Clinical research progress on pediatric lung transplantation / 器官移植

Lung transplantation is an efficacious treatment for end-stage lung diseases in children. Shortage of donor lungs, poor donor-recipient matching, difficult postoperative management, multiple postoperative complications and high fatality jointly restrict the development of pediatric lung transplantation. However, significant progress has been achieved in each transplantation center along with the popularization of organ donation after citizen' s death, advancement of medical science and technology and accumulation of lung transplantation experience. In recent years, clinical application of donor lung from donation after brain death and marginal donor lung repair, maturity of perioperative life support technology and surgical transplantation procedure and reference of management experience after adult lung transplantation have accelerated rapid development of pediatric lung transplantation. In this article, current status and progress on primary diseases, utilization and allocation of donor lungs, selection of surgical techniques, management of postoperative complications and clinical prognosis of pediatric lung transplantation were elucidated, aiming to provide reference for clinical diagnosis and treatment.

Lung transplantation for pulmonary lymphangioleiomyomatosis:a report of 9 cases / 中华胸心血管外科杂志

Objective To investigate the selection of recipients,operative technique, and perioperative management of lung transplantation.Methods From June 2013 to September 2016, 9 patients with pulmonary lymphangioleiomyomatosis un-derwent lung transplantation at Affiliated Wuxi People's Hospital.There were 9 females aged from 23 to 52 years.Chest en-hancement of CT in 9 patients prior to transplantation suggests multiple different sized thin-walled cystic shadows in whole lung. Nine patients received bilateral sequence lung transplantation ( BSLT) .The pathological findings after the operation indicated that cells of the abnormal proliferation of smooth muscle diffused around the bronchi , vessels and lymphatics , and widened the alveolar septum, which was consistent with the pathological changes in the patients with PLAM .We analyzed the differences of oxygenation index, forcedexpiratory volume at 1 sec(FEV1), and DLCO％ pred.Using paired t test to compare these indica-tors, P<0.05 was considered statistically significant.Results The oxygenation index was increased from(210 ±55) mmHg (1 mmHg=0.133 kPa) to(400 ±80)mmHg after treatment, the difference was statistically significant(P<0.05).The FEV1 was increased from(1.0 ±0.2)L to(2.8 ±0.4)L, and the difference was statistically significant(P<0.05).The DLCO％pred was increased from(27.5 ±2.5)％ to(75.0 ±10.0)％, and the difference was statistically significant(P<0.05).Fi-nally, 8 patients were discharged from the hospital, and the pulmonary function was good.1 patients died of infection and acute rejection on the 13 day after operation.Conclusion Lung transplantation is effective in the treatment of chronic thromboem-bolic pulmonary hypertension , and long-term survival requires further investigations .Lung transplantation is the only effective means for the treatment of end-stage pulmonary lymphangioleiomyomatosis .Bilateral sequence lung transplantation is the first choice.

Risk factors analysis of malignancy from gallbladder polyps / 中华消化外科杂志

Objective To investigate the risk factors of malignancy from gallbladder polyps (GBPs).Methods The retrospective case-control study was conducted.The clinicopathological data of 604 patients with GBPs who were admitted to the Chinese PLA General Hospital between January 2011 and October 2016 were collected.There were 255 males and 349 females,aged from 19 to 88 years,with an average age of 47 years.There were 565 of 604 patients with benign GBPs and 39 with malignant GBPs.Observation indicators:(1) risk factors analysis of malignancy from GBPs;(2) the predictive ability of polyp diameter for malignancy from GBPs.Measurement data with normal distribution were expressed as Mean ± SD,measurement data with skewed distribution were described as M (range),and the univariate analysis was done using the t test or rank-sum test.Count data were described by the absolute amount,and the univariate analysis was done using the chi-square test or Fisher exact probability.The indicators with P＜0.05 in the univariate analysis based on clinical application were used in the Logistic regression models for multivariate analysis.The receiver operating characteristic (ROC) curve was drawn.The Youden index was calculated to analyze the predictive ability of polyp diameter for malignancy from GBPs.Results (1) Risk factors analysis of malignancy from GBPs:results of univariate analysis showed that age,polyp diameter,polyp number,chronic cholecystitis and carcinoembryonic antigen (CEA) level were related factors affecting malignancy from GBPs (t=-5.50,Z=-9.65,x2=15.92,312.65,Z=-1.78,P＜0.05).The results of multivariate analysis showed that age,polyp diameter and polyp number were independent factors affecting malignancy from GBPs (odds ratio =1.088,45.190,9.655,95％ confidence interval:0.974-1.159,4.312-121.139,0.890-117.551,P＜0.05).(2) The predictive ability of polyp diameter for malignancy from GBPs.The sensitivity and specificity predicting malignancy from GBPs were 94.9％ and 81.2％ in patients with polyp diameter =10 mm and Youden index =0.761,89.7％ and 90.6％ in patients with polyp diameter =12 mm and Youden index =0.803,84.6％ and 92.6％ in patients with polyp diameter =13 mm and Youden index =0.772,respectively.Conclusions The age,polyp diameter and polyp number are the independant factors affecting malignancy from GBPs.The malignancy possibility from GBPs is higher in patients with the age ＞ 50 years,polyp diameter ＞ 12 mm,solitary polyp,and should undergo surgical therapy actively.

Clinical analysis of lung transplantation from donors combined with pulmonary contusion / 器官移植

Objective To explore the efficacy and prognosis of lung transplantation from donors combined with pulmonary contusion on the treatment of patients with end-stage lung disease. Methods Clinical data of 73 cases of donors and recipients were collected. The donors and recipients were divided into contusion group (23 cases of donors and recipients, with a maximum diameter of contusion in 5-8 cm) and standard group (50 cases of donors and recipients) depending on combined pulmonary contusion. Major clinical indicators [postoperative oxygenation index, duration of mechanical ventilation and chest tube drainage and incidence of primary graft dysfunction (PGD)] and prognosis of the recipients in both groups were compared. Results The recipients in both groups presented no significant difference in postoperative oxygenation index, duration of mechanical ventilation and chest tube drainage and incidence of PGD (all P>0.05). The postoperative 1-year survival of the recipients in standard group and contusion group was 74％ and 83％, which presented no statistically significant difference (P>0.05). Conclusions The efficacy and prognosis of lung transplantation from donors combined with pulmonary contusion (with a maximum diameter of 5-8 cm) are comparable to those of lung transplantation from standard donors.

Effect of azitromycin on Th17/Treg balance in bronchiolitis obliterans mice after lung transplantation / 器官移植

Objective To evaluate the effect of azitromycin upon the bronchiolitis obliterans and T helper (Th)17/regulatory T cell (Treg) balance after lung transplantation. Methods Twenty-four specific pathogen free(SPF) C57BL/6 mice were used as the donors and 48 Balb/c mice were utilized as the recipients. The Balb/c mice were randomly divided into the control (C group), azitromycin control (Cazm group), transplantation (T group) and transplantation + azitromycin groups (Tazm group), 12 mice in each group. In the T and Tazm groups, heterotopic tracheal transplantation models were established to simulate bronchiolitis obliterans after lung transplantation. From 1 d post-transplantation, intragastric administration of azitromycin was given at a dose of 30 mg/kg three times per week in the Cazm and Tazm groups. At 14 and 28 d after transplantation, the transplanted trachea was removed and peripheral blood was collected. The tracheal sample was prepared for hematoxylin-eosin (HE) staining for pathological observation. The expression levels of ROR-γt and Foxp3 messenger ribonucleic acid (mRNA) in the peripheral blood were quantitatively measured by reverse transcription polymerase chain reaction (RT-PCR). The variation in the related cytokines levels of Th17 cells and Treg in the plasma was detected by enzyme linked immunosorbent assay (ELISA). Results After heterotopic tracheal transplantation, compared with the C group, thetracheal occlusion accompanied with inflammatory infiltration was observed in the T and Tazm groups. The severity of relevant symptoms in the Tazm group was slighter than that in the T group. Compared with the T group, the expression level of ROR-γt mRNA in the Tazm group was significantly down-regulated (P<0.05). No statistical significance was identified in the expression of Foxp3 mRNA between two groups (P>0.05). Compared with the T group, the levels of interleukin (IL)-6 and IL-17 cytokines in the Tazm group were significantly down-regulated (all P<0.05). Conclusions Persistent therapy of azitromycin can delay the progression of bronchiolitis obliterans after transplantation, which is probably associated with inhibiting Th17 cell differentiation and inflammation.

Lung transplantation for chronic thromboembolic pulmonary hypertension: a report of 6 cases / 中华器官移植杂志

Objective To investigate the selection of recipients,operative technique,and perioperative management of lung transplantation for chronic thromboembolic pulmonary hypertension.Methods This article reviews the clinical data of 6 patients with chronic thromboembolic pulmonary hypertension receiving lung transplantation from January 2012 to June 2016.From January 2012 to June 2016,6 patients with chronic thromboembolic pulmonary hypertension underwent lung transplantation at Department of Thoracic Surgery,Affiliated Wuxi People's Hospital,Nanjing Medical University.There were 4 male and 2 female patients aged from 34 to 59 years.Chest enhancement of CT or CTPA in 6 patients prior to transplantation suggests a different degree of pulmonary embolism.The mean pulmonary artery pressure (mPAP) was＞30 mmHg,NYHA 11Ⅰ or Ⅳ.Four patients received bilateral sequence lung transplantation (BSLT) under extracorporeal membrane oxygenation (ECMO) support.Two patients received single lung transplantation (SLT).We analyzed the differences of oxygenation index,pulmonary systolic pressure,pulmonary artery diastolic pressure,mean pulmonary arterial pressure,and central venous pressure before and after treatment.Using paired t test to compare these indicators,P＜0.05 was considered statistically significant.Results The oxygenation index increased from (195 ± 85) to (440 ± 140) mmHg after treatment,the difference was statistically significant (P＜0.05).the The systolic pressure of pulmonary artery was decreased from (108 ± 28) mmHg to (56 ± 16) mmHg,and the difference was statistically significant (P＜0.05).the The diastolic pressure of pulmonary artery was decreased from (72 ± 18) mmHg to (25 ± 10) mmHg,and the difference was statistically significant (P＜0.05).the The mean pulmonary artery pressure was decreased from (84 ± 27) mmHg to (36 ± 10) mmHg,and the difference was statistically significant (P＜0.05).the The central venous pressure was decreased from (17.5 ± 4.5) mmHg to (8.5 ± 1.5) mmHg,and the difference was statistically significant (P＜0.05).Finally,5 patients were discharged from the hospital,and the pulmonary valve? functioned? well.1 patients died of shock and systemic failure 3 days after operation.Conclusion Lung transplantation is effective in the treatment of chronic thromboembolic pulmonary hypertension,and long-term survival requires further investigations.

Risk factors related to early survival after lung transplantation for idiopathic pulmonary fibrosis / 中华器官移植杂志

Objective To estimate the effects of risk factors on early survuval (90 days) after lung transplantation for idiopathic pulmonary fibrosis (IPF).Method We reviewed 49 cases of lung tansplant male patients which suffered from IPF.Two groups were set up according to the early survival.The early outcomes (90 days) were compared between two groups by multiple logistic regression analysis.Result The early survival rate was 81.6％.Multivariate analysis confirmed that mean pulmonary artery pressure and bilateral lung transplantation (BLTx) were risk factors after adjustment for potential confounders.Recipients' age,lung volume reduction on donors,and use of extracorporeal membrane oxygenation (ECMO) were not risk factors for early mortality.Conclusion The increased pulmonary artery pressure and BLTx are risk factors for death after lung transplantation in IPF.Preoperative evaluation of mean pulmonary artery pressure and choosing suitable operative method could improve the surgical outcomes of lung transplantation.