For the repair of complex wounds involving bone and joint infections resulting from severe trauma, the conventional approach typically involves a two-stage procedure: initial implantation of an artificial dermis (AD), followed by autologous split-thickness skin grafting (STSG) after 2-3 weeks. This report presents an innovative onestage technique in which AD and autologous STSG were transplanted simultaneously onto a wound bed prepared with antibiotic-loaded bone cement (ALBC). The patient had sustained multiple open fractures, dislocations, bone defects, and bone and joint infections following a traffic accident. After two initial surgical procedures that included thorough debridement, fracture fixation, and ALBC placement for infection control, a one-stage skin graft was performed to co-implant AD and autologous STSG (0.15-0.25 mm thick) for wound closure. At the 18-month follow-up, the graft flap exhibits no contraction, and its color, texture, softness, and elasticity closely resemble those of the surrounding normal skin. This ALBC-assisted one-stage transplantation of AD combined with autologous STSG offers a feasible and efficient method for repairing complex wounds involving bone and joint injuries with concomitant skin and soft tissue defects. Moreover, it may reduce treatment duration and simplify the clinical pathway compared with traditional two-stage skin grafting protocols.

To evaluate the feasibility and safety of ileal ureteral replacement (IUR) for long-segment ureteral strictures secondary to urogenital tuberculosis (UGTB). 11 patients with complex tuberculous ureteral strictures underwent IUR across three tertiary centers between March 2015 and January 2024. Surgical approaches included open (n = 2), laparoscopic (n = 4), and robotic-assisted (n = 5). Demographic characteristics, perioperative data and follow-up outcomes were prospectively collected. 11 patients (8 males, 3 females) with a mean age of 38.3 ± 13.1 years were included. Two patients had bilateral involvement, and nine patients had unilateral involvement. Four patients underwent concomitant ileocystoplasty. The mean stricture length was 19.0 ± 6.3 cm, and the median length of ileum harvested was 25 cm. The mean operative time was 283.9 ± 28.1 min. The median estimated blood loss was 150 mL. The median postoperative hospital stay was 15 days, with the robotic approach significantly reducing hospitalization time (p = 0.015). During the median follow-up of 36 months, all patients achieved ureteral patency. The mean preoperative and latest estimated glomerular filtration rate were 82.0 ± 24.1 and 74.7 ± 22.9 mL/min/1.73 m2 (p = 0.062), respectively. Complications were reported in 8 patients, primarily metabolic acidosis (6/11) and urinary tract infections (4/11). Metabolic acidosis was associated with renal function decline (p = 0.015). Two patients experienced major complications, consisting of ileus and incision infection respectively. IUR is a safe and effective last resort for patients with complex ureteral strictures secondary to UGTB. High complication rates and long-term metabolic risks limit its application, necessitating strict patient selection and rigorous lifelong management.

Background: This study aimed to evaluate the impact of the donor-recipient relationship on the long-term outcomes of living-related kidney transplantation (LRKT), a topic that has been previously underreported. Material/Methods: A total of 598 LRKTs performed between 2001 and 2021were analyzed and classified into 5 groups based on the donor-recipient relationship: 228 from mothers (M-to-C), 160 from fathers (F-to-C), 115 from siblings, 55 from spouses, and 40 from offspring. Graft survival, postoperative complications within the first year, serum creatinine (Scr), and hazard ratio (HR) for all-cause graft loss were assessed. Results: The overall 1-, 3-, 5-, 7-, and 10-year graft survival rates were 96.0%, 92.4%, 86.4%, 79.9%, and 69.9%, respectively. The graft survival rate in the sibling group was slightly higher than those in the M-to-C and F-to-C groups, and the differences between the groups were insignificant. The survival rates of grafts donated by spouses and offspring were lower than in other groups, and the incidence of graft loss within the first postoperative year was higher in the offspring group. In comparison to the sibling group, spouse and offspring donations increased the graft loss risk (HR, 3.3; 95% CI, 1.6-6.9) and 3.8 (1.7-8.4), respectively, followed by M-to-C and F-to-C donations (HR, 1.9; 95% CI: 1.2-3.4) and 1.8 (1.1-3.1), respectively, which were associated with elevated postoperative Scr levels. Conclusions: Spouse and offspring donations significantly increased the risk of graft loss compared to donations from siblings, followed by M-to-C and F-to-C pairings, which were associated with higher postoperative Scr levels.

Background: Limited research has been conducted on laparoscopic partial nephrectomy for kidney tuberculosis. This study aimed to evaluate the effectiveness of the skirted continuous suture technique in laparoscopic partial nephrectomy for localized renal tuberculosis. Material/Methods: Five patients with kidney tuberculosis underwent standard retroperitoneal laparoscopic partial nephrectomy after computed tomography evaluation. The skirted continuous suture technique was utilized during the procedure. This retrospective study analyzed the outcomes of these patients who received treatment between January 2011 and December 2020 at Beijing Tsinghua Changgung Hospital and Eighth Medical Center of Chinese People's Liberation Army General Hospital. Results: The surgical success rate was 100%. Renal function was well preserved, with a decrease of glomerular filtration rate by 9.6 +/- 9.0 ml/min. Only 1 patient experienced postoperative urinous infiltration and lymphatic fistula, while the others did not have any surgical complications. Antituberculous therapy was continued postoperatively, and 1 patient had recurrence during follow-up. Conclusions: The laparoscopic continuous suturing technique offers a reliable and straightforward method for extensively closing incision edges of the renal parenchyma in laparoscopic surgery. It contributes to the improved efficacy and safety of treating localized renal tuberculosis with exceptional application.

Allogeneic skin transplantation is an important clinical treatment for many diseases. Although Galectin-9 demonstrates multifaceted roles in modulating immune cell homeostasis and inflammation, its precise impact on balancing effector T cells and Tregs during allogeneic skin transplantation remains uncertain. This work was performed to evaluate the modulation of the survival time of allogeneic skin grafts by Gal-9 and to explore the critical mechanism involved in this process. Skin graft transplantation was conducted using C57BL/6 and BALB/c mice. Additionally, the levels of IL-2, IFN-γ, IL-4, and IL-17A were measured. Hematoxylin and eosin staining assay was performed to analyze the pathological conditions of skin grafts of experiment mice. The results revealed that Gal-9 noticeably prolonged the survival of the allogeneic skin graft and ameliorated the damage caused by acute immune rejection. Furthermore, Gal-9 resulted in selective reduction of effectors T cells such as Th1, and Th17. Simultaneously, Gal-9 didn't attenuate the protective function for allograft, which alleviated the immune rejection caused by abnormal immune imbalance. Gal-9 exhibited a therapeutic effect on the allogeneic skin graft by selectively reducing CD4+TIM-3+ T effector cells and inducing a shift from a Th1 to an anti-inflammatory Th2 response. Furthermore, Gal-9 did not attenuate the protective function. Our present study may represent a novel therapeutic candidate for modulating effector T cells and Tregs imbalance-based therapy of allograft transplantation.

BACKGROUND Malignancy after kidney transplantation (MKT) remains a leading cause of death in transplant recipients and over the past few decades there have been many reports on this topic. However, the task of extracting crucial information from intricate events poses a significant challenge in guiding clinical work. Hence, bibliometrics was employed to summarize and predict the future in this study. MATERIAL AND METHODS Reviews and articles on MKT were extracted from the Web of Science Core Collection (WoSCC) and were analyzed by the software VOSviewer, CiteSpace, Scimago Graphica, and R package Bibliometrix for bibliometric analysis. RESULTS The analysis considered 5700 publications from 28 647 authors and 4924 institutions across 100 countries, spanning the years 1970-2022. Reference co-citation analysis showed that "renal cell carcinoma", "skin cancer", "post-transplant lymphoproliferative disorder" and "COVID-19 vaccine" were research hotspots. Keywords that co-occurred early were "immunosuppressant", "cancer", "Epstein-Barr virus", "squamous cell carcinoma", and "infection", etc., while "impact","risk factor", "outcomes", "mortality", "management" frequently co-occurred later. From 2020 to 2022, newly emerging keywords such as "SARS-CoV-2" and "COVID-19", together with citation bursts for "immune checkpoint inhibitors" and "ipilimumab," were observed. CONCLUSIONS The focus of MKT-related studies has evolved from exploring the spectrum, risk factors, and outcomes of MKT, to examining the pathogenesis, individualized screening, prevention, and treatment, including appropriate use of immune checkpoint inhibitors. Reports of renal transplant recipients infected with SARS-CoV-2 or COVID-19 have also gained attention since 2019. These suggest that individualized management remains a frontier for research and a future direction in MKT topics.

Dear Editor, Urogenital tuberculosis(UGTB)is the second most com-mon type of extra-pulmonary tuberculosis(TB)and is defined as tuberculous infectious inflammation of uro-genital system organs.Currently,the modern therapeutic approach to UGTB has shifted focus from saving lives to saving functional kidney units,which implies that surgical intervention should be considered for kidneys with structural damage.

目的 评价膀胱扩大术治疗结核性挛缩膀胱的效果.方法 回顾性分析2009年1月-2020年9月解放军总医院第八医学中心泌尿外科结核性挛缩膀胱行开放性乙状结肠膀胱扩大术22例、回肠膀胱扩大术3例患者的临床资料.记录手术时长、术中出血量、抗痨时长、术后住院时长、术后12月的日间排尿间隔及最大膀胱容量、膀胱残余尿量、末次随访血清肌酐及不良事件.结果 男性12例,女性13例,年龄(35.6±11.5)岁.术前8例血清肌酐升高,16例经皮肾造瘘术,21例单侧肾切除史,最大膀胱容量(52±15)mL,日间排尿间隔(26±16)min.手术时长(278±62)min,术中出血(320±154)mL,术后住院时长(21±13)d,未见肠瘘、尿瘘、活动性出血早期不良事件发生.术后12月最大膀胱容量(305±76)m L,残余尿量(48±13)m L,日间排尿间隔(138±18)min,20例(80％)日间排尿间隔>2 h,较术前差异有统计学意义.22例(88％)末次随访血清肌酐正常,13例(52％)反复尿路感染,2例发生泌尿系结石,1例术后8年死于肺癌.结论 膀胱扩大术治疗结核性膀胱挛缩可有效增加膀胱容量,保护肾功能,安全性好.

Background . Th17 cell differentiation is involved in the development and progression of many diseases, such as rheumatoid arthritis and systemic lupus erythematosus. Present study mainly focused on the role of LINC-XIST in Th17 cell differentiation. Methods . The naïve CD4+ T cells were isolated from human whole blood. Cells were cultured under Th17 cell-polarizing condition for 6 days. The expression of LINC-XIST and miR-153-3p was measured by qPCR. The relationship between LINC-XIST, miR-153-3p, and ETS1 was predicted by TargetScan website and authenticated by luciferase reporter assay. ELISA assays were conducted to evaluate the IL-17 concentration. Western blot was utilized to measure the protein expression of ETS1. Th17 cell frequency was examined by flow cytometry. Results . The expression of XIST markedly decreased and miR-153-3p expression markedly increased with Th17 cell differentiation. The mRNA expression of IL-17, IL-17 concentration, and Th17 cell frequency were observably decreased in overexpressed LINC-XIST group. Luciferase reporter assay authenticated that miR-153-5p was directly regulated by LINC-XIST. miR-153-3p inhibitor observably decreased IL-17 concentration, mRNA expression of IL-17, and Th17 cell frequency while si-XIST reversed this impact. ETS1 was confirmed to be regulated by miR-153-5p via luciferase reporter assay. In addition, ETS1 markedly decreased IL-17 mRNA expression, IL-17 concentration, and Th17 cell frequency while miR-153-5p mimic reversed this impact. Conclusion . LNCRNA XIST inhibited miR-377-3p to hinder Th17 cell differentiation through upregulating ETS1.

肾上腺结核可来自结核菌的原发感染或血行、淋巴播散,临床少见但误诊率较高.早期或单侧病变的症状隐匿,当双侧肾上腺破坏90％ 以上时,可出现肾上腺皮质功能不全甚至肾上腺危相,是艾迪森氏病的第二大病因.肾上腺C T是最有价值的影像学检查手段,肾上腺皮质功能测定、结核菌病原学检查及病理学检查亦具有重要诊断价值.在抗结核药物治疗基础上联合激素替代治疗、外科干预为主的综合治疗手段对于病灶清除、提高治愈率、预防并发症至关重要.

目的:对比脂多糖(lipopolysaccharide,LPS)腹腔注射及盲肠结扎穿刺(cecum ligation and puncture,CLP)诱导脓毒血症肾损伤建模方法的肾脏损伤情况及炎症过程特点.方法:将48只8～10周龄C57BL/6雄性小鼠分为LPS组(n = 16),磷酸盐缓冲溶液(phosphate buffer saline,PBS)组(n=8),CLP组(n= 16)和假手术组(sham组,n=8).LPS组根据小鼠体质量注射LPS溶液20 mg/kg(浓度1 mg/ml),PBS组注射等量PBS,CLP组在距结肠末端1 cm行结扎术,并用21号针对穿两孔后关闭腹腔,sham组仅开腹暴露盲肠闭合腹腔.分别在建模后0 h、6 h、12 h、24 h、48 h处死小鼠,比较观察期内各组小鼠肾功能指标、病理损伤及炎症指标变化.用免疫荧光染色观察肾小管上皮细胞的凋亡.结果:PBS组及sham组小鼠建模前后血清肌酐、尿素氮水平比较,差异无统计学意义(P＞0.05);而LPS组和CLP组小鼠肌酐、尿素氮迅速升高,均在24 h达峰值,分别与建模前比较,差异有统计学意义(均P＜0.05),且48 h后均逐渐恢复.肾脏病理检查提示,LPS组及CLP组均显示肾小管上皮细胞空泡形成明显增多,小管坏死及凋亡不明显,但炎症反应过程有显著差别,其中LPS组白介素6、肿瘤坏死因子等炎症因子水平较CLP组迅速升高,6 h达到峰值后逐渐降低,且CLP组下降较LPS组缓慢.细胞凋亡染色显示LPS组和CLP组均存在局部凋亡,而PBS组和sham组均未见明显凋亡.结论:LPS腹腔注射及CLP均能成功建立脓毒血症肾损伤模型,其中LPS模型的全身性炎症反应剧烈,重复性好,而CLP模型更贴近临床败血症的炎症特点,在科研实践中可根据需要选择合适的模型.

目的:探讨程序优化下后腹腔镜下左侧活体供肾切取术(LLDN)238例的临床经验及安全性.方法:选择2011年11月－2019年3月在中国人民解放军总医院第八医学中心移植外科由单一术者行后腹腔镜下左侧亲属供肾切取术的238例供者资料.手术常规取腰部3个穿刺点,采用程序化供肾切取的游离顺序:①充分利用肾周无血管解剖层面,首先游离肾脏腹侧面,快速显露肾静脉腹侧,然后从逆时针方向游离肾下极、输尿管、肾动脉和肾静脉背侧、肾上极,最后与肾静脉腹侧面汇合.在肾脏游离过程中完成血管属支的处理和输尿管的显露;②保留输尿管周围脂肪,尽可能保护输尿管的血供,游离输尿管至跨髂血管处剪断;③充分游离供肾及动静脉后,将腹侧Trocar切口延长5 cm,术者左手握住肾脏,牵引供肾血管,用Hem-o-lok分别夹闭肾动脉和肾静脉后剪断,迅速取出供肾交台下灌注及修整.结果:238例供肾切取手术均成功,无中转开腹及供肾废弃,供者100％安全.左肾动脉多支30例,其中2支25例,3支5例(3例全部术中吻合,2例第3支细小分支CTA未显影,术中偶然发现结扎废弃).腔镜操作手术时间37～186 min,平均(73±22)min.热缺血时间1.1～4.5 min,平均(2.3± 0.8)min.出血10～350 mL,平均(45±20)mL,均未输血.发生手术并发症6例,淋巴瘘1例,短期自愈,腰静脉损伤出血2例,被膜下血肿3例,均无严重并发症.术后住院时间5～10 d,平均(6.3土1.2)d.238例供者随访1～15个月,平均7个月,均健康.结论:程序优化下后腹腔镜下亲属供肾切取术安全可靠,可以降低学习曲线,提高供肾质量.

Rationale: Carbapenem-resistant Klebsiella pneumonia (CRKP) infections have been a concerning threat, especially in organ transplant patients with very high mortality. Allograft hemorrhage associated with CRKP infection has never been described. Patient concerns: A total of 6 recipients tested positive for CRKP were identified in 297 adult kidney transplant recipients who received kidney from donors according to Chinese type donation after cardiac death (DCD) at our center between January 2006 and December 2017. Diagnoses: CRKP identification was performed via Vitek 2 system, and the susceptibility was tested by broth microdilution and disk diffusion. Based on the signs of infection and the positive culture, the diagnosis of CRKP infection was established. Interventions: Therapy with antibiotic such as including ceftazidime-avibactam or tigecycline and surgical control of primary infection source including allograft nephrectomy and/or thorough debridement was administrated. Outcomes: The most striking aspect was that spontaneous recurrent hemorrhage occurred in all the 6 patients. The mortality of CRKP infection in our study was 50%. Lessons: CRKP infection possibly due to donor-to-recipient transmission in DCD kidney transplants was essentially a necrotic hemorrhagic inflammation and characterized by recurrent hemorrhage and high mortality. The pre-donation screening for CRKP colonization should be mandatory and, if positive, donation should be contraindicated. And, the effective infection source control such as allograft nephrectomy and/or thorough debridement was important to improve outcomes. Further investigation will be required to further characterize the clinical efficacy of new pharmacotherapeutic schemes including ceftazidime-avibactam.

目的 探讨后腹腔镜下亲属活体右侧供肾切取术的安全性,并总结相关临床经验.方法 回顾性分析2010年2月至2019年6月解放军总医院第八医学中心实施的14例亲属活体右侧供肾切取术临床资料,其中8例为后腹腔镜下供肾切取(腹腔镜组),6例为经腰部开放供肾切取(开放手术组).腹腔镜组供者常规采取左侧卧位,腰部采用三套管法穿刺.采用成组t检验比较两组供者手术时间、腔静脉切口缝合时间、供肾动脉长度、供肾静脉长度、供肾热缺血时间、手术出血量和术后住院时间.P<0.05为差异有统计学意义.结果 14例亲属活体右侧供肾切取术均成功,两组供者术中均未输血,腹腔镜组供肾切取术中均未中转开腹.腹腔镜组与开放手术组供肾静脉长度分别为(2.2±0.4)和(1.2±0.3)cm,术中出血量分别为(45±12)和(80±10)mL,差异均有统计学意义(t=1.042和5.781,P均<0.05).两种术式手术时间、腔静脉切口缝合时间、供肾动脉长度、供肾热缺血时间及术后住院时间差异均无统计学意义(P均>0.05).截至2019年8月,开放手术组和腹腔镜组供者中位随访时间分别为6个月(3～18个月)和8个月(3～24个月),均健康.受者术前及术后应用巴利昔单抗行免疫诱导治疗,术后免疫抑制方案为CNI+抗代谢类药物+糖皮质激素.移植肾功能均于术后2周内恢复,术后均顺利摆脱透析.截至2019年8月,14例受者随访时间3～12个月,期间受者及移植肾功能均正常.结论 亲属活体右侧供肾获取过程中采用腹腔镜联合Satinsky钳技术安全、可行,可较大限度地延长供肾静脉,且术中出血量更少.

肾移植是目前治疗终末期肾病的最佳方式,但术后也会面临各种并发症[1].其中泌尿系统外科并发症(如尿漏、输尿管膀胱吻合口狭窄、输尿管缺血坏死、膀胱输尿管反流和移植肾新发结石等)需行二次手术治疗[2].肾移植术后移植肾结石是一种相对少见的泌尿系统并发症,发病率为0.17％～1.80％[2] .

目的 探讨心脏死亡器官捐献(donation after cardiac death,DCD)肾移植术后早期(术后1年以内)受者移植肾丢失的原因.方法 回顾性分析50例DCD供肾移植术后早期移植肾丢失受者的临床资料.结果 受者移植肾丢失50例,移植肾丢失的原因包括排斥反应19例(38.0％)、受者带移植肾功能死亡17例(34.0％)、移植肾血管并发症5例(10.0％)、供体来源泛耐药肺炎克雷伯杆菌(carbapenem-resistant Klebsiella pnermoniae,CRKP)感染4例(8.0％)、原发性无功能肾4例(8.0％)、旧肾原发病(膜性肾病)复发1例(2.0％).DCD供肾移植术后1年内受者移植肾丢失的主要原因为排斥反应,次要原因为受者带功能死亡、移植肾血管并发症、原发性无功能肾、耐药菌感染,旧肾原发病复发少见.结论 总结DCD供肾移植术后早期移植物丢失的原因,为器官移植医师提供临床参考,从而有针对性地加强防治,进一步提高DCD供肾移植1年成功率,减少因患者及家属的不满而引起的医疗纠纷.

目的 应用荟萃分析系统评价HCV感染是否为肾移植后糖尿病(PTDM)的相关危险因素.方法 系统检索中国期刊全文数据库、中国生物医学数据库、PubMed数据库、Embase数据库、Google scholar和Web of science database截至2019年12月公开发表的相关文献.应用Stata 15.1统计软件使用随机效应模型进行荟萃分析,计算相对危险度(RR).结果 共纳入22篇文献,包含129981例肾移植受者.荟萃分析结果显示,HCV感染的肾移植受者术后发生PTDM的风险为非HCV感染者的2.5倍(RR=2.50,95％CI:1.95～3.20,P<0.001).在亚洲、高加索和美洲人种中,HCV感染均为肾移植术后PTDM的危险因素.结论 HCV感染是促进肾移植术后发生PTDM的危险因素,感染者需尽早进行清除HCV的相关治疗.

目的 总结肾移植术后患者早期耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CRKP)感染的临床表现、实验室检查、影像和病理检查结果,探讨其临床特征及机制.方法 对2015年1月-2018年12月我中心确诊的12名肾移植术后早期(移植术后3个月内)CRKP感染患者进行回顾性研究.收集患者的症状、体征、实验室检查、化验检查及临床转归等临床特征信息.采用全自动微生物分析鉴定仪进行菌株的鉴定.应用Vitek 2全自动微生物分析鉴定系统联合纸片扩散法进行药物敏感实验.结果 12例患者平均年龄为45.7岁,其中男性8例.11例发生感染相关的系统性炎症反应综合征,5例发生移植肾区出血,5例发现化脓性坏死分泌物;12例患者均伴随感染性指标如血中性粒细胞及降钙素原升高;且随感染时间长短、侵及组织器官不同而具有不容发的临床表现.移植肾病理检查结果显示移植肾内大量出血伴急性炎症细胞浸润,移植肾髓质内见微脓肿形成.药敏试验发现CRKP对替加环素(9例)和复方磺胺甲恶唑(5例)敏感.结论 移植术后早期移植肾CRKP感染的本质是一种出血坏死性炎症,提示筛查供者CRKP、监测受者出血坏死性炎症征象,全程警惕并管控其引发出血风险是提高CRKP感染救治成功率的关键.

目的 总结心脏死亡器官捐献(DCD)时代肾移植术后耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的临床治疗经验.方法 回顾性分析2015年1月至2019年1月行DCD供肾移植术后CRKP感染的17例受者和10例供者临床资料.供、受者均行细菌培养和药敏试验;记录CRKP感染受者的临床表现、治疗及转归情况.结果 7例供者感染CRKP,对其预处理后,2例供者CRKP转阴,5例供者CRKP未转阴.所有供肾均接受替加环素+美罗培南+伏立康唑灌洗预防感染.17例CRKP感染的受者中,包括11例血培养阳性、10例尿培养阳性、3例痰培养阳性、3例切口分泌物阳性、3例腹膜后引流液阳性;其临床表现包括发热8例、移植肾动脉破裂出血7例或移植肾动脉内血栓形成1例、膀胱刺激征3例、咳砖红色胶冻样痰1例.接受替加环素+美罗培南治疗5例,移植肾丢失1例,受者死亡4例;接受头孢他啶-阿维巴坦+美罗培南治疗12例,移植肾丢失3例,受者死亡1例.结论 CRKP感染供者并非肾移植的绝对禁忌证,提前处理供者感染,受者术后早期给予足量敏感抗生素可以治愈感染,改善肾移植受者预后.

Objective:To explore the risk factors of pulmonary infection in elderly (aged 60+ years) kidney transplant recipients.Methods:The clinical data were retrospectively analyzed for 119 elderly kidney transplant recipients from January 2010 to January 2019 . According to whether or not pulmonary infection occurred after renal transplantation, the recipients were divided into infected group (n=40) and non-infected group (n=79). Clinical data was analyzed for two groups. The relevant risk factors of gender, age, donor type, body mass index, history of smoking, preoperative dialytic time, preoperative dialysis, immune induction, immune maintenance, presence or absence of delayed graft function, leucopenia, serum creatinine before infection, venous hormone shock therapy or not, diabetic history before or after surgery, history of coronary heart disease, history of hepatitis B virus, prophylactic dosing of compound sulfamethoxazole, prophylactic valganciclovir or ganciclovir, were examined by univariate analysis and multivariate logistic regression analysis.Results:The incidence of pulmonary infection in elderly kidney transplant recipients was 33.6% (40/119). In infected group, 15 patients died of severe pulmonary infection with a mortality rate of 37.5%(15/40). History of smoking (OR=10.58, 95%CI: 1.98-56.40, P=0.006), venous hormone shock therapy (OR=25.06, 95%CI: 4.25-147.71, P<0.001) and preoperative dialytic time (OR=1.032, 95%CI: 1.003-1.062, P=0.033) were the risk factors for pulmonary infection in elderly kidney transplant recipients. Conclusions:The incidence and mortality of lung infection are higher in elderly kidney transplant recipients. Smoking history, venous hormone shock therapy and long preoperative dialytic are associated with pulmonary infection in elderly kidney transplant recipients.