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1.
Chinese Medical Journal ; (24): 181-186, 2021.
Article in English | WPRIM | ID: wpr-921253

ABSTRACT

BACKGROUND@#Delayed graft function (DGF) is the main cause of renal function failure after kidney transplantation. This study aims at investigating the value of hypothermic machine perfusion (HMP) parameters combined with perfusate biomarkers on predicting DGF and the time of renal function recovery after deceased donor (DD) kidney transplantation.@*METHODS@#HMP parameters, perfusate biomarkers and baseline characteristics of 113 DD kidney transplantations from January 1, 2019 to August 31, 2019 in the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively analyzed using univariate and multivariate logistic regression analysis.@*RESULTS@#In this study, the DGF incidence was 17.7% (20/113); The multivariate logistic regression results showed that terminal resistance (OR: 1.879, 95% CI 1.145-3.56) and glutathione S-transferase (GST)(OR = 1.62, 95% CI 1.23-2.46) were risk factors for DGF; The Cox model analysis indicated that terminal resistance was an independent hazard factor for renal function recovery time (HR = 0.823, 95% CI 0.735-0.981). The model combining terminal resistance and GST (AUC = 0.888, 95% CI: 0.842-0.933) significantly improved the DGF predictability compared with the use of terminal resistance (AUC = 0.756, 95% CI 0.693-0.818) or GST alone (AUC = 0.729, 95% CI 0.591-0.806).@*CONCLUSION@#According to the factors analyzed in this study, the combination of HMP parameters and perfusate biomarkers displays a potent DGF predictive value.


Subject(s)
Biomarkers , Delayed Graft Function , Graft Survival , Humans , Kidney/physiology , Kidney Transplantation/adverse effects , Organ Preservation , Perfusion , Retrospective Studies , Tissue Donors
2.
Article in Chinese | WPRIM | ID: wpr-911678

ABSTRACT

Objective:To explore the prognostic utility of LifePort perfusion parameters plus perfusate biomarkers for predicting delayed graft function(DGF)and recovery time during deceased donor kidney transplantation(KT).Methods:From January 1, 2019 to August 31, 2019, retrospective analysis was performed for clinical data of 113 KT recipients. Based upon whether or not DGF occurred within 3 months, they were divided into two groups of DGF group(20 cases)and non-DGF (93 cases). Two groups were compared using LifePort perfusion parameters, biomarker concentrations, incidence of DGF and kidney recovery time. Statistical analysis was performed.Results:The incidence of DGF was 17.7%(20/113); Multivariate Logistic regression results indicated that terminal resistance(OR 1.879, 95% CI 1.145~3.56)and glutathione S-transferase(GST)(OR 1.62, 95% CI 1.23~2.46)were independent risk factors for DGF; Cox hazard model revealed that terminal resistance was a risk factor for recovery time of renal function(HR=0.823, 95% CI 0.735~0.981). The model combining terminal resistance and GST(AUC=0.888, 95% CI 0.842~0.933)significantly improved the predictive efficacy for DGF as compared with using terminal resistance(AUC=0.756, 95% CI 0.693~0.818)or GST alone(AUC=0.729, 95% CI 0.591~0.806).Conclusions:Combining LifePort perfusion parameters and fluid biomarkers can improve the predictive utility of DGF.

3.
Article in Chinese | WPRIM | ID: wpr-911656

ABSTRACT

Objective:To explore the clinical data of acute rejection in kidney transplant recipients of different ages with elderly donor kidneys.Methods:During January 2012 and June 2020, a retrospective review was conducted for clinical data of 298 recipients undergoing kidney transplantation from elderly donors aged ≥60 years after citizen's death.According to the age, recipients were divided into group A(age<30 yr, 59 cases), group B(30~39 yr, 125 cases), group C(40~49 yr, 83 cases)and group D(age≥50 yr, 31 cases). The incidence of acute rejection(AR)was analyzed.Also based upon age difference between donors and recipients, they were divided into two groups of(30~39 yr)and (40~49 yr)and the occurrence of AR was recorded.Results:The incidence of AR within 1 year post-transplantation in groups A, B, C, and D were 15.3%(9/59), 8.8%(11/125), 7.2%(6/83) and 3.2%(1/31)respectively.The incidence of AR in age difference≥25 yr group(12.5%)and age difference <25 yr group(5.3%) had significant difference( P<0.05). The proportion and absolute value of peripheral blood lymphocytes in each group at 1 week/month post-transplantation had significant difference( P<0.05). No significant difference was observed in serum level of creatinine(SCr), the incidence of pulmonary infection and urinary tract infection or the survival rate of recipients and transplanted kidneys in each group within 1 year post-transplantation among four groups( P>0.05). Conclusions:Elderly donor kidneys can obtain better transplant outcomes in kidney transplant recipients of different ages.As the age of recipients decreases, AR shows an upward trend.Clinicians should pay more attention to the prevention and treatment of AR in recipients with large age difference between donors and recipients.

4.
Article in Chinese | WPRIM | ID: wpr-911648

ABSTRACT

Objective:Discuss the etiological characteristics of pulmonary infection after renal transplantation and the diagnostic value of metagenomics nextgeneration sequencing (mNGS) technique.Methods:A total of 40 patients with pulmonary infection who were admitted to the Department of Renal Transplantation of the First Affiliated Hospital of Medical College, Xi'an Jiaotong University from January, 2018 to January, 2021 were selected, and identification of pathogens through routine pathogen detection methods and mNGS. The routine pathogen detection methods included: blood culture, bronchoalveolar lavage fluid (BALF) and sputum culture and smear staining, lung histopathology, antigen detection and PCR, etc. BALF were used to search for pathogens by mNGS. Combined with the results of the two groups to give accurate anti-infection treatment, the clinical data were retrospectively analyzed.Results:Eventually 36 patients were cured and discharged, and 4 patients deaths. In 40 cases of pulmonary infection, the BALF mNGS pathogens detection of BALF was positive in 37 cases and negative in 3 patients, with a detection sensitivity of 92.5%. In addition, there were 15 cases of single pulmonary infection and 22 cases of mixed pulmonary infection, including 8 cases of bacterial infection, 9 cases of viral infection and 20 cases of fungal infection, among which pneumocystis (20/40, 50%) and cytomegalovirus (10/40, 25%) were the most common. In contrast, the positive rate of pathogens by routine detection were only 30% (12/40), and the difference between the two detection methods was statistically significant ( χ2=32.92, P<0.05). The diagnostic rates of mixed pulmonary infection were 55% and 10% respectively, the difference was statistically significant ( χ2=18.46, P<0.05), the single type pulmonary infection was 30% and 20% respectively, the difference was not statistically significant( χ2=2.99, P>0.05). Conclusions:mNGS has more advantages than routine pathogen detection methods in terms of pathogen species and distribution, detection time, sensitivity, mixed infection diagnosis rate and benefit. Using mNGS can be more efficient to find pathogens of pulmonary infection after renal transplantation, take accurate treatment, reduce costs, and improve cure rate, such as worth wide application..

5.
Article in Chinese | WPRIM | ID: wpr-870609

ABSTRACT

Objective:To explore the pathogenesis, diagnosis and treatment of pneumocystis jirovecii pneumoniae (PJP) after renal transplantation.Methods:A total of 20 PJP patients were selected from January 2018 to January 2020. The major symptoms included fever, chest tightness, dyspnea and cough with minimal sputum. Chest computed tomography (CT), laboratory tests and metagenomic next-generation sequencing (mNGS) of bronchoscopic pulmonary alveolar perfusion fluid (BALF) were performed. They received cotrimoxazole (SMZ: 18.75-25 mg/kg + TMP: 3.75-5 mg/kg q6 h) and basic regimen of caspofungin (50-70 mg/d) for 14-21 days. At the same time, bacterial, fungal or viral infections were treated, immunosuppressants were tapered or discontinued, supportive therapy and methylprednisolone, immunoglobulin and continuous renal replacement therapy (CRRT) were provided. Chest CT examination was performed for 5-7 days to evaluate the therapeutic effect and clinical data were retrospectively analyzed.Results:Among them, fever was predominant in 13 cases with an average body temperature of (38.8±0.68) ℃ while chest tightness and dyspnea occurred in 7 cases. Fourteen patients presented hypoxemia, 13 received non-invasive ventilator assisted breathing, 1 received mechanical ventilation via endotracheal intubation and the remainders received mask oxygen therapy. Seventeen patients were cured and discharged from hospital for 12~90 days. Three patients died of respiratory and circulatory failures due to deteriorating pulmonary infection. And 19 patients had elevated renal function initially and basically normalized around 2 weeks.Conclusions:PJP is one of the most serious complications after renal transplantation. Timely diagnosis and targeted treatment are essential. And mNGS examination plays a crucial role in the diagnosis of PJP. The basic anti-infective scheme of compound sulfamethoxazole plus carbophennet is efficacious. At the same time, appropriate tapering or discontinuation of immunosuppressants, supportive therapy and assisted respiration are also important.

6.
Article in Chinese | WPRIM | ID: wpr-870587

ABSTRACT

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

7.
Article in Chinese | WPRIM | ID: wpr-870581

ABSTRACT

Objective:To explore the efficacy and safety of low-dose valganciclovir for preventing CMV infection after renal transplantation.Methods:Patients undergoing the first renal transplantation from January 2015 to January 2017 were selected. Recipients were divided into two groups according to anti-CMV prophylactic strategy. Recipients in test group (valganciclovir group, n=85) received oral valganciclovir 450 mg once daily and those in control group (ganciclovir group, n=81) had oral ganciclovir 1g thrice daily. Both drugs were prescribed within 10 days after transplantation and maintained for 3 months. Dose adjustments were based upon renal function. All recipients were followed up for 12 months posttransplantation. CMV-DNA, renal function, blood routine and liver function were regularly monitored. The incidence of CMV infection/disease, the median time to CMV infection onset, the incidence of opportunistic infections (OI) and acute rejection, graft or recipient survival and drug safety were evaluated.Results:A total of 166 renal recipients were admitted. Fewer recipients in test group (12, 14.1 %) than in control group (26, 32.1 %) had CMV infection ( P=0.006). The median time to CMV infection onset was longer in test group than in control group: 140.5 days (interquartile range [IQR]: 77.3-198.5 days) versus 47.5 days (IQR: 36.8-67.8 days) respectively ( P=0.014). The CMV disease rate was lower in test group ( P=0.080). The incidence of OI decreased significantly in test group (10.6 % vs 21.0 %, P=0.037). No patients in test group suffered allograft loss while 6 recipients (7.4 %) in control group ( P=0.032). Other adverse and side effects of both regimens were comparable. Conclusions:Low-dose valganciclovir regimen is both safe and efficacious in preventing CMV infection among kidney transplant recipients during the first year posttransplantation.

8.
Organ Transplantation ; (6): 566-2020.
Article in Chinese | WPRIM | ID: wpr-825572

ABSTRACT

Objective To compare the clinical efficacy of different T lymphocyte polyclonal antibodies in renal transplantation from donor kidney of organ donation after citizen's death. Methods Clinical data of 691 donors and recipients undergoing renal transplantation from donor kidney of organ donation after citizen's death were retrospectively analyzed. According to different T lymphocyte polyclonal antibodies used for induction, all recipients were divided into the rabbit anti human T lymphocyte immunoglobulin (rALG) group (n=414) and rabbit anti human thymocyte immunoglobulin (rATG) group (n=277). The recovery of renal graft function in recipients of the two groups were collected, including the incidence of delayed graft function (DGF) and acute rejection (AR), and the changes of serum creatinine level after renal transplantation. The 1-year survival rate of the recipients and renal grafts was collected. The incidence of adverse effects within 1 year after operation was calculated. According to the DGF risk score of donors, all recipients were divided into 5 groups. The use proportion of rALG and rATG in the recipients of each group was calculated. Results The incidence of DGF in the recipients of rALG and rATG groups was 14.5% (60/414) and 11.9% (33/277), respectively. The duration of DGF in the recipients of rALG and rATG groups was (7±4) d and (12±7) d respectively, with no statistically significant difference between two groups (P > 0.05). The incidence of AR in the rALG group was 7.5% (31/414), significantly higher than 4.0% (11/277) in the rATG group (P < 0.05). The serum creatinine levels of recipients within 6 months after renal transplantation tended to gradually decline in both groups. In renal transplantation for donor kidney with a DGF risk score of 0-15, the use proportion of rALG was significantly higher than that of rATG. However, the use proportion of rATG was significantly higher than that of rALG in renal transplantation for donor kidney with a DGF risk score over 16 (P < 0.05). The 1-year survival rates of the recipients and renal grafts in the rALG and rATG groups were 99.8% and 99.6%, 98.1% and 98.2%, respectively. There was no significant difference between two groups (both P > 0.05). The incidence of acute pulmonary edema and leukopenia in the recipients of rATG group was significantly higher than that in the rALG group (both P < 0.05). Conclusions Both rALG and rATG can effectively reduce the incidence of DGF and AR and achieve good clinical efficacy after renal transplantation from donor kidney of organ donation after citizen's death. The incidence of leukopenia and acute pulmonary edema induced by rATG is higher than that by rALG in the renal transplant recipients.

9.
Organ Transplantation ; (6): 379-2020.
Article in Chinese | WPRIM | ID: wpr-821546

ABSTRACT

Objective To analyze the prediction efficiency of scoring models at home and abroad on delayed graft function (DGF) after renal transplantation in China. Methods The clinical data of 112 donors and 220 recipients undergoing renal transplantation were prospectively analyzed. The DGF predicted by KDRI model, Jeldres model, and model of our center was compared with actual DGF incidence of renal transplant recipients. The prediction efficiency of each model was analyzed. The predictive accuracy was compared by the area under curve (AUC) of receiver operating characteristic (ROC) curve. Results The DGF incidence of 220 renal transplant recipients was 14.1% (31/220). DGF prediction using KDRI model showed that 41 cases were high risk donors, the AUC was 0.57, the sensitivity was 0.37, the specificity was 0.66, and the positive predictive value was 22%. DGF prediction using Jedres model showed that 22 cases were high risk recipients, the AUC was 0.56, the sensitivity was 0.13, the specificity was 0.92 and the positive predictive value was 20%. DGF prediction using the model of our center showed that 25 cases were high risk donors, the AUC was 0.80, the sensitivity was 0.53, the specificity was 0.84, the positive predictive value was 40%. Conclusions Compared with the KDRI and Jedres models, the prediction model of our center has higher AUC and sensitivity with a better prediction efficiency on DGF. Therefore, it is a suitable evaluation system of donors from donation after citizen's death in Chinese.

10.
Organ Transplantation ; (6): 259-2020.
Article in Chinese | WPRIM | ID: wpr-817602

ABSTRACT

Objective To evaluate the clinical effect of hypothermic machine perfusion (HMP) in the storage of renal grafts from deceased donor (DD) with high-risk delayed graft function (DGF). Methods Clinical data of 52 donors with high-risk DGF were collected in this prospective randomized controlled study. Two renal grafts from each donor were randomly divided into the HMP group (n=52) and static cold storage (SCS) group (n=52). In the HMP group, the renal grafts were stored by LifePort under HMP, whereas the renal grafts in the SCS group were preserved in University of Wisconsin solution (UW solution). The incidence of DGF and primary nonfunction (PNF) after renal transplantation was statistically compared between two groups. The recovery of renal graft function, the survival rates of the recipients and renal grafts within postoperative 1 year were observed in two groups. Results The incidence of DGF in the HMP group was 4%(2/52), significantly lower than 17% (9/52) in the SCS group (P < 0.05). No PNF was reported in the HMP group and 1 case of PND was noted in the SCS group, the difference was not statistically significant (P > 0.05). The recovery time of graft function of the recipients in the HMP and SCS groups were (7.2±0.6) d and (7.7±1.0) d with no statistical significance (P > 0.05). In the HMP group, the urine volume of the recipients on the day of operation, postoperative 1 and2 d was significantly larger than that in the SCS group (all P < 0.05). In the HMP group, the levels of serum creatinine at each time point after operation were significantly lower than those in the SCS group (all P < 0.05). The 1-year survival rates of the recipient and kidney were 98.1%, 92.3% and 100%, 96.2% in the HMP and SCS groups with no statistical significance (all P > 0.05). Conclusions HMP can significantly reduce the incidence of DGF after renal transplantation from DD with high-risk DGF and promote the early recovery of graft function.

11.
Article in Chinese | WPRIM | ID: wpr-743882

ABSTRACT

BACKGROUND: Development of bone tissue engineering provides a new method to solve bone defect repair. Scaffold material and structure construction are issues of concern. OBJECTIVE: To fabricate a silk fibroin and hydroxyapatite scaffold with biomimetic interconnected macropores structure using the paraffin-sphere leaching technology and to evaluate its possibility of cytocompatibility. METHODS: The scaffold with biomimetic interconnected macropores structure was made by the paraffin-sphere leaching technology. The structure of scaffold was observed by the stereomicroscope and scanning electron microscope. The pore size and elasticity modulus were calculated. Passage 3 rabbit adipose-derived mesenchymal stem cells were seeded into the scaffold. The cell viability was detected by live/dead staining at 48 hours after culture. The cell adhesion was observed by hematoxylin-eosin staining at 1 week of culture. The scaffold-cell composite was observed under scanning electron microscope at 3 days of culture. The cell proliferation was detected by the cell counting-kit 8 assay at 1, 3, 5 and 7 days of culture. Those cells cultured alone were considered as control group. RESULTS AND CONCLUSION: (1) Stereomicroscope showed the ivory silk fibroin/hydroxyapatite scaffold. Scanning electron microscope revealed pore structures in cross-section and longitudinal-section with good connectivity. The scaffold pore size was (362.23±26.52) μm and the elasticity modulus was (54.93±5.44) kPa. (2) Scanning electron microscope showed that adipose-derived mesenchymal stem cells adhered and stretched well in the pore wall and connected pore, secreted abundant extracellular matrix, and filled in the pores of silk fibroin/hydroxyapatite scaffold. (3) Hematoxylin-eosin staining results found that adipose-derived mesenchymal stem cells evenly adhered onto the inner wall of silk fibroin/hydroxyapatite scaffold, and proliferated well. (4) Live/dead staining revealed a good viability of adipose-derived mesenchymal stem cells. (5) Cell counting-kit 8 assay results showed the good proliferation of adipose-derived mesenchymal stem cells on the scaffold. (6) To conclude, the silk fibroin/hydroxyapatite scaffold possesses good pore size and cytocompatibility.

12.
Article in Chinese | WPRIM | ID: wpr-791846

ABSTRACT

Objective Engineer a scaffold with mesenchymal stem cells and small intestinal submucosal to evaluate the effect of islet transplantation in diabetic rats .Methods MSC and pancreatic islets were isolated from Sprague-Dawley rats ,and SIS was isolated from Bamei pigs .MSC were seeded on the SIS to construct MSC-SIS scaffold .The STZ-induced diabetic rats were divided into three groups :islets ,SIS ,and MSC-SIS .The expressions of insulin and CD31 were detected by immunofluorescence on the 14th day after transplantation ,and serum cytokines were detected by protein microarray .One-way ANOVA was used to compare the transplantation effect of each group .Results In MSC-SIS group ,the expressions of insulin and CD31 were significantly higher than those in the other two groups .Cytokines of VEGFA were increased while TNF-α,IFN-γand IL-6 decreased ,showing a significant difference (P<0 .05) .These results suggest that MSC-SIS scaffold significantly improve graft function and promote the expression of insulin and CD 31 , which may be related to the angiogenesis and anti-inflammatory effects of MSC .Conclusions Mesenchymal stem cells combined with intestinal submucosal scaffold can improve the effect of islet transplantation and provide a new method for the treatment of diabetes .

13.
Article in Chinese | WPRIM | ID: wpr-797556

ABSTRACT

Objective@#Engineer a scaffold with mesenchymal stem cells and small intestinal submucosal to evaluate the effect of islet transplantation in diabetic rats.@*Methods@#MSC and pancreatic islets were isolated from Sprague-Dawley rats, and SIS was isolated from Bamei pigs. MSC were seeded on the SIS to construct MSC-SIS scaffold. The STZ-induced diabetic rats were divided into three groups: islets, SIS, and MSC-SIS. The expressions of insulin and CD31 were detected by immunofluorescence on the 14th day after transplantation, and serum cytokines were detected by protein microarray.One-way ANOVA was used to compare the transplantation effect of each group.@*Results@#In MSC-SIS group, the expressions of insulin and CD31 were significantly higher than those in the other two groups. Cytokines of VEGFA were increased while TNF-α, IFN-γ and IL-6 decreased, showing a significant difference (P<0.05). These results suggest that MSC-SIS scaffold significantly improve graft function and promote the expression of insulin and CD31, which may be related to the angiogenesis and anti-inflammatory effects of MSC.@*Conclusions@#Mesenchymal stem cells combined with intestinal submucosal scaffold can improve the effect of islet transplantation and provide a new method for the treatment of diabetes.

14.
Article in Chinese | WPRIM | ID: wpr-710692

ABSTRACT

Objective Hypothermic machine perfusion may improve the outcome after transplantation of kidney donated after citizen's death (DCD),but few powered prospective studies have been reported,especially in China.The aim is to compare hypothermic machine perfusion (HMP) with simple cold storage (SCS) in Chinese DCD kidney transplantation,which can offer an optimal method for graft storage with better graft function and survival.Methods 54 kidney pairs from DCD donors were included in this controlled trial in one single center from December 2015 to March 2017.Every two kidneys from each DCD donor wavs randomly assigned to HMP and SCS group.One-year recipient and graft survival rate and endpoints containing the incidence of DGF,the duration of DGF,creatinine reduction ratio (CRR),estimated glomerular filtration rate (Egfr),primary non-function (PNF),acute rejection (AR),toxicity of the immunosuppressive drugs,nosocomial infections and the length of hospital stay were compared between HMP and SCS group.Results One-year recipient survival rate was 98.15 % and 96.23% after DCD transplant in HMP and SCS group,and one-year graft survival rate was 90.74% and 88.68%,respectively.DGF incidence was 9.62% in total DCD kidney transplant,8.00% in HMP group and 11.11% in SCS group,which was no difference in two groups.22 DCD was from expanded criteria donor (ECD) donation,DGF happened in 15.91% ECD kidney transplant.However,HMP reduced the incidence of DGF from 27.27% to 4.55% after ECD kidney transplant,which was significantly different (x2 =4.247,P =0.039).HMP group acquired significantly lower creatinine level (130.95 ± 46.60) μmol/L than SCS group (181.64 ± 72.94) μmol/L on day 14 after ECD transplant (t =-2.686,P =0.011).Conclusion There was a higher recipient and graft survival rate after DCD and ECD kidney transplant,which would be an effective method to expand donor pool for kidney transplant.HMP was not associated with lower DGF rate in DCD kidney transplant and more rapid recovery in early graft function.However,HMP preservation not only made renal function recover more rapidly but reduced the risk of DGF after ECD kidney transplant.

15.
Article in Chinese | WPRIM | ID: wpr-710675

ABSTRACT

Objective To study long term renal function of Donation after citizen's deceased transplantation.Methods We compared the data of 38 subjects who got Delayed Graft Function(DGF) with 80 Immediate Graft Function (IGF) subjects underwent DCD transplantation in our hospital before June 2016.Evaluated the renal function by detecting the serum creatinine (sCr),the estimating glomerular filtration rate (eGFR) calculated with MDRD formula and urine protein at the 1,2,3 year post transplantation.Results Analyzed the serum eGFR of two groups,there was no significant differences at 1 and 2 year post transplantation,sCr of two groups showed no significant differences at 3 year (P =0.053)post transplantation,eGFR of two groups showed significant differences at 3 year (P =0.042)post transplantation and positive incidence of urine protein showed significant differences at 2 year (P =0.028)and 3 year (P =0.037)post transplantation.Conclusion DGFoccuring after DCD transplantation had an effect on long term renal function,.mainly on reducing of eGFR and increasing of urine protein positive rate 2 or 3 years after transplant.

16.
Chinese Journal of Orthopaedics ; (12): 321-329, 2018.
Article in Chinese | WPRIM | ID: wpr-708543

ABSTRACT

Objective The biomimetic osteochondral scaffold contained calcified cartilage layer(CCL) was fabricated using slik fibroin (SF) and hydroxyapatite (HA) for materials.To investigate effects of biomimetic osteochondral scaffold contained CCL compounding with ADSCs on regeneration of the osteochondral defect on the rabbit knee,explore the feasibility of this design as a concept of osteochondral tissue engineering.Methods We fabricated a novel biomimetic osteochondral scaffold with CCL using SF and HA by the combination of paraffin-sphere leaching and modified temperature gradient-guided thermal-induced phase separation (TIPS) technique.The pore size,porosity,and compressive modulus of elasticity of the scaffold cartilage layer and the osteogenic layer were measured by scanning electron microscopy and microscopy CT.The osteochondral defect model on rabbit bilateral knees were established,and implanted with the non-CCL group (non-CCL scaffold compounding with ADSCs) and CCL group (CCL scaffold compounding with ADSCs).At 4,8 and 12 weeks after implantation,the rabbits were euthanized,respectively.Gross observation score,histological and immunohistochemical assessment,biochemical quantitative of new osteochondral tissue,micro-CT scans for new bone,were executed.We evaluated the regeneration of osteochondral defects in each group,and verified the role of CCL in vivo.Results The biomimetic osteochondral scaffold with CCL had a consecutively overlapping trilayer structure with different densities and pore structures,including a chondral layer (top layer),intermediate layer and bony layer (bottom layer).The cartilage layer had a well-oriented microporous structure with a uniform distribution with a pore size of (112.43± 12.65)μm and a porosity of 90.25%±2.05%.The subchondral bone layer had a good three-dimensional macroporous structure,good connectivity,pore size (362.23±26.52) μm,porosity of osteogenic layer was 85.30%± 1.80%.The cartilage regeneration in CCL+AD-SCs group was better than non-CCL+ADSCs group.The content of GAG and type Ⅱ collagen in new cartilage tissue in CCL+AD-SCs group was much more than non-CCL+ADSCs group.The new bone tissue analysis and biomechanical testing had no significant differences between the two groups.Conclusion The biomimetic osteochondral SF/HA scaffold contained CCL mimics the structure of normal osteochondral tissue with good 3-dimensional pore structure and biocompatibility.The scaffold complex autologous ADSCs successfully repair osteochondral defects in rabbit knee,and the presence of CCL accelerates the growth of cartilage.

17.
Article in Chinese | WPRIM | ID: wpr-745846

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Objective To investigate the influence of quality evaluation of donated kidney after citizen's death on prognosis of renal allograft recipients.Methods A retrospective analysis on 577 cases of deceased organ donation/1084 cases of renal transplantation was made in the First Affiliated Hospital of Xi'an Jiaotong University from December 2011 to August 2018.The quality of donor/ donated kidney was evaluated through various aspects,and the prognostic data of renal transplant recipients were summarized and analyzed.Results 1 084 cases of donated kidney transplantation were completed,and the average follow-up time was (14.3 ± 13.5) months.The 1-and 3-year survival rate of transplant recipients was 97.4% and 92.1%,respectively,and the 1-and 3-year survival rate of transplanted kidney was 94.6% and 89.2% respectively.There were significant differences in human/ kidney survival rate and DGF incidence after renal transplantation among those various groups according to the criteria of subdivision of score of points for donor assessment.Conclusion Comprehensive evaluation of donated kidney quality in all aspects has a significant positive effect on improving the effect of transplantation.

18.
Article in Chinese | WPRIM | ID: wpr-734817

ABSTRACT

Objective To analyze the relationship of donor kidney histopathology scores with Lifeport parameters and donor grades before kidney transplantation.Methods Retrospective analysis was including 25 cases of organ donation (DCD) donor kidney transplantation from January 2017 to May 2018.The correlation analysis was performed on histopathological data of donor kidney,Lifeport parameters,and donor grades.Histopathological examination was carried out by rapid paraffin method,and the scores were graded according to the Remuzzi standard and acute tubular injury (ATI) degree.The donor grades were based on the standard score of our center.Data were analyzed by SPSS(R) 17.0 software.Results Remuzzi scores were positively correlated with protopathy scores (r =0.546,P =0.005) and hypertension scores of donor scores (r =0.500,P =0.011).Remuzzi scores and Lifeport parameters flow (Flow) and resistance index (RI) were found to be correlated.Remuzzi scores of glomeruli sclerosis (GS),tubule atrophy (TA),interstitial fibrosis (IF),arterial narrow (AN) and Lifeport parameters were also correlated,among which the correlation of AN scores were strongest correlated with Lifeport parameters (Flow:r =0.539,P<0.001;RI:r =0.497,P =0.001).ATI had a correlation with Lifeport parameters (Flow:r =0.368,P =0.016;RI:r =0.456,P =0.002),which is most relevant to the RI.However,there was no correlation of the donor grades with Lifeport parameters,and ATI (Flow:r=0.216,P =0.169;RI:r=0.06,P =0.707;ATI:r =0.005,P =0.977).Of 50 cases of kidney transplantation,recover time of DGF group was significantly higer than that of nomal recovery group F =14.729,P =0.001);Lifeport flow parameters of normal recovery group were statistically higher than those of other groups (F =3.612,P =0.020).Conclusion Histopathology scores of donors kidney are correlated with protopathy scores,hypertension scores,and Lifeport parameters,and could be used to evaluate the renal quality effectively.In the clinical work,the donor grades,histopathology scores and Lifeport parameters should be combined to evaluate the kidney quality.

19.
Article in Chinese | WPRIM | ID: wpr-710656

ABSTRACT

Objective To investigate the effects of IL-10/TGF-β-modified macrophages on renal ischemia reperfusion injury (IRI).Methods Bone marrow-derived macrophages were modified ex vivo by IL-10/TGF-β to acquire M2c (a subset of activated macrophages).M2c were transferred into treated C57BL/6 mice by a single tail-vein injection at 6 h after renal IRI.Mice were killed on the day 3 after renal IRI.Blood samples were collected to check renal function.Kidneys were harvested to determine tubular necrosis and apoptosis by H&E staining and TUNEL assay.Immunofluorescence was performed to analyze the proliferating tubular cell nuclear antigen.Meanwhile,proinflammatory cytokines and regulatory T cells in renal tissues were analyzed with real-time PCR and flow cytometry.Results In comparison with M1,M2c expressed lower levels of MHC Ⅱ (P<0.01),CD86 (P< 0.01),TNFα (P<0.01) and IL-1β (P<0.01) and higher level of IL-10 (P<0.01).M2c significantly attenuated renal functional decline (P<0.01 or 0.05),structural injury (P<0.05),apoptosis of tubular cells (P<0.01) and inflammation factors infiltration (P<0.01 or 0.05).What's more,the cells could promote tubular cells proliferation (P<0.05) and regulatory T cells expression (P<0.01).Conclusion Our results demonstrated that M2c macrophages effectively protect against renal IRI and may become a therapeutic strategy for renal IRI.

20.
Article in Chinese | WPRIM | ID: wpr-607198

ABSTRACT

Objective To investigate the effects of panax notoginseng saponins(PNS) on the expression of IL-10 and TNF-α in the brain after focal cerebral ischemia-reperfusion injury in rats,and the mechanism was explored.Methods 30 male adult Sprague-Dawley rats were randomly divided into sham-operation group,ischemia-reperfusion group and PNS treatment group,10 rats in each group.The middle cerebral artery occlusion(MCAO) was established with ischemia-reperfusion group.The rats received continuous gastric lavage for 4 weeks,who were observed for 3 days and then killed to the detect the expression of IL-10 and TNF-αin ischemic region by ELISA,immunohistochemistry and RT-PCR.The behavioral ability score in rats were tested.Results Compared with the sham-operation group and ischemia-reperfusion group,the expression of IL-10 was increased,while the expression of TNF-α was decreased significantly in PNS treatment group,behavior score of PNS treatment group increased significantly than that of ischemia-reperfusion group.Conclusion The panax notoginseng saponins can reduce the neurons injury after focal cerebral ischemia-reperfusion injury in rats partly by regulating the expression of IL-10 and TNF-α in the brain.

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