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Chinese practice guidelines for diagnosis and treatment of ischemic-type biliary lesion after liver transplantation

Yingcai ZHANG ; Xiao FENG ; Zhengran LI ; Jie REN ; Jin WANG ; Fengping ZHENG ; Wenjie CHEN ; Qi ZHANG ; Xiao XU ; Yang YANG

Organ Transplantation.2024;15(5):661-670. doi:10.3969/j.issn.1674-7445.2024209

Over the years of exploration and development, the surgical techniques and prognosis of liver transplantation in China have been significantly improved, resulting in a notable decrease in the prevalence of postoperative complications. However, ischemic-type biliary lesion remain a non-negligible issue. The Third Affiliated Hospital of Sun Yat-sen University formulated and published the "Expert Consensus on the Diagnosis and Treatment of Ischemic-Type Biliary Lesions after Liver Transplantation in Mainland China" in 2015, which has now been updated into a guideline based on current conditions and literature reports. This guideline elaborates in detail on the definition, incidence, pathogenesis, diagnosis, prevention of high-risk factors, and treatment of ischemic-type biliary lesion, aiming to provide standardized and normative guidance for the diagnosis and treatment of ischemic-type biliary lesion after liver transplantation, thereby reducing the rate of re-transplantation and fatality, and to improve the overall quality of life of liver transplant recipients.

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Clinical diagnosis and treatment guidelines for cytomegalovirus infection in kidney transplant recipients in China (2023 edition)

Organ Transplantation.2024;15(3):303-322. doi:10.3969/j.issn.1674-7445.2024096

In recent years, there have been significant advances in the diagnosis and treatment of cytomegalovirus (CMV) infection in solid organ transplant (SOT) recipients, including diagnostic method and anti-CMV drugs. These advancements have had a positive impact on the management of CMV infection in SOT recipients. To further standardize the management of CMV infection after kidney transplantation in China, Branch of Organ Transplantation of Chinese Medical Association organized a multidisciplinary group of experts in relevant fields. They referred to the ‘Diagnosis and Treatment Guidelines for Cytomegalovirus Infection in Solid Organ Transplant Recipients in China (2016 edition)’ and the latest published literature and guidelines, resulting in the development of the ‘Clinical Diagnosis and Treatment Guidelines for Cytomegalovirus Infection in Kidney Transplant Recipients in China (2023 edition)’. The updated guideline includes CMV epidemiology, research progress on the risk factors and universal prevention of CMV infection, the definition for CMV infection, detailed diagnostic criteria for CMV viremia and CMV disease, as well as an introduction to new anti-CMV drugs.

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Guideline for clinical diagnosis and treatment of tuberculosis in kidney transplant recipients in China (2023 edition)

Organ Transplantation.2024;15(3):323-332. doi:10.3969/j.issn.1674-7445.2024098

This guideline aims to provide comprehensive and practical guidance for clinical management of tuberculosis in kidney transplant recipients. First, it summarizes the particularity of tuberculosis in kidney transplant recipients, and highlights the high incidence and diverse clinical manifestations. To better understand the patients' conditions, relevant assessment of tuberculosis is recommended before kidney transplantation. Extensive attention should be paid to the monitoring of tuberculosis after kidney transplantation. Regarding the diagnosis, the guideline explicitly introduces common diagnostic approaches for tuberculosis, and evaluates the applicability in kidney transplant recipients. After the diagnosis is confirmed, it discusses how to balance the treatment and rejection of tuberculosis under the background of immunosuppressants, and focuses upon the potential drug interaction. In terms of prevention, it emphasizes the screening of tuberculosis prior to kidney transplantation. This guideline is designed to deepen the understanding of medical staff for tuberculosis management in kidney transplant recipients, promote more effective clinical practice and improve the quality of life of the recipients.

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Expert consensus on the use of hypoglycemic drugs in post transplantation diabetes mellitus (2024 edition)

Organ Transplantation.2024;15(3):333-351. doi:10.3969/j.issn.1674-7445.2024111

In recent years, increasing clinical evidence has been accumulated to support the diagnosis and treatment of post transplantation diabetes mellitus (PTDM), especially the advent of novel hypoglycemic drugs and glucose monitoring technologies, which further promotes the advancement of diagnosis and treatment of PTDM. To elaborate the use of hypoglycemic drugs in PTDM, Diabetology Committee of Chinese Research Hospital Association, Chinese Diabetes Society and Diabetes Branch of Beijing Medical Association jointly organized relevant experts to compile Expert consensus on the use of hypoglycemic drugs in post transplantation diabetes mellitus (2024 Edition), which mainly focuses on the hypoglycemic mechanism, recommended intensity, cautions in clinical application and the interaction with immunosuppressants, aiming to further enhance clinical management level for PTDM patients and improve clinical outcomes. The release of this expert consensus will contribute to standardizing clinical diagnosis and treatment of PTDM.

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Hepatitis E virus infection in liver transplant recipients

Fansheng GUO ; Qiang ZENG ; Jian DOU

Organ Transplantation.2024;15(3):352-358. doi:10.3969/j.issn.1674-7445.2023216

Hepatitis E virus infection is a common cause of acute viral hepatitis. In recent years, the incidence of hepatitis E has shown an increasing trend, which has gradually become an important cause of acute viral hepatitis worldwide. Age, sex, intensity of immunosuppression and socio-economic factors are all risk factors for hepatitis E virus infection. Liver transplant recipients require long-term use of immunosuppressive drugs for anti rejection treatment, prone to hepatitis E virus infection and at the risk of liver fibrosis and cirrhosis due to immunosuppression status. Therefore, special attention should be paid to liver transplant recipients in clinical practice. Meantime, related risk factors should be identified to assist diagnosis and take stricter preventive measures. According to literature review, the etiological characteristics of hepatitis E virus and the epidemiological characteristics, clinical manifestations, diagnosis and treatment of hepatitis E virus infection in liver transplant recipients were reviewed, aiming to properly monitor, treat and prevent hepatitis E virus infection in liver transplant recipients in clinical practice, improving the prognosis of liver transplant recipients.

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The question of death criteria in human organ donation

Shunliang YANG ; Zhelong JIANG ; Lizhi LYU ; Yushu LI ; Dong WANG

Organ Transplantation.2024;15(3):359-366. doi:10.3969/j.issn.1674-7445.2024033

Donation after death is the most important ethical principle to carry out organ donation after citizens’ death. The newly-revised Regulations on Human Organ Donation and Transplantation does not define death, and avoids the key question of “whether to recognize brain death”. Certain legal risks or damages to the rights and interests of donors may exist in organ donation. Death is an inevitable part of human life. It is necessary to establish specific criteria, which is also the only approach, to define death in any era. Death criteria are established based on the view of death, and restricted by the development level of productive forces and other social factors. The determination of death criteria hugely varies between China and the West. To standardize organ donation and transplantation and promote high-quality development of organ donation, medical staff must adhere to the principle of pure motivation, take informed consents as the premise, respect the donors' and their close relatives' rights to choose their own death criteria, strictly follow the death judgment procedures and operating norms, and ensure the scientificity, accuracy and fairness of death determination.

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Summary of basic research on liver transplantation in China of 2023

Xiaoyong YE ; Lin ZHOU ; Qiang HE

Organ Transplantation.2024;15(3):367-376. doi:10.3969/j.issn.1674-7445.2024060

Liver transplantation is the optimal treatment for end-stage liver disease and hepatocellular carcinoma, which can significantly improve clinical prognosis and quality of life of patients. However, multiple challenges, such as rejection, immune tolerance, shortage of donor liver, preservation of donor liver, ischemia-reperfusion injury and postoperative complications, etc., limit the efficacy of liver transplantation in clinical practice. Research teams in China have made significant contributions to the basic research related to liver transplantation by making continuous efforts and combining the development of emerging technologies, interdisciplinary integration and other emerging fields. In this article, the frontier progress in the basic research of liver transplantation in 2023 was reviewed, highlighting the progress made by Chinese research teams in the basic research of liver transplantation, aiming to provide reference for promoting the integration of Chinese characteristics into the research of liver transplantation, accelerate the integration of Chinese liver transplantation research with international community, and promote further advancement of liver transplantation in China.

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Highlights of clinical research on liver transplantation in China of 2023

Fangfei WANG ; Qiang HE

Organ Transplantation.2024;15(3):377-382. doi:10.3969/j.issn.1674-7445.2024063

As a mature organ transplantation, liver transplantation has become the optimal treatment for end-stage liver disease, which can improve the quality of life of recipients. However, liver transplantation still faces multiple challenges, such as rejection, infection, biliary complications, delayed graft function, ischemia-reperfusion injury, recurrence of hepatocellular carcinoma after liver transplantation, kidney-related diseases after transplantation, and donor shortage, etc., which remain to be improved and urgently resolved. With persistent attempts and experience accumulated by Chinese experts and scholars, these problems related to liver transplantation have been gradually resolved year by year. In 2023, liver transplantation teams in China have achieved a series of significant progresses in the field of clinical research. In this article, clinical frontiers and novel technological progresses in the field of liver transplantation in 2023 were reviewed, and the achievements of clinical liver transplantation in China in 2023 were summarized, aiming to provide novel ideas for promoting further development of liver transplantation in China.

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Research progress on domestic kidney transplantation of 2023

Xinyue ZENG ; Wangtianxu ZHOU ; Qiquan SUN

Organ Transplantation.2024;15(3):383-389. doi:10.3969/j.issn.1674-7445.2024059

Kidney transplantation has achieved significant success in treating end-stage renal disease. Nevertheless, it still faces a series of complex and significant challenges after surgery, such as infection, rejection, ischemia-reperfusion injury and chronic renal allograft dysfunction, etc. With the development of science and technology, including biomaterials, gene sequencing and other emerging technologies, Chinese researchers have launched a series of remarkable research in the field of kidney transplantation, aiming to solve these thorny issues. In 2023, relevant research of kidney transplantation in China not only focused on resolving the above challenges, but also highlighting on expanding novel technologies and concepts to build a brighter future of kidney transplantation. In this article, academic achievements of Chinese research teams in the field of kidney transplantation in 2023 were systematically reviewed, covering the frontiers of basic and clinical research and the application of emerging technologies, aiming to provide novel ideas and strategies for major clinical problems in the field of kidney transplantation from the local perspective and accelerate the advancement of kidney transplantation in China to a higher peak.

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Application status and prospect of organ from hepatitis C donor in solid organ transplantation

Zhiwen QIN ; Wu ZHANG

Organ Transplantation.2024;15(3):390-397. doi:10.3969/j.issn.1674-7445.2023207

As a marginal organ donor, organs from hepatitis C donors have been applied in solid organ transplantation. While effectively alleviating the shortage of organs, it also faces certain challenges, such as the spread of hepatitis C virus (HCV). With the emergence and application of direct-acting antiviral agent, the cure of hepatitis C has gradually become a reality, laying the foundation for hepatitis C patients to become organ transplant donors. At present, with adjuvant treatment using antiviral drugs, certain efficacy has been achieved in solid organ transplantation from hepatitis C donors. In this article, research progress in kidney, heart, lung and liver transplantation from hepatitis C donors, the application of hepatitis C donors in solid organ transplantation and the safety and effectiveness of antiviral drugs were reviewed, and the feasibility of hepatitis C donors in solid organ transplantation was evaluated, aiming to provide reference for expanding the donor pool of organ transplantation and shortening the waiting time for organ transplantation in patients with end-stage diseases.

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