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World Journal of transplantation 2024年第1期14卷 72-83页

作者： Maurizio Salvadori Giuseppina Rosso Department of Renal transplantation Careggi University HospitalFlorence 50139TuscanyItaly Division of Nephrology San Giovanni di Dio HospitalFlorence 50143ToscanaItaly

Gut microbiota is often modified after kidney *** principally happens in the first period after *** and,most of all,immunosuppressive drugs are the main *** relationship between immunosuppressive drugs and the gut microbiota is *** one side immunosuppressive drugs modify the gut microbiota,often generating dysbiosis;from the other side microbiota may interfere with the immunosuppressant pharmacokinetics,producing products more or less active with respect to the original *** phenomena have influence over the graft outcomes and clinical consequences as rejections,infections,diarrhea may be caused by the dysbiotic ***,calcineurin inhibitors such as tacrolimus and cyclosporine,mycophenolate mofetil and mTOR inhibitors are the immunosuppressive drugs whose effect on the gut microbiota is better *** contrast is well known how the gut microbiota may interfere with glucocorticoids,which may be transformed into *** may be transformed by microbiota into a product called M1 that is 15-fold less active with respect to *** pro-drug mycophenolate mofetil is normally transformed in mycophenolic acid that according the presence or not of microbes producing the enzyme glucuronidase,may be transformed into the inactive product.

关键词： Immunosuppressive therapy kidney transplantation Gut microbiota Dysbiosis Pathobionts Graft outcomes

Predicting outcomes after kidney transplantation: Can Pareto’s rules help us to do so?

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World Journal of transplantation 2024年第1期14卷 9-11页

作者： Fernando M Gonzalez Francisca Gonzalez Cohens Department of Nephrology Faculty of MedicineUniversidad de ChileSantiago 7500922Chile Web Intelligence Centre Faculty of Physics and Mathematical SciencesSantiago 7500922Chile

kidney transplantation is the best option for kidney replacement therapy,even considering that most of the times the grafts do not survive as long as their *** the Khalil et al's experience,published in this issue of the Journal,they analyze their second kidney graft survival and describe those significant predictors of early *** editorial comments on the results and put in perspective that most of the times,long-term graft survival could be inadvertently jeopardized if the immunosuppressive therapy is reduced or withdrawn for any reason,and that it could happen frequently if the transplant physician intends to innovate with the clinical care without proper evidence-based data.

关键词： kidney transplantation Graft survival Acute rejection Interstitial fibrosis and tubular atrophy Immunosuppression

Challenges to establishing and maintaining kidney transplantation programs in developing countries:What are the coping strategies?

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World Journal of Methodology 2024年第2期14卷 1-16页

作者： Rabea Ahmed Gadelkareem Amr Mostafa Abdelgawad Nasreldin Mohammed Mohammed Ali Zarzour Mahmoud Khalil Ahmed Reda Hisham Mokhtar Hammouda Department of Urology Assiut Urology and Nephrology HospitalFaculty of MedicineAssiut UniversityAssiut 71515Egypt

kidney transplantation(KT)is the optimal form of renal replacement therapy for patients with end-stage renal ***,this health service is not available to all patients,especially in developing *** deceased donor KT programs are mostly absent,and the living donor KT centers are ***-center studies presenting experiences from developing countries usually report a variety of *** review addresses these challenges and the opposing strategies by reviewing the single-center experiences of developing *** financial challenges hamper the infrastructural and material availability,coverage of transplant costs,and qualification of medical *** sociocultural challenges influence organ donation,equity of beneficence,and regular follow-up *** interests and motives for transplantation may result from high medicolegal responsibilities in KT practice,intense potential psychosocial burdens,complex qualification protocols,and low productivity or compensation for KT *** medical literacy about KT advantages is prevalent among clinicians,patients,and the *** inefficient organizational and regulatory oversight is translated into inefficient healthcare systems,absent national KT programs and registries,uncoordinated job descriptions and qualification protocols,uncoordinated on-site investigations with regulatory constraints,and the prevalence of commercial KT *** challenges resulted in noticeable differences between KT services in developed and developing *** coping strategies can be summarized in two main mechanisms:The first mechanism is maximizing the available resources by increasing the rates of living kidney donation,promoting the expertise of medical personnel,reducing material consumption,and supporting the establishment and maintenance of KT *** latter warrants the expansion of the public sector and the elimination of non-ethical KT *** second mechanism is recru

关键词： Challenges Coping strategies Developing countries kidney transplantation Low resources Single-center

kidney transplantation from donors with hepatitis C infection

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World Journal of Gastroenterology 2014年第11期20卷 2801-2809页

作者： Massimiliano Veroux Daniela Corona Nunziata Sinagra Alessia Giaquinta Domenico Zerbo Burcin Ekser Giuseppe Giuffrida Pietro Caglià Riccardo Gula Vincenzo Ardita Pierfrancesco Veroux Vascular Surgery and Organ Transplant Unit Department of SurgeryTransplantation and Advanced TechnologiesUniversity Hospital of Catania95123 CataniaItaly

The increasing demand for organ donors to supply the increasing number of patients on kidney waiting lists has led to most transplant centers developing protocols that allow safe utilization from donors with special clinical situations which previously were regarded as contraindications. Deceased donors with previous hepatitis C infection may represent a safe resource to expand the donor pool. When allocated to serology-matched recipients, kidney transplantation from donors with hepatitis C may result in an excellent short-term outcome and a significant reduction of time on the waiting list. Special care must be dedicated to the pre-transplant evaluation of potential candidates, particularly with regard to liver functionality and evidence of liver histological damage, such as cirrhosis, that could be a contraindication to transplantation. Pre-transplant antiviral therapy could be useful to reduce the viral load and to improve the long-term results, which may be affected by the progression of liver disease in the recipients. An accurate selection of both donor and recipient is mandatory to achieve a satisfactory long-term outcome.

关键词： kidney transplantation Deceased donor Hepatitis C virus De novo glomerulonephritis Liver failure Graft survival End-stage renal disease Hemodialysis

kidney transplantation in Indonesia: An update

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Asian Journal of Urology 2019年第4期6卷 305-311页

作者： Tommy Supit Eriawan Agung Nugroho Ardy Santosa Moh Adi Soedarso Nanda Daniswara Sofyan Rais Addin Department of General Surgery Faculty of Medicine Diponegoro UniversityDr.Kariadi General HospitalSemarangJawa TengahIndonesia Department of Urology Faculty of Medicine Diponegoro UniversityDr.Kariadi General HospitalSemarangJawa TengahIndonesia

Objective:Indonesia has overcome several barriers to the growth of kidney transplantation within the past ***,the procedure is increasingly performed in several centers across the *** there are limited publications on kidney transplantation from Indonesia,especially from centers outside *** study aims to give a brief overview on transplantation performed,discuss current efforts and progresses of transplantation in Indonesia and chiefly ***:Retrospective analysis of 20 transplant cases in Semarang during 2014e2018 was *** from other transplant centers was acquired through formal correspondences with 11 central teaching hospitals in Jakarta,Surabaya,Yogyakarta,Malang,Bali,Solo,Palembang,Aceh,Medan,Bandung,and ***:There were 629 recorded kidney transplantations performed in 12 centers,and we report on 245 cases with viable *** average age of kidney recipients were younger(35.4 years old)compared to the donors(41.3 years old).Approximately half of the kidneys were obtained from related donors(49.0%)and there was only one case of cadaveric *** three leading etiologies of end-stage renal disease were hypertension(37.4%),diabetes mellitus(26.1%),and autoimmune disease(11.3%).There is only one center that has performed more than 100 kidney transplants in ***:Indonesia has successfully overcome several major hurdles that had previously hindered the growth of *** improvement should concentrate on the development of integrated organ transplant infrastructure,decentralization of transplant professionals,establishment of National kidney transplant database and changing the Nation’s paradigm on cadaveric organ donor through public education.

关键词： kidney transplantation End-stage renal disease Chronic kidney disease Indonesia Semarang Epidemiology Update

Changes in biochemical parameters on the first day after kidney transplantation： risk factors for nosocomial infection？

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Chinese Medical Journal 2010年第5期123卷 563-568页

作者： YANG Yi REN Liang ZHANG Yong LIU Hang CAO Bin ZHANG Xiao-dong Department of Urology Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China Department of Infectious Disease Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China

Background Nosocomial infection in early post-transplantation period is a tough problem for kidney transplantation. Few reports have explored the relations between biochemical parameters and nosocomial infection in kidney transplantation. This retrospective study was carried out to describe the characteristics of nosocomial infection in the very early period of kidney transplantation and to determine the risk factors in biochemical parameters and their alterations. Methods Patients who underwent their first kidney transplantation from January 2001 to March 2009 in Beijing Chao-Yang Hospital were recruited and the nosocomial infectious episodes were collected for this study. Gender, age, donor type, delayed graft function （DGF） and biochemical parameters such as serum uric acid, lipids files and albumin on day 0 （before transplantation） and day 1 （24 hours after transplantation） and their changes were analyzed with Logistic regression models for nosocomial infection. Results A total of 405 patients （315 men and 90 women） were involved in this study. There were 80 patients experiencing 113 infection episodes and 105 strains of microorganism were indentified. In univariate analysis, there were significant differences in DGF, albumin on day 0, lipoprotein （a）（Lp（a）） on day 1, change in low density lipoprotein-cholesterol （LDL-C, day 1-day 0） and change in uric acid （day 1-day 0） between nosocomial infection patients and noninfectious patients （P 〈0.05）. In multivariate analysis, change in uric acid （day 1-day 0）（OR 5.139, 95% CI 1.176-22.465, P 〈0.05）, change in LDL-C （day 1-day 0）（OR4.179, 95% CI 1.375-12.703, P 〈0.05） and DGF （OR 14.409, 95% CI 1.603-129.522, P 〈0.05） were identified as independent risk factors for nosocomial infection in kidney transplantation. Conclusions Most nosocomial infections in early postoperative period of kidney transplantation are bacterial, especially with Gram-negative bacteria. The most common infection sites are respiratory tract, u

关键词： delayed graft function cholesterol, low density lipoprotein cross infection kidney transplantation uric acid

Outcome of kidney transplantation between controlled cardiac death and brain death donors： a meta-analysis

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Chinese Medical Journal 2014年第15期127卷 2829-2836页

作者： Ming Yingzi Shao Mingjie Tian Tingting She Xingguo Liu Hong Ye Shaojun Ye Qifa Research Center of Chinese Health Ministry on transplantation Medicine Engineering and Technology the Third Affiliated Hospital Central South University Changsha Hunan 410013 China Department of Radiology the Third Affiliated Hospital Central South University Changsha Hunan410013 China

Background Our goal was to evaluate the outcomes of kidney transplants from controlled cardiac death donors compared with brain death donors by conducting a meta-analysis of cohort *** The PubMed database and EMBASE were searched from January 1980 to July 2013 to identify studies that met pre-stated inclusion *** lists of retrieved articles were also *** authors independently extracted information on the designs of the studies,the characteristics of the study participants,and outcome *** Nine cohort studies involving 84 398 participants were included in this meta-analysis; 3 014 received kidneys from controlled cardiac death donors and 80 684 from brain death *** ischemia time was significantly longer for the controlled cardiac death donor *** incidence of delayed graft function was 2.74 times （P 〈0.001） greater in the controlled cardiac death donor *** results are in favor of the brain death donor group on short-term patient and graft survival while this difference became nonsignificant at mid-term and long *** analysis yielded similar *** evidence of publication bias was *** This meta-analysis of retrospective cohort studies suggests that the outcome after controlled cardiac death donors is comparable with that obtained using kidneys from brain death donors.

关键词： heart-beating donor donation after cardiac death non-heart-beating donor donation after brain death kidney transplantation

Early Immunosuppressive Exposure of Enteric-Coated-Mycophenolate Sodium Plus Tacrolimus Associated with Acute Rejection in Expanded Criteria Donor kidney transplantation

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Chinese Medical Journal 2018年第11期131卷 1302-1307页

作者： Chen-Guang Ding Li-Zi Jiao Feng Han He-Li Xiang Pu-Xun Tian Xiao-Ming Ding Xiao-Ming Pan Xiao-Hui Tian Yang Li Jin Zheng Wu-Jun Xue Department of Renal transplantation Nephropathy Hospital The First Affiliated Hospital of Xi'an Jiaotong University Xi'an Shaanxi 710061 China Institute of Organ transplantation Xi'an Jiaotong University Xi'an Shaanxi 710061 China

Background： lmmunosuppressive agents are still inefficient in preventing biopsy-proven acute rejection （BPAR） alter expanded criteria donor （ECD） kidney transplantation. The aim of this study was to investigate the relationships between early imrnunosuppressive exposure and the development of BPAR. Methods： We performed a retrospective study of 58 recipients of ECD kidney transplantation treated with enteric-coated-mycophenolate sodium, tacrolirnus （Tac）, and prednisone. The levels of mycophenolic acid-area under the curve （MPA-AUC）0-12h and Tac C0 were measured at the 1st week and the 1st month posttransplant, respectively. The correlation was assessed by multivariate logistic regression. Results： The occurrence rates of BPAR and antibody-mediated rejection were 24.1% and 10.3%, respectively. A low level of MPA-AUC0-12h at the 1st week posttransplant was found in BPAR recipients （38.42 ± 8.37 vs. 50.64 ± 13.22, P 〈 0.01）. In addition, the incidence of BPAR was significantly high （P 〈 0.05） when the MPA-AUC0-12h level was 〈30 mg·h-1·L-1 at the 1st week （ 15.0% vs. 44.4%） or the Tac C0 was 〈4 ng/ml at the 1 st month posttransplant （33.3% vs. 21.6%）. Multivariable logistic regression analysis showed that the MPA-AUC 0-12 h at the 1st week （OR： 0.842, 95% CI： 0.784-0.903） and the Tac C0 at the 1st month （OR： 0.904, 95% C7： 0.822-0.986） had significant inverse correlation with BPA R （ P 〈 0.05 ）. Conclusions： Low-level exposure of MPA and Tac C0 in the early weeks posttransplant reflects an increased acute rejection risk, which suggested that MPA-AUC0-12h 〈30 mg·h-1·L -1 and Tac C0 〈4 ng/ml should be avoided in the first few weeks alter transplantation.

关键词： Enteric-Coated-Mycophenolate Sodium Tacrolimus Acute Rejection Expanded Criteria Donor kidney transplantation

Nonlinear relationship between enteric-coated mycophenolate sodium dose and mycophenolic acid exposure in Han kidney transplantation recipients

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Acta Pharmaceutica Sinica B 2017年第3期7卷 347-352页

作者： Jun Zhang Mengmeng Jia Lihua Zuo Na Li Yonggang Luo Zhi Sun Xiaojian Zhang Zhenfeng Zhu Department of Pharmacy The First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China Department of Integrated Intensive Care Unit The First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China

The aim of the research was to investigate the pharmacokinetics(PK) of enteric-coated mycophenolate sodium(EC-MPS) by quantification of the active metabolite of mycophenolic acid(MPA)after multiple escalating oral doses in Han kidney transplant recipients. A total of 28 Han postoperative kidney transplant recipients were given a multiple-dose of 540, 720 or 900 mg of EC-MPS two times a day in combination with tacrolimus for 6 days. Blood specimens were collected at each time point from0 to 12 h after EC-MPS administration. MPA plasma concentrations were measured by UPLC–UV. The relationship between the EC-MPS dose and its PK parameters was assessed. In the range from 540 to900 mg, C_(max) and AUC_(0–12h) did not increase with dose escalation. The AUC_(0–12h), C_(max), C_0 and T_(max) for the 540 720 and 900 mg doses were not significantly different, respectively(P 40.05). AUC_0–12 h and C_(max) were increased less than proportionally with increasing EC-MPS dose levels. Inter-individual variability in AUC_(0–12h), C_(max) and C_0 were considerable. Nonlinear PK relationships were found from the doses of 540–900 mg of EC-MPS.

关键词： Enteric-coated Mycophenolate sodium Mycophenolic acid Nonlinear dynamics kidney transplantation Pharmacokinetics UPLC-UV Human plasma

Renal function of donors and recipients after living donor kidney transplantation in a Chinese cohort

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Chinese Medical Journal 2011年第9期124卷 1290-1295页

作者： GONG Nian-qiao MING Chang-sheng ZENG Fan-jun ZHANG Wei-jie LIN Zhen-bin ZHOU Ping CHEN Xiao-ping CHEN Zhi-shui Institute of Organ transplantation Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei 430030 China Department of Surgery Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei 430030 China

Background Living donor kidney transplantation （LKT） has been booming in China. This study aimed to elucidate the renal function of both Chinese donors and recipients after the donation and transplantation. Methods One hundred and forty-one pairs of donors and recipients for LKT were randomly selected and followed up for up to seven years. The donors＇ and recipients＇ renal function was recorded before and after operation. Results The donors presented a mean age of （43.9±7.5） years at donation. The female contributed 101/141 （71.6%） in all donors, and no effect was shown between genders on healthy donors＇ renal function. The donors＇ glomerular filtration rates （GFR） were （119.5±20.4） ml/min, （85.2±17.6） ml/min, （87.2±15.9） ml/min, （82.1±14.6） ml/min and （83.0±13.7） ml/min preoperatively, and for five days, three months, one year and beyond one year after the operation. The donors for the period of 1-3 years, 3-5 years and more than 5 years after donation showed GFR as （83.9±12.7） ml/min, （83.0±17.6） ml/min, and （80.9±20.8） ml/min, respectively, no statistically significant difference was found. Moreover, no significant clinical changes in blood pressure and proteinuria were found among the donors. In the recipients, delayed graft function （DGF） rate was 6.4%, acute rejection rate was 11.3%, and GFR were （66.5±16.4） ml/min, （73.2±19.6） ml/min and （63.9±18.6） ml/min respectively at three months, one year and beyond one year post-transplantation respectively. Conclusion The donors/recipients of LKT in Chinese population experience well-functioning remaining/donor kidneys.

关键词： kidney transplantation living donors recipient renal function