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El Rafei A, Cogswell R, Atik FA, Zuckermann A, Allen LA. Review of the Global Activity of Heart Transplant. Circ Heart Fail 2025:e012272. [PMID: 40181780 DOI: 10.1161/circheartfailure.124.012272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 02/10/2025] [Indexed: 04/05/2025]
Abstract
Heart failure is a global disease with significant morbidity. Heart transplant (HT) can be a lifesaving therapy for select patients with end-stage heart failure. In 2020, over 7000 HTs were performed globally; 90% of HTs were performed in the United States and Western Europe, with only 10% throughout the rest of the world. In this article, we offer an overview of the global landscape of HT, exploring challenges and prospects worldwide. We review HT practices, rates and post-HT outcomes, underscoring the differences between countries within each region. We review limitations hindering HT expansion, such as sociocultural factors, as seen in Japan and Israel; health care funding, in countries like India and South Africa; socioeconomic disparities in access, like the United States; and shortage in organ supply, as seen in China and Saudi Arabia. This review underscores the need to address limitations and highlights opportunities to enhance global HT accessibility, especially in lower- and middle-income countries.
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Affiliation(s)
- Abdelghani El Rafei
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (A.E.R., L.A.A.)
| | - Rebecca Cogswell
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis (R.C.)
| | - Fernando A Atik
- Department of Cardiology, University of Brasília Medical School, Brazil (F.A.A.)
| | - Andreas Zuckermann
- Department of Cardiac Surgery/Medical, Medical University of Vienna, Austria (A.Z.)
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (A.E.R., L.A.A.)
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Xiong L, Kwan KJS, Pan J, Lu ZQ, Fu Y. Manual manipulation and ex vivo flexible ureteroscopic lithotripsy to salvage deceased donor kidneys with renal stones: a case series. BMC Nephrol 2025; 26:173. [PMID: 40181269 PMCID: PMC11967039 DOI: 10.1186/s12882-025-04081-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 03/19/2025] [Indexed: 04/05/2025] Open
Abstract
BACKGROUND Nephrolithiasis is generally considered a relative contraindication for kidney donation. This study aimed to evaluate the feasibility and effectiveness of a surgical technique designed to salvage deceased donor kidneys with renal stones. The technique involves manual manipulation of the recovered kidney combined with flexible ureteroscopic lithotripsy (MM-FURSL) to clear the stones prior to transplantation. CASE PRESENTATION A total of nine kidneys were recovered from six deceased donors. The recipients (66.7% female; mean age 43.9 ± 12.2 years) had been on dialysis for an average of 2.6 years before undergoing renal transplantation with MM-FURSL. Donor kidneys contained 1 to 4 stones each, with a mean maximum stone diameter of 15.1 ± 10.6 mm and an average CT density of 942.0 ± 106.6 HU. The mean warm and cold ischemia times were 5 min and 480 ± 108.2 min, respectively. The average total operative duration was 57.0 ± 63.4 min. The first patient to undergo MM-FURSL had the longest operative and cold ischemia times due to the use of a reusable flexible ureteroscope, which was damaged during the procedure. She was the only patient to experience acute tubular necrosis (ATN), but her creatinine levels normalized within three weeks. No other complications were observed during a mean follow-up period of 11.7 ± 8.2 months. CONCLUSION MM-FURSL is an effective method for removing renal stones in donor kidneys. Short-term outcomes were favorable, suggesting that this technique could be a viable approach to expand the donor pool by salvaging kidneys with nephrolithiasis. However, prolonged cold ischemia time may increase the risk of ATN and should be minimized.
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Affiliation(s)
- Lin Xiong
- Department of Urology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Kristine J S Kwan
- Department of Vascular Surgery, Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Fudan University Pudong Medical Center, Shanghai, China
| | - Jianyong Pan
- First Department of kidney Transplant, Organ Transplant Institute, Shenzhen Third People's Hospital, 29 Bulan Road, Longgang District, Shenzhen, 518053, China
| | - Zhen-Quan Lu
- Department of Urology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Yingxin Fu
- First Department of kidney Transplant, Organ Transplant Institute, Shenzhen Third People's Hospital, 29 Bulan Road, Longgang District, Shenzhen, 518053, China.
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Symeou S, Avramidou E, Papalois V, Tsoulfas G. Global transplantation: Lessons from organ transplantation organizations worldwide. World J Transplant 2025; 15:99683. [PMID: 40104190 PMCID: PMC11612884 DOI: 10.5500/wjt.v15.i1.99683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 08/30/2024] [Accepted: 09/13/2024] [Indexed: 11/26/2024] Open
Abstract
Although national transplant organizations share common visions and goals, the creation of a unified global organization remains impractical. Differences in ethnicity, culture, religion, and education shape local practices and infrastructure, making the establishment of a single global entity unfeasible. Even with these social disparities aside, logistical factors such as time and distance between organ procurement and transplantation sites pose significant challenges. While technological advancements have extended organ preservation times, they have yet to support the demands of transcontinental transplantations effectively. This review presents a comparative analysis of the structures, operational frameworks, policies, and legislation governing various transplant organizations around the world. Key differences pertain to the administration of these organizations, trends in organ donation, and organ allocation policies, which reflect the financial, cultural, and religious diversity across different regions. While a global transplant organization may be out of reach, agreeing on best practices for the benefit of patients is essential.
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Affiliation(s)
- Solonas Symeou
- Medical School, University of Ioannina, Ioannina 45110, Greece
| | - Eleni Avramidou
- Department of Transplantation Surgery, Center for Research and Innovation in Solid Organ Transplantation, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Vassilios Papalois
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W120HS, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London SW72AZ, United Kingdom
| | - Georgios Tsoulfas
- Department of Transplantation Surgery, Center for Research and Innovation in Solid Organ Transplantation, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
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Ma M, Han F, Leng Q, Chen X, Tang Z, Zhang J, Luo Y, Zhang Y, Huang Z, Na N. Preoperative donor urinary UDP-Glc as an independent risk factor for delayed graft function. Front Immunol 2025; 16:1545280. [PMID: 40165952 PMCID: PMC11955600 DOI: 10.3389/fimmu.2025.1545280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2024] [Accepted: 03/03/2025] [Indexed: 04/02/2025] Open
Abstract
Background Expanded criteria donors (ECD) have the potential to greatly increase the donor organ pool but pose a higher risk of delayed graft function (DGF) post-transplantation. Uridine diphosphate-glucose (UDP-Glc) plays a significant role in extracellular signaling related to tissue damage and retains stability for detection. Donor urinary UDP-Glc level may be an appropriate and effective biomarker for predicting DGF. Methods Recipients who underwent successful kidney transplantation, with corresponding collection of donor urine samples, between June 2023 and August 2024 were included. We measured preoperative donor urinary UDP-Glc levels and analyzed their correlation with graft recovery. The study was registered in the Clinical Trial Registry (no. NCT06707272). Results Preoperative donor urinary UDP-Glc levels were different between immediated, slowed, and delayed graft function subgroups (7.23 vs. 9.04 vs. 10.13 ug/mL, p < 0.001). Donor urinary UDP-Glc level was an independent risk factor for DGF (odds ratio [OR] = 1.741, 95% confidence interval [CI]: 1.311-2.312, p < 0.001). Furthermore, donor urinary UDP-Glc showed a better predictive value for DGF (AUROC = 0.791, 95% CI: 0.707-0.875, p < 0.001), and combining donor urinary UDP-Glc and donor terminal serum creatinine improved the model predictive value for DGF (AUROC = 0.832, 95% CI: 0.756-0.908, Youden index = 0.56, sensitivity = 0.81, specificity = 0.75, PPV = 0.72, NPV = 0.83, p < 0.001). Additionally, the donor urinary UDP-Glc level was related to the recipient serum creatinine level at 1 month post-transplantation (rs = 0.475, p < 0.001). Conclusions Donor urinary UDP-Glc level is an independent risk factor for DGF and can provide surgeons with a novel strategy to predict DGF earlier and more accurately without invasive procedures. Clinical trial registration https://clinicaltrials.gov, NCT06707272 identifier.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Zhengyu Huang
- Organ Transplantation Research Institution, Division of Kidney Transplantation, Department of Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ning Na
- Organ Transplantation Research Institution, Division of Kidney Transplantation, Department of Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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Bo X, Xue F, Xia Q, He K. Investigation and self-assessment of liver transplantation training physicians at Shanghai Renji Hospital: A preliminary study. Surg Open Sci 2024; 22:24-33. [PMID: 39525882 PMCID: PMC11550166 DOI: 10.1016/j.sopen.2024.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/28/2024] [Accepted: 10/07/2024] [Indexed: 11/16/2024] Open
Abstract
Background Continuing medical education in liver transplantation is pivotal in enhancing the proficiency of liver surgeons. The goal of this study is to obtain information on all aspects of the training, enable us to pinpoint the training's strengths, and address any shortcomings or challenges. Method We conducted an online questionnaire survey, which was comprised of 33 questions, offering response options in the form of "yes/no", single choice, or multiple choice. Results A total of 59 liver surgeons actively participated in the questionnaire survey. The majority of them exhibited a comprehensive understanding of the liver transplant training program, encompassing its structure, content, and assessment format. It is noteworthy that all respondents expressed keen interest in novel course components such as medical humanities, interpersonal communication, full-process patient management, and scientific research and academic activities. The overall satisfaction with the diverse specialized training courses was notably high. Furthermore, there was a significant improvement in self-confidence among participants for performing relevant clinical practices post-training, signifying the effectiveness of the program. Notably, key determinants influencing physicians' confidence levels before and after training included accumulated clinical practice time, basic operation cases, and educational background. Conclusion This survey reveals that trainees possess a commendable grasp of the program, maintain a positive outlook, and gain substantial benefits from the training. Importantly, it underscores the need to enhance the pedagogical skills of professional training instructors, continually refine the curriculum, and serve as a foundation for informed decisions in the ongoing training of liver transplant physicians.
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Affiliation(s)
- Xiaochen Bo
- Department of Liver Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Feng Xue
- Department of Liver Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Qiang Xia
- Department of Liver Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Kang He
- Department of Liver Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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Tan SSX, Phoompoung P, Okamoto K, Chayakulkeeree M, Koh XX, Tan CK, Kong SNM, Tan TT, Chung SJ, Tan BH. Donor-derived infections-Insights from Singapore, Japan, and Thailand. Transpl Infect Dis 2024; 26 Suppl 1:e14370. [PMID: 39226139 DOI: 10.1111/tid.14370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 08/15/2024] [Accepted: 08/20/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Solid organ transplantation (SOT) has expanded significantly in Asia over past few decades. Donor-derived infections (DDIs) remain a significant concern as they may adversely impact transplant outcomes. We aim to review the existing regulatory frameworks, screening protocols, and management practices for DDIs in Asia. METHODS We reached out to transplant infectious diseases experts in Asia to provide standardized data on annual SOT numbers, incidence of DDIs, regulatory frameworks, donor and recipient screening protocols, and DDI surveillance measures. We present the data from Singapore, Japan, and Thailand. RESULTS Donor screening for HIV, hepatitis B, hepatitis C, and syphilis is mandatory in all countries. Additionally, Japan screens for HTLV-1 antibody due to its endemicity. We also reviewed the protocols for screening and prevention of endemic infections in Asia. Singapore is the only country implementing universal screening for all donors for dengue, Zika, and chikungunya via blood and urine RT-PCR. Strongyloidiasis screening is not routinely done, although some transplant centers empirically give ivermectin prophylaxis to organ recipients. Tuberculosis screening with a donor questionnaire and chest radiograph is common for deceased donors, and some centers do Interferon Gamma Release Assay test for living donors. We also found a significant gap in the surveillance and reporting of potential DDIs in Asia and the overall incidence of DDIs in Asia is unknown and likely underreported. CONCLUSION The experiences of Singapore, Japan, and Thailand offer valuable insights into current practices and the unmet needs regarding a DDI registry and call for coordinated efforts to address this critical issue in the region.
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Affiliation(s)
- Sophie Seine Xuan Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Pakpoom Phoompoung
- Department of Medicine, Division of Infectious Disease and Tropical Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Koh Okamoto
- Department of Infectious Diseases, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Methee Chayakulkeeree
- Department of Medicine, Division of Infectious Disease and Tropical Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Xiu Xian Koh
- National Organ Transplant Unit, Ministry of Health, Singapore, Singapore
| | - Chee-Kiat Tan
- Duke-NUS Medical School, Singapore, Singapore
- National Organ Transplant Unit, Ministry of Health, Singapore, Singapore
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | | | - Thuan Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Singhealth Duke Transplant Centre, Singapore, Singapore
| | - Shimin Jasmine Chung
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Singhealth Duke Transplant Centre, Singapore, Singapore
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Singhealth Duke Transplant Centre, Singapore, Singapore
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7
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Ma S, Qi R, Han S, Li Z, Zhang X, Wang G, Liu K, Xu T, Zhang Y, Han D, Zhang J, Wei D, Fan X, Pan D, Jia Y, Li J, Wang Z, Zhang X, Yang Z, Tao K, Yang X, Dou K, Qin W. Plasma exchange and intravenous immunoglobulin prolonged the survival of a porcine kidney xenograft in a sensitized, deceased human recipient. Chin Med J (Engl) 2024:00029330-990000000-01272. [PMID: 39420636 DOI: 10.1097/cm9.0000000000003338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND The primary limitation to kidney transplantation is organ shortage. Recent progress in gene editing and immunosuppressive regimens has made xenotransplantation with porcine organs a possibility. However, evidence in pig-to-human xenotransplantation remains scarce, and antibody-mediated rejection (AMR) is a major obstacle to clinical applications of xenotransplantation. METHODS We conducted a kidney xenotransplantation in a deceased human recipient using a porcine kidney with five gene edits (5GE) on March 25th, 2024 at Xijing Hospital, China. Clinical-grade immunosuppressive regimens were employed, and the observation period lasted 22 days. We collected and analyzed the xenograft function, ultrasound findings, sequential protocol biopsies, and immune surveillance of the recipient during the observation. RESULTS The combination of 5GE in the porcine kidney and clinical-grade immunosuppressive regimens prevented hyperacute rejection. The xenograft kidney underwent delayed graft function in the first week, but urine output increased later and the single xenograft kidney maintained electrolyte and pH homeostasis from postoperative day (POD) 12 to 19. We observed AMR at 24 h post-transplantation, due to the presence of pre-existing anti-porcine antibodies and cytotoxicity before transplantation; this AMR persisted throughout the observation period. Plasma exchange and intravenous immunoglobulin treatment mitigated the AMR. We observed activation of latent porcine cytomegalovirus toward the end of the study, which might have contributed to coagulation disorder in the recipient. CONCLUSIONS 5GE and clinical-grade immunosuppressive regimens were sufficient to prevent hyperacute rejection during pig-to-human kidney xenotransplantation. Pre-existing anti-porcine antibodies predisposed the xenograft to AMR. Plasma exchange and intravenous immunoglobulin were safe and effective in the treatment of AMR after kidney xenotransplantation.
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Affiliation(s)
- Shuaijun Ma
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Ruochen Qi
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Shichao Han
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Zhengxuan Li
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Xiaoyan Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Guohui Wang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Kepu Liu
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Tong Xu
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Yang Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Donghui Han
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Jingliang Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Di Wei
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Xiaozheng Fan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Dengke Pan
- Clonorgan Co., Ltd., Chengdu, Sichuan 610041, China
| | - Yanyan Jia
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Jing Li
- Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Zhe Wang
- Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Xuan Zhang
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Zhaoxu Yang
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Kaishan Tao
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Xiaojian Yang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Kefeng Dou
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Weijun Qin
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
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Tan J, Mabood Khalil MA, Kee T, Tiong HY, Khan TT, El-Madhoun I, Ishida H, Jasuja S, Ahmad G, Tang SC, Vathsala A. Deceased donor kidney transplant policies in Asia - implications on practice and recommendations for the future. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 21:100312. [PMID: 38361593 PMCID: PMC10866990 DOI: 10.1016/j.lansea.2023.100312] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/16/2023] [Accepted: 10/16/2023] [Indexed: 02/17/2024]
Abstract
Deceased donor kidney transplantation (DDKT) is common in high income Western countries with high transplantation rates. However, the utilization of deceased organs is suboptimal in Asia, due to a multitude of factors. Coherent policies are integral to the development of DDKT programs and deterrence of commercialization, but most are still at an infancy and formative stage in Asia. This review article identifies the glass ceiling effects of social, cultural, religious, political, and technical factors hampering the progress of DDKT in Asia. Additionally, it reviews the history of policy development in different countries and describes their idiosyncratic barriers and challenges. Lastly, it discusses innovative policy measures that can be undertaken to proliferate DDKT practice and curtail commercialization. The long-term ideal is to achieve regional equity and self-sufficiency, through a shared ethos of social and ethical responsibility that transcends and resonates with the different segments of the Asian community.
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Affiliation(s)
- Jackson Tan
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | | | | | | | | | | | - Hideki Ishida
- Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | | | | | - Sydney C.W. Tang
- Department of Medicine, School of Clinical Medicine, University of Hong Kong, Hong Kong
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He Q, Tan Z, Zhou L. Litigation on kidney transplantation: 10-year experience from China. Int J Surg 2023; 109:3700-3702. [PMID: 37526123 PMCID: PMC10651275 DOI: 10.1097/js9.0000000000000625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 08/02/2023]
Affiliation(s)
| | - Zhimin Tan
- Department of Anaesthesiology, West China Hospital of Sichuan University, Sichuan Province, Chengdu, People’s Republic of China
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10
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Chen T, Chao W, Zou Y, Di J, Zhou X, Zong Y, Zhang M, Yang M. Personality traits and peritoneal dialysis patients' prognosis. Ren Fail 2023; 45:2264935. [PMID: 37846973 PMCID: PMC10583605 DOI: 10.1080/0886022x.2023.2264935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023] Open
Abstract
Objective: Peritoneal dialysis (PD) requires high patient conscientiousness. Therefore, we aimed to investigate the relationship between conscientiousness score and prognosis in PD patients.Methods: The ten-item Big Five Personality Inventory's Chinese version was used to assess the conscientiousness score. Basic clinical information, prior medical history, hematological examination results, the occurrence of the first peritonitis and catheter-related infection, the start of hemodialysis, and the time of renal transplantation were collected. The patients were split into two groups, high and low conscientiousness groups, based on the mean value of the conscientiousness score. The differences in prognostic indicators were compared between groups, and the association between conscientiousness score and prognostic indicators in PD patients was assessed.Results: Enrolled PD patients were divided into low conscientiousness group 103 and high conscientiousness group 98. There were significant differences in serum albumin (p = 0.021) and iPTH (p = 0.045) between the two groups. Multivariate Cox regression analysis identified conscientiousness score as an independent risk factor for the development of first peritonitis (HR = 0.558, 95% CI 0.400-0.779, p = 0.001) and first catheter-related infection (HR = 0.544, 95% CI 0.308-0.962, p = 0.036) in PD patients. Conscientiousness score (HR = 2.377, 95% CI 1.109-5.095, p = 0.026) was independently associated with renal transplantation.Conclusion: Conscientiousness personality is closely related to the prognosis of PD patients.
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Affiliation(s)
- Tianlei Chen
- Department of Nephrology, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
| | - Wenying Chao
- Department of Nephrology, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
| | - Yun Zou
- Department of Nephrology, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
| | - Jia Di
- Department of Nephrology, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
| | - Xin Zhou
- Department of Nephrology, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
| | - Yin Zong
- Department of Nephrology, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
| | - Mengyu Zhang
- Department of Nephrology, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
| | - Min Yang
- Department of Nephrology, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
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11
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Ascher NL, Delmonico FL. Organ Donation and Transplantation in China. Transplantation 2023; 107:1880-1882. [PMID: 37606905 DOI: 10.1097/tp.0000000000004562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
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Yao Z, Liu Y, Zhan L, Qiu T, Li G, Chen Z, Fang X, Liu Z, Wu W, Liao Z, Xia W. The utilization of nanopore targeted sequencing proves to be advantageous in the identification of infections present in deceased donors. Front Microbiol 2023; 14:1238666. [PMID: 37664117 PMCID: PMC10469296 DOI: 10.3389/fmicb.2023.1238666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Background Nanopore Target Sequencing (NTS) represents a novel iteration of gene sequencing technology; however, its potential utility in the detection of infection in deceased donors has yet to be documented. The present study endeavors to assess the applicability of NTS in this domain. Methods This retrospective study comprised a cohort of 71 patients who were under intensive care at Renmin Hospital of Wuhan University between June 2020 and January 2022. The specimens were subjected to microbiological tests utilizing NTS, culture, and other techniques, and subsequently, the diagnostic accuracy of NTS was compared with conventional methods. Results Blood NTS exhibited a better agreement rate of 52.11% and a greater positive rate of pathogen detection than blood culture (50.70% vs. 5.63%, p < 0.001). In NTS of deceased donors, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii were the most frequently found bacteria, and Candida was the most frequently found fungus. Blood NTS had a considerably better sensitivity for detecting clinical bloodstream infection than blood culture (62.50%: 7.14%, p < 0.001). These findings were supported by comparisons between blood NTS and conventional microbial detection methods (such as blood culture, glucan testing, galactomannan testing, T cell spot testing for tuberculosis infection, smear, etc.). Conclusion The pathogen detection technology NTS has a high sensitivity and positive rate. It can more accurately and earlier detect infection in deceased donors, which could be very important for raising the donation conversion rate.
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Affiliation(s)
- Zhiyuan Yao
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yu Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Liying Zhan
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Tao Qiu
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Guang Li
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhongbao Chen
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiaoyu Fang
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhou Liu
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Wei Wu
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhaomin Liao
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Wenfang Xia
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Dong NG, Hu XJ, Wang HB, Chen JY, Wan S. Deeds Speak Louder Than Biased Critiques. Ann Thorac Surg 2023; 115:1087-1088. [PMID: 35525285 DOI: 10.1016/j.athoracsur.2022.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Nian-Guo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing-Jian Hu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hai-Bo Wang
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China Organ Transplant Response System, Guangzhou, China
| | - Jing-Yu Chen
- Wuxi Lung Transplant Center, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, China
| | - Song Wan
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, NT, Hong Kong, China.
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Zeng M, Li H, Song X, Jiang J, Chen Y. Factors Associated with Willingness toward Organ Donation in China: A Nationwide Cross-Sectional Analysis Using a Social–Ecological Framework. Healthcare (Basel) 2023; 11:healthcare11060824. [PMID: 36981481 PMCID: PMC10048496 DOI: 10.3390/healthcare11060824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
Improving public willingness toward organ donation is an important solution to the low organ donation rate. This study aimed to explore factors impacting public willingness for organ donation in China from a multi-agent perspective and further explore the impact of these factors on high or low willingness, using a social–ecological framework. Data from a total of 11,028 (effective rate, 94.18%) participants were analysed. Generalised linear model (GLM) and quantile regression were used to explore factors associated with willingness and high/low willingness toward organ donation, respectively. The mean willingness toward organ donation was 56.9 (range, 0–100) points. GLM regression revealed that age, family health, males, lower educational levels, and agricultural hukou were negatively associated with willingness. For personality, conscientiousness was negatively associated with willingness, whereas openness was positively associated with willingness. Health literacy perceived social support, and media utilisation were positively associated with willingness. Quantile regression further indicated that educational levels of college, bachelor, master’s, and PhD, openness, health literacy, perceived social support, and media utilisation were positively associated with organ donation willingness at all percentiles. It is necessary to adopt more targeted and diversified publicity, education, and guidance for different types of individuals. Meanwhile, social support needs to be strengthened. To enhance the willingness of the residents to donate organs, media publicity should be strengthened, particularly by using modern ways to improve their health literacy.
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Affiliation(s)
- Mengjun Zeng
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Haomiao Li
- School of Political Science and Public Administration, Wuhan University, Wuhan 430072, China
| | - Xiaohui Song
- Department of Cardiology, Renmin Hospital, Wuhan University, Wuhan 430060, China
- School of Basic Medical Science, Wuhan University, Wuhan 430062, China
| | - Jipin Jiang
- Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Correspondence: (J.J.); (Y.C.)
| | - Yingchun Chen
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan 430030, China
- Correspondence: (J.J.); (Y.C.)
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Xu Y, Lian QY, Chen A, Zhang JH, Xu X, Huang DX, He JX, Ju CR. Clinical characteristics and treatment strategy of nocardiosis in lung transplant recipients: a single-center experience. IDCases 2023; 32:e01758. [PMID: 37092136 PMCID: PMC10119885 DOI: 10.1016/j.idcr.2023.e01758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/07/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Objective Nocardia are infrequent pathogens that disproportionately afflict organ transplant recipients. The present study aimed to summarize the clinical manifestations, diagnostic approaches, and treatment strategies of nocardiosis in lung transplant recipients. Methods This retrospective study reviewed the clinical data of adult lung transplant recipients who were complicated with nocardiosis between January 2018 and December 2021 at the largest lung transplant center in South China. Results The incidence of nocardiosis was 4.2% (13/316), including 9 cases of pulmonary nocardiosis and 4 disseminated nocardiosis (blood, pulmonary and intracranial). The accuracy in diagnosing nocardiosis was 77.8% by culture and 100% by metagenomic next-generation sequencing (mNGS). Nocardia farcinica was the most common causative pathogen. Trimethoprim-sulfamethoxazole-based combination therapy was administered initially, followed by a single antibiotic as the maintained therapy, lasting for 4-8 months. Conclusions mNGS is more accurate than culture in diagnosing nocardiosis. Most patients responded well to the antibiotic therapy with combined antibiotics at the initial stage followed by a single antibiotic treatment.
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16
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吴 亚, 潘 亚. [Research Progress in Oral Diseases and Oral Microbiota of Organ Transplant Patients]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:61-65. [PMID: 36647644 PMCID: PMC10409052 DOI: 10.12182/20230160210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Indexed: 01/18/2023]
Abstract
Organ transplantation is an effective treatment for end-stage organ diseases. However, organ transplant recipients are susceptible to a wide variety of oral diseases, including gingival enlargement, periodontitis, oral mucosal diseases, oral malignant tumors, and dental caries. Oral microbiota may have played an important role in the organ transplant patients' increased susceptibility to oral diseases and is associated with adverse events after organ transplantation, which is gradually gaining more attention among scholars. We, herein, reviewed the common oral diseases, including periodontal tissue diseases, oral mucosal diseases, oral malignant tumors, and dental caries in organ transplantation patients. Furthermore, we discussed the characteristic changes in the oral microbiota of organ transplantation patients and the influencing factors of these changes. In-depth study of oral microbiota of organ transplant patients provides a reference for the prevention and treatment of relevant diseases after organ transplantation and serves an important role in oral and systemic health management of organ transplant patients.
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Affiliation(s)
- 亚红 吴
- 中国医科大学附属口腔医院 牙周病科 （沈阳 110002）Department of Periodontology, Hospital of Stomatology, China Medical University, Shenyang 110002, China
| | - 亚萍 潘
- 中国医科大学附属口腔医院 牙周病科 （沈阳 110002）Department of Periodontology, Hospital of Stomatology, China Medical University, Shenyang 110002, China
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17
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Xie Q, Lei L, Duan F, Luo Y, Luo C. Exploration of Profession Experience Among In-Hospital Organ Procurement Coordinators in China: A Qualitative Study. Transplant Proc 2022; 54:2082-2087. [PMID: 36127172 DOI: 10.1016/j.transproceed.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The gap between the supply and demand of organs is continuously increasing. The emergence of organ procurement coordinators (OPCs), to a certain extent, has decreased the gap. In China, a majority of OPCs work in hospitals that are qualified for transplants, namely in-hospital OPCs (Ih-OPCs). Their profession experiences are closely related to donation rates and indirectly reveal aspects that should be further improved. However, no data are available in China. We sought to explore Ih-OPCs' subjective feeling of the practice experience and provide targeted interventions for administrators. METHODS A project team was established and then interview outlines were listed by virtue of discussion and literature review. Furthermore, a total of 13 Ih-OPCs were selected as participants for interview. After that, the conversation was analyzed and encoded, and themes were finally identified according to phenomenology. RESULTS A total of 3 themes including positive emotions, negative emotions, and personal needs were identified, which were furthermore divided into 7 minor themes ranging from professional identity, competence improvement, recruitment methods, quality of life, workload evaluation, career prospects, and training courses. CONCLUSIONS Social support and public understanding play a pivotal role in strengthening positive emotions. Meanwhile, the administrators should put more emphasis on negative emotions and personal needs, and management system should be further optimized.
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Affiliation(s)
- Qin Xie
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing 400038, P.R. China
| | - Lei Lei
- Xinqiao Hospital, Army Medical University (Third Military Medical University), No. 83 Xinqiao Street, Shapingba District, Chongqing, 400037, P.R. China
| | - Fangjian Duan
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing 400038, P.R. China
| | - Yu Luo
- Xinqiao Hospital, Army Medical University (Third Military Medical University), No. 83 Xinqiao Street, Shapingba District, Chongqing, 400037, P.R. China.
| | - Chunmei Luo
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing 400038, P.R. China.
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18
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Xie W, Kong S, He H, Xiong H, Zhu Q, Huang P. A mixed-methods study of emotional support for families of organ donors in Hunan Province, China. Front Psychol 2022; 13:952524. [PMID: 36118472 PMCID: PMC9478748 DOI: 10.3389/fpsyg.2022.952524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Family consent is a prerequisite for the organ donation of the deceased in China. However, a large number of donors are individuals who died due to accidental injuries or unanticipated diseases, which means that most of the families of such donors have just experienced the sudden death of their loved one and have to make a donation decision in a short time. This decision may cause psychological stress and some psychological damage to the minds of relatives of the donors. In addition, cultural sensitivity also has largely caused the relatives of donors inner conflicts and contradictions. And sometimes organ donation may still be stigmatized. However, have they received any emotional support and what is their emotional support needs are some questions that need to be answered. Therefore, this study aims to investigate the emotional support, influencing factors, and needs of the family members of organ donors in Hunan Province, China. Materials and methods This is mixed-methods research that combines quantitative and qualitative research methods. A cross-sectional survey was conducted among 102 donor families using a questionnaire to investigate their emotional support status. To further understand their emotional support needs, 12 donor families participated in the semi-structured interview. Results The results confirmed that: (1) A total of 67.7% of the 102 respondents received emotional support or psychological comfort. Thus, only a small number of respondents (31.4%) felt respected by the public. (2) Emotional support came mainly from immediate family members (73.91%), and official organizations such as the Red Cross (43.48%). (3) Marital status, health status, occupation, and coping style can affect the emotional support of the donor families (p < 0.05). (4) Interview showed that the families of donors need emotional support and psychological aid from psychological professionals mostly. And they also wish to receive the understanding and respect of the public. Conclusion Most families of organ donors received emotional support from family, Red Cross, and friends, but only a minority of families of donors reported receiving respect from the public after the donation. And families of donor showed a strong need for emotional support and professional psychological aid from institutions.
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Affiliation(s)
- Wenzhao Xie
- The Third Xiangya Hospital of Central South University, Changsha, China
- Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China
- School of Life Sciences, Central South University, Changsha, China
| | - Shufeng Kong
- The Third Xiangya Hospital of Central South University, Changsha, China
- Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China
- School of Life Sciences, Central South University, Changsha, China
| | - Haiyan He
- The Third Xiangya Hospital of Central South University, Changsha, China
- Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China
- School of Life Sciences, Central South University, Changsha, China
| | - Huan Xiong
- The Third Xiangya Hospital of Central South University, Changsha, China
- Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China
- School of Life Sciences, Central South University, Changsha, China
| | - Qizhen Zhu
- The Third Xiangya Hospital of Central South University, Changsha, China
- Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China
- School of Life Sciences, Central South University, Changsha, China
- School of Medical Information Engineering, Jining Medical University, Rizhao, China
| | - Panhao Huang
- The Third Xiangya Hospital of Central South University, Changsha, China
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Panhao Huang,
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Wu X, Wang W, Li Q, Peng Z, Zhu J. Current Situation With Organ Donation and Transplantation in China: Application of Machine Learning. Transplant Proc 2022; 54:1711-1723. [DOI: 10.1016/j.transproceed.2022.03.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/26/2022] [Indexed: 11/16/2022]
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20
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Should we tolerate biased critiques in cardiothoracic surgery journals? J Thorac Cardiovasc Surg 2022; 164:e127-e129. [DOI: 10.1016/j.jtcvs.2022.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022]
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21
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Zhang Z, Liu Z, Shi B. Global Perspective on Kidney Transplantation: China. KIDNEY360 2021; 3:364-367. [PMID: 35373138 PMCID: PMC8967634 DOI: 10.34067/kid.0003302021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/08/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Zijian Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhijia Liu
- Chinese Society of Organ Transplantation of Chinese Medical Association, Beijing, China,Organ Transplant Institute, The 8th Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Bingyi Shi
- Chinese Society of Organ Transplantation of Chinese Medical Association, Beijing, China,Organ Transplant Institute, The 8th Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China
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22
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Konyn P, Ahmed A, Kim D. Current epidemiology in hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol 2021; 15:1295-1307. [PMID: 34624198 DOI: 10.1080/17474124.2021.1991792] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/07/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third-leading cause of cancer-related mortality in the world. AREAS COVERED This review will discuss risk factors, demographic differences, global trends, and the economic burden of HCC. Viral hepatitis, particularly hepatitis B virus (HBV) infection, is the most common underlying liver disease leading to HCC in those with cirrhosis. Other important risk factors include alcoholic liver disease, nonalcoholic fatty liver disease, metabolic syndrome, etc. With the introduction of direct-acting antiviral agents for hepatitis C virus infection, routine vaccination against HBV, and increasing support for robust public screening programs, the incidence rates for HCC due to viral hepatitis is falling in many countries. Meanwhile, the prevalence of obesity and metabolic syndrome are on the rise, as is NAFLD-related HCC incidence. Asia and Africa have the highest incidence rates of HCC. In multiethnic countries, racial and ethnic minorities experience disparities in HCC incidence as well as mortality, representing an essential area for improvement in terms of healthcare inequity. EXPERT OPINION Interventions to minimize the global burden of HCC aim to reduce rates of the most common risk factors and implement effective treatment of underlying etiology and comprehensive screening programs for HCC.
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Affiliation(s)
- Peter Konyn
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Donghee Kim
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
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Rela M, Rammohan A. Why are there so many liver transplants from living donors in Asia and so few in Europe and the US? J Hepatol 2021; 75:975-980. [PMID: 34111504 DOI: 10.1016/j.jhep.2021.05.036] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023]
Abstract
Acceptance of liver transplantation (LT) as an established treatment modality for end-stage liver disease has led to an exponential increase in the demand for organs, resulting in an ever-increasing gap between the availability of organs and the number of sick patients waiting for them. Interestingly, influenced by cultural, socio-economic and other constraints, the West and the East have attempted to address this problem of shortage in different ways. Living donor LT (LDLT) became polarised to the East with over 90% of LT in this region being LDLT. On the other hand, the West chose to concentrate their efforts on optimising the use of cadaveric livers with techniques such as split LT, or by using extended criteria donors (including donation after cardiac death donors) and machine perfusion devices etc. Consequently, LDLT did not find the widespread acceptance it did in the East and hence over 90% of all LT are DDLT in this region. We review each regions' perspective and attempt to provide a globally viable roadmap to bridge the widening gap between the demand and availability of livers for LT.
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Affiliation(s)
- Mohamed Rela
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India.
| | - Ashwin Rammohan
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India
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Zhao J, Liu D, Huang J, Jiang HC, Chen Y, Li HX, Li XS, Chen JY. The Low Utilization Rate of Donor Lungs in China: A Single-Center Experience. Ann Transplant 2021; 26:e931409. [PMID: 34373440 PMCID: PMC8364286 DOI: 10.12659/aot.931409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Despite the increasing number of organ donations, the utilization rate of donor lungs in China is much lower than that in many other countries. MATERIAL AND METHODS The donor lungs were evaluated before departure (stage 1), after on-site management (stage 2), and after harvesting (stage 3). Variables of donor lungs from medical institutions with lung transplant qualification (group A) and those without qualification (group B) were compared. The outcome measurements for lung recipients were early survival and primary graft dysfunction. RESULTS Among the 277 donor lungs, 140 (51%) were suitable for transplantation and 101 were sent to our institution for 62 single-lung transplantations and 50 double-lung transplantations. The acceptability rates at stage 1, stage 2, and stage 3 were 78%, 56%, and 51%, respectively. In addition, 69 (50.4%) donor lungs were abandoned for poor quality related to management, 24 (17.5%) for no adequate recipients, 15 (10.9%) for family refusal, 14 (10.2%) for organ procurement organization-related reasons, and 15 (10.9%) for other reasons. Donors in group A were ventilated longer and had longer ischemic time than those in group B. However, bronchoscopy, imaging, and oxygenation in group A achieved better results than in group B. No between-group difference in 30-day mortality or rate of grade 3 primary graft dysfunction was observed. CONCLUSIONS Problems at supply and demand ends contribute to the low utilization rate of donor lungs in China. The poor management of donor lungs and the short waiting list for lung transplantation are major reasons.
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Affiliation(s)
- Jin Zhao
- Wuxi Lung Transplant Center, Wuxi People's Hospital Affiliated with Nanjing Medical University, Wuxi, Jiangsu, China (mainland)
| | - Dong Liu
- Wuxi Lung Transplant Center, Wuxi People's Hospital Affiliated with Nanjing Medical University, Wuxi, Jiangsu, China (mainland)
| | - Jian Huang
- Wuxi Lung Transplant Center, Wuxi People's Hospital Affiliated with Nanjing Medical University, Wuxi, Jiangsu, China (mainland)
| | - Hua-Chi Jiang
- Wuxi Lung Transplant Center, Wuxi People's Hospital Affiliated with Nanjing Medical University, Wuxi, Jiangsu, China (mainland)
| | - Yuan Chen
- Wuxi Lung Transplant Center, Wuxi People's Hospital Affiliated with Nanjing Medical University, Wuxi, Jiangsu, China (mainland)
| | - Hui-Xing Li
- Wuxi Lung Transplant Center, Wuxi People's Hospital Affiliated with Nanjing Medical University, Wuxi, Jiangsu, China (mainland)
| | - Xiao-Shan Li
- Chinese Lung Transplantation Registry and Data Management Center, Wuxi, Jiangsu, China (mainland)
| | - Jing-Yu Chen
- Wuxi Lung Transplant Center, Wuxi People's Hospital Affiliated with Nanjing Medical University, Wuxi, Jiangsu, China (mainland)
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25
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Fu Y, Cao Y, Wang H, Zhao J, Wang Z, Mo C, Shi X, Feng G, Song W. Metabolic outcomes and renal function after simultaneous kidney/pancreas transplantation compared with kidney transplantation alone for type 2 diabetes mellitus patients. Transpl Int 2021; 34:1198-1211. [PMID: 33896062 PMCID: PMC8362174 DOI: 10.1111/tri.13892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 01/01/2023]
Abstract
In this study, we aimed to compare the metabolic outcomes, renal function, and survival outcomes of simultaneous pancreas and kidney transplantation (SPK) and kidney transplantation alone (KTA) among end‐stage kidney disease (ESKD) patients with type II diabetes mellitus (T2DM). Patients with ESKD and T2DM who underwent KTA (n = 85) or SPK (n = 71) in a transplant center were retrospectively reviewed. Metabolic profiles, renal function, and survival outcomes were assessed repeatedly at different follow‐up time points. Propensity score procedures were applied to enhance between‐group comparability. The levels of renal and metabolic outcomes between SPK and KTA over time were examined and analyzed using mixed‐model repeated‐measures approaches. The median follow‐up period was 1.8 years. Compared with KTA, SPK resulted in superior metabolic outcomes and renal function, with lower levels of glycated hemoglobin (HbA1c; P = 0.0055), fasting blood glucose (P < 0.001), triglyceride (P = 0.015), cholesterol (P = 0.0134), low‐density lipoprotein (P = 0.0161), and higher estimated glomerular filtration rate (eGFR; P < 0.001). SPK provided better metabolic outcomes and renal function. The survival outcomes of the recipients and grafts were comparable between the two groups.
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Affiliation(s)
- Yingxin Fu
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Yu Cao
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Hui Wang
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Jie Zhao
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Zhen Wang
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Chunbai Mo
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Xiaofeng Shi
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Gang Feng
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Wenli Song
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
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Biotech in China 2021, at the beginning of the 14th five-year period ("145"). Appl Microbiol Biotechnol 2021; 105:3971-3985. [PMID: 33937929 PMCID: PMC8088835 DOI: 10.1007/s00253-021-11317-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 02/08/2023]
Abstract
Abstract As China assumes a more and more dominant role in global science, this mini-review attempts to provide a bird’s eye view on how the bio-digital revolution impacts China’s biosciences and bioindustry. Triggered by top-down political programs and the buildup of an impressive infrastructure in science, information technology, and education, China’s biomedical and MedTech industries prosper. Plant and animal breeding programs transform agriculture and food supply as much as the Internet of things, and synthetic biology offers new opportunities for the manufacturing of specialty chemicals within the Chinese version of a “bioeconomy.” It is already becoming apparent that the new five-year period “145” (2021–2025) will further emphasize emission control, bioenvironmental protection, and more supply of biomass-derived energy. This review identifies key drivers in China’s government, industry, and academia behind these developments and details many access points for deeper studies. Key points
Biotechnology in China Biomedical technology New five-year period
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