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This review summarizes the clinical data of one pediatric liver transplant recipient and two adult kidney transplant recipients with posterior reversible encephalopathy syndrome(PRES)at Tongji Hospital of Huazhong University of Science & Technology.The relevant clinical characteristics of recipients are discussed for providing reference for clinical diagnoses and treatments.
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Objective To analyze the clinicopathological features and prognosis of polyomavirus nephropathy (PyVN) after kidney transplantation. Methods Clinical data of 44 patients who were diagnosed with PyVN after kidney transplantation were retrospectively analyzed. The causes of puncture and the time of pathological diagnosis were analyzed. Histological grading was carried out according to Banff 2018 classification. Clinical data and pathological characteristics of patients at all grades were statistically compared. BK viral DNA loads in the blood and urine were measured and renal allograft function were assessed. Clinical prognosis of all patients was compared among different groups and the risk factors affecting clinical prognosis were also analyzed. Results The time interval between pathological diagnosis of PyVN and kidney transplantation was 16(8, 29) months, and the increase of serum creatinine level was the main cause for puncture. Among 44 patients, 19 cases were classified as grade ⅠPyVN, 21 cases of grade Ⅱ PyVN and 4 cases of grade Ⅲ PyVN, respectively. Under optical microscope, there was no significant difference in the positive rate of virus inclusion bodies among different groups (P=0.148). Inflammatory cell infiltration, interstitial fibrosis and polyomavirus load in grade Ⅱ PyVN patients were all more or higher than those in grade Ⅰ counterparts. Inflammatory cell infiltration and polyomavirus load in grade Ⅲ patients were more or higher than those in grade Ⅰ counterparts. Polyomavirus load in grade Ⅲ patients was more or higher than that in grade Ⅱ counterparts. The differences were statistically significant (all P < 0.05/3). Upon diagnosis, BK viral DNA load was detected in the blood and urine of 39 patients. Among them, 38 patients were positive for BK virus in the urine and 30 patients were positive for BK virus in the blood. The serum creatinine level upon diagnosis was higher compared with that at postoperative 1 month. The serum creatinine level at the final follow-up was significantly higher than that upon diagnosis. The differences were statistically significant (P < 0.001, P=0.049). There was no significant difference in the serum creatinine level among patients with different grades of PyVN at postoperative 1 month (P=0.554). The serum creatinine level of patients with grade Ⅱ PyVN upon diagnosis was significantly higher than that of those with grade Ⅰ PyVN (P=0.007). The 1-, 3- and 5-year cumulative survival rates of renal allografts were 95%, 69% and 62%, respectively. The survival rates of renal allografts significantly differed among patients with different grades of PyVN. The higher the grade, the lower the survival rate (P=0.014). Univariate and multivariate Cox's regression analyses prompted that intrarenal polyomavirus load and serum creatinine level upon diagnosis were the independent risk factors for renal allograft dysfunction (all P < 0.05). Conclusions PyVN mainly occurs within 2 years after kidney transplantation. Clinical manifestations mainly consist of increased serum creatinine level, BK viremia and BK viruria. Postoperative routine monitoring of BK virus contributes to early diagnosis and protection of renal allografts. Banff 2018 classification may effectively predict the prognosis of renal allografts.
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Objective:To summarize the medium-term outcomes of single kidney transplantation from senile deceased donors aged above 65 years.Methods:Forty-three kidney recipients from donors aged above 65(old-aged donor group, OAD) and 43 kidney recipients of the same age and gender from donors aged 18 to 49 years(standard-criteria donor group, SCD) were retrospectively reviewed.The survival outcomes of patients and grafts, renal functions, the incidence of delayed graft function(DGF)and other complications were recorded within the 3-year follow-up post-transplantation.Results:The 3-year patient survival rates were 95.3% both in OAD and SCD and the 3-year death-censored graft survival rates 92.7% and 97.6% respectively.The serum levels of creatinine were significantly higher in OAD than that in SCD( P<0.05). And lower estimated glomerular filtration rate(eGFR)was found in OAD as compared with SCD( P<0.05). No significant difference existed in the incidence of DGF(OAD 20.9% and SCD 18.6%, P>0.05), acute rejection (OAD 4.7% and SCD 2.3%, P>0.05)or proteinuria(OAD 27.9%and SCD 14.0%, P>0.05). Conclusions:Single kidney transplantation from old-aged deceased donors may achieve excellent medium-term survival outcomes of patients and grafts.It can expand the donor pool though kidney functions were not as good as those of SCD.
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Objective:To summarize the transplant outcomes of pediatric kidney transplantation at a single center and discuss probable measures of improving the outcomes.Methods:A total of 111 pediatric renal transplantation were performed from September 2002 to September 2019. They were divided into adult-donor group ( n=41) and pediatric-donor group ( n=70). Adult-donor group consisted of two subgroups based upon donor sources: living-donor group ( n=19) and deceased-donor group ( n=22). Pediatric-donor group consisted of two subgroups based upon surgical types: single kidney group ( n=48) and en bloc kidney group ( n=22). Clinical data and outcomes of grafts and recipients were retrospectively analyzed. Results:The average age of recipients was (15.6±1.9) years in adult-donor group. None developed delayed graft function (DGF) in living-donor group whereas 6 patients (27.3%) had DGF in deceased-donor group ( P<0.05). During a follow-up period of 22-181 months, 1-year and 5-year graft survivals were 100% vs 94.1% and 93.8% vs 94.1% in living-donor and deceased-donor groups respectively. There were no statistical differences. In pediatric-donor group, the age of donors was significantly lower in en bloc subgroup than that in single kidney subgroup (median: 0.5 vs 6 months, P<0.05). The age of recipients was similar between two subgroups: (9.5±5.3) years in single kidney group vs. 11.5± 1.8 years in en bloc kidney group. In addition, 7 cases of single kidney were transplanted for infant recipients aged under 1 year. Vascular thrombosis occurred in 3 patients (6.3%) of single kidney group, less than that in 5 patients (22.7%) of en bloc kidney group ( P=0.06). During a follow-up period of 4-54 months, 1-year and 2-year graft survivals were 85% and 80% in single kidney group whereas 75% and 70% in en bloc kidney group. However, there was no statistically significant difference. One-year survival was 98% in single kidney group and 95% in en bloc kidney group. Conclusions:For elder pediatric recipients, excellent kidney transplant outcomes may be achieved with grafts from adult donors. For pediatric kidney recipients, transplant outcomes can be further improved with careful assessments and cautious usage of small grafts, particularly those form neonatal donors.
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Objective To investigate the diagnosis and treatment of graft-versus-host-disease (GVHD) after solid organ transplant (SOT) and the possible mechanism.Methods In this study,we retrospectively reported a rare case of GHVD after kidney transplantation and performed a literature review.This 51 year old male patient presented with over 10-day history of sporadic skin rash on postoperative day 50.Skin biopsy examination revealed GVHD.For further clear diagnosis,patient's peripheral blood was collected immediately for short tandem repeats (STR) enriched for CD3+ cells and we also performed immunofluorescent staining for patient's skin with specific HLA-A11 antibody,one of donor specific HLA sites.Meanwhile,the decreased immunosuppression was used for treatment.Results In our report,chimerism analysis by STR revealed no chimerism in patient's peripheral blood.However,immunofluorescent staining of patient's skin demonstrated abundant donor-derived lymphocytic infiltration existed.GVHD was definitely made in this case.After treatment with decreased immunosuppression and a low dose of methylprednisolone (MP),his clinical symptom was quickly alleviated.Now the patient was discharged and the renal function was normal.Conclusion Combined with literature review and our case report,we thought that chimerism analysis by STR and immunofluorescent staining by donor-specific HLA antibody were very useful for diagnosis of GVHD after SOT.Furthermore,GVHD referred to over-immunosuppression and prognosis of GVHD after kidney transplantation is usually satisfactory.
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Objective To analyze the safety of renal transplant from donors with primary central nervous system (CNS) tumors.Methods We retrospectively analyzed the clinical data of 33 donors with primary CNS tumors and the 63 corresponding renal recipients between January 2013 and December 2016 in Tongji Hospital.Results The mean period from diagnosis as primary CNS tumor to donation was about (21.8± 46.4) months (range:0.5 to 192.0 months).The pathological classification of these tumors included gliomas,meningioma,medulloblastoma,etc.Besides,there were 10 donors with high-grade CNS malignancies.Eleven donors have ever been through at least one of the four treatments (craniotomy,V-P/V-A shunt,radiotherapy and chemotherapy),14 donors have undergone none,and the clinical data of rest were unavailable.All the 63 recipients got well renal function after transplant.During an average follow-up of (15.9 ± 8.2) months (range:2.7 to 35.5 months),one recipient got donor-derived rhabdoid tumor 4 months posttransplant,underwent comprehensive treatments,including allograft nephrectomy,radiotherapy,chemotherpy and returned to hemodialysis,while the 62 cases got no donor-derived tumors.Conclusion Tumor transmission of renal allograft from donors with primary CNS tumors is inevitable but with low risk,which means this kind of donors can be used with careful assessment,full informed consent and good balance between wait-list death and tumor transmission.
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Objective To investigate the feasibility and safety of the single kidney transplantation from pediatric donors to adult recipients.Methods From May 2013 to January 2017,a total of 50 single kidney transplants from pediatric donation after citizen death (DCD) donors of age between 3 to 12 years to adult recipients were performed and the data were summarized.Results The average age of donors was 6.4 ± 2.5 years with an average donor weight of 19.1 ± 5.9 kg,and the average kidney length was 6.3 ± 0.6 cm.For the 50 adult recipients,the average age was 38.5 ± 12.1 years,the average body weight was 56.1 ± 13.1 kg,and the number of female patients was 26 (52％).All except 3 of these patients were transplanted for the first time.Delayed graft function (DGF) was observed in 15 patients (30％).The average value of eGFR among all the patients was rapidly increased in the first 3 months after transplantation and then steadily increased to (82.3 ± 13.4) mL· min-1·1.73 m-2 at 1 st year,followed by (83.8 ± 22.5) mL· min-1·1.73 m-2 at 2nd year.Four renal grafts developed acute rejection (8％),and 3 of them were successfully reversed by the treatment.Pulmonary infection occurred in 4 recipients,and 2 died.During a follow-up period of 19 months,uncensored grafts survival was 94％,and patients survival was 96％.Conclusion Excellent intermediate-term transplant outcome can be achieved by using single kidneys from pediatric donors elder than 3 years,which may shorten the waiting time in adult recipients and alleviate the contradictions in the absence of suitable pediatric recipients.
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Objective To discuss the improvement of surgical techniques and adjustment of immunosuppressive regimen for combined liver and intestinal transplantation.Method A male patient with liver dysfunction and short bowel syndrome underwent the combined liver and intestinal transplantation.Ostomy of graft was performed instead of intestinal anastomosis during the operation.The anastomosis of graft and autologous intestine was performed 8 months after transplantation.Hospital and follow-up data of the patients were analyzed retrospectively.Result The functions of liver and small bowel recovered smoothly after operation.Slight rejection occurred one month after operation with normal function of intestine but dysfunction of liver.In the first month after operation, abdominal infection was controlled by intraperitoneal drainage with open surgery.Immunosuppression protocol was administrated with alemtuzumab for induction plus maintenance treatment with tacrolimus, and mycophenolate mofetil was added because of renal dysfunction 2 years after transplantation.The patient was followed up for nearly 3 years with good quality of life without rejection and infection.Conclusion Combined liver and intestinal transplantation could improve patient's life quality and extend the survival time through the improvement of surgical techniques and individual immunosuppressive regimen.
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Objective To investigate the effects of treatment on end-stage liver disease and diabetes mellitus by simultaneous liver-pancreas-duodenum transplantation with the pancreas of the recipients reserved.Method Simultaneous liver-pancreas-duodenum transplantations were carried out in three patients with the pancreas of the recipients reserved.The diseases of the recipient 1,2,and 3 were alcoholic liver cirrhosis and diabetes mellitus,chronic hepatitis B liver cirrhosis and diabetes mellitus,and chronic hepatitis B liver cirrhosis and diabetes mellitus complicated with renal function failure.The recipient 3 received simultaneous renal transplantation.Result The recipient 1 suffered from pancreatitis after the operation and discharged with normal liver function and blood glucose levels,and he was treated with insulin at 4th year after the operation.Intestinal fistula occurred in the recipient 2 and drainage was done without acute peritonitis,the liver allograft was experienced an acute rejection episode treated by intravenous bolus methylpredisolone at 19th month after operation,but gastrointestinal perforation happened and the patient died of acute peritonitis.In the recipient 3,peripancreatic effusion and pancreatitis happened and were treated by drainage,and the recipient survived to now with normal liver and kidney functions,but given insulin at first year after operation.Conclusion It is effective to implement simultaneous liver-pancreas-duodenum transplantation with the pancreas of the recipients reserved on the patients with end-stage liver disease and diabetes mellitus.However,how to maintain the pancreatic endocrine function after the transplantation for a long period awaits further investigation.
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Objective To investigate the effective regimen and security to treat the hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT).Methods The clinical data of 9 cases of HCV related end-stage hepatopathy after liver transplantation were retrospectively analyzed.Five patients with recurrent HCV after OLT were selected for treatment,and all of them were given pygylated interferon αα-2a and ribavirin.The treatment course was 48 weeks.The changes in hemoglobin,white blood cells,transaminase,and HCV RNA copies were observed before and after treatment.The early viral response (EVR),sustained viral response (SVR) and adverse reactions were assessed.Results Three cases out of 5 cases of HCV recurrence after OLT obtained EVR within 12 weeks,all of them obtained SVR after the treatment,and the function of the transplanted liver returned to normal; In one case,HCV RNA was declined by less than 102 copies after 12 weeks of treatment,and the treatment was terminated; In one case,HCV RNA was declined by greater than 102 copies after 12 weeks of treatment,and at 24th week,HCV RNA was still positive and the treatment was terminated,but HCV RNA remained at a low level at 48th week.Side effects occurred in all 5 cases after antiviral treatment,and alleviated after symptomatic treatment.Conclusion To treat the recurrence of HCV timely after OLT by pygylated interferon (in combination with ribavirin was safe,and the majority of patients could achieved sustained virological response.
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Objective To discuss the curative effect of transplantation using donation after cardiac death (DCD) according with Chinese standard Ⅲ (C-Ⅲ).Methods The organs were obtained from 4 DCDs from 2011 to 2012,and the clinical data of DCD transplantation were retrospectively analyzed.Withdrawal of life support occurred in the operating room.Donor warm ischemia time was 7-15 min.Results The biopsy of liver was performed on the 3rd DCD.Eight cases were subjected to renal transplantations,and 3 to liver transplantations.One patient exhibited delayed graft function of the kidney from the 4th DCD.All patients made an uneventful recovery and were discharged from the hospital without rejection or surgical complication.They were followed up in outpatient department.Conclusion The use of DCD according with C-Ⅲ is an effective way to increase the number of organs available for transplantation,and can obtain satisfactory effects.
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Objective To discuss the surgical procedures and treatment after combined liver and intestinal transplantation with portal venous drainage and enterostomy of two ends in one case.Methods A male patient with liver dysfunction and short bowel syndrome underwent the combined liver and intestinal transplantation.With the techniques of en bloc,the liver and intestinal grafts were harvested from cadaveric donor.The intestinal graft,200 cm long,was implanted with portal venous drainage and aortic inflow,and enterostomy of both ends was performed instead of intestinal anastomosis.The liver graft was placed in a piggyback fashion with end to end anastomosis of the bile ducts without T tube. Inmunosuppression protocol was administrated with campath-1H and tacrolimus.Endoscopic biopsy of intestinal graft was performed regularly,and clinical observation was done to monitor the acute rejection.Results In the first month after operation,abdominal infection was controlled by intraperitoneal drainage with open surgery.One suspect acute rejection was treated with methylprednisolone.Until sixth month,the functions of liver and intestine were progressively restored.However,the patient lost weight and could not be free from intravenous nutrition because of diarrhea.Conclusion Combined liver and intestinal transplantation with portal venous drainage and enterostomy of two ends is a simple surgical procedure with lower risk of surgical complications.This method is propitious to monitoring rejection and function improvement of the grafts.Diarrhea and loss of digestive juice are the main reasons of low body weight and malnutrition.
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Objective To analyze the curative effect of simultaneous liver and kidney transplantation (SLKT) for patients with end-stage liver and kidney diseases and liver cirrhosis patients with hepatorenal syndrome.Methods All SLKTs (n=21) performed at our center from January 1999 to December 2010 were reviewed and SLKT outcomes were compared with those of kidney transplantation (KT) (n=609) and liver transplantation (LT) (n=133) performed during the same period.Results There were 3 deaths due to infection 2 weeks, 6 months and 5 years respectively after operation. One patient died due to multiple organ dysfunction syndrome 2 weeks after operation. One patient was dead 5 years after operation because of rejection. MELD level between SLKT and LT had no significant difference, but serum creatinine in SLKT group was significantly higher than in LT group (516.0±329.9 vs 111.4±138.1 mmol/L, P<0.01). The 1-year acute kidney rejection rate and rate of delayed graft function (DGF) of the kidney had no significant difference between SLKT group (0 vs 9.5 %) and KT group (6 % vs 17.3 %). There was no significant difference in one-, 3- and 5-year patient survival rate between SLKT group (87.7 %, 67.8 % and 67.8 %) and LT group (84.2 %, 73.5 % and 69.4 %).Conclusion SLKT is a safe and effective treatment for end-stage liver and kidney diseases.
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We report a case of reversible hepatofugal portal flow after auxiliary partial orthotopic liver transplantation (APOLT) from a living donor in this study. On postoperative day 6, continuous hepatofugal portal flow was observed in the grafted liver without portal thrombosis and obstruction of the hepatic vein. Based on histological findings, acute rejection was the suspected cause. The normal portal venous flow was restored after steroid pulse and antithymocyte globulin (ATG) therapies. The patient was discharged on the 30th postoperative day. It was concluded that hepatofugal flow after liver transplantation is a sign of serious acute rejection, and can be successfully treated by anti-rejection therapy.
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We report a case of reversible hepatofugal portal flow after auxiliary partial orthotopic liver transplantation (APOLT) from a living donor in this study. On postoperative day 6, continuous hepatofugal portal flow was observed in the grafted liver without portal thrombosis and obstruction of the hepatic vein. Based on histological findings, acute rejection was the suspected cause. The normal portal venous flow was restored after steroid pulse and antithymocyte globulin (ATG) therapies. The patient was discharged on the 30th postoperative day. It was concluded that hepatofugal flow after liver transplantation is a sign of serious acute rejection, and can be successfully treated by anti-rejection therapy.
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Adult , Humans , Male , Antilymphocyte Serum , Therapeutic Uses , Graft Rejection , Hepatic Artery , Diagnostic Imaging , Physiology , Hepatolenticular Degeneration , General Surgery , Immunosuppression Therapy , Methods , Immunosuppressive Agents , Therapeutic Uses , Liver Transplantation , Methods , Living Donors , Portal Vein , Diagnostic Imaging , Tacrolimus , Therapeutic Uses , UltrasonographyABSTRACT
Objective To evaluate the relevant causes of neurologic complications following liver transplantation.Methods 155 adult patients (131 males, 24 females) who received liver transplantation for the first time at Tongji Hospital between January 2005 and September 2009 were identified.Case notes were reviewed and demographic data, details of the liver disease, neurologic complications, MELD score and discharge information were recorded.Results Neurologic complications occurred following 36 transplants (23.2 %), The complications included mental symptoms in 15 cases (41.7 %), disorder of consciousness and action in 9 cases (25 %), and coma in 12 cases (33.3 %).Twelve percent patients with liver cancer experienced a neurologic complication, which was lower than for other transplant indications, like acute and chronic hepatic failure because of HBV infection (33.3 %, P＜0.01), inborn/metabolic disease (40 %, P＜0.05), and HCV Infection (25 %, P = 0.36).Patients who experienced a neurologic problem had significantly higher MELD score (for non-cancer patients:22.93 ± 8.21; for cancer patients:17 ± 5.4) than the other Patients (for non-cancer patients:18.33 + 8.47, P＜0.05; for cancer patients:13 ±3.4, P＜0.01).The rate of infection (36.1 %) and mortality (30.5 %) were significantly higher in patients with neurologic complications (P＜0.01).The levels of ALT, TBil, ALB, PT and the concentrations of serum sodium and chlorine had no impact on neurologic complications.Conclusion Neurologic complications are common in liver transplant recipients.These complications are related to primary disease and liver function before the operation, and increase the rate of infection and mortality.
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Objective To evaluate the efficacy of comprehensive treatment for liver cancer recurrence and metastasis after liver transplantation, and investigate the risk factors affecting the lifespan of patients with liver cancer recurrence and metastasis. Methods Of 29 patients with liver cancer recurrence and metastasis after liver transplantation, 11 patients in the comprehensive treatment group were treated by TACE, microwave coagulation, radiotherapy or hepatectomy, and the remaining 18 patients were classified into chemotherapy group. The differences in efficacy between the 2 treatment modalities were compared, and the factors influencing the patients' lifespan were analyzed. Results Compared with patients in the chemotherapy group, patients in the comprehensive treatment group had significantly longer lifespan after liver cancer recurrence and metastasis (t = 5. 617, P < 0.01). TNM staging, pathological classification, time of postoperative recurrence and metastasis and treatment method were the factors that influence the lifespan of patients with liver cancer recurrence and metastasis after liver transplantation (t =2.843, 3.061,22.781,5.617, P <0.01). Conclusions Comprehensive treatment could prolong the lifespan of patients with liver cancer recurrence and metastasis after liver transplantation. The efficacy of comprehensive treatment is superior to that of the chemotherapy.