Objective To investigate the impact of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection on the long-term survival of renal transplantation recipients. Methods A total of 443 patients who received renal al...Objective To investigate the impact of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection on the long-term survival of renal transplantation recipients. Methods A total of 443 patients who received renal allografts from 1992 to 2002 were analyzed. Outcome and survival were compared among four groups retrospectively. Results Twelve patients were positive for both hepatitis B surface antigen (HBsAg) and HCV antibody (anti-HCV) (group 1), 18 were HBsAg-positive and anti-HCV-negative (group 2), 26 were HBsAg-negative and anti-HCV-positive (group 3) and 387 were negative for both markers (group 4). The mean follow-up period was 6.1 ± 2.8 years (range, 0.5-10 years) for all patients. Group 2 had significantly higher liver-related complications (38.9%) and liver-related death (16.7%) than did group 4 (0%, P < 0.01). Among all patients, 4 HBsAg-positive patients had fulminant hepatitis and died within two years of transplantation. Three patients (group 2) who died were seropositive for HBeAg and/or HBV DNA and none had a history of or positive serologic marker to indicate hepatitis of other etiologies. One (group 1), two (group 2), and one patient (group 3) developed liver cirrhosis respectively, and hepatocellular carcinoma occurred in two patients (group 2) and one patient (group 3). Despite high liver-related mortality in HBV-infected patients, no significant differences among the four groups in the long-term graft and patient survivals were demonstrated. The presence of HBsAg or anti-HCV was not associated with poor prognosis as determined by Cox regression analysis. Conclusion HBV or HCV infection is not a contraindiction to kidney transplantation in Chinese patients. However, it should be noted that serious liver-related complications may occur and limit survival in patients infected with HBV and/or HCV after kidney transplantation.展开更多
Objective.The purpose of this study was to assess the renal graft expression of ICAM 1(intercellular adhesion molecule 1) and LFA 1(lymphocyte function associated antigen 1)molecule with rela...Objective.The purpose of this study was to assess the renal graft expression of ICAM 1(intercellular adhesion molecule 1) and LFA 1(lymphocyte function associated antigen 1)molecule with relation to graft rejection. Methods.Rat kidney transplantation was performed according to the procedure of Kamada with some modification.Experimental rats were divided into 5 groups.The survival time of recipient rats and function of grafts after renal transplantation were observed.The sections of renal graft were stained for monoclonal antibody ICAM 1 and LFA 1, and then quantification of ICAM 1 and LFA 1 expression was accomplished by computer image analysis. Results.ICAM 1 and LFA 1 increased significantly in the renal allograft rejection group as compared with the non rejection groups(P<0 05). Conclusion.Both biopsy of renal graft and monitoring of ICAM 1 and LFA 1 are useful tools in diagnosing and treating acute rejection.展开更多
Objective To explore methods of preventing and reversing rejection after simultaneous pancreas-kidney （SPK） transplantation. Methods Seventeen patients underwent SPK transplantation from September 1999 to September...Objective To explore methods of preventing and reversing rejection after simultaneous pancreas-kidney （SPK） transplantation. Methods Seventeen patients underwent SPK transplantation from September 1999 to September 2003 were reviewed retrospectively. Immunosuppression was achieved by a triple drug regimen consisting of cyclosporine, mycophenolate mofleil （MMF）, and steroids. Three patients were treated with anti-CD3 monoclone antibody （OKT3, 5 mg·d^-1） for induction therapy for a mean period of 5-7 days. One patients received IL-2 receptor antibodies （daclizumab） in a dose of I mg·kg^-1 on the day of transplant and the 5th day posttransplant. One patient was treated with both OKT3 and daclizumab for induction. Results No primary non-functionality of either kidney or pancreas occurred in this series of transplantations. Function of all the kidney grafts recovered within 2 to 4 days after transplantation. The level of serum creatinine was 94 ± 11 μmol/L on the 7th day posttransplant. One patient experienced the accelerated rejection, resulting in the resection of the pancreas and kidney grafts because of the failure of conservative therapy. The incidence of the first rejection episodes at 3 months was 47.1% （8/17）. Only the kidney was involved in 35.3% （6/17）; and both the pancreas and kidney were involved in 11.8% （2/17）. All these patients received a high-dose pulse of methylprednisone （0.5 g·d^-1） for 3 days. OKT3 （0.5 mg·d^-1） was administered for 7-10 days in two patients with both renal and pancreas rejection. All the grafts were successfully rescued. Conclusion Rejection, particularly acute rejection, is the major cause influencing graft function in SPK transplantation. Monitoring renal function and pancreas exocrine secretion, and reasonable application of immunosuppressants play important roles in the diagnosis and treatment of rejection.展开更多
Objective:To establish a sensitized canine model for kidney transplantation.Methods:12 male dogs were averagely grouped as donors and recipients. A small number of donor canine lymphocytes was infused into different a...Objective:To establish a sensitized canine model for kidney transplantation.Methods:12 male dogs were averagely grouped as donors and recipients. A small number of donor canine lymphocytes was infused into different anatomic locations of a paired canine recipient for each time and which was repeated weekly. Specific immune sensitization was monitored by means of Complement Dependent Cytotoxicity (CDC) and Mixed Lymphocyte Culture (MLC) test. When CDC test conversed to be positive and MLC test showed a significant proliferation of reactive lymphocytes of canine recipients, the right kidneys of the paired dogs were excised and transplanted to each other concurrently. Injury of renal allograft function was scheduled determined by ECT dynamic kidney photography and pathologic investigation. Results:CDC test usually conversed to be positive and reactive lymphocytes of canine recipients were also observed to be proliferated significantly in MLC test after 3 to 4 times of canine donor lymphocyte infusions. Renal allograft function deterioration occurred 4 d post-operatively in 4 of 6 canine recipients, in contrast to none in control dogs. Pathologic changes suggested antibody-mediated rejection (delayed) or acute rejection in 3 excised renal allograft of sensitized dogs. Seven days after operation, all sensitized dogs had lost graft function, pathologic changes of which showed that the renal allografts were seriously rejected. 2 of 3 dogs in control group were also acutely rejected.Conclusion:A convenient method by means of repeated stimulation of canine lymphocyte may induce specific immune sensitization in canine recipients. Renal allografts in sensitized dogs will be earlier rejected and result in a more deteriorated graft function.展开更多
Objective： To explore the characteristic of operation, intra-operation treatment and the application of immunosuppressant in pediatric renal transplantation in order to improve therapeutic effectiveness. Methods： Fr...Objective： To explore the characteristic of operation, intra-operation treatment and the application of immunosuppressant in pediatric renal transplantation in order to improve therapeutic effectiveness. Methods： From March 1986 to October 2006, the clinical data of 63 children who underwent renal transplantation in our hospital were retrospectively analyzed. Results： The 1-, 3-, 5-, 10-year graft survival rates were 98.4%, 90.5%, 88.9% and 68.3%, respectively. And the corresponding patient survival rates were 100%, 95.2%, 92.1%, 71.4%. The body weight increased 4 to 12 kg and the body height grew up 2 to 6 cm during the first year post-transplantation. The main complications in the first year post-transplantation were hypertension （26/63, 41.3%）, crinosity （14/63, 22.2%）, drug-induced hepatic injury（11/63, 17.5%）, gingival hyperplasia （10/63, 15.8%）, pulmonary infection（9/63, 14.3%）, bone marrow suppression（5/63, 7.9%）, herpes （4/63, 6.3%） and diabetes （3/63, 4.8%）. Conclusion： Renal transplantation is a preferred method for the treatment of children in end-stage renal disease （ESRD）. Good tissue matching, proper operative time and pattern, peri-operactive care were essential to success, as well as appropriate immuno-suppressant strategy and good compliance.展开更多
Objective: In order to study the role and significance of transforming growth factor beta-1 (TGF-β1 )mRNA in transplanted renal fibrosis(TRF). Methods: Renal pathologic changes and expression of TGF-β1 mRNA were obs...Objective: In order to study the role and significance of transforming growth factor beta-1 (TGF-β1 )mRNA in transplanted renal fibrosis(TRF). Methods: Renal pathologic changes and expression of TGF-β1 mRNA were observed using in situ hybridization technique. The normal renal tissue as a. control group. Results: Expression of TGF-β1, mRNA in the renal fibrosis increased, compared with that in the control group. The expression rate were co-related to the stage of TRF. Conclusion: TGF-β1 is related to the pathogenesis and development of TRF.展开更多
Objective To evaluate the safety and feasibility of steroid or mycophenolate mofetil （MMF） withdrawal from tacrolimus-based immunosuppressant regimen in renal allograft recipients. Methods A cohort of 45 patients f...Objective To evaluate the safety and feasibility of steroid or mycophenolate mofetil （MMF） withdrawal from tacrolimus-based immunosuppressant regimen in renal allograft recipients. Methods A cohort of 45 patients following cadaveric renal allograft transplantation were randomly divided into 3 groups based on the regimen of combination of tacrolimus, steroid, and MMF： triple therapy group, steroid withdrawal group, and MMF withdrawal group. During 2 years, survival of patients and allografts, clinical acute rejection, adverse events, hepatic and renal allograft function, and blood lipids were monitored to evaluate the safety and feasibility of steroid or MMF withdrawal after renal transplantation. Results During two-year observation, steroid or MMF was successfully withdrawn from immunosuppressant regimen based on tacrolimus without any clinical acute rejection renal allografts kept excellent function. Some adverse events among groups. Patient and graft survival rates were 100% and all the occurred and there were no significant differences Conclusion Withdrawal of steroid or MMF in low-immunological-risk renal allografts treated with tacrolimus-based immunosuppressant regimen can be achieved with no increased risk of acute rejection.展开更多
Objective To investigate the effects of losartan, a specific angiotensin Ⅱ receptor blocker, on slowing progression of renal insufficiency in patients with biopsy-proven chronic allograft nephropathy （CAN） and the ...Objective To investigate the effects of losartan, a specific angiotensin Ⅱ receptor blocker, on slowing progression of renal insufficiency in patients with biopsy-proven chronic allograft nephropathy （CAN） and the molecular mechanism of the therapy. Methods Twenty-two renal transplant recipients with biopsy-proven CAN （group A） were treated with losartan within two months after renal dysfunction for at least one year. Losartan was administered at a dose of 50 mg/d. Twenty-four recipients in the same fashion （group B） who never received angiotensin Ⅱ receptor antagonist were studied as control. The investigation time for each patient lasted one year. Renal functions and concentrations of plasma and urine transforming growth factor-betal （TGF-betal） were compared between the two groups at the initiation and end of the study. In group A, expressions of TGF-betal mRNA and immunofluorescence intensity of TGF-betal protein and pathological alterations in renal biopsy specimens were compared between before losartan therapy and after one year of the therapy. Results At the initiation of the investigation, no significant differences were found between group A and group B in clinical data such as donor age, cold-ischemia time, HLA mismatch, levels of creatinine clearance （Ccr）, plasma and urine TGF-betal concentrations. One year later, 14 of 22 （63.6%） patients showed stable or improved graft functions in group A, and 4 of 24 （16.7%） in group B. The difference was significant （P 〈 0.05）. At the end of the study, urine TGF-betal concentration was 273.8 ± 84.1 pg/mg.Cr in group A and 457.2 ± 78.9 pg/mg.Cr in group B. During one year study period, loss of Ccr was 6.6 ± 5.4 mL/min in group A and 16.2 ± 9.1 mL/min in group B. Both of the differences were significant between the two groups （P 〈 0.01）. No significant differences were found in plasma TGF-betal concentrations between the four values determined at the initiation and end of the study in the two groups （F= 2.56, P〉 0.05）. After one year losartan therapy, group A showed a significant decrease in expressions of TGF-betal mRNA and TGF-betal protein in renal biopsy specimens [from 1.59 ± 0.35 to 0.96 ± 0.27 and from （10.83 ± 2.33）×10^6 to （6.41 ± 1.53）×10^6, respectively; both P 〈 0.01], but in light microscopy the histological changes were similar to the first renal biopsy. Losartan was excellently tolerated in all patients in group A. No cases with losartan therapy showed too low blood pressure and other side effects. Conchusion This study suggests that losartan have an effect on slowing progression of CAN. Reducing production of intrarenal TGF-betal may play a decisive role in the efficacy of losartan.展开更多
Objective To retrospectively investigate the distribution in kidney transplantation for fifteen years in Peking Union Medical College Hospital.Methods We conducted a descriptive research counting up the number of pati...Objective To retrospectively investigate the distribution in kidney transplantation for fifteen years in Peking Union Medical College Hospital.Methods We conducted a descriptive research counting up the number of patients who received kidney transplantation each year in our hospital during 1995 and 2010.Results The first kidney transplantation in our hospital occurred in the 1960s.The number of kidney transplantation increased until reaching a maximum of 47 grafts in 2001;since then the number fell.Conclusions With the decreased number of kidney transplantation,we have realized the shortage of transplantable organs is very serious.The continuing transplant shortage requires major efforts to expand the donor pool.Donation after cardiac death offers the potential to enlarge the donor pool,but we need to strictly control the criteria for potential donors.展开更多
Objective.To investigate the difference of rejection in single versus combined pancreas and kidney transplantation in rats. Methods.Allograft models including simultaneous pancreas and kidney(SPK)transplant and pancre...Objective.To investigate the difference of rejection in single versus combined pancreas and kidney transplantation in rats. Methods.Allograft models including simultaneous pancreas and kidney(SPK)transplant and pancreas or kidney transplant alone were established in SD-Wistar rats, rejections of pancreas and kidney in different models were compared morphologically and functionally. Results.Mean survival time(MST)of pancreas was significantly prolonged in SPK than in pancreas transplant alone(PTA)(115 days vs. 92 days, P<005). Incidence of interstitial pancreatic rejection at grade Ⅱ and grade Ⅲ was much obvious in PTA than in SPK(429% vs. 125% at grade Ⅱ and 286% vs 63% at grade Ⅲ , P<005). No significant difference was found in MST between SPK and kidney transplant alone(KTA). Administration of cyclosporine A prolonged the MST of pancreas and kidney, without altering the tendency stated above. Conclusions.In SPK, the function of pancreas is protected by kidney hence the severity of rejection is reduced, whereas the function of kidney is not protected by pancreas. It suggests that different organs differ in immunoallergization and immunoregulation, and immune response tend to attack organs with greater immunoactivity, those organs with minor one could be protected. Cyclosporine A is effective on prolonging the MST of pancreas and kidney.展开更多
Objective:To explore the peculiarities of kidney transplantation in elderly patients and define the perioperative managements. Methods: The clinical data of kidney transplantation in 29 patients older than 65years wer...Objective:To explore the peculiarities of kidney transplantation in elderly patients and define the perioperative managements. Methods: The clinical data of kidney transplantation in 29 patients older than 65years were reviewed, the eldest being 84 years old and the mean age 68. 1 years. Results: Four episodes of acute rejection (13. 80%) were encountered. FK506 toxicity occurred in one case (3.40%) and lung infection in another (3.40%), who (along with the former 4 patients) all were cured subsequently. In one case, the kidney graft was removed for thrombogenesis of the renal artery. The 1- and 3-year patients/grafts survival of 100% and 96.5% respectively was achieved, with the longest survival exceeding 5 years. Conclusions:Old age was not the absolute contraindication for kidney transplantation. Strict observance of the indications of kidney transplantation and donor selection with well-matched tissue-typing are crucial in elderly patients.Adequate application of immunosuppressants and effective long-term follow-up are also major factors for long-term allograft survival.展开更多
Objective: To study the effect of tacrolimus (Prograf, FK506) in preventing renal allograft rejection. Methods: The curative effect, therapy index, toxicity and side effects of FK506 were observed in 294renal transpla...Objective: To study the effect of tacrolimus (Prograf, FK506) in preventing renal allograft rejection. Methods: The curative effect, therapy index, toxicity and side effects of FK506 were observed in 294renal transplant recipients among whom 268 received FK506 24 h after the operation and the other 26 with cyclosporine (CsA) developed acute rejection after transplantation and were given FK506 to replace methylprednisolone (MP) when the latter did not result. All the patients were given oral mycophenolate mofetil (MMF, 1.0 g/d) and meticorten (Pred, 30 mg/d) 24 h later after operation. Results: In the 268 recipients previously mentioned, the incidence of acute rejection was 10. 45%, glycometabolism disorder 9.33%, nervous system disturbance 1.59%, liver function abnormality 2.99%, nephrotoxicity 1.87%, gastrointestinal disorder 17. 5%, cytomegalovirus (CMV) viremia 2.99%, and non-CMV pulmonary infection 1. 59%(4/268), with 1 fatal case for cerebral hemorrhage with normal allograft function and another 2 non-fatal cases in which function loss resulted in removal of the allografts. The blood trough concentrations of FK506were between 5 and 20μg/L. In the 26 cases of steroid-resistant rejection, 23 (88. 46%, 23/26) were reversed and the rest 3 required plasma exchange and application of OKT3 before recovery. Conclusion: As a safe and effective immunosuppressant, FK506 can reduce the incidence of allograft rejection in kidney transplant recipients with little side effects or toxicity, which is particularly applicable in patients with steroid-resistant rejection or CsA nephrotoxicity. Attention should to be paid to glycometabolism disorder due to FK506, however, the long-term effects of FK506 need further investigation.展开更多
For renal transplant recipients, intestinal obstruction caused by incisional hernia is a rarely encountered event. Until now, there is no specific literature concerning the adjustment of immunosuppressants under such ...For renal transplant recipients, intestinal obstruction caused by incisional hernia is a rarely encountered event. Until now, there is no specific literature concerning the adjustment of immunosuppressants under such clinical condition. We present such a case who received a successful long-term single intravenous prograf administration to transitionally maintain the immunosuppression.展开更多
Objective: To observe the central nervous system (CNS) complications among 1083 consecutive renal transplant (RT) recipients. Methods: Systemic analyses of the incidence, time of onset and clinical outcome of CNS comp...Objective: To observe the central nervous system (CNS) complications among 1083 consecutive renal transplant (RT) recipients. Methods: Systemic analyses of the incidence, time of onset and clinical outcome of CNS complications were conducted in 1083 patients receiving cadaveric RT in Nanfang Hospital during Jan 1992 to Dec 1999. Results: Various CNS complications occurred in a total of 68 RT recipients (6. 28%, 68/1083) with a mortality of (1.29%, 14/1083). Of all the 1 083 recipients enrolled in this study,diffuse encephalopathy occurred in 31 cases (2.86%), cerebrovascular accidents in 17 (1.56%), seizure in 11 (1.02%) and CNS infection in 9 (0. 83%). Immusuppressive agents was the major cause for diffuse encephalopathy (93.5 %, 29/31), and cerebrovascular accidents were associated with a mortality rate of 70. 5%(12/17) and CNS infection with a mortality rate of 22. 22% (2/9). Most of the complications took place within the first month after RT, especially the first 2 weeks, but the majority of CNS infection occurred 1 year after RT. Conclusion: About 6% of renal transplant recipients develop CNS complications that result in a mortality of 1. 29%, which require early diagnosis and vigorous treatment. Diffuse encephalopathy and cerebrovascular accidents are the two most common CNS complications, and immunosuppressive agents play a important role in the occurrence of encephalopathy. Most of the CNS complications occurred early after RT, but CNS infections may occur rather late, and cerebrovascular accidents and CNS infection are the two major causes of death.展开更多
For meeting the clinic needs in simultaneous pancreas and kidney transplantation (SPK), we success-fully establish a syngeneic SPK transplatation model in Lewis rats. The results indicate that this model isfeasible wi...For meeting the clinic needs in simultaneous pancreas and kidney transplantation (SPK), we success-fully establish a syngeneic SPK transplatation model in Lewis rats. The results indicate that this model isfeasible with a 82. 6% successful rate of operation and a 69. 6% survival rate in the first postoperativeweek. In long-term survived rats, the blood supplies are well established, function of the grafts (pancreasand kidney) maintains normal. This model is suitable for theoretical reserach in SPK transplantation for itsreasonable physiology with pancreatic juice drained into intestine and reduced postoperative complications inurinary tract and carbohydrate metabolism.展开更多
文摘Objective To investigate the impact of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection on the long-term survival of renal transplantation recipients. Methods A total of 443 patients who received renal allografts from 1992 to 2002 were analyzed. Outcome and survival were compared among four groups retrospectively. Results Twelve patients were positive for both hepatitis B surface antigen (HBsAg) and HCV antibody (anti-HCV) (group 1), 18 were HBsAg-positive and anti-HCV-negative (group 2), 26 were HBsAg-negative and anti-HCV-positive (group 3) and 387 were negative for both markers (group 4). The mean follow-up period was 6.1 ± 2.8 years (range, 0.5-10 years) for all patients. Group 2 had significantly higher liver-related complications (38.9%) and liver-related death (16.7%) than did group 4 (0%, P < 0.01). Among all patients, 4 HBsAg-positive patients had fulminant hepatitis and died within two years of transplantation. Three patients (group 2) who died were seropositive for HBeAg and/or HBV DNA and none had a history of or positive serologic marker to indicate hepatitis of other etiologies. One (group 1), two (group 2), and one patient (group 3) developed liver cirrhosis respectively, and hepatocellular carcinoma occurred in two patients (group 2) and one patient (group 3). Despite high liver-related mortality in HBV-infected patients, no significant differences among the four groups in the long-term graft and patient survivals were demonstrated. The presence of HBsAg or anti-HCV was not associated with poor prognosis as determined by Cox regression analysis. Conclusion HBV or HCV infection is not a contraindiction to kidney transplantation in Chinese patients. However, it should be noted that serious liver-related complications may occur and limit survival in patients infected with HBV and/or HCV after kidney transplantation.
文摘Objective.The purpose of this study was to assess the renal graft expression of ICAM 1(intercellular adhesion molecule 1) and LFA 1(lymphocyte function associated antigen 1)molecule with relation to graft rejection. Methods.Rat kidney transplantation was performed according to the procedure of Kamada with some modification.Experimental rats were divided into 5 groups.The survival time of recipient rats and function of grafts after renal transplantation were observed.The sections of renal graft were stained for monoclonal antibody ICAM 1 and LFA 1, and then quantification of ICAM 1 and LFA 1 expression was accomplished by computer image analysis. Results.ICAM 1 and LFA 1 increased significantly in the renal allograft rejection group as compared with the non rejection groups(P<0 05). Conclusion.Both biopsy of renal graft and monitoring of ICAM 1 and LFA 1 are useful tools in diagnosing and treating acute rejection.
文摘Objective To explore methods of preventing and reversing rejection after simultaneous pancreas-kidney （SPK） transplantation. Methods Seventeen patients underwent SPK transplantation from September 1999 to September 2003 were reviewed retrospectively. Immunosuppression was achieved by a triple drug regimen consisting of cyclosporine, mycophenolate mofleil （MMF）, and steroids. Three patients were treated with anti-CD3 monoclone antibody （OKT3, 5 mg·d^-1） for induction therapy for a mean period of 5-7 days. One patients received IL-2 receptor antibodies （daclizumab） in a dose of I mg·kg^-1 on the day of transplant and the 5th day posttransplant. One patient was treated with both OKT3 and daclizumab for induction. Results No primary non-functionality of either kidney or pancreas occurred in this series of transplantations. Function of all the kidney grafts recovered within 2 to 4 days after transplantation. The level of serum creatinine was 94 ± 11 μmol/L on the 7th day posttransplant. One patient experienced the accelerated rejection, resulting in the resection of the pancreas and kidney grafts because of the failure of conservative therapy. The incidence of the first rejection episodes at 3 months was 47.1% （8/17）. Only the kidney was involved in 35.3% （6/17）; and both the pancreas and kidney were involved in 11.8% （2/17）. All these patients received a high-dose pulse of methylprednisone （0.5 g·d^-1） for 3 days. OKT3 （0.5 mg·d^-1） was administered for 7-10 days in two patients with both renal and pancreas rejection. All the grafts were successfully rescued. Conclusion Rejection, particularly acute rejection, is the major cause influencing graft function in SPK transplantation. Monitoring renal function and pancreas exocrine secretion, and reasonable application of immunosuppressants play important roles in the diagnosis and treatment of rejection.
文摘Objective:To establish a sensitized canine model for kidney transplantation.Methods:12 male dogs were averagely grouped as donors and recipients. A small number of donor canine lymphocytes was infused into different anatomic locations of a paired canine recipient for each time and which was repeated weekly. Specific immune sensitization was monitored by means of Complement Dependent Cytotoxicity (CDC) and Mixed Lymphocyte Culture (MLC) test. When CDC test conversed to be positive and MLC test showed a significant proliferation of reactive lymphocytes of canine recipients, the right kidneys of the paired dogs were excised and transplanted to each other concurrently. Injury of renal allograft function was scheduled determined by ECT dynamic kidney photography and pathologic investigation. Results:CDC test usually conversed to be positive and reactive lymphocytes of canine recipients were also observed to be proliferated significantly in MLC test after 3 to 4 times of canine donor lymphocyte infusions. Renal allograft function deterioration occurred 4 d post-operatively in 4 of 6 canine recipients, in contrast to none in control dogs. Pathologic changes suggested antibody-mediated rejection (delayed) or acute rejection in 3 excised renal allograft of sensitized dogs. Seven days after operation, all sensitized dogs had lost graft function, pathologic changes of which showed that the renal allografts were seriously rejected. 2 of 3 dogs in control group were also acutely rejected.Conclusion:A convenient method by means of repeated stimulation of canine lymphocyte may induce specific immune sensitization in canine recipients. Renal allografts in sensitized dogs will be earlier rejected and result in a more deteriorated graft function.
文摘Objective： To explore the characteristic of operation, intra-operation treatment and the application of immunosuppressant in pediatric renal transplantation in order to improve therapeutic effectiveness. Methods： From March 1986 to October 2006, the clinical data of 63 children who underwent renal transplantation in our hospital were retrospectively analyzed. Results： The 1-, 3-, 5-, 10-year graft survival rates were 98.4%, 90.5%, 88.9% and 68.3%, respectively. And the corresponding patient survival rates were 100%, 95.2%, 92.1%, 71.4%. The body weight increased 4 to 12 kg and the body height grew up 2 to 6 cm during the first year post-transplantation. The main complications in the first year post-transplantation were hypertension （26/63, 41.3%）, crinosity （14/63, 22.2%）, drug-induced hepatic injury（11/63, 17.5%）, gingival hyperplasia （10/63, 15.8%）, pulmonary infection（9/63, 14.3%）, bone marrow suppression（5/63, 7.9%）, herpes （4/63, 6.3%） and diabetes （3/63, 4.8%）. Conclusion： Renal transplantation is a preferred method for the treatment of children in end-stage renal disease （ESRD）. Good tissue matching, proper operative time and pattern, peri-operactive care were essential to success, as well as appropriate immuno-suppressant strategy and good compliance.
文摘Objective: In order to study the role and significance of transforming growth factor beta-1 (TGF-β1 )mRNA in transplanted renal fibrosis(TRF). Methods: Renal pathologic changes and expression of TGF-β1 mRNA were observed using in situ hybridization technique. The normal renal tissue as a. control group. Results: Expression of TGF-β1, mRNA in the renal fibrosis increased, compared with that in the control group. The expression rate were co-related to the stage of TRF. Conclusion: TGF-β1 is related to the pathogenesis and development of TRF.
文摘Objective To evaluate the safety and feasibility of steroid or mycophenolate mofetil （MMF） withdrawal from tacrolimus-based immunosuppressant regimen in renal allograft recipients. Methods A cohort of 45 patients following cadaveric renal allograft transplantation were randomly divided into 3 groups based on the regimen of combination of tacrolimus, steroid, and MMF： triple therapy group, steroid withdrawal group, and MMF withdrawal group. During 2 years, survival of patients and allografts, clinical acute rejection, adverse events, hepatic and renal allograft function, and blood lipids were monitored to evaluate the safety and feasibility of steroid or MMF withdrawal after renal transplantation. Results During two-year observation, steroid or MMF was successfully withdrawn from immunosuppressant regimen based on tacrolimus without any clinical acute rejection renal allografts kept excellent function. Some adverse events among groups. Patient and graft survival rates were 100% and all the occurred and there were no significant differences Conclusion Withdrawal of steroid or MMF in low-immunological-risk renal allografts treated with tacrolimus-based immunosuppressant regimen can be achieved with no increased risk of acute rejection.
文摘Objective To investigate the effects of losartan, a specific angiotensin Ⅱ receptor blocker, on slowing progression of renal insufficiency in patients with biopsy-proven chronic allograft nephropathy （CAN） and the molecular mechanism of the therapy. Methods Twenty-two renal transplant recipients with biopsy-proven CAN （group A） were treated with losartan within two months after renal dysfunction for at least one year. Losartan was administered at a dose of 50 mg/d. Twenty-four recipients in the same fashion （group B） who never received angiotensin Ⅱ receptor antagonist were studied as control. The investigation time for each patient lasted one year. Renal functions and concentrations of plasma and urine transforming growth factor-betal （TGF-betal） were compared between the two groups at the initiation and end of the study. In group A, expressions of TGF-betal mRNA and immunofluorescence intensity of TGF-betal protein and pathological alterations in renal biopsy specimens were compared between before losartan therapy and after one year of the therapy. Results At the initiation of the investigation, no significant differences were found between group A and group B in clinical data such as donor age, cold-ischemia time, HLA mismatch, levels of creatinine clearance （Ccr）, plasma and urine TGF-betal concentrations. One year later, 14 of 22 （63.6%） patients showed stable or improved graft functions in group A, and 4 of 24 （16.7%） in group B. The difference was significant （P 〈 0.05）. At the end of the study, urine TGF-betal concentration was 273.8 ± 84.1 pg/mg.Cr in group A and 457.2 ± 78.9 pg/mg.Cr in group B. During one year study period, loss of Ccr was 6.6 ± 5.4 mL/min in group A and 16.2 ± 9.1 mL/min in group B. Both of the differences were significant between the two groups （P 〈 0.01）. No significant differences were found in plasma TGF-betal concentrations between the four values determined at the initiation and end of the study in the two groups （F= 2.56, P〉 0.05）. After one year losartan therapy, group A showed a significant decrease in expressions of TGF-betal mRNA and TGF-betal protein in renal biopsy specimens [from 1.59 ± 0.35 to 0.96 ± 0.27 and from （10.83 ± 2.33）×10^6 to （6.41 ± 1.53）×10^6, respectively; both P 〈 0.01], but in light microscopy the histological changes were similar to the first renal biopsy. Losartan was excellently tolerated in all patients in group A. No cases with losartan therapy showed too low blood pressure and other side effects. Conchusion This study suggests that losartan have an effect on slowing progression of CAN. Reducing production of intrarenal TGF-betal may play a decisive role in the efficacy of losartan.
文摘Objective To retrospectively investigate the distribution in kidney transplantation for fifteen years in Peking Union Medical College Hospital.Methods We conducted a descriptive research counting up the number of patients who received kidney transplantation each year in our hospital during 1995 and 2010.Results The first kidney transplantation in our hospital occurred in the 1960s.The number of kidney transplantation increased until reaching a maximum of 47 grafts in 2001;since then the number fell.Conclusions With the decreased number of kidney transplantation,we have realized the shortage of transplantable organs is very serious.The continuing transplant shortage requires major efforts to expand the donor pool.Donation after cardiac death offers the potential to enlarge the donor pool,but we need to strictly control the criteria for potential donors.
文摘Objective.To investigate the difference of rejection in single versus combined pancreas and kidney transplantation in rats. Methods.Allograft models including simultaneous pancreas and kidney(SPK)transplant and pancreas or kidney transplant alone were established in SD-Wistar rats, rejections of pancreas and kidney in different models were compared morphologically and functionally. Results.Mean survival time(MST)of pancreas was significantly prolonged in SPK than in pancreas transplant alone(PTA)(115 days vs. 92 days, P<005). Incidence of interstitial pancreatic rejection at grade Ⅱ and grade Ⅲ was much obvious in PTA than in SPK(429% vs. 125% at grade Ⅱ and 286% vs 63% at grade Ⅲ , P<005). No significant difference was found in MST between SPK and kidney transplant alone(KTA). Administration of cyclosporine A prolonged the MST of pancreas and kidney, without altering the tendency stated above. Conclusions.In SPK, the function of pancreas is protected by kidney hence the severity of rejection is reduced, whereas the function of kidney is not protected by pancreas. It suggests that different organs differ in immunoallergization and immunoregulation, and immune response tend to attack organs with greater immunoactivity, those organs with minor one could be protected. Cyclosporine A is effective on prolonging the MST of pancreas and kidney.
文摘Objective:To explore the peculiarities of kidney transplantation in elderly patients and define the perioperative managements. Methods: The clinical data of kidney transplantation in 29 patients older than 65years were reviewed, the eldest being 84 years old and the mean age 68. 1 years. Results: Four episodes of acute rejection (13. 80%) were encountered. FK506 toxicity occurred in one case (3.40%) and lung infection in another (3.40%), who (along with the former 4 patients) all were cured subsequently. In one case, the kidney graft was removed for thrombogenesis of the renal artery. The 1- and 3-year patients/grafts survival of 100% and 96.5% respectively was achieved, with the longest survival exceeding 5 years. Conclusions:Old age was not the absolute contraindication for kidney transplantation. Strict observance of the indications of kidney transplantation and donor selection with well-matched tissue-typing are crucial in elderly patients.Adequate application of immunosuppressants and effective long-term follow-up are also major factors for long-term allograft survival.
文摘Objective: To study the effect of tacrolimus (Prograf, FK506) in preventing renal allograft rejection. Methods: The curative effect, therapy index, toxicity and side effects of FK506 were observed in 294renal transplant recipients among whom 268 received FK506 24 h after the operation and the other 26 with cyclosporine (CsA) developed acute rejection after transplantation and were given FK506 to replace methylprednisolone (MP) when the latter did not result. All the patients were given oral mycophenolate mofetil (MMF, 1.0 g/d) and meticorten (Pred, 30 mg/d) 24 h later after operation. Results: In the 268 recipients previously mentioned, the incidence of acute rejection was 10. 45%, glycometabolism disorder 9.33%, nervous system disturbance 1.59%, liver function abnormality 2.99%, nephrotoxicity 1.87%, gastrointestinal disorder 17. 5%, cytomegalovirus (CMV) viremia 2.99%, and non-CMV pulmonary infection 1. 59%(4/268), with 1 fatal case for cerebral hemorrhage with normal allograft function and another 2 non-fatal cases in which function loss resulted in removal of the allografts. The blood trough concentrations of FK506were between 5 and 20μg/L. In the 26 cases of steroid-resistant rejection, 23 (88. 46%, 23/26) were reversed and the rest 3 required plasma exchange and application of OKT3 before recovery. Conclusion: As a safe and effective immunosuppressant, FK506 can reduce the incidence of allograft rejection in kidney transplant recipients with little side effects or toxicity, which is particularly applicable in patients with steroid-resistant rejection or CsA nephrotoxicity. Attention should to be paid to glycometabolism disorder due to FK506, however, the long-term effects of FK506 need further investigation.
文摘For renal transplant recipients, intestinal obstruction caused by incisional hernia is a rarely encountered event. Until now, there is no specific literature concerning the adjustment of immunosuppressants under such clinical condition. We present such a case who received a successful long-term single intravenous prograf administration to transitionally maintain the immunosuppression.
文摘Objective: To observe the central nervous system (CNS) complications among 1083 consecutive renal transplant (RT) recipients. Methods: Systemic analyses of the incidence, time of onset and clinical outcome of CNS complications were conducted in 1083 patients receiving cadaveric RT in Nanfang Hospital during Jan 1992 to Dec 1999. Results: Various CNS complications occurred in a total of 68 RT recipients (6. 28%, 68/1083) with a mortality of (1.29%, 14/1083). Of all the 1 083 recipients enrolled in this study,diffuse encephalopathy occurred in 31 cases (2.86%), cerebrovascular accidents in 17 (1.56%), seizure in 11 (1.02%) and CNS infection in 9 (0. 83%). Immusuppressive agents was the major cause for diffuse encephalopathy (93.5 %, 29/31), and cerebrovascular accidents were associated with a mortality rate of 70. 5%(12/17) and CNS infection with a mortality rate of 22. 22% (2/9). Most of the complications took place within the first month after RT, especially the first 2 weeks, but the majority of CNS infection occurred 1 year after RT. Conclusion: About 6% of renal transplant recipients develop CNS complications that result in a mortality of 1. 29%, which require early diagnosis and vigorous treatment. Diffuse encephalopathy and cerebrovascular accidents are the two most common CNS complications, and immunosuppressive agents play a important role in the occurrence of encephalopathy. Most of the CNS complications occurred early after RT, but CNS infections may occur rather late, and cerebrovascular accidents and CNS infection are the two major causes of death.
文摘For meeting the clinic needs in simultaneous pancreas and kidney transplantation (SPK), we success-fully establish a syngeneic SPK transplatation model in Lewis rats. The results indicate that this model isfeasible with a 82. 6% successful rate of operation and a 69. 6% survival rate in the first postoperativeweek. In long-term survived rats, the blood supplies are well established, function of the grafts (pancreasand kidney) maintains normal. This model is suitable for theoretical reserach in SPK transplantation for itsreasonable physiology with pancreatic juice drained into intestine and reduced postoperative complications inurinary tract and carbohydrate metabolism.
