量，它的发生与糖皮质激素之间有着密切的关系。国外有研究报道，股骨头坏死的发生率为3%～41%，其中85%为双侧髋关节病变［1］。近年来，由于免疫方案的改变，临床上激素的用量趋于减少，抗免疫排斥药物也得到了改良，加上肾移植术式的成熟和肾移植术后病情随访和复查的开展，股骨头坏死的发病率呈现出下降的趋势，但是患者之间存在着个体差异，因此对激素的敏感程度也有所不同，这成为影响激素性股骨头坏死发生的重要因素［2］。当前，公民逝世后器官捐献（donation after citizen's death， DCD）成为我国器官捐献的唯一合法渠道。武汉大学中南医院作为我国首家获得DCD移植资质的医院，所进行的肾移植均为DCD供肾肾移植。2010年3月至2015年1月，在武汉大学中南医院完成DCD供肾肾移植术的患者中，先后有6例发生了股骨头坏死，经综合护理干预后，患者的并发症得到了良好控制。现将护理体会报道如下。

Objective To analyze the psychologic status and influence factors of the DCD preoperative transplant patients, provide the basis for implementing psychological intervention, improve patients'' unhealthy emotions for improving the preoperative patients'' understanding of disease and treatment, let them treat the disease in a positive emotion, makethe treatment smooth, guarantee the postoperative life quality of patients.Methods Questionnaire survey was applied to108 registered patients from January2014 to June2014. The patients were divided into control group with regular nursing and experiment group with nursing intervention. SAS, SDS, MuIs-A and self-design psychological effect factor survey had been used to evaluate the psychological status and factor analysis. After intervention for half year, the same survey was applied and evaluated again.Results With the extension of the waiting time, the patient will gradually exhibit a variety of emotional disorders.70% of them show anxiety, the reason for40% of those anxious patient was related to long-time disease, long waiting time, financial burden, repeatedly matching failure, unpredictability of transplantation, uncomprehensive understanding of disease. After nursing intervention,the situation of anxiety, depressed and uncertainty in illness in control and experiment group had improved (P<0.05).Conclusion Taking nursing intervention according to influence factors can dramatically improve the patient''s understanding and cooperation.