We present dincopathologic features of three cases of biopsy-proven pancreas allograft dysfunction in Korea. All patients had advanced insulin-dependent diabetes mellitus (IDDM). Case 1 was a 30-year-old woman who underwent a simultaneous pancreas-kidney transplantation. Urinary infection developed 6 days after the operation, which remitted and reappeared, when urine amylase level was normal. Since the 55th day after the operation, intermittent hematuria has persisted. Cytomegalovirus inclusions were detected on the urinary bladder and grafted duodenal mucosa. The graft was removed due to perforation of the grafted duodenum and panperitonitis. Case 2 was a 27-year-old man undergoing pancreas transplantation alone (PTA). Ten days after the transplatation, the level of 24 urine amylase decreased and the graft was not delineated by 99mTc DTPA scintigraphy. Allograft needle biopsy revealed multiple acinar cell necrosis and mild lymphocytic infiltration which were compatible with mild acute rejection. Case 3 was a 25-year-old man undergoing cadevaric PTA. Three months after the transplantation, graft was removed due to gastric perforation associated with cytomegalovirus and angiodestructive fungal infection. Various causes of pancreas allograft dysfunction can be diagnosed by needle biopsy, thus appropriate biopsy specimen should be taken using improved biopsy technique.
Adult ; Biopsy, Needle ; Case Report ; Female ; Graft Rejection/physiopathology ; Graft Rejection/pathology ; Human ; Male ; Pancreas/physiopathology* ; Pancreas Transplantation/pathology* ; Transplantation, Homologous

OBJECTIVETo investigate the etiology and therapy of delayed graft function (DGF) recovery in renal transplant recipients.

METHODSThe clinical data were retrospectively analyzed in 15 renal recipients with DGF. All the 15 patients received hemodialysis along with pulse treatment against acute rejection (AR), or immunosuppressant adjustment, or in situ retransplantation after the resection of the original transplanted kidney according to different etiological factors.

RESULTSAmong the 15 patients, 8 developed AR, 5 showed acute renal tubular necrosis (ATN), 1 had grafting-associated renal vein embolism and 1 had acute cyclosporine nephrotoxication. The renal function recovered within 10 to 35 days after transplantation without complication during the follow-up period (0.5-3.0 years).

CONCLUSIONDGF is a common complication after kidney transplantation mainly due to the occurrence of AR and ATN. Good prognosis is expected if etiology-oriented therapy is performed properly and promptly.

Adult ; Delayed Graft Function ; physiopathology ; therapy ; Female ; Graft Rejection ; physiopathology ; therapy ; Graft Survival ; Humans ; Immunosuppressive Agents ; therapeutic use ; Kidney Transplantation ; Male ; Recovery of Function ; Renal Dialysis ; Retrospective Studies

OBJECTIVETo evaluate the feasibility of MR diffusion-weighted imaging (DWI) in diagnosis of acute rejection after renal transplantation.

METHODSSixty-nine patients who underwent renal transplantation were enrolled in the study. According to the clinical features and renal biopsy, 26 patients were designated in rejection group and 43 in non-rejection group. Patients in non-rejection group underwent MR DWI scan at 2 to 3 weeks after operation, and those in rejection group underwent scan at 5 d before or after renal biopsy. Then the apparent diffusion coefficient (ADC) values of transplanted kidneys were measured with high diffusion sensitivity gradient factors (b values).

RESULTSPatients with acute rejection had significantly lower ADC (P <0.04) than non-rejection patients with all the different b values (b=200, 400, 600, 800, 1,000 s/mm(2)). The ROC curves showed that sensitivity and specificity were best when b value was 800 s/mm(2).

CONCLUSIONDWI is a potential and reliable non-invasive method for the diagnosis of the acute rejection after renal transplantation.

Acute Disease ; Diffusion Magnetic Resonance Imaging ; Female ; Graft Rejection ; diagnosis ; Humans ; Kidney ; physiopathology ; Kidney Transplantation ; adverse effects ; Male ; Sensitivity and Specificity

Liver transplantation is a conventional treatment for terminal stage liver diseases. However, several complications still hinder the survival rate. Intestinal barrier destruction is widely observed among patients receiving liver transplant and suffering from ischemia-reperfusion or rejection injuries because of the relationship between the intestine and the liver, both in anatomy and function. Importantly, the resulting alteration of gut microbiota aggravates graft dysfunctions during the process. This article reviews the research progress for gut microbial alterations and liver transplantation. Especially, this work also evaluates research on the management of gut microbial alteration and the prediction of possible injuries utilizing microbial alteration during liver transplantation. In addition, we propose possible directions for research on gut microbial alteration during liver transplantation and offer a hypothesis on the utilization of microbial alteration in liver transplantation. The aim is not only to predict perioperative injuries but also to function as a method of treatment or even inhibit the rejection of liver transplantation.
Animals ; Gastrointestinal Microbiome ; Graft Rejection ; prevention & control ; Humans ; Intestinal Mucosa ; physiopathology ; ultrastructure ; Liver Transplantation ; Rats ; Reperfusion Injury ; prevention & control

OBJECTIVETo gain insight into the role of dendritic cells in graft rejection following penetrating keratoplasty by investigating their distribution in rat cornea.

METHODSOrthotopical corneal transplantation was performed and immunohistochemical staining of the whole-mount cornea and the spleen tissue specimen employed to determine the distribution of the dendritic cells in the cornea.

RESULTSGraft rejection occurred in all rats following the transplantation. No OX-62(+) dendritic cells were found in normal cornea but they were present in the epithelium of the cornea graft with allograft rejection.

CONCLUSIONOX-62(+) dendritic cells presenting in the rejected cornea may be related to acute graft rejection after penetrating keratoplasty.

Animals ; Cornea ; immunology ; pathology ; surgery ; Dendritic Cells ; immunology ; physiology ; Female ; Graft Rejection ; etiology ; immunology ; physiopathology ; Keratoplasty, Penetrating ; adverse effects ; methods ; Male ; Rats ; Rats, Sprague-Dawley ; Rats, Wistar

Adolescent ; Adult ; Aged ; Biopsy ; Delayed Graft Function ; diagnosis ; pathology ; Female ; Graft Rejection ; diagnosis ; pathology ; Humans ; Kidney ; pathology ; physiopathology ; Kidney Function Tests ; Kidney Transplantation ; pathology ; Male ; Middle Aged ; Young Adult

INTRODUCTIONThe status of heart transplantation in Singapore is reviewed in this article.

MATERIALS AND METHODSThe database of 40 consecutive heart transplantations from July 1990 through December 2007 is reviewed retrospectively. The data is compared with the 2008 registry data of the International Society for Heart and Lung Transplantation (ISHLT).

RESULTSThe average age of recipients was 45.3 years. Ages ranged from 14 to 64 years. Ischaemic cardiomyopathy (52.5%) and dilated cardiomyopathy (42.5%) were the major indications. From 1990 to 1999, 50% of the donors sustained brain death from road traffic accident, 25% from cerebrovascular accident and 25% from falling from height, whereas the cause of brain death in the donors from 2000 to 2007 was 33%, 47% and 9.5%, respectively. The average donor age increased from 28.3 to 38.1 years. The significant morbidities in the recipients were hypertension, cytomegalovirus (CMV) infection, cardiac allograft vasculopathy and renal dysfunction. Thirtytwo required treatment for hypertension. 67.5% developed CMV disease requiring treatment. Cardiac allograft vasculopathy was diagnosed in 10. Rising creatinine levels reaching over 2.5 mg/dL was seen in 7. Three required renal dialysis. Epstein-Barr virus related lympho proliferative disorder occurred in 2 patients. One patient developed adenocarcinoma of stomach. The 30-day mortality was 10% and half life was 10 years. Cardiac allograft vasculopathy and sepsis caused 41.7% of mortality each. 11.7% of the mortality was due to cerebrovascular accident.

CONCLUSIONThe status of heart transplantation in Singapore is comparable to the ISHLT registry data. Transplant provides excellent early survival of 80%; however, the expected half life is around 10 years after cardiac transplantation. The late mortality is mainly caused by cardiac allograft vasculopathy (CAV) and renal failure. More effort and research needs to be directed towards these issues to improve the long-term results.

Adolescent ; Adult ; Cytomegalovirus Infections ; Female ; Graft Rejection ; epidemiology ; Heart Failure ; etiology ; physiopathology ; surgery ; Heart Transplantation ; mortality ; utilization ; Humans ; Immunosuppression ; Male ; Middle Aged ; Retrospective Studies ; Singapore ; epidemiology ; Tissue and Organ Procurement ; Transplantation, Homologous ; Young Adult

OBJECTIVETo evaluate the effect of emodin in combination with cyclosporine A (CsA) on rejective reaction against liver graft in rats.

METHODSThe LEW-->BN orthotopic liver transplantation rat model was used in the study. A total of 48 rats were divided into 4 groups randomly and equally, after operation they were intraperitoneally injected respectively with normal saline (0.5 mL d(-1), group A); CsA (10.0 mg kg(-1) d(-1), group B); emodin (50.0 mg kg(-1) d(-1), group C); and CsA plus emodin (group D, at the same dose as in B and C). Six rats taken from each group were sacrificed on the 8th day after operation to calculate the rejection active index (RAI) and hepatocyte apoptosis index (AI). The remainder were stopped medication and used for observing the survival time.

RESULTSThe inter-group comparisons in mean survival time, RAI and AI showed significant difference in comparing group A with group B, C and D (P <0.01), and those in group D were more obvious than in group B and C (P < 0.05, but showed no significant difference between group B and group C (P > 0.05).

CONCLUSIONAdministering of emodin combined with CsA after liver transplantation shows a synergistic effect for suppressing acute rejective reaction in rats.

Animals ; Apoptosis ; drug effects ; Cyclosporine ; administration & dosage ; Drug Synergism ; Emodin ; administration & dosage ; Graft Rejection ; drug therapy ; physiopathology ; Hepatocytes ; cytology ; drug effects ; Liver Transplantation ; Male ; Random Allocation ; Rats ; Rats, Inbred Lew

OBJECTIVETo observe the effects of acupuncture-moxibustion on chronic allograft nephropathy (CAN) and explore the methods of acupoint selection along meridian for transplanted-kidney-related diseases.

METHODSA total of 180 patients of CAN were randomized into a syndrome differentiation group, a spleen-meridian group, a kidney-meridian group and a control group, 45 cases in each one. A total of 33 cases dropped out before the end of the study, including 8 cases in the syndrome differentiation group, 12 cases in the spleen-meridian group, 13 cases in the kidney-meridian group and no case in the control group. Patients in the control group were treated with conventional western medicine; based on this, patients in other three groups were treated with acupuncture-moxibustion. In the syndrome differentiation group, Qihai (CV 6), Hegu (LI 4), Guanyuan (CV 4), Feishu (BL 13), Shenshu (BL 23), etc. were selected for qi deficiency of lung and kidney; Qihai (CV 6), Zusanli (ST 36), Sanyinjiao (SP 6), Taixi (KI 3), Yinlingquan (SP 9), etc. were selected for deficiency of qi and yin; Ganshu (BL 18), Shenshu (BL 23), Sanyinjiao (SP 6), Taixi (KI 3), Yinlingquan (SP 9), Ququan (LR 8), etc. were selected for yin deficiency of liver and kidney; Zhongji (CV 3), Guanyuan (CV 4), Mingmen (GV 4), Guanyuanshu (BL 26), etc. were selected for yang deficiency of spleen and kidney. In addition, Sanyinjiao (SP 6), Diji (SP 8), Yinlingquan (SP 9), Xuehai (SP 10), etc. were added in the spleen-meridian group; Taixi (KI 3), Zhaohai (KI 6), Fuliu (KI 7), Ciliao (BL 32), etc: were added in the kidney-meridian group. Serum creatinine (Scr), creatinine clearance (Ccr) and 24-hour urinary protein before and after the treatment were com- pared among the four groups.

RESULTSAfter treatment, 24-hour urinary protein in the acupuncture-moxibustion groups and control group were all reduced (all P < 0.05); compared before treatment, the Scr in the spleen-meridian group was significantly reduced (P < 0.05); the difference of Ccr before and after treatment was insignificant in all the groups (all P > 0.05). Compared with the control group, 24-hour urinary protein in spleen-meridian group could relieve or recover the damage of transplant kidney induced by CAN. A new interlink may be established between the transplanted kidneys and the spleen meridians, indicating that transplanted kidney-related diseases can be treated by selecting acupoints of spleen meridian.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Allografts ; physiopathology ; Female ; Graft Rejection ; Humans ; Kidney Transplantation ; adverse effects ; Male ; Meridians ; Middle Aged ; Moxibustion ; Renal Insufficiency, Chronic ; etiology ; therapy ; Transplantation, Homologous ; adverse effects

OBJECTIVETo investigate the effect of Danshen injection (DSI) on early stage of renal transplantation.

METHODSOne hundred and twelve patients in early stage after renal transplantation were allocated in the treated group, they were treated by conventional treatment with DSI 60 ml given additionally once a day for 10 days. And 109 patients who received conventional treatment alone after renal transplantation at the corresponding period were allocated in the control group. Indexes in the two groups, including volume of urine, serum creatinine (SCr), endogenous creatinine clearance rate, incidence of delayed graft function and acute rejection reaction, blood viscosity (BV), platelet aggregation rate (PAR) as well as the blood flow resistance in graft measured by color Doppler ultrasonography.

RESULTSThe urinary volume and endogenous creatinine clearance rate in the treated group were significantly higher, but levels of SCr, incidence of renal function recovery retardation, BV, PAR and blood flow resistance in graft were significantly lower than those in the control group (P < 0.05). The difference of incidence of acute rejection reaction between the two groups was insignificant (P > 0.05).

CONCLUSIONDSI can improve blood microcirculation, decrease the incidence of renal function recovery retardation, these effects are helpful for recovery of renal function after renal transplantation.

Adolescent ; Adult ; Aged ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Graft Rejection ; prevention & control ; Humans ; Kidney ; physiopathology ; Kidney Function Tests ; Kidney Transplantation ; Male ; Middle Aged ; Phytotherapy ; Postoperative Period ; Salvia miltiorrhiza ; Transplantation, Homologous