Influence of the interruption of arteria iliaca interna distal end on penile vascularity and erectile function in male renal transplant recipients / 中华男科学杂志

<p><b>OBJECTIVE</b>It is controversial whether unilateral interruption of the arteria iliaca interna distal end affects penile hemodynamics and erectile function. The purpose of this study was to prospectively evaluate this influence by detecting the blood flow of the penile artery before and after renal transplantation.</p><p><b>METHODS</b>Thirty-three patients with chronic renal failure (CRF) on maintenance hemodialysis (MHD) received renal transplantation, the grafts revascularized by end-to-end anastomosis to the right internal iliac artery. Six months before and after the surgery, we obtained the IIEF scores of the patients, recorded their penile blood flow on color Doppler ultrasonography and the levels of serum creatinine, hemoglobin and serum cholesterol, and analyzed post-transplantation immunosuppressive medication.</p><p><b>RESULTS</b>The patients ranged in age from 21 to 55 years, of whom 36% had erectile dysfunction (ED) during MHD, and 33% after renal transplantation. A total of 67% of the renal transplant recipients (RTR) complained of unchanged and 15% deteriorated ED, while 18% admitted improved erectile function. The patients showed a significantly stronger sexual desire after the transplantation than before it (6.2 +/- 1.6 vs 8.9 +/- 0.9, P < 0.01). There was a significant decrease in peak systolic velocity (PSV) in the cavernous arteries after transplantation as compared with pre-transplantation (P < 0.01). Penile arterial blood flow insufficiency was found in none of the RTRs.</p><p><b>CONCLUSION</b>Unilateral interruption of the internal iliac artery decreases penile arterial blood flow, but not to such a degree as to result in ED. Unilateral interruption of the arteria iliaca interna distal end does not affect the erectile function of RTRs.</p>

Clinical study of application of sirolimus with dose-reduced or discontinued cyclosporine A for prevention of acute rejection after kidney transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical efficacy, safety and feasibility of sirolimus (SRL) for preventing acute rejection of kidney transplantation.</p><p><b>METHODS</b>Thirty patients with end-stage kidney dysfunction received kidney transplants from June 2004 to December 2004. There were 21 male and 9 female aged from 22 to 67 years old, with a mean of (46.3 +/- 10.0) years old. SRL was used in primary immunosuppression therapy to prevent acute rejection after surgery, and all of them were treated in combination with dose-reduced cyclosporine A (CsA) and steroid. CsA reduction began 3 months after the surgery, the weekly dose of CsA about 10 to 25 percent reduction until completely discontinued. During a 4-year follow-up period, the adverse events, acute rejection and infection were observed and recorded in detail. The graft function and other laboratory indicators were checked and analyzed.</p><p><b>RESULTS</b>Of the 30 patients, 4 recipients died, patients survival rate was 86.7%. In other 26 cases, 25 recipients had good graft function, the average blood creatinine was (103.8 +/- 4.6) micromol/L at the end of 4(th) year and the incidence of acute rejection was 6.7% (2/30). The side effects included hyperlipidemia, proteinuria, delayed healing incision, lactate dehydrogenase increased and joint pain.</p><p><b>CONCLUSION</b>The combination of sirolimus with dose-reduced CsA till completely discontinued and steroid to prevent acute rejection of kidney transplantation is safe and efficient.</p>

Appropriate use of immunosuppressants after renal transplantation / 中国医学科学院学报

Kidney transplantation has become an important method in treating advanced renal failure. Immunosuppressants play a key tool in this progress. It is important to understand the goal, mechanism, and adverse effects of immunosuppressive therapy, so as to appropriately use these drugs in post-transplantation patients on a customized basis.

Prevention and treatment of hypertension after renal transplantation / 中国医学科学院学报

Hypertension is a common complication after renal transplantation. Among post-transplantation patients died of cardiovascular diseases, about 41% have hypertension. Hypertension is an independent risk factor for kidney transplant failure. Post-transplantation hypertension can be caused by many factors, including the use of immunosuppressants. When the blood pressure exceeds 130/90 mmHg in a kidney transplant recipient, it is reasonable to provide active medical intervention. In summary, prevention and treatment of hypertension is important to prolong the survival of kidney transplant recipients.

Prevalence and influential factors of erectile dysfunction in male renal transplant recipients: a multiple center survey / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Renal transplants can improve the quality of life for recipients, but the quality of their sexual life might not be improved. This study was conducted to research the prevalence of erectile dysfunction (ED) and the influential factors in male renal transplant recipients (RTRs).</p><p><b>METHODS</b>A cross-sectional survey was conducted in three renal transplantation centers. Structured questionnaires were administrated by trained interviewers to 824 male renal transplant patients, who had active sexual lives in the last 6 months.</p><p><b>RESULTS</b>Complaints of ED were reported by 75.5% of the 809 RTRs (age range 19 - 75 years, mean age (45 +/- 10) years), whose questionnaires were completed. Mild, moderate and severe ED were reported at 53.6%, 8.3% and 13.6%, respectively. The mean age and the graft duration were significantly higher in male RTRs with ED compared to potent graft recipients (P = 0.00 and 0.04, respectively). The prevalence of ED increased with the increase in age. It was 60.7%, 65.8%, 75.2%, 87.5% and 92.2% in patients with age below 30 years, 31 - 40 years, 41 - 50 years, 51 - 60 years and over 60 years, respectively (P = 0.000). Moreover, the severity of ED increased with aging. The percentage of moderate and severe cases of ED increased from 6.7% in patients below 40 years to 28.9% in those over 40 years (P = 0.000). The prevalence of ED in the RTR who had no occupation was higher than in those who were holding a position (P = 0.001). The prevalence of ED decreased with the increase in the education level. The prevalence of ED was 94.3%, 86.4%, 74.0% and 67.8% in men with elementary school or lower, middle school, high school, and college or higher degrees, respectively (P = 0.000). Patients, whose distal end of arteria iliaca interna was interrupted and underwent iterative transplantation, worried transplanted kidney function was impacted by sexual life, and received cyclosporine (CsA)-based immunosuppressive regimens, were more likely to have ED (P = 0.000, 0.001, 0.000, 0.000, respectively). After Logistic regression analysis, only five factors, age, education level, interruption of arteria iliaca interna distal end, worrying transplanted kidney function impacted by sexual life and CsA-based immunosuppressive regimens sustained their significance.</p><p><b>CONCLUSIONS</b>Renal transplant has varying effects on erectile function. ED is highly prevalent among RTRs and its influential factors are multiple. Age, education level, interruption of arteria iliaca interna distal end, worrying transplanted kidney function impacted by sexual life, CsA-based immunosuppressive regimens are the main influential factors of ED in male RTRs.</p>

Prevention and treatment of HBV recurrence with lamivudine in HBsAg positive renal allograft recipients / 中华器官移植杂志

Objective To analyze the effect of prevention and treatment with lamivudine in HBsAg positive renal allograft recipients with HBV recurrence.Methods In 28 patients with chronic renal failure whose HBsAg was positive,8 cases were positive for HBV-DNA positive.All these 28 cases had normal liver function without hepatic cirrhosis before renal transplantation.All donors were negative for HBsAg.Twenty patients received lamivudine prophylactic treatment:14 cases positive for HBsAg but negative for HBV-DNA before transplantation received lamivudine treatment immedia- tely after transplantation and 6 cases positive for both HBsAg and HBV-DNA received lamidudine treatment before transplantation.Eight patients were treated with lamivudine when their hepatic dys- function with recurrent HBV antigenemia were developed after transplantation.Lamivudine was orally taken and its initial dosage was 100 rag/day.Results The follow-up period of the 28 patients were 13- 54 months with the average of 23.6 months,and 2 died during this period.Mild hepatic dysfunction with recurrent HBV antigenemia developed in 3 of 20 hepatitis antigenemia patients received lamivu- dine prophylactic treatment with a mean duration of 9.3 months after transplantation.The highest average level of serum ALT was 87.5 U/L.The liver function returned to the normal with HBV-DNA negative after lamivudine treatment in 3 patients.The other 17 patients maintained normal liver func- tion with HBV-DNA negative during the follow-up period.Hepatic dysfunction with recurrent HBV antigenemia(or HBV-DNA titer increased significantly)developed with a mean duration of 4.6 months in all 8 patients without receiving lamivudine prophylactic treatment.The highest average level of serum ALT was 174.5 U/L.The liver function returned to the normal with HBV-DNA negative after larnivudine treatment in the 8 cases.HBV-DNA,however,reappeared in 5 eases without any dis- continuation of lamivudine.The creatinine level remained normal without any severe drug side effects in 28 patients during lamivudine treatment.Conclusion Lamivudine treatment before hepatic dysfunc- tion might be a safe and effective strategy for prevention of recurrence of hepatitis B viremia in HBsAg positive renal allograft recipients.