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Objective: To evaluate the correlation between the quality of donor renal grafts and graft rejection., Methods: The cold ischemia time and the pathological findings by biopsies of the donor grafts in 87 cases were analyzed in conjunction with the occurrence of acute or chronic graft rejection after transplantation., Results: After transplantation, acute rejection occurred in 28 cases, in which 5 (17.8%) had adverse changes in the donor grafts; chronic allograft nephropathy developed in 13 cases, in which 6 (46.1%) had adverse changes in the donor grafts. By binary logistic regression analysis, the cold ischemia time and acute renal tubular injury were identified as the factors affecting acute graft rejection, and cold ischemia time and glomeruloserosis as the risk factors for chronic rejection., Conclusion: High-quality donor kidney and minimization of the risk factors help reduce the occurrence of graft rejection after kidney transplantation.

Objective: To investigate the expressions of transforming growth factor (TGF)-beta1 and collagen IV in the renal tissues of patients with chronic allograft nephropathy (CAN)., Methods: Immunohistochemical method and computer-assisted image analysis system were used to detect the expressions of TGF-beta1 and collagen IV in the renal tissues of patients with CAN, and the association between TGF-beta1 and collagen IV expressions as well as that between their expressions and the pathological grading of CAN were analyzed., Results: The expressions of TGF-beta1 and collagen IV were significantly higher in the renal tissues of the patients than in normal renal tissues (P<0.001), and the expressions tended to increase with the pathological grades of CAN; TGF-beta1 and collagen IV expressions in both the renal glomeruli and the tubulointerstitium were in patients with CAN positively correlated with normal renal tissues (r=0.943, P<0.001; r=0.910, P<0.001)., Conclusions: Abnormal collagen IV deposition is one of the major factors associated with renal fibrosis in CAN, and TGF-beta1 might play an important role in renal fibrosis in CAN through up-regulation of collagen IV in the renal tissues.

Objective: To summarize the experience with perioperative management of multiorgan transplantation., Methods: From October 2001 to January 2005, 19 patients received multiorgan transplantation in Nanfang Hospital, including 6 with simultaneous kidney-pancreas transplantation (SKPT), 12 with combined liver-kidney transplantation (CLKT), and 1 with simultaneous liver-pancreas transplantation (SLPT). The surgical techniques, application of immunosuppressants, and complication management were reviewed., Results: All transplantation procedures were performed successfully. The transplantation-related complications included tacrolimus-induced renal toxicosis in 1 (5.3%) case, acute graft rejection in 3 (15.8%) cases, intestinal hemorrhage in 2 (10.5%) cases, intra-abdominal hemorrhage in 1 (5.3%) case, and lung infection in 1 (5.3%) case, all of which were cured after proper treatment., Conclusions: Donor selection, good quality of the donor organ, proper surgical approaches, adequate use of the-mmunosuppressants, and prevention of complications are essential to the success of multiorgan transplantation.

Objective: To investigate the causes, prevention measures and treatment of deep venous thrombosis in the lower extremities (LDVT) following renal transplantation., Method: Thirty-eight renal transplant recipients who developed LDVT following the transplantation were analyzed for the causes, evidence for diagnosis, prevention measures and treatment of LDVT., Results: The 38 cases were diagnosed by B-mode ultrasound and systemic medical history review and after timely and effective therapy, all the patients recovered between 3 to 20 d, showing evidence of establishment of efficient collateral circulation as found in color Doppler ultrasound examination., Conclusion: Following renal transplantation, the recipients are exposed to greater risks of developing LDVT, for which B-mode ultrasound provides the most effective diagnosis. The patients generally respond well to timely interventions with anticoagulation, clot removal and thrombolysis, and preventive measures are indicated in those at high risk of LDVT following transplantation.

Objective: To investigate the relationship of the renal allograft weight and the recipient's body weight with allograft function after transplantation., Methods: The correlation of the renal allograft weight, the recipient's body weight, the ratio of the allograft weight to the recipient body weight and the mean serum creatinine (sCr) 3 years after transplantation were measured in 108 kidney recipients., Results: The allograft weight was inversely correlated with the mean sCr 3 years after transplantation (P<0.01)., Conclusion: The renal allograft weight, recipient's body weight and the ratio of allograft weight to recipient's body weight are important indicators of the long-term allograft function after transplantation, and recipients with greater body weight should receive allografts of higher weight.

Objective: To summarize the experiences of pneumatic lithotripsy under ureteroscope for pyonephrosis due to calculus obstruction., Methods: Twelve patients with pyonephrosis due to calculus obstruction were treated using endoscopic manipulation such as ureteroscopy, pneumatic lithotripsy and indwelling double J catheter., Results: In the 12 cases, the ureteral calculi were cleared after one treatment in 10 cases, and the other 2 cases were cured by additional extracorporeal shock-wave lithotomy performed 1 to 2 weeks later., Conclusion: Ureteroscopic manipulation is safe, minimally invasive and effective for the treatment of pyonephrosis due to calculus obstruction.

Objectives: To observe the clinical efficacy and safety of three-dose regimen of Zenapax combined with tacrolimus (FK506), mycophenolate mofetil (MMF), and steroid in the early-stage management of liver transplantation., Method: Thirteen liver transplantation recipients received the same immunosuppression regimen with three-dose Zenapax combined with FK506, MMF, and steroid. The incidence of acute allograft rejection (AR), blood concentration and dosage of FK506, and the liver graft function were observed in the 30 days after liver transplantation and compared with the results documented in literatures., Results: One patient developed AR 17 days after transplantation and 3 patients died on the postoperative days 14, 19 and 23, respectively, due to pulmonary fungal infection, acute hepatic failure or multiple organ failure resulting from stenosis and thrombosis of hepatic artery respectively. Ten recipients had various infections. An average of 16.56+/-10.40 d was taken for functional recovery of the liver graft, and the blood concentration of FK506 was maintained at (10.25+/-1.99)x10(-3) mg/L. Anaphylaxis, post-transplant lymphoproliferative disorder (PTLD), or other adverse effects were not observed., Conclusion: Three-dose regimen of Zenapax in combination with FK506, MMF and steroid is safe and effective in the postoperative management of orthotopic liver transplantation.

Objective: To study the influence of hepatitis C virus (HCV) infection on the clinical outcome of kidney transplantation., Methods: The recipient/graft survival, the incidence of acute/chronic rejection and cause of death in 86 HCV-infected recipients of renal transplantation were compared with those in another 86 recipients without HCV infection., Results: HCV-infected recipients had significantly shorter 5-year survival (74.4%) than those without HCV infection (87.2%, P<0.01). The 1-year (94.2%/90.7% vs 96.8%/96.0%) and 3-year recipient/graft survival rates (88.4%/79.1% vs 90.7%/87.2%), the incidence of acute/chronic rejection (31.3% vs 21.2%, and 12.5% vs 6.5%) and the 5-year graft survival (73.3%/81.4%) were comparable between the two groups (P>0.05). Hepatic disease was identified as the primary cause of mortality., Conclusions: HCV infection may affect the long-term survival of the recipients with kidney transplantation, and therefore should be considered as a relative contraindication of kidney transplantation.

Objective: To investigate the transfection efficiency of nuclear factor (NF)-kappaB decoy oligodeoxynucleotides (ODN) mediated by in vivo liposome in human umbilical vascular endothelial cell line ECV-304 under hypothermic and anoxic conditions., Methods: ECV-304 cells were cultured in RPMI 1640 culture medium containing 10% fetal bovine serum at 37 degrees Celsius; in the presence of 5% CO2. Liposome-ODN complexes were prepared just before use and added to the cells with a liposome-ODN charge ratio of 2:1. ECV-304 cell monolayers were transfected with liposome-ODN complexes containing 0.50, 0.75, 1.00 and 1.25 micromol/L ODN respectively in Euro-Collins solution (ECs) at 4 degrees celsius; and then stored for 2, 4, 6 and 8 hours respectively under anoxic condition. The ODN without liposome was transfected into ECV-304 cells under identical conditions as the control. The distribution of fluorescein isothiocyanate (FITC)-labeled ODN in ECV-304 cells was observed by fluorescence microscope, and the transfection efficiency and mean fluorescence intensity (MFI) were evaluated by flow cytometry., Results: MFI was enhanced as the storage time extended and ODN concentration increased, reaching the peak level at 6 h (P<0.05). After a 6-hour storage, most of the ODN was found to locate in the cell nuclei, and the transfection efficiency did not vary significantly between the groups. Compared with the control group, however, the differences in transfection efficiency and MFI were significant., Conclusion: ODN can be highly efficiently transfected into ECV-304 cells by in vivo liposome in ECs under hypothermic and anoxic conditions, which provides an experimental basis for further study of the donor organ preservation at the level of genetic regulation.

Objective: To evaluate the clinical effect of abdominal multiorgan transplantation in patients with multiorgan failure., Methods: Simultaneous kidney-pancreas transplantation (SKPT) with enteric drainage of pancreatic exocrine secretions was performed in 2 patients with type 1 diabetes and end-stage renal disease. A combined liver-kidney transplantation (CLKT) was done in a 66-year-old patient with alcoholic liver cirrhosis and uremia. Simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantation (SLPT) was performed in a patient with hepatitis B, hepatocirrhosis, hepatic cellular cancer, and type 1 diabetes., Results: The function of kidney grafts became normal 5 days postoperatively and insulin-independent after treatment with low dose insulin for 10 days in the 2 SKPT patients. For the CLKT patient, both transplanted organs rapidly achieved normal functions after operation but suffered-acute liver graft rejection on postoperation day 10 and the rejection was controlled after methylprednisolone pulse therapy. In the SLPT patient, insulin was withdrawn 5 days after operation, liver allograft function recovered well. All the patients are alive with stable allograft function after following-up for 29, 26, 9 and 6 months, respectively., Conclusions: Abdominal multi organ transplantation was effective therapy to patients with multiple organ failure. SLPT can reduce acute pancreas rejection and promote the recovery of liver allograft.

Objective: To study the effect of combined transplantation of the liver and the pancreas in diabetic patients with end-stage liver disease, and explore the optimal surgical procedure., Methods: Simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantations were performed in a patient diagnosed as having chronic hepatitis B, hepatocirrhosis, hepatic cellular cancer, and insulin-dependent diabetes. Immunosuppression therapy utilized prednisone, tacrolimus (FK506), mycophenolate mofetil (MMF), and simulect. The function of the liver graft, serum amylase and lipase, blood glucose, and C-peptide were monitored after transplantation., Results: Insulin was withdrawn at the 6th day after operation, good liver allograft functional recovery was achieved, without such complications as pancreatitis, thrombosis, and localized infections., Conclusion: End-stage liver disease with concomitant insulin-dependent diabetes is the indication for combined liver-pancreas transplantations, for which simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantations may constitute the optimal surgical approaches as the primary choice.

Objective: To compare the efficacy and safety of tacrolimus (FK506)- versus cyclosporine (CsA)-based immunosuppression protocol in the treatment of patients with renal transplantation for diabetic end-stage renal disease., Methods: A total of 64 patients with end-stage renal disease were randomized into FK506 (n=33) and CsA (n=31) group after cadaveric renal transplantation, the former group adopting small-dose FK506 therapy with low trough concentration, and the latter receiving CsA therapy. The dose of insulin was adjusted according to blood glucose level of the patients after the operation. The incidence of acute rejections, blood glucose level, the dose of insulin and changes in blood pressure, lipid metabolism and liver function were compared between the two groups., Results: The 1-year patient/graft survival rates were 96.97%/93.94% in FK506 group and 96.77%/90.32% in CsA group. Four patients (12.12%) developed acute rejection in the FK506 group, while 11 (35.48%) did in the CsA group during the first year after the operation (P<0.05). The dose of the insulin of the FK506 group (34.35 U/d, 14.09 U/d) was not significantly different from that in the CsA group (28.15 U/d, 13.05 U/d) at the first month and 1 year after the operation (P>0.05). One year after the operation, 21 patients (63.63%) required anti-hypertension treatment, 5 (15.15%) needed anti-hyperlipidemia treatment and 3 (9.09%) had abnormal liver function in FK506 group, while in the CsA group, 28 patients (90.32%) needed anti-hypertension therapy, 13 (41.94%) received anti-hyperlipidemia treatment and 11 (35.48%) showed signs of abnormal liver function, with significant differences between the two groups., Conclusions: Small-dose FK506 therapy with low concentrations is effective in the postoperative management of patients with renal transplantation for diabetic end-stage renal disease, with only mild adverse effect. FK506 is comparable with CsA in terms of the effect on glucose metabolism of the patients.

Objective: To investigate the effect of hypoxia-reoxygenation on of endothelium-dependent NO and endothelium-derived hyperpolarizing factor (EDHF) relaxation of., Methods: The organ chamber technique was employed to study rabbit renal artery rings. By inhibiting the PGI2 relaxation pathway with hypoxia-reoxygenation of the renal artery rings, followed by inhibition of NO and EDHF relaxation pathways respectively, the effects of hypoxia-reoxygenation on NO and EDHF relaxation were observed., Results: Hypoxia-reoxygenation decreased the endothelial NO relaxation of rabbit renal rings, but the endothelial EDHF relaxation., Conclusion: Hypoxia-reoxygenation may injure endothelium-derived NO relaxation, but not the endothelium-derived EDHF relaxation of rabbit renal rings.

Objective: To study the surgical techniques, perioperative management, management of infections and graft rejection in patients with combined liver-kidney transplantation (CLKT)., Methods: CLKT was performed in a 66-year-old patient with alcoholic liver cirrhosis and uremia. Lavage in situ with University of Wisconsin (UW) solution of the donor organs and en hoc resection was performed. Orthotopic liver transplantation (OLT) and routine kidney transplantation were respectively carried out. Immunosuppression therapy consisted of tacrolimus (FK506), antithymocyte globulin (ATG), mycophenolate mofetil (CellCept, MMF) and corticosteroid., Results: Both of the transplanted organs rapidly recovered normal functions after operation, and acute rejection of the liver graft occurred on day 10 after operation but was controlled after methylprednisolone pulse therapy. The patient fully recovered and was discharged from hospital on day 29 after operation., Conclusions: CLKT is effective against both liver and renal function failure. Well-matched HLA tissue typing, proficient surgical skills, adequate application of immunosuppressants and effective management of postoperative complications are crucial for successful CLKT.

Objective: To explore the possible causes of transplant renal artery stenosis (TRAS) in cadaveric transplant recipients., Method: We retrospectively analyzed multiple factors that may contribute to TRAS (including the patients' age, presence of diabetes, cold ischemic time, acute rejection episode, cytomegalovirus infection, serum cholesterol, LDL cholesterol, pre-operative dialysis, number of donor renal arteries, which side of donor kidney, type of surgical anastomosis, different protocols of inductive and maintenance drug therapy) in 18 recipients with transplant renal artery stenosis after cadveric renal transplantation from Jan. 2000 to Dec. 2001 in comparison with another 566 non-TRAS recipients who underwent the transplantation during the same period., Results: There was a higher incidence of acute rejection in the TRAS group than non-TRAS group (66.67% vs 5.48%, P<0.01), and no significant difference was noted between TRAS and non-TRAS cases in terms of the pre-operative dialysis, presence of diabetes, cold ischemic time, number of donor renal arteries, whith side of donor kidney, type of surgical anastomosis, different protocols of inductive and maintenance drug therapy, cytomegalovirus infections and serum and LDL cholesterols., Conclusion: The occurrence of TRAS in cadaveric allografts is associated with acute graft rejection episode, suggesting the importance of the treatment of acute graft rejection in the prevention of TRAS.

Objective: To establish a simple and reliable rat model of simultaneous liver and kidney transplantation., Methods: The simultaneous transplantation was performed in healthy male SD rats as the recipients and other SD rats of either gender as the donors. The donor liver and kidney were resected simultaneously and grafted into the recipients whose corresponding organs were previously removed. Anastomosis of the portal vein and the inferior vein cava (IVC) inferior to the kidney between the graft and the recipient was performed by a double cuff method, followed by end-to-side anastomosis of the IVC superior to the liver between the donor and the recipient. The urethra and bile duct were anastomised using a simple inside bracket., Results: The time for blood vessel anastomosis and for recipient operation were reduced, with a success rate of 73.3% in the operations. The function of the grafted liver and kidney remained normal., Conclusion: This rat model of simultaneous liver-kidney transplantation is simple and reliable.

Objective: To investigate the effect of anti-tumor necrosis factor-alpha monoclonal antibody (anti-TNF-alpha mAb) in alleviating renal ischemia-reperfusion injury., Methods: Fifty normal male Sprague-Dawley rats were randomly divided into 3 groups, namely group A that was subjected to ischemia-reperfusion injury with intravenous administration of anti-TNF-alpha mAb (0.1mg/kg.b.w.) 5 min before reperfusion (treatment group), group B with the same injury followed by saline administration in the same manner (control group), and group C with only anesthetization and leparotomy but not ischemia (sham operation group). Routine assays were performed for testing the levels of blood creatine (Cr), blood urea nitrogen (BUN), plasma TNF-alpha and the cell apoptosis. Ultrastructure of the kidney was also observed., Results: Renal ischemia-reperfusion resulted in significant increase of the levels of Cr, BUN and TNF-alpha in the plasma (P<0.01), but these effects were offset by administration of anti-TNF-alpha mAb (P<0.01). In group B, widespread pathological changes and cell apoptosis were observed in the renal tissue following renal ischemia-reperfusion injury, while similar changes were scarcely visible in group A due to the protective effect of intravenous administration of anti-TNF-alpha mAb 5 min before reperfusion., Conclusion: Renal ischemia-reperfusion injury can be alleviated by anti-TNF-alpha mAb treatment.

Objective: To investigate the incidence and cause of transplant renal artery stenosis (TRAS) and explore its diagnosis and management., Method: A retrospective study was conducted in 10 TRAS cases confirmed by selective artery angiography between 2000 and 2001., Results: Seven patients had a history of acute rejection episode, balloon angioplasty was per-formed in 9 patients, and stent implantation in 1 patient. Revascularization resulted in a decrease in arterial pressure and renal function improvement in all but 1 case. Restenosis occurred in 2 of the 9 patients receiving balloon angioplasty, but after stent implantation, their renal function was improved. Serious graft failure occurred in 1 case, resulting eventually in renal graft loss., Conclusions: TRAS is related to episodes of acute rejection. Doppler ultrasonography is useful in screening of TRAS, the definite diagnosis of which relies on artery angiography, and angioplasty constitutes an effective therapeutic modality.

Objective: To investigate the effect of portal venous inoculation of donor splenocytes combined with cyclosporin A (CsA) administration on cardiac allograft survival in mice., Methods: Heterotopic cardiac transplantation between fully allogenic NIH/q and BALB/C strain mice was performed. A modified procedure of neonatal heart-in-ear transplantation, as originally described by Fulmer et al, was adopted. We prepared donor splenocytes from NIH/q or third-party C57BL/6 spleens for BALB/C recipients, which were injected preoperatively via the recipient portal vein or the systemic vein 1 week before the heart-in-ear transplantation. The recipients were subsequently treated with a short course of the immunosuppressive agent, CsA (4 mg/kg starting from 7 d before the operation till 5 d after it)., Results: Portal venous inoculation of donor splenocytes combined with CsA significantly prolonged cardiac graft survival (n=6, P<0.05) that reached 31.00+/-3.23 d, and 2 of the 6 allografts survived for more than 35 d. Donor splenocytes injected via the systemic vein or third-party C57BL/6 mice splenocytes injected via the portal vein did not prolong graft survival (P>0.05). CsA alone or portal venous inoculation of donor-specific splenocytes alone also prolonged graft survival (P<0.05), with mean graft survival time of 18.50+/-2.59 d and 16.11+/-1.97 d respectively., Conclusion: Combination of portal venous inoculation of donor-specific splenocytes and CsA can prolong murine cardiac allograft survival, which is donor antigen-specific.

Objective: To observe the long-term effect of ilio-inguinal and umbilical-thoracic compound flaps in one-stage reconstruction of the penis., Methods: Eight patients, who received one-stage reconstruction of the penis using ilio-inguinal and umbilical-thoracic compound flaps, were all followed up regularly at 6 months, 1, 3, 7 and 13 years postoperatively. The color, diameter, length, and sense recovery of the organ, along with urodynamics and satisfaction degree of both patients and their wives were recorded., Results: The reconstructed organ retained the original color all through the follow-up, but had shrunk and shortened to some degree within the first 3 years after the operation, a condition that was stabilized afterwards. The sense of the proximal end of the constructed organ began to recover six months after the operation and almost assumed normal sense. The sense of the distal end also recovered, though relatively slowly. Few long-term complications were observed, and the patients and their wives were reasonably satisfied with the reconstructed organs in terms of their shape and function., Conclusion: Good long-term effect of one-stage reconstruction of the penis can be achieved by using illio-inguinal and umbilical-thoracic compound flaps, which can be adopted clinically in cases of penis reconstruction.

Objective: To establish rabbit model of renal allograft transplantation with reduced complications and high survival rate using microsurgical technique., Methods: Twelve healthy adult rabbits were randomly divided into 2 groups of equal number, one as donor group and the other recipient. The left kidneys of the donor rabbits were removed followed by immediate reperfusion with 4 degrees celsius H-CA solution, before they were transplanted into the recipient rabbits with their left kidneys excised and end-to-end anastomosis of the renal arteries, veins and ureter respectively performed with microsurgical technique. Another 12 normal rabbits received operations to temporarily block the right renal arteries and veins, serving as control group, in which 11 completed the experiment., Results: No thrombosis or stricture occurred at the site of anastomosis in rabbits with renal allograft transplantation, and the survival rate reached 91.7% (11/12)., Conclusion: This rabbit model of renal allograft transplantation has markedly fewer complications with improved survival rate, thus providing a more practical and reliable model for experimental and clinical studies of renal transplantation.

Objective: To evaluate the management of acute rejection (AR) after kidney transplantation and investigate the factors influencing the clinical outcome of the patients., Methods: A retrospective study was conducted in 86 cases of AR developed after primary kidney transplantation in the light of therapeutic measures, clinical outcome and prognosis., Results: Among these patients, 81 survived AR after treatment. In patients with pulse treatment with methylprednisolone (MP), 48 out of 68 managed to survive the crises, while in those who received ATG as the first line drug therapy 10 out of 11 patients survived and in other cases, 6 out of 7 did due to first-line OKT3 administration. All the 20 patients who did not respond to MP received ATG or OKT3 instead, with 14 recovered. Of the 8 patients who failed to be cured by the management above, 6 with previous CSA treatment took FK506 and 3 were consequently cured. Five patients lost the allografts because of uncontrollable infection, allograft rupture or thrombosis., Conclusions: MP therapy is still the most commonly used primary treatment for acute rejection episodes. Increase of SCr by more than 10% on days 2 and 3 of MP therapy indicates poor prognosis. ATG or OKT3 can be effective against acute rejection not only as first-line but also as second-line drug. In condition of steroid-resistant rejection when ATG and OKT3 fail to manage, a change to baseline immunosuppression may be considered as the replacement of CSA with FK506.

Objective: To evaluate the role of panel reactive antibody (PRA) screening and human leukocyte antigen (HLA) typing in renal transplantation., Methods: PRA screening and HLA typing were performed in 1 700 patients eligible for the first group of renal transplantation who had 3 to 6 HLA matches in HLA-A, B and DR with the donor, and in cases positive for PRA, plasma exchange was conducted. Another 423 patients who did not receive PRA screening or HLA typing constituted the second group. The changes of immune variables, incidences of acute rejection and the effect of HLA-A, B, DR matching on long-term graft survival were observed., Results: In 1 700 cases of group 1, post-transplantation CsA dose was reduced to 5 to 7 mg*kg(-1)*d(-1) and the graft function recovery time ranged from 2 to 16 d, averaging 5 d. Acute graft rejection occurred in 252 (14.8%) cases, but no hyper-acute rejection was observed. The 1-, 3- and 5-year patient/graft survival rates were 98.6%/96.7%, 93.1%/87.3% and 88.1%/83.6% respectively. In group 2, CsA dose ranged from 8 to 12 mg*kg(-1)*d(-1) and the graft function recovery time was 4 to 30 d, averaging 13 d. Hyper-acute rejection occurred in 9 (2.1%) and acute rejection in 198 (46.8%) cases, and the 1-, 3- and 5-year patient/graft survival rates were 86.7%/76.3%, 72.5%/67.9% and 69.5%/59.3% respectively., Conclusions: Negative PRA and good HLA matching can eliminate the incidences of hyper-acute rejection, decrease the rate of acute rejection and improve both patient and graft survival rates.