To compare the early clinical effect of immune induction between interleukin 2 receptor antagonist (IL-2Ra) and antithymocyte globulin (ATG) in kidney transplantation from donation after cardiac death (DCD) so as to explore a reasonable immune suppression scheme in kidney transplantation from DCD.

The clinical data of 110 recipients of kidney transplantation from DCD in the department of organ transplantation of Renmin Hospital of Wuhan University during January 2015 and May 2016 were analyzed, retrospectively, among which 82 recipients received IL-2Ra and 28 recipients received ATG for immune induction. In addition, all the recipients received triple immunosuppressant (tacrolimus, mycophenolate mofetil and glucocorticiod). The preoperative and postoperative serum creatinine between the two groups at different time points was compared by t test. The incidence of DGF, pulmonary infection, acute rejection and the survival condition of transplanted kidney/recipients were compared by chi-square test. P<0.05 was deemed statistically significant.

The incidence of DGF of IL-2Ra group and ATG group was 20.7% and 42.9%, and the difference was statistically significant (χ²=5.263, P<0.05). But the incidence of pulmonary infection, acute rejection and the survival condition of transplanted kidney/recipients between the two groups had no statistical difference (P all>0.05). There was also no statistical difference in serum creatinine between the two groups at the time points of preoperative and 90 days after operation (P all>0.05). There was significant difference in serum creatinine between the two groups at the time points of 1, 2, 4, 7, 14, 21, 30 and 60 days after operation, respectively (P all<0.05).

Both IL-2Ra and ATG can effectively prevent the occurrence of acute rejection after kidney transplantation. Reasonable drug selection for immune induction should be based on the situation of donors and recipients.

Summary and analysis the experience of immunosuppressive therapy of 4 recipients who survived over 16 years after heart transplantation.

The clinical data of 4 heart transplant recipients in the Second Affiliated Hospital of Harbin Medical University during April 1992 and January 2000 was analyzed retrospectively, which mainly focusing on the treatment experience of immunosuppressive therapy. Four donors were all donation after brain death and donor organs were preserved by improved St. Thomas fluid. The protopathys of recipients were chronic keshan disease (1 case) and dilated cardiomyopathy (3 cases), respectively. The methods of heart transplantation were standard anastomosis (3 cases) and whole-heart (1 case). The immunosuppressive treatment protocol after operation was ciclosporin+ azathioprine+ glucocorticoid and ciclosporin was used for immunosuppressive maintenance therapy. Blood concentration of ciclosporin, periphery white blood count and lymphocyte function were monitored during follow-up. Electrocardiogram, chest X-ray plain film, ultrasonic cardiogram, coronary arteriography, optical coherence tomography (OCT) and endomyocardial biopsy were also did during follow-up. Implosive therapy or immunosuppressive agent replacement therapy was used when rejection occured.

Three recipients survived and 1 recipient died until June 2016. The survival time of the 3 survivors was 22 years and 4 months, 20 years and 7 months, 16 years and 5 months, respectively. The dead recipient died of multiple organ failure 18 years and 6 months after operation. Four recipients occured rejection 1 to 6 times during 10 years after operation and all recoverd after implosive therapy. The dose of ciclosporin for 3 survivors adjusted to 0.5-1.0 mg·kg^-1·d^-1 at 10 years after operation. All the recipients showed no coronary artery lesion during 10 years after operation. Three recipients recieved coronary arteriography and OCT in May 2009, and 1 recipient showed plaques infiltration and did not feel any uncomfortable, but the test results of coronary arteriography and OCT of this recipient in May 2015 showed that coronary artery stenosis was found and then stent placement was did. Test results of other two recipients were normal.

Diagnosis of rejection timely and accurately, adjusting immunosuppressive treatment plan reasonably, individualized immunosuppressive therapy and preventing the complication actively and effectively were helpful to improve long-term survival for heart transplantation recipients.

To summarize the development of China donation after cardiac death (DCD), influence factors of DCD potential donors and application of extracorporeal membrane oxygenation (ECMO) in DCD.

The clinical data of DCD donors in Guangzhou General Hospital of Guangzhou Military of PLA Organ Procurement Organization (OPO) during January 2010 and December 2015 was analyzed retrospectively, mainly focusing on the indexes like the total number of DCD, average growth rate per annum, donation rate per million population (PMP), discard of DCD donor liver, proportion of C-Ⅰ, C-Ⅱ and C-Ⅲ, influence factors of organ donation in DCD potential donors and the ECMO application in DCD. The data of DCD of China and Guangdong province during the same period was also summerized. Chi-square test and Man-Whitney U test was used to compare the proportion of C-Ⅰ between our hospital and China and average growth rate per annum between our hospital and Guangdong province, respectively. P<0.5 was deemed statiatically significant.

There were 241 DCD donors during January 2010 and December 2015 in our hospital, with C-Ⅰ, C-Ⅱ and C-Ⅲ accounting for 29.9% (72/241) , 26.6% (64/241) and 43.5% (105/241), respectively. The proportion of C-Ⅰ(29.9%) in our hospital was higher than national average (13%) (χ²=55.381, P<0.05). 234 donor livers were obtained from 241 DCD donors, 26 of the livers were discarded and the liver discard rate was 11.1% (26/234). The main reasons for discard were overlength of cold/warm ischemia time, liver cirrhosis, poor perfusion, abnormal liver function and contusion. There was no statistical significance for average growth rate per annum of DCD between our hospital (67.78%) and Guangdong province (104.50%) (U=11.0, P>0.05). The donation rate per million population of our hospital and Guangdong province was increased from 0.407 PMP and 0.144 PMP to 3.948 PMP and 4.145 PMP, respectively. The donation conversion rate was 31.0% (241/778) within the scope of the OPO of our hospital. The influence factors for poor conversion rate were mainly because of family and social factors, the condition of donors and doctor-patient relationship. One hundred and forty-five DCD donors were implemented organ donation supported by ECMO during the same period, with C-Ⅰ, C-Ⅱ and C-Ⅲ accounting for 58.3% (42/72), 62.5% (40/64) and 60.0% (63/105).

Enhancing the attention and acceptance of organ donation in public, and reasonable application of organ preservation technology will help to promote the development of DCD liver transplantation.

Antibody-mediated rejection (AMR) has become a main reason in graft loss. The detection of C4d deposition in peritubular capillarie (PTC) is a valuable marker of humoral activity in the renal allograft. C4d positivity alone is nondiagnostic for antibody-mediated rejection. Presence of circulating HLA donor-specific antibody (DSA), histologic features, and/or graft dysfunction must be considered in the context of the clinical scenario. C4d positivity and DSA, particularly complement fixing, are associated with decreased allograft survival, particularly when detected in the setting of graft dysfunction.

Lung transplantation has become an important therapy for patients with end-stage benign lung disease. With the progress of surgical technique, perioperative mananment and immunosuppressive therapy, surival rate in early stage after transplant have significantly improved, while long-term surival rate has not changed much. Obliterative bronchiolitis (OB) is the major limitation to long-term surival after lung transplatation. Ivestigation basing on animal models is indispensable to understand the underlying pathological mechanisms and to develop novel preventive and therapetic stragies for OB. So far, many animal models have been developed to study OB. This article reviews the strengths and drawbacks of those animal models, hoping to help researchers in chooseing the appropriate model for their intrended research.