ABSTRACT
Objective To investigate the clinical efficacy of neoadjuvant chemotherapy (oxaliplatin +capecitabine,XELOX) for the resectable locally advanced adenocarcinoma of esophageal-gastric junction (AEG).Methods The prospective study was conducted.The clinicopathological data of 106 locally advanced AEG patients who were admitted to the Cancer Hospital of Shantou University Medical College from January 2011 to December 2014 were collected.All the patients were divided into the treatment group and control group by single blind,randomized,controlled random number table.Patients underwent preoperative neoadjuvant chemotherapy (XELOX) + surgery + postoperative adjuvant chemotherapy (XELOX) in the treatment group and surgery + postoperative adjuvant chemotherapy (XELOX) in the control group.Total gastrectomy + Roux-en-Y esophagojejunostomy + D2 lymphadenectomy were applied to patients by the same team of doctors.Observation indicators:(1) treatment situations;(2) results of postoperative pathological examination;(3) follow-up and survival situations.Follow-up using outpatient examination was performed to detect the postoperative tumor recurrence or metastasis and patients' survival up to February 2017.Measurement data with normal distribution were represented as (-x)±s,and comparisons between groups were evaluated with the t test.Measurement data with skewed distribution were described as M (range) and analyzed by the nonparametric test.Comparisons of count data were analyzed using the chi-square test.The ordinal data were compared using the nonparametric test.Survival rate and curve were respectively calculated and drawn by the Kaplan-Meier method and survivals were compared using the Long-rank method.Results One hundred and six patients were screened for eligibility,including 54 in the treatment group and 52 in the control group.(1) Treatment situations:① preoperative neoadjuvant chemotherapy:54 in the treatment group received 2-4 cycle neoadjuvant chemotherapy.During the chemotherapy,gastrointestinal reaction,grade 1-2 granulocytopenia,elevated alanine transaminase (ALT) and grade 3 granulocytopenia were detected in 21,17,8,1 patients,and 7 patients had no adverse reaction.The complete response(CR),partial response (PR),stable disease (SD) and progressive disease (PD) of neoadjuvant chemotherapy in the treatment group were detected in 4,27,20 and 3 patients,respectively.Of 54 patients in the treatment group,4,13,25 and 12 were in grade 0,1,2 and 3 of response to preoperative chemotherapy,respectively.② Surgical situations:preoperative carcinoembryonic antigen (CEA) in the treatment and control groups were respectively 4.71 μg/L (range,0.20-36.19 μg/L) and 14.09 μg/L (range,0.71-178.20 μg/L),with a statistically significant difference between groups (Z =-1.92,P＜ 0.05).All patients underwent total gastrectomy + Roux-en-Y esophagojejunostomy + D2 lymphadenectomy.Operation time in the treatment and control groups were respectively (210± 31) minutes and (195 ±26) minutes,with a statistically significant difference between groups (t =-2.45,P ＜ 0.05).Volume of intraoperative blood loss,cases with intraoperative blood transfusion,time to postoperative anal exsufflation,time to defecation,time for initial diet intake,cases with postoperative complications and duration of hospital stay were respectively (216± 172) mL,6,(4.3± 1.0) days,(4.5±0.8)days,(3.1±0.5)days,11,(15.0±5.0)days in the treatment group and (174±108)mL,4,(4.2± 1.0) days,(4.4± 0.8) days,(3.1 ± 0.5) days,15,(15.0± 5.0) days,with no statistically significant difference between groups (t=-1.01,x2 =0.36,t=-0.31,-0.88,-0.36,x2 =1.03,t=-0.38,P＞0.05).③Postoperative adjuvant chemotherapy:all the patients completed the postoperative adjuvant chemotherapy.The granulocytopenia,elevated ALT and gastrointestinal reaction occurred in 25,5,28 patients in the treatment group and 21,7,30 patients in the control group,respectively,with no statistically significant difference between groups (x2 =0.38,0.47,0.36,P＞0.05).Some of the patients were merged with multiple adverse reactions.(2) Results of postoperative pathological examination:maximum tumor dimension,cases with lymphovascular invasion,perineural invasion,T0,T2,T3,T4 (T stage),stage 0,Ⅰ,Ⅱ and Ⅲ1 (TNM stage) were respectively (3.6±1.4)cm,5,10,4,10,20,20,4,7,15,28 in the treatment group and (4.5±1.7)cm,24,30,0,2,13,37,0,1,12,39 in the control group,with statistically significant differences between groups (t=-2.88,x2 =18.14,17.30,Z=14.74,8.13,P＜0.05).(3) Follow-up and survival situations:of 54 patients in the treatment group,52 were followed up for 4-72 months,with a median time of 32 months;of 52 patients in the control group,49 were followed up for 5-71 months,with a median time of 36 months.The postoperative diseasefree survival time,1-,3-and 5-year tumor-free survival rates,postoperative overall survival time and 1-,3-and 5-year overall survival rates were respectively 26 months (range,3-72 months),79.5％,64.7％,61.3％,27 months (range,5-72 months),88.3％,69.2％ and 62.1％ in the treatment group.Seventeen patients had tumor recurrence,including 2 with intraperitoneal local recurrence and 15 with distant metastasis.The postoperative disease-free survival time,1-,3-and 5-year tumor-free survival rates,postoperative overall survival time and 1-,3-and 5-year overall survival rates were respectively 33 months (range,2-71 months),89.7％,55.4％,55.4％,33 months (range,5-71 months),91.8％,72.1％ and 59.7％ in the control group.Nineteen patients had tumor recurrence,including 8 with intraperitoneal local recurrence and 11 with distant metastasis.There was no statistically significant difference in disease-free survival and overall survival between groups (x2 =0.018,0.596,P＞0.05).There was a statistically significant difference in cases with local recurrence between groups (x2=4.41,P＜ 0.05) The tumor-free survival time and overall survival time in the treatment group were respectively 29 months (range,8-72 months),38 months (range,10-72 months) in 31 patients with CR and PR and 11 months (range,3-68 months),18 months (range,4-68 months) in 23 patients with SD and PD,showing statistically significant differences in tumor-free and overall survival times (x2=5.27,7.72,P＜0.05).Concluslon Neoadjuvant chemotherapy with oxaliplatin and capecitabine is safe and effective for patients with the resectable locally advanced AEG,it can also decrease tumor stage and reduce local recurrence,but fail to demonstrate a survival benefit.
ABSTRACT
Objective:To study the effects and safety of triamcinolone acetonide oral ointment in the treatment of erosive oral lichen planus(EOLP).Methods:62 cases with EOLP were randomly divided into 2 groups.The patients in test group(n =29) were treated by local application of triamcinolone acetonide oral ointment (TAOO),oral administration of hydmxychloroquine(HCQ) and gargle with cetylpyridinium chloride buccal tablets(CCBT),in control group (n =33) by HCQ and CCBT.The patients were followed up for 4 weeks.The changes of the erosion area and the VAS pain degree of the patients were analysed at the first visit,the second week and the fourth week follow-up respectively.The safety indexes were examined at the first visit and the fourth week follow-up respectively.Results:TAOO accelerated the erosion surface healing of EOLP in 2 weeks(P ＜ 0.05),and reduced the pain index of the patients (P＜0.05),but after 4 week treatment,no significant difference was observed between 2 groups (P ＞ 0.05).Fungal infection was found in 4 cases in test group.Conclusion:Local application of TAOO combined with oral administration of HCQ and gargle with CCBT is more effective than HCQ and CCBT in the treatment of EOLP,attention should be paid to prevent fungal infection.
ABSTRACT
Background The relationship between corneal central thickness (CCT) and corneal biomechanical property does not reflect the effective amount of ablated tissue because CCT measures only the change in a single point.Corneal volume (CV) is a representative parameter of corneal morphology,and it can fully reflect corneal thickness and tissue distribution.Objective This study was to investigate the correlation between volumetric corneal changes and corneal biomechanical properties after small incision lenticule extraction (SMILE).Methods A prospective series cases-observational study was carried out.This study protocol was approved by Ethic Committee of Tianjin Eye Hospital,and written informed consent was obtained from each patient prior to entering the cohort.Sixty-seven right eyes of 67 myopia or myopic astigmatism patients who received SMILE in Tianjin Eye Hospital from June 2014 to July 2015 were included in this study.Before and 3 months after surgery,the CV at 3,3-5,5-7 and 7-10 mm (CV3,CV3-5,CV5-7,CV7-10) was measured by Pentacam anterior segment analysis system,and corneal hysteresis (CH) and corneal resistance factor (CRF) were obtained by ocular response analyzer (ORA).The changes of CV (ACV),CH (ACH) and CRF (ACRF) were calculated,and the correlations between ACV and ACH or ACRF were analyzed.Results CV3,CV3-5 and CV5-7 values after SMILE were significantly lower than those before SMILE (t =36.24,20.38,16.17,all at P＜ 0.001).The CH values before and after SMILE were (10.06± 1.11) mmHg and (8.10± 1.05) mmHg (1 mmHg =0.133 kPa),and the CRF values before and after SMILE were (10.40 ± 1.38) mmHg and (6.91 ± 1.19) mmHg,respectively,showing significant reduces after SMILE than before SMILE (t =16.71,27.41,both at P＜0.001).Positive correlations were seen between the CV values at different corneal areas and CH value or CRF value.Moderate positive correlations were found between CV3 and CH or CRF (r =0.571,0.569;both at P＜0.001) before surgery,and 3 months after surgery,a weak positive correlation was seen between ACV3 and ACH (r =0.394,P ＜ 0.001) or a moderate positive correlation between ACV3 and ACRF (r=0.501,P＜0.001).Conclusions The CV value is gradually increased from the central cornea to periphery cornea.The CV change is associated with CH and CRF changes after SMILE,and CV3 probably is a useful parameter for the evaluation of corneal biomechanics after refractive surgery.
ABSTRACT
Background Small incision lenticule extraction (SMILE) is increasingly applied in the correction of myopia and astigmatism.However,the early clinical outcomes of SMILE for different refractive myopia and astigmatism is seldom reported.Objective This study was to investigate the safety,efficacy,predictability and early stability after SMILE in low,moderate and high myopia.Methods A series of cases-observational study was carried out.A total of 195 eyes of 108 myopic patients were enrolled in Tianjin Eye Hospital from May to December 2012 under the informed consent.The patients were divided into the low (≤-3.00 D),moderate (＞-3.00 to-6.00 D) and high myopia (＞-6.00 D) groups according to different diopters,with 57 eyes,76 eyes and 62 eyes,respectively.SMILE was performed on all the eyes.The uncorrected visual acuity (UCVA)(LogMAR),best corrected visual acuity (BCVA) (LogMAR),equivalent sphere (SE),intraocular pressure,anterior segment and corneal topography were examined before operation and 1 day,1 week,1 month and 3 months after operation to evaluate the effective index (postoperative UCVA/preoperative BCVA),safety index (postoperative BCVA/preoperative BCVA),predictability and early stability of SMILE.The linear regression analysis was used to analyze the relationships between the attempted refraction and the achieved refraction postoperative 3 months in three groups.Results The percentage of UCVA (LogMAR)＜0.1 was 100％,97.1％ and 92.8％ in the low,moderate and high myopia group,respectively in 3 months after SMILE.The postoperative BCVA of all the operated eyes reached preoperative one.The residual SE was (-0.07±0.16),(-0.05 ±0.20) and (-0.08±0.27)D in the low,moderate and high myopia group,respectively in 3 months after SMILE.The percentage of residual SE±0.5 D was 100％,98.7％ and 93.6％ in the low,moderate and high group,and that of SE±1.0 D was 100％ in all of the groups.The postoperative corrected SE was gradually increased with the raise of predicted SE in the low,moderate and high myopia groups (r=0.942,0.959,0.957,all at P＜0.001).Conclusions SMILE is safe,effective,predictable and stable for the correction of low,moderate and high myopia.The corneal wound healing was slightly slower in the low myopia group than that in the moderate and high group.A slight regression of myopic power appears in high myopia eyes 3 months after SMILE.
ABSTRACT
Objective To compare the outcome of adult-to-adult single kidney transplantation from donation after drain death and cardiac death. Methods The outcome of adult-to-adult single kidney transplantation from October 2012 to September 2015 in kidney transplantation center of Zhujiang Hospital was retrospectively analyzed. 53 recipients received donation from donors after brain death (DBD group) and 28 from cardiac death (DCD group). The deadline of follow-up is May 2016. Results During the period of observation, the mean follow-up was (17.26±10.85) months and patient's survival rate was 100%. When compared graft survival rate with the two groups, survival rate is 93.7% in DBD group and 92% in DCD group (χ2= 0.184,P = 0.668). There was no statistically significant difference (P > 0.05), the overall incidence of DGF was 28.4%. General DGF incidence is 28.4%, and DGF incidence between groups is χ2= 4.402,P = 0.036. Infection rate within 1 year is χ2= 4.507,P = 0.034, and the difference is significant (P 0.05) in AR, eGFR of 1 month, proteinuria of 1 month after, transplantation and surgical complications. Conclusions Adult-to-adult single kidney transplantation from donation after cardiac death (DCD) has a higher rate of incidence of DGF, and the postoperative infection rate within 1 year. Renal transplantation from donation after cardiac death could have a good outcome.
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the clinical value of serum 1,3-beta-D-glucan (BG) and galactomannan (GM) detection for early diagnosis of invasive aspergillosis (IA) in patients after renal transplantation.</p><p><b>METHODS</b>Blood samples collected from 69 renal transplant recipients were divided into diagnosis group, clinical diagnosis group, suspected diagnosis group, and non-infected group for detection of serum BG and GM.</p><p><b>RESULTS</b>The mean serum levels of BG in the diagnosis group, clinical diagnosis group, and suspected diagnosis group were significantly higher than that in non-infected group (P<0.05). The sensitivity, specificity, and positive and negative predictive values of BG was 69.49%, 70%, 93.18% and 35.71% for IA diagnosis, respectively. The serum levels of GM in the 3 diagnosis groups were also significantly higher than that in the non-infected group (P<0.05) with the sensitivity, specificity, and positive and negative predictive values of 84.75%, 90%, 96.15% and 52.63% for IA diagnosis, respectively.</p><p><b>CONCLUSION</b>Increased serum BG and GM levels can serve as the evidence for early diagnosis of IA with a high diagnostic sensitivity and specificity in renal transplant recipients.</p>
Subject(s)
Humans , Aspergillosis , Diagnosis , Early Diagnosis , Kidney Transplantation , Mannans , Blood , Sensitivity and Specificity , beta-Glucans , BloodABSTRACT
BACKGROUND:The rate of tuberculosis infection was high in patients after renal transplantation. Clinical manifestation is not typical, which brings inconvenience to diagnose. OBJECTIVE:To summarize the diagnosis and therapeutic methods of tuberculosis infection after al ograft renal transplantation. METHODS:Relevant diagnosis and therapeutic method of 13 patients with tuberculosis infection after renal transplantation were retrospectively analyzed in the Department of Organ Transplantation, Zhujiang Hospital of Southern Medical University from January 2010 to October 2013. RESULTS AND CONCLUSION:The onset time was 4-120 months after operation;62%(8/13) patients within 18 months after transplantation. Patients affected long-period fever, mainly low-grade fever. Four cases were identified according to the history, imaging data in combination with positive pathogenic diagnosis. Five cases were identified according to the history, imaging data combined with lung biopsy histopathology. The remaining four cases were identified according to the history, imaging data with experimental effective anti tuberculosis treatment. Early pulmonary symptom was not obvious. Chest CT was helpful in early diagnosis and differential diagnosis. Al patients fol owed early, law, ful , right amount, combined with principles of anti-tuberculosis treatment, and treatment usual y lasted for 6-10 months. They were given combined anti-tuberculosis infection drugs, adjustment of immunosuppressive agents and five-ester capsule for liver protection therapy. Thirteen patients were alive, no deaths. Two cases with early infection without timely treatment suffered from acute rejection, leading to loss of graft function and returned to hemodialysis. The others were cured and left hospital. Renal function was normal after 6-month fol ow-up (serum creatinine). Results indicated that after renal transplantation, patients with pulmonary tuberculosis should be early detected, early diagnosed and early treated. CT guided biopsy can be used as an effective and feasible means for diagnosis and identification of smear negative pulmonary tuberculosis after renal transplantation. Adjustment of immune scheme, anti-tuberculosis treatment and five-ester capsule significantly reduced calcineurin inhibitor dose, and lessened their adverse reactions.
ABSTRACT
Objective To investigate the possible mechanisms of acute humoral rejection (AHR) after renal transplantation and the significance of early diagnosis and prevention.Methods The clinical data of 296 cases receiving renal transplantations from January 2006 to December 2010 were retrospectively analyzed. After renal transplantation,the dynamic changes of panel reactive antibodies (PRA) and donor specific antibodies (DSA) in peripheral blood were monitored by using ELISA,and C4d deposition and molecular markers of infiltrating lymphocytes in biopsy tissue were observed by using immunohistochemistry.The AHR was diagnosed according to Banff 2005 criteria and clinical related indexes. Results Among 296 patients,25 were diagnosed as AHR after transplantation with the incidence being 8.4％ (25/296).The AHR incidence after transplantation in patients positive and negative for PRA before transplantation was 23.1 ％ (6/26) and 7.0％ (19/270) respectively (P＜0.01).The DSA positive rate in the recipients with AHR and without AHR after transplantation was 80.0％ (20/25) and 6.7％ (4/60) respectively.Thcrc was significant difference in DSA and C4d positive rate between AHR and non-AHR patients (P＜0.001).By adjusting several therapies, such as the immunosuppressive program and (or) application of intravenous immunoglobulin,plasmapheresis,antithymocyte globulin and rituximab monoclonal antibody, 19 cases of AHR were reversed,and the remaining 6 cases had rupture of renal allograft due to ineffective treatment,leading to the removal of the transplanted kidney.Conclusion PRA and DSA were important for AHR after renal transplantation.Immediately monitoring of the PRA and DSA after transplantation is recommended in order to achieve the purposes of prevention,early diagnosis and rational treatment for AHR,thus improving the survival of the transplanted kidney.
ABSTRACT
Objective Toobservetheindication, safetyandefficacyofanew immunosuppressant Rituximab in kidney transplantation. MethodsFive patients, who were diagnosed as antibody mediated rejection (AMR) from December 2010 to June 2011, were treated with single dose of Rituximab (500 mg) and followed up for 6 months. The clinical data, such as age, gender, onset of illness, induction therapy, maintaining therapy, allograft function, change of PRA, opportunistic infection and other complications were collected and retrospectively analyzed to evaluate the safety and efficacy of Rituximab used in AMR patients. ResultsAfter Rituximab therapy, all the patients had improved renal function measured by sera creatinine level: 4 cases retumed to normal, and 1 keep stable. Series of allograft biopsy demonstrated obviously reduced C4d deposition in nephridial tissue after treatment. One patient developed CMV viremia, another had urinary infection, but no one had lifethreatening infection during the follow-up period. The survival rate of human and allograft was both 100 ％. Conclusion Rituximab has a good efficacy and safety in treatment of AMR after renal transplantation.
ABSTRACT
BACKGROUND: Pneumocystis carinii pneumonia(PCP)is a severe and life-threatening complication in renal transplantation patients.It is associated with high mortality,occult onset and rapid progression,so the clinicians who care organ transplant patients need in-depth study and understanding the law of occurrence,development and therapy of the disease to achieve the better outcome.OBJECTIVE: To retrospective analyze the etiopathogenisis,clinical characteristics,diagnosis,as well as the prognoses of PCP in renal transplant recipients.METHODS: A total of 36 patients who suffered complication of PCP after renal transplantation in the Organ Transplantation Center,Zhujiang Hospital,were retrospective analyzed.The general information of cases,clinical manifestation,therapeutic regimen,and prognoses were analyzed.The diagnosis and intervention measures were summarized.RESULTS AND CONCLUSION: Among 36 patients,22 were male and 14 were female.Three patients died of complicated acute respiratory distress syndrome,the rest were cured with good renal graft functions.Among 36 PCP patients,31 cases were occurred within 6 months,and 5 in 7-18 months.Pneumocystis carinfiwas examined in bronchoalveloar lavage fluid or lung tissues of 15 cases(41.7%),which was not be checked out in the other 21 cases.Most of patients were cured and the transplanted renal function was well after reducing immunosuppressive agent doses,administrating compound sulfamethoxazole and supportive treatment.The findings demonstrated that PCP common occurred with 6 months after renal transplantation,with typical clinical symptom but indiscoverable pathogen.Its early stage diagnosis was based on clinical history,symptom,and image examination.Among organ transplantation cases,PCP is a severe opportunistic infection,but with early diagnosis and proper treatment the prognosis remains good.
ABSTRACT
BACKGROUND: Panel reactive antibody (PRA) can mediate hyperacute rejection, and lead to decrease in success rate of transplantation and survival rate of renal graft in highly sensitized recipients compared to non-sensitized recipients.OBJECTIVE: According to human leucocyte antigen (HLA) cross-matching standards to select suitable donors for sensitized recipients and to evaluate the incidence of acute rejection and survival rate of renal allografts.DESIGN: Case observation.SETTING: Zhujiang Hospital of Southern Medical University.PARTICIPANTS: 136 sensitized recipients with positive PRA underwent renal transplantation in Department of Organ Transplantation, Zhujiang Hospital of Southern Medical University between January 1997 and December 2003 were selected, including 41 males and 95 females, aged (45±9) years. Recipients of first, second, third, and fourth transplant were 115, 18, 2 and 1 case, respectively. The informed consent was obtained from all patients. The protocol was approved by Hospital Ethics Committee. Lambda antigen tray (LAT) and LAT-Mix were purchased from One Lambda, Inc, USA. Special monoclonal tray -Asian HLA class Ⅰ (SMT72R) and Micro SSP Generic HLA Class Ⅱ (DRB/DQB) were also purchased from One Lambda, Inc, USA.METHODS: Pre-operative PRA levels and specificity of recipients were detected by ELISA test with Lambda antigen tray (LAT). Donor and recipient HLA class Ⅰ typing was performed with special tray - Asian HLA class Ⅰ (SMT72R), and HLA class Ⅱ gene typing with Micro SSP Generic HLA Class Ⅱ (DRB/DQB) (Micro-SSP). HLA-matching between donor and recipient was performed according to HLA cross-reactive group (CREG) standards by UNOS and class Ⅱ antigen permissible mismatch. The incidence of acute rejection and survival rate of renal allografts were evaluated within 1, 3 and 5 years.MAIN OUTCOME MEASURES: ①PRA levels and specificity of sensitized recipients before and after transplantation; ②HLA-matching between donor and recipient; ③Incidence of acute rejection and survival rate of renal allografts after transplantation.RESULTS: 136 PRA positive sensitized recipients were all included in final analysis. ① There were 104 recipients with anti-HLA class Ⅰ IgG antibody, 76 with anti-HLA class Ⅱ IgG antibody, and 44 with both anti-HLA class Ⅰ and Ⅱ IgG antibodies in 136 recipients. ②The number of cases of 0, 1, 2, 3, and 4 mismatch (MM) was 7, 26, 47, 39 and 17, respectively by the standard of conventional HLA antigen matching; However, the number of the recipients with 0, 1, 2, 3, and 4MM was 31, 53, 36, 16, and 0, respectively according to the principle of HLA CREG matching. ③By the principle of HLA CREG matching, rates of acute rejection in sensitized recipients with 2MM and 3MM HLA-CREG were significantly higher than those with 0MM (P < 0.05). Renal allograft survival rate in sensitized recipients with 0MM was significantly higher than those with 2MM and 3MM (P < 0.05).CONCLUSION: ①HLA CREG matching can significantly improve the ratio of well-matched. ② Good HLA matching can reduce the incidence of acute rejection in sensitized recipients and increase the survival rate of renal grafts.
ABSTRACT
BACKGROUND: Panel reactive antibodies (PRA) easily appear in the peripheral blood of organ transplant recipients sensitized by allogeneic human leukocyte antigen (HLA).How to enhance the success rate of renal transplantation.and long-term survival rate of renal allografts in sensitized recipients should be further studied.OBJECTIVE: This study was to detecthuman leukocyte antigen immunoglobulin G(HLA-IgG) antibody level and its specificity in renal transplant recipients,evaluate humoral immunity sensitization,and investigate the relationship of the acceptable mismatching of HLA cross-reactive group and survival rate of renal allograft.DESIGN: A clinical observation.SETTING: Zhujiang Hospital Affiliated to Southern Medical University.PARTICIPANTS: A total of 1297 patients,824 males and 473 females,averaging (42±16) years of age,received renal transplantation in the Department of Organ Transplantation,Zhujiang Hospital,Southern Medical University between January 1998 and December 2005,were recruited for this study.Among these patients,165 were HLA-IgG antibody-positive recipients,1132 were HLA-IgG antibody-negative ones,1217 received renal transplantation for the first time,77 received renal transplantation twice,2 three times,and 1 four times.Written informed consent was obtained from each subject for related laboratory measurements and treatment.The protocol was approved by the Hospital's Ethics Committee.Reagents:Lamhda antigen tray (LAT),Lambda antigen tray mixed (LATM),Special Monocloneal Tray-Asian HLA Class Ⅰ,and Micro SSP? Generic HLA Class Ⅱ were purchased from One Lambda Company,USA.Taq polymerase was purchased from PE Company,USA. DNA extract reagent was from Qiagen Company,Germany.Anti-human complement 4d (C4d) polyclonal antibody and chrornogenic substrate DAB were purchased from Biomedica Company,Austria.METHODS: Prior to operation,serum HLA-IgG antibody in the recipients was determined by an enzyme linked immunosorbent assay (ELISA).HLA-IgG antibody-positive serum was further detected by antigen tray (LAT1240 and LATIHDS) for antibody-positive rate and specificity.HLA genotyping was performed by a sequence specific primer polymerase chain reaction (PCR-SSP).For 40 recipients who had elevated serum creatinine (Scr),anti-HLA antibody detection and renal transplant needle biopsy were conducted.At the same time,C4d deposition on the capillary wall around the renal tubule was observed by immunohistochemical staining.Survival rate of renal allografts in recipients 1,3,and 5 years after transplantation,and relationships of gender and renal transplantation and antibody-positive rate were investigated.Survival rate of renal allograft in recipients that received different mismatch of HLA cross-reactive group was analyzed.MAIN OUTCOME MEASURES: Prior to and after renal transplantation,HLA-IgG antibody-positive rate and HLA genotyping in renal transplant recipients.Characterization of C4d deposition on the capillary wall around the renal tubule in the renal transplant biopsy tissue.Difference of survival rate of renal allograft.RESULTS: All 1297 recipients were included in the final analysis.Among them,1132 were HLA-IgG antibody-negative recipients,165 were HLA-IgG antibody-positive ones,126 were anti-HLA class Ⅰ IgG antibody-positive ones,90 were anti-HLA class Ⅱ IgG antibody-pesitive ones,51 were anti-HLA class Ⅰ and Ⅱ IgG antibody-positive ones,and 94 were highly sensitized ones (antibody-positive rate ＞50%).Among 40 recipients with needle biopsy,C4d deposition was found in the 13 recipients,but not found in the 27 recipients.Ten out of thirteen C4d-positive recipients presented with anti-HLA antibody-positive in the peripheral circulation.The incidence for delayed graft function (DGF) was significantly higher in recipients with HLA-IgG antibody-positive than in recipients with HLA-IgG antibody-negative (P ＜ 0.01).There was no significant difference in the survival rates of renal allografts between recipients with HLA-IgG antibody-positive and with HLA-IgG antibody-negative 1 ,3,and 5 years after renal transplantation (P ＞ 0.05).Antibody-positive rate was significantly higher in female recipients than in male recipients (P ＜ 0.01).Antibody-positive rate was significantly higher in recipients that received renal transplantation for the second time than in recipients that received renal transplantation for the first time (P ＜ 0.01).With HLA cross-reactive group mismatching increasing,survival rate of renal allograft presented a tendency of decline.One,three and five years after renal transplantation,the survival rate of renal allograft was respectively 97%,94%,and 92% for recipients with no mismatching,and 91%,82%,and 77% for recipients with two mismatches,which was respectively decreased by 6%,12%,and 15% compared to recipients that received no mismatching.For recipients with three mismatches,the survival rate of renal allograft was respectively decreased by 9%,15%,and 24% compared to recipients with no mismatching.CONCLUSION: C4d deposition on the capillary wall around the renal tubule can be detected as an indicator of antibody-mediated humoral rejection.A good HLA matching can noticeably decrease the incidence of rejection and improve the survival of renal allograft.
ABSTRACT
Objective To evaluate the clinical application of HLA matching in highly sensitized recipients of renal allografts.Methods Recipient's panel reactive antibody (PRA) was detected by using ELISA test with Lambda antigen tray (LAT).Donor and recipient HLA classⅠtyping was performed with special monoclonal tray,and HLA classⅡgene typing with micro-sequence specific primers (Micro-SSP).Results There were 104 recipients with anti-HLA class-ⅠIgG antibody,76 with anti-HLA class-ⅡIgG antibody,and 44 with both anti-HLA class-1 and anti HLA class-ⅡIgG antibody respectively in 136 sensitized recipients.HLA class-ⅠIgG antibody positive rate was 11%-97 %,with an average of 49.6%?23.8%;The common public epitopes antibody was not found in each recipient of 13 cases with PRA＜20%,but was found in I2 recipients in 44 cases with PRA be- tween 20%-50%,and 39 recipients in 47 cases with PRA＞50%.HLA class-ⅡIgG antibody posi- tive rate was 17%-100%,with an average of 28.2%?63.8%.The number of cases of 0,1,2,3, 4 MM was 7 (5.1%),26 (19.1%),47 (34.6%),39 (28.7%) and 17 (12.5%) respectively by the standard of conventional HLA antigen matching;however the number of the recipients with 0,1, 2,3 MM was 31 (22.8%),53 (39.0%),36 (26.5%) and 16 (11.7%) respectively according to the rule of HLA CREGs matching and none with 4 MM.Rates of acute rejection in sensitized recipi- ents with 2MM and 3MM HLA-CREGs were 25.0% and 37.5% respectively and were significantly higher than those with 0MM (P＜0.05,＜0.05 respectively).Kidney year-survival was decreased when the number of MM of HLA CREGs matching increased.Conclusion The HLA CREGs matching can improve the ratio of well-matched significantly.Good HLA matching can reduce the incidence of acute rejection in sensitized recipients and increase the survival rate of grafts.
ABSTRACT
Objective To evaluate the level of specific anti human leukocyte antigen IgG antibodies and its effect on renal transplantation Methods Specific anti HLA IgG antibodies of 685 serum samples were measured by the micro enzyme linked immunosorbent assay with Lambda Antigen Tray and Lambda Antigen Tray Mixed Results There were 12% positive recipients of anti HLA IgG antibodies among 685 renal transplantation patients The rates of allografts rejection after transplantation were 50% and obviously higher in the sensitized recipients than in non sensitized ones ( P
ABSTRACT
Objective To investigate the clinical implication of human leukocyte antigen(HLA)matching in sensitized recipients of renal transplantation.Methods Recipient's panel reactive antibody (PRA) was detected by using micro-complement-dependent-lymphocytotoxicity test with Lambda cell tray.Donor and recipient HLA class Ⅰ typing was performed with special monoclonal tray and HLA class Ⅱ gene typing with micro-sequence-specific-primers (Micro-SSP).Results PRA positive rate in 17 recipients was 5.1% to 80% with an average of 37.9%;patients with 0,1 or 2 mismatch (MM) of HLA crossreactive antigen group(CREGs) were 5(29%),8(47%)and 4(24%)cases respectively according to the rule of CREGs matching and no cases had 3-6 MM,however the cases of 0,1 or 2 MM were 1(6%),1(6%)and 8(47%) respectively by the standard of conventional HLA antigen matching and 7(41%)cases had 3-4 MM. Only 3 patients developed acute rejection and were reversed by OKT3 treatment.Renal function retumed normal in all patients.Conclusions The possibility of good matching was greatly enhanced by the CREGs matching.Good HLA matching plays an important role in reducing the incidence of acute rejection and in improving the survival of renal transplants.
ABSTRACT
Objective To investigate the significance of human leukocyte antigen (HLA) matching in highly sensitized recipients of renal transplantation. Methods 18 highly sensitized recipients preexisting panel reactive antibody IgG (PRA IgG) and their specificities were detected by enzyme linked immunosorbent assay (ELISA) with lambda antigen tray (LAT and LATM). Donors and recipients HLA class I typing was performed using complement dependent cytotoxicity (CDC) test with special monoclonal tray (SMT) and HLA class II gene typing by micro sequence specific primers polymerase chain reaction (Micro PCR SSP). Results PRA IgG positive rate in 18 highly sensitized recipients was between 40%～96% with an average of 56%, patients with 0～1 or 2～3 mismatch (MM) of HLA A,B,DR antigen were 28%(5/18) and 72% (13/18) respectively according to the standard of conventional HLA antigen matching.Whereas cases with 0～1 or 2～3 MM of HLA crossreactive antigen groups (CREGs) were 11 (61%) and 7 (39%) respectively by the rule of CREGs matching and the cases with 0～1 MM increased 33%. Only 4 (22%) cases of posttransplantation developed acute rejection and was reversed by OKT 3 treatment. Conclusions The allocation based on CREGs matching should result in a significantly higher percentage of well matched between donors and recipients. Good HLA matching plays an important role in reducing the incidence of acute rejection and in improving the survival of grafts.
ABSTRACT
The level of HLA-antibody and sensitization can be predicated by the determination of panel reactive antibody(PRA)which is of great significance in preventing hyperaeute and accelcrated rejection.The sensitivity of PRA is markedly higher than CDC.The level of PRA(positive rate above 50%)is closely relevant,to the degree of rejection and the decrease of graft survival.Although plasma exchange(PE)can be used to decrease the level of PRA before transplantation to prevent hyperacute and accelerated rejection,good HLA-matching is more important in securing a successful graft patient.Control study between random panel lymphocytotoxicity test(RPLT)and PRA showed that RPLT is a simpler and more dependent and more easily practised method to predict the sensitivity of recipients of renal transplantation.