A retrospective comparison of the efficacy and safety in kidney transplant recipients with basiliximab and anti-thymocyte globulin / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Induction therapy are utilized to achieve an adequate immunosuppression at the time of transplantation. The use of basiliximab or anti-thymocyte globulin (ATG) for induction therapy has significantly reduced the incidence of acute rejection episodes post-transplantation. The purpose of this study was to compare the efficacy and safety of the basiliximab in patients with immuno-induction therapy after kidney transplantation with the ATG.</p><p><b>METHODS</b>A retrospective analysis was carried out in kidney transplant recipients including 146 patients with the basiliximab and 116 cases with the ATG and the acute rejection, graft function, infective complications and 1-year and 5-year actuarial patient and graft survival after renal transplantation were compared between the two treatment groups.</p><p><b>RESULTS</b>There were no statistically significant difference between groups regarding age, sex, cold ischemic time, warm ischemic time, human leukocyte antigen (HLA) matching type between the donor and recipient, lymphotoxin test and the use of immunosuppressive agents. There was no statistical significance regarding the incidence of the acute rejection (9.59% vs. 8.62%, P = 0.481) and delayed graft function (10.27% vs. 9.48%, P = 0.501) between groups. There were significantly lower lung infection incidence (5.48% vs. 12.93%, P = 0.029) in the basiliximab-treated group in comparison with the ATG-treated group. One-year patient and graft survival rates were 98%, 97% for the basiliximab-treated group, and 95%, 73% for the ATG-treated group, respectively. Five-year patient and graft survival rates were 92%, 86% for the basiliximab-treated group and 93%, 72% for the ATG-treated group, respectively. Log rank test showed statistically significant difference with P = 0.038 for patients and P = 0.033 for grafts, respectively. There were significantly lower the incidence of granulocytopenia (8.22% vs. 17.24%, P = 0.022) and thrombocytopenia (4.11% vs. 19.83%, P = 0.000) after transplantation in the basiliximab-treated group in comparison with the ATG-treated group. There was no statistical significance regarding the incidence of the heart dysfunction after transplantation between the two groups (6.16% vs. 6.90%, P = 0.502).</p><p><b>CONCLUSION</b>The immuno-induction therapy with the basiliximab in kidney transplant recipients is efficient and safe with less complication compared with the ATG.</p>

Forkhead box protein 3 mRNA expression in the peripheral blood of kidney-transplant recipients with acute rejection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Regulatory T cells (Tregs) are immunologically and clinically interesting not least because of the important role they play in allograft rejection. Likewise, expression of the transcription factor forkhead box protein 3 (FOXP3), detected in transplant biopsies, is also of interest because of its role in the development of regulatory T cells. In this study, we investigated the relationship between FoxP3 mRNA expression and acute organ rejection in kidney-transplant recipients.</p><p><b>METHODS</b>In this prospective study, FoxP3 mRNA expression levels in peripheral blood samples from 10 recipients of living relative-donor kidney transplants were measured before transplantation as well as at the 14th and 90th days post-transplantation. In addition, 46 first-time kidney-transplant recipients participated in a cross-sectional study, with 28 patients classified as having acute organ rejection; whilst the remaining 18 patients had functionally stable allografts. FoxP3 mRNA expression levels in peripheral blood samples were compared between these two different groups.</p><p><b>RESULTS</b>Before transplantation mean FoxP3 mRNA levels vs. GADPH mRNA levels (lg(FoxP3 mRNA/GADPH mRNA)) in the 10 recipients were 1.11 ± 0.67. The mean FoxP3 mRNA expression levels measured at 14th and 90th days post-transplantation were significantly higher than before transplantation (1.69 ± 0.38, P = 0.03; 1.44 ± 0.21, P = 0.04, respectively). Additionally, the mean FoxP3 mRNA levels vs. GADPH mRNA expression levels (lg(FoxP3 mRNA/GADPH mRNA)) were significantly higher in recipients suffering acute rejection compared with those with stable allografts (1.77 ± 0.61 and 1.43 ± 0.27, respectively, P = 0.03).</p><p><b>CONCLUSIONS</b>After kidney transplantation, FoxP3 mRNA levels were found to increase in the peripheral blood of all recipients. Considerably higher FoxP3 mRNA levels were observed in recipients suffering acute rejection. These results suggest that FoxP3 mRNA levels in peripheral blood samples can be used as a diagnostic tool for identifying acute rejection.</p>

Monitoring immune function after rapid corticosteroid reduction in kidney transplant recipients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Long-term use of steroid with large dosage might cause many adverse effects in kidney transplant patients; reducing steroid dosage to a low level for maintenance is helpful in avoiding the side-effects, but meanwhile, acute rejection may rise to be a main concern. The present research monitored the immune function changes and the incidence of acute rejection and infection after rapid steroid reduction to investigate the safety of this strategy.</p><p><b>METHODS</b>A prospective trial was conducted, using tacrolimus and mycophenolate mofetil as the basic immunosuppressive regimen, in addition to antibody induction with basiliximab. Corticosteroid dosage was rapidly reduced to 10 mg/d seven days post-transplantation in the experimental group, and the standard corticosteroid therapy was employed in the control group. Patient immunity was monitored by the Immune Cell Function Assay pre- and two weeks post-transplantation. The incidence of acute rejection and infection were compared between the experimental and control group.</p><p><b>RESULTS</b>Comparison of intracellular adenosine triphosphate (iATP) values detected two weeks post-transplantation for the control group ((324 ± 45) ng/ml) and the experimental group ((345 ± 91) ng/ml) did not reveal a significant difference (P > 0.05). The incidence of acute rejection was analogous between groups (P > 0.05), while an increased incidence of infection was observed in the control group (53% (n = 16)) versus the experimental group (22% (n = 6), P < 0.05). Overall, recipients in the control group had longer and more recurrent infections than those in the experimental group (P < 0.05). Patients in the control group had a lower immune response ((235 ± 35) ng/ml) than those in the experimental group ((286 ± 16) ng/ml) when infection occurred (P < 0.05).</p><p><b>CONCLUSION</b>Rapid reduction of steroid early after kidney transplantation does not lead to a significant rise in patient immunity. It is a safe and effective therapy for kidney transplant patients.</p>

Factors affecting the long-term renal allograft survival / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In the past decades, the one-year graft survival of cadaveric renal allografts has been markedly improved, but their long-term survival has not kept pace. The attrition rate of renal allografts surviving after one year remains almost unchanged. The causes for late graft loss are multiple. The aim of this study was to analyze the predictive factors that impact long-term survival of grafts after kidney transplantation.</p><p><b>METHODS</b>We retrospectively analyzed 524 kidney transplantation patients who were treated in our hospital between January 1991 and January 2000, including 254 patients who had lived more than 10 years with normal graft function (long survival group), and 270 cases whose renal graft had survived less than 10 years (control group). Specifically, we analyzed 10 factors that may potentially affect graft survival by both univariate and Logistic model multivariate analyses to pinpoint the independent risk factors.</p><p><b>RESULTS</b>Univariate analyses showed that no significant differences existed in the age or gender of recipients, dialysis time, lymphotoxin levels, or cold ischemia time between the two groups. However, the ratio of delayed graft function and acute rejection, and the uric acid levels of patients in the long survival group were significantly lower than those in the control group (P < 0.01). Furthermore, we found that the concentration of cyclosporin A at one year after transplantation and the histocompatibility antigen match of donor-recipients for patients within the long survival group were significantly higher than those in the control group (P < 0.01). Furthermore, multivariate analyses showed that these four factors were independent risk factors that impact patient survival.</p><p><b>CONCLUSIONS</b>The ratios of delayed graft function and acute rejection, the concentration of cyclosporin A at one year after transplantation, and serum uric acid levels are very important factors that affect the long-term survival of renal grafts.</p>

Hurthle cell thyroid tumor: an analysis of 28 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the clinical features and the combined treatment modality of Hurthle cell thyroid tumor (HCT).</p><p><b>METHODS</b>Twenty-eight cases of HCT treated between 2001 and 2009 were analyzed retrospectively.</p><p><b>RESULTS</b>The age of the patients ranged from 18 to 72 years (with a median of 46.5 years); 22 females and 6 males. The main symptoms were thyroid solitary node or mass (22 cases) and multiple nodule (6 cases), 2 cases with cervical lymph node metastasis. All of the patients underwent surgery, 11 cases with thyroid lobectomy, 11 cases with thyroid lobectomy plus isthmusectomy, 4 cases with subtotal thyroidectomy, and 2 cases with thyroid lobectomy plus isthmusectomy and combined with modified radical cervical lymph node dissection. Postoperative pathological examination showed that 22 cases were Hurthle cell adenomas and 6 cases were Hurthle cell carcinomas, 1 of them with cervical lymph node metastasis. Twenty-one patients with Hurthle cell adenomas were followed up for 6 months to 7.5 years (with a median of 45 months) and 6 patients with Hurthle cell carcinomas for 3 to 8 years (with a median of 54 months), with no recurrence and death case.</p><p><b>CONCLUSIONS</b>HCT is a potential malignant neoplasm. There are some difficulties in the diagnosis of HCT by frozen section. Surgery is an effective treatment for HCT. L-Thyroxine can be used to inhibit TSH excretion.</p>

Rapamycin instead of mycophenolate mofetil or azathioprine in treatment of post-renal transplantation urothelial carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Malignant tumor is the most common complication occurred in transplant recipients. It is widely recognized that immunosuppressive treatments increase the risk of cancer in transplant recipients. The efficacy and safety of rapamycin (RPM) in combination with low-dose calcineurin inhibitor (CNI) in treating 15 renal allograft recipients which developed urothelial carcinoma were observed.</p><p><b>METHODS</b>Immunosuppressive regimen in all recipients was altered with rapamycin to replace mycophenolate mofetil (MMF) or azathioprine (Aza). The initial loading dosage was 2 mg/d, and the next dosage was 1 mg/d. The dosage of rapamycin was carefully adjusted according to the blood drug level and concentration of the drug was maintained at 4 - 6 microg/L. In all the 15 patients, the calcineurin inhibitor was reduced down to one third of the original dosage after the rapamycin blood concentration became stable. Surgical treatment and intravesical instillation chemotherapy were carried out in all patients. Recurrence of the tumor was monitored throughout the study. Post-transplant renal function and side effects were also closely monitored.</p><p><b>RESULTS</b>Among the 15 patients, 9 had no tumor recurrence in 2 years, 2 had tumor recurrences twice, and 4 had once. There was no acute rejection observed during RPM treatment. Post-transplant renal function in 11 patients was improved, with a decreased creatinine level. Hyperlipoidemia and thrombocytopenia were the most frequent adverse events which responded well to corresponding treatments.</p><p><b>CONCLUSION</b>Among the renal allograft recipients with urothelial carcinoma, combination of rapamycin and low dose calcineurin inhibitor treatment is effective and safe.</p>

Experimental study on effect of Bailing Cpsule on dendritic cells in mice / 中国中西医结合杂志

<p><b>OBJECTIVE</b>Comparing with the classic immuno-supressors, to probe in the in vitro effect of Cordyceps Sinensis (CS) on the differentiation, maturation and function of dentritic cells (DCs), and further to explore its mechanism.</p><p><b>METHODS</b>Mice myeloid DCs were cultured respectively with extraction of Bailing Capsule (CSE), a Chinese medical preparation made of CS, Rapamycin and Tacrolimus, and the effect of various drugs on phenotype of DCs was analyzed with flow cytometer. Then, using as the stimulator, the DCs cultured with different drugs were mixed and cultured with heterogenous lymphocytes for observing the stimulating capacity of DCs on cell proliferation.</p><p><b>RESULTS</b>CSE showed no in vitro effect on phenotype markers and co-stimulation molecules of DCs, the difference between CSE and Tacrolimus was insignificant, while Rapamycin could reduce the two parameters. CSE showed a marked suppressive effect on DCs in stimulating leucocyte proliferation in a dose-dependent manner.</p><p><b>CONCLUSION</b>CSE could affect the stimulating capacity of DCs on cell proliferation, which is probably by means of inhibiting the function of antigen presentating cells to block the presentation of extrinsic signal, and make the low immune response condition, thus to obtain the effect of immunosuppression.</p>

Analysis of gene expression of fatty acid synthase in squamous cell carcinoma of the oral cavity by the method of real-time quantitative PCR / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To relatively quantify the gene expression of fatty acid synthase in squamous cell carcinoma, adjacent tissue, and some normal oral tissues by real-time quantitative PCR.</p><p><b>METHODS</b>The tissues were collected fresh from surgical specimens. The collected tissues were minced. Then the total RNA was extracted. The RNA was reversely transcripted into cDNA with random prime. And then the cDNA was amplified by real-time quantitative PCR to quantify the gene expression of FAS according to an internal control GAPDH. The difference of FAS gene expression was compared between squamous cell carcinoma, adjacent tissue, and some normal oral tissues.</p><p><b>RESULTS</b>The expression of FAS of squamous cell carcinoma was notably higher than the other two (P < 0.001).</p><p><b>CONCLUSION</b>Real-time quantitative PCR provides a method for monitoring the expression of fatty acid synthetic activity in squamous cell carcinoma, adjacent and normal tissues.</p>