Objective To analyze clinical outcome of kidney transplantation from elderly livingrelated donors. Methods The clinical data of living-related kidney transplantation between November 2005 to June 2011 in the First Affiliated Hospital of Zhengzhou University were retrospectively analysed.The patients were divided into elderly donor kidney transplantation group (elderly group,36 cases) and non-elderly living related donor kidney transplantation group (nonelderly group,208 cases).The mean recipients' serum creatinines before and 3 days,7 days,1 month,3 month,6 month,12 month,24 month,36 month after surgery,peri-operation complications,the incidence rate of acute rejection,calcineurin inhibitor (CNI)-induced renal toxicity,delayed graft function(DGF),1 year and 3 year recipient/kidney survival were compared respectively between the two groups. Results The serum creatinine levels were higher in elderly group than in non-elderly group at 3 days,7 days,1 month after surgery [(245.2±135.2)μmol/L vs.(185.6±148.4)μmol/L,(150.5±86.8)μmol/L vs.(122.2± 136.8)μmol/L,(140.6±42.5)μmol/L vs.(117.8±33.2)μmol/L,t =84.07,31.90,21.54; all P =0.000].In addition,the incidence rate of CNI induced renal toxicity was higher in the elderly group than in non-elderly group [22.2％(8/36)vs.1.9％(4/208),x2=27.04,P=0.000].Nevertheless,there were no significant differences between the two groups in recipients' serum creatinines before and 3 month,6 month,12 month,24 month,36 month after surgery,in peri-operation complications,the incidence rate of acute rejection,delayed graft function,and in 1 year and 3 year recipient/kidney survival (all P ＞ 0.05). Conclusions With stringent screening and overall assessment of elderly donors,healthy elderly donors should not be barriers to organ donation.Renal toxicity of CNI agents should be carefully monitored in recipients of elderly donor.

Objective To investigate the effect of icariin on renal ischemia-reperfusion injury (IRI) and the action mechanism.Methods SD rats were divided into 3 groups.The model of unilateral renal IRI was established in SD rats,and Icariin (100 mg/kg) was orally administrated by gavage daily from 2 days before operation to 12 days after operation (icariin group).The vehicle of icariin was administrated to IRI model rats as control group,while in the sham-operation group the renal pedicel was only dissociated without treatment.Body weight and kidney function were monitored within 14 days after reperfusion.The kidney was harvested at 24 h after reperfusion,and then malonaldehyde (MDA) and activity of reactive oxygen species (ROS) scavenger enzymes were examined.Histopathological changes were observed at postoperative day (POD) 3 and 14.Results At POD 3,7,11 and 14,the creatinine clearance rate was significantly higher in icariin group than in control group (P＜0.01). Icariin group had significantly lower Paller scores which indicated tubules injury than in control group at day 3 after reperfusion (P＜0.01 ).In icariin group,MDA level was obviously decreased at 24 h after operation.Compared to control group,icariin group had statistically higher activity of glutathion reductase (GR),catalase and superoxide dismutase (SOD),as well as higher level of reduced glutathione (GSH) (P＜0.05).Conclusion Icariin has protective effects on renal IRI,and can promote recovery of kidney function. Icariin can reduce oxidative stress through increasing activity of ROS scavengers.

Objective To investigate the status of living relative kidney transplantation, and the clinical effects and social significances of kidney transplantation between spouses. Methods We retrospectively collected the clinical data of the department of kidney transplant of the First Affiliated Hospital of Zhengzhou University, from January 2011 to December 2013. The spouse group as group 1, the age and sex of doners were taken into account,the siblings with the similar age of the same period were enrolled in group 2. Then the postoperative recoveries of the two groups were compared. Considering the current social status, particularly the shortage of donor kidneys, the clinical, social and family significances of kidney transplantation between spouses were analyzed. Results Twelve cases of spouses in group 1, 8 cases of siblings in group 2 , the differences of donor and recipient age of the two groups were 0.33 ± 0.98 years and 2.29 ± 7.23 years, respectively. The human major histocompatibility complex antigens (HLA) was less than three in group 1, and was greater than or equal to three in group 2. The changes of serum creatinine and urea nitrogen were analyzed. No significant differences of serum creatinine and downward trend of blood urea nitrogen were observed between two groups (P = 0.84, P = 0.79). Conclusion The kidney transplantation between spouses has good clinical efficacy and great social significance, improving the status of the shortage of donor kidney and contributing to family harmony. The renal transplantation between spouses has obvious advantages and need further promotion.

Objective To analyze the clinical effectiveness of using marginal donor kidney in living kidney transplant. Methods From November 2005 to June 2011,274 cases of living kidney transplant were performed in the First Affiliated Hospital of Zhengzhou University.The cases were divided into the marginal donors group ( Donor ages over 60 years old,suboptimal renal anatomy or physiology) of 66 cases and standard donors group of 208 cases.The clinical data were retrospectively analyzed.The criteria of marginal donors were as follows:36 cases of donors with age over 60 yrs (6 cases with renal cysts and 1 case with renal calculus),22 cases of renal cysts ( with diameter range from 4 mm to 40 mm ),4 cases of renal calculus (with diameter range from 3 mm to 6 mm),4 cases of low GFR (under 35 ml/min.The mean recipients' serum creatinine before surgery and after surgery on day 3,day 7,month 1,month 3,month 6,month 12,related complications,the rate of acute rejection and delayed graft function,1 year,3 year recipient/kidney survival were compared between the 2 groups,respectively. Results The serum creatinine levels in the marginal donor group and standard donor group were (242.7 ± 132.2 vs 185.6 ± 148.4) and ( 156.7 ±86.8 vs 122.2 ± 136.8 ) on day 3,day 7 respectively ( P ＜ 0.05 ).Nevertheless,there were no significant differences between the 2 groups in recipients' serum creatinines before surgery and after surgery on month 1,month 3,month 6,month 12,peri-operative complications,the rate of acute rejection and delayed graft function,1 year,3 year recipient/kidney survival (P ＞ 0.05). Conclusions Healthy old donors and donors with renal cyst (the diameter of renal cysts under 40mm) should not be the barriers to organ donation.To those living donors with low GFR,we should consider of donor age,donor/recipient body weight,donor/recipient body surface area and whether we could deal with the problem by surgical operation.Donor with renal calculus should be carefully evaluated.

Objective To dynamically monitor the changes of peripheral blood lymphocyte subsets of renal transplant recipients and investigate the relationship between lymphocyte subsets with infection and rejection.Methods The clinical data of allogenic kidney transplantation recipients and living relative donors in the Department of Kidney Transplantation of the First Affiliated Hospital of Zhengzhou University were prospectively collected from June 2015 to December 2016.The data of lymphocyte subsets and other related indexes were obtained from renal transplant recipients and relatives of the same period.Results Sixty-four cases of living-relative donors and 351 cases of renal transplant recipients were enrolled in this study,and the recipients were divided into 3 groups:infection group (67 cases),acute rejection group (46 cases),and stable group (238 cases),according to the diagnostic criteria.There was significant difference in the concentration distribution of lymphocytes between the stable group and the control group (P<0.05).The stable frequency distribution range of the stable group was as follows (cells/μL):Lym (1 000-1 500),T (<1 500),CD4+ (<1 000),CD8+ (<1 000),B (<300),NK (100-300),CD4+/CD8+ (0.5-1.0).The number of Lym,T,CD4+,CD8+,NK and B cells in the preoperative patients was less than that in the healthy population (P<0.05);The number of Lym,T,CD4+, CD8+,B and NK cells was gradually decreased in the postoperative infection group,which was less than that in the stable group (P<0.05).After treatment the indicators gradually restored to the level in the stable group level;the number of T,CD4+,CD8+,B cells was highly correlated with infection.The number of T and CD4+ cells,and CD4+/CD8+ ratio were significantly increased in acute rejection group as compared with the stable group,and gradually decreased after the rejection was reversed.The number of T,CD4+,CD8+ cells was highly correlated with rejection.Lymphocyte subsets had a predictive effect on infection and rejection of recipients,and CD4+ cell count and CD4+/CD8+ ratio were independent risk factors.Conclusion The monitoring of lymphocyte subsets has an important clinical value in the evaluation of immune status and individual treatment of renal recipients.

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 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 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 significance of time-zero renal biopsy on evaluating renal function and postoperative complications after transplantation from donation in old age donors.Methods Clinical and pathological data of 112 transplantations with time-zero renal biopsy which performed in the First Affiliated Hospital of Zhengzhou Hospital from August 2016 to April 2017 were collected.Based on donor age and Remuzzi score,112 transplantations were divided into four groups:Group A (donor age ＜50 years and Remuzzi score is 0 to 3) with 58 recipients,Group B (donor age ＜50 years and score is 4 to 6) with 9 recipients,Group C (donor age≥50 years and score is 0 to 3) with 35 recipients,and Group D (donor age≥50 years and score is 4 to 60) with 10 recipients.Renal function and postoperative complications of recipients in each group were recorded and compared among groups.Results The estimated glomerular filtration rate (eGFR) at 6th month after operation was significantly negatively correlated with glomerular sclerosis (r=-0.398,P=0.05),arteriolar hyaline degeneration (r=-0.416,P＜0.05) and arterial intimal fibrosis (r=-0.242,P＜0.05).Arteriolar hyaline degeneration (β=-0.249,P＜0.05) and arterial intimal fibrosis (β=-0.246,P=0.020) were the independent correlated factors of eGFR at 6th month after operation.The levels of serum creatinine of group D were higher than those in the other three groups at each time after operation(all P＜0.05);Moreover,in group D the eGFR values at each time were lower than those in the other three groups(P＜0.05).Additionally,the incidences of acute rejection within 6 months after operation in group C and D were higher than those in group A and B (all P＜0.05),but the incidences of delayed graft function,hematuria,proteinuria among four groups were not significantly different (all P＞ 0.05).Conclusions Patients who accepted older kidney with moderate histological lesions show worse renal function and higher incidence of acute rejection after transplantation.Recipient selection and postoperative immunosuppressive treatment should be more cautious for those renal donors.