Objective: To evaluate the short-and mid-term efficacy of pediatric kidney transplantation and the risk factors for kidney graft and recipient. Methods: The baseline data and postoperative complications of pediatric donors and recipients of 284 kidney transplants were retrospectively analyzed in the Department of Kidney Transplantation in the First Affiliated Hospital of Zhengzhou University from August 2010 to May 2021 and all subjects were followed up until December 31, 2021. According to the survival status of donors and recipients, they were divided into the graft-loss group and the graft-survival group, and the recipient death group and survival group, respectively. Univariate comparison between groups was performed by Log-rank test, and Cox proportional risk model was used to explore the independent risk factors for the graft and recipient survival. Results: Among the 284 children recipients, 184 cases (64.8%) were male and 100 cases(35.2%) were female, and 19 cases (6.7%) were living relative donor renal transplantation, 19 cases (6.7%) were preemptive transplantation, and 8 cases were secondary transplantation. The age of 284 recipients at the time of transplantation was 13.0 (9.0, 15.0) years, among whom 29 cases aged 0-6 years, 96 cases aged 7-11 years old, and 159 cases aged 12-18 years. The 1, 3, and 5 year survival rates were 92.3%, 88.9% and 84.8% for the kidney grafts, and were 97.1%, 95.6% and 94.4% for the recipients, respectively. Multivariate analysis showed postoperative acute rejection (HR=3.14, 95%CI 1.38-7.15, P=0.006) and perioperative vascular complications (HR=4.73, 95%CI 2.03-11.06, P<0.001) were independent risk factors for the survival of kidney graft. Postoperative infection (HR=14.23, 95%CI 3.45-58.72, P<0.001) was an independent risk factor for the postoperative mortality of recipients. Conclusions: Pediatric kidney transplantation shows a good short-and mid-term prognosis. Postoperative acute rejection and perioperative vascular complications are the risk factors for the survival of kidney graft, and postoperative infection is the risk factor affecting the survival of recipient.
Child ; Female ; Graft Rejection ; Graft Survival ; Humans ; Kidney Transplantation/adverse effects* ; Living Donors ; Male ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Risk Factors

BACKGROUND: BK virus-associated nephropathy (BKVN) is an important cause of chronic allograft dysfunction. The objective of our study was to evaluate the prognosis of BKVN. METHODS: We retrospectively reviewed the data of 133 renal transplant recipients with BKVN treated at the First Affiliated Hospital of Sun Yat-Sen University between July 2007 and July 2017. BK viral loads, graft function, and pathologic indexes were compared between initial diagnosis and last follow-up. RESULTS: After a mean follow-up period of 14.4 (range, 0.3-109.6) months after diagnosis of BKVN, BK viruria, and BK viremia become negative in 19.5% and 90.2% of patients, respectively. The mean estimated glomerular filtration rate (eGFR) at last follow-up was lower than at diagnosis of BKVN (18.3 ± 9.2 vs. 32.8 ± 20.6 mL·min·1.73 m, t = 7.426, P < 0.001). Eight (6.0%) patients developed acute rejection after reducing immunosuppression. At last follow-up, the eGFR was significantly lower in patients with subsequent rejection than those without (21.6 ± 9.8 vs. 33.5 ± 20.9 mL·min·1.73 m, t = 3.034, P = 0.011). In 65 repeat biopsies, SV40-T antigen staining remained positive in 40 patients and became negative in the other 20 patients. The eGFR (42.6 ± 14.3 vs. 26.5 ± 12.3 mL·min·1.73 m), urine viral loads (median, 1.3 × 10vs. 1.4 × 10 copies/mL), and plasma viral load (median, 0 vs. 0 copies/mL) were all significantly lower in patients with negative SV40-T antigen staining than those with persistent BK involvement (all, P < 0.05). Five (3.8%) recipients lost their graft at diagnosis of BKVN, and 13 (9.8%) lost their graft during the follow-up period. The 1-, 3-, and 5-year graft survival rates after diagnosis of BKVN were 99.2%, 90.7%, and 85.7%, respectively. Higher pathologic stage correlated with lower allograft survival rate (χ = 6.341, P = 0.042). CONCLUSION Secondary rejection and persistent histologic infection in BKVN lead to poor prognosis.
Adolescent ; Adult ; Aged ; BK Virus ; Child ; Female ; Glomerular Filtration Rate ; Graft Rejection ; Graft Survival ; Humans ; Kidney Diseases ; complications ; Kidney Transplantation ; adverse effects ; Male ; Middle Aged ; Polyomavirus Infections ; complications ; Retrospective Studies ; Viral Load ; Viremia ; complications ; Young Adult

OBJECTIVETo investigate the clinical predictors of cytomegalovirus (CMV) infection after liver transplantation.

METHODSThe clinical data of 182 patients (146 male and 36 female with a mean age of (50 ± 7) years) receiving liver transplantation in Beijing Chaoyang Hospital between January 2004 and December 2008 were retrospectively analyzed.All patients were divided into two groups, namely the CMV infection group (n=24) and the control group (n=158). Logistic regression was used to identify the predictive factors of postoperative CMV infection.

RESULTSAccording to univariate analysis results, the factors for CMV infection were acute liver failure (P=0.032), MELD score ≥ 30 (P=0.001), liver retransplantation (P=0.002), acute rejection (P=0.000) and delayed graft function (P=0.022). According to multi-analysis results, MELD score ≥ 30 (P=0.037, 95%CI:1.194-271.461) and acute rejection (P=0.033, 95%CI:1.179-51.863) were proved to be independent predictors by multivariate analysis.

CONCLUSIONThe study indicates that MELD score ≥ 30 and acute rejection are the independent predictors of CMV infection.

Adult ; Beijing ; Cytomegalovirus Infections ; diagnosis ; End Stage Liver Disease ; diagnosis ; Female ; Graft Rejection ; Humans ; Liver Transplantation ; adverse effects ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications ; virology ; Reoperation ; Retrospective Studies ; Severity of Illness Index

OBJECTIVE: To determine the effect of transient withdrawal of immunosuppressive agents during the treatment of pulmonary infection on long-term survival of patients and graft s. METHODS: A total of 104 patients with post-transplant pulmonary infection were enrolled in this study. These patients received renal transplantation in Center for Organ Transplantation, Xiangya Hospital, Central South University, during December 2005 and August 2014. Among them, 50 patients stopped immunosuppressive agents during the treatment of infection. These patients served as stopping drug (SD) group, whereas the remaining patients who served as a control group did not stop immunosuppressive drugs. The five-year cumulative patient survival, graft survival, and laboratory results were compared between the 2 groups. RESULTS: The five-year cumulative patient survival rates in the SD group were significantly lower than those in the control group [(69.8 ± 7.0)% vs (94.2 ± 3.2)%, P=0.001]. There was no significant difference in the allograft survival rates between the 2 groups [(81.7 ± 6.6)% vs (90.9 ± 4.3)%, P=0.113]. In patients who survived from pulmonary infection, there was no significant difference in long-term survival rates between the 2 groups (P=0.979). CONCLUSION Pulmonary infection impacts allograft survival after patients underwent renal transplantation. Transient stopping immunosuppressive agents during the treatment of infection is a safe and necessary treatment strategy for patients with serious post-transplant pulmonary infection.
Graft Rejection ; Graft Survival ; Humans ; Immunosuppressive Agents ; administration & dosage ; Kidney Transplantation ; Lung Diseases ; therapy ; Postoperative Complications ; Survival Rate ; Transplantation, Homologous

INTRODUCTIONDue to lifelong immunosuppression, renal transplant recipients (RTRs) are at risk of infectious complications such as pneumonia. Severe pneumonia results in respiratory failure and is life‑threatening. We aimed to examine the influence of immunosuppressant dose reduction on RTRs with bacterial pneumonia and respiratory failure.

METHODSFrom January 2001 to January 2011, 33 of 1,146 RTRs at a single centre developed bacterial pneumonia with respiratory failure. All patients were treated using mechanical ventilation and aggressive therapies in the intensive care unit.

RESULTSAverage time from kidney transplantation to pneumonia with respiratory failure was 6.8 years. In-hospital mortality rate was 45.5% despite intensive care and aggressive therapies. Logistic regression analysis indicated that a high serum creatinine level at the time of admission to the intensive care unit (odds ratio 1.77 per mg/dL, 95% confidence interval 1.01-3.09; p = 0.045) was a mortality determinant. Out of the 33 patients, immunosuppressive agents were reduced in 17 (51.5%). We found that although immunosuppressant dose reduction tended to improve in-hospital mortality, this was not statistically significant. Nevertheless, during a mean follow-up period of two years, none of the survivors (n = 18) developed acute rejection or allograft necrosis.

CONCLUSIONIn RTRs with bacterial pneumonia and respiratory failure, higher serum creatinine levels were a mortality determinant. Although temporary immunosuppressant dose reduction might not reduce mortality, it was associated with a minimal risk of acute rejection during the two-year follow-up. Our results suggest that early immunosuppressant reduction in RTRs with severe pneumonia of indeterminate microbiology may be safe even when pathogens are bacterial in nature.

Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Bacterial Infections ; complications ; Comorbidity ; Creatinine ; blood ; Female ; Graft Rejection ; Hospital Mortality ; Humans ; Immunosuppression ; adverse effects ; Immunosuppressive Agents ; administration & dosage ; therapeutic use ; Intensive Care Units ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Pneumonia ; complications ; microbiology ; Renal Insufficiency ; complications ; immunology ; surgery ; Respiratory Insufficiency ; complications ; Retrospective Studies ; Risk Factors

Since the introduction of pancreas transplantation more than 40 years ago, surgical techniques and immunosuppressive regiments have improved and both have contributed to increase the number and success rate of this procedure. However, graft survival corresponds to early diagnosis of organ-related complications. Thus, knowledge of the transplantation procedure and postoperative image anatomy are basic requirements for radiologists. In this article, we demonstrate the imaging spectrum of pancreas transplantation with enteric exocrine drainage.
Adult ; Anastomosis, Surgical/methods ; Diagnostic Imaging/methods ; Drainage/methods ; Female ; Graft Rejection/pathology ; Graft Survival ; Humans ; Iliac Artery/radiography/surgery ; Immunosuppressive Agents ; Kidney Transplantation ; Male ; *Medical Illustration ; Mesenteric Artery, Superior/radiography/surgery ; Middle Aged ; Pancreas/*blood supply/radiography ; Pancreas Transplantation/adverse effects/*methods ; Pancreatitis, Graft/etiology ; Portal Vein/radiography/surgery ; Postoperative Complications/radiography ; Postoperative Hemorrhage/etiology ; Survival Rate

PURPOSE: To investigate the clinical outcomes of primary pediatric keratoplasty. METHODS: Records of patients who underwent penetrating keratoplasty at the age of 5 years or younger were retrospectively reviewed. The survival rates of corneal grafts, postoperative complications, and causes of graft failure were evaluated. RESULTS: A total of 31 penetrating keratoplasties were performed in 29 patients, two of which were bilateral. The mean follow-up period was 78.72 +/- 8.94 months. The overall graft survival rate was 51.61%. The graft survival rate was 77.4% at 6 months, 61.3% at 12 months, 57.5% at 2 years, and 49.5% at 5 years after the surgery (the median survival time, 39.2 months). The main surgical indications included sclerocornea (35.5%), followed by Peter's anomaly (25.8%) and congenital glaucoma (9.7%). There were significant differences in graft survival time among the surgical indications, of which sclerocornea was the worst (p = 0.003). The main cause of graft failure was rejection (46.7%), followed by infection (26.7%) and primary endothelial decompensation (20%). When patients were sub-grouped according to age (under 12 months, between 12 to 48 months, and over 48 months), there was significant difference in graft survival time (p = 0.037) but not in overall graft survival rate (p = 0.154). Graft rejection occurred more frequently in patients between 12 to 48 months of age compared to other age groups (p = 0.016). Three out of 13 graft infections occurred in patients under 12 months of age. CONCLUSIONS: The type of disease causing corneal opacity was a significant factor affecting the clinical outcomes of penetrating keratoplasty in children.
Child ; Cornea ; Corneal Diseases ; Corneal Opacity ; Follow-Up Studies ; Glaucoma ; Graft Rejection ; Graft Survival ; Humans ; Keratoplasty, Penetrating ; Postoperative Complications ; Rejection (Psychology) ; Retrospective Studies ; Survival Rate ; Transplants

To summarize the case of combined heart-lung transplantation for a patient who survived for 8.5 years. On September 20, 2003, at Second Xiangya Hospital of Central South University, homologous heartlung transplantation was performed on a male patient who was diagnosed with cardiopulmonary failure secondary to congenital ventricular septal defect with severe pulmonary hypertension. Heart-lung allograft was preserved with 1500 mL modified St.Thomas solution and 3000 mL modified LPD solution. Postoperative immunosuppressive therapies included: methylprednisolone and human anti-lymphocyte globulin protein in the induction period; and combination of ciclosporin A, CellCept and prednisolone in the stable period. In 2007, the treatment was changed to CellCept mg, twice a day+FK506 4 mg, twice a day. The patient lived 8.5 years of normal life with cardiac function of NYHA I-II. Echocardiogram showed left ventricular ejection fraction of 61% to 74%. Heart-lung transplantation proved reliable therapy modality for terminal cardiopulmonary failure. Excellent donor organ preservation and proper perioperative treatment are key factors for long-term survival after heart-lung transplantation.
Eisenmenger Complex ; surgery ; Follow-Up Studies ; Graft Rejection ; Heart Septal Defects, Ventricular ; complications ; surgery ; Heart-Lung Transplantation ; methods ; Humans ; Hypertension, Pulmonary ; etiology ; surgery ; Immunosuppressive Agents ; therapeutic use ; Male ; Young Adult

PURPOSE: To report the long term clinical results of penetrating keratoplasty as a treatment for corneal macular dystrophy. METHODS: Retrospective review of the medical record of 46 eyes (31 indivisuals) who underwent primary PK for corneal macular dystrophy at the Seoul St. Mary's Hospital between November, 1986 and December, 2011. Data extracted preoperative and postoperative best-corrected visual acuity (BCVA), postoperative complications (including graft rejection episodes, and recurrent dystrophy), change of endothelial cell density at 1, 6, 12, 24, 36 months and yearly thereafter. RESULTS: After a mean follow-up period of 91.59 +/- 3.2 months, the mean BCVA was significantly improved after penetrating keratoplasty. Endothelial cell loss rate was marked during the 1st year after penetrating keratoplasty. Graft survival was 40 graft (89.7%) at 8yrs. There was a statistically significant increased likelihood of graft failure if the patient was older than 40 years at the time of surgery (p = 0.03). Glaucoma as postoperative complication was 17.4%. Clinically significant recurrence was 2%. CONCLUSIONS: Penetrating keratoplasty is associated with a good visual outcome and prognosis for graft survival of long-term efficacy with a low complication rate in eyes with macular corneal dystrophy.
Corneal Dystrophies, Hereditary ; Endothelial Cells ; Eye ; Follow-Up Studies ; Glaucoma ; Graft Rejection ; Graft Survival ; Humans ; Keratoplasty, Penetrating ; Medical Records ; Postoperative Complications ; Prognosis ; Recurrence ; Retrospective Studies ; Transplants ; Visual Acuity

Transplantation of islet cells into diabetic patients is a promising therapy, provided that the islet cells are able to evade host immune rejection. With improved islet viability, this strategy may effectively reverse diabetes. We applied 2% calcium alginate to generate small and large capsules to encapsulate porcine neonatal pancreatic cell clusters (NPCCs) using an air-driven encapsulator. After encapsulation, the viability was assessed at 1, 4, 7, 14 and 28 days and secretion of functional insulin in response to glucose stimulation were tested at days 14 and 28. Selective permeability of the small alginate capsules was confirmed using various sizes of isothiocyanate-labeled dextran (FITC-dextran). Encapsulation of NPCCs was performed without islet protrusion in the small and large capsules. The viability of NPCCs in all experimental groups was greater than 90% at day 1 and then gradually decreased after day 7. The NPCCs encapsulated in large capsules showed significantly lower viability (79.50 +/- 2.88%) than that of naive NPCCs and NPCCs in small capsule (86.83 +/- 2.32%, 87.67 +/- 2.07%, respectively) at day 7. The viability of naive NPCCs decreased rapidly at day 14 (75.67 +/- 1.75%), whereas the NPCCs encapsulated in small capsules maintained (82.0 +/- 2.19%). After 14 and 28 days NPCCs' function in small capsules (2.67 +/- 0.09 and 2.13 +/- 0.09) was conserved better compared to that of naive NPCCs (2.04 +/- 0.25 and 1.53 +/- 0.32, respectively) and NPCCs in large capsules (2.04 +/- 0.34 and 1.13 +/- 0.10, respectively), as assessed by a stimulation index. The small capsules also demonstrated selective permeability. With this encapsulation technique, small capsules improved the viability and insulin secretion of NPCCs without islet protrusion.
Alginates/chemistry/metabolism ; Animals ; Animals, Newborn ; Capsules/chemistry ; Cell Survival ; Diabetes Mellitus/pathology/*therapy ; Disease Models, Animal ; Glucuronic Acid/chemistry/metabolism ; Graft Rejection/etiology/*prevention & control ; Hexuronic Acids/chemistry/metabolism ; Humans ; Insulin/secretion ; Islets of Langerhans/*metabolism/pathology ; Islets of Langerhans Transplantation/*methods ; Postoperative Complications/etiology/*prevention & control ; *Swine