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Objective To investigate the clinical effect of donor kidneys in rhabdomyolysis(RM) combined with acute kidney injury(AKI).Methods A retrospective analysis was made on the clinical data of 10 donors with RM and 14 cases of renal transplantation from March 2017 to May 2018.Results AKI was caused by RM in 10 donors.Before harvesting the donor kidneys,blood creatine kinase (CK) level was (14 005.19 ± 11 894.27) U/L in 10 donors,plasma myoglobin level was ＞3 000 μg/L in 7 cases,and that was (2 288 ± 680) μg/L in 3 cases.LDH level was 883 ± 453 IU/L and serum creatinine (Cr) value was (216.55 ± 125) μmol/L.6 donors received continuous renal replacement therapy.Six patients with delayed renal function recovery (DGF) were treated with CRRT.The duration of GDF was 3-20 days,with an average of 10 ± 6.6 days.All the patients were followed up for 3-15 months.The glomerular filtration rate was (40.19 ± 19.55) ml·min· 1.73 m-2 and (55.01 ± 15.94) ml · min· 1.73 m-2 at 1st and 3rd month after operation,respectively.Conclusion The incidence of DGF in donor kidneys with RM and AKI is high,and the short-term effect is satisfactory.The long-term effect needs to be further observed.
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Objective@#The aim of this study was to summarize and analyze the clinical features and characteristics of de novo HBV infection after liver transplantation in non-HBV-related liver disease. @*Methods@#We retrospectively analyzed the clinical data of 13 patients with new HBV infection in 376 cases of liver transplantation patients with non-HBV related liver diseases from April 2002 to December 2013 in our hospital. @*Results@#Among 376 patients with non-HBV-related liver disease after liver transplantation, 13 patients developed new HBV infection, and the rate of new HBV infection was 3.46%. Of the 13 cases, 5 were males and 8 were females. The follow-up time was 14.7 -128.7 months, and the average time from surgery to new HBV infection was 19.06 months. The primary diseases were as follows: 5 cases of primary biliary cholangitis, 3 cases of alcoholic liver disease, 2 cases of drug-induced liver damage, 1 cases of post-hepatitis C cirrhosis, congenital biliary atresia and congenital liver fibrosis. All patients were positive for HBsAg, HBeAg, anti-HBc, 11 were positive for HBV DNA, and 2 were negative for HBV DNA. 6 cases had abnormal liver function and 7 cases had normal liver function. All patients were treated with antiviral therapy with nucleoside (acid) analogues. HBsAg was negative in 6 patients; HBsAg remained positive in 7 cases, including HBsAg, HBeAg, anti-HBc positive in 6 cases, HBsAg, anti-HBe, anti- HBc was positive in 1 case, HBV DNA was still positive in 1 patient, and HBV DNA was negative in 6 patients; liver function was normal in all patients. @*Conclusion@#Non-HBV- related liver transplantation are high-risk group of new HBV infection, with the highest incidence of autoimmune liver disease. It is speculated that it may be related to the long-term use of hormones after the transplantation. The prognosis of newly diagnosed HBV infection after liver transplantation is fine as long as it can be found and treated early.
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Objective To observe the effects of tacrolimus on blood glucose, insulin, expressions of protein phos-phatase 2A and P-AKT in rats in order to explore the mechanism of hyperglycemic action of tacrolimus. Methods Sixty male SD rats (body weight 89. 83 ±4. 44 g) were randomly divided into tacrolimus group (n =40) and control group (n=20). The rats in the tacrolimus group were administrated with tacrolimus 4 mg/kg daily. The rats in the control group were given the same amount of normal drinking water daily. The rat body weight, fasting blood glucose concentration and blood concentration of tacrolimus were measured monthly. All rats were killed at 5 months after the tacrolimus administra-tion. The serum insulin levels were detected by radioimmunoassay method. The expressions of PP2A and P-AKT in liver tissues were assessed by immunohistochemistry. Results After two months of administration, the blood glucose levels in the tacrolimus group were significantly higher than those in the control group. The HOMA-IR in tacrolimus group was signif- icantly higher than that in the control group P<0. 05 ) . ISI was significantly lower than that in the control group ( P<0. 05). Immunohistochemical examination showed that the expression of PP2A in hepatocytes in the tacrolimus group was increased compared with the control group, while expression of P-AKT in hepatocytes of the tacrolimus group was decreased than that in the control group. Conclusions Tacrolimus can induce necrosis of islet cells, decrease of the amount of islet cells and insulin secretion, decease of sensitivity to insulin, and increase the resistance to insulin, therefore, leading to in-crease the blood glucose level in rats. The expression of PP2A in hepatocytes in the tacrolimus group is increased, while the expression of P-AKT is decreased. Interfering of insulin signal transduction pathways may be involved in the hyperglyce-mic effects of tacrolimus.
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Objective To analyze the incidence and related risk factors of hyperuricemia after liver transplantation.Methods A total of 286 cases undergoing liver transplantation from 2009 to 2012 in the Armed Police General Hospital , who had normal uric acid before transplantation and had been followed up for more than 1 year, were enrolled in this study.The clinical data, including liver and kidney function , blood glucose, and lipids were collected .The potential risk factors of hyperuricemia were analyzed .Results 53.5% cases ( 153/286)had hyperuricemia after transplantation.Hyperuricemic patients were predominately older (P =0.038). They also had a higher prevalence of increasing creatinine (P=0.000),and hyperlipidemia(P=0.000).Among female cases, hyperuricemic patients had a higher average BMI (P=0.027).Hyperuricemia group had an elevat-ed ratio of blood lipids 60.1%(92/153), higher than normal uric acid group (39.1%,52/133) ( P<0.05). Conclusions Liver transplantation recipients have a higher incidence of hyperuricemia , particularly in elderly and overweight female patients .Our findings suggest that postoperative hyperuricemia may be associated with high serum creatinine, elevated blood lipids.We should strengthen follow-up, take early detection and early treat-ment.
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Objective To compare the impact of the sirolimus and tacrolimus on the tumor recurrence after liver transplantation due to HCC beyond Milan criteria.Method Sixty-one liver transplantation recipients due to HCC beyond Milan criteria,between Jan.2008 and Apri.2012,were randomized,with the informed consent,into two different immunosuppression groups: sirolimus group (n=30) and tacrolimus group (n=31).In tacrolimus group,tacrolimus was used as the basic immunosuppressant,methylprednisolone was discontinued within one month postoperatively,and mycophenolate mofetil was used within the dosage of 1.5 g/d accordingly.In sirolimus group,the immunosuppresive scheme was the same as that of the tacrolimus group within postoperative one month,and from that,tacrolimus was transferred to sirolimus.No antineoplastic agents were given before tumor recurrence.The tumor recurrence rate and the survival rate of the recipients were compared between the two groups.Result The median follow-up duration was 35.2 months (10.3～ 60.2).The tumor recurrence rate at postoperative year 1,2,3 and 4 in the sirolimus group (13.3％,36.7％,43.3％ and 53.3％) was significantly lower than that in the tacrolimus group (38.7％,67.7％,74.2％ and 77.4％),P ＜ 0.05 for all.The one-year survival rate in the recipients postoperation had no significant difference between sirolimus group and tacrolimus group (90.0％ vs.87.1％,P=0.438).The 2-,3-and 4-year survival rate in the recipients was significantly higher in the sirolimus group (53.3％,33.3％ and 20.0％) than that in the tacrolimus group (41.9％,22.6％ and 9.7％),P ＜ 0.05 for all.The liver function and renal function of the recipients at the postoperative year 1,2,3 and 4 showed no significant difference between the two groups,P＞0.05.Conclusion In comparison with tacrolimus,sirolimus could significantly reduce the tumor recurrence rate and increase the survival rate for the liver transplant recipients due to HCC beyond Milan criteria.
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Objective To evaluate the outcomes of liver transplant recipients who received liver grafts from HBsAg positive donors in patients with hepatocellular carcinoma beyond UCSF (University of California,San Francisco) Criteria.Method The medical records of patients who underwent HBsAg-positive donor liver transplantation for hepatocellular carcinoma beyond UCSF Criteria from October 2008 to December 2012 at our hospital were analyzed retrospectively,including the existence status of HBV,graft function,tumor recurrence,and the survival after transplantation.Result A total of 20 patients were enrolled in the study.One patient lost follow-up while the remaining 19 patients had complete follow-up data.All the patients were followed up until June 2013,with a median follow-up duration of 12 months (range 2-57 months).One patient died from postoperative abdominal bleeding and multiple organ failure at post-transplantative day 21.Five patients survived up to now,including 4 cases with disease-free survival,who has been surviving for 57,35,26 and 12 months respectively.The remaining all 14 patients died from tumor recurrence at different time points after transplantation.Entecavir was used alone in 19 patients and Entecavir combined with Adefovir dipivoxilalone were used as anti-HBV therapy in the recipients.At posttransplant day 45,all the recipients were positive for serum HBsAg and negative for serum HBVDNA,and the liver enzymatic criteria,coagulation criteria and the serum bilirubin restored to normal levels or within twice the upper limit of normal levels.Throughout the follow-up period,recipients were all positive for serum HBsAg,but there was no recurrence of hepatitis B.The 1-,2-,3-and 4-year cumulative survival rate was 48.0％,35.0％,18.7％ and 18.7％ respectively.Conclusion The HBsAg positive liver may be used as a donor in liver transplantation and the graft probably works well after the operation.Liver transplantation may prolong the survival and improve the quality of life,even achieve long-term disease-free survival in patients with hepatocellular carcinoma beyond UCSF Criteria.The use of nucleotide analogue only,instead of combination with hepatitis B immune globulin,can also bring HBV well under control in liver transplant recipients with HBsAg positive donors.
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Objective To evaluate the efficacy and safety of glargine combined with repaglinide in the treatment of post-transplantation diabetes mellitus(PTDM).Methods PTDM patients who were treated in our hospital from Jan 1,2010 to Dec 31,2010 were enrolled in this study.They were administrated with glargine combined with repaglinide for 6 months,and their glucose level,hepatic and renal function indicators,and tacrolimus concentration were examined at baseline and 1,3,and 6 months after treatment.Results Totally 44 patients were included and given dietary control.Three cases were not given any hypoglycemic drugs,7 were administrated with glargine only,30 cases received glargine combined with repaglinide therapy,and 4 cases required intensive insulin therapy.All the patients achieved satisfactory glycemic control.The hepatic function,renal function,and serum tacrolimus concentration showed no significant change before and after repaglinide therapy(P ＞ 0.05).Five hypoglycemic events were recorded during the treatment,in which the lowest blood glucose level was 3.7 mmol/L.No severe hypoglycemia happened.Conclusion On the basis of dietary control,glargine combined with repaglinide provides a safe and effective therapy for PTDM.
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ObjectiveTo analyze the etiologies and diagnosis of jaundice after liver transplantation during mid later stage and summarize the experience of clinical practice.Methods822 liver transplantation patients were collected from the Department of Internal Medicine, Organ Transplantation Institute in General Hospital of Chinese People's Armed Police Forces between June 2005 and Dec.2008.The clinical data of these cases were analyzed retrospectively.ResultsAmongst 822 patients,129 experienced jaundice after liver transplantation and the occurrence of jaundice ranged from 43 days to 39 months postoperation.Total bilirubin levels were from 27.4 to 503 μmol/L.The etiologies of jaundice and its percentage were as follow:59 cases of biliary complications (45.7％),36 of rejection (27.8％ ),11 cases of virus infection (8.5％),5 cases of drug-induced hepatic injury (3.9％),4 cases of tumor recurrence (3.1％),4 cases of Gilbert syndrome (3.1％),3.cases of dysfunction of papillary muscle (2.3％),2 cases of vascellum complication (1.6％),2 cases of radiation hepatitis (1.6％),1 case of hepatapostema (0.8％),2 cases of unknown reasons (1.6％),respectively.The jaundice of most patients (93％) got released while small part of patients (7％)failed to treatment,of whom 5 cases received liver re-transplantation and 4 cases died of disease progression.ConclusionThe etiologies of jaundice after liver transplantation during mid-later stage are diversiform and complex.And the etiological diagnosis is the premise to treat effectively.
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Objective To investigate the effects of a newly developed health belief model (HBM)on the survival of liver transplant recipients. Methods The most important health concerns and follow-up service expectations were learned from out-patients who received long-term liver transplant follow up, and a new HBM for liver transplant was developed. The impact of the HBM on survival was evaluated in this prospective randomly controlled trial. Results In 374 liver transplant recipients who completed the questionnaire, the most common health concerns were the implication of follow-up service and optimal medications ,etc. Moreover,liver transplant club and improved role and function of health-care providers were expressed by the participants to enhance interactions with the medical staff. After 2 years' follow up, the incidence of abnormal liver function ( 16. 8% vs 21.2% ), infection ( 3.2% vs 10. 3% ) and disease recurrence (2. 6% vs 9. 8% ) were significantly decreased in the study group (n = 190) when compared with the control group ( n = 184) ( all P ＜ O. 05 ). Conclusion Adverse health events could be reduced following the application of HBM for liver transplantation.
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To summarize and explore the etiopathogenisis, clinical 'characteristics, diagnosis and treatment and prognosis of idiopathic adulthood ductopenia. We described a 27-year-old Chinese female initially manifested with jaundice, pruritus, dark urine, and pallor of the stools in October, 2002. Symptoms occurred repetitively and severed progressively, and she received therapy at the General Hospital of Chinese People's Armed Police Forces. B-ultrasound demonstrated that hepatic lesion and slightly swelling spleen. Pathological diagnosis of liver biopsy showed that she affected idiopathic adulthood ductopenia. The outcome of treatment of ursodeoxycholic acid and adrenal cortical hormone was not significant. She received orthotopic liver transplantation on June 24~(th), 2005. After liver transplantation, pruritus and jaundice were promptly disappeared. Each index of hepatic function recovered to a normal level. In March 2007, decreased dose of hormone induced an abnormal hepatic function, with mildly acute rejection. Drug dose was regulated, and hepatic function gradually returned to normal. During follow-up 51 months after the operation, she was doing well and was free of symptoms with normal liver function and no evidence of allograft dysfunction. The pathogenesis of idiopathic adulthood ductopenia is still unknown. There are still no precise and effective drugs for treatment of idiopathic adulthood ductopenia. Liver transplantation offers an effective therapy for end-stage patients with idiopathic adulthood ductopenia.
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Objective To wmpare the differences of the mixing time and contamination rate between liquid and powder EN preparations. Methods 20 patients,receiving enteral nutrition for more than 6 days, were enrolled in. this study. They were randomized to receive either powder enteral diet (control group, n=10) or liquid enteral diet (study group, n=10). The mixing time was examed by stopwatch. The contamination rate was determined by culture of bacteria in the solution. Results 1. The mixing time of study group was significantly shorter than that of control group ( 18.9 ± 3.0 vs 106.0 ± 21.0 , P<0. 001). 2. The bacterial culture in both groups were negative before enteral feeding. There was no positive case in study group and only 2 positive eases in control group after infusion. However, there was no statistical difference between the two groups ( P=0.14). Conclusions Liquid form of enteral nutfitent was less time cost and no ease contaminated by enveriorment, but it is expensive. he ligurd preparation has more advantages than powdor one in mixing time and comtamination.