ObjectiveTo verify the efficacy and safety of conversion from cyclosporine (CsA) to tacrolimus (Tac) in renal transplant recipients. MethodsThe clinical data of conversion from CsA to Tac in renal transplant recipients were retrospectively analyzed. In 97 patients undergoing kidney transplantation, there were 62 cases of chronic allograft nephropathy (CAN), 21 cases of refractory renal allograft rejection, 8 cases of hepatic impairment, and 6 cases of gingival overgrowth and hirsutism. The patients were followed up with renal function, hepatic function, blood fat, pressure,glucose,acute rejection incidence, patients/kidney survival rate,and adverse drug reaction for 3 years.ResultsThe renal function of patients with CAN and refractory acute rejection was greatly improved after conversion from CsA to Tac treatment at the first year (P＜0. 05) ,and steady at the 2nd or 3rd year. The conversion treatment could greatly improve the hepatic function of patients with dysfunction of liver, improve the gum hypertrophy and hypertrichosis results from CsA. The 1- and 3-year patients/kidney survival rate after conversion from CsA to Tac was 100 ％/97. 9 ％ and 100 ％/92. 8 ％, respectively. The conversion treatment showed a significantly lower degree of plasma cholesterol, low density lipoprotein, triglyceride, and blood pressure (P ＜ 0.05). Incidence of pathoglycemia, diarrhea or anepithymia,and tremor after conversion treatment was 13.4 ％ (13/97),2. 1％ (2/97) and 5. 2 ％ (5/97),respectively. There were no serious pulmonary infection and tumor during the observation period. ConclusionThe mid-long term effect of conversion from CsA to Tac in patients with kidney transplantation is safe and effective.

Objective To investigate correlation between microRNA (miR-494) and TH 17 cell differentiation in murine cervical heterotopic cardiac transplant model.Method The heterotopic cardiac transplant models of Balb/c→C57BL/6 mice were established as experimental group,and those of C57BL/6→C57BL/6 mice as control group.Real time-polymerase chain reaction(PCR) was used to detect miR-494 and interleukin(IL)-17A mRNA expression in the grafts.CD4+ T cells,CD8+ T cells and CD45+ myeloid cells were isolated from the grafts,and miR-494 and IL-17 mRNA expression was detected.In vitro,lymphocytes in the spleen from C57BL/6 mice were harvested,and CD4+ T cells were isolated with MACS and then stimulated to TH 1,TH 2,TH 17,Treg subset cells.The expression of IL-17A mRNA and miR-494 in different T subsets was examined by Reverse transcription-polymerase chain reaction(RT-PCR).Result Two grafts from each study group were harvested on the 7th day post-transplantation.In experimental group,the IL-17A mRNA expression was increased,while the expression of miR-494 was decreased as compared with control group with the difference being significant between two groups.The expression of IL-17A rnRNA in CD4+ T cells of the grafts was significantly increased,while that expression of miR-494 was decreased.In vitro,the expression of miR-494 in TH 17 cells was significantly lower than that in TH 1,TH 2 and Treg cells.Conclusion miR-494 is related closely to TH 17 cells differentiation in the transplant rejection,which may play a role in transplant rejection through regulating TH 17 cells.

Objective To investigate the efficacy and safety of conversion therapy to mizoribine (MZR) for renal transplant patients who suffered MMF or Aza adverse reaction. Methods In 56 patients with adverse reactions at different time points after renal transplantation, there were 23 cases of pulmonary infection, 14 cases of bone marrow depression, 6 cases of hepatic functional lesion and 13 cases of diarrhea. The immunosuppressive protocols of these patients were changed to CNI + MZR + Pre when the adverse reaction occurred. During the follow-up period (11 to 53 months), the effect and adverse events of conversion treatment were observed. Results After conversion treatment, 1 of 23 patients with pulmonary infection was re-infected after 26 months and finally died of heart and lung function failure. In 14 patients with bone marrow depression, blood test returned to normal in 13cases. Six patients with hepatic functional lesion were administered hepatoprotection treatment and their liver function was restored without recurrence of impaired liver function. All 13 patients with diarrhea were relieved without recurrence. The serum creatinine was 123 ± 21.3 μmol/L and 119±18. 2 μmol/L before and after the conversion therapy respectively (P＞0. 05). During the follow-up period, all patients' graft function was good. The incidence of rejection was 1.7 % (1 case). Nine patients (16. 1 %) had a higher level of uric acid after conversion. One patient had finger and toe joint pain. The symptoms were relieved after symptomatic treatment. Conclusion There were high security and good effect of conversion therapy to MZR due to MMF or Aza adverse reaction. Besides, MZR conversion therapy for renal transplantation patients provided a new option for individual immunosuppression.

Objective To investigate the correlation between urine levels of IP-10,Mig,OPG and the occurrence of renal allograft rejection.Methods As a retrospective nested case-control study,biopsy confirmed acute rejection reaction by 20 cases was rejection group,and recovery of renal function in kidney transplant after the elect good by 20 cases was control group.morning urine was tested of IP-10,Mig and OPG level of the two groups within 30 d after transplantation.The advantage was taken of the Luminex 2000 test platform,through PlexMark triple kidney injury marker kit to detect the daily urine of recipients.Results The rejection group's urinary IP10 wa (394.7 ± 67.3)ng/L,significantly higher than that in the control group of (10.9 ± 3.8) ng/L (P＜0,05).Urine Mig level of rejection group was (443.0 ± 88.9) ng/L,and the control group was only (15.7 ± 6.99)ng/L.Rejection group was significantly higher than that in the control group (P＜0.05).Urine OPG peak levels,the difference between the two groups was not statistically significant.Rejection group in the rejection period urinary IP-10 and Mig levels were significantly non-exclusion period,the difference was statistically significant (P＜0.01) higher than its level at different times with serum creatinine concentration showed obvious correlation,IP-10 with serum creatinine of correlation coefficients (R2)=0.8673,P＜0.01,Mig and serum creatinine R2 =0.7951,P＜0.01,IP-10 and Mig change time earlier than serum creatinine,to the exclusion of the before and after OPG differences no statistically significant.Conclusion The increasing of IP-1O and Mig content in the urine is associated with acute renal allograft rejection,which is an early reflect of subclinical tubular injury.And its changes as early as elevated serum creatinine,is expected to become independent indicators to predict acute rejection reaction occurs.

Objective To compare the efficacy and safety of conversion from CCB to ARB in the treatment of hypertension and proteinuria in kidney transplant recipients.Methods 127 long-term recipients who used CCB as their anti-hypertensive drug were enrolled.All recipients had stable renal function and no diabetes.Recipients were randomly assigned to experimental group (65 cases) which received ARB (Losartan,50～ 100 mg/day) instead of CCB,or control group (62 cases) which received routine CCB.All recipients were followed up for 2 years.Blood count,urinalysis,liver and kidney chemistry,blood lipid,serum electrolytes,24-h urine protein,blood concentration of CNI drugs and other biochemical indexes were observed.Results During the 2-year follow-up,the blood pressure of the two groups was maintained within normal level.The 24-h urine protein was decreased in the experimental group ( 176.32 ± 54.54 to 155.69 ± 62.25,P＜0.05),but increased slightly in the control group (P＞0.05).Although the blood lipid of the experimental group was not different before and after the follow-up,the high density lipoprotein (HDL) was increased statistically (2.25 ± 0.26 to 2.46 ±0.31,P＜0.05).The blood count,liver and kidney chemistry,serum potassium,blood concentration of CNI drugs in both groups showed no significant differences.Conclusion Both CCB and ARB could be effectively and safely used for the treatment of hypertension and proteinuria in kidney transplant recipients.ARB would be more effective in reducing cardiovascular disease (CVD)rate and decreasing proteinuria.

BACKGROUND: Current guidelines recommend hepatocellular carcinoma (HCC) screening in high-risk populations. However, the ideal HCC screening interval and screening modality have not been determined. This study aimed to compare the screening efficacy among different modalities with various intervals. METHODS: PubMed and other nine databases were searched through June 30, 2021. Binary outcomes were pooled using risk ratio (RR) with 95% confidence intervals (CIs). Survival rates were also pooled using RR with 95% CIs because most eligible studies only provided the number of survival patients instead of hazard ratio. RESULTS: In all, 13 studies were included. Two random controlled trials (RCTs) and six cohort studies compared screening intervals for ultrasonography (US) screening and found no significant differences between shorter (3- or 4-month) and longer (6- or 12-month) screening intervals in terms of early HCC proportion, HCC significant mortality, 1-year survival rate; screening at 6-month interval significantly increased the proportion of early HCC (RR = 1.17, 95% confidence interval [CI]: 1.08-1.26) and prolonged the 5-year survival rate (RR = 1.39, 95% CI: 1.07-1.82) relative to the 12-month interval results. Three other RCTs and two cohort studies compared different screening modalities in cirrhosis or chronic hepatitis B, which indicated no statistical differences in the proportion of early HCC (RR = 0.89, 95% CI: 0.40-1.96) and HCC mortality (RR = 0.69, 95% CI: 0.23-2.09) between the biannual US and annual computed tomography (CT screening). Biannual US screening showed a lower proportion of early HCC than biannual magnetic resonance imaging (MRI) (RR = 0.60, 95% CI: 0.37-0.97) and biannual US combined with annual CT (RR = 1.31, 95% CI: 1.13-1.51) screening. The proportion of early HCC in the contrast-enhanced US group was slightly higher than that in the B-mode US (RR = 1.08, 95% CI: 1.00-1.23) group. CONCLUSIONS: The evidence suggests that 6 months may be the best HCC screening interval for US screening. The effectiveness of CT and MRI is better than US during same screening intervals. However, MRI and CT are more expensive than US, and CT also can increase the risk of radiation exposure. The selection of CT or MRI instead of US should be carefully considered. REGISTRATION No. CRD42020148258 at PROSPERO website ( https://www.crd.york.ac.uk/PROSPERO/ ).
Humans ; Carcinoma, Hepatocellular/pathology* ; Liver Neoplasms/pathology* ; Liver Cirrhosis/complications* ; Risk Factors ; Cohort Studies