Clinical application of donor HLA quartile genotyping by biopsy of transplanted kidney / 中华器官移植杂志

Objective:To determine the accuracy and clinical application of donor HLA quartile genotyping based upon transplanted kidney biopsy.Methods:The clinical and follow-up data are retrospectively reviewed for 38 recipients of kidney transplantation(KT)at First Affiliated Hospital of Xi'an Jiaotong University from 2019 to 2022.They are suspected of rejection.HLA quartile genotyping of donor kidney is performed through puncture and DNA analysis by LABType SSO method.Known HLA genotypes of recipients are compared for predicting HLA genotypes of donors.Donor-specific antibody(DSA)is detected by Labscreen Single kit.And SPSS18.0 statistical software is employed for processing baseline data, donor/recipient HLA typing data, recipient DSA antibody data and transplant nephropathy parameters.Results:Among them, 12(31.58%)belonged to HLA-A, B, C, DR and DQ.Four loci are detected in 14 cases(36.84%). Three sites are detected in 10 cases(26.32%). Two sites are detected in 2 cases(5.26%)and a negative correlation exists between detected sites and transplantation time( rs=-0.707, P=0.001). The detection rate of HLA loci is 78.94%(30 cases). B: 65.78%(25 cases); C: 84.21%(32 cases); DR: 57.89%(22 cases); DQ: 100% (38 cases); HLA sites detected in puncture tissue are 89.47% consistent with the results of donor whole blood test, among which HLA-C and HLA-DQ sites are 100% consistent and HLA-A and HLA-B sites 87.50% and 90% consistent and HLA-DR sites 66.7% consistent( P<0.01). Spearman's rank correlation analysis indicated that pathological diagnosis of interstitial inflammation( rs=-0.432, P=0.017), renal tubule atrophy( rs=-0.587, P=0.001)and interstitial fibrosis( rs=-0.560, P=0.001)are correlated negatively with HLA detected sites in transplanted kidney puncture tissue.DSA is detected in 42.1% of recipients and 68.75% of recipients belonged to HLA-DQ. Conclusions:HLA typing results of puncture tissue are consistent with those of whole blood test.Time after transplantation, infiltration of transplanted nephritis cells and degree of fibrosis may influence the detection of HLA loci.Donor HLA quartile genotyping using transplanted kidney biopsy has some diagnostic values for detecting the presence of DSA.

Pathologic Scoring and Postoperative Liver Function in Canine Partial Liver Transplantation: after Desferrioxamine Exposure / 대한이식학회지

PURPOSE: Liver biopsy plays an important role in the histopathological evaluation of the transplanted liver, but till now pretransplant graft biopsy has limited role in predicting primary non function of the graft. Desferrioxamine (DFO), the iron chelating agent, has been known to be effective in reducing rat liver ischemia-reperfusion injury. We tried desferrioxamine in canine partial liver transplantation, and pathologic scores were compared. METHODS: ~70% partial liver was harvested and reimplanted in same mongrel dog weighing about 25 kg. Desferrioxamine (20 mg/kg) was infused via splenic vein just from the beginning of reperfusion of the partial liver graft (n=5). Serum aspartate aminotransferase (AST) Alkaline phosphatase (ALP), Lactate dehydrogenase (LDH) were checked and compared with the control group (n=5). Morphological liver injury score were compared to the control group. Statistical analysis was done with independent T-test. RESULTS: Total ischemic time was 4 hours and 42 minutes in average. AST level was significantly lower in Desferrioxamine group at 1 hour and 48 hours after reperfusion, (P=0.4) ALP level was significantly lower in desferrioxamine group at 48 hours after reperfusion (P=0.4). LDH level in desferrioxamine group was lower than that of control group but without statistical significance. The pathologic score at 1 hour after reperfusion showed a reduced degree of sinusoidal injury among the DFO group but the difference was not statistically significant. The pathologic score just before harvest of the graft showed no correlation with serum AST, ALP, LDH levels at that time or at 1 hour or 48 hours after reperfusion. Only the pathologic score at 1 hour after reperfusion had significant correlation with the serum LDH levels at 48 hours after reperfusion. CONCLUSION: In canine live donor partial liver transplantation, desferrioxamine infusion just before reperfusion might be an effective way of reducing ischemia-reperfusion injury. And the pathologic grading on samples obtained at 1 hour after reperfusion showed a significant correlation with subsequent liver function

Acute Allograft Pyelonephritis Following Renal Transplantation / 대한내과학회지

OBJECTIVE: Urinary tract infections are mostly benign, but allograft pyelonephritis may induce renal dysfunction or acute rejection. The purpose of this study was to evaluate the frequency of acute allograft pyelonephritis and its influence on graft function and induction of allograft rejection. METHODS: We reviewed the medical records of 1167 renal transplant recipients retrospectively. The allograft pyelonephritis was defined as pyuria with overt clinical manifestations such as fever and graft tenderness. In cases of poor response to antibiotics, abdominal CT and/or graft biopsy were done. RESULTS: During mean follow-up period of 60.9+/-46.8 months, there were 100 episodes of acute allograft pyelonephritis in 65 patients(5.6%). Seventeen patients (26.2%) had recurrent pyelonephritis. Primary renal disease and recipient sex were important predisposing factors for acute allograft pyelonephritis. In patients whose primary renal disease was chronic pyelonephritis or polycystic kidney disease, the prevalance was 30.8% and 18.2% respectively, while in patients with other primary diseases the prevalance ranged from 3.8% to 5.7% (p<0.05). In female patients, the prevalance of pyelonephritis was 14%, which was much higher than that in male patients(2%) (p<0.01). Thirty one out of 100 cases showed deterioration of renal function defined as an increase in serum creatinine by more than 50% of baseline. In twenty five out of 31 cases, grafted kidney biopsy was performed. In 9 cases(36%), the biopsy showed acute rejection together with pyelonephritis, which was mainly manifested by tubulitis. Renal dysfunction occurred mostly in patients who had septicemia or whose previous serum creatinine was higher than 1.2 mg/dl. Renal CT, which was performed in 34 cases, showed findings consistent with acute focal bacterial nephritis (AFBN) in 13 cases (38.2%). Voiding cystourethrogram was performed in 11 patients and six patients (54.5%) were found to have vesicoureteral reflux. E.Coli was the most frequent causative organism (63.6%). CONCLUSION: Acute allograft pyelonephritis was frequently associated with acute focal bacterial nephritis and graft rejection. Imaging study and graft biopsy were helpful for accurate diagnosis and proper management of acute allograft pyelonephritis in cases of renal dysfunction. In patients who have acute rejection together with pyelonephritis, rejection therapy including methylprednisolone pulses in addition to antibiotic therapy for pyelonephritis is recommended.