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Objective: To summarize the experience with perioperative management of multiorgan transplantation., Methods: From October 2001 to January 2005, 19 patients received multiorgan transplantation in Nanfang Hospital, including 6 with simultaneous kidney-pancreas transplantation (SKPT), 12 with combined liver-kidney transplantation (CLKT), and 1 with simultaneous liver-pancreas transplantation (SLPT). The surgical techniques, application of immunosuppressants, and complication management were reviewed., Results: All transplantation procedures were performed successfully. The transplantation-related complications included tacrolimus-induced renal toxicosis in 1 (5.3%) case, acute graft rejection in 3 (15.8%) cases, intestinal hemorrhage in 2 (10.5%) cases, intra-abdominal hemorrhage in 1 (5.3%) case, and lung infection in 1 (5.3%) case, all of which were cured after proper treatment., Conclusions: Donor selection, good quality of the donor organ, proper surgical approaches, adequate use of the-mmunosuppressants, and prevention of complications are essential to the success of multiorgan transplantation.

Objective: To investigate the relationship of the renal allograft weight and the recipient's body weight with allograft function after transplantation., Methods: The correlation of the renal allograft weight, the recipient's body weight, the ratio of the allograft weight to the recipient body weight and the mean serum creatinine (sCr) 3 years after transplantation were measured in 108 kidney recipients., Results: The allograft weight was inversely correlated with the mean sCr 3 years after transplantation (P<0.01)., Conclusion: The renal allograft weight, recipient's body weight and the ratio of allograft weight to recipient's body weight are important indicators of the long-term allograft function after transplantation, and recipients with greater body weight should receive allografts of higher weight.

Objective: To study the influence of hepatitis C virus (HCV) infection on the clinical outcome of kidney transplantation., Methods: The recipient/graft survival, the incidence of acute/chronic rejection and cause of death in 86 HCV-infected recipients of renal transplantation were compared with those in another 86 recipients without HCV infection., Results: HCV-infected recipients had significantly shorter 5-year survival (74.4%) than those without HCV infection (87.2%, P<0.01). The 1-year (94.2%/90.7% vs 96.8%/96.0%) and 3-year recipient/graft survival rates (88.4%/79.1% vs 90.7%/87.2%), the incidence of acute/chronic rejection (31.3% vs 21.2%, and 12.5% vs 6.5%) and the 5-year graft survival (73.3%/81.4%) were comparable between the two groups (P>0.05). Hepatic disease was identified as the primary cause of mortality., Conclusions: HCV infection may affect the long-term survival of the recipients with kidney transplantation, and therefore should be considered as a relative contraindication of kidney transplantation.

Objective: To evaluate the clinical effect of abdominal multiorgan transplantation in patients with multiorgan failure., Methods: Simultaneous kidney-pancreas transplantation (SKPT) with enteric drainage of pancreatic exocrine secretions was performed in 2 patients with type 1 diabetes and end-stage renal disease. A combined liver-kidney transplantation (CLKT) was done in a 66-year-old patient with alcoholic liver cirrhosis and uremia. Simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantation (SLPT) was performed in a patient with hepatitis B, hepatocirrhosis, hepatic cellular cancer, and type 1 diabetes., Results: The function of kidney grafts became normal 5 days postoperatively and insulin-independent after treatment with low dose insulin for 10 days in the 2 SKPT patients. For the CLKT patient, both transplanted organs rapidly achieved normal functions after operation but suffered-acute liver graft rejection on postoperation day 10 and the rejection was controlled after methylprednisolone pulse therapy. In the SLPT patient, insulin was withdrawn 5 days after operation, liver allograft function recovered well. All the patients are alive with stable allograft function after following-up for 29, 26, 9 and 6 months, respectively., Conclusions: Abdominal multi organ transplantation was effective therapy to patients with multiple organ failure. SLPT can reduce acute pancreas rejection and promote the recovery of liver allograft.

Objective: To study the effect of combined transplantation of the liver and the pancreas in diabetic patients with end-stage liver disease, and explore the optimal surgical procedure., Methods: Simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantations were performed in a patient diagnosed as having chronic hepatitis B, hepatocirrhosis, hepatic cellular cancer, and insulin-dependent diabetes. Immunosuppression therapy utilized prednisone, tacrolimus (FK506), mycophenolate mofetil (MMF), and simulect. The function of the liver graft, serum amylase and lipase, blood glucose, and C-peptide were monitored after transplantation., Results: Insulin was withdrawn at the 6th day after operation, good liver allograft functional recovery was achieved, without such complications as pancreatitis, thrombosis, and localized infections., Conclusion: End-stage liver disease with concomitant insulin-dependent diabetes is the indication for combined liver-pancreas transplantations, for which simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantations may constitute the optimal surgical approaches as the primary choice.

Objective: To compare the efficacy and safety of tacrolimus (FK506)- versus cyclosporine (CsA)-based immunosuppression protocol in the treatment of patients with renal transplantation for diabetic end-stage renal disease., Methods: A total of 64 patients with end-stage renal disease were randomized into FK506 (n=33) and CsA (n=31) group after cadaveric renal transplantation, the former group adopting small-dose FK506 therapy with low trough concentration, and the latter receiving CsA therapy. The dose of insulin was adjusted according to blood glucose level of the patients after the operation. The incidence of acute rejections, blood glucose level, the dose of insulin and changes in blood pressure, lipid metabolism and liver function were compared between the two groups., Results: The 1-year patient/graft survival rates were 96.97%/93.94% in FK506 group and 96.77%/90.32% in CsA group. Four patients (12.12%) developed acute rejection in the FK506 group, while 11 (35.48%) did in the CsA group during the first year after the operation (P<0.05). The dose of the insulin of the FK506 group (34.35 U/d, 14.09 U/d) was not significantly different from that in the CsA group (28.15 U/d, 13.05 U/d) at the first month and 1 year after the operation (P>0.05). One year after the operation, 21 patients (63.63%) required anti-hypertension treatment, 5 (15.15%) needed anti-hyperlipidemia treatment and 3 (9.09%) had abnormal liver function in FK506 group, while in the CsA group, 28 patients (90.32%) needed anti-hypertension therapy, 13 (41.94%) received anti-hyperlipidemia treatment and 11 (35.48%) showed signs of abnormal liver function, with significant differences between the two groups., Conclusions: Small-dose FK506 therapy with low concentrations is effective in the postoperative management of patients with renal transplantation for diabetic end-stage renal disease, with only mild adverse effect. FK506 is comparable with CsA in terms of the effect on glucose metabolism of the patients.

Objective: To study the surgical techniques, perioperative management, management of infections and graft rejection in patients with combined liver-kidney transplantation (CLKT)., Methods: CLKT was performed in a 66-year-old patient with alcoholic liver cirrhosis and uremia. Lavage in situ with University of Wisconsin (UW) solution of the donor organs and en hoc resection was performed. Orthotopic liver transplantation (OLT) and routine kidney transplantation were respectively carried out. Immunosuppression therapy consisted of tacrolimus (FK506), antithymocyte globulin (ATG), mycophenolate mofetil (CellCept, MMF) and corticosteroid., Results: Both of the transplanted organs rapidly recovered normal functions after operation, and acute rejection of the liver graft occurred on day 10 after operation but was controlled after methylprednisolone pulse therapy. The patient fully recovered and was discharged from hospital on day 29 after operation., Conclusions: CLKT is effective against both liver and renal function failure. Well-matched HLA tissue typing, proficient surgical skills, adequate application of immunosuppressants and effective management of postoperative complications are crucial for successful CLKT.

Objective: To explore the possible causes of transplant renal artery stenosis (TRAS) in cadaveric transplant recipients., Method: We retrospectively analyzed multiple factors that may contribute to TRAS (including the patients' age, presence of diabetes, cold ischemic time, acute rejection episode, cytomegalovirus infection, serum cholesterol, LDL cholesterol, pre-operative dialysis, number of donor renal arteries, which side of donor kidney, type of surgical anastomosis, different protocols of inductive and maintenance drug therapy) in 18 recipients with transplant renal artery stenosis after cadveric renal transplantation from Jan. 2000 to Dec. 2001 in comparison with another 566 non-TRAS recipients who underwent the transplantation during the same period., Results: There was a higher incidence of acute rejection in the TRAS group than non-TRAS group (66.67% vs 5.48%, P<0.01), and no significant difference was noted between TRAS and non-TRAS cases in terms of the pre-operative dialysis, presence of diabetes, cold ischemic time, number of donor renal arteries, whith side of donor kidney, type of surgical anastomosis, different protocols of inductive and maintenance drug therapy, cytomegalovirus infections and serum and LDL cholesterols., Conclusion: The occurrence of TRAS in cadaveric allografts is associated with acute graft rejection episode, suggesting the importance of the treatment of acute graft rejection in the prevention of TRAS.

Objective: To evaluate the role of panel reactive antibody (PRA) screening and human leukocyte antigen (HLA) typing in renal transplantation., Methods: PRA screening and HLA typing were performed in 1 700 patients eligible for the first group of renal transplantation who had 3 to 6 HLA matches in HLA-A, B and DR with the donor, and in cases positive for PRA, plasma exchange was conducted. Another 423 patients who did not receive PRA screening or HLA typing constituted the second group. The changes of immune variables, incidences of acute rejection and the effect of HLA-A, B, DR matching on long-term graft survival were observed., Results: In 1 700 cases of group 1, post-transplantation CsA dose was reduced to 5 to 7 mg*kg(-1)*d(-1) and the graft function recovery time ranged from 2 to 16 d, averaging 5 d. Acute graft rejection occurred in 252 (14.8%) cases, but no hyper-acute rejection was observed. The 1-, 3- and 5-year patient/graft survival rates were 98.6%/96.7%, 93.1%/87.3% and 88.1%/83.6% respectively. In group 2, CsA dose ranged from 8 to 12 mg*kg(-1)*d(-1) and the graft function recovery time was 4 to 30 d, averaging 13 d. Hyper-acute rejection occurred in 9 (2.1%) and acute rejection in 198 (46.8%) cases, and the 1-, 3- and 5-year patient/graft survival rates were 86.7%/76.3%, 72.5%/67.9% and 69.5%/59.3% respectively., Conclusions: Negative PRA and good HLA matching can eliminate the incidences of hyper-acute rejection, decrease the rate of acute rejection and improve both patient and graft survival rates.