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Organ transplantation has been an important means of rescuing the lives of end-stage patients with organ failure. However, an acute shortage of donor organs has become a common dilemma for organ transplantation all over the world so as to seriously restrict the development of organ transplantation. Many foreign countries have established a relatively mature organ donation system to foster favorable conditions for alleviating a shortage of donor organs. This review summarized the global measures and current domestic efforts of facilitating organ donation to provide theoretical rationales for further optimizing organ donations and transplantation system in China.
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Since the 20th century, organ transplantation has become a breakthrough technology to effectively save the lives of patients with end-stage organ failure, which has significantly enhanced the quality of life of patients. Organ donation is an important source of organ transplantation. Improving the quality of donor organ procurement is the key to promote the translation of donor organs and improve the prognosis of organ transplantation recipients. The United States, Spain and other countries have put forward a series of policies and standards in the quality management and control of donor organ procurement and achieved positive results. In this article, related concepts of medical quality management and control, advanced strategies and models of international donor organ procurement quality management, and quality control measures of Organ Procurement Organization, donors and donor organs were reviewed, aiming to provide reference for establishing a quality management and control system of donor organs with "Chinese characteristics" and advancing high-speed and high-quality development of donor organ procurement.
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Autoimmune liver diseases mainly include primary biliary cholangitis (PBC), autoimmune hepatitis (AIH), and primary sclerosing cholangitis. Simultaneous or successive occurrence of the features of any two of the above diseases is called overlap syndrome, among which PBC-AIH overlap syndrome is the most common type. Overlap syndrome can progress rapidly to liver cirrhosis and liver failure without timely treatment. This article summarizes the research advances in overlap syndrome of autoimmune liver disease in recent years.
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Objective@#To investigate the current situation of exposure of solid particles in medical staff and the occurrence of related diseases, and to understand the distribution characteristics of occupational exposure and the influencing factors.@*Methods@#In August 2016, the stratified cluster sampling method was adopted to select three tertiary general hospitals with different regions, different administrative levels and departments in Shandong Province. A face-to-face questionnaire survey was conducted on the basic situation of the staff of the hospital, the status of exposure to occupational hazards and the health effects. Two-class logistic regression analysis was used to analyze the relationship between medical staff's solid particle contact and occupational health effects. In August 2016, the stratified cluster sampling method was adopted to select three tertiary general hospitals with different regions, different administrative levels and departments in Shandong Province, which were in contact with the basic conditions and occupational hazards of the staff of the hospital. Current situation and health impacts were conducted face-to-face questionnaires. Two-class logistic regression analysis was used to analyze the relationship between medical staff's solid particle contact and occupational health effects.@*Results@#The overall contact rate of solid particles of medical staff was 41.5% (1843/4 446) , and the solid particles with the highest contact rate were 28.2% (1254/4 446) of talc dust. There was a statistically significant difference in the contact rate of solid particles between medical staff of different occupations, current working age, education and hospital type (χ2=76.30, 41.26, 26.16, 188.97, P<0.05) . There were significant differences in the conditions and types of solid particles in different departments (χ2=740.23, P<0.05) . Compared with the control group, the incidence of allergic asthma, chronic tracheobronchitis and dermatitis was higher in the contact group medical staff (P<0.05) . Contact with zirconia dust, talc dust, cotton dust is a risk factor for dermatitis in medical staff (OR=2.09, 1.45, 1.34) ; exposure to zirconia dust and cotton dust is a risk factor for chronic tracheobronchitis in medical staff (OR=2.38, 1.66) ; exposure to zirconia dust, gypsum dust is a risk factor for allergic asthma in medical staff (OR=3.90, 1.52) .@*Conclusion@#The contact rate of solid particles in medical staff is high, and there are many types of contact. Frequent contacted with solid particles is a dangerous cause of related diseases. The working environment of medical staff should be further monitored and be strengthen the targeted protective measures and regulatory systems for the exposure of medical personnel to solid particles.
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The electroencephalographic characteristics of mental fatigue, which was induced by long-term working memory task of 2-back, were studied by event-related potential (ERP) technology in order to obtain objective evaluation indicators for mental fatigue. Thirty-two healthy male subjects, 22-28 years old, were divided into two groups evenly, one is un-fatigue group and the other is fatigue group. The fatigue group performed a 2-back task for 100 min continuously, while the un-fatigue group just performed a 2-back task at the first and last 10 min respectively, and rested during the middle 80 min. The subjective levels of fatigue, task performance and electroencephalogram were recorded. The impaired thought and attention states, enhanced sleepy and fatigue feeling were found in the fatigue group, meanwhile their reaction time to 2-back task extended, and the accuracy decreased significantly. These results verified the validity of mental fatigue model induced by 2-back task, and then the ERP characteristic parameters were compared and analyzed between fatigue group and un-fatigue group. The results showed that the fatigue group's amplitudes of P300 ( = 2.539, 0.05). These results demonstrate that P300 and ERN can be considered as potential evaluation indictors for mental fatigue induced by long-term working memory task, which will provide basis for the future exploring of countermeasure for mental fatigue.
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Objective To investigate the protective effect of glycyrrhizin against renal ischemiareperfusion injury in mice and its mechanisms.Methods Male C57BL/6 mice were divided into three groups of six.Bilateral flank incisions were made,the right kidney was removed and the left kidney was subjected to ischemia using a microvascular clamp,which was removed after 30 min.In the shamoperated group,the mice underwent anesthesia,bilateral flank incisions and a right nephrectomy.In the glycyrrhizin-treated group,the mice were injected with 60 mg/ kg glycyrrhizin 1 h prior to ischemia.In the saline-treated group,the mice were administered with 60 mg/ kg saline.The mice were sacrificed 6 h after reperfusion and the blood and kidney samples were immediately collected for kidney function,inflammatory response and signal pathway test.Results As compared with those in the saline-treated group,the mice in glycyrrhizin0-treated group exhibited notably decreased serum levels of creatine and blood urea nitrogen at 6 h following reperfusion (P＜0.01),the SOA level was significantly reduced (P＜0.01) and the SOD activity was increased.The activity of MPO (P＜0.01)in the glycyrrhizin-treated group was significantly reduced as compared with the saline-treated group,also the serum level of pro-inflammatory TNF-α (P＜0.05),IFN-γ (P＜0.05),IL-1β (P＜0.01) and IL-6 (P＜0.01).Furthermore,the phosphorylated-p38 protein level in the glycyrrhizin-treated group was notably as reduced compared with that in the saline-treated group.Conclusion Pretreatment with glycyrrhizin attenuates renal ischemia-reperfusion injury via inhibition of tissue inflammation by downregulating p38 mitogen-activated protein kinase signaling.
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Objective To sum up the experiences in liver transplantations from donation after brain death (DBD),and compare the clinical effect,complications and influential factors with international situation.Methods The retrospective descriptive study was adopted.All the data of 66 DBD liver donors and the matched recipients from authors' affiliations during June 2010 and June 2013 were collected.Original articles,meta-analysis and data reports with high academic influence were read and data were analyzed with SPSS 22.0.Results The incidence of serious complications,vascular complications and biliary complications during the first year among 66 recipients was 21.2％,10.6％,and 6.1％,respectively.Compared to international situation,graft 1-,3-,and 5-year survival rate was similar (P＞0.05) (83％,80％ and 73％ respectively),similar to that of recipients.There was no statistically significant difference in primary nonfunction and vascular complications between our center and other centers.As for biliary complications,morbidity was lower in our center (P＜0.05).The 3-and 5-year survival rate of recipients was also similar (P＞0.05),though the 1-year survival rate was slightly lower (P＜ 0.05).Conclusion These findings provide evidence that patient's prognosis under DBD liver transplantation in our center is acceptable,and long-term survival rate has reached international level.Still,1-year survival rate of recipients is unsatisfactory.In order to achieve a good clinical efficacy,we need to find out disadvantages during donor maintenance,recipient selection,surgical procedure and postoperative management.
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Objective To investigate the differences in the biochemical and pathological features and therapeutic response between the elderly-onset autoimmune hepatitis (AIH) and young-onset AIH.Methods From October 2013 to November 2016,a total of 87 consecutive AIH patients diagnosed by liver biopsy were enrolled and divided into elderly-onset group (≥60 years) and the young-onset group (＜ 60 years).The biochemical and pathological features and therapeutic response of the two groups were compared.Mann Whitney test and chi square test were performed for statistical analysis.Results As AIH diagnosed,the proportion of liver cirrhosis detected by imaging examination of elderly-onset group and the young-onset group were 67.7％(21/31) and 35.7％(20/56),respectively,the former was higher than the latter,and the difference was statistically significant (X2 =8.214,P=0.004).The proportion of patients complicated with extrahepatic autoimmune diseases of the elderly-onset group was 9.7％ (3/31),which was lower than that of the young-onset group (28.6％,16/56),and the difference was statistically significant (X2 =4.173,P=0.041).The median levels of alanine aminotransferase (ALT) and albumin of the elderly-onset group were 50.0 U/L (22.0 U/L,193.0 U/L) and 34.8 g/L (31.3 g/L,40.5 g/L),which were lower than those of the young-onset group (146.0 U/L (43.8 U/L,390.5 U/L),39.4 g/L (35.8 g/L,44.6 g/L),and the differences were statistically significant (Z=-2.109,-2.092;both P＜ 0.05).Between the two groups,there was no statistically significant difference in inflammation grade,fibrosis stage,interface hepatitis,lymphoplasmacytic infiltration,positive rate of hepatocyte rosette pattern,positive rate of centrilobular necrosis and small bile duct injury (all P＞0.05).After treatment,among 17 patients of elderly-onset group,seven patients obtained biochemical remission and the median time to remission was 3.2 months;among 37 patients of young-onset group,18 patients (48.6％) obtained biochemical remission and the median time to remission was 2.3 months.There was no significant difference in the percentage of patients achieved biochemical remission and the median time between the two groups (both P＞0.05).Conclusion The percentage of complicated with extrahepatic autoimmune diseases of elderly-onset group is lower than that of young-onset group,which indicates that age-associated immune dysfunction may involve in the genesis and development of elderly-onset AIH.
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Hypoxia-inducible factors 1α (HIF-1α) is the key cellular oxygen-sensitive transcription factors that could activate diverse pathways in regulating cellular metabolism,angiogenesis,proliferation and migration,enabling a cell to generate adaptive responses to a low oxygen or hypoxic environment.HIF-1 α has been shown to play an important role in the pathogenesis of multiple liver diseases.This review explores the impact of HIF1α on liver ischemia-reperfusion injury and liver transplantation as well as its mechanism.
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Objective To establish the vein bypass assisted porcine liver auto transplantation model and study the methods of liver cold storage during the operation , in order to provide experience for the clini-cal application of liver auto transplantation and experimental evidence for liver machine perfusion .Methods A total of 5 pigs were operated to establish the portal-vein bypass by inserting cannula into vena jugularis in-terna, femoral vein and splenic vein , with liver being hypothermic perfused and stored in situ by 4℃ UW solution through hepatic artery and portal vein .Vital signs and clinical outcomes were monitored during the operation, and the changes of liver function indexes such as aminotransferase , total bilirubin and albumin were detected at different time points .Results During the operation , the vital signs kept steady and liver were perfused well , achieving fully blood supply after reperfusion .All animals survived over 120 h.Both al-anine aminotransferase and aspartate transaminase peaked at 24 h after blood reperfusion (69.8 ±16.2 U/L and 457.7 ±50.1 U/L), and then dropped within normal range at 96 ho after reperfusion.Total bilirubin peaked at 48 h after blood reperfusion (7.1 ±3.3μmol/L), and then decreased rapidly .The plasma albu-min kept falling after blood reperfusion , reaching the minimum of 11.1 ±2.7 g/L at 4 h after reperfusion, and then rose to normal level steadily at 16 h.Conclusions The vein bypass assisted liver auto transplanta-tion could guarantee the steady vital signs and survival rate , which may supply an experimental basis for de-veloping new efficient liver preservation and restoration methods .
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As one of the commonest postoperative complications after liver transplantation,fungal infection has a high incidence and mortality.Nowadays,the development of the organ transplantation technique in China has already entered into the era of donation after citizen's death (DCD).Donors of DCD are mainly derived from the patients after brain death,cardiac death or death of both brain and cardiac.These donors usually suffer from long-term hypotension,ischemia,anoxia and secondary recessive or dominant infections during emergency treatment.Hence,preventing the fungal infections in donor organs and recipients after transplantation plays an important role in improving the success rate of liver transplantation.This review focuses on the clinical significance of preventing fungal infection in DCD of liver transplantation.
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Portal vein thrombosis (PVT) is a common complication of liver cirrhosis. This article reviews the research advances in liver cirrhosis complicated by PVT in recent years and points out that PVT is induced by the combined effect of various factors. Hemodynamic disorder is an important basis for the development of PVT. PVT can be classified into different types according to the degree of thromboembolism and the portal vein branches involved. At present, anticoagulant therapy and interventional therapy are commonly used in the treatment of PVT. The development of PVT may not promote the progression of liver cirrhosis, but it may affect the prognosis of patients with liver cirrhosis who receive liver transplantation.
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<p><b>OBJECTIVE</b>To investigate the changes in the afferent discharge activities of the sensory nerve endings in muscle spindles of rats with hindlimb immobilization.</p><p><b>METHODS</b>Plaster cast was used immobilize the hindllimbs of rats. Using air-gap technique, the spontaneous discharge of the muscle spindles and its responses to perfusion with succinylcholine (0.05 mg/ml) and suspension in an extended position were observed in isolated muscle spindles from rats with hindlimb immobilization for 3, 7, and 14 days.</p><p><b>RESULTS</b>The muscle spindles of rat soleus showed a sharp decrease in spontaneous discharge frequency (P<0.01) and response to succinylcholine perfusion after 3 days of hindlimb immobilization (P<0.05). Significant changes of the firing rate in an extended position was observed in rats after a 14-day immobilization (P<0.01). The duration of individual spikes was significantly prolonged following hindlimb immobilization (P<0.01).</p><p><b>CONCLUSION</b>Muscle spindle discharges decrease significantly in rats following hindlimb immobilization, which might be related to reduced contractile properties of the muscle spindle.</p>
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Animales , Ratas , Suspensión Trasera , Husos Musculares , Músculo EsqueléticoRESUMEN
BACKGROUND:At present, there are a number of articles about hypothermic machine perfusion versus static cold storage of kidney alografts; however, the conclusions are various. Furthermore, due to the limitation of single sample size, there is a lack of objective evaluation on the merits and demerits of hypothermic machine perfusion. OBJECTIVE: To compare the prognostic outcomes of hypothermic machine perfusion and static cold storage of kidney alografts. METHODS: A computer-based search of PubMed, sinoMed, EMbase, Web of Science, the Cochrane Central Register of Controled Trials (CENTRAL), Wanfang and CNKI databases were searched from their establishment to March 4, 2015 to screen the randomized controled trials (RCTs) about hypothermic machine perfusion versus static cold storage for kidney transplantation. Meanwhile, the references of included RCTs were also searched by hand. After study selection, RCTs screening, data extraction and quality assessment were conducted by two reviewers independently. Meta-analyses were performed by using the RevMan5.3.0 software. The quality of evidence was assessed by using the GRADEpro3.6 software. RESULTS AND CONCLUSION: Six articles were included, involving 619 cases undergoing hypothermic machine perfusion and 620 cases undergoing static cold storage. The results of Meta-analyses showed that the incidence of primary graft non-function, incidence of delayed graft function of functional kidney alografts, and incidence of delayed graft function were significantly lower in the hypothermic machine perfusion group than the static cold storage group (P 0.05). These findings indicate that the hypothermic machine perfusion only can reduce the incidence of postoperative complications to maintain the function of kidney, but cannot improve the 1-year recipient survival rate and 1-year alograft survival rate. Hypothermic machine perfusion has no advantage on the long-term preservation of donor organ compared with the static cold storage.
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Liver transplantation is the main treatment for end-stage liver diseases and liver tumor.To solve the problem of the insufficient donor liver,autologous liver transplantation (ALT) is becoming widely acknowledged,which could serve as a complementary technique for treating unresectable liver space-occupying lesions in routine operation.However,compared with allogeneic liver transplantation,the long anhepatic phase during ALT may influence the outcome of such patients.Veno-venous bypass (VVB) as a technology which can maintain the stability of hemodynamics and internal environment in the anhepatic phase is routinely used in ALT.In this paper,the application of VVB in the ALT was mainly discussed.
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Objective To establish the rabbit brain death model,and observe the change of kidney function and morphology in the brain death rabbits,fully evaluate the possibility of transplantation surgery carried out with brain death donor kidney.Method 40 male healthy New Zealand rabbits were randomly divided into sham group (n =20) and brain death group (n =20),and each group further was divided into four groups according to 2,4,6 and 8 h after brain death groups.At the end of the experiment,the blood samples and kidney tissues were collected.The level of blood urea nitrogen(BUN),serum creatinine (Cr) and the apoptosis of kidney cells were determined by automatic biochemistry analyzer and TUNEL method,respectively.The morphology changes of liver were detected by HE staining.Result Although BUN values were with no obviously alteration (P＞0.05) within 8 h after brain death,the renal Cr levels in the states of 2,4 and 8 h (P＜0.05) brain death were found significantly increased compared with shamed groups.The denaturalization in the epithelial cells of renal tubule,glomerulus atrophygradually,swelling and vacuolation of epithelial cells,edema in the interstitium and inflammatory cell infiltration and partly occlusion in proximal convoluted tubule gradually emerged in the brain dead groups.The inflammatory factor intercellular adhesion molecule (ICMA) and the apoptosis index in brain dead groups increased in a time dependent manner but the expressions of protective factor HSP70 conducted a contrary tendency.Conclusin Brain death could lead to the damage of kidney function and morphology and this injury aggravated in a time dependent manner.The alterations might be relevant to the production of inflammatory factors.Within 8 h after brain death there were obvious changes in the kidney function and morphology,which provide experimental basis for the rational use of brain death donor kidney transplantation.
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Objective To explore the differential proteins in livers with the help of proteomics,which provide experimental basis for the study of influence factors of liver injury in the state of brain-death.Methods Slow intracranial pressure method was used to establish the rabbit brain death model.Each liver tissue from 6 h after brain death of rabbit was collected.Total proteins were extracted and separated by two-dimensional gel electrophoresis.The image was analyzed by PDQuest software.The differentially expressed proteins between the two groups in more than two-fold were identified by matrix-assisted laser desorption ionization time of flight mass spectrometry and retrieved in the NCBI database to identify the corresponding protein.And the different proteins were re-identified by western blot.Results Two-dimensional gel electrophoresis showed that there were about 973 ± 34 and 987 ± 38 protein spots in sham and brain death groups.A total of 52 differentially expressed protein spots between the two groups,29 were up-regulated,and 23 were down-regulated.10 different proteins were:DPYL4,ALDH2,PRDX6,PDK1,THTM,RUNX1,PPA1,ADH,GCLR,CYB5.RUNX1 is a protein of interest,so the expression of RUNX1 was detected by western blot and it showed that the expression of RUNX1 in liver decreased gradually in a time-dependent manner.Conclusions Two-dimensional gel electrophoresis and mass spectrometry identification is a reliable platform and powerful tool for differential proteomics studies.Identified protein RUNX1 may be related with liver injury after brain death,which is beneficial for the understanding of the mechanism of liver damage after brain death.
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Objective To study the effect of extracorporeal membrane oxygenation (ECMO) in donor preservation and organ procurement of donation after citizens' death.Method From 2013 to 2014,according to the ECMO indications,we used ECMO to provide circulation and breathing support for circulatory or respiratory function failure donation after brain death (DBD) donor and uncontrolled donation after cardiac death(DCD) donors.Through percutaneous liver puncture and living tissue rapid frozen section,the liver steatosis and fibrosis degree was determined.ECMO indications,ECMO related parameters and the result of blood gas analysis were recorded.alanine aminotransferase(ALT),aspartate aminotransferase(AST) and creatinine(Cr) before and after ECMO intervention were detected to evaluate liver and kidney function and damage.Whether the liver and kidney reached the requirements of the organ transplantation was assessed.Result The ECMO was used in 6 donors.Five cases of DBD were assisted through V-A ECMO because of circulatory or respiratory function failure.In one case of uncontrolled DCD recirculation was established through the thoracic aorta-blocked V-A ECMO.Four livers and 8 kidneys,from 4 donors,were retrieved and transplanted.Two donors' organs were discarded for damage beyond the standard.Conclusion For DBD donor with circulatory or respiratory function failure and uncontrolled DCD donors,the use of ECMO to assist circulatory and respiratory function or establish DCD recirculation can avoid liver and kidney injuries from vascular active drugs and DCD warm ischemia injury,thus,reduce the organ discarding rate of donation after citizens' death.
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Objective To compare the outcome of donation after cardiac death (DCD) versus donation after brain death (DBD) for liver transplantation.Method Such databases as PubMed,Cochrane Central Register of Controlled Trials (CENTRAL),EMbase,the ISI Web of Knowledge databases and CBMdisk were searched from Month 1990 to March 2011 for collecting the randomized controlled trials (RCTs),case control studies and cohort analysis about DCD versus DBD for liver transplantation,and the references of those trials were also searched by hand.After study selection,assessment and data extraction conducted by two reviewers independently,meta-analyses were performed by using the RevManS.1 software.The quality of evidence was assessed by using the GRADEpro software.Result DCD group had similar MELD of recipients with DBD group before operation [Z =1.37,95％ CI(-2.25,0.26),P =0.17],and DCD group got shorter cold ischemia time than DBD group [Z=2.26,95％CI(-1.76,-0.12),P =0.02].DCD group had higher hiliary complication incidence [Z =6.37,95％ CI(1.89,3.31),P＜0.000 01],higher vascular complication incidence [Z =2.14,95％ CI(1.03,2.17),P =0.03],higher liver primary non-function (PNF) incidence [Z =4.43,95％ CI (2.02,6.17),P＜0.000 01],lower 1-year graft survival rate [Z =3.78,95％ CI(0.84,0.94),P =0.0002] and lower 3 year graft survival rate[Z=2.54,95％ CI(0.73,0.96),P =0.01] than DBD group.The quality of the result was verified from low to moderate.Conclusion Liver transplantation using DCD had higher incidence of complications and lower 1-year and 3-year graft survival rate than DBD.For the poor quality of the original studies,a prudent choice is suggested.More randomized controlled trials are needed.
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Objective To investigate the repair function of extracorporeal membrane oxygenation (ECMO) in vivo for the liver after cardiac death with warm ischemia injury for 30 min from cardiac death swinc.Method Ten landraces,30 to 40 kg,randomized to experimental group and control group,were used to make 30-min cardiac death models through clamping trachea after deep anesthesia.An intravenous cannula was placed through right iliac arteries and veins,and connected to ECMO extracorporeal circulation pipes in experimental group.The balloon catheter was placed to diaphragm plane through left femoral artery.The ECMO was performed to infuse abdominal organs,and pH and electrolyte were adjusted.The circulation flow rate,intraperitoneal organ perfusion pressure,venous blood gas,electrolyte,transaminase,and bile product,etc.were monitored and recorded.The livers of control group were retrieved after 30-min cardiac arrest and stored in cold UW for 4 h.Pathological tissue was sliced and stained by HE.Result After 30-min cardiac arrest,the liver showed obvious congestion appearance; pathologically,there were hepatic sinus expansion,blood cells clog,and erythrocyte aggregation.Circulating blood gas analysis revealed severe acidosis.After the ECMO recirculation started,circulation flow rate maintained to 1 L/min,the liver gradually restored bright red,pathological biopsy showed that hepatic sinus expansion disappeared,and clogged blood cells dispelled.AST was markedly increased to (226.0 ± 28.0) U/L after 30-min cardiac arrest and reduced to (150.0 ± 30.0) U/L 4 h after the ECMO recirculation.Average bile production was 7.75 ml/h.Conclusion ECMO recirculation in vivo can repair the injured livers from cardiac death donor with 30-min cardiac arrest.