Clinical outcomes after treatment for NDM-producing Klebsiella pneumoniae infection after kidney transplantation / 中华器官移植杂志

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.

Identification of M1 macrophage-related genes in rejection after kidney transplantation based on weighted gene co-expression network analysis / 器官移植

Objective To identify M1 macrophage-related genes in rejection after kidney transplantation and construct a risk prediction model for renal allograft survival. Methods GSE36059 and GSE21374 datasets after kidney transplantation were downloaded from Gene Expression Omnibus (GEO) database. GSE36059 dataset included the samples from the recipients with rejection and stable allografts. Using this dataset, weighted gene co-expression network analysis (WGCNA) and differential analysis were conducted to screen the M1 macrophage-related differentially expressed gene (M1-DEG). Then, GSE21374 dataset (including the follow-up data of graft loss) was divided into the training set and validation set according to a ratio of 7∶3. In the training set, a multivariate Cox's model was constructed using the variables screened by least absolute shrinkage and selection operator (LASSO), and the ability of this model to predict allograft survival was evaluated. CIBERSORT was employed to analyze the differences of infiltrated immune cells between the high-risk group and low-risk group, and the distribution of human leukocyte antigen (HLA)-related genes was analyzed between two groups. Gene set enrichment analysis (GSEA) was used to further clarify the biological process and pathway enrichment in the high-risk group. Finally, the database was employed to predict the microRNA (miRNA) interacting with the prognostic genes. Results In the GSE36059 dataset, 14 M1-DEG were screened. In the GSE21374 dataset, Toll-like receptor 8 (TLR8), Fc gamma receptor 1B (FCGR1B), BCL2 related protein A1 (BCL2A1), cathepsin S (CTSS), guanylate binding protein 2(GBP2) and caspase recruitment domain family member 16 (CARD16) were screened by LASSO-Cox regression analysis, and a multivariate Cox's model was constructed based on these 6 M1-DEG. The area under curve (AUC) of receiver operating characteristic of this model for predicting the 1- and 3-year graft survival was 0.918 and 0.877 in the training set, and 0.765 and 0.736 in the validation set, respectively. Immune cell infiltration analysis showed that the infiltration of rest and activated CD4+ memory T cells, γδT cells and M1 macrophages were increased in the high-risk group (all P < 0.05). The expression level of HLA I gene was up-regulated in the high-risk group. GSEA analysis suggested that immune response and graft rejection were enriched in the high-risk group. CTSS interacted with 8 miRNA, BCL2A1 and GBP2 interacted with 3 miRNA, and FCGR1B interacted with 1 miRNA. Conclusions The prognostic risk model based on 6 M1-DEG has high performance in predicting graft survival, which may provide evidence for early interventions for high-risk recipients.

The efficiency study on different scoring models in predicting delayed graft function after renal transplantation / 器官移植

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.

Prophylaxis for cytomegalovirus with low-dose valganciclovir after renal transplantation / 中华器官移植杂志

Objective:To explore the efficacy and safety of low-dose valganciclovir for preventing CMV infection after renal transplantation.Methods:Patients undergoing the first renal transplantation from January 2015 to January 2017 were selected. Recipients were divided into two groups according to anti-CMV prophylactic strategy. Recipients in test group (valganciclovir group, n=85) received oral valganciclovir 450 mg once daily and those in control group (ganciclovir group, n=81) had oral ganciclovir 1g thrice daily. Both drugs were prescribed within 10 days after transplantation and maintained for 3 months. Dose adjustments were based upon renal function. All recipients were followed up for 12 months posttransplantation. CMV-DNA, renal function, blood routine and liver function were regularly monitored. The incidence of CMV infection/disease, the median time to CMV infection onset, the incidence of opportunistic infections (OI) and acute rejection, graft or recipient survival and drug safety were evaluated.Results:A total of 166 renal recipients were admitted. Fewer recipients in test group (12, 14.1 %) than in control group (26, 32.1 %) had CMV infection ( P=0.006). The median time to CMV infection onset was longer in test group than in control group: 140.5 days (interquartile range [IQR]: 77.3-198.5 days) versus 47.5 days (IQR: 36.8-67.8 days) respectively ( P=0.014). The CMV disease rate was lower in test group ( P=0.080). The incidence of OI decreased significantly in test group (10.6 % vs 21.0 %, P=0.037). No patients in test group suffered allograft loss while 6 recipients (7.4 %) in control group ( P=0.032). Other adverse and side effects of both regimens were comparable. Conclusions:Low-dose valganciclovir regimen is both safe and efficacious in preventing CMV infection among kidney transplant recipients during the first year posttransplantation.

The comparison between hypothermic machine perfusion and simple cold storage in chinese donation after citizen's death kidney transplantation / 中华器官移植杂志

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.

Kidney quality assessment of deceased donation-large sample experience sharing / 中华器官移植杂志

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.

Clinical research of renal transplant from donation after citizen's death (DCD) donor with acute kidney injury / 中华器官移植杂志

Objective To explore the clinical effect of renal transplant from donation after citizen's death (DCD) donors with acute kidney injury (AKI).Methods This was an observational retrospective study of 622 patients who underwent renal transplantation from 312 DCD donors' kidneys at the First Affiliated Hospital of Xi'an Jiaotong University from December 2011 to December 2016.The transplant patients were divided into AKI group and non-AKI group according to the Acute Kidney Injury Network (AKIN) criteria based on initial and terminal creatinine values.We evaluated and compared transplant outcomes of these two groups.Results There were 131 donors with AKI,and the incidence of AKI was 42.0 ％.AKI group and non-AKI group recipients respectively had DGF in 20.2％ and 7.2％ of cases (P＜0.01),153.6 ± 56.2 and 119.3 ± 40.7 μmol/L of serum creatinine (SCr) levels at 1st month (P＜0.01),and 38.5 ± 14.1 and 57.6 ± 23.4 ml· min-1 (1.73 m2)-1 of eGFR at 1st month (P＜0.01).There was no significant difference in SCr and eGFR between two groups at 1st year after transplantation.Conclusion Most of kidneys from DCD donors with AKI can be considered for transplantation.Renal transplantation of organs from DCD donors with AKI showed greater DGF but good outcomes.

Clinical study of effect on renal transplantation from donation of pediatric donors / 器官移植

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.

Endothelial cells promote islet survival and function / 中南大学学报(医学版)

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.

A multifactorial analysis on long-term survival of kidney transplantation recipients : a report of 989 cases in one centre / 中华器官移植杂志

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.

Retrospective analysis on switch between ciclosporin A and tacrolimus in triple immunosuppressive protocol after renal transplantation / 中华器官移植杂志

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.

Clinical analysis of effectiveness and adverse reactions of different immunosuppressive protocols after kidney transplantation / 中华器官移植杂志

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.

The cell-mediated immune status of patients with cytomegalovirus pneumonia after renal transplantation / 中华器官移植杂志

Objective To evaluate the clinical value of adenosine triphosphate (ATP) determination in CD4+ cells in cytomegalovirus pneumonia after renal transplantation.Methods The ATP level of CD4+ T cells was measured by ImmuKnowTM kit.The ATP levels were determined in 187 renal transplant recipients before and 30,60,90,180 days after operation,and at the time of CMV pneumonia and 4 weeks after treatment of CMV pneumonia.The associations between ATP levels and CMV pneumonia were analyzed.Analysis of variance (ANOVA),Pearson-Spearman and relative risks were used for data analysis.Results 17 cases out of 187 renal transplant recipients were diagnosed as CMV pneumonia (9.1％),and the onset of CMV pneumonia started on the (2.8 ±1.2)month after renal transplantation.ATP concentrations in CD4+ T cells were significantly lower after operation than those before operation (P＜0.01).ATP concentrations reached the lowest on the about postoperative day 90 (P＜0.05),then increased gradually.In 17 recipients with CMV pneumonia,the ATP levels before and 30,90 days after operation,at the time of CMV pneumonia and 4th week after treatment of CMV pneumonia were (376 ±182),(283 ± 146),(196 ± 112),(145 ± 102) and (236 ± 117) μg/L respectively.ATP levels at the time of CMV pneumonia were significantly lower than any other time points (P＜0.05).There was close correlation between ATP levels and CMV pneumonia.Conclusion The determination of ATP in CD4+ cells could reflect the status of cell-mediated immunity in renal transplant recipients,and could evaluate the severity and prognosis of CMV pneumonia and guide the clinical treatment.

Effects of HLA matching on long survival of patients with kidney transplantation (report of 2508 cases) / 中华器官移植杂志

Objective To investigate the effects of HLA matching on long survival of patients with kidney transplantation. Methods In 2508 cases of renal transplants, based on Ag M standard, in 0 MM-6 MM (7 groups), the effects of HLA matching on the survival rate of 1 year, 5 years and 10 years, and the incidence of renal acute rejection (AR) in renal allografts were analyzed. Results Only 7 cases had 0-missmatches, and most cases had 2 or 3 missmatches. In the group of zero antigen mismatches, the incidence of renal AR was 5 %, lower than other groups (P＜0. 01); in the group of six antigen mismatches, the incidence of AR was 23 %, obviously higher than other groups (P＜0. 01). The 1-year, 5-year and 10-year survival rate was 97 %, 90 %, 88 % in the group of zero antigen mismatches; 94 %, 86 %, 83 % in the group of one antigen mismatches; 94 %, 84 %, 82 % in the group of two antigen mismatches; 93 %,85 %, 81% in the group of three antigen mismatches; 91%, 82 %, 74 % in the group of four antigen mismatches; 90 %, 81%, 72 % in the group of five antigen mismatches; 88 %, 80 %, 70 % in the group of six antigen mismatches. Conclusion Good HLA matching can significantly reduce the incidence of AR of renal allografts and increase the survival rate. If recipients are offered to choose those with HLA antigen mismatches ≤3, it is good for the effective use of donor kidneys, the prevention of rejection, and the improvement of the transplantation results.

Living-related donor kidney transplantation in 158 patients / 中南大学学报(医学版)

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.

The effect of prostaglandin E1 on recovery of early renal graft functions after transplantation / 药物分析学报

Objective To investigate the effect of prostaglandin E: (PGE1) on recovery of early renal graft functions after transplantation. Methods One hundred and seven patients after renal transplantation were allocated in the treated group, and treated by conventional treatment with injection of 10 μg prostaglandin E1 additionally twice a day for 14 days. And eighty-eight patients who received conventional treatment alone after renal transplantation at the corresponding period were allocated in the control group. Indexes of the two groups, including incidence of delayed graft function and acute rejection reaction, volume of urine, serum certaintie (SCr), endogenous certainties clearance rate (CCr), the blood flow resistance in graft as well as blood viscosity (BV), and platelet aggregation rate (PAR), were determined. Results The urinary volume and endogenous certainties clearance rate of the treated group were significantly higher, but the level of SCr, incidence of renal function recovery retardation, BV, PAR and blood flow resistance in graft were significantly lower than these of the control group (P<0.05). The difference of incidence of acute rejection reaction between the two groups was insignificant (P>0.05). Conclusion Prostaglandin E1 can improve blood microcirculation and decrease the incidence of renal function recovery retardation. These effects are helpful for recovery of renal function after renal transplantation.

Renal Transplant:the Comparative Study on Color Doppler Flow Image,Single Photon Emission Computer Tomography and Biopsy / 实用放射学杂志

Objective To evaluate the value of color Doppler flow image(CDFI)in diagnosis of acute renal allograft rejection in early stage,by comparative study on CDFI,single photon emission computer tomography(SPECT)and biopsy.Methods A total of 65 patients were included in this study,including acute rejection in 26 cases,chronic rejection in 12 cases,acute tubular necrosis in 7 cases,toxic reaction of cyclosporine a in 2 cases and normal in 18 cases.They were all subjected to CDFI and biopsy,and 44 were detected by SPECT.We reviewed two-dimension gray scale picture,spectrogram,perfusion index(PI),resistant index(RI),the ratio of blood flowing velocity of systole period and diastole period(S/D) as correlated to the findings of SPECT and biopsy.Results The RI values were 0.77?0.05 and 0.72?0.07 in acute rejection group and chronic rejection group respectively,which were obviously higher than those in normal group(0.57?0.07).Conclusion CDFI is a fast,accurate and non-invasive technique in evaluating renal transplant rejection early.

Effects of AG490 on proliferation of human lymphocyte / 中华器官移植杂志

Objective To evaluate the possibility of AG490 as a potential immunosuppressor and to explore its basic mechanism. Methods Human peripheral blood lymphocytes (both T and B) isolated from healthy donors were cultured with PHA or IL 2 separately for MLC to induce the proliferation of human lymphocytes. The inhibitory rate of human lymphocyte proliferation, the release of cytokines (IL 2, IL 6 and IFN ?) and the changes in differentiation of lymphocyte subsets were observed under different immunosuppressors of AG490, CsA and FK506. Results In vitro experiment, AG490 could suppress the proliferation of lymphocytes induced by various mechanisms (especially the CD3 + and CD4 + cells), obviously inhibit the IL 2 and IFN ? production, but could not inhibit the IL 6 production. Conclusion AG490 is a potential immunosuppressor.