Cross-cultural adaptation of the Kidney Transplant Questionnaire for Chinese adult kidney allograft recipients.

OBJECTIVE: To provide a disease-specific instrument for evaluating the health-related quality life of Chinese kidney allograft recipients. METHODS: Cross-cultural adaptation of the Kidney Transplant Questionnaire (KTQ) was performed by forward translation of the original English version into Chinese, followed by back translation and evaluation of the Chinese version by health care professionals, language professionals, and the translators. RESULTS: A total of 297 patients (110 women and 187 men; mean age, 43.91 ± 11.38 y; average time since transplant, 40.36 ± 32.86 mo) completed the Chinese versions of the KTQ and 36-Item Short Form Health Survey, and the results were used to evaluate the validity and reliability of the Chinese KTQ. The Cronbach α values for all KTQ dimensions were satisfactory (physical symptoms, α = 0.876; fatigue, α = 0.896; uncertainty/fear, α = 0.686; appearance, α = 0.701; and emotions, α = 0.886) and similar to values reported for the English and Spanish versions. The correlation coefficients among the dimensions of the Chinese KTQ ranged from 0.26 to 0.69, and those between the KTQ and 36-Item Short Form Health Survey physical component summary and mental component summary subscales were low and moderate to high, respectively, except for the appearance dimension. A good fit of the data in the confirmatory factor analysis indicated that the individual items of the translated instrument indeed evaluated the intended concepts. CONCLUSION: The Chinese version of the KTQ was found to be similarly valid and reliable compared with the original version and, thus, can be used to evaluate health-related quality of life among Chinese adult kidney allograft recipients.

Factors Influencing Health-Related Quality of Life of Living-Donor Kidney Transplant Recipients: A Population-Based Study.

OBJECTIVES: Our objective was to explore factors influencing health-related quality of life in living-donor kidney transplant recipients. MATERIALS AND METHODS: A total of 140 kidney transplant recipients, enrolled between December 2014 and April 2015, were administered questionnaires on medical outcomes, 36-item Short Form Health Survey, medical coping modes, cognitive appraisal of health scale, and adverse effects of medications. Path analysis was employed to verify the hypothesized model. RESULTS: Increased serum creatinine level and high economic burden had direct positive effects on negative appraisal (ß = 0.18, P < .05 and ß = 0.46, P < .01). Adverse effects of medication had direct positive effects on confrontation; whereas negative appraisal had direct positive effect on acceptance-resignation (ß = 0.21, P < .05) and direct negative effect on physical component summary (ß = -0.43, P < .001) and mental component summary (ß = -0.51, P < .001). In addition, confrontation directly affected mental component summary (ß = -0.15, P < .05). The enrolled variables accounted for 25.0% of physical component summary variance and 35.4% of mental component summary variance. CONCLUSIONS: In this study, economic burden, serum creatinine levels, and adverse effects of immunosuppressive therapy were the key external factors, whereas patients' cognitive appraisal and coping strategies were the main internal factors affecting patients' health-related quality of life. Medical care providers attending to transplant recipients should be able to identify patients developing negative coping strategies in response to stressors and plan individualized counseling programs for these patients.

Pilot feasibility research of Chinese version of kidney transplant questionnaire in recipients of living donor kidney transplantation.

OBJECTIVE: To explore the feasibility of the Chinese version of Kidney Transplant Questionnaire (KTQ) by evaluating the health-related quality of life (HRQoL) in Chinese recipients of living donor kidney transplantation. METHODS: The English version of KTQ was translated into Chinese and underwent cultural adaptation to obtain the Chinese version of KTQ. HRQoL of 136 Chinese recipients of living donor kidney transplantation that met the inclusion criteria were evaluated to assess the validity and reliability of the questionnaire. RESULTS: One hundred and thirty-six recipients (98 males and 38 females) of living donor kidney transplantation were included. The mean age of the recipients was 43.91 years. For each dimension of the questionnaire, the Cronbach's alpha coefficient was 0.7-0.9, test-retest reliability coefficient ≥0.7, goodness of fit index (GFI) >0.9, and comparative fitness index (CFI) >0.9. CONCLUSION: The validity and reliability of the Chinese version of KTQ is similar to the English version, suggesting that the Chinese version of KTQ could be applied as a disease-specific questionnaire to evaluate the HRQoL of the recipients of living donor kidney transplantation in China.

Anti-HBc-positive/HBsAg-negative liver donors pose a higher risk of occult HBV infection but do not cause severe histological damage in liver grafts.

BACKGROUND: The use of serum anti-hepatitis B core antibody (HBc)-positive/hepatitis B surface antigen (HBsAg)-negative liver donors for patients with hepatitis B virus (HBV)-related liver disease (HBRLD) is a promising means of expanding the organ donor pool and does not increase the risk of HBV recurrence. However, whether such donors will compromise the histology of the liver grafts is unclear. METHODS: Among 84 patients who underwent transplantation for HBRLD and who did not have post-transplant HBV recurrence (non-detectable serum HBsAg and HBV DNA), 19 underwent liver biopsy (eight received anti-HBc-positive/HBsAg-negative liver grafts; 11 received anti-HBc-negative liver grafts) and were included in the study. Intrahepatic total HBV DNA and covalently closed circular DNA (cccDNA) were detected using real-time polymerase chain reaction; histological characteristics were evaluated with the Batts-Ludwig semi-quantitative scoring system. RESULT: Of the 19 recipients, nine (47.4%) were positive for intrahepatic HBV DNA; 82.5% (7/8) received grafts from anti-HBc-positive donors and 18.2% (2/11) received grafts from anti-HBc-negative donors (P=0.003). HBV cccDNA was not detectable in the liver grafts of the 19 recipients. Ten patients had mild inflammation and minimal fibrosis in the portal area: four of the eight in the anti-HBc-positive group and six of the 11 in the anti-HBc-negative group (P>0.05). CONCLUSION: Anti-HBc-positive/HBsAg-negative donors for HBRLD pose a higher risk of occult HBV infection post-liver transplant but do not cause liver damage. Thus, anti-HBc-positive grafts may be considered an effective and safe means of expanding the pool of liver donors for patients with HBRLD.

Tacrolimus reversibly reduces insulin secretion, induces insulin resistance, and causes islet cell damage in rats.

OBJECTIVE: To investigate the diabetogenic effects of the immunosuppressive agent tacrolimus, the reversibility of these effects upon treatment discontinuation, and the underlying mechanisms in a rat model. MATERIALS AND METHODS: 60 healthy male rats were randomly divided into three groups for intragastric administration of tacrolimus either at 4 mg/kg/d or 2 mg/kg/d or an equal volume of normal saline (control). The treatment was administered for 5 months, followed by a 5-month period of no intervention. Fasting plasma glucose and insulin levels were used to calculate the homeostasis model assessment of ß-cell function (HOMA-ß) and insulin sensitivity index (ISI). RESULTS: Tacrolimus treatment significantly increased blood glucose concentrations (p < 0.05) and lowered HOMA-ß and ISI (p < 0.01) in a time- and dose-dependent manner. Five months after tacrolimus treatment, significant islet cell injury was observed. However, 5 months after tacrolimus discontinuation, blood glucose concentrations significantly declined, HOMA-β and ISI levels significantly increased, and islet cell morphology noticeably improved. CONCLUSIONS: In conclusion, tacrolimus treatment of healthy rats increased blood glucose concentrations in a time- and concentration-dependent manner. Development of tacrolimus-induced diabetes and reversibility after tacrolimus discontinuation may involve factors of and interactions between the insulin secretion pathway, local and/or systemic insulin resistance, and islet cell damage.

Vasculitis of anti-neutrophil cytoplasmic antibody after liver transplantation.

OBJECTIVE: We reported a case of vasculitis of anti-neutrophil cytoplasmic antibody after liver transplantation. A 56-year-old male patient underwent orthotopic liver transplantation of the classic style on February 25, 2010 because of alcoholic cirrhosis. METHODS: Pathology analysis showed it was nodular cirrhosis. The patient was given conventional treatment programs of FK (tacrolimus) + mycophenolate mofetil + hormone; hormone was suspended at the third month. He began to cough and spit, and there was blood in the sputum in September. Lung CT scanning images showed that there was a visible multiple low-density patchy shadow in both lungs; however, a number of other detecting results were negative. RESULTS: Considering the patient with contact suspected mold, we improved the inspection and switched to experimental treatment (itraconazole), and the patient improved and was then discharged. Two months later, he complained about appearing hemoptysis. Final diagnostic results showed it was anti-neutrophil cytoplasmic antibody-associated vasculitis after liver transplantation. Then we stopped medication with itraconazole. Treatment with methylprednisolone was continued, and the patient gradually stopped coughing and had no expectoration and hemoptysis. CONCLUSIONS: Reviewing CT respectively showed significant improvement at the 7th and 24th days of hormone therapy; thus, we confirmed it was anti-neutrophil cytoplasmic antibody-associated vasculitis after liver transplantation.

Concerns of and coping strategies by parents of pediatric liver transplant recipients: a qualitative study from China.

Parents of liver transplant recipient children have to face complicated health issues of their children. Coping strategies of parents as major care providers not only impacts on their handling of stresses on themselves but also on the recipients' quality of life. In this study, we sought to investigate the coping strategies of parents of Chinese pediatric liver transplant recipients at a single tertiary care institution in China. Twenty-five parents of liver transplant recipients were selected by the purposive sampling method and data was collected using qualitative semi-structured interview. Interviews were conducted until thematic saturation was achieved. We extracted 5 major themes: 1) guilt and self-blame for not giving a happy life to the sick child; 2) seeking social support for helping to treat the sick child; 3) standing firm by not giving up on treating the sick child; 4) cautious caretaking; 5) compromise: a helpless acceptance of truth. In summary, parents of transplant recipients present 5 major coping strategies. Proper assessment of stresses on parents of liver transplant recipient children and their coping strategies may help the medical staff and social services to provide more targeted support, and help and promote the balance of the family function.

Immunogenicity of different hepatitis B virus vaccination schedules in liver transplant recipients.

AIM: To compare the immunogenicity of two modified hepatitis B virus (HBV) vaccination schedules in liver transplant recipients. Hepatitis B immunoglobulin (HBIG) in combination with nucleoside/nucleotide analogs (NUCs) is the recommended prophylaxis for preventing HBV recurrence following liver transplantation (LT). However, HBIG treatment is expensive. Active immunization with hepatitis B vaccine would be a preferable alternative prophylaxis to replace HBIG treatment. However, the overall response rate to standard vaccination (given at months 0, 1 and 6) is relatively low in immune-compromised patients. METHODS: Two cohorts of 114 subjects were immunized with recombinant HBV vaccine containing S-antigen. The patients in the rapid schedule group were immunized with 40 µg HBV vaccine at months 0, 1, 2 and 3, and with 20 µg at months 4, 5 and 6. The patients in the accelerated schedule group were immunized with 40 µg of HBV vaccine at days 0, 7, 14 and 28, and 20 µg at months 2, 3 and 4. RESULTS: The overall response rate was 16.7% (19/114) and all responders discontinued HBIG injection and only one patient developed HBV recurrence. The response rate was 24.6% (14/57) and 8.8% (5/57) in the rapid vaccination and the accelerated vaccination schedules, respectively (P = 0.024). CONCLUSION: HBV vaccination may induce endogenous anti-HBs to replace HBIG in selected patients. Vaccination schedules may influence vaccine response, and individual optimization may improve response rate to HBV vaccination.

The survival benefit of liver transplantation for hepatocellular carcinoma patients with hepatitis B virus infection and cirrhosis.

BACKGROUND: A precise predictive survival model of liver transplantation (LT) with antiviral prophylaxis for hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) and cirrhosis has not been established. The aim of our study was to identify predictors of outcome after LT in these patients based on tumor staging systems, antitumor therapy pre-LT, and antiviral prophylaxis in patients considered to be unfit by Milan or UCSF criteria. METHODS: From 2002 to 2008, 917 LTs with antiviral prophylaxis were performed on patients with HBV-cirrhosis, and 313 had concurrent HCC. RESULTS: Stratified univariate and multivariate analyses demonstrated that independent predictors for poor survival were tumor size >7.5 cm (P = 0.001), tumor number >1 (P = 0.005), vascular invasion (P = 0.001), pre-LT serum alpha-fetoprotein (AFP) level ≥1000 ng/ml (P = 0.009), and pre-LT aspartate aminotransferase (AST) level ≥120 IU/L (P = 0.044). Pre-LT therapy for HCC was an independent predictor of better survival (P = 0.028). Based on CLIP and TNM tumor staging systems, HCC patients with HBV-cirrhosis who met the following criteria: solitary tumor ≤7.5 cm, or ≤4 multifocal nodules, the largest lesion ≤5 cm and total tumor diameter ≤10 cm, or more nodules with the largest lesion ≤3 cm, and pre-LT serum AFP level <1000 µg/L and AST level <120 IU/L without vascular invasion and lymph node metastasis who were unfit for UCSF, had survival rates of 89% at 5 years. There was a 47% 5-year survival rate for patients with HCC exceeding the revised criteria. CONCLUSIONS: The current criteria for LT based on tumor size, number and levels of AFP and AST may be modestly expanded while still preserving excellent survival after LT. The expanded criteria combined with antiviral prophylaxis and pre-LT adjuvant therapy for HCC may be a rational strategy to prolong survival after LT for HCC patients with HBV-associated cirrhosis.

[Causes and therapeutic principles of pulmonary infections in renal transplant recipients].

Pulmonary infection after renal transplantation is a well recognized and prevalent postoperative complication, which can occur at either the early stage or late stage after transplantation. The etiology and this phenomenon and its impacts remains unclear. It may be life-threatening in severe patients. Early diagnosis and treatment are important; meanwhile, the dosage of immunosuppressant should be minimized. Prophylactic management should also be emphasized.

[The study of the different medicating ways and the formula for intravenous loading dosage of hepatitis B immunoglobulin in liver transplantation].

OBJECTIVE: To evaluate the efficacy and safety of hepatitis B immunoglobulin (HBIG) by different medicating ways in patients with liver transplantation and to explore the methods for calculating the intravenous loading dosage of HBIG. METHODS: The patients enrolled were randomized into three groups (i.v group, i.m group and domino group). Under the combined utilization with Lamivudine, HBIG was given in different ways during anhepatic phase and the postoperative six days. The physical examination was done, the serum conversion rate of HBsAg was studied, the serum level of HBsAb titer, WBC, PLT, AST, GGT, TBIL, DBIL, CR, PT and PTA were tested daily within the postoperative seven days. The preoperative body weight, serum HBsAg and HBeAg titer were analyzed with the intravenous loading dosage of HBIG by multiple-factor linear regression (Stepwise). RESULTS: Both the average negative-conversion rate of serum HBsAg and the average increasing rate of serum HBsAb titer are significantly faster in i.v group and domino group than that in i.m group within the postoperative four days (P < 0.05). The regression equation to calculate the i.v loading dosage of HBIG (IU) by preoperative criteria was drawn as 1123 + 3.4 x serum HBsAg titer (IU/L) +73 x body weight (kg). There was no linear correlation found between the level of HBeAg and the loading dosage of HBIG. There were no significant difference in body temperature, pulse rate, respiratory rate, blood pressure, WBC, PLT, AST, GGT, TBIL, DBIL, CR, PT and PTA among the three groups within the postoperative seven days (P < 0.05). The rate of the second elevation of serum ALT was 10.3% (3/29), 3.4% (1/29) and 6.7% (2/30) in i.v group, i.m group and domino group, respectively (P < 0.05), and the rate of the local complications (sclerosis, edema, pain) at the injection site was 0, 89.6% (26/29) and 0, respectively (P < 0.05). CONCLUSIONS: Based on the combined utilization of lamivudine and HBIG, the qualified intervention efficacy, less complications could be obtained by medicating HBIG in a domino way (i.v first, followed by i.m), which is worthy to be promoted.

[Liver transplantation for the treatment of hepatocellular carcinoma].

OBJECTIVE: To retrospectively evaluate the clinical outcomes of liver transplantation for patients with hepatocellular carcinoma (HCC). METHODS: The clinical data of 88 consecutive HCC patients who underwent orthotopic liver transplantation between 2002. 4 and 2004. 7 were retrospectively reviewed. HCC stage of those patients were defined according to the pTNM classification system of UICC. All patients were followed up for more than 12 months after liver transplantation. The recurrence and overall survival rate were evaluated by univariate and multivariate analysis with SAS software. RESULTS: The cumulative 1-year recurrence rate of stage I, II, III and IV after liver transplantation was 0%, 4.8%, 40.0% and 71.3%, respectively (P < 0.01). The cumulative 1-year overall survival rate of stage I, II, III and IV was 100%, 95.2%, 71.5% and 41.7%, respectively (P < 0.01). CONCLUSION: Liver transplantation may be suitable for stage I or II hepatocellular cancer patients and improve their prognosis, while it is not suitable for stage IV HCC patients.

[Assay of carnitine in plasma and urine of healthy adults].

OBJECTIVE: To determine the levels of carnitine in plasma and daily excretion of carnitine in urine of healthy adults so as to provide the reference standard for studying the changes of carnitine in patients. METHODS: Carnitine in plasma and urine was assayed with high performance liquid chromatography (HPLC). The levels of total carnitine (TC), free carnitine (FC) and acetyl-carnitine (AC) in fasting plasma and the daily excretion of TC, FC and AC in urine were assayed in 40 healthy adults (20 men and 20 women) with standard diet. RESULTS: Good linearity (r 2 > or = 0.999) was observed in assaying TC, FC and AC. The relative standard deviation (RSD) was lower than 9.1% and bias lower than 5.6%. It was showed that the plasmatic levels of TC, FC and AC in healthy men [(53.1 +/- 8.5), (41.2 +/- 6.1), (6.2 +/- 0.6) mumol/L] were significantly higher than those in healthy women [(45.4 +/- 5.6), (35.2 +/- 4.9), (5.7 +/- 0.7) mumol/L] (P = 0.002, 0.002, 0.035). The daily urinary excretion of TC, FC and AC in healthy men [(386.1 +/- 22.9), (180.5 +/- 31.8), (33.8 +/- 3.3) mumol] were also significantly higher than those in healthy women [(240.1 +/- 35.6), (112.7 +/- 22.6), (29.3 +/- 4.3) mumol] (P < 0.0005, < 0.0005, < 0.0005) when the adults were given standard diet. Both the plasmatic levels and the daily urinary excretion of TC, FC and AC were of significantly positive correlation with lean body mass (LBM) (r = 0.501-0.856). The (TC-FC)/FC ratios in plasma were 0.29 +/- 0.05 for male and 0.29 +/- 0.04 for female. CONCLUSION: Good precision and accuracy were observed in assaying carnitine with HPLC. After standard diet, both the level of carnitine in fasting plasma and the daily urinary carnitine excretion of healthy adults were positively correlated with LBM.