Objective To compare the clinical outcomes of pre-emptive renal transplantation and transplantation after dialysis, and to evaluate the safety and advantages of pre-emptive renal transplantation. Methods The data of 50 cases of pre-emptive renal transplantation between January 1999 and January 2003 in our hospital were analyzed.Another 50 cases of renal transplantation after dialysis were selected as control group.The 2 groups were matched in the following variables:age,gender,blood type,cold (warm) ischemic time of the grafts,human leukocyte antigen (HLA),primary diseases, and use of immunosuppressants. The patient/allograft survival,incidence of rejection and delayed graft function were compared. Results The control patients (32/50) were more likely to have received blood transfusion before transplantation than patients of pre-emptive renal transplantation (14/50) (64% vs 28%, P

Objective To study the therapeutic effects and its possible mechanism ofBushen Paidu Mixture on renal interstitial fibrosis. Methods A total of 60 mice were randomly divided into a normal group,UUO group, Bushen Paidu Mixture group and Lotensin group. Mice models were induced by unilateral ureteral occlusion (UUO). Execute the mice at 7, 14, 21, and 28 days after UUO. The involved kidney were separated and had HE staining. Determine integrinβ1 in kidney tissue through immunohistochemical methods. Results Integrinβ1 tissues had a weak expression in normal kidney. Integrinβ1 expressed higher in UUO group than normal group. The expression of integrinβ1 in Bushen Paidu Mixture group and Lotensin group was lower than the UUO group at every timing point. There is no significant difference between the Bushen Mixture group and Lotensin group in terms of integrinβ1 expression. Conclusion Bushen Paidu Mixture can slow down the process of renal interstitial fibrosis through regulating integrinβ1 expression.

Objective To evaluate whether serum cystatin C (SCys C) could be used as an ideal index to assess renal function of renal transplant recipients during posttransplant follow-up.Methods Seventy patients who were followed up for at least 6 months after renal transplantation in our centre were recruited in the study. SCys C and serum creatinine (SCr) were determined during the follow-up period, and glomerular filtration rate (GFR) was measured using an isotope Tc99m DTPA.The correlation between SCys C, SCr and GFR was analyzed. The performance of SCys C and SCr in diagnosing the mild impairment of renal allgraft function (GFR ＜ 1 ml/s) was evaluated using ROC curve. Results Both SCys C and SCr had a linear negative correlation with GFR (r = -0. 82 and -0. 66 respectively, P＜0. 01 ). The sensitivity, specificity and positive predictive values (PPV) of SCys C for diagnosing the mild impairment of renal allgraft function were higher than those of SCr,but the AUC of SCys C did not differ from that of SCr significantly (0. 935 vs. 0. 877, P＞0. 05).Conclusion SCys C could be used an ideal index to evaluate the allograft renal function for its better correlation with actual GFR.

Objective To observe the effects of Qutantongluo decoction on the expression of TGF-β1 in renal tissue of diabetic nephropathy(DN) rats,which can help to understand the mechanism of action.Methods The rats models of diabetic nephropathy were established by injecting with streptozotocin intraperi-toneally.All Wistar rats were randomly divided into 6 groups:the normal control group,the model control group,Benazepril Hydrochloridec group ( 1 mg/kg ·d-1 ),Qutantongluo decoction low dose group (3 g/kg ·d-1 ),Qutantongluo decoction median dose group (4.5 g/kg · d-1 ),and Qutantongluo decoction high dose group (6 g/kg · d-1 ).Rats in the normal control group and the model control group were given celiac perfusion of distilled water once at the same time and dose.All the rats were gavaged once daily for 8 weeks.The expression of TGF-β1 at the level of gene and protein in renal tissue were tested by immunohistochemistry and RT-PCR methods.Results Compared with the model control group(2.79±0.22),the expression of TGF-β1 at the level of protein in renal tissue of Benazepril Hydrochloridec group (1.55 ±0.12)and the Qutantongluo decoction low dose group ( 1.54± 0.16),Qutantongluo decoction median dose group (1.49 ± 0.17),Qutantongluo decoction high dose group(l.39±0.25) decreased significantly (P＜0.05).Compared with the model control group (0.35±0.07),the expression of TGF-β1 mRNA in renal tissue of Benazepril Hydrochloridec group(0.35± 0.07)and the Qutantongluo decoction low dose group(0.39±0.03),Qutantongluo decoction median dose group (0.35± 0.06),Qutantongluo decoction high dose group (0.32± 0.07) decreased significantly (P＜0.05).Conclusion Qutantongluo decoction can down regulate the expression of TGF-β1 in kidney,which may be one of the mechanisms of Qutantongluo decoction effectiveness in clinical treatment of diabetic nephropathies.

Objective To evaluate the clinical and pathological characteristics and treatment of small cell carcinoma of the prostate. Methods Two patients with small cell carcinoma of the prostate were reported. Case 1 was 50 year-old. He was admitted with a history of dysuria and perineal pain for 3 months. Digital rectal examination (DRE) showed that the enlarged prostate was 5. 0 cm?6. 0 cm and palpated hard and rough. Low-echo mass was shown on ultrasonography, and heterogeneous density of the prostate on CT. His serum PSA level was 0. 31 ng/ml,and fPSA level was 0.09 ng/ml. Prostate cancer was suspected by biopsy,and radical prostatectomy was performed. Case 2 was 82 year-old. The complaints consisted of dysuria and intermittent gross hematuria for 4 months. The enlarged prostate was 4. 0 cm?5. 0 cm and palpated hard and rough with multiple nodes by DRE. Low-echo mass was shown on ultrasonography, and heterogeneous density of the prostate and involvement of seminal vesicle and bladder neck on CT. His serum PSA level was 2.61 ng/ml,and fPSA level was 0.05 ng/ml. Prostate carcinoma was indicated by biopsy, and orchiectomy plus TURP was performed. Results The diagnosis of small cell carcinoma of the 2 cases were confirmed by postoperative pathology. Microscopically, the tumor cells were arranged in solid-sheet and nest structures, showing the histologic type of diffuse infiltrative carcinoma. Coagulated necrosis could be found easily. Small round or oval cells resembling lymphocytes or oat cells were the main constituents of the tumor. The nuclei were extremely hyperchromatic and scanty. The seminal vesicle and bladder neck had tumor infiltration. The immunohistochemical staining results were negative for LCA,L-26 and 34?E12,but positive for PSA,AE1/ AE3 and AR ,and suspected positive for CgA and S-100. Case 1 died of extensive lung metastasis 1 month after operation. Case 2 had retroperitoneal metastasis of the tumor 3 months after operation, and has been followed till now. Conclusions Small cell cancer of the prostate is rare but can be diagnosed properly based on clinical and pathological features. Radical prostatectomy combined with hormone and chemotherapy is reliable treatment for early stage cancer; but for late stage cancer, there is no effective treatment and the prognosis is poor.

Objective To probe the indication, technique and effect of combined liver pancreas transplantation. Methods Donor organs were harvested by the technique of total abdominal evisceration. Simultaneous orthotopic liver and heterotopic pancreas duodenum transplantation was performed in one patient diagnosed as having chronic hepatitis B, hepatocirrhosis, hepatic cellular cancer, and insulin dependent diabetes. Liver and pancreas graft function was monitored after transplantation. Results The recipient recovered with excellent allograft function, and insulin independence was achieved without any surgical complication. Conclusion End stage liver disease with concomitant insulin dependent diabetes is the indication for combined liver pancreas transplantation.

Objective To investigate expression and suppressive function of CD39 + regulatory T cells (Treg) in kidney transplant recipients.Method Thirty recipients of first kidney transplants were treated with tacrolimus,mycophenolate mofetil and prednisone.Within 28 days posttransplantation,there were 14 patients subject to acute rejection (AR group),and the rest 16 patients had no episodes of acute rejections (NR group).Twelve healthy volunteers served as healthy controls (HC group).We collected peripheral blood from the three groups and separated PBMC by density gradient centrifugation,and sorted Tresp,CD39-Treg and CD39+ Treg by flow cytometry.We next analyzed the ratio of CD39 + Treg/CD4+ T cells.ELISA was used to determine the suppressive ability of CD39-Treg and CD39+ Treg on secretion of IFN-γ and IL-17 by Tresp.Results The ratio of CD39 + Treg/CD4 + T cells in AR group was significantly reduced as compared with HC group and NR group (P＜0.05).In HC group and NR group,the secretion of IFN-γ and IL-17 by Tresp was suppressed significantly (P＜0.05) by CD39+ Treg.CD39Treg could suppress secretion of IFN-γ but not IL-17 production by Tresp.CD39+ Treg in AR group AR could suppress the secretion of IFN-γ significantly (P＜0.01),but not to IL-17 production.Conclusion CD39+ Treg have important immunoregulation function.The relative amount of CD39+ Treg was reduced and their regulatory function was impaired in patients with acute rejection.

Objective To summarize the clinical experience of combined liver and kidney transplantation (CLKT). Methods CLKT was performed on 22 patients. The orthotopic liver transplantation (LT) was preceded with the classic fashion in 10 patients and piggyback fashion in 12 patients. The renal allograft was implanted to the iliac fossa routinely. After operation, the patients received an induction therapy with anti-CD25 monoclonal antibody or antithymocyte globulin ( ATG) and a maintenance therapy with tacrolimus (Tac), mycophenolate mofetil and prednisone. Results The CLKT was successfully performed on all 22 patients, and the graft function was restored well postoperation. During the perioperative period, an acute rejection episode of liver occurred in one patient and acute renal allograft rejection episode in 2 patients. The Tac toxicity occurred in one patient. The hemorrhage of digestive tract occurred in one recipient and the hemorrhage of peritoneal cavity in one patient. The pleural effusion occurred in 6 recipients. The pneumonia occurred in 2 cases and the peritoneal infection in one patient During a follow-up period of 6 months to 7 years 11 months, three patients died because of cytomegalovirus pneumonia in 2 patients and acute myocardial infarction in, one patient, The 1-, 3-, 5-year survival rate of recipients was 86,4 %, 81.3 %, 72.7 % respectively. Conclusion The CLKT is an effective method for treatment of patients with end-stage liver djsease and chronic renal failure.

Objective To explore the relationship of serum anti-MICA antibody and development of chronic rejection (CR) after renal transplantation. Methods The enrolled 105 patients included 43 cases of CR, and 62 cases of functioning renal allograft as controls. Data including PRA level before transplantation, HLA mismatch, cold ischemic time, SCr at discharge, immunosuppressive regimen,and months after transplantation were analyzed. Blood samples were collected immediately after grouping for anti-MICA antibodies, SCr determination. Acute rejection episodes and renal allograft function which was evaluated by △SCr/M [(SCr at present - SCr at discharge) /months after transplantation) were compared between anti-MICA-antibody positive patients and anti-MICA-antibody negative patients. Results There was no significant difference in gender, age, HLA mismatch, cold ischemic time, immunosuppressive regimen, SCr at discharge, months after transplantation between CR and control groups (P＞0.05). Serum creatinine level and number of antiMICA-antibody positive patients in CR group were significantly increased as compared with those in control group (P＜0.01 ). Acute rejection episodes during the first 3 months after transplantation in anti-MICA-antibody positive patients were significantly more than those in anti-MICA-antibody negative patients (P＜0.05),and the △SCr/M in the former was higher than that in the latter (8.3 +3.6 vs 2.4 ± 2.6, P＜0.05). Conclusion Humoral immunoreaction mediated by MICA partly participates the development of CR after renal transplantation. MICA antibody is a risk factor affecting long-term allograft function.

Objective To investigate a possible association of donor-recipient compatibility for ABO blood group alleles with acute rejection (AR) in renal transplantation. Methods A study comprising 87 pairs of donor and recipient was performed. The ABO genotype A1, A2, O1, O2, and B alleles of renal transplanted recipients and their respective donors were assessed by PCR amplification with sequence-specific primers (PCR-SSP). Accordingly, recipients were divided into donor-recipient ABO genotype matched and mismatched groups. Results The PCR-SSP based types of all cases showed total concordance with their serologically assigned ABO groups. Fifty pairs (57. 5%) were matched for ABO genotype among the 87 pairs of donor and recipient while 37 (42. 5%) were mismatched, including 1 allele mismatch in 31 pairs (83.8%), 2 alleles mismatches in 6 pairs (16. 2%).The incidence of AR was 12.0% (6 cases) and 29. 7% (11 cases) for ABO genotype matched and mismatched transplant patients, respectively ( P ＜ 0.05). After high dose methylprednisolone (MP)treatment, all cases exepienced reversion of AR except a A2O1 recipient receiving kidney from a A1O1enced 4 AR episodes within 3-10 months, and the period of AR was gradually shortened. After high dose MP was administered empirically, even though short-term improvement of renal function was observed, the serum creatinine continued to increase progressively with decreased efficacy of high dose MP. One year after operation the serum creatinine rose to 441 μmol/L. Conclusions Simultaneous definition of the ABO genotype and HLA is highly feasible. The A2 patient is suitable for receiving kidneys from blood group O donors. DNA mismatch for ABO genotype of renal transplant recipients and their respective donors is an independent risk factor for AR. Genotyping of ABO blood group is conducive to prevent AR.