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.

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 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.

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.

Objective To investigate the changes in gastrointestinal circulation during the operation of orthotopic liver transplantation. Methods In 15 patients undergoing orthotopic liver transplantation, PgCO2 and PaCO2 were determined and the values of Pg-aCO_2 and pHi were calculated at the time points as follows: pre-operation (T0), 30min before anhepatic phase (T1), 30min of anhepatic phase (T2), and 5min (T3), 30min (T4) and 90min (T5) after reperfusion of the transplanted liver, and at the end of the operation(T6). Results Compared with that of pre-operation, PgCO2 and Pg-aCO2 increased significantly at the following time points: 30min before anhepatic phase, 30min of anhepatic phase, as well as 5min and 30min after reperfusion of the transplanted liver (P0.05). The values of pHi decreased significantly at 30min before anhepatic phase, 30min of anhepatic phase, and 5min and 30min in neohepatic phase (P

Objective To study the hepatotoxicity of cyclosporine-A, tacrolimus and other immunosuppressive drugs in patients with renal transplantation. Methods In 346 cases undergone renal transplantation, ALT, AST, BILT and BILD levels of venous blood 1-90 days after operation, and treatment methods and outcome were reviewed, in order to evaluate the effectiveness of the treatment of hepatotoxicity. Results In CsA group, the occurrence rate of liver dysfunction was 26.9%, in whom ALT, AST and BILD increased apparently (P0.05). In MMF and MRZ group, the incidence of liver dysfunction was almost the same. In 18 cases the drug was changed into FK506, ALT, AST, BILT and BILD all apparently decreased 1 week later (P

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.