13:14,8,Aug,2006 | (664/0/0) | Original

kidney transplant management


HC Network Home> Pharmaceutical Industry> Pharmaceutical Policies and Regulations> Regulations document keyword search technology management practices kidney transplant
2007/4/29/10: 34

(Ix) equipment
Magnetic resonance imaging (MRI), X ray computer tomography (CT), color Doppler ultrasonic diagnostic apparatus, bedside X ray cameras, fiber cystoscope, fiber mirror pelvis, pulmonary function analyzer, kidney transplant-specific instruments, rapid frozen section equipment; donor organ harvesting and preservation of drugs and equipment.
(X) has at least five clinical renal transplantation capacity of practitioners working hospital, after a kidney transplant with the knowledge and skills training, and adapted to carry out kidney transplants and other professional and technical personnel.
Second, the basic requirements for personnel
(A) of the renal transplant physician
1, to obtain "certificates of practicing doctors" scope of practice for the surgery.
2 Department of Urology, 10 years of clinical experience, participation in clinical renal transplantation more than 5 years, and has more than doctors, deputy director of the qualifications of professional and technical positions.
3, after a kidney transplant recognized by the Ministry of Health training base systems training and qualifications.
4, by two or more applications with the ability of clinical renal transplantation physicians recommend at least one physician called the outer court.
5, the last 3 years as a performer than a year to complete the difficult outside the kidney transplant urologic surgery less than 50 cases.
(B) of the anesthesiologist
1, MD, deputy director with the anesthesia professional and technical positions over professional qualifications.
2, after organ transplant anesthesia professional training and qualifications.
(C) other related health professionals
After the liver transplantation system of professional training and qualifications.
Third, the basic requirements of technical management
(A) strictly abide by the Ministry of Health, the clinical application of human organ transplant technology experts developed the Organic kidney transplant clinical application specification.
(B) the removal of the kidney consistent with aseptic requirements; the principle of organ cold ischemia time less than 24 hours, you must use a dedicated organ preservation solution.
(C) the need for blood before kidney transplantation, cross-matching, tissue matching and panel reactive antibodies (PRA) testing.
(D) Each established kidney transplant patients treated group, patients who have renal transplantation by the ability of clinical application as the hospital physicians, patients should develop a reasonable treatment and management programs.
(E) Establishing a sound system of follow-up after renal transplantation, were followed up in accordance with regulations, record.
(F) medical institutions to carry out kidn
ey transplants each year not less than 30 cases of kidney transplantation 1-year survival rate of not less than 85%, 3-year survival rate of not less than 70%, 5-year survival rate of not less than 60%.
Clinical application of renal transplantation with the ability of physicians as patients who completed a year of not less than 15 cases of kidney transplants.
(Vii) Medical institutions and physicians received a kidney transplant on a regular basis in accordance with the provisions of clinical competency assessment techniques, including case selection, surgical success rate, complications, medical incidents, postoperative patient management, 1,3,5-year survival in kidney transplant rate, quality of life of patients, follow-up information and medical records quality.
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kidney transplant management

I help in the Medical Section, the need for organ transplant rules and regulations such as 'kidney transplant' 'corneal transplant' 'peripheral blood stem cell' transplant system of the division of responsibilities; materials management system; equipment management system; special drugs management system; confidentiality; file management system; patient follow-up system; self-examination system; staff code of conduct; could have been engaged in the business, suddenly engage in administration, and to do so many systems, death of me really hard, find mentors to help you! Thank you! Quality control standards for liver transplantation
Liver transplantation since 1963 was first used by the United States, Starzl clinic, along with the development of surgical technique, anesthesia, monitoring system, progress and development of potent immunosuppressive agents, has been increasingly used in clinical and end-stage liver disease proved to have better efficacy. Liver transplantation in China started late, and because conditions of factors, the development of relatively slow. Since the late 90s of last century, liver transplantation in China created an upsurge, increasing unit carried out and achieved good results. However, liver transplantation is complicated, many factors affect the treatment, so its definitely help to improve the quality control of treatment. Because of this, through their own experience and learn from some successful experiences, developed a liver transplant quality control standards.
First, the standard donor
The source of donor organs is the main body of brain death and non-heart beating donor body donor in recent years, as the source of donor organ shortage, donor source extended to the living donor.
1, the choice of living donor
Conditions must be met:
1), the donor must be determined over time interval of the two on the basis of fully informed consent to the;
2), must be the receptor for a direct or sub-immediate family members;
3), for there must be no chronic disease;
4) for the recipient's ABO blood type must be compatible, but there is no stored for 2 years and can be detected by the ABO blood group antibodies who are not required.
Completely meet the above conditions, the donor must be planned with a comprehensive medical examination including:
1), medical, social and family medical history, mental evaluation;
2), a strict physical body;
3), laboratory tests: blood, lymphatic drug cross-match test, blood biochemistry (including liver function, kidney function, electrolytes, glucose, lipase, C-reactive protein, etc.), coagulation function tests, arterial blood gas analysis, thyroid function tests , lipid analysis, a full set of hepatitis C virus, herpes simplex congealed, cytomegalovirus, EB virus, HIV, pregnancy test for women of childbearing;
4), chest radiograph, ECG and exercise ECG, pulmonary function tests, body plethysmography map;
5), celiac artery and superior mesenteric arteriography;
6), children with Alagille syndrome donor for endoscopic retrograde cholangiopancreatography (ERCP).
Check if the above conditions were obviously not suitable for surgery should be excluded as donors. In addition, the following conditions for those who can not be used as:
1), cardiovascular disease risk factors: smoking, hypertension, hypercholesterolemia, obesity, use of contraceptives, a history of venous thrombosis and pulmonary embolism, low anti-coagulation factor III, low-C protein. For the smoking and the use of contraceptives must be stopped 3 months before surgery;
2), mental instability: surgical fears and doubts on the donor, family relationship problems, financial problems after predictable and professional issues.
2, the choice of donor body
Because each individual's situation is different, choose the conditions for possible changes in the larger body. The choice of the donor body, should meet the following conditions:
1), immune selection: Because the liver is a preferential immune organs, immunological requirements relatively low. Choose between the donor and recipient ABO blood type only requires the same or compatible.
2), non-immune selection
(1), physical health, brain death, blood circulation and stability;
(2), brain death within 10 days prior to intensive care;
(3), liver warm ischemia less than 15min, no long period of cardioplegia, no recovery time and shock;
(4), no acute and chronic difficult to control bacteria, tuberculosis, viral and fungal infections;
(5), no HIV and AIDS infection;
No liver and systemic malignancy;
(7), no poisoning, a serious abdominal injury;
No recent liver, gall bladder surgery;
(9), no hepatitis, alcoholism, drug abuse, malnutrition and liver cirrhosis;
(10), brain tumors, no systemic metastasis;
(11), skin cancer, no systemic spread;
(12), no severe liver metabolic diseases;
(13), no hepatitis virus infection;
(14), liver and kidney function was normal.
Second, the receptor Standard
Receptor selection is the first step in an organ transplant, and transplant patients long-term effects and survival are closely related.
1, the major adult liver transplant recipients for the following diseases:
(1), liver cirrhosis
(2), cholestatic cirrhosis
(3), alcoholic cirrhosis
(4), sclerosing cholangitis
(5), chronic aggressive hepatitis
, Acute or subacute liver failure (mostly the virus, caused by drug or snake venom)
(7), liver degeneration
, Budd-Chiari syndrome
(9), polycystic liver disease, liver cysts
(10), Caroli disease (cystic expansion of intrahepatic bile duct)
(11), diffuse hepatic hydatid disease
(12), primary liver cancer without distant metastasis, vascular invasion by non-
(13), liver retransplantation
2, in children, the main target of liver transplantation for congenital biliary atresia and in patients with congenital metabolic diseases:
(1), congenital biliary atresia
(2), liver degeneration
(3), tyrosinemia
(4), galactosemia
(5), glycogen storage syndrome type I and type â…£
Nerve myelin phospholipid accumulation disease (Niemann-Pick disease)
(7), α1-antitrypsin deficiency
, Type II Hyperlipoproteinemia
(9), congenital non-hemolytic jaundice
(10), phenylpyruvic acid in urine
(11), sea-blue histiocyte syndrome
(12), severe combined immunodeficiency
(13), urea cycle enzyme deficiency
(14), hemophilia A and B
(15), neonatal hepatitis outbreak
(16), familial cholestatic
3, the receptor hospital check
Before liver transplantation, recipients need to do a detailed history taking and physical examination. In addition to carefully check the physical signs of liver disease, we must also watch for jaundice, ascites and signs of portal hypertension. Laboratory tests include: blood, DIC complete, carbon dioxide combining power, renal function; serum electrolytes; a full set of liver function, blood glucose, blood ammonia, alpha fetoprotein; HBsAg, HbeAg; blood culture and sensitivity test; routine determination of serum total complement , IgA, IgG, IgM, and HLA typing; urine, urine three bile, urine ketone, urine sugar, urine culture and sensitivity test; stool, stool, sputum, throat swab for bacterial culture and sensitivity. It should also be as electrocardiogram, chest radiograph, abdominal B ultrasound, color ultrasound, CT, MRI, selective arteriography when necessary, for special checks.
Third, the technical standards for liver transplantation
Liver transplantation is a highly collaborative work, requiring a relatively high transplant unit comprehensive medical level, close coordination between various departments. The level of liver transplantation, a direct impact on the quality of transplants. In terms of its technology, including donor's cut technology, liver resection techniques and liver disease implantation.
1, donor technical standards for cut
In our case, the donor is currently the main source of fresh non-brain-dead bodies, in order to shorten the warm ischemic time reduce the damage caused by the graft, the operation requires fast, skilled, without damage to other organs. Therefore, surgery and organ harvesting techniques have certain requirements.
(1), patients were asked
The technique of liver cut line must have a more solid basis for abdominal surgical operation, familiar with the anatomy of the abdomen, at least 5-7 times over to help others cut through the liver, at least for the high qualification titles Hospitalization or above the intermediate level of migration surgeon.
(2), technical requirements
Cut principles: to ensure a good donor hepatic artery, portal vein, common bile duct anatomy of the right length of clear-cut and the liver, inferior vena cava, and retention of a certain length of the ligament of liver. Hepatic inferior vena cava is usually near the right atrium at the cut off, liver renal vein and inferior vena cava in the following cut, portal vein, together with cutting off the superior mesenteric vein, hepatic artery should be cut to the celiac artery and abdominal aorta. To prevent intraoperative bypass revascularization is required, usually harvested iliac vessels to spare. The first liver graft trimming the door not too much separation.
Technology cut the use of international donor has been the standardization of multiple organ perfusion in situ gravity quickly cut technology. Quick abdominal big "cross" cut (straight incision from the xiphoid down to the pubic symphysis, transverse incision in the navel, up to the left and right sides of the anterior axillary line) Rufu, fully reveal the abdominal organs. Cut donor liver warm ischemia time required <10min, no damage, no pollution, good perfusion, even without pale spots.
2, graft repair of technical standards
(1), patients were asked
Requires surgery have a very solid hepatobiliary surgery technology and rich clinical experience, able to complete hepatic resection surgery, and has served as the first assistant of 8 to 10 times the liver repair experience. Title at least should be the high qualification or above the intermediate level hospital doctors transplant surgeon.
(2), technical requirements
Donor liver was cut, it should be trimmed at low temperature mainly as necessary to facilitate the operation of plant and liver when the identification of the pipeline. Separation of the pipeline repair required a good donor no damage, excess tissue can not be left too much detail to avoid planting the liver after ligation of bleeding.
3, the technical standard liver resection patients
Liver resection for liver transplant patients in the most difficult step, in particular, have had abdominal surgery for the receptor. Different receptors in the abdominal cavity and the situation is different, changed greatly, which adds to the difficulty of liver resection. Therefore, patients who have higher requirements and technology.
(1), patients were asked
Requires surgery have a very solid hepatobiliary surgery technology and rich clinical experience, able to complete hepatic resection surgery, and has served as the first assistant of 10 ~ 20 liver resection for liver transplantation experience. Title should be at least or above the subtropical high, there is extensive clinical experience in hepatobiliary surgery experts.
(2), technical requirements
For the choice of different operations, cut the request of the liver are different. Liver transplantation does not require separation of the classic third portal, only requires the free hepatic inferior vena cava after the End of the liver after complete resection. The piggyback liver transplantation and inferior vena cava due to the retention, separation of the third portal, the difficulty of operation is relatively large.
The exact requirements of bleeding, careful separation. Should be clear cut liver abdominal anatomy, fully reveal the first portal, the second hepatic portal blood vessels and other channels at and no damage. Piggyback liver transplantation required at the third short hepatic portal vein without tearing, and precise ligation. Liver transplantation for hepatocellular carcinoma, ask for a higher tumor-free technology.
4, the donor liver implanted standards
Implantation of donor hepatic artery reconstruction including reconstruction of portal vein, inferior vena cava reconstruction of outflow tract reconstruction and enlightenment. The surgical technique of surgery and requirements for:
(1), patients were asked
Patients must have a rich vascular surgical techniques, can strictly abide by the principle of vascular anastomosis, to ensure the smooth reconstruction of blood vessels. Patients must undergo a rigorous training in anastomosis of small vessel anastomosis patency rate should be above 95%.
(2), surgical technical requirements
Requires microsurgical techniques and highly vascular anastomosis. Vascular anastomosis requires no stricture and no anastomotic leakage, no embolism and thrombosis; bile duct reconstruction requires that no stenosis, no bile leakage; plants placed moderate liver, no outflow tract obstruction and so on.
In the liver explant, if not guarantee the time of anhepatic phase within an hour, it is recommended that vein - venous bypass (VV. Transplant units need to bypass the pump and other equipment, and required dialysis sector support and cooperation.
Fourth, postoperative monitoring standards
After liver transplantation as surgical trauma, the condition changes quickly immunosuppressant, after complicated by infection. Therefore, the recipient should be in the ICU ward care after about a week.
1, the transplant ICU, standard equipment
As a special liver transplant patients, transplant ICU ward of some requirements. With ultra clean laminar flow equipment, improved monitoring systems, breathing machines, bedside film machine, color Doppler, MARS artificial liver, biochemistry analyzer, blood glucose monitors and other equipment in order to conduct timely monitoring and postoperative patients treatment.
2, the transplant ICU nursing work, personnel requirements
Transplant ICU staff work by a high quality of the staff. ICU nursing care must undergo a rigorous training, proficiency in the care and rescue for severe and can grasp the general knowledge of transplantation, transplant recipients are familiar with the dynamic observation of the patient's condition changes. Postoperative care should:
(1) Dynamic observation of the disease
1), observation of vital signs using ECG, within 24 hours after surgery measured every 30-60 minutes, temperature, pulse, respiration, blood pressure 1. If the vital signs were stable future, may be appropriate to extend the measurement interval.
2) to observe the situation and found the wound oozing bleeding.
3), observe the mind and the recovery time of postoperative recovery time, patients were observed state of consciousness, feelings and activities of the limbs in order to prevent possible complications.
4), observed temperature changes in body temperature regularly, if necessary, take precautionary measures. Fever on the basis of the anti-infection primarily based physical cooling.
5) was observed in patients without acute rejection attention to psychiatric symptoms, body temperature, appetite, sleep and the amount of bile and color, combined with changes in blood biochemistry, timely detection of the occurrence of acute rejection.
6), observe the stool by stool color and character, combined with clinical symptoms and signs, to some extent the situation on the reaction function of the liver.
7), observe the proper performance of the drainage tube fixed the drainage tube drainage tube to maintain patency, pay attention to the drainage of fluid volume and nature of the alert to whether the new blood, and detailed records.
(2) to prevent the occurrence of infectious complications
Note that the patients were placed in isolation disinfection disinfection single room, room temperature of about 200C to maintain, and regularly disinfect the room.
1) to strengthen the oral care with compound borax solution or 5% sodium bicarbonate mouth, clean the oral foreign body, throat swab 1-2 times a week training.
2) the prevention of biliary tract infection during the biliary drainage canal irrigation, and replacement of catheter angiography, should be strictly sterilized, remain absolutely sterile.
3) keep the wound dry and free from contamination and timely change dressings, keep the wound dry, sterile dressing operation of the attention.
4), laying the foundation to maintain the integrity of the skin care, to prevent skin damage, to avoid bedsores.
(3) Note supine
Because after liver transplantation has not been fixed, in order to avoid liver displacement of the head, are likely caused by vascular anastomosis bending, pressure and affect blood circulation, patients must pay attention to posture. Anesthesia when the patient was supine unawakened; to be fully awake consciousness, blood pressure was stable, the desirability of recumbency bit mild, will head up 30 degrees; sat up after a week of not more than 45 degrees; get out of bed after 10 days activities.
(4) to maintain airway patency
If the patient is conscious, encourage it will cough up sputum, cough, should pay attention to protect the abdominal incision; If the patient is completely awake, we should always pay attention to suction; for tracheotomy patients, should be routine care after tracheotomy.
3, the transplant ICU staff required on duty
Transplant ICU, mainly by the duty anesthesiologist, ICU doctors and transplant surgeon doctor more staff, monitoring and management of postoperative changes in the disease. Medical division of labor subjects, timely and correctly handle various situations that occurred after surgery.
V, liver transplantation facilities, technology and management system requirements
(A), agencies set requirements
1, three hospitals and tertiary hospital level of technology with specialist hospitals;
2, to carry out liver transplant clinic project with the equipment conditions, technical personnel and base;
3, the competent department for legal or other conditions.
(B) of the facility requirements
1, a separate ward, dedicated more than 10 beds, wards and beds set up specifically to meet the requirements for transplant patients in the laminar flow unit (500 / m bacterial content of the following); ward points common area, isolation and buffer zones, with central oxygen, the center to attract and closed-circuit television surveillance systems and air purification and disinfection equipment,
2, with national technical standards for the intensive care unit (ICU), more than 5 beds, fully equipped, such as air purification equipment, multi-function monitor, breathing machine, bed B extra fine equipment, and equipped with bio-pump bypass, blood recovery, blood, biochemical monitoring instruments;
3, the operating room 40 square meters, the layout is reasonable, consistent with laminar flow clean sterile requirements;
4, the clinical transplantation laboratory: to carry out biochemical, blood, immune, pathogen and pathology; carry out rapid tissue typing (HLA), lymphatic toxicity (CDC), panel reactive antibodies (PRA) determination of the diagnosis and monitoring of rejection, a variety of immunosuppressive agents (CSA, FK506) concentration determination and so on.
5, Room hemodialysis: hemodialysis machine 10 or above, completion of emergency dialysis, conventional dialysis, bedside dialysis, plasma exchange, ultrafiltration and other technical skills alone.
6, the animal laboratory: the laboratory of animal liver transplantation and the necessary equipment.
(C), equipment requirements
1, diagnostic monitoring equipment requirements:
(1) the necessary equipment: computer-assisted X ray tomography (CT), quick frozen section equipment, in vitro venovenous bypass pump, color Doppler ultrasonic diagnostic equipment, intensive care systems, portable X-ray imaging system; gastrointestinal fiber endoscopy, pulmonary function tester
(2) There should be equipment: digital subtraction angiography (DSA), zymogram detector, detector hormones and cellular immune function detector.
2, surgical equipment requirements:
Necessary equipment: special equipment liver transplantation (liver transplantation, including the classic instruments and equipment piggyback liver transplantation), ECG and other portable defibrillator necessary surgical equipment, a cold light source, good lighting, cardiopulmonary bypass machine , blood dialysis filtration device.
(D), technical personnel requirements
All technical personnel qualifications must be made by the health administrative department or official in preparing for registration appointments.
1, diagnostic personnel requirements:
(1) one or more medical laboratories liver transplantation, with titles above the intermediate level;
(2) 5 or more medical imaging diagnosis of hepatobiliary and pancreatic, including one or more senior technical titles;
(3) two or more doctors of liver pathology, in which one or more senior technical titles.
2, surgical personnel requirements:
(1) surgeon: general surgery in the liver and bile duct more than 5 years of professional work; surgery surgeon is a senior technical titles, surgeon must be able to complete more than 15 cases of liver surgery and cut more than 20 cases of liver resection, and in the domestic and foreign organ transplant center for further study of liver transplant more than six months;
(2) Surgical Nurses: 5 or more skilled, knowledge of the operation with hepatobiliary surgery nurses, nurse or more titles of which more than 3;
(3) anesthesia personnel: 3 or more familiar with hepatobiliary surgery and transplantation and anesthesia anesthesia group of doctors, including one or more senior technical titles.
3, intensive care unit personnel: five or more familiar with the intensive care professional perioperative organ transplantation and blood purification technology to the intensive care group, and in the endocrine and cardiovascular round of Division 3 months or more, of which two or more senior technical titles.
4, others: blood bank staff, with titles above the intermediate level more than 1.
(E), comprehensive technical requirements
1, surgery to implement a strong unit of Hepatobiliary and Pancreatic Surgery and liver transplants based on the work of the successful completion of hepatobiliary and pancreatic tumors, about half of liver resection and pancreaticoduodenectomy, etc.;
2, must successfully complete each year more than 50 cases of kidney transplant surgery, more than 20 cases of liver transplants, more than 5 cases of pancreas-kidney transplantation surgery, 1 year survival rate of 90% or more. Medical records, records meet the requirements.
(F), the management system
1, the general management system: hospital management requires the establishment of the management system improvement, such as case management, quality control, hospital infection control, equipment management system;
2, special management system:
(1) liver transplant specialist division of labor and responsibilities of relevant personnel;
(2) diagnosis and treatment of liver transplant technical specifications, operating procedures;
(3) and the corresponding liver transplant administration management system.
3, the establishment of medical ethics agencies, and a corresponding system of work. Living donor renal transplantation quality control standards
As for the kidney shortage of dead bodies, and the effect of transplantation in order to pursue a better, more and more living donor kidney transplantation medical attention. Living donor renal transplantation technical difficulties, equipment, demanding, and expensive. *** Benefits for the protection of patients, standard of living donor renal transplantation in clinical use, and ensuring public health, the development of the project technical quality control standards.
[Institutional setup needs]
1, three hospitals and tertiary hospitals level of technology with specialist hospitals;
2, with the kidney transplant organ transplant clinics and other large items of equipment, technical personnel and work base.
3, the competent department for legal or other conditions.
[Facility requirements]
1, a separate ward, dedicated more than 15 beds, wards and beds set up specifically to meet the requirements for transplant patients in the laminar flow unit (500 / m bacterial content of the following); ward points common area, isolation and buffer zones, with central oxygen, the center to attract and closed-circuit television surveillance systems and air purification and disinfection equipment,
2, with national technical standards for the intensive care unit (ICU), more than 5 beds, fully equipped, such as air purification equipment, multi-function monitor, breathing machine, bed B extra fine equipment, and equipped with bio-pump bypass, blood recovery, blood, biochemical monitoring instruments;
3, the operating room 40 square meters, the layout is reasonable, consistent with laminar flow clean sterile requirements;
4, the clinical transplantation laboratory: to carry out biochemical, blood, immune, pathogen and pathology; carry out rapid tissue typing (HLA), lymphatic toxicity (CDC), panel reactive antibodies (PRA) determination of the diagnosis and monitoring of rejection, a variety of immunosuppressive agents (CSA, FK506) plasma concentration and so on.
5, Room hemodialysis: hemodialysis machine 10 or above, completion of emergency dialysis, conventional dialysis, bedside dialysis, plasma exchange, ultrafiltration and other technical skills alone.
6, the animal laboratory: the laboratory of animal kidney transplantation and the necessary equipment.
[Equipment requirements]
1, diagnostic monitoring equipment requirements:
(1) the necessary equipment: computer-assisted X ray tomography (CT), quick frozen section equipment, in vitro venovenous bypass pump, color Doppler ultrasonic diagnostic equipment, intensive care systems, portable X-ray imaging system; gastrointestinal fiber endoscopy, pulmonary function tester
(2) There should be equipment: digital subtraction angiography (DSA), zymogram detector, detector hormones and cellular immune function detector.
2, surgical equipment requirements:
Necessary equipment: a kidney transplant-specific instruments, such as ECG defibrillator transplant necessary surgical equipment, a cold light source, good lighting, cardiopulmonary bypass machine, blood dialysis filtration device.
[Technical staff required]
All technical personnel qualifications must be made by the health administrative department or official in preparing for registration appointments.
1, diagnostic personnel requirements:
(1) 1 Transplantation Laboratory more than doctors, with titles above the intermediate level;
(2) 2 or more medical imaging diagnosis of urinary system, including a more senior technical titles;
(3) two or more doctors of renal pathology, in which one or more senior technical titles.
2, surgical personnel requirements:
(1) the surgeon: in general surgery, bleeding outside the professional or kidney transplant 5 years professional work; surgery surgeon is a senior technical titles, surgeon must participate in more than 30 cases of kidney transplant surgery and organ transplantation in the center of domestic and foreign more than six months for further study;
(2) Surgical Nurses: 5 or more skilled, knowledge of the operation with the urology nurses, including nurse more than 3 or more titles;
(3) anesthesia personnel: 3 or more familiar with the urology and organ transplantation anesthesia anesthesia group of doctors, including one or more senior technical titles.
3, intensive care unit personnel: five or more familiar with the intensive care professional perioperative organ transplantation and blood purification technology to the intensive care group, and Department of Nephrology and Urology in the Division 3 months or more wheels, of which two or more senior technical titles.
4, others: blood bank staff, with titles above the intermediate level more than 1.
[General technical requirements]
1, surgery to implement a strong unit of Urology and Kidney Transplantation basis for the work;
2, must successfully complete each year more than 50 cases of kidney transplant surgery, 1 year survival rate of 90% or more. Medical records, records meet the requirements.
[Management system]
1, the general management system: hospital management requires the establishment of the management system improvement, such as case management, quality control, hospital infection control, equipment management system;
2, special management system:
(1) kidney transplant specialist division of labor and responsibilities of relevant personnel;
(2) diagnosis and treatment of renal transplantation technical specifications, operating procedures;
(3) kidney transplant management institutions and the corresponding management system.
3, the establishment of medical ethics agencies, and a corresponding system of work.
[Indications]
General requirements for the age of 15 to 55 years old, but the age range of transplant recipients is increasing, children older than kidney transplantation and kidney transplantation 55 years old, as long as can be carefully selected to obtain satisfactory results. Recipients without active infection before surgery, heart, lung, liver and other vital organs no significant damage, general condition can tolerate transplant. The wide range of primary disease, mainly
1. Glomerular nephritis: (1) and idiopathic crescentic glomerulonephritis after infection; (2), membranous nephropathy; (3) mesangial capillary glomerulonephritis (I, II type) ; (4) IgA nephropathy; (5) anti-GBM nephritis; (6), focal glomerular sclerosis; (7), Henoch-Schonlein purpura glomerulonephritis.
2. Chronic pyelonephritis: completely control the infection before transplantation.
3. Genetic disease; (1), hereditary nephritis; (2) congenital bilateral polycystic kidney disease; (3) renal medullary cystic change.
4. Metabolic diseases: (1) diabetic nephropathy; (2) hyperlipidemia oxalate nephropathy; (3) light acid polycythemia; (4) diffuse blood vessels in skin tumors; (5) renal amyloidosis; (6), gouty nephropathy.
5. Urinary tract obstruction.
6. Hypertensive nephropathy.
7. Toxic diseases: (1) analgesic potency nephritis; (2) opioid abuse nephropathy; (3) heavy metal poisoning.
8. Systemic disease: (1) systemic lupus erythematosus nephritis; (2) vasculitic nephritis; (3) progressive sclerosis glomerulonephritis.
9. Hemolytic uremic syndrome.
10. Tumors: (1) embryonic kidney tumor; (2) renal cell carcinoma; kidney cancer patients 1 year after transplantation, the recurrence rate is higher, but the tumor cured 1 year after transplant is not a taboo.
11. Congenital malformations: (1), congenital renal hypoplasia; (2) horseshoe kidney.
12. Acute irreversible renal failure: (1) bilateral renal cortical necrosis; (2) acute tubular necrosis.
13. Kidney serious injury
[Contraindications]
1. Systemic diffuse malignant lymphoma, metastatic cancer patients with clear.
2. Refractory heart failure.
3. Chronic respiratory failure.
4. Severe vascular disease.
5. Progressive liver disease.
6. Systemic serious infection, active tuberculosis.
7. Severe congenital malformations of urinary system.
8. Clotting mechanism disorders.
9. Psychosis.
In addition, people with ulcer disease before transplantation to cure; old tuberculosis, easy to activate after transplantation, we must be cautious; hepatitis B surface antigen (HBsAg) positive patients, although not as a transplant taboo, but choices have to be careful.
[Donor selection]
1. HLA genetic pending points
Human leukocyte antigen major histocompatibility antigens, as is the variety of receptors induced by the material basis for rejection. To reduce the incidence of rejection, there must be a better HLA match.
2. Blood selection
Principle can be implemented blood transfusion, the 0-type O donor can be supplied by the rest of the blood type, A-type can only supply the receptor type A or AB, B-type receptor for B or AB, AB AB type by type only body before they can accept. Blood group antigen-antibody reaction but also induce hyperacute rejection of the body paradox, its clinical manifestations and antibody drug caused lymph hyperacute rejection can not be identified. Therefore, examination should include blood group ABO blood group and Rh blood group system so common.
3. Lymphatic drug test
Receptor lymph in vivo toxicity test is to test the specificity of anti-donor antibody levels. These antibodies cause hyperacute rejection is the most important factor. Lymphatic drug test more than 20% cell death is an absolute contraindication to kidney transplantation, if the dead cells of the 10% to 20% for plasma exchange technology can be used, 1-2 times per week. After consecutive 2-4 weeks to re-do the lymphatic drug test, until less than 10% before transplantation. General surgery is the first - days need to repeat it.
4. Donor Age
Too young, renal development is not yet complete but the body still in the developmental stage, bad for future growth. Too old. Aging organ function, renal function can not be guaranteed. A special donor vessels in the 18-60 years age limit.
5. The health status of the donor
Living donor kidney transplantation, not only to ensure the success of renal transplantation, but also to do though to ensure the safety of the donor. Kidney transplantation with influence on the success of their own safety or for the following diseases, the body should not be considered as a kidney donor:
(1) cardiovascular diseases: such as a variety of organic heart disease, hypertension, arteriosclerosis and so on.
(2) urinary system diseases: glomerular disease, renal disease, nephritis or renal pelvis, urethra and bladder stone road over the urinary system such as infection or congenital malformations.
(3) infectious disease cases: various types of hepatitis, AIDS, cytomegalovirus infection, the TB infection tube.
(4) cancer; prepare the body organ systems, including various malignancies.
(5) mental illness: a variety of mental patients, untreated or treated poorly or often repeatedly made. Intellectual dysgenesis should be their legal guardian, requested by the legal department before they can be notarized.
[Operation timing]
Living donor kidney transplantation for the elective surgery. Sufficient time for preoperative preparation. In the preoperative examination. Receptor emerging issues should be corrected one by one. The receptor is more tolerate surgery, reduce complications, in order to improve the success rate of transplantation.
1. Irreversible end-stage renal disease patients, serum creatinine rose to 707.2 ~ 884.0umol / L, the line should start dialysis treatment, and actively support given medical treatment, then the results of tissue typing to select the ideal kidney for a kidney transplant .
2. On the accepted rules of dialysis patients, there little or no urine, worsening anemia, cardiac enlargement, heart failure and other recurring objects of these are urgent transplantation, shall be as soon as possible to choose a suitable kidney donor renal transplant.
3. Late in uremic patients, such as coma or serious cardiovascular complications, you should not rush to surgery, and to take effective enough dialysis treatment, supplemented by medical supportive care in a stable condition after undergoing surgery.
4. If the patient has been receiving dialysis treatment, there are still difficult to control high blood pressure medication, pericarditis, hyperparathyroidism or progressive multiple neuritis, etc., should create conditions for early kidney transplant carried out.
[Receptor preoperative preparation]
1. Preoperative examination:
(1) history and physical examination: should be carefully detailed history and systemic physical examination and found that the disease may exist.
(2) blood chemistry, serology and immunology tests: blood count, electrolytes, liver and kidney function, blood coagulation function and virological tests such as the AIDS virus (HIV), cytomegalovirus (CMV), herpes simplex virus (HSV) and hepatitis virus; preoperative immunological tests such as T lymphocyte subsets, such as mixed lymphocyte culture, immunological monitoring for postoperative control.
(3) Special inspections: routine chest X-ray, ECG, and depending on the specific circumstances of patients to select the appropriate special examinations.
2. Full of dialysis: dialysis during the serum creatinine remained at 353.6 ~ 618.8umol / L. Increase in renal dialysis before transplantation through time.
3. To correct anemia: patients before renal transplantation is best to maintain hemoglobin 70g / L or more.
4. To control infection: preoperative use of a variety of tests such as throat swabs, sputum, urine, peritoneal fluid bacterial and fungal culture, fever in patients with chest radiograph to exclude TB regularly reviewed to strengthen the means of the virus laboratory surveillance, early detection and to be treated.
5. Nephrectomy disease: the absolute indications for removal of kidney: (1) difficult to control the stubborn persistence of high blood pressure; (2) associated with recurrent pyelonephritis, obstruction, reflux and stone; (3) kidney Malignant tumor; (4) prevent large polycystic kidney transplant; (5) glomerular basement membrane antibody glomerulonephritis, serum antibody negative, if not do first disease after nephrectomy. The relative indications for the resection of renal vein thrombosis in both kidneys and severe proteinuria.
6. Urinary tract obstruction: lift required before transplantation urinary tract obstruction, such as resection of urethral stricture formation, prostate resection, urethral valve resection.
7. Tissue typing: (1) ABO blood group identical or the same as the best principles of blood transfusion; (2) groups reactive antibody (PRA)-negative or less than 10% of the lymphocyte toxicity test; (3) to seek more with HLA loci , could improve the graft survival.
[Donor preoperative preparation]
1. Donor preoperative
Complexity from simple interest on principle, never damage to damage inspection.
(1) blood group identification: the intention to provide for the blood of the donor kidney is identified. Choose the same or compatible blood type and those receptors.
(2) lymphatic drug testing and HLA stereotypes; select lymphatic drug test was negative and HLA matching the best person.
(3) routine preoperative examination: including liver function, kidney function, blood routine, urine routine,
Serum electrolytes, coagulation tests, ECG, chest x ray, KUB plain film.
(4) for special inspection body; urine culture, various types of hepatitis antigen-antibody, cytomegalovirus
Virus, AIDS virus, endogenous creatinine clearance rate, heart, liver B-, or radionuclide
Kidney ECT, IVP, and finally invasive examination renal arteriography.
2. And prepare the donor before operation
(1) Psychology Preparation: As a healthy person to go through a big surgery and removal of a healthy kidney, although kidney voluntary, but the surgery there will inevitably be close to fear, including fear of the surgery itself After removal of the side of the kidney and the future impact of health status. Therefore, preoperative response to a detailed explanation of the donor, the foster confidence in the triumph for the operation to eliminate the fear.
〔2〕 routine preoperative heart: ① skin preparation; ② Preparation of blood, ③ preoperative fasting 12h, 4h water deprivation ④ indwelling catheter; ⑤ preoperative routine medication; ⑥ ⑦ surgery essential drugs as graft donor, preoperative treatment is not necessary to do immunology.
1. Objective:
1. Objective:
Interview topics: March 11, 2010 World Kidney Day - Experts on renal transplantation and postoperative management
Invited guests: Department of Urology, Zhongshan Hospital, Fudan University Professor Zhu Tongyu
Interview Date: March 11, 2010 15:00-16:00 PM
Moderator: Good afternoon, Sohu users, Welcome to Sohu health interview, the Today is World Kidney Day 2010, a year from 2006 to the second Thursday of March as Kidney Day established, this year is the fifth world Kidney Day, this year's theme is "protection of the kidney, control of diabetes," honored to have this Sohu Health, Zhongshan Hospital, Fudan University, Department of Urology, MD, director of health Zhu Sohu interview with Jade guest rooms.
Professor Zhu Tongyu: Thank you friends, welcome.
Moderator: World Kidney Day With the continuous promotion of chronic kidney disease we now know more and more, as our country of chronic kidney disease including end-stage renal disease is kind of how?
Zhu Tong-Yu: uremic patients across the country now more than 150 million, an increase every year 12-150000 new uremic patients, our base will be greater in patients with kidney disease, another topic of today is very good, "Diabetes and Kidney Diseases," This is today facing a very serious health problems.
Moderator: Diabetic nephropathy is caused by one very important reason, then we will detail, you have just introduced our country now more and more severe incidence of uremia, users may not understand the chronic kidney disease and uremia, What would cause any injury or harm, this brief introduction?
Zhu Tong-Yu: chronic kidney disease should be said that the entire human body has a lot of damage, especially in the kidney to the end, like a lot of early kidney disease are proteinuria, hematuria, loss of body protein will result in the body floating, etc., and if to the end of uremia, metabolic wastes in our bodies can not be excreted through the kidneys, when that is our heart, liver lungs brain and all organs are immersed in the middle of toxins will cause uremic encephalopathy, uremic heart disease, skin itching and so on. We see many patients are by their own grasp of skin wounds of a Road, as well as the eye, retinal problems, all the organs are due to uremia and involvement.
Moderator: uremic patients, there are many features of its own.
Zhu Tong-Yu: Yes, sometimes to a patient to our clinic came to know of a uremia, a look at this face was very pale, kidney disease later will cause anemia, kidney secretion of the role of erythropoietin, these patients are low hemoglobin levels, sometimes to the clinic in patients with uremia, ammonia is the taste of his speech, it is because the body's waste is not discharged due to accumulation of too much.
Moderator: more than just the incidence of uremia, uraemia, chronic kidney damage is terrible, we should be more concerned about this disease. This year's theme is to protect the kidneys kidney, control of diabetes, shows that diabetes is closely related with the kidney, diabetes, uremia is caused mainly due to late?
Zhu Tong-Yu: I see them in the previous year to the United States transplant centers, and where doctors exchange, I asked a question, "So many uremic patients, the first factor is what?" The answer is: the first one factors are diabetes, uremia is the second cause high blood pressure, take a look at China's first chronic nephritis, diabetes and hypertension is the third and fourth, but after several years of development as we look at this situation undergone great changes, diabetes, kidney disease caused by a sharp increase in incidence, there is a data, I diabetes mellitus 20% to 40% will lead to renal failure, one-third of patients with diabetes can cause kidney disease will eventually lead to renal failure, diabetes, renal failure is increasingly becoming an important factor.
Moderator: You introduced the diabetes can cause chronic kidney disease, including China, there are many patients with chronic kidney disease, as these patients have little chance of eventually develop into the stage renal disease, such as uremia?
Zhu Tong-Yu: If it is a kidney disease, nephrotic syndrome or diabetic nephropathy, we found the disease very early and very good control of the disease, then the opportunity to develop into uremia is not a lot, but unfortunately, many of our young people to that uremia, a lot of 20,30 years of age get up to urinate at night, this time the rhythm of the kidney has changed, but do not go, go until the time had uremia, and when in the early to do physical examination, we should see no kidney disease, early detection can prevent a future direction to uremia, it stressed that early diagnosis and treatment.
Moderator: Is it because the early symptoms of the disease is not obvious, we tend to overlook.
Zhu Tong-Yu: Actually that is not difficult, treatment is not difficult, a small trick, we went to check once a year is enough urine to see if there is no proteinuria, proteinuria may have nephritis, so early detection, early diagnosis , early treatment is not very difficult.
Moderator: Unfortunately there are a lot of patients with chronic kidney disease will eventually be developed to uremia, to this stage of uremia, we major clinical treatment include?
Zhu Tong-Yu: There are two treatments to uremia, called dialysis, called transplants, dialysis which can choose hemodialysis, peritoneal dialysis can also choose not necessary for a kidney dialysis.
Moderator: Can you briefly explain the two approaches different characteristics, such as their own people for what?
Zhu Tong-Yu: We are very concerned about, if it is renal failure, and choose what way are two ways you can choose, have their own advantages and disadvantages, first of all that transplant, a kidney can later change the normal work and normal life The most important you can eat every day, not because of uremic patients to eat, not drink, especially not to drink water, sometimes a person can not drink half a year and saw the water after the eyes are luminous, it is very painful One thing, for a kidney can live a normal life after work, but there is also a drawback when the transplant takes a lot of money at once, the most important issue in the first half of our transplant a risky surgery, after surgery eat a lot of the first half of immunosuppressive agents, these drugs will generally lower the resistance, it is easy raw pneumonia, the pneumonia is very severe pneumonia, the same as the 2003 SARS is very serious, we also have the benefits of dialysis, spend relatively more stable, once each week do not need to spend hundreds of thousands of money, but also a relatively large number, but the cost is relatively stable, regardless of wind and rain have to go to hospital dialysis, difficult to restore normal life and work, so for young people is not a good choice of means, so everyone has the right treatment.
Moderator: We have problems in the early collection of users when asked a very critical issue, what stage of chronic kidney disease to kidney transplant needed?
Zhu Tong-Yu: This is a very good question, from our 70s started migrating to now 40 years old, select the actual timing is in constant change, the beginning is that dialysis six months after the transplants, the beginning of general condition poor do not transplant well, but the sooner it is possible to do transplants, when what needs to be done when you can do dialysis transplantation.
Moderator: Are there some situations not suitable for transplant?
Zhu Tong-Yu: such as the elderly, old chronic bronchitis, bronchiectasis, such as these do often have pneumonia after transplantation, the other caused by the tumor, such as bilateral renal tumors caused by uremia after cut off, including other parts of the body are tumors, the standard is now recognized as three years without recurrence of the tumor transplant was done, in addition to things like mental disorders, a history of mental illness, do not take medicine well after a transplant is very troublesome.
Moderator: The description can be seen through your transplant is a very good treatment, while patients have required dialysis Xuqiu kidney transplant, just talked about the diabetic patients with chronic kidney disease caused by the probability of large, as is appropriate to patients with diabetic nephropathy kidney transplant it?
Zhu Tong-Yu: Now with the drugs and technology improve, diabetes, kidney disease can also be caused by the transplant, but the general effect of the renal effects than other better, if the diabetes led to kidney failure, and have other effects will be worse lesions, but The key issue is not the most crucial after transplantation to the normal range of blood glucose control should not put the new kidneys to go into a diabetic kidney, so the basic treatment of disease is critical.
Moderator: Just about kidney transplantation on the improvement of human health, treatment of disease is obvious, is there such examples to our friends about it?
Zhu Tong-Yu: There are a number of transplants after the effect is still very good, but some patients also received a lot of lessons, if a patient does not listen, do not come for three months, six months do not come, do not come even a year, when he The time has come again into a new uremic patients, so in this case is very troublesome, there are some very successful example has been to follow up, there are dozens in our hospital over 20 years of kidney transplant patients, These patients are among the pillars of the family, some of the boss, some are experts.
Moderator: Organ transplantation is the treatment for uremia is a very good tool, it should be said that organ transplants, including liver transplant, kidney transplants have been a very long development experience, and now the status of renal transplantation in our country is like?
Zhu Tong-Yu: world's first successful kidney transplant patients is successful in the United States in 1954, is the twin brother, in 1956 we started doing experiments in China, and now with the international kidney transplant on the clinical level is about the same year The survival rate is 94%, and the international level with about the same. Now it is more than eighty thousand cases of renal transplantation, long-term survival is not too happy, but short-term survival results is good.
Our Ministry of Health, the State Council have made a relevant management documents, should be said that the management of our national norms on the organ transplant spent a lot of energy, I believe that these norms on the work of the whole organ transplantation is a promotion, in particular, of our patients is protected, we do not want to do a transplant, the patient to nobody, because transplantation is the first step in the Long March, after more things to do for life after a transplant to hospitals in need with the doctors, to manage, regulate the core of our country these patient care and manage, which is the core of our work, this is a very good thing.
Moderator: You work in renal transplantation has been 20 years, 20 years of work in your process, you feel that the success rate of kidney transplantation and improve what causes it?
Zhu Tong-Yu: a surgical techniques have improved, we doctors have a lot of opportunities to improve, to learn, to practice. One is the progress of the drug, advances in immunosuppression, which is the most central aspects of the two of us. A very interesting example, when we say that kidney transplantation, the factors that affect graft survival is not the first matching result, investigations in the United States, the first factor is not matching, the first factor is which transplant centers do surgery, that is, level of transplant surgery, this is the first factor, surgical technology is also very important.
Moderator: How do we determine how to surgical standards?
Zhu Tong-Yu: a year to determine how many cases do the indicators depends on a number of doctors have received training in this area, the number of patient contacts, etc., can now do a small baby's kidney transplant, which is technically demanding surgery high, we have done for the same four kidney transplant patients, the progress in our country very quickly.
Moderator: You talked about the continuous progress of immunosuppressant transplant is a guarantee of success. Can you tell us about progress in immunosuppression reflected in what areas?
Zhu Tong-Yu: There is no progress in immunosuppression kidney transplant today, 78 years ago renal transplantation in the survival rate of only 30% a year more than 70 years after the emergence of cyclosporine after year survival rate improved to 80% to more than 90%, this is a revolution, so the transplant community cyclosporine is the revolution until 1995 and there was a drug, that is, we now know, MMF, and why all of a sudden short-term survival rate increased to so many, and long-term survival is not very high, the results found that the permeability of these immunosuppressive agents have a lot of these drugs after long-term eating on recipient has caused great harm, MMF can be used later to other nephrotoxic drugs reduce the amount, but also have a good long-term survival, of course, there are newer antibody class of drugs that will enter a better era in the future, antibodies era.
Moderator: I believe that with continued research and development of drugs, patients will be long-term chance of survival, more and more like our country the longest survival was many years?
Zhu Tong-Yu: We Chinese are more than 30 years.
Moderator: post-renal transplant patients taking the drugs, including secondary to diabetes, this is not the protection of the kidney have a great impact?
Zhu Tong-Yu: Transplant surgery is the first step in the Long March, is behind the problem of how to manage the drug problem, including hypertension, diabetes, high cholesterol is a threat to long-term survival of renal transplant patients of the three killers, we must take after transplant diabetes control is good, why students of diabetes after transplantation, for example, our hormones, cyclosporine, FK506 also easily lead to diabetes, so a series of drugs can cause the emergence of new onset diabetes, poor control of these patients, but also affect the long-term survival is very important.
Moderator: There is also talked about the management of transplant patients for their own management is also very important, can not specifically talk about include renal transplant patients after the transplant surgery how to conduct a good management?
Zhu Tong-Yu: The first: the recommendation for all patients or a piece of advice, be sure to contact more with the doctors, do not self-assertion, there are many painful lessons, feel very good after transplantation, long-term dialysis, uremia after the mental and physical exhaustion, after transplantation Ye Hao appetite, feeling very good, we feel in good shape, is not by that drug, minus some medicine for a few weeks or even months later put the drug stopped, and this is a very serious problem that may cause rejection. Young people do not go to work every day, every day, playing games, a dozen 24-hour, the result does not eat food, medicine does not eat. Listen to the doctors, follow doctor's orders, this is the most important.
We also like to mention that we have a lot of dialysis patients will be, and do not listen to people saying that so rarely take medicine, do not follow other people to learn because everyone is different, others less medication, does not mean you can also be less medication, less medication, when some contact with the Doctor, this is the most important point.
The second part: we need to do after transplantation activities within its capacity, to work all day at home than the lifetime of the long, because when life is very regular work, sleep is also very regular, very happy spirit, will take part in some social activities, exercise, in which case the state of the body better, while others do not participate in the work, do not participate in the activities of people every day at home to sleep and eat, eat and sleep, to disrupt their rhythm of life, their mood not very good, long-term survival of these patients to work as well, must do activities within its capacity.
Moderator: done in patients with renal transplantation, compared with normal subjects, the physical energy on a relatively large difference?
Zhu Tong-Yu: In 2007 I went to the United States will participate in international organ transplants, the U.S. NBA is a very intense exercise movement, there is a star called Mourning, well after transplantation also participating in NBA basketball game, and get a championship, good NBA kidney transplant can still participate in this violent sport, so the normal working of our renal transplant patients is not a problem, I contacted a number of transplant patients survive 20 years, all at home, pillar, is also a pillar in the community, do not regard myself as a patient, I would like to tell you the third point, how to manage after transplantation, do not eat too much, start with the mouth, the disease is to eat out, comes down to our topic of diabetes, high blood pressure , high cholesterol is eating out the disease, after transplantation eat hormones, appetite hormones will be very good eating, the original could not eat, can now eat three or four bowls of rice, 100 kg to 160 kg were long, in which case kidney, heart, blood pressure, the burden will be heavier, so be sure to control body weight after transplantation, it is our clinical experience, such as 120 pounds before surgery, after surgery do not increase or decrease of 20 kg, which is in the range of very healthy state, of course, is normal, do not eat too much.
Moderator: There are also sports a lot of friends ask the question, normal movement after renal transplantation is it?
Zhu Tong-Yu: Basically, a month later in the transplant can participate in sports, of course, depends on the normal hemoglobin is not recovered, the wound is not restored well, good if the restore can work like a normal person, life.
Moderator: After taking a long-term immunosuppressive drugs to prevent infection is a very important key in this area have any suggestions?
Zhu Tong-Yu: well after transplantation everyone to take immunosuppressive drugs for life, a life-long resistance to be lower than others, so easy to be infected early in the first six months of transplantation is not recommended when we go to public places such as cinemas, Stadium crowd the place of mass gathering, maintaining a healthy state, if such recovery six months later, lymphocytes, white blood cells are returned to normal state can resume normal work, but many people do not recommend the place to have a fever, infection the first time to the hospital.
Moderator: I just talked about some of the renal transplant patients is helpful, while there are a lot of clubs, including kidney transplant patients is also very much the club, the patient to participate in this club for their own health and recovery of no help ?
Zhu Tong-Yu: It is helpful, and now every business, every transplant center has a lot of clubs in the form of a number of dialysis organizations that share our patients very well, because there are some older patients, some new patients, through face to face AC can get a lot of information, you can not get from a doctor to obtain the information, because the doctors busy couple of minutes to read, but face to face communication between dialysis patients can have much to say.
Moderator: There is also a feeling of home, warm feeling.
Zhu Tong-Yu: Yes, this club is a family, like many centers also have a website, the site has a special mental health counseling hotline, such as sex life all right, many patients are embarrassed to ask, kidney transplantation will we be able to lead a normal married life, embarrassed to ask if you can by the mental health hotline to solve this problem.
Moderator: I've heard over the kidney Friendship Club has "brook club", there are many renal transplant patients treated with communication problems and the postoperative recovery, life after long-term illness is also a lot of help.
Zhu Tong-Yu: not only the club, there are dialysis magazine, to many experts, patients to write their feelings and experiences, I believe there is a lot of help.
Moderator: Next question to users of our time.
User: My father was suffering from gout for 20 years led to kidney failure in 04 years to do the kidney transplant surgery was successful to do only that uric acid has been cut down, the current situation is, do not fall down uric acid often causes gout attacks , Professor Zhu would like to ask the next, how can down uric acid, I hope to help answer under Professor Chu.
Zhu Tong-Yu: If to the uric acid 500, has been difficult to control through diet, in which case I suggest the drug by lowering uric acid to return to within the normal range of uric acid.
User: seven years after renal transplantation, medication is mycophenolate mofetil, 6 capsules per day, the latest is that nausea and vomiting, uric acid 500, the rest of the normal, causing nausea and vomiting causes?
Zhu Tong-Yu: It is not a direct result of drugs, as has been done for seven years, your doctor Gastroenterology, treatment can be taken to protect the stomach to solve this problem.
User: After two years, occult blood in recent months, several numbers.
Zhu with Jade: This is a signal, there are occult blood in urine, is caused by glomerulonephritis or other causes uremia uremia, to do a ultrasound to see if the kidneys have any questions, suggestions if there is no problem to do a kidney biopsy, to know there is no exclusion, there is no recurrence of primary disease, among other factors, and then find the cause of specific treatment.
User: 70-year-old patients, MMF can always eat it? How to deal with side effects? Intestinal bleeding is not there can not eat? Chinese medicine is not to eat?
Zhu Tong-Yu: MMF is to have swallowed them, if there is a case of shingles can reduce, but resumed and other diseases, the need to return to the last dose, while Chinese medicine is not recommended to eat more, because there are many traditional Chinese medicines do not understand the ingredients, we do not recommend eating.
User: made in 2000 kidney transplant, the current situation can, however, surgery after surgery increases the right of the testis, some doctors recommended surgery, but fear no other phenomenon.
Zhu Tong-Yu: I did not guess wrong, he is the kidney on the right, which is 10% male renal transplant patients hydrocele of the problems occur, if the fluid affect the life, for example, is not very easy to walk , and recommends a sheath reversal surgery, this has no effect on the body, also had no effect on the transplanted kidney.
User: I uremia, very worried about rejection after transplantation.
Zhu Tong-Yu: Whether or not pro-body transplant rejection rate of about 10%, but even if rejection occurred in 90% of rejection can be treated, the world has done several one hundred thousand cases, you can rest assured that to do , should be able to control.
User: is not all organ transplant rejection will happen?
Zhu Tong-Yu: Yes, except identical twins does not exclude the other place will have the opportunity to exclusion, there is now such a good immunosuppressive agents, rejection rate will be so low, only about 10%.
User: family just had kidney transplants, needs attention?
Zhu Tong-Yu: The first follow-up regularly to the hospital, the second not to eat too much exercise.
User: Select MMF after kidney transplantation, can be stopped when the long-term use what is?
Zhu Tong-Yu: Generally not recommended to MMF stopped, and now the world's most recognized programs is to use MMF, calcineurin inhibitors, hormones, some people can be stopped, but the risk of MMF stopped large some, it is generally not recommended to disable MMF, long-term use is not too bad.
User: renal transplantation time of meals and medication have any suggestions? Also taking MMF and FK506, taking time to have any plans?
Yu Zhu same: can take, but we take medicine on an empty stomach, when effective, better absorption, and if today eat, so eat tomorrow.
User: For the recovery after any suggestions?
Zhu Tong-Yu: a week in the hospital every day within the doctor will abandon you, this is not three months later everyone would return to normal physical exercise on it.
User: What is the point to kidney disease to kidney transplant must be done?
Yu Zhu same: to do dialysis to transplant needs to be done.
Users: 30 year old male, currently taking cyclosporine concentration of about 100, now higher blood urea nitrogen, have any effect on renal function?
Zhu Tong-Yu: blood urea nitrogen to see what changes is relatively high, look up how much the rise how, if rise rapidly, less is not a drug, is not to increase the point of drugs, in this case or to Please emphasize to the hospital doctor, is not to do an inspection, not to arbitrarily adjust medication.
User: 6 years after renal transplantation, women 29 years old, can birth?
Yu Zhu same: to birth, usually after 3 years for fertility, and to encourage everyone to fertility, the fertility when to give us a proposal, it is best replaced by azathioprine.
Users: 57 year-old woman, do transplant surgery has been 9 years, drug use is cyclosporine, only R0.76, a problem?
Zhu Tong-Yu: No, and the result is very good.
User: As has been 9 years after transplantation, the need to pay attention to?
Yu Zhu same: to yourself, like an old doctor, on his own physical condition, the change will be very clear clues.
Users: 58 year-old woman a kidney transplant is four and a half years, hormone 0.75 mg, and now has pain in the right thigh, and from 2009 to the present has been hurt and did a CT without any conditions.
Zhu Tong-Yu: The first is to maintain the number of drug concentration, the concentration of each person is different, the key is 4 years Banzhong Jian, another right thigh pain may be muscular nerve problem, you can take a look.
User: a kidney transplant 7 years, recently and anemia, high creatinine.
Yu Zhu same: first the first case is not too much medication, medication too easily lead to anemia, high creatinine to 300 when the hemoglobin level may affect, and specific to the hospital to look at.
User: 1 year after renal transplantation, due to fever caused by cytomegalovirus infection, do not know how to do?
Zhu Tong-Yu: Cytomegalovirus infection can be optimistic about, to see if there is an issue of the merger.
User: tofu you can eat after transplantation?
Zhu Tong-Yu: You can eat, but do not every day a lot of food, diet, no special taboo, but does not suggest that you eat ginseng, ginseng can be activated lymphocytes.
Netizen: What are the symptoms of chronic rejection?
Zhu Tong-Yu: Chronic rejection is the warm boiled frog, that do not know, six months after the creatinine 160, 240 a year later, is chronic rejection, how to prevent this situation, be sure to check regularly to the hospital to understand the changes in renal function trend, to have a judge is to do renal biopsy the gold index.
User: transplant six years, the daily dosage of MMF is six, can not be reduced?
Zhu Tong-Yu: day six is a more standard dose, if a large number of age and renal function is stable can be reduced to five words.
Moderator: Professor Zhu on Finally some suggestions of our users, as well as message to the International Kidney Day 2010.
Zhu Tong-Yu: I am glad to have this opportunity to share with you together, I hope everyone has a healthy kidney, there is a problem early diagnosis and early treatment, early detection, which is the core of kidney well that ends well, I wish you all good.
Moderator: As Professor Zhu said, must be early diagnosis and early treatment, and finally professor asked Zhu about his visits time and place convenient to the majority of patients for medical treatment, Professor Zhu can face to face consultation,
because the answer just more is instructive.
Zhu Tong-Yu: Monday and Thursday morning at the Zhongshan Hospital out-patient services.
Moderator: This concludes today's interview, thank you friends to watch and Professor Zhu Tongyu the visit. The relationship of time, and today some of the problems users may not be answered, netizens in the future, "kidney transplantation and postoperative management," interview subjects, Internet experts concerned about the additional answer.
Interviews with experts:
Professor Zhu Tongyu
Professor Zhu Tongyu 1966, MD, vice president of Fudan University, Zhongshan Hospital, Urology, Professor, Director of the Shanghai Key Laboratory of Organ Transplantation. Branch of Chinese Medical Association of Organ Transplantation, Shanghai Organ Transplant branch members and other committee members, the National Natural Science Foundation, "863" and technology assessment experts and Cell Biology, Organ Transplantation, Journal of Epithelial Biology
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