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ABSTRACT: The diagnosis of extra-pulmonary tuberculosis (TB) seems relatively difficult due to the absence of specific symptoms and signs in patients on peritoneal dialysis or hemodialysis. We report four cases of extra-pulmonary tuberculosis on dialysis, with two cases on peritoneal dialysis and two cases on hemodialysis. The presentations, therapy, and outcomes of TB infection in these patients were reviewed. Otherwise, the English literature published in the PubMed database associating extra-pulmonary tuberculosis on dialysis over the last three decades is reviewed. A total of 61 studies containing 70 cases were included. The most common primary disease was diabetic nephropathy (22.86%, 16/70). The peritoneum (31.42%, 22/70), bone (21.42%, 15/70), and lymph node (20%, 14/70) were the most frequently infected. Single organ infection was common (90%, 63/70). Fever (58.57%, 41/70), pain (35.71%, 25/70), and enlarged lymph node (20%, 14/70) were the most common symptoms. Biopsy (67.14%, 47/70) and culture (40%, 28/70) provided most reliable methods for clear diagnosis of tuberculosis. The combined treatment of isoniazid, rifampicin, pyrazinamide, and ethambutol (44.29%, 31/70) was the most common therapy. The majority of patients improved (82.86%, 58/70); however, 12 cases got worse (17.14%), with 10 of them dying (14.29%). Physicians should be aware of the non-specific symptoms and location of infection, and consider tuberculosis in their differential diagnoses in dialysis patients presenting with symptoms such as fever, pain, and weight loss.
Journal of Zhejiang University SCIENCE B 01/2013; 14(1):76-82. · 1.10 Impact Factor
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ABSTRACT: Increasing evidence indicates that the expression of tumor necrosis factor-α (TNF-α) in myocardium correlates with the severity of cardiac dysfunction in septic shock. The aim of this study was to investigate the impact of high-volume hemofiltration (HVHF) on the expression of TNF-α in myocardium in septic shock pigs. Sixteen male Landrace pigs weighing 31 ± 5 kg were randomly assigned to control group (n = 4), septic shock group (n = 6), and HVHF group (septic shock + HVHF, n = 6). All animals were anesthetized and mechanically ventilated. After baseline examinations, septic shock group and HVHF group underwent induction of peritonitis. One hour later, the animals in HVHF group received treatment with HVHF and the treatment was continued for 12 h. As the control of HVHF group, the animals in septic shock group received the same support but hemofiltration. Twelve hours after HVHF therapy, all the animals were sacrificed. TNF-α and nitric oxide (NO) levels in both circulation and myocardium were measured. Compared with those of septic shock animals, the levels of cardiac output, stroke volume, and mean arterial pressure were better maintained in HVHF group. The expression of TNF-α in myocardium in HVHF group was lower than that in septic shock group (44.17 ± 18.70 vs. 92.50 ± 33.89 pg/mg protein, P = 0.015). The difference of TNF-α in circulation between HVHF group and septic shock group was no significance at different time. However, circulating NO in HVHF group was lower than that in septic shock group. These results suggest that HVHF improves hemodynamics and heart dysfunction in septic shock pigs, which may be attributed to reduction of TNF-α in myocardium but not in circulation.
Artificial Organs 09/2012; · 2.00 Impact Factor
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ABSTRACT: Hemodialysis (HD) patients are at high risk of infection by hepatitis B virus (HBV) or hepatitis C virus (HCV). The present study was designed to determine the impact of quality control measures on the prevention of transmission of blood-borne viruses.
A total of 6182 adult maintenance HD patients from all HD units in Zhejiang Province were recruited on January 1, 2007. The baseline demographic and clinical characteristics were recorded and all patients were followed up until death or survival at 4 years later. The Quality Control Standards of Hemodialysis were gradually implemented in HD units. The HBV or HCV seroconversion rates of the recruited patients were calculated and compared every year during the observation period.
The prevalence of HBV was 8.3% at the beginning of the study, and 6.6% for HCV. With the implementation of the HD quality control measures, the HBV seroconversion rate tended to decrease year by year (X2=6.620, P=0.085), and the HCV seroconversion rate decreased significantly (X2=10.41, P=0.015). Compared with the data in 2007, the HBV seroconversion rate (X2=4.204, P=0.040, relative risk ratio 0.393, 95% CI 0.156-0.991) and the HCV seroconversion rate (X2=7.373, P=0.007, relative risk ratio 0.386, 95% CI 0.189-0.787) decreased significantly in 2010.
Quality control measures for HD decreased the seroconversion rates of HBV or HCV in HD patients, showing that updated quality control measures reduce the risk for transmission of blood-borne viruses in the HD population.
Hepatobiliary & pancreatic diseases international: HBPD INT 06/2012; 11(3):302-6. · 1.08 Impact Factor
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ABSTRACT: Enhancement of stem cell Ag-1 (Sca-1) expression by myeloid precursors promotes the granulopoietic response to bacterial infection. However, the underlying mechanisms remain unclear. ERK pathway activation strongly enhances proliferation of hematopoietic progenitor cells. In this study, we investigated the role of Sca-1 in promoting ERK-dependent myeloid lineage proliferation and the effects of alcohol on this process. Thirty minutes after i.p. injection of alcohol, mice received i.v. challenge with 5 × 10(7) Escherichia coli for 8 or 24 h. A subset of mice received i.v. BrdU injection 20 h after challenge. Bacteremia increased Sca-1 expression, ERK activation, and proliferation of myeloid and granulopoietic precursors. Alcohol administration suppressed this response and impaired granulocyte production. Sca-1 expression positively correlated with ERK activation and cell cycling, but negatively correlated with myeloperoxidase content in granulopoietic precursors. Alcohol intoxication suppressed ERK activation in granulopoietic precursors and proliferation of these cells during bacteremia. Granulopoietic precursors in Sca-1(-/-) mice failed to activate ERK signaling and could not increase granulomacrophagic CFU activity following bacteremia. These data indicate that Sca-1 expression promotes ERK-dependent myeloid cell proliferation during bacteremia. Suppression of this response could represent an underlying mechanism for developing myelosuppression in alcohol-abusing hosts with severe bacterial infection.
The Journal of Immunology 02/2012; 188(4):1961-9. · 5.79 Impact Factor
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ABSTRACT: Acute kidney injury (AKI) is a major complication in patients with sepsis and is an independent predictor of mortality. However, the optimal intensity of renal replacement therapy for such patients is still controversial.
From 1 January 2004 to 30 September 2009, we randomly assigned 280 patients with sepsis and AKI to continuous renal replacement therapy by high-volume hemofiltration (50 mL/kg/h, HVHF) or extra high-volume hemofiltration (85 mL/kg/h, EHVHF). The primary study outcome was death from any cause within 28, 60 and 90 days. Results were analyzed by univariate and multivariate methods and by Kaplan-Meier survival curves.
A total of 141 patients were given EHVHF and 139 were given HVHF. The two groups had similar baseline characteristics and received treatment for an average of 9.38 days (EHVHF group) and 8.88 days (HVHF group). There were no significant differences between the groups in number of deaths at 28, 60 or 90 days. There were also no differences between the groups in renal outcome of survivors at 90 days. Multivariate analysis indicated that inotropic support by norepinephrine, time in hospital of >7 days, blood platelet count <8 × 10(9)/L, Acute Physiological and Chronic Health Evaluation (APACHE) II score >25, total bilirubin >100 μmol/L, prothrombin time >18 s, serum creatinine <250 μmol/L and blood urea nitrogen >20 mmol/L were independent risk factors for death at 90 days after initiation of renal replacement therapy.
In patients with sepsis and AKI, increasing the intensity of renal replacement therapy from 50 (HVHF) to 85 mL/kg/h (EHVHF) had no effect on survival at 28 and 90 days.
Nephrology Dialysis Transplantation 09/2011; 27(3):967-73. · 3.40 Impact Factor
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ABSTRACT: To determine whether the main mitochondrial DNA (mtDNA) haplogroups of the Han people are associated with neurological recovery from septic encephalopathy.
We studied 137 individuals with septic encephalopathy who were sequentially admitted to the intensive care unit or the emergency intensive care unit at the First Affiliated Hospital, College of Medicine, Zhejiang University, and the People's Hospital of Zhejiang Province. Demographic and clinical data were recorded along with clinical outcome over 28 days. The Glasgow coma scale (GCS) score was calculated daily until it reached 15 or until the patient died during the 28-day period. Follow-up was completed for all study participants. We then determined the mtDNA haplogroups of the patients by analyzing sequences of hypervariable mtDNA segments and testing diagnostic polymorphisms in the mtDNA coding region with DNA probes.
MtDNA haplogroup R, one of the main mtDNA haplogroups of the Han people, was a strong independent predictor of outcome following septic encephalopathy, conferring a 4.053-fold (95% CI 1.803-9.110, p = 0.001) increased chance of neurological recovery within 28 days compared with those with a non-R mtDNA haplogroup.
In the Han population, mtDNA haplogroup R is a strong independent predictor of the outcome of septic encephalopathy, conferring an increased chance of neurological recovery compared with individuals with a non-R haplogroup. Our results provide potential insights into the mechanisms involved in septic encephalopathy, and reveal that the mtDNA haplogroup R is an independent predictor of the outcome of septic encephalopathy.
European Journal of Intensive Care Medicine 08/2011; 37(10):1613-9. · 5.17 Impact Factor
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ABSTRACT: The aim of the study was to evaluate the effect of high-flux (HF) hemodialysis (HD) on delayed protective hepatitis B virus (HBV) antibody seroconversion in HD patients who had no response to the classic third dose of HBV vaccination.
We performed a prospective cohort study. Forty-two patients who did not respond within 6 months after the third dose of the vaccination were enrolled in the study. The patients were randomized to either an HF HD treatment group (n =19) or a conventional HD treatment group (n = 23). Patients' serum hepatitis B surface antibody levels were followed monthly.
After 6 months of follow-up, there were 15 (78.9%) patients in HF group and 7 (30.4%) patients in the control group showing delayed HBV vaccination response. The level of antibody titer of HBV vaccination responders was 103.6 ± 48.3 mIU/mL in the HF group and 23.5 ± 15.7 mIU/mL in the control group. The antibody titer did not correlate with sex, age, serum albumin, or hemoglobin in either group. Four patients in control group lost HBV vaccination response > 2 times after 3 months of follow-up, whereas no patients in the HF group lost HBV vaccination response.
Hemodialysis patients who do not respond to the classic third dose of HBV vaccination could reobtain a delayed higher protective HBV antibody seroconversion rate by HF HD without other intervention.
Postgraduate Medicine 05/2011; 123(3):150-2. · 1.78 Impact Factor
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ABSTRACT: Mitochondrial DNA (mtDNA) haplogroup discrimination is interesting not only for phylogenetic and clinical but also for forensic studies. We discriminated the mtDNA haplogroups of 570 healthy unrelated Han people from Zhejiang Province, Southeast China, by comprehensive analysis mutations of the hypervariable segments-I sequence and diagnostic polymorphisms in mtDNA coding region using real-time polymerase chain reaction (RT-PCR), which was compared with the widely used PCR and restriction fragment length polymorphism (PCR-RFLP) method. The results showed that in superhaplogroup M, haplogroup D was the most common haplotype within this assay to 24.6%, and in the other superhaplotype N, haplogroup B and F were the most common groups. Samples re-identified by PCR-RFLP showed the consistent results that were got with RT-PCR. In conclusion, the RT-PCR strategy appears to be an accurate, reproducible, and sensitive technique for the discrimination of mtDNA haplogroups, especially for mass screenings quickly and economically.
Journal of Forensic Sciences 04/2011; 56(3):586-90. · 1.23 Impact Factor
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ABSTRACT: To evaluate the efficacy of adjunctive continuous high-volume hemofiltration (HVHF) in patients with severe acute pancreatitis.
Seventy-five patients admitted to the intensive care unit for severe acute pancreatitis from July 2006 to May 2009 were given informed consent and were followed prospectively. Patients were divided into 4 groups according to whether they accepted continuous HVHF (42 vs 33) and if they showed signs of acute kidney injury.
Patients of the 4 groups were comparable at baseline. The 28-day survival rate was higher in patients who accepted HVHF (81% vs 57.6%, P=0.026), especially in those without acute kidney injury (95% vs 66.7, P=0.026). Furthermore, after 72 hours of therapy, the patients who accepted HVHF had significantly better Acute Physiology and Chronic Health Evaluation II scores (16.8±4.37 vs 13.39±3.17; P<0.05), body temperature (38.2°C±1.01°C vs 37.73°C±0.95°C; P<0.05), urine volume (1186±841 mL vs 2381±2462 mL; P<0.05), and base excess (-6.3±4.5 vs 0.64±3.4; P<0.05). However, the improvement in patients who did not accept HVHF was not so obviously.
High-volume hemofiltration was associated with improved clinical outcome in acute pancreatitis patients, and should be initiated before kidney injury appearance.
Pancreas 10/2010; 40(1):109-13. · 2.39 Impact Factor
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ABSTRACT: The renin-angiotensin system (RAS) plays a critical role in chronic renal failure associated with heart failure. In the past few years, angiotensin (Ang) (1-7) have been reported to counteract the effects of angiotensin II (Ang II) and were even considered as a new therapeutical target in RAS. The purposes of this study were to examine whether the Ang (1-7) improves the heart function and remodeling of the left ventricle (LV) in mice with 5/6 nephrectomy (NC). We used a 5/6 nephrectomy to induce significant renal dysfunction in wildtype mice (WT). Twelve weeks after NC, WT showed high blood pressure, significant left-ventricular dilation and dysfunction, which were accompanied by cardiomyocyte hypertrophy, diffuse interstitial fibrosis and oxidative damage of cardiomyocytes. Exogenous Ang (1-7) injection improved the heart function and remodeling of LV in mice with 5/6 NC accompanied by a reduction in cardiac interstitial fibrosis, inflammatory cytokine expression and oxidative damage levels of cardiomyocytes, decrease in the profibrotic signaling molecule transforming growth factor (TGF)-beta and increase in the collagen degradation signaling molecule matrix metalloproteinase (MMP)-2, -9. However, these beneficial effects did not occur in hydralazine-treated mice. These findings suggest that (1) Exogenous Ang (1-7) injection improve the heart function and remodeling of LV in mice with 5/6 NC. (2) These beneficial effects are independent of its anti-blood pressure effect.
Hypertension Research 04/2009; 32(5):369-74. · 2.58 Impact Factor
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ABSTRACT: Catheter-related infection (CRI) is associated with increased all-cause mortality and morbidity in hemodialysis patients and may be reduced by using antimicrobial lock solutions. But the safety of long-term use of antimicrobial lock still needs to be defined.
Patients with a new inserted permanent tunneled cuffed hemodialysis catheter were randomly assigned to an antibiotic lock solution of gentamicin (4 mg/ml) heparin (G group) or heparin alone (H group).
A total of 140 patients were enrolled in this study. CRI rates were 0.06/1,000 catheter-days for the G group versus 0.67 in the H group (p = 0.014). The risk of CRI was 10.54 higher in patients with a heparin-alone locked catheter (p = 0.025) than that with gentamicin. The serum-measured gentamicin levels were very low.
Gentamicin lock solution reduces CRI and improves catheter survival rates in hemodialysis patients. It is relatively safe in strictly catheter-restricted antibiotic lock solution therapy.
Blood Purification 02/2009; 27(2):206-11. · 2.10 Impact Factor
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ABSTRACT: OBJECTIVE. To evaluate the efficacy of continuous high-volume hemofiltration for the treatment of severe acute pancreatitis patients and the impact of acute physiology and chronic health evaluation (APACHE) II score on the efficacy of high-volume hemofiltration. MATERIAL AND METHODS. A total of 63 patients diagnosed with severe acute pancreatitis between January 2005 and July 2007 were retrospectively analyzed: 34 accepted adjunctive continuous high-volume hemofiltration (HVHF group); and 29 only accepted conventional recommended treatments (control group). RESULTS. There were no differences in physiological characteristics between the two groups when entering the intensive care unit. After treatment, the percentages of patients successfully weaned from mechanical ventilation (p = 0.004) and who experienced renal function recovery (p = 0.046) were significantly higher in the HVHF group than in the control group. The 28-day survival rate was 91.2% in the HVHF group, compared with 65.5% in the control group (p = 0.014). For patients with APACHE II scores > 15, survival was significant higher in the HVHF group than in the control group (87.5% vs 50%; p = 0.044). No difference in survival was found in patients with APACHE II scores < or = 15 between the two groups (94.4% vs 76.5%; p = 0.177). After HVHF therapy, APACHE II score, body temperature, urine volume and laboratory indices, including serum creatinine, base excess and blood calcium, were significantly improved. CONCLUSIONS. Adjunctive continuous HVHF was beneficial for the survival of severe acute pancreatitis patients. Survival improvement was significant in patients with APACHE II score > 15.
Scandinavian journal of gastroenterology 01/2009; 44(11):1363-9. · 2.08 Impact Factor
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ABSTRACT: To determine whether the main mitochondrial DNA (mtDNA) haplogroups of the Han people have an impact on long-term clinical outcome.
We prospectively studied 181 individuals who were sequentially admitted to the intensive care unit. Demographic and clinical data were recorded along with clinical outcome over 180 days. Follow-up was completed for all study participants. We then determined the mtDNA haplogroups of the patients and 570 healthy, age-matched Han people from Zhejiang province, Southeast China, by analyzing sequences of hypervariable mtDNA segments and testing diagnostic polymorphisms in the mtDNA coding region with DNA probes.
The frequency of the main subhaplogroups of the Han population in the study cohort did not differ significantly from the control group. mtDNA haplogroup R, one of the three main mtDNA haplogroups of the Han people, was a strong independent predictor for the outcome of severe sepsis, conferring a 4.68-fold (95% CI 1.903-10.844, P = 0.001) increased chance of survival at 180 days compared with those without the haplogroup R.
In the Han population, mtDNA haplogroup R was a strong independent predictor for the outcome of severe sepsis, conferring an increased chance of long-term survival compared with individuals without the R haplogroup.
Genetics in medicine: official journal of the American College of Medical Genetics 04/2008; 10(3):187-92. · 3.92 Impact Factor
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ABSTRACT: Granulocyte colony-stimulating factor (G-CSF) has been shown to exert protective effects in various tissues and experimental models of ischaemia-induced injury. However, the mechanism of renoprotective action in ischaemia/reperfusion (I/R) renal injury of G-CSF was unknown.
Male C57BL/6J mice, subjected to renal ischaemia for 45 min, 48 h and 7 days reperfusion, were administered either saline, wortmannin, G-CSF, and G-CSF plus wortmannin 3 days prior to I/R. Saline-treated group served as the control. At 48 h and 7 days of reperfusion, the mice were killed.
Significantly, renal dysfunction and morphological injury were identified at 48 h and 7 days after I/R. Wortmannin pretreatment worsened the renal injury significantly. However, G-CSF pretreatment significantly attenuated renal injury, reduced the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling-positive ratio of renal tubular epithelial cells and inflammation cytokine expression in the kidney. Moreover, G-CSF pretreatment inhibited the expression of Bax and increased the expression of bcl-2 and p-Akt in the kidney. Wortmannin blunted the beneficial effects of G-CSF.
The cytoprotective action of G-CSF against I/R injury seems to be associated with its anti-apoptotic action mediated by upregulation of p-Akt signal pathway.
Nephrology 04/2008; 13(6):508-16. · 1.31 Impact Factor
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ABSTRACT: To explore the influence of early completely reversal vascular rejection on late rejection.
The data of 1062 patients who received their first cadaveric transplants between May 1988 and March 2003 were analyzed respectively. The patients were divided into 2 groups: group with vascular rejection occurring within 1 month postoperatively (n = 45), and group without vascular rejection (n = 1017). Follow up was performed for at least 6 months. The influence of demographic characteristics (transplant age, sex), transplant variables (complement dependent cytotoxicity test, cold/warm ischemia time), and post-transplant variables (immunosuppressive agents for the prevention of acute rejection,) were analyzed.
There were no differences in the age at transplantation, sex, complement dependent cytotoxicity test, cold/warm ischemia time, immunosuppression agent protocol, and serum creatinine during follow-up between the recipients of these two groups. Late rejection, including acute interstitial rejection, borderline rejection, and chronic rejection, occurring one month after transplantation was 2.22% (1/45) in the vascular rejection group, significantly lower than that of the no vascular rejection group (12.59%, 128/1017, P = 0.034)
Early completely reversal vascular rejection can reduce the rate of late rejection.
Zhonghua yi xue za zhi 03/2005; 85(5):332-4.
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Jianghua Chen,
Lihui Qu,
Jianyong Wu,
Yiming Wang,
Jianguo Zhang,
Zhangfei Shou,
Huiping Wang,
Hongfeng Huang,
Qiang He, Ping Zhang,
Xiaohui Zhang,
Zong Zhu
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ABSTRACT: During the last 29 years the dramatic changes that have taken place in our transplant programs and in solid organ transplantation permit us to face tomorrow with courage and confidence. In the future we will be deeply concerned that the long-term benefit of more effective immunosuppression or novel strategies might be unfavorably impacted by the tendency to use organs whose intrinsic lifespan may be limited. We are deeply concerned by the inexorably increasing discrepancy between supply and demand for deceased kidneys, especially for the added morbidity that this inevitably entails for those patients with ESRD who do not have live donors. Our program continues to seek better ways to improve survival and the quality of the life of our patient population.
Clinical transplants 01/2005;
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ABSTRACT: To observe the incidence of long-term venous indwelling catheter related complications in hemodialysis patients and to report our clinical approach to the complications.
A hundred eleven hemodialysis patients was prospectively studied from Jan. 2001 to Mar. 2003, in whom the venous indwelling catheter had been in place for more than 6 months. Catheter related complications were observed over a total period of 1090 patients months, with a mean period of 9.8 months (6 - 27 months).
The incidence of hematoma was 8.1% (9/111), and that of catheter malposition was 4.5%. There was no hemothorax, pneumothorax, air embolism or veinous laceration. Six episodes of catheter related infection were observed during the observation, with an incidence of 5.4%; two cases with bacterial infection were successfully treated; while among the 4 cases with fungal infection, one was successfully treated and catheters were removed in other 3 cases for uncontrolled infection. The incidence of catheter thrombosis was 18.9% (21/111) and the catheter had been used for a mean period of 36 days (6 - 725 days) from placement to thrombosis. Catheter patency was restored in 95.2% (20/21) by urokinase infusion. Recurrent thrombosis occurred in 18 of 20 catheters (90.0%), of which 5 worked functionally following anti-platelet therapy and 13 had recurrent thrombosis. Following anticoagulation by warfarin, 9 became functional (69.2%), but the other 4 cases turned to other vascular access. Urokinase infusion followed by anticoagulation had prolonged the mean catheter life-time for 6 months (3 - 18 months).
Cuffed dual lumen catheter as permanent access is safe and effective. Catheter thrombosis is the most common complication. Urokinase infusion followed by anticoagulation can significantly prolong the catheter life-time.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 04/2004; 43(3):198-200.
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ABSTRACT: To assess the impact of the number, and time of acute rejection (AR) and outcome of anti-rejection therapy on the long-term survival of renal allografts and the relative risk factors.
The Kaplan-Meier analysis and log-rank test were used to calculate the survival rates of patients and grafts in no acute rejection group (NAR, 895 patients), 1 rejection episode group (1AR, 183), 2 and more than 2 rejection episodes group (2AR, 17), acute rejection group [AR (1AR + 2AR), 200], early acute rejection group (within 90 days after transplantation, EAR, 125), late acute rejection group (91 days later, LAR, 58), completely AR reversed group (CAR, 105), and incompletely AR reversed group (IAR, 68). The relative risk factors were analyzed by the Cox proportional hazards regression.
The 5- and 10-year survival rates of renal allografts were 75.4% and 17.1% in AR and 93.2% and 86.5% in the NAR group (P < 0.0001). The long-term graft survival was much lower in the 2AR group than in the NAR or 1AR groups (P < 0.0001 and P = 0.002, respectively). It was similar in either the NAR or CAR groups (P = 0.31), but it was significantly lower (P < 0.0001) in the IAR group. Multivariate Cox regression analysis revealed that the outcome of anti-rejection therapy is an important risk factor affecting the long-term survival of allografts.
AR is significantly associated with poor long-term survival of renal allografts. But the long-term graft survival of patients with one acute rejection but completely reversed is not significantly different from that of patients without acute rejection.
Chinese medical journal 11/2003; 116(11):1741-5. · 0.86 Impact Factor
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ABSTRACT: To assess the influence of times and duration of acute rejection episodes and the effect of antirejection therapy in renal transplantation recipients on the long-term survival of renal allograft.
The clinical data of 946 patients who received renal transplantation were analyzed to analyze the survival of renal allograts in different conditions: times of rejection episode, time of onset of acute rejection, and effect of antirejection therapy by life table and Wilcoxon test, and to identify the risk factors through Cox regression analysis.
During the follow-up with a range of 3 approximately 158 months acute rejection occurred in 172 patients. The 946 cases of kidney transplantation were divided into rejection free group (NAR, n = 774), one time rejection group (1AR, n = 159), and twice and more rejection group (2AR, n = 13) according to the times of rejection. The 1AR group was subdivided into completely reversed group (CAR) and incompletely reversed group (1AR). The 1AR cases were subdivided into early-stage rejection group (EAR, with episode within 90 days after transplantation, n = 112) and late-stage rejection group (LAR, with episode 90 days later transplantation, n = 47) according to the onset time of rejection episode. The five-year survival rate was 70.9% in the AR group (n = 172) and was 93.3% in the NAR group (P < 0.000 1). The ten-year survival rate of renal allografts was 29.8% in the AR group, and was 83.3% in the NAR group (P < 0.000 1). The 5-year survival rate of renal allograft was less than 30% in the 2AR group, significantly lower than those in the NAR and IAR groups (P < 0.000 1 and P< 0.003). The 5-year survival rate of renal allograft was 89.0% in the EAR group, significantly higher than that in the LAR group (48.9%, P < 0.000 1). The 8-year survival rate was 84.3% in the EAR group, significantly higher than that in the LAR group (32.1%, P < 0.000 1). Both the survival rates of renal allograft in the EAR and LAR groups were significantly lower than that in the NAR group (P = 0.025 and P < 0.000 1). The condition had been completely reversed in 95 patients and incompletely reversed in 54 patients, and failed to be improved in 10 patients out of the 159 cases in the IAR group after antirejection therapy. The 5-year survival rate of renal allograft was 93.9% in the CAR group, significantly higher than that in the IAR group (63.1%, P < 0.000 1) but not significantly different from that in the NAR group (P = 0.96). The 8-year survival rate of renal allograft was 89.2% in the CAR group, significantly higher than that in the IAR group (41.4%, P < 0.000 1) but not significantly different from that in the NAR group (P = 0.96). The time of rejection onset was not the main factor effecting survival rate of grafts. The main risk factor influencing the long-term survival of renal allograft was the therapeutic effect after the onset of rejection with a risk rate of 3.14.
The acutely rejected renal allografts have poor long-term survival. The long-term survival rate of renal allograts with acute rejection that occurs only once and is completely recovered after antirejection therapy is not significantly different from that of the renal allografts in NAR group.
Zhonghua yi xue za zhi 01/2003; 83(2):106-9.
