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Objective:To investigate the clinical effect of spousal kidney transplantation , and to explore the significance in today's society.Methods:We retrospectively collected the relevant clinical data from the transplantation department of the first hospital of jilin university, from October 2009 to December 2018. Receptors who accepted spousal, parental and compatriot donor kidney is respectively obtained.Then the postoperative efficacy of the three groups were compared.Results:The graft survival rates of spousal kidney transplantation were 94.1% at 3 years and 83.7% at 5 years, which were not significantly different from other types of living kidney transplantation ( P=0.260). There was no significant difference in creatinine at each time point within 3 years after operation between three groups. At 3 years and 5 years after operation, there was no significant difference in creatinine between spouse group and sibling group.But the creatinine of spouse group was lower compared with parent group ( P=0.014, 0.038). The incidence of rejection within 1 years after spousal renal transplantation was 25%, which was significantly higher than parent group and sibling group ( P=0.029). Age of donor, gender of recipient, D/R BMI and incidence of AR or not in recipient were independent predictors for 1-year creatinine in living kidney transplantation (correlation coefficient: 0.048、-26.03、-15.95、10.23; P=0.003、<0.001、0.021、0.013). Conclusions:Spousal kidney transplantation has same clinical efficacy compared with other types of living kidney transplantation, which can greatly improve the donor kidney resource.So it worth being further promotion, but compared with other types of living kidney transplantation, we should be more alert to the incidence of rejection reaction, so as to obtain better curative effect.
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Objective:To study the dynamic characteristics of reconstruction of B lymphocytes in peripheral blood at different time points in the patients with immune tolerance induced by combined transplantation of kidney and bone marrow,and to provide the basis for the further illumination of the role of B lymphocytes in immune tolerance of organ transplantation.Methods:Five patients(Pt.A,Pt.B,Pt.C,Pt.D,and Pt.E)with end stage of kidney disease received kidney and bone marrow transplantation after induction therapy.Immunosuppression was discontinued gradually.The number of B lymphocytes and the distribution of subsets of B lymphocytes in peripheral blood were detected by flow cytometry in the patients before and after transplantation,and the dynamic changes of B lymphocytes at different time points were compared.The distribution of immunoglobulin heavy chain variable region(IGHV)was analyzed using next generation sequencing technology.Results:Four patients were enrolled in the study expect one patient with graft failure(Pt.C).The B lymphocyte counts of Pt.A,Pt.B and Pt.D recovered approximately 1 year after transplantation and Pt.E experienced delayed reconstitution.The B lymphocyte recovery was accompanied by a high frequency of CD20+CD24highCD38hightransitional B lymphocytes and a diversified clonal repertoire.All patients showed the prevalence of CD20+CD27+ memory B cells around 6 months after transplantation.Through the calculation of Shannon diversity index(SDI)of IGHV at each time point after transplantation,the SDI of IGHV for all transplant recipients at 182 d after transplantation was significantly lower than before transplantation(P=0.004),and this index was gradually recovered at approximately 1 year after transplantation.The calculation of somatic mutation of B lymphocyte IGHV gene sequence at different time points showed that the somatic mutation rate was elevated at 182 d for all patients except Pt.B(P = 0.032). Conclusion:The presence of mutated memory B lymphocytes in peripheral blood of the patients with kidney and bone marrow transplantation is found,and the B lymphocytes play the potential contribution to tolerance induction.
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Objective To explore the role of regulatory T cells (Tregs) in skin and heart grafts survival prolongation after different CD47 genotype donor specific splenocytes pretreatment.Methods Mouse skin plus hearts transplantation model was set up by using C57BL/6 as recipients and MHC class I-mismatched bm1 as donors.In CD47-/-DST group,recipients received CD47-/-bm1 splenocytes transfusion at 7th d before transplantation.In CD47+/+DST group,recipients received CD47+/+bm1 splenocytes transfusion at 7th day before transplantation.In control group,recipients only received bm1 skin and heart grafts.The populations of Tregs were analyzed by FACS and immunohistochemistry,respectively.The inhibitory effect of Tregs and anti-donor T cell responses was assessed by MLR.Results Result As compared with control group,the survival time of skin grafts in CD47-/-DST group was slightly longer than in non-DST group (20 days vs.17.5 days,P>0.05),but skin grafts had long-term survival in CD47+/+DST group (46.5 days,P0.05),but heart grafts had long-term survival in CD47+/+DST group (42.5 days vs.17 days,P0.05).As compared with CD47-/-DST group,the ratio of Tregs in lymph node cells in CD47+/+DST group increased significantly (P<0.01).Compared to CD47-/-DST group and control group,anti donor specific T cell proliferation was decreased in CD47+/+DST group at 7th day after transplantation (P<0.05).The inhibitory effects of Tregs were similar among groups.Conclusion CD47 expressed on DST cells plays an important role in grafts survival prolongation.The ratio of Tregs in lymphocytes plays the key role in grafts survival prolongation.but not the number or inhibitory function of single Treg.
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Objective To investigate the significance of The Maryland Aggregate Pathology Index in the evaluation of donation after citizens death (DCD) kidney by time-zero renal biopsy.Methods 124 kidney grafts were donated by 62 donors after cardiac death in First Hospital of Jilin University between Jan.2015 and Dec.2015.One kidney was deprecated after evaluation and 123 transplants were performed eventually.Time-zero renal biopsy was performed on 123 cases of DCD donor kidney,and rapid frozen pathological examination was performed.The pathological results of donor kidneys were graded by The Maryland Aggregate Pathology Index:low risk group (less than 7 points) (n =112 cases);the middle risk group (8-11 points) (n =11 cases),high the risk group (more than 12 points) (n =0).The incidence of delayed graft function (DGF),the incidence of perioperative acute rejection (AR),and the average creatinine level in the patients at different time points one year post-transplantation were observed.The median value of follow-up was 19 months,and the 1-year survival rate of patients and renal grafts was observed.Results All 123 cases of kidney transplantation from DCD were performed successfully.The incidence of DGF in low risk group and in middle risk group was 6.3％ (7/112) and 27.3％ (3/11),respectively (P =0.046).The incidence of perioperative acute rejection (AR) in low risk group and middle risk group was 9.8％ (11/112) and 27.3％ (3/11),respectively (P =0.112).The mean serum creatinine (Scr) levels at 7th day,1st month,3rd month,and 12th month after operation were 123.3 ± 79.7,104.4 ± 52.6,72.9 ± 32.0 and 107.6 ± 34.6 μmol/L in low risk group,and 321.0 ± 74.3,172.6 ± 59.9,142.9 ± 45.7 and 140.8 ± 63.6 μmol/L in middle risk group,respectively.The mean Scr levels in patients at different time points one year post-transplantation in low risk group were significantly lower than those in middle risk group (P＜0.000 1,=0.000 3,＜0.000 1,=0.012 respectively).The 1-year survival rate of patients and renal grafts was 98.2％ (10/112)/98.2 (110/112 in low risk group,and 81.8％ (9/11)/81.8％ (9/11) in middle risk group,respectively (P =0.040).Conclusion The Maryland aggregate pathology index obtained from time-zero renal biopsy of rapid frozen pathological examination can provide some guidance for the evaluation of the quality of DCD and the prognosis.Incidence of DGF was lower in low risk group than that in middle risk group,and the renal function of each time point was better within 1 year,and the 1-year survival rate of patients and renal grafts was higher.
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Objective To investigate the factors influencing delayed graft function (DGF)following kidney transplants from donation after citizens death (DCD) in single transplant center.Methods The clinical data of 504 kidney transplants from DCD in the First Hospital of Jilin University between August,2011 and May,2017 were collected and analyzed retrospectively.The functional recovery of kidney graft and the related factors were analyzed,respectively.Results The DGF occurred in 32 cases among 504 kidney transplant recipients during perioperative period,who received dialysis treatment (6.3％).The average recovery time of DGF was 21.0 ± 17.1 days.The average dialysis duration (41.3 ± 38.2 months) pre-transplant in DGF group was significantly longer than that in non-DGF group (28.9 ± 26.2 months) (P =0.024).The average age of donors (42.7 ±9.4 years) in DGF group was significantly older than that in non-DGF group (39.0 ± 15.9 years) (P=0.009).The ratio of donors who received CPR treatment in DGF group (21.9％) was significantly higher than that in non-DGF group (6.4％) (P =0.001).The average last serum creatinine level of donors in DGF group (149.3 ± 98.3 mol/L) was significantly higher than that in non-DGF group (92.8 ± 41.6 mol/L) (P＜0.001).The multivariate analysis revealed that CPR treatment for donors before organ donation,the last serum creatinine level of donors as well as BMI of kidney transplant recipients were all independent risk factor influencing DGF (P =0.001,P＜0.001 and P =0.008,respectively).Conclusion Our study focused on analysis of factors influencing DGF following kidney transplants from DCD in single transplant center.The results of this study are helpful to find and avoid the high risk factors that could influence DGF,reduce the incidence of DGF,improve the quality of patients' life as well as reduce the cost of medical treatment.
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Objective To study the effect of serum uric acid (UA) levels on kidney graft function as well as long-term graft survival after renal transplantation.Methods The clinical data of 859 kidney transplant recipients from Jan.2008 to May 2014 were investigated retrospectively.The differences in clinical indexes between normal UA group and hyperuricemia group were compared based on UA levels.Cox regression model was built to analyze the effect of elevated UA on overall graft loss,death censored graft failure and death of patients,respectively.Kaplan-Meier graft survival curve was used to compare the overall graft loss,death censored graft failure and death of patients between normal UA group and hyperuricemia group.Results The average follow-up time was 38.6 ± 17.3 months for 859 kidney transplant recipients.590 (68.7％) recipients were enrolled in normal UA group and 269 (31.3％) recipients were defined as hyperuricemia patients.The average eGFR in hyperuricemia group was significantly decreased as compared with normal UA group (79.4 ± 20.93 vs.94.7 ± 20.55,P＜0.001).Cox regression model showed that if UA level increased per 10 mol/L,the risk of overall graft lost increased 1.070 times (P＜0.001) and the risk of death censored graft failure increased 1.121 times (P＜0.001) accordingly.Kaplan-Meier analysis showed the overall graft loss was dramatically decreased (P =0.009),and the death censored graft failure was significantly decreased (P＜0.0001) in hyperuricemia group as compared with that in normal UA group.The death of patients showed no significant difference between two groups (P =0.638).Conclusion Serum UA levels after kidney transplantation affect graft function as well as long-term graft survival.
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Objective To observe the transdifferentiation of renal tubular epithelial phenotype in allograft biopsy samples of patients with various rejections,and to analyze the association between rejection and transdifferentiation.Method Immunohistochemistry (SP method) was applied to detect α-SMA expression in tubular epithelial cells from 55 renal allograft biopsy samples with various rejection.Results Positive α-SMA expression was found in all the atrophic tubular epithelial cells adjacent to cytoplasm of basement membrane,which indicated the atrophic renal tubular epithelial cells appeared the phenotypic transdifferentiation.Positive α-SMA was also detected in some renal epithelial cells without atrophy.No phenotypic change was found in 7 cases without obviously rejection.Among 28 cases of acute T-cell-mediated rejection IA grade,α-SMA positive expression rate of non-atrophy renal epithelial cells was 25％-50％ in 1 case and 10％-25％ in 3 cases.Among 14 cases of more severe acute rejection group IB grade,α-SMA positive expression rate was over 50％ in 1 case,25％-50％ in 2 cases and 10％-25％ in 2 cases.Conclusion When acute T-cell-mediated rejection becomes more serious in renal allograft,the phenotype transdifferentiation aggravates in renal tubular epithelial cells.
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Objective To study the microanatomy of the petrosal vein(PV) and discuss the surgical management of the vessel during microvascular decompression.Methods A total of 15 cadaveric(30 PVs) heads were obtained from dead adults.The position,morphology,branches,and variation of the PV,and anatomical relationship between the trigeminal,facial and acoustic nerves and the vessel were observed.Sixty patients with trigeminal neuralgia or hemifacial spasm were also enrolled in this study.Microvascular decompression was performed on the cases,and the PV and its branches were observed during the operation.Results The PV is formed by the union of 2 to 3 branches.It passes through the the subarachnoid space and terminates in the inner two third of the superior petrosal sinus.Classfied by number of the unilateral PVs,3 types of the vessel has been observed:single-stem(9 sides,30.0%),double-stem(17 sides,56.7%) and triple-stem types(4 sides,13.3%).Moreover,according to the anatomical relationship between the end of the PV and auditory meatus,the vein has 3 subgroups:interior-side(17/55,30.9%),intermediate(24/55,43.6%),and exterior-side(14/55,25.5%) subgroups.In our specimens,8 PVs(the main stem or a branch) touched the trigeminal nerve,and 19 PVs were less than 1 mm away from the nerve.None of the PVs connected to the faical and acoustic nerves.In the 60 patients who recieved microvascular decompression,107 PV branches(19 single-stem veins,35 double-stem vessels,and 6 triple-stem veins) were found during the operation,among which 33 belonged to interior-side subgroup,46 were classifed as intermediate type,and 28 were exterior-side veins.Conclusions Management of the PV is the key step for cerebellopontine angle surgery.The vein or its branches can be cut off when they compress the surrounding tissues or obstruct the surgical field.