[Outcome of kidney transplantation with graft from intracerebral hemorrhage donors].

Objective: To analyze the data of kidney transplantation with allografts from intracerebral hemorrhage donors of China donation after citizen's death (CDCD) and provide evidence to guide the clinical practice. Methods: The clinical data of CDCD donors (age ≥10 years)and corresponding kidney allograft recipients, which were done by Second Xiangya Hospital of Central South University during January 1 2013 to December 31 2017, were analyzed retrospectively. Results: 327 CDCD cases were analyzed, the number and percentage of intracerebral hemorrhage donors were gradually increasing and the percentage reached to 39.5% in 2017. The discarding rateof kidney allografts donated by intracerebral hemorrhage donors was higher than those donated by non-intracerebral hemorrhage donors, but intracerebral hemorrhage donor may not be a risk factor for DGF after the rigorous evaluation of kidney allografts. For 145 primary recipients transplanted in 2016 and had a 22±4 month follow-up, the recipients accepted the kidney from intracerebral hemorrhage donors had a higher level of serum creatinine[(130±60)µmol/L vs (111±38) µmol/L,P<0.05]and a lower eGFR[(61±23) ml·min(-1)·(1.73m(2))(-1) vs (70±23) ml·min(-1)·(1.73m(2))(-1),P<0.05] compared to the recipients accepted the kidney from non-intracerebral hemorrhage donors. Conclusion: The number and percentage of organ donation from intracerebral hemorrhage donor is increasing, but the intracerebral hemorrhage donor may be a risk factor for long-term outcome of kidney transplantation.

[Selective preimplantation pathological evaluation in renal transplantation: a single center's experience].

Objective: To summarize the clinical data of pre-implantation biopsy donors in our hospital and explore the clinical characteristics of those donors in pathological high-risk, and to provide references for the selective histological evaluation of extended criteria donor kidneys. Methods: We retrospectively reviewed the clinical data and pre-implantation renal pathologic score of donors from January 1, 2015 to May 1, 2017.During this period, 247 cases of donation after citizen's death (DCD) occurred.After clinical evaluation and selective machine perfusion( Lifeport) evaluation, 30 cases of pre-implantation pathological evaluation were performed.According to Remuzzi scores, donors were divided into low-risk and high-risk group.Nine cases of low-risk group (bilateral kidney's Remuzzi score ≤3) and 16 cases of high-risk group (bilateral or unilateral kidney's Remuzzi score ≥4, severe glomerular micro-thrombi or severe tubular necrosis) were included.Five cases of donors were excluded due to only unilateral renal pathological result available.Both high-risk and low-risk groups' clinical data, including sex, age, height, body weight, body mass index, proteinuria, hematuria, urinary glucose, baseline or admission serum creatinine, serum creatinine before procurement, history of hypertension and/or diabetes mellitus, cardiopulmonary resuscitation or not, with or without the history of shock, urine output prior to acquisition, macroscopical manifestations of donor kidney, cause of death were statistically analyzed. Results: The donors' baseline serum creatinine/upper limit of normal serum creatinine range in high-risk group were significantly higher than that in low-risk group [(129.8±42.2)% vs(92.4±30.5)%, P=0.029]. The poor macroscopical manifestations of donor kidneys were significantly more frequent in high-risk group than that in low-risk group (12/16 vs 0/9, P= 0). No significant differences between two groups were found regarding their age, height, weight, BMI, proteinuria, hematuria, urine glucose, pre-procure creatinine level, history of hypertension and/or diabetes mellitus, cause of death and so on (P>0.05). Conclusions: After clinical evaluation and selective Lifeport evaluation, donor grafts of whose baseline serum creatinine levels increased beyond normal range and of whose grafts' macroscopical manifestations were poor, should undergo pre-implantation pathological evaluation further.Also, it is reasonable to perform pre-implantation biopsy in cases of equivocal results after Lifeport evaluation.This will be beneficial to identify histological high-risk donors and also be predictive to allocate the grafts.

[Risk factors for acute rejection in living-donor kidney transplant recipients in China: a subgroup analysis of a multi-center, registry study].

Objective: To evaluate pre-and early post-transplantation risk factors for acute rejection(AR) in kidney recipients. Methods: This subgroup analysis of a multi-center registry study was conducted on living-donor kidney transplant recipients in China with 10 years of follow-up. This study analyzed 1 255 recipients including 921 males(73.4%) and with a mean age of (33±10)years. Data from patients were first analyzed with univariate analysis and then multivariate analysis was used for finding out the potential risk factors of AR. Results: A total of 106(8.4%) patients were suspected with AR after kidney transplantation, while 1 149 patients were considered as non-AR. Multivariable analysis demonstrated a significant influence of recipient age and cold ischemia time(CIT) on the occurrence of AR(OR: 0.956, 95% CI: 0.923-0.990; OR: 1.006, 95% CI: 1.002-1.011, respectively). The frequency of severe infection was significantly higher in the AR group than non-AR group(38.7% vs 10.8%; P<0.000 1). The occurrence of new-onset diabetes mellitus and tumors was similar in the two groups. Conclusions: Recipient age and CIT are risk factors for AR after living-donor kidney transplantation. Reducing CIT and intensive management of younger recipient could benefit kidney transplant patients.

Dual Kidney Transplantation From Pediatric Donors to Adult Recipients.

BACKGROUND: The organ shortage is a global problem. A potential approach to expanding the deceased donor pool is to harvest organs from pediatric patients. METHODS: Seven cases of dual kidney transplantation from pediatric donors to adult recipients were performed between 2012 and 2014 in our center. The proximal end of the donor aorta (AO) was anastomosed to the right common iliac artery or external artery. The proximal end of the donor inferior vena cava (IVC) was anastomosed to the right external iliac vein. Recipients received basiliximab or antithymocyte globulin as induction therapy, followed by tacrolimus, mycophenolate mofetil, and prednisone. Prophylactic anticoagulation was not universal in our study. RESULTS: During the 21-month study period, both patient and graft survivals were 100%. No patient showed thrombotic complications. Complications included an acute rejection episode in 1 patient, urine leakage in 2, and anticoagulation related hemorrhage in 1. All recipients had excellent graft function with normal serum creatinine ranging from 0.49 to 1.45 mg/dL and estimated glomerular filtration rate ranging from 56.89 to 145.27 mL/min/1.73 m(2). CONCLUSIONS: Dual kidney transplantation from pediatric donors to adult recipients is a promising way to expand the donor pool. Using the proximal end of the AO/IVC for anastomosis brings satisfactory results.

MiR-200c sensitizes clear-cell renal cell carcinoma cells to sorafenib and imatinib by targeting heme oxygenase-1.

Clear-cell renal cell carcinoma is a highly treatment-resistant tumor type. Heme oxygenase-1 plays an anti-apoptotic role in cancer chemotherapeutic inducing tumor-progression. The miR-200 family was involved in the process of mesenchymal-epithelial transition (MET) during renal development. In the present study, we demonstrated the regulatory relationship between miR-200c and HO-1. We provided evidences to elucidate that miR-200c could sensitize ccRCC cells to sorafenib or imatinib to inhibit cell proliferation, at least partly by targeting HO-1. Moreover, the correlation between miR-200c and HO-1 expression level and drug resistance in ccRCC was also determined. Combined application with chemotherapeutic drugs, miR-200c, a HO-1 inhibitor, may enhance the efficiency of therapy by promoting both apoptosis and autophagy.

Dyslipidemia in human kidney transplant recipients receiving cyclosporine and tacrolimus is associated with different expression of CD36 on peripheral blood monocytes.

PURPOSE: We studied the mechanisms by which immunosuppressants result, in dyslipidemia among human kidney transplant recipients. METHODS: Seventy-five living donor kidney transplant recipients were enrolled in our study with informed consent and the approval of out Institutional Ethics Committee. Each donor-recipient pair were relatives, there were no prisoners. The serum lipid profile, the expression of CD36 on peripheral blood monocytes, and the whole blood concentrations of cyclosporine (CsA) or tacrolimus (FK506) were determined at various times after transplantation. RESULTS: CsA significantly increased serum lipid concentrations. The CsA concentration correlated positively with low-density lipoprotein cholesterol (LDL) levels, whereas FK506 showed no significant effect on serum lipid level. There was a positive correlation between the CsA concentrations and the expression of CD36; FK507 showed no significant effect on CD36 expression. CONCLUSIONS: Hyperlipidemia in kidney transplant recipients treated with CsA was associated with overexpression of CD36 on peripheral blood monocytes.