Parasitism characteristics of spirometra mansoni sparganum in the living donor kidney are analyzed by present cases and relevant literatures. A female aged 49 years voluntarily donated a kidney to her son. Results of healthy evaluation were accorded with the standards of living donor kidney. During repairing kidney, a sliver cyst was found in the adipose capsule on the kidney ventral surface, near to the renal hilum. The cyst was incised, and a ivory white girdle-shaped worm was obtained. After identification, the worm was identified spirometra mansoni sparganum (living body). Pathological examination showed that the cyst developed granulomatous inflammation, combined with neutrophil and eosinophilic granuiocyte infitration. Following surgery, the donor and recipient were treated with praziquantel. No proglottid or worm ovum was detected by dung detection within 3 months, without any discomfortable symptom. The infection mode and pathway may be by eating unmatured paratenic host meat or infected cyclops. The donor and recipient should be examined for parasitic infection of sparganosis mansoni prior to transplantation. No significant symptom could be detected following parasitism of sparganosis mansoni in the kidney, so it was seldom found. Worm ovum was examined in feces, which could be the evidence for sparganosis mansoni and for case history inquisition. Eosinophilia in the blood always indicated that chronic parasitic infection. Zoogenetic infection test could be tested when necessary. Sparganum antigen could be used for various immunological tests, which could provide evidence for auxiliary diagnosis of immunology. The diagnosis was usually confirmed by obtaining a polypide by surgery or histological examination. CT scanning and magnetic resonance imaging have diagnostic value of renal sparganosis mansoni.

BACKGROUND: Post-transplantation diabetes mellitus has the same characteristics as type II diabetes mellitus; however, correlation between human leucocyte antigen (HLA) and post-transplantation diabetes mellitus remains unclear among Han population in Hunan and Jiangxi provinces. OBJECTIVE: To analyze the correlation between HLA and post-transplantation diabetes mellitus, to determine predisposing genes and protecting genes of post-transplantation diabetes mellitus, and to provide reference data for personalized medicine of post-transplantation diabetes mellitus. DESIGN, TIME AND SETTING: A survey analysis was performed at Department of Urological Organ Transplantation, the Second Xiangya Hospital of Central South University from May 2007 to July 2008. PARTICIPANTS: Patients with kidney transplantation selected from Department of Urological Organ Transplantation, the Second Xiangya Hospital of Central South University between 2003 and 2008 were followed-up on individual information, testing results before and after transplantation, and zygosity. Among 195 included cases, there were 22 patients with post-transplantation diabetes mellitus and 173 with non-post-transplantation diabetes mellitus. Methods: METHODS: χ~2 was used to compare frequency of HLA antigen between post-transplantation diabetes mellitus and non-post-transplantation diabetes mellitus groups. The 195 patients were divided into ciclosporin A group and tacrolimus group according to immunosuppressive regimen, and the incidence of post-transplantation diabetes mellitus were compared usingχ~2 test. All the patients were then divided into elderly group (age ≥ 40) and low-age group (age < 40), and the incidences of post-transplantation diabetes mellitus were calculated and compared usingχ~2 test.MAIN OUTCOME MEASURES: Following-up was performed including age, blood pressure, urine volume, blood and urine routine test, liver and kidney function, blood glucose, and blood drug level. RESULTS: HLA-A30 and HLA-DR7 might be the predisposing genes of post-transplantation diabetes mellitus in south China; however, protecting genes were not found. Low dosage and low blood drug level of calcineurin inhibitors were applied in this study, and there was no significant difference in the incidence of post-transplantation diabetes mellitus between ciclosporin A and tacrolimus groups (P > 0.05). The incidence of post-transplantation diabetes mellitus in elderly group was significantly higher than that in low-age group (P < 0.05).CONCLUSION: HLA-A30 and HLA-DR7 might be the predisposing genes of post-transplantation diabetes mellitus in south China; therefore, they should be paid much attention on levels of blood glucose and urine glucose after transplantation so as to adjust the types and dosages of immunosuppressive drug in time. Low-dosage and low-concentration tacrolimus was not increased incidence of post-transplantation diabetes mellitus remarkably. However, the incidence of post-transplantation diabetes mellitus in the elderly patients was high; moreover, the incidence of cardio-cerebrovascular disease was also high. Therefore, post-transplantation diabetes mellitus might easily cause the onset of cardio-cerebrovascular disease. It was important for elderly patients to monitor blood glucose and urine glucose levels and set up an individual immunosuppression program following transplantation.

Objective To investigate the clinical effect and safety of kidney transplantation from donors with severe hand-foot-mouth disease (HFMD).Methods Five cases of kidney transplantation from three donors with HFMD between Jan.2014 and Dec.2016 were analyzed.The age of three donors was 2 years,2 years and one month,and 3 years and 11 months respectively,and body weight was 11 kg,10 kg and 15 kg respectively.The age of recipients ranged from 26 to 41 years and weight from 50 to 59 kg.Single kidney transplantations were performed on 4 cases,and dual separating kidney transplantation on one case.Results One case of the transplantations was failure due to the allograft artery thrombosis.The rest 4 cases gained satisfied clinical effect.None of the 5 cases showed any symptoms associated with HFMD.Conclusion The clinical effect of kidney transplantation from donors with severe HFMD is satisfactory.The organs from donors with severe HFMD could only be used by adult recipients.

BACKGROUND: The introduction of cyclosporin A (CsA) has greatly enhanced the early survival rate of kidney graft, but the long-term graft survival rate is still limited. Whether tacrolimus prevents chronic allograft nephropathy (CAN) and prolongs survival time is now becoming a hot spot in field of renal transplantation.OBJECTIVE: To investigate the feasibility and safety of converting CsA to tacrolimus (FK506) in preventing progression of CAN. DESIGN: Observation and controlled trial.SETTING: Department of Urological Organ Transplantation, Center of Organ Transplantation, the Second Xiangya Hospital, Central South University.PARTICIPANTS: A total of 73 patients who had received kidney transplantation at the Department of Urological Organ Transplantation, Center of Organ Transplantation, the Second Xiangya Hospital of Central South University from April 2001 to October 2005, and had been diagnosed as CAN by graft biopsy (42 male patients and 31 female patients; age ranged 19-69 years), were enrolled in the study approved by the ethics committee of this hospital after their written informed consents. CsA soft capsules (Hangzhou Zhongmei Huadong Pharmaceutical Limited Company or Huabei Pharmaceutical Limited Company); mycophenolate mofetil capsules (Shanghai Roche Pharmaceutical Limited Company); prednisone acetate tablets (Second Xiangya Hospital of Central South University); tacrolimus capsules (Fujisawa Pharmaceutical Limited Company).METHODS: Seventy-three patients voluntarily participated in CsA group (n =30) or FK506 group (n =43). The two groups were homogenous regarding patients' sex, age and general data (P > 0.05). Patients in the CsA group were continued on their initial immunosuppression protocol, which consisted of CsA, mycophenolate mofetil and prednisone acetate. In the FK506 group, CsA was stopped, and FK506 was started at a dose of 0.08-0.1 mg/(kg·d) 24 hours later, twice daily, administered 2 hours after breakfast and supper. Three days later, the blood trough concentration of FK506 was tested and adjusted to a target range of 5-8μg/L. FK506 dosage adjustment was based on the blood trough concentration, serum creatinine (SCr) and its side effects. All 73 patients were treated for 12 months. MAIN OUTCOME MEASURES: SCr, glomerular filtration rate (GFR), 24-hour urine protein excretion, serum total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL) and the toxic side effects of calcineurin inhibitors (incidences of tremor, hyperglycemia and hypertension) were monitored during a follow-up of over 12 months. RESULTS: A total of 73 patients were involved in the result analysis.①12 months after conversion, the level of SCr was statistically reduced and GFR levels were markedly elevated in the FK506 group compared with the CsA group (P < 0.01). TC, TG and LDL levels in the FK506 group were significantly lower than those in the CsA group (P < 0.01).②Compared with the CsA group, the incidence of tremor was obviously increased [30% (9/30), 5% (2/43), P < 0.01] and the incidence of hypertension was obviously decreased [56% (24/43), 83% (25/30), P < 0.05] in the FK506 group.CONCLUSION: Conversion from CsA to FK506 can postpone renal dysfunction, reduce proteinuria and improve hyperlipidemia. FK506 treatment is an effective therapy in slowing the progression of CAN.

Objective To explore the prevention and treatment strategies for the infectious renal artery rupture after renal transplantation of organ donation after citizens death (DCD).Methods The clinical data of 5 donors and their corresponding recipients with infectious renal artery rupture after renal transplantation were retrospectively analyzed with review of the literature.Results The corresponding donors of 5 recipients had the potential risk factors for donor-transmitted infection (DTI):1 case of traumatic rupture of small intestine,2 cases of digestive tract injury when resecting the donor kidney from DCD donors,1 case of severe pneumonia and 1 case of multiple renal contusion.The pathogenic microorganisms were found in the culture of kidney preservation solution,including klebsiella pneumoniae in 1 case,candida albicans in i case,enterococcus.No pathogens were detected in 1 case,and kidney preservation solution taken from the external hospital was not cultured in 1 case.The pathological examination on the resected renal grafts revealed the necrosis of the arteries and the infiltration of lymphocytes.The culture of bacteria and fungi in the removed vessel walls of renal grafts and the iliac tissues showed there were 2 cases positive for candida albicans (case 2 and case 4),1 case for cryptococcus neoformans (case 1),1 case for klebsiella pneumonia (case 5).No pathogenic bacteria were detected in 1 case,but the possibility of fungal infection was more likely.In case 1,the second kidney transplantation was performed 10 months later after artery re-transplantation,and the kidney function was normal during the follow-up period.In case 4,the second kidney transplantation was performed 2 months later after transplant nephrectomy due to the refractory rejection,the transplanted kidney experienced a rapid loss of graft function,and the blood dialysis was given continuously.The remaining 3 patients survived so far,waiting for re-transplantation.No case of bleeding occurred again in the 5 recipients.Conclusion Renal graft artery rupture is one of most severe complications after renal transplantation.It is the key for preventing infectious renal artery rupture to screen strictly infection of donors and recipients,and to use sensitive and wide coverage antimicrobial to the donors before the removal of donor kidney and during the perioperative period after renal transplantation.Early detection and operation as soon as possible is the only treatment to save the lives of the recipients.

Objective To compare the clinical efficacy of kidney transplantations from donors with acute kidney injury (AKI) and without AKI,and summarize the experience of evaluation and application.Methods The clinical data of 240 kidney transplantations from donation after citizen's death (DCD) performed in our hospital between November 2011 and March 2015 were retrospectively analyzed.The recipients were classified into AKI group (n =37) and non-AKI group (n =203) according to donors' renal function and urine output.Basic characteristics and evolution of the donors and recipients were compared between the two groups.Results The donor serum creatinine was significantly higher in the AKI group than that in the non-AKI group (P＜0.01).Most transplant recipients accepted ATG for immune induction therapy in the AKI group,while Basiliximab was given in the non-AKI group,which was significantly different (P＜0.01).Delayed graft function developed more frequently and longer in the AKI group than in the non-AKI group (P＜0.01).However,patient and graft survival rates did no differ between the AKI and non-AKI groups (P＞0.05).There was no significant difference in other indexes between the two groups (P＞0.05).Conclusion The transplants from donors with AKI showed higher incidence of delayed graft function but no effect on 1-year allograft and patient survival.This type of kidney transplantation is safe and effective.

Objective To investigate the influence of nerve growth factor (NGF) on the ability of differentiation and proliferation of regulatory T cells (Tregs) induced by mesenchymal stem cells (MSCs).Methods The MSCs were stimulated directly by NGF.IL-10,TGF-β and HLA-G were tested.The expression of CD4 and CD25 was detected by flow cytometry after co-culture.The expression of CD4,CD25 and Foxp3 was detected by flow cytometry after Transwell co-culture.Results As compared with control group,the expression of IL-10,TGF-β and HLA-G in NGF group was increased (P＜0.05 for all).The number of Tregs was increased after the co-culture (P＜0.05).The reduction in IL-10 and TGF-β could block the inducing function of NGF (P＜0.05).Conclusion NGF can enhance the ability of differentiation and proliferation of Tregs induced by MSC,which is possibly associated with the increases in the expression of IL-10 and TGF-β.

OBJECTIVE: To determine the expression and mechanism of osteoactivin (OA) in the kidney by establishing SD rat model of acute cyclosporine A (CsA) toxicity. METHODS: SD rats were fed with normal diet for a week, which they were then randomly divided into 3 groups: an experimental group (gavage with cycloporin A and olive oil), a vector group (gavage with olive oil), and a control group (gavage with normal saline). SD rats were killed 2 days, 1 week, or 2 weeks after the gavage to examine the serum creatinine (SCr) and body weight. HE staining was used to detect the kidney histopathological change. Immunohistochemistry was used to observe the staining degree and area of OA. Western blot was used to detect the OA protein.The mRNA expressions of the OA, matrix metalloproteinase-13(MMP-13), and collagen type III(Col III) were examined by RT-PCR. RESULTS: The body weight and SCr of the rats in the experimental group 1 week and 2 days after the gavage had no significant difference compared with the vector group or the control group (P>0.05).On the end of 2nd week, the rats' body weight was significantly reduced, and SCr significantly increased compared with the vector group or the control group (P<0.001).The main histopathological changes in the experimental group were inflammatory cell infiltration, vacuolar degeneration of interstitial cells, or tubular epithelial cell necrosis. Intense OA expression located in the tubular epithelium and interstitial fibroblasts in the kidney of the experimental group was observed by immunohistochemistry. After CsA gavage, the relative mRNA expressions of OA, MMP-13, and Col III significantly increased with time. Western blot did not find the expression of OA protein in the control and the vector group, which increased with time in the experimental group. CONCLUSION OA expresses in the kidney of SD rats after acute CsA toxicity and mainly expresses in the tubular epithelial cells and renal interstitium. OA is more sensitive to the damage of kidney tissue caused by CsA than by SCr. The early-phase up-regulation of OA expression in the tubular epithelium in response to renal injury caused by acute CsA toxicity might play a key role in triggering the renal interstitial fibrosis via activating expression of MMPs and collagen remodeling in SD rats.
Animals ; Collagen Type III ; genetics ; metabolism ; Cyclosporine ; toxicity ; Epithelial Cells ; metabolism ; pathology ; Immunosuppressive Agents ; toxicity ; Kidney Diseases ; chemically induced ; metabolism ; pathology ; Kidney Tubules ; metabolism ; pathology ; Male ; Matrix Metalloproteinase 13 ; genetics ; metabolism ; Membrane Glycoproteins ; genetics ; metabolism ; RNA, Messenger ; genetics ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley

OBJECTIVE: To explore the effect and safety of transplantation of kidneys from HBV-positive or HCV-positive donors. METHODS: From January 2002 to June 2006, 283 kidney transplantations were performed in Second Xiangya Hospital. Altogether 57 recipients were HBV-positive, including 31 from donors with viral B hepatitis (DB + /RB +), and 26 from donors with HBV-negative (DB - /RB +). Nineteen patients with hepatitis C virus underwent a kidney transplantation, including 6 who received kidneys from anti-HCV-positive donors (DC + /RC +) and 13 from seronegative donors (DC - /RC +). Recipient's liver function, acute rejection, graft survival, and patient survival had been observed for an average follow-up of 14 months. RESULTS: No significant difference was observed between the DB + /RB + group and DB - /RB + group, or the DC + /RC + group and DC - /RC + group in the rate of liver disfunction, acute rejection, graft survival, and patient survival. CONCLUSION Kidney transplantations from HBV-positive or HCV-positive donors into the matched serology-positive recipients is safe in the short term, and the long-term results need further observation.
Adult ; Female ; Follow-Up Studies ; Graft Survival ; Hepatitis B ; prevention & control ; transmission ; Hepatitis B Antibodies ; blood ; Hepatitis C ; prevention & control ; transmission ; Hepatitis C Antibodies ; blood ; Humans ; Kidney Transplantation ; adverse effects ; immunology ; Male ; Middle Aged ; Tissue Donors ; Young Adult

OBJECTIVE: To gain an insight into the transplantation with donor kidneys from extended criterion donation after cardiac death (DCD) and to improve the management during and after renal transplantation METHODS: Renal transplantation in 2 patients who used organs from small pediatric donors (<3 years) was performed. The graft kidneys were procured from 1 donor aged 11 months and the other 1 year and 7 months. The 2 donors were diagnosed as brain death caused by serious infantile hepatitis syndrome and severe craniocerebral injury, respectively. After the cardiac death, en bloc organ resection was performed. En bloc kidneys were transplanted to 2 adult recipients who were 37 and 41 years old, respectively. RESULTS: The recipients were followed-up for 6 months. Both of them developed large volume of bloody drainage in the early post-operational period and relieved after relevant treatment. The kidney grafts functioned well and no other surgical complications or acute rejections happened during the follow-up. CONCLUSION Based on modified peri-operative techniques, it is safe to perform renal transplantation with kidneys procured from cardiac death donors who are younger than 3 years old, an important source to increase the number of organs available for transplantation, yet the vascular complications require attention.
Adult ; Graft Survival ; Humans ; Infant ; Kidney ; Kidney Transplantation ; Postoperative Period ; Tissue Donors