ObjectiveTo examine the characteristics of Rhodococcus equi (R. equi) infection for better awareness of this disease.MethodsThe clinical data of a patient with pulmonary abscess caused by R. equi after renal transplantation were reported. We also reviewed the reports of infections caused by R. equi.ResultsThe clinical manifestations and laboratory examination of the patient were consistent with the characteristics of R. equi infection. The growth of R. equi was found in sputum and blood culture. The follow-up data showed that the treatment was effective. Literature search identified 23 similar patients. In all the 24 patients (containing this one), the time of infection after renal transplantation ranged from 4 months to 11 years. There were 21 patients with cumulative pulmonary infection, and 10 patients had a clear epidemiological history of direct or indirect contact with horses. Eighteen patients improved after regular antibacterial treatment or surgical treatment.ConclusionsOpportunistic infections caused by R. equi mainly affect transplant recipients and other patients with lower immunity. Infections caused by R. equi may affect many organ systems with various manifestations. The optimal therapy is not established due to the rarity of this infection. Clinicians should select antibiotic agents rationally based on antimicrobial susceptibility testing and treatment response of patients.
ObjectiveTo explore the effect of donation after citizen death (DCD) kidney transplantations performed in Sichuan.MethodsThe data of 97 cases of DCD kidney transplantations performed in West China Hospital of Sichuan University between January 2012 and March 2016 was retrospectively reviewed. The 53 donors were aged from 7 months to 54 years (with a median of 28 years, and lower quartile of 15 years and upper quartile of 45 years), including 40 males and 13 females; the causes of death included craniocerebral trauma in 21 cases, craniocerebral tumor in 12 cases, cerebrovascular accident in 15 cases, hypoxic-ischemic encephalopathy in 4 cases, and hydrocephalus in 1 case. The 97 recipients were aged from 18 to 66 years (with a median of 39 years, and lower quartile of 30 years and upper quartile of 44 years), including 71 males and 26 females. The recipients were classified into C-Ⅰ (n=36) and C-Ⅲ (n=61) according to type of donation. The baseline and perioperative situation of the donors and recipients, and the postoperative kidney function, infection, recipient survival and kidney survival of the recipients were analyzed.ResultsAfter transplantation, none of primary graft nonfunction occurred but delayed graft function (DGF) occurred in 26 cases. There were no significant differences in creatinine level between C-Ⅰ and C-Ⅲ recipients at 1 week [(226.71±187.46) vs. (249.94±249.84) μmol/L, P=0.636], 1 month [(136.32±63.34) vs. (157.37±147.83) μmol/L, P=0.428], 3 months [(110.51±25.26) vs. (115.02±36.60) μmol/L, P=0.527] and 12 months [(103.42±21.57) vs. (104.18±39.36) μmol/L, P=0.911] after transplantation, as well as acute rejection [13.9% vs. 19.7%, P=0.469] and complications at early time after transplantation. There were no significant differences in 1-year recipient survival rate (91.7% vs. 93.4%) and 1-year kidney survival rate (100.0% vs. 91.8%) between C-Ⅰ and C-Ⅲ recipients.ConclusionDCD kidney transplantation has excellent short-term outcomes despite a high incidence of early DGF, and may represent another potential method to safely expand the donor pool.
ObjectiveTo analyze the clinical characteristics and measures of diagnosis and treatment of renal transplant recipients complicated with Pneumocystis carinii pneumonia (PCP), in order to provide basis for prevention and treatment.MethodsThe clinical data of 82 renal transplant recipients complicated with PCP admitted to the West China Hospital of Sichuan University from January 2016 to December 2019 were retrospectively analyzed.ResultsThe median time from transplantation to diagnosis of PCP was 3.50 (2.78, 8.27) months, and 57 cases (69.51%) were occurred within 6 months. The main clinical manifestations were fever, cough and shortness of breath, and chest CT scan mainly showed ground-glass opacity and patchy shadows. The laboratory examination showed a decrease of lymphocyte, increased high-sensitivity C-reactive protein and (1-3)-beta-D glucan. All 82 patients (100%) were complicated with bacterial, virus infections or other fungal infections. The median time of diagnosis, treatment and hospital stay was 6.00 (3.00, 8.25) d, 20.00 (12.75, 32.25) d, 26.50 (20.75, 39.00) d, respectively. Sixty-six cases (80.49%) were discharged with effective treatment, yet 14 cases (17.07%) suffered a failed treatment and 2 cases (2.44%) died.ConclusionsThe incidence of PCP infection was highest within the first 6 months after renal transplantation, and multiple infections tend to easily occured. Early diagnosis should be made in combined with clinical manifestations, laboratory and imaging examinations, and individualized treatment should be taken early.
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.
目的 研究無創通氣(NIPPV)治療對腎移植術后巨細胞病毒(CMV)肺炎患者的療效。方法 1998年1月~2005年12月間入住中山大學附屬第一醫院內科重癥監護病房(MICU)的78例腎移植術后CMV肺炎患者，根據是否接受無創通氣治療而分為非NIPPV組和NIPPV組，比較兩組患者在接受有創機械通氣比例、病死率、住院時間及并發癥等方面的差異。對52例NIPPV組患者，比較無創通氣治療前后生命體征及血氣分析指標的變化。結果 NIPPV組與非NIPPV組相比，接受有創機械通氣比例(30.8％ 比80.8％)、醫院獲得性肺炎發生率（32.7％ 比61.5％)及病死率(30.8％ 比57.7％)較低，兩組比較均有顯著性差異(P均lt;0.05)；而住院時間、氣壓傷發生率無顯著差異。NIPPV組患者無創通氣治療后患者呼吸頻率有所減慢，動脈血pH值逐漸降低，PaCO2水平緩慢上升，PaO2、PaO2 ／FiO2及SaO2明顯升高，兩組比較均有顯著差異(P均lt;0.05)。而無創通氣治療前后心率、血壓的變化則無明顯規律。結論 NIPPV治療能夠改善腎移植術后CMV肺炎患者的低氧血癥，緩解呼吸窘迫癥狀，降低有創機械通氣治療比例及醫院獲得性肺炎的發生率，從而降低病死率。用無創通氣治療巨細胞病毒肺炎值得在臨床上推廣使用。
Objective To compare the therapeutic effect of new “One-Stitch” ureterovesical anastomosis to that of the classic Lich-Gregoir method. Methods From January 2002 to December 2004, 445 patients suffering from uremia due to chronic nephritis were treated with renal transplantation. Among them, 121 patients were operated with our new modified ureteroneocystostomy technique (the new One-Stitch group), and 324 patients were operated with Lich-Gregoir technique (the Lich-Gregoir group). In the new One-Stitch group, there were 79 males and 42 females, aged 20-62 years (35.7 years on average). The course of the disease was 2-11 years (2.7 years on average). In the Lich-Gregoir group, there were 211 males and 113 females, aged 19-65 years (33.9 years on average). The disease course was 1-14 years (2.3 years on average). There was no significant difference between the two groups in age, proportion of genders, primary diseases and course of the disease (P gt; 0.05). The operative time, the ureteral compl ications and non-ureteral compl ications were compared between the two groups after the renal transplantation. Results The operative time for the new One-Stitch and Lich-Gregoir techniques was (8.7 ± 1.1) minutes and (22.4 ± 5.1) minutes, indicating the difference was significant (P lt; 0.05). All recipients were followed up for 3-5 years. In the new One-Stitch group, there were 5 patients with leakage of urine, 15 with gross hematuria, 4 with ureteral obstruction and 28 with urinary system infection. Symptomatic vesicoureteral reflux and stone formation were not observed in this group. In the Lich-Gregoir group, there were 17 patients with leakage of urine, 12 with gross hematuria, 13 with ureteral obstruction, 86 with urinary system infection, 6 with symptomatic vesicoureteral reflux and 2 with stones. In the new One-Stitch group, the incidence rate of compl ications of gross hematuria was 12.4%, which was significantly different from 3.7% in the Lich-Gregoir group (P lt; 0.05). The incidence rates of ureteral compl ications in the Lich-Gregoir and the new One-Stitch groups were 19.8% and 15.4%, respectively. The difference was not significant (P gt; 0.05). There was no significant difference between the two groupsin incidence rate of urinary system infection, delayed recovery of kidney function after kidney transplantation and rejectionreaction (P gt; 0.05). Conclusion The new One-Stitch group has no significant difference in ureteral compl ications ompared with the Lich-Gregoir group, and has become a preferential ureterovesical reimplantation technique because of its simple and has convenient operation.
Objective To explore the effect of kidney transplantation on chronic prostatitis-like symptoms. Methods A total of 300 male renal transplant recipients between January 2015 and January 2017 were collected in the study. All recipients received the questionnaire survey of the National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) preoperatively and at 3 months after transplantation. The score and relevant risk factors were statistically analyzed. Results A total of 210 recipients (70.0%) completed questionnaire effectively, in whom 150 (71.4%) had preoperative and 90 (42.9%) had postoperative chronic prostatitis-like symptoms, respectively. In the 210 patients, the preoperative and postoperative pain score was 6.57±3.12 vs. 3.57±3.16 (P<0.001), voiding score was 3.71±2.38vs. 3.29±2.66 (P=0.116), quality of life score was 7.57±1.60 vs. 5.14±2.75 (P<0.001), and the total NIH-CPSI score was 17.86±3.81vs. 12.00±6.65 (P<0.001), respectively. The severity of chronic prostatitis-like symptoms was alleviated significantly after kidney transplantation. Conclusion Kidney transplantation can alleviate the chronic prostatitis-like symptoms significantly, and improve the quality of life in uremia patients.
Objective To evaluate the efficacy and safety of low-dose versus standard-dose cyclosporine immunosuppressive therapy in kidney transplant recipients. Methods We searched MEDLINE, EMbase, SCI, CBM and The Cochrane Library from the establishment to December 2009 to screen randomized controlled trials (RCTs) of low-dose versus standard-dose cyclosporine immunosuppressive therapy in kidney transplant recipients. Quality assessment and meta-analyses were performed for the included studies. Results A total of 6 RCTs involving 1551 patients were identified, among which 4 RCTs were graded A and two were graded B. The meta-analyses indicated that there were no significant differences between the two groups at the end of 6-month and 12-month follow-up in the acute rejection rate at a RR 1.07, 95%CI 0.69 to 1.65 and a RR 1.06, 95%CI 0.71 to 1.57, respectively. There were no significant differences between the two groups at the end of 6-month and 12-month follow-up in the patients’ death rate at a RR 0.64, 95%CI 0.20 to 2.03 and a RR 0.61, 95%CI 0.30 to 1.24, respectively. There were no significant differences between the two groups in renal function and safety. Conclusion Based on the current evidence, compared with standard-dose CsA, low-dose CsA has the same effect and safety for the short-term results, but the long-term results need to be further studied.
ObjectiveTo compare the outcomes of kidney transplantation (KT) between Tibetan and Han recipients.MethodsPatients greater than 18 years old, who had received the first ABO-compatible KT between April 2006 and March 2017, were retrospectively included. A propensity score matching (PSM) of Tibetans to Hans was performed by 1∶3 ratio. Survival, renal function and adverse events of the two groups were compared.ResultsOf the 1 820 patients who fit the screening criteria, 123 Tibetans and 357 Hans were included after PSM. The median follow-up time was 48 months. There was no statistically significant difference in death-censored grafts survival (P=0.061) or patients survival (P=0.440) between the two groups. The serum creatinine was higher in Tibetans than that in Hans within one year after KT (P<0.05), and the estimated glomerular filtration rate was lower in Tibetans than that in Hans within 5 years after KT (P<0.05), but no difference thereafter (P>0.05). The incidence of delayed graft function in Tibetan patients after operation was higher than that in Han patients (4.9% vs. 1.4%, P=0.037), but there was no significant difference in the incidence of acute rejection, infection, reoperation, or cancer between the two groups (P>0.05).ConclusionTibetans receiving KT achieve excellent and comparable long-term graft and patient survival to Hans, with similar long-term graft function.