Objective To discuss the way of treating accelerated rejection. Methods Seven patients of accelerated rejection were treated by efficient anti-rejection treatment. ResultsSix patients of accelerated rejection were reversed by efficient treatment of anti-rejection. One allograft was removed because treatment was invalid. And six patients were still alive, the longest survival one has reached to 3 years. ConclusionThe treatment emphasis of accelerated rejection should be focused on 3 aspects, including early diagnosis, efficient treatment in time, and paying more attention to any possible complications during the process of treatment.

Objective To investigate the relationship bet wee n cytomegalovirus (CMV) infection and the production of anticardiolipin antibody (ACA) in renal transplant recipients.Methods Polymerase c hain reaction (PCR) was used qualitat ively for detection of CMV-DNA in 146 renal transplant recipients.Meanwhile,enz yme-linked immunosorbent assay (ELISA) was used for detection of ACA-IgG in bl ood serum samples from these recipients and 32 healthy individuals. Results The ACA positive rate was 17.1% among the 146 ren al transplant recipients,and that of the control group was 6.3%.There was no sig nificant difference.However,the ACA positive rate of the renal transplant recipi ents infected with CMV was 31.2%.It was clearly higher than that of those with n o infection of CMV and that of the control group (P＜0.005). Con clusion The production of ACA was closely related to CMV infection.It m ight be one of the factors of chronic angiopathy of the transpl anted kidney due to CMV infection.

Objective To investigate the clinical effects of diltiaze in renal transplantation patients treated with cyclosporine A (CsA). Methods 1529 renal transplant cases were randomly ~divi -ded into experimental group 1 receiving CsA, Aza, Pred and Diltiaze, experimental group 2 receiving CsA, MMF, Pred and diltiaze, and control group receiving CsA, Aza and Pred without diltiaze. The dosage and blood concentrations of CsA, the outcome of renal transplant, the incidence of acute rejection, and the hepatic and renal toxicity were observed in the experimental groups and control group.Results The dosage of CsA in experimental group 1 was less, while the blood concentrations of CsA was higher than in control group (P~0.05 ). The recovery time of the graft function was cut down to 4.7 days (experimental group 1) and 3.9 days (experimental group 2) respectively with the difference being significant between the experimental groups and control group (P

Objective To study the mechanism of acute rejection of human renal transplantation and detect the sensitive markers for early diagnosis of acute rejection. Methods Immunohistochemistry was used to detect the expression of Perforin and Granzyme B molecules during acute rejection in the renal grafts. The immunocytochemical ABC assay and flow cytometry ways were used to detect the expression of Perforin and Granzyme B molecules in peripheral blood. Results Perforin and Granzyme B molecules were increased in all tissue specimens and lymphocytes of peripheral blood during acute rejection. There was a correlation between the Granzyme B and histological changes ( P

0.05);but adding active virus,it was strongly positive;the results were obviously higher than those of the other 3 groups,respectively(P0.05).Conclusion When infected with CMV,the expression of ICAM1 increased obviously.CMV caused rejection reaction mainly by inducing the increase of the expression of ICAM-1 in endothelial cells.

Objective To investigate the role of peripheral lymphocytes Sialyl Lewis(x) (CD15s) antigen before and after kidney transplantation. Methods Flow cytometry technique was applied to examine the expression of peripheral lymphoid cell surface CD15s antigen after renal transplantation, and to evaluate various therapeutic regimen. Results The statistic analysis results of peripheral lymphoid cell surface CD15s antigen expression level showed that there was significant difference among the patients with acute rejection, long-term dialysis and with normal renal function post-transplant; significant difference of CD15s expression level between group of rejection and infection; no significant difference of CD15s expression among the different groups treated by various therapeutic regimens. Conclusion The different therapeutic regimen has no influence to CD15s expression; Detection of peripheral lymphoid cell surface CD15s antigen expression periodically, intelligently make convenience to understand suitable status of immunosuppression.

Objective To explore the relationship between HLA sensitization and crossmatch and to assess its clinical value. Methods The subjects were divided into 3 groups :high sensitization group (PRA≥40％),low sensitization group (40％＞PRA≥10％) and non-sensitization group (PRA＜10％) according to the HLA antibody level detected by ELISA. The results of crossmatch were compared among the 3 groups. Results There was significant difference among the ratio of positive crossmatch in high sensitization group (39.4％),low sensitization group (10.5％)and non-sensitization group (2. 6％). Conclusion The sensitization level is positively correlated with the result of crossmatch. The improvement of matching precision can be made by using both of techniques mentioned above.

Objective To explore the significance of serum CD30 in predicting acute rejection in kidney transplant recipients.Method A total of 106 kidney transplant recipients were recruited in this prospective six months follow-up study from December 2010 to October 2012.According to the clinical outcome,the subjects were devided into stable renal function group (72 cases) and acute rejection group (34 cases).Twenty healthy subjects were choosed as controls.Serum sCD30 levels were detected by ELISA.The whole peripheral blood samples were collected from all recipients before transplantation,at days 7,14,21 and 28 post-transplantation,and at months 2,3,4,5 and 6 posttransplantation.Additional blood samples were collected for on the days that acute rejection occurred and reversed.Result Preoperative serum sCD30 levels were 33.42 ± 11.49 and 26.5 1 ± 13.70μg/L in AR group and stable group respectively.When acute rejection occurred,serum sCD30 levels in AR group was 50.38 ± 12.10μg/L,which was significantly higher than stable group (20.03 ± 6.68μg/L,P＜0.05) and healthy control group (13.57 ± 5.56 ng/L,P＜0.05).After the anti-rejection therapy,serum sCD30 levels decreased to 15.31 ± 6.37μg/L,which was lower than that before the therapy started (50.38± 12.10 μg/L,P＜0.05).Elevated preoperative serum sCD30 levels suggested a higher risk of acute rejection in kidney transplant recipients,with Cutoff values of 24.96 μg/L,and the sensitivity and specificity were 91.30％ and 84.21％ respectively.Conclusion Serum sCD30 levels can predict and assess the risks of rejection episodes in kidney transplant recipients.

Objective To evaluate the clinical value of adenosine triphosphate (ATP) determination in CD4+ cells in cytomegalovirus pneumonia after renal transplantation.Methods The ATP level of CD4+ T cells was measured by ImmuKnowTM kit.The ATP levels were determined in 187 renal transplant recipients before and 30,60,90,180 days after operation,and at the time of CMV pneumonia and 4 weeks after treatment of CMV pneumonia.The associations between ATP levels and CMV pneumonia were analyzed.Analysis of variance (ANOVA),Pearson-Spearman and relative risks were used for data analysis.Results 17 cases out of 187 renal transplant recipients were diagnosed as CMV pneumonia (9.1％),and the onset of CMV pneumonia started on the (2.8 ±1.2)month after renal transplantation.ATP concentrations in CD4+ T cells were significantly lower after operation than those before operation (P＜0.01).ATP concentrations reached the lowest on the about postoperative day 90 (P＜0.05),then increased gradually.In 17 recipients with CMV pneumonia,the ATP levels before and 30,90 days after operation,at the time of CMV pneumonia and 4th week after treatment of CMV pneumonia were (376 ±182),(283 ± 146),(196 ± 112),(145 ± 102) and (236 ± 117) μg/L respectively.ATP levels at the time of CMV pneumonia were significantly lower than any other time points (P＜0.05).There was close correlation between ATP levels and CMV pneumonia.Conclusion The determination of ATP in CD4+ cells could reflect the status of cell-mediated immunity in renal transplant recipients,and could evaluate the severity and prognosis of CMV pneumonia and guide the clinical treatment.

Objective To explore the relationship between adjustment of immunosuppressant and prognosis in renal transplantation recipients with pulmonary infection. Methods The clinical data of 98 patients with pulmonary infection following renal transplantation were retrospectively analyzed.Patients were divided into two groups: conventional group (n = 45) and immunosuppressant adjustment group (n = 53). The mortality, recovery time and rejection rate in two groups were analyzed under the statement of serious infection (SOFA≥12) and slight infection (SOFA＜ 12) by sequential organ failure assessment (SOFA) score. Results When the SOFA scores ≥ 12, the mortality and recovery time in immunosuppressant adjustment group were significantly lower than in conventional group (P＜0.05), but there was no significant difference in the rejection rate between two groups (P＞0.05). When the SOFA scores ＜11, there was no significant difference in mortality and recovery time between the two groups (P＞0.05). The incidence of rejection in immunosuppressant adjustment group was significantly higher than in conventional group (P＜0.05).Conclusion Mortality could be decreased and course of anti-infection treatment could also be shortened by adjusting the immunosuppressant in renal transplantation recipients with serious pulmonary infection (SOFA≥12). Immunosuppressant agent was proposed to maintain the original treatment protocol when the infection was slight (SOFA＜12).