ABSTRACT
Objective To analyze the risk factors of high-level BK viruria after renal transplantation and the significance in preventing BK virus-associated nephropathy (BKVAN). Methods Clinical data of 262 renal transplant recipients with regular follow-up data were retrospectively analyzed. According to the DNA load of BK virus, all recipients were divided into the high-level BK viruria group (n=35) and non-high-level BK viruria group (n=227). The incidence of high-level BK viruria after renal transplantation was summarized. The risk factors of high-level BK viruria after renal transplantation were analyzed by univariate analysis and multivariate analysis. Survival curve was delineated by Kaplan-Meier method, and survival analysis of recipients was performed. Results Among 262 renal transplant recipients, 35 cases developed high-level BK viruria with an incidence of 13.4%. The median time of occurrence of high-level BK viruria was 181 (126, 315) d. The incidence was the highest within 6 months after renal transplantation, gradually decreased from 6 months to 2 years, and then increased after 2 years. Univariate analysis showed that the history of antithymocyte globulin (ATG) treatment, acute rejection (AR), donation type and delayed graft function (DGF) were the risk factors of high-level BK viruria after renal transplantation (all P < 0.05). Multivariate Cox regression analysis demonstrated that donation after brain death followed by cardiac death (DBCD), AR and DGF were the independent risk factors of high-level BK viruria after renal transplantation. The 1-, 3- and 5-year survival rates of recipients with ATG treatment history, AR, DGF and donation type of DBCD were significantly lower than those with non-ATG treatment history, non-AR, non-DGF and other donation types [donation after brain death (DBD), donation after cardiac death (DCD) and living organ donation] respectively (all P < 0.05). Conclusions DBCD, AR and DGF are the independent risk factors of high-level BK viruria after renal transplantation. Strengthening the postoperative monitoring of these recipients and delivering early intervention may effectively prevent BKVAN.
ABSTRACT
Objective To compare the early clinical efficacy of renal transplantation between extended criteria donor (ECD) and standard criteria donor (SCD). Methods Clinical data of 85 recipients undergoing renal transplantation from donation after cardiac death (DCD) were retrospectively analyzed. According to the types of donors, all recipients were divided into the ECD group (n=31) and SCD group (n=54). The level of serum creatinine (Scr), incidence of early complications and clinical prognosis within 3 months after renal transplantation were compared between 2 groups. Results No statistical significance was observed in the levels of Scr within 1 month after renal transplantation between the ECD group and SCD group (all P>0.05). At postoperative 60 and 90 d, the level of Scr in the ECD group was (189±97) and (175± 69) μmol/L respectively, significantly higher than (142±49) and (135±41) μmol/L in the SCD group (P=0.005 and 0.002). In the ECD group and SCD group, the incidence of acute rejection (AR) was 6% and 15%, the incidence of delayed graft function (DGF) was 23% and 19%, the incidence of pulmonary infection was 10% and 6%, the incidence of other early complications was 32% and 15%, respectively, no statistical significance was identified (all P>0.05). In the ECD group and SCD group, the survival rate of the recipient was 97% and 94%, the survival rate of the renal was 84% and 91%, no statistical significance was identified (all P>0.05). Conclusions Compared with the SCD, renal transplantation from ECD can achieve equivalent early clinical efficacy. In the present condition of serious deficiency of donor kidney, the application of ECD can enlarge the supply of the donor kidney.
ABSTRACT
Purpose: The aim of the present study was to identify whether the percentages of T cell subset, the serum interferon-gamma (IFN gamma ) as a Th1 cytokine, soluble CD30 (sCD30) as a marker for activation of Th2 cytokine producing T cells, and intracellular cytokines (IL-2, IL-4) can predict the acute cellular rejection episodes of liver transplant patients. Methods: Pretransplant and posttransplant sera on days 1, 3 and 7 after surgery of 88 adult living donor liver transplant recipients were tested for the percentage of T cell subset (CD3+, CD4+ and CD8+ T cells), IL-2, IL-4 production by peripheral mononucleated cells with fluorescence activated cell sorter analysis and for the serum IFN gamma , sCD30 concentrations with commercial ELISA kits. Recipients were subdivided into three groups as control (n=51), ELE (the group which showed elevated liver enzyme but RAI score or =3. n=13). The differences in the level of cytokines among each group were analyzed. Results: The percentages of CD3+ T cell subset at preoperatively and day 1, 7 after surgery in AR were higher than those of control (P <0.05). The IL-2 production in AR was the highest and the IL-4 production was the lowest on posttransplant 7th day among three groups without significance. AR had a significantly higher pretranspant IFN gamma concentration than control (P <0.05). The pretransplant serum level of sCD30 was not different between the control and AR. However, in comparison with control, which showed a steadily decreasing serum sCD30 level after transplantation, 12 of the 14 patients in the AR showed an increase in their sCD30 levels from day 1 to day 3 after transplantation (P <.05). Conclusion: The measurement of serum IFN gamma and sCD30 during pre- and early post-LDLT period might be helpful to evaluate the risk of the occurrence of liver allograft rejection.