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Monitoring immune function after rapid corticosteroid reduction in kidney transplant recipients

Chinese Medical Journal 2011年第5期124卷 679-682页

作者： li shi-hai wang wei hu xiao-peng yin hang ren liang yang xiao-yong liu hang zhang xiao-dong Department of Urology Beijing Chaoyang Hospital of Capital Medical University Beijing 100020 China

Background Long-term use of steroid with large dosage might cause many adverse effects in kidney transplant patients; reducing steroid dosage to a low level for maintenance is helpful in avoiding the side-effects, but meanwhile, acute rejection may rise to be a main concern. The present research monitored the immune function changes and the incidence of acute rejection and infection after rapid steroid reduction to investiclate the safety of this *** A prospective trial was conducted, using tacrolimus and mycophenolate mofetil as the basic immunosuppressive regimen, in addition to antibody induction with basiliximab. Corticosteroid dosage was rapidly reduced to 10 mg/d seven days post-transplantation in the experimental group, and the standard corticosteroid therapy was employed in the control group. Patient immunity was monitored by the Immune Cell Function Assay pre- and two weeks post-transplantation. The incidence of acute rejection and infection were compared between the experimental and control *** Comparison of intracellular adenosine triphosphate （iATP） values detected two weeks post-transplantation for the control group （（324±45） ng/ml） and the experimental group （（345±91） ng/ml） did not reveal a significant difference （P 〉0.05）. The incidence of acute rejection was analogous between groups （P 〉0.05）, while an increased incidence of infection was observed in the control group （53% （n=-16）） versus the experimental group （22% （n=-6）, P 〈0.05）. Overall, recipients in the control group had longer and more recurrent infections than those in the experimental group （P 〈0.05）. Patients in the control group had a lower immune response （（235±35） ng/ml） than those in the experimental group （（286±16） ng/ml） when infection occurred （P 〈0.05）.Conclusion Rapid reduction of steroid early after kidney transplantation does not lead to a significant rise in patient immunity. It is a safe and effective therapy for kidney transplant patients.

关键词： kidney transplantation corticosteroid reduction acute rejection immune cell function assay infection

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A retrospective comparison of the efficacy and safety in kidney transplant recipients with basiliximab and anti-thymocyte globulin

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Chinese Medical Journal 2012年第6期125卷 1135-1140页

作者： wang wei yin hang li xiao-bei hu xiao-peng yang xiao-yong liu hang ren liang wang yong zhang xiao-dong Department of Urology Beijing Chao-Yang HospitalCapital Medical UniversityBeijing 100020China

Background Induction therapy are utilized to achieve an adequate immunosuppression at the time of transplantation. The use of basiliximab or anti-thymocyte globulin （ATG） for induction therapy has significantly reduced the incidence of acute rejection episodes post-transplantation. The purpose of this study was to compare the efficacy and safety of the basiliximab in patients with immuno-induction therapy after kidney transplantation with the ATG. Methods A retrospective analysis was carried out in kidney transplant recipients including 146 patients with the basiliximab and 116 cases with the ATG and the acute rejection, graft function, infective complications and 1-year and 5-year actuarial patient and graft survival after renal transplantation were compared between the two treatment groups. Results There were no statistically significant difference between groups regarding age, sex, cold ischemic time, warm ischemic time, human leukocyte antigen （HLA） matching type between the donor and recipient, lymphotoxin test and the use of immunosuppressive agents. There was no statistical significance regarding the incidence of the acute rejection （9.59% vs. 8.62%, P=0.481） and delayed graft function （10.27% vs. 9.48%, P=0.501） between groups. There were significantly lower lung infection incidence （5.48% vs. 12.93%, P=0.029） in the basiliximab-treated group in comparison with the ATG-treated group. One-year patient and graft survival rates were 98%, 97% for the basiliximab-treated group, and 95%, 73% for the ATG-treated group, respectively. Five-year patient and graft survival rates were 92%, 86% for the basiliximab-treated group and 93%, 72% for the ATG-treated group, respectively. Log rank test showed statistically significant difference with P=0.038 for patients and P=-0.033 for grafts, respectively. There were significantly lower the incidence of granulocytopenia （8.22% vs. 17.24%, P=0.022） and thrombocytopenia （4.11% vs. 19.83%, P=0.000） after transplantation in the b

关键词： basiliximab anti-thymocyte globulin kidney transplantation inducing treatment

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Factors affecting the long-term renal allograft survival

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Chinese Medical Journal 2011年第8期124卷 1181-1184页

作者： wang wei li xiao-bei yin hang yang xiao-yong liu hang ren liang hu xiao-peng wang yong zhang xiao-dong Department of Urology Beijing Chaoyang Hospital CapitalMedical University Beijing 100020 China

Background In the past decades, the one-year graft survival of cadaveric renal allografts has been markedly improved,but their long-term survival has not kept pace. The attrition rate of renal allografts surviving after one year remains almost unchanged. The causes for late graft loss are multiple. The aim of this study was to analyze the predictive factors that impact long-term survival of grafts after kidney *** We retrospectively analyzed 524 kidney transplantation patients who were treated in our hospital between January 1991 and January 2000, including 254 patients who had lived more than 10 years with normal graft function （long survival group）, and 270 cases whose renal graft had survived less than 10 years （control group）. Specifically, we analyzed 10 factors that may potentially affect graft survival by both univariate and Logistic model multivariate analyses to pinpoint the independent risk *** Univariate analyses showed that no significant differences existed in the age or gender of recipients, dialysis time, lymphotoxin levels, or cold ischemia time between the two groups. However, the ratio of delayed graft function and acute rejection, and the uric acid levels of patients in the long survival group were significantly lower than those in the control group （P ＜0.01）. Furthermore, we found that the concentration of cyclosporin A at one year after transplantation and the histocompatibility antigen match of donor-recipients for patients within the long survival group were significantly higher than those in the control group （P ＜0.01 ）. Furthermore, multivariate analyses showed that these four factors were independent risk factors that impact patient *** The ratios of delayed graft function and acute rejection, the concentration of cyclosporin A at one year after transplantation, and serum uric acid levels are very important factors that affect the long-term survival of renal grafts.

关键词： kidney transplantation long-term survival predictive factors

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Protein A immunoadsorption combined with rituximab in highly sensitized kidney transplant recipients

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Chinese Medical Journal 2009年第22期122卷 2752-2756页

作者： yin hang hu xiao-peng li xiao-bei liu hang wang wei ren liang wang yong zhang xiao-dong Kidney Transplantation Program Department of Urology Beijing Chaoyang Hospital Capital Medical University Beijing 100020 China

Background The number of highly sensitized patients is rising, and sensitization can lead to renal transplant failure. The present study aimed to investigate the safety and efficacy of protein A immunoadsorption combined with rituximab （RTX） in highly sensitized recipients of kidney transplants.Methods Seven highly sensitized recipients of living-related renal transplants （4 men and 3 women, mean aged 42.5 years old （range 33-51）） were pretreated with this combination. human leukocyte antigen （HLA） mismatch number was 2-5. Panel reactive antibody （PRA） of class Ⅰwas high in 2 cases and that of class Ⅱwas high in 1 case. All patients were pretreated with immunoadsorption 2-10 times. Immunoglobulin and PRA changes were monitored before and after absorption. The operation was conducted when PRA or immunoglobulin levels were at or below normal levels. Immunosuppressive drugs were provided 3-5 days before the operation, and one dose of RTX （375 mg/m^2） was infused with polyclonal antibody on the day of operation. Postoperative creatinine （Cr）, creatinine clearance rate （Ccr）, PRA ratio, and immunoglobulin changes were monitored.Results All 7 patients had good recovery without delayed graft function. Acute rejection occurred in 3 cases at postoperative days 8, 10, and 14, respectively. The Banff 07 biopsy grades were la in 1 case and lla C4d0 in 2 cases. Successful reversion was achieved after giving methylprednisolone or antithymocyte immunoglobulin ＋ cyclophosphamide. All patients were discharged with normal renal function, mean class Ⅰ PRA was 14% and mean class ⅡPRA was 35%. PRA was completely negative in 3 cases. Conclusion Protein A immunoadsorption combined with RTX can safely reduce the occurrence of humoral rejection in highly sensitized renal transplant recipients.

关键词： renal transplantation highly sensitized protein A immunoadsorption rituximab

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Rituximab induction therapy in highly sensitized kidney transplant recipients

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Chinese Medical Journal 2011年第13期124卷 1928-1932页

作者： yin hang WAN Hao hu xiao-peng li xiao-bei wang wei liu hang ren liang zhang xiao-dong Kidney Transplantation Program Department of Urology BeijingChao-Yang Hospital Capital Medical University Beijing 100020China

Background The number of highly sensitized patients is rising, The present study aimed to investigate the safety and efficacy of rituximab in highly sensitized kidney transplant recipients. and sensitization can lead to renal transplant failure. renal transplantation following induction therapy with Methods Seven highly sensitized kidney transplant recipients who underwent rituximab therapy from December 2008 to December 2009 were retrospectively analyzed. There were 3 men and 4 women, with a mean age of 38.5 years （range, 21-47 years）. The duration of hemodialysis was 3-12 months, with a mean duration of 11 months. For 4 patients, this was the second transplant; the previous graft survival time was 2-11 years, with a mean survival time of 5.8 years. All the female recipients had history of multiple pregnancies, and all patients had previously received blood transfusions. All donors were men, with a mean age of 32.5 years （range, 25-37 years）. In 2 of the 7 patients, both class I and class II of panel reactive antibody were high; the remaining 5 patients showed either high in class I or in class II of panel reactive antibody. The mean panel reactive antibody value was 31% for class I and 51% for class II respectively. The donors and the recipients had the same blood type, with low lymphocyte cytotoxicity ranging from 2% to 5%. The human leukocyte antigen （HLA） mismatch numbers were from 2 to 4. All patients received tacrolimus （0.1 ***^-1 .d^-1） and mycophenolate mofetil （750 mg twice per day） orally 3 days prior to surgery. All patients received a single dose of 600 mg rituximab （375 mg/m^2） infusion on the day before surgery and polyclonal antibody （antithymocyte globulin） on the day of surgery. Postoperative creatinine, creatinine clearance rate, and occurrence of rejection by pathological biopsy confirmation were monitored. Results No patient had delayed graft function after surgery. Two patients had acute rejection, one on day 7 and the other on day 13 post-s

关键词： kidney transplant highly sensitized rituximab

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早期急性排斥反应导致移植肾动脉狭窄的诊治分析

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中华医学杂志 2008年第29期88卷 2056-2058页

作者：尹航张小东胡小鹏李晓北王玮王勇刘航任亮首都医科大学附属北京朝阳医院泌尿外科 100020

目的探讨肾移植术后早期由急性排斥导致移植肾动脉狭窄的治疗方法及疗效。方法回顾经彩色多普勒超声筛查并经动脉造影证实为移植肾动脉狭窄并同时经移植肾穿刺病理证实发生急性排斥反应的3例肾移植患者的治疗过程。结果3例患者造影证实... 详细信息

目的探讨肾移植术后早期由急性排斥导致移植肾动脉狭窄的治疗方法及疗效。方法回顾经彩色多普勒超声筛查并经动脉造影证实为移植肾动脉狭窄并同时经移植肾穿刺病理证实发生急性排斥反应的3例肾移植患者的治疗过程。结果3例患者造影证实移植肾动脉狭窄未予球囊扩张或支架治疗，给予抗排斥治疗，3例患者治疗均取得成功，患者血压和肌酐均较前明显下降，随访B超无狭窄表现。结论彩色多普勒超声可用于移植肾动脉狭窄的筛查和治疗后随访，移植肾动脉造影是其诊断的金标准，急性排斥是引起移植肾动脉狭窄的原因之一，明确动脉狭窄原因为急性排斥后抗排斥治疗是有效的治疗方法。

关键词：肾移植肾动脉狭窄急性排斥抗排斥治疗

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免疫吸附在高致敏肾移植受者中的应用

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中华医学杂志 2010年第36期90卷 2532-2535页

作者：王玮刘航尹航李晓北杨晓勇任亮胡小鹏王勇张小东首都医科大学附属北京朝阳医院泌尿外科 100020

目的探讨蛋白A免疫吸附（IA）治疗在预防高致敏肾移植受者急性排斥反应中的效果和安全性.方法回顾性分析2008年3月至2009年10月首都医科大学附属北京朝阳医院收治的12例群体反应性抗体（PRA）高的肾移植患者在术前应用IA治疗的临床资... 详细信息

目的探讨蛋白A免疫吸附（IA）治疗在预防高致敏肾移植受者急性排斥反应中的效果和安全性.方法回顾性分析2008年3月至2009年10月首都医科大学附属北京朝阳医院收治的12例群体反应性抗体（PRA）高的肾移植患者在术前应用IA治疗的临床资料.比较治疗前后血免疫球蛋白IgG、IgM、IgA及PRA水平.观察患者术后急性排斥反应发生情况及不良反应.结果 12例患者IA治疗次数为3～8次.治疗后PRA Ⅰ和Ⅱ类抗体均较治疗前明显下降[14%（4%,27%）比86%（73%,98%）,6%（0,23%）比68%（34%,88%）,均P＜0.01] 血清总IgG水平较治疗前明显下降[（550±341）g/L比（1301±393）g/L,P＜0.01] IgA和IgM也较治疗前降低[（144±78）g/L比（185±93）g/L,（103±48）g/L比（131±66）g/L,P＜0.01].5例患者在术后发生了急性排斥反应,给予抗胸腺细胞球蛋白（ATG）或联合IA（2例）治疗后均逆转.术后6个月内,1例患者发生烟曲霉菌肺炎,2例出现卡氏肺囊虫肺炎,均治愈.结论 IA治疗可降低高致敏患者体内预存抗体水平.辅以诱导治疗对预防和减轻肾移植术后排斥反应疗效确切.

关键词：肾移植免疫吸附技术群体反应性抗体

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55岁以上活体供肾移植中供受者肾功能的恢复特点

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中华医学杂志 2009年第38期89卷 2702-2704页

作者：胡小鹏尹航张小东王玮任亮杨晓勇李晓北刘航王勇首都医科大学附属北京朝阳医院泌尿外科 100020

目的探讨使用年龄≥55岁的活体供肾肾移植的临床特点、疗效及安全性。方法对北京朝阳医院近年完成的19例供者年龄在55岁以上的活体供肾肾移植手术进行回顾性研究。19例供者平均年龄58岁，肌酐清除率（Ccr）平均（81．7±2．2）ml／min... 详细信息

目的探讨使用年龄≥55岁的活体供肾肾移植的临床特点、疗效及安全性。方法对北京朝阳医院近年完成的19例供者年龄在55岁以上的活体供肾肾移植手术进行回顾性研究。19例供者平均年龄58岁，肌酐清除率（Ccr）平均（81．7±2．2）ml／min；19例受者平均年龄34岁，血液透析时间平均4个月。移植肾术中常规0点穿刺行组织学检查。结果全部供者均平稳度过围手术期，未发生任何手术并发症，血肌酐术后1周均在正常范围内。术后1年血肌酐和Ccr分别与术后1周和6个月时比较差异无统计学意义。血压和血糖无明显变化，尿蛋白（-）。所有受者肾功能早期恢复，无移植物功能延迟恢复（DGF）发生。7例接受Ccr低于80ml／min供者肾源的受者术后血肌酐下降相对缓慢。在19例供肾中，3例。肾小球硬化超过10％。结论肾源紧缺是目前制约肾移植发展的重要因素，放宽对活体供者年龄的限制无疑会扩大。肾源，挽救更多尿毒症患者；高龄供者的活体肾移植是安全可行的。

关键词：肾移植活体供肾边缘供者

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10B-doped MCP detector developed for neutron resonance imaging at Back-n white neutron source

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Nuclear Science and Techniques 2024年第8期35卷 58-68页

作者： Qiang li li‑Jiao wang Jing‑Yu Tang Xiang‑Biao Qiu Zhen Chen Mao‑Yuan Zhao Chang‑Jun Ning Kai Pan wei Xu Tao li Su‑peng Lu Han Yi Rui‑Rui Fan Chang‑Qing Feng Rong zhang xiao‑yang Sun Qi An Hao‑Fan Bai Jiang‑Bo Bai Jie Bao Ping Cao Qi‑Ping Chen yong‑Hao Chen Zeng‑Qi Cui An‑Chuan Fan Fan‑Zhen Feng Min‑Hao Gu Chang‑Cai Han Zi‑Jie Han Guo‑Zhu He yong‑Cheng He yang Hong Yi‑wei hu Han‑Xiong huang wei Jiang Zhi‑Jie Jiang Zheng‑Yao Jin ling Kang Bo li Gong li xiao li yang li Jie liu Rong liu Shu‑Bin liu Yi‑Na liu Guang‑Yuan Luan Jie ren Zhi‑Zhou ren Xi‑Chao Ruan Zhao‑hui Song Kang Sun Zhi‑Xin Tan Sheng‑Da Tang Jin‑Cheng wang peng‑Cheng wang Zhao‑hui wang Zhong‑wei Wen xiao‑Guang Wu Xuan Wu Cong Xia yong‑Ji Yu Guo‑hui zhang hang‑Chang zhang lin‑Hao zhang Qi‑wei zhang Xian‑peng zhang Yu‑liang zhang Yue zhang Zhi‑yong zhang Zhi‑Hao Zhou Ke‑Jun Zhu Chong Zou Institute of High Energy Physics Chinese Academy of Sciences(CAS)Beijing 100049China Spallation Neutron Source Science Center Dongguan 523803China State Key Laboratory of Particle Detection and Electronics Institute of High Energy Physics Chinese Academy of SciencesBeijing 100049China dongguan Songshan Lake Future School Dongguan 523808China School of Nuclear Science and Technology University of Science and Technology of ChinaHefei 230027China State Key Laboratory of Particle Detection and Electronics University of Science and Technology of ChinaHefei 230026China North Night Vision Science and Technology(Nanjing)Research Institute Co.Ltd Nanjing 211106China Department of Modern Physics University of Science and Technology of ChinaHefei 230026China State Key Laboratory of Nuclear Physics and Technology School of PhysicsPeking UniversityBeijing 100871China Institute of Modern Physics Fudan UniversityShanghai 200433China Key Laboratory of Nuclear Data China Institute of Atomic EnergyBeijing 102413China China Academy of Engineering Physics Institute of Nuclear Physics and ChemistryMianyang 621900China USTC archaeometry lab University of Science and Technology of ChinaHefei 230026China Northwest Institute of Nuclear Technology Xi’an 710024China University of Chinese Academy of Sciences Beijing 100049China China shipbuilding Trading Co. LtdBeijing 100044China

Neutron resonance imaging(NRI)has recently emerged as an appealing technique for neutron *** complexity surpasses that of conventional transmission imaging,as it requires a high demand for both a neutron source and ***,the progression of NRI technology has been sluggish since its inception in the 1980s,particularly considering the limited studies analyzing the neutron energy range above *** white neutron source(Back-n)at the China Spallation Neutron Source(CSNS)provides favorable beam conditions for the development of the NRI technique over a wide neutron energy range from eV to ***-sensitive microchannel plates(MCP)have emerged as a cutting-edge tool in the field of neutron detection owing to their high temporal and spatial resolutions,high detection efficiency,and low *** this study,we report the development of a 10B-doped MCP detector,along with its associated electronics,data processing system,and NRI experiments at the *** heavy elements such as gold,silver,tungsten,and indium can be easily identified in the transmission images by their characteristic resonance peaks in the 1–100 eV energy range;the more difficult medium-weight elements such as iron,copper,and aluminum with resonance peaks in the 1–100 keV energy range can also be *** particular,results in the neutron energy range of dozens of keV(Aluminum)are reported here for the first time.

关键词： Neutron resonance imaging 10B doped MCP detector White neutron source Sample nuclide identification

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肾移植后淋巴组织增生性疾病四例并文献复习

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白血病．淋巴瘤 2013年第7期22卷 444-447页

作者：任亮胡小鹏王玮刘航张小东首都医科大学附属北京朝阳医院泌尿外科 100020

目的探讨肾移植后淋巴组织增生性疾病（PTLD）的病理特点、临床表现、诊治及预后.方法回顾性分析4例肾移植后PTLD患者的临床病理资料,并对相关文献进行复习.结果 4例患者肾移植术后均采用三联免疫抑制疗法,移植后至PTLD诊断时间为5～ ... 详细信息

目的探讨肾移植后淋巴组织增生性疾病（PTLD）的病理特点、临床表现、诊治及预后.方法回顾性分析4例肾移植后PTLD患者的临床病理资料,并对相关文献进行复习.结果 4例患者肾移植术后均采用三联免疫抑制疗法,移植后至PTLD诊断时间为5～ 112个月,平均34个月.病理组织学类型：2例早期病变（浆细胞增生和传染型单核细胞增生样PTLD各1例）,1例多形性PTLD,1例单一型PTLD.均无特异性临床表现,确诊后均予免疫抑制剂减量,或辅以利妥昔单抗和化疗.单一型PTLD患者在短期内死亡,余患者均生存.结论 PTLD是发生在器官移植后具有独特形态和临床特征的淋巴组织增生异常；治疗上以免疫抑制剂减量、生物治疗和化疗为主；单一型PTLD预后差.

关键词：肾移植移植后淋巴组织增生性疾病诊断治疗

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