1.Clinical experience of treating accelerated rejection of cadaver renal transplantation
Xiaoming DING ; Wujun XUE ; Puxun TIAN
Journal of Xi'an Jiaotong University(Medical Sciences) 2000;21(5):483-485
Objective To discuss the way of treating accelerated rejection. Methods Seven patients of accelerated rejection were treated by efficient anti-rejection treatment. ResultsSix patients of accelerated rejection were reversed by efficient treatment of anti-rejection. One allograft was removed because treatment was invalid. And six patients were still alive, the longest survival one has reached to 3 years. ConclusionThe treatment emphasis of accelerated rejection should be focused on 3 aspects, including early diagnosis, efficient treatment in time, and paying more attention to any possible complications during the process of treatment.
2.The effects of diltiaze in renal transplantation patients treated with cyclosporine A
Wujun XUE ; Xiaoming DING ; Puxun TIAN
Chinese Journal of Organ Transplantation 2003;0(01):-
Objective To investigate the clinical effects of diltiaze in renal transplantation patients treated with cyclosporine A (CsA). Methods 1529 renal transplant cases were randomly ~divi -ded into experimental group 1 receiving CsA, Aza, Pred and Diltiaze, experimental group 2 receiving CsA, MMF, Pred and diltiaze, and control group receiving CsA, Aza and Pred without diltiaze. The dosage and blood concentrations of CsA, the outcome of renal transplant, the incidence of acute rejection, and the hepatic and renal toxicity were observed in the experimental groups and control group.Results The dosage of CsA in experimental group 1 was less, while the blood concentrations of CsA was higher than in control group (P~0.05 ). The recovery time of the graft function was cut down to 4.7 days (experimental group 1) and 3.9 days (experimental group 2) respectively with the difference being significant between the experimental groups and control group (P
3.Clinical Curative Effect and Safety of MCT/LCT Fat Emulsions at Different Doses in Preterm and Low Birth Weight Infants
Jing YUAN ; Man HE ; Wujun DING
China Pharmacist 2015;(3):444-445
Objective:To analyze the effect of MCT/LCT fat emulsions at different doses on the growth and development of prema-ture and low birth weight infants. Methods: Totally 76 cases of preterm or low birth weight infants were divided into the treatment group (40 cases) and the control group (36 cases), both groups were given MCT/LCT fat emulsions, amino acid and glucose injec-tions in 12-24 h after the birth. The initial dose of MCT/LCT fat emulsions in the treatment group was 2. 0 g·kg-1 ·d-1 and the dose was gradually increased to 3. 0 g·kg-1 ·d-1 with 0. 5 g·kg-1 ·d-1 progressive increase. The initial dose of MCT/LCT fat emulsions in the control group was 0. 5 g·kg-1 ·d-1 , and the dose was increased to 3. 0 g·kg-1 ·d-1 with 0. 5 g·kg-1 ·d-1 progressive in-crease. The treatment course was 7 days. The neonatal weight, serum total bilirubin, direct bilirubin, alanine aminotransferase, total cholesterol, triacylglycerol and blood glucose were monitored in the two groups. Results:The born body mass recovery time of the ob-servation group was (4. 38+0. 93) d, which was significantly shorter than that in the control group [(6. 81+1. 90) d]. After the re-covery, the body weight growth rate of the observation group was (30. 41+1. 81) g·kg-1 ·d-1 , which was significantly higher than that of the control group [(18. 21 +2. 08) g·kg-1 ·d-1, P <0. 05]. After the 7-day treatment, the blood biochemical indices showed no statistically significant difference between the two groups (P>0. 05). Conclusion:Early application of MCT/LCT fat emul-sions at high dose is beneficial to the improvement of nutritional status in premature infants.
4.Application of cell immnune function monitoring by Cylex ImmuKnow assay for individual immunosuppressive therapy in renal transplantion recipients
Xuzhen WANG ; Wujun XUE ; Xiaoming DING ; Xiaohui TIAN ; Jin ZHENG
Chinese Journal of Organ Transplantation 2015;36(8):453-457
Objective To investigate the correlation between immune cell function and the infection after renal transplantation through monitoring of immune function intracellular ATP by Cylex ImmuKnow assay,and explore its significance in individual immunosuppressive therapy of renal transplantion recipients.Method We collected 44 renal transplant patients suffered from pulmonary infection from January 2014 to March 2015.The patients were divided into two groups according to the clinical status,namely,ImmuKnow monitoring group (n =22) and empirical treatment group (n =22).Thirty-two non-infection recipients were collected as controls.All the kidney transplantation recipients received immunosuppressive therapy based on calcineurin inhibitors,mycophenolate mofetil and prednisone,and ATG for induction therapy after transplantatior.The immune cell function levels were measured by Cylex ImmuKnow assay.The whole blood samples were collected before infection onset,at the time of infection,and 1 week after infection resolution.Result When infection occurred,ATP concentrations in CD4+ T cells of the kidney transplant recipients were significantly lower than those in non-infection group [(151.30--71.35 ng/mL vs.(308.34 ± 141.29 ng/mL,P<0.05).When the infection got controlled,the ATP concentrations in CD4+ T cells increased to those before infection occurred.The average hospitalization time in ImmuKnow monitoring group was 12.27 ± 0.74 days,which was significantly shorter than in empirical treatment group (16.64 ± 1.98 days,P< 0.05).The incidence of acute rejection was 4.5% in ImmuKnow monitoring group,and 13.6% in empirical treatment group (P>0.05).Conclusion The examination of ATP in CD4+ T cells by Cylex Immuknow assay could reflect the status of cellular immunity,provide reliable and objective basis for the diagnosis and treatment of infection after renal transplantation,and guide the clinical individualized immunosuppressive therapy.
5.Clinical application of color doppler flow imaging for diagnosis of transplant renal artery stenosis
Xuzhen WANG ; Wujun XUE ; Xiaoming DING ; Heli XIANG ; Yang LI ; Chenguang DING ; Lizi JIAO
Chinese Journal of Organ Transplantation 2016;37(9):537-540
Objective To investigate the clinical value of color Doppler flow imaging (CDFI) for evaluating transplant renal artery stenosis (TRAS).Methods Clinical and ultrasonographic data of 216 kidney transplant recipients were collected by follow-up monitoring from September 2015 to July 2016.CDFI indexes included the peak systolic velocity (PSV) in the renal artery and resistant index (RI).Renal artery PSV and RI were measured.All suspected TRAS patients accepted transplant renal artery angiography (DSA).Results Fourteen patients with suspected TRAS accepted DSA,of which 12 patients were confirmed.The diagnostic accuracy of CDFI was 85.7%.When the POST-PSV ratio> 1 0,the sensitivity and specificity of diagnosis of TRAS were 91 % and 95 %,respectively.CDFI indexes remarkably changed after the TRAS patients had undergone renal artery dilatation or stent implantation.PSV of the main renal artery and the POST-PSV ratio decreased significantly,and the PSV of interlobar arteries increased.Conclusions CDFI is a reliable first choice for screening transplant renal artery stenosis.The POST-PSV ratio has relatively higher sensitivity and specificity in the diagnosis of TRAS.
6.The effect of prostaglandin E1 on recovery of early renal graft functions after transplantation
Huanjin SONG ; Wujun XUE ; Xiaohui TIAN ; Yang LI ; Chenguang DING ; Xiaoming DING ; Xinshun FENG ; Zhankui JIN
Journal of Pharmaceutical Analysis 2008;20(4):221-224
Objective To investigate the effect of prostaglandin E: (PGE1) on recovery of early renal graft functions after transplantation. Methods One hundred and seven patients after renal transplantation were allocated in the treated group, and treated by conventional treatment with injection of 10 μg prostaglandin E1 additionally twice a day for 14 days. And eighty-eight patients who received conventional treatment alone after renal transplantation at the corresponding period were allocated in the control group. Indexes of the two groups, including incidence of delayed graft function and acute rejection reaction, volume of urine, serum certaintie (SCr), endogenous certainties clearance rate (CCr), the blood flow resistance in graft as well as blood viscosity (BV), and platelet aggregation rate (PAR), were determined. Results The urinary volume and endogenous certainties clearance rate of the treated group were significantly higher, but the level of SCr, incidence of renal function recovery retardation, BV, PAR and blood flow resistance in graft were significantly lower than these of the control group (P<0.05). The difference of incidence of acute rejection reaction between the two groups was insignificant (P>0.05). Conclusion Prostaglandin E1 can improve blood microcirculation and decrease the incidence of renal function recovery retardation. These effects are helpful for recovery of renal function after renal transplantation.
7.Adjustment of immunosuppressant in pulmonary infection following renal transplantation
Xiaohui LUO ; Wujun XUE ; Hang YAN ; Puxun TIAN ; Xiaoming DING ; Heli XIANG ; Yang LI ; Yong SONG
Chinese Journal of Organ Transplantation 2010;31(9):524-527
Objective To explore the relationship between adjustment of immunosuppressant and prognosis in renal transplantation recipients with pulmonary infection. Methods The clinical data of 98 patients with pulmonary infection following renal transplantation were retrospectively analyzed.Patients were divided into two groups: conventional group (n = 45) and immunosuppressant adjustment group (n = 53). The mortality, recovery time and rejection rate in two groups were analyzed under the statement of serious infection (SOFA≥12) and slight infection (SOFA< 12) by sequential organ failure assessment (SOFA) score. Results When the SOFA scores ≥ 12, the mortality and recovery time in immunosuppressant adjustment group were significantly lower than in conventional group (P<0.05), but there was no significant difference in the rejection rate between two groups (P>0.05). When the SOFA scores <11, there was no significant difference in mortality and recovery time between the two groups (P>0.05). The incidence of rejection in immunosuppressant adjustment group was significantly higher than in conventional group (P<0.05).Conclusion Mortality could be decreased and course of anti-infection treatment could also be shortened by adjusting the immunosuppressant in renal transplantation recipients with serious pulmonary infection (SOFA≥12). Immunosuppressant agent was proposed to maintain the original treatment protocol when the infection was slight (SOFA<12).
8.The cell-mediated immune status of patients with cytomegalovirus pneumonia after renal transplantation
Heli XIANG ; Wujun XUE ; Puxun TIAN ; Xiaoming DING ; Xiaoming PAN ; Hang YAN ; Jun HOU ; Xinshun FENG
Chinese Journal of Organ Transplantation 2011;32(10):592-595
Objective To evaluate the clinical value of adenosine triphosphate (ATP) determination in CD4+ cells in cytomegalovirus pneumonia after renal transplantation.Methods The ATP level of CD4+ T cells was measured by ImmuKnowTM kit.The ATP levels were determined in 187 renal transplant recipients before and 30,60,90,180 days after operation,and at the time of CMV pneumonia and 4 weeks after treatment of CMV pneumonia.The associations between ATP levels and CMV pneumonia were analyzed.Analysis of variance (ANOVA),Pearson-Spearman and relative risks were used for data analysis.Results 17 cases out of 187 renal transplant recipients were diagnosed as CMV pneumonia (9.1%),and the onset of CMV pneumonia started on the (2.8 ±1.2)month after renal transplantation.ATP concentrations in CD4+ T cells were significantly lower after operation than those before operation (P<0.01).ATP concentrations reached the lowest on the about postoperative day 90 (P<0.05),then increased gradually.In 17 recipients with CMV pneumonia,the ATP levels before and 30,90 days after operation,at the time of CMV pneumonia and 4th week after treatment of CMV pneumonia were (376 ±182),(283 ± 146),(196 ± 112),(145 ± 102) and (236 ± 117) μg/L respectively.ATP levels at the time of CMV pneumonia were significantly lower than any other time points (P<0.05).There was close correlation between ATP levels and CMV pneumonia.Conclusion The determination of ATP in CD4+ cells could reflect the status of cell-mediated immunity in renal transplant recipients,and could evaluate the severity and prognosis of CMV pneumonia and guide the clinical treatment.
9.The clinical value of enzyme-multiplied immunoassay technique monitoring the plasma concentrations of cyclosporine A after renal transplantation
Xiaohui LUO ; Wujun XUE ; Puxun TIAN ; Xiaoming DING ; Hang YAN ; Heli XIANG ; Yang LI
Journal of Pharmaceutical Analysis 2011;01(2):139-142
The feasibility and the clinical value of the enzyme-multiplied immunoassay technique (EMIT) monitoring of blood concentrations of cyclosporine A (CsA) in patients treated with CsA were investigated after kidney transplantation.The validation method was performed to the EMIT determination of CsA blood concentration,the CsA whole blood trough concentrations (Co) of patients in different time periods after renal transplantation were monitored,and combined with the clinical complications,the statistical results were analyzed and compared.EMIT was precise,accurate and stable,also with a high quality control.The mean postoperative blood concentration of CsA was as follows:<1 month,(281.4± 57.9)ng/mL; 2 - 3 months,(264.5 ± 41.2)ng/mL; 4 - 5 months,(236.4 ± 38.9)ng/mL; 6 - 12 months,(206.5 ± 32.6)ng/mL; >12 months,(185.6 ± 28.1)ng/mL.The toxic reaction rate of CsA blood concentration within the recommended therapeutic concentration was 14.1%,significantly lower than that of the none-recommended dose group (37.2%) (P<0.05); the transplantation rejection rate was 4.4%,significantly lower than that of the nonerecommended dose group (22.5%) (P<0.05).Using EMIT to monitor the blood concentration of CsA as the routine laboratory method is feasible,and is able to reduce the CsA toxicity and rejection significantly,leading to achieving the desired therapeutic effect.
10.Dynamic monitoring serum CD30 in predicting acute rejection in kidney transplant recipients
Xuzhen WANG ; Wujun XUE ; Xiaohui TIAN ; Jin ZHENG ; Puxun TIAN ; Xiaoming DING
Chinese Journal of Organ Transplantation 2014;35(10):590-593
Objective To explore the significance of serum CD30 in predicting acute rejection in kidney transplant recipients.Method A total of 106 kidney transplant recipients were recruited in this prospective six months follow-up study from December 2010 to October 2012.According to the clinical outcome,the subjects were devided into stable renal function group (72 cases) and acute rejection group (34 cases).Twenty healthy subjects were choosed as controls.Serum sCD30 levels were detected by ELISA.The whole peripheral blood samples were collected from all recipients before transplantation,at days 7,14,21 and 28 post-transplantation,and at months 2,3,4,5 and 6 posttransplantation.Additional blood samples were collected for on the days that acute rejection occurred and reversed.Result Preoperative serum sCD30 levels were 33.42 ± 11.49 and 26.5 1 ± 13.70μg/L in AR group and stable group respectively.When acute rejection occurred,serum sCD30 levels in AR group was 50.38 ± 12.10μg/L,which was significantly higher than stable group (20.03 ± 6.68μg/L,P<0.05) and healthy control group (13.57 ± 5.56 ng/L,P<0.05).After the anti-rejection therapy,serum sCD30 levels decreased to 15.31 ± 6.37μg/L,which was lower than that before the therapy started (50.38± 12.10 μg/L,P<0.05).Elevated preoperative serum sCD30 levels suggested a higher risk of acute rejection in kidney transplant recipients,with Cutoff values of 24.96 μg/L,and the sensitivity and specificity were 91.30% and 84.21% respectively.Conclusion Serum sCD30 levels can predict and assess the risks of rejection episodes in kidney transplant recipients.