Non-tuberculous mycobacteria (NTM) infection has become a significant public health concern due to its rapid increase in NTM disease. Solid organ transplant (SOT) recipients, as the immunocompromised hosts, are at significantly increased risk of infection by various pathogens, including NTM infections. NTM infections can cause damage to tissues and organs, resulting in NTM disease. This disease can affect multiple tissues and organs throughout the body. In lung transplant recipients, especially those who have undergone single-lung transplantation, or those who have pre-existing structure damaged lung disease, often are facing increased risk of developing NTM lung disease. Being familiar with the epidemiological characteristics of NTM disease and the characteristics of different kinds of NTM diseases in SOT recipients, and mastering the diagnostic and therapeutic techniques for this disease contributes to improving patient prognosis. This expert commentary refers to the latest version of the Guidelines for the Treatment of Non-Tuberculous Mycobacterial Disease issued by the American Thoracic Society and the European Respiratory Society, China′s Expert Consensus on the Diagnosis and Treatment of Non-Tuberculous Mycobacterial Disease, and the Diagnostic and Treatment Criteria for Non-Tuberculous Mycobacterial Disease in Organ Transplant Recipients, providing a brief description of the incidence of NTM disease in SOT recipients, the clinical characteristics of common NTM disease, novel diagnostic techniques, and different anti-infective therapeutic strategies, tailored to the characteristics of the population of SOT recipients to provide clinical references.
With the continuous progress of renal transplantation technology, the survival rate of patients with end-stage renal disease has been increasing, and at the same time, it has brought about many changes and challenges. The past year has opened a whole new chapter in organ transplantation worldwide. This article summarizes the major advances in allogeneic kidney transplantation, expanding donor sources and surgery, graft rejection, immunologic tolerance, and the progress and significance of regenerative medicine in 2023.
Organ donation and transplantation is related to people′s health and livelihood, and the political image of the country. Therefore, under the premise of national policy leadership and operational guidance, the administrative authorities formulate relevant policies to promote the work of organ donation, which plays a decisive role in standardizing the implementation and healthy development. At the same time, the clinical work of organ donation and transplantation begins with the identification of potential donors, and the level of the identification rate of potential donors determines the total scale of local organ donation. At the same time, the clinical work of organ donation and transplantation begins with the identification of potential donors. The identification and referral of potential donors requires the active participation of medical staff of ICU, neurology, neurosurgery, emergency department and other relevant departments, and to further increase the contact between organ procurement organization (OPO) and various medical institutions, and to explore the possibility of building a localized regional organ donation network. It has further strengthened the connection between OPO and various medical institutions, explored the construction of local organ donation network, and played an active and effective role in promoting the local organ donation rate. Organ donation coordinators′ professional knowledge and communication skills have an important impact on the support of medical staff and the attitude of family members towards organ donation. In this paper, we discuss how to strengthen the institutional construction of OPO under the policy support of the government and the higher authorities, to build a perfect organ donation system in conjunction with local medical institutions, to improve the implementation process of organ donation, and to strengthen the clinical ability and effective communication ability of organ donation coordinators, so as to form a good situation of cooperation among multiple parties, multi-measures, up-and-down linkage, and multidisciplinary integration, in order to promote the local organ donation rate and improve the local organ donation rate, improve the conversion rate of organ donation, the average organ output rate, and the utilization rate of acquired organs, thereby improving the quality of acquired organs and the postoperative results of organ transplantation.
This study aimed to analyze the mycophenolic acid (MPA) blood concentration in patients during the perioperative period after kidney transplantation and to observe the adverse reactions to MPA to promote rational clinical medication.
Methods
The clinical data of perioperative recipients after kidney transplantation at the First Affiliated Hospital of Zhejiang University School of Medicine from October 1 to November 31, 2022 were retrospectively analyzed. MPA- concentration of 0 h (C0) were monitored in fifty-two recipients beginning on the second day after the operation. The MPA-area under curve (AUC) was monitored for 29 recipients on the fourth day after the operation. Patient information about age, sex, MPA-C0, MPA-AUC, white blood cell levels, incidence of diarrhea and rejection was collected through the hospital information system. Independent sample t-test was used for comparisons between two groups, and P<0.05 indicated a statistically significant difference.
Results
The average MPA-C0 in 52 kidney transplant recipients was (4.1±2.3) mg/L, with 24 (46.15%) ranging from 1.0 to 3.5 mg/L and 28 (53.85%) exceeding 3.5 mg/L. The average MPA-AUC of 29 recipients was (54±23) mg·h-1·L-1, including 14 patients (48.28%) receiving 30-60 mg·h-1·L-1, 5 patients (17.24%) receiving less than 30 mg·h-1·L-1, and 10 patients (34.48%) receiving more than 60 mg·h-1·L-1. The MPA-AUC of female recipients (n=9) was higher than that of male recipients (n=20), with values of (68±16) and (48±23) mg·h-1·L-1, respectively (t=-2.31, P<0.05). Among the 29 recipients for whom the MPA-AUC was monitored, 19 used mycophenolate mofetil (MMF), and 10 used enteric-coated mycophenolate sodium (EC-MPS). The AUC of MMF and EC-MPS were (53±26) and (57±15) mg·h-1·L-1, respectively, with no statistically significant difference (t=0.46, P >0.05). None of the recipients experienced any rejection reactions during the perioperative period. One (1.92%) of the recipients experienced granulocytopenia on the 21st day after kidney transplantation. Six (11.54%) of the recipients experienced diarrhea, and symptoms improved after reducing the dosage of MPA and symptomatic treatment with montmorillonite powder.
Conclusions
There was a significant difference in MPA exposure levels among recipients during the perioperative period after kidney transplantation, with nearly half of the recipients not meeting the guidelines. The incidence of adverse reactions to MPA was relatively low, and higher exposure to MPA was not related to adverse reactions in recipients.
To analyze the reconstitution of lymphocyte subset at various time points before and after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children with severe β-thalassemia.
Methods
Twenty-two children with severe β-thalassemia who completed allo-HSCT from December 2021 to August 2023 in Maoming People′s Hospital were selected as the study objects. The changesof lymphocyte subsets, including CD3+ T cell ratio, CD4+ T cell ratio, CD8+ T cell ratio, CD19+ B cell ratio, NK cell ratio and CD4+ /CD8+ ratio, were dynamically monitored before and 10, 30 and 60 days after allo-HSCT in all children. To compare the changes of lymphocyte subsets at each time point between HLA complete and incomplete match children and children of different genders. On the day of donor peripheral blood stem cell reinfusion, lymphocyte subsets of related donors were also measured to analyze the correlation between donor immunity and the occurrence of postoperative acute graft-versus-host disease (aGVHD) in children. Measurement data were expressed as mean±standard deviation (±s) and compared using group t-test or repeated measures analysis of variance; enumeration data were expressed as frequency and compared using Fisher′s exact test. P<0.05 was considered statistically significant.
Results
The success rate of allo-HSCT was 100% in 22 cases, all of which were separated from blood transfusion, including 15 cases of HLA complete match and 7 cases of HLA incomplete matched. There was no significant difference in gender composition, age and three-lineage implantation time between the two groups. The proportion of NK cells exceeded the preoperative level at 10 d and 30 d after allo-HSCT (P<0.05), and decreased to the preoperative level at 60 d after allo-HSCT (P>0.05). The proportion of CD19+ B cells decreased transiently at 30 d after operation and rose to a higher level than 30 d at 60 d after allo-HSCT, but it was still lower than the preoperative level (all P<0.05). The proportion of CD3+ T cells and CD8+ T cells showed a transient decrease at 10 d after allo-HSCT (all P<0.05), and recovered to the preoperative level at 30 d and 60 d after allo-HSCT (all P>0.05). The proportion of CD4+ T cells was lower than the preoperative level at all time points after allo-HSCT, but there was no significant difference between 60 d after allo-HSCT and preoperative level (P>0.05). The CD4+ /CD8+ ratio at each time point after surgery was lower than the preoperative level, but the differences were not statistically significant (P>0.05). There was no statistically significant difference in the changes of lymphocyte subsets between HLA complete and incomplete match children as well as children of different genders at each time points before and after allo-HSCT (P>0.05). There was no significant association in the proportion of lymphocyte subsets between related donors of children who developed and those who did not develop aGVHD (P>0.05).
Conclusions
Lymphocyte subsets fluctuate after allo-HSCT in children with β-thalassemia major, and there is no difference in lymphocyte subsets between HLA complete and incomplete match and between genders; the level of lymphocyte subsets in related donors is not associated with aGVHD in children.
A survey was conducted on the social support, parenting stress, anxiety, physical and mental health, and sleep quality of the fathers or mothers of children undergoing liver transplantation before the operation, and a correlation analysis was conducted.
Methods
A total of 355 fathers or mothers of children who were scheduled to undergo living liver transplantation at the Renji Hospital, Shanghai Jiao Tong University School of Medicine were selected as the research subjects. A general information questionnaire, the social support rating scale (SSRS), the parenting stress index-short form (PSI-SF), the Pittsburgh sleep quality index (PSQI) scale, the generalized anxiety disorder-7 (GAD-7) scale, and the World Health Organization five-item well-being index (WHO-5) were used for questionnaire survey and analysis. Pearson correlation analysis was used for correlation test, and Kruskal-Wallis rank sum test was used to analyze the factors affecting the sleep quality of parents with different characteristics of their children. P<0.05 was considered statistically significant.
Results
The average SSRS score of 355 children who needed liver transplantation was (43.9±9.0). The average PSI-SF score was (81.2±27.5), the average GAD-7 score was (7.8±5.3), the average WHO-5 score was (12.4±6.5), and the median PSQI score was 7.0 (4.0, 11.0). The difference in PSQI scores between parents of children with different sleep durations was statistically significant (Z=4.759, P<0.05). Children with a clear to sleep late and wake up late had the highest PSQI score, while those with a clear early to bed and wake up early had the lowest score, with scores of 10.0 (5.0, 13.5) and 4.0 (1.0, 6.5), respectively. The difference in PSQI scores between parents of children with different marital statuses was statistically significant (Z=2.732, P<0.05), with the highest being widowhood and the second being unmarried. The sleep quality of the father or mother of the patient was positively correlated with anxiety (r=0.541) and negatively correlated with physical and mental health (r=-0.584). Anxiety was negatively correlated with physical and mental health (r=-0.584), while parental stress was negatively correlated with social support (r=-0.380).
Conclusions
Most parents of children who plan to undergo liver transplantation have sleep disorders, mild depression and anxiety, high parental pressure, and low social support. Overall, effective measures should be taken to improve poor physical and mental health to provide effective and long-term support for subsequent pediatric liver transplantation.
Lung transplantation has improved the quality of life and prognosis of patients with various end-stage lung illnesses as an efficient therapy. Severe ischemia-reperfusion injury (IRI) in the donor lung might result in primary graft dysfunction, lowering the overall survival probability following transplant.The mechanism behind the incidence of IRI is currently unknown. As a result, it is critical for the success of lung transplantation to investigate the mechanism of IRI and develop innovative methods of IRI therapy and management. A number of research on treatment IRI have been conducted as a strategy for conserving, assessing, and healing marginal lung grafts. This study outlines the main IRI processes and several IRI treatment techniques during ex vivo lung perfusion (EVLP), with the goal of providing a foundation for precise targeted and tailored therapy of lung IRI during EVLP.
With the gradual maturity of kidney transplantation technology, the concept of enhanced recovery after surgery (ERAS) has attracted much attention in kidney transplantation surgery. In order to further improve perioperative management of kidney transplantation, this paper quotes the research results of some scholars to review the application progress of ERAS concept in perioperative period of kidney transplantation from the three stages of preoperative, intraoperative and postoperative, so as to provide reference for its application and promotion.
Human leukocyte antigen (HLA) antibodies have been the focus in the prevention and treatment of antibody-mediated rejection (AMR) in organ transplantation. However, evidence from the clinic and basic studies has shown that non-HLA antibodies are associated with AMR or AMR like histologic lesions. There have been many methods to test non-HLA antibodies. Reliable and sensitive testing methods can help promote the application of non-HLA antibody detection in organ transplantation and improve clinical outcomes. This article review the research progress on testing methods of non-HLA antibodies.
±s) and compared using group t-test or repeated measures analysis of variance; enumeration data were expressed as frequency and compared using Fisher′s exact test. P<0.05 was considered statistically significant.