No abstract available.
Humans ; Pregnancy* ; Ultrasonography*

We report our experience of endoluminal expandable stent placement for the treatment of post- transplant renal artery stenosis. Fourty years old male patient, underwent living donor renal allograft 16 months ago, was admitted due to uncontrollable hypertension and gradual graft dysfunction. On the past history, he had had acute rejection at post-transplant day 4 and it had been treated successfully with steroid pulse therapy. After then, he have been relatively doing well and the graft function has shown normal with serum creatinine of 1.1 mg/dl. His blood pressure has been marked 140/90 mmHg, which has been well controlled with amlodipine (calcium channel blocker) and atenolol (beta blocker). On the physical examination, there was no briut on the iliac fossa and blood pressure was 190/110 mmHg. Serum creatinine was 2.0 mg/dl and blood renin level showed 15.61 ng/ml in supine postion, 11.51 ng/ml in erect postion, which were about 10 times above the normal range, respectively. With the impression of post-transplant renal artery stenosis, angiography was performed. The angiogram showed nearly complete transplant renal artery stenosis(about 90% of the lumen) at the anastomotic site. Expandable metal stent was indwelled successfully into the endolumen of transplant renal artery. After this precedure, the blood pressure of this patient was down to 130/80 mmHg and serum creatinine was stabilized to 1.1 mg/dl. Percutaneous endoluminal stent procedures for resistant transplant renal artery stenosis is promising. Longer follow-up periods are necessary for true evaluation of this procedure.
Allografts ; Amlodipine ; Angiography ; Atenolol ; Blood Pressure ; Creatinine ; Follow-Up Studies ; Humans ; Hypertension ; Living Donors ; Male ; Physical Examination ; Reference Values ; Renal Artery Obstruction* ; Renal Artery* ; Renin ; Stents* ; Transplants

We report our experience of endoluminal expandable stent placement for the treatment of post- transplant renal artery stenosis. Fourty years old male patient, underwent living donor renal allograft 16 months ago, was admitted due to uncontrollable hypertension and gradual graft dysfunction. On the past history, he had had acute rejection at post-transplant day 4 and it had been treated successfully with steroid pulse therapy. After then, he have been relatively doing well and the graft function has shown normal with serum creatinine of 1.1 mg/dl. His blood pressure has been marked 140/90 mmHg, which has been well controlled with amlodipine (calcium channel blocker) and atenolol (beta blocker). On the physical examination, there was no briut on the iliac fossa and blood pressure was 190/110 mmHg. Serum creatinine was 2.0 mg/dl and blood renin level showed 15.61 ng/ml in supine postion, 11.51 ng/ml in erect postion, which were about 10 times above the normal range, respectively. With the impression of post-transplant renal artery stenosis, angiography was performed. The angiogram showed nearly complete transplant renal artery stenosis(about 90% of the lumen) at the anastomotic site. Expandable metal stent was indwelled successfully into the endolumen of transplant renal artery. After this precedure, the blood pressure of this patient was down to 130/80 mmHg and serum creatinine was stabilized to 1.1 mg/dl. Percutaneous endoluminal stent procedures for resistant transplant renal artery stenosis is promising. Longer follow-up periods are necessary for true evaluation of this procedure.
Allografts ; Amlodipine ; Angiography ; Atenolol ; Blood Pressure ; Creatinine ; Follow-Up Studies ; Humans ; Hypertension ; Living Donors ; Male ; Physical Examination ; Reference Values ; Renal Artery Obstruction* ; Renal Artery* ; Renin ; Stents* ; Transplants

A microemulsion cyclosporine(Me-CsA) was developed and became available with more predictable whole blood CsA concentration and minimal inter- and intra-personal variability in daily dosage of CsA. We prospectively performed this study to assess 1) the ability of Me-CsA maintaining the adequate predefined therapeutic level and 2)long-term safety and tolerability of Me-CsA in kidney transplant recipients. A total of 123 renal transplant patients were enrolled on the Me-CsA group, who have been on Me-CsA as an initial main immunosuppressant since their transplantation. This group of patients were compared to 200 renal transplant patients on conventional cyclosporine(Con-CsA) as a historical control group(Con-CsA group). There were no differences in the methods of operation, induction immunosuppression, the strategies of maintenance immunosuppression and anti-rejection therapy between these two groups. The clinical status and laboratory values were monitored at 1,3,6,9, and 12 months after the kidney transplantation. There were no statistical differences in acute rejection episodes, serum creatinine level, and graft failure and survival rate between Con-CsA and Me-CsA groups. In this study, we could demonstrate the significant fluctuation of the mean values of daily dosage and whole blood trough level and their standard deviations of cyclosporine in Con-CsA group compare to those of Me-CsA group. We also could demonstrate early stabilization of CsA blood trough level in patients using Me-CsA. These results mean that Me-CsA has less interpersonal variations than Con-CsA. In conclusion, Me-CsA has more predictable pharmacodynamic characteristics than Con-CsA and comparable tolerability and safety to Con-CsA with no additional side effects.
Allografts* ; Creatinine ; Cyclosporine* ; Follow-Up Studies* ; Humans ; Immunosuppression ; Kidney ; Kidney Transplantation ; Prospective Studies ; Survival Rate ; Transplantation ; Transplants

In this study, we evaluated the safety and efficacy of mycophenolate mofetil(MMF) for the prevention of acute rejection episodes when given in combination with cyclosporine and corticosteroids during the first 6 postoperative months in living donor kidney transplantation. One hundred patients were enrolled; 50 patients received dual immunosuppression (cyclosporine+corticosteroids: control group) and another 50 patients received triple regimen including MMF 2 g/day(cyclosporine+corticosteroids+MMF: study group) through randomization. In the protocol, first-line treatment for acute rejection was a high-dose steroid pulse therapy. Steroid resistant acute rejection was to be treated with polyclonal antilymphocyte agents(ATG). There was no demographic difference between study and control groups. There were 7(14%) acute rejection episodes in the study group and 16(32%) in the control group with statistical significance. Two cases of premature withdrawal were developed in the study group(one severe abdominal pain and another profound leukopenia). The incidence of opportunistic infection was 7(14%) in the study group and 6(12%) in the control group within 6 months post transplantation. There was no statistical differences in serum creatinine level between study and control group at 6 months after transplantation(1.28+/-0.33 mg/dl vs. 1.24+/-0.51 mg/dl). The addition of MMF to a dual immunosuppressive regimen with cyclosporine and corticosteroids seems to lower the incidence and severity of acute rejection in living donor kidney transplantation during the early post-transplantation period. The graft function of the MMF group is comparable with that of the control group. The most common adverse effect of MMF was abdominal pain and diarrhea but almostly resolved with symptomatic treatment. If the frequency of acute rejection during the first 6 months is one of the main determinants of long-term graft survival, it might be expected that MMF could lead to an improved graft survival in combination with cyclosporine and corticosteroids.
Abdominal Pain ; Adrenal Cortex Hormones ; Allografts* ; Creatinine ; Cyclosporine ; Diarrhea ; Graft Survival ; Humans ; Immunosuppression ; Incidence ; Kidney Transplantation ; Living Donors* ; Opportunistic Infections ; Prospective Studies* ; Random Allocation ; Transplants

No abstract available.
Humans ; Living Donors*

No abstract available.
Humans ; Living Donors*

We report our experience of renal polyomavirus infection after renal allograft leading to graft dysfunction. A fourty seven-years-old male patient, has been on Tacrolimus based dual immunosuppression, showed graft dysfunction with rising serum creatinine at post-transplant day 140. His graft function had been good without any acute rejection episode. A tentative diagnosis of acute rejection was rendered and core needle biopsy was performed. Viral infection was initially suggested by the occurrence of markedly enlarged tubular epithelial cells containing large nuclei with smudgy chromatin pattern. Confirmatory diagnosis of human polyomavirus induced interstitial nephritis was obtained by electron microscopy, which showed viral particles in the nuclei of tubular epithelial cells. After Tacrolimus was converted to cyclosporine, renal function was stabilized. A review of the literature indicates that asymptomatic infection, ureteric stricture, and hemorrhagic cystitis are other possible manifestations of polyomavirus in the human urogenital tract. According to some prior reports, polyomavirus induced interstitial nephritis might be a cause of graft loss. But our patient has retained a stable graft function with a chnange of immunosuppression.
Allografts* ; Asymptomatic Infections ; Biopsy, Large-Core Needle ; Chromatin ; Constriction, Pathologic ; Creatinine ; Cyclosporine ; Cystitis ; Diagnosis ; Epithelial Cells ; Humans ; Immunosuppression ; Male ; Microscopy, Electron ; Nephritis* ; Nephritis, Interstitial ; Polyomavirus Infections ; Polyomavirus* ; Tacrolimus ; Transplants ; Ureter ; Virion

Transplant glomerulopathy (TG) is a special form of glomerular injury in renal allografts. It affects varying proportions of glomeruli, which may have an influence on the amount of proteinuria or graft survival. We reviewed 32 cases of TG to evaluate histologic changes and graft outcome. The severity of TG as well as acute and chronic changes of the glomerular, tubulointerstitial and vascular compartment were scored according to Banff classification. There were 17 cases of cg1, 3 cases of cg2 and 12 cases of cg3. There was no significant difference in age, duration of transplant at time of biopsy and duration of follow-up between groups. Serum creatinine level and the degree of proteinuria were higher in cg3 and statistically significant. However, there was no difference in the degree of glomerulosclerosis, interstitial inflammation, fibrosis, tubular atrophy or vascular wall thickening between groups. Graft failure was present in 13 cases, mostly due to chronic rejection including sepsis and CMV infection in one case each. Five-year graft survival was 84.1% and was not significantly different from cases without TG. In conclusion, the severity of TG indicates profuse proteinuria, but does not affect graft outcome, which indicates tubulointerstitial and vascular pathology as being a more important prognosticator.
Allografts ; Atrophy ; Biopsy ; Classification ; Creatinine ; Fibrosis ; Follow-Up Studies ; Graft Survival* ; Inflammation ; Pathology ; Proteinuria* ; Sepsis ; Transplants*

Diffuse glomerular basement membrane (GBM) lamellation, reminiscent of Alport's syndrome, has rarely, and exclusively, been reported in renal allografts from pediatric donors to adult recipients. We report on a similar lesion, identified in a 42-year-old male, who received a kidney from an unrelated 21-year-old living male donor. The disease of the recipient was unknown. Renal allograft biopsies were performed 3.5 and 4.8 years after the renal transplantation, due to massive proteinuria and serum creatinine elevation. The histological features of both biopsies were similar, but more advanced in the second biopsy. Glomerular mesangium was widened and had an IgA deposit in the first biopsy. In addition to the presence of mesangial electron dense deposits, the GBM showed diffuse lamellation and splintering on the subepithelial side, but no definite deposits. In the second biopsy, IgA deposits were extended to the peripheral capillary walls, but electron microscopic examination was not available. Two months after the second biopsy, the patient returned for hemodialysis.
Adult ; Basement Membrane/*pathology ; Case Report ; Glomerulonephritis, IGA/*etiology/*pathology ; Human ; Kidney Glomerulus/*pathology ; *Kidney Transplantation/*adverse effects ; Male