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Klebsiella pneumoniae infections after liver transplantation:Drug resistance and distribution of pathogens,risk factors,and influence on outcomes

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World Journal of Hepatology 2024年第4期16卷 612-624页

作者： Long Guo Peng Peng Wei-Ting Peng Jie Zhao Qi-Quan Wan Department of Respiratory and Critical Care Medicine The Third Xiangya Hospital of Central South UniversityChangsha 410013Hunan ProvinceChina Clinical Laboratory Medicine center Zhuzhou Hospital Affiliated to Xiangya School of MedicineCentral South UniversityZhuzhou 421007Hunan ProvinceChina The Second Affiliated Hospital Class Xiangya School of MedicineCentral South UniversityChangsha 410013Hunan ProvinceChina Department of Liver Surgery Renji HospitalShanghai Jiaotong University School of MedicineShanghai 200127China Department of transplant Surgery The Third Xiangya Hospital of Central South UniversityChangsha 410013Hunan ProvinceChina Engineering and Technology Research center for transplantation Medicine of National Health Commission The Third Xiangya Hospital of Central South UniversityChangsha 410013Hunan ProvinceChina

BACKGROUND Liver transplantation(LT)is the only curative treatment for end-stage liver ***,LT recipients are susceptible to infection,which is the leading cause of early mortality after *** pneumoniae infections(KPIs)in the bloodstream are common in LT *** hypothesized that KPIs and carbapenemresistant Klebsiella pneumoniae(CRKP)infections may affect the outcomes of LT *** To assess KPI incidence,timing,distribution,drug resistance,and risk factors following LT and its association with *** This retrospective study included 406 patients undergoing LT at The Third Xiangya Hospital of Central South University,a tertiary hospital,from January 2015 to January *** investigated the risk factors for KPIs and assessed the impact of KPIs and CRKP infections on the prognosis of LT recipients using logistic regression *** KPI incidence was 7.9%(n=32),with lung/thoracic cavity the most frequent site of infection;the median time from LT to KPI onset was 7.5 *** 44 Klebsiella pneumoniae isolates,43(97.7%)and 34(77.3%)were susceptible to polymyxin B or ceftazidime/avibactam and tigecycline,respectively;>70%were resistant to piperacillin/tazobactam,ceftazidime,cefepime,aztreonam,meropenem,and *** sex[odds ratio(OR)=2.827,95%confidence interval(CI):1.256-6.364;P=0.012],pre-LT diabetes(OR=2.794,95%CI:1.070-7.294;P=0.036),day 1 post-LT alanine aminotransferase(ALT)levels≥1500 U/L(OR=3.645,95%CI:1.671-7.950;P=0.001),and post-LT urethral catheter duration over 4 d(OR=2.266,95%CI:1.016-5.054;P=0.046)were risk factors for *** infections,but not KPIs,were risk factors for 6-month all-cause mortality *** KPIs occur frequently and rapidly after *** factors include female sex,pre-LT diabetes,increased post-LT ALT levels,and urethral catheter *** infections,and not KPIs,affect mortality.

关键词： Liver transplantation Klebsiella pneumoniae infections Carbapenem-resistant Klebsiella pneumoniae Risk factors Outcomes

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miR-26a regulates mouse hepatocyte proliferation via directly targeting the 3' untranslated region of CCND2 and CCNE2

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Hepatobiliary & Pancreatic Diseases International 2016年第1期15卷 65-72页

作者： Jian Zhou Wei-Qiang Ju Xiao-Peng Yuan Xiao-Feng Zhu Dong-Ping Wang Xiao-Shun He Organ transplant center the First Affiliated HospitalSun Yat-Sen University

BACKGROUND： The deficiency of liver regeneration needs to be addressed in the fields of liver surgery, split liver transplan- tation and living donor liver transplantation. Researches of microRNAs would broaden our understandings on the mecha- nisms of various diseases. Our previous research confirmed that miR-26a regulated liver regeneration in mice; however, the relationship between miR-26a and its target, directly or in- directly, remains unclear. Therefore, the present study further investigated the mechanism of miR-26a in regulating mouse hepatocyte proliferation. METHODS： An established mouse liver cell line, Nctc-1469, was transfected with Ad5-miR-26a-EGFP, Ad5-anti-miR-26a- EGFP or AdS-EGFP vector. Cell proliferation was assessed by MTS, cell apoptosis and cell cycle by flow cytometry, and gene expression by Western blotting and quantitative real-time PCR. Dual-luciferase reporter assays were used to test targets of miR-26a. RESULTS： Compared with the Ad5-EGFP group, Ad5-anti- miR-26a-EGFP down-regulated miR-26a and increased prolif- eration of hepatocytes, with more cells entering the G1 phase of cell cycle （82.70%＋1.45% vs 75.80%＋_3.92%）, and decreased apoptosis （5.50%＋0.35% vs 6.73%_＋0.42%）. CCND2 and CCNE2 were the direct targeted genes of miR-26a, miR-26a down- regulation up-regulated CCND2 and CCNE2 expressions and down-regulated p53 expression in Nctc-1469 cells. On the con- trary, miR-26a over-expression showed the opposite results. CONCLUSIONS： miR-26a regulated mouse hepatocyte pro- liferation by directly targeting the 3＇ untranslated regions of cyclin D2/cyclin E2; miR-26a also regulated p53-mediated apoptosis. Our data suggested that miR-26a may be a promis- ing regulator in liver regeneration.

关键词： microRNA miR-26a gene expression hepatocyte proliferation regulation

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Altered Allogeneic Immune Responses in Middle-Aged Mice

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Cellular & Molecular Immunology 2004年第6期1卷 440-446页

作者： Alan N.Langnas Department of Surgery University of Nebraska Medical CenterThe Lied Transplant CenterUNMCOmahaNEUSA.

It is well known that leukocyte composition,T cell phenotypes and immune function change in aged mice and ***,limited and conflicting results on the age-related immune changes in middle-aged mice were *** of the characteristics of allogeneic immune responses in aging mice may offer important information for transplantation *** major age-related changes in the immune cell phenotypes and function of 12 months old mice include:1)the significantly decreased CD4^+ cell population in the peripheral blood,the major peripheral CD4^+ cells is CD45RB^(low)CD62L^(low)memory phenotype;2)the in vitro responses to alloantigens and Con A of splenocytes markedly reduced;3)the in vivo secondary humoral immune responses to alloantigens significantly declined;4)the age-related alteration in the thymus mainly occurred in CD4/CD8 double positive(DP)stage;and 5)increased CD80^+ and MHC class II^+ cell population in ***,the major age-related immune changes in 12 months old mice occurred in CD4^+ T cells in the periphery and DP stage in the thymus,which may subsequently lead to the decreased allogeneic immune responses and the different sensitivity to immunosuppressive drugs and *** studies on the characteristics of allogeneic immunity in aging individuals may help to determine the appropriated treatment for transplant aging *** & Molecular Immunology.2004;1(6):440-446.

关键词： allogene middle-aged transplantation

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Robotic surgery in living liver donors and liver recipients

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Laparoscopic, Endoscopic and Robotic Surgery 2024年第3期7卷 123-127页

作者： Konstantin Semash Department of Mini-Invasive Surgery National Children’s Medical CenterTashkent 100171Uzbekistan

There have been nearly 60 years since Thomas Starzl’s first liver *** this period,advancements in medical technology have progressively enabled the adoption of new methods for *** these innovations,robotic surgery has emerged in recent decades and is gradually being integrated into transplant *** hepatectomy and liver implantation represent significant advancements in the field of transplant *** precision and minimally invasive nature of robotic surgery offer substantial benefits for both living donors and *** living donors,robotic hepatectomy reduces postoperative pain,minimizes scarring,and accelerates *** liver recipients,robotic liver implantation enhances surgical accuracy,leading to better graft positioning and vascular *** systems provide more precise and maneuverable control of instruments,allowing surgeons to perform complex procedures with greater accuracy and reduced risk to *** review encompasses publications on minimally invasive donor liver surgery,with a specific focus on robotic liver resection in transplantation,and aims to summarize current knowledge and the development status of robotic surgery in liver transplantation,focusing on liver resection in donors and graft implantation in recipients.

关键词： Liver transplantation Robotic surgery Robotic liver resection Robotic hepatectomy Robotic liver implantation

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Post-transplant lymphoproliferative disorder after liver transplantation: Incidence, long-term survival and impact of serum tacrolimus level

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World Journal of Gastroenterology 2017年第7期23卷 1224-1232页

作者： Ahad Eshraghian Mohammad Hadi Imanieh Seyed Mohsen Dehghani Saman Nikeghbalian Alireza Shamsaeefar Frouzan Barshans Kourosh Kazemi Bita Geramizadeh Seyed Ali Malek-Hosseini transplant Research center Shiraz University of Medical Sciences Gastroenterohepatology Research center Namazi Hospital

To investigate incidence and survival of post-transplant lymphoproliferative disorder (PTLD) patients after liver *** cross-sectional survey was conducted among patients who underwent liver transplantation at Shiraz transplant center (Shiraz, Iran) between August 2004 and March 2015. Clinical and laboratory data of patients were collected using a data gathering *** were 40 cases of PTLD in the pediatric age group and 13 cases in the adult group. The incidence of PTLD was 6.25% in pediatric patients and 1.18% in adult liver transplant recipients. The post-PTLD survival of patients at 6 mo was 75.1% ± 6%, at 1 year was 68.9% ± 6.5% and at 5 years was 39.2% ± 14.2%. Higher serum tacrolimus level was associated with lower post-PTLD survival in pediatric patients (OR = 1.07, 95%CI: 1.006-1.15, P = 0.032). A serum tacrolimus level over 11.1 ng/mL was predictive of post PTLD survival (sensitivity = 90%, specificity = 52%, area under the curve = 0.738, P = 0.035).CONCLUSIONIncidence of PTLD in our liver transplant patients is comparable to other centers. transplant physicians may consider adjustment of tacrolimus dose to maintain its serum level below this cutoff point.

关键词： Post-transplant lymphoproliferative disorder Liver transplantation Survival Tacrolimus Epstein-Barr virus

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Management of refractory ascites in cirrhosis:Are we out of date?

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World Journal of Hepatology 2016年第28期8卷 1182-1193页

作者： Alagappan Annamalai Lauren Wisdom Megan Herada Mazen Nourredin Walid Ayoub Vinay Sundaram Andrew Klein Nicholas Nissen Comprehensive transplant center Cedars Sinai Medical Center

Cirrhosis is a major cause of morbidity and mortality worldwide with liver transplantations as it only possible *** the face of a significant organ shortage many patients die waiting.A major complication of cirrhosis is the development of portal hypertension and *** management of ascites has barely evolved over the last hundred years and includes only a few milestones in our treatment approach,but has overall significantly improved patient morbidity and *** mainstay to ascites management includes changes in diet,diuretics,shunt procedures,and large volume *** understanding of the pathophysiology of cirrhosis and portal hypertension has significantly improved in the last couple of decades but the changes in ascites management have not seemed to mirror this newer *** herein review the history of ascites management and discuss some its current limitations.

关键词： Portal hypertension Cirrhosis Ascites Transhepatic portosystemic shunts Paracentesis

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Analysis of surgical and perioperative complications in seventy-five right hepatectomies for living donor liver transplantation

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World Journal of Gastroenterology 2008年第20期14卷 3159-3164页

作者： Salvatore Gruttadauria James Wallis Marsh Giovan Battista Vizzini Fabrizio di Francesco Angelo Luca Riccardo Volpes Amadeo Marcos Bruno Gridelli Department of Abdominal transplant Surgery Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione Department of Abdominal transplant Surgery University of Pittsburgh Medical Center

AIM: To present an analysis of the surgical and perioperative complications in a series of seventy- five right hepatectomies for living-donation (RHLD) performed in our center. METHODS: From January 2002 to September 2007, we performed 75 RHLD, defined as removal of a portion of the liver corresponding to Couinaud segments 5-8, in order to obtain a graft for adult to adult living-related liver transplantation (ALRLT). Surgical complications were stratified according to the most recent version of the Clavien classification of postoperative surgical complications. The perioperative period was defined as within 90 d of surgery. RESULTS: No living donor mortality was present in this series, no donor operation was aborted and no donors received any blood transfusion. Twenty- three (30.6%) living donors presented one or more episodes of complication in the perioperative period. Seven patients (9.33%) out of 75 developed biliary complications, which were the most common complications in our ***: The need to define, categorize and record complications when healthy individuals, such as living donors, undergo a major surgical procedure, such as a right hepatectomy, reflects the need for prompt and detailed reports of complications arising in this particular category of patient. Perioperative complications and post resection liver regeneration are not influenced by anatomic variations or patient demographic.

关键词： Right hepatectomy Surgery Living-relatedliver transplantation Surgical complications

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Living donor liver hilar variations: surgical approaches and implications

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Hepatobiliary & Pancreatic Diseases International 2011年第5期10卷 474-479页

作者： Onur Yaprak Tolga Demirbas Cihan Duran Murat Dayangac Murat Akyildiz Yaman Tokat Yildiray Yuzer Hepatobiliary and Organ transplant center Florence Nightingale Hospital Istanbul Turkey

BACKGROUND: Varied vascular and biliary anatomies are common in the liver. Living donor hepatectomy requires precise recognition of the hilar anatomy. This study was undertaken to study donor vascular and biliary tract variations, surgical approaches and implications in living liver transplant patients. METHODS: Two hundred living donor liver transplantations were performed at our institution between 2004 and 2009. All donors were evaluated by volumetric computerized tomography (CT), CT angiography and magnetic resonance cholangiography in the preoperative period. Intraoperative ultrasonography and cholangiography were carried out. Arterial, portal and biliary anatomies were classified according to the Michels, Cheng and Huang criteria. RESULTS: Classical hepatic arterial anatomy was observed in 129 (64.5%) of the 200 donors. Fifteen percent of the donors had variation in the portal vein. Normal biliary anatomy was found in 126 (63%) donors, and biliary tract variation in 70% of donors with portal vein variations. In recipients with single duct biliary anastomosis, 16 (14.4%) developed biliary leak, and 9 (8.1%) developed biliary stricture; however more than one biliary anastomosis increased recipient biliary complications. Donor vascular variations did not increase recipient vascular complications. Variant anatomy was not associated with an increase in donor morbidity. CONCLUSIONS: Living donor liver transplantation provides information about variant hilar anatomy. The success of the procedure depends on a careful approach to anatomical variations. When the deceased donor supply is inadequate, living donor transplantation is a life-saving alternative and is safe for the donor and recipient, even if the donor has variant hilar anatomy.

关键词： living donor liver transplantation anatomical variation

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Diagnostic performance of a multiplexed gastrointestinal PCR panel for identifying diarrheal pathogens in children undergoing hematopoietic stem cell transplant

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World Journal of Pediatrics 2024年第9期20卷 966-975页

作者： Yue Tao Cheng-Juan Luo Bing-Hua Zhang Xin-Yan Shen Rui-Ke Zhao Bei-Ying Ma Nan Shen Chang-Ying Luo Jian-Min Wang Yi-Jun Xia Li Xie Jing Chen Xi Mo Pediatric Translational Medicine Institute Shanghai Children’s Medical CenterSchool of MedicineShanghai Jiao Tong University1678 Dongfang Rd.Shanghai200127China Department of Hematology and Oncology Shanghai Children’s Medical CenterSchool of MedicineShanghai Jiao Tong University1678 Dongfang Rd.Shanghai200127China Department of Infectious Diseases Shanghai Children’s Medical CenterSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina Medical Affairs BioMérieux(Shanghai)CompanyLimitedShanghaiChina Clinical Research Institute School of MedicineShanghai Jiao Tong UniversityShanghaiChina

Background Diarrhea is a common complication of hematopoietic stem cell transplantation(HSCT)and is associated with substantial morbidity,but its etiology is often *** of diarrhea in this population include infectious causes,chemotherapy-or medication-induced mucosal injury and graft-versus-host disease(GVHD).Distinguishing these potential causes of diarrhea is challenging since diarrheal symptoms are often multifactorial,and the etiologies often overlap in transplant *** objectives of this study were to evaluate whether the FilmArray gastrointestinal(GI)panel would increase diagnostic yield and the degree to which pre-transplantation colonization predicts post-transplantation *** From November 2019 to February 2021,a total of 158 patients undergoing HSCT were prospectively included in the *** specimens were obtained from all HSCT recipients prior to conditioning therapy,28±7 days after transplantation and at any new episode of *** stool samples were tested by the FilmArray GI panel and other clinical microbiological *** The primary cause of post-transplantation diarrhea was infection(57/84,67.86%),followed by medication(38/84,45.24%)and GVHD(21/84,25.00%).Ninety-five of 158 patients were colonized with at least one gastrointestinal pathogen before conditioning therapy,and the incidence of infectious diarrhea was significantly higher in colonized patients(47/95,49.47%)than in non-colonized patients(10/63,15.87%)(Ptransplantation developed a post-transplantation norovirus ***-four of 62(38.71%)patients colonized with Clostridium difficile developed a diarrheal *** addition,FilmArray GI panel testing improved the diagnostic yield by almost twofold in our study(55/92,59.78%vs.30/92,32.61%).Conclusions Our data show that more than half of pediatric patients who were admitted for HSCT were colonized

关键词： Children Diarrhea Hematopoietic stem cell transplantation Multiplexed polymerase chain reaction

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Radiation injury and gut microbiota-based treatment

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Protein & Cell 2024年第2期15卷 83-97页

作者： Weihong Wang Bota Cui Yongzhan Nie Lijuan Sun Faming Zhang Department of Microbiota Medicine and Medical center for Digestive Diseases The Second Affiliated Hospital of Nanjing Medical UniversityNanjing210011China Department of Microbiotherapy Sir Run Run HospitalNanjing Medical UniversityNanjing 211166China State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research center for Digestive Diseases Xijing Hospital of Digestive DiseasesFourth Military Medical UniversityXi'an 710032China National Clinical Research center for Digestive Diseases Xi'an 710032China Key Laboratory of Resource Biology and Biotechnology in Western China Ministry of EducationSchool of MedicineNorthwest UniversityXi'an 710069China

The exposure to either medical sources or accidental radiation can cause varying degrees of radiation injury(RI).RI is a common disease involving multiple human body parts and organs,yet effective treatments are currently *** evidence suggests gut microbiota are closely associated with the development and prevention of various *** article summarizes 10 common types of RI and their possible *** also highlights the changes and potential microbiota-based treatments for RI,including probiotics,metabolites,and microbiota ***,a 5P-Framework is proposed to provide a comprehensive strategy for managing RI.

关键词： microbiome ionizing radiation radiation-induced injury short-chain fatty acids fecal microbiota transplant washed microbiota transplantation war nuclear microbiota medicine

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