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1.
Article in Chinese | WPRIM | ID: wpr-911692

ABSTRACT

Objective:To explore whether hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) preconditioning can relieve inflammation, reduce cell apoptosis and alleviate renal ischemia-reperfusion injury in mice.Methods:Male C57BL/6 mice were randomly divided into three groups of sham operation (sham), ischemia reperfusion injury (IRI) and IRI+ HIF-PHI ( n=6 each). In IRI+ HIF-PHI group, mice received an intragastric dose of roxadustat (20 mg/kg) every other day one week before. After renal IRI modeling, serum creatinine (SCr) level was monitored and hematoxylin-eosin (HE) staining employed for observing the pathological changes of renal tissue and scoring injury degree. Apoptosis of renal tubular epithelial cells was assessed by terminal-deoxynucleoitidyl transferase mediated nick end labeling (TUNEL). Reverse transcription-polymerase chain reaction (RT-PCR) was utilized for detecting the mRNA expressions of HIF-1α, TNF-α and IL-1β in renal tissues. Immunofluorescence and immunohistochemistry were employed for detecting the expressions of hypoxia-inducing factor 1α (HIF-1α), inflammatory cytokines tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β). Results:As compared with IRI group, SCr level declined markedly in IRI+ HIF-PHI group ( P<0.01), renal tissue injury improved markedly, semi-quantitative score of renal tubule injury dropped ( P<0.01), apoptotic cells decreased ( P<0.01) and the expression levels of TNF-α and IL-1β declined ( P<0.05). Compared with sham group, the mRNA expression of HIF-1α was not significantly elevated in IRI group ( P>0.05). Immunofluorescence showed that the expression of HIF-1α in medulla of renal tissues was up-regulated in IRI group, but not markedly in cortex. While the mRNA expression of HIF-1α was markedly up-regulated after a pretreatment of HIF-PHI ( P<0.05), the expression spiked markedly in renal cortex, but was weaker in medulla than that in IRI group. Conclusions:HIF-PHI can boost the expression level of HIF-1α, reduce the expression of inflammatory factors, relieve the inflammatory response, reduce cell apoptosis, improve renal function and alleviate renal ischemia reperfusion injury.

2.
Article in Chinese | WPRIM | ID: wpr-911649

ABSTRACT

Objective:To evaluate the effect of unilateral pediatric kidney donation for adult kidney transplantation.Methods:Retrospective analysis was conducted on the cases of children who donated unilateral donor kidney for adult kidney transplantation recipients in our hospital, and those who were followed up for more than three years were included in this study. The body weight of the recipients in group A was ≤50 kg, and the body weight of the recipients in group B was ≤70 kg.The recipients were divided into 0-5 year old donor group (group A) and 6-17 year old donor group (B group). Clinical data, recipient/kidney survival, graft function and growth, and complications of the recipient were analyzed.Results:A total of 45 adult recipients were enrolled, including 12 in group A and 33 in group B. The renal survival rate at 3 years after operation was (100%, 96.9%)/(91.6%, 93.9%). One week after the operation, the early postoperative recovery of renal function in group B was better than that in group A, and the difference of serum creatinine was statistically significant ( P<0.05), while the difference of serum creatinine in other postoperative follow-up time points was not statistically significant ( P>0.05). Within a year, both groups of grafts continued to grow, reaching adult levels in one year. There was no statistical significance in the incidence of complications between the two groups ( P>0.05). The incidence of protein in the two groups was 33.3% and 6.1%, respectively, 1 case in each group still had proteinuria at 1 year after surgery, and only 1 case in the infant donor kidney recipient in group A had proteinuria at 3 years after surgery. Conclusions:Unilateral donor kidney transplantation from children can provide good results for adult patients with uremia by selecting suitable donors according to the weight of the recipient.

3.
Article in Chinese | WPRIM | ID: wpr-908025

ABSTRACT

Objective:To retrospectively analyze clinical data of infant donors with body weight ≤15 kg into children recipients, and to investigate the efficacy and complications under the strategy of pediatric donor to pediatric recipient (PTP) of pediatric kidney transplantation allocation.Methods:Clinical data of kidney transplantation for children with infant donors performed in the First Affiliated Hospital of Zhengzhou University from August 2010 to December 2019 were collected.Clinical data of donors and recipients, postoperative adverse events, postoperative renal recovery, and human and renal survival were analyzed.Results:A total of 50 infant donors and 93 pediatric recipients were enrolled in this study.Recipients included 89 patients with single kidney transplantation (SKT) and 4 with en-bloc kidney transplantation (EBKT). The major perioperative complications were delayed graft function (DGF) (5 cases, 5.4%) and vascular thrombosis (VT) (3 cases, 3.2%), followed by recurrence of primary nephropathy (3 cases, 3.2%), respiratory tract infection (3 cases, 3.2%), and acute rejection (AR) (2 cases, 2.2%). During the follow-up period, the main cause of death was respiratory tract infection (4 cases, 4.3%). Except for the cause of death, the main causes of graft loss were rejection (2 cases, 2.2%) and recurrence of primary kidney disease (2 cases, 2.2%). Serum creatinine decreased progressively from (824.77±150.24) μmol/L preoperatively to (90.73±47.24) μmol/L 1 month postoperatively.In SKT group, the median follow-up time was 31 months (3-74 months), and the survival rates of recipients and transplanted kidneys at 1, 3 and 5 years postoperatively were 97.5%/94.2%, 96%/88.8% and 93.1%/86.1%, respectively.In EBKT group, the median follow-up time was 50 months (13-65 months), and the survival rates of recipients and transplanted kidneys at 1, 3 and 5 years postoperatively were all 100.0%.During the fo-llow-up period, there was no significant difference in the human/kidney survival rate between groups (all P>0.05), and well acceptable transplantation outcomes were obtained. Conclusions:Single/double kidney transplantation for children and adolescent recipients from infant donors in the First Affiliated Hospital of Zhengzhou University has achieved acceptable outcomes.Adopted by the PTP strategy, the incidence of complications after kidney transplantation does not increase, indicating its safety and reliability.

4.
Chinese Journal of Urology ; (12): 370-374, 2021.
Article in Chinese | WPRIM | ID: wpr-885024

ABSTRACT

Objective:To compare the efficacy of single kidney transplantation for children from pediatric donors between body weight ≤15 kg and >15 kg.Methods:A retrospective review in 156 children with single donor kidney transplantation from August 2010 to December 2019 in the Kidney Transplantation Department of the First Affiliated Hospital of Zhengzhou University was conducted. The patients were classified into the small kidney group (pediatric donor body weight ≤15 kg) and the big kidney group (pediatric donor body weight >15 kg). In this study, 89 cases were concluded in the small kidney group and 67 cases were concluded in the big kidney group. The donor kidneys were obtained from 46 cases of small weight (≤15 kg) pediatric donors and 48 cases of large weight (>15 kg) pediatric donors. There were significant differences in age [1.00 (0.02 - 4.00) years vs. 10.00 (3.00-18.00) years], body weight [10.0 (3.4 - 15.0) kg vs. 35.0 (16.2- 35.0) kg], height [76 (50- 113) cm vs. 144 (67-172) cm], GFR [(31.50±7.46)ml/min vs. (36.79±7.00) ml/min], and renal length to diameter [(5.91±0.48) cm vs. (8.71±1.88) cm] between the small kidney group and the big kidney group ( P < 0.01). There was no significant difference between the two groups of donors in gender, cold/warm ischemia time and cause of death ( P>0.05). There were significant differences in age [(11.28±3.89) years vs. (13.86±3.56) years], body weight [(31.83±10.45)kg vs. (35.13±9.15) kg], and height [(130.02±28.56) cm vs. (143.97±16.59) cm] between recipients of the small kidney group and big kidney group ( P < 0.05). While there were no significant differences in preoperative serum creatinine level [(822.65 ± 135.04) μmol/L vs. (777.31 ± 165.40) μmol/L], HLA mismatch [(3.4 ± 1.4) site vs. (3.2±1.3) site], and primary disease between the two groups ( P > 0.05). The recovery of renal function, postoperative adverse events, postoperative children, and graft survival were compared between the two groups. Results:The renal function of the two groups of recipients returned to normal 3 months after operation. The perioperative complications in the small kidney group and the big kidney group mainly included renal delayed recovery [5.6% (5/89) vs. 7.5% (5/67), P=0.89], renal vascular embolization [3.4% (3/89) vs. 0, P=0.35], and acute rejection [2.2% (2/89) vs. 4.3% (3/67) , P=0.75]. The main cause of recipient death during the follow-up period was pulmonary infection [4.5% (4/89) vs. 6.0% (4/67) , P=0.68]. The postoperative small kidney group was followed up for an average of 30 (3-74) months. The survival rates of children in the small kidney group at the 1, 3 and 5 years after surgery were 96.6% (86/89), 91.0% (81/89) and 91.0%(81/89), while the transplanted renal survival rates were 92.1% (82/89), 86.5% (77/89) and 84.2% (75/89), respectively. The postoperative big kidney group was followed up for an average of 32 (4-89 ) months. The survival rates of children in the big kidney group were 95.5% (64/67), 94.0% (63/67) and 91.0%(61/67) in the first 1, 3 and 5 years postoperatively, while the graft survival rates were 92.5% (62/67), 83.6% (56/67) and 83.6% (56/67), respectively. The postoperative kidneys of two groups were fast-growing, and there was no significant difference between the small kidney group and the big kidney group in graft length to diameter [(9.63±0.31) cm vs. (9.75±0.71) cm] after 1 year ( P>0.05). Conclusions:The effect of single pediatric kidney transplantation for pediatric donor with body weight ≤15 kg is equivalent to that for pediatric donor with body weight >15 kg , which can be carried out clinically.

5.
Article in Chinese | WPRIM | ID: wpr-870587

ABSTRACT

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.

6.
Article in Chinese | WPRIM | ID: wpr-870550

ABSTRACT

Objective:To explore the efficacies of single-center pediatric transplantations and discuss the current problems.Methods:From July 2007 to September 2019, the clinical data of 202 children (aged ≤17 years) undergoing renal transplantation were reviewed. And their perioperative complications, transplantation outcomes and patient/kidney survival were analyzed.Results:The most common perioperative complication was delayed graft function (DGF)( n=24, 11.9%), recurrence of renopathy ( n=8, 4.0%) and acute rejection ( n=21, 10.4%). The major causes of death and graft failure were lung infection ( n=9, 4.5%) and rejection ( n=11, 5.4%). Perioperative serum creatinine decreased progressively from (816.1±303.1) μmol/L preoperatively to (62.7±20.6) μmol/L at Month 3 post-operation. The value of eGFR were (166.8±37.3), (135.1±29.0) and (109.9±31.1) ml/(min·1.73 m 2) at Year 1/3/5 post-operation respectively. The survival rates were 96.7%, 96.3%, 94.1%, 93.5%, 94.1% and 90.7% at Year 1/3/5 post-operation respectively. No difference existed in human/kidney survival rate between LD and DD groups at Year 1/3/5 post-operation ( P>0.05) and transplantation outcomes were excellent. Conclusions:Effective and successful outcomes have been achieved at our center. And further optimizations are required for resolving various problems.

7.
Article in Chinese | WPRIM | ID: wpr-791856

ABSTRACT

Objective To explore the evaluations and recipient selection methods of extended criteria donor (ECD) kidney donation in the death of citizens and analyze the transplantation outcomes .Methods From January to September 2019 ,the clinical data of donor-recipients were retrospectively studied .The recipients of ECD donor kidneys not evaluated for kidney zero puncture assessment from January 2014 to July 2016 were group A1 and those receiving standard donor kidney (SCD) belonged to group A2 .From August 2016 to March 2019 ,all DCD donors were routinely evaluated for kidney zero puncture and those receiving ECD recipients fell into Group B1 and those receiving SCD belonged to Group B2 .Analysis was performed for ECD/SCD donor renal zero puncture pathological features and lesion degree and utilization of ECD donor kidney ;donor-recipient body surface area (BSA ) ratio and lesion degree of ECD donor kidney on recipient selecting and matching . Serum creatinine value ,perioperative adverse events and 1-year follow-up of human/kidney survival rate in each group were compared at 1 day ,1 week ,1 month ,3 months ,6 months and 1 year .Results A total of 108 , 264 ,306 and 416 recipients were recruited into A1 ,A2 ,B1 and B2 groups respectively .The ECD donor renal utilization rate was 88 .5% vs 93 .3% during two time periods . According to the 2016 Banff standard , glomerular sclerosis (GS) ,renal interstitial fibrosis (Ci) and intimal fibrosis thickening (Cv ) ,small arterial intimal hyalinization (ah) ,tubular atrophy (ct) and acute tubular injury (ati) accounted for more than B1 group than B2 group (P<0 .05) .The severity of ECD donor kidney disease ,BSA ratio <1 .1 group and ≥1 .1 group 1 week ,1 month ,3 months postoperative blood creatinine value was lower than the former while declining amplitude of blood creatinine was higher .A significant difference existed in the degree of moderate lesions in donor kidney (P<0 .05) .After 1 year ,serum creatinine value of B1 group was lower than that of A1 group (P<0 .05) .Conclusions The quality of ECD donor kidney is obviously inferior to that of SCD donor kidney . The Banff donor kidney criterion is an effective mode of evaluating the quality of ECD donor kidney .Based upon the extent of Banff's nephropathy ,the ratio of donor/recipient BSA is an important selecting method for ECD donors to receive kidneys and recipients ,ultimately improving graft utilization and recipient transplantation .

8.
Article in Chinese | WPRIM | ID: wpr-791838

ABSTRACT

Objective To compare the therapeutic efficacy of plasmapheresis (PP ) and intravenous immunoglobulin (IVIG) plus Rituximab for antibody-mediated rejection (AMR) after kidney transplantation .Methods From May 2015 to November 2018 ,a single-center retrospective cohort study was conducted for 540 recipients with high-resolution HLA undergoing kidney transplantation .According to the criteria of diagnosing AMR and patient selection ,20 patients were selected for PP+IVIG (group A ,n=12) ,PP+ IVIG+ Rituximab (group B ,n=8) .The efficacies and outcomes of two groups were compared .Results During a follow-up period of (12 .0 ± 5 .8 ) months ,no significant inter-group differences existed in basic profiles (P> 0 .05) .After AMR treatment ,serum creatinine levels decreased significantly from 283 .4 to 226 .4 μmol/L in group A (P=0 .001) and from 289 .4 to 166 .6 μmol/L in group B (P=0 .049) .And the magnitude of decline was more marked in group B (P=0 .023) .Meanwhile ,antibody MFI (log10) decreased from 3 .73 to 3 .62 in group A (P=0 .012) and from 3 .57 to 3 .02 in group B (P=0 .043) .At months 3 and 6 , serum creatinine level was lower in group B than that in group A (125 .0 vs .166 .1 μmol/L , P=0 .03 ;127 .0 vs .169 .0μmol/L ,P=0 .048) .The serum creatinine levels of AMR patients were 249 .8 and 233 .8 μmol/L respectively ( P= 0 .182 ) .Serum creatinine levels were 176 .1 and 120 .3 μmol/L ( P=0 .045) and 180 .2 and 114 .8 μmol/L at months 3 and 6 (P=0 .044) respectively .Serum creatinine levels were 202 .8 and 122 .5μmol/L (P=0 .049) in group A and 142 .7 and 107 .0μmol/L (P=0 .046) in group B respectively .Four recipients developed allograft failure .At month 6 post-operation ,AMR occurred in group A (n=3 ,25% ) and group B (n=1 ,12 .5% ) .And the incidence of leucopenia was 37 .5% and 0 (P=0 .049) in groups A and B respectively .Conclusions PP and IVIG plus rituximab is more efficacious for AMR .The earlier occurring time ,the better prognosis .

9.
Article in Chinese | WPRIM | ID: wpr-796531

ABSTRACT

Objective@#To explore the evaluations and recipient selection methods of extended criteria donor (ECD) kidney donation in the death of citizens and analyze the transplantation outcomes.@*Methods@#From January to September 2019, the clinical data of donor-recipients were retrospectively studied. The recipients of ECD donor kidneys not evaluated for kidney zero puncture assessment from January 2014 to July 2016 were group A1 and those receiving standard donor kidney (SCD) belonged to group A2. From August 2016 to March 2019, all DCD donors were routinely evaluated for kidney zero puncture and those receiving ECD recipients fell into Group B1 and those receiving SCD belonged to Group B2. Analysis was performed for ECD/SCD donor renal zero puncture pathological features and lesion degree and utilization of ECD donor kidney; donor-recipient body surface area (BSA) ratio and lesion degree of ECD donor kidney on recipient selecting and matching. Serum creatinine value, perioperative adverse events and 1-year follow-up of human/kidney survival rate in each group were compared at 1 day, 1 week, 1 month, 3 months, 6 months and 1 year.@*Results@#A total of 108, 264, 306 and 416 recipients were recruited into A1, A2, B1 and B2 groups respectively. The ECD donor renal utilization rate was 88.5% vs 93.3% during two time periods. According to the 2016 Banff standard, glomerular sclerosis (GS), renal interstitial fibrosis (Ci) and intimal fibrosis thickening (Cv), small arterial intimal hyalinization (ah), tubular atrophy (ct) and acute tubular injury (ati) accounted for more than B1 group than B2 group (P<0.05). The severity of ECD donor kidney disease, BSA ratio <1.1 group and ≥1.1 group 1 week, 1 month, 3 months postoperative blood creatinine value was lower than the former while declining amplitude of blood creatinine was higher. A significant difference existed in the degree of moderate lesions in donor kidney (P<0.05). After 1 year, serum creatinine value of B1 group was lower than that of A1 group (P<0.05).@*Conclusions@#The quality of ECD donor kidney is obviously inferior to that of SCD donor kidney. The Banff donor kidney criterion is an effective mode of evaluating the quality of ECD donor kidney. Based upon the extent of Banff's nephropathy, the ratio of donor/recipient BSA is an important selecting method for ECD donors to receive kidneys and recipients, ultimately improving graft utilization and recipient transplantation.

10.
Article in Chinese | WPRIM | ID: wpr-710665

ABSTRACT

Objective To explore the long-term clinical effect of kidney transplantation in children.Methods The clinical data of 53 children with kidney transplantation from March 2008 to September 2014 were retrospectively analyzed.The influence of the dependent factors on the estimated glomerular filtration rate (eGFR) (greater than 90 mL/min/1.73 m2 or <90 mL/min/1.73 m2) was estimated in the three years after the operation,and the influencing factors were analyzed by the dual logistic regression equation.Results There were 19 cases of living donors,17 cases of organ donors after death,and 6 others.The 53 patients were followed up for 3-9 years.The level of blood creatinine was decreased from the preoperative (820.1 ± 323.1) μmol/L to (51.6 ± 24.9) μmol/L 3 years after the operation (P<0.05).eGFR was increased to (103.5 ± 11.4) mL/min/1.73 m2at 3rd year after the operation from the preoperative (17.1 ± 7.8) mL/min/1.73 m2 (P<0.05).The age of recipients,preoperative dialysis time,number of HLA mismatching and postoperative delayed graft function healing (DGF),rejection and infection were the influencing factors of eGFR at 3rd year postoperation (P<0.05).The multi-factor binary logistic regression equation analysis showed that only rejection was the risk factor for eGFR at 3rd year p0ostoperation.Eight cases of DGF (8/53,15.1%) recovered rapidly.There were 6 cases of acute rejection (6/47,12.8 %) and 1 case of chronic rejection (1/47,2.1%).There were 9 cases of infection (9/47,19.1%).There were 6 cases of recurrence after surgery.The 3-year recipient and kidney survival rate was 94.3% (50/53) and 88.7% (47/53) respectively.The average height of the patients in the first,second and third year after the surgery was increased by (4.6 ± 1.9) cm (0.5-19.1 cm),(3.7 ± 1.8) cm (0.7-14.3 cm) and (2.8± 1.2) cm (0.3-8.7 cm) respectively.Conclusion The long-term effect of children kidney transplantation is satisfactory.

11.
Chinese Journal of Geriatrics ; (12): 1009-1012, 2018.
Article in Chinese | WPRIM | ID: wpr-709406

ABSTRACT

Objective To investigate the clinical significance of serum and urinary levels of neutrophil gelatinase-associated lipocalin (NGAL ) for evaluating changes of residual renal function after living donor kidney resection under different operation model in young versus elderly patients. Methods The clinical data of renal transplants were retrospectively analyzed by successfully using 66 living-related donors at the First Affiliated Hospital of Zhengzhou University from September 2016 to October 2017. According to the operation model and age ,renal donors were divided into 4 groups :group A (young/open) ,group B (young/laparoscopic) ,group C (aged/open) ,and group D (aged/laparoscopic).Blood and urinary NGAL and serum levels of creatinine ,cystatin C ,and other indices of renal function were assayed and collected before and at 1 ,3 ,7 days after operation. Results Both blood NGAL levels and urinary NGAL levels showed no statistically significant difference (all P>0.05) among four groups both before and after operation ,except that urinary NGAL was higher in group C (aged/open) than other groups ,at 1 day after operation ,(P = 0.03).The post-vs.pre-operation level dynamic changes of renal function were four or three times higher in urine or serum NGAL level than in serum creatinine or cystatin C level at 1 day after operation ,which showed an important role for predicting an early residual renal damage and relative treatment. Conclusions NGAL can be used as indices in evaluating changes of residual renal function after living donor kidney resection ,especially in the elderly receiving open kidney resection.

12.
Chinese Journal of Geriatrics ; (12): 306-310, 2018.
Article in Chinese | WPRIM | ID: wpr-709245

ABSTRACT

Objective To explore the significance of time-zero renal biopsy on evaluating renal function and postoperative complications after transplantation from donation in old age donors.Methods Clinical and pathological data of 112 transplantations with time-zero renal biopsy which performed in the First Affiliated Hospital of Zhengzhou Hospital from August 2016 to April 2017 were collected.Based on donor age and Remuzzi score,112 transplantations were divided into four groups:Group A (donor age <50 years and Remuzzi score is 0 to 3) with 58 recipients,Group B (donor age <50 years and score is 4 to 6) with 9 recipients,Group C (donor age≥50 years and score is 0 to 3) with 35 recipients,and Group D (donor age≥50 years and score is 4 to 60) with 10 recipients.Renal function and postoperative complications of recipients in each group were recorded and compared among groups.Results The estimated glomerular filtration rate (eGFR) at 6th month after operation was significantly negatively correlated with glomerular sclerosis (r=-0.398,P=0.05),arteriolar hyaline degeneration (r=-0.416,P<0.05) and arterial intimal fibrosis (r=-0.242,P<0.05).Arteriolar hyaline degeneration (β=-0.249,P<0.05) and arterial intimal fibrosis (β=-0.246,P=0.020) were the independent correlated factors of eGFR at 6th month after operation.The levels of serum creatinine of group D were higher than those in the other three groups at each time after operation(all P<0.05);Moreover,in group D the eGFR values at each time were lower than those in the other three groups(P<0.05).Additionally,the incidences of acute rejection within 6 months after operation in group C and D were higher than those in group A and B (all P<0.05),but the incidences of delayed graft function,hematuria,proteinuria among four groups were not significantly different (all P> 0.05).Conclusions Patients who accepted older kidney with moderate histological lesions show worse renal function and higher incidence of acute rejection after transplantation.Recipient selection and postoperative immunosuppressive treatment should be more cautious for those renal donors.

13.
Article in Chinese | WPRIM | ID: wpr-611474

ABSTRACT

Objective To dynamically monitor the changes of peripheral blood lymphocyte subsets of renal transplant recipients and investigate the relationship between lymphocyte subsets with infection and rejection.Methods The clinical data of allogenic kidney transplantation recipients and living relative donors in the Department of Kidney Transplantation of the First Affiliated Hospital of Zhengzhou University were prospectively collected from June 2015 to December 2016.The data of lymphocyte subsets and other related indexes were obtained from renal transplant recipients and relatives of the same period.Results Sixty-four cases of living-relative donors and 351 cases of renal transplant recipients were enrolled in this study,and the recipients were divided into 3 groups:infection group (67 cases),acute rejection group (46 cases),and stable group (238 cases),according to the diagnostic criteria.There was significant difference in the concentration distribution of lymphocytes between the stable group and the control group (P<0.05).The stable frequency distribution range of the stable group was as follows (cells/μL):Lym (1 000-1 500),T (<1 500),CD4+ (<1 000),CD8+ (<1 000),B (<300),NK (100-300),CD4+/CD8+ (0.5-1.0).The number of Lym,T,CD4+,CD8+,NK and B cells in the preoperative patients was less than that in the healthy population (P<0.05);The number of Lym,T,CD4+, CD8+,B and NK cells was gradually decreased in the postoperative infection group,which was less than that in the stable group (P<0.05).After treatment the indicators gradually restored to the level in the stable group level;the number of T,CD4+,CD8+,B cells was highly correlated with infection.The number of T and CD4+ cells,and CD4+/CD8+ ratio were significantly increased in acute rejection group as compared with the stable group,and gradually decreased after the rejection was reversed.The number of T,CD4+,CD8+ cells was highly correlated with rejection.Lymphocyte subsets had a predictive effect on infection and rejection of recipients,and CD4+ cell count and CD4+/CD8+ ratio were independent risk factors.Conclusion The monitoring of lymphocyte subsets has an important clinical value in the evaluation of immune status and individual treatment of renal recipients.

14.
Article in Chinese | WPRIM | ID: wpr-668403

ABSTRACT

Objective To explore the morphological changes of renal grafts in implantation protocal biopsy,and early stage effect of lesions from donation after cardiac death (DCD) donors.Methods Preimplantation kidney biopsy from 48 cases of DCD donors from August 2016 to March 2017 was retrospectively reviewed.Protocal biopsy was performed on dual kidneys and evaluated according to Banff 2016 donor criteria before transplantation.The Banff score of kidneys was calculated and its effects on renal function were evaluated.Results There were 48 donors and 95 kidneys (there was one kidney with congenital renal indevelopment).In.one case,diffused thrombus in arteriae arcuata occurred on the left side (normal on the right side),and the left kidney was discarded.In one case,diffused arteriolar hyaline (ah3) occurred on the left side (normal on the right side),and the left kidney was discarded.Severe interstitial fibrosis (>70%) was seen in one pair of kidneys,and the kidneys were discarded.The proportion of glomerulosclerosis (GS) was >30% in one pair of kidneys,and the kidneys were discarded.There was no statistically significant difference in morphometric changes between left kidney group and right kidney group (P>0.05).Besides GS,the morbidity of interstitial fibrosis (ci) was 17%,that of tubular atrophy (ct) was 16%,that of interstitial inflammation (i) was 13%,that of fibrous intimal thickening (cv) was 19%,that of arteriolar hyaline changes (ah) was 28%,that of glomerolar thrombi (gt) was 0%,and that of acute kidney injury (AKI) was 81 %.Glomerular filtration rate (eGFR) estimated was compared between ah >2 group and ah≤2 group.eGFR in ah>2 group was significantly higher in 16 days,one month and three months,but not in 7 days.Terminal blood serum creatinine (t-Scr) in ah>2 group in three months was significantly higher than that in ah≤2 group (152.5 ± 47.38 vs.122.08 ± 36.57 μmol/L,P<0.05).The eGFR was compared between Banff score >3 group and Banff score ≤3 group.The eGFR in ah>2 group was significantly higher in one month and three months,but not in 7 days and 16 days.t-Scr in Banff score >3 group was higher significantly than in Banff score ≤3 group (146.18-± 44.55 vs.115.27 ± 30.67 μmol/L,P<0.05).Seven patients were diagnosed as having delayed graft function (DGF),there were 2 patients with ah>2 and Banff score>3,and 1 patient with primary non-function (PNF).Conclusion Vasculopathy and acute renal tubular injury were most common lesions in donor renal pathology.Kidneys with diffused arteriolar hyaline change (ah>2) or Banff score >3 have poor graft function at 3rd month.

15.
Article in Chinese | WPRIM | ID: wpr-507082

ABSTRACT

Objective To investigate the status of living relative kidney transplantation, and the clinical effects and social significances of kidney transplantation between spouses. Methods We retrospectively collected the clinical data of the department of kidney transplant of the First Affiliated Hospital of Zhengzhou University, from January 2011 to December 2013. The spouse group as group 1, the age and sex of doners were taken into account,the siblings with the similar age of the same period were enrolled in group 2. Then the postoperative recoveries of the two groups were compared. Considering the current social status, particularly the shortage of donor kidneys, the clinical, social and family significances of kidney transplantation between spouses were analyzed. Results Twelve cases of spouses in group 1, 8 cases of siblings in group 2 , the differences of donor and recipient age of the two groups were 0.33 ± 0.98 years and 2.29 ± 7.23 years, respectively. The human major histocompatibility complex antigens (HLA) was less than three in group 1, and was greater than or equal to three in group 2. The changes of serum creatinine and urea nitrogen were analyzed. No significant differences of serum creatinine and downward trend of blood urea nitrogen were observed between two groups (P = 0.84, P = 0.79). Conclusion The kidney transplantation between spouses has good clinical efficacy and great social significance, improving the status of the shortage of donor kidney and contributing to family harmony. The renal transplantation between spouses has obvious advantages and need further promotion.

16.
Article in Chinese | WPRIM | ID: wpr-619824

ABSTRACT

BACKGROUND: Donation after cardiac death (DCD) is becoming the main source of organs for transplantation. Donor and recipient gender may play an important role in preoperative evaluation and recipient selection of transplantation. OBJECTIVE: To analyze the effect of donor and recipient gender on the recovery of renal function after DCD renal transplantation, and to further guide the selection of recipients. METHODS: The clinical data of recipients and donors of DCD kidney transplantation performed at the First Affiliated Hospital of Zhengzhou University from July 2012 to March 2015 were analyzed retrospectively. According to donor and recipient gender, the donors and recipients were divided into four groups: group A (male donor, male recipient), group B (male donor, female recipient), group C (female donor, male recipient), group D (female donor, female recipient). The renal function of the recipients was recorded at 1 and 2 weeks, 1, 3, 6, and 12 months postoperatively to compare the effect of donor and recipient gender on the recovery of renal function. RESULTS AND CONCLUSION: The serum creatinine level in the groups A and B was lower than that in the groups C and D at postoperative different time points, and there was a significant difference at 3, 6 and 12 months postoperatively (P < 0.05). The estimated glomerular filtration rate in the groups A and B was significantly higher than that in the groups C and D at postoperative different time points (P < 0.05). The serum creatinine level in the group C was significantly higher than that in the other three groups at postoperative different time points (P < 0.05). The serum creatinine level in the group A was significantly higher than that in the group B at 3, 6 and 12 months postoperatively (P < 0.05). The glomerular filtration rate in the group A was significantly higher than that in the group C at postoperative different time points (P < 0.05). The glomerular filtration rate in the group B was significantly higher than that in the group D at 12 months postoperatively (P < 0.05). These results suggest that the male donors show superior renal function to the female donors. The postoperative recovery of renal function is relatively slow when the male recipients receive a kidney of female donors. The female recipients with lower body surface area who receive the kidney of elderly male donors with poor renal function can achieve favorable clinical effects. Therefore, the gender should be used as a reference index for selecting potential recipients.

17.
Article in Chinese | WPRIM | ID: wpr-710651

ABSTRACT

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.

18.
Organ Transplantation ; (6): 289-294,310, 2017.
Article in Chinese | WPRIM | ID: wpr-731687

ABSTRACT

Objective To evaluate the clinical efficacy of en-bloc kidney transplantation from pediatric organ donation after death. Methods Clinical data of donors and recipients undergoing en-bloc kidney transplantation from pediatric donor kidneys were retrospectively analyzed. The 1-year survival rates of the recipient and grafted kidney were calculated. The recovery of renal function at postoperative 1 year was observed. The changes in the length of grafted kidney and incidence of postoperative adverse events were monitored. Results The 1-year survival rate of the recipients was 8/9, and 72% for the grafted kidney. During 1-year follow-up, the serum creatinine (Scr) level was down-regulated from (747± 170) μmol/L before transplantation to (83±27) μmol/L post-transplantation, the blood urea nitrogen concentration was decreased from (24.5±4.9) mmol/L to (6.8±2.0) mmol/L, and the length of transplanted kidney was increased from (61.1±9.8) mm to (100.3±1.7) mm. Two recipients suffered from delayed graft function(DGF) and restored after hemodialysis. Two cases developed acute rejection and healed after methylprednisolone shock therapy. One recipient presented with lung fungal infection at postoperative 2 weeks after transplantation, and was treated by the withdrawal of immunosuppressive agents and antibacterial treatment with poor clinical efficacy. Then the recipient died at 3rd month. One case had renal arterial thrombosis at postoperative 7 d, underwent nephrectomy at postoperative 10 d and returned to hemodialysis. At postoperative 1st month, one recipient suffered from thrombosis of unilateral renal artery. The grafted kidney in other side normally functioned and significantly grew in size at postoperative 6 months. In addition, two cases had ureterostenosis of the transplanted kidney, albuminuria in 2, abdominal aortic stenosis in 1 and urinary fistula in 1. All these symptoms were cured or alleviated after corresponding treatment. Conclusions The incidence of perioperative complications is relatively high in en-bloc kidney transplantation from pediatric organ donation after death, whereas the clinical efficacy of such kidney transplantation can be gradually increased along with the accumulation of clinical experience.

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Article in Chinese | WPRIM | ID: wpr-462326

ABSTRACT

BACKGROUND:Uremia patients have different degree of anemia before kidney transplantation, preoperative, and perioperative anemia is harmful to intraoperative and postoperative recovery of the organism and renal function. OBJECTIVE:To observe the effects of perioperative anemia degree and total blood transfusion on non-living and living-relative donor kidney transplantation, and to summarize the perioperative drug treatment for anemia and perioperative principles of blood transfusion. METHODS: A retrospective study was done in 115 cases of non-living donor kidney transplantation (test group) and 92 cases of living-relative donor kidney transplantation (control group) from January 2012 to December 2013. Degree of anemia, total perioperative blood transfusion, electrolyte change within 12 hours of blood transfusion, and adverse events after blood transfusion were recorded and analyzed. RESULTS AND CONCLUSION:The incidence of anemia had no significant difference between the two groups (P > 0.05). Compared with the control group, the intraoperative and postoperative blood transfusion rate was higher in the test group (P < 0.05), and the preoperative red blood cel level, hemoglobin level, hematokrit, average hemoglobin level, average concentration of hemoglobin, and average amount of blood transfusions were significantly lower in the test group (P< 0.05). Fever (5.5%) was the main adverse event during the transfusion in the two groups, and there was no severe severe alergic reaction and electrolyte acid-base disturbance. These findings suggest that the perioperative degree of anemia is higher in patients undergoing non-living donor kidney transplantation and those undergoing living-relative donor kidney transplantation; preoperative drug treatment for anemia is crucial for correcting anemia status; intraoperative and/or postoperative blood transfusion treatment should be in strict accordance with the principles of perioperative blood transfusion.

20.
Article in Chinese | WPRIM | ID: wpr-428001

ABSTRACT

Objective To investigate the effect of icariin on renal ischemia-reperfusion injury (IRI) and the action mechanism.Methods SD rats were divided into 3 groups.The model of unilateral renal IRI was established in SD rats,and Icariin (100 mg/kg) was orally administrated by gavage daily from 2 days before operation to 12 days after operation (icariin group).The vehicle of icariin was administrated to IRI model rats as control group,while in the sham-operation group the renal pedicel was only dissociated without treatment.Body weight and kidney function were monitored within 14 days after reperfusion.The kidney was harvested at 24 h after reperfusion,and then malonaldehyde (MDA) and activity of reactive oxygen species (ROS) scavenger enzymes were examined.Histopathological changes were observed at postoperative day (POD) 3 and 14.Results At POD 3,7,11 and 14,the creatinine clearance rate was significantly higher in icariin group than in control group (P<0.01). Icariin group had significantly lower Paller scores which indicated tubules injury than in control group at day 3 after reperfusion (P<0.01 ).In icariin group,MDA level was obviously decreased at 24 h after operation.Compared to control group,icariin group had statistically higher activity of glutathion reductase (GR),catalase and superoxide dismutase (SOD),as well as higher level of reduced glutathione (GSH) (P<0.05).Conclusion Icariin has protective effects on renal IRI,and can promote recovery of kidney function. Icariin can reduce oxidative stress through increasing activity of ROS scavengers.

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