Experience Of Organ Transplantation And Analysis Of Multivariate Factors That Influence Survival With Lung Cancer In Recipients

Explores in organ transplantation have been continuing since the first kidneytransplantation in human was reported in 1906. With the development of surgicaltechnique and immunosuppression agents, organ transplantation has been the highestand hardest field in medical science. Current clinic focuses of transplantation are onlong-term outcome and intense recipients as well as acute and chronic rejection, suchas multiple organ transplantation, transplant-related malignance, cardiovasculardisease post transplantation and pregnancy in recipients. This article will provide theresearch on combined liver-kidney transplantation and analysis of multivariatefactors that influence survival with lung cancer in recipients as follows:Partâ… Experience with combined liver-kidney transplantationChapterâ… Experience with combined liver-kidney transplantationChapterâ…¡A liver graft from the same donor protect a kidney in combinedliver-kidney transplantationPartâ…¡Analysis of multivariate factors that influence survival with lungcancer in recipientsChapterâ… Multivariate risk factors survival analysis of de novo lung cancerin organ transplant recipients Chapterâ…¡Multivariate risk factors survival analysis of pre-existing lungcancer in organ transplant recipientsPartâ… Experience with combined liver-kidney transplantationChapterâ… Experience with combined liver-kidney transplantationObjective To describe the indications, surgical techniques, clinical experiences andtreatment of complications of combined liver-kidney transplantation (CLKT).Methods 18 cases subject to CLKT from Oct 2001 to June 2006 were reviewed inour center. 13 men and 5 women. Median age 57.9ys, age range 41 to 71ys. Primarydiseases as follow: 8 polycystic liver and kidney with uremia, 2 alcoholic cirrhosiswith uremia, 7 liver cirrhosis led by Hepatitis B with uremia, 1 liver cirrhosis led byHepatitis C and grafted renal failure 14 years after transplantation. Livertransplantations were performed with piggyback style or standard techniques withoutveno-venous bypass. Kidney transplantation followed routines. Care should be takenon third hepatic portal during hepatectomy. Immunosuppressive therapy includedATG or basilimab as introduction and Tacrolimus/Mycophenolate mofetil/steroid.The period of follow up ranges from 2 months to 4 years and 10 months.Results All the 18 operations were completed successfully. 16 are alive till nowwith good liver and kidney function. Among the 16 cases, the longest survival time is4 years and 10 months, 2 patients' are over 3 years, 6 are over 2 years, 3 are over 1year and 3 are within 1 year. ldied of myocardial infarction on the eighteenth monthafter Tx. The other died of cytomegalovirus (CMV) infection of lung on thirteenthmonth. Complications included 1 acute rejection, 1 secondary hemorrhage, 1myocardial infarction, hydrothorax in 4, and pulmonary infection in 3. Except for 2dead cases, other compilations were rescued after therapy.Conclusions CLKT is an effective treatment method for liver and renal function failure. Proficient surgical skill and immediate management of complications arecrucial for successful CLKT.Chapterâ…¡A liver graft from the same donor protect a kidney in combinedliver-kidney transplantationObjective To compare the improvement of renal graft function of combined liver-kidney transplantation(CLKT) and kidney alone transplantation(KAT).Methods The data of 18 CLKT and 18 contralateral kidney alone transplantationswere analyzed. The two groups Were matched in the following variables: age, gender,blood type, cold and warm ischemic time of the grafts, human leukocyte antigen(HLA), primary renal disease, and use of immunosuppressants. Incidences of acuterejection, chronic rejection, delayed graft function and improved serum creatinine (Cr)on discharge were compared.Results The rates of acute rejection and delayed graft function were much lower inCLKT than that in KAT with significant difference (5.56% vs 33.3% P=0.035; 0vs 27.8% P=0.045). CR incidence was lower in CLKT without significantdifference (0 vs 11.1% P=0.486) . There was much lower Cr lever in CLKT thanthat in KAT (77.6±23.4umol/L vs 123.1±23.8umol/L P=0.000).Conclusions Analysis of the data indicates an allograft enhancing perfect effect ofliver transplantation on the renal allograft in combined liver- kidney transplantation. Partâ…¡Analysis of multivariate factors that influence survivalwith lung cancer in recipientsLung cancer ranks among the most commonly occurring malignancies and currentlyis the leading cause of cancer-related deaths worldwide. In the United States, lungcancer is the most common cause of cancer-related deaths in men as well in women,with an incidence approximating 70 per 100,000 in individuals. Lung cancercurrently accounts for one-third of all cancer-related deaths in the European Union.In China, the mortality rate from lung cancer in males now approximates 33 per100,000, and death rates are expected to substantially increase over the next severaldecades. Transplant recipients develop malignancies at a rate of 1-2%approximately per year but this is higher (5-10%) for certain types of cancer (skin,lymphoma, kidney) and the overall rate of 1-2% increases in subsequent years withlonger exposure times to immunosuppressive drugs. However, the effects of organtransplantation on lung cancer incidence in recipients are unclear, literatures onwhich are limited to single center and small samples. Multivariate risk factorssurvival analysis of organ transplantation recipients with de novo (n=662) andpre-existing (n=28) lung cancer reported to the Israel Penn International TransplantTumor Registry from November 1968 to December 2006 was performed.Chapterâ… Multivariate risk factors survival analysis of de novo lung cancer inorgan transplant recipients Objective To investigate the risk factors that influence survival of de novo lungcancer in organ transplant recipientsMethods Multivariate risk factors survival analysis of lung cancer post organtransplantation reported to the Israel Penn International Transplant Tumor Registryfrom November 1968 to December 2006 was performed.Results Lung cancer presented 44 months (median) (range 0-1054) in 662 patientspost organ transplantation. Overall survival was 33%. Death risks were increased forthose who were older (P=0.033) at transplant, diagnosed with small cell lung cancer(P=0.004), and administered with ATG/ALG/OKT₃ (P=0.032) for induction therapy.Surgery (P=0.000) and chemotherapy (P=0.001) were associated with increasedsurvival. Stage makes difference in survival time in recipients (P=0.000). Nodifferences in death risk for age at diagnoses, gender, race, time from transplantationto diagnosis, donor type, transplantation organ and other immunosuppression wereidentified.Conclusion1. Lung cancer takes rapid progress and grim outcome under immunosuppression.2. Death risk was increased for patients with older age at transplantation, histology ofsmall cell lung cancer, induction therapy with ATG/ALG/OKT₃ and later stage oftumor.3. Death risk was improved for those receiving surgery and chemotherapy.4. We would suggest immunosuppression regulation with discontinuation of antimetabolites, and 25-50ï¼…reduction in CNI dose.5. Close surveillance is needed for the recipients that used to be heavy smokers.6. Similar registry as IPITTR should be set up in China transplant community forbetter outcome and follow up for the transplant recipients.Chapterâ…¡Multivariate risk factors survival analysis of pre-existing lungcancer in organ transplant recipientsObjective To investigate the risk factors that influence survival of pre-existing lungcancer in organ transplant recipientsMethods Multivariate risk factors survival analysis of pre-existing lung cancer inorgan transplant recipients reported to the Israel Penn International Transplant TumorRegistry from November 1968 to December 2006 was performed.Results The IPITTR has reviewed a series of 28 cases of pre-existing lung cancer intransplant recipients. Stage data were not included for analysis because of incompleterecords. No differences in death risk for age at diagnoses or transplantation, gender,race, wait time from diagnosis to transplantation, donor type, transplantation organand immunosuppression agents were identified. Recurrences in 6 (21ï¼…) patientsoccurred within 5 years post transplantation. 9 patients died within 5 years. Overallsurvival was 68ï¼…and mortality was 32ï¼…. Conclusion1. In literature, transplantation is generally acceptable for only patients with earlystage disease. Overall survival rate has not been good.2. Survival cures of lung cancer do not begin to flatten until 5 years post diagnosis ingeneral populations. We would recommend 5 years of disease free prior totransplantation.