脑死亡供肾肾移植受者的近期状况分析

背景:供者短缺严重限制了肾移植的发展,脑死亡供肾在一定程度上缓解了供肾短缺的问题。目的:比较脑死亡供肾与尸体供肾肾移植患者移植后短期预后情况,初步探讨脑死亡供者在肾移植临床应用中的安全性。方法:回顾性分析肾移植90例患者移植过程中和移植后情况,其中80例供者为尸体供肾,10例为脑死亡供肾,比较两组受者移植中出血量、手术时间、移植后移植肾功能恢复情况、各种并发症的发生率及移植后近期生存情况(围手术期、移植后6个月)的差异。结果与结论:两组间移植时间、移植过程中出血量比较差异无显著性意义,移植后1,6个月生存率及移植后并发症的发生率比较,差异亦无显著性意义。说明脑死亡供肾与尸体供肾肾移植患者移植后早期预后无明显差异,安全可靠。     

Predictors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in cirrhotic patients: a systematic review

Background and Aim: Hepatic encephalopathy (HE) is a very common complication in patients after transjugular intrahepatic portosystemic shunt (TIPS). The purpose of this study is to determine the most robust predictors of post‐TIPS HE by performing a systematic review of studies that identified the risk factors for patients with post‐TIPS HE. Methods: A PUBMED search was performed using the predefined rule. Studies were selected for analysis based on certain inclusion and exclusion criteria. Data were extracted from each study on the basis of predefined items. Meta‐analyses were executed to verify the relevant risk factors. Results: Thirty studies were included in this systematic review. In the 30 studies, the numbers of variables evaluated by univariate and multivariate analyses were 60 and 32, respectively. The numbers of variables found to be significant in univariate and multivariate analyses were 18 and 14, respectively. According to the accumulated number of studies that identified these variables as significant, the three most vigorous predictors of post‐TIPS HE were age, prior HE and Child–Pugh class/score in both univariate analysis and multivariate analysis. Our meta‐analysis showed that patients with HE before TIPS or higher Child–Pugh class/score had increased risk of post‐TIPS HE. Conclusions: Increased age, prior HE and higher Child–Pugh class/score were the most robust predictors for post‐TIPS HE.     

Reduced corticosteroid use in adult patients with primary immune thrombocytopenia receiving romiplostim