近40年来，胰腺移植在基础和临床研究方面都获得了令人振奋的长足进步。据国际胰腺移植登记中心（IPTR）记录，全球已实施了18 900余例胰腺移植（截至2002年10月），其中绝大多数在美国（近14 000例），约90%为胰肾联合移植（SPK）。迄今为止，SPK被公认是治疗糖尿病合并肾功能衰竭的最有效的方法。据报道，胰腺移植受体1年生存率超过95%，3年生存率接近90%； 移植胰腺有功能（患者不依赖胰岛素）者的1年和3年生存率分别为83%和77%。
目的总结胰肾联合移植术后感染的特点，并对其预防及治疗进行讨论。方法对我院施行的2例胰肾联合移植术后感染的临床资料结合有关文献进行讨论。结果1例术后发生7次感染，其中2次为肺部感染，4次为泌尿系感染，1次为巨细胞病毒感染，移植之胰肾有功能存活3年余； 另1例发生呼吸系统及泌尿系统感染各1次，术后早期恢复尚可，3周发生急性肾排斥，7周死于混合菌感染败血症。结论胰肾联合移植围手术期感染根据其临床特点，正确的围手术期处理非常重要。
Abstract： Objective To investigate the protective effects of adenosine (ADO) on lung ischemia/reperfusion injury following heart-lung transplantation in canine. Methods Canine heart-lung transplantation was performed．Canines were divided into two groups: transplant control groupand ADO group. The changes of arterial partial pressure of oxygen(PaO2) after reperfusion in two groups at 30，60，90，120 min were observed．The tissue contents of nitric oxide (NO) were measured at 10 min before ischemia, 10 min and 120 min after ischemia; 10 min and 60 min after reperfusion．The lung tissue samples were obtained 1h after reperfusion．The tissue myeloperoxidase(MPO) activity,content of malondialdehyde(MDA), content of superoxide dismutase(SOD), wet/dry ratio of lung(W/D) were measured.Microscopic examination of lungs was also conducted. Results (1)In ADO group，PaO2 were significantly higher than that in control group at 30，60，90 and 120 min after reperfusion (Plt;0.05)．(2) The tissue contents of NO at 120 min after ischemia, 10 min and 60 min after reperfusion were significantly lower than that at 10 min before ischemia(Plt;0.05). In ADO group，the tissue contents of NO at 120 min after ischemia, 10 min and 60 min after reperfusion were higher than that in control group respectively(Plt;0.05). (3)The tissue MPO activity, content of MDA, W/D in ADO group were significantly lower than those in corresponding control group. The content of SOD in ADO group were higher than that in control group(Plt;0. 05)．(4)The microscopic examination showed that there were severe leukocyte infiltration and edema formation in the alveolar space in control group, but the changes were less severe in ADO group. Conclusion Administration of ADO in canine heart-lung transplantation can protect the donor lung against ischemia／reperfusion injury．
Objective To investigate the effects of allogenic transplantation of acellular muscle bioscaffolds (AMBS) seeded with bone marrow mesenchymal stem cells (BMSCs) on the repair of acute hemi-transection spinal cord injury (SCI) in rats. Methods AMBS were prepared by reformed chemical approach and sterilized by compound cold sterilization; BMSCs were harvested by density gradient centrifugation and cultured with adherent method. The 3rd generation BMSCs labeled by Hoechst 33342 were injected into AMBS to construct the BMSCs-AMBS composite scaffolds; the biocompatibility was observed under scanning electron microscope (SEM) and fluorescence microscope in vitro at 14 days. Forty-eight adult female Sprague Dawley rats were used to build SCI model by hemi-transecting at T9-11 level, then randomly divided into 4 groups (n=12). Defects were repaired with BMSCs-AMBS composite scaffolds, BMSCs, and AMBS in groups A, B, and C, respectively; group D was blank control by injecting PBS. At 1, 2, 3, and 4 weeks after surgery, the functional recovery of the hind limbs was evaluated by the Basso-Beattie-Bresnahan (BBB) locomotor rating score. At 4 weeks after surgery, HE staining and immunofluorescent assay were adopted. Results Masson staining and HE staining showed that AMBS was mainly of the collagen fibers in parallel arrange, without muscle fibers. After 14 days of BMSCs and AMBS co-culture, a large number of survival BMSCs labeled by Hoechst 33342 were seen under fluorescence microscope; SEM showed that BMSCs grew and attached to the inner surfaces of AMBS. At 2-4 weeks, the BBB score in group A was significantly higher than that in groups B, C, and D (P lt; 0.05), and it was significantly lower in group D than in the other 3 groups (P lt; 0.05); at 4 weeks, the BBB score in group B was significantly higher than that in group C (t=10.352, P=0.000). HE staining revealed that the area of spinal cord cavity after SCI was markedly smaller in group A than in the other 3 groups; immunofluorescent assay showed that more neurofilament 200 positive fibers and Nestin positive cells were detected in group A than in groups B, C, and D, but glial fibrillary acidic protein (GFAP) positive cells significantly decreased. The integral absorbance (IA) values of GFAP were 733.01 ± 202.04, 926.42 ± 59.46, 1 069.37 ± 33.42, and 1 469.46 ± 160.53 in groups A, B, C, and D, respectively; the IA value of group A was significantly lower than that of groups B, C, and D (P lt; 0.05), and it was significantly higher in group D than in groups A, B, and C (P lt; 0.05). Conclusion With relatively regular internal structures and good biocompatibility, AMBS can inhibit glial scar and enhance the survival, migration, and differentiation of BMSCs, so AMBS is the ideal nature vector for cell transplantation. Co-transplantation of AMBS and BMSCs has synergistic effect in treating SCI, it can promote rat motor function recovery.
Objective To find out the beneficial and harmful effectiveness of tacrolimus (TAC) compared with cyclosporine A (CSA) for simultaneous pancreas-kidney transplant (SPKT) recipients. Methods Randomized controlled trials (RCTs) of TAC versus CSA for SPKT recipients were collected from The Cochrane Library, MEDLINE, EMbase, SCI, and CBM database. Bias risk assessment and meta-analysis were performed based on the methods recommended by the Cochrane Collaboration. Results Five RCTs including 342 recipients were included. Pooled data of pancreas survival favored TAC (RR=1.15, 95%CI 1.04 to 1.27; RD=0.11, 95%CI 0.03 to 0.19). However, there were no significant differences of acute rejection (RR=0.81, 95%CI 0.58 to 1.12), patient survival (RR=1.00, 95%CI 0.94 to 1.05), kidney survival (RR=1.02, 95%CI 0.95 to 1.09), and infection (RR=1.00, 95%CI 0.83 to 1.20). Conclusion Based on the recent evidence, TAC results in higher episodes of pancreas survival compared with CSA after SPKT. Treating 100 patients with TAC instead of CSA would increase pancreas survival in 11 recipients.
Objective To evaluate the impact of portal or systemic venous pancreas graft drainage on patient and graft outcomes following simultaneous pancreas kidney transplantation (SPK). Methods We searched The Cochrane Library (2008, Issue 1), PubMed (1970 to Feb 2008) and EMBASE (1974 to Feb 2008) to find studies concerning the effect of systemic versus portal venous pancreas graft drainage on patient and graft outcomes. Meta-analyses were conducted using The Cochrane Collaboration’s RevMan 4.2 software. Results Three RCTs involving 401 simultaneous pancreas kidney transplants were included in our meta-analysis. Statistically significant differences were only observed in 3- and 5-year pancreas graft survival rates (P=0.03 and P=0.05). No significant difference was noted in patient or kidney graft survival rates. Conclusion Currently available evidences from RCTs does not support the effectiveness of portal drainage in preventing thrombosis, rejection or infection after SPK. Large-scale, long-term and appropriately designed RCTs are required to conclude whether portal and systemic drainage in pancreas transplantation are equivalent in terms of patient and graft survival.
目的：总结护理干预在预防胰肾联合移植术后感染中的作用。方法：分析我科2007年3月实施的1例胰肾联合移植病例围手术期护理资料。结果：患者术后恢复顺利，未发生呼吸道、泌尿道、腹腔、切口、深静脉插管等处感染。结论:积极、有效的护理干预能预防和降低术后感染的发生。
【Abstract】Objective To investigate the potential role of tumor necrosis factoralpha (TNFα) in apoptosis after combined liver and kidney transplantation in rats. MethodsEighty rats which had combined liver and kidney transplantation were randomly paired, were divided into study group (n=20) and control group (n=20). 40 ml of 4 ℃ sodium chloride and antiTNFα monoclonal antibody (30 ml was infused from portal veins to donated livers and 10 ml from renal arteries to donated kidneys) were infused to the study group (0.1 mg/kg weight),and the same quantity of 4 ℃ sodium chloride was infused the control group. Venous blood was drew at different phases after the transplantations to detect the function of kidney and liver. The level of TNFα and the cell apoptosis were detected in the transplanted tissues of liver and kidney by ELISA and terminal deoxynucleotidy transferase mediated dTUPbiotin nickend labeling (TUNEL). ResultsThe levels of AST, ACT, Cr and BUN in the study group were significantly lower than those of the control group at the same phases (P＜0.05). The level of TNFα in the transplanted tissues of kidney and liver was also significantly lower as compared with those of control group. The cell apoptosis index of the transplanted tissues of kidney and liver was significantly smaller in the study group （P＜0.05）. There was no dramatically pathological change in the tissues of transplanted kidney and liver, which were treated with antiTNFα monoclonal antibody, and the structures are almost normal. ConclusionAntiTNFα monoclonal antibody may reduce cell apoptosis and accelerate the restoration of function of liver and kidney after combined liver and kidney transplantation.
目的探讨肝肾联合移植的手术技术及临床治疗经验。方法对1例原发性弥漫性肝癌、肝硬变合并肾病综合征、慢性肾功能衰竭患者施行一期肝肾联合移植术，肝移植采用改良背驮式肝移植技术，肾移植采用常规方法。术前、术后行全身辅助性化疗。结果移植肝肾发挥功能，无手术并发症发生，术后3个月无肿瘤复发征象及远处转移，AFP下降到25 μg/L以下。结论对常规手术无法切除且无远处转移的肝癌合并肾功能衰竭者行肝肾联合移植，可以取得较好的临床治疗效果。