Clinical characteristics and 2-year outcomes of COVID-19-associated acute kidney injury (AKI) during the Omicron wave in Chinese kidney transplant recipients are lacking. This study aimed to investigate the clinical features and 2-year outcomes of COVID-19-associated AKI in this population. A retrospective analysis was performed on 316 kidney transplant recipients hospitalized with COVID-19 between December 2022 and August 2023. Patients were divided into AKI (n = 117) and non-AKI (n = 199) groups to compare the clinical characteristics and 2-year outcomes. Among kidney transplant recipients with COVID-19, the AKI group had significantly higher baseline creatinine levels (p < 0.001) and a higher risk of graft loss (p < 0.001) compared to the non-AKI group. At 1, 3, 6, 12, and 24 month post-COVID-19 infection, serum creatinine levels were significantly higher (all p < 0.001) and estimated glomerular filtration rate (eGFR) was significantly lower (all p < 0.001) in the AKI group. Multivariate Cox regression analysis identified AKI (hazard ratio [HR] = 4.325, 95

BACKGROUND:The exact mechanism of graft dysfunction has not been fully clarified. We aimed to explore the causal effects of serum metabolites on graft dysfunction and the mediating role of inflammatory proteins. METHODS:We first analyzed the causal association of 1,091 serum metabolites and 91 inflammatory proteins with graft dysfunction by Mendelian randomization (MR) to find the most important indicators and calculated the mediating role of inflammatory proteins. Second, we further intergrated the single-cell analysis, machine learning, and Shapley Additive exPlanations (SHAP) methods to validate the role of the inflammatory protein in rejected transplanted kidneys. RESULTS:In MR analysis, the inverse variance weighted (IVW) method showed that N-acetylaspartyl glutamate (NAAG) levels reduced the risk of graft dysfunction (OR 0.648, 95% CI 0.522-0.805). Interleukin-2 receptor subunit beta (IL-2RB) mediated the association between NAAG and graft dysfunction with a mediation ratio of 11.35% (95% CI 1.85%-24.69%). In transplanted kidneys, IL-2RB is predominantly expressed elevated in T cells from rejection samples and is associated with decreased renal function. 10 hub genes were identified based on T cells with high and low expression of IL-2RB, of which NGboost reached AUC 0.77. The SHAP method obtained the gene with the greatest model contribution: the IL-2RB gene. CONCLUSION:NAAG plays a protective role in graft dysfunction, and part of the effect is mediated by inhibition of IL-2RB, which is verified as an important gene that functions in transplant kidney rejection. NAAG and IL-2RB may be novel molecular markers and therapeutic targets for graft dysfunction.

BACKGROUND:Kidney transplantation is the optimal treatment for end-stage renal disease; however, the limited availability of donor kidneys hinders the advancement of this procedure. The utilisation of expanded criteria donor (ECD) kidneys and kidney donor profile index (KDPI) > 85% kidneys represents a significant initiative in addressing this shortage. Our study aimed to investigate the clinical outcomes of kidney transplantation by the ECD and KDPI > 85% kidneys, as well as the risk factors influencing graft survival, with the aim of providing a reference for the clinical application of the ECD and KDPI > 85% kidneys in Chinese population. METHODS:This retrospective analysis included 326 adult donor kidney transplant recipients from July 2018 to June 2020. The donor kidneys were classified into ECD kidneys (n = 110) and standard criteria donor (SCD) kidneys (n = 216) based on the United Network for Organ Sharing (UNOS) criteria, as well as into kidneys with KDPI > 85% (n = 42) and KDPI ≤ 85% (n = 284), according to the donor's KDPI value. T tests, chi-square tests, and Mann-Whitney U tests were used to compare complications and renal function following kidney transplantation. Additionally, the log-rank test was used to assess differences in survival rates, whereas Cox regression analysis was conducted to identify risk factors associated with graft loss. RESULTS:Analysis revealed that grafts from ECDs exhibited significantly poorer survival rates (P = 0.004), whereas the survival rates of their recipients were comparable (P = 0.710). No significant differences were observed between the ECD and SCD groups regarding the incidence of DGF (22.7% vs. 26.4%, respectively; P = 0.471) or AR (24.5% vs. 25.9%, respectively; P = 0.787). At 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years posttransplantation, the SCr level and eGFR in the ECD group were significantly lower than those in the SCD group (all P < 0.05); however, no differences were noted at 1 month posttransplantation. Furthermore, the SCr level and eGFR in the kidneys of patients with a KDPI > 85% were significantly worse than those in the kidneys of patients with a KDPI ≤ 85% at 6 months, 2 years, 3 years, and 4 years posttransplantation (all P < 0.05), with no differences being observed at 1 month, 3 months, and 1 year posttransplantation. Additionally, no significant differences were observed between the KDPI > 85% and KDPI ≤ 85% groups regarding the incidence of DGF, AR, graft survival, or recipient survival (all P > 0.05). Multivariate Cox regression analysis indicated that ECD kidneys (HR = 3.647, P = 0.003) and AR (HR = 4.675, P < 0.001) were independent risk factors for graft loss. CONCLUSION:In this validation study of the transplant scoring criteria based on the Chinese population, our study indicated that compared with SCD kidneys, ECD kidneys demonstrated poorer graft survival and a tendency towards inferior postoperative renal function. However, the rates of recipient survival, DGF, and AR were comparable. Additionally, graft and recipient survival, as well as the incidence of DGF and AR, in KDPI > 85% kidneys were also similar to those in KDPI ≤ 85% kidneys. Nevertheless, kidneys with a KDPI > 85% tended to exhibit inferior postoperative renal function. Thus, the KDPI score is a valuable tool for predicting graft function in Chinese population.

BACKGROUND:The aim of this study was to find novel diagnostic markers for renal fibrosis based on bioinformatics analysis. METHODS:In this study, we first identified differentially expressed genes and modular genes associated with renal fibrosis. We utilized the GSE76882 dataset (81 renal fibrosis patients and 91 control samples) to identify these genes and then intersected them with the DEGs in the GSE120495 dataset (5 renal fibrosis patients and 5 control samples). To gain insights into the biological processes involved, we performed GO and KEGG analyses on the intersection genes and constructed protein interaction networks. Next, we employed the LASSO regression algorithm and the random forest algorithm to further screen the candidate biomarkers. The sensitivity and specificity of the candidate biomarkers were assessed using ROC curves. Finally, we induced renal fibrosis using the Unilateral Ureteral Obstruction (UUO) model (characterized by renal tubular damage and fibrosis in response to obstructed urinary flow) to observe the impact of the candidate biomarkers on the progression of renal fibrosis. RESULTS:A total of 383 differential genes and 689 renal fibrosis-related module genes were identified from the GSE76882 dataset, and 213 genes were obtained by intersecting the two. A total of 2431 differentially expressed genes were identified from the GSE120495 dataset, and 34 genes were obtained by intersecting them with the results of the previous step. Five candidate biomarkers (SFN, ARHGAP9, VSIG4, ISG20, CD3G) were identified by LASSO regression analysis and random forest algorithm. The comprehensive AUC values of the five genes in both datasets were greater than 0.7. Finally, in vivo experiments were performed to verify that VSIG4 may promote renal function injury induced by UUO. CONCLUSIONS:VSIG4 is highly expressed in UUO and may be an important mediator involved in renal fibrosis.

BACKGROUND:Riboflavin, which is mainly obtained from dietary sources, plays a role mainly in energy metabolism and antioxidants, and has been used for the prevention and treatment of several diseases. However, the epidemiological and molecular mechanisms linking riboflavin to chronic kidney disease (CKD) are unclear. METHODS:Epidemiological studies were conducted using data from the National Health and Nutrition Examination Survey. Logistic regression models and restricted cubic spline were used to assess the association between riboflavin and CKD. Mediation analyses were applied to explore the effects of inflammatory factors. In addition, molecular mechanism studies were conducted using multiple publicly available databases. STRING, Cytoscape and microarray data were used to screen the genes. Clinical relevance and distribution of targets in the kidney were explored using the Nephroseq v5 online platform and single-cell RNA sequencing. The binding activity of riboflavin to target proteins was investigated by molecular docking. RESULTS:The weighted prevalence of CKD was 14.8%. High riboflavin intake is associated with a reduced risk of CKD (especially early CKD). Mediation analysis showed that alkaline phosphatase mediated riboflavin to reduce CKD prevalence with a mediation ratio of 10.5%. 74 potential targets of riboflavin against CKD were obtained through data mining. The possible mechanisms of riboflavin against CKD are related to apoptosis, PI3K/Akt signaling, MAPK signaling and IL17 signaling pathway, among which 9 hub genes (MYC, TP53, BCL2, AKT1, TNF, JUN, IL1B, IL6 and CASP3) are mainly related to MAPK signaling. In CKD patients, IL1B expression levels were increased, mainly in renal macrophages, and correlated with decreased renal function, while signals such as VISFATIN and SPP1 were highly expressed. Molecular docking verified that riboflavin has good binding potential to IL1B protein. CONCLUSIONS:This study highlights the clinical potential of riboflavin in preventing CKD, and explores its epidemiological and preventive mechanisms.

Kidney transplantation is the optimal treatment for end-stage renal disease; however, the limited availability of donor kidneys hinders the advancement of this procedure. The utilisation of expanded criteria donor (ECD) kidneys and kidney donor profile index (KDPI) > 85

[This corrects the article DOI: 10.3389/fphar.2024.1502097.].

Macrophages (MAC) play a crucial role in the immune response during allograft rejection in organ transplantation. Therefore, our study aimed to explore the genomic features of MAC in mouse heart transplants and use single-cell RNA sequencing to investigate Galectin-9 (Gal-9 and Lgals9), a lectin that can mediate the activation and differentiation of immune cells through ligand-receptor interactions, and the effects of its regulation in transplantation. We discovered a new subset of MAC called "Myoz2+ MAC," which specifically expressed genes related to myocardial contraction. We identified a distinct differentiation trajectory and process for the Saa3+ macrophage population, representing anti-inflammatory functionality. Also, we observed a significant downregulation of Lgals9 expression in the MAC after mouse heart transplantation. Then, we validated our findings using RT-qPCR and Western blotting and also investigated the impact of Lgals9 on macrophage function through flow cytometry and ELISA. Furthermore, in vitro, we found that rLgals9 (Recombinant Mouse Galectin-9 Protein) treated MAC polarized toward the M2b phenotype at appropriate concentrations.

BackgroundPrompt identification and management of donor-derived infections post-kidney transplantation are critical. This study aims to assess the effectiveness of metagenomic next-generation sequencing (mNGS) in detecting pathogens within donor organ preservation fluids and recipient wound drainage fluids, with a comparison made against conventional culture methods.MethodsThis study involved 141 kidney transplant patients (May 1st, 2020 to Jan 31st, 2024). Donor organ preservation fluids and recipient wound drainage fluids were collected and analyzed by mNGS and conventional culture. Pathogen detection differences between mNGS and culture were evaluated. The antibiotic adjustment and infectious complications of the recipients were recorded.ResultsFor organ preservation fluids, the positive rate of convention culture were lower than that of mNGS (24.8% (35/141) vs 47.5% (67/141), p<0.05). For recipient wound drainage fluids, the positivity rate of convention culture were lower than that of mNGS (2.1% (3/141) vs 27.0% (38/141), p<0.05). Compared to traditional culture-based methods, mNGS demonstrated a significantly higher positive detection rate for the combination of ESKAPE pathogens and/or fungi (28.4% (40/141) vs 16.3% (23/141) p< 0.05). Of the pathogens detected through convention culture, mNGS was capable of detecting 79.2% (19/24) of combinations comprising Enterobacteriaceae and non-fermenting bacteria, yet it detected only 22.2% (2/9) of Gram-positive bacteria, and 55.6% (5/9) of fungi. Certain clinically atypical pathogens, mainly Mycobacterium, Clostridium tetanus, and parasites, can solely be detected via mNGS. The rehospitalization rate due to infections was 13.5% (19/141), while the donor-derived infection rate amounted to 2.8% (4/141). Guided by mNGS and bacterial culture results, adjustments were made to antibiotic administration, with no severe vascular complications arising.ConclusionsBy employing mNGS to analyze drainage fluids and organ preservation fluids, highly pathogenic and atypical pathogenic microorganisms can be rapidly identified with high throughput. While limitations exist in detecting fungi and Gram-positive bacteria, mNGS are need to be jointly applied with conventional culture under current conditions.

BACKGROUND:Sepsis-induced acute kidney injury (AKI) is a severe condition characterized by dysregulation of pro- and anti-inflammatory responses. Targeting macrophage polarization between pro-inflammatory M1 and anti-inflammatory M2 cells offers a potential therapeutic approach for AKI. Trametinib (TRAM), an inhibitor of the MEK1/2 signaling pathway, was evaluated for its impact on M1/M2 polarization in AKI. METHODS:Wild-type (WT) mice were subjected to lipopolysaccharide (LPS)-induced AKI and intraperitoneally treated with dimethyl sulfoxide (DMSO) or TRAM (10 mg/kg) for three days. Renal function was assessed by measuring creatinine levels. While histopathological changes, RNA sequencing data, and serum cytokine levels were analyzed. Macrophage M1/M2 polarization in kidney tissues was examined using flow cytometry and immunohistochemistry. Murine bone marrow-derived macrophages (BMDMs) were polarized to the M1 or M2 phenotype in vivo and treated with or without TRAM (10 μM). M1/M2 polarization was analyzed via flow cytometry, and PI3K/Akt signaling was evaluated by western blotting. RESULTS:TRAM significantly improved renal function, as demonstrated by reduced serum creatinine levels (p < 0.01) and ameliorated histopathological damage (p < 0.01). Flow cytometry and immunohistochemistry revealed that TRAM markedly inhibited pro-inflammatory M1 macrophage polarization (p < 0.001). Additionally, TRAM reduced serum level of IFN-γ (p < 0.01) and IL-17 (p < 0.001). In vitro, TRAM suppressed M1 polarization (p < 0.05) by inhibiting the PI3K/Akt signaling pathway. CONCLUSION:TRAM mitigated LPS-induced AKI by suppressing M1 macrophage polarization via the PI3K/Akt pathway, highlighting its therapeutic potential for AKI and other inflammatory kidney diseases.

BackgroundThe concurrent administration of tacrolimus and voriconazole in kidney transplant recipients can lead to drug interactions, potentially resulting in severe adverse reactions. This study aimed to establish a robust population pharmacokinetic model to explore the interaction between tacrolimus and voriconazole in greater depth.MethodsTacrolimus blood samples and laboratory data were prospectively collected from eligible patients enrolled between April 2023 and April 2024, following predefined inclusion and exclusion criteria. Using Phoenix (version 8.1), a pharmacokinetic prediction model was developed. Model performance was assessed using model fitting plots, bootstrap analysis, and visual predictive checks (VPC).ResultsThis study ultimately included 51 eligible patients, with a total of 281 blood samples collected. Analysis revealed a significant negative correlation between voriconazole concentration (Cvrc) and tacrolimus volume of clearance rate (CL), a significant positive correlation between platelets (PLT) and tacrolimus clearance (CL), and a significant negative correlation between blood cells (RBC) and tacrolimus clearance (CL).ConclusionThis study successfully established a population pharmacokinetic model for renal transplant patients concurrently receiving tacrolimus and voriconazole. The model demonstrated good predictive performance and offers valuable insights to clinicians for optimizing tacrolimus dosing in this patient population.

OBJECTIVES:The mouse kidney transplantation model presents challenges in terms of surgical difficulty and low success rate, making it difficult to master. This study aims to provide a crucial model for transplantation immunology research by modifying and developing novel techniques for mouse kidney transplantation. METHODS:A total of 57 pairs of mice were used to establish and compare the modified and innovative surgical techniques for mouse kidney transplantation. Three different surgical models were established, including the abdominal suture technique for orthotopic kidney transplantation, the abdominal cuff technique for orthotopic kidney transplantation, and the cervical cuff technique for ectopic kidney transplantation. BALB/c or C57BL/6 male mice, aged 8 to 12 weeks and weighed 20 to 25 g with specified pathogen free-grade were served as the donor mice or the recipient mice. The surgical technique characteristics, key surgical times, complications, and pathological examination in the early postoperative period were summarized and compared. RESULTS:Three different surgical models of mouse kidney transplantation were successfully established. The comparison of warm ischemic time for the 3 groups of mice showed no statistical significance (P=0.510 4). The abdominal suture group had the shortest total operation time of the donor compared with the abdominal cuff group and the cervical cuff group [(18.3±3.6) min vs (26.2±4.7) min and (22.8±2.5) min; both P<0.000 1]. There was a significant difference in cold ischemia time among the 3 groups (all P<0.000 1), with (60.8±4.1) min in the cervical cuff group, (43.3±5.0) min in the abdominal suture group, and (88.8±6.7) min in the abdominal cuff group. Due to different anastomosis methods, the cervical cuff group had the shortest time [(17.6±2.7) min], whereas the abdominal cuff group had the longest time [(38.8±5.4) min]. The total operation time for the recipients showed significant differences (P<0.000 1), with the abdominal suture group having the shortest time [(44.0±6.9) min], followed by the cervical cuff group [(64.1±5.2) min], and the abdominal cuff group [(80.0±6.0) min] being the longest. In the 32 mice of the abdominal suture group, there were 6 with intraoperative bleeding, including 1 arterial intimal injury bleeding and 5 with bleeding after vessel opening. Six mice had ureteral complications, including ureteral bladder anastomotic stenosis, necrosis, and renal pelvis dilation. Two mice had postoperative abdominal infections. In the abdominal cuff group, there was no intraoperative bleeding, but 6 mice showed mild arterial stenosis and 5 showed venous stenosis, 4 arterial injury, 4 arterial thrombosis, and 2 ureteral complications. No postoperative infections occurred in the mice. In the cervical cuff group, no intraoperative bleeding, arterial intimal injury, arterial/venous stenosis, or thrombosis were found in 13 mice. Five mice had ureteral complications, including ureteral necrosis and infection, which were the main complications in the cervical cuff group. The renal function in mice of the 3 groups remained stable 7 days after surgery. Hematoxylin and eosin staining and periodic acid-Schiff staining showed no significant differences in terms of acute rejection among the 3 surgical methods (all P>0.05). CONCLUSIONS:All 3 surgical methods are able to successfully establish mouse kidney transplantation models, with no significant differences observed in the short-term graft survival and acute rejection. The modified abdominal suture technique and abdominal cuff technique have their respective advantages in research applications. The novel cervical cuff technique for ectopic kidney transplantation model is relatively simple to be prepared and causes less trauma to the mice, providing more options for studies involving xenotransplantation, secondary transplantation, and local lymphatic drainage. However, the difficulty in harvesting the donor kidney and the high incidence of ureteral infections need further validation in long-term survival. This study holds important reference value for choosing the type of mouse kidney transplantation model for different research needs.

ObjectivesSignificant increase in tacrolimus exposure was observed during co-administration with voriconazole, and no population pharmacokinetic model exists for tacrolimus in renal transplant recipients receiving voriconazole. To achieve target tacrolimus concentrations, an optimal dosage regimen is required. This study aims to develop individualized dosing parameters through population pharmacokinetic analysis and simulate tacrolimus concentrations under different dosage regimens.MethodsWe conducted a retrospective study of renal transplant recipients who were hospitalized at the Second Xiangya Hospital of Central South University between January 2016 and March 2021. Subsequently, pharmacokinetic analysis and Monte Carlo simulation were employed for further analysis.ResultsNineteen eligible patients receiving tacrolimus and voriconazole co-therapy were included in the study. We collected 167 blood samples and developed a one-compartment model with first-order absorption and elimination to describe the pharmacokinetic properties of tacrolimus. The final typical values for tacrolimus elimination rate constant (Ka), apparent volume of distribution (V/F), and apparent oral clearance (CL/F) were 8.39 h−1, 2690 L, and 42.87 L/h, respectively. Key covariates in the final model included voriconazole concentration and serum creatinine. Patients with higher voriconazole concentration had lower tacrolimus CL/F and V/F. In addition, higher serum creatinine levels were associated with lower tacrolimus CL/F.ConclusionOur findings suggest that clinicians can predict tacrolimus concentration and estimate optimal tacrolimus dosage based on voriconazole concentration and serum creatinine. The effect of voriconazole concentration on tacrolimus concentration was more significant than serum creatinine. These findings may inform clinical decision-making in the management of tacrolimus and voriconazole therapy in solid organ transplant recipients.

BACKGROUND:Homoharringtonine (HHT) is an effective anti-inflammatory, anti-viral, and anti-tumor protein synthesis inhibitor that has been applied clinically. Here, we explored the therapeutic effects of HHT in a mouse heart transplant model. METHODS:Healthy C57BL/6 mice were used to observe the toxicity of HHT in the liver, kidney, and hematology. A mouse heart transplantation model was constructed, and the potential mechanism of HHT prolonging allograft survival was evaluated using Kaplan-Meier analysis, immunostaining, and bulk RNA sequencing analysis. The HHT-T cell crosstalk was modeled ex vivo to further verify the molecular mechanism of HHT-induced regulatory T cells (Tregs) differentiation. RESULTS:HHT inhibited the activation and proliferation of T cells and promoted their apoptosis ex vivo . Treatment of 0.5 mg/kg HHT for 10 days significantly prolonged the mean graft survival time of the allografts from 7 days to 48 days ( P <0.001) without non-immune toxicity. The allografts had long-term survival after continuous HHT treatment for 28 days. HHT significantly reduced lymphocyte infiltration in the graft, and interferon-γ-secreting CD4 + and CD8 + T cells in the spleen ( P <0.01). HHT significantly increased the number of peripheral Tregs (about 20%, P <0.001) and serum interleukin (IL)-10 levels. HHT downregulated the expression of T cell receptor (TCR) signaling pathway-related genes ( CD4 , H2-Eb1 , TRAT1 , and CD74 ) and upregulated the expression of IL-10 and transforming growth factor (TGF)-β pathway-related genes and Treg signature genes ( CTLA4 , Foxp3 , CD74 , and ICOS ). HHT increased CD4 + Foxp3 + cells and Foxp3 expression ex vivo , and it enhanced the inhibitory function of inducible Tregs. CONCLUSIONS:HHT promotes Treg cell differentiation and enhances Treg suppressive function by attenuating the TCR signaling pathway and upregulating the expression of Treg signature genes and IL-10 levels, thereby promoting mouse heart allograft acceptance. These findings may have therapeutic implications for organ transplant recipients, particularly those with viral infections and malignancies, which require a more suitable anti-rejection medication.

Aim and objectives: The relationship between dietary metal intake and mortality risk is controversial, and we investigated the relationship between intake of five metals (iron, copper, selenium, zinc, and magnesium) and all -cause, cardiovascular mortality in the total population, gender subgroups, and age subgroups. Materials and methods: 17,207 participants from the National Health and Nutrition Examination Survey (NHANES) database from 2009 to 2016 were included in this study. Kaplan -Meier survival curves, multivariate Cox proportional hazards models, and restrictive cubic spline (RCS) curves were used to explore the association between metal intake and all -cause, cardiovascular mortality. Results: In this study, the average dietary metal intake of men and older people was lower than that of women and younger people. The RCS curves found in the whole population that all -cause mortality was negative linearly associated with copper intakes, L-shaped with zinc and magnesium intakes. Further subgroup analyses of copper, zinc, and magnesium by age and gender revealed that only magnesium showed statistically significant differences in the age subgroups. In the 20-40 population, there was a non-linear increasing trend in magnesium intake and all -cause mortality, whereas there was a non-linear decreasing trend in the > 60 population. Conclusion: The relationship between metal intake and mortality is more than a simple linear correlation, and differences in age can affect this correlation. In metal exposure studies, different populations can be studied to better determine the effect of metal exposure on mortality.

Renal fibrosis is the common final pathway of progressive renal diseases, in which the macrophages play an important role.ELISA was used to detect CD5 antigen-like (CD5L) in serum samples from end-stage renal disease (ESRD), as well as in mice serum with unilateral ureteral occlusion (UUO). Recombinant CD5L was injected into UUO mice to assess renal injury, fibrosis, and macrophage infiltration.The expression of CD5L was significantly upregulated in the serum of patients with ESRD and UUO mice. Histological analysis showed that rCD5L-treated UUO mice had more severe renal injury and fibrosis. Furthermore, rCD5L promoted the phenotypic transfer of monocytes from Ly6Chigh to LyC6low. RCD5L promoted TGF-β signaling pathway activation by promoting Smad2/3 phosphorylation. We used Co-IP to identify HSPA5 interact with CD5L on cell membrane could inhibit the formation of the Cripto/HSPA5 complex, and promote the activation of the TGF-β signaling pathway. The CD5L antibody could reduce the degree of renal fibrosis in UUO mice.

The relationship between vitamin intake and cancer risk in the chronic kidney disease (CKD) population is unknown. For this reason, we investigated the relationship between dietary vitamin intake and cancer risk in CKD patients and looked for effective vitamin dietary patterns. This study included 3518 CKD patients from 2007 to 2018 National Health and Nutrition Examination Survey database. All participants were categorized into four groups based on vitamin intake by K-mean clustering. The data were collected and analyzed from June 2023 to December 2023. A total of 3518 CKD patients with a mean age of (61.8 ± 16.3) years were included in the study. During a median follow-up of 7.3 years, 137 participants died of cancer. In the multivariate adjusted cox proportional hazards model for single vitamin intake, vitamin E Q4 intake (reference Q1) reduced cancer mortality (HR (95

OBJECTIVES:Immunoglobulin A nephropathy (IgAN) is one of the most common types of kidney disease, and kidney transplantation is the most effective treatment for end-stage renal disease. This study aims to analyze the clinical curative effect of renal transplantation for adults with IgAN and to discuss the efficacy and safety of kidney transplantation for IgAN at the perioperative period and medium- and long-term follow-up.METHODS:This retrospective study included the clinical and follow-up data of 81 adult patients with IgAN who underwent kidney transplantation at the Second Xiangya Hospital, Central South University from January 2018 to January 2022. Of the 81 patients whose age at (34.1±9.9) years old, 47 (58.0%) were male. The body mass index was (20.8±3.2) kg/m2, and the human leukocyte antigen (HLA) mismatch number was 3.5±1.2. The estimated glomerular filtration rate (eGFR) and daily 24-hour urine output for the recipients on the 1st, 5th, and 7th day after kidney transplantation and when they were discharged were analyzed. The recovery of the transplanted kidney and occurrence of complications were comprehensively evaluated. The eGFR, urinary protein, and occult blood were evaluated at the 6th, 12th, 24th, 36th, and 48th month and at the last follow-up.RESULTS:The follow-up time was (25.7±15.8) months. No primary non-function occurred in any patient during the perioperative period time. Fifty-one (63.0%) patients had immediate graft function recovery, and 16 (19.8%) patients had slow graft function recovery. Delayed recovery of graft function was observed in 14 (17.3%) patients. A total of 19 perioperative complications occurred, including 9 patients with acute rejection, 5 patients with urinary fistula, 1 thrombosis in both lower limbs, and 4 lymphatic fistula. The eGFR at 6th, 12th, 24th, 36th, and 48th month of follow-up were (65.3±22.9), (67.6±23.0), (64.3±21.8), (65.9±24.7), and (68.7±31.2) mL/(min·1.73 m2), respectively. The eGFR remained high during the medium- and long-term follow-ups. At the longest follow-up of 56 months, eGFR fluctuation was still mild, and the positive rate of urine protein and occult blood was low. IgAN recurred in 4 transplanted kidneys, accounting for 4.94% of the total patients, without severe renal insufficiency. Three patients had kidney dysfunction due to severe pneumonia, rejection, and stone in the transplanted kidney. The overall survival rate of the transplanted kidney was higher than 95%, and the survival rate of all patients was 100% till Januray 2022.CONCLUSIONS:Renal transplantation for adults with IgAN had a remarkable short-term effect. The recipients can be beneficial significantly to favorable midium- and long-term outcomes. IgAN recurrence is infrequent and rarely causes severe renal function damage.