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Clinical diagnosis and treatment guidelines for long-term systemic complications in kidney transplant recipients in China

Branch of Organ Transplantation of Chinese Medical Association ; Youzan LI ; Meng YANG ; Wenhan QIN ; Weili WANG ; Yajun SONG ; Chibing HUANG ; Hongwen ZHAO

Organ Transplantation.2024;15(4):479-496. doi:10.3969/j.issn.1674-7445.2024127

In order to further standardize the diagnosis and treatment of long-term systemic complications in kidney transplant recipients,Branch of Organ Transplantation of Chinese Medical Association initiated the formulation of"Clinical Diagnosis and Treatment Guidelines for Long-term Systemic Complications in Kidney Transplant Recipients in China".Experts on organ transplantation were organized to summarize and integrate the latest progress in this field based on existing clinical guidelines,systematic evaluations,case studies,expert consensus.The guideline was formed after multiple rounds of discussion and reaching a consensus which included complications of hematological system,central nervous system,cardiovascular system,ocular,cutaneous and osteoporosis disorders.The full text focuses on 27 clinical problems and forms 40 recommendations,mainly involving the risk factors,classification,diagnosis,treatment and prevention of various complications.This guideline graded the quality of evidence and the strength of recommendation for each clinical issue using 2009 Oxford Centre for Evidence-Based Medicine(OCEBM)Grading and Strength of Recommendation criteria,so as to provide reference for the diagnosis and treatment of late complications,comprehensively improve the management capacity of clinicians to benefit kidney transplant recipients.

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Clinical diagnosis and treatment guidelines for digestive system complications in kidney transplant recipients in China

Branch of Organ Transplantation of Chinese Medical Association ; Meng YANG ; Wenhan QIN ; Weili WANG ; Youzan LI ; Hongwen ZHAO

Organ Transplantation.2024;15(4):497-508. doi:10.3969/j.issn.1674-7445.2024126

The diagnosis and treatment of digestive system complications of kidney transplant recipients is related to the long-term survival and quality of life of patients,which needs great attention.In order to further standardize its diagnosis and treatment,Branch of Organ Transplantation of Chinese Medical Association initiated the formulation of"Clinical Diagnosis and Treatment Guidelines for Digestive System Complications in Kidney Transplant Recipients in China",and organized experts in organ transplantation and related disciplines to summarize the new progress in diagnosis and treatment of digestive system complications of kidney transplant recipients at home and abroad in recent years based on existing clinical research,systematic evaluation,case study,expert consensus and existing guidelines,and reached a consensus after many discussions.This paper focuses on 11 clinical problems,forming 16 recommendations,and grading the evidence quality and recommendation strength of each clinical problem by the evidence grading and recommendation strength standard of Oxford University Evidence-based Medicine Center in 2009,in order to provide reference for the diagnosis and treatment of digestive system complications of kidney transplant recipients,comprehensively improve the management ability of digestive system complications of clinicians in an all-round way and benefit transplant recipients.

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Guidelines for clinical diagnosis and treatment of hypertension in kidney transplant recipients in China

Branch of Organ Transplantation of Chinese Medical Association ; Jian ZHANG ; Jun LIN ; Xiaopeng HU ; Xiaoming DING ; Ning LI ; Wujun XUE

Organ Transplantation.2024;15(4):509-532. doi:10.3969/j.issn.1674-7445.2024116

To further standardize the diagnosis and treatment of hypertension after kidney transplantation in China,Branch of Organ Transplantation of Chinese Medical Association organized experts in kidney transplantation and cardiovascular diseases to formulate"Guidelines for Clinical Diagnosis and Treatment of Hypertension in Kidney Transplant Recipients in China"based on"Diagnosis and Treatment Specification for Hypertension after Solid Organ Transplantation in China(2019 edition)"in combination with clinical status of hypertension after organ transplantation in China,and referring to the latest guidelines for diagnosis and treatment of hypertension at home and abroad.This guideline was formulated to provide theoretical reference for medical practitioners in the field of kidney transplantation in China,aiming to better control adult hypertension after kidney transplantation,mitigate adverse outcomes and improve the quality of life.

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Guidelines for clinical diagnosis and treatment of combined liver and kidney transplantation

Branch of Organ Transplantation of Chinese Medical Association ; Xuyong SUN

Organ Transplantation.2024;15(4):533-547. doi:10.3969/j.issn.1674-7445.2024129

Combined liver and kidney transplantation has been steadily applied in major transplantation centers,saving the lives of many patients with end-stage liver and renal failure.However,there are still multiple unresolved problems in the clinical diagnosis,treatment and long-term prognosis of combined liver and kidney transplantation.By referring to"Technical Operating Standards for Combined Liver and Kidney Transplantation(2019 Edition)"and the latest published literature and guidelines at home and abroad,"Guidelines for Clinical Diagnosis and Treatment of Combined Liver and Kidney Transplantation"was formulated.Recommendations and suggestions were delivered regarding the surgical indications and contraindications,preoperative preparation and evaluation,the timing of transplantation for end-stage liver and kidney diseases,the selection of surgical approaches and postoperative follow-up,specific pathophysiology,surgical techniques,complication management and immunosuppressive treatment of combined live and kidney transplantation,aiming to enhance the utilization rate of grafts and improve the survival and prognosis of combined liver and kidney transplant recipients.

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Expert Consensus on quantify monitoring and assessment of immune cell function status and clinical application

China International Exchange and Promotive Association for Medical and Health Care(CPAM),Society of Liver Transplantation ; China International Exchange and Promotive Association for Medical and Health Care(CPAM),Society of Kidney Transplantation ; China Medicinal Biotech Association(CMBA),Society of Biological Diagnostics ; Qiang HE ; Xianliang LI

Organ Transplantation.2024;15(4):548-557. doi:10.3969/j.issn.1674-7445.2024078

The immune system is the important guarantee for maintaining the health of organ function and preventing diseases.The goal of immune health management and immune treatment is to restore the normal function of the immune system.The technical problems of how to inhibit or enhance the immune status has been solved in the field of immunology,but how to comprehensively detect and quantitatively evaluate the immune status is still a challenge.There is no mature solution at present.The quantification detection and visualization evaluation of immune status are of great significance for disease prevention and control,sub-health status management,and immune treatment.This expert consensus has carried out preliminary discussions on the definition of normal immune status and the comprehensive quantitative evaluation and visual scoring techniques of immune cell function status(immune function),put forward the basic concepts and thinking related to normal immune status,discussed the direction and principles of quantitative detection and evaluation of immune cell function status,and taken this as an opportunity to promote the decoding of immunity and the study of basic and clinical trials in the field of immune health.

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Optimization of immunosuppressive regimen for kidney transplant recipients

Zhen DONG ; Hongyang WANG

Organ Transplantation.2024;15(4):558-562. doi:10.3969/j.issn.1674-7445.2024087

With the maturity and development of surgical techniques,as well as the improvement of perioperative management level,the success rate of kidney transplantation has been significantly improved.However,due to evident differences in heredity and antigenicity between donors and recipients,rejection will occur after kidney transplantation,which will affect the survival of renal grafts.Immunosuppression is an important treatment for rejection,which is of significance to reduce the risk of rejection and enhance graft survival rate.Nevertheless,immunosuppressants may cause multiple complications while lowering the incidence of rejection,such as infection,cardiovascular diseases and tumors,etc.,which seriously affect the quality of life of patients and may even lead to their death.Reasonable selection of immunosuppressants and continuous optimization of immunosuppressive regimen for recipients play a critical role in improving the survival of recipients and renal grafts.In this article,the development history of organ transplantation,immune induction therapy and immune maintenance therapy was reviewed,and the progress in the optimization of immunosuppressive regimens for kidney transplant recipients was discussed,aiming to provide reference for improving clinical prognosis of kidney transplant recipients.

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Research progress in adult liver retransplantation

Ruolin WU ; Hongchuan ZHAO ; Xiaoping GENG

Organ Transplantation.2024;15(4):563-569. doi:10.3969/j.issn.1674-7445.2024040

Liver retransplantation is the final option for graft failure after liver transplantation.The interval between the first and second liver transplantation will directly affect surgical indications,technical diffiiculties and treatment outcomes of adult liver retransplantation.Previous studies have shown that the overall survival of liver allografts and recipients after liver retransplantation is significantly lower than that after the first liver transplantation.However,with comprehensive progress in organ preservation methods,anesthesia management concepts,intensive care strategies,surgical techniques and new immunosuppressive drugs,clinical efficacy of adult liver retransplantation has been significantly improved.In this article,the changes of indications,timing of operation,long-term effiicacy and its influencing factors,technical difficulties,selection of immunosuppressive regimens and the implementation of living donor liver retransplantation were reviewed,and the achievements,challenges and potential solutions of adult liver retransplantation were summarized,aiming to provide reference for enhancing clinical efficacy of adult liver retransplantation.

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Management of immunosuppressive drugs in HIV-positive solid organ transplant recipients

Kun SHAO ; Xianghui WANG ; Peijun ZHOU

Organ Transplantation.2024;15(4):570-574. doi:10.3969/j.issn.1674-7445.2024009

The application of combination antiretroviral therapy(cART)has significantly prolonged the life expectancy of patients infected with human immunodeficiency virus(HIV).However,viral infection and adverse reactions of cART drugs make patients more prone to organ failure.Solid organ transplantation has become a standard treatment for HIV-infected patients with end-stage organ failure.Nevertheless,among HIV-positive soild organ transplant recipients,multiple problems remain to be resolved,such as increased incidence of graft rejection,increased infection risk,drug toxicity and drug interaction between cART therapy and immunosuppressive drugs,etc.It is extremely challenging to deliver appropriate management for HIV-positive soild organ transplant recipients.Therefore,the application of immune induction therapy,calcineurin inhibitors,mammalian target of rapamycin(mTOR)inhibitors and other immunosuppressive drugs in HIV-positive soild organ transplant recipients was reviewed,aiming to provide reference for subsequent management of immunosuppression in HIV-positive soild organ transplant recipients.

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Research progress on the role of tolerogenic dendritic cells in immune tolerance of liver transplantation

Zhiqi YANG ; Minghao LI

Organ Transplantation.2024;15(4):575-580. doi:10.3969/j.issn.1674-7445.2024039

Rejection after liver transplantation severely affects the survival of recipients.Long-term use of immunosuppressants is an important approach to prevent rejection,whereas it may cause toxic effects and increase the risk of adverse events such as systemic infection and tumor recurrence,etc.Therefore,before successful liver transplantation,how to induce individual immune tolerance of recipients and achieve complete or early withdrawal of postoperative immunosuppressants remains to be investigated by practitioners of organ transplantation.In recent years,certain progresses have been made in the mechanism of immune tolerance induced by tolerogenic dendritic cells in liver transplantation,and preliminary outcomes have been obtained in clinical trials.In this article,basic research and clinical application progress in the characteristics of tolerogenic dendritic cells,the mechanism underlying participating in liver immune microenvironment remodeling,and inducing immune tolerance in liver transplantation were reviewed,aiming to provide reference for the application of tolerogenic dendritic cells in immune tolerance of liver transplantation.

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Study of adverse drug events related to tacrolimus in pediatric solid organ transplant recipients based on FAERS database

Boqing DONG ; Jingwen WANG ; Huanjing BI ; Zuhan CHEN ; Cuinan LU ; Wujun XUE ; Yang LI ; Xiaoming DING

Organ Transplantation.2024;15(4):581-590. doi:10.3969/j.issn.1674-7445.2024031

Objective To investigate the characteristics of adverse drug event(ADE)related to tacrolimus(Tac)in pediatric solid organ transplant recipients.Methods The data were retrieved from the US Food and Drug Administration Adverse Event Reporting System database from the first quarter of 2004 to the second quarter of 2023.The ADE data of pediatric organ transplant recipients with Tac as the primary suspected drug were extracted.The relationship between Tac and ADE was quantitatively analyzed by proportional imbalance method.Basic characteristics and signal strength of ADE related to Tac were analyzed.ADE related to Tac in children of different ages and different types of organ transplantation were analyzed.Results A total of 1 443 children's ADE reports involving Tac were screened,including 188 cases(13.0％)of heart transplantation,668 cases(46.3％)of liver transplantation,531 cases(36.8％)of kidney transplantation and 56 cases(3.9％)of lung transplantation.The median age of children was 10 years old.The top three countries with ADE reporting were the United States,France and the United Kingdom.China reported 26 cases,accounting for 1.8％.Infection and infectious diseases accounted for the highest proportion(20.96％)in ADE related to Tac,including EB virus and cytomegalovirus infection,etc.Infection and infectious diseases occupied the largest proportion of ADE related to Tac in children of different ages,whereas the pathogen types were different.Rejection,unstable immunosuppression level and renal function damage were also common ADE related to Tac in children of all ages.Nervous system disease was the main ADE in heart transplant recipients,while infection and infectious diseases were more common in liver and kidney transplant recipients.Rejection was the most common ADE in lung transplant recipients.Conclusions ADE related to Tac possess different distribution characteristics in different types of organ transplantation.Extensive attention should be paid to individualized drug monitoring and risk assessment in pediatric organ transplant recipients,thereby optimizing Tac treatment and reducing the risk of ADE.

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