Objective To evaluate the efficacy of tigecycline plus prolonged high-dose meropenem infusion in the prevention and treatment of early carbapenem-resistant Klebsiella pneumoniae (CRKP) infection after renal transplantation .Methods From January 2016 to December 2018 ,clinical data were retrospectively analyzed for 13 renal transplant recipients with graft-carried CRKP .The relevant clinical data included treatments and outcomes of grafts and recipients .KPC-2 gene was the only resistance gene detectable in all isolates of CRKP . Among 13 CRKP positive recipients ,there were positive cultures of graft preservation solution ,recipient blood & urine (n=1) , positive cultures of graft preservation solution & urine (n=1) ,positive cultures of graft preservation solutions & peri-graft drainage (n=3) ,continuous positive cultures of peri-graft drainage more than twice (n= 3) and positive culture of graft preservation solution (n= 5).All patients received tigecycline plus prolonged high-dose meropenem infusion-based antibiotics .Results Five patients with CRKP positive in preservation solution were successfully prevented from infection after a treatment period of (12 .4 ± 2 .1)days .Among another 8 cases ,additional topical medications (n= 3) and surgical debridement (n= 1) were used .It took a median time of 16 (7～60) days until a negative culture and the total antibiotic treatment course was 20 (10～93) days .The average hospitalization duration was (50 ± 35) days .During a median follow-up period of 25 (6～28) months ,there was no onset of renal arterial rupture ,graft nephrectomy or death .The survival rate was 100％ for recipients and 92 .3％ for grafts .Conclusions For post-transplant infections due to graft-carried KPC-2 producing CRKP ,rapid diagnostics and tigecycline plus prolonged high-dose meropenem infusion may optimize clinical outcomes by decreasing the rate of graft nephrectomy and the recipient mortality .

Objective To explore the feasibility and safety of kidney transplantation for pre-sensitized infants using deceased donors and summarize the relevant literature reports .Methods A second kidney transplantation was successfully performed for an 8-month-old pre-sensitized girl in July 2017 .She had a low level of donor specific antibody (DSA ) against human leucocyte antigen (HLA ) B62 due to severe acute rejection (AR) after her first kidney transplantation .For desensitization , plasmapheresis and intravenous immunoglobulin plus anti-CD20 antibodies were offered on operative day .Clinical data and outcomes were retrospectively analyzed .Results Renal graft regained immediate function after transplantation .Preformed DSA could be detected at 1 week .However ,there was no de novo DSA .At 1 year post-transplantation ,preformed DSA turned negative .During a follow-up period of 2 years ,renal graft showed an excellent function with a serum creatinine of 31 μmol/l and eGFR of 110 ml/min/1 .73m2 .No AR episode or proteinuria occurred .DSA stayed negative .Simultaneously physical development also caught up .Her height of 93 cm tall and weight of 13 .5 kg at month 24 & 8 months corresponded to normal grow th curve of her age .Conclusions Pre-sensitized infant could tolerate desensitization therapy well and achieve satisfactory outcomes .With surgical precisions and optimized managements ,kidney transplantation provides excellent renal functions and survivals for infants with organs from deceased donors .

Objective: To explore the management strategy and clinical outcome of renal transplantation in presensitized recipients using deceased donor kidneys. Methods: From January 2011 to June 2018, twenty-one presensitized patients, including 8 with positive donor specific antibodies (DSA) and 13 with positive panel-reactive antibodies (PRA) but no DSA, received renal retransplantation from deceased donors in our center. The incidence of delayed graft function (DGF) and acute rejection (AR), changes of DSA, and the graft and patient survival were retrospectively analyzed. Results: None of the renal allografts had primary non-function (PNF) and DGF after transplantation. Four of the 13 recipients with PRA(+)/DSA-had a total of 5 episodes of acute cell-mediated rejection (CMR), while 5 of 8 recipients with pre-existing DSA(+) developed AR, including 3 cases with CMR alone and 2 cases with mixed AR. All episodes of rejection were successfully reversed after targeted treatment. Interestingly, of the 8 recipients with positive preformed DSA, 4 cases with positive DR-DSA and/or class Ⅰ-DSA had their DSA disappeared after transplantation, whereas DQ-DSA remained positive in 4 of 5 recipients. After a median follow-up of 26 months, all recipients maintained normal renal allograft function, and the survival rates of both graft and recipient were 100%. Conclusions: With the use of deceased donors, kidney transplantation can be successfully performed in presensitized patients by appropriate HLA-matching screening, choosing donor kidneys with good quality, and the combination of optimal perioperative treatment.

目的 总结公民逝世后器官捐献(DCD)肾移植术后早期移植肾丢失的原因并探讨其预防、诊疗措施.方法 施行DCD肾移植病人521例,总结术后3个月内移植肾丢失的原因并探讨其预防、诊疗措施.结果 2013年DCD肾移植丢失率为1.3％(1/76),2014年早期移植肾丢失率为7.8％ (12/154),2015年早期移植肾丢失率为4.1％ (12/291).其中移植肾出血(52.0％)已成为我中心移植肾早期丢失的主要因素,其次为肺部感染(16.0％)以及心脑血管意外(12.0％),而原发性移植肾无功能(PNF)和排斥反应仅各占4.0％,术后早期移植肾感染是早期移植肾出血的主要因素(61.5％).结论 感染所致的移植肾血管破裂出血是DCD肾移植早期移植肾丢失的主要原因,术前多次供体采样进行微生物学培养及针对性抗感染治疗,对感染高危受者术后进行强化预防性抗感染治疗,有利于降低早期移植肾丢失风险.

目的 探讨肾移植DCD供者来源的白色念珠菌感染的临床特点和防治策略.方法 回顾性分析2015年1月-2016年12月共8例DCD供肾保存液白色念珠菌培养阳性的肾移植受者手术后的临床资料.结果 8例患者中,1例受者未进行预防性抗真菌药物治疗,在术后2周因突发移植肾动脉破裂出血而行移植肾切除,1例受者采用治疗剂量的米卡芬净预防10天,仍然在术后3周因移植肾动脉破裂出血而切除移植肾.其余6例受者在保存液培养回报为白色念珠菌后,结合移植肾周引流液的定期培养监测,5例采用足量足疗程的米卡芬净进行防治,未出现不良后果;1例采用两性霉素B脂质体序贯伏立康唑防治,未出现真菌感染表现.结论 对DCD供肾保存液培养为白色念珠菌的受者,建立有效的监控和防治体系,对于避免真菌感染导致的移植肾严重后果十分必要.

Objective To analyze the outcomes of renal transplantation that donation from ex-panded criteria donors(ECD)in our single center.Methods Reported 50 cases of ECD renal transplan-tation and 140 cases of standard criteria donors(SCD)renal transplantation in the same period.We com-pared the early graft recovery(the percentage of patients in IGF,SGF,DGF)and one year survival rate af-ter transplantation in both two group.Results The differences between ECD group and SCD group in 1-year survival rate of recipients and graft were not statistically significant(P>0.05).But the ECD group in 1,3,6 and 12 mouth post-surgery the serum creatinine and eGFR was worse than the SCD group. The differences had statistically significant(P <0.05). Conclusion While ECD was worse than SCD in transplant renal function(serum creatinine level and eGFR).But there was no significant difference in the early stage of renal transplantation between ECD and SCD,and the reasonable use of ECD for kidney can be an important way to deal with the shortage of organs.But the long-term graft survival should be explored in further follow-up.

Objective: To compare the safety and effectiveness between antithymocyte globulin (ATG) and basiliximab in deceased donor renal transplantation within matched groups where paired recipients received graft donations from same donors. Methods: A total of 124 cases of deceased donor kidney transplantation performed at Wuhan Tongji Hospital from January 2013 to November 2015 were retrospectively analyzed. Based upon their induction therapies, the recipients receiving graft donations from same donors were divided into two groups, namely ATG group (n=62) and basiliximab group (n=62). Clinical data were gathered and comparisons were made between the two groups. Results: Delayed graft function (DGF) implicated less patients in the ATG group (11, 17.7%) compared with basiliximab group (21, 33.9%) (P=0.040). Duration of DGF was also significantly shorter in the ATG group than in the basiliximab group[(14.92±6.23) vs(20.26±7.89)days, P=0.048]. The rates of DGF were 5/18 in the ATG group and 10/15 in the basiliximab group (P=0.025), when subgrouping the patients with elevated risk factors (donor age >50 or a history of hypertension or graft cold ischemia time >24 h) for DGF. The acute rejection rates did not differ between the two groups significantly; comparable one-year graft and patient survival were observed between the ATG and basiliximab groups(all P>0.05). Conclusions: The duration of DGF and DGF rate after deceased donor renal transplantation is reduced by ATG, when compared with basiliximab. Moreover, in recipients with elevated risk factors for DGF, ATG diminishes DGF incidence significantly.

Objective To investigate the feasibility and safety of the single kidney transplantation from pediatric donors to adult recipients.Methods From May 2013 to January 2017,a total of 50 single kidney transplants from pediatric donation after citizen death (DCD) donors of age between 3 to 12 years to adult recipients were performed and the data were summarized.Results The average age of donors was 6.4 ± 2.5 years with an average donor weight of 19.1 ± 5.9 kg,and the average kidney length was 6.3 ± 0.6 cm.For the 50 adult recipients,the average age was 38.5 ± 12.1 years,the average body weight was 56.1 ± 13.1 kg,and the number of female patients was 26 (52％).All except 3 of these patients were transplanted for the first time.Delayed graft function (DGF) was observed in 15 patients (30％).The average value of eGFR among all the patients was rapidly increased in the first 3 months after transplantation and then steadily increased to (82.3 ± 13.4) mL· min-1·1.73 m-2 at 1 st year,followed by (83.8 ± 22.5) mL· min-1·1.73 m-2 at 2nd year.Four renal grafts developed acute rejection (8％),and 3 of them were successfully reversed by the treatment.Pulmonary infection occurred in 4 recipients,and 2 died.During a follow-up period of 19 months,uncensored grafts survival was 94％,and patients survival was 96％.Conclusion Excellent intermediate-term transplant outcome can be achieved by using single kidneys from pediatric donors elder than 3 years,which may shorten the waiting time in adult recipients and alleviate the contradictions in the absence of suitable pediatric recipients.

Objective To analyze the safety of renal transplant from donors with primary central nervous system (CNS) tumors.Methods We retrospectively analyzed the clinical data of 33 donors with primary CNS tumors and the 63 corresponding renal recipients between January 2013 and December 2016 in Tongji Hospital.Results The mean period from diagnosis as primary CNS tumor to donation was about (21.8± 46.4) months (range:0.5 to 192.0 months).The pathological classification of these tumors included gliomas,meningioma,medulloblastoma,etc.Besides,there were 10 donors with high-grade CNS malignancies.Eleven donors have ever been through at least one of the four treatments (craniotomy,V-P/V-A shunt,radiotherapy and chemotherapy),14 donors have undergone none,and the clinical data of rest were unavailable.All the 63 recipients got well renal function after transplant.During an average follow-up of (15.9 ± 8.2) months (range:2.7 to 35.5 months),one recipient got donor-derived rhabdoid tumor 4 months posttransplant,underwent comprehensive treatments,including allograft nephrectomy,radiotherapy,chemotherpy and returned to hemodialysis,while the 62 cases got no donor-derived tumors.Conclusion Tumor transmission of renal allograft from donors with primary CNS tumors is inevitable but with low risk,which means this kind of donors can be used with careful assessment,full informed consent and good balance between wait-list death and tumor transmission.

It has been reported that kidney retransplant patients had high rates of early acute rejection due to previous sensitization. In addition to the acute antibody-mediated rejection (ABMR) that has received widespread attention, the early acute T-cell-mediated rejection (TCMR) may be another important issue in renal retransplantation. In the current single-center retrospective study, we included 33 retransplant patients and 90 first transplant patients with similar protocols of induction and maintenance therapy. Analysis focused particularly on the incidence and patterns of early acute rejection episodes, as well as one-year graft and patient survival. Excellent short-term clinical outcomes were obtained in both groups, with one-year graft and patient survival rates of 93.9%/100% in the retransplant group and 92.2%/95.6% in the first transplant group. Impressively, with our strict immunological selection and desensitization criteria, the retransplant patients had a very low incidence of early acute ABMR (6.1%), which was similar to that in the first transplant patients (4.4%). However, a much higher rate of early acute TCMR was observed in the retransplant group than in the first transplant group (30.3% versus 5.6%, P < 0.001). Acute TCMR that develops early after retransplantation should be monitored in order to obtain better transplant outcomes.

Objective To study the potential role of early generated de novo donor specific antibodies (DSA) in the occurrence of prolonged delayed graft function (DGF).Method Patient 1 was a 42-year-old female who received a living kidney donation from her husband.She had a historic positive PRA but none DSA was detected before kidney transplantation.Patient 2 was a 49-year-old female who received a DCD kidney transplant with negative PRA and CDC.Both patients had prolonged DGF that lasted for more than 1 month.In patient 1,the retrospective measurement of PRA using serum collected on day 10 showed that PRA-Ⅰ increased to 28％,meanwhile,the flow-CDC showed a clear shift from 2.3％ at the baseline to 13.9％,indicating that a relative low level of cytotoxic DSA had been generated.In patient 2,single antigen bead test by Luminex demonstrated the existence of anti-DR9 DSA with a MFI value of 2500 at day 17.Biopsies did not show any typical features of AAMR in both patients.Result In patient 1,without any special treatment of the DSA,the graft function began to recover at 8th week.At day 62 after transplantation,the serum creatinine level decreased to 96 mol/L.In patient 2,with the treatments of plasmapheresis (PP) and intravenous immunoglobulin (IVIG),DSA turned to negative and the urine output began to increase at 7th week after transplantation,followed by a serum creatinine level of 95 mol/L at day 56 post-transplant.Conclusion When the early produced de novo DSA is not potent enough to mediate acute humoral rejection,it may cause renal tubular injury,which can have significant impact on the degree of DGF and its recovery time.Early detection and treatment of DSA seems to be beneficial for the recovery of patients from prolonged DGF.

OBJECTIVE:To assess the effectiveness and safety of the conversion therapy from traditional cyclosporine (CsA) triple immunosuppression therapy to sirolimus (SRL) combined with low dose CsA and prednisone (Pred) in renal transplantation recipients in a five-year follow-up period.METHODS:A prospective, open-label non-randomized study was performed with 46 renal allograft recipients who visited Tongji Hospital regularly for follow-up visits between January 2007 and May 2011 and were taking CsA+ mycophenolate mofetil (MMF)+ Pred. Conversion therapy to SRL+ low dose CsA+ Pred was initiated after renal transplantation. The recipients were allocated to 2 groups according to their renal function and proteinuria before the conversion: active conversion group [n=27, serum creatinine (SCr) ≤ 140 μmol/L with no or minimal proteinuria] and passive conversion group [n=19, SCr>140 μmol/L with less than moderate proteinuria]. After conversion, dosages of SRL and CsA were adjusted for trough levels of 5-7 μg/L and 20-60 μg/L, respectively. SCr and urine protein were compared before and after the conversion in five-year follow-up. Incidence of acute rejection, renal graft survival and SRL-related adverse effects of the immunosuppressive regimen were also observed.RESULTS:After conversion, an average 63% dose reduction of CsA was achieved in all the patients. In the active conversion group, the mean SCr level was (110±19) μmol/L at the time of conversion. Eight patients in this group withdrew from the study during the follow-up period for the following reasons: arthralgia (1 case), deteriorated proteinuria (2 cases), chronic diarrhea (2 cases), mild or suspicious acute rejection (2 cases), and recurrent fever (1 case). The rest patients (19/27) with a mean follow-up time of 5 years had a stable SCr level [(103±12) μmol/L] and a 100% 5-year graft survival. In the passive conversion group, the mean SCr level was (205±45) μmol/L at the time of conversion. There were 4 patients quitting the study, 2 for deteriorated proteinuria and 2 for lost to follow-up. Chronic allograft failure developed in 10 patients in this group 1-50 months after conversion, while the remaining 5 patients had a stable SCr during the 5-year follow-up period [(218 ±46) μmol/L before conversion vs (205±73) μmol/L 5 years after conversion]. The overall 5-year graft survival after the conversion therapy in the passive conversion group was 33.3%, significantly lower than that of the active conversion group (P<0.001). Acute rejection was observed in 2 cases in the active conversion group, while not observed in the passive conversion group. None of the patients developed leukopenia, thrombocytopenia, oral ulcer, or pneumonia in the follow-up.CONCLUSIONS:The combination therapy of SRL and low dose of CsA is overall a safe and effective maintenance immunosuppressive regimen, but it is important to initiate at an appropriate stage. More favourable long-term benefits may be obtained from the conversion therapy in patients with normal or only slightly impaired renal graft function. It may offer an option of individualized immunosuppressive therapy after renal transplantation.

Objective To clarify the quality evaluation and functional repair of donated kidneys of machine perfusion using LifePort kidney transporter machine (LifePort) in the kidneys.Methods During the period from Jan.2013 to Aug.2016,625 kidneys from Chinese donation after citizen death (DCD) were grafted in our institution after static preservation,while 119 DCD kidneys were performed machine perfusion using LifePort among which 105 kidneys were transplanted.The rate of delayed graft function (DGF),the recovery period of renal function,the recovery period of renal function in DGF-censored cases,the recovery period of renal function of DGF cases,and the occurrence of primary non-function (PNF) were calculated in the two groups of kidneys receiving machine perfusion and static preservation respectively.Pathological analysis was performed in part of discarded kidneys.Results The discarding rate of DCD kidneys receiving machine perfusion was 11.76％.In the kidneys receiving machine perfusion,the rate of DGF was 13.33％ and the renal function recovery period was (17.7 ± 13.6) days,while the renal function recovery period of the DGF-censored cases was (8.1 ± 5.2) days and the renal function recovery period of the cases undergoing DGF was (33.7 ± 16.9) days.PNF occurred in one case.Two discarded kidneys were examined pathologically with the finding of severe edema,90％ tubular necrosis,foot process fusion,mesangial matrix proliferation and electron dense deposits.In the kidneys subject to static preservation,the rate of DGF was 12.8％ and the renal function recovery period was (18.6 ± 24.5) days,while the renal function recovery period of the DGF-censored cases was (5.6 ± 7.3) days and the renal function recovery period of the cases undergoing DGF was (31.1 ± 19.0) days.PNF occurred in one case.Conclusion Machine perfusion is beneficial to quality evaluation and functional repair of CDCD kidneys.Resistant index and flux volume at the end of perfusion,combining with other clinical parameters,play roles for quality evaluation.

Objective To investigate an appropriate immunosuppressive therapy in kidney transplantation using pediatric donation after citizen death (DCD) donors.Method From July 2013 to Aug.2015,a total of 46 renal transplants were performed in our center using kidneys from pediatric DCD donors.Forteen were given en bloc kidney transplantation and the rest 32 cases were subjected to single kidney transplantation.The average donor age and recipient body weight was 61.2 ± 63.2 days and 39 ± 9.9 kg in en bloc renal transplantation,and 2.8 ± 2.3 days and 47.3 ± 10.6 kg in single renal transplantation,respectively.Most patients with en bloc renal transplantation received an induction therapy of rATG,followed by a maintenance immunosuppression of CsA/MPA/Prednisone.For patients with single renal transplantation,either rATG or anti-CD25 was given as induction therapy,then mostly followed by tacrolimus combined with MMF or MPA and prednisone as maintenance immunosuppression.Result In en bloc kidney transplantation group,only 2 panties had DGF (14.3 ％),1 patient had pneumonia (7.1 ％),and no one developed acute rejection.In single kidney transplantation group,DGF happened in 4 patients (12.5％),acute rejection was developed in 2 patients and pneumonia occurred in 6 patients (18.8％).Conclusion By choosing appropriate immunosuppressive regimen according to the specificity of renal transplantation with pediatric kidneys,excellent early outcome can be achieved.

Objective To investigate the clinical pattern,therapeutic principle and influencing factors of interstitial pneumonia in renal allograft recipients.Method The general information,clinical manifestation,treatment and outcomes of 30 recipients with interstitial pneumonia after renal transplantation from Nov.2006 to Dec.2013 were analyzed retrospectively.Result Twenty-nine of 30 patients developed interstitial pneumonia between 2 to 6 months post-transplant.The total course of the pneumonia lasted for 34.9 ± 7.5 days on average.Chest CT scans were used to monitor severity of interstitial pneumonia each week.The mean duration between the onset to the fastigium of pneumonitis was approximately 14.8 ± 1.9 days.The mean duration of the fastigium lasted for 7.3 ±3.6 days,after that the patients usually started to recover.Deteriorated chest CT scan findings and long terms of the fastigium usually indicated poor outcomes.The mean duration of the recovery period was 13.1 ± 3.7 days.After adjusted administration of methylprednisolone,antibiotics,antifungal agents,nutritional support as well as immunosuppressive drugs,23 patients with mild and moderate pneumonia by the chest CT scans were cured and discharged.However,4 of the 7 patients with severe pneumonia by the chest CT scans died.Conclusion The progression of interstitial pneumonia after renal transplantation is characterized by a more consistent regularity.After adjusted administration of methylprednisolone,antibiotics,antifungal agents,nutritional support as well as immunosuppressive drugs,renal allograft recipients with interstitial pneumonia could obtain a good therapeutic effect without over-treatment.

Kidney tubular damage caused by ischemia-reperfusion injury is considered the major cause of delayed graft function (DGF) after renal transplantation. It is not clear whether early generated de novo donor specific antibodies (DSA) play a role in DGF. Here, we report 2 cases of renal transplant with DGF, which seems to be associated with de novo DSA. When the early produced de novo DSA are not potent enough to mediate acute rejection, they may cause mild intra-graft injury, which has a significant impact on the degree of DGF and its recovery. Antibody-targeted therapy seems to be beneficial to the recovery of patients with DGF.

OBJECTIVE:To explore the generation pattern and clinical relevance of de novo HLA-DQ antibodies in renal transplantation. METHODS:A total of 175 primary renal transplant recipients without pre-transplant HLA antibodies were recruited from January 2012 to December 2013. The average follow-up period was 10 (6-18) years. They were divided into control group (n = 94) with normal renal graft function (serum creatinine <120 µmol/L); dysfunction group (n = 54) with continued serum creatinine >150 µmol/L over 6 months; and graft loss group (n = 27) with resumed hemodialysis. The sera were collected and screened for de novo HLA antibodies by flow PRA or Luminex mixed beads. And HLA-A, -B, -DR and -DQ specific antibodies were identified by HLA single antigen beads. RESULTS:Positive de novo HLA antibodies were detected in 48% (26/54) of patients from dysfunction group and in 52% (14/27) from graft loss group, but only in 17% (16/94) from control group (P < 0.01). The frequency of de novo DQ antibodies among patients with any positive HLA antibody was the highest in all three groups (14/16, 24/26 and 14/14). Additionally, the average mean peak fluorescence intensity of DQ antibodies was almost the highest when compared to other antibodies. Moreover, when those with positive HLA antibodies in each group were analyzed, 10/16 in control group were detected to have DQ antibodies alone. However, 17/26 of patients in dysfunction group and 14/14 in graft loss group were detected to have DQ antibodies plus HLA-DR and/or -A, -B antibodies. It indicated that the combined presence of DQ-and non-DQ- antibodies was associated with chronic renal graft failure. CONCLUSIONS:The presence of de novo HLA-DQ antibodies is frequent after renal transplantation. And it is associated with chronic graft failure when co-displaying with other HLA antibodies. The screening and detection of HLA-DQ antibodies after kidney transplantation may aid early warning of donor antigen-specific activation of immune system and subsequent graft dysfunction. Thus it serves as an indication for early treatment.

Objective To determine the effect of Wuzhi capsule (WZ) on pharmacokinetics of Tacrolimus (Tac) in kidney transplant patients who have taken WZ to reduce the dose of Tac for a long term.Method Twenty stable renal transplant patients with similar trough level of Tac were divided into WZ group (n =10) and control group (n =10).Whole blood concentrations of Tac at 0,0.5,1,1.5,2,3,4,6,8 and 12 h after the morning dose was determined.Estimated pharmacokinetic parameters were calculated and compared.Additionally,CYP3A5 genotypes of each patient were analyzed using Polymerase Chain Reaction Restriction Fragment Length Polymorphism to compare the effect of CPY3A5 genotypes and WZ on Tac dose requirement.Result Pharmacokinetics data showed that Co of Tac was 6.3μg/L in WZ group and 5.9 μg/L in control group.The average peak time of Tac was similar (1.4 h in WZ group,and 1.3 h in control group,P＞0.05).Both the peak concentration of Tac and AUG0-12h of Tac were slightly higher in WZ group than in control group with the difference being not statistically significant.The frequency of CYP3A5 * 1/* 3 genotype was 60％ in both groups,while the average dose of Tac was reduced by 30％ in WZ group as compared with control group (0.042 mg·kg-1 ·day-1,and 0.067 mg·kg 1 ·day-1,P＜0.01).In WZ group,the average dose of Tac was even lower in carriers of * 1/* 1 genotype (0.036 mg·kg-1 ·day 1) than that in carriers of * 1/* 3 genotype,which was close to the lowest dose requirement in the carriers of * 3/* 3 genotype from the control group (0.034 mg·kg-1 day-1).Conclusion In kidney transplant patients with CYP3A5 * 1 genotype,a long-term application of WZ to reduce the required tacrolimus dose is a generally safe way without significant changes in regular pharmacokinetics of tacrolimus.For patients with genotype of CYP3A5 * 1/* 1,WZ is particularly suitable.

Objective To recognize the characteristics of acute antibody-mediated rejection (AAMR) after kidney transplantation and to investigate the factors influecing the prognosis of AAMR after treatment.Method Three patients with negative cytotoxic cross-match developed early AAMR after kidney transplantation from Jan.2011 to Aug.2012.Pretransplant panel-reactive antibodies (PRA) were strong positive in 1 patient against class Ⅱ and negative in 2 patients who had positive PRA previously.All 3 patients had marked increase of PRA within 1 week post-transplantation and the renal allograft function deteriorated rapidly.After the diagnosis,plasmapheresis (PP)/intravenous immunoglobulin (IVIG) or combined with Bortezomib was used to treat AAMR.Result One patient underwent nephrectomy because of severe hemorrhage in the allograft at the time of diagnosis.One patient treated with PP/IVIG 4 times achieved a full recovery of renal function at postoperative day (POD) 50,while the rest failed to respond to PP/IVIG/Bortezomib treatments 5 times and the allograft had to be removed at POD 24 due to extensive hemorrhage and ischemic necrosis.Conclusion HLA sensitized patients are at high risk of AAMR after kidney transplantation,even with a negative pretransplant PRA.Immediate HLA antibody screening and allograft biopsy are needed to identify AAMR when the allograft represents non-function or early impaired function.PP/IVIG may be effective to treat AAMR,and the prognosis of AAMR depends on the time of when the treatment is started and the severity of antibody-mediated injury in the grafts.