To observe the protective effect of MMF against short term(3 months) acute rejection of renal transplantion. 112 patients undergone renal transplantation were randomly divided into two groups: MMF group (2.0 g/d) and...To observe the protective effect of MMF against short term(3 months) acute rejection of renal transplantion. 112 patients undergone renal transplantation were randomly divided into two groups: MMF group (2.0 g/d) and azathioprine group. Patients in both groups received cyclosporine A (CsA) and steroid hormone treatment in the same way. In three months time, 10/60 cases in the MMF treated group showed acute rejection with an acute rejection rate of 16.6%. 22/52 patients of the AZA group had acute rejection with a rejection rate of 41.5%. The difference between the two groups is significant (P<0 01). Side effects manifested in MMF group includereduction of blood white cell count and platelet count (5 cases) and diarrhea (3 cases). They resume recovery after reduction of the dosage of or stoppage of MMF. Both hepatic renal functions are not affected. In AZA group, liver function is damaged in 9 patients. MMF is effective in the prevention or reduction of short term acute rejection of transplants. Its side effects are mild and reversible.展开更多
Objective To evaluate the safety and feasibility of steroid or mycophenolate mofetil （MMF） withdrawal from tacrolimus-based immunosuppressant regimen in renal allograft recipients. Methods A cohort of 45 patients f...Objective To evaluate the safety and feasibility of steroid or mycophenolate mofetil （MMF） withdrawal from tacrolimus-based immunosuppressant regimen in renal allograft recipients. Methods A cohort of 45 patients following cadaveric renal allograft transplantation were randomly divided into 3 groups based on the regimen of combination of tacrolimus, steroid, and MMF： triple therapy group, steroid withdrawal group, and MMF withdrawal group. During 2 years, survival of patients and allografts, clinical acute rejection, adverse events, hepatic and renal allograft function, and blood lipids were monitored to evaluate the safety and feasibility of steroid or MMF withdrawal after renal transplantation. Results During two-year observation, steroid or MMF was successfully withdrawn from immunosuppressant regimen based on tacrolimus without any clinical acute rejection renal allografts kept excellent function. Some adverse events among groups. Patient and graft survival rates were 100% and all the occurred and there were no significant differences Conclusion Withdrawal of steroid or MMF in low-immunological-risk renal allografts treated with tacrolimus-based immunosuppressant regimen can be achieved with no increased risk of acute rejection.展开更多
Mycophenolate mofetil(MMF) is an important medication used for maintenance immunosuppression in solid organ transplants. A common gastrointestinal(GI) side effect of MMF is enterocolitis, which has been associated wit...Mycophenolate mofetil(MMF) is an important medication used for maintenance immunosuppression in solid organ transplants. A common gastrointestinal(GI) side effect of MMF is enterocolitis, which has been associated with multiple histological features. There is little data in the literature describing the histological effects of MMF in small intestinal transplant(SIT) recipients. We present a case of MMF toxicity in a SIT recipient, with histological changes in the donor ileum mimicking persistent acute cellular rejection(ACR). Concurrent biopsies of the patient's native colon showed similar changes to those from the donor small bowel, suggesting a non-graft specific process, raising suspicion for MMF toxicity. The MMF was discontinued and complete resolution of these changes occurred over three weeks. MMF toxicity should therefore be considered as a differential diagnosis for ACR and graftversus-host disease in SITs.展开更多
To investigate the imbalance state of helper T lymphocytes （Th） and cytotoxic T lymphocytes （Tc） and the roles of Thl/Th2/Th3 and Tcl/Tc2 cells in renal transplantation rejection, the percentages of these cells in...To investigate the imbalance state of helper T lymphocytes （Th） and cytotoxic T lymphocytes （Tc） and the roles of Thl/Th2/Th3 and Tcl/Tc2 cells in renal transplantation rejection, the percentages of these cells in peripheral blood of 24 cases of renal transplantation recipients with acute rejection and the dynamic changes of the CD4/CD8 ratio were determined by flow cytometry analysis, while 30 cases of healthy individuals were set up as controls. In these healthy controls, the percentages of the Thl, Th2 and Th3 cells were （ 10.45 ± 8.15） %, （5.05 ± 4.15） % and （3.90 ± 3.21 ） %, and those of Tcl and %2 cells were （9.83 ± 7.03） % and （4.51 ± 2.17） %, respectively. However, the percentages of Thl and Tcl cells in peripheral blood of the stable recipients after transplantation were （7.29 ± 5.62） % and （7.04 ± 5.15）%, showing definite reduction, while those of Th2, Th3 and Tc2 cells showed significant increase, （ 6.34 ± 5.67） %, （4.94 ± 4.14） % and （ 6.86 ± 4.42） %, respectively. In case of recipients with acute rejection, the percentages of Thl and Tcl cells appeared to be （ 18.55 ± 13.21 ） % and （ 15.84 ± 11.72） %, also showing significant increase, but those of Th2, Th3 and %2 cells appeared to be reduced, （4.19 ± 3.62） %, （3.02 ± 2.83 ） % and （3.88 ± 1.63） %, respectively. Significant differences could be detected among these three groups （ P 〈 0.05）. The CD4/CD8 ratio in cases with acute rejection was higher than those of stable recipients （2.24 ± 0.59 vs 1.95 ± 0.45）, but that of the stable recipients and healthy controls （ 1.98 ± 0.31 ） showed no any significant difference. From the above observation, it is evident that imbalance between Thl, Th2 and Th3 with Tcl and Tc2 cells may exist after renal transplantation and probably, the im- mune imbalance may be induced through the secretion of cytokines INF-γby Thl or Tcl cells , Ⅱ-4 by Th2 and Tc2 cells and TGF-β by Th3.展开更多
Kidney transplantation is the best available treatment for patients with end stage renal disease. Despite the introduction of effective immunosuppressant drugs, episodes of acute allograft rejection still endanger gra...Kidney transplantation is the best available treatment for patients with end stage renal disease. Despite the introduction of effective immunosuppressant drugs, episodes of acute allograft rejection still endanger graft survival. Since efficient treatment of acute rejection is available, rapid diagnosis of this reversible graft injury is essential. For diagnosis of rejection, invasive core needle biopsy of the graft is the "gold-standard". However, biopsy carries the risk of significant graft injury and is not immediately feasible in patients taking anticoagulants. Therefore, a non-invasive tool assessing the whole organ for specific and fast detection of acute allograft rejection is desirable. We herein review current imaging-based state of the art approaches for non-invasive diagnostics of acute renal transplant rejection. We especially focus on new positron emission tomography-based as well as targeted ultrasoundbased methods.展开更多
AIM To explore the benefits and harms of corticosteroid(CS) minimization following renal transplantation. METHODS CS minimization attempts to improve cardiovascular risk factors(hypertension, diabetes, dyslipidemia), ...AIM To explore the benefits and harms of corticosteroid(CS) minimization following renal transplantation. METHODS CS minimization attempts to improve cardiovascular risk factors(hypertension, diabetes, dyslipidemia), to enhance growth in children, to ameliorate bone disease and to lead to better compliance with immunosuppressive agents. Nevertheless, any benefit must be carefully weighed against the reduction in net immunosuppression and the potential harm to renal allograft function and survival. RESULTS Complete CS avoidance or very early withdrawal(i.e., no CS after post-transplant day 7) seems to be associated with better outcomes in comparison with later withdrawal. However, an increased incidence of CS-sensitive acute rejection has been observed with all CS minimization strategies. Among the prerequisites for the safe application of CS minimization protocols are the administration of induction immunosuppression and the inclusion of calcineurin inhibitors in maintenance immunosuppression regimens. CONCLUSION Transplant recipients at low immunological risk(primary transplant, low panel reactive antibodies) arethought as optimal candidates for CS minimization. CS avoidance may also be undesirable in patients at risk for glomerulonephritis recurrence or with severe delayed graft function and prolonged cold ischemia time. Thus, CS minimization is not yet ready for implementation in the majority of transplant recipients.展开更多
Background： lmmunosuppressive agents are still inefficient in preventing biopsy-proven acute rejection （BPAR） alter expanded criteria donor （ECD） kidney transplantation. The aim of this study was to investigate t...Background： lmmunosuppressive agents are still inefficient in preventing biopsy-proven acute rejection （BPAR） alter expanded criteria donor （ECD） kidney transplantation. The aim of this study was to investigate the relationships between early imrnunosuppressive exposure and the development of BPAR. Methods： We performed a retrospective study of 58 recipients of ECD kidney transplantation treated with enteric-coated-mycophenolate sodium, tacrolirnus （Tac）, and prednisone. The levels of mycophenolic acid-area under the curve （MPA-AUC）0-12h and Tac C0 were measured at the 1st week and the 1st month posttransplant, respectively. The correlation was assessed by multivariate logistic regression. Results： The occurrence rates of BPAR and antibody-mediated rejection were 24.1% and 10.3%, respectively. A low level of MPA-AUC0-12h at the 1st week posttransplant was found in BPAR recipients （38.42 ± 8.37 vs. 50.64 ± 13.22, P 〈 0.01）. In addition, the incidence of BPAR was significantly high （P 〈 0.05） when the MPA-AUC0-12h level was 〈30 mg·h-1·L-1 at the 1st week （ 15.0% vs. 44.4%） or the Tac C0 was 〈4 ng/ml at the 1 st month posttransplant （33.3% vs. 21.6%）. Multivariable logistic regression analysis showed that the MPA-AUC 0-12 h at the 1st week （OR： 0.842, 95% CI： 0.784-0.903） and the Tac C0 at the 1st month （OR： 0.904, 95% C7： 0.822-0.986） had significant inverse correlation with BPA R （ P 〈 0.05 ）. Conclusions： Low-level exposure of MPA and Tac C0 in the early weeks posttransplant reflects an increased acute rejection risk, which suggested that MPA-AUC0-12h 〈30 mg·h-1·L -1 and Tac C0 〈4 ng/ml should be avoided in the first few weeks alter transplantation.展开更多
Combined liver-kidney transplantation(CLKT)is a rarely performed complex surgical procedure in children and involves transplantation of kidney and either whole or part of liver donated by the same individual(usually a...Combined liver-kidney transplantation(CLKT)is a rarely performed complex surgical procedure in children and involves transplantation of kidney and either whole or part of liver donated by the same individual(usually a cadaver)to the same recipient during a single surgical procedure.Most common indications for CLKT in children are autosomal recessive polycystic kidney disease and primary hyperoxaluria type 1.Atypical haemolytic uremic syndrome,methylmalonic academia,and conditions where liver and renal failure co-exists may be indications for CLKT.CLKT is often preferred over sequential liver-kidney transplantation due to immunoprotective effects of transplanted liver on renal allograft;however,liver survival has no significant impact.Since CLKT is a major surgical procedure which involves multiple and complex anastomosis surgeries,acute complications are not uncommon.Bleeding,thrombosis,haemodynamic instability,infections,acute cellular rejections,renal and liver dysfunction are acute complications.The long-term outlook is promising with over 80%5-year survival rates among those children who survive the initial six-month postoperative period.展开更多
文摘To observe the protective effect of MMF against short term(3 months) acute rejection of renal transplantion. 112 patients undergone renal transplantation were randomly divided into two groups: MMF group (2.0 g/d) and azathioprine group. Patients in both groups received cyclosporine A (CsA) and steroid hormone treatment in the same way. In three months time, 10/60 cases in the MMF treated group showed acute rejection with an acute rejection rate of 16.6%. 22/52 patients of the AZA group had acute rejection with a rejection rate of 41.5%. The difference between the two groups is significant (P<0 01). Side effects manifested in MMF group includereduction of blood white cell count and platelet count (5 cases) and diarrhea (3 cases). They resume recovery after reduction of the dosage of or stoppage of MMF. Both hepatic renal functions are not affected. In AZA group, liver function is damaged in 9 patients. MMF is effective in the prevention or reduction of short term acute rejection of transplants. Its side effects are mild and reversible.
文摘Objective To evaluate the safety and feasibility of steroid or mycophenolate mofetil （MMF） withdrawal from tacrolimus-based immunosuppressant regimen in renal allograft recipients. Methods A cohort of 45 patients following cadaveric renal allograft transplantation were randomly divided into 3 groups based on the regimen of combination of tacrolimus, steroid, and MMF： triple therapy group, steroid withdrawal group, and MMF withdrawal group. During 2 years, survival of patients and allografts, clinical acute rejection, adverse events, hepatic and renal allograft function, and blood lipids were monitored to evaluate the safety and feasibility of steroid or MMF withdrawal after renal transplantation. Results During two-year observation, steroid or MMF was successfully withdrawn from immunosuppressant regimen based on tacrolimus without any clinical acute rejection renal allografts kept excellent function. Some adverse events among groups. Patient and graft survival rates were 100% and all the occurred and there were no significant differences Conclusion Withdrawal of steroid or MMF in low-immunological-risk renal allografts treated with tacrolimus-based immunosuppressant regimen can be achieved with no increased risk of acute rejection.
文摘Mycophenolate mofetil(MMF) is an important medication used for maintenance immunosuppression in solid organ transplants. A common gastrointestinal(GI) side effect of MMF is enterocolitis, which has been associated with multiple histological features. There is little data in the literature describing the histological effects of MMF in small intestinal transplant(SIT) recipients. We present a case of MMF toxicity in a SIT recipient, with histological changes in the donor ileum mimicking persistent acute cellular rejection(ACR). Concurrent biopsies of the patient's native colon showed similar changes to those from the donor small bowel, suggesting a non-graft specific process, raising suspicion for MMF toxicity. The MMF was discontinued and complete resolution of these changes occurred over three weeks. MMF toxicity should therefore be considered as a differential diagnosis for ACR and graftversus-host disease in SITs.
文摘To investigate the imbalance state of helper T lymphocytes （Th） and cytotoxic T lymphocytes （Tc） and the roles of Thl/Th2/Th3 and Tcl/Tc2 cells in renal transplantation rejection, the percentages of these cells in peripheral blood of 24 cases of renal transplantation recipients with acute rejection and the dynamic changes of the CD4/CD8 ratio were determined by flow cytometry analysis, while 30 cases of healthy individuals were set up as controls. In these healthy controls, the percentages of the Thl, Th2 and Th3 cells were （ 10.45 ± 8.15） %, （5.05 ± 4.15） % and （3.90 ± 3.21 ） %, and those of Tcl and %2 cells were （9.83 ± 7.03） % and （4.51 ± 2.17） %, respectively. However, the percentages of Thl and Tcl cells in peripheral blood of the stable recipients after transplantation were （7.29 ± 5.62） % and （7.04 ± 5.15）%, showing definite reduction, while those of Th2, Th3 and Tc2 cells showed significant increase, （ 6.34 ± 5.67） %, （4.94 ± 4.14） % and （ 6.86 ± 4.42） %, respectively. In case of recipients with acute rejection, the percentages of Thl and Tcl cells appeared to be （ 18.55 ± 13.21 ） % and （ 15.84 ± 11.72） %, also showing significant increase, but those of Th2, Th3 and %2 cells appeared to be reduced, （4.19 ± 3.62） %, （3.02 ± 2.83 ） % and （3.88 ± 1.63） %, respectively. Significant differences could be detected among these three groups （ P 〈 0.05）. The CD4/CD8 ratio in cases with acute rejection was higher than those of stable recipients （2.24 ± 0.59 vs 1.95 ± 0.45）, but that of the stable recipients and healthy controls （ 1.98 ± 0.31 ） showed no any significant difference. From the above observation, it is evident that imbalance between Thl, Th2 and Th3 with Tcl and Tc2 cells may exist after renal transplantation and probably, the im- mune imbalance may be induced through the secretion of cytokines INF-γby Thl or Tcl cells , Ⅱ-4 by Th2 and Tc2 cells and TGF-β by Th3.
基金Supported by The Collaborative Research Centre 656(Deutsche Forschungsgemeinschaft,SFB656,Projects C7 and PM12 and 21)Innovative Medizinische Forschung,Medical Faculty,University of Münster,No.IRE121102
文摘Kidney transplantation is the best available treatment for patients with end stage renal disease. Despite the introduction of effective immunosuppressant drugs, episodes of acute allograft rejection still endanger graft survival. Since efficient treatment of acute rejection is available, rapid diagnosis of this reversible graft injury is essential. For diagnosis of rejection, invasive core needle biopsy of the graft is the "gold-standard". However, biopsy carries the risk of significant graft injury and is not immediately feasible in patients taking anticoagulants. Therefore, a non-invasive tool assessing the whole organ for specific and fast detection of acute allograft rejection is desirable. We herein review current imaging-based state of the art approaches for non-invasive diagnostics of acute renal transplant rejection. We especially focus on new positron emission tomography-based as well as targeted ultrasoundbased methods.
文摘AIM To explore the benefits and harms of corticosteroid(CS) minimization following renal transplantation. METHODS CS minimization attempts to improve cardiovascular risk factors(hypertension, diabetes, dyslipidemia), to enhance growth in children, to ameliorate bone disease and to lead to better compliance with immunosuppressive agents. Nevertheless, any benefit must be carefully weighed against the reduction in net immunosuppression and the potential harm to renal allograft function and survival. RESULTS Complete CS avoidance or very early withdrawal(i.e., no CS after post-transplant day 7) seems to be associated with better outcomes in comparison with later withdrawal. However, an increased incidence of CS-sensitive acute rejection has been observed with all CS minimization strategies. Among the prerequisites for the safe application of CS minimization protocols are the administration of induction immunosuppression and the inclusion of calcineurin inhibitors in maintenance immunosuppression regimens. CONCLUSION Transplant recipients at low immunological risk(primary transplant, low panel reactive antibodies) arethought as optimal candidates for CS minimization. CS avoidance may also be undesirable in patients at risk for glomerulonephritis recurrence or with severe delayed graft function and prolonged cold ischemia time. Thus, CS minimization is not yet ready for implementation in the majority of transplant recipients.
基金This work was supported by grants from the major clinical research projects of the First Affiliated Hospital of Xi＇an Jiaotong University （No. XJTU 1AF-CRF-2015-005） and the National Natural Science Foundation of China （No. 81670681）.
文摘Background： lmmunosuppressive agents are still inefficient in preventing biopsy-proven acute rejection （BPAR） alter expanded criteria donor （ECD） kidney transplantation. The aim of this study was to investigate the relationships between early imrnunosuppressive exposure and the development of BPAR. Methods： We performed a retrospective study of 58 recipients of ECD kidney transplantation treated with enteric-coated-mycophenolate sodium, tacrolirnus （Tac）, and prednisone. The levels of mycophenolic acid-area under the curve （MPA-AUC）0-12h and Tac C0 were measured at the 1st week and the 1st month posttransplant, respectively. The correlation was assessed by multivariate logistic regression. Results： The occurrence rates of BPAR and antibody-mediated rejection were 24.1% and 10.3%, respectively. A low level of MPA-AUC0-12h at the 1st week posttransplant was found in BPAR recipients （38.42 ± 8.37 vs. 50.64 ± 13.22, P 〈 0.01）. In addition, the incidence of BPAR was significantly high （P 〈 0.05） when the MPA-AUC0-12h level was 〈30 mg·h-1·L-1 at the 1st week （ 15.0% vs. 44.4%） or the Tac C0 was 〈4 ng/ml at the 1 st month posttransplant （33.3% vs. 21.6%）. Multivariable logistic regression analysis showed that the MPA-AUC 0-12 h at the 1st week （OR： 0.842, 95% CI： 0.784-0.903） and the Tac C0 at the 1st month （OR： 0.904, 95% C7： 0.822-0.986） had significant inverse correlation with BPA R （ P 〈 0.05 ）. Conclusions： Low-level exposure of MPA and Tac C0 in the early weeks posttransplant reflects an increased acute rejection risk, which suggested that MPA-AUC0-12h 〈30 mg·h-1·L -1 and Tac C0 〈4 ng/ml should be avoided in the first few weeks alter transplantation.
文摘Combined liver-kidney transplantation(CLKT)is a rarely performed complex surgical procedure in children and involves transplantation of kidney and either whole or part of liver donated by the same individual(usually a cadaver)to the same recipient during a single surgical procedure.Most common indications for CLKT in children are autosomal recessive polycystic kidney disease and primary hyperoxaluria type 1.Atypical haemolytic uremic syndrome,methylmalonic academia,and conditions where liver and renal failure co-exists may be indications for CLKT.CLKT is often preferred over sequential liver-kidney transplantation due to immunoprotective effects of transplanted liver on renal allograft;however,liver survival has no significant impact.Since CLKT is a major surgical procedure which involves multiple and complex anastomosis surgeries,acute complications are not uncommon.Bleeding,thrombosis,haemodynamic instability,infections,acute cellular rejections,renal and liver dysfunction are acute complications.The long-term outlook is promising with over 80%5-year survival rates among those children who survive the initial six-month postoperative period.
