The experience on management of abnormal blood vessels in 128 cases of donor kidney during the tailoring operation was reported. The various techniques used for different types of abnormal arteries and veins, and the critical points which should be paid attention to have been discussed. It was concluded that the multiple renal arteries should be treated in a single renal artery and anastomosed with internal iliac artery or/and external iliac artery. The appropriate management given to abnormal renal blood vessels during the tailoring operation may shorten the warm ishemia time, ensure the renal blood supply, reduce the renal vasular complication, and promote the recovery of renal function.
Objective To explore the cl inical appl ication of rib autograft for reconstructing il iac crest by anterior approach of thoracic and lumbar vertebrae, and to observe the short-term and long-term effects. Methods From September 2004 to September 2007, 54 cases of thoracic and lumbar injuries were treated by the surgery of anterior approach of thoracic and lumbar vertebrae.There were 39 males and 15 females with an average age of 42 years old (range, 27-59 years old), including 4 cases of tuberculosis of spine and 50 cases of thoracic and lumbar vertebrae bursting fracture. All cases underwent the surgery of anterior approach of thoracic or lumbar and il iac crest was used as autograft. Fifty-four patients wererandomized into the reconstruction group (RG, n=25) and the non-reconstruction group (NRG, n=29). The patients of RGgroup were treated with rib autograft for reconstructing il iac crest. There were no statistically significant differences in general data between two groups (P gt; 0.05). The visual analogue scores (VAS) was used to estimate pain degree of treated hip after 2 weeks, and 3, 12 months. The extenion satisfaction grade of il iac crest and the comfort degree of action while bundl ing waist belt were estimated after 12 months. It was observed whether or not anterior superior il iac spine avulsion fracture occurred on the premise of non-accidental trauma within 1 year. The occurrence of fracture and the union status of reconstructed il iac crest were observed by X-ray after 1 year. Results All wounds achieved primary heal ing. No compl ication was found at early stage. All patients were followed up 1 year. There was no significant difference in the VAS of the treated hip under conditions of cl inostatism rest between two groups after 2 weeks and 3 months (P gt; 0.05). But there was significant difference in the VAS under conditions of action after 2 weeks and 3 months, under conditions of cl inostatism rest after 12 months (P lt; 0.05), and the VAS of RG was lower than that of NRG. The exterior satisfaction grade of il iac crest and comfort degree of action while bundl ing waist belt in RG were higher than those in NRG after 1 year, showing significant differences (P lt; 0.05). No anterior superior il iac spine avulsion fracture occurred after 1 year. And in RG group no fracture of reconstructed il iac crest occurred after 1 year. The X-ray film showed that the two ends of rib reconstructed by il iac crest were blur, and that the rib healed well with il iac bone. Conclusion Rib autograft for reconstruction of il iac crest by anterior approach of thoracic and lumbar vertebrae was economic and convenient. It could improve local appearance, reduce the local pain, and improve patients’ l ife quality.
【Abstract】Objective To investigate the effect of donor blood transfusion on inducing pancreatic allograft tolerance in outbred rat model. Methods Wistar male rats were used as blood and pancreas donor, and diabetic recipients. One ml of donor blood injected into abdomen of diabetic recipients on the day of transplantation and azathioprine given 2 days pretransplant and continued for three days. Results Pancreas allograft survival was significantly prolonged (28 to 112 days, media survival time 64.2 days). One ml of donor blood alone injected into the abdomen and azathioprine given alone 2 days pretransplant did not improve allograft survival (media survival time 9.8 vs 10.2 days). Conclusion Donor blood injected on the day of transplantation and a 3 days course of azathioprine started 2 days pretransplant have b synergism in inducing long term graft survival in this rat model.
Objective To discuss venous drainage types of median hepatic lobe and their guiding significances on the selection of grafts. Methods Between April 2005 and March 2009, 109 potential living donors underwent 3-dimensional reconstruction of computed tomography (CT) and the volume of graft was determined in the center of organ transplantation of Ruijin Hospital. The venous drainage types of median hepatic lobe of each donor were analyzed by the computer-based liver operation-planning system in detail to assign middle hepatic vein (MHV) types according to Marcos classification and venous types of Ⅳb segment according to Nakamura classification. Results The branching pattern of MHV was divided into 3 types: Type Ⅰ and Ⅱwere relatively more accounting for 44.0% （48/109）, 37.6% （41/109）, and type Ⅲ was fewest 〔18.3% （20/109）〕. There were no significant differences in volume of whole liver, volume of left liver or left liver/total liver volume ratio among various types of MHV of the donor (Pgt;0.05). Ⅳb vein was also divided into 3 types: The most common was type Ⅰ, accounting for 72.4% (79/109); Type Ⅱ 〔12.8% （14/109）〕, type Ⅲ 〔14.7% （16/109）〕 were relatively fewer. At last, 37 donors provided right liver, for Marcos Ⅰ, Ⅱ, and Ⅲ type of donors, donors remained with MHV was 12/17, 8/11, and 5/9; for Nakamura Ⅰ, Ⅱ, and Ⅲ type of donors, those number were 16/26, 4/6, and 5/5. Conclusion In adult-to-adult living donor liver transplantation, there may be great significances in accordance with Marcos and Nakamura typing results to harvest right lobe liver graft with or without MHV.
Objective To investigate the protective effects of cardioplegic solution with creatine phosphate on donor heart preservation in rats, and the possibility of prolonging outofbody heart preservation in lack of blood supply to improve on transplantation quality. Methods Twenty Wistar rats were randomly divided into two groups, control group (n=10): pure St.ThomasⅡ cardioplegic solution was perfused to protect donor hearts; experimental group (n=10): St.ThomasⅡ cardioplegic solution with 2.5g/L sodium creatine phosphate was perfused to protect donor hearts. After 4 hours of refrigerated preservation, myocardial tissues were tested for adenosinetriphosphate(ATP) level and super oxide dismutase (SOD) activity. Cardiac ultrastructure and mitochondria swelling condition were monitored with light and electron microscopes. Results After the 4hour low temperature preservation of donor hearts, ATP content in experimental group cardiac tissue was significantly higher than that in control group (2.75±0.99μmol/mg vs. 1.77±0.86μmol/mg, Plt;0.05); SOD in experimental group cardiac tissue was significantly higher than that in control group（49.6±2.52 U/mg vs. 45.27±2.21 U/mg，Plt;0.05）. Electron microscopic inspection demonstrates that in the control group, chromatin condensed and dissolved inside the nuclear membrane; mitochondria ridge gap disappeared; myocardial cell pyknosis and mesenchymal vascular endothelia necrosis appeared. In contrast, myocardial cell nuclei remained in the center; sarcomere band structure was distinct; sarcoplasmic reticulum expanded and intercalated disk band structure was clear in experimental group. Conclusion Cardioplegic solution with creatine phosphate is able to enhance donor heart myocardial protection significantly.
ObjectiveTo evaluate donor safety in living donor liver transplantation. MethodsThe clinical data of 356 donors underwent living liver donation in our center from January 2001 to September 2015 were retrospectively analyzed. These patients were divided into pre-2008 group(before January 2008) and post-2008 group(after January 2008). The donor safety was evaluated with regard to three aspects, i.e. complications, liver function, and quality of life. Results①There was no donor death in our center.②The overall complications rate was 23.3%(83/356). The proportion of ClavienⅠ, Ⅱ, Ⅲ, andⅣcomplications was 50.6%(42/83), 26.5%(22/83), 21.7%(18/83), and 1.2%(1/83), respectively. In all the donors, the incidence of ClavienⅠ, Ⅱ, Ⅲ, andⅣcomplications was 11.8%(42/356), 6.2%(22/356), 5.1%(18/356), and 0.3%(1/356), respectively. The overall complications rate in the post-2008 group was significantly lower than that in the pre-2008 group〔18.1%(41/227) versus 32.6%(42/129), P < 0.01〕. The most common complication was the biliary complication with an incidence of 8.4%(30/356).③The postoperative liver dysfunction was transient and generally retur-ned to normal level within a week.④The donor's quality of life was generally satisfied as assessed by the SF-36 tool, and 94.8%(239/252) of them would donate again if necessary. ConclusionEver improving surgical and anesthetic techniques, together with strict donor selection and specialized perioperative management, could guarantee a low donor morbidity and a satisfactory long-term prognosis.
ObjectiveTo discuss the effectiveness of free croin flap in repairing defects of donor after toe or feet tissue flap transplantation. MethodsBetween March 2010 and May 2015, 23 cases of defects of donor after toe or feet tissue flap transplantation were repaired with free croin flap and followed up for more than 6 months, and the clinical data were retrospectively analyzed. There were 15 males and 8 females, with an age range from 17 to 52 years (mean, 25.6 years). All finger or soft tissue defects were caused by trauma. Defects were repaired in emergency operation with toe or feet tissue flap transplantation in 18 cases, defects were secondarily reconstructed at 3-8 months after injury in 5 cases. The defect area at the feet donor site ranged from 3 cm×3 cm to 10 cm×6 cm, all accompanied with exposure of bone, and tendon. The area of free croin flap was 3.5 cm×3.5 cm-11.0 cm×6.5 cm, the vessel of flap was anastomosed with artery and vein of foot. The inguinal donor site was sutured directly. ResultsThe operation time was 3-9 hours (mean, 4.5 hours); the intraoperative blood loss was 50-300 mL (mean, 120 mL). Vessel crisis occurred in 1 case postoperatively; mild and moderate swelling occurred in 3 cases, with small sporadic blisters formation; free croin flap survived completely in the other cases, and primary healing was obtained at feet wound and inguinal donor sites. Twenty-three cases were followed up 6-24 months (mean, 9 months). The color and texture of the croin flaps were similar to that of the adjacent skin, no obvious scar contracture and pigmentation were observed; the patient could walk with weight loading, the two-point discrimination was 18-35 mm (mean, 26 mm) at 6 months after operation. The color, texture, and shape of reconstructed finger was good; the function of grasping and pinching recovered well; the two-point discrimination was 5.5-11.0 mm (mean, 6.5 mm) at 6 months after operation. According to upper extremity functional evaluation standard by Chinese Medical Association, the results were excellent in 18 cases and good in 5 cases. ConclusionFree croin flap can effectively repair skin and soft tissue defects of donor after toe or feet tissue flap transplantation, and good function and appearance of feet can be obtained.
【Abstract】Objective To explore the feasibility that the recipient against donor antigen-specific T lymphocytes clones are formed,and the suicide genes are induced into the clone. In the end it may induce the transplanted-organ tolerance. Methods The recipient rats were immunized by the donor rats-splenocytes, then the recipient’s T cell were isolated, purified and diluted with limited-dilute methods into single cell.The T cells were cultured by adding raise cells,ConA or IL2 under the different concentration and at last the T cell clone were formed. Results A stable recipient against donor antigen-specific T cell clone was established. The difference among the different immune groups was very significant(tgt;t0.05). The T cell clone was not formed without raise cells or only with raise cells. The rare clone could be formed by ConA stimulation but without IL-2. The clone-forming rate was associated with concentration of IL-2. ConclusionThe mature T cell is able to proliferate to form clone when the condition is suitable. The recipient is immunized with donor rats spleen cellular antigen. The T cells clones selected in the end are donor antigen-specific.
Objective To summarize the clinical experience of harvesting the lung of a brain death donor by international standardized methods, so as to establ ish a set of standards and regulations appl icable for harvesting the lung of brain-death donors in China. Methods The operation was performed on 1 brain-death donor who had endured 50 hours of mechanical ventilation. The donor was assessed by donor lung function test and international brain death standard. Then the organ was perfused and trimmed ready for lung transplantation. Results We succeeded in harvesting the heart, lung, liver, kidney and cornea from this brain-death voluntary donor. The harvested lung was successfully transplanted into a recipient. And the recipient recovered well after operation. Conclusion The successful experience of harvesting the lung of the brain-death voluntary donor will contribute to the development and promotion of the utilization of brain-death donor suppl ies.
linically,free neurovascular warparound flap big toe is generally used as one of the methods forthe reconstruction of thumb. The fate of the donor foot , and the various problems brought about bythe transfer, however, had not drawn enough concentration from the surgeons.Free warparound flap transfer was performed on 107 patients and 62 cases of the total werefollowed-up. It was found that the results of the transfer were generally satisfactory to the thumb,but much were complained about ...