ABSTRACT
<p><b>OBJECTIVE</b>To investigate the effect of donor bone marrow transfusion on kidney function in renal allograft recipients.</p><p><b>METHODS</b>From May 1999 through May 2004, 74 cadaver renal transplant patients received postoperative donor bone marrow transfusion (DBMT group), the clinical outcomes were compared with 74 non-infused renal transplant recipients (control group). Both groups received the renal allograft from the same donor and were given equivalent immunosuppressant. The immunosuppressive regimen included tacrolimus/CiclosporinA, mycophenolate mofetil, and prednisolone maintenance. Patients were followed up for 24 to 108 months (mean 69.5 months).</p><p><b>RESULT</b>The serum creatinine concentrations of DBMT group at 1,2 and 3 y after operation were (105 + or - 23.9)micromol/L,(107.5 + or - 32.4) micromol/L and (115 + or - 26.6)micromol/L; those of control group were (114.7 + or - 28)micromol/L,(116.5 + or - 27.6)micromol/L and (125 + or - 32.6)micromol/L,respectively. Glomerular filtration rate (GFR) of DBMT group at 1,2 and 3 y after operation were (70.2 + or - 24.4)ml/min, (74.3 + or - 24.1)ml/min and (73.5 + or - 22.4)ml/min; those of control group were (62.4 + or - 15.8)ml/min, (63.9 + or - 18.7)ml/min and (61.9 + or - 20.3)ml/min. After 5 year-follow-up,the prevalence of proteinuria in DBMT group was 50% (37/74),that was 77% (57/74) in control group (P<0.01). Only 3/74 DBMT recipients had biopsy-proven chronic rejection, whereas 12/74 showed chronic rejection in the controls (P<0.05).</p><p><b>CONCLUSION</b>In kidney transplant recipients DBMC infusions may improve the long-term graft survival.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Bone Marrow Transplantation , Creatinine , Blood , Follow-Up Studies , Glomerular Filtration Rate , Kidney , Kidney Transplantation , Tissue DonorsABSTRACT
To assess the influence of cyclosporin A (CsA) and tacrolimus (FK506) on mycophenolic acid (MPA) and correlation analysis of the pharmacokinetic parameters and patient characteristics, clinical outcome in Chinese kidney transplant recipients, the pharmacokinetics of 1000 mg mycophenolate mofetil (MMF) twice daily was measured by high-performance liquid chromatography (HPLC). PKS (Pharmaceutical Kinetics Software) 1.0.2 software package was used for the calculation of pharmacokinetic parameters. The mean C(max), t(max), and AUC((0-12))were (21.88+/-10.52) microg/ml, (1.20+/-0.95) h, and (52.546+/-13.215) microg.h/ml, respectively. The level of AUC((0-12)) in the FK506 group was significantly higher than that in the CsA group. MPA appeared not to be affected by renal function. MPA AUC((0-12)) showed statistically significant difference according to the patient's gender.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Cyclosporine , Immunosuppressive Agents , Pharmacokinetics , Kidney Transplantation , Physiology , Mycophenolic Acid , Pharmacokinetics , TacrolimusABSTRACT
<p><b>OBJECTIVE</b>To study the diagnosis of adult nutcracker phenomenon (NCP) and assess the therapeutic value of endovascular stenting (ES) and superior mesentery artery transposition (SMAT) for the treatment of NCP in long-term follow-up.</p><p><b>METHODS</b>Six patients (6 men) aged 16 and 34 years old (mean age, 22.7 +/- 18.0 years) were diagnosed as having NCP using the examination of the doppler ultrasound and/or magnetic resonance of artery/digital radiography (MRA/DSA). Three patients underwent ES and 3 patients received SMAT for the treatment of the NCP patients associated with recurrent gross hematuria and left flank pain. Doppler ultrasound and urine examination were used at pre- and post-operation.</p><p><b>RESULTS</b>In 3 patients who underwent SMAT, the postoperative complications comprised retroperitoneal hematoma necessitating surgical revision (n = 1). Functional disorder of intestine (n = 1) and paralytic ileus (n = 1) that were resolved by conservative management. In 3 patients who experienced ES, 1 patient received surgical revision because the position of stent was not suitable in left renal vein but no other complication took place. During the follow-up of 6 approximately 50 months (mean 24.7 +/- 18.0 months), except that 1 patient's hematuria disappears at rest and reappears after motion while the other 5 patients remain asymptomatic and free of hematuria. The dopplar ultrasound showed the left renal vein diameters of the angel segment between superior mesentery artery and aorta were (0.18 +/- 0.05) cm preoperation and (0.65 +/- 0.17) cm postoperation, P < 0.001; the left renal vein diameters of the portal segment were (0.89 +/- 0.22) cm preoperation and (0.79 +/- 0.20) cm postoperation, P = 0.003; the left renal vein diameter's ratio between portal and angel segment were (4.99 +/- 0.79) preoperation and (1.23 +/- 0.16) postoperation, P < 0.001.</p><p><b>CONCLUSIONS</b>Dopplar ultrasound plays a very important role in the diagnosis of adult NCP. SMAT is an efficient surgical approach to the treatment of the nutcracker phenomenon and is associated with an acceptable risk of complications. But ES is safer and more efficient than SMAT and may represent a valuable approach to lessening the morbidity of surgical procedures. ES is a new therapeutic method for adult NCP.</p>