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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.
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Objective To evaluate the immune status of acute rejection recipients,and to improve the short-term and long-term survival rate of renal transplant recipients and grafts,and to investigate dynamically the changes in the immune repertoire of patients with acute rejection.Methods Combined multiplex PCR amplification technique and high throughput sequencing technique,the TCR β chain complementarity determining region 3(CDR3)diversity and repertoire characteristics at different time points during renal transplantation were analyzed,in order to reveal the immunological characteristics of T lymphocytes in patients with acute rejection.Results The diversity of TCR CDR3 in acute rejection patients was reduced to the lowest one day after surgery.The diversity of TCR CDR3 before acute rejection was higher than before.The acute rejection-related upregulated TCR CDR3 amino acid sequences were screened out.In addition,TCR beta chain V and J subfamily showed the phenomenon of advantage usage in pre-acute rejection,which may be due to T cell recognition of transplanted kidney antigens in vivo.Conclusions The immune diversity of patients with acute rejection is significantly lower.In addition,TCR beta chain V and J subfamily show the phenomenon of advantage usage.
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Objective To explore the outcomes of the transplanted kidney as donor for clinical renal transplantation and summarize experience in combination with related literature.Method This study retrospectively analyzed the clinical documents of one case of uremia receiving renal allograft transplantation with the transplanted kidney as the donor in one case of renal transplantation after brain death in February,2015.The donor was a 31-year-old man who received renal transplantation for uremia in November,2014 and obtained normal renal function.Two months later,the patient was brain dead because of neurologic disorder and donated his transplanted kidney.The serum creatinine of the donor was 167 μmol/L,and the glomerular filtration rate was about 35 mL/min befor donation.The recipient was 27 years old who needed transplantation because of chronic renal function failure and uremia.Preoperation tests showed that PRA was negative,and serum creatinine was 1 353 μmol/L.After separating and dissecting the donor kidney carefully,we perfused and compensated the kidney by Lifeport Organ Perfusion and Preservation Conveyor.The warm ischemia time was about 15 min.The renal vein of the donor was anastomized with right external iliac vein of the receptor,artery with right external iliac artery,and ureter with right centrifugal ureter.Result The operating time was more than 3 h.Postoperatively,the recipient was given the immunosuppressive regimen as tacrolimus,mycophenolate mofetil and methylprednisolone to prevent rejection.At 1 st day postoperation,the 24-h urine volume of the receptor was 5 000 mL,serum creatinine was declined gradually to a minimum of 180μmol/L,and there was trace urine protein.The renal function of patient recovered well by now.Meanwhile,the patient was still under the follow-up.Conclusion It is practical that using transplanted kidney as donor kidney for re-transplantation.There were certain clinical significance for shortening the waiting time of renal transplantation in uremia patients and relieving the shortage of transplant kidney.