In order to further standardize the vaccination of kidney transplant candidates and recipients in China, the Branch of Organ Transplantation of Chinese Medical Association has organized experts in kidney transplantation and infectious diseases. Based on the "Vaccination of Solid Organ Transplant Candidates and Recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice", and in combination with the clinical reality of infectious diseases and vaccination after organ transplantation in China, as well as referring to relevant recommendations from home and abroad in recent years, these guidelines are formulated from aspects such as epidemiology, types of vaccines, vaccination principles, target population, and specific vaccine administration. The "Guidelines for Vaccination of Kidney Transplant Candidates and Recipients in China" aims to provide theoretical reference for medical workers in the field of kidney transplantation in China, regarding the vaccination of kidney transplant candidates and recipients. It is expected to better guide the vaccination of kidney transplant candidates and recipients, reduce the risk of postoperative infection, and improve survival outcomes.

Viral infection has always been a significant challenge to human health. Transplant recipients, including those who have undergone solid organ transplantation and allogeneic hematopoietic stem cell transplantation, are at high risk of viral infection due to their weak immune function under immunosuppressive therapy. Unlike the general population, transplant recipients are prone to pneumonia and even severe pneumonia after respiratory viral infection, which requires close attention from clinicians. Therefore, this article reviews the clinical characteristics and special management of viral infection in this population, focusing on the epidemiological features of common respiratory viral infection in transplant recipients, early diagnosis and intervention after infection, severe warning signs and drug treatment strategies, for the reference of clinical colleagues.

Objective To analyze the nonlinear relationship between hypothermic machine perfusion (HMP) parameters and delayed graft function (DGF) and optimize the construction of a predictive model for DGF. Methods The data of 923 recipients who underwent kidney transplantation from deceased donors were retrospectively analyzed. According to the occurrence of DGF, the recipients were divided into DGF group (n=823) and non-DGF group (n=100). Donor data, HMP parameters and recipient data were analyzed for both groups. The nonlinear relationship between HMP parameters and the occurrence of DGF was explored based on restricted cubic splines (RCS). Over-sampling, under-sampling and balanced sampling were used to address the imbalance in the proportion of DGF to construct logistic regression predictive models. The area under the curve (AUC) of each model was compared in the validation set, and a nomogram model was constructed. Results Donor BMI, cold ischemia time of the donor kidney, and HMP parameters (initial and final pressures, resistance, and perfusion time) were significantly different between the DGF and non-DGF groups (all P<0.05). The RCS analysis revealed a threshold-like nonlinear relationship between HMP parameters and the risk of DGF. Among the models constructed using different sampling methods, the balanced sampling model had the highest AUC. Using this model, a nomogram was constructed to stratify recipients based on risk scores. Recipients in the high-risk group had higher serum creatinine levels at 1, 6, and 12 months after kidney transplantation compared to those in the low-risk group (all P<0.05). Conclusions There is a nonlinear relationship between HMP parameters and the risk of DGF, and the threshold is helpful for organ quality assessment and monitoring of graft function after transplantation. The predictive model for DGF constructed on the base of balanced sampling algorithms helps perioperative decision-making and postoperative graft function monitoring of kidney transplantation.

To further standardize the diagnosis and treatment of hypertension after kidney transplantation in China,Branch of Organ Transplantation of Chinese Medical Association organized experts in kidney transplantation and cardiovascular diseases to formulate"Guidelines for Clinical Diagnosis and Treatment of Hypertension in Kidney Transplant Recipients in China"based on"Diagnosis and Treatment Specification for Hypertension after Solid Organ Transplantation in China(2019 edition)"in combination with clinical status of hypertension after organ transplantation in China,and referring to the latest guidelines for diagnosis and treatment of hypertension at home and abroad.This guideline was formulated to provide theoretical reference for medical practitioners in the field of kidney transplantation in China,aiming to better control adult hypertension after kidney transplantation,mitigate adverse outcomes and improve the quality of life.

Objective To investigate the characteristics of adverse drug event(ADE)related to tacrolimus(Tac)in pediatric solid organ transplant recipients.Methods The data were retrieved from the US Food and Drug Administration Adverse Event Reporting System database from the first quarter of 2004 to the second quarter of 2023.The ADE data of pediatric organ transplant recipients with Tac as the primary suspected drug were extracted.The relationship between Tac and ADE was quantitatively analyzed by proportional imbalance method.Basic characteristics and signal strength of ADE related to Tac were analyzed.ADE related to Tac in children of different ages and different types of organ transplantation were analyzed.Results A total of 1 443 children's ADE reports involving Tac were screened,including 188 cases(13.0％)of heart transplantation,668 cases(46.3％)of liver transplantation,531 cases(36.8％)of kidney transplantation and 56 cases(3.9％)of lung transplantation.The median age of children was 10 years old.The top three countries with ADE reporting were the United States,France and the United Kingdom.China reported 26 cases,accounting for 1.8％.Infection and infectious diseases accounted for the highest proportion(20.96％)in ADE related to Tac,including EB virus and cytomegalovirus infection,etc.Infection and infectious diseases occupied the largest proportion of ADE related to Tac in children of different ages,whereas the pathogen types were different.Rejection,unstable immunosuppression level and renal function damage were also common ADE related to Tac in children of all ages.Nervous system disease was the main ADE in heart transplant recipients,while infection and infectious diseases were more common in liver and kidney transplant recipients.Rejection was the most common ADE in lung transplant recipients.Conclusions ADE related to Tac possess different distribution characteristics in different types of organ transplantation.Extensive attention should be paid to individualized drug monitoring and risk assessment in pediatric organ transplant recipients,thereby optimizing Tac treatment and reducing the risk of ADE.

Delayed graft function in kidney transplant recipients is one of the common early complications after kidney transplantation,which is an independent risk factor affecting the short-term and long-term survival of renal allografts.Branch of Organ Transplantation of Chinese Medical Association and Branch of Kidney Transplantation of China International Exchange and Promotive Association for Medical and Health Care organized well-known Chinese experts in organ transplantation and related disciplines to formulate and discuss the determination of the scope and clinical problems,evidence retrieval and screening,and the formation of recommendations based on"Technical Specification for the Diagnosis and Treatment on Delayed Graft Function After Renal Transplantation(2019 edition)".After two rounds of collective examination and approval by Chinese Medical Association and China International Exchange and Promotive Association for Medical and Health Care,"Guidelines for Clinical Diagnosis and Treatment of Delayed Graft Function in Kidney Transplant Recipients in China"was finally formulated.This guideline puts forward recommendations and explanations regarding 21 clinical problems including the concept,mechanism,risk factors,diagnosis,prevention,treatment and application of immunosuppressive drugs for delayed graft function in kidney transplant recipients,aiming to standardize the diagnosis,prevention and treatment of delayed graft function in kidney transplant recipients,enhance clinical efficacy of kidney transplantation,prolong short-term and long-term survival of kidney transplant recipients and renal allografts and promote the development of the discipline of transplantation.

Urinary tract infection is the most common infectious complication after kidney transplantation.To further reduce the incidence of urinary tract infection after kidney transplantation,improve the diagnosis and treatment level of urinary tract infection after kidney transplantation in China,prevent the development of bacterial drug resistance and ensure the safety and effectiveness of drug use,Branch of Organ Transplantation of Chinese Medical Association organized experts in the fields of kidney transplantation and infectious diseases to consider clinical status of urinary tract infection after kidney transplantation in China,refer to"Diagnosis and Treatment of Urological and Andrological Diseases in China(2022 edition)"and"Urinary Tract Infection in Solid Organ Transplant Recipients in American Society of Transplantation Practical Guidelines for Infectious Diseases(2019 edition)",and formulate"Guidelines for Clinical Diagnosis and Treatment of Urinary Tract Infection in Kidney Transplant Recipients in China"from the perspectives of clinical classification and definition,epidemiology and etiology,diagnosis and treatment of urinary tract infection after kidney transplantation,respectively.

In order to promote the standardized application of ex vivo hypothermic machine perfusion preservation technology for donor kidney from deceased organ donation,Branch of Organ Transplantation of Chinese Medical Association organized the formulation of the"Guidelines for ex vivo hypothermic machine perfusion preservation of donor kidney from deceased organ donation in China".This guideline integrates expert consensus from the fields of kidney transplantation and deceased organ donation,based on existing clinical guidelines,systematic reviews,case studies,expert consensus,and other materials,and combined with clinical issues related to ex vivo hypothermic machine perfusion preservation technology for kidneys from deceased organ donation in recent years both domestically and internationally.After multiple expert discussions and reaching a consensus,the guideline was completed.The guideline contains 11 clinical questions and 14 recommendations,and the strength of recommendations and evidence levels for each clinical question have been graded according to the 2009 Oxford Centre for Evidence-Based Medicine levels of evidence and grades of recommendation.This guideline aims to provide guidance for clinical practice,improve the level of donor kidney preservation from deceased organ donation in China,reduce the rate of organ discard,and alleviate the shortage of organs.

Nocardiosis is a collective term for tissue and organ damage caused by Nocardia infection.Solid organ transplant recipients(SOTR)are at an increased risk of various pathogen infections,including Nocardia infection,due to immunosuppressive therapy which weakens their immune function.The diagnosis of nocardiosis has been challenging in the past.With the advent of molecular biology and other diagnostic methods,the diagnostic rate has significantly improved.Nocardia not only prone to cause necrotic pulmonary lesions but also invade other organs and tissues,such as intracranial infections and skin soft tissue infections,and can develop into systemic disseminated infections.For SOTR,nocardiosis is a potentially fatal disease with a fatality as high as 30%.Therefore,this article reviews the clinical characteristics of common nocardiosis in SOTR,new diagnostic technologies,and different anti-infective treatment strategies,aiming to provide a reference for the prevention and treatment of nocardiosis in clinical SOTR.

Objective To explore the molecular mechanisms and cell-cell interactions in the injury process of pancreatic islet transplantation.Methods Single-cell transcriptome data from mouse islets treated with inflammatory factors were used,and data processing was performed using the Seurat package,with integrated data to remove batch effects.Cell subpopulations were annotated based on known markers.Cell-cell interactions in the inflammatory factor-treated group were analyzed using the CellChat package,and inferred based on the expression of cell surface receptors and ligands.Gene set enrichment analysis was used to clarify the biological processes enriched in β-cells after treatment with inflammatory factors.Finally,differentially expressed transcription factors were identified and verified using microarray datasets of donor islet ischemic injury and Western blotting.Results A total of 7 different cell subpopulations were found in mouse islets,with β-cells being the most abundant.Cell-cell interaction network analysis showed that the number and strength of interactions between ductal cells and other cells were the highest.Gene set enrichment analysis showed that after treatment with inflammatory factors,the immune response was positively enriched in β-cells,while peptide hormone metabolism,bile acid metabolism,and ion homeostasis were downregulated.The common differential transcription factors identified in the mouse single-cell transcriptome and the microarray dataset of donor islet ischemic injury were early growth response 1(EGR1),nuclear factor-κB inhibitor α(NFKBIA),and activating transcription factor 3(ATF3).Among them,NFKBIA and ATF3 were upregulated,while EGR1 was downregulated.The expression of EGR1 protein was downregulated after 24 h,48 h,and 72 h of cold ischemia.Conclusions EGR1 is a transcription factor closely related to islet cold ischemia,and future research should focus on the specific mechanisms of EGR1 and its downstream target genes,in order to provide more effective strategies for clinical treatment of islet transplantation.