Clinical Research Of Bayes Discriminatory Analysis And Vitamin D Receptor’s Gene Polymorphism On Early Diagnosis Of The Complications After Kidney Transplantation

Objective To investigate the implementation of Bayes discriminatory analysis to the early diagnosis of complications (acute rejection, AR; acute tubular necrosis, ATN; and nephrotoxicity of calcineurin inhibitor, NOCIN.) which cause patients’24h urine quantity suddenly decrease in the1st month post kidney transplantation. Methods the authors analyzed125recipients’case histories1st month post kidney transplantation from the309th hospital of PLA’s677recipients. The patients were randomly divided into two groups with randomized table:equation group (100) and verify group (25). Clinical and laboratory datum of the equation group were retrospectively analyzed. The preliminary data of common symptoms, signs and chemical results were examined through discriminatory analysis using SPSS software, and diagnosis model was built. When the3individual Bayes equations were established for the three complications, the authors correlated those against clinical data from the verify group.Results The authors used the following3Bayes equations for the early diagnosis of3complications of the kidney transplantation that cause patients’urine quantities suddenly decrease in the1st month:Acute Rejection y1=—162.384+1.350x1(age)6.329x3(corpse)+27.073x5(swell)+11.094x6(arthralgia)42.288x7(medication)+15.821x8(time)+5.444x9(blood pressure)0.978x10(temperature)+14.824x15(kalium)+14.038x16(BUN)+41.856x17(Cr)+13.105x18(urine)；Acute Tubular Necrosis y2=—111.755+3.678x1(age)+0.267x3(corpse)+4.845x5(swell)+0.106x6(arthralgia)—37.255x7(medication)+8.382x8(time)+5.827x9(blood pressure)2.157x10(temperature)+8.177x15(kalium)+13.757x16(BUN)+38.798x17(Cr)+9.600x18(urine)；Nephrotoxicity of Calcineurin Inhibitor y3—120.512+2.690x1(age)—2.245x3(corpse)+18.833x5(swell)—1.353x6(arthralgia)+41.266x7(medication)+9.192x8(time)+1.341x9(blood pressure)+0.724x10(temperature)+5.739x15(kalium)+ 8.995x16(BUN)+24.532x17(Cr)+20.531x18(urine). The variance data of the verify group patients were taken into3Bayes discriminatory equations. The acute rejection’s accuracy rate of Bayes equation is90%; the acute tubular necrosis is100%; and the nephrotoxicity of calcineurin inhibitor is90.9%. The total result shows93.6%accuracy. Conclusion The authors analyzed acute rejection, acute tubular necrosis and nephrotoxicity of calcineurin inhibitor’s characteristic that can cause patients’urine quantity suddenly decrease1st month post kidney transplantation, and used weight factors according to characteristic to build Bayes discriminatory equations. Bayes discriminatory analysis can be useful when diagnosing those3early-stage complications in the1st month after transplantation. Objective:This study is to investigate the relationship between VDR gene polymorphisms and acute rejection, and then discuss the usage of the polymorphism to forecast the risk of acute rejection or even resume condition of the apparatus allograft. Methods:one hundred and fifty-five kidney transplantation recipients were chosen randomly.55kidney transplantation recipients were chosen as a rejection group for their experiencing at least one episode of acute rejection in the first3months post operation.100recipients who have no acute rejection are selected randomly as a control group. Their VDR polymorphisms and case histories are carefully researched respectively. Results:Statistical difference in the genotypes of BsmI and Apal (BsmI:p=0.022, Apal: p=0.018) between both groups can be found, while there is no obvious statistics significant in the genotypes of Fokl and TaqI (Fokl:p=0.105, TaqI:p=0.089). It is remarkable that the reduction ratio of serum creatinine of the recipients with “bb”,“aa” and “bbaa” is much lower than that of the control group’s recipients. There are statistically significant differences in the ratio of two groups’ recipients with the “aa” and "bbaa" genotypes (aa:p=0.042bbaa:p=0.029). Conclusion:"b" and “a” allelic gene of VDR can be regarded as a risky gene to acute rejection while the “aa” and “bbaa” genotypes recipients have higher possibility in kidney graft’s slow recovery post transplantation. Objective:This study is to investigate the relationship between Vitamin D Receptor (VDR) Fokl, Apal gene polymorphisms and Human Cytomegalovirus Disease (HCMVD), and then discuss the usage of the polymorphism to forecast the risk of HCMVD. Methods:ninety-eight kidney transplantation recipients were chosen randomly. Their samples of peripheral blood and case histories in the first3months after kidney transplantation were carefully researched respectively. The authors found out that30recipients have“FF” of VDR genetype,47have “Ff”,21have “ff” and12recipients have “AA” of VDR genetype,36have “Aa”,50have “aa” with Polymerase Chain Reaction-Restriction Fragment Length Polymorphisms (PCR-RFLP). Factors affecting the prognosis of kidney transplantation were compared among both genotypes by a univariate analysis before operation. Then Cytomegalovirus (CMV) of all recipients was detected by Immunofluorescence Assay (IFA) in order to help diagnose HCMVD. Results:there is no statistics significance in the factors affecting the prognosis of kidney transplantation between both genotypes, however, statistical difference in HCMVD among the Fokl genotypes can be found. The possibility of HCMVD of the “ff” recipients is much higher than that of the other genotypes’recipients. There is no statistics significance in HCMVD among the Apal genotypes can be found. Conclusion:“f” allelic gene of VDR can be regarded as a risky gene causing HCMVD while the recipients with “FF” gene have lower possibility of HCMVD after kidney transplantation. There is no association of Apal genotypes with HCMVD. Objective:this study is to investigate the relationship between VDR’s gene polymorphism and immunological tolerance to prevent acute rejection with the immunosuppressant after kidney transplantation, and then discuss the usage of the polymorphism to forecast the risk of failure of some immunosuppressant or even resume condition of the apparatus allograft. Methods:one hundred and fifty-three five kidney transplantation recipients were chosen randomly.55kidney allograft recipients were chosen randomly as the Tac group because their immunosuppressant were Tac (Tacrolimus, Tac)+MMF (Mycophenolate mofetil, MMF)+Pred (Prednisone, Pred) after kidney transplantation.98kidney allograft recipients were selected randomly as the CsA group for CsA (Cyclosporine A, CsA)+MMF (Mycophenolate mofetil, MMF) +Pred(Prednisone, Pred). All patients did not experience any episodes of acute rejection during the first3months after operation. Their VDR’s polymorphism and case histories were carefully researched respectively: the reduction ratio of serum creatinine (Cr), the reduction ratio of immunosuppressant (Is) and the time of Hemoglobin recovery to normal or pretransplantation level (He). Results:Cr, Is and He have no statistical difference in the four genotypes of the Tac groups can be found. CR and IS have statistical significant with Apal genotypes in the CsA groups can be found (CR H=6.712, p=0.034; IS H=7.410, p=0.029), especially "aa" type. Conclusion:the VDR’s gene polymorphism cannot forecast the efficiency of Tac+MMF+Pred after kidney transplantation. The "a" allelic gene, especially the "aa" genotypes, of VDR can be regarded as a risk gene to forecast the higher possibility of failure or inefficiency of CsA+MMF+Pred and kidney graft’s slow recovery post transplantation.