Applications and new understandings of protocol biopsy during kidney transplantation / 中华器官移植杂志

Protocol biopsy (PB) is a planned needle biopsy of transplanted kidney and pathological observation for timely diagnosing the potential complications in transplanted kidney and guiding clinical interventions and adjusting immunosuppression regimen before an onset of dysfunction of transplanted kidney.With accurate information, it may grasp the baseline data of transplanted kidney histopathology.If detected early, timely measures may avert the existence of subclinical rejection or viral infection, avoid inflammation or injury and prevent various complications to ensure a better prognosis of transplanted kidney.At the same time, it is imperative to recognize the disadvantages of procedural biopsy, such as invasiveness, time consuming, greater patient discomfort and medical expenditure.This review focused upon the advantages and disadvantages of PB and its clinical application value.In light of the latest advances of clinical researches, favorable factors of PB are optimized for better long-term functional survival of transplanted kidney.

Ureteroscope/flexible combined with balloon in the treatment of ureteral stricture with stones in transplanted kidney: a report of 9 cases in a single center / 现代泌尿外科杂志

【Objective】 To evaluate the efficacy and safety of ureteroscope or flexible ureteroscope combined with balloon dilatation in the treatment of ureteral stricture with renal calculi in transplanted kidney. 【Methods】 The clinical data of 9 patients treated in our hospital during 2016 and 2022 were reviewed. The changes of the width of hydronephrosis, levels of creatinine and urea nitrogen, reoperation, and re-dwelling of stents were analyzed. 【Results】 One patient failed the operation because the guide wire could not be inserted, and the other 8 patients successfully completed the surgery. The stents were removed 6 to 8 weeks after surgery. During the follow-up of 8 to 48 months, no recurrence of renal calculi occurred; 5 patients had no recurrence of ureteral stricture; 3 patients (cases 4, 6, 9) underwent regular ureteral stent replacement due to hydronephrosis; the width of hydronephrosis, creatinine and urea nitrogen levels of 8 patients were significantly improved (P<0.05). 【Conclusion】 Ureteroscope/flexible with balloon dilatation is safe and effective in the treatment of transplanted kidney with ureteral stricture and kidney stones.

Effect of the ratio of living related donor renal volume to recipient body surface area on early function of transplanted kidney / 器官移植

Objective To investigate the relationship between the ratio of living related donor renal volume (RV) to recipient body surface area (BSA) (RV/BSA) and early postoperative function of transplanted kidney. Methods Clinical data of 120 pairs of donors and recipients undergoing living related renal transplantation were retrospectively analyzed. According to the RV/BSA ratio, the recipients were divided into group A (RV/BSA<65.33 mL/m2), group B (RV/BSA 65.33~76.49 mL/m2), group C (RV/BSA 76.50~96.96 mL/m2) and group D (RV/BSA > 96.96 mL/m2). The postoperative estimated glomerular filtration rate (eGFR) of recipients was compared among 4 groups. The correlation between the RV/BSA and eGFR of recipients at postoperative 6 and 12 months was analyzed. Results The eGFR at postoperative 6 month in group A was significantly lower than that in groups B, C and D (t=2.313, 2.947, 5.903; all P<0.05). The eGFR at postoperative 12 month in group A was also significantly lower than that in groups B, C and D (t=2.189, 2.433, 2.909;all P<0.05). The RV/BSA was significantly correlated with the eGFR of recipients at postoperative 6 and 12 months (all P<0.05).Conclusions RV/BSA is intimately correlated with the early function of transplanted kidney after living related renal transplantation.

Interventional treatment of the complications occurring after renal transplantation: a clinical study / 介入放射学杂志

Objective To evaluate the safety and effectiveness of multi-mode interventional therapy for complications occurring after renal transplantation.Methods The clinical data of 26 patients with complications occurring after renal transplantation were retrospectively analyzed.Vascular and non-vascular complications were treated with different interventional techniques,and the curative effects were analyzed.Results Vascular complications were observed in 19 patients and non-vascular complications were seen in 7patients.The technical success rate of interventional therapy was 100％.One week after the treatment,the total creatinine level (SCr) was significantly improved,which decreased from preoperative (372.7±295.5)μmol/L to postoperative (184.3±138.4) μmol/L (P＜0.001).No severe complications occurred.Further analysis indicated that no statistically significant differences in patient's general condition,kidney donor source,anastomosis method existed between vascular intervention group and non-vascular intervention (P＞0.05).However,the onset time of vascular complications was markedly earlier than that of non-vascular complications (1.8± 1.4 months vs.118.3 ±54.4 months),the difference was statistically significant (P＜0.001).During the follow-up period lasting for 4-55 months (mean of 18.6 months),3 patients developed recurrence of complications;interventional therapy had to be carried out in 2 patients and their creatinine level returned to normal after treatment,and transplanted renal artery embolization had to be performed in the other patient as whose pseudoaneurysm became enlarged.Conclusion For the treatment of complications occurring after renal transplantation,interventional therapy is less-invasive,rapidly-effective and safe,this technique can timely and effectively improve the renal function and save the transplanted kidney.

Application value of contrast-enhanced ultrasound in vascular complications of transplanted kidney / 器官移植

Objective To evaluate the application value of contrast-enhanced ultrasound (CEUS) in the diagnosis of vascular complication (VC) of transplanted kidney. Methods Imaging data of conventional ultrasound and CEUS in 28 patients suspected with VC of transplanted kidney were analyzed retrospectively.The results of computed tomography angiography (CTA)or digital subtraction angiography (DSA)were served as the diagnostic standard. The value of CEUS in diagnosing VC of transplanted kidney was analyzed. Results No adverse reaction related to contrast agent was observed in 28 patients during the CEUS examination. And 22 cases with VC were confirmed. VCs were detected correctly by CEUS in 17 cases,but 5 cases with transplant renal artery stenosis (TRAS ) were missed and 1 case with focal infarction in transplanted kidney was misdiagnosed. The diagnostic sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV)and accuracy of CEUS for VC of transplanted kidney were 0.77,1.00,1.00,0.55 and 0.82, respectively. The diagnostic sensitivity,specificity,PPV,NPV and accuracy of conventional ultrasound and CEUS for TRAS were 0.37 and 0.74,0.89 and 1.00,0.88 and 1.00,0.40 and 0.64,0.54 and 0.82, respectively. There were significant differences in the sensitivity and accuracy between conventional ultrasound and CEUS (both in P<0.05 ). Conclusions CEUS is an effective method for detecting VC of transplanted kidney.

Anti-HLA and anti-MICA antibodies are positively correlated with transplanted kidney dysfunction / 中华微生物学和免疫学杂志

Objective To study the correlation between transplanted kidney dysfunction and oc-currence of the panel reactive antibody ( PRA, also referred as anti-HLA antibody ) and anti-Major-Histo-compatibility-Complex class Ⅰrelated chain A (MICA) antibody.Methods The tests for detecting PRA and anti-MICA antibody were performed on 679 renal transplant patients from December , 2009 to June, 2010 who received transplantation before 2008 in Beijing Friendship Hospital .Enzyme-Linked Immunosor-bent Assay ( ELISA) was used to detect anti-HLA antibody using LAT-1240 ( OneLambda Inc .) .MICA Ab-Scan Kit was adopted to detect anti-MICA antibody .Continuous observation of graft function was conducted . Results 108 out of 679 patients showed anti-HLA antibody and/or anti-MICA antibody positive results . Among them, 81 patients were positive only for anti-HLA antibody, 18 patients were positive only for anti-MICA antibody and other 9 patients showed anti-HLA and anti-MICA antibodies double positive .Among all of the kidney transplant patients with a failed or decreased renal function , 71 patients were positive for anti-HLA antibody;16 patients were positive for anti-MICA antibody;and other 9 patients were positive for both anti-HLA and anti-MICA antibodies .The results demonstrated that anti-HLA and anti-MICA antibodies af-fected the renal functions in patient with renal transplantation (χ2 =353.92, P <0.001).Conclusion Anti-HLA and MICA antibodies showed significant positive correlations with chronic allograft failure in the patients with renal transplantation .

Acute Renal Failure in a Renal Allograft Recipient Caused by a Post-Biopsy Renal Arteriovenous Fistula with Transplant Renal Artery Stenosis / 대한이식학회지

Renal biopsy is an essential diagnostic tool for detecting acute and chronic kidney rejection as well as recurrent and de novo nephropathies in renal allograft recipients. However, a well-known complication of percutaneous renal biopsy is arteriovenous fistula (AVF). Most post-biopsy AVFs are asymptomatic and regress spontaneously but some AVFs result in hypertension, hematuria, and renal insufficiency. Whether post-biopsy AVF superimposed on transplant renal artery stenosis (TRAS) also regresses spontaneously is unknown. We present a case of acute renal insufficiency in a 51-year-old female renal allograft recipient with post-biopsy AVF and TRAS. Percutaneous angioplasty with stent implantation was performed for the TRAS and transcatheter arterial coil embolization therapy applied for AVF. The patient's renal function returned to baseline levels and is currently being followed up for 6 months.

Three-dimensional imaging of living transplanted kidney vasculature by 3D color Doppler ultrasonography.

Background: It is of clinical importance to display the vasculature of transplanted kidney in three-dimensional (3D) and in non-invasive way. 3D color Doppler ultrasonographic imaging (3D-CDUI) is a non-invasive technique to display the 3D vasculature of living organs. Objective: Probe into characteristics of 3D vasculature of living transplanted kidney by 3D-CDUI, and evaluate the clinical value of 3D-CDUI on monitoring complications after operation of renal transplant. Methods: Nine patients who received allogeneic transplantation of kidney were monitored with 3D-CDUI. The instruments used included ACUSON Sequoia 512 and TomTec computer station of 3D-CDUI. Using magnetic positioning free-hand scanning, the 3D reconstruction and display of renal tissue structure and blood flow were performed off-line. Results: All patients underwent 3D-CDUI examinations without any side effect or complication. When acute rejection occurred, the 3D distribution change of renal blood flow signal could be observed clearly. During treatment of acute necrosis of renal tubules, changes of renal blood flow signal in 3D color Doppler images could be detected earlier compared with 2D color Doppler images. The position of embolized vassels could be diagnosed accurately by 3D-CDUI. Conclusion: The 3D-CDUI was helpful to improve diagnosis level of ultrasonography by monitoring complications after renal transplantation.

Aneurisma de artéria renal em rim transplantado: reparo ex vivo e reimplante do enxerto / Renal artery aneurysm in a transplanted kidney: ex vivo graft repair and reimplantation

Aneurisma verdadeiro de artéria renal em rim transplantado é ocorrência rara. As possibilidades de tratamento dependem do tamanho, da localização do aneurisma e da clínica apresentada pelo paciente. Descreve-se um caso de aneurisma gigante de artéria renal em rim transplantado que recebeu tratamento ex vivo e reimplante na fossa ilíaca direita. Detalhes do procedimento cirúrgico são descritos.

True aneurysm of a renal artery in a transplanted kidney is a rare occurrence. Treatment options depend on size and location of the aneurysm and the patient's clinical condition. We report a case of a giant aneurysm of the renal artery in a transplanted kidney that was treated ex vivo and reimplanted in the right iliac fossa. Details of the surgical procedure are described.

The Effects of the Duration of Chronic Renal Failure and Hemodialysis on Transplanted Kidney / 대한이식학회지

Immunodeficiency of the patients with end-stage renal disease and various side effects of hemodialysis have been studied. We want to evaluate the effects of the duration of chronic renal failure(CRF) and hemodialysis on transplanted kidneys. This report is based on 111 patients who had received kidney transplantation at Wonkwang university hospital from August 1987 to march 1996. The patients were classified into 3 groups according to the duration of CRF; Group I(1yr and 5yr, n=15). The incidence of acute rejection within 6months was 28(60.8%) in group I, 31(62%) in group II, 9(60%) in group III. The 3-year graft survival rate was 34(73.9%), 38(76%), and 14(93.3%), respectively. The bacterial infection rate of each group within 1 year was 10(22%), 8(15%), and 4(28%). The viral infection rate of each group within 1 year was 15(33%), 11(27%), and 5(35%). To evaluate the effects of hemodialysis, the patients were divided into 3 groups; Group A(without hemodialysis, n=8(7.2%)), Group B(6 months, n=63(56.7%)). The incidence of acute rejection within 6months was 6(75%) in Group A, 24(60%) in Group B, 38(60.3%) in group C. The 3-year graft survival rate was 6(75%), 30(75%), and 50(79.3%), respectively. The bacterial infection rate of each group with 1 year was 2(25%), 10(25%) and 13(26%). The viral infection rate within 1 year was 2(25%), 16(40%) and 13(20.6%). The authors' analysis reveal the 3-year survival rate in the group III was higher than the other groups. But there was no significant difference of acute rejection rate, infection rate and wound complication rate. We suggest more basic study of the immune status of chronic renal failure patients is needed to provide proper immunosuppressive regimen according to the duration of end stage renal disease and hemodialysis.

A case of transplanted kidney stone treated by ESWL / 대한비뇨기과학회지

Urinary calculi are an uncommon complication in renal transplant recipients. We report a case of transplanted kidney stone preexisting in the donor kidney. which was treated successfully with extracorporeal shock wave lithotripsy.