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Endothelial dysfunction in the kidney transplant population:Current evidence and management strategies

World Journal of transplantation 2025年第1期15卷 24-43页

作者： Arun Prabhahar Akshey Batta Juniali Hatwal Vivek Kumar Raja Ramachandran Akash Batta department of Telemedicine(Internal Medicine and nephrology) Post Graduate Institute of Medical Education and ResearchChandigarh 160012India department of Urology and renal Transplant Neelam HospitalRajpura 140401PunjabIndia department of Internal Medicine Post Graduate Institute of Medical Education and ResearchChandigarh 160012India department of nephrology Post Graduate Institute of Medical Education and ResearchChandigarh 160012India department of Cardiology Dayanand Medical College and HospitalLudhiana 141001PunjabIndia

The endothelium modulates vascular homeostasis owing to a variety of vasoconstrictors and *** dysfunction(ED),characterized by impaired vasodilation,inflammation,and thrombosis,triggers future cardiovascular(CV)*** kidney disease,a state of chronic inflammation caused by oxidative stress,metabolic abnormalities,infection,and uremic toxins damages the *** is also associated with a decline in estimated glomerular filtration *** kidney transplantation,endothelial functions undergo immediate but partial restoration,promising graft longevity and enhanced CV ***,the anticipated CV outcomes do not happen due to various transplant-related and unrelated risk factors for ED,culminating in poor CV health and graft *** in kidney transplant recipients is an underrecognized and poorly studied *** diseases are the leading cause of death among kidney transplant candidates with functioning *** contributes to the pathogenesis of many of the CV *** biomarkers and vasoreactivity tests are available to study endothelial *** an increasing number of transplants happening every year,and improved graft rejection rates due to the availability of effective immunosuppressants,the focus has now shifted to endothelial protection for the prevention,early recognition,and treatment of CV diseases.

关键词： Endothelial dysfunction Endothelium Cardiovascular disease Kidney transplantation Chronic kidney disease Nitric oxide Flow-mediated dilatation Nitro-glycerine-mediated dilatation Biomarkers

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Expanding role of antibodies in kidney transplantation

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World Journal of transplantation 2025年第1期15卷 57-71页

作者： Khawar Abbas Muhammed Mubarak department of Transplant Immunology Sindh Institute of Urology&TransplantationKarachi 74200SindhPakistan Javed I.Kazi department of Histopathology Sindh Institute of Urology&TransplantationKarachi 74200SindhPakistan

The role of antibodies in kidney transplant(KT)has evolved significantly over the past few *** role of antibodies in KT is multifaceted,encompassing both the challenges they pose in terms of antibody-mediated rejection(AMR)and the opportunities for improving transplant outcomes through better detection,prevention,and treatment *** our understanding of the immunological mechanisms continues to evolve,so too will the approaches to managing and harnessing the power of antibodies in KT,ultimately leading to improved patient and graft *** narrative review explores the multifaceted roles of antibodies in KT,including their involvement in rejection mechanisms,advancements in desensitization protocols,AMR treatments,and their potential role in monitoring and improving graft survival.

关键词： Antibodies Humoral theory Kidney transplantation Rejection

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Global transplantation:Lessons from organ transplantation organizations worldwide

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World Journal of transplantation 2025年第1期15卷 44-56页

作者： Solonas Symeou Eleni Avramidou Vassilios Papalois Georgios Tsoulfas Medical School University of IoanninaIoannina 45110Greece department of transplantation Surgery Center for Research and Innovation in Solid Organ TransplantationSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece Imperial College renal and Transplant Centre Imperial College Healthcare NHS TrustHammersmith HospitalLondon W120HSUnited Kingdom department of Surgery and Cancer Imperial College LondonLondon SW72AZUnited Kingdom

Although national transplant organizations share common visions and goals,the creation of a unified global organization remains *** in ethnicity,culture,religion,and education shape local practices and infrastructure,making the establishment of a single global entity *** with these social disparities aside,logistical factors such as time and distance between organ procurement and transplantation sites pose significant *** technological advancements have extended organ preservation times,they have yet to support the demands of transcontinental transplantations *** review presents a comparative analysis of the structures,operational frameworks,policies,and legislation governing various transplant organizations around the *** differences pertain to the administration of these organizations,trends in organ donation,and organ allocation policies,which reflect the financial,cultural,and religious diversity across different *** a global transplant organization may be out of reach,agreeing on best practices for the benefit of patients is essential.

关键词： Organ transplantation National transplant organizations Organ donation Global transplantation Transplant systems

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Therapeutic apheresis in kidney transplantation: An updated review

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World Journal of transplantation 2019年第6期9卷 103-122页

作者： Maurizio Salvadori Aris Tsalouchos department of transplantation renal unit Careggi University HospitalFlorence 50139Italy nephrology and Dialysis unit Saints Cosmas and Damian HospitalPescia 51017Italy

Therapeutic apheresis is a cornerstone of therapy for several conditions in transplantation medicine and is available in different technical variants. In the setting of kidney transplantation, immunological barriers such as ABO blood group incompatibility and preformed donor-specific antibodies can complicate the outcome of deceased-or living-donor transplantation. Postoperatively,additional problems such as antibody-mediated rejection and a recurrence of primary focal segmental glomerulosclerosis can limit therapeutic success and decrease graft survival. Therapeutic apheresis techniques find application in these issues by separating and selectively removing exchanging or modifying pathogenic material from the patient by an extracorporeal aphaeresis system. The purpose of this review is to describe the available techniques of therapeutic aphaeresis with their specific advantages and disadvantages and examine the evidence supporting the application of therapeutic aphaeresis as an adjunctive therapeutic option to immunosuppressive agents in protocols before and after kidney transplantation.

关键词： Kidney transplantation Therapeutic plasma exchange Double-filtrationplasmapheresis Immunoadsorption Extracorporeal photopheresis Desensitization Antibody-mediated rejection Focal segmental glomerulosclerosis

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Microbiota,renal disease and renal transplantation

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World Journal of transplantation 2021年第3期11卷 16-36页

Aim of this frontier review has been to highlight the role of microbiota in healthy subjects and in patients affected by renal diseases with particular reference to renal *** microbiota has a relevant role in conditioning the healthy status and the *** particular gut microbiota is essential in the metabolism of food and has a relevant role for its relationship with the immune *** indigenous microbiota in patients with chronic renal failure is completely different than that of the healthy subjects and pathobionts *** abnormality in microbiota composition is called dysbiosis and may cause a rapid deterioration of the renal function both for activating the immune system and producing large quantity of uremic ***,after renal transplantation the microbiota changes with the appearance of pathobionts,principally in the first period because of the assumption of immunosuppressive drugs and *** changes may deeply interfere with the graft outcome causing acute rejection,renal infections,diarrhea,and renal interstitial *** addition,change in the microbiota may modify the metabolism of immunosuppressive drugs causing in some patients the need of modifying the immunosuppressant *** restoration of the indigenous microbiota after transplantation is important,either to avoiding the complications that impair the normal renal graft,and because recent studies have documented the role of an indigenous microbiota in inducing tolerance towards the *** use of prebiotics,probiotics,smart bacteria and diet modification may restore the indigenous microbiota,but these studies are just at their beginning and more data are needed to draw definitive conclusions.

关键词： Gut commensals Microbioma Microbiota renal disease renal transplantation Transplant outcomes

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Current protocols and outcomes of ABO-incompatible kidney transplantation

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World Journal of transplantation 2020年第7期10卷 191-205页

One of the principal obstacles in transplantation from living donors is that approximately 30%are immunologically incompatible because of the presence in the recipient of antibodies directed against the human leukocyte antigen system of the donor or because of the incompatibility of the ABO *** aim of this review is to describe the more recent data from the literature on the different protocols used and the clinical outcomes of ABO-incompatible kidney *** different strategies are used to overcome these barriers:desensitization of the recipient to remove the antibodies and to prevent their rebound after transplantation and the exchange of organs between two or more *** largest part of this review is dedicated to describing the techniques of *** if the first reports of successful renal transplantation between ABO-incompatible pairs have been published by 1980,the number of ABO-incompatible transplants increased substantially in this century because of our improved knowledge of the immune system and the availability of new *** has substantially replaced *** technique of apheresis has improved and more recently a tailored desensitization proved to be the more efficient strategy avoiding an excess of immunosuppression with the related side *** reports document outcomes for such transplantation similar to the outcomes of standard transplantation.

关键词： ABO-incompatible transplants Desensitization strategies Immunological aspects B cell depletion Immunomodulation Apheresis techniques Kidney paired donation

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Hepatitis C in hemodialysis patients

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World Journal of Hepatology 2015年第3期7卷 548-558页

作者： Smaragdi Marinaki John N Boletis Stratigoula Sakellariou Ioanna K Delladetsima department of nephrology and renal transplantation unit Medical School University of Athens Laiko General Hospital First department of Pathology Medical School University of Athens

Despite reduction of hepatitis C prevalence after recognition of the virus and testing of blood products, hemodialysis(HD) patients still comprise a high risk group. The natural history of hepatitis C virus(HCV) infection in dialysis is not fully understood while the clinical outcome differs from that of the general population. HD patients show a milder liver disease with lower aminotransferase and viral levels depicted bymilder histological features on liver biopsy. Furthermore, the "silent" clinical course is consistent with a slower disease progression and a lower frequency of cirrhosis and hepatocellular carcinoma. Potential explanations for the "beneficial" impact of uremia and hemodialysis on chronic HCV infection are impaired immunosurveillance leading to a less aggressive host response to the virus and intradialytic release of "hepatoprotective" cytokines such as interferon(IFN)-α and hepatocyte growth factor. However, chronic hepatitis C is associated with a higher liver disease related cardiovascular and allcause mortality of HD patients. Therapy is indicated in selected patients groups including younger patients with low comorbidity burden and especially renal transplant candidates, preferably after performance of a liver biopsy. According to current recommendations, choice of treatment is IFN or pegylated interferon with a reported sustained viral response at 30%-40% and a withdrawal rate ranging from 17% to 30%. New data regarding combination therapy with low doses of ribavirin which provide higher standard variable rates and good safety results, offer another therapeutic option. The new protease inhibitors may be the future for HCV infected HD patients, though data are still lacking.

关键词： Hemodialysis Hepatitis C infection Interferon Ribavirin Protease inhibitors

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Indications and results of renal biopsy in children:a 36-year experience

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World Journal of Pediatrics 2018年第2期14卷 127-133页

作者： Luisa Santangelo Giuseppe Stefano Netti Paolo Giordano Vincenza Carbone Marida Martino Diletta Domenica Torres Michele Rossini Anna Maria Di Palma Loreto Gesualdo Mario Giordano unit of Pediatric nephrology and Dialysis Pediatric Hospital"GiovanniⅩⅩⅢ"BariItaly Clinical Pathology Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly unit of nephrology Dialysis and TransplantationDepartment of Emergency and OrganTransplantationUniversity"Aldo Moro"BariItaly

Background This study was conducted to investigate retrospectively the indications for renal biopsy(RB)in native kidneys and to analyze pathological findings in a single tertiary pediatric hospital in Southern Italy for the last 36 *** All patients who underwent RB at our hospital from 1979 to 2014 were *** renal tissue specimens were studied under light and immunofluorescent microscopy,while electron microscopy was performed only for specific clinical *** The study group included 213 patients(female 43.2%)who underwent 225 percutaneous native kidney *** age was 10.4 years(range 0.6-24 years).The most frequent indication for RB was nephrotic syndrome(44.4%),fol-lowed by proteinuria(27.6%),asymptomatic hematuria(17.3%)and acute kidney injury(9.8%).Gross hematuria appeared after biopsy in less than 5%of the patients,but none of them needed blood *** renal tissue sample was obtained in 95.5%of the renal *** glomerulonephritis(GN)was the most common finding(61.4%),followed by secondary GN(21.4%),tubulointerstitial diseases(3.7%)and hereditary nephropathy(2.8%),while in 10.7%of the cases,normal renal tissues were *** to histopathological diagnosis,the most common causes of primary GN were IgA nephropathy(20.9%),followed by minimal change disease(18.1%)and focal segmental glomerulosclerosis(11.6%).Conclusions The epidemiology of glomerular disease in our single-center cohort is similar to that shown in other national and international ***,our study shows that percutaneous ultrasound-guided RB is a safe,reliable and effec-tive technique in children.

关键词： Epidemiology Glomerular diseases Nephropathy Pediatric patients renal biopsy

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DETECTION OF CYTOMEGALOVIRUS(CMV) IMMEDIATE EARLY ANTIGEN IN KIDNEY BIOPSIES AND TRANSPLANT NEPHRECTOMIES

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Journal of Pharmaceutical Analysis 2004年第1期16卷 88-91页

作者：燕航薛武军田普训郭奇何晓丽 department of renal transplantation

Objective To investigate the relationship between CMV infection and renal allograft rejection. Methods 39 kidney biopsies and transplant nephrectomies were collected and investigated for CMV immediate early antigen by immunohistochemistry. Results In 14 out of 39 tissue specimens CMV immediate early antigen were found. 8 biopsies from normal donor kidneys were negative; only 1 (10%) in 10 tissue specimens with early stage acute rejection was positive; 5(55.6%) in 9 biopsies with late stage acute rejection and 8 (66.7%) in 12 tissue blocks with chronic rejection were positive. Compared with normal kidney tissues, the infections in tissues with early stage acute rejection didn't increase obviously, but increased obviously in kidney tissue specimens with late stage rejection and with chronic rejection (Prenal transplantation.

关键词： renal transplantation cytomegalovirus immunohistochemistry immediate early antigen allograft rejection

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Utilising continuous glucose monitoring for glycemic control in diabetic kidney disease

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World Journal of Diabetes 2024年第10期15卷 2006-2009页

作者： Vamsidhar Veeranki Narayan Prasad department of nephrology and renal transplantation Sanjay Gandhi Postgraduate Institute of Medical SciencesLucknow 226014Uttar PradeshIndia

In this editorial,we comment on the article by Zhang et *** kidney disease(CKD)presents a significant challenge in managing glycemic control,especially in diabetic patients with diabetic kidney disease undergoing dialysis or kidney *** markers like glycated haemoglobin(HbA1c)may not accurately reflect glycemic fluctuations in these populations due to factors such as anaemia and kidney *** comprehensive review discusses the limitations of HbA1c and explores alternative methods,such as continuous glucose monitoring(CGM)in CKD *** emerges as a promising technology offering real-time or retrospective glucose concentration measure-ments and overcoming the limitations of *** studies demonstrate the utility of CGM in different CKD settings,including hemodialysis and peritoneal dialysis patients,as well as kidney transplant *** challenges like sensor accuracy fluctuation,CGM proves valuable in monitoring glycemic trends and mitigating the risk of hypo-and hyperglycemia,to which CKD patients are *** review also addresses the limitations of CGM in CKD patients,emphasizing the need for further research to optimize its utilization in clinical ***,this review advocates for integrating CGM into managing glycemia in CKD patients,highlighting its superiority over traditional markers and urging clinicians to consider CGM a valuable tool in their armamentarium.

关键词： Chronic kidney disease Diabetic kidney disease Glycemic control Continuous glucose monitoring Glycated hemoglobin Glycemic variability

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