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Objective To investigate the influence of renal allograft donor cytokine and cytokine receptor gene polymorphisms on acute rejection after renal transplantation.Methods (1) 126 cases of cadaveric renal allograft recipients were divided into two groups according to the presence or absence of acute graft rejection.The distribution of 22 polymorphisms in 13 cytokine genes and production types of some cytokines were compared between donors of two groups as well as latent factors affecting acute rejection.(2) Based on the result of HLA-DR matching,all recipients were stratified into two conditions:0～1 locus HLA-DR mismatched and HLA-DR completely mismatched.Previous positive gene polymorphisms were compared between rejection group and no rejection group under two conditions.Results (1) Compared with no rejection group,the number of HLA-DR mismatched was significantly higher in rejection group.In the donors of rejection group,the genotype frequency of IL-1α-889 C/C,IL-1Rα msp I 11100 T/T,IL-4Rα+ 1902 A/A,TGF-β1 codon 10 C/C,IL-10-1082 A/A and lower production type frequency of IL-10 were significantly higher,whereas the genotype frequency of IL-12-1188 A/A,IL-2-330 G/G and IL-10 GCC/ATA was significantly lower.(2) With 0～1 locus HLA-DR mismatched,the genotype frequency of IL-1Rα msp I 11100 T/T,IL-4Raα+1902 A/A,IL-2-330 G/G,TGF-β1 codon 10 C/C and lower production type frequency of IL-10 showed significant difference between two groups,whereas with HLA-DR completely mismatched,the genotype frequency of IL-12-1188 A/A had significant difference.Conclusions This study verifies renal allograft donor genotype of IL-1α-889 C/C,IL-4Rα+ 1902 A/A,IL-1Ra msp I 11100 T/T,TGF-β1 codon 10 C/C,IL-10-1082 A/A and lower production type of IL-10 gene as the genetic safe factors for the development of acute allograft rejection and genotype of IL-12-1188 A/A and IL-2-330G/G as the major genetic risk factors for acute rejection after kidney transplantation Furthermore,the condition of HLA-DR mismatching might interfere with the action of these cytokine and cytokine receptor polymorphisms.
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Objective To investigate the changes of sexual hormones, trace elements and fertility in female uremia patients and their relations during hemodialysis or after renal transplantation.Methods Data of 43 cases of uremia during hemodialysis or after renal transplantation from March 1999 to December 2002 were retrospectively analyzed. The conditions of menses, sexuality and fertility before and after renal transplantation were also studied. Twenty healthy women served as controls. Results During the hemodialysis, 4 patients had regular menstrual cycle, 28 irregular menstrual cycle, and 11 menolipsis. Some sexual hormones, such as LH, FSH, PRL and E_2 were significantly increased (P
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Objective To investigate the relation of sexual hormones, trace elements and erectile function in male uremia patients subject to the therapy of hemodialysis or after renal transplantation.Methods Data of 136 cases from March 1999 to December 2002 were retrospectively analyzed.Results The differences in sexual hormones, trace elements and erectile function between male uremia patients receiving hemodialysis and control groups were respectively significant (P
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<p><b>OBJECTIVE</b>To review kidney transplantation in the center and analyze the risk factors affecting long-term allograft survival.</p><p><b>METHODS</b>Thirty-two relative variables were analyzed with SAS statistical software. Using Log-rank method, we investigated influence of these variables on short-and long-term survival of grafts. Kaplan-Meier analysis was used to estimate the 1-, 3-, 5-, 10-years graft survival rates and half-life. Proportional hazards regression analysis (Cox model) was used to assess and rank the relative risk of potential variables.</p><p><b>RESULTS</b>The 1-, 3-, 5-, 10-years graft survival rates were 83%, 75%, 66% and 48%. After excluding the patients died with functioning grafts, the 1-, 3-, 5-, 10 years grafts survival rate increased to 89%, 82%, 75% and 69%, respectively. The mean half-life was 8.78 +/- 0.14 and 14.09 +/- 0.20 years, respectively. By Log-rank analysis, factors affecting short- and long-term graft survival were identified as: renal function, duration of graft function became normal, cold-ischemia time, presence of acute rejection, delayed graft function, immunosuppressive regimen, complication, infection, anti-rejection therapy. Cox model multivariate analysis showed that there were 18 factors affecting graft survival.</p><p><b>CONCLUSIONS</b>New immunosuppressive agents not only significantly increase short-term graft survival, but also have the better long-term outcome tendency. Making assurance to get high quality donor organ and minimizing the death with graft function may be the most feasible way to prolong graft survival at present.</p>
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Adult , Female , Humans , Male , Cadaver , Graft Survival , Immunosuppressive Agents , Pharmacology , Kidney Transplantation , Multivariate Analysis , Transplantation, HomologousABSTRACT
Objective To evaluate the efficacy and safety of Simulect for the prevention of acute rejection in renal allograft recipients receiving Neoral-based immunosuppressive regimen. Methods A prospective,multicenter and open-label clinical trial was conducted from March to October 2001.A total of 33 patients [20 men and 13 women; age range,18-63 years;mean age,(42.6?11.6) years] who received first kidney allograft were enrolled.Thirty-two cases had panel-reactive antibody
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Objective To investigate the effects of full length p16 gene transfer by replication-defective recombinant adenoviruses on cell growth of the human bladder carcinoma. Methods Ad-p16 was infected into the human bladder carcinoma cell line with no expression of p16 protein,T24.The transfection efficiency of the recombinant adenoviruses was tested using Ad-LacZ by X-gal staining.The expression of p16 protein was evaluated by Western-blot analysis. The effects of Ad-p16 infection on cell proliferation were evaluated by MTT assay and flow cytometry. Results Higher transfection efficiency(97%) to T24 could be obtained at MOI(multiplicity of infection) of 50.This Ad-p16 has a high gene expression in T24 cells.The proliferation of Ad-p16 infected T24 cells was significantly suppressed as compared with that of Ad-LacZ-infected and non-infected cells ( P
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Objective To retrospectively analyze the effectiveness and safeness of tension-free vaginal tape(TVT) as a treatment for female stress urinary incontinence (SUI) with minimal injury. Methods A longitudinal incision of 1.5cm was made through vaginal mucosa at the midsection of the urethra, and a suspension tape was inserted in 40 SUI patients. Results Thirty four out of 40 patients recovered completely without urinary retention and SUI. Two patients experienced mild urinary retension 2 weeks postoperative, and another patient with similar complaint 3 months after the operation. The symptom was totally alleviated by urethral dilatation. SUI symptom was improved markedly in 1 patient. In 4 patients, bladder perforation occurred during the operation. One patient experienced vaginal mucosa desquamation, and it healed spontaneously. One patient died of myocardial infarction 5 days after the operation. Conclusion TVT seemed to be a good method with minimal injury, with little pain, good result, less complications and high safety.
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Objectives:To investigate the method of generating recombinant adenovirus vector containing human p16(Ad-p16) efficiently. Methods:Recombinant adenovirus vector was generated with HEK 293 cells, and the titer of the adenovirus was detected. Results:The titer of generated adenovirus is about 5×108 PFU/ml. Conclusions:Recombinant adenovirus vector was generated with HEK 293 cells with high titer. This set the foundation of adenovirus mediated gene-transfer.
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Objective: To probe into the etiology of the sever e post-renal transplantation infection and its diagnosis and t reatment. Methods: A retrospective analysis was made on the seve re infected cases among 1 504 renal transplantation cases. Results: (1)The infected rate in the whole group was 23.74%,and 14.01% of the infecti on cases was severely involved. (2) About 86% of the severe infection occurred within 6 months after operation and as high as 82% of the patients were successf ully rescued by various etiological treatment. (3) The main etiological causes according to their frequency and type were: Bacteria(Mycobacterium tub erculosis, Pseudomonas, Aureus staphylococcus, Bacillus cloacae, etc.); Fungus (Candida albians, Candida tropicals, Penicillum patulum). Cytomegalo virus also often appeared. Conclusion: (1) Infection is one of t h e common complications after renal transplantation and severe infection is an im portant cause of death. (2) Correct diagnosis and combined therapy in time may improve its success rate. (3) Characterized germ spectrum exists in severe post -renal transplantation infection and its role is of great importance to clinica l management.
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Objective: To evaluate the therapeutic effect of cystic de compression (CD) operation autosomal dominant polycystic kidney disease(APKD) based on clinical material, experience and related theory. Methods: Thirty-nine APKD received CD operation(unilateral 31 cases, bilateral 8 cas e s) in our hospital from 1985 to 1995. Four main parameters, cystic renal enlargi ng rate(CRER)，lumbar pain recurring rate(LPRR)，blood pressure elevating rate(B PER) and renal function abnormal rate(RFAR), were observed 3, 6, 12, 36 and 60 months after CD operation. And the changes were analyzed based on related theory . Results: The changes of 4 main parameters on 5 different time points post operation in unilateral 31 cases were:（1）CRER 19.4%,38.7%,61.3%,1 0 0% and 100%; （2）LPRR 12.9%,48.4%,71.0%,100% and 100%; （3）BPER 6.5%,22.6%,4 1.9%,71.0% and 96.8%;（4） RFAR 3.2%, 12.9%,22.6%,74.2% and 96.8% respectively. Conclusion: During a short period, CD operation can relieve th e lumbar pain, but it is not certain for improving CRER,BPER and RFAR. in the lo ng run, the therapeutic effect is not sure.
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Objective:To discuss the management principles and skills for treatment of intractable ureterostenosis under ureteroscope.Methods:Our management experience on 19 patients with intractable ureteral stenosis was retrospectively analyzed.The 19 cases included urological TB-caused multiple ureteral stenosis,oncothlipsis to ureters from intestinal tract or gynecology,restenosis 3 months to 12 years after pelviureteric junction plasty,operative site stenosis after ureterolithotomy. double ureter back flow accompanied by stenosis,ureter imperforation after renal parenchyma lithotomy without placing double"J",ureter imperforation 3 months after extracorporeal shock-wave lithotripsy due to ureterolith,tubal bladder stoma stenosis after renal transplantation,restenosis after tubal bladder stoma due to distal ureterostenosis,and so on.All the patients were treated under ureteroscope.The management methods included:the Wolf 8/9.8 CH12?and Wolf 6/7.6 CH5?ureteroscope was used as a dilator to dilate the stenoses:balloon expanding under ureteroscope was used to dilate the stenoses;the ureter pliers was used to expand the stenoses to different directions;the cold knife was used to open the stenoses;if the diameter of stenoses were smaller than the that of the ureteroscopes,F4.5 or F3 double"J"tubes were inserted guided by a wire under ureteroscope; and 2 or 3 weeks later,a larger tube or two tubes were introduced into the stenoses already dilated partly by the former tube. Results:Ureteroscopic method failed in treating 2 patients in our group and succeeded in treating all the other patients.The outcomes of patient were fine during 9 months to 3 years'follow-up.Conclusion:It is difficult to treat patients with intractable ureterostenoses.With good experience in manipulation of ureteroscope,the flexible application of several techniques according to the different conditions of different patients can guarantee successful treatment in most patients.
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Objective:To perform trans-peritoneal laparoscopic adrenalectomy via a single incision in treatment of adrenal tumors,and to discuss its clinical outcome and safety.Methods:Single incision trans-peritoneal laparoscopic adrenalectomy was used in treatment of three patients with adrenal tumors.The incision was made 3 cm below the costal margin of anterior axillary line; three Tocars were placed in the cut.The instruments used included single port access,CUSA,Hem-o-lok,etc..Results:The three operations were all successful,and there were no conversion to open procedure or a need for extra Ttrocars.The operating time periods were 75,116,and 135 min,with a mean of (108.7?30.7)min.The perioperative blood losses were 10,20,and 30 ml,with a mean of (20?10)ml.The gastric canal and ureteral catheter were withdrew one day after operation,and the drainage tube was withdrew 3 d after operation.The mean postoperative hospital stay was 4 d.Conclusion:Single incision trans-peritoneal laparoscopic adrenalectomy has the advantage of little trauma,less blood loss,satisfactory safety,and prompt postoperative recovery,but is difficult to manage.
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Objective To investigate the diagnosis and treatment of fungal infections of the lungs after renal transplantation. Methods A total of 43 cases (35 males and 8 females,mean age of 32 years) fungal infections of the lungs after renal transplantation from January 1999 to March 2002 were retrospectively analyzed.The mean time from post-operation to onset of the infection was 59 days. Results Among the 43 cases,16 were infected with candidiasis ,4 with candida Krusei ,2 with candida parapsilosis ,3 with mycormyccosis ,4 with aspergillosis ,1 with cryptococcosis neoformans and 2 with nocardiasis .14 cases out of 43 cases were coinfected with bacteria and CMV.The other 11 cases were negative for fungus-culturing test.23 cases were cured with fluconazole (100 mg,3 times per day for 10 days),17 with amphotericin B (50 mg,once a day for 10 days)and 3 died. Conclusions Fungal infection of the lungs is a severe complication after renal transplantation. Early diagnosis and timely treatment may achieve satisfactory effects.
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%85, entered into the high sensitive group (30 cases), and the patients with negative PRA into control group. The fresh blood was collected, and PBMCs was collected by Ficoll method. Total RNA were extracted by one-step technique and purified. The total RNA in high sensitive group were labeled with Cy5-dUTP, and control group with Cy3-dUTP, then the cDNA probe was labeled by reverse transcript way. High throughout gene chip ((16 920)) was hybrided and scanned. Cy3/Cy5 image files were copied. Then fluorescent signal value of gene expressing was obtained, and differential expression genes were sifted. RESULTS: Among the differential expression 877 genes, there were up-regulated 88 genes and down- regulated 789 genes. The mechanism of high sensitive status in human immune system was analyzed by some function-known genes which coded NY-REN-55 antigen, CD100, defender against cell death 1, breast cancer resistance protein, transcriptional repressor, death domain containing protein, cyclophilin-33A, rapamycin-binding protein, heat shock protein 40, interferon-alpha receptor and STAT inhibitor-2. CONCLUSIONS: The effect of PBMCs in high sensitive status of human immune system in patients with uremia may be associated with recognition of auto-antigen,signal conduction, aggregation and differentiation of B lymphocyte, anti-apoptosis and resistance of immunosuppressant. [
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Objective: To provide clinicians with diagnostic strategy and techniques for adrenal tumor by evaluating various imaging studies.Methods: The accuracy of localizing and qualitative diagnosis was analyzed by comparing various imaging examination with pathological findings after surgery combined with centesis by BUS.The clinical data of 112 patients with adrenal tumors were analyzed.Results: The pre operation lesion localizing accuracy with BUS,CT and MRI was 85.71%, 95.54%, and 98.14%,respectively.The qualitative accuracy with the same modalities as above were 33.33%,65.69%, 79.63%, respectively.For combining different imaging examination group, the accuracy of localizing and qualitative diagnosis was 100% and 86.92%,respectively.Tolally 102 cases were treated by operation and were surgically cured, of which 9 cases were treated with intervention therapy,30 cases had large tumors(exceeding 10.0 cm? 5.0 cm? 4.0 cm). Conclusion:The diversified diagnostic imaging should be applied orderly and rationality.BUS can be used as a screening method.CT and MRI are accurate in localization and differentiation of benign and malignant.Combination of various examinations has the advantages of different modalities and greatly increase the diagnostic accuracy.We should select right incision. Sufficient preparation during perioperation can reduce the complication.
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Objective To study the therapeutic effects and side effects of foscarnet in the treatment of active(IgG+,IgM+)and inactive(IgC+,IgM-)cytomegalovirus(CMV)infection after cadaver renal transplantation.Methods Forty-one cases of active cytomegalovirus infection and 22 of inactive cytomegalovirus were selected to receive foscarnet treatment.Besides,10 cases of inactive cytomegalovirus infection served as control group without receiving foscarnet.The usage of foscarnet was 40 mg/kg,iv.,2 ～3 weeks in the active stage,50 mg/kg,iv.,3～4 weeks in the inactive stage.Results Clinical symptoms of patients in the active stage were controlled,and serologic CMV IgG turned negative.Moreover,no positive infection was found after 3-month follow-up for those who received foscarnet.At the same time, 3 patients in the control group turned into active infection. Only one receiving foscarnet appeared urine volume cutting down temporarily,and the renal function had a reversible change;2 patients had skin red reaction.Conclusion Foscarnet could control CMV active infection quickly,markedly and firmly.and no recurrence was found during a 3-month follow-up.Foscarnet may protect the inactive patients from turning positive.And foscarnet had no obvious damage to the renal graft function and didn't interfere with the metabolism of blood calcium and cyclosporine A.Foscarnet is a safe and effective drug to treat CMV infection.
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Retrospective analysis of 761 case-times successive color Doppler sonography for 518 renal transplant patients was carried out.six parameters of sonography were used to compare, the CsA-NT hemodynamic changes among the patients with normal function, rejected and hy-dronephrotic kidney.It revealed that during rejection of the rendl srafts, besides an elevation of resistance index(RI)and a decrease of D/S ratio, the velocity and volume of renal blood flow were also slowed down and decreased respectively.After combating rejection, the renal function recovered to normal gradually, and RI dropped below 0.75 subsequently.Otherwise R1 would be persistently elevated, which indicated an irreversible rejection.The diagnosis of acute rejection was given at RI≥0.83, with the sensitivity rate being 82.70%and specificity being 80.10%.It was suggested that RI is a relatively sensitive and relialble parameter for the diagnosis of rejection.In combination with the clinical manifestations RI is of great important clinical value for the early diagnosis and treatment of acute rejection.
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Objective To study the therapeutic window of rapamycin(RPM) concentration in primary recipients of renal transplantation. Methods An open label, multi center study was performed. One hundred primary renal allograft recipients with cadaveric donors were enrolled from 4 transplantation centers in China. The immunosuppressive regimen was triple therapy,i.e.RPM combined with CsA and steroid. A loading dose of RPM 6 mg/d was administered within 48 hours after transplantation, then a maintaining dose of 2 mg/d was administered. The whole blood concentration of RPM was measured by HPLC method. Results The whole blood concentration of RPM in this group was (6.65?2.75)ng/ml, the 10th and 90th percentile for RPM concentration was 3 2 ng/ml and 10 26 ng/ml,respectively.9 5%(8/84)patients suffered from acute rejection during the 6 month period after transplantation in this study, and the concentration of RPM in these was lower than that in non rejection patients(P=0.001). Hyperlipidemia and liver dysfunction were the most frequently adverse events, and RPM concentration was significantly associated with the concentration of triglyceride. Conclusions 4～8 ng/ml is a suitable level for RPM concentration. Regular drug monitoring and reasonable dose modulation may increase the validity and security of RPM.
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Objective To explore the influence of renal allograft recipient cytokine and cytokine receptor gene polymorphisms on the infection after renal transplantation. Methods (1) 126 cases of cadaveric renal allograft recipients were divided into two groups according to the presence or Absence of infection in 6 months after renal transplantation: infection group and un infection group. The distribution of 22 polymorphisms in 13 cytokines and cytokine receptors gene were compared between two groups as well as latent factors affecting the onset of infection. The production types of IL 10, TNF ?, TGF ?1 and IL 6 were analyzed; (2) All recipients were stratified into two conditions: presence of rejection or Absence of rejection. Previous positive gene polymorphisms were compared between infection group and un infection group under two conditions. Results (1) The incidence of acute allograft rejection was significantly higher in infection group than in un infection group. In infection group, the genotype frequency of IL 1? 889 C/C, IL 1? 511 C/C, IL 1?+3962 C/T or T/T, and the higher production type frequency of TGF ?1 were significantly higher than those in un infection group. (2) In the recipients without acute rejection, the genotype frequency of IL 1? 511C/C was significantly higher in infection group than in un infection group; whereas in those with acute rejection, the genotype frequency of TGF ?1 (codon10 codon 25) CG/TG and frequency of TGF ?1 with high production were significantly higher than those in no infection group. Conclusion This study identified recipient genotype of IL 1? 889 C/C, IL 1? 511 C/C, TGF ?1(codon10 codon 25) CG/TG and higher production type of TGF ?1 gene as major risk factors for the onset of infection after renal transplantation as well as presence of acute allograft rejection, which might affect the action of these gene polymorphisms.
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Objective To analyze the epidemiographic features of urologic malignant tumor in renal allograft recipients in a single center.Methods A retrograde analysis was undertaken on 2 300 patients who received renal allografts between June 1978 and December 2001 and anti rejection treatment for at least 3 months. Results Among 2 300 recipients, 27 were diagnosed as malignant tumors that included 9 (an incidence about 0.39% ) cases of urologic malignant tumors that were one third of 27 cases: 1 case of renal cell carcinoma, 2 cases of bilateral pelvic transitional cell carcinoma (TCC), 3 cases of unilateral pelvic TCC, 1 case of ureter TCC and 2 cases of bladder TCC. The mean age at diagnosis of urologic carcinoma was 57.5 ? 5.6 , and the mean duration of immunosuppressive treatment 58?18 months. Six cases received CsA+Aza+Pred, 3 cases CsA+MMF+Pred. Surgical treatment was carried out in 8 cases. Seven of them were alive well. One case died of the malignant tumor soon after the diagnosis. One case died of cerebral hemorrhage.Conclusion Urologic malignant tumor is an important complication in renal transplantation in our center. The occurrence of malignant tumor is intimately related to immunosuppressive treatment. We must pay more attention on painless eyeable hematuria in posttransplantation patients.