肾移植术后肺部感染的诊断和鉴别诊断

肾移植已成为治疗终末期肾功能衰竭的最佳方法。为预防移植肾排斥反应，需要长期应用免疫抑制剂治疗，特别在肾移植术后早期由于大剂量免疫抑制剂的应用，易导致受者免疫力大幅度下降，从而使感染机会增多，其中肺部感染最为常见，也是肾移植受者最主要的死亡原因之一。     

三例造血干细胞移植术的护理体会

造血干细胞移植(HSCT)是通过大剂量放化疗预处理,清除受者体内的肿瘤或异常细胞,再将自体或异体造血干细胞移植给受者,使受者重建正常造血及免疫系统的一种治疗方法.按照采集造血干细胞的来源不同分为:骨髓移植、脐血移植、外周血造血干细胞移植等.造血干细胞迄今仍然是一种高风险、高费用、高难度的治疗方法.目前主要用于恶性血液病和非血液系统疾病.现对我科三例造血干细胞移植术的护理体会总结如下.     

卵子赠送技术的应用及进展

卵子赠送是一种有效的辅助生殖技术(ART),主要应用于各种原因导致的卵巢功能缺陷.其基本技术过程包括:受者的激素替代治疗(HRT),供者促超排卵、取卵,与受者丈夫的精子进行体外受精,受者胚胎移植.影响其妊娠成功率的因素包括子宫内膜同步化的程度,受者的年龄、既往病史,供者的年龄、妊娠史,移植胚胎质量、数目,移植方式等.卵子来自供卵者、冷冻卵子、未成熟卵体外培养等.     

器官移植术后的代谢调理治疗

器官移植术后移植器官的功能恢复至关重要,用代谢调理治疗取代常规的营养支持,有利于移植器官功能的早期恢复和受者营养状态的改善.     

器官移植受者的妊娠问题

接受器官移植的妇女能够正常妊娠。器官移植受者妊娠的主要问题有：妊娠与移植器官和移植受者的相互影响；免疫抑制治疗对妊娠的影响；围产期的护理等。     

器官移植受者的妊娠问题

接受器官移植的妇女能够正常妊娠。器官移植受者妊娠的主要问题有妊娠与移植器官和移植受者的相互影响;免疫抑制治疗对妊娠的影响;围产期的护理等。     

Flow-CDC技术在肾移植中的应用研究

目的为了更好地识别造成移植肾排斥的特异性抗供者HLA的IgG类型同种抗体,将Flow-CDC方法应用于肾移植及其临床相关性研究。方法对96例等候肾移植受者同时进行PRA、NIH-CDC和Flow-CDC实验,并观察了其中34例接受NIH-CDC阴性肾移植术的受者近期移植效果。结果Flow-CDC和NIH-CDC两种实验方法的阳性率[27·8%(42/151)和17·2%(26/151)]之间呈显著性差异(2=14·06,p<0·001)。另外,PRA阴性受者其NIH-CDC和Flow-CDC均为阴性,阴性吻合率100%;在接受同种异体肾移植术的34例受者,其中20例PRA阴性受者接受了NIH-CDC和Flow-CDC均阴性供肾,移植后未发生排斥,移植肾功能迅速恢复;13例接受NIH-CDC和Flow-CDC均阴性供肾的致敏受者中,1例发生急性排斥经治疗后逆转,12例无排斥移植肾功能良好;1例PRA阳性再次移植受者接受了NIH-CDC阴性而Flow-CDC阳性的供肾,移植后第2d出现少尿,第10d切除移植肾。结论Flow-CDC方法是一种能够识别具有补体结合能力的抗供者特异性HLA抗体的交叉配型技术,比经典的NIH-CDC方法具有更敏感,可标准化,快速等优点,对预示肾移植术后的排斥反应方面更具有前瞻性。     

肾移植群体反应性抗体水平与排斥反应的观察

目的探讨群体反应性抗体(PCR)对肾移植效果的影响.方法采用酶联免疫吸附法(ELISA)对182例肾移植受者的血清PRA进行检测.同时对120份血清分成四组包括首次移植术前及术后1个月,半年至1年肾功能稳定期病人,第一次尸肾移植失功恢复血透病人进行PRA检测.结果PRA阴性组受者移植术后排斥发生率为11.7%,阳性组受者平均PRA高达40.3%,两组比较差异显著(P<0.001).首次移植术前A组阳性率15.4%,术后B组阳性率25.0%,肾功能稳定组(C组)PRA阳性率11.1%.而移植失功恢复血透者(D组)PRA阳性率达73.3%.结论PRA的检测是肾脏移植术前筛选致敏受者的重要指标,与肾脏移植后排斥反应关系密切.     

人子宫移植后临床妊娠并成功分娩活产儿案例分析

目的探讨文献报道的人子宫移植后，在受者移植子宫内临床妊娠，并成功分娩活产儿的可行性，以及母儿结局分析。 方法选择受者接受子宫移植后，在移植子宫内临床妊娠，并成功分娩活产儿的文献为研究对象。以"uterine transplantation"或"uterus transplantation"为英文检索词，"子宫移植"和"活产"为中文检索词，检索PubMed数据库、万方数据知识服务平台及中国知网数据库中，关于人子宫移植后，在移植子宫内临床妊娠，并成功分娩活产儿的文献，检索时间设定为各文献库建库至2018年12月。分析文献报道的接受子宫移植受者的临床病例资料，包括一般临床资料，孕期并发症、分娩及产后情况，母儿结局，以及分娩的活产新生儿情况等。 结果①自检索文献中筛选符合本研究纳入与排除标准的文献共计15篇，均为国外文献。涉及子宫移植后在移植子宫内临床妊娠，并成功分娩活产儿的受者共计12例，分娩活产儿共计12例。②受者一般临床资料：66.7%(8/12)受者在瑞典接受子宫移植，并成功分娩活产儿。90.9%(10/11)受者接受子宫移植的原因为苗勒管发育不全(MRKH)综合征。58.3%(7/12)受者接受子宫移植的子宫供体，来源于与其有血缘关系的供者。91.7%(11/12)受者采取活体供体子宫移植，1例为死亡供体子宫移植。本组12例子宫移植受者的受孕方式，均为体外受精-胚胎移植(IVF-ET)，并且均为单胚胎移植。在其孕期，多采用免疫抑制治疗预防移植物抗宿主反应，并采用宫颈活组织检查进行免疫监测。③受者孕期、分娩及产后情况：孕期主要的产科并发症为妊娠期高血压疾病及妊娠期肝内胆汁淤积症(ICP)。其中，10例受者分娩时的平均孕龄为34^＋孕周；12例受者采取剖宫产术分娩，并且剖宫产术中及产后24 h无大出血、死亡等严重并发症发生，75.0%(9/12)继续保留子宫，其中1例再次成功妊娠。④分娩的活产新生儿情况：12例新生儿中，11例新生儿的平均出生体重为2 497 g；12例均无出生缺陷，1例有轻度呼吸窘迫症状，其余无新生儿相关并发症发生。对8例在瑞典分娩新生儿随访至年龄为2个月至3岁，均未见明显异常。 结论子宫移植后，在移植子宫内临床妊娠，并成功分娩活产儿是可以实现的，并且受者及新生儿的预后均良好。对子宫移植受者孕期需严格按照高危妊娠积极管理。     

造血干细胞移植能治哪些病

造血干细胞是血液和免疫系统的起始细胞,CD34是造血干/组细胞表面的标记抗原.造血干细胞移植是指将供者的造血干细胞取出体外作为移植物,然后回输移植给经过预处理的受者,重建受者的造血和免疫系统,通过移植物抗白血病或抗肿瘤作用,达到治愈某些疾病的方法.     

Current nutrition practices in adult lung transplantation.

Nutrition therapy is vital to the overall management of lung transplant recipients. The objective of this review is to outline the current applications of pre- and posttransplant nutrition management of the adult lung transplant recipient. Pretransplant nutrition therapy decisions are based on cause of end-stage lung disease, transplant indications, and pretransplant nutritional status. Maintaining adequate nutrient stores is the major goal of nutrition therapy for patients awaiting transplantation. In the posttransplant course, several gastrointestinal (GI) complications such as gastroesophageal reflux, gastroparesis, and distal intestinal obstruction syndrome complicate nutritional recovery. Long-term nutrition therapy for lung transplant recipients is aimed at management of common comorbid conditions such as obesity, diabetes mellitus, hypertension, osteoporosis, and hyperlipidemia. Lung transplantation outcomes are steadily improving; however, much has yet to be explored to improve the nutrition management of these patients in both the pre- and posttransplantation course.     

Liver transplant and hepatitis C in methadone maintenance therapy: a case report

Methadone maintenance therapy for the treatment of opioid dependence continues to carry a social stigma. Until recently, patients on methadone were not considered for liver transplantation. We describe the first case of a patient on methadone who received a liver transplant for end stage liver disease and was successfully treated for recurrent hepatitis C. More than five years post transplant and three years post viral clearance, the patient continues to do well and is stable on low-dose methadone. This case emphasizes the need to reconsider the non-evidence based policy adopted by transplant centers that require methadone maintenance therapy patients to stop methadone prior to consideration for transplant evaluation.     

Pre and Post Operative Occupational Therapy for a Toe to Hand Transplantation

Thumb loss is a significant disability for the hand. This paper describes a traumatic thumb injury and amputation after which the occupational therapist placed an orthotic device to substitute for the thumb. When the patient was undecided about a proposed toe-to-hand transplant, the occupational therapist fabricated a mold of the toe, and attached it to the patient's hand. After training with the mold, the patient was ready to accept the toe-to-hand transplant. The post transplant occupational therapy program and patient's return to work was described.     

Hospitalizations for cytomegalovirus disease after renal transplantation in the United States

PURPOSE: Risk factors, sites, and mortality of hospitalized cytomegalovirus (CMV) disease in renal transplant recipients have not been studied in a national population. METHODS: Therefore, 33,479 renal transplant recipients in the United States Renal Data System from 1 July 1, 1994 to June 30, 1997 were analyzed in an historical cohort study of patients with a primary discharge diagnosis of CMV disease (ICD9 Code 078.5x). RESULTS: Renal transplant recipients had an incidence density of hospitalized CMV disease of 1.26/100 person years, and 79% of hospitalizations for CMV disease occurred in the first six months post transplant. The leading manifestation of hospitalized infection was pneumonia (17%). In logistic regression analysis controlling for transplant era, pre-transplant dialysis > or = 6 months, maintenance mycophenolate mofetil (MMF) therapy, and allograft rejection, but not induction antibody therapy, were significantly associated with hospitalized CMV disease. Compared with recipients with negative CMV serology (R-) who had donor kidneys with negative CMV serology (D-), D+/R- had the highest risk of hospitalization for CMV disease [adjusted odds ratio (AOR) 5.19, 95% confidence interval (CI) 3.89-6.93] followed by D+/R+ recipients, whereas D-/R+ were not at significantly increased risk. In Cox Regression analysis the relative risk of death associated with hospitalized CMV disease was 1.32 (95% CI 1.02-1.71). CONCLUSIONS: Even in modern era, renal transplant recipients were at high risk for hospitalizations for CMV disease, which were associated with decreased patient survival. Current prophylactic measures have apparently not reduced the high risk of D+/R- recipients. Prolonged pre-transplant dialysis and maintenance MMF should also be considered risk factors for hospitalized CMV infection, and prospective trials of prophylactic antiviral therapy should be performed in these subgroups.     

Nutrition management of small bowel transplant patients.

Nutrition therapy after small bowel or combined liver/small bowel transplantation is challenging. The objective is to restore enteral autonomy to a patient with a complex past surgical history and equally complex posttransplant immunosuppressive regimen in the context of a newly created surgical anatomy. Improved surgical techniques and immunosuppressive regimens have led to superior outcomes. Accompanying these advances is a range of nutrition issues that require specific management strategies. This review outlines the current clinical practice and decision making used to create individualized nutrition regimens for small bowel or combined liver/small bowel transplant recipients. Successful small bowel transplant outcomes require a coordinated effort from a transplant team to restore nutritional autonomy to transplant recipients and free them from parenteral nutrition.     

How can we achieve global equity in provision of renal replacement therapy?

There is a significant emerging burden of chronic and end-stage kidney disease in low- and middle-income countries, driven by population ageing and the global epidemic of type 2 diabetes. Sufferers of end-stage kidney disease require ongoing dialysis or kidney transplantation to survive; however, in many low- and middle-income countries, treatment options are strictly limited or unaffordable. Low numbers of maintenance dialysis patients and transplant recipients reflect profound economic and service provision challenges for health-care systems in low- and middle-income countries in sustaining renal replacement therapy programmes. Underdeveloped organ donor and transplant programmes, health system and financing issues, ethical regulation of transplantation and the cost of pharmaceuticals commonly pose additional barriers to the delivery of efficient and cost-effective renal replacement therapy. Development of locally appropriate transplant programmes, effective use of nongovernmental sources of funding, service planning and cost containment, use of generic drugs and local manufacture of dialysis consumables have the potential to make life-saving renal replacement therapy available to many more in need. Select low- and middle-income countries demonstrate more equitable provision of renal replacement therapy is possible outside high-income countries. For other low- and middle-income countries, education, the development of good public policy and a supportive international environment are critical. Prevention of end-stage kidney disease, ideally as part of an integrated approach to chronic vascular diseases, must also be a key objective.     

Selection of congestive heart failure patients for heart transplant

Heart failure is one of the most common causes of hospitalization in adult patients. With the recent technological advances and the use of new medications for controlling rejection, heart transplant has been established as a definite therapeutic measure for properly selected patients with advanced congestive heart failure. As there is an active transplant program in the Cardiovascular Center of Puerto Rico and the Caribbean, this review is intended to acquaint the practicing physician with the required work up and management of patients referred for cardiac transplant. Emphasis is given to indications, clinical and psychosocial evaluation, optimization of medical therapy and to the absolute and relative contraindications.     

Kidney transplant

The kidney transplant is the therapy of choice for the majority of the causes of chronic terminal kidney insufficiency, because it improves the quality of life and survival in comparison with dialysis. A kidney transplant from a live donor is an excellent alternative for the young patient in a state of pre-dialysis because it offers the best results. Immunosuppressive treatment must be individualised, seeking immunosuppressive synergy and the best safety profile, and must be adapted to the different stages of the kidney transplant. In the follow-up to the kidney transplant, cardiovascular risk factors and tumours must be especially taken into account, given that the death of the patient with a working graft is the second cause of loss of the graft following the first year of the transplant. The altered function of the graft is a factor of independent cardiovascular mortality that will require follow-up and the control of all its complications to postpone the entrance in dialysis.