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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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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 summarize the incidence of acute rejection (AR) after pediatric kidney transplantation (KT) at a single center and examine its impact on graft/patient survival and risk factors for AR.Methods:This is a retrospective cohort study including pediatric recipients who underwent kidney transplantation in past 8 years.After excluding recipients of graft thrombosis within a week post-transplant and lost to follow-ups, a total of 143 cases were ultimately recruited and assigned into two groups of AR (n=29) and non-AR (n=114).Basic profiles of both donors and recipients and graft/patient survival rate were compared between two groups.Relative risk factors for AR episodes were also examined by Logistic regression.Results:Renal grafts for 130/143 cases (90.9%) were harvested from deceased donors and 120(83.9%) cases from children.Twenty-seven transplants (18.9%) were performed in infants and young recipients aged < 3 years.During a median follow-up of 33 months, 34 AR episodes occurred in 29(20.3%) patients.Rate of re-transplantation (27.6% vs. 7.9%), pediatric donor (96.5% vs. 80.7%) and rabbit anti-human thymocyte globulin (rATG) induction (79.3% vs. 36%) were significantly higher in AR group than non-AR group ( P=0.007, P=0.046, P<0.001).Multivariate regression analysis indicated that basiliximab induction caused a significant reduction in the risk of AR incidence as compared with rATG induction (odds ratio 0.13, 95% confidence interval 0.04-0.43, P<0.001).The median time of AR incidence was 1.3 months post-transplantation and 23 episodes (67.6%) were confirmed by biopsy.After anti-rejection treatment, 52.9%(n=18) of the cases achieved a full recovery and 38.3% (n=13) had improved graft function.However, 3 cases (8.8%) developed irreversible graft failure.The 1/3-year graft survival rates were significantly lower in AR group than those in non-AR group (75.3% vs. 95.2%, 68.4% vs. 90.4%, P=0.01), and there was no significant difference in 1-and 3-year patient survival rates between two groups. Conclusions:The incidence of AR is relatively high in pediatric renal transplantation, which has an impact on graft survival.Basiliximab induction can effectively reduce the risk of AR.
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In recent years, although the quantity of organ donation after citizen's death has been constantly increased, a large number of patients with end-stage renal diseases are waiting for kidney transplantation every year. The imbalance between donor and recipient is still one of the main problems affecting kidney transplantation in clinical practice. Therefore, it is of clinical significance to accurately evaluate the quality of donor kidney and fully utilize the expanded criteria donor kidney. Contrast-enhanced ultrasound has been gradually applied in the detection of multiple solid organs due to its safety, portability, real-time detection, quantification and other characteristics, and it also has promising application prospect in the evaluation of donor kidney quality. In this article, the advantages and limitations of current evaluation methods for donor kidney and current status and advantages of contrast-enhanced ultrasound in donor kidney evaluation were reviewed, and the application prospect of contrast-enhanced ultrasound in the evaluation of donor kidney quality was discussed, aiming to increase the methods and enhance the accuracy for donor kidney evaluation, and provide reference for rational use of expanded criteria donor kidney.
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Objective:To explore the safety and feasibility of optimized pathological evaluation system of donor's kidney and modified surgery during adult dual kidney transplantation(DKT)and evaluate its effectiveness to provide more alternative protocols for kidney transplantation from extended criteria donors.Methods:DKT was performed in 10 recipients using the same protocol from June 2019 to May 2021.And retrospective reviewing was performed for clinical data, including characteristics of donors and recipients, optimized pathological evaluation system, modified surgery, treatment regimens, complications and follow-ups.Results:There were 8 male and 2 female donors with an age of(57.9±12.8)years and BMI(24.1±4.1)kg/m 2.The percentage of DCD was 70% and DBD 30%.The serum creatinine before procurement was 107.6(93.3-163.5)μmol/l.Zero-point puncture biopsy was performed for both kidneys and optimized pathological evaluation system was implemented(Banff criteria & Remuzzi score). The pathological results indicated that glomerular sclerosis for left and right kidneys were 2.0(1.5-2.0)and 1.5(1.0-2.0). And Remuzzi score for left and right kidneys were(4.4±1.2)and(3.6±1.5)points respectively.All recipients were male with an age of(43.1±9.0)years and BMI(22.2±1.9)kg/m 2.All PRAs were negative pre-operation.Modified surgery was performed in all recipients(two kidneys were implanted outside iliac vessels without patch and artery of superior kidney was anastomosed to internal iliac artery). Operative duration was(195±54.3)min and serum creatinine before discharge 125.0(102.0-199.0)μmol/L.Renal dynamic scintigraphy indicated that glomerular filtration rate was(30.0±8.2)ml/min for left kidney and(29.2±13.9)ml/min for right kidney.MRA results indicated that morphologies of renal arteries and veins were regular.The time between operation and discharge was(22.4±4.7)days.Compared with SKT, serum creatinine before discharge of DKT was lower and DGF incidence of DKT was higher without statistical significance.The time between operation and discharge was longer for DKT than that for SKT( P<0.05). The complications consisted of 20% donor derived infection(DDI)and 50% DGF.And there was no surgical complication associated with vessels and ureter.Renal function remained stable during 6-month follow-ups. Conclusions:Optimized pathological evaluation system of donor's kidney and modified surgery during adult dual kidney transplantation are both safe and feasible.The postoperative function of transplanted dual kidney is successfully restored.However, long-term follow-ups are required for evaluating its effectiveness.
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Objective:To explore the advantages and disadvantages of frozen section versus rapid paraffin section in the evaluations of donor organ.Methods:Five cases of donor liver and 8 cases of discarded donor kidney were collected from 2017 to 2021.Tissues were harvested and prepared by frozen section, rapid paraffin section and normal paraffin section.After hematoxylin-eosin (H&E) staining, the specimens of donor kidney/liver were evaluated by differential histopathological structures and donor quality scoring system.Results:Rapid paraffin section was similar to normal paraffin section in reflecting the proportion of glomerulosclerosis (18.6%±22.3%), arteriolar hyaline degeneration (43.7%±23.8%) and arteriolar stenosis (47.9%±29%). The proportion of glomerulosclerosis (0.8%±2.2%), arteriolar hyaline degeneration (4.9%±7.4%) and arteriolar stenosis (5.3%±7.5%) were lower in frozen sections than those in rapid paraffin sections.The diagnoses of hydropic degeneration and necrosis in donor liver were more accurate in rapid paraffin section.Conclusions:Rapid paraffin section is superior to frozen section in observing histopathological changes under microscope.Scoring of donor organ is more precise according to rapid paraffin section.
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Objective:To explore the efficacy of sirolimus-based immunosuppressive protocol on tumor recurrence and tumor-free survival after liver transplantation(LT)in hepatocellular carcinoma (HCC)patients.Methods:From January 1, 2016 to December 31, 2018, a total of 114 HCC patients undergoing LT were recruited and divided into two groups of sirolimus(SRL)and tacrolimus. Univariate and multivariant analyses were performed for evaluating the risk factors of recurrence after LT. Tumor-free survival were compared using Cox logistic regression analysis.Results:Tumor recurrence and/or metastasis occurred in 45 patients. Univariate and multivariate regression analysis indicated that sirolimus was an independent protective factor for preventing tumor recurrence( P=0.005, HR=0.38, 95% CI 0.193~0.748). The median tumor-free survival time was 5(4~19)months in tacrolimus group and 23(13~31)months in sirolimus group. No inter-group statistical difference existed in incidence of infection or rejection complications( P>0.05). Conclusions:HCC patients benefit from sirolimus-based immunosuppressive protocol after LT. And sirolimus may reduce tumor recurrence rate and prolong tumor-free survival time.
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The procurement, preservation and transportation of the donor organs directly affect the clinical prognosis of the recipients. The establishment of process optimization and quality control standards of organ procurement, preservation and transportation contributes to improving the quality and utilization rate of donor organs and reducing the medical risk. According to Guide to the Quality and Safety of Organs for Transplantation (6th edition) proposed by European Union, the 11th chapter of organ procurement, preservation and transportation was interpreted and summarized in this article.
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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 clinical outcome of single kidney transplantation from pediatric donors and to explore the application criteria.Methods The clinical data of 14 recipients undergoing renal transplantation from October 2006 to October 2016 were retrospectively analyzed.All the recipients received primary kidney transplantation from pediatric donor and the renal artery was anastomosed with external iliac artery.Based on the length of the kidney donor,the recipients were divided into two groups as group A (length beyond 6 cm) and group B (length 5-6 cm).The clinical effect and complications of the 14 recipients,the survival of the recipients and grafts,the recovery of renal function,the change of the renal length and the postoperative complications were compared between the two groups.Results The renal length in group A (n =7) was (7.5 ± 1.2) cm,and (5.7 ± 0.1) cm in group B (n =7).During the follow up period,all renal grafts and recipients survived.No significant difference was observed between two groups in renal graft function evaluated by serum creatinine and estimated glomerular filtration rate (eGFR) at 7th day,14th day,1st,2nd,3rd and 6th month postoperatively,P＞0.05.The length of transplanted kidney increased after operation in both groups,with results of 9.9 ± 0.6 cm in group A and 10.4 ± 1.5 cm in group B (P＞0.05),respectively,at 2nd month post-transplantation.Delayed graft function (DGF) occurred in 2 cases of group A and 1 case of group B.Seven cases developed proteinuria (50.0％),including 2 cases in group A (28.6％) and 5 cases in group B (71.4％).Four cases suffered hematuria (28.6％),including 2 cases in group A (28.6％) and 2 cases in group B (28.6％).One recipient in group B suffered acute rejection.No vascular embolization,urine leakage,pulmonary infection and other complications were observed in all the recipients.Conclusion The length beyond 5 cm is acceptable for single pediatric kidney donor for adult recipients with a promising clinical outcome in short-term.However,the high incidence of proteinuria and hematuria remains obstacle,and the long-term outcome needs further exploration.
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Objective To investigate the value of different biopsy methods for quality evaluation of the donated kidney organ after citizen death.Methods Six cases (6 pairs) of discard donor kidneys were collected from October 2016 to May 2017,respectively,and grouped by wedge biopsy and core needle biopsy.After being fixed and processed for routine paraffin embedding and hematoxylin-eosin (H&E) staining,the specimens were evaluated by the qualified rate of sample,the number of glomerulus,sclerotic glomerulus and small arteries.Results The comparison of two different biopsy methods showed that the number of samples obtained by wedge biopsy was 30.There were 29 samples which were qualified and the qualification rate was 96.7％.The number of samples obtained by core needle biopsy was 30,and only 21 samples were qualified and the qualification rate was 70％.In the wedge biopsy samples,the average number of glomeruli was 22.1 and 6.9 of them were sclerotic glomeruli.The ratio of sclerotic glomeruli was 31.3％.The average number of glomeruli in core needle biopsy samples was 9.5 and 2.1 of them were sclerotic glomeruli.The ratio of sclerotic glomeruli was 22.1 ％.The average number of arteries in wedge biopsy samples was 5.4,and that in core needle biopsy samples was 3.9.The results indicated that the qualification rate of wedge biopsy was significantly higher than that of core needle biopsy (P＜0.01).The number of glomeruli,sclerotic glomeruli and small arteries in wedge biopsy samples was significantly greater than than in core needle biopsy (P＜0.05).Conclusion Wedge biopsy was superior to core needle biopsy for the quality evaluation of specimens and identifying clinically significantly histopathological findings.Thus it is potential for wedge biopsy to become the main method in pre-implantation histopathological evaluation.
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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 summarize the effect of professional organ procurement team at Tongji Hospital in Chinese donation after citizen's death.Methods A retrospective analysis was done on the clinical data of 335 cases of organ acquisition by the professional organ procurement team of Tongji Hospital,including 27 infant donors and the efficiency of the team was assessed.Results Retrospective analysis on the clinical data of 335 cases of organ acquisition by the professional organ procurement team of Tongji Hospital,including cases of 27 infant donors and assessment on the efficiency of the team.Conclusion The establishment of a professional organ procurement team is to standardize the procurement procedure and shorten the time in pre-surgical preparation and operation,decreasing the errors and deviations caused by human factors in the procurement process.
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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 analyze the clinical effects of the diverse prevention strategies on donation after citizen's death (DCD) donor fungal infection.Methods A retrospective study was performed on the clinical data of the antifungal preventive scheme to 261 DCD donors from January 2015 to August 2015 (the first period) and September 2015 to December 2016 (the second period) in Tongji Hospital.During the first period,the donors were administrated by ICU doctors and the antifungal agents were not applied as routine.The processes of organ procurement and trim were in accordance with the past experience.During the second period,the donor maintenance was reinforced,including antifungal preventive scheme,aseptic manipulation of organ procurement and rinsing and immersing allografts with broad-spectrum antibiotics or diluting povidone-iodine solutions during organ trim.Microbial culture specimens were performed in 1 574 samples including blood samples,perfusion fluids and arterial tissues and the pathogen distribution at the different periods was identified.Result In the microbial culture specimens of 1 574 samples,907 strains of pathogens were detected,including 799 strains of bacteria and 108 strains of fungi.The positive rate of fungi was 12.0％ (108/907) of all pathogens,and 17.3％ (108/626) of fungal cultures specimens.The fungi positive rate in the second period (13.6％,59/433) was significantly lower than that in the first period (25.4％,49/193,P＜ 0.05).Conclusion It is essential to reduce the incidence of donor fungal infection by increasing the microbial cultures and antifungal preventive scheme.And it is necessary that the organ procurement organization team enhances the risk awareness of donor-derived fungal infection and improves the aseptic manipulation of organ procurement.Additionally,rinsing and immersing allografts with broad-spectrum antibiotics or diluting povidone-iodine solutions may be a better option for preventing the donor-derived fungal infection during the allograft trim.
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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 Budd-Chiari syndrome is apt to be misdiagnosed,so we explore its diagnosis and treatment by liver transplantation.Methods We retrospectively analyzed the clinical data of two patients who underwent liver transplantation for Budd-Chiari syndrome.One patient was misdiagnosed before the transplantation and another was diagnosed correctly.Results Both patients were grouped to Child C category with decompensated liver cirrhosis.Patient 1 was diagnosed as recurrent hepatocellular carcinoma,but the etiology of liver disease was first unknown then suspected to be schistosomiasis.This patient underwent piggyback liver transplantation.Because there was significant swelling in the perineum and lower extremities after liver transplantation,we re-reviewed the preoperative imaging data and found communicant veins between hepatic veins,which proved that the patient was actually suffered from Budd-Chiari syndrome with hepatic vein and suprahepatic vena cava occlusion before the transplantation.After conservative treatment,the swelling of the lower body was alleviated,however,the long-term survival of the patient would be compromised.Learning from the first case,we found communicant veins between hepatic veins in imaging data of patient 2,resulting in correct diagnosis of Budd-Chiari syndrome with hepatic vein and retrohepatic vena cava diseases before the transplantation,so the patient underwent orthotopic liver transplantation,in which the liver and retrohepatic vena cava were resected,and recovered uneventfully.Liver function was normal during the follow up period of 7 months.Conclusion We should consider the possibility of Budd-Chiari syndrome in patients with unexplained end-stage liver diseases.Communicant veins between the hepatic veins shown in thin CT or MRI image are the characteristic sign for diagnosing Budd-Chiari syndrome.Simultaneously hepatic vein or cava vena disease determines the choice of various technique of liver transplantation.
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Objective To explore the factors associated with the quality of life (QOL) in patients after liver and kidney transplantation.Methods A multicenter cross-sectional survey was carried out in 5 Level Ⅲ Class A hospitals.153 liver transplant recipients and 301 kidney transplant recipients of outpatient clinic follow-up from March to December in 2015 were selected and investigated with a self-designed general state questionnaire,and Quality of Life Scale for Liver and Kidney Transplant Recipients which developed by our research group.Results There were significant differences in QOL total score in liver and kidney transplant recipients among groups of marital status and occupation.Divorced,unemployed and low-educated patients showed lower QOL total score than married,employed and high-educated ones (P ＜ 0.05).As compared with non-living-related transplantation group,patients undergoing living-related transplantation presented a better status in QOL total scores (P＜0.05).The QOL total score was obviously lower in patients suffering from complications and rejection than in those without occurrence of complications and rejection (P＜ 0.01).Postoperative time was correlated positively and significantly with QOL scores,and variances existed among different stages postoperation (P ＜ 0.01).Multivariable regression analysis demonstrated that education,marital status,postoperative time,type of donor and chemotherapy were the factors influencing liver transplant recipients' QOL,while marital status,postoperative time,type of donor,medical care assurance,complications and rejection after operation had effect on kidney transplant recipients.Conclusion Attaching importance to QOF among liver and kidney transplant recipients,and implementing scientific and effective nursing intervention based on the characteristics of them are necessary.
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Objective To Establish an evaluation system of the quality of life for Chinese liver and kidney transplant recipients,and develop a specialized scale to measure the quality of life (QOL)for such recipients preliminarily.Methods By combining subjective and objective methods,this study determined the evaluation system and created items of QOL scale based on literature analysis,Delphi method (expert consultation),interviews,and experience of researchers.Then,a nationwide clinical survey was conducted on 5 Level Ⅲ Class A hospitals.454 valid questionnaires were collected,including 153 from liver recipients,and 301 from kidney recipients.Subjective statistical methods such as critical Ratio method,correlation coefficient method,dispersion tendency method,and exploratory factor analysis were used for selection of questionnaire items.Results The study established an evaluation system of QOL for liver and kidney transplant recipients,including 4 primary indexes and 12 secondary indexes,and developed QOL scales that were appropriate for liver and kidney transplant recipients respectively.Conclusions The structure of QOL scale for liver and kidney transplant recipients was basically consistent with theoretical assumption.The QOL scale for patients showed good reliability and validity,therefore,it can fully reflect the quality of their life.
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Objective To analyze the outcomes of renal transplantation from donation after citizen death (DCD) in our single center.Method We retrospectively investigated the recipient outcomes of renal allografts from DCD.Between November 2010 and 31st December 2014,our institution performed 242 renal transplants from DCD.Outcome variables (survival of recipients/allografts and adverse events) and characteristics of marginal donor transplants were analyzed.Result There were 139 males and 44 females in the enrolled 183 donors,and the range of age was from 2 days to 68 years.183 donors included 102 cases of donation after brain death (category Ⅰ),22 cases of donation after circulatory death (category Ⅱ) and 59 cases of donation after brain death followed by circulatory death (category Ⅲ).Utilizing these renal allografts,we performed 242 kidney transplantations including 237 single kidney transplants and 5 pediatric en bloc kidney transplants.The age of recipients ranged from 12 to 64 years.The data indicated that the 1-year recipient/allograft survival rate was 93.8％ and 90.5％,respectively.The rate of delayed graft function (DGF) was 33.1 ％,higher than that from executed prisoners allografts (23.6％,P＜0.05).However,the rate of 1-year acute rejection,interstitial pneumonia and the other adverse events (urinary fistula,ureteral obstruction and cardiac and cerebral vascular accident,etc.) was similar to that from executed prisoners allografts.In addition,good results from pediatric and elder donor renal transplantation were shown in our data,even though the discard rate of elder donor kidney was high.Conclusion By comprehensive evaluation,strictly screening donors and enhancing the rnanagenent of donors,the long-term survival of recipients may be prolonged and the incidence of DGF and primary graft non-function (PNF) may be decreased.The marginal donors from pediatric and elder DCD donors could be utilized in clinical transplantation safely and effectively as long as reasonable evaluation was carried out.