BACKGROUND: Donor antigen presenting cells immigrated into the recipient can induce the immunological tolerance of recipient T cells to donor, leading to a final acceptance to grafts, lnterleukin-10 (IL-10) modification maintains dendritic cells at a desirable differentiating state, which is an effective method to promote the protection to kidney in the simultaneous liver-kidney transplantation.OBJECTIVE: To observe the immigration of IL-10-modified dendritic cells in rats subjected to simultaneous liver-kidney transplantation and to investigate the mechanism of action.DESIGN, TIME AND SETTING: A randomized, controlled, animal experiment was performed in the Medical College of Sun Yat-sen University between June 2004 and February 2006.MATERIALS: Male DA donor rats (n=60) and Lewis recipient rats (n=60), both were adult and of clean grade, were included.Sixty Lewis rats were randomly and evenly divided into 3 groups: IL-10-modified cell group, simple cell group, and model control group.METHODS: Donor rat liver and kidney were harvested by simultaneous liver-kidney transplantation. Recipient rats in each group were subjected to orthotopic liver and left kidney transplantation to establish models of immunological rejection. Under sterile condition, donor rat femur and tibia were harvested. Dnlbecco's modified eagle's medium (DMEM) was used to wash out the bone marrow. After removal of red cells, dendritic cells were isolated and cultured by adherent method. After modified with 20 μg/L IL-10 for 72 hours, dendritic cells were intravenously transfused into rat bodies in the IL-10-modified group, 2×10(7) cells/rat, In the simple cell group, rats were treated with donor dendritic cells without modification with IL-10. Rats in the model control group received no any interventions.MAIN OUTCOME MEASURES: [1]Dynamic changes of vital sign, urine volume, liver and renal function in recipient tissues;[2] Pathohistological detection results;[3]Distribution of donor dendritic cells in the recipient rats by in situ hybridization.RESULTS: In the simple cell and model control groups, urinary volume was reduced to 0 mL 5-6 days after transplantation. In addition, both groups presented with severe acute rejection. In the IL-10-modified cell group, urinary volume maintained at 6-12mL within 2 weeks after transplantation. The acute rejection of liver and kidney transplantation was obviously inhibited, surviving for(20.0±2.6) days on average, which was significantly longer than that in the simple cell group and model control group. A probability value of less than 0.05 in the Log Rank test was considered statistically significant. There were many Y chromosome-labeled dendritic cells immigrated into the mesenteric lymph node in the recipient rats.CONCLUSION: IL-10-modified dendritic cells play an immunoprotective effect on the liver and kidney transplanted simultaneously. Donor immature dendritic cells immigrated into recipient tissue could reduce acute rejections and prolong the survival time of liver and kidney grafts and recipients.

Objective To study the influence of donor GFR on the early renal function in recipients undergoing living donor transplantation.Methods A total of 172 living donor transplant recipients in our kidney transplantation center from 2006 to 2011 were enrolled into this study.Among them,166 were genetically related (96.5％),while 6 were genetically unrelated (spouses in 5 and other in 1).The predonation GFR was measured by isotope clearance (99mTC-DTPA with few exceptions).The range of donor GFR was 62 to 148 ml/min.The recipients were classified into two groups according to donor graft GFR level (GFR≤45 ml/min,n=76; GFR＞45 ml/min,n =96).The predonation dialysis,cold and warm ischemia time,antibody induction,immunosuppressive regimens and HLA mismatch were not significantly different between two groups.Results There were no significant differences in the incidence of postoperative acute rejection and delay graft function (DGF).The postoperative Scr of GFR＞45 ml/min group in 1 week,1 month,3 months and 1 year was lower compared with the GFR ≤45 ml/min group,and only the difference of Scr in 1 week was significantly different (P＜0.05).A repeated-measure ANOVA revealed no significant differences were found in Scr variation of two groups during the first year after transplantation.Conclusions Predonation GFR of the donor has effect on the Scr of postoperative Ⅰ week of recipients,not on the Scr within a year.Recipients with graft GFR＞45 ml/min have lower Scr levels.

Objective To analyze the influence of donating kidney of marginal donors on the early prognosis of living-related kidney transplant recipients.Methods Sixty-six cases of living-re-lated kidney transplant patients between February 2004 and September 2007 were divided into the marginal donors group(28 cases)and non-marginal donors group(38 cases).Serum creatinine before and after surgery,creatinine clearance after surgery and perioperation complications were compared respectivelv between the 2 groups.Results The serum creatinine levels in the marginal donors group and non-marginal donors group were 154,131,127μmol/L and 132,117,118 ttmol/L on 7th day,1st month and 3rd month after transplantation respectively,and there were no significant differences between the 2 groups(P＞0.05).The serum creatinine level in parent-child donating kidney of the 2 groups Was 160,131,126μmol/L and 132,129,126μtmol/L on 7th day,1st month and 3rd month after transplantation respectively,and there were no significant differences too(P＞0.05).There was no difference in the rate of perioperation complications and creatinine clearance after kidney transplantation between the 2 groups.Conclusions The early prognosis of marginal donors'recipients is ideal.The marginal donors could be selected as the living-related kidney transplant donors,especially between parent and child,as long as they are evaluated according to stricter criteria.But the long-term prognosis of the recipients should be further observed.

Objectives To investigate the influence of cytomegalovirus infection after kidney transplantation on the recipients and the associated risk factors of cytomegalovirus infection .Methods Data of 892 kidney transplantation recipients from January 2000 to December 2004 in our department were analyzed retrospectively . All the recipients were divided into case group (with cytomegalovirus infection) and control group (without cytomegalovirus infection) . Log-Rank test was used to compare the 1-, 3-, 5-year survival of patients and grafts between two groups . The incidence of complications, the difference of regiment of immunosuppressant and anti-CMV drugs were compared as well . The independent risk factors of cytomegalovirus infection were assessed by Logistic regression analysis . Results One-, 3-, 5-year survival rates of patients in case group were 81 .3%, 72 .8% and 54 .8% respectively, while the patients in control group were 96 .4%,91 .4% and 79 .9% respectively, the prior was significantly lower than the latter (Log-Rank value=49 .62, P＜0 .01) . One-, 3-, 5-year survival rates of grafts in case group were 71 .0%, 66 .2% and 46 .1%, while the grafts in control group were 91 .5%, 86 .6% and 74 .5% respectively, the prior was significantly lower than the latter as well (Log-Rank value=44 .87, P＜0 .01) . The incidence of acute rejection in case group was 24 .9%, while it was 13 .9% in control group, with significant difference between two groups (x2=14 .49, P＜0 .01 ) . Logistic regression showed that acute rejection,mycophenolate mofetil dose more than 2 g, and usage of ATG/ALG or OKT3 were the independent risk factors of cytomegalovirus infection (OR=1 .464, 3 .097 and 2 .837, P＜0 .05 ) . Ganciclovir was the protective factor of cytomegalovirus infection (OR =0 .234, P ＜0 .01) . Conclusions Cytomegalovirus infection decreases the long-term survival of recipients and grafts in kidney transplantation . Acute rejection, high dose of mycophenolate mofetil, and ATG/ALG or OKT3 are the independent risk factors of cytomegalovirus infection . Prophylactic usage of ganciclovir after kidney transplantation can effectively reduce cytomegalovirus infection .

6.2 mmol/L) who underwent renal transplantation accepted pravastatin therapy 10 mg once evening for 8 weeks. Total cholesterol(TC),low-density lipoprotein-cholesterol (LDL-C),high-density lipoprotein-cholesterol (HDL-C),triglyceride(TG),endothelin(ET) and nitrous oxide(NO) were measured before and after pravastatin therapy. The endothelium-dependent relaxing function was measured before and post pravastatin therapy by high-resolution ultrasound. Thirty people with normal blood cholesterol accepted same examination as control. Results The level of ET in renal transplantation group was significantly higher than that of control group,and the level of NO in renal transplantation group was significantly lower than that of control group. After 8 week′s therapy,the level of NO rose significantly,and the level of ET,TC,LDL-C,TG decreased significantly. The level of HDL-C increased but there was no significant difference between two groups. Flow-mediated vasodilations were improved after pravastatin therapy,while the level in transplantation group was lower than that of control group. Conclusion Pravastatin is effective in treatment of dyslipidemia after renal transplantation,which can improve the endothelium-dependent vasodilation.

Objective To analyze the characteristics of extra-pulmonary tuberculosis in renal transplant recipients,and discuss its diagnosis and management. Methods From Jan.1991 to Apr.2007,37 cases of post-operational tuberculosis were identified out of the 2333 renal transplantations done in our center.Among them there were 19 cases with extra-pulmonary foci(51%),which involved allograft kidney in 5 cases,meninges in 4 cases,pleura in 4 cases,lymph node in 3 cases,soft issue in 2 cases,larynx,liver,vertebra and intestine in 1 case each.In 3 cases,there were 2 extrapulmonary sites involved at the same time.Most of the cases happened within one year post-transplant (53%).The most common clinical manifestation was fever. Results After anti-tuberculosis therapy,14 cases were cured and 5 were irresponsible and died.Eight cases (42%) experienced acute rejection and 4 cases(21%)had abnormal liver function during the treatment. Conclusions Extra-pulmonary tuberculosis had a high incidence and high mortality in post-renal-transplant population.Therefore,attention should be given to its differential diagnosis in clinical practice.Balancing anti-tuberculosis and anti-rejection therapy is important for this specific population.

Objective To analyze the risk factors affecting BK virus(BKV)infection after kidney transplantation.Methods Taking 90 renal recipients as objectives,urine and peripheral blood (PB)samples of which were taken for the BKV cytologieal test of urinary sediment and real-time PCR tests for BKV DNA of both urine and PB at 1,3,6,9 and 12 months after transplantation.Part of the renal-recipients had been received the graft biopsy.According to BKV DNA in urine,90 recipients were divided into two groups:BKV infected group and non-BKV infected group.Potential variables were compared between the two groups and analyzed by Logistic regression model multivariate analysis to assess and rank the BKV infection related factors.Results The positive rates of urine decoy cell,BKV viruria and viremia in 90 renal recipients were 42.2%(38/90),45.6%(41/90)and 22.2%(20/90),respectively.The proportion of the recipients who used FK506+MMF protocol in the BKV infected group was 68.3%(28/41),which was higher than that of the non-BKV infected group 40.8%(20/49,P＜0.01).Using FK506+MMF protocol was the independent risk factor impacting on BKV infection in renal recipients(X2=6.579,P=0.01,OR=3.123).Five cases of BK virus associated nephropathy(BKVAN)were diagnosed.Conclusion Using FK506+MMF can increase the possibility of BKV infection and then result in BKVAN in renal transplant recipients,intensively BKV monitoring is necessary for these recipients.

Objective To investigate the pathological type and characteristics of renal allograft in kidney transplantation recipients,and to analyze the relevant clinical conditions and prognosis of renal function.Methods 230 patients received renal allograft biopsy after renal transplantation.The pathological type and characteristics of renal allograft specimens were observed,and the serum creatinine (SCr) in the recipients with different pathological types were analyzed.The function of renal allograft in the recipients was followed-up after one year,and their prognosis was evaluated.Results In 10 cases of protocol biopsy,normal renal tissues were found in 9 cases,IgA nephropathy occurred at the 3rd month after transplantation.In 220 cases having impaired renal function,there were 33 cases of borderline change,45 cases of acute rejection (AR),24 cases of chronic rejection (CR),26 cases of chronic allograft nephrapathy (CAN),and 39 cases of posttransplantation glomerulonephritis (PTGN).Except for above 167 cases,lesions of 28 cases showed multiple pathology types.Furthermore,there were 8 cases of calcineurin inhibitor nephrotoxicity (CNI-NT),7 cases of BK virus nephropathy (BKVN),and 5 cases of acute tubular necrosis (ATN).Five cases could not be diagnosed for little tissue.In the recipients with pathological diagnosis of borderline change,AR,CR,CAN and nephritis,SCr levels were (171 ± 17),(259 ± 25),(343 ± 33),(406 ± 67) and (207 ± 26) respectively.There was significant difference in SCr levels of recipients among the above 5 groups (P＜0.01).One year after biopsy,137 recipients (80.2%) were followed up.The dysfunction rate of renal allograft was 3.1%,18.2%,22.2 %,33.3% and 13.5% respectively.The △SCr was (-47 ± 20.7),(-37.3± 36.9),(25.5 ± 24.3),(13.5 ± 27.7) and (25.2 ± 17.1) μmol/L respectively.Conclusion Complex and diverse pathological changes were showed in renal allograft.Accurate diagnoses come from renal biopsy and clinical analysis may help clinicians select appropriate treatment programs to promote long-term graft survival.

Objective To explore the risk factors of invasive fungal infection after kidney transplantation and to evaluate their effect on prognosis. Methods Data of 2573 patients of kidney transplantation in our center from Jan 1994 to May 2008 were analyzed retrospectively. Patients were divided into case group and control group according to fungal infection after operation. Differences of age, preoperative conditions, complications after operation, drainage time, application of broad-spectrum antibiotics, and use of anti-rejection drugs were compared between these two groups to identify the risk factors of postoperative fungal infection. The impact of risk factor amount on the incidence and mortality of invasive fungal infection, as well as on the mortality of patients and graft loss rate was analyzed. Results Compared with control group, the number of aged patients elevated significantly, as well as the incidence of delayed graft function (DGF), acute rejection, CMV infection, liver function impairment, delayed incision healing, and myelosuppression went up significantly in case group. The incidence of long drainage time (>1 week), using broad-spectrum antibiotics (>1 week) and anti-rejection drugs was also increased in case group (P<0.01) . Multivariate Logistic regression showed that aging (≥60 years), DGF, delayed incision healing, myelosurppression, and using broad-spectrum antibiotics (>1 week) were independent risk factors for invasive fungal infection. With the risk factor number increasing, the incidence and mortality increased significantly (X2=91.2 and 18.1 ,respectively, P<0.01), the graft loss rate also increased significantly (X2=93.0, P<0.01). Conclusion Evaluaton of risk factors and prevention of fungal infection after kidney transplantation are very important for improving the prognosis.

Objective To analyze the characteristics of tuberculosis (TB) in renal-transplant recipients from our hospital, and summarize the corresponding experiences in diagnosis and management.Methods A retrospective study was performed on 61 documented post-transplant TB cases out of the 2842 patients who received kidney transplantation in the First Affiliated Hospital of Sun Yat-sen University between Jan.1991 and Dec.2010.Results TB in the post-renal-transplant population in our hospital displayed the following characteristics:(1) High incidence (2.1％ ).54.1％ recipients were diagnosed within the first year post-transplant; (2) Lung was the most common site (77.0 ％).There was high prevalence (60.7 ％) of extra-pulmonary TB (lymphatic TB,23.0 ％; pleuritis,13.1 ％; graft,11.5％); (3) Fever (83.6 ％),cough (55.7 ％),sputum (41.0 ％) were the most common clinical manifestations.There were also emaciation (3.3 ％) and enlargement of lymph nodes (18.0 ％); (4) Chest X-ray and CT were of great value during TB diagnosis while purified protein derivative of tuberculin (PPD) skin test had little diagnostic value with a negative result in 56 cases (91.8 ％) ; (5) Liver function damage ( 16.4 ％),kidney function injury (39.3 ％) and peripheral nerve toxicity (3.3 ％) were the main adverse reactions of anti-tuberculosis chemotherapy,also the major cause of anti-TB failure; (6) Pre-transplant TB (17 cases) increased the probability of TB recurrence (4 cases,23.5 ％) post-transplantation; (7) The post-transplant TB patients were accompanied with cellular immune deficiency,resulting in overlapping infection of bacteria,viruses and fungi (19.7 ％); (8) 1- and 3-year patient/graft survival rate of patients with post-transplant TB was 85.2 ％/78.7 ％ and 85.2 ％/75.4 ％ respectively. The accumulative mortality rate reached to 14.8％,while overlapping infection was the major cause of death (66.7 ％).Conclusion Chinese renal transplant recipients still face a high risk of TB because of their immunecompromised state and epidemiological prevalence of the disease. For the high mortality rate and associated serious complications,rapid diagnosis and effective anti-TB chemotherapy are of great value for TB population.