Effect of irregular follow-up during normalized prevention and control of epidemic on viral load upon BK virus reactivation and prognosis of kidney transplant recipients / 器官移植

<b>Objective</b> To evaluate the effect of irregular follow-up during normalized prevention and control of novel coronavirus pneumonia (COVID-19) epidemic on BK virus (BKV) reactivation and clinical prognosis of kidney transplant recipients. <b>Methods</b> Clinical data of 363 kidney transplant recipients were retrospectively analyzed, and they were divided into the pre-epidemic follow-up group and during-epidemic follow-up group according to the follow-up time. All patients were followed up for 1 year. The follow-up interval was compared between two groups. The infection of BKV and the correlation between the infection process of BKV and renal graft function were analyzed in two groups. <b>Results</b> A total of 1 790 preson-times were followed up before COVID-19 epidemic and 2 680 during COVID-19 epidemic. Compared with the during-epidemic follow-up group, the follow-up intervals within 3, 3-6 and 7-12 months after kidney transplantation were shorter in the pre-epidemic follow-up group, and the differences were statistically significant (all <i>P</i><0.05). Within 1 year after kidney transplantation, 35 cases（32%） were diagnosed with BKV viruria, 3 cases（3%） of BKV viremia and 1 case（1%） of BKV-associated nephropathy (BKVAN) in the pre-epidemic follow-up group, and 53（25%）, 3（1%） and 1（1%） in the during-epidemic follow-up group, with no statistical significance (all <i>P</i>>0.05). In the pre-epidemic follow-up group, the time for the initial diagnosis of BKV viruria was longer and the viral load of the first urinary BKV reactivation was smaller than those in the during-epidemic follow-up group, with statistical significance (both <i>P</i><0.05). The load of the first urinary BKV reactivation was positively correlated with the peak load of urinary BKV, and the differences between the baseline and serum creatinine levels at 1 and 3 months after BKV reactivation (all <i>P</i><0.05). <b>Conclusions</b> Irregular follow-up after kidney transplantation may lead to early BKV reactivation and higher detection value of the first viral load of urinary BKV, delay diagnosis and interventions, and lead to poor prognosis. It is urgent to establish a remote follow-up system to meet the follow-up requirements of kidney transplant recipients when public health incidents occur.

Clinical characteristics of infection-induced central nervous system complications in renal transplant recipients / 中华器官移植杂志

Objective:To summarize the clinical characteristics of central nerve system (CNS) infection and grasp the necessity and possibility of early diagnosis and precise intervention of CNS infection after renal transplantation.Methods:This retrospective study enrolled consecutive recipients of renal transplantation with CNS infection after transplant between January 2000 and December 2020. Correlative factors for CNS infection after renal transplant were determined by comparing the clinical data between recipients with and without CNS infection. After screening 3, 199 consecutive renal transplant recipients, 12 patients with CNS infection post-transplant were identified and recruited. The median age-of-onset was 48.5 (23-65) years. And the median time to disease onset after transplant was 50.5(1-204) months. The most common symptoms of CNS infection after renal transplant included fever (75.00%), consciousness disorder (58.33%), headache (58.33%) and neck rigidity (41.67%).Results:Hepatitis B virus carrier and pulmonary infection were correlated with CNS infection after transplantation ( P<0.05). Nine patients failed to identify the pathogen and only received empirical anti-infective regimen. The outcomes were curing ( n=3) and death ( n=6). Metagenomic sequencing was performed for identifying the pathogen in three recipients and actively adjusting the anti-infective regimen. As a result, 2 were cured and 1 died. The overall mortality was 58.33%. The median time to death or curing from disease onset were 20(2-19) and 25(16-35) days respectively in surviving and non-surviving recipients. Conclusions:The progress of CNS infection after transplantation is rapid with a high mortality. HBV carrier and pulmonary infection are possible risk factors of CNS infection after renal transplantation. Early pathogenic identification and precise etiological intervention are vital for better clinical outcomes.

Multi-disciplinary team on renal allograft dysfunction induced by recurrence of primary hyperoxaluria type I after renal transplantation / 器官移植

Objective To investigate the clinical characteristics and the experience of multi-disciplinary team (MDT) on recurrence of primary hyperoxaluria (PH) type I after renal transplantation. Methods One case presenting with unexplained rapid decline of renal allograft function after allogeneic renal transplantation was discussed by MDT. The role of MDT in diagnosing rare hereditary diseases and improving the long-term survival of renal transplant recipients was summarized. Results After MDT consultation, the patient was diagnosed with recurrence of PH type I. Routine immunosuppressive regimen was initiated after the exclusion of rejection. The patient was instructed to drink a large quantity of water, and given with high-quality protein and low-phosphorus diet, vitamin B6, calcium and other conservative therapies to actively prevent and treat postoperative complications. The deterioration of renal graft function was delayed. Nevertheless, regular hemodialysis was resumed at 5 months after renal transplantation until the submission date of this manuscript. Conclusions Recurrence of PH type I after renal transplantation is relatively rare. The main clinical manifestations are recurrent kidney stones and decreased renal function with multiple complications and poor prognosis. The condition of the patient is consulted by MDT for confirming the diagnosis, determining the optimal treatment scheme, delaying the progression and improving the clinical prognosis.

Clinical values of 16S rRNA and ITS gene sequencing for pathogenic identification of renal transplant recipients with urinary tract infection / 中华器官移植杂志

Objective:Objective To explore the clinical values of next-generation sequencing (NGS) in bacterial 16S rRNA region and fungal ITS region for diagnosing and treating urinary tract infection (UTI) in renal transplant recipients.Methods:A total of 90 mid-stream clean-catch urine samples were collected from renal transplant recipients who were diagnosed with UTI at Hospital from January 2017 to December 2019. Each sample was equally divided and tested via NGS method and traditional urine culture separately. The results of pathogen test and detection rate were analyzed and compared.Results:And 21/90 sample were considered to be contaminated due to the identification of three or more kinds of microorganisms by culture. And among the remaining 69 samples, 36 (52.17%) cases tested positive by 16S rRNA sequencing, 25 (36.23%) positive by urine bacterial culture; meanwhile, 34(49.28%) tested positive by ITS sequencing and 4(5.80%) positive by urine fungal culture.Conclusions:The detection rate of both bacteria and fungi in NGS microorganism testing is higher than that in traditional urine culture ( P< 0.05). For renal transplant recipients with UTI, NGS microorganism testing is an effective supplement for traditional urine culture. Improving the detection rate and accuracy of etiology may enable an optimization of individualized treatment.

Application of immunosuppressants in patients with autosomal dominant polycystic kidney disease after kidney transplantation / 南方医科大学学报

OBJECTIVE@#To investigate the optimal dose range of immunosuppressants in patients with autosomal dominant polycystic kidney disease (ADPKD) after renal transplantation.@*METHODS@#A cohort of 68 patients with ADPKD who received their first renal transplantation between March, 2000 and January, 2018 in our institute were retrospectively analyzed, with 68 non-ADPKD renal transplant recipients matched for gender, age and date of transplant as the control group. We analyzed the differences in patient and renal survival rates, postoperative complications and concentrations of immunosuppressive agents between the two groups at different time points within 1 year after kidney transplantation. The concentrations of the immunosuppressants were also compared between the ADPKD patients with urinary tract infections (UTI) and those without UTI after the transplantation.@*RESULTS@#The recipients with ADPKD and the control recipients showed no significantly difference in the overall 1-, 5-, and 10- year patient survival rates (96.6% 96.0%, 94.1% 93.9%, and 90.6% 93.9%, respectively; > 0.05), 1-, 5-, and 10-year graft survival rates (95.2% 96.0%, 90.8% 87.2%, and 79.0% 82.3%, respectively; > 0.05), or the incidences of other post- transplant complications including acute rejection, gastrointestinal symptoms, cardiovascular events, pneumonia, and neoplasms ( > 0.05). The plasma concentrations of both tacrolimus and mycophenolate mofetil (MPA) in ADPKD group were significantly lower than those in the control group at 9 months after operation ( < 0.05). The incidence of UTI was significantly higher in ADPKD patients than in the control group ( < 0.05). In patients with ADPKD, those with UTI after transplantation had a significantly higher MPA plasma concentration ( < 0.05).@*CONCLUSIONS@#In patients with ADPKD after renal transplant, a higher dose of MPA is associated with a increased risk of UTI, and their plasma concentrations of immunosuppressants for long-term maintenance of immunosuppression regimen can be lower than those in other kidney transplantation recipients.

De novo malignant tumor after renal transplantation: single-center trial / 器官移植

Objective To analyze the incidence and risk factors of de novo malignant tumors in renal transplant recipients. Methods Clinical data of 1 549 renal transplant recipients were retrospectively analyzed, including the basic status, pathological type and incidence rate of patients with de novo malignant tumors after renal transplantation. The survival situation of these patiensts was assessed. And the risk factors of de novo malignant tumors after renal transplantation were identified. Results The incidence rate of de novo malignant tumors in renal transplant recipients was 3.03%(47/1 549). The 47 recipients were (48±12) years old when undergoing renal transplantation, and they were (55±12) years old when diagnosed malignant tumors. The time interval between transplantation and diagnosis was 66 (36, 100) months. Among the de novo malignant tumors, colorectal cancer was the most common, with a cumulative incidence rate (CIR) of 0.58%. The survival time of 47 recipients with de novo malignant tumors after renal transplantation was 59 (2, 135) months, and the 5-year survival rate was 50%. The recipients with the age > 45 years old when undergoing renal transplantation was a risk factor for de novo malignant tumors after renal transplantation (P < 0.05). Conclusions The incidence rate of de novo malignant tumors is relatively high in renal transplant recipients. The recipients with the age > 45 years old when undergoing renal transplantation is a risk factor for de novo malignant tumors.

Characteristics of BK polymavirus infection in kidney transplant recipients / 南方医科大学学报

OBJECTIVE@#To analyze the characteristics of BK polymavirus (BKV) infection and the optimal time window for intervention in kidney transplant recipients (KTRs).@*METHODS@#We retrospectively analyzed the clinical data and treatment regimens in 226 KTRs in our center between January, 2013 and January, 2018. Among the recipients, 157 had a urine BKV load ≥1.0×10 copy/mL after transplantation, and 69 had a urine BKV load below 1.0×10 copy/mL (control group).@*RESULTS@#Among the 157 KTRs, 60 (38.2%) recipients were positive for urine BKV, 66 (42.0%) had BKV viruria, and 31(19.7%) had BKV viremia. The incidence of positive urine occult blood was significantly higher in BKV-positive recipients than in the control group ( < 0.05). The change of urine BKV load was linearly related to that of Tacrolimus trough blood level (=0.351, < 0.05). In urine BKV positive group, the average estimated glomerular filtration rate (eGFR) was below the baseline level (60 mL·min·1.73 m) upon diagnosis of BKV infection reactivation, and recovered the normal level after intervention. In patients with BKV viruria and viremia, the average eGFR failed to return to the baseline level in spite of improvement of the renal function after intervention.@*CONCLUSIONS@#Positive urine occult blood after transplantation may be associated with BKV infection reactivation in some of the KTRs. BKV infection is sensitive to changes of plasma concentration of immunosuppressive agents. Early intervention of BKV replication in KTRs with appropriate dose reduction for immunosuppression can help to control virus replication and stabilize the allograft function.

Clinical analysis on hyperpotassemia induced by pharmacologic interaction between tacrolimus and other drugs in 10 renal ;transplant recipients / 器官移植

Objective To investigate the therapeutic methods of hyperpotassemia induced by excessively high blood concentration of tacrolimus (FK506) caused by drug use after renal transplantation. Methods Clinical data of 10 patients diagnosed with hyperpotassemia induced by excessively high blood concentration of FK506 after administration of antifunga l medication following renal transplantation were collected and retrospectively analyzed. Results At 1-2 months after renal transplantation, 10 patients suffered from pulmonary infectiono r pneumonia complicated with pulmonary fungal infection . An appropriate dose of compound sulfamethoxazole, micafungin, cefoperazone sodium-sulbactam sodium and moxifloxacin was administered for antifungal infection. After potassium-lowering therapy, termination of antifungal medication and FK506 dose adjustment (replaced by cyclosporin for certain cases), the serum level of potassium was declined and maintained within normal range for 10 cases. The serum concentration of FK506 was within normal range. No sign of excessively high level of potassium was observed without any potassium-lowering intervention. Conclusions Postoperative administration of drugs is likely to cause excessively high level of FK506 and hyperpotasesmia. Potassium-lowering therapy, termination of drug use and adjustment of immunosuppressive agents should be adopted to avoid the incidence of adverse pharmacologic interaction.

Clinical study of chronic hyponatremia after liver transplantation / 器官移植

Objective To summarize clinical characteristics, prevention and treatment of postoperative chronic hyponatremia after liver transplantation(LT). Methods Clinical data of 26 patients presenting with chronic hyponatremia after LTwereretrospectivelyanalyzed.BaselinedataandmaincomplicationsofpatientswithhyponatremiaafterLTwererecorded. Thecorrelationbetweenpostoperativelengthofhospitalstayandthedurationofhyponatremiawasanalyzed.Clinicaltreatment and prognosis were summarized. Results Among 26 patients, the median blood sodium concentration was 131 mmol/L (range 125 to 133 mmol/L). Al patients were diagnosed with mild or moderate degree of hyponatremia. Main complications included pulmonary infection (n=13, 50%), acute rejection of liver graft (n=7, 27%) and digestive tract hemorrhage (n=7, 27%). Postoperative length of hospital stay was correlated with the duration of hyponatremia. After ful evaluation of patient's conditionandexcludingthepotentialinducers,aportionof3%ofhypertonicsalinewasadministeredviagastro-intestinaltract and/or vein. After positive treatment, 23 cases (88%) were healed and 3 (12%) died from infection complicated with multiple organ failure. Conclusions After LT, the incidence of chronic hyponatremia is low with mild severity. Postoperative length of hospitalstayiscorrelatedwiththedurationofhyponatremia.Thekeyoftreatmentistotimelyexcludetheinducers,correctthe low level of sodium based upon the individual principles and prevent the incidence of postoperative complications.

Characteristics of urinary tract infection in kidney transplant recipients and non-recipient patients / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To compare the characteristics of urinary tract infection (UTI) between kidney transplant recipients and non-recipient patients.</p><p><b>METHODS</b>Forty-nine kidney transplant recipients with UTI (69 episodes) and 401 non-recipient patients with UTI (443 episodes) admitted in Nanfang Hospital from January 2003 to August 2014 were enrolled in the study. The characteristics of UTI were compared between two groups.</p><p><b>RESULTS</b>In both groups of UTI, female patients comprised a greater proportion (63.3% and 58.6%) and Escherichia coli was the most common pathogen isolated (37.7% and 34.1%). However, the infection rate of Klebsiella pneumonia in recipients was higher than that in non-recipients (11.6% vs 3.2%, P= 0.001), while the infection rate of Candida albicans was lower (1.5% vs 11.3%, P=0.008) than that in non-recipients. Recipients were likely to develop antibiotic resistance and with a higher recurrence rate than non-recipient patients (38.8% vs 16.7%, P<0.001). Compared to non-recipient UTI patients, the symptoms of urinary irritation in recipient UTI patients were more common. There was higher percentage of neutrophil granulocyte (72.65% ± 1.90% vs 68.59% ± 0.73%, P=0.048), lower proportion of lymphocytes (17.73% ± 1.27% vs 21.28% ± 0.61%, P=0.037), and less platelets [(187.64 ± 10.84) × 10(9)/L vs (240.76 ± 5.26) × 10(9)/L, P<0.01] in recipients than in non-recipient UTI patients.</p><p><b>CONCLUSION</b>These results indicate that the characteristics of UTI in kidney transplantation recipients and non-recipients patients are different.</p>

Pure red cell aplasia caused by human parvovirus B19 infection after renal transplantation:a report of ;2 cases and literature review / 器官移植

Objective To investigate the diagnosis and treatment characteristics of pure red cell aplasia (PRCA)caused by human parvovirus (HPV)B19 infection after renal transplantation.Methods Two cases with PRCA caused by HPV B19-induced after renal transplantation,who were treated in the Department of Organ Transplantation,Nanfang Hospital,Southern Medical University,were summarized.Combined with literature review,the clinical characteristics,diagnostic method,course of treatment and prognosis of such disease were investigated.Results Two renal transplant recipients developed severe anemia early after transplantation with progressive deterioration and failed transfusion therapy.Other causes of anemia were ruled out and two patients were diagnosed as PRCA caused by HPV B19 infection according to bone marrow aspiration and biopsy as well as HPV DNA detection by fluorescent polymerase chain reaction (PCR).The symptoms of anemia were improved significantly after adjustment of immunosuppressive treatment protocol and intravenous immunoglobulin (IVIG).Conclusions For patients with unexplained and progressed anemia early after renal transplantation,especially those complicated with reticulocyte deficiency,the possibility of PRCA caused by HPV B19 infection shall be considered.The results of bone marrow aspiration and fluorescent PCR are the main bases for diagnosing PRCA.Immunosuppressive agents reduction and application of IVIG are the major treatment measures.Most of patients have great prognosis after treatment,but this disease is likely to recur.

Effects of cyclosporin A and tacrolimus on biological behaviors of lung cancer A549 cells in nude mice / 中华器官移植杂志

Objective To explore the effects of cyclosporin A (CsA) and tacrolimus (Tac) on biological behaviors of lung cancer A549 cells in nude mice.Methods Thirty-six models of transplanted tumor in Balb/c mice were established by using lung cancer A549 cells and divided into three groups:control group,without given any immunosuppressant; CsA group,intraperitoneally given CsA; Tac group,intraperitoneally given Tac.The transplanted tumor growth curve was drawn according to the transplanted tumor volume,and the influencing ratio was calculated according to the final tumor weight.The changes in cell migration ability were observed by using Transwell system.Terminal deoxynucleotidyl transferase mediated UTP nick end labeling (TUNEL) assay was used to examine the apoptosis index of the transplanted tumor.Quantitative RT-PCR was used to detect the expression levels of Bcl-2 mRNA and Bax mRNA.Results The growth of transplanted tumor in CsA and Tac groups was faster than in control group.Final tumor volume and final tumor weight in CsA and Tac groups were greater than those in control group.The influencing ratio in CsA and Tac groups was 19％ (P＜0.05) and 25％ (P＜0.05),respectively.The migration ability was greater in CsA and Tac groups than in control group (P＜0.01).The apoptosis index of the transplanted tumor in CsA and Tac groups was lower than in control group (P＜0.05).The expression level of Bcl-2 mRNA was higher in CsA and Tac groups than in control group (P＜0.05),and that of Bax mRNA was lower in CsA and Tac groups than in control group (P＜0.05).Conclusion Both CsA and Tac can promote the growth of transplanted tumor in nuce mice bearing 549 cells and enhance the invasion forces,which is probably related with the apoptosis induction of tumor cells.

Curative effect of conversion from mycopheolate mofetil to enteric coated mycophenolate sodium on MMF-related chronic diarrhea in renal recipients of long-term stage following transplantation / 中华器官移植杂志

Objective To evaluate the curative effects of conversion from mycophenolate mofetil (MMF) to enteric-coated mycophenolate sodium (EC-MPS) on MMF-related chronic diarrhea in the renal transplant (RT) recipients of long-term stage following transplantation.Methods Twenty-six RT recipients with persistent and severe diarrhea,diagnosed as MMF-related diarrhea after a systemic examining procedure including macroscopic and microscopic examinations of the upper and lower gastrointestinal tracks,serology of the blood for CMV and culture of stool for the bacteria.In all the 26 recipients,the dosage of MMF was reduced to 250 mg,twice every day for 2 weeks.Those without significant improvement at the end of this period were shifted to EC-MPS at a dose of 180 mg,twice every day for 2 weeks.The EC-MPS dose was increased to 360 mg,twice every day if the symptoms were improved significantly at the third week after conversion,or EC-MPS was withdrawn if the diarrhea still existed.The dosage of EC-MPS would be reduced to 180 mg,twice every day if the diarrhea recurred in the next 3 months. The clinical symptoms,biological parameters and renal function were observed for 3 months after the conversion.Results ( 1 ) All the 26 recipients were switched to EC-MPS because of the persistent existence of diarrhea after reduction of MMF.After conversion,the diarrhea disappeared completely in 19 out of the 26 recipients in 2 weeks and 2 patients also showed significantly improvement of diarrhea with the total efficiency being 80.8％ (21/26).In the rest 5 cases,EC-MPS was withdrawn at the second week; (2) The disturbance of internal environment was improved significantly following the EC-MPS conversion.Serum potassium,sodium and TCO2 were elevated to normal level.The benefit was predominantly observed in the recipients with moderate to severe proteinuria.The 24-h urinary protein secretion was significantly reduced from 0.76±0.48 to 0.46±0.53 (g/24 h) (P＜0.05) at the third month.Conclusion In RT recipients with MMF-related chronic diarrhea after long-term stage following renal transplantation,switching MMF to EC-MPS can significantly alleviate the diarrhea and rectify the imbalance of internal environment of the recipients.

Impact of induction therapy with anti-lymphocyte agents on long-term survival of kidney transplantation / 中华器官移植杂志

Objective To explore the impact of induction therapy with anti-lymphocyte agents on long-term survival of kidney transplantation.Methods 271 recipients of first cadaveric kidney transplants were treated with tacrolimus,mycophenolate mofetil and prednisone.110 patients of them received induction therapy with anti-thymocyte globulin(ATG group),88 patients received Basiliximab(Bax group),and the remaining 73 patients did not receive induction therapy(control group).The data of AR,DGF,CMV infection,and 1- 3- 5-year patient/allograft survival rate in three groups were retrospectively during a follow-up period of 1 to 5 years postoperatively.Results Within 6 months after operation,the incidence of AR in control group,ATG group and Bax group was 17.8 %(13/73),9.1 %(10/110)and 10.2 %(9/88)respectively.The incidence of AR in ATG group and Bax group was significantly lower than in control group (P<0.05).There was no significant difference in incidence of DGF and CMV infection among three groups.The 1-,3- and 5-year allograft survival rate postoperation in ATG group and Bax group was 95.5 %,90.9 %,87.3 % and 93.2 %,87.5 %,83.8 % respectively,which was significantly higher than in control group(87.7 %,80.8 % and 75.3 %,P<0.05).Conclusion Induction therapy with anti-lymphocyte agents may reduce the early incidence of AR and prolong long-term allograft survival significantly.

Risk factors for standard Tac-related nephrotoxicity in renal transplant recipients / 中华器官移植杂志

ObjectiveTo investigate the factors for standard TAC-related nephrotoxicity in renal transplant recipients. MethodsClinical data of 132 patients in TAC-based regiment with a dose of 0. 15-0.3 mg· kg-1 · day-1 and a trough level of 8-11 μg/L during first 2 years post renal transplantation, were retrospectively analyzed. TAC-related nephrotoxicity was diagnosed by renal biopsy and/or clinical criteria. All recipients were divided into 2 groups: TAC nephrotoxicity group (n = 25) and control group (n = 107). Logistic regression analysis was used to rank the relative risk of potential variables including age, gender, delayed graft function (DGF), drug exposure, duration of therapy,liver function, albumin level, hematocrit and gene polymorphism for CYP3A5 and MDR1.ResultsTAC-related nephrotoxicity was found in 25 (18. 9 ％ ) recipients. Univariate and Logistic regression analysis revealed that the influencing factors for TAC-related nephrotoxicity with a standard immunosuppressive regimen and a normal trough level range were identified as: abnormal liver function (RR = 3. 05,95 ％ CI 0. 879-11. 533, P = 0. 024), albumin level (RR = 0. 966,95 ％ CI 0. 994-1. 006, P = 0. 018 ), hematocrit ( RR = 0. 999, 95 ％ CI 0. 998-1. 000, P = 0. 032), CYP3A5 gene polymorphism (RR= 0. 777,95 ％ CI 0. 023-6. 798,P= 0. 032) ,and MDR1 gene polymorphism (RR=0. 654,95 ％ CI 0. 053-7. 109, P = 0. 017). ConclusionLiver function, albumin level, hematocrit, and gene polymorphism for CYP3A5and MDR1as well are influencing factors for TAC-related nephrotoxicity in renal transplant recipients with a standard immunosuppressive regimen and a normal trough level range,in which abnormal liver function is the most important adverse risk factor. These factors should be considered for better individual therapy in renal transplant recipients.

In vitro expansion of human CD8+ CD28- suppressor T cells and their immunological regulatory effect with antigen specificity / 中华器官移植杂志

Objective To study the In vitro expansion of human CD8+ CD28- suppressor T cells and their immunological regulatory effect.Methods Human CD8 + CD28- suppressor T cells were expanded in vitro driven by the combination of cytokines and allogeneic antigen presenting cells (APCs).Flow cytometry was used to assess the development of CD28- subpopulation.Expanded CD8+ CD28- T cells were isolated by immunomagnetic microspheres and then added as third part modulators into mixed lymphocyte culture to assess their immunological regulatory characteristics.Results The combination of cytokines included IL-2,IL-7 and IL-15 and allogeneic APCs could increase the portion of CD8 + CD28- T cell subtype,and expansion fold of CD8+ CD28- T cell subtype was significantly increased as compared with others (P＜0.05).Expanded CD8+ CD28- T cells could suppress the proliferation of CD4+ T cells stimulated by allogeneic APCs.Moreover,this suppression had antigen specificity.Conclusion Human CD8 + CD28- suppressor T cells can be in vitro expanded in large amounts driven by the combination of cytokines and allogeneic APCs.Expanded CD8 + CD28- T cells in this study have antigen specific regulatory characteristics.

Pregnancy outcomes in female kidney transplant recipients and follow-up of the health status of the offspring / 中华泌尿外科杂志

ObjectiveTo evaluate the pregnancy outcomes in female kidney transplant recipients and the long-term follow-up for the health of the offspring. MethodsClinical data from April 1978 to April 2011 of 15 female renal transplant recipients who were pregnant more than 5 months and their offspring were retrospectively analyzed. ResultsThe 15 recipients were taking CsA or Tac based immunosuppressive regimens.Twelve had successful pregnancies with stable and functioning grafts ; 1 paitent died of pulmonary infection and cardiac failure with functioning graft after the delivery of a healthy male infant; 2 experienced chronic rejection proven by biopsy at week 21 and 23 respectively,the pregnancies were therefore terminated and the grafts were lost even after rescue.All 13 newborns were smoothly delivered by cesarean section,they had an average gestational age of 35.2 ± 4.0 weeks,and a mean birth weight of 2510 ± 68 g,Apgar scale for each infant was 10,respectively.There were no birth defects,structural malformations,nor learning disabilities in 13 newborns,and their mothers all chose to bottle-feed.Thirteen children had normal intelligence,physical and mental development.Seven children experienced repeated respiratory tract infections during 0- 2 years,and 1 was diagnosed with attention deficit hyperactivity disorder.The oldest offspring is 21 years old and the youngest is 3 years old. ConclusionsFemale renal kidney recipients could achieve successful pregnancies and deliveries 3 years post transplantation with strict criteria.Their offspring were healthy during follow-up.

A single center experience of combined liver and kidney transplantation:a report of 22 cases and review of literature / 中华器官移植杂志

Objective To summarize the clinical experience of combined liver and kidney transplantation (CLKT). Methods CLKT was performed on 22 patients. The orthotopic liver transplantation (LT) was preceded with the classic fashion in 10 patients and piggyback fashion in 12 patients. The renal allograft was implanted to the iliac fossa routinely. After operation, the patients received an induction therapy with anti-CD25 monoclonal antibody or antithymocyte globulin ( ATG) and a maintenance therapy with tacrolimus (Tac), mycophenolate mofetil and prednisone. Results The CLKT was successfully performed on all 22 patients, and the graft function was restored well postoperation. During the perioperative period, an acute rejection episode of liver occurred in one patient and acute renal allograft rejection episode in 2 patients. The Tac toxicity occurred in one patient. The hemorrhage of digestive tract occurred in one recipient and the hemorrhage of peritoneal cavity in one patient. The pleural effusion occurred in 6 recipients. The pneumonia occurred in 2 cases and the peritoneal infection in one patient During a follow-up period of 6 months to 7 years 11 months, three patients died because of cytomegalovirus pneumonia in 2 patients and acute myocardial infarction in, one patient, The 1-, 3-, 5-year survival rate of recipients was 86,4 %, 81.3 %, 72.7 % respectively. Conclusion The CLKT is an effective method for treatment of patients with end-stage liver djsease and chronic renal failure.

Correlation between serum anti-MICA antibodies and chronic rejection in renal transplant recipients / 中华器官移植杂志

Objective To explore the relationship of serum anti-MICA antibody and development of chronic rejection (CR) after renal transplantation. Methods The enrolled 105 patients included 43 cases of CR, and 62 cases of functioning renal allograft as controls. Data including PRA level before transplantation, HLA mismatch, cold ischemic time, SCr at discharge, immunosuppressive regimen,and months after transplantation were analyzed. Blood samples were collected immediately after grouping for anti-MICA antibodies, SCr determination. Acute rejection episodes and renal allograft function which was evaluated by △SCr/M [(SCr at present - SCr at discharge) /months after transplantation) were compared between anti-MICA-antibody positive patients and anti-MICA-antibody negative patients. Results There was no significant difference in gender, age, HLA mismatch, cold ischemic time, immunosuppressive regimen, SCr at discharge, months after transplantation between CR and control groups (P＞0.05). Serum creatinine level and number of antiMICA-antibody positive patients in CR group were significantly increased as compared with those in control group (P＜0.01 ). Acute rejection episodes during the first 3 months after transplantation in anti-MICA-antibody positive patients were significantly more than those in anti-MICA-antibody negative patients (P＜0.05),and the △SCr/M in the former was higher than that in the latter (8.3 +3.6 vs 2.4 ± 2.6, P＜0.05). Conclusion Humoral immunoreaction mediated by MICA partly participates the development of CR after renal transplantation. MICA antibody is a risk factor affecting long-term allograft function.

De novo cancers in kidney transplant recipients / 中华器官移植杂志

Objective To explore the outcome for kidney transplant recipients who suffered from cancers after transplantation. Methods De novo cancer data in 59 transplant recipients were collected. 6 cases of native renal cell carcinomas, 4 cases of native pelvo-ureteral carcinomas, 14 cases of bladder cancers, 7 cases of prostate cancers, 9 cases of hepatocellular carcinomas, 3 cases of gastric carcinomas, 2 cases of colon cancers, 1 case of pancreatic cancer, 4 cases of breast cancers, 3 cases of cervical cancers, 2 cases of skin cancers, 2 cases of non-small cell lung cancers, 1 case of thyroid cancer and 1 case of post-transplant lymphoproliferative disease. These data were compared with those from 59 patients in general population with the same gender, age and tumor stage. Results Overall incidence rate for de novo malignancy post-transplantation was 1. 9 % (59/3150). Urinary cancers were the most common. Compared to the general population, the overall survival was significantly worsened in transplant recipients (P<0. 01), and 5-year survival rate in transplantation group and control group was 30 % vs 75 0 %. Multivariate analyses demonstrated cancer stage to he a negative risk factor for survival of transplant recipients with de novo cancer, and surgery and functioning graft to be the positive survival predictors. Conclusion Transplant recipients experience worse outcomes than the general population for these cancers. These data suggest that cancers in transplant recipients are more aggressive biologically at the time of diagnosis.