Turun Song

Calcineurin Inhibitors Associated Posterior Reversible Encephalopathy Syndrome in Solid Organ Transplantation: Report of 2 Cases and Literature Review.

AbstractPosterior reversible encephalopathy syndrome (PRES) is a rare neurologic side effect of calcineurin inhibitors (CNIs) with poorly understood clinical features.We report cases of 2 patients with PRES developing after kidney transplantation and summarize PRES clinical features through a literature review.The 1st case was a 28-year-old man who received a kidney transplant from a deceased donor. Initial immunosuppressive therapy consisted of tacrolimus/mycophenolate mofetil/prednisolone. He developed headache and blurred vision with visual field loss15 days after transplantation and generalized seizures 4 days later. The 2nd case was a 34-year-old man who received a living kidney transplant. His initial immunosuppressive therapy comprised tacrolimus/mycophenolate mofetil/prednisolone. Two months after transplantation, he developed seizures. Both patients were diagnosed with PRES based on neurological symptoms and magnetic resonance imaging (MRI) findings; they recovered after switching from tacrolimus to either a cyclosporine or a lower tacrolimus dose. CNI-associated PRES is an acute neurological syndrome with seizures, encephalopathy, visual abnormalities, headache, focal neurological deficits, and nausea/vomiting. It is always accompanied by hypertension. A fluid-attenuated inversion recovery signal MRI scan typically shows reversible subcortical white matter changes in the posterior cerebral hemisphere that usually occur within the 1st month after transplantation. CNI-associated PRES has a generally favorable prognosis with early diagnosis and prompt treatment including alternating or discontinuing CNIs and blood pressure control.CNI-associated PRES should be considered in patients exhibiting acute neurological symptoms after transplantation. Early diagnosis and immediate treatment are critical for a favorable prognosis.

Circumcision with "no-flip Shang Ring" and "Dorsal Slit" methods for adult males: a single-centered, prospective, clinical study

This paper was aimed to compare the clinical effectiveness and safety of adult male circumcision using the Shang Ring™ (SR) with the no-flip technique compared with Dorsal Slit (DS) surgical method. A single-centered, prospective study was conducted at the West China Hospital, where patients were circumcised using the no-flip SR (n = 408) or the DS (n = 94) procedure. The adverse events (AEs) and satisfaction were recorded for both groups, and ring-removal time and percentage of delayed removals were recorded for the SR group. Finally, complete follow-up data were collected for 76.1% of patients (SR: n = 306; DS: n = 76). The average ring-removal time for the SR group was 17.62 ± 6.30 days. The operation time (P < 0.001), pain scores during the procedure (P < 0.001) and at 24 h postoperatively (P < 0.001), bleeding (P = 0.001), infection (P = 0.034), and satisfaction with penile appearance (P < 0.001) in the SR group were superior to those in the DS group. After two postoperative weeks, the percentage of patients with edema in the SR group (P = 0.029) was higher but no differences were found at 4 weeks (P = 0.185) between the two groups. In conclusions, the no-flip SR method was found to be superior to the DS method for its short operation time (<5 min), involving less pain, bleeding, infection, and resulting in a satisfactory appearance. However, the time for recovery from edema took longer, and patients may wear device for 2-3 weeks after the procedure.

Androgen-deprivation therapy alone versus combined with radiation therapy or chemotherapy for nonlocalized prostate cancer: a systematic review and meta-analysis

In this paper, we reviewed the long-term survival outcomes, safety, and quality-of-life of androgen-deprivation therapy (ADT) alone versus combined with radiation therapy (RT) or chemotherapy for locally advanced and metastatic prostate cancer (PCa). A literature search was performed using OvidSP. Randomized controlled trials (RCTs) that met the following criteria were included: including locally advanced or metastatic PCa, comparing ADT alone versus combined with any treatment method and reporting quantitative data of disease control or survival outcomes. Finally, eight RCTs met the inclusion criteria. Among these, three compared ADT versus ADT plus RT (n = 2344) and one compared ADT versus ADT plus docetaxel-estramustine (n = 413) in locally advanced PCa; two compared ADT versus ADT plus docetaxel (n = 1175) and two compared ADT versus ADT plus estramustine (n = 114) in metastatic PCa. For locally advanced PCa, the addition of RT to long-term ADT can improve the outcomes of survival and tumor control with fully acceptable adverse effects. Specially, the pooled odds ratio (OR) of overall survival (OS) was 1.43 (95% confidence interval 1.20-1.71) when compared ADT plus RT with ADT alone (P < 0.0001). For metastatic hormonally sensitive PCa, the concurrent use of docetaxel plus ADT was effective and safe (pooled OR of OS: 1.29 [1.01-1.65]: P = 0.04). In all, long-term ADT plus RT and long-term ADT plus docetaxel should be considered as proper treatment option in locally advanced and metastatic hormonally sensitive PCa, respectively. The major limitation for the paper was that only eight RCTs were available.

Fluoroquinolone prophylaxis in preventing BK polyomavirus infection after renal transplant: A systematic review and meta-analysis.

Previous studies regarding the prevention of BK viremia following renal transplantation with fluoroquinolone have yielded conflicting results. The purpose of this systematic review was to examine the evidence regarding the efficacy of fluoroquinolone in preventing BK polyomavirus infection following renal transplantation. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for research articles published prior to January 2015 using keywords such as “fluoroquinolone,” “BK viremia,” and “renal transplantation.” We extracted all types of study published in English. The primary outcome was BK viremia and viruria at 1 year post‐transplantation. Secondary outcomes were BK virus‐associated nephropathy (BKVN), graft failure, and fluoroquinolone‐resistant infection. We identified eight trials, including a total of 1477 participants with a mean duration of fluoroquinolone prophylaxis of >1 month. At 1 year, fluoroquinolone prophylaxis was not associated with a decreased incidence of BK viremia [risk ratio (RR), 0.84; 95% confidence interval (95% CI), 0.58–1.20). No significant differences in BKVN (RR, 0.88; 95% CI, 0.37–2.11), risk of graft failure due to BKVN (RR, 0.68; 95% CI, 0.29–1.59), or fluoroquinolone‐resistant infection (RR, 1.08; 95% CI, 0.64–1.83) were observed between the fluoroquinolone prophylaxis and control groups. The results of this study suggest that fluoroquinolone is ineffective in preventing BK polyomavirus infection following renal transplantation.

Kidneys from Older Living Donors Provide Excellent Short and Intermediate Outcomes--A Single China Center's Experience.

Background Transplantation with kidneys from older living donors is on the rise, yet controversy still exists over whether the outcomes are as satisfactory as with kidneys from younger donors. Methods We retrospectively analyzed 1009 living donor kidney transplants performed at our center between 2006 and 2013. Graft and patient outcomes were compared between transplants with kidneys from old living donors (OLD, 55-65 years) (n = 264) and from young living donors (YLD, <55 years) (n = 745). Results The age was 32.80 ± 9.71 years and 33.91 ± 5.98 years for recipient in YLD and OLD group, respectively. Death-censored graft survival at 1, 3, and 5 years was 98.8%, 97.1%, and 95.8% in patients receiving YLD kidneys, similar to the corresponding values of 97.6%, 95.5% and 95.5% in patients receiving OLD kidneys (P = 0.356). Patient survival at 1, 3, and 5 years after transplantation was also similar for patients receiving YLD kidneys (98.5%, 97.1%, and 96.7%) and for patients receiving OLD kidneys (99.6%, 99.6%, and 96.8%; P = 0.110). The OLD kidneys were not associated with increased risk of death-censored graft failure (hazard ratio, 2.5; 95% confidence interval, 0.57 to 11.11) and patient death (hazard ratio, 1.67; 95% confidence interval, 0.75 to 3.73). In addition, there is no increased graft loss or patient death for each 10-year increase in donor age. Transplantation with OLD kidneys was not associated with reduced patient or graft outcomes in the short term (⩽12 months) or medium term (>1 year). Conclusions Graft and patient outcomes after living-donor kidney transplantation are similar in the short-term and medium-term for donors aged 55 to 65 years and for younger donors. Therefore, the use of OLD kidneys should be encouraged in China.

Stilamin in the Treatment of Lymphatic Leaks After Living-Related Renal Transplantation

OBJECTIVE This study evaluated the safety and efficacy of Stilamin (Somatostatin) in the treatment of lymphatic leaks after living-related renal transplanatation. METHODS Twenty-four patients with lymphatic leaks after kidney transplantation were recruited. All patients were treated with Stilamin and the drainage recorded. RESULTS The incidence of lymphatic leaks after kidney transplantation was 3.5% usually occurring in 3-9 days after operation. Stilamin decreased the drainage dramatically and shortened the time of wound healing. In most cases, lymphatic fluid outflow was reduced by 50% after 1 day of stilamin treatment. No major adverse reactions were found except temporary hyperglycemia. CONCLUSIONS Stilamin administration is a safe and effective treatment for lymphorrhea after kidney transplanation.

Short-term therapeutic drug monitoring of mycophenolic acid reduces infection: a prospective, single-center cohort study in Chinese living-related kidney transplantation.

The role of therapeutic drug monitoring (TDM) of mycophenolic acid (MPA) in kidney transplant recipients (KTRs) is not clear. We performed a prospective cohort study to evaluate the efficiency of MPA TDM in the Chinese population.

Factors affecting willingness to receive a kidney transplant among hemodialysis patients in West China: A cross-sectional survey

Abstract Many factors are associated with the willingness of ESRD patients to receive a kidney transplant. No data are available for patients in China. The study aim was to describe the attitudes toward transplantation in a cohort of patients at a single dialysis center in China. A study questionnaire derived from previously published literature was completed by 239 hemodialysis outpatients. Factors associated with willingness to receive a transplant were identified by univariate and multivariate logistic regression analyses. The respondents were primarily men 50.7 ± 15.1 years of age; 46.4% were willing to receive a transplant. Younger age (OR = 0.928, 95% CI: 0.898–0.959), good self-reported health (OR = 0.203, 95% CI: 0.081–0.51), and awareness of the benefits of transplantation (OR = 0.195, 95% CI: 0.083–0.456) were less likely to deny the transplant. Patients ⩽60 years of age were about 13 times more likely to favor transplantation than those >60 years of age (OR = 12.99, 95% CI: 3.75–45.45). For every 10 years under 60, participants were 2.16 times more willing to receive a kidney transplant (OR = 2.16, 95% CI: 1.53–3.02). Older patients were also less likely to be referred for evaluation (OR = 0.955, 95% CI: 0.923–0.989, P = .009). The percentage of ESRD patients in China, particularly older patients, who are willing to accept a transplant, is relatively low. A better understanding of the benefits of transplantation is needed to increase their acceptance.

Assessment of intrarenal oxygenation in renal donor with blood oxygenation level-dependent magnetic resonance imaging.

OBJECTIVE To examine change of the apparent relaxation rate R2* values in living kidney donors after uninephrectomy using blood oxygenation level-dependent magnetic resonance imaging. METHODS Between July 2011 and January 2012, 45 kidney donors were enrolled into this study. Blood oxygenation level-dependent magnetic resonance imaging scanning was performed before surgery, 3 and 7 days postoperatively. Participants were followed up for 1 year. RESULTS The R2* values in medulla (mR2*) were significantly greater than that of cortex (cR2*), both in resected kidney and remaining one. cR2* values of the remaining kidney was 17.52 ± 1.36 s(-1) and then decrease significantly by 8.97% to 15.95 ± 1.14 s(-1) at 3 days (P <.001) and by 7.82% to 16.15 ± of 1.05 s(-1) at 7 days. No significant modification occurred in mR2* after surgery. Multivariate regression analysis showed that the decrease in cR2* values of the remaining kidney was positively associated with sex (r = 0.418), body surface area (r = 0.307), and preoperative cR2* values (r = 0.659). Comparing with glomerular filtration rate at 7 days, a further increment in the glomerular filtration rate was noted at 1 year in patients with cR2* values decrease of ≥ 10% at 1 week (62.63 ± 11.69 vs 56.97 ± 7.51 mL/min/1.73 m(2), P = .02) but not in the other patients (66.43 ± 10.89 vs 62.78 ± 13.74, P = .064). CONCLUSION Kidney donation will induce early, profound oxygenation modification within the renal cortex of the remaining kidney. Donors with cR2* value decrease of ≥ 10% at 1 week have a more favorable renal function compensation at 1 year.

The pre-transplant anemic condition is independent of long-term outcome in living-related kidney transplantation.

Abstract The relationship between pre-transplant Hemoglobin (Hb) concentration and long-term outcome of living-related kidney transplantation is far from well addressed. A retrospective cohort study was conducted by reviewing the medical profile of the patients who received living-related kidney transplantations at our center from January 2006 to January 2013. Patients were divided into two groups: high Hb group (≥10 g/dL) and low Hb group (<10 g/dL). Cox regression model was utilized to analyze the effect of pre-transplant hemoglobin concentration on the patient and graft survival. About 422 patients were of Hb level <10 g/dL (78.30 ± 14.18 g/dL), 280 were >10 g/dL (116.2 ± 14.43 g/dL) (p < 0.001). In a follow-up of 35.34 ± 18.12 months, we did not find any difference in serum creatinine between the two groups. Low Hb concentration is not associated with increased risk of developing DGF (HR = 1.186, 95% CI: 0.53–2.654), acute rejection (HR = 1.338, 95% CI: 0.919–1.947), overall infection (HR = 1.263, 95% CI: 0.847–1.885) nor perioperational infection (HR = 1.019, 95% CI: 0.513–2.026). Though we detected a trend that low Hb level group were of higher incidence of patient death and graft failure, the two groups did not differ significantly (2.38% vs. 0.71%, p = 0.096; and 4.04% vs. 2.14%, p = 0.165, respectively). Cox regression model revealed that pre-transplant Hb level <10 g/dL was independent of increased overall mortality (HR = 3.379; 95% CI: 0.706–17.172) and increased death censored allograft failure risk (HR = 1.556; 95% CI: 0.595–4.069). Pre-transplant Hb concentration <10 g/dL is independent of poor long-term outcome of living-related kidney transplantation.