记忆性CD4+T淋巴细胞对小鼠腹腔移植心脏排斥反应的影响

目的 探讨记忆性CD4+T淋巴细胞对来自同一抗原特异性移植心脏急性排斥反应的影响.方法 将C57BL/6小鼠的皮肤移植给Balb/c小鼠,使其致敏,3个月后,取受者的脾脏,应用小鼠记忆性CD4+T淋巴细胞纯化试剂盒纯化记忆性CD4+T淋巴细胞.同时取未进行皮肤移植的Balb/c小鼠,同法获取非致敏CD4+T淋巴细胞.以C57BL/6小鼠为供者,正常Balb/c小鼠为受者,行腹腔心脏移植,移植前3周,实验组受者经阴茎背静脉注射记忆性CD4+T淋巴细胞;非致敏对照组受者经阴茎背静脉注射非致敏CD4+T淋巴细胞;空白对照组不注射任何T淋巴细胞.各组均于移植前1 d、移植当天及移植后1 d给予环孢素A.术后记录移植心脏存活时间;取移植心脏,进行病理学观察.结果 实验组、非致敏对照组和空白对照组移植心脏存活时间分别为(8.5±1.5)d、(25.7±5.5)d和(21.2±9.2)d,实验组明显短于另两组(P<0.05).移植心脏急性排斥反应的病理学分级,实验组为3.43±0.68,非致敏对照组为1.29±0.46,空白对照组为1.31±0.49,实验组病理学分级明显高于非致敏对照组和空白对照组(P<(0.05).结论 当记忆性CIN+T淋巴细胞再次接触同一抗原特异性的移植心脏时,可促进急性排斥反应的发生,且对常规剂量的环孢素A不敏感.     

RANTES在CD4+Tm细胞介导小鼠心脏移植急性排斥反应中的表达及意义

目的 探讨趋化因子RANTES在CD4+记忆性T淋巴细胞(Tm细胞)介导的小鼠心脏移植急性排斥反应中表达的变化及意义.方法 以Balb/c小鼠为供鼠,C57BL/6小鼠为受鼠,进行皮肤移植,提取并纯化受鼠脾脏中的CD4+ Tm细胞.分为两组进行实验:实验组,C57BL/6小鼠输注1×106个CD4+ Tm细胞,第2天以Balb/c小鼠为供鼠,进行颈部异位心脏移植;对照组,C57BL/6小鼠未输注CD4 Tm细胞,直接进行心脏移植.观察两组移植心脏存活时间和组织病理学改变,检测移植物中RANTES基因的相对表达量及RANTES在受鼠血清中的浓度.结果 皮肤移植受鼠脾脏中CD4+ Tm细胞达到26.83％.对照组受鼠存活时间为(7.67±0.21)d,实验组为(5.17±0.17) d(P＜0.01).对照组移植心脏急性排斥反应的评级为(2.67±0.14)级,实验组为(3.92±0.08)级(P＜0.01).实验组移植心脏中RANTES基因的相对表达量为对照组的(2.6±0.21)倍(P＜0.01).实验组血清中RANTES浓度为(223.6±16.79) pg/ml,对照组为(120.7±9.47) pg/ml(P＜0.01).结论 接受CD4+ Tm细胞输注的心脏移植受鼠,其体内RANTES的表达量明显增加,加速了急性排斥反应的发生.     

地西他滨诱导体内Foxp3基因表达上调延长心脏移植小鼠的存活时间

目的 探讨甲基转移酶抑制剂地西他滨诱导体内叉状头螺旋转录因子(Foxp3)基因表达延长同种心脏移植小鼠存活时间的作用及其机制.方法 以经丝裂霉素处理的Balb/c小鼠和C57BL/6小鼠脾细胞作为刺激细胞,未经丝裂霉素处理的C57BL/6小鼠脾细胞作为反应细胞,进行体外单向混合淋巴细胞培养,观察地西他滨对培养体系中CD4+CD25+调节性T淋巴细胞(Treg细胞)比例的影响.分别以Balb/c小鼠和C57BL/6小鼠作为供、受者,建立同种小鼠腹部异位心脏移植模型.实验组受鼠术后1～3 d经尾静脉注射地西他滨(1.5 mg/kg),同种对照组受鼠术后1～3 d经尾静脉注射等体积生理盐水.监测两组移植心存活时间,检测受鼠外周血CD4+ CD25+ Treg细胞比例及Foxp3 mRNA的表达,观察移植心组织病理学变化.结果 地西他滨能够上调体外同种混合淋巴细胞反应体系中CD4+ CD25+Treg细胞的水平.同种对照组和实验组移植心脏中位存活时间分别为7和11d,实验组较对照组明显延长(P＜0.01).与同种对照组相比,实验组CD4+ CD25+ Treg细胞比例和Foxp3 mRNA的表达均明显升高(P＜0.01);移植心肌炎症细胞浸润的程度明显减轻.结论 地西他滨能够诱导同种心脏移植小鼠体内Foxp3基因的表达,从而明显减轻急性排斥反应,延长移植心存活时间,其机制可能与Foxp3表达能够诱导CD4+ CD25+ Foxp3+ Treg细胞的增殖和分化密切相关.     

CXC趋化因子受体6在小鼠心脏移植排斥反应中的表达及意义

目的 研究CXC趋化因子受体6(CXCR6)在同种异体小鼠心脏移植中的表达及CXC趋化因子配体16(CXCL16)与CXCR6相互作用对移植物存活时间的影响.方法 以野生型Balb/c小鼠(H-2d)为供者(同种移植组),或以野生型C57BL/6小鼠(H-2b)为供者(同系移植组),以野生型C57BL/6小鼠为受者分别行小鼠腹腔异位心脏移植.测定同系和同种移植组小鼠移植心脏CXCR6mRNA的表达,并测定受者脾脏CD8+T淋巴细胞CXCR6的表达.另制作小鼠同种异位心脏移植模型(Balb/c小鼠为供者,C57BL/6小鼠为受者),将其分为实验组和对照组,实验组受者移植当天至发生排斥反应时腹腔注射抗CXCL16抗体,对照组受者同期注射对照抗体.记录两组移植心脏存活时间.进行CD8+T淋巴细胞的细胞毒试验,即用Balb/c小鼠脾细胞免疫C57BL/6小鼠后,获取C57BL/6小鼠脾脏CD8+T淋巴细胞,将Balb/c小鼠脾细胞与C57BL/6小鼠CD8+T淋巴细胞混合培养,分别加入抗CXCL16抗体、小鼠IgG(对照抗体)和抗CD40L抗体.结果 同种移植组移植心脏中CXCR6 mRNA的表达以及脾脏CD8+T淋巴细胞上CXCR6的表达均高于同系移植组和正常对照组.抗CXCL16抗体对CD8+T淋巴细胞的细胞毒活性无影响.与对照组相比较,实验组小鼠移植心脏存活时间并未明显延长.结论 小鼠心脏移植排斥反应中CD8+T淋巴细胞CXCR6的表达上升,阻断CXCL16/CXCR6相互作用并不能延长移植心脏的存活时间.     

CXC趋化因子受体6在小鼠心脏移植排斥反应中的表达及意义

目的 研究CXC趋化因子受体6(CXCR6)在同种异体小鼠心脏移植中的表达及CXC趋化因子配体16(CXCL16)与CXCR6相互作用对移植物存活时间的影响.方法 以野生型Balb/c小鼠(H-2d)为供者(同种移植组),或以野生型C57BL/6小鼠(H-2b)为供者(同系移植组),以野生型C57BL/6小鼠为受者分别行小鼠腹腔异位心脏移植.测定同系和同种移植组小鼠移植心脏CXCR6mRNA的表达,并测定受者脾脏CD8+T淋巴细胞CXCR6的表达.另制作小鼠同种异位心脏移植模型(Balb/c小鼠为供者,C57BL/6小鼠为受者),将其分为实验组和对照组,实验组受者移植当天至发生排斥反应时腹腔注射抗CXCL16抗体,对照组受者同期注射对照抗体.记录两组移植心脏存活时间.进行CD8+T淋巴细胞的细胞毒试验,即用Balb/c小鼠脾细胞免疫C57BL/6小鼠后,获取C57BL/6小鼠脾脏CD8+T淋巴细胞,将Balb/c小鼠脾细胞与C57BL/6小鼠CD8+T淋巴细胞混合培养,分别加入抗CXCL16抗体、小鼠IgG(对照抗体)和抗CD40L抗体.结果 同种移植组移植心脏中CXCR6 mRNA的表达以及脾脏CD8+T淋巴细胞上CXCR6的表达均高于同系移植组和正常对照组.抗CXCL16抗体对CD8+T淋巴细胞的细胞毒活性无影响.与对照组相比较,实验组小鼠移植心脏存活时间并未明显延长.结论 小鼠心脏移植排斥反应中CD8+T淋巴细胞CXCR6的表达上升,阻断CXCL16/CXCR6相互作用并不能延长移植心脏的存活时间.     

CXC趋化因子受体6在小鼠心脏移植排斥反应中的表达及意义

目的 研究CXC趋化因子受体6(CXCR6)在同种异体小鼠心脏移植中的表达及CXC趋化因子配体16(CXCL16)与CXCR6相互作用对移植物存活时间的影响.方法 以野生型Balb/c小鼠(H-2d)为供者(同种移植组),或以野生型C57BL/6小鼠(H-2b)为供者(同系移植组),以野生型C57BL/6小鼠为受者分别行小鼠腹腔异位心脏移植.测定同系和同种移植组小鼠移植心脏CXCR6mRNA的表达,并测定受者脾脏CD8+T淋巴细胞CXCR6的表达.另制作小鼠同种异位心脏移植模型(Balb/c小鼠为供者,C57BL/6小鼠为受者),将其分为实验组和对照组,实验组受者移植当天至发生排斥反应时腹腔注射抗CXCL16抗体,对照组受者同期注射对照抗体.记录两组移植心脏存活时间.进行CD8+T淋巴细胞的细胞毒试验,即用Balb/c小鼠脾细胞免疫C57BL/6小鼠后,获取C57BL/6小鼠脾脏CD8+T淋巴细胞,将Balb/c小鼠脾细胞与C57BL/6小鼠CD8+T淋巴细胞混合培养,分别加入抗CXCL16抗体、小鼠IgG(对照抗体)和抗CD40L抗体.结果 同种移植组移植心脏中CXCR6 mRNA的表达以及脾脏CD8+T淋巴细胞上CXCR6的表达均高于同系移植组和正常对照组.抗CXCL16抗体对CD8+T淋巴细胞的细胞毒活性无影响.与对照组相比较,实验组小鼠移植心脏存活时间并未明显延长.结论 小鼠心脏移植排斥反应中CD8+T淋巴细胞CXCR6的表达上升,阻断CXCL16/CXCR6相互作用并不能延长移植心脏的存活时间.     

门静脉输注供者脾细胞诱导的供者特异性免疫低反应性

目的 探讨经门静脉输注供者脾细胞能否诱导皮肤移植小鼠产生供者特异性的免疫低反应性及其可能机制.方法 取Balb/c小鼠,随机分为空白对照组(经小鼠门静脉输注RPMI 1640培养液)、受者脾细胞组(经小鼠门静脉输注Balb/c小鼠脾细胞)、供者脾细胞组(经小鼠门静脉输注C57BL/6小鼠脾细胞)、空白移植对照组(经小鼠门静脉输注RPMI 1640培养液,7 d后移植C57BL/6小鼠的皮肤)、实验对照组(经小鼠门静脉输注Balb/c小鼠脾细胞,7 d后移植C57BL/6小鼠的皮肤)、实验组(经小鼠门静脉输注C57BL/6小鼠脾细胞,7 d后移植C57BL/6小鼠的皮肤)以及第三方移植组(经小鼠门静脉输注C57BL/6小鼠脾细胞,7 d后移植C3H小鼠的皮肤).记录空白移植对照组、实验对照组、实验组和第三方移植组移植皮肤的存活时间,并观察移植皮肤的病理学变化;脾细胞输注后7 d,分别获取空白对照组、受者脾细胞组和供者脾细胞组小鼠的外周血、脾脏和肝脏,用流式细胞仪测定样本中CD4+CD25+Foxp3+调节性T淋巴细胞(CD4+CD25+Foxp3+Treg细胞)的比例.结果 实验组移植皮肤的存活时间为(19.8±4.6)d,明显长于空白移植对照组、实验对照组和第三方移植组,但仍未达到长期存活.皮肤移植后7 d,空白移植对照组和实验对照组的移植皮肤呈现重度急性排斥反应的病理学改变,而实验组移植皮肤呈现中度急性排斥反应的病理学改变.供者脾细胞组外周血、肝脏和脾脏中CD4+CD25+Foxp3+Treg细胞比例明显高于空白对照组和受者脾细胞组.结论 门静脉输注供者脾细胞可特异性地延长供者皮肤移植物的存活时间,减轻移植物的排斥反应,该效应可能与受者体内的CD4+CD25+Foxp3+Treg细胞增加有关.     

抗CD8单抗与抗CD40L单抗联合应用对小鼠心脏移植后慢性排斥反应的影响

目的 探讨干预慢性迟发性超敏反应（DTH）与CD8^＋T淋巴细胞的细胞毒等效应机制对同种小鼠心脏移植后慢性排斥反应的影响。方法 建立小鼠颈部异位心脏移植模型，实验组以BALB／c小鼠为供者，C57BL／6小鼠为受者，术后0、2、6及14d腹腔注射抗CD8单克隆抗体（抗CD8单抗）200μg／d，术后0、2及4d腹腔注射抗CD40L单克隆抗体（抗CD40L单抗）250μg／d；同系移植对照组供、受者均为BALB／C小鼠，术后同期腹腔注射等量生理盐水；同种移植对照组以BALWc小鼠为供者，C57BL／6小鼠为受者，术后不使用上述单抗。观察各组移植心的存活时间及移植心组织病理学变化。结果同种移植对照组移植心的平均存活时间为7．3d；实验组与同系移植对照组移植心的存活时间均超过60d。同种移植对照组移植心呈典型急性排斥反应病理学改变；同系移植对照组移植心组织未见明显病理变化；实验组移植心呈现血管周围炎、间质纤维化和血管内膜增生等慢性排斥反应组织病理改变。结论 清除CD8^＋T淋巴细胞和阻断CD40／CD40L通路的处理方案虽可预防急性排斥反应，显著延长移植心的存活时间，但并不能阻止慢性排斥反应的发生。     

混合培养的供、受者骨髓细胞过继回输延长小鼠移植心脏存活时间

目的 将供、受者骨髓细胞经混合培养后过继回输,以观察其对同种异体移植心脏存活时间和受者免疫功能的影响.方法 取Balb/c小鼠和C57BL/6J小鼠的骨髓细胞,进行混合培养.配制含Balb/c小鼠和C57BL/6J小鼠脾淋巴细胞的混合淋巴细胞反应体系(MLR)以及含Balb/c小鼠和C3H小鼠脾淋巴细胞的MLR,分别加入混合培养的骨髓细胞,观察其对MLR中细胞增殖的影响.以C57BL/6J小鼠为供者,Balb/c小鼠为受者行腹腔异位心脏移植,实验分为4组:(1)移植对照组,受者仅进行心脏移植,不作其他处理;(2)实验对照组,心脏移植后给予西罗莫司灌胃;(3)实验组,移植手术结束前注射混合培养的骨髓细胞1×10~7个,术后给予西罗莫司;(4)第三方对照组,受者接受C3H小鼠的移植心脏,手术结束前注射混合培养的骨髓细胞1×10~7个,术后给予西罗莫司.记录移植心脏存活时间;移植心脏停跳当日,取受者外周血,检测CD4~+ CD25~+ T淋巴细胞的比例及供者来源的H-2K~b细胞的比例.结果 加入混合培养的骨髓细胞后,Balb/c和C57BL/6J的MLR的淋巴细胞增殖率低于Balb/c和C3H的MLR.实验组移植心脏的存活时间长于其他3组(P<0.05).实验组CD4~+CD25~+T淋巴细胞的百分率高于其他3组(P<0.05).实验组外周血中H-2K~b细胞的比例高于其他3组(P<0.05).结论 受者输注混合培养的供、受者骨髓细胞可在一定程度上调节免疫应答,延长小鼠移植心脏的存活时间,该作用具有供者抗原特异性.     

槐耳清膏在小鼠心脏移植排斥反应中作用的初步探讨

目的 探讨槐耳清膏在小鼠心脏移植急性排斥反应中的作用.方法 实验分为3组:A组:同种异基因移植后槐耳清膏处理组(槐耳清膏组);B组:同种异基因移植财照组(移植排斥组)及C组:同系移植对照组(同系移植组).观察各组移植心脏的存活时间、术后第5天供心的组织病理改变.用免疫荧光检测移植心脏中CD8+T淋巴细胞的浸润和颗粒酶B的表达水平.结果 A组移植心脏的平均存活时间为(6.38±0.69)d,与B组(8.31±0.59)d相比明显缩短(P<0.01);心肌组织呈3级急性排斥反应病理改变,CD8+T淋巴细胞弥漫性浸润及颗粒酶B表达与两个对照组相比明显增强(P<0.05).结论 在术后早期单用槐耳清音会促进小鼠心脏移植物的急性排斥反应,可能机制足促进CD8+T淋巴细胞的组织浸润并增强颗粒酶B的表达.     

Pancreas transplantation

Pancreas transplantation is now standard of care for selected patients with diabetes and end-stage renal failure or life-threatening diabetic complications. The morbidity and mortality of pancreas transplantation is higher than other transplant types, and for this reason selection criteria for both donors and recipients are more stringent. Meticulous organ retrieval technique and back-table preparation, and a standard implantation technique using enteric drainage are central to good outcomes. Modern immunosuppression has reduced acute rejection rates and lowered the need for long-term corticosteroids. Results have improved over time and recipients of a simultaneous kidney–pancreas transplant can now expect 5-year transplant survival of around 75%. The addition of a pancreas to a kidney transplant for suitable recipients has clear benefits in both length and quality of life, and there is increasing evidence that pancreatic transplantation can reduce or halt the progression of diabetic nephropathy, neuropathy, retinopathy and cardiovascular disease. In patients with normal renal function, pancreatic islet transplantation offers an alternative with reduced peri-procedural morbidity and mortality, at the expense of lower rates of long-term insulin independence.     

Pancreas transplantation

Pancreas transplantation is now standard of care for selected patients with diabetes and end-stage renal failure or life-threatening diabetic complications. The morbidity and mortality of pancreas transplantation is higher than other transplant types, and for this reason selection criteria for both donors and recipients are more stringent. Meticulous organ retrieval technique and back-table preparation, and a standard implantation technique using enteric drainage are central to good outcomes. Modern immunosuppression has reduced acute rejection rates and lowered the need for long-term corticosteroids. Results have improved over time and recipients of a simultaneous kidney-pancreas transplant can now expect 5-year transplant survival of over 75%. The addition of a pancreas to a kidney transplant for suitable recipients has clear benefits in both length and quality of life, and there is increasing evidence that pancreatic transplantation can reduce or halt the progression of diabetic nephropathy, neuropathy, retinopathy and cardiovascular disease. In patients with normal renal function, pancreatic islet transplantation offers an alternative with reduced peri-procedural morbidity and mortality, at the expense of lower rates of long-term insulin independence.     

Pancreas transplantation

Pancreas transplantation is now the standard of care for selected patients with diabetes and end-stage renal failure or life-threatening diabetic complications. The morbidity and mortality of pancreas transplantation is higher than other transplant types, and for this reason selection criteria for both donors and recipients are more stringent. Meticulous organ retrieval technique and back-table preparation, and a standard implantation technique using enteric drainage are central to good outcomes. Modern immunosuppression has reduced acute rejection rates and lowered the need for long-term corticosteroids. Results have improved over time and recipients of a simultaneous kidney–pancreas transplant can now expect 5-year transplant survival of around 75%. The addition of a pancreas to a kidney transplant for suitable recipients has clear benefits in both length and quality of life, and there is increasing evidence that pancreatic transplantation can reduce or halt the progression of diabetic nephropathy, neuropathy, retinopathy and cardiovascular disease. In patients with normal renal function, pancreatic islet transplantation offers an alternative with reduced peri-procedural morbidity and mortality, at the expense of lower rates of long-term insulin independence.     

劈离式肝移植

劈离式肝移植术是一种理想的扩大供肝利用和缓解供肝短缺矛盾的方法,可以缩短受者等待时间,降低等待期间患者病死率.劈离式肝移植与全肝移植比较,在供肝及受者选择、移植物血管分配、供肝劈分技术要点及移植物保护等方面的要求更严格,是影响劈离式肝移植效果的关键因素.随着对部分肝移植认识的加深,器官保存技术、外科技术的不断发展,并发症预防手段的进步,劈离式肝移植必将拥有更广泛的发展空间.     

Lung and heart-lung transplantation

This report is a brief summary on current events related to lung and heart-lung transplantation. Eleven patients have undergone transplantation of the heart and both lungs at Stanford University. The ages ranged from 22–45, the average age being about 36 years, and included were four females and seven males. The diagnosis was primary pulmonary hypertension in three and Eisenmenger syndrome-congenital heart disease with pulmonary hypertension-in eight. Eight patients are living and well, two to more than 24 months after transplantation of the heart and both lungs. All these patients were discharged and are fully rehabilitated, which is an important consideration. There have been three operative deaths, one was secondary to two previous operations that made our operation much too long, another was secondary to the use of intravenous cyclosporine, and the third was related to the poor maintenance of the donor lung. Three of the eleven patients were catheterized following the transplant from six months to a year after transplantation, and the pulmonary artery pressure and pulmonary vascular resistance were absolutely normal in all three of these individuals. Of course the plan is to go ahead with further catheter studies at yearly intervals in all of the patients. The last patient underwent transplantation in January, 1983. I think no matter how effective or how ingenious the medical staff is with artificial organs, it will be a long time before these early results of transplantation of the heart and both lungs can be matched by any types of artificial organ implants. Supported in part by a grant (HL 13108) from the National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, and from the Dr. Ralph and Marian Falk Foundation for Medical Research Gist of a Lecture given at the Japan Surgical Society, April 7, 1983.     

Intestinal and multivisceral transplantation

Intestinal and multivisceral transplantation represents an important treatment option for patients with intestinal failure. Early attempts were hindered by technical and immunological complications. However, significant developments in immunosuppressive therapy have led to marked improvements in outcomes in recent years. The main indications for intestinal transplantation are life-threatening complications or unacceptable quality of life on total parenteral nutrition (TPN), or following evisceration for extensive intra-abdominal tumours. In suitable patients, in the absence of significant liver disease, an isolated intestinal graft is appropriate. A combined liver and intestinal transplant is indicated in patients with significant liver disease, almost always as a result of long-term TPN. Pathology affecting the foregut may require more extensive grafts including the stomach, duodenum and pancreas. Multivisceral transplantation is technically demanding. The transplant recipient has frequently undergone multiple previous laparotomies and may present with multiple stomata, fistulae, collections, distortion of intra-abdominal anatomy and significant contraction of the abdominal cavity. The most important early complications are acute rejection and sepsis, which frequently occur together. In the long-term, chronic rejection and malignancy are the leading causes of graft loss and mortality and immunosuppression related renal impairment a major source of morbidity. It is hoped that ongoing improvements in intestinal and multivisceral transplantation may eventually justify its use as a primary alternative to long-term TPN.     

Intestinal and multivisceral transplantation

Intestinal and multivisceral transplantation represents an important treatment option for patients with intestinal failure. Early attempts were hindered by technical and immunological complications. However, significant developments in immunosuppressive therapy have led to marked improvements in outcomes in recent years. The main indications for intestinal transplantation are life-threatening complications or unacceptable quality of life on total parenteral nutrition (TPN), or following evisceration for extensive intra-abdominal tumours. In suitable patients, in the absence of significant liver disease, an isolated intestinal graft is appropriate. A combined liver and intestinal transplant is indicated in patients with significant liver disease, almost always as a result of long-term TPN. Pathology affecting the foregut may require more extensive grafts, including the stomach, duodenum and pancreas. Multivisceral transplantation is technically demanding. The transplant recipient has frequently undergone multiple previous laparotomies and may present with multiple stomata, fistulae, collections, distortion of intra-abdominal anatomy and significant contraction of the abdominal cavity. The most important early complications are acute rejection and sepsis, which frequently occur together. In the long term, chronic rejection and malignancy are the leading causes of graft loss and mortality and immunosuppression related renal impairment a major source of morbidity. It is hoped that ongoing improvements in intestinal and multivisceral transplantation may eventually justify its use as a primary alternative to long-term TPN.     

Intestinal and multivisceral transplantation

Intestinal and multivisceral transplantation represents an important treatment option for patients with intestinal failure. Early attempts were hindered by technical and immunological complications. However, significant developments in immunosuppressive therapy have led to marked improvements in outcomes in recent years. The main indications for intestinal transplantation are life-threatening complications or unacceptable quality of life on total parenteral nutrition (TPN), or following evisceration for extensive intra-abdominal tumours. In suitable patients, in the absence of significant liver disease, an isolated intestinal graft is appropriate. A combined liver and intestinal transplant is indicated in patients with significant liver disease, almost always as a result of long-term TPN. Pathology affecting the foregut may require more extensive grafts including the stomach, duodenum and pancreas. Multivisceral transplantation is technically demanding. The transplant recipient has frequently undergone multiple previous laparotomies and may present with multiple stomata, fistulae, collections, distortion of intra-abdominal anatomy and significant contraction of the abdominal cavity. The most important early complications are acute rejection and sepsis, which frequently occur together. In the long-term, chronic rejection and malignancy are the leading causes of graft loss and mortality. It is hoped that ongoing improvements in intestinal and multivisceral transplantation may eventually justify its use as a primary alternative to long-term TPN.     

中国人体器官分配与共享基本原则和肝脏与肾脏移植核心政策

一、人体器官分配与共享基本原则 （一）总则。申请人体器官移植手术患者的排序,应当符合医疗需要,遵循公平、公正和公开的原则。（二）基本原则。1．人体器官分配与共享应当符合医疗的需要。2．移植医院根据合理的医学判断,有权为其移植等待者拒绝接受不合适的器官。     

代谢组学在器官移植中的应用

代谢组学是继基因组学、转录组学和蛋白组学后出现的一种新的生物组学。代谢组学关注的是整个代谢过程中所有小分子代谢物的整体轮廓。与其他组学不同,代谢组学研究的是生物事件的终点,这一技术也许会对临床有深远的影响。尽管代谢组学尚不成熟,但在发现疾病的生物标志物研究中已经展现出巨大的潜力。本文主要从临床角度阐述代谢组学在肝移植、心脏移植和肾移植后移植器官功能和排斥反应监测中的应用。