Objectives: Our objective was to explore factors influencing health-related quality of life in livingdonor kidney transplant recipients. Materials and Methods: A total of 140 kidney transplant recipients, enrolled between December 2014 and April 2015, were administered questionnaires on medical outcomes, 36-item Short Form Health Survey, medical coping modes, cognitive appraisal of health scale, and adverse effects of medications. Path analysis was employed to verify the hypothesized model. Results: Increased serum creatinine level and high economic burden had direct positive effects on negative appraisal (β = 0.18, P < .05 and β = 0.46, P < .01). Adverse effects of medication had direct positive effects on confrontation; whereas negative appraisal had direct positive effect on acceptance-resignation (β = 0.21, P < .05) and direct negative effect on physical component summary (β = -0.43, P < .001) and mental component summary (β = -0.51, P < .001). In addition, confrontation directly affected mental component summary (β = -0.15, P < .05). The enrolled variables accounted for 25.0% of physical component summary variance and 35.4% of mental component summary variance. Conclusions: In this study, economic burden, serum creatinine levels, and adverse effects of immunosuppressive therapy were the key external factors, whereas patients' cognitive appraisal and coping strategies were the main internal factors affecting patients' health-related quality of life. Medical care providers attending to transplant recipients should be able to identify patients developing negative coping strategies in response to stressors and plan individualized counseling programs for these patients.
Methods:We infused MSC using a dose escalation model: 3 patients received a low volume infusion (1 million MSC/Kg), 3 received an intermediate volume ( 2 million MSC/kg) and 3 received high volume infusion (4 million MSC/Kg). Blood samples were collected as baseline (day -1), on day +1 and day +7 following infusion to measure biomarker assays (B cells, natural killer -NK-cells), and T cell enumerations (T-regulatory cells). We used a multiplex cytokine assay to assess pro-inflammatory cytokine (TH1) and tolerogenic cytokine (TH2) levels and pro-angiogenic factors (vascular endothelial growth factor-VEGF). Changes in cytokine levels greater or less than 1 standard deviation from the mean baseline levels was considered significant. Results: We observed no increment in circulating MSC on days +1 and +7 regardless of the volume of MSC infused, suggesting that MSC were trapped in the lung as has been reported. Blood levels of tolerance-inducing T regulatory cells doubled in patients receiving low infusion MSC. NK and B cell numbers decreased in the low volume group. Contrarily, an increase or no change was observed in the other groups. Epidermal Growth Factor (EGF), a potent promoter of cell proliferation, anti-apoptotic and pro-angiogenic factor was significantly increased in the low volume group while no significant change was observed in other groups. Tolerance-inducing TH2 cytokines such as IL-4 significantly increased on patients receiving low and intermediate volume MSC infusion. Pro-inflammatory TH1 cytokines(IL-1, IL-6, and IL-8), and pro-inflammatory chemokines (MCP-1, MIP-1α , and MIP-1β ) significantly decreased in patients receiving low volume infusion. Overall, the biological effects of the MSC therapy appeared to decrease with increasing cell volumes infused. Conclusion: Low volume MSC infusion induces anti-inflammatory effects and promotes cell proliferation and angiogenesis in patients with obstructive CLAD. Higher MSC volumes appear to have less positive biological effects. These results need clinical correlation.( 412)
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