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OBJECTIVES@#To summarize the emergency management of the kidney transplantation for a large tertiary first-class hospital in response to the epidemic of coronavirus disease 2019 (COVID-19).@*METHODS@#The clinical data of inpatients in the Department of Kidney Transplantation from January 24, 2020 to February 29, 2020 were retrospectively analyzed. Since the outbreak of COVID-19, we conducted telephone, Wechat follow-up, and online education for kidney transplant recipients and patients on waiting-list for kidney transplantation one by one. We also strictly screened for COVID-19 in outpatients. To guarantee the security of medical staff and recipients and to reduce the transmission risk of COVID-19, we have made detailed approaches to prevent COVID-19, which mainly included 6 aspects of preventive approaches, such as kidney transplant clinic, kidney transplant ward, patients on waiting-list for kidney transplantation, kidney transplant operation, medical staff self-protection, and postoperative follow-up of kidney transplant recipients.@*RESULTS@#There were altogether 47 inpatients which included 20 recipients who had just received kidney transplantation in the meantime, 2 577 kidney transplant recipients, 1 689 patients on waiting-list for kidney transplantation, and 794 outpatients in our hospital. No case of COVID-19 occurred in this period.@*CONCLUSIONS@#Through strictly implementing proactive and preventive approaches, we avoid the occurrence of COVID-19 in carrying out kidney transplantation in the epidemic period.
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Humans , Betacoronavirus , Coronavirus Infections , Epidemiology , Kidney Transplantation , Pandemics , Pneumonia, Viral , Epidemiology , Retrospective Studies , Tertiary Care Centers , Transplant Recipients , Waiting ListsABSTRACT
Objective To analyze the distribution of microorganisms in kidney perfusion fluid and perirenal drainage of the renal allografts,and provide evidence to guide clinical practice.Methods The clinical data from the kidney donors and the recipients,the microbiologic culture results of kidney perfusion fluid and perirenal drainage were retrospectively analyzed.Results Ninety-one kidney perfusion fluid samples and 91 perirenal drainage samples were collected from 61 individual renal allografts,and 48 renal allografts were paired.Fourteen (15.4％,14/91) cultured kidney perfusion fluid samples were positive,17 strains were confirmed including 13 strains of bacteria and 4 strains of fungal,and 9 (69.2％,9/13) of bacterial strains were multidrug-resistance with 7 strains resistant to carbapenems,but there was no significant heterogeneity in the outcome of recipients with positive or negative culture results of kidney perfusion fluid samples.Eight (8.8％,8/91) perirenal drainage samples from different recipients were positive,5 of 8 bacterial strains were multidrug-resistance and 3 of them were resistant to carbapenems including meropenem or imipenern.There was no significant correlation between the length of donors' hospital stay and the culture results (P＞0.05),and there was also no significant correlation between the length of recipients' hospital stay after transplantation and the culture results (P＞0.05).Conclusion The kidney with positive perfusion fluid microbiologic culture can be transplanted safely using the prophylaxis or preemptive anti-infection therapy.
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Objective To compare the clinical efficacy of kidney transplantations from donors with acute kidney injury (AKI) and without AKI,and summarize the experience of evaluation and application.Methods The clinical data of 240 kidney transplantations from donation after citizen's death (DCD) performed in our hospital between November 2011 and March 2015 were retrospectively analyzed.The recipients were classified into AKI group (n =37) and non-AKI group (n =203) according to donors' renal function and urine output.Basic characteristics and evolution of the donors and recipients were compared between the two groups.Results The donor serum creatinine was significantly higher in the AKI group than that in the non-AKI group (P＜0.01).Most transplant recipients accepted ATG for immune induction therapy in the AKI group,while Basiliximab was given in the non-AKI group,which was significantly different (P＜0.01).Delayed graft function developed more frequently and longer in the AKI group than in the non-AKI group (P＜0.01).However,patient and graft survival rates did no differ between the AKI and non-AKI groups (P＞0.05).There was no significant difference in other indexes between the two groups (P＞0.05).Conclusion The transplants from donors with AKI showed higher incidence of delayed graft function but no effect on 1-year allograft and patient survival.This type of kidney transplantation is safe and effective.
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Objective To explore the use of marginal kidneys from DBD (donation after brain death) donors and the indication for adult dual kidney transplantation.Methods Two pairs of graft kidneys were procured from two marginal adult donors.Dual kidney transplants were performed in two recipients.In each recipient,two kidneys were implanted in unilateral site of right lower quadrant and placed extraperitoneally,two separate extravesical ureterneocysto-anastomoses were performed.Results Delayed graft function (DGF) combined with acute rejection occurred in two cases,and all two cases recovered after treatments.Lymphocele and hematoma occurred in one case.No graft embolism and no urinary leak happened.Conclusions Adult dual kidney transplant offers an important use of kidneys from marginal donors to increase the number of organs available for transplantation.
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Objective To explore the prevention and treatment strategies for the infectious renal artery rupture after renal transplantation of organ donation after citizens death (DCD).Methods The clinical data of 5 donors and their corresponding recipients with infectious renal artery rupture after renal transplantation were retrospectively analyzed with review of the literature.Results The corresponding donors of 5 recipients had the potential risk factors for donor-transmitted infection (DTI):1 case of traumatic rupture of small intestine,2 cases of digestive tract injury when resecting the donor kidney from DCD donors,1 case of severe pneumonia and 1 case of multiple renal contusion.The pathogenic microorganisms were found in the culture of kidney preservation solution,including klebsiella pneumoniae in 1 case,candida albicans in i case,enterococcus.No pathogens were detected in 1 case,and kidney preservation solution taken from the external hospital was not cultured in 1 case.The pathological examination on the resected renal grafts revealed the necrosis of the arteries and the infiltration of lymphocytes.The culture of bacteria and fungi in the removed vessel walls of renal grafts and the iliac tissues showed there were 2 cases positive for candida albicans (case 2 and case 4),1 case for cryptococcus neoformans (case 1),1 case for klebsiella pneumonia (case 5).No pathogenic bacteria were detected in 1 case,but the possibility of fungal infection was more likely.In case 1,the second kidney transplantation was performed 10 months later after artery re-transplantation,and the kidney function was normal during the follow-up period.In case 4,the second kidney transplantation was performed 2 months later after transplant nephrectomy due to the refractory rejection,the transplanted kidney experienced a rapid loss of graft function,and the blood dialysis was given continuously.The remaining 3 patients survived so far,waiting for re-transplantation.No case of bleeding occurred again in the 5 recipients.Conclusion Renal graft artery rupture is one of most severe complications after renal transplantation.It is the key for preventing infectious renal artery rupture to screen strictly infection of donors and recipients,and to use sensitive and wide coverage antimicrobial to the donors before the removal of donor kidney and during the perioperative period after renal transplantation.Early detection and operation as soon as possible is the only treatment to save the lives of the recipients.
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Objective To investigate the correlation of the expression of human telomerase reverse transcriptase (hTERT) mRNA in peripheral and portal vein blood to liver metastasis and prognosis of patients with colorectal cancer (CRC).Methods From January 2009 to April 2011,a total of 181 patients diagnosed as primary CRC and received radical resection were enrolled.The relative quantitative expression of hTERT mRNA in preoperative peripheral blood and intraoperative portal vein blood were detected by real-time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-PCR).All the patients were followed up for three years after operation.The relative quantitative expression of hTERT mRNA in peripheral blood before operation and intraoperative portal vein blood were compared between patients with synchronous liver metastasis (18 cases) and without synchronous liver metastasis (163 cases); between metachronous liver metastases (29 cases) and without metachronous liver metastases (152 cases).The relationship between the expression of hTERT mRNA in intraoperative portal vein blood and clinicopathological features of patients with CRC was analyzed.The t-test was used.Univariate and Multivariate Cox analysis were used for risk analysis of metachronous liver metastases.Log-rank test was used for comparisons of survival rate between the group with high hTERT mRNA expression in intraoperative portal vein blood during operation and the group with low expression.Results The relative quantitative expression of hTERT mRNA in preoperative peripheral blood and intraoperative portal vein blood in synchronous liver metastases group (8.04±3.79 and 11.88±4.19) was higher than that of no synchronous liver metastases group (4.30±2.81 and 4.94±3.37,t=5.159 and 8.084; both P＜0.01).The relative quantitative expression of hTERT mRNA in preoperative peripheral blood and intraoperative portal vein blood in metachronous liver metastases group (7.16±3.08 and 9.83 ± 2.96) was higher than that of no synchronous liver metastases group (4.11±2.58 and 4.56±3.09,t=5.648 and 8.467;both P＜0.01).The hTERT mRNA expression in intraoperative portal vein blood of patients with CRC changed significantly with the differentiated degree of tumor,tumor size,different invasion degree of tumor,lymph node metastasis,recurrence after operation,survival time (t =2.987,2.281,2.135,5.070,5.431 and 6.803,all P＜0.05).Univariate analysis revealed that the expression of hTERT mRNA in preoperative peripheral blood and intraoperative portal vein blood both were correlated with postoperative metachronous liver metastases (x2=9.522 and 16.393,both P＜0.01).Multivariate Cox analysis showed that both of them were independent risk factors (relative risk (RR)=4.286 and 9.783).The two-and three-year survival rates of the patients with high hTERT mRNA expression levels in intraoperative portal vein blood were 64.6 ％ and 52.3 ％,and those of low expression group were 91.4 ％ and 85.3 ％,and the differences between two groups in two-and three-year survival rate were statistically significant (x2 =5.313,P＜0.05; x2 =8.925,P＜0.01).Conclusions The expression of hTERT mRNA in intraoperative portal vein blood was closely correlated with the important pathologic features,prognosis and liver metastasis of patients with CRC and its predictive value of postoperative CRC metachronous liver metastases was higher than the expression of hTERT mRNA in preoperative peripheral blood.The hTERT mRNA in intraoperative portal vein blood can be a postoperative prognostic marker of patients with CRC.
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Objective To investigate the correlation between expression of human telomerase reverse transcriptase (hTERT) mRNA in peripheral blood and postoperative recurrence and prognosis in the patients with advanced colorectal cancer (CRC).Methods The preoperative and 1 month postoperative quantitative expression of hTERT mRNA in peripheral blood in 85 patients with advanced CRC were detected with real-time fluorescence quantitative real-time fluorescence quantitative polymerase chain reaction (RTPCR).The quantitative expression of hTERT mRNA in peripheral blood in 30 normal controls were also detected.The postoperative prognosis was followed-up,and the quantitative expression of hTERT mRNA in peripheral blood in the patients with recurred CRC and the patients without recurred CRC were detected repeatedly.The factors that affected the preoperative hTERT mRNA expression were analyzed.The relationship was investigated between the hTERT mRNA expression levels and postoperative recurrence and prognosis in the patients with advanced CRC.Results The hTERT mRNA expression levels in peripheral blood in advanced CRC group were significantly higher than those in the normal controls [(6.22 ±5.85)2-△△Ct vs (0.45 ±0.27)2-△△Ct,(P ＜0.01)],and were significantly decreased at the time point of 1 month after the operation (P ＜ 0.01).The hTERT mRNA expression levels in the postoperative recurred CRC group were significantly higher than those in the 1 month postoperation group and no recurrence CRC group [(5.07 ± 2.87)2-△△Ct vs (1.83 ± 1.08)2-△△Ct,(2.15 ± 1.49)2-△△Ct,(P ＜0.01)].Univariate analysis revealed that preoperative high hTERT mRNA expression levels in peripheral blood were related to the differentiated degree of tumor,tumor size,lymph node metastasis ratio,and liver metastasis (P ＜ 0.05 or P ＜ 0.01).Multivariate logistic regression analysis revealed that differentiated degree of the tumor,lymph node metastasis,and liver metastasis were independent risk factors for the elevation of preoperative hTERT mRNA expression in the advanced CRC.Elevated preoperative hTERT mRNA expression was positively related to the postoperative recurrence rate,and was negatively related to postoperative survival rate.Conclusions Preoperative hTERT mRNA expression levels in peripheral blood were related to the important pathologic features in patients with advanced CRC,and might be a valuable prognostic factor.Postoperatively elevated hTERT mRNA expression in peripheral blood was related to recurrence of advanced CRC.
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OBJECTIVE@#To gain an insight into the transplantation with donor kidneys from extended criterion donation after cardiac death (DCD) and to improve the management during and after renal transplantation@*METHODS@#Renal transplantation in 2 patients who used organs from small pediatric donors (<3 years) was performed. The graft kidneys were procured from 1 donor aged 11 months and the other 1 year and 7 months. The 2 donors were diagnosed as brain death caused by serious infantile hepatitis syndrome and severe craniocerebral injury, respectively. After the cardiac death, en bloc organ resection was performed. En bloc kidneys were transplanted to 2 adult recipients who were 37 and 41 years old, respectively.@*RESULTS@#The recipients were followed-up for 6 months. Both of them developed large volume of bloody drainage in the early post-operational period and relieved after relevant treatment. The kidney grafts functioned well and no other surgical complications or acute rejections happened during the follow-up.@*CONCLUSION@#Based on modified peri-operative techniques, it is safe to perform renal transplantation with kidneys procured from cardiac death donors who are younger than 3 years old, an important source to increase the number of organs available for transplantation, yet the vascular complications require attention.
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Adult , Humans , Infant , Graft Survival , Kidney , Kidney Transplantation , Postoperative Period , Tissue DonorsABSTRACT
Objective To investigate the relationship between juxtapapillary duodenal diverticular (JPDD) and choledocholithiasis,and the effects of JPDD on endoscopic sphinctemtomy(EST) in treatment of choledocholithiasis.Methods Fifty-one cases of choledocholithiasis combined with JPDD (choledocholithiasis combined with JPDD group) and 210 cases of choledocholithiasis without JPDD (choledocholithiasis without JPDD group) were treated by EST,and the clinical data of patients in the two groups were retrospectively analyzed.The relationship between JPDD and choledocholithiasis was studied.The JPDD' influence on the intubation success rate of endoscopic retrograde cholangiopancreatography (ERCP),the success rate of the stone removal by EST and complication were analyzed.Results The incidences of choledocholithiasis in patients of JPDD diameter ＜ 1 cm,1-3 cm and ＞ 3 cm were 39.3％(11/28),53.2％ (33/62) and 7/8 respectively.The larger the JPDD diameter,the higher the incidence of choledocholithiasis,and there was statistical difference (P ＜ 0.01).The incidence of choledocholithiasis in peripheral type JPDD was significantly higher than that in parallel type and circumvolution type [81.0％(17/21) vs.41.9％(26/62) and 8/15],and there were statistical differences (P ＜0.05).There was no statistical difference in the intubation success rate of ERCP between the two groups (P ＞ 0.05),but the success rate of the stone removal by EST in choledocholithiasis combined with JPDD group was significantly lower than that in choledocholithiasis without JPDD group [91.8％ (45/49) vs.99.5％ (208/209)].The incidence of EST incision bleeding was significantly higher than that in choledocholithiasis without JPDD group [11.1％ (5/45) vs.1.9％ (4/208)],and there was statistical difference (P ＜ 0.01) ; there were statistical differences in the incidences of others complication between the two groups (P ＞ 0.05).Logistic regression analysis showed that JPDD was independent risk factor for EST incision bleeding (P =0.043).Conclusions JPDD is relative with choledocholithiasis.JPDD makes EST a little more difficult and risky,while EST is still a safe and effective therapy for choledocholithiasis patients combined with JPDD.
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OBJECTIVE@#To better understand the pre-operation evaluation of donor kidneys from extended criteria donation after cardiac death and to improve the management during and after renal transplantation.@*METHODS@#Both of the donor kidneys were from the donor who underwent liver transplantation 5 years ago in the Center of Organ Transplantation of Central South University. The donor was admitted because of liver function deterioration which led to hepatic coma, brain death, hepatorenal syndrome and cardiac death sequentially. Deceased donor score (DDS) and "zero point" kidney biopsy were applied to evaluate the donor kidney. After thorough examination of the donor and the renal function, renal transplantation was performed on 2 recipients.@*RESULTS@#The recipients were followed up by 6 months, both of whom developed pulmonary infection and relieved after treatments. The kidney grafts functioned well and no surgical complication and no acute rejection occurred during the follow-up.@*CONCLUSION@#Proper evaluation of the donor organs ensures the safety of renal transplantation with kidneys from cardiac death donors who underwent liver transplantation, which is an important way to increase the number of organs for transplantation, yet the long-term effects need further observation.
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Adult , Humans , Male , Middle Aged , Death , Follow-Up Studies , Heart Arrest , Kidney Transplantation , Liver Transplantation , Tissue Donors , Tissue and Organ Procurement , MethodsABSTRACT
Objective To investigate the correlation between serum soluble epithelial cadherin (sE-cad) and postoperative recurrence and prognosis in patients with advanced gastric cancer.Methods The level of serum sE-cad in 85 patients with advanced gastric cancer (advanced gastric cancer group) was detected by ELISA technique preoperative and postoperative 1 month,and compared with 30 healthy controls(control group).The patients in advanced gastric cancer group were followed up for 3 years,the level of serum sE-cad in recurrent patients and non-recurrent patients was compared.Results The level of serum sE-cad in advanced gastric cancer group preoperative was significantly higher than that in control group [(24.3 ± 14.8) μ g/L vs.(9.4 ± 3.8) μ g/L,P ＜ 0.01].The level of serum sE-cad in advanced gastric cancer group was significantly decreased postoperative 1 month [(12.5 ± 6.4) μ g/L vs.(24.3 ± 14.8) μ g/L,P ＜0.01].The level of serum sE-cad in recurrent patients was significantly higher than that in non-recurrent patients and postoperative 1 month [(20.7 ±9.8)μg/L vs.(12.5 ±6.4),(14.8 ±6.2) μg/L,P＜0.01].Univariate analysis revealed that preoperative high serum sE-cad level was related with tumor size,differentiated degree,lymph node metastasis ratio,depth of tumor invasion (P ＜0.05),but had no relationship with histological type(P＞ 0.05).Elevated preoperative serum sE-cad level negatively affected the postoperative survival rate and recurrence rate.Multivariate Logistic regression anaiysis revealed that preoperative serum sE-cad level was an independent risk factor for postoperative 3 years survival rate in advanced gastric cancer (HR =2.068,P =0.013).Conclusions Preoperative elevated serum sE-cad level is related with pathologic features in patients with advanced gastric cancer,and may be an important prognostic factor.Postoperative monitoring the level of serum sE-cad is useful for evaluating the prognosis and recurrence.
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ObjectiveTo study the correlation between preoperative serum angiopoietin-2 (Ang2) levels and lymph node metastasis in early gastric cancer(EGC).MethodsPreoperative serum Ang-2 and CEA levels in 62 patients with EGG and 30 normal controls were measured by ELISA technique respectively.The metastasis of lymph node in these cases were determined by HE staining.The relation between preoperative serum Ang-2 levels and lymph node metastasis in EGC and pathologic characterization was investigated.ResultsCompared with normal controls,preoperative serum Ang-2 levels in EGC group were significantly elevated [( 282.5 ± 110.6 ) μg/L vs ( 187.4 ± 32.7 ) μg/L,P ＜ 0.01].Preoperative serum Ang-2 levels in node-positive gastric cancer group was significantly higher than that in the node-negative gastric cancer group [(34 7.2 ± 79.5 ) μg/L vs (265.6 ± 90.2) μg/L,P ＜ 0.01],while CEA levels changed a little.Preoperative serum Ang-2 levels in the EGC group presented marked correlation with the differentiated degree of the tumor tissue,tumor size,depth of tumor invasion but it had no correlation with the histological type.Preoperative serum Ang-2 levels were an independent high-risk factor of lymph node metastasis in EGC according to multivariate logistic regression analysis.ConclusionsPreoperative serum Ang-2 levels may be a good clinical predictor for lymph node metastasis of EGC,which is useful for the treatment direction.
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Objective To study the difference and clinical significance of serum Angiopoietin-2 (Ang-2) level in gastric cancer, precancerous disease and the changes in post operation follow-up patients.MethodsSerum Ang-2 and CEA levels were detected with ELISA method in 158 gastric cancer patients, 31 chronic astrophic gastritis patients, 38 gastric adenomatous polyp patients, 28 chronic gastritis patients with benign gastric ulcer and 30 healthy controls.The changes of serum Ang2 levels in 131 patients with radical gastrectomy were measured in 2-year post-operational followed-up and the prognosis was also evaluated.The correlation between serum Ang-2 level and the pathologic character of gastric cancer was analyzed.ResultsThe serum Ang-2 and CEA levels of gastric cancer group were (331.8± 64.3) μg/L and (42.6 ± 37.3) μg/L, respectively, which were significantly higher than those of healthy control group [(187.4±32.7) μg/L and (4.2±3.1) μg/L]and benign gastric ulcer group [(197.3±35.4) μg/L and (4.5±3.2) μg/L](all P ＜0.01).The serum Ang-2 level in chronic astrophic gastritis group was also markedly increased (P＜0.05), however there was no significant change in CEA level.There was no obvious change of Ang-2 and CEA level in gastric adenomatous polyp group (P＞0.05).Pre-operation serum Ang-2 levels of the relapse group and the metastasis group were significantly higher than that of no relapse group (P＜0.05).Post-operation serum Ang-2 level of no relapse group decreased to normal range in 1 month and without obvious increase in 2 years follow-up.The serum Ang-2 level of the relapse group also decreased to normal range in 1 month post-operation, while which was significantly higher than that of no relapse group and normal control group from 6 months to 2 years after operation (P＜0.01).Serum Ang-2 level of the metastasis group was markedly higher than that of no relapse group and normal control group during 2 years after operation (P＜0.01).The 2-year survival rate of no relapse group was significant higher than that of relapse group and metastasis group.The change of serum Ang-2 level was correlated with in the gastric cancer differentiation degree, TNM pathologic classification, lymphatic metastasis, distant metastasis, the depth of invasion and the tumor size (P＜0.01), however not correlated with histopathology type and the location of tumor.ConclusionSerum Ang-2 level may be a new and valuable gastric cancer marker, which will help to monitor tumor relapse, migration and prognosis assessment.
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Objective To study the differential diagnostic value of soluble epithelial cadherin (sE-cad) in malignant and benign ascites. Methods The concentrations of sE-cad and carcino-embryonic antigen (CEA) in abdominal cavity synovia patients with benign diseases (31 cases), benign ascites(82 cases) and malignant ascites(119 cases) were ineasured by ELISA technique. Results The concentrations of sE-cad and CEA in malignant ascites patients were significantly higher than those in benign ascites patients and abdominal cavity synovia patients (P < 0.01). The sensitivity, negative predictive value and totally accurate rate of sE-cad was 89.9%, 86.8% and 92.5% respectively,which was significantly higher than those of CEA(68.1%, 65.8% and 76.6%)(P < 0.05). sE-cad in malignant ascites showed a certain tissue specificity. Conclusion sE-cad is an useful tumor marker in differential diagnosis of benign and malignant ascites.
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OBJECTIVE@#To explore the effect and safety of transplantation of kidneys from HBV-positive or HCV-positive donors.@*METHODS@#From January 2002 to June 2006, 283 kidney transplantations were performed in Second Xiangya Hospital. Altogether 57 recipients were HBV-positive, including 31 from donors with viral B hepatitis (DB + /RB +), and 26 from donors with HBV-negative (DB - /RB +). Nineteen patients with hepatitis C virus underwent a kidney transplantation, including 6 who received kidneys from anti-HCV-positive donors (DC + /RC +) and 13 from seronegative donors (DC - /RC +). Recipient's liver function, acute rejection, graft survival, and patient survival had been observed for an average follow-up of 14 months.@*RESULTS@#No significant difference was observed between the DB + /RB + group and DB - /RB + group, or the DC + /RC + group and DC - /RC + group in the rate of liver disfunction, acute rejection, graft survival, and patient survival.@*CONCLUSION@#Kidney transplantations from HBV-positive or HCV-positive donors into the matched serology-positive recipients is safe in the short term, and the long-term results need further observation.
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Adult , Female , Humans , Male , Middle Aged , Young Adult , Follow-Up Studies , Graft Survival , Hepatitis B , Hepatitis B Antibodies , Blood , Hepatitis C , Hepatitis C Antibodies , Blood , Kidney Transplantation , Allergy and Immunology , Tissue DonorsABSTRACT
BACKGROUND: The introduction of cyclosporin A (CsA) has greatly enhanced the early survival rate of kidney graft, but the long-term graft survival rate is still limited. Whether tacrolimus prevents chronic allograft nephropathy (CAN) and prolongs survival time is now becoming a hot spot in field of renal transplantation.OBJECTIVE: To investigate the feasibility and safety of converting CsA to tacrolimus (FK506) in preventing progression of CAN. DESIGN: Observation and controlled trial.SETTING: Department of Urological Organ Transplantation, Center of Organ Transplantation, the Second Xiangya Hospital, Central South University.PARTICIPANTS: A total of 73 patients who had received kidney transplantation at the Department of Urological Organ Transplantation, Center of Organ Transplantation, the Second Xiangya Hospital of Central South University from April 2001 to October 2005, and had been diagnosed as CAN by graft biopsy (42 male patients and 31 female patients; age ranged 19-69 years), were enrolled in the study approved by the ethics committee of this hospital after their written informed consents. CsA soft capsules (Hangzhou Zhongmei Huadong Pharmaceutical Limited Company or Huabei Pharmaceutical Limited Company); mycophenolate mofetil capsules (Shanghai Roche Pharmaceutical Limited Company); prednisone acetate tablets (Second Xiangya Hospital of Central South University); tacrolimus capsules (Fujisawa Pharmaceutical Limited Company).METHODS: Seventy-three patients voluntarily participated in CsA group (n =30) or FK506 group (n =43). The two groups were homogenous regarding patients' sex, age and general data (P > 0.05). Patients in the CsA group were continued on their initial immunosuppression protocol, which consisted of CsA, mycophenolate mofetil and prednisone acetate. In the FK506 group, CsA was stopped, and FK506 was started at a dose of 0.08-0.1 mg/(kg·d) 24 hours later, twice daily, administered 2 hours after breakfast and supper. Three days later, the blood trough concentration of FK506 was tested and adjusted to a target range of 5-8μg/L. FK506 dosage adjustment was based on the blood trough concentration, serum creatinine (SCr) and its side effects. All 73 patients were treated for 12 months. MAIN OUTCOME MEASURES: SCr, glomerular filtration rate (GFR), 24-hour urine protein excretion, serum total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL) and the toxic side effects of calcineurin inhibitors (incidences of tremor, hyperglycemia and hypertension) were monitored during a follow-up of over 12 months. RESULTS: A total of 73 patients were involved in the result analysis.①12 months after conversion, the level of SCr was statistically reduced and GFR levels were markedly elevated in the FK506 group compared with the CsA group (P < 0.01). TC, TG and LDL levels in the FK506 group were significantly lower than those in the CsA group (P < 0.01).②Compared with the CsA group, the incidence of tremor was obviously increased [30% (9/30), 5% (2/43), P < 0.01] and the incidence of hypertension was obviously decreased [56% (24/43), 83% (25/30), P < 0.05] in the FK506 group.CONCLUSION: Conversion from CsA to FK506 can postpone renal dysfunction, reduce proteinuria and improve hyperlipidemia. FK506 treatment is an effective therapy in slowing the progression of CAN.
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AIM: To explore the effects of sodium ferulate (SF) on function of macrophages in colonic tissue of the colitis rats in vivo. METHODS: The immunological colitis model of rats was produced. SF was used intracolonically for 21 days. The contents of malondialdehyde (MDA), nitric oxide (NO), prostaglandin E_2 (PGE_2) and the activity of superoxide dismutase (SOD), interleukin-1 (IL-1), TNF-?, myelopexoxidase (MPO), and the expression level of NF-?B p65 in colonic tissue of the rats were detected. RESULTS: SF (200,400,800 mg/kg) decreased the elevated contents of MDA, NO, PGE_2, the activity of IL-1, TNF-?, MPO, and the expression level of NF-?B p65, while increased the reduced activity of SOD in colonic tissue of the colitis rats in a dose-depended manner. CONCLUSION: SF restrained the activity of activated colonic macrophages and relieved the colonic inflammation reaction in vivo in colitis rats, which may be related to the suppression of NF-?B activation. [