Early Prediction of Cardiovascular Disease in Kidney Transplant Recipients

Cardiovascular disease (CVD) is frequent after kidney transplantation (KT). This study investigated CVD prediction in KT by information available before KT or within 6 months after KT. The study cohort consisted of 629 patients with KT in 2005–10 and with adult age at KT. The end point was incidence up to 2015 of CVD (coronary heart disease, cerebrovascular disease, peripheral artery disease). Graft failure, non-CVD death with functioning graft, and loss to follow-up were considered competing events. CVD prediction was investigated for 34 variables by means of competing-risks regression. Follow-up range was 0.28–10.00 years (mean ± SD, 7.30 ± 3.10). First incident event was CVD in 103 patients and competing events in 146 patients. In the multivariable model for pre-KT variables only, CVD predictors were male sex (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.06–2.66), diabetic nephropathy (HR, 6.63; 95% CI, 1.81–24.35), pre-KT dialysis for ≥5 years (HR, 1.52; 95% CI, 1.02–2.27), pre-KT CVD (HR, 4.87; 95% CI, 2.84–8.35), and age at KT ≥45 years (HR, 2.98; 95% CI, 1.83–4.87). In the model for pre-KT and post-KT variables together, the sole post-KT CVD predictor was estimated glomerular filtration rate <60 mL/min at the 6-month visit (HR, 1.75; 95% CI, 1.11–2.77). Diabetic nephropathy, pre-KT dialysis, pre-KT CVD, and age at KT predicted 91.2% of incident CVD. Early available information effectively predicted CVD in KT independently from competing events.     

张仁教授针刺治疗视神经脊髓炎谱系疾病经验

Prof. Ren ZHANG's experience in clinical treatment of neuromyelitis optica spectrum disorders (NMOSD) is summarized in this paper. The pathogenesis of this kind of disease is complicated. Prof. Ren ZHANG treats it in both symptoms and root cause. In the acute stage and remission stage, based on the standard application of western medicines, acupuncture should be applied as early as possible and continued. In the acute stage, acupuncture can be an alternative and complementary treatment to reduce the adverse reaction of high dose hormone and shorten the acute course of this disease. In the remission stage, acupuncture can not only improve the visual function of patients, but also helps to retard the deterioration of this disease, reduce the recurrence and disability degree, having a long-term effect. The specific treatment method of Prof. Ren ZHANG emphasizes a combination of acupuncture and acupoint injection, with the extraordinary points as the main acupoints and coordinate with meridian acupoints in application. In the manipulation, it is emphasized deep insertion, penetrating method, and needling sensation to the diseased location. For the treatment course, it is emphasized that early intervention and long-term regular treatment. Here is the summarization of Prof. Ren ZHANG 's experience in treating this disease, which can be the reference for clinicians.     

New Left Lobe Transplantation Procedure with Caval Reconstruction Using an Inverted Composite Graft for Chronic Budd-Chiari Syndrome in Living-Donor Liver Transplantation—A Case Report

When the Budd-Chiari syndrome (BCS) lesion extends to the inferior vena cava (IVC) or the orifices of the hepatic vein, the thickened IVC and/or hepatic vein wall must be removed and IVC reconstruction is required in living-donor liver transplantation (LDLT). In various reports about IVC resection in LDLT for BCS, there are none about left lobe liver transplantation with reconstruction of the retrohepatic IVC (rhIVC). To overcome removal and reconstruction of the rhIVC in LDLT for BCS, we introduced a composite IVC graft that is applicable to both right and left lobe partial liver grafts for LDLT for BCS. Pathogenic IVC was removed together with the native liver between the lower edge of the right atrium and 5 cm above the renal vein junction with the use of venovenous bypass. The e-polytetrafluoroethylene graft was anastomosed to the suprarenal intact IVC. Then the native part was detached at the level of just above the renal junction. The composite graft was inverted and a half rim of the native part of the graft was anastomosed to the posterior wall of the right atrium. Next, the common venous orifice of the left lobe graft was anastomosed to the wall defect which was composed of the anterior wall of the right atrium and the distal end of the native part of the composite graft. In conclusion, our inverted composite graft technique will overcome the weak points of LDLT for BCS, such as incomplete removal of the pathogenic caval wall and reconstruction of the rhIVC.