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Objective To explore the efficacy of renal transplantation plus hematopoietic stem cell transplantation on inducing immune tolerance and summarize its long-term follow-up outcomes . Methods From 2009 to 2018 ,a total of 11 cases of living related donor kidney transplantation plus hematopoietic stem cell transplantation were performed .Two of them were HLA-matched and the remainder were mismatched for one HLA haplotype . The donor hematopoietic stem cells were mobilized using granulocyte colony-stimulating factor at 5 days pre-transplantation and collected at 1 day pre-operation .The recipients received total lymphoid irradiation for 3 days pre-transplantation and received anti-thymocyte globulin induction during transplantation .The donor hematopoietic stem cells were infused at 2 ,4 and 6 postoperative day .Postoperative regulatory T cells ,chimerism ,B cell activating factor and mixed lymphocyte culture and other parameters were detected and long-term follow-up outcomes tracked .Results The immune tolerance-inducible recipients had a significant increase in activated Treg .One HLA-matched recipient achieved 30％-50％ of chimerism and lost after 6 months .However ,other recipients did not achieve mixed chimerism .The BAFF of recipient spiked sharply after transplantation .Mixed lymphocyte culture indicated that a donor-specific low response was induced .The recipients were followed up for 717 to 3612 days .The first recipient lost renal function and another ten recipients had stable renal function . None of the recipients had myelosuppression or graft-versus-host disease .Allograft biopsy confirmed only one case of mild acute rejection . The dose of immunosuppressive agents was lowered in 5 patients .Conclusions Hematopoietic stem cell transplantation for inducing tolerance is safe during renal transplantation . And chimerism is essential for inducing immune tolerance .
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Objective To evaluate the clinic value of multiple tumor markers plus PSA in diagnosing prostate cancer.Methods We collected serum samples of 140 prostate cancer patients with average age of 68 (48-82) years,104 benign prostate hyperplasia patients with average age of 70 (52-87) years,and 162 healthy people with average age of 38 (23-49) years.We had detected PSA levels and also the protein expressions of XAGE-1b,SSX-2,AM ACR and AKAP4.In healthy people,the ranges of the normal values with 95％ data range were determined.Multiple tumor markers and PSA were calculated their positive rate,specificity and sensitivity in diagnosing prostate cancer.We had randomly chosen one positive serum,and analyzed the 4 protein expressions by Western bolt.We detected the serum with the four markers plus PSA by Luminex medthod,then drew ROC curve and calculated AUC area according to the results.Results Among all those samples,PSA levels of 266 samples were under 4tμg/L,86 samples were between 4-10 μg/L,and 54 samples were above 10 μg/L.The positive rates of XAGE-1b,SSX-2,AMACR and AKAP4 in prostate cancer patients were 53.6％ (75/140),34.3％ (48/140),27.9％ (39/140),44.3％ (62/140) respectively.The AUC of XAGE-1b,SSX-2,AMACR,AKAP4 and PSA were 0.666,0.615,0.551,0.768,0.675 respectively.The AUC of their combination was 0.887; The specificity and sensitivity of single PSA detection and combination detection were 60.0％,46.2％ and 80.0％,82.2％.Among those whose PSA value was between 4-10 μg/L,the AUC of single PSA detection was 0.505,the specificity and sensitivity of single PSA detection were 43.2％ and 31.8％; the AUC of the combination detection was 0.803; their specificity and sensitivity were 83.7％ and 73.2％.Conclusions Compared with the single PSA detection,the combination of XAGE-1b,SSX-2,AMACR,AKAP4 and PSA has been greatly improved the specificity and sensitivity in prostate cancer detection.This tool still has significant value even in patients with PSA value between 4-10 μg/L.
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Objective To investigate the change and implication of plasma osteopontin (OPN) levels in renal allograft rejection.Methods The clinical data and biological samples of 46 renal transplant recipients were analyzed rerrospecnvely,including 16 patiens with stable allograft function and no evidence of biopsy-proved rejection (Non-R),22 patients with biopsy-proved acute cellular rejection (ACR),and 8 paients with biopsy-proved chronic allograft nephropathy (CAN).Six living related donors served as healthy controls (HC).Plasma OPN level was determined by using the human OPN ELISA kit.Type and grade of ACR were diagnosed based on Banff 03 classification criteria of renal allograft pathology.The plasma OPN levels were compared among different groups.The assistant diagnostic value of plasma OPN levels in differentiating rejection patients were also evaloated.Results The plasma OPN level in HC,Non-R,CAN and ACR groups was ( 12.23 ±5.95),(19.38±8.23),(27.77± 12.27) and (41.84± 18.51) μg/L,respectively.There was no significant difference in plasma OPN levels among HC,Non-R and CAN groups (P＞0.05),but the OPN levels in ACR group were decreased significantly as compared with Non-R and CAN groups (P＜0.05 ).OPN levels were positively correlated with Banff grading of ACR (P＜0.05).OPN levels were significantly different between grade Ia and grade IIb (P＜0.05).Conclusion The change in plasma OPN level has a relationship with acute rejection.Besides,the plasma OPN levels were also positively correlated with the severity of ACR.Monitoring plasma OPN levels should be useful in predicting and evaluating the severity of ACR in renal transplant recipients.
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Objective To analyze the relationship between the genetic polymorphisms of organic anion transporting polypeptide (SLCO1B1 and SLCO1B3) and mycophenolic acid ( MPA)pharmacokinetics in Chinese kidney transplant recipients. Methods Gene mutations (SLCO1B3T334G, SLCO1B1 A338G) were detected in 68 recipients by PCR-LDR. The plasma samples were collected and blood concentration of MPA was measured on the 28 th day after transplantation. The area under the curve (AUC)0-12 of MPA in different genotype recipients was compared to analyze the correlation between single nucleotide polymorphisms (SNPs) and MPA pharmacokinetics. Results MPA AUC0-12 was higher in SLCO1B3 T334G GG carriers group than in TT carriers [(54. 54 ±14.40)vs(37.30±12.88)mg·h·L-1,(P=0.052)].However,there was no difference in MPA AUC0-12 among each genotype of SLCO1B1 A338G (P>0. 05). Conclusion Genetic polymorphisms of SLCO1B3 affect interindividual variety in plasma MPA concentration in Chinese kidney transplantation recipients.