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Objective To discuss the efficacy of application combination Of minimal immunosuppressive drugs in chronic allograft nephropathy after renal transplantation. Methods Data were drawn from the First Hospital of Tsinghua University.From September 1,2004 to July 1,2006,31 cadaver kidney transplantations were performed using triple immunosuppression with tacrolimus(n=31)and MMF plus steroids before using new strategy.The new strategy is Rapamycin+tacrolimus+MMF+Prednisone.The serum ereatinine,GFR(ml/min/1.73 m2)and 24-hours urine protein before and after 12 months of using lOW dose combination of calcineurin inhibitors,MMF,Rapamune,Predsone and Q80 were recorded.During this time,the concentration of tacrolimus,rapamune were monitored as well. Results After 12 months follow-up,the serum creatinine of 28 patients were decreased from(300±21)μmol/L to(215±38)μmol/L.GFR(ml/min/1.73m2)was elevated from 42.54±2.95 to 49.98±3.05.Three patients whose serum creatinine was 416-464μmol/L had to take hemodialysis.The 24-hours urine protein(g)of 31 patients below 0.8 g did not increase urine protein during follow-up.One patient's 24-hours urine protein(g)increased from 0.95 to 1.29.The patient and graft survival rate was 100%(31/31),90.3%(28/31)respectively.The rapamune main side effect was hyperlipidemia. Conclusions Rapamune and low dose Tacrolimus+Myeophenolate Mofetil+Corticosteroid could be a safe treatment.It may improve renal function in chronic allograft nephropathy.
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ObJective To discuss the causes,diagnosis,treatment and outcomes of renal artery aneurysm(RAA). Methods Duriog August 1998 and December 2004,1251 patients underwent rehal transplantation,and 5 men(mean age,43)who received end-to-end anastomose from renal graft artery to the internal iliac artery were found to develop RAA.The main complains included aggravated renal function,sudden oliguria or anuria,hypertension and allograft pain.Color Doppler flow and digital subtraction angiography were used to confirm aneurysm.Size of the RAA were 1.8 cm×2.0 cm×2.0 am to 4.0 cm×4.0 cm×5.0 cm. Results Two aneurysms were located at the anastomotic stoma.One patient who lost renal function 1 month after the aneurysm was diagnosed received nephrectomy,regular hemodialysis,and another renal transplantation 1 year later.The other patient successfully underwent cadaver transplantation without removing the original renal allograft after the renal dysfunction occurred.The renal function remained normal during 2 years'follow-up.Two renal artery aneurysm cases also accompanied with proximate renal artery stenosis.One patient was treated with balloon dilatation and stent implantation,and normal renal function was observed during 1 years followup. Another patient had graft removed and underwent retransplantation.The renal function was excellent during 3 years'follow-up.Atherosclerotic plaque within internal iliac artery anastomotic stoma,which lead to artery stenosis and aneurysm,was found in 1 patient.Two days after the renal allograft was removed,this patient died of brainstem embolism. Conclusions End-to-end anastomose from renal graft artery to the internal iliac artery seems to be related with postoperative complications.Patients with confirmed RAA should be cautiously managed.Retransplantation and interventional thera PY may be the choice.
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Objective To evaluate the operative characteristics and efficacy of retroperitoneoscopic resection of renal, ureter and partial bladder for the treatment of native renal pelvic and ureteral transitional cell cancer occurring at the same side of transplanted kidney.Methods In 5 cases of renal transplantation, there were 2 cases of right native renal pelvic cancer, 1 case of right native renal (pelvic) and ureter cancer and 2 cases of right ureter cancer respectively. The transplanted kidney was in the same iliac fossa side of the tumor. All 5 patients were subjected to nephroureterectomy and bladder cuff excision by retroperitoneoscopic technique.Result Five operations were completed successfully. The operative time was 180 to 280 min, and the blood loss was 50 to 200 ml. The recovery of intestinal function after operation was 12 to 36 h. The urine output was 1 500 to 4 000 per day. Postoperative serum creatinine was still normal. The mean hospital stay after operation was 4.5 days.Conclusion Retroperitoneal laparoscopic nephroureterectomy and bladder cuff excision is a good method to treat the native renal pelvic and ureteral transitional cell cancer occurring at the same side of transplanted kidney. The procedure is safe and less invasive, which provides a good protection of transplanted (kidney).
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<p><b>OBJECTIVE</b>To study pathogeny, diagnosis and treatment of ureter fistula after renal transplantation.</p><p><b>METHODS</b>The clinical data from 30 cases after renal transplantations were analyzed.</p><p><b>RESULTS</b>Four patients received conservative treatment, and 2 repairment of the fistula. Eleven patients had resection of the ureter or adjustment of the kidney, followed by the anastomosis of the ureter and bladder again. After the turning of the bladder's lamella, 13 patients were given 20 - 24 Foley's tube connecting the pelvis and bladder and nine of them were not subjected to re-anastomosis waiting for the pelvis crawling to the bladder as a tunnel. The one-year survival rates for 30 cases and kidneys was 96.7% (29/30) and 86.7% (26/30) respectively.</p><p><b>CONCLUSIONS</b>There a lot of causes for ureter which are fistula, running related to every aspect of transplantation. Early diagnosis and treatment is important to prognosis. Most patients need reanastomosis. According to the blood stream, edema, length of the ureter, operative procedures are selected to ensure free of strain.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Kidney Transplantation , Postoperative Complications , Urinary Fistula , Diagnosis , TherapeuticsABSTRACT
Objective To evaluate the relation between blood level of tacrolimus and AUC after renal transplantation. Methods Blood assay of FK506 was conducted at 0～12 h after oral administration,the study was carried out in 60 renal transplantation or pancreas kidney transplantation patients.AUC was computed according to the blood FK506 levels.Regression analysis was used to study the relation between AUC and Cx. Results The blood FK506 levels 0～12 h after renal transplantation were different from those after pancreas kidney transplantation.In renal transplantation patients,the correlation between C 2 and AUC ( r 2=0.89) has been better than C 0 and AUC ( r 2= 0.74 ).In some renal transplantation patients with hepatopathy and in some pancreas kidney transplantation patients,the corretation between C 2 and AUC ( r 2=0.91) has been similar to that of C 0 and AUC ( r 2=0.90). Conclusions The equation AUC=7?C 2 could be applied in renal transplantation patients free of hepatopathy whereas,in renal transplantation patients with hepatopathy and in pancreas kidney transplantation patients,it is better to assess C 1～4 in the early stage of FK506 administration and suitable equation selected to compute AUC.
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Objective To evaluate the efficacy of living related kidney transplants (LRKT). Methods Retrospectively clinical results of 25 LRKT were reviewed and analyzed. Results Living related donors underwent nephrectomy without any complications and the donors have had normal renal function on follow up studies.All the renal grafts survived.Two recipients experienced delayed graft function recovery,Both the patients and the grafts have been surviving. Conclusions The patient and graft survival rates of LRDT are better than cadaveric donor transplantation.Living related donor serves as an alternate way of kidney source.
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Objective To evaluate the mechanism of immunosuppressive activity of 1,25-dihydroxyvitamin D_3 and provide a theoretical basis for clinical use. Methods Different inbred strain male BALB/C (H-2d) and male C57BL/6(H-2b) mice were used as skin transplantation donors and recipients, respectively. After operation C57BL/6 mice were conditioned with 1,25-dihydroxyvitamin D_3 2.5 ??g/kg every day, Cyclosporine A (CsA) po 25 mg/kg every day separately or unitedly. Ten days after transplantation, the recipients were sacrificed, and the spleens were collected. The mouse splenic T lymphocytic subsets, mixed lymphocyte reaction (MLR), the activity of natural killer (NK) cells were determined. Results The mean survival time (MST) of skin allografts was prolonged from ( 9.75 ? 0.89 ) days to ( 13.13 ? 1.13 ) days by treatment of the recipient mice with 1,25-dihydroxyvitamin D_3. CD3 + and CD4 + subset percentage in 1,25-dihydroxyvitamin D_3 group was lower than that in control group CD3 + ( 40.19 ? 4.25 )% vs ( 48.70 ? 7.19 )%, P
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0.05 ). But there was significant difference in islet function when warm ischemia time was prolonged to 30 min compared with that in site perfusion group ( P