Preliminary study on the safety of liver transplantation recipients with Rh blood group mismatching / 中华器官移植杂志

Objective@#To explore the safety of liver transplantation recipients with Rh blood group mismatchming.@*Methods@#From May 2005 to December 2018, 1 546 cases of liver transplantation in our hospital were retrospectively analyzed. Among these cases, 5 cases of Rh blood group mismatched were Rh(-) recipients receiving Rh(+ ) donor liver. For each Rh blood group mismatched liver transplantation, 5 patients received the same Rh blood group liver allograft were matched according to a certain principle and were defined as Rh-mismatch group and Rh-match group respectively. The serum alanine aminotransferase (ALT), aspartate aminotransferase(AST)and creatinine(SCr)were compared between two groups at Days 7 & 14 post-operation. Serum total bilirubin(TB), gamma-glutamyl transpeptidase(GGT)were compared between two groups at Month 1, 6 & 12 post-operation. Hemoglobin (Hb)were compared between two groups Month 1, 3 & 6 post-operation. The rates of infection, vascular complications and acute rejection was also compared. Indirect antiglobulin test (IAT)was used for detecting the production of anti-RhD antibody in patients in Rh-mismatch group at Month 1, 6 & 12 post-operation.@*Results@#At the mentioned time, no significant inter-group difference existed in serum ALT, AST, SCr, TB, GGT and blood Hb levels(all P>0.05); Also, no significant difference existed in the incidence of infection, vascular complications or acute rejection(all P>0.05). In Rhmismatch group, 4 recipients received Rh(+ )RBC transfusion during perioperative period and no hemolytic anemia occurred after operation. Rh(D) antibody was negative at all timepoints.@*Conclusions@#Taking into account the rarity of Rh-negative blood group in Chinese, it is safe and feasible to carry out Rh blood group mismatched liver transplantation when donor or recipient with the same Rh blood group is not available.

Preliminary study on the safety of liver transplantation recipients with Rh blood group mismatching / 中华器官移植杂志

Objective To explore the safety of liver transplantation recipients with Rh blood group mismatchming .Methods From May 2005 to December 2018 ,1546 cases of liver transplantation in our hospital were retrospectively analyzed . Among these cases ,5 cases of Rh blood group mismatched were Rh(-) recipients receiving Rh(+ ) donor liver .For each Rh blood group mismatched liver transplantation ,5 patients received the same Rh blood group liver allograft were matched according to a certain principle and were defined as Rh-mismatch group and Rh-match group respectively .The serum alanine aminotransferase (ALT ) ,aspartate aminotransferase (AST ) and creatinine(SCr)were compared between two groups at Days 7 & 14 post-operation .Serum total bilirubin(TB) ,gamma-glutamyl transpeptidase(GGT)were compared between two groups at Month 1 , 6 & 12 post-operation .Hemoglobin (Hb)were compared between two groups Month 1 ,3 & 6 post-operation . The rates of infection ,vascular complications and acute rejection was also compared . Indirect antiglobulin test (IAT)was used for detecting the production of anti-RhD antibody in patients in Rh-mismatch group at Month 1 ,6 & 12 post-operation .Results At the mentioned time ,no significant inter-group difference existed in serum ALT ,AST ,SCr ,TB ,GGT and blood Hb levels (all P>0 .05);Also ,no significant difference existed in the incidence of infection ,vascular complications or acute rejection(all P> 0 .05) .In Rhmismatch group ,4 recipients received Rh (+ )RBC transfusion during perioperative period and no hemolytic anemia occurred after operation .Rh(D) antibody was negative at all timepoints .Conclusions Taking into account the rarity of Rh-negative blood group in Chinese ,it is safe and feasible to carry out Rh blood group mismatched liver transplantation when donor or recipient with the same Rh blood group is not available .

Clinical Results of the Intra-Arterial Thrombolysis with Stent Retriever Device Weather Perfusion Diffusion Mismatching and Intravenous Tissue Plasminogen Activator Administration

OBJECTIVE: Intraarterial thrombolysis (IA-Tx) with stent retriever is accepted as an additional treatment for selected patients and the clinical benefit is well reported. Each intravenous tissue plasminogen activator administration (IV-tPA) and perfusion diffusion mismatching (P/D-mismatching) is well known the beneficial effects for recanalization and clinical outcomes. In this report, authors analyzed the clinical outcomes of additional IA-Tx with retrieval stent device, according to the combined IV-tPA and P/D-mismatching or not. METHODS: Eighty-one treated IA-Tx with the Solitaire stent retriever device, diagnosed as anterior circulation larger vessel occlusion were included in this study. Computed tomography-angiography (CTA) was done as an initial diagnostic image and acute stroke magnetic resonance image (MRI) followed after the IV-tPA. Forty-two patients were in the tPA group and 39 patients were in the non-tPA group. Recanalization rate, clinically significant hemorrhagic (sICH) and clinical outcomes were recorded according to the IV-tPA and P/D-mismatching. RESULTS: Recanalization rate was 81.0% in IV-tPA group, and it was 69.2% in non-tPA group (p = 0.017). While sICH were 19.9% and 25.6%, respectively (p = 0.328). Neurologic outcomes did not influence by IV-tPA administration or not. But according to the P/D-mismatching, the recanalization rate and sICH were 91.9% and 16.7% in the mismatched group and 46.7% and 46.7% in the matched group (p = 0.008 and p = 0.019, respectively). CONCLUSION: For patients treated with IA-Tx with retrieval stent, IV-tPA infusion does not influence on the sICH, recanalization rate and neurologic outcomes. But P/D-mismatching was correlated well with sICH, recanalization rate and clinical outcomes.

Efeito da plataforma Switching sobre os tecidos peri-implantares: estudo experimental em cães / Effect of plataform Switching on peri-implant tissues: an experimental study in dogs

Objetivo: Avaliar a influência da plataforma Switching sobre a remodelação dos tecidos peri-implantares. Material e métodos: Em 6 cães labradores, foram extraídos os pré-molares e primeiro molares inferiores bilateralmente. Após 3 meses de cicatrização, na região correpondente ao 1º molar, foi instalado um implante cônico em cada lado da mandíbula, com o ombro do mesmo posicionado ao nível da crista óssea alveolar vestibular. No lado direito da mandíbula, foi utilizado um pilar de diâmetro reduzido em relação à plataforma do implante, criando uma incompatibilidade de 0,85 milímetros (grupo teste), enquanto no lado esquerdo selecionou-se um pilar do mesmo diâmetro da plataforma do implante (grupo controle). Os retalhos foram suturados permitindo a cicatrização não-submersa. Após 4 meses, os animais foram eutanasiados para obtenção dos cortes histológicos para avaliação histométrica. Resultados: Todos os implantes apresentaram-se completamente osseointegrados. No grupo teste foram observados que os níveis ósseos apresentaram-se superiores ao grupo controle. No entanto, a diferença estatisticamente significativa foi encontrada apenas na região vestibular e na região proximal. A dimensão vertical dos tecidos moles foi maior no grupo controle em comparação ao grupo teste. No entanto, foi encontrada diferença estatisticamente significativa apenas na vestibular. Conclusões: O presente estudo demonstrou diferenças nas dimensões dos tecidos duros e moles peri-implantares (vestibular e proximal) como resultado da incompatibilidade do implante / pilar de 0,85 milímetros, quando o ombro do implante foi posicionado ao nível da crista óssea vestibular...

Aim: to evaluate the effect of platform switching on the peri-implant tissue remodeling. Material & methods: Mandibular premolars and first molars of 6 Labrador dogs were extracted bilaterally. After 3 months of healing, 1 tapered implant was installed on each side of the mandibular molar region with the implant shoulder placed at the level of the alveolar buccal bony crest. On the right side of the mandible, an abutment of reduced diameter in relation to the platform of the implant was used creating a mismatch of 0.85mm (test), while an abutment of the same diameter of the implant platform was affixed in the left side of the mandible (control). The flaps were sutured to allow a non-submerged healing. After 4 months, the animals were sacrificed and ground sections were obtained for histometric assessment. Results: All implants were completely osseointegrated. Bone levels were superior at the test than at the control sites. However, statistically significant differences were found only at the buccal and proximal aspects. The soft tissue vertical dimension was higher at the control compared to the test sites. However, statistically significant differences were demonstrated only or at the buccal aspects. Conclusions: The present study demonstrated differences in peri-implant (buccal and proximal) hard and soft tissue dimensions as a result of an implant/abutment mismatch of 0.85mm, when the implant shoulder was placed at the level of the buccal bony crest

Efeito da plataforma Switching sobre os tecidos peri-implantares: estudo experimental em cães / Effect of plataform Switching on peri-implant tissues: an experimental study in dogs

Objetivo: Avaliar a influência da plataforma Switching sobre a remodelação dos tecidos peri-implantares. Material e métodos: Em 6 cães labradores, foram extraídos os pré-molares e primeiro molares inferiores bilateralmente. Após 3 meses de cicatrização, na região correpondente ao 1º molar, foi instalado um implante cônico em cada lado da mandíbula, com o ombro do mesmo posicionado ao nível da crista óssea alveolar vestibular. No lado direito da mandíbula, foi utilizado um pilar de diâmetro reduzido em relação à plataforma do implante, criando uma incompatibilidade de 0,85 milímetros (grupo teste), enquanto no lado esquerdo selecionou-se um pilar do mesmo diâmetro da plataforma do implante (grupo controle). Os retalhos foram suturados permitindo a cicatrização não-submersa. Após 4 meses, os animais foram eutanasiados para obtenção dos cortes histológicos para avaliação histométrica. Resultados: Todos os implantes apresentaram-se completamente osseointegrados. No grupo teste foram observados que os níveis ósseos apresentaram-se superiores ao grupo controle. No entanto, a diferença estatisticamente significativa foi encontrada apenas na região vestibular e na região proximal. A dimensão vertical dos tecidos moles foi maior no grupo controle em comparação ao grupo teste. No entanto, foi encontrada diferença estatisticamente significativa apenas na vestibular. Conclusões: O presente estudo demonstrou diferenças nas dimensões dos tecidos duros e moles peri-implantares (vestibular e proximal) como resultado da incompatibilidade do implante / pilar de 0,85 milímetros, quando o ombro do implante foi posicionado ao nível da crista óssea vestibular.

Aim: to evaluate the effect of platform switching on the peri-implant tissue remodeling. Material & methods: Mandibular premolars and first molars of 6 Labrador dogs were extracted bilaterally. After 3 months of healing, 1 tapered implant was installed on each side of the mandibular molar region with the implant shoulder placed at the level of the alveolar buccal bony crest. On the right side of the mandible, an abutment of reduced diameter in relation to the platform of the implant was used creating a mismatch of 0.85mm (test), while an abutment of the same diameter of the implant platform was affixed in the left side of the mandible (control). The flaps were sutured to allow a non-submerged healing. After 4 months, the animals were sacrificed and ground sections were obtained for histometric assessment. Results: All implants were completely osseointegrated. Bone levels were superior at the test than at the control sites. However, statistically significant differences were found only at the buccal and proximal aspects. The soft tissue vertical dimension was higher at the control compared to the test sites. However, statistically significant differences were demonstrated only or at the buccal aspects. Conclusions: The present study demonstrated differences in peri-implant (buccal and proximal) hard and soft tissue dimensions as a result of an implant/abutment mismatch of 0.85mm, when the implant shoulder was placed at the level of the buccal bony crest.

Time-dependent Effect of Non-immunologic Factors on the Graft Survival and Graft Function in Haplotype Matched Living Donor Renal Transplant Recipients / 대한이식학회지

PURPOSE: In the analysis of risk factors affecting the renal graft survival and graft function, time-dependent effect of each risk factor should be differentiated from net effect of risk factor. We attempted to analyze the impact of immunologic and/or non-immunologic risk factors on the graft function and survival after renal transplantation among the recipients having same immunologic risks at the time of transplantation. METHODS: Three hundred ninety recipients who underwent haplotype matched living related donor kidney transplantation and have been regularly followed-up were retrospectively evaluated in a single center. All recipients were treated with cyclosporine-based double or triple regimens. The graft function was evaluated by serum creatinine (Scr) level and 24 hours urinary excretion of protein every year until 5 years after transplantation. The donor kidney weight/ recipient body weight ratio (KW/BW), donor age/ recipient age ratio (DA/RA), donor-recipient sex (D-R sex) relationship, and episodes of acute rejection (AR) within 1 year were regarded as the potential risk factors affecting the graft survival and function in this study. Kaplan-Meier method and Cox proportional-hazard model were used for survival analysis. ANOVA to evaluate time-point difference of graft function, and repeated measures ANOVA to evaluate the yearly difference of graft function were used. RESULTS: Only the episode of AR was a significant risk factor affecting the graft survival. However, each non-immunologic risk factors (KW/BW, DA/RA, D-R sex) and AR episode persistently showed statistically significant impact on Scr level until 5 years after transplantation. Recipients having lowest KW/BW (1st Q KW/BW) and highest DA/RA (4th Q DA/RA) had experienced accelerated increment of Scr level from 4th year after transplantation. From 3rd year after transplantation, there is a significant correlation between the numbers of non-immunologic risk factor the recipients having had and yearly increment of Scr level. However, episode of AR didn't influence the annual slope of Scr level even 4th year after transplantation. CONCLUSIONS: Non-immunologic risk factors had an detrimental effect on renal graft function, especially from 3rd year after transplantation. To have a better long-term graft function, non-immunologic risk factors should be considered from the time of live donor evaluation for transplantation. From the early period of transplantation, the recipients should be aware of the negative impact of overweight in terms of graft function and other metabolic derangement.

A Successful Transplant of HLA-3 Loci Mismatched Umbilical Cord Blood into a Patient with Acute Myeloid Leukemia from an Unrelated Donor

Cord blood is a useful source of allogeneic hematopoietic stem cells for bone marrow reconstitution. The number of umbilical cord blood transplants is increasing worldwide. In this a case 15- month-old boy with acute myeloid leukemia was treated with umbilical cord blood transplant from an HLA-3 loci mismatched unrelated donor. Granulocyte recovery greater than 500/mm3 occurred at day 49, and the platelet recovered greater than 20,000/mm3 independent of transfusion at day 81 after stem cell infusion.

Risk Factors for Chronic Rejection after Renal Transplantation / 대한이식학회지

PURPOSE: Chronic allograft nephropathy is the most common cause of renal transplant failure in the first post-transplant decade, but its pathogenesis has remained unclear. The most effective option to prevent chronic allograft nephropathy is the prevention of graft injury from both immune and non-immune mechanisms. To prevent chronic allograft rejection as avoiding high risk factors in donor selection, we analyzed the potential risk factors of chronic allograft rejection in renal transplantation. METHODS: Retrospective review was performed on clinical courses of 592 recipients of renal transplantation treated with cyclosporine, azathioprine or mycophenolate mofetile and prednisone from January, 1985 to December, 2000 in Hanyang University Hospital. Of 592 cases, chronic rejection was occurred in 51 cases, we analysed this group. The control group was demographically matched using the parameters of age, gender, date of transplantation, and immunosuppressive protocol, the numbers of control group was 98 cases in same period. We compared with two groups for risk factors, such as donor age, HLA mismatching, acute rejection episode and frequency, and proteinuria at 1 month after transplantation. We identified statistical analysis using univariate logistic regression analysis with SPSS program. The data comparison was performed through chi-square test. RESULTS: The average age of recipient is 33.8 years and that of donor is 45.5 years in chronic rejection group. Acute rejection episode was 51% (26/51) compared with control group 10.2% (10/98). Univariate analysis of risk factors revealed that acute rejection episode (P=0.000), HLA-DR mismatching (P=0.000), and donor age (P=0.000) were significant independent risk factors. CONCLUSION: We suggested that acute rejection episode, over 50 years of donor age and the degree of HLA-DR mismatching were the risk factors of chronic rejection. And so, in selecting donor for living donor renal transplantation, we should concern donor age, HLA-DR mismatching, and aggressive treatment in occurring acute rejection episode after transplantation.

The relationship between HLA typing,CREGs and early rejection after kidney transplantation / 中国免疫学杂志

Objective:To study the relationship between human leukocyte antigen(HLA) typing, HLA crossreaction antigen group(CREGs) mismatching and early rejection after cadaver donor kidney transplantation.Methods:Donor and recipient HLA class Ⅰ typing was performed with Paul Terasaki monoclonal antibody tray and HLA class Ⅱ gene typing with Micro-sequence-specific-primers(Micro-SSP). PRA was detected by using Paul Terasaki mixture antigen tray.Results:The cases of 6, 5, 4, 3, 2, 1, 0 HLA mismatching(MM) in 131 recipients with negative PRA were respectively 0, 4, 26, 49, 33, 15, 4. The incidence of early rejection were 0,25%,23.1%,14.3%,12.1%,6.7%,0. No recipient with 5 and 6 CREGs MM. The case of 4,3,2,1,0 CREGs MM, the early rejection were respectively 28.6%,22.9%,9.5%,6.9%,5.5%.Conclusion:HLA typing and HLA crossreactive antigen group(CREGs) matching play an important role in selecting suitable donor, reducing early rejection, improving the effect of kidney transplantation.

The Effects of Body Posdition and Flow Rates on Pulmonary Oxygention during Constant Flow Ventilation in Apneic dogs / 대한마취과학회지

In 7 apneic dogs, pulmonary gas exchange was compared between the supine and prone position during constant flow ventilantion (CFV) with room air or 100% oxygen at the different flow rate (5, 10, 15, 20 L/min). CFV was performed through two catheter (I.D. 2.0 mm) inserted into both main stem bronchi. The body position of the dogs was changed alternately and the order of flow rate selection was randomized. After 10 min. of each run of CFV, arterial blood gases were measured and alveolar arterial oxygen partial pressure difference (AaDO2) was calculated. AaDO2 with room air under the prone position was significantly smaller than that under the supine position at the flow rate of 5, 15 and 20 L/min. with increasing flow rate, AaDO2 with room air increased significantly regardless body position. No significant difference of AaDO2 with 100% oxygen were observed between the flow rate. The present study shows that ventilation perfusion (V/Q) mismatching during CFV in apneic dogs improved by changing the supine position to the prone position and deteriorated by increasing flow rates, which fact suggests that the impaired oxygenation during CFV is associated with the changes of the status of ventilation perfusion relationship, airway geometry and relative position of intrathoracic organ.