RESUMO
BACKGROUND:The changes of single cytokine before and after transplantation has no clinical significance in the diagnosis of acute rejection, but the joint monitoring of cytokines is better to determine the immune status of transplanted patients. OBJECTIVE:To observe the dynamics changes of Th1/Th2 cytokines before and after transplantation in order to investigate the clinical significance in the diagnosis of acute rejection. METHODS:It was a prospective cohort study. The Th1 and Th2 cytokine levels in the rejection group and non-rejection group were dynamical y monitored with double-antibody sandwich enzyme-linked immunosorbent assay before, and 3, 7 and 14 days after transplantation. RESULTS AND CONCLUSION:Before renal transplantation, the Th1 (γ-interferon and interleukin-12) cytokine levels in the rejection group were significantly higher than those in the non-rejection group (P<0.05);the Th2 (interleukin-4 and interleukin-10) cytokine levels in the rejection group were significantly lower than those in the non-rejection group (P<0.05). After renal transplantation, there were no significant changes in Th1 and Th2 cytokines levels of the non-rejection group at different time points;the Th1 cytokine levels in the rejection group were increased rapidly at different time points, and reached a peak before acute rejection, and the Th1 cytokine levels at different time points in the rejection group were significantly higher than those in the non-rejection group;the Th2 cytokines were increased gradual y in the rejection group, and reached a peak before acute rejection, and the Th2 cytokine levels at different time points in the rejection group were stil lower than those in the non-rejection group. The results showed that the Th1/Th2 cytokines in the non-rejection group were kept stably before and after renal transplantation, but not in the rejection group, in which, the Th1 cytokines were increased rapidly before acute rejection and the Th2 cytokines were increased gradual y.
RESUMO
Objective To summarize the experiences of 5-year relative living kidney transplantation in the minorities. Methods The clinical data of HLA matching, rejection, survival and causes of death were retrospectively analyzed from 2004 to July 2009. There were 97 blood relative donations, including 1 case of father → son, 1 case of daughter → father, 1 case of mother → son, 24 cases of donation between brother and sister, 2 cases of non-blood relative donors (husband and wife),1 case of inter-ethnics, and the remaining were collateral relative donors. All the donations were voluntary, and all the recipients were minorities and all donors were their blood relatives. There were no mismatch of gene matching of 6 antigenic sites (0 MM) in 1 patient, 1 mismatch point (1 MM) in 2 patients, 2 mismatch points (2 MM) in 5 patients, 3 mismatch points (3 MM) in 10 patients, 4 mismatch points (4 MM) in 21 patients, 5 mismatch points (5 MM) in 39 patients and complete mismatch in 22 patients. Results All donors were discharged after 1 week and followed up for 3-6 months. Blood creatinine was normal and urine protein was negative. Up to July 2009, the conditions of the recipients were as follows: (1) Ninety-one receptors survived after transplantation. The longest survival time was up to 5 years. Among 9 deaths, 1 case died from myocardial infarction, 1 case from hemorrhagic shock and the others from respiratory failure (7 %) ; (2) Two renal grafts lost their functions and the patients restarted dialysis, in whom the preoperative panel reactive antibodies (PRA) of 1 patient was high and the patient had postoperative acute rejection, and the other patient stopped immunosuppressive agents on his own, leading to renal function loss; (3) After transplantation 10 patients had acute rejection, of which 2 cases received methylprednisolone plus OKT3, and the remaining 9 patients were treated with methylprednisolone. All rejections were reversed; (4) Urethral fistula occurred in one case and was improved after 45 days. Three patients had vesicoureteral anastomotic stenosis and were cured surgically. lyrnph leakage occurred in one case and was improved after 2 months. Fourteen patients had lung infection, including 7 mild lung infections which were improved after treatment, and 7 severe lung infections which died from respiratory failure.Other complications included secondary diabetes mellitus (4 cases), urinary tract infection (2 cases),acute renal failure (2 cases), deep venous thrombosis (3 cases), drug-induced liver damage (5 cases),polycythemia (5 cases), hepatitis C (3 cases), chronic allograft nephropathy (3 cases), and all were improved after treatment. Conclusion Comprehensive assessments of the donors and receptors before transplantation are guarantee to successful living kidney transplantation from relative donors; Living kidney transplantation from relative donors has the advantages of good matching, short ischemia period of donated kidney, less rejections and high survival rate of transplanted kidneys.
RESUMO
Objective To find the spectacular indexes in the diagnosis of acute rejection of renal transplantation with color Doppler ultrasonography. Methods Forty-two patients with renal rejection were confirmed with percutaneous needle biopsy and 115 patients with stable renal function were confirmed with following-up (>1 year) and clinical examination. The length, width, thickness, cortex thickness and resistive index (RI) of two groups were analyzed statistically. Then the specificity, sensitivity, misdiagnosis rate, false negative rate and consistency rate of renal volume, pyramid swelling, echo weakening, RI＜0.7, RI≥0.7 and RI≥0.8 were calculated. Results The length, width and thickness were statistically different in two groups (P＜0.05). In patients with renal rejection, the marginal blood vessels in renal cortex decreased, and the blood velocity reduced obviously in the diastolic phase and RI increased obviously (P＜0.05). The sensitivity of the above indexes were 55.30%, 55.20%, 42.10%, 57.90%, 31.60%, respectively, while the specificity were 71.30%, 87.10%, 25.70%, 74.20% and 98.20%, respectively. Conclusion Enlargement of renal volume, swelling of renal pyramids, echo weakening and RI increasing are specific indexes for diagnosis of acute rejection of renal transplantation.