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Y-J Chiang

Publications and source records attributed to Y-J Chiang.

16 recordsLinked to original sources
PubMed2004

Posttransplant Kaposi's sarcoma: report from a single center.

UNLABELLED: Posttransplant Kaposi's sarcoma (KS) is not uncommon. This study investigated the clinical manifestations, impact of immunosuppression, and presence of HHV-8 antigen in our patients. METHODS: Among 568 renal transplant recipients, four developed KS. The physical findings, radiologic studies, immunosuppressive regimens, and the clinical outcomes were reviewed. In two patients, the expression of human herpes virus-8 was examined with polymerase chain reaction and in situ hybridization. RESULTS: The incidence of KS was 0.7% in our recipients. The intervals between the transplantation and the development of KS ranged from 2 months to 8.4 years. All KS patients had calcineurin inhibitor-based antirejection therapies. Peripheral lymphadenopathy was the initial manifestation in three of four patients; the fourth presented with violaceous papules over his lower legs. Besides lymphadenopathy, KS in one patient also involved internal visceral organs. One patient died at the time of diagnosis because of Salmonellosis; the other three experienced tumor regression after discontinuation of calcineurin inhibitors. HHV-8 expression was detected in two examined specimens. CONCLUSION: Lymph node involvement is the most common clinical presentation in our posttransplant KS patients. HHV-8 infection is associated with the development of KS. Early withdrawal of calcineurin inhibitors produces a favorable outcome in posttransplant KS.

Herpesvirus 8, Human↗
PubMed2004

Clinical experience of mycophenolate mofetil in the treatment of chronic allograft nephropathy in kidney transplantation: three-year follow-up.

BACKGROUND: Mycophenolate mofetil (MMF) in conjunction with calcineura antagonists has been shown to prevent acute rejection in renal allograft recipients. Its role in treatment of chronic rejection or allograft nephropathy is still controversial. We initiated the study to investigate the effect of adding MMF to a cyclosporine plus prednisolone regimen in renal recipients with chronic allograft nephropathy. MATERIALS AND METHODS: We retrospectively studied 36 patients with chronic allograft nephropathy, defined clinically as increased of serum creatinine, proteinuria, and hypertension. Renal function, cyclosporine level, renal biopsy, and renal scan were regularly done as indicated. MMF was added to 20 recipients after initial treatment with cyclosporine and prednisolone. The other 16 recipients were managed without adding MMF. Serum creatinine was monitored for 3 years. RESULTS: The demographic characteristics of the patients in the two groups were comparable. The average dose of prednisolone was unchanged throughout the study and the trough level of cyclosporine was maintained in the range of 100 to 150 ng/mL. The serum creatinine decreased initially in the group on MMF, but renal function deteriorated progressively after 6 months. There was a difference in serum creatinine between the two groups but this did not reach statistical significance. CONCLUSION: MMF therapy tender to improve renal function initially but did not attenuate significantly the impairment in chronic allograft nephropathy.

Creatinine↗
PubMed2004

De novo cancer occurrence after renal transplantation: a medical center experience in Taiwan.

INTRODUCTION: Renal transplantation has been advocated as the treatment of choice for end-stage renal disease. Organ transplantation increases the incidence of cancer through unclear mechanisms. A literature review showed that the most common neoplasms are of skin origin, which are uncommon in Eastern people. We reviewed cancer patterns in our renal transplant series. MATERIALS AND METHODS: From July 1981 to December 2002, among 560 renal transplantations performed in this hospital, we retrospectively surveyed cancer incidence, types, and usage of immunosuppressants. RESULTS: Twenty nine cancer cases 5.18% (incidence) included hepatocellular carcinoma (HCC) as the highest mortality rate (9 of 13 cases). Eight of these 13 cases were hepatitis B carriers. All four hepatitis C carriers expired three of them with unresectable multinodular tumors at diagnosis in Posttransplantation lymphoproliferative disorder (PTLD) was the second most common cancer (seven cases); all but one survived with reduced doses of or changes in immunosuppressants. No skin cancer other than four Kaposi's sarcomas with skin manifestations was detected in our series. DISCUSSIONS: HCC was the main cancer in our series. Accepting hepatitis B carriers as candidates for renal recipients and donors may be one of the causes. PTLD was the second most common cancer, while there were no skin cancers.

Adult↗
PubMed2004

Outcome of renal transplantation in children with pericardiopleural effusion.

INTRODUCTION: Children with end-stage renal disease may present with pericardiopleural effusion secondary to volume overload and overhydration. The present study was designed to investigate the efficacy and safety of renal transplantation in these pediatric patients. METHODS: From 1981 to 2001, six of 20 patients (30%) under 18 years old who received renal transplants showed pericardiopleural effusion after serial pretransplant imaging studies. These patients also displayed associated diseases, such as congestive heart failure (n = 3), ascites (n = 2), and splenomegaly (n = 2). The recipients included five boys and one girl of mean age of 12.7 years (range, 8 to 17 years), all of whom had undergone hemodialysis before transplantation. The waiting time for grafts ranged from 1.3 to 6 years (mean = 2.6 years). Episodes of acute pulmonary edema had been observed in three patients pretransplant. RESULTS: One recipient died with a functioning graft due to heart failure with acute pulmonary edema at 4 months after transplantation. Acute rejection episodes were observed in three, and chronic rejection in two children. The median follow-up was 11 years (range = 6 to 16 years) in the other five recipients, all of whom presently survive with functioning grafts. The posttransplant mean serum creatinine levels at 1 year, 3 years, and 5 years were 1.54 +/- 0.44, 1.74 +/- 0.56, and 1.92 +/- 0.56 mg/dL, respectively. CONCLUSION: Renal transplantation in children displaying pericardiopleural effusion was associated with a high success rate. However, these patients must be followed closely with regular cardiopulmonary evaluation since their condition may deteriorate.

Adolescent↗
PubMed2004

Does mycophenolate mofetil increase the incidence of infections in stable renal transplant recipients initially treated with a two-drug regimen?

BACKGROUND: A drug regimen including a calcineurin inhibitor (cyclosporine or tacrolimus) and prednisone has been the mainstay of maintenance immunosuppression in our renal transplant recipients for more than 10 years. After the introduction of mycophenolate mofetil (MMF), a new, potent immunosuppressant that may reduce the incidence of late rejection in renal transplant recipients, the immunosuppressive protocol in some recipients was changed to an MMF-based regimen. We sought to ascertain whether the addition of MMF lead to greater susceptibility to infectious complications. PATIENTS AND METHODS: Between May 1991 and November 2002, all renal transplant recipients who received a two-drug regimen initially for more than 6 months were changed to an MMF-based regimen. The study includes patients with functional grafts for more than 6 months thereafter. Differences in the incidence, etiology, and outcome of infections were compared during the non-MMF versus the MMF periods. RESULTS: Eighty patients of mean age of 38.6 years (range 13 to 69) included 43 men and 37 women. The mean daily MMF dose was 663 mg/patient (range 250 to 1500 mg). The mean follow-up time of non-MMF period and MMF periods were 3.4 and 2.1 years, respectively. The overall incidence of infections in the two periods was similar (0.2 infections/patient in the non-MMF period and 0.25 infections/patient in the MMF period, P = .57). No mortality was associated with these infectious complications. In conclusion, addition of MMF, a more potent immunosuppressive protocol, did not increase the incidence of infections in stable renal transplant recipients initially treated with a two-drug regimen.

Bacterial Infections↗
PubMed2004

Risks and quality-of-life changes in living kidney donors.

INTRODUCTION: Although the benefits of living donor organs for recipients are well documented, the risks and quality-of-life changes in living kidney donors are seldom reported. METHODS: From July 1992 to June 2002, all living kidney donors underwent regular follow-up at our hospital. The MOS 36-item short-form health survey (SF-36), a standardized questionnaire to measure quality of life, was used in this study. Furthermore, donor renal function and associate complications were assessed. RESULTS: Seventeen donors answered the questionnaire, including eight men and nine women of mean age of 41 years (range = 25 to 56). No perioperative mortality was noted. No proteinuria or hematuria was found during long-term follow-up. The mean serum creatinine level was 0.95 +/- 0.22 mg/dL before the operation. The postoperative mean serum creatinine levels at 6 months, 1 year, and 3 years were 1.22 +/- 0.34, 1.19 +/- 0.20, and 1.29 +/- 0.21 mg/dL, respectively. Two cases underwent scar revision and one complained long-term wound pain for more than 1 year. One donor became depressed because of graft failure in her son. The SF-36 scores were 84.4 +/- 4.4 (physical function), 84.0 +/- 4.7 (role-physical), 78.4 +/- 8.0 (body pain), 81.5 +/- 5.9 (general health), 83.2 +/- 3.7 (vitality), 83.9 +/- 5.9 (social functioning), 79.9 +/- 4.1 (role-emotional), and 78.6 +/- 2.3 (mental health), respectively. CONCLUSION: The quality-of-life changes and risks after donation are low; most donors are concerned about cosmetic problems and pain-related scar formation.

Adult↗
PubMed2004

Use of simulect can reduce the incidence of acute rejection and demonstrates with superior 3-year patient and graft survival rates in renal transplantation.

BACKGROUND: Acute rejection is a major cause of graft loss in renal transplantation. Because the highest risk for acute rejection is in the first month posttransplantation, improved prophylaxis could be most beneficial in this period. Simulect administration provides 30 to 45 days of immunoprophylaxis against acute rejection during the critical period after transplantation. OBJECTIVES: We sought to assess the incidence of acute rejection episodes and the safety and tolerability of Simulect plus Neoral immunosuppression. Patient and graft survival rates up to 3 years posttransplantation were evaluated. METHOD: Forty-one transplant recipients received Simulect by intravenous infusion of an initial 20-mg dose on the day of renal transplantation and a second 20-mg dose on day 4 posttransplant. All renal recipients received immunosuppression with Neoral and steroid. RESULTS: There were eight cases (19.5%) of acute rejection within 1 year. The rejection episodes were easily reversed with steroid pulse therapy in seven patients except for graft loss. The 1-, 2-, and 3-year graft survival rates were 95%, 93%, and 88%, respectively. Overall, the 3-year patient survival rate was 100%. CONCLUSIONS: Simulect in combination with Neoral and steroid-reduced the incidence of acute rejection without an increase in adverse events. The low incidence and severity of acute rejection may have led to the superior 3-year patient and graft survival rates in renal transplantation.

Adolescent↗
PubMed2004

Sirolimus (rapamycin) reduces the incidence of acute rejection episodes in renal transplantation: an initial experience in Taiwan.

BACKGROUND: Acute rejection is the major cause of graft loss in renal transplantation. Sirolimus (rapamycin) inhibits the effects of cytokines on T and B cells; therefore, it provides prophylaxis against acute renal rejection. This open-label trial assessed the incidence of biopsy-confirmed acute rejection episodes, variation in renal function, as well as graft and patient survival rates up to 12 months posttransplantation when using sirolimus in combination with cyclosporine and prednisolone as immunosuppressants. METHODS: Ten kidney transplant recipients received sirolimus 2 mg daily after a 6-mg loading dose. Doses were then adjusted to keep the whole-blood trough level between 5 and 20 mg/mL. All patients received sirolimus in combination with cyclosporine and prednisolone. RESULTS: At 12 months after renal transplantation, the graft and patient survival rates were 90% and 90%, respectively. One patient died at 2 months due to sepsis with a functioning graft. The mean serum creatinine levels at 1, 3, and 6 months were 1.59 mg/dL, 1.71 mg/dL, and 1.65 ml/dL, respectively. There was no biopsy-confirmed acute rejection episode within 12 months. CONCLUSIONS: Sirolimus in combination with cyclosporine and prednisolone significantly protected kidney transplant recipients from acute rejection for up to 1 year of follow-up.

Acute Disease↗
PubMed2004

Laparoscopic donor nephrectomy: new combination of hand-assisted and standard approaches.

BACKGROUND: Although laparoscopic live donor nephrectomy (LLDN) was conceived to decrease morbidity and reduce donor disincentives, it requires considerable experience. We present a new combination of hand-assisted and standard laparoscopic approaches to live donor nephrectomy. METHODS: Between March 2002 and February 2003, ten LLDNs were performed with the new procedures. Using the new methodology the surgeon can withdraw his hand and insert a trocar through the hand-assisted device whenever he desires. Although the hand-assisted procedure was performed in most patients, we attempted to dissect the renal hilum without hand assistance in the final patient, successfully procuring the kidney. RESULTS: Mean operation time was 245 minutes and warm ischemic time was 179 seconds. No vascular, renal parenchymal, or ureteral injuries occurred. The patient with multiple left renal arteries had a longer warm ischemic time and delayed graft function. Mean predonation creatinine was 0.97 mg/dL, it increased to 1.44 and 1.15 mg/dL at 7 days and 3 months postdonation, respectively. One patient had chylous ascites and another had a transient left brachial plexus paralysis. CONCLUSIONS: Both pure laparoscopic and hand-assisted LLDN have advantages and disadvantages. In our modification, the free conversion from hand-assisted to a purely laparoscopic approach allows the surgeon to practice two procedures simultaneously. With this combination, 90% of the LLDN were accomplished, with pure laparoscopy in the last case.

Humans↗
PubMed2004

Laparoscopic live donor nephrectomy in a patient with duplex inferior vena cava.

BACKGROUND: Modern imaging, such as CT and MRI, improves the preoperative assessment for variants of renal vasculature. We present a kidney donor with a duplex inferior vena cava. In conjunction with CT and hand-assisted laparoscopic surgery, live donor nephrectomy was performed successfully. METHODS: A 35-year-old woman wished to donate a kidney to her son. Preoperative CT showed normal functional kidneys without uretal duplication. A duplex inferior vena cava was noted below the level of the left renal vein. A hand-assisted transperitoneal laparoscopic left nephrectomy was performed. Blood loss was minimal and the warm ischemia time was 3 minutes. Renal transplantation was performed with good initial perfusion and urine output. RESULTS: The donor was discharged in good condition at 3 days postoperatively. Both donor and recipient are alive with good renal function and without late surgical complications at 9 months. CONCLUSIONS: Live donor nephrectomy is unique as it involves two different patients. Benefits from laparoscopic operation include less pain, shorter hospital stay, earlier resumption of normal food intake, and earlier return to full activity. Graft function was not deleteriously affected and the survival of graft and recipient was not affected. Vascular anomalies, although uncommon, had a significant influence on live renal transplantation. Our patient represents a case of a rare venous anomaly, which has an an incidence rate of 0.5% to 3%. Helical CT with reconstruction of vascular anatomy helped in evaluating donor vasculature. In conjunction with modern imaging techniques and laparoscopic operation, live donor nephrectomy can be performed safely, even in patients with vascular anomalies.

Adolescent↗
PubMed2004

Is sirolimus a safe alternative to reduce or eliminate calcineurin inhibitors in chronic allograft nephropathy in kidney transplantation?

PURPOSE: We evaluate whether cyclosporine (CsA) or tacrolimus (FK) could be reduced or eliminated after sirolimus was added in chronic allograft nephropathy (CAN). By reducing doses of CsA or FK, we expected that renal function would improve. METHOD AND MATERIAL: Twenty-one patients with CAN had sirolimus added as an immunosuppressive agent. We evaluated the creatinine (Cr) level 3 months after addition. The doses of CsA and FK were decreased gradually and then eliminated over a course of 4 to 6 weeks. If the Cr level rose rapidly or other prominent signs of rejection occurred; low-dose CsA or FK would be added per protocol. We evaluated the duration of engraftment before sirolimus and the Cr level when it was added. RESULTS: Renal function improved in 13 of 21 cases. The improvement in Cr ranged from 12.5% maximally to 1.84% minimally. Seven of 13 cases still required low-dose CsA. The average duration of engraftment before sirolimus was 13.66 +/- 10.80 months. The average Cr level before sirolimus was 1.65 +/- 0.56 mg/dL. In the other eight cases, the Cr level kept rising from 5.1% to 20.4%. The average duration of engraftment was 88.38 +/- 42.21 months. The average Cr level before sirolimus was 2.85 +/- 0.54 mg/dL. Hyperuricemia was noted in 31.3% and hyperlipidemia in 68.8%. CONCLUSION: Sirolimus is a safe alternative to reduce or eliminate CsA or FK in CAN. In cases with a long duration of engraftment and high Cr level, sirolimus might have some effect as a substitute for CNI and thus prevent further nephrotoxicity.

Chronic Disease↗
PubMedDate not supplied

Liver stellate cells suppress dendritic cells through IL-10.

Liver allografts can be spontaneously accepted across an MHC class I disparity, the mechanism of which is still not known. Since the liver has a large amount of immature dendritic cells, these elements may contribute to transplant acceptance. However, the reason why liver dendritic cells are immature status is unknown. In this study, bone marrow-derived dendritic cell progenitors were cocultured with liver stellate cells, which produce the immunosuppressive cytokines IL-10 and TGF-beta. The results revealed that dendritic cells cocultured with liver stellate cells express low levels of costimulatory molecules with decreased allostimulatory capacity. Addition of anti-IL-10 antibody to the culture media to neutralize IL-10 effects reversed the allostimulatory function of dendritic cells cocultured with stellate cells. In conclusion, liver dendritic cells are conditioned by stellate cells to maintain an immature status, which may contribute to the low immunity of liver. One of the mechanisms that stellate cells may influence dendritic cells is through IL-10.

Animals↗