| Kidney transplantation in radical resection with end-stage renal failure is the best means of treatment, with the progressive increase in kidney transplant success rate makes more and more patients to life. However, early after renal transplantation: delayed graft function (DGF) is a significant cause of allograft long-term survival rates decline. Clinically observed, once DGF in renal transplant recipients, will be accompanied by varying degrees of Transplant Renal bleeding, hematuria and inflammation and pathology under the graft of vascular endothelial inflammatory cell infiltration. Platelets not only have the function of blood coagulation, but also participated in the inflammation process. We found in the clinical work in the early period after renal transplantation in many changes in the number of platelets in peripheral blood was evident when DGF widespread elevated inflammatory cells in the peripheral blood. Renal ischemia after cryopreservation and transplantation opened after ischemia-reperfusion injury in blood circulation activates a series of reactions, damage to transplanted kidney, DGF play a leading role in the development. Related studies confirm, reduce lipid peroxidation and decreased oxygen free radicals, dilated blood vessels, antioxidant, anti-inflammation treatment can relieve the DGF correlation between renal injuries. These phenomena indicate that platelets inflammation likely plays a role in the onset of the DGF. In January2012, Park later reported in some of the detection of platelet secretion after kidney transplantation antioxidant levels in the early recovery of smooth and DGF body statistical differences emerged.Graft inevitably exist ischemia-reperfusion injury (Ischemia-reperfusion injury, IRI), it can cause graft primary non-function, delayed graft function, at the same time also synergy cause acute rejection reaction and immune factors, severe cases can lead to loss of graft function, early recovery and long-term prognosis of graft. IRI refers to ischemic tissues or organs to regain the blood perfusion and oxygen supply for aggravate after injury, and even irreversible damage occurs. Ischemia-reperfusion injury not only renal tubular epithelial cells, also caused the renal interstitial inflammation and microvascular lesion, and microvascular lesion is renal dysfunction caused by ischemia-reperfusion injury of the key factors, after ischemia microvascular lesion with swollen endothelial cells and subsequent microvascular occlusion, lead to graft reperfusion can’t run smoothly.Early delayed graft function after renal transplantation (DGF) and acute rejection (AR), are important reasons resulting in a decline in long-term graft survival. Clinically observed, whether it is caused by DGF happen first after renal transplantation of acute rejection, or induced by acute rejection happen first DGF, these two kinds of adverse reactions like twin complications after transplantation and the recipients in the event of DGF, or acute rejection, with varying degrees of transplanted kidney nephron bleeding tendency, the clinical manifestation of hematuria and inflammation, pathology of endovascular subcutaneous transplanted renal inflammatory cells infiltration, the serious influence of renal transplantation descendants/kidney survival time, extend the length of hospital stay. Diagnostic criteria for delayed graft function of oliguria after kidney transplantation (24h<1200ml) or no urine, serum creatinine level has no obvious drop even higher or the seventh day of postoperative serum creatinine is still greater than400umol/L, must be line hemodialysis treatment. The main factor causing DGF included before renal, renal and kidney after three, kidney transplantation and early after transplantation in low blood volume, low blood pressure, renal arteriovenous anastomosis stenosis of renal before sex factors. Ring spore A renal toxicity, renal tubular necrosis, rejection and kidney was the original diseases (such as high blood pressure kidney disease, diabetes kidney disease, etc.) for renal factors. Graft urinary tract obstruction, such as external hematoma compression, or blood clots infarction, anastomotic stricture, ureteral of kidney is too long lead to distortion factor. Now although it combined use of immune inhibitor significantly increased graft survival, but acute rejection after kidney transplantation is still one of the most common cause of DGF.Platelets are not only have the function of the hemostatic and accelerate the blood coagulation, is also a kind of important inflammatory cells. Studies have shown that in ulcerative colitis and crohn’s disease, diseases such as rheumatoid arthritis and ankylosing spondylitis in average platelet volume (MPV) parameters; Elevated MPV is a predictor of early atherosclerosis, mean platelet volume reflects the size of the platelets, platelet activation, blood platelet volume increases, the volume of blood platelets contain more particles and higher activity, the activation of platelets secrete a series of inflammatory substances, such as chemokines, cytokines and so on, in order to promote the platelet aggregation, adhesion and thrombosis. In addition platelet secretion of inflammatory substances through platelet P-choose to raise neutrophils, monocytes, eosinophils and other body parts into the inflammation, promote inflammation reaction. Studies confirm that platelets have important influence on the function of the graft. In our clinical work, we found that after renal transplantation in DGF platelet number and have obvious changes, thus infer that platelets may be one of DGF risk factors of the disease. Platelet membrane has large phospholipase, under the stimulus inflammation factors through the signal transduction mechanism can generate a large number of bioactive substances, such as leukotriene (leukotrienes, LT), lipid oxygen element (lipoxins, LXS), thrombosis, alkanes and prostaglandin (prostaglandin, PG) and so on, these biological activity substances to the functions of endothelial cells, white blood cells and platelet activation plays an important role in regulating, etc. The current research has confirmed that platelets cause inflammation in atherosclerosis, ischemic encephalopathy, cerebral infarction, angina, ischemic heart disease and autoimmune disease due to abnormal function of the immune system and play an important role in various diseases such as kidney disease. About the number of platelets (platelet number, PLT), platelet volume measurement (platelet hematocrit, PCT), mean platelet volume (average platelet volume, MPV) and platelet volume distribution width (platelet volume distribution width, PDW) and large platelet ratio (large platelet ratio, P-LCR) of the five parameters are associated with DGF, there is no related reports, this topic proposed by peripheral blood platelets within2months after renal transplantation recipients of the five parameters of statistical analysis, to explore the role of platelet in DGF.The first part of study, statistical analysis of related parameters of platelet test results in renal transplant recipients.ObjectivePeripheral blood platelet related indicators to detect early after renal transplantation recipients, explore the related parameters of platelet in renal transplantation recipients.MethodIn our hospital from January2009to September2013of the232cases of preoperative and postoperative renal transplant recipients within2months of clinical data were retrospectively analyzed, including162cases of male, female70cases, aged14-80years old, average40.9years. ABO blood group for recipients, lymph toxin experiments are negative, HLA match test A, B, DR three loci, all recipients are using oral tacrolimus (FK506) or ring spore, A (CsA)+mycophenolate mofetil (MMF)+prednisone acetate (Mr Pred) the joint scheme of anti-rejection drugs. Take subjects preoperative and postoperative day1, day2, day3, day4, day5,day6, day7, day8, day9, day10, day15, days30, day45and day60venous blood each2ml, ethylenediamine tetraacetic acid dipotassium anticoagulation, adopt Sysmex XE2100automatic blood analyzer and supporting the imported reagent of platelet parameter determination, all test data with mean±standard deviation (X±s), using SPSS19.0statistical software, comparison between the two groups using independent sample T test, with P<0.05has statistically significant.ResultsBased on2months after232cases of renal transplant recipients platelet related index inspection found that compared with the preoperative, postoperative day1PLT renal transplant recipients, PCT falling rapidly, in postoperative of heaven to the minimum and significantly lower than the preoperative level (p<0.05), and then began to rise, in the15th day after the highest and significantly higher than the preoperative level (p<0.05), and then slowly decreased,30to60days close to preoperative levels (p>0.05). PLT, PCT1to15days after surgery compared with preoperative difference was statistically significant (p<0.05), the30th day,45th and60th day after surgery heaven to close to preoperative levels, there was no statistically significant difference compared with before operation (p>0.05). Postoperative day1MPV and PDW and P-LCR rapidly increases, in the highest and significantly higher than the preoperative level7days postoperatively (P<0.05), and then slowly reduced to close to preoperative and postoperative15heaven level (P>0.05), and then slowly rise, MPV, P-LCR from30to60days postoperatively (P<0.05), significantly higher than the preoperative level PDW to significantly higher than the preoperative level45to60days postoperatively (P<0.05).ConclusionsAll the related parameters of platelet in232cases of renal transplantation recipient regularity of change, prompt clinical related parameters of platelet as monitoring index of the bone marrow function recovery after renal transplantation has certain clinical value. The second part of study,whether post-surgical DGF recipients of related parameters of platelet statistical analysis of test results.ObjectiveTo investigate the relationship between the variation of blood platelet parameters and the delayed graft function group in the early stage after kidney transplantation.MethodIn our hospital between January2009and September2009, a review of232cases of renal transplant recipients, Analysis to need hemodialysis therapy within one weeks after hemodialysis treatment or without hemodialysis treatment, but in the seventh day of postoperative serum creatinine level is still greater than400umol/L as diagnostic criteria of DGF, ABO blood group for recipients, lymph toxin experiments are negative, HLA match test A, B, DR three loci, all recipients are using oral tacrolimus(FK506) or ring sporeA(CsA) and mycophenolate mofetil(MMF), prednisone acetate (Mr Pred) triple anti-rejection drugs. There were29cases with DGF patients after renal transplantation, the incidence was12.5%(29/232), the other203cases without DGF. Take the same subjects preoperative and postoperative day1, day2, day3, day4,day5,day6, day7,day8, day9, day10,day15,day30, day45and day60venous blood each2ml, ethylenediamine tetraacetic acid dipotassium anticoagulation, adopting Sysmex XE2100automatic blood analyzer and supporting the imported reagent of platelet parameter determination, all test data with mean±standard deviation (X±s),using SPSS19.0statistical software, comparing two paired sample T test was used to P<0.05with statistical significance.Results29cases of DGF after renal transplantation recipients with related parameters of platelet in203cases of DGF recipients detection found that non DGF PLT group of recipients of heaven to the lowest on the5th day after surgery, began to rise and on15th day after the highest and significantly higher than the preoperative levels, to close to30to60heaven after preoperative level; PLT in DGF group of recipients on the6th day of heaven to a minimum, the highest and significantly higher than the15th day after preoperative levels, after30days and fell to below the preoperative level, recovery of45to60days to close to preoperative levels. The MPV and PDW in DGF group of recipients, and P-LCR rose to the highest on the7th day after operation, the postoperative15heaven to close to preoperative levels, and then slowly rise; DGF patients MPV and PDW and P-LCR rose to the highest on the7th day after operation, the postoperative30heaven to minimum level, but still higher than preoperative group two recipients postoperative platelet quantity change has certain regularity, the early significantly lower platelet count, after rising and significantly higher than the preoperative level, after2days of the DGF group platelet amount of DGF was always lower than the group of recipients, recipients of7to10days2set of recipients platelet count difference was statistically significant (P<0.05); PCT both has no significant statistical significance (p>0.05); DGF patients MPV and PDW and P-LCR are always higher than the DGF group of patients; The7th day,10th day and15th day in two groups of MPV and PDW and P-LCR difference had statistical significance (P<0.05).Conclusions232cases of renal transplantation recipients of PLT and PCT in postoperative heaven to a minimum on the5th day, the highest and significantly higher than the15th day after the preoperative levels (p<0.05), MPV and PDW and P-LCR in the renal transplantation has increased, which rose to the highest on the6th day or the7th day (p<0.05), postoperative15of heaven to the lowest (p>0.05), renal transplantation belong to invasive surgery, early PLT decrease in platelet involved in traumatic bleeding and blood coagulation process, prevent blood loss after trauma, increased platelet destruction. Kidney transplant patients increased MPV may be the mechanism of renal transplantation can effectively remove uremic toxins, uremia retention product inhibition of bone marrow gradually lifted, bone marrow hematopoietic microenvironment gradually returned to normal, normal differentiation of hematopoietic stem cells can be mature, giant nuclear cell normal value, platelet is by the mature in the bone marrow megakaryocyte cytoplasm falls off, make the circulation of blood in more young big platelet, also make the PLT gradually increased number (5-15days). Reduce PLT and MPV, platelet production, MPV decreased; Increased platelet destruction, MPV increase; Platelet distribution of defect in thrombocytopenia, MPV little change, thus, MPV and PDW and P-LCR function recovery can be used as bone marrow after renal transplantation dynamic monitoring indicator. This study also found that the PLT in DGF patients after renal transplantation was always lower than the non DGF patients, including DGF patients compared with non DGF group of patients after7th day to10th day was statistically significant (p<0.05); Similarly, patients with DGF MPV and PDW, P-LCR are always higher than that of DGF in patients, DGF group of these patients were compared with non DGF group of patients after7th day,10th day,15th day was statistically significant (P<0.05),shows that in the process of bone marrow hematopoietic stem cells mature, platelet activation in patients with DGF process, increased platelet destruction, increase the consumption, platelets involved in transplantation nephritis syndrome reaction and damage and repair process. In early after renal transplantation recipients of peripheral blood platelet count (PLT), platelet volume measurement (PCT), mean platelet volume (MPV) and platelet volume distribution width (PDW), the ratio of large platelet (P-LCR) of the five parameters of monitoring, for the occurrence of DGF after renal transplantation and reverse provide new markers for disease control and prevention, drug targets and new treatment method, which will be conducive to reduce the incidence of DGF, and improve the long-term survival of patients treated with renal transplantation. |
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