RESUMO
Objective To investigate the effect of cyclosporine blood level at first year after kidney transplantation on patients with a survival time over 10 years. Methods 380 patients with functional allograft, a survival time over 10 years and long-term administration of cyclosporine A (CsA) were studied, and received CsA-based treatments. According to the blood CsA level at the first year after kidney transplantation, patients were divided into five groups: group 1, blood CsA level was above 0. 208 μmol/L (1 μmol/L = 1201.9 μg/L), group 2, blood CsA level between 0. 166-0. 208μmol/L; group 3, blood CsA blood level between 0. 125-0. 166 μmol/L; group 4, blood CsA blood level between 0. 083-0. 125 μmol/L; group 5, blood CsA level less than 0. 083 μmol/L. Systolic blood pressure (SBP), diastolic blood pressure (DBP), serum creatinine(SCr), uric acid (UA), cholesterol (CH), triglyceride (TG), alanine aminotransferase (ALT), direct bilirubin (DBil) and total bilibubin (TBil), albumin (Alb), hemoglobin (Hb), count of white blood cells and positive rate of proteinuria in 5 groups at the 1st, 5th and 10th year after kidney transplantation were analyzed. Results At the 5th year SBP in groups 1 and 2 was higher than in groups 3, 4 and 5. UA level in group 5 was lower than other groups, and Alb level in group 5 was higher than other 4 groups. Proteinuria positive rate in groups 4 and group was lower than other groups. At the 10th year after kidney transplantation,indexes among 5 groups had no statistically significant difference, except for SBP, DBP, DBil and CH in some groups. There was also no significant difference in SCr level among 5 groups at the 5th or 10th year after transplantation. Conclusion Blood CsA levels at the first year after kidney transplantation has no significant effect on long-term allograft function. But higher level of CsA (＞0. 166μmol/L) at the first year maybe predict high rate of hypertension, high blood UA and proteinuria at the 5th and 10th year after transplantation.
RESUMO
Objective To investigate the clinical features and prognosis of pulmonary infection at different stages after renal transplantation.Methods Medical records of 61 patients with pulmonary infection after renal transplantation from January 2003 to July 2008 in our hospital were reviewed in this retrospective study. According to stages of infection onset, we divided all patients into two groups, early onset group (43/61, 70.5%, ≤12 months after transplantation) and late onset group (18/61, 29.5%, >12 months after transplantation). Clinical manifestations and prognosis were compared between the two groups.Results In the early onset group, the radiographic manifestation suggested diffuse interstitial changes of bilateral lungs. Combination of anti-infective therapy and early mechanical ventilation was preferred. While in the late onset group, unilateral pulmonary lesions were seen in most cases. More patients showed cardiac and gastrointestinal complications in this group, the mortality of which was much higher. Conclusions Pulmonary infection is a major complication of renal transplantation. The etiology, clinical characteristics and prognosis of infection varies with the stage after transplantation. Effective preventive and therapeutic measures should be applied more vigorously in patients with pulmonary infection, especially early onset ones.
RESUMO
Objective To study the incidence of malignant tumors in renal allografts and explore the mechanism of increased incidence.Methods A retrospective study was performed on 1 120 renal allografts under at least 0.5 year immunosuppression from 1978～2000. Results 47 cases of malignant tumors were found in 1 120 cases undergoing renal transplantation with the incidence being 4.2?%. 40 cases had intact medical history and 34 cases were demonstrated pathologically. Most patients accepted operations, additional therapies including chemical or radiological and immunological therapies. 25 cases survived and the longest survived time was 4.5 years. Conclusions The incidence of malignant tumors in renal allografts was higher than normal persons. Besides the outcome of immunosuppression, the effects of transplantation itself, such as oncogene chimera, transition of carcinogenic virus and so on, can not be neglected.