ABSTRACT
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.
ABSTRACT
Objective To evaluate the efficacy and safety of single bolus high dose (SD group) ATG-Fresenius induction therapy in kidney transplantation vs.multiple low dose (MD group) administration.Methods A multiple center,prospective,randomized and controlled clinical study was performed on 280 de novo renal transplant recipients from 19 centers.Patients were randomized into 2 groups as follows:SD group,a single high dose (7-9 mg/kg) of ATG-F infused as an induction agent before the vessel anastomoses;MD group,2 mg/kg of ATG-F daily administrated in postoperative 4 days.All the patients accepted maintenance immunosuppressive protocol including tacrolimus,mycophenolate and prednisone.Patients were assessed and data were collected at regular schedule clinic visits on the day 1,3,7,14,30,90,180,270 and 365.The primary end point of efficacy was therapeutic failure rate [the number of death,grafts loss and acute rejection (AR)].The event first occurred should be used in the classification of patients.The non-inferiority evaluation of the two treatment regimens was done based on treatment failure rate.The secondary end points of efficacy were the incidence of AR,delayed graft function (DGF),1-year survival rate of patients and grafts,and serum creatinine at each visiting point.The indicators for safety evaluation included hemotologic variation and incidence of adverse events.Results The therapeutic failure rate in SD group was non-inferior to the MD group (17.24％ vs.23.08％).AR was the major cause of therapeutic failure and there was similar incidence of AR between SD gronp and MD group (12.07％ vs.21.37％).There was no significant difference in the incidence of DGF between SD group and MD group (12.07％ vs.6.84％,P =0.1721).The 1-year patient's survival rate and 1-year graft survival rate in SD group and MD group showed no significant difference (96.55％ vs.98.29％,P =0.6714;94.83％ vs 98.29％,P =0.2750).The serum creatinine level showed no significant differences between two groups at each visit point.There was also no significant difference in total incidence of adverse events between the two groups.In addition,there was also no statistically significant difference in the incidence of concerned and drug-related adverse events between the two groups,including infection,hemotologic abnormality,liver or renal dysfunction,gastrointestinal disorder,etc.After ATG--F administration,peripheral blood lymphocytes in the SD and the MD group immediately decreased but nearly restored to the normal level on the postoperative day 30 and 90 respectively.No severe granulocytopenia,erythropenia or thrombocytopenia occurred in both two groups.Conclusion The efficacy and safety of single high dose of ATG-F induction are non-inferior to multiple low dose ATG-F induction,moreover,single high dose of ATG-F induction is administered more conveniently and economically.
ABSTRACT
Objective To establish a new method of cutting human pancreases from cadaver donors for islets transplantation, and to discuss the relationship between activity of islets and the cold ischemia preservation time after hypertonic citrate adenine solution perfused.Methods 1500-2000 ml of hypertonic citrate adenine solution was perfused into aorta. Kidey-pancreases-duodenum-spleen were cut together. Digestion of pancreases was done with collagenase P. The islets were isolated, purified and stained. The purity and activity of the islets were measured.Results There was a negative correlation between activity of islets and the cold ischemia preservation time. But there was a positive correlation between activity of islets and the ischemic index.Conclusion The activity of the islets infused with hypertonic citrate adenine solution and degested with collagenase P is high, but the cold ischemia preservation time of the pancreases preserved in hypertonic citrate adenine solution is better not more than 5-6 h.
ABSTRACT
Objective To investigate the application and significance of human leukocyte antigen (HLA) and cross reactive groups(CREGs) matching in clinical renal transplantation. Methods A total of 312 cases of kidney transplantation were divided into two groups.In one group of 149 cases of kidney transplantations,ClassⅠCREGs matching criteria were applied instead of conventional HLA A,B matching which had two A,B mismatches(MM).In the other group of 163 cases of kidney transplantation there were A,B 0～2MM by the conventional criteria.The graft survival rate at 1 year and incidence of acute rejection within 1 month after transplantation were compared between the 2 groups. Results The percentages of HLA Ⅰ antigens 0,1,2MM were 16.7%,41.6% and 34.2% by CREGs matching criteria,and were 6.7 %,21.5% and 71.8% by conventional matching criteria.The matching rates in CREGs 0,1MM group were significantly higher than those in corresponding conventional matching group ( P 0.05);however,the incidence rate of CREGs 0MM group was obviously lower than that of A,B 2MM group ( P 0.05 ),but the rate of CREGs 0MM group was obviously higher than that of A,B 2MM group ( P
ABSTRACT
Objective To investigate the clinical diagnosis and treatment of pneumocystis carinii pneumonia(PCP) after kidney transplantation. Methods Eight patients who developed PCP between 90 days and 140 days following renal transplantation were enrolled in this study.All of them were male with a mean age of 28 years.The clinical manifestations,accessory examinations and treatment were retrospectively analyzed. Results All the 8 patients fully recovered.With early diagnosis and administration of compound sulfamethoxazole(SMZ),clinical symptoms of 6 patients were rapidly controlled within 5 to 7 days.Because of delayed diagnosis and treatment,the conditions of the other 2 cases were more severe and were controlled within 25 days and 46 days separately. Conclusions Application of percutaneous pneumocentesis biopsy can be useful for correct diagnosis in early stage of PCP and has high positive rate of the pathogen. Most PCP patients can be cured with early use of SMZ.Types and doses of immunosuppressor should be adjusted properly.
ABSTRACT
Objective To evaluate the efficacy and safety of two-dose basiliximab vs two-dose daclizumab for prevention of acute rejection in renal transplantation. Methods A total of 58 renal transplant recipients were randomized into 2 groups:basiliximab group ( n =30) and daclizumab group ( n =28).All the cases received the triple therapy of cyclosporine,mycophenolate mofetil and prednisolone (CsA+MMF+Pred).The 3 medications were administered as follows.For CsA,initial dose of 6 mg/kg per day was downtitrated to 4～5 mg/kg per day at 3 months,then to 3～4 mg/kg per day at 6 months.For MMF,initial dose of 0.5 g,3 times per day was downtitrated to 0.5 g,twice per day at 1 month.For Pred,initial dose of 30 mg per day was downtitrated to 20 mg per day at 3 weeks,then to 10～15 mg per day at 6 months.Basiliximab group received two-dose basiliximab (20 mg intravenous infusion) 2 hours before operation and 4 days after transplantation.Daclizumab group received two-dose daclizumab (50 mg) 1 day before operation and 14 days after transplantation.Postoperatively,acute rejection was monitored for 6 months,and adverse events and person/allograft survival were observed for 6～12 months.CD25 + cell count was tested using Beckman Coulter flow cytometer before operation and postoperatively once a week for 2 months. Results During 6-month follow-up, the number of acute rejection episodes were 5 in daclizumab group and none in basiliximab group ( 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
0.05 ). In Zenapax and OKT3 groups, 1 and 2 allografts were removed as a result of rupture respectively. 4 cases were suffered from delayed graft function(DGF) in Zenapax group and 9 in OKT3 group respectively with the difference being significant ( P
ABSTRACT
Objective To evaluate the efficacy and safety of FK506 and the clinical signifinance of serially monitoring whole blood concentration of FK506 in renal transplant recipients.Methods Seventy patients were divided into FK506 group and CsA group. The initial dose was 0.1～ 0.2?mg/kg every day, 6～8?mg/kg every day, respectively. Whole blood trough concentrations of FK506 and CsA were serially monitored. The clinical efficacy and safety of the two groups were also evaluated. Results FK506 had a shorter time to reach contant trough level than CsA, 4 days and 10 days, respectively. The rate of diabetic mellitus in FK506 group ( 20?%) was higher than that ( 7.5?%) in CsA group (P