[Clinical effect analysis of 146 cases of ipsilateral simultaneous pancreas and kidney transplantation].

Objective: To investigate the clinical effect of ipsilateral simultaneous pancreas and kidney transplantation (SPK). Methods: A total of 146 cases of SPK surgeries completed in the Second Affiliated Hospital of Guangzhou Medical University from September 2016 to June 2020 were selected to summarize the outcome, curative effect and complications of the operation. Results: The patients were followed up for 1 to 45 months. Good clinical results were obtained in 146 patients. Renal function indicators suggest that on the 7th day after operation, the serum creatinine returned to normal level [142.4 (108.6, 213.4)µmol/L]. The index of pancreatic function decreased to the normal level as expected. The level of blood amylase was 160.5(109.3, 249.8) U/L within 7 days after operation, and then decreased. The trend of urinary amylase was similar to that of blood amylase, which was 240(121.0, 370.0) U/L 7 days after operation, and glycosylated hemoglobin decreased to the normal level (5.8%±1.4%) 1 month after operation. The main medical complications were infection including pulmonary infection (26.03%, 38/146), urinary tract infection (26.03%,38/146), and abdominal infection (4.79%,7/146), acute rejection including renal graft rejection (5.8%,8/146), pancreas/duodenum rejection (18.49%,27/146), and renal graft combined pancreatic graft rejeciton (6.85%,10/146), as well as gastrointestinal bleeding (30.82%,45/146), of which 5 cases were severe bleeding (3.42%, 5/146). The main surgical complications were poor incision healing (10.27%, 15/146), serious surgical complications including arteriovenous thrombosis of the transplanted pancreas (2.05%, 3/146) and intestinal leakage (0.68%,1/146). The 1-year and 3-year patient, renal and pancreatic survival rates were both 92.5%, 91.5% and 89.5%, respectively, and despite the death, the 1-year, 3-year transplanted kidney survival rate was both 99.3%, and 95% for the the 1-year, 3-year pancreas survival rate. Conclusion: Strict preoperative evaluation of the function of large organs, reasonable surgical methods, perioperative anticoagulation, and prompt diagnosis of complications can achieve good clinical results for patients with SPK.

[Clinical efficacy and safety of combined induction therapy with rituximab and ATG in highly sensitized kidney transplant recipients].

Objective: To summarize the efficacy and safety of the combination of rituximab and ATG as induction therapy in highly sensitized kidney transplant recipients. Methods: Clinical data of patients who received kidney transplantation from donation after cardiac death(DCD) in Organ Transplant Center of Second Affiliated Hospital of Guangzhou Medical University from January 1st 2015 to December 31th 2016 was retrospectively analyzed. Highly sensitized patients with over 30% active panel reactive antibody (PRA>30%) received rituximab, while non-sensitized recipients as controlled group. All selected patients were observed in the renal function, urine protein, hemogram and the variation of PRA at each time point. Acute rejection, infection required hospitalization, delayed graft function(DGF), primary nonfunction (PNF), graft dysfunction, the mortality rate of patients with good allograft function and the graft survival rate were also observed. Results: 46 groups of patients were selected into highly-sensitized group and non-sensitized group. In both groups, there was no statistical difference in the renal function, urine protein and WBC (all P>0.05). Highly sensitized recipients at day 7 and day 14 following the surgery, had a significantly lower percentage of lymphocyte counts and lymphocyte proportion compared to other groups, with statistical differences(all P<0.05). Both groups had a similar incidence of DGF(2.2%) and no occurrence of PNF. 19.5% of highly sensitized recipients experienced acute rejection and 13% in control group. More specifically, no statistical difference was noted in the rate of infection required hospitalization(30.4% vs 22.2%), graft loss(2.2% vs 0) and the mortality rate of patients with good allograft function(4.3% vs 2.2%)(all P>0.05). The graft survival rate was 97.8% in the highly-sensitized group, while 100% in the control group. And the rate of patient survival in these two groups was 95.7% and 97.8%, with no statistical differences(all P>0.05). Conclusions: Immune-induction therapy that combines Rituximab with ATG can significantly inhibit lymphocyte proliferation. It is effective and safe in treating hypersensitive patients. The survival rate of human/kidney of hypersensitive patients in the short and medium term is comparable to those with low immune risk.

[Clinical application of renal autotransplantation in complex urological diseases].

Objective: To summarize the experience of renal autotransplantation for severe iatrogenic proximal ureteral damage and renal artery aneurysms in eight patients and to explore the clinical application value of renal autotransplantation. Methods: Two patients of renal artery aneurysms and six patients of severe iatrogenic proximal ureteral damage between January 2010 and March 2018 in our center were retrospectively reviewed. Results: The procedures of eight cases were successful, with immediate return of renal function in the patients. The warm ischemia time was (3±1) minutes, the total operation time was (340±164) min, and the estimated blood loss was (180±60) ml, respectively. For renal artery anastomosis, six patients of severe iatrogenic proximal ureteral damage received end-to-end anastomosis between the internal iliac artery and renal artery, and two patients of renal artery aneurysms were treated with renal artery and internal iliac artery for reconstruction, then end-to-side anastomosis to recipien external iliac artery. A direct ureterovesical anastomosis was performed in seven patients, one patient was received pyeloureteroplasty. No serious complications of blood vessel and ureter were found during perioperative and long-term follow-up. All cases follow-up hitherto have normal renal function and blood pressure. Conclusions: Renal autotransplantation can be appropriate for patients with proximal ureteral loss and complex hilar renal artery aneurysms. In addition, it is able to protect renal functions to the most extent and provides a surgical alterative for complex renal diseases.

Effects of high pressure on the luminescent properties of nanocrystalline and bulk Y2O3:Eu3+.

High pressure-induced spectral changes in a 20-nm cubic nanocrystalline yttria doped with europium and its corresponding bulk were studied in the range of 550-750 nm, corresponding to the 5D0 --> 7Fd (J = 0-4) transitions. The results demonstrate that the bulk Y2O3 underwent phase transition from the cubic phase to the monoclinic phase as the pressure increased to 15 GPa, while the 20-nm nanocrystals did not. This can be concluded from the fact that the 5D0 --> 7F0 line and the three 5D0 --> 7F1 sublines originating from the cubic phase disappeared, while another group of 5D0 --> 7F0 and 5D0 --> 7F1 lines appeared. In addition, the relative intensity of the peak around 630 nm to that around 611 nm varied obviously as the pressure surpassed 15 GPa. The variations in the nanocrystals were more sluggish in comparison to those in the bulk, indicating that the nanocrystalline yttria had improved compressibility, which is attributed to an increased surface energy in nanocrystals. The local environment surrounding luminescent Eu3+ in the nanocrystals and the bulk both became more disordered with the increase of the pressure. The phase transition from the cubic to the monoclinic is irreversible.

[Intestinal flora in renal allograft recipients].

OBJECTIVE: To explore the change of 10 kinds of intestinal flora in renal allograft recipients and its significance. METHODS: Ten kinds of intestinal flora in faeces were investigated in 30 renal allograft recipients by Kang Bai's classification of flora, and compared with 100 patients with diarrhea and 30 normal controls. RESULTS: The number of enteric bacilli in renal allograft recipients (8.5 +/- 1.0 CFU/g) was increased more markely than in the diarrhea patients (7.7 +/- 1.1 CFU/g, P < 0.01). The number of bacteroid (7.8 +/- 0.6 CFU/g), bifidobactercium (7.7 +/- 0.3 CFU/g), eubaclerium (7.2 +/- 0.6 CFU/g), and clostridium (7.8 +/- 0.5 CFU/g) in renal allograft recipients were decreased more markedly in than normal control (8.2 +/- 0.7 CFU/g, P < 0.01, 8.3 +/- 0.7 CFU/g, P < 0.01, 8.1 +/- 0.9 CFU/g, P < 0.01, 8.0 +/- 0.8 CFU/g, P < 0.01), but the number of Bifidobactercum was higher than that is the diarrhea patients (7.3 +/- 0.6 CFU/g, P < 0.01). The number of eubacterium was Lower than that in the diarrhea patients (7.7 +/- 0.8 CFU/g, P < 0.01). Among 30 renal allograft recipients 3 had constipation and 20 diarrhea. Two cases died of toxic shock with serious diarrhea because of imbalance of intestinal flora. CONCLUSION: The imbalance of intestinal flora existes in the early stage of renal transplantation. It is characterized by anaerobic bacilli imabalance such as bifidobacteriam and may be a direct cause of intestinal infection as diarrhea.