Objective To explore the efficacy and safety of converting the triple immunosuppressive regimen of tacrolimus (Tac) + mycophenolate mofetil (MMF) + prednisone (Pred) to a quadruple regimen of low-dose sirolimus (SRL) + low-dose Tac + MMF + Pred at 3 to 6 months after expanded criteria donor (ECD) kidney transplantation. Methods A single-center, retrospective, donor-matched controlled study included 22 ECD kidney transplant recipients from September 2021 to June 2024. Two recipients from the same donor kidneys were respectively assigned to the SRL group and the conventional triple regimen control group. The main outcome measures were the differences in serum creatinine (Scr), estimated glomerular filtration rate (eGFR), and adverse events before the regimen conversion and after conversion during the 1, 3, 6, and 12-month follow-up. Results There were no statistically significant differences in baseline characteristics between the two groups. In the SRL group, Scr decreased and eGFR increased starting from 3 months after conversion, and this was superior to the control group starting from 6 months(all P < 0.05). There were no statistically significant differences in the incidence of rejection reactions, pulmonary infections, hyperlipidemia and proteinuria between the two groups after conversion and during the 12-month follow-up (all P > 0.05). Conclusions For ECD kidney transplant recipients, converting the triple regimen to the SRL quadruple regimen at 3 to 6 months after transplantation may improve the function of the transplanted kidney without increasing the risk of adverse events.

Objective To establish a nomogram model which is used for predicting lower extremity deep venous thrombosis(DVT)after interventional treatment of lower extremity arteriosclerosis obliterans(LEASO),and to make an external validation of the model.Methods A total of 434 LEASO patients receiving intraluminal therapy between January 2020 and December 2022,who were retrieved from the database of patients with limb ischemia(JCLIMB)established by the Japanese Society of Vascular Surgery,were collected and used as modeling group,and other 60 LEASO patients,who received interventional treatment at the Hefei Binhu Hospital of China between January 2020 and May 2023,were collected and used as validation group.Through the electronic medical record system,the clinical data of the patients were obtained,which included gender,age,coexisting diabetes mellitus,coexisting hypertension,coexisting coronary heart disease,body mass index(BMI),Fontaine stage,D-dimer,prothrombin time(PT),activated partial thromboplastin(APTT),platelet lymphocyte ratio(PLR),and neutrophil-to-lymphocyte ratio(NLR).The nomogram model was established by using R software,and the prediction model was evaluated by the calibration curve,the decision curve analysis(DCA)and the receiver operating characteristic(ROC)curve.Results The differences in BMI,Fontaine stage,D-dimer,PLR and NLR between DVT patients and non-DVT patients were statistically significant(P＜0.05).Multivariate logistic regression analysis showed that BMI,Fontaine stage,D-dimer,PLR and NLR were the independent influencing factors for DVT in LEASO patients(P＜0.05).The nomogram model was established based on the results of the logistic regression analysis.The calibration curve analysis showed that the predicted values of the model was basically consistent with the actual values,indicating that this nomogram model carried a good accuracy.Taking the net income as the ordinate and the threshold as the abscissa,the none line represented that DVT would not occur in all LEASO patients.The nomogram model represented the actual curve of DVT,and the threshold range was 0.09-1.00,indicating that using this model for decision-making had good clinical benefits,suggesting the clinical utility of this model.ROC analysis revealed that using this nomogram model,which was established in this study,to predict the area under the DVT curve(AUC)of LEASO patients,the AUC in the modeling group and in the validation group was 0.912 and 0.834 respectively,the sensitivity was 96.50 and 99.20 respectively,and the specificity was 76.60 and 66.70 respectively.Conclusion The prediction model of DVT in LEASO patients that is established on the BMI,Fontaine stage,D-dimer,PLR and NLR has a good predictive value for the occurrence of DVT,therefore,this model is worth popularizing in clinical practice.