ABSTRACT
Objective To analyze the risk factors of high-level BK viruria after renal transplantation and the significance in preventing BK virus-associated nephropathy (BKVAN). Methods Clinical data of 262 renal transplant recipients with regular follow-up data were retrospectively analyzed. According to the DNA load of BK virus, all recipients were divided into the high-level BK viruria group (n=35) and non-high-level BK viruria group (n=227). The incidence of high-level BK viruria after renal transplantation was summarized. The risk factors of high-level BK viruria after renal transplantation were analyzed by univariate analysis and multivariate analysis. Survival curve was delineated by Kaplan-Meier method, and survival analysis of recipients was performed. Results Among 262 renal transplant recipients, 35 cases developed high-level BK viruria with an incidence of 13.4%. The median time of occurrence of high-level BK viruria was 181 (126, 315) d. The incidence was the highest within 6 months after renal transplantation, gradually decreased from 6 months to 2 years, and then increased after 2 years. Univariate analysis showed that the history of antithymocyte globulin (ATG) treatment, acute rejection (AR), donation type and delayed graft function (DGF) were the risk factors of high-level BK viruria after renal transplantation (all P < 0.05). Multivariate Cox regression analysis demonstrated that donation after brain death followed by cardiac death (DBCD), AR and DGF were the independent risk factors of high-level BK viruria after renal transplantation. The 1-, 3- and 5-year survival rates of recipients with ATG treatment history, AR, DGF and donation type of DBCD were significantly lower than those with non-ATG treatment history, non-AR, non-DGF and other donation types [donation after brain death (DBD), donation after cardiac death (DCD) and living organ donation] respectively (all P < 0.05). Conclusions DBCD, AR and DGF are the independent risk factors of high-level BK viruria after renal transplantation. Strengthening the postoperative monitoring of these recipients and delivering early intervention may effectively prevent BKVAN.
ABSTRACT
In recent years, organ donation has developed rapidly in China, whereas the brain death criteria have not been confirmed by relevant legislation. In this article, the current legislation situation of brain death criteria at home and abroad, and the current criteria for determination of death for organ donation after citizen's death in China were introduced. The necessity of legislation of brain death criteria in China was discussed from the perspective of organ donation, and suggestions on the form and content of brain death criteria legislation were proposed based on the actual national conditions, aiming to provide reference for the legislation of brain death criteria.
ABSTRACT
Organ transplantation is one of the effective methods for the treatment of end-stage diseases, but the lack of donors has hindered the development of organ transplantation. Extracorporeal membrane oxygenation (ECMO) can improve the hypoxia and hypoperfusion of organs, shorten the warm ischemia time, and maintain the function of donor organs effectively, in case of emergency or donor hemodynamic instability. It helps to make effective use of donor organs and benefit patients who are in urgent need of organ transplants. This article summarized the progress on application of ECMO in donor maintenance and provided suggestions for its application in organ transplantation.
ABSTRACT
Objective To get a knowledge of the current status of organ donation and utilization after citizen's death in Wuxi District, and thereby provide ideas and basis for further development of organ donation work in local areas. Methods Clinical data from 151 organ donors, included 37 successful donors and 114 potential donors, were retrospectively analyzed. The reasons for donation failure of potential donors were analyzed. The general information for successful donors was collected. And the information on organ donation and organ utilization in successful donors were analyzed. Results Among the 151 organ donors, 37 were successful donors, with the conversion rate reaching 24.5%. For the 114 donors with failed organ donation, the reasons for failure included family disagreement, failure to meet donation status criteria, insufficient evaluation time, and unresolved work injury disputes. The categories for organ donation included 34 cases of donation after brain death followed by cardiac death (DBCD), 3 cases of donation after brain death (DBD), and no case of donation after cardiac death (DCD). The reasons for death of donors includes 19 cases of craniocerebral trauma, 14 cases of stroke and 4 cases of others. Among the 37 cases of successful donors, the majority were floating population. A total of 154 major organs and tissues were donated, of which 124 were major organs. The number of major organs and tissues donated per citizen was (4.2± 1.6) and the number of major organs donated per citizen was (3.4± 1.1). The utilization rate of the 154 donated organs reached 96.7% (149/154), with Nanjing, Wuxi, Suzhou and Changzhou ranking the top 4 of organ distribution. Conclusions The rate for successful organ donation and conversion after citizen's death is low in Wuxi District. The organ donation work networks in local areas should be established. And organ donation promotion efforts and skills training for coordinators should be developed.
ABSTRACT
Objective To investigate the citizen's attitude towards the cognition of brain death and the legislation of brain death criteria. Methods A questionnaire survey was performed in 1 500 outpatients or accompanying personnel by the convenient sampling method. The questionnaire data were independently recorded by two professionals using the Epidata 3.02 software. The factors influencing the citizen's support of the legislation of brain death were analyzed by univariate and multivariate Logistic regression models. Results Among 1 433 eligible respondents, 84.65% (1 213/1 433) of them knew brain death, and 24.32% (295/1 213) considered brain death as a reasonable criterion for death. The proportion of respondents who supported and opposed the legislation of brain death was 49.79% (604/1 213) and 17.31% (210/1 213).Male [odds ratio (OR)=1.3, 95% confidence interval (CI) 1.0-1.6], those with junior college degree or above at educational level (OR=1.5, 95%CI 1.1-1.9), those whose relatives and friends were engaged in organ donation (OR=3.3, 95%CI 1.1-10.3), those who participated in public welfare activities of organ donation (OR=3.1, 95%CI 1.6-6.0) and those who regarded brain death as a reasonable criterion for death (OR=2.0, 95%CI 1.5-2.6) were more inclined to support the legislation of brain death, which were the independent influencing factors of the legislation of brain death (all P < 0.05). Conclusions Citizens have relatively low cognition and support of the legislation of brain death criteria. Relevant propaganda on brain death should be widely carried out to strengthen the citizen basis for the legislation.
ABSTRACT
Objective To explore the feasibility of extracorporeal membrane oxygenation (ECMO) in protecting the donor liver in donation after citizen's death. Methods Clinical data of 16 donors and recipients undergoing liver transplantation using ECMO to protect the donor liver were retrospectively analyzed. The effect of ECMO on different indicators of the donors was evaluated. The liver function and clinical prognosis of the recipients after liver transplantation were observed. Results Compared with the time before ECMO, the heart rate, total bilirubin (TB), alanine transaminase (ALT) and aspartate transaminase (AST) of the donors after ECMO were significantly reduced, whereas the systolic blood pressure, diastolic blood pressure and partial pressure of arterial oxygen (PaO2) were remarkably increased (all P < 0.05). The liver function of the recipients was properly recovered after liver transplantation, and gradually restored normal at postoperative 7 to 28 d. Postoperative complications occurred in 3 recipients, including delayed liver function recovery in 1 case, biliary tract stenosis in 1 case and portal vein thrombosis in 1 case. Among them, the patient with portal vein thrombosis died after secondary operation, and the other 2 patients were recovered and discharged after symptomatic treatment. Conclusions The hemodynamics, liver function and other indicators of donors from donation after citizen's death are significantly improved after ECMO, and the liver function of the recipients also recover well.