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BackgroundRemote ischemic conditioning (RIC) has the potential to benefit graft function following kidney transplantation by reducing ischemia-reperfusion injury; however, the current clinical evidence is inconclusive. This meta-analysis with trial sequential analysis (TSA) aimed to determine whether RIC improves graft function after kidney transplantation.MethodsA comprehensive search was conducted on PubMed, Cochrane Library, and EMBASE databases until June 20, 2023, to identify all randomized controlled trials that examined the impact of RIC on graft function after kidney transplantation. The primary outcome was the incidence of delayed graft function (DGF) post-kidney transplantation. The secondary outcomes included the incidence of acute rejection, graft loss, 3- and 12-month estimated glomerular filtration rates (eGFR), and the length of hospital stay. Subgroup analyses were conducted based on RIC procedures (preconditioning, perconditioning, or postconditioning), implementation sites (upper or lower extremity), and graft source (living or deceased donor).ResultsOur meta-analysis included eight trials involving 1038 patients. Compared with the control, RIC did not significantly reduce the incidence of DGF (8.8% vs. 15.3%; risk ratio = 0.76, 95% confidence interval [CI], 0.48-1.21, P = 0.25, I2 = 16%), and TSA results showed that the required information size was not reached. However, the RIC group had a significantly increased eGFR at 3 months after transplantation (mean difference = 2.74 ml/min/1.73 m2, 95% CI: 1.44-4.05 ml/min/1.73 m2, P

Background: Identifying the cause of renal allograft dysfunction is important for the clinical management of kidney transplant recipients. Purpose: To evaluate the diagnostic efficiency of diffusion tensor imaging (DTI) for identifying allografts with acute rejection (AR) and chronic allograft nephropathy (CAN). Study Type: Prospective. Subjects: Seventy‐seven renal transplant patients (aged 42.5 ± 9.5 years), including 29 patients with well‐functioning stable allografts (Control group), 25 patients diagnosed with acute rejection (AR group), and 23 patients diagnosed with chronic allograft nephropathy (CAN group). Field Strength/Sequence: 1.5 T/T2‐weighted imaging and DTI. Assessment: The serum creatinine, proteinuria, pathologic results, and fractional anisotropy (FA) values were obtained and compared among the three groups. Statistical Test: One‐way analysis of variance; correlation analysis; independent‐sample t‐test; intraclass correlation coefficients and receiver operating characteristic curves. Statistical significance was set to a P‐value <0.05. Results: The AR and CAN groups presented with significantly elevated serum creatinine as compared with the Control group (191.8 ± 181.0 and 163.1 ± 115.8 μmol/L vs. 82.3 ± 20.9 μmol/L). FA decreased in AR group (cortical/medullary: 0.13 ± 0.02/0.31 ± 0.07) and CAN group (cortical/medullary: 0.11 ± 0.02/0.27 ± 0.06), compared with the Control group (cortical/medullary: 0.15 ± 0.02/0.35 ± 0.05). Cortical FA in the AR group was higher than in the CAN group. The area under the curve (AUC) for identifying AR from normal allografts was 0.756 and 0.744 by cortical FA and medullary FA, respectively. The AUC of cortical FA and medullary FA for differentiating CAN from normal allografts was 0.907 and 0.830, respectively. The AUC of cortical FA and medullary FA for distinguishing AR and CAN from normal allografts was 0.828 and 0.785, respectively. Cortical FA was able to distinguish between AR and CAN with an AUC of 0.728. Data Conclusion: DTI was able to detect patients with dysfunctional allografts. Cortical FA can further distinguish between AR and CAN. Evidence Level: 2 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Abstract: Background: Acute rejection (AR), initiated by alloreactive CD4+ T cells, hampers allograft survival. Soluble fibrinogen-like protein 2 (sFGL2) is a novel effector of CD4+ T cells. We previously found that serum sFGL2 significantly increased in renal allograft recipients with AR. In this study, sFGL2 secretion by CD4+ T cells and its mechanism were further explored both in vivo and in vitro. Materials and methods: Forty cases of living-related renal transplant recipients with biopsy-proven AR or stable renal function were collected and detected serum sFGL2, tumor necrosis factor (TNF)-α and interferon (IFN)-γ, and peripheral CD4+ T cells. In vitro, the isolated human CD4+ T cells were stimulated by TNF-α or IFN-γ. sFGL2 in the supernatant and mitogen-activated protein kinase (MAPK) proteins in the CD4+ T cells were investigated. Approval for this study was obtained from the Ethics Committee of Fudan University. Results: sFGL2, TNF-α, IFN-γ, and CD4+ T cells were significantly increased in the peripheral blood of renal allograft recipients with AR. Stimulation with 1000 U/mL TNF-α or 62.5 U/mL IFN-γ for 48 h provided an optimal condition for CD4+ T cells to secrete sFGL2 in vitro. Phosphorylated (p-) c-Jun N-terminal kinase was remarkably upregulated in the activated CD4+ T cells, whereas no significant changes were found in p-p38 MAPK or p-ERK1/2 expression. Furthermore, inhibition of c-Jun N-terminal kinase significantly reduced sFGL2 secretion by CD4+ T cells. Conclusions: sFGL2 secretion by CD4+ T cells can be induced with TNF-α and IFN-γ stimulation through MAPK signaling in renal allograft AR. Our study suggests that sFGL2 is a potential mediator in the pathogenesis of allograft rejection. [Copyright &y& Elsevier]

Objectives: Lymphocele is a frequent complication after kidney transplant and needs attention. This study was undertaken to analyze perioperative risk factors and short-term outcomes associated with lymphocele after kidney transplant., Materials and Methods: Our single-center study retrospectively analyzed 264 recipients of kidney allografts from January 2018 to October 2021. Patients were classified into 2 groups according to the occurrence of lymphocele. Perioperative clinical data and follow-up indicators were compared between groups., Results: The incidence of lymphocele after kidney transplant was 19.7%. Univariate analysis showed that percentage of male patients, hypothermic machine perfusion proportion, and postoperative hemoglobin and albumin were lower and flow velocity of renal artery was higher in the lymphocele group compared with the control group. Multivariate logistic regression revealed that postoperative hemoglobin <95 g/L (odds ratio = 2.01; 95% confidence interval, 1.01-4.05; P = .03) was an independent risk factor and hypothermic machine perfusion (odds ratio = 0.27; 95% confidence interval, 0.08-0.96; P = .04) was a protective factor for the determination of lymphocele. Comparisons of related complications indicated that drainage tube and urinary catheter removal times were longer and urinary tract infection and moderate to severe anemia proportions were higher in the lymphocele group. Follow-up data showed that postoperative 1-month serum creatinine was higher and 1-month estimated glomerular filtration rate was lower in lymphocele group compared with the control group, but no significant differences were shown at 12 months., Conclusions: Postoperative hemoglobin may be a risk factor and hypothermic machine perfusion may be a protective factor for lymphocele after kidney transplant. Lymphocele only temporarily affects short-term kidney function, especially during hospitalization.