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Minimizing tacrolimus decreases the risk of new-onset diabetes mellitus after liver transplantation

World Journal of Gastroenterology 2016年第6期22卷 2133-2141页

作者： Jiu-Lin Song Wei Gao Yan Zhong Lu-Nan Yan Jia-Yin Yang Tian-Fu Wen Bo Li Wen-Tao wang Hong Wu Ming-Qing Xu Zhe-Yu Chen Yong-Gang Wei Li Jiang Jian Yang Department of liver Surgery Liver Transplantation CenterWest China Hospital of Sichuan University

AbstractAIM： To investigate the impact of minimum tacrolimus（TAC） on new-onset diabetes mellitus （NODM） afterliver transplantation （LT）.METHODS： We retrospectively analyzed the data of973 liver transplant recipients between March 1999and September 2014 in West China Hospital livertransplantation Center. Following the exclusion ofineligible recipients, 528 recipients with a TAC-dominantregimen were included in our study. We calculatedand determined the mean trough concentration ofTAC （cTAC） in the year of diabetes diagnosis in NODMrecipients or in the last year of the follow-up in non-NODM recipients. A cutoff of mean cTAC value forpredicting NODM 6 mo after LT was identified usinga receptor operating characteristic curve. TAC-relatedcomplications after LT was evaluated by χ^2 test, andthe overall and allograft survival was evaluated usingthe Kaplan-Meier method. Risk factors for NODM afterLT were examined by univariate and multivariate Cox ***： Of the 528 transplant recipients, 131（24.8%） developed NODM after 6 mo after LT, andthe cumulative incidence of NODM progressivelyincreased. The mean cTAC of NODM group recipientswas significantly higher than that of recipients in thenon-NODM group （7.66 ± 3.41 ng/mL vs 4.47 ± 2.22ng/mL, P 〈 0.05）. Furthermore, NODM group recipientshad lower 1-, 5-, 10-year overall survival rates （86.7%,71.3%, and 61.1% vs 94.7%, 86.1%, and 83.7%, P 〈0.05） and allograft survival rates （92.8%, 84.6%, and75.7% vs 96.1%, 91%, and 86.1%, P 〈 0.05） thanthe others. The best cutoff of mean cTAC for predictingNODM was 5.89 ng/mL after 6 mo after LT. Multivariateanalysis showed that old age at the time of LT （〉 50years）, hypertension pre-LT, and high mean cTAC （≥5.89 ng/mL） after 6 mo after LT were independent riskfactors for developing NODM. Concurrently, recipientswith a low cTAC （〈 5.89 ng/mL） were less likely tobecome obese （21.3% vs 30.2%, P 〈 0.05） or todevelop dyslipidemia （27.5% vs 44.8%, P 〈0.05）,chronic kidney dysfunction （14.

关键词： liver transplantation Minimum tacrolimus New-onset diabetes mellitus Immunosuppressants Allografts failure

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Primary sclerosing cholangitis as an independent risk factor for colorectal cancer in the context of inflammatory bowel disease: A review of the literature

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World Journal of Gastroenterology 2014年第27期20卷 8783-8789页

作者： Rosy wang Rupert Leong Gastroenterology and liver services Concord Hospital

To examine and evaluate recent evidence regarding the epidemiology, pathogenesis and management of colorectal cancer(CRC) development in inflammatory bowel disease(IBD)-primary sclerosing cholangitis(PSC) patients. Using the PubMed database, a literature search was conducted for relevant articles in English from the past 10 years. Relevant studies investigating PSC as a risk factor for CRC in IBD in the context of incidence and prevalence, pathogenesis, prevention and prognosis were included in this review. Recent evidence increasingly points to PSC as a significant risk factor in the development of CRC in patients with concomitant IBD. PSC may be an important risk factor for CRC in different populations worldwide. The mechanism for this increase in risk is still unclear. The efficacy of UDCA as a chemopreventive agent remains controversial. liver transplantation does not halt the development of CRC, although there is not enough evidence to suggest that it is associated with increased incidence of CRC. While routine colonoscopic surveillance should be performed in patients with concurrent PSC and IBD, more high-level evidence is required to support the benefits of the procedure. While many new developments have taken place in the last decade, the pathogenesis and optimal management of CRC development in IBD-PSC patients remain unclear.

关键词： Primary sclerosing cholangitis Ulcerative colitis Crohn's Inflammatory bowel disease Colorectal cancer liver transplantation Ursodeoxycholic acid

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Epstein-Barr virus-associated monomorphic post-transplant lymphoproliferative disorder after pediatric kidney transplantation: A case report

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World Journal of Clinical Cases 2021年第2期9卷 469-475页

作者： Zhen wang Yang Xu Jie Zhao Ying-Xin Fu Department of kidney transplantation Tianjin First Central HospitalTianjin 300192China

BACKGROUND Post-transplant lymphoproliferative disease(PTLD)is the most common malignant tumor that occurs after kidney transplantation in children,and is associated with Epstein-Barr virus(EBV).CASE SUMMARY We report a case of PTLD that occurred in a 17-year-old female patient at 5 mo *** first symptom was abdominal pain accompanied by fever,nausea,and ***-associated monomorphic PTLD with multiple abdominal nodules was diagnosed by pathology,clinical manifestations,imaging results,and the presence of *** successful treatment with rituximab,the abdominal nodules in the spleen and liver *** Early pathological biopsy to confirm the diagnosis is critical to treatment and *** immunosuppression and rituximab therapy are effective methods for treating PTLD,but need to be initiated as early as possible.

关键词： Post-transplant lymphoproliferative disorder Epstein-Barr virus kidney transplantation Case report Biopsy Calcineurin inhibitors

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Recurrent hepatitis C after liver transplant

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World Journal of Gastroenterology 2014年第31期20卷 10668-10681页

作者： Andrew S deLemos Paul A Schmeltzer Mark W Russo Department of Medicine Center for Liver Diseases and Transplantation Carolinas Medical Center

End stage liver disease from hepatitis C is the most common indication for liver transplantation in many parts of the world accounting for up to 40% of liver transplants. Antiviral therapy either before or after liver transplantation is challenging due to side effects and lower efficacy in patients with cirrhosis and liver transplant recipients, as well as from drug interactions with immunosuppressants. Factors that may affect recurrent hepatitis C include donor age, immunosuppression, IL28 B genotype, cytomegalovirus infection, and metabolic syndrome. Older donor age has persistently been shown to have the greatest impact on recurrent hepatitis C. After liver transplantation, distinguishing recurrent hepatitis C from acute cellular rejection may be difficult, although the development of molecular markers may help in making the correct diagnosis. The advent of interferon free regimens with direct acting antiviral agents that include NS3/4A protease inhibitors, NS5 B polymerase inhibitors and NS5 A inhibitors holds great promise in improving outcomes for liver transplant candidates and recipients.

关键词： Hepatitis C liver transplant Donor risk factors Immunosuppression Protease inhibitors Fibrosing cholestatic hepatitis C Acute cellular rejection Cytomegalovirus

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Desferrioxamine in warm reperfusion media decreases liver injury aggravated by cold storage

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World Journal of Gastroenterology 2013年第5期19卷 673-681页

作者： Peter G Arthur Xian-wa Niu Wen-Hua Huang Bastiaan DeBoer Ching Tat Lai Enrico Rossi John Joseph Gary P Jeffrey School of Biomedical Biomolecular and Chemical Sciencesthe University of Western AustraliaCrawleyWA 6009Australia School of Medicine and Pharmacology the University of Western AustraliaCrawleyWA 6009Australia Gastroenterology/Hepatology Sir Charles Gairdner HospitalNedlandsWA 6009Australia wa liver and kidney transplantation services QEII Medical CentreHospital AvenueNedlandsWA 6009Australia Division of Anatomical Pathology PathWestQEII Medical CentreHospital AvenueNedlandsWA 6009Australia Department of Biochemistry Path-WestQEII Medical CentreHospital AvenueNedlandsWA6009Australia

AIM:To evaluate whether desferrioxamine decreases ischemia and perfusion injury aggravated by cold storage(CS)in a rat liver perfusion model. METHODS:Isolated rat livers were kept in CS in University of Wisconsin Solution for 20 h at 4℃,then exposed to 25 min of warm ischemia(WI)at 37℃ followed by 2 h of warm perfusion(WP)at 37℃with oxygenated(95%oxygen and 5%carbon dioxide) Krebs-Henseleit ***(DFO),an iron chelator,was added at different stages of storage,ischemia and perfusion:in CS only,in WI only,in WP only, in WI and perfusion,or in all *** samples were collected after CS and after *** samples and bile were collected every 30 min(0,0.5,1,1.5 and 2 h)during liver *** injury was assessed by the determination of lactate dehydrogenase(LDH) and aspartate aminotransferase(AST)in the effluent and perfusate *** iron was analysed in the perfusate *** WP,the liver was collected for the determination of liver swelling(wet to dry ratio) and liver morphological examination(hematoxylin and eosin staining). RESULTS:Increased CS time caused increased liver dysfunction during *** 2 h of WP,liver injury was indicated by increased release of AST(0.5 h CS:9.4± 2.2 U/g liver vs 20 h CS:45.9±10.8 U/g liver,Pliver vs 20 h CS:297 ±71 U/g liver,Pwas an associated increase in iron release into the perfusate(0.5 h CS:0.11 ±0.03μmoL/g liver vs 20 h CS:0.58±0.10μmoL/g liver,Pliver,Pwas added during WI and WP following 20 h of CS,release of iron into the perfusate was de- creased(DFO absent 0.58±0.10μmoL/g liver vs DFO present 0.31±0.06μmoL/g liver,Pliver function substantially improved with decreased release of AST(DFO absent 45.9±10.8 U/g liver vs DFO present 8.1±0.9 U/g liver,Pliver vs DFO present 56±7 U/g liver,P<0.05),and inc

关键词： Iron chelation Ischemia and perfusion injury liver Organ preservation Rat

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Transient elastography(Fibro Scan~?) with controlled attenuation parameter in the assessment of liver steatosis and fibrosis in patients with nonalcoholic fatty liver disease- Where do we stand?

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World Journal of Gastroenterology 2016年第32期22卷 7236-7251页

作者： Ivana Mikolasevic Lidija Orlic Neven Franjic Goran Hauser Davor Stimac Sandra Milic Department of Gastroenterology UHC Rijeka Department of Nephrology Dialysis and Kidney Transplantation UHC Rijeka

Non-alcoholic fatty liver disease(NAFLD) is the most common cause of chronic liver disease worldwide. Currently, the routinely used modalities are unable to adequately determine the levels of steatosis and fibrosis(laboratory tests and ultrasonography) or cannot be applied as a screening procedure(liver biopsy). Among the non-invasive tests, transient elastography(Fibro Scan?, TE) with controlled attenuation parameter(CAP) has demonstrated good accuracy in quantifying the levels of liver steatosis and fibrosis in patients with NAFLD, the factors associated with the diagnosis and NAFLD progression. The method is fast, reliable and reproducible, with good intra- and interobserver levels of agreement, thus allowing for population-wide screening and disease follow-up. The initial inability of the procedure to accurately determine fibrosis and steatosis in obese patients has been addressed with the development of the obese-specific XL probe. TE with CAP is a viable alternative to ultrasonography, both as an initial assessment and during follow-up of patients with NAFLD. Its ability to exclude patients with advanced fibrosis may be used to identify low-risk NAFLD patients in whom liver biopsy is not needed, therefore reducing the risk of complications and the financial costs.

关键词： Non-alcoholic fatty liver disease Transient elastography Controlled attenuation parameter

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From prolonging life to prolonging working life: Tackling unemployment among liver-transplant recipients

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World Journal of Gastroenterology 2016年第14期22卷 3701-3711页

作者： Fredrik Aberg transplantation and liver Surgery Clinic HUCH Meilahti Hospital Helsinki University 00029 HUS Finland

Return to active and productive life is a key goal of modern liver transplantation(LT). Despite marked improvements in quality of life and functional status, a substantial proportion of LT recipients are unable to resume gainful employment. Unemployment forms a threat to physical and psychosocial health, and impairs LT cost-utility through lost productivity. In studies published after year 2000, the average postLT employment rate is 37%, ranging from 22% to 55% by study. Significant heterogeneity exists among studies. Nonetheless, these employment rates are lower than in the general population and kidneytransplant population. Most consistent employment predictors include pre-LT employment status, male gender, functional/health status, and subjective work ability. Work ability is impaired by physical fatigue and depression, but affected also by working conditions and society. Promotion of post-LT employment is hampered by a lack of interventional studies. Prevention of pre-LT disability by effective treatment of(minimal) hepatic encephalopathy, maintaining mobility, and planning work adjustments early in the course of chronic liver disease, as well as timely post-LT physical rehabilitation, continuous encouragement, self-efficacy improvements, and depression management are key elements of successful employment-promoting strategies. Prolonging LT recipients' working life would further strengthen the success of transplantation, and this is likely best achieved through multidisciplinary efforts ideally starting even before LT candidacy.

关键词： Employment Workforce transplantation Quality of life Work ability

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Increasing access to kidney transplantation for sensitized recipient through three-way kidney paired donation with desensitization: The first Indian report

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World Journal of Clinical Cases 2016年第10期4卷 351-355页

作者： Vivek B Kute Himanshu V Patel Pankaj R Shah Pranjal R Modi Veena R Shah Sayyed J Rizvi Bipin C Pal Manisha P Modi Priya S Shah Umesh T Varyani Pavan S wakhare Saiprasad G Shinde Viajay A Ghodela Minaxi H Patel Varsha B Trivedi Hargovind L Trivedi Department of Nephrology and Clinical transplantation Institute of Kidney Diseases and Research CenterDr.HL Trivedi Institute of Transplantation Sciences(IKDRC-ITS) Department of Urology and transplantation IKDRC-ITS Department of Anesthesia IKDRC-ITS Department of Pathology Laboratory MedicineTransfusion Services and ImmunohematologyIKDRC-ITS

The combination of kidney paired donation(KPD) with desensitization represents a promising method of increasing the rate of living donor kidney transplantation(LDKT) in immunologically challenging patients. Patients who are difficult to match and desensitize due to strong donor specific antibody are may be transplanted by a combination of desensitization and KPD protocol with more immunologically favorable donor. We present our experience of combination of desensitization protocol with three-way KPD which contributed to successful LDKT in highly sensitized end stage renal disease patient. All recipients were discharged with normal and stable allograft function at 24 mo follow up. We believe that this is first report from India where three-way KPD exchange was performed with the combination of KPD and desensitization. The combination of desensitization protocol with KPD improves access and outcomes of LDKT.

关键词： kidney failure Chronic Desensitization Immunologic kidney transplantation Blood group incompatibility Living donors Tissue and organ procurement

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Analysis of CD8^+CD28^-T-suppressor cells in living donor liver transplant recipients

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Hepatobiliary & Pancreatic Diseases International 2009年第3期8卷 241-246页

作者： Yi-Xin Lin,Lan-Lan wang,Lu-Nan Yan,Pei Cai,Bo Li,Tian-Fu Wen and Yong Zeng Center of liver transplantation and Department of Surgery,Division of Clinical Immunology and Department of Laboratory Medicine,West China Hospital,Sichuan University,Chengdu610041,China Center of liver transplantation and Department of Surgery West China Hospital Sichuan University Chengdu China.

BACKGROUND:Human CD8 + CD28 - T-suppressor(Ts) cells have been considered to indicate a reduced need for immunosuppression in pediatric liver-intestine transplant recipients and recipients of deceased heart-kidney ***,in adult-to-adult living donor liver transplantation(A-A LDLT)little information is available and the clinical significance is still unknown. METHODS:Flow cytometry was used to detect the population of CD8+CD28 -Ts cells present in peripheral blood in A-A LDLT recipients(n=31),patients with end- stage liver disease(n=24)and healthy controls(n=19). Meanwhile,we tested the graft function and trough levels of immunosuppression in *** clinical and follow- up data of 31 transplant recipients were analyzed. RESULTS:Compared with diseased controls(P=0.007) and healthy individuals(P=0.000),a notable expansion of CD8 + CD28 - Ts cells was found in recipients of A-A *** was associated with graft function,levels of immunosuppression and rejection episodes. CONCLUSIONS:To monitor the CD8 + CD28 - Ts cells levels is important to evaluate the immune state of recipients. Meanwhile,it is also important to promote expansion of CD8+CD28 -Ts cells in recipients of A-A LDLT,not only to sustain good graft function and decrease the dosage of immunosuppressants,but also to reduce the occurrence of rejection.

关键词： T-suppressor cells CD8-positive living donor liver transplantation clinical analysis

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Prophylaxis of chronic kidney disease after liver transplantation-experience from west China

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World Journal of Gastroenterology 2012年第9期18卷 991-998页

作者： Zhen-Yong Shao Lu-Nan Yan Wen-Tao wang Bo Li Tian-Fu Wen Jia-Yin Yang Ming-Qing Xu Ji-Chun Zhao Yong-Gang Wei liver transplantation Center Department of LiverSurgery West China Hospital of Sichuan University Chengdu610041 Sichuan Province China

AIM： TO evaluate the prophylaxis of chronic kidney dis- ease （CKD） after liver transplantation （LT） with low-dose calcineurin inhibitor （CNI） and mycophenolate mofetil （MMF）.

关键词： liver transplantation Chronic kidney dis-ease Calcineurin inhibitor Mycophenolate mofetil Riskfactor

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