Child ; China ; Humans ; Kidney Transplantation ; Pediatrics

Objective To investigate the diagnosis and treatment of vascular complications after allograft kidney transplantation.Methods The clinical data of 34 patients with vascular complications after renal allograft transplantation were retrospectively studied,and the characteristics,diagnosis and therapeutics were analyzed.Results Among the 34 patients,there were 13 cases of allograft renal(artery) obstruction,8 cases of allograft renal artery hemorrhage,7 cases of arterial anastomosis(rupture),4 cases of allograft renal vein obstruction,1 case of external iliac artery aneurysm and 1 case of external iliac vein thrombosis.Diagnosis was made in 21 patients by color Doppler flow imaging(CDFI),among whom 10 received further examination of magnetic resonance angiography(MRA).In the 5 cases of allograft renal artery stenosis(TRAS),3 came out with well renal function after the placement of endovascular stents.During the follow-up duration of 8,10 and 14 months,their serum creatinine(Scr) maintained between 115 and 135 ?mol/L.TRAS patient's allograft renal artery which had been anastomosed end-to-end with internal iliac artery was shifted to end-to-side style with(external) iliac artery at the second time,and came out with normal Scr one month postoperation.One TRAS patient received conservative treatment because MRA examination indicated only mild stenosis,and his Scr has been decreasing for 21 days till now.Three patients with allograft renal vein(obstruction) was treated with surgery,in whom one died of heart failure,and the other 2 patients'(renal) function recovered well during the follow-up of respectively 13 and 36 months.One patient with external iliac vein thrombus died of allograft rupture.All the other patients underwent allograft(resection).Conclusion Vascular complications after renal transplantation progresses fast once(developed) with a poor prognosis,so early diagnosis is essential for graft as well as survival and(effective) management should be administrated accordingly.CDFI could be the first choose for screening.

Objective To observe the effect of tacrolimus vs cyclosporin A on liver function after kidney transplantation. Methods Seventy-three cases of HBV carriers received kidney transplantation. Their liver functions before operation were normal and HBV DNA was negative. After operation they were divided into two groups: FK506 group (n=40) taking FK506, mycofenolate mofetil (MMF) and prednisone to prevent rejection. CsA group (n=33) taking CsA, MMF and prednisone to prevent rejection. The cases were followed for 1 to 6 years. The incidence of liver function admage and HBV DNA positive rate were observed in two groups. When damage to liver function appeared, the doses of immunosuppresive drugs were regulated, and the drugs protecting liver function were given. Results Four cases ( 10.0 % ) in FK506 group and 16 cases ( 48.5 %) in CsA group suffered the damage to liver function. In 2 cases ( 5.0 %) of FK506 group and 9 cases ( 27.3 %) of CsA group, HBV-DNA transferred to positive (P

6.2 mmol/L) who underwent renal transplantation accepted pravastatin therapy (10 mg, qn) for 8 weeks. The changes of total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) , triglyceride (TG), endothelin (ET) and nitrous oxide (NO) were measured before and after pravastatin treatment. By using high resolution ultrasound, endotheli-um-dependent relaxing function was measured before and post pravastatin treatment. Thirty people with normal blood cholesterol served as controls and subjected to the above examinations. Results In renal transplantation group, ET was significantly higher and NO significantly lower than in control group. After treatment with pravastatin, NO was significantly increased, while ET, TC, LDL-C and TG were significantly reduced. HDL-C was increased, but no significant difference was found. Flow-mediated vasodilations were greater after pravastatin treatment than before, but smaller than control group. Conclusion Pravastatin can theat dyslipidemia after renal transplantation and improve impaired endothelium-dependent vasodilation.

0.05) than those with that of 1.0 mm (P

Objective To study the feasibility and safety of horseshoe kidney transplantation and avoid the waste of the donor kidney. Methods The horseshoe kidney was identified and confirmed during the organ procurement process. It was perfused in situ and procured en bloc. With an appropriate dissection and reconstruction on the beach table, the horseshoe kidney was carefully divided at the isthmus and transplanted into two separate recipients. The surgical strategies and postoperative outcomes of transplanting the cadaveric horseshoe kidneys were evaluated. Results Two recipients had a immediate return of renal function after the blood vessels were opened. One recipient had a normal renal function presented as lower post-transplant serum creatinine values with a follow-up of 12 months. There was no complications related to the horseshoe kidney. Another case died of infection 1.5 month later after the transplantation. Conclusions Cadaveric horseshoe kidney may be transplanted successfully using various individual technical strategies based on the specific renal anatomy. Considering the lack of donor horseshoe kidney transplantation is feasible and safe.

Objective To compare the long-term effect and safety between tacrolimus (FK506) and cyclosporine (CsA) in patients receiving cadaveric renal transplantation. Method A total of 210 patients were randomized to FK506 and CsA after cadaveric renal transplantation, and were followed up for 12-32 months for the variation of trough concentration in whole blood, the incidence of acute rejection and chronic rejection, one-year survival rate of patient/graft, variation of creatinine level, impairment of liver function and glucose metabolism and lipid metabolism, incidence of infection, and side effects. Results The variation of trough concentration of FK506 was similar to CsA. The incidence of acute rejection was significantly lower in FK506 group than in CsA group ( 16.3 % vs 33.0 % , P 0.05 ). The incidence of impaired liver function and impaired lipid metabolism and gingivitis and creatinine level three months after transplantation were significantly lower in FK506 group than in CsA group ( P

Objective To study the clinical efficacy and safety of rapamycin in combination with CsA and steroid to prevent the acute rejection of kidney transplantation. Methods In an open-label,multi-center study,there were 100 primary renal allograft recipients with cadaveric donors enrolled from 4 transplantation centers in China. The immunosuppressive regimen was the triple therapy of rapamycin in combination with CsA and steriod. Rapamycin was administered in 48 h after grafting. The first dose of rapamycin was 6 mg /day and the maintenance dose was 2 mg /day. Results Eighty-four recipients were followed up for more than 6 months. Rapamycin was discontinued in 16 patients because of the adverse events and other reasons. Eight patients experienced acute rejection and 7 patients were reversed by methyprednisolon therapy. In 6 of the 7 patients,the dose of rapamycin was maintained 2 mg /day. The remaining one was added to 3 mg /day. No recurrence of AR was observed in a continuous follow-up of more than half-year. The most common and significant adverse events were hyperlipoidemia and abnormal liver function.Conclusions The combination of rapamycin with CsA and steroid to treat recipients of kidney transplantation is safe and efficient. There was a low incidence of AR but a high incidence of hyperlipoidemia and abnormal liver function. The rational regulation of the dose may reduce the incidence of the side-effects. Further observation and study are required for long-term application.

Objective To investigate the effects of a corrective tr ea tment on open bite malformations, such as gnash their teeth, nail-biting, tongu e thrusting, impacted tooth, cross bite with improper correction, open bite defo rmity resulted from premature shedding of deciduous tooth and molar cysts. Methods We used dental resin technology: acid etching the teeth, adh ering metal clasps to the teeth by means of composite resin, and applying elasti c bands for intermaxillary traction to correct the cross bite. Results We had treated 22 patients, age ranged from 7-30, with the malformatio ns resulted from different kinds of reasons, and obtained significant results. Conclusion With cooperation of the patients, simple corrections for open bite with sticky clasp and occlusion with elastic band are easy to car ry on, with short period of treatment time, and every patient gets prominent out come. It is effective, prior to commonly-used corrective therapy and deserves t o be widely used.

Objective To investigate the therapeutic effect of rapamycin in the treatment of malignancies after kidney transplantation (KT).Methods Of the 23 inoperable patients with malignancies after KT, 8 (RPM group) received Rapamycin as treatment as well as there immunosuppressive regimens were modulated, and the remaining 15 (non-RPM group) were treated only by immunosuppressive regimen modulation, some of whom also received chemotherapy. The survival of the patients in the two groups was compared.Results In RPM group, the median survival time was (14.5) months and no acute rejection (AR) occurred during whole follow-up period. There are still 7 patients alive at the end of this study. One recipient with Kaposi’s sarcoma developed AR because of RPM dose reduction, and finally died of transplanted kidney failure and pulmonary infection. In non-RPM group, the median survival time was (3.0) months, and all of them died during the follow-up period. The 12- and 20-month survival rates were respectively (75.0) % and (37.5) % in RPM group, while (7.1) % and 0 in non-RPM group with the difference being statistically significant (P