Objective To summarize the role of costimulatory molecules in inducing immune tolerance of organ transplantation. Methods Domestic and international publications online involving costimulatory molecules and immune tolerance in recent years were collected and reviewed. Results The relationship between costimulatory pathways and transplantation immunity has already been clarified in recent years. The main costimulatory molecules alreadly found mainly include B7-CD28/CTLA4, CD40-CD154, 4-1BB/4-1BBL, and ICOS-B7h, etc. Costimulatory pathways com-inhibition or combining with other immunosuppression methods could obtain stable and long lasting immune tolerance. Conclusions With the development of immunology and molecular biology, costimulatory pathways of T lymphocyte activation will be further interpreted. Other new costimulatory molecules will be discovered in the future, which will afford theory evidence for inducing immune tolerance.
ObjectiveTo compare tacrolumus (FK506) with cyclosporine A (CsA) in clinical application to organ transplantation.MethodsThe literature in recent years has been reviewed and compared. ResultsFK506 was a powerful immunosuppression with a mechanism of action similar to that of CsA, but significantly superiori to CsA in terms of prophylaxis and treatment of allograft acute rejection, delay of chronic rejection, and withdrawal of steroid in early period. The cardiovascular mortality and chronic graft nephropathy (CGN),such as hypertension and hyperlipidemia were less frequently seen in FK506treated patients and FK506 also had an acceptable safety profile, including a low incidence of hypertrichosis,gingival hyperplasia and infections.However, CsA had been showed a better result in prevention of posttransplantation diabetes mellitus (PTDM ) and more economic agent than FK506. Pharmacokinetic studies showed CsA in the form of Sandimmun Neoral showed less inter an intrapatient variability than FK506.Meanwhile, the combination of MMF and FK506 or CsA has been proved effectively with excellent graft and patients survival. Conclusion FK506 and CsA are safe and effective long term maintenance immunosuppressive agents in organ transplantation with wonderful prospect.
Through analyzing the relevant regulations of organ transplantation in China, we identified the problems in the regulations of organ transplantation in China, including more strict limitation of the living organ donors resulting in a serious shortage of organ supply, difficulties in preventing the hidden organ trading, and opaque process of organ allocation resulting in unfair distribution. We also put forward the solutions to address above problems, including the improvement of organ transplantation regulations, establishment of the reimbursement mechanism for organ donation, rational mechanism of organ allocation and the brain death criteria, so as to promote more comprehensive sources of organ donation for the patients with end-stage organ failure.
ObjectiveTo summarize the research progress of surgical technique and immunosuppressive regimen of abdominal wall vascularized composite allograft transplantation in animals and clinical practice. MethodsThe literature on abdominal wall transplantation at home and abroad in recent years was extensively reviewed and analyzed. ResultsThis review includes animal and clinical studies. In animal studies, partial or total full-thickness abdominal wall transplantation models have been successfully established by researchers. Also, the use of thoracolumbar nerves has been described as an important method for functional reconstruction and prevention of long-term muscle atrophy in allogeneic abdominal wall transplantation. In clinical studies, researchers have utilized four revascularization techniques to perform abdominal wall transplantation, which has a high survival rate and a low incidence of complications. ConclusionAbdominal wall allotransplantation is a critical reconstructive option for the difficulty closure of complex abdominal wall defects. Realizing the recanalization of the nerve in transplanted abdominal wall to the recipient is very important for the functional recovery of the allograft. The developments of similar research are beneficial for the progress of abdominal wall allotransplantation.
Objective To investigate the impact of immunonutrition in organ transplantation.Methods The literatures of recent years on the studies of immunonutrition in organ transplantation were reviewed. Results Immunonutrition including ω-3 fatty acid and special amino acids etc could reduce inflamation and supress immunal response following organ transplantation markably. Conclusion Application of immunonutrition associated with immunosupress could take the place of traditional steroids completely in the treatment following organ transplantation, even shorten clinical course of immunosupress.
目的 總結活體部分小腸移植在治療短腸綜合征合并腸瘺中的臨床經驗。方法 1例短腸綜合征合并腸瘺患者接受其子的150 cm 回腸，供腸動、靜脈分別與受體的腹主動脈和下腔靜脈行端側吻合，受體殘余空腸與供體回腸近端行端端吻合，受體結腸與供腸遠端行端側吻合，供腸遠端造瘺作為觀察窗，術后給予免疫抑制等治療。 結果 患者小腸移植術后恢復順利，腸道功能恢復，血管吻合口通暢，正常生活110 d后因心臟意外死亡。結論 短腸綜合征合并腸瘺患者實施活體部分小腸移植是可行的，植入腸管的血管植入技術對小腸移植成功非常重要。
肝臟移植、心臟移植及腎臟移植等已廣泛開展，大批受者長期存活。本文現就這組特殊人群在移植術后患膽道結石病的機理及其處理原則介紹如下。1器官移植受體膽石病的發生機理肝移植術后膽管結石與膽泥形成并引起膽道梗阻可隨時發生。除了明確的結石外，膽泥形成膽管鑄形并廣泛分布于肝內膽管也有報道。膽管粘膜損害、膽管梗阻、移植肝的冷、熱缺血、感染及膽固醇過飽和等都在膽管結石形成過程中發揮作用，但膽管梗阻可能是肝移植術后膽管結石形成的最重要因素［1］。膽管結石和膽泥形成的患者，絕大多數都伴有膽管狹窄，這個狹窄可以發生在膽管膽管吻合口和膽管空腸吻合口，也可發生在非吻合口處的膽管。膽管內異物如T型管或內支撐管也可作為結石形成的核心。除了這些引起膽汁淤積的物理學原因外，環孢素A（CsA）在膽石發生中也起了作用［2］： 它可抑制膽汁分泌，促進膽汁淤積，而FK506（普樂可復）似乎沒有這方面的副作用。此外，肝移植受者膽汁中膽固醇呈過飽和狀態，且T管引流及膽酸池的減少還加重這種狀態。目前還不清楚膽道重建方式對膽道結石形成有沒有影響。但從理論上講，膽腸吻合會增加腸源性細菌進入膽道的機會，從而導致膽紅素去結合化，并進一步形成色素石。但到底是膽管對端吻合還是膽腸吻合后更易形成結石，目前尚無詳盡研究。