Objective To investigate the role of biopsy kidney allograft in the early diagnosis and differential diagnosis of acute and chronic rejection and other diseases involving renal allograft,and to determine the optimal time for early biopsy in chronic allograft rejection.Methods Non-random biopsy of renal allograft was performed in 44 kidney transplant recipients with the clinical manifestation of diagnosis-unconfirmed allograft diseases,in the presence increased in serum creatinine,microalbuminuria or/and proteinuria,glomerular hematuria and so on.Another 6 kidney transplant recipients received routine allograft biopsy 1 month after operation.Pathological evaluation was performed in all sections according to Banff 97 classification and based on clinical data.Results Chronic allograft rejection was discovered in the renal allograft specimens of 31.3%,76.5% and 88.2% recipients,respectively,in the 1st year,the 2nd to 3rd year and over 3 years after operation,and most of them showed no obvious clinical manifestation.A part of recipients with clinical diagnosis of acute rejection also showed pathological manifestations of chronic rejection and/or glomerulonephritis and chronic cyclosporine nephropathy.A part of recipients with clinical diagnosis of chronic rejection showed pathological manifestations of acute rejection and/or glomerulonephritis and chronic cyclosporine nephropathy.Pathological features of acute or chronic rejection,glomerulonephritis and chronic cyclosporine nephropathy were observed respectively in recipients with disorders of kidney allograft with unknown diagnosis.No obvious clinical symptoms were observed in nearly half of the patients with pathological diagnosis of glomerulonephritis.Good therapeutic effect was obtained in these recipients who were correctly treated on the basis of definite pathological diagnosis.Conclusions It is indicated that optimal time for early diagnosis in chronic renal allograft rejection might be the 2nd and 3rd year after transplantation,and routine biopsy should be performed in this period.It is suggested that biopsy of renal allograft is of importance value for rectification of clinical diagnosis and for recipients with clinically undefined renal allograft diseases.It is also indicated that there might be coexistence of acute,chronic rejection and/or glomerulonephritis and chronic cyclosporine nephropathy.

Objective To investigate the differential expression of microRNAs(miRNAs) in transplanted kidney undergoing chronic rejection by the technique of RNA microarray.Methods Four biopsy specimens from transplanted kidney undergoing chronic rejection were harvested as test group(CR),and 3 biopsy specimens were obtained from normal renal cortex as normal control group(NC).Total RNA of each sample was extracted using Trizol reagent.miRNAs were isolated and differential expression of miRNAs were screened by miRNA array analysis.The results of miRNA array were validated by RT-PCR.The quantity and quality of all the RNA samples were checked by gel electrophoresis and absorbance at A260/280,respectively.Results It was confirmed that the isolated RNA was of appropriate quality.The results of miRNA array analysis showed that there were 63 differential expression miRNAs in CR group,of which 35 were up-regulated and 28 down-regulated.There were 9 differential expression miRNAs which distributed in 3 gene clusters: 14q32.31,22q11.21 and xq27.3.The miRNAs hsa-miR-637,hsa-miR-648 and hsa-miR-516-5p were randomly selected for relative quantification by real-time PCR.It was showed that the expression ratios of hsa-miR-637,hsa-miR-648 and hsa-miR-516-5p in AR/NC,when detected by RT-PCR,were 0.034,2.670 and 7.846,while the ratios were 0.035,2.660 and 7.857 when analyzed by miRNAs array.The results from two methods were not significantly different,so the method of miRNAs array was reliable.Conclusions It is notable that the differential expression of miRNAs existed in the transplanted kidney undergoing chronic rejection.miRNAs might be helpful in protecting the patients undergoing kidney transplantation against chronic rejection.

Objective To investigate immunoadsorption in the prevention of hyperacute rejection in highly sensitized recipients of renal allografts.Methods Immunoadsorption treatment was performed on 10 patients whose panel reactive antigen (PRA) was more than 40 %. The adverse effect and hyperacute rejection were observed.Results Two cases of acute rejection of renal allografts were found in highly sensitized recipients and reversed by the therapy of immunoadsorption and adjusting immuno-suppressive drugs.Conclusion Immunoadsorption treatment could effectively and safely prevent highly sensitized recipients from hyperacute rejection post-transplantation.

Objective To observe the role of preoperative single administration of zenapax in the prevention of acute rejection after kidney transplantation, and evaluate its safety. Methods A total of 80 renal transplant recipients during the same period were divided into treatment and control groups, each group containing 40 patients. There were no difference between the two groups in treatment regime except the preoperative single administration of zenapax in the treatment group. Results Acute rejection rate was significantly lower in the treatment group(7.5%) than the control group(25%) within 6 months after kidney transplantation(P

40%)were observed in HLA CREGs matching and outcome of post-transplantation.Results Patients with 0,1,2 or 3 mismatching(MM) of HLA CREGs+DR were 4(28%), 6(44%)and 4(28%)cases respectively according to the the rule of CREGs matching and no case had 3～6 MM.However the cases of 0,1,2,3 and 4 MM were 1(7%),3(21%),5(36%)and 5(36%)respectively by the standard of conventional HLA antigen matching,without 4～6 MM and only 4 cases had shared 0～1MM.Only 9 patients were developed into acute rejection, and were reversed by OKT3 treatment after transplantation.Renal function was returned to normal in all patients.Conclusions Using CREGs matching criteria would significantly increase the chance of recipients to receive well-matched kidney and provide more chance for waiting recipients.Suitable HLA matching could play an important role in reducing the incidence of acute rejection and improving graft survival in sensitized patients.

Objective To investigate the etiological diagnosis and therapy of liver function lesion after kidney transplantation.Methods By analyzing the etiological factor of 82 cases of liver function lesion,we provided a reasonable and operative therapy scheme in kidney post-transplantation.Results Of 82 cases,the number of drug toxicity and viral hepatitis B which result in liver functional lesion were 70 cases(85 5%) and 12 cases(14 5%) respectively.The former were all cured,8 cases in the latter were cured and the other 4 cases were died from acute hepatic failure.Conclusions The liver function lesion of post-transplantation should be diagnosed carefully and treated particularly.Morever,the adjustment of immuno-suppressive drugs and monitoring circlosporin A concentration should be done for the patients with liver function damaged.

Otransplantation is a new subject which is developed so rapid that usually over the development of medical ethics.The shortage of organ supplement made organ transplantation face the challenge of medical ethics.Live organ donation has become a focal point of medical ethics in organ transplantation.It is necessary to eliminate all kinds of human organ commercialization and illegal transaction.We need pay more attention in the medical ethics issue about organ transplant,especially about live organ donation.Here is about the survey of medical ethics on live organ donation in People's Liberation Army No.181 Hospital.

Objective:To investigate the significance of regulatory T cells in peripheral blood of chronic renal insufficientce.Methods:The peripheral blood samples were collected from 40 patients with chronic renal insufficient.The ratios ot CD4+T cell in lymphocyte and CD4+CD127-Treg and CD4+CD25+CD127-Treg in CD4+T were detected by flow cytometry.Results:The number of CD4+T in lymphocyte of chronic renal insufficient was higher than in healthy control group and there wasn’t significantly difference of the CD4+CD25+CD127-Treg ratios in CD4+T between chronic renal insufficience and healthy central.The ratio of CD4+T cells in lymphocytes of chronic renal insufficience was lower than in healthy control group except compensatory stage.There was no correlation between CD4+T cell ratios in lymphocytes,CD4+CD127-Treg or CD4+CD25+CD127-Treg ratios in CD4+T cells and the values of BUN,Cr among the hypertension patients.Conclusion:The number of CD4+T cells increases,and CD4+CD127-Treg decreases in the patients with chronic renal insufficience and their immune functions are shown in disoroler .

Objective To introduce and evaluate the technique of laparoscopic live donor nephrectomy in renal transplantation.Methods Three donors underwent laparoscopic live donor nephrectomy, and 3 recipients received renal transplantation. The procedures were described in detail. Results The surgery was successfully performed in all 3 cases. Ischemia of the harvested kidneys was less than 8 min. All 3 kidneys were successfully transplanted and functioned well in 3 recipients up to now.Conclusion Laparoscopic live donor nephrectomy is a minimally invasive surgery. Advantages include less postoperative pain, shorter hospital stay and convalescence. The recipients also have a satisfactory renal function.

BACKGROUND: A large number of researches have confirmed that hypertension, vascular nephrosclerosis and chronic systemic inflammatorome were the importance factors of chronic allograft dysfunction. Hyperuricemia is associated with primary hypertension and vascular nephrosclerosis, and can result in chronic systemic inflammatorome, but it was uncertain whether post-transplantation hyperuricemia and its lesion influence the long term graft function. OBJECTIVE: To investigate the prevalence of hyperuricemia in renal transplant recipients (RTRs) before and after transplantation and the influence of hyperuricemia on long term graft function. METHODS: A total of 216 renal transplant recipients [146 males with the mean age of (40.98±11.09) years and 70 females with mean age of (40.01±11.62) years]with normal renal function after transplantation were selected from PLA Center of Kidney Transplantation and Dialysis, the 181 Hospital of Chinese PLA. In order to compare the influence of different hyperuricemia status on the long term graft function, the patients were divided into 4 groups according their pre-transplant baseline and post-transplant serum uric acid (SUA) levels, SUA normal group, pre-transplant high SUA group, post-transplant high SUA group and both pre-transplant and post-transplant high SUA group. The patients were also divided into 3 groups according to their post-transplantation SUA level to study the influence of SUA on the long term graft function, normal SUA group, hyperuricemia (SUA < 500 μmol/L) group and hyperuricemia (SUA > 500 μmol/L) group. Effects of hyperuricemia and SUA levels pre-and post-transplantation on long term graft function were observed. RESULTS AND CONCLUSION: Hyperuricemia existed in 34.2% male RTRs and 37.7% females before transplantation, while it existed in 36.2% male RTRs and 42.4% females at the first month post-transplantation when they had normal Scr levels. The incidence rate of post-transplant hyperuricemia in female RTRs was significantly higher than male RTRs (P < 0.05). The average post-transplantation SUA levels in both male and female RTRs were significantly higher than those before transplantation (P < 0.01). At follow-up end, the pre-transplantation SUA levels did not significantly influence on the long term graft function (P > 0.05), meanwhile the RTRs with continuous post-transplant hyperuricimia had poorer long term graft function than those with normal post-transplantation SUA levels. It is indicated that hyperuricemia is more common in post-transplantation recipients, especially in female RTRs, when compared to pre-transplantation, and post-transplantation hyperuricemia often existed in renal transplant recipients with normal graft function. Furthermore it is suggested that post-transplantation hyperuricimia, but not pre-transpiantation hyperuricemia, could also act as a factor inducing chronic renal allograft dysfunction.