器官移植

Clinical diagnosis and treatment guidelines for long-term systemic complications in kidney transplant recipients in China

Branch of Organ Transplantation of Chinese Medical Association,

2024, 15(4): 479-496. doi: 10.3969/j.issn.1674-7445.2024127

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In order to further standardize the diagnosis and treatment of long-term systemic complications in kidney transplant recipients, Branch of Organ Transplantation of Chinese Medical Association initiated the formulation of “Clinical Diagnosis and Treatment Guidelines for Long-term Systemic Complications in Kidney Transplant Recipients in China”. Experts on organ transplantation were organized to summarize and integrate the latest progress in this field based on existing clinical guidelines, systematic evaluations, case studies, expert consensus. The guideline was formed after multiple rounds of discussion and reaching a consensus which included complications of hematological system, central nervous system, cardiovascular system, ocular, cutaneous and osteoporosis disorders. The full text focuses on 27 clinical problems and forms 40 recommendations, mainly involving the risk factors, classification, diagnosis, treatment and prevention of various complications. This guideline graded the quality of evidence and the strength of recommendation for each clinical issue using 2009 Oxford Centre for Evidence-Based Medicine (OCEBM) Grading and Strength of Recommendation criteria, so as to provide reference for the diagnosis and treatment of late complications, comprehensively improve the management capacity of clinicians to benefit kidney transplant recipients.

Clinical diagnosis and treatment guidelines for digestive system complications in kidney transplant recipients in China

Branch of Organ Transplantation of Chinese Medical Association,

2024, 15(4): 497-508. doi: 10.3969/j.issn.1674-7445.2024126

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The diagnosis and treatment of digestive system complications of kidney transplant recipients is related to the long-term survival and quality of life of patients, which needs great attention. In order to further standardize its diagnosis and treatment, Branch of Organ Transplantation of Chinese Medical Association initiated the formulation of “Clinical Diagnosis and Treatment Guidelines for Digestive System Complications in Kidney Transplant Recipients in China”, and organized experts in organ transplantation and related disciplines to summarize the new progress in diagnosis and treatment of digestive system complications of kidney transplant recipients at home and abroad in recent years based on existing clinical research, systematic evaluation, case study, expert consensus and existing guidelines, and reached a consensus after many discussions. This paper focuses on 11 clinical problems, forming 16 recommendations, and grading the evidence quality and recommendation strength of each clinical problem by the evidence grading and recommendation strength standard of Oxford University Evidence-based Medicine Center in 2009, in order to provide reference for the diagnosis and treatment of digestive system complications of kidney transplant recipients, comprehensively improve the management ability of digestive system complications of clinicians in an all-round way and benefit transplant recipients.

Guidelines for clinical diagnosis and treatment of hypertension in kidney transplant recipients in China

Branch of Organ Transplantation of Chinese Medical Association,

2024, 15(4): 509-532. doi: 10.3969/j.issn.1674-7445.2024116

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To further standardize the diagnosis and treatment of hypertension after kidney transplantation in China, Branch of Organ Transplantation of Chinese Medical Association organized experts in kidney transplantation and cardiovascular diseases to formulate “Guidelines for Clinical Diagnosis and Treatment of Hypertension in Kidney Transplant Recipients in China” based on “Diagnosis and Treatment Specification for Hypertension after Solid Organ Transplantation in China (2019 edition)” in combination with clinical status of hypertension after organ transplantation in China, and referring to the latest guidelines for diagnosis and treatment of hypertension at home and abroad. This guideline was formulated to provide theoretical reference for medical practitioners in the field of kidney transplantation in China, aiming to better control adult hypertension after kidney transplantation, mitigate adverse outcomes and improve the quality of life.

Guidelines for clinical diagnosis and treatment of combined liver and kidney transplantation

Branch of Organ Transplantation of Chinese Medical Association,

2024, 15(4): 533-547. doi: 10.3969/j.issn.1674-7445.2024129

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Combined liver and kidney transplantation has been steadily applied in major transplantation centers, saving the lives of many patients with end-stage liver and renal failure. However, there are still multiple unresolved problems in the clinical diagnosis, treatment and long-term prognosis of combined liver and kidney transplantation. By referring to "Technical Operating Standards for Combined Liver and Kidney Transplantation (2019 Edition)" and the latest published literature and guidelines at home and abroad, "Guidelines for Clinical Diagnosis and Treatment of Combined Liver and Kidney Transplantation" was formulated. Recommendations and suggestions were delivered regarding the surgical indications and contraindications, preoperative preparation and evaluation, the timing of transplantation for end-stage liver and kidney diseases, the selection of surgical approaches and postoperative follow-up, specific pathophysiology, surgical techniques, complication management and immunosuppressive treatment of combined live and kidney transplantation, aiming to enhance the utilization rate of grafts and improve the survival and prognosis of combined liver and kidney transplant recipients.

Expert Consensus on quantify monitoring and assessment of immune cell function status and clinical application

China International Exchange and Promotive Association for Medical and Health Care (CPAM), Society of Liver Transplantation，Society of Kidney Transplantation; China Medicinal Biotech Association（CMBA）, Society of Biological Diagnostics,

2024, 15(4): 548-557. doi: 10.3969/j.issn.1674-7445.2024078

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The immune system is the important guarantee for maintaining the health of organ function and preventing diseases. The goal of immune health management and immune treatment is to restore the normal function of the immune system. The technical problems of how to inhibit or enhance the immune status has been solved in the field of immunology, but how to comprehensively detect and quantitatively evaluate the immune status is still a challenge. There is no mature solution at present. The quantification detection and visualization evaluation of immune status are of great significance for disease prevention and control, sub-health status management, and immune treatment. This expert consensus has carried out preliminary discussions on the definition of normal immune status and the comprehensive quantitative evaluation and visual scoring techniques of immune cell function status (immune function), put forward the basic concepts and thinking related to normal immune status, discussed the direction and principles of quantitative detection and evaluation of immune cell function status, and taken this as an opportunity to promote the decoding of immunity and the study of basic and clinical trials in the field of immune health.

Optimization of immunosuppressive regimen for kidney transplant recipients

Dong Zhen, Wang Hongyang

2024, 15(4): 558-562. doi: 10.3969/j.issn.1674-7445.2024087

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With the maturity and development of surgical techniques, as well as the improvement of perioperative management level, the success rate of kidney transplantation has been significantly improved. However, due to evident differences in heredity and antigenicity between donors and recipients, rejection will occur after kidney transplantation, which will affect the survival of renal grafts. Immunosuppression is an important treatment for rejection, which is of significance to reduce the risk of rejection and enhance graft survival rate. Nevertheless, immunosuppressants may cause multiple complications while lowering the incidence of rejection, such as infection, cardiovascular diseases and tumors, etc., which seriously affect the quality of life of patients and may even lead to their death. Reasonable selection of immunosuppressants and continuous optimization of immunosuppressive regimen for recipients play a critical role in improving the survival of recipients and renal grafts. In this article, the development history of organ transplantation, immune induction therapy and immune maintenance therapy was reviewed, and the progress in the optimization of immunosuppressive regimens for kidney transplant recipients was discussed, aiming to provide reference for improving clinical prognosis of kidney transplant recipients.

Research progress in adult liver retransplantation

Wu Ruolin, Zhao Hongchuan, Geng Xiaoping

2024, 15(4): 563-569. doi: 10.3969/j.issn.1674-7445.2024040

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Liver retransplantation is the final option for graft failure after liver transplantation. The interval between the first and second liver transplantation will directly affect surgical indications, technical difficulties and treatment outcomes of adult liver retransplantation. Previous studies have shown that the overall survival of liver allografts and recipients after liver retransplantation is significantly lower than that after the first liver transplantation. However, with comprehensive progress in organ preservation methods, anesthesia management concepts, intensive care strategies, surgical techniques and new immunosuppressive drugs, clinical efficacy of adult liver retransplantation has been significantly improved. In this article, the changes of indications, timing of operation, long-term efficacy and its influencing factors, technical difficulties, selection of immunosuppressive regimens and the implementation of living donor liver retransplantation were reviewed, and the achievements, challenges and potential solutions of adult liver retransplantation were summarized, aiming to provide reference for enhancing clinical efficacy of adult liver retransplantation.

Management of immunosuppressive drugs in HIV-positive solid organ transplant recipients

Shao Kun, Wang Xianghui, Zhou Peijun

2024, 15(4): 570-574. doi: 10.3969/j.issn.1674-7445.2024009

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The application of combination antiretroviral therapy (cART) has significantly prolonged the life expectancy of patients infected with human immunodeficiency virus (HIV). However, viral infection and adverse reactions of cART drugs make patients more prone to organ failure. Solid organ transplantation has become a standard treatment for HIV-infected patients with end-stage organ failure. Nevertheless, among HIV-positive soild organ transplant recipients, multiple problems remain to be resolved, such as increased incidence of graft rejection, increased infection risk, drug toxicity and drug interaction between cART therapy and immunosuppressive drugs, etc. It is extremely challenging to deliver appropriate management for HIV-positive soild organ transplant recipients. Therefore, the application of immune induction therapy, calcineurin inhibitors, mammalian target of rapamycin (mTOR) inhibitors and other immunosuppressive drugs in HIV-positive soild organ transplant recipients was reviewed, aiming to provide reference for subsequent management of immunosuppression in HIV-positive soild organ transplant recipients.

Research progress on the role of tolerogenic dendritic cells in immune tolerance of liver transplantation

Yang Zhiqi, Li Minghao

2024, 15(4): 575-580. doi: 10.3969/j.issn.1674-7445.2024039

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Rejection after liver transplantation severely affects the survival of recipients. Long-term use of immunosuppressants is an important approach to prevent rejection, whereas it may cause toxic effects and increase the risk of adverse events such as systemic infection and tumor recurrence, etc. Therefore, before successful liver transplantation, how to induce individual immune tolerance of recipients and achieve complete or early withdrawal of postoperative immunosuppressants remains to be investigated by practitioners of organ transplantation. In recent years, certain progresses have been made in the mechanism of immune tolerance induced by tolerogenic dendritic cells in liver transplantation, and preliminary outcomes have been obtained in clinical trials. In this article, basic research and clinical application progress in the characteristics of tolerogenic dendritic cells, the mechanism underlying participating in liver immune microenvironment remodeling, and inducing immune tolerance in liver transplantation were reviewed, aiming to provide reference for the application of tolerogenic dendritic cells in immune tolerance of liver transplantation.

Study of adverse drug events related to tacrolimus in pediatric solid organ transplant recipients based on FAERS database

Dong Boqing, Wang Jingwen, Bi Huanjing, Chen Zuhan, Lu Cuinan, Xue Wujun, Li Yang, Ding Xiaoming

2024, 15(4): 581-590. doi: 10.3969/j.issn.1674-7445.2024031

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Objective To investigate the characteristics of adverse drug event (ADE) related to tacrolimus (Tac) in pediatric solid organ transplant recipients. Methods The data were retrieved from the US Food and Drug Administration Adverse Event Reporting System database from the first quarter of 2004 to the second quarter of 2023. The ADE data of pediatric organ transplant recipients with Tac as the primary suspected drug were extracted. The relationship between Tac and ADE was quantitatively analyzed by proportional imbalance method. Basic characteristics and signal strength of ADE related to Tac were analyzed. ADE related to Tac in children of different ages and different types of organ transplantation were analyzed. Results A total of 1 443 children's ADE reports involving Tac were screened, including 188 cases (13.0%) of heart transplantation, 668 cases (46.3%) of liver transplantation, 531 cases (36.8%) of kidney transplantation and 56 cases (3.9%) of lung transplantation. The median age of children was 10 years old. The top three countries with ADE reporting were the United States, France and the United Kingdom. China reported 26 cases, accounting for 1.8%. Infection and infectious diseases accounted for the highest proportion (20.96%) in ADE related to Tac, including EB virus and cytomegalovirus infection, etc. Infection and infectious diseases occupied the largest proportion of ADE related to Tac in children of different ages, whereas the pathogen types were different. Rejection, unstable immunosuppression level and renal function damage were also common ADE related to Tac in children of all ages. Nervous system disease was the main ADE in heart transplant recipients, while infection and infectious diseases were more common in liver and kidney transplant recipients. Rejection was the most common ADE in lung transplant recipients. Conclusions ADE related to Tac possess different distribution characteristics in different types of organ transplantation. Extensive attention should be paid to individualized drug monitoring and risk assessment in pediatric organ transplant recipients, thereby optimizing Tac treatment and reducing the risk of ADE.

Establishment of prognostic model for severe primary graft dysfunction in patients with idiopathic pulmonary fibrosis after lung transplantation

Song Zhiyun, Dai Taoyin, Gu Sijia, Li Xiaoshan, Huang Murong, Tang Shixiao, Hu Chunxiao, Chen Jingyu

2024, 15(4): 591-598. doi: 10.3969/j.issn.1674-7445.2024066

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Objective To explore the establishment of a prognostic model based on machine learning algorithm to predict primary graft dysfunction (PGD) in patients with idiopathic pulmonary fibrosis (IPF) after lung transplantation. Methods Clinical data of 226 IPF patients who underwent lung transplantation were retrospectively analyzed. All patients were randomly divided into the training and test sets at a ratio of 7:3. Using regularized logistic regression, random forest, support vector machine and artificial neural network, the prognostic model was established through variable screening, model establishment and model optimization. The performance of this prognostic model was assessed by the area under the receiver operating characteristic curve (AUC), positive predictive value, negative predictive value and accuracy. Results Sixteen key features were selected for model establishment. The AUC of the four prognostic models all exceeded 0.7. DeLong and McNemar tests found no significant difference in the performance among different models (both P>0.05). Conclusions Based on four machine learning algorithms, the prognostic model for grade 3 PGD after lung transplantation is preliminarily established. The overall prediction performance of each model is similar, which may predict the risk of grade 3 PGD in IPF patients after lung transplantation.

Correlation between metabolic markers and blood lipid levels in kidney transplant recipients

Xu Yuan, Hou Shuang, Chen Qian, Niu Yulin, Li Haiyang

2024, 15(4): 599-606. doi: 10.3969/j.issn.1674-7445.2024014

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Objective To analyze the co-expressed genes in blood lipid metabolism, hyperlipidemia and tacrolimus metabolism and their correlation with blood lipid levels in kidney transplant recipients. Methods Co-expressed genes were screened from Comparative Toxicogenomic Database (CTD). Baseline data of 25 kidney transplant recipients were collected. The expression levels of ATP binding cassette subfamily A member 1(ABCA1), peroxisome proliferator activated receptor γ (PPAR-γ) and glycosylphosphatidylinositol anchored high density lipoprotein binding protein 1 (GPIHBP1) were measured. All recipients were followed up. The concentrations of fasting blood glucose, glycosylated hemoglobin, triglyceride, total protein, albumin, globulin, cholesterol, high-density lipoprotein, low-density lipoprotein and tacrolimus blood concentration were collected at postoperative 1, 3, 6 and 12 months, and the incidence of hyperlipidemia in the recipients was analyzed. The correlation between ABCA1, GPIHBP1, PPAR-γ and clinical indexes was assessed. The diagnostic efficiency of related indexes for hyperlipidemia after kidney transplantation was evaluated. Results Three co-expressed genes including ABCA1, PPAR-γ and GPIHBP1 were screened. ABCA1 was positively correlated with cholesterol level at postoperative 6 months and tacrolimus blood concentration at postoperative 3 months, whereas negatively correlated with fasting blood glucose level at postoperative 3 months (all P<0.05). GPIHBP1 was negatively correlated with preoperative cholesterol and triglyceride levels, whereas positively correlated with tacrolimus blood concentration at postoperative 3 months (all P<0.05). PPAR-γ was negatively correlated with preoperative globulin and low-density lipoprotein levels (both P<0.05). ABCA1, GPIHBP1 and PPAR-γ combined with preoperative globulin and blood glucose level at postoperative 1 and 6 months after operation yielded high diagnostic efficiency for hypertriglyceridemia after kidney transplantation (AUC=0.900). ABCA1, GPIHBP1 and PPAR-γ combined with tacrolimus blood concentrations at postoperative 1 and 6 months and blood glucose level at postoperative 6 months had high diagnostic efficiency for hypercholesterolemia after kidney transplantation (AUC=0.931). Conclusions ABCA1, GPIHBP1 and PPAR-γ are correlated with blood lipid level and tacrolimus blood concentration after kidney transplantation to different degrees. No definite evidence has been supported for predicting hyperlipidemia after kidney transplantation. Immunity improvement and rational blood glucose management may be beneficial factors for hyperlipidemia control.

Effect of preoperative metabolic syndrome on early function of renal allografts in kidney transplant recipients

Tang Yongbin, Tian Zijian, Zhang Zhipeng, Wang Jinfu, Liu Ming, Zhang Yaqun

2024, 15(4): 607-613. doi: 10.3969/j.issn.1674-7445.2024045

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Objective To evaluate the effect of preoperative metabolic syndrome on early function of renal allografts in allogeneic kidney transplant recipients. Methods Clinical data of 117 kidney transplant recipients were retrospectively analyzed. According to the renal allograft function, they were divided into the delayed graft function (DGF) group (n=29) and non-DGF group (n=88). Relevant risk factors of DGF in recipients undergoing allogeneic kidney transplantation were assessed by univariate and multivariate regression analyses. The effect of preoperative metabolic syndrome on early function of renal allografts was analyzed. Results Among 117 kidney transplant recipients, 47 cases were complicated with preoperative metabolic syndrome, and 29 cases developed postoperative DGF. In the DGF group, 83% of the recipients were complicated with preoperative metabolic syndrome, higher than 74% in the non-DGF group (P<0.05). Univariate analysis showed that the body mass index (BMI) and terminal serum creatinine (Scr) level of the donors, and BMI, blood glucose level, triglyceride level and the proportion of preoperative metabolic syndrome of the recipients in the DGF group were higher than those in the non-DGF group (all P<0.05). Multivariate logistic regression analysis revealed that high Scr levels of the donors, high hemoglobin levels of the recipients and preoperative metabolic syndrome of the recipients were the independent risk factors for DGF after kidney transplantation (all P<0.05). Conclusions Preoperative metabolic syndrome is an independent risk factor for DGF in allogeneic kidney transplant recipients. Corresponding measures should be taken to lower the incidence of DGF and other metabolic complications.

Clinical characteristics and risk factors of 209 cases of urinary tract infection after kidney transplantation

Wang Peiyu, Ding Handong, Zhong Jinbiao, Liao Guiyi, Liang Chaozhao

2024, 15(4): 614-621. doi: 10.3969/j.issn.1674-7445.2024095

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Objective To investigate clinical characteristics and risk factors of different stages of urinary tract infection after kidney transplantation. Methods Clinical data of 209 kidney transplant recipients were retrospectively analyzed. According to time points of postoperative follow-up, all recipients were divided into 3 stages: within 1 month post-kidney transplantation, 1-6 months post-kidney transplantation, and 7-12 months post-kidney transplantation. The incidence of urinary tract infection, urine culture results of recipients with urinary tract infection and drug resistance characteristics of common pathogens during different stages after kidney transplantation were analyzed. The strains of patients with recurrent urinary tract infection were identified. The risk factors of urinary tract infection and the effect of urinary tract infection on renal allograft function were analyzed. Results The urinary tract infection rate was 90.0% in the first stage, 49.3% in the second stage and 22.5% in the third stage. The urinary tract infection rates of male recipients undergoing living-related organ donation in the second and third stages were lower than those of female recipients (both P<0.05). Urine culture test yielded positive results in 60 cases, and 84 strains of pathogenic bacteria were detected, mainly Gram-negative bacteria, among which Klebsiella pneumoniae accounted for the highest proportion. Sixty-six recipients had recurrent urinary tract infection, and the detected pathogens included Klebsiella pneumoniae, Escherichia coli and Candida glabrata, etc. Univariate analysis showed that postoperative use of antithymocyte globulin was the risk factor for urinary tract infection in the first stage. Preoperative urinary tract infection and donor type were the risk factors for urinary tract infection in the second stage. Gender and age of the recipients were the risk factors for urinary tract infection in the third stage. Multivariate analysis revealed that postoperative use of antithymocyte globulin was the risk factor for urinary tract infection in the first stage. Gender and age of the recipients were the risk factors for urinary tract infection in the third stage (all P<0.05). In the third stage, 65 cases were cured and 38 cases were not cured. In the treated recipients, the serum creatinine level and white blood cell count were decreased after corresponding treatment than those before treatment (both P<0.05). Conclusions Gram-negative bacteria are the main pathogens of urinary tract infection in kidney transplant recipients, and drug resistance is relatively high. Postoperative use of antithymocyte globulin, female and old age are the risk factors for urinary tract infection in kidney transplant recipients.

Clinical outcome of kidney transplantation from DBD donors complicated with acute kidney injury

Wang Hongyu, Wang Hong, Shen Songying, Zhao He, Qin Xingsong, Qin Wei, Qian Xinling, Dong Huijun, Zhao Yunfeng, Wang Yafang, Li Peiliang

2024, 15(4): 622-629. doi: 10.3969/j.issn.1674-7445.2024027

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Objective To evaluate the clinical outcome of kidney transplantation from donation after brain death (DBD) donors complicated with acute kidney injury (AKI). Methods Clinical data of 216 DBD donors were retrospectively analyzed, and they were divided into the AKI group (n=69) and control group (n=147) according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Donors in the AKI group were further divided into the KDIGO stage 1 and stage 2-3 subgroups. One hundred and thirty-five recipients were assigned into the AKI group and 288 recipients in the control group. Postoperative recovery of renal function and clinical outcomes of the recipients were recorded. The risk factors of delayed graft function (DGF) were identified. Results The highest serum creatinine (Scr) level, Scr level before procurement, the highest blood sodium level and blood sodium level before procurement in the AKI group were higher than those in the control group. The application duration of vasopressors in the AKI group was longer than that in the control group. In the AKI group, the amount of fluid resuscitation within 48 h was higher, the HCO₃⁻ level at admission was lower, and the incidence of diabetes insipidus and hypotension was higher than those in the control group. The highest Scr level and the Scr level before procurement in KDIGO stage 2-3 donors were significantly higher than those in KDIGO stage 1 counterparts (all P<0.05). Compared with the control group, the incidence of DGF and acute rejection was higher, the proportion of continuous renal replacement therapy was higher, the Scr level within postoperative 90 d was higher, and the urine amount within postoperative 3 d was less than those of recipients in the AKI group. Compared with KDIGO stage 1 recipients, KDIGO stage 2-3 recipients had higher Scr levels at postoperative 3, 4, 5 and 15 d, and less urine amount at postoperative 2 d (all P<0.05). Univariate analysis showed that donor age, the highest Scr level, the highest blood sodium level and the amount of fluid resuscitation within 48 h were the risk factors for DGF in recipients after kidney transplantation. Multivariate analysis showed that donor age was the independent risk factor for DGF in recipients after kidney transplantation (all P<0.05). Conclusions For the application of DBD donors complicated with AKI, active organ maintenance should be performed to alleviate AKI. It exerts no effect upon graft function and survival rate at postoperative 6 months, which may achieve equivalent efficacy as non-AKI donors and may be used as a source of extended criteria donor kidneys.

Evaluation of the predictive ability of individualized drug administration adjuvant decision-making system JPKD for tacrolimus blood concentration in kidney transplant recipients

Yan Hui, Wu Furong, Ji Peng, Shen Aizong, Zhang Shengyu

2024, 15(4): 630-636. doi: 10.3969/j.issn.1674-7445.2024011

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Objective To evaluate the predictive ability and influencing factors of individualized drug administration adjuvant decision-making system Java PK^® for Desktop (JPKD) for tacrolimus blood concentration in kidney transplant recipients. Methods The monitoring data of tacrolimus blood concentration from 149 recipients early after kidney transplantation were collected. The trough blood concentration of tacrolimus was predicted by JPKD. The absolute weighted deviation and relative prediction deviation between the actual and predicted concentration were calculated. The influencing factors of the absolute weighted deviation were analyzed by univariate and multivariate logistic regression analyses, and the predictive values of these influencing factors on the accuracy of software prediction were assessed by delineating the receiver operating characteristic (ROC) curve. Results Two hundred and sixty-six samples of tacrolimus blood concentration data were collected from 149 patients. The measured blood concentration of tacrolimus was (6.5±3.0) ng/mL (1.1-16.6 ng/mL), and the predicted value calculated by JPKD was (5.6±2.5) ng/mL (1.4-14.4 ng/mL). The absolute weighted deviation of the calculated data was 28.38%, and the relative prediction deviation was −13.55%. Univariate analysis showed that gender, albumin, changes in hematocrit, cytochrome P450 (CYP)3A5*3 genotype and C3435T genotype were associated with the inaccurate prediction results. Multivariate logistic regression analysis found that CYP3A5*3 genotype of AA and the changes in hematocrit were the independent risk factors affecting the accuracy of tacrolimus blood concentration predicted by JPKD. ROC curve analysis showed that when the changes in hematocrit exceeded 2.25%, the risk of inaccurate software prediction was increased. Conclusions JPKD possesses certain accuracy in predicting the blood concentration of tacrolimus in kidney transplant recipients, which may improve the qualified rate of tacrolimus blood concentration. Nevertheless, CYP3A5*3 genotype and the changes of hematocrit may affect the accuracy of predictions.

Development course and research status of incisions in lung transplantation

Xu Jian, Shao Jingbo, Chen Yuan, Wei Dong, Ye Shugao, Chen Jingyu

2024, 15(4): 637-642. doi: 10.3969/j.issn.1674-7445.2024048

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Surgical technique of lung transplantation exerts significant impact on clinical prognosis of the recipients. Choosing an appropriate surgical incision determines the exposure of intraoperative visual field, which is the first step of surgical success and directly affects subsequent surgical procedures. Lung transplantation incision is usually considered as primary closure. Nevertheless, for patients with high-risk factors such as oversized lung allografts and primary graft failure after lung transplantation, primary closure cannot be achieved. Hence, delayed chest closure is an effective strategy. The selection of incisions and the adoption of delayed chest closure of lung transplantation exert profound impact upon perioperative prognosis, long-term quality of life and surgical complications of the recipients. Therefore, the development and research status of Clamshell incision, anterolateral incision, posterolateral incision and median sternal incision in lung transplantation were reviewed, highlighting the effect of incision patterns on clinical prognosis of lung transplantation and providing reference for the selection of incisions in clinical lung transplantation.

Re-understanding of the clinical application value of dopamine in kidney transplantation

Zhong Yuqi, Wang Yuchen, Miao Yun

2024, 15(4): 643-647. doi: 10.3969/j.issn.1674-7445.2024030

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Dopamine is the precursor of biosynthesis of norepinephrine. Low-dose dopamine mainly excites dopamine receptors, which may dilate renal and mesenteric vessels, increase renal blood flow and improve the microcirculation. In recent years, low-dose dopamine has been widely applied in the field of kidney transplantation due to its vasoactive effect. However, with the development of evidence-based medicine, the role of dopamine in protecting the perfusion function of renal allograft in kidney transplantation has been questioned. Multiple studies have shown that dopamine brings no significant benefit to renal and cardiac function in kidney transplantation, exerts low pressor effect, and may even increase the risk of perioperative complications. Norepinephrine may be used as a safe substitute. In this article, recent progress in the effect of dopamine upon renal and cardiac function and hemodynamics during kidney transplantation was reviewed, aiming to provide reference for clinical application of dopamine in kidney transplantation.

Hypomagnesemia and kidney transplantation: research progress in immune effect and infection risk

Hu Yao, Liu Ling

2024, 15(4): 648-652. doi: 10.3969/j.issn.1674-7445.2024029

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As a cation with abundant intracellular contents and extensive functions, magnesium plays an active role in immune function and captivates widespread attention. Under the influence of multiple factors, such as use of calcineurin inhibitors, hypomagnesemia post-kidney transplantation is not uncommon. Infection is a common complication post-kidney transplantation and one of the main causes of death of kidney transplant recipients. Recent clinical studies have shown that hypomagnesemia post-kidney transplantation is closely associated with the risk of infection post-transplantation. Emphasizing and monitoring magnesium concentration in kidney transplant recipients may help prevent infection and improve clinical prognosis of both recipients and grafts. Therefore, research progress in magnesium and immune response, the causes of hypomagnesemia post-kidney transplantation and hypomagnesemia and infection post-kidney transplantation was reviewed, aiming to provide reference for the prevention and treatment of infection post-kidney transplantation.

Current Issue 2024 Vol. 15, No. 4

Current Issue
2024 Vol. 15, No. 4