Research highlights on kidney transplantation in 2021: voices from China / 器官移植

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.

Contrasting roles of donor and recipient TGFB1 and IFNG gene polymorphic variants in chronic kidney transplant rejection / Papéis contrastantes das variantes polimórficas dos genes TGFB1 e IFNG do doador e do receptor na rejeição crônica de transplantados renais

Objective: To assess the long-term impact (minimum of 3 years follow-up) of polymorphisms in cytokine genes in donor: recipient pairs on the results of the transplant. Methods: We compared genetic cytokine polymorphisms and the primary factors of risk for the development of chronic rejection in paired groups of renal transplant patients with and without chronic allograft nephropathy [CAN]. Results: Multivariate analysis indicated that the presence of the high-production TT genotype (codon 10) of the transforming growth factor beta-1 (TGFB1) was protective in receptors (p=0.017), contrasting with the increased risk when present in donor samples (p=0.049). On the other hand, in the case of the gamma interferon studied, the greater frequency of the high production allele was protective in the analysis of the donor group (p=0.013), increasing the risk of chronic nephropathy of the allograft when present in the recipients (p=0.036). Conclusion: Our results highlight the importance of TGFB1 genotyping in donors, and indicate that polymorphisms in the gene of this cytokine in donor cells might contribute to the development of chronic allograft nephropathy.

Objetivo: Avaliar o impacto de longo prazo (com seguimento mínimo de 2 anos) de polimorfismos em genes de citocinas em pares doador:receptor sobre os resultados do transplante. Métodos: Comparamos os polimorfismos genéticos das citocinas e os principais fatores de risco para o desenvolvimento de rejeição crônica em grupos pareados de pacientes transplantados renais com e sem nefropatia crônica do aloenxerto [CAN]. Resultados: A análise multivariada indicou que a presença do genótipo TT (códon 10) de alta produção do fator de crescimento transformador beta-1 (TGFB1) era protetor nos receptores (p=0,017), em contraste com o risco aumentado quando presente nas amostras de doadores (p=0,049). Por outro lado, no caso do interferon gama estudado, a maior frequência do alelo de alta produção foi protetora na análise do grupo de doadores (p=0,013), mas aumentava o risco de nefropatia crônica do aloenxerto quando presente nos receptores (p=0,036). Conclusão: Nossos resultados ressaltam a importância da genotipagem de TGFB1 também em doadores, e indicam que polimorfismos no gene desta citocina em células do doador podem contribuir no desenvolvimento da nefropatia crônica do aloenxerto.

Association of Polymorphisms in the IL-10 and IFN-gamma Genes with Allograft Dysfunction Following Kidney Transplantation in Koreans / 대한이식학회지

PURPOSE: IL-10 and IFN-gamma are amongst important cytokines, which are thought to have influence on organ transplantation outcome. The aim of this study was to investigate the IL-10 and IFN-gamma gene polymorphisms in Koreans, and their association with renal transplantation outcome. METHODS: Three SNP sites (-1082 G/A, -819 C/T, -592 C/A) of IL-10 promoter region and CA repeats in intron 1 of IFN-gamma gene were analyzed using PCR-single strand conformation polymorphism (SSCP) and direct sequencing methods in 73 controls and 164 kidney allograft recipients. Association between polymorphisms of these genes and transplantation outcome was analyzed using chi square test or Fisher's exact test. RESULTS: The allele frequencies of the IL-10 and IFN-gamma genes showed no significant differences between the control and patient groups. The frequencies of IL-10 and IFN-gamma high producer alleles were markedly lower than those of Caucasians. The incidence of multiple acute rejection episodes was higher in IL-10low producer (-1082 AA) than intermediate producer (-1082 GA) group (8.6% vs 0%), and in IFN-gamma high producer ([CA]12 positive) than low producer ([CA]12 negative) group (11.9% vs 6.6%). The incidence of chronic renal allograft dysfunction was lower in IL-10 intermediate producer than low producer group (7.7% vs 18.0%), and also lower in the combination of IL-10 intermediate/IFN-gamma low producer type than in other combinations (0% vs 18.2%). However, all these differences were not statistically significant. CONCLUSION: IL-10 and IFN-gamma have little influence on renal transplantation outcome in Koreans, probably due to quite limited polymorphisms of these genes in this population. The results of this study would be useful as basic data for renal transplantation in Koreans.

Determination of sCD30 and Th1/Th2 in the evaluation of immune status of patients with chronic renal allograft dysfunction / 解放军医学杂志

0.05).The expression percentage of IL-4 of CD3+CD8-T lymphocytes cells in peripheral blood of the patients in group A(4.0%?2.8%)was significantly lower than that in group B and C(7.9%?5.5% and 10.2%?7.5%,P0.05).The level of serum sCD30 in the patients of group A(20.2?12.4ng/ml)was significantly higher than that of group B and C(7.8?3.1ng/ml and 7.6?3.0ng/ml,P0.05).ROC curve analysis indicated that when the ratio of Th1/Th2 was at the cut-off value of 1.95,the sensitivity and specificity to identify CRAD caused mainly by immune injury was 80% and 90%,respectively;and when the level of serum sCD30 was at the cut-off value of 10ng/ml,the sensitivity and specificity to identify CRAD caused mainly by immune injury was 93.3% and 86.7%,respectively.Conclusions Disequilibrium of Th1/Th2(drift to Th1)and raised level of serum sCD30 exist in most of the patients with CRAD which was caused mainly by immune injury.It is with high sensitivity and specificity to identify the CRAD by determining the ratio of Th1/Th2 of CD3+CD8-T lymphocytes cells in peripheral blood and the level of serum sCD30.