A new carotid artery transplantation model of rats

To establish a murine carotid artery transplantation model for the study of the chronic rejection, 80 rats were divided into two groups, an allotransplant （ACI-Lewis） group and an isotransplant （Lewis-Lewis） group （control group）. The donor carotid artery and the recipient carotid artery were anastomosed by using a polyethylene cuff （internal diameter： 0.7 mm, length： 3 mm）.The pathological changes of carotid artery transplant were observed 14, 28 and 56 days after the transplantation. The results showed that the model was successfully established in 95% of the animals. The chronic rejection-associated arteriosclerosis was induced 28 days after the transplantation. The new chronic rejection model of carotid artery by using cuff technique caused fewer traumas and was easy to make. The pathological changes of the transplant mimicked the chronic rejection-associated arteriosclerosis found in human transplant.     

大鼠肺移植受体OB与细胞凋亡关系的初步研究

目的探讨大鼠肺移植受体闭塞性细支气管炎(OB)与细胞凋亡的关系。方法采用大鼠气管异位移植模型模拟肺移植术后OB。随机分为对照组、移植组和免疫抑制剂治疗组,分别于术后7、14和28?d取出移植物。原位末端标记法（TUNEL）检测移植气管细胞凋亡情况;免疫组织化学EnVison法检测移植气管Caspase 3和Bax基因蛋白的表达。结果① 动物模型气管HE染色检测到术后排斥反应,与OB组织学改变符合;② TUNEL检测到大鼠OB模型存在细胞凋亡,免疫抑制剂治疗组较移植组细胞凋亡数少,移植中后期两组差异有统计学意义（P＜0.05）;③ 免疫组织化学检测到大鼠OB模型Caspase 3、Bax基因蛋白表达在移植组和免疫抑制剂治疗组增高,移植中后期两组差异有统计学意义（P＜0.05）。结论① 大鼠肺移植受体OB与细胞凋亡相关;② 抑制细胞凋亡可治疗肺移植受体OB。     

Skin cancer chemoprophylaxis in renal transplant recipients: 5 years of experience using low-dose acitretin

Renal transplant recipients have an increased risk of developing skin cancers, which are often multiple and aggressive. Frequently, these tumours develop on a background of widespread epidermal dysplasia. Systemic retinoids are known inhibitors of skin cancer but reports of their use in renal transplant patients are limited. We describe our experience using 0.3 mg/kg daily of acitretin in 16 patients over a 5-year period. Overall, there was a significant reduction in the number of new tumours excised in 12 of 16 patients during treatment compared with the same pretreatment interval. A significant chemoprophylactic effect was shown for up to 4 years of treatment. Patients with five or more tumours prior to acitretin benefited most. Two patients discontinued treatment because of side-effects and two patients developed hyperlipidaemia. Two patients with end-stage graft failure proceeded to haemodialysis. The introduction of low-dose acitretin proved to be a useful strategy in the long-term reduction of skin cancer in renal transplant recipients with multiple skin cancers and extensive epidermal dysplasia.     

Reduction of immunosuppression for transplant-associated skin cancer: expert consensus survey

BACKGROUND: Reduction of immunosuppression is considered a reasonable adjuvant therapeutic strategy in solid-organ transplant recipients experiencing multiple or high-risk skin cancers. However, the literature provides no guidance about what threshold of cancer development would warrant initiation of reduction of immunosuppression. OBJECTIVES: To develop expert consensus guidelines for initiation of reduction of transplant-associated immunosuppression for solid-organ transplant recipients with severe skin cancer. METHODS: An expert consensus panel was convened by the International Transplant Skin Cancer Collaborative and Skin Care for Organ Transplant Patients Europe Reduction of Immunosuppression Task Force. Thirteen hypothetical patient scenarios with graduated morbidity and mortality risks were presented and mean and mode expert opinions about appropriate level of reduction of systemic immunosuppression (mild, moderate, severe) were generated. RESULTS: Mild reduction of transplant-associated immunosuppression was considered warranted once multiple skin cancers per year developed or with individual high-risk skin cancers. Moderate reduction was considered appropriate when patients experienced > 25 skin cancers per year or for skin cancers with a 10% 3-year risk of mortality. Severe reduction was considered warranted only for life-threatening skin cancers. CONCLUSIONS: Reduction of immunosuppression is considered a reasonable adjuvant management strategy for transplant recipients with numerous or life-threatening skin cancers. Proposed guidelines are presented for the graduated reduction of immunosuppression coincident with the increasing skin cancer risks.     

ImmuKnowTM-Cylex检测技术在肾移植术后重症肺炎中的应用研究

目的 探讨ImmuKnowTM-Cylex检测技术能否作为肾移植术后发生肺部感染的预警指标.方法 收集17例肾移植受者的肝素钠抗凝全血46份,通过测量CD4+T细胞刺激后释放的ATP浓度来判定机体细胞免疫水平.结果 肾移植术后重症肺炎发生前(移植术后两周内)组CD4+T细胞ATP值为(383.47±186.51)ng/...     

高压电击伤36例的治疗分析

目的：探讨并总结高压电击伤的治疗方法。方法：36例高压电击伤患者均给予系统治疗,并对患者的不同创面情况、症状、并发症等进行分析,掌握好全身休克的预防、并发症的治疗、清创截肢的适应证。结果：36例患者中,31例痊愈,5例好转后自动出院,其中,16例同时存在复合伤,皮瓣转移修复共30块（3块坏死）,截肢10例,中厚皮片移植10例（全部存活）。结论：高压电击伤病情复杂,损伤重,治疗时间长,并发症多,应予以及时救治。     

他克莫司和雷帕霉素对肝癌肝移植术后患者的疗效比较

目的探讨免疫抑制剂他克莫司和雷帕霉素对肝癌肝移植术后受者治疗预后的比较。方法将22例肝癌肝移植术后患者随机分为两组：FK506组11例：术后采用FK506＋MMF＋Pred方案;Rapa组11例：术后4周内采用FK506＋MMF＋Pred方案,4周后改用Rapa＋MMF＋Pred方案。比较两组患者术后的肿瘤复发情况、死亡（因肿瘤因素）、排斥反应、感染发生率及肝、肾功能等情况。结果 FK506组患者与Rapa组患者在术后急性排斥反应、感染发生率、同时期的谷丙转氨酶（ALT）浓度方面差异无统计学意义（P〉0.05）;两组患者在术后肿瘤复发率、死亡率、血肌酐（CREA）浓度方面差异有统计学意义（P〈0.05）,Rapa组患者比FK506组患者术后疗效更好。结论雷帕霉素能明显改善肝癌肝移植术后患者的预后,并无肾功能损害,且不增加排斥反应的发生率,为肝癌肝移植术后的治疗提供了一种新的选择。     

肾移植的随访体会

目的总结肾移植临床经验,减少并发症,提高远期人、肾存活率。方法随访161例肾移植受者术后3-7年人、肾存活情况及并发症,分析术前、术中、术后并发症对移植受者人、肾存活率的影响。结果人、肾存活率88.75%和86.8%,主要并发症为高脂血症、高血压、慢性移植肾肾病、感染、排斥反应和移植肾功能延迟恢复（DGF）。结论良好术前准备、娴熟的手术技术、严格的术后管理,是手术成功、减少术后外科并发症的关键。