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    30 April 2011, Volume 15 Issue 18 Previous Issue    Next Issue
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    Monitoring of liver cell metabolism in early transplantation with the multi parameter system biosensor Neurotrend-7
    Tang Ji-hong, Tang Bo, Zhang Jie, Yang Da-kuan, Tian Da-guang, Fu Bi-mang, Li Han-yu, Yu Sheng-feng, Zhu Hong
    2011, 15 (18):  3231-3234.  doi: 10.3969/j.issn.1673-8225.2011.18.001
    Abstract ( 215 )   PDF (776KB) ( 385 )   Save

    BACKGROUND: At present, various monitoring equipments have been used in graft early monitoring, but there is no way to continuous monitoring transplant liver cell metabolic changes to reflect the graft internal environment changes.
    OBJECTIVE: To explore continuous monitoring of liver cell metabolism with multi parameter system biosensor (Neurotrend-7), and to provide the basis for the liver hypofunction after transplantation in early stage.
    METHODS: A total of 24 healthy, adult, male, New Zealand, White rabbits were divided into 3 groups: control group, experimental group 1, and experimental group 2. Control group (n=4): They were treated with buried oxygen metabolism monitoring sensor of liver tissue when abdomen was opened, and abdomen was closed, after the specimen drawn. Multi parameter system biosensor probe was inserted into liver after liver transplantation between experimental group 1 and experimental group 2. Ten cases of rabbits underwent the liver transplantation, for the liver retention time was lesser than 2 hours in experimental group 1; 4 cases of rabbits underwent the liver transplantation, for the liver retention time was more than 4 hours in experimental group 2. Before transplantation and 1, 3, 5 days after transplantation, the changes of the pH, PCO2, and PO2 value in liver tissue were continually monitored, and PaO2, PaCO2, and arterial blood gas (ABG) pH value were measured. At the same time, the liver tissue cut in the corresponding points was observed under the optical microscope and electron microscope.
    RESULTS AND CONCLUSION: PO2 value of liver tissue in experimental group 2 was significantly lower than that in experimental group 1 (P < 0.05), and gradually decreased with the time. However, PCO2 value of liver tissue in experimental group 2 at each time was significantly higher than that in experimental group 1 (P < 0.05), and gradually increased with the time. pH value of liver tissue in experimental group 2 at each time was lower than that in experimental group 1 (P < 0.05). It is indicated that liver function is serious adverse and transplant is non-function. The PO2 and PaO2 were positive correlation; however, PCO2 and PaCO2 were not obvious relevance. Also, the pH value and ABG pH value were not obvious relevance. Changes are similar to the histology inspection. It suggested that multi parameter system biosensor (Neurotrend-7) can discover liver hypofunction after transplantation at early stage and observes its evolution rule, to guide early prevention and the treatment in clinic, it also can provides the accurate data for clinical application in the liver surgery and organ transplantation field.

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    Relationship between macrophages and hepatitis B recurrence in hepatitis B-related patients after liver transplantation
    Chen Ying, Wu Zhong-Jun
    2011, 15 (18):  3235-3238.  doi: 10.3969/j.issn.1673-8225.2011.18.002
    Abstract ( 152 )   PDF (1106KB) ( 374 )   Save

    BACKGROUND: HBV-CCCDNA existing in peripheral blood mononuclear cell has been reported in literatures, then, whether the recurrent hepatitis B (HBV) possibly comes from the DNA grains which are phagocytized by macrophages but not clear wholly.
    OBJECTIVE: To investigate the relationship between macrophages and HBV recurrence in HBV-related patients after liver transplantation.
    METHODS: Venous blood with anticoagulation was extracted from 13 different HBV-related patients whose hepatitis B recurred after liver transplantation, while, we collected 14 examples from patients whose HBV was negative after liver transplantation for comparison. These examples were separated though Ficoll-Hypaque density centrifugation to get PBMC, then PBMC was cultured for 7 days with rhGM-CSF and RPMI-1640 which contained 10% calf serum to get adherent cells. Special antibody CD-14 was detected with flow cytometry to assay the adherent cells nature. HBV-CCCDNA within the cells was detected though fluorescent-quantitative PCR.
    RESULTS AND CONCLUSION: Of 13 patients who had HBV again after liver transplantation, 69.23% were HBV-CCCDNA positive within macrophages. Only 1 patient of 14 whose HBV did not recur, and its HBV- CCCDNA was positive, that was 7.14% (P < 0.01). There is probably a relationship between HBV recurrence after liver transplantation and HBV CCCDNA in macrophages.

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    Pre-infusion of donor apoptotic lymphocytes effects on receptor CD4+T, CD8+T, CD4+CD25+ T regulatory cells during porcine liver transplantation
    Zhang Qing-jun, Sun Ke-jian, Chen Yun, Xie Jin-min, Gao Yi
    2011, 15 (18):  3239-3242.  doi: 10.3969/j.issn.1673-8225.2011.18.003
    Abstract ( 176 )   PDF (1177KB) ( 407 )   Save

    BACKGROUND: Apoptotic cells can actively regulate the body’s immune function, and induce immune tolerance through regulation of cellular and humoral immune, which has been only confirmed in rat liver transplantation models.
    OBJECTIVE: To investigate the influence of CD4+T, CD8+T, CD4+CD25+ T regulatory cells of preoperative transfusion of lymphocyte from in vitro 60Coγ-treated donor porcine on allograft survival of orthotopic liver transplantation (OLT).
    METHODS: OLT models were performed without veno-venous bypass (VVB) in Chinese inbred miniature porcine. The recipient porcine were administrated intravenously with donor apoptotic lymphocyte (5×108) 7 days before liver transplantation, or not treated. Changes of CD4+T, CD8+T, CD4+CD25+ T regulatory cells and liver pathological changes were observed after the transplantation. Apoptotic percentage of lymphocytes from in vitro 60Coγ-treated was measured by flow cytometry using AnnexinⅤ/PI double staining method.
    RESULTS AND CONCLUSION: Liver grafts biopsy of two group showed the same change after operation, there were mild or serious acute rejections on the 3rd day after operation, and serious acute rejection on the 6th day. The increasing changes of CD4+T, CD8+T and CD4+CD25+T regulatory cells were just like the change of lymphocytes. But the contrast of two group was of non-significance (P >0.05). These indicate that immunological tolerance cannot be induced by transfusion of preoperative donor 60Coγ-treated lymphocytes in porcine liver allograft, preoperative transfusion of lymphocytes cannot influence the expression of CD4+T, CD8+T, CD4+CD25+ T regulatory cells in tolerance receptor of porcine liver transplantation.

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    Steatotic liver in donor for living related liver transplantation
    Cui Zi-lin, Fu Zhi-ren, Zhu Zhi-jun, Zhang Ya-min, Zhang Jian-jun, Jiang Wen-tao, Yang Tao, Huai Ming-sheng, Zhang Wei
    2011, 15 (18):  3243-3246.  doi: 10.3969/j.issn.1673-8225.2011.18.004
    Abstract ( 110 )   PDF (1068KB) ( 325 )   Save

    BACKGROUND: Steatotic liver graft transplantation affects donor safety as well as recipient survival in living related liver transplantation (LRLT).
    OBJECTIVE: To assess safety of donors of steatotic liver and prognosis of steatotic liver grafts’ recipients in LRLT.
    METHODS: We retrospectively reviewed 104 cases of LRLT, dividing them into 4 groups according to degree of macrovesicular fatty change upon intraoperative liver biopsy. The degree of macrovesicular steatosis was compared among four groups, and death cause was analyzed among 104 cases undergoing right liver transplantation.
    RESULTS AND CONCLUSION: There was no statistically significant difference in postoperative hepatic function recovery of donors and recipients among four groups. Overall recipients’ prognosis was not different among the groups. No primary graft nonfunction (PNF) or delayed graft function (DGF) occurred. Mild macrovesicular steatotic livers may be good donor candidates without significant complications as long as sufficient residual liver volume is left for the donor. Mild macrovesicular steatotic graft did not increase the risk of graft dysfunction or morbidity in LRLT.

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    Diagnostic value of color Doppler ultrasound for biliary complications of liver transplantation
    Ling Wen-wu, Quan Jie-rong, Lu Qiang, Wen Xiao-rong, Lin Ling, Luo Yan
    2011, 15 (18):  3247-3250.  doi: 10.3969/j.issn.1673-8225.2011.18.005
    Abstract ( 96 )   PDF (1311KB) ( 374 )   Save

    BACKGROUND: Liver graft dysfunction is caused by the biliary complications after liver transplantation. Color Doppler ultrasound is widely recognized as the preferred simple inspection method of patients follow-up, which can provide reliable evidence for the diagnosis of complications after liver transplantation.
    OBJECTIVE: To evaluate color Doppler ultrasound in diagnostic value of biliary complications after liver transplantation.
    METHODS: The incidence of biliary complications of 126 cases with routine ultrasound examination after liver transplantation and color Doppler ultrasound results were retrospectively analyzed. The standard of diagnosis biliary complications is based on the diagnosis by magnetic resonance cholangiopancreatography (MRCP) or contrast-enhanced ultrasound or puncture and drainage or clinical treatment of diagnosis. Color Doppler ultrasound after liver transplantation was used to observe whether common bile duct and intrahepatic bile duct have bile leakage, stenosis, bile leakage, dilation, biliary sludge and stone formation.
    RESULTS and CONCLUSION: A total of 33 cases with biliary complication by ultrasonic diagnosis in 126 cases, including 4 cases with bile leakage (3.2%), 11 cases with biliary stenosis (8.7%), 18 cases with biliary calculi and (or) 18 cases with biliary sludge (14.3%). It is indicated that color Doppler ultrasound has an important value in diagnosis of the biliary complications after liver transplantation, which can provide the evidence for clinical diagnosis and treatment.

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    Continuous blood purification for renal failure after liver transplantation
    Fang Li, Han Ju-hui, Jin Ying, Zhang Na, Li Jun
    2011, 15 (18):  3251-3254.  doi: 10.3969/j.issn.1673-8225.2011.18.006
    Abstract ( 150 )   PDF (1584KB) ( 462 )   Save

    BACKGROUND: Continuous blood purification, also known as renal replacement therapy, is an important technique in recent years. It has been an essential way for treatment of acute renal failure, multiple organ failure and various acute and critical patients.
    OBJECTIVE: To evaluate the effect of continuous blood purification (CBP) on acute renal failure after liver transplantation.
    METHODS: We retrospectively analyzed the data of 10 patients complicated with acute renal failure after liver transplantation received CBP therapy using BM-25 CBP machine. Treatment pattern adopted continuous veno-venous hemofiltration (CVVH) and anterior/posterior dilution method. Ordinary heparin or low molecular heparin or non heparin was used as anticoagulant. Treatment time was 5-30 days. Heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), blood urea nitrogen (BUN), serum creatinine (SCr), potassium chloride (K+), and base excess (BE) were observed.
    RESULTS AND CONCLUSION: In the ten cases, eight cases survived, and the survival rate from ICU was 80.0%. During CBP treatment, vital signs were stable, hemodynamic markers improved, and anasarca gradually relieved. Twenty-four hours after CBP, HR and CVP decreased obviously as MAP increased. Electrolyte and blood gas analysis ameliorated obviously. BUN, SCr, and K+ decreased. There was significant difference between the data before and after treatment (P < 0.05). It is indicated that CBP can obviously improve the prognosis of patients with acute renal failure after liver transplantation.

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    Protective effects of penequinine hydrochloride on acute lung injury induced by orthotopic liver transplantation
    Si Jian-luo, Song Shao-tuan, Chang Sheng
    2011, 15 (18):  3255-3258.  doi: 10.3969/j.issn.1673-8225.2011.18.007
    Abstract ( 130 )   PDF (626KB) ( 381 )   Save

    BACKGROUND: Penequinine hydrochloride can alleviate inflammatory response and protect against cell injury, but therapeutic effects were uncertainty on acute lung injury after orthotopic liver transplantation.
    OBJECTIVE: To evaluate protective efficacy of intravenous penequinine hydrochloride on acute lung injury after orthotopic liver transplantation.
    METHODS: Thirty-five patients with acute lung injury after orthotopic liver transplantation were randomly assigned to 2 groups: treatment group (n=17) and control group (n=18). On the base of routine comprehensive therapy, the patients received intravenous infusion with 0.05 mg/kg penequinine hydrochloride once a day for 3 days in the treatment group or with normal saline of same volume in the control group. Plasma interleukin (IL)-8, and IL-10 were measured and index of oxygenation was calculated before and 24, 72 hours after the treatment. Length of mechanical ventilation was recorded.
    RESULTS AND CONCLUSION: Compared with the control group, the level of plasma IL-8 decreased significantly in the treatment group at 24 and 72 hours after the treatment, but the level of plasma IL-10 in the treatment group was significantly higher than that in the control group at the same time (P < 0.05). In the treatment group, the patients’ index of oxygenation was higher and length of mechanical ventilation was shorter than that in the control group (P < 0.05). These findings show that penequinine hydrochloride can regulate the level of inflammatory factors in patients with acute lung injury after orthotopic liver transplantation, improve arterial oxygenation and shorten the length of mechanical ventilation.

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    Clinical implication of monitoring interleukin-18 receptor in peripheral lymphocytes using flow cytometric after renal transplantation
    Hao Jun-wen, Min Zhi-lian, Li Xiang-tie, Chen Ying-jian, Zheng Jun-hua
    2011, 15 (18):  3259-3262.  doi: 10.3969/j.issn.1673-8225.2011.18.008
    Abstract ( 121 )   PDF (611KB) ( 449 )   Save

    BACKGROUND: As cytokines are often released in the early stage following renal transplantation, they can used as an indicator for early diagnosis of rejection.
    OBJECTIVE: To investigate the expression of interleukin 18 receptor (IL-18R) in peripheral blood of uremia patients before and after renal transplantation.
    METHODS: The expression of CD4/IL-18Rα and CD8/IL-18Rα in peripheral lymphocytes was determined using flow cytometric analysis in 32 uremia patients receiving renal transplantation including 24 patients with stable function, 8 with acute rejection, 12 who had a long-term survival (average 4 years), and 7 healthy controls.
    RESULTS AND CONCLUSION: CD4/IL-18Rα and CD8/IL-18Rα positive rates were higher in the uremia patients than the healthy controls (P=0.02, P=0.04). The expression of CD4/IL-18Rα and CD8/IL-18Rα in peripheral lymphocytes in the patients with stable function and those who had a long-term survival was lower than that in the patients with acute rejection. After steroid plus therapy, the positive rates for CD4/IL-18Rα and CD8/IL-18Rα were decreased significantly in the patients with acute rejection (P < 0.05). IL-18Rα expression was stronger after steroid pulse therapy in the 3 patients resistant to steroids than in the 5 patients responsive to steroid treatment. The results demonstrate that detection of CD4/IL-18Rα and CD8/IL-18Rα in the peripheral lymphocytes by flow cytometric analysis was an easy, hopeful, and noninvasive means for the diagnosis and treatment of patients with acute rejection after renal transplantation.

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    Valuation of color Doppler ultrasound in monitoring hemodynamic parameters following renal transplantation
    Zhang Yu-hong
    2011, 15 (18):  3263-3266.  doi: 10.3969/j.issn.1673-8225.2011.18.009
    Abstract ( 140 )   PDF (699KB) ( 356 )   Save

    BACKGROUND: Ultrasound examination has been a routine examination and monitoring method following renal transplantation.
    OBJECTIVE: To investigate the value of color Doppler ultrasound in monitoring hemodynamic parameters of the transplanted kidney.
    METHODS: Sixty-one patients of allograft renal transplantation were divided into 3 groups of which 35 patients in normal group, 22 in acute rejection group, and 4 in chronic rejection group. Conventional ultrasound examination combined with color Doppler flow image (CDFI) and power Doppler image (PDI) was performed with each objects to observe construction, blood perfusion and measure the hemodynamic parameters of various vessels in transplanted kidney.
    RESULTS AND CONCLUSION: Swelling, renal parenchyma thickening and echo enhancement were demonstrated in acute rejection group. The bound between cortex and medullary substance was blurring. CDFI and PDI indicated that the blood signal was reduced in renal parenchyma, especially in relaxing period. The peak of frequency spectrum of renal arterial vessels was high in systole period, but less spectrum or no signals in relaxing period, even some seemed singlet. The resistance index (RI) and pulsatility index (PI) rose up obviously in different vessels. The kidney turned to be small, echo enhancement and the bound was not clear in chronic rejection group. CDFI and PDI showed the internal diameter was decreased; vessel branches were rare and interrupted. The flow rate was apparently descent both in relaxing and systole periods. The priming volume was reduced RI and PI obviously heightened. As a non-invasive method, ultrasound can be used in early observation of the blood perfusion of the transplanted kidney without trauma. The function status of the kidney could be relaxed by measuring hemodynamic parameters of different vessels.   

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    Immunoglobulin prevents pneumonia in patients with decreased T lymphocytes after renal transplantation
    Huang Yun, Zhan Feng, Lin Shu-dian, Chen Dao-jun, Li Wen-ning
    2011, 15 (18):  3267-3270.  doi: 10.3969/j.issn.1673-8225.2011.18.010
    Abstract ( 121 )   PDF (674KB) ( 394 )   Save

    BACKGROUND: Decrease in T lymphocyte after renal transplantation can easily lead to pneumonia. As a key target organ, it is important to control pneumonia, especially severe pneumonia, which becomes a key for patient’s prognosis following renal transplantation.
    OBJECTIVE: To investigate the effect of immunoglobulin against pneumonia after renal transplantation based on decreased T lymphocytes.
    METHODS: Thirty patients accepting renal transplantation within six month were enrolled, and randomly divided into treatment group (15 cases) and control group (15 cases). All the patients were received immunosuppressive agents. The patients in the treatment group were treated with immunoglobulin 0.2 g/(kg•d), twice per day, and other therapy options were similar to the control group. The incidence of pulmonary infection, renal function and T lymphocyte level were detected.
    RESULTS AND CONCLUSION: The incidence of ordinary pneumonia and severe pneumonia and the mortality in the treatment group were significantly lower than those in the control group (P < 0.05). CD4+ T lymphocyte and CD4+/CD8+ T lymphocytes subsets were significantly increased (P < 0.01), and CD4+ T lymphocyte subsets was significantly higher in 7, 14, 21 day as compared to the baseline (P < 0.01), but there was no change in renal function. Our findings suggested that patients treated with immunoglobulin after renal transplantation can improve the level of T lymphocytes, immune function and reduce the incidence of pulmonary infection.

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    Therapeutic outcomes evaluation and multi-factor prognostic analysis of renal retransplantation
    Zhao Yu-jun, Cheng Ke, Ming Ying-zi, Liu Lian, Liu Hong, She Xing-guo, YE Qi-fa
    2011, 15 (18):  3271-3275.  doi: 10.3969/j.issn.1673-8225.2011.18.011
    Abstract ( 148 )   PDF (600KB) ( 363 )   Save

    BACKGROUND: Renal retransplantation has more benefits of used new immunosuppressive agents and improved perioperative management; however, compared with the primary allografts, regrafts face more risk factors. With the shortage of renal donations, it is necessary to assess long-term outcome of regrafts and to identify risk factors associated with long-term graft survial.
    OBJECTIVE: To evaluate the therapeutic outcomes of renal retransplantation and analyze the prognostic factors.
    METHODS: The clinical and follow-up data of 68 patients who underwent renal retransplantation between April 2001 and June 2009 in Xiangya Transplantation Medical Academy of the Third Xiangya Hospital of Central South University were analyzed retrospectively. The patient/graft survival rates were calculated by Kaplan-Meier method and compared to primary ones performed during the same period. A total of 12 clinical indictors were selected, Log-rank test and Cox proportional hazards regression model were performed to analyze prognostic factors of regraft outcome.
    RESULTS AND CONCLUSION: The follow-up time ranged from 6 to 86 months (median, 38.6 months). The mortality was 14.7%, The regraft loss rate was 26.5%. Survival rates at 1-, 3- and 5-year of the patient/graft of retransplantation group were 94.1%/89.7%, 87.3%/80.5% and 80.3%/68.7% respectively,while those at 1-, 3- and 5- years of the patient/graft of the primary renal transplantation were 96.3%/94.5%, 90.5%/85.4% and 83.8%/75.6%, respectively. No significant difference in the patient/graft survival rates was observed between two groups (P > 0.05). Univariate analysis showed that the duration of primary graft survival, peak panel reactive antibody (PRA) level, HLA mismatch,acute rejection, delayed graft function (DGF) and induction therapy were significantly associated with regraft survival. Multivariate Cox regression analysis showed that the duration of primary graft survival, peak PRA level and HLA mismatch were independent prognostic factors of regraft.The regraft had more benefits of improved pre-transplant screening and post-transplant management, and its survival rate was satisfactory and similar to that of primary one. The duration of primary graft survival, peak PRA level and HLA mismatch are main determinants of regraft outcome.

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    Comparative study of bedside chest radiograph quality based on screen piece and computed radiography system after lung transplantation
    Qian Bin, Hu Xiao-yun, Qian Li-xin, Cui Zhi-min, Li Guo-liang, Bao Jian
    2011, 15 (18):  3276-3279.  doi: 10.3969/j.issn.1673-8225.2011.18.012
    Abstract ( 154 )   PDF (567KB) ( 256 )   Save

    BACKGROUND: Quality of beside chest radiography is very important for lesion assessment after lung transplantation.
    OBJECTIVE: To compare the quality of bedside chest radiography based on screen piece combination (TP) and computed radiography system (CR) after lung transplantation, and to select a better plan.
    METHODS: A retrospective analysis of 425 TP and 411 CR bedside chest images from 78 patients after lung transplantation admitted in Wuxi People’s Hospital Affiliated to Nanjing Medical University were conducted. All the images were classified into
    Ⅰ-Ⅳ levels by three high qualification physicians and technicians to analyze the influential factors related to quality of bedside chest radiographs in the two groups and calculate average exposure dosages.
    RESULTS AND CONCLUSION: In the TP group, there were 135 (31.8%) for level Ⅰ, 171 (40.2%) for level Ⅱ, 107 (25.2%) for level Ⅲ, and 12 (2.8%) for level Ⅳ. In the CR group, there were 266 (64.7%) for level Ⅰ, 105 (25.5%) for level Ⅱ, 37 (9.0%) for level Ⅲ, and 3 (0.7%) for level Ⅳ.There was a significant difference between the two groups (P < 0.01). The average exposure dosage was 1.56 mAs in the CR group, significantly lower than that in the TP group (3.27 mAs) (P < 0.01). These findings show that CR can improve the quality of bedside chest radiography, and decrease the average exposure dose.

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    Several problems in brain-dead donor kidney transplantation
    Wang Guang-ce, Wang Suo-gang, Zhang Zhu, Chen Zhu, Wang Wen-sheng, Cui Yong
    2011, 15 (18):  3280-3283.  doi: 10.3969/j.issn.1673-8225.2011.18.013
    Abstract ( 115 )   PDF (565KB) ( 591 )   Save

    BACKGROUND: Using the source of kidney up to the international standard, namely the kidney contributed freely by the cognitive death may alleviate the critical shortage in the present kidney transplant .In recent years ,the cognitive death organ contribution and the transplant have began to implant successfully in china ,but there are few reports about that.
    OBJEECTIVE: To discuss the practicality of the cognitive death organ contribution kidney transplant in China and the essential condition to guarantee successful transplant. 
    METHODS: Twelve patients’ experience in the cognitive death organ contribution for kidney transplant from 2007-01 to 2010-07 were summarized, including donor/for kidney’s appraisal for kidney's selecting and preservation, kidney transplant situation, transplant acceptor kidney function and complication, the time in hospital, quality of life and so on.
    RESUITS AND CONCLUSION: In the 12 cases of cognitive death organ contribution kidney transplants, there were 10 patients’ kidney function recovering 2-5 days after the operation, and being discharged from hospital 14-21 days later. Two patients’ kidney function recovered slower relatively which became normal 10,15 days after transplanting separately and they were discharged from hospital on the 28th day. In 2-42 months revisiting, kidney function in 8 cases was normal, urinate protein was negative. They had been engaged in work normally and the quality of life was good; in 2 cases, urinate protein presented positive, but the kidney function was normal. One patient’s kidney function was normal, the liver function was unusual, while after treatment, it turned better; one case died of serious lung infection 3 months after operation. It indicates that the cognitive death organ contribution kidney transplant may obtain the development in China ; the cognitive death must have satisfactory blood stream dynamics, urine amount, good kidney function, who can be the ideal kidney donor; Choose the best transplant opportunity, attach importance to the systematic revisit. In this way, we can guarantee the success of cognitive death free organ contribution kidney transplants.

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    Contemporaneous heart and lung transplantation in 6 cases
    Xu Ning, Xie Qiang, Chen Jing-yu, Kui Yu-chuan, Shu Nan, Qu Yong-ye, Lü Shu-liang
    2011, 15 (18):  3284-3287.  doi: 10.3969/j.issn.1673-8225.2011.18.014
    Abstract ( 127 )   PDF (1352KB) ( 318 )   Save

    BACKGROUND: Heart and lung transplantation remain the optimal treatment for end-stage heart and lung diseases, but donor shortage in China is a very serious problem because of various reasons.
    OBJECTIVE: To discuss the possibility of heart and lung transplantation for different recipients with same donor’s heart and lung at the same time.
    METHODS: Hearts and lungs were obtained from 3 donors, transplanted into 3 cases with end-stage heart diseases and 3 cases with lung diseases. Heart and lung transplantation performed separately at the same time. The transplantation outcomes were observed.
    RESULTS AND CONCLUSION: Among double-lungs transplantation patients, one had developed venous embolism and conducted right pulmonary upper lobectomy at 9 days and discharged at 30 days after operation. Another recipient got infection and cured with antibiotics. One heart transplant patient suffered renal dysfunction and then was treated with consecutive renal replacement therapy. The remains had no postoperative complications. All these recipients got through the postoperative period and had good life quality. Heart and lung transplantation for different recipients with same donor can maximize the use of available donor and save more patients’ lives.

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    Epithelial proliferation and apoptosis in heterotopic tracheal transplantation model
    Wang Lin-mao, Wu Kai, Gao Wen, Chen Chang, Bao Fang, Zheng Hui
    2011, 15 (18):  3288-3292.  doi: 10.3969/j.issn.1673-8225.2011.18.015
    Abstract ( 119 )   PDF (1079KB) ( 276 )   Save

    BACKGROUND: The process of epithelial cells in heterotopic trachea transplantation remains unclear. The studies demonstrated that epithelial proliferation is accompanied by irreversible cell death, and airway epithelial regeneration and death occurred before airway occlusion transplantation.
    OBJECTIVE: To observe epithelial proliferation and apoptosis in the process of heterotopic mouse trachea transplantation.
    METHODS: The allogeneic BALB/c mouse trachea was implanted subcutaneously in the nape of BALB/c mouse. Ciclosporin A (CsA) was not injected after transplantation. The allogeneic BALB/c mouse trachea was implanted subcutaneously in the nape of C57BL/6 mouse. One group was not injected with CsA, the other group was the whole course injected with CsA in abdominal cavity. At 3, 7, 14, 21, 30 days after transplantation, the integrity of airway epithelium, submucosal infiltration of inflammatory cells and fibrous tissue proliferation were evaluated by hematoxylin-eosin staining. BrdU labelling index and TUNEL positive cells in trachea transplantation were determined.
    RESULTS AND CONCLUSION: At 3 days after receptor BALB/c mouse transplantation, airway epithelial cells suffered from minor injury and loss. At 7-21 days after transplantation, airway epithelial cells recovered normal gradually. Airway epithelium approached to normal epithelium at 30 days after transplantation. The extent of BrdU labelling index was 3%- 5%. The number of TUNEL positive cells was basically unchanged. At 3 days after receptor C57BL/6 mouse transplantation, airway epithelial cells suffered from minor injury. The shedding and necrosis were existed in airway epithelium, at 7-21 days after transplantation; fibrous proliferation was appeared and became more serious gradually. At 30 days after transplantation, epithelial cells completely disappeared, lumens were filled by fibrous tissue, closed to occlusion. The peak of BrdU labelling index was at 14 days after transplantation. The group of not injected with CsA was higher than group of injected with CsA in BrdU labelling indexes (P=0.000). At 21 and 30 days after transplantation, the BrdU labelling index was significantly reduced. The peak of UNEL positive cells in group of not injected with CsA was at 21 days after transplantation, the peak of UNEL positive cells group of injected with CsA was at 14 days after transplantation. It is indicated that epithelial proliferation in heterotopic trachea transplantation was accompanied by irreversible cell death. CsA could reduce the incidence of bronchiolitis obliterans, but did not prevent its occurrence.

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    Effect of bone marrow derived mesenchymal stem cells transplantation combined with cryopreservation on trachea allograft epithelium vascular endothelial growth factor levels
    Han Yun, Ji Zi-zhao, Lan Ni, Pang Chao-jian, Tong Xiao-jie, Shi Wen-jun
    2011, 15 (18):  3293-3297.  doi: 10.3969/j.issn.1673-8225.2011.18.016
    Abstract ( 126 )   PDF (1627KB) ( 262 )   Save

    BACKGROUND: Cryopreserved tissues can maintain their vitality and integrity, and reduce the antigenicity.
    OBJECTIVE: Using intravenous transplantation of bone marrow derived mesenchymal stem cells (BMSCs) combined with cryopreserved allograft, to investigate the role of BMSCs on enhancing the implant survival and revascularization by measuring vascular endothelial growth factor (VEGF) levels.
    METHODS: After transplanted with cryopreserved 2 weeks and 6 weeks allocraft, PKH-26 labeled 3-5 passage BMSCs were injected into the recipient rats via the tail vein. Rats in the control groups were injected with the same amount of phosphate buffer solution (PBS). We observed the histology of the transplanted trachea and measured the VEGF protein levels in the epithelium to evaluate the role of BMSCs transplantation on the epithelium revascularization.
    RESULTS AND CONCLUSION: Rats from BMSCs injection group survived a long period. Histological observation showed that the tracheal lumen was covered by psudo-striated ciliated columnar epithelium. VEGF protein levels in the BMSCs injection group were higher than PBS group. BMSCs may exert their reparation function via enhancing epithelium VEGF expression and revascularization.

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    Roles of Genistein combined with subtherapeutic FK506 in the rejection of pancreas transplantation
    Zhou Jian, Zhu Xin-guo, Chen Yan, Li De-chun
    2011, 15 (18):  3298-3301.  doi: 10.3969/j.issn.1673-8225.2011.18.017
    Abstract ( 115 )   PDF (1242KB) ( 300 )   Save

    BACKGROUND: It has been demonstrated that CXCR3-inhibitor Genistein can mitigate the acute rejection of pancreas transplantation efficiently, but the effect of Genistein and FK506 has not been illustrated.
    OBJECTIVE: To investigate the role of CXCR3-inhibitor Genistein combined with subtherapeutic FK506 in the rejection of pancreas transplantation. 
    METHODS: Five groups of rats underwent pancreas transplantation: the groups were untreated group; large-dose FK506 group; small-dose FK506 group; Genistein group; and Genistein+small-dose FK506 group. The grafts of three groups were harvested at day 7 after operation for histopathology. The expressions of CD3+, CD4+, CD8+T cells in peripheral blood were assessed by FCM, and the levels of interferon gamma (IFN-γ) and interleukin 2 (IL-2) in serum were examined by ELISA. 
    RESULTS AND CONCLUSION: The damage of graft tissue in Genistein+small-dose FK506 group significantly alleviated and the infiltration of lymphocytes decreased as compared with untreated group, small-dose FK506 group and Genistein group . It proved that the Genistein+small-dose FK506 combination-therapy could prevent the acute rejection. Genistein+small-dose FK506 combination therapy decreased the dosage of FK506 and prevented the damage effect on the recipients’ hepatic and renal functions. The number of CD3+, CD4+, CD8+ T cells in Genistein+small-dose FK506 group were much less; in addition, down-regulation of IFN-γ, IL-2 in serum were observed in Genistein+small-dose FK506 group. It was demonstrated that CXCR3-inhibitor Genistein combined with  subtherapeutic FK506 could mitigate the acute rejection of pancreas transplantation efficiently and not increase hepatic and renal toxicity.

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    Optimization of MRI scan sequence for tracking superparamagnetic iron oxide-labeled pancreatic islet ceils in vivo
    Ni Ping, Chen Zi-qian
    2011, 15 (18):  3302-3305.  doi: 10.3969/j.issn.1673-8225.2011.18.018
    Abstract ( 115 )   PDF (683KB) ( 274 )   Save

    BACKGROUND: There are no effective methods to track superparamagnetic iron oxide (SPIO)-labeled pancreatic islet cells in vivo. By the development of molecule imaging, it is possible to track SPIO-labeled islet cells in vivo using MRI.
    OBJECTIVE: To optimize MRI scan sequence for tracking SPIO-labeled pancreatic islet cells in rats using 1.5T MR scanner, and to set up optimize sequences of tracking and perfect measures of quality control.
    METHODS: MR imaging of transplanted cells were performed using a GE 1.5T Excite MRI scanner with a 7 cm animal coil. Different sequences such as SE T1WI, FSE T2WI, FGRE T2*WI and SPGR T1WI were applied. Contrast noise ratio of different sequences between SPIO and liver images of different sequences after SPIO-labeled pancreatic islet ceils were compared. 
    RESULTS AND CONCLUSION: SPIO-labeled pancreatic islet cells were seen on MRI as distinct homogenous, low-signal spots in the liver. Better contrast between SPIO-labeled pancreatic islet cells and livers were gained in the images of FGRE T2* WI and SPGR T1WI sequences. The findings demonstrate that MRI can be used to track SPIO-labeled islet cells in vivo, and has significant value in detecting the survival and rejection of grafts after transplantation in rats. It’s very important to choose suitable sequences.

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    Contribution of mouse CD1d to immune toleration induced by immature dendritic cells in vitro
    Ma Zhao-hui, Han Yong, Yao Jia-lin, Yao Zhi-fa
    2011, 15 (18):  3306-3310.  doi: 10.3969/j.issn.1673-8225.2011.18.019
    Abstract ( 281 )   PDF (740KB) ( 508 )   Save

    BACKGROUND: Dendritic cells (DCs) possess two-way immune regulation ability: mature DCs (mDCs) can activate the immune response, and immature DCs (imDCs) tend to induce immune tolerance.
    OBJECTIVE: To discuss the role of CD1d in immune toleration induced by imDCs after transplantation and the mechanism of cytokine played in this process.
    METHODS: imDCs of BALB/c mouse transfected by viral interleukin-10 were stimulated with GM-CSF, LPS in vitro, and separated into three groups after anti-CD1d intervention. The expression of cytokine and phenotypes of the cells were observed. 1st MLC and 2nd MLC were performed in different experimental conditions to observe the immunity of CD1d with heterogeneity T lymphocyte existing. Proliferation of T lymphocyte and the expression of cytokine were observed.
    RESULTS AND CONCLUSION: Proliferation of heterogeneity T lymphocyte induced by imDC was suppressed by anti-CD1d intervention. The immune function of heterogeneity T lymphocyte was deficient after sensitized by imDCs with anti-CD1d intervention. Anti-CD1d intervention would affect the functional maturity of imDCs in case the heterogeneity T lymphocyte existed, in that it could suppress the secretion of Th1 type cytokine interleukin-12, however enhance the secretion of Th2 type cytokine interleukin-10.

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    Antibody mediated rejection during transplant kidney biopsy
    Han Yong, Guo Hui, Huang Hai-yan, Xu Xiao-guang, Cai Ming, Shi Bing-yi
    2011, 15 (18):  3311-3314.  doi: 10.3969/j.issn.1673-8225.2011.18.020
    Abstract ( 119 )   PDF (542KB) ( 432 )   Save

    BACKGROUND: Acute humoral rejection, characterized as hormone resistance and refractory feature, often occurs in immune hypersensitivity recipients.
    OBJECTIVE: To observe the effect on antibody-mediated rejection during transplant kidney biopsy and to analyze the safety of transplant kidney biopsy.
    METHODS: Eighty-four patients underwent transplant kidney biopsy following renal transplantation. The biopsy was performed using B-ultrasound guided BARD puncture. Hematoxylin-eosin staining, histochemical staining and C4d immunohistochemical staining were performed. All biopsies were systematically diagnosed and evaluated according to the Banf 2005 schema.
    RESULTS AND CONCLUSION: Except for 1 case which was difficult to diagnose because of few tissues, there were 1 case of hyperacute rejection, 5 of acute antibody mediated rejection, 2 of chronic antibody mediated rejection, and 16 positive for C4d. After treatment, 4 of 8 antibody mediated rejection cases recovered renal transplantation, 3 did not recover, and 1 lost renal function. There were no adverse effects. The results showed that transplant kidney biopsy is safe and reliable for the assist diagnosis and treatment of renal dysfunction after renal transplantation.

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    Severe acute humoral rejection induced by secondary immune response at early stage after kidney transplantation
    Chen Jian-rong, Li Liu-yang, Qian Jun, Zhao Ming, Liu Zhan-guo, Liu Yong-guang, Guo Ying, Liu Zhen-xi
    2011, 15 (18):  3315-3318.  doi: 10.3969/j.issn.1673-8225.2011.18.021
    Abstract ( 125 )   PDF (1328KB) ( 458 )   Save

    BACKGROUND: The prevention of hyperacute or acute rejection in highly sensitized recipients after renal transplantation has obtained satisfactory results. However, there are rare reports about secondary immune response of sensitized recipients with negative panel reactive antibody (PRA) after kidney transplantation.
    OBJECTIVE: To explore the mechanism of acute humoral rejection (AHR) in sensitized recipients with negative PRA for early prophylaxis.
    METHODS: The AHR related factors including HLA IgG HE stain, anti-C4d deposition and cell surface molecules were analyzed in 21 PRA negative recipients receiving kidney for the first time from the 1st day to the 14th day post-Tx.
    RESULTS AND CONCLUSION: All the 21 patients had records of blood transfusion or pregnancy. In 18 patients, anti-HLAⅠIgG and 11 pones anti-HLAⅡIgG positive rates were both over 80% on the 7th day. Five female ones were found rupture of allograft and both anti-HLAⅠand anti-HLAⅡIgG positive rates were over 96% during the 5th and 8th day. DSA(donor specific antibodies) were found in all the 21 patients, among of them, 13 patients including 5 ones with rupture of kidney had mismatching of HLA-A2 and HLA-A11. Kidney damage was shown by patho-histomorphology examination. Immunohistochemistry examination showed C4d deposition in peritubular capillary zone (PTC), In situ staining showed CD34(+),CD68(+)and CD4(+) positive. Pre-operative test of PRA can reflect the sensitization to some extent but not completely. Prediction and diagnosis of AHR would be done by early monitoring of PRA post-Tx. The diagnosis rate of AHR could be improved by the specific pathological markers of C4d and CD68 which were used as diagnostic criteria. HLA-A2 and HLA-A11 are genes highly dangerous for sensitized patients suffering from AHR.

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    Effect of tripterygium wilfordii polyglucoside on histological changes of a rat model of chronic renal allograft rejection
    Yu Peng-cheng, Liu Yong-guang, Li Min, Guo Ying, Chen Hua, Yue Liang-sheng, Wu Jian-ping, Zhao Ming
    2011, 15 (18):  3319-3322.  doi: 10.3969/j.issn.1673-8225.2011.18.022
    Abstract ( 125 )   PDF (1286KB) ( 435 )   Save

    BACKGROUND: Tripterygium wilfordii polyglucoside possess a variety of immune regulation. Whether it can be used for chronic renal allograft rejection needs animal experiments as well as multi-center, large-sample clinical trials.
    OBJECTIVE: To explore the effect of TWP on chronic renal allograft rejection in rats.
    METHODS: Orthotropic kidney transplantation was performed in strain combinations of SD-Wistar. The native kidney of the recipients were kept and used as an internal control. All recipients received a short course treatment of cyclosporine A (CsA microemulsion) (2 mg/kg/d for 10 days i.p) after transplantation to prevent acute rejection to establish chronic renal allograft rejection model. Fifteen successful recipient rats were randomized into TWP-treating group (n=8) and control group (n=7). The recipient rats of the two groups were treated with TWP at doses of 30 mg/kg (TWP-treating group) or the same volume of 0.9% saline solution (control group) per day from day 10 until week 12 after transplantation. All recipient rats were killed in week 12 after transplantation, the histology examination of grafts and native kidneys was performed in parallel according to the Banff 07 working classification for renal allograft pathology. Graft histology was quantified by using the Banff sum score. Immunohistochemistry of transforming growth factor-β1 (TGF-β1) of each allograft was examined and was semiquantitatively evaluated.
    RESULTS AND CONCLUSION: All allografts of each group survived up to 12 weeks after transplantation and develop chronic renal allograft rejection, characterized by neointimal hyperplasia, interstitial fibrosis, tubular atrophy, glomerulosclerosis and mononuclear cell infiltration. Compared with those in the control group, the Banff sum scores and TGF-β1 expressions in the renal allograft tissues were significantly decreased in the TWP-treating group in week 12 ( P < 0.01 for both). The native kidney of recipients of each group showed no inflammation or histological alterations. In conclusion, TWP effectively reduces the histological damages and the expression of TGF-β1 in the renal allograft tissues and may be used as a new agent to treat chronic renal allograft rejection.

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    Endothelial microparticles for diagnosis of acute rejection following renal transplantation
    Yang Jing, Cui Jie-wei, Li Ding-xian, Cao Wei-ke, Sun Yi
    2011, 15 (18):  3323-3327.  doi: 10.3969/j.issn.1673-8225.2011.18.023
    Abstract ( 193 )   PDF (1475KB) ( 415 )   Save

    BACKGROUND: Variation of endothelial cells is closely associated with graft rejective reaction. After transplantation, endothelial microparticles (EMPs) are shed from the plasma membrane of endothelial cells, and can reflect the change of endothelial cells directly. Accordingly, it is significant to detect plasma EMPs for monitoring acute rejection after renal transplantation.   
    OBJECTIVE: To study the changes of EMPs in rats of acute rejection after renal transplantation and their relations with acute rejection.
    METHODS: The syngeneic and allogeneic rat models of orthotopic renal transplantation were established. Pathological changes of the kidneys were observed at 5 days after transplantation by haematoxylin-eosin staining, and were graded according to the Bnaff criteria. The expression of intercellular adhesion molecule-1 in rat kidneys was quantitatively detected by immunohistochemistry. The level of CD144+ EMPs and intercellular adhesion molecule (ICAM)-1+/CD144+ EMPs were measured by flow cytometry. The relation between quantity and phenotype of EMPs and pathological changes of kidneys was analyzed.
    RESULTS AND CONCLUSION: Compared with syngeneic group, the Bnaffs grades (P < 0.01), the expression of ICAM-1 of kidney (P < 0.01) in allogeneic group was significantly increased. Compared with syngeneic group, the level of CD144+ EMPs and ICAM-1+/CD144+EMPs (P < 0.01) in allogeneic group were significantly increased. The level of CD144+ EMPs was positively related with the Bnaffs grades (P < 0.01), and the level of ICAM-1+/ CD144+EMPs was positively related with the expression of ICAM-1 of kidney (P < 0.01). The level of EMPs detection may be helpful to the diagnosis of acute rejection after transplantation.

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    Effects of inactivation of aryl hydrocarbon receptor nuclear translocator on renal ischemia reperfusion injury in mice
    Zhou Li, Zhang Ming, Zhou Jie-xue, Wu Jia-qing, Li Cheng, Meng Shan-dong, Shen Sheng, Liu Dong
    2011, 15 (18):  3328-3332.  doi: 10.3969/j.issn.1673-8225.2011.18.024
    Abstract ( 114 )   PDF (1627KB) ( 315 )   Save

    BACKGROUND: It is a hot investigation to many scholars that how to cure and prevent renal ischemic reperfusion injury (IRI) in a utility way, but the mechanism is unclear at present.The investigation indicates that hypoxia inducible factor (HIF) plays an important role during this process.
    OBJECTIVE: To investigate the effects and possible mechanism of HIFs on renal ischemia reperfusion injury in mice.
    METHODS: Two kinds of mice were selected: one kind was aryl hydrocarbon receptor nuclear translocator (ARNT) gene inactivation, and the other kind was used as controls. Each kind of mice were randomly divided into sham operation group, ischemic reperfusion group, ischemic reperfusion+ recombinant human erythropoietin (rhEPO) group, ischemic reperfusion+0.9% normal saline (NS) group. Mice were established for renal IRI models. Serum erythropoietin (EPO) levels after 1 hour and 24-hour serum creatinine (Cr) values were examined, 24-hour renal tubular injury score following PAS staining was recorded, and 24-hour renal tubular cell apoptosis was counted by using TUNEL method.
    RESULTS AND CONCLUSION: One hour after reperfusion ARNT knockout serum EPO levels were significantly lower than the control group (P < 0.01). At 24 hours, Cr levels of ARNT knockout mice were significantly higher than the control group (P < 0.01). Renal Tubular injury scores of ARNT knockout group were significantly higher than the control group (P< 0.01). The number of TUNEL positive cells of ARNT knockout group was significantly more than the control group (P < 0.01). After rhEPO injection, there were no significant difference between ARNT knockout mice and control mice (P > 0.05). The results showed that HIF system on renal ischemia reperfusion injury has important protective role. It may be the maximum protective effect mediated by EPO.

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    Treatments for acute humoral rejection after renal transplantation
    Shen Bei-li, Li Yu-hua, Hu Jun-jie, Wang Su-jing, Hu Meng-pei, Li Xiao-yan
    2011, 15 (18):  3333-3336.  doi: 10.3969/j.issn.1673-8225.2011.18.025
    Abstract ( 113 )   PDF (549KB) ( 314 )   Save

    BACKGROUND: The acute humoral rejection after renal transplantation is a kind of human leukocyte antigen antibody-mediated rejection, which often leads to the loss of graft’s function. At present the application of potent immunosuppressive agents and B lymphocyte inhibitors significantly improve reversal rate of acute humoral rejection.
    OBJECTIVE: To explore the therapeutic regimen of acute humoral rejection after renal transplantation.
    METHODS: A total of 20 cases with acute humoral rejection in renal transplant recipients were retrospectively analyzed, patients were treated with antithymocyte globulin, protein A immunoadsorption and large dose gamma globulin therapeutic alliance. All patients were first received protein A immunoadsorption treatment before and after the last treatment, blood preparation was used to detect panel reaction antibody and serum immune globulin IgG, IgA, IgM.
    RESULTS AND CONCLUSION: Twenty cases with acute humoral rejection were effectively reverse. After 48 months follow-up, 1case stopped using immunodepressant due to severe pulmonary infection at 5 months after renal transplantation. And then gravis acute rejection was occurred, patients underwent removal of transplanted renal, hemodialysis was recovered. The graft function of the remaining patients is good, the average serum creatinine concentration was (132.6±44.2) µmol/L to the end point of follow-up. It is indicated that antithymocyte globulin combined with protein A immunoadsorption and large dose gamma globulin can effectively reverse acute humoral rejection after renal transplantation with high success rate, few complication, and completely reversed acute humoral rejection does not affect the prognosis of graft.

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    Changes in serum soluble Fas and soluble Fas ligand of renal graft recipients in early period post-transplant as a predictor of acute renal allograft rejection
    Song Jie, Li Hui, Zhang Xiao-dong, Li Ying
    2011, 15 (18):  3337-3340.  doi: 10.3969/j.issn.1673-8225.2011.18.026
    Abstract ( 130 )   PDF (712KB) ( 343 )   Save

    BACKGROUND: Apoptosis of target cells plays a crucial effect on acute rejection after organ transplantation. Fas/Fas ligand (FasL) system is considered as one of action pathways of acute rejection after organ transplantation.
    OBJECTIVE: To study the serum soluble Fas and soluble FasL levels of renal graft recipients in early post-transplant period and their application as a predictor of acute renal allograft rejection.
    METHODS: The sequential monitoring of serum soluble Fas and soluble FasL levels in 80 patients was conducted by ELISA technique before and after renal transplantation and the relationship between sFas/sFasL with acute renal allograft rejection were analyzed.
    RESULTS AND CONCLUSION: The levels of serum soluble Fas and soluble FasL in the patients for renal transplantation were significantly higher than that in control before operation (P < 0.05). The levels of serum soluble Fas and soluble FasL in acute rejection group at same time were significantly higher than that in normal group after operation (P < 0.05), and compared with that in CsA-induced nephrotoxicity group, there was no significant difference. The sequential monitoring of serum soluble Fas and soluble FasL in renal allograft recipients may be of a useful value to make early and differential diagnosis of acute renal rejection.

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    Surgical technique improvement for liver transplantation in rats using 30% small-for-size grafts
    Li Jiang, Liu Jing, Hou Yu, Li Li
    2011, 15 (18):  3341-3346.  doi: 10.3969/j.issn.1673-8225.2011.18.027
    Abstract ( 105 )   PDF (804KB) ( 447 )   Save

    BACKGROUND: The techniques of partial liver transplantation, using a living donor graft, expand the supply of organs and partially overcome the grafts shortage. But these benefits are limited in adult recipients when the volume of the grafts is small. To establish a model of small-for-size liver transplantation, using a simple and effective way, is the basis for the study mentioned above.
    OBJECTIVE: To explore a simple and effective way of establishing a 30% small-for-size liver transplantation in rats.
    METHODS: 280 Spraque-Dawley rats were selected as the donors and recipients to establish 30% small-for-size orthotropic live transplantation using two-cuff techniques. Animals were divided into two groups depending on the techniques modified or not. Sixty pairs of rats were divided into before modification group, using the way according to reference 10 to 15 and the median lobe of the liver as graft. These 60 pairs of rats were divided into two groups again depending on hepatectomy in vivo or in vitro. Group Ⅰ, performed hepatectomy in vivo before liver irrigation; groupⅡ, performed hepatectomy in vitro after liver irrigation. Eighty pairs of rats transplanted using the way of improvement by us were divided into modification group (group Ⅲ), in which hepatectomy was performed in suit after liver irrigation, the median and right lobes of liver were used as graft, body weights of donor were 100-120 g less than those of recipients, two-cuff technique and bile duct stent techniques were improved. Time of operation, survival and technical complications were compared among these groups.
    RESULTS AND CONCLUSION: The time of hepatectomy and graft harvest were significantly shorter in group Ⅲ than those in group Ⅱ andⅠ(P < 0.05). The cold ischemia time in group Ⅱ was significantly longer than those in groupⅠand Ⅲ(P < 0.05). The incidence of bleeding, bile leakage IVC stricture, graft less perfusion and gas embolism were significantly less in group Ⅲ than those before modification. The rats in group Ⅲ had a higher transplanting successful rate, more 7-d and 14-d survivors post operation and longer median survival time (14 d) than those before modification (P < 0.05). The way of modification by us was a more effective and simple for establishing a 30% small-for-size liver transplantation in rats with higher transplanting successful rate and survival rate but fewer complications after operation.

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    Rat models of orthotopic kidney transplantation
    Mai Hai-xing, Qu Nan, Zhao Li, Huan Chen, Wang Ya-lin, Li Xue-chao, Li Jian-tao, Chen Li-jun
    2011, 15 (18):  3347-3350.  doi: 10.3969/j.issn.1673-8225.2011.18.028
    Abstract ( 84 )   PDF (664KB) ( 568 )   Save

    BACKGROUND: There are many ways to prepare kidney transplantation models in rats; however, there are still many problems about operation time, transplantation effect and so on.
    OBJECTIVE: To study the microsurgical technique of establishing a reliable rat model of orthotopic kidney transplantation.
    METHODS: Kidney transplantation was performed from SD to Wistar strain (allogeneic),the donor’s artery and renal vein were put on the self-make rubber septum and underwent the end to end anastomosis surgeon with the receptor’s arteriae renalis and renal vein. After that, the donor’s bladder valva was inosculated with the receptor’s bladder. All the rats were divided into two groups: control group and Cyclosporin A (CsA) group, each group included 30 rats. The control group received 1 mL D-hanks each day after transplantation; the CsA group received subcutaneous injection of CsA for 15 mg/kg. The serum creatinine levels were observed at days 3, 5 and 10 after transplantation, pathological changes were also observed at 10 days after transplantation.  
    RESULTS AND CONCLUSION: Rat orthotopic kidney transplantation was performed in 60 rats, and the successful rate was 85%. The serum creatinine level in the CsA group was lower than that in the control group (P < 0.05), but the survival time in the CsA group was longer than that in the control group (P < 0.05). Allografts of the control group exhibited typical severe acute rejection. It is indicated that this rat model of kidney transplantation is a reliable model with good reproducibility and high achievement ratio.

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    Establishment of a rat model of ischemic biliary strictures induced by clamping
    Zhao De-fang, Zhang Tong, Zhao Li-jun, Chen Da-zhi
    2011, 15 (18):  3351-3353.  doi: 10.3969/j.issn.1673-8225.2011.18.029
    Abstract ( 185 )   PDF (515KB) ( 295 )   Save

    BACKGROUND: Studies have showed that forceps operation can be used to prepare myocardial ischemia-reperfusion injury models.
    OBJECTIVE: To prepare a rat biliary ischemic stenosis model using forceps operation.
    METHODS: After the optimal time of biliary ischemia was determined, 40 Wistar rats were randomly divided into 2 groups. 0.8 cm common bile duct was clamped for 90 minutes with 2 micro-vessel clips in the experimental group. The common bile duct was not clamped in the sham operation group. Twenty-one days later, the intravenous cholangiography was conducted in all the rats. Blood samples were collected from the inferior vena cava to investigate the serum concentration of total bilerubin (TBIL) and direct bilerubin (DBIL).
    RESULTS AND CONCLUSION: Twenty-one days later: 3 rats in experimental group could be evidenced to bile duct distension by intravenous cholangiography. But they all had serious dilatation, and their liver was bad when autopsy was done. Obvious dilatation of the common bile duct appeared over the clamped site. There was no dilatation of the common bile duct in the sham operation group. The serum concentration of TBIL and DBIL were significantly higher in the experimental group than in the sham operation group (P < 0.05). The result proved that The rat model of ischemic biliary strictures resulting from clamping has been successfully established.

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    Establishment and management of hepatocarcinoma tissue bank and data base
    He Guo-lin, Gao Yi, Pan Ming-xin, Zhang Jian
    2011, 15 (18):  3354-3356.  doi: 10.3969/j.issn.1673-8225.2011.18.030
    Abstract ( 316 )   PDF (549KB) ( 823 )   Save

    BACKGROUND: Currently, the genetic resource of hepatocarcinoma has not be collected and protected well; therefore, in order to save the proband pedigrees of Guangdong Province, a information-based management of tumor database was established in Zhujiang Hospital Affiliated to Southern Medical University.
    OBJECTIVE: To investigate the collection and conservation of tumor tissue specimens, and the approaches to information-based management of tumor database.
    METHODS: The tumor tissues, tumor-adjacent tissues, distal normal tissues removed from surgery and patient serum and extracted nucleic acids from tumor tissues were collected. Specimens of the tissue fragments, nucleic acids, serum, plasma, lymphocyte and stem cells, etc. were respectively conserved in liquid nitrogen or -80 ℃ refrigerator. Meanwhile, a database of information management of tumor tissue bank was established, including positions of sample placement, specimen use, laboratory results, comprehensive query, management of specimen disposal, etc.
    RESULTS AND CONCLUSION: Specimens of 45 cases, including relevant specimens of 5 cases of benign tumors and 40 cases of malignant tumors, were collected. The tumor tissue data base was established and managed according to the above-mentioned methods, which functioned with good results in the past 1 year. The establishment of tumor tissue database enables the quantity control of the specimens and information-based management, as well as conservation of infrequent specimens and resource share.

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    Construction of eukaryotic expression vector carrying rat heat shock protein 72 gene and its expression in COS7 cells
    Yan Chun-gen, Huang Dan-wen, Ren Guang-yuan, Zhu Dong-fang
    2011, 15 (18):  3357-3360.  doi: 10.3969/j.issn.1673-8225.2011.18.031
    Abstract ( 140 )   PDF (665KB) ( 454 )   Save

    BACKGROUND: In vitro cloning and expression of heat shock proteins (HSP), especially HSP72, is important in the study of ischemia-reperfusion injuries.
    OBJECTIVE: To construct eukaryotic expression vector carrying HSP72 and study its transient expression in COS7 cells, and to establish the foundation for further research of the immune function of HSP72.
    METHODS: HSP72 cDNA was amplified from hepatocytes of BABL/C mice by RT-PCR, and correctly inserted into corresponding sites of eukaryotic expression vector pcDNA3.1(+)after restriction endonuclease digestion, and the recombinant plasmid was transfected into COS7 cells and gene expression was determined by RT-PCR.
    RESULTS AND CONCLUSION: The gene fragment inserted into the vector pcDNA3.1(+)was confirmed by nucleotide sequencing, and the recombinant plasmid mRNA was successfully expressed in COS7 cells.

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    Effect of oxygen free radicals on adenosine triphosphatase and somatostatin in reproductive cells
    Hu Jian-xin, He Jian, Liu Jun, Sun Zhao-lin, Wang Yuan-lin, Liu Xiu-heng
    2011, 15 (18):  3361-3364.  doi: 10.3969/j.issn.1673-8225.2011.18.032
    Abstract ( 156 )   PDF (723KB) ( 315 )   Save

    BACKGROUND: Most of studies about oxygen free radicals focus on production and scavenging of free radicals in animal cells.
    OBJECTIVE: To investigate the effect of oxygen free radical on adenosine triphosphatase (ATPase) and somatostatin (SOM) in spermatogonial cells cultured in vitro.
    METHODS: Spermatogonial cells isolated from mice were purified and cultured in vitro and divided into two groups after 24-hour culture. In the experimental group, xanthine-xanthinoxidase (X-XO) was used to establish an oxygen free radical damaging model. In the control group, normal saline was added. After 24 and 48 hours, changes of ATPase and SOM were observed in the two groups. Gray value and absorbance value at 492 nm were determined.
    RESULTS AND CONCLUSION: After 24 and 48 hours, the gray values of ATPase and SOM in the experimental group were significantly higher than those in the control group (P < 0.01), while the absorbance values in the experimental group were lower than those in the control group (P < 0.01). These indicated that oxygen free radicals can decrease the ATPase and SOM, and influence the growth and proliferation of spermatogonial cells cultured in vitro.

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    Application of liver grafts from anti-hepatitis B core positive donors
    Lu Hao-ran, Cai Qiu-cheng, Lü Li-zhi, Chen Shao-hua, Jiang Yi
    2011, 15 (18):  3367-3370.  doi: 10.3969/j.issn.1673-8225.2011.18.034
    Abstract ( 124 )   PDF (696KB) ( 555 )   Save

    BACKGROUND: Utilization of anti-HBc positive liver anti-HBc positive graft relieves organ shortage despite it increases risk of hepatitis B virus (HBV) recurrence after liver transplantation.
    OBJECTIVE: To evaluate the risk of HBV infection after liver transplantation with anti-HBc positive donors and anti-HBV prophylaxis.
    METHODS: The PubMed database was researched using a computer for articles published from January 1994 to December 2009 using the key words of “hepatitis B core antibody; donor; liver transplantation” in English. We performed a literature review over the last 15 years identifying 39 studies including 903 recipients of anti-HBc positive liver grafts.
    RESULTS AND CONCLUSION: Recurrent HBV infection developed in 11% of HBsAg-positive liver transplant recipients of anti-HBc positive grafts, while survival was similar (67%–100%) to HBsAg-positive recipients of anti-HBc negative grafts. Neonatal HBV infection developed in 19% of HBsAg-negative recipients being less frequent in anti-HBc/anti-HBs positive than HBV negative cases without prophylaxis (15% vs. 48%). Anti-HBV prophylaxis reduced neonatal infection rates in both anti-HBc/anti-HBs positive (3%) and HBV naive recipients (12%). Neonatal infection rates were 19%, 2.6% and 2.8% in HBsAg-negative recipients under hepatitis B immune-globulin, lamivudine and their combination, respectively. Liver grafts from anti-HBc positive donors can be safely used, preferentially in HBsAg-positive or anti-HBc/anti-HBs positive recipients. HBsAg-negative recipients should receive prophylaxis with lamivudine.

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    Apoptosis and ischemia-reperfusion injury following liver transplantation
    Wu Qin-rong, Shi Jun, Wang Yong-gang
    2011, 15 (18):  3371-3375.  doi: 10.3969/j.issn.1673-8225.2011.18.035
    Abstract ( 136 )   PDF (775KB) ( 377 )   Save

    BACKGROUND: Liver transplantation has become an effect means for end-stage liver disease. Hepatic ischemia-reperfusion injury is an important factor to influence the effects of liver transplantation. Cell apoptosis is one of important mechanisms for transplanted liver ischemia reperfusion injury
    OBJECTIVE: To provide references for the clinical application of anti-apoptosis treatment in relieving organ ischemia-reperfusion injury based on recent studies about apoptosis and transplanted liver ischemia-reperfusion injury.
    METHODS: The databases of PubMed (http://www.ncbi.nlm.nih.gov/PubMed) and CNIKI (http://dlib.cnki.net/kns50/) were retrieved by the first author with key words of “apoptosis, organ transplantation, ischemia-reperfusion injury” in both Chinese and English from 1990 to 2010. The repetitive studies were excluded. Totally 339 articles were gotten by computers according to criteria, 39 articles of which were included in the final analysis.
    RESULTS AND CONCLUSION: There is close relationship between the apoptosis and liver ischemia-reperfusion injury. And inhibiting cell apoptosis can effectively reduce the liver ischemia-reperfusion injury, which will play an important role for the graft survival.

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    Influence of transplant surgery and anesthesia stress on the activity of body cytokines
    Xi Zi-ming
    2011, 15 (18):  3376-3380.  doi: 10.3969/j.issn.1673-8225.2011.18.036
    Abstract ( 89 )   PDF (744KB) ( 487 )   Save

    BACKGROUND: Whether the patients can successfully recover is related to many factors, among which immune factor is an important one. Cytokine is a major component for immune function and also a research hotspot in recent years. Mental stimulation, anesthesia stimulation, real stimulation in surgery, and anesthesia reaction stimulation after surgery can lead to a change in patients’ body cytokines, which affects the patient’s recovery.
    OBJECTIVE: To review the influence of transplant surgery and anesthesia stress on the activity of body cytokines.
    METHODS: A computer search was performed for relative articles in Wanfang, VIP, Qikan, and CNKI databases from January 2005 to October 2010. The key words are “surgery, anesthesia, cytokines” in Chinese and English. There were altogether 26 documents retrieved.
    RESULTS AND CONCLUSIONS: There were 26 relative literature retrieved, with one involving the basic theory, 19 about surgery, and 6 related to anesthesia. It is found that surgery can cause imbalance of body cytokines, especially with interleukin (IL)-6, IL-10, IL-1, IL-2, IL-8, tumor necrosis factor (TNF)-α changing (increased) significantly. Compared with conventional surgery, the change of cytokines in laparoscopic surgery is relatively not obvious, which indicates cytokine changes are related to the degree of body damage. Anesthesia can also lead to imbalance of the body cytokines, mainly with IL-6, IL-10, TNF-α changing (increased), while epidural anesthesia has no obvious effect on cytokines. Surgery, trauma and general anesthesia can lead to cytokine imbalance, thus affecting the immune system and endocrine system, etc, and further influencing the rehabilitation of the body. Epidural anesthesia/epidural anesthesia assists other narcotic effect on cytokine balance in the body less. In clinical surgery work, we should try to choose a small trauma and surgical method during anesthesia.

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    The process and quality management of allograft tissue bank
    Wang Pei-tao, Shao Cui-hua, Li Qiang
    2011, 15 (18):  3381-3386.  doi: 10.3969/j.issn.1673-8225.2011.18.037
    Abstract ( 129 )   PDF (801KB) ( 365 )   Save

    BACKGROUND: With the development of tissue transplantation and preservation technology, allograft tissue bank has been widely developed and its technical level has improved constantly. Meanwhile, the synergism of involved standards and governing principles are becoming increasingly prominent, and the quality control attracts more and more attention.
    OBJECTIVE: To explore the establishment and application of tissue bank based on the experiences of scientific research, clinical medicine, and management about allograft tissue bank over the past 25 years.
    METHODS: The literature related to establishment and management, quality standard and control of allograft tissue bank from Medline database (1966/2010), Excerpta Medica database (1974/2010), Chinese Scientific and Technical Literature database 1999/1999), and Chinese Biomedical Literature database (1978/2009) was retrieved by the second and the third author.
    RESULTS AND CONCLUSION: Allograft tissue bank plays an important role in clinical treatment and provides an effective and convenient approach for doctors. The establishment and application of allograft tissue bank constitute a comprehensive and particular medical field, which possesses its own management mode and quality control system. A complete process management involved in a tissue bank should includes the setting and management mode, operational process of technology, and quality control system. Tissue bank should regulate operation, and included into areas of scientific management of medical institution, in order to make allograft tissue bank assist Chinese medical course more efficiently.

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    Immunological rejection reaction and cryopreserved cartilage allograft 
    Wu Ya-di, Zhang Gang
    2011, 15 (18):  3387-3390.  doi: 10.3969/j.issn.1673-8225.2011.18.038
    Abstract ( 84 )   PDF (631KB) ( 473 )   Save

    BACKGROUND: At present, cryopreserved method is used to reduce immunological rejection after cartilage allograft transplantation, but allograft source, cryopreservation method, and frozen storage conditions still need in-depth studies.
    OBJECTIVE: To retrospectively analyze the action mechanism related to immunological rejection reaction following transplantation of cryopreserved cartilage allograft, and to compare the characteristics of different preservation methods.
    METHODS: The search by the first author was performed to retrieve PubMed and Wanfang databases for articles about immunological rejection following transplantation of cryopreserved cartilage allograft and cryopreservation effects on cartilage transplantation published 1990 to 2008.
    RESULTS AND CONCLUSION: Cartilage allograft transplantation is better than other treatments for patients with articular cartilage defects. The cryopreservation method maintains the properties and biological activity of cartilage tissues, and based on this method, we can choose date for joint reconstruction and have plenty of time to complete the detection of a number of indicators so as to prevent the spread of bacteria, viruses and infectious diseases carried by the donor, and to reduce the antigenicity of cartilage tissue, with great clinical value. However, in all aspects of cryopreservation, such as, the application of cryoprotectant, cooling and rewarming speed, there are still many problems. And after cartilage transplantation, there is occurrence of cartilage resorption, degeneration and so on. With the development of frozen biology and revealing of frozen injury mechanism, these problems will be met, cartilage cryopreservation technology will be further improved.

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    Immune response treatments after heterogeneous tendon transplantation
    Gao Chun-guang, Lin Yue-qiu
    2011, 15 (18):  3391-3394.  doi: 10.3969/j.issn.1673-8225.2011.18.039
    Abstract ( 254 )   PDF (661KB) ( 357 )   Save

    BACKGROUND: Tendon defects or damaged when clinically repairing needed transplant tendons. Heterogeneous tendon is an ideal method to repair the tendon defects. Heterogeneous tendon source is sufficient, but post-transplantation rejection limits the use of heterogeneous tendons.
    OBJECTIVE: To review the antigens of heterogeneous tendons and post-transplantation immune response as well as reduction of xenograft rejection.
    METHODS: Using “tendons, transplantation, immunity” in Chinese and English as the key words, the first author conducted a computer search of Pubmed database (http://www/ncbi.nlm.nih.gov/PubMed) and CNKI database (www.cnki.net/index.htm) through screening the titles and abstracts. Articles recently published or published in the authority magazines were preferred in the same field. Totally 30 documents were included.
    RESULTS AND CONCLUSION: At present, the study for heterogeneous graft antigens involves Gal-a-1, 3-Gal antigen (Gal) and non-Gal antigen, especially Gal antigen gene. Gal antigen is a main factor of super rejection (HAR). Cellular immunity mainly exists at early stage after heterogeneous tendon transplantation, and only humoral immunity exists at late stage. Animal experiments have shown that heterogeneous tendons after different physical and chemical treatments have potential application value. Unlike other organ transplantation, tendon transplantation is a non-functional transplantation, which only provides a growth support for the recipient. The biological research after transplantation mainly focuses on bio-mechanical characteristics. Therefore, the elimination of the immunogenicity and reservation of graft biomechanical properties is the key to heterogeneous tendon graft.

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    Clinical effect analysisis of the elder living kidney donors and relatives kidney transplants
    Wang Kai, Qu Qing-shan, Miao Shu-zhai
    2011, 15 (18):  3395-3397.  doi: 10.3969/j.issn.1673-8225.2011.18.040
    Abstract ( 155 )   PDF (534KB) ( 338 )   Save

    BACKGROUND: In recent years with various transplant regulations were enacted, the number of relatives kidney transplants has increased in many transplantation centers at home. At present, there is no definite restriction about the oldest age to living body kidney donor in international. Due to the extreme shortage of organ transplants, in many international transplantation centers, they are trying for the elder donor.
    OBJECTIVE: To investigate the clinical effects and application prospect of the elder living kidney donors and the relatives kidney transplants.
    METHODS: According to the age, 65 patients with living donor kidney transplantation were divided into 2 groups: 16 cases in the aged group (donor age ≥ 55 years) and 49 cases in the control group (donor age < 55 years). The donors of the two groups were eucrasia, functions of heart, liver, lung were perfect, and without hypertension and diabetes mellitus. The creatinine clearance rates were above 80mL/min before transplantation. The baseline datas of two groups were similar. A follow-up at 6 months after transplantation was to evaluate the renal function recovery and early complications of the two groups.
    RESULTS AND CONCLUSION: The renal functions of the two groups were recovered well. There was no significant difference in early complications of acute rejection, delaying recovery of the graft function (P > 0.05). Under the lack of source of kidney, the elder donors undergo living related renal transplantation according to strict donor kidney inclusion criteria, which can obtain good therapeutic efficacy.

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    Sepsis following renal transplantation in 7 cases
    Chen Tong-qing, Lin Min-wa, Kong Yao-zhong, Ma Jun-bao
    2011, 15 (18):  3398-3400.  doi: 10.3969/j.issn.1673-8225.2011.18.041
    Abstract ( 220 )   PDF (429KB) ( 262 )   Save

    BACKGROUND: Due to the use of immunosuppressants and broad-spectrum antibiotic, the pathogenic bacteria of sepsis is diverse and complex, accompanying with severe illness and high death rate. Therefore, to enforce clinical etiology characteristics understanding of sepsis after renal transplantation and to perform appropriate treatment as soon as possibly are the key to improve infection cure rate.
    OBJECTIVE: To analyze the clinical etiology characteristics and therapy of sepsis following renal transplantation.
    METHODS: The clinical data of 7 cases of sepsis in 376 patients following renal transplantation were collected from the Department of Nephrology, the First people’s Hospital of Foshan from June 2007 to June 2010. Predisposing factor, etiology characteristics, clinical manifestation and treatment of sepsis were retrospectively analyzed, respectively.
    RESULTS AND CONCLUSION: There were 7 cases of shivering and fever (T38.5-40.2 ℃), 4 cases of fantod and breathlessness, and 4 cases of urinary irritation symptoms; 4 cases of blood pressure less than 90/60 mm Hg (1 mm Hg=0.133 kPa) with increased serum creatinine, 4 cases of Escherichia, 1 case of Staphylococcus epidermidis, 1 case of Blastomyces albicans, 1 case of Penicillium marneffi; 5 cases of bacterial infection was community infection, 2 cases of fungous infection was hospital oneset of infection; 4 cases suffered from Escherichia combined with urinary tract infection, and 4 cases suffered from hypotension shock and acute renal failure. Six sepsis patients were cured and one died after giving anti-infective therapy, reducing the dosage of immunosuppressant and symptomatic treatment. Early diagnosis, drug combination, and reducing the dosage of immunosuppressant are the key to improving cure rate against infection.

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    Acute rejection following kidney transplantation in 12 cases
    Long Wei, Yang Guang-ting, Jiang Wei, Liu Yan-bin, Pei Xiang-ke, Bai Yu-mei, Tuo Ya, Zhang Chun-yuan
    2011, 15 (18):  3401-3404.  doi: 10.3969/j.issn.1673-8225.2011.18.042
    Abstract ( 592 )   PDF (550KB) ( 890 )   Save

    BACKGROUND: After the allogeneic kidney transplant operation, acute rejection is one of the most important reasons of transplant kidney hypofunction and eventually defunctionalization. So effective prevention, early diagnosis and acute rejection therapy are important things which relate closely to how long the patient can live.
    OBJECTIVE: To summarize the experience of application of immunosuppressive on patients with acute rejection in one month after kidney transplantation.
    METHODS: A total of 12 kidney transplantation patients were selected, who are all the first time to do the transplant. After the kidney transplantation, using mycophenolate mofetil capsules, cyclosporine A and methylprednisolone as triple regimen to prevent rejection. During 3 to 30 days after operations, the 12 patients had different clinical manifestation, such as hypourocrinia, kidney transplanted area swollen, serum creatinine increase, urine protein increase, instituted as acute rejection after renal transplantation. First, the patients were treated with methylprednisolone pulse therapy: 5mg/d (d1-3), intravenous drip. Then, taking it orally instead, 24 mg/d, decreasing by 4 mg every 5-7 d, until 8 mg/d.
    RESULTS AND CONCLUSION: 12 cases reversed successfully, including 6 cases which reversed by methylprednisolone. Those unable to reverse were treated with Antithymocyte Globulin (ATG) or CD3. In 1 of 4 cases with ATG, urinary output increased rapidly within 8 hours, 2 cases within 24 hours and 1 case within 72 hours. One case with CD3, patient’s urinary output rose quickly within 48 hours. One case used tacrolimus instead of cyclosporine A, at the same time took mycophenolate mofetil capsules and methylprednisolone. After the above treatments, kidney function in all 12 cases recovered gradually. The results suggested that, for patients with acute rejection after kidney transplantation, early detection, diagnosis and timely therapy is the key to reversal successfully.

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    Meek micrograft technique for extensive deep burns
    Hu Wei-dong, Huang Ai-ping, Xie Xi-yu, Zhou Rong, Li Yue-cheng, Zeng Yuan-lin
    2011, 15 (18):  3405-3407.  doi: 10.3969/j.issn.1673-8225.2011.18.043
    Abstract ( 72 )   PDF (463KB) ( 488 )   Save

    BACKGROUND: The Meek technique of skin expansion is a novel method for wound healing, which has been introduced to many domestic hospitals in the past 5 years.
    OBJECTIVE: To investigate the clinical effect of Meek micrograft in treating extensive deep burns.
    METHODS: Sixteen cases of extensive deep burns were treated with Meek micrograft technique after early tangential excision, escharectomy, or granulation tissue formation. Meek autografts with expansion ratio of 1:4 was placed on joint position. Besides, expansion ratio of 1:4 or 1:6 was chosen according to size of wound and donor site. As comparison, stamp-like grafts were used in different places of the same bodies in 6 cases with 30% TBSA burns. Scarring proliferation situation was evaluated.
    RESULTS AND CONCLUSION: In Meek skin graft group, skin graft survival rate was 65% to 95%; healing time was 21 to 65 days, averaged 35 days. Scar hyperplasia showed light and less contraction. Joint function was satisfied. The results show that Meek technique skin graft has good effect and worth to popularizing in treating extensive burns with the advantages of simple, time saving, high survival rate of skin graft, short time of epithelialization, less scar, and better joint function.

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    Immunosuppressive regimen after simultaneous pancreas and kidney transplantation
    Wu Lin-wei, Zhang Jian-wei, Tai Qiang, Ju Wei-qiang, He Xiao-shun, Guo Zhi-yong, Wang Dong-ping, Zhu Xiao-feng, Ma Yi, Wang Guo-dong, Wang Chang-xi, Hu An-bin
    2011, 15 (18):  3408-3412.  doi: 10.3969/j.issn.1673-8225.2011.18.044
    Abstract ( 127 )   PDF (381KB) ( 351 )   Save

    BACKGROUND: Simultaneous pancreas and kidney transplantation (SPK) has been considered an effective therapeutic means of diabetes mellitus (including type 1 and type 2) combined with end stage uremia. Because the pancreas possesses high immunogenicity, so a feasible immunosuppressive regimen is a key to successful pancreas transplantation.
    OBJECTIVE: To investigate the feasible immunosuppressive regimen after simultaneous pancreas and kidney transplantation (SPK). 
    METHODS: From January 2005 to June 2009, 9 patients with diabetic nephropathy and end stage uremia, consisting of 5 males and 4 females, received SPK. The pancreatic allograft exocrine secretion was drained into the proximal jejunum via a side-to-side duodenojujunostomy. Quadruple immunosuppressive regimen including induction of interleukin-2 receptor monoclonal antibody, tacrolimus, mycophenolate mofetil and steroid, and gradual tacrolimus monotherapy. The clinical data of the 9 patients were analyzed retrospectively.
    RESULTS AND CONCLUSION: SPK was successfully applied to all patients without serious surgical complications such as pancreatitis, graft dysfunction and pancreatic fistula. One patient died of cardiovascular accident in the early stage after SPK. The other 8 patients were followed up for 4-50 months. Serum creatinine decreased to normal range within 1 week after surgery. The 8 patients achieved euglycemia during early postoperative stage with insulin independence time (11.5±3.5) days and with fasting blood glucose recovery time (15.4±6.3) days. Acute rejection of the renal graft occurred in 4 patients, 1 patient died of cardiovascular accident and the other 3 recovered after antihuman thymocyte globulin or steroids bolus treatment. No rejection was noted in pancreatic grafts. These findings indicate that SPK is an effective treatment for patients with diabetes mellitus-related middle- and end-stage uremia.Quadruple immunosuppressive regime including interleukin-2 receptor monoclonal antibody induction is feasible after SPK, and such a regimen can be safely converted to tacrolimus monotherapy.

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    Cause analysis of early death after liver transplantation in rhesus monkey
    Ran Jiang-hua, Liu Jing, Zhang Sheng-ning, Li Zhu, Wu Shu-yuan, Liang Yu, Zhang Xi-bing, Li Li
    2011, 15 (18):  3413-3416.  doi: 10.3969/j.issn.1673-8225.2011.18.045
    Abstract ( 112 )   PDF (310KB) ( 320 )   Save

    BACKGROUND: Various factors contribute to the establishment of liver transplantation models in rhesus monkey, the rate of successful operation and long-term survival are very low.
    OBJECTIVE: To analyze the cause of early death following liver transplantation in rhesus monkey.
    METHODS: Liver transplantation models were fabricated with the classical and modified methods in rhesus monkeys. Operation of donor was performed quickly by a big crucial incision of abdomen. The improved double-cuff of the portal vein and inferior vena cava were finished, in addition to stay pipe of biliary tract in the process of repairing donor liver. Operation of the receptor was performed by classical orthotopic liver transplantation.
    RESULTS AND CONCLUSION: A total of 25 pairs of rhesus monkeys were successfully for establishing liver transplantation models. Seven rhesus monkeys died within early stage of post-operation, including six out of nine monkeys died by using the classical approach and one out of sixteen monkeys died by using the improved approach. There were five of seven monkeys died of intra-abdominal hemorrhage, one died of primary graft nonfunction and one died of respiratory failure. Results indicated that, the major death cause after classical orthotopic liver transplantation in rhesus monkey is abdominal hemorrhage. The improved methods of liver transplantation apparently reduce the hemorrhage and raise early survival rate following liver transplantation.

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    Application of low-dose calcineurin inhibitors in living-related donor renal transplantation
    Xu Dong-liang, Bai Jin-ming, Yu Xin, Lü Qiang, Yin Chang-jun, Xu Zheng-quan, Zhang Wei, Gu Min
    2011, 15 (18):  3417-3420.  doi: 10.3969/j.issn.1673-8225.2011.18.046
    Abstract ( 92 )   PDF (345KB) ( 274 )   Save

    BACKGROUND: Adequate preparation of donors and recipients prior to living-related donor renal transplantation, short warm and cold ischemia time for donor kidney, good histocompatibility of human leukocyte antigen match, and low postoperative rejection incidence provide feasibility for use of low-dose immunosuppressive agents after living-related donor renal transplantation.
    OBJECTIVE: To investigate the safety and effectiveness of low-dose calcineurin inhibitors (CNI), an immunosuppressive agent, in living-related donor renal transplantation.
    METHODS: A total of 38 recipients who underwent living-related donor renal transplantation at the Center of Renal Transplantation of the First Affiliated Hospital of Nanjing Medical University from January 2006 to June 2008 were randomized for treatment with mycophenolate mofetil (750 mg twice a day), prednisone, and either standard-dose CNI (n=18) or low-dose CNI (n=20) during 12 months post-transplantation. Ciclosporin A was given orally (starting dose, 6 and 4 mg/kg per day, respectively) in two divided doses to achieve the 12-hour whole blood concentration as measured by fluorescence polarization immunoassay. The starting dose of tacrolimus was 0.12 and 0.08 mg/kg per day respectively, and its whole blood concentration was measured by enzyme-multiplied immunoassay technique. After transplantation, patients were followed up. Renal function, pulmonary infection, liver dysfunction, and CNI nephrotoxicity at different time periods were compared between different regimens.
    RESULTS AND CONCLUSION: During 12 months post-transplantation, patient death occurred in one of 18 patients (5.6%) in the CNI standard-dose group and none of 20 patients (0%) in the CNI low-dose group. There was no significant difference in renal function and acute rejection between CNI standard-dose and CNI low-dose groups (P > 0.05). The incidence of liver dysfunction and CNI nephrotoxicity was significantly lower in the CNI low-dose group than in the CNI standard-dose group (P < 0.05). In addition, a low-dose CNI regimen helped recipients to lessen the economic burdens. These findings indicate that it is effective, safe and economical to use a low-dose CNI regimen in living-related donor renal transplantation.

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