BackgroundDual kidney transplantation (DKT) from small pediatric donors, either en-bloc or split dual kidney transplantation, contributes to mitigating organ scarcity. This study investigates the prognosis of DKT from pediatric deceased donors, and influencing factors.MethodA retrospective study included recipients who underwent DKT from pediatric donors between 2012 and 2022. Recipients were categorized into low mismatch (BWLM, n = 30) and high mismatch (BWHM, n = 10) groups based on donor-recipient weight ratio of 1:10. Outcome encompassed recipient and graft survival, renal function, and adverse events.ResultForty recipients were included. The average follow-up period was 54.6 months. The 1, 3, and 5-year patient survival were 97.4%, with no significant differences between en-bloc and split dual kidney transplantation or between BWLM and BWHM groups. The graft survival at 1, 3, and 5 years were 89.9%, the graft survival of BWHM group was lower than BWLM group (70% vs 96.7%, p = 0.039). The average eGFR at 1, 3, and 5 years postoperatively were (78.93 +/- 25.23), (83.82 +/- 32.4), and (85.92 +/- 37.08) mL/min/1.73 m2, respectively. The BWHM group also experienced higher rates of graft-related surgical complications (p = 0.006) and urinary tract surgical complications (p = 0.042).ConclusionDKT from pediatric donors yields favorable outcomes, with similar graft survival and complication rates across surgical subgroups. However, significant donor-recipient weight mismatch, particularly when the ratio is less than 1:10, may contribute to increased surgical complications and poorer graft survival. Efforts to minimize extreme weight mismatch are recommended to optimize outcomes.

ObjectivesEffectiveness of nirmatrelvir/ritonavir (NR) in kidney transplant recipients (KTRs) infected COVID-19 for more than 5 days has not been evaluated.MethodsIn this multicenter retrospective study, 85 KTRs with COVID-19 were enrolled, including 50 moderate, 21 severe, and 14 critical patients.ResultsThe median time from onset to starting NR treatment was 14 (IQR, 11-19) days. Before NR treatment, 96.5% patients reduced use of antimetabolites. They also stopped using calcineurin inhibitors (CNI) 12-24 hours before NR treatment, with CNI concentrations well-controlled during NR treatment. The use of intravenous corticosteroids increased with COVID-19 severity. The median time to reach viral negative conversion was 5 (IQR, 4-8) days for all patients. For moderate and severe COVID-19 patients, they had a low rate of ICU admission (1.4%), exacerbation requiring upgraded oxygen therapy (5.6%), and dialysis (2.8%); no intubation and mechanical ventilation, and no deaths were observed. Patients with critical COVID-19 had a low mortality rate (7.1%).ConclusionsA regimen including NR for clearing SARS-CoV-2 along with reducing immunosuppressants and using intravenous corticosteroids is associated with lower rates of exacerbation and mortality in KTRs who have moderate to critical SARS-CoV-2 infection and the virus still present after 5 days.

Objective This study aimed to investigate the role of microRNA-34a (miR-34a) in regulating liver regeneration (LR) and the development of liver cancer in rats by targeting Notch signaling pathway. Methods Thirty male Sprague-Dawley (SD) rats were randomly assigned into partial hepatectomy (PH) group and sham hepatectomy (SH) group. Hematoxylin and eosin (HE) staining was used to observe the histological change in liver tissues. Enzyme-linked immunosorbent assay (ELISA) was used to measure the serum tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) levels. Dual-luciferase reporter gene assay was performed to examine whether miR-34a targeted Notch1 gene. Human liver cancer Huh7 cells were transfected and divided into blank, negative control (NC), miR-34a mimics and miR-34a inhibitors groups. MTT and flow cytometry were used to detect cell growth, and cell cycle and apoptosis, respectively. Quantitative real-time polymerase chain reaction (qRT-PCR) was applied detect to the expressions of miR-34a and Notch receptor mRNA. Western blotting was performed to detect the protein expressions of Notch receptors, P21, Bax, Bcl-2 and Bcl-xL. Tumor xenograft in nude mice was done to observe tumor formation in different groups. Results Compared to the SH group, miR-34a expression in liver tissues in the PH group decreased first and then increased to the normal level during LR. In early stage of LR, the expressions of Notch receptors and miR-34a were negatively correlated. Compared to the blank and NC groups, the cell growth was inhibited, cell cycle was mainly arrested in the G2/M phase and cell apoptosis rate increased in the miR-34a mimics group. Moreover, the expressions of miR-34a, P21 and Bax were up-regulated, while the expressions of Notch receptors, and Bcl-2 and Bcl-xL were down-regulated in this group. Additionally, the tumor growth in the miR-34a mimics group was reduced. The miR-34a inhibitors group showed contrary tendencies. Conclusion Our study demonstrates that miR-34a regulated LR and the development of liver cancer by inhibiting Notch signaling pathway.

To analyse the difference in COVID-19 infection between kidney transplant patients and non-transplant patients. We included post-transplant patients with COVID-19 infection who attended Shenzhen No. 3 Hospital from December 2022 to February 2023, and enrolled the general population with COVID-19 infection who were hospitalized during the same period, matched by age and gender. They were divided into Kidney Transplant Recipients group (KTR) (n=194) and Non-Kidney Transplant Recipients Group（NKTR）(n=516) and the basic information, clinical symptoms, laboratory data, treatments and outcomes of these two groups were compared. The proportion of the renal transplant population classified as severe and critical was 15.5%, which was significantly higher than that in NKTR group (P < 0.05); the proportion of patients with pneumonia was also significantly higher than that in NKTR group. The mean maximum fever temperature was slightly higher in the NKTR( P <0.001);Kidney transplant population having lower absolute lymphocyte counts on admission and 7 days after admission than the general population, with statistically significant differences（ P <0.001, P ＜0.001). The use of intravenous hormones was significantly higher (42.8% vs. 6.0%, p=0.000), as was the use of small molecules such as Azvudine and Paxlovid, compared to the general population. A total of 10 patients in the included population required ICU admission, all in the KTR group; six patients experienced death, also in the renal transplant group. Conclusion: Post-transplant COVID-19 infections are more severe and require hormonal and small molecule antiviral therapy, and the prognosis is worse than in the general population.

Background We analyzed the effects of small-molecule antiviral treatment for coronavirus disease-2019 (COVID-19) Omicron strain in kidney transplant recipients. Methods We enrolled 140 kidney transplant patients admitted for COVID-19-related pneumonia were treated using small-molecule antivirals. Patients were divided into three groups: azvudine (n=62), paxlovid (n=49), and a combination of azvudine+paxlovid (A+P, n=29). Differences in clinical outcomes owing to COVID-19 infections were compared among three groups. Results Paxlovid group had a higher proportion of comorbid diabetes than the other two groups (P=0.032). There were differences in the clinical typing of the coronavirus , with the highest proportion of heavy and critical cases in the A+P group (35.5%). The immunosuppression prior to infection did not differ among the groups; however, after adjusting for immunosuppression during antiviral treatment, differences were observed. Of the 140 patients, 125 (89.29%) had fever, 114 (81.43%) had cough, and 66 (47.1%) had malaise. Combination of two or more symptoms were found in 90% patients. Mean length of hospitalization was slightly longer in the combination group than in the azvudine and paxlovid groups. Four deaths, all in the A+P group; five cases of loss of function, two in the paxlovid group and three in the A+P group; and acute kidney injury occurred in 30 patients with 7 in the azvudine, 17 in paxlovid, and 6 in A+P groups. Conclusion The use of small-molecule medications may be the optimal treatment approach; however, they should be modified based on the patients’ conditions, such as clinical symptoms, laboratory results, paraclinicals, and examinations.

Objective:To establish donor liver quality related risk factors for the loss of function of transplanted liver.Methods:The data of donors and recipients of liver transplantation at the Organ Donation and Transplantation Center of the First Affiliated Hospital of Sun Yat-sen University from Nov 2011 to Dec 2018 were analyzed retrospectively. Propensity score matching (PSM) was performed to evaluate and screen the data of donors and recipients, in order to balance the covariates.Results:Of the organ donation, there were 70 males and 20 females , aging (40.6±16.3) years. Of the liver transplantation recipients, there were 70 males and 20 females , aging (41.8±20.3) years. Liver dysfunction after transplantation was significantly correlated with the following variables: the donor's CPR time( t=0.429, P=0.000), 15-minute retention rate of indocyanine green ( χ2=67.151, P=0.000), liver function grading ( χ2=54.154, P=0.000), bullae fatty liver grading ( χ2=8.120, P=0.017), vesicular fatty liver grading ( χ2=16.000, P=0.001), ICU stay time ( χ2=14.900, P=0.001)and serum creatinine level ( χ2=44.685, P=0.000). The donor scoring system was established in our studying. For the 90 organ donation cases, the donated liver quality were classified into four levels,which were of good correspondence to the prognosis of the recipients. Conclusion:This donor scoring system and grading standards established by analyzing the high-risk factors of liver dysfunction after transplantation helps evaluate the quality of donor liver in China.

Background Metabolic syndrome (MS) is common in kidney transplant recipients(KTRs) and associated with an increased risk of cardiovascular events. There is a need for accurate, non-invasive methods to predict MS in this population. Lipid accumulation product (LAP) is an effective marker of central lipid accumulation related to high risk of MS, cardiovascular disease(CVD) and diabetes. This study aims to assess the ability of LAP as a marker of MS in KTRs. Methods A total of 92 KTRs were included in this study. The general anthropometries and blood biochemical indexes were measured. Body mass index(BMI), waist-hip ratio (WHR), LAP, HOMA-IR and Framingham risk scores(FRS) were calculated. Results The prevalence of MS was 57.8 % in KTRs. Respectively, 64.1%, 16.3%, and 19.6% of patients with KTRs were at low, intermediate, and high risk of CVD according to FRS categorization. KTRs with MS had significantly higher LAP levels compared to those without MS. LAP was highly correlated with lipid metabolism, abdominal obesity, glucose metabolism and inflammatory factor in KTRs. Our analyses revealed that LAP is an independent risk factor for development of MS. Receiver operating characteristic curve (ROC) analysis showed that LAP was a significant discriminator for prediction of MS in KTRs. The optimal cutoff value for LAP in predicting MS was 39.72 (80.8 % sensitivity, 90 % specificity). Conclusion Our study revealed all adiposity measures of interest present themselves as easy and practical tools for evaluating MS in KTRs and LAP is the best index for the determination of MS in KTRs among them.

Objective:To explore the clinical efficacy of dual-kidney transplantation from infant donors to adult recipients.Methods:From December 2012 to November 2020 in Organ Transplant Center First Affiliated Hospital Sun Yat-sen University, rertrospective reviews were conducted for clinical data of 25 pairs of infant donors and adult recipients. The survival rates were calculated for both recipients and transplanted kidneys at Year 1/3/5 post-transplantation. And the postoperative recovery status and the postoperative incidence of adverse events of recipients were observed.Results:The survival rates of recipients were all 95.8% at Year 1/3/5 and those of transplanted kidney and dealth-cancelling transplanted kidney all 87.2%. One case died due to acute inferior-wall cardiac infarction while three others lost renal functions for vascular thrombosis, ureteral stenosis and urinary fistula. Except for loss of renal function and death, the postoperative estimated golmerular fitration rate was (99.35±21.78), (103.11±29.20) and (114.99±28.55) ml/(min·1.73 m 2) at Year 1/2/3 respectively. Conclusions:Selecting proper recipients, standardizing donor acquisition and surgical procedures and strengthening perioperative managements may expand the donor pool. The overall outcomes are excellent for adult recipients with dual-kidney transplantation from donations after infants' death.

Background Kidneys from very small pediatric donors (≤10 kg) are underutilized. Compared to en bloc kidney transplantation (EBKT), single kidney transplantation (SKT) can maximize donor resources. However, it remains unknown whether it’s appropriate to perform SKTs from donors weighing ≤10 kg. Methods A total of 35 adult recipients undergoing kidney transplantation from donors weighing ≤10 kg at our center from December 2014 to December 2019 were included and grouped into SKT group (n=20) and EBKT group (n=15). Transplant outcomes were retrospectively analyzed and compared between 2 groups. Results The 1-year and 3-year death-censored graft survival in SKT group was 95%, it is not significantly higher than that in EBKT group (80%, log-rank test, P=0.38). Significant improvement in estimated glomerular filtration rate (eGFR) was noted in both groups, despite eGFR at 1 year was lower in the SKT group (P<0.01). Proteinuria was common in both groups but subsided gradually during the follow-up time. Complication rates were similar between 2 groups with no vascular thrombosis in the SKT group. Conclusions In conclusion, SKTs from donors weighing ≤10 kg to adult recipients achieves comparable outcomes with EBKTs, which provides evidence to support performing SKTs from donors weighing ≤10 kg in certain donor and recipient scenarios.

多粘菌素B被认为是针对某些顽固性革兰阴性菌的终极抗菌药物,它具有出色的抗菌活性,会对患者造成多种不良影响.然而,由多粘菌素B引起的皮肤色素沉着很少.报告1例多粘菌素B引起的32岁男性皮肤色素沉着过度.据所知,这在中国是很少见的多粘菌素B引起的皮肤色素沉着的案例.一例32岁男性肾移植术后脓毒症患者接受了静脉注射多粘菌素B,用于治疗多药耐药性大肠杆菌感染.此后,在治疗期间服用多粘菌素B 5d后,其患有罕见的药物不良反应,即多粘菌素B引起的皮肤色素沉着.起初在全身皮肤上散布了多个红色皮疹.随着皮疹的消失,出现带有黑色圆形斑点的色素沉着,无疼痛或瘙痒.头颈部皮肤明显变黑,躯干和四肢皮肤上散布着黑褐色斑点.停止注射多粘菌素B大约半个月后,其病逝于脓毒性休克,那时肤色还没有恢复.案例与文献综述均证实多粘菌素B确实可以引起皮肤色素沉着.临床医生和药剂师应更加注意这种罕见的色素性疾病,也需要进一步检查.

Background: Ischemia-reperfusion injury (IRI) has been considered an inevitable event in organ transplantation since the first successful kidney transplant was performed in 1954. To avoid IRI, we have established a novel procedure called ischemia-free organ transplantation. Here, we describe the first case of ischemia-free kidney transplantation (IFKT). Materials and Methods: The kidney graft was donated by a 19-year-old brain-dead donor. The recipient was a 47-year-old man with end-stage diabetic nephropathy. The graft was procured, preserved, and implanted without cessation of blood supply using normothermic machine perfusion. Results: The graft appearance, perfusion flow, and urine production suggested that the kidney was functioning well-during the whole procedure. The creatinine dropped rapidly to normal range within 3 days post-transplantation. The levels of serum renal injury markers were low post-transplantation. No rejection or vascular or infectious complications occurred. The patient had an uneventful recovery. Conclusion: This paper marks the first case of IFKT in humans. This innovation may offer a unique solution to optimizing transplant outcomes in kidney transplantation.

Background Baseline chronic donor kidney injury is usually scored using Remuzzi’s classification. It has been suggested that kidneys with Remuzzi scores of 0-3 can be transplanted singly. The kidney function and graft survival of renal grafts from donation after cardiac death (DCD) donors with Remuzzi scores of 4-5 in solitary kidney transplantation is unknown. Methods Preimplant kidney biopsy for 145 consecutive, solitary, DCD kidneys transplanted at our center from July 2013 to December 2016 was retrospectively reviewed. Kidneys with Remuzzi scores of 4-5 were accepted for solitary kidney transplantation in our center if the donors’ terminal serum creatinine clearance > 60 ml/min (Cockcroft formula). Results The 12 months estimated glomerular filtration rate (eGFR, by the CKD-EPI equation) of renal grafts with Remuzzi score of 0-3 was significantly higher than grafts with Remuzzi score of 4-5 (76.3 ± 21.4 ml/min vs. 44.0 ± 10.9 ml/min,P<0.001). The 12 months eGFR of renal grafts with Remuzzi score of 3 was significantly higher than grafts with Remuzzi score of 4 or 5 (P<0.01) . With a follow-up of 14-40 months, Kaplan-Meier analysis showed that there were no statistical differences in graft survival between kidneys with Remuzzi score 0-3 and 4-5. Conclusions Kidneys from DCD donors with Remuzzi score 4-5 have worse graft function at one year after solitary kidney transplantation but with acceptable short-term graft survival.

Background Rhabdomyolysis is common in trauma patients with acute renal injury (AKI). The kidneys from donors with rhabdomyolysis and AKI may show discolored appearance. The transplant surgeons may be unwilling to accept a kidney with AKI and black appearance, especially when the kidney is anuric. Method Fourteen discolored (from brown to glossy black) kidneys from 7 deceased donors with severe rhabdomyolysis and AKI (defined as Kidney Disease Improving Global Outcomes (KDIGO) AKI Stage 1 - 3) were accepted for transplantation at our centers. Generally, we accept kidneys with a resistance < 0.4 mmHg/mL/min in pump perfusion when an preimplant biopsy excludes cortical necrosis and chronic lesions (>10% glomerulosclerosis, interstitial fibrosis, tubular atrophy). The kidney transplant results of 14 black kidneys from rhabdomyolysis donors were compared with those of 30 renal grafts from standard criteria donors (SCD). Results Two donors received continuous renal replacement therapy due to anuria. The peak serum creatinine kinase, myoglobin, and serum creatinine of the these donors was 27738 ± 7394 U/L, 76003 ± 50708 μg/L, and 442 ± 214 μmol/L, respectively. Pathological examination showed massive casts in the distal convoluted tubules. Immunohistochemically stained for myoglobin showed luminal myoglobin casts or prominent tubular epithelial cell reaction for myoglobin in the absence of luminal casts. Electron microscopy showed electron-dense casts consistent with myoglobin within tubular lumens. The estimated glomerular filtration rate (by the CKD-EPI Creatinine 2009 equation) at 1 years post-transplantation was similar between black kidneys from donors with rhabdomyolysis and SCD (69.8 ± 13.6 ml/min/1.73m2 vs. 71.2 ± 15.1 ml/min/1.73m2, P = 0.56). Conclusion If the rhabdomyolysis donor has a peak serum creatinine kinase level higher than 20 000 U/L and has tea- colored urine, the kidneys are likely to have a black appearance after in situ cold perfusion. Discolored kidneys from rhabdomyolysis donors with AKI can achieve excellent graft function, even when the kidneys are anuric. Routine screening for rhabdomyolysis should be performed in donors with AKI.

The acute kidney injury (AKI) of deceased donors was an important strategy to address donor shortage. This meta-analysis was conducted to explore the clinical effect of kidney transplantation from donors with AKI. PubMed, Embase, and Cochrane Library were searched through July 2017. Fourteen cohort studies, involving a total of 15,345 donors, were included. Studies were pooled, and the hazard ratio (HR), relative risk (RR), weighted mean difference (WMD), and their corresponding 95% confidence interval (CI) were calculated. The present meta-analysis showed no significant difference in allograft survival between the AKI and non-AKI groups (HR = 1.16, 95% CI = 0.99–1.37, Pheterogeneity = 0.238, I2 = 21.6%) from 12 months to 120 months after kidney transplantation. However, the time of hospital stay was significantly longer (WMD = 2.49, 95% CI = 1.06–3.92, Pheterogeneity = 0.458, I2 = 0%) and the incidence of delayed graft function (DGF) was significantly higher (RR = 1.76, 95% CI = 1.52–2.04, Pheterogeneity < 0.001, I2 = 71.2%) in the AKI group than in the non-AKI group. We concluded that even though hospital stay time was longer and the incidence of DGF was significantly higher in the AKI group, there is no significant difference in allograft survival between the two groups.

Objective To explore the clinical outcome of renal transplantation and analyze the risk factors influencing the kidney allograft survival after transplantation.Methods The clinical data of 524 cases of renal transplantation between January 2007 and December 2015 were retrospectively analyzed.Serum creatinine was determined,and glomerular filtration rate(GFR) was estimated.The 1-,2-and 3-year patient and graft survival after transplantation was calculated.Adverse events were recorded.Results The median follow-up time was 17.2 months.The 1-,2-and 3-year graft survival rate after transplantation was 97％,95.8％ and 95.3％,respectively.The 1-,2-and 3-year patient survival rate after transplantation was 97.8％,97％ and 97％,respectively.The eGFR was (67.6 ± 24.1),(68.9±24.2) and (72.7 ± 26.2) ml·min-1 ·1.73 m-2 at 1st,2nd and 3rd year after transplantation.The incidence of delayed graft function(DGF) was 20.6％ (108/524).Multivariate analysis revealed donor type (P =0.005) and the terminal creatinine (P＜0.001) were the independent risk factors of DGF.Elder recipients (P =0.004),recipients with diabetes(P =0.031),preoperative positivity of panel reactive antibody(PRA) (P =0.023),and donor with hypertension (P =0.046) were risk factors influencing the kidney allograft survival.Conclusion Kidney transplantation showed good outcomes at 3rd year after transplantation.The recipient age,recipient's history of diabetes,preoperative PRA and donor's history of hypertension are independent risk factors for renal graft survival.

我国自2010年开展心脏死亡器官捐献（donation after cardiac death,DCD）试点工作[1]以来,截至2016年9月,已完成8 866例器官捐献,获取各类供器官近2.5万个。由于DCD供肾功能差异较大,供肾弃用时有发生。本研究回顾性分析2011年7月至2015年9月中山大学附属第一医院器官移植三区弃用供肾的DCD供者资料,总结相关

Objective To analyze the incidence of BK virus (BKV) infection after kidney transplantation in our center and to evaluate the efficacy and safety of conversion treatment with Mizoribine (MZR) on BKV infection after kidney transplantation.Methods The information of recipients who received BK virus screening in hospital or outpatient during 2015-02 to 2016-12 in our center was retrospectively analyzed.The recipients positive for BKV were divided into experiment group (given conversion treatment with MZR) and control group (not given MZR conversion) according to the inclusion criteria.The negative rate of BKV,AR,hyperuricemia and the function of renal allograft during the conversion treatment with MZR were observed.Results 182 recipients accepted BKV screening during 2015-02 to 2016-12 and 68 cases were positive.The positive rate of BKV was 38.5 ％.The positive rate of peripheral blood specimens and midstream urine specimens was 7.1％ and 36.8％ respectively.Twelve recipients were positive for BKV in both peripheral blood specimens and midstream urine specimens.There were 27 recipients in experiment group and 36 cases in control group.Fourteen recipients positive for BKV became negative after MZR conversion in experiment group and the negative rate was up to 51.9％.The mean time of negative rate was 3.2 ± 2.7 (1-10) months after MZR conversion.During the conversion treatment with MZR,AR occurred in 1 case and was reversed by the impact therapy with Thymoglobulin in experiment group.The value of serum uric acid was maintained stable before and after MZR conversion under the action of uric-acidlowering drug.The renal function was kept stable in both experiment group and control group after renal transplantation.No deaths and renal allograft failure cases occurred in both groups during the research period.The 2-year survival rate for patients and kidneys was both 100％.Conclusion The incidence of BKV infection after kidney transplantation was high and the treatment scheme of MZR conversion was safe and effective.

Rhabdomyolysis in deceased donors usually causes acute renal failure (ARF), which may be considered a contraindication for kidney transplantation. From January 2012 to December 2016, 30 kidneys from 15 deceased donors with severe rhabdomyolysis and ARF were accepted for transplantation at our center. The peak serum creatinine (SCr) kinase, myoglobin, and SCr of the these donors were 15569 +/- 8597U/L, 37092 +/- 42100 mu g/L, and 422 +/- 167 mu mol/L, respectively. Two donors received continuous renal replacement therapy due to anuria. Six kidneys exhibited a discolored appearance (from brown to glossy black) due to myoglobin casts. The kidney transplant results from the donors with rhabdomyolysis donors were compared with those of 90 renal grafts from standard criteria donors (SCD). The estimated glomerular filtration rate at 2 years was similar between kidney transplants from donors with rhabdomyolysis and SCD (70.3 +/- 14.6 mL/min/1.73m(2) vs 72.3 +/- 15.1 mL/min/1.73m(2)). We conclude that excellent graft function can be achieved from kidneys donors with ARF caused by rhabdomyolysis.

It has been reported that microRNAs (miRs) can regulate renal response to acute injury and members of them are believed to be important in maintenance of renal function and development of renal injury. We investigated the actions of microRNA423- 5p (miR-423-5p) and glutathione-S-transferase (GST) M1 after acute kidney injury. MiR-423-5p was up-regulated and GSTM1 was down-regulated in human kidney (HK-2) cells subjected to hypoxia/reoxygenation (H/R) and in rat kidneys subjected to ischemia/reperfusion (I/R) injury. Dual luciferase assays revealed miR-423-5p binding to the 3' untranslated region of GSTM1. Proliferation was lower and apoptosis, ER stress and oxidative stress were all higher in H/R-treated HK-2 cells transfected with or without miR-423-5p mimics and GSTM1 siRNA than in the same cells transfected with miR-423-5p inhibitors and a GSTM1 expression vector. Increased miR-423-5p and decreased GSTM1 mRNA and protein levels were observed in rat kidneys on days 1, 2 and 7 after I/R. Levels had normalized by days 14 and 21. On day 3 after treatment, rats receiving I/R or I/R plus miR-423-5p mimics exhibited higher serum creatinine and urea nitrogen levels than rats receiving I/R plus a miR423- 5p inhibitor. MiR-423-5p and lower GSTM1 mRNA and protein levels were higher in the I/R and I/R plus miR-423-5p mimic groups than in the I/R plus miR-423-5p inhibitors group. These findings demonstrate that after acute kidney injury, miR-4235p induces ER stress and oxidative stress by inhibiting GSTM1and suppresses repair.