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Objective To reveal the change trend of malignant tumor after renal transplantation in China based on the epidemiological and clinical features that were publicly reported in China in recent 10 years. Methods The search terms ‘renal transplantation’and ‘tumor’were searched on China Academic Journal Network Publishing Database and China Science Periodical Database to screen out the qualified researches strictly.General conditions,tumor sites and regional differences of malignant tumors were analyzed.Results Fifteen thousand one hundred and twenty cases from nine literatures published from 2003 to 2014 and a single-center experience of renal transplantation in Beijing Friendship Hospital of Capital Medical University were screened out.Four hundred and fourty-six cases had malignant tumor after renal transplantation with the total tumor incidence of 2.95% (446 /15 120) and the tumors were mainly urinary system tumors after transplantation (55.8%).Conclusions The total incidence of malignant tumor in renal transplant recipients is 2.95% and the urinary system tumors are most common.Thus,tumor screening after renal transplantation should be taken as the routine examination during follow-up.
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<p><b>BACKGROUND</b>Advances in transplantation immunology show that the balance between dendritic cells (DCs) and their subsets can maintain stable immune status in the induction of tolerance after transplantation. The aim of this study was to investigate if DCs and DC subpopulations in recipient peripheral blood are effective diagnostic indicators of acute rejection following kidney transplantation.</p><p><b>METHODS</b>Immunofluorescent flow cytometry was used to classify white blood cells (WBCs), the levels of mononuclear cells and DCs (including the dominant subpopulations, plasmacytoid DC (pDC) and myeloid DC (mDC)) in peripheral blood at 0, 1, 7, and 28 days and 1 year after kidney transplantation in 33 patients. In addition, the blood levels of interleukin-10 (IL-10) and IL-12 were monitored before and after surgery. Fifteen healthy volunteers served as normal controls. Patients were undertaking hemodialysis owing to uremia before surgery.</p><p><b>RESULTS</b>The total number of DCs, pDC, and mDC in peripheral blood and the pDC/mDC ratio were significantly lower in patients than controls (P < 0.05). Peripheral DCs suddenly decreased at the end of day 1, then gradually increased through day 28 but remained below normal levels. After 1 year, levels were higher than before surgery but lower than normal. The mDC levels were higher in patients with acute rejection before and 1 day after surgery (P < 0.005). There was no significant difference in IL-10 and IL-12 levels between patients with and without acute rejection.</p><p><b>CONCLUSION</b>The changes in DCs and DC subpopulations during the acute rejection period may serve as effective markers and referral indices for monitoring the immune state, and predicting rejection and reasonably adjusting immunosuppressants.</p>
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Adolescent , Adult , Humans , Middle Aged , Young Adult , Dendritic Cells , Allergy and Immunology , Graft Rejection , Allergy and Immunology , Kidney Transplantation , Myeloid Cells , Allergy and ImmunologyABSTRACT
Objective To investigate the infection following the lymphocytes deleted agent (ATG) and IL-2 receptor antagonists (Basilixinab and Daclizumab)-based induction therapy after renal trausplantation.Methods A retrospective analysis was carried out on 701 kidney transplant recipients between Jan. 1,2005 to Dec.31,2010.According to exclusive and inclusive criteria,finally 549 patients were evaluated,including 429 patients treated with ATG (ATG group) and 120 patients with anti-CD25 monoclonal antibodies (monoclonal antibodies group; 86 patients with Basiliximab,and 34 patients with Daclizumab).The incidence of acute rejection,infection rate,infection time,hospital stay,severe infection rate and mortality were analyzed.After operation,the patients received an immunosuppression therapy including Tacrolimus (cyclosporine A),Mycophenolate-Mofetil and prednisone to present rejection. Part of the patients were treated with ganciclovir and sulfamethoxazole sulfadiazine and trimethoprim for infection prevention.Results The acute rejection rate in ATG group and monoclonal antibodies group was 15.9％ (68/429) and 10.0％ (12/120),and there was no statistically significant difference (P＞0.05).The infection rate in ATG group was 11.9％ (51/429),including 13.7％ (7/51) with severe infection,and mortality was 7.8％(4/51).The infection rate was 15.0％ (18/120) in monoclonal antibodies group,including 11.1％ (2/18) with severe infection,and mortality was 5.6％ (1/18).There was no statistically significnat difference in infection rate,severe infection rate and mortality between two groups (P＞0.05).The hospital stay in ATG group and monoclonal antibodies group was 25.8 days and 19.1 days respectively (P＜0.05).Dead cases had not received regular anti-infection treatment,and the patients age was over 50 years.Conclusion The infection risk and mortality between these two induction therapies are identical,but hn comparison to the patients using ATG,the infection of patients using anti-CD25 monoclonal antibodies is easier to control.Anti-infection prophylaxis is important to reduce infection rate and decrease infectious mortality.
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Objective To improve the technology of retroperitoneal laparoscopic living donor nephrectomy and observe its clinical effect.Methods Forty-one cases of living donors subject to nephrectomy by the new retroperitoneal laparoscopic technique from July 2009 to June 2012 were retrospectively.The new technique was modified as follows: (1) Alternate use of blunt dissection,sharp dissection and harmonic scalpel; (2) After separation of renal vein,artery and ureter,a 5-6 cm incision parallel to rectus abdominis from Trocar was made in order to put a hand inside retroperitoneum; (3) A biopsy of the kidney was made from Trocar with the help of a hand for holding the kidney; (4) Pulling the kidney with a proper strength and blocking renal artery and renal vein with Hem-o-lock,then cutting off them and taking out the kidney.Results Forty-one cases of live donors subject to nephrectomy were operated on successfully,and were not converted to open operation.The operative time was 65-130 min (mean 85 min).The warm ischemia time was 58-110 s (average 78 s).Living donor kidney artery length was 2.1-3.7 cm (average 2.9 cm).Living donor kidney vein length was 2.5-4.1 cm (average 3.5 cm).Blood loss was 15-80 ml (average 28 ml).Hospital stay after surgery was 4-7 days (average 4.8 days).All biopsy specimens were achieved from 41 cases.None suffered from complications except two cases of perilymphorrhea.Forty-one recipients recovered well after renal transplantation.Conclusion The improved retroperitoneal laparoscopic living donor nephrectomy is considered to be safe,effective and feasible.It is a good way to protect renal function and reduce injury.
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Objective To investigate the incidence of infection and the effect of anti-infection prophylaxis in renal transplanted patients after Basiliximab induction therapy. Methods A total of 204patients who have received renal transplantation and Basiliximab induction therapy from January 1,2001 to December 31, 2010 in our hospital have been retrospective analysed in this study. These patients were divided into a prophylaxis group (118 cases) with Ganciclovir + Sulfadiazine +Trimethoprim therapy and a control group (86 cases) without any anti-infection prophylaxis.Furthermore, 440 transplanted patients in the same peroid without any induction therapy were also analysed. They were also devided into two groups: an anti-infection prophylaxis group (206 cases)and a control group (234 cases) without any anti-infection prophylaxis. Results In the prophylaxis group with Basiliximab induction therapy, there were 23 patients (19. 5 %, 23/118)experienced hospitalization due to infection, 3 cases (13. 0 %,3/23) among them were severe infection, and 3patients (13.0 %, 3/23) died from vital infection. In the non-prophylaxis control group with Basiliximab induction therapy, 27 patients (31.4 %, 27/86) had infection complication, 7 patients (25.9 % ,7/27) among them were severe infection, and 4 patients(14. 8 % ,4/27)died. The incidence of infection between the above two groups is significantly different (P＜0. 05). In the prophylaxis group without induction therapy, the incidence of infection was 15.0 % (31/206), there were no severe infection cases but 7 patients (22. 6 %, 7/31) died from infection. In the non-prophylaxis control group without induction therapy, the incidence of infection was 12. 8 % (30/234), 3 cases among them were severe infection(10. 0 %,3/30)and 5 patients died from infection (16. 7 %, 5/30).The incidence of infection in Basiliximab induced patients without anti-infection prophylaxis is significantly higher than that in patients without induction therapy and anti-infection prophylaxis (31.4 % vs. 12.8 %,P＜0.01). Conclusion Basiliximab induction therapy increased the risk of infection, but not the rate of mortality. It is necessary to give anti-infection prophylaxis in renal transplanted patients with Basiliximab induction therapy.
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Objective To analyze the dynamic changes of dendritic ceils (DCs) and their subsets plasmacytoid DC (pDC) and myeliod DC (mDC) in peripheral blood of renal transplantation patients,and to confer the relationship between DCs subsets and graft rejection.Methods White blood cells (WBC) and mononuclear cells (PBMNCs) in peripheral blood of 28 renal transplantation recipients (test group) were measured before operation and at 1st,7th,28th day after operation.The number of DCs and subsets,and pDC/mDC were detected by using flow cytometry,and IL-10 and IL-12 levels were determined by using ELISA before and after operation.Ten volunteers (control group) served as controls.Results The levels of DCs,pDC and mDC before operation in test group were lower than in control group (P＜0.05),but there was no statistically significant difference in pDC/mDC ratio between two groups (P＞0.05).The number of DCs in test group was significantly decreased on the first day after operation up to the lowest level,then slowly increased,and recovered 73.7 ％ at 28th day after operation.The number of mDC and pDC was also decreased after operation,but mDC recovered faster than pDC (P＜0.05).On the day 7th after operation,the number of mDC in the recipients with graft rejection was higher than in those without graft rejection in test group (P＜0.01 ).There was no significant difference before and after operation in the levels of IL-10 and IL-12 in test group.Conclusion The number of DCs and subsets are related to the recipients' immune state,and their abnormality displays unstable immune state of recipients.The number of DCs and subsets can be used as an assistance index to diagnose graft rejection.
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ObjectiveTo study the sirolimus (SRL)-associated interstitial pneumonitis,which is a severe side effect of sirolimus therapy. Methods In 7 renal grafts treated with SRL, interstitial pneumonitis (8 times) was diagnosed. One patient suffered a relapse after sirolimus treatment was given again. Two patients received de novo sirolimus treatment, and rest 5 patients were switched from a calcineurin inhibitor-containing regimen to a SRL-based protocol for various indications: chronic allograft nephropathy (n = 4) and cancer (n = 1 ). The patients presented with fever, dyspnea on exertion and the chest X-ray or computed topographic (CT) scan on admission showed bilateral mostly peripheral interstitial infiltrates. ResultsSRL was discontinued in 4 patients and the dose was reduced in the remaining 3 patients. Symptoms were improved within 3-14 days in all patients, the radiographic findings improved within 2-4 weeks, and the lesions were absorbed completely in 2-6 months.ConclusionThe frequency of interstitial pneumonitis appears to be increased in renal transplant patients receiving SRL. Discontinuation or reduced dose of SRL appears to be the safest treatment option for the patients with interstitial pneumonitis.
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objective To evaluate the influence of HLA matching and new immunosuppressants on pre-venting acute rejection of renal allograft in sensitized recipients. Methods 751 recipients underwent renal transplantation were enrolled in this study including 46 sensitized recipients (study group) with PRA be-tween 10%-90% and 705 non-sensitized recipients (control group) with PRA less than 10% pretransplant. All patients in the study group received induction course (ATG 100 mg/d, 5-7 d) plus triple-immunosup-pressive therapy including FK506 + MMF + steroid. The rate of acute rejection and delayed graft function after renal transplantation was analyzed. The influence of HLA matching on preventing acute rejection was al-so evaluated. Results The acute rejection rate in the study group and control group was 30.43% and 19. 57%, respectively, (P < 0.05). The rate of delayed graft function was 60.86% in the study group, signifi-cantly higher than that of the control group (11.87%). There was no statistically difference of one-year pa-tient / graft survival rotes between the two groups. The average serum creatinin levels at one-year posttrans-plantation were similar between the two groups (130 mmol/dl in the study group and 125 mmol/di in the control group). The average loci of HLA matching in the study group (4.2) was significantly higher than that in the control group (2.8). The acute rejection rate in the study group was significantly higher when lo-ci of HLA mismatch ranging from 2-4 compared with loci of HLA mismatch less than 2. The acute rejection rate was significantly higher in the highly sensitized recipients (PRA ranging from 50% -90% pretmnsplant) than that in the less sensitized (PRA ranging from 10% to 20% pretransplant) in the study group. Patients with higher PRA level posttransplantation were prone to developing acute rejection. Conclusion HLA matching and new immunosuppressants can reduce the incidence of acute rejection in sensitized recipi-ents and increase the survival rate of patients and allografts.
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The article retrospectively analyzes the clinical characteristics and prevention measures of cytomegalovirus (CMV) infections after renal transplantation in 395 patients from Beijing Friendship Hospital Affiliated to Capital Medical University. All patients received preventive treatment of CMV infections and pneumocystis carinii infections in three months after renal transplantation. CMV infections occurred in 24 of 395 patients. The patients with viremia were treated with Ganciclovir or foscarnet sodium. The patients with severe infections (eg. severe pulmonary infections) should be treated with decrease dosage of immunosuppressive drugs, even stop administration. Then the immunosuppressive drugs were adopted again if the infections were controlled. Twenty-four patients obtained the satisfied efficacy. The results suggested that evaluation of the risk for CMV infections before transplantation, preventive treatment in early time after transplantation, measurement of clinical epidemiology, early diagnosis, and individual medication scheme of immunosuppressive drugs for patients should be effective to prevent and against CMV infections. And they also played an important role in preventing acute allograft rejection after renal transplantation and protecting the function of the graft.
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Objective To evaluate the effects of pregnancy and delivery on allograft function and newborns in renal transplant recipients.Methods The effects of pregnancy and delivery on allograft function and newborns in 3 renal transplant recipients were observed and analyzed.The age of the 3 recipients was 32,31 and 31 years,respectively,at pregnancy.They all received triple immunosuppressive therapy(CSA+AZA+prednisone) for the prevention of acute rejection after renal transplantation.Results No acute rejection occurred during pregnancy,and the liver and renal functions were normal in the 3 patients.Preeclampsia occurred in 2 of them.Caesarean section was performed successfully on them at 34,38 and 37 gestational weeks,respectively.The weight of the neonates was 2350 g,3800 g and 3800 g,respectively;and the Apgar scores of the newborns were all 10.(Apgar scores include appearance,pulse,grimace,activity,and respiration.Apgar score ≥8 means newborns in healthy status).After follow-up for 14-46 months,there was no abnormity of the function of transplanted renal and the upgrowth of the newborns.Conclusions Successful pregnancy and delivery are possible in renal transplant recipients with normal renal function.
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Objective To investigate the outcome of renal transplantation in the patients with systemi c autoimmune disease. Method The clinical data of 25 patients with autoimmune disease undergoing renal transp lantation were retrospectively analyzed. Results The survival rate for 1 year, 3 years, 5 years after renal transplantation in t he patients with autoimmune disease and without autoimmune disease were 88 .0 %, 80.0 %, 72.0 % and 88.9 %, 84.4 %, 77.8 % r espectively. The graft survival rate for 1 year,3 years, 5 years after renal tra nsplantation in the patients with autoimmune disease and without autoimmune dise ase were 84.0 %, 72.0 %, 60.0 % and 86.2 %, 77.0 %, 66.4 % respectively. The average intervals of dialysis pre-transplantati on b etween the patients with recurrent underlying diseases (4 patients) and with out recurrent underlying diseases (21 patients) was not difference. Among the 4 p atients with positive ANA and elevated anti-dsDNA serology pre- and post-tr ansp lant, 2 patients had recurrent underlying diseases. Conclusions Renal transplantation should be offered to th e patients with autoimmune diseases because relapses of underlying diseases after renal transplantation seem to be rare. The patient and graft survival rate was not significantly differen t in the patients with autoimmune diseases and without autoimmune diseases.
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Objective To investigate the infection of hepatitis virus and spirochete in renal transplant donors and recipients to study the relationship between infection and human/kidney survival rate following renal transplantation. Methods A total of 361 donors and 300 recipients were investigated on infection of HBV, HCV, HGV, CMV, EBV, HSV, HIV and RPR. Results Of the 361 donors, 31 cases (8.6!%), 9 cases (2.5!%) and 2 cases (0.6!%) were found having HBV, HCV, HGV infection respectively. In the 231 recipients, the percentage of CMV, EBV, HSV, HIV and RPR carriers was 16.9!%, 11.7!%, 16.0!%, 0.4!% and 0.8!% respectively. Among the 300 grafting recipients, the infective rate of HBV, HCV and HBV plus HCV was 68.7!%, 34.7!% and 25.0!% respectively. Forty patients were randomly selected from the 300 patients, it was found that 10 (25.0!%) patients were positive for anti-HGV, 10 (25.0!%) for HGV and HBV, 5 (12.5!%) for all HGV, HBV and HCV. The percentage of CMV, EBV, HSV, HIV, RPR carriers among the 300 recipients was 49.0!%, 32.7!%, 42.0!%, 0 and 0.3!% respectively. Conclusion Viral infectious status of the donors and recipients before operation might contribute to the occurrence of viral infection in the recipients after transplantation.
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Objective To observe the clinical effects of combined islet cell and kidney transplantation in the treatment of insulin-dependent diabetes mellitus associated with end-stage renal failure.Methods Four patients with type I diabetes and ESRD received combined renal and islet cells transplantation.Clinical and metabolic data were studied during the follow-up.Results The cultured human adults islet cells were infused into the portal vein system of the 4 patients.Immunosuppression included CsA.azathioprine and prednisone.Metabolic follow-up comprised assessment of daily fasting and non-fasting blood glucose,basal C-peptide secretion,HbAIc,renal function and blood cell counts.Islet isolation yielded 25 000～48 000 equivalents(single or multiple donors).No adverse effects were seen subsequent to islet transplantation.Basal C-peptide secretion maintained at normal levels.and blood glucose and HbAIc levels were normalized throughout the observation period.The dosage of insulin were decreased by over 25% in all 4 patients after transplantation.Conclusions Combined adult islet cells and renal transplantation has a good effect in the treatment of the patients with type Ⅰ diabetes and ESRD and can be used as an effective way for treating ESRD secondary to the type Ⅰ diabetes.Postoperative efficacy is related not only to the quantlty and quality of the islet cells,but also to the rejection of the grafts.
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Objective To investigate the clinical characteristics and risk factors for postrenal transplant diabetes mellitus (PTDM). Methods 512 consecutive kidney recipients were included in this study from 1994.1 to 1997. 5.Biochemical data, body weight changes, drug history, genetic markers such as HLA phenotypes, anti-virus antibodies were studied in these patients.Results The mean age and the dose of hormone used 6 months after operation in the diabetes mellitus group were older and higher than in the nondiabetes groups respectively. PTDM often occurred half a year following renal transplantation. And no patients with PTDM were obese. Most PTDM patients had a higher blood glucose level, but few of them had ketoacidosis. The occurrence of HLA-B15 and the positive rate of anti-gland virus antibody were significantly higher in PTDM group. Conclusion Both genetic factors such as HLA type antigens and environmental factors such as the amounts of steroid and cyclosporine A used, infections of some kinds of viruses, and also stress during transplantation may play an important role in the causes of PTDM.
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The renal artery stenosis is a common complication in renal transplantation.Therenal failure can be easily caused if treatment is not effective.4 cases of renal artery stenosis in re-nal transplantation were treated in our department from Dec.1995 tO Jan.1997.Three cases weretreated by implanted renal artery stent and the remaining one received the stripping of adhesive tis-sue.After operation,blood pressure and renal function in the 4 patients recovered normally.Long-term effect was satisfactory.It is concluded that the above tWO methods are effective for thetreatment of renal artery stenosis in renal transplantation.
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In order to observe the pharmacological action and clinical effects of Implanta (from Hanmi Pharm. Co. Ltd) on renal transplantation, 30 patients receiving renal transplantation were treated with Implanta. Among the 30 patients, 12 patients (group A) just underwent renal transplantation, the remaining 18 cases underwent the operation 0.5 to 4 years ago and administered Sundimin or Cyspin. The results showed that the blood concentration, the effcets of inhibiting the rejection, the function recovery of transplanted kidney and side effects of Implanta were the same as those of Sundimin or Cyspin. It was conlcuded that Implanta was safe and effective.