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Objective To analyze the donor specific antibody (DSA) in liver transplantation,and discuss the therapeutic schemes.Methods We retrospectively analyzed prospectively collected samples from 139 cases of liver transplantation from September 1,2013 to July 1,2015.Luminex assays were applied to determine human leukocyte antigen,panel reactive antibody (PRA).For PRA positive cases,DSA,C1q and C4d were detected,and liver biopsy was done.Results Of 139 cases enrolled,there were 12 cases positive for DSAs,including 2 cases of PreDSA:1 case of Ⅰ DSA (HLA-A mismatch),and 1 case of Ⅱ DSA (HLA-DQ mismatch).Ten cases of de novo DSA (including 1 case of PreDSA) all were HLA-DQ mismatch.The liver biopsy on 5 cases showed hepatic fibrosis,early rejection and intrahepatic cholestasis,and only 2 cases showed positive C4d.Of 6 cases of DSA,5 cases showed positive C1q.In the patients positive for DSA,tacrolimus dose was adjusted postoperatively,adding mycophenolatemofetil or increasing its dose,or methylprednisolone and immunoglobulin given.Conclusion DSAs are important indicators of sensitized recipients in liver transplantation,associated with trends toward worse outcomes in patients or allografts.The monitoring of DSA is requisite in order to adjust the immunosuppressant.
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Objective To determine the prevalence and risk factors of Epstein-Barr virus (EBV) infection after pediatric liver transplantation for patients with biliary atresia. Methods Clinical data of 65 pediatric patients with biliary atresia, who underwent liver transplantation, were retrospectively analyzed. Patients were divided into EBV infection group (n=30) and non-EBV infection group (n=35). The univariate analysis was used to analyse the preoperative, intraoperative and postoperative data of patients included. The variables with a P <0.1 were included in the multivariate Logistic regression analysis of EBV infections after pediatric liver transplantation for patients with biliary atresia. Results A total of 30 cases (46.15%) of pediatric recipients showed EBV infection in 65 cases, of which 23 cases (76.67%) occurred within 3 months after operation. The univariate analysis showed that there were significant differences in the ratio of patients younger than 1 year preoperation, EBV serology D+/R-, acute rejection, the usage of mycophenolate mofetil and supratheraputic tacrolimus level between two groups (P<0.05) . The type of graft (P=0.060), input quantity of red blood cell intraoperation (P=0.063) and factors mentioned above were included in the multivariate Logistic regression analysis. It revealed that donor EBV serology positive but recipient negative, acute rejection and supratheraputic tacrolimus level were risk factors of EBV infection for pediatric liver transplantation recipients with biliary atresia. Conclusion Donor EBV serology positive but recipient negative, acute rejection, supratheraputic tacrolimus level are closely related to EBV infection in pediatric recipients with biliary atresia after liver transplantation. Appropriate antiviral drugs should be adopted to prevent EBV infection in high risk patients.
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Objective To summarize the clinical characteristics and treatment of rotavirus infection after liver transplantation in children.Methods Thirty nine children undergoing liver transplantation in Beijing Friendship Hospital affiliated to Capital Medical University from October to December 201 4 were retrospectively analyzed.And 6 cases were infected with rotavirus after liver transplantation.Characteristics of clinical symptoms,complications,treatments and prognosis in these six children were retrospectively analyzed.Results Six cases were diagnosed with rotavirus infection at 8-1 97 d after liver transplantation with a median time of 22 d,3 cases of whom mainly manifested as high fever,diarrhea and vomiting and the remaining 3 presenting with diarrhea.The longer interval time between rotavirus infection and liver transplantation was,the slighter degree of rotavirus infection-related symptoms was.Among 6 cases,5 cases were complicated with EB virus,cytomegalovirus or respiratory syncytial virus,and 2 cases were complicated with abnormal liver or heart function.The main treatment was decreasing the dose of FK506.Gamma globulin was administered in partial affected children to enhance immunity.Effective therapy was delivered to regulate intestinal tract bacterial colony and relieve diarrhea.All children recovered after oral use of antibiotics and supporting therapy using fluid infusion.Two cases complicated with severe cardiac and liver function abnormality were healed after expectant treatment.Conclusions Rotavirus infection-related symptoms are relatively severe after liver transplantation in children,occasionally complicated with cardiac and liver function injury,which can gradually return to normal after efficacious therapy.