Objective To investigate the influence of renal allograft donor cytokine and cytokine receptor gene polymorphisms on acute rejection after renal transplantation.Methods (1) 126 cases of cadaveric renal allograft recipients were divided into two groups according to the presence or absence of acute graft rejection.The distribution of 22 polymorphisms in 13 cytokine genes and production types of some cytokines were compared between donors of two groups as well as latent factors affecting acute rejection.(2) Based on the result of HLA-DR matching,all recipients were stratified into two conditions:0～1 locus HLA-DR mismatched and HLA-DR completely mismatched.Previous positive gene polymorphisms were compared between rejection group and no rejection group under two conditions.Results (1) Compared with no rejection group,the number of HLA-DR mismatched was significantly higher in rejection group.In the donors of rejection group,the genotype frequency of IL-1α-889 C/C,IL-1Rα msp I 11100 T/T,IL-4Rα+ 1902 A/A,TGF-β1 codon 10 C/C,IL-10-1082 A/A and lower production type frequency of IL-10 were significantly higher,whereas the genotype frequency of IL-12-1188 A/A,IL-2-330 G/G and IL-10 GCC/ATA was significantly lower.(2) With 0～1 locus HLA-DR mismatched,the genotype frequency of IL-1Rα msp I 11100 T/T,IL-4Raα+1902 A/A,IL-2-330 G/G,TGF-β1 codon 10 C/C and lower production type frequency of IL-10 showed significant difference between two groups,whereas with HLA-DR completely mismatched,the genotype frequency of IL-12-1188 A/A had significant difference.Conclusions This study verifies renal allograft donor genotype of IL-1α-889 C/C,IL-4Rα+ 1902 A/A,IL-1Ra msp I 11100 T/T,TGF-β1 codon 10 C/C,IL-10-1082 A/A and lower production type of IL-10 gene as the genetic safe factors for the development of acute allograft rejection and genotype of IL-12-1188 A/A and IL-2-330G/G as the major genetic risk factors for acute rejection after kidney transplantation Furthermore,the condition of HLA-DR mismatching might interfere with the action of these cytokine and cytokine receptor polymorphisms.

Retrospective analysis of 761 case-times successive color Doppler sonography for 518 renal transplant patients was carried out.six parameters of sonography were used to compare, the CsA-NT hemodynamic changes among the patients with normal function, rejected and hy-dronephrotic kidney.It revealed that during rejection of the rendl srafts, besides an elevation of resistance index(RI)and a decrease of D/S ratio, the velocity and volume of renal blood flow were also slowed down and decreased respectively.After combating rejection, the renal function recovered to normal gradually, and RI dropped below 0.75 subsequently.Otherwise R1 would be persistently elevated, which indicated an irreversible rejection.The diagnosis of acute rejection was given at RI≥0.83, with the sensitivity rate being 82.70%and specificity being 80.10%.It was suggested that RI is a relatively sensitive and relialble parameter for the diagnosis of rejection.In combination with the clinical manifestations RI is of great important clinical value for the early diagnosis and treatment of acute rejection.

Objective To study the therapeutic effects and side effects of foscarnet in the treatment of active(IgG+,IgM+)and inactive(IgC+,IgM-)cytomegalovirus(CMV)infection after cadaver renal transplantation.Methods Forty-one cases of active cytomegalovirus infection and 22 of inactive cytomegalovirus were selected to receive foscarnet treatment.Besides,10 cases of inactive cytomegalovirus infection served as control group without receiving foscarnet.The usage of foscarnet was 40 mg/kg,iv.,2 ～3 weeks in the active stage,50 mg/kg,iv.,3～4 weeks in the inactive stage.Results Clinical symptoms of patients in the active stage were controlled,and serologic CMV IgG turned negative.Moreover,no positive infection was found after 3-month follow-up for those who received foscarnet.At the same time, 3 patients in the control group turned into active infection. Only one receiving foscarnet appeared urine volume cutting down temporarily,and the renal function had a reversible change;2 patients had skin red reaction.Conclusion Foscarnet could control CMV active infection quickly,markedly and firmly.and no recurrence was found during a 3-month follow-up.Foscarnet may protect the inactive patients from turning positive.And foscarnet had no obvious damage to the renal graft function and didn't interfere with the metabolism of blood calcium and cyclosporine A.Foscarnet is a safe and effective drug to treat CMV infection.

Objective To investigate the diagnosis and treatment of fungal infections of the lungs after renal transplantation. Methods A total of 43 cases (35 males and 8 females,mean age of 32 years) fungal infections of the lungs after renal transplantation from January 1999 to March 2002 were retrospectively analyzed.The mean time from post-operation to onset of the infection was 59 days. Results Among the 43 cases,16 were infected with candidiasis ,4 with candida Krusei ,2 with candida parapsilosis ,3 with mycormyccosis ,4 with aspergillosis ,1 with cryptococcosis neoformans and 2 with nocardiasis .14 cases out of 43 cases were coinfected with bacteria and CMV.The other 11 cases were negative for fungus-culturing test.23 cases were cured with fluconazole (100 mg,3 times per day for 10 days),17 with amphotericin B (50 mg,once a day for 10 days)and 3 died. Conclusions Fungal infection of the lungs is a severe complication after renal transplantation. Early diagnosis and timely treatment may achieve satisfactory effects.

Objective To review the kidney transplantation performed in our center and analyze the risk factors affecting long-term allografts survival. Methods Thirty two relative variables were analyzed by SAS statistical software. Using Log-Rank method, the influence of these variables on short and long-term grafts survival was investigated. A Kaplan-Meier analysis was used to estimate the 1-, 3-, 5-, 10-year graft survival rate and its half-life. Proportional hazards regression analysis (Cox model) was used to assess and rank the relative risk of potential variables.Results The 1-year, 3-year, 5-year, 10-year grafts survival rate was 82.5 %, 75.2 %, 65.5 % and 48.4 % respectively. When excluding the patients died with functioning grafts, the 1-year, 3-year, 5-year, 10-year grafts survival rate was increased to 91.0 %, 82.0 %, 75.9 %, 68.5 %, respectively. The mean half-life was 8.78? 0.14 and 14.09? 0.20 years, respectively. By Log-Rank analysis, factors affecting short- and long-term grafts survival were identified as: renal function and duration of which become normal, cold-ischemia time, acute rejection, delayed grafts function, immunosuppressive regimen, complication, infection, the method of anti-rejection therapy. A Cox model multivariate analysis showed that there were 18 factors affecting graft survival.Conclusion New immunosuppressive agent not only has significantly increased short-term graft survival, but also prolonged the long-term survival. Making assurance to get high quality donor organ and minimizing the death with graft function may be the most feasible way to prolong a graft survival at present.

Objective To evaluate the efficacy and safety of piperacillin/tazobactam in the treatment of moderate and severe pulmonary infection (MSPI). Methods The clinical data of 35 patients with MSPI following kidney transplantation were retrospectively analyzed.Results Thirty-five cases out of the 35 MSPI patients ( 97.14 % ) was rescued successfully. The overall clinical efficacy rate of piperacillin/tazobactam was 91.43 % (32/35). The bacterial clearance rate was 92.59 % . The incidence of adverse reaction was 8.57 % (3/35).Conclusions Intensive care and active measures should be given to the MSPI patients after kidney transplantation. The key points of successful treatment involve the in time application of effective antibiotics,the adjustment of immunosuppressant and the correction of hypoproteinemia.

Objective To investigate the relation of sexual hormones, trace elements and erectile function in male uremia patients subject to the therapy of hemodialysis or after renal transplantation.Methods Data of 136 cases from March 1999 to December 2002 were retrospectively analyzed.Results The differences in sexual hormones, trace elements and erectile function between male uremia patients receiving hemodialysis and control groups were respectively significant (P

Objective To investigate the changes of sexual hormones, trace elements and fertility in female uremia patients and their relations during hemodialysis or after renal transplantation.Methods Data of 43 cases of uremia during hemodialysis or after renal transplantation from March 1999 to December 2002 were retrospectively analyzed. The conditions of menses, sexuality and fertility before and after renal transplantation were also studied. Twenty healthy women served as controls. Results During the hemodialysis, 4 patients had regular menstrual cycle, 28 irregular menstrual cycle, and 11 menolipsis. Some sexual hormones, such as LH, FSH, PRL and E_2 were significantly increased (P

Objective To investigate the effects of full length p16 gene transfer by replication-defective recombinant adenoviruses on cell growth of the human bladder carcinoma. Methods Ad-p16 was infected into the human bladder carcinoma cell line with no expression of p16 protein,T24.The transfection efficiency of the recombinant adenoviruses was tested using Ad-LacZ by X-gal staining.The expression of p16 protein was evaluated by Western-blot analysis. The effects of Ad-p16 infection on cell proliferation were evaluated by MTT assay and flow cytometry. Results Higher transfection efficiency(97%) to T24 could be obtained at MOI(multiplicity of infection) of 50.This Ad-p16 has a high gene expression in T24 cells.The proliferation of Ad-p16 infected T24 cells was significantly suppressed as compared with that of Ad-LacZ-infected and non-infected cells ( P

To study the diagnosis of cytomegalovirus (CMV) infection after renal transplantation and the effects and side effects of preventive use of foscarnet (PFA). ELISA assay was used to determine active CMV infection (IgM+,IgG+) and inactive CMV infection (IgM-,IgG+). Seventy four cases of active CMV infection and 25 of inactive CMV infection were selected to receive PFA treatment. Besides, 10 cases of inactive CMV infection without PFA treatment served as a control group. The results showed that the serological tests turned negative in subclinical patients in active stage after 12 5 days of treatment. In those patients with clinical symptoms, infection was controlled in 34 patients after 15 days of treatment. In another 2 patients, serology turned negative after 1 month of treatment, and no recurrence found one year later. In patients in inactive stage, IgM became positive, but with no symptoms, one year after treatment. At the same time, 3 patients in the control group turned into active infection after 1, 2 and 3 months. The results suggested ELISA assay was a good method to determine serum CMV IgG and IgM at present; PFA could definitively control active CMV infection quickly, and no recurrence was found during 1 year follow up; PFA might prevent reversion of serological indexes in patients with inactive infection. Moreover, PFA did not impose damage to the function of the renal graft, and nor interfered with the metabolism of blood calcium and cyclosporine A. Thus, PFA is a safe and effective drug to treat CMV infection.