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Pharmacological and clinical observation on Implanta

Chinese Journal of Organ Transplantation.1997;18(3):172-173.

In order to observe the pharmacological action and clinical effects of Implanta (from Hanmi Pharm. Co. Ltd) on renal transplantation, 30 patients receiving renal transplantation were treated with Implanta. Among the 30 patients, 12 patients (group A) just underwent renal transplantation, the remaining 18 cases underwent the operation 0.5 to 4 years ago and administered Sundimin or Cyspin. The results showed that the blood concentration, the effcets of inhibiting the rejection, the function recovery of transplanted kidney and side effects of Implanta were the same as those of Sundimin or Cyspin. It was conlcuded that Implanta was safe and effective.

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Infiltrate and deposition of Ig in the graft

Junhong SUN ; Mongchao WU ; Han CHEN

Chinese Journal of Organ Transplantation.1996;17(3):131-133.

We investigated the mechanism of tolerance induction by identifying differences in infiltrating cell population and Ig subclasses deposition between tolerant and rejecting rat liver allografts.There were occasional minor differences in the T cell or CD11 b/c+(monoeyte/macrophage/granulocyte)infiltrate.By contrast,there was a major difference in B cell infiltrate with more B cells in tolerant grafts.IgM was increased in both tolerant and rejecting livers while deposition of IgG1 was observed in rejecting but not in tolerant livers.

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Islet transplantation tolerance induced by immunotoxins and donor soluble antigen

Ping LAN ; Lunan YAN ; Lujia XIAO

Chinese Journal of Organ Transplantation.1999;20(4):218-220.

Objective To induce islet grafting tolerance by intravenous injection of anti-CD4,anti-CD8 immunotoxins and donor soluble antigen.Methods 14 days or 7 days prior to transplantation,the immunotoxon 200 μg respectively,and donor soluble antigen 500 μg were injected intravenously into the recipients, then 500 donor islets were translanted under the left renal subcapsular space of diabetes reciPients (SD rats).Results The islet grafting survival time that pretreated with immunotoxon and dono soluble antigen was over 60 days(P<0.01).The immunotoxins or donor soluble antigen treatment alone only slightly prolonged the graft survival.Conclusion The anti-CD4,anti-CD8 immunotoxins combined with donor soluble antigen can induce donor specific immune tolerance.

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The clinical experience of simultaneous combined liver-kidney transplantation after liver/kidney transplantation

Tong ZHANG ; Binsheng FU ; Genshu WANG ; Shuhong YI ; Huimin YI ; Chi XU ; Yang YANG ; Changjie CAI ; Minqiang LU ; Guihua CHEN

Chinese Journal of Organ Transplantation.2010;31(9):534-537. doi:10.3760/cma.j.issn.0254-1785.2010.09.006

Objective To investigate the indications, complication and survival of combined liver-kidney transplantation (CLKTs) after liver/kidney transplantation. Methods From Oct. 2003 to Dec. 2008, the clinical data of 3 patients who underwent CLKTs after liver/kidney transplantation were retrospectively followed up and literature was reviewed at our institution. The perioperative mortality, post-operative complications, survival were analyzed. Results The perioperative mortality of patients with CLKTs was 1/3. The postoperative complications: one patient with massive abdominal bleeding died of pulmonary infection, acute renal failure of graft, multiple organ failure on the 29th day after operation; 3 patients with pulmonary infection; no acute rejection of the graft. Two of 3 patients survived 56 months, 228 months from primary transplantation, respectively, while survived 40 months, 48 months from CLKTs, respectively. Conclusion CLKTs is only radical treatment method for patients with end-stage liver disease and end-stage kidney disease. CLKTs after liver/kidney transplantation were feasible.

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Early diagnosis and preemptive therapy of human cytomegalovirus infection in renal transplant recipients

Jiwei YANG ; Tongyi MEN ; Guangyun LI ; Jianning WANG ; Xiaoming ZHANG ; Xianduo LI ; Bin SHEN ; Zhensheng WANG

Chinese Journal of Organ Transplantation.2010;31(9):528-530. doi:10.3760/cma.j.issn.0254-1785.2010.09.004

Objective To evaluate early diagnosis and preemptive therapy of human cytomegalovirus infection in renal transplant recipients. Methods We selected 165 renal transplant recipients who underwent transplantation from January 2007 to January 2009 and adhered to follow-up as research subjects. The samples of blood and urine were collected before transplantation, every 1 week from 2 to 8 weeks and every 2 weeks from 9 to 24 weeks after transplantation. The viral load of blood and urine was detected by fluorescence quantitative polymerase chain reaction (FQ-PCR). Once HCMV DNA load was more than 103 copies/ml, preemptive therapy was done immediately by ganciclovir. Results All the samples of blood and urine were negative before operation. HCMV DNA load could be detected in the concentrated urine at the second week and the peak of HCMV DNA loadoccurred from the sixth to eighth week after operation. At the same detection time, the number ofpositive recipients in the concentrated urine was more than in blood. In 30 cases HCMV DNA load was detected in the blood and the positive rate was 18.18%. In 64 cases HCMV DNA load was detected in the concentrated urine and the positive rate was 38.79%. The positive rate of the concentrated urine was significantly higher than in blood (P＜0.05). In 30 cases positive for HCMV DNA in the blood and urine, ganciclovir was given and the viral load was decreased gradually. But 8 recipients developed into CMV pneumonia and were cured through the comprehensive treatment. The clearance time of HCMV DNA in the concentrated urine was 10.2 ± 3.4 days. Thirty-four cases that were only positive for HCMV DNA in the urine were also treated by ganciclovir and no case developed into CMV pneumonia. The clearance time of HCMV DNA was 5.5 ± 2.1 days, and the clearance time was shortened as compared with that in those positive for HCMV DNA in the blood and urine (P＜0.05). Conclusion FQ-PCR can detect HCMV DNA in the concentrated urine in advance and increase the positive rate. Once the sample of the concentrated urine is positive, preemptive therapy has a good effect.

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Efficacy and safety of Alemtuzumab induction in kidney transplantation

Weizhen WU ; Jianming TAN ; Shunliang YANG ; Jingquan CAI ; Junqi GUO

Chinese Journal of Organ Transplantation.2010;31(9):519-523. doi:10.3760/cma.j.issn.0254-1785.2010.09.002

Objective To evaluate the efficacy and safety of alemtuzumab in renal transplant recipients treated with induction therapy. Methods Eighty-nine cadaveric renal transplant recipients in our department were randomly divided into experimental group (n = 43) treated with alemtuzumab induction, 15 mg i. v. and control group (n = 46). Main immunosuppressive therapy regimen consisted of steroids, tacrolimus or cyclosporine and mycophenolate mofetil in all recipients. Post-transplant kidney function, acute rejection,infection, DGF, graft survival, lymphocyte counts were recorded within 1 year. ATP values in CD4+ T cells after transplantation was determined by using Cylex ImmuKnow assay. Results There was significant difference in the incidence of biopsy-proven acute rejection, but no significant difference was found in ImmuKnow ATP values during 6 months after transplantation and lymphocyte counts during 3 months, graft survival and the incidence of infections between the two groups. Conclusion Induction therapy with alemtuzumab appeared to be effective in the prevention of acute rejection.

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Cuff technique for cardiac xenotransplantation

Ping LAN ; Jifu WANG

Chinese Journal of Organ Transplantation.1997;18(4):212-213.

The mouse heart was transplanted into the neck of rat using the cuff technique deseribed by Heron with a little modification.The graft accending aorta to the host common carotiel artery and the graft pulmonary artery to the host exteral jugular vein were performed.22 times of formal transplantation were done with the successful rate being 86%.The mean survival time was 2.10±0.80 days.The method is easy,quick and reliable.The superficial cervical localigation of the transplant is easily observed.This is a good model to observe the hyperacute rejection(HAR),to induce the translantation tolerance,and to screen the new immunosuppressive agents.

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Effects of donor antigen treatment and graft venous drainage on pancreas graft survival

Xiaofeng ZHU ; Jifu WANG

Chinese Journal of Organ Transplantation.1997;18(4):204-206.

Wistar-to-SD rat pancreas transplantation was performed in 35 SD rat recipients with diabetes-induced.Donor antigen was administered through IV or PV and the antigen treatment was performed before or during the transplantation.Graft vein was drained into IV or PV.The results showed that donor antigen pretreatment via PV combined with graft drainage PV synergistically prolongs the pancreas graft survival,and the effect of simultananeous antigen treat-ment during transplantation is not as satisfactory as that of antigen pretreatment,but may be more practical.

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Bilateral lung transplantation for idiopathic pulmonary artery hypertension

Jingyu CHEN ; Yanhong ZHU ; Mingfeng ZHENG ; Yijun HE ; Zhaohui JING

Chinese Journal of Organ Transplantation.2010;31(9):541-544. doi:10.3760/cma.j.issn.0254-1785.2010.09.009

Objective To evaluate the operative technique, perioperative management and outcomes of bilateral lung transplantation for idiopathic pulmonary artery hypertension. Methods There were 2 cases of idiopathic pulmonary hypertension subject to bilateral sequential lung transplantation with ECMO support (16, 17 years old, respectively). The pulmonary artery pressure was 10/70 and 148/72 mm Hg respectively. The heart function was NYHA Ⅳ, the operative procedure was right lung first, then left lung, and the cold ischemia time was 230 min/430 min and 185 min/300 min respectively. The ECMO support time was 550 min and 450 min respectively. The blood loss during the operation was 3000 and 1200 ml, respectively. Resuits The ECMO was withdrawn 16 and 13 h postoperation respectively. There was unstable hemadynamics and acute left heart failure on the 3rd and 4th day after the operation. The patients were treated with ventilate support and tracheotomy on 3rd and 6th day respectively. Additionally, the patients were given cardiotonic, dieresis and the ventilation was withdrawn on 33rd and 12th day after the operation respectively. They were discharged from the hospital on 93rd and 32nd day after the operation. The heart function both reached NYHA I, two cases were followed up for 25 and 10 months respectively.Both of them had an excellent quality life. Conclusion Bilateral lung transplantation is effective for end-stage idiopathic pulmonary artery hypertension even with slight right ventricular dysfunction with satisfactory short-term outcome. A limited operative time, an ECMO support for heart and lung during the peri-operative period and a perfect management for the left ventricular dysfunction after surgery are key roles for the success. Closed follow-up and surveillance are needed for long-term outcomes.

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Laparoscopic procurement model for left lobe living donor liver transplantation

Xuan ZHANG ; Hongguang WANG ; Jiahong DONG

Chinese Journal of Organ Transplantation.2010;31(9):562-564. doi:10.3760/cma.j.issn.0254-1785.2010.09.014

Objective To assess the feasibility of laparoscopic hepatic lobe procurement for living donor liver transplantation. Methods The technique included pneumoperitoneum with CO2,ports placement, porta hepatis dissection, laparoscopic ultrasound mapping, mobilization of the liver,and transection of the parenchyma into right and left lobes. The vascular structures were stapled and sectioned just prior to removal of the specimen. Results Hepatic lobectomies were successfully performed laparoscopically in 9 adult pigs. One pig was dead due to bleeding in IVC and following gas embolism during the parenchymal transection. The operative time was 208±25 min. The duration of warm ischemia was 8 ± 2. 3 min. The blood loss was 313 ± 75 mL. The vascular and biliary structures were preserved to allow for subsequent transplantation. Conclusion Laparoscopic living donor procurement for liver transplantation in a porcine model is safe and feasible.

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