-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: To evaluate the safety and efficacy of steroid-minimization in liver transplantation (LT) recipients with hepatitis B virus related deceases in China. METHODS: Between March 2000 and June 2007, 502 adult LT recipients mostly with hepatitis B related primary diseases were enrolled in a prospective open-label nonrandomized single-centre study. Four study groups were setup according to steroid-minimization protocols: Tacrolimus (TAC) with 6 months steroids withdraw (6M SW), TAC with 3 months SW (3M SW), TAC with 14 days SW (14d SW), and TAC with basiliximab induction and steroids avoidance (Bas SA). All patients were followed up at least 36 months after LT. RESULTS: There were no significant differences in 3-year survival rates, graft survival rates and chronic rejection (CR) among the four groups (P = 0.092, P = 0.113 and P = 0.684, respectively). There was also no difference in acute rejection (AR) within the 12 months after LT (P=0.514). The 3-year recurrence of HBV and HCC after LT was significantly different among all groups (lowest in TAC/Bas SA group; P = 0.037 and P = 0.029, respectively). The overall incidence of infections were significantly higher in the 6M SW group (62.2% vs 56.1% in 3M SW, 30.5% in 14d SW, 20.5% in Bas SA; P < 0.01). By the end of post-LT year 3, more than 90% of survival patients after LT could safely receive TAC monotherapy. CONCLUSION: Bas SA immunosuppressive protocol can be achieved safely in LT and can reduce the hepatitis B and tumor recurrences, side effects of steroids after LT.
Journal of Digestive Diseases 10/2012; · 1.59 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the efficacy and safety of an immunosuppressive regimen of steroid avoidance in combination with induction therapy and tacrolimus in liver transplant recipients.
Eighty-two adult liver transplant recipients were randomized into 2 groups: standard protocol group (n=41) in which steroids were withdrawn 3 months after the operation, and a 24-hour steroid avoidance group (n=41) in which steroids were eliminated within 24 hours. The incidence of acute rejections, infections (bacterial, fungal, and cytomegalovirus), and metabolic complications were analyzed between the groups.
The incidence of early posttransplant diabetes mellitus and the average dosage of insulin consumption among diabetic recipients were significantly higher in recipients in the standard protocol group than in the 24-hour avoidance group (P < .05). In addition, the incidence of hypertension and infection during the follow-up were also higher in patients of the standard protocol group (P < .05). The incidence of hypertension in the early posttransplant period, hyperlipemia, and acute rejection during the follow-up were comparable between the groups (P > .05).
Twenty-four hour steroid avoidance combined with induction therapy and tacrolimus maintenance is a safe and efficient immunosuppression strategy that can significantly reduce posttransplant infections and other complications owing to long-term use of steroids, without increasing the risk of acute rejection.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 06/2012; 10(3):258-62.
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the efficacy and safety of sorafenib in the prevention and treatment of hepatocellular carcinoma (HCC) relapse after liver transplantation.
A retrospective cohort study was performed to assess the efficacy and safety of sorafenib for HCC. Forty-four patients who underwent liver transplant for HCC beyond Milan criteria form July 2007 to May 2010 were included study group (sorafenib, n = 22) and control group (without sorafenib, n = 22). The primary endpoints of the study were disease-free survival (DFS), overall survival (OS). Secondary outcomes included the rates of acute rejection and graft survival.
The clinical data of 44 patients were completely collected. There were significantly differences between sorafeinb group and control group in 1-year DFS (81.8% (n = 18) vs 63.6% (n = 14), P < 0.05) and OS (90.9% (n = 20) vs 72.7% (n = 16), P < 0.05) respectively. The acute rejection rates in Sorafenib were 13.6% (3/22), compared with 18.2% (4/22) in control group (P = 0.524) and 1-year graft survival in Sorafenib group were 86.4% (19/22), compared with 72.7% (16/22) in control group (P = 0.086). The overall incidence of treatment-related adverse events was 68.1% (n = 15) in sorafenib group and 31.8% (n = 7) in the control group (P < 0.01). Adverse events that were reported for patients receiving sorafenib were predominantly grade 1 or 2 in severity including diarrhea (45.5%, n = 10), liver dysfunction (40.9%, n = 9), hand-foot skin reaction (31.8%, n = 7) and pains of head and four limbs (22.7%, n = 5). Two patients with grade 3 adverse events in study group were stopped continuing to use the sorafenib. Three patients with the dose of 400 mg twice daily and 17 patients with the dose reduction of sorafenib continued to the study endpoint.
Patients with HCC undergoing liver transplantation could get the benefits of Sorafenib in reducing the incidence of tumor recurrence and extending disease-free and overall survival time.
Zhonghua yi xue za zhi 05/2012; 92(18):1264-7.
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the efficacy and safety of conversion from calcineurin inhibitors to sirolimus among liver transplant recipients with calcineurin inhibitor-induced complications.
After receiving liver transplants, 25 patients with calcineurin inhibitor-induced complications (22 renal dysfunction and 3 new-onset diabetes mellitus) were converted from sirolimus to tacrolimus. The serum creatinine, sirolimus trough level, liver function, acute rejection episodes, and drug-related adverse effects were monitored.
The patients were followed for 12 to 50 months (median, 25 months). The renal function of the 22 patients with renal dysfunction improved after sirolimus conversion. The serum creatinine levels were significantly lower at 3 months after conversion versus before conversion (113.2 ± 21.8 μmol/L vs 163.2 ± 45.3 μmol/L; P < .05). At the end of the follow-up, the average serum creatinine level was 101.9 ± 23.4 μmol/L among the 20 living recipients. Diabetes also was under control in 3 diabetic recipients after the conversion. Four patients experienced episodes of acute rejection, and intravenous steroid bolus therapy was administered in 2 of them. No graft was lost because of acute rejection. The adverse effects of sirolimus included hyperlipidemia (7/25), anemia (8/25), and mouth ulcers (9/25). All these adverse effects were relieved after a short-term symptomatic therapy, and no patient was withdrawn from the conversion trial.
Sirolimus monotherapy is effective and safe in liver transplant recipients. Conversion to sirolimus was associated with a sustained improvement in renal function and diabetes mellitus without an increased incidence of acute rejection episodes.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 04/2012; 10(2):132-5.
-
[show abstract]
[hide abstract]
ABSTRACT: Steroids have been the mainstay of immunosuppressive regimen in liver transplantation. However, the use of steroids is associated with various post-transplant complications. This study evaluated the efficacy and safety of reduced immunosuppressive regimen with steroids (steroid elimination within 24 hours post-transplant) in a cohort of Chinese liver transplant recipients.
Seventy-six patients in line with the selection criteria were enrolled in this prospective study. All patients received anti-IL-2 receptor antibody induction and tacrolimus-based maintenance therapy. The recipients were divided into two groups according to the duration of steroid use: 40 transplant in a 3-month withdrawal group and the remaining 36 in a 24-hour elimination group. Recipient survival, post-operative infections, biopsy-proven acute rejection and steroid-resistant acute rejection, non-healing wound, recurrence of hepatitis B virus (HBV) and hepatocellular carcinoma (HCC), de novo diabetes, hyperlipidemia and hypertension were assessed in the two groups.
There was no significant difference in patient survival, incidence of acute rejection episodes and hyperlipidemia, and recurrence of HBV and HCC between the two groups. However, the incidence rates of post-transplant infection, non-healing wound, de novo diabetes and hypertension were significantly lower in the 24-hour elimination group than in the 3-month withdrawal group (all P values <0.05).
Under anti-IL-2 receptor antibody induction and tacrolimus-based maintainance, steroid elimination within 24 hours post-transplant is associated with reduced steroid-related complications without increasing the risk of rejection.
Hepatobiliary & pancreatic diseases international: HBPD INT 04/2012; 11(2):137-42. · 1.08 Impact Factor
-
Jian Zhou,
Wei-qiang Ju,
Xiao-shun He, Lin-wei Wu,
Xiao-feng Zhu,
Dong-ping Wang,
Yi Ma,
An-bin Hu,
Guo-dong Wang,
Qiang Tai,
Jie-fu Huang
[show abstract]
[hide abstract]
ABSTRACT: To investigate the clinical characteristics, diagnosis and treatment of digestive tract leakage after orthotopic liver transplantation (OLT).
Sixty-one recipients had digestive tract leakage in early stage after OLT among 1173 cases from January 2000 to December 2010. There were 55 male and 6 female patients, aging from 36 to 61 years, with a median of 45 years. Digestive tract leakage included bile leakage (46 cases), gastric leakage (5 cases), duodenal leakage (1 case), jejunal leakage (4 cases), ileal leakage (1 case) and colon transversum leakage (4 cases). Ten of recipients with gastrointestinal leakage had 1 to 3 times of abdominal surgery before OLT. Abdominal drainage was used in 28 cases with bile leakage, and additionally, endoscopic retrograde cholangiopancreatography, endoscopic nasobiliary drainage and stenting were performed for 8 of them, and surgical neoplasty for another 18 patients with bile leakage. Simple surgical neoplasty of perforation was performed for 13 patients with gastrointestinal leakage, and diverticulectomy and neoplasty for 1 case with duodenal leakage, and partial jejunectomy for one severe jejunal leakage. Nutritional support was administered for all of cases.
The incidence rate of digestive tract leakage in early stage after OLT was 5.20% (61/1173). Intra-operative iatrogenic injury of gastrointestinal tract was occurred in 6 cases with gastrointestinal leakage. After treatment, 11 cases died of multiple organ failure resulted from severe infection, with mortality of 18.0% (11/61), including 4 cases with bile leakage, with the mortality of 8.6% (4/46), and 7 cases with gastrointestinal tract leakage, with the mortality of 46.6% (7/15). The remanent 50 cases through comprehensive treatment with a span of 1 to 3 months recovered and discharged healthily. No digestive tract leakage reoccurred in the follow-up of 6 to 84 months.
The morbidity of digestive tract leakage in early stage after OLT is low, but its mortality is high, especially for gastrointestinal tract leakage. High dose corticosteroids therapy, history of abdominal operation and intra-operative iatrogenic injury may be high risk factor. Comprehensive treatment is crucial for improving prognosis.
Zhonghua wai ke za zhi [Chinese journal of surgery] 03/2012; 50(3):222-5.
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the outcomes of liver transplant recipients who received liver allografts from hepatitis B surface antigen (HBsAg)-positive donors.
The medical records of 23 male patients (median age, 42.5 years; range: 29-61) who received HBsAg-(+) liver allografts in our organ transplant center were retrospectively analyzed. All patients had confirmed diagnosis of end-stage liver disease (ESLD) secondary to hepatitis B virus (HBV) infection, including 13 HBsAg(+)/HBeAg(-)/HBcAb(+) cases and 10 HBsAg(+)/HBeAb(+)/HBcAb(+) cases. After transplantation, all patients were administered oral entecavir and intravenous anti-hepatitis B immunoglobulin (HBIG) (2000 IU/d during the first week), along with a steroid-free immune suppression regimen. HBV-related antigen and antibody and HBV DNA were detected on post-transplantation days 1, 7, 14, 21, and 30. The liver allografts were monitored by ultrasound imaging. After discharge, monthly follow-up recorded liver function, renal function, acute rejection, infections, vascular complications, biliary complications, HBV recurrence, cancer recurrence, and patient survival.
Two of the recipients died from severe perioperative pneumonia. The remaining 21 recipients were followed-up for 10 to 38 months, and all 21 patients remained HBsAg(+). One recipient developed biliary ischemia and required a second liver transplantation at five months after the primary transplantation. Three recipients (all primary) died from tumor recurrence at 9, 14, and 18 months post-transplantation, respectively. All other recipients survived and had acceptably low HBV DNA copy levels. Color Doppler imaging showed good graft function and normal texture. The patient and graft survival rates were 78.3% (18/23) and 73.9% (17/23), respectively. The recurrence rate of HBV infection was 100% (23/23). In surviving patients, no liver function abnormality, graft loss, or death was found to be related to the recurrence of HBV infection.
Liver transplantation using HBsAg(+) liver grafts was safe for patients with ESLD secondary to HBV infection.
Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 01/2012; 20(1):14-6.
-
Qiang Tai,
Xiao-shun He,
An-bin Hu, Lin-wei Wu,
Wei-qiang Ju,
Xiao-feng Zhu,
Dong-ping Wang,
Guo-dong Wang,
Yi Ma,
Zhi-yong Guo,
Jie-fu Huang
[show abstract]
[hide abstract]
ABSTRACT: To explore the resistance rate, risk factors and mortality of Escherichia coli bloodstream infections (BSI) after liver transplantation.
From January 1993 to May 2010, a retrospective analysis of Escherichia coli in liver transplants were conducted.
A total of 88 BSI occurred in 83/695 patients and Escherichia coli (n = 23) was most commonly found. Carbapenem and piperacillin-tazobactam were the most consistently active against Escherichia coli while the resistance rate to enterococcus for ciprofloxacin, gentamycin, ampicillin-clavulanic acid was over 60%. Univariate analysis identified the following variables as risk factors for Escherichia coli bacteremia: cholangioenterostomy (P < 0.001) and ductal complications (P < 0.001). Escherichia coli bloodstream infection could increase the mortality at 15 days after bloodstream infection. No significant difference in mortality occurred at 30 days and 1 year after enterococcal bacteremia.
Escherichia coli after liver transplantation is resistant to agents but commonly active to carbapenem and piperacillin-tazobactam. The risk factor associated with Escherichia coli bloodstream infections are cholangioenterostomy and ductal complications. Escherichia coli bloodstream infection can increase the mortality at 15 days after bloodstream infection.
Zhonghua yi xue za zhi 11/2011; 91(42):2977-80.
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the efficacy and safety of ABO-incompatible liver transplantation in adult patients with fulminant hepatitis B.
The clinical data of 97 cases of adult liver transplantation for fulminant hepatitis B were retrospectively analyzed. The patients were grouped as ABO-identical (ABO-Id, n = 58), ABO-compatible (ABO-C, n = 19) and ABO-incompatible (ABO-In, n = 20). The rates of rejection, infection, biliary tract complications, vascular complications, and patient and graft survivals were compared among 3 groups.
The 3-month, 1-year and 3-year graft survival rates were 87.9%/77.6%/65.3% in ABO-Id group, 84.2%/73.7%/66.5% in ABO-C group and 50.0%/35.0%/33.3% in ABO-In group respectively. There were significant differences between ABO-Id and ABO-In (P < 0.05). The incidences of rejection, infection, vascular complications and biliary tract complications were 8.6%, 20.7%, 3.4% and 6.9% in ABO-Id group, 35%, 60%, 20% and 30% in ABO-In group (P < 0.05) and 10.5%, 26.3%, 5.3% and 10.5% respectively in ABO-C group (P > 0.05).
ABO-C liver transplantation is an important therapeutic option in adult patients with acute liver failure awaiting an emergency procedure. ABO-In transplantation can be used only for life-rescuing in patients with fulminant hepatitis since it is associated with a higher risk of rejection, infection, vascular thrombosis, ischemic bile duct complications and poor patient and graft survival.
Zhonghua yi xue za zhi 09/2011; 91(36):2558-60.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the feasibility and management of retransplantation for diffuse biliary strictures occurring after initial liver transplantation.
The clinical data of 53 consecutive liver retransplantation patients at our hospital from January 2001 to December 2009 were collected and analyzed retrospectively. Among them, 20 (37.7%) were due to diffuse biliary strictures.
Diffuse biliary strictures appeared at 3 - 16 months after initial transplantation. The mean time was 6.3 months. The specific types included intra-hepatic diffuse biliary strictures (n = 16) and multi-strictures involving both intra- & extra-hepatic biliary ducts (n = 4). Retransplantation was performed after a failure of intervention or/and other comprehensive treatments. Among them, 14 were cured and 6 died from peri-operative complications including serious abdominal infection & MODS (multiple organ dysfunction syndrome) (n = 3, 50%), biliary fistula (n = 2, 33.3%) and hepatic artery embolism (n = 1, 16.7%). These patients were followed up for a mean time of 1.8 years (range: 1 - 5 years). The accumulative survival rates at 1, 3 and 6 months were 80.0%, 75.0% and 70.0% respectively.
Liver retransplantation is the ultimate treatment for diffuse biliary strictures after liver transplantation. The survival rate is associated with operative timing, surgical techniques and peri-operative management.
Zhonghua yi xue za zhi 06/2011; 91(22):1529-32.
-
Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 06/2011; 19(6):473-4.
-
[show abstract]
[hide abstract]
ABSTRACT: To summarize the treatment outcomes after combined en bloc liver and pancreas transplantation.
Five patients with end-stage liver disease and type 2 diabetes mellitus received combined en bloc liver and pancreas transplantation after hepatectomy.
Five operations were performed successfully. The operative time ranged from 9 to 16 hours and blood loss from 1600 to 3000 ml. Postoperatively, one patients developed pulmonary infection, one died of graft-versus-host disease(GVHD), and one experienced acute renal failure. No intestinal fistula, anastomotic leakage, biliary complications, chronic and acute rejection and pancreatitis were seen. Liver function index including alanine aminotransferase, aspartate aminotransferase and total bilirubin returned to normal levels a week after surgery, while levels of C peptide and blood glucose resumed within 1 to 2 weeks. Apart from 1 case died of GVHD, the other 4 maintained normal liver function during the follow up ranging from 2 to 23 months and no insulin was required for the diabetes.
Combined en bloc liver and pancreas transplantation is technically feasible and an effective treatment for multi-organ diseases.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 05/2011; 14(5):343-6.
-
Jian Zhou,
Wei-Qiang Ju,
Xiao-Shun He,
Dong-Ping Wang,
Xiao-Feng Zhu, Lin-Wei Wu,
Qiang Tai,
Yi Ma,
An-Bin Hu,
Guo-Dong Wang,
Jie-Fu Huang
[show abstract]
[hide abstract]
ABSTRACT: To investigate the effect of Campath-1H induction on immunosuppression in small intestine transplantation.
Clinical data of a patient who underwent small intestine transplantation were retrospectively summarized.
Intraoperative Campath-1H induction by intravenous injection was administered. Triple immunosuppression(FK506, MMF and methylprednisolone) was used postoperatively. The lymphocyte and leukocyte decreased significantly following Campath-1H induction, and returned to normal after adjusting the dose of immunosuppressant and use of colony stimulating factor. There were no acute rejection, graft versus host disease, or severe infection during the immediate postoperative period. The patient recovered and discharged.
Intraoperative Campath-1H induction and postoperative triple immunosuppression using FK506, MMF, and methylprednisolone may prevent rejection and graft versus host disease in the early stage after small intestine transplantation.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 03/2011; 14(3):199-201.
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the indication, surgical and post-operative complications of the multivisceral transplantation.
The post-transplant complications of 8 patients who underwent multivisceral transplantation between May 2004 and May 2010 were analyzed. There were 7 male and 1 female, aged from 28 to 65 years. Five patients who suffered from non-resectable advanced upper abdominal malignancy experienced the liver, stomach, spleen, pancreas, duodenum, omentum and variable amounts of the colon resection, and then underwent standard multivisceral transplantation (included liver, stomach, pancreaticoduodenal and small bowel). After underwent hepatectomy while retaining the native pancreas and entire gastrointestinal, three recipients with end-stage liver cirrhosis and type 2 insulin-dependent diabetes mellitus (IDDM) was performed combined en bloc liver/pancreaticoduodenal transplantation.
Since the third day post-operation, all recipients no longer needed exogenous insulin and had normal blood glucose concentrations. Two weeks after transplantation, their liver function almost became normal. For the 5 recipients who suffered abdominal malignancy, the longest survival period was 326 days. Cause of death are recurrent tumor (n = 2), multiple organ failure (n = 3). All the 5 patients experienced infection. For 3 patients suffered cirrhosis and IDDM, the longest survival was over 18 month. Excepting the case 8 died of graft versus host disease, all were still living without apparently post-transplant complication.
Multivisceral transplantation is an alternative in the treatment of the patients with benign massive abdominal pathologies. Careful patient selection and technical modification are crucial to improve the outcome of these patients.
Zhonghua wai ke za zhi [Chinese journal of surgery] 12/2010; 48(23):1800-4.
-
Qiang Tai,
Xiao-shun He,
An-bin Hu, Lin-wei Wu,
Wei-qiang Ju,
Xiao-feng Zhu,
Yi Ma,
Dong-ping Wang,
Guo-dong Wang,
Zhi-yong Guo,
Jie-fu Huang
[show abstract]
[hide abstract]
ABSTRACT: To explore the resistance rate, risk factor and mortality of enterococcal bloodstream infections (BSI) after liver transplantation.
From January 1993 to May 2010, a retrospective analysis of enterococcus in liver transplants were conducted.
Fifty-eight BSI occurred in 53 of 695 patients. And a total of 30 enterococci were isolated. Linezolid and glycopeptide antibiotics were the most consistently active against the Enterococcus. The resistance rates to Enterococcus for erythromycin, clindamycin, imipenem, ciprofloxacin, gentamycin and ampicillin-clavulanic acid were all over 70%. The univariate analysis identified the following variables as the risk factors for enterococcal bacteremia: retransplantation (P=0.03) and biliary duct complications (P=0.02). Enterococcal bloodstream infection increased the mortality at Day 15. No significant difference was found in the mortality rate at Day 30 and 1 year after enterococcal bacteremia.
Enterococcus after liver transplantation is resistant to multiple agents but active to linezolid and glycopeptide antibiotics. The risk factors commonly associated with enterococcal BSI are retransplantation and biliary duct complications. Enterococcal BSI can increase the mortality at Day 15 after liver transplantation.
Zhonghua yi xue za zhi 12/2010; 90(46):3279-82.
-
Qiang Tai,
Xiao-shun He, Lin-wei Wu,
Wei-qiang Ju,
Xiao-feng Zhu,
Yi Ma,
Dong-ping Wang,
An-bin Hu,
Guo-dong Wang,
An Hu,
Jie-fu Huang
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the influence of simultaneous pancreas-kidney (SPK) transplantation on the quality of life of diabetic recipients with end-stage renal disease.
We performed a retrospective analysis of the data of diabetic patients with end-stage renal disease and evaluated the quality of life of the recipients using SF-36 health survey.
One patient died of cerebrovascular accident, and 7 patients recovered smoothly. During the follow-up lasting for a mean of 23.3 months, the blood glucose, C-peptide and creatine levels of the patients remained stable. The score of 8 domains of SF-36 of the diabetic recipient at 2 years after SPK transplantation showed a significant improvement compared with that before the operation, similar to that of Chinese normal population(P > 0.05).
SPK transplantation can achieve a significant improvement of the quality of life of diabetic patients with end-stage renal disease.
Nan fang yi ke da xue xue bao = Journal of Southern Medical University 09/2010; 30(9):2089-92.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the safety and feasibility of steroids minimization immunosuppressive regimen in liver transplantation.
One hundred and sixteen patients in line with the selecting criteria from January 2005 to June 2008 were divided into three groups according to the withdrawal of steroids: 40 cases in 3 months withdrawal group, 40 cases in 7 d withdrawal group and the other 36 cases in 24 h withdrawal group. The difference of recipients' survival, infection, acute rejection and steroids resistant acute rejection, wound healing, recurrence of HBV and hepatocellular cell (HCC), new on-set of diabetes, hyperlipidemia and hypertension between the three groups were compared.
The difference of recipients' survival, acute rejection including steroids resistant acute rejection, recurrence of HBV and HCC, hyperlipidemia between the three groups were not significant (P > 0.05), the incidence of wound un-healing and hypertension in 24 h withdrawal group was significantly lower than that in the other 2 groups (P < 0.05), the incidence of infection and new on-set diabetes in 24 h withdrawal group and 7 d withdrawal group was significantly lower than that in 3 months withdrawal group (P < 0.05).
Steroids minimization immunosuppressive strategy is safe and feasible in liver transplantation field, it will significantly reduce the steroids related complications without increasing the risk of rejection.
Zhonghua wai ke za zhi [Chinese journal of surgery] 04/2010; 48(7):492-5.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the causes and treatment of postoperative gastrointestinal bleeding after orthotopic liver transplantation (OLT).
Clinical data of 776 patients after OLT between January 2000 and December 2006 were analyzed retrospectively.The experiences in diagnosis and treatment of postoperative gastrointestinal bleeding after OLT were reviewed.
Gastrointestinal bleeding occurred in 18 patients (2.3%) after OLT, among whom 8 (44.5%) were from peptic ulcer, 3 (16.7%) from gastric and esophageal varices, 3 (16.7%) from gastroduodenitis, 3 (16.7%) from hemobilia, and 1 (5.6%) had diverticular bleeding in the jejunum. These 18 patients with gastrointestinal bleeding were managed with conservative treatment, endoscopic treatment, radiological interventional embolism,or exploratory laparotomy. Five patients died of gastrointestinal bleeding and the gastrointestinal bleeding-related mortality rate was 27.8%. After a mean follow up of 3.5 years, only 1 patient died of recurrence of hepatic cellular carcinoma while others survived disease-free.
Gastrointestinal bleeding may occur from different sites after OLT and the mortality is high. Prompt identification of the source of bleeding and correct management are required to improve the prognosis.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 01/2010; 13(1):26-8.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the efficacy of conversion from calcineurin-inhibitor (CNI) to rapamycin in liver recipients with CNI-associated renal insufficiency.
This retrospective study examined the liver transplant recipients who had switched from CNI to rapamycin between January 2004 and June 2008 in the first affiliated hospital of Sun Yat-sen University. The data of renal function before and after the conversion were analyzed by Wilcoxon sum rank test, and rapamycin-related adverse effects were also observed.
Compared with that before conversion, the renal funtion 4 months after the conversion improved significantly (P<0.05). The blood lipid level 3 months after the conversion increased significantly (P<0.05) but were well controlled.
Rapamycin can be used safely as a good alternative in liver transplant recipients with CNI-related renal insufficiency.
Nan fang yi ke da xue xue bao = Journal of Southern Medical University 11/2009; 29(11):2276-8.
-
[show abstract]
[hide abstract]
ABSTRACT: Researchers recently discovered a group of semimature dendritic cells that induce autoimmune tolerance by activating host antigen-specific CD4+CD25+ T-regulatory cells. We hypothesized that donor semimature dendritic cells injected into recipients would induce effector T-cell hyporesponsiveness by activating CD4+CD25+ T-regulatory cells.
Donor myeloid semimature dendritic cells were cultivated for 6 days and were then stimulated with tumor necrosis factor a for 24 hours. BALB/c mice were pretreated with semimature dendritic cells to generate antigen-specific CD4+CD25+ T-regulatory cells in vivo. The role of CD4+CD25+ T-regulatory cells in transplant immunity was studied via mixed lymphocyte culture in vitro.
Surface markers and cytokines secreted by semimature dendritic cells differed from those secreted by immature myeloid dendritic cells or mature dendritic cells. Semimature dendritic cells and immature myeloid dendritic cells did not activate allogenic lymphocyte responses in coculture studies. CD4+CD25+ T-regulatory cells of recipients challenged by donor semimature dendritic cells, which expressed a high level of interleukin-10, induced hyporesponsiveness in host effector T cells that were stimulated by donor splenocytes. In contrast, CD4+CD25+ T-regulatory cells did not induce hyporesponsiveness in effector T cells when the host T cells were stimulated by third-party antigen from DBA2 mice splenocytes.
Our findings confirm that semimature dendritic cells are an independent subgroup of dendritic cells in both immune function and morphologic profile. It may be the cytokine secretion profile of semimature dendritic cells (rather than that of surface markers) that has a key role in inducing CD4+CD25+ T-regulatory cells to express a high level of interleukin-10. Immunization with donor semimature dendritic cells may be an effective method of inducing transplant tolerance, but further evidencebased studies of that topic are necessary.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 10/2009; 7(3):149-56.
