肝脏移植、心脏移植及肾脏移植等已广泛开展，大批受者长期存活。本文现就这组特殊人群在移植术后患胆道结石病的机理及其处理原则介绍如下。1器官移植受体胆石病的发生机理肝移植术后胆管结石与胆泥形成并引起胆道梗阻可随时发生。除了明确的结石外，胆泥形成胆管铸形并广泛分布于肝内胆管也有报道。胆管粘膜损害、胆管梗阻、移植肝的冷、热缺血、感染及胆固醇过饱和等都在胆管结石形成过程中发挥作用，但胆管梗阻可能是肝移植术后胆管结石形成的最重要因素［1］。胆管结石和胆泥形成的患者，绝大多数都伴有胆管狭窄，这个狭窄可以发生在胆管胆管吻合口和胆管空肠吻合口，也可发生在非吻合口处的胆管。胆管内异物如T型管或内支撑管也可作为结石形成的核心。除了这些引起胆汁淤积的物理学原因外，环孢素A（CsA）在胆石发生中也起了作用［2］： 它可抑制胆汁分泌，促进胆汁淤积，而FK506（普乐可复）似乎没有这方面的副作用。此外，肝移植受者胆汁中胆固醇呈过饱和状态，且T管引流及胆酸池的减少还加重这种状态。目前还不清楚胆道重建方式对胆道结石形成有没有影响。但从理论上讲，胆肠吻合会增加肠源性细菌进入胆道的机会，从而导致胆红素去结合化，并进一步形成色素石。但到底是胆管对端吻合还是胆肠吻合后更易形成结石，目前尚无详尽研究。
Objective We aimed to investigate the attitude and suggestion from doctors, pharmacists and civil servants concerning brain death and organ transplantation and the legislation. Methods A questionnaire with 10 sections and 44 questions was designed and distributed. The effective questionnaire data was then recorded and checked for descriptive analysis. Results In 1 400 questionnaires distributed, 1 063 were responded and 969 of them were valid and analyzed. The respondents showed an incomplete understanding of brain death and organ transplantation laws. Seventy-four percent of the respondents recognized and accepted the standard of brain death. They agreed that legislation should be involved in the removal of organs for transplantation, the future use of the organs, and insurance and compensation for the donor for possible health risks induced by organ removal. Of the 969 respondents, 92% considered it necessary to have legislation in brain death and organ transplantation, and 61% thought that it is time to legislate. Conclusion Legislation for brain death and organ transplantation is urgent and timely in China. The laws must include the respective rights and obligations of patients, close relatives, and medical institutions. Educating the public about brain death and organ transplantation should also be encouraged in a variety of ways.
In recent years, breakthroughs in genetic engineering (GE) and cloning technology have led to the successful cultivation of “designated pathogen free (DPF) xenotransplantation (XENO) medical (M) pigs” (hereinafter referred to as GE-DPF-XENO-M pigs). Based on GE-DPF-XENO-M pigs, a large number of xenotransplantation experiments with non-human primates (NHPs) as recipients basically answered the most concerned questions: overcoming hyperacute rejection and cross species infection. These achievements directly accelerate to the emergence of a new “xenotransplantation subclinical research model”. At the end of 2021, Montgomery and Porrett teams in the United States successively transplanted GE pig kidney into the remains of 3 brain dead cases, no hyperacute rejection occurred after 48–72 hours. These three subclinical studies provide a scientific basis for xenotransplantation into clinical research. On January 7, 2022, Griffith, Maryland, USA, etc. transplanted a GE pig heart to a patient with severe heart failure and survived for 59 days. The above progress shows that xenotransplantation has taken a key step towards the stage of clinical research, which is worthy of our peers’ attention and reference.
Objective To get the information about the cognition and attitude towards organ transplantation and donation in inpatients. Methods The inpatients were investigated by using a self-designed questionnaire，including general data，cognition and attitude towards organ transplantation and donation. The influence factors of organ transplantation and donation were analyzed by SPSS 18.0. Results A total of 1 000 questionnaires were delivered，973 returned，the effective questionnaire was 906，and the effective rate was 93.1%. In 906 valid questionnaires，788 （87.0%） patients knew organ transplantation；189 （20.9%） patients had transplanted relatives；511 （56.4%） patients were willing to accept the organ transplant surgery，226 （24.9%） patients did not want，169 （18.7%） patients did not know；490 （54.1%） patients agreed to donate organ，173 （19.1%） patients disagreed，243 （26.8%） patients did not know. The age，education，occupation，knowing organ transplants，and with organ transplanted relatives or not had significant influences to the willingness towards organ transplantation and donation （P＜0.01）. The gender had no effect on organ transplantation （P=0.727） and donation （P=0.935） concerned issues，but the age，education，knowing organ transplantation，and with organ transplanted relatives or not had significant influences on it （P＜0.01）. Most concerned factors about organ transplantation were as follows：with an available organ for transplantation 〔28.7% （260/906）〕，postoperative quality of life 〔23.0% （208/906）〕，risk of surgery 〔21.5%（195/906）〕，surgery costs 〔19.5% （177/906）〕，and postoperative rejection 〔7.3% （66/906）〕. Most concerned factors about organ donation were as follows：the reasonable usage of donated organs 〔57.4% （520/906）〕，attitude of relatives 〔23.8% （216/906）〕，and donation compensation 〔17.6% （159/906）〕，and others 〔1.2% （11/906）〕. According to the way of organ donation，403 （44.4%） patients were willing to accept donation after cardiac death （DCD），257 （28.4%） patients accept donation after brain death，246 （27.2%） patients accept living organ donation. The gender，education，and occupation had significant influences on the way of organ donation （P＜0.05），but age，knowing organ transplantation，and with organ transplanted relatives or not had no effects on it （P＞0.05）. Conclusions The lack of propaganda and the high costs of transplantation surgery are the main factors restricting the acceptance rate of organ transplantation. Over time，with continuous improvement of universal education and strengthening the publicity of organ transplantation，the acceptance rate will show a constant increase in the trend. By now，the most accepted way of organ donation is DCD in inpatients. The establishment of a reasonable organ allocation and compensation system is a corner stone to promote organ donation.
ObjectiveTo summarize the research progress of surgical technique and immunosuppressive regimen of abdominal wall vascularized composite allograft transplantation in animals and clinical practice. MethodsThe literature on abdominal wall transplantation at home and abroad in recent years was extensively reviewed and analyzed. ResultsThis review includes animal and clinical studies. In animal studies, partial or total full-thickness abdominal wall transplantation models have been successfully established by researchers. Also, the use of thoracolumbar nerves has been described as an important method for functional reconstruction and prevention of long-term muscle atrophy in allogeneic abdominal wall transplantation. In clinical studies, researchers have utilized four revascularization techniques to perform abdominal wall transplantation, which has a high survival rate and a low incidence of complications. ConclusionAbdominal wall allotransplantation is a critical reconstructive option for the difficulty closure of complex abdominal wall defects. Realizing the recanalization of the nerve in transplanted abdominal wall to the recipient is very important for the functional recovery of the allograft. The developments of similar research are beneficial for the progress of abdominal wall allotransplantation.
Objective Chronic graft dysfunction (CGD) has become the major factor that influences the long-term survival of grafts. It is unclear whether the different incidence of CGD has organ specificity. Methods We collected the graft survival rates (GSRs) of solid organ transplantations from the OPTN/SRTR (organ procurement and transplantation network/ scientific registry of transplant recipient). The solid organ transplantations were classified according to the cluster analyses of GSRs during two time periods. We defined the standard of lower survival rate and compared it to the 3-month GSRs (3mGSRs), 1-year GSRs (1y GSRs), 3y GSRs, and 5y GSRs of various solid organ transplantations. Results Deceased donor ECD kidney (DD-ECDK), pancreas transplantation alone (PTA), pancreas after kidney transplantation (PAK), Intestine (In), deceased donor lung (DD-Lu), and heart-lung (H-Lu) were classified into a category which was associated with lower graft survival rates based on the variables of GSRs during the time periods of 1991-1995 and 1996-2000. Compared with those of DD-ECDK, the lowest in the three types of kidney transplantation, the GSRs during the two time periods of the above organ transplantations of lower graft survival were lower [3mGSRs: OR 0.26-0.92, 95%CI (0.20, 0.35)-(0.61,1.39); 1y GSRs : OR 0.30-0.87, 95%CI (0.23,0.37)-(0.78,0.97); 3y GSRs: OR 0.39-0.77, 95%CI (0.30,0.51)-(0.61,0.98); 5y GSRs: OR 0.12-0.87, 95%CI (0.09,0.71)- (0.75,1.0)]. Conclusion The CGD had organ specificity. The grafts of DD-ECDK, PTA, PAK, In, DD-Lu, and H-Lu were identified as the organs with earlier onsets and higher incidence of CGD.
Objective To review the research progress of Toll-like receptors （TLRs） signaling and its effects in organ transplantation. Methods The structural and functional features of TLRs and their ligands were summarized，the literatures in recent years about the research progress of TLRs signaling in animal experiment and clinical organ transplantation were reviewed. Results TRLs played an important role in the organ transplantation，the activation of TLRs could activate the specific immune system，and contribute to ischemic reperfusion injury，acute and chronic allograft rejections，and induce the immune tolerance. Early treatment intervention could reduce the activation of TRLs through ischemic reperfusion injury in the organ transplantation，and improve the allograft survival. The efficient immunosuppressive drugs which aimed at the related immunosuppressive target in immune and its signal transduction pathway could reduce ischemic reperfusion injury in the organ transplantation and immune rejection. Conclusions TRLs signaling plays an important role in ischemic reperfusion injury，immune rejection，and immune regulation.
Objective We investigated the effectiveness of legislation in developed countries by analyzingtheir legislation, and produced ideas and strategies for organ transplantation and brain death legislation in China.Methods Official websites were searched as follows: UNOS, TCE, CLTR, ANZDATA, and SRTR through December6, 2008. We included statistical reports and data analysis of organ donations and transplants, and excluded literatureabout non-solid organs. The absolute transplantation numbers were standardized to per one million people. Results 1.The following data was retrieved: The number of eight kinds of organ transplants and organ donations in Britain, the United States, New Zealand, Spain, France, Italy, Germany, and Australia from 2003 to 2005; the number of deceased donors in the United States and Spain from 1988 to 2007; the total number of organ transplants in Australia from 2002 to 2006; the amount of organ transplants in the United States from 1993 to 2006; liver and kidney transplant totals in the United States from 1988 through March, 2008; liver transplants number of China from 1993 through March, 2008; and the number of kidney transplants in some provinces and cities in China. 2. Transplant totals were greatest in the United States; in Spain, after ONT was founded in 1990, the rate of donation from the deceased was the most in theworld. 3. Spain had the best rate of donation with 34.5 pmp, 10.9 pmp higher than in the United States with separate legislation from 2003 to 2005. There was a rate difference of 0.98 pmp between Germany and the United Kingdomwhich implemented separated legislation nine years earlier. 4. Southern Australia had a maximum rate of average kidneytransplant in the country from 2002 to 2006. 5. Live donor kidney transplants accounted for 31.2~44% compared to4.3% and 4.1% for liver transplants in 2006 and 2007 respectively in the United States. 6. The following have been appliedglobally to regulate organ transplantation and brain death: 1) International or multilateral treaties; 2) Regulation ofNGOs; 3) Self-discipline in the field of organ transplantation; 4) Expert consensus; 5) Establishment of patient’s alliance.Conclusion Countries that have implemented organ transplantation and brain death laws have developed successfulmeasures to improve and support insurance and follow-up information for donors and recipients, however, legislation isstill urgently needed in China. As long as brain death and organ transplant laws are reasonably developed and legislatorsresolve to deal with the difficult issues, then the legislation and its subsequent enforcement will reflect the interests of the people and improve health quality for all.