Clinical analysis of rejection after pediatric kidney transplantation / 中华器官移植杂志

Objective:To explore the morbidity features and therapeutic outcomes of rejections in pediatric kidney transplantation (KT) recipients.Methods:Between January 2013 and June 2022, 360 children undergoing KT were recruited.The relevant clinical data were collected for examining the morbidity features and therapeutic outcomes of rejections.The serum levels of creatinine were compared among groups by non-parametric rank test.And Kaplan-Meier and Log-rank methods were employed for examining the incidence of rejection and comparing mortality-censored graft survival rates among patients with different times of rejection.Results:A total of 58 recipients had 82 incidents of rejection with a cumulative incidence of 6.3%, 9.2% and 11.3% at 3/6/12 months respectively.Among 50 incidents of biopsy-proved rejections, the types were T cell-mediated rejection [TCMR, 42.0%(21/50)], antibody-mediated rejection [20.0%(10/50), ABMR] and mixed rejection [38.0%(19/50)].Among 58 incidents of initial rejection, 69% had maintained graft function (MGF) and 31% impaired graft function (IGF) after anti-rejection regimens.Among 80.8%, 85.7% and 75% of recipients with clinical rejection, ABMR or borderline rejection while 36.4% in TCMR patients had MGF.Fifteen kidney allografts lost function in 58 recipients with rejection.Five-year death-censored graft survival was significantly lower in patients with two or more incidents of rejection (30.5%, 95% CI: 12.3%-75.4%) than in those without rejection (92.9%, 95% CI: 89.3%-96.6%) ( P<0.000 1) or with only one rejection (82.9%, 95% CI: 65.9%-100%)( P<0.001). Conclusions:The rejection rate remains high in KT children and it affects graft survival.And TCMR is more likely to cause impaired graft function.Recurrent rejections have a more pronounced impact upon graft survival.

Clinical experience of different switching schemes of tacrolimus slow-release dosage forms after kidney transplantation: a report of 101 cases / 中华器官移植杂志

Objective:To conduct a retrospective analysis of efficacy and safety of different conversion schemes of tacrolimus to slow-release dosage forms for recipients in stable phase after renal transplantation to provide rationales for the conversion strategy of tacrolimus.Methods:From January 2020 to June 2020, clinical data were reviewed for 101 kidney transplant recipients converting from common tacrolimus dosage form to tacrolimus sustained-release dosage form during postoperative stable period.There were 62 males and 49 females with an age range of 19 to 69 years.They were divided into two groups according to iso-dose and incremental-dose switching schemes.The common dosage form of tacrolimus was converted into a sustained-release dosage form with different conversion doses, They were divided into two groups of 1∶1 conversion( n=55)and >1∶1 conversion( n=46). The clinical parameters of serum creatinine(Scr), blood urea nitrogen(BUN), alanine aminotransferase(ALT)and aspartate aminotransferase(AST), alkaline phosphatase(ALP), serum albumin(ALB), white blood cell count(WBC), urinary white blood cell(UWBC), hemoglobin(Hb)and fasting blood glucose(Glu)were compared between two groups after conversion. Results:Regarding numerical change trend after switching to tacrolimus sustained-release dosage form, drug dose/variation trend was smaller and blood drug concentration more stabilized.In two subgroups converted by 1∶1 and 1>1 initial dose, change trend of dose/blood concentration in 1∶1 conversion group appeared to be more stable.However, no inter-group difference existed in long-term parameters.Scr was lower at 1 week and 3 months after switching to extended-release dosage form( P<0.05)and BUN was lower at 2 weeks( P<0.05). In addition, at 5 months after conversion, ALT and AST significantly improved as compared with common dosage form( P<0.05). Significant differences existed in urinary WBC(UWBC)at 2/3 weeks( P<0.05). After switching for 2 weeks, hemoglobin significantly improved compared with common dosage form( P<0.05). No significant differences existed in ALP, ALB or Glu at other timepoints and pre-conversion( P>0.05). In 1∶1 switch group, renal function tended to improve.At 2 weeks, BUN was lower than pre-conversion; at 1/3 weeks, Scr was lower than pre-conversion( P<0.05). In addition, there was also a trend of improvement in liver function in 1∶1 conversion group.At 1 week and 5 months, ALT was lower than pre-conversion( P<0.05). However, no significant differences existed in AST, ALB, ALP, Glu, UWBC and serum WBC count at each timepoint between two different dose conversion groups( P>0.05). After conversion, intra-individual variability of tacrolimus trough concentration significantly improved( P<0.05). Conclusions:With the same safety and efficacy as common dosage form, sustained-release dosage form of tacrolimus may improve drug variability of individuals.When converting common dosage form into sustained-release dosage form, individual differences should be considered.While monitoring trough concentrations, proper doses should be adjusted on the basis of various clinical parameters.

Diagnosis and treatment of transplanted renal artery stenosis in 7 children from deceased donors / 中华器官移植杂志

Objective:To explore the diagnosis and treatment of transplanted renal artery stenosis(TRAS)in children.Methods:From January 2016 to August 2021, clinical data of 7 TRAS patients were collected.A definite diagnosis was confirmed by Doppler ultrasound and computed tomography angiography.Results:Patient age was significantly higher than donor age(11.9±3.7 vs 1.0±0.5 years, P<0.001); 5 patients had a widened diameter at stenotic grafted renal artery after intervention(1.98±0.47 vs 4.64±1.19 mm, P=0.002). A reduction in peak systolic flow velocity in stenotic segment of artery(463.3±90.6 vs 183.6±58.9 cm/s, P<0.001)and lower systolic blood pressure(137.2±15.5 vs 129.7±12.3 mmHg, P=0.029)were observed.Resistance index rose(0.38±0.22 vs 0.60±0.03, P=0.063). Significant difference of estimated glomerular filtration rate was observed at Week 4 post-operation as compared with pre-intervention.Two patients developed complications after intervention, including perirenal hematoma and stent-attached thrombus.Two patients were treated conservatively with a gradual increase in blood pressure and three antihypertensive drugs prescribed. Conclusions:Doppler ultrasound should be performed regularly after renal transplantation for detecting TRAS at an early stage in children.Interventional treatment is ideal for severe TRAS to improve perfusion and renal function.Clinicians should pay more attention to complications.

A child with diffuse mesangial sclerosis caused by a missense mutation of TRPC6 gene / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic etiology and clinical outcome of a child with steroid-resistant nephrotic syndrome and diffuse mesangial sclerosis.@*METHODS@#Genomic DNA was extracted from peripheral blood leukocytes of the proband and his parents. Targeted capture - next generation sequencing and Sanger sequencing were carried out. Candidate variant was verified by segregation analysis in his family.@*RESULTS@#A heterozygous missense variant of the TRPC6 gene, namely c.325G>A (p.Gly109Ser), was detected in the proband. The same variant was not detected in either parent. According to the guidelines for the interpretation of sequence variants developed by American College of Medical Genetics and Genomics, the variant was predicted as pathogenic.@*CONCLUSION@#The missense variant of the TRPC6 gene probably underlay the diffuse mesangial sclerosis in this patient. Above finding has expanded the phenotypic spectrum of the TRPC6 gene.

Modified technique of ureter implantation for urinary tract reconstruction in murine renal transplantation model / 中华器官移植杂志

Objective:To explore the application value of modified technique of ureter implantation in murine renal transplantation.Methods:Thirty left donor kidneys from BALB/c mice was transplanted into syngeneic mice. Cuff technique was applied for anastomosing kidney artery and vein. The procedure of ureter-bladder anastomoses shifted from implication-fixation-embedding to fixation-implication-embedding. Operative duration, recipient survival rate and complications were recorded.Results:Time for separating vessels, perfusion and excision of donor graft was (25±3) min, (10±6) s for warm ischemia and (25±5) min for cold ischemia. Time for separating recipient vessels was (12±5) min, (7±1) min for arterial anastomosis, (7±1) min for venous anastomosis, (13±2) min for ureter-bladder anastomosis, (5±1) min for right kidney excision and (5±1) min for abdominal closure. Operative duration was(77±3)min. Twenty-six recipients survived over 3 months. The successful operative rate was 86.7%.Conclusions:With a shorter learning curve, modified technique of ureter implantation is easier and faster so as to reduce the postoperative incidence of urinary tract complications during murine renal transplantation.

Clinical efficacy of dual-kidney transplantation from infant donors to adult recipients / 中华器官移植杂志

Objective:To explore the clinical efficacy of dual-kidney transplantation from infant donors to adult recipients.Methods:From December 2012 to November 2020 in Organ Transplant Center First Affiliated Hospital Sun Yat-sen University, rertrospective reviews were conducted for clinical data of 25 pairs of infant donors and adult recipients. The survival rates were calculated for both recipients and transplanted kidneys at Year 1/3/5 post-transplantation. And the postoperative recovery status and the postoperative incidence of adverse events of recipients were observed.Results:The survival rates of recipients were all 95.8% at Year 1/3/5 and those of transplanted kidney and dealth-cancelling transplanted kidney all 87.2%. One case died due to acute inferior-wall cardiac infarction while three others lost renal functions for vascular thrombosis, ureteral stenosis and urinary fistula. Except for loss of renal function and death, the postoperative estimated golmerular fitration rate was (99.35±21.78), (103.11±29.20) and (114.99±28.55) ml/(min·1.73 m 2) at Year 1/2/3 respectively. Conclusions:Selecting proper recipients, standardizing donor acquisition and surgical procedures and strengthening perioperative managements may expand the donor pool. The overall outcomes are excellent for adult recipients with dual-kidney transplantation from donations after infants' death.

Diagnosis and treatment of focal segmentalglomerulosclerosis after kidney transplantation in children / 中华器官移植杂志

Objective:To explore the diagnosis and treatment of focal segmental glomerulosclerosis (FSGS) post-kidney transplantation in children.Methods:Clinical data were retrospectively analyzed for 6 FSGS children after transplantation from 2015 to 2019. Massive proteinuria (3.2-13 g/24 h) occurred at 4 days-49 days post-transplantation. For proteinuria, glucocorticoid plus therapeutic plasma exchange and/or rituximab were provided with supplemental ACEI/ARB drugs. Five cases received tacrolimus as maintenance therapy while another case had cyclosporin A as an initial intensive therapy and switched to tacrolimus.Results:Four cases achieved complete remission after therapy. One recipient showed partial remission. During a follow up period of 11 months to 4 years, serum creatinine remained normal and stable in five cases while one died from severe pulmonary infection.Conclusions:Once FSGS occurs post-transplantation, prompt treatment of pulse glucocorticoid plus therapeutic plasma exchange and/or rituximab with supplemental ACEI/ARB drugs may yield favorable outcomes.

Retrospective analysis of pediatric kidney transplantation: a report of 244 cases / 中华器官移植杂志

Objective:To explore the clinical characteristics and outcomes of pediatric kidney transplantations at a single center and discuss the related clinical issues.Methods:From January 1990 to October 2019, clinical data were analyzed retrospectively for 244 pediatric renal transplants. The youngest recipient was aged 1.8 years and the median age of pediatric recipients was 12.2 years. The major disease was primary or hereditary glomerulonephritis ( n=160, 69.0%), congenital anomalies of kidney and urinary tract (CAKUT), cystic renopathy and other hereditary nephropathies ( n=55, 23.7%). The donor sources included traditional deceased donor ( n=42, 17.2%), living-related donor ( n=19, 7.8%) and organ donation ( n=183, 75.0%). The median age of donors was 2 years (0-51) and the median weight 12.0(2.7-72.0) kg. From January 2013 to October 2019, 170 cases), the major induction immunosuppression regimen was anti-thymocyte globulin (ATG) ( n=110, 64.7%) or basiliximab ( n=58, 34.1%). The maintenance regimen was tacrolimus + mycophenolic acid (MPA) + glucocorticosteroids. Finally the outcomes and the complications were analyzed. Results:The survival rates of 244 kidney allograft recipients were 98.1%, 94.5% and 93.4% and the graft survival rates 92.6%, 84.2% and 82.0% at 1/3/5 years respectively. Ten recipients died of accident ( n=2, 20.0%), pneumonia after transplantation ( n=2, 20.0%) and intracranial hemorrhage ( n=2, 20.0%). Thirty-three recipients lost their allografts mainly due to intravascular thrombosis in graft ( n=5, 14.3%), acute rejection ( n=5, 14.3%) and death ( n=9, 25.7%). Besides, among 109 deceased donor allograft recipients, the postoperative outcomes were delayed graft function recovery (DGF) ( n=27, 24.8%), arterial thrombosis ( n=6, 5.5%), venous thrombosis ( n=1, 0.9%), graft perirenal hematoma ( n=6, 5.5%), raft artery stenosis ( n=10, 9.2%) and graft ureteral fistula ( n=1, 0.9%). The incidence of acute rejection was 17.5% and 23.2% at 1/3 year respectively. The recurrent rate of primary disease was 6.9%, including primary FSGS ( n=3, 42.9%) and IgA nephropathy ( n=2, 28.6%). At 1/3 year post-operation, the incidence of pulmonary infection was 16.9% and 22.4% and the incidence of urinary tract infection 26.9% and 31.7%. Excluding recipients with graft failure, the estimated glomerular filtration rate (eGFR) at 1/2/3 year postoperatively was (80.3±25.2), (81.4±27.8) and (71.8±27.6) ml/(min·1.73 m 2)respectively. Conclusions:The outcomes of pediatric renal transplantations are excellent at our center. Future efforts shall be devoted to optimizing the strategies of donor kidney selection and strengthening preoperative evaluations, perioperative and postoperative managements for improving the long-term outcomes of pediatric renal transplantations.

Desensitization strategies for ABO-incompatible living related kidney transplantation / 中华器官移植杂志

Objective To explore the strategies of desensitization treatment for ABO incompatible (ABOi) related living-donor kidney transplantation .Methods A retrospective analysis was performed for 14 recipients undergoing ABOi related living kidney transplantation from July 2015 to December 2018 .The clinical outcomes and expenditures of desensitization treatment before and after optimizing desensitization were compared .Results After desensitization treatment , 14 recipients successfully underwent ABOi-kidney transplantation . Within 2 weeks post-transplantation , blood group antibody rebounded to 1:64 in only 1 recipient .Within 1 week post-transplantation ,the serum creatinine levels decreased to 85-165 μmol/L in 14 recipients .Thirteen patients stabilized after 1 week while another patient had an elevated level of serum creatinine at Day 12 post-operation and renal allograft function recovered after treatment . Two cases of rejection were diagnosed by clinical manifestations and 1 case was confirmed by pathological biopsy . Five cases of programmed renal allograft biopsy indicated critical or suspected acute T-lymphocytic rejection within 1 year .Thirteen cases (92 .6％ ) demonstrated varying degrees of peritubular capillary deposition of C 4d .One case developed BK viral uropathy within 1 year and four patients of pulmonary infections requiring hospitalization were cured after treatment . During an early stage , the incidence of postoperative infection was 57 .14％ and declined to 14 .29％ after optimized desensitization .The expenditure of early desensitization treatment was (27004 .86 ± 10719 .85) yuan and (10612 .29 ± 8143 .05) yuan after optimization .And the expenditure of optimized desensitization was significantly lowered (P<0 .05) . During follow-ups ,renal allograft function of 14 recipients remained decent .And the survival rate of recipient/allograft was 100％ up to the statistical cut-off point .Conclusions Both desensitization strategies may achieve the goal of desensitization for ABOi kidney transplantation and the outcomes are excellent .The expenditure of desensitization treatment is significantly lowered after optimization .

Efficacy and safety of initial-dose mizoribine plus tacrolimus and corticosteroids in living-related renal transplant recipients / 中华器官移植杂志

Objective To assess the efficacy and safety of mizoribine (MZR) in initial immunosuppression in living-related renal transplant recipients.Methods From October 2015 to October 2017,twenty-two patients undergoing initial living-related renal transplantation received MZR (3-4 mg/kg/d) plus tacrolimus and corticosteroid.During a follow-up period of 12 months,patient/graft survival,incidence of acute rejection and adverse events were observed.Results There was no onset of graft loss and death and acute rejection rate was 22.7％.Renal allograft function remained stable.The incidence rate of cytomegaloviral infection was 4.5％ and no CMV disease occurred.The incidence of BKV viruria was 36.4％ and the infection rate was 18.2％.Digestive symptoms occurred (n =3,13.6％).The major side effect of hyperuricemia could be controlled without reduction or withdrawal of MZR.Conclusions Excellent graft survival can be achieved when using MZR as initial immunosuppression in living-donor renal transplant recipients,yet the incidence of acute rejection remains high.Further study is required for determining the effect of MZR in the prevention of BK viral infection during renal transplantation.

Efficacy and safety of febuxostat in renal transplant recipients with hyperuricemia / 中华器官移植杂志

Objective To assess the efficacy and safety of febuxostat in the treatment of hypemricemia in renal transplant recipients.Methods A total of 124 renal transplant patients with hyperuricemia receiving febuxostat between June 2016 and July 2018 were retrospectively analyzed.Uric acid (UA),liver function and renal function parameters before and 3 months after treatment were compared.Adverse events,recipient and renal allograft survival were recorded throughout the follow-up period.Results Serum level of uric acid significantly decreased after 3-month treatment (P＜0.001).And 66.1％ of them achieved target UA level at Month 3 after dosing.Estimated glomerular filtration rate (eGFR) was maintained.No severe adverse event was observed.All recipient and renal grafts survived during the follow-up period.Conclusions Febuxostat is both effective and safe in the treatment of hyperuricemia in renal transplant.

Clinical analysis and outcome of 524 cases of kidney transplantation / 中华器官移植杂志

Objective To explore the clinical outcome of renal transplantation and analyze the risk factors influencing the kidney allograft survival after transplantation.Methods The clinical data of 524 cases of renal transplantation between January 2007 and December 2015 were retrospectively analyzed.Serum creatinine was determined,and glomerular filtration rate(GFR) was estimated.The 1-,2-and 3-year patient and graft survival after transplantation was calculated.Adverse events were recorded.Results The median follow-up time was 17.2 months.The 1-,2-and 3-year graft survival rate after transplantation was 97％,95.8％ and 95.3％,respectively.The 1-,2-and 3-year patient survival rate after transplantation was 97.8％,97％ and 97％,respectively.The eGFR was (67.6 ± 24.1),(68.9±24.2) and (72.7 ± 26.2) ml·min-1 ·1.73 m-2 at 1st,2nd and 3rd year after transplantation.The incidence of delayed graft function(DGF) was 20.6％ (108/524).Multivariate analysis revealed donor type (P =0.005) and the terminal creatinine (P＜0.001) were the independent risk factors of DGF.Elder recipients (P =0.004),recipients with diabetes(P =0.031),preoperative positivity of panel reactive antibody(PRA) (P =0.023),and donor with hypertension (P =0.046) were risk factors influencing the kidney allograft survival.Conclusion Kidney transplantation showed good outcomes at 3rd year after transplantation.The recipient age,recipient's history of diabetes,preoperative PRA and donor's history of hypertension are independent risk factors for renal graft survival.

Impact of renal impairment on pharmacokinetics of mycophenolate mofetil in chinese adult renal transplant recipients early after kidney transplantation / 中华器官移植杂志

Objective To identify the effect of renal impairment on the pharmacokinetics of mycophenolate mofetil in Chinese adult renal recipients during the early post-transplant period.Methods Thirty Chinese renal allograft recipients treated with mycophenolate mofetil in combination with tacrolimus and corticosteroids were divided into three groups based on their renal functions.Group Ⅰ had preserved renal function (eGFR≥90 mL/min/1.73 m2,n =9);Group Ⅱ had moderate renal insufficiency (30≤eGFR＜90 mL/min/1.73 m2,n =12) and Group Ⅲ had severe renal impairment (eGFR ＜30 mL/min/1.73 m2,n =9).mycophenolic acid (MPA) exposure and MPA glucuronide (MPAG) exposure were determined by high performance liquid chromatography (HPLC)at first month after transplantation.MPA-AUC0-12h and MPAG-AUC0-12h were calculated by the linear trapezoidal rule.Results Mean MPA-AUC0-12h values were similar between group Ⅰ and group Ⅱ(37.8 ± 15.6 vs.54.5 ± 27.0μg·h·ml-1,P＞0.05).MPA-AUC0-12h values were significantly higher in group Ⅲ than in group Ⅰ (75.7-±29.5 vs.37.8-± 15.6μg·h·ml-1,P＜0.05).The severe renal insufficiency group showed a significantly increased AUC0-12h for MPAG (1899.1 ± 987.1 μg·h· ml-1vs.859.9 ± 261.4 vs.692.6 ± 384.8,P＜0.05).There was no significant difference in MPAGAUC0-12h between group Ⅱ and Group Ⅰ (P =0.532).Conclusion In adult renal recipients during the early post-transplant period,total MPA exposure was significantly increased because of severe renal insufficiency with oliguria or anuria.Adjusting MMF dose according to renal function may help to prevent side effects and improve efficacy.

Antibody monitoring and graft biopsy after renal transplantation contribute to early diagnosis of antibody mediated rejection / 器官移植

Objective To analyze the necessity of anti-human leukocyte antigen (HLA)antibody monitoring and graft biopsy on early diagnosis of antibody-mediated rejection (AMR). Methods Fifty-one recipients with de novo donor specific antibody (dnDSA)were screened and chosen. Donor specific antibody (DSA)and its ability to bind with C1 q were evaluated. Pathological biopsy of the kidney graft was performed. The recipients diagnosed with AMR were divided into the unstable and stable kidney function groups. Type of DSA,binding ability of the complement and Banff score were statistically compared between two groups. Kaplan-Meier survival analysis of the kidney graft in the recipients from non-rejection, unstable and stable kidney function groups was performed. Results Type of HLA antibody,mean fluorescent intensity (MFI)of DSA,C1 q binding ability and C4d deposition in peritubular capillary did not significantly differ between the unstable and stable groups (all P>0. 05 ). Histomorphologically,the Banff score of microvasculitis,endarteritis,renal tubule-interstitial nephritis,transplantation glomerulopathy and renal tubular atrophy-stroma fibrosis did not significantly differ between two groups (all P>0. 05 ). In the unstable group,the accumulated survival rate of the kidney graft was significantly lower compared with that in the stable group,which was significantly lower than that of their counterparts who were ineligible for pathological diagnosis (P=0. 002). Conclusions It is necessary to perform regular anti-HLA antibody monitoring and pathological puncture examination after renal transplantation,which contributes to early detection and diagnosis of AMR.

Current status of pediatric kidney transplantation in China: data analysis of Chinese Scientific Registry of Kidney Transplantation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Kidney transplantation (KTx) is the primary therapy for children with renal failure. Unlike KTx in adult patients, it is commonly agreed that pediatric KTx in China is far behind that of America. There has been no systematic analysis of Chinese pediatric KTx reported. This study aimed to demonstrate the current status of pediatric KTx in China.</p><p><b>METHODS</b>Registry data of pediatric KTx (1983-2012) from Chinese Scientific Registry of Kidney Transplantation (CSRKT) were retrospectively analyzed.</p><p><b>RESULTS</b>There were 851 pediatric KTx from 102 transplant units. The recipients were (15.4±2.5) years of age, 93.9% of who were over 10 years old. Chronic glomerulonephritis and pyelonephritis accounted for 75.6% of recognized primary diseases. Allografts were from deceased donors (72.2%) or living donation (27.7%). The patient survival for 1, 3, 5, and 10 years was 96.9%, 94.2%, 92.3%, and 92.3% and the graft survival was 94.6%, 91.4%, 86.3%, and 79.2%, respectively. The majority of post-transplant complications were acute rejection and infections. Annual transplant reached the peak in 2008 (n = 114), and decreased sharply in 2006 (n = 41) and 2010 (n = 57). The percentage of pediatric KTx in total KTx was highest in 2007 (1.95%) and decreased to trough level in 2010 (1.0%). Living donation increased by 32.5-folds from 2004 to 2008 and then decreased by 86.6% till 2010. The percentage of living donation in pediatric or total KTx dynamically changed in a similar manner, while living donation ratio in pediatric KTx was much higher.</p><p><b>CONCLUSIONS</b>Kidney transplant can provide long-term benefits to pediatric recipients. Rejection and infections are worthy of concern during follow-up. Pediatric kidney transplant in China is very much lagging behind that in developed countries. Living donation played an important role in its development in the past decades. New strategies for implementation are encouraged to increase the priority of uremic children in organ allocation so as to promote its progress in China.</p>

Detection of immune cell subsets in renal allograft recipients before operation and its significance / 中国组织工程研究

BACKGROUND:The immune cells of renal al ograft recipients have always been the hot spot of research. However, there are few studies addressing the immune cellsubsets in renal al ograft recipients before operation. OBJECTIVE:To investigate the proportional distribution of immune cellsubsets in renal al ograft recipients before operation. METHODS:Fifteen de novo living-related renal transplant recipients were enrol ed in this study with 15 healthy volunteers, aged 18-40 years, as healthy controls. Flow cytometry was employed to observe the proportion of the immune cellsubsets by extracting peripheral venous blood of al participants. RESULTS AND CONCLUSION:In the renal al ograft recipients, the proportions of CD4+CD25+T cells, the proportion of CD4+CD25+/CD4+T cells, CD19+B cells, CD19+CD5+B cells, CD19+CD27+B cells, NKG2A/NK cells, and NKG2A/NKG2 cells were al lower than those in the healthy controls;however, the proportion of CD38+IgD-/CD19+B cells and NKG2D cells were higher than those in the healthy controls. The difference of the proportion of immune cellsubsets aforementioned between the two groups was statistical y significant (P<0.05), while no difference was observed in other subsets. Immune cellsubsets in renal al ograft recipients before operation could be used to assess the immune status of the recipients, and also could be seen as the basal control for postoperative immunological monitoring.

Single center experiences: characteristics of tuberculosis in iost-renal-transplant recipients during 20 years / 中华器官移植杂志

Objective To analyze the characteristics of tuberculosis (TB) in renal-transplant recipients from our hospital, and summarize the corresponding experiences in diagnosis and management.Methods A retrospective study was performed on 61 documented post-transplant TB cases out of the 2842 patients who received kidney transplantation in the First Affiliated Hospital of Sun Yat-sen University between Jan.1991 and Dec.2010.Results TB in the post-renal-transplant population in our hospital displayed the following characteristics:(1) High incidence (2.1％ ).54.1％ recipients were diagnosed within the first year post-transplant; (2) Lung was the most common site (77.0 ％).There was high prevalence (60.7 ％) of extra-pulmonary TB (lymphatic TB,23.0 ％; pleuritis,13.1 ％; graft,11.5％); (3) Fever (83.6 ％),cough (55.7 ％),sputum (41.0 ％) were the most common clinical manifestations.There were also emaciation (3.3 ％) and enlargement of lymph nodes (18.0 ％); (4) Chest X-ray and CT were of great value during TB diagnosis while purified protein derivative of tuberculin (PPD) skin test had little diagnostic value with a negative result in 56 cases (91.8 ％) ; (5) Liver function damage ( 16.4 ％),kidney function injury (39.3 ％) and peripheral nerve toxicity (3.3 ％) were the main adverse reactions of anti-tuberculosis chemotherapy,also the major cause of anti-TB failure; (6) Pre-transplant TB (17 cases) increased the probability of TB recurrence (4 cases,23.5 ％) post-transplantation; (7) The post-transplant TB patients were accompanied with cellular immune deficiency,resulting in overlapping infection of bacteria,viruses and fungi (19.7 ％); (8) 1- and 3-year patient/graft survival rate of patients with post-transplant TB was 85.2 ％/78.7 ％ and 85.2 ％/75.4 ％ respectively. The accumulative mortality rate reached to 14.8％,while overlapping infection was the major cause of death (66.7 ％).Conclusion Chinese renal transplant recipients still face a high risk of TB because of their immunecompromised state and epidemiological prevalence of the disease. For the high mortality rate and associated serious complications,rapid diagnosis and effective anti-TB chemotherapy are of great value for TB population.

Effect of Converted Regulatory T Cells with Renca Conditioned Media on Suppressive Profile of Allo-immunity in Mice / 中山大学学报(医学科学版)

[Objective]This study was designed to investigate capability of the conditioned media that originated from Renca cells to convert CIM~+ CD25~- T cells into CD4~+ CD25~+ T cells,which can exert immunosuppressive effect on effector T cells in vitro and in vivo.[Methods]The common media were mixed with the conditioned media at different ratios,and fresh enriched CD4~+ CD25~- T cells with MACS were cultured in mixed media for 7 days.At end-point of culture,the cells were collected and detected phenotypes in flow cytometer.Moreover,we detected immunosuppressive effect of converted CD4~+ CD25~+ T cells on effeetor T cells proliferation in one-way mixed lymphocytes reaction by using CCK-8,and we observed survival time and histology of grafts.The delayed type hypersensitivity was determined 14 days after transplantation.[Results]The mixed media could increase ratio of CD4~+ CD25~+ Foxp3~+ T cells in conditioned media ratio-dependent(P＜0.05),compared with control groups,when the mixed media contained no mote than 75% of conditioned media.The converted CD4~+ CD25~+ T cells significantly suppress proliferation of effector T cells in vitro,and prolong survival time of grafts,which were(29.6±1.4)d in converted CD4~+ CD25~+ T cells treated groups(P＜0.05),compared with that in untreated groups(9.8±0.6 d)or PBS treated groups(10.9±0.6 d).Moreover,delayed-type hypersensitivity reaction were conducted at day 14 after transplantation in the recipients,and the results showed that less pad swelling in the group treated with converted CD4~+ CD25~+ T cells than other control groups was found,according to measurement of pad swelling.In addition,progressed to complete necrosis of grafts were exhibited in the mice treated with PBS and untreated mice,whereas better healing of grafts and less lymphocytes infiltration were displayed in the mice treated with converted CD4~+ CD25~+ T cells,which were similar to the mice treated with natural regulatory T cells.[Conclusion]The converted CD4~+ CD25~+ T cells with Renca conditioned media play suppressive role in vitro and in vivo.

Diagnosis and treatment of vascular complication after renal allograft transplantation / 中华器官移植杂志

Objective To investigate the diagnosis and treatment of vascular complications after allograft kidney transplantation.Methods The clinical data of 34 patients with vascular complications after renal allograft transplantation were retrospectively studied,and the characteristics,diagnosis and therapeutics were analyzed.Results Among the 34 patients,there were 13 cases of allograft renal(artery) obstruction,8 cases of allograft renal artery hemorrhage,7 cases of arterial anastomosis(rupture),4 cases of allograft renal vein obstruction,1 case of external iliac artery aneurysm and 1 case of external iliac vein thrombosis.Diagnosis was made in 21 patients by color Doppler flow imaging(CDFI),among whom 10 received further examination of magnetic resonance angiography(MRA).In the 5 cases of allograft renal artery stenosis(TRAS),3 came out with well renal function after the placement of endovascular stents.During the follow-up duration of 8,10 and 14 months,their serum creatinine(Scr) maintained between 115 and 135 ?mol/L.TRAS patient's allograft renal artery which had been anastomosed end-to-end with internal iliac artery was shifted to end-to-side style with(external) iliac artery at the second time,and came out with normal Scr one month postoperation.One TRAS patient received conservative treatment because MRA examination indicated only mild stenosis,and his Scr has been decreasing for 21 days till now.Three patients with allograft renal vein(obstruction) was treated with surgery,in whom one died of heart failure,and the other 2 patients'(renal) function recovered well during the follow-up of respectively 13 and 36 months.One patient with external iliac vein thrombus died of allograft rupture.All the other patients underwent allograft(resection).Conclusion Vascular complications after renal transplantation progresses fast once(developed) with a poor prognosis,so early diagnosis is essential for graft as well as survival and(effective) management should be administrated accordingly.CDFI could be the first choose for screening.

Clinical study of pediatric renal transplantation: a report of 23 cases / 中华器官移植杂志

Objective To investigate the clinical features of pediatric renal transplantation and improve the effect of pediatric renal transplantation. Methods Clinical data of 23 children (3 17 years old) who underwent renal transplantation were retrospectively analyzed. Results In these 23 recipients, 4 cases suffered from pulmonary infection, 2 from heart failure and 2 from transplanted renal vein echmasis. Two patients' liver function was injured and one suffered from acute tubular necrosis. The incidence of acute rejection (AR) was 30.4 % (7/23) and that of chronic rejection (CR) was 8.7 % (2/23). During the follow up of 5 days to 72 months (average of 26.1 months), one died of heart failure and severe pulmonary infection. The 1 year patient and graft survival rate was respectively 93.3 % and 86.6 % . Conclusion Different from renal transplantation in adult, pediatric renal transplantation has special treatment in the operation process. HLA well matching is necessary for a good effect of pediatric renal transplantation. In spite of its high AR incidence, pediatric renal transplantation is an effective treatment with its satisfactory one year graft survival rate. Nevertheless, its long term effect should be improved much more.