[Combined application of 2 micron microwave resection and laparoscopy in treatment of urinary tumor in patients after renal transplantation].

OBJECTIVE: To reduce the negative intervention for the transplant kidney and explore the optimal operational method for treating urinary tumor in patients after renal transplantation. METHODS: From March 2006 to March 2013, a total of 12 post renal transplantation patients with renal pelvis tumor/ureter tumor underwent operations. After the general anesthesia, the patient was placed in lithotomy position. The 2 micron microwave resection was performed, with the ureteral orifice as the center. After the ureteral wall section was resected, the resection was forwarded 6 cm. Then the patient was placed in lateral position. The laparoscopic radical nephrectomy was performed, and when this procedure was completed, the laparoscopy was converted to the other side to observe to the bladder side. Meanwhile, the operator pulled the ureter and maintained some tension, using the ultrasound knife to dissect the adjacent tissue and avoiding injuring the transplant kidney. With this method, the resected distal ureter and partial bladder were resected en bloc. In some condition, the uerteral tumor was tightly connected to the adjacent tissue, and the upper ureter failed to be removed completely, a short incision could be performed besides the musculus rectus abdominis. The Foley catheter had remained for 2 weeks after the operation. RESULTS: The 12 operations were successfully performed. The operation duration ranged from 110 to 290 minutes, and the bleeding volume was from 50 to 200 mL. Only one female patient developed secondary bleeding 18 hours after the operation, however, the secondary operation successfully stopped the bleeding. The mean hospital stay was 10.5 days. CONCLUSION: The combination use of 2 micron microwave resection and laparoscopy in the treatment of urinary tumor in patients after renal transplantation is effective, and has its advantages: lowering the risk of damaging the transplant kidney and easing the operation. Furthermore, this procedure is minimally invasive and safe. The patient could recover soon.

[Clinical analysis of urothelial cancer after renal transplantation].

OBJECTIVE: To analyze and summarize the risk factors of malignant tumor after renal transplantation. METHODS: We retrospectively analyzed 435 renal recipients who underwent renal transplantation in our institute from May 1991 to March 2011, and found 14 patients developed malignant tumor, of which 12 were from our institute, and the other 2 were referred from other institute. We analyzed the risk factors of those tumors for their incidence, classification, time of final diagnosis, immunity suppression therapy and prognosis. RESULTS: The incidence of malignant tumors after renal transplantation in our hospital was 2.8%.Of the 14 cases, 11 were urothelial tumor (6 cases developed both in pelvis and ureter, 2 cases of primary ureter cancer and 3 cases of primary bladder cancer), and the other 3 were thyroid carcinoma, colon carcinoma and lymphoma. We carried out radical corrections in 13 patients,of whom 10 were in good status, 2 underwent the secondary operation in 1 year due to relapse (one patient died in half a year due to tumor size expansion), and 1 died from repeated relapse in 3 years. Chemotherapy was used for the patient with lymphoma. CONCLUSION: Immunity suppression and surgery are associated with the high incidence of maglinant tumor (78% were urinary tract tumors) after renal transplantation. The risk of tumor is strongly associated with the recipient's survival. The key point of management is early diagnosis and treatment. Further attention should be emphasized to painless gross hematuria, unconfirmed back pain, hydronephrosis, hydroureter and infections.

Treatment of hyperhomocysteinemia and endothelial dysfunction in renal transplant recipients with B vitamins in the Chinese population.

PURPOSE: We studied the efficacy of B vitamins as a treatment for hyperhomocysteinemia and endothelial dysfunction in renal transplant recipients in the Chinese population. MATERIALS AND METHODS: A total of 36 stable renal transplant recipients with hyperhomocysteinemia were randomly assigned to folate treatment (5 mg folic acid per day, 50 mg vitamin B6 per day and 1,000 microg vitamin B12 per day) or to the control group (placebo only) for 6 months. All subjects underwent tests for creatinine, creatinine clearance rate, average blood pressure, total cholesterol, triglyceride and fasting homocysteine. Endothelial function was evaluated using high resolution vascular ultrasound. RESULTS: Homocysteine significantly decreased in those with folate treatment after intervention compared with baseline (12.6 +/- 3.9 vs 20.1 +/- 5.4 micromol/l, t = 5.3, p <0.01), whereas no significant changes were observed in controls. In the folate treatment group endothelium dependent and independent vasodilatation responses significantly increased after intervention (12.2% +/- 4.6% vs 8.8% +/- 5.2%, t = 2.9, p <0.01 and 17.6% +/- 3.9% vs 12.2% +/- 4.7%, t = 3.4, p <0.01, respectively). However, no significant changes were observed in controls. Endothelium dependent and independent vasodilatation responses were significantly lower in controls compared to levels in the folate group after treatment (8.7% +/- 6.3%, t = 2.8, p <0.01 and 12.2% +/- 5.3%, t = 3.5, p <0.01, respectively). CONCLUSIONS: Based on these data B vitamin supplementation may decrease blood homocysteine and improve endothelial function in renal transplant recipients with hyperhomocysteinemia.

[Analysis of eleven cases of severe pneumonia in kidney transplant recipients].

OBJECTIVE: To analyse retrospectively the diagnosis and treatment of severe pneumonia in kidney transplantation recipients. METHODS: Between January 1999 and December 2003, 172 adult patients underwent kidney transplantation at our department. In all severe pneumonia cases, empirical therapy was initiated with aztreonam, erythromycin and ganciclovir. And the therapy was switched to proper antibiotics according to the results of sensitivity testing. Responsible pathogen was detected by study of BAL (bronco-alveolar-lavage), sputum and blood specimen. Analyses included cell differential count, cytopathologic examination and cultures for bacteria, fungi and viruses. The immunosuppressive therapy was drastically reduced. Hypoxia was relieved by BiPAP (Bi-level Positive Airway Pressure) or mechanical ventilation if necessary. RESULTS: Seventeen cases (9.9%) of pneumonia were observed in the 172 recipients, only 11 (65%) patients experienced severe pneumonia, 1 (9%) of them died. Fever was the most common symptom on presentation (82%). On presentation 46% of the patients presented with classical clinical syndrome of fever accompanied by cough and dyspnea. Positive rate of BAL and blood culture were 100% and 46% respectively. BiPAP and mechanical ventilation were required in 6 and 2 cases respectively. CONCLUSION: BAL is preferred for early detection of responsible pathogen. A combination of drastic reduction of the immunosuppressive regimen, implementation of appropriate empirical antibiotics, proper BiPAP or mechanical ventilation are important.

[Treatment of hyperhomocysteinemia and endothelial dysfunction in renal-transplant recipients with vitamin B].

OBJECTIVE: To study the effect of vitamin B on treatment of hyperhomocysteinemia and endothelial dysfunction in renal-transplant recipients. METHODS: Thirty-six stable hyperhomocysteinemic renal-transplant recipients were randomly assigned to vitamin treatment (group A, n = 18, folic acid 5 mg/d, vitamin B(6) 50 mg/d, B(12) 1000 microg/d) or controlled group (group B, n = 18) for 6 months. All subjects underwent assessment of levels for creatinine, creatinine clearance, average pressure, total cholesterol, triglyceride and fasting homocysteine. Endothelial function was evaluated using high-resolution vascular ultrasound. RESULTS: The levels of homocysteine markedly decreased in group A [(13 +/- 4) micromol/L vs (20 +/- 5) micromol/L, t = 5.3, P < 0.01] after treatment, whereas no significant changes were observed in group B. In group A, endothelium dependent [(12 +/- 5)% vs (9 +/- 5)%, t = 2.9, P < 0.01] and independent [(18 +/- 4)% vs (12 +/- 5)%, t = 3.4, P < 0.01] vasodilatation responses significantly increased after treatment, no significant changes were observed in group B. Endothelium dependent [(9 +/- 6)%, t = 2.8, P < 0.01] and independent [(12 +/- 5)%, t = 3.5, P < 0.01] vasodilatation responses of group A were significantly lower than that of group B after treatment. CONCLUSIONS: Vitamin B supplementation can reduce the levels of homocysteine and improve the endothelial function in hyperhomocysteinemic renal-transplant recipients.

Electron paramagnetic resonance in monitoring of nitric oxide production after kidney transplantation in rats.

BACKGROUND: Much research has been focused on ischemia/reperfusion injury (IRI) to the transplanted organs. As a free radical, nitric oxide (NO) plays an important role in IRI. In this study, the production of NO and its functions during IRI were monitored in rat models after allotransplantation of kidney grafts. METHODS: Of 75 male LEW rats, 30 served as donors, and the remaining 45 rats were divided into three groups (15 rats in each group): controls (group 1), kidney allotransplantation followed by bilateral nephrectomy during reperfusion (group 2), 2 hours before operation, donors and recipients were treated with N(G)-nitro L-arginine methyl ester (L-NAME), a NO synthase inhibitor, at a dose of 30 mg/kg (group 3). Bilateral nephrectomies were performed while kidney grafts were reperfused. The kidney grafts were hypothemically stored for 24 hours. The production of NO before and after reperfusion was measured by electron paramagnetic resonance (EPR). The creatinine level, the glomerular filtration rate (GFR) and the protein carbonyl content in tissue samples were recorded on the first and the fifth day after operation. The data were evaluated by one-way analysis of variance. Differences were considered to be statistically significant when a P value was less than 0.05. RESULTS: After reperfusion for 15 minutes, the production of NO increased remarkably and kept increasing till 120 minutes, after which the level returned to normal. In group 3, which was pretreated with L-NAME, creatinine levels were higher than those in group 2 at the 24th hour (4.10 +/- 0.50 mg/dl vs. 3.77 +/- 0.42 mg/dl, P < 0.05) and the 120th hour (3.19 +/- 0.79 mg/dl vs. 2.22 +/- 0.53 mg/dl, P < 0.05). GFR levels in group 3 were lower than those in group 2 at the 24th hour (0.50 +/- 0.12 ml/min vs. 0.71 +/- 0.19 ml/min, P < 0.05) and the 120th hour (0.59 +/- 0.38 ml/min vs. 1.27 +/- 0.23 ml/min, P < 0.01). The content of protein carbonyl in tissue samples of group 3 was lower than that in group 2 at the 24th hour (29.01 +/- 7.02 nmol/mg protein vs. 49.39 +/- 13.13 nmol/mg protein, P < 0.05), but was higher than that at the 120th hour (75.71 +/- 16.74 nmol/mg protein vs. 57.93 +/- 15.32 nmol/mg protein, P < 0.05). CONCLUSIONS: After transplantation of hypothemically stored kidney grafts, the increased NO production in the early stage has protective effects on the transplanted kidney. Application of L-NAME to inhibit NO production is harmful to the recovery of the renal functions of kidney grafts.