Does the use of double hormone replacement therapy for trauma patient organ donors improve organ recovery for transplant

BACKGROUND With an ongoing demand for transplantable organs,optimization of donor management protocols,specifically in trauma populations,is important for obta-ining a high yield of viable organs per patient.Endocrine management of brain-dead potential organ donors(BPODs)is controversial,leading to heterogeneous clinical management approaches.Previous studies have shown that when levo-thyroxine was combined with other treatments,including steroids,vasopressin,and insulin,BPODs had better organ recovery and survival outcomes were increased for transplant recipients.AIM To determine if levothyroxine use in combination with steroids in BPODs increased the number of organs donated in trauma patients.METHODS A retrospective review of adult BPODs from a single level 1 trauma center over ten years was performed.Exclusion criteria included patients who were not solid organ donors,patients who were not declared brain dead(donation after circulatory death),and patients who did not receive steroids in their hospital course.Levothyroxine and steroid administration,the number of organs donated,the types of organs donated,and demographic information were recorded.Univariate analyses were performed with P<0.05 considered to be statistically significant.RESULTS A total of 88 patients met inclusion criteria,69(78%)of whom received levothyroxine and steroids(ST/LT group)vs 19(22%)receiving steroids without levothyroxine(ST group).No differences were observed between the groups for gender,race,pertinent injury factors,age,or other hormone therapies used(P>0.05).In the ST/LT group,68.1%(n=47)donated a high yield(3-5)of organ types per donor compared to 42.1%(n=8)in the ST group(P=0.038).There was no difference in the total number of organ types donated between the groups(P=0.068).CONCLUSION This study suggests that combining levothyroxine and steroid administration increases high-yield organ donation per donor in BPODs in the trauma patient population.Limitations to this study include the retrospective design and the relatively small number of organ donors who met inclusion criteria.This study is unique in that it mitigates steroid administration as a confounding variable and focuses specifically on the adjunctive use of levothyroxine.

Liver transplantation using organs from deceased organ donors: a single organ transplant center experience

BACKGROUND： In 2011, a pilot program for deceased organ donation was initiated in China. We describe the first successful series of liver transplants in the pilot program.METHODS： From July 2011 to August 2012, our center performed 26 liver transplants from a pool of 29 deceased donors. All organ donation and allograft procurement were conducted according to the national protocol. The clinical data of donors and recipients were collected and summarized retrospectively.RESULTS： Among the 29 donors, 24 were China Category II donors（organ donation after cardiac death）, and five were China Category III donors（organ donation after brain death followed by cardiac death）. The recipients were mainly the patients with hepatocellular carcinoma. The one-year patient survival rate was 80.8% with a median follow-up of 422（2-696） days. Among the five mortalities during the follow-up,three died of tumor recurrence. In terms of post-transplant complications, 9 recipients（34.6%） experienced early allograft dysfunction, 1（3.8%） had non-anastomotic biliary stricture,and 1（3.8%） was complicated with hepatic arterial thrombosis.None of these complications resulted in patient death. Notably,primary non-function was not observed in any of the grafts.CONCLUSION： With careful donor selection, liver transplant from deceased donors can be performed safely and plays acritical role in overcoming the extreme organ shortage in China.

High-performance asymmetric small molecular donor materials based on indenothiophene for solution-processed organic solar cells

Two novel asymmetric organic small molecules of IT(2FBT-T3Cz)_2and IT(2FBT-TT3Cz)_2with an indenothiophene(IT)central donor core,fluorinated benzothiadiazole(2FBT)as acceptor and 3-carbazole(Cz)unit as terminal group were designed and synthesized as the donor materials in organic solar cells(OSCs).The thermal,optical absorption,electrochemical property,hole–electron mobility,film morphology were thoroughly studied.Using PC_(71)BM as an electron acceptor,without any additive and thermal annealing(TA)treatment,the IT(2FBT-T3Cz)_2-based cells showed a promising power conversion efficiency(PCE)of5.81%and the IT(2FBT-TT3Cz)_2-based cells exhibited a PCE of 4.39%.Our results demonstrate that the IT-based asymmetric small molecules can be developed as a promising class of donor materials for highperformance OSCs.

High Responsivity Organic Ultraviolet Photodetector Based on NPB Donor and C60 Acceptor

We report fabrication and characterization of organic heterojunction UV detectors based on N,N＇-bis（naphthalen- 1-y1）-N,N＇-bis （phenyl） benzidine （NPB） and fullerene C60. The effects of different thicknesses of NPB and C60 layers are studied and compared. Notably, the optimal thicknesses of electron acceptor C60 and electron donor NPB are 40 nm and 80 nm, respectively. The J V characteristic curves of the device demonstrate a three-order- of-magnitude difference when illuminated under a 350nm UV light and in the dark at -0.5 V. The device exhibits high sensitivity in the region of 320-380nm with the peak located around 35Onm. Especially, it shows excellent photo-response characteristic with a responsivity as high as 315 mA/W under the illumination of 192μW.cm 2 350nm UV light at -5 V. These results indicate that the NPB/C60 heterojunction structure device might be used as low-cost low-voltage UV photodetectors.

Unsymmetrical donor—acceptor—donor—acceptor type indoline based organic semiconductors with benzothiadiazole cores for solution-processed bulk heterojunction solar cells

Bulk heterojunction(BHJ) solar cells based on small molecules have attracted potential attention due to their promise of conveniently defined structures, high absorption coefficients, solution process-ability and easy fabrication. Three D—A—D—A type organic semiconductors(WS-31,WS-32 and WS-52) are synthesized, based on the indoline donor and benzotriazole auxiliary acceptor core, along with either bare thiophene or rigid cyclopentadithiophene as π bridge, rhodanine or carbonocyanidate as end-group. Their HOMO orbitals are delocalized throughout the whole molecules. Whereas the LUMOs are mainly localized on the acceptor part of structure, which reach up to benzothiadiazole, but no distribution on indoline donor. The first excitations for WS-31 and WS-32 are mainly originated by electron transition from HOMO to LUMO level, while for WS-52, partly related to transition between HOMO and LUMO+1 level. The small organic molecules are applied as donor components in bulk heterojunction(BHJ) organic solar cells, using PC_(61)BM as acceptor material to check their photovoltaic performances. The BHJ solar cells based on blended layer of WS-31:PC_(61)BM and WS-32:PC_(61)BM processed with chloroform show overall photoelectric conversion efficiency(PCE) of 0.56% and 1.02%, respectively. WS-32 based BHJ solar cells show a higher current density originated by its relatively larger driving force of photo-induced carrier in photo-active layer to LUMO of PC_(61)BM.

Kidney transplant from donors with hepatitis B: A challenging treatment option

Utilizing kidneys from donors with hepatitis B is one way to alleviate the current organ shortage situation.However,the risk of hepatitis B virus(HBV)transmission remains a challenge that undermines the chance of organs being used.This is particularly true with hepatitis B surface antigen(HBsAg)positive donors despite the comparable long-term outcomes when compared with standard donors.To reduce the risk of HBV transmission,a comprehensive approach is needed.This includes assessment of donor risk,optimal allocation to the proper recipient,appropriate immunosuppressive regimen,optimizing the prophylactic therapy,and post-transplant monitoring.This review provides an overview of current evidence of kidney transplants from donors with HBsAg positivity and outlines the challenge of this treatment.The topics include donor risk assessment by adopting the nucleic acid test coupled with HBV DNA as the HBV screening,optimal recipient selection,importance of hepatitis B immunity,role of nucleos(t)ide analogues,and hepatitis B immunoglobulin.A summary of reported long-term outcomes after kidney transplantation and proposed criteria to utilize kidneys from this group of donors was also defined and discussed.

Organ donation in China:the major progress and the continuing problem

China has banned harvesting organs from executed prisoners since January 1st, 2015, making voluntary donation the only legitimate venue for organ transplant. It is a critical move to settle all the controversies about China＇s organ transplant process by making a loud and strong statement worldwide that the Chinese government respects human rights and is streamlining its organ transplant process to conform with internationally accepted standards on organ transplantation. This regulation removes one major obstacle of organ transplant in China; however, China still faces the other maior obstacle of critical organ shortage.

Can the rat donor liver tolerate prolonged warm ischemia?

The last two decades of the twentieth century have witnessed increasingly successful rates of liver transplantation. The number of liver transplantations has increased steadily while the number of organ donors has remained relatively constant. Thus a great disparity has developed between the demand and supply of donor organs and remains a major limiting factor for further expansion of liver transplantation. Although many procedures, such as split liver[1] , living-related transplantation[2] , and xenotransplantation[3], have been attempted clinically to overcome the shortage, it is hoped that livers harvested from non-heart-beating donors (NHBDs) would alleviatethe problem of organ shortage, which again becomes the focus of attention[4-9]. However, sensitivity of the liver to warm ischemia remains a major worry for use of theNHBDs. The aim of this animal study was to assess if murine liver could tolerate prolonged period of warm ischemia and to determine the optimum timing of intervention in the cadaver donor in order to preserve liver viability.

Deceased organ donation for transplantation: Challenges and opportunities

Organ transplantation saves thousands of lives every year but the shortage of donors is a major limiting factor to increase transplantation rates. To allow more patients to be transplanted before they die on the waitlist an increase in the number of donors is necessary. Patients with devastating irreversible brain injury, if medically suitable, are potential deceased donors and strategies are needed to successfully convert them into actual donors. Multiple steps in the process of deceased organ donation can be targeted to increase the number of organs suitable for transplant. In this review, after describing this process, we discuss current challenges and potential strategies to expand the pool of deceased donors.

Detection of Bronchial Function of NHBD Lung Following One-h Warm Ischemia by Organ Bath Model

This study investigated the feasibility and effects of organ bath to be used for detection of bronchial function of non-heart-beating donor （NHBD） lung after 1-h warm ischemia. Sixteen Swedish pigs were divided into two groups randomly： heart-beating donor （HBD） group and NHBD with 1-h warm ischemia （NHBD-1 h） group. The bronchial rings whose lengths and inner diameters were both 1.5 mm were obtained from isolated left lungs of all the pigs. Acetylcholine, arachidonic acid natrium and papaverine were used to test and compare the contractile and relaxant function of bron- chial smooth muscles and epithelium-dependent relaxation （EpiDR） response between HBD and NHBD-1 h groups. The results showed that there was no significant difference in the values of bronchial precontraction between HBD and NHBD-1 h groups （5.18±0.07 vs 5.10±0.11 mN, P〉0.05）. No significant difference in the values of EpiDR responses between HBD and NHBD-1 h groups （1.26±0.05 vs 1.23±0.07 mN, P〉0.05） was observed either. During the process of EpiDR induction, the tings had no spontaneous relaxation in two groups. In addition, papaverine solution completely relaxed the bronchial smooth muscles of all bronchial tings. It was concluded that after warm ischemla for 1 h, the contractile and relaxant abilities of bronchial smooth muscles, and the epithelium-dependent adjustment both kept intact. Organ bath model could be a liable and scientific way to evaluate the bronchial function of NHBD lung.

Monday blues of deceased-donor liver transplantation

BACKGROUND:There is a constant and global shortage of deceased-donor organs for transplantation.Ways to identify areas for securing potential deceased-donor organs may improve the supply and hence benefit more patients in need of transplantation. METHODS:We looked into the disparity of the number of deceased-donor liver transplantation(DDLT)performed at our hospital on different days of the weeks from January 2000 to the end of December 2009(237 DDLTs).The number of DDLT performed on each day was compared with the other days of the week. RESULTS:It was apparent that there were fewer DDLTs on Mondays,as shown by the numbers of DDLT performed on different days of the week in an ascending order:Monday 18(7.6%),Sunday 30(12.7%),Thursday 34(14.3%),Friday 36(15.2%),Wednesday 38(16.0%),Tuesday 40(16.9%), and Saturday 41(17.3%).The difference reached statistical significance when Monday was compared with Tuesday (P=0.019),Wednesday(P=0.010),Friday(P=0.021),and Saturday(P=0.007).It was twice as unlikely a DDLT would be performed on Monday as compared with other days.Such a trend did not change even with an increase in the number of deceased-donor liver grafts in the last year.As consent to donation was obtained from the donor family the day before DDLT,fewer consents were thus obtained on Sundays.CONCLUSION:These findings suggested that deceased-donor organ donation activities were less active on Sundays and could be improved.This further raises the concern of possible wastage of potential cases of organ donation.

病原体宏基因检测在器官捐献患者中的应用

目的探讨病原体宏基因组二代测序(metagenomic next-generation sequencing,mNGS)应用于器官捐献者病原微生物的检测,为器官移植后的抗感染药物靶向治疗提供依据。方法回顾性分析了武汉大学中南医院于2021年8月至2023年6月142例器官捐献者的临床病例,收集捐献者的血液样本的mNGS检测和病原微生物培养检测结果,对其进行分析比较。结果142例捐献者中98例在mNGS中检测到病原微生物,阳性检出率为69.01%。其中,59例(60.20%)为单纯病毒感染,12例(12.24%)为单纯细菌感染,4例(4.08%)为单纯真菌感染,混合感染23例(23.47%)。共检测出病原微生物173株。其中,病毒125株(72.25%),细菌40株(23.12%),真菌8株(4.62%)。对捐献者血液样本送检mNGS同时送检微生物培养检测,142例捐献者中20例(14.08%)血培养检测到病原微生物,共检测出21株病原微生物,其中20例(95.24%)为细菌,1例(4.76%)为真菌。器官保存液中培养出病原微生物2例(1.40%)。结论mNGS对病原微生物的检出率高于微生物血培养检测。mNGS检测和血培养病原微生物检测在细菌的诊断上差异不明显,而在检测真菌及病毒阳性时有统计学意义,且mNGS检测比血培养病原微生物检测能大幅度缩短检验时长。

基于喹喔啉和吡啶并吡嗪及咔唑和二苯胺衍生物电子给体-受体结构荧光材料的合成和光电性能

通过α-二酮与邻苯二胺、吡啶二胺缩合反应,构建了喹喔啉和吡啶并吡嗪衍生物作为电子受体,分别以二苯胺、咔唑衍生物为电子给体,合成了4个具有电子给体-电子受体结构的氮杂环荧光材料F1~F4。通过低温荧光/磷光光谱、荧光寿命测试,结合密度泛函理论计算可知,F1~F4均为荧光小分子。室温荧光光谱结果表明,利用电子给体和受体的电子效应不同可以调控材料的发光颜色,其中三苯胺相对于苯基咔唑的供电子能力更强,表现为F1比F2、F3比F4红移现象更加明显;而吡啶并吡嗪具有多氮的缺电子结构,与喹喔啉相比共轭程度增加,导致F3比F1、F4比F2发生的斯托克斯位移数值增大。总之,F1~F4的甲苯溶液最大荧光光谱发射峰位于529、464、568和507 nm,荧光寿命分别为12.21、2.61、9.76和6.03 ns,荧光量子效率最高可达98.2%,具有良好的发光性能。将F1~F4发光材料掺杂在主体材料中制备了有机电致发光二极管DF1~DF4。所得器件DF1和DF3性能更好,最大电流效率分别为13.38和11.98 cd·A-1,且最大外量子效率分别达到4.8%和4.5%。

国外捐献器官获取质量管理与控制进展

器官移植是二十世纪以来有效挽救终末期器官衰竭患者生命的一项突破性技术,显著改善了患者生存质量。器官捐献作为器官移植的重要来源,提升捐献器官获取质量是促进捐献器官转化、改善器官移植预后的关键。美国、西班牙等国家在捐献器官获取质量管理与控制方面提出了系列政策和标准,并取得了积极成果。本文通过探讨医疗质量管理与控制有关概念、国际捐献器官获取质量管理先进策略及模式,研究器官获取组织、捐献者、捐献器官质控举措,以期为形成具有“中国特色”的捐献器官获取质量管理与控制体系、推进捐献器官获取高速度高质量发展提供参考。

遗体器官捐献协调工作指南

遗体器官捐献和移植工作坚持人民至上、生命至上原则。国家鼓励遗体器官捐献,建立了遗体器官捐献和移植工作体系,推动遗体器官捐献,规范遗体捐献器官获取和分配,提升遗体器官移植服务能力。器官捐献协调是遗体器官捐献实施过程中最重要的环节,决定着捐献能否成功实施的关键。协调员作为连接器官捐献者与移植等待者之间的桥梁,在遗体器官捐献工作中发挥着极其重要的作用。为进一步规范我国遗体器官捐献协调工作的实施,由中华医学会器官移植学分会、中国医师协会器官移植医师分会组织制定《遗体器官捐献协调工作指南》。针对捐献协调和见证工作中主要的16个问题,依据国家相关法律法规、政策规定、国际通则、专家共识和实际工作经验,总结形成了20条推荐意见,以指导协调员依法依规、科学规范开展捐献的协调和见证工作,推动遗体器官捐献工作高质量发展。

脑死亡器官捐献供体评估和供心选择临床分析

目的总结73例脑死亡器官捐献供体评估和供心选择的临床经验。方法回顾73对脑死亡器官捐献心脏移植供受者临床资料,评估供体,选择供心,分析心脏移植受者生存情况和边缘供心使用情况。结果发现潜在供体,在判定脑死亡状态后,明确供体家属同意器官捐献后,评估供体,选择供心,使供受体最大限度匹配。73例心脏移植受者手术成功率为94.5%(69/73),围手术期死亡4例,术后随访1年死亡4例。边缘供心使用情况:供体年龄≥45岁17例,供受体体质量不匹配2例,供体中毒1例,供心冷缺血时间≥4 h 43例,大部分心脏移植受者予主动脉内球囊反搏和(或)体外膜肺氧合辅助,最终顺利出院。结论供受体最大限度匹配可使心脏移植患者获益最大;同时,适当放宽供心选择标准,增加供心数量,将为众多等待心脏移植患者带来希望。

调控共价有机框架供-受体促进光催化水析氧

为探究电子供体-受体结构对共价有机框架(COFs)材料光催化性能的影响,以N,N'-对乙腈苯基-1,4,5,8-萘二酰亚胺(NBA)为基础构筑单体,分别与供电子的三(4-甲酰基)苯胺(N-CHO)、吸电子的1,3,5-三(4-甲酰苯基)三嗪(TFPT)脱水缩合,构筑了由C=C连接的NN-COF和NT-COF。采用XRD、FTIR、^(13)CNMR、XPS、SEM、TEM、EDS和紫外光电子能谱(UPS)表征了两种COFs材料的结构、形貌和光电性能,并测试其光催化水分子氧化反应(OER)性能。结果表明,与NN-COF相比,NT-COF中三嗪单元的吸电子能力和高度平面性使其具有更紧密的层间π-π堆积、更宽的可见光吸收范围和更强的光生载流子产生能力;Co(NO_(3))_(2)·6H_(2)O作为助催化剂添加后,NN-COF和NT-COF在连续6 h内平均析氧速率分别为303.73和449.53μmol/(g·h);NT-COF中相对缺电子的萘酰亚胺单元更有利于光生空穴在其杂原子上的积累,从而更高效地催化水分子OER的进行。

伴急性肾损伤的DBD供肾肾移植的临床结局

目的探讨伴急性肾损伤(AKI)的脑死亡器官捐献(DBD)供者供肾肾移植的临床结局。方法回顾性分析216例DBD供者的资料,按照改善全球肾脏病预后组织(KDIGO)标准将分为AKI组(69例)与正常组(147例),AKI组进一步分为KDIGO 1期和2~3期两组,AKI组受者135例,正常组受者288例。总结受者术后肾功能恢复情况及临床结局。分析移植物功能延迟恢复(DGF)发生的危险因素。结果AKI组供者血清肌酐(Scr)最高值、获取前Scr值、血钠最高值、获取前血钠值均高于正常组,升压药物应用时间长于正常组,48 h内液体复苏用量高于正常组,入院HCO3−值低于正常组,尿崩症、低血压发生率高于对照组;KDIGO 2~3期供者Scr最高值、获取前Scr值较KDIGO 1期供者高(均为P<0.05)。与正常组比较,AKI组受者DGF、急性排斥反应发生率较高,行连续性肾脏替代治疗的比例较高,术后90 d内Scr水平较高,术后3 d尿量较少;与KDIGO 1期受者比较,KDIGO 2~3期受者术后3、4、5、15 d Scr水平较高,术后2 d尿量较少(均为P<0.05)。单因素分析结果显示供者年龄、Scr最高值、血钠最高值、48 h内液体复苏用量是肾移植术后受者发生DGF的危险因素,多因素分析结果显示,供者年龄是肾移植术后受者发生DGF的独立危险因素(均为P<0.05)。结论伴AKI的DBD供者供肾用于肾移植,经过积极的器官维护可纠正AKI,对术后6个月移植物功能和存活率没有影响,可达到与非AKI供肾同样的效果,可作为扩大供肾来源。

人工智能在肝移植中的应用研究进展

随着手术技术及围手术期管理的进步,肝移植已成为挽救终末期肝病患者生命的有效方法,但仍面临器官供需不平衡的问题,肝移植的决策过程仍面临较多挑战。人工智能可以更高效地从复杂因素中提取特征并建立联系,肝移植的临床决策可以受益于人工智能提供的数据驱动方法,包括移植前优化移植候选资格决策和供受者匹配、移植后预测疾病复发和其他相关并发症的危险因素,指导肝移植受者的管理等。因此,本文就人工智能在肝移植器官分配、供肝评估、肝细胞癌术后复发及术后并发症预测等方面的应用进行综述,以期为人工智能在肝移植领域的研究和发展提供参考。

《献血者选择:献血适宜性评估指南》内容阐释及启示

世界卫生组织《献血者选择:献血适宜性评估指南》系统介绍了献血者选择国家体系和献血者选择基本标准等内容,具有较强的可操作性。与之相比,我国《献血者健康检查要求》更为严格,容易导致献血者非必要延期。我国献血者选择工作需从完善献血者选择体系,修改献血者年龄、献血间隔、血压等方面,从“基于预防”向“基于证据”转变,在安全与风险中寻找到最佳平衡点,提高献血者依从性,开发工具识别急性HIV感染等方面持续改进。