In order to observe the pharmacological action and clinical effects of Implanta (from Hanmi Pharm. Co. Ltd) on renal transplantation, 30 patients receiving renal transplantation were treated with Implanta. Among the 30 patients, 12 patients (group A) just underwent renal transplantation, the remaining 18 cases underwent the operation 0.5 to 4 years ago and administered Sundimin or Cyspin. The results showed that the blood concentration, the effcets of inhibiting the rejection, the function recovery of transplanted kidney and side effects of Implanta were the same as those of Sundimin or Cyspin. It was conlcuded that Implanta was safe and effective.

The renal artery stenosis is a common complication in renal transplantation.Therenal failure can be easily caused if treatment is not effective.4 cases of renal artery stenosis in re-nal transplantation were treated in our department from Dec.1995 tO Jan.1997.Three cases weretreated by implanted renal artery stent and the remaining one received the stripping of adhesive tis-sue.After operation,blood pressure and renal function in the 4 patients recovered normally.Long-term effect was satisfactory.It is concluded that the above tWO methods are effective for thetreatment of renal artery stenosis in renal transplantation.

Objective　To investigate the infection of hepatitis virus and spirochete in renal transplant donors and recipients to study the relationship between infection and human/kidney survival rate following renal transplantation. Methods　A total of 361 donors and 300 recipients were investigated on infection of HBV, HCV, HGV, CMV, EBV, HSV, HIV and RPR. Results　Of the 361 donors, 31 cases (8.6!%), 9 cases (2.5!%) and 2 cases (0.6!%) were found having HBV, HCV, HGV infection respectively. In the 231 recipients, the percentage of CMV, EBV, HSV, HIV and RPR carriers was 16.9!%, 11.7!%, 16.0!%, 0.4!% and 0.8!% respectively. Among the 300 grafting recipients, the infective rate of HBV, HCV and HBV plus HCV was 68.7!%, 34.7!% and 25.0!% respectively. Forty patients were randomly selected from the 300 patients, it was found that 10 (25.0!%) patients were positive for anti-HGV, 10 (25.0!%) for HGV and HBV, 5 (12.5!%) for all HGV, HBV and HCV. The percentage of CMV, EBV, HSV, HIV, RPR carriers among the 300 recipients was 49.0!%, 32.7!%, 42.0!%, 0 and 0.3!% respectively. Conclusion　Viral infectious status of the donors and recipients before operation might contribute to the occurrence of viral infection in the recipients after transplantation.

Objective　To investigate the outcome of renal transplantation in the patients with systemi c autoimmune disease. Method　The clinical data of 25 patients with autoimmune disease undergoing renal transp lantation were retrospectively analyzed. Results　 The survival rate for 1 year, 3 years, 5 years after renal transplantation in t he patients with autoimmune disease and without autoimmune disease were 88 .0 %, 80.0 %, 72.0 % and 88.9 %, 84.4 %, 77.8 % r espectively. The graft survival rate for 1 year,3 years, 5 years after renal tra nsplantation in the patients with autoimmune disease and without autoimmune dise ase were 84.0 %, 72.0 %, 60.0 % and 86.2 %, 77.0 %, 66.4 % respectively. The average intervals of dialysis pre-transplantati on b etween the patients with recurrent underlying diseases (4 patients) and with out recurrent underlying diseases (21 patients) was not difference. Among the 4 p atients with positive ANA and elevated anti-dsDNA serology pre- and post-tr ansp lant, 2 patients had recurrent underlying diseases. Conclusions　Renal transplantation should be offered to th e patients with autoimmune diseases because relapses of underlying diseases after renal transplantation seem to be rare. The patient and graft survival rate was not significantly differen t in the patients with autoimmune diseases and without autoimmune diseases.

Objective To investigate the clinical characteristics and risk factors for postrenal transplant diabetes mellitus (PTDM). Methods 512 consecutive kidney recipients were included in this study from 1994.1 to 1997. 5.Biochemical data, body weight changes, drug history, genetic markers such as HLA phenotypes, anti-virus antibodies were studied in these patients.Results The mean age and the dose of hormone used 6 months after operation in the diabetes mellitus group were older and higher than in the nondiabetes groups respectively. PTDM often occurred half a year following renal transplantation. And no patients with PTDM were obese. Most PTDM patients had a higher blood glucose level, but few of them had ketoacidosis. The occurrence of HLA-B15 and the positive rate of anti-gland virus antibody were significantly higher in PTDM group. Conclusion Both genetic factors such as HLA type antigens and environmental factors such as the amounts of steroid and cyclosporine A used, infections of some kinds of viruses, and also stress during transplantation may play an important role in the causes of PTDM.

Objective To observe the clinical effects of combined islet cell and kidney transplantation in the treatment of insulin-dependent diabetes mellitus associated with end-stage renal failure.Methods Four patients with type I diabetes and ESRD received combined renal and islet cells transplantation.Clinical and metabolic data were studied during the follow-up.Results The cultured human adults islet cells were infused into the portal vein system of the 4 patients.Immunosuppression included CsA.azathioprine and prednisone.Metabolic follow-up comprised assessment of daily fasting and non-fasting blood glucose,basal C-peptide secretion,HbAIc,renal function and blood cell counts.Islet isolation yielded 25 000～48 000 equivalents(single or multiple donors).No adverse effects were seen subsequent to islet transplantation.Basal C-peptide secretion maintained at normal levels.and blood glucose and HbAIc levels were normalized throughout the observation period.The dosage of insulin were decreased by over 25% in all 4 patients after transplantation.Conclusions Combined adult islet cells and renal transplantation has a good effect in the treatment of the patients with type Ⅰ diabetes and ESRD and can be used as an effective way for treating ESRD secondary to the type Ⅰ diabetes.Postoperative efficacy is related not only to the quantlty and quality of the islet cells,but also to the rejection of the grafts.

The article retrospectively analyzes the clinical characteristics and prevention measures of cytomegalovirus (CMV) infections after renal transplantation in 395 patients from Beijing Friendship Hospital Affiliated to Capital Medical University. All patients received preventive treatment of CMV infections and pneumocystis carinii infections in three months after renal transplantation. CMV infections occurred in 24 of 395 patients. The patients with viremia were treated with Ganciclovir or foscarnet sodium. The patients with severe infections (eg. severe pulmonary infections) should be treated with decrease dosage of immunosuppressive drugs, even stop administration. Then the immunosuppressive drugs were adopted again if the infections were controlled. Twenty-four patients obtained the satisfied efficacy. The results suggested that evaluation of the risk for CMV infections before transplantation, preventive treatment in early time after transplantation, measurement of clinical epidemiology, early diagnosis, and individual medication scheme of immunosuppressive drugs for patients should be effective to prevent and against CMV infections. And they also played an important role in preventing acute allograft rejection after renal transplantation and protecting the function of the graft.

ObjectiveTo study the sirolimus (SRL)-associated interstitial pneumonitis,which is a severe side effect of sirolimus therapy. Methods In 7 renal grafts treated with SRL, interstitial pneumonitis (8 times) was diagnosed. One patient suffered a relapse after sirolimus treatment was given again. Two patients received de novo sirolimus treatment, and rest 5 patients were switched from a calcineurin inhibitor-containing regimen to a SRL-based protocol for various indications: chronic allograft nephropathy (n = 4) and cancer (n = 1 ). The patients presented with fever, dyspnea on exertion and the chest X-ray or computed topographic (CT) scan on admission showed bilateral mostly peripheral interstitial infiltrates. ResultsSRL was discontinued in 4 patients and the dose was reduced in the remaining 3 patients. Symptoms were improved within 3-14 days in all patients, the radiographic findings improved within 2-4 weeks, and the lesions were absorbed completely in 2-6 months.ConclusionThe frequency of interstitial pneumonitis appears to be increased in renal transplant patients receiving SRL. Discontinuation or reduced dose of SRL appears to be the safest treatment option for the patients with interstitial pneumonitis.

Objective To evaluate the effects of pregnancy and delivery on allograft function and newborns in renal transplant recipients.Methods The effects of pregnancy and delivery on allograft function and newborns in 3 renal transplant recipients were observed and analyzed.The age of the 3 recipients was 32,31 and 31 years,respectively,at pregnancy.They all received triple immunosuppressive therapy(CSA+AZA+prednisone) for the prevention of acute rejection after renal transplantation.Results No acute rejection occurred during pregnancy,and the liver and renal functions were normal in the 3 patients.Preeclampsia occurred in 2 of them.Caesarean section was performed successfully on them at 34,38 and 37 gestational weeks,respectively.The weight of the neonates was 2350 g,3800 g and 3800 g,respectively;and the Apgar scores of the newborns were all 10.(Apgar scores include appearance,pulse,grimace,activity,and respiration.Apgar score ≥8 means newborns in healthy status).After follow-up for 14-46 months,there was no abnormity of the function of transplanted renal and the upgrowth of the newborns.Conclusions Successful pregnancy and delivery are possible in renal transplant recipients with normal renal function.

Objective To investigate the infection following the lymphocytes deleted agent (ATG) and IL-2 receptor antagonists (Basilixinab and Daclizumab)-based induction therapy after renal trausplantation.Methods A retrospective analysis was carried out on 701 kidney transplant recipients between Jan. 1,2005 to Dec.31,2010.According to exclusive and inclusive criteria,finally 549 patients were evaluated,including 429 patients treated with ATG (ATG group) and 120 patients with anti-CD25 monoclonal antibodies (monoclonal antibodies group; 86 patients with Basiliximab,and 34 patients with Daclizumab).The incidence of acute rejection,infection rate,infection time,hospital stay,severe infection rate and mortality were analyzed.After operation,the patients received an immunosuppression therapy including Tacrolimus (cyclosporine A),Mycophenolate-Mofetil and prednisone to present rejection. Part of the patients were treated with ganciclovir and sulfamethoxazole sulfadiazine and trimethoprim for infection prevention.Results The acute rejection rate in ATG group and monoclonal antibodies group was 15.9％ (68/429) and 10.0％ (12/120),and there was no statistically significant difference (P＞0.05).The infection rate in ATG group was 11.9％ (51/429),including 13.7％ (7/51) with severe infection,and mortality was 7.8％(4/51).The infection rate was 15.0％ (18/120) in monoclonal antibodies group,including 11.1％ (2/18) with severe infection,and mortality was 5.6％ (1/18).There was no statistically significnat difference in infection rate,severe infection rate and mortality between two groups (P＞0.05).The hospital stay in ATG group and monoclonal antibodies group was 25.8 days and 19.1 days respectively (P＜0.05).Dead cases had not received regular anti-infection treatment,and the patients age was over 50 years.Conclusion The infection risk and mortality between these two induction therapies are identical,but hn comparison to the patients using ATG,the infection of patients using anti-CD25 monoclonal antibodies is easier to control.Anti-infection prophylaxis is important to reduce infection rate and decrease infectious mortality.