Analysis and clinical significance of culture results of donor renal perfusate / 中华器官移植杂志

Objective To study the culture results of renal graft cold storage solution and therapeutic strategies.Methods This study retrospectively studied the bacterial culture,drug sensitivity test and fungal culture results of donor kidney preservation fluid in 172 cases in our hospital from February 2016 to December 2017.The prevention and treatment strategies of our hospital,and relevant literatures retrieved were comprehensively analyzed.Results Positive culture results were found in 13.4％ (22/172) cases.Among them,17 cases were positive for bacteria,including 1 case positive for Stenotrophomonas maltophilia,2 for Enterococcus faecium,2 for Acinetobacter baumannii (1 case of extensive drug resistance),4 for Klebsiella pneumoniae (2 cases of extensive drug resistance),1 for Klebsiella oxytoca,3 for Escherichia coli (2 expressing extended-spectrum beta-lactamase),1 for Enterobacter cloacae,1 for Staphylococcus epidermidis,1 for both Enterococcus faecium and Klebsiella pneumoniae,1 for both Escherichia coli expressing extendedspectrum beta-lactamase and Klebsiella pneumoniae.Three cases were positive for fungi,including 2 for Canidia albicans and 1 for Candida krusei.Two cases were positive for both bacteria and fungi,including 1 for Candida tropical and Enterococcus faecium,1 for Candida glabrata and Klebsiella pneumoniae with extensive drug resistance.One recipient died of serious cardiac arrhythmia on the 32nd day after implantation with positive results of Stenotrophomonas maltophilia.One recipient positive for Candida tropicalis fecal faecium had graft nephrectomy because of rupture of renal artery at day 14 after implantation.The remaining 15 and all culture-negative cases had good graft outcome during 6 months of follow-up.Conclusion Culture of renal graft cold storage fluid as well as targeted prevention and treatment strategies based on positive results can effectively reduce the incidence of infectious vascular complications in recipients.

The infection characteristics of urinary E.coli after kidney transplantation and virulence factor detection / 中华器官移植杂志

Objective To analyze the clinical characteristics of urinary tract infection after kidney transplantation and to analyze the distribution of pathogenic virulence factors.Methods From January 2014 to June 2016,a total of 255 cases were subjected to DCD renal transplantation in our center,and 45 cases of urinary tract infection occurred after operation.Among them,urinary tract E.coli infection occurred in 32 cases.The virulence factors gene aer,hly,irp2 and iucD in the 32 strains of E.coli isolated from urine were tested using PCR and multiple PCR.Results Thirty-two cases (71.1％) of urinary tract infection after renal transplantation was caused by E.coli,and divided into 9 cases of nosocomial infection group,and 23 cases of community-acquired group.The positive rate for aer,hly,irp2 and iucD in Nosocomial infection group was 66.7％,33.3％,88.9％ and 77.8％,and that in community-acquired group was 30.4％,8.70％,39.1％ and 34.7％,respectively.There were statistically significant differences among four kinds of virulence factors between two groups (P＜0.05).The positive rate of virulence factors was significantly higher in nosocomial infection group than in community-acquired groups.The total resistance rate was 84.38％,and there was significarit difference in multi-drug resistance rate between two groups (P＜0.01).Conclusion E.coli is the main pathogenic bacteria of urinary tract infection after renal transplantation,especially nosocomial infections.The detection rate of virulence factor is high,and the multiple drug resistance is outstanding,so the attention should be paid clinically.

Significance of the R.E.N. A.L. nephrometry scoring system in renal tumour of T1 stage / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the application value of R.E.N. A.L. nephrometry score for surgery type decisions of T1 stage renal tumor.</p><p><b>METHODS</b>Clinical data including image data, surgery type and prognosis etc were collected retrospectively for 122 cases from January 2010 to December 2012. There were 76 male and 46 female patients and they were 29-82 years (mean 51 years). The body mass index was (22.8 ± 3.9) kg/m(2). The patients were undergoing surgical excision with renal tumor of T1 stage. The R.E.N. A.L. nephrometry score was analyzed to evaluate their relationships to surgery type (RN or NSS) and the approach of NSS (ONSS or LNSS) using chi-square tests, Fisher's exact tests, and logistic regressions analysis.</p><p><b>RESULTS</b>All surgery had been completed. The surgery included RN of 45 patients, LNSS of 45 patients and ONSS of 32 patients. The R.E.N. A.L. nephrometry score was significantly associated with the type of surgery (χ(2) = 27.89, P < 0.05), and the NSS approach (χ(2) = 12.87, P < 0.05). When the scores less than 7 points, it is majorly treated by nephron sparing surgery (92.9%), and when the scores more than 9 points, it is majorly treated by radical nephrectomy (69.4%). Individual component scores were analyzed to evaluate that they were all related to surgery type (χ(2) = 7.00-14.57, P < 0.05), and the individual component N associated the surgery type mostly. Furthermore, individual component R,E,N and L were statistically significant predictors of the NSS approach (χ(2) = 4.92-15.07, P < 0.05).</p><p><b>CONCLUSION</b>The R.E.N. A.L. nephrometry scoring system provides a simple, useful, and stable system to character the salient renal anatomy of T1 stage, and can provide the best surgery approach.</p>

Significance of the PADUA nephrometry scoring system in determining the operative method for T1 stage renal tumour / 中华泌尿外科杂志

Objective To evaluate the efficacy of preoperative aspects and dimensions used for an anatomical (PADUA) scores in determining the surgical approach for T1 stage renal masses.Methods From Jan 2010 to Dec 2012,clinical data of 122 cases (76 males and 46 females),who underwent surgery for T1 stage renal masses,were collected retrospectively.The mean age was 51 years(range 21-81) and mean body mass index was (22.8±3.9) kg/m2.Sixty-three tumors were found in left kidney and 59 in right kidney.Among them,78 patients were diagnosed as T1a stage and 44 patients were T1b stage.In patients with T1a stage,56 received nephron sparing surgery (NSS) and 22 received radical nephrectomy (RN).In patients with T1b stage,21 received NSS and 23 received RN.The PADUA nephrometry score was analyzed to evaluate their relationships to surgical type and the approach of NSS.Results According to the PADUA nephrometry score,the number of low risk,middle risk and high risk patients were 24,62,26,respectively.Inlow risk group,middle risk group and high risk group,the proportion of RN and NSS was 8.3％/ 91.7％,30.6％/69.4％,66.7％/33.3％.In 77 patients received NSS,the unmber of laparoscopic NSS and open NSS was 18 ∶ 4,25 ∶ 18,2 ∶ 10,respectively.The PADUA nephrometry score was significantly associated with the type of surgery (x2 =23.16,P＜0.01),and the NSS approach (x2 =13.57,P＜0.01).Tumor size (HR =2.79 ; 95％ CI,1.29-6.02 ; P＜ 0.01),percentage of tumor deepening into the kidney (HR =3.82; 95％CI,1.77-8.09; P＜0.01),longitudinal (HR=4.00;95％CI,1.83-8.72; P＜0.01),tumor relationships with renal sinus(HR=103.13; 95％CI,21.85-486.81 ; P＜0.01),tumor relationships with urinary collecting system (HR =15.11 ; 95％ CI,5.95-38.35 ; P＜ 0.01),rim tumor location (HR =3.50 ; 95％ CI,1.61-7.59; P＜0.01) were closely related with surgery approach.The correlation coefficients of relationship with renal sinus was highest (r=0.70).Conclusions The PADUA nephrometry score provides a simple,useful and stable system to character the salient renal anatomy and guide the surgery.Low risk group should consider the NSS as the first line therapy.NSS could also be chosen in the middle risk group.However,the renal anatomy in those patients should be referred.RN should be chosen in high risk group.