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1.
Minimally invasive approaches are increasingly being applied in surgeries and have recently been used in living donor hepatectomy. We have developed a safe and reproducible method for minimally invasive living donor liver transplantation, which consists of pure laparoscopic explant hepatectomy and pure laparoscopic implantation of the graft, which was inserted through a suprapubic incision. Pure laparoscopic explant hepatectomy without liver fragmentation was performed in a 60-year-old man with alcoholic liver cirrhosis and hepatocellular carcinoma. The explanted liver was retrieved through a suprapubic incision. A modified right liver graft, procured from his 24-year-old son using the pure laparoscopic method, was inserted through a suprapubic incision, and implantation was performed intracorporeally throughout the procedure. The time required to remove the liver was 369 min, and the total operative time was 960 min. No complications occurred during or after the surgery. The patient recovered well, and his hospital stay was of 11 days. Pure laparoscopic living donor liver transplantation from explant hepatectomy to implantation was performed successfully. It is a feasible procedure when performed by a highly experienced surgeon and transplantation team. Further studies with larger sample sizes are needed to confirm its safety and feasibility.

  相似文献   

2.
Livers from donors after circulatory death (DCD) are a promising option to increase the donor pool, but their use is associated with higher complication rate and inferior graft survival. Normothermic machine perfusion (NMP) keeps the graft at 37°C, providing nutrients and oxygen supply. Human liver stem cell-derived extracellular vesicles (HLSC-EVs) are able to reduce liver injury and promote regeneration. We investigated the efficacy of a reconditioning strategy with HLSC-EVs in an experimental model of NMP. Following total hepatectomy, rat livers were divided into 4 groups: (i) healthy livers, (ii) warm ischemic livers (60 min of warm ischemia), (iii) warm ischemic livers treated with 5 × 108 HLSC-EVs/g-liver, and (iv) warm ischemic livers treated with a 25 × 108 HLSC-EVs/g-liver. NMP lasted 6 h and HLSC-EVs (Unicyte AG, Germany) were administered within the first 15 min. Compared to controls, HLSC-EV treatment significantly reduced transaminases release. Moreover, HLSC-EVs enhanced liver metabolism by promoting phosphate utilization and pH self-regulation. As compared to controls, the higher dose of HLSC-EV was associated with significantly higher bile production and lower intrahepatic resistance. Histologically, this group showed reduced necrosis and enhanced proliferation. In conclusion, HLSC-EV treatment during NMP was feasible and effective in reducing injury in a DCD model with prolonged warm ischemia.  相似文献   
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<正>器官移植手术技术的改良、基础研究的突破以及新型免疫抑制剂的成功研发等医学进步,已使器官移植受者生存率和生活质量不断提高,但供器官来源问题始终是器官移植领域最大的困扰~([1])。我国开展公民逝世后器官捐献工作相对较晚,相关法规条例尚不够完善。同时,由于各地人口密度、地域文化、经济发展以及医疗设施和技术的差异,器官捐献工作的发展极不均衡,导致全国移植医疗资源严重失衡和医疗迁徙不断加剧,不仅增加了器官衰竭  相似文献   
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器官移植术是20世纪出现的针对器官功能衰竭的最有效治疗方法,每年拯救全球超过12万例患者。但供器官短缺的现状,与器官移植技术和辅助药物的发展不匹配,制约了器官移植事业的发展。我国自2015年起已成为全球器官捐献和移植大国之一,2017年公民逝世后器官捐献数量超过5 000例,占全球捐献总量的15%以上。黄洁夫教授总结的器官捐献与移植"中国模式"得到了世界卫生组织、国际移植界的高度重视和充分肯定。本文通过整理全球及各国的器官捐献与移植数据,剖析全球现状与发展趋势,进一步探索我国公民器官捐献的影响因素并提出针对性的应对策略,以期实现我国器官捐献和移植的"自给自足"。  相似文献   
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介绍上海、深圳及其他地区药品集团采购(GPO)的发展现状,并将深圳与上海GPO模式进行对比,分析GPO发展及拓展过程中面临与现有政策和政策引导中的困扰和挑战,提出明确GPO在新形势下发展的定位、制定GPO本土化发展的游戏规则、建立规范GPO发展的监管体系等相关政策建议。  相似文献   
8.
Combining simultaneously lung and liver procurement in controlled donation after circulatory death (cDCD) using normothermic abdominal perfusion (NRP) for abdominal grafts and cooling and rapid recovery technique (RR) for the lungs increases the complexity of the procurement procedure and might injure the grafts. A total of 19 cDCDs from two centers using this combined procedure were evaluated, and 16 liver and 21 lung transplantations were performed. As controls, 34 donors after brain death (DBDs) were included (29 liver and 41 lung transplantations were performed). Two cDCD liver recipients developed primary nonfunction (12.5%). No cases of ischemic cholangiopathy were observed among cDCD recipients. The 1‐year and 2‐year liver recipients survival was 87.5% and 87.5% for the cDCD group, and 96% and 84.5% for the DBD group, respectively (P = .496). The 1‐year and 2‐year lung recipients survival was 84% and 84% for the cDCD group and 90% and 90% for the DBD group, respectively (P = .577). This is the largest experience ever reported in cDCD with the use of NRP combined with RR of the lungs. This combined method offers an outstanding recovery rate and liver and lung recipients survival comparable with those transplanted with DBDs. Further studies are needed to confirm our findings.  相似文献   
9.
新型冠状病毒肺炎疫情爆发以来,严重影响了群众的正常工作、生活以及就医诊疗。奥密克戎毒株现已成为主要流行株,由于其传播力更强,且早期多以无症状感染者为主,极易造成人群中大面积播散,给疫情防控带来巨大挑战。2022年3月以来,上海地区发生新冠病毒奥密克戎亚型毒株大流行,为解决患者住院就诊需求,同时做好疫情防控,控制院内感染,某大型三甲医院创新性开设院内集中过渡病房,病房运行期间,各项工作井然有序开展,极大缓解专科病房压力,且住院患者和医务人员均未发生新冠肺炎院内感染。现将我院开展集中过渡病房的筹备、运行、管理等各项工作进行总结,为公立医院在疫情下开展该项工作提供方法指导和参考。  相似文献   
10.
In the context of a rapidly evolving pandemic, multiple organizations have released guidelines stating that all organs from potential deceased donors with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection should be deferred, including from otherwise medically eligible donors found to have mild or asymptomatic SARS‐CoV‐2 discovered on routine donor screening. In this article, we critically examine the available data on the risk of transmission of SARS‐CoV‐2 through organ transplantation. The isolation of SARS‐CoV‐2 from nonlung clinical specimens, the detection of SARS‐CoV‐2 in autopsy specimens, previous experience with the related coronaviruses SARS‐CoV and MERS‐CoV, and the vast experience with other common RNA respiratory viruses are all addressed. Taken together, these data provide little evidence to suggest the presence of intact transmissible SARS‐CoV in organs that can potentially be transplanted, specifically liver and heart. Other considerations including ethical, financial, societal, and logistical concerns are also addressed. We conclude that, for selected patients with high waitlist mortality, transplant programs should consider accepting heart or liver transplants from deceased donors with SARS‐CoV‐2 infection.  相似文献   
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