Objective Based on the detection of soluble leukocyte-associated immunoglobulin-like recepter-1 (sLAIR-1) in the serum of the recipient after transplantation, the role of sLAIR-1 in graft rejection was analyzed. Methods Serum sLAIR-1 level was determined by double mAb sandwich enzyme linked immunosorbent assay (ELISA) in 20 healthy volunteers and 162 patients of liver or kidney transplantation, and the results were analyzed and compared. Results In the healthy volunteers and 98 recipients with normal graft function, the sLAIR-1 were detected at the low levels of 4.3?2.3?g/L and 6.3?3.7?g/L, which showed no significant difference (P=0.054). In the 6 cases of acute rejection of liver transplantation, 20 cases of acute rejection of renal transplantation, and 5 cases of graft loss, serum sLAIR-1 was found to be increased remarkably to high levels of 47.2?35.9, 36.3?14.7 and 28.8?19.4?g/L, and they had significant differences compared with that of the healthy volunteers and with the recipients with normal graft function (P

To study the interrelationship between serum sPTA1 level and actue allograft rejection in renal transplantation, solid-phase lig-and ELISA method was used to analyze serum sPTAl level in renal transplantation. Five out of 19 patients after renal transplantation were confirmed haying actue allograft rejection by pathologic examination. The level of serum sPTA1 increased remarkably and the change in serum sP-TA1 level occurred earlier than appearance of clinical symptoms and in histopathologic manifestation. It decreased rapidly after enhancement of immune therapy. The allografts did not show any signs of acute rejection by clinic symptom and/or histopathology until the activation reached to a certain level. Therefore, the level of serum sPFA1 is a credibable guideline to recognize and monitor allograft renal transplantation. Its result is consistent with that of histopathological examination.

To investigate expression of the novel membrane molecule p140 on activated T cell in patients after renal transplantation, im-munofluoescence staining and FCM analysis were utilized to monitor the expression of p140, and transplanted renal biopsy was employed to confirm acute allograft rejection. p140 is a transplantion antigen-induced molecule on activated T cells. It expresses weakly on T cells in patients after renal transplantation, but expresses remarkably during actue allograft rejection.

Objective To study the effect of basiliximab,an anti-IL-2R monoclonal antibody,on the prevention of acute rejection and promoting graft survival in renal allograft recipients.Methods Published literature regarding the effects of basiliximab used for the prevention of acute rejection and promoting renal graft survival was reviewed,and Meta analysis was employed to analyze the results.Odds ratio(OR)and its 95% confidence interval(95%CI)were used as the parameters to evaluate the therapeutic effects.The statistical analyses were performed with RevMan 4.2 software.Results A total of 13 pertinent research articles were reviewed,including 2 papers written by Chinese authors and 11 by foreign authors.Meta-analysis of pooled results indicated that basiliximab prevented the recipients of kidney transplantation from acute rejection effectively with half-year prevention of OR 0.49 and 95%CI 0.28-0.87(P=0.01),and one-year prevention of OR 0.48,95%CI 0.35-0.65(P

OBJECTIVE: Tacrolimus is widely used in organ transplant. However, the long-term effects of tacrolimus on Asian, in particular in Chinese people, are few. The aim of this study is to evaluate the efficacy and safety of long-term curative effect of tacrolimus used in kidney transplantation patients in China.DATA SOURCES: Electronic and manual retrieve of Medline database, Chinese journal full-text database, Cochrane library, and CEBM/CCD, and relevant medical journals in China were applied.DATA SELECTION: Published randomized controlled trials on tacrolimus in kidney allograft recipient were retrieved, and the data were underwent Meta analysis. Odds ratio (OR) and its 95% confidence interval (CI) were used as the measurement parameter of efficacy comparison. The statistical analyses were performed using Stata software.MAIN OUTCOME MEASURES: ①The survival ratio of patient/kidney after 1 year. ②The survival ratio of patient/kidney after 3 years. ③Rejection ratio after 3 years. ④Infection rate after 3 years. ⑤Incidence of liver dysfunction after 3 years. ⑥Blood glucose disorder after 3 years.RESULTS: A total of 3 trials were eligible for the inclusion efficacy, including 3 Chinese trials and 0 foreign trials. Results of meta-analysis indicated that tacrolimus prevented the recipients of kidney transplantation from rejection effectively in three years [OR=0.40, 95%CI (0.27-0.61), P < 0.000 1]. Tacrolimus prevented the recipients of kidney transplantation from impaired liver function in three years [OR=0.28, 95%CI (0.15-0.52), P < 0.000 1]. No statistical difference of the 1-year and 3-year survival rate of patients/ kidney was found in the patients between group tacrolimus and group cyclosporine. Statistical difference of blood glucose disorder were found in the patients between group tacrolimus and group cyclosporine [OR=2.39, 95%CI (1.41-4.05), P=0.001].CONCLUSIONS: Tacrolimus prevented the recipients of kidney transplantation from rejection and impaired liver function effectively in three years in China. No statistical difference of the 1-year and 3-year survival rate of patients/kidney was found in the patients between two groups. In addition, the main side effect of tacrolimus is blood glucose elevation.

BACKGROUND: Removal of immunosuppressants in patients with recurrent tumor in long-term following organ transplantation is always a hot controversial point in academic circles. To further elevate clinical efficiency, people began to invent new immunosuppressant and studied immune efficiency of various immunosuppressant component. They tried to reduce the application of cyclosporin A (CsA).OBJECTIVE: To analyze the CsA safe withdrawal of a case of kidney recipients, at 18 years after renal transplantation, who developed bladder carcinoma and renal pelvic carcinoma at 11 years and 18 years after transplantation, respectively. METHODS: After identified diagnosis, we performed transurethral resection of bladder tumor (TURBt) and total nephroureterectomy merobladder excision. Pathologic examination revealed grade Ⅰ-Ⅱ of bladder and renal pelvic transitional cell carcinoma. After the operation, patient was treated with immune suppression program of CsA withdrawal gradually in 12 days.Within 12 days, 5 mg CsA was decreased every 3 days, and complete withdrawal was done at 12 days. The dosage of azathioprine tablets and prednisone acetate tablets was not changed. Serum creatinine levels were rechecked every 3 days during drug withdrawal, and blood pressure, urine volume, physical symptom of patients and ultrasound of transplanted kidney were observed.RESULTS AND CONCLUSION: During the three months of CsA withdrawal, the blood creatinine levels were from 65 to indicated that the CsA gradually withdrawal of a case of kidney recipients after renal transplantation, who developed transitional cell carcinoma and was performed transurethral resection of bladder tumor (TURBt) and total nephro- ureterectomy merobladder excision, was safe. No tumor relapse or diversion was found.

Objective To study the relationship of soluble LAIR (sCD305 and CD3060) expression in recipient serum with cytomegalovirus (CMV) pneumonitis after renal transplantation. Methods Nineteen serum specimens from recipients were divided into CMV pneumonitis group (n=10) and control group (n=9). Then the concentrations of sCD305 and CD3060 were quantitated with sandwich ELISA. The data were analyzed by using student t test. Results sCD305 was skewness distributed in both 2 groups, was 0.000-3.039 μg/L in CMV pneumonitis group and 0.000-8.375 μg/L in con-trol group. CD3060 was skewness distributed in CMV pneumonitis group and the concentration was 0.000-0.017μg/L. CD3060 was mormally distributed in control group and the concentration was 0.046±0.035 μg/L. There was significant difference of CD3060 (P=0.000) concentrations and no sig-nificant difference of sCD305(P=0.316) concentrations in 2 groups, respectively. Conclusions The concentration of CD3060 is low in CMV pneumonitis patients. The combination of CMV PP65 antigen detection and CD3060 detection is helpful for the early and precise diagnosis of CMV pneumonitis in renal transplantation patients.

BACKGROUND: Pancreas-kidney transplantation is an effective treatment for diabetes combined with final stage renal disease. However, as the patients suffer diabetes for a long period of time, and cardiovascular system disease is complex, pre- and post-transplantation treatment is very important for successful pancreas-kidney transplantation.OBJECTIVE: To discuss immunosuppressant, coagulant, perioperative and postoperative treatment during pancreas-kidney transplantation to provide some clinical experience for pancreas-kidney transplantation.METHODS: Clinical data of 5 cases undergoing simultaneous pancreas-kidney transplantation in Department of Urinary Surgery, the 309 Hospital of Chinese PLA General Hospital between 2003 and 2008 were retrospectively analyzed to summarize the application of immunosuppressants and anticoagulant drugs and perioperative clinical monitoring focus. RESULTS AND CONCLUSION: There were 5 male patients with an average age of 43 years, and suffered type I diabetes mellitus complicated with final stage renal disease. The preoperative insulin dosage was 1.5-2.4 U/(kg·d). One case had diabetic retinopathy and fundus oculi hemorrhage for many times; two cases showed apparent coronary atherosclerotic heart disease with preoperative cardiac ejection fraction of 52% and 50%. Exocrine of transplanted pancreas had been considered by the intestinal fluid drainage. A total of 3 cases were complete rehabilitation. Of them, 1 case developed acute rejection in the first seven days after operation, but renal function restored with the hormones impact; 1 case had postoperative acute rejection of transplanted duodenum as well as intestinal fistula, eventually, transplanted pancreas was ectomized, but transplanted kidney was preserved; two cases succeeded in restoring and no complications occurred; 1 had postoperative gastrointestinal bleeding and died from multiple organ failure. Simultaneous pancreas-kidney transplantation is the most effective way to treat the diabetes mellitus with terminal nephropathy. Because of complications in the transplanted exocrine pancreas with bladder drainage, it has been replaced by the enteric drainage. Recovery of the transplanted kidney function is important for successful transplantation. After operation, oral FK should be taken when the serum creatinine returned to 300 umol/L. The application of clotting drug is one of the important factors for recovery of transplanted pancreatic function. Jejunostomy is an important therapeutic measure to prevent the reflux of intestinal juice to the transplanted pancreas in perioperative period. In the follow-up period cathartic drugs are recommended to prevent constipation and reduce the occurrence of acute pancreatitis caused by intestinal fluid reflux.

BACKGROUND: Brain death patient is the optimal donator due to the short warm ischemia time, which is conductive to renal function recover following transplantation. However, there are no reports concerning the recovery of renal function in uremia patients following renal transplantation with brain death patients' kidney. OBJECTIVE: To summarize the experience and therapeutic efficacy of renal transplantation using brain death free-donated kidney. METHODS: Six patients with urinsmia underwent renal transplantation with donor kidney of brain death patients from May 2006 to November 2008 at the Organ Transplantation Center, 309~(th) Hospital of Chinese PLA, were selected, including 2 patients receiving kidneys from a brain death patient, 4 patients receiving kidneys from 3 brain death patients. Four recipients received immunosupprsssive regimen of mycophenolate+ciclosporin+steroid, and 2 recipients received mycophenolate+ acrolimus+steroid. The renal function and medicine density were detected regularly, and change of renal function and pathogenetic condition were retrospective analyzed. RESULTS AND CONCLUSION: All 6 patients accepted renal transplantation successfully. The serum creatinine level was obvious descended in 5 patients within a week after transplantation, which meant that the transplanted kidney had begun to work. One patient suffered delayed renal graft function, and returned to normal at 10 days after transplantation. Three patients suffered acute rejection in the first year, and recovered by intravenous glucocorticoid therapy. One patient died after 1 year for pulmonary infection, which accompanied by serum creatinine of 469 pmol/L. The other patients reexamined regularly, and they had good quality of life up to now. The results reveled that renal function recovers in time after transplantation using brain death free-donated kidney, which can ameliorate life quality of patients.

BACKGROUND: Living-donor kidney transplantation is not only associated to prognosis of recipients, but also donors' healthy. Complete medical and psychological assessment should be performed prior to transplantation to ensure the safety of donors. OBJECTIVE: To analyze and summarize the assessment experience of living-relative kidney donors prior to transplantation. METHODS: Totally 77 cases of living-relative kidney donors admitted at Organ Transplantation Center, Second Affiliated Hospital of General Hospital of Chinese PLA between January 2006 and March 2008 were reviewed. Among them, the analysis was carried out respectively according to the live donor nephrectomy guide of the United Kingdom (2005 Edition) before January 20, 2008, and live donor kidney transplantation consensus Boao meeting after January 20, 2008. In common practice, hypertension, diabetes mellitus, cardiovascular system, infectious disease study, age, obesity, proteinuria, renal artery, renal function, receptor for HLA typing and medical ethics, were systematically evaluated. RESULTS AND CONCLUSION: Of the 77 cases of assessed patients, 69 were qualified, successful donors, and completely cured, without complications. Totally 8 cases of non-donors were due to: 2 cases for hypertension combined with end organ damage; 2 for diabetes mellitus; 1 confirmed malignant tumor in kidney-donated surgery; 1 in the activity period of hepatitis B; 1 for resistance from his wife with medical ethics. The average age of donors was 45.3 years old, including and 7 cases above 60 years old, 24 of 50-59 years old, 29 of 30-49 years old, and 9 below 30 years old. There were 39 cases of parent child donation, 1 child parent donation, 19 siblings donation, 7 cases of three generations of collateral serum, and 3 cases of donation between husband and wife. Of successful donors, blood pressure was above 140/90 in 8 cases; Successful donors were without symptoms of myocardial ischemia but 14 cases had consciously ECG ST-T changes; 3 cases had abnormal fasting blood glucose. The successful donors' body mass index (BMI) reached the average of 23.05 kg/m~2, were below 30 kg/m~2; In assessment of infectious diseases, 3 cases were hepatitis B HBs and HBc-positive in a non-activity period, and the antibody titers were below 500 IU/L. In renography, glomerular filtration rate (GFR) was assessed to average (137.3±28.5) mL/min, and no significant statistical difference emerged (P < 0.05). Vascular three-dimensional CT prompted many left renal artery root in 3 cases, accounting for 4% in successful donors, 1 case did not match, accounting for 1%. It demonstrated that the primary purpose of assessment of -living-donor renal transplantation is to ensure that the adaptability, safety and health of donors. In order to avoid the omission of important medical information and unnecessary invasive inspection, as well as reducing the fees of medical assessment, the assessment should be based on the familiar, universally recognized, clinical evidence-based and reasonable procedures and the flexible assessment process.