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Objective:To explore the causes, clinical characteristics, diagnoses and outcomes of post-lymphoproliferative disease(PTLD)after renal transplantation.Methods:Retrospective reviews were conducted for a total of 2 844 adult kidney recipients between January 2000 and January 2019. And 13 of them developed PTLD. Their clinical features and outcomes were analyzed. There were 11 males and 2 females with a median age of 55(31~78)years. All were diagnosed as diffuse large B-cell lymphoma at a median time of 86(12~204)months post-transplantation.Results:The locations of PTLD were diverse, including lung, stomach, colon, skin and central nervous system. Biopsy immunohistochemical EBV positivity was detected in 76.9% of cases.After a tapering of immunosuppression intensity, 6 cases were operated. Patients not tolerating R-CHOP regimen (rituximab + CHOP) were switched to R2 regimen(rituximab + nalidomide). The total effective rate was 91.6%, including complete remission(10 cases), partial remission(1 cases), progressive disease (1 case)and death(2 cases).Conclusions:As a rare but serious complication after renal transplantation, PTLD is closely correlated with EBV infection.Reducing the dose of immunosuppressive drugs is a core of comprehensive treatment.Switching to R2 regimen is an effective alternative in the treatment of PTLD after renal transplantation.
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Abstract BACKGROUND: Calcium dobesilate (calcium dihydroxy-2, 5-benzenesulfonate) has been widely used to treat chronic venous insufficiency and diabetic retinopathy, especialy many clinical studies showed that calcium dobesilate as vasoprotective compound ameliorates renal lesions in diabetic nephropathy. However, there are few literatures reported calcium dobesilate in the treatment of chronic renal alograft dysfunction after renal transplantation. OBJECTIVE:To observe the efficacy and safety of calcium dobesilate on chronic renal dysfunction after renal transplantation. METHODS:A total of 152 patients with chronic renal alograft dysfunction after renal transplantation were enroled from the Military Institute of Organ Transplantation, Changzheng Hospital, Second Military Medical University of Chinese PLA. They were randomly divided into the treatment group (n=78) and the control group (n=74). Patients in the treatment group received 500 mg of calcium dobesilate three times daily for eight weeks. Al patients were treated with calcineurin inhibitor-based triple immunosuppressive protocols and comprehensive therapies. RESULTS AND CONCLUSION: For patients receiving calcium dobesilate, serum creatinine, blood urea nitrogen and uric acid decreased significantly at two weeks after treatment and maintained a stable level (P 0.05). Administration of calcium dobesilate did not change the general condition of patients with renal insufficiency, nor did it affect blood concentrations of the immunosuppressive agents. Calcium dobesilate may help to delay the progress of graft injury in patients with chronic renal graft dysfunction by conjugating with creatinine, ameliorating the impaired microcirculation and its antioxidant property. The decline in serum creatinine aleviates patients’ anxiety and concern arising from the elevation of creatinine. However, the negative interference with serum creatinine caused by calcium dobesilate should be cautious in order to avoid misjudgment of patients’ condition.
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BACKGROUND:Fol ow-up researches have shown that there is no statistical y difference in safety between kidney donor and healthy person after kidney transplantation, even the donors wil have better life quality. OBJECTIVE:To evaluate the safety of living-related kidney transplantation in living kidney donors. METHODS:Ninety-four cases of kidney donors received 1-10 years fol ow-up through regular clinical fol ow-up, telephone fol ow-up and regular renal patients self-help groups to compare the changes of serum creatinine, hematuria, proteinuria and blood pressure and lipid level in the donors before and after kidney transplantation. RESULTS AND CONCLUSION:The serum creatinine was significantly increased after nephrectomy (P0.05). After nephrectomy, three cases (3.2%) suffered from hematuria, two cases (2.1%) had proteinuria, and improved after rest;six cases (6.4%) were subject to hypertension and six cases (6.4%) to hyperlipidemia. Al of the donors were alive. The living donor nephrectomy is feasible and safe. Preoperative assessment and long-term postoperative fol ow-up can guarantee the safety of the donors.
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Objective To investigate the correlation between urine levels of IP-10,Mig,OPG and the occurrence of renal allograft rejection.Methods As a retrospective nested case-control study,biopsy confirmed acute rejection reaction by 20 cases was rejection group,and recovery of renal function in kidney transplant after the elect good by 20 cases was control group.morning urine was tested of IP-10,Mig and OPG level of the two groups within 30 d after transplantation.The advantage was taken of the Luminex 2000 test platform,through PlexMark triple kidney injury marker kit to detect the daily urine of recipients.Results The rejection group's urinary IP10 wa (394.7 ± 67.3)ng/L,significantly higher than that in the control group of (10.9 ± 3.8) ng/L (P＜0,05).Urine Mig level of rejection group was (443.0 ± 88.9) ng/L,and the control group was only (15.7 ± 6.99)ng/L.Rejection group was significantly higher than that in the control group (P＜0.05).Urine OPG peak levels,the difference between the two groups was not statistically significant.Rejection group in the rejection period urinary IP-10 and Mig levels were significantly non-exclusion period,the difference was statistically significant (P＜0.01) higher than its level at different times with serum creatinine concentration showed obvious correlation,IP-10 with serum creatinine of correlation coefficients (R2)=0.8673,P＜0.01,Mig and serum creatinine R2 =0.7951,P＜0.01,IP-10 and Mig change time earlier than serum creatinine,to the exclusion of the before and after OPG differences no statistically significant.Conclusion The increasing of IP-1O and Mig content in the urine is associated with acute renal allograft rejection,which is an early reflect of subclinical tubular injury.And its changes as early as elevated serum creatinine,is expected to become independent indicators to predict acute rejection reaction occurs.
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Objective To compare the efficacy and safety of conversion from CCB to ARB in the treatment of hypertension and proteinuria in kidney transplant recipients.Methods 127 long-term recipients who used CCB as their anti-hypertensive drug were enrolled.All recipients had stable renal function and no diabetes.Recipients were randomly assigned to experimental group (65 cases) which received ARB (Losartan,50～ 100 mg/day) instead of CCB,or control group (62 cases) which received routine CCB.All recipients were followed up for 2 years.Blood count,urinalysis,liver and kidney chemistry,blood lipid,serum electrolytes,24-h urine protein,blood concentration of CNI drugs and other biochemical indexes were observed.Results During the 2-year follow-up,the blood pressure of the two groups was maintained within normal level.The 24-h urine protein was decreased in the experimental group ( 176.32 ± 54.54 to 155.69 ± 62.25,P＜0.05),but increased slightly in the control group (P＞0.05).Although the blood lipid of the experimental group was not different before and after the follow-up,the high density lipoprotein (HDL) was increased statistically (2.25 ± 0.26 to 2.46 ±0.31,P＜0.05).The blood count,liver and kidney chemistry,serum potassium,blood concentration of CNI drugs in both groups showed no significant differences.Conclusion Both CCB and ARB could be effectively and safely used for the treatment of hypertension and proteinuria in kidney transplant recipients.ARB would be more effective in reducing cardiovascular disease (CVD)rate and decreasing proteinuria.
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Objective To investigate the efficacy and safety of conversion therapy to mizoribine (MZR) for renal transplant patients who suffered MMF or Aza adverse reaction. Methods In 56 patients with adverse reactions at different time points after renal transplantation, there were 23 cases of pulmonary infection, 14 cases of bone marrow depression, 6 cases of hepatic functional lesion and 13 cases of diarrhea. The immunosuppressive protocols of these patients were changed to CNI + MZR + Pre when the adverse reaction occurred. During the follow-up period (11 to 53 months), the effect and adverse events of conversion treatment were observed. Results After conversion treatment, 1 of 23 patients with pulmonary infection was re-infected after 26 months and finally died of heart and lung function failure. In 14 patients with bone marrow depression, blood test returned to normal in 13cases. Six patients with hepatic functional lesion were administered hepatoprotection treatment and their liver function was restored without recurrence of impaired liver function. All 13 patients with diarrhea were relieved without recurrence. The serum creatinine was 123 ± 21.3 μmol/L and 119±18. 2 μmol/L before and after the conversion therapy respectively (P＞0. 05). During the follow-up period, all patients' graft function was good. The incidence of rejection was 1.7 % (1 case). Nine patients (16. 1 %) had a higher level of uric acid after conversion. One patient had finger and toe joint pain. The symptoms were relieved after symptomatic treatment. Conclusion There were high security and good effect of conversion therapy to MZR due to MMF or Aza adverse reaction. Besides, MZR conversion therapy for renal transplantation patients provided a new option for individual immunosuppression.
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Objective To discuss the diagnosis and treatment of invasive aspergillosis(IA)of lung after kidney transplantation. Methods Ten cases of IA infection of lung after kidney transplantation from January 1999 to May 2006 were reviewed.Among 10 cases.all had been examined by FOB and 3 positive.Six cases had a typical sign of IA in chest CT.Five cases had GM positive. Results Eight cases were cured including 3 cases with itraconazole,5 with amphotericin B.The other 2 died of infection. Conclusions Invasive pulmonary aspergillosis is a severe complication of renal transplantation.Early diagnosis and proper treatment can reduce the mortality.
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Objective To compare the difference of clinical and laboratory characteristics between the patients undergoing uninephrectomy for urologic diseases and healthy living kidney donors.Methods The change of blood pressure,renal function,blood routine examination,urine protein,plasma electrolytes and blood fat in two groups preoperatively and at one week,one month,6 months and one year postoperatively were retrospectively assessed.Of the 65 living kidney donors,12 were male and 53 were female.Among 354 cases of uninephrectomy for urologic diseases,there were 291 cases of hpper urinary tract tumor,56 cases of hydronephrosis and 7 cases of severe kidney injury.Results Compared to the preoperative status,there was significant difference of hemoglobin,creatinine,urea nitrogen and urine protein in two groups.Clinical and laboratory characteristics of two groups became stable at one months postoperatively,and could reach the preoperative level at 6 months or one year postoperatively.But the creatinine was 25.71%higher than the preoperative level in healthy donors and 25.49%in patients undergoing uninephrectomy for urologic diseases.There was no significant difference between the two groups at one year postoperatively.Conclusions Two groups are safety after nephrectomy.There is no significant difference of clinical and laboratory characteristics between the 2 groups.Strict donor selection,appropriate pretransplantation evaluation,careful operation and postoperative health consulting play important roles in donors;safety and health.
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Objective To investigate the adjustment of immunosuppression and prevention of infections in lung after renal transplantation.Methods 253 cases of pulmonary infections after renal transplantation between January 1999 to March 2004 were analyzed. After 2003, postinduction period, the blood concentrations of CsA and FK506 were maintained at 0.125~0.166 ?mol/L and 5 ?g/L respectively. The oral dose of MMF was 1 g every day. Results The creatinine levels were stable 253 patients after treatment. Among 253 cases, 229 cases were cured (90.51 %) and 24 died (9.49 %). After adjustment of immunosuppressants, common pulmonary infections and severe pulmonary infections were decreased.Conclusions Infection in lung was a severe complication after renal transplantation. Timely treatment, nursing care and adequate adjustment of immunosuppression may achieve satisfactory effects in preventing lung infection.
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Objective To investigate the changes of sexual hormones, trace elements and fertility in female uremia patients and their relations during hemodialysis or after renal transplantation.Methods Data of 43 cases of uremia during hemodialysis or after renal transplantation from March 1999 to December 2002 were retrospectively analyzed. The conditions of menses, sexuality and fertility before and after renal transplantation were also studied. Twenty healthy women served as controls. Results During the hemodialysis, 4 patients had regular menstrual cycle, 28 irregular menstrual cycle, and 11 menolipsis. Some sexual hormones, such as LH, FSH, PRL and E_2 were significantly increased (P
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Objective To investigate the relation of sexual hormones, trace elements and erectile function in male uremia patients subject to the therapy of hemodialysis or after renal transplantation.Methods Data of 136 cases from March 1999 to December 2002 were retrospectively analyzed.Results The differences in sexual hormones, trace elements and erectile function between male uremia patients receiving hemodialysis and control groups were respectively significant (P
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<p><b>OBJECTIVE</b>To review kidney transplantation in the center and analyze the risk factors affecting long-term allograft survival.</p><p><b>METHODS</b>Thirty-two relative variables were analyzed with SAS statistical software. Using Log-rank method, we investigated influence of these variables on short-and long-term survival of grafts. Kaplan-Meier analysis was used to estimate the 1-, 3-, 5-, 10-years graft survival rates and half-life. Proportional hazards regression analysis (Cox model) was used to assess and rank the relative risk of potential variables.</p><p><b>RESULTS</b>The 1-, 3-, 5-, 10-years graft survival rates were 83%, 75%, 66% and 48%. After excluding the patients died with functioning grafts, the 1-, 3-, 5-, 10 years grafts survival rate increased to 89%, 82%, 75% and 69%, respectively. The mean half-life was 8.78 +/- 0.14 and 14.09 +/- 0.20 years, respectively. By Log-rank analysis, factors affecting short- and long-term graft survival were identified as: renal function, duration of graft function became normal, cold-ischemia time, presence of acute rejection, delayed graft function, immunosuppressive regimen, complication, infection, anti-rejection therapy. Cox model multivariate analysis showed that there were 18 factors affecting graft survival.</p><p><b>CONCLUSIONS</b>New immunosuppressive agents not only significantly increase short-term graft survival, but also have the better long-term outcome tendency. Making assurance to get high quality donor organ and minimizing the death with graft function may be the most feasible way to prolong graft survival at present.</p>
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Adult , Female , Humans , Male , Cadaver , Graft Survival , Immunosuppressive Agents , Pharmacology , Kidney Transplantation , Multivariate Analysis , Transplantation, HomologousABSTRACT
Objective: To probe into the etiology of the sever e post-renal transplantation infection and its diagnosis and t reatment. Methods: A retrospective analysis was made on the seve re infected cases among 1 504 renal transplantation cases. Results: (1)The infected rate in the whole group was 23.74%,and 14.01% of the infecti on cases was severely involved. (2) About 86% of the severe infection occurred within 6 months after operation and as high as 82% of the patients were successf ully rescued by various etiological treatment. (3) The main etiological causes according to their frequency and type were: Bacteria(Mycobacterium tub erculosis, Pseudomonas, Aureus staphylococcus, Bacillus cloacae, etc.); Fungus (Candida albians, Candida tropicals, Penicillum patulum). Cytomegalo virus also often appeared. Conclusion: (1) Infection is one of t h e common complications after renal transplantation and severe infection is an im portant cause of death. (2) Correct diagnosis and combined therapy in time may improve its success rate. (3) Characterized germ spectrum exists in severe post -renal transplantation infection and its role is of great importance to clinica l management.
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Objective To investigate the diagnosis and treatment of fungal infections of the lungs after renal transplantation. Methods A total of 43 cases (35 males and 8 females,mean age of 32 years) fungal infections of the lungs after renal transplantation from January 1999 to March 2002 were retrospectively analyzed.The mean time from post-operation to onset of the infection was 59 days. Results Among the 43 cases,16 were infected with candidiasis ,4 with candida Krusei ,2 with candida parapsilosis ,3 with mycormyccosis ,4 with aspergillosis ,1 with cryptococcosis neoformans and 2 with nocardiasis .14 cases out of 43 cases were coinfected with bacteria and CMV.The other 11 cases were negative for fungus-culturing test.23 cases were cured with fluconazole (100 mg,3 times per day for 10 days),17 with amphotericin B (50 mg,once a day for 10 days)and 3 died. Conclusions Fungal infection of the lungs is a severe complication after renal transplantation. Early diagnosis and timely treatment may achieve satisfactory effects.
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Objective To analyze the epidemiographic features of urologic malignant tumor in renal allograft recipients in a single center.Methods A retrograde analysis was undertaken on 2 300 patients who received renal allografts between June 1978 and December 2001 and anti rejection treatment for at least 3 months. Results Among 2 300 recipients, 27 were diagnosed as malignant tumors that included 9 (an incidence about 0.39% ) cases of urologic malignant tumors that were one third of 27 cases: 1 case of renal cell carcinoma, 2 cases of bilateral pelvic transitional cell carcinoma (TCC), 3 cases of unilateral pelvic TCC, 1 case of ureter TCC and 2 cases of bladder TCC. The mean age at diagnosis of urologic carcinoma was 57.5 ? 5.6 , and the mean duration of immunosuppressive treatment 58?18 months. Six cases received CsA+Aza+Pred, 3 cases CsA+MMF+Pred. Surgical treatment was carried out in 8 cases. Seven of them were alive well. One case died of the malignant tumor soon after the diagnosis. One case died of cerebral hemorrhage.Conclusion Urologic malignant tumor is an important complication in renal transplantation in our center. The occurrence of malignant tumor is intimately related to immunosuppressive treatment. We must pay more attention on painless eyeable hematuria in posttransplantation patients.
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Objective To evaluate the efficacy and safety of piperacillin/tazobactam in the treatment of moderate and severe pulmonary infection (MSPI). Methods The clinical data of 35 patients with MSPI following kidney transplantation were retrospectively analyzed.Results Thirty-five cases out of the 35 MSPI patients ( 97.14 % ) was rescued successfully. The overall clinical efficacy rate of piperacillin/tazobactam was 91.43 % (32/35). The bacterial clearance rate was 92.59 % . The incidence of adverse reaction was 8.57 % (3/35).Conclusions Intensive care and active measures should be given to the MSPI patients after kidney transplantation. The key points of successful treatment involve the in time application of effective antibiotics,the adjustment of immunosuppressant and the correction of hypoproteinemia.