The experience on management of abnormal blood vessels in 128 cases of donor kidney during the tailoring operation was reported. The various techniques used for different types of abnormal arteries and veins, and the critical points which should be paid attention to have been discussed. It was concluded that the multiple renal arteries should be treated in a single renal artery and anastomosed with internal iliac artery or/and external iliac artery. The appropriate management given to abnormal renal blood vessels during the tailoring operation may shorten the warm ishemia time, ensure the renal blood supply, reduce the renal vasular complication, and promote the recovery of renal function.
Objective To evaluate the safety of mycophenolate mofetil (MMF) versus azathioprine (AZA) for rejection after renal transplantation. Methods We searched MEDLINE (1966 to Jun. 2004), EMBASE (1984 to Jun. 2004), The Cochrane Library (Issue 2, 2004) and Chinese Biomedical Database (CBM, 1979 to Jun. 2004). Randomized controlled trials (RCTs) comparing MMF with AZA for rejection after renal transplantation were included. The quality of included studies such as randomization, blinding, allocation concealment was evaluated and meta-analysis was performed using RevMan 4.1.1 software. Results Twenty-Four RCTs comparing MMF (2 g/day or 3 g/day) with AZA for rejection after renal transplantation were identified. The digest system morbidity of MMF group was higher than that of AZA group. The incidence of vomiting, bellyache and diarrhea of MMF 3 g/day group was statistical by higher than that of AZA group (P＜0.05). The cytom egalovirus (CMV) infection morbidity of MMF 3 g/day group during 6 months, 1 year and 2 years follow-up was higher than AZA group with statistical difference, but for MMF 2 g/day group, this difference was only seen during 1 year follow-up. Leukopenia incidence of MMF 3g/day group was higher than AZA group with statistical difference, but this difference was not seen in MMF 2 g/day group. Thrombocytopenia incidence of MMF 3 g/day group was lower than AZA group with statistical difference. For skin carcinoma morbidity, no statistical difference was found among MMF 3 g/day, MMF 2 g/day and AZA groups. Conclusions Compared with AZA, MMF represents higher digest system side-effects incidence, higher morbidity of leucopenia and CMV infection and lower incidence of thrombocytopenia. The dose-response relationship of adverse drug reaction is found.
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.
Objective To evaluate the efficacy of mycophenolate Mofetil (MMF) and azathioprine (AZA) after renal transplantation. Method Searching: Medline, Embase, Cochrane library and Chinese Biomedicine database (CBM); identified the randomized controlled trials (RCTs) and applied Revman 4.11 for statistical analyses. Results Twenty-two RCTs were identified, involving MMF and AZA for anti-rejection after renal transplantation. The data shown that MMF (2 g/d) was more beneficial than AZA in improving the graft survival rate of short periods and the long-term patient survival rate, but there was no statistical differences between MMF (3 g/d) with AZA. Whether in 6 months or in 1 year after renal transplantation, the use of MMF (2 g/d) or MMF (3 g/d) could markedly reduce the incidence of biopsy-proven rejection. Conclusions Comparing with AZA, MMF is a more potent immunosuppressive drug, and more efficient in reducing the acute rejection after renal transplantation. MMF can improve the graft and patient survival rate. The 2 gram per day is more acceptable.
【摘要】 目的 探讨肾移植术后药物（环孢素A和钙离子拮抗剂）、口腔卫生与牙龈增生的关系。 方法 随访2003年1月—2010年3月间321例肾移植患者，记录患者术后药物使用和口腔卫生情况，观察牙龈增生程度。结果 〖HTSS〗口腔卫生水平与牙龈增生程度之间存在统计学相关性（rs=0.344，P=0.000），口腔卫生水平越差，牙龈增生越严重。服用环孢素A和钙离子拮抗剂患者（A组）牙龈增生发生率为62.15%，高于单纯服用环孢素A患者（B组）23.40%，二者比较，差异有统计学意义（χ2=39.220，P=0.000）。结论 〖HTSS〗肾移植术后环孢素A和钙离子拮抗剂联合应用明显增加了牙龈增生的发病率。口腔卫生水平与牙龈增生程度之间存在重要关联，口腔卫生差是牙龈增生的危险因素。【Abstract】 Objective To investigate the correlation between drugs (cyclosporine A and calcium channel blocker), oral hygiene and gingival hyperplasia in patients after renal transplantation. Methods We continuously followed up 321 patients undergoing renal transplantation from January 2003 to July 2009 in our hospital. The levels of oral hygiene, medication and gingival hyperplasia were recorded. Results There was a close relationship between the level of oral hygiene and the degree of gingival hyperplasia (rs=0.344, P=0.000). Higher grades of gingival hyperplasia (grades Ⅱ and Ⅲ) were found exclusively in patients who did not have good oral hygiene. There was a higher tendency of developing gingival hyperplasia among patients who received cyclosporine A and calcium channel blocker than those who only received cyclosporine A (62.15% vs. 23.40%; χ2=39.220, P=0.000). Conclusion The prevalence of gingival hyperplasia is higher in renal transplant recipients taking cyclosporine A and calcium channel blockers. There is a significant relationship between the level of oral hygiene and the development of gingival hyperplasia. Poor oral hygiene is a risk factor of gingival hyperplasia.
目的 研究无创通气(NIPPV)治疗对肾移植术后巨细胞病毒(CMV)肺炎患者的疗效。方法 1998年1月~2005年12月间入住中山大学附属第一医院内科重症监护病房(MICU)的78例肾移植术后CMV肺炎患者，根据是否接受无创通气治疗而分为非NIPPV组和NIPPV组，比较两组患者在接受有创机械通气比例、病死率、住院时间及并发症等方面的差异。对52例NIPPV组患者，比较无创通气治疗前后生命体征及血气分析指标的变化。结果 NIPPV组与非NIPPV组相比，接受有创机械通气比例(30.8％ 比80.8％)、医院获得性肺炎发生率（32.7％ 比61.5％)及病死率(30.8％ 比57.7％)较低，两组比较均有显著性差异(P均lt;0.05)；而住院时间、气压伤发生率无显著差异。NIPPV组患者无创通气治疗后患者呼吸频率有所减慢，动脉血pH值逐渐降低，PaCO2水平缓慢上升，PaO2、PaO2 ／FiO2及SaO2明显升高，两组比较均有显著差异(P均lt;0.05)。而无创通气治疗前后心率、血压的变化则无明显规律。结论 NIPPV治疗能够改善肾移植术后CMV肺炎患者的低氧血症，缓解呼吸窘迫症状，降低有创机械通气治疗比例及医院获得性肺炎的发生率，从而降低病死率。用无创通气治疗巨细胞病毒肺炎值得在临床上推广使用。