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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.
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Gut Microbial species have different physiologic functions, such as digestion, nutrition, immunity, etc. Studies have shown that gut microbiota plays an important role in intestinal function. Gut microbiota is a complex ecosystem that participates in the physiological and pathological processes of the human body and forms a dynamic equilibrium with the human body. If this balance is broken, it may lead to or aggravate the occurrence and development of diseases. In recent years, researches have confirmed that the biological composition of gut microbiota in patients with diseases is significantly different from that of healthy people. The detection and transformation of gut microbiota has certain value and therapeutic effect on the diagnosis of diseases. Systematic biological methods can be used to study the relationship between gut microbiota and immunity and metabolism. In this paper, the related researches on the interactions between gut microbiota and human diseases were reviewed, including immunodeficiency-related diseases, autoimmune diseases, celiac diseases, intestinal microbial-related metabolic diseases and neurological diseases, and the related pathogenesis was summarized as well.
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Objective To evaluate the immune status of acute rejection recipients,and to improve the short-term and long-term survival rate of renal transplant recipients and grafts,and to investigate dynamically the changes in the immune repertoire of patients with acute rejection.Methods Combined multiplex PCR amplification technique and high throughput sequencing technique,the TCR β chain complementarity determining region 3(CDR3)diversity and repertoire characteristics at different time points during renal transplantation were analyzed,in order to reveal the immunological characteristics of T lymphocytes in patients with acute rejection.Results The diversity of TCR CDR3 in acute rejection patients was reduced to the lowest one day after surgery.The diversity of TCR CDR3 before acute rejection was higher than before.The acute rejection-related upregulated TCR CDR3 amino acid sequences were screened out.In addition,TCR beta chain V and J subfamily showed the phenomenon of advantage usage in pre-acute rejection,which may be due to T cell recognition of transplanted kidney antigens in vivo.Conclusions The immune diversity of patients with acute rejection is significantly lower.In addition,TCR beta chain V and J subfamily show the phenomenon of advantage usage.
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Objective To investigate the effect of double filtration plasmapheresis (DFPP) upon the removal of donor specific antibody (DSA) in highly sensitized recipients with renal transplantation. Methods Four highly sensitized recipients undergoing renal transplantation received 7 cycles of DFPP. Luminex technology was adopted to monitor the changes of DSA. Clinical efficacy, incidence of acute rejection and adverse reactions were observed. Results After DFPP, the DSA MFI [1036 (0-4113)] was significantly declined than that before treatment [6446 (2999-12905), Z= -2.503, P=0.012]. No hyperacute rejections occurred in four highly sensitized recipients undergoing renal transplantation.Acute rejection was noted in one case, which was mitigated by postoperative DFPP and adjustment of immunosuppressive agents. During postoperative follow-up, the function of transplant kidney was normal and no rejection reactions occurred. The level of albumin was decreased after DFPP. Conclusions DFPP can effectively remove the DSA in the recipients.It is an efficacious and safe approach to prevent the incidence of acute rejections in highly sensitized recipients after renal transplantation.
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Objective To evaluate the effect of conversion from mycophenolic acid (MPA) to mizoribine (MZR) in renal transplant recipients with gastrointestinal tract (GI) symptoms.Methods A total of 355 renal transplant recipients with GI symptoms caused by MPA administration were enrolled from April 2015 to March 2017 in 25 different renal transplant centers in China.The symptomatic improvement of GI before (baseline) and after conversion to MZR (1,2,4 weeks) was assessed by each item of GI symptoms indication.In addition,the efficacy and safety of the conversion therapy during 12 months were determined.Results Patients showed improvement in GI symptoms including diarrhea,abdominal pain,abdominal distention and stomachache after conversion to MZR 1,2,4 weeks (P<0.05).In patients with different severity of diarrhea,conversion to MZR therapy significantly improved diarrhea (P<0.05).During 12 months,no patient experienced clinical immune rejection.We did not observe any infections,leucopenia and other serious side effects.Conclusion MZR could markedly improve GI symptoms caused by MPA administration in renal transplant recipients.
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Objective To investigate the value of anti-human leukocyte antigen (HLA)antibody level detected by Luminex testing in predicting clinical prognosis of renal transplantation recipients. Methods A total of 1 105 patients scheduled to undergo renal transplantation (354 successfully undergoing renal transplantation)in the 181st Hospital of People's Liberation Army from June 2013 to November 2015 were selected. The serum samples were collected from 1 923 cases before and after renal transplantation. The positive rate and fluorescent intensity of anti-HLA antibody were detected by Luminex testing before and after renal transplantation. The renal function of recipients was also evaluated after renal transplantation. Results Prior to renal transplantation,51.0%(546/1 071)of serum samples were positive for anti-HLA antibody,including 26.0%(279/1 071)positive for anti-HLAⅠantibody,24.9%(267/1 071)positive for anti-HLAⅡantibody and 11.4% (122/1 071 )positive for both anti-HLA Ⅰ and anti-HLA Ⅱ antibodies. Among 354 patients undergoing renal transplantation,59 (17%)were positive for anti-HLA antibody after renal transplantation,including 25 (4 newly positive after surgery)positive for anti-HLAⅠantibody,15 (1 newly positive after surgery)positive for anti-HLAⅡantibody and 19 (4 newly positive after surgery)positive for both anti-HLA Ⅰ and anti-HLA Ⅱ antibodies. During subsequent follow-up,13 patients positive for anti-HLAⅠantibody,5 positive for anti-HLAⅡantibody and 1 1 positive for both anti-HLA Ⅰ and anti-HLA Ⅱ antibodies developed transplant kidney dysfunction. All patients newly positive for anti-HLA antibody after renal transplantation presented with transplant kidney dysfunction. Conclusions Luminex testing can perform dynamic detection of the positive rate of anti-HLA antibody,which is important in predicting clinical prognosis of recipients after renal transplantation.
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Objective To investigate the role of the 5-hydroxymethylcytosine (5-hmC) DNA modification in the onset of systemic lupus erythemosus (SLE),we compared tihe levels 5-hmC between SLE patients and normal controls.Methods With informed consent,whole blood was obtained from patients,and genomic DNA was extracted.Using hMeDIP-seq analysis and validation by quantitative real-time quantitative polymerase chain reaction (RT-PCR),we identified the differentially hydroxymethylated regions that were associated with SLE.Results There were 1 701 genes with significantly different 5-hmC levels at the promoter region in the SLE patients compared with the normal controls.The CpG islands of 3 826 genes showed significant difference at 5-hmC levels in SLE patients compared with the normal controls.Out of the differentially hydroxymethylated genes,three were selected for validation,including TREX1,CDKN1A,and CDKN1B.The hydroxymethylation levels of these three genes were confirmed by quantitative RT-PCR.Conclusion Our studies indicate that there are significant alterations of 5-hmC in SLE patients;these differentially hydroxymethylated genes may contribute to the pathogenesis of SLE.Such novel findings show the significance of 5-hmC as a potential biomarker or promising target for epigenetic-based SLE therapies.
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Objective To explore the outcomes of the transplanted kidney as donor for clinical renal transplantation and summarize experience in combination with related literature.Method This study retrospectively analyzed the clinical documents of one case of uremia receiving renal allograft transplantation with the transplanted kidney as the donor in one case of renal transplantation after brain death in February,2015.The donor was a 31-year-old man who received renal transplantation for uremia in November,2014 and obtained normal renal function.Two months later,the patient was brain dead because of neurologic disorder and donated his transplanted kidney.The serum creatinine of the donor was 167 μmol/L,and the glomerular filtration rate was about 35 mL/min befor donation.The recipient was 27 years old who needed transplantation because of chronic renal function failure and uremia.Preoperation tests showed that PRA was negative,and serum creatinine was 1 353 μmol/L.After separating and dissecting the donor kidney carefully,we perfused and compensated the kidney by Lifeport Organ Perfusion and Preservation Conveyor.The warm ischemia time was about 15 min.The renal vein of the donor was anastomized with right external iliac vein of the receptor,artery with right external iliac artery,and ureter with right centrifugal ureter.Result The operating time was more than 3 h.Postoperatively,the recipient was given the immunosuppressive regimen as tacrolimus,mycophenolate mofetil and methylprednisolone to prevent rejection.At 1 st day postoperation,the 24-h urine volume of the receptor was 5 000 mL,serum creatinine was declined gradually to a minimum of 180μmol/L,and there was trace urine protein.The renal function of patient recovered well by now.Meanwhile,the patient was still under the follow-up.Conclusion It is practical that using transplanted kidney as donor kidney for re-transplantation.There were certain clinical significance for shortening the waiting time of renal transplantation in uremia patients and relieving the shortage of transplant kidney.
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<p><b>OBJECTIVE</b>To explore the relationship between the major allergens of 6 common allergic foods and IgA nephropathy.</p><p><b>METHODS</b>A sensitive sandwich enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of food-specific IgA1, IgG and IgE in 31 patients with IgA nephropathy and 80 healthy volunteers. All the patients were examined for a history of food allergy using a questionnaire.</p><p><b>RESULTS</b>Serum levels of IgA1 and IgG against the major allergens of the 6 common allergic foods were significantly higher in patients with IgA nephropathy than in healthy volunteers (P<0.05). There was no detectable food-specific IgE antibodies in the two groups. No patients had a clear history of food allergy. All the patients with increased IgG levels specific to 4 or more foods simultaneously had proteinuria.</p><p><b>CONCLUSIONS</b>Some foods especially the highly allergic ones may participate in the pathogenesis and progression of IgA nephropathy.</p>
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Adulto , Femenino , Humanos , Masculino , Adulto Joven , Especificidad de Anticuerpos , Estudios de Casos y Controles , Hipersensibilidad a los Alimentos , Clasificación , Alergia e Inmunología , Glomerulonefritis por IGA , Sangre , Alergia e Inmunología , Inmunoglobulina A , Sangre , Inmunoglobulina E , Sangre , Inmunoglobulina G , SangreRESUMEN
Objective To explore the clinical effect of mechanical perfusion for preserving kidney.Methods From May to October 2013, 36 donors’ kidneys were preserved by mechanical perfusion in the Department of Kidney in the 181st Hospital of Chinese People's Liberation Army.The donors’ kidneys were preserved , transported and perfused by the LKT-100 type Lifeport organ transporter and special software.General condition of patients and the relationship between resistance coefficient , flow velocity and occurrence of delayed graft function ( DGF) were analyzed.Results None of 36 recipients had graft loss.Thirty cases ’ (83%) renal function recovered well without DGF.Six cases developed DGF and returned to normal gradually after 3-18 days postoperative treatment.After mechanical renal perfusion for 1 h, 28 recipients with kidneys ’ resistance coefficient ≤0.3 mmHg/( ml · min ) hadn't developed DGF after transplantation.Among 8 recipients with kidneys ’ resistance coefficient >0.3 mmHg/( ml · min ) , 6 recipients developed DGF.Eight recipients with kidneys ’ flow velocity >100 ml/min hadn't developed DGF.Among 21 recipients with kidneys ’ flow velocity 60-100 ml/min, 1 case developed DGF.In 7 recipients with kidneys ’ flow velocity <60 ml/min, 5 cases developed DGF.Conclusions Mechanical perfusion for preserving kidney can improve graft quality and reduce the incidence of DGF in recipients.
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PURPOSE: The purpose of the present study was to investigate the aberrance of histone H3 lysine 4 trimethylation (H3K4me3) in patients with IgA Nephropathy (IgAN). MATERIALS AND METHODS: In this study, H3K4me3 variations in peripheral blood mononuclear cells (PBMCs) from 15 IgAN patients and 15 healthy subjects were analyzed using chromatin immunoprecipitation linked to microarrays analysis (ChIP-chip). ChIP real-time PCR was used to validate the microarray results. Expression analysis by quantitative real-time PCR (qRT-PCR) revealed correlations between mRNA and H3K4me3 levels. DNA methylation status was analyzed by quantitative methylation-specific PCR. RESULTS: We found that 321 probes displayed significant H3K4me3 differences in IgAN patients compared with healthy controls. Among these probes, 154 probes displayed increased H3K4me3 and 167 probes demonstrated decreased H3K4me3. For further validation, we selected 4 key relevant genes (FCRL4, GALK2, PTPRN2 and IL1RAPL1) to study. The results of ChIP real-time PCR coincided well with the microarray data. Quantitative RT-PCR revealed the correlations between the mRNA expression and the methylation levels of H3K4me3. Different degrees of DNA methylation alterations appeared on the selected positive genes. CONCLUSION: Our studies indicated that there were significant alterations in H3K4me3 in IgAN patients. These findings may help to explain the disturbed immunity and abnormal glycosylation involved in IgAN patients.
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Adulto , Femenino , Humanos , Masculino , Adulto Joven , Estudios de Casos y Controles , Inmunoprecipitación de Cromatina , Glomerulonefritis por IGA/genética , Histonas/metabolismo , Leucocitos Mononucleares/metabolismo , Lisina/metabolismo , Metilación , Análisis de Secuencia por Matrices de Oligonucleótidos/métodos , Reacción en Cadena en Tiempo Real de la PolimerasaRESUMEN
Objective To detect the prevalence of hyperuricemia and its relationship to chronic kidney disease(CKD) in the residents of Guangxi, and to discuss the risk factors for the hyperuricemia associated renal damage. Methods The residents aged 18-75 years old(n=6 273) in Xiangshan community,Guilin, were screened by means of cross-sectional study. Blood pressure was measured at 8:00-9:00.Fasting blood and urine samples were collected to determine blood glucose, lipid, insulin, creatinine, and urine albumin. Results The prevalence of hyperuricemia in the community residents was 23.5% in all cohort, being significantly higher in male residents than in female(28.4% vs 19.7%,P<0.01). The prevalence of CKD was 21.6% in all cohort, and was 24.9% in males and 19.0% in females(P<0.01). The prevalence of CKD was 30.4% and 18.9% respectively in residents with and without hyperuricemia(P<0.01).The prevalence of CKD in males with hyperuricemia(34.3%) was significantly higher than in males without hyperuricemia(21.2%) and females with hyperuricemia(25.9%, all P<0.01). CKD was only positively related to low-density lipoprotein cholesterol, blood glucose, and systolic blood pressure shown by logistic regression analysis. Conclusions The prevalence of hyperuricemia markedly increases in the urban residents, which contribute to the raised prevalence of CKD. Slightly elevated blood uric acid level is associated with raised prevalence of CKD.
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Objective To compare the serum peptidome spectrum between nephrotic syndrome patients and normal controls, and to search for their variations. Methods The serum peptide profiling was determined by ClinProt magnetic bead enrichment and matrix assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) in 17 mesangial proliferative glomerulonephritis (MsPGN) patients, 12 minimal change nephrotic syndrome (MCNS) patients, 10 membranous nephropathy (MN) patients, 10 focal segmental glomerulosclerosis (FSGS) patients, and 10 healthy volunteers. Results 5 differentially expressed polypeptides were screened out between MsPGN and normal controls (15.28±7.61, P<0.01). 7 differentially expressed polypeptides were screened out between MCNS and normal controls (2.16±1.59, P<0.01). 6 differential expressed polypeptides were screened out between MN and normal controls (35.48±13.71, P<0.01). 5 differential expressed polypeptides were screened out between FSGS and normal controls (18.06±8.07, P<0.05). The statistical significance was set at P<0.05. A Genetic Algorithm was used to set up the classification model between patients and normal controls. The model separated MsPGN, MCNS, MN and FSGS group from normal controls with a cross validation of 96.18%, 100%, 98.53% and 94.12%, respectively. The recognition capabilities were 100%. Conclusions The study established the serum peptidome spectrum for nephrotic syndrome by proteomic technology, and provided a new viewpoint to better understand the pathogenesis of nephrotic syndrome.
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Objective To observe the efficacy and safety of different doses of mizoribine to prevent rejection after renal transplantation. Methods Sorted by time of operation and odevity, 206 primary kidney transplant recipients were divided into 3 groups, including MMF group, MZR Ⅰ group and MZR Ⅱ group. All recipients in 3 groups were administrated CsA and Pred, combined with mycophenolate mofitile (MMF) in MMF group and mizoribine (MMF) in MZR Ⅰ and Ⅱ groups.The dosage of MMF was 1. 0 g/day, while dosage of MZR in MZR Ⅰ and Ⅱ groups was 100 and 200 mg/day, respectively. There was no difference in usage of cyclosporine (CsA) and prednisone (Pred) among 3 groups. 100, 60 and 30 recipients were followed up in MMF, MZR Ⅰ and MZR Ⅱ groups respectively in 5 years. During the follow-up period of 5 years, the incidence of acute rejection, patient/graft survival and adverse effects associated with drugs in three groups were observed. Results The patient/graft survival was 88. 3 % (53/60), 85 % (51/60) in MZR Ⅰ group, 90 % (27/30),86.7 % (26/30) in MZR Ⅱ group, and 88% (88/100), 86% (86/100) in MMF group, respectively (P>0. 05). There was no significant difference in incidence of acute rejection among MZR Ⅰ (10 %, 6/60), MZR Ⅱ (6. 7 %, 2/30) and MMF groups (9 %, 9/100). The incidence of severe pulmonary infection in MZR Ⅰ group was 3. 3 % (2/60), and 10 % (3/30) in MZR Ⅱ , and the former was lower than MMF group (15 %, 15/100) significantly. There was significant difference in mortality of severe pulmonary infection between MZR Ⅰ group (0, 0/2) and MMT group (73. 3 %, 11/15). The rate of ACR in MZR Ⅱ group (10 %, 3/30) was lower significantly than MMF group (30 %, 30/100) and MZR Ⅰ group (31.7 %, 19/60). There was significant difference in the incidence of hyperuricacidemia between two MZR groups (30 %, 56. 7 %) and MMF group (10 %)(P<0. 05), while the incidence of diarrhea and myelosuppression was lower significantly in MZR Ⅰ group than in MMF group. Conclusion MZR can prevent acute rejection after kidney transplantation effectively and safely. Immunosuppressive therapy including mizoribine is the best choice especially for high risk group because of susceptibility to infection and those who suffer from tenacious diarrhea owing to the side effect.
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BACKGROUND: A large number of researches have confirmed that hypertension, vascular nephrosclerosis and chronic systemic inflammatorome were the importance factors of chronic allograft dysfunction. Hyperuricemia is associated with primary hypertension and vascular nephrosclerosis, and can result in chronic systemic inflammatorome, but it was uncertain whether post-transplantation hyperuricemia and its lesion influence the long term graft function. OBJECTIVE: To investigate the prevalence of hyperuricemia in renal transplant recipients (RTRs) before and after transplantation and the influence of hyperuricemia on long term graft function. METHODS: A total of 216 renal transplant recipients [146 males with the mean age of (40.98±11.09) years and 70 females with mean age of (40.01±11.62) years]with normal renal function after transplantation were selected from PLA Center of Kidney Transplantation and Dialysis, the 181 Hospital of Chinese PLA. In order to compare the influence of different hyperuricemia status on the long term graft function, the patients were divided into 4 groups according their pre-transplant baseline and post-transplant serum uric acid (SUA) levels, SUA normal group, pre-transplant high SUA group, post-transplant high SUA group and both pre-transplant and post-transplant high SUA group. The patients were also divided into 3 groups according to their post-transplantation SUA level to study the influence of SUA on the long term graft function, normal SUA group, hyperuricemia (SUA < 500 μmol/L) group and hyperuricemia (SUA > 500 μmol/L) group. Effects of hyperuricemia and SUA levels pre-and post-transplantation on long term graft function were observed. RESULTS AND CONCLUSION: Hyperuricemia existed in 34.2% male RTRs and 37.7% females before transplantation, while it existed in 36.2% male RTRs and 42.4% females at the first month post-transplantation when they had normal Scr levels. The incidence rate of post-transplant hyperuricemia in female RTRs was significantly higher than male RTRs (P < 0.05). The average post-transplantation SUA levels in both male and female RTRs were significantly higher than those before transplantation (P < 0.01). At follow-up end, the pre-transplantation SUA levels did not significantly influence on the long term graft function (P > 0.05), meanwhile the RTRs with continuous post-transplant hyperuricimia had poorer long term graft function than those with normal post-transplantation SUA levels. It is indicated that hyperuricemia is more common in post-transplantation recipients, especially in female RTRs, when compared to pre-transplantation, and post-transplantation hyperuricemia often existed in renal transplant recipients with normal graft function. Furthermore it is suggested that post-transplantation hyperuricimia, but not pre-transpiantation hyperuricemia, could also act as a factor inducing chronic renal allograft dysfunction.
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Objective To investigate the risk factors of insulin resistance(IR)and its relationship with metabolic syndrome in patients after lenal transplantation.Methods 133 renal transplant redpients who had not undergone acute rejection,calcinurine intoxication and severe infection,and had normal renal function and no proteinuria at the 6th month post-transplantation,were involved in the study.They had a history of chronic glomerulonephritis as the primary disease of ESRF but rio diabetes mellitus.108 recipients(CsA group)were treated with CsA,mycophenolate mofetil(MMF)and prednisone after transplantation,19 recipients(Tac group)with tacrolimns(Tac),MMF and prednimne,and 6 recipients with Simlimus,respectively.One year later,blood and urine biochemical tests and physical examinations were performed on the recipients,and HOMA calculated.200 cormnunity residents were randomly selected as controls.Results The incidence of MS in the recipients was 33.1%,significantly higher than controls(15.0%).There was no significant difference in the incidence of obesity and overweight between recipients(29.3%)and controls(37.5%).In recipients with obesity or overweight,the insulin-resistance level and urine albumin level,and the incidence of MS weree significantly higher than those without obesity or overweight.The insulin-resistance level in Tac-treated recipients was markedly higher than CsA-treated recipients,and there was a positive correlation between the blood concentration of Tac and insulin-resistance levd.Microalbuminufia-positive recipients had higher insulin-resistance levels.Metabolic syndrome-complicating recipients had higher insulin-resistance levels than those without metabolic synawme,and higher insulinresistance levels existed in recipients with hypertriglyceridemia or hyperchcllesterolemia,hypertension.Conclusion Obesity or overweight,Tac(especially when blood concentration was higher)were risk factors resulting in imulin-resistanee in kidney transplant recipients.It is suggested that insulin-resistance might be involved in the pathogenesis of metabolic syndrome including hypertrglyceridmaia,hypercbolestemlemia and hypertenion.
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40%)were observed in HLA CREGs matching and outcome of post-transplantation.Results Patients with 0,1,2 or 3 mismatching(MM) of HLA CREGs+DR were 4(28%), 6(44%)and 4(28%)cases respectively according to the the rule of CREGs matching and no case had 3~6 MM.However the cases of 0,1,2,3 and 4 MM were 1(7%),3(21%),5(36%)and 5(36%)respectively by the standard of conventional HLA antigen matching,without 4~6 MM and only 4 cases had shared 0~1MM.Only 9 patients were developed into acute rejection, and were reversed by OKT3 treatment after transplantation.Renal function was returned to normal in all patients.Conclusions Using CREGs matching criteria would significantly increase the chance of recipients to receive well-matched kidney and provide more chance for waiting recipients.Suitable HLA matching could play an important role in reducing the incidence of acute rejection and improving graft survival in sensitized patients.
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Objective To investigate the etiological diagnosis and therapy of liver function lesion after kidney transplantation.Methods By analyzing the etiological factor of 82 cases of liver function lesion,we provided a reasonable and operative therapy scheme in kidney post-transplantation.Results Of 82 cases,the number of drug toxicity and viral hepatitis B which result in liver functional lesion were 70 cases(85 5%) and 12 cases(14 5%) respectively.The former were all cured,8 cases in the latter were cured and the other 4 cases were died from acute hepatic failure.Conclusions The liver function lesion of post-transplantation should be diagnosed carefully and treated particularly.Morever,the adjustment of immuno-suppressive drugs and monitoring circlosporin A concentration should be done for the patients with liver function damaged.
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Objective To investigate the role of biopsy kidney allograft in the early diagnosis and differential diagnosis of acute and chronic rejection and other diseases involving renal allograft,and to determine the optimal time for early biopsy in chronic allograft rejection.Methods Non-random biopsy of renal allograft was performed in 44 kidney transplant recipients with the clinical manifestation of diagnosis-unconfirmed allograft diseases,in the presence increased in serum creatinine,microalbuminuria or/and proteinuria,glomerular hematuria and so on.Another 6 kidney transplant recipients received routine allograft biopsy 1 month after operation.Pathological evaluation was performed in all sections according to Banff 97 classification and based on clinical data.Results Chronic allograft rejection was discovered in the renal allograft specimens of 31.3%,76.5% and 88.2% recipients,respectively,in the 1st year,the 2nd to 3rd year and over 3 years after operation,and most of them showed no obvious clinical manifestation.A part of recipients with clinical diagnosis of acute rejection also showed pathological manifestations of chronic rejection and/or glomerulonephritis and chronic cyclosporine nephropathy.A part of recipients with clinical diagnosis of chronic rejection showed pathological manifestations of acute rejection and/or glomerulonephritis and chronic cyclosporine nephropathy.Pathological features of acute or chronic rejection,glomerulonephritis and chronic cyclosporine nephropathy were observed respectively in recipients with disorders of kidney allograft with unknown diagnosis.No obvious clinical symptoms were observed in nearly half of the patients with pathological diagnosis of glomerulonephritis.Good therapeutic effect was obtained in these recipients who were correctly treated on the basis of definite pathological diagnosis.Conclusions It is indicated that optimal time for early diagnosis in chronic renal allograft rejection might be the 2nd and 3rd year after transplantation,and routine biopsy should be performed in this period.It is suggested that biopsy of renal allograft is of importance value for rectification of clinical diagnosis and for recipients with clinically undefined renal allograft diseases.It is also indicated that there might be coexistence of acute,chronic rejection and/or glomerulonephritis and chronic cyclosporine nephropathy.
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Objective To investigate the differential expression of microRNAs(miRNAs) in transplanted kidney undergoing chronic rejection by the technique of RNA microarray.Methods Four biopsy specimens from transplanted kidney undergoing chronic rejection were harvested as test group(CR),and 3 biopsy specimens were obtained from normal renal cortex as normal control group(NC).Total RNA of each sample was extracted using Trizol reagent.miRNAs were isolated and differential expression of miRNAs were screened by miRNA array analysis.The results of miRNA array were validated by RT-PCR.The quantity and quality of all the RNA samples were checked by gel electrophoresis and absorbance at A260/280,respectively.Results It was confirmed that the isolated RNA was of appropriate quality.The results of miRNA array analysis showed that there were 63 differential expression miRNAs in CR group,of which 35 were up-regulated and 28 down-regulated.There were 9 differential expression miRNAs which distributed in 3 gene clusters: 14q32.31,22q11.21 and xq27.3.The miRNAs hsa-miR-637,hsa-miR-648 and hsa-miR-516-5p were randomly selected for relative quantification by real-time PCR.It was showed that the expression ratios of hsa-miR-637,hsa-miR-648 and hsa-miR-516-5p in AR/NC,when detected by RT-PCR,were 0.034,2.670 and 7.846,while the ratios were 0.035,2.660 and 7.857 when analyzed by miRNAs array.The results from two methods were not significantly different,so the method of miRNAs array was reliable.Conclusions It is notable that the differential expression of miRNAs existed in the transplanted kidney undergoing chronic rejection.miRNAs might be helpful in protecting the patients undergoing kidney transplantation against chronic rejection.