目的 探讨利格列汀治疗肾脏移植术后新发糖尿病患者的临床效果及其安全性.方法 回顾性分析30 例接受口服利格列汀治疗的肾脏移植术后新发糖尿病患者的临床资料.比较患者治疗前后的空腹血糖水平、HbA1c水平、体质指数、24 h尿蛋白含量、血生化指标(血肌酐、总胆红素、ALT、AST)水平及血脂水平,并记录治疗过程中并发症的发生情况.结果 与治疗前比较,患者治疗9 个月后的空腹血糖水平降低,治疗6 个月及9 个月后患者的HbA1c水平降低(均P<0.05);患者治疗12 个月后的体质指数、24 h尿蛋白含量及血肌酐、总胆红素、ALT、AST、总胆固醇、LDL水平差异无统计学意义(均P>0.05),而三酰甘油水平降低(P<0.05).利格列汀治疗期间,共有4 例患者出现并发症,并发症发生率为13.33%.结论 利格列汀能够有效控制肾脏移植术后新发糖尿病患者的血糖水平,降低患者血脂水平,且安全性良好.临床上可将利格列汀作为治疗肾脏移植术后新发糖尿病患者的替选方案,尤其适用于三酰甘油水平升高的患者.

Objective To explore the related factors of perioperative diarrhea in cadaveric renal transplant recipients. Methods A case-control trial was conducted on 545 recipients receiving cadaveric renal transplantation in the Affiliated Hospital of Guizhou Medical University from July 2017 to December 2021. Their clinical data during perioperative period were collected, and then all recipients were divided into the diarrhea group (n=207) and non-diarrhea group (n=338). Their age, gender, body mass index (BMI), duration of operation, dialysis types, type 2 diabetes or not, immune induction regimen, mycophenolic acid (MPA) types, infection prevention regimen, preoperative enema, and occurrence of delayed graft function (DGF) were observed and recorded. Multivariate stepwise logistic regression analysis was used to analyze the factors related to the perioperative diarrhea in these recipients. Results The incidence of perioperative diarrhea was 37.98% (207/545). The occurrence time of diarrhea was in 5.90±6.94 d after transplantation, and 71.98% (149/207) of diarrheal patients occurred within 3 d. Univariate analysis showed that significant differences were observed in age, gender, BMI, type 2 diabetes, immune induction regimen, antibiotic prevention regimen, preoperative enema, and post-operative DGF occurrence between the diarrhea and non-diarrhea groups. Multivariate stepwise logistic regression analysis indicated that overweight(OR=1.074, 95%CI: 1.011~1.141), male (OR=1.596, 95%CI: 1.032~2.470), post-operative DGF (OR=3.001, 95%CI: 1.712~5.260) and use of piperacillin after transplantation (OR=3.119, 95%CI: 1.918~5.074) were independent risk factors for perioperative diarrhea in cadaveric kidney transplant recipients. Conclusion Overweight, male, DGF and piperacillin use after transplantation may be the risk factors of perioperative diarrhea in cadaveric transplant recipients.

背景:由抗体介导排斥反应引起的移植肾失功目前临床尚缺乏有效的治疗手段.有研究显示肾移植患者血浆miR-4286的表达显著上调,miR-4286可靶向下调转化生长因子β的表达而激活免疫反应.目的:探讨沉默miR-4286上调滤泡调节性T细胞治疗肾移植抗体介导排斥反应的作用及机制.方法:选择贵州医科大学附属医院接受肾移植的患者,纳入20例肾移植抗体介导排斥反应患者与20例免疫耐受患者,对两组活检肾组织进行苏木精-伊红染色与C4d免疫组化染色,检测两组患者外周血淋巴细胞miR-4286 mRNA的表达与滤泡辅助性、调节性T细胞比例.将排斥反应患者淋巴细胞分组处理,空白载体组、miR-4286过表达组、miR-4286沉默组、转化生长因子β阻断组(该组转染miR-4286抑制的慢病毒载体的同时加入转化生长因子β中和抗体),48 h后,检测B细胞、浆细胞和滤泡调节性T细胞的比例,以及细胞上清转化生长因子β、干扰素γ、白细胞介素6和白细胞介素21的水平.结果 与结论:①苏木精-伊红染色显示,排斥反应组肾组织浸润的炎细胞数量高于免疫耐受组(P<0.05);免疫组化染色显示,排斥反应组肾组织可见大量C4d阳性的细胞,免疫耐受组未见C4d阳性细胞.②排斥反应组miR-4286 mRNA表达量、滤泡辅助性T细胞比例高于免疫耐受组(P<0.05),滤泡调节性T细胞比例低于免疫耐受组(P<0.05).Spearman相关分析显示,miR-4286表达与滤泡辅助性T细胞比例呈正相关,与滤泡调节性T细胞比例呈负相关.③与对照组比较,miR-4286过表达组转化生长因子β水平降低(P<0.05),干扰素γ、白细胞介素6、白细胞介素21水平升高(P<0.05);miR-4286沉默组转化生长因子β水平升高(P<0.05),干扰素γ、白细胞介素6、白细胞介素21水平降低(P<0.05).与miR-4286沉默组比较,转化生长因子β阻断组转化生长因子β水平降低(P<0.05),干扰素γ、白细胞介素6、白细胞介素21水平升高(P<0.05).④与对照组比较,miR-4286过表达组B细胞与浆细胞比例均升高(P<0.05),滤泡调节性T细胞比例降低(P<0.05);miR-4286沉默组B细胞与浆细胞比例均降低(P<0.05),滤泡调节性T细胞比例升高(P<0.05).与miR-4286沉默组比较,转化生长因子β阻断组B细胞与浆细胞比例均升高(P<0.05),滤泡调节性T细胞比例降低(P<0.05).⑤结果表明,miR-4286在肾移植抗体介导排斥反应患者外周血淋巴细胞中高表达,miR-4286沉默可通过转化生长因子β途径上调淋巴细胞中滤泡调节性T细胞比例,抑制体液免疫.

目的 探讨肝移植(LT)患者早期监测白细胞介素(IL)4项的临床意义.方法 145例LT术后患者根据围手术期是否发生感染分为感染组和非感染组,比较两组患者的年龄、性别、原发疾病、是否合并乙肝病毒感染等一般情况,比较两组患者术后第1天的IL-2、IL-6、IL-8、IL-10、总胆红素(TB)、直接胆红素(DB)、凝血酶原时间(PT)、C反应蛋白(CRP)及降钙素原(PCT)等血清学指标;采用logistic回归分析LT患者围术期发生感染的危险因素,Spearman相关性检验分析IL 4项与CRP、PCT之间的相关性.结果 术后第1天,两组LT患者外周血中TB、DB、PT、CRP以及Child-Pugh分级比较,差异有统计学意义(P<0.05);logistic回归显示,DB、CRP是LT患者围手术期发生感染的独立危险因素;Spearman相关性分析显示,IL-6与CRP水平呈负相关(r=-0.397,P<0.001),IL-10与CRP水平呈负相关(r=-0.431,P<0.001);IL-2与PCT水平呈正相关(r=0.247,P=0.006).结论 早期监测外周血白介素4项变化可能有利于评估LT患者的感染风险.

Background Clear cell renal cell carcinoma (ccRCC) is a type of kidney cancer, and one of the most common malignant tumors. Many studies have shown that certain microRNAs (miRNAs) play an important role in the occurrence and development of ccRCC. Nevertheless, the prognosis of ccRCC patients is very rarely based on these “immuno-miRs”. Our aim was thus to determine the relationship between immune-related miRNA signatures and ccRCC. Methods We downloaded the miRNA expression data from 521 KIRC and 71 normal tissues in The Cancer Genome Atlas (TCGA). We used “limma” package and univariate Cox regression analysis to identify differentially expressed miRNAs (DEMs) that related to overall survival (OS). We applied lasso and multivariate Cox regression analyses to construct a prognostic model based on immuno-miRs. We evaluated the performance of model by using the Kaplan-Meier method. Furthermore, Cox regression analysis was used to determine independent prognostic signatures in ccRCC. Results A total of 59 significant immuno-miRs were identified. We use univariate Cox regression analysis to acquire 18 immune-related miRNAs which were markedly related to OS of ccRCC patients in the training set. We then constructed the 9-immune-related-miRNA prognostic model (miR-21, miR-342, miR-149, miR-130b, miR-223, miR-365a, miR-9-1, and miR-146b) by using lasso and multivariate Cox regression. Further analysis suggested that the immune-related prognostic model could be an independent prognostic indicator for patients with ccRCC. The prognostic performance of the 9-immune-related-miRNA prognostic model was further validated successfully in the testing set. Conclusions We established a novel immune-based prognostic model of ccRCC based on potential prognostic immune-related miRNAs. Our results indicated that the 9-miRNA signature could be a practical and reliable prognostic tool for ccRCC.

肾血管性高血压(renovascular hypertension,RVH)是由于单侧或双侧肾动脉主干或分支狭窄致肾供血减少,激活肾素—血管紧张素—醛固酮系统,导致血压升高,进而形成的顽固性高血压.国内研究发现,约2％的高血压患者是由肾动脉狭窄所致,老年继发性高血压患者中RVH占比高达67 .8％[1-2].因此,及时解除肾动脉狭窄对于延缓肾疾病进展及改善患者预后具有极其重要的意义.贵州医科大学附属医院2020 年7月收治了1 例肾动脉狭窄合并肾动脉瘤患者,采用自体肾移植术治疗,取得了良好疗效.临床上该病少见,此例手术是贵州省完成的首例自体肾移植术,现结合文献总结其临床特点及诊治体会,以供临床参考.

目的 探讨贵州省同种异体肾移植受者的临床预后.方法 回顾性分析完成同种异体肾移植196例受者的临床资料,分析肾移植受者术后并发症情况.结果 本组196例受者肾移植手术均成功,术后随访6～30个月,出现急性排斥反应24例(11.7％),移植物功能延迟恢复13例(6.6％),肺部感染61例(27.6％),切口延迟愈合17例(8.7％),移植肾出血1例(0.5％)等,肾移植受者远期死亡2例(1％),1例因严重肺部感染于肾移植术后9个月死亡,另1例因吉兰一巴雷综合征于肾移植术后8个月死亡.结论 本组肾移植术后近期效果良好,肺部感染是术后最常见的并发症.

Background: To investigate the effect of disseminated intravascular coagulation (DIC) on donor kidney in donation after citizens' death (DCD) donors. Methods: The clinical and laboratory data of 159 DCD donors obtained by our center in 2018 were retrospectively analyzed. The DIC diagnosis was performed according to the Chinese DIC scoring system (CDSS). The donors were divided into two groups: DIC (+) and DIC (-). The difference between kidney rejection rate and zero puncture glomerular microthrombus formation rate were compared. Results: Among the 159 DCD donors, 11 were discarded (accounting for 6.91%). The reasons for the discarded cases included 5 cases (3.14%) for moderate and severe glomerular microthrombus formation in the renal zero puncture pathology; 2 cases (1.26%) for glomerular sclerosis ratio over 50%; 2 cases (1.26%) for long-term low blood pressure before pregnancy and significantly increased serum creatinine level and no urine; 1 case (0.73%) for kidney stones and stagnant water; 1 case (0.63%) for malignant tumor. The donor rejection rate of the DIC (+) group was higher than that of the DIC (-) group, and the difference was statistically significant (P<0.05). Among all donors, 10 cases (6.29%) were found to have glomerular microthrombus at zero puncture, and the microthrombotic rate in the DIC (+) group was significantly higher than that in the DIC (-) group (P<0.05). Of the 10 microthrombotic donors, 5 donors with severe glomerular microthrombus were discarded. Conclusions: Donor-induced DIC can easily cause renal glomerular microthrombus formation, and the donor kidney rejection rate has increased.

We aimed to evaluate the functions of long non-coding RNA taurine upregulated gene 1 (lncRNA TUG1) in renal ischemia-reperfusion (I/R) injury and identify the potential mechanisms. Pathological changes of renal tissues were examined using H&E staining after mimic renal I/R injury in vivo. The contents of serum renal functional parameters and inflammatory factors were measured. The expression of TUG1 and miR-449b-5p in renal tissues and HK-2 cells stimulated by I/R were detected. Then, the effects of TUG1 silencing on inflammation and apoptosis of cells were evaluated. Dual luciferase reporter assays were executed for determining the correlation between miR-449b-5p and TUG1, high mobility group box 1 (HMGB1), or matrix metalloproteinase 2 (MMP2). Subsequently, cells were co-transfected with miR-449b-5p mimic and pcDNA3.1 TUG1. The levels of inflammation, apoptosis, and the expression of HMGB1 and MMP2 were detected. The results revealed that renal tissues were obviously damaged after I/R accompanied by changes in renal functional markers and inflammatory factors. TUG1 was highly expressed whereas miR-449b-5p was lowly expressed. TUG1 silencing reduced the inflammation and apoptosis. Dual luciferase reporter assays confirmed that miR-449b-5p was a target of TUG1 as well as HMGB1 and MMP2 were direct targets of miR-449b-5p. Meanwhile, miR-449b-5p mimic presented the same results with TUG1 silencing, which were reversed after TUG1 overexpression. Moreover, MMP2 and HMGB1 expression was decreased after miR-449b-5p overexpression while that of was increased after TUG1 overexpression. These findings demonstrated that TUG1 silencing attenuates I/R-induced inflammation and apoptosis via targeting miR-449b-5p and regulating HMGB1 and MMP2 expression.

Objective:To summarize the management experience of ureter during simultaneous pancreas and kidney(SPK)transplantation and explore the safety and efficacy of end-to-end anastomosis of donor/ recipienter ureter.Methods:From January 2016 to December 2019, 116 cases of SPK were successfully completed. During operation, ureter was anastomosed end-to-end. A F6 ureteral stent was retained in ureter and removed after 1~3 months. Ureteral complications and changes of autogenous kidney were recorded.Results:There were 5 cases of ureteral related complications. One case of urinary fistula was cured conservatively while 4 cases of incomplete ureteral obstruction were managed by intraluminal ureteroscopy. One case was cured and 3 cases had regular replacement of ureteral stent. A total of 89 SPK patients were reexamined by abdominal computed tomography(CT)and 85 cases developed right autogenous hydronephrosis. No significant difference existed in the incidence of postoperative autogenous hydronephrosis between patients with preoperative urine and those without preoperative urine( P=0.554). No special treatment was needed for postoperative autogenous hydronephrosis. Conclusions:Ureteral end-to-end anastomosis is both safe and effective during SPK transplantation. It offers the advantages of lowering operative complexity and minimizing postoperative complications. After ureteral obstruction, it is also convenient to employ endoscopy and avoid reoperation due to its similar natural lumen.

Objective: To investigate the clinical effect of ipsilateral simultaneous pancreas and kidney transplantation (SPK). Methods: A total of 146 cases of SPK surgeries completed in the Second Affiliated Hospital of Guangzhou Medical University from September 2016 to June 2020 were selected to summarize the outcome, curative effect and complications of the operation. Results: The patients were followed up for 1 to 45 months. Good clinical results were obtained in 146 patients. Renal function indicators suggest that on the 7th day after operation, the serum creatinine returned to normal level [142.4 (108.6, 213.4)μmol/L]. The index of pancreatic function decreased to the normal level as expected. The level of blood amylase was 160.5(109.3, 249.8) U/L within 7 days after operation, and then decreased. The trend of urinary amylase was similar to that of blood amylase, which was 240(121.0, 370.0) U/L 7 days after operation, and glycosylated hemoglobin decreased to the normal level (5.8%±1.4%) 1 month after operation. The main medical complications were infection including pulmonary infection (26.03%, 38/146), urinary tract infection (26.03%,38/146), and abdominal infection (4.79%,7/146), acute rejection including renal graft rejection (5.8%,8/146), pancreas/duodenum rejection (18.49%,27/146), and renal graft combined pancreatic graft rejeciton (6.85%,10/146), as well as gastrointestinal bleeding (30.82%,45/146), of which 5 cases were severe bleeding (3.42%, 5/146). The main surgical complications were poor incision healing (10.27%, 15/146), serious surgical complications including arteriovenous thrombosis of the transplanted pancreas (2.05%, 3/146) and intestinal leakage (0.68%,1/146). The 1-year and 3-year patient, renal and pancreatic survival rates were both 92.5%, 91.5% and 89.5%, respectively, and despite the death, the 1-year, 3-year transplanted kidney survival rate was both 99.3%, and 95% for the the 1-year, 3-year pancreas survival rate. Conclusion: Strict preoperative evaluation of the function of large organs, reasonable surgical methods, perioperative anticoagulation, and prompt diagnosis of complications can achieve good clinical results for patients with SPK.

Background To investigate the application of the superior mesenteric artery (SMA) for the in vitro reconstruction of the hepatic artery for liver transplantation, and to improve the success rate and safety of donor liver transplantation. Methods The donor liver and the pancreas were obtained, and the SMA and its branches were used to reconstruct the hepatic artery. Liver transplantation was performed after reconstruction to understand the intraoperative situation after donor liver opening, as well as postoperative liver function. Color Doppler ultrasound of the transplanted liver was also performed. Results During the period from September 2016 to March 2020, a total of 98 pancreases were obtained. The common hepatic artery and gastroduodenal artery loop (CHA-GDA) were preserved to the donor pancreas, and only the proper hepatic artery (PHA) or left/right hepatic artery (LHA/RHA) were preserved to the donor liver. If the PHA of the donor liver was short or absent, the SMA was used for lengthening the PHA or in vitro reconstruction of the LHA/RHA, followed by implantation of the donor liver after reconstruction. A total of 17 cases of this type of donor liver required mesenteric artery lengthening or reconstruction. After opening, the donor liver was well-filled, bile secretion was normal, and liver function recovered as scheduled after surgery. Color Doppler ultrasound and CT angiography (CTA) of the transplanted liver revealed that hepatic arteries were normal without complications such as hepatic artery embolism. Conclusions In vitro reconstruction of the hepatic artery with the SMA is an effective new method of vascular reconstruction, which ensures the blood flow of the hepatic artery, reduces the anastomosis difficulty of the arteries of the donor liver, and reduces the occurrence of vascular complications.

Objective To explore the possible mechanism of lncRNA TapSAKI in urine derived sepsis-induced kidney injury. Materials and methods In vivo urine-derived sepsis (US) rat model and in vitro LPS-induced HK-2 cells were established, and TapSAKI, miR-22, PTEN, TLR4 and p-p65 expressions were detected by qRT-PCR and western blot. RNA precipitation and RNA pull-down were performed to confirm the interaction between TapSAKI and miR-22. Results TapSAKI was up-regulated, miR-22 was down-regulated, PTEN, TLR4 and p-p65 expressions, and inflammatory factors TNF-alpha and IL-6 levels were up-regulated in kidney tissue of US rats and LPS-induced HK-2 cells. In addition, TapSAKI interacted with miR-22, and negatively modulate miR-22 expression. We also observed TapSAKI promoted PTEN expression, TLR4/NF-kappa B pathway related proteins TLR4 and p-p65, and apoptosis protein cleaved-caspase-3 through negatively regulating miR-22. Further experiments proved TapSAKI/miR-22/TLR4/NF-kappa B pathway could promote HK-2 cell apoptosis. Finally, in vivo experiments showed TapSAKI knockdown negatively regulated miR-22 and positively regulate PTEN, decreased renal function indicators blood urea nitrogen and serum creatinine, and reduced TNF-alpha and IL-6. Conclusion TapSAKI was elevated in urine derived sepsis-induced kidney injury, and promoted HK-2 cell apoptosis and inflammatory response through miR-22/PTEN/TLR4/NF-kappa B pathway.

Objective: To summarize the efficacy and safety of the combination of rituximab and ATG as induction therapy in highly sensitized kidney transplant recipients. Methods: Clinical data of patients who received kidney transplantation from donation after cardiac death(DCD) in Organ Transplant Center of Second Affiliated Hospital of Guangzhou Medical University from January 1st 2015 to December 31th 2016 was retrospectively analyzed. Highly sensitized patients with over 30% active panel reactive antibody (PRA>30%) received rituximab, while non-sensitized recipients as controlled group. All selected patients were observed in the renal function, urine protein, hemogram and the variation of PRA at each time point. Acute rejection, infection required hospitalization, delayed graft function(DGF), primary nonfunction (PNF), graft dysfunction, the mortality rate of patients with good allograft function and the graft survival rate were also observed. Results: 46 groups of patients were selected into highly-sensitized group and non-sensitized group. In both groups, there was no statistical difference in the renal function, urine protein and WBC (all P>0.05). Highly sensitized recipients at day 7 and day 14 following the surgery, had a significantly lower percentage of lymphocyte counts and lymphocyte proportion compared to other groups, with statistical differences(all P<0.05). Both groups had a similar incidence of DGF(2.2%) and no occurrence of PNF. 19.5% of highly sensitized recipients experienced acute rejection and 13% in control group. More specifically, no statistical difference was noted in the rate of infection required hospitalization(30.4% vs 22.2%), graft loss(2.2% vs 0) and the mortality rate of patients with good allograft function(4.3% vs 2.2%)(all P>0.05). The graft survival rate was 97.8% in the highly-sensitized group, while 100% in the control group. And the rate of patient survival in these two groups was 95.7% and 97.8%, with no statistical differences(all P>0.05). Conclusions: Immune-induction therapy that combines Rituximab with ATG can significantly inhibit lymphocyte proliferation. It is effective and safe in treating hypersensitive patients. The survival rate of human/kidney of hypersensitive patients in the short and medium term is comparable to those with low immune risk.

Objective To preliminarily explore the clinical efficacy of ipsilateral simultaneous pancreas and kidney transplantation (SPK) .Methods Ipsilateral SPK was performed in 40 patients from September 2016 to August 2018 .During a follow-up period of 6 to 29 months ,we summarized the efficacy and complications of the technique .Results Up to now ,38 patients achieved an exceelent clinical efficacy with no major surgical complications .However ,two patients died of severe pneumonia .The postoperative serum levels of creatinine at 3 ,6 ,12 ,24 months were 107 ,102 ,107 ,110 umol/L ;creatinine clearance rate 64 ,67 ,64 ,63 ml/min;fasting glucose 4 .6 ,5 .1 ,4 .6 ,5 .2 mmol/L ;glycated hemoglobin 4 .8％ , 5 .4％ ,4 .9％ ,5 .2％ respectively .And 1/2-year pancrea and kidney graft survival rates both were 92％ . Complications included kidney graft rejection (n= 11) ,pancreas graft rejection (n= 12) ,simultaneous renal & pancreas graft rejection (n=6) ,renal graft DGF (n=1) ,pulmonary infection (n=14) ,urinary tract infections (n=18) ,gastrointestinal bleeding (n=10) diarrhea (n=6) ,splenic venous thrombosis (n=2) ,incomplete ureteric obstruction of renal allograft (n=3) ,urine leakage (n=1) and pancreas allograft dysfunction (n= 2) .There were no severe surgical complications .After aggressive interventions ,all postoperative complications were cured and none required excision of kidney or pancreas .Conclusions Ipsilateral SPK has definite therapeutic efficacy and it is worth wider popularization .

Background: In this paper, the regular flow of ultrasound-guided renal allograft biopsies was established by analyzing complications and clinical management principle of ultrasound-guided renal allograft biopsies, to increase the safety of ultrasound-guided renal allograft biopsies. Methods: The purpose of this study was to analyze the cases of ultrasound-guided renal allograft biopsies in our hospital from January 2006 to October 2018 because of abnormal renal function (including symptoms of albuminuria and elevated serum creatinine). The type of puncture needle used in renal allograft biopsies, the number of puncture needle and the relationship between puncture needle and complication were counted, and the treatment measures were analyzed. Results: From January 2006 to October 2018, a total of 487 patients underwent ultrasound-guided renal allograft biopsies in our hospital. Among them, the successful sampling rate was 98.8%, and the average number of glomeruli per specimen was 15.24 +/- 2.26. The complications of the patient after puncture included: perirenal hematomas, subcapsular hematomas, acute ureter obstruction caused by hematuria, gross hematuria, and microscopic hematuria. Among them, two patients were treated with open surgery to save the function of renal transplantation, and the primary treatment measures were to increase the absolute bed rest time. The symptoms of the patients were relieved after treatment. Conclusions: The analysis showed that ultrasound-guided renal allograft biopsies are safe and feasible, and the analysis of the biopsies of patients can provide meaningful pathological information for the clinic.

目的 通过长期病理随访探讨青年受体接受高龄亲属活体供肾肾移植的安全性.方法 根据供体年龄不同,将28例青年受体分为观察组(14例,高龄供体)和对照组(14例,中青年供体).分别比较两组移植肾术后7年的存活情况及术后各时间点的血清肌酐(Scr)水平;比较两组在零时、术后6个月、术后7年移植肾活组织检查(活检)的慢性病理损伤评分;比较两组受体术后6个月、术后7年移植肾间质纤维化相关指标结缔组织生长因子(CTGF)、转化生长因子(TGF)-β、层黏连蛋白(LN)、纤维连接蛋白(FN)及细胞衰老相关指标细胞间连接蛋白(Cx)43及哺乳动物雷帕霉素靶蛋白(mTOR)的表达量.结果 观察组和对照组移植肾术后7年存活率分别为78.5％和92.8％,差异无统计学意义(P>0.05).观察组、对照组术后7 d Scr水平分别为190、160μmol/L,术后1个月Scr水平分别为170、125μmol/L,观察组术后各时间点的Scr水平均高于对照组,差异均有统计学意义(均为P<0.05).观察组移植肾组织零时活检的慢性病理损伤总评分明显高于对照组(P<0.05),但两组术后7年的慢性病理损伤总评分无明显差异(P>0.05).观察组和对照组组内各时间点比较,术后7年活检的慢性病理损伤总评分均高于零时活检及术后6个月活检的慢性病理损伤总评分(均为P<0.05).两组术后7年移植肾组织中CTGF、TGF-β、LN、FN、mTOR、Cx43表达量的比较差异均无统计学意义(均为P>0.05).结论 长期随访结果显示青年受体接受高龄供肾与接受中青年供肾的病理学改变相似,从病理学角度考虑青年受体接受高龄供肾是安全可行的.

Chronic kidney disease (CKD) is a highly heterogeneous nephrosis that occurs when the structure and function of the kidney is damaged. Gene expression studies have been widely used to elucidate various biological processes; however, the gene expression profile of CKD is currently unclear. The present study aimed to identify diagnostic biomarkers and therapeutic targets using renal biopsy sample data from patients with CKD. Gene expression data from 30 patients with CKD and 21 living donors were analyzed by weighted gene co-expression network analysis (WGCNA), in order to identify gene networks and profiles for CKD, as well as its specific characteristics, and to potentially uncover diagnostic biomarkers and therapeutic targets for patients with CKD. In addition, functional enrichment analysis was performed on co-expressed genes to determine modules of interest. Four co-expression modules were constructed from the WGCNA. The number of genes in the constructed modules ranged from 269 genes in the Turquoise module to 60 genes in the Yellow module. All four co-expression modules were correlated with CKD clinical traits (P<0.05). For example, the Turquoise module, which mostly contained genes that were upregulated in CKD, was positively correlated with CKD clinical traits, whereas the Blue, Brown and Yellow modules were negatively correlated with clinical traits. Functional enrichment analysis revealed that the Turquoise module was mainly enriched in genes associated with the ‘defense response’, ‘mitotic cell cycle’ and ‘collagen catabolic process’ Gene Ontology (GO) terms, implying that genes involved in cell cycle arrest and fibrogenesis were upregulated in CKD. Conversely, the Yellow module was mainly enriched in genes associated with ‘glomerulus development’ and ‘kidney development’ GO terms, indicating that genes associated with renal development and damage repair were downregulated in CKD. The hub genes in the modules were acetyl-CoA carboxylase α, cyclin-dependent kinase 1, Wilm's tumour 1, NPHS2 stomatin family member, podocin, JunB proto-oncogene, AP-1 transcription factor subunit, activating transcription factor 3, forkhead box O1 and v-abl Abelson murine leukemia viral oncogene homolog 1, which were confirmed to be significantly differentially expressed in CKD biopsies. Combining the eight hub genes enabled a high capacity for discrimination between patients with CKD and healthy subjects, with an area under the receiver operating characteristic curve of 1.00. In conclusion, this study provided a framework for co-expression modules of renal biopsy samples from patients with CKD and living donors, and identified several potential diagnostic biomarkers and therapeutic targets for CKD.

Background: Although immunosuppressive agents used in recipients of organ transplants can suppress T cell immune responses, type 1 allergy to ingested or inhaled allergens after organ transplantation have frequently been reported in pediatric patients. This study aims to investigate the relationship between the use of immunosuppressive agents and the transplant-acquired allergy (TAA) in adult renal transplant recipients (RTRs). Methods: Seventy-nine RTRs treated in our hospital from February 2015 to February 2016 were interviewed for allergic diseases by using a standard questionnaire. UniCAP allergen screening tests were performed to detect total IgE and specific IgE levels before and after renal transplantation after the use of calcineurin inhibitor tacrofimus (FK506) or cyclosporin A (CsA). The follow-up visits were scheduled for 6 months, 1 year, 2 years, and 3 years after transplantation. Results: Allergen sensitization occurred in 9 of 79 patients. Among them, the sensitization occurred in 2 cases within 6 months after renal transplantation, in 1 case from 6 months to 1 year, in 3 cases from 1 to 2 years, and in 3 cases from 2 to 3 years. The majority of sensitization was induced by inhaled allergens (n=7), among whom 3 patients (3/79, 3.8%) had a history of type I allergy, which occurred within 6 months after transplantation in 2 cases (allergic dermatitis) and from 2 to 3 years in 1 case (diarrhea after peanut allergy). The total IgE levels of RTRs using immunosuppressive agents at different time points including 6 months, 1 year, 2 years, and 3 years after renal transplantation were significantly lower than that before surgery (all P<0.05). Sensitization occurred in 8 RTRs using FK506 and in 1 patient treated with CsA (P=0.432), and allergies occurred in 3 RTRs using FK506 and were not found among CsA users (P=0.561). Conclusions: Administration of immunosuppressive agents in adult RTRs cannot wholly prevent allergy or sensitization. Studies with larger sample sizes and more extended follow-up periods arc still required to further explore the potential association between the use of FK506 and CSA and the allergies or sensitization.

BACKGROUND:Simultaneous pancreas-kidney (SPK) transplants for patients with type 1 diabetes mellitus (T1DM) remains disproportionately higher than that for type 2 diabetes mellitus (T2DM) patients. However, understanding the surgical outcomes for these patients is not well described. Therefore, the results of DM patients with end-stage renal disease and their transplantations were reported. METHODS:Between September 2016 and June 2019, 63 SPK transplants were performed in our organ transplantation center. χ2 and t-test compared the variables between the groups and the record review verified the patient survival. Using Kaplan-Meier survival estimates and Cox proportional hazards regression, we examined the influence of SPK on patient and graft survivals. RESULTS:Sixty-three SPK transplantation was performed, 18 (29%) were T1DM, and 45 (71%) T2DM. T2DM recipients had older age, duration of diabetes, and pretransplant dialysis time. No differences were found in human leukocyte antigen (HLA) mismatch, body mass index (BMI), and other variables. Patient survivals for T1DM was 98.2% and 94.8% at 1 and 2 years vs. 100% and 94.1% for T2DM recipients (P=0.87). There was no increased risk between kidney disease, pancreas failure, or death when comparing T2DM and T1DM. CONCLUSIONS:In our single-center cohort of SPK transplants, we concluded that SPK recipients with T2DM diagnosis were not at increased risk for death, kidney failure, or pancreas failure when compared with recipients with T1DM.