老龄供者亲属活体肾移植疗效分析

背景：近几年随着各项移植法规相继出台,亲属肾移植数量在国内多个移植中心呈逐渐增多趋势。目前国际上对活体供肾供者尚没有最大年龄的明确限制,由于供器官的极度短缺,国际上很多移植中心开始尝试老龄供者。 目的：探讨老龄供者亲属肾移植的临床疗效及应用特点。 方法：亲属活体肾移植65例按供肾者年龄分为2组：老龄组(n=16)：供者年龄≥55岁;对照组(n=49)：供者年龄<55岁。两组供者平素健康状况良好,心肝肺等重要脏器功能健全,无高血压及糖尿病,移植前查血肌酐清除率均在80 mL/min以上。两组基线资料相似。移植后6个月内进行随访,评价两组受者移植后的肾功能恢复及早期并发症发生情况。 结果与结论：移植后两组受者肾功能恢复良好,急性排斥反应、移植物功能延迟恢复等早期并发症发生率比较,差异无显著性意义(P > 0.05)。提示在目前肾源缺少的情况下,选择老龄供者进行亲属活体肾移植,只要严格供肾纳入标准,可以取得良好的治疗效果。     

Isolated HLA-DP mismatches between donors and recipients do not influence the function or outcome of renal transplants.

The matching of donors and renal graft recipients for human leukocyte antigens A, B, and DR has been shown to exert beneficial effects on the outcome of transplantation. Until the advent of polymerase chain reaction amplification-based genotyping, the effect of HLA-DP compatibility on graft survival could not be thoroughly investigated. HLA-DP compatibility has been determined in three living-related transplants and 34 cadaveric transplants for donor-recipient pairs matched for HLA-DR and -DQ. The effect of DP mismatching on graft survival and function was assessed. No clear benefit from matching donor and recipient for HLA-DP could be discerned.     

Soluble HLA class i antigens in pediatric patients with renal transplants from related living donors without acute rejection and treated with triple therapy

All HLA class I Ag—expressing cells may be the source of serum Ag sHLA I. T and B lymphocytes secrete considerable amounts of Ag sHLA I in a variety of in vitro and in vivo activation systems. The purpose of this study was to evaluate the level of Ag sHLA I in serum of children with kidney transplants from related living donors without acute rejection and with triple therapy. We studied 25 patients (2–21 years) with first kidney transplant, 19 individuals (10–20 years) undergoing hemodialysis without transplant, and 25 normal children (4–21 years). The levels of Ag sHLA in transplant patients was 0.2–3.2 μg/ml ( ). The hemodialyzed patients was 0.48-4.5 μg/ml ( ), and the normal control was 0.30-4.38 μg/ml ( ). A statistically significant reduction was observed in transplant patients compared to normal control and hemodialyzed patients (p < 0.05 in both cases), whereas between normal and hemodialyzed patients no significant difference was seen ( ). The reduced levels of Ag sHLA I in blood could be an expression of adequate immunosuppressive treatment. Human Immunology 50, 135–139 (1996)     

End-stage renal failure due to multiple myeloma--poor survival on peritoneal dialysis

This report describes five subjects with end-stage renal failure due to multiple myeloma. All of the patients died within seven months of commencing chronic peritoneal dialysis. Complications were frequent during the dialysis period. Our experience supports the opinion that patients with multiple myeloma and a high tumour cell mass should not be offered dialysis.     

Morphological findings in 70 kidneys of living donors for renal transplant

Seventy donor kidneys for transplant were studied with light microscopy (LM), electron microscopy (EM) and immunofluorescence (IM) for C3, C4, Clq, IgG, IgA, IgE, IgM, and antifibrin; the samples were taken just before transplanting the allograft kidney. Glomerular changes were found in 35.7% of apparently normal living donors: 9 cases showed relative glomerular ischemia with an irregular basal membrane (12.9%); 5 cases showed a diffusely widened basal membrane without antecedents of hyperglycemia (7.1%); in one case (1.4%) there was a lesion similar to type 1 mesangio-capillary glomerulonephritis with C3++, IgG++, IgA+, and IgM+; in another case (1.4%) there were scant isolated C3 glomerular, subepithelial deposits with indentation of the basement membrane of the immunocomplex type with a microhematuria which was demonstrated only after donation, and in 9 cases (among them two pairs of siblings) there were mesangial IgA and mesangial electron-dense deposits compatible with Berger's disease (12.9%). None of these glomerulopathies were evident under LM.     

Biopsychosocial aspects of long-term survival on end-stage renal failure therapy

At ten-years follow-up of 64 haemodialysis patients, 43 had died and 21 were alive, twelve with cadaver renal transplants and nine on haemodialysis. Examination of the influence of psychological, demographic, physical and biochemical factors revealed the Beck Depression Inventory and age as the two most important predictors of survival. The behaviour of the patient was directly responsible for five (11.6%) of the deaths, by suicide in three cases and dietary non-compliance in two cases. Hypothetical mechanisms linking depression with reduced survival have been reviewed. As the impact of depression on survival was maximal in the first few years of dialysis, monitoring for depression should be incorporated into routine care from the start of dialysis together with evaluative interventions that might enhance survival.     

Multidetector computed tomography for preoperative evaluation of vascular anatomy in living renal donors

Background  Currently, multidetector computed tomographic (MDCT) angiography has become a noninvasive alternative imaging modality to catheter renal angiography for the evaluation of renal vascular anatomy in living renal donors. In this study, we investigated the diagnostic accuracy of 16-slice MDCT in the preoperative assessment of living renal donors. Methods  Fifty-nine consecutive living renal donors (32 men, 27 women) underwent MDCT angiography followed by open donor nephrectomy. All MDCT studies were performed by using a 16-slice MDCT scanner with the same protocol consisting of arterial and nephrographic phases followed by conventional abdominal radiography. The MDCT images were assessed retrospectively for the number and branching pattern of the renal arteries and for the number and presence of major or minor variants of the renal veins. The results were compared with open surgical results. Results  The sensitivity and specificity of MDCT for the detection of anatomic variants of renal arteries including the accessory arteries (n = 9), early arterial branching (n = 7) and major renal venous anomalies including the accessory renal veins (n = 3), late venous confluence (n = 4), circumaortic (n = 2) or retroaortic (n = 3) left renal veins were 100%. However, the sensitivity for identification of minor venous variants was 79%. All of three ureteral duplications were correctly identified at excretory phase conventional abdominal radiography. Conclusion  Sixteen-slice MDCT is highly accurate for the identification of anatomic variants of renal arteries and veins. Dual-phase MDCT angiography including arterial and nephrographic phases followed by conventional abdominal radiography enables complete assessment of renal donors without significant increase of radiation dose. However, the evaluation of minor venous variants may be problematic because of their small diameters and poor opacification.     

Factors affecting survival and outgrowth from transplants of entorhinal cortex

The purpose of this study was to examine injury-related effects on the survival and growth of entorhinal tissues transplanted to the adult rat entorhinal area. Embryonic entorhinal cortex was transplanted to the angular bundle region of adults either immediately, or 8-10 days, after severing specific host projections. Graft survival (Nissl stain) and connectivity (acetylcholesterase stain and retrograde labeling with wheat germ agglutinin-horseradish peroxidase) were examined two months post-transplantation. Grafts transplanted 8-10 days after severing the angular bundle were large and contained many cells which innervated the hippocampal formation. Grafts transplanted immediately after severing the angular bundle were small, did not integrate well with the host tissues, and failed to innervate the hippocampal formation. Grafts transplanted without producing any prior lesion, or following lesions which did not damage host entorhinal projections, were intermediate in size, but failed to innervate the hippocampal formation. The data demonstrate that: (1) introducing a delay between the lesion and implant surgeries can significantly enhance graft survival and the establishment of transplant-to-host projections, and (2) transplant-derived innervation of the host is significantly impaired when host homologous fibers are intact. These findings suggest that environmental factors, induced specifically by the destruction of host homologous fibers, are responsible for the differences in transplant survival and connectivity observed.     

Effect of the ownership of dialysis facilities on patients' survival and referral for transplantation

BACKGROUND: More than 200,000 patients with end-stage renal disease undergo dialysis in the United States each year, about two thirds in for-profit centers. Economic pressures, such as the decline in inflation-adjusted Medicare payments for dialysis, may compromise the quality of care. Facilities may also be reluctant to refer patients to be evaluated for transplantation because of the loss of revenues from dialysis after patients receive transplants. It is unknown whether for-profit facilities respond more aggressively than not-for-profit facilities to these financial pressures. Therefore, we examined the effect of for-profit ownership of dialysis facilities on patients' survival and referral for possible transplantation. METHODS: We used data from the U.S. Renal Data System to assemble a nationally representative cohort of patients with end-stage renal disease of recent onset. We followed patients for a minimum of three years and a maximum of six years, until death, placement on the waiting list for a renal transplant, or loss to follow-up, or until May 31, 1996. We used proportional-hazards models to assess the effect of the profit status of the dialysis facility on patients' outcomes and adjusted for differences in sociodemographic, clinical, and facility-level characteristics. RESULTS: Of the 3681 patients who were eligible for inclusion, we included 3569 in the analysis of mortality and 3441 in the analysis of the waiting list. The crude mortality rate per 100 person-years of end-stage renal disease was 21.2 for patients treated in for-profit facilities and 17.1 for patients treated in not-for-profit centers (adjusted relative hazard, 1.20; 95 percent confidence interval, 1.02 to 1.42). The likelihood of being placed on the waiting list for a renal transplant was lower for patients treated at for-profit centers (adjusted relative hazard, 0.74; 95 percent confidence interval, 0.56 to 0.98). CONCLUSIONS: In the United States, for-profit ownership of dialysis facilities, as compared with not-for-profit ownership, is associated with increased mortality and decreased rates of placement on the waiting list for a renal transplant.