献血员、化验员乙型肝炎病毒感染的血清流行病学调查

本文采用SPRIA和ELISA法测定了128名献血员和49名化验员的五项血清学指标及SGPT。结果表明献血员中HBV感染率城市高于农村,男高于女,AB血型者高于其它血型(P<0.01)。化验员HBV感染率(51.02％)高于献血员(48.33％)(RR=1.05),HBV的感染随工龄增长而升高。     

Donation after cardiac death liver transplantation is associated with increased risk of end‐stage renal disease

Limited organ supply has led to greater use of liver allografts with higher donor risk indices (DRI) and/or donated after cardiac death (DCD). DCD status is associated with acute kidney injury after liver transplantation; however, less is known about the association between donor quality and end‐stage renal disease (ESRD). Using SRTR data, we assembled a cohort of liver transplant recipients from 2/2002 to 12/2010. We fit multivariable Cox regression models for ESRD. Model 1 included total DRI; model 2 included components of DRI, including DCD, as separate variables. Forty thousand four hundred and sixty‐three liver transplant recipients were included. Median DRI was 1.40 (IQR 1.14, 1.72); 1822 (5%) received DCD livers. During median follow‐up of 3.93 years, ESRD occurred in 2008 (5%) and death in 11 075 (27%) subjects. There was a stepwise increase in ESRD risk with higher DRI (DRI ≥1.14 and <1.40: HR 1.17, P = 0.06; DRI ≥1.40 and <1.72: HR 1.29, P = 0.003; DRI ≥1.72: HR 1.39, P < 0.001, compared with DRI <1.14). Adjusting for DRI components separately, DCD status was most strongly associated with ESRD (HR 1.40, P = 0.008). Higher DRI is associated with ESRD after liver transplantation, driven in part by DCD status. Donor quality is an important predictor of long‐term renal outcomes in liver transplant recipients.     

Selective Hemi-Portocaval Shunt Based on Portal Vein Pressure for Small-for-Size Graft in Adult Living Donor Liver Transplantation

We developed an algorithm of graft selection in which left lobe donation is considered primarily if the graft-to-recipient weight ratio (GRWR) is estimated to be greater than 0.6% in preoperative volumetry with utilization of a hemi-portocaval shunt (HPCS) based on portal vein pressure (PVP) more than 20 mmHg at the time of laparotomy. A total of 11 consecutive adult living donor liver transplantations with small-for-size graft according to our graft selection algorithm were performed between December 2005 and August 2007. Ten patients required HPCS using a vein graft all survived without small-for-size syndrome (SFSS) and shunt complications with a median follow-up of 296 days. One patient without HPCS died of chronic vascular rejection. In all cases, PVP were regulated successfully under 20 mmHg by HPCS. Graft volume reached in mean 84.3% of standard liver volume in right lobe grafts and mean 95.4% in left lobe grafts at 3 months after liver transplantation. Actuarial rate of shunt patency at 1, 3, 6 months and 1 year were 80%, 55%, 26% and 20%, respectively. Selective HPCS based on PVP is an effective procedure and results in excellent patient and graft survival with avoidance of SFSS in grafts greater than 0.6% of GRWR.     

器官和组织捐献家属沟通专家共识

家属沟通是器官和组织捐献工作的关键环节,也是捐献成功与否的关键。为更好地帮助潜在器官和组织捐献者家属了解法律赋予的器官捐献自主选择权利,提升家属沟通效率,充分体现人文关怀,同时帮助相关从业者长期保持专业的工作状态及健康的心理状态,分享和总结各地最佳临床经验,共同商议并解决目前家属沟通面临的困难,在多方专家的共同参与下,特制订《器官和组织捐献家属沟通专家共识》。本共识以器官和组织捐献家属沟通的关键问题为导向,查阅相关文献,经多学科专家编写,并通过德尔菲投票方法达成共识,形成18个器官和组织捐献家属沟通关键元素及推荐建议,以期为器官和组织捐献家属沟通工作提供指引。本共识已在国际实践指南注册平台进行中英文注册。

     

Cord blood transplantation in Western Australia

Background/Aims: Thirty‐one umbilical cord blood transplants performed in Western Australia were retrospectively examined in order to document local experience and relevant prognostic factors. Three cord units were from human leucocyte antigen‐matched siblings and the remainder were unrelated single (n= 22) or double (n= 6) cord blood transplants. Methods: Twenty patients were transplanted for malignant conditions and 11 for non‐malignant conditions. Cord units contained a median of 5.6 × 10⁷ total nucleated cells/kg and 1.4 × 10⁵ CD34+ cells/kg. Cumulative incidence of neutrophil engraftment was 76% at day 60. Results: Of those who did not engraft, two patients remain alive following subsequent allogeneic bone marrow transplant. There were no deaths caused by graft‐versus‐host disease. Overall survival at median follow up of 28 months was 62%. Two year overall survival was influenced by type of disease (non‐malignant = 91 ± 9% vs malignant = 41 ± 13%, P= 0.005), total nucleated cell dose (>3.5 × 10⁷/kg = 87 ± 9% vs <3.5 × 10⁷/kg = 34 ± 15%, P= 0.01) and CD34 dose (>1.7 × 10⁵/kg = 92% vs <1.7 × 10⁵/kg = 46%, P= 0.04). Age and human leucocyte antigen match did not influence survival. Four relapses occurred, all of which were fatal. Conclusion: Cord blood transplantation for malignant and non‐malignant disease is practised in Western Australia and outcomes are satisfactory. Trends and techniques in cord blood transplantation in this state are comparable with those observed nationally and overseas. Although numbers are small, cell dose appears to be predictive of overall survival.     

From a Social Issue to Policy

Summary

This paper outlines a 22 year campaign to introduce openness into the arena of donor conception in the UK. It identifies key aspects of the development of an advocacy based approach to such work and argues that social work values and principles can prove key to identifying structural inequalities which are not necessarily based in socio-economic disadvantage. Donor conceived people may find themselves in families which enjoy material privilege but whose exposure to a legislative framework and dominant professional cultures within the treatment centres encourages secrecy around genetic origins. Social workers' experience of adoption and family work leads them to recognise the danger of such secrets within families. Turning such social issues into policy changes requires vision, strategic long term advocacy and partnership with those directly affected.