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Objective To explore the clinical features and feasibility of renal transplantation for end-stage renal disease (ESRD) following hematopoietic stem cell transplantation (HSCT).Method A retrospective study was done in one case of renal transplantation for ERSD following HSCT.Clinical manifestations were summarized and prognosis was described.The 22-year-old male recipient had received HLA allele matched related bone marrow transplantation from his sister in 2001 and accepted renal transplantation 14 years after HSCT because of delayed renal dysfunction.Donor was a cardiac death patient,the preoperative Panel Reactive Antibody Testing was negative and there were 1.5 HLA antigen mismatches of 6 HLA-A,B,DR antigens of donor and recipient.The recipient received immunosuppressive therapy of tacrolimus + mycophenolate mofetil + steroid after renal transplantation.Result The patient's renal function remained stable and serum creatinine level was 65 μmol/L.The outcome of the patient was fairly good during the follow-up period of short-term.Conclusion Renal transplant is a feasible alternative for patients with ESRD following HSCT.If the transplanted kidney and abbr.hematopoietic stem cells are from different donors,irnmunosuppressive treatment is essential after renal transplantation.Long-term follow-up and adjustment of immunosuppression treatment are needed to prevent and treat postoperative complications.
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<p><b>OBJECTIVE</b>To explore the impact of killer cell immunoglobulin-like receptor (KIR) gene mismatch on the outcomes of renal transplantation.</p><p><b>METHODS</b>We collected the data from 111 donor-recipient pairs of kidney transplant and analyzed the status of KIR gene matching, acute rejection (AR), and 1-year and 3-year survival of the recipients who were followed continuously for over 37 months.</p><p><b>RESULTS</b>Seventeen KIR genes were expressed in both recipient and donor groups, and the frequency of KIR3DS1 was significantly higher in the recipients than in the donors (38.75% vs 24.66%, OR=2.17, χ² = 3.94, P<0.05). The average rate of donor-recipient KIR matching was 82.53%. The donor-recipient KIR2DS1 matching rate was significantly higher in AR group than in no-AR group (85.00% vs 54.95%, χ² = 6.19, P<0.05). The rate of donor-recipient KIR AB-AB genotype was significantly higher in AR group than in no-AR group (33.33% vs 8.00%, P<0.05). The 1- and 3-year survival rates was 94.59% and 82.88% in these recipients, respectively. The frequency of donor KIR-AB genotpye was significantly higher in recipients with poor outcomes (57.89% vs 29.63%, χ² = 8.19, P<0.05); the frequency of both donor and recipient KIR-AB genotype was also significantly higher in recipients with poor prognoses (36.84% vs 9.78%, χ² = 14.87, P<0.05).</p><p><b>CONCLUSIONS</b>KIR3DS1 may be the susceptible gene associated with uremia. A KIR-AB genotype of either the donor or the recipient can increase the risk of AR and reduce the 1- and 3-year survival rate. This finding can be of ethically importance in choosing a living related donor.</p>
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Humans , Genotype , Kidney Transplantation , Receptors, KIR , Genetics , Survival Rate , Tissue Donors , Treatment OutcomeABSTRACT
Objective To quantitatively detect intragraft and peripheral blood monocyte cells (PBMCs) perforin mRNA,and analysis the relationship between acute rejection and perforin mRNA. Methods In the allograft group Wistar and male SD rats were used as donors and recipients.SD rats served as donors and recipients in the isograft group.The graft specimens were harvested 5 days postoperatively.They were examined histologically after sectioning and staining with hematoxylin and eosin,Masson’s trichrome, periodic acid-Schiff reagent and periodic acidsilver metheramine.And then the fluorescent quantitative PCR was employed to measure the intragraft and PBMCs expression level of perforin mRNA. Results The histological scores in allograft and isograft kidney samples were 2~5 (3.43?0.98) and 0~1 (0.71?0.49)(P
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Objective To establish a simple,reliable and high successful model of simultaneous liver-kidney transplantation(SLKT). Methods SLKT were performed with some self-made instruments in healthy male SD rats as the recipients,and other SD rats as the donors.The donor liver and kidney were resected simultaneously.The anastomosis of inferior vein cava(IVC) and kidney artery was modified. Results The operation time of donors was (38?5) min;no liver period of recipients was (20?3) min,the operation time of recipients was (81?13)min,the hot ischemic time was less than 4 s,cold ischemic time was less than 83 min,the successful rate is 87.1%(183/210) and postoperation complication was 12.9%(27/210). Conclusions The new model of simultaneous liver-kidney transplantation in the rat was simple,high successful,easily repeated and the complications rate was low.It might be a good model of fundamental research on simultaneous liver-kidney transplantation in the rat.
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0. 05) in a year, respectively. Conclusions FK506 was an effective and high safe basic immunosuppressant in long-term application in renal transplant recipients, especially suitable for children and old recipients. To those patients with DM, FK506 had almost the same influence on the glucose metabolism as the CsA.
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0.05 ) with the CsA group ( 28.15 ? 8.33 )U/d, ( 13.05 ? 2.17 )U/d at the first month and 1 year after the operation. One year after the operation, 21 patients ( 63.63 %) were subjected to anti-hypertensiom, 5 patients ( 15.15 %) to anti-hyperlipidemia treatment and 3 patients ( 9.09 %) to liver protection treatment due to abnormal liver function in FK506 group, while in the CsA group 28 patients ( 90.32 %) were subjected to anti-hypertension, 13 patients ( 41.94 %) to anti-hyperlipidemia treatment and 11 patients ( 35.48 %) to liver protection treatment due to abnormal liver function. There were significant differences between the two groups.Conclusion The small dose low concentration FK506 is effective in the end stage renal disease of diabetic renal allograft recipients and side effect incidence of it was low, and it has almost the same influence on the glucose metabolism as the CsA.
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Objective To explore the long-term clinical effect and safety of tacrolimus (FK506) in renal transplant recipients. Methods There were 126 recipients received FK506 based immunosuppressive therapy and 109 recipients received Cyclosporine A (CsA) based immunosuppressive therapy enrolled into our study according to the criterion and were followed up for 3 years. The dose and trough blood concentrations of FK506, incidence of rejection and side-effect, survival of patients and grafts were recorded in detail. Results The 1-, 3-year patients/grafts survival of FK06 group and CsA group were 98.4?% / 96.8?% , 95.2?% / 90.5?% and 97.2?% / 96.3?% , 94.4?% / 89.0?% , respectively. The incidence of acute rejection was 13.5?% and 19.3?% ( P
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0.05). Conclusions When SD rats serve as both donors and recipients,the rejection is mild because of their good tissue compatibility.The rejection of Wistar-SD rat kidney transplants is rapid and severe, which can serve as good animal model of acute rejection.
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Objective To carry out a pharmacokinetic evaluation of oral FK506 in 13 patients after renal transplant. Methods 13 patients after renal transplantation were given prograf based immunosupressive regimen 24 hours after surgery.Blood samples to determine FK506 levels were drawn in heparinized tube at 0、20、40、60、90 min and 2、3、6、8、10 hours after the first oral dosing.The whole blood concentrations were measured by MEIA and the pharmacokinetic parameters were calculated by 3P87 program.The FK506 doses were recorded in detail for the first month. Results Cmax was (13.6259?4.1117)ng/ml;T(peak) was (1.4866?1.0725)h;t1/2 ? was (0.7749?0.7791)h,t1/2 ? was (10.7267?10.4926)h;AUC was (91.0415?40.7694)ng?ml -1 ?h -1 ,CL was (0.046?0.0036)ng?ml -1 ?h -1 and MRT was (8.1540?4.2937)h.AUC was negative correlateld with prograf dose in the first month posttransplant (r=-0.53, P =0.038). Conclusions The absorption of oral administration of FK506 was rapid in patients after renal transplantation,and can achieve Cmax in (1.5?1.1)h,the mean half life time being 10.7 h.The pharmacokinetic parameters can be the guideline for FK506 application.
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Objective To explore the best procurement technology for cadaveric donor nephrectomy. Methods Clinical data of 1 439 donors nephrectomy in the past 24 years were retrospected.Bilateral nephrectomy,en bloc removal of both kidneys and en bloc removal with in situ cooling both kidneys were adopted in different periods of time.Operation time(OT),hot ischemia time(HIT),cold ischemia time(CIT),total ischemia time(TIT), renal graft beginning to produce urine time after revascularization(UT),renal function recovery time(RRT), damage rate(DR),quantity of preservation solution(PS), rate of acute tubular necrosis(ATN),primary non function(PNF) and poor perfusion of donor kidney(PPK) were observed and comparad among the 3 techniques. Results 216 cases were accomplished by bilateral nephrectomy and 432 kidneys were procured.1 134 cases were accomplished by en bloc removal and 2 264 kidneys were procured(4 cases had only one kidney each).Eighty nine cases were accomplished by en bloc removal with in situ cooling and 178 kidneys were procured. HIT of these three techniques (bilateral nephrectomy,en bloc removal and en bloc removal with in situ cooling) were 8.22?3.01min?5.35?1.88min?1.89?0.92min ( P 0.05).UT were ( 28.24 ?10.65)min,(22.72?8.35)min,(9.26? 10.95 )min.RRT were (9.98?6.84)d,( 7.59 ?6.35)d,(4.91? 7.68 )d.ATN were 15.40%,7.31%,3.98%( P