Older liver grafts from donation after circulatory death are associated with impaired survival and higher incidence of biliary non-anastomotic structure

Background:Grafts from older donors after circulatory death were associated with inferior outcome in liver transplants in the past.But it has seemed to remain controversial in the last decade,as a result of modified clinical protocols,selected recipients,and advanced technology of organ perfusion and preservation.The present study aimed to examine the impact of older donor age on complications and survival of liver transplant using grafts from donation after circulatory death(DCD).Methods:A total of 944 patients who received DCD liver transplantation from 2015 to 2020 were included and divided into two groups:using graft from older donor(aged≥65 years,n=87)and younger donor(age<65 years,n=857).Propensity score matching(PSM)was applied to eliminate selection bias.Results:A progressively increased proportion of liver transplants with grafts from older donors was observed from 1.68%to 15.44%during the study period.The well-balanced older donor(n=79)and younger donor(n=79)were 1:1 matched.There were significantly more episodes of biliary nonanastomotic stricture(NAS)in the older donor group than the younger donor group[15/79(19.0%)vs.6/79(7.6%);P=0.017].The difference did not reach statistical significance regarding early allograft dysfunction(EAD)and primary non-function(PNF).Older livers had a trend toward inferior 1-,2-,3-year graft and overall survival compared with younger livers,but these differences were not statistically significant(63.1%,57.6%,57.6%vs.76.9%,70.2%,67.7%,P=0.112;64.4%,58.6%,58.6%vs.76.9%,72.2%,72.2%,P=0.064).The only risk factor for poor survival was ABO incompatible transplant(P=0.008)in the older donor group.In the subgroup of ABO incompatible cases,it demonstrated a significant difference in the rate of NAS between the older donor group and the younger donor group[6/8(75.0%)vs.3/14(21.4%);P=0.014].Conclusions:Transplants with grafts from older donors(aged≥65 years)after circulatory death are more frequently associated with inferior outcome compared to those from younger donors.Older grafts from DCD are more likely to develop NAS,especially in ABO incompatible cases.

The critical role of therapeutic plasma exchange in ABO-incompatible liver transplantation

Background:The shortage of donor liver restricts liver transplantation(LT).Nowadays,donor liver with ABO blood group incompatibility between donor and recipient has become an option to expand the source of donor liver.Although it is now possible to perform ABO-incompatible(ABO-I)LT,antibody-mediated rejection(AMR)has been recognized as the primary cause of desperate outcomes after ABO-I LT.Anti-A/B antibody is the trigger of immune response to ABO-I LT graft injury.Therapeutic plasma ex-change(TPE)can quickly reduce the titer of plasma antibodies and effectively inhibit humoral immunity.Data sources:We searched PubMed and CNKI databases using search terms“therapeutic plasma ex-change”,“ABO-incompatible liver transplantation”,“ABO-I LT”,“liver transplantation”,“LT”,“antibody-mediated rejection”,and“AMR”.Additional publications were identified by a manual search of references from key articles.The relevant publications published before September 30,2020 were included in this review.Results:Different centers have made different attempts on whether to use TPE,when to use TPE and how often to use TPE.However,the control standard of lectin revision level is always controversial,the target titer varies significantly from center to center,and the standard target titer has not yet been estab-lished.TPE has several schemes to reduce antibody titers,but there is a lack of clinical trials that provide standardized procedures.Conclusions:TPE is essential for ABO-I LT.Hence,further research and clinical trials should be conducted to determine the best regimen for TPE to remove ABO antibodies and prevent AMR.

Effect of acupuncture intervention on the intestinal mucosal inflammatory response and immune response balance in animals with ulcerative colitis

Objective:To study the effect of acupuncture intervention on the intestinal mucosal inflammatory response and immune response balance in animals with ulcerative colitis (UC).Methods:Adult, male SPF SD rats were selected and randomly divided into the control group, UC group and acupuncture group, and then the acupuncture intervention was established after the UC animal model was established. 14 d after intervention, the expression of inflammatory mediators and Th1/Th2/Th17/Treg cytokines in intestinal mucosa, and the levels of inflammatory mediators and Th1/Th2/Th17/Treg cytokines in serum were detected. Results:NF-kB, HMGB-1, TNF-α, IL-1β, IFN-γ and IL-17 mRNA expression in intestinal mucosa as well as HMGB-1, TNF-α, IL-1β, IFN-γ and IL-17 levels in serum of UC group were significantly higher than those of control group while IL-4, IL-5 and TGF-β1 mRNA expression in intestinal mucosa as well as IL-4, IL-5 and TGF-β1 levels in serum were significantly lower than those of control group;NF-kB, HMGB-1, TNF-α, IL-1β, IFN-γ and IL-17 mRNA expression in intestinal mucosa as well as HMGB-1, TNF-α, IL-1β, IFN-γ and IL-17 levels in serum of acupuncture group were significantly lower than those of UC group while IL-4, IL-5 and TGF-β1 mRNA expression in intestinal mucosa as well as IL-4, IL-5 and TGF-β1 levels in serum were significantly higher than those of UC group. Conclusions: Acupuncture intervention can regulate the intestinal mucosal inflammatory response and immune response of animals with ulcerative colitis.