Objective To investigate the protective effect and mechanism of irbesartan and edaravone on the rat liver transplantation model using small-for-size graft during acute phase of reperfusion.MethodsWe used 300 S-D rats for small-for-size graft liver transplantation,and the light rats were used as donors.Survived recipients were divided into five groups according table of random number:group A,control group; group B,edaravone treatment group; group C,irbesartan treatment group; group D,irbesartan and edaravone treatment group; group E,sham operation group.The rat 30％ small-for-size graft model was established.Six rats in each group were sacrificed randomly at 6th and 24th h after reperfusion respectively. The survival rate of animals and portal pressure were investigated.The rats in every group were sacrificed and blood samples were collected for liver function measurement.The contents of SOD and MDA in liver tissues were measured.Fresh liver tissue was used to detect the mRNA expression of Egr-1,ET1 and Bax by RT-PCR. Paraffinembedded liver specimens were used to assay apoptosis (TUNEL).Six rats at each time point in each group were studied.Results(1) One-week survival rate in the groups A,B,C,D and E was 8.33％(1/12),33.3％ (4/12),58.7％ (7/12),83.3％ (10/12),and 100％ (12/12),respectively,P＜0.05; (2) There was significant difference in the portal pressure,ALT,AST,MDA,SOD,Egr-1,ET-1,Bax,and the apoptotic index between treatment groups and control group,especially in the group D,P＜0.05 or P＜0.01.Conclusion Irbesartan and edaravone could protect small-for-size graft in partial liver transplantation probably by reducing portal vein pressure and diminishing ischemia reperfusion injury.The combined use of Irbesartan and edaravone is more effective than irbesartan or edaravone used alone.

Objective To examine the benefits of ECMO for potential organ donors with hemodynamic instability after brain death.Methods Three brain-dead potential donors who presented with hemodynamic instability despite maximal medical management,finished a declaration of brain death,that were supported by extracorporeal circulation membrane oxygenation (ECMO).Results Donor organs,including six kidneys,and two livers,were harvested from the three donors under ECMO support,leading to 8 successful transplantations.The organs functioned well and the recipients made full recoveries.Conclusion Our experience indicates that ECMO allows for the maintenance of abdominal organ tissue perfusion without warm ischemia before organ procurement,providing sufficient time for safe organ donation procedures and reducing the risk of unpredictable cardiac arrest that could result in the donor death and graft loss.

Objective To summarize the short-term results of simultaneous pancreas-kidney transplantation (SPK) at a single center in China.Methods SPK was performed on 12 consecutive patients from Jan.2010 to July 2014.All patients had long-standing insulin-dependent diabetes mellitus (IDDM) and subsequent renal failure.Bladder drainage (BD) of exocrine secretion was used in the 10 cases and enteric drainage (ED) in 2 patients.The patients were treated with quadruple therapy,which included ATG or anti-CD25 monoclonal antibody induction therapy,prednisone,tacrolimus and mycophenolat-mofetil (MMF).Results The SPK was performed successfully in 10 cases.One patient accepted re-pancreas transplantation due to necrotizing pancreatitis.One patient suffered hemorrhage of bladder,accepted 3 times of embolization therapy and died due to lung infection.Ten patients achieved excellent renal function and euglycemia,and no further insulin treatment was given in 9.5 ± 4.2 days posttransplant.Fasting plasma glucose returned to normal in 14.2 ± 5.1 days.Serum creatinine returned to normal in 10.4 ± 6.5 days.The mean hospital stay was 21.4 ± 7.3 days.One biopsy-proven renal rejection episodes occurred in 14 days postoperation.Main complications included wound infections on the side of pancreatic graft,lymphorrhagia,tacrolimus toxicity and urinary tract infection.Conclusion SPK is an effective therapy of ESRD.Donated graft protection system foundation,refinement and individualized treatment posttransplantion may be the key factors for successful SPK.

Objective To evaluate the efficacy of sirolimus (SRL) after liver transplantation for hepatocellular carcinoma (HCC).Methods The information up to January 2018 was retrieved from Cochrane library,Pubmed,EMbase,CBM,CNKI,VIP.Collected publications were all about casecontrol study of SRL versus calcineurin inhibitors (CNIs) after liver transplantation for HCC.After evaluating the literatures' quality and extracting the data,RevMan 5.3 was used to analyze the data of each study.Results A total of 13 articles including 4181 patients were enrolled.There was no significant difference between SRL and CNIs in 3 and 5 year diseasefree survival (RR=1.13,95％CI:0.97-1.31,P=0.11;RR=1.07,95%CI:0.92-1.24,P=0.37),however,the 1-,3-and 5-year overall survival rate and 1-year disease-free survival rate in SRL were significantly higher than CNIs (RR=1.09,95％CI.:1.03-1.15,P=0.005;RR=1.08,95％CI:1.02-1.14,P =0.006;RR =1.11,95％CI:1.00-1.23,P =0.05;RR=1.14,95％CI:1.05-1.24,P =0.001).Conclusion There was no significant difference between SRL and CNIs in 3-and 5-year disease-free survival,but the 1-,3-and 5-year overall rate and 1-year disease-free survival rate in SRL was significantly higher than in CNIs.

Organ shortage is one of the important factors restricting the development of human organ transplantation. The identification and referral of potential donors determine the total scale of organ donation. Whether potential donors can be identified and referred is the most important reason for the difference of organ donation rates in different regions. This paper interprets the chapter of the identification and referral of potential donors in the Guide to the Quality and Safety of Organs for Transplantation (6th edition) issued by European Union in order to provide reference for the staff of organ procurement organization and related medical personnel in China and improve the organ donation rate in China.

Objective To observe the clinical effect of the maintenance for the liver and kidney function by extra corporeal membrane oxygenation (ECMO) in brain death donor with severe hemodynamic instability.Methods Ninety-nine brain death donors maintained by ECMO were followed up.The criteria for using the ECMO to protect the organ function were as follow:cardiopulmonary resuscitation history (cardiac compression ＞ 20 min);mean arterial pressure (MAP),for Adult ＜60-70 mmHg,for child ＜50-60 mmHg,and for infant ＜40-50 mmHg;cardiac index ＜2 L/(m2 ·min) (3 h);Large doses of vasoactive drugs,for doparnine 20μg/(kg·min),for (norepinephrine) epinephrine 1.0 μg/(kg· min) (3 h),and for oliguria ＜0.5 mL/(kg · h);blood biochemical indexes,moderate,severe impairment on acute hepatic and renal function;others,ST-T significant changes in electrocardiogram,and difficult to correct the metabolic acidosis (3 h).The organs were evaluated during their retrieval and as well their evolution after transplantation was evaluated.Results ECMO allowed for the maintenance of hemodynamic stability before organ procurement.A total of 99 cases receiving ECMO maintenance were collected,equal to100 ％ of the total donation cases (100％).198 kidneys,and 99 livers were procured from these donors meanwhile 15 kidneys and 42 livers respectively were discarded as theywere shown in a macroscopic evaluation.177 of the procured kidneys were transplanted.DGF of kidney transplantation was observed in 20.9％of the cases.Acute rejection incidence was 12.99％.Transplanted kidneys and recipient survival rate was 96.1％/99.3％ for one year,94.7％/97.8％ for 3 years,and 93.6/97.8％ for 4 years,respectively.There was no significant difference in patient or graft survival between the group with ECMO and the group without ECMO.Conclusion ECMO in the brain dead donors with severe circulatory dysfunction allows to avoid organ donors loss and obtain good quality kidneys and livers with excellent graft survival after transplantation.

Objective By analyzing the perioperative management in our hospital to explore the clinical effect and safety of single kidney transplantation from deceased juveniles' donors.Methods We retrospectively analyze 86 cases of kidney transplantations from deceased juveniles' donors in our hospital from 2007 December to 2015 August.Results The success rate of the operations was 100％.The postoperative complications occurred as fellows:7 cases of acute rejection (8.14％);10 cases of drug intoxication (11.62％);21 cases of DGF (24.44％),4 cases of leakage of urine (4.65％),7 cases of lung infection (8.14％).Two cases (2.32％) died after the operation because of serious lung infection,and by corresponding treatment 47 cases recovered after 2-4 weeks.The creatinine level in 37 cases without any complications was 131.88 ± 44.20 μmol/L during discharge.Conclusion With strict selection,the organ from a deceased juvenile donor is safe and practicable.

Objective:To examine the technique and effect of combined thoracic and abdominal organ clusters resection.Methods:From February 2019 to August 2021, totally 50 cases of combined thoracoabdominal organ cluster resection were completed at Transplant Medical Center, the Second Affiliated Hospital of Guangxi Medical University from donation after brain death donors. There were 47 males and 3 females, aging (34.8±12.3) years (range: 5 to 55 years). The length of hospital stay( M(IQR)) was 4(4) days (range: 2 to 43 days), the length of tube time was 4(2) days (range: 1 to 43 days). Through the midsternal incision and the abdominal grand cross incision, the cold perfusion was performing simultaneously when the perfusion lines of each target organ was established respectively. The combined resection was performed with the diaphragm as the boundary and the organ cluster as the unit. The heart and lung were separated on site and sent to the transplant hospital, and the abdominal organ cluster was directly preserved and returned to our hospital for further separation and repair. Results:Totaly 21 hearts, 47 pairs of lungs, 49 livers, 47 pairs of kidneys and 11 pancreas were harvested by this surgical treatment. The resection time was (32.6±6.5) minutes (range: 19 to 50 minutes), with no hot ischemia time. There was no accidental injury that affected organ quality and function. Heart transplantation was performed in 17 cases, combined heart-kidney transplantation in 2 cases, double lung transplantation in 43 cases, single lung transplantation in 6 cases, liver transplantation in 41 cases, combined liver-pancreas-duodenal cluster transplantation in 1 case, combined liver-kidney transplantation in 3 cases, combined pancreas-kidney transplantation in 9 cases, and kidney transplantation in 74 cases.Conclusion:Simultaneous perfusion and combined resection of thoracic and abdominal organ clusters for donation after brain death donors are feasible and effective.

Objective:To examine the technique and effect of combined thoracic and abdominal organ clusters resection.Methods:From February 2019 to August 2021, totally 50 cases of combined thoracoabdominal organ cluster resection were completed at Transplant Medical Center, the Second Affiliated Hospital of Guangxi Medical University from donation after brain death donors. There were 47 males and 3 females, aging (34.8±12.3) years (range: 5 to 55 years). The length of hospital stay( M(IQR)) was 4(4) days (range: 2 to 43 days), the length of tube time was 4(2) days (range: 1 to 43 days). Through the midsternal incision and the abdominal grand cross incision, the cold perfusion was performing simultaneously when the perfusion lines of each target organ was established respectively. The combined resection was performed with the diaphragm as the boundary and the organ cluster as the unit. The heart and lung were separated on site and sent to the transplant hospital, and the abdominal organ cluster was directly preserved and returned to our hospital for further separation and repair. Results:Totaly 21 hearts, 47 pairs of lungs, 49 livers, 47 pairs of kidneys and 11 pancreas were harvested by this surgical treatment. The resection time was (32.6±6.5) minutes (range: 19 to 50 minutes), with no hot ischemia time. There was no accidental injury that affected organ quality and function. Heart transplantation was performed in 17 cases, combined heart-kidney transplantation in 2 cases, double lung transplantation in 43 cases, single lung transplantation in 6 cases, liver transplantation in 41 cases, combined liver-pancreas-duodenal cluster transplantation in 1 case, combined liver-kidney transplantation in 3 cases, combined pancreas-kidney transplantation in 9 cases, and kidney transplantation in 74 cases.Conclusion:Simultaneous perfusion and combined resection of thoracic and abdominal organ clusters for donation after brain death donors are feasible and effective.

Objective To evaluate the effectiveness of salvage liver transplantation ( SLT) versus repeat hepatectomy (RH) in post-hepatectomy recurrent hepatocellular carcinoma. Methods Data from 1 January 1990 to 31 July 2018 were retrieved from the Cochrane library, PubMed, EMbase, Wan Fang Data, CBM, CNKI, VIP and other databases. The collected publications were all on case-control studies comparing SLT with RH for post-hepatectomy recurrent hepatocellular carcinoma. The literatures’ quality and the data of each study were evaluated and analyzed using RevMan. Relative risk (RR) and 95% confidence interval (CI) were used. Results Five articles which included 525 patients were enrolled. There were no signifi-cant differences between SLT and RH on the 1-, 3-and 5-year overall survival (P＞0. 05 for all). Howev-er, for the 1-year (RR=2. 86, 95% CI: 1. 37～5. 97, P＜0. 05), 3-year (RR=2. 57, 95% CI: 0. 99～6. 70, P=0. 05), and 5-year disease-free survivals (RR=4. 79, 95% CI: 1. 88～12. 25, P＜0. 05), PLT was significantly better than RH. Conclusion The effectiveness of SLT was superior to RH in the treatment of post-heptectomy recurrent hepatocellular carcinoma. However, considering the similar overall survival rates, RH is still an important treatment option for post-hepatectomy recurrent hepatocellular carcinoma because of liver donor shortage.