BACKGROUND: Donation after cardiac death (DCD) is becoming the main source of organs for transplantation. Donor and recipient gender may play an important role in preoperative evaluation and recipient selection of transplantation. OBJECTIVE: To analyze the effect of donor and recipient gender on the recovery of renal function after DCD renal transplantation, and to further guide the selection of recipients. METHODS: The clinical data of recipients and donors of DCD kidney transplantation performed at the First Affiliated Hospital of Zhengzhou University from July 2012 to March 2015 were analyzed retrospectively. According to donor and recipient gender, the donors and recipients were divided into four groups: group A (male donor, male recipient), group B (male donor, female recipient), group C (female donor, male recipient), group D (female donor, female recipient). The renal function of the recipients was recorded at 1 and 2 weeks, 1, 3, 6, and 12 months postoperatively to compare the effect of donor and recipient gender on the recovery of renal function. RESULTS AND CONCLUSION: The serum creatinine level in the groups A and B was lower than that in the groups C and D at postoperative different time points, and there was a significant difference at 3, 6 and 12 months postoperatively (P < 0.05). The estimated glomerular filtration rate in the groups A and B was significantly higher than that in the groups C and D at postoperative different time points (P < 0.05). The serum creatinine level in the group C was significantly higher than that in the other three groups at postoperative different time points (P < 0.05). The serum creatinine level in the group A was significantly higher than that in the group B at 3, 6 and 12 months postoperatively (P < 0.05). The glomerular filtration rate in the group A was significantly higher than that in the group C at postoperative different time points (P < 0.05). The glomerular filtration rate in the group B was significantly higher than that in the group D at 12 months postoperatively (P < 0.05). These results suggest that the male donors show superior renal function to the female donors. The postoperative recovery of renal function is relatively slow when the male recipients receive a kidney of female donors. The female recipients with lower body surface area who receive the kidney of elderly male donors with poor renal function can achieve favorable clinical effects. Therefore, the gender should be used as a reference index for selecting potential recipients.

Objective:To compare the efficacy of single kidney transplantation for children from pediatric donors between body weight ≤15 kg and >15 kg.Methods:A retrospective review in 156 children with single donor kidney transplantation from August 2010 to December 2019 in the Kidney Transplantation Department of the First Affiliated Hospital of Zhengzhou University was conducted. The patients were classified into the small kidney group (pediatric donor body weight ≤15 kg) and the big kidney group (pediatric donor body weight >15 kg). In this study, 89 cases were concluded in the small kidney group and 67 cases were concluded in the big kidney group. The donor kidneys were obtained from 46 cases of small weight (≤15 kg) pediatric donors and 48 cases of large weight (>15 kg) pediatric donors. There were significant differences in age [1.00 (0.02 - 4.00) years vs. 10.00 (3.00-18.00) years], body weight [10.0 (3.4 - 15.0) kg vs. 35.0 (16.2- 35.0) kg], height [76 (50- 113) cm vs. 144 (67-172) cm], GFR [(31.50±7.46)ml/min vs. (36.79±7.00) ml/min], and renal length to diameter [(5.91±0.48) cm vs. (8.71±1.88) cm] between the small kidney group and the big kidney group ( P < 0.01). There was no significant difference between the two groups of donors in gender, cold/warm ischemia time and cause of death ( P>0.05). There were significant differences in age [(11.28±3.89) years vs. (13.86±3.56) years], body weight [(31.83±10.45)kg vs. (35.13±9.15) kg], and height [(130.02±28.56) cm vs. (143.97±16.59) cm] between recipients of the small kidney group and big kidney group ( P < 0.05). While there were no significant differences in preoperative serum creatinine level [(822.65 ± 135.04) μmol/L vs. (777.31 ± 165.40) μmol/L], HLA mismatch [(3.4 ± 1.4) site vs. (3.2±1.3) site], and primary disease between the two groups ( P > 0.05). The recovery of renal function, postoperative adverse events, postoperative children, and graft survival were compared between the two groups. Results:The renal function of the two groups of recipients returned to normal 3 months after operation. The perioperative complications in the small kidney group and the big kidney group mainly included renal delayed recovery [5.6% (5/89) vs. 7.5% (5/67), P=0.89], renal vascular embolization [3.4% (3/89) vs. 0, P=0.35], and acute rejection [2.2% (2/89) vs. 4.3% (3/67) , P=0.75]. The main cause of recipient death during the follow-up period was pulmonary infection [4.5% (4/89) vs. 6.0% (4/67) , P=0.68]. The postoperative small kidney group was followed up for an average of 30 (3-74) months. The survival rates of children in the small kidney group at the 1, 3 and 5 years after surgery were 96.6% (86/89), 91.0% (81/89) and 91.0%(81/89), while the transplanted renal survival rates were 92.1% (82/89), 86.5% (77/89) and 84.2% (75/89), respectively. The postoperative big kidney group was followed up for an average of 32 (4-89 ) months. The survival rates of children in the big kidney group were 95.5% (64/67), 94.0% (63/67) and 91.0%(61/67) in the first 1, 3 and 5 years postoperatively, while the graft survival rates were 92.5% (62/67), 83.6% (56/67) and 83.6% (56/67), respectively. The postoperative kidneys of two groups were fast-growing, and there was no significant difference between the small kidney group and the big kidney group in graft length to diameter [(9.63±0.31) cm vs. (9.75±0.71) cm] after 1 year ( P>0.05). Conclusions:The effect of single pediatric kidney transplantation for pediatric donor with body weight ≤15 kg is equivalent to that for pediatric donor with body weight >15 kg , which can be carried out clinically.

Objective:To evaluate the effect of unilateral pediatric kidney donation for adult kidney transplantation.Methods:Retrospective analysis was conducted on the cases of children who donated unilateral donor kidney for adult kidney transplantation recipients in our hospital, and those who were followed up for more than three years were included in this study. The body weight of the recipients in group A was ≤50 kg, and the body weight of the recipients in group B was ≤70 kg.The recipients were divided into 0-5 year old donor group (group A) and 6-17 year old donor group (B group). Clinical data, recipient/kidney survival, graft function and growth, and complications of the recipient were analyzed.Results:A total of 45 adult recipients were enrolled, including 12 in group A and 33 in group B. The renal survival rate at 3 years after operation was (100%, 96.9%)/(91.6%, 93.9%). One week after the operation, the early postoperative recovery of renal function in group B was better than that in group A, and the difference of serum creatinine was statistically significant ( P<0.05), while the difference of serum creatinine in other postoperative follow-up time points was not statistically significant ( P>0.05). Within a year, both groups of grafts continued to grow, reaching adult levels in one year. There was no statistical significance in the incidence of complications between the two groups ( P>0.05). The incidence of protein in the two groups was 33.3% and 6.1%, respectively, 1 case in each group still had proteinuria at 1 year after surgery, and only 1 case in the infant donor kidney recipient in group A had proteinuria at 3 years after surgery. Conclusions:Unilateral donor kidney transplantation from children can provide good results for adult patients with uremia by selecting suitable donors according to the weight of the recipient.

Objective:To explore whether hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) preconditioning can relieve inflammation, reduce cell apoptosis and alleviate renal ischemia-reperfusion injury in mice.Methods:Male C57BL/6 mice were randomly divided into three groups of sham operation (sham), ischemia reperfusion injury (IRI) and IRI+ HIF-PHI ( n=6 each). In IRI+ HIF-PHI group, mice received an intragastric dose of roxadustat (20 mg/kg) every other day one week before. After renal IRI modeling, serum creatinine (SCr) level was monitored and hematoxylin-eosin (HE) staining employed for observing the pathological changes of renal tissue and scoring injury degree. Apoptosis of renal tubular epithelial cells was assessed by terminal-deoxynucleoitidyl transferase mediated nick end labeling (TUNEL). Reverse transcription-polymerase chain reaction (RT-PCR) was utilized for detecting the mRNA expressions of HIF-1α, TNF-α and IL-1β in renal tissues. Immunofluorescence and immunohistochemistry were employed for detecting the expressions of hypoxia-inducing factor 1α (HIF-1α), inflammatory cytokines tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β). Results:As compared with IRI group, SCr level declined markedly in IRI+ HIF-PHI group ( P<0.01), renal tissue injury improved markedly, semi-quantitative score of renal tubule injury dropped ( P<0.01), apoptotic cells decreased ( P<0.01) and the expression levels of TNF-α and IL-1β declined ( P<0.05). Compared with sham group, the mRNA expression of HIF-1α was not significantly elevated in IRI group ( P>0.05). Immunofluorescence showed that the expression of HIF-1α in medulla of renal tissues was up-regulated in IRI group, but not markedly in cortex. While the mRNA expression of HIF-1α was markedly up-regulated after a pretreatment of HIF-PHI ( P<0.05), the expression spiked markedly in renal cortex, but was weaker in medulla than that in IRI group. Conclusions:HIF-PHI can boost the expression level of HIF-1α, reduce the expression of inflammatory factors, relieve the inflammatory response, reduce cell apoptosis, improve renal function and alleviate renal ischemia reperfusion injury.

Objective:To explore the clinical efficacy of vascular interventional therapy in children with transplantation renal artery stenosis(TRAS).Methods:From January 2013 to September 2021, retrospective analysis was performed for clinical data of 238 TRAS children.Peak systolic velocity(PSV)of transplant renal artery, interlobular artery PSV, transplant renal artery PSV/ interlobular artery PSV(post PSV ratio)and serum creatinine level before and after vascular interventional therapy and at the last follow-up were compared.Results:Six pediatric kidney transplantation recipients were diagnosed as TRAS.The median operative age was 12(9-17)years, the median postoperative time to diagnosing TRAS 4(1.7-18.0)months and the median follow-up period 6.6(2.5-8.0)years.All of them received vascular interventional therapy of percutaneous transluminal angioplasty(PTA, n=5)and stent angioplasty( n=1). The serum creatinine pre-treatment with vascular interventional therapy was significantly higher than baseline serum creatinine level at discharge(200.8±88.5)vs(75.2±27.9)μmol/L, P=0.025 and decreased to(103.8±44.7)μmol/L at Month 1 post-treatment( P=0.196)and(98.7±30.2)μmol/L at the last follow-up( P=0.115). Comparing with internal diameter of grafted renal artery anastomosis site(2.6±0.6 mm)pre-treatment with vascular interventional therapy, significant changes occurred at 24 h post-treatment(3.8±0.5 mm)and at the last follow-up(4.1±0.8 mm)(all P=0.027). In addition, PSV and post PSV ratio of transplanted renal artery at 24 h post-treatment(163±45.0 cm/s, 6.5±2.2)and at the last follow-up(184.7±80.8 cm/s, 5.4±2.0)were significantly lower than that before vascular interventional therapy(356.5±77.9 cm/s, 18.0±5.8)and interlobular artery PSV was significantly higher than that before vascular interventional therapy( P=0.024, P=0.032, respectively). During follow-ups, no restenosis or thrombosis occurred in transplanted renal arteries. Conclusions:PTA or stent angioplasty for TRAS children is technically feasible with low restenosis rate and relatively satisfactory mid/long-term outcomes.

Objective:To explore the efficacies of single-center pediatric transplantations and discuss the current problems.Methods:From July 2007 to September 2019, the clinical data of 202 children (aged ≤17 years) undergoing renal transplantation were reviewed. And their perioperative complications, transplantation outcomes and patient/kidney survival were analyzed.Results:The most common perioperative complication was delayed graft function (DGF)( n=24, 11.9%), recurrence of renopathy ( n=8, 4.0%) and acute rejection ( n=21, 10.4%). The major causes of death and graft failure were lung infection ( n=9, 4.5%) and rejection ( n=11, 5.4%). Perioperative serum creatinine decreased progressively from (816.1±303.1) μmol/L preoperatively to (62.7±20.6) μmol/L at Month 3 post-operation. The value of eGFR were (166.8±37.3), (135.1±29.0) and (109.9±31.1) ml/(min·1.73 m 2) at Year 1/3/5 post-operation respectively. The survival rates were 96.7%, 96.3%, 94.1%, 93.5%, 94.1% and 90.7% at Year 1/3/5 post-operation respectively. No difference existed in human/kidney survival rate between LD and DD groups at Year 1/3/5 post-operation ( P>0.05) and transplantation outcomes were excellent. Conclusions:Effective and successful outcomes have been achieved at our center. And further optimizations are required for resolving various problems.

Objective To investigate the clinical significance of serum and urinary levels of neutrophil gelatinase-associated lipocalin (NGAL ) for evaluating changes of residual renal function after living donor kidney resection under different operation model in young versus elderly patients. Methods The clinical data of renal transplants were retrospectively analyzed by successfully using 66 living-related donors at the First Affiliated Hospital of Zhengzhou University from September 2016 to October 2017. According to the operation model and age ,renal donors were divided into 4 groups :group A (young/open) ,group B (young/laparoscopic) ,group C (aged/open) ,and group D (aged/laparoscopic).Blood and urinary NGAL and serum levels of creatinine ,cystatin C ,and other indices of renal function were assayed and collected before and at 1 ,3 ,7 days after operation. Results Both blood NGAL levels and urinary NGAL levels showed no statistically significant difference (all P>0.05) among four groups both before and after operation ,except that urinary NGAL was higher in group C (aged/open) than other groups ,at 1 day after operation ,(P = 0.03).The post-vs.pre-operation level dynamic changes of renal function were four or three times higher in urine or serum NGAL level than in serum creatinine or cystatin C level at 1 day after operation ,which showed an important role for predicting an early residual renal damage and relative treatment. Conclusions NGAL can be used as indices in evaluating changes of residual renal function after living donor kidney resection ,especially in the elderly receiving open kidney resection.

Objective To explore the long-term clinical effect of kidney transplantation in children.Methods The clinical data of 53 children with kidney transplantation from March 2008 to September 2014 were retrospectively analyzed.The influence of the dependent factors on the estimated glomerular filtration rate (eGFR) (greater than 90 mL/min/1.73 m2 or ＜90 mL/min/1.73 m2) was estimated in the three years after the operation,and the influencing factors were analyzed by the dual logistic regression equation.Results There were 19 cases of living donors,17 cases of organ donors after death,and 6 others.The 53 patients were followed up for 3-9 years.The level of blood creatinine was decreased from the preoperative (820.1 ± 323.1) μmol/L to (51.6 ± 24.9) μmol/L 3 years after the operation (P＜0.05).eGFR was increased to (103.5 ± 11.4) mL/min/1.73 m2at 3rd year after the operation from the preoperative (17.1 ± 7.8) mL/min/1.73 m2 (P＜0.05).The age of recipients,preoperative dialysis time,number of HLA mismatching and postoperative delayed graft function healing (DGF),rejection and infection were the influencing factors of eGFR at 3rd year postoperation (P＜0.05).The multi-factor binary logistic regression equation analysis showed that only rejection was the risk factor for eGFR at 3rd year p0ostoperation.Eight cases of DGF (8/53,15.1％) recovered rapidly.There were 6 cases of acute rejection (6/47,12.8 ％) and 1 case of chronic rejection (1/47,2.1％).There were 9 cases of infection (9/47,19.1％).There were 6 cases of recurrence after surgery.The 3-year recipient and kidney survival rate was 94.3％ (50/53) and 88.7％ (47/53) respectively.The average height of the patients in the first,second and third year after the surgery was increased by (4.6 ± 1.9) cm (0.5-19.1 cm),(3.7 ± 1.8) cm (0.7-14.3 cm) and (2.8± 1.2) cm (0.3-8.7 cm) respectively.Conclusion The long-term effect of children kidney transplantation is satisfactory.

Objective To explore the morphological changes of renal grafts in implantation protocal biopsy,and early stage effect of lesions from donation after cardiac death (DCD) donors.Methods Preimplantation kidney biopsy from 48 cases of DCD donors from August 2016 to March 2017 was retrospectively reviewed.Protocal biopsy was performed on dual kidneys and evaluated according to Banff 2016 donor criteria before transplantation.The Banff score of kidneys was calculated and its effects on renal function were evaluated.Results There were 48 donors and 95 kidneys (there was one kidney with congenital renal indevelopment).In.one case,diffused thrombus in arteriae arcuata occurred on the left side (normal on the right side),and the left kidney was discarded.In one case,diffused arteriolar hyaline (ah3) occurred on the left side (normal on the right side),and the left kidney was discarded.Severe interstitial fibrosis (＞70％) was seen in one pair of kidneys,and the kidneys were discarded.The proportion of glomerulosclerosis (GS) was ＞30％ in one pair of kidneys,and the kidneys were discarded.There was no statistically significant difference in morphometric changes between left kidney group and right kidney group (P＞0.05).Besides GS,the morbidity of interstitial fibrosis (ci) was 17％,that of tubular atrophy (ct) was 16％,that of interstitial inflammation (i) was 13％,that of fibrous intimal thickening (cv) was 19％,that of arteriolar hyaline changes (ah) was 28％,that of glomerolar thrombi (gt) was 0％,and that of acute kidney injury (AKI) was 81 ％.Glomerular filtration rate (eGFR) estimated was compared between ah ＞2 group and ah≤2 group.eGFR in ah＞2 group was significantly higher in 16 days,one month and three months,but not in 7 days.Terminal blood serum creatinine (t-Scr) in ah＞2 group in three months was significantly higher than that in ah≤2 group (152.5 ± 47.38 vs.122.08 ± 36.57 μmol/L,P＜0.05).The eGFR was compared between Banff score ＞3 group and Banff score ≤3 group.The eGFR in ah＞2 group was significantly higher in one month and three months,but not in 7 days and 16 days.t-Scr in Banff score ＞3 group was higher significantly than in Banff score ≤3 group (146.18-± 44.55 vs.115.27 ± 30.67 μmol/L,P＜0.05).Seven patients were diagnosed as having delayed graft function (DGF),there were 2 patients with ah＞2 and Banff score＞3,and 1 patient with primary non-function (PNF).Conclusion Vasculopathy and acute renal tubular injury were most common lesions in donor renal pathology.Kidneys with diffused arteriolar hyaline change (ah＞2) or Banff score ＞3 have poor graft function at 3rd month.

Objective:To retrospectively analyze clinical data of infant donors with body weight ≤15 kg into children recipients, and to investigate the efficacy and complications under the strategy of pediatric donor to pediatric recipient (PTP) of pediatric kidney transplantation allocation.Methods:Clinical data of kidney transplantation for children with infant donors performed in the First Affiliated Hospital of Zhengzhou University from August 2010 to December 2019 were collected.Clinical data of donors and recipients, postoperative adverse events, postoperative renal recovery, and human and renal survival were analyzed.Results:A total of 50 infant donors and 93 pediatric recipients were enrolled in this study.Recipients included 89 patients with single kidney transplantation (SKT) and 4 with en-bloc kidney transplantation (EBKT). The major perioperative complications were delayed graft function (DGF) (5 cases, 5.4%) and vascular thrombosis (VT) (3 cases, 3.2%), followed by recurrence of primary nephropathy (3 cases, 3.2%), respiratory tract infection (3 cases, 3.2%), and acute rejection (AR) (2 cases, 2.2%). During the follow-up period, the main cause of death was respiratory tract infection (4 cases, 4.3%). Except for the cause of death, the main causes of graft loss were rejection (2 cases, 2.2%) and recurrence of primary kidney disease (2 cases, 2.2%). Serum creatinine decreased progressively from (824.77±150.24) μmol/L preoperatively to (90.73±47.24) μmol/L 1 month postoperatively.In SKT group, the median follow-up time was 31 months (3-74 months), and the survival rates of recipients and transplanted kidneys at 1, 3 and 5 years postoperatively were 97.5%/94.2%, 96%/88.8% and 93.1%/86.1%, respectively.In EBKT group, the median follow-up time was 50 months (13-65 months), and the survival rates of recipients and transplanted kidneys at 1, 3 and 5 years postoperatively were all 100.0%.During the fo-llow-up period, there was no significant difference in the human/kidney survival rate between groups (all P>0.05), and well acceptable transplantation outcomes were obtained. Conclusions:Single/double kidney transplantation for children and adolescent recipients from infant donors in the First Affiliated Hospital of Zhengzhou University has achieved acceptable outcomes.Adopted by the PTP strategy, the incidence of complications after kidney transplantation does not increase, indicating its safety and reliability.