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Objective:To explore the clinical efficacy of ceftazidime/avibactam(CZA)plus aztreonam(ATM)for New Delhi metallo-β-lactamase(NDM)carbapenem-resistant Klebsiella pneumoniae(CRKP)infection after kidney transplantation.Methods:Clinical data are retrospectively reviewed for 11 RT recipients infected with NDM metallo-β-lactamase CRKP admitted into First Affiliated Hospital of Xi 'an Jiaotong University and Affiliated Renji Hospital of Shanghai Jiao Tong University from November 2018 to December 2019.Based upon treatment protocol, they are divided into two groups of ceftazidime/avibactam plus aztreonam(CZA-ATM, 5 cases)and other effective antibiotics(OAA, 6 cases).Age, gender, infection type, drug resistance gene, changes in body temperature and leucocyte count, treatment course and prognosis are summarized.Results:A total of 11 patients with NDM-producing CRKP infection after RT are recruited.There are seven males and four females with an age range of(19~66)(38.9±14.4)years.There are mixed pulmonary and urinary tract infections(3 cases), urinary tract infection(2 cases), pulmonary infection(1 case)and perirenal infection(5 cases).All isolates harbore NDM carbapenemase gene, 5 isolates carry Klebsiella pneumoniae carbapenemase(KPC)gene and 1 isolate contained both imipenemase metallo-β-lactamase(IMP)and verona integron-encoded metallo-β-lactamase(VIM)gene concurrently.Ceftazidime-avibactam plus aztreonam(CZA-ATM)is prescribed in five patients while the remainders receive OAA.No adverse reactions occurred in individuals on CZA-ATM and 2 cases on OAA have adverse reactions with a poor appetite and diarrhea.After 30-day infection, the curative cases of CZA-ATM and OAAs groups reach 4 and 5 respectively.No death occurred in neither groups at Day 30.And 90-day mortality is 0 and 1 respectively.Conclusions:For RT patients infected with NDM-producing CRKP, CZA-ATM combination therapy may be another effective treatment.
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Objective To evaluate the efficacy and safety of basiliximab (BAS) and antithymocyte globulin (ATG) in immune induction therapy in kidney transplantation by systematic review and Meta-analysis. Methods Prospective randomized controlled clinical trials screening and comparing BAS and ATG in immune induction therapy in kidney transplantation were systematically searched from global databases, screened and compared. The quality of clinical trials was evaluated by Jadad scoring system and data extraction was performed. The effects of BAS and ATG on the incidence of acute rejection, survival rate of kidney allografts, survival rate of recipients, incidence of delayed graft function, infection, cytomegalovirus infection, malignant tumor, leukopenia and thrombocytopenia at 1 year after kidney transplantation were analyzed. Results A total of 10 clinical trials in English consisting of 1 721 kidney transplant recipients were searched, including 883 cases in the ATG group and 838 cases in the BAS group. No significant differences were observed in the incidence of acute rejection, survival rate of kidney allografts, survival rate of recipients, incidence of delayed graft function, infection, cytomegalovirus infection and thrombocytopenia at postoperative 1 year between the ATG and BAS groups (all P > 0.05). The incidence of malignant tumor and leukopenia at postoperative 1 year in the ATG group were significantly higher than those in the BAS group (both P < 0.05). Conclusions The use of ATG and BAS for immune induction therapy in kidney transplantation yield equivalent efficacy at postoperative 1 year, but BAS is safer than ATG. Clinical trials related to stratified analyses of immune risk are urgently required to achieve individualized precision treatment.
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BACKGROUND@#Delayed graft function (DGF) is the main cause of renal function failure after kidney transplantation. This study aims at investigating the value of hypothermic machine perfusion (HMP) parameters combined with perfusate biomarkers on predicting DGF and the time of renal function recovery after deceased donor (DD) kidney transplantation.@*METHODS@#HMP parameters, perfusate biomarkers and baseline characteristics of 113 DD kidney transplantations from January 1, 2019 to August 31, 2019 in the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively analyzed using univariate and multivariate logistic regression analysis.@*RESULTS@#In this study, the DGF incidence was 17.7% (20/113); The multivariate logistic regression results showed that terminal resistance (OR: 1.879, 95% CI 1.145-3.56) and glutathione S-transferase (GST)(OR = 1.62, 95% CI 1.23-2.46) were risk factors for DGF; The Cox model analysis indicated that terminal resistance was an independent hazard factor for renal function recovery time (HR = 0.823, 95% CI 0.735-0.981). The model combining terminal resistance and GST (AUC = 0.888, 95% CI: 0.842-0.933) significantly improved the DGF predictability compared with the use of terminal resistance (AUC = 0.756, 95% CI 0.693-0.818) or GST alone (AUC = 0.729, 95% CI 0.591-0.806).@*CONCLUSION@#According to the factors analyzed in this study, the combination of HMP parameters and perfusate biomarkers displays a potent DGF predictive value.
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Humans , Biomarkers , Delayed Graft Function , Graft Survival , Kidney/physiology , Kidney Transplantation/adverse effects , Organ Preservation , Perfusion , Retrospective Studies , Tissue DonorsABSTRACT
Objective To evaluate the clinical effect of hypothermic machine perfusion (HMP) in the storage of renal grafts from deceased donor (DD) with high-risk delayed graft function (DGF). Methods Clinical data of 52 donors with high-risk DGF were collected in this prospective randomized controlled study. Two renal grafts from each donor were randomly divided into the HMP group (n=52) and static cold storage (SCS) group (n=52). In the HMP group, the renal grafts were stored by LifePort under HMP, whereas the renal grafts in the SCS group were preserved in University of Wisconsin solution (UW solution). The incidence of DGF and primary nonfunction (PNF) after renal transplantation was statistically compared between two groups. The recovery of renal graft function, the survival rates of the recipients and renal grafts within postoperative 1 year were observed in two groups. Results The incidence of DGF in the HMP group was 4%(2/52), significantly lower than 17% (9/52) in the SCS group (P < 0.05). No PNF was reported in the HMP group and 1 case of PND was noted in the SCS group, the difference was not statistically significant (P > 0.05). The recovery time of graft function of the recipients in the HMP and SCS groups were (7.2±0.6) d and (7.7±1.0) d with no statistical significance (P > 0.05). In the HMP group, the urine volume of the recipients on the day of operation, postoperative 1 and2 d was significantly larger than that in the SCS group (all P < 0.05). In the HMP group, the levels of serum creatinine at each time point after operation were significantly lower than those in the SCS group (all P < 0.05). The 1-year survival rates of the recipient and kidney were 98.1%, 92.3% and 100%, 96.2% in the HMP and SCS groups with no statistical significance (all P > 0.05). Conclusions HMP can significantly reduce the incidence of DGF after renal transplantation from DD with high-risk DGF and promote the early recovery of graft function.
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Objective To analyze the prediction efficiency of scoring models at home and abroad on delayed graft function (DGF) after renal transplantation in China. Methods The clinical data of 112 donors and 220 recipients undergoing renal transplantation were prospectively analyzed. The DGF predicted by KDRI model, Jeldres model, and model of our center was compared with actual DGF incidence of renal transplant recipients. The prediction efficiency of each model was analyzed. The predictive accuracy was compared by the area under curve (AUC) of receiver operating characteristic (ROC) curve. Results The DGF incidence of 220 renal transplant recipients was 14.1% (31/220). DGF prediction using KDRI model showed that 41 cases were high risk donors, the AUC was 0.57, the sensitivity was 0.37, the specificity was 0.66, and the positive predictive value was 22%. DGF prediction using Jedres model showed that 22 cases were high risk recipients, the AUC was 0.56, the sensitivity was 0.13, the specificity was 0.92 and the positive predictive value was 20%. DGF prediction using the model of our center showed that 25 cases were high risk donors, the AUC was 0.80, the sensitivity was 0.53, the specificity was 0.84, the positive predictive value was 40%. Conclusions Compared with the KDRI and Jedres models, the prediction model of our center has higher AUC and sensitivity with a better prediction efficiency on DGF. Therefore, it is a suitable evaluation system of donors from donation after citizen's death in Chinese.
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Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.
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To develop an intelligent lower limb rehabilitation instrument which could realize the quantification and visualization of lower limbs' raising angle and frequency, using the smart client to realize the remote control, autonomous data acquisition and the establishment of database. Doctors had the access to the database in order to adjust the rehabilitation program in time to meet the individual requirement. We realized the design of intelligent lower limb instrument based on the Andriod smartphone, which is suitable for clinical and family use.
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Humans , Computers , Databases, Factual , Leg , Mobile Applications , Rehabilitation , SmartphoneABSTRACT
Objective Hypothermic machine perfusion may improve the outcome after transplantation of kidney donated after citizen's death (DCD),but few powered prospective studies have been reported,especially in China.The aim is to compare hypothermic machine perfusion (HMP) with simple cold storage (SCS) in Chinese DCD kidney transplantation,which can offer an optimal method for graft storage with better graft function and survival.Methods 54 kidney pairs from DCD donors were included in this controlled trial in one single center from December 2015 to March 2017.Every two kidneys from each DCD donor wavs randomly assigned to HMP and SCS group.One-year recipient and graft survival rate and endpoints containing the incidence of DGF,the duration of DGF,creatinine reduction ratio (CRR),estimated glomerular filtration rate (Egfr),primary non-function (PNF),acute rejection (AR),toxicity of the immunosuppressive drugs,nosocomial infections and the length of hospital stay were compared between HMP and SCS group.Results One-year recipient survival rate was 98.15 ％ and 96.23％ after DCD transplant in HMP and SCS group,and one-year graft survival rate was 90.74％ and 88.68％,respectively.DGF incidence was 9.62％ in total DCD kidney transplant,8.00％ in HMP group and 11.11％ in SCS group,which was no difference in two groups.22 DCD was from expanded criteria donor (ECD) donation,DGF happened in 15.91％ ECD kidney transplant.However,HMP reduced the incidence of DGF from 27.27％ to 4.55％ after ECD kidney transplant,which was significantly different (x2 =4.247,P =0.039).HMP group acquired significantly lower creatinine level (130.95 ± 46.60) μmol/L than SCS group (181.64 ± 72.94) μmol/L on day 14 after ECD transplant (t =-2.686,P =0.011).Conclusion There was a higher recipient and graft survival rate after DCD and ECD kidney transplant,which would be an effective method to expand donor pool for kidney transplant.HMP was not associated with lower DGF rate in DCD kidney transplant and more rapid recovery in early graft function.However,HMP preservation not only made renal function recover more rapidly but reduced the risk of DGF after ECD kidney transplant.
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Objective To investigate the influence of quality evaluation of donated kidney after citizen's death on prognosis of renal allograft recipients.Methods A retrospective analysis on 577 cases of deceased organ donation/1084 cases of renal transplantation was made in the First Affiliated Hospital of Xi'an Jiaotong University from December 2011 to August 2018.The quality of donor/ donated kidney was evaluated through various aspects,and the prognostic data of renal transplant recipients were summarized and analyzed.Results 1 084 cases of donated kidney transplantation were completed,and the average follow-up time was (14.3 ± 13.5) months.The 1-and 3-year survival rate of transplant recipients was 97.4％ and 92.1％,respectively,and the 1-and 3-year survival rate of transplanted kidney was 94.6％ and 89.2％ respectively.There were significant differences in human/ kidney survival rate and DGF incidence after renal transplantation among those various groups according to the criteria of subdivision of score of points for donor assessment.Conclusion Comprehensive evaluation of donated kidney quality in all aspects has a significant positive effect on improving the effect of transplantation.
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Objective To evaluate short-term clinical efficacy of renal transplantation from the donation of pediatric donors.Methods Clinical data of 1 5 pediatric donors and 28 recipients (including 2 cases of bilateral renal transplantation)undergoing renal transplantation in the Department of Renal Transplantation of the First Affiliated Hospital of Xi'an Jiaotong University from November 201 3 to December 201 5 were retrospectively analyzed. Results Renal transplantation was successfully performed in 28 recipients.The median warm ischemia time of transplant kidney was 1 2.5 min (range:0-1 7.0 min)and 4.3 h (range:1 .5-7.7 h)for the median cold ischemia time.After operation,4 cases developed with delayed graft function (DGF),1 required dialysis,2 died from pulmonary infection,2 underwent renal resection due to renal anastomosis stenosis and renal thrombosis.Postoperative follow-up lasted for 1 -24 months.Twenty-six (93%)recipients survived after renal transplantation and 24 (86%)recipients survived with restored normal renal function.Conclusions Unilateral and bilateral renal transplantation from pediatric donors has relatively favorable short-term clinical efficacy.
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ABSTRACT:Objective For preparation of vascularized islets , to isolate and culture human adipose derived stem cells , investigate the role of adipose derived stem cells (ADSCs ) in promoting the proliferation and vascularization of human umbilical vein endothelial cells (HUVECs ) co‐cultured in vitro , and explore its mechanism .Methods ADSCs and HUVECs were isolated by collagenase digestion method ,then cultured ,and identified by morphology ,immunofluorescence or multi‐directional differentiation .The co‐culture system of ADSCs and HUVECs was established , HUVECs cultured alone were set up for control group . The proliferation , vascularization and concentration of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (b‐FGF)in the supernatant were compared between the two groups .Results The third generational ADSCs had uniform long spindle fiberous morphology and multi‐directional differentiational function . Immunofluorescence test of surface antigens on ADSCs revealed CD44/CD49d (+ ) ,CD31/CD34 (-) ,on HUVECs CD31/vWF (+ ) . High vascular density was found when co‐cultured in Matrigel of ADSCs and HUVECs than alone of HUVECs .Growth curve shown at days 3 , 4 and 5 of the logarithmic phase , HUVECs count in co‐culture group of ADSCs and HUVECs was (4 .52 ± 0 .31) × 104 ,(7 .18 ± 0 .45) × 104 ,and (8 .23 ± 0 .36) × 104 under indirect co‐culture condition , while that in individual HUVECs group was (2 .71 ± 0 .25) × 104 ,(4 .87 ± 0 .26) × 104 ,and (6 .86 ± 0 .33) × 104 ( P<0 .01) .Population doubling time of HUVECs was shorter in co‐culture group than in individual group .Also ,the OD value of HUVECs was higher in co‐culture group than in individual group when cultured at days 1 ,3 ,5 and 7 ( P<0 .01) .When cultured at days 3 ,7 and 13 ,the concentration of VEGF and b‐FGF in the supernatant was higher in co‐culture group than in individual group ( P< 0 .01 ) . Conclusion ADSCs can promote the proliferation and vascularization of HUVECs in vitro co‐culture conditions by secreting or increasing the HUVECs secretion of VEGF and b‐FGF .
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Objective To isolate and culture human adipose-derived stem cells (hADSCs),investigate the influence of hADSCs on the cellular morphology,survival rate,and function of human islet cells under the in vitro non-contact co-culture conditions,and explore its mechanism.Method hADSCs were isolated by collagenase digestion method,then cultured,and identified by morphology,immunofluorescence and multi-directional differentiation.Adult islet cells were separated and purified by Liberase enzyme and Ficoll 400,then divided into co-culture group and individual group.The cellular growth morphology of islet cells was observed by inverted phase contrast microscope.The survival rate of islet cells,insulin secretory volume,insulin stimulation index and concentration of growth factor in the supernatant were compared between the two groups.Result hADSCs of the third generation showed uniform long spindle fibrocyte-like morphology,and had multi-directional differentiational potentials of osteogenesis and adipogenesis.Immunofluorescence test of surface antigens on hADSCs revealed CD44 + and CD49d +,CD31-,CD34-and CD106-.After 14-day culture,the islet cellular morphology in co-culture group was more intact than that in individual group.The survival rate of islet cells in co-culture group was (82.83 + 2.32) ％,and that in individual group was (53.00 + 2.82) ％ (P＜0.01).Insulin secretory volumes were (23.66 + 2.11) and (7.82 +1.09) mU/L respectively in co-culture group and individual group under high glucose concentration,and 13.22 + 0.77 and 6.40 + 0.44 mU/L respectively under low glucose concentration (P＜0.01 for all).Insulin stimulation index was decreased from 1.67 + 0.10 (at 3rd day) to 1.77 + 0.13 (at 14th day) in co-culture group,and from (1.67 + 0.10) (at 3rd day) to (1.77 + 0.13) (at 14th day) in individual group (P＜0.01).After 14-day culture,the concentrations of HGF,TGF-β,VEGF and bFGF in the supernatant were higher in co-culture group than in individual group (P＜0.01).Conclusion hADSCs were isolated and cultured successfully from adult adipose tissue.They could increase the survival rate and improve the function of islet cells when co-culture with the adult islet cells in vitro through secreting HGF,TGF-β,VEGF and b-FGF.
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Objective To investigate the correlation between immune cell function and the infection after renal transplantation through monitoring of immune function intracellular ATP by Cylex ImmuKnow assay,and explore its significance in individual immunosuppressive therapy of renal transplantion recipients.Method We collected 44 renal transplant patients suffered from pulmonary infection from January 2014 to March 2015.The patients were divided into two groups according to the clinical status,namely,ImmuKnow monitoring group (n =22) and empirical treatment group (n =22).Thirty-two non-infection recipients were collected as controls.All the kidney transplantation recipients received immunosuppressive therapy based on calcineurin inhibitors,mycophenolate mofetil and prednisone,and ATG for induction therapy after transplantatior.The immune cell function levels were measured by Cylex ImmuKnow assay.The whole blood samples were collected before infection onset,at the time of infection,and 1 week after infection resolution.Result When infection occurred,ATP concentrations in CD4+ T cells of the kidney transplant recipients were significantly lower than those in non-infection group [(151.30--71.35 ng/mL vs.(308.34 ± 141.29 ng/mL,P＜0.05).When the infection got controlled,the ATP concentrations in CD4+ T cells increased to those before infection occurred.The average hospitalization time in ImmuKnow monitoring group was 12.27 ± 0.74 days,which was significantly shorter than in empirical treatment group (16.64 ± 1.98 days,P＜ 0.05).The incidence of acute rejection was 4.5％ in ImmuKnow monitoring group,and 13.6％ in empirical treatment group (P＞0.05).Conclusion The examination of ATP in CD4+ T cells by Cylex Immuknow assay could reflect the status of cellular immunity,provide reliable and objective basis for the diagnosis and treatment of infection after renal transplantation,and guide the clinical individualized immunosuppressive therapy.
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OBJECTIVE@#To investigate islet graft survival and function after co-culture and co-transplantation with vascular endothelial cells (ECs) in diabetic rats.@*METHODS@#We isolated ECs, and assessed the viability of isolated islets in a group of standard culture and a group of co-culture with ECs. Then we put the diabetic rats in 4 groups: an islet transplantation group, an islet graft with EC transplantation group, an EC transplantation group, and a PBS control group. Blood glucose and insulin concentrations were measured daily. Cell morphology and cell markers were investigated by immunohistochemical staining and electron microscope.@*RESULTS@#Normal morphology was shown in more than 90% of AO/PI staining positive islets while co-cultured with ECs for 7 days. Insulin release assays showed a significantly higher simulation index co-culture except for the first day (P<0.05). There was a significant difference in concentrations of blood glucose and insulin among the 4 groups after 3 days after the transplantation (P<0.05).@*CONCLUSION@#EC-islet co-culture can improve the function and survival of isolated islets in vitro, and EC-islet co-transplantation can effectively prolong the islet graft survival in diabetic rats.
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Animals , Rats , Blood Glucose , Coculture Techniques , Diabetes Mellitus, Experimental , Endothelial Cells , Cell Biology , Graft Survival , Insulin , Blood , Islets of Langerhans , Cell Biology , Islets of Langerhans TransplantationABSTRACT
Objective To explore the significance of serum CD30 in predicting acute rejection in kidney transplant recipients.Method A total of 106 kidney transplant recipients were recruited in this prospective six months follow-up study from December 2010 to October 2012.According to the clinical outcome,the subjects were devided into stable renal function group (72 cases) and acute rejection group (34 cases).Twenty healthy subjects were choosed as controls.Serum sCD30 levels were detected by ELISA.The whole peripheral blood samples were collected from all recipients before transplantation,at days 7,14,21 and 28 post-transplantation,and at months 2,3,4,5 and 6 posttransplantation.Additional blood samples were collected for on the days that acute rejection occurred and reversed.Result Preoperative serum sCD30 levels were 33.42 ± 11.49 and 26.5 1 ± 13.70μg/L in AR group and stable group respectively.When acute rejection occurred,serum sCD30 levels in AR group was 50.38 ± 12.10μg/L,which was significantly higher than stable group (20.03 ± 6.68μg/L,P＜0.05) and healthy control group (13.57 ± 5.56 ng/L,P＜0.05).After the anti-rejection therapy,serum sCD30 levels decreased to 15.31 ± 6.37μg/L,which was lower than that before the therapy started (50.38± 12.10 μg/L,P＜0.05).Elevated preoperative serum sCD30 levels suggested a higher risk of acute rejection in kidney transplant recipients,with Cutoff values of 24.96 μg/L,and the sensitivity and specificity were 91.30％ and 84.21％ respectively.Conclusion Serum sCD30 levels can predict and assess the risks of rejection episodes in kidney transplant recipients.
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<p><b>OBJECTIVE</b>To evaluate the association of major histocompatibility complex class I chain related gene A (MICA) antibodies with acute rejection (AR), chronic rejection (CR) and renal function after renal transplantation.</p><p><b>METHODS</b>Serum MICA antibodies were detected with ELISA before and after transplantation with also examinations of panel reactive antibodies (PRA), serum creatinine, urine, graft ultrasound, lymphocyte subsets and the pathology of graft biopsy. The study was carried out in two parts to monitor MICA antibodies in acute and chronic rejections after renal transplantation.</p><p><b>RESULTS</b>In the first part of the study 18 of the 41 recipients experienced episodes of acute rejection, and the incidence rate was markedly higher in MICA(+) group than in MICA(-) group (P<0.05). Compared with the recipients with stable renal functions, the patients with acute graft rejection showed a significantly higher positivity rate of MICA antibodies. Postoperative MICA antibody monitoring showed that MICA antibody level increased gradually 2-3 days after the occurrence of acute rejection; anti-rejection treatment lowered serum creatinine to a normal level but MICA antibodies remained positive. In the second part, 21 of 40 patients had chronic graft rejection and showed significantly higher positivity rate of MICA than the patients with stable renal functions (P<0.05). In patients with chronic rejections, the serum creatinine levels were significantly higher in MICA(+) than in MICA(-) cases (P<0.05). Graft biopsy of all MICA(+) cases showed C4d deposition.</p><p><b>CONCLUSION</b>The status of MICA antibodies can predict the occurrence and treatment outcomes of acute rejection, and also as one of the major causes of chronic graft rejection, they affect the long-term survival of the renal grafts.</p>
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Adolescent , Adult , Humans , Young Adult , Antibodies , Blood , Allergy and Immunology , Complement C4b , Metabolism , Creatinine , Blood , Follow-Up Studies , Graft Rejection , Blood , Allergy and Immunology , Pathology , HLA Antigens , Allergy and Immunology , Histocompatibility Antigens Class I , Allergy and Immunology , Kidney , Metabolism , Kidney Transplantation , Peptide Fragments , MetabolismABSTRACT
Objective To analyze the risk factors affecting long-term survival of recipients and renal allografts.Methods From January 1979 to December 2001,the clinical data of 1380 renal allograft recipients were retrospectively analyzed.The clinical and complication data of kidney transplantation were reviewed.Thirteen relative factors were analyzed by SAS statistical software.A Kaplan-Meier rank analysis was used to estimate the 10-year allograft survival rate.Proportional hazards regression analysis (with Cox model) was used to assess and rank the relative risk of potential variable.Results (1) As of Dec.31,2001,utility visiting rate was 93.62％,989 recipients survived over 10 years.The complications were as follows:acute rejection (191 cases),infection (112 cases),liver damage (106 cases).The postoperational 10-year survival rate of recipients and renal allografts was 71.67％ and 62.25％ respectively.(2) CAN,acute rejection,DGF,infection,diabetic mellitus,PRA ＞10％ and HLA mismatch＞3 were the independent risk factors resulting in the reduced survival rate of the renal allografts (P＜0.05).Immunosuppressive regimen with MMF could significantly increase long-term survival rate (P＜ 0.01); (3) The cardiocerebral vascular diseases,liver insufficiency,infection,tumor and diabetic mellitus were independent risk factors for long-term survival (P＜0.01).Conclusion The ideal HLA match is the key step in increasing survival rate; Low dosage of calcineurin inhibitor with MMF and Pred is the ideal regimen of immunosuppressive therapy for long-term survival; active prevention and treatment of cardiocerebral vascular diseases/CAN,infection,diabetic mellitus,and tumor are the main points focused during the follow-up period.
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Objective To explore the clinical significance of switch between ciclosporin A (CsA) and tacrolimus (TAC) in the triple immunosuppressive protocol including calcineurin inhibitors (CNI),mycophenolate mofetil (MMF),and prednisone (Pred) after renal transplantation.Methods The data of 148 patients with CNI switch were collected from Jan.2000 to Dec.2010,including 51patients with Tac switching to CsA (group A) and 97 patients with CsA switching to Tac (group B).The clinical indexes were analyzed by paired t-test.Results In group A,the serum creatinine,urea and blood glucose were significantly reduced,and hemoglobin,bilirubin,cholesterol significantly increased as compared with those before switch (P＜0.05).In group B,the serum creatinine and urea began were significantly reduced from 4th and 2nd week respectively after switch (P＜0.05).Platelet counts began significantly dropping from 20th week after switch (P＜0.05).Albumin,globulin and bilirubin were significantly increased from 20th,12th and 36th week respectively after switch (P＜0.05).Blood glucose and cholesterol were significantly decreased from 12th and 3rd week respectively after switch (P＜0.05).The trough concentrations of CNI and MMF AUC kept stable before and after switch.Conclusion The renal function of all patients was improved to varying degrees by CNI switch between CsA and Tac no matter what reason.The switch of immunosuppressive agents has benefits to alleviate adverse reactions.
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Objective To summarize the incidence and treatment experience of the effectiveness and adverse reactions of the different immunosuppressive protocols and to increase the long-term survival rate in kidney recipients. Methods Single-center retrospective analysis was performed on 3102 cases of kidney transplant recipients in effectiveness and adverse reactions of different immunosuppressive protocols. The immunosuppressive protocols were as follows: CsA + Aza + Pred,low dose CsA + MMF + Pred, low dose Tac + MMF + Pred, low dose CsA + SRL + Pred, and low dose Tac+ SRL+ Pred. Results The 1-, 5-, 10-year survival rate of patients/kidney in low dose CsA + MMF + Pred protocol was higher than that in CsA + Aza + Pred protocol. The incidence of adverse reactions, such as hypertension, hyperuricemia, kidney and liver toxicity, and leukopenia was significantly lower, but the incidence of diarrhea was significantly higher in CsA + MMF + Pred protocol than in CsA + Aza + Pred protocol (all P＜0. 01). The incidence of hyperglycemia was significantly higher (P＜0. 05), and that of hairy and gingival hyperplsia was significantly lower (P＜0. 05) in low dose Tac+ MMF+ Pred than in low dose CsA+ MMF+ Pred protocol. The incidence of hyperlipidemia in low dose CsA (or Tac)+ SRL + Pred was significantly higher than in CsA (or Tac)+ MMF+ Pred protocol (P＜0. 05). The incidence of hirsutism in low dose Tac + SRL + Pred was significantly lower than that in CsA + SRL + Pred protocol (P ＜ 0. 05). The incidence of hyperglycemia in low dose Tac + SRL + Pred was significantly higher than that in low dose CsA + SRL + Pred protocol. Conclusion The triple drug protocol with a low dose of CsA (or Tac)+ MMF+ Pred significantly improved the survival of renal transplant recipients and graft, and reduced the incidence of adverse reactions, especially Tae + MMF + Pred protocol. Adjustment of the immunosuppressant dosage and protocol, improvement of eating habits, exercise, reduction of blood pressure, reduction of blood lipid, and control of blood glucose were particularly important in preventing and controlling adverse reactions during kidney transplantation.
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OBJECTIVE@#To introduce clinical experience for living-related donor kidney transplantation (LDKT) by reviewing LDKT clinical data.@*METHODS@#A total of 158 patients underwent LDKT. Expect for 7 patients donated by their spouses, the others had blood relationship donors. Donor-recipient HLA matching showed 2 patients had 5-loci mismatch, 5 with 4-loci mismatch, 88 with 3-loci mismatch, 50 with 2-loci mismatch, 12 with 1-loci mismatch, the other 1 with 0-loci mismatch. All of the 158 donors underwent open nephrectomy, 35 of whom donated the right kidneys and the other 123 donated the left kidneys. Triple immunosuppressive regimen consisted of calcineurin inhibitors or FK506, MMF or AZa, and steroid.@*RESULTS@#All donors were healthy after the operation. All donors were followed up for 6 to 12 months and blood exams showed that inosine levels were normal. The longest kidney transplant functional survival time was 10 years to up June 2008. The one year patient/graft survival rate was 95.5%. Delayed graft function (DGF) occurred in 5 patients, 4 of whom recovered in 2-5 weeks. Five patients died, 4 of whom died of post-operational pulmonary infection within 3-5 months, with no transplantational complications. The other one died of pulmonary bleeding during dialysis while treating for DGF. One patient received a second deceased kidney transplant because of hyperacute rejection during the surgery. Five developed acute rejection 1 month after the operation (incidence rate 3.16%), 4 of whom were cured by administration of methylprednisolone, and the other one returned to dialysis because of renal toxicity of cyclosporine. Three patients had positive chronic rejection, 2 of whom lost graft function in 1.5-3.5 years. Eight patients developed pulmonary infection and 4 of them were cured.@*CONCLUSION@#Sufficient LDKT pre-operational assessment, satisfactory tissue matching and reduced ischemia time may result in lower incidence of DGF, acute rejection and higher patient/graft survival rate. In LDKT, importance should also be attached to the prevention of DGF and graft rejection. Rational dosage of immunosuppressants is advocated to prevent secondary infective complications. Donor specifications and all around evaluation of the living-related donors should also be emphasized to minimize the harm to the donors. Long term follow-up is also essential to ensure donors' post-operational healthy life.