大鼠肾移植模型技术的改进

目的对大鼠异体肾移植模型技术进行改进,为开展器官移植实验研究提供依据。方法使用Wistar大鼠分别作为供者和受者,供者主动脉、下腔静脉分别与受者主动脉、下腔静脉进行端侧吻合,在受者膀胱上剪去一个与供者相同大小的圆瓣,然后进行一层膀胱吻合。结果手术成功率为90％左右,动物死亡的原因主要为血管吻合口出血、麻醉过深、休克、血栓形成以及膀胱漏尿致弥漫性腹膜炎。结论通过技术改进建立大鼠异体肾移植模型不需要特殊的器械或设备,可在常规条件的实验室开展。     

供体取双肾的大鼠肾移植模型手术方法和技巧

目的探索一种新的大鼠取肾方法,建立稳定的供体取双肾的大鼠肾移植模型。方法30只180～220gF344大鼠,雌雄各半,随机选取10只做为供体,用一种新的方法摘取双肾,分别对20只受体做左侧原位肾移植,动脉采用供体带盘和受体腹主动脉端侧吻合,静脉采用端端吻合,供体输尿管膀胱瓣和受体膀胱吻合重建尿路,术后第二天背侧右肋肌角入路切除受体右侧健肾,观察大鼠成活天数。结果受体除1例因血尿路梗阻切除健肾后第2天死亡,其余受体均成活超过3个月,手术成功率95%。结论大鼠肾移植模型中,采用新的取肾方法,供体的双肾均能成功加以利用,手术时间和热缺血时间短,受体手术成功率高。     

内支架法在大鼠肾移植模型中的应用

目的建立一种稳定、操作简单的肾移植模型。方法以BN（RT1n）大鼠为供体,Lewis（RT11）大鼠为受体,实验组静脉吻合用3号prolene线作内支架,对照组直接端端吻合肾动静脉,将输尿管带膀胱瓣吻合于膀胱。结果实验组和对照组移植成功率分别为90%和85%,两组准备供体耗时为（23.0±2.4）min,供肾热缺血时间为（5.6±1.3）s,实验组和对照组移植手术耗时分别为（40.6±6.3）min和（54.1±4.2）min,冷缺血时间分别为（38.4±5.7）min和（49.7±6.3）min,手术耗时和冷缺血时间比较,两组有显著差异（P〈0.05）。结论内支架法简单实用,明显缩短肾缺血时间。     

改良式大鼠肾移植模型的建立

目的:建立简便、成功率高、远期肾静脉血栓发生率低的大鼠肾移植模型.方法:SD大鼠为供受体.切除受体左肾,采用自行设计的供体腹腔动脉、硬膜外导管内撑法重建动脉血供.供体后腔静脉与受体近后腔静脉处肾静脉端端吻合.结果:供体手术时间为(42±3)min;受体手术时间为(90±10)min.供体器官热缺血时间为≤2 s,冷缺血时间≤100 min.53例次手术中,成功48例,手术成功率为90.6%(48/53).无远期并发症.结论:改良后的大鼠肾移植模型,保留了原术式操作简单、对手术器械和术者的显微外科技能要求低、成功率高等优点、又降低了肾静脉血栓等远期并发症的发生率,可作为慢性排斥反应的动物研究模型.     

小鼠→大鼠异种移植耐受模型的建立

目的：用非清髓方法建立小鼠→大鼠混合嵌合体模型，探讨免疫耐受机制。方法：给SD大鼠亚致死全身照射(TBI)后，4h内输入Balb／c小鼠骨髓细胞(BMC)，2d后腹腔注射环磷酰胺(CTX)，分别于BMT后30、60和90d，检测小鼠源性BMC在大鼠体内植活情况。通过皮肤移植、迟发超敏反应(DTH)和混合淋巴细胞反应(MLR)检查，探讨其耐受机制。结果：经处理大鼠外周血可测出小鼠源性嵌合体，皮肤移植、DTH和MLR检查显示对Balb／c小鼠产生特异性耐受，且较持久。结论：应用7．5Gy TBI 腹腔注射50mg／kg CTX 供体BMT、可成功建立小鼠→大鼠混合嵌合体模型诱导特异性耐受，嵌合体与耐受有关系。     

胎儿肾移植的解剖学要点

在以胎肾为供体的肾移植应用解剖学研究的基础上,我们先后为11例患者进行了大月龄胎儿肾整块移植术,成功9例.对于手术至关重要的低温灌洗途径的选择、供体血管的解剖及与受体血管的吻合方式和部位等解剖学技术逐步进行了改进和完善,介绍了供肾体外血循环的建立和观察方法,提出了保护肾上极动脉的初步意见。     

肾移植后血管并发症介入治疗8例*☆

背景：肾移植后血管并发症采用介入治疗已成为一种安全有效的治疗方法。 目的：探讨肾移植后血管并发症介入治疗的经验及价值评估。 方法：回顾性分析8例肾移植后血管并发症患者介入治疗的临床资料。 结果与结论：8例移植后5例肾移植肾动脉狭窄,2例假性动脉瘤,1例肾静脉血栓,均经彩色多普勒血流显像作出初步诊断,其中5例进一步行磁共振血管成像明确诊断。5例移植肾动脉狭窄行球囊扩张,分别随访6,8,20,36,40个月,1例出现再狭窄,随访血肌酐维持在130~160 μmol/L之间,其余4例移植肾狭窄无复发,随访血肌酐均正常。2例假性动脉瘤患者经动脉鞘放入支架释放系统释放带膜支架后动脉瘤消失,目前常规血液透析治疗。1例肾静脉血栓形成患者,尿激酶介入溶栓治疗后血栓消失,患者发生移植肾功能延迟恢复,35 d后血肌酐降至210 μmol/L,此后患者血肌酐维持在200~250 μmol/L。8例介入治疗临床效果说明肾移植后血管并发症治疗可选用介入治疗方法。 关键词：血管并发症;介入治疗;肾移植;肌酐;器官移植 doi:10.3969/j.issn.1673-8225.2012.05.044     

非HLA因素致大鼠肾移植CAN加快模型的建立

目的建立大鼠异体肾移植慢性移植肾肾病(CAN)加快模型,为研究非HLA免疫因素及非免疫因素致CAN的病因、病理及病理生理机制提供平台。方法采用雄性Fisher大鼠和Lewis大鼠分别作为供-受体,并以假手术组作为对照,进行异体原位肾移植。受体移植术前对供肾进行强化冷缺血处理1 h,于术后4 w,8 w,12 w分别观察各受体血肌酐和移植肾组织病理变化情况。结果移植术后4周Fisher-Lewis组开始出现血肌酐的升高及移植肾CAN的病理改变,8~12周病变渐趋明显,与对照组比较有统计学差异(P<0.05)。结论以Fisher和Lewis近交系大鼠作为供-受体建立的大鼠异体肾移植CAN加快模型是一种可靠、实用和研究价值高的肾移植实验动物模型。     

无血缘夫妻活体供肾7例肾移植

背景：通过诱导移植受体产生供-受体嵌合体或免疫耐受以利于受体长期存活,一直是器官移植的研究热点,并且在实验动物模型中获得了大量成功的经验和知识。在临床实践中也观察到结婚多年的夫妻,丈夫-妻子器官移植后排斥反应小,具有比其他的亲属器官移植有更多的优点。 目的：回顾性分析无血缘关系的活体供肾移植—丈夫对妻子供肾移植的临床效果。 方法：选择7例夫供妻活体肾移植,供者年龄 32~58岁,受者年龄 31~56岁,双方婚龄在5~36年。供、受者 ABO血型完全相同者 4例,O-B 1例,O-A 1例,A-AB型 1例。淋巴细胞毒交叉配合试验阴性。HLA配型情况：1个抗原错配 1例,2个抗原错配 2例,3个抗原错配3例,4抗原错配 1例。开放手术取肾,6例左肾,1例右肾。术后采用三联免疫抑制方案：环孢素A/他克莫司+麦考酚酸吗乙酯+泼尼松预防排斥反应,7对供受者随访3~70个月。 结果与结论：手术成功率100%,供受者均未发生手术相关并发症,所有供者血压、尿常规及肾功正常,受者及移植肾全部存活。验证了虽然移植前组织配型结果较差,但由于夫妻间长期生活在一起产生的免疫耐受,使夫供妻肾移植后排斥反应小、移植效果理想,具有比其他的亲属肾移植有更多的优点。     

大鼠和小鼠胚胎后肾移植的形态学研究

目的观察不同胚龄的大鼠和小鼠的后肾植入同种异体远交系成年宿主体内后的生长变化,探讨胚胎后肾移植的最佳胚龄及血管起源。方法应用光、电镜及免疫组织化学技术观察不同胚龄的后肾移植后,肾脏各部的发育情况及后肾内CD31+阳性细胞的分布。结果离体后肾移植10天后成熟的肾小体形成,胚龄16天的大鼠和胚龄13天的小鼠后肾移植10天后,排斥反应轻微;胚龄20天的大鼠后肾和胚龄14、16天的小鼠后肾移植10天后,出现明显排斥反应,且随着胚龄的增长排斥反应逐渐加重。CD31+阳性细胞分布在肾小体毛细血管内皮及部分皮质中的间质细胞。结论胚龄16天的大鼠和胚龄13天的小鼠后肾中均无成熟肾小体出现,是移植的最佳时间;后肾移植物内的毛细血管袢是由移植物的间质细胞分化而来的。     

The pathological implications of heart transplantation: Experience with 50 cases in a single center

Heart transplantation started in Japan in 1999. Since then, 50 transplants have been performed at our center. We performed histopathological analyses of the 50 explanted hearts and the post‐transplant biopsy specimens. The median age of recipients was 39 years. The primary diseases before transplant were idiopathic dilated cardiomyopathy in 33 patients (66%), hypertrophic cardiomyopathy in seven (14%), restrictive cardiomyopathy in one, arrhythmogenic right ventricular cardiomyopathy in one, and secondary cardiomyopathy in eight (16%). Before transplantation, 47 patients (94%) had left ventricular assist devices. No severe cardiovascular failure due to allograft rejection occurred. The post‐transplant survival rate was 97.6% at 1 year and 93.1% at 10 years. One recipient was lost to sepsis from myelodysplastic syndrome in the fourth year, one died of multiple organ failure and peritonitis 8 months after transplant. Another patient died of recurrent post‐transplant lymphoproliferative disorders (PTLD). Mild cardiac dysfunction occurred in seven recipients in the early postoperative period. Moderate acute cellular rejection occurred in six patients (12%), and antibody‐mediated rejection occurred in three (6%). The number of heart transplants performed in Japan is very small. However, the outstanding 10‐year survival rate is due to donor evaluation and post‐transplant care resulting in low grade rejection. Pathological evaluation has also greatly contributed to the results.     

改进的大鼠心脏异位移植模型的应用

目的 以0no建立的大鼠心脏异位移植术为基础，并对其进行简化和改进。方法 供体为SD大鼠，受体为Wistar大鼠，将供心升主动脉和肺动脉分别与受体的腹主动脉和下腔静脉吻合。结果 50次正式实验成功率达到85％，手术时间和从心缺血时间缩短，心肌保护良好，移植心存活时间2－14d。结论 该方法方便、简单，是研究器官移植排斥反应以及筛选免疫抑制药物的一种较为理想动物模型，值得进一步推广。     

Kidney lesions in copper-deficient rats

Rats fed a diet deficient in copper were found, in comparison to control rats, to have lesions in the cortex, medulla and papilla of the kidney. Within the cortex, the lesions consisted of mild atrophy of the convoluted tubules, thickening of their basement membranes and fragmentation of the reticulin framework. In the medulla and papilla, selected zones of the loop of Henle were disorganized, with their epithelia appearing atrophied and their basement membranes fragmented and irregular. The epithelial cells of the collecting tubules were atrophied and vacuolated and their basement membranes thickened. Throughout the kidney, blood vessels were distented and engorged with large numbers of erythrocytes. The most likely explanation for these lesions is vascular underperfusion which could be due to a primary effect of copper deficiency on the kidney or could be secondary to the other cardiovascular lesions that are known to occur in copper deficiency.     

Kidney transplantation in hepatitis B surface antigen carriers

Chronic hepatitis B surface antigen (HBsAg) carriers run a high risk of developing chronic liver disease after renal transplantation. To determine the impact of liver disease on long-term morbidity and mortality of HBsAg carriers following kidney transplantation we analyzed 1977 patients, including 76 HBsAg carriers, who underwent renal transplantation during the period 1968–1992. Although the HBsAg carriers had a better 5-year patient and graft survival rate (94% and 83%) than HBsAg-negative patients (87% and 61%), the prognosis was poor after the tenth year of transplantation. Transplant loss is more frequently caused by death of the HBsAg carriers, in contrast to the total population (34% vs 17% for HBsAg-negative patients). Death occurs in 73% of cases due to complications of hepatitis B. In the HBsAg-negative patients, the predominant cause of death is cardiovascular failure (51% vs 11% in HBsAg carriers), whereas only 2% died of liver disease. Kidney transplantation in HBsAg carriers with normal liver function appears to be justified because of rare graft loss due to acute rejection, low early morbidity and mortality, and late onset of fatal hepatic deterioration.Abbreviations HBsAg hepatitis B surface antigen - HBV hepatitis B virus - HBeAg hepatitis B e antigen - GOT glutamic oxaloacetic transaminase - GPT glutamic pyruvate transaminase - GLDH glutamate dehydrogenase - AP alkaline phosphatase - GGT gamma-glutamyl transferase - CHE buturyl cholinesterase - LDH lactate dehydrogenase - HBc hepatitis B core - HDV hepatitis delta virus - HCV hepatitis C virus - CsA cyclosporine A - Aza azathioprine - RIA radioimmunoassay - HD haemodialysis - KTx kidney transplantation - LTx liver transplantation - CMV cytomegalovirus Correspondence to: V Kliem     

肾移植手术的带教体会

肾移植手术是治疗终末期肾病、尿毒症最有效手段。随着各种新型免疫抑制剂的出现,肾移植手术在各类大型综合性医院也得到广泛开展。如何有效地进行肾移植手术教学,成为肾移植专科医生越来越关注的问题。作者结合多年肾移植工作实践及教学经验,将肾移植手术的带教体会报告如下。     

Kidney and bladder calculi in spontaneously hypertensive rats.

Naturally occurring kidney stones are rare in animals. The Japanese strains of spontaneously hypertensive rats (SHR) are normotensive at birth but develop high blood pressure, hyperglycaemia and hyperlipidaemia as they mature. The SHR strain is prone to develop kidney stones. A unique sub-strain of SHR has been developed in which some animals develop hypothalamic obesity concomitantly with their rising blood pressure, i.e. Obese/SHR. The Obese/SHR characteristically develop microscopic kidney stones which become detached at an early stage of formation, migrate to the bladder, and grow by concretion into huge, rounded calculi. The stone nidus starts as a subepithelial cyst-like focus containing oedema, colloidal acidic mucoprotein, and red and white blood cells suspended on a delicate network of fibrils. THe nidi grow by concretion of an admixture of calcium and acidic protein in a lamellar arrangement. The disparate morphogenesis and anatomic location of kidney stones in Obese is opposed to non-obese/SHR suggest that calculus formation may be governed by specific differences in genetic programming. The incidence of kidney stones parallels the severity and chronicity of the hypertension in SHR, non-obese and Obese/SHR, and the Cushingoid habitus in the Obese/SHR.     

肾移植后败血症7例

背景：由于免疫抑制剂及广谱抗生素的使用,使肾移植术后合并败血症的病原菌多样复杂,病情严重,致死率高。因此加强肾移植术后合并败血症临床病原学特点的认识,及早合适的治疗是提高感染治愈率的关键。 目的：分析肾移植后并发败血症的临床病原学特点与治疗情况。 方法：收集佛山市第一人民医院肾内科2007-06/2010-06的376例肾移植患者移植后并发败血症7例的临床资料,分别对其易感因素、病原学特点、临床表现及治疗方案进行回顾性分析。 结果与结论：7例患者均有寒颤、发热(体温38.5~42.0 ℃),烦燥、气促4例,尿路刺激症4例。血压低于90/60 mm Hg   (1 mm Hg=0.133 kPa)伴血肌酐增高4例。大肠埃希氏菌4例,表皮葡萄球菌1例,白色念珠菌1例,马尔尼菲青霉菌1例。5例细菌感染为院外感染,2例真菌感染者为院内感染。4例感染大肠埃希氏菌者合并尿路感染。4例低血压休克并急性肾功能衰竭。经抗感染治疗、减少免疫抑制药物用量及对症处理。6例痊愈,1例死亡。早期诊断,联合用药,减少免疫抑制剂的用量是提高感染治愈率的关键。