BACKGROUND: Pre-transplant exposure to immune checkpoint inhibitors (ICIs) significantly increases the risk of allograft rejection after liver transplantation (LT); however, whether ICI-related rejection leads to increased graft loss remains controversial. Therefore, this study aimed to investigate the association between ICI-related allograft rejection and perioperative graft loss. METHODS: This was a retrospective analysis of adult liver transplant recipients with early biopsy-proven T-cell-mediated rejection (TCMR) at Liver Transplantation Center of Sun Yat-sen Memorial Hospital from June 2019 to September 2024. The pathological features, clinical characteristics, and perioperative graft survival were analyzed. RESULTS: Twenty-eight patients who underwent early TCMR between June 2019 and September 2024 were included. Based on pre-LT ICI exposure, recipients were categorized into ICI-related TCMR (irTCMR, n = 12) and conventional TCMR (cTCMR, n = 16) groups. Recipients with irTCMR had a higher median Banff rejection activity index (RAI) (6 vs . 5, P = 0.012) and more aggressive tissue damage and inflammation. Recipients with irTCMR showed higher proportion of treatment resistance, achieving a complete resolution rate of only 8/12 compared to 16/16 for cTCMR. Graft loss occurred in 5/12 of irTCMR recipients within 90 days after LT, with no graft loss in cTCMRs recipients. Cox analysis demonstrated that irTCMR with an ICI washout period of <30 days was an independent risk factor for perioperative graft loss (hazard ratio [HR], 6.540; 95% confidence interval [CI], 1.067-40.067, P = 0.042). CONCLUSION IrTCMR is associated with severe pathological features, increased resistance to treatment, and higher graft loss in adult liver transplant recipients.
Humans ; Liver Transplantation/adverse effects* ; Male ; Female ; Middle Aged ; Retrospective Studies ; Graft Rejection/immunology* ; Immune Checkpoint Inhibitors/therapeutic use* ; Adult ; T-Lymphocytes/drug effects* ; Graft Survival/immunology* ; Aged

Objective To investigate the role of clinical pharmacist in anti-infection therapy for patients with augmented renal clearance (ARC).Methods A case with multi-site severe infection after traffic accident was treated with anti-infection therapy.According to the characteristics of infection and pharmacokinetics,clinical pharmacist discussed the intervention by clinical pharmacist in terms of formulating anti-infection program and adjustment of individual dose.Results After consultation and evaluation by clinical pharmacist,the patient was diagnosed as ARC.According to pharmacokinetics characteristics reported by literature,vancomycin was adjusted to 1 g (once per 8 h).Based on detection result of pathogenic bacteria,meropenem was replaced by cefoperazone/sulbactam,and the dose was increased to 3 g (once per 6 h).And then,vancomycin concentration was detected again,and it reached ＞ 10 μg· mL-1;pathogenic bacteria culture result was negative.This patient obtained good therapeutic effect.Conclusion Clinical pharmacist could assist physician on anti-infection treatment and dose adjustment of ARC patient,and improve ARC patient's therapeutic effect.

Objective To explore the efficacy of negative pressure lavation in stool collec-tion of patients with diarrhea and to explore the application effect to prevent of incontinent related dermatitis.Methods Ostomy collection bags were put into the anus of 20 patients with diarrhea, and one disposable silicone gastric tube was inserted into the tail of each bag.The tail of the bag was then folded lengthways to cover the gastric tube,which was fixed with adhesive tapes.After that,the tube was connected to an electric sucker,and lukewarm water was poured into the bag to dilute stool.Thus stool was collected after repeated suctions.Results Among 20 patients,only one patient had skin dermatitis at the end of ostomy bag after stopped receiving negative pressure lavation.And the rest patients had stools collected effectively,and no one suffered from incontinent dermatitis.Conclusion Negative pressure lavation is effective in stool collection of patients with diarrhea and prevention of incontinent related dermatitis.It can accurately record the amount of stool,alleviate the pains of patients,and reduce nursing workload.Thus it is worthy of clinical promotion.

Objective To explore the efficacy of negative pressure lavation in stool collec-tion of patients with diarrhea and to explore the application effect to prevent of incontinent related dermatitis.Methods Ostomy collection bags were put into the anus of 20 patients with diarrhea, and one disposable silicone gastric tube was inserted into the tail of each bag.The tail of the bag was then folded lengthways to cover the gastric tube,which was fixed with adhesive tapes.After that,the tube was connected to an electric sucker,and lukewarm water was poured into the bag to dilute stool.Thus stool was collected after repeated suctions.Results Among 20 patients,only one patient had skin dermatitis at the end of ostomy bag after stopped receiving negative pressure lavation.And the rest patients had stools collected effectively,and no one suffered from incontinent dermatitis.Conclusion Negative pressure lavation is effective in stool collection of patients with diarrhea and prevention of incontinent related dermatitis.It can accurately record the amount of stool,alleviate the pains of patients,and reduce nursing workload.Thus it is worthy of clinical promotion.

Acute-on-chronic liver failure is a common form of liver failure characterized by complicated clinical manifestations and high mortality.The pathophysiology of ACLF is still unclear.More efficacious treatments are based mainly on a better understanding of the pathophysiology of ACLF.The advances in the pathophysiology of ACLF have been extremely encouraging in the last few years.In this article,we reviewed the progress of ACLF,its definition,etiology and,pathophysiology.