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Objective:To explore the safety and feasibility of optimized pathological evaluation system of donor's kidney and modified surgery during adult dual kidney transplantation(DKT)and evaluate its effectiveness to provide more alternative protocols for kidney transplantation from extended criteria donors.Methods:DKT was performed in 10 recipients using the same protocol from June 2019 to May 2021.And retrospective reviewing was performed for clinical data, including characteristics of donors and recipients, optimized pathological evaluation system, modified surgery, treatment regimens, complications and follow-ups.Results:There were 8 male and 2 female donors with an age of(57.9±12.8)years and BMI(24.1±4.1)kg/m 2.The percentage of DCD was 70% and DBD 30%.The serum creatinine before procurement was 107.6(93.3-163.5)μmol/l.Zero-point puncture biopsy was performed for both kidneys and optimized pathological evaluation system was implemented(Banff criteria & Remuzzi score). The pathological results indicated that glomerular sclerosis for left and right kidneys were 2.0(1.5-2.0)and 1.5(1.0-2.0). And Remuzzi score for left and right kidneys were(4.4±1.2)and(3.6±1.5)points respectively.All recipients were male with an age of(43.1±9.0)years and BMI(22.2±1.9)kg/m 2.All PRAs were negative pre-operation.Modified surgery was performed in all recipients(two kidneys were implanted outside iliac vessels without patch and artery of superior kidney was anastomosed to internal iliac artery). Operative duration was(195±54.3)min and serum creatinine before discharge 125.0(102.0-199.0)μmol/L.Renal dynamic scintigraphy indicated that glomerular filtration rate was(30.0±8.2)ml/min for left kidney and(29.2±13.9)ml/min for right kidney.MRA results indicated that morphologies of renal arteries and veins were regular.The time between operation and discharge was(22.4±4.7)days.Compared with SKT, serum creatinine before discharge of DKT was lower and DGF incidence of DKT was higher without statistical significance.The time between operation and discharge was longer for DKT than that for SKT( P<0.05). The complications consisted of 20% donor derived infection(DDI)and 50% DGF.And there was no surgical complication associated with vessels and ureter.Renal function remained stable during 6-month follow-ups. Conclusions:Optimized pathological evaluation system of donor's kidney and modified surgery during adult dual kidney transplantation are both safe and feasible.The postoperative function of transplanted dual kidney is successfully restored.However, long-term follow-ups are required for evaluating its effectiveness.
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Objective@#To explore the clinical and prognostic features of lipoprotein glomerulopathy (LPG) in renal allografts.@*Methods@#Retrospective analysis was performed for two case of LPG in renal allografts. The onset time was 6 and 9 years after living transplantation respectively. Initial symptoms included proteinuria and hypoproteinemia. Color Doppler ultrasound showed an enlarged graft size and greater parenchymal echogenicity. One patient had hyperlipemia and elevated apolipoprotein E (ApoE). Methylprednisolone pulse was offered with an early control of hyperlipidaemia and proteinuria by fenofibrate and angiotensin-converting enzyme inhibitors (ACEIs). Yet it had no effect on graft function. The definite diagnosis was made by graft biopsy. Pathological examination indicated non-homogeneous lipid deposition in glomerular capillary, glomerular sclerosis, mesangial hypercellularity and tubular atrophy.@*Results@#During a follow-up period of 8 and 10 years post-transplantation, two cases eventually lost their grafts within 2 and 1 year after biopsy respectively. With long-term dietary control and drug therapy, regular dialysis continued and both awaited a second transplantation.@*Conclusions@#LPG is generally steroid-resistant and refractory in renal allografts. And routine biopsy is recommended for patients with a high risk of occurrence. Early controls of hyperlipemia and hypoproteinemia and other risk factors should be also properly managed.
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Objective@#To explore the evaluations and recipient selection methods of extended criteria donor (ECD) kidney donation in the death of citizens and analyze the transplantation outcomes.@*Methods@#From January to September 2019, the clinical data of donor-recipients were retrospectively studied. The recipients of ECD donor kidneys not evaluated for kidney zero puncture assessment from January 2014 to July 2016 were group A1 and those receiving standard donor kidney (SCD) belonged to group A2. From August 2016 to March 2019, all DCD donors were routinely evaluated for kidney zero puncture and those receiving ECD recipients fell into Group B1 and those receiving SCD belonged to Group B2. Analysis was performed for ECD/SCD donor renal zero puncture pathological features and lesion degree and utilization of ECD donor kidney; donor-recipient body surface area (BSA) ratio and lesion degree of ECD donor kidney on recipient selecting and matching. Serum creatinine value, perioperative adverse events and 1-year follow-up of human/kidney survival rate in each group were compared at 1 day, 1 week, 1 month, 3 months, 6 months and 1 year.@*Results@#A total of 108, 264, 306 and 416 recipients were recruited into A1, A2, B1 and B2 groups respectively. The ECD donor renal utilization rate was 88.5% vs 93.3% during two time periods. According to the 2016 Banff standard, glomerular sclerosis (GS), renal interstitial fibrosis (Ci) and intimal fibrosis thickening (Cv), small arterial intimal hyalinization (ah), tubular atrophy (ct) and acute tubular injury (ati) accounted for more than B1 group than B2 group (P<0.05). The severity of ECD donor kidney disease, BSA ratio <1.1 group and ≥1.1 group 1 week, 1 month, 3 months postoperative blood creatinine value was lower than the former while declining amplitude of blood creatinine was higher. A significant difference existed in the degree of moderate lesions in donor kidney (P<0.05). After 1 year, serum creatinine value of B1 group was lower than that of A1 group (P<0.05).@*Conclusions@#The quality of ECD donor kidney is obviously inferior to that of SCD donor kidney. The Banff donor kidney criterion is an effective mode of evaluating the quality of ECD donor kidney. Based upon the extent of Banff's nephropathy, the ratio of donor/recipient BSA is an important selecting method for ECD donors to receive kidneys and recipients, ultimately improving graft utilization and recipient transplantation.
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Objective To explore the clinical and prognostic features of lipoprotein glomerulopathy (LPG) in renal allografts .Methods Retrospective analysis was performed for two case of LPG in renal allografts . The onset time was 6 and 9 years after living transplantation respectively . Initial symptoms included proteinuria and hypoproteinemia .Color Doppler ultrasound showed an enlarged graft size and greater parenchymal echogenicity .One patient had hyperlipemia and elevated apolipoprotein E (ApoE) . Methylprednisolone pulse was offered with an early control of hyperlipidaemia and proteinuria by fenofibrate and angiotensin-converting enzyme inhibitors (ACEIs) . Yet it had no effect on graft function .The definite diagnosis was made by graft biopsy .Pathological examination indicated non-homogeneous lipid deposition in glomerular capillary ,glomerular sclerosis , mesangial hypercellularity and tubular atrophy .Results During a follow-up period of 8 and 10 years post-transplantation , two cases eventually lost their grafts within 2 and 1 year after biopsy respectively .With long-term dietary control and drug therapy , regular dialysis continued and both awaited a second transplantation .Conclusions LPG is generally steroid-resistant and refractory in renal allografts .And routine biopsy is recommended for patients with a high risk of occurrence .Early controls of hyperlipemia and hypoproteinemia and other risk factors should be also properly managed .
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Objective To explore the evaluations and recipient selection methods of extended criteria donor (ECD) kidney donation in the death of citizens and analyze the transplantation outcomes .Methods From January to September 2019 ,the clinical data of donor-recipients were retrospectively studied .The recipients of ECD donor kidneys not evaluated for kidney zero puncture assessment from January 2014 to July 2016 were group A1 and those receiving standard donor kidney (SCD) belonged to group A2 .From August 2016 to March 2019 ,all DCD donors were routinely evaluated for kidney zero puncture and those receiving ECD recipients fell into Group B1 and those receiving SCD belonged to Group B2 .Analysis was performed for ECD/SCD donor renal zero puncture pathological features and lesion degree and utilization of ECD donor kidney ;donor-recipient body surface area (BSA ) ratio and lesion degree of ECD donor kidney on recipient selecting and matching . Serum creatinine value ,perioperative adverse events and 1-year follow-up of human/kidney survival rate in each group were compared at 1 day ,1 week ,1 month ,3 months ,6 months and 1 year .Results A total of 108 , 264 ,306 and 416 recipients were recruited into A1 ,A2 ,B1 and B2 groups respectively .The ECD donor renal utilization rate was 88 .5％ vs 93 .3％ during two time periods . According to the 2016 Banff standard , glomerular sclerosis (GS) ,renal interstitial fibrosis (Ci) and intimal fibrosis thickening (Cv ) ,small arterial intimal hyalinization (ah) ,tubular atrophy (ct) and acute tubular injury (ati) accounted for more than B1 group than B2 group (P<0 .05) .The severity of ECD donor kidney disease ,BSA ratio <1 .1 group and ≥1 .1 group 1 week ,1 month ,3 months postoperative blood creatinine value was lower than the former while declining amplitude of blood creatinine was higher .A significant difference existed in the degree of moderate lesions in donor kidney (P<0 .05) .After 1 year ,serum creatinine value of B1 group was lower than that of A1 group (P<0 .05) .Conclusions The quality of ECD donor kidney is obviously inferior to that of SCD donor kidney . The Banff donor kidney criterion is an effective mode of evaluating the quality of ECD donor kidney .Based upon the extent of Banff's nephropathy ,the ratio of donor/recipient BSA is an important selecting method for ECD donors to receive kidneys and recipients ,ultimately improving graft utilization and recipient transplantation .
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Objective To explore the correlation between pre-transplantation donor kidney biopsy and short-term renal function after transplantation.Methods This study include 240 kidney transplantation of donation after cardiac death (DCD) from July 2016 to April 2018.Banff's score of donor kidney biopsy was employed for estimating kidney status.Results No significant correlation existed between rate of glomerulosclerosis and delayed graft function (DGF) (P =0.815).The rate of glomerulosclerosis was significantly correlated with 1-week estimated glomerular filtration rate (eGFR) and discharge eGFR (P＜0.05).Based upon the glomerulosclerosis rate,the patients were divided into two groups ＜ 20％ (n =220) and ≥20％ (n =20),there was no significant inter-group difference in DGF,1-week eGFR or discharge eGFR (P＞0.05).Arterial fibrosis was significantly positively correlated with DGF and negatively with 1-week eGFR and discharge eGFR (P＜0.05).Statistically significant inter-group differences existed in 1-week eGFR and discharge eGFR that arterial fibrosis scores ＜ 2 (n =19) and ≥2 (n =41) (P＜0.05).Arteriolar hyalinosis score was negatively correlated with 1-week eGFR and discharge eGFR (P＜0.05).Based upon arteriolar hyalinosis scores,they were divided into two groups ＜ 2 (n =193) and ≥2 (n =47).There were significant inter-group differences in DGF,1-week eGFR and discharge eGFR (P＜0.05).Remuzzi scores were negatively correlated with 1-week eGFR and discharge eGFR (P＜0.05).Interstitial fibrosis was significantly positively correlated with DGF (P＜0.05) and negatively with 1-week eGFR and discharge eGFR (P＜0.05).Conclusions Donor kidney glomerulosclerosis rate affects short-term renal function of recipients after transplantation.However,using 20％ as a threshold value is limited in clinical practice.Arterial intimal fibrosis and arteriolar hyalinosis are important factors affecting short-term eGFR.Recipient kidneys with Remuzzi score ＞ 4 had poor renal function after transplantation.Interstitial fibrosis score may be used as a predictor of postoperative DGF and shortterm renal function recovery.It is expected to be discussed more extensively in literature.