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【Objective】 To systematically evaluate the correlation between pretransfusion prophylactic medication and the incidence of adverse reactions to blood transfusion(ARBT) by Meta analysis. 【Methods】 The relevant literature concerning the effect of pretransfusion prophylactic medication on the incidence of ARBT was searched via Pubmed, Embase, Cochrane Library, CNKI, WanFang Data, and VIP databases, with the date duration from database creation to May 9, 2021. The literature was independently screened by two researchers according to the inclusion and exclusion criteria, relevant data information was extracted, quality evaluation was performed, and Meta analysis was performed using RevMan 5.3 software. 【Results】 A total of 36 publications were finally included, involving 137 996 transfusion recipients, of which 62 581 were administered medication before transfusion while 75 415 not. And1742 patients experienced ARBT. Meta analysis results showed that the incidence of ARBT in the pre-transfusion medication group was not statistically different from that in the non-medication group {[RR=0. 88, 95% CI(0.76, 1.01), P>0.05]}, the incidence of febrile reactions was lower in the pre-transfusion group than in the control {[RR=0. 72, 95% CI(0.61, 0.86), P0.05] vs [RR=0. 24, 95% CI(0.03, 2.13), P>0.05]. Pre-transfusion use of dexamethasone, isoproterenol, and niclosamide had no preventive effect on ARBT, i. e. [RR=0. 91, 95% CI(0.79, 1.04), P>0.05] vs [RR=0. 83, 95% CI(0.68, 1.01), P>0.05] vs [RR=1.21, 95% CI(0.69, 2.10), P>0.05]. 【Conclusion】 The incidence of ARBT in the pre-transfusion prophylaxis group was not significantly different from that in the control without considering the patient's history of transfusion, history of ARBT, and use of leukocyte-deleted blood products. The incidence of febrile reactions in the pre-transfusion medication group was lower than that in the control, and further studies in larger randomized controlled trials of higher quality still need to be established due to the suboptimal quality of the included literature and study size. Strictly grasping the indications for blood transfusion, strengthening the monitoring and awareness of ARBT, and using life-saving drugs rationally remain the key clinical concerns.
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Objective:To explore the prevalence of passenger lymphocyte syndrome(PLS) after liver transplantation, minimize the result bias caused by previous multicenter confounding factors, make up for the lack of statistical analysis of PLS and provide reference for a diagnosis and treatment of PLS after liver transplantation.Methods:We reviewed liver transplants performed in our center from 2018 to 2019, searching for cases with minor ABO incompatibility or bidirectional ABO incompatibility. Diagnostic criteria for PLS: laboratory confirmation included biochemical identifiers of hemolysis, positivity of the direct antiglobul in test(DAT), donor attributed anti-recipient antibody in recipient's sera, and exclusion of other causes of decreased HGB(i.e. postoperative infection, acute rejection & surgical blood loss). A total of 666 liver transplants were performed. Among 52 patients with minor ABO incompatibility or bidirectional ABO incompatibility, 10 cases developed PLS(19.23%)and 42 cases did not(80.77%). Statistical comparisons between patients with and without PLS were performed using the chi-square test and Fisher's exact test.Results:There were no statistically significant differences in PLS group subjects in terms of sex, age, blood group, type of incompatibility, type of immunosuppressants and postoperative outcome. There was statistically significant correlation between postoperative blood transfusion and PLS( P< 0.05), and donor blood group B cohort demonstrated a higher risk of PLS than donor blood group A and O cohorts( P< 0.05). Conclusions:PLS is one of the causes for postoperative anemia in liver transplantation, and donor blood group B graft is a risk factor for PLS.
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【Objective】 To summarize the serological characteristics of B311 subtype and analyze its gene sequence. 【Methods】 PCR-SSP, direct sequencing of promoter 5'end and 1-7 exons were performed on 4 samples, which were consistent by forward and reverse blood typing via automatic blood type system, but presented mixed agglutination of B antigen via test tube method. 【Results】 The 4 samples, with the presence of B antigen 4+ in the microcolumn gel card, were determined as the blood group of B or AB by the automatic blood type system according to the consistency between forward and reverse blood typing. While mixed agglutination of B antigen 2+ -3+ was observed by test tube method. Among the 4 samples, 2 were B/O01, 1 B/O02, and 1 AB by PCR-SSP. No mutation was found in B101 by direct sequencing of exons 1-7, and a heterozygous mutation of -35--18delGGCGGAAGGCGGAGGCCG was found at the 5'end of the promoter. 【Conclusion】 The -35--18del base mutation at B allele is the molecular genetic mechanism of B311. The reduced promoter activity leads to B3 serological performance. The automatic blood type system has certain limitations in detecting B311 subtype.
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OBJECTIVE@#To analyze serological and molecular characteristics of a case with Bw11 subtype.@*METHODS@#The ABO antigen and antibody in serum were respectively detected with the classical tube method, microcolumn gel method, and absorption and diffusion method. The ABO genotype was determined with PCR using sequence-specific primers (PCR-SSP). Exons 1-7 of the ABO gene were analyzed by Sanger sequencing. Haplotype analysis was carried out for exons harboring variants.@*RESULTS@#Forward and reverse typing with the microcolumn gel method has suggested type O, while forward and reverse typing with the classical tube method yielded inconsistent results. Absorption and diffusion test confirmed presence of B antigen. Antibody screening excluded presence of alloantibodies. The result of PCR-SSP suggested a B/O1 genotype.A 695T>C variant was identified in exon 7 as compared with the B101/O01 allele, which resulted in conversion of Leucine to Proline at position 232, and was confirmed as Bw11/O1 heterozygote.@*CONCLUSION@#The nt695T>C variant probably underlay the weakening of B antigenin the individual. There may be strong anti-B antibodies in Bw11 subtypes. Human-derived and certain monoclonal reagents may not detect Bw11 subtypes which is easy to be misjudged as type O. Application of molecular methods can identify ABO subtypes with accuracy.
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Objective To explore the changes and significance of hepatic cytokines during ischemia and reperfusion in rats undergoing donation after circulatory death (DCD) liver transplantation in different functional warm ischemic durations.Methods Maastricht Ⅲ DCD liver transplantation was simulated and a rat model of functional warm ischemia established.DCD liver transplantation was established by cutting diaphragm.There were four groups of functional warm ischemia 0/15/30 min and living donor liver transplantation control.Liver tissues and serum samples were obtained after donor liver acquisition and 6-hour reperfusion respectively.Luminex liquid chip was employed for detecting the concentrations of 23 cytokines in liver tissue,superoxide dismutase or malondialdehyde (SOD/MDA) expression in liver tissue and alanine transaminase or aspartate aminotransferase (ALT/AST) expression in sera.And hematoxylin-eosin (HE) staining was utilized for detecting liver tissue damage.Results The levels of cytokines in liver tissues during ischemia and reperfusion were significantly different in different functional warm ischemic durations.SOD/MDA in liver tissue,AST/ALT in sera and pathological examinations also showed that,with the prolongation of functional warm ischemic duration,the degree of liver tissue injury gradually aggravated.Conclusions Functional warm ischemic duration has a significant effect on cytokines during ischemia and reperfusion in rat DCD liver transplantation.This phenomenon can help us further elucidate the mechanism of ischemia-reperfusion injury and provide new ideas for preventing ischemia-reperfusion injury during DCD liver transplantation.
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Objective Monitoring the thyroid hormone levels in patients before and after renal transplantation to realize the relationship between thyroid hormones and renal function.Methods Fifty-seven patients were subdivided into stabled graft function group (50 cases) and delayed graft function (DGF) group (7 cases).Thirty healthy men served as control group.Serum triiodothyronine (T3),thyroxine (T4),thyroid-stimulating hormone (TSH) and serum creatinine (Scr) were determined respectably before transplantation and on different days after transplantation.Correlations between thyroid hormones and Scr at 10th day after transplantation were analyzed.Results Serum T3 and T4 levels before transplantation in the two groups were significantly lower than those in the control group (P＜0.01).These four parameters levels had no significant difference between stabled graft function group and DGF group (P＞0.05).In stabled graft function group:T3 level was decreased obviously by 30％ in the 1st day after transplantation,which was higher than the others,elevated at the 1st week post-transplantation,reached the normal range.at the 2nd week post-operation,and higher than pre-transplantation (P ＜ 0.01) at 3rd week; T4 revealed a decrease trend after transplantation and was elevated at 10th day post-transplantation,returned to the pre-transplantation level at 3rd week; TSH had slight decrease after operation,and had no significant difference among every period in comparing with pre-transplantation; Scr revealed a decrease trend continuously and returned to the normal level at the 7th day post-transplantation.In DGF group,Hormones levels were obviously decreased as compared with stabled graft function group; T3 reached the normal range at the 3rd week post-transplantation,whereas T4 returned to pre-transplantation levels at the 30th day; TSH had a significant decrease at the 5th day,and began to increase at the 10th day post-operation; Scr retuned to the normal range at the 30th day post-operation.The correlation coefficients between Scr and T3,T4 were 0.546 and 0.423 respectively.Conclusion There is a significant correlation between thyroid hormones and renal function (T3,T4).Monitoring the thyroid hormones,specially T3,can diagnose renal function change.
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Objective To assess the clinical application of Cylex ImmuKnow assay in patients with renal dysfunction after liver transplantation for individualized immunosuppressive therapy.Method Twenty adult patients undergoing liver transplant between January 2009 and December 2011 received regular ImmuKnow assay monitoring combined with determination of serum tacrolimus trough concentration to guide immunosuppressive regimens,all of whom showed sustained renal dysfunction 6 months after transplant with normal and stable liver function.Clinical data were collected to observe the changes of renal function in those patients after treatment.Results The recipients were followedup for 15-54 months,received ImmuKnow assay 61 times and the results fluctuated 33-943 μg/L [median 282 μg/L,interquartile range (IQR) 267 μg/L].After ImmuKnow monitoring,serum creatinine level in patients was decreased significantly from median 151.8 μmol/L with IQR 44.9 μmol/L to median 114.9 μmol/L with IQR 35.3 μmol/L (Z =-3.845,P =0.000),and estimated glomerular filtration rate (eGFR) was increased significantly from median 0.746 mL/s with IQR 0.025 mL/s to median 1.005 mL/s with IQR 0.454 mL/s (Z =-3.771,P =0.000).ImmuKnow results showed a linear correlation with the white blood cell count in patients (Spearman correlation coefficient r =0.429,P =0.001),but no linear correlation with the patients' age,primary disease before transplantation,postoperative time,serum tacrolimus trough concentration,lymphocyte count,CD3+ T lymphocyte count,CD4+ T lymphocyte count or CD4+/CD8+ T lymphocyte ratio (P＞ 0.05).Conclusion Cylex IrmmuKnow assay can be applied in patients with renal dysfunction after liver transplantation for individualized immunosuppressive therapy monitoring,which is of certain clinical value.
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Serologic characters of Bx subtype were analyzed with standard Methods , PCR-SSP method was used for its genotype, and DNA sequences of 6 and 7 exons of ABO genes were analyzed by DNA sequencing. Serologically, the anti-B test was no or 1+, with anti-AB (1+ or 2+). The patient's auto antibodies were negative. PCR-SSP showed the patient was Bx02/O2. ABO genetic locus sequencing was 261delG in exon 6 and 297 was GG homozygous. The sample was a combination of blood group B and O2 because 297A> G, 526C> G, 657C> T, 703G> A, 796C> A, 803G> C, 905A> G, 930A> G shown by direct DNA sequencing and 803G> C, 905A> G shown by cloning DNA sequencing. The serological phenotype of the specimen was B and the genetic sequence was a combination of ABO*Bx.02.1.1 and ABO*O21.01.1.1.
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Humans , Male , ABO Blood-Group System , Genetics , Alleles , Base Sequence , Blood Grouping and Crossmatching , Exons , Genetics , Heterozygote , Molecular Sequence Data , Point Mutation , Polymerase Chain Reaction , Methods , Polymorphism, Single Nucleotide , Sequence Analysis, DNAABSTRACT
Objective To evaluate the value of monitoring serum cystatin C in assessment of renal function in patients with renal transplantation.Methods Serum cystatin C, creatinine (SCr), β2-microproglobin (β2-MG) and urea nitrogen (BUN) levels were determined at different time points (pre- or post-operation) in 58 renal transplant patients.Glomerular filtrated rate (GFR) was determined by using of 99mTc-DTPA at the seventh day after operation.The correlation between GFR and the four markers was analyzed.Diagnostic characteristics and ROC curve for the four markers were obtained using a GFR cut-off of 1.5 ml/s.Intra-individual coefficients of variation (CV) for cystatin C and SCr according to different time points during post-operation monitoring and the ratio (R) between CVSCr and CVcystatin C were calculated.Results Cystatin C was decreased by 48.1 % at the first day after operation, which was higher than others.The correlation coefficients between GFR and cystatin C, SCr, β2-MG, and BUN were 0.876, 0.691, 0.589, 0.516 respectively.Diagnostic characteristics for GFR and cystatin C, SCr, β2-MG, and BUN were as follows:sensitivity (91.3 %, 87.2 %, 82.6 %, 87.0 %); specificity (80.0 %, 69.2 %, 71.4 %, 42.9 %), positive predictive value (82.0 %, 73.7 %, 74.3 %, 60.4 %); positive likelihood rate (4.81, 2.83, 2.87, 1.53).The area under the curve (AUC) for GFR and cystatin C, SCr, β2-MG, and BUN was 0.914, 0.828, 0.803, and 0.765 respectively.The CVSCr was significantly lower than CVcystatin C (P＜ 0.01).R was less than 1 in most patients with cystatin C＜2 mg/L.In patients with cystatin C＞2 mg/L, R tended value 1 with increasing concentrations of cystatin C.Conclusion Cystatin C showes the best correlation to GFR, and is superior to the other markers in accurate in differentiate mild renal impairment from moderate and severe renal impairment.When renal function has minimal change, the cystatin C level has significant change.When the renal function has mild impairment, great changes in serum cystatin C indicate the unstable renal function.
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Objective To evaluate the role of cytokine levels for prediction of HBV recurrence after liver transplanta- tion.Methods 34 cases of liver transplantation from June 2002 to December 2003 in our hospital were observed.The measurements of cytokine in serum by ELISA method were taken on the 7 days before operation and recurrence after oper- ation and the change rules were studied.Results The serum TNF-?,IL-10和 INF-? levels gradually increased in HBV non-recurrence group,but which in recurrence group had no markedly change and always skept on normal levels after operation.In addition,the serum TNF-?和 IL-10 levels after operation were significantly higher in nonrecur- rence group than in recurrence group.The serum IL-2 levels in recurrence group always kept on higher levels without marked changes after operation.Conclusion TNF-? and IL-10 are better laboratory index in the prediction of HBV recurrence after liver transplantation and which are noninvaded and cheap.