Objective:To introduce a newly modified surgical approach and explore the clinical efficacy of en bloc kidney transplantation from deceased infant donors to adults.Methods:Four cases of en bloc kidney transplantation from deceased infant donor to adult were performed with a new modified surgical approach in renal transplantation and dialysis center of the Second People's Hospital of Shanxi Province from January 2017 to September 2019. All 4 cases were cardiac death donors. There were 3 males and 1 female donors, aged (54 ± 22.69) d and weighing (5.6 ± 0.79) kg. There were 1 male and 3 female recipients, aged (41.5 ± 5.97) years and weighing (45 ± 3.56) kg. For lowering operative difficulties and preventing hemodynamic disturbances, bilateral kidneys were sutured and fixed during trimming. Then end-to-side anastomosis was performed between donor kidney abdominal aortic valve and recipient external iliac artery and between donor renal inferior vena cava valve and recipient external iliac vein.Results:All operations were successful without vascular or urinary complication. The average duration of donor kidney repair was 20 min and the average duration of transplantation 68.75 min. The functions of transplanted kidney recovered well during a follow-up period of 12 months. The long-term survivals of recipient and transplanted kidney were satisfactory.Conclusions:The newly modified surgical approach of en bloc kidney transplantation from deceased infant donor to adult has optimized operative handling. With a higher success rate, vascular complications are lowered. A wider popularization is recommended.

Objective To evaluate the efficacy and safety of converting traditional triple immunosuppressive regimen into quadruple immunosuppressive regimen of low-dose tacrolimus plus sirolimus plus mycophenolic acid plus hormone in expanded criteria donor (ECD) renal transplant recipients .Methods A retrospective analysis was conducted for 39 patients undergoing extended standard kidney transplantation with conversion therapy from January 2015 to June 2018 .Renal function ,liver function ,blood lipid ,bone marrow suppression ,positive rate of urinary protein ,positive rate of urinary BK virus and other adverse reactions were analyzed .Results A total of 39 recipients fulfilled the inclusion criteria ,including 28 boys and 11 girls with an average age of (37 .69 ± 11 .07) years and a median postoperative conversion time of 6 months .As compared with pre-conversion therapy ,renal function and estimated glomerular filtration rate improved significantly at 1 month ,3 months ,6 months and 1 year (P<0 .05) .No significant difference existed in the level of blood lipid ,whole blood leukocyte or hemoglobin at pre and post-conversion ( P>0 .05) .No significant difference existed between AST and ALT at pre and post-conversion (P< 0 .05) . After conversion , the positive rates of urinary protein and BK virus urine declined . Subacute rejection occurred in 1 case after conversion .Addition of sirolimus was curative .No severe adverse reactions such as infection and diarrhea occurred in the remaining cases .Conclusions T he quadruple immunosuppressive regimen of low-dose tacrolimus plus sirolimus plus mycophenolic acid and hormone is both safe and effective for ECD recipients of renal transplantation .

Objective:To summarize the clinical experiences of 9 ABO-incompatible kidney transplantation at our center and explore its clinical application value.Methods:Methods From April 2016 to December 2019, there were 9 living kidney transplants of ABO incompatible relatives, including type A to type B (n=3), type B to type O (n=3), type B to type A (n=1) and type AB to type B (n=2). Immunosuppressant plus single membrane plasmapheresis (PE) and/or double filtration plasmapheresis (DFPP) and rituximab were employed for pretreating recipients. Adverse reactions of recipients were observed during and after pretreatment. Blood group antibody titer, complications and other related parameters were recorded before and after transplantation before and after monitoring pretreatment.Results:After pretreatment, IgM, IgG and total titer of blood group antibodies were ≤1: 4 on the day of transplantation and the titer of non-blood group antibodies rebounded within 2 weeks (≤1: 8). During preconditioning, 2 patients experienced oral numbness and involuntary dithering during plasmapheresis and there was 1 case of infusion reaction after rituximab dosing. The early recovery of renal function was all excellent. Renal biopsy was performed in 4 patients with slow elevation of serum creatinine and 1 case developed acute antibody-mediated rejection. The survival rate of all recipients at the last follow-up was 100%.Conclusions:Live kidney transplantation of ABO-incompatible relatives is both safe and feasible so that it may help alleviate some shortage of donor kidney.

A vast majority of renal transplant recipients receive hemodialysis prior to kidney transplantation(KT). Currently the commonly employed blood purification accesses include non-cuffed catheter(NCC), tunnel-cuffed catheter(TCC), autologous arteriovenous fistula(AVF)and arteriovenous graft(AVG). And the above four accesses types have their inherent advantages and disadvantages.In clinical practices, patients of end-stage renal disease(ESRD)are selected by vascular status, disease severity and expected duration of dialysis.However, no standard recommendation is available for selecting hemodialysis accesses for patients awaiting KT.Summarizing the latest researches in the field, this review compared the advantages and disadvantages of various hemodialytic accesses in conjunctions with the clinical characteristics of patients awaiting KT.The goal was to resolve the choices of selecting and maintaining hemodialysis access for patients awaiting KT.