Objective To explore the protective role of PR-39 on the ischemia reperfusion injury renal tissue of rats.Methods 60 male SD rats were enrolled and randomly divided into experimental KP group and negative control KE group.The rats orthotopic renal transplantation model were established.The recombinant adenoviral vectors containing promoter KSP and PR-39 gene (KP) or none (KE) were injected via renal artery.HE staining,immunohistochemistry and TUNEL staining were performed on the rats' renal tissues at 2 days after IRI modeling,and the renal tubular interstitial injury score and peritublar capillary rarefaction was also evaluated.The renal function related factors of rats was monitored before and after IRI,and the blood urea nitrogen and creatinine level was also compared between KP and KE groups.Results Blood urea and creatinine concentration was increased,part of glomerular and tubular injury in renal tissue were also visible in rats underwent renal IRI,which proved the rat orthotopic renal transplantation model were successfully estabilshed.PR-39 gene specifically expressed in renal interstitial tissue,but not in glomerular.The degree of kidney tublar injury and the number of apoptotic cells were lower in KP groups by comparing with negative control KE groups.Renal tubular injury was significantly decreased in group KP than in group KE.Peritubular capillary rarefaction index is smaller in KP than in KE group.The blood urea nitrogen and creatinine level in KP group were significantly lower than those in KE group,and the renal function were also recovered more quickly.Conclusion The specific expressed PR-39 in renal interstitial and tubule,can inhibit the apoptosis of renal tubular epithelial cells and promote the angiogenesis of peritubular capillary,so as to exert its protective role on IRI renal tissue.

Objective To explore the clinical significance of switch between ciclosporin A (CsA) and tacrolimus (TAC) in the triple immunosuppressive protocol including calcineurin inhibitors (CNI),mycophenolate mofetil (MMF),and prednisone (Pred) after renal transplantation.Methods The data of 148 patients with CNI switch were collected from Jan.2000 to Dec.2010,including 51patients with Tac switching to CsA (group A) and 97 patients with CsA switching to Tac (group B).The clinical indexes were analyzed by paired t-test.Results In group A,the serum creatinine,urea and blood glucose were significantly reduced,and hemoglobin,bilirubin,cholesterol significantly increased as compared with those before switch (P＜0.05).In group B,the serum creatinine and urea began were significantly reduced from 4th and 2nd week respectively after switch (P＜0.05).Platelet counts began significantly dropping from 20th week after switch (P＜0.05).Albumin,globulin and bilirubin were significantly increased from 20th,12th and 36th week respectively after switch (P＜0.05).Blood glucose and cholesterol were significantly decreased from 12th and 3rd week respectively after switch (P＜0.05).The trough concentrations of CNI and MMF AUC kept stable before and after switch.Conclusion The renal function of all patients was improved to varying degrees by CNI switch between CsA and Tac no matter what reason.The switch of immunosuppressive agents has benefits to alleviate adverse reactions.

Objective To evaluate the clinical effect of hypothermic machine perfusion (HMP) in the storage of renal grafts from deceased donor (DD) with high-risk delayed graft function (DGF). Methods Clinical data of 52 donors with high-risk DGF were collected in this prospective randomized controlled study. Two renal grafts from each donor were randomly divided into the HMP group (n=52) and static cold storage (SCS) group (n=52). In the HMP group, the renal grafts were stored by LifePort under HMP, whereas the renal grafts in the SCS group were preserved in University of Wisconsin solution (UW solution). The incidence of DGF and primary nonfunction (PNF) after renal transplantation was statistically compared between two groups. The recovery of renal graft function, the survival rates of the recipients and renal grafts within postoperative 1 year were observed in two groups. Results The incidence of DGF in the HMP group was 4%(2/52), significantly lower than 17% (9/52) in the SCS group (P < 0.05). No PNF was reported in the HMP group and 1 case of PND was noted in the SCS group, the difference was not statistically significant (P > 0.05). The recovery time of graft function of the recipients in the HMP and SCS groups were (7.2±0.6) d and (7.7±1.0) d with no statistical significance (P > 0.05). In the HMP group, the urine volume of the recipients on the day of operation, postoperative 1 and2 d was significantly larger than that in the SCS group (all P < 0.05). In the HMP group, the levels of serum creatinine at each time point after operation were significantly lower than those in the SCS group (all P < 0.05). The 1-year survival rates of the recipient and kidney were 98.1%, 92.3% and 100%, 96.2% in the HMP and SCS groups with no statistical significance (all P > 0.05). Conclusions HMP can significantly reduce the incidence of DGF after renal transplantation from DD with high-risk DGF and promote the early recovery of graft function.

Objective To compare the clinical efficacy of different T lymphocyte polyclonal antibodies in renal transplantation from donor kidney of organ donation after citizen's death. Methods Clinical data of 691 donors and recipients undergoing renal transplantation from donor kidney of organ donation after citizen's death were retrospectively analyzed. According to different T lymphocyte polyclonal antibodies used for induction, all recipients were divided into the rabbit anti human T lymphocyte immunoglobulin (rALG) group (n=414) and rabbit anti human thymocyte immunoglobulin (rATG) group (n=277). The recovery of renal graft function in recipients of the two groups were collected, including the incidence of delayed graft function (DGF) and acute rejection (AR), and the changes of serum creatinine level after renal transplantation. The 1-year survival rate of the recipients and renal grafts was collected. The incidence of adverse effects within 1 year after operation was calculated. According to the DGF risk score of donors, all recipients were divided into 5 groups. The use proportion of rALG and rATG in the recipients of each group was calculated. Results The incidence of DGF in the recipients of rALG and rATG groups was 14.5% (60/414) and 11.9% (33/277), respectively. The duration of DGF in the recipients of rALG and rATG groups was (7±4) d and (12±7) d respectively, with no statistically significant difference between two groups (P > 0.05). The incidence of AR in the rALG group was 7.5% (31/414), significantly higher than 4.0% (11/277) in the rATG group (P < 0.05). The serum creatinine levels of recipients within 6 months after renal transplantation tended to gradually decline in both groups. In renal transplantation for donor kidney with a DGF risk score of 0-15, the use proportion of rALG was significantly higher than that of rATG. However, the use proportion of rATG was significantly higher than that of rALG in renal transplantation for donor kidney with a DGF risk score over 16 (P < 0.05). The 1-year survival rates of the recipients and renal grafts in the rALG and rATG groups were 99.8% and 99.6%, 98.1% and 98.2%, respectively. There was no significant difference between two groups (both P > 0.05). The incidence of acute pulmonary edema and leukopenia in the recipients of rATG group was significantly higher than that in the rALG group (both P < 0.05). Conclusions Both rALG and rATG can effectively reduce the incidence of DGF and AR and achieve good clinical efficacy after renal transplantation from donor kidney of organ donation after citizen's death. The incidence of leukopenia and acute pulmonary edema induced by rATG is higher than that by rALG in the renal transplant recipients.

Objective To study long term renal function of Donation after citizen's deceased transplantation.Methods We compared the data of 38 subjects who got Delayed Graft Function(DGF) with 80 Immediate Graft Function (IGF) subjects underwent DCD transplantation in our hospital before June 2016.Evaluated the renal function by detecting the serum creatinine (sCr),the estimating glomerular filtration rate (eGFR) calculated with MDRD formula and urine protein at the 1,2,3 year post transplantation.Results Analyzed the serum eGFR of two groups,there was no significant differences at 1 and 2 year post transplantation,sCr of two groups showed no significant differences at 3 year (P =0.053)post transplantation,eGFR of two groups showed significant differences at 3 year (P =0.042)post transplantation and positive incidence of urine protein showed significant differences at 2 year (P =0.028)and 3 year (P =0.037)post transplantation.Conclusion DGFoccuring after DCD transplantation had an effect on long term renal function,.mainly on reducing of eGFR and increasing of urine protein positive rate 2 or 3 years after transplant.

Objective:To explore the prognostic utility of LifePort perfusion parameters plus perfusate biomarkers for predicting delayed graft function(DGF)and recovery time during deceased donor kidney transplantation(KT).Methods:From January 1, 2019 to August 31, 2019, retrospective analysis was performed for clinical data of 113 KT recipients. Based upon whether or not DGF occurred within 3 months, they were divided into two groups of DGF group(20 cases)and non-DGF (93 cases). Two groups were compared using LifePort perfusion parameters, biomarker concentrations, incidence of DGF and kidney recovery time. Statistical analysis was performed.Results:The incidence of DGF was 17.7%(20/113); Multivariate Logistic regression results indicated that terminal resistance(OR 1.879, 95% CI 1.145~3.56)and glutathione S-transferase(GST)(OR 1.62, 95% CI 1.23~2.46)were independent risk factors for DGF; Cox hazard model revealed that terminal resistance was a risk factor for recovery time of renal function(HR=0.823, 95% CI 0.735~0.981). The model combining terminal resistance and GST(AUC=0.888, 95% CI 0.842~0.933)significantly improved the predictive efficacy for DGF as compared with using terminal resistance(AUC=0.756, 95% CI 0.693~0.818)or GST alone(AUC=0.729, 95% CI 0.591~0.806).Conclusions:Combining LifePort perfusion parameters and fluid biomarkers can improve the predictive utility of DGF.

Objective:To explore the clinical data of acute rejection in kidney transplant recipients of different ages with elderly donor kidneys.Methods:During January 2012 and June 2020, a retrospective review was conducted for clinical data of 298 recipients undergoing kidney transplantation from elderly donors aged ≥60 years after citizen's death.According to the age, recipients were divided into group A(age<30 yr, 59 cases), group B(30~39 yr, 125 cases), group C(40~49 yr, 83 cases)and group D(age≥50 yr, 31 cases). The incidence of acute rejection(AR)was analyzed.Also based upon age difference between donors and recipients, they were divided into two groups of(30~39 yr)and (40~49 yr)and the occurrence of AR was recorded.Results:The incidence of AR within 1 year post-transplantation in groups A, B, C, and D were 15.3%(9/59), 8.8%(11/125), 7.2%(6/83) and 3.2%(1/31)respectively.The incidence of AR in age difference≥25 yr group(12.5%)and age difference <25 yr group(5.3%) had significant difference( P<0.05). The proportion and absolute value of peripheral blood lymphocytes in each group at 1 week/month post-transplantation had significant difference( P<0.05). No significant difference was observed in serum level of creatinine(SCr), the incidence of pulmonary infection and urinary tract infection or the survival rate of recipients and transplanted kidneys in each group within 1 year post-transplantation among four groups( P>0.05). Conclusions:Elderly donor kidneys can obtain better transplant outcomes in kidney transplant recipients of different ages.As the age of recipients decreases, AR shows an upward trend.Clinicians should pay more attention to the prevention and treatment of AR in recipients with large age difference between donors and recipients.

Objective:To study the impact of the Varian real-time position management (RPM) respiratory gating system on radiotherapy planning dosimetry.Methods:The radiotherapy plans of 40 cases with thoracic or abdominal tumors were retrospectively selected in this study. The motion phantom for quality control was adopted to generate respiratory gating signals, and the 30%-60% stable phase at the end of expiratory was selected as the respiratory gating window. The dose verification for the abovementioned radiotherapy plans was performed using the Portal Dosimetry (PD) system under RPM respiratory gating mode with the Edge accelerator. Afterwards, dose analysis was performed with different γ passing rate criteria and the distribution characteristics of γ values were analyzed. Finally, the verification results between the non-gating mode and the gating mode were compared.Results:Under the respiratory gating mode, the passing rates of all intensity-modulated radiation therapy/volumetric-modulated arc therapy (IMRT/VMAT) plans with or without flattening filters were over 95.5% by γ criteria of (3%, 3 mm) or (3%, 2 mm) and were over 90% by stricter γ criteria of (2%, 2 mm). All plans met the clinical requirements recommended by the American Association of Physicists in Medicine (AAPM). The passing rates of dose verification under non-gating mode were slightly better than those under respiratory gating mode, and the differences between the two modes were statistically significant (3%/3 mm, Z =-1.45; 3%/2 mm, Z =-2.86; 2%/2 mm, Z =-3.70; 1%/1 mm, Z =-4.52; P<0.05). There was no significant difference in the minimum and maximum values of γ and the share of γ > 1.5 of plan verification result under the two modes. However, the average value and standard deviation of the γ were generally smaller under the non-gating mode. Conclusions:The impact of the introduction of RPM respiratory gating technology on dose is clinically acceptable, and the execution of these plans in this gating mode is safe and reliable.

Objective To analyze the prediction efficiency of scoring models at home and abroad on delayed graft function (DGF) after renal transplantation in China. Methods The clinical data of 112 donors and 220 recipients undergoing renal transplantation were prospectively analyzed. The DGF predicted by KDRI model, Jeldres model, and model of our center was compared with actual DGF incidence of renal transplant recipients. The prediction efficiency of each model was analyzed. The predictive accuracy was compared by the area under curve (AUC) of receiver operating characteristic (ROC) curve. Results The DGF incidence of 220 renal transplant recipients was 14.1% (31/220). DGF prediction using KDRI model showed that 41 cases were high risk donors, the AUC was 0.57, the sensitivity was 0.37, the specificity was 0.66, and the positive predictive value was 22%. DGF prediction using Jedres model showed that 22 cases were high risk recipients, the AUC was 0.56, the sensitivity was 0.13, the specificity was 0.92 and the positive predictive value was 20%. DGF prediction using the model of our center showed that 25 cases were high risk donors, the AUC was 0.80, the sensitivity was 0.53, the specificity was 0.84, the positive predictive value was 40%. Conclusions Compared with the KDRI and Jedres models, the prediction model of our center has higher AUC and sensitivity with a better prediction efficiency on DGF. Therefore, it is a suitable evaluation system of donors from donation after citizen's death in Chinese.