Risk factors of BK virus infection after kidney transplantation / 中华器官移植杂志

Objective:To retrospectively analyze the BKV infection of recipients after kidney transplantation(RT)and provide references for diagnosing and treating BK virus infection post-RT.Methods:From January 1, 2018 to December 31, 2020, clinical and follow-up data were reviewed for 561 RT recipients(cadaveric and living donor kidney)at First Hospital of Jilin University. DNA loading of BK virus in blood and urine was determined by quantitative polymerase chain reaction(qPCR)and kidney allograft biopsy performed. Based upon the results, they are divided into four groups of A (372 cases), high-level BK viruria(group B, 128 cases), BK viremia(group C, 52 cases)and BK virus nephropathy(BKVN)(group D, 9 cases). The variables related to BK virus infection were screened by univariate analysis. Meaningful variables( P<0.1)are incorporated into the multi-factor ordered Logistic regression model for examining the independent risk factors of postoperative BK virus infection. Results:The incidence of high-level BKV viruria is 33.69%(189/561)at 18 months post-RT. The average detection time is(4.2±3.8)months, the incidence of BK viremia 10.87%(61/561)and the average detection time(5.2±3.6)months post-RT. The incidence of BKVN is 1.78%(9/561)and the average detection time(7.0±4.0)months post-RT. Univariate analysis showed that gender, age, immunotherapeutic regimen, history of acute rejection and type of donor are correlated with BKV infection. Multivariate Logistic regression analysis indicated that male recipient( P=0.013), immune maintenance regimen( P<0.001)and history of acute rejection( P=0.002)were independent risk factors for developing postoperative BKV infection. Conclusions:There is a high incidence of BKV infection within 12 months post-RT. Male recipient, history of acute rejection and immune maintenance regimen are independent risk factors for BKV infection post-RT.

Analysis of middle/long-term clinical efficacy of expanded criteria donor kidney transplantation / 中华器官移植杂志

Objective:To compare the medium/long-term prognosis of kidney transplant recipients with expanded criteria donor(ECD)versus standard criteria donor(SCD).Methods:From August 2011 to May 2017, a total of 506 cases underwent renal transplantation.Based upon baseline clinical data, they were divided into two groups of ECD(67 cases)and SCD(230 cases). And 1: 4 propensity score matching was employed for maximizing the elimination of selection bias influence on the results by rank-sum test.Results:There was no statistical difference existed between ECD and SCD donor kidney in acute rejection, delayed graft function and all-cause infection(all P>0.05). The value of eGFR of ECD donor kidney recipients was slightly lower than that of SCD group at Week 1 and Year 4 postoperatively( P<0.05). And there was no inter-group statistical significance in the fifth year( P=0.273). No significant inter-group difference existed in human/renal survival rate( P=0.143, P=0.076). Conclusions:Appropriate selection criteria and recipient selection criteria can make the application of ECD donor kidney safer and more scientific so as to benefit more patients.

The clinical effect of living kidney transplantation between spouses / 中华器官移植杂志

Objective:To investigate the clinical effect of spousal kidney transplantation , and to explore the significance in today's society.Methods:We retrospectively collected the relevant clinical data from the transplantation department of the first hospital of jilin university, from October 2009 to December 2018. Receptors who accepted spousal, parental and compatriot donor kidney is respectively obtained.Then the postoperative efficacy of the three groups were compared.Results:The graft survival rates of spousal kidney transplantation were 94.1% at 3 years and 83.7% at 5 years, which were not significantly different from other types of living kidney transplantation ( P=0.260). There was no significant difference in creatinine at each time point within 3 years after operation between three groups. At 3 years and 5 years after operation, there was no significant difference in creatinine between spouse group and sibling group.But the creatinine of spouse group was lower compared with parent group ( P=0.014, 0.038). The incidence of rejection within 1 years after spousal renal transplantation was 25%, which was significantly higher than parent group and sibling group ( P=0.029). Age of donor, gender of recipient, D/R BMI and incidence of AR or not in recipient were independent predictors for 1-year creatinine in living kidney transplantation (correlation coefficient: 0.048、-26.03、-15.95、10.23; P=0.003、<0.001、0.021、0.013). Conclusions:Spousal kidney transplantation has same clinical efficacy compared with other types of living kidney transplantation, which can greatly improve the donor kidney resource.So it worth being further promotion, but compared with other types of living kidney transplantation, we should be more alert to the incidence of rejection reaction, so as to obtain better curative effect.

Treg cells prolong skin and heart grafts survival after different CD47 genotype donor specific splenocytes pretreatment / 中华器官移植杂志

Objective To explore the role of regulatory T cells (Tregs) in skin and heart grafts survival prolongation after different CD47 genotype donor specific splenocytes pretreatment.Methods Mouse skin plus hearts transplantation model was set up by using C57BL/6 as recipients and MHC class I-mismatched bm1 as donors.In CD47-/-DST group,recipients received CD47-/-bm1 splenocytes transfusion at 7th d before transplantation.In CD47+/+DST group,recipients received CD47+/+bm1 splenocytes transfusion at 7th day before transplantation.In control group,recipients only received bm1 skin and heart grafts.The populations of Tregs were analyzed by FACS and immunohistochemistry,respectively.The inhibitory effect of Tregs and anti-donor T cell responses was assessed by MLR.Results Result As compared with control group,the survival time of skin grafts in CD47-/-DST group was slightly longer than in non-DST group (20 days vs.17.5 days,P>0.05),but skin grafts had long-term survival in CD47+/+DST group (46.5 days,P0.05),but heart grafts had long-term survival in CD47+/+DST group (42.5 days vs.17 days,P0.05).As compared with CD47-/-DST group,the ratio of Tregs in lymph node cells in CD47+/+DST group increased significantly (P<0.01).Compared to CD47-/-DST group and control group,anti donor specific T cell proliferation was decreased in CD47+/+DST group at 7th day after transplantation (P<0.05).The inhibitory effects of Tregs were similar among groups.Conclusion CD47 expressed on DST cells plays an important role in grafts survival prolongation.The ratio of Tregs in lymphocytes plays the key role in grafts survival prolongation.but not the number or inhibitory function of single Treg.

Analysis of factors influencing delayed graft function following kidney transplants from donation after citizens death / 中华器官移植杂志

Objective To investigate the factors influencing delayed graft function (DGF)following kidney transplants from donation after citizens death (DCD) in single transplant center.Methods The clinical data of 504 kidney transplants from DCD in the First Hospital of Jilin University between August,2011 and May,2017 were collected and analyzed retrospectively.The functional recovery of kidney graft and the related factors were analyzed,respectively.Results The DGF occurred in 32 cases among 504 kidney transplant recipients during perioperative period,who received dialysis treatment (6.3％).The average recovery time of DGF was 21.0 ± 17.1 days.The average dialysis duration (41.3 ± 38.2 months) pre-transplant in DGF group was significantly longer than that in non-DGF group (28.9 ± 26.2 months) (P =0.024).The average age of donors (42.7 ±9.4 years) in DGF group was significantly older than that in non-DGF group (39.0 ± 15.9 years) (P=0.009).The ratio of donors who received CPR treatment in DGF group (21.9％) was significantly higher than that in non-DGF group (6.4％) (P =0.001).The average last serum creatinine level of donors in DGF group (149.3 ± 98.3 mol/L) was significantly higher than that in non-DGF group (92.8 ± 41.6 mol/L) (P＜0.001).The multivariate analysis revealed that CPR treatment for donors before organ donation,the last serum creatinine level of donors as well as BMI of kidney transplant recipients were all independent risk factor influencing DGF (P =0.001,P＜0.001 and P =0.008,respectively).Conclusion Our study focused on analysis of factors influencing DGF following kidney transplants from DCD in single transplant center.The results of this study are helpful to find and avoid the high risk factors that could influence DGF,reduce the incidence of DGF,improve the quality of patients' life as well as reduce the cost of medical treatment.

Significance of The Maryland Aggregate Pathology Index in the evaluation of donation after citizens death (DCD) kidney by time-zero renal biopsy / 中华器官移植杂志

Objective To investigate the significance of The Maryland Aggregate Pathology Index in the evaluation of donation after citizens death (DCD) kidney by time-zero renal biopsy.Methods 124 kidney grafts were donated by 62 donors after cardiac death in First Hospital of Jilin University between Jan.2015 and Dec.2015.One kidney was deprecated after evaluation and 123 transplants were performed eventually.Time-zero renal biopsy was performed on 123 cases of DCD donor kidney,and rapid frozen pathological examination was performed.The pathological results of donor kidneys were graded by The Maryland Aggregate Pathology Index:low risk group (less than 7 points) (n =112 cases);the middle risk group (8-11 points) (n =11 cases),high the risk group (more than 12 points) (n =0).The incidence of delayed graft function (DGF),the incidence of perioperative acute rejection (AR),and the average creatinine level in the patients at different time points one year post-transplantation were observed.The median value of follow-up was 19 months,and the 1-year survival rate of patients and renal grafts was observed.Results All 123 cases of kidney transplantation from DCD were performed successfully.The incidence of DGF in low risk group and in middle risk group was 6.3％ (7/112) and 27.3％ (3/11),respectively (P =0.046).The incidence of perioperative acute rejection (AR) in low risk group and middle risk group was 9.8％ (11/112) and 27.3％ (3/11),respectively (P =0.112).The mean serum creatinine (Scr) levels at 7th day,1st month,3rd month,and 12th month after operation were 123.3 ± 79.7,104.4 ± 52.6,72.9 ± 32.0 and 107.6 ± 34.6 μmol/L in low risk group,and 321.0 ± 74.3,172.6 ± 59.9,142.9 ± 45.7 and 140.8 ± 63.6 μmol/L in middle risk group,respectively.The mean Scr levels in patients at different time points one year post-transplantation in low risk group were significantly lower than those in middle risk group (P＜0.000 1,=0.000 3,＜0.000 1,=0.012 respectively).The 1-year survival rate of patients and renal grafts was 98.2％ (10/112)/98.2 (110/112 in low risk group,and 81.8％ (9/11)/81.8％ (9/11) in middle risk group,respectively (P =0.040).Conclusion The Maryland aggregate pathology index obtained from time-zero renal biopsy of rapid frozen pathological examination can provide some guidance for the evaluation of the quality of DCD and the prognosis.Incidence of DGF was lower in low risk group than that in middle risk group,and the renal function of each time point was better within 1 year,and the 1-year survival rate of patients and renal grafts was higher.

Effect of serum uric acid levels on graft function and long-term graft survival after kidney transplantation / 中华器官移植杂志

Objective To study the effect of serum uric acid (UA) levels on kidney graft function as well as long-term graft survival after renal transplantation.Methods The clinical data of 859 kidney transplant recipients from Jan.2008 to May 2014 were investigated retrospectively.The differences in clinical indexes between normal UA group and hyperuricemia group were compared based on UA levels.Cox regression model was built to analyze the effect of elevated UA on overall graft loss,death censored graft failure and death of patients,respectively.Kaplan-Meier graft survival curve was used to compare the overall graft loss,death censored graft failure and death of patients between normal UA group and hyperuricemia group.Results The average follow-up time was 38.6 ± 17.3 months for 859 kidney transplant recipients.590 (68.7％) recipients were enrolled in normal UA group and 269 (31.3％) recipients were defined as hyperuricemia patients.The average eGFR in hyperuricemia group was significantly decreased as compared with normal UA group (79.4 ± 20.93 vs.94.7 ± 20.55,P＜0.001).Cox regression model showed that if UA level increased per 10 mol/L,the risk of overall graft lost increased 1.070 times (P＜0.001) and the risk of death censored graft failure increased 1.121 times (P＜0.001) accordingly.Kaplan-Meier analysis showed the overall graft loss was dramatically decreased (P =0.009),and the death censored graft failure was significantly decreased (P＜0.0001) in hyperuricemia group as compared with that in normal UA group.The death of patients showed no significant difference between two groups (P =0.638).Conclusion Serum UA levels after kidney transplantation affect graft function as well as long-term graft survival.

Effect of penile erectile dysfunction on quality of life in male renal transplant recipients / 中华器官移植杂志

Objective To explore the effects of penile erectile dysfunction (ED) on the quality of life in male renal transplant recipients.Methods 150 cases of male married recipients undergoing renal transplantation were selected randomly.The recipients were divided into ED group (n =63) and non-ED group (n =87) through the IIEF-5 score.The Short Form-36 Health Status Survey (SF-36)and Hamilton Anxiety Scale were used to compare their living quality and the state of mental health between the two groups,respectively.Results The SF-36 scores in ED group in General Health,Vitality,Social Function,Role Limitation due to Emotional Problems,Mental Health were significantly lower than those in non-ED group (P＜0.05).There were 13 cases in ED group with anxiety disorders (20.6％),significantly more than in non-ED group (3.4％),P＜0.05.Conclusion ED is an important influencing factor for the quality of life in male kidney transplant recipients.

Experience of renal hilum controlling during right retroperitoneal laparoscopic living donor nephrectomy / 中华器官移植杂志

Objective To investigate the safety and clinical effect of renal hilum controlling during right retroperitoneal laparoscopic living donor nephrectomy (RPLDN).Methods From January 2009 to May 2012,62 cases of right RPLDN were performed in our department.The clinical data,including the general status of donors,operative time,blood loss,donor kidney warm ischemic time,hospital stays and complications,were analyzed retrospectively.Results Right RPLDN was performed successfully on all 62 cases without conversion to open procedure and apparent complications.The function of all the kidney grafts recovered well.Mean operative time was 73.5 ± 10.4 min,mean blood loss was 30.7 ± 10.4 ml,mean warm ischemic time was 107.2 ± 24.8 s,mean artery and vein lengths were 3.3 ± 0.5 cm and 2.0 ± 0.4 cm,vena cava incision suture time was 2.0 ± 0.5 min and mean hospital stay was 5.2 ± 1.6 days,respectively.Conclusion Right donor kidney with small part of vena cava can be harvested by using retroperitoneal laparoscopy plus open passage way.This technique of renal hilum controlling in RPLDN has good clinical effect and more advantages,including ensuring the safety of donors and kidney grafts,promoting the operation done smoothly,reducing the pain and financial burden of donors.

Renal tubular epithelial phenotypic transdifferentiation in renal allograft rejection / 中华肾脏病杂志

Objective To observe the transdifferentiation of renal tubular epithelial phenotype in allograft biopsy samples of patients with various rejections,and to analyze the association between rejection and transdifferentiation.Method Immunohistochemistry (SP method) was applied to detect α-SMA expression in tubular epithelial cells from 55 renal allograft biopsy samples with various rejection.Results Positive α-SMA expression was found in all the atrophic tubular epithelial cells adjacent to cytoplasm of basement membrane,which indicated the atrophic renal tubular epithelial cells appeared the phenotypic transdifferentiation.Positive α-SMA was also detected in some renal epithelial cells without atrophy.No phenotypic change was found in 7 cases without obviously rejection.Among 28 cases of acute T-cell-mediated rejection IA grade,α-SMA positive expression rate of non-atrophy renal epithelial cells was 25％-50％ in 1 case and 10％-25％ in 3 cases.Among 14 cases of more severe acute rejection group IB grade,α-SMA positive expression rate was over 50％ in 1 case,25％-50％ in 2 cases and 10％-25％ in 2 cases.Conclusion When acute T-cell-mediated rejection becomes more serious in renal allograft,the phenotype transdifferentiation aggravates in renal tubular epithelial cells.

Cyclosporin A instead of Tacrolimus for treatment of hemolytic uremic syndrome in a kidney transplant recipient / 中国组织工程研究

A patient with impaired kidney function after kidney transplantation and received treatment at the First Hospital of Jilin University was retrospective analyzed. The patient was male, 45 years old, and was diagnosed hemolytic uremic syndrome by transplanted kidney biopsy. The patient received cyclosporine A (CsA) as maintenance centered immunosuppression therapy postoperatively. He was admitted because of 1 week acratia followed by 1 day increased serum creatinine level at 1.5 years after transplantation. At 1 day after admission, he was received renal needle biopsy, and underwent 2 days Prednlsolone treatment. After hemolytic-uremic syndrome was diagnosed, CsA was transferred to Tacrolimus (Fk506) with dose of 2 mg/d, and Azathioprine was replaced by mycophenolate, Prednisone was taken orally for 20 mg/d. The function of the transplanted kidney and the change of routine blood tests were observed. After 1 week treatment of the changed Immunosuppression therapy, the function of the transplanted kidney was improved obviously, and the hemoglobin and platelets was decreased during the treatment. The results demonstrated that kidney biopsy is a key method to diagnose hemolytic-uremic syndrome, and adjustment of immunosuppressive agents, replacing CsA with FK506 are effective for postoperative hemolytic-uremic syndrome.

Expressions of MIF,CD68 and CD57 in ovarian cancer tissues and their significances / 吉林大学学报(医学版)

Objective To study the expressions of MIF,CD68 and CD57 which are the markers of macrophages,macrophage migration inhibition factors and natural killer cells in ovarian cancer tissues and their significances. Methods Immunohistochemistry staining was used to detect the expressions of MIF,CD68 and CD57 in 56 ovarian cancer tissues and 5 normal ovary tissues. Results MIF,CD68 and CD57 had positive expressions in ovarian cancer tissues at different degrees,but the expressions of MIF,CD68 and CD57 were week or negative in normal ovary tissues.Furthermore,the positive expression levels of MIF,CD68 and CD57 in ovarian cancer tissues were increased with the grade of ovarian cancer.The expression of CD57 was lower than the expression of CD68 in ovarian cancer(P

Expressions of MMP-2 and TIMP-2 in lung cancer tissue and their relationships with microvessel density / 吉林大学学报(医学版)

Objective To study the expressions of metalloproteinase 2(MMP-2) and tissue inhibitors of metalloproteinase 2(TIMP-2) in lung cancer,and their relationships with microvessel density(MVD).(Methods The) expressions of MMP-2,TIMP-2 and Ⅷ factor were tested by immunohistochemical staining in(90 cases) of lung cancer tissue and 40 cases of para-cancer lung tissue.Results The immunohistochenmical staining results analyzed by IPP software indicated that MMP-2 and TIMP-2 expressed in all pathological types of lung cancer.The expreesion level of MMP-2 in lung cancer tissue was higher than that in para-cancer tissue(P

Analysis of 28 Fatal Cases Caused by Drug Adverse Reaction / 中国药房

OBJECTIVE： To study the disease distribution and lethal factors of ADRs in 28 fatal cases,so as to improve the prophylactic measures for diseases and rationality and therapeutic effect of drug-use.METHODS： According to ADRs evaluation standard,the cases who died in this hospital in recent 2 years were analysed with computer internet.RESULTS： 28 cases directly died of ADRs.Insulin and glibenclamidium were the most common lethal agents,accounting for 32.14％ ,and mannitol and azathiopurine were the next ones.Senile patient accounted for 63.28％ of all patients died of ADRs.CONCLUSION： (1)Rational drug-use has clinical significance in reducing mortality of geratic diseases.(2)It will be an important way in reducing the fatality of ADRs that we inquire about patients' illness carefully and handle the indications and dosages of drugs seriously.

Study of CREG zygosity principles applied in kidney transplantation / 中国免疫学杂志

Objective:To study the applied value of CREG Zygosity Principles in kidney transplantation.Methods:Relationship between HLA CREG zygosity and acute rejection incidence was analyzed in 173 kidney transplantation and the concerned principles were discussed.Results:HLA-A,B,DR antigens of 0 mismatch (MM) were 7.51%,4.04%,3.46%;and those of 2 MM were 39.88%,65.31%,58.38% respectively.Compared in CREGs,A,B,and DR,the 0 MMs were 49.71%,30.63% and 24.27%;whereas 2MMs were only 5.20%,12.14% and 8.67%.In HLA-A,B and DR antigens 0 MM,the incidence of acute rejection was 21.96%,21.38% and 7.51% respectively;and in 2MMs,those were 22.54%,20.23%,and 66.67% respectively.Compared by CREGs A,B and DR 0 MM,acute rejection reached 21.83%,20.21% and 6.14%;and in 2MMs the incidence of acute rejection were 22.22%,20.00% and 69.82%.Conclusion:CREGs model is a novel method of choosing kidney transplantation donor-recipients’s matching.

Clinical experience of using anti CD3 monoclonal antibody to prevent allograft rejection episodes after renal transplantation / 中国免疫学杂志

Objective:To study the effect of anti CD3 monoclonal antibody on preventing acute rejection episodes after renal transplantation.Methods:42 patients undergoing renal transplantation were treated with anti CD3 monoclonal antibody (5 mg) daily for a mean of 10 days (treated group).122 patients who were not treated with anti CD3 monoclonal antibody (control group).Acute rejection episodes,graft loss,death and rate of CMV infection in patients were observed.Results:The treated group had a significantly reduced risk of acute rejection (18 6%),as compared with the control group (28 7%).The rate of graft loss were significantly reduced in the treated group 1 year,2 years,or 3 years after renal transplantation.There were no significant differences in mortality between treated group and control group 1 year,2 years,or 3 years after renal transplantation.The incidence rate of CMV infection were significantly increased in the treated group (33 3%),as compared with the control group (13 9%).The first acute rejection episode was postponed significantly in the treated group.There were more acute rejection episodes that could be reversed by MP in the treated group.Conclusion:Anti CD3 monoclonal antibody significantly reduced the risk of acute rejection and significantly reduced the rate of graft loss.Anti CD3 monoclonal antibody significantly increased the incidence rate of CMV infection,which should be paid attention. [

Microchimerism in the cell-free blood samples of recipients associates with the acceptance of transplanted kidneys / 中国免疫学杂志

Objective:To examine whether the existence of the donor-and-recipient-derived DNA chimerism in recipient’s plasma can be a predictive marker for the status of transplanted organ.Methods:One hundred and twenty-six female patients who had been transplanted with male kidney were enrolled in the present study.In these female recipients,the SRY1,DYZ11st and DYZ12nd genes on the Y chromosome from the plasma were prospectively examined using reverse transcription polymerase chain reaction (RT-PCR).Results:SRY1,DYZ11st and DYZ12nd sequences were detected in the cell-free blood (plasma) of 97 (77%) of 126 female patients with male kidney.The average time-span when the transplanted kidneys functioned was 8.7 years and 5.4 years among microchimerism-positive and microchimerism-negative recipients,respectively.The frequency of the patients who had acute rejection after renal transplantation was approximately 10% and 28%in microchimerism-positive and microchimerism-negative recipients,respectively.Serum creatinine levels in microchimerism-positive patients were significantly lower than those in microchimerism-negative patients.Conclusion:These results suggest that plasma DNA microchimerism is present in certain patients following renal transplantation and measurement of plasma DNA microchimerism using quantitative RT-PCR might be a useful predictor for the acceptance of transplanted kidneys.