Belatacept: a new weapon in anti-rejection battlefield / 器官移植

As a co-stimulatory blocker against CD28 receptor, belatacept has been approved and applied to the treatment of rejection in organ transplantation in Europe and America. Belatacept has been proven to outperform calcineurin inhibitor (CNI) in improving the long-term survival rate of recipients and grafts, and enhancing graft function. Nevertheless, it might cause a high incidence of rejection. To resolve this issue, transplant workers have attempted to optimize belatacept immunosuppressive regimen and achieved good clinical efficacy. Although belatacept has been proven to exert poor effect on memory T cells, it has potential value in exploring new co-stimulatory molecular targets to optimize immunosuppressive regimes due to its specificity for immune cells and mild adverse effects. In this article, the advent of co-stimulatory blocker, clinical efficacy and application of belatacept, and the causes of belatacept-resistant rejection were reviewed.

Analysis of survival and influencing factors of patients with recurrent and de novo nephritis of renal allograft / 器官移植

Objective To analyze the survival and influencing factors of patients with recurrent and de novo nephritis of the renal allograft. Methods Clinical data of 95 patients undergoing pathological puncture (biopsy) of the renal allograft were retrospectively analyzed. According to the biopsy results, all recipients were assigned into the recurrent group (n=28), de novo group(n=33) and non-nephritis group (n=34). The 1-, 3- and 5-year survival was statistically analyzed and the survival rates were calculated in three groups. Kaplan-Meier survival curve was adopted to analyze the 5-year survival. Clinical data of patients with recurrent and de novo nephritis were analyzed by univariate analysis. Logistic regression analysis was utilized to analyze the influencing factors of clinical prognosis of patients with recurrent and de novo nephritis. Results The 1-year survival rate did not significantly differ among three groups (all P > 0.05). The 3-year survival rates in the de novo group and non-nephritis group were 97% and 100%, significantly higher than 86% in the recurrent group (both P < 0.05). The 5-year survival rates in the de novo group and non-nephritis group were 82% and 91%, considerably higher than 61% in the recurrent group (both P < 0.05). Logistic regression analysis demonstrated that the survival rate of patients with recurrent renal nephritis was significantly correlated with the times of renal transplantation, cold ischemia time (≥12 h), immunosuppressive regime, recovery time of postoperative serum creatinine (Scr) (≥14 d), complications at postoperative 1 month (acute renal tubular necrosis, ultra-acute rejection and acute rejection) and type of nephritis (IgA nephropathy, focal segmental glomerular sclerosis and hemolytic-uremic syndrome) (all P < 0.05). In patients with de novo nephritis, the survival rate was significantly associated with cold ischemia time (≥12 h), immunosuppressive regime, recovery time of postoperative Scr (≥14 d) and complications at postoperative 1 month (acute renal tubular necrosis, ultra-acute rejection and acute rejection) (all P < 0.05). Conclusions The survival rate of patients with recurrent renal nephritis is lower than those in their counterparts with de novo nephritis and without nephritis. Cold ischemia time, immunosuppressive regime, recovery time of postoperative Scr and complications at postoperative 1 month are pivotal influencing factors of the clinical prognosis of patients with recurrent and de novo nephritis of the renal allograft.