CD4+CD25+FoxP3+Treg may regulate the immune responses and induce tolerance to alloantigen in vivo in organ transplantation. A high expression of CD4+CD25+FoxP3+Treg may be a possible indicator of acute allograft rejection. The patients with renal transplantation showing a high expression of CD4+CD25+FoxP3+Treg might be more prone to the development of acute allograft rejection,and the detection of its expression may contribute to predict allograft acceptance or rejection. It seems plausible that the imbalance between effector T cells and Treg might reflect an immune state. Additional experimentation and clinical studies are needed to investigate the long-term impact of development and function of Treg cells on immunosuppression in allogeneic renal transplantation.

The development status and specific problems of liver transplantation in China were analyzed, and the strategies to resolve these problems were discussed in this study. "Hepatitis B related diseases", including cirrhosis and hepatic cancer, were the main indications for liver transplantation in China. Recurrence of hepatitis B and hepatic cancer was found to significantly affect the long term survival of the recipients of liver transplantation. Severe hepatitis and fulminating liver failure were the main causes of death in the perioperative periods of liver transplantation. Nonanastomotic biliary stricture (NABS) and acute rejection often occurred. Lamivudine and anti-Hepatitis B immunoglobulin(HBIg) could effectively protect the recipients from hepatitis B recurrence. The indication of liver transplantation for the patients with the hepatic cancer should be observed strictively, and measures should be taken before and during the operation to prevent the recurrence of the cancer. In the patients with severe hepatitis and fulminating liver failure, therapy to support the liver function should be emphasized and the artificial liver support system (ALSS) should be administered. The prognosis of NABS was found to be poor, and biliary duct dilatation with balloon catheter might be an effective treatment for NABS, but retransplantation was necessary for some of the patients. The rate of biopsy of the liver graft, the quality of the biopsy and the level of pathological diagnosis should be greatly enhanced.

Recent advances in transplantation tolerance were comprehensively reviewed. The contents included the mechanisms and methods of induction and maintenance of transplantation tolerance. Some experimental protocols were introduced including mixed chimerism of allogeneic bone marrow, blockade of co-stimulation signal and transgene technology for transplantation tolerance induction. The problems and the future of clinical transplantation tolerance were objectively evaluated here.

The low-density lipoprotein (LDL) receptor level and endocrine function were studied in 30 cases of non-familial hypercholesterolemia. The results showed that endocrine dysfunction may play a role in the pathogenesis of hyper-cholesterolemia, for example, the elevation of insulin and growth hormone level, the abnormal ratio of estrogen and testosterone. In addition, the increase of TXB2 and 6-ketone prostacyclihe may make the blood hypercoagulative, raise the incidence of myocardial infarction and cerebral thrombosis. Except the physiologic compensation the LDL receptor level in non-familial hypercholesterolemia may also be regulated by insulin and estrogen.

BACKGROUND: Mesenchymal stem cells (MSCs) from adult bone marrow can alter alloimmune response in vitro and vivo. Their potentiality is great in solid organ transplantation.OBJECTIVE: To develop MSC antirejection therapy and identify behind mechanishm of MSCs immunomodulation ability. METHODS: We searched Pubmed (1994-Mar.2009) with the key words of "mesenchymal stem cells, solid organ transplantation, tolerance, immunosuppression, animal model". RESULTS AND CONCLUSION: Totally 262 English articles about influence and mechanism of action of adult bone marrow mesenchymal stem cells on solid organ transplantation were collected. The 49 suitable articles were included without earlier publication time, repeated and analogous study. Human mesenchymal stem cells did not express MHC2 Ⅱ antigen and T cell costimulatory molecules B7. Coculture with allogenic T lymphocytes could not induce T cell proliferation, but inhibited mixed lymphocyte reaction and mitogenstimulated T cell proliferation. Inhibitory effects of mesenchymal stem cells on T cell proliferation were not limited by major histocompatibility complex. Mesenchymal stem cells no matter from donors or recipients had similar immunoloregulation effects. Allogene mesenchymal stem cells could cause immunereaction in vivo, no complete immune privilege. The in vivo effects of mesenchymal stem cells will strongly depend on their localization and migration pattern after injection. Therefore, MSCs are interesting candidate cells for tolerance induction in clinical organ transplantation.

ObjectiveTo introduce an improved implantation for urethral stents in patients with infra-sacral neurogenic voiding dysfunction and to evaluate its outcome.MethodsTwelve patients with infrasacral neurogenic voiding dysfunction were treated by implantation of urethral stent according to an improved method.The following objective parameters were used to evaluate the outcome:voiding diary,urine residue volume(URV),renal hydronephrosis and urodynamic tests.ResultsThese parameters were improved significantly after implantation:detrusor leak point pressure,voiding pressure and URV decreased,voiding volume and urine flow increased.The main complications were incontinence,difficult voiding and hematuria,but these were transient and disappeared during a week.ConclusionsThis procedure is effective with fewer complications,protects the function of upper urinary tract and improves the life quality of the patients with infra-sacral neurogenic voiding dysfunction.

AIM:Anti-hepatis B immunoglobulin in combination with lamivudine is efficient to prevent chronic hepatitis B virus (HBV) reinfection following liver transplantation. However, long-term usage of lamivudine can result in YMDD variation and lead to medicine resistance even HBV relapse. In this study, we investigated etiological factors and prevention and treatment protocol of HBV recurrence and YMDD variation after liver transplantation. METHODS:A computer-based online search of Pubmed database from January 2002 to January 2008 and Chinese Journal Full-text Database from January 2003 and December 2007 was undertaken to identify articles about HBV recurrence and YMDD variation after liver transplantation. The collected articles were firstly selected and the references of each article were looked up. Only articles that involved in HBV recurrence and YMDD variation after liver transplantation were included. The articles published in authoritative journals in recent 5 years were accepted in priority. Repetitive articles and Meta analysis were excluded. RESULTS:HBV recurrence after liver transplantation is associated with hepatitis B DNA loading dose, invasion of hepatitis B into non-liver tissues, immunosuppressive therapy and viral genovariation. The major prevention and treatment protocol of HBV reinfection after liver transplantation is the combination of anti-hepatis B immunoglobulin and lamivudine, which is economical and efficient. However, long-term administration of lamivudine induces YMDD variation in hepatitis B DNA polymerase, leading to drug resistance even HBV recurrence. Now adefovir dipivoxil is regarded as an effective remedy for YMDD variation. CONCLUSION:Virus variation and HBV recurrence can influence prognosis of HBV-related end-stage diseases after liver transplantation. Prevention and cure approaches are developing. It is important to find an economic, safe, convenient and effective therapeutic regimen. In addition, individualized treatment and the evaluation of risk and advantage should be emphasized.

BACKGROUND: Lower urinary tract abnormality (LUTA) can lead to end-stage renal disease (ESRD). However, insufficient attention has been paid to these patients in China, and they are usually thought unsuitable for kidney transplantation because of high incidences of graft dysfunction and septic complication.OBJECTIVE: To explore the characteristics and postoperative follow-up after kidney transplantation in four patients with LUTA.DESIGN, TIME AND SETTING: A retrospective analysis of LUTA cases was performed from July 2002 to June 2006 at the Organ Transplantation Center of Chinese PLA, Second Affiliated Hospital of General Hospital of Chinese PLA.PARTICIPANTS: Four ESRD cases of LUTA, who received allograft kidney transplantation.METHODS: Four cases of LUTA experienced detail evaluation before kidney transplantation. Ureter was reimplanted into the original bladder during transplantation and suprapubic cystostomy was performed as urinary drainage.MAIN OUTCOME MEASURES: Patient and graft survival, graft function, urinary tract infection (UTI) and graft rejection were supervised after surgery and quality of life was evaluated.RESULTS: Two patients recovered well with normal renal function and no rejection. Despite the moderate but easily controlled UTI, they handled the urinary diversion well and were satisfied with the quality of life. One patient experienced an acute rejection 17 days after transplantation and survived with functional graft until now after the rejection was reversed. One patient lost the graft for repeated hemorrhage at the site of vascular anastomosis, and then returned to hematodialysis.CONCLUSION: Kidney transplantation is suitable but special for patients with LUTA. Careful evaluation before transplantation, suitable urinary drainage and rigorous follow-up after surgery are keys to the success of kidney transplantation for this subgroup of patients.

Objective To study the diagnosis and treatment of the severe pulmonary infection in the patients after kidney transplantation. Methods The clinical data of 26 patients with severe pulmonary infection following kidney transplantation were analyzed retrospectively. Results Microorganisms were isolated and identified in 22 patients out of 26 kidney transplantation patients with severe pulmonary infection. The main etiological pathogens according to their frequency and type were: bacteria (15 cases, including Escherichia coli, Aerobacter cloacae, Klebsiella fredlanderi, Enterococcus faecalis, Staphylococcus epidermidis, etc.), fungi (12 cases, Fermentum, Blastomyces albicans, Candida tropicalis, Aspergillus, etc.), and cytomegalovirus (10 cases). 46.15% (12/26) of patients were infected with one kind of microorganism, and 53.85% (14/26) of patients were mixed infection. In 73.1% (19/26) of patients the pulmonary infection occurred during 1-6 months after renal transplantation. Among 26 patients, 12 developed ARDS, and 4 patients gave up therapies due to high expenses. With energetic treatment, 18 patients (81.82%) were cured and 4 died. Conclusions Intensive care and active measures should be given in the treatment of severe pulmonary infection after kidney transplantation. Early diagnosis, administration of broad-spectrum and combined use of antibiotics, the early identification of pathogens, enforcement in systemic support, including correction of immunosuppression, the timely use of mechanical ventilation to correct hypoxia, are the key treatment strategies for a successful result.

Objective To study the chimerism formation in kidney transplantation recipient receiving peripheral blood stem cells (PBSCs) of the donor after the patient received preoperative total lymphoid irradiation (TLI). Methods 5 patients of living donor kidney transplantation were involved in present study. The mean age of donors was 40 and that of recipients was 27. There was one patients with 4 HLA antigen mismatches out of 6 HLA-A, B, DR antigens, two patients with 3 HLA-mismatches, and two patients with 1 HLA-mismatch. The patients received TLI in doses 90cGy/d from day -5 to day -1. The immunosuppression protocol for these patients during operation and afteroperation was similar to that for other cases, but the dosage was slightly reduced. Donor PBSCs were harvested twice via leukapheresis after the administration of human recombinant granulocyte colony stimulating factor (G-CSF). PBSCs were infused intravenously to the recipients on postoperative day 4 and 7. Chimerism of peripheral blood cell in recipients was detected by PCR-SSP assays. The grafted kidney function, acute rejection frequency and GVHD episodes were also observed. Results After 5 days of G-CSF based mobilizing regimen, the average number of PBSCs harvested from donors was 34?10~6. At 1 month post-transplantation, donor type HLA-DR gene was detected in all the recipients. At 2 and 3 months post-transplantation, chimerism was not detectable in the recipient with 4 HLA antigens (including 2 HLA-DR) mismatched donor kidney and in the recipient with 3 HLA (including 2 HLA-DR and 1 HLA-B) mismatched donor, respectively. In the other 3 recipients, chimerism was still positive 3 months post-transplantation. There were no symptoms of GVHD or infections after infusion of PBSCs. Transplanted kidneys functioned normally and no rejection episodes were observed till the end of the study. The immunosuppressant dosage was lower for these 5 cases than those after conventional cadavar renal transplantation. Conclusions Non-myeloablative TLI conditioning regimen is a safe and effective method which can promote the engraftment of donor PBSCs and induce hemopoietic chimerism. Chimerism can alleviate rejection of the transplanted kidney and reduce the immunosuppressant dosage. Collection and infusion of PBSCs are simple, convenient, effective, and inexpensive, and it is an optimal source of hemopoietic stem cells.