Analysis of the outcome of 22 cases with donation after cardiac death liver transplantation

YUE Yang, ZANG Yun-jin, WU Feng-dong, REN Xiu-jun, GUAN Zhao-jie, LI Wei, CHEN Xin-guo, SHEN Zhong-yang.

2013, (1): 13-16.

Abstract ( ) PDF (623KB)( )

Objective To summarize the experience of liver transplantation with donor after cardiac death free-donated liver. Methods There were 22 patients with end stage liver disease patients underwent orthotopic liver transplantation（OLT） with donor liver of after cardiac death patients from March 2008 to December 2012 at our institute. The age of donors was from 2 to 53 years old.The average of warm-ischemia time was 18 minutes，and the cold-ischemia time was 7.5 hours. All recipients received triple immunosuppression including tacrolimus（FK506），mycoplenolate mofetil and methyprednisolone post-transplantation. The liver function and FK506 blood level were detected routinely. Results All 22 patients were underwent liver transplantation successfully，one case of primary transplantation liver nonfunction post operation happened ；2 died during peroperative period，and 20 cases recovered smoothly. Patients were followed from 2 months to 40 months，one patient died after 16 months for cancer recurrence，the liver function of other patients recover successfully，prognosis were well and none suffered surgical complications.Conclusion The results revealed that liver function recovers on time after transplantation using donor after cardiac

death free-donated liver，while there is no obvious post operation complications happening.

Report of 13 cases of organ transplantation using donation after cardiac death donors

ZHANG Wei-jie, CHEN Zhi-shui, WEI Lai, MING Chang-sheng, ZHOU Ping, CHEN Gang, ZENG Fan-jun, CHANG Sheng, CHEN Dong, DU Dun-feng, GUO Hui, CHEN Xiao-ping.

2013, (1): 17-21.

Abstract ( ) PDF (5212KB)( )

Objective To investigate the feasibility and precautions of donation after cardiac death（DCD），clinical data of organtransplantations using DCD donors were analyzed. Methods We retrospectively reviewed the clinical data of organ transplantations using DCD donors in Tongji Hospital of Tongji Medical College of Huazhong University of Science & Technology from March 2010 to October 2012. Results There were totally 13 recipients in this study，including 8 kidney transplants and 5 liver transplants，2 renal grafts were resected because of renal graft artery rupture and acute antibody-mediated rejection respectively，1 kidney transplant recipients died of cerebrovascular accident，1 liver transplant recipient died of hepatic artery rupture. Totally 1-year graft / recipient survival was 69.2% and 84.6% respectively. Conclusion Donor source can be expanded with DCD donors，theoccurrence of complications should be paid attention to and the effects of DCD transplantation should be improved.

Single-center experience of organ donation after cardiac death

WU Xiao-tong, WANG Zhen-xing, CHEN Hua.

2013, (1): 22-25.

Abstract ( ) PDF (690KB)( )

Objective To analyze transplantation cases in our hospital using the organs of donors after cardiac death（DCD），and explore its feasibility and announcement. Methods The organs were obtained from DCD during January 2011 to September 2012 in this hospital，and clinical data of DCD were analyzed retrospectively. Results Seven renal transplantations and 4 liver transplantations were performed by using 4 cases of DCD. DCD were performed by the classification of Maastricht Ⅲ criteria. Donor warm ischemic time was 10-18 minutes. Among the seven kidney transplantation patients，one patient experienced double kidney plus bladder loop transplantation. All patients were alive with excellent graft function，and without complication or death. Conclusions We need to strictly control the criteria for potential donors. By controlled DCD program，donor resources can be expanded andcomplications after transplantation can be decreased.

Application of liver grafts from ABO incompatible dono

JIANG Chun-ping, DING Yi-tao, XU Qing-xiang, WU Ya-fu.

2013, (1): 27-30.

Abstract ( ) PDF (2011KB)( )

Objective To discuss the effect of ABO incompatible donor on postoperative liverfunction and prognosis in liver transplantation and to share our experience of perioperative care in thesecases. Methods We analyzed 8 ABO incompatible donor liver transplantation cases carried out in the AffiliatedDrum Tower Hospital of Nanjing University Medical College from January 2008 to December 2011 and comparedwith 10 control cases of ABO compatible donor liver transplantation. Postoperative liver function，prothrombintime（PT），intensive care unit（ICU）stay days，the incidence of rejection，biliary tract complication，infection，donor liver initial poor function/primary nonfunction（IPF/PNF）and 1 year survival rate were summarized andcompared between marginal donor cases and control cases. Results We found no significant differencebetween ABO incompatible donor cases and ABO compatible donor cases in all above analyzed parameters（all P＞0.05）. Conclusion With proper perioperative care，the application of ABO incompatible donor liver inthe situation of organ shortage may have similar therapeutic efficacy as ABO compatible donor liver transplantation.

Clinical efficacies of ABO-incompatible adult liver transplantation ：a report of 3 cases and review of the literature

QUMing, WANG Ying, SHI Yan-fen, DU Ying-dong, YIN Hui-sheng, LIU Yan-jun, ZHANG Cheng-jun.

2013, (1): 31-34.

Abstract ( ) PDF (623KB)( )

Objective To summarize clinical efficacies of ABO-incompatible adult liver transplantation，review related literature，and explore correlated treatment strategy. Methods The clinical data of 3 patientsundergoing ABO-incompatible adult liver transplantation in our hospital from January 2008 to June 2011 wereanalyzed to summarize clinical efficacies of ABO-incompatible adult livertransplantation. Results All thepatients were recovered in 72 hours. Different extent of psychiatric symptoms occurred in 2 patients and recoveredafter olanzapine and haloperidol were given. Blood vessel and biliary duct complications had not occurred. Onepatient died of neoplasm metastasis. The other 2 were followed 1 year and 8 months respectively with good living status. Conclusion In the state of an illness threat to life，the ABO-incompatible adult liver transplantation is afeasible treatment strategy.

Effect of CYP3A5 genotype on concentration and efficacy of tacrolimus in early period after kidneytransplantation

WANG Yi, ZHAO Wen-yu, ZHANG Lei, ZENG Li, ZHU You-hua.

2013, (1): 35-39.

Abstract ( ) PDF (677KB)( )

Objective To investigate the role of polymorphism of cytochrome P450 CYP3A5 in determinationof initial tacrolimus（Tac）dosages and the influence on blood drug concentrations/dose（C/D）in early period afterrenal transplantation. Methods 157 patients transplanted with cadaver kidney were divided into expresser group（*1/*1 and *1/*3，n＝72），non-expresser group（*3/*3，n＝85）according to the CYP3A5 genotype. The Tac C/Dratio，the incidence of acute rejection and adverse reaction were compared between two groups. The initial dosage ofTac and the time needed to achieve first target tacrolimus blood concentration（7-14 μg/L）after transplantation in allof the different genotype patients were recorded. Results At 7，14 and 30 days after transplantation，the C/D ratioin the non-expresser group was significantly higher than that in the expresser group（all P＜0.05）；the difference ofthe ratio of acute rejection between two groups within 1 month was not significant（P＞0.05）；the adverse effects ofTac were increased in non-expresser group compared with expresser group within 1 month（P＜0.05）. The differenceof initial dosage of Tac between two group was not statistically significant（0.129，0.132 mg/kg respectively，P＞0.05）.However，the time needed to achieve first target TBC in expresser group was shorter than that in non-expresser（P＜0.05）. Conclusions To achieve target TBC rapidly and reduce the ratio of acute rejection and adverseeffects，the initial dosage of Tac for CYP3A5 *1/*1 & *1/*3 needs to be increased，and for CYP3A5 *3/*3 needs tobe decreased. Determined the initial dosage of Tac by CYP3A5 genotype is a way to reduce the ratio of acute rejectionand adverse effects of Tac and enhances the clinical effect of kidney transplantation.

Investigation of vascular anastomosis technique for small bowel transplantation model in rat

YANG Yang, SONG Hong-li, ZHANG Wen, SHEN Zhong-yang.

2013, (1): 40-43.

Abstract ( ) PDF (1586KB)( )

Objective To contrast two different types of vascular anastomosis for small bowel transplantation（SBT）in rat in order to improve survival rate of SBT. Method 120 SBT models were established which the donorsand recipients were from SD and Wistar respectively. They were divided into two groups evenly（each n=60）. The abdominal aorta and portal vein of the donors were end-to-side anastomosed with abdominal aorta and vena cavainferior of the recipients by continuous suture of two thread with two points fixed（control group）and continuous sutureof single thread with one points fixed（experimental group）. The time of vascular anastomosis，complication and 3-daysurvival rate were compared between two groups. Results The total time of vascular anastomosis were（53.42±4.16）minutes in control group and（42.31±3.72）minutes in experimental group（P＜0.01）. Bleeding was more likely tooccur in experimental group，while error suture of the opposite side were more likely in control group（P＜0.05 andP＜0.01）. There was no significance in anastomotic stoma complication between two groups（P＞0.05）. Survival

rate on day 3 were 57.1% in control group and 78.9% in experimental group（P＜0.05）. Conclusion The timeof vascular anastomosis by continuous suture of single thread with one points fixed was significantly reduced，whichimproved the survival rate of SBT in rat.

The role of CD4+ T lymphocyte ATP assay in predicting infections after liver transplantation

WANG Kai, GAO Wei, ZHU Zhi-jun, SUN Li-ying, SUN Xiao-ye, QU Wei, SHEN Zhong-yang.

2013, (1): 44-46.

Abstract ( ) PDF (1736KB)( )

Objective To investigate the relationship between the CD4+T lymphocytes ATP level inperipheral blood and infections after liver transplantation（LT）. Methods Total 142 samples were collected from101 patients' peripheral blood post-LT. CD4+T lymphocytes ATP value was analyzed by ImmuKnow immune cellfunction assay kits. According to the occurrence of infection and immune responses conditions，the patients post-LTwere divided into different groups and then the relationship between the level of CD4+T cells ATP and infection wasanalyzed. Results According to the clinical state，the patients were divided into infection group and non-infectiongroup. CD4+T lymphocytes ATP value was significantly different between the two groups（P ＝ 0.001），which were236.0（41.0～512.0）μg/L and 371.5（9.0～1000.0）μg/L respectively. On the other hand，the patients post-LT weredivided into low immune response group，normal immune response group and high immune response according to the ATP levels of CD4+T lymphocytes in peripheral blood. The infection rates were 25.0%，13.6% and 0 in these groupsrespectively，which had significant statistic difference among three groups（P ＝ 0.003）. Conclusion The ATP value of CD4+T lymphocyte in peripheral blood was significantly correlated with occurrence of infection post-LT whichwould be helpful to conduct clinical therapy.

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