ABSTRACT
Objective:To explore the clinical features, etiologies and outcomes of unknown origin fever after simultaneous pancreas-kidney transplantation(SPK).Methods:From March 2015 to January 2020, clinical data were retrospectively reviewed for 120 SPK recipients.According to the definite evidence of fever, such as microbial culture, imaging findings or rejection, they were divided into three groups of free-fever(FF, n=41)and defined-fever(DF, n=47)and fever of unknown origin(FUO, n=32). The differences in general clinical features, surgical complications, laboratory tests and prognoses were compared.Logistic regression was employed for analyzing the risk factors of FUO and Kapla-Meier for survival analysis.And P<0.05 was deemed as statistically significant. Results:Multivariate analysis revealed that preoperative diabetic gastroenteropathy was an independent risk factor for unexplained fever.Significant differences existed between FUO and DF groups in leucocyte count[6.50(5.13, 7.36)vs.10.36(6.11, 12.97)×10 9/L], C-reactive protein(CRP)[11.75(6.25, 16.85)vs.35.00(16.30, 75.00)μg/ml], procalcitonin[0.13(0.06, 0.18)vs.0.19(0.11, 1.05)ng/ml]( P<0.001, P<0.001, P=0.025). As compared with DF group, 19 recipients in FUO group only received 1-2 antibiotics and there was a shorter course of treatment[13(40.6%)vs.32(68.1%), P=0.016]. For 6(18.7%)recipients after a diagnosis of FUO, clinical outcome was achieved with only NSAIDs.Length of stay was(48.72±19.51)days in FUO group versus(57.36±27.46)days in DF group and the difference was statistically significant( P<0.001). Hospitalization expenses of two groups were 253 463.25 and 334 605.96 yuan respectively and the difference was also statistically significant( P=0.002). Conclusions:Diabetic gastroenteropathy is an independent risk factor for early FUO after SPK transplantation.Inflammatory markers of leukocytes, CRP and procalcitonin in FUO patients are significantly lower than DF group.And these clinical features can help diagnose FUO in an early stage.
ABSTRACT
Objective:To explore the risk factors of paralytic ileus (PI) after simultaneous pancreas-kidney (SPK) transplantation.Methods:From January 2017 to December 2019, clinical data were reviewed retrospectively for 115 cases of SPK transplantation. The risk factors of PI after SPK were analyzed. According to the occurrence of PI, they were divided into two groups of occurrence and non-occurrence. One-way analysis of variance was utilized for analyzing such influencing factors as gender, age, body mass index (BMI), diabetic type, duration of diabetes, mode of dialysis, duration of dialysis, diabetic gastroenterology, history of open surgery, bowel preparation, operative duration, hemorrhagic volume, immunosuppressant and hypoproteinemia. Multivariate Logistic regression analysis was performed for screening the suspected risk factors.Results:Among them, 19 patients (16.5%) had PI. Univariate analysis showed that PI was associated with diabetic gastroenterology, operative duration, history of open surgery, no bowel preparation and hypoproteinemia ( P<0.05). Multivariate Logistic regression analysis revealed that the risk factors of PI after SPK included diabetic gastroenterology, operative duration time, history of open surgery and no bowel preparation ( P<0.05). Conclusions:Diabetic gastroenterology, operative duration, history of open surgery and no bowel preparation are risk factors for PI after SPK. Clinical interventions for the above factors are necessary.
ABSTRACT
Objective:To explore the efficacy and safety of simultaneous pancreas-kidney (SPK) transplantation in patients aged over 60 years.Methods:A retrospective analysis was performed for 150 SPK patients from January 1, 2013 to June 30, 2019. Based upon age, they were divided into three groups of ≥60 years ( n=21), 50-60 years ( n=44) and <50 years ( n=85). Clinical data of three groups were compared, including postoperative rejection, perioperative graft thrombosis, reoperative frequency, average hospitalization time and readmission ratio. And cardiocerebrovascular complications before/after-SPK, CMV viremia within 1 year post-SPK, fasting blood glucose, fasting C-peptide, fasting insulin level, HbA1c at 1 year post-SPK, glomerular filtration rate (eGFR) at 1 year post-SPK and survival rate of patient/graft were compared. Results:There were 21 cases in ≥60 years group, accounting for 14% of the total number of cases and the maximal age was 67 years. The proportion of preoperative cardiovascular events was 14.3%(3/21) in ≥60 years group, 34.1%(15/44) in 50-60 years group and 7.1%(6/85) in <50 years group. Statistical difference existed among three groups ( P=0.001). A pairwise comparison indicated that preoperative cardiovascular event in 50-60 years group was higher than that in <50-years group ( P=0.0006). The postoperative cardiovascular events in three groups were 4.8%, 4.5% and 2.4% respectively and there was no statistical difference ( P=0.537). The incidence of graft thrombosis in three groups was 2 cases (9.5%) in ≥60 years group, 1 case (2.3%) in 50-60 years group and 7 cases (8.2%) in <50 years group ( P=0.384). The proportion of reoperation in three groups was 14.3%, 18.3% and 18.8% respectively and there was no statistical difference ( P=0.889). The causes of death were cerebral hemorrhage ( n=2), myocardial infarction ( n=2) and tumor ( n=1); ≥ 60 years group ( n=1), 50-60 years group ( n=1) and <50 years group ( n=3). No significant difference existed among three groups ( P=0.842). There was no significant difference in average postoperative hospitalization time, readmission rate, postoperative rejection, postoperative 1-year CMV viremia, postoperative cerebrovascular events, postoperative 1-year fasting blood glucose, fasting C-peptide, fasting insulin level, HbA1c, postoperative 1-year eGFR or patient/graft survival rate among three groups. Conclusions:Through strict preoperative evaluations, SPK for patients aged over 60 years increases no operative risk and achieves the same outcome.
ABSTRACT
To summarize the clinical experience regarding a patient with early recurrence of atypical hemolytic uremic syndrome (aHUS) after renal transplantation. AHUS is a rare disease with high recurrence rate and poor prognosis. Although the patient was treated with plasma exchange, intravenous gamma globulin, rituximab block B lymphocyte, hormone shock and so on, he still suffered renal transplantation failure. The risk of aHUS recurrence after renal transplantation should be fully evaluated.
ABSTRACT
Objective To explore the surgical indications for pancreas-kidney surgery and summarize the experiences of ,selecting surgical approaches ,formulating immunosuppressive regimens and preventing complications .Methods A total of 145 donor simultaneous pancreas-kidney transplants in uremic patients with T1DM/T2DM between 2002 and 2018 were retrospectively analyzed .Based upon surgical approaches and immunosuppressive agents ,they were divided into three eras of 2002-2010 ,2011-2014 and 2015-2018 respectively .Patient profiles ,survival outcomes of patient and graft , surgical techniques ,immunosuppressive agents and incidence of common complications were compared among different groups .Results The overall 1/3/5-year patient and graft survival rates of three groups were above 75％ and the survival rates of group Ⅰ were inferior to those of groups Ⅱ and Ⅲ(P<0 .001) .The overall 1/3/5-year pancreas graft survival rates were the highest in group Ⅲ and the lowest in group Ⅱ (P=0 .004) .In the 2015-2018 group ,ipsilateral pancreas-kidney transplantation and SE-ED surgery were more preferred .Regarding the incidence of complications ,graft thrombosis frequently occurred from 2011 to 2014 and intestinal obstruction was more common from 2002 to 2010 .For univariable analysis of graft loss ,anticoagulation programme with argatroban monohydrate were 0 .28 times likely to lose pancreas graft (OR= 0 .28 ,95％ CI:0 .09-0 .86) and T1DM patients were 4 times likely to have kidney graft loss (OR=4 .08 ,95％ CI:1 .37-12 .15) .Conclusions SPK is an effective treatment for uremic diabetics . Effective perioperative management and preventing complications are crucial for prolonging patient and graft survivals .
ABSTRACT
Objective To explore the relationship of quality of life with optimisms and sense of coherence in adult kidney transplant recipients. Method A total of 295 kidney transplant recipients participated in the study by a self-designed general questionnaire, revised life orientation test (LOT-R), sense of coherence (SOC-13) and the MOS 36-item short form health survey (MOS SF-36). Results The mean score of mental health scale (PCS) was 47.02±7.30, which differed with different age, employment status and transplant vintage (P ＜0.01). The mean score of phyical health scale (MCS) was 46.87 ±11.14, which differed with education, economic burden and transplant vintage (P ＜0.05). PCS and MCS were positively correlated with the total score of sense of coherence (52.05％) and optimism (23.45％) (P＜0.001). Optimism played a partially mediating role in the relationship between sense of coherence and quality of life. Conclusions The quality of life of kidney transplant recipients needs to be improved, which was at a low level.Optimism (medium to high level) and sense of coherence (medium to low level) are influencing factors of the quality of life. Improving accessment of mental state of patients with kidney transplant receients, paying more atentent and support to their mental change can improve their optimism and sense of coheherce and then life quiality.
ABSTRACT
Kidney transplantation is the best treatment for end-stage renal disease.The types of the rejection can be divided into hyperacute rejection,accelerated rejection,acute rejection (AR) and chronic rejection according to the time of rejection after renal transplantation.Long noncoding RNAs (lncRNAs) play an important role in a variety of pathophysiological processes in the body,which can affect the stability of tissues.It is also closely related to various pathological processes such as acute kidney injury,glomerular disease and acute allograft rejection.What's more,the scholars found its huge potential for early diagnosis of AR after renal transplantation.This article will summarize the function of lncRNA in acute rejection of renal transplantation.
ABSTRACT
Purpose To discuss the value of longitudinal assessment of the remaining kidney of the donor and kidney blood oxygen level changes after receiving kidney transplantation by applying blood oxygen level-dependent (BOLD) MRI. Materials and Methods Sixty patients underwent parental kidney transplantation from Jul. 2015 to Feb. 2017 in Tianjin First Center Hospital were prospectively collected, including 30 healthy kidney transplant donors and 30 recipients corresponding to them. The donors received renal BOLD examination 3 days before and 2 weeks after unilateral nephrectomy. Recipients received renal BOLD examination 2 weeks after kidney transplantation, of which, 15 pairs of patients underwent parental kidney transplantation received renal BOLD examination again six months after surgery. The apparent transverse relaxation rate (R2*) values of the cortex and medulla at different times before and after transplantation were measured and recorded. The differences of R2* values between 30 donors' cortex and medulla in both kidneys before surgery were compared; the differences of R2* values between 30 pairs of subjects' cortex and medulla in remaining and donated kidney within 2 weeks before and after surgery were compared; variance gained through single factor repeated measurement was applied to analyze and compared the difference of R2* values between 15 pairs of follow-up subjects' cortex and medulla in remaining and donated kidney at different time points before and after surgery. Results All 60 subjects received MRI scan, and there was no statistical difference in R2* values between 30 subjects' cortex and medulla in both kidney before surgery (P>0.05). The difference between the cortex and medulla was statistically significant, with R2* value of medulla higher than that of cortex (P<0.01). R2* values of cortex and medulla of the remaining kidney in 30 subjects two weeks after receiving unilateral nephrectomy were lower than those before surgery. R2* value of cortex and medulla of donated kidney were both lowered before surgery, the difference of which was statistically significant (P<0.01). R2*values of cortex and medulla in remaining and donated kidney of 15 pairs of subjects who have received half a year's follow up were both evidently reduced two weeks after surgery, and R2* values six months after surgery were raised compared with two weeks after surgery, but were still lower than that before surgery, the difference of which were both statistically significant (P<0.05). Conclusion BOLD MRI can be used for longitudinal monitor of changes in blood oxygen levels in remaining and donated kidney after receiving parental kidney transplantation.
ABSTRACT
Objective To summarize the clinical characteristics of recipients of renal transplantation who used tacrolimus extended-release capsules,to optimize the postoperative immunosuppressive regimen,and provide reference for the therapeutic administration of imnmunosuppressive agents after renal transplantation.Methods 156 patients who had renal transplant in our center were divided into three groups according to the time of the change of the extended-release tacrolimus capsules,and the blood glucose and blood lipids of each group were analyzed.Results The longer the postoperative duration was,the higher proportion of new-onset diabetes cases (P =0.025).There was no significant difference among the three groups of immune induction regimens.The immnunosuppressive regimen was changed from MMF (68.8％ in G3 group) to MPA (72％ in G1 group).With the prolongation of postoperative time,the dosage of tacrolimus decreased gradually.The mean tacrolimus concentration in the 3 groups was significantly different (P＜0.001) as time went by.There was no significant change in the average daily dosage before and after the change.The trough value before and after the change in the first two groups was significantly different (P＜0.001).Conclusion The extended-release tacrolimus capsules could be used in different stages after renal transplantation.After the conversion of the extended-release tacrolimus capsules,the dosage of adjuvant is reduced,and blood concentration and creatinine level are more stablem which is a more optimized immunosuppressive regimen.
ABSTRACT
Objective To evaluate the correlation between anti-angiotensin type 1 receptor (AT1R) antibody and the prognosis of HLA-positive sensitized renal transplant recipients.Methods Forty-three HLA-positive sensitized recipients positive for AT1R antibodies were tested.HLA antibodies were tested by Lurninex-based single antigen beads assay.AT1R antibody was detected by ELISA.The patients were divided into two groups according to AT1R antibody level:AT1R-AA positive group (AT1R-AA ≥9 U/mL,n =12) and AT1R-AA negative group (AT1R-AA＜9 U/mL,n =31).We also analyzed the rate of rejection and allograft loss,HLA antibodies level,kidney function,kidney survival and patients' survival,etc.Results The rate of allograft loss in the AT1RAA positive group and the AT1R-AA negative group was 41.7％ (5/12) and 9.6％ (3/31)respectively (P =0.02).The rate of AMR in the AT1R-AA positive group and the AT1R-AA negative group was 25％ (3/12) and 0.0％ (0/31) respectively (P =0.03).Meanwhile,the one-yearpatients' survival in the AT1R-AA positive group was lower than in the AT1R-AA negative group (P＜0.05).There was no significant association between AT1R-AA (mean AT1R-AA =8.7 U/mL)and MFI (mean MFI =9119).AT1R antibody was one of risk factors to acute antibody-mediated rejection and kidney allograft loss for sensitized recipients.Conclusion The rate of allograft loss in the AT1R-AA positive group and the AT1R-AA negative group was 41.7％ (5/12) and 9.6％ (3/31)respectively (P =0.02).The rate of AMR in the AT1R-AA positive group and the AT1R-AA negative group was 25％ (3/12) and 0.0％ (0/31) respectively (P =0.03).Meanwhile,the one-yearpatients' survival in the AT1R-AA positive group was lower than in the AT1R-AA negative group (P ＜0.05).There was no significant association between AT1R-AA (mean AT1R-AA =8.7 U/mL)and MFI (mean MFI =9119).AT1R antibody was one of risk factors to acute antibody-mediated rejection and kidney allograft loss for sensitized recipients.
ABSTRACT
In recent years,rapamycin has been used as an immunosuppressive agent in clinical practice.Rapamycin has the effect of accelerating lipid metabolism in the test,but it has the adverse reaction of hyperlipidemia at the same time.In view of this double-side conclusion,this article mainly analyzes the following aspects:direct inhibition of mTOR pathway,reduce expression of peroxisome proliferator-activated receptor γ,inhibition of leptin secretion,down-regulation of cholesterol-regulating element binding protein and excitation cell autophagy.Based on current research at home and abroad,it suggested that the the effects of dose-response effects of rapamycin and the exact mechanism of interaction between PI3K/PKB/mTOR signaling pathways and other cytokines can be a further research direction,so that the relationship between rapamycin and blood lipid metabolism can be learn more about in a quantify way.
ABSTRACT
Objective To explore the correlationships between microperfusion diffusion indexes derived from intravoxel incoherent motion(IVIM)and perfusion values measured by arterial spin labeling (ASL)in renal allograft. Methods A total of 76 renal allograft recipients and 26 age-matched volunteers (group 0)were included in this prospective study. All subjects were underwent conventional MRI, IVIM and ASL MRI which were performed in the oblique-sagittal plane. Seventy-six recipients were divided into two groups based on the estimated glomerular filtration rate(eGFR):recipients with good allograft function(group 1, eGFR≥ 60 ml · min-1 · 1.73m-2,n=44)and recipients with impaired allograft function(group 2, eGFR0.05), but RBF value was significantly lower(P<0.05). The ADCslow, ADCfast, PF and RBF values of renal cortex were significantly lower in allografts with impaired function compared to allografts with good function(all P<0.01). In renal allografts, there were significant positive correlations between cortical ADCslow, ADCfast, PF, RBF value and eGFR(r values were 0.604, 0.552, 0.579 and 0.673, all P<0.01). Cortical ADCfast and PF value exhibited a significant correlation with RBF for recipients(r values were 0.501 and 0.423, all P<0.01). Conclusion Cortical ADCfast and PF values derived from IVIM and RBF measured by ASL show a significant positive correlation in renal allografts.
ABSTRACT
Objective To explore the indications of simultaneous pancreas-kidney (SPK) transplantation for type 2 diabetes mellitus (DM) combined with end-stage renal disease by comparing the outcome of patients with type 1 and type 2 DM combined with end-stage renal disease after renal transplantation.Methods 109 patients accepting SPK from January 2008 to July 2016 in our center were divided into two groups according to the types of DM:T1DM (n =36),and T2DM (n =73).The basic characteristics of recipients,outcome,and pancreas and kidney functions after operation were compared between two groups.Results There was no significant difference in 5-year survival rate and surgical complications between two groups although recipients of T2DM group were older and had higher BMI than T1DM group.But rejection rate was higher in T1DM group.Conclusion SPK for T2DM recipients will not increase the surgical risk and can get good long-term outcome.
ABSTRACT
Objectives To investigate the ability of T1 mapping and intravoxel incoherent motion imaging (IVIM) parameters for evaluating renal allografts at the early stage after renal transplantation. Methods This prospective study protocol was approved by the local ethics committee, and written informed consent was obtained from all subjects. Sixty two recipients 2 to 4 weeks after kidney transplantation and 20 healthy volunteers (control group) underwent routine MRI, T1 mapping, and IVIM imaging (11 b values, 0 to 700 s/mm2). Recipients were divided into two groups base on their estimated glomerular filtration rate (eGFR):37 recipients with good allograft function (eGFR≥60 ml·min-1·1.73 m-2) and 25 recipients with impaired allograft function (eGFR<60 ml·min-1·1.73 m-2). The ADC, true diffusion coefficient (ADCslow), pseudo-diffusion coefficient (ADCfast), perfusion fraction (f) and T1 values were measured on both cortex and medulla. Differences among groups were compared using the one-way analysis of variance. Correlations between eGFR and the parameters in renal allografts were assessed by using Pearson correlation analysis. ROC was performed to assess the diagnostic utilities of using these parameters to discriminate allografts with impaired function from good function. Results Excepting for cortical T1, ADCfast and medullary T1, f values, allografts with good function showed no differences in other parameters compared with healthy control. Excepting for medullary T1 and ADCfast,the other values showed significantly differences in allografts with impaired function compared to allografts with good function (all P<0.05). Excepting for medullary f and ADCfast values, allografts with impaired function showed significantly differences in the parameters compared with good function group(all P<0.05). In renal allografts, excepting for medullary T1, ADCfast, and f values, cortical T1 exhibited a negative correlation with renal function, and there was a significant positive correlation between eGFR and other parameters. Cortical T1 value showed high sensitivity(91.9%) to discriminate renal allografts with different function, with the threshold of 17.36 × 102 ms, and ADC value showed high specificity(96.0%)with the threshold of 1.98 × 10-3 mm2/s. Conclusion T1 mapping and IVIM technique may be useful for detecting renal allograft dysfunction, and be a reliable imaging for evaluating and monitoring allograft function.
ABSTRACT
Objective To investigate the relationship between HLA antibodies strength and complement-binding ability in sensitized renal patients waiting for renal transplantation.Method Serum samples of 31 sensitized renal patients waiting for renal transplantation were retrospectively analyzed by single-antigen bead array (SAB) to identify HLA antibodies and in parallel by C1q-SAB to determine the complement binding of HLA antibodies.Result C1q-positive HLA antibodies had significantly higher MFI than C1q-negative HLA antibody (for Class Ⅰ,11052 ± 3291 vs.4506 ± 2960,P＜0.05;for Class Ⅱ,13347 ± 4076 vs.4448 ± 3602,P＜0.05).The mean fluorescence intensities (MFI) of IgG-SAB were correlated with the MFI of C1q-SAB for the same antibodies (Spearman correlation; Class Ⅰ,r =0.665,P ＜ 0.01 ; Class Ⅱ,r =0.761,P ＜ 0.01).Receiver operating characteristics (ROC) curve analysis showed that the MFIs of HLA antibodies by IgG-SAB could predict their C1q-binding abilities [area under the curve (AUC)Class Ⅰ =0.917; AUCclass Ⅱ =0.927).Using MFI cut-off value of 8238 and 6754 for HLA Class Ⅰ and Class Ⅱ antibodies,respectively,the sensitivity and specificity for C1q binding were 82.4％ and 87.4％ for Class Ⅰ antibodies,and 90.9％ and 82％ for Class Ⅱ antibodies,respectively.Conclusion The MFI of HLA antibodies by IgG-SAB can predict the C1q binding capability at a certain extent before transplantation.
ABSTRACT
With the development of immunosuppression and diagnosis method,cell mediated rcjection can be controlled well after transplantation.Antibody mediated rejection has become a hot problem due to sensitized recipients increasing.Complements play an important role during antibody mediated rejection.This review focuses on the development of mechanism of complements mediated antibody mediated rejection,the role of complements in diagnosis of antibody mediated rejection and treatment protocol aim at compliments.
ABSTRACT
Objective To investigate the merit and demerit for surgical excision of polycystic kidney at the same time of kidney transplantation and to analyze its effect on complications and prognosis.Methods The data of 63 cases of polycystic kidney were retrospectively analyzed.Among the 63 recipients,43 recipients were combined with polycystic liver,and 2 with pancreatic cyst.For the large size of polycystic kidney,in 31 patients with hematuria or urinary tract infection,the polycystic kidney was resected during kidney transplantation(kidney-cut group,31 cases).The polycystic kidneys in The remaining 32 cases were preserved during kidney transplantation (reservation group).All the recipients were treated with CsA(Tacrolimus),mycophenolate mofetil (MMF)and prednisone after transplantation.The general conditions of recipients,the occurrence of delayed graft function(DGF),acute graft rejection.operative complications and infection,and survival rate of recipients and grafts were observed.Results Operative time in kidney-cut group was (300±31)min,and perirenal drainage tube duration was(4.6±1.4)days in kidney-cut group,significantly longer than in reservation group(both P＜0.01).Volume of red blood cells transfusion in kidney-cut group was(4.31±1.05)U,significantly more than reservation group(P＜0.01).29.0%(9/31)recipients in kidney-cut group had surgical complications,significantly higher than reservation group(6.2 0A,2/32)(P＜0.05).The ineidence of urinary tract irdection was 31.2% (10/32)in reservation group,significantly higher than in kidney-cut group(6.5%,2/31,P＜0.05).12.5%(4/32)patients in reservation group needed surgical excision of polycystic kidney after kidney transplantation due to polycystic kidney infection.In 24 recipients with preoperative high blood pressure in each group,the blood pressure of 8 recipients(33.3%)in kidney-cut group returned to normal,compared with only 2 recipients(8.3%)in reservation group(P＜0.05).The incidence of DGF,incidence of acute rejection,human/kidney 1-and 5-year survival rate between 2 groups had no statistically significant difference.Conclusion As long as the detailed operation.it is safe to resect patient's polycystic kidney during renal transplantation,but there are no effects on patient/kidney survival rate.
ABSTRACT
Objective To investigate the clinical effects of tube flushing in donor duodenum to prevent the hematuria post combined pancreas-kidney transplantation(SPK)with pancreatic fluid drainage through bladder.Methods 18 cases of diabetic patients associated with end-stage renal disease were subjected to combined pancreas-kidney transplantation with pancreatic fluid drainage through bladder,within which 12 cases were pre-placed douche tube in donor duodenum,while the other six were not.As for the cases in group with the tube,T tube of No.10 was put in the donor duodenum through the abdominal wall and then bladder.After that the tube was fixed using 5-0 absorbable suture,then the bladder sutured if the tube was smooth confirmed by flushing with saline.After the operation,flushing was maintained using saline consecutively with the speed of 500 ml/h through the douche tubes of these 12 patients.Then the speed was changed to 250 ml/h 3 days later if the flushing fluid was limpid.One week later,changed to rinse intermittently and prolonged the flushing interval gradually.Till 14 days post the operation,flushing was ceased.After 2 days' survey,the urethral catheter was removed.As for the other 6 cases without douche tube,the urethral catheter was removed during 7-10 days after the operation if hematuria didn't occur.Results In the 12 cases with douche tube,there was only one patient(8.3 %,1/12)having slight hematuria on the 7th day after the cessation of the bladder washout.Through strengthening the flushing,the hematuria disappeared.The urethral catheter was removed on the 14th day after the operation and the hematuria never happened again.In the group without the douche tube,4 cases(66.7 %,4/6)had serious hematuria complicated with bladder obturation.The incidence of that was obviously higher than in the group with the douche tube(P＜0.05).Only one patient(1/12,8.3%)in the group of regular insertion of douche tube had urinary system infection,but in the group without the tube,the incidence of urinary system infection was 66.7 %(4/6)(P＜0.05).Conclusion The tube flushing in donor duodenum can significantly reduce the occurrence of hematuria after combined pancreas-kidney transplantation with pancreatic fluid drainage through bladder.
ABSTRACT
Objective To analyze the risk factors of BKV infection and compare the real-time PCR procedure and urinary sediment smears of patients checked for decoy cells. Methods The peripheral blood samples of 129 renal recipients were collected. According to the result of PCR, 129 patients were divided into 2 groups:①BKV-DNA(+);②BKV-DNA(-). The sex, age, cold ischemia time, hemotodialysis duration, immunosuppressive agent and other clinical parameters were compared between the 2 groups and a Logistic regression was performed to analyze the risk factors of BKV infection. Results There were 20(15. 5%) patients in BKV-DNA(+), 109(84. 5%)patients in BKV-DNA(-)group. Logistic regression found that the cold ischemia time, hematodialysis duration, living donor were significantly related to the BKV-DNA. The results of the real-time PCR procedure and urinary sediment smears of patients checked for decoy cells were related. Conclusion Real-time fluorescent quantitative PCR and urine decoy cell are good way for detection of BKV infection after renal transplantation. The cold ischemia time and hematodialysis duration and brain death donor were the risk factors of BKV infection post renal transplantation.