Liver transplantation is a conventional treatment for terminal stage liver diseases. However, several complications still hinder the survival rate. Intestinal barrier destruction is widely observed among patients receiving liver transplant and suffering from ischemia-reperfusion or rejection injuries because of the relationship between the intestine and the liver, both in anatomy and function. Importantly, the resulting alteration of gut microbiota aggravates graft dysfunctions during the process. This article reviews the research progress for gut microbial alterations and liver transplantation. Especially, this work also evaluates research on the management of gut microbial alteration and the prediction of possible injuries utilizing microbial alteration during liver transplantation. In addition, we propose possible directions for research on gut microbial alteration during liver transplantation and offer a hypothesis on the utilization of microbial alteration in liver transplantation. The aim is not only to predict perioperative injuries but also to function as a method of treatment or even inhibit the rejection of liver transplantation.
Animals ; Gastrointestinal Microbiome ; Graft Rejection ; prevention & control ; Humans ; Intestinal Mucosa ; physiopathology ; ultrastructure ; Liver Transplantation ; Rats ; Reperfusion Injury ; prevention & control

OBJECTIVETo observe the effects of acupuncture-moxibustion on chronic allograft nephropathy (CAN) and explore the methods of acupoint selection along meridian for transplanted-kidney-related diseases.

METHODSA total of 180 patients of CAN were randomized into a syndrome differentiation group, a spleen-meridian group, a kidney-meridian group and a control group, 45 cases in each one. A total of 33 cases dropped out before the end of the study, including 8 cases in the syndrome differentiation group, 12 cases in the spleen-meridian group, 13 cases in the kidney-meridian group and no case in the control group. Patients in the control group were treated with conventional western medicine; based on this, patients in other three groups were treated with acupuncture-moxibustion. In the syndrome differentiation group, Qihai (CV 6), Hegu (LI 4), Guanyuan (CV 4), Feishu (BL 13), Shenshu (BL 23), etc. were selected for qi deficiency of lung and kidney; Qihai (CV 6), Zusanli (ST 36), Sanyinjiao (SP 6), Taixi (KI 3), Yinlingquan (SP 9), etc. were selected for deficiency of qi and yin; Ganshu (BL 18), Shenshu (BL 23), Sanyinjiao (SP 6), Taixi (KI 3), Yinlingquan (SP 9), Ququan (LR 8), etc. were selected for yin deficiency of liver and kidney; Zhongji (CV 3), Guanyuan (CV 4), Mingmen (GV 4), Guanyuanshu (BL 26), etc. were selected for yang deficiency of spleen and kidney. In addition, Sanyinjiao (SP 6), Diji (SP 8), Yinlingquan (SP 9), Xuehai (SP 10), etc. were added in the spleen-meridian group; Taixi (KI 3), Zhaohai (KI 6), Fuliu (KI 7), Ciliao (BL 32), etc: were added in the kidney-meridian group. Serum creatinine (Scr), creatinine clearance (Ccr) and 24-hour urinary protein before and after the treatment were com- pared among the four groups.

RESULTSAfter treatment, 24-hour urinary protein in the acupuncture-moxibustion groups and control group were all reduced (all P < 0.05); compared before treatment, the Scr in the spleen-meridian group was significantly reduced (P < 0.05); the difference of Ccr before and after treatment was insignificant in all the groups (all P > 0.05). Compared with the control group, 24-hour urinary protein in spleen-meridian group could relieve or recover the damage of transplant kidney induced by CAN. A new interlink may be established between the transplanted kidneys and the spleen meridians, indicating that transplanted kidney-related diseases can be treated by selecting acupoints of spleen meridian.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Allografts ; physiopathology ; Female ; Graft Rejection ; Humans ; Kidney Transplantation ; adverse effects ; Male ; Meridians ; Middle Aged ; Moxibustion ; Renal Insufficiency, Chronic ; etiology ; therapy ; Transplantation, Homologous ; adverse effects

OBJECTIVETo evaluate the association of major histocompatibility complex class I chain related gene A (MICA) antibodies with acute rejection (AR), chronic rejection (CR) and renal function after renal transplantation.

METHODSSerum MICA antibodies were detected with ELISA before and after transplantation with also examinations of panel reactive antibodies (PRA), serum creatinine, urine, graft ultrasound, lymphocyte subsets and the pathology of graft biopsy. The study was carried out in two parts to monitor MICA antibodies in acute and chronic rejections after renal transplantation.

RESULTSIn the first part of the study 18 of the 41 recipients experienced episodes of acute rejection, and the incidence rate was markedly higher in MICA(+) group than in MICA(-) group (P<0.05). Compared with the recipients with stable renal functions, the patients with acute graft rejection showed a significantly higher positivity rate of MICA antibodies. Postoperative MICA antibody monitoring showed that MICA antibody level increased gradually 2-3 days after the occurrence of acute rejection; anti-rejection treatment lowered serum creatinine to a normal level but MICA antibodies remained positive. In the second part, 21 of 40 patients had chronic graft rejection and showed significantly higher positivity rate of MICA than the patients with stable renal functions (P<0.05). In patients with chronic rejections, the serum creatinine levels were significantly higher in MICA(+) than in MICA(-) cases (P<0.05). Graft biopsy of all MICA(+) cases showed C4d deposition.

CONCLUSIONThe status of MICA antibodies can predict the occurrence and treatment outcomes of acute rejection, and also as one of the major causes of chronic graft rejection, they affect the long-term survival of the renal grafts.

Adolescent ; Adult ; Antibodies ; blood ; immunology ; Complement C4b ; metabolism ; Creatinine ; blood ; Follow-Up Studies ; Graft Rejection ; blood ; immunology ; pathology ; HLA Antigens ; immunology ; Histocompatibility Antigens Class I ; immunology ; Humans ; Kidney ; metabolism ; physiopathology ; Kidney Transplantation ; Peptide Fragments ; metabolism ; Young Adult

OBJECTIVETo evaluate the feasibility of MR diffusion-weighted imaging (DWI) in diagnosis of acute rejection after renal transplantation.

METHODSSixty-nine patients who underwent renal transplantation were enrolled in the study. According to the clinical features and renal biopsy, 26 patients were designated in rejection group and 43 in non-rejection group. Patients in non-rejection group underwent MR DWI scan at 2 to 3 weeks after operation, and those in rejection group underwent scan at 5 d before or after renal biopsy. Then the apparent diffusion coefficient (ADC) values of transplanted kidneys were measured with high diffusion sensitivity gradient factors (b values).

RESULTSPatients with acute rejection had significantly lower ADC (P <0.04) than non-rejection patients with all the different b values (b=200, 400, 600, 800, 1,000 s/mm(2)). The ROC curves showed that sensitivity and specificity were best when b value was 800 s/mm(2).

CONCLUSIONDWI is a potential and reliable non-invasive method for the diagnosis of the acute rejection after renal transplantation.

Acute Disease ; Diffusion Magnetic Resonance Imaging ; Female ; Graft Rejection ; diagnosis ; Humans ; Kidney ; physiopathology ; Kidney Transplantation ; adverse effects ; Male ; Sensitivity and Specificity

We report a case of reversible hepatofugal portal flow after auxiliary partial orthotopic liver transplantation (APOLT) from a living donor in this study. On postoperative day 6, continuous hepatofugal portal flow was observed in the grafted liver without portal thrombosis and obstruction of the hepatic vein. Based on histological findings, acute rejection was the suspected cause. The normal portal venous flow was restored after steroid pulse and antithymocyte globulin (ATG) therapies. The patient was discharged on the 30th postoperative day. It was concluded that hepatofugal flow after liver transplantation is a sign of serious acute rejection, and can be successfully treated by anti-rejection therapy.
Adult ; Antilymphocyte Serum ; therapeutic use ; Graft Rejection ; prevention & control ; Hepatic Artery ; diagnostic imaging ; physiology ; Hepatolenticular Degeneration ; surgery ; Humans ; Immunosuppression ; methods ; Immunosuppressive Agents ; therapeutic use ; Liver Transplantation ; adverse effects ; methods ; Living Donors ; Male ; Portal Vein ; diagnostic imaging ; physiopathology ; Tacrolimus ; therapeutic use ; Ultrasonography

INTRODUCTIONThe status of heart transplantation in Singapore is reviewed in this article.

MATERIALS AND METHODSThe database of 40 consecutive heart transplantations from July 1990 through December 2007 is reviewed retrospectively. The data is compared with the 2008 registry data of the International Society for Heart and Lung Transplantation (ISHLT).

RESULTSThe average age of recipients was 45.3 years. Ages ranged from 14 to 64 years. Ischaemic cardiomyopathy (52.5%) and dilated cardiomyopathy (42.5%) were the major indications. From 1990 to 1999, 50% of the donors sustained brain death from road traffic accident, 25% from cerebrovascular accident and 25% from falling from height, whereas the cause of brain death in the donors from 2000 to 2007 was 33%, 47% and 9.5%, respectively. The average donor age increased from 28.3 to 38.1 years. The significant morbidities in the recipients were hypertension, cytomegalovirus (CMV) infection, cardiac allograft vasculopathy and renal dysfunction. Thirtytwo required treatment for hypertension. 67.5% developed CMV disease requiring treatment. Cardiac allograft vasculopathy was diagnosed in 10. Rising creatinine levels reaching over 2.5 mg/dL was seen in 7. Three required renal dialysis. Epstein-Barr virus related lympho proliferative disorder occurred in 2 patients. One patient developed adenocarcinoma of stomach. The 30-day mortality was 10% and half life was 10 years. Cardiac allograft vasculopathy and sepsis caused 41.7% of mortality each. 11.7% of the mortality was due to cerebrovascular accident.

CONCLUSIONThe status of heart transplantation in Singapore is comparable to the ISHLT registry data. Transplant provides excellent early survival of 80%; however, the expected half life is around 10 years after cardiac transplantation. The late mortality is mainly caused by cardiac allograft vasculopathy (CAV) and renal failure. More effort and research needs to be directed towards these issues to improve the long-term results.

Adolescent ; Adult ; Cytomegalovirus Infections ; Female ; Graft Rejection ; epidemiology ; Heart Failure ; etiology ; physiopathology ; surgery ; Heart Transplantation ; mortality ; utilization ; Humans ; Immunosuppression ; Male ; Middle Aged ; Retrospective Studies ; Singapore ; epidemiology ; Tissue and Organ Procurement ; Transplantation, Homologous ; Young Adult

OBJECTIVETo evaluate the effect of emodin in combination with cyclosporine A (CsA) on rejective reaction against liver graft in rats.

METHODSThe LEW-->BN orthotopic liver transplantation rat model was used in the study. A total of 48 rats were divided into 4 groups randomly and equally, after operation they were intraperitoneally injected respectively with normal saline (0.5 mL d(-1), group A); CsA (10.0 mg kg(-1) d(-1), group B); emodin (50.0 mg kg(-1) d(-1), group C); and CsA plus emodin (group D, at the same dose as in B and C). Six rats taken from each group were sacrificed on the 8th day after operation to calculate the rejection active index (RAI) and hepatocyte apoptosis index (AI). The remainder were stopped medication and used for observing the survival time.

RESULTSThe inter-group comparisons in mean survival time, RAI and AI showed significant difference in comparing group A with group B, C and D (P <0.01), and those in group D were more obvious than in group B and C (P < 0.05, but showed no significant difference between group B and group C (P > 0.05).

CONCLUSIONAdministering of emodin combined with CsA after liver transplantation shows a synergistic effect for suppressing acute rejective reaction in rats.

Animals ; Apoptosis ; drug effects ; Cyclosporine ; administration & dosage ; Drug Synergism ; Emodin ; administration & dosage ; Graft Rejection ; drug therapy ; physiopathology ; Hepatocytes ; cytology ; drug effects ; Liver Transplantation ; Male ; Random Allocation ; Rats ; Rats, Inbred Lew

OBJECTIVETo evaluate the efficacy of kushenin in treating patients with chronic hepatitis C after renal transplantation.

METHODSFifty-five patients were randomly assigned by lottery to the treatment group (29 cases) and control group (26 cases). The same immunosuppression therapy was given to all patients in both groups. Patients in the treatment group were treated with kushenin 0.6 g once a day, while those in the control group were treated with conventional liver protective agents such as vitamins. The treatment duration of both groups was 3 months. The incidences of serious hepatitis and acute rejection reaction, serum biochemistry parameters including indicators of liver and kidney functions, hepatic fibrosis index, and serum HCV-RNA were compared between the two groups.

RESULTS(1) The incidence of serious hepatitis in the treatment group and the control group was 3.45% (1/29 cases) and 11.54% (3/26 cases), respectively, which was insignificantly different between the two groups (P=0.335). (2) The incidence of acute rejection in the treatment group was 6.90% (2/29 cases) and that in the control group was 7.69% (2/26 cases), showing insignificant difference (P=0.335). (3) The differences in serum alanine aminotransferase (ALT), direct bilirubin (DBIL), hyaluronic acid (HA), propeptide collagen type III (PC III), laminin (LN), collagen type IV (Col IV) levels between the two groups were insignificant before transplantation (P>0.05), while the above-mentioned parameters in the treatment group were significantly lower than those in the control group after transplantation (P<0.05). The difference in serum creatinine (SCr) and endogenous creatinine clearance rate (CCr) between the two groups was insignificant before and after transplantation (P>0.05). (4) The negative conversion rate of HCV-RNA in the treatment group was 31.03% (9/29 cases), significantly higher than the value of 11.54% (3/26 cases) in the control group after transplantation (P<0.05). (5) The levels of serum ALT and DBIL in patients with HCV-RNA converted to negative were significantly lower than those with still-positive HCV-RNA (P<0.05).

CONCLUSIONSKushenin has a certain effect on inhibiting the proliferation of HCV, protecting liver cells, and anti-liver fibrosis. On the other hand, it has no obvious influence on renal allograft function. Thus, the drug is clinically safe and effective for use in treating patients with chronic hepatitis C after renal transplantation.

Adolescent ; Adult ; Antiviral Agents ; administration & dosage ; adverse effects ; therapeutic use ; China ; epidemiology ; Female ; Graft Rejection ; Hepacivirus ; genetics ; Hepatitis C, Chronic ; drug therapy ; epidemiology ; etiology ; physiopathology ; Humans ; Incidence ; Kidney Function Tests ; Kidney Transplantation ; adverse effects ; Liver Cirrhosis ; complications ; drug therapy ; Liver Function Tests ; Male ; Pterocarpans ; administration & dosage ; adverse effects ; therapeutic use ; RNA, Viral ; blood

OBJECTIVETo investigate the etiology and therapy of delayed graft function (DGF) recovery in renal transplant recipients.

METHODSThe clinical data were retrospectively analyzed in 15 renal recipients with DGF. All the 15 patients received hemodialysis along with pulse treatment against acute rejection (AR), or immunosuppressant adjustment, or in situ retransplantation after the resection of the original transplanted kidney according to different etiological factors.

RESULTSAmong the 15 patients, 8 developed AR, 5 showed acute renal tubular necrosis (ATN), 1 had grafting-associated renal vein embolism and 1 had acute cyclosporine nephrotoxication. The renal function recovered within 10 to 35 days after transplantation without complication during the follow-up period (0.5-3.0 years).

CONCLUSIONDGF is a common complication after kidney transplantation mainly due to the occurrence of AR and ATN. Good prognosis is expected if etiology-oriented therapy is performed properly and promptly.

Adult ; Delayed Graft Function ; physiopathology ; therapy ; Female ; Graft Rejection ; physiopathology ; therapy ; Graft Survival ; Humans ; Immunosuppressive Agents ; therapeutic use ; Kidney Transplantation ; Male ; Recovery of Function ; Renal Dialysis ; Retrospective Studies

OBJECTIVETo compare the long-term effect and safety of tacrolimus (FK506) and cyclosporine (CsA) in kidney transplant (KT) recipients carrying hepatitis B Virus(HBV).

METHODSA total of 109 patients with HBV were randomized into FK506 group (52 cases) and CsA group (57 cases) after KT, and a 2-year-long follow-up of the patients was conducted to record the patient and graft survival, incidence of acute graft rejection and postoperative liver function.

RESULTSThe 2-year patient/graft survival was 86.0%/73.7% and 94.2%/90.3% in CsA and FK506 groups, respectively (P<0.05), with incidence of acute rejection of 10.5% and 9.6% (P>0.05), and rate of abnormal liver function of 26.3% and 15.4% (P<0.05), respectively. Eight patients (14.4%) in CsA group required a drug conversion but none in FK506 group. The drug conversion resulted in significant reduction of ALT/AST level from 255.13+/-31.38/201.88+/-21.25 U/L to 31.25+/-11.50/25.13+/-9.68 U/L (P<0.01).

CONCLUSIONFor HBV-carrying renal transplant recipients, FK506 as the primary choice of immunosuppressant can be more effective and safer than CsA.

Adolescent ; Adult ; Carrier State ; physiopathology ; Cyclosporine ; administration & dosage ; adverse effects ; pharmacology ; Drug-Related Side Effects and Adverse Reactions ; Female ; Graft Rejection ; Hepatitis B Surface Antigens ; metabolism ; Hepatitis B virus ; Humans ; Kidney Transplantation ; adverse effects ; Liver ; drug effects ; physiology ; Male ; Middle Aged ; Tacrolimus ; administration & dosage ; adverse effects ; pharmacology ; Young Adult