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 investigate the diagnosis and treatment of vascular complications after allograft kidney transplantation.Methods The clinical data of 34 patients with vascular complications after renal allograft transplantation were retrospectively studied,and the characteristics,diagnosis and therapeutics were analyzed.Results Among the 34 patients,there were 13 cases of allograft renal(artery) obstruction,8 cases of allograft renal artery hemorrhage,7 cases of arterial anastomosis(rupture),4 cases of allograft renal vein obstruction,1 case of external iliac artery aneurysm and 1 case of external iliac vein thrombosis.Diagnosis was made in 21 patients by color Doppler flow imaging(CDFI),among whom 10 received further examination of magnetic resonance angiography(MRA).In the 5 cases of allograft renal artery stenosis(TRAS),3 came out with well renal function after the placement of endovascular stents.During the follow-up duration of 8,10 and 14 months,their serum creatinine(Scr) maintained between 115 and 135 ?mol/L.TRAS patient's allograft renal artery which had been anastomosed end-to-end with internal iliac artery was shifted to end-to-side style with(external) iliac artery at the second time,and came out with normal Scr one month postoperation.One TRAS patient received conservative treatment because MRA examination indicated only mild stenosis,and his Scr has been decreasing for 21 days till now.Three patients with allograft renal vein(obstruction) was treated with surgery,in whom one died of heart failure,and the other 2 patients'(renal) function recovered well during the follow-up of respectively 13 and 36 months.One patient with external iliac vein thrombus died of allograft rupture.All the other patients underwent allograft(resection).Conclusion Vascular complications after renal transplantation progresses fast once(developed) with a poor prognosis,so early diagnosis is essential for graft as well as survival and(effective) management should be administrated accordingly.CDFI could be the first choose for screening.

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.

Objective To investigate the clinical features of pediatric renal transplantation and improve the effect of pediatric renal transplantation. Methods Clinical data of 23 children (3 17 years old) who underwent renal transplantation were retrospectively analyzed. Results In these 23 recipients, 4 cases suffered from pulmonary infection, 2 from heart failure and 2 from transplanted renal vein echmasis. Two patients' liver function was injured and one suffered from acute tubular necrosis. The incidence of acute rejection (AR) was 30.4 % (7/23) and that of chronic rejection (CR) was 8.7 % (2/23). During the follow up of 5 days to 72 months (average of 26.1 months), one died of heart failure and severe pulmonary infection. The 1 year patient and graft survival rate was respectively 93.3 % and 86.6 % . Conclusion Different from renal transplantation in adult, pediatric renal transplantation has special treatment in the operation process. HLA well matching is necessary for a good effect of pediatric renal transplantation. In spite of its high AR incidence, pediatric renal transplantation is an effective treatment with its satisfactory one year graft survival rate. Nevertheless, its long term effect should be improved much more.

Drug stability is closely related to drug safety and needs to be considered in the process of drug production, package and storage. To investigate the stability of epalrestat, a carboxylic acid derivative, a reversed-phase high-performance liquid chromatography (RP-HPLC) method was developed in this study and applied to analyzing the degradation kinetics of epalrestat in aqueous solutions in various conditions, such as dif-ferent pH, temperatures, ionic strengths, oxidation and irradiation. The calibration curve was A=1.6 × 105C–1.3 × 103 (r=0.999) with the liner range of 0.5–24 μg/mL, the intra-day and inter-day precision was less than 2.0%, as was the repeatibility. The average accuracy for different concentrations was more than 98.5%, indicating that perfect recoveries were achieved. Degradation kinetic parameters such as degradation rate constants (k), activation energy (Ea) and shelf life (t0.9) under different conditions were calculated and discussed. The results indicated that the degradation behavior of epalrestat was pH-dependent and the stability of epalrestat decreased with the rised irradiation and ionic strength;however, it was more stable in neutral and alkaline conditions as well as lower temperatures. The results showed that the degradation kinetics of epalrestat followed first-order reaction kinetics. Furthermore, the degradation products of epalrestat under stress conditions were identified by UHPLC-PDA-MS/MS, with seven degradation products being detected and four of them being tentatively identified.

[Objective]This study was designed to investigate capability of the conditioned media that originated from Renca cells to convert CIM~+ CD25~- T cells into CD4~+ CD25~+ T cells,which can exert immunosuppressive effect on effector T cells in vitro and in vivo.[Methods]The common media were mixed with the conditioned media at different ratios,and fresh enriched CD4~+ CD25~- T cells with MACS were cultured in mixed media for 7 days.At end-point of culture,the cells were collected and detected phenotypes in flow cytometer.Moreover,we detected immunosuppressive effect of converted CD4~+ CD25~+ T cells on effeetor T cells proliferation in one-way mixed lymphocytes reaction by using CCK-8,and we observed survival time and histology of grafts.The delayed type hypersensitivity was determined 14 days after transplantation.[Results]The mixed media could increase ratio of CD4~+ CD25~+ Foxp3~+ T cells in conditioned media ratio-dependent(P＜0.05),compared with control groups,when the mixed media contained no mote than 75% of conditioned media.The converted CD4~+ CD25~+ T cells significantly suppress proliferation of effector T cells in vitro,and prolong survival time of grafts,which were(29.6±1.4)d in converted CD4~+ CD25~+ T cells treated groups(P＜0.05),compared with that in untreated groups(9.8±0.6 d)or PBS treated groups(10.9±0.6 d).Moreover,delayed-type hypersensitivity reaction were conducted at day 14 after transplantation in the recipients,and the results showed that less pad swelling in the group treated with converted CD4~+ CD25~+ T cells than other control groups was found,according to measurement of pad swelling.In addition,progressed to complete necrosis of grafts were exhibited in the mice treated with PBS and untreated mice,whereas better healing of grafts and less lymphocytes infiltration were displayed in the mice treated with converted CD4~+ CD25~+ T cells,which were similar to the mice treated with natural regulatory T cells.[Conclusion]The converted CD4~+ CD25~+ T cells with Renca conditioned media play suppressive role in vitro and in vivo.

Objective To study the correlations of VDR FokⅠgene polymorphism with type 2 diabetes in postmenopausal women of Han nationality in south Sichuan. Methods 160 patients with type 2 diabetes (T2DM) and 190 healthy cases were enrolled in the study. The VDR FokⅠgene polymorphisms were detected using RFLP-PCR and DNA sequencing. Results The FF, Ff and ff genotype frequencies were 32.5%, 47.5%and 20% in the T2DM group and 15.8%, 53.7%, 30.5% in the control group, respectively (P < 0.05). The allele frequencies were 56.3%, 43.8% in the T2DM group and 42.6%, 57.4% in the control group, respectively (P < 0.05). The risk of T2DM in the FF genotype people was 2.568 times higher than Ff/ff genotype (adjusted OR = 2.568, 95%CI = 1.246 ~ 5.292, P < 0.05). The levels of 2 h PG and HbA1C in the FF genotype people were significantly higher than those of the Ff/ff genotype people (P<0.05). Conclusions There was an association between the VDR FokⅠgene polymorphism and type 2 diabetes incidence in the postmenopausal women in south Sichuan area.

Objective To analyze the characteristics of tuberculosis (TB) in renal-transplant recipients from our hospital, and summarize the corresponding experiences in diagnosis and management.Methods A retrospective study was performed on 61 documented post-transplant TB cases out of the 2842 patients who received kidney transplantation in the First Affiliated Hospital of Sun Yat-sen University between Jan.1991 and Dec.2010.Results TB in the post-renal-transplant population in our hospital displayed the following characteristics:(1) High incidence (2.1％ ).54.1％ recipients were diagnosed within the first year post-transplant; (2) Lung was the most common site (77.0 ％).There was high prevalence (60.7 ％) of extra-pulmonary TB (lymphatic TB,23.0 ％; pleuritis,13.1 ％; graft,11.5％); (3) Fever (83.6 ％),cough (55.7 ％),sputum (41.0 ％) were the most common clinical manifestations.There were also emaciation (3.3 ％) and enlargement of lymph nodes (18.0 ％); (4) Chest X-ray and CT were of great value during TB diagnosis while purified protein derivative of tuberculin (PPD) skin test had little diagnostic value with a negative result in 56 cases (91.8 ％) ; (5) Liver function damage ( 16.4 ％),kidney function injury (39.3 ％) and peripheral nerve toxicity (3.3 ％) were the main adverse reactions of anti-tuberculosis chemotherapy,also the major cause of anti-TB failure; (6) Pre-transplant TB (17 cases) increased the probability of TB recurrence (4 cases,23.5 ％) post-transplantation; (7) The post-transplant TB patients were accompanied with cellular immune deficiency,resulting in overlapping infection of bacteria,viruses and fungi (19.7 ％); (8) 1- and 3-year patient/graft survival rate of patients with post-transplant TB was 85.2 ％/78.7 ％ and 85.2 ％/75.4 ％ respectively. The accumulative mortality rate reached to 14.8％,while overlapping infection was the major cause of death (66.7 ％).Conclusion Chinese renal transplant recipients still face a high risk of TB because of their immunecompromised state and epidemiological prevalence of the disease. For the high mortality rate and associated serious complications,rapid diagnosis and effective anti-TB chemotherapy are of great value for TB population.

Objective:To explore the clinical efficacy of dual-kidney transplantation from infant donors to adult recipients.Methods:From December 2012 to November 2020 in Organ Transplant Center First Affiliated Hospital Sun Yat-sen University, rertrospective reviews were conducted for clinical data of 25 pairs of infant donors and adult recipients. The survival rates were calculated for both recipients and transplanted kidneys at Year 1/3/5 post-transplantation. And the postoperative recovery status and the postoperative incidence of adverse events of recipients were observed.Results:The survival rates of recipients were all 95.8% at Year 1/3/5 and those of transplanted kidney and dealth-cancelling transplanted kidney all 87.2%. One case died due to acute inferior-wall cardiac infarction while three others lost renal functions for vascular thrombosis, ureteral stenosis and urinary fistula. Except for loss of renal function and death, the postoperative estimated golmerular fitration rate was (99.35±21.78), (103.11±29.20) and (114.99±28.55) ml/(min·1.73 m 2) at Year 1/2/3 respectively. Conclusions:Selecting proper recipients, standardizing donor acquisition and surgical procedures and strengthening perioperative managements may expand the donor pool. The overall outcomes are excellent for adult recipients with dual-kidney transplantation from donations after infants' death.

Objective:To explore the application value of modified technique of ureter implantation in murine renal transplantation.Methods:Thirty left donor kidneys from BALB/c mice was transplanted into syngeneic mice. Cuff technique was applied for anastomosing kidney artery and vein. The procedure of ureter-bladder anastomoses shifted from implication-fixation-embedding to fixation-implication-embedding. Operative duration, recipient survival rate and complications were recorded.Results:Time for separating vessels, perfusion and excision of donor graft was (25±3) min, (10±6) s for warm ischemia and (25±5) min for cold ischemia. Time for separating recipient vessels was (12±5) min, (7±1) min for arterial anastomosis, (7±1) min for venous anastomosis, (13±2) min for ureter-bladder anastomosis, (5±1) min for right kidney excision and (5±1) min for abdominal closure. Operative duration was(77±3)min. Twenty-six recipients survived over 3 months. The successful operative rate was 86.7%.Conclusions:With a shorter learning curve, modified technique of ureter implantation is easier and faster so as to reduce the postoperative incidence of urinary tract complications during murine renal transplantation.