ABSTRACT
Parasitic infection is manifested with the characteristics of both endemic and infectious diseases, and the onset of parasitic infection is regional and infectious. The incidence of parasitic infection after organ transplantation is relatively low, primarily occurring in single case or case series in developing countries and regions. With the development of social economy and a gradual increasing number of organ transplantation, the risk of parasitic exposure is increased when the recipients travel among different countries or regions. In addition, immunosuppression is the risk factor of parasitic infection. Consequently, the risk of parasitic infection in organ transplant recipients cannot be ignored. In this article, epidemiological characteristics, clinical manifestations, diagnosis, treatment and prevention of parasitic infection after organ transplantation were classified and summarized according to literature review, aiming to provide reference for the prevention and treatment of parasitic infection in organ transplant recipients.
ABSTRACT
Objective To evaluate the effect and mechanism of terminal fucosylation inhibitor 2-deoxy-D-galactose (2-D-gal) on ciclosporin (CsA)-induced renal epithelial-mesenchymal transition (EMT). Methods Fifteen male C57BL/6 mice aged 8-10 weeks were randomly and evenly divided into the control group (Ctrl group), CsA group and CsA+2-D-gal group (n=5). The expression levels of fucosyltransferase 1 (FUT1), EMT-associated proteins including E-cadherin, Vimentin, α-smooth muscle actin (α-SMA) in the kidney tissues of the Ctrl and CsA groups were detected by Western blot. The expression levels of terminal fucose in the kidney tissues of Ctrl and CsA groups were determined by immunofluorescence. The renal fibrosis of mice in each group was evaluated by Masson staining. The blood urea nitrogen and serum creatinine levels of mice in each group were detected. The in vitro EMT model of renal tubular epithelial cell HK2 was induced by CsA. HK2 cells were stimulated with 0, 2.5, 5.0 and 10.0 μmol/L CsA for 24 h, respectively. In addition, HK2 cells were divided into the Ctrl, 2-D-gal, CsA and CsA+2-D-gal groups. The morphology of HK2 cells after stimulation with different concentrations of CsA and in each group was observed. The expression levels of FUT1, E-cadherin, Vimentin and α-SMA in HK2 cells after stimulation with different concentrations of CsA and in each group were detected by Western blot. The expression level of terminal fucose in HK2 cells of the Ctrl and CsA groups was measured by immunofluorescence. Results Compared with the Ctrl group, the relative expression of E-cadherin protein was down-regulated, those of FUT1, Vimentin and α-SMA proteins were up-regulated (all P < 0.05), and that of terminal fucose in the mouse kidney tissues was up-regulated in the CsA group. Compared with the Ctrl group, the blood urea nitrogen and serum creatinine levels in the CsA and CsA+2-D-gal groups were up-regulated (all P < 0.05). Compared with the CsA group, the blood urea nitrogen and serum creatinine levels in the CsA+2-D-gal group were down-regulated (both P < 0.05). Compared with the Ctrl group, the collagen fiber deposition was increased and the relative expression of α-SMA protein was up-regulated in the mouse kidney tissues of CsA and CsA+2-D-gal groups (all P < 0.05). Compared with the CsA group, the collagen fiber deposition was decreased and the relative expression of α-SMA protein in the mouse kidney tissues was down-regulated in the CsA+2-D-gal group (both P < 0.05). With the increase of CsA concentration, the morphology of HK2 cells gradually became longer and thinner from original normal cobblestone shape, the relative expression levels of FUT1, Vimentin and α-SMA protein in HK2 cells were up-regulated, and that of E-cadherin protein was down-regulated in a concentration-dependent manner. Compared with the Ctrl group, the expression level of terminal fucose of HK2 cells was up-regulated in the CsA group. After CsA treatment combined with 2-D-gal intervention, the morphology of HK2 cells in the CsA+2-D-gal group was restored to resemble that of normal HK2 cells. Compared with the CsA group, the relative expression of E-cadherin protein in HK2 cells was up-regulated, whereas those of Vimentin and α-SMA proteins were down-regulated in the CsA+2-D-gal group (all P < 0.05). Conclusions CsA may induce EMT both in vivo and in vitro, and the terminal fucosylation is increased. 2-D-gal may inhibit CsA-induced EMT by suppressing the terminal fucosylation.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the relationship between acute graft rejection early after renal transplantation and the variations of platelet parameters.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 167 renal transplant recipients before and within 2 months after the surgery. Before and at 1-10 days, 15 days, 30 days, 45 days and 60 days after the transplantation, 5 platelet parameters, including platelet count (PLT), platelet hematocrit (PCT), mean platelet volume (MPV), platelet volume distribution width (PDW), and large platelet ratio (P-LCR), were detected in the 35 patients with acute graft rejection within two months (AR group) and in the other 132 recipients with good graft recovery (control group).</p><p><b>RESULTS</b>The AR group and control group showed no significant difference in PLT, PCT, MPV, or P-LCR before the surgery, but the PDW was significantly higher in the AR group (t=2.18, P=0.035). These parameters were similar within 5 postoperative days between the two groups (P>0.05), but in postoperative days 6-15, the AR group showed significantly increased MPV, PDW and P-LCR compared with the control group (P<0.05). In postoperative days 6-9, MPV, PDW and P-LCR became stable in AR group but tended to decrease in the control group, showing obviously different patterns of variation between the two groups (P<0.05).</p><p><b>CONCLUSIONS</b>Preoperative PDW may have a positive correlation with acute graft rejection after renal transplantation. Monitoring the variations of MPV, PDW and P-LCR may help in the diagnosis of acute graft rejection early after renal transplantation.</p>
Subject(s)
Humans , Blood Platelets , Cell Biology , Graft Rejection , Blood , Hematologic Tests , Kidney Transplantation , Platelet Count , Retrospective StudiesABSTRACT
Objective To investigate expression and suppressive function of CD39 + regulatory T cells (Treg) in kidney transplant recipients.Method Thirty recipients of first kidney transplants were treated with tacrolimus,mycophenolate mofetil and prednisone.Within 28 days posttransplantation,there were 14 patients subject to acute rejection (AR group),and the rest 16 patients had no episodes of acute rejections (NR group).Twelve healthy volunteers served as healthy controls (HC group).We collected peripheral blood from the three groups and separated PBMC by density gradient centrifugation,and sorted Tresp,CD39-Treg and CD39+ Treg by flow cytometry.We next analyzed the ratio of CD39 + Treg/CD4+ T cells.ELISA was used to determine the suppressive ability of CD39-Treg and CD39+ Treg on secretion of IFN-γ and IL-17 by Tresp.Results The ratio of CD39 + Treg/CD4 + T cells in AR group was significantly reduced as compared with HC group and NR group (P＜0.05).In HC group and NR group,the secretion of IFN-γ and IL-17 by Tresp was suppressed significantly (P＜0.05) by CD39+ Treg.CD39Treg could suppress secretion of IFN-γ but not IL-17 production by Tresp.CD39+ Treg in AR group AR could suppress the secretion of IFN-γ significantly (P＜0.01),but not to IL-17 production.Conclusion CD39+ Treg have important immunoregulation function.The relative amount of CD39+ Treg was reduced and their regulatory function was impaired in patients with acute rejection.
ABSTRACT
Tissue engineering has evolved as a dynamic research field that encompasses multidisciplinary approaches involving cytology,material science,bioreactor engineering,and medicine.The overarching goal is to construct human tissue and organs in the laboratory for tissue regeneration or replacement.It offers a potential solution to the donor shortage in organ transplantation and to the difficulties in regenerative medicine.The basic components for tissue engineering include seed cell selection,bio-scaffold construction,and ex vivo tissue formation via a bioreactor. Over the past decade,tremendous progress has been made in bioengineering cartilage,trachea,urinary bladder,heart valve and endocrine tissues. However,there remain significant challenges in creating complex and human-sized tissues and organs for clinical use.In this article,we review the basic components and strategies for bioengineering organs. We attempt to provide an overview of current progress and challenges in developing organ-level tissue engineering and in the successful translation of bioengineered tissue and organ products into daily clinical practice.
ABSTRACT
Objective To explore the impact of induction therapy with anti-lymphocyte agents on long-term survival of kidney transplantation.Methods 271 recipients of first cadaveric kidney transplants were treated with tacrolimus,mycophenolate mofetil and prednisone.110 patients of them received induction therapy with anti-thymocyte globulin(ATG group),88 patients received Basiliximab(Bax group),and the remaining 73 patients did not receive induction therapy(control group).The data of AR,DGF,CMV infection,and 1- 3- 5-year patient/allograft survival rate in three groups were retrospectively during a follow-up period of 1 to 5 years postoperatively.Results Within 6 months after operation,the incidence of AR in control group,ATG group and Bax group was 17.8 %(13/73),9.1 %(10/110)and 10.2 %(9/88)respectively.The incidence of AR in ATG group and Bax group was significantly lower than in control group (P<0.05).There was no significant difference in incidence of DGF and CMV infection among three groups.The 1-,3- and 5-year allograft survival rate postoperation in ATG group and Bax group was 95.5 %,90.9 %,87.3 % and 93.2 %,87.5 %,83.8 % respectively,which was significantly higher than in control group(87.7 %,80.8 % and 75.3 %,P<0.05).Conclusion Induction therapy with anti-lymphocyte agents may reduce the early incidence of AR and prolong long-term allograft survival significantly.
ABSTRACT
Objective To explore the relationship of serum anti-MICA antibody and development of chronic rejection (CR) after renal transplantation. Methods The enrolled 105 patients included 43 cases of CR, and 62 cases of functioning renal allograft as controls. Data including PRA level before transplantation, HLA mismatch, cold ischemic time, SCr at discharge, immunosuppressive regimen,and months after transplantation were analyzed. Blood samples were collected immediately after grouping for anti-MICA antibodies, SCr determination. Acute rejection episodes and renal allograft function which was evaluated by △SCr/M [(SCr at present - SCr at discharge) /months after transplantation) were compared between anti-MICA-antibody positive patients and anti-MICA-antibody negative patients. Results There was no significant difference in gender, age, HLA mismatch, cold ischemic time, immunosuppressive regimen, SCr at discharge, months after transplantation between CR and control groups (P＞0.05). Serum creatinine level and number of antiMICA-antibody positive patients in CR group were significantly increased as compared with those in control group (P＜0.01 ). Acute rejection episodes during the first 3 months after transplantation in anti-MICA-antibody positive patients were significantly more than those in anti-MICA-antibody negative patients (P＜0.05),and the △SCr/M in the former was higher than that in the latter (8.3 +3.6 vs 2.4 ± 2.6, P＜0.05). Conclusion Humoral immunoreaction mediated by MICA partly participates the development of CR after renal transplantation. MICA antibody is a risk factor affecting long-term allograft function.
ABSTRACT
Objective To summarize the clinical experience of combined liver and kidney transplantation (CLKT). Methods CLKT was performed on 22 patients. The orthotopic liver transplantation (LT) was preceded with the classic fashion in 10 patients and piggyback fashion in 12 patients. The renal allograft was implanted to the iliac fossa routinely. After operation, the patients received an induction therapy with anti-CD25 monoclonal antibody or antithymocyte globulin ( ATG) and a maintenance therapy with tacrolimus (Tac), mycophenolate mofetil and prednisone. Results The CLKT was successfully performed on all 22 patients, and the graft function was restored well postoperation. During the perioperative period, an acute rejection episode of liver occurred in one patient and acute renal allograft rejection episode in 2 patients. The Tac toxicity occurred in one patient. The hemorrhage of digestive tract occurred in one recipient and the hemorrhage of peritoneal cavity in one patient. The pleural effusion occurred in 6 recipients. The pneumonia occurred in 2 cases and the peritoneal infection in one patient During a follow-up period of 6 months to 7 years 11 months, three patients died because of cytomegalovirus pneumonia in 2 patients and acute myocardial infarction in, one patient, The 1-, 3-, 5-year survival rate of recipients was 86,4 %, 81.3 %, 72.7 % respectively. Conclusion The CLKT is an effective method for treatment of patients with end-stage liver djsease and chronic renal failure.
ABSTRACT
Objective To evaluate whether serum cystatin C (SCys C) could be used as an ideal index to assess renal function of renal transplant recipients during posttransplant follow-up.Methods Seventy patients who were followed up for at least 6 months after renal transplantation in our centre were recruited in the study. SCys C and serum creatinine (SCr) were determined during the follow-up period, and glomerular filtration rate (GFR) was measured using an isotope Tc99m DTPA.The correlation between SCys C, SCr and GFR was analyzed. The performance of SCys C and SCr in diagnosing the mild impairment of renal allgraft function (GFR ＜ 1 ml/s) was evaluated using ROC curve. Results Both SCys C and SCr had a linear negative correlation with GFR (r = -0. 82 and -0. 66 respectively, P＜0. 01 ). The sensitivity, specificity and positive predictive values (PPV) of SCys C for diagnosing the mild impairment of renal allgraft function were higher than those of SCr,but the AUC of SCys C did not differ from that of SCr significantly (0. 935 vs. 0. 877, P＞0. 05).Conclusion SCys C could be used an ideal index to evaluate the allograft renal function for its better correlation with actual GFR.
ABSTRACT
Objective To investigate a possible association of donor-recipient compatibility for ABO blood group alleles with acute rejection (AR) in renal transplantation. Methods A study comprising 87 pairs of donor and recipient was performed. The ABO genotype A1, A2, O1, O2, and B alleles of renal transplanted recipients and their respective donors were assessed by PCR amplification with sequence-specific primers (PCR-SSP). Accordingly, recipients were divided into donor-recipient ABO genotype matched and mismatched groups. Results The PCR-SSP based types of all cases showed total concordance with their serologically assigned ABO groups. Fifty pairs (57. 5%) were matched for ABO genotype among the 87 pairs of donor and recipient while 37 (42. 5%) were mismatched, including 1 allele mismatch in 31 pairs (83.8%), 2 alleles mismatches in 6 pairs (16. 2%).The incidence of AR was 12.0% (6 cases) and 29. 7% (11 cases) for ABO genotype matched and mismatched transplant patients, respectively ( P ＜ 0.05). After high dose methylprednisolone (MP)treatment, all cases exepienced reversion of AR except a A2O1 recipient receiving kidney from a A1O1enced 4 AR episodes within 3-10 months, and the period of AR was gradually shortened. After high dose MP was administered empirically, even though short-term improvement of renal function was observed, the serum creatinine continued to increase progressively with decreased efficacy of high dose MP. One year after operation the serum creatinine rose to 441 μmol/L. Conclusions Simultaneous definition of the ABO genotype and HLA is highly feasible. The A2 patient is suitable for receiving kidneys from blood group O donors. DNA mismatch for ABO genotype of renal transplant recipients and their respective donors is an independent risk factor for AR. Genotyping of ABO blood group is conducive to prevent AR.
ABSTRACT
Objective To study the influential factors of tacrolimus'dosage and concentration differences between individuals in morning periods after renal transplantation.Methods The clinical data consisted of 118 receptors in morning periods after renal transplantation,whose immune suppressions were tacrolimus,mycophenolate and hormone.At 3,7,14 and 30 d after operation,all the receptors'weight,dosage of tacrolimus,dosage of hormone,diarrhea,blood fat,liver function,renal function,albumn and erythrocrit were recorded respectively,and at the same time their concentrations of tacrolimus and genetic polymorphisms of CYP3A5,MDRl 3435,MDR1 2677 and MDRl 1236 weredetected.Multiple linear regressions were performed.Results The fitting degrees of stepwise regression equations were low.At 3,7,14 and 30 d after operation,the adjusted R2was 0.284,0.267,0.417 and 0.324,respectively.From the aspect of pharmacogenomics,the main factors rela-ted to the differences of tacrolimus'dosage and concentration included MDR1 2677,MDRl 1236 and MDR13435,which varied intensively.Age,albumn,renal function,blood fat and liver function were important factors too.Conclusions The main reasons of the differences of tacrolimus'dosage and concentration between individuals in morning periods after renal transplantation are medicines and changes of internal environment after operation.The genetic polymorphisms of MDR1,age,albumn,renal runetion.blood fat and liver function are important factors too.
ABSTRACT
Objective To probe the indication, technique and effect of combined liver pancreas transplantation. Methods Donor organs were harvested by the technique of total abdominal evisceration. Simultaneous orthotopic liver and heterotopic pancreas duodenum transplantation was performed in one patient diagnosed as having chronic hepatitis B, hepatocirrhosis, hepatic cellular cancer, and insulin dependent diabetes. Liver and pancreas graft function was monitored after transplantation. Results The recipient recovered with excellent allograft function, and insulin independence was achieved without any surgical complication. Conclusion End stage liver disease with concomitant insulin dependent diabetes is the indication for combined liver pancreas transplantation.
ABSTRACT
Objective To compare the clinical outcomes of pre-emptive renal transplantation and transplantation after dialysis, and to evaluate the safety and advantages of pre-emptive renal transplantation. Methods The data of 50 cases of pre-emptive renal transplantation between January 1999 and January 2003 in our hospital were analyzed.Another 50 cases of renal transplantation after dialysis were selected as control group.The 2 groups were matched in the following variables:age,gender,blood type,cold (warm) ischemic time of the grafts,human leukocyte antigen (HLA),primary diseases, and use of immunosuppressants. The patient/allograft survival,incidence of rejection and delayed graft function were compared. Results The control patients (32/50) were more likely to have received blood transfusion before transplantation than patients of pre-emptive renal transplantation (14/50) (64% vs 28%, P