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 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 examine the levels of CD38+CD8+ T lymphocyte in kidney transplant recipients with cytomegalovirus infection and investigate the possibility in monitoring the cytomegalovirus active infection after kidney transplantation. Methods Before and after kidney transplantation, CD38+ CD8+T lymphocyte and cytomegalovirus leucocyte antigen were measured respectively by flow cytometry and immunohistochemistry method in 56 transplant recipients. The data of CD38+CD8+ T lymphocyte and the cylomegalovirus leucocyte antigen were analyzed. Results Before kidney transplantation, cytomegalovirus leucocyte antigen was negative among all the patients, while the mean ratio of (CD38+CD8+)/CD8+ was 0. 11?0. 05. In 14 recipients whose cytomegalovirus leucocyte antigen was positive, the appearing time of the positive antigen was(32. 7?16. 6) days of post-transplantation, meanwhile, the mean ratio of (CD38+ CD8+)/CD8+ was 0. 43?0. 21 (29. 6?8. 4) days of post-transplantation, which was significantly higher than that of pre-transplantation. After the treatment with ganciclovir intravenously, the cytomegalovirus leucocyte antigen became negative and the mean ratio of (CD38+CD8+)/CD8+ decreased to 0. 16?0.09 which was significantly lower than that of pre-treatmmt ( P

BACKGROUND:The immune cells of renal al ograft recipients have always been the hot spot of research. However, there are few studies addressing the immune cellsubsets in renal al ograft recipients before operation. OBJECTIVE:To investigate the proportional distribution of immune cellsubsets in renal al ograft recipients before operation. METHODS:Fifteen de novo living-related renal transplant recipients were enrol ed in this study with 15 healthy volunteers, aged 18-40 years, as healthy controls. Flow cytometry was employed to observe the proportion of the immune cellsubsets by extracting peripheral venous blood of al participants. RESULTS AND CONCLUSION:In the renal al ograft recipients, the proportions of CD4+CD25+T cells, the proportion of CD4+CD25+/CD4+T cells, CD19+B cells, CD19+CD5+B cells, CD19+CD27+B cells, NKG2A/NK cells, and NKG2A/NKG2 cells were al lower than those in the healthy controls;however, the proportion of CD38+IgD-/CD19+B cells and NKG2D cells were higher than those in the healthy controls. The difference of the proportion of immune cellsubsets aforementioned between the two groups was statistical y significant (P<0.05), while no difference was observed in other subsets. Immune cellsubsets in renal al ograft recipients before operation could be used to assess the immune status of the recipients, and also could be seen as the basal control for postoperative immunological monitoring.

6.2 mmol/L) who underwent renal transplantation accepted pravastatin therapy 10 mg once evening for 8 weeks. Total cholesterol(TC),low-density lipoprotein-cholesterol (LDL-C),high-density lipoprotein-cholesterol (HDL-C),triglyceride(TG),endothelin(ET) and nitrous oxide(NO) were measured before and after pravastatin therapy. The endothelium-dependent relaxing function was measured before and post pravastatin therapy by high-resolution ultrasound. Thirty people with normal blood cholesterol accepted same examination as control. Results The level of ET in renal transplantation group was significantly higher than that of control group,and the level of NO in renal transplantation group was significantly lower than that of control group. After 8 week′s therapy,the level of NO rose significantly,and the level of ET,TC,LDL-C,TG decreased significantly. The level of HDL-C increased but there was no significant difference between two groups. Flow-mediated vasodilations were improved after pravastatin therapy,while the level in transplantation group was lower than that of control group. Conclusion Pravastatin is effective in treatment of dyslipidemia after renal transplantation,which can improve the endothelium-dependent vasodilation.

Objective To study the influence of donor GFR on the early renal function in recipients undergoing living donor transplantation.Methods A total of 172 living donor transplant recipients in our kidney transplantation center from 2006 to 2011 were enrolled into this study.Among them,166 were genetically related (96.5％),while 6 were genetically unrelated (spouses in 5 and other in 1).The predonation GFR was measured by isotope clearance (99mTC-DTPA with few exceptions).The range of donor GFR was 62 to 148 ml/min.The recipients were classified into two groups according to donor graft GFR level (GFR≤45 ml/min,n=76; GFR＞45 ml/min,n =96).The predonation dialysis,cold and warm ischemia time,antibody induction,immunosuppressive regimens and HLA mismatch were not significantly different between two groups.Results There were no significant differences in the incidence of postoperative acute rejection and delay graft function (DGF).The postoperative Scr of GFR＞45 ml/min group in 1 week,1 month,3 months and 1 year was lower compared with the GFR ≤45 ml/min group,and only the difference of Scr in 1 week was significantly different (P＜0.05).A repeated-measure ANOVA revealed no significant differences were found in Scr variation of two groups during the first year after transplantation.Conclusions Predonation GFR of the donor has effect on the Scr of postoperative Ⅰ week of recipients,not on the Scr within a year.Recipients with graft GFR＞45 ml/min have lower Scr levels.

Objective To analyze diagnostic value of renal biopsy in living-related kidney transplantation and the influence of kidneys from marginal donors on the early prognosis of recipients. Methods According to donors age and risks of donors, 142 living-related kidney transplant recipients from February 2004 to July 2008 were divided into marginal donor group (51 cases) and non-marginal donor group (91 cases). Renal biopsy was performed on 49 kidneys Postsurgical serum creatinine (Scr), the lowest Scr and post-transplant complications were analyzed between the two groups. Results Pathological changes were detected in 13 cases. The Scr at 4 weeks, 12 weeks, 6 months post-transplant and the lowest level of Scr in marginal donor group were higher than those in non-marginal donor group (all P<0.05). There were no significant differences of Scr levels at 12 months, 24 months, 36 months post-transplant, the time required to return to the lowest Scr, and post-transplant complications between two groups (all P>0.05). Conclusions The early clinical efficacy of the marginal donor is ideal, but the baseline of Scr of recipients is higher than that of recipients with kidneys from non-marginal donors. Renal biopsy has an important diagnostic and therapeutic value for both donors and recipients.

Objective To analyze the influence of donating kidney of marginal donors on the early prognosis of living-related kidney transplant recipients.Methods Sixty-six cases of living-re-lated kidney transplant patients between February 2004 and September 2007 were divided into the marginal donors group(28 cases)and non-marginal donors group(38 cases).Serum creatinine before and after surgery,creatinine clearance after surgery and perioperation complications were compared respectivelv between the 2 groups.Results The serum creatinine levels in the marginal donors group and non-marginal donors group were 154,131,127μmol/L and 132,117,118 ttmol/L on 7th day,1st month and 3rd month after transplantation respectively,and there were no significant differences between the 2 groups(P＞0.05).The serum creatinine level in parent-child donating kidney of the 2 groups Was 160,131,126μmol/L and 132,129,126μtmol/L on 7th day,1st month and 3rd month after transplantation respectively,and there were no significant differences too(P＞0.05).There was no difference in the rate of perioperation complications and creatinine clearance after kidney transplantation between the 2 groups.Conclusions The early prognosis of marginal donors'recipients is ideal.The marginal donors could be selected as the living-related kidney transplant donors,especially between parent and child,as long as they are evaluated according to stricter criteria.But the long-term prognosis of the recipients should be further observed.

Objective To analyze the characteristics of extra-pulmonary tuberculosis in renal transplant recipients,and discuss its diagnosis and management. Methods From Jan.1991 to Apr.2007,37 cases of post-operational tuberculosis were identified out of the 2333 renal transplantations done in our center.Among them there were 19 cases with extra-pulmonary foci(51%),which involved allograft kidney in 5 cases,meninges in 4 cases,pleura in 4 cases,lymph node in 3 cases,soft issue in 2 cases,larynx,liver,vertebra and intestine in 1 case each.In 3 cases,there were 2 extrapulmonary sites involved at the same time.Most of the cases happened within one year post-transplant (53%).The most common clinical manifestation was fever. Results After anti-tuberculosis therapy,14 cases were cured and 5 were irresponsible and died.Eight cases (42%) experienced acute rejection and 4 cases(21%)had abnormal liver function during the treatment. Conclusions Extra-pulmonary tuberculosis had a high incidence and high mortality in post-renal-transplant population.Therefore,attention should be given to its differential diagnosis in clinical practice.Balancing anti-tuberculosis and anti-rejection therapy is important for this specific population.

Objectives To investigate the influence of cytomegalovirus infection after kidney transplantation on the recipients and the associated risk factors of cytomegalovirus infection .Methods Data of 892 kidney transplantation recipients from January 2000 to December 2004 in our department were analyzed retrospectively . All the recipients were divided into case group (with cytomegalovirus infection) and control group (without cytomegalovirus infection) . Log-Rank test was used to compare the 1-, 3-, 5-year survival of patients and grafts between two groups . The incidence of complications, the difference of regiment of immunosuppressant and anti-CMV drugs were compared as well . The independent risk factors of cytomegalovirus infection were assessed by Logistic regression analysis . Results One-, 3-, 5-year survival rates of patients in case group were 81 .3%, 72 .8% and 54 .8% respectively, while the patients in control group were 96 .4%,91 .4% and 79 .9% respectively, the prior was significantly lower than the latter (Log-Rank value=49 .62, P＜0 .01) . One-, 3-, 5-year survival rates of grafts in case group were 71 .0%, 66 .2% and 46 .1%, while the grafts in control group were 91 .5%, 86 .6% and 74 .5% respectively, the prior was significantly lower than the latter as well (Log-Rank value=44 .87, P＜0 .01) . The incidence of acute rejection in case group was 24 .9%, while it was 13 .9% in control group, with significant difference between two groups (x2=14 .49, P＜0 .01 ) . Logistic regression showed that acute rejection,mycophenolate mofetil dose more than 2 g, and usage of ATG/ALG or OKT3 were the independent risk factors of cytomegalovirus infection (OR=1 .464, 3 .097 and 2 .837, P＜0 .05 ) . Ganciclovir was the protective factor of cytomegalovirus infection (OR =0 .234, P ＜0 .01) . Conclusions Cytomegalovirus infection decreases the long-term survival of recipients and grafts in kidney transplantation . Acute rejection, high dose of mycophenolate mofetil, and ATG/ALG or OKT3 are the independent risk factors of cytomegalovirus infection . Prophylactic usage of ganciclovir after kidney transplantation can effectively reduce cytomegalovirus infection .