Zheng Ss

Surgical intervention of severe post-ERCP-pancreatitis accompanied with duodenum perforation.

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure widely used to diagnose and treat conditions of biliary or pancreatic ductal system. The post-ERCP severe acute pancreatitis (SAP) accompanied with duodenum perforation is rare but serious, remaining a challenge in clinic. In this study we report two such cases. Two Chinese women were treated for clinical suspicion of bile duct obstruction and underwent ERCP after admission. Both developed duodenum perforation and SAP after ERCP, and were managed in the intensive care unit (ICU) and required an organ-failure support. The surgical intervention of the peri-pancreatic debridement with lumber-abdominal compound incisions and postoperative washing and drainage was performed, and the two patients recovered well. The therapeutic effect of the peri-pancreatic debridement with lumber-abdominal compound incisions combined with postoperative washing and drainage in the patients of severe post-ERCP-pancreatitis (PEP) and duodenum perforation is satisfactory.

Infusion of nonmyeloablative bone marrow alleviates acute rejection reaction in liver allotransplantation

Objective: To study the effect and implication of nonmyeloablative donor specific bone marrow (DSBM) infusion on the immunoreaction of liver allotransplantation. Methods: Orthotopic liver transplantation model was used in this study. Groups were set as follows: Group I, syngeneic control (Wistar-to-Wistar); Group II, acute rejection (SD-to-Wistar); Group III, acute rejection treated with cyclosporine A (CsA) by intramuscular injection (SD-to-Wistar+CsA); Group IV, bone marrow infusion at 7 d pretransplantation followed by short-term CsA treatment (SD-to-Wistar+DSBM); Another group of short-term CsA treatment preoperatively without bone marrow infusion was also set as control. General characteristics and survival time were observed. Histological grades of rejection were determined by pathological examination. IL-2 and IFN-γ level in peripheral blood and donor liver were detected respectively by Enzyme-Linked Immuno-Sorbent Assay (ELISA) and Western blot. Chimerism of donor cells was measured by PCR for a male-specific marker (Y-chromosome-specific sequence, Sry). Results: No signs of rejection were found in Group I. Acute rejection occurred in both Group II and the short-term CsA treated group. All the recipients died at (9:_15) d posttransplantation with a median survival time of (10.7±0.5) d and (11.2±2.4) d, respectively. Only mild rejection could be seen in Group III. In Group IV, 4 out of 6 recipients had long-term survival (>100 d), the histological grade of rejection was significantly lower than that of Group II, so did the expression level of IL-2 and IFN-γ in both peripheral blood and grafted liver. Y-chromosome-specific sequence (Sry) of male SD rats could be detected in the bone marrow, spleen and thymus of female recipients at 15 d after bone marrow infusion. Conclusion: Mild preconditioning nonmyeloablative donor specific bone marrow infusion can enhance chimerism formation in recipients, alleviate the rejection of liver allotransplantation and prolong survival of liver allotransplantation.

Efficacy and safety of basiliximab in liver transplantation for patients with hepatitis B virus‐related diseases: a single centre study

We aim to evaluate the efficacy and safety of basiliximab in liver transplantation (LT) for patients with hepatitis B virus‐related diseases.

Enteric-coated mycophenolate sodium: an update

Mycophenolate mofetil (MMF), the first mycophenolic acid (MPA) formulation, has been used as a major immunosuppressive regimen in organ transplantation for over a decade. Treatment with MMF in combination with calcineurin inhibitors (CNIs) and steroids results in a spectacular decrease of acute rejection and prolongs allograft survival. MMF inhibits the proliferation of T and B lymphocytes by targeting the de novo pathway for purine biosynthesis (1,2). MPA also suppresses dendritic cell maturation, decreasing its capacity for antigen presentation to T lymphocytes. However, MMF is often associated with gastrointestinal (GI) complications that can lead to dose reduction or discontinuation. Such dosage reductions increase the incidence of acute rejection and lead to subsequent graft loss (3–6). Enteric-coated mycophenolate sodium (EC-MPS) is an enteric-coated formulation based on the sodium salt of MPA. It has been demonstrated to provide equivalent MPA exposure and to have similar effects on inosine monophosphate dehydrogenase (IMPDH) enzyme activity. This Perspective aims to summarise the recent data on the clinical implications of EC-MPS treatment in organ transplantation and other diseases.