Fungal and virus infection following kidney transplantation / 中国组织工程研究

BACKGROUND: Infection following kidney transplantation has become one of the main reasons for graft failure and death of allograft recipients. However, there is not a standard therapeutic scheme for infection following kidney transplantation. OBJECTIVE: To investigate the clinical features and treatment measures of infection, additionally, to increase the cure rate of infection following kidney transplantation.DESIGN, TIME AND SETTING: A retrospectively analysis was performed at the Organ Transplantation Center, the First Affiliated Hospital of Kunming Medical College from February 2006 to February 2008.PARTClPANTS: Eighteen cases of infections in 84 kidney allograft recipients.METHODS: All cases were checked by chest X-ray. Patients who had no significant lung infection symptoms or obvious signs received lung CT scan. Pathogen detection was performed, including hemoculture, urine culture, sputum culture, nose swabs culture, throat swab culture, checking clinically important cytomegalovirus (CMV), EB-DNA and mycoplasma in blood, acid-fast bacilli and eumycete culture in sputum. All cases of pulmonary infection underwent a comprehensive treatment-antiviral drugs, antibiotics and antifungal. Depending on the individual condition and absolute values of lymphocytes and CD4+T cells, the immunosuppressant was adjusted individually. The occurrence time, clinical symptom, auxiliary examination and treatment strategies were analyzed.MAIN OUTCOME MEASURES: The occurrence time of infection and clinical symptoms; imaging manifestation and results of pathogenic detection; selection of antibiotics and immunosuppressant adjustment.RESULTS: Among 18 cases, 11 cases (61.2%) were deceased-donor kidney transplant recipients. Inflection following kidney transplantation occurred in 12 cases (66.7%) within 3 months, and increased to 15 cases (83.3%) within 3-6 months. Of the 18 infection cases, 14 cases (77.8%) had a main symptom of fever. There were 15 cases (83.3%) of respiratory tract infection, including 13 cases (72.2%) of pulmonary infection. Fungal cultivation, especially Monilia, was positive in 6 cases. Three out of the 18 cases (16.7%) died, two of whom had CMV infection. Mixed infection occurred in all cases.CONCLUSION: Infected patients following kidney transplantation present with diversity pathogens, which are dominated by bacteria, fungus and virus. Severe pneumonia combined with CMV infection demonstrates that poor prognosis, fungal and virus infection following kidney transplantation should be given more attention. Combined de-escalation therapy is the main method, and timely adjustment and even discontinuance of immunosupprassive agents is one of the key points in the treatment of infection following kidney transplantation

Treatment of female bladder neck obstruction with transurethral resection of bladder neck: Report of 26 cases / 中国微创外科杂志

15 ml/s;dysuria was significantly improved in the other 2 cases,with the Qmax being 13 and 11 ml/s,respectively.Conclusions Transurethral resection of bladder neck is an effective means for the treatment of female bladder neck obstruction.

Living relative donor renal transplantation:Report of 19 cases / 中国微创外科杂志

Objective To summarize the clinical experience of living relative donor kidney transplantation.Methods A retrospective analysis on 19 cases of living relative donor kidney transplantation from February 2002 to May 2006 was carried out.Results No blood transfusion was needed and no serious postoperative complications occurred in donors.The 19 donors were discharged from hospital at 7～10 days postoperatively.Follow-up examinations for 1～51 months(mean,28 months)in the 19 donors revealed normal liver and renal functions.Among the 19 recipients,follow-up examinations for 1～51 months(mean,28 months)showed that the renal functions recovered in 3～5 postoperative days in 16 recipients and within 3 weeks after transplantation in 3.Acute rejection occurred in 2 recipients postoperatively,and was reversed by steroid pulse therapy in 1 recipient and by ALG treatment for 10 days in 1 recipient,in whom the hormone pulse therapy was invalid.The hormone treatment was needed for only 3 weeks in a renal transplantation between monozygotic twins,without using other immunosuppressors,and no acute rejection occurred.Two patients with an uneventful recovery developed an acute rejection because of voluntary decrement and even stopping of immunosuppressor after 6 months,and then was treated with hormone pulse treatment until a reversion.The 1-year survival rate for patient/kidney was 100%.Conclusions Living relative donor renal transplantation is safe and feasible,offering a high survival rate for patient/kidney.