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Ischemia-reperfusion injury (IRI) is an extremely complicated pathophysiological process, which may occur during the process of myocardial infarction, stroke, organ transplantation and temporary interruption of blood flow during surgery, etc. As key molecules of immune system, macrophages play a vital role in the pathogenesis of IRI. M1 macrophages are pro-inflammatory cells and participate in the elimination of pathogens. M2 macrophages exert anti-inflammatory effect and participate in tissue repair and remodeling and extracellular matrix remodeling. The balance between macrophage phenotypes is of significance for the outcome and treatment of IRI. This article reviewed the role of macrophages in IRI, including the balance between M1/M2 macrophage phenotype, the mechanism of infiltration and recruitment into different ischemic tissues. In addition, the potential therapeutic strategies of targeting macrophages during IRI were also discussed, aiming to provide reference for alleviating IRI and promoting tissue repair.
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As a mature organ transplantation surgery, kidney transplantation has become the best means for treating end-stage renal diseases and improves the quality of survival of patients. However, there are still many challenges after kidney transplantation, such as rejection, infection, ischemia-reperfusion injury and fibrosis of transplant kidney, which seriously affect the efficacy of kidney transplantation. With the development of translational medicine, regenerative medicine, biomaterials and other emerging fields, Chinese research teams continue to work hard and publish many bright researches to solve various clinical problems related to kidney transplantation. This article reviews the basic and clinical frontiers of kidney transplantation in 2022 as well as the new techniques and advances in the field of transplantation, focuses on the achievements made by the Chinese team in the field of transplantation in 2022, and provides ideas for solving the major clinical problems of kidney transplantation from the perspective of localization to promote the further development of kidney transplantation in China.
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Over the past 70 years, kidney transplantation has become not only the most mature but also the highest-success-rate surgery among all organ transplantation surgeries. However, the long-term survival of kidney transplant recipients is still challenged by such key factors as ischemia-reperfusion injury related to kidney transplantation, rejection, chronic renal allograft dysfunction, renal allograft fibrosis, immunosuppressive therapy, infections and others. Relevant fundamental and clinical studies have emerged endlessly. At the same time, the research related to kidney transplantation also becomes a new hot spot accordingly in the context of the normalization of novel coronavirus pneumonia. This article reviewed the cutting-edge hot spots in relation to the fundamental and clinical aspects of kidney transplantation together with relevant new techniques and new visions. The studies included in this article focused on the reports published by Chinese teams that are more applicable to the current situation of kidney transplantation in China, for the purpose of providing new thoughts and strategies for the diagnosis and treatment of kidney transplantation related issues in China.
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Renal transplantation is the optimal approach to improve the quality of life and restore normal life for patients with end-stage renal diseases.With the development of medical techniques and immunosuppressants, the shortterm survival of renal graft has been significantly prolonged, whereas the long-term survival remains to be urgently solved.Renal ischemia-reperfusion injury (IRI), acute rejection, chronic renal allograft dysfunction, renal fibrosis and other factors are still the major problems affecting the survival of renal graft.Relevant researches have always been hot spots in the field of renal transplantation.Meantime, 2020 is an extraordinary year.The novel coronavirus pneumonia (COVID-19) pandemic severely affects the development of all walks of life.Researches related to renal transplantation have also sprung up.In this article, the frontier hotspots of clinical and basic studies related to renal transplantation and the COVID-19 related researches in the field of renal transplantation in China were reviewed, aiming to provide novel therapeutic ideas and strategies.
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How to improve the long-term prognosis of transplant kidney and solve the shortage of donor kidney are still two major problems that plague clinicians. Among them, ischemia-reperfusion injury (IRI), rejection, infection, and immunosuppressive therapy are important issues in the research field of renal transplantation. Therefore, strengthening the literature study in the field of renal transplantation and understanding the nature of transplant kidney related diseases and international frontier research hotspots, help to further improve the function and prolong the survival time of the transplant kidney in clinic. This article interpreted literatures on the research hotspots and new progress in the field of renal transplantation in the third quarter of 2020, combined with the meeting minutes of the 12th Lingnan Reading Club, and reviewed from the three aspects of IRI, rejection and infection.
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The American Transplant Congress (ATC) is an annual international academic conference in the field of transplantation, which includes the latest achievements of scholars around the world in transplantation, and also leads the frontier direction of transplantation research. In this paper, the international forefront hotspots in basic and translational medicine research associated with renal transplantation in 2020 ATC were summarized, including the new discoveries of memory cell function and immune memory mechanism, the latest discovery in the mechanism of rejection and immune tolerance, the current research status of xenotransplantation, the potential solutions of antibody-mediated rejection (AMR), and the application of nanomedicine and single-cell RNA sequencing in renal transplantation, etc.
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Shortage of donor kidney is a major problem in renal transplantation. Accurate evaluation of donor kidney function may reduce the organ rejection rate and save more patients with uremia. Compared with pathological examination, detection of circulating molecular markers is more convenient in clinical application. In this article, the research progress on the markers of kidney injury, such as serum creatinine, serum cystatin C (Cys-C), neutrophil gelatinase-associated lipocalin (NGAL), liver-type fatty acid-binding protein (L-FABP), mitochondrial DNA (mtDNA), kidney injury molecule-1(KIM-1) and interleukin -18 (IL-18), were briefly reviewed.
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Objective To establish a mouse model of acute antibody-mediated rejection (AMR) in heart transplantation and to analyze its characteristics. Methods Mouse models of heart transplantation and skin transplantation were established. According to different treatment methods, all animals were divided into the homologous control group, non-sensitized group, pre-sensitized group and pre-sensitized+ ciclosporin group (9 donors and 9 recipients in each group). The graft survival time, donor-specific antibody (DSA) level and pathological manifestations of each group were observed, and the characteristics of rejection were analyzed. Results In the homologous control group, the cardiac grafts of the mice survived for a long period of time during the 3-month observation period. The survival time of the cardiac grafts in the non-sensitized group, pre-sensitized group and pre-sensitized+ciclosporin group was (7.0±0.7) d, (2.6±0.5) d and (5.0±0.7) d, respectively. The differences among the groups were statistically significant (all P < 0.01). The DSA level in the pre-sensitized group was significantly elevated than the baseline level at 3 d after heart transplantation, and that in the pre-sensitized+ciclosporin group was remarkably up-regulated at 5 d after heart transplantation, the differences were statistically significant (P < 0.05, P < 0.01). The pathological manifestation of the non-sensitized group was the myocardial cell destruction, the formation of interstitial inflammation, mild C4d deposition and a large amount of CD3 cell infiltration. The pathological manifestations of the pre-sensitized group and the pre-sensitized+ciclosporin group showed myocardial cell destruction, capillary inflammation and a large amount of C4d deposition, whereas the amount of CD3 cell infiltration in the pre-sensitized group was more than that in the pre-sensitized+ciclosporin group. Conclusions The use of ciclosporin on the basis of heart transplantation and skin transplantation between different strains of mice can successfully establish a practical acute AMR model in mouse heart transplantation, which provides the basis for subsequent AMR pathogenesis and intervention research.
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Objective To evaluate the curative efficacy of multimodality for severe pulmonary infection (SPI) following kidney transplantation (KT).Methods Fifty-seven cases of SPI following KT were treated with multimodality therapy in our hospital between Jan.2014 and Jan.2017.The outcome and data were analyzed and evaluated retrospectively.Results Of these 57 patients,45 cases were cured (41 cases were alive with functioning grafts,and 4 cases had grafts loss).The pulmonary lesions in 4 cases of pulmonary fungal infection were improved and oral anti-fungal drugs were continuously given after discharge.The symptoms in one case of tuberculosis were obviously improved and anti-tuberculosis treatment was given continuously after discharge.There were 5 deaths,including 2 deaths due to functioning grafts loss.Two cases abandoned treatment during therapy because of financial problem.Pathogens could be detected in only 29 cases.Conclusion SPI after KT is an acute important complication with rapid progression.Early and prompt treatment with combined antibiotics,antifungal drugs as well as antivirus is essential.The keys to successful rescue for SPI should also include immunosuppressant reduction,intravenous immunoglobulin and nutrition support.The combined therapy is successful and could reduce mortality of SPI obviously.
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Objective To compare the change features of anti-donor specific antibody (DSA) in different species of sentitized mice after skin transplantation. Methods All mice were divided into the Balb/c → C57BL/6 (6 pairs) and Balb/c → C3H skin transplantation groups (6 pairs). At d0, d2, d4, d7, d13, d17, d28, d35, d42, d49 and d56 after skin transplantation, the serum sample was prepared for detection of DSA-IgG and DSA-IgM levels. Results Moderate increase was noted in the DSA-IgG level in the sensitized mice within 1 week after skin transplantation. The IgG level was significantly increased within 1-4 week and peaked and stabilized within 4-8 week. No significant variation was observed in the DSA-IgM level at 8 weeks after skin transplantation. In the Balb/c → C57BL/6 skin transplantation group, the DSAIgG level was significantly lower than that in the Balb/c → C3H group. Statistical significance was identified in the IgG levels between two groups at d2, d17, d28, d35, d42, d49 and d56 after skin transplantation (all P<0.05). No statistical significance was noted in the DSA-IgM levels between two groups at each time point (all P>0.05). Conclusions Advancing the time of renal transplantation after skin transplantation moderately in the Balb/c → C3H group, or changing to the lower immunoreactive combination of Balb/c → C57BL/6 are aimed to establish AMR mouse models with mild rejection reaction.
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Objective To investigate the current status of the willingness of organ donation among floating population in Guangdong Province and explore its influence factors.Methods The questionnaire survey was conducted to investigate general information of the floating population and their willingness of organ donation,knowledge of organ donation,attitude towards organ donation and death as well as the willingness of family discussion (organ donation),etc.The correlation analysis of variables and the willingness of organ donation in floating population was conducted by Spearman rank correlation,and the multivariate analysis was conducted by multiple linear regression model.Results Among the floating population,the people who were female,from city,owned an average monthly household income per capita of RMB 4 001 -5 000 yuan,got acquaintance with the organ donors or their families,got acquaintance with accepted the organ donors or their families had higher willingness of organ donation (all in P <0.05 ).Scores of the willingness of organ donation,knowledge of organ donation,attitude towards organ donation and the willingness of family discussion were 1.95 ± 0.91 ,5.02 ±2.40,92.00 ±1 6.78 and 3.98 ±1 .28 respectively.The willingness of family discussion,knowledge of organ donation and recognition of the value of organ donation showed positive correlation with the willingness of organ donation (P <0.05-0.01 ).The cause hindering organ donation and fear of death showed negative correlation with the willingness of organ donation (all in P <0.01 ).Five variables were integrated into the multiple linear regression analysis model,including willingness of family discussion,knowledge of organ donation,recognition of the value of organ donation, cause hindering organ donation and fear of death.Conclusions The willingness of organ donation among the floating population in Guangdong Province is on or below the medium level,and its influence factors include willingness of family discussion,knowledge of organ donation,recognition of the value of organ donation,cause hindering organ donation and fear of death.
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Objective To investigate the renal pathologic changes in both donors and transplant recipients with delayed graft function (DGF).Methods The clinical and laboratory data were retrospectively analyzed in 144 renal recipients with DGF.All the patients received renal biopsy,and donors' biopsy was performed on 131 recipients.The pathological changes were examined under the light microscopy (LM),immunofluorescence (IF) and electron microscopy (EM).Results (1) The incidence of DGF was 10.16%-7.48% during 1994 to 2005,and decreased to 5.35 % during 2006 to 2009.(2) Anuria occurred in 24 cases (16.67 %),oliguria in 24 (16.67%) and hypertension in 68 cases (47.22 %).The enlargement of transplanting kidney and the increased vascular resistance was detected in 79.67 % (98/123 cases) and 45.53 % (56/123 cases) respectively by ultrasound examination.(3) The level of serum creatinine was ranged from 451 to 707 μmol/L.The high level of urinary NAG enzyme was found in 102 cases (70.83 %),proteinuria in 79 recipients (54.86 %) and hematuria in 77 cases (53.47 %).(4) The acute rejection was observed in 66 cases (45.83 %),toxicity of CNI in 22 (15.28 %),IgA nephropathy in 18 (12.50 %),acute tubular necrosis in 8 (5.56 %),and recurrent FSGS in 2 cases (1.39 %).(5) In most recipients (66/109 cases,60.55 %)immunosuppressive regimen altered and renal replacement therapy was given.Conclusion The causes of DGF are complicated.The quality of donors' kidney and early histological changes of recipients are contributed to the development of DGF.It is necessary to perform renal biopsy not only in donors but also in recipients with DGF.And kidney biopsy in transplanted patients was also beneficial to the treatment.