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Objective To investigate the clinical efficacy of renal transplantation from donors of donation after brain and cardiac death(DBCD) complicated with acute kidney injury (AKI),and summarize the clinical experience of evaluation and application.Methods The clinical data of the 45 DBCD donors and 80 recipients in the First People's Hospital of Foshan from September 2011 to September 2015 were retrospectively analyzed.DBCD donors were classified into the AKI group (n=26) and non-AKI group (n=19) according to the serum creatinine level and urine output when the donors were admitted to the intensive care unit (ICU) in this hospital.A total of 80 recipients were divided into the AKI group (n=46) and non-AKI group (n=34) correspondingly.The condition of the donors before organ procurement between the two groups was compared,and the incidence of various complications,the 1 years survival rates of recipients and graft after renal transplantation were compared between the two groups.Results Among 45 donors,26 cases(57.8％) suffered from AKI.The serum creatinine of donors was significantly higher in the AKI group than that in the non-AKI group (P ＜ 0.01).The incidence of delayed graft function (DGF) in AKI group and non-AKI group was 21.7％ and 8.8％ respectively (P ＞ 0.05).After 1 years,the serum creatinine of the recipients in AKI group was significantly higher than that in non-AKI group [(134.9±63.4) μmol/L vs (106.6±28.2) μmol/L,P＜ 0.05],but the survival rates of recipients and grafts did no differ between the two groups (both P ＞ 0.05).Conclusions The donors combined with AKI do nothave a worse effect on the incidence of DGF,the 1-year survival rates of recipients and grafts after transplantation.So,the donors with AKI for transplantation can widen the origin of kidney grafts.
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Objective To compare the influence of hemodialysis (HD) and peritoneal dialysis (PD) on early outcome of patients underwent kidney transplantation from donation after cardiac death (DCD).Methods Patients admitted in the First People's Hospital of Foshan with DCD kidney transplant from January 1st,2011 to June 30th,2016 were analyzed retrospectively.Recipients were grouped into HD group (n=61) and PD group (n=28) according to their pre-transplant dialysis modality.Their short-term outcomes after DCD kidney transplant were compared,including recovery of renal function,short-term complications and laboratory data.Results Patients had longer dialysis duration and lower hemoglobin,serum albumin and phosphorus in PD group than those in HD group (all P ＜ 0.05),but no significant difference shown in age,gender,body mass index,primary disease,blood pressure,and hepatitis B infection (all P ＞ 0.05).HD patients with 6.00(4.00,11.00) d recovery time of renal function,18.00(17.00,21.50) d hospital time,had 24.59％ the delayed graft function (DGF),3.28％ acute rejection and 16.39％ infection during hospitalization.While for PD patients the recovery time of renal function was 4.00(3.75,7.00) d;hospital time was 19.00(15.00,21.75) d;the incidence rate of DGF was 14.29％;acute rejection was 3.57％;and infection during hospitalization reached 17.86％.Above indexes were not significantly different between HD and PD groups (all P ＞0.05).Repeated measure ments showed that,compared with those before transplant surgery,after 1 month,3 months and 6 months HD and PD groups had decreased creatinine and phosphorus,and increased hemoglobinserum albumin and calcium;Serum albumin and calcium were different between the two groups (P ＜ 0.001,P=0.040),whereas creatinine,hemoglobin and phosphorus did not show difference (all P ＜ 0.05).After transplantation the trends of creatinine,hemoglobin,calcium and phosphorus were not different between the two groups (P values were 0.295,0.310,0.501 and 0.063,respectively).Conclusions No significant difference of the recovery regarding renal function,anemia,nutrition status and mineral metabolites was found between pre-transplant HD and PD modality in patients who underwent DCD kidney transplantations.
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Objective To observe the short?term clinical outcomes of kidney transplantation from brain and cardiac death donors (DBCD) and assess its feasibility to expand organ donor pool. Methods A retrospective analysis was performed on 48 cases of kidney transplantation from DBCD. The transplant recipients had finished 12?month follow?up in the First People's Hospital of Foshan from September 2011 to February 2015, with their renal function, rejection reaction and complications at 1 week, 1 month, 3 months, 6 months and 12 months after renal transplantation being collected. Survival rates of transplant recipients and transplant kidneys, incidence of delayed graft function (DGF) and its influence for recipients and graft survival were analyzed by statistics. Results In the 48 cases, the survival rates of recipients at 1, 3, 6 and 12 months after transplantation were 100.0%, 100.0%, 97.9%, 95.8%, and the survival rates of transplanted kidneys were 95.8%, 95.8%, 93.8%, 91.7%, respectively. DGF occurred in 8 of 48 (17.0%), but the occurrence of DGF did not adversely influence patient's survival (P=0.524) or graft survival (P=0.362). Conclusions The short?term clinical outcomes of kidney transplantation from DBCD are ideal. As the legislation of donation after brain death (DBD) has not been ratified in China, the kidney transplantation from DBCD could be an important way to solve the shortage of organs, and increase the number of kidneys available for transplantation.
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Objective To evaluate the accuracy of using prothrombin time (PT ) derivative algorithm(PT‐Fib) method to detect fibrinogen(Fib)content in plasma samples with Sysmex CA7000 automatic coagulometer and its correlation with results of Clauss method .Methods Clauss method and PT‐Fib method were used to detect Fib concentration in plasma of patients′ blood samples by Sysmex CA7000 automated blood coagulation analyzer and supporting reagent .Data were randomly collected as the Fib content were in 1 .00 - 1 .99 ,2 .00 - 2 .99 ,3 .00 - 3 .99 ,4 .00 - 4 .99 g/L detected by PT‐Fib method ,each range with 21 patients .The difference and correlation of two methods were analyzed .Results There was significant statistical difference between PT‐Fib meth‐od and Clauss method(P< 0 .05) when the level of Fib detected by PT‐Fib method were 1 .00 - 1 .99 ,2 .00 - 2 .99 ,3 .00 - 3 .99 , 4 .00 - 4 .99 g/L (n= 21) .The result of the PT‐Fib method was obviously lower than those of the Clauss method on average 15 .2%( - 4 .9% - 38 .3% ) ,27 .2% ( - 0 .9% - 49 .4% ) ,24 .6% ( - 3 .7% - 35 .6% )and 32 .7% (15 .7% - 48 .2% )respectively ,and results of the two methods were positively correlated .Conclusion Fib value calculated by the PT‐Fib method in the fully automatic coagu‐lation Sysmex CA7000 analyzer is obviously lower than that of the Clauss method .It is suggested that the Fib detection should be changed to adopt Clauss method while detecting Fib content in plasma samples with Sysmex CA7000 automatic coagulometer .
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Objective To establish reference range of fibrinogen (FIB) for normal parturient women in labor in Hefei area and compare it with previous FIB reference .Methods FIB of plasma samples for normal parturient women in labor were determined by Sysmex CA7000 automated blood coagulation analyzer and supporting reagent .All the FIB results were statistically analyzed and the reference range of FIB for normal parturient women was established in our laboratory .Consistency checking was applied for the comparisonwithpreviousreferencefromNationalClinicalLaboratorySOP (2.00-4.00g/L)anddecidedbytheKappavalue.Re‐sults The single sample K‐S test showed that distribution of FIB results for samples was skewed (P=0 .001) .The present FIB reference(P2 .5 ~ P97 .5 ) investigated was 4 .15(2 .81 -5 .40 g/L) .Compared to the previous FIB reference ,after using present FIB reference interval the abnormal rate was reduced from 61 .36% (991/1 615) to 5 .02% (81/1 615) .Through the consistency test ,we figured out that Kappa=0 .015(<0 .40) ,U=2 .25 ,P<0 .05 and these two reference intervals were inconsistent in criteria jud‐ging .These results showed that two reference intervals had poor judgment standard of consistency ,the previous reference range was not suitable for normal parturient women in labor .Conclusion The previous FIB reference range was not suitable for normal partu‐rient women in labor and we should establish a new FIB reference range in order to improve the evaluation of the accuracy of the parturient women in labor individual risk .
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Objective To evaluate the methodological performance of the new enzymatic method for detecting glycated hemo-globin(HbAIc)and its influencing factors.Methods HbAIc was detected by the enzymatic method.The precision,anti-interfer-ence,recovery rate,accuracy and the influence of pre-processing(anti-coagulation,preservation,centrifugation)on the detection re-sults were evaluated,its correlation with HPLC and the bias degree were analyzed.Results The within-run coefficients of variation (CVs)for high,middle and low value QC samples in the enzymatic assay were 1.04%,1.26% and 1.37% respectively and the be-tween-run CVs were 1.83%,2.24% and 2.64%,respectively;the enzymatic method showed the linear correlation with HPLC(r=0.996,P 0.05);the sample was centrifuged at 500,1 000 r/min(R=15 cm)for different time(1,2,5,10 min)and at 2 000 r/min for 1 min,their detection results had statistical differences compared with the sample centrifuged=3 000 r/min for 5 min (P <0.05).Conclusion The precision,anti-interference,accuracy and linearity range of the enzymatic method all conform to the clinical requirement.Compared with the conventional method,its correlation is good with small deviation,which can entirely satisfy the demand of the HbAIc detection in clinic.
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OBJECTIVE: To investigate the effect of Losartan and Amlodipine on serum and urine transforming growth factor -β_1 in patients undergoing kidney transplantation. METHODS: A total of 40 patients with mild or moderate hypertension (systolic pressure 140-170 mm Hg, and diastolic pressure 85-100 mm Hg, 1 mm Hg=0.133 kPa) following primary kidney transplantation were selected from First People's Hospital of Foshan, including 23 males and 17 females aged (38.6±19.2) years. They were randomly divided into two groups (n=20): Losartan group (oral administration 50 mg per day) and Amlodipine group (oral administration 5 mg per day). The blood pressure of patients should be controlled below 130/80 mm Hg. The blood pressure, renal function, 24 h-proteinuria, serum and urine transforming growth factor-β_1 6 months after medication were observed. RESULTS: A total of 40 patients were included in the final analysis. The systolic pressure and diastolic pressure of patients were decreased after administration (P < 0.05) and decreased to normal levels 6 months after administration (P < 0.01). During treatment, there were significant differences in blood pressure decrease and mean arterial pressure between two groups (P > 0.05). No difference was found in total efficacy between two groups (P > 0.05). In addition, blood urea nitrogen, creatinine, and blood uric acid did not significantly alter after treatment in two groups (P > 0.05). After 6 months of treatment, 24 h-proteinuria, serum and urine transforming growth factor -β_1 in Losartan group were significantly decreased compared with before treatment (P < 0.05), while no obvious changes were found in Amlodipine group (P > 0.05). The 24 h-proteinuria, serum and urine transforming growth factor-β_1 in Iosartan group were significantly less than Amlodipine group (P < 0.05).CONCLUSION: Both Losartan and Amlodipine effectively controlled hypertension of patients following kidney transplantation, but Losartan significantly decreased 24 h-proteinuria, serum and urine transforming growth factor-β_1 compared with Amlodipine.
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OBJECTIVE: To study the effect of continuous renal replacement therapy on acute renal failure and multiple organ dysfunction syndrome following simultaneous pancreas-kidney transplantation. METHODS: A patient was complicated with acute renal failure, severe acute pancreatitis, lung infection, bleeding in anastomosisbetween duodenum and jejunum, and peritonitis following simultaneous pancreas-kidney transplantation. He was treated with immunosuppressor, antibiotics, amylopsin inhibitor, haemostatic and alimentation; at the same time, he was treated with continuous renal replacement therapy for 22 days. The Baxter system was used for continuous venovenous hemofiltration. RESULTS: The vital signs and hemodynamic indicators were stable during continuous renal replacement therapy. Pulmonary edema was well controlled, and acid-base equilibrium of water electrolyte was maintained. The function of vital organs was stableand graft function was normal following continuous renal replacement therapy for 22 days. He was completely cured and out of hospital on day 40. CONCLUSION: Continuous renal replacement therapy plays an important role in treating acute renal failure and multiple organ dysfunction syndrome following simultaneous pancreas-kidney transplantation. Thus, it is a well kidney support for ultaneous pancreas-kidney transplantation.
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This paper retrospectively analyzed the clinical manifestation,diagnostic method,as well as the clinical treatment of 8 cases,who suffered complicated tuberculosis infection following renal transplantation.Of the 8 cases,2 cases showed blood Tb-Ab positive,1 case was positive to antiacid bacillus of sputum,the rest cases with negative TBAb.3 patients with 2 showed organs infection,6 patients passed the tissue biopsy diagnose,body temperature of 6 cases fall to normal after 3-7 days of antituberculotic treatment,mild liver dysfunction appeared in 2 patients,hyperuricemia occurred in 7 patients,in addition,1 patient developed reject reaction.Among all the cases,7 cases healed,1 died of pulmonary fungal infection.The result showed that minimal invasive tissue biopsy offers reliable basis for early diagnosis and treatment of disease.
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(0.05)).Conclusions Losartan can only effectively hypertension following renal transplantation,but also obviously lessen slight hyperuricemia.