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Objective:To explore the risk factors associated with the clinical progression of COVID-19 infection in kidney transplant(KT)recipients during the spread of Omicron variant and evaluate the effectiveness of anti-RNA virus agents in blocking the clinical progression of COVID-19 in these recipients.Methods:Retrospective analysis was conducted for the clinical data on COVID-19 infection in 232 KT recipients followed up from December 4, 2022 to January 31, 2023 at Department of Renal Transplantation, Organ Transplantation Center, Beijing Tsinghua Changgung Hospital.Inclusion criteria were age ≥18 years and stable kidney function without renal replacement therapy.The follow-up time was 30 days after COVID-19 infection.Based upon whether or not there was an infection of COVID-19, KT recipients were divided into two groups of infection(181 cases)and non-infection(51 cases). In infection group, recipients were further assigned into two sub-groups of disease progression(n=23)and stable(158 cases)according to whether or not there was a progression to severe disease.Various factors such as gender, age, body mass index(BMI), time after transplantation, underlying diseases(history of hypertension, diabetes mellitus, coronary heart disease & chronic lung disease), smoking history and dosing of anti-RNA virus agents were collected.Pearson χ2 test or Fisher's exact probability method was utilized for examining enumeration data while Mann-Whitney U test for measurement data.Univariate Logistic regression analysis was conducted and variables with P<0.05 were included into multifactorial Logistic regression analysis to identify independent risk factors for clinical progression of COVID-19 infection in KT recipients. Results:Among 232 KT recipients, infection rate of COVID-19 was 78.0%(181/232). The clinical classification was mild(112 cases), moderate(46 cases), severe(21 cases)and critical(n=2 cases). The severe rate was 12.7%(23/181). After infection with COVID-19, the proportion of KT recipients aged ≥65 years progressing from mild/moderate to severe was higher than those aged<65 years[38.5%(5/13)vs 10.7%(18/168)]. The difference was statistically significant( P=0.014); The proportion of diabetic KT recipients progressing from mild/moderate to severe was higher than those without diabetes[19.1%(13/68)vs 8.8%(10/113)]. The difference was statistically significant( P=0.045). Univariate Logistic analysis showed similar results.Age≥65 years( OR=5.21, 95% CI: 1.54-17.64, P=0.008)or diabetes mellitus( OR=2.44, 95% CI: 1.003-5.911, P=0.049)were the risk factors for COVID-19 infection recipients progressing from mild/moderate to severe disease.Multivariate Logistic analysis revealed that age ≥65 years( OR=4.03, 95% CI: 1.14-14.34, P=0.031)was an independent risk factor for COVID-19 infection recipients progressing from mild/moderate to severe.Among 181 cases of COVID-19 mild/medium infected patients, 18 cases received nimativir/ritonavir and 10 cases had azvudine for anti-RNA virus treatment.However, none of them progressed to severe; 153 cases did not use anti-RNA virus drugs and 23 cases(15.0%)progressed to severe disease and the difference was statistically significant( P=0.028). Among 23 severe cases, 14 cases received nirmatrelvir/ritonavir and 2 cases had azivudine for anti-RNA virus treatment.The former did not progress to critical disease while 1 case in the latter progressed to critical illness and death; 1/7 recipients not using anti-RNA virus agents progressed to critical illness and died while another 6 cases did not progress to critical illness. Conclusions:KT recipients aged ≥65 years or diabetes mellitus have a greater risk of progression from mild/moderate to severe disease after COVID-19 infection.Among them, age ≥65 years is an independent risk factor for patients with COVID-19 infection to progress from mild/moderate to severe.Antiviral treatment with nirmatrelvir/ritonavir or azivudine in KT recipients during mild/moderate stage of COVID-19 infection can significantly reduce the rate of severe disease.Treatment with Nirmatrelvir/Ritonavir is still effective in the severe stage.
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Lymphatic leakage and lymphatic cysts are common complications after radical resection of middle- and high-risk prostate cancer. There are many treatment methods but the effect is not accurate. This article reports two patients who were diagnosed by lipiodol lymphangiography under ultrasound guidance and used a mixture of n-butyl cyanoacrylate and lipiodol to embolize lymphatic leakage. Among them, one patient achieved success after one session of interventional embolization. Another patient achieved success after 3 interventions and embolization. Two patients had no complications related to lymphatic interventional therapy, and no lymphatic leakage recurred during the 3-month follow-up. Ultrasound-guided lymphangiography and lymphatic embolization through the inguinal lymph nodes are a feasible option for the treatment of refractory lymphoma leakage
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Objective:To summarize the experience of Bacillus Calmette-Guerin(BCG) in the treatment of bladder cancer secondary to renal transplantation.Methods:The clinical data of 5 patients who underwent BCG bladder irrigation after secondary bladder cancer after kidney transplantation in Tianjin First Central Hospital from January 2015 to December 2019 were analyzed. There were 1 male and 4 female cases. During the period of immunosuppression after transplantation, 1 case developed secondary high-level non-muscular invasive bladder cancer (NMIBC), 3 cases developed secondary low-grade NMIBC, and 1 case developed secondary glandular cystitis (4 cases). The mean age of the 5 patients with secondary bladder cancer was 59.7±4.0 years. Case one with high level NMIBC was treated with transurethral resection of bladder tumor (TURBT) and postoperative irrigation of epirubicin. Case 3 and 5 with low-level NMIBC accepted regular postoperative irrigation of gemcitabine. No irrigative therapy was performed in case 2. Bladder cancer recurred in case 1, 2, 3 and 5 after 20.1±9.7 months. TURBT was observed in all the 4 patients, among which 3 were of high grade NMIBC and 1 was of low grade NMIBC. Four patients were irrigated with BCG 2 weeks after operation. Postoperative pathology indicated low-level NMIBC in case 4, and BCG was irrigated 2 weeks after the operation. During perfusion therapy, immunosuppressive agents were continued.Results:During BCG perfusion, 4 of the 5 cases showed BCG related local inflammation, among which 2 cases presented symptoms of bladder irritation, 1 case presented hematuria, and 1 case presented hematuria with low fever. Patients with frequent urination, pain in urine, hematuria and other symptoms improved after drinking plenty of water, taking bed rest and taking levofloxacin (0.5g/ day ×7 days). Patients with low fever were treated with antipyretic treatment. No antituberculous agents were used prophylactically during BCG perfusion. There were no symptoms of tuberculosis infection or sepsis. The function of transplantated kidney was normal and no tendency of rejection. The 5 patients were followed up for 7-24 months, 1 patient was lost to follow-up after 7 months of BCG bladder perfusion, and no tumor recurrence or metastasis was found in 5 patients during the follow-up.Conclusions:The use of immunosuppressive agents does not reduce the biological activity of BCG, and BCG does not increase the risk of systemic toxicity or affect the function of transplanted kidneys in immunocompromised patients. BCG is a treatment option for bladder cancer secondary to renal transplantation.
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Nephron sparing surgery ( NSS ) has become the standard treatment of small renal cancer . NSS have the similar curative effect compared with radical nephrectomy and preserve the kidney fuction. However, positive surgical margins after NSS is increasing and has attracted more and more attention. We will discuss positive surgical margins related factors and how to reduce the positive surgical margins in this review.
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Objective Systematic assessment of the effect of positive margin on recurrence and metastasis in patients with renal cell carcinoma who underwent partial nephrectomy.Methods The literature were searched on the rate of recurrence and metastasis in patients with positive margin and partial nephrectomy published in PubMed,Embase,Cochrane,China Biomedical Literature Database,China Knowledge Network,VIP Chinese Science and Technology Journal Database,and Wanfang Chinese Database up to December 2018.The quality of the literature included in this study was evaluated by two reviewers,and a meta-analysis was performed on the literature that met the inclusion criteria using the Revman 5.0 statistical software provided by Cochrane Collaboration.Results A total of seven articles were included,six of which were case-control studies,and the other one was a cohort study.These seven articles consisted of 6 928 patients,including 407 positive margins and 6 521 negative margins.For recurrence and metastasis,407 positive margins were composed of 25 recurrences and 21 distant metastases,while 6 521 negative margins consisted of 68 recurrence and 96 distant metastasis.The disease-free survival rate of patients with positive margins is lower than that with negative margins (OR =4.92,95％ CI 2.66-9.08,P ＜ 0.001).The results of subgroup analysis of patients with recurrence and metastasis based on positive margin exhibited that positive margin increased the risk of recurrence in patients undergoing partial nephrectomy (OR =5.05,95％ CI 2.06-12.37,P ＜0.001),as well as the risk of metastasis (OR =3.70,95％ CI 2.18-6.26,P ＜0.001).Since different studies consisted of patients with different tumor staging,a stratified analysis was conducted and the disease-free survival rate of patients with positive margins decreased compared with that of negative margins (OR =4.13,95％ CI 2.54-6.70,P ＜ 0.001),although there were differences in the staging of tumor patients included in different studies,which did not weaken the results.Conclusions Positive margins increase the risk of recurrence and metastasis in patients undergoing partial nephrectomy.
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Objective@#Systematic assessment of the effect of positive margin on recurrence and metastasis in patients with renal cell carcinoma who underwent partial nephrectomy.@*Methods@#The literature were searched on the rate of recurrence and metastasis in patients with positive margin and partial nephrectomy published in PubMed, Embase, Cochrane, China Biomedical Literature Database, China Knowledge Network, VIP Chinese Science and Technology Journal Database, and Wanfang Chinese Database up to December 2018. The quality of the literature included in this study was evaluated by two reviewers, and a meta-analysis was performed on the literature that met the inclusion criteria using the Revman 5.0 statistical software provided by Cochrane Collaboration.@*Results@#A total of seven articles were included, six of which were case-control studies, and the other one was a cohort study. These seven articles consisted of 6 928 patients, including 407 positive margins and 6 521 negative margins. For recurrence and metastasis, 407 positive margins were composed of 25 recurrences and 21 distant metastases, while 6 521 negative margins consisted of 68 recurrence and 96 distant metastasis. The disease-free survival rate of patients with positive margins is lower than that with negative margins (OR=4.92, 95%CI 2.66-9.08, P<0.001). The results of subgroup analysis of patients with recurrence and metastasis based on positive margin exhibited that positive margin increased the risk of recurrence in patients undergoing partial nephrectomy (OR=5.05, 95%CI 2.06-12.37, P<0.001), as well as the risk of metastasis (OR=3.70, 95%CI 2.18-6.26, P<0.001). Since different studies consisted of patients with different tumor staging, a stratified analysis was conducted and the disease-free survival rate of patients with positive margins decreased compared with that of negative margins (OR=4.13, 95%CI 2.54-6.70, P<0.001), although there were differences in the staging of tumor patients included in different studies, which did not weaken the results.@*Conclusions@#Positive margins increase the risk of recurrence and metastasis in patients undergoing partial nephrectomy.
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Objective To evaluate the safety,feasibility and results of the hand-assisted retroperitoneal laparoscopic living donor nephrectomy ( HRPLDN ) with a modified technique. Methods Living donors (n =32) were divided into HRPLDN group (n =16) and open group (n =16) according to surgical technique.Operative data and postoperative outcomes including operative time,estimated blood loss,warm ischemia time,length of hospital stay and complication rate,were collected. Results All procedures were completed successfully.In HRPLDN group,the mean operative time was 101.3 ± 21.2 min (range from 70 to 150 min),with an estimated blood loss of 53.8 ±25.5 ml (range from 20 to 100 ml) and warm ischemia time of 2.4 ± 0.6 min ( range from 1.5 to 3.5 min).No living donor needed conversion to open surgery and the urine volume of transplanted kidney after first 24 hours was 5036 ml (range from 3500 -6500 ml).The mean postoperative on bed time were (2.8 ± 0.7 ) d (ranging from 2 -4 d).All parameters of HRPLDN were significantly better than that of open groups. Conclusion Living donor nephrectomy with HRPLDN is a safe and reliable surgical technique.
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Objective To analyze the incidence and clinical features of urothelial tumors in renal allograft recipients.Methods A retrospective analysis of 1042 patients received renal allografts who had taken immunosuppression for at least six months between 2006 and 2011 in The First Centre Hospital of Tianjin was performed.Results Eleven cases of uroepithelial tumors were diagnosed in the 1042 cases of renal transplantation ( 1.06％ ),of whom 9 cases were noticed by hematuria ( 81.8 ％ ),2 cases ( 18.2％ ) by medical examination.Six patients were diagnosed with multifocal urothelial carcinomas.Surgery was performed on all the patients with renal tumors and followed by chemotherapy or radiotherapy.Conclusion Malignancies in urinary tract after renal transplantation should be bore in mind.Early diagnosis is very important.The treatment options include reducing immunosuppressive agents and removing tumor lesions completely.