Objective To investigate the adjustment of immunosuppression and prevention of infections in lung after renal transplantation.Methods 253 cases of pulmonary infections after renal transplantation between January 1999 to March 2004 were analyzed. After 2003, postinduction period, the blood concentrations of CsA and FK506 were maintained at 0.125~0.166 ?mol/L and 5 ?g/L respectively. The oral dose of MMF was 1 g every day. Results The creatinine levels were stable 253 patients after treatment. Among 253 cases, 229 cases were cured (90.51 %) and 24 died (9.49 %). After adjustment of immunosuppressants, common pulmonary infections and severe pulmonary infections were decreased.Conclusions Infection in lung was a severe complication after renal transplantation. Timely treatment, nursing care and adequate adjustment of immunosuppression may achieve satisfactory effects in preventing lung infection.

Objective To investigate the diagnosis and treatment of fungal infections of the lungs after renal transplantation. Methods A total of 43 cases (35 males and 8 females,mean age of 32 years) fungal infections of the lungs after renal transplantation from January 1999 to March 2002 were retrospectively analyzed.The mean time from post-operation to onset of the infection was 59 days. Results Among the 43 cases,16 were infected with candidiasis ,4 with candida Krusei ,2 with candida parapsilosis ,3 with mycormyccosis ,4 with aspergillosis ,1 with cryptococcosis neoformans and 2 with nocardiasis .14 cases out of 43 cases were coinfected with bacteria and CMV.The other 11 cases were negative for fungus-culturing test.23 cases were cured with fluconazole (100 mg,3 times per day for 10 days),17 with amphotericin B (50 mg,once a day for 10 days)and 3 died. Conclusions Fungal infection of the lungs is a severe complication after renal transplantation. Early diagnosis and timely treatment may achieve satisfactory effects.

Objective To evaluate the efficacy and safety of piperacillin/tazobactam in the treatment of moderate and severe pulmonary infection (MSPI). Methods The clinical data of 35 patients with MSPI following kidney transplantation were retrospectively analyzed.Results Thirty-five cases out of the 35 MSPI patients ( 97.14 % ) was rescued successfully. The overall clinical efficacy rate of piperacillin/tazobactam was 91.43 % (32/35). The bacterial clearance rate was 92.59 % . The incidence of adverse reaction was 8.57 % (3/35).Conclusions Intensive care and active measures should be given to the MSPI patients after kidney transplantation. The key points of successful treatment involve the in time application of effective antibiotics,the adjustment of immunosuppressant and the correction of hypoproteinemia.

Objective To investigate the relation of sexual hormones, trace elements and erectile function in male uremia patients subject to the therapy of hemodialysis or after renal transplantation.Methods Data of 136 cases from March 1999 to December 2002 were retrospectively analyzed.Results The differences in sexual hormones, trace elements and erectile function between male uremia patients receiving hemodialysis and control groups were respectively significant (P

Objective To investigate the changes of sexual hormones, trace elements and fertility in female uremia patients and their relations during hemodialysis or after renal transplantation.Methods Data of 43 cases of uremia during hemodialysis or after renal transplantation from March 1999 to December 2002 were retrospectively analyzed. The conditions of menses, sexuality and fertility before and after renal transplantation were also studied. Twenty healthy women served as controls. Results During the hemodialysis, 4 patients had regular menstrual cycle, 28 irregular menstrual cycle, and 11 menolipsis. Some sexual hormones, such as LH, FSH, PRL and E_2 were significantly increased (P

Objective To investigate changes and the clinical significance of serum 25-Hydroxyvitamin D level in patients of Xinjiang Uygur and Han nationalities with mild cognitive impairment.Methods On the base of early stage of epidemiological survey of Xinjiang Uygur and Han population over 60 years old,adopting multi-stage stratified random cluster sampling method and referencing DSM-Ⅳ,206 cases of MCI patients (study group)were selected and 412 healthy elderly subjects (control) matching for age,nationality and gender were recruited for case-control study.The serum level of 25(OH) D was measured by enzyme-linked immunosorbent assay (ELISA).Results The serum level of 25(OH)D was significantly lower in MCI group of two nationalities (7.89±0.29 μg/L) than in normal control group [(8.65± 0.21) μg/ml,P＜0.05].The serum level of 25(OH)D was (8.41±0.34) μg/L in Han group,and (8.37±0.32)μg/L in Uygur group,with no significant difference (P＞0.05).The 25 (OH)D level was significantly lower in female[(8.23± 0.32) μg/L] than in male [(8.70±0.42) μg/L,P＜0.05].The serum level of 25(OH)D was lower in female MCI group [(7.56±0.34) μg/L] than in female control group [(8.41 ±0.31)μg/L],with significant difference (P＜0.05).While there was no significant difference between male MCI and male control group (P＞0.05).Multivariate Cox regression analysis showed that the risk factors of MCI might include low serum 25 (OH) D levels (OR =1.163,95 ％ CI:0.978-1.447),a decreased physical labor (OR=1.420,95％ CI:1.10-1.860),low education degree (OR =1.504,95％ CI:1.129-2.130),celibacy (OR=1.293,95％CI:0.845-1.440),hypertension (OR=1.954,95％CI:1.342-2.670),diabetes (OR =1.320,95％ CI:1.145-1.710),smoking history (OR =1.350,95％ CI:1.101-2.293),high BMI (OR=1.329,95％CI:1.068-1.781).Conclusions The serum 25(OH)D level is lower in MCI patients in Xinjiang Uygur and Han populations than in normal people,but there is no significant difference.The 25 (OH)D deficiency is associated with increased odds for cognitive impairment in the elderly Xinjiang population,which is more obvious in the female.The occurrence and development of MCI is affected by multiple risk factors.

Objective:To explore the causes, clinical characteristics, diagnoses and outcomes of post-lymphoproliferative disease(PTLD)after renal transplantation.Methods:Retrospective reviews were conducted for a total of 2 844 adult kidney recipients between January 2000 and January 2019. And 13 of them developed PTLD. Their clinical features and outcomes were analyzed. There were 11 males and 2 females with a median age of 55(31~78)years. All were diagnosed as diffuse large B-cell lymphoma at a median time of 86(12~204)months post-transplantation.Results:The locations of PTLD were diverse, including lung, stomach, colon, skin and central nervous system. Biopsy immunohistochemical EBV positivity was detected in 76.9% of cases.After a tapering of immunosuppression intensity, 6 cases were operated. Patients not tolerating R-CHOP regimen (rituximab + CHOP) were switched to R2 regimen(rituximab + nalidomide). The total effective rate was 91.6%, including complete remission(10 cases), partial remission(1 cases), progressive disease (1 case)and death(2 cases).Conclusions:As a rare but serious complication after renal transplantation, PTLD is closely correlated with EBV infection.Reducing the dose of immunosuppressive drugs is a core of comprehensive treatment.Switching to R2 regimen is an effective alternative in the treatment of PTLD after renal transplantation.

Objective To investigate the surgical procedure of restoring stenosed hilar bile duct by gallbladder lamella with cystic artery.Methods Based on extensive incising and hilar cholangioplasty,stenosed hilar bile duct was restored by gallbladder lamella with cystic artery.Results Among all the 12 pa tients,including 10 intrahepatic bile duct calculi patients,1 right hepatic duct injury and 1 left intrahepatic chaolangiocarcinoma,no cystic fistula,reflexed cholangitis and recurrent stone were noticed by post operative follow-up.Conclusion This procedure is a ideal method by remaining the normal function of Oddis sphincter while removing stenosis.

Abstract BACKGROUND: Calcium dobesilate (calcium dihydroxy-2, 5-benzenesulfonate) has been widely used to treat chronic venous insufficiency and diabetic retinopathy, especialy many clinical studies showed that calcium dobesilate as vasoprotective compound ameliorates renal lesions in diabetic nephropathy. However, there are few literatures reported calcium dobesilate in the treatment of chronic renal alograft dysfunction after renal transplantation. OBJECTIVE:To observe the efficacy and safety of calcium dobesilate on chronic renal dysfunction after renal transplantation. METHODS:A total of 152 patients with chronic renal alograft dysfunction after renal transplantation were enroled from the Military Institute of Organ Transplantation, Changzheng Hospital, Second Military Medical University of Chinese PLA. They were randomly divided into the treatment group (n=78) and the control group (n=74). Patients in the treatment group received 500 mg of calcium dobesilate three times daily for eight weeks. Al patients were treated with calcineurin inhibitor-based triple immunosuppressive protocols and comprehensive therapies. RESULTS AND CONCLUSION: For patients receiving calcium dobesilate, serum creatinine, blood urea nitrogen and uric acid decreased significantly at two weeks after treatment and maintained a stable level (P < 0.05). However, serum creatinine and blood urea nitrogen returned to the original level soon after drug withdrawal. No significant difference was observed in blood cel count, liver function, blood lipids, electrolytes, blood pressure and 24-hour urine output between the two groups before and after therapy (P > 0.05). Administration of calcium dobesilate did not change the general condition of patients with renal insufficiency, nor did it affect blood concentrations of the immunosuppressive agents. Calcium dobesilate may help to delay the progress of graft injury in patients with chronic renal graft dysfunction by conjugating with creatinine, ameliorating the impaired microcirculation and its antioxidant property. The decline in serum creatinine aleviates patients’ anxiety and concern arising from the elevation of creatinine. However, the negative interference with serum creatinine caused by calcium dobesilate should be cautious in order to avoid misjudgment of patients’ condition.

Objective To analyze the epidemiographic features of urologic malignant tumor in renal allograft recipients in a single center.Methods A retrograde analysis was undertaken on 2 300 patients who received renal allografts between June 1978 and December 2001 and anti rejection treatment for at least 3 months. Results Among 2 300 recipients, 27 were diagnosed as malignant tumors that included 9 (an incidence about 0.39% ) cases of urologic malignant tumors that were one third of 27 cases: 1 case of renal cell carcinoma, 2 cases of bilateral pelvic transitional cell carcinoma (TCC), 3 cases of unilateral pelvic TCC, 1 case of ureter TCC and 2 cases of bladder TCC. The mean age at diagnosis of urologic carcinoma was 57.5 ? 5.6 , and the mean duration of immunosuppressive treatment 58?18 months. Six cases received CsA+Aza+Pred, 3 cases CsA+MMF+Pred. Surgical treatment was carried out in 8 cases. Seven of them were alive well. One case died of the malignant tumor soon after the diagnosis. One case died of cerebral hemorrhage.Conclusion Urologic malignant tumor is an important complication in renal transplantation in our center. The occurrence of malignant tumor is intimately related to immunosuppressive treatment. We must pay more attention on painless eyeable hematuria in posttransplantation patients.