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Objective To sum up the experience in the treatment on delayed graft function (DGF) complicated with severe pulmonary infection. Methods Clinical data of 15 patients undergoing renal transplantation and suffering delayed graft function (DGF)complicated with severe pulmonary infection in Chengdu Military General Hospital from January 2008 to November 2014 were retrospectively studied.The treatment course and prognosis were studied.Results Continuous renal replacement therapy was adopted and dosage regimen was adjusted according to the dosage adjustment table for continuous veno-venous hemofiltration.Antibiotic de-escalation therapy was adopted.Immunosuppressive agents were adjusted and low-dose adrenocortical hormone and other comprehensive treatment were applied.Of the 15 patients,8 cases underwent tracheal intubation,2 cases underwent mechanical ventilation after tracheotomy and 5 cases underwent noninvasive ventilator-assisted breathing.Through positive rescue treatment,11 patients were cured and 4 patients died.The cure rate was 73% and the fatality rate was 27%.All died patients were complicated with acute respiratory distress syndrome.Conclusions DGF complicated with severe pulmonary infection after renal transplantation is characterized by severe condition and fast progression. Once cases confirmed, continuous renal replacement therapy shall be ‘fully’applied ‘as early as possible’,and dosage regimen shall be adjusted according to the dosage adjustment table for continuous veno-venous hemofiltration.And other comprehensive treatments shall be combined in order to improve the cure rate.
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BACKGROUND:Although the renal transplantation technology has been quite mature, vascular complications during and after transplantation inevitably occur. OBJECTIVE: To investigate the diagnosis and management of vascular complications during and after renal transplantation. METHODS: A retrospective analysis was performed in 11 patients suffering from vascular complications during and after renal transplantation. During the transplantation, there were two cases of arterial anastomotic stenosis, one case of renal vain transverse, three cases of atherosclerosis plaque of the external iliac artery blocking the transplant renal artery, one case of twisted renal vein. After transplantation, there were two cases of extra renal pseudoaneurysm, one case of arterial anastomotic stenosis, and one case of renal artery obstruction. RESULTS AND CONCLUSION: Two cases of arterial anastomotic stenosis during operation had good recovery, and renal alograft dysfunction occurred after 6 and 11 years, respectively. In the case of renal vain transverse, the renal alograft functioned for 12 years. Among the three cases of atherosclerosis plaque of external iliac artery blocking the transplant renal artery, 1 case presented with renal alograft dysfunction immediately, the other two patients,renal function recovered wel during the folow-up of 6 and 2 years respectively. In the case of twisted renal vein, delayed graft function occurred, and the patient died of severe pulmonary infection 1 month later. The renal alograft dysfunction occurred in the two cases of post-transplantation extra renal pseudoaneurysm. The case of post-transplantation arterial anastomotic stenosis was treated by baloon angioplasty and metalic stent placement via femoralartery, and the renal function became normal during 18 months of folow-up. The case of post-transplantation renal artery obstruction appeared to have delayed graft function, and died of severe pulmonary infection 3 weeks later. These findings indicate that patients with vascular complications during and after renal transplantation can obtain satisfactory outcomes if receiving accurate diagnosis and timely treatment.
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The etiological factor, diagnosis, as well as therapeutic results of 23 cases with urinary fistula following renal transplantation, at the Chengdu Military General Hospital, from December 1998 to December 2008, were analyzed retrospectively, including 21 cases with a renal transplantation, 2 cases with retransplantation; 9 cases adopt renal artery, renal veins to external lilac artery, external lilac vein anastomosis, 14 cases with renal artery to internal lilac artery, renal veins to external lilac vein anastomosis. 23 cases were followed-up for 6-12 months, 17 cases suffered urinary fistula at days 3-7 after transplantation, 6 cases occurred at days 7-10; there were 17 stoma fistulae, 4 distal end necrosis of ureter, 2 ureteral fistulae. 11 cases were received conservative treatment, and 12 cases with operation. Among the surgery patients, 9 cases received conventional operation and 1 of them returned with urinary fistula and then was cured by second operations; 3 patients received pedicled omentum transplantation and no recurrence or hydronephrosis happened with normal renal function. The one-time success rate was 92% (11/12), of which the repair success rate using pedicled omental was 100%. The results demonstrated that prevention plays an important role in urinary fistula, and ureter should be protected during the surgery. Meanwhile, stoma fistula should be avoided. Promptly treatment following urinary fistula is also necessary to reduce the damage of urinary fistula to the renal function.
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Objective To explore the feasibility of B-ultrasound guided ureteroscopic holmium laser nephrolithotomy via percutaneous nephrostomy for the treatment of complex renal calculi. Methods A total of 32 cases of complex renal calculi was included in the study. Under local anaesthesia and B-ultrasound guidance, a percutaneous nephrostomy was performed untill a F_ 16 catheter could be introduced, with the sheath indwelling in the tract. Then under a F_ 8/9.8 ureteroscopy, holmium laser nephrolithotomy was conducted for 1~3 fractions with an interval of 3~5 d. Results The renal puncture was successfully accomplished in all the cases. The stone-free rate was 75% (24/32) at 4 weeks, and 94% (30/32) at 12 weeks after procedure. No serious hemorrhage or infection happened. No conversion to open surgery was required. Conclusions Under local anaesthesia and B-ultrasound guidance, ureteroscopic holmium laser nephrolithotomy via percutaneous nephrostomy for the treatment of complex renal calculi is safe, effective, and feasible.
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3.Three cases failed to respond to treatment.Two cases had recurrence 7 and 9 months after treatment.The effective rate was 82%. The ICSI score was decreased to 6.1?3.4 at 1 month,6.3?3.5 at 2 months (P
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Objective To investigate the early and long-term effects of enhanced ischemia/reperfusion injury on the transplanted abdominal aorta. Methods Abdominal aorta grafts from Sprague-Dawley (SD) rats were cold stored for 1 or 24 hours, and they were orthotopically transplanted to SD or Wistar recipients. The pathohistological changes and the expression of TGF-? 1 in the grafts were observed. The levels of serum lipid peroxides before and after transplantation were also measured. Results The intima was significantly thicker in aorta transplants which was cold stored, both in SD→SD and SD→Wistar groups 10 weeks and 6 weeks after transplantation, whereas grafts which were cold stored for 24 hours showed pronounced thickening as early as 2 weeks after transplation. Serum lipid peroxides levels were elevated significantly 2 hours post-transplantation in all groups, but they were lowered 4 and 24 hours post-transplantation. The expression of TGF-? 1 in 24 hours of ischemia became stronger 1 week after transplantation regardless the difference in strains of the animal. Conclusions The enhanced ischemia/reperfusion injury can aggravate the infiltration of inflammatory cells, intensify the expression of TGF-? 1, accelerate the thickening of intimal layer.