Purpose:To avoid using steroid in long term and decrease its side effects. Methods:We analyzedthe data of 9 cases of patients whose immunosuppressive therapy were based on FK506 and MMF. Steroid hasbeen withdrawn in 6 to 8 months after kidney transplantation. Results:All patients have been followed-up. Theresults indicated that no patient exhibited any acute rejection episode, and the side effects of steroid were dimin-ished. Conclusions :We believe that withdrawal of steroid on basis of FK506 and MMF may be safe. and furtherinvestigations are necessary.

Purpose:To investigate the clinical significance of endothelin(ET) and nitric oxide(NO) analysisin renal allograft recipients. Methods:Blood ET-1 and NO were measured in 32 cases of renal allograft recipients.Results:The ET-1 levels reduced( P＜0.05) and NO levels rose( P＜0.01) after renal transplantation. In pa-tients with acute rejection, the NO level was markedly higher than that in normal group and in chronic rejectiongroup( P＜0.01). In patients with chronic rejection, the ET-1 level was higher than that in normal group( P＜0.01). While the NO level was lower than that in patients with hypertension. Conclusions:The analysis of bloodET-1 and NO would be used to diagnose renal allograft rejection, and contribute to the anti-damage treatment ofgraft after renal transplantation.

Purpose:To summarize our experience in related donor renal transplantation. Methods:Analyzedand reviewed the clinical date of 7 cases related donor renal transplantation in our center. Results:All 7 patientsrecovered smoothly from the operation. 1 of 7 had rejection. 6 of 7 had their transplanted kidney funtioned well,and 1 case died of liver function failuer. Conclusions:The advantage of related transplantation was less rejectionoccoured and much longer graft survive time obtained. But a care operation in the harvesting of donor graft wasneeded.

Purpose:To clarify the perioperative management for living-related kidney donors. Methods:Thepre, mid, and postoperative clinical manifestations of 5 living related donors were analyzed retrospectively. Re-sults:5 living-related kidney donors were dismissed 15 days after the operations on average. Following up for 3～10 months, their postoperative blood routine, urine routine, hepatic function, renal function, the amount oturine protein in 24 hours were all within normal range. Conclusions:The safety of operation for living-related kid-ney donors is high and the donors can recover well.

Purpose:To investigate the effect of MMF on the postoperative infection after renal transplanta-tion. Methods: Before 1997, the CsA + Aza + prednisone were used as immunosuppresive agents postoperativelyfor 56 cases; Since 1998, drugs used for 34 cases were changed into MMF and CsA+MMF+prednisone respec-tively. The dose initially used for CsA was 65 mg/kg · d 1 in the patients of Aza group and 5 mg/kg · d 1 for theMMF group and then this dosage was regulated according to the determination of plasma level of the drug. Re-sults:The total infection rate of these 90 patients was 17.8%, 12 cases were infected in the Aza group (21.4%)and 11.8% (4 cases) in the MMF group. There were 2 patients died in the Aza group. Conclusions:The postop-erative infection rate of the patients underwent kidney transplantation might be reduced when MMF was used tosubstitute Aza during the period of postoperative management.

Purpose:In order to investigate the effects of repair of arteriovenous fistula on heart function soas to widen the range of the indication of allogenetic transplantation of kidney. Methods :Repair of arteriovenousfistula was performed in 8 patients who have received long term hemodialysis and then complicated with repeatedattack of heart failure 5 months before renal transplantation. Results:There are 7 patients had their cardiac cham-bers returned to normal, and 1 returned to normal upper limit. Renal transplantation was successfully performedin 6 patients, but death occurred in 1 case resulting from liver function failure. Superacute rejection and sponta-neous rupture of the kidney occurred in 1 patient. Conclusions:It is considered that the repair of arteriovenous fis-tula before renal transplantation is beneficial to improvement of heart function in these patients so as to widen therange of operative indications and create favourable condition for renal transplantation and decrease complica-tions. Color doppler sonography is of great value in monitoring pre-and postoperative heart function.

Purpose:To explore the application of vascular allografts for hemodialysis access. Methods:Freezing-dried and irradiated human cadaveric vascular grafts were placed in forearm or upper arm as permanenthemodialysis vascular access in 52 patients with uremia. Results:Immediate patency rate was 100%. All graftswere performed in 3～4 weeks after operation. Among the 44 grafts still being used hitherto, 9 grafts had beenused for 2～3 years, 19 for 1～2 years and 16 in 1 year. Other 8 grafts failured due to complications: thrombosis(5 cases ) 、aneurysm (2 cass) and infection (1 case). Conclusions: Freezing-dried and irradiated vascular allograftswere inexpensive, easy to approach and preserve and, with no antigenicity. The allograft is easy to manage dur-ing surgery and with high patency rate when it was used for hemodialysis access. It was indicated that freezing-dried and irradiated vascular allograft is a good alternative in case of direct A-V fistula failure or inability to per-form a direct A-V anastomosis in patients undergoing hemodialysis.

Purpose:To introduce a method of lengthening the right renal vein for kidney graft. Methods:AV-shaped excision of the neighbouring vena cava wall may lengthen a short rigth renal vein. Results: 6 cases ofpatients have been done, and all obtained satisfactory outcome. Follow up for 1.5 month to 1.5 year, all 6 pa-tients had their transplanted kidney function well. Conclusions:A V-shaped excision and sewing up the rest venacava is a simple, effective measure for a short right renal vein during kidney transplantation.

Purpose:To find a valuable index for the qualitative diagnosis of renal tumor by color doppleranalysis. Methods :The arteriorenal blood flow of 32 patients with renal tumor and 30 healthy person were inves-tigated by color doppler analysis. Results:The arteriorenal systolie peak flow velocity of malignant tumor groupwas higher than that of the benign tumor group and the control group ( P ＜0. 01 ); but the resistance index of themalignant tumor group was lower than that of the other two groups ( P ＜0.01). There was no significant differ-ence between the benign tumor group and the control group in arteriorenal peak flow velocity and resistance in-dex. Conclusions :The increase of arteriorenal systolie peak flow velocity and the decrease of resistance index wereconsidered to be a valuable index for the qualitative diagnosis of malignant renal tumor.

Purpose:To clarify the diagnosis and management of ureteral obstruction owing to vena cava orcongenital crossing vessels. Methods: Preoperative sonography, intavenous urography (IVU), retrograde urogra-phy or magnetic resonance urography(MRU) were performed in 19 cases of patients for evaluation of hy-droureteronepherosis. Combined with magnetic resonance imaging(MRI) or cavography, retrocaval ureter couldbe detected. Colour Doppler imaging was used to detect crossing vessels. During operations, retrocaval (8cases) or retroiliac (1 cases) ureters were excised, crossing vessels (10 cases) were divided then ureteroureteralanastomosis or dismembered pyeloplasty (Anderson-Hynes) were completed. Results:3 to 6 months after opera-tions, hydroureteronepherosis was lightened to different extends in all patients. After median follow-up of 15.7months (range 1 to 4.5 years), hydroureteronepherosis was found in one patient. Conclusions:Disorder of bloodvessels should be considered in the differential diagnosis of extrinsic ureteral obstruction. Sonography, IVU,MRI combined with cavography, color Doppler imaging are of great value in the diagnosis of those conditions.Early diagnosis and treatment are very important.