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Objective To observe the early clinical effect of single kidney transplantation from cardiac death pediatric donors to adult recipients. Methods Clinical data of 6 single kidney transplantations from cardiac death pediatric donors in adult recipients in Department of Organ Transplantation ,Guangdong Province No.2 People′s hospital were retrospectively analyzed. the transplant operations were carried out between January 2010 to may 2016.The median age of 6 pediatric donors was 9 years (5 years to 15 years). All recipients had the same blood type. The median age of 12 recipients was 38 years (21 years to 65 years),with 4 man and 8 women. All recipients received kidney transplantation for the first time,and overall reactive antibodies(PRA) were negative,with HLA mismatch between 1to 4. All recipients received single kidney transplantation in right fossa iliaca. Results 12 kidney transplantations were successful. The renal allografts recovered successfully without acute renal rejection , delayed graft function or primary nonfunction. Renal function of 5 of recipients immediately recovered in 5 days,5 recovered in 10 days,and 2 recovered slowly. 1 recipient manifested urine leak and recovered after drainage. 1 case developed delayed incision healing and recovered after dressing at stage II. All patients and renal grafts functions were wellnormal during follow?up period between 1 month to 36 months. Conclusion The early clinical effect of single kidney transplantation from cardiac death pediatric donors to adult recipients is good and could be a promising pathway to expand the organ donor sources.
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Objective To investigate the changes of panel reaction antibody (PRA) and the effects of HLA sensitized paths in patients waiting for renal transplantation.Methods PRA of 10 555 samples from 8926 renal transplant recipients in 51 transplant centers was analyzed.In 1991-1998 group,PRA was by using NIH-CDC technique,and in 1999-2010 group,PRA was detected by using ELISA.The effects of blood transfusion,pregnancy and transplantation on the PRA positive rate were analyzed.Results There were 1324 recipients positive for PRA in 8926 (14.83 ％ ).The average PRA positive rate in 1991 1998 group and 1999-2010 group was 18.17％ (513/2823) and 13.29％ (811/6103) repectively (P＜0.01).Among 1324 PRA positive recipients,the number of recipients with PRA of 1％-30％ and PRA of ≥30％ respectively accounted for 71.83％ and 28.17％.There were statistically significant differences in the PRA positive rate between the recipients receiving blood transfusion and those without blood transfusion (31.77％ vs 1.21％,P ＜ 0.01 ),between the recipients having pregnancy history and those without pregnancy history (24.64％ vs 7.19％,P＜ 0.01 ),and between primary transplant and re-transplant recipients (13.35 ％ vs 40.62％,P＜0.01).Conclusion In last 20 years, PRA in majority of PRA positive recipients was ＜ 30％ (low sensitized).Renal transplantation and blood transfusion were the important influencing factors that led to positive PRA,and pregnancy history was a related factor.
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Objective To study the calcium metabolism in tacrolimus(FK506)induced rats nephrotoxicity and the preventive effect of calcium channel blocker.Methods Twenty-four Spragueinduced or FK506-induced nephropathy model.Blood creatinine,blood electrolytes,renal tissue histopathology(HE stain)and the change of ultrastructural organization in renal cells by transmission electron microscope were observed.Results The blood creatinine levels of both CsA and FK506 groups [(36.00±2.61)and(34.17±4.54)μmol/L] were significantly higher than those of the FK506+Dilgroup and control group(all P＜0.05).The blood calcium levels of both CsA and FK506 groups (2.00±0.04 and 2.05±0.04 mmol/L) were significantly lower than those of the FK506+Dil group and control group(all P＜0.05).The blood creatinine and calcium levels of FK506+Dil group were not significantly different with those of control group(P＞O.05).Histopathology examination showed cloudy swelling and vacuolization of the renal tubular epithelial cells and intra-cellular mitochondria swelling and vacuolization in the CsA and FK506 groups.However,the pathological changes of the FK506+Dil group were remarkably milder in comparison with the CsA and FK506 groups.Concluum channel blocker,Dil,could prevent the FK506-induced nephrotoxicity.
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6.2 mmol/L) who underwent renal transplantation accepted pravastatin therapy 10 mg once evening for 8 weeks. Total cholesterol(TC),low-density lipoprotein-cholesterol (LDL-C),high-density lipoprotein-cholesterol (HDL-C),triglyceride(TG),endothelin(ET) and nitrous oxide(NO) were measured before and after pravastatin therapy. The endothelium-dependent relaxing function was measured before and post pravastatin therapy by high-resolution ultrasound. Thirty people with normal blood cholesterol accepted same examination as control. Results The level of ET in renal transplantation group was significantly higher than that of control group,and the level of NO in renal transplantation group was significantly lower than that of control group. After 8 week′s therapy,the level of NO rose significantly,and the level of ET,TC,LDL-C,TG decreased significantly. The level of HDL-C increased but there was no significant difference between two groups. Flow-mediated vasodilations were improved after pravastatin therapy,while the level in transplantation group was lower than that of control group. Conclusion Pravastatin is effective in treatment of dyslipidemia after renal transplantation,which can improve the endothelium-dependent vasodilation.
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6.2 mmol/L) who underwent renal transplantation accepted pravastatin therapy (10 mg, qn) for 8 weeks. The changes of total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) , triglyceride (TG), endothelin (ET) and nitrous oxide (NO) were measured before and after pravastatin treatment. By using high resolution ultrasound, endotheli-um-dependent relaxing function was measured before and post pravastatin treatment. Thirty people with normal blood cholesterol served as controls and subjected to the above examinations. Results In renal transplantation group, ET was significantly higher and NO significantly lower than in control group. After treatment with pravastatin, NO was significantly increased, while ET, TC, LDL-C and TG were significantly reduced. HDL-C was increased, but no significant difference was found. Flow-mediated vasodilations were greater after pravastatin treatment than before, but smaller than control group. Conclusion Pravastatin can theat dyslipidemia after renal transplantation and improve impaired endothelium-dependent vasodilation.
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Objective To evaluate the significance of immediate early 1 (IE) mRNA detection by nucleic acid sequence-based amplification (NASBA) in the diagnosis of human cytomegalovirus (HCMV) infection after renal transplantation.Methods The expression of IE-mRNA and pp67-(mRNA) was detected by NASBA in 55 patients after renal transplantation, and pp65 antigenemia (assays) were done for all cases.Results Twenty cases were positive for IE-mRNA. Thirteen cases were suffered from CMV disease with symptoms. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of IE-mRNA by NASBA were 92.3 %, 80.9 %, 60.0 % and 97.1 %, respectively. Time to first IE-mRNA positive detection after transplantation was shortest, compared with pp67 and antigenemia (P
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<p><b>OBJECTIVE</b>To evaluate the clinical value of the four regions 12-core systemic prostate biopsy.</p><p><b>METHODS</b>Ninety-one patients suspected of prostate cancer received four regions 12-core systemic prostate biopsy, and the detection rate and complications were compared with those of the sextant method.</p><p><b>RESULTS</b>More positive results were obtained in detecting prostate cancer with the four regions 12-core method, and the complications were similar to those of the sextant biopsy.</p><p><b>CONCLUSION</b>The four regions 12-core biopsy was suggested for patients suspected of prostate cancer with enlarged prostate gland above 40 ml.</p>
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Aged , Aged, 80 and over , Humans , Male , Middle Aged , Biopsy, Needle , Prostate , Pathology , Prostatic Neoplasms , Diagnosis , PathologyABSTRACT
Objective To investigate the clinical features, diagnosis and therapy of avascular necrosis of the femoral head after renal transplantation Methods Of the 24 renal transplantation patients with avascular necrosis of the femoral head 0.7 - 7.8 years postoperatively, 20 cases were unilateral and 4 bilateral respectively. According to the standard of Ficat's, all cases were classed as 0-Ⅳ stages. All cases accepted immunosuppressive therapy that included corticoids. The corticoids were reduced in dose at the time when the patients were diagnosed as having avascular necrosis of femoral head and withdrawn in 2 weeks. Surgical treatment was not done unless the expectant treatment was invalid.Results The clinical manifestations of femoral head avascular necrosis after renal transplantation included knee joint, hip joint, inguina or thigh pain in the earlier period (Ⅰ-Ⅱa stage) and hip joint pain in progression (Ⅱb-Ⅳ stage). Some cases were associated with hip joint flex, adduct, abduction and intorsion dysfunction. After expectant treatment, the symptoms of hip were alleviated or disappeared in 4 cases; In 16 cases, the symptoms of hip were relieved to some extent, but Ficat’s stage had no change. Eight cases had no reaction to expectant treatment and were subjected to surgical operation. In 4 cases, acute rejection occurred after corticoid withdrawal, reversed after therapy by MP and ATG and could tolerance corticoid withdrawal again.Conclusion Corticoid is the main reason of avascular necrosis of the femoral head after renal transplantation. The therapeutic effectiveness of avascular necrosis of the femoral head was not satisfactory and the emphasis was put on the prevention.
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Objective To study the clinical monitoring of tacrolimus (FK506) area under the curve (AUC) of concentration-time after the first oral dose in kidney transplant recipients. Methods Sixteen kidney transplant recipients were treated with anti-lymphocyte globulin (ALG) and methyprednisolone (MP) for 3 days after operation.Then FK506 capsules were given orally at the same dose,0.075 mg/kg,on the third day.The pharmacokinetic monitoring of FK506 were conducted as follows.FK506 concentrations were measured by ELISA at 0.5,1.0,1.5,2.0,3.0,5.0,8.0,12.0 hours after the first oral dose. The data of FK506 pharmacokinetics were calculated using 3P87 pharmacokinetic procedures and SPSS 8.0. Results AUC of concentration-time of the first dose ranged from 44.40 ?g?h -1 ?L -1 to 158.01 ?g?h -1 ?L -1 (mean, 92.23?34.97 ?g?h -1 ?L -1 ). The correlation between the first tacrolimus trough concentration (C min ) and AUC had statistic significance ( r=0.650,P
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Objective To evaluate the late complications of continent ileocolic reservoir with an unaltered in situ appendix conduit and the management. Methods Thirty patients with bladder cancer who had undergone the surgery of continent ileocolic diversion with an unaltered in situ appendix conduit were followed up for 108 to 126 months (mean 118 months).The long-term post-operative complications were documented. Results The complications occurred as follows:urinary pouch superdistention in 5 cases,calculus formation in the urinary pouch in 6,difficulty with catheterization in 4,uerteral obstruction in 3,hemorrhage of the pouch in 1 and mild hyperchloremic acidosis in 1.These complications were managed accordingly and good results achieved. Conclusions Although continent ileocolic diversion with an unaltered in situ appendix conduit has a long-term efficacy,the complications occur frequently.The procedure needs further improvement.
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Objective To explore the role of apoptosis and Fas, bax and bcl-2 proteins in the pathogenesis of testicular carcinoma. Methods Cell apoptosis was determined with TUNEL and flow cytometry, and the expression of Fas, bax and bcl-2 proteins were detected by cellular immunofluoresence technique in 56 cases of testicular carcinomas. Results Apoptotic index was closely correlated with the pathological type and lymph node metastasis of testicular carcinomas(P0.05). The apoptotic index was positively correlated with Fas and bax expression, and negatively correlated with bcl-2 expression (P
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Objective To investigate the effects of kidney transplantation in sensitized recipients receiving conventional human leukocyte antigen(HLA) and cross-reactive groups(CREG) matching.Methods The HLA and CREG matching were used to select the best donors for 82 recipients with high titer of panel reactive antibody(PRA),and adjunctive application of plasma exchange and intravenous immunoglublin were conducted.Results The successful rate was 90%(74/82) and mortality rate was 1%(1/82).The incidence of hyperacute rejection,accelerated acute rejection,acute rejection and delayed graft function was 4%(3/82),6%(5/82),28%(23/82) and 21%(17/82),respectively.The incidences of acute rejection in groups of broad sensitized,HLA class Ⅰantibody positive recipients,HLA antibody positive recipients of post-transplantation and donor specific antibody were higher than those in groups of mild sensitized,HLA classⅡantibody positive recipients,HLA antibody positive recipients of pre-transplantation non-donor and specific antibody respectively(all P
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Objective To study the therapeutic window of rapamycin(RPM) concentration in primary recipients of renal transplantation. Methods An open label, multi center study was performed. One hundred primary renal allograft recipients with cadaveric donors were enrolled from 4 transplantation centers in China. The immunosuppressive regimen was triple therapy,i.e.RPM combined with CsA and steroid. A loading dose of RPM 6 mg/d was administered within 48 hours after transplantation, then a maintaining dose of 2 mg/d was administered. The whole blood concentration of RPM was measured by HPLC method. Results The whole blood concentration of RPM in this group was (6.65?2.75)ng/ml, the 10th and 90th percentile for RPM concentration was 3 2 ng/ml and 10 26 ng/ml,respectively.9 5%(8/84)patients suffered from acute rejection during the 6 month period after transplantation in this study, and the concentration of RPM in these was lower than that in non rejection patients(P=0.001). Hyperlipidemia and liver dysfunction were the most frequently adverse events, and RPM concentration was significantly associated with the concentration of triglyceride. Conclusions 4～8 ng/ml is a suitable level for RPM concentration. Regular drug monitoring and reasonable dose modulation may increase the validity and security of RPM.
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Objective To study the clinical efficacy and safety of rapamycin in combination with CsA and steroid to prevent the acute rejection of kidney transplantation. Methods In an open-label,multi-center study,there were 100 primary renal allograft recipients with cadaveric donors enrolled from 4 transplantation centers in China. The immunosuppressive regimen was the triple therapy of rapamycin in combination with CsA and steriod. Rapamycin was administered in 48 h after grafting. The first dose of rapamycin was 6 mg /day and the maintenance dose was 2 mg /day. Results Eighty-four recipients were followed up for more than 6 months. Rapamycin was discontinued in 16 patients because of the adverse events and other reasons. Eight patients experienced acute rejection and 7 patients were reversed by methyprednisolon therapy. In 6 of the 7 patients,the dose of rapamycin was maintained 2 mg /day. The remaining one was added to 3 mg /day. No recurrence of AR was observed in a continuous follow-up of more than half-year. The most common and significant adverse events were hyperlipoidemia and abnormal liver function.Conclusions The combination of rapamycin with CsA and steroid to treat recipients of kidney transplantation is safe and efficient. There was a low incidence of AR but a high incidence of hyperlipoidemia and abnormal liver function. The rational regulation of the dose may reduce the incidence of the side-effects. Further observation and study are required for long-term application.
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ObjectiveTo establish a new method for diagnosis of active human cytomegalovirus (HCMV) i nfection and disease in transplant recipients.MethodsThe expression of HCMV pp67-mRNA in blood was detected by the nucleic acid sequence-based amplification (NASBA), in comparison to detection of pp65 HCMV a ntigen in white blood cells.ResultsIn 50 patients subject to transplantation, 26 were positive for pp65 (≥1/50 000 WBC). Among them, 16 were positive for pp67. In 9 cases of CMV with symptoms, b oth pp65 and pp67 were positive. In the patients negative for pp65, pp67 was not positive. The sensitivity, specificity, positive predictive value and negative predictive value were 100?%, 88?%, 56?% and 100?%, respectively.ConclusionDetection of pp67-mRNA by NASBA is a rapid objective and accurate approach for the diagnosis of HCMV infection.
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Objective To study the effect of delayed cyclosporine(CsA) therapy combined with prophylactic use of antilympho-cyte globulin (ALG) (sequential quadruple immunosuppressive protocol) on early graft function in renal transplantation. Methods The experimental group included 90 renal recipients who were treated with posttransplant quadruple sequential therapy. Their short-term outcomes were compared with those of 215 recipients who were given CsA immediately after transplantation(control group). Results Not only was the recovery of renal allograft function faster in the experimental group ( P 0. 05). Conclusion Delayed CsA therapy in conjunction with prophylactic use of ALG is a desirable protocol for treating posltransplant renal recipients.