OBJECTIVETo study the frequency of major histocompatibility complex class I-related chain A (MICA) antibody in patients with end-stage renal disease (ESRD).

METHODSLuminex flow cytometry and beads loaded with 11 MICA antigens were used to identify the MICA antibody and evaluate the antibody specificity in 110 patients with ESRD.

RESULTSThe positivity rate of MICA antibody was 40% (12/30) in PRA-positive patients, significantly higher than the rate of 17.5% (14/80) in PRA-negative patients (chi(2)=6.120, P=0.013). MICA-specific antibodies against 10 of the 11 MICA antigens were detected in 26 MICA antibody-positive patients, and 26.92% of the MICA antibody-positive patients had antibodies with single-specificity and 73.08% had polyspecific antibodies. Three MICA antibody-positive patients with cadaveric kidney transplantation showed good function of the graft without acute rejection 2 months after the operation.

CONCLUSIONThe positivity rate of MICA antibody is significantly higher in PRA-positive patients, suggesting a strong correlation between MICA and PRA positivity. The MICA antibodies are polyspecific and probably consist of IgM and IgG. These data can be used as prospective data for these ESRD patients considering potential renal transplantation, and may facilitate further investigation of the association of MICA with renal transplantation.

Adult ; Antibodies ; blood ; immunology ; Female ; Histocompatibility Antigens Class I ; immunology ; Humans ; Immunoglobulin alpha-Chains ; blood ; immunology ; Kidney Failure, Chronic ; immunology ; surgery ; Kidney Transplantation ; Male ; Middle Aged ; Retrospective Studies

Since heparin is an anticoagulant commonly used in hemodialysis and the patients on hemodialysis are repeatedly exposed to heparin, heparin may be the cause of the development of heparin-dependent antibodies and thrombotic complications in patients on hemodialysis. The purpose of this study was to determine the prevalence and the clinical significance of the antibodies against heparin-platelet factor 4 complexes as determined by enzyme immunoassay in patients on maintenance hemodialysis. The prevalence of anti-heparin-platelet factor 4 antibodies was higher in hemodialysis patients than in normal subjects (8.8 vs 0.0%, p<0.05). The number of past episodes of vascular access obstruction per year was significantly higher in the anti-heparin-platelet factor 4 antibody positive group than antibody negative group. Anti-heparin-platelet factor 4 antibody positive patients experienced more frequent vascular access obstructions than control subjects. In conclusion, anti-heparin-platelet factor 4 antibody might be a risk factor for vascular access obstructions in patients with end-stage renal disease on maintenance hemodialysis.
Adult ; Autoantibodies/immunology* ; Autoimmune Diseases/immunology* ; Catheters, Indwelling* ; Enzyme-Linked Immunosorbent Assay ; Female ; Heparin/immunology* ; Human ; Kidney Failure, Chronic/blood ; Kidney Failure, Chronic/immunology ; Kidney Failure, Chronic/therapy* ; Male ; Middle Aged ; Platelet Factor 4/immunology* ; Recurrence ; Renal Dialysis* ; Risk Factors ; Thrombophilia/immunology* ; Thrombosis/epidemiology* ; Thrombosis/immunology ; Thrombosis/prevention & control

In the 21st century, one of the focuses in the field of organ transplantation is the prevention of chronic kidney graft dysfunction (CKGD) and the furtherance of the long-term survival rate. Researches on the mechanism and prevention of CKGD have made progress in the important immune and nonimmune factors of CKGD. Researchers' endeavors to establish the model of CKGD in the animals such as inbreeding pigs; to develop new drugs which are characterized by high efficacy, low toxicity, low cost, and synergy when used together with immune depressants available from natural medicine; and to probe deeply into the mechanism and prevention of CKGD, will be the important aspects in the field of organ transplantation in the 21st century.
Graft Survival ; immunology ; Humans ; Kidney ; blood supply ; physiopathology ; Kidney Failure, Chronic ; prevention & control ; Kidney Transplantation ; adverse effects ; Reperfusion Injury ; prevention & control ; Time Factors

This study aimed to determine the prevalence of anti- Toxoplasma gondii antibodies in haemodialysis patients with chronic renal failure (CRF). Methods: One hundred and seventy three haemodialysis patients, and 40 healthy controls, were studied for the prevalence of anti-Toxoplasma gondii antibodies by a micro enzyme-linked immunosorbent assay (ELISA). Anti-T. gondii IgG antibodies were detected in 97 (56.06%) haemodialysis patients and 8 (20%) controls with a statistical significance. In addition, anti-T. gondii IgM antibodies were detected in 1.73% of patients, but none of the controls. In conclusion, a high percentage of positivity for Toxoplasma antibodies in patients with CRF undergoing haemodialysis was noticed, thus parasitological surveys of CRF patients should be periodically performed to prevent the possible dissemination of toxoplasmosis through the dialysis procedure.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Animals ; Antibodies, Protozoan/*blood ; Human ; Kidney Failure, Chronic/*immunology/therapy ; Middle Aged ; *Renal Dialysis ; Toxoplasma/*immunology

Renal transplantation has been considered the optimal therapeutic modality for children afflicted with end-stage renal disease since the capability became available more than three decades ago to prolong the lives of such children. Nowadays, the outcome of renal transplantation was marked improved, due to the development of immunology and new immunosuppressive agent. But the reports on renal transplantation in children were not many. The Severance Hospital of Yonsei University College of Medicine started the renal transplant program in April, 1979. There were 400 transplants from 1979 to August 1989. Among them, there were 13 cases of child age, and the results were summarized & analyzed. 1. The age incidence of recipients was from 8 to 16. Males were 10 cases and females were 3 Cases. 2. Among the primary diseases of recipients, the congenital diseases were 10 cases and the acquired diseases were 8 cases. And 4 cases were received bilateral nephrectomy due to vesicoureteral reflux and severe proteinuria. 3. Among the donors, 6 cases were related and 7 cases were unrelated. Related donors were 1 haplotype mismatch and unrelated, donors were 2 antigen match including DR locus. 4. There were 6 rejections in 13 cases. Among them, acute rejections were 4 cases and chronic rejections were 2 cases. 5. Postoperative complications were found in 6 cases ; peritoneal rupture, hemoperitoneum, urinary tract infection, smallpox, congestive heart failure and sepsis. 6. Among 13 cases, 11 cases of grafts were survived from 3 months to 9 years. The 1 case was expired due to chronic rejection and respiratory infection after postop. 30 months. And the other 1 case was peritoneal dialyzed due to chronic rejection after postop. 6 months. From the results presented here, we think the outcome of renal transplantation in children is good and the indication should be evaluated carefully.
Allergy and Immunology ; Child* ; Female ; Haplotypes ; Heart Failure ; Hemoperitoneum ; Humans ; Incidence ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation* ; Male ; Nephrectomy ; Postoperative Complications ; Proteinuria ; Rupture ; Sepsis ; Smallpox ; Tissue Donors ; Transplantation ; Transplants ; Urinary Tract Infections ; Vesico-Ureteral Reflux

Kidney transplantation is the treatment of choice for end stage renal disease. Successful kidney transplantation improves the quality of life and reduces the mortality risk for most patients, when compared with maintenance dialysis. Recent advances, including immunosuppressants, desensitization treatment for highly sensitized kidney transplant candidates, and better medical care, have resulted in an increase number of transplants with improved outcomes. However, kidney transplant recipients require close follow-up after transplantation since they are on complex immunosuppressive regimens that render them susceptible to infection, malignancy, and cardiovascular disease. The additional obstacles of kidney transplantation include the lack of improvement in long term outcomes, shortage of organs, and multiple co-morbidities due to their underlying chronic kidney disease. To improve the long-term outcome of renal allograft, physicians must be aware in developing newer immunosuppressive regimens, with lower side effects, and reduction of death with functioning graft and chronic allograft dysfunction will be the greatest challenge of all physicians who care for kidney transplant recipients. This review highlights current status of kidney transplantation in Korea, brief transplant immunology, immunologic tests, donor/recipient evaluation, immunosuppressive medications, and complications of kidney transplantation involving rejection, post transplantation infections, malignancy, cardiovascular disease and recurrence of primary disease.
Allergy and Immunology ; Allografts ; Cardiovascular Diseases ; Dialysis ; Humans ; Immunologic Tests ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Korea ; Mortality ; Quality of Life ; Recurrence ; Renal Insufficiency, Chronic ; Tissue Donors ; Transplantation ; Transplants

Kidney transplantation is the treatment of choice for end stage renal disease. Successful kidney transplantation improves the quality of life and reduces the mortality risk for most patients, when compared with maintenance dialysis. Recent advances, including immunosuppressants, desensitization treatment for highly sensitized kidney transplant candidates, and better medical care, have resulted in an increase number of transplants with improved outcomes. However, kidney transplant recipients require close follow-up after transplantation since they are on complex immunosuppressive regimens that render them susceptible to infection, malignancy, and cardiovascular disease. The additional obstacles of kidney transplantation include the lack of improvement in long term outcomes, shortage of organs, and multiple co-morbidities due to their underlying chronic kidney disease. To improve the long-term outcome of renal allograft, physicians must be aware in developing newer immunosuppressive regimens, with lower side effects, and reduction of death with functioning graft and chronic allograft dysfunction will be the greatest challenge of all physicians who care for kidney transplant recipients. This review highlights current status of kidney transplantation in Korea, brief transplant immunology, immunologic tests, donor/recipient evaluation, immunosuppressive medications, and complications of kidney transplantation involving rejection, post transplantation infections, malignancy, cardiovascular disease and recurrence of primary disease.
Allergy and Immunology ; Allografts ; Cardiovascular Diseases ; Dialysis ; Humans ; Immunologic Tests ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Korea ; Mortality ; Quality of Life ; Recurrence ; Renal Insufficiency, Chronic ; Tissue Donors ; Transplantation ; Transplants

OBJECTIVETo compare the effect on erythropoietin (Epo) resistance between acupoint injection and subcutaneous injection of rHuEpo in patients with chronic renal failure (CRF).

METHODSThirty-eight cases were randomly divided into two groups, 19 cases in each one. In subcutaneous injection group (control group), subcutaneous injection of rHuEpo was administered, 3 times a week, lasting 2 months. In acupoint group (observation group), rHuEpo was injected on unilateral Shenshu (BL 23) and Zusanli (ST 36), one point was chosen each time, the bilateral acupoints were injected alternatively, 3 times a week, for 2 months. Meanwhile, a normal control group of 19 healthy persons was set up. The levels of CRP, IL-6, TNF-alpha, Scr, BUN, Hb, Hct and SF were observed.

RESULTSBefore treatment, the values of CRP, IL-6 and TNF-alpha in two groups were all higher than those in normal control group (all P < 0.01). After treatment for 2 months, the values of CRP, IL-6,TNF-alpha, Scr and BUN in two groups decreased apparently and those of Hb, Hct and SF increased obviously, indicating statistic significant differences as compared with the values before treatment separately (P < 0.05, P < 0.01). In comparison between two groups after treatment, every index above in observation group was improved much significantly (P < 0.05, P < 0.01).

CONCLUSIONAcupoint injection of rHuEpo at Zusanli (ST 36) and Shenshu (BL 23) increases significantly the values of Hb, Hct and SF, and decreases apparently the values of BUN, Scr and inflammatory factors, such as CRP, IL-6 and TNF-alpha as compared with subcutaneous injection. Acupoint injection improves Epo resistance and enhances Epo efficacy via alleviating micro-inflammatory state of the body.

Acupuncture Points ; Adult ; Aged ; Drug Resistance ; Erythropoietin ; administration & dosage ; Female ; Humans ; Inflammation Mediators ; blood ; immunology ; Injections, Subcutaneous ; Interleukin-6 ; blood ; immunology ; Kidney Failure, Chronic ; blood ; drug therapy ; immunology ; Male ; Middle Aged ; Recombinant Proteins ; Tumor Necrosis Factor-alpha ; blood ; immunology

No abstract available.
Adult ; Female ; Graft Rejection/immunology/*prevention & control ; Graft Survival ; *Hematopoietic Stem Cell Transplantation ; Humans ; *Immune Tolerance ; Immunosuppressive Agents/therapeutic use ; Kidney Failure, Chronic/diagnosis/*surgery ; *Kidney Transplantation ; Living Donors ; Siblings ; Time Factors ; *Transplantation Chimera ; Treatment Outcome

Several parameters of cell-mediated immunity thirty-eight patients with end stage chronic renal failure were measured including total lymphyocytes, B-and T-lymphocytes, T-cell subsets and the mitogenic reponse to PHA and Con A at three different times; before dialysis, 3 months and 12 months after dialysis treatment. There were no significant differences in the absolute numbers of peripheral leukocytes between each patient and the control group. But the absolute numbers of lymphocytes of each patient group were significantly reduced compared to the control group (p< 0.01). The proportion of peripheral blood active T cells and helper T cells was significantly reduced both in the predialysis uremic and dialysis populations compared to the control group, although the helper/suppressor(OKT4/OKT8) ratio was not different between each patient and the control group except for a lower ratio in the hemodialysis 12 month follow-up group (HD 12M). With respect m the PHA and Con A stimulation tests, the stimulation indices of the predialysis and hemodialysis groups were significantly lower than those of the control group. However, patients on continuous ambulatory peritoneal dialysis (CAPD) exhibited a normal mitogenic response and a lower suppressor cell removal index compared to the patients on hemodialysis, suggesting an improved cell-mediated immunity in the patients undergoing CAPD.
Adult ; Aged ; B-Lymphocytes/*immunology ; Comparative Study ; Human ; In Vitro ; Kidney Failure, Chronic/*immunology/therapy ; Lectins/pharmacology ; Leukocyte Count ; Lymphocyte Activation/drug effects ; Middle Age ; Peritoneal Dialysis, Continuous Ambulatory ; Renal Dialysis ; Support, Non-U.S. Gov't ; T-Lymphocytes/classification/*immunology ; T-Lymphocytes, Helper-Inducer/immunology ; T-Lymphocytes, Suppressor-Effector/immunology