When Glanzmann thrombasthenia encounters antithrombin defi ciency: how do we balance the risk and benefi t of antithrombotic therapy?

Glanzmann’s thrombasthenia(GT)is an inherited autosomal recessive bleeding disorder,resulting from mutations in the ITGA2B and ITGB3 genes,that lead to a defect in the platelet membrane integrinαIIbβ3.[1]As integrinαIIbβ3 plays an important role in thrombus formation,the clinical manifestation of GT includes bleeding(mostly mucocutaneous)and purpura.For this reason,patients with GT are typically thought to be unlikely to suffer from thromboembolic incidents.Antithrombin is an anticoagulant that inhibits thrombin and is activated factor X and other serine proteases in the coagulation cascade.[2]Antithrombin deficiency is an autosomal dominant hereditary disease with an approximate prevalence of 1/500 in the overall population.[3]In contrast to the hemorrhagic tendency of GT,patients with antithrombin deficiency are at increased risk of thromboembolism,especially in the venous system.Herein,we describe a rare case of GT and antithrombin deficiency coexisting in a single patient.Rivaroxaban was used for the treatment of pulmonary embolism(PE)and deep vein thrombosis(DVT).

PULSBD DYE LASER THROMBOLYSIS IN VITRO AND ITS EFFECTS ON VASCULAR FUNCTION AND STRUCTURE IN VIVO

The purpose of the study is to evatuate the feasibility of pulsed dye laser(PDL)throm bolysis In vitro and the effect of PDL on vascular function and structure invivo.In vitro,fifty hum an throm biwere divided into laser treated group(n=35),irritation group(n=11),and controgroup(n=4).In the laser treated group thethrom biwere irradiated by PDL with 300 pulses at 100m J/pulse.No irradiation wasgiven to the throm bi in the irritation group,while the catheter was put to and frointo the throm bi for there times,Neither irradintion nor irritation was given to thethrom bi in the controlgroup.Sixteen healthy dogs were studied in vivo.Under theguidance of the guide-w ire PDL catheter was put into the left coronary arteries(n=16)from which PDL was em itted for 1380±60 pulses at 100m J/pulse,whereasthe rightcoronary srteries(n=16)which did not receieve PDL em ission were servedas irritation group.Then the PDL were irradiated directly to the right coronaryarterial wall in the irritation group without the guidance of the guide-wire.AfterPDL irradiation.the weight of the throm bi was reduced from 1.79±0.23g to0.61±0.12g while in the irritation group theweight of the throm biwas only reducedfrom 1.65±0.19 to 1.42±0.15g.In these two aroups the reduction of throm biweightwere 68%±6% and 15%±7% resoectively(P【0.001).No self-dissolution of thethrom bi occurred in the control group.The finding under the contrast phasem icroscope indicated 91% of the debris size were smaller than the size of redcells.In vivo study,coronary angiography showed that no changes in luminalduam eter of both groups.Nomechanicalor thermal in jury to the coronary arterieswas found excepta light irregularity of the intima.PDL Throm bolysis was effectivein vitro.There was no mechanicaldam age or therm al in jury to the vessels during theprocedure of intracoronary PDL irradiation in vivo.

Perinatal arterial ischemic stroke and multiple thrombo-emboli in a term newborn

The etiology of perinatal arterial ischemic strokes may be maternal, fetal or both. Venous thrombo-embolism is almost always catheter associated in new-borns. Preliminary guidelines for management of perinatal arterial ischemic strokes exist but are mostly based on adult studies. We report a unique case of perinatal arterial ischemic stroke, lower extremity arterial and inferior vena-caval thrombosis. Our patient was treated with unfractionated heparin for 10 days then switched to low molecular heparin to complete 6 months of therapy. The patient responded well to therapy and shows minimal signs of permanent neurologic deficits after 6 months.

Theromboeyte and thrombocyte function

950384 Observation of the effectiveness of heparintherapy in patients with chronic idiopathic thrombocy-topenic purpura.SHEN Zhixiang(沈志祥),et al.RuijinHosp,Shanghai 2nd Med Univ,Shanghai,200025.ChinJ Hematol 1995:16(4)196-197.Fourteen cases (5 males and 9 females,mean age 47years) of chronic idiopathic thrombocytopenic purpura(CITP) were treated with0 low dose of heparin.The ill-ness courses of patients were 6 months to 20 years(mean 6.3years).and all of them were resistant to theconventional corticoth,rapy and other immunosuop-pressive drugs.Heparin was given subcutaneously in

Thrombocyte and thrombocyte function

930164 Molecular pathology study on intherit-ed Glanzmann’s thrombasthenia:A report of 11cases.RUAN Changgeng(阮长耿),et al.InstitHematol,Thrombosis & Hemostasis Res Unit,Suzhou Med Coll,215007.Chin J Intern Med1992;31(10):639-641.Glycoprotein Ⅱb-Ⅲa(GPⅡb-Ⅲa)concen-tration was studied in 11 patients withGlanzmann’s thrombasthenia(GT)with sensi-tive Western blotting technique.7 patients withsevere GPⅡb-Ⅲa deficiency(less than 10% ofthe normals)were designated as type Ⅰ(64%

Haemorrhage after thrombectomy with adjuvant thrombolysis in unknown onset stroke depends on high early lesion water uptake

Background and purpose In wake-up stroke,CT-based quantitative net water uptake(NWU)might serve as an alternative tool to MRI to guide intravenous thrombolysis with alteplase(IVT).An important complication after IVT is symptomatic intracerebral haemorrhage(sICH).As NWU directly implies ischaemic lesion progression,reflecting blood-brain barrier injury,we hypothesised that NWU predicts sICH in patients who had a ischaemic stroke undergoing thrombectomy with unknown onset.Methods Consecutive analysis of all patients who had unknown onset anterior circulation ischaemic stroke who underwent CT at baseline and endovascular treatment between December 2016 and October 2020.Quantitative NWU was assessed on baseline CT.The primary endpoint was sICH.The association of NWU and other baseline parameters to sICH was investigated using inverse-probability weighting(IPW)analysis.Results A total of 88 patients were included,of which 46 patients(52.3%)received IVT.The median NWU was 10.7%(IQR:5.1–17.7).The proportion of patients with any haemorrhage and sICH were 35.2%and 13.6%.NWU at baseline was significantly higher in patients with sICH(19.1%vs 9.6%,p<0.0001)and the median Alberta Stroke Program Early CT Score(ASPECTS)was lower(5 vs 8,p<0.0001).Following IPW,there was no association between IVT and sICH in unadjusted analysis.However,after adjusting for ASPECTS and NWU,there was a significant association between IVT administration and sICH(14.6%,95%CI:3.3%to 25.6%,p<0.01).Conclusion In patients with ischaemic stroke with unknown onset,the combination of high NWU with IVT is directly linked to higher rates of sICH.Besides ASPECTS for evaluating the extent of the early infarct lesion,quantitative NWU could be used as an imaging biomarker to assess the degree of blood-brain barrier damage in order to predict the risk of sICH in patients with wake up stroke.

Thrombus migration in patients with acute ischaemic stroke undergoing endovascular thrombectomy

Objective The impact of thrombus migration(TM)prior to endovascular thrombectomy(EVT)on clinical outcomes and revascularisation rates remains unknown.We aimed to examine whether preinterventional TM modifies the treatment effects of direct EVT versus bridging EVT in acute large vessel occlusion patients.Methods All patients undergoing catheter angiography in the Direct Intra-arterial thrombectomy in order to Revascularise acute ischaemic stroke patients with large vessel occlusion Efficiently in Chinese Tertiary hospitals:A Multicentre randomised clinical Trial were included.TM was determined by radiologists unaware of the study by analysing discrepancies between computed tomographic angiography at baseline and first-run digital subtraction angiography before EVT.The primary outcome was the score on the modified Rankin scale(mRS)assessed at 90 days.Results Of 627 included patients,the TM rate was 11.3%(71/627).In the multivariable logistic regression model,baseline National Institutes of Health Stroke Scale score(adjusted OR 0.956,95%CI 0.916 to 0.999;p=0.043)and intravenous thrombolysis(adjusted OR 2.614,95%CI 1.514 to 4.514;p<0.001)were independently associated with TM.The patients with TM were less likely to be completely recanalised than those without TM(21.27%vs 36.23%,p=0.040).The interaction of TM and the EVT treatment effect did not significantly affect mRS shift analysis(p=0.687)or mRS scores of 0 to 1(p=0.436).Conclusion Preinterventional TM does not modify the treatment effects of direct versus bridging EVT on functional outcomes in patients with acute ischaemic stroke with anterior large vessel occlusion.TM leads to a lower complete recanalisation rate.

Randomised study of bailout intracranial angioplasty following thrombectomy for acute large vessel occlusion(ANGEL-REBOOT):protocol of a multicentre randomised controlled trial

Rationale Unsuccessful thrombectomy of acute large vessel occlusions(LVOs)has been associated with unfavourable outcomes.Multiple randomised controlled trials(RCTs)have reported a failure rate of 12%–41%for thrombectomy procedures.Various factors contribute to failed thrombectomy,including technical difficulties in accessing the occlusion,unsuccessful thrombus retrieval,thrombotic reocclusion and pre-existing intracranial atherosclerotic stenosis.Although some studies have explored balloon dilation or permanent stenting as rescue intracranial angioplasty for failed thrombectomy in individual cases,there is currently no evidence from RCTs on this specific topic.Aim To evaluate the potential superiority of bailout angioplasty over standard treatment in cases of unsuccessful recanalisation(eTICI 0 to 2a)or residual severe stenosis(>70%)after thrombectomy in acute LVO patients within 24 hours of stroke onset.Design This study is a multicentre,prospective,randomised,controlled clinical trial designed by investigators.It compares bailout angioplasty with standard therapy and follows an open-label treatment approach while maintaining a blinded outcome assessment(PROBE design).Our objective is to allocate 348 patients in a 1:1 ratio to either receive bailout angioplasty as an intervention or standard therapy as a control,following unsuccessful thrombectomy.Outcome The main measure of interest is the modified Rankin Scale(mRS)Score,which will be assessed in a blinded manner at 90(±14)days following randomisation.The primary effect size will be determined using ordered logistic regression to calculate the common OR,representing the shift on the six-category mRS Scale at the 90-day mark.Additionally,the safety outcomes will be evaluated,including symptomatic intracranial haemorrhage within 18–36hours,severe procedure-related complications and mortality within 90(±14)days,among others.Discussion The ANGEL-REBOOT study aims to generate substantial evidence regarding the efficacy and safety of bailout intracranial angioplasty as a treatment option for patients with LVO who have experienced unsuccessful thrombectomy.Trial registration number NCT05122286.

Characterising acute ischaemic stroke thrombi:insights from histology,imaging and emerging impedance-based technologies

Treatment of acute ischaemic stroke(AIS)focuses on rapid recanalisation of the occluded artery.In recent years,advent of mechanical thrombectomy devices and new procedures have accelerated the analysis of thrombi retrieved during the endovascular thrombectomy procedure.Despite ongoing developments and progress in AIS imaging techniques,it is not yet possible to conclude definitively regarding thrombus characteristics that could advise on the probable efficacy of thrombolysis or thrombectomy in advance of treatment.Intraprocedural devices with dignostic capabilities or new clinical imaging approaches are needed for better treatment of AIS patients.In this review,what is known about the composition of the thrombi that cause strokes and the evidence that thrombus composition has an impact on success of acute stroke treatment has been examined.This review also discusses the evidence that AIS thrombus composition varies with aetiology,questioning if suspected aetiology could be a useful indicator to stroke physicians to help decide the best acute course of treatment.Furthermore,this review discusses the evidence that current widely used radiological imaging tools can predict thrombus composition.Further use of new emerging technologies based on bioimpedance,as imaging modalities for diagnosing AIS and new medical device tools for detecting thrombus composition in situ has been introduced.Whether bioimpedance would be beneficial for gaining new insights into in situ thrombus composition that could guide choice of optimum treatment approach is also reviewed.

Mechanical thrombectomy in patients with M1 occlusion and NIHSS score≤5:a single-centre experience

Background:The recent success of several mechanical thrombectomy trials has resulted in a significant change in management for patients presenting with stroke.However,it is still unclear how to manage patients that present with stroke and low National Institutes of Health Stroke Scale(NIHSS)≤5.We sought to review our experience of mechanical thrombectomy in patients with low NIHSS and confirmed M1 occlusion.Methods:We retrospectively analysed our prospectively maintained database of all patients undergoing mechanical thrombectomy between January 2008 and August 2016.We identified 41 patients with confirmed M1 occlusion and low NIHSS(≤5)on admission to our hospital.We collected demographic,radiological,procedural and outcome data.Results:The mean age of patients was 72±14,with 20 male patients.Associated medical conditions were common with hypertension seen in∼80%.Just over 50%presented with NIHSS 4 or 5.The average ASPECTS score on admission was 8.8(range 6–10),and the average clot length 10 mm.Angiographically Thrombolysis in Cerebral Infarction(TICI)≥2b was obtained in 87.8%of patients.7 patients had haemorrhage on follow-up,2 of which were symptomatic.Of 40 patients with 90-day follow-up,75%had modified Rankin Scale(mRS)score 0–2.There were 3 deaths at 90 days.Conclusions:Mechanical thrombectomy in patients with low NIHSS and proximal large vessel occlusion is technically possible and carries a high degree of success with good safety profile.Patients with low NIHSS and confirmed occlusion should be considered for mechanical thrombectomy.

Advances in mechanical thrombectomy for acute ischaemic stroke from large vessel occlusions

Advances in endovascular treatment of acute ischaemic stroke from intracranial large vessel occlusions have continued in the past decade.Here,we performed a detailed review of all the new trials and studies that had the highest evidence,the guidelines for mechanical thrombectomy,the selection of the particular population outside the guidelines and endovascular therapeutic strategies for acute ischemic stroke from occluded intracranial arteries.

老年营养风险指数对老年急性脑梗死患者静脉溶栓短期转归的预测价值

目的评价老年营养风险指数(GNRI)对老年急性缺血性卒中(acute ischemic stroke,AIS)阿替普酶静脉溶栓治疗患者短期转归的预测价值。方法对天津市北辰医院自2021年7月-2024年1月进行阿替普酶静脉溶栓的773例老年AIS患者进行回顾性研究,根据其临床数据计算GNRI,并对其营养状态进行评价。应用改良的Rankin(mRS)评分对患者转归进行评估,其中转归不良组(mRS评分>2分)575例,转归良好组(mRS评分≤2分)198例。对GNRI与短期转归的关系进行logistic回归分析。结果转归不良组GNRI明显低于转归良好组[90.106(84.622,98.141)vs 90.722(82.239,100.055),P<0.01]。多因素logistic回归结果表明:年龄、入院美国国立卫生研究院卒中量表(NIHSS)评分、心源性栓塞型(TOAST病因分型)、出血转化、体质量指数和低GNRI是短期转归不良的独立影响因子(P<0.01)。GNRI预测老年AIS患者静脉溶栓预后的ROC曲线下区域面积为0.876(95%CI:0.845~0.907)。结论GNRI是老年AIS患者营养不良与静脉溶栓后转归不良的独立风险因素并且GNRI可以作为一个重要的指标来评估老年AIS患者的免疫营养状况。

Mechanical thrombectomy with combined stent retriever and contact aspiration versus stent retriever alone for acute large vessel occlusion:data from ANGEL-ACT registry

Background and purpose An analysis of the ASTER 2 trial revealed similar final recanalisation levels and clinical outcomes in acute large vessel occlusion(LVO)stroke between stent retrieval(SR)alone as a first-line mechanical thrombectomy(MT)technique(SR alone first-line)and concomitant use of contact aspiration(CA)plus SR as a first-line MT technique(SR+CA first-line).The purpose of the present study was to compare the safety and efficacy of SR+CA first-line with those of SR alone first-line for patients with LVO in China.Methods We conducted the present study by using the data from the ANGEL-ACT registry.We divided the selected patients into SR+CA first-line and SR alone first-line groups.We performed logistic regression and generalised linear models with adjustments to compare the angiographic and clinical outcomes,including successful/complete recanalisation after the first technique alone and all procedures,first-pass successful/complete recanalisation,number of passes,90-day modified Rankin Scale,procedure duration,rescue treatment and intracranial haemorrhage within 24 hours.Results Of the 1233 enrolled patients,1069(86.7%)received SR alone first-line,and 164(13.3%)received SR+CA first-line.SR+CA first-line was associated with more thrombectomy passes(3(2-4)vs 2(1-2);β=1.77,95%CI=1.55 to 1.99,p<0.001),and longer procedure duration(86(60-129)min vs 80(50-122)min;β=10.76,95%CI=1.08 to 20.43,p=0.029)than SR alone first-line group.Other outcomes were comparable(all p>0.05)between the two groups.Conclusions Patients undergoing SR+CA first-line had more thrombectomy passes and longer procedure duration than patients undergoing SR alone first-line.Additionally,we suggested that SR+CA first-line was not superior to SR alone first-line in final recanalisation level,first-pass recanalisation level and 90-day clinical outcomes in the Chinese population.

Mobile stroke care expedites intravenous thrombolysis and endovascular thrombectomy

Background The number of mobile stroke programmes has increased with evidence,showing they expedite intravenous thrombolysis.Outstanding questions include whether time savings extend to patients eligible for endovascular therapy and impact clinical outcomes.Objective Our mobile stroke unit(MSU),based at an academic medical centre in upstate New York,launched in October 2018.We reviewed prospective observational data sets over 26 months to identify MSU and non-MSU emergency medical service(EMS)patients who underwent intravenous thrombolysis or endovascular thrombectomy for comparison of angiographic and clinical outcomes.Results Over 568 days in service,the MSU was dispatched 1489 times(2.6/day)and transported 300 patients(20%of dispatches).Intravenous tissue plasminogen activator(tPA)was administered to 57 MSU patients and the average time from 911 call-to tPA was 42.5 min(±9.2),while EMS transported 73 patients who received tPA at 99.4 min(±35.7)(p<0.001).Seven MSU patients(12%)received tPA from 3.5 hours to 4.5 hours since last known well and would likely have been outside the window with EMS care.Endovascular thrombectomy was performed on 21 MSU patients with an average 911 call-to groin puncture time of 99.9 min(±18.1),while EMS transported 54 patients who underwent endovascular thrombectomy(ET)at 133.0 min(±37.0)(p=0.0002).There was no difference between MSU and traditional EMS in modified Rankin score at 90-day clinic follow-up for patients undergoing intravenous thrombolysis or endovascular thrombectomy,whether assessed as a dichotomous or ordinal variable.Conclusions Mobile stroke care expedited both intravenous thrombolysis and endovascular thrombectomy.There is an ongoing need to show improved functional outcomes with MSU care.

Intra-arterial thrombolytics during endovascular thrombectomy for acute ischaemic stroke in the MR CLEAN Registry

Introduction The efficacy and safety of local intra-arterial(IA)thrombolytics during endovascular thrombectomy(EVT)for large-vessel occlusions is uncertain.We analysed how often IA thrombolytics were administered in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands(MR CLEAN)Registry,whether it was associated with improved functional outcome and assessed technical and safety outcomes compared with EVT without IA thrombolytics.Methods In this observational study,we included patients undergoing EVT for an acute ischaemic stroke in the anterior circulation from the MR CLEAN Registry(March 2014-November 2017).The primary endpoint was favourable functional outcome,defined as an modified Rankin Scale score≤2 at 90 days.Secondary endpoints were reperfusion status,early neurological recovery and symptomatic intracranial haemorrhage(sICH).Subgroup analyses for IA thrombolytics as primary versus adjuvant revascularisation attempt were performed.Results Of the 2263 included patients,95(4.2%)received IA thrombolytics during EVT.The IA thrombolytics administered were urokinase(median dose,250000 IU(IQR,193750-250000))or alteplase(median dose,20 mg(IQR,12-20)).No association was found between IA thrombolytics and favourable functional outcome(adjusted OR(aOR),1.16;95%CI 0.71 to 1.90).Successful reperfusion was less often observed in those patients treated with IA thrombolytics(aOR,0.57;95%CI 0.36 to 0.90).The odds of sICH(aOR,0.82;95%CI 0.32 to 2.10)and early neurological recovery were comparable between patients treated with and without IA thrombolytics.For primary and adjuvant revascularisation attempts,IA thrombolytics were more often administered for proximal than for distal occlusions.Functional outcomes were comparable for patients receiving IA thrombolytics as a primary versus adjuvant revascularisation attempt.Conclusion Local IA thrombolytics were rarely used in the MR CLEAN Registry.In the relatively small study sample,no statistical difference was observed between groups in the rate of favourable functional outcome or sICH.Patients whom required and underwent IA thrombolytics were patients less likely to achieve successful reperfusion,probably due to selection bias.

肝细胞癌潜在血清标志物GRO-1和Thrombin的蛋白鉴定及其临床特征分析

目的寻找有效的早期诊断及判断肝细胞癌（HCC）预后的血清标志物。方法利用表面增强激光解吸离子化-飞行时间质谱（SELDI-TOF-MS）技术确定HCC患者血清蛋白表达谱。对HCC81例、肝炎82例和健康志愿者80例血清标本蛋白表达谱进行比较，经高效液相色谱分离和质谱鉴定蛋白质序列。另取48例HCC、54例肝硬化、62例大肠癌、55例鼻咽癌、36例肺癌和42例健康志愿者血清，利用PS20免疫芯片和SEI-DI技术对候选标志物进行验证。荧光定量PCR技术检测55例HCC患者癌和癌旁组织，13例正常肝组织中候选标志物基因的表达情况，探讨它们与HCC患者临床预后的相关性。结果检出两个HCC候选标志物凝血酶轻链（Thrombinlightchain）和生长相关性癌基因编码蛋白（GRO1）。以这两个因子建立的HCC诊断模型敏感性和特异性均为89．6％，显著高于甲胎蛋白（AFP）单独检测敏感性和特异性（69％，83％）。它们与AFP联合使用后的灵敏度和特异度更高（91．7％，92．7％），而对大肠癌、鼻咽癌、肺癌的敏感性均不超过50Vo。HCC患者癌组织的GRO-1与Thrombin的表达具有显著相关性（r=0．73，P〈0．01），GRO-1表达与肝外转移及术后复发显著相关（P〈0．05），Thrombin的表达量与术后复发及AFP升高相关（P〈0．05）。GRO1和Thrombin高表达的患者术后5年生存率明显低于GRO-1低表达的患者。GRO-1表达量是影响HCC预后的独立影响因素。结论Thrombinlightchain和GRO-1是HCC的潜在血清标志物，并有希望成为HCC患者术后复发转移的预测指标。

Should ateplase be used before endovascular thrombectomy in patients with acute stroke?

To the Editor:Stroke is a sudden attack of disturbance of cerebral blood circulation;its incidence is getting higher and higher,and it has become the second most common cause of death,the fourth leading cause of loss of productivity,and the main cause of disability of people all over the world,[1,2]which has caused very serious pressure and burden on the social economy and public health.

Efficacy and safety of bridging therapy and direct mechanical thrombectomy in large vessel occlusions:a meta-analysis

To the Editor:Acute large vessel occlusion(LVO)is responsible for most acute ischemic stroke(AIS),a common cause of disability and death worldwide.Randomized controlled clinical trials(RCTs)provided evidence endorsing intravenous thrombolysis(IVT,also termed bridging therapy[IVT])and endovascular thrombectomy over IVT alone as the current standard treatment for people with LVO in the anterior circulation.[1]The current American and European guidelines recommend using IVT for all eligible individuals with LVO before direct mechanical thrombectomy(d-MT)(class of recommendation-I).Recent RCTs suggest that MT was noninferior to BT in terms of efficacy and safety,[2,3]which contradict the results from multiple meta-analyses favoring BT over d-MT.[4]The benefit of routine IVT for eligible individuals before thrombectomy has become controversial.BT is associated with complications,including the risk of vasospasm,distal emboli,or symptomatic intracranial hemorrhage.

Semiquantitative assessment of iodine extravasation in acute ischemic stroke after mechanical thrombectomy

Iodine extravasation is commonly seen in stroke patients after successful mechanical thrombectomy.Iodine extravasation may be associated with patient prognosis,and more iodine extravasation is highly associated with the development of severe hemorrhagic transformation(HT).Hence,it is essential to identify early hemorrhage after intra-artery therapy and the imaging indicators that can predict late hemorrhage transformation.

Outcomes of allograft from donor kidney microthrombi and secondary recipient thrombotic microangiopathy: should we consider loosening the belt?

There is currently a huge worldwide demand for donor kidneys for organ transplantation.Consequently,numerous marginal donor kidneys,such as kidneys with microthrombi,are used to save patients'lives.While some studies have shown an association between the presence of microthrombi in donor kidneys and an increased risk for delayed graft function(DGF)(McCall et al.,2003;Gao et al.,2019),other studies have demonstrated that microthrombi negatively impact the rate of DGF(Batra et al.,2016;Hansen et al.,2018),but not graft survival rate(McCall et al.,2003;Batra et al.,2016;Gao et al.,2019).In contrast,Hansen et al.(2018)concluded that fibrin thrombi were not only associated with reduced graft function six months posttransplantation but also with increased graft loss within the first year of transplantation.On the other hand,Batra et al.(2016)found no significant differences in the DGF rate or one-year graft function between recipients in diffuse and focal microthrombi groups.To date,however,the overall influence of donor kidney microthrombi and the degree of influence on prognosis remain controversial,necessitating further research.