Blockade of Macrophage Migration Inhibitory Factor Does Not Prevent Acute Renal Allograft Rejection

Macrophage migration inhibitory factor (MIF) is a pro-inflammatory molecule involved in cell-mediated immunity and delayed-type hypersensitivity (DTH). We inhibited systemic and local MIF production to determine its contribution to acute rejection (AR). Skin DTH response and acute rejection of skin and kidney allografts were examined using MIF gene knockout (MIF -/-) and wild-type mice (MIF +/+) with anti-MIF or control antibody. MIF-Ab reduced skin DTH by 60% (p < 0.01), but absence of the MIF gene (MIF -/-) had no effect. Local absence of MIF had no effect on the survival of skin grafted onto BALB/c recipients. Similarly MIF +/+ and MIF -/- kidneys transplanted into BALB/c recipients showed a similar degree of histological rejection, graft dysfunction and cellular infiltrate suggesting that AR is not dependent on local MIF production. To investigate the influence of systemic MIF, BALB/c donor skin was grafted onto MIF +/+ and MIF -/- mice. The tempo of AR was not altered by systemic absence of MIF (MIF-Ab or MIF -/-). BALB/c kidneys transplanted into MIF +/+ (with or without MIF-Ab) and MIF -/- mice showed similar parameters of rejection. MIF blockade reduces the DTH response; however, neither local nor systemic MIF are required for the rejection of fully mismatched skin and renal allografts.     

Kidney transplantation from non-heart-beating donors after oxygenated low-flow machine per fusion preservation with histidine-tryptophan-ketoglutarate solution

Abstract The aim of this study was to determine the potential benefit of aerobic machine preservation (MP) with non‐colloidal histidine‐tryptophan‐ketoglutarate (HTK) solution compared with MP with Belzer machine perfusion solution (MPS) and standard cold storage, after marginal kidneys had been obtained from non‐heart‐beating donors. Cardiac arrest was electrically induced in anaesthetized German landrace pigs (20–25 kg bw). Their kidneys were harvested 40 min thereafter, flushed with HTK by gravity of 100 cm H₂O via the renal artery and then stored in HTK for 18 h at 4°C. Other organs were subjected to oxygenated (pO2 > 500 mmHg) hypothermic pulsatile low‐flow machine perfusion with HTK or MP with Belzer MPS at Pmax = 40 mmHg, yielding trans‐renal flow values of 0.2–0.3 ml/min per g with HTK and approximately twice that amount with Belzer MPS. A well‐preserved vascular endothe‐lium and intact tubular epithelium were documented by electron microscopy at the end of perfusion preservation in both solutions as well as after cold storage. Concentrations of ATP (in micromoles per gramme) in tissue homogenates at the end of perfusion preservation with HTK were 1.18±0.12 vs 0.16 ± 0.02 (P>0.05) after simple cold storage and 2.43 ±0.23 after perfusion with Belzer MPS, thus documenting a relevant effect of low‐flow perfusion on tissue oxygenation. Viability of the grafts was followed for 1 week after heterotopic transplantation and bilateral ne‐phrectomy in the recipient pigs. Machine perfusion with HTK significantly improved cortical micro‐circulation upon early reperfusion in vivo, as well as maximal serum levels of urea and creatinine, compared to recipients receiving cold‐stored grafts. No differences could be found between MP with HTK or Belzer MPS. In conclusion, provision of oxygen during storage is possible by low‐flow perfusion with HTK as with Belzer MPS and apparently improves graft viability after transplantation.     

肾移植手术中特殊供肾的处理

目的 总结特殊供肾的外科处理经验。方法 回顾性分析1996年1月-2001年6月间进行的868例尸体肾移植中326只特殊供肾的处理，并与542只普通供肾的移植效果进行比较。结果 326只特殊供肾均得到了利用，血管变异的供肾移植后1个月血肌酐水平，急性肾小管坏死（ATN）发生率及1年移植肾存活率与普通供肾均远见显著差异；其他特殊供肾均未发生与修整术有关的并发症。结论 畸形供肾或损伤供肾，通过合理手术整形，灵活运用等方法保肾，并不影响肾移植的效果。     

肾移植中供肾血管变异的处理

目的提高血管变异的供肾的临床应用价值。方法根据具体情况，将血管变异的供肾进行合并、修整、重建等，使供肾安全、有效的移植给受者。结果78只供肾动脉变异(包括23只供肾静脉变异)经处理后，77只供肾良好。供肾移植后数分钟内有尿排出，2周内肾功能恢复正常，1年后随访无并发症。仅有1例因肾静脉回流障碍，被迫切除移植肾。结论供肾血管变异只要正确处理，移植后可获得良好效果。     

Rotor综合征合并慢性肾衰1例家系调查并文献复习

目的：探讨Rotor综合征的发病机制及临床特点,提高临床医师对该病的认识.方法：报告1例合并有慢性肾衰的Rotor综合征的临床资料,复习相关文献,总结其临床表现,诊断方法及预后.结果：该患者通过其临床表现、家族史和肝活检诊断为Rotor综合征,并行肾移植,术后肝功并无明显受损.结论：该病罕见,临床自幼表现为波动性黄疸,肝活检及99mTc-HIDA胆道显像有助于明确诊断,预后较好.     

1 124例次肾移植回顾分析

目的　总结肾移植的经验 ,提高长期存活率。方法　总结 1978年 7月至 2 0 0 1年 10月的 112 4例次肾移植经验。分析术前准备、组织配型、供肾质量、手术操作、并发症防治、免疫抑制剂使用等方面对肾移植效果的影响。结果　 1、3、5年人 /肾存活率 ( % )分别为 :83 .1/70 .3、74.6 /6 8.6和6 2 .6 /5 6 .1。淋巴毒试验 >2 %和 <2 %的肾移植群体中 ,发生超急性排斥反应 (AR)、加速性排斥反应 (HAR)的百分率差异无显著性。 335例术前行HLA血清学分型的患者 ,与 5 5 0例单纯行淋巴毒试验比较 ,前者肾移植中HAR发生率明显减少 ;在 2 0 0 0年以后的 130例肾移植中 ,AR和HAR发生率较早期 5 5 0例均有所下降。结论　充分的术前准备、良好的组织配型、供肾质量以及手术技巧的掌握是肾移植成功的关键。减少并发症、合理应用免疫抑制剂、个体化给药和长期随访是提高肾移植长期存活率的保证。     

腹腔镜活体供肾切取术10例报告

目的　探讨活体供肾切取新方法。方法　对 10名亲属活体供肾者采用腹腔镜切取供肾 ,供者采用全身麻醉 ,经腹腔途径 ,取右侧卧位 ,在脐旁、剑突下偏右及左腹股沟韧带中点上方1.5cm各开一孔 ,脐旁放入观察镜 ,另两孔为操作孔。供肾经左下腹操作孔的延长切口用手取出。供、受者术后随访 2～ 12个月。结果　供肾切取耗时 (3.6± 0 .6 )h ,热缺血时间平均 4 .5min ;供者术后无并发症发生 ,肾功能正常 ,住院时间 (5± 1)d ,术后 2个月内均恢复正常工作。结论　腹腔镜活体供肾切取术是一种创伤小的供肾切取方法 ,供者术后疼痛轻 ,恢复快。     

Bidirectional Regulatory Effect of Lishen Injection(丽参注射液)on Sex Hormones in Senile Female Patients Coronary Heart Discase of kidney deficiency Type

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Transglomerular Transport of DEAE Dextran in the Isolated Perfused Kidney

Objective: The renal fractional clearance of [³H]DEAE dextran has been widely used to substantiate the charge selective model for renal permselectively, although there has only been one reported study on this type of clearance. This study sets out to examine the fractional clearance and glomerular processing of DEAE dextran. Methods: Fractional clearance studies were performed using isolated perfused rat kidneys. The glomerular processing of DEAE dextran was assessed by examining the kinetics of DEAE dextran uptake in glomerluli isolated post perfusion. Results: The fractional clearance of DEAE dextran used in the concentration range of 15–150 μg/ml in the perfusate of the isolated perfused kidney did not produce the classical in vivo facilitated transport of DEAE dextran as compared to dextran as observed by Bohrer et al. The fractional clearance curve displays retarded clearance of low molecular weight (small radii) DEAE dextran, giving the appearance of a ‘flat curve’. Similar results were obtained when an oxygen free radical scavenger cocktail was included in the perfusate. These results may be due to the fact that DEAE dextran binds to the glomeruli (at an order of magnitude greater than dextran sulfate). Perfused kidneys with [³H]DEAE dextran for 1 h followed by a five minute perfusion with unlabelled DEAE dextran revealed no significant change in the glomerular levels of [³H]DEAE dextran (unlike dextran sulfate). Perfusion of rat kidneys with 15 μg/ml DEAE dextran produced no changes in the electron microscopical morphology of the glomerulus and no changes in the fractional clearance of dextran. Conclusions: These results do not support the glomerular charge selectivity model that involves a non-binding electrostatic interaction of the charged dextran with the fixed anion charges of the glomerular capillary wall.     

Multimodality approach to staging renal cell carcinoma

Renal imaging has dramatically improved since the introduction of ultrasound (US), computed tomography (CT), and most recently magnetic resonance (MR) imaging. US and MR imaging are ideal for patients with compromised renal function preventing administration of iodinated contrast material or those who have experienced reactions to contrast. Staging errors occur due to limitations in assessing microscopic tumor invasion of the renal capsule and perinephric fat, detecting metastatic deposits in normal sized lymph nodes and differentiating inflammatory hyperplastic lymph nodes from neoplastic ones. These limitations are shared by US, CT, and MR imaging. Vascular invasion by tumor can be evaluated by all imaging modalities including venography. The advantages and limitations of each examination will be presented.