ObjectiveTo explore the imaging manifestations of posttransplantation lymphoproliferative disease (PTLD) for making a further understanding of this disease and its imaging diagnosis. MethodsBy the method of litera-ture review, the imaging manifestations of PTLD in the abdomen, thorax, head and neck, and central nervous system were summarized, respectively, and also the epidemiologic features, pathogenesis and pathologic classification were reviewed. ResultsPTLD is a spectrum of lymphoproliferative diseases following transplantation mainly caused by Epstein-Barr virus and immunosuppressive therapy with different pathologic types.Lesions at imaging examinations may be the first clue to diagnose, and the appearance of PTLD at imaging can vary depending on the region. ConclusionImproving the cognition of PTLD and the imaging features plays a pivotal role in identifying the presence of disease, guiding tissue sampling, and evaluating response to treatment.
ObjectiveTo analyze the clinical outcomes of cardiac surgery in patients after kidney transplantation underwent immunosuppression therapy. Methods Clinical data of 6 patients (including 4 males and 2 females aged from 27 to 66 years) undergoing cardiac surgery after kidney transplantation with immunosuppression between January 2011 and October 2013 in Beijing Anzhen Hospital were retrospectively analyzed. Two patients underwent off pump coronary artery bypass grafting, 3 patients underwent aortic valve replacement and 1 patient underwent mitral valve replacement. The interval between kidney transplantation and cardiac operation was 8.5±1.7 years (range, 6-10 years). ResultsAll the operations were performed successfully without in-hospital death and complications. Operation time was 237.0±93.0 min. Cardiopulmonary bypass (CPB) time was 101.3±16.7 min. Aortic cross-clamping time was 75.6±9.7 min. in-hospital stay was 17±6 d. There was a statistical difference in preoperative and postoperative left ventricle ejection fraction (63.5%±4.5% vs. 56.5%±5.8%, P < 0.05), as well as preoperative and postoperative left ventricular enddiastolic diameter (54.5±8.5 mm vs. 43.7±6.8 mm, P < 0.05), but there was no statistical difference in preoperative and postoperative serum creatinine levels (103.7±15.1μmol/L vs. 106.6±34.7μmol/L, P > 0.05). The mean follow-up time of the 6 patients was 4-15 months. The follow-up rate was 100%. All the patients were in cardiac function NYHA classⅠ-Ⅱ. And the quality of life was improved. ConclusionCardiac operations for kidney transplant recipients undergoing immunosuppressive treatment are effective and safe as long as appropriate perioperative treatment are taken.
ObjectiveTo analyze the clinical effects of allograft orthotopic heart transplantation.MethodsThe clinical data of 36 patients with allograft orthotopic heart transplantation performed in the Heart Centre of Nanjing First Hospital from January 1, 2014 to January 1, 2019 were retrospectively analyzed. There were 31 males and 5 females, aged 23-65 (46.2±8.8) years. Protopathy diseases of recipients included dilated cardiomyopathy in 33 patients, end-stage coronary heart disease in 2 patients, and end-stage valvular heart disease in 1 patient. Heart transplantations were performed through double vena cava anastomosis. Immune induction during operations was treated with a combination therapy of both bariximab and methylprednisolone. Postoperatively, all patients were treated with a new triple immunosuppression protocol: FK506+cellcept+prednisone.ResultsDuring the perioperative period, 1 patient died of severe infection. For 8 patients with heart failure, after adjustment and intra-aortic balloon pump, the cardiac function of all the 8 patients improved. For 5 patients with renal failure, after continuous renal replacement therapy, the renal function of all the patients returned to normal. One patient died of graft failure after 1 year of follow-up. The follow-up time for each patient postoperatively differed from 3 to 49 months with an average time of 16±4 months while the 1-year survival rate was 97.1% (34/35). Among them, 10 patients were marginal donors, with no significant differences between conventional donors and them. Conclusion For end-stage heart diseases, heart transplantation is one of the effective treatment methods in China with fine early- and middle-term curative effects. Reasonable application of intra-aortic balloon pump, continuous renal replacement therapy and other adjuvant treatments and the new triple immunosuppression protocol can significantly improve the success rate of heart transplantation, reduce the occurrence of acute and chronic rejections. The application of marginal donors can alleviate the current situation of shortage of donors to some extent.