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BACKGROUND:Pulmonary infection after kidney transplantation evolves rapidly. There is a high mortality rate in patients with server pulmonary infection. It has the important significance of early diagnosis and treatment of pulmonary infection, but some patients appear to have impaired kidney function because of the adjustment of immunosuppressants. OBJECTIVE:To explore the approaches to applying the immunosuppressants during the treatment of pulmonary infection after kidney transplantation. METHODS:The clinical data of 85 kidney transplantation patients who suffered from pulmonary infection were retrospectively analyzed. There were 43 cases in which the infection occurred within 1-6 months after kidney transplantation, 39 of which within 2-4 months; 7 cases of infection occurring within 6-12 months; 7 cases of infection within 12-24 months; 6 cases of infection within 24-36 months; 22 cases of infection occurring beyond 36 months. The immunosuppressant dose was adjusted based on a per-case basis. As a complement, the smal-dose hormone was used for anti-inflammation. Etiological treatments for resisting infections were also conducted accordingly. Ventilators were utilized for patients with respiratory failures. The body temperature of patients was monitored and controled. Appropriate nutrition support was also provided accordingly. There were 44 cases of decreasing or stopping the use of immunosuppressants during the early period of pulmonary infection; 19 cases of decreasing or stopping the use of immunosuppressants during the treatment of pulmonary infection;5 cases of stopping the use of immunosuppressants during the period of severe pneumonia; 15 cases of gradualy changing the dose of immunosuppressants during the early and progressive period of pneumonia; 2 cases of decreasing the use during the early period of pneumonia and stopping the use during the period of severe pneumonia. The duration of decreasing or stopping the use of immunosuppressants ranged from 3-51 days, with an average of 10.7 days. RESULTS AND CONCLUSION: Among the 85 patients, there were 81 cases cured and 4 cases of death. Among the four death cases, two cases died of acute respiratory failure and two cases died of multiple organ failure. Of the cured 81 cases, acute rejection occurred in 3 cases, while renal alograft dysfunction occurred in 6 cases. Decreasing or temporarily stopping the use of immunosuppressants during the treatment of pulmonary infection caused by the kidney transplantation increases the cure rate and decreases the mortality rate; while timely resuming the usage of immunosuppressants effectively protects the renal graft function, especialy for patients with renal graft dysfunction.
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Objective To investigate the safety of renal transplantation in patients with idiopathic thrombocytopenic purpura (ITP).Methods Clinical data of two ITP patients undergoing renal transplantation were retrospectively analyzed and pertinent literatures were reviewed.Results Prior to renal transplantation, the platelet count of these two patients was 41 ×109 /L and 34 ×109 /L,respectively.The coagulation function was normal and no active bleeding was observed.They underwent renal transplantation successfully without obvious bleeding intra-or post-operatively.The platelet count of one patient who received hydrocortisone impulse therapy for three days and maintenance treatment with immunosuppressant based on ciclosporin recovered to normal range and kept stable at 7 days after renal transplantation.Though receiving platelet-promoting drugs and platelet infusion,the platelet count of the other patient treated with methylprednisolone impulse therapy for 3 days and maintenance therapy with immunosuppressant based on tacrolimus did not recover to normal range but fluctuated between 10 ×109 /L and 30 ×109 /L after renal transplantation.Renal function was well maintained in both recipients.Conclusions The risk of renal transplantation related bleeding in ITP patients is correlated with whether the preoperative active bleeding or not.Renal transplantation is relatively safe for uremia patients without active bleeding pre-operation.
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BACKGROUND: Living-donor kidney transplantation is not only associated to prognosis of recipients, but also donors' healthy. Complete medical and psychological assessment should be performed prior to transplantation to ensure the safety of donors. OBJECTIVE: To analyze and summarize the assessment experience of living-relative kidney donors prior to transplantation. METHODS: Totally 77 cases of living-relative kidney donors admitted at Organ Transplantation Center, Second Affiliated Hospital of General Hospital of Chinese PLA between January 2006 and March 2008 were reviewed. Among them, the analysis was carried out respectively according to the live donor nephrectomy guide of the United Kingdom (2005 Edition) before January 20, 2008, and live donor kidney transplantation consensus Boao meeting after January 20, 2008. In common practice, hypertension, diabetes mellitus, cardiovascular system, infectious disease study, age, obesity, proteinuria, renal artery, renal function, receptor for HLA typing and medical ethics, were systematically evaluated. RESULTS AND CONCLUSION: Of the 77 cases of assessed patients, 69 were qualified, successful donors, and completely cured, without complications. Totally 8 cases of non-donors were due to: 2 cases for hypertension combined with end organ damage; 2 for diabetes mellitus; 1 confirmed malignant tumor in kidney-donated surgery; 1 in the activity period of hepatitis B; 1 for resistance from his wife with medical ethics. The average age of donors was 45.3 years old, including and 7 cases above 60 years old, 24 of 50-59 years old, 29 of 30-49 years old, and 9 below 30 years old. There were 39 cases of parent child donation, 1 child parent donation, 19 siblings donation, 7 cases of three generations of collateral serum, and 3 cases of donation between husband and wife. Of successful donors, blood pressure was above 140/90 in 8 cases; Successful donors were without symptoms of myocardial ischemia but 14 cases had consciously ECG ST-T changes; 3 cases had abnormal fasting blood glucose. The successful donors' body mass index (BMI) reached the average of 23.05 kg/m~2, were below 30 kg/m~2; In assessment of infectious diseases, 3 cases were hepatitis B HBs and HBc-positive in a non-activity period, and the antibody titers were below 500 IU/L. In renography, glomerular filtration rate (GFR) was assessed to average (137.3±28.5) mL/min, and no significant statistical difference emerged (P < 0.05). Vascular three-dimensional CT prompted many left renal artery root in 3 cases, accounting for 4% in successful donors, 1 case did not match, accounting for 1%. It demonstrated that the primary purpose of assessment of -living-donor renal transplantation is to ensure that the adaptability, safety and health of donors. In order to avoid the omission of important medical information and unnecessary invasive inspection, as well as reducing the fees of medical assessment, the assessment should be based on the familiar, universally recognized, clinical evidence-based and reasonable procedures and the flexible assessment process.
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BACKGROUND: Pancreas-kidney transplantation is an effective treatment for diabetes combined with final stage renal disease. However, as the patients suffer diabetes for a long period of time, and cardiovascular system disease is complex, pre- and post-transplantation treatment is very important for successful pancreas-kidney transplantation.OBJECTIVE: To discuss immunosuppressant, coagulant, perioperative and postoperative treatment during pancreas-kidney transplantation to provide some clinical experience for pancreas-kidney transplantation.METHODS: Clinical data of 5 cases undergoing simultaneous pancreas-kidney transplantation in Department of Urinary Surgery, the 309 Hospital of Chinese PLA General Hospital between 2003 and 2008 were retrospectively analyzed to summarize the application of immunosuppressants and anticoagulant drugs and perioperative clinical monitoring focus. RESULTS AND CONCLUSION: There were 5 male patients with an average age of 43 years, and suffered type I diabetes mellitus complicated with final stage renal disease. The preoperative insulin dosage was 1.5-2.4 U/(kg·d). One case had diabetic retinopathy and fundus oculi hemorrhage for many times; two cases showed apparent coronary atherosclerotic heart disease with preoperative cardiac ejection fraction of 52% and 50%. Exocrine of transplanted pancreas had been considered by the intestinal fluid drainage. A total of 3 cases were complete rehabilitation. Of them, 1 case developed acute rejection in the first seven days after operation, but renal function restored with the hormones impact; 1 case had postoperative acute rejection of transplanted duodenum as well as intestinal fistula, eventually, transplanted pancreas was ectomized, but transplanted kidney was preserved; two cases succeeded in restoring and no complications occurred; 1 had postoperative gastrointestinal bleeding and died from multiple organ failure. Simultaneous pancreas-kidney transplantation is the most effective way to treat the diabetes mellitus with terminal nephropathy. Because of complications in the transplanted exocrine pancreas with bladder drainage, it has been replaced by the enteric drainage. Recovery of the transplanted kidney function is important for successful transplantation. After operation, oral FK should be taken when the serum creatinine returned to 300 umol/L. The application of clotting drug is one of the important factors for recovery of transplanted pancreatic function. Jejunostomy is an important therapeutic measure to prevent the reflux of intestinal juice to the transplanted pancreas in perioperative period. In the follow-up period cathartic drugs are recommended to prevent constipation and reduce the occurrence of acute pancreatitis caused by intestinal fluid reflux.
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BACKGROUND: Lower urinary tract abnormality (LUTA) can lead to end-stage renal disease (ESRD). However, insufficient attention has been paid to these patients in China, and they are usually thought unsuitable for kidney transplantation because of high incidences of graft dysfunction and septic complication.OBJECTIVE: To explore the characteristics and postoperative follow-up after kidney transplantation in four patients with LUTA.DESIGN, TIME AND SETTING: A retrospective analysis of LUTA cases was performed from July 2002 to June 2006 at the Organ Transplantation Center of Chinese PLA, Second Affiliated Hospital of General Hospital of Chinese PLA.PARTICIPANTS: Four ESRD cases of LUTA, who received allograft kidney transplantation.METHODS: Four cases of LUTA experienced detail evaluation before kidney transplantation. Ureter was reimplanted into the original bladder during transplantation and suprapubic cystostomy was performed as urinary drainage.MAIN OUTCOME MEASURES: Patient and graft survival, graft function, urinary tract infection (UTI) and graft rejection were supervised after surgery and quality of life was evaluated.RESULTS: Two patients recovered well with normal renal function and no rejection. Despite the moderate but easily controlled UTI, they handled the urinary diversion well and were satisfied with the quality of life. One patient experienced an acute rejection 17 days after transplantation and survived with functional graft until now after the rejection was reversed. One patient lost the graft for repeated hemorrhage at the site of vascular anastomosis, and then returned to hematodialysis.CONCLUSION: Kidney transplantation is suitable but special for patients with LUTA. Careful evaluation before transplantation, suitable urinary drainage and rigorous follow-up after surgery are keys to the success of kidney transplantation for this subgroup of patients.
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0.05).The CD4+ lymphocyte of them was(53.37?4.38)% and(29.25?9.38)%,respectively,and the difference between two groups was significant(P