肝移植及腹部多器官移植手术的成分输血

BACKGROUND: The liver transplantation and abdominal multiple organ transplantation are complicated surgeries, characterized by massive blood loss and high blood transfusion requirements. OBJECTIVE: To explore the characteristics of blood loss and blood transfusion in liver transplantation and abdominal multiple organ transplantation and post-operative survival rate. METHODS: Clinical data from 192 patients were retrospectively analyzed, including blood transfusion data with the first 24 hours after surgery and post-operative survival rate. RESULTS AND CONCLUSION: These 192 patients included 177 patients receiving liver transplantation,    2 patients receiving liver and kidney transplantation and 13 patients receiving abdominal multiple organ transplantation. The average intra-operative blood loss of each patient was (2 401.5±3 239.5) mL. The average infusion of red blood cells, platelet, cryoprecipitate and frozen plasma of each patient at the first 24 hours after surgery was (11.3±11.9), (0.8±0.9), (10.7±11.7) U and (2 805.5±1 393.1) mL, respectively. All kinds of blood infusion in the liver cancer group were obviously less than those in the hepatic failure group. The infusion of cryoprecipitate and frozen plasma in the cirrhosis group was obviously less than that in the hepatic failure group, but the infusion of platelet in the cirrhosis group was significantly more than that in the liver cancer group. The infusion of red blood cells from July 2013 to June 2015 was significantly less than that from July 2012 to June 2013. The blood loss, infusion of red blood cells and frozen plasma in the liver transplantation group of cirrhosis were significantly more than those in the abdominal multiple organ transplantation group of cirrhosis (all P < 0.05). In conclusion, diagnosis of liver diseases, and the maturity of surgery exert an effect on the blood loss and blood infusion. As the development of liver transplantation and abdominal multiple organ transplantation, both the blood loss and blood infusion are decreased. Besides, compared with liver transplantation, the blood loss and blood infusion show no increase in the abdominal multiple organ transplantation. 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     

阿伦和达珠单抗与抗胸腺蛋白对肾移植的有效性及安全性比较

背景：免疫抑制剂是通过影响机体的体液免疫和细胞免疫抑制机体的免疫功能来完成抗急性排斥反应,提高人/肾存活率。 目的：比较3种免疫抑制诱导剂阿伦单抗、达珠单抗和抗胸腺蛋白在肾移植免疫诱导中的有效性与安全性。 方法：运用Cochrane系统评价法,检索1966年至2011年PUBMED,EMBASE等数据库。纳入阿伦单抗、达珠单抗和抗胸腺蛋白3种药物在肾移植中的随机对照试验(RCT)进行Meta分析。 结果与结论：9个RCT的777例患者纳入分析,3种药物24个月的人/肾存活率和急性排斥发生率差异无显著性意义(均P > 0.05)。随访36个月时,阿伦单抗感染率显著低于抗胸腺蛋白(P < 0.05)。分析结果表明,3种药物的免疫诱导效果相近;随访36个月时,阿伦单抗较抗胸腺蛋白的感染率低。 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;组织工程全文链接：     

器官捐献和移植教育影响医学生认知和态度的系统评价

背景：医务工作人员在器官捐献和移植过程中发挥着重要的作用,但作为未来的医务工作人员-医学生对器官捐献和移植呈现出知识的不足和矛盾的态度。 目的：系统评价器官捐献和移植教育对医学生认知和态度的影响。 方法：检索外文数据库PubMed、WILEY ONLINE LIBRARY、ProQuest Health、Medline、EMbase、中文数据库中国知网、维普及万方数据库,全面检索对医学生进行器官捐献和移植教育的研究,纳入符合标准的文献,应用澳大利亚JBI循证卫生保健中心对随机对照试验和类实验性研究文献真实性评价的原则进行评价,以GRADE指南进行质量分级,主要评价结局指标为医学生对器官捐献和移植的认知和态度。 结果与结论：来自3个国家的8篇文献符合纳入标准,1篇为随机对照试验,质量评价为高质量;1篇类实验研究评价为高质量;5篇类实验研究质量评价为中级;1篇类实验研究质量评价为低级。6篇研究评价了教育对医学生知识水平的影响,6篇研究评价了教育对医学生态度的影响。通过系统评价得出运用教育能够提高医学生对器官捐献和移植的认知,改变对器官捐献和移植的态度。由于纳入的文献多为类试验研究,结论有待于高质量的随机对照试验进一步验证。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

肾移植后1年存活者空腹血糖变化及预后

背景：肾移植后糖尿病是移植脏器的重要代谢并发症,严重影响患者生活质量与长期生存率,是移植肾失功能、心血管疾病的危险因素。 目的：观察肾移植后存活1年以上患者空腹血糖变化规律以及对预后的影响。 方法：选取2003年1月至2013年1月接受过肾移植后来仙桃市第一人民医院就诊的患者42例,其中移植前糖尿病患者7例、空腹血糖受损组11例和空腹血糖正常患者24例,观察各组患者移植后1,7,14 d以及1,3,6,12个月空腹血糖变化,并比较各组移植后生存情况,采用Cox比例风险模型分析影响肾移植患者生存的因素。 结果与结论：糖尿病组患者移植前及移植后各时间段空腹血糖明显高于空腹血糖受损和空腹血糖正常组患者(P < 0.05),糖尿病、空腹血糖受损和空腹血糖正常组患者空腹血糖在移植后第1天均升高(P < 0.05),各组空腹血糖在移植后3个月趋于平稳;空腹血糖正常组生存率明显高于糖尿病组和空腹血糖受损组(P < 0.05)。Cox比例风险模型分析结果显示,移植前空腹血糖、年龄、移植后肿瘤和感染是肾移植患者死亡的独立危险因素,其中移植后发生肿瘤的死亡危险比最高,为2.376。结果证实,移植前糖尿病对肾移植后存活1年以上患者生存率有一定的影响,移植后糖尿病对患者生存率的无明显影响。  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     

Comparison of the Child-Turcotte-Pugh classification and the model for end-stage liver disease score as predictors of the severity of the systemic inflammatory response in patients undergoing living-donor liver transplantation

The aim of this study was to evaluate and compare the Child-Turcotte-Pugh (CTP) classification system and the model for end-stage liver disease (MELD) score in predicting the severity of the systemic inflammatory response in living-donor liver transplantation patients. Recipients of liver graft were allocated to a recipient group (n = 39) and healthy donors to a donor group (n = 42). The association between the CTP classification, the MELD scores and perioperative cytokine concentrations in the recipient group was evaluated. The pro-inflammatory cytokines measured included interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α; the anti-inflammatory cytokines measured included IL-10 and IL-4. Cytokine concentrations were quantified using sandwich enzyme-linked immunoassays. The IL-6, TNF-α, and IL-10 concentrations in the recipient group were significantly higher than those in healthy donor group patients. All preoperative cytokine levels, except IL-6, increased in relation to the severity of liver disease, as measured by the CTP classification. Additionally, all cytokine levels, except IL-6, were significantly correlated preoperatively with MELD scores. However, the correlations diminished during the intraoperative period. The CTP classification and the MELD score are equally reliable in predicting the severity of the systemic inflammatory response, but only during the preoperative period.     

Improved gastrointestinal symptoms and quality of life after conversion from mycophenolate mofetil to enteric-coated mycophenolate sodium in renal transplant patients receiving tacrolimus

It is reported that a conversion from mycophenolate mofetil (MMF) to enteric-coated mycophenolate sodium (EC-MPS) relieves gastrointestinal (GI) symptom burden and improves health-related quality of life (HRQoL). However, it is unclear whether renal transplant recipients using tacrolimus receive the same benefit from the conversion. In this prospective, multi-center, open-label trial, patients were categorized into two groups by their GI symptom screening. Equimolar EC-MPS (n=175) was prescribed for patients with GI burdens; those with no complaints remained on MMF (n=83). Gastrointestinal Symptom Rating Scale (GSRS) and Gastrointestinal Quality of Life Index (GIQLI) were evaluated at baseline and after one month. Patients and physicians completed Overall Treatment Effect (OTE) at one month. EC-MPS-converted patients had worse GSRS and GIQLI scores at baseline than MMF-continued patients (all P<0.001). Significant improvements in GSRS and GIQLI scores were observed for EC-MPS-converted patients at one month, but MMF-continued patients showed worsened GSRS scores (all P<0.05). OTE scale indicated that EC-MPS patients improved in overall GI symptoms and HRQoL more than MMF patients did (P<0.001). In tacrolimus-treated renal transplant recipients with GI burdens, a conversion from MMF to EC-MPS improves GI-related symptoms and HRQoL.     

Comparison of long-term outcome between anti-Jo1- and anti-PL7/PL12 positive patients with antisynthetase syndrome

The aims of the present study were to: compare the characteristics between antisynthetase syndrome (ASS) patients with anti-Jo1 antibody and those with anti-PL7/PL12 antibody. The medical records of 95 consecutive patients with ASS were reviewed. Seventy-five of these patients had anti-Jo1 antibody; the other patients had anti-PL7 (n=15) or anti-PL12 (n=5) antibody. At ASS diagnosis, the prevalence of myalgia (p=0.007) and muscle weakness (p=0.02) was significantly lower in the group of anti-PL7/PL12-positive patients than in those with anti-Jo1 antibody; median value of CK (p=0.00003) was also lower in anti-PL7/PL12 patients. Anti-Jo1 positive patients developed more rarely myositis resolution (21.3% vs. 46.2%); in addition, the overall recurrence rate of myositis was higher in anti-Jo1 positive patients than in patients with anti-PL7/PL12 antibody (65.9% vs. 19.4%). Anti-Jo1-positive patients, compared with those with anti-PL7/PL12 antibody, more often experienced: joint involvement (63.3%vs. 40%) and cancer (13.3% vs. 5%). By contrast, anti-PL7/PL12 positive patients, compared with those with anti-Jo1 antibody, more commonly exhibited: ILD (90% vs. 68%); in anti-PL7/PL12 positive patients, ILD was more often symptomatic at diagnosis, and led more rarely to resolution of lung manifestations (5.6% vs. 29.4%). Finally, the group of anti-PL7/PL12 positive patients more commonly experienced gastrointestinal manifestations related to ASS (p=0.02). Taken together, although anti-Jo1 positive patients with ASS share some features with those with anti-PL7/PL12 antibody, they exhibit many differences regarding clinical phenotype and long-term outcome. Our study underscores that the presence of anti-Jo1 antibody results in more severe myositis, joint impairment and increased risk of cancer. On the other hand, the presence of anti-PL7/PL12 antibody is markedly associated with: early and severe ILD, and gastrointestinal complications. Thus, our study interestingly indicates that the finding for anti-Jo1 and anti-PL7/PL12 antibodies impacts both the long-term outcome and prognosis of patients with ASS.     

A blueprint for electronic utilization of ambiguous molecular HLA typing data in organ allocation systems and virtual crossmatch

Virtual crossmatch (VXM) compares a transplant candidate’s unacceptable antigens to the HLA typing of the donor before an organ offer is accepted and, in selected cases, supplant a prospective physical crossmatch. However, deceased donor typing can be ambiguous, leading to uncertainty in compatibility prediction. We have developed a prototype web application that utilizes ambiguous HLA molecular typing data to predict which unacceptable antigens are present in the donor HLA genotype as donor-specific antibodies (DSA). The application compares a candidate’s listed unacceptable antigens to computed probabilities of all possible two-field donor HLA alleles and UNOS antigens. The VIrtual CrossmaTch for mOleculaR HLA typing (VICTOR) tool can be accessed at http://www.transplanttoolbox.org/victor. We reanalyzed historical VXM cases where a transplant center’s manual interpretation of molecular typing results influenced offer evaluation. We found that interpretation of ambiguous donor molecular typing data using imputation could one day influence VXM decisions if the DSA predictions were rigorously validated. Standardized interpretation of molecular typing data, if applied to the match run, could also change which offers are made. HLA typing ambiguity has been an underappreciated source of immunological risk in organ transplantation. The VICTOR tool can serve as a testbed for development of allocation policies with the aim of decreasing offers refused due to HLA incompatibility.     

Virtual crossmatch for deceased donor kidney transplantation in the United States: A survey of histocompatibility lab directors and transplant surgeons

Virtual crossmatch (VXM) is used as an alternative to or in conjunction with a cell-based physical crossmatch (PXM) for assessing HLA (human leukocyte antigen) compatibility prior to deceased donor kidney transplantation (DDKT). Data on practice patterns and perceptions regarding VXM use in the US are limited. We performed a survey of US HLA directors and transplant surgeons regarding HLA testing and crossmatch strategies. 53 (56 %) HLA directors and 68 surgeons (representing ～ 23 % of US transplant centers) completed the survey. Both groups agreed that VXM could reduce cold ischemia time (CIT), costs and improve allocation efficiency. VXM use increased following the 2021 kidney allocation change. Reducing CIT was the primary reason for favoring VXM over PXM. Preference for VXM reduced as candidates’ panel reactive antibodies increased. Regulations, program policies and limitations of HLA technology were cited as important reasons for preferring PXM over VXM. Surgeons reported similar perceptions, but findings are limited by the low response rate. Finally, half the labs reported lacking specific protocols for VXM use. In conclusion, improved HLA technology and protocols along with changes to institutional procedures and policy regulations are needed for safer expansion of VXM in DDKT.