Objective To evaluate the effectiveness and safety of calcineurin inhibitor (CNI) withdrawal from target-of-rapamycin-inhibitor(TOR-I)-based immunosuppression in kidney transplant recipients. Methods We searched MEDLINE, EMbase, SCI, CBM and The Cochrane Library to screen randomized controlled trials (RCT) of calcineurin inhibitor (CNI) withdrawal from target-of-rapamycin-inhibitor-(TOR-I)-based immunosuppression in kidney transplant recipients. The search was updated in Semptember 2009. The quality of the included trials was assessed. RevMan 5.0 software was used for meta-analyses. Results A total of 14 reports from 10 RCTs were identified. Five RCTs were graded A and five graded B. The meta-analyses indicated: RR (95%CI) values of the 1, 2, 4-year acute rejection rates were 1.64 (1.19, 2.27), 1.53 (1.06, 2.22) and 1.21 (0.73, 1.98), respectively; RD (95%CI) values of 1, 2, 4-year patient survival rates were – 0.01 (– 0.02, 0.01), – 0.00 (– 0.03, 0.02) and 0.03 (– 0.01, 0.08), respectively; RD (95%CI) values of 1, 2, 4-year graft survival rates were 0.00 (– 0.02, 0.02), 0.00 (– 0.03, 0.04) and 0.07 (0.01, 0.12), respectively; and glomerular filtration rate WMD was 9.50 and 95%CI 2.96 to 16.03. Conclusion Based on the current evidence, compared to CNI, CNI withdrawal from sirolimus-based immunosuppression in kidney transplantation could be advantageous for renal function. One-year acute rejection rate and 4-year graft survival rate increase. One-year patient/graft survival and fouryear acute rejection rate remain virtually unvariable. The long-term results need further confirmation.
Objective To compare the therapeutic effect of new “One-Stitch” ureterovesical anastomosis to that of the classic Lich-Gregoir method. Methods From January 2002 to December 2004, 445 patients suffering from uremia due to chronic nephritis were treated with renal transplantation. Among them, 121 patients were operated with our new modified ureteroneocystostomy technique (the new One-Stitch group), and 324 patients were operated with Lich-Gregoir technique (the Lich-Gregoir group). In the new One-Stitch group, there were 79 males and 42 females, aged 20-62 years (35.7 years on average). The course of the disease was 2-11 years (2.7 years on average). In the Lich-Gregoir group, there were 211 males and 113 females, aged 19-65 years (33.9 years on average). The disease course was 1-14 years (2.3 years on average). There was no significant difference between the two groups in age, proportion of genders, primary diseases and course of the disease (P gt; 0.05). The operative time, the ureteral compl ications and non-ureteral compl ications were compared between the two groups after the renal transplantation. Results The operative time for the new One-Stitch and Lich-Gregoir techniques was (8.7 ± 1.1) minutes and (22.4 ± 5.1) minutes, indicating the difference was significant (P lt; 0.05). All recipients were followed up for 3-5 years. In the new One-Stitch group, there were 5 patients with leakage of urine, 15 with gross hematuria, 4 with ureteral obstruction and 28 with urinary system infection. Symptomatic vesicoureteral reflux and stone formation were not observed in this group. In the Lich-Gregoir group, there were 17 patients with leakage of urine, 12 with gross hematuria, 13 with ureteral obstruction, 86 with urinary system infection, 6 with symptomatic vesicoureteral reflux and 2 with stones. In the new One-Stitch group, the incidence rate of compl ications of gross hematuria was 12.4%, which was significantly different from 3.7% in the Lich-Gregoir group (P lt; 0.05). The incidence rates of ureteral compl ications in the Lich-Gregoir and the new One-Stitch groups were 19.8% and 15.4%, respectively. The difference was not significant (P gt; 0.05). There was no significant difference between the two groupsin incidence rate of urinary system infection, delayed recovery of kidney function after kidney transplantation and rejectionreaction (P gt; 0.05). Conclusion The new One-Stitch group has no significant difference in ureteral compl ications ompared with the Lich-Gregoir group, and has become a preferential ureterovesical reimplantation technique because of its simple and has convenient operation.
Objective To evaluate the efficacy and safety of low-dose versus standard-dose cyclosporine immunosuppressive therapy in kidney transplant recipients. Methods We searched MEDLINE, EMbase, SCI, CBM and The Cochrane Library from the establishment to December 2009 to screen randomized controlled trials (RCTs) of low-dose versus standard-dose cyclosporine immunosuppressive therapy in kidney transplant recipients. Quality assessment and meta-analyses were performed for the included studies. Results A total of 6 RCTs involving 1551 patients were identified, among which 4 RCTs were graded A and two were graded B. The meta-analyses indicated that there were no significant differences between the two groups at the end of 6-month and 12-month follow-up in the acute rejection rate at a RR 1.07, 95%CI 0.69 to 1.65 and a RR 1.06, 95%CI 0.71 to 1.57, respectively. There were no significant differences between the two groups at the end of 6-month and 12-month follow-up in the patients’ death rate at a RR 0.64, 95%CI 0.20 to 2.03 and a RR 0.61, 95%CI 0.30 to 1.24, respectively. There were no significant differences between the two groups in renal function and safety. Conclusion Based on the current evidence, compared with standard-dose CsA, low-dose CsA has the same effect and safety for the short-term results, but the long-term results need to be further studied.
Objective To formulate an evidence-based treatment plan for a patient with hepatitis C after kidney transplantation with combination of interferon-α and ribavirin. Methods Based on an adequate assessment of the patient’ s condition and using the principle of PICO, we searched The Cochrane Library (Issue 1, 2009), PubMed (1995 to March 2009), and CHKD (1995 to 2008.12). Results Eighteen studies were identified including 17 in English (5 case reports, 11 cohort studies, and 1 meta–analysis) and 1 in Chinese. According to the current evidence as well as the patient’ s clinical condition and preference, PEG-IFNα-2b 50 µg /week plus ribavirin 600 mg/day was given to the patient for 6 months. Conclusion Evidence-based approaches help us to prepare the anti-viral therapy plan and will improve the assessment of the efficacy and safety in kidney transplantation.
Objective To evaluate the short and long term effectiveness and safety of rapamycin-based immunosuppression regimes with CsA preserving versus CsA withdrawal. Methods We searched MEDLINE, EMBASE, The Cochrane Library and CNKI from Jan. 1995 to Dec. 2005. We identified randomized controlled trials of rapamycin-hased immunosuppression regimes with CsA preserving versus CsA withdrawal for renal transplantation patients. The quality of included trials was evaluated by two reviewers. Meta-analysis was conducted on homogeneous studies. Results Ten studies （1 121 patients） undergoing renal transplantation were included. All included studies were graded in term of randomization, allocation concealment and bhnding. Six studies were graded A and the other 4 were graded B. Meta-analysis results showed CsA withdrawal in sirolimus-based therapy in renal transplantation patients survival rate OR.（95% CI ） values were 0,77（0.17, 3.52）, 1.24（0.48, 3.16）, 1.32（0.57, 3.08）, 1.21（0.60, 2.41） at the end of 6, 12, 24, 36 months respectively; renal allografts survival rate OR. （95% CI） values were 1.79 （0.63, 5.06）, 1.15 （ 0.56, 2.36） , 1.39 （0.68, 2.85）, 1.80（0.99, 3.29）, 2. 13（1.16, 3.89）, 2.01（1.15, 3.51） at the end of 6, 12, 24, 36, 48, 54 months respectively; and acute rejection OP,（95% CI） values were 0.92（0.48, 1.78）, 1.90（1.25, 2.89）, 2. 01 （0.94,4.27）, 1.93（0.93, 4.00）, 1.52（0.77, 3.02） at the end of6, 12, 24, 36, 48 months respectively. Conclusions Available evidence shows that compared with CsA preserving, CsA withdrawal in rapamycin-based immunosuppression regimes can lead to higher incidence rates of acute rejection at the end of one year while there is no statistical difference to survival rate of patients/renal allograft in cases with stabilized renal function post-transplantation. And CsA withdrawal is of benefit to allografts for long term survival rate and is helpful to recovery of renal function. Owing to high possibility of selection bias and measurement bias in included studies, there must be a negative impact on evidence intensity of our results. We expect best evidence from with high quality double blind randomized control trials.
Objective To approach the questions of donation after cardiac death （DCD） and transplantation through analyzing the DCD cases in this hospital. Methods The organs were obtained from 4 DCD from 2010 to 2011 in this hospital， the clinical data of DCD were analyzed retrospectively. Results Seven renal transplantations and 3 liver transplantations were performed. Donor warm ischemic time was 10-40 min. The liver and left kidney of the first DCD donator （Maastricht categoryⅣ） were eliminated through biopsy. One patient exhibited delayed graft function of kidney from the first DCD，the nephrectomy had to be done on day 7 after operation due to renal allograft rupture. Nine patients received 3 livers and 6 kidneys from the other 3 DCD donators （Maastricht categoryⅢ），whose patients were alive with excellent graft function. Conclusions The use of controlled DCD （Maastricht categoryⅢ） might be an effective way to increase the number of organs available for transplantation because that it might obtain satisfactory transplant outcomes and acceptable postoperative complications. The widespread implementation of controlled DCD in China should be encouraged.
目的 研究无创通气(NIPPV)治疗对肾移植术后巨细胞病毒(CMV)肺炎患者的疗效。方法 1998年1月~2005年12月间入住中山大学附属第一医院内科重症监护病房(MICU)的78例肾移植术后CMV肺炎患者，根据是否接受无创通气治疗而分为非NIPPV组和NIPPV组，比较两组患者在接受有创机械通气比例、病死率、住院时间及并发症等方面的差异。对52例NIPPV组患者，比较无创通气治疗前后生命体征及血气分析指标的变化。结果 NIPPV组与非NIPPV组相比，接受有创机械通气比例(30.8％ 比80.8％)、医院获得性肺炎发生率（32.7％ 比61.5％)及病死率(30.8％ 比57.7％)较低，两组比较均有显著性差异(P均lt;0.05)；而住院时间、气压伤发生率无显著差异。NIPPV组患者无创通气治疗后患者呼吸频率有所减慢，动脉血pH值逐渐降低，PaCO2水平缓慢上升，PaO2、PaO2 ／FiO2及SaO2明显升高，两组比较均有显著差异(P均lt;0.05)。而无创通气治疗前后心率、血压的变化则无明显规律。结论 NIPPV治疗能够改善肾移植术后CMV肺炎患者的低氧血症，缓解呼吸窘迫症状，降低有创机械通气治疗比例及医院获得性肺炎的发生率，从而降低病死率。用无创通气治疗巨细胞病毒肺炎值得在临床上推广使用。
ObjectiveTo analyze the clinical outcomes of cardiac surgery in patients after kidney transplantation underwent immunosuppression therapy. Methods Clinical data of 6 patients (including 4 males and 2 females aged from 27 to 66 years) undergoing cardiac surgery after kidney transplantation with immunosuppression between January 2011 and October 2013 in Beijing Anzhen Hospital were retrospectively analyzed. Two patients underwent off pump coronary artery bypass grafting, 3 patients underwent aortic valve replacement and 1 patient underwent mitral valve replacement. The interval between kidney transplantation and cardiac operation was 8.5±1.7 years (range, 6-10 years). ResultsAll the operations were performed successfully without in-hospital death and complications. Operation time was 237.0±93.0 min. Cardiopulmonary bypass (CPB) time was 101.3±16.7 min. Aortic cross-clamping time was 75.6±9.7 min. in-hospital stay was 17±6 d. There was a statistical difference in preoperative and postoperative left ventricle ejection fraction (63.5%±4.5% vs. 56.5%±5.8%, P < 0.05), as well as preoperative and postoperative left ventricular enddiastolic diameter (54.5±8.5 mm vs. 43.7±6.8 mm, P < 0.05), but there was no statistical difference in preoperative and postoperative serum creatinine levels (103.7±15.1μmol/L vs. 106.6±34.7μmol/L, P > 0.05). The mean follow-up time of the 6 patients was 4-15 months. The follow-up rate was 100%. All the patients were in cardiac function NYHA classⅠ-Ⅱ. And the quality of life was improved. ConclusionCardiac operations for kidney transplant recipients undergoing immunosuppressive treatment are effective and safe as long as appropriate perioperative treatment are taken.
ObjectiveTo explore the effect of donation after citizen death (DCD) kidney transplantations performed in Sichuan.MethodsThe data of 97 cases of DCD kidney transplantations performed in West China Hospital of Sichuan University between January 2012 and March 2016 was retrospectively reviewed. The 53 donors were aged from 7 months to 54 years (with a median of 28 years, and lower quartile of 15 years and upper quartile of 45 years), including 40 males and 13 females; the causes of death included craniocerebral trauma in 21 cases, craniocerebral tumor in 12 cases, cerebrovascular accident in 15 cases, hypoxic-ischemic encephalopathy in 4 cases, and hydrocephalus in 1 case. The 97 recipients were aged from 18 to 66 years (with a median of 39 years, and lower quartile of 30 years and upper quartile of 44 years), including 71 males and 26 females. The recipients were classified into C-Ⅰ (n=36) and C-Ⅲ (n=61) according to type of donation. The baseline and perioperative situation of the donors and recipients, and the postoperative kidney function, infection, recipient survival and kidney survival of the recipients were analyzed.ResultsAfter transplantation, none of primary graft nonfunction occurred but delayed graft function (DGF) occurred in 26 cases. There were no significant differences in creatinine level between C-Ⅰ and C-Ⅲ recipients at 1 week [(226.71±187.46) vs. (249.94±249.84) μmol/L, P=0.636], 1 month [(136.32±63.34) vs. (157.37±147.83) μmol/L, P=0.428], 3 months [(110.51±25.26) vs. (115.02±36.60) μmol/L, P=0.527] and 12 months [(103.42±21.57) vs. (104.18±39.36) μmol/L, P=0.911] after transplantation, as well as acute rejection [13.9% vs. 19.7%, P=0.469] and complications at early time after transplantation. There were no significant differences in 1-year recipient survival rate (91.7% vs. 93.4%) and 1-year kidney survival rate (100.0% vs. 91.8%) between C-Ⅰ and C-Ⅲ recipients.ConclusionDCD kidney transplantation has excellent short-term outcomes despite a high incidence of early DGF, and may represent another potential method to safely expand the donor pool.