RESUMO
Objective:To summarize and analyze the clinical treatment of aspergillus infection in the central nervous system.Methods:Data was obtained from a recipient who were diagnosed with invasive aspergillosis in the central nervous system after liver transplantation.We retrospectively analyzed the clinical character of the recipient." Liver transplantation" , " Aspergillus" , " brain" and " aspergillus" were searched for literature published in English or Chinese in Wanfang data, CNKI and PubMed database for nearly 5 years until January 2022.Results:A 33 years old recipient was admitted to the hospital with fatigue, chest distress and shortness of breath after liver transplantation on postoperative day(POD)48.On the computed tomography(CT)scan of the chest, multiple exudative lesions was observed in both lungs.Multiple sputum cultures were grown as Candida albicans.The symptoms of chest tightness and shortness of breath were significantly improved by treating with caspofungin compared before.On POD 79, the recipient developed stubborn nausea and vomiting.Cranial enhanced magnetic resonance imaging(MRI)showed central nervous system(CNS)infection.Numerous traditional pathogenic microorganisms tests of cerebrospinal fluid(CSF)were all negative.With the help of metagenomics next generation sequencing(mNGS), aspergillus fumigatus was detected in CSF.The recipient received therapy with voriconazole and rehabilitation.Therapy with voriconazole was continuous for 8 months.Unfortunately, the recipient developed cholestasis due to repeated biliary infection and eventually died of liver failure 13 months later.Conclusions:Although the mortality rate of aspergillus infection in the central nervous system is very high after liver transplantation, timely and effective treatment is still expected to improve its prognosis.
RESUMO
Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.