Clinical effects of renal transplantation with kidneys from donors dying of organophosphate poisoning

doi:10.3969/j.issn.2095-4344.2016.29.008

Chinese Journal of Tissue Engineering Research ›› 2016, Vol. 20 ›› Issue (29): 4311-4318.doi: 10.3969/j.issn.2095-4344.2016.29.008

Previous Articles Next Articles

Clinical effects of renal transplantation with kidneys from donors dying of organophosphate poisoning

Dong Jian-hui, Li Hai-bin, Sun Xu-yong, Qin Ke, Liao Ji-xiang, Li Mei-si, Huang Xiao-dan, Huang Chen, Huang Ying, Cao Song, Gao Zhao, Li Zhuang-jiang, Nie Feng, Yang Jian-jun

Institute of Transplant Medicine, No. 303 Hospital of Chinese PLA; Guangxi Key Laboratory for Transplantation Medicine Guangxi, Department of Organ Transplantation in Guangzhou Military Region; Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning 530021, Guangxi Zhuang Autonomous Region, China

Received:2016-04-25 Online:2016-07-08 Published:2016-07-08
Contact: Sun Xu-yong, M.D., Chief physician, Institute of Transplant Medicine, No. 303 Hospital of Chinese PLA; Guangxi Key Laboratory for Transplantation Medicine Guangxi, Department of Organ Transplantation in Guangzhou Military Region; Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning 530021, Guangxi Zhuang Autonomous Region, China
About author:Dong Jian-hui, Master, Attending physician, Institute of Transplant Medicine, No. 303 Hospital of Chinese PLA; Guangxi Key Laboratory for Transplantation Medicine Guangxi, Department of Organ Transplantation in Guangzhou Military Region; Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Supported by:
the Natural Science Fundation of Guangxi, China, No. 2013GXNSFAA019253; Science Research and Technology Development Program of Guangxi, China, No. 14124003-8; Research Project of Health and Family Planning Commission of Guangxi Zhuang Autonomous Region, China, No. Z2015293

Abstract

Abstract:

BACKGROUND: Delayed graft function (DGF) occurs frequently in kidney transplants from donation after cardiac death if creatinine level is high in kidney recipients.
OBJECTIVE: To analyze the clinical effects of renal transplantation with kidneys from donors dying of cardiac death in organophosphate poisoning.
METHODS: Data were collected from kidney transplants from two donors dying of cardiac death in organophosphate poisoning. After some donor maintenance, donor organ were obtained and perfused with impulse type machine. Recipients were treated with intervention of immunity induction, anti-rejection drugs and infection prevention drugs during and after renal transplantation. Pathological data of donor kidney zero needle biopsy, DGF after kidney transplantation, complication rate (such as acute rejection), renal allograft recovery situation, the survival rate of recipients and kidney transplants were collected and analyzed.
RESULTS AND CONCLUSION: Needle biopsy results from four donor kidneys showed that glomerular morphology was normal, but there were edema and degeneration in kidney tubules in some degree. Donor DGF rate was 75% (3/4), acute rejection rate was 0% (0/4), perioperative period donor kidney and recipient survival rate were 100% (4/4). All recipients showed a good result of transplanted kidney, their creatinine and urea nitrogen were at low level, and had no proteinuria. One recipient died of severe pulmonary infection 4 months after surgery. For some organophosphate poisoning donors dying of cardiac death, donor kidney quality can be improved by suitable donor maintenance and high-quality donor kidney preservation using machine perfusion. Kidney transplants from donors dying of cardiac death in organophosphate poisoning who receive the maintenance of organ function may be a promising candidate for renal transplantation due to a severe lack of kidney donor sources.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Organ Transplantation, Kidney Transplantation

CLC Number:

R318

Dong Jian-hui, Li Hai-bin, Sun Xu-yong, Qin Ke, Liao Ji-xiang, Li Mei-si, Huang Xiao-dan, Huang Chen, Huang Ying, Cao Song, Gao Zhao, Li Zhuang-jiang, Nie Feng, Yang Jian-jun. Clinical effects of renal transplantation with kidneys from donors dying of organophosphate poisoning[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(29): 4311-4318.

Figures/Tables 1

2.1 体外膜肺氧合在器官捐献供体维护中的作用体外膜肺氧合保证了持续的供体的组织器官的氧合灌注，能够有效缩短供体器官热缺血损伤的时间。对已受损伤的器官能够通过相应的体外循环支持措施，结合中深低温技术的器官保存作用，使供体器官功能得于恢复，提高供体质量。 2.2 肾脏离体灌注(Lifeport)在器官捐献供体维护中的相关数据在Lifeport运行的过程中，会连续记录一些灌注参数：如血管阻力系数[mm Hg/(mL•min)]、灌注流量(mL/min)、灌注压力(mm Hg)、灌注温度(℃)，研究中2个案例的采集数据如表2所示。 2.3 移植肾彩超对比图供者1和供者2的4例受者移植肾血流灌注均良好，且无明显差异(图1)。 2.4 供肾零点穿刺活检供体1和供体2的苏木精-伊红染色结果如图2。 2.5 围手术期及出院情况接受有机磷中毒脑死亡供体肾移植的4例受者，移植手术进展顺利，手术时间分别为90，110，100，120 min，与常规平均手术时间(110±21) min相当。同时平稳安全渡过围手术期；4例受者肾移植后肾功能基本恢复正常时间分别为14，9，57，31 d，较常规恢复时间(7.00±2.67) d延长，住院期间病情平稳，移植后住院时间分别为49，28，33，45 d，较常规的住院时间(15.0±4.7) d延长。出院时肌酐分别为98，113，158，122 μmol/L，均未出现蛋白尿，与常规受者无差异。有1例受者肾移植后4个月因重症肺部感染带肾死亡。见表3，4。 2.6 不良反应及移植肾功能延迟恢复发生情况结合彩超检查结果和移植肾穿刺活检病理结果，导致移植肾功能延迟恢复原因推测为缺血再灌注损伤3例(75.0%)，急性排斥0例。其中因移植肾功能延迟恢复患者肌酐快速升高或升高至约900 μmol/L的患者，以规律性血液透析治疗，3次/周，同时使用前列地尔注射液、红花注射液等药物以改善移植肾微循环，1-8周后因缺血-再灌注损伤导致的移植肾功能延迟恢复 3例受者血肌酐均开始恢复。"

References

[1] Snoeijs MG, Schaubel DE, Hene R, et al. Kidneys from donors after cardiac death provide survival benefit.J Am Soc Nephrol.2010;21(6):1015-1021.
[2] Farney AC,Singh RP,Hines MH,et al.Experience in renal and extrarenal transplantation with donation after cardiac death donors with selective use of extracorporeal support. J Am Coll Surg.2008;206(5): 1028-1037, 1037.
[3] 石炳毅.中国公民逝世器官捐献肾移植的发展与进步[J]. 中华器官移植杂志, 2014, 35(10): 577-579.
[4] Le Dinh H, Weekers L, Bonvoisin C, et al. Delayed graft function does not harm the future of donation- after-cardiac death in kidney transplantation. Transplant Proc.2012;44(9): 2795-2802.
[5] Pine JK, Goldsmith PJ, Ridgway DM, et al.Comparable outcomes in donation after cardiac death and donation after brainstem death: a matched analysis of renal transplants. Transplant Proc.2010;42(10): 3947-3948.
[6] Monbaliu D,Pirenne J,Talbot D.Liver transplantation using Donation after Cardiac Death donors. J Hepatol. 2012;56(2): 474-485.
[7] Johnson RJ, Bradbury LL, Martin K, et al.Organ donation and transplantation in the UK-the last decade: a report from the UK national transplant registry. Transplantation.2014;97 Suppl 1: S1-S27.
[8] de Vries EE,Hoogland PE,Wind J,et al.Transplantation of kidneys from paediatric DCD donors: a comparison with DBD donors. Nephrol Dial Transplant.2013; 28(1): 220-226.
[9] 中华医学会器官移植学分会,中华医学会外科学分会移植学组,中国医师协会器官移植医师分会. 中国心脏死亡捐献器官评估与应用专家共识[J]. 中华移植杂志：电子版,2014,8(3):117-122.
[10] 董永逵,杨叶华,董永山.13例有机磷农药中毒合并急性肾衰的临床研究[J].医药前沿,2013,(19):152.
[11] 徐彬.400例口服有机磷农药中毒抢救分析[J].中国卫生标准管理, 2015,1(1):108-110.
[12] 姜秀国,伏圣高.急性有机磷中毒403例分析[J]. 中国医药指南, 2015,15(2):40-41.
[13] 刘春晓,韦真理,阮海林.急性肾损伤生物标志物在有机磷农药中毒时的研究进展[J]. 右江民族医学院学报, 2009, (3): 478-480.
[14] 刘学革,张震.急性重度有机磷农药中毒并发肾损害45例分析[J].中国实用乡村医生杂志,2012,19(11):48-49.
[15] 张可. NGAL与急性有机磷农药中毒急性肾损伤相关性研究[J]. 国际检验医学杂志,2012, 33(5): 532-534.
[16] 刘春晓,韦真理,阮海林.急性肾损伤生物标志物在有机磷农药中毒时的研究进展[J]. 右江民族医学院学报, 2009, 31(3):478-480.
[17] 庄清武,刘利青.急性有机磷农药中毒对肾脏的影响[J]. 医师进修杂志, 2005,28(17): 40-41.
[18] Wang C, Liu L, Fu Q, et al. Kidney transplantation from donors after brain or cardiac death in China--a clinical analysis of 94 cases.Transplant Proc.2013; 45(4): 1323-1326.
[19] 容松.肾移植后急性排斥反应及免疫抑制剂的应用[J].中国组织工程研究, 2012,16(40):7564-7571.
[20] 徐莹,王仁定,吴建永,等.肾移植后急性排斥反应发生相关术前因素分析[J].中华移植杂志:电子版,2010,(1): 30-33.
[21] 孙小齐. 肾移植受者与肝移植受者术后肺部感染的临床研究[D]. 南方医科大学, 2013.

Clinical effects of renal transplantation with kidneys from donors dying of organophosphate poisoning

PDF

Knowledge

Cited

Abstract

Cite this article

share this article

Figures/Tables 1

References

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	Yang Xin, Jin Zhe, Feng Xu, Lu Bing. The current situation of knowledge and attitudes towards organ, eye tissue, body donation of residents in Shenyang [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(5): 779-784.
[2]	Wang Xiaobo, Wang Changan, Han Jianle, Yang Qingyan, Yang Shuaiping, Yang Junwei. Influence of conversion from cyclosporine to tacrolimus on glucose metabolism and cardiovascular risk profiles in stable kidney transplant patients [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(14): 2236-2240.
[3]	Liu Junchang, Gao Xiaolin, Jiang Taimao. Correlation of CY3A5 genetic polymorphism with concentration/dosage of tacrolimus and individualized administration of tacrolimus after kidney transplantation [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(11): 1740-1744.
[4]	Guo Juan, Zheng Shan, Xie Hui, Hu Yahui. An analysis of pathogenic bacteria infection in 422 kidney transplant recipients [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(32): 5198-5202.
[5]	Liu Luhao, Fang Jiali, Zhang Lei, Li Guanghui, Xu Lu, Lai Xingqiang, Xiong Yunyi, Chen Rongxin, Ma Junjie, Chen Zheng. Clinical assessment criteria of donor pancreas transplants for simultaneous pancreas-kidney transplantation [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(26): 4157-4161.
[6]	Cai Qiucheng, Fan Hongkai, Xiong Rihui, Jiang Yi. Intravenous administration of bone marrow mesenchymal stem cells protects liver function following fatty liver transplantation from donors after cardiac death [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(17): 2625-2629.
[7]	Yang Jin, Zhang Meixia, Yan Pei, Cheng Qiao, Li Jianzhen . Meta-analysis of risk factors for new-onset diabetes mellitus after kidney transplantation [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(15): 2450-2460.
[8]	Jiang Shanshan, Wang Feng, Yu Limei. Immunomodulatory properties of mesenchymal stem cells and their application in organ transplantation [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(1): 103-109.
[9]	Yang Qi-shun1, Jiang Wei1, Huang Chi-bing2. Staging diagnosis and treatment for pulmonary infection after renal transplantation can improve the stability of transplanted renal functions [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(8): 1255-1260.
[10]	Shang Wen-jun, Wang Zhi-gang, Suo Jing-jun, Li Jin-feng, Pang Xin-lu, Feng Yong-hua, Liu Lei, Xie Hong-chang,Feng Gui-wen. Caspofungin for preventing fungal infection after kidney transplantation using donation after cardiac death donors: a prospective controlled trial [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(32): 5189-5196.
[11]	Liu Teng-fei, Zhou Jian-kang, Huang Tuan-jie, Xing Qu, Cheng Kang, Li Peng, Li Dong-peng, Yang Bo, Ma Shan-shan, Guan Fang-xia . MG53 protein protects against multiorgan ischemia/reperfusion injury: present and future [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(20): 3248-3254.
[12]	Yang Jin, Fang Fang, Yang Fu. Risk factors for new-onset diabetes mellitus after kidney transplantation: a retrospective study [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(20): 3275-3280.
[13]	Li Jin-feng, Sun Jia-jia, Feng Gui-wen, Shang Wen-jun, Pang Xin-lu, Liu Lei, Xie Hong-chang, Feng Yong-hua, Wang Zhi-gang. Effect of donor and recipient gender on the recovery of renal function after donation after cardiac death renal transplantation [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(16): 2593-2599.
[14]	Lv Dao-yuan1, 2, Zhou Qin1, 2, Xia Yue1, 2, You Xu1, 2, 3, Zhao Zhi-hong4, Li Yong-qiang1, 2, Zou He-qun1, 2 . Establishment and analysis of a rat model of chronic renal allograft dysfunction complicated with insulin resistance [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(12): 1894-1902.
[15]	Li Ling, Li Ning, Ai Zi-ye, Yao Ya-jun, Wei Wan-hui, He Wei-yang, Wang Yan-feng, Ye Qi-fa. Intra-patient variability of tacrolimus concentration in transplant recipients: a prognostic predictor post transplantation [J]. Chinese Journal of Tissue Engineering Research, 2016, 20(49): 7437-7422.