OBJECTIVETo summarize the experiences in kidney transplantation for 23 years.

METHODSFrom 1978 to 2001, 2123 kidney transplantations were performed for 2012 patients with end stage renal failure. We analyzed the survival rate of patient/kidney at 1-, 3-, 5 years. The possible factors that could influence the transplantation including general data, donor kidney, surgical technique, immunosuppressants, PRA measurement, HLA-antigen matching, complications were also analyzed retrospectively.

RESULTSIn 423 cases (1978 to 1990), hyper-acute rejection occurred in 9 (2.1%) and acute rejection in 198 (46.8%). The 1-, 3-, and 5 years patient/graft survival rates were 86.7%/76.3%, 72.5%/67.9% and 69.5%/59.3% respectively. In the 1700 cases (1991 to 2001), acute graft rejection occurred in 252 (14.8%) but no hyper-acute rejection was observed. The 1-, 3-, and 5 year patient/graft survival rates were 98.6%/96.7%, 93.1%/87.3% and 88.1%/83.6% respectively.

CONCLUSIONSKidney transplantation is a treatment of choice for patients with end-stage renal failure. Well preoperative preparation is the assurance of a successful transplantation; the high quality of donor's kidney is essential to a successful transplant operation. PRA negative and high grade HLA matching can decrease the ratio of early allograft loss and improve patient/kidney survival rate. Combined medication is also important to prevent rejection and decrease drug toxicity. Low-dosage of CsA with MMF and Pred is the ideal regimen of immunosuppressive therapy.

Aged ; Aged, 80 and over ; Female ; Graft Rejection ; Graft Survival ; drug effects ; Humans ; Kidney Transplantation ; immunology ; Male ; Multivariate Analysis ; Retrospective Studies

BACKGROUNDA living fetus within the maternal uterus provides an example of allogene tolerance in mammals. Poria cocos Wolf is the main component of many Chinese medicinal combination drugs that have therapeutic effects on recurrent spontaneous abortion and that can maintain pregnancy until delivery. It was hypothesized that this herbal medicine can also prolong allograft survival after organ transplantation. Here, in an in vivo study, we report the anti-rejection effect of the ethanol extract of Poria cocos Wolf (EEPCW) in rats after cardiac allograft implantation.

METHODSTen normal rats were healthy controls. Eighty rats receiving homologous heart transplants were divided into 4 groups of 20 rats each based on type of treatment: olive oil 8 ml.kg(-1).d(-1), EEPCW 25 mg.kg(-1).d(-1), EEPCW 50 mg.kg(-1).d(-1) or cyclosporin A 5 mg.kg(-1).d(-1). Allograft survival was observed in 10 rats from each group. On the seventh day post transplantation, pathological lesions and percentages of CD3+, CD4+, and CD8+ lymphocytes and the CD4+/CD8+ ratio in peripheral blood were assessed in another 10 rats from each group and in 10 normal rats.

RESULTSThe survival time of donor hearts in the two EEPCW groups was significantly prolonged, to (15.9 +/- 2.4) days and (30.0 +/- 0.0) days, respectively, compared with (6.7 +/- 0.8) days in the control group. Pathological lesions in the two EEPCW groups were also less severe, and the percentages of CD3+, CD4+, and CD8+ lymphocytes and CD4+/CD8+ ratio were significantly lower in the EEPCW groups.

CONCLUSIONSAcute rejection of heart transplants and cellular immune reaction can be effectively suppressed using the EEPCW. Taking advantage of novel immunosuppressants derived from Chinese medicinal herbs used to treat abnormal pregnancy provides a hopeful road for future research and treatment in organ transplantation.

Animals ; Drugs, Chinese Herbal ; pharmacology ; Graft Rejection ; prevention & control ; Graft Survival ; drug effects ; Heart Transplantation ; Immunosuppressive Agents ; pharmacology ; Male ; Polyporales ; chemistry ; Rats ; Rats, Sprague-Dawley ; Rats, Wistar

BACKGROUND: It has been well known that the degree of HLA matching in renal transplantation is important in graft and patient survival. Because HLA-identical living-related donor grafts are free from immunological attacks, they have benefits of one immunosuppressants or early withdrawal of steroids. However, there is acute rejection due to early withdrawal of immunosuppressants and graft loss due to recurrent glomerulonephritis following HLA- identical living-related renal transplantation. The purpose of this study is to determine the graft survival and the impact of recurrent glomerulonephritis on graft survival in HLA-identical living-related donor grafts. METHODS: From December 1984 to March 2004, 44 HLA-identical and 80 HLA-haploidentical living- related renal transplants in Bongsaeng Memorial Hospital were included in this study. We evaluated graft survivals, immunosuppressants and causes of graft failure. RESULTS: The mean graft survival for HLA-identical transplants is 198 months (16.5 years) and for HLA-haploidentical transplants is 166 months (13.8 years), respectively (p=NS). Acute rejection episodes occurred in 2 of the 44 (5%) identical transplants and 17 of the 80 (21%) haploidentical transplants, respectively (p=0.013). 6 grafts were lost in HLA- identical transplants and the causes are 4 recurrent glomerulonephritis (66.7%), 2 chronic rejections (33.4 %). 11 grafts were lost in HLA-haploidentical transplants and the causes are 6 chronic rejections (54.5 %), 1 acute rejection (9.1%), 1 drug toxicity (9.1%), 3 patient deaths (27.3%). Recurrent glomerulonephritis in HLA-identical transplants are three, but in HLA-haploidentical transplants are none. CONCLUSION: Our data revealed that there was no difference in graft survival between the two groups, but lower acute rejection rate in HLA-identical groups. Recurrent glomerulonephritis was the main cause of graft failure in HLA-identical groups and the impact of recurrent disease on graft survival needs to be investigated.
Drug-Related Side Effects and Adverse Reactions ; Glomerulonephritis ; Graft Survival ; Humans ; Immunosuppressive Agents ; Kidney Transplantation ; Steroids ; Tissue Donors* ; Transplants

OBJECTIVETo review kidney transplantation in the center and analyze the risk factors affecting long-term allograft survival.

METHODSThirty-two relative variables were analyzed with SAS statistical software. Using Log-rank method, we investigated influence of these variables on short-and long-term survival of grafts. Kaplan-Meier analysis was used to estimate the 1-, 3-, 5-, 10-years graft survival rates and half-life. Proportional hazards regression analysis (Cox model) was used to assess and rank the relative risk of potential variables.

RESULTSThe 1-, 3-, 5-, 10-years graft survival rates were 83%, 75%, 66% and 48%. After excluding the patients died with functioning grafts, the 1-, 3-, 5-, 10 years grafts survival rate increased to 89%, 82%, 75% and 69%, respectively. The mean half-life was 8.78 +/- 0.14 and 14.09 +/- 0.20 years, respectively. By Log-rank analysis, factors affecting short- and long-term graft survival were identified as: renal function, duration of graft function became normal, cold-ischemia time, presence of acute rejection, delayed graft function, immunosuppressive regimen, complication, infection, anti-rejection therapy. Cox model multivariate analysis showed that there were 18 factors affecting graft survival.

CONCLUSIONSNew immunosuppressive agents not only significantly increase short-term graft survival, but also have the better long-term outcome tendency. Making assurance to get high quality donor organ and minimizing the death with graft function may be the most feasible way to prolong graft survival at present.

Adult ; Cadaver ; Female ; Graft Survival ; drug effects ; Humans ; Immunosuppressive Agents ; pharmacology ; Kidney Transplantation ; Male ; Multivariate Analysis ; Transplantation, Homologous

OBJECTIVETo observe the effect of basic fibroblast growth factor (bFGF) on neovascularization and prefabricated flap survival.

METHODSMale New-Zealand rabbits weighting 2.0-2.5 kg were used in this study. The experimental model used a prefabricated neck flap, supplied by the transferred and implanted central vascular bundle of the ear. 9 micrograms bFGF and 0.2 ml of normal saline was instilled in the vascular pedicle of the experimental and the control group respectively. After 1, 2, 3 weeks of operation, the neovascularization was studied by confocal laser scanning microscope (CLSM) and flap survival was observed.

RESULTSThe neovascularization and survival of the prefabricated flap was different in the experimental and the control groups. The experimental group was better than the control group.

CONCLUSIONbFGF treatment improved sprouting of the implanted vessel and the prefabricated flap survival.

Animals ; Fibroblast Growth Factor 2 ; pharmacology ; Graft Survival ; drug effects ; physiology ; Male ; Microscopy, Confocal ; Neovascularization, Physiologic ; drug effects ; Rabbits ; Surgical Flaps ; blood supply ; physiology ; Time Factors

OBJECTIVETo explore the effect of CD40 blockade in suppressing acute rejection of renal graft in rats.

METHODSWith Wistar rats as the donor and male SD rats as the recipients, rat models of acute renal graft rejection was established. The rat models were divided into therapy group and control group, and in the former group, CD40 ligand (CD40L) monoclonal antibody was injected daily for 4 consecutive days starting on the next day following kidney transplantation. On day 5 after the transplantation, the renal graft was harvested for histological examination, and graft rejection was evaluated semiquantitatively.

RESULTSThe mean semiquantitative score of the renal graft was 0.63∓0.52 in the therapy group, significantly lower than that of the control group (3.72∓1.48, P<0.05).

CONCLUSIONCD40L monoclonal antibody can inhibit acute renal graft in rats.

Animals ; Antibodies, Monoclonal ; pharmacology ; therapeutic use ; CD40 Antigens ; antagonists & inhibitors ; immunology ; CD40 Ligand ; immunology ; Female ; Graft Rejection ; drug therapy ; prevention & control ; Graft Survival ; drug effects ; Kidney Transplantation ; adverse effects ; Male ; Rats ; Rats, Sprague-Dawley ; Rats, Wistar

OBJECTIVETo explore the clinical significance of early diagnose and treatment of subclinical renal allograft rejection.

METHODSNinety-six renal allograft recipients (54 male and 42 female) with normal renal function aged 17 to 58 years (mean 37.5 years) were included in this study. Early subclinical rejection was diagnosed 3 months after the transplantation by color Doppler examination.

RESULTSPatients with early subclinical rejection were given methylpredisolone followed by adjustment of immunosuppressive regimens, and no difference was observed in 3-year survival rate between these patients and those with normal renal allograft findings.

CONCLUSIONEarly diagnosis and treatment of subclinical renal allograft rejection is significant to improve renal allograft survival rate.

Adolescent ; Adult ; Aged ; Early Diagnosis ; Female ; Graft Rejection ; diagnosis ; drug therapy ; etiology ; Graft Survival ; drug effects ; Humans ; Immunosuppressive Agents ; therapeutic use ; Kidney Transplantation ; adverse effects ; methods ; Male ; Methylprednisolone ; therapeutic use ; Middle Aged ; Time Factors ; Ultrasonography, Doppler, Color

Objective: To investigate the effect of exogenous L-Arg on the survival of extended perforator flap in rats. Methods: Sixteen male Sprague Dawley rats were randomly divided into L-Arg group (n=8) and control group(n=8). The extended dorsal three-vascular territory perforator flaps were made in rats. L-Arg (400 mg·kg^-1·d^-1) was injected intraperitoneally in L-Arg group 1d before operation, immediately and 1-7 d after operation, while the same volume of saline was injected intraperitoneally in control group at the same time points. The appearance and distribution of blood vessels were observed, and the flap survival areas were measured 7d after operation. The tissue samples were harvested from choke zone Ⅱ for histological study and the expression of vascular endothelial growth factor (VEGF) was detected by immunohistochemistry and Western blot, respectively. Results: After 7d, the clearer vascular structure and more new vessels in choke zone Ⅱ were observed in L-Arg group. The survival rate of flap in L-Arg group was (88.42±4.19)%, which was significantly higher than that in control group[(76.52±5.37)%, t=3.707, P<0.01]. The microvessel density and caliber of choke zone Ⅱ in L-Arg group was (29.47±5.28)/mm² and(47.27±5.32)μm, which were significantly higher than those in control group (t=2.694 and 2.389, P<0.05 or P<0.01). The immunohistochemistry and Western blot showed that the expression of VEGF in choke zone Ⅱ of L-Arg group was significantly higher than that in control group (t=9.428 and -3.054,P<0.05 or P<0.01). Conclusion: Exogenous L-Arg can increase the survival rate of extended dorsal perforator skin flap through promoting vascularization and dilatation of vessels in choke zone Ⅱ in rats.
Animals ; Arginine ; pharmacology ; Graft Survival ; drug effects ; Male ; Neovascularization, Physiologic ; drug effects ; Perforator Flap ; blood supply ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Skin ; drug effects ; Vascular Endothelial Growth Factor A ; metabolism

OBJECTIVETo study the effect of multiglycosides of Tripterygium wilfordii (MTW) for treatment of proteinuria in kidney transplant recipients.

METHODForty-five kidney transplant recipients with proternuria were randomized into 3 groups (n=15) and received full daily dose (1 mg/kg) MTW, half dose (0.5 mg/kg) MTW or no MTW (control) in addition to immunosuppressant therapy. The 24-hour urinary protein (24 h Upro), blood urea nitrogen (BUN), serum creatinine (Scr), dose of ciclosporin and the adverse effects of MTW were recorded.

RESULTSMTW at both the full dose and half dose significantly reduced the 24 h Upro as compared to exclusive immunosuppressant therapy (P<0.05). The therapeutic dose of ciclosporin in patients with full and half dose of MTW was significantly lower than that in the control group (P<0.05), and the patients receiving full dose MTW showed greater adverse effects than those having half dose MTW (P<0.05).

CONCLUSIONSMTW can significantly ameliorate proteinuria, reduce the therapeutic dose of ciclosporin and protect the renal function in kidney transplant recipients. While producing similar therapeutic effect to routine full dose, long-term use of half dose MTW may reduce the adverse effect associated with MTW.

Adult ; Aged ; Female ; Glycosides ; therapeutic use ; Graft Survival ; immunology ; Humans ; Kidney Transplantation ; adverse effects ; immunology ; Male ; Middle Aged ; Proteinuria ; drug therapy ; etiology ; Tripterygium ; chemistry ; Young Adult

OBJECTIVETo investigate the effect of Hirudin on random skin flap survival in rats.

METHODS24 SD rats were randomly divided into control group and experimental group. The "McFarlane flap (3 cm x 9 cm)" rat models were established on the rat dorsum. 3 ml Hirudin (30 ATU) was injected into the flap in the experimental group, while 3 ml saline in the control group. The injection was performed for 7 days. The flap survival area in the two groups was measured. The tissue samples were taken from proximal (I), middle (II) and distal (III) portions of flaps for histologic study. The VEGF and bFGF expression was also detected with immunohistochemistry method.

RESULTS7 days after operation, the flap survival rate was (69.52 +/- 3.23)% in the experimental group, while (50.36 +/- 2.37)% in control group, showing a significant difference between the two groups (P < 0. 01). In the middle portion, tissue edema and infiltration of neutrophils in experimental group was markedly slighter than that in control group. The VEGF and bFGF expression and neovascularization was enhanced markedly in experimental group.

CONCLUSIONSHirudin can increase the survival of random pattern skin flaps. It may increase the VEGF, bFGF expression through a series of complex regulatory pathway. Then flap neovascularization is promoted and the flap blood supply is increased.

Animals ; Fibroblast Growth Factor 2 ; metabolism ; Graft Survival ; drug effects ; Hirudins ; pharmacology ; Male ; Rats ; Rats, Sprague-Dawley ; Skin Transplantation ; Surgical Flaps ; Vascular Endothelial Growth Factor A ; metabolism