Coupling structural evolution and oxygen-redox electrochemistry in layered transition metal oxides.

Lattice oxygen redox offers an unexplored way to access superior electrochemical properties of transition metal oxides (TMOs) for rechargeable batteries. However, the reaction is often accompanied by unfavourable structural transformations and persistent electrochemical degradation, thereby precluding the practical application of this strategy. Here we explore the close interplay between the local structural change and oxygen electrochemistry during short- and long-term battery operation for layered TMOs. The substantially distinct evolution of the oxygen-redox activity and reversibility are demonstrated to stem from the different cation-migration mechanisms during the dynamic de/intercalation process. We show that the π stabilization on the oxygen oxidation initially aids in the reversibility of the oxygen redox and is predominant in the absence of cation migrations; however, the π-interacting oxygen is gradually replaced by σ-interacting oxygen that triggers the formation of O-O dimers and structural destabilization as cycling progresses. More importantly, it is revealed that the distinct cation-migration paths available in the layered TMOs govern the conversion kinetics from π to σ interactions. These findings constitute a step forward in unravelling the correlation between the local structural evolution and the reversibility of oxygen electrochemistry and provide guidance for further development of oxygen-redox layered electrode materials.

Nondestructive volumetric optical analysis of corroded copper oxidation using 1700nm swept-source optical coherence microscopy.

This study presents a novel nondestructive analysis method for precise characterization of corroded copper oxidation using optical coherence microscopy (OCM). By exploiting the partial light transmission through metallic oxide layers, we employed a specialized OCM system with a wavelength of 1700nm and enhanced the analysis accuracy compared to conventional optical coherence tomography (OCT). The developed OCM system featured a numerical aperture (NA) of 0.15, providing improved surface profiling and higher lateral resolution than OCT. we developed a peak-finding algorithm to accurately determine the thickness of the copper oxide layer from the acquired interference data with zero padding. Our method was validated by comparing the measured thickness profiles with those obtained from scanning electron microscope (SEM) images of corroded metals. The copper oxidation specimens were prepared after heat treatment for 1, 2, 4, and 8 h in an alumina tube furnace at a temperature of 900 °C to find the correlation between the OCM thickness measurement. Additionally, the acquired enface 3D images enabled the identification of local corrosion distribution within a 4 mm × 4 mm area. The en-face mapping images are utilized to analyze the uniformity of the metal oxidation process across the imaging area of the copper oxidation specimens. With an increase in heat treatment time, the median value of the thickness histogram for the copper oxide within the area consistently remained around 10 µm. However, the thickness variation ranged from -2 µm to 5 µm. This indicates that as the heat treatment time progresses, the thickness of the copper oxide becomes more non-uniform. Our technique holds great potential for nondestructive and noncontact detection of metal corrosion and assessment of corrosion rates in various industrial applications. Future research efforts could focus on expanding the application of OCM to different metals and exploring its commercialization prospects for practical implementation in diverse industries.

Post-operative recurrence of focal segmental glomerulosclerosis according to pre-transplant treatment after kidney transplantation.

BACKGROUND: Recurrent focal segmental glomerulosclerosis (FSGS) after kidney transplantation (KT) is a serious complication and a significant risk factor for graft failure. However, there is no clear evidence of the effectiveness of pre-transplant treatment using plasmapheresis (PP) or rituximab in preventing post-operative FSGS recurrence after KT. METHODS: This single-center retrospective study included 99 adult patients with biopsy-proven primary FSGS who underwent KT between 2007 and 2018. The patients were divided into the pre-treatment group (N = 53, 53.5%) and no pre-treatment group (N = 46, 46.5%). In the pre-transplant group, prophylactic PP was administered before KT in patients undergoing living donor transplantation and the day after KT in those undergoing deceased donor transplantation. RESULTS: The rate of immediate post-operative recurrence was significantly higher in the no pre-treatment group (16 [34.8%]) than in the pre-treatment group (5 [9.4%]; P = 0.002). There were three cases of graft failure due to recurrent FSGS, all of which were in the no pre-treatment group. After adjusting for possible confounding factors, age (per 10-year increase; OR = 0.61, CI, 0.42-0.90; P = 0.012) and pre-transplant treatment (vs. no pre-transplant treatment; OR = 0.17, CI, 0.05-0.54; P = 0.003) were identified as significant factors associated with FSGS recurrence. The rate of death-censored graft survival was significantly superior in the pretransplant treatment group (P = 0.042). CONCLUSION: Pre-transplant treatment with PP was associated with beneficial effects on preventing FSGS recurrence after KT.

Versatile Redox-Active Organic Materials for Rechargeable Energy Storage.

With the ever-increasing demand on energy storage systems and subsequent mass production, there is an urgent need for the development of batteries with not only improved electrochemical performance but also better sustainability-related features such as environmental friendliness and low production cost. To date, transition metals that are sparse have been centrally employed in energy storage devices ranging from portable lithium ion batteries (e.g., cobalt and nickel) to large-scale redox flow batteries (e.g., vanadium). Toward the sustainable battery chemistry, there are ongoing efforts to replace the transition metal-based electrode materials in these systems to redox-active organic materials (ROMs). Most ROMs are composed of the earth abundant elements (e.g., carbon, nitrogen, oxygen, sulfur), thus are less restrained by the resource, and their production does not require high-energy consuming processes. Furthermore, the structural diversity and chemical tunability of organic compounds make them more attractive for the versatile design of future energy storage systems. Accordingly, the timely development of high-performance ROM-based electrodes would expedite the shift from the current resource-limited battery chemistry to more sustainable energy solutions.In this Account, we provide an overview of the endeavors to employ and develop ROMs as high-performance active materials for various battery systems. Diverse approaches will be introduced starting from the new ROM design mimicking the energy carrying molecules in biological metabolism to the chemical modifications to tailor the properties for specific battery systems. The molecular redesign of ROM, for example, can be carried out by substituting heteroatoms in the redox center, which leads to the enhancement of the redox potential by the inductive effect. Or, tailoring the ROM molecule by removing redox-inactive functionals results in a reduced molecular weight, thereby an increased specific capacity. The intrinsic limitations of ROMs, such as the low electrical conductivity and the dissolving nature, have been under extensive scrutiny; however, they can be partly addressed through efforts including intermolecular fusion and/or nanoscale hybridization with a conducting scaffold. On the other hand, this problematic dissolving nature of ROMs makes them appealing for some new battery configurations such as redox flow batteries that employ the liquid-state active materials. The high solubility and the stability of the ROM were found to be beneficial in attaining the enhanced energy density and the cycle stability of flow batteries, which could be further optimized by the chemical modifications of ROMs. Besides the role of active materials, the redox activity of ROMs has also enabled their use as catalysts to promote the electrode reaction in metal-air batteries. The redox capability of the ROM was often proven to be effective in the solution-based redox mediation that facilitates both the charging and discharging reaction in metal-air batteries. Finally, we conclude this account by proposing the future research directions regarding the fundamental electrochemistry and the further practical development of ROMs for the sustainable rechargeable energy storage.

Serum procalcitonin as a biomarker for differentiating between infectious and non-infectious fever after pancreas transplantation.

Laboratory biomarkers that can differentiate non-infectious fever from infectious fever after pancreas transplantation have yet to be discovered. Non-infectious fever was defined as the presence of fever (>38.3°C) in the absence of a documented clinical diagnosis of infection or a positive culture. Among 184 consecutive recipients, a total of 91 recipients developed fever within 1-month post-transplant, of whom 46 had infectious fever and 45 had non-infectious fever at our center between August 2014 and July 2019. The onset of fever was earlier in the non-infectious fever group (14.4 ± 3.7 post-transplant days) compared with the infectious fever group (16.5 ± 5.8 post-transplant days; p = .033). Multivariate analysis showed that serum procalcitonin at the peak of fever could significantly differentiate infectious fever from non-infectious fever (OR 53.378, 95% CI: 6.819-417.802, p < .001). The area under the curve for differentiating between the two groups was 0.853 (95% CI, 0.780-0.926) for procalcitonin and 0.667 (95% CI, 0.549-0.785) for CRP. The best cutoff values of serum procalcitonin and CRP were 0.405 ng/ml (sensitivity, 77.1%; specificity, 80.8%) and 7.355 mg/dl (sensitivity, 66.7%; specificity, 67.3%), respectively. Serum procalcitonin may be useful for differentiating non-infectious fever from infectious fever after pancreas transplantation.

Pneumocystis pneumonia occurrence and prophylaxis duration in kidney transplant recipients according to perioperative treatment with rituximab.

BACKGROUND: Pneumocystis pneumonia (PCP) is a life-threatening fungal infection that can occur in kidney transplantation (KT) recipients. A growing number of KT recipients are receiving perioperative treatment with rituximab, which is associated with prolonged B-cell depletion and possible risk of PCP occurrence; however, the optimal prophylaxis duration according to rituximab treatment is yet unknown. We compared the occurrence of PCP and the duration of prophylaxis in KT recipients according to rituximab treatment. METHODS: We retrospectively analyzed 2110 patients who underwent KT between January 2009 and December 2016, who were divided into non-Rituximab group (n = 1588, 75.3%) and rituximab group (n = 522, 24.7%). RESULTS: In the rituximab group, the estimated number needed to treat (NNT) for prophylaxis prolongation from 6 to 12 months was 29.0 with a relative risk reduction of 90.0%. In the non-rituximab group, the estimated NNT value was 133.3 and the relative risk reduction was 66.4%. Rituximab treatment (hazard ratio (HR) = 3.09; P <  0.01) and acute rejection (HR = 2.19; P = 0.03) were significant risk factors for PCP in multivariate analysis. CONCLUSIONS: Our results suggest that maintaining PCP prophylaxis for 12 months may be beneficial in KT recipients treated with rituximab for desensitization or acute rejection treatment.

Anchored Mediator Enabling Shuttle-Free Redox Mediation in Lithium-Oxygen Batteries.

Redox mediators (RMs) are considered an effective countermeasure to reduce the large polarization in lithium-oxygen batteries. Nevertheless, achieving sufficient enhancement of the cyclability is limited by the trade-offs of freely mobile RMs, which are beneficial for charge transport but also trigger the shuttling phenomenon. Here, we successfully decoupled the charge-carrying redox property of RMs and shuttling phenomenon by anchoring the RMs in polymer form, where physical RM migration was replaced by charge transfer along polymer chains. Using PTMA (poly(2,2,6,6-tetramethyl-1-piperidinyloxy-4-yl methacrylate)) as a polymer model system based on the well-known RM tetramethylpiperidinyloxyl (TEMPO), it is demonstrated that PTMA can function as stationary RM, preserving the redox activity of TEMPO. The efficiency of RM-mediated Li2 O2 decomposition remains remarkably stable without the consumption of oxidized RMs or degradation of the lithium anode, resulting in an improved performance of the lithium-oxygen cell.

Direct Observation of Redox Mediator-Assisted Solution-Phase Discharging of Li-O2 Battery by Liquid-Phase Transmission Electron Microscopy.

Li-O2 battery is one of the important next-generation energy storage systems, as it can potentially offer the highest theoretical energy density among battery chemistries reported thus far. However, realization of its high discharge capacity still remains challenging and is hampered by the nature of how the discharge products are formed, causing premature passivation of the air electrode. Redox mediators are exploited to solve this problem, as they can promote the charge transfer from electrodes to the solution phase. The mechanistic understanding of the fundamental electrochemical reaction involving the redox mediators would aid in the further development of Li-O2 batteries along with rational design of new redox mediators. Herein, we attempt to monitor the discharge reaction of a Li-O2 battery in real time by liquid-phase transmission electron microscopy (TEM). Direct in situ TEM observation reveals the gradual growth of toroidal Li2O2 discharge product in the electrolyte with the redox mediator upon discharge. Moreover, quantitative analyses of the growth profiles elucidate that the growth mechanism involves two steps: dominant lateral growth of Li2O2 into disclike structures in the early stage followed by vertical growth with morphology transformation into a toroidal structure.

Intracranial aneurysms in patients receiving kidney transplantation for autosomal dominant polycystic kidney disease.

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease, leading to kidney failure. One of the most serious extrarenal complications of ADPKD is comorbid intracranial aneurysms. The aim of this study is to evaluate the prevalence, rupture rate, and treatment outcomes of intracranial aneurysms in ADPKD. METHODS: Adult patients with a documented diagnosis of ADPKD who received kidney transplantation at our center from January 1994 to December 2018 were included in the study. Medical history, physical examination, laboratory findings, imaging studies, and operation records were collected and analyzed from our database. RESULTS: Among 154 kidney transplant recipients with ADPKD, 113 (73.4%) patients were screened for intracranial aneurysms preoperatively. Twenty three patients (14.9%) had intracranial aneurysms with mean diameter size of 4.5 ± 2.7 mm. Nine patients (5.8%) experienced aneurysm rupture and the mean age at time of rupture was 34.9 ± 9.3 years. Twelve patients (52.2%) presented with multiple aneurysms. The most common aneurysm location was the bifurcation of the middle cerebral artery (34.9%). Clipping was the most common treatment in both ruptured and unruptured aneurysms. CONCLUSIONS: Intracranial aneurysms are more frequent in patients with ADPKD, and the average age of intracranial artery rupture in patients with ADPKD is earlier than in the general population. It is necessary to consider proper evaluation and management of intracranial aneurysms when counseling ADPKD patients who will undergo kidney transplantation.

Reaction chemistry in rechargeable Li-O2 batteries.

The seemingly simple reaction of Li-O2 batteries involving lithium and oxygen makes this chemistry attractive for high-energy-density storage systems; however, achieving this reaction in practical rechargeable Li-O2 batteries has proven difficult. The reaction paths leading to the final Li2O2 discharge products can be greatly affected by the operating conditions or environment, which often results in major side reactions. Recent research findings have begun to reveal how the reaction paths may be affected by the surrounding conditions and to uncover the factors contributing to the difficulty in achieving the reactions of lithium and oxygen. This progress report describes the current state of understanding of the electrode reaction mechanisms in Li-O2 batteries; the factors that affect reaction pathways; and the effect of cell components such as solvents, salts, additives, and catalysts on the discharge product and its decomposition during charging. This comprehensive review of the recent progress in understanding the reaction chemistry of the Li-O2 system will serve as guidelines for future research and aid in the development of reliable high-energy-density rechargeable Li-O2 batteries.

Effect of pre-transplantation use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in kidney transplant recipients-propensity score-matched analysis.

BACKGROUND: Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEi/ARBs) can cause acute kidney injury under dehydratation or in hemodynamically unstable conditions. Regarding kidney transplantation (KT), the risk of using ACEi/ARBs before surgery is not well established. Therefore, we evaluated the clinical outcomes to determine the effect of preoperative use of ACEi/ARBs on KT. METHODS: We retrospectively collected 1187 patients who received living-donor KT between January 2017 and December 2021. We conducted a propensity score-matched analysis between the ACEi/ARB(+) and ACEi/ARB(-) groups and evaluated the effects of ACEi/ARBs on delayed graft function, post-KT renal function, hyperkalemia events, rejection, and graft survival. RESULTS: The ACEi/ARB(+) group showed a similar incidence of delayed graft function as the ACEi/ARB(-) group (1.8% vs. 1.0%, P = 0.362). The risk of delayed graft function was not upregulated in the ACEi/ARB(+) group after propensity score-matching (odds ratio: 0.50, 95% confidence interval (CI) 0.13-2.00). Postoperative creatinine levels and the slope of creatinine levels after KT also were not significantly different between the two groups (creatinine slope from POD#0 to POD#7: - 0.73 ± 0.35 vs. - 0.75 ± 0.32 mg/dL/day, P = 0.464). Hyperkalemia did not occur more often in the ACEi/ARB(+) group than in the ACEi/ARB(-) group during perioperative days. Rejection-free survival (P = 0.920) and graft survival (P = 0.621) were not significantly different between the two groups. CONCLUSIONS: In KT, the preoperative use of ACEi/ARBs did not significantly affect clinical outcomes including delayed graft function, postoperative renal function, hyperkalemia events, incidence of rejection, and graft survival rates compared to the patients who did not receive ACEi/ARBs.

Predicting prognostic factors in kidney transplantation using a machine learning approach to enhance outcome predictions: a retrospective cohort study.

BACKGROUND: Accurate forecasting of clinical outcomes after kidney transplantation is essential for improving patient care and increasing the success rates of transplants. Our study employs advanced machine learning (ML) algorithms to identify crucial prognostic indicators for kidney transplantation. By analyzing complex datasets with ML models, we aim to enhance prediction accuracy and provide valuable insights to support clinical decision-making. MATERIALS AND METHODS: Analyzing data from 4077 KT patients (June 1990 - May 2015) at a single center, this research included 27 features encompassing recipient/donor traits and peri-transplant data. The dataset was divided into training (80%) and testing (20%) sets. Four ML models-eXtreme Gradient Boosting (XGBoost), Feedforward Neural Network, Logistic Regression, and Support Vector Machine-were trained on carefully selected features to predict the success of graft survival. Performance was assessed by precision, sensitivity, F1 score, Area Under the Receiver Operating Characteristic (AUROC), and Area Under the Precision-Recall Curve. RESULTS: XGBoost emerged as the best model, with an AUROC of 0.828, identifying key survival predictors like T-cell flow crossmatch positivity, creatinine levels two years post-transplant and human leukocyte antigen mismatch. The study also examined the prognostic importance of histological features identified by the Banff criteria for renal biopsy, emphasizing the significance of intimal arteritis, interstitial inflammation, and chronic glomerulopathy. CONCLUSION: The study developed ML models that pinpoint clinical factors crucial for KT graft survival, aiding clinicians in making informed post-transplant care decisions. Incorporating these findings with the Banff classification could improve renal pathology diagnosis and treatment, offering a data-driven approach to prioritizing pathology scores.

Development and validation of risk prediction model for post-donation renal function in living kidney donors.

This study aimed to create and validate a predictive model for renal function following live kidney donation, using pre-donation factors. Accurately predicting remaining renal function post live kidney donation is currently insufficient, necessitating an effective assessment tool. A multicenter retrospective study of 2318 live kidney donors from two independent centers (May 2007-December 2019) was conducted. The primary endpoint was the reduction in eGFR to below 60 mL/min/m2 6 months post-donation. The primary endpoint was achieved in 14.4% of the training cohort and 25.8% of the validation cohort. Sex, age, BMI, hypertension, preoperative eGFR, and remnant kidney proportion (RKP) measured by computerized tomography (CT) volumetry were found significant in the univariable analysis. These variables informed a scoring system based on multivariable analysis: sex (male: 1, female: 0), age at operation (< 30: 0, 30-39: 1, 40-59: 2, ≥ 60: 3), preoperative eGFR (≥ 100: 0, 90-99: 2, 80-89: 4, < 80: 5), and RKP (≥ 52%: 0, < 52%: 1). The total score ranged from 0 to 10. The model showed good discrimination for the primary endpoint in both cohorts. The prediction model provides a useful tool for estimating post-donation renal dysfunction risk, factoring in the side of the donated kidney. It offers potential enhancement to pre-donation evaluations.

Immunoprotective Effect of Liver Allograft on Patients with Combined Liver and Kidney Transplantation.

BACKGROUND Simultaneous liver-kidney transplantation (SLKT) and kidney transplantation (KT) after liver transplantation (LT) provide potential treatment options for patients with end-stage liver and kidney disease. There is increasing attention being given to liver-kidney transplantation (LTKT), particularly regarding the immune-protective effects of the liver graft. This retrospective, single-center, observational study aimed to evaluate the clinical outcomes of KT in LTKT patients - either SLKT or KT after LT (KALT) - compared to KT alone (KTA). MATERIAL AND METHODS We included patients who underwent KT between January 2005 and December 2020, comprising a total of 4312 patients divided into KTA (n=4268) and LTKT (n=44) groups. The LTKT group included 11 SLKT and 33 KALT patients. To balance the difference in sample sizes between the 2 groups, we performed 3: 1 propensity score matching (PSM). RESULTS There was no significant difference in graft survival between the groups. However, the LTKT group exhibited significantly superior rejection-free survival compared to the KTA group (P.

Closed-loop cathode recycling in solid-state batteries enabled by supramolecular electrolytes.

Deconstructing solid-state batteries (SSBs) to physically separated cathode and solid-electrolyte particles remains intensive, as does the remanufacturing of cathodes and separators from the recovered materials. To address this challenge, we designed supramolecular organo-ionic (ORION) electrolytes that are viscoelastic solids at battery operating temperatures (-40° to 45°C) yet are viscoelastic liquids above 100°C, which enables both the fabrication of high-quality SSBs and the recycling of their cathodes at end of life. SSBs implementing ORION electrolytes alongside Li metal anodes and either LFP or NMC cathodes were operated for hundreds of cycles at 45°C with less than 20% capacity fade. Using a low-temperature solvent process, we isolated the cathode from the electrolyte and demonstrated that refurbished cells recover 90% of their initial capacity and sustain it for an additional 100 cycles with 84% capacity retention in their second life.

Comparison of long-term outcomes in simultaneous pancreas-kidney transplant versus simultaneous deceased donor pancreas and living donor kidney transplant.

Simultaneous deceased donor pancreas and living donor kidney transplant (SPLK) has certain advantages over conventional simultaneous pancreas-kidney transplant (SPK) and may be beneficial for overcoming the paucity of organs needed for diabetic patients requiring transplant. We compared the clinical outcomes of patients who underwent either SPK (n = 149) or SPLK (n = 46) in terms of pre- and post-transplantation variables, development of de novo DSA, occurrence of biopsy-proven acute rejection (BPAR), and graft survival rates. There were no significant differences in the baseline characteristics between the SPK and SPLK groups except for the shorter cold ischemic time of kidney grafts, shorter duration of diabetes, older age of pancreas graft-donors, and younger age of kidney graft-donors in the SPLK group. Our results showed that the death-censored pancreas graft survival rate was lower in the SPLK group. In addition, the incidence of BPAR of the pancreas graft was higher in the SPLK group. There was no significant difference in the presence of de novo DSA and the rates of kidney graft failure, kidney BPAR, and mortality. Our results show that SPLK can be considered an alternative option for SPK although higher incidences of BPAR and graft failure of pancreas after SPLK need to be overcome.

Robot-assisted kidney transplantation in a morbidly obese patient with incisional hernia reconstruction and abdominoplasty: a case report.

Performing kidney transplantations in patients with morbid obesity presents unique challenges using the conventional retroperitoneal approach. Robot-assisted kidney transplantation (RAKT) offers several advantages, such as better access to hard-to-reach areas. A 56-year-old morbidly obese woman presented with end-stage renal disease due to diabetic nephropathy. The patient had a history of obesity for over 20 years, with a peak body mass index (BMI) of 46.9 kg/m2. Before transplantation, she successfully reduced her BMI to 28.9 kg/m2, but was left with excessive skin folds. The surgery began with the removal of the sac from the incisional hernia and umbilical hernia, which was then used as the site for the GelPOINT port. The da Vinci X robot system was utilized to perform RAKT. After completing RAKT, the plastic surgery team initiated abdominal reconstruction involving panniculectomy, followed by hernial reconstruction and abdominoplasty. The patient's postoperative course was uneventful, and she was discharged on postoperative day 7. Her creatinine level was 0.69 mg/dL, and she did not experience any episodes of rejection during the 16 months following RAKT. This case report describes the successful combination of RAKT with incisional hernia reconstruction and abdominoplasty in a patient with morbid obesity.

Transplant-associated Kaposi's sarcoma in a kidney allograft: a case report.

Kaposi's sarcoma (KS) is a disease that is not widely known among the general public, but has a high prevalence among organ transplant recipients. Here, we present a rare case of intragraft KS after kidney transplantation. A 53-year-old woman who had been on hemodialysis due to diabetic nephropathy underwent deceased-donor kidney transplantation on December 7, 2021. Approximately 10 weeks after kidney transplantation, her creatinine level increased to 2.99 mg/dL. Upon examination, ureter kinking was confirmed between the ureter orifices and the transplanted kidney. As a result, percutaneous nephrostomy was performed, and a ureteral stent was inserted. During the procedure, bleeding occurred due to a renal artery branch injury, and embolization was performed immediately. Subsequently, kidney necrosis and uncontrolled fever developed, leading to graftectomy. Surgical findings revealed that the kidney parenchyma was necrotic as a whole, and lymphoproliferative lesions had formed diffusely around the iliac artery. These lesions were removed during graftectomy, and a histological examination was performed. The kidney graft and lymphoproliferative lesions were diagnosed as KS based on a histological examination. We report a rare case in which a recipient developed KS in the kidney allograft as well as in adjacent lymph nodes.

A prospective, randomized, non-blinded, non-inferiority pilot study to assess the effect of low-dose anti-thymocyte globulin with low-dose tacrolimus and early steroid withdrawal on clinical outcomes in non-sensitized living-donor kidney recipients.

BACKGROUND: The optimal dose of anti-thymocyte globulin (ATG) as an induction regimen in Asian living-donor kidney recipients is unclear. METHODS: This is a pilot study in which 36 consecutive patients undergoing living-donor kidney transplantation were randomly assigned to receive either 4.5 mg/kg (n = 19) or 6.0 mg/kg (n = 17) of ATG; all patients had corticosteroid withdrawal within 7 days. The primary end point was a composite of biopsy-proven acute rejection, de novo donor-specific antibody formation, and graft failure. RESULTS: At 12 months post-transplant, biopsy-proven acute rejection was more common in the ATG4.5 group (21.1%) than in the ATG6.0 group (0%)(P = .048). Importantly, the rate of the composite end point was significantly higher in the ATG4.5 group (36.8% vs 0%)(P = .006). There were significant differences in neither the renal function nor adverse events between the two groups. One case of death-censored graft failure occurred in the ATG4.5 group and no mortality was observed overall. Compared with pre-transplantation, T cells, natural killer (NK) cells, and natural killer T (NKT) cells were significantly decreased in the first week post-transplantation except for B cells. Although T and NKT cells in both groups and NK cells in the ATG4.5 group had recovered to the pre-transplant levels, NK cells in the ATG6.0 group remained suppressed until six months post-transplant. CONCLUSIONS: Compared with ATG 6.0 mg/kg, ATG 4.5 mg/kg with early corticosteroid withdrawal and low dose maintenance regimen was associated with higher rates of acute rejection in non-sensitized Asian living-donor kidney recipients. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02447822.

Slab gliding, a hidden factor that induces irreversibility and redox asymmetry of lithium-rich layered oxide cathodes.

Lithium-rich layered oxides, despite their potential as high-energy-density cathode materials, are impeded by electrochemical performance deterioration upon anionic redox. Although this deterioration is believed to primarily result from structural disordering, our understanding of how it is triggered and/or occurs remains incomplete. Herein, we propose a theoretical picture that clarifies the irreversible transformation and redox asymmetry of lithium-rich layered oxides by introducing a series of global and local dynamic structural evolution processes involving slab gliding and transition-metal migration. We show that slab gliding plays a key role in trigger/initiating the structural disordering and consequent degradation of the anionic redox reaction. We further reveal that the 'concerted disordering mechanism' of slab gliding and transition-metal migration produces spontaneously irreversible/asymmetric lithiation and de-lithiation pathways, causing irreversible structural deterioration and the asymmetry of the anionic redox reaction. Our findings suggest slab gliding as a crucial, yet underexplored, method for achieving a reversible anionic redox reaction.