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Objective To evaluate the effect of erythropoietin (EPO) on the proliferation and migration of bone marrow mesenchymal stem cell (BMSC) in rats. Methods The 5th generation BMSCs were divided into the control (without EPO) and 10, 100, 500, 1 000 IU/mL EPO groups. After 24 h and 48 h of culture, the proliferation rate, migration ability and the expression levels of CXCR4 of BMSCs were detected in each group. The 5th generation BMSCs were further divided into BMSC and EPO-BMSC groups. After 48 h of culture, the effect of EPO upon surface markers, directional differentiation and cytoskeleton morphology of BMSCs were evaluated in both groups. Results After theco-culture of EPO and BMSCs for 48 h, the proliferation rate and migration ability of BMSCs were significantly enhanced, and the expression level of CXCR4 protein was significantly up-regulated in the 100 IU/mL and 500 IU/mL EPO groups compared with those in the control group (all P < 0.05). However, EPO exerted no effect upon the expression levels of surface markers and directional differentiation ability of BMSCs in the EPO-BMSC group. In the EPO-BMSC group, the fibrous skeleton of most BMSCs was arranged along the long axis in parallel. Conclusions EPO can improve the proliferation rate, migration ability and tissue repair capability of BMSCs, probably by promoting the directional homing of BMSCs to injured organs and tissues via up-regulating the expression level of CXCR4.
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Objective To investigate the role of bone marrow mesenchymal stem cells (BMSCs) pretreated with erythropoietin (EPO) in the prevention of acute rejection after renal transplantation in rats. Methods BMSCs were divided into five groups: control group (without EPO), group A (pretreated with EPO at a final concentration of 10 IU/mL), group B (pretreated with EPO at a final concentration of 100 IU/mL), group C (pretreated with EPO at a final concentration of 500 IU/mL) and group D (pretreated with EPO at a final concentration of 1 000 IU/mL). In each group, the BMSCs were cultured for 24 h and 48 h. The proliferation rate of the BMSCs was determined by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) assay. The BMSCs were divided into two groups: BMSC group (without EPO) and EPO-BMSC group (pretreated with EPO at a final concentration of 500 IU/mL). After 48 h culture, Western blot was adopted to measure the expression level of CXC chemokine receptor (CXCR) 4 protein in BMSCs. Wistar rats were used as the donors, and SD rats were utilized as the recipients to establish the rat models with acute rejection after renal transplantation. The recipient rats were randomly divided into four groups (n=6 in each group) including the control group (without any intervention), EPO group (injection of 1 mL of solution containing 500 IU EPO via tail vein immediately after surgery), BMSC group (injection of 1 mL of solution containing 1×106/mL BMSCs via tail vein immediately after surgery) and EPO-BMSC group (injection of 1 mL of solution containing 1×106/mL BMSCs cultured in vitro with 500 IU/mL EPO via tail vein). The level of serum creatinine (Scr) level was determined by Scr detection kit. Western blot was used to detect the expression levels of interferon (IFN)-γ and interleukin (IL)-4 proteins. Results After 24 h culture, the proliferation rate of BMSCs did not significantly differ among all groups (all P>0.05). After 48 h culture, the proliferation rate of BMSCs in group C (pretreated with EPO at a final concentration of 500 IU/mL) was significantly higher than that in the control group (P<0.05). Compared with the BMSC group, the expression level of CXCR4 protein on the surface of BMSCs was higher in the EPO-BMSC group (P<0.05). At 1 d after renal transplantation, the levels of Scr did not significantly differ among all groups (all P>0.05). At 5 d after operation, the levels of Scr in the EPO, BMSC and EPO-BMSC groups were significantly lower than that in the control group (all P<0.05). The level of Scr in the EPO-BMSC group was markedly lower than those in the EPO and BMSC groups (both P<0.05). At postoperative 1 d and 5 d, the expression levels of IL-4 protein in the kidney tissues did not significantly differ among all groups (all P>0.05). At 1 d after surgery, compared with control group, the expression levels of IFN-γ protein and IFN-γ/IL-4 ratio in the renal tissues in the EPO, BMSC and EPO-BMSC groups were significantly decreased to varying extents (all P<0.05), and similar results were obtained at 5 d after surgery (all P<0.05). The expression levels of IFN-γ protein and IFN-γ/IL-4 ratio in the EPO-BMSC group were significantly lower than those in the EPO group and BMSC group (both P<0.05). Conclusions BMSCs pretreated with EPO can prevent the incidence of acute rejection after renal transplantation and protect the renal graft function.
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Objective To evaluate the growth and survival of single kidney transplants with donation after citizen death (DCD) donors from infants and children (＜3 years of age) to adults.Methods We retrospectively analyzed the data of single kidney transplants with donors from infants and young children to adults in our center.All the recipients were divided into infant donor group (≤3 years of age) and children donor group (1 year＜ age ≤3 years) in terms of the donor's age.The serum creatinine (SCr) level after surgery was determined and the major diameter of the kidney was measured by Doppler B ultrasonography.DGF,vascular complications,urinary tract complications,proteinuria,acute rejection,and infection were recorded during the follow-up period.Results There were 24 cases in infant donor group and 37 in children donor group.The mean follow-up period was 28 months.The SCr level at 1 st month post-transplantation was significantly higher in infant donor group than in children donor group (350.67 ± 35.57 μmol/L versus 193.70 ± 86.76 μmol/L),and the major diameter ((X-)± s) of the kidney in children donor group was significantly greater than that in infant donor group (78.29 ± 4.68 mm versus 93.62 ± 5.57 mm),but there was no significant difference during the subsequent 3-year follow-up period.The incidence of DGF in infant donor group was significantly higher than in children donor group,but there was significant difference in the rate of vascular complications,urinary tract complications,proteinuria,acute rejection,and infection between two groups.Conclusion The single kidney transplants from infants and young children to adults can grow rapidly,and their survival rate is relatively high.
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The mutation of isocitrate dehydrogenase (IDH) gene is associated with gliomagenesis.It has also significant positive effects on survival and chemosensitivity in comparison with IDH wild-type glioma.Being an important energetic metabolism enzyme,mutation of IDH results in changes of microstructures and metabolism.Quantitative multimodality MR imaging has ability to obtain imaging biomarkers about microstructural,physiologic and functional information,which demonstrates the promises to assess IDH gene status in vivo.The progresses of association between quantitative multimodality MRI features and IDH genesmutations in glioma were reviewed in this paper.
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The mutation of isocitrate dehydrogenase (IDH) gene is associated with gliomagenesis.It has also significant positive effects on survival and chemosensitivity in comparison with IDH wild-type glioma.Being an important energetic metabolism enzyme,mutation of IDH results in changes of microstructures and metabolism.Quantitative multimodality MR imaging has ability to obtain imaging biomarkers about microstructural,physiologic and functional information,which demonstrates the promises to assess IDH gene status in vivo.The progresses of association between quantitative multimodality MRI features and IDH genesmutations in glioma were reviewed in this paper.
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Objective To analyze the clinical characteristics of single renal transplantation from infant kidney donation after death (DCD) and summarize the nursing measures for nursing the infants. Method The clinical data of 36 cases of single kidney transplantation from 18 infant donors from January 2014 to June 2016 in our centre were reviewed and summarize the nursing experience. Results Pulmonary infection occurred in 3 cases, incision infection occurred in 2 cases and graft vascular complication occurred in 2 cases. Urinary fistula occurred in 2 cases, ureteral obstruction occurred in 1 case, delayed graft function (DGF) occurred in 16. Postoperative follow-ups for 1 to 20 months showed all the grafted kidneys survived and 34 of them were well recovery in view of renal function of grafted kidney and the rest two had the grafted kidneys resected because of arterial and venous thrombus in them. Conclusions The renal transplantation from infant DCD is difficult. The nurses should handle postoperative care to the patients, paying attention to the complications. On the other hand, intra-and post-operative monitoring of blood pressure, control of input and output and early observation of complications and treatment is of value for the improvement of survival rate of grafted kidneys, reduction of complication incidence and propelled recovery of the patients.
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Objective To summarize the puncture indications and the pathological type features of renal allografts biopsies in our center for evaluating its safety and diagnostic value .Methods The data of 773 percutaneous renal allograft biopsies in 629 kid‐ney transplants in the Pearl River Hospital of Southern Medical University from January 2005 to June 2014 were retrospectively an‐alyzed .Results The success rate of renal biopsy was 100% ,9 cases(1 .2% ) were complicated postoperative perirenal small hemato‐ma ,33 cases(4 .3% ) with gross hematuria and 1 case(0 .13% )with abdominal pain .Among the indications of 773 biopsies ,protein urine occured 205 cases(26 .5% ) of patient ,blood Cr increased in 187 cases(24 .2% )of patients ,protein urine simultaneously com‐plicating blood Cr increased ,in 313 cases of patients ,53 cases(6 .9% )had postoperative oliguria urinary ,and 15 cases(1 .9% )were get procedural biopsy .In the pathological types ,21 cases(2 .7% ) were normal ,179 cases (23 .2% ) were acute T cell‐mediated rejec‐tion after transplantation ,51 cases (6 .6% )were acute antibody‐mediated rejection ,205 cases (26 .5% ) were chronic T cell‐mediated rejection and 43 cases(5 .6% ) were chronic antibody‐mediated rejection;41 cases(5 .3% ) were drug toxicity ,29 cases(3 .7% ) were acute tubular necrosis(ATN) ,11 cases(1 .4% ) were relapsed or new nephropathy ;9 cases(1 .2% )were HBV related renal disease;39 cases (5 .0% ) were critical lesion and 145 cases(18 .8% )were others .Conclusion Rrenal allograft biopsy is safe ,it is important to the etiological diagnosis of renal disease after renal transplant ,which can guide the clinical treatment and improve the long term survival of renal graft and should be routinely carried out in clinic .
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BACKGROUND:Fisher-Lewis rat kidney transplant models are the international common chronic renal alograft rejection models, but their application is greatly limited because of difficulty in model preparation and high costs. OBJECTIVE:To explore a new method of establishing SD-Wistar rat models of chronic renal alograft rejection. METHODS: Fifty-six pairs of SD-Wistar rats were subjected to left kidney orthotopic transplantation. The right kidneys of the recipients were intact and used as internal controls. 23 rat recipients were randomly divided into model group (n=15) and control group (n=8). The rats in the model group were injected with cyclosporine microemulsion for 10 days (2 mg/kg/day,i.p.) after kidney transplantation. The rats in the control group were not treated with immunosuppressive therapy. RESULTS AND CONCLUSION:The irreversible acute rejection occurred in al the transplanted kidneys of rats in the control group within 4 weeks, leading to the necrosis of transplanted kidney. Moderate inflammatory cel infiltration appeared in the transplanted kidneys of rats in the model group at 4, 8 and 12 weeks after transplantation. Typical histopathological changes of chronic rejection were observed within 12 weeks after transplantation. The Banff total scores were increased with time after transplantation. Al these histopathological changes were not observed in the intact right kidneys of rat recipients in both groups. The valey value of
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BACKGROUND:The rate of tuberculosis infection was high in patients after renal transplantation. Clinical manifestation is not typical, which brings inconvenience to diagnose. OBJECTIVE:To summarize the diagnosis and therapeutic methods of tuberculosis infection after al ograft renal transplantation. METHODS:Relevant diagnosis and therapeutic method of 13 patients with tuberculosis infection after renal transplantation were retrospectively analyzed in the Department of Organ Transplantation, Zhujiang Hospital of Southern Medical University from January 2010 to October 2013. RESULTS AND CONCLUSION:The onset time was 4-120 months after operation;62%(8/13) patients within 18 months after transplantation. Patients affected long-period fever, mainly low-grade fever. Four cases were identified according to the history, imaging data in combination with positive pathogenic diagnosis. Five cases were identified according to the history, imaging data combined with lung biopsy histopathology. The remaining four cases were identified according to the history, imaging data with experimental effective anti tuberculosis treatment. Early pulmonary symptom was not obvious. Chest CT was helpful in early diagnosis and differential diagnosis. Al patients fol owed early, law, ful , right amount, combined with principles of anti-tuberculosis treatment, and treatment usual y lasted for 6-10 months. They were given combined anti-tuberculosis infection drugs, adjustment of immunosuppressive agents and five-ester capsule for liver protection therapy. Thirteen patients were alive, no deaths. Two cases with early infection without timely treatment suffered from acute rejection, leading to loss of graft function and returned to hemodialysis. The others were cured and left hospital. Renal function was normal after 6-month fol ow-up (serum creatinine). Results indicated that after renal transplantation, patients with pulmonary tuberculosis should be early detected, early diagnosed and early treated. CT guided biopsy can be used as an effective and feasible means for diagnosis and identification of smear negative pulmonary tuberculosis after renal transplantation. Adjustment of immune scheme, anti-tuberculosis treatment and five-ester capsule significantly reduced calcineurin inhibitor dose, and lessened their adverse reactions.
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Objective To study the effect of Alemtuzumab on acute rejection (AR) and graft survival after kidney transplantation.Method Published domestic and foreign literatures regarding the effects of Alemtuzumab used on acute rejection and graft survival were reviewed,and Meta analysis was employed to analyze the Results.Odds ratio (OR) and its 95％ confidence interval (95％ CI) were used as the parameters to evaluate the therapeutic effects.The statistical analyses were performed with RevMan 5.1 software.Result A total of 9 pertinent research articles were reviewed.Meta-analysis of pooled results indicated that Alemtuzumab prevented the recipients of kidney transplantation from acute rejection effectively with half year prevention of OR 0.37 and 95％ CI 0.24-0.58 (P＜0.01),one year prevention of OR 0.43 and 95 ％ CI 0.29-0.64 (P＜0.01),and two year prevention of OR 0.69 and 95％ CI 0.47-1.02 (P ＜ 0.01),respectively.It was revealed that Alemtuzumab could reduce the incidence of acute rejection by 55％ in half year,51％ in one year and 28％ in two years,respectively.No statistically significant difference in graft survival was found between Alemtuzumab group and control group (OR =1.18,95％ CI 0.76-1.85,P =0.46).No statistically significant difference in patients' survival was found between Alemtuzumab group and control group (OR =0.94,95 ％ CI 0.52-1.72,P =0.85).Conclusion Alemtuzumab may effectively prevent the recipients of kidney transplantation from acute rejection,but not obviously influence the graft and patient survival.
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Objective To investigate the implication of nonspecific cellular infiltrates in biopsy of chronic allograft nephropathy and the prognosis.Methods Recipients indicated to renal biopsyproven CAN were analyzed from June 2007 to June 2009 retrospectively,and classified into three groups according to the Banff 2009 criteria:chronic active T-cell-mediated rejection (CTMR),chronic active antibody-mediated rejection (CAMR),interstitial fibrosis and tubular atrophy not otherwise specified (NOS).All the cases were followed up for 2 years.CD4,CD8,CD20 and CD3 expression,and C4d deposits were investigated.Results Eighty-three cases were enrolled in the study,diagnosed as having CTMR in 34 cases (40.9％),CAMR in 12 cases (14.6％),and NOS in 37 cases (44.5％).There was significant difference in total interstitial inflammation (ti),peritubular capillaritis (ptc) and C4d deposition among CTMR,CAMR and NOS groups.The number of CD4+ and CD8+ in CTMR group was increased as compared with CAMR and NOS groups.The 2-yeard renal graft survival in CTMR,NOS and CAMR groups was 73.5％,78.4％ and 41.7％ respectively.The prognosis in CAMR group was worst.Conclusion CAMR predicated a worse graft survival.Infiltration of CD4+ and CD8 + cells may help to make the diagnosis of CTMR.
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ObjectiveTo compare the clinical effectiveness and adverse effects following low doses versus traditional doses of amphotericin B liposome (L-AmB) in the treatment of patients with invasive pulmonary fungal infections (IPFI) after renal transplantation.MethodsA total of 26 postrenal transplantation patients with IPFI between Jan. 2005 and Mar. 2011in Zhujiang hospital received L-AmB treatment identified low doses group (0.2-0.5 mg·kg-1·d-1,n =19) or traditional doses group (1-5 mg· kg-1,d-1,n =7) were reviewed.ResultsThe treatment duration in low doses group and traditional doses group was 20.3 +12.7 and19.3 ±13.2 days respectively (P＞0.05).The effective rate in low doses group and traditional doses group was 84.2％ and 57.1％ respectively (P＞0.05).The overall dosage was significantly less in the low doses group (414.7 ± 241.7 mg) than in the traditional doses group (1158.8 ± 928.0 mg) (P＜0.05).The incidence of adverse effect was significantly lower in the low doses group than in the traditional doses group (21.1％ vs.85.7％,P＜0.05).ConclusionThe effectiveness of low doses of L-AmB protocol in the treatment of IPFI postrenal transplantation patients was similar to that of traditional doses of L-AmB protocol,but the incidence of adverse effects in low doses of L-AmB protocol was significantly lower.
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Objective To investigate the possible mechanisms of acute humoral rejection (AHR) after renal transplantation and the significance of early diagnosis and prevention.Methods The clinical data of 296 cases receiving renal transplantations from January 2006 to December 2010 were retrospectively analyzed. After renal transplantation,the dynamic changes of panel reactive antibodies (PRA) and donor specific antibodies (DSA) in peripheral blood were monitored by using ELISA,and C4d deposition and molecular markers of infiltrating lymphocytes in biopsy tissue were observed by using immunohistochemistry.The AHR was diagnosed according to Banff 2005 criteria and clinical related indexes. Results Among 296 patients,25 were diagnosed as AHR after transplantation with the incidence being 8.4％ (25/296).The AHR incidence after transplantation in patients positive and negative for PRA before transplantation was 23.1 ％ (6/26) and 7.0％ (19/270) respectively (P＜0.01).The DSA positive rate in the recipients with AHR and without AHR after transplantation was 80.0％ (20/25) and 6.7％ (4/60) respectively.Thcrc was significant difference in DSA and C4d positive rate between AHR and non-AHR patients (P＜0.001).By adjusting several therapies, such as the immunosuppressive program and (or) application of intravenous immunoglobulin,plasmapheresis,antithymocyte globulin and rituximab monoclonal antibody, 19 cases of AHR were reversed,and the remaining 6 cases had rupture of renal allograft due to ineffective treatment,leading to the removal of the transplanted kidney.Conclusion PRA and DSA were important for AHR after renal transplantation.Immediately monitoring of the PRA and DSA after transplantation is recommended in order to achieve the purposes of prevention,early diagnosis and rational treatment for AHR,thus improving the survival of the transplanted kidney.
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Objective To explore the optimized method of venous anastomosis for right donor kidney transplantation in rats.Methods Sprague Dawley (SD) rats were used as donors and recipients for homologous rat kidney transplantation.Both bilateral kidneys were harvested from the donor rats (n =45).Ninety rats were used as recipients and divided into 4 groups according to randomly digital table:In groups AC (n =15 each),the right donor kidneys were transplanted into the left nephridial pit of recipients,and endto-side,venous bypass and modified end-toend (donor's proximal end of vena cava was anastomosed to recipients renal Vein followed by ligation of its distal end) venous anastomosis was done,respectively; In the control group (n =45),the left donor kidneys were transplanted into the same side of the recipients,and the conventional end-to-end venous anastomosis was used.Then the intra-operative findings,successful operation rate and postoperative complications were compared between two groups.Results The venous anastomosis time in group B was longer than in groups A,C and control group (P＜0.05),which significantly increased warm ischemia time of donor kidneys and operative time of recipients (P＜0.05).The venous anastomosis time,warm ischemia time of donor kidneys and operative time of recipients showed no significant difference between groups A or C and control group (P＞0.05).The successful operation rate in group C (93.3％)was similar to that in control group (86.7％) (P＞0.05),but higher than in group A (53.3％) and group B (53.3％) (P＜0.05).There was no significant difference in postoperative complications between group A and group C.Conclusion For right donor kidney transplantation,the method of harvesting the right donor kidney with a part of vena cava,and then anastomosing the proximal end to recipients renal vein and ligating the distal end,is highly feasible,efficient and economic.
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Objective Toobservetheindication, safetyandefficacyofanew immunosuppressant Rituximab in kidney transplantation. MethodsFive patients, who were diagnosed as antibody mediated rejection (AMR) from December 2010 to June 2011, were treated with single dose of Rituximab (500 mg) and followed up for 6 months. The clinical data, such as age, gender, onset of illness, induction therapy, maintaining therapy, allograft function, change of PRA, opportunistic infection and other complications were collected and retrospectively analyzed to evaluate the safety and efficacy of Rituximab used in AMR patients. ResultsAfter Rituximab therapy, all the patients had improved renal function measured by sera creatinine level: 4 cases retumed to normal, and 1 keep stable. Series of allograft biopsy demonstrated obviously reduced C4d deposition in nephridial tissue after treatment. One patient developed CMV viremia, another had urinary infection, but no one had lifethreatening infection during the follow-up period. The survival rate of human and allograft was both 100 ％. Conclusion Rituximab has a good efficacy and safety in treatment of AMR after renal transplantation.
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BACKGROUND: Pneumocystis carinii pneumonia(PCP)is a severe and life-threatening complication in renal transplantation patients.It is associated with high mortality,occult onset and rapid progression,so the clinicians who care organ transplant patients need in-depth study and understanding the law of occurrence,development and therapy of the disease to achieve the better outcome.OBJECTIVE: To retrospective analyze the etiopathogenisis,clinical characteristics,diagnosis,as well as the prognoses of PCP in renal transplant recipients.METHODS: A total of 36 patients who suffered complication of PCP after renal transplantation in the Organ Transplantation Center,Zhujiang Hospital,were retrospective analyzed.The general information of cases,clinical manifestation,therapeutic regimen,and prognoses were analyzed.The diagnosis and intervention measures were summarized.RESULTS AND CONCLUSION: Among 36 patients,22 were male and 14 were female.Three patients died of complicated acute respiratory distress syndrome,the rest were cured with good renal graft functions.Among 36 PCP patients,31 cases were occurred within 6 months,and 5 in 7-18 months.Pneumocystis carinfiwas examined in bronchoalveloar lavage fluid or lung tissues of 15 cases(41.7%),which was not be checked out in the other 21 cases.Most of patients were cured and the transplanted renal function was well after reducing immunosuppressive agent doses,administrating compound sulfamethoxazole and supportive treatment.The findings demonstrated that PCP common occurred with 6 months after renal transplantation,with typical clinical symptom but indiscoverable pathogen.Its early stage diagnosis was based on clinical history,symptom,and image examination.Among organ transplantation cases,PCP is a severe opportunistic infection,but with early diagnosis and proper treatment the prognosis remains good.
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Objective To investigate the effect of C4d deposition in peritubular capillary (PTC)in chronic allograft nephropathy (CAN) on prognosis and intervention of renal transplantation recipients. Methods All the cases who received the renal graft biopsy due to diagnosis of CAN from January 2000 to August 2008, and had the 2-year follow-up data were included in the study. The clinical data were analyzed according to the C4d deposition in PTC. Results Among 86 cases 39 cases were C4d positive (C4d+ group) and the remaining 47 cases were negative (C4d group). There was no significant difference in sex, age, donor source, transplant times, time after biopsy, the panel reactive antibodies (PRA) level between two groups (P＞0. 05). Before intervention, there was no significant difference in serum creatinine (Scr) and 24 h urinary protein between two groups (P＞0. 05). At the end of 2-year followed-up period, graft loss rate and urinary protein levels in C4d+group were significantly higher than in C4d- group (P＜0. 05). Before intervention, the incidence of blood lipid disorder and hypertension was higher in C4d- group (P ＜ 0. 05 ), but no significant difference was found in uric acid and blood sugar levels (P＞0. 05). At the end of 2-year followed-up period, there was no significant difference in blood glucose, uric acid, blood pressure and lipid profile (eliminating renal lost cases) between two groups (P＞0. 05). Conclusion The patients with CAN and C4d+ means the involvement of chronic humoral rejection and have poor clinical results. Effective intervention against humoral immune response can improve renal allograft survival.
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BACKGROUND: Recent studies have suggested that conversion from cyclosporine A (CsA) to tacrolimus (FK 506)-based regimen can improve renal allograft function and survival rate. But little is known about whether the conversion from CsA to tacrolimus(FK 506) plus mycophenolate mofetil (MMF)-based regimen exhibits the same or similar clinical efficacy. OBJECTIVE: To investigate the clinical efficacy and safety of converting CsA to FK506 plus MMF in treatment of different types of chronic allograft nephropathy (CAN). DESIGN, TIME AND SETTING: An observational and controlled trial was performed at the Center for Organ Transplantation, Zhujiang Hospital, Southern Medical University from January 2005 to October 2007. PARTICIPANTS: Fifteen-nine enrolled patients received CsA-based regimen after renal allografting. Following pathological confirm and typing, all patients were assigned to two groups: CAN with chronic rejection (CR, n = 31) and CAN without chronic rejection (non-CR, n = 28). FK 56 was purchased from Fujisawa Pharmaceutical Company, Ltd., Japan. MMF was sourced from Shanghai Roche Pharmaceutical Co., Ltd., China. METHODS: When patients were diagnosed CAN, the CsA regimen was conversed to FK506 plus MMF regimen. FK506 initiated at a dose of 0.08 mg/kg per day and then was adjusted to achieve steady-state whole blood trough levels of approximately 5-8 μg/L. MMF was used at a fixed dosage, 1.0 g/d, twice a day, only if relative adverse events occurred. All patients were followed up at least 6 months. MAIN OUTCOME MEASURES: Serum creatinine(Scr), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), 24-h proteinuria, glomerular filtration rate (GFR), and complications. RESULTS: All initial 59 patients were included in the final analysis. At 6 months after regimen conversion, the levels of Scr, TC, TG, LDL, and 24-hour proteinuria were significantly reduced in non-CR, in particular CR, groups, compared with prior to conversion (P< 0.05). GFR was markedly increased in both the CR and non-CR groups (P< 0.05). In the CR group, 20 patients obtained improved results, 7 got stable results, and 4 showed ineffective results. The effective rate of regimen conversion was 64.5% and 32.1% in the CR and non-CR groups, respectively, and significant difference existed between the two groups (P < 0.05). Compared with prior to conversion, the incidence of hypertension and hyperlipemia was significantly decreased after regimen conversion (P< 0.05). There was no significant difference in diabetes mellitus, opportunistic infection, and malignancy between prior to and after regimen conversion. CONCLUSION: FK506 plus MMF-based regimen can markedly improve the function of renal graft of CAN, in particular CR, patients.
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Objective To modify and improve the technique of continent outlet and to find an optional method of simpler construction and easier catheterization. Methods 47 patients underwent continent cecal-ascending colon urinary reservoir were followed up,among whom 37 were detenial and 10 were detubularized. All reservoirs used incisive terminal ileum being overlapped and sutured again as efferent tube. The limb was fixed between the back surface of the rectus and the pouch wall. The internal orifice of the overlapped ileum was ileocecal valve reinforced with few sutures.Its external orifice was anastomosed to the umbilicus.Urodynamic studies of the pouch and efferent limb were carried out more than 6 months postoperatively. Results All the tubes were easily catheterized with 16 F catheter.45/47 patients were completely continent during the day and 44/47 patients completely continent at night. Urodynamic study of the efferent tubes showed that the maximum close pressure with the pouch full was significantly higher than with the pouch empty( P