Study on 2 patients with acute rejection of transplanted kidneys among 12 patients with renal transplantations at Hue Central Hospital. Results: the incidence of acute rejection was 16.66%. Attacks of acute rejection occurred between 4th and 7th day after transplantations. The signs and symptoms of acute rejection appeared in order: pain in transplanted kidneys, fever, decrease of diuresis, palpable graft enlargement, hypertension, increase in serum creatinine and urea concentrations, weight gain, anorexia. Treatment involved intravenous methyl prednisone (Solumédrol) with average dose of 250 mg/day for 5 days, followed by oral administration; replacing azathioprine by mycophenolate mofetil gave good outcomes. The signs and symptoms of acute rejection disappeared after 5-6 days of using Solumédrol and mycophenolate mofetil.
Kidney Transplantation ; Rejection (Psychology)

Scatter correction for I-131 plays a very important role to improve image quality and quantitation. I-131 has multiple and higher energy gamma-ray emissions. Image quality and quantitative accuracy in I-131 imaging are degraded by object scatter as well as scatter and septal penetration in the collimator. The purpose of this study was to estimate scatter and septal penetration and investigate two scatter correction methods using Monte Carlo simulation. The gamma camera system simulated in this study was a FORTE system (Phillips, Nederland) with high energy, general-purpose, parallel hole collimator. We simulated for two types of high energy collimators. One is composed of lead, and the other is composed of artificially high Z number and high density. We simulated energy spectrum using a point source in air. We estimated both full width at half maximum (FWHM) and full width at tenth maximum (FWTM) using line spread function (LSF) in cylindrical water phantom. We applied two scatter correction methods, triple energy window scatter correction (TEW) and extended triple energy window scatter correction (ETEW). The TEW method is a pixel-by pixel based correction which is easy to implement clinically. The ETEW is a modification of the TEW which corrects for scatter by using abutted scatter rejection window, which can overestimate or the underestimate scatter. The both FWHM and FWTM were estimated as 41.2 mm and 206.5 mm for lead collimator, respectively. The FWHM and FWTM were estimated as 27.3 mm and 45.6 mm for artificially high Z and high density collimator, respectively. ETEW showed that the estimation of scatter components was close to the true scatter components. In conclusion, correction for septal penetration and scatter is important to improve image quality and quantitative accuracy in I-131 imaging. The ETEW method in scatter correction appeared to be useful in I-131 imaging.
Gamma Cameras ; Rejection (Psychology) ; Water

PURPOSE: Immunosuppressive regimen based on reduced-dose Tacrolimus (TAC) is widely accepted in the field of renal transplantation. However, optimal targetsfor TAC whole blood trough concentrations during the early period after kidney transplantation remain uncertain. METHODS: A total of 184 consecutive adult renal transplant recipients with triple immunosuppression (TAC/Mycophenolate/corticosteroid) were included in this study. According to the trough level of TAC at day 7 after transplantation, patients were classified as low TAC concentration (LT, <10 ng/ml, n=85), intermediate TAC concentration (IT, 10~15 ng/ml, n=75), and high TAC concentration (HT, >15 ng/ml, n=24) groups. Rate of acute rejection, graft function and side effects of TAC within 1 yr after transplantation were evaluated. RESULTS: There was no difference in trough concentrations of TAC at 2 weeks, 1 month, 3 months, 6 months and 12 months after transplantation among the three groups. Significantly higher incidence of acute rejection within 2 weeks after transplantation was observed in LT group compared with IT and HT groups (17.4%, 5.6% and 4.8%, respectively, P=0.037). HT patients showed significantly better estimated glomerular filtration rates until 6 months after transplantation than IT and LT patients (75.5+/-24.8 vs. 63.8+/-12.8 and 64.3+/-15.2 ml/min at 6 months, P=0.03). There was no significant difference in TAC toxicity in terms of post-transplant diabetes and renal toxicity. CONCLUSION: Short-term high TAC exposure immediately after kidney transplantation may provide lower incidence of acute rejection and better restoration of graft function compared with low or intermediate TAC exposure.
Adult ; Glomerular Filtration Rate ; Graft Rejection ; Humans ; Immunosuppression ; Incidence ; Kidney Transplantation ; Rejection (Psychology) ; Tacrolimus ; Transplants

Macrophage accumulation has been recognized as a feature of allograft rejection, however, the role of macrophages in rejection remains underappreciated. Macrophages are present within graft tissues throughout the lifespan of the graft, including acute rejection episodes. Recent advances in macrophage biology have demonstrated that different types of macrophages in grafts serve a range of functions, including promotion or attenuation of inflammation, participation in innate and adaptive immune responses, and mediation of tissue injury, fibrosis, and tissue repair. Macrophages contribute to both the innate and acquired arms of the alloimmune response, and, thus, may be involved in all aspects of acute and chronic allograft rejection. Macrophages are also involved in hyperacute and acute vascular rejection of xenografts. A deeper understanding of how macrophages accumulate within grafts and of the factors that control differentiation and function of these cells could lead to identification of novel therapeutic targets in transplantation.
Arm ; Biology ; Fibrosis ; Graft Rejection ; Inflammation ; Macrophages ; Negotiating ; Rejection (Psychology) ; Transplantation, Heterologous ; Transplantation, Homologous ; Transplants

PURPOSE: Despite the well-known public health benefits of vaccination, increasing public concern about the safety of childhood vaccinations has led some parents to refuse or hesitate having their children immunized. The purpose of this study was to identify the subjectivity of parents toward refusal of childhood vaccination. METHODS: Q-methodology, in which subjective viewpoints are explored and analyzed using a combination of quantitative and qualitative techniques, was used. Thirty-five participants were asked to rank 42 statements on diverse issues of childhood vaccination according to a continuous 9-point scale ranging from -4 for strongly disagree to +4 for strongly agree. Collected data was analyzed using the PC-QUANAL program. RESULTS: The results revealed three discrete groups of parents in the refusal of children's immunization: type I, distrust; type II, concern about side effects, and type III, belief that vaccinations are unnecessary. CONCLUSION: Special nurse counselors who can provide correct information about vaccination based on the three types should be part of the government policy. Customized education programs to shift viewpoints should be also redeveloped according to the results in this study.
Child ; Counseling ; Disulfiram ; Humans ; Parents ; Public Health ; Rejection (Psychology) ; Vaccination

Liver transplantation (LT) across the ABO-blood type barrier is prone to antibody-mediated rejection (AMR), which often leads to a deleterious clinical outcome. While it is of paramount importance to make an early diagnosis of AMR, the morphologic features of AMR in the liver are not specific, and the differential diagnosis is often difficult or even impossible on a morphologic basis alone. The clinical utility of C4d immunostaining is limited in the liver, unlike other organs, further complicating the situation. Therefore, the diagnosis of AMR in the liver requires integration of clinical, morphologic, immunopathologic, and serological evidence.
Diagnosis, Differential ; Early Diagnosis ; Liver ; Liver Transplantation ; Rejection (Psychology) ; Transplants

Steroid is a critical component of immunosuppressive regimen. Unfortunately, steroid is associated with numerous adverse effects including diabetes, hypertension, hyperlipidemia, osteoporosis, sodium retention, and avascular necrosis. These adverse effects have prompted trials of steroid withdrawal with introduction of potent immunosuppressive agents in renal transplantation. Although late steroid withdrawal raised acute rejection rate compared with early steroid withdrawal, results of recent trials that used diverse steroid withdrawal protocols suggest good short and long term graft outcomes. But, in patients survival, patients with steroid withdrawal is similar to patients administered steroid. This review summarizes usefulness according to timing of steroid withdrawal and re-exams benefits of steroid withdrawal in renal transplantation.
Humans ; Hyperlipidemias ; Hypertension ; Immunosuppressive Agents ; Kidney Transplantation ; Necrosis ; Osteoporosis ; Rejection (Psychology) ; Retention (Psychology) ; Sodium ; Transplants

PURPOSE: Previously, acute rejection (AR) episode in the elderly recipients was reported to be lower compared to that of young recipients. However, the relationship between the recipients age, incidence of AR, and graft survival has not been reevaluated recently. METHODS: Four hundred thirty-one recipients who had the first kidney transplantation were recruited, and we performed a retrospective study evaluating the incidence of AR, infectious episodes in one year, and graft and patient survival rates at 1 and 5 years. We divided recipients into 2 groups (age< 50, n=340 and age=50, n=91) and compared the outcomes. RESULTS: The incidence of AR was 18.8% in the younger group and 24.2% in the elderly group (p=NS). The incidence of infectious episodes was 24.7% in the younger group and 24.2% in the elderly group (p=NS). Five-year graft survival in the elderly was not significantly different from that in the younger group (90.8% vs. 91.8%). However, the patient survival at five year was different between the younger and the elderly groups (99.1% and 92.2%, respectively, p<0.05). CONCLUSION: Our findings suggest that recipients age would not influence the incidence of AR and graft survival. Therefore, the immunosuppression should be applied according to the conditions of recipients, not to recipients age.
Aged ; Graft Rejection ; Graft Survival ; Humans ; Immunosuppression ; Incidence ; Kidney ; Kidney Transplantation ; Rejection (Psychology) ; Retrospective Studies ; Survival Rate ; Transplants

Progress in the field of antibody mediated rejection (ABMR) in kidney transplantation has shown a rapid increase during the past two decades. New pathologic entities have emerged and replace old concepts and diagnostic terms. According to newly acknowledged facts discovered by clinicians, researchers, and pathologists all over the world, an updated classification, rather than Banff 07, is needed. In order to improve the diagnostic accuracy for ABMR in clinicians as well as pathologists, recognition and awareness of various conditions such as C4d-negative ABMR, subclinical ABMR, de novo donor specific antibody, microcirculation inflammation, isolated vascular lesion, antibody-mediated transplant arteriopathy, etc. are essentially important.
Antibodies ; Complement C4b ; Graft Rejection ; Humans ; Inflammation ; Kidney ; Kidney Transplantation ; Microcirculation ; Peptide Fragments ; Rejection (Psychology) ; Tissue Donors ; Transplants

During the last few decades our knowledge of transplantation has been remarkably expanded to the point where transplants are a standard treatment modality. However, despite the fact that certain tolerogenic protocols seemed to be very successful in small animal models, researchers anticipated the same outcomes in humans, which has mostly not been true yet. Immunological memory is known to be one of the reasons for such discrepancies. Donor-specific memory T cells are thought to be a crucial barrier in transplant success due to their unique properties. Recently, efforts to overcome this issue have been made, and several protocols showed the inhibition of memory T cell functions both in vitro and in vivo. In this review, we discuss the role of memory T cells in transplant rejection and the rising strategies to overcome this barrier.
Graft Rejection ; Humans ; Immune Tolerance ; Immunologic Memory ; Memory ; Models, Animal ; Rejection (Psychology) ; T-Lymphocytes ; Transplantation, Homologous ; Transplants