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Objective:To study the dynamic characteristics of reconstruction of B lymphocytes in peripheral blood at different time points in the patients with immune tolerance induced by combined transplantation of kidney and bone marrow,and to provide the basis for the further illumination of the role of B lymphocytes in immune tolerance of organ transplantation.Methods:Five patients(Pt.A,Pt.B,Pt.C,Pt.D,and Pt.E)with end stage of kidney disease received kidney and bone marrow transplantation after induction therapy.Immunosuppression was discontinued gradually.The number of B lymphocytes and the distribution of subsets of B lymphocytes in peripheral blood were detected by flow cytometry in the patients before and after transplantation,and the dynamic changes of B lymphocytes at different time points were compared.The distribution of immunoglobulin heavy chain variable region(IGHV)was analyzed using next generation sequencing technology.Results:Four patients were enrolled in the study expect one patient with graft failure(Pt.C).The B lymphocyte counts of Pt.A,Pt.B and Pt.D recovered approximately 1 year after transplantation and Pt.E experienced delayed reconstitution.The B lymphocyte recovery was accompanied by a high frequency of CD20+CD24highCD38hightransitional B lymphocytes and a diversified clonal repertoire.All patients showed the prevalence of CD20+CD27+ memory B cells around 6 months after transplantation.Through the calculation of Shannon diversity index(SDI)of IGHV at each time point after transplantation,the SDI of IGHV for all transplant recipients at 182 d after transplantation was significantly lower than before transplantation(P=0.004),and this index was gradually recovered at approximately 1 year after transplantation.The calculation of somatic mutation of B lymphocyte IGHV gene sequence at different time points showed that the somatic mutation rate was elevated at 182 d for all patients except Pt.B(P = 0.032). Conclusion:The presence of mutated memory B lymphocytes in peripheral blood of the patients with kidney and bone marrow transplantation is found,and the B lymphocytes play the potential contribution to tolerance induction.
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Objective To investigate the factors influencing delayed graft function (DGF)following kidney transplants from donation after citizens death (DCD) in single transplant center.Methods The clinical data of 504 kidney transplants from DCD in the First Hospital of Jilin University between August,2011 and May,2017 were collected and analyzed retrospectively.The functional recovery of kidney graft and the related factors were analyzed,respectively.Results The DGF occurred in 32 cases among 504 kidney transplant recipients during perioperative period,who received dialysis treatment (6.3％).The average recovery time of DGF was 21.0 ± 17.1 days.The average dialysis duration (41.3 ± 38.2 months) pre-transplant in DGF group was significantly longer than that in non-DGF group (28.9 ± 26.2 months) (P =0.024).The average age of donors (42.7 ±9.4 years) in DGF group was significantly older than that in non-DGF group (39.0 ± 15.9 years) (P=0.009).The ratio of donors who received CPR treatment in DGF group (21.9％) was significantly higher than that in non-DGF group (6.4％) (P =0.001).The average last serum creatinine level of donors in DGF group (149.3 ± 98.3 mol/L) was significantly higher than that in non-DGF group (92.8 ± 41.6 mol/L) (P＜0.001).The multivariate analysis revealed that CPR treatment for donors before organ donation,the last serum creatinine level of donors as well as BMI of kidney transplant recipients were all independent risk factor influencing DGF (P =0.001,P＜0.001 and P =0.008,respectively).Conclusion Our study focused on analysis of factors influencing DGF following kidney transplants from DCD in single transplant center.The results of this study are helpful to find and avoid the high risk factors that could influence DGF,reduce the incidence of DGF,improve the quality of patients' life as well as reduce the cost of medical treatment.
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Objective To investigate the significance of The Maryland Aggregate Pathology Index in the evaluation of donation after citizens death (DCD) kidney by time-zero renal biopsy.Methods 124 kidney grafts were donated by 62 donors after cardiac death in First Hospital of Jilin University between Jan.2015 and Dec.2015.One kidney was deprecated after evaluation and 123 transplants were performed eventually.Time-zero renal biopsy was performed on 123 cases of DCD donor kidney,and rapid frozen pathological examination was performed.The pathological results of donor kidneys were graded by The Maryland Aggregate Pathology Index:low risk group (less than 7 points) (n =112 cases);the middle risk group (8-11 points) (n =11 cases),high the risk group (more than 12 points) (n =0).The incidence of delayed graft function (DGF),the incidence of perioperative acute rejection (AR),and the average creatinine level in the patients at different time points one year post-transplantation were observed.The median value of follow-up was 19 months,and the 1-year survival rate of patients and renal grafts was observed.Results All 123 cases of kidney transplantation from DCD were performed successfully.The incidence of DGF in low risk group and in middle risk group was 6.3％ (7/112) and 27.3％ (3/11),respectively (P =0.046).The incidence of perioperative acute rejection (AR) in low risk group and middle risk group was 9.8％ (11/112) and 27.3％ (3/11),respectively (P =0.112).The mean serum creatinine (Scr) levels at 7th day,1st month,3rd month,and 12th month after operation were 123.3 ± 79.7,104.4 ± 52.6,72.9 ± 32.0 and 107.6 ± 34.6 μmol/L in low risk group,and 321.0 ± 74.3,172.6 ± 59.9,142.9 ± 45.7 and 140.8 ± 63.6 μmol/L in middle risk group,respectively.The mean Scr levels in patients at different time points one year post-transplantation in low risk group were significantly lower than those in middle risk group (P＜0.000 1,=0.000 3,＜0.000 1,=0.012 respectively).The 1-year survival rate of patients and renal grafts was 98.2％ (10/112)/98.2 (110/112 in low risk group,and 81.8％ (9/11)/81.8％ (9/11) in middle risk group,respectively (P =0.040).Conclusion The Maryland aggregate pathology index obtained from time-zero renal biopsy of rapid frozen pathological examination can provide some guidance for the evaluation of the quality of DCD and the prognosis.Incidence of DGF was lower in low risk group than that in middle risk group,and the renal function of each time point was better within 1 year,and the 1-year survival rate of patients and renal grafts was higher.
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Objective To explore the role of regulatory T cells (Tregs) in skin and heart grafts survival prolongation after different CD47 genotype donor specific splenocytes pretreatment.Methods Mouse skin plus hearts transplantation model was set up by using C57BL/6 as recipients and MHC class I-mismatched bm1 as donors.In CD47-/-DST group,recipients received CD47-/-bm1 splenocytes transfusion at 7th d before transplantation.In CD47+/+DST group,recipients received CD47+/+bm1 splenocytes transfusion at 7th day before transplantation.In control group,recipients only received bm1 skin and heart grafts.The populations of Tregs were analyzed by FACS and immunohistochemistry,respectively.The inhibitory effect of Tregs and anti-donor T cell responses was assessed by MLR.Results Result As compared with control group,the survival time of skin grafts in CD47-/-DST group was slightly longer than in non-DST group (20 days vs.17.5 days,P>0.05),but skin grafts had long-term survival in CD47+/+DST group (46.5 days,P0.05),but heart grafts had long-term survival in CD47+/+DST group (42.5 days vs.17 days,P0.05).As compared with CD47-/-DST group,the ratio of Tregs in lymph node cells in CD47+/+DST group increased significantly (P<0.01).Compared to CD47-/-DST group and control group,anti donor specific T cell proliferation was decreased in CD47+/+DST group at 7th day after transplantation (P<0.05).The inhibitory effects of Tregs were similar among groups.Conclusion CD47 expressed on DST cells plays an important role in grafts survival prolongation.The ratio of Tregs in lymphocytes plays the key role in grafts survival prolongation.but not the number or inhibitory function of single Treg.
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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.
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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.
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Objective To study the effect of serum uric acid (UA) levels on kidney graft function as well as long-term graft survival after renal transplantation.Methods The clinical data of 859 kidney transplant recipients from Jan.2008 to May 2014 were investigated retrospectively.The differences in clinical indexes between normal UA group and hyperuricemia group were compared based on UA levels.Cox regression model was built to analyze the effect of elevated UA on overall graft loss,death censored graft failure and death of patients,respectively.Kaplan-Meier graft survival curve was used to compare the overall graft loss,death censored graft failure and death of patients between normal UA group and hyperuricemia group.Results The average follow-up time was 38.6 ± 17.3 months for 859 kidney transplant recipients.590 (68.7％) recipients were enrolled in normal UA group and 269 (31.3％) recipients were defined as hyperuricemia patients.The average eGFR in hyperuricemia group was significantly decreased as compared with normal UA group (79.4 ± 20.93 vs.94.7 ± 20.55,P＜0.001).Cox regression model showed that if UA level increased per 10 mol/L,the risk of overall graft lost increased 1.070 times (P＜0.001) and the risk of death censored graft failure increased 1.121 times (P＜0.001) accordingly.Kaplan-Meier analysis showed the overall graft loss was dramatically decreased (P =0.009),and the death censored graft failure was significantly decreased (P＜0.0001) in hyperuricemia group as compared with that in normal UA group.The death of patients showed no significant difference between two groups (P =0.638).Conclusion Serum UA levels after kidney transplantation affect graft function as well as long-term graft survival.
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Objective: To compare caudal block with intrarectal local anesthesia plus periprostatic nerve block for transrectal ultrasound guided prostate biopsy
Methods: One hundred and ninety patients scheduled for transrectal ultrasound guided prostate biopsy were randomized equally into Group-A who received caudal block [20 ml 1.2% lidocaine] and Group-B who received intrarectal local anesthesia [0.3% oxybuprocaine cream] plus periprostatic nerve block [10 ml 1% lidocaine plus 0.5% ropivacaine] before biopsy. During and after the procedure, the patients rated the level of pain/discomfort at various time points
Complications during the whole study period and the patient overall satisfaction were also evaluated
Results: More pain and discomfort was detected during periprostatic nerve block than during caudal block
Pain and discomfort was significantly lower during prostate biopsy and during the manipulation of the probe in the rectum in Group-A than in Group-B. No significant differences were detected in the pain intensity after biopsy and side effects between the two groups
Conclusions: Caudal block provides better anesthesia than periprostatic nerve block plus intrarectal local anesthesia for TRUS guided prostate biopsy without an increase of side effects
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Objective To investigate the mechanism of chronic intermittent hypoxia (CIH)-induced renal injury and the protection of metallothionein (MT).Methods 8-10 weeks old male MT-1 transgenic (MT-TG) mice (n=12) and the wide type (WT) mice (n=12) were randomly divided into two groups respectively,Air mimic control(Ctrl) group (n=6) and CIH group (n=6).The period of chronic intermittent hypoxia was continued for 8 weeks.The CIH paradigm consisted of 20.9％ O2 and 8％ O2 fraction of inspiration O2 (FiO2) alternation cycles (30 episodes per hour) with 20 seconds at the nadir FiO2 for 12 hours/day during daylight.The nadir hemoglobin oxygen saturations mainly ranged from 60％ to 70％.Urine,blood,kidney were collected at the end of study respectively.Histopathology,Western blotting and colorimetric method for related target were performed respectively.Results In WT mice,renal fibrosis,the expression of connective tissue growth factor (CTGF),type-1 plasminogen activator inhibitor (PAI-1),hypoxia-inducible factor 1α (HIF-1α),transforming growth factor β1 (TGF-β1),phosphorylated Smad2 and the MDA content were significantly increased by CIH (P ＜ 0.01).In WT mice,the expression of MT detected by using Western blotting was significantly decreased by CIH (P ＜ 0.01).However,in MT-TG mice,above-mentioned indicators showed no significant difference between CIH and Ctrl group.Conclusions Oxidative stresses is the main mechanism of CIH-induced renal injury.The possible molecular mechanism of CIH-induced renal injury is that CIH increases the expression of HIF-1α in kidney tissue,then activate the TGF-β1-Smad2 signaling pathway and lead to the renal fibrosis.The protection of MT on CIH-induced renal injury may be via its antioxidant effect.
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Objective To investigate the mechanism of increasing of the level of kidney injury molecule-1(KIM-1)in culture supernatant of human kidney cells(HKC)induced by cyclosporine A(CsA),and to clarify the relationships between the expression levels of KIM-1 and p38 MAPK pathway and ERK1/2MAPK pathway in HKC. Methods The HKC at logarithmic growth phase were randomly divided into control group, CsA control group, CsA + p38 kinase inhibitor group, p38 kinase inhibitor group, CsA + ERK1/2 inhibitor group and ERK1/2 kinase inhibitor group.The inhibitory rates of proliferation of HKC in various groups were detected by MTT assay, and the expression levels of KIM-1 in HKC supernatant in various groups were detected by ELISA;the survival rates,apopototic rates and necrotic rates of the HKC in various groups were detected by flow cytometry. Results Compared with control group,the expression level of KIM-1 protein in the supernatant of HKC in CsA control group was significantly increased (P0.05).Compared with CsA control group,the expression levels of KIM-1 protein in CsA+ p38 kinase inhibitor group and CsA+ ERK1/2 kinase inhibitor group were significantly decreased (P<0.05),and the survival rate was significantly increased (P<0.05),while the apoptotic rate and the necrotic rate were significantly decreased (P<0.05).Conclusion p38 MAPK pathway and ERK1/2MAPK pathway are involved in the process of up-regulation of the KIM-1 level in HKC culture supernatant induced by CsA,and the expression of KIM-1 may become the biochemical marker of clinical monitoring of CsA nephrotoxicity.
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Objective To explore the effects of penile erectile dysfunction (ED) on the quality of life in male renal transplant recipients.Methods 150 cases of male married recipients undergoing renal transplantation were selected randomly.The recipients were divided into ED group (n =63) and non-ED group (n =87) through the IIEF-5 score.The Short Form-36 Health Status Survey (SF-36)and Hamilton Anxiety Scale were used to compare their living quality and the state of mental health between the two groups,respectively.Results The SF-36 scores in ED group in General Health,Vitality,Social Function,Role Limitation due to Emotional Problems,Mental Health were significantly lower than those in non-ED group (P＜0.05).There were 13 cases in ED group with anxiety disorders (20.6％),significantly more than in non-ED group (3.4％),P＜0.05.Conclusion ED is an important influencing factor for the quality of life in male kidney transplant recipients.
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Objective To investigate the safety and clinical effect of renal hilum controlling during right retroperitoneal laparoscopic living donor nephrectomy (RPLDN).Methods From January 2009 to May 2012,62 cases of right RPLDN were performed in our department.The clinical data,including the general status of donors,operative time,blood loss,donor kidney warm ischemic time,hospital stays and complications,were analyzed retrospectively.Results Right RPLDN was performed successfully on all 62 cases without conversion to open procedure and apparent complications.The function of all the kidney grafts recovered well.Mean operative time was 73.5 ± 10.4 min,mean blood loss was 30.7 ± 10.4 ml,mean warm ischemic time was 107.2 ± 24.8 s,mean artery and vein lengths were 3.3 ± 0.5 cm and 2.0 ± 0.4 cm,vena cava incision suture time was 2.0 ± 0.5 min and mean hospital stay was 5.2 ± 1.6 days,respectively.Conclusion Right donor kidney with small part of vena cava can be harvested by using retroperitoneal laparoscopy plus open passage way.This technique of renal hilum controlling in RPLDN has good clinical effect and more advantages,including ensuring the safety of donors and kidney grafts,promoting the operation done smoothly,reducing the pain and financial burden of donors.
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A patient with impaired kidney function after kidney transplantation and received treatment at the First Hospital of Jilin University was retrospective analyzed. The patient was male, 45 years old, and was diagnosed hemolytic uremic syndrome by transplanted kidney biopsy. The patient received cyclosporine A (CsA) as maintenance centered immunosuppression therapy postoperatively. He was admitted because of 1 week acratia followed by 1 day increased serum creatinine level at 1.5 years after transplantation. At 1 day after admission, he was received renal needle biopsy, and underwent 2 days Prednlsolone treatment. After hemolytic-uremic syndrome was diagnosed, CsA was transferred to Tacrolimus (Fk506) with dose of 2 mg/d, and Azathioprine was replaced by mycophenolate, Prednisone was taken orally for 20 mg/d. The function of the transplanted kidney and the change of routine blood tests were observed. After 1 week treatment of the changed Immunosuppression therapy, the function of the transplanted kidney was improved obviously, and the hemoglobin and platelets was decreased during the treatment. The results demonstrated that kidney biopsy is a key method to diagnose hemolytic-uremic syndrome, and adjustment of immunosuppressive agents, replacing CsA with FK506 are effective for postoperative hemolytic-uremic syndrome.
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Objective To investigate the relationship between microchimerism and immunologic tolerance in kidney transplantation recipients. Methods In samples of peripheral blood and urinary sediment from 176 females who received male donor's kidney,DNA and mRNA expression of specific fragment in Y chromosome were determined by PCR and RT PCR. Results The test results were positive for chimerism in 137 out of 176 recipients(77.84%),and negative in 39 cases (22.16%).The mean survival period in chimerism positive group was 8.9?3.7 years,and 5.2?3.9 years in chimerism negative group.The difference was statistically significant between the 2 groups ( P
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Objective:To study the applied value of CREG Zygosity Principles in kidney transplantation.Methods:Relationship between HLA CREG zygosity and acute rejection incidence was analyzed in 173 kidney transplantation and the concerned principles were discussed.Results:HLA-A,B,DR antigens of 0 mismatch (MM) were 7.51%,4.04%,3.46%;and those of 2 MM were 39.88%,65.31%,58.38% respectively.Compared in CREGs,A,B,and DR,the 0 MMs were 49.71%,30.63% and 24.27%;whereas 2MMs were only 5.20%,12.14% and 8.67%.In HLA-A,B and DR antigens 0 MM,the incidence of acute rejection was 21.96%,21.38% and 7.51% respectively;and in 2MMs,those were 22.54%,20.23%,and 66.67% respectively.Compared by CREGs A,B and DR 0 MM,acute rejection reached 21.83%,20.21% and 6.14%;and in 2MMs the incidence of acute rejection were 22.22%,20.00% and 69.82%.Conclusion:CREGs model is a novel method of choosing kidney transplantation donor-recipients’s matching.
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Objective:To investigate the effects of serum sICAM-1 and sVCAM-1 in renal allograft recipients with infection, acute rejection and CsA-induced nephrotoxicity for the clinical significance of early diagnosis and differential diagnosis.Methods:The sequential monitoring of serum sICAM-1 and sVCAM-1 were conducted by ELISA technique in 86 patients before and after renal transplantation.Results:The levels of serum sICAM-1 and sVCAM-1 increased in the first three day posttransplantation, decreased and stabilized after one to two weeks,increased one to three days prior to the clinical diagnosis in acute rejection and decreased with effective treatment,increased in infection and had no significant difference in CsA-induced nephrotoxicity.Conclusion:Sequential monitoring of serum sICAM-1 and sVCAM-1 of renal allograft recipients can be used to estimate the function of graft,as markers of the early diagnosis and differential diagnosis of acute rejection.
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Objective:To study the levels of TNF ? in serum and in urine and IL 6 in serum of renal allograft recipients with acute rejection, infection and CsA induced nephrotoxicity.Methods:The sequential monitoring of TNF ? and IL 6 was conducted by ELISA technique in 106 patients before and after renal transplantation.Results:The levels of IL 6 and TNF ? increased in the first day posttransplant, decreased and stabilized after 1 to 2 weeks, and increased 1 to 3 days prior to the clinical diagnosis in acute rejection, then decreased with effective treatment. IL 6 and TNF ? increased in serum in infection and had no difference in urine. TNF ? in serum and in urine and IL 6 in serum had no significant difference in CsA induced nephrotoxicity.Conclusion:It suggests that the sequential monitoring of IL 6 and TNF ? of renal allograft recipients can be used to estimate the function of graft, as markers of the early diagnosis of acute rejection.
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Objective To study the effect of renal ischemic reperfusion injury on intracellular ionized calcium level and apoptosis. Methods The model of rat's acute renal ischemic reperfusion injury was established.A total of 30 Wistar rats were divided into 5 groups:control, 1 h ischemia and 1 h,2 h,24 h reperfusion groups (n=6 for each group).Renal intracellular [Ca 2+]i level was determined by Fura-2/AM fluorescence assay,and renal cell apoptosis rates were measured by flow cytometry. Results The renal intracellular [Ca 2+]i levels at 1h,2h and 24h timepoint of reperfusion were 156.2 nmol/L,181.6 nmol/L and 260.6 nmol/L,respectively,which were significantly higher (P
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Objective:To investigate the effect of anti-CD25 monoclonal antibody in preventing acute rejection after renal transplantation.Methods:71 patients were randomly divided into two groups;treatment gourp( n =26)and control group( n =45).The treatment group received anti-CD25 monoclonal antibody twice before and after renal transplantation.The occurrence of rejection postoperation and renal function and T lymphocyte subtypes were sequentially monitored.Results:The occurrence of aute rejection in treatment group in 1,3,6 and 12 months after renal transplantation was 7.7% ,19.2%,23.1% and 30.8%,while it was 15.6%,28.9%,35.6% and 46.7% in control group.There was significant difference between the two groups( P0.05 ).Conclusion:It suggests that anti-CD25 monoclonal antibody reduce the occurrence of acute rejection and have no influence on T lymphocyte subtypes.
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Objective:To study the effect of anti CD3 monoclonal antibody on preventing acute rejection episodes after renal transplantation.Methods:42 patients undergoing renal transplantation were treated with anti CD3 monoclonal antibody (5 mg) daily for a mean of 10 days (treated group).122 patients who were not treated with anti CD3 monoclonal antibody (control group).Acute rejection episodes,graft loss,death and rate of CMV infection in patients were observed.Results:The treated group had a significantly reduced risk of acute rejection (18 6%),as compared with the control group (28 7%).The rate of graft loss were significantly reduced in the treated group 1 year,2 years,or 3 years after renal transplantation.There were no significant differences in mortality between treated group and control group 1 year,2 years,or 3 years after renal transplantation.The incidence rate of CMV infection were significantly increased in the treated group (33 3%),as compared with the control group (13 9%).The first acute rejection episode was postponed significantly in the treated group.There were more acute rejection episodes that could be reversed by MP in the treated group.Conclusion:Anti CD3 monoclonal antibody significantly reduced the risk of acute rejection and significantly reduced the rate of graft loss.Anti CD3 monoclonal antibody significantly increased the incidence rate of CMV infection,which should be paid attention. [