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Feng X.-F.,Central Hospital of Zhabei District in Shanghai Changzheng Hospital Zhabei Branch | Min M.,Central Hospital of Zhabei District in Shanghai Changzheng Hospital Zhabei Branch | Zuo F.-J.,Central Hospital of Zhabei District in Shanghai Changzheng Hospital Zhabei Branch | Zhou M.-S.,Shanghai University | Wang L.-M.,Shanghai University
Chinese Journal of Tissue Engineering Research | Year: 2013

Background: The pathogenesis of new-onset diabetes mellitus after transplantation remains unclear. It is generally recognized that the onset is associated with patient's ethnics, age, body weight, familial history, hepatitis C virus and immunosuppressant scheme. Objective: To discuss the efficiency and safety of conversion from tacrolimus to cyclosporine A in renal transplant recipients with new-onset diabetes mellitus after transplantation. Methods: Forty-two renal transplant recipients, who met the inclusion criteria, were divided into two groups randomly: conversion group (n=20; tacrolimus was converted to cyclosporine A) and control group (n=22; tacrolimus was given contrinuously). All the involved patients were followed up for 1 year after the diagnosis of new-onset diabetes mellitus after transplantation in control group and conversion from tacrolimus to cyclosporine A conversion group. The blood glucose levels of patients were dynamically monitored. Meanwhile body mass index, serum creatinine, urea nitrogen, serum uric acid, liver function, blood lipid, the dose and concentration range of immunosuppressants, urinary albumin, the incidence of acute rejection, infection rate of hepatitis C virus, the survival rate of patients and renal graft were all recorded. Results and Conclusion: With the time going, fasting blood glucose and glycosylated hemoglobin were improved gradually in conversion group and the number of cases needing glucose-lowering treatment was gradually decreased. Eleven cases (55%) presented a complete remission after one year and needed no glucose-lowering treatment. In the control group, the cases needing glucose-lowering treatment were increased gradually, and all cases still needed glucose-lowering treatment after one year. Fasting blood glucose and glycosylated hemoglobin levels were higher than those in conversion group. Meanwhile, serum creatinine, alanine aminotransferase, triacylglycerol, cholesterol and serum uric acid showed no differences between two groups, but urinary albumin level in control group was higher than conversion group at 6 months. The incidence of acute rejection, the rate of infection, the survival rate of patient and renal graft also showed no differences between the two groups. Our findings indicate that, conversion from tacrolimus to cyclosporine A is an effective and safe strategy to improve new-onset diabetes mellitus after transplantation within a short time (less than one year). Source


Zuo F.-J.,Central Hospital of Zhabei District in Shanghai Changzheng Hospital Zhabei Branch | Feng X.-F.,Central Hospital of Zhabei District in Shanghai Changzheng Hospital Zhabei Branch | Min M.,Central Hospital of Zhabei District in Shanghai Changzheng Hospital Zhabei Branch | Zhou M.-S.,Shanghai University | Wang L.-M.,Shanghai University
Chinese Journal of Tissue Engineering Research | Year: 2013

Background: Patients with chronic renal allograft dysfunction need dialysis to maintain their survivals and even re-transplantation. However, there is little evidence addressing the time for the initiation of dialysis in patients with chronic renal allograft dysfunction. Objective: To discuss the timing of beginning dialysis and the factors that might contribute to dialysis in chronic renal allograft dysfunction patients. Methods: A retrospective study was performed in clinical data of 98 chronic renal allograft dysfunction patients which were recruited from Shanghai Changzheng Hospital from July 2005 to December 2012. The clinical data included creatinine clearance, serum creatinine concentration, symptoms of uremia and comorbidity. Factors that might affect the timing of dialysis were further analyzed. Results and Conclusion: 86.73% of the patients experienced nausea or vomiting before dialysis, 77.55% occurred with cardiac morbidity and/or neuropathy, and 31.63% needed urgent hemodialysis. Among the 98 patients, the mean creatinine clearance at the time for initiation of hemodialysis was (5.94±063) mL/min, the initial mean creatinine clearance was > 10 mL/min in 9 patients, 5-10 mL/min in 51 patients, and < 5 mL/min in 38 patients. Hepatitis C virus infection patients had higher initial creatinine clearance than non-infected patients (P < 0.05). Experimental findings suggest that, chronic renal allograft dysfunction patients have obvious uremia complications at the beginning of dialysis, the timing for dialysis is late, especially in hepatitis C virus infection patients. Health education and medical care of chronic kidney disease are key factors that affect the timing of dialysis. Source

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