器官移植中的适应现象

适应现象是目前器官移植研究中的一个热点,本文综述了器官移植中适应的动物模型、适应现象产生的机制,并对其应用前景提出展望.     

器官移植免疫耐受研究概况

器官移植的长期存活至今仍面临宿主免疫排斥所致的移植物功能丧失.临床上抗排斥治疗价格昂贵并存在明显的毒副作用.诱导宿主产生对移植器官的特异性免疫耐受是人们长期追求的目标.本文就器官移植的免疫耐受最新进展作一综述.     

器官移植进展:2000年国际器官移植会议述评

由于移植免疫学的进展及新型免疫抑制剂的不断问世,近年来器官移植获得了长足进步.至1999年底全世界已施行器官移植720 099例次.其中以肾移植最多,达473 597例次.     

器官移植中细胞因子网络的调控

ＴＨ１／ＴＨ２模式已不能反映体内ＣＫ网络的复杂性。在器官移植中，存在免疫调节的ＣＫ网络，但任何特异性针对某一种或一部分ＣＫ采取的措施来进行免疫调节，是比较困难的。移植耐受存在于多层水平如转录免疫倾斜，无反应性，凋亡等。     

器官移植后的嵌合现象与免疫耐受

器官移植后，供者骨髓来源的细胞从器官中释出，在受者体内迁移并长期存活，形成所谓的嵌合现象，各种不同器官移植后均可发现此现象，嵌合与供者特异性免疫耐受的诱导有关，但两者并无必然的联系。     

网上医疗和医院网站建设

随着我国INTERNET的发展,目前很多大中型医院都建立了自己的网站,这些网站主要是以介绍、宣传医院为主题,着重于文字和图片的宣传,访问量都不理想,国外1996年之前就开始了医疗网站的建设,利用INTERNET新技术（如WEBPHONE）在网上进行有偿的在线医疗咨询服务,并可以开具处方,形成了WWW网上医疗的新概念,在我国,目前具有网上咨询医疗服务的医院网站较砂,只有一些综合性医学网站,其实从医院具备的资源来讲,医院是最有条件来进行此项服务的,但因医院网站策划的基点没有考虑到这一层,医院管理者的意识尚不能达到这一戚,导致目前我国医院网站尚不能很好地开展此项服务,最后,介绍了广州市肿瘤医院网站建设的一些具体情况。     

器官移植中细胞因子网络的调控

ＴＨ１／ＴＨ２模式已不能反映体内ＣＫ网络的复杂性。在器官移植中,存在免疫调节的ＣＫ网络,但任何特异性针对某一种或一部分ＣＫ采取的措施来进行免疫调节,是比较困难的。移植耐受存在于多层水平如转录免疫倾斜,无反应性,凋亡等。     

器官移植中的基因治疗

基因治疗是解决器官移植排斥一个很有潜力的方案，而且有着独特的优点。器官移植是把一个个体的组织或器官切取下来移植给另一个个体，这就为我们提供了一个在体外使用转基因载体改造供体器官或组织的时机。这样就可以在局部表达免疫移植抑制分子，让受者免于全身使用免疫抑制剂，而且有望达到抗原特异性耐受的状态。现就有关内容综述如下。     

器官移植免疫抑制剂应用现状及其发展趋势

器官移植的发展取得了令人瞩目的成绩,除了外科技术的日臻成熟外,更为有效、安全的新型免疫抑制剂的不断推出及临床应用起了重要作用。由于移植免疫耐受机制未能弄清,器官克隆,干细胞移植(从细胞→组织→器官→临床应用)到移植临床实际应用尚需经历漫长的道路,因此,21世纪最初的10～15年,器官移植领域依然是免疫抑制为主的时代,但免疫抑制的发展引入了新概念,新趋势。新一代免疫抑制剂使早期移植器官失功的危险性降到最低限度,但同种肾移植长期存活的改善并不乐观。慢性移植肾失功已经成为影响肾脏移植长期存活的最主要因素。此外,移植受者的感染,心血管疾病,免疫抑制剂尤其是calcineurin抑制剂长期应用造成的肝,肾毒性,移植肾血移植肾血管病变及肝功能严重受损,移植后恶性肿瘤的发生等诸多问题,给免疫抑制剂的调控提出了新的课题及要求。未来免疫抑制剂研究与应用的趋势:(1)免疫抑制须建立在对免疫应答的充分理解基础上;(2)尽管许多新型免疫抑制剂在细胞内靶分子作用点的不断完善能产生淋巴细胞特异性免疫抑制作用,而无特异的毒副作用,但免疫抑制的最终目的依然是应当诱导产生/建立供者特异性耐受状态;(3)新型免疫抑制剂应同时保留宿主对病毒、真菌、肿瘤等抗原的免疫反应功能。皮质激素撤除,CNIs的减?     

CD13介导器官移植受者CMV感染的作用

预防ＣＭＶ感染对移植患者具有重要意义，但目前尚无公认的预防性给药方案。为此，采用免疫分子对器官移植患者ＣＭＶ感染的防治，特别是应用ＣＤ１３介导器官移植受者的ＣＭＶ感染的作用颇值得深入研究。     

建立器官移植随访系统提高临床资料管理水平

器官移植随访系统是针对专科疾病特点的特殊数据管理系统,作为医院管理系统的补充,协助医师分析判断、做出正确决策。通过建立《通用器官移植管理系统》,实现了：与医院管理系统数据接口,自动采集数据;全面收纳所有检验数据;内建数据挖掘工具,协助从海量数据中提取有用部分,进行临床科研工作。该系统的应用提高了我院器官移植患者临床资料管理水平。     

利用ASPmaker快速开发中国透析移植学会（CDTA）网站

以中国透析移植学会网站开发过程为例，介绍利用ASPmaker快速开发基于ASP技术医学网站的方法。ASPmaker的应用，不仅加快了ASP网站开发过程，而且降低了技术难度，使广大医务工作者也能参与医学网站的开发建设。     

Analysis of Factors Affecting Emergency Physicians’ Attitudes toward Deceased Organ & Tissue Donation

BackgroundThis study aimed to investigate differences in knowledge, and attitudes toward deceased organ and tissue donation of emergency physicians. Additionally, we analyzed factors affecting the attitudes toward deceased organ and tissue donation.MethodsWe conducted a survey of specialists and residents registered with the Korean Society of Emergency Medicine in December 2020. The respondents’ sex, age, position, personal registration for organ donation, experience of soliciting organ donation, participation in related education, knowledge, and attitude about brain death organ donation, and attitude toward stopping life-sustaining treatments were investigated. According to the characteristics of the respondents (specialists or residents, experience and education on organ and tissue donation), their knowledge and attitude toward deceased organ donation were compared. Stepwise hierarchical multiple regression analysis was used to investigate the factors affecting the attitudes toward deceased organ and tissue donation.ResultsOf the total 428 respondents, there were 292 emergency medicine specialists and 136 medical residents. Specialists and those who registered or wished to donate organs had higher knowledge and attitude scores regarding deceased organ and tissue donation. Those who had experience recommending organ and tissue donation more than 6 times had higher knowledge scores on deceased organ and tissue donation and higher overall scores in attitude. Those who received education from the Korean Organ Donation Agency had higher knowledge scores. Specialists, and those who wished to donate or had registered as organ donors and had a higher life-sustaining treatment attitude score and knowledge about deceased organ and tissue donation, had more positive attitudes toward deceased organ and tissue donation.ConclusionFor more potential deceased organ and tissue donors to be referred for donation, there should be continuous education for emergency physicians on brain-dead organ and tissue donation-related knowledge and procedures. In addition, institutional or systematic improvements that can lead to organ donation when deciding on the withdrawal of life-sustaining treatment should be considered.     

Performance Changes Following the Revision of Organ Allocation System of Lung Transplant: Analysis of Korean Network for Organ Sharing Data

BackgroundThere is currently a lack of data on the impact of the recent revision of the domestic lung allocation system on transplant performance.MethodsWe conducted a retrospective analysis of transplant candidates and transplant patients registered in Korean Network for Organ Sharing between July 2015 and July 2019. Study periods were classified according to the introduction of the revised lung allocation system as follows: period 1 from July 2015 to June 2017 and period 2 from August 2017 to July 2019.ResultsDuring the study period, a total of 627 patients were on the waiting list, of which 398 lung transplantations were performed. Total waiting list size increased by 98.6%, from 210 in period 1 to 417 in period 2. The number of transplant patients also increased by 32.7%, from 171 in period 1 to 227 in period 2. The number of donors decreased from 1,042 to 878, whereas the usage rate, i.e., the number of lung donors used for transplantation among the total number of reported lung donors, increased from 16.4% to 25.9%. The proportion of patients with high urgent status at transplantation increased from 45% to 60.4%, whereas those with urgent status decreased from 46.8% to 35.7% (P = 0.006). The use of marginal donor lungs increased from 29.8% to 53.7% (P < 0.001). To adjust urgency status and marginal donor usage between two groups, we conducted a propensity score matching analysis. No significant differences were detected in 1-year survival rates between the two periods after propensity score matching. As well, no significant difference was observed in mortality on the waiting list between the two periods.ConclusionThe recent revision of the lung allocation system in Korea did not change the performance of lung transplant in terms of waiting list mortality and 1-year survival. The rapid increase in the volume of waiting list between the two periods increased the waiting time, transplantation of high-urgency patients, and use of marginal lung donors.     

有机磷中毒供肾移植的效果评价

BACKGROUND: Delayed graft function (DGF) occurs frequently in kidney transplants from donation after cardiac death if creatinine level is high in kidney recipients. OBJECTIVE: To analyze the clinical effects of renal transplantation with kidneys from donors dying of cardiac death in organophosphate poisoning. METHODS: Data were collected from kidney transplants from two donors dying of cardiac death in organophosphate poisoning. After some donor maintenance, donor organ were obtained and perfused with impulse type machine. Recipients were treated with intervention of immunity induction, anti-rejection drugs and infection prevention drugs during and after renal transplantation. Pathological data of donor kidney zero needle biopsy, DGF after kidney transplantation, complication rate (such as acute rejection), renal allograft recovery situation, the survival rate of recipients and kidney transplants were collected and analyzed. RESULTS AND CONCLUSION: Needle biopsy results from four donor kidneys showed that glomerular morphology was normal, but there were edema and degeneration in kidney tubules in some degree. Donor DGF rate was 75% (3/4), acute rejection rate was 0% (0/4), perioperative period donor kidney and recipient survival rate were 100% (4/4). All recipients showed a good result of transplanted kidney, their creatinine and urea nitrogen were at low level, and had no proteinuria. One recipient died of severe pulmonary infection 4 months after surgery. For some organophosphate poisoning donors dying of cardiac death, donor kidney quality can be improved by suitable donor maintenance and high-quality donor kidney preservation using machine perfusion. Kidney transplants from donors dying of cardiac death in organophosphate poisoning who receive the maintenance of organ function may be a promising candidate for renal transplantation due to a severe lack of kidney donor sources. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Heart transplantation in pediatric patients: twelve-year experience of the Asan Medical Center

Heart transplantation is a standard treatment for end-stage heart disease. Pediatric heart transplantation, however, is not frequently performed due to the shortage of pediatric heart donors. This is the first report of pediatric heart transplantation in Korea. Our retrospective study included 37 patients younger than 18 yr of age who underwent heart transplantation at Asan Medical Center between August 1997 and April 2009. Preoperative diagnosis was either cardiomyopathy (n = 29, 78.3%) or congenital heart disease (n = 8, 22.7%). Mean follow up period was 56.9 ± 44.6 months. There were no early death, but 7 late deaths (7/37, 18.9%) due to rejection after 11, 15, 41 months (n = 3), infection after 5, 8, 10 months (n = 3), suspicious ventricular arrhythmia after 50 months (n = 1). There was no significant risk factor for survival. There were 25 rejections (25/37, 67.6%); less than grade II occurred in 17 patients (17/25, 68%) and more than grade II occurred in 8 patients (8/25, 32%). Actuarial 1, 5, and 10 yr survival was 88.6%, 76.8%, and 76.8%. Our midterm survival of pediatric heart transplantation showed excellent results. We hope this result could be an encouraging message to do more pediatric heart transplantation in Korean society.     

低温机械灌注与单纯冷保存供肾对肾移植预后影响的Meta分析

背景：目前,国内外低温机械灌注与冷保存对肾移植预后影响的文章比较多,但结论各异,且由于大多单个研究样本量存在局限,对低温机械灌注的优缺点缺乏客观评价。 目的：比较低温机械灌注与冷保存对肾移植预后的影响。 方法：计算机检索PubMed、sinoMed、EMbase、Web of Science、the Cochrane Central Register of Controlled Trials (CENTRAL)、万方数据库及中国知网,查找并筛选出所有比较低温机械灌注与冷保存对肾移植预后影响的随机对照试验(Randomized Controlled Trial,RCT),同时手检纳入文献的参考文献,检索时限均为建库至2015年3月4日。按纳入排除标准由2位评价者独立进行RCT的筛选、资料提取和质量评价后,采用RevMan(5.3.0版)软件进行Meta分析,并采用GRADEpro3.6软件进行证据质量评价。 结果与结论：共纳入文献6篇,低温机械灌注保存供肾共619例,冷保存保存供肾共620例。结果显示：低温机械灌注组原发性移植物无功能发生率、功能性移植肾功能延迟恢复发生率、移植肾功能延迟恢复发生率均显著低于冷保存组(P < 0.05或0.01)。患者1年生存率、移植物1年存活率差异均无显著性意义(P > 0.05)。结果表明低温机械灌注保存供体只能降低肾移植后近期并发症的发生率,维护肾脏功能,但无法提高患者1年生存率和移植物1年存活率,相比较冷保存的保存方式,低温机械灌注对供体器官的保护无长期优势。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

公民逝世后器官捐献合并AKI供体肾移植的疗效观察

目的 探讨公民逝世后器官捐献（DCD）合并急性肾损伤（AKI）供体肾移植的临床疗效。方法 回顾性分析2015年1月~2017年11月我院纳入的DCD 42例,其中合并AKI供体13例,非AKI供体29例,比较两组供者、受者一般资料、两组受者术后指标及并发症发生率。结果 本研究共13例AKI供体,其中标准供体7例,扩大标准供体6例;对照组29例非AKI供体,标准供体28例,扩大标准供体1例。两组供体年龄、性别、死亡原因、初始Scr及热缺血时间比较,差异无统计学意义（P＞0.05）;AKI组EDC供体占比、获取前Scr水平均高于对照组,差异有统计学意义（P＜0.05）。AKI组中13例AKI供体行肾移植24例,对照组29例非AKI供体行肾移植56例。两组受者年龄、性别、体重指数、人类白细胞抗原错配数、群体反应性抗体＞10%、冷缺血时间、灌注流量、灌注阻力指数比较,差异无统计学意义（P＞0.05）;AKI组肾脏机械灌注占比高与对照组,差异有统计学意义（P＜0.05）。AKI组受者DGF发生率、DGF天数、住院时间,术后1周、1月Scr水平均高于对照组,差异有统计学意义（P＜0.05）;两组术后1年Scr水平、术后1年肾小球滤过率、术后1年移植肾存活率及术后1年患者存活率比较,差异无统计学意义（P＞0.05）。AKI组并发症总发生率为37.50%,高于对照组的12.50%,差异有统计学意义（P＜0.05）。结论 DCD合并AKI的供体肾移植受者能获得较好的疗效,可作为扩大供体池的一种选择。