Clinical treatment and management of invasive fungal disease in recipients of solid organ transplantation / 器官移植

With widespread application of solid organ transplantation (SOT), the incidence of postoperative invasive fungal disease (IFD) in SOT recipients has been increased year by year. In recent years, the awareness of preventive antifungal therapy for SOT recipients has been gradually strengthened. However, the problem of fungal resistance has also emerged, leading to unsatisfactory efficacy of original standardized antifungal regimens. Drug-drug interaction and hepatorenal toxicity induced by drugs are also challenges facing clinicians. In this article, the characteristics of drug-drug interaction and hepatorenal toxicity among triazole, echinocandin and polyene antifungal drugs and immunosuppressants were reviewed, and postoperative preventive strategies for IFD in different types of SOT recipients and treatment strategies for IFD caused by infection of different pathogens were summarized, aiming to provide reference for physicians in organ transplantation and related disciplines.

Investigation of patients’preferences regarding therapeutic drug monitoring of mycophenolic acid in solid organ transplantation / 中国药房

OBJECTIVE To investigate the preferences of patients who underwent solid organ transplantation regarding therapeutic drug monitoring （TDM） of mycophenolic acid （MPA） and explore the factors influencing patients’ decision-making process， so as to provide support for the development of individualized medication guidelines for MPA and improvement of clinical decision-making. METHODS The cross-sectional study was used to design the questionnaire on the patients’ preferences to accept MPA TDM， and involved patients who underwent solid organ transplantation and received MPA treatment at two tertiary hospitals in Beijing from April 14， 2022， to June 27， 2022. The Likert 5-level scoring method was used to score the patients’ preferences to accept MPA TDM， the influencing factors and their correlation of the patients’ preferences to accept MPA TDM were analyzed by Pearson correlation analysis and binary Logistic regression analysis， and the nonparametric test and chi-square test were used to rank and analyze the consistency of the factors affecting patients’ preference decision. RESULTS A total of 140 questionnaires were collected， and the effective recovery rate was 77.35%. The average preference score of 140 patients to receive MPA TDM was （4.01±0.65）， and the overall preference value was high. There were 116 （82.86%） patients agreed or strongly agreed with MPA TDM. Significant differences were observed in preference scores between patients who had previously undergone MPA TDM and those who had never undergone it （[ 4.30±0.53） scores vs. （3.80±0.65） scores， P＜0.001]. Additionally， patients’ preference scores were significantly influenced by their understanding level and attention level （P＜0.001）. The ranking of factors contributing to decision-making exhibited consistency （P＜0.001）. The factors were ranked in descending order of clinical efficacy， safety， comfortability， economy and time cost. CONCLUSIONS The patients who underwent solid organ transplantation hold high preferences towards MPA TDM. The primary factors influencing their decisions are their prior experience， understanding level， and attention level.

Expert consensus on diabetes mellitus after solid organ transplantation in adults / 器官移植

Post-transplant diabetes mellitus (PTDM) is a common endocrine and metabolic disorder after adult solid organ transplant (SOT), affecting 10% to 40% of recipients. PTDM has been associated with increased mortality, heightened risk of infections, graft-related complications and cardiovascular diseases, all of which seriously threaten the quality of life and long-term survival of recipients. According to recent studies and the domestic healthcare system, this consensus provides a comprehensive overview of the epidemiology, risk factors, pathogenesis, screening and diagnosis, treatments, prevention strategies, cardiovascular risk factor management and microvascular complications associated with PTDM, in order to further standardize the diagnosis and treatment of PTDM. The objective is to standardize the comprehensive management of PTDM with the aim of enhancing the long-term quality of life and clinical outcomes for SOT recipients.

Chinese experts consensus on the management of surgical site infection in solid organ transplantation (2022 edition) / 器官移植

The quality of solid organ transplantation has been improved significantly in China in recent years. However, surgical site infection (SSI) is still a main factor affecting the survival of solid organ transplantation recipients. With the joint efforts of experts in fields of organ transplantation, infectious diseases, critical care medicine, laboratory medicine and clinical pharmacy, this expert consensus systematically summarizes the experiences of SSI management in solid organ transplantation in China, focusing on basic management principles, epidemiology, risk factors, special pathogen infection and diagnostic techniques of SSI. It aims to standardize the prevention measures of SSI in transplantation centers to reduce the incidence and mortality of SSI in solid organ transplantation recipients.

Diagnosis and treatment strategies for solid organ transplant recipients with SARS-CoV-2 infection / 器官移植

Due to long-term use of immunosuppressive agents, solid organ transplant recipients (SOTR) belong to high-risk populations of multiple pathogenic infection, including SARS-CoV-2. In addition, SOTR are constantly complicated by chronic diseases, such as hypertension and diabetes mellitus, etc. After infected with SARS-CoV-2, the critically ill rate and fatality of SOTR are higher than those of the general population, which captivates widespread attention from experts in the field of organ transplantation. Omicrone variant is currently the significant pandemic strain worldwide, rapidly spreading to more than 100 countries worldwide and causing broad concern. According to the latest international guidelines on the diagnosis and treatment of SARS-CoV-2 infection and relevant expert consensus in China combined with current domestic situation of SARS-CoV-2 pandemic and China's "diagnosis and treatment regimen for SARS-CoV-2 infection (Trial Version 10)", the epidemiology, clinical manifestations and prognosis, diagnosis, clinical classification and treatment of SARS-CoV-2 infection were briefly reviewed.

Expert consensus on diagnosis and treatment of SARS-CoV-2 infection in solid organ transplant recipients (2023 edition) / 器官移植

Since the end of 2019, the SARS-CoV-2 infection pandemic has swept the world. Although the current SARS-CoV-2 mutants have decreased in pathogenicity and virulence compared with the original strains, and most patients have a good prognosis, the solid organ transplant (SOT) recipients are vulnerable to SARS-CoV-2. And even with vaccination, the risk of hospitalization or death is still high in SOT recipients infected with SARS-CoV-2. What's more, the clinical manifestations, diagnosis and treatment strategy of SOT recipients infected with SARS-CoV-2 has its unique features, which needs high attention. At present, there is a lack of guidelines or consensus in the diagnosis and treatment field of SARS-CoV-2 for such a large number of SOT recipients. Therefore, referring to the "Diagnosis and treatment regimen for SARS-CoV-2 infection (Trial Version 10)" and global published literature, the writing team wrote the "Expert consensus on diagnosis and treatment of SARS-CoV-2 infection in solid organ transplantation recipients (2023 edition)". This consensus was evidence-based written and reached by experts after multiple rounds of discussions, forming 21 recommendations, providing reference for the diagnosis and treatment of SOT recipients infected with SARS-CoV-2.

Role of fibrinogen in the attenuation of ischemia reperfusion and remote ischemic preconditioning / El papel del fibrinógeno en la atenuación de la isquemia-reperfusión y el preacondicionamiento isquémico remoto

Abstract Background: Ischemic reperfusion injury (IRI) is a common hazard involved in many human diseases, such as cerebral stroke, myocardial infarction, solid organ transplant dysfunction or failure, and vascular diseases. Understanding the molecular bases of this injury is essential for the prevention and control of these life-threatening conditions. Ischemic and remote ischemic preconditioning techniques (IPC and RIPC, respectively) have gained increasing importance in the clinical practice to protect against the IRI; however, the exact mechanisms of these techniques are not fully understood, which renders their clinical application query. Possible effectors: Nitric oxide (NO) has been reported by multiple studies to be an important mediator of the protective effects of those techniques. While the physiological concentrations of NO and fibrinogen (FB) are known to antagonize each other, the circulating levels of both effectors increase in response to RIPC. Hypothesis: While NO has potential anti-inflammatory effects, non-soluble fibrinogen (sFB) shows pro- inflammatory effects. However, the sFB may have the potential to act synergistically rather than antagonistically with NO toward the attenuation of the IRI. Conclusion: While increased FB is considered a risk factor for cardiovascular and inflammatory conditions that is also able to decrease the efflux of NO, and increase the NO oxidative metabolits and S- nitroglutathione, the increased sFB during the acute phase reaction might have other protective aspects that should be carefully investigated.

Resumen Antecedentes: La lesión por isquemia-reperfusión (LIR) es un riesgo común involucrado en muchas enfermedades humanas tales como derrame cerebral, infarto del miocardio, disfunción o falla de trasplante de órgano sólido, y enfermedades vasculares. Una comprensión de la base molecular de esta lesión es fundamental para la prevención y el control de estas enfermedades potencialmente mortales. Las técnicas de preacondicionamiento isquémico y preacondicionamiento isquémico remoto (PIR) han cobrado una creciente importancia en la práctica clínica para la protección contra la LIR, sin embargo, los mecanismos precisos de estas técnicas no se entienden plenamente, lo cual pone en duda su aplicación clínica. Posibles efectores: El óxido nítrico (ON) ha sido reportado por varios estudios como un importante mediador de los efectos protectores de estas técnicas. Si bien se sabe que las concentraciones fisiológicas del ON y fibrinógeno son antagónicas, los niveles circulantes de ambos efectores aumentan en respuesta al PIR. Hipótesis: Aunque el ON tiene posibles efectos anti-inflamatorios, el fibrinógeno insoluble muestra efectos proinflamatorios. Sin embargo, el fibrinógeno soluble puede tener el potencial de actuar de manera sinérgica en lugar de antagónica con el ON hacia la atenuación de la LIR. Conclusión: Aunque el fibrinógeno elevado se considera un factor de riesgo para las enfermedades cardiovasculares e inflamatorias, que también puede disminuir la descarga de ON y aumentar los niveles de metabolitos oxidantes del ON y de S-nitrosoglutatión, el aumento de fibrinógeno soluble durante la reacción de fase aguda puede tener otros aspectos protectores que deben ser cuidadosamente investigados.

Progress in diagnosis and treatment of Epstein-Barr virus associated lymphoproliferative disease after solid organ transplantation in children / 国际儿科学杂志

Post transplant lymphoproliferative disease(PTLD)is one of the most serious malignant complication in children after solid organ transplantation.Immunosuppression after transplantation and Epstein-Barr virus infection are the two main reasons for the onset of PTLD.The diagnosis of the disease depends on pathology, which includes early lesions, monomorphic PTLD, polymorphic PTLD and Hodgkin′s lymphoma PTLD.The treatment includes reduction in immunosuppression, rituximab, chemotherapy, radiotherapy and surgery, etc.The selection of chemotherapy mainly depends on pathology.The advance in the management of PTLD will be reviewed in the manuscript.

Progress in the diagnosis and treatment of secondary spinal infection after solid organ transplantation / 中华临床感染病杂志

Spinal infection is a serious health-threatening clinical condition, which more frequently occurs in solid organ transplantation receipients than in non transplant receipients. With the increase of solid organ transplantation, the incidence of secondary spinal infection has been increased in recent years. The symptoms and signs of secondary spinal infection are not obvious, and early diagnosis and treatment are difficult, leading to recurrent attacks and protracted disease courses. This article reviews the progress in the diagnosis and treatment of secondary spinal infection after solid organ transplantation.

Liver transplant after SARS-CoV-2 infection: A systematic review

Abstract Background: The Coronavirus 19 (COVID-19) pandemic has dramatically impacted liver organ transplantation. The American Society of Transplantation recommends a minimum of 28 days after symptom resolution for organ donation. However, the exact time for transplantation for recipients is unknown. Considering that mortality on the waiting list for patients with MELD >25 or fulminant hepatitis is higher than that of COVID-19, the best time for surgery after SARS-CoV-2 infection remains undetermined. This study aims to expand the current knowledge regarding the Liver Transplantation (LT) time for patients after COVID-19 and to provide transplant physicians with essential decision-making tools to manage these critically ill patients during the pandemic. Methods: Systematic review of patients who underwent liver transplantation after diagnosis of COVID-19. The MEDLINE, PubMed, Cochrane, Lilacs, Embase, and Scielo databases were searched until June 20, 2021. The MESH terms used were "COVID-19" and "Liver transplantation". Results: 558 articles were found; of these 13 articles and a total of 18 cases of COVID-19 prior to liver transplantation were reported. The mean age was 38.7±14.6, with male prevalence. Most had mild symptoms of COVID. Five patients have specific treatment for COVID-19 with convalescent plasm or remdesivir/oseltamivir, just one patient received hydroxychloroquine, and 12 patients received only symptomatic treatment. The median time between COVID-19 to LT was 19 days (13.5-44.5). Deceased donor liver transplantation accounted for 61% of cases, while living donor transplantation was 39%. Conclusion: Despite the concerns regarding the postoperative evolution, the mortality of patients with high MELD or fulminant hepatitis transplanted shortly after COVID-19 diagnosis does not seem to be higher. (PROSPERO, registration number = CRD42021261790)

Correlation of rib fracture patterns with abdominal solid organ injury: A retrospective observational cohort study / 中华创伤杂志(英文版)

PURPOSE@#Rib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury (ASOI). The purpose of this study was to investigate the correlation of ASOI with the number, location, and involved segments of rib fracture(s) in blunt chest trauma.@*METHODS@#This retrospective cohort study was conducted on patients with blunt chest trauma over the age of 15 years, who were hospitalized with the diagnosis of rib fractures from July 2015 to September 2020. After ethic committee approval, a retrospective chart review was designed and patients with a diagnosis of rib fractures were selected. Patients who had chest and abdominopelvic CT scan were included in the study and additional data including age, gender, injury severity score, trauma mechanism, number and sides of the fractured ribs (left/right/bilateral), rib fracture segments (upper, middle, lower zone) and results of chest and abdominal spiral CT scan were recorded. The correlation between ASOI and the sides, segments and number of rib fracture(s) was assessed by Pearson's correlation coefficient.@*RESULTS@#Altogether 1056 patients with rib fracture(s) were included. The mean age was (42.76 ± 13.35) years and 85.4% were male. The most common mechanism of trauma was car accident (34.6%). Most fractures occurred in the middle rib zone (60.44%) and the most commonly involved ribs were the 6th and 7th ones (15.7% and 16.4%, respectively). Concurrent abdominal injuries were observed in 103 patients (34.91%) and were significantly associated with middle zone rib fractures.@*CONCLUSION@#There is a significant relationship between middle zone rib fractures and ASOI. Intra-abdominal injuries are not restricted to fractures of the lower ribs and thus should always be kept in mind during management of blunt trauma patients with rib fractures.

Disseminaded coccidiodomycosis presentig as acute respiratory distress syndrome in a liver postrasplant recipient / Síndrome de dificultad respiratoria aguda (SDRA) como prensentacion de Coccidiodomicosis diseminada en un paciente receptor de trasplante hepatico ortotópico

Abstract Acute respiratory distress syndrome (ARDS) is a respiratory process of acute onset, showing on X rays as bilateral pulmonary infiltrates and severe respiratory failure, Coccidiodomycosis is a unusual cause of acute respiratory distress syndrome, the incidence of coccidiomycosis in a solid organ trasplant recipientes ranges from 1.4% a 6.9%, inadecuancy of cellular inmunity is a well established risk factor for development of coccididomcosis, less than 1% of patients develop disseminaded infecction and carrying high mortality, the case that we are presenting add to the small list of reports documenting the ocasionally acute and agressive nature of the disseminated clinical form of coccidiodomycosis.

Resumen El síndrome de dificultad respiratoria aguda (SDRA) es un proceso respiratorio de inicio agudo, que se manifiesta en las radiografías como infiltrados pulmonares bilaterales, clinicamente como insuficiencia respiratoria grave, la coccidiodomicosis es una causa inusual de síndrome de dificultad respiratoria aguda, la incidencia de coccidiomicosis en receptores de trasplante de órgano sólido varía desde 1.4% a 6.9%, una inadecuada inmunidad celular es un factor de riesgo bien establecido para el desarrollo de coccidomicosis, menos del 1% de los pacientes desarrollan enfermedad diseminada y alta mortalidad, el caso que presentamos se suma a la pequeña lista de informes que documentan la naturaleza ocasionalmente aguda y agresiva de la forma clínica diseminada de coccidiodomicosis.

Liver Injury in Abdominal Trauma: Management and Association with Other Solid Abdominal Organ Injury

Background and objective : Blunt abdominal injury remains one of the commonest injuries. The solid organs, namely the Liver, Spleen & Kidney are the most commonly injured intra-abdominal organs. Non operative line of management is now considered the line of treatment for patients with intra-abdominal organ injury who are hemodynamically stable. In the case of polytraumatized patients with open or blunt abdominal trauma, the liver is the most frequently injured abdominal organ. Earlier, surgical treatment was the standard procedure globally for all kinds of trauma-related liver injuries. However, development of new interventional radiological techniques has changed the paradigm towards a non-surgical patient management. Methodology: An observational study of 50 patients with solid organ injuries of the abdomen following abdominal trauma admitted over a period from July 2018 up to August 2020 was carried out. Patient management either operative or conservative was decided on basis of hemodynamic status and they were divided in groups OP (Operated) and NOM (Non Operative Management). Interpretation and conclusion : In our study, majority of liver injury were treated conservatively. Splenic injury patients were mostly managed by operative intervention and renal injury patients were managed according to grading of organ injury.

Serie de casos de trasplante hepático ortotópico del Hospital "Dr. Rafael Ángel Calderón Guardia" / Case series of liver transplantation in "Dr. Rafael Ángel Calderón Guardia Hospital"

Resumen Objetivo: Analizar los resultados y evolución del programa de trasplante hepático del Hospital "Dr. Rafael Ángel Calderón Guardia", así como las complicaciones más frecuentes y características de las hepatopatías que llevaron a trasplante hepático. Métodos: Esta es una investigación retrospectiva que involucra la revisión de expedientes clínicos de los pacientes que recibieron un trasplante de hígado entre los años 2009 y 2018 en el Hospital "Dr. Rafael Ángel Calderón Guardia" en San José, Costa Rica. Se consideraron las siguientes variables categóricas o discontinuas: edad, sexo, nacionalidad, lugar de procedencia, manifestaciones de la hepatopatía, motivo del trasplante, curso clínico postrasplante, comorbilidades, medicamentos empleados, complicaciones, resultados relevantes de exámenes de gabinete y biopsias. Los cálculos estadísticos se llevaron a cabo con paquetes estadísticos STATA, empleando como umbral de significancia estadística un valor de p menor de 0,05. Resultados: La muestra estuvo compuesta de un total de 45 cirugías de trasplante hepático y 44 pacientes que requirieron trasplante de hígado entre abril de 2009 y agosto de 2018, provenientes principalmente de la provincia de San José. El promedio de edad al momento del trasplante para la muestra total fue de 51 años. La hepatopatía que más frecuentemente llevó a trasplante fue la cirrosis etílica, seguida por esteatohepatitis no alcohólica y cirrosis criptogénica. Las complicaciones de la hepatopatía documentadas previo al trasplante: várices esofágicas, sangrado digestivo alto y síndrome hepatorenal. De los pacientes incluidos en el estudio fallecieron 10 en total, lo cual equivale a 22.7%. Conclusiones: La mortalidad observada en los casos de trasplante hepático analizados fue de 22,7%, la mayoría de los casos fueron llevados a trasplante por hepatopatía relacionada con cirrosis etílica, esteatohepatitis y cirrosis criptogénica.

Abstract Objective. To analyze the outcomes, most frequent complications and characteristics of the patients enrolled in the Liver Transplant Program from the Hospital "Dr. Rafael Ángel Calderón Guardia". Methods: This is a retrospective investigation that involves the revision of clinical records from the patients that received a liver transplant between the years 2009 and 2018 in the Hospital "Dr. Rafael Ángel Calderón Guardia". The following variables were considered: age, gender, nationality, city of residence, manifestations of the liver disease, reason for the liver transplant, clinical outcomes after transplant, comorbidities, medication received, important laboratory results and biopsies. The data analysis was performed with STATA, using a statistic significance threshold of a p < 0.05. Results: The sample was composed of a total of 45 liver transplant surgeries and 44 patients who received a liver transplant between the years 2009 and 2018. The patients mostly came from the city of San José. The average age at the time of the surgery was 51 years. The most common liver disease that led to transplant was alcoholic cirrhosis, followed by NASH and cryptogenic cirrhosis. The most common complications of the liver disease documented prior to transplant where esophageal varices, gastrointestinal bleeding and hepatic-renal syndrome. 10 of the patients included in the study died, which corresponds to 22.7% of the sample. Conclusions: The mortality observed in the liver transplant cases analyzed was 22.7%, most of the cases were taken to transplantation due to liver disease related to alcoholic cirrhosis, steatohepatitis and cryptogenic cirrhosis.

Systematic evaluation on PD-1 monoclonal antibody in the treatment of malignant tumor after solid organ transplantation / 器官移植

Objective To investigate the efficacy and safety of programmed cell death protein-1 (PD-1) monoclonal antibody on the treatment of malignant tumor after solid organ transplantation (SOT). Methods The relevant literatures in 7 databases were searched. The data on 54 cases of recipients with malignant tumors treated with PD-1 monoclonal antibody after SOT were collected, and the clinical effects and rejection of SOT recipients treated with PD-1 monoclonal antibody were analyzed. Results Total 32 acceptable articles including 54 SOT recipients were incorporated, including 43 males and 11 females aged 14-79 years old. There are 29 renal transplant recipients, 19 liver transplant recipients and 6 heart transplant recipients. The types of PD-1 monoclonal antibody agent used by SOT recipients included pembrolizumab for 28 patients and nivolumab for 26 patients. The overall remission rate, disease progression rate and fatality rate of PD-1 monoclonal antibody for postoperative malignant tumors of SOT recipients were 32% (17/54), 44% (24/54) and 36% (19/54), respectively. After treatment with PD-1 monoclonal antibody for postoperative malignant tumors of SOT recipients, the incidence of rejection was 39% (21/54), indicating no significant correlation between rejection and type of PD-1 monoclonal antibody (P > 0.05). Conclusions PD-1 monoclonal antibody can effectively treat postoperative malignant tumors of SOT recipients, and may induce rejection during the treatment. But rejection is not the most common cause for death of recipients.

COVID-19 in solid organ transplantation patients: A systematic review

Coronavirus disease (COVID-19) rapidly progresses to severe acute respiratory syndrome. This review aimed at collating available data on COVID-19 infection in solid organ transplantation (SOT) patients. We performed a systematic review of SOT patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The MEDLINE and PubMed databases were electronically searched and updated until April 20, 2020. The MeSH terms used were "COVID-19" AND "Transplant." Thirty-nine COVID-19 cases were reported among SOT patients. The median interval for developing SARS-CoV-2 infection was 4 years since transplantation, and the fatality rate was 25.64% (10/39). Sixteen cases were described in liver transplant (LT) patients, and the median interval since transplantation was 5 years. The fatality rate among LT patients was 37.5% (6/16), with death occurring more than 3 years after LT. The youngest patient who died was 59 years old; there were no deaths among children. Twenty-three cases were described in kidney transplant (KT) patients. The median interval since transplantation was 4 years, and the fatality rate was 17.4% (4/23). The youngest patient who died was 71 years old. Among all transplant patients, COVID-19 had the highest fatality rate in patients older than 60 years : LT, 62.5% vs 12.5% (p=0.006); KT 44.44% vs 0 (p=0.039); and SOT, 52.94% vs 4.54% (p=0.001). This study presents a novel description of COVID-19 in abdominal SOT recipients. Furthermore, we alert medical professionals to the higher fatality risk in patients older than 60 years. (PROSPERO, registration number=CRD42020181299)

Posttransplant epithelioid inflammatory myofibroblastic sarcoma: A case report

Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare entity and a novel variant of inflammatory myofibroblastic tumor (IMT), usually seen in children and nonsmoking young adults. Their occurrence in a posttransplant setting is still rare. These tumors are characterized by prominent epithelioid morphology, large histiocytoid “Reed Sternberg”-like cell, unique pattern of ALK immuno-reactivity, and aggressive clinical behavior. Their etiology and metastatic potential is controversial. In a post-transplant setting, many factors such as trauma, infections with EBV, HIV, Hepatitis C, mycobacteria, fungus, and chemotherapy-induced immunosuppression have been implicated in their etiology. We present the case of a 2-year-old female child who developed multiple omental and mesenteric tumor nodules, 8 months post liver transplant for progressive familial intrahepatic cholestasis (PFIC). Following a histopathological diagnosis of “mesenchymal neoplasm of possible malignant nature” on a trucut biopsy and frozen section, tumor debulking was performed. A final histological diagnosis of EMIS was made on the completely resected tumor. The patient remains in remission nearly 7 months after presentation, without any follow-up systemic chemotherapy. IMT after a solid organ transplant is rare, only 5 cases have been reported in the literature until now. Similar phenomenon has also been noted with hematopoietic stem cell transplant. However, to our knowledge, this case of EMIS in a post liver transplant patient is first of its kind.

Are radiological modalities really necessary for the long-term follow-up of patients having blunt solid organ injuries? A single center study / 世界急诊医学杂志（英文）

@#During the past two decades, management of blunt solid organ injuries had shifted from conventional surgery to more conservative approach, namely nonoperative management (NOM).[1] The non-operative approach mainly depends on the trauma experience of surgeons and the institution, quality of radiographic imaging and its interpretation.[2-5] If the surgeon decides to observe the patients by NOM, close monitoring of vital signs and frequent physical examinations must be done accordingly with radiological evaluations if needed.

Advances on cytomegalovirus infection after hematopoietic stem cell transplantation and solid-organ transplantation / 中国小儿急救医学

Cytomegalovirus ( CMV) infection continues to be one of the most common infections after hematopoietic stem cell transplantation and solid-organ transplantation( SOT) ,resulting in significant ad-verse outcomes and mortality. Management of CMV infection after hematopoietic stem cell transplantation and solid-organ transplantation is based on early prevention and early treatment, using of effective antiviral treatment regimens ,thus it has significantly improved the prognosis of CMV infection in transplant recipi-ents. This article reviewed the risk factors,diagnosis,standard treatment and emerging treatment of cytomega-lovirus infection after transplantation,in order to improve the understanding of the disease and understand the novel treatment.

Paniculitis por Candida en paciente trasplantado hepático / Candida Panniculitis in a liver trasnsplant patient

Los trasplantes de órganos sólidos, son tratamientos médico-quirúrgicos cada vez más habituales y suponen una importante mejora en la calidad de vida de los pacientes, con enfermedades graves. La inmunosupresión crónica, necesaria para evitar el rechazo del órgano trasplantado, aumenta el riesgo de complicaciones principalmente las de índole infecciosa. ¹ Dentro de las causas infecciosas, encontramos las de etiologías fúngicas siendo las más frecuentes, aquellas causadas por Candida albicans.

Solid organ transplants are increasingly common medical-surgical treatments and suppose a significant improvement in the quality of life of patients with serious diseases. Chronic immunosuppression, that is necessary to avoid rejection of the transplanted organ, increases the risk of complications mainly of infectious nature. Among the infectious causes we find those of fungal etiology being the most frequent those caused by Candida albicans.