Objective To study the effect of genomic HLA-DR compatibility on long-term survival in renal transplantation.Methods A retrospective study was performed on 518 first-cadaver renal transplants by using genotyping technique.Results More than 10%recipients shared HLA-DR matching at DNA level.half of 1 DR mismatches.The recipients with HLA-DR matched transplants showed a significant decrease of acute rejection episodes and a smooth recovery of early renal function as compared with those of DR mismatching kidneys.The 1 to 5 year-person survival rate was increased by 17%to 37.7% (P＜0.01)respectively.Multivariate analysis of 10 variables by Cox regression model revealed that DR mismatching was the most important factors influencing the long-term graft survival.Conclusion Genomic HLA-DR compatibility had a significant impact on long-term survival of first-cadaver kidney transplantation.

Objective To explore the single point target concentration for Neoral at 2 h postdose (C2) in Chinese renal transplantation recipients for the first 3 months following surgical procedures. Methods Neoral trough levels (C0) and C2 monitoring were measured by fluorescence polarization immunoassay (TDX) in 114 cases of cadaver renal transplants treated with Neoral (6～7 mg?kg -1 ?d -1 ), mycopherolate mofetil (MMF,1.0～1.5 g/d) and steroids for the first 3 months after renal transplantation.The effectiveness of the new monitoring method in predicting the acute rejection and side effects was retrospectively analyzed. Results The acute rejection rate of 114 transplants for the first 3 months was 15.8%(18/114).The incidence of side effects was 30.7% (35/114),including hepatoxicity(26.3%) and nephrotoxicity(7.0%).The results of 234 pairs of Neoral C0, C2 monitoring showed that the difference was not statistically significant between C0 levels of rejection and non rejection,while the difference between C2 levels [(921.55 ?431.31) vs (1 185.17?358.86)ng/ml) ] was significant.There was also no statistically significant between C0 levels of the recipients with side effects and those without side effects,but statistically significant difference was found between C2 levels [(1 302.59?450.21) vs (1 105.23? 371.64 )ng/ml].Analysis of the relationships between C2 levels and the incidences of acute rejection and side effects showed that no acute rejection and side effects rate of 4.3% were observed in the Neoral C2 interval from 1 250 ng/ml to 1 500 ng/ml. Conclusions Neoral C2 monitoring is a more sensitive predictor not only for acute rejection but also for side effect rate.The optimal C2 target level of Chinese renal transplantation recipients is 1 250 ～1 500 ng/ml for the first 3 months post transplantation.

Objective:To explore the role of peripheral blood lymphocyte (PBL) of the renal transplant recipients during the acute rejection phase by gene chips.Methods:The 8 patients with acute rejection (AR) after renal transplantation were collected peripheral blood before operation (as control samples) and renal biopsy (as experimental samples).By Ficoll method,PBL was collected.Total RNA were extracted by one-step technique and purified.The total RNA were labeled with Cy5-dUTP (experimental samples) or Cy3-dUTP (control samples),then to label the cDNA probe by reverse transcript way.The gene chip (419 genes) was hybridized and scanned.Then fluorescent signal value of gene expressing was obtained,and differential expression genes were sifted.Results:There were differential expression 49 immunological genes in peripheral blood lymphocyte (PBL) of the renal transplant recipients during the acute rejection phase,including up-regulated 25 and down-regulated 24.Conclusion:Peripheral blood lymphocyte was involved in various stages during the acute rejection,and immunosuppressants influenced on these stages in various degrees. [

Objective To evaluate the short-term safety and efficacy of transurethral plasma kinetic enucleation of the prostate (PKEP)for benign prostatic hyperplasia (BPH)larger than 60 ml. Methods A retrospective analysis was carried out on clinical data and treatment outcomes of 87 cases of BPH with prostate volume larger than 60 ml in Fuzhou General Hospital of Nanjing Military Command from September 2013 to August 2015.The patients were divided into either PKEP group (45 cases)or plasma kinetic resection of prostate (PKRP)group (42 cases).The operation time,resected adenoma weight,decline in hemoglobin 1 day after operation,and catheterization and irrigation duration were recorded and analyzed.The international prostate symptom score (IPSS), quality of life score (QOL),post-void residual urine volume (PVR),maximum urinary flow rate (Qmax)before surgery and 1 ,3,6 months after operation respectively were evaluated. Results As compared with the PKRP group,the PKEP group excelled in greater resected prostate weight [(52.4 ±15.2)g vs.(40.0 ±14.1 )g,t =3.94,P =0.00],less decline in hemoglobin [(9 ±4)g /L vs. (17 ±6)g /L,t =-7.36,P =0.00],shorter irrigation duration [(1 .1 ±0.3)d vs.(1.4 ±0.5)d,t =-3.42,P =0.00],and shorter catheterization duration [(3.3 ±0.5)d vs.(5.5 ±0.5 )d,t =-20.50,P =0.00].There were no significant differences between the two groups in terms of operation time and operative complications such as transient incontinence and hematuria (P >0.05).Postoperative improvements in IPSS,QOL,PVR,and Qmax were similar between the two groups (P >0.05)but significantly improved as compared with before operation (P <0.05). Conclusion PKEP is a new,safe,and effective minimal invasive surgical option for the treatment of BPH larger than 60 ml.

Objective To study the relationship of cytokines and cytokine receptors gene polymorphism with acute rejection in kidney transplantation recipients,whose 21 single nucleotide polymorphisms in 5 kinds of cytokines and their receptors were tested with cytokine oligonucleotide array.Methods According to the allele sequences of 21 gene polymorphisms of IL-4,IL-6,IL-10,TNF-?,TGF-?_1 and their receptors,58 oligonucleotide probes were synthesized. A pair of group special primers labeled by the Cy5 were designed and were used in the PCR. The labeled PCR products with Cy5 were hybridized with array. The signals were scanned by a scanner and analyzed by image software. Genomic DNA samples from the peripheral blood lymphocytes of 144 kidney transplant recipients were tested by this array. The distribution of 21 single nucleotide polymorphism in cytokines and cytokine receptors was compared between two groups according to the presence or absence of acute renal rejection.Results In recipients,the gene polymorphism distribution in rejection group and non-rejection group showed significant difference (P

Objective To establish a new technique isolating pancreatic islet of langerhans and evaluate the clinical efficacy and safety of adult islet transplantation.Methods Pancreases were stored using the "2-layer method" of the oxygenated perfluorochemical (PFC) and UW solution. The Pancreases were digested by Liberase collagenase enzyme and purified using continuous gradients of Ficoll-diatrizoic acid on a refrigerated COBE 2991 centrifuge to separate the islets. Cultured islets were infused by surgical approach to the liver via portal vasculature. Clinical metabolic data such as blood glucose, dose of insulin, C-peptide, HbA1c, liver function and renal function, was determined and compared with the pre-transplant data.Results Islets of langerhans were isolated successfully in 42 pancreases. The average of islet yield was 285000 islet equivalents(IEQ). Islet purity and viability were 95.7%, 93.2%, respectively. The stimulation index(SI) as assessing function of human islet was 2.43 and negative-etiology in vivo. Twenty clinical islet transplant infusions have been carried out in 11 subjects with type 1 diabetes mellitus(T1DM). The average islet mass for infusion was 11200 IEQ/kg. The treatment strategies for islet transplantation was glucocorticoid-free immunosuppressive regimen. During 7 months to 4 years follow-up, 7 recipients had insulin independence, the dosage of insulin decreased by 60% in 4 patients after islet transplantation. The level of blood glucose and HbA1c, liver and renal function were normalized throughout follow-up period. All patients had C-peptide positive after islet transplantation. No adverse effects and complications related to islet infusion procedure.Conclusions New technique has proved to be suitable for isolating pancreatic islet of langerhans. Adult islet transplantation can be used as an effective and safe way for treating T1DM.

Objective To investigate the effect of recipient dendritic cells (DC) loaded with donor-derived apoptotic cells on inducing murine cardiac allograft tolerance. Methods Apoptosis of donor-derived splenocytes (SC) was induced by ultraviolet B irradiation(UVB). UVB-irradiated allogenic SC were co-cultured with recipient bone marrow-derived DC that maturation was inhibited by NF-?B ODN Decoy, so that could acquire tolerogenic-immature DC loaded with donor-derived apoptotic cells (Decoy Apo-SC DC). A heterotopic vascularized heart transplantation was performed from BALB/c to C57BL/6 mice, and recipients were given one injection of recipient immature (Decoy Apo-SC DC) or mature (Apo-SC DC) DC engulfed donor-derived apoptotic cells (2?10 6 cells) through the portal vein at 7 days before the heart transplantation in the absence of immunosuppression. The cardiac survival and the expression of intragraft cytokines (IL-2, IL-10 and IFN-?) were evaluated.Results DC had potent phagocytosis of allogenic apoptotic SC (Apo-SC). NF-?B ODN Decoy inhibited engulfment of apoptotic cells-induced maturation of DC and then induced recipient tolerogenic DC. Recipient tolerogenic DC loaded with donor-derived apoptotic cells were able to cross-tolerate recipient T cells, which revealed by alloantigen-specific T-cell hyporesponsiveness in primary and secondary mixed leukocyte reaction. Injection of recipient tolerogenic DC loaded with Decoy Apo-SC DC through the portal vein at 7 days before the heart transplantation significantly prolonged vascularized heart allograft survival (MST 36.4 days versus 7 days in control group, P

Objective To explore the validity and security of Simulect (basiliximab) induction immunosuppressive therapy in terms of prevention of acute allograft rejection in sensitive recipients.Methods Thirty-six adult recipients of cadaveric kidney transplant with panal reactive antibody 30 %～ 50 % were assigned randomly in a 1∶1 ratio to receive either two doses Simulect or matching placebo. Both patient groups also received baseline triple immunosuppression with the cyclosporine microemulsion, MMF and steroids. A total 40 mg Simulect was given in two doses of 20 mg eachon day 0 about 2 h before transplantation and the day 4 after transplantation respectively.Results No hyperacute rejection and delayed graft function occurred in the two groups. No apparent adverse and toxic events were recorded in the Simulect group. The incidence of acute rejection 3 months after transplantation was 11.1 % in Simulect group compared with 50 % in the placebo group ( 77.8 % reduction, P