The choice of the immunosuppressant for the patients of the malignant tumors after kidney transplantation

Objective: To evaluate the efficacy and safety of the immunosuppressant treatment among 10 post-renal transplantation recipients with malignant tumors. Methods: Conversion to sirolimus (SRL) treatment was performed for 10 cases which had found malignant tumors after kidney transplantation. During the follow-up period, the recurrence and diffusion of the tumor, the renal function and rejection were monitored. Results: All these cases despite the death had been followed up for at least 1 year. 9 cases had no recurrence and diffusion. 1 case died due to the tumor diffusion 7 months after the drug conversion. 1 case suffered once acute rejection 2 months after the drug conversion. This acute rejection had been inhibited by flushing dose MP. Conclusion: As a new immunosuppressant, SRL not only can prevent the generation of AR, but inhibit proliferation and development of malignant tumors in kidney transplantation recipients as well.

COVID-19 in the immunocompromised population:data from renal allograft recipients throughout full cycle of the outbreak in Hubei province,China

Coronavirus disease 2019(COVID-19)is an infectious disease caused by a newly discovered coronavirus and has rapidly spread to most of the world and resulted in a global pandemic.However,there is a paucity of information available to characterize the immunodeficient population in the COVID-19 pandemic,especially information that focuses on patients after renal transplantation as the typical representative of this population.

Adenovirus-mediated antisense ERK2 gene therapy ameliorates chronic allograft nephropathy in a rat model

To investigate the effect and underlying mechanism of adenovirus-mediated antisense ERK2(Adanti-ERK2)gene therapy upon chronic allograft nephropathy(CAN)of rats,male Lewis(LEW,RT11)rats received male Fisher(F344,RT11v1)renal allografts.The recipients were divided into three groups:(1)empty control group;(2)vector control group;(3)gene therapy group.All recipients were sacrificed for the grafts and serum analysis at the 24th week after transplantation.Morphometric analysis was used to determine thefibrosis of grafts.Immunohistochemistry was used to detect the expression of E-Cadherin,Vimentin,TβR I and the infiltration of CD4+T lymphocyte,CD8+T lymphocyte and ED-1+monocytes.Enzyme linked immunosorbent assay(ELISA)was used to detect TGF-β1 in serum.The grafts in the empty control group and vector control group showed CAN.There was less E-Cadherin in renal tubular epithelial cells in the empty control group but more Vimentin and TβR I.In the gene therapy group,thefibrosis was ameliorated and fewer T lymphocytes and ED-1+monocytes infiltrated in the interstitium.There was no significant difference in the expression of E-Cadherin between the gene therapy group and normal rats.Compared with the empty control group,the expression of TGF-β1 in the gene therapy group was down-regulated.Adanti-ERK2 gene therapy protects the renal allograft and attenuates graftfibrosis,which may be correlated with a decreased renal tubular epithelial mesenchymal transition,a decreased infiltration of CD4+T lymphocyte,CD8+T lymphocytes and ED-1+monocytes in renal interstitium,and the down-regulated TGF-β1 expression.

Successful kidney transplantation in highly sensitized patients

Highly sensitized patients experience an increased number of rejection episodes and have poorer graft survival rates;hence,sensitization is a significant barrier to both access to and the success of organ transplantation.This study reports our experience in kidney transplantation in highly sensitized patients.Fourteen patients with sensitization or high levels of panelreactive antibodies(PRA)were studied.All patients were desensitized with pre-transplant intravenous immunoglobulin(IVIG)/plasmapheresis(PP)with or without rituximab and thymoglobulin induction therapy,combined with a Prograf/MMF/Pred immunosuppressive regimen.Of 14 patients,10 showed good graft functions without acute rejection(AR)episodes.Acute cellular rejection in two patients was reversed by methylprednisolone.Two patients underwent antibody-mediated rejection;one was treated with PP/IVIG successfully,whereas the other lost graft functions due to the de novo production of donor-specific antibodies(DSA).Graft functions were stable,and there were no AR episodes in other patients.Conclusively,desensitization using PP/IVIG with or without rituximab increases the likelihood of successful live-donor kidney transplantation in sensitized recipients.