Risk Factors for Preoperative Anxiety and Depression in Patients Scheduled for Abdominal Aortic Aneurysm Repair / 中华医学杂志(英文版)

Background@#Perioperative emotional disorders of patients underwent abdominal aortic aneurysm (AAA) repair is an emerging area of study, and preoperative mental distress of those patients remains poorly understood. The aim of this study was to investigate the prevalence and identify the risk factors of preoperative anxiety and depression in patients scheduled for AAA repair.@*Methods@#A total of 189 patients who underwent elective AAA repair between 2015 and 2016 were included in this study. These patients were preoperatively evaluated by Hospital Anxiety and Depression Scale (HADS). Demographics and anxiety and depression scores of the patients were documented. Logistic regression was used to identify the independent risk factors of preoperative anxiety and depression.@*Results@#A total of 150 AAA patients were included in final analysis. Of these 150 patients, 44 patients (29.3%) had borderline anxiety or clinical anxiety, and 42 patients (28.0%) were found to have borderline or clinical depression. Female (odds ratio [OR]: 2.81, 95% confidence interval [CI]: 1.08-7.26), the American Society of Anesthesiologists (ASA) Grade 3/4 (OR: 4.34, 95% CI: 1.13-16.68), higher education (OR: 1.44, 95% CI: 1.02-2.04), and abdominal or back pain (OR: 3.08, 95% CI: 1.20-7.87) were identified as significant independent risk factors of abnormal HADS-anxiety in overall patients; and higher level of education (OR: 1.87, 95% CI: 1.16-3.01) was predictive of anxiety in patients planned for endovascular aortic repair. Besides, higher body mass index (BMI) (OR: 1.18, 95% CI: 1.04-1.33) and abdominal or back pain (OR: 3.93, 95% CI: 1.70-9.11) were predictive of abnormal preoperative HADS-depression in overall patients.@*Conclusion@#As for patients scheduled for AAA repair, female, higher ASA, higher level of education, and symptom may be independent risk factors for preoperative anxiety, and symptom and higher BMI may predict preoperative depression.

Augmented hepatic regeneration of living donor liver graft by intraportal insulin administration / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of postoperative intraportally administration of insulin on hepatic regeneration in adult patients underwent living donor right lobe liver transplantation (LDLT).</p><p><b>METHODS</b>From July 2005 to September 2007, 15 right lobe LDLT adult recipients voluntarily receiving posttransplant intraportal insulin administration, without postoperative vascular and bile duct complications, without immune rejection, with more than 1 month survival and complete clinical data were enrolled in this study as intraportal insulin-therapy group (Group I). Another consecutive 15 right lobe LDLT adult recipients meeting the upwards referred criteria were enrolled in as non-insulin-therapy control group (Group NI). Recipients in Group I were treated postoperatively with intraportal insulin infusion, as follows: a 18-gauge catheter was inserted into right gastro-omental vein during surgery, regular insulin was administered just after the operation at the rate of 2 units/hour for 7 days. Liver function and serum insulin level were measured at before-operative day 1, postoperative day (POD) 7 and 30. Graft volume (GV) were measured during operation, and at POD 7 and 30.</p><p><b>RESULTS</b>The rate defined as ratio of POD 7 GV/operation GV in Group I was higher than that of Group NI [(186.1 +/- 35.4)% vs. (160.6 +/- 22.1)%, P < 0.05]. The rate defined as ratio of POD 7 GRWR/operation GRWR was also higher in Group I than Group NI [(179.0 +/- 35.8) % vs. (156.6 +/- 18.5%, P < 0.05], whereas significant differences were not appeared between two groups in terms of regeneration rates at POD 30. Serum levels of total bilirubin, aspartate aminotransferase and alanine aminotransferase in Group I were lower than that in Group NI at POD 7 (P < 0.05). Significant differences were not presented between two groups in terms of post-transplant serum insulin levels and total insulin dosage by subcutaneous administration and venous injection (P > 0.05).</p><p><b>CONCLUSIONS</b>These results suggest that intraportal insulin administration could augment liver graft regeneration during the first postoperative week.</p>

Evaluation of the effect of living donor liver transplantation on the treatment of severe hepatitis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate the effect of living donor liver transplantation on the treatment of severe hepatitis.</p><p><b>METHODS</b>18 patients with severe hepatitis received liver transplantation (transplanted severe hepatitis group), 28 patients with sever hepatitis received non surgical treatment (non-transplanted severe hepatitis group), and 30 patients with end stage liver cirrhosis (without cancer) received liver transplantation (transplanted cirrhosis group). The vital sign, blood coagulation, and renal function were monitored during operation. After liver transplantation, patients received immunosuppressive therapy (including tacrolimus or cyclosporine A, mycophenolate, mofetil and corticosteroids), intensive care, antiviral therapy (including lamivudine and HBIg) and other treatments (including restoration of liver function and prevention of blood coagulation). Pre-operation data, operation procedure, liver function, renal function and the operation complications of three groups were compared, and survival rate at 1, 6 and 12 months after operation was followed.</p><p><b>RESULTS</b>There was no significant difference in the operation time, warm ischemia time, hypothermic ischemia time and Graft-to-recipient weight ratio between the two transplantation groups. The blood loss volume and blood transfusion volume in the transplanted severe hepatitis group were higher than that those in the cirrhosis transplantation group (t = 0.001, 0.004). The levels of TBil, ALT and AST at day 7 after operation were (100.5 +/- 96.4)mumol/L, (215.3 +/- 195.7) U/L , (209.8 +/- 188.6) U/L in the transplanted severe hepatitis group, and (53.3 +/- 31.9)mumol/L, (56.3 +/- 22.1) U/L, (51.3 +/- 13.5) U/L in the transplanted cirrhosis group (t = 0.017, 0.021, 0.004). However, there was no significant difference in the levels of Alb and Cr between these two groups (P > 0.05). Survival rate was 88.89%, 83.33% 83.33% in the transplanted severe hepatitis group, and 96.67%, 93.33% 93.33% in the transplanted cirrhosis group at 1, 6 and 12 months after transplantation.</p><p><b>CONCLUSION</b>Living donor liver transplantation is one of effect ways for the treatment of severe hepatitis.</p>

Outcomes of adult-to-adult living donor liver transplantation: a single center experience / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Since January 2002, adult-to-adult living donor liver transplantation (AALDLT) has gained increasing popularity in China in response to the shortage of cadaveric donor livers. This study presents a detailed analysis of the outcomes of AALDLT in a single center.</p><p><b>METHODS</b>A total of 70 patients underwent AALDLT at our center between January 2002 and January 2007. Among these, 67 patients received a right lobe graft without the middle hepatic vein and 3 patients received dual grafts. Three-dimensional volumetric computed tomography, magnetic resonance imaging with angiography and cholangiography were performed preoperatively. Recipient operation time, intraoperative transfusion requirement, length of intensive care unit stay, length of hospital stay, liver function tests, coagulation tests and surgical outcomes were routinely investigated throughout this study.</p><p><b>RESULTS</b>All donors survived the procedure with an overall complication rate of 15.3%. Overall recipient 1-year survival and complication rates were 87.1% and 34.2%, respectively. Among the 70 cases, average graft recipient weight ratio was 0.94% (0.72% - 1.43%) and average graft volume/standard liver volume ratio was 46.42% (31.74% - 71.68%). All residual liver volumes exceeded 35%. Liver function and coagulation recovered rapidly within the first 7 days after transplantation.</p><p><b>CONCLUSIONS</b>AALDLT is a safe procedure for the donors and an effective therapy for patients with end-stage liver disease. Patient selection and timely decision-making for transplantation are essential in achieving good outcomes. With accumulation of experience in surgery and clinical management, timely feedback and proper modification, we foresee better outcomes in the future.</p>

Hepatic arterial reconstruction and complications management in adult-to-adult living donor liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the experience of hepatic arterial reconstruction and its management of complications in adult-to-adult living donor liver transplantation (A-A LDLT) using right lobe liver grafts.</p><p><b>METHODS</b>From January 2002 to July 2006, 50 of A-A LDLT using right lobe liver grafts were performed. All arterial anastomosis were performed to protect the donor hepatic arterial supply, in which donor right hepatic artery was sutured to recipient right hepatic artery in 24 patients, to recipient proper hepatic artery in 12 patients, to recipient left hepatic artery in 3 patients, to recipient common hepatic artery in 2 patients, to recipient aberrant right hepatic artery arising from superior mesenteric artery in 2 patients. Interpositional bypass using autogenous saphenous vein was performed between donor right hepatic artery and recipient common hepatic artery in 2 patients. Bypass was done between donor right hepatic artery and recipient abdominal aorta using autogenous saphenous vein in 2 patients and using stored cadaveric iliac vessels in 2 patients respectively. The diameter of donor right hepatic artery is between 1.5-2.5 mm, microsurgical technique was used under the magnified lobe of 3.5 times and operative microscope of 5-10 times.</p><p><b>RESULTS</b>In these series, hepatic artery thrombosis (HAT) occurred in 2 recipients on 1st and 7th days following A-A LDLT (4%), which were revascularized with autogenous saphenous vein between donor right hepatic artery and recipient abdominal aorta immediately, HAT in 1 recipient occurred one and a half month following A-A LDLT, but no symptom was presented. No hepatic artery stenosis and aneurysm occurred during follow-up period. No death related to hepatic artery complications occurred. All recipients were followed up from 2 to 52 months (mean follow-up 9 months). 1-year survival rate was 92%.</p><p><b>CONCLUSIONS</b>Proper anastomotic vessel choose and use of microsurgical technique in hepatic arterial reconstruction would reduce significantly the incidence of hepatic artery complications and provide an excellent graft survival following A-A LDLT.</p>

Excision and reconstruction of anomalous portal venous branching in adult-to-adult right lobe living donor liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the techniques for excision and reconstruction of anomalous portal venous branches (APVB) in adult-to-adult right lobe living donor liver transplantation (A-A RL LDLT).</p><p><b>METHODS</b>From February 2002 to April 2007, 70 cases of A-A RL LDLT were performed. Preoperative three-dimensional computed tomography of the donor revealed the configurations of hepatic artery, portal vein and hepatic vein. Nine donors had anomalous portal venous branching (APVB). The APVB were type II (trifurcation) in 7 cases and type III in two. Except the excision of APVB with a common opening by a narrow bridge of main portal vein tissue in one type II donor, all the right APVB were transected on the principal of donor priority: right APVB being excised approximately 2-3 mm from the confluence while leaving the donor's portal vein intact. In type II APVB, the donor portal venous branches were transected with separate two openings and reconstructed as double anastomoses in 4 cases, with separate two openings joined as a common orifice at the back table and reconstructed as single anastomoses in 2 cases, and with one common opening with narrow-bridge of tissue and reconstructed as single anastomoses in 1 case. In type III APVB, the APVB were transected with separate two openings and were reconstructed by double anastomoses in 1 case and by a new technique named U-shaped vein graft interposition in the another one.</p><p><b>RESULTS</b>There were no vascular complications such as portal vein stricture or thrombosis, hepatic artery stricture or thrombosis and hepatic vein outflow stricture in all 9 recipients transplanted with grafts with APVB. Only the type II APVB donor undergoing a excision of APVB with a common opening by a narrow bridge of main portal vein tissue developed portal vein thrombosis on the third postoperative day and underwent thrombectomy followed by repair with vein patch plasty. The velocity of blood flow in the U-graft was normal.</p><p><b>CONCLUSIONS</b>It is feasible and safe of APVB excision on the principal of donor priority and reconstruction including double anastomoses and the novel U-graft interposition in A-A RL LDLT, and has a good outcome without increasing the management difficulty.</p>

Evaluation of living donor liver transplantation for patients with hepatocellular carcinoma / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate the donor risks and potential recipient benefits of living donor liver transplantation (LDLT) for adult patients with hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>From January 2002 to December 2006, a total of 27 LDLT for HCC patients were performed in our center, of which 25 received right lobe grafts and 2 received dual grafts. The clinical and follow-up data of these 27 recipients and 29 donors were analyzed retrospectively.</p><p><b>RESULTS</b>Of the 29 donors, the overall complication rate was 17.24% (5 cases). Two cases (6.90%) experienced major complications (one with intra-abdominal bleeding and one with portal vein thrombosis) and three cases (10.34%) experienced minor ones (fat necrosis and infection of the surgical skin wound in one, pleural effusion in another and transient chyle leakage in the third). All donors were fully recovered and returned to their previous work. No recipients developed small-for-size syndrome. The overall HCC patients survival rate at 1- and 3-years was 84.01% and 71.40%, respectively, similar to that of patients undergoing LDLT for various nonmalignant diseases during the same period (P > 0.05).</p><p><b>CONCLUSION</b>Although further study is needed to fully assess the risks and benefits of LDLT for the HCC patients and donors, our present results preliminarily suggest that LDLT offers an acceptable chance and duration of survival in patients with HCC, and it is a relatively safe procedure.</p>

Hepatic venous outflow reconstruction in adult right lobe living donor liver transplantation without middle hepatic vein / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It is difficult and challenging to reconstruct hepatic venous outflow in adult right lobe living donor liver transplantation (LDLT) without the middle hepatic vein (MHV). Excessive perfusion of the portal vein and venous outflow obstruction will lead to acute congestion of the graft, ultimately resulting in primary nonfunction. Although various reconstruction patterns have been explored in many countries, there is currently no clear consensus. In this study we describe a technique to prevent "chocking" of the graft at the outflow anastomosis with the inferior vena cava (IVC) in LDLT using right lobe graft without the MHV.</p><p><b>METHODS</b>A retrospective analysis was conducted on clinical data from 55 recipients undergoing LDLT using right lobe grafts without the MHV or reconstruction of hepatic venous outflow. The donor's right hepatic vein (RHV) was anastomosed with a triangular opening of the recipient IVC; the inferior right hepatic vein (IRHV), if large enough, was anastomosed directly to the IVC. The great saphenous vein (GSV) was used for reconstruction of significant MHV tributaries.</p><p><b>RESULTS</b>No deaths occurred in any of the donors. Of the 55 recipients, complications occurred in 6, including hepatic vein stricture (1 case), small-for-size syndrome (1), hepatic artery thrombosis (1), intestinal bleeding (1), bile leakage (1), left subphrenic abscess and pulmonary infection (1). A total of three patients died, one from small-for-size syndrome and two from multiple system organ failure.</p><p><b>CONCLUSIONS</b>The multiple-opening vertical anastomosis was reconstructed with hepatic vein outflow. This technique alleviates surgical risk of living donors, ensures excellent venous drainage, and prevents vascular thromboses and primary nonfunction.</p>

Liver transplantation for chronic hepatitis B patients with lamivudine monotherapy or lamivudine combined with individualized low-dose hepatitis B immunoglobulin treatment / 中华肝脏病杂志

<p><b>OBJECTIVE</b>The aim of this study was designed to evaluate the outcomes of liver transplant recipients with chronic hepatitis B (CHB) receiving either lamivudine monotherapy or lamivudine combined with individualized low-dose hepatitis B immunoglobulin (HBIG) therapy.</p><p><b>METHODS</b>A total of 111 liver transplant recipients with CHB were divided not randomly into two groups according to the availability of HBIG before liver transplantation (LT). Thirty-two patients received lamivudine monotherapy (100 mg/d) and 79 patients received lamivudine (100 mg/d) combined with individualized low-dose HBIG (intramuscular administration) to maintain the titer of antibody to hepatitis B virus (HBV) surface antigen (anti-HBs) not less than 100 U/L. The patients were followed-up for a median time of 32 months (1 to 88 months).</p><p><b>RESULTS</b>In the lamivudine monotherapy group, 5 patients hepatitis B relapsed (3/5 developed YMDD mutants of HBV), with 1-, 2-, and 3-year cumulative recurrence rates of 7.1%, 14.3% and 17.9% and survival rates of 87.5%, 84.4% and 74.6%. In the lamivudine and HBIG combination therapy group, 2 patients hepatitis B relapsed (2/2 developed YMDD mutants of HBV), with 1-, 2-, and 3-year cumulative recurrence rates of 0, 1.8% and 5.7% (P < 0.01) and survival rates of 83.5%, 80.9% and 77.6% (P > 0.05).</p><p><b>CONCLUSIONS</b>Compared with lamivudine monotherapy, lamivudine combined with individualized low-dose HBIG can further reduce the recurrence risk of hepatitis B in liver transplant recipients. This combined therapy could be used as a rational strategy for prophylaxis of hepatitis B recurrence in such patients.</p>

Clinical study of adult to adult living donor liver transplantation: a report of 56 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the ways to ensure the safety of donors and recipients in adult-to-adult living donor liver transplantation (A-ALDLT).</p><p><b>METHODS</b>From January 2002 to September 2006, 56 A-ALDLT were performed in our division, including 52 cases of right lobe graft were obtained without medial hepatic vein (MHV) and 4 cases of dual grafts (1 case using two left lobes, 3 cases using 1 right and 1 left lobe). The most common diagnoses were hepatitis B liver cirrhosis (62.5%) and hepatocellular carcinoma (30.4%) in recipients. Among them, 10 cases scored more than 25 with the model of end-stage liver disease (MELD) scoring system. Triphasic liver computed tomography were used for reconstruction of hepatic vessels and to calculate total liver and right liver volumes in donors. Various innovative surgical techniques were adopted too.</p><p><b>RESULTS</b>From the 58 living donors, 55 right lobes and 3 left lobes were obtained. The 55 right lobe grafts were obtained without medial hepatic vein, weighed 400 approximately 860 g (median 550 g). The ratio of graft volume to recipient standard liver volume ranged from 31.7% to 71.7% (median 45.4%). All donors' remnant liver volumes were over 35% of the total liver volume. There was no donor mortality, but 7 (12.5%) donors experienced complications. Of the 56 recipients, with a follow-up period of 2 approximately 52 months (median 11 months), 15 (26.8%) developed complications and 4 (7.2%) died within 3 months post operation. The 1-year actual survival rate was 92.8%.</p><p><b>CONCLUSIONS</b>When preoperative CT volume shows remnant liver volume is greater than 35% of the total liver volume, and graft volume to recipient's standard liver volume ratio is over 40%, A-ALDLT using right lobe graft is a safe procedure for both donors and recipients, otherwise the dual graft liver transplantation should be considered.</p>

Modifications of surgical technique in adult-to-adult living donor liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To report the authors' experience with adult-to-adult living donor liver transplantation using right lobe liver grafts performed by a modified technique.</p><p><b>METHODS</b>From March to June 2005, 13 patients underwent living donor liver transplantation using right lobe grafts. Among these, one patient received two left lobes from his two elder sisters, one received a right lobe from his mother and a left lobe from a cadaveric donor. All patient underwent a modification designed to improve the reconstruction of right hepatic vein, the reconstruction the tributaries of the middle hepatic vein by interpositioning a vein grafts, and the anastomosis of the hepatic arteries and bile ducts.</p><p><b>RESULTS</b>There were no severe complications and deaths found in donors. Four complications occurred in recipients including hepatic artery thrombosis (n = 1), bile leakage (n = 1), left subphrenic abscess (n = 1) and pulmonary infection (n = 1). The patient with pulmonary infection died of multiple organ failure (MOF). All patients underwent direct anastomosis of right hepatic vein and inferior vena cava (IVC), 5 cases plus the reconstructions of right inferior hepatic vein, and the other 5 cases plus the reconstruction of the tributaries of the middle hepatic vein by interpositioning a vein graft to provide sufficient venous outflow. The graft and recipient weight ratio (GRWR) were between 0.72% and 1.24%, among these, 9 cases < 1.0% and 2 cases < 0.8%, and there was no "small-for-size syndrome" occurred.</p><p><b>CONCLUSIONS</b>With modifications of surgical technique, especially the reconstruction of hepatic vein to provide sufficient venous outflow, living donor liver transplantation in adults using right lobe liver grafts can become a relatively safe procedure and prevent the "small-for-size syndrome".</p>

Safety of donor of right lobe graft in living donor liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety of donors of right lobe graft.</p><p><b>METHODS</b>We retrospectively studied 13 living donors of right lobe graft from January 2002 to June 2005. The right lobe grafts were obtained by transecting the liver on the right side of the middle hepatic vein. Liver transection was done by using an ultrasonic dissector without inflow vascular occlusion. The standard liver volume and the ratio of left lobe volume to the standard liver volume were calculated.</p><p><b>RESULTS</b>The mean blood loss was 490 ml. The mean blood transfusion was 440 ml. In the perioperative period the mean albumin administered was 85 g. One donor had portal vein trifurcation, two had a right posterior bile duct and a right anterior bile duct draining into the left bile duct, respectively. One had bile ducts from left lateral and left internal segment and right duct draining into common hepatic duct. On postoperative day 1 the donors' liver functions were found impaired to some extent, but all the indices rapidly returned to the normal level at the end of the first week. Postoperative complications included 1 case of abdominal bleeding, 2 wound steatosis and 1 chyle leak. There was no donor mortality. All donors are well and have returned to their previous occupations.</p><p><b>CONCLUSIONS</b>The donation of right lobe graft for adult living donor liver transplantation is safe provided that the patency of the remnant hepatic vasculature and bile duct is ensured, the volume of the remnant liver exceeds 30% of the total liver volume, and there is no injury to the remnant liver.</p>

Colon-specific delivery tablets of sodium 4-aminosalicylic acid / 药学学报

<p><b>AIM</b>To prepare a new oral colon-specific delivery formulation and to investigate the release profile in vitro and the colon-specific delivery property in vivo in dogs.</p><p><b>METHODS</b>Sodium 4-aminosalicylic acid was selected as the model drug. The combination of Eudragit RL30D and RS30D were used as sustained-release film, and Eudragit FS30D used as enteric film, which was expected to release drug depending on pH and time. The release profile of tablets was studied in three phosphate buffers with the pH 6.5, 7.0 or 7.4 for 12 h after a simulated gastric presoak for 2 h in 0.1 mol x L(-1) HCl. The tablets were radiolabelled with 99mTc to make their release times and positions in the gastrointestinal tract be followed using a gamma camera.</p><p><b>RESULTS</b>For the in vitro study, there was no drug released in 0.1 mol x L(-1) HCl for 2 h, and release occurred slowly when pH was above 6.5. Drug was released faster while pH was higher. For the in vivo study, the coated tablets remained intact in the upper gastrointestinal tract, and drug release began after the colonic arrival. The uncoated tablets, however, disintegrated in the stomach of the dogs rapidly.</p><p><b>CONCLUSION</b>The coating could protect the drug until the tablets reached the ascending colon, where drug was released slowly for over 10 h.</p>

Diagnosis and treatment of bacterial pneumonia in liver transplantation recipients: report of 33 cases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Bacterial pneumonia in the recipients of liver transplantation (LTX) is a common postoperative complication influencing the prognosis greatly. In this article, the diagnosis and treatment of bacterial pneumonia in 33 LTX recipients are reported.</p><p><b>METHODS</b>From February 1999 to January 2003, a total of 103 patients underwent allogeneic LTX at our center; afterwards, a retrospective analysis was made on their postoperative clinical manifestations, including symptoms (expectoration, panting and fever), sign (rale), results of laboratory examinations (white blood cell count and sputum culture of tracheal secretions or pleural fluid culture), and chest X-ray films. The following data of the pneumonia and non-pneumonia groups were collected, and the rank sum test (SPSS 11.0, Wilcoxon's method) was used to analyze the duration of postoperative respirator utilization and the volume of pleural effusion through pleurocentesis or pleural drainage.</p><p><b>RESULTS</b>In the 103 patients, 33 experienced 53 episodes of bacterial pneumonia during their hospital stay after transplantation, 14 of them (42.42%) had more than three manifestations of the seven mentioned above. The pathogens causing bacterial pneumonia included Pseudomonas aeruginosa (17.48%), Klebsiella pneumoniae (15.53%), Acinetobacter baumannii (10.68%), and Staphylococcus aureus (7.77%). Amilkacin, tienam, ciprofloxacin, vancomycin, etc. were the antibiotics of choice against those bacteria. Acute rejection occurred during the treatment of bacterial pneumonia in 16 patients, and 5 of them died. Wilcoxon's rank sum test of the data indicated that the pneumonia group had longer duration of postoperative ventilator treatment and larger volume of pleural effusion than the non-pneumonia group (P < 0.05).</p><p><b>CONCLUSIONS</b>The clinical manifestations of pneumonia after LTX might be atypical, and special attention should be paid to the respiratory symptoms and signs within 2 months after LTX. Whenever the diagnosis of bacterial pneumonia is confirmed, consideration should be given to reasonable use of antibiotics and regulation of immunity in addition to other routine therapies.</p>