Decellularization is an essential step in the generation of biological scaffolds in tissue engineering. Here, we report the effects of decellularization with Triton X-100 and sodium dodecyl sulfate (SDS) on the histological and biochemical characteristics of the corpus cavernosum in a rabbit model. Briefly, we cut the corpus cavernosum into 10-mm-thick slices and treated the slices with 1% SDS or 1% Triton X-100. Following this, we conducted qualitative and quantitative analyses using the slices. We successfully obtained acellular corpus matrices (ACMs) using both decellularization methods. The ACMs exhibited suitable characteristics of cell adhesion and survival. SDS treatment was more effective for the removal of cellular components from the native tissues but altered both the biochemical and biomechanical properties of the ACMs. Triton X-100 was less effective for cellular extraction but helped maintain the biochemical and histological characteristics of the ACMs to a greater extent than SDS. Although additional research is needed, the results indicate that ACMs generated using Triton X-100 are superior three-dimensional scaffolds that can be used for constructing engineered corpus cavernosum.

BACKGROUND:Emerging evidence indicated that CHEK2 played crucial functions in the development of several cancers. However, its role in kidney renal clear cell carcinoma (KIRC) is still remained unclear. The present study was designed to investigate the prognostic value and biological function of CHEK2 in KIRC. METHODS:To investigate CHEK2's expression in KIRC, raw gene expression data were downloaded from the GEO database. Western blot was performed to validate the expression level of CHEK2 in twelve pairs of KIRC tumor tissues. Immunohistochemistry (IHC) analyses based on clinical samples were employed to verify the relationship between CHEK2 expression and KIRC malignancy. MTT, wound healing, and transwell assay were conducted to explore CHEK2's biological functions. The xenograft models were used to explore the function of CHEK2 in vivo. RESULTS:CHEK2 expression was up-regulated in KIRC tumors, and high expression of CHEK2 was significantly correlated with advanced TNM stages and poor prognosis. Functional studies demonstrated that up-regulation of CHEK2 promoted cancer cell aggressiveness, including cell proliferation, migration, and invasion. Subsequent evidence proved that TEAD4/RUNX1 is the downstream effector for CHEK2-mediated KIRC malignancy. CONCLUSIONS:CHEK2 was identified as a novel biomarker to predict the prognosis and tumor progression in KIRC, and a promising therapeutic target to prevent tumor progression.

The complexities of acute kidney injury (AKI), a multifaceted pathological occurrence, are not fully understood. At present, there is a lack of effective pharmaceutical treatments in clinical practice. Studies have shown that icariin has beneficial effects in models of acute kidney injury (AKI) caused by cisplatin and lipopolysaccharide (LPS). The aim is to explore the mechanisms that cause folic acid (FA)-induced AKI and examine the protective effects of icariin against this condition. To establish a mouse model of AKI, FA was administered via intraperitoneal injection. Icariin was used as the drug intervention. The model and the impact of drug intervention were assessed using measurements of renal function parameters, staining with hematoxylin and eosin, and Q-PCR. The analysis of protein expression changes in the control, model, and icariin treatment groups was conducted using proteomics. KEGG signaling pathway analysis indicates that differential expressed proteins are enriched in the component and coagulation cascades signaling pathway. Through protein-protein interaction network analysis, it was found that compared to the normal group, the expression of Fibrinogen and other proteins was significantly upregulated at the center of the protein interaction network in the model group. After drug treatment, the expression of these proteins was significantly downregulated. The validation experiment supports the above results. In conclusion, this study clarified the molecular mechanism of FA induced acute renal injury from the proteomics level, and provided target selection for AKI; At the same time, the mechanism of icariin in the treatment of AKI was analyzed from the proteomics level.

Background:5-Methylcytidine (m5C) methylation is a recently emerging epigenetic modification that is closely related to tumor proliferation, occurrence, and metastasis. This study aimed to investigate the clinicopathological characteristics and prognostic value of m5C regulators in bladder cancer (BLCA), and their correlation with the tumor immune microenvironment. Methods:Thirteen m5C RNA methylation regulators were analyzed using RNA-sequencing and corresponding clinical information obtained from the TCGA database. The Cluster Profiler package was used to analyze the gene ontology function of potential targets and enriched the Kyoto Encyclopedia of Genes and Genomes pathway. Kaplan-Meier survival analysis was used to compare survival differences using the log-rank test and univariate Cox proportional hazards regression. The correlation between signature prognostic m5C regulators and various immune cells was analyzed. Univariate and multivariate Cox regression analyses identified independence of the ALYREF gene signature. Results:Nine out of the 13 m5C RNA methylation regulators were differentially expressed in BLCA and normal samples and were co-expressed. These 9 regulators were associated with clinicopathological tumor characteristics, particularly high or low tumor risk, pT or pTNM stage, and migration. Consensus clustering analysis divides the BLCA samples into 4 clusters. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment annotation and gene ontology function analysis identified 273 upregulated and 594 downregulated genes in BLCA. Notably, only ALYREF was significantly correlated with OS (P < .05). ALYREF exhibited significant infiltration levels in macrophage cells. Therefore, we constructed a nomogram for ALYREF as an independent prognostic factor. Additionally, we observed that both the mRNA and protein levels of ALYREF were upregulated, and immunofluorescence showed that ALYREF was mainly distributed in nuclear speckles. ALYREF overexpression was significantly associated with poor OS. Conclusion:Our findings demonstrated the potential of ALYREF to predict clinical prognostic risks in BLCA patients and regulate the tumor immune microenvironment. As such, ALYREF may serve as a novel prognostic indicator in BLCA patients.

Background: The study aimed to find predictive biomarkers to evaluate donor kidney function to predict graft dysfunction as well as to assess an early signs of acute graft rejection.Method: Twenty-seven deceased donors and 54 recipients who underwent a successful kidney transplantation were enrolled in the study. An assessment was made in serum and urine from donors and recipients to measure the following biomarkers: neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), tissue inhibitor of metalloproteinase 2 (TIMP-2) and urinary N-acetyl-b-D-glucosaminidase (uNAG). These bio-markers were used to establish a model for predicting a reduced graft function (RGF) classified as either a delayed or slow graft function.Result: Our analysis suggest that out of four tested biomarkers, the serum TIMP-2 and uNAG levels of the donors had a predictive value for RGF; the area under the receiver operating characteristic curves (AUROC) of serum TIMP-2 and uNAG were 0.714 and 0.779, respectively. The combined best fitting prediction model of serum TIMP-2, uNAG, and creatinine levels was better in predicting RGF than the serum creatinine level alone. In addition, the recipient serum TIMP-2 level on the third day post-transplantation (D3) was associated with the estimated glomerular filtration rate (eGFR) on the seventh day post-transplantation (D7; OR 1.119, 95% CI 1.016-1.233, p = 0.022). Furthermore, the ROC curve value revealed that the AUROC of TIMP-2 on D3 was 0.99 (95% CI 0.97-1, p < 0.001), and this was the best predictive value of the renal function on D7.Conclusions: Donor serum TIMP-2 and uNAG levels are useful predictive biomarkers because they can provide the donor-based prediction for RGF.

Ligustrazine is a Chinese herb (Chuanxiong) approved for use as a medical drug in China. Recent evidence suggests that ligustrazine has prom-ising antitumor properties. Our preliminary results showed that ligustrazine could inhibit the growth of human renal cell carcinoma (RCC) cell lines. However, the complicated molecular mechanism has not been fully revealed. Therefore, the purpose of this study to investigate the mech-anism of ligustrazine resistance in human RCC cells. Cell proliferation, migration, invasion, and colony-formation ability of RCC cells A498 were detected by MTT assay, clonal formation rates, and transwell chamber assay in vitro. The expression of epithelial-mesenchymal transition (EMT)-related proteins were analyzed using western blot test. The effect of ligustrazine on the growth of A498 cells in nude mice was investi-gated in vivo. Our results showed that ligustrazine could significantly inhibit the proliferation, migration, and invasion of A498 both in vivo and vitro. Western blot analysis showed that the expressions of EMT-related, N-cadherin, snail, and slug proteins were significantly decreased in A498 in the ligustrazine treatment group. This study indicated that ligustrazine could significantly inhibit the malignant biological behaviors of RCC cell lines, possibly by inhibiting the EMT process.

Mean platelet volume (MPV) is an indicator of platelet activation and has been proposed as a diagnostic marker for several kinds of cancers. We investigated the value of MPV as a diagnostic marker for prostate cancer (PCa) and examined whether MPV in combination with prostate-specific antigen (PSA) could increase the sensitivity or specificity of PSA for PCa diagnosis. For this study, 107 pathologically confirmed PCa and 177 non-PCa patients who underwent prostate biopsy were retrospectively studied. Clinical data and pre-biopsy hematological parameters were collected. The above parameters were compared between PCa and non-PCa patients. The correlation between MPV and clinical characteristics was analyzed. Receiver operating characteristic (ROC) analysis was used to explore the diagnostic value of MPV for PCa. Among all parameters analyzed, the difference was only found in MPV, platelet distribution width (PDW), and PSA between PCa and non-PCa patients. MPV was significantly decreased and PDW increased in PCa than that of non-PCa among men. ROC analysis identified MPV ≤ 9.05 fl as a cut-off value for potential PCa with area under the ROC curve (AUC) = 0.783, 95% CI = 0.733–0.833, sensitivity = 0.746, and specificity = 0.708. AUC and the sensitivity of MPV were comparable with total PSA (TPSA) or free PSA (FPSA). However, the specificity of MPV was larger than that of TPSA (0.461) or FPSA (0.561). Furthermore, MPV combined with TPSA or FPSA further enhanced the specificity of TPSA (0.844) or FPSA (0.927), but PDW did not. These findings suggested that MPV could have a predictive value for the diagnosis of PCa. MPV in combination with TPSA or FPSA could enhance the specificity of PSA and may reduce the rate of unnecessary biopsy for patients with high levels of PSA.

Renal cell carcinoma (RCC) is a common cancer, and extensive research suggests that microRNA may play an important role in the progression of RCC. The emphasis of this article was to reveal the function and mechanism of microRNA-1293(miR-1293) in the development of RCC tumors. First, the authors carried out bioinformatics analysis. The differential expression of miR-1293 in RCC tumor and normal cells was analyzed using the data from The Cancer Genome Atlas database, and Kaplan-Meier survival analysis was carried out to test the survival rate. Subsequently, the miR-1293 expression in RCC cell lines was examined by quantitative real-time PCR. Then Cell counting kit-8 and Transwell assays were executed to detect the function of miR-1293 in RCC. Bioinformatics prediction, western blotting, and dual-luciferase reporter assay were set to check the target gene of miR-1293. Finally, they conducted rescue experiments to verify whether the regulation of miR-1293 on the biological function of RCC cells was achieved by regulating hydrocyanic oxidase 2 (HAO2). Bioinformatics results showed that miR-1293 was highly expressed in RCC, and the miR-1293 high-expression group showed a lower survival rate than the miR-1293 low-expression group, which suggested that the high expression of miR-1293 was related to unfavorable prognosis in RCC. Subsequent assays evidenced that upregulation of miR-1293 expression significantly increased the cell viability and promoted cell migration and invasion in RCC. Silencing miR-1293 expression showed opposite results. Furthermore, HAO2 was confirmed to be a direct target gene of miR-1293 by dual-luciferase reporter assay, and miR-1293 negatively regulated the expression of HAO2. Moreover, rescue experiments evidenced that miR-1293 reduced the cell viability, invasion, and migration of RCC by regulating HAO2. In sum, miR-1293 can regulate the viability, invasion, and migration of RCC tumor cells by targeting HAO2, suggesting that miR-1293 can be used as a new biomarker for clinical treatment of RCC.

Objective To assess the efficacy and safety of direct-acting antiviral ( DAA) therapy for hepatitis C after renal transplantation. Methods By a retrospective analysis, we recruited seven patients who were infected with hepatitis C virus ( HCV RNA) and treated with direct-acting antiviral agents therapy after kidney transplantation in our transplantation department. Serum HCV RNA, alanine transaminase ( ALT), estimate glomerular filtration rate ( e GFR) and serum creatinine level were measured at baseline, 2nd, 4th, 12 thweek of treatment, and 12 th, 24th, 48 thweek after the treatment. Survival rate of these patients at 1 year post-therapy was analyzed. Results Seven kidney graft recipients infected with HCV were enrolled in our study. All these patients were given DAA therapy for 12 weeks. At the end of therapy, HCV RNA was negative in all patients. The serological test had a rapid virologic response ( RVR) of 100％ ( 7/7), SVR12, SVR24 were 100％, and ALT at 2thweek of treatment had improvement compared with that before treatment. ALT levels remained stable thereafter; e GFR and blood muscle levels remained stable throughout the study period. Conclusion During the 1 year follow-up period, the therapy for patients infected with hepatitis C virus after kidney transplantation is safe and effective, and kidney function after transplantation was relatively stable during the research period.

Purpose: Combination therapy is increasingly used as a primary cancer treatment regimen. In this report, we designed EGFR peptide decorated nanoparticles (NPs) to co-deliver docetaxel (DTX) and pH sensitive curcumin (CUR) prodrug for the treatment of prostate cancer.Results: EGFR peptide (GE11) targeted, pH sensitive, DTX and CUR prodrug NPs (GE11-DTX-CUR NPs) had an average diameter of 167 nm and a zeta potential of -37.5 mV. The particle size of the NPs was adequately maintained in serum and a sustained drug release pattern was observed. Improved inhibition of cancer cell and tumor tissue growth was shown in the GE11-DTX-CUR NPs group compared to the other groups.Conclusion: It can be summarized that DTX and CUR prodrug could be delivered into tumor cells simultaneously by the GE 11 targeting and the EPR effect of NPs. The resulting GE11-DTX-CUR NPs is a promising system for the synergistic antitumor treatment of prostate cancer. (C) 2017 Elsevier Masson SAS. All rights recived

OBJECTIVES:Transplant renal artery stenosis is a frequently recognized complication of kidney transplant procedures. A single-center retrospective study was conducted to examine the use of 3-dimensional computed tomography reconstruction in diagnosing transplant artery stenosis.MATERIALS AND METHODS:During 2013 at our center, 86 patients underwent kidney transplant. All patients underwent ultrasonographic analyses. Patients with clinically suspected transplant renal artery stenosis were examined by 3-dimensional computed tomography reconstruction and were treated with endovascular approaches or medically managed.RESULTS:Ten patients were diagnosed with transplant renal artery stenosis by 3-dimensional computed tomography reconstruction. No evidence of contrast-induced nephrotoxicity was observed. Nine of the 10 patients underwent percutaneous transluminal angio-plasty, whereas the remaining patient was treated conservatively. Procedural success rate was 100%. Patients were followed for a mean period of 20 ± 3 months. Blood pressure improved from a mean of 163/90 to 132/73 mm Hg at the end of the follow-up period. In the 9 patients who underwent angioplasty, serum creatinine improved from 198 ± 24 to 134 ± 16 μmol/L at the end of the follow-up period. The cystatin C level in some patients declined after interventional therapy.CONCLUSIONS:Three-dimensional computed tomography reconstruction is a safe choice for patients who present with increased serum creatinine levels and refractory hypertension. Percutaneous transluminal angioplasty is the preferred therapeutic technique for transplant renal artery stenosis.

Various methods have been used to reconstruct the penis. The objective of this study was to investigate the feasibility of constructing engineered corpus cavernosum with primary mesenchymal stem cells (MSCs) in a rabbit model in vitro . Acellular corporal matrices (ACMs) were obtained from adult rabbit penile tissues through an established decellularization procedure. MSCs were separated, purified, and then seeded on ACMs to construct engineered corpus cavernosum. The seeded ACMs were subsequently cultured in an incubator for 14 days. Histological analyses showed that MSCs seeded on the ACMs had proliferated and were well distributed. Detection of CD31, vWF, smooth muscle actin (SMA), and myosin protein as well as vWF and myosin mRNA revealed that the MSCs had differentiated into endothelial cells and smooth muscle cells. In addition, cell morphology of the engineered corpus cavernosum was directly observed by transmission electron microscopy. This study demonstrated that engineered corpus cavernosum could be successfully constructed using primary MSCs in vitro . This technology represents another step towards developing engineered corpus cavernosum in vitro .

Abstract Objective: Docetaxel (DTX) remains the only effective drug for prolonging survival and improving quality of life of metastatic castration-resistant prostate cancer (mCRPC) patients. Combination anticancer therapy encapsulating DTX and another extract of traditional Chinese medicine is one nano-sized drug delivery system promising to generate synergistic anticancer effects, to maximize the treatment effect, and to overcome multi-drug resistance. The purpose of this study is to construct lipid–polymer hybrid nanoparticles (LPNs) as nanomedicine for co-encapsulation of DTX and curcumin (CUR). Methods: DTX and CUR co-encapsulated LPNs (DTX-CUR-LPNs) were constructed. DTX-CUR-LPNs were evaluated in terms of particles size, zeta potential, drug encapsulation, and drug delivery. The cytotoxicity of the LPNs was evaluated on PC-3 human prostate carcinoma cells (PC3 cells) by MTT assays. In vivo anti-tumor effects were observed on the PC3 tumor xenografts in mice. Results: The particle size of DTX-CUR-LPNs was 169.6 nm with a positive zeta potential of 35.7 mV. DTX-CUR-LPNs showed highest cytotoxicity and synergistic effect of two drugs in tumor cells in vitro. In mice-bearing PC-3 tumor xenografts, the DTX-CUR-LPNs inhibited tumor growth to a greater extent than other contrast groups, without inducing any obvious side effects. Conclusion: According to these results, the novel nanomedicine offers great promise for the dual drugs delivery to the prostate cancer cells, showing the potential of synergistic combination therapy for prostate cancer.

Kidney transplantation is now one of the most effective treatment for end-stage renal failure. However, organ shortage remains a major problem. Hence, an alternative solution for the limited donor organs is in great need. Xenotransplantation of metanephros and cell-scaffold technology (CST) provide new ways for kidney regeneration. The structure and function of regenerated kidneys using these two methods are compared to identify the trend for kidney regeneration. Kidney scaffolds, which were decellularized by SDS perfusion, were recellularized with human umbilical vein endothelial cells (HUVEC) and mouse embryonic stem (ES) cells. Metanephros from embryonic day 13.5 were transplanted into the omentum of adult rats. After cultured in vivo for a period, the structural integrity was evaluated. The quantity and type of cells of kidney generated from metanephros were much more than that of the kidney regenerated from CST. But the latter was more suitable for transplantation. Both kidney regeneration methods have their own advantages, and one method which could offer all these advantages may be the optimal way for kidney transplantation.

The standard two dose protocol of basiliximab is effective in reducing acute rejection rate in kidney transplantation, but very expensive. This study aims to investigate the efficacy and safety of one dose of basiliximab in the prevention of acute rejection in renal transplant recipients. A total of 28 renal transplant recipients treated with one dose of basiliximab were studied and followed for six months as a non-randomized retrospective study, a simultaneous 28 renal transplant recipients without anti-lymphocyte induction therapy served as control group. All the grafts were from donation after cardiac death. Acute rejection rate was lower in the study group compared with the control group (21% vs. 50%, P < 0.05). All acute rejection episodes were reversed by methylprednisolone pulse therapy or Anti-human T Lymphocyte Porcine Immunoglobulin (ALG) therapy. There was no significant difference (P > 0.05) in six-month patient or kidney survival rate between the treatment group and the control group. Difference of adverse events including gastrointestinal dysfunctions, leukopenia, impaired liver function and infection between two groups was not found. One dose regimen of basiliximab was effective in the prevention of acute rejection in renal transplant recipients, and is fit for the situation of China because of the significant reduction of cost.

Objective: To produce and examine decellularized kidney scaffolds from porcine as a platform for kidney regeneration research. Methods: Porcine kidneys were decellularized with sodium dodecyl sulfate solution and Triton X-100 after the blood was rinsed. Then the renal ECM scaffolds were examined for vascular imaging, histology to investigate the vascular patency, degree of decellularization. Results: Renal ECM scaffolds of porcine kidneys were successfully produced. Decellularized renal scaffolds retained intact microarchitecture including the renal vasculature and essential extracellular matrix components. Conclusion: We have developed an excellent decellularization method that can be used in large organs. These scaffolds maintain their basic components, and show intact vasculature system. This represents a step toward development of a transplantable organ using tissue engineering techniques. (C) 2015 Elsevier B.V. All rights reserved.

End stage renal disease (ESRD) is a progressive loss of kidney function with a high rate of morbidity and mortality. Transplantable organs are hard to come by and hold a high risk of recipient immune rejection. We intended to establish a more effective and faster method to decellularize and recellularize the kidney scaffold for transplant and regeneration. We successfully produced renal scaffolds by decellularizing rat kidneys with 0.5% sodium dodecyl sulfate (SDS), while still preserving the extracellular matrix (ECM) 3D architecture, an intact vascular tree and biochemical components. We recellularized the kidney scaffolds with mouse embryonic stem (ES) cells that then populated and proliferated within the glomerular, vascular, and tubular structures. After in vivo implantation, these recellularized scaffolds were easily reperfused, tolerated blood pressure and produced urine with no blood leakage. Our methods can successfully decellularize and recellularize rat kidneys to produce functional renal ECM scaffolds. These scaffolds maintain their basic components, retain intact vasculature and show promise for kidney regeneration.

Objective To investigate the pharmacokinetic (PK) characteristics of enteric-coated mycophenolate sodium (EC-MPS) and area under the curve (AUC) from 0 to 12 h by limited sampling strategies (LSSs) in de novo kidney transplant patients of Chinese ethnicity.Method The PK data from 20 Chinese renal transplant recipients collected during the maintenance period after transplantation were analyzed retrospectively.Ten blood samples were obtained after EC-MPS was given on the postoperative day 21.Blood concentrations of mycophenolic acid were measured and AUC was estimated using high performance liquid chromatography in recipients receiving immunosuppressant EC-MPS plus tacrolimus and steroid.LSSs with jackknife technique,multiple stepwise regression analysis,and Origin 7.5 analysis were developed to estimate mycophenolic acid (MPA) AUC.Result There was wide inter-individual variation in MPA plasma level and the AUC.The best equations obtained in the test group were for 3 and 4 time points:AUC0-12h (mg· h· L-1) =12.820 + 0.662 × C1.5h + 1.750 × C4h + 4.213 × C8h,and AUC0-2h (mg· h· L-1) =12.119 + 0.676 × C1.5h + 1.685 × C4h + 1.429 × C6h + 2.573 × C8h respectively.When these LSSs were.tested in the validation group,the results were acceptable (R =0.861,P＜0.001 for 3 time points,and R =0.882,P＜0.001 for 4 time points).Conclusion LSSs are useful for MPA AUC0-12h estimation in Chinese renal transplantation patients.LSSs using time points at C1.5h-C4h-C8h or C1.5h-C4h-C6h-C8h provide the most reliable and accurate estimation of the AUC0-12h of mycophenolic acid in Chinese stable renal transplant recipients receiving EC-MPS and tacrolimus.

Objective The aim of this study was to examine the expression patterns of CEACAM5 in prostatic non-neoplastic and neoplastic lesions and further investigate its relationship with tumor microvessel density(MVD) and lymphatic vessel density(LVD). Methods CEACAM5 expression was detected using immunohistochemical staining in a serial sections of the benign prostatic hyperplasia (BPH), prostate intraepithelial neoplasia (PIN) and prostate carcinoma (PCa) lesions. MVD and LVD were quantified in CEACAM5 positive areas by dual-labelling with CD34 and D2-40 respectively. Results Both PIN and PCa had significantly higher expression for CEACAM5 than BPH which has no positive expression for CEACAM5(P<0.05). In PIN and PCa, CEACAM5 staining showed different expression patterns in terms the of most of membranous staining for PIN, less membranous staining and more cytoplasmic staining for PCa. MVD results showed that PCa and PIN had more angiogenesis than BPH tissue. The value of MVD in PCa tissue was correlated with tumor Gleason grading (P<0.05). LVD results showed that neoplastic lesions had more lymphangiogenesis than non-neoplastic lesion. Conclusion CEACAM5 had different expression patterns in prostatic non-neoplastic and neoplastic lesions, and these various expression patterns may be correlated with tumor progression through promoting tumorous angiogenesis or lymphangiogenesis.

Objective To evaluate the safety and validity of an early steroid withdrawal protocol including cyclosporine (CsA) and mycophenolate mofetil (MMF) in middle aged and elderly renal transplant patients. Methods Between September 2000 and April 2008, the prospective, randomized study design was used in 80 middle aged and elderly renal transplant patients. Steroid withdrawal group (n=39) with primary cadaveric kidney transplants received a protocol consisting of CsA 4～6 mg·kg~(-1)·d~(-1) beginning at postoperative day 3, MMF 0. 75 g twice a day from the next postoperative day, and methylprednisolone (MP) 500 mg daily from day 0 to 3. Then prednisone (Pred) 20 mg daily was gradually tapered and withdrawn after postoperative day 30. Conventional steroid treatment group (control group, n=41) received a regimen consisting of CsA, MMF and MP, and Pred 20 mg daily. Pred was tapered to 5 mg daily over a period of 6 months, then maintained thereafter. Outcome parameters were patient and graft survival rates, renal function, acute rejection ( AR), arterial hypertension, hyperlipidemia or diabetes mellitus, weight gain and infection. Results The incidence of AR in the steroid withdrawal group was similar to the control group (23. 1% vs. 19. 5%, χ~2=0. 15,P>0. 05). Patient survival rates at 12, 24, 36 months were 97. 4%, 94. 8% and 88.0% in the steroid withdrawal group and were 97.6%, 97.6 and 87.8% in the control group, respectively (χ~2=0. 17, P>0. 05). And graft survival rates were 94. 9%, 88. 6% and 83. 7% in the steroid withdrawal group and were 95. 1%, 91. 5% and 79. 5% in control group, respectively (χ~2 = 0.07, P>0. 05). Conclusions In middle aged and elderly renal transplant patients, early steroid withdrawal is feasible and may not significantly increase the risk of acute rejection episodes.