Child ; China ; Humans ; Kidney Transplantation ; Pediatrics

Objective To study the clinical efficacy and safety of rapamycin in combination with CsA and steroid to prevent the acute rejection of kidney transplantation. Methods In an open-label,multi-center study,there were 100 primary renal allograft recipients with cadaveric donors enrolled from 4 transplantation centers in China. The immunosuppressive regimen was the triple therapy of rapamycin in combination with CsA and steriod. Rapamycin was administered in 48 h after grafting. The first dose of rapamycin was 6 mg /day and the maintenance dose was 2 mg /day. Results Eighty-four recipients were followed up for more than 6 months. Rapamycin was discontinued in 16 patients because of the adverse events and other reasons. Eight patients experienced acute rejection and 7 patients were reversed by methyprednisolon therapy. In 6 of the 7 patients,the dose of rapamycin was maintained 2 mg /day. The remaining one was added to 3 mg /day. No recurrence of AR was observed in a continuous follow-up of more than half-year. The most common and significant adverse events were hyperlipoidemia and abnormal liver function.Conclusions The combination of rapamycin with CsA and steroid to treat recipients of kidney transplantation is safe and efficient. There was a low incidence of AR but a high incidence of hyperlipoidemia and abnormal liver function. The rational regulation of the dose may reduce the incidence of the side-effects. Further observation and study are required for long-term application.

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Objective To study the feasibility and safety of horseshoe kidney transplantation and avoid the waste of the donor kidney. Methods The horseshoe kidney was identified and confirmed during the organ procurement process. It was perfused in situ and procured en bloc. With an appropriate dissection and reconstruction on the beach table, the horseshoe kidney was carefully divided at the isthmus and transplanted into two separate recipients. The surgical strategies and postoperative outcomes of transplanting the cadaveric horseshoe kidneys were evaluated. Results Two recipients had a immediate return of renal function after the blood vessels were opened. One recipient had a normal renal function presented as lower post-transplant serum creatinine values with a follow-up of 12 months. There was no complications related to the horseshoe kidney. Another case died of infection 1.5 month later after the transplantation. Conclusions Cadaveric horseshoe kidney may be transplanted successfully using various individual technical strategies based on the specific renal anatomy. Considering the lack of donor horseshoe kidney transplantation is feasible and safe.

Objective To compare the long-term effect and safety between tacrolimus (FK506) and cyclosporine (CsA) in patients receiving cadaveric renal transplantation. Method A total of 210 patients were randomized to FK506 and CsA after cadaveric renal transplantation, and were followed up for 12-32 months for the variation of trough concentration in whole blood, the incidence of acute rejection and chronic rejection, one-year survival rate of patient/graft, variation of creatinine level, impairment of liver function and glucose metabolism and lipid metabolism, incidence of infection, and side effects. Results The variation of trough concentration of FK506 was similar to CsA. The incidence of acute rejection was significantly lower in FK506 group than in CsA group ( 16.3 % vs 33.0 % , P 0.05 ). The incidence of impaired liver function and impaired lipid metabolism and gingivitis and creatinine level three months after transplantation were significantly lower in FK506 group than in CsA group ( P

Objective To investigate the effects of a corrective tr ea tment on open bite malformations, such as gnash their teeth, nail-biting, tongu e thrusting, impacted tooth, cross bite with improper correction, open bite defo rmity resulted from premature shedding of deciduous tooth and molar cysts. Methods We used dental resin technology: acid etching the teeth, adh ering metal clasps to the teeth by means of composite resin, and applying elasti c bands for intermaxillary traction to correct the cross bite. Results We had treated 22 patients, age ranged from 7-30, with the malformatio ns resulted from different kinds of reasons, and obtained significant results. Conclusion With cooperation of the patients, simple corrections for open bite with sticky clasp and occlusion with elastic band are easy to car ry on, with short period of treatment time, and every patient gets prominent out come. It is effective, prior to commonly-used corrective therapy and deserves t o be widely used.

Objective To investigate the therapeutic effect of rapamycin in the treatment of malignancies after kidney transplantation (KT).Methods Of the 23 inoperable patients with malignancies after KT, 8 (RPM group) received Rapamycin as treatment as well as there immunosuppressive regimens were modulated, and the remaining 15 (non-RPM group) were treated only by immunosuppressive regimen modulation, some of whom also received chemotherapy. The survival of the patients in the two groups was compared.Results In RPM group, the median survival time was (14.5) months and no acute rejection (AR) occurred during whole follow-up period. There are still 7 patients alive at the end of this study. One recipient with Kaposi’s sarcoma developed AR because of RPM dose reduction, and finally died of transplanted kidney failure and pulmonary infection. In non-RPM group, the median survival time was (3.0) months, and all of them died during the follow-up period. The 12- and 20-month survival rates were respectively (75.0) % and (37.5) % in RPM group, while (7.1) % and 0 in non-RPM group with the difference being statistically significant (P

Objective To evaluate the significance of immediate early 1 (IE) mRNA detection by nucleic acid sequence-based amplification (NASBA) in the diagnosis of human cytomegalovirus (HCMV) infection after renal transplantation.Methods The expression of IE-mRNA and pp67-(mRNA) was detected by NASBA in 55 patients after renal transplantation, and pp65 antigenemia (assays) were done for all cases.Results Twenty cases were positive for IE-mRNA. Thirteen cases were suffered from CMV disease with symptoms. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of IE-mRNA by NASBA were 92.3 %, 80.9 %, 60.0 % and 97.1 %, respectively. Time to first IE-mRNA positive detection after transplantation was shortest, compared with pp67 and antigenemia (P

Objective To investigate the therapeutic role of glucocorticoid in treating cytomegalovirus (CMV) severe pneumonia after kidney transplantation. Methods Two groups of patients with CMV severe pneumonia after kidney transplantation were analyzed. The therapeutics for 12 patients of group A included the elimination of immunosuppressive agents such as cyclosporine (or tacrolimus) and cellcept, the use of antiviral drug such as gancyclovir, measures to prevent and cure other bacterial and fungal infections, supportive therapies and suck of oxygen or mechanical ventilation by respirators. Except for the above therapies, methylprednisolone was routinely injected to those 14 patients of group B. At the beginning, the dose of methylprednisolone was 120 mg/day to 150 mg/day. Three to five days later, the dose was decreased to 80 mg/day. The dose was further decreased to 40 mg/day when patients’ signs were improved. After patients’ signs were excluded, prednisone was taken orally in place of methylprednisolone. In our patients, methylprednisolone was used for average 12 days, ranging from 8 to 21 days. Results Among the patients of group A, 9 (75 %) were treated with mechanical ventilation by respirators, 7 ( 58.33 %) died and 2 ( 16.67 %) received dialysis due to dysfunction of the transplanted kidneys. Among the patients of group B, 4 ( 28.57 %) were treated with mechanical ventilation by respirators, 2 ( 14.29 %) died and no case with the transplanted kidney loss was found. There were significant differences between the two groups on the probability of using mechanical ventilation by respirators and the mortality (P= 0.047 and P= 0.038 respectively). In the patients of group B, no severe side effects caused by methylprednisolone were found. Conclusion The treatment with proper dose of methylprednisolone may extenuate effectively the inflammatory reaction from the CMV severe pneumonia after kidney transplantation while reduce the rejection related to the absence of other immunosuppressants and decrease the mortality and the rate of transplanted kidney loss.

Objective To investigate the clinical features, diagnosis and therapy of avascular necrosis of the femoral head after renal transplantation Methods Of the 24 renal transplantation patients with avascular necrosis of the femoral head 0.7 - 7.8 years postoperatively, 20 cases were unilateral and 4 bilateral respectively. According to the standard of Ficat's, all cases were classed as 0-Ⅳ stages. All cases accepted immunosuppressive therapy that included corticoids. The corticoids were reduced in dose at the time when the patients were diagnosed as having avascular necrosis of femoral head and withdrawn in 2 weeks. Surgical treatment was not done unless the expectant treatment was invalid.Results The clinical manifestations of femoral head avascular necrosis after renal transplantation included knee joint, hip joint, inguina or thigh pain in the earlier period (Ⅰ-Ⅱa stage) and hip joint pain in progression (Ⅱb-Ⅳ stage). Some cases were associated with hip joint flex, adduct, abduction and intorsion dysfunction. After expectant treatment, the symptoms of hip were alleviated or disappeared in 4 cases; In 16 cases, the symptoms of hip were relieved to some extent, but Ficat’s stage had no change. Eight cases had no reaction to expectant treatment and were subjected to surgical operation. In 4 cases, acute rejection occurred after corticoid withdrawal, reversed after therapy by MP and ATG and could tolerance corticoid withdrawal again.Conclusion Corticoid is the main reason of avascular necrosis of the femoral head after renal transplantation. The therapeutic effectiveness of avascular necrosis of the femoral head was not satisfactory and the emphasis was put on the prevention.