Hepatofugal portal flow associated with acute rejection in living-donor auxiliary partial orthotopic liver transplantation: A report of one case and literature review

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.     

肾移植术后间质性肺炎的临床分析

目的:分析肾移植术后间质性肺炎的临床特点和诊疗经验.方法:回顾性分析肾移植术后间质性肺炎患者36例临床资料,诊断标准依据临床症状、体征、胸部影像学表现和病原学检查综合判定.病因诊断为巨细胞病毒(CMV)肺炎26例(含混合细菌感染4例)、霉菌性肺炎2例、原因不明8例.患者早期给予氧疗,缺氧严重者予机械通气.抗感染治疗应用更昔洛韦与广谱抗生素,同时撤减免疫抑制剂,辅助给予丙种球蛋白.结果:30例治愈,6例死亡(其中5例系成人呼吸窘迫综合征无法控制导致多系统衰竭,1例系感染并发自发性气胸致死).结论:CMV感染是肾移植术后间质性肺炎的主要病因,但西罗莫斯相关性肺毒性也应引起必要的重视.     

鱼油脂肪乳注射液对肝移植术后肝功能及机体免疫功能的影响

目的 观察鱼油脂肪乳注射液对肝移植术后肝功能恢复、免疫功能和炎性反应的影响.方法 将64例肝移植患者随机分为治疗组和对照组(n=32),对照组采用常规免疫抑制和静脉营养治疗,治疗组在上述治疗的基础上加用ω-3鱼油脂肪乳剂.检测治疗1周后的肝功能、肿瘤坏死因子(TNF)-α和白细胞介素(IL)-1水平,比较排斥反应和感染的发生率.结果 治疗组和对照组患者的肝功能、排斥反应发生率(12.5%比9.4%),感染率(18.8%比25.0%)差异无统计学意义(P>0.05),死亡率分别为0和6.25%.治疗组TNF-α、IL-I水平较术前明显下降(P<0.05),也明显低于对照组(P<0.05).结论 ω-3鱼油脂肪乳剂运用于肝移植术后不影响肝功能恢复,在不干扰免疫抑制治疗的同时,可以减少炎症介质的释放,改善重度感染的预后.     

中国肝癌肝移植的现状与医学伦理学思考

探讨中国肝癌肝移植的现状,包括受体的选择标准、疗效以及与其他常规治疗的比较,并思考由此而带来的伦理学问题。在我国目前大力发展肝移植的同时,我国卫生资源短缺且分配不均带来了大量尖锐的伦理学冲突。对于肝癌患者,临床医生是选择常规治疗、肝移植还是放弃治疗,已不简单是一个临床决策,其背后的医学伦理学问题值得深思。     

肾移植术后并发恶性肿瘤患者免疫抑制药方案的选择

［摘要］目的评估肾移植术后并发恶性肿瘤患者选择不同免疫抑制药方案的有效性和安全性。方法肾移植术后并发恶性肿瘤患者10例,在检查确诊恶性肿瘤后,将其免疫抑制药方案调整成以西罗莫司为基础免疫抑制的方案,观察肿瘤生长、复发情况,监测移植肾功能及排斥反应情况。结果所有患者随访至少1 a,其中9例病情稳定,1例患者因肿瘤扩散转移,于调整药物后7个月死亡;1例患者药物转换2个月后出现一次急性排斥反应,激素冲击治疗后恢复。结论对肾移植术后并发恶性肿瘤患者使用以西罗莫司为基础免疫的免疫抑制方案安全,有效。     

老龄亲属活体供肾移植疗效观察

目的:探讨老龄亲属活体供肾移植的疗效. 方法:我院自2006年1月至2006年12月共施行亲属活体肾移植74例,收集该74例活体供肾移植的临床资料,按供者年龄大小分为2组:老龄组(≥55岁)11例,低龄组(＜55岁)63例.分别对两组受体术后不同时间点临床资料和两组供体术前术后的临床资料进行分析比较,探讨老龄活体供肾移植的疗效. 结果:(1)受者情况:老龄组有1例术后发生移植肾功能延迟恢复,低龄组有7例,组间比较无差别(P>0.05),两组受者移植术后肾功能恢复情况比较无差异,1年人/肾存活率均为100%.供者情况:两组供者术后一周血肌酐均明显升高,老龄组术前血肌酐(85.6±13.7)μmol/L,术后1周升高至(106.4±15.6)μmol/L,而低龄供者术前血肌酐(73.7±6.8)μmol/L,术后1周升高至(101.8±13.1)μmol/L.但术后1年随访,两组供者血肌酐恢复术前水平. 结论:在严格供体筛查的前提下,老龄供肾(55～65岁)对供者是安全的;而对受者,接受老龄供肾术后近期肾功能恢复情况良好,远期效果有待进一步观察.华中科技大学同济医学院附属同济医院器官移植研究所,教育部/卫生部器官移植重点实验室 (武汉,430030)     

老年患者肾移植围手术期的处理体会

目的总结老年患者肾移植围手术期处理的经验及教训。方法对１４例年龄为６０～７６岁的老年患者肾移植的资料进行回顾性分析。结果术后患者肾功能恢复正常的时间为３～３０天，平均（８．９±７．５）天；无移植肾功能丧失；术后未发生排斥反应；术后并发症有环孢素Ａ肝毒性、尿瘘、急性肾小管坏死、白细胞减少等。结论针对老年患者的特点做好围手术期各项工作，老年患者肾移植是可以取得较好效果的     

MAPK反义寡核苷酸诱导大鼠成纤维细胞凋亡的研究

目的 探讨MAPK反义寡核苷酸（antisense oligodeoxynucleotide，ASO）对大鼠肾成纤维细胞凋亡的影响。方法 脂质体转染法将MAPK反义寡核苷酸导入NRK-49F细胞中，Western—blotting测定细胞内MAPK蛋白的表达。DAPI染色观察细胞形态，流式细胞术检测细胞凋亡比率。结果 MAPKASO降低细胞MAPK蛋白含量；且可促进细胞凋亡，转染细胞出现凋亡特征性改变，凋亡率为35．8％，与其余各组有显著差异（P〈0．05）。结论 MAPK反义寡核苷酸通过阻断信号转导分子MAPK诱导大鼠成纤维细胞细胞凋亡，为防治肾移植术后间质纤维化提供一定的理论依据。     

结缔组织生长因子诱导人肾小管上皮细胞向间充质细胞转化的实验研究

Objective To investigate the role of connective tissue growth factor ( CTGF) in epithelial mesenchymal transition of HK-2 cells in vitro.Methods HK-2 cells were randomly divided into two groups; (1) control group including cells cultured in DMEM medium supplemented with 10% fetal bovine serum only; and (2) experimental group including cells cultured in DMEM medium supplemented with 10% fetal bovine serum and recombinant CTGF at a final concentration of 5 p-g/L The cells were collected at 72 h time points.Direct immunoiluorescence staining and immunohistochemistry were used to evaluate the E-cadherin,Vimentin,α-SMA and ERK2 in cells.Western-blotting was used to detect the E-cadherin,Vimentin and ERK2 protein expression.Boyden Chamber was used to detect the migration of tubular endothelium at 1 d,3 d and S d.Results There were less E-cadherin but more Vimentin expressed in cells of the experimental group.The presence of α-SMA was detected at 48 h with peak at 72 h in the cells of the experimental group.On the first day,the cellular migration in the two groups showed no difference.However,after 3 days,the transformed cells migrated surpassed the control group with peak at the 5th day [ (45.0±1.1) : (14.0±1.2),P < 0.05 ) ].Conclusion Connective tissue growth factor induces mesenchymal transformation of HK-2 cells,in which the ERK2 signaling pathway may play an important role.     

结缔组织生长因子诱导人肾小管上皮细胞向间充质细胞转化的实验研究

Objective To investigate the role of connective tissue growth factor ( CTGF) in epithelial mesenchymal transition of HK-2 cells in vitro.Methods HK-2 cells were randomly divided into two groups; (1) control group including cells cultured in DMEM medium supplemented with 10% fetal bovine serum only; and (2) experimental group including cells cultured in DMEM medium supplemented with 10% fetal bovine serum and recombinant CTGF at a final concentration of 5 p-g/L The cells were collected at 72 h time points.Direct immunoiluorescence staining and immunohistochemistry were used to evaluate the E-cadherin,Vimentin,α-SMA and ERK2 in cells.Western-blotting was used to detect the E-cadherin,Vimentin and ERK2 protein expression.Boyden Chamber was used to detect the migration of tubular endothelium at 1 d,3 d and S d.Results There were less E-cadherin but more Vimentin expressed in cells of the experimental group.The presence of α-SMA was detected at 48 h with peak at 72 h in the cells of the experimental group.On the first day,the cellular migration in the two groups showed no difference.However,after 3 days,the transformed cells migrated surpassed the control group with peak at the 5th day [ (45.0±1.1) : (14.0±1.2),P < 0.05 ) ].Conclusion Connective tissue growth factor induces mesenchymal transformation of HK-2 cells,in which the ERK2 signaling pathway may play an important role.