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Objective:To conduct a retrospective analysis of efficacy and safety of different conversion schemes of tacrolimus to slow-release dosage forms for recipients in stable phase after renal transplantation to provide rationales for the conversion strategy of tacrolimus.Methods:From January 2020 to June 2020, clinical data were reviewed for 101 kidney transplant recipients converting from common tacrolimus dosage form to tacrolimus sustained-release dosage form during postoperative stable period.There were 62 males and 49 females with an age range of 19 to 69 years.They were divided into two groups according to iso-dose and incremental-dose switching schemes.The common dosage form of tacrolimus was converted into a sustained-release dosage form with different conversion doses, They were divided into two groups of 1∶1 conversion( n=55)and >1∶1 conversion( n=46). The clinical parameters of serum creatinine(Scr), blood urea nitrogen(BUN), alanine aminotransferase(ALT)and aspartate aminotransferase(AST), alkaline phosphatase(ALP), serum albumin(ALB), white blood cell count(WBC), urinary white blood cell(UWBC), hemoglobin(Hb)and fasting blood glucose(Glu)were compared between two groups after conversion. Results:Regarding numerical change trend after switching to tacrolimus sustained-release dosage form, drug dose/variation trend was smaller and blood drug concentration more stabilized.In two subgroups converted by 1∶1 and 1>1 initial dose, change trend of dose/blood concentration in 1∶1 conversion group appeared to be more stable.However, no inter-group difference existed in long-term parameters.Scr was lower at 1 week and 3 months after switching to extended-release dosage form( P<0.05)and BUN was lower at 2 weeks( P<0.05). In addition, at 5 months after conversion, ALT and AST significantly improved as compared with common dosage form( P<0.05). Significant differences existed in urinary WBC(UWBC)at 2/3 weeks( P<0.05). After switching for 2 weeks, hemoglobin significantly improved compared with common dosage form( P<0.05). No significant differences existed in ALP, ALB or Glu at other timepoints and pre-conversion( P>0.05). In 1∶1 switch group, renal function tended to improve.At 2 weeks, BUN was lower than pre-conversion; at 1/3 weeks, Scr was lower than pre-conversion( P<0.05). In addition, there was also a trend of improvement in liver function in 1∶1 conversion group.At 1 week and 5 months, ALT was lower than pre-conversion( P<0.05). However, no significant differences existed in AST, ALB, ALP, Glu, UWBC and serum WBC count at each timepoint between two different dose conversion groups( P>0.05). After conversion, intra-individual variability of tacrolimus trough concentration significantly improved( P<0.05). Conclusions:With the same safety and efficacy as common dosage form, sustained-release dosage form of tacrolimus may improve drug variability of individuals.When converting common dosage form into sustained-release dosage form, individual differences should be considered.While monitoring trough concentrations, proper doses should be adjusted on the basis of various clinical parameters.
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Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.
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Objective:To explore the clinical characteristics and outcomes of pediatric kidney transplantations at a single center and discuss the related clinical issues.Methods:From January 1990 to October 2019, clinical data were analyzed retrospectively for 244 pediatric renal transplants. The youngest recipient was aged 1.8 years and the median age of pediatric recipients was 12.2 years. The major disease was primary or hereditary glomerulonephritis ( n=160, 69.0%), congenital anomalies of kidney and urinary tract (CAKUT), cystic renopathy and other hereditary nephropathies ( n=55, 23.7%). The donor sources included traditional deceased donor ( n=42, 17.2%), living-related donor ( n=19, 7.8%) and organ donation ( n=183, 75.0%). The median age of donors was 2 years (0-51) and the median weight 12.0(2.7-72.0) kg. From January 2013 to October 2019, 170 cases), the major induction immunosuppression regimen was anti-thymocyte globulin (ATG) ( n=110, 64.7%) or basiliximab ( n=58, 34.1%). The maintenance regimen was tacrolimus + mycophenolic acid (MPA) + glucocorticosteroids. Finally the outcomes and the complications were analyzed. Results:The survival rates of 244 kidney allograft recipients were 98.1%, 94.5% and 93.4% and the graft survival rates 92.6%, 84.2% and 82.0% at 1/3/5 years respectively. Ten recipients died of accident ( n=2, 20.0%), pneumonia after transplantation ( n=2, 20.0%) and intracranial hemorrhage ( n=2, 20.0%). Thirty-three recipients lost their allografts mainly due to intravascular thrombosis in graft ( n=5, 14.3%), acute rejection ( n=5, 14.3%) and death ( n=9, 25.7%). Besides, among 109 deceased donor allograft recipients, the postoperative outcomes were delayed graft function recovery (DGF) ( n=27, 24.8%), arterial thrombosis ( n=6, 5.5%), venous thrombosis ( n=1, 0.9%), graft perirenal hematoma ( n=6, 5.5%), raft artery stenosis ( n=10, 9.2%) and graft ureteral fistula ( n=1, 0.9%). The incidence of acute rejection was 17.5% and 23.2% at 1/3 year respectively. The recurrent rate of primary disease was 6.9%, including primary FSGS ( n=3, 42.9%) and IgA nephropathy ( n=2, 28.6%). At 1/3 year post-operation, the incidence of pulmonary infection was 16.9% and 22.4% and the incidence of urinary tract infection 26.9% and 31.7%. Excluding recipients with graft failure, the estimated glomerular filtration rate (eGFR) at 1/2/3 year postoperatively was (80.3±25.2), (81.4±27.8) and (71.8±27.6) ml/(min·1.73 m 2)respectively. Conclusions:The outcomes of pediatric renal transplantations are excellent at our center. Future efforts shall be devoted to optimizing the strategies of donor kidney selection and strengthening preoperative evaluations, perioperative and postoperative managements for improving the long-term outcomes of pediatric renal transplantations.
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Objective@#To explore the clinical and prognostic features of lipoprotein glomerulopathy (LPG) in renal allografts.@*Methods@#Retrospective analysis was performed for two case of LPG in renal allografts. The onset time was 6 and 9 years after living transplantation respectively. Initial symptoms included proteinuria and hypoproteinemia. Color Doppler ultrasound showed an enlarged graft size and greater parenchymal echogenicity. One patient had hyperlipemia and elevated apolipoprotein E (ApoE). Methylprednisolone pulse was offered with an early control of hyperlipidaemia and proteinuria by fenofibrate and angiotensin-converting enzyme inhibitors (ACEIs). Yet it had no effect on graft function. The definite diagnosis was made by graft biopsy. Pathological examination indicated non-homogeneous lipid deposition in glomerular capillary, glomerular sclerosis, mesangial hypercellularity and tubular atrophy.@*Results@#During a follow-up period of 8 and 10 years post-transplantation, two cases eventually lost their grafts within 2 and 1 year after biopsy respectively. With long-term dietary control and drug therapy, regular dialysis continued and both awaited a second transplantation.@*Conclusions@#LPG is generally steroid-resistant and refractory in renal allografts. And routine biopsy is recommended for patients with a high risk of occurrence. Early controls of hyperlipemia and hypoproteinemia and other risk factors should be also properly managed.
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Objective To explore the clinical and prognostic features of lipoprotein glomerulopathy (LPG) in renal allografts .Methods Retrospective analysis was performed for two case of LPG in renal allografts . The onset time was 6 and 9 years after living transplantation respectively . Initial symptoms included proteinuria and hypoproteinemia .Color Doppler ultrasound showed an enlarged graft size and greater parenchymal echogenicity .One patient had hyperlipemia and elevated apolipoprotein E (ApoE) . Methylprednisolone pulse was offered with an early control of hyperlipidaemia and proteinuria by fenofibrate and angiotensin-converting enzyme inhibitors (ACEIs) . Yet it had no effect on graft function .The definite diagnosis was made by graft biopsy .Pathological examination indicated non-homogeneous lipid deposition in glomerular capillary ,glomerular sclerosis , mesangial hypercellularity and tubular atrophy .Results During a follow-up period of 8 and 10 years post-transplantation , two cases eventually lost their grafts within 2 and 1 year after biopsy respectively .With long-term dietary control and drug therapy , regular dialysis continued and both awaited a second transplantation .Conclusions LPG is generally steroid-resistant and refractory in renal allografts .And routine biopsy is recommended for patients with a high risk of occurrence .Early controls of hyperlipemia and hypoproteinemia and other risk factors should be also properly managed .
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Objective To explore the strategies of desensitization treatment for ABO incompatible (ABOi) related living-donor kidney transplantation .Methods A retrospective analysis was performed for 14 recipients undergoing ABOi related living kidney transplantation from July 2015 to December 2018 .The clinical outcomes and expenditures of desensitization treatment before and after optimizing desensitization were compared .Results After desensitization treatment , 14 recipients successfully underwent ABOi-kidney transplantation . Within 2 weeks post-transplantation , blood group antibody rebounded to 1:64 in only 1 recipient .Within 1 week post-transplantation ,the serum creatinine levels decreased to 85-165 μmol/L in 14 recipients .Thirteen patients stabilized after 1 week while another patient had an elevated level of serum creatinine at Day 12 post-operation and renal allograft function recovered after treatment . Two cases of rejection were diagnosed by clinical manifestations and 1 case was confirmed by pathological biopsy . Five cases of programmed renal allograft biopsy indicated critical or suspected acute T-lymphocytic rejection within 1 year .Thirteen cases (92 .6％ ) demonstrated varying degrees of peritubular capillary deposition of C 4d .One case developed BK viral uropathy within 1 year and four patients of pulmonary infections requiring hospitalization were cured after treatment . During an early stage , the incidence of postoperative infection was 57 .14％ and declined to 14 .29％ after optimized desensitization .The expenditure of early desensitization treatment was (27004 .86 ± 10719 .85) yuan and (10612 .29 ± 8143 .05) yuan after optimization .And the expenditure of optimized desensitization was significantly lowered (P<0 .05) . During follow-ups ,renal allograft function of 14 recipients remained decent .And the survival rate of recipient/allograft was 100％ up to the statistical cut-off point .Conclusions Both desensitization strategies may achieve the goal of desensitization for ABOi kidney transplantation and the outcomes are excellent .The expenditure of desensitization treatment is significantly lowered after optimization .
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Objective To evaluate the clinical efficacy and safety of ABO incompatible living kidney transplantation(ABOi-KT). Methods Clinical data of 11 donors and recipients with ABOi-KT were retrospectively analyzed. All the recipients were treated with desensitization before operation. The recovery condition of renal function and blood type antibody titer of the ABOi-KT recipients were monitored after operation. The incidence of complications and clinical prognosis of ABOi-KT recipients were observed. Results The serum creatinine (Scr) of 11 recipients were well recovered after ABOi-KT. No delay in recovery of graft renal function. Among them, 2 recipients experienced a significant increase in the Scr level at postoperative 14 and 45 d respectively, 1 recipient showed criticality cellular rejection after operation and 1 recipient presented with elevated Scr level at postoperative 33 d, accompanied by an increase in blood type antibody titer. The condition became stable after corresponding treatment. The remaining 7 recipients obtained normal graft renal function and postoperative blood type antibody titer did not rebound. During postoperative follow-up until November 2018, no recipient died or graft renal failure occurred. The survival rate of the recipient and graft renal was 100%. Among them, 3 patients suffered from postoperative complications, including pulmonary infection, BK viruria and granulocytopenia, which were cured after symptomatic treatment. Conclusions ABOi-KT is safe, feasible and yields high long-term clinical efficacy, which can increase the source of living donor kidney and relieve the shortage of donor kidney.
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Objective To explore the clinical outcome of renal transplantation and analyze the risk factors influencing the kidney allograft survival after transplantation.Methods The clinical data of 524 cases of renal transplantation between January 2007 and December 2015 were retrospectively analyzed.Serum creatinine was determined,and glomerular filtration rate(GFR) was estimated.The 1-,2-and 3-year patient and graft survival after transplantation was calculated.Adverse events were recorded.Results The median follow-up time was 17.2 months.The 1-,2-and 3-year graft survival rate after transplantation was 97％,95.8％ and 95.3％,respectively.The 1-,2-and 3-year patient survival rate after transplantation was 97.8％,97％ and 97％,respectively.The eGFR was (67.6 ± 24.1),(68.9±24.2) and (72.7 ± 26.2) ml·min-1 ·1.73 m-2 at 1st,2nd and 3rd year after transplantation.The incidence of delayed graft function(DGF) was 20.6％ (108/524).Multivariate analysis revealed donor type (P =0.005) and the terminal creatinine (P＜0.001) were the independent risk factors of DGF.Elder recipients (P =0.004),recipients with diabetes(P =0.031),preoperative positivity of panel reactive antibody(PRA) (P =0.023),and donor with hypertension (P =0.046) were risk factors influencing the kidney allograft survival.Conclusion Kidney transplantation showed good outcomes at 3rd year after transplantation.The recipient age,recipient's history of diabetes,preoperative PRA and donor's history of hypertension are independent risk factors for renal graft survival.
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Objective To introduce the advantages,incision designing methods and surgical procedures of spigelius' line incision in retroperitoneal laparoscopic living donor nephrectomy.Methods Among the 114 donors,39 were obtained by spigeliu'line incision (13 males and 26 females),with an average age of 35 years,35 left kidneys and 4 right kidneys.Gibson incision was performed in 75 patients (28 males and 47 females),with an average age of 31 years,73 left kidneys and 2 right kidneys.The clinical data of 114 donors undergoing retroperitoneal laparoscopic living donor nephrectomy from September 2012 to July 2017 were analyzed retrospectively.The operation was performed by laparoscopic surgery to separate the ureter,renal vessels and perirenal fat.Finally,the renal vessels were removed and the kidneys were removed with hand-assistant.75 cases were taken out of the kidney through the inguinal parallel incision (Gibson incision),while the other 39 cases used the spigelius' line incision (Through the linea pararectalis,the anterior sheath is cut opened at the margin of the rectus sheath (spigelius' line) and the lateral peritoneum is pushed into the midline between the arcuate line and the inferior abdominal vessels to expose the retroperitoneal space).The intraoperative data were collected.Results All the operations were not converted to open surgery.The incision length of the spigelius' line incision group was (6.8 ± 0.6) cm,and the incision length of the Gibson incision group was (7.0 ± 0.4) cm,P =0.02.The blood loss of the operation of the spigelius' line incision group was (59.2 ± 33.4) ml,while the Gibson incision group was (80.7 ± 32.8) ml,P =0.002.The warm ischemia time of the spigelius'line incision group was (2.8 ± 1.1) min,while the Gibson incision group was (3.1 ± 1.7) min,P =0.31.The operation time of the spigelius' line incision group was (160.8 ± 30.7) min,while the Gibson incision group was (162.5 ± 28.1) min,P =0.77.There was no significant difference between the two groups in the warm ischemia time and the operation time.No incisional hernia was found in these two groups.Conclusions Compared with Gibson incision,the spigelius' line incision is safe.It can completely avoid to cut the abdominal muscles,and effectively avoid the abdominal nerves injury.Without damaging the integrity of the peritoneum,it can avoid abdominal organ injury.
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Objective To explore the clinicopathologic characteristics of polyomavirus nephropathy (PyVN) in renal transplantation.Methods Clinicopathological data from 101 cases of PyVN from January 2006 to October 2016 in our hospital were collected and analyzed retrospectively.There were 72 males and 29 females.The mean time from operation to the diagnosis of PyVN was 16.5 months (2.2-63.9 months),with 86 cases (85.1％) occurring within 2 years.The indications for biopsy included elevated serum creatinine in 81 cases (80.2％),elevated serum creatinine with proteinuria in 13 (12.9％) cases,active BK virus(BKV) infection in 5 cases (5.0％) and proteinuria in 2 cases (2.0％).Results BK viruia was detected in 98 (97.0％) recipients with viral loads of 1.5 × 109 (0-9.0 × 1011) copies/ml,and BK viremia in 80 (79.2％) recipients with viral loads of 1.8 × 104 (0-2.1 × 107) copies/ml.5 patients lost their graft function at biopsy and the other 96 patients reserved graft function with serum creatinine of 187.0 μmol/L.After 20.1 (3.7-109.6) months of follow-up,19 (18.8％) patients lost their graft function.The average serum creatinine of the 77 patients with graft function was 165.0 μmol/L,with no statistical difference (P ＞ 0.05) compared with that of patients at diagnosis.There were 18 cases of stage A,72 cases of stage B and 11 cases of stage C with 5-year allograft cumulative survival of 92.9％,82.8％ and 55.6％,respectively.Conclusions PyVN can occur within 5 years after renal transplantation,mostly within 2 years.The typical clinical manifestations include elevated serum creatinine,BK viruia and BK viremia.The severe the histopathological lesions were correlated the worse the clinical prognosis.
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Objective To analyze the necessity of anti-human leukocyte antigen (HLA)antibody monitoring and graft biopsy on early diagnosis of antibody-mediated rejection (AMR). Methods Fifty-one recipients with de novo donor specific antibody (dnDSA)were screened and chosen. Donor specific antibody (DSA)and its ability to bind with C1 q were evaluated. Pathological biopsy of the kidney graft was performed. The recipients diagnosed with AMR were divided into the unstable and stable kidney function groups. Type of DSA,binding ability of the complement and Banff score were statistically compared between two groups. Kaplan-Meier survival analysis of the kidney graft in the recipients from non-rejection, unstable and stable kidney function groups was performed. Results Type of HLA antibody,mean fluorescent intensity (MFI)of DSA,C1 q binding ability and C4d deposition in peritubular capillary did not significantly differ between the unstable and stable groups (all P>0. 05 ). Histomorphologically,the Banff score of microvasculitis,endarteritis,renal tubule-interstitial nephritis,transplantation glomerulopathy and renal tubular atrophy-stroma fibrosis did not significantly differ between two groups (all P>0. 05 ). In the unstable group,the accumulated survival rate of the kidney graft was significantly lower compared with that in the stable group,which was significantly lower than that of their counterparts who were ineligible for pathological diagnosis (P=0. 002). Conclusions It is necessary to perform regular anti-HLA antibody monitoring and pathological puncture examination after renal transplantation,which contributes to early detection and diagnosis of AMR.
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Objective To summarize the experience of retroperitoneal laparoscopic living donor nephrectomy.Methods Clinical data of 22 donors undergoing retroperitoneal laparoscopic living donor nephrectomy in the First Affiliated Hospital of Sun Yat-sen University from January 201 2 to May 201 4 were analyzed retrospectively.The ureter,renal vessel and perirenal fat were dissected by laparoscopic approach.Then the renal vessels were cut off and the kidney was extracted by hand through superomedial inguinal parallel incision.The surgical process and the postoperative follow-up of the donors were recorded.Results One right kidney and 21 left kidneys were extracted.The operations in 22 cases were performed successfully without conversion to laparotomy.The operation time was (1 23 ±31 )min.The length of kidney extracting incision was (7.2 ±0.5)cm.The intraoperative blood loss was 1 5-80 ml and the warm ischemia time was 60-1 50 s.The length of donor renal arteries was 2.0-3.2 cm.The length of renal veins was 1 .0-3.5 cm.The donors were followed up for 1 -21 months.The serum creatinine (Scr)levels at 1 d,1 week and 1 month after operation were (1 20 ±57),(95 ±25),(90 ±21 )μmol/L respectively.Two cases suffered from renal fossa hematoma and poor wound healing after operation respectively.The pain score of the donors was 0-5 at 1 week after operation and 0-1 at 1 month after operation.No donor had the perception that donating kidney had obvious impacts on the general health,but 1 donor felt it had some influence on physical strength.Conclusions It is safe to perform retroperitoneal laparoscopic living donor nephrectomy on the basis of strict donor selection.It has little impacts on the donor's quality of life with small surgical incision and mild postoperative pain.
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Objective To document retrospectively long-term quality of life (QOF) and safety of living kidney donors.Methods A total of 219 living-related kidney donors which can be followed up had donated their kidneys between May 2004 and Sap.2011.The renal function,complications and QOF were estimaged.Results Donors included 104 men and 115 women with age from 19 to 66 years.Follow-up period was from 12 to 103 months.No cases died.The mean serum creatinine (Scr) was (84.0± 18.7) μmol/L and creatinine clearance (Ccr) was (1.23 ± 0.37) ml/s over 12 months postoperation.The average Ccr was lower in donors age over 50 years than in younger donors.The kidney function was still abnormal in 3 elder donors at end of the study.Thirty donors had hypertension including 5 newly cases.Microscopic hematuria was found in 4 cases.Hyperlipidemia developed in 3 cases.Mild anemia occurred in 2 cases.Femoral head necrosis occured in 1 case.Majority of 18.26％ donors (40 cases) reported weak healthy feeling (mild impact in 31 cases,moderate impact in 7 cases and severe impact in 2 cases).Thirty-five donors reported mild pain of incision (31 cases occasionally,and 4 cases frequently).Conclusion Living kidney donors have good long-term QOF and safety though there still exist risks of renal impact.Close follow-up is required especially in elderly donors.Compliance of donors needs to be further improved.
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Objective To document the impact of conversion to mycophenolate mofetil (MMF)at different time points after transplantation on the renal function of renal function.Methods A longterm,multicenter,non-interventional and observational study was done.Two cohorts were included:One was Switch cohort (340 cases) including renal allograft recipients who switched to MMF at least 6 months after renal transplantation and followed up for 4 years after switch; The other was Stay cohort (123 cases),including renal allograft recipients who received MMF treatment after transplantation and followed up for 4 years after enrollment.Results GFR values of patients in Switch cohort was significantly increased after switch,and the change in GFR slope was 3.1 mL· min-1 · year-1 (P＜0.01).GFR values of patients in Stay cohort kept steady before and after enrollment,and the change in GFR slope was 0.44 mL·min-1 ·year-1 (P＞0.05).Statistically significant difference in the onset time of GFR decline (defined as 20％ decline from the baseline) was observed among subgroups within Switch cohort (P＜0.01),but there was no significant difference among subgroups within Stay cohort (P＞0.05).Stay cohort was 12％ higher than in Switch cohort every year.Conclusion Conversion to MMF ＞6 months or even many years after transplantation can obviously improve the renal function of recipients.The earlier conversion can benefit improvement of the renal function.
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Objective To assess the impact of donor age on the outcome of living donor kidney transplantation.Methods A total of 217 patients undergoing living donor kidney transplantation during 2004 to 2011 were enrolled in our retrospective study.The recipients were divided into different groups according to their donors' age or the age gaps between donors and recipients.A follow-up survey was conducted to evaluate the serum creatinine level and the incidence of complications after transplantation.Results As the donors age grew,the recipients' serum creatinine increased.The serum creatinine levels of patients with older donors(age gap＞5 years) at 1 month[(143.5±42.1) μmol/L vs (114.4±30.4) μmol/L],3 months (139.9±36.6)μmol/L vs (110.6±33.3) μ mol/L],1 year [(132.1±22.1) μmol/L vs (105.5±35.9) μmol/L] and 2years (132.0±45.4) μmol/L vs (97.2±17.5) μ mol/L] after operation were significantly higher than those with younger donors(age gap＜-5)(P＜0.05).The incidence of acute rejection (19.4％ vs 9.7％,P＜0.05) and chronic rejection (9.7％ vs 1.4％,P＜0.05) was significantly higher in the group with donors older than 50 years old than those with donors younger than 50 years old.But no significant difference was observed in the survival of the grafts or the recipients.Age gap between the donor and recipient was an independent risk factor for abnormal serum creatinine level at 2 years after transplantation (OR=5.010,P＜0.05).Conclusions Donor age is an important impact factor on the outcome of living kidney transplantation.Recipients of older living donation have poorer Prognosis.
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Objective To compare the efficacy and safety of twice-daily tacrolimus (Tacrolimus BID; Prograf) vs once-daily prolonged release tacrolimus (Tacrolimus QD; Advagraf), combined with steroids and mycophenolate mofetil in preventing acute rejection in De Novo renal transplantation patients. Methods 241 patients from 11 centers were randomized into two groups with 3 months observation period post-transplantation. Advagraf was administered as a single oral dose in the morning (initially 0. 1-0. 15 mg/kg every day) and Prograf was administered in two equal oral doses 12h apart (initially 0. 1-0. 15 mg/kg). Study visits were scheduled for days 1, 3, 7, 14, 28, 56, 84post-transplantion. The efficacy, safety, compliance and adverse effects were compared between two groups. Results Totally 223 patients completed the study. The two groups were comparable in age,gender and primary disease. There were 12 episodes of acute rejection in each group. There was no graft loss or patient death in both groups. The incidence of drug related adverse events was 32. 1 %and 33. 3% respectively in the control and experimental groups. Dosage was decreased in both groups and there was significant difference in each group. The trough level was similar at the initiate period.Twenty-eight days post-transplantation the trough level in the Advagraf group was lower than in the Prograf group. Conclusion Advagraf has the same efficacy, safety and drug related adverse effects as Prograf. It is practical and feasible for Advagraf substitute for Prograf in clinical practice.
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Objective To analyze diagnostic value of renal biopsy in living-related kidney transplantation and the influence of kidneys from marginal donors on the early prognosis of recipients. Methods According to donors age and risks of donors, 142 living-related kidney transplant recipients from February 2004 to July 2008 were divided into marginal donor group (51 cases) and non-marginal donor group (91 cases). Renal biopsy was performed on 49 kidneys Postsurgical serum creatinine (Scr), the lowest Scr and post-transplant complications were analyzed between the two groups. Results Pathological changes were detected in 13 cases. The Scr at 4 weeks, 12 weeks, 6 months post-transplant and the lowest level of Scr in marginal donor group were higher than those in non-marginal donor group (all P0.05). Conclusions The early clinical efficacy of the marginal donor is ideal, but the baseline of Scr of recipients is higher than that of recipients with kidneys from non-marginal donors. Renal biopsy has an important diagnostic and therapeutic value for both donors and recipients.
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Objective To analyze the characteristics of tuberculosis (TB) in renal-transplant recipients from our hospital, and summarize the corresponding experiences in diagnosis and management.Methods A retrospective study was performed on 61 documented post-transplant TB cases out of the 2842 patients who received kidney transplantation in the First Affiliated Hospital of Sun Yat-sen University between Jan.1991 and Dec.2010.Results TB in the post-renal-transplant population in our hospital displayed the following characteristics:(1) High incidence (2.1％ ).54.1％ recipients were diagnosed within the first year post-transplant; (2) Lung was the most common site (77.0 ％).There was high prevalence (60.7 ％) of extra-pulmonary TB (lymphatic TB,23.0 ％; pleuritis,13.1 ％; graft,11.5％); (3) Fever (83.6 ％),cough (55.7 ％),sputum (41.0 ％) were the most common clinical manifestations.There were also emaciation (3.3 ％) and enlargement of lymph nodes (18.0 ％); (4) Chest X-ray and CT were of great value during TB diagnosis while purified protein derivative of tuberculin (PPD) skin test had little diagnostic value with a negative result in 56 cases (91.8 ％) ; (5) Liver function damage ( 16.4 ％),kidney function injury (39.3 ％) and peripheral nerve toxicity (3.3 ％) were the main adverse reactions of anti-tuberculosis chemotherapy,also the major cause of anti-TB failure; (6) Pre-transplant TB (17 cases) increased the probability of TB recurrence (4 cases,23.5 ％) post-transplantation; (7) The post-transplant TB patients were accompanied with cellular immune deficiency,resulting in overlapping infection of bacteria,viruses and fungi (19.7 ％); (8) 1- and 3-year patient/graft survival rate of patients with post-transplant TB was 85.2 ％/78.7 ％ and 85.2 ％/75.4 ％ respectively. The accumulative mortality rate reached to 14.8％,while overlapping infection was the major cause of death (66.7 ％).Conclusion Chinese renal transplant recipients still face a high risk of TB because of their immunecompromised state and epidemiological prevalence of the disease. For the high mortality rate and associated serious complications,rapid diagnosis and effective anti-TB chemotherapy are of great value for TB population.
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Objective To investigate the pathological type and characteristics of renal allograft in kidney transplantation recipients,and to analyze the relevant clinical conditions and prognosis of renal function.Methods 230 patients received renal allograft biopsy after renal transplantation.The pathological type and characteristics of renal allograft specimens were observed,and the serum creatinine (SCr) in the recipients with different pathological types were analyzed.The function of renal allograft in the recipients was followed-up after one year,and their prognosis was evaluated.Results In 10 cases of protocol biopsy,normal renal tissues were found in 9 cases,IgA nephropathy occurred at the 3rd month after transplantation.In 220 cases having impaired renal function,there were 33 cases of borderline change,45 cases of acute rejection (AR),24 cases of chronic rejection (CR),26 cases of chronic allograft nephrapathy (CAN),and 39 cases of posttransplantation glomerulonephritis (PTGN).Except for above 167 cases,lesions of 28 cases showed multiple pathology types.Furthermore,there were 8 cases of calcineurin inhibitor nephrotoxicity (CNI-NT),7 cases of BK virus nephropathy (BKVN),and 5 cases of acute tubular necrosis (ATN).Five cases could not be diagnosed for little tissue.In the recipients with pathological diagnosis of borderline change,AR,CR,CAN and nephritis,SCr levels were (171 ± 17),(259 ± 25),(343 ± 33),(406 ± 67) and (207 ± 26) respectively.There was significant difference in SCr levels of recipients among the above 5 groups (P＜0.01).One year after biopsy,137 recipients (80.2%) were followed up.The dysfunction rate of renal allograft was 3.1%,18.2%,22.2 %,33.3% and 13.5% respectively.The △SCr was (-47 ± 20.7),(-37.3± 36.9),(25.5 ± 24.3),(13.5 ± 27.7) and (25.2 ± 17.1) μmol/L respectively.Conclusion Complex and diverse pathological changes were showed in renal allograft.Accurate diagnoses come from renal biopsy and clinical analysis may help clinicians select appropriate treatment programs to promote long-term graft survival.
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Objective To investigate the characteristics of BK virus (BKV) infection in renal transplant recipients. Methods A total of 243 renal recipients from our clinic within 48 months after transplantation were enrolled as the trial group and 82 healthy people as the control group. Urine and peripheral blood samples of these two groups were harvested for urinary sediment BKV cytology by Decoy cell counting and BKV DNA by real-time PCR. Results The positive rates of urinary Decoy cell, BKV viruria and viremia were 35.4%, 36.6% and 16.9% in trial group, and 4.9%, 20.7% and 2.9% in control group, respectively. In trial group, the medians of urinary Decoy cell, urinary BKV and peripheral blood BKV were 6/10 HPF, 1.00×104 copy/ml and 6.87×103 copy/ml respectively, while in control group, they were 2/10 HPF, 1.10×104 copy/ml and 2.24×1(3 copy/ml. Compared with the healthy people, the positive rates and the levels of BKV DNA in urine and peripheral blood of recipients were significantly higher. The amount of urinary Decoy cells was positively correlated to urinary BKV load (r=0.636, P＜0.01). Conclusions BKV replication is easier to happen in renal recipients as compared to healthy people. Counting of urinary Decoy cells is convenient, useful and sensitive to evaluate BK viruria and viremia in renaltransplant recipients. BKV DNA detection in urine and peripheral blood can be used to screen the evidence of BK reaction in order to prevent irreversible graft damage by BKV.[ Key words ] Kidney transplantation; BK virus; Kidney diseases; Decoy cells