ObjectiveTo conduct a Meta-analysis to determine the clinical effect of protocol biopsy (PB)-monitored therapy after renal transplantation.MethodsPubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Standards Database and VIP Database for Chinese Technical Periodicals were searched for trials comparing the efficacy of timely intervention under PB surveillance with the conventional treatment. The quality of included studies was assessed and Meta-analysis was conducted by RevMan 5.3 software.ResultsSix randomized controlled trials met our inclusion criteria, including 698 cases. No significant difference was found between the PB group and the control group in 1-year [relative risk (RR)=0.99, 95% confidence interval (CI) (0.97, 1.01), P=0.39] and 2-year recipient survival rate [RR=1.00, 95%CI (0.97, 1.02), P=0.72]. Graft survival rate after 1 year [RR=1.01, 95%CI (0.99, 1.04), P=0.29] and 2 years [RR=1.02, 95%CI (0.99, 1.06), P=0.19] were also statistically similar. No statistical difference was found in glomerular filtration rate between the two groups [mean difference (MD)=0.45 mL/(min·1.73 m2), 95%CI (–3.77, 4.67) mL/(min·1.73 m2), P=0.83]. Renal function of PB group, monitored by serum creatinine, was superior to the control group [MD=–0.46 mg/dL, 95%CI (–0.63, –0.29) mg/dL, P<0.000 01]. No statistical difference was found in infection between the two groups [RR=1.23, 95%CI (0.69, 2.19), P=0.48].ConclusionsOur study did not suggest PB for every kidney transplantation recipient. However, long-term randomized controlled trials with larger sample size would be necessary to determine whether PB was effective for specific populations.
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.
Objective To evaluate the short and long term effectiveness and safety of rapamycin-based immunosuppression regimes with CsA preserving versus CsA withdrawal. Methods We searched MEDLINE, EMBASE, The Cochrane Library and CNKI from Jan. 1995 to Dec. 2005. We identified randomized controlled trials of rapamycin-hased immunosuppression regimes with CsA preserving versus CsA withdrawal for renal transplantation patients. The quality of included trials was evaluated by two reviewers. Meta-analysis was conducted on homogeneous studies. Results Ten studies （1 121 patients） undergoing renal transplantation were included. All included studies were graded in term of randomization, allocation concealment and bhnding. Six studies were graded A and the other 4 were graded B. Meta-analysis results showed CsA withdrawal in sirolimus-based therapy in renal transplantation patients survival rate OR.（95% CI ） values were 0,77（0.17, 3.52）, 1.24（0.48, 3.16）, 1.32（0.57, 3.08）, 1.21（0.60, 2.41） at the end of 6, 12, 24, 36 months respectively; renal allografts survival rate OR. （95% CI） values were 1.79 （0.63, 5.06）, 1.15 （ 0.56, 2.36） , 1.39 （0.68, 2.85）, 1.80（0.99, 3.29）, 2. 13（1.16, 3.89）, 2.01（1.15, 3.51） at the end of 6, 12, 24, 36, 48, 54 months respectively; and acute rejection OP,（95% CI） values were 0.92（0.48, 1.78）, 1.90（1.25, 2.89）, 2. 01 （0.94,4.27）, 1.93（0.93, 4.00）, 1.52（0.77, 3.02） at the end of6, 12, 24, 36, 48 months respectively. Conclusions Available evidence shows that compared with CsA preserving, CsA withdrawal in rapamycin-based immunosuppression regimes can lead to higher incidence rates of acute rejection at the end of one year while there is no statistical difference to survival rate of patients/renal allograft in cases with stabilized renal function post-transplantation. And CsA withdrawal is of benefit to allografts for long term survival rate and is helpful to recovery of renal function. Owing to high possibility of selection bias and measurement bias in included studies, there must be a negative impact on evidence intensity of our results. We expect best evidence from with high quality double blind randomized control trials.
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 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.
Objective To evaluate the effectiveness and safety of calcineurin inhibitor (CNI) withdrawal from target-of-rapamycin-inhibitor(TOR-I)-based immunosuppression in kidney transplant recipients. Methods We searched MEDLINE, EMbase, SCI, CBM and The Cochrane Library to screen randomized controlled trials (RCT) of calcineurin inhibitor (CNI) withdrawal from target-of-rapamycin-inhibitor-(TOR-I)-based immunosuppression in kidney transplant recipients. The search was updated in Semptember 2009. The quality of the included trials was assessed. RevMan 5.0 software was used for meta-analyses. Results A total of 14 reports from 10 RCTs were identified. Five RCTs were graded A and five graded B. The meta-analyses indicated: RR (95%CI) values of the 1, 2, 4-year acute rejection rates were 1.64 (1.19, 2.27), 1.53 (1.06, 2.22) and 1.21 (0.73, 1.98), respectively; RD (95%CI) values of 1, 2, 4-year patient survival rates were – 0.01 (– 0.02, 0.01), – 0.00 (– 0.03, 0.02) and 0.03 (– 0.01, 0.08), respectively; RD (95%CI) values of 1, 2, 4-year graft survival rates were 0.00 (– 0.02, 0.02), 0.00 (– 0.03, 0.04) and 0.07 (0.01, 0.12), respectively; and glomerular filtration rate WMD was 9.50 and 95%CI 2.96 to 16.03. Conclusion Based on the current evidence, compared to CNI, CNI withdrawal from sirolimus-based immunosuppression in kidney transplantation could be advantageous for renal function. One-year acute rejection rate and 4-year graft survival rate increase. One-year patient/graft survival and fouryear acute rejection rate remain virtually unvariable. The long-term results need further confirmation.
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.
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 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.
