Rare complication after pediatric living donor liver transplantation: right diaphragmatic hernia / 器官移植

Objective To analyze the clinical characteristics, pathogenic causes and therapeutic experience of right diaphragmatic hernia after pediatric living donor liver transplantation. Methods Clinical data of 3 recipients with right diaphragmatic hernia after pediatric living donor liver transplantation were retrospectively analyzed. The clinical characteristics, diagnosis and treatment process and therapeutic experience were analyzed and summarized. Results The primary diseases of 3 children with diaphragmatic hernia after living donor liver transplantation were biliary atresia. The diaphragmatic hernia occurred at 4-6 months after liver transplantation. The contents of diaphragmatic hernia included the intraperitoneal and interperitoneal tissues and organs. Diaphragmatic defects were all located in the posterior medial area of the right diaphragm. The primary stage intermittently suturing repair was performed during intraoperative period. No diaphragmatic hernia recurred during long-term follow-up. Conclusions The clinical manifestations of right diaphragmatic hernia after pediatric living donor liver transplantation are diverse. The risk factors include malnutrition, low body weight, surgical trauma, chemical erosion caused by bile leakage, focal infection and pleural-peritoneal pressure gradient, etc. Surgical intervention is the preferred treatment strategy for diaphragmatic hernia after liver transplantation.

Effect of donor-derived infection on prognosis of liver transplant recipients / 器官移植

Objective To evaluate the effect of donor-derived infection on the clinical prognosis of the recipients undergoing liver transplantation. Methods Clinical data of 75 donors and recipients undergoing liver transplantation were retrospectively analyzed. According to the culture results of donor organ lavage fluid, all recipients were divided into the positive group (n=26) and negative group (n=49). Clinical parameters of the recipients during perioperative period were observed in the positive and negative groups. The sputum and peritoneal drainage fluid of the recipients undergoing liver transplantation were cultured. The incidence of postoperative infection of the recipients was observed. The 1.5-year survival curve of the recipients was analyzed by Kaplan-Meier method. Results In the positive group, the incidence of portal vein stenosis and thrombosis was significantly higher than that in the negative group (P < 0.05). Among 75 recipients undergoing liver transplantation, 33 cases (44%) developed postoperative infection mainly in the lung and abdominal cavity. The infection rate significantly differed between the positive group (77%) and negative group (27%, P < 0.05). In the positive group, sputum culture was positive in 10 recipients and peritoneal drainage culture was positive in 11 recipients. The sputum culture outcomes of 4 recipients were consistent with those of the organ lavage fluid culture of their donors. The peritoneal drainage culture results of 6 recipients were consistent with those of the organ lavage fluid culture of their donors. After anti-infection treatment, 2 recipients in the positive group died at postoperative 5 and 12 d, and the culture results of the remaining recipients were negative. In the negative group, 7 recipients were positive for sputum culture and 6 recipients were positive for peritoneal drainage culture. The culture results of all recipients were negative following anti-infection therapy. Two recipients died from graft failure at postoperative 1 month and 1 year. The 1.5-year survival rate did not significantly differ between the positive and negative groups (P > 0.05). Conclusions The effect of donor-derived infection on the early prognosis of liver transplant recipients cannot be neglected, whereas it exerts mild impact on the intermediate- and long-term clinical prognosis of the recipients.

Diagnosis and treatment of posttransplant lymphoproliferative disorder after pediatric liver transplantation / 中华器官移植杂志

Objective To retrospectively explore the clinical symptoms ,diagnosis ,treatment and prognosis of posttransplant lymphoproliferative disorder (PTLD) after pediatric liver transplantation .Methods The diagnosis and treatment of PTLD were reviewed for 3 children recipient with living donor liver transplantation .Their primary diseases were biliary atresia ,glycogen storage disease type III and ornithine-transcarbamylase deficiency . All of them received FK506 for immunosuppression therapy . They were diagnosed as PTLD at 7 ,8 ,6 months post-operation respectively .Their major clinical manifestations were non-specific ,including fever ,diarrhea and anemia .Positron emission tomography/computed tomography (PET/CT) and ultrasound revealed enlarged mesenteric lymph nodes with neck lymphoadenopathy (n=2) . Pathological examinations of resected enlarged lymph nodes indicated post-transplantation lymphoproliferative disorder .One case was diffuse large B cell lymphoma and two of them belonged to preliminary EBER + . Results After a definite diagnosis ,there was one cycle of R-CHOP regimen (rituximab ,cyclophosphamide , pirarubicin ,vincristine ,dexamethasone) or 2 cycles of rituximab along with a .reduction of anti-rejection drug and they stayed in remission .Three were followed up for 37 ,39 and 20 months respectively from May 31 , 2019 . Currently transplanted liver function was stable and EBV viral load remained negative persistently .Conclusions This case highlights the complexity of clinical presentations and co-morbidities of PTLD . Reducing immunosuppressive agents and using rituximab plus chemotherapy can achieve a satisfactory efficacy for Epstein-Barr virus-related PTLD patients after pediatric liver transplantation .

The clinical research of donor specific antibody in liver transplantation / 中华器官移植杂志

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.

Pediatric liver transplantation for metabolic liver disease:report of 42 cases / 中华器官移植杂志

Objective To Analyze the clinical outcomes of pediatric liver transplantation (LT) for liver-based metabolic disorders.Methods We conducted a retrospective analysis on 42 pediatric patients with liver-based metabolic disorders from June 2013 to March 2017,and analyzed the pediatric end stage liver disease model (PELD),growth and development,type of transplant,postoperative complications and prognosis of patients.Results There were 42 children with liver-based metabolic disorders (15.56%) out of all the 270 children who underwent LT.The median age was 51.0 months (range,3.4-160.9 months).Of the 42 children,19 received living donor liver transplantation (LDLT),18 cases received deceased donor liver transplantation (DDLT) and 5 cases received domino liver transplantation.1-,2-and 3-year cumulative survival rate of 42 recipients was 97.7%,93.6% and 93.6%,and that of the grafts was 95.3%,91.4% and 91.4%,respectively.As compared with the 194 children with biliary atresia who underwent LT,significant difference was found in PELD and weight Z-score between the two groups.Conclusion Liver transplantation is a valuable option for children with metabolic disorders,and it has gained a better prognosis.

Effective observation of electroacupuncture with different courses for female stress urinary incontinence / 中国针灸

<p><b>OBJECTIVE</b>To verify the effect of electroacupuncture (EA) for female stress urinary incontinence (SU).</p><p><b>METHODS</b>Forty-two patients were randomly divided into an observation group(20 cases) and a control group (22 cases). EA at Zhongliao (BL 33) and Huiyang (BL 35) was used in the observation group. Sham acupuncture at non meridian points, one can beside Zhongliao (BL 33) and Huiyang (BL 35), was applied, and placebo EA was adopted in the control group. Treatment with needle retained for 30 min a time was given once every other day and three times a week for continuous six weeks in the two groups. Urinary and reproductive simple score (UDI),visual analogue scale (VAS) and the frequency of nocturnal enuresis were observed before treatment, at the second, forth and sixth week of treatment in the two groups, and the efficacy was compared.</p><p><b>RESULTS</b>The effective rates of the observation group were 80.0% (16/20), 95.0% (19/20) and 95.0% (19/20), which were better than 40.9% (9/22), 31.8% (7/22) and 27.3% (6/22) of the control group at the second, forth and sixth week of treatment. The differences were statistically significant between the two groups (all P < 0.05). After treatment in the observation group, the results of UDI, VAS and frequency of nocturnal enuresis were improved compared with those before treatment (all P < 0.05). Along with treatment, all indices were gradually improved, and the change at the sixth week was the most obvious in observation group. The results of the observation group were better than those of the control group at all times (all P < 0.05).</p><p><b>CONCLUSION</b>EA achieves obvious effect for female SUI, and effectively improves the lower urinary trace symptoms, the degree of urinary incontinence and the frequency of nocturnal enuresis. The effect becomes increasingly better along with treatment within six weeks.</p>

Risk factor analysis of EB virus infection after liver transplantation in children with biliary atresia / 天津医药

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.

Clinical characteristics and analysis of rotavirus infection after liver transplantation in children / 器官移植

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.

Impact of electroacupuncture on the life quality in patients of female mixed urinary incontinence / 中国针灸

<p><b>OBJECTIVE</b>To observe the impact of electroacupuncture (EA) on the quality of life in the patients of female mixed urinary incontinence (MUI) and evaluate its clinical efficacy.</p><p><b>METHODS</b>EA was adopted in 25 cases of MUI at Zhongliao (BL 33) and Huiyang (BL 35), needle retaining for 30 min each time. The treatment was given once every two days, three treatments a week, totally for 12 weeks of treatment. The incontinence quality of life questionnaire (I-QOL), the incontinence impact questionnaire-7 (IIQ-7), the urogenital distress inventory short form (UDI-SF) and the visual analogue scale (VAS) were adopted in the comparison before and after treatment. The efficacy was evaluated.</p><p><b>RESULTS</b>The curative rate was 52.0% (13/25) and the total effective rate was 96.0% (24/25) in 25 cases. In comparison before and after treatment, in I-QOL, the score of limiting behaviors was increased up to (30.32 ± 3.39) from (11.52 ± 2.45), the score of psychosocial impacts was up to (36.48 ± 2.90) from (13.52 ± 2.25) and the score of social isolation was up to (21.52 ± 1.61) from (9.84 ± 2.23). The score of IIQ-7 was decreased, down to (2.48 ± 1.36) from (11.96 ± 3.45), the score of UDI-SF was down to (2.92 ± 0.95) from (8.84 ± 2.58) and VAS score was down to (1.40 ± 0.91) from (6.96 ± 1.65). The differences were all significant statistically in comparison (all P < 0.05).</p><p><b>CONCLUSION</b>EA improves effectively the quality of life in MUI patients and the clinical efficacy is apparent.</p>

Liver transplantation for the treatment of hyperammonemia due to urea cycle disorder: report of four cases / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze clinical efficacy and prognosis of liver transplantation in children with hyperammonemia caused by urea cycle disorders.</p><p><b>METHOD</b>A retrospective analysis was performed on the occurrence of disease, operation and the follow-up post liver transplantation in 4 patients with urea cycle disorders who underwent liver transplantation during June 2001 to May 2014.</p><p><b>RESULT</b>Four girls were diagnosed with ornithine carbamoyl transferase deficiency by genetic test. They had the clinical onset at the age of 1.5 to 3.0 years. Liver transplantation had been performed at their age of 53.9 months, 40.6 months, 40.3 months and 22.8 months, respectively. The grafts of case 1 and case 2 were from left lateral lobe of liver of cadaveric donor, the graft of case 3 was from left lateral lobe of liver of a living donor, the graft of case 4 was a whole liver of a dead child. The liver function of 4 patients gradually returned to normal, blood ammonia levels were normal and restored the normal diet, 4 children were discharged on postoperative 25-30 days. Regular follow-up was done, the liver function, biochemical features and growth status have been followed up for 162.2 months, 124.2 months, 12.0 months and 4.8 months after liver transplantation, respectively. Now, all the four cases are healthy and growth is normal.</p><p><b>CONCLUSION</b>Liver transplantation is an important way to the patients with severe hyperammonemia caused by urea cycle disorders. In this study, the patients with ornithine carbamoyl transferase defect got satisfactory long-term outcome after liver transplantation.</p>

Clinical study of de novo hepatitis B virus infection after pediatric living liver transplantation / 器官移植

Objective To investigate the clinical characteristics,prevention and treatment strategy of de novo hepatitis B virus (HBV)infection after pediatric living liver transplantation.Methods In total,106 pediatric recipients undergoing living liver transplantation in Organ Transplantation Center of Affiliated Beijing Friendship Hospital of Capital Medical University and Organ Transplantation Center of Tianjin First Center Hospital from July 2010 to July 2014 were enrolled in this study.All surgeries were performed by the same surgical team.According to preoperative test outcomes of donor HBV serological markers,all recipients were divided into the positive (n =45)and negative (n =61)antibody to hepatitis B core antigen (anti-HBc)donor liver groups (positive group and negative group),and the prevalence of de novo HBV infection was compared between two groups.The risk factors of de novo HBV infection in the positive group were analyzed to elucidate the clinical characteristics of de novo HBV infection in affected children.Results The incidences of de novo HBV infection in positive and negative group were 18% (8 /45 )and 2% (1 /61 )respectively.The risk factors of de novo HBV infection in recipients with positive anti-HBc were negative anti-HBs before transplantation and absence of antiviral therapy post-transplantation in recipients (both in P <0.05 ).The median interval between time of onset and time of liver transplantation was 12 months (8-48 months).Seven cases were treated with lamivudine and the remaining two cases were left untreated.All nine recipients survived.Conclusions Application of positive anti-HBc donor liver have a risk of HBV infection in recipients after pediatric liver transplantation.Absence of postoperative nucleoside analogue therapy and negative anti-HBs before transplantation acts as risk factors of de novo HBV infection in the recipients with positive anti-HBc donor liver.After liver transplantation,nucleoside analogue therapy is recommended for the pediatric recipients with positive anti-HBc donor liver to prevent the incidence of de novo HBV infection.Besides,hepatitis B vaccine should be administered prior to liver transplantation.