Preoperation risk factor analysis in orthotopic liver transplantation with pre-transplant artificial liver support therapy / 中华肝脏病杂志

<p><b>OBJECTIVES</b>Orthotopic liver transplantation (OLT) is an accepted therapy for selected patients with advanced liver diseases. However, the early mortality rate after OLT remains relatively high due to the poor selection of candidates with various serious conditions. The aim of this study is to assess the value of pretransplantation artificial liver support treatment in reducing the pre-operation risk factors relating to early mortality after OLT.</p><p><b>METHODS</b>50 adult patients in various stages of different etiologies who underwent OLT procedures had been treated with molecular adsorbent recycling system (MARS) preoperatively. The study was designed in two parts: the first one was to evaluate the effectiveness of a single MARS therapy by using some clinical and laboratory parameters which were supposed to be therapeutical pretransplantation risk factors. The second part was to study the patients undergoing OLT by using the regression analysis on preoperation risk factors relating to early (within 30 d after OLT) mortality rate.</p><p><b>RESULTS</b>Among the 50 patients, a statistically significant improvement of the biochemical parameters was observed (pretreatment vs posttreatment). 8 patients cancelled their scheduled LTXs due to significant improvements in their clinical conditions or recovery of their failing liver functions. 8 patients died and 34 patients successfully underwent LTX. The immediate outcome (within 30 postoperative days) of these 34 patients was that 28 were kept alive and 6 died.</p><p><b>CONCLUSIONS</b>Preoperation sequential organ failure assessment (SOFA), level of creatinine, INR, TNFalpha, and IL-10 are the main preoperative risk factors relating to early death after an operation. MARS treatment before a transplant operation can relieve these factors significantly, hence improve survival rate of liver transplantation or even make the transplantation unnecessary.</p>

Over 55 years-old live-related donor kidney transplants: a report of 12 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the risk factors of the over 55-year-old donor and the safety and efficacy of the donor, and the recipient with the immediate and long-term of the kidney.</p><p><b>METHODS</b>The living-related donor kidney transplantation in 15 cases was performed in our unit from October 1999 to April 2002. Of these, 12 donors were over 55 with age ranging from 55 to 73 years-old and mean age of 62, 75 years. 5 donors were male and 7 were female. Father in 5 cases and 6 and 1 were mother and grandmother, respectively. The donors were evaluated depending on general state of health, hypertension, diabate and important organa in condition; and renal function by creatinine (Cre), creatinine clearance (Ccr), Glomerular filtration rate (GFR), B ultrasound and renal arteriograph prior to operation. The all receipients with ages ranging from 14 to 46 years with end-stage renal diseases (ESRD) from and their mean age was 32.9 years. The donor' left nephrectomy was performed in 10 cases and right nephrectomy in 2. Warm-ischemia time was from 70 s to 170 s (mean time, 92 s). Cold-ischemia time was from 60 minutes to 120 minutes and mean 84 minutes. The follow-up is from 12 to 42 months and mean 20, 84 months.</p><p><b>RESULTS</b>All the 12 donors were perfectly recovered during operation and postoperation. During their 11-day stay in the hospital no complications was observed. The donor' creatinine was raised to about 12 to 34 micro mol/L (mean, 22 micro mol/L). One recipient died from lung infection at 28 days postoperative and 1 died due to liver failure with normal graft function after transplanted 6 months and yet one recipient with delayed graft function had recovered by 12 times dialysis. The remain recipient had a better recovered.</p><p><b>CONCLUSION</b>Aged (>or= 55 years-old) donor renal transplantation can be carried out as the poor supply of can be used kidney but must to controled the indication and the prepare to be accomplished seriously.</p>