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Objective To summarize the clinical treatment experience of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection after renal transplantation in donation after cardiac death (DCD) era. Methods Clinical data of 10 donors and 17 recipients with CRKP infection after DCD renal transplantation from January 2015 to January 2019 were retrospectively analyzed. Both donors and recipients received bacterial culture and drug sensitivity test. Clinical manifestations, treatment and outcome of CRKP-infected recipients were recorded. Results Seven donors were infected with CRKP. After pretreatment, CRKP in 2 cases turned negative, CRKP in 5 donors did not turn negative. All renal grafts were treated with tigecycline+meropenem+voriconazole lavage to prevent infection. Among 17 recipients with CRKP infection, 11 cases were positive for blood culture, 10 positive for urine culture, 3 positive for sputum culture, 3 positive for incisional secretion and 3 positive for retroperitoneal drainage. Clinical manifestations included fever in 8 cases, rupture and hemorrhage of the transplant renal artery in 7 cases or thrombosis in the transplant renal artery in 1 case, bladder irritation sign in 3 cases and cough with brick red jelly-like sputum in 1 case, respectively. Five patients were treated with tigecycline+meropenem, 1 patient suffered from renal graft loss and 4 recipients died. Twelve patients were treated with ceftazidime-avibactam +meropenem, 3 patients presented with renal graft loss and 1 recipient died. Conclusions CRKP-infected donor is not the absolute contraindication of renal transplantation. Pretreatment of donor infection and early administration of sufficient sensitive antibiotics can cure CRKP infection and improve the clinical prognosis of renal transplant recipients.
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Objective:To explore the risk factors of pulmonary infection in elderly (aged 60+ years) kidney transplant recipients.Methods:The clinical data were retrospectively analyzed for 119 elderly kidney transplant recipients from January 2010 to January 2019 . According to whether or not pulmonary infection occurred after renal transplantation, the recipients were divided into infected group (n=40) and non-infected group (n=79). Clinical data was analyzed for two groups. The relevant risk factors of gender, age, donor type, body mass index, history of smoking, preoperative dialytic time, preoperative dialysis, immune induction, immune maintenance, presence or absence of delayed graft function, leucopenia, serum creatinine before infection, venous hormone shock therapy or not, diabetic history before or after surgery, history of coronary heart disease, history of hepatitis B virus, prophylactic dosing of compound sulfamethoxazole, prophylactic valganciclovir or ganciclovir, were examined by univariate analysis and multivariate logistic regression analysis.Results:The incidence of pulmonary infection in elderly kidney transplant recipients was 33.6% (40/119). In infected group, 15 patients died of severe pulmonary infection with a mortality rate of 37.5%(15/40). History of smoking (OR=10.58, 95%CI: 1.98-56.40, P=0.006), venous hormone shock therapy (OR=25.06, 95%CI: 4.25-147.71, P<0.001) and preoperative dialytic time (OR=1.032, 95%CI: 1.003-1.062, P=0.033) were the risk factors for pulmonary infection in elderly kidney transplant recipients. Conclusions:The incidence and mortality of lung infection are higher in elderly kidney transplant recipients. Smoking history, venous hormone shock therapy and long preoperative dialytic are associated with pulmonary infection in elderly kidney transplant recipients.
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Objective To investigate the characteristics and manifestations of the different stages of BK virus infection in the recipients after renal transplantation.Methods A retrospective survey from January 2015 to December 2016 was done in our hospital.A total 135 recipients were included and accepted BK virus detection in 1,3,6,9,12,15 months respectively after renal transplantation.The prevalence of decoy cell,BK virus DNA load in urine and BK virus DNA load in blood was 56 cases (41.5％),9 cases (43.7％) and 30 cases (22.2％),5 cases of BK vims nephropathy confirmed by pathological biopsy (3.7％).At the same time,51 cases (37.8％) were combined with decoy cells and virus DNA load in urine.Positive decoy cells and negative BK virus DNA load in urine was 5 cases,and Positive BK virus DNA load in urine and negative decoy cells was 8 cases.The recipients were divided into positive group of urine decoy cell,positive group of urinary BK virus DNA load,and positive group of blood BK virus DNA load.Statistical correlation analysis was conducted on the laboratory test results of the 3 groups.Results The positive group of blood BK virus DNA load were detected the high level urine decoy cell count [median of 23/10HPF(2-48/10HPF)] and high level of urinary BK virus DNA load [4.52 × 106 copies/ml (6.51 × 103-7.89 × 109 copies/ml)],significantly higher than the positive group of decoy cells [8/10HPF(2-40/10HPF)] and the positive group of urine BK virus DNA load [4.56 × 105 copies/ml(5.62 × 103-7.89 ×109 copies/ml)] (P ＜ 0.05).The decoy cell count and urine DNA load has a significant linear correlation in viruria recipients,and the urinary BK DNA load and blood BK virus DNA load has the same significant 0.939 and 0.702 in 3 months,0.969 and 0.910 in 6 months,0.782 and 0.766 in 9 months,0.898 and 0.615 in 12 months after renal transplantation.Conclusions There is a linear correlation between decoy cell in urine,viruria and viremia,suggesting that the infection of BK virus in kidney transplant recipients is a continuous process.linear correlation in viremia recipients(P ＜ 0.05).The correlation coefficients at different time points were
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Objective To investigate the relationship between the metabolic rate of tacrolimus (FK506) and BK virus infection early after renal transplantation. Methods Eighty recipients undergoing allogenic renal transplantation in Institute of Organ Transplantation of the 309thHospital of Chinese People's Liberation Army were recruited in this study. The polymorphism of cytochrome P450 (CYP) 3A5 gene was detected in 80 recipients. All patients were divided into fast metabolism group ( CYP3A5*1/*3 and CYP3A5*1/*1 genotypes, n=38) and slow metabolism group ( CYP3A5*3/*3 genotype, n=42) based on the gene detection results. The distribution of CYP3A5 genotypes in 80 recipients was analyzed. The metabolic rate [concentration/dose ratio (C/D value)] of FK506 was statistically compared between two groups. The incidence of BK virus infection events [BK viruria, BK viremia and BK virus nephropathy(BKVN)] within postoperative 6 months were compared between two groups. Results Among 80 recipients, 5 cases (6%) were detected with CYP3A5*1/*1 genotype, 33 (41%) with CYP3A5*1/*3 genotype, and 42 (53%) with CYP3A5*3/*3 genotype. Among the 160 alleles in 80 recipients, 117 CYP3A5*3 allele were identified, suggesting that the mutation rate of CYP3A5*3 allele was 73.1%. In the fast metabolism group, the C/D values at postoperative 1, 3, and 6 months were significantly lower than those in the slow metabolism group (all P<0.01). The incidence rates of BK viruria in the fast and slow metabolism groups were 37% and 29%, 18% and 2% for BK viremia, and 3% and 0 for BKVN, respectively. In the fast metabolism group, the incidence of BK virenia was significantly higher than that in the slow metabolism group (P=0.02). The incidence of BK viruria and BKVN did not significantly differ between two groups (both P>0.05). Conclusions According to the CYP3A5 genotyping outcomes, the recipients with a high metabolic rate of FK506 have a high risk of BK viremia early after renal transplantation.
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Objective To analyze the impairment of renal allograft function in renal transplant recipients caused by BK virus infection after renal transplantation. Methods Clinical data of 210 recipients who underwent allogenic renal transplantation and received BK virus monitoring regularly were analyzed retrospectively. The incidence of BK viruria, viremia and BK virus nephropathy (BKVN) after renal transplantation was summarized. The effect of BK virus infection on renal allograft function and prognosis of renal allograft function after the removement of BK virus were analyzed. Results Among the 210 recipients, there were 46 cases with pure viruria, 46 cases with viremia complicated with viruria and 7 cases with BKVN confirmed by pathological biopsy. The level of serum creatinine (Scr) in the recipients with viremia after renal transplantation was linearly related to BK viral load in urine and blood (r=0.594, 0.672, both P<0.01). The level of Scr increased significantly when BK viral load in blood of the recipients with viremia was found positive for the first time, and increased continuously after viremia sustained. And the level of Scr decreased slightly when blood viral load turned to negative after treatment, but still significantly higher than before virus infection. All the above differences were statistically significant (all P<0.05). Compared with the basic level, there was no significant difference in the level of Scr of recipients with pure viruria during positive viruria (all P>0.05). Conclusions It will impair the renal allograft function when BK viremia occurs after renal transplantation, and it is necessary to monitor viral infection regularly. Once the blood BK virus is found positive, it shall be implemented immediately to reduce the intensity of immunosuppression as the preferred clinical intervention.
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Objective To investigate the clinical characteristics of DCD donor-derived CRKP infection and bleeding in kidney transplantation,and to summarize the experience of diagnosis,treatment and prevention.Methods A retrospective analysis was carried out from July 2016 to December 2017 in hospital,containing clinical data of 4 cases of CRKP-infected DCD donors and 7 cases of kidney transplantation recipients.Results In the CRKP culture of 4 cases of DCD donors,1 case was positive for blood culture,1 case was positive for urine culture,1 case was positive for sputum culture,and 1 case was negative for blood,urine and sputum culture.The corresponding 7 recipients were all positive for blood culture after renal transplantation,4 cases were positive for urine culture,3 cases were positive for sputum culture,and 5 cases were positive for perirenal drainage.Of the 7 patients,4 cases had renal artery hemorrhage,1 of them was died.The average bleeding time was 17.75 days after operation (14-19 days).In 7 patients with renal transplantation,CRP increasd.And in 3 cases of deaths,CRP was stably higher than normal.Meanwhile,CRP in 4 surviving patients gradually decreased to the normal range after effective anti-infection treatment.All 7 patients were treated with carbapenems;2 patients were dead without avibactam therapy;and 5 cases were treated with avibactam and carbapenems and survived,1 case died and 1 case had good renal function recovery.Conclusion Positive CRKP in blood,urine and sputum of DCD donors can lead to CRKP infection in kidney transplant recipients.Even if the body fluids of donors are all negative,the false negative results could not be excluded.Persistent or increased high-level CRP after operation is an early warning on CRKP infection.And CRP can be used as an indicator for evaluating the effectiveness of anti CRKP therapy.The combination of avibactam and carbapenem antibiotics is an effective regimen in the treatment of DCD donor-derived CRKP.
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Objective To compare the effects of cyclosporine A (CsA) and tacrolimus (FK506) on BK virus infection after renal transplantation by retrospective clinical study.Methods The data of calcineurin inhibitor (CNI)-based immunosuppression and virus infection were collected in allograft renal transplantation recipients (n =135) from Jan.2014 to Dec.2015.According to the severity of the virus infection the recipients were divided into three groups:viruria,viremia and virus nephropathy.The difference in BK virus infection between FK506 and CsA was compared.Results A total of 135 cases of transplant recipients,postoperative were enrolled.The number of viruria recipients given FK506 and CsA was 41 cases (69.5％) and 18 cases (30.5％),and that of viremia recipients was 26 cases (86.7 ％) and 4 cases (13.3 ％).Statistical analysis showed that CNI immunosuppressive agents had a significant correlation with viremia only (P＜0.05).There was a positive correlation between FK506 and viremia (r =0.423,P =0.018),and CsA showed a negative correlation yet (r =-0.336,P =0.022).Conclusion Tacrolimus is independent risk factors for early BK viremia after kidney transplantation,and CsA may inhibit the progression of BK viremia.
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Objective To analyze and summarize clinical characteristics and treatment of diffuse alveolar hemorrhage syndrome (DAHS)complication after renal transplantation.Methods Clinical data of one patient,admitted to the 309 th Hospital of People's Liberation Army in December 201 2, who was complicated with DAHS after renal transplantation,were obtained.The incidence,diagnosis and treatment courses of DAHS were retrospectively analyzed.Literature review was conducted to summarize clinical experience.Results The patient was clinically manifested with respiratory failure,progressive aggravation of hemoptysis and anemia.Imaging examination revealed that diffusive infiltration of bilateral lungs was aggravated.After the diagnosis of DAHS was confirmed,adrenal cortical hormone (hormone)shock and anti-infectious medication therapies were timely delivered to actively prevent and treat relevant complications.The patient was successfully healed.Until the submission date,the patient presented with normal renal function and no pulmonary complications were noted.Conclusions DAHS is a rare and fatal complication after renal transplantation.Early diagnosis, active anti-infection therapy and timely administration of large-dose hormone shock treatment determine the success of clinical treatment.
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Objective To analyze the clinical efficacy of multiple renal arteries on outcomes of renal donors and recipients in hand-assisted retroperitoneoscopic donor nephrectomy.Method From 2012 to 2014,121 patients underwent hand-assisted laparoscopic donor nephrectomy,including 92 cases of a single renal artery and 29 cases of multiple arteries.Donor and recipient outcomes for single artery and multiple arteries allografts were compared.Result The study included 121 pairs of donors and recipients.The demographic characteristics between multiple renal artery group and single renal artery group had no significant difference.The operative time,blood loss,postoperative complications,and hospital stay had no significant difference between two groups.Cold ischemia time and warm ischemia time in multiple renal artery group were longer than single donor renal artery group (128.5 ± 13.2 vs.50.2 ± 17.3 min,P＜0.001;196.0 ± 63.3 vs.154.1 ± 55.2 min,P=0.002,respectively).The operative time in multiple renal artery group was longer than in single renal artery group (213.5 ± 28.2 vs.182.2 ± 31.1 min,P＜0.001).There was no significant difference in blood loss,vascular complications and ureternal complications between two groups.The renal functions of two groups were likewise within one year.Conclusion There was no statistically significant difference in clinical efficacy between hand-assis-ted retroperitoneoscopic donor nephrectomy with multiple renal arteries and single artery.The use of these grafts was safe for both recipients and donors.
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Objective To investigate the effect of body mass index (BMI)on short-term prognosis of patients after renal transplantation.Methods Clinical data of 1 041 adult patients undergoing the first renal transplantation in the Institute of Organ Transplantation of the 309 th Hospital of People's Liberation Army from March 2009 to March 201 3 were retrospectively studied.According to the Adult Obesity and Overweight Standard commonly used in China,these patients were divided into 4 groups:112 patients in BMI <1 8.5 kg/m2 group (emaciation group),606 patients in BMI 1 8.5-23.9 kg/m2 group (normal group),250 patients in BMI 24.0-27.9 kg/m2 group (overweight group)and 73 patients in BMI≥28.0 kg/m2 group (obesity group).The incidence of delayed graft function (DGF)and acute rejection (AR)of the 4 groups one year after renal transplantation were observed and compared.One-year patient and graft survival rates were calculated.The relationship between BMI and DGF was studied by univariate and multivariate Logistic regression analysis to investigate the effect of different BMI on DGF.Results After the follow-up for one year,the incidence of DGF in the obesity group was significantly higher than that in the emaciation group and the normal group(both in P <0.05).The difference in the incidence of acute rejection one year after renal transplantation as well as one-year patient or graft survival rate had no statistical significance (all in P >0.05).Univariate analysis showed that obesity increased the risk of DGF after renal transplantation (OR was 1 .33,P <0.05).Multivariate analysis showed that both overweight and obesity were independent risk factors of DGF after renal transplantation (OR was respectively 1 .56 and 1 .37,both in P <0.05).Conclusions Overweight and obesity increases the risk of DGF after renal transplantation,but do not increase the incidence of AR after renal transplantation and do no influence short-term patient and graft survival rates after renal transplantation.
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Objective To observe the curative effect and adverse reaction of benazepril on polycythemia (PTE ) after renal transplantation. Methods Twenty-two patients undergoing kidney transplantation for the first time at the Department of Urinary Surgery of the 309 th Hospital of People's Liberation Army and developed PTE after renal transplantation from June 2012 to June 2013 were enrolled as the object of study.The patients were divided into the hypertension group (n =14)and the normal blood pressure group (n =8)according to whether the patients were with hypertension or not.The hypertension group was given benazepril with an initial dose of 10 mg/d and increased to the maximum dose of 40 mg/d according to the changes of patients’conditions.The normal blood pressure group was given benazepril with an initial dose of 5 mg/d and with the maintenance dose of 2.5 mg/d after hemoglobin and hematokrit returning to normal.The patients in two groups were followed up for 6 months.The curative effect and adverse reactions during the follow-up were compared between the two groups.Results After 6 months of treatment,12 patients had marked effect,1 had effect and 1 was improved in the hypertension group.Six patients had marked effect, 1 had effect and 1 had no effect in the normal blood pressure group.The difference of efficacy had no statistical significance between the two groups (P >0.05).During the treatment,the blood pressure of the hypertension group dropped significantly (P <0.05 ),while that of the normal blood pressure group had no significant change.Red blood cells,neutrophils,platelets,serum creatinine,uric acid and estimated glomerular filtration rate of the two groups had no obvious abnormality before and after treatment.One patient in the hypertension group developed irritable cough during the treatment and recovered after withdrawal.Conclusions It is safe and effective to take benazepril for patients with PTE after renal transplantation.It is recommended to start with small dose and the dose shall be adjusted according to blood pressure.The blood pressure,blood routine and renal function shall be monitored during the treatment.
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Objective To examine the relationship between hypercalcemia (HC) and the development of posttransplant erythrocytosis (PTE).Method 169 patients with normal graft function who underwent renal transplantation between January 1, 2012 and January 1, 2014 in 309th Hospital of PLA were retrospectively reviewed.Result 169 patients with normal graft function who underwent kidney transplantation for the first time in 309th Hospital from January 1, 2012 to January 1, 2014 were enrolled, including 121 males and 48 females.During the follow-up period, PTE appeared in 48 (28.4％) patients.Thirty-three (19.5％) patients developed HC, PTE occurred in 17/33 (51.5％) patients with HC, and in 31/136 (22.8％) patients without HC.PTE and HC were highly correlated (P＜0.001).Serum calcium levels tended to increase in patients with PTE, but significantly decreased in patients without PTE.HC patients had a higher probability of PTE (51.5％ vs.22.8％;P＜0.001).Similarly, HC was more common among patients with PTE compared with patients without PTE (35.4％ vs.13.2％;P＜0.001).Simple linear regression analysis showed that calcium concentration was independent predictor of hemoglobin levels (P＜0.01).In multivariate analysis, multiple linear regression model showed that the calcium concentration was still a significant predictor of hemoglobin levels (P＜0.001).Multivariate logistic regression analysis showed that the occurrence of HC was an independent risk factor of PTE (P =0.01).Estimated glomerular filtration rate was also associated with PTE (P =0.012).As compared with women, the relative risk of men who had PTE was 4.373 times (P＜0.05).The risk of PTE in patients with HC was about five times higher than in patients with normal blood calcium.Conclusion HC is associated with PTE.HC may lead to the increased PTE in renal transplant recipients.
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Objective To investigate the epidemiological characteristics of polyomavirus type BK infection in renal transplant recipients.Method We systematically screened for active BKV infection preoperation and at 0.5,1,3,6,9,12 and 15 months after transplantation in 116 renal transplant recipients.The screening tests included urine cytology (by the Papanicolaou method) and BKV DNA PCR (the kit for testing the BK virus) assay of both urine and plasma,and the results were recorded.Renal biopsy was performed if the graft function was deteriorated gradually or the loads of BKV replication were very high.Routine histopathological examination and immunohistochemistry were performed on renal tissues from partial patients who received the tests of renal biopsy.Result Throughout the follow-up of 15 months,urinary decoy cells (median 8/10 HPF,[1～ 48/10 HPF]),BKV viruria (median 2.63 × 105 copies/mL,[1.78 × 103 ～ 8.54 × 109 copies/mL]),BKV viremia (median 2.70 × 104 copies/mL,[1.95 × 103 ～6.31 × 106 copies/mL]),and BKVAN (4 patients) occurred in 53.46％,24.17％,20.72％ and 3.45％ of renal-transplant recipients,respectively.The positive rate of the decoy cell and BKV DNA in urine reached the peak at the third month to the ninth month after transplantation,and the peak time of the BK viremia was the fifth month post-transplantation throughout the follow-up period.The change in BKV DNA level remained constant in blood and urine throughout the follow-up period.Conclusion The peak time of BKV infection was apparently three to nine months after transplantation,suggesting the importance of monitoring urine cytology and BKV DNA loads in post-transplantation patients closely during this period in order to reduce BKVAN after transplantation.
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Objective To investigate the clinical efficacy of BK viremia and BK virus-associated nephropathy (BKVAN) with rescuing therapy in renal-transplant recipients.Methods We systematically screened for active BKV infection at 0.5,1,3,6,9,12 and 15 months after transplantation in 116 renal transplant recipients.The screening tests included BKV DNA PCR (the kit for testing the BK virus) assay of both urine and plasma,and the results were recorded.Renal biopsy was performed if the graft function deteriorated gradually or the loads of BKV replication were very high.According to the existing literature material,preferential therapy was given to the patients with BK viremia and BKVAN after renal transplantation.Results Throughout the follow-up of 15 months,urine BKV viruria (median 2.63 × 105 copies/mL,1.78 × 103 8.54 × 109 copies/mL),blood BKV viremia (median 2.70 × 104 copies/mL,1.95 × 103-6.31 × 106 copies/mL),and BKVAN (4 patients) occurred in 24.17％,20.72％ and 3.45％ renal-transplant recipients,respectively.According to related literature and guide,in 24 cases of BKV viremia including 4 BKVAN patients,the dosages of immunosuppressants were reduced or FK506 was replaced with CsA,the disease conditions were effectively improved,and no acute rejection,allograft dysfunction or graft loss occurred.Conclusion Rescuing therapy of immunosuppression reduction or replacing FK506 with CsA was effective for BKV viremia and BKVAN recipients,and could not increase the risk of acute rejection and graft loss.
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Objective To investigate the incidence of and risk factors for benign prostatic hyperplasia (BPH) in transplant recipients.Methods 197 males aged 50 years and older who received kidney transplants were recruited if they were clinically stable.They were divided into three age groups:50 to 59 years (87 cases),60 to 69 years (64 cases) and ≥ 70 years (46 cases).Two hundred and forty people who had not undergone kidney transplant were randomly selected from the community as controls.A cross-sectional study was performed to study the BPH incidence in kidney transplant recipients according to standard diagnostic criteria.At the same time,the expression levels of keratinocyte growth factor,transforming growth factor-β and serum testosterone and the CD4/CD8 ratio in T lymphocytes were determined.Results There was no significant difference in age,PSA and the postmicturition residual volume between the study group and the control group.The total BPH incidence in kidney transplant recipients was 16.2％ (32/197).The symptomatic BPH incidence was 6.9％ (6/87) in the 50-to 59-year-old study group and 20.2％ (19/94) in the control group,representing a significant statistical difference in the symptomatic BPH incidence between the two groups (P =0.010).The symptomatic BPH incidence was 18.8％ (12/64) in the 60-to 69-year-old study group and 41.9％ (34/81) in the control group,indicating a significant statistical difference in the symptomatic BPH incidence between the two groups (P =0.004).The symptomatic BPH incidence was 30.4％ (14/46) in the ≥ 70-year-old study group and 52.3％ (34/65) in the control group,indicating a significant statistical difference in the symptomatic BPH incidence between the two groups (P =0.032).Compared to the control group,the peripheral blood serum testosterone level (9.4 ± 4.7,18.2 ± 5.6,P =0.040) and the CD4/CD8 ratio (1.1±0.3,1.8±0.3,P=0.014) of kidney transplant recipients was lower.The transforming growth factor-β expression level (5015± 1087,1829±963,P＜0.001) was higher in kidney transplant recipients than in the control group.The kasatinocyte growth factor expression levels (35.8±20.7,21.0± 18.3,P =0.064) was not statistically different than in the control group.Conclusions Kidney transplant recipients who had long-term administration of calcineurin inhibitor might have a low benign prostatic hyperplasia incidence,which might be related to transforming growth factor-β and keratinocyte growth factor expression,testosterone levels and the lymphocyte infiltration.Further high-quality prospective studies are still needed to confirm the conclusions.
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ObjectiveTo investigate the localization G protein couple receptor 30 (GPR30) and its mRNA in submaxillary gland, and to supply theoretic evidence for further studying functional significance of the GPR30 in submaxillary gland of rats. Methods Four male SD rats were sacrificed by cervical dislocation after the intraperitoneal anesthesia, and excised the submaxillary glands. The distribution of GPR30 and its mRNA were studied through immunohistochemistry and in situ hybridization in the experiment. After isolation of the total RNA from the submaxillary gland, RT-PCR was conducted to obtain GPR30 cDNA by using the specific primers. The products of PCR were analyzed by sequencing with Sanger's method. Results The serous acinus epithelial cells and granular convoluted epithelial cells in submaxillary gland of rats showed GPR30 immunoreactivity, which were located in cytoplasm with negative nuclei. GPR30 mRNA hybridized signals were also detected in cytoplasm in the above cells. The products of PCR is identical to that of the GPR30 sequence of rats. Conclusion The serous acinus and granular convoluted epithelial cells not only express GPR30 but also may be a target organ by rapid estrogen signaling pathway in submaxillary gland of rats. This may be involved in the functional regulation of submaxillary gland.
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Objeetive To discuss the correlation of creatinine reduction ratio(CRR2)from posttransplant day 1 to day 2 and early graft function recovery status after kidney transplantation. Methods Clinical data of 80 patients after renal transplantation from Jan 2005 to Mar 2007 were retrospectively analyzed.Patients were divided into three groups according to the post-operative serum creatinine level:53 patients within IGF group[cereatinine＜265.2 μmol/L by post-operative day(POD)no.5],14 patients within SGF group(creatinine＞265.2 μmol/L on POD no.5,but no need for dialysis),and 13 patients within DGF group(need for dialysis in the first week post-transplant).Then the value and 99%CI of CRRz of these three groups were calculated. Results The value of CRR2 of IGF,SGF and DGF was(46.8±14.6)%,(25.6±13.5)%and(0.7±17.7)%respectively.And CRR2 99%CI of IGF,SGF and DGF was 41%-52%,15%-36%and-14%-16 0A respectively.There was significant difference in the value of CRR2 among IGF,SGF and DGF group.So a criteria for early diagnosis of IGF,SGF and DGF by CRR2 99%C1 was established:IGF(CRR2≥40%),SGF (15%＜CRR2＜40%)and DGF(CRR2≤15%). Conclusion CRR2 has a good correlation with early graft function recovery after kidney transplantation,and can be used to predict the occurrence of SGF and DGF.
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Objective To assess the effect of immunosuppression conversion from cyclosporine(CsA) to tacrolimus(FK506) on progression of chronic allograft nephropathy(CAN).Methods A retrospective study was performed in 36 cyclosporine treated renal transplant recipients.Patients were included if they were biopsy-proven CAN and they were converted from cyclosporine to tacrolimus due to CAN.The FK506 dose was 1/50 to 1/100 of the cyclosporine's and the dose was adjusted according to the trough level of tacrolimus,body weight of the patient and the situation of CAN.Other immunosuppressive agents kept unchanging.Serum creatinine and FK506 trough level were monitored after conversion.Fasting blood triglyceride,total cholesterol and glucose were determined at baseline and 6th month after conversion to tacrolimus.Results After switching over to FK506 for 6 months,there was a significant improvement in function of renal allograf(P
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To investigate the change in renal CD11a and myeloperoxidase (MPO) contents and renal function during ischemia-reperfusion injury (IRI) of rat kidney, as well as the role of lymphocyte function associated antigen-1 (LFA-1) played in renal IRI, we utilized a rat model of renal IRI to detect the renal tissue contents of CDlla and MPO and renal functioa The results showed that the levels of CD11a and MPO were very low in normal renal tissue, but increased significantly in ischemia reperfusion. Renal failure was presented in rats with IRI. The levels in the ischemia-60min-reperfusion group were higher than those in the ischemia-30min-reperfusion group in the same time points. Our conclusion is the levels of CD11a and MPO in rat renal tissue increase significantly during renal IRI. LFA-1-mediated leukocyte adherence plays an important role in renal IRI. Up-regulation of CDlla further elucidates the mechanism of relation between IRI and acute rejection: more heavier IRI is, more possible acute rejection would be.
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Objective To study the diagnosis and treatment of the severe pulmonary infection in the patients after kidney transplantation. Methods The clinical data of 26 patients with severe pulmonary infection following kidney transplantation were analyzed retrospectively. Results Microorganisms were isolated and identified in 22 patients out of 26 kidney transplantation patients with severe pulmonary infection. The main etiological pathogens according to their frequency and type were: bacteria (15 cases, including Escherichia coli, Aerobacter cloacae, Klebsiella fredlanderi, Enterococcus faecalis, Staphylococcus epidermidis, etc.), fungi (12 cases, Fermentum, Blastomyces albicans, Candida tropicalis, Aspergillus, etc.), and cytomegalovirus (10 cases). 46.15% (12/26) of patients were infected with one kind of microorganism, and 53.85% (14/26) of patients were mixed infection. In 73.1% (19/26) of patients the pulmonary infection occurred during 1-6 months after renal transplantation. Among 26 patients, 12 developed ARDS, and 4 patients gave up therapies due to high expenses. With energetic treatment, 18 patients (81.82%) were cured and 4 died. Conclusions Intensive care and active measures should be given in the treatment of severe pulmonary infection after kidney transplantation. Early diagnosis, administration of broad-spectrum and combined use of antibiotics, the early identification of pathogens, enforcement in systemic support, including correction of immunosuppression, the timely use of mechanical ventilation to correct hypoxia, are the key treatment strategies for a successful result.