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Objective:To explore the risk factors of pulmonary infection in elderly (aged 60+ years) kidney transplant recipients.Methods:The clinical data were retrospectively analyzed for 119 elderly kidney transplant recipients from January 2010 to January 2019 . According to whether or not pulmonary infection occurred after renal transplantation, the recipients were divided into infected group (n=40) and non-infected group (n=79). Clinical data was analyzed for two groups. The relevant risk factors of gender, age, donor type, body mass index, history of smoking, preoperative dialytic time, preoperative dialysis, immune induction, immune maintenance, presence or absence of delayed graft function, leucopenia, serum creatinine before infection, venous hormone shock therapy or not, diabetic history before or after surgery, history of coronary heart disease, history of hepatitis B virus, prophylactic dosing of compound sulfamethoxazole, prophylactic valganciclovir or ganciclovir, were examined by univariate analysis and multivariate logistic regression analysis.Results:The incidence of pulmonary infection in elderly kidney transplant recipients was 33.6% (40/119). In infected group, 15 patients died of severe pulmonary infection with a mortality rate of 37.5%(15/40). History of smoking (OR=10.58, 95%CI: 1.98-56.40, P=0.006), venous hormone shock therapy (OR=25.06, 95%CI: 4.25-147.71, P<0.001) and preoperative dialytic time (OR=1.032, 95%CI: 1.003-1.062, P=0.033) were the risk factors for pulmonary infection in elderly kidney transplant recipients. Conclusions:The incidence and mortality of lung infection are higher in elderly kidney transplant recipients. Smoking history, venous hormone shock therapy and long preoperative dialytic are associated with pulmonary infection in elderly kidney transplant recipients.
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Objective To summarize the clinical treatment experience of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection after renal transplantation in donation after cardiac death (DCD) era. Methods Clinical data of 10 donors and 17 recipients with CRKP infection after DCD renal transplantation from January 2015 to January 2019 were retrospectively analyzed. Both donors and recipients received bacterial culture and drug sensitivity test. Clinical manifestations, treatment and outcome of CRKP-infected recipients were recorded. Results Seven donors were infected with CRKP. After pretreatment, CRKP in 2 cases turned negative, CRKP in 5 donors did not turn negative. All renal grafts were treated with tigecycline+meropenem+voriconazole lavage to prevent infection. Among 17 recipients with CRKP infection, 11 cases were positive for blood culture, 10 positive for urine culture, 3 positive for sputum culture, 3 positive for incisional secretion and 3 positive for retroperitoneal drainage. Clinical manifestations included fever in 8 cases, rupture and hemorrhage of the transplant renal artery in 7 cases or thrombosis in the transplant renal artery in 1 case, bladder irritation sign in 3 cases and cough with brick red jelly-like sputum in 1 case, respectively. Five patients were treated with tigecycline+meropenem, 1 patient suffered from renal graft loss and 4 recipients died. Twelve patients were treated with ceftazidime-avibactam +meropenem, 3 patients presented with renal graft loss and 1 recipient died. Conclusions CRKP-infected donor is not the absolute contraindication of renal transplantation. Pretreatment of donor infection and early administration of sufficient sensitive antibiotics can cure CRKP infection and improve the clinical prognosis of renal transplant recipients.
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Objective To analyze the clinical efficacy of multiple renal arteries on outcomes of renal donors and recipients in hand-assisted retroperitoneoscopic donor nephrectomy.Method From 2012 to 2014,121 patients underwent hand-assisted laparoscopic donor nephrectomy,including 92 cases of a single renal artery and 29 cases of multiple arteries.Donor and recipient outcomes for single artery and multiple arteries allografts were compared.Result The study included 121 pairs of donors and recipients.The demographic characteristics between multiple renal artery group and single renal artery group had no significant difference.The operative time,blood loss,postoperative complications,and hospital stay had no significant difference between two groups.Cold ischemia time and warm ischemia time in multiple renal artery group were longer than single donor renal artery group (128.5 ± 13.2 vs.50.2 ± 17.3 min,P＜0.001;196.0 ± 63.3 vs.154.1 ± 55.2 min,P=0.002,respectively).The operative time in multiple renal artery group was longer than in single renal artery group (213.5 ± 28.2 vs.182.2 ± 31.1 min,P＜0.001).There was no significant difference in blood loss,vascular complications and ureternal complications between two groups.The renal functions of two groups were likewise within one year.Conclusion There was no statistically significant difference in clinical efficacy between hand-assis-ted retroperitoneoscopic donor nephrectomy with multiple renal arteries and single artery.The use of these grafts was safe for both recipients and donors.
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Objective To analyze and summarize clinical characteristics and treatment of diffuse alveolar hemorrhage syndrome (DAHS)complication after renal transplantation.Methods Clinical data of one patient,admitted to the 309 th Hospital of People's Liberation Army in December 201 2, who was complicated with DAHS after renal transplantation,were obtained.The incidence,diagnosis and treatment courses of DAHS were retrospectively analyzed.Literature review was conducted to summarize clinical experience.Results The patient was clinically manifested with respiratory failure,progressive aggravation of hemoptysis and anemia.Imaging examination revealed that diffusive infiltration of bilateral lungs was aggravated.After the diagnosis of DAHS was confirmed,adrenal cortical hormone (hormone)shock and anti-infectious medication therapies were timely delivered to actively prevent and treat relevant complications.The patient was successfully healed.Until the submission date,the patient presented with normal renal function and no pulmonary complications were noted.Conclusions DAHS is a rare and fatal complication after renal transplantation.Early diagnosis, active anti-infection therapy and timely administration of large-dose hormone shock treatment determine the success of clinical treatment.
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Objective To examine the relationship between hypercalcemia (HC) and the development of posttransplant erythrocytosis (PTE).Method 169 patients with normal graft function who underwent renal transplantation between January 1, 2012 and January 1, 2014 in 309th Hospital of PLA were retrospectively reviewed.Result 169 patients with normal graft function who underwent kidney transplantation for the first time in 309th Hospital from January 1, 2012 to January 1, 2014 were enrolled, including 121 males and 48 females.During the follow-up period, PTE appeared in 48 (28.4％) patients.Thirty-three (19.5％) patients developed HC, PTE occurred in 17/33 (51.5％) patients with HC, and in 31/136 (22.8％) patients without HC.PTE and HC were highly correlated (P＜0.001).Serum calcium levels tended to increase in patients with PTE, but significantly decreased in patients without PTE.HC patients had a higher probability of PTE (51.5％ vs.22.8％;P＜0.001).Similarly, HC was more common among patients with PTE compared with patients without PTE (35.4％ vs.13.2％;P＜0.001).Simple linear regression analysis showed that calcium concentration was independent predictor of hemoglobin levels (P＜0.01).In multivariate analysis, multiple linear regression model showed that the calcium concentration was still a significant predictor of hemoglobin levels (P＜0.001).Multivariate logistic regression analysis showed that the occurrence of HC was an independent risk factor of PTE (P =0.01).Estimated glomerular filtration rate was also associated with PTE (P =0.012).As compared with women, the relative risk of men who had PTE was 4.373 times (P＜0.05).The risk of PTE in patients with HC was about five times higher than in patients with normal blood calcium.Conclusion HC is associated with PTE.HC may lead to the increased PTE in renal transplant recipients.
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Objective To investigate the effect of body mass index (BMI)on short-term prognosis of patients after renal transplantation.Methods Clinical data of 1 041 adult patients undergoing the first renal transplantation in the Institute of Organ Transplantation of the 309 th Hospital of People's Liberation Army from March 2009 to March 201 3 were retrospectively studied.According to the Adult Obesity and Overweight Standard commonly used in China,these patients were divided into 4 groups:112 patients in BMI <1 8.5 kg/m2 group (emaciation group),606 patients in BMI 1 8.5-23.9 kg/m2 group (normal group),250 patients in BMI 24.0-27.9 kg/m2 group (overweight group)and 73 patients in BMI≥28.0 kg/m2 group (obesity group).The incidence of delayed graft function (DGF)and acute rejection (AR)of the 4 groups one year after renal transplantation were observed and compared.One-year patient and graft survival rates were calculated.The relationship between BMI and DGF was studied by univariate and multivariate Logistic regression analysis to investigate the effect of different BMI on DGF.Results After the follow-up for one year,the incidence of DGF in the obesity group was significantly higher than that in the emaciation group and the normal group(both in P <0.05).The difference in the incidence of acute rejection one year after renal transplantation as well as one-year patient or graft survival rate had no statistical significance (all in P >0.05).Univariate analysis showed that obesity increased the risk of DGF after renal transplantation (OR was 1 .33,P <0.05).Multivariate analysis showed that both overweight and obesity were independent risk factors of DGF after renal transplantation (OR was respectively 1 .56 and 1 .37,both in P <0.05).Conclusions Overweight and obesity increases the risk of DGF after renal transplantation,but do not increase the incidence of AR after renal transplantation and do no influence short-term patient and graft survival rates after renal transplantation.
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Objective To observe the curative effect and adverse reaction of benazepril on polycythemia (PTE ) after renal transplantation. Methods Twenty-two patients undergoing kidney transplantation for the first time at the Department of Urinary Surgery of the 309 th Hospital of People's Liberation Army and developed PTE after renal transplantation from June 2012 to June 2013 were enrolled as the object of study.The patients were divided into the hypertension group (n =14)and the normal blood pressure group (n =8)according to whether the patients were with hypertension or not.The hypertension group was given benazepril with an initial dose of 10 mg/d and increased to the maximum dose of 40 mg/d according to the changes of patients’conditions.The normal blood pressure group was given benazepril with an initial dose of 5 mg/d and with the maintenance dose of 2.5 mg/d after hemoglobin and hematokrit returning to normal.The patients in two groups were followed up for 6 months.The curative effect and adverse reactions during the follow-up were compared between the two groups.Results After 6 months of treatment,12 patients had marked effect,1 had effect and 1 was improved in the hypertension group.Six patients had marked effect, 1 had effect and 1 had no effect in the normal blood pressure group.The difference of efficacy had no statistical significance between the two groups (P >0.05).During the treatment,the blood pressure of the hypertension group dropped significantly (P <0.05 ),while that of the normal blood pressure group had no significant change.Red blood cells,neutrophils,platelets,serum creatinine,uric acid and estimated glomerular filtration rate of the two groups had no obvious abnormality before and after treatment.One patient in the hypertension group developed irritable cough during the treatment and recovered after withdrawal.Conclusions It is safe and effective to take benazepril for patients with PTE after renal transplantation.It is recommended to start with small dose and the dose shall be adjusted according to blood pressure.The blood pressure,blood routine and renal function shall be monitored during the treatment.
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Objeetive To discuss the correlation of creatinine reduction ratio(CRR2)from posttransplant day 1 to day 2 and early graft function recovery status after kidney transplantation. Methods Clinical data of 80 patients after renal transplantation from Jan 2005 to Mar 2007 were retrospectively analyzed.Patients were divided into three groups according to the post-operative serum creatinine level:53 patients within IGF group[cereatinine＜265.2 μmol/L by post-operative day(POD)no.5],14 patients within SGF group(creatinine＞265.2 μmol/L on POD no.5,but no need for dialysis),and 13 patients within DGF group(need for dialysis in the first week post-transplant).Then the value and 99%CI of CRRz of these three groups were calculated. Results The value of CRR2 of IGF,SGF and DGF was(46.8±14.6)%,(25.6±13.5)%and(0.7±17.7)%respectively.And CRR2 99%CI of IGF,SGF and DGF was 41%-52%,15%-36%and-14%-16 0A respectively.There was significant difference in the value of CRR2 among IGF,SGF and DGF group.So a criteria for early diagnosis of IGF,SGF and DGF by CRR2 99%C1 was established:IGF(CRR2≥40%),SGF (15%＜CRR2＜40%)and DGF(CRR2≤15%). Conclusion CRR2 has a good correlation with early graft function recovery after kidney transplantation,and can be used to predict the occurrence of SGF and DGF.
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Objective To study the incidence of malignant tumors in the patients undergone renal transplantation, and to explore the mechanism of higher incidence. Methods A retrospective study was performed on 829 patients undergone renal transplantation followed by immunosuppression therapy from 1998-2006. 15 cases developed malignant tumors among the 829 patients with incidence of 1.9%. The incidence of urinary system tumor was 66.7%, of hepatoma was 13.3%, and 6.7% for lymphoma, cutaneous cancer and pulmonary carcinoma respectively. Results 15 patients suffered from renal tumors 11-73 months after kidney transplantation, in whom renal function was normal in 14 patients, and in 1 patient the grafted kidney showed dysfunction. No tumor metastasis was found in those cases, except in 3 patients ureteral lumen infiltration was found. Most patients accepted operations, with the dose of the immuosurpression drugs adjusted or reduced, and supplemented with chemotherapy or rediotherapy and immunotherapy. Conclusions The pathogenesis might be related with immunosuppression drugs postoperatively, and also the effects of transplantation itself and the primary disease before transplantation, for instance, uroepithelium malignancy was prolonged medication was frequently the reason for renal transplantation.