RESUMEN
To test the reliability of CEUS on the diagnosis of acute (AR) or chronic rejection (CR) after renal transplantation, patients who received renal transplantation in our center from January 2011 and December 2015 were retrospectively included in the current study. All the included patients underwent contrast-enhanced ultrasonography tests. Two regions of interests were chosen to carry out time-intensity curves (TICs). The main indexes include time indexes, intensity indexes, and difference indexes. Separation of TIC1 and TIC2 was evaluated by the authors. Results revealed that time to peak 1 (TTP-1), TTP-2, absolute time to peak 1 (ATTP-1), and ATTP-2 in the CR group were significantly later than those in the graft function stable group. Peak intensity 2 is smaller in the AR group than that in the GFS group, velocity of intensity ascending 2 is slower in the CR group than that in the GFS group, terminal intensity 1 (TI-1) and TI-2 are lower in the CR group than those in the GFS group, and Vd-1 is faster in the CR group than that in the GFS group (P < 0.05). Those results indicated that contrast-enhanced ultrasonography test can satisfactorily reflect the microcirculation of transplanted kidney and can be used to assist in the early diagnosis of graft rejection.
Asunto(s)
Rechazo de Injerto/diagnóstico por imagen , Trasplante de Riñón , Ultrasonografía/métodos , Adulto , Medios de Contraste , Femenino , Humanos , Riñón/irrigación sanguínea , Riñón/diagnóstico por imagen , Masculino , Microcirculación , Persona de Mediana Edad , Fosfolípidos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Hexafluoruro de AzufreRESUMEN
BACKGROUND: Primary hyperoxaluria (PH) is a rare inborn disorder of the metabolism of glyoxylate, which causes the hallmark production oxalate and forms insoluble calcium oxalate crystals that accumulate in the kidney and other organs. Since the manifestation of PH varies from recurrent nephrolithiasis, nephrocalcinosis, and end-stage renal disease with age at onset of symptoms ranging from infancy to the sixth decade, the disease remains undiagnosed until after kidney transplantation in some cases. CASE PRESENTATION: Herein, we report 3 cases of PH diagnosed after kidney transplantation failure, providing the comprehensive clinical course, the ultrasonic image of renal graft and pathologic image of the biopsy, highlighting the relevance of biopsy findings and the results of molecular genetic testing. We also focus on the treatment and the unfavorable outcome of the patients. Meanwhile, we review the literature and show the additional 10 reported cases of PH diagnosed after kidney transplantation. Additionally, we discuss the progressive molecular understanding of the mechanisms involved in PH and molecular therapy. CONCLUSIONS: Overall, the necessity of preoperative screening of PH in all patients even with a minor history of nephrolithiasis and the importance of proper treatment are the lessons we learn from the 3 cases, which prompt us to avoid tragedies.
Asunto(s)
Hiperoxaluria Primaria/diagnóstico por imagen , Hiperoxaluria Primaria/etiología , Trasplante de Riñón/efectos adversos , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Insuficiencia del Tratamiento , Adulto , Humanos , Trasplante de Riñón/tendencias , MasculinoRESUMEN
Talaromyces marneffei is an emerging opportunistic infection among immunocompromised patients. We observe the first native case of disseminated T. marneffei involving the kidney in a renal transplant recipient in mainland China. We describe the comprehensive clinical course, and ultrasound imaging of renal transplant biopsy, pathologic images, and electron microscopy observation of the biopsy specimen, highlighting the relevance of biopsy findings and the blood culture. We also focus on the treatment and good outcome of the patient. Then we review the literature and show the additional 10 reported cases of T. marneffei in renal transplant recipients. In addition, we discuss the new methods of rapid diagnosis of T. marneffei. In brief, timely diagnosis and proper treatment of T. marneffei infection is important in renal transplant recipients.
Asunto(s)
Antifúngicos/uso terapéutico , Trasplante de Riñón/efectos adversos , Micosis/tratamiento farmacológico , Infecciones Oportunistas/tratamiento farmacológico , Penicillium/aislamiento & purificación , Talaromyces/aislamiento & purificación , Aloinjertos , China , Ciclosporina/uso terapéutico , Humanos , Huésped Inmunocomprometido , Riñón/microbiología , Riñón/patología , Masculino , Persona de Mediana Edad , Micosis/diagnóstico por imagen , Micosis/microbiología , Micosis/patología , Infecciones Oportunistas/diagnóstico por imagen , Infecciones Oportunistas/microbiología , Infecciones Oportunistas/patología , Receptores de Trasplantes , Resultado del TratamientoRESUMEN
Myeloid-derived suppressor cells (MDSCs) are negative regulators of the immune response and are in part responsible for the inhibition of the T cell-mediated immune response. A recent paper indicated that MDSCs were involved in prolonged allograft survival in animal models of transplantation, but the significance of MDSCs in human renal transplantation is still unknown. In our study, 50 patients with biopsy-proven acute T cell-mediated rejection (ATCMR) were included. The ratio of MDSCs in peripheral blood mononuclear cell (PBMC) was evaluated with FACS, and the patients were divided into the MDSCs high group (MDSCs, >10 %) or the MDSCs low group (MDSCs, <10 %). We compared the allograft function, severity of tissue injury, and long-time survival between the two groups. In the MDSCs high group, allograft function was significantly increased compared with the MDSCs low group. Furthermore, we found that isolated MDSCs from transplant recipients are capable of expanding regulatory T cell (Treg), meanwhile, inhibiting production of IL-17 in vitro. We also found that the ratio between Foxp3(+) and IL-17-producing CD4(+) T cells positively correlated with MDSCs frequency in PBMC. In conclusion, we demonstrated a potential role for MDSCs in prolonging allograft survival after ATCMR, and this was associated with higher CD4(+)Foxp3(+)/CD4(+)IL-17(+) ratio in PBMC.
Asunto(s)
Rechazo de Injerto/inmunología , Supervivencia de Injerto/inmunología , Trasplante de Riñón , Células Mieloides/inmunología , Células Mieloides/trasplante , Linfocitos T Reguladores/fisiología , Células Cultivadas , Rechazo de Injerto/diagnóstico , Rechazo de Injerto/prevención & control , Humanos , Trasplante de Riñón/efectos adversos , Leucocitos Mononucleares/inmunología , Estudios Retrospectivos , Factores de TiempoRESUMEN
OBJECTIVE: To identify the risk factors of acute rejection in sensitized recipients undergoing kidney transplantation. METHODS: The clinical data of 102 sensitized kidney transplant recipients were retrospectively analyzed to evaluate the incidence of acute rejection in relation to panel reactive antibodies (PRA), amino acid residual match, postoperative elevation of PRA level and cytokine genotypes. RESULTS: During the follow-up, acute rejection occurred in totally 33 patients, and the incidence was higher in the recipients with high tumor necrosis factor (TNF)-alpha or high interleukin (IL)-10 producer genotype than in those with low TNF-alpha or low/intermediate IL-10 producer genotype (53.1%, 55.0% vs 22.8%, 20.9%, P(18)0.01 respectively). Acute rejection was even more frequent in the recipients with both high TNF-alpha and high/intermediate IL-10 producer genotypes than in those with low TNF-alpha and IL-10 producer genotype (66.7% vs 10.2%, P<0.01). No relations were found between TGF-beta1, IL-6, IFN-gamma gene polymorphisms and the incidence of acute rejection. The incidence in the recipients with PRA level of more than 40% was also higher than those with lower PRA level (<20%, 53.3% vs 22.7%, P<0.05), and the amino acid residual mismatch with 3-4 MM was responsible for a higher incidence in comparison with a mismatch with 0-1 MM (75.0% vs 24.1%, P<0.01). Postoperative elevation of PRA level also increased the risk of acute rejection (45.4% vs 22.4%, P<0.01). CONCLUSION: TNF-alpha, IL-10 gene polymorphism, PRA, amino acid residual mismatch, and increased postoperative PRA level may significantly influence acute rejection in sensitized kidney transplantation recipient, and preoperative evaluation of these factors may benefit the designing of immunosuppressive protocols for these patients.
Asunto(s)
Rechazo de Injerto/epidemiología , Interleucina-10/biosíntesis , Isoanticuerpos/inmunología , Trasplante de Riñón/inmunología , Adulto , Anciano , Anticuerpos/inmunología , Formación de Anticuerpos , China/epidemiología , Femenino , Humanos , Incidencia , Interleucina-10/genética , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Factor de Necrosis Tumoral alfa/biosíntesis , Factor de Necrosis Tumoral alfa/genéticaRESUMEN
OBJECTIVE: To investigate the independent prognostic factors for graft survival in sensitized recipients undergoing kidney transplantation, so as to identify the individuals at high risk of graft loss before transplantation. METHODS: A retrospective investigation was conducted in 102 sensitized kidney transplant recipients and 31 relative variables were analyzed with SPSS10.0 software. Using log-rank method, the influence of these variables on short- and long-term graft survivals was evaluated, and Kaplan-Meier analysis was performed to estimate the 1-, 3- and 5-year graft survival rates and half-life. Proportional hazards regression analysis (Cox model) was used to assess the relative risks of the potential variables. RESULTS: In the recipients with a mean half-life of 8.9 years, the 1-, 3- and 5-year graft survival rates were 90%, 85%, and 75%, respectively. By log-rank analysis, the factors affecting short- and long-term graft survivals were identified, namely the recipient age, times of transplantation, levels of panel reactive antibody and the post-operative anti-HLA-IgG antibody, HLA mismatch, renal function, time needing for graft function recovery, presence of acute rejection, delay of graft function recovery and infection, which affected the graft survival demonstrated by Cox model multivariate analysis. CONCLUSION: High-quality donor kidney and minimization of the risk factors for graft survival may insure successful kidney transplantation in sensitized recipients.