Correlation of Hypoxia Inducible Factor-1alpha & Transforming Growth Factor-beta1 Expression and Progression of Renal Allograft / 대한이식학회지

PURPOSE: Transforming growth factor (TGF)-beta1 and Hypoxia inducible factor (HIF)-1alpha are renal fibrogenetic cytokines involved with the fibrosis of renal allograft. The aim of this study was to investigate TGF-beta1 and HIF-1alpha in renal allograft patients. METHODS: Between January, 1995 and February, 2005, we performed 72 renal allograft biopsies from 61 recipients. Immunohistochemical studies were performed with a immunoperoxidase technique using the primary antibody, rabbit anti-human TGF-beta1 polyclonal antibody (C-teminus, 1:1,000, Santa-Cruz Biotechnology, Santa Cruz, CA, USA) and mouse anti-human HIF-1alpha monoclonal antibody (clone H1alpha 67-sup, 1:1,000, Novus Biological Inc., Littleton, CO, USA). RESULTS: Tubular and interstitial TGF-beta1 expressions in CAN were higher than other groups, showing significant differences (P<0.05). HIF-1alpha expression in CAN was much higher than other groups (P<0.05). The glomerular TGF-beta1 expression of the heavy proteinuria (2.5 gm/day <) group was significantly higher than the low proteinuria group (<1.0 gm/day) (P<0.05). The tubular TGF-beta1 expression of the graft functioning group was significantly lower than the graft loss group (P<0.05). CONCLUSION: In conclusion, HIF-1alpha expression in renal allograft strongly suggests the development of CAN as well as tubular or interstitial TGF-beta1 expression. TGF-beta1 expression in the glomerulus shows significant correlation with the amount of 24 hours urine protein. The tubular TGF-beta1 expression has strong correlation with graft survival.

Native Ureterotransplant Ureterostomy for Ureteral Obstruction after Simultaneous Pancreas Kidney Transplantation

Significant surgical complications occur in about half of patients after simultaneous pancreas kidney transplantation (SPK) with bladder drainage. Urologic complications are very common in bladder-drained pancreas transplants. Urinary obstruction occurs in either the early or the late period following transplantation. Predictors of urological complications after transplantation have not been well established. Early obstruction is usually diagnosed by an increment of serum creatinine or through imaging studies, such as ultrasound and antegrade pyelogram. Surgical management is inevitable when conservative managements fails. If the length of the donor ureter is sufficient, it is possible to redo the ureteroneocystostomy. However, if this is not the case or the stricture is at a high level, a native ureterotransplant ureterostomy may be the procedure of choice. SPK was performed on a 36 year old male patient with insulin dependent diabetes mellitus and diabetic nephropathy. The pancreatic exocrine secretion was drained by duodenocystostomy. The patient developed an obstruction in upper ureter on the postoperative 16th day. On the postoperative 32nd day, a native ureterotransplant ureterostomy with a double J stent was performed. The postoperative course was uneventful. The double J stent was removed on postoperative 112nd day by cystoscope. A subsequent follow up showed excellent pancreatic and renal function.