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简介：Splanchniccirculationistheprimarymechanismthatregulatesvolumesofcirculatingbloodandsystemicbloodpressureinpatientswithcirrhosisaccompaniedbyportalhypertension.Recently,interesthasbeenexpressedinmodulatingsplanchniccirculationinpatientswithlivercirrhosis,becausethiscapabilitymightproducebeneficialeffectsincirrhoticpatientsundergoingalivertransplant.Pharmacologicmodulationofsplanchniccirculationbyuseofvasoconstrictorsmightminimizevenouscongestion,replenishcentralbloodflow,andthusoptimizemanagementofbloodvolumeduringalivertransplantoperation.Moreover,splanchnicmodulationminimizesanyhighportalbloodflowthatmayoccurfollowingliverresectionandthesubsequentlivertransplant.Thiseffectissignificant,becausehighportalflowimpairsliverregeneration,andthusadverselyaffectsthepostoperativerecoveryofatransplantpatient.Anincreaseinportalbloodflowcanbeminimizedbyeithersurgicalmethods（e.g.,splenicarteryligation,splenectomyorportocavalshunting）oradministrationofsplanchnicvasoconstrictordrugssuchasVasopressinorterlipressin.Finally,modulationofsplanchniccirculationcanhelpmaintainperioperativerenalfunction.Splanchnicvasoconstrictorssuchasterlipressinmayhelpprotectagainstacutekidneyinjuryinpatientsundergoinglivertransplantationbyreducingportalpressureandtheseverityofahyperdynamicstate.Theseeffectsareespeciallyimportantinpatientswhoreceiveatoosmallforsizegraft.TerlipressinselectivelystimulatesV1receptors,andthuscausesarteriolarvasoconstrictioninthesplanchnicregion,withaconsequentshiftofbloodfromsplanchnictosystemiccirculation.Asaresult,terlipressinenhancesrenalperfusionbyincreasingbotheffectivebloodvolumeandmeanarterialpressure.

简介：Inarecentstudy,researcherstookadultfemaleFischerratsandperformedaspinalcordtransectionontheminanattempttostudythegrowthoftransplantedearly-stageneurons.Whensuchearly-stageneuronsweretransplantedintoratssufferingfromparalysis,remarkableaxonalgrowthwasobserved.Theresultwasmanynewrelaycircuitsthatformed,whichsignificantlyimprovedfunction,

简介：AbstractObjective:This study aims to describe presenting characteristics of patients diagnosed with non-invasive chronic rhinosinusitis (CRS) following liver or kidney transplant and determine factors associated with disease-related complications, selection of endoscopic sinus surgery (ESS), and disease resolution in this population.Study design:Retrospective chart review.Setting:An academic tertiary care center (Mayo Clinic, Rochester, Minnesota).Subjects and methods:Liver and kidney transplant recipients evaluated by Mayo Clinic otolaryngologists for CRS between 1998 and 2018 were identified. Univariate and multivariate logistic regression analyses were used to determine patient factors and treatment modalities associated with developing complications, selection of ESS, and disease resolution.Results:Fifty-seven patients met inclusion criteria. No patients developed intraorbital or intracranial complications of their CRS. Multivariate modeling demonstrated that the presence of polyps (P = 0.036) was associated with undergoing ESS within one year of presentation. A higher Lund-Mackay (LM) computed tomography score (P = 0.023) and older age (P = 0.018) were significantly associated with decreased disease resolution. No other factors were significantly associated with the use of endoscopic sinus surgery within one year of otolaryngology presentation or resolution of CRS in this cohort.Conclusion:The risk of developing CRS-related intraorbital or intracranial complications in this immunecompromised patient cohort may be lower than originally thought. For liver- and kidney-recipients stable on immunosuppressive medication for many years, prognostic factors for CRS may mirror those for immunocompetent patients.

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简介：AbstractSince December 2019, increasing attention has been paid to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in Wuhan, China. SARS-CoV-2 primarily invades the respiratory tract and lungs, leading to pneumonia and other systemic disorders. The effect of SARS-CoV-2 in transplant recipients has raised significant concerns, especially because there is a large population of transplant recipients in China. Based on the current epidemic situation, this study reviewed publications on this virus and coronavirus disease 2019 (COVID-19), analyzed common features of respiratory viral pneumonias, and presented the currently reported clinical characteristics of COVID-19 in transplant recipients to improve strategies regarding the diagnosis and treatment of COVID-19 in this special population.

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简介：AbstractBackground:BK polyomavirus (BKPyV)-associated nephropathy (BKPyVAN) is an important cause of dysfunction and failure of renal transplants. This study aimed to assess the diagnostic performance of morning urine specific gravity (MUSG) in diagnosing BKPyVAN in kidney transplant recipients.Methods:A total of 87 patients, including 27 with BKPyVAN, 22 with isolated BKPyV viruria, 18 with T cell-mediated rejection(TCMR), and 20 with stable graft function, were enrolled in the First Affiliated Hospital of Sun Yat-Sen University from March 2015 to February 2017. MUSG at biopsy and during a follow-up period of 24 months after biopsy was collected and analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine the ability of MUSG to discriminate BKPyVAN.Results:At biopsy, the MUSG of BKPyVAN group (1.008 ± 0.003) was significantly lower than that of isolated BK viruria group(1.013 ± 0.004, P < 0.001), TCMR group (1.011 ± 0.003, P = 0.027), and control group (1.014 ± 0.006, P < 0.001). There was no significant difference in MUSG among the isolated BK viruria group, TCMR group, and control group (P = 0.253). In BKPyVAN group, the timing and trend of MUSG elevate were consistent with the timing and trend of the decline of viral load in urine and plasma, reaching a statistical difference at 3 months after treatment (1.012 ± 0.003, P < 0.001) compared with values at diagnosis. ROC analysis indicated that the optimal cut-off value of MUSG for diagnosis of BKPyVAN was 1.009, with an area under the ROC curve (AUC) of 0.803 (95% confidence interval [CI]: 0.721–0.937). For differentiating BKPyVAN and TCMR, the optimal MUSG cut-off value was 1.010, with an AUC of 0.811 (95% CI: 0.687–0.934).Conclusion:Combined detection of MUSG and BKPyV viruria is valuable for predicting BKPyVAN and distinguishing BKPyVAN from TCMR in renal transplant recipients.

简介：Inanerawhencardiactransplantpatientsaresurvivingmoreimmediateissuesofrejectionandinfection,theprevalenceofmorechronicissuessuchascardiacallograftvasculopathy(CAV)isrising.Thiscasedescribesaman20yearsaftercardiactransplantwithhisfirstpresentationofCAV.Acutemyocardialinfarctionwasdiagnosedonthebasisofsymptomsandbiochemicalmarkersandoncoronaryangiography,andhewasfoundtohaveacriticalstenosisofthemidportionoftheleftanteriordescendingartery.Itwaselectedtotreatthispercutaneouslywithafullybioresorbablevascularscaffold(BVS)becauseofthediffusenatureofthediseaseprocess.Thiswassuccessfullyperformedwithopticalcoherencetomographyguidance.TheuseofBVSinCAVhasnotbeenwellstudied.ThisisoneoffewcasereportsdescribingtheuseofBVSinCAV.

简介：AbstractBackground:The calcineurin inhibitor (CNI)-based immune maintenance regimen that is commonly used after renal transplantation has greatly improved early graft survival after transplantation; however, the long-term prognosis of grafts has not been significantly improved. The nephrotoxicity of CNI drugs is one of the main risk factors for the poor long-term prognosis of grafts. Sirolimus (SRL) has been employed as an immunosuppressant in clinical practice for over 20 years and has been found to have no nephrotoxic effects on grafts. Presently, the regimen and timing of SRL application after renal transplantation vary, and clinical data are scarce. Multicenter prospective randomized controlled studies are particularly rare. This study aims to investigate the effects of early conversion to a low-dose CNI combined with SRL on the long-term prognosis of renal transplantation.Methods:Patients who receive four weeks of a standard regimen with CNI + mycophenolic acid (MPA) + glucocorticoid after renal transplantation in multiple transplant centers across China will be included in this study. At week 5, after the operation, patients in the experimental group will receive an additional administration of SRL, a reduction in the CNI drug doses, withdrawal of MPA medication, and maintenance of glucocorticoids. In addition, patients in the control group will receive the maintained standard of care. The patients’ vital signs, routine blood tests, routine urine tests, blood biochemistry, serum creatinine, BK virus (BKV)/cytomegalovirus (CMV), and trough concentrations of CNI drugs and SRL at the baseline and weeks 12, 24, 36, 48, 72, and 104 after conversion will be recorded. Patient survival, graft survival, and estimated glomerular filtration rate will be calculated, and concomitant medications and adverse events will also be recorded.Conclusion:The study data will be utilized to evaluate the efficacy and safety of early conversion to low-dose CNIs combined with SRL in renal transplant patients.Trial registration:Chinese Clinical Trial Registry, ChiCTR1800017277.