Clinical analysis of infection in recipients after renal transplantation / 器官移植

Objective To analyze the clinical characteristics of the recipients infected with cryptococcus neoformans after renal transplantation. Methods Clinical data of 9 patients infected with cryptococcus neoformans after renal transplantation were retrospectively analyzed, including the infection site, clinical manifestations, mycological, histopathological, imaging examination results, treatment process and clinical prognosis. Results Nine recipients were treated with routine triple immunosuppressive therapy of tacrolimus (FK506) + mycophenolate mofetil (MMF)+prednisone. The median time of onset was 6 years (1-13 years) after operation. Among them, 1 case was diagnosed with cryptococcal meningitis, 5 cases of cryptococcal meningitis complicated with cryptococcal pneumonia, 2 cases of cryptococcal pneumonia and 1 case of cutaneous cryptococcal infection. Cryptococcal pneumonia was clinically manifested as fever, cough, expectoration, shortness of breath and chest pain, etc. Chest CT demonstrated the signs of nodules and pleural effusion, etc. The diagnosis was mainly confirmed by lung biopsy and negative ink staining of the alveolar lavage fluid. Clinical manifestations of cryptococcal meningitis primarily included fever and paroxysmal headache accompanied by vomiting, which was mainly confirmed by blood culture and negative ink staining of the cerebrospinal fluid. Cutaneous cryptococcal infection was characterized by a mass in the right shoulder, which was confirmed by skin biopsy. All patients were given with standard antifungal therapy including amphotericin B and fluconazole, and immunosuppressive therapy at a reduced dosage. Among 9 recipients, 1 recipient died, and the other recipients obtained excellent clinical prognosis. Conclusions Cryptococcus neoformans infection dominantly occurs in the middle and late stage after renal transplantation presenting with non-specific clinical symptoms. Blood culture, lung biopsy and cerebrospinal fluid examination should be timely performed to validate the diagnosis of this disease. Standard anti-fungal therapy can reduce the mortality rate.

Median-long term clinical analysis 96 kidney transplant from hepatitis B surface antigen positive donors to hepatitis B antigen positive recipients / 中华器官移植杂志

Objective To investigate the safety and efficacy of hepatitis B surface antigen (HBsAg) positivity of the donors on graft survival and liver complications in HBsAg (+) renal transplant recipients.Methods We retrospectively evaluated 96 HBsAg (+) patients who received HBsAg(+) donor kidney transplant fellow-up during 20～ 139 months,in order to observe the renal allograft dysfunction,liver dysfunction and others complications.Results All 96 patients underwent renal transplantation successfully in our hospital.during the follow-up period,18 cases accepted entecavir-treated,one case lost graft function,two cases died,one of them developed drug resistance and liver function failure,the other because of cancer of the liver.Twenty-three of the 78 lamivudinetreated patients (29.5％) developed drug resistance in 7～96 months,and 3 cases developed liver function failure,2 cases died and one cured,15 of the 19 cases who been salvage treated with entecavir was successful and well tolerated after 1 year,2 cases who been salvage treated with adefovir and lamivudine with HBV DNA-negative after 12 months and 23 months.The 5-year patient/graft rates of patients who been treated with lamivudine and entecavir were 88.5％/84.6％ and 88.9％/83.3％ respectively.Conclusion It is safe and feasible for renal transplantation from HBsAg(+) donors to HBsAg(+) recipients with antiviral treatment,patients would require lifelong anti-viral suppression and strictly follow-up,which is important for patient and graft survival,anti-viral drugs resistance and the liver complications should be closely monitored and treated.

Clinical analysis on donor liver protection and function evaluation for organ donation after citizen's death / 器官移植

Objective To summarize the preliminary experience of donor liver protection and function evaluation for organ donation after citizen's death. Methods Clinical data of 35 donors from organ donation after citizen's death and 33 recipients were retrospectively analyzed. Donor liver procurement and clinical prognosis of the recipients were summarized. According to serum level of sodium ion (serum sodium) before organ procurement, all recipients were divided into the serum sodium <155 mmol/L, 155-160 mmol/L and 161-180 mmol/L groups. The incidence of liver graft dysfunction early after liver transplantation was statistically compared among three groups. Results In 35 donors,27 cases were Chinese type Ⅱ and 8 cases were Chinese type Ⅲ. Thirty-three donor livers were used for liver transplantation, and the remaining 2 cases of donor livers were excluded due to congestive cirrhosis. In 33 liver transplantation recipients, 30 cases were successfully recovered. The liver function was gradually restored at postoperative 7-14 d, and normal liver function was obtained during long-term follow-up. Postoperatively, 3 recipients died including 2 cases dying from portal vein thrombosis and 1 case from pulmonary infection complicated with multiple organ failure. The incidence of early liver graft dysfunction of the recipients after liver transplantation was 18%, 23% and 4/5 in the serum sodium <155 mmol/L, 155-160 mmol/L and 161-180 mmol/L groups, respectively. Statistical significance was observed between the 161-180 mmol/L and <155 mmol/L groups (P<0.05). Conclusions Timely protection of donor liver, accurate evaluation and maintenance of liver function play a pivotal role in enhancing the utilization rate of donor liver, maintaining liver function and yielding good efficacy for transplantation.

Clinical analysis of liver transplant from a child of brain death to an adult / 中华肝胆外科杂志

Objective To explore clinical feasibility of liver transplant from child of brain death to adult, to summarize the clinical experiences that a child of brain death transplants liver to an adult. Methods The recipient was a 39-year-old woman patient with primary hepatic carcinoma and posthepatitis cirrhosis (decompensation stage); while the donor was a 8-old-year child of brain death because of brain neoplasms. Donated liver was gained by the method of en bloc multivisceral procurement in a short time; the operative method was classic orthotopic liver transplantation. The postoperative managements included immunosuppression, prevention of infection, hepatic protection, and other relevant supports etc. Results The transplantation operative duration was 6 hours, after which not only did the recipient survive but also her body functioned well including the liver part, with no severe postoperative complications. Conclusions The technology of transplanting livers from children to adults is feasible. The key to ensure the success of transplant operation is systematic preoperative evaluation, excellent operative technique, and perfect postoperative treatment.

Combined liver-kidney transplantation in one case / 中国组织工程研究

A 32-year old male who had liver cirrhosis accompanying with chronic renal insufficiency (uremia) was suffered from homochronous allograft transplantation of liver-kidney. The blood and other tissue typing were in concord between the donor and recipient. The liver transplantation took typical orthotopic transplantation technique while the kidney transplantation took general operation method to place the transplanted kidney at the recipient's right lilac fossa. Daclizumab was taken for the immunity induction treatment before transplantation while the trigeminy of tacrolimus+mycophemocate mofeil+methylprednisolone were taken as immunosuppressant after transplantation. The transplanted liver and kidney recovered well which could work at once without any serious complications after transplantation, suggesting that combined liver-kidney transplantation was an effective treatment method for homochronous function failure of liver and kidney characterizing by perfect tissue typing, excellent operation skill, reasonable usage of immunosuppresant being the key point of success for transplantation.