| Part One: Clinical Research on ADPKD Before and After Renal Transplantation1, Clinical aspects of renal transplantation in polycystic kidney disease Objective A long term follow-up of renal graft recipients with ADPKD was undertaken to evaluate the results of transplantation and to discuss its main effects. Methods 46 ADPKD patients were compared with 46 non-diabetic patients in a retrospective follow-up after renal transplantation from 1978 to 2002. Patient and graft survival (1, 3 and 5 years after transplantation) as well as complications such as infections and cardiovascular events were evaluated. Results A comparable overall patient (1,3, and 5 years: 95.7%, 91.3%, 91.3% ADPKD vs. 97.8%, 95.7%, 93.5% controls) and transplant survival rate (1,3, and 5 years: 93.5%, 89.1%, 87.0% ADPKD vs. 95.7%, 89.1%, 87.0% controls) was found in both groups. Infectious complications with the exception of urinary tract infections (UTIs: ADPKD 43.4%, vs. 10.9%) were diagnosed in similar frequency in the graft recipients. ADPKD patients were significantly more affected by UTIs than their control group (p<0.05) Cardiovascular events were not observed to be significantly different between both groups (ADPKD 3 vs. controls 4). An obvious difference was found in patients (p<0.05) and transplant survival rates (p<0.05) of male and female ADPKD patients. The female group showed a significantly better outcome. Conclusions The overall patient and graft survival rates did not differ between the ADPKD and control groups. The better outcome of female ADPKD graft recipients compared to the male group may be related to a gender-dependent disease severity, possibly due to hormonal effects. As UTIs and lethal lung infections were the leading complications in ADPKD patients, a careful monitoring for infections is important in the post-transplant follow-up.2, Therapeutic effect of immunosuppressant for polycystic kidney disease Objective To discuss the therapeutic effect of immunosuppressant for polycystic kidneydisease. Methods collecting 24 cases of ADPKD patients undergone renal transplantation for 1-8 years (mean time is 3.18 years). The checking item were waist pain, haematuria, hypertension and polycystic size before and after renal transplantation. Immunosuppressants include cyclosporine, azathioprine prednisone. Results After transplantation, release of waist pain was most obious; occurance rate of haematuria decreased from 83.3% to 12.5 %,( p<0.01); hypertension did not change in 1 month but improved in 1 year (p<0.01); polycystic kidney size examined by B-ultrasound showed no difference and stayed in "steady"size. Conclusion Immunosuppressants contribute to all the above improvements. ADPKD may be gene-dependent immunodisease or immunity plays an important role in its pathogenesis.Part two: Basic Research on ADPKD Before and After RenalTransplantation1, The laminin level and its significance in cyst fluid from patients withautosomal dominant polycystic kidney disease (ADPKD) before and afterrenal transplantationObjective To detect the level of laminin in cyst fluid of ADPKD before and after renal transplantation. Methods 11 renal cyst fluid samples were analysed for the level of laminin by using RIA Kit. These samples were obtained from 11 patients with ADPKD, four of which had undergone renal transplantation for 0-3 years(mean time is 1.65 years). Results The mean level value of laminin is 550.57ng/ml for the 7 ADPKD patients with no renal transplantation. On the other hand, it is 290.25ng/ml for the 4 ADPKD patients undergone renal transplantation (p<0.05). The expression level of laminin has a negative correlation with the time after renal transplantation (r=- 0.958, p<0.05). Conclusion Laminin fragments exert significant proliferative action on ADPKD cells. The obvious descent of laminin level after renal transplantation indicates that this is an important factor for slowing down the proliferative speed of polycystic kidney in ADPKD patients. Furthermore, we can guess that th...
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