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.
With the in-depth understanding of the severe acute respiratory syndrome coronavirus 2, it has been found that the virus not only causes serious damage to the human respiratory system, but also damages the kidney system, which can be manifested as acute kidney injury, and in severe cases, renal failure can occur. Patients with coronavirus disease 2019 and chronic kidney disease are at higher risk of worsening their condition and even death. Therefore, early recognition and intervention of renal injury is particularly important for prognosis. In this paper, the clinical data of renal injury in patients with coronavirus disease 2019 were reviewed, and the possible pathogenesis, incidence, clinical features, diagnosis and treatment were proposed for reference in clinical decision-making.
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.
ObjectiveTo conduct a Meta-analysis to determine the clinical effect of protocol biopsy (PB)-monitored therapy after renal transplantation.MethodsPubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Standards Database and VIP Database for Chinese Technical Periodicals were searched for trials comparing the efficacy of timely intervention under PB surveillance with the conventional treatment. The quality of included studies was assessed and Meta-analysis was conducted by RevMan 5.3 software.ResultsSix randomized controlled trials met our inclusion criteria, including 698 cases. No significant difference was found between the PB group and the control group in 1-year [relative risk (RR)=0.99, 95% confidence interval (CI) (0.97, 1.01), P=0.39] and 2-year recipient survival rate [RR=1.00, 95%CI (0.97, 1.02), P=0.72]. Graft survival rate after 1 year [RR=1.01, 95%CI (0.99, 1.04), P=0.29] and 2 years [RR=1.02, 95%CI (0.99, 1.06), P=0.19] were also statistically similar. No statistical difference was found in glomerular filtration rate between the two groups [mean difference (MD)=0.45 mL/(min·1.73 m2), 95%CI (–3.77, 4.67) mL/(min·1.73 m2), P=0.83]. Renal function of PB group, monitored by serum creatinine, was superior to the control group [MD=–0.46 mg/dL, 95%CI (–0.63, –0.29) mg/dL, P<0.000 01]. No statistical difference was found in infection between the two groups [RR=1.23, 95%CI (0.69, 2.19), P=0.48].ConclusionsOur study did not suggest PB for every kidney transplantation recipient. However, long-term randomized controlled trials with larger sample size would be necessary to determine whether PB was effective for specific populations.
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.
【Abstract】ObjectiveTo investigate the protective effect of melatonin on renal injury induced by bile duct ligation in rats. MethodsSixtyfour rats were randomly divided into four experimental groups (n=16 rats per group): the control group (CN), sham operative group (SO), bile duct ligation group (BDL) and bile duct ligation melatonin treatment group (BDL+Mel). Obstructive jaundice was induced by common bile duct ligation. Plasma level of nitric oxide (NO), total bilirubin (TB), direct bilirubin (DB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea nitrogen (BUN) and creatinine (Cr) were measured 4 d and 8 d after operation. NO and inducible nitric oxide synthase (iNOS) in renal tissue were detected at the same time point, too. Histopathological changes of kidneys were examined by HE staining. ResultsIn BDL group, the plasma levels of NO, TB, DB, ALT, AST, BUN and Cr were higher than those of SO group (P＜0.01）, and the level of NO and activities of iNOS in renal tissue were significantly increased (P＜0.01）. However, in BDL+Mel group, the plasma levels of NO, ALT, AST, BUN and Cr were lower than those of the BDL group (P＜0.01）, and the level of NO and activities of iNOS in renal tissue were significantly suppressed (P＜0.01）; histopathological changes of kidneys were improved.ConclusionAugmentation of iNOS activities and increasing of NO production in local tissue contributed to renal injury induced by bile duct ligation, and the mode of melatonin’s protective actions, at least in part, relates to interference with no pathways.
Objective To investigate the risk factors of acute kidney injury（AKI）after onpump coronary artery bypass grafting(on-pump CABG) and off-pump coronary artery bypass grafting (off-pump CABG) in order to provide superior renal protective measure after operation. Methods The clinical data of 849 consecutive patients undergone coronary artery bypass grafting（CABG） in a single institution between January 1990 and August 2006 were retrospectively analyzed. A simplex module and a multivariate logistic regression model were constructed to identify risk factors for the development of AKI. Results AKI were occurred in 61 patients （11.8%，61/518） undergone off-pump CABG and 63 patients （19.0%，63/331） undergone onpump CABG. Peak of serum creatinine (Scr) after operation arrived at the 12th hour and 24th hour in patients undergone off-pump CABG and patients undergone on-pump CABG respectively. The rapidly recovering period of Scr in patients undergone off-pump CABG and on-pump CABG were from the 24th hour to the 48th hour and from the 48th hour to the 72th hour respectively.The results of the multivariate forward stepwise logistic regression analysis found that risk factors for the development of postoperative AKI following isolated CABG were associated with heavy body mass index（OR=1.190，1.179）, emergent procedure（OR=2.737，3.678）, diabetes（OR=1.705，2.042）, peripheral vascular disease（OR=2.002，2.559）,ejection fraction≤30%（OR=2.267，4.606）, and New York Heart Association(NYHA) class Ⅲ and Ⅳ（OR=1.861，1.957） were risk factors for the development of postoperative AKI following offpump and on-pump CABG; pulse pressure≥60mmHg and triplevessel disease were risk factors for the development of postoperative AKI following off-pump CABG. But perioperative and postoperative intra aortic balloon pumping (IABP) could make protective effect on kidney for on-pump CABG （OR=0.146）which could lessen development of AKI. Conclusions It is critical period for AKI that renal protection strategies should be performed from general anesthesia until postoperative 48 hours (off-pump CABG) and 72 hours (on-pump CABG). AKI might be the most important stage in which a positive test should increase the physician’s awareness of the presence of risk for renal injury and then preventive or therapeutic intervention could be performed when the situation still is reversible.
ObjectiveTo investigate the influence of enteral nutrition (EN) and total parenteral nutrition (TPN) on liver, kidney and gastrointestinal function in patients after esophagectomy. MethodsA total of 124 patients with esophageal cancer who underwent esophagectomy in the Affiliated Hospital of Guangdong Medical College from January 2012 to August 2013 were enrolled in this study. There were 71 male and 53 female patients with their average age of 59.7 years (range 31 to 85 years). All the patients were randomly divided into an experimental group and a control group. Postoperatively, patients in the experimental group received EN via nasogastric/nasointestinal tube, and patients in the control group received TPN. Preoperatively, 1, 3 and 7 days postoperatively, plasma alanine transaminase (ALT), aspartate transaminase (AST), indirect bilirubin (I_BIL), direct bilirubin (DB), total bilirubin (TB), total protein (TP) and albumin (ALB) were examined to evaluate liver function, blood urea nitrogen (BUN) and serum creatinine (Scr) were examined to evaluate renal function. Postoperative time to first audible bowel sounds, time to first flatus, and time to first stool were examined to evaluate gastrointestinal function. ResultsThere was no statistical difference in ALT, AST, I_BIL, DB or TB preoperatively and on the 1st postoperative day between the 2 groups (P > 0.05), but these parameters of the experimental group were significantly lower than those of the control group on the 3rd and 7th postoperative day (P < 0.05). There was no statistical difference in TP or ALB between the 2 groups (P > 0.05). There was no statistical difference in BUN or Scr preoperatively, on the 1st or 3rd postoperative day between the 2 groups (P > 0.05). BUN (4.94±1.07 mmol/L vs. 6.67± 2.88 mmol/L, P < 0.05) and Scr (52.50±12.46 μmol/L vs. 68.23±7.61 μmol/L, P < 0.05) of the experimental group were significantly lower than those of the control group on the 7th postoperative day. Postoperative time to first audible bowel sounds (42.00±1.68 hours vs. 50.00±1.54 hours), time to first flatus (64.15±10.35 hours vs. 70.64±14.73 hours) and time to first stool (4.20±1.50 days vs. 5.20 ±1.40 days) of the experimental group were significantly shorter than those of the control group (P < 0.05). ConclusionPostoperative EN can promote the recovery of gastrointestinal function, and has less influence on liver and kidney function, which is beneficial to postoperative recovery and morbidity reduction after esophagectomy.
ObjectivesTo establish statistical analysis and result reporting model for evaluation of the applicability of the clinical guidelines. We conducted empirical study for clinical guidelines for diagnosis and treatment of renal transplantation rejection in China.MethodsA cross-sectional survey was conducted to select 16 medical institutions in China which had carried out kidney transplantations. In each medical institution, 6 to 8 clinicians from the kidney transplantation department or related departments were selected to complete the questionnaire. Descriptive analysis was carried out for characteristics of evaluators, scores of each dimension, access to guidelines and factors affecting implementation. The Kruskal-Wallis rank sum test and Nemenyi test were used for multi-group comparison and pairwise comparison. Multiple linear regression with stepwise strategy were used to screen out the association factors.ResultsIn this survey, 128 questionnaires were distributed, in which 105 valid questionnaires were collected, and the recovery rate was 82.03%. The subjects of this survey were all kidney transplant clinicians from public tertiary hospitals, with an average 10.95 years of working time. The results showed the accessibility score was lowest and the acceptability score was highest. The results of multi-group comparison and multiple linear regression analysis showed that familiarity with the guidelines was the influencing factor of each score (P<0.05). The guidelines were primarily obtained from biomedical literature database (73.3%), academic journals (55.2%) and academic conferences (55.2%). Among the evaluators, 44 (41.9%) believed that there were implementation obstacles in the guidelines, among which 40 (38.1%) believed that implementation obstacles were environmental factors.ConclusionsThe applicability of clinical guidelines for diagnosis and treatment of renal transplantation rejection in China is adequate. However, the publicity of the guideline requires improvement. As the guideline is updated, consideration should be given to including access to the guideline, adding free public information promotion, and familiarizing clinicians with the guidelines through training programs to promote application of the guideline.
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.