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Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.
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Objective To summarize the outcomes and clinical experience of combined heart and kidney transplantation.Methods The clinical data of one case of combined heart and kidney transplantation were retrospectively analyzed.The kidney transplant was completed immediately after the heart transplant.The immunosuppressive therapy strategies included tacrolimus,corticosteroids and mycophenolate mofetil.Results For heart transplantation,heart cold ischemia time was 200 min,aorta blocking time was 136 min,and extracorporeal circulation time was 201 min.The kidney was transplanted to the right iliac fossa after heart transplantation.The endotracheal tube was removed 15 h after surgery.The patient was transferred to the general ward on the 8th day after surgery.The patient was discharged from the hospital at 27th day after surgery,the renal function was normal and no activity was restricted.Conclusion Reasonable perioperative management and selection of surgical methods are the keys to the success of combined heart and kidney transplantation.
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Objective To evaluate the effect of conversion from mycophenolic acid (MPA) to mizoribine (MZR) in renal transplant recipients with gastrointestinal tract (GI) symptoms.Methods A total of 355 renal transplant recipients with GI symptoms caused by MPA administration were enrolled from April 2015 to March 2017 in 25 different renal transplant centers in China.The symptomatic improvement of GI before (baseline) and after conversion to MZR (1,2,4 weeks) was assessed by each item of GI symptoms indication.In addition,the efficacy and safety of the conversion therapy during 12 months were determined.Results Patients showed improvement in GI symptoms including diarrhea,abdominal pain,abdominal distention and stomachache after conversion to MZR 1,2,4 weeks (P＜0.05).In patients with different severity of diarrhea,conversion to MZR therapy significantly improved diarrhea (P＜0.05).During 12 months,no patient experienced clinical immune rejection.We did not observe any infections,leucopenia and other serious side effects.Conclusion MZR could markedly improve GI symptoms caused by MPA administration in renal transplant recipients.
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Objective To investigate the feasibility of magnetic resonance diffusion tensor imaging (DTI) as a noninvasive way for assessment of kidney transplant function in the early posttransplantation period.Method Fifty-one kidney transplant recipients less than 1 month after kidney transplantation and 26 age-matched healthy volunteers were included and examined using a fatsaturated echo-planar DTI sequence in oblique-coronal orientation at 3.0 Tesla magnetic resonance (MR) imager (diffusion directions=6,b =0,300 s/mm2).According to the estimated glomerular filtration rate (eGFR) recorded and calculated on the examined day,all subjects were divided into four groups:group 1,healthy volunteers (n =26) ; group 2,eGFR≥60 mL/min/1.73 m2 (n =24) ; group 3,30≤eGFR＜60 mL/min/1.73 m2 (n =19) ; group 4,eGFR＜30 mL/min/1.73 m2 (n =8).Mean apparent diffusion coefficient (ADC) and mean fractional anisotropy (FA) were determined separately for the cortex and the medulla.The paired Students t test was used to compare ADC and FA between cortex and medulla within each group.ADC and FA between groups were compared by using the one-way analysis of variance test.Relationship between ADC and FA with eGFR of the transplants was assessed by using Pearson correlation analysis.Result Mean cortical FA was significantly higher in group 1 than in other three groups (P＜0.01 for all),while differences among groups of allograft recipients were not significant (P＞0.05 for all).There was a gradually decreasing trend of medullary FA and ADC,and cortical ADC from group 2 to group 4,and the differences among groups were all pronounced (P＜0.05 for all).In renal allografts,there was a significant positive correlation between eGFR and medullary FA,medullary ADC as well as cortical ADC (r =0.812,0.756,0.757,respectively,P＜0.01).The cortical-medullary discrimination of FA-map and ADC-map in group 3 and group 4 apparently decreased.Meanwhile,DTI revealed that the radial diffusion tracts in the medulla of group 3 and group 4 obviously broke off and reduced,especially in group 4.Conclusion DTI is a promising way to evaluate kidney transplant function early after transplantion,and can quantitatively and visually distinguish transplants with different functions.
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Objective To analyze the complications, treatments and prognosis of simultaneous pancreas-kidney transplantation. Methods Forty cases of simultaneous pancreas-kidney transplantation performed between Dec. 1999 and Jan. 2010 in our center were retrospectively analyzed. Results Regarding surgical complications, 4 cases had severe hematuria after operation,which needed clinical intervention, including 1 patient receiving catheterization in duodenum to stop bleeding. Two patients were treated with continuous bladder irrigation, and the remaining one received surgical haemostasis because of donor's duodenum and bladder anastomotic artery hemorrhage.Abdominal hemorrhage occurred in 4 patients, including pancreatic hemorrhage in 3 cases and duodenal muscularis hemorrhage in one case. All of them received surgical treatment for hemostasis.Abdominal infection occurred in 8 cases: one died of multiple organ failure, 2 cases were cured after drainage of abscess, 2 cases underwent surgical removal of abscess, and 3 cases were cured after antibiotic therapy. In one case of postoperative anastomotic leakage, pancreas was resected. Four cases of postoperative ileus were cured by continuous clysis with traditional Chinese medicine. Seven cases had pulmonary bacterial infections, including one cases associated with fungal infection. They were cured by the anti-infective treatment. Other complication included poor healing in 5 cases and urinary infection in 2 cases. After combined simultaneous pancreas-kidney transplantation, 10 patients received reoperation because of surgical complications (14 operations). The re-operation rate was 25 %, including 2 patients (4 operations) for hematuria, 4 patients for abdominal hemorrhage, 2 patients (3 operations) for abdominal infection, 1 patient for pancreatic venous thrombosis, 1 patient for anastomotic leakage, and 1 patient for pancreatic fistula. Conclusion Although simultaneous pancreas-kidney transplantation provides a successful and effective treatment for diabetics with endstage renal disease, surgical complication is still affecting the pancreas and kidney grafts after transplantation.
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Objective To investigate the merit and demerit for surgical excision of polycystic kidney at the same time of kidney transplantation and to analyze its effect on complications and prognosis.Methods The data of 63 cases of polycystic kidney were retrospectively analyzed.Among the 63 recipients,43 recipients were combined with polycystic liver,and 2 with pancreatic cyst.For the large size of polycystic kidney,in 31 patients with hematuria or urinary tract infection,the polycystic kidney was resected during kidney transplantation(kidney-cut group,31 cases).The polycystic kidneys in The remaining 32 cases were preserved during kidney transplantation (reservation group).All the recipients were treated with CsA(Tacrolimus),mycophenolate mofetil (MMF)and prednisone after transplantation.The general conditions of recipients,the occurrence of delayed graft function(DGF),acute graft rejection.operative complications and infection,and survival rate of recipients and grafts were observed.Results Operative time in kidney-cut group was (300±31)min,and perirenal drainage tube duration was(4.6±1.4)days in kidney-cut group,significantly longer than in reservation group(both P＜0.01).Volume of red blood cells transfusion in kidney-cut group was(4.31±1.05)U,significantly more than reservation group(P＜0.01).29.0%(9/31)recipients in kidney-cut group had surgical complications,significantly higher than reservation group(6.2 0A,2/32)(P＜0.05).The ineidence of urinary tract irdection was 31.2% (10/32)in reservation group,significantly higher than in kidney-cut group(6.5%,2/31,P＜0.05).12.5%(4/32)patients in reservation group needed surgical excision of polycystic kidney after kidney transplantation due to polycystic kidney infection.In 24 recipients with preoperative high blood pressure in each group,the blood pressure of 8 recipients(33.3%)in kidney-cut group returned to normal,compared with only 2 recipients(8.3%)in reservation group(P＜0.05).The incidence of DGF,incidence of acute rejection,human/kidney 1-and 5-year survival rate between 2 groups had no statistically significant difference.Conclusion As long as the detailed operation.it is safe to resect patient's polycystic kidney during renal transplantation,but there are no effects on patient/kidney survival rate.