Great progress has been made in the field of liver transplantation over the past two decades. This progress, however, also brings up the next set of challenges: First, organ shortage remains a major limitation, and ac...Great progress has been made in the field of liver transplantation over the past two decades. This progress, however, also brings up the next set of challenges: First, organ shortage remains a major limitation, and accounts for a large proportion of wait list mortality. While living donation has successfully increased the total number of liver transplants done in Asian countries, the total number of such transplants has been stagnant in the western hemisphere. As such, there has been a significant effort over the past decade to increase the existing deceased donor pool. This effort has resulted in a greater use of liver allografts following donation after cardiac death(DCD) along with marginal and extended criteria donors. Improved understanding of the pathophysiology of liver allografts procured after circulatory arrest has not only resulted in better selection and management of DCD donors, but has also helped in the development of mechanical perfusion strategies. Early outcomes demonstrating the clinical applicability of both hypothermic and normothermic perfusion and its potential to impact patient survival and allograft function have generated much interest. Second, long-term outcomes of liver transplant recipients have not improved significantly, as recipients continue to succumb to complications of long-term immunosuppression, such as infection, malignancy and renal failure. Furthermore, recent evidence suggests that chronic immune-mediated injury to the liver may also impact graft function.展开更多
Background:Lung transplantation(LT)has been demonstrated as the only effective therapy for patients with end-stage lung diseases.Increasing listed lung transplant candidates and expanding volumes of lung transplant ce...Background:Lung transplantation(LT)has been demonstrated as the only effective therapy for patients with end-stage lung diseases.Increasing listed lung transplant candidates and expanding volumes of lung transplant centers across China require wellorganized programs and registry data collection based on the large population.This study aimed to summarize and analyze the data of LT development in China.Methods:We retrospectively collected and analyzed data from the China Lung Transplantation Registry(CLuTR).Key data were reported from the registry with transplant types,indications,donor and recipient characteristics,outcomes and survival.The survival<30 days,1-year and 3-year survival rates were estimated with risk factors identified.Results:CLuTR contained data from 1053 lung transplants performed through January 1st,2015 to December 31st,2018 reported by 18 registered transplant centers.The largest category of diagnosis before transplantation was idiopathic interstitial pneumonitis.The total<30 days,1-year and 3-year survival rates in CLuTR were 81.45%,70.11%,and 61.16%with discrepancy by indications.Large proportion of recipients who were more than 60 years old required higher standard of care.Infection-related complications resulted in more death events in the early post-surgery periods.New York Heart Association grading at listing,extra-corporeal membrane oxygenation usage peri-transplantation,allograft dysfunction(primary graft dysfunction>Grade 0),renal insufficiency(estimated glomerular filtration rate<60 mL min_11.73 m^2),were independently associated with a higher risk for 3-year mortality in the entire cohort.Conclusions:Facing more end-stage of lung diseases and comorbidities,this study analyzed the outcomes and survival of LT recipients in China.Further prospectively stratified analyses with longer follow-up will be needed.展开更多
AIM To investigate blood cultures of deceased donors and report the confirmed transmission of bacterial infection from donors to liver recipients.METHODS We retrospectively studied the results of blood cultures among ...AIM To investigate blood cultures of deceased donors and report the confirmed transmission of bacterial infection from donors to liver recipients.METHODS We retrospectively studied the results of blood cultures among our donation after cardiac death(DCD) donors and calculated the donor-derived bacterial infection rates among liver recipients. Study participants underwent liver transplantation between January 1, 2010 and February 1, 2017. The study involved a total of 67 recipients of liver grafts from 67 DCD donors. We extracted the data of donors' and patients' characteristics, culture results and clinical outcomes, especially the post-transplant complications in liver recipients, from electronic medical records. We analyzed the characteristics of the donors and the corresponding liver recipients with emphasis put on donor-derived infections.RESULTS Head trauma was the most common origin of death among our 67 DCD donors(46.3%). Blood taken prior to the procurement operation was cultured for 53 of the donors, with 17 episodes of bloodstream infections developing from 13 donors. The predominant organism isolated from the blood of donors was Gram-positive bacteria(70.6%). Only three(4.5%) of 67 liver recipients developed confirmed donor-derived bacterial infections,with two isolates of multidrug-resistant Klebsiella pneumoniae and one isolate of multidrug-resistant Enterobacter aerogenes. The liver recipients with donorderived infections showed relation to higher crude mortality and graft loss rates(33.3% each) within 3 mo post transplantation, as compared to those without donor-derived infections(9.4% and 4.7%, respectively). All three liver recipients received appropriate antimicrobial therapy.CONCLUSION Liver recipients have high occurrence of donor-derived infections. The liver recipients with donor-derived multidrug-resistant Enterobacteriaceae infections can have good outcome if appropriate antimicrobial therapy is given.展开更多
文摘Great progress has been made in the field of liver transplantation over the past two decades. This progress, however, also brings up the next set of challenges: First, organ shortage remains a major limitation, and accounts for a large proportion of wait list mortality. While living donation has successfully increased the total number of liver transplants done in Asian countries, the total number of such transplants has been stagnant in the western hemisphere. As such, there has been a significant effort over the past decade to increase the existing deceased donor pool. This effort has resulted in a greater use of liver allografts following donation after cardiac death(DCD) along with marginal and extended criteria donors. Improved understanding of the pathophysiology of liver allografts procured after circulatory arrest has not only resulted in better selection and management of DCD donors, but has also helped in the development of mechanical perfusion strategies. Early outcomes demonstrating the clinical applicability of both hypothermic and normothermic perfusion and its potential to impact patient survival and allograft function have generated much interest. Second, long-term outcomes of liver transplant recipients have not improved significantly, as recipients continue to succumb to complications of long-term immunosuppression, such as infection, malignancy and renal failure. Furthermore, recent evidence suggests that chronic immune-mediated injury to the liver may also impact graft function.
文摘Background:Lung transplantation(LT)has been demonstrated as the only effective therapy for patients with end-stage lung diseases.Increasing listed lung transplant candidates and expanding volumes of lung transplant centers across China require wellorganized programs and registry data collection based on the large population.This study aimed to summarize and analyze the data of LT development in China.Methods:We retrospectively collected and analyzed data from the China Lung Transplantation Registry(CLuTR).Key data were reported from the registry with transplant types,indications,donor and recipient characteristics,outcomes and survival.The survival<30 days,1-year and 3-year survival rates were estimated with risk factors identified.Results:CLuTR contained data from 1053 lung transplants performed through January 1st,2015 to December 31st,2018 reported by 18 registered transplant centers.The largest category of diagnosis before transplantation was idiopathic interstitial pneumonitis.The total<30 days,1-year and 3-year survival rates in CLuTR were 81.45%,70.11%,and 61.16%with discrepancy by indications.Large proportion of recipients who were more than 60 years old required higher standard of care.Infection-related complications resulted in more death events in the early post-surgery periods.New York Heart Association grading at listing,extra-corporeal membrane oxygenation usage peri-transplantation,allograft dysfunction(primary graft dysfunction>Grade 0),renal insufficiency(estimated glomerular filtration rate<60 mL min_11.73 m^2),were independently associated with a higher risk for 3-year mortality in the entire cohort.Conclusions:Facing more end-stage of lung diseases and comorbidities,this study analyzed the outcomes and survival of LT recipients in China.Further prospectively stratified analyses with longer follow-up will be needed.
基金Supported by the New Xiangya Talent Project of The Third Xiangya Hospital of Central South University,No.20170311
文摘AIM To investigate blood cultures of deceased donors and report the confirmed transmission of bacterial infection from donors to liver recipients.METHODS We retrospectively studied the results of blood cultures among our donation after cardiac death(DCD) donors and calculated the donor-derived bacterial infection rates among liver recipients. Study participants underwent liver transplantation between January 1, 2010 and February 1, 2017. The study involved a total of 67 recipients of liver grafts from 67 DCD donors. We extracted the data of donors' and patients' characteristics, culture results and clinical outcomes, especially the post-transplant complications in liver recipients, from electronic medical records. We analyzed the characteristics of the donors and the corresponding liver recipients with emphasis put on donor-derived infections.RESULTS Head trauma was the most common origin of death among our 67 DCD donors(46.3%). Blood taken prior to the procurement operation was cultured for 53 of the donors, with 17 episodes of bloodstream infections developing from 13 donors. The predominant organism isolated from the blood of donors was Gram-positive bacteria(70.6%). Only three(4.5%) of 67 liver recipients developed confirmed donor-derived bacterial infections,with two isolates of multidrug-resistant Klebsiella pneumoniae and one isolate of multidrug-resistant Enterobacter aerogenes. The liver recipients with donorderived infections showed relation to higher crude mortality and graft loss rates(33.3% each) within 3 mo post transplantation, as compared to those without donor-derived infections(9.4% and 4.7%, respectively). All three liver recipients received appropriate antimicrobial therapy.CONCLUSION Liver recipients have high occurrence of donor-derived infections. The liver recipients with donor-derived multidrug-resistant Enterobacteriaceae infections can have good outcome if appropriate antimicrobial therapy is given.
