No abstract available.
Kidney Transplantation*

Renal transplantation is the optimal treatment for end stage renal disease and it has been improved through the development of operative methods and immunosuppressants. However some patients must receive dialysis or undergo retransplantation after a loss of the primary graft due to rejection or other causes. Recently the frequency of retransplantation has begun to increase gradually. Some articles have reported that retransplantation results do not significantly differ in comparison with initial transplantation results when living related donor kidneys are used. Our study focused on the outcome of 445 first transplantation and 12 retransplantation cases. The sex distribution of retransplanted patients was 11 male and 1 female. The mean age (yrs) for recipients was 32.3 at the first transplantation and 39.1 at the retransplantation. The underlying causes of end stage renal disease were presumed to be chronic glomerulonephritis in all retransplantion patients; the mean duration of graft survival (mo) for first transplantation was 77.92. The causes of previous graft failure were as follows: 10 due to chronic rejection, 1 due to recurrent glomerulonephritis, 1 resulted from a graft rupture due to a motorcar accident. The interval (mo) between graft failure and retransplantation averaged 6.7 and 9 out of 12 patients underwent regrafting within 1 year of their previous graft loss. Recipient-donor relationships in first transplantations were as follows: 9 were living related and 3 were living non-related. Recipient-donor relationships in second transplantations were as follows: 4 were living related and 8 were living non-related. Acute rejection within 1 month of transplantation occurred in 4 primary transplantation patients and 2 retransplantation patients. The incidence of acute rejection within 1 month was as follows: 23% of 445 first renal transplantation patients, 16.7% of 12 second transplantation patients. The 1 year and 2 year graft survival rate was 100% and the mean survival duration (mo) was 33 for retransp
Dialysis ; Female ; Glomerulonephritis ; Graft Survival ; Humans ; Immunosuppressive Agents ; Incidence ; Kidney Failure, Chronic ; Kidney Transplantation ; Kidney* ; Male ; Rupture ; Sex Distribution ; Tissue Donors ; Transplants

We report one case of renal PV infection after renal allograft transplantation leading to graft dysfunction. According to prior reports, PV induced interstitial nephritis might be a cause of graft loss. Pathologic findings show varying degrees of interstitial infiltration and tubular degenerative changes, which resemble acute cellular rejection. Therapeutic strategies have not yet been developed. Case ; A 23 years old male underwent renal transplantation from his HLA haploidentical 25 year old sister. His renal function had been good with cyclosporin, steroid and azathioprine until 9 months after transplantation, when his serum creatinine level rose to 2.2mg/dl. The renal biopsy revealed diffuse lymphocyte infiltration in the interstitium and feature of the tubulitis. Also, giant tubular epithelial cells with large, hyperchromic nuclei were present. Despite steroid pulsing and OKT3, renal function progressively de- teriorated. After 10 days of OKT3 therapy, the patient suffered from high fever, dyspnea and general aches. A chest X-ray revealed interstitial infiltration in both lung fields and the cytomegalovirus PCR (polymerase chain reaction) test of serum and blood was positive. Intravenous ganciclorvir was administered and immunosuppressants were tapered. 4 months after admission, he lost his graft function and underwent hemodialysis. The aforementioned renal biopsy was retested immunohistochemically. Nuclear inclusions in renal tubular epithelial cells were shown and these inclusions were reacted positively with PV monoclonal antibodies.
Adult ; Allografts* ; Antibodies, Monoclonal ; Azathioprine ; Biopsy ; Creatinine ; Cyclosporine ; Cytomegalovirus ; Dyspnea ; Epithelial Cells ; Fever ; Humans ; Immunosuppressive Agents ; Intranuclear Inclusion Bodies ; Kidney Transplantation ; Lung ; Lymphocytes ; Male ; Muromonab-CD3 ; Nephritis, Interstitial ; Polymerase Chain Reaction ; Renal Dialysis ; Siblings ; Thorax ; Transplants ; Young Adult

Increasingly aggressive chemotherapy regimens, advances in transplantation technology, and the acquired immunodeficiency syndrome have resulted in a growing number of immunocompromised patients. Infections are a major cause of morbidity and mortality in this population. One of the most ominous complications is the development of typhlitis in this immunocompromised patients. Treatment of this process is controversial, and no consensus has emerged. We report a case of typhlitis who complicated agranulocytosis after exposure to drugs to treat "flu" like illness and recovered completely after two operations of appendectomy and ileocolectomy. Reviewing articles and this case, the favorable outcome seemed to be related to following three factors recognition of the acute surgical abdomen by abdominal CT scan, a prompt return of normal circulating white cells by the use of Granulocyte Colony Stimulating Factor and discontinuation of causative drugs, and an appropriately timed surgical intervention.
Abdomen ; Acquired Immunodeficiency Syndrome ; Agranulocytosis* ; Appendectomy ; Colony-Stimulating Factors ; Consensus ; Drug Therapy ; Granulocytes ; Immunocompromised Host ; Mortality ; Tomography, X-Ray Computed ; Typhlitis*

OBJECTIVES: Protein-calorie malnutrition has been shown to be prevalent among patients on chronic dialysis, And assessment of nutritional status of continuous ambulatory peritoneal dialysis(CAPD) patients has assumed greater importance because of the association of protein-calorie malnutrition with increasing morbidity and mortality. So we observed the incidence and clinical effect of protein-calorie malnutrition, and we compared the indices of nutrition with dialysis adequacy utilizing urea kinetic modeling and cretinine clearance in CAPD patients. METHODS: We performed a cross-sectional study in which eight parameters, based on anthropometry, blood chemistry and subjective symptoms, were scored according to the degree of abnormalities in 82CAPD patients. A malnutrition index was derived from these scores. We also performed comparative analysis to identify significant correlations of the indices of urea kinetic modeling and creatinine clearance with the other parameters of nutritional status. RESULTS: The malnutrition index classified 47(57%) patients as normal, 30(37%) intermediately malnourished, and 5(6%) as severely malnourished. Malnutrition index showed a significant correlation with the body mass index(BMI), triceps skinfold thickness(TSF), mid-arm circumference(MAC), mid-arm muscle area (MAMA), duration of CAPD, subjective symptoms, serum albumin, transferrin, cholesterol, and triglyceride. The malnutrition index also showed a significant correlation with residual renal function(RRF), and standardized creatinine clearance(SCCr). The TWR-Kt/V(total Kt/Vurea per week with consideration of residual renal urea clearance) was significantly lower in the severely malnourished group than in the normal group. Serum alkaline phosphatase and BUN levels were higher in the severely malnourished group than in the normal and inter-mediate groups. CONCLUSION: In assessing the nutrition status of CAPD patients, body weight, TSF, MAC, MAMA, subjective symptoms, serum albumin, transferrin, cholesterol, triglyceride, urea nitrogen, and alkaline phosphatase were considered useful parameters. There was a trend of increased BUN and decreased TWR-Kt/V in severely malnourished patients, and the value of SCCr was significantly lower in malnourished patients. However, no meaningful relationships between TW-Kt/V and malnutrition index or between NPCR(normalized protein catabolic rate) and malnutrition index were found m this cross-sectional study. As the number of patients with longer duration of CAPD or negligible RRF has increased in the malnourished patients, regular monitoring of these parameters, especially TWR-Kt/V and SCCr, may be helpful to assess dialysis adequacy to keep good nutritional status of each CAPD patient.
Alkaline Phosphatase ; Anthropometry ; Body Weight ; Chemistry ; Cholesterol ; Creatinine* ; Cross-Sectional Studies ; Dialysis ; Humans ; Incidence ; Malnutrition ; Mortality ; Nitrogen ; Nutritional Status ; Peritoneal Dialysis, Continuous Ambulatory* ; Protein-Energy Malnutrition ; Serum Albumin ; Transferrin ; Triglycerides ; Urea*

No abstract available.
Erythropoietin* ; Humans* ; Renal Dialysis*

No abstract available.
Hepatitis B Vaccines* ; Hepatitis B* ; Hepatitis* ; Histocompatibility Antigens* ; Histocompatibility* ; Humans ; Kidney Failure, Chronic* ; Kidney* ; Survival Rate* ; Transplants*

No abstract available.
Kidney Transplantation* ; Urinary Tract Infections* ; Urinary Tract*

No abstract available.
Anemia* ; Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Renal Dialysis*

No abstract available.
Kidney Transplantation*