Objective To study the hepatotoxicity of cyclosporine-A, tacrolimus and other immunosuppressive drugs in patients with renal transplantation. Methods In 346 cases undergone renal transplantation, ALT, AST, BILT and BILD levels of venous blood 1-90 days after operation, and treatment methods and outcome were reviewed, in order to evaluate the effectiveness of the treatment of hepatotoxicity. Results In CsA group, the occurrence rate of liver dysfunction was 26.9%, in whom ALT, AST and BILD increased apparently (P0.05). In MMF and MRZ group, the incidence of liver dysfunction was almost the same. In 18 cases the drug was changed into FK506, ALT, AST, BILT and BILD all apparently decreased 1 week later (P

Objective To study the diagnosis and treatment of the severe pulmonary infection in the patients after kidney transplantation. Methods The clinical data of 26 patients with severe pulmonary infection following kidney transplantation were analyzed retrospectively. Results Microorganisms were isolated and identified in 22 patients out of 26 kidney transplantation patients with severe pulmonary infection. The main etiological pathogens according to their frequency and type were: bacteria (15 cases, including Escherichia coli, Aerobacter cloacae, Klebsiella fredlanderi, Enterococcus faecalis, Staphylococcus epidermidis, etc.), fungi (12 cases, Fermentum, Blastomyces albicans, Candida tropicalis, Aspergillus, etc.), and cytomegalovirus (10 cases). 46.15% (12/26) of patients were infected with one kind of microorganism, and 53.85% (14/26) of patients were mixed infection. In 73.1% (19/26) of patients the pulmonary infection occurred during 1-6 months after renal transplantation. Among 26 patients, 12 developed ARDS, and 4 patients gave up therapies due to high expenses. With energetic treatment, 18 patients (81.82%) were cured and 4 died. Conclusions Intensive care and active measures should be given in the treatment of severe pulmonary infection after kidney transplantation. Early diagnosis, administration of broad-spectrum and combined use of antibiotics, the early identification of pathogens, enforcement in systemic support, including correction of immunosuppression, the timely use of mechanical ventilation to correct hypoxia, are the key treatment strategies for a successful result.

Objectives To investigate the surgical technique and some other related problems of simultaneous heptorenal transplantation. Methods Combined liver-kidney transplantation was performed in one patient with huge polycystic liver, bilateral kidney, and another with liver cirrhosis after hepatitis B complicated with hepatic carcinoma and uremia due to chronic nephritis. Donors' organs were infused in situ with UW solution and rapidly harvested. Orthctopic or piggyback liver tranlsplantation was carried out and the kidney was transplanted with conventional method respectively. The patients received an immunosuppression therapy including simulect (CD25 antibody), FK506 or CsA, Mycophenolate mofitil (MMF), and Predinision. Results Both transplanted organs rapidly functioned well after the operation. One patient recovered well but suffered from ALI (acute lung injury) on the 2nd postoperative day and ARDS on the 11th postoporative day. There were no acute rejection or recurrence of the primary diseases in both cases. Conclusions Simultaneous hepatorenal transplantation is one of the treatment methods for end stage liver and kidney diseases. Skillful operative technique, comprehensive perioperative monitoring and appropriate management are all important factors for obtaining a successful result. It requires more shillful techniques than single organ transplantation.

0.05).The expression percentage of IL-4 of CD3+CD8-T lymphocytes cells in peripheral blood of the patients in group A(4.0%?2.8%)was significantly lower than that in group B and C(7.9%?5.5% and 10.2%?7.5%,P0.05).The level of serum sCD30 in the patients of group A(20.2?12.4ng/ml)was significantly higher than that of group B and C(7.8?3.1ng/ml and 7.6?3.0ng/ml,P0.05).ROC curve analysis indicated that when the ratio of Th1/Th2 was at the cut-off value of 1.95,the sensitivity and specificity to identify CRAD caused mainly by immune injury was 80% and 90%,respectively;and when the level of serum sCD30 was at the cut-off value of 10ng/ml,the sensitivity and specificity to identify CRAD caused mainly by immune injury was 93.3% and 86.7%,respectively.Conclusions Disequilibrium of Th1/Th2(drift to Th1)and raised level of serum sCD30 exist in most of the patients with CRAD which was caused mainly by immune injury.It is with high sensitivity and specificity to identify the CRAD by determining the ratio of Th1/Th2 of CD3+CD8-T lymphocytes cells in peripheral blood and the level of serum sCD30.

Objective To investigate the clinical application of mizoribine (MZR) in minimizing virus infection risk in renal transplant patients. Methods Four transplantation centers in Beijing participated in this clinical trial, and 112 primary cadaveric renal allograft recipients were enrolled. MZR in combination with CsA and corticosteroids was used for the prevention of acute rejection (AR). The biochemical data were observed and the infections of 7 different viruses were monitored and recorded. Results All patients were followed up for 12-20 months (average 15. 5 months). The patient/graft survival rate was 96% and the morbidity of AR was 11.6%. All ARs were converted. The major side effect was hyperuricimia, which could be controlled without withdrawal of MZR. The morbidity of CMV infection was 11.6% and no CMV diseases occurred. Only one case experienced adenovirus infection. Conclusions MZR is a safe and effective immunosuppressants. Hyperuricimia should be controlled after operation. The morbidity of virus infections was relatively lowered.

Objective To study the inhibition effect of anti-CD 25 monoclonal antibody (Simulect) to the activated T cells in the recipients of kidney transplantation. Methods Forty-six recipients of renal transplantation were randomly divided into therapeutic group with simulect (23 cases) and control group (23 cases).All recipients in both groups received immunosuppressive therapy with neoral,azatheoprine and predonine conventionally.The recipients in simulect group received additionally 20 mg simulect at 2h preoprative and 4d postoperative,respectively.Several phenotypes of lymphocyte in the peripheral blood of all recipients were observed sequentially with flow cystometer. Results Compared with the control group,the number of activated T cells(CD + 25 ) decreased significantly within 24h after the first dose in the patients who received simulect,and the level of the cells that expressed CD 25 was significantly lower than that of control during the whole observation( P

To study the expression of matrical metalloproteinases 2 and 9 (MMP 2 ,MMP 9 ) in human renal cell carcinoma(hRCC) and its relation to prognosis, 36 specimens of human renal cell carcinoma (hRCC) and 6 normal kidneys served as controls were assessed by immunohistochemistry (SP method). The results showed that the positive expression rates of MMP 2 , MMP 9 in hRCC were 44 4% and 52 8%,respectively. There was a significant difference in expression between various grades and stages of hRCC. The expected survival time was shorter in patients with higher expresson of MMP 2 and MMP 9 . Therefore, MMP 2 and MMP 9 are considered as important factors in invasive metastasis and prognosis of hRCC.

Objective To evaluate the effect of biochemotherapy (?-interferon or recombinant interleukin 2 plus 5-fluorouracil) in the treatment of renal cell carcinoma (RCC) after nephrectomy. Methods Thirty-six patients with RCC admitted during 1993 and 1996 were randomly divided into two groups; the treatment group (combined nephrectomy and biochemotherapy) and control group with nephrectomy alone. Results Biochemotherapy did not show significant effect on five-year survival rate in those patients with the lower grading (Ⅰ, Ⅱ stages) RCC or with negative expression of matrix metalloproteinases 2 and 9 (MMP 2,MMP 9). On the other hand, this treatment regimen showed good clinical results in the higher grading (Ⅲ, Ⅳ stages) cancer patients, and the five-year survival rate was higher in the patients with positive expression of MMP 2 and MMP 9 of RCC than those without biochemotherapy. Conclusion Biochemotherapy is a safe and effective adjunctive treatment for patients with RCC after nephrectomy. Some side-effects should be taken care of. Its doses and administration route should be further studied to enhance the treatment efficacy and reduce side-effects.

Objective To investigate the causes of death of renal transplantation recipients during perioperative period. Methods One thousand one hundred and twenty-three cases of renal transplantation patients admitted to 309 Hospital of PLA from Nov. 1988 to Apr. 2003 were analyzed retrospectively. Results Twenty-four patients died (2.1%), among them, 10 died from infection, 8 from cadio-cerebral vascular disease, 3 from stress ulcer, 2 from fulminant hepatic failure, and 1 from hyperosmolar nonketosis diabetic coma. Conclusions It is essential to confirm the diagnosis early and give effective treatment immediately in renal transplantation patients during perioperative period. Preventive measures aiming at decreasing the risk factors should be emphasized.

Objective To evaluate the technique of modified simultaneous renal-pancreatico-duodenal transplantation (SKPT) with enteric drinage (ED). Methods Simultaneous pancreaticoduodenal and kidney transplantation of cadaver donors has been performed for one uremic patient with insulin-dependent diabetes mellitus (IDDM). The allograft exocrine secretions were drained into the proximal jejunum via a side-to-side duodenojejunostomy (non Roux-en-Y). The patient received an immunosuppression therapy including zenapax (CD25 antibody), FK506, mycophenolate mofitil (MMF), and predinisone. Results Exogenous insulin was withdrawn on the 7 th day after operation and the renal function became normal on the 3 rd day. No serious surgical complication occurred. 35 days after operation, the patient was discharged with normal pancreatic and renal function. Conclusions (1) The modified ED-SKPT without Roux-en-Y anastomosis is a safe and effective procedure for the treatment uremia accompanied by of IDDM. (2) The modified ED-SKPT (non Roux-en-Y) is simpler than traditional method (with Roux-en-Y) in surgical technique, and it has no operation related complications as seen after BD-SKPT (simultaneous kidney-pancreatico-duodenal transplantation with bladder drainage). (3) Current immunosuppressive agents and good HLA-typing may decrease complications.