The Omicron variant of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly contagious, but compared to early virus typing has milder symptoms and better prognosis.This article reviewed and analyzed the clinical characteristics, treatment, prognosis and vaccination effect of Omicron infection in Kidney transplant recipients (KTR) in recent years.The clinical manifestations of KTR infected with Omicron and the comparison with early variants, the clinical characteristics of KTR infected with Omicron compared with the general population, the treatment of KTR infected with Omicron after foreign countries, the effect of vaccination on KTR to prevent Omicron and the measures to increase the ted of vaccine, the summary of the prevention and treatment of KTR infected with Omicron abroad and the experience and the shortcomings of the current researches were analyzed and summarized.

After continuous efforts from generations of transplant surgeons, kidney transplantation (KT) has become an optimal treatment for end-stage renal disease.However, an imbalance between supply and demand of organs has always restricted the development of KT.For this clinical dilemma, xenotransplantation is expected to become one practical alternative for alleviating organ shortage.This review summarized recent literature reports of kidney xenotransplantation and the latest cases of pig-to-human kidney and heart transplantations.Also clinical transformations and applications of kidney xenotransplantation were discussed.

Objective:To explore the attitude of kidney transplant (KT) recipients towards xenotransplantation and explore its related influencing factors to provide auxiliary references for the clinical research of xenotransplantation in China.Methods:The questionnaire data of "Attitude survey of KT recipients towards xenotransplantation" were collected from 194 KT recipients followed up at Organ Transplant Center of Affiliated Tongji Hospital. Nonparametric tests were utilized for comparing score differences and χ2 tests for comparing responses to specific questions. Variables with statistical significance in non-parametric test were included into multifactor linear regression analysis for exploring the influencing factors of recipients' attitudes towards xenotransplantation. Results:KT recipients had a higher score (75 points) on attitude scale of xenotransplantation. "Cognitive preference" dimension scored the highest (85 points); "Fear of risk" dimension scored lowest (50 points). The results of univariate analysis indicated that gender ( P=0.020), medical background ( P=0.006) and knowledge of clinical trial cases ( P<0.001) were the influencing factors of score of cognitive preference. Educational background ( P=0.029) was the factor affecting the score of "risk concern" dimension. Age ( P=0.028) and knowledge of clinical trial cases ( P=0.001) were the factors influencing the score of "psychosocial" dimension. Whether medical background ( P=0.018) and knowledge of clinical trial cases ( P=0.008) were the factors influencing the score of "efficacy expectation" dimension; Gender ( P=0.010), medical background ( P=0.018) and knowledge of clinical trial cases ( P=0.008) were the factors influencing total score. The results of multi-factor analysis revealed that gender ( B=-0.821, 95% CI: -1.419~0.223, P=0.007), medical background ( B=0.938, 95% CI: 0.097~1.779, P=0.029) and knowledge of clinical trials of xenotransplantation in the United States ( B=1.498, 95% CI: 0.887~2.110, P<0.001) was the influencing factor of cognitive preference. Educational background (B=-0.693, 95% CI: -1.353~-0.034, P=0.040) was the influencing factor of score on "risk concern" dimension. Knowledge of clinical trials of xenotransplantation in the United States ( B=1.075, 95% CI: 0.418~1.731, P=0.001) was an influencing factor of score on "social psychological" dimension; Knowledge of clinical trials of xenotransplantation in the United States ( B=0.710, 95% CI: 0.063~1.358, P=0.032) was an influencing factor of score on "efficacy expectation" dimension; Gender ( B=-2.259, 95% CI: -4.094~-0.423, P=0.016), medical background ( B=2.799, 95% CI: 0.219~5.378, P=0.034) and knowledge of clinical trials of xenotransplantation in the United States ( B=3.237, 95% CI: 1.360~5.114, P=0.001) were the influencing factors of total score. Conclusions:KT recipients have a higher awareness rate of xenotransplantation and a better acceptance of xenotransplantation in general. Those males with medical background and knowing clinical cases of xenotransplantation demonstrate a better attitude towards xenotransplantation. More concerned about the risk of infection, respondents expect heterologous pig kidneys to achieve the same long-term survival as allogeneic kidneys.

Objective To summarize the occurrence of complications in renal graft biopsy,and to analyze the indications for puncture and types of pathological diagnosis.Methods The data of 703 samples of ultrasound-guided renal graft biopsy from 644 kidney transplant recipients from January 1,2017,to December 31,2022 was retrospectively analyzed.The puncture qualification rate,complications,indicative biopsy indications and pathological diagnosis types were analyzed.The application of surveillance biopsy and pathological diagnosis were also analyzed.Results The qualification rate of renal tissue puncture biopsy was 99.9％,and the complications of puncture bleeding included one sample of perinephric hematoma and one sample of hematuria.Increased serum creatinine(76.8％)and proteinuria(13.8％)were the main indications for puncture,and 48 samples(6.8％)were surveillance biopsy for the assessment of therapeutic effects.A total of 399 samples of pathological diagnosis of rejection,including 293 samples of cellular rejection reaction,60 samples of antibody rejection reaction,and 46 samples of mixed rejection reaction.One hundred and ninety-five samples of recurrence or new-onset kidney disease,mainly including 144 samples of IgA nephropathy and 42 samples of focal segmental glomerulosclerosis.Fifty-seven samples of infection related kidney disease,including 56 samples of BK virus-associated nephropathy(BKVAN).Thirty-one samples of calcineurin inhibitor(CN1)nephrotoxicity injury,including 15 samples of acute CNI nephrotoxicity injury and 16 samples of chronic CNI nephrotoxicity injury.Forty-five samples for other diagnoses.Conclusions The success rate and safety of renal graft biopsy are high,and at present,cellular rejection reaction is still the main pathological diagnosis of indicative biopsy for renal graft.

Objective:To explore the efficacy and safety of daratumumab in late antibody-mediated rejection (late AMR) after kidney transplantation (KT).Methods:From December 2020 to December 2021, the relevant clinical data were reviewed for 8 patients with late AMR after receiving daratumumab at Affiliated Tongji Hospital. In intensive phase, the combination of plasma exchange (PP)/intravenous immunoglobulin (IVIG) and daratumumab were dosed once a week; in maintenance phase, once every 2 to 4 weeks. The levels of donor-specific antibody (DSA) and renal function were compared pre-treatment and Month 3/12 post-treatment. The treatment-related toxicities were observed. Independent sample T test was utilized for inter-group comparison.Results:The median treatment course during intensive period was 9(4-17) sessions. Maintenance treatment lasted for 5 to 19 months and 2 cases withdrew after 5 to 6 treatments for achieving antibody clearance. A total of 11 DSAs were detected in 8 recipients. At Month 3/12, mean fluorescent intensity (MFI) of DSA was 6 016±4 775 and 6 438±3 668. Both were significantly lower than 11 944±5 237 pre-treatment and the difference was statistically significant ( P=0.012, 0.004). Seven recipients achieved stable renal function during treatment and one recipient resumed hemodialysis at Month 18 due to acute rejection. Glomerular filtration rate of 7 recipients was (40.6±20.1), (53.6±20.9) and (49.0±17.2) ml·min -1· (1.73 m 2) -1 pre-treatment and Month 3/12 and no significant differences existed among different timepoints. During follow-ups, 2 cases developed mild nasal congestion during an early stage of daratumumab infusion while the remainders had no obvious discomfort during infusion and tolerance was decent. Conclusion:Early combination of daratumumab with PP/IVIG, followed by a course of daratumumab has demonstrated an excellent antibody reduction effect on late AMR. During treatment, renal function remains generally stable.