Objective To assess the effect of immunosuppression conversion from cyclosporine(CsA) to tacrolimus(FK506) on progression of chronic allograft nephropathy(CAN).Methods A retrospective study was performed in 36 cyclosporine treated renal transplant recipients.Patients were included if they were biopsy-proven CAN and they were converted from cyclosporine to tacrolimus due to CAN.The FK506 dose was 1/50 to 1/100 of the cyclosporine's and the dose was adjusted according to the trough level of tacrolimus,body weight of the patient and the situation of CAN.Other immunosuppressive agents kept unchanging.Serum creatinine and FK506 trough level were monitored after conversion.Fasting blood triglyceride,total cholesterol and glucose were determined at baseline and 6th month after conversion to tacrolimus.Results After switching over to FK506 for 6 months,there was a significant improvement in function of renal allograf(P

Objective To study the inhibition effect of anti-CD 25 monoclonal antibody (Simulect) to the activated T cells in the recipients of kidney transplantation. Methods Forty-six recipients of renal transplantation were randomly divided into therapeutic group with simulect (23 cases) and control group (23 cases).All recipients in both groups received immunosuppressive therapy with neoral,azatheoprine and predonine conventionally.The recipients in simulect group received additionally 20 mg simulect at 2h preoprative and 4d postoperative,respectively.Several phenotypes of lymphocyte in the peripheral blood of all recipients were observed sequentially with flow cystometer. Results Compared with the control group,the number of activated T cells(CD + 25 ) decreased significantly within 24h after the first dose in the patients who received simulect,and the level of the cells that expressed CD 25 was significantly lower than that of control during the whole observation( P

Objective To study the hepatotoxicity of cyclosporine-A, tacrolimus and other immunosuppressive drugs in patients with renal transplantation. Methods In 346 cases undergone renal transplantation, ALT, AST, BILT and BILD levels of venous blood 1-90 days after operation, and treatment methods and outcome were reviewed, in order to evaluate the effectiveness of the treatment of hepatotoxicity. Results In CsA group, the occurrence rate of liver dysfunction was 26.9%, in whom ALT, AST and BILD increased apparently (P0.05). In MMF and MRZ group, the incidence of liver dysfunction was almost the same. In 18 cases the drug was changed into FK506, ALT, AST, BILT and BILD all apparently decreased 1 week later (P

Objective To study the diagnosis and treatment of the severe pulmonary infection in the patients after kidney transplantation. Methods The clinical data of 26 patients with severe pulmonary infection following kidney transplantation were analyzed retrospectively. Results Microorganisms were isolated and identified in 22 patients out of 26 kidney transplantation patients with severe pulmonary infection. The main etiological pathogens according to their frequency and type were: bacteria (15 cases, including Escherichia coli, Aerobacter cloacae, Klebsiella fredlanderi, Enterococcus faecalis, Staphylococcus epidermidis, etc.), fungi (12 cases, Fermentum, Blastomyces albicans, Candida tropicalis, Aspergillus, etc.), and cytomegalovirus (10 cases). 46.15% (12/26) of patients were infected with one kind of microorganism, and 53.85% (14/26) of patients were mixed infection. In 73.1% (19/26) of patients the pulmonary infection occurred during 1-6 months after renal transplantation. Among 26 patients, 12 developed ARDS, and 4 patients gave up therapies due to high expenses. With energetic treatment, 18 patients (81.82%) were cured and 4 died. Conclusions Intensive care and active measures should be given in the treatment of severe pulmonary infection after kidney transplantation. Early diagnosis, administration of broad-spectrum and combined use of antibiotics, the early identification of pathogens, enforcement in systemic support, including correction of immunosuppression, the timely use of mechanical ventilation to correct hypoxia, are the key treatment strategies for a successful result.

Objectives To investigate the surgical technique and some other related problems of simultaneous heptorenal transplantation. Methods Combined liver-kidney transplantation was performed in one patient with huge polycystic liver, bilateral kidney, and another with liver cirrhosis after hepatitis B complicated with hepatic carcinoma and uremia due to chronic nephritis. Donors' organs were infused in situ with UW solution and rapidly harvested. Orthctopic or piggyback liver tranlsplantation was carried out and the kidney was transplanted with conventional method respectively. The patients received an immunosuppression therapy including simulect (CD25 antibody), FK506 or CsA, Mycophenolate mofitil (MMF), and Predinision. Results Both transplanted organs rapidly functioned well after the operation. One patient recovered well but suffered from ALI (acute lung injury) on the 2nd postoperative day and ARDS on the 11th postoporative day. There were no acute rejection or recurrence of the primary diseases in both cases. Conclusions Simultaneous hepatorenal transplantation is one of the treatment methods for end stage liver and kidney diseases. Skillful operative technique, comprehensive perioperative monitoring and appropriate management are all important factors for obtaining a successful result. It requires more shillful techniques than single organ transplantation.

0.05).During the DGF period,there was a lower incidence of acute rejection in the induction group compared with that in the control group(0% vs 25%,P

0.05).The expression percentage of IL-4 of CD3+CD8-T lymphocytes cells in peripheral blood of the patients in group A(4.0%?2.8%)was significantly lower than that in group B and C(7.9%?5.5% and 10.2%?7.5%,P0.05).The level of serum sCD30 in the patients of group A(20.2?12.4ng/ml)was significantly higher than that of group B and C(7.8?3.1ng/ml and 7.6?3.0ng/ml,P0.05).ROC curve analysis indicated that when the ratio of Th1/Th2 was at the cut-off value of 1.95,the sensitivity and specificity to identify CRAD caused mainly by immune injury was 80% and 90%,respectively;and when the level of serum sCD30 was at the cut-off value of 10ng/ml,the sensitivity and specificity to identify CRAD caused mainly by immune injury was 93.3% and 86.7%,respectively.Conclusions Disequilibrium of Th1/Th2(drift to Th1)and raised level of serum sCD30 exist in most of the patients with CRAD which was caused mainly by immune injury.It is with high sensitivity and specificity to identify the CRAD by determining the ratio of Th1/Th2 of CD3+CD8-T lymphocytes cells in peripheral blood and the level of serum sCD30.

Objective To study the incidence of malignant tumors in renal allografts and explore the mechanism of increased incidence.Method A retrospective study was performed on 1814 renal allografts under immunosuppression from 1998-2010.Result Twenty-nine cases of malignant tumors were found in 1814 cases undergoing renal transplantation with the incidence being 1.60％.Among these cases,the incidence of urinary system tumor was 72.4％,that of hepatoma carcinoma was 10.3％,that of lung cancer was 6.9％,and each of lymphoma,cutaneous cancer or nasppharyngeal carcinoma was 3.4％.Most patients accepted operations,additional therapies including chemical or radiological and immunological therapies.Conclusion The incidence of malignant tumors in renal allografts was higher than normal persons.Besides the outcome of immunosuppression,the effects of transplantation itself and primary disease before transplantation,for instance,the higher incidence of uroepithelium malignancy was frequently associated with history of long term medications.

Objective To investigate the clinical application of mizoribine (MZR) in minimizing virus infection risk in renal transplant patients. Methods Four transplantation centers in Beijing participated in this clinical trial, and 112 primary cadaveric renal allograft recipients were enrolled. MZR in combination with CsA and corticosteroids was used for the prevention of acute rejection (AR). The biochemical data were observed and the infections of 7 different viruses were monitored and recorded. Results All patients were followed up for 12-20 months (average 15. 5 months). The patient/graft survival rate was 96% and the morbidity of AR was 11.6%. All ARs were converted. The major side effect was hyperuricimia, which could be controlled without withdrawal of MZR. The morbidity of CMV infection was 11.6% and no CMV diseases occurred. Only one case experienced adenovirus infection. Conclusions MZR is a safe and effective immunosuppressants. Hyperuricimia should be controlled after operation. The morbidity of virus infections was relatively lowered.

Objective To study the blood pressure and cardiovascular conditions in kidney transplant recipients in order to prevent the cardiovascular complications in such patients. Methods The blood pressure and ECG were monitored day and night by noninvasive means for 86 patients after transplantation.The results were analysed and compared with the pretransplantation studies. Results Hypertension occurred in 55 out of 86 patients.There was a significant difference of average blood pressure and the occurrence of abnormal ST segment or T wave between day and night whereas no significant change was observed in blood CsA concentration,blood creatinine,serum cholesterol,blood sugar,triglyceride and K+,N+,Cl-,TCO 2,Ca 2+ ,etc. Conclusions Cardiovascular complications in kidney transplant recipients is related to the high blood pressure during night,the normal day-night blood pressure rhythm being violated.It is not related to the immunosuppresives used.