Diagnosis and treatment of lymphoproliferative diseases after renal transplantation / 中华器官移植杂志

Objective:To explore the causes, clinical characteristics, diagnoses and outcomes of post-lymphoproliferative disease(PTLD)after renal transplantation.Methods:Retrospective reviews were conducted for a total of 2 844 adult kidney recipients between January 2000 and January 2019. And 13 of them developed PTLD. Their clinical features and outcomes were analyzed. There were 11 males and 2 females with a median age of 55(31~78)years. All were diagnosed as diffuse large B-cell lymphoma at a median time of 86(12~204)months post-transplantation.Results:The locations of PTLD were diverse, including lung, stomach, colon, skin and central nervous system. Biopsy immunohistochemical EBV positivity was detected in 76.9% of cases.After a tapering of immunosuppression intensity, 6 cases were operated. Patients not tolerating R-CHOP regimen (rituximab + CHOP) were switched to R2 regimen(rituximab + nalidomide). The total effective rate was 91.6%, including complete remission(10 cases), partial remission(1 cases), progressive disease (1 case)and death(2 cases).Conclusions:As a rare but serious complication after renal transplantation, PTLD is closely correlated with EBV infection.Reducing the dose of immunosuppressive drugs is a core of comprehensive treatment.Switching to R2 regimen is an effective alternative in the treatment of PTLD after renal transplantation.

A retrospective study of cryptococcal infection after renal transplantation and literature review / 中华器官移植杂志

Objective:To explore the clinical characteristics, diagnosis and treatment of cryptococcal infection after renal transplantation.Methods:The clinical data were analyzed retrospectively for 17 hospitalized cases of cryptococcal infection after kidney transplantation from January 2003 to December 2019. The relevant parameters included site of infection, clinical manifestations, complications, comorbidities, treatments and outcomes. The average time to infection after transplantation was (7.9±5.4) years, the median baseline level of creatinine was 137(75-741) μmol/L. Concurrent conditions included hypertension (n=15, 88.2%), diabetes (n=6, 35.3%) and chronic hepatitis (n=9, 52.9%). The most common site of infection was central nervous system (88.2%), followed by lungs (29.4%) and skin (17.6%).Results:The clinical manifestations were diverse. Most patients received amphotericin B liposome and/or fluconazole as an initial option. The outcomes were curing (n=17, 58.8%), death from cryptococcal infection (n=5, 29.4%), partial relief (n=1, 5.9%) and stable disease (n=1, 5.9%). Among 10 curative cases, 2 cases died from other causes and 4 cases returned to hemodialysis with graft loss.Conclusions:Cryptococcosis is typically a late-occurring infection in kidney transplant recipients. Many factors, such as complications, nonstandard antifungal treatment, immune dysbalance, have adverse prognoses. Strengthening follow-ups, dealing with complications, validating the diagnosis early, interdepartmental cooperations, standardizing antifungal therapy and balancing immune status may improve the outcomes of cryptococcosis after kidney transplantation.

Transplantation of kidneys from small pediatric donors into pediatric recipients / 中华器官移植杂志

Objective To investigate the clinical features of kidney transplantation of small pediatric donors to pediatric recipients.Method A retrospective analysis of 48 kidney transplants from small pediatric donors into pediatric recipients was performed.Result Based on the transplantation types,the patients were divided into two groups:the single kidney transplantation (SKT) group and the en bloc kidney transplantation (EBKT) group.SKT was performed on 36 patients and EBKT on 12 patients.In the SKT group,postoperative complications included vascular thrombosis in 1 case (2.8％),primary disease recurrence in 1 case (2.8％),ureteral stenosis in 1 case (2.8％),delayed graft function in 17 cases (47.3 ％) and acute rejection in 4 cases (11.1 ％).In the EBKT group,postoperative complications included vascular thrombosis in 4 cases (33.3％),urine leak in 2 cases (16.7％),delayed graft function in 2 cases (16.7％) and acute rejection in 2 cases (16.7％).At last follow-up,patient survivals were 100％ in both groups,whereas graft survival was 94.4％ (34/36) in the SKT group and 75％ (9/12) in the EBKT group.The mean serum creatinine in the SKT and EBKT group was (68.4 ± 22.1) and (55.8 ± 16.7) μmol/L,respectively.Conclusion Favorable outcomes can be obtained from transplantation from small pediatric donors.The use of this donor population for pediatric recipients should be encouraged.

Pretreatment of SS31 prevents hypoxia/reoxygenation-induced apoptosis in renal tubular epithelial cells / 中华器官移植杂志

Objective To investigate whether the pretreatment of SS31 could alleviate hypoxia/reoxygenation (H/R)-induced injury by inhibiting p66Shc.Method The cultured rat renal proximal tubular cell line NRK52E cells were exposed to 24-h hypoxia (5％ CO2,1％ O2,and 94％ N2) followed by 6-h reoxygenation (5％ CO2,21％ O2,and 74％ N2).SS31 was added to the culture medium 4 h prior to the treatment.Then the cell viability,apoptosis,ROS and MTP were determined.In addition,Western blotting was used to detect the expression of p66Shc and p-p66Shc.Result H/R induced apoptotic cell death,accompanied with activation of total and p-p66Shc in NRK52E cells.Total p66Shc and p-p66Shc were detected at low levels in control NRK52E cells,and their levels were dramatically increased in cells after H/R treatment.Pretreatment with 100 μmol/L SS31 significantly prevented cell death and attenuated total p66Shc and p-p66Shc levels after H/R.Conclusion This study revealed that SS31 pretreatment serves a protective role against H/R-induced apoptosis of human renal tubular epithelial cells by suppressing p66Shc.

Transplantation of en-bloc kidneys and single kidney from pediatric donors to pediatric recipients: 11 cases report / 中华器官移植杂志

Objective To investigate the therapeutic principle of en-bloc kidney and single kidney transplantation from pediatric donors to pediatric recipients.Method A retrospective analysis of 11 pediatric kidney transplants into pediatric recipients was performed.The age of donors and recipients was 33 days to 48 months,and (9.1 ± 3.4) years (4.6 14.3 years) respectively.Result During the follow-up period of 1 to 22 months,the patient survival rate was 100％.Complications included delayed graft function in 1 case (managed by peritoneal dialysis),urine leak in 2 cases (treated by reoperation),hydronephrosis in 2 cases (treated by extracting ureteral catheter) and vascular thrombosis in 1 case.Due to thrombosis,one graft was lost.Of the remaining 10 recipients,all had excellent long-term function.At the last follow-up,their serum creatinine levels were 65.5 ±13.6 μmol/L (49-83μmol/L),and transplanted renal ultrasound examination showed no abnormality.Conclusion Kidney grafts from pediatric donors can be successfully transplanted to pediatric recipients,but the therapeutic principle is different from that in adult kidney transplantation.

The mid-long term effect of conversion from cyclusporine to tacrolimus in patients with kidney transplantation / 中华器官移植杂志

ObjectiveTo verify the efficacy and safety of conversion from cyclosporine (CsA) to tacrolimus (Tac) in renal transplant recipients. MethodsThe clinical data of conversion from CsA to Tac in renal transplant recipients were retrospectively analyzed. In 97 patients undergoing kidney transplantation, there were 62 cases of chronic allograft nephropathy (CAN), 21 cases of refractory renal allograft rejection, 8 cases of hepatic impairment, and 6 cases of gingival overgrowth and hirsutism. The patients were followed up with renal function, hepatic function, blood fat, pressure,glucose,acute rejection incidence, patients/kidney survival rate,and adverse drug reaction for 3 years.ResultsThe renal function of patients with CAN and refractory acute rejection was greatly improved after conversion from CsA to Tac treatment at the first year (P＜0. 05) ,and steady at the 2nd or 3rd year. The conversion treatment could greatly improve the hepatic function of patients with dysfunction of liver, improve the gum hypertrophy and hypertrichosis results from CsA. The 1- and 3-year patients/kidney survival rate after conversion from CsA to Tac was 100 ％/97. 9 ％ and 100 ％/92. 8 ％, respectively. The conversion treatment showed a significantly lower degree of plasma cholesterol, low density lipoprotein, triglyceride, and blood pressure (P ＜ 0.05). Incidence of pathoglycemia, diarrhea or anepithymia,and tremor after conversion treatment was 13.4 ％ (13/97),2. 1％ (2/97) and 5. 2 ％ (5/97),respectively. There were no serious pulmonary infection and tumor during the observation period. ConclusionThe mid-long term effect of conversion from CsA to Tac in patients with kidney transplantation is safe and effective.