Objective To investigate the prognosis and management strategies of renal transplant recipientswith end-stage diabetic nephropathy. Methods The clinical data of 276 recipients of deceased donor kidneytransplantation after the death of citizens in our hospital from January 2015 to January 2018 were retrospectively analyzed. Twenty patients with diabetic nephropathy were defined as the experimental group and 256 patients withnon-diabetic nephropathy were defined as the control group. The delayed recovery of renal function（DGF），infection，rejection and the survival of transplant recipients and kidneys during perioperative period of kidney transplantation were compared between the two groups. Results The incidence of DGF，infection and rejection in the experimentalgroup was higher than that in the control group during the perioperative period，but there was no significant differencebetween the two groups. In addition，there was no significant difference in the survival rate of transplant recipients and kidneys in the two groups at 1，2 and 3 years after transplantation. Conclusion End-stage diabetic nephropathyrecipients are likely to suffer from infection，DGF and rejection during perioperative period. Perioperative managementand long-term scientific and comprehensive follow-up should be strengthened. There is no difference in 3 years survival rate between diabetic nephropathy recipients and non-diabetic nephropathy recipients.

Objective To investigate the safety and efficacy of febuxostat in the treatment of patientswith hyperuricemia after renal transplantation. Methods The clinical data of renal transplant recipients whowere regularly followed up in Shanghai Changzheng Hospital from January 2016 to December 2017，were analyzed retrospectively. They were received traditional uric acid reduction therapy〔lifestyle intervention，alkalized urine，allopurinol（0.1 ～ 0.2 g/d）or phenyl bromide Malone（50 mg/d）〕for at least 4 weeks，a total of 104 patients with hyperuricemia were diagnosed with hyperuricemia，these patients were switched to oral febuxostat on the basis ofdiscontinuation of allopurinol or benzbromarone with follow-up of 12 weeks，the changes of blood uric acid level and adverse reactions before and after treatment with febuxostat were compared，and the concentrations of immunosuppressive drugs were observed. Results The serum uric acid level before treatment with febuxostatwas（497.88±47.37）μmol/L，andthe blood uric acid level decreased significantly to（348.05±49.88）μmol/L at the12th week after treatment（P ＜ 0.001）. There were no significant differences in white blood cell，serum creatinine，and immunosuppressive drug concentration levels. No cardiovascular events occurred during the observation，and2 patients with acute gout after the medication were cured.Conclusion When the traditional comprehensive treatment of hyperuricemia after renal transplantation is not effective，the conversion to febuxostat is effective and safe.

Objective To summarize the clinical experience of renal transplantation in highlysensitized recipients. Methods Allogeneic kidney transplantation was performed in 25 hypersensitized patients with panel reactive antibody peak ≥ 30%. There were 8 males and 17 females. The average agewas（45±12）. There were 8 patients who underwent transplantation for the first time，15 patients with secondarytransplantation，2 patients with three transplants，17 patients with a history of blood transfusion，and 12 patientswith a history of pregnancy. There were 3 patients with living donor kidney transplantation，and the rest were cadaveric donor kidney transplants. Preoperatively，plasma exchange or protein A immunosorbent + rituximab +intravenous gamma globulin desensitization were performed. Preoperative cross lymphatic toxicity test was negative. Rabbit anti-human thymocyte immunoglobulin and methylprednisolone were induced，and tacrolimus +mycophenolate mofetil + corticosteroid triple maintenance therapy was used. Results The serum creatininewas decreased to normal in 20（20/25）patients within 1 week after transplantation. The hyperrejection occurred in 1 patient，and the transplanted kidney was removed on the day of surgery. The accelerated rejection occurred in1 patient on the 3 d after surgery，plasma exchange therapy was ineffective for 3 times，the transplanted kidney was removed on the 7 d after surgery. The delayed recovery of graft function occured in 4 patients，and renal function was returned to normal between 18 and 25 d after surgery. Acute rejection occurred in 5 patients（20%），of which2 patients were diagnosed with the reversal of antibody mediated acute rejection after 3 times of plasma exchange therapy and 1 week of fiverine shock therapy，and the remaining 3 patients were the reversal of cellular rejectionafter steroid bolus therapy. The 1 year survival rate of transplanted kidney was 92%（23/25）. Conclusion Renaltransplantation of highly sensitized recipients could effectively prevent and treat acute rejection by preoperativedesensitization with plasma exchange or immunosorption combined with rituximab and intravenous gamma globulin under the premise of good human leukocyte antigen（HLA）matching and avoiding the preexisting anti-HLA antibody sites.

Objective To investigate the protective role and molecular mechanism of recombinant human erythropoietin（rhEPO）in preventing hepatocytes against simulated ischemia-reperfusion injury. Methods BRL3Acells were purchased from cell bank of chinese academy of sciences in Shanghai and cultured in 96-well plates with 2 000（100 μl·well），H2O2 was added to induce cell oxidative damage at a concentration of 200 μmol/L for 2 h. Cultured BRL3A cells were divided into 4 groups ：① normal control group ；② H2O2 group ；③ H2O2 +10 U/ml rhEPO group ；④ H2O2 + 20 U/ml rhEPO. Continued culture for 4 h，CCK-8 was performed to test cell survival rate.The aspartate aminotransferase（AST）and alanine aminotransferase（ALT）was measured with chemical colorimetry.Acridine orange staining was used to detect the formation of autophagosome in hepatocytes. The protein expressionof LC3- Ⅰ，LC3- Ⅱ，p62，and the phosphorylation level of PI3K/AKT signal pathway were detected by western-blot. Results Treated with H2O2，the cell survival rate of BRL3A cells in vitro decreased significantly. The release of AST and ALT was significantly increased，and the formation of autophagosomes was significantly increased，LC3- Ⅱ expression was increased，p62 protein was decreased，and the expression of p-p85 and p-AKT was also decreased. After rhEPO treatment，the situation above was significantly improved. Compared with the control group，the cell survival rate increased，AST and ALT release decreased，autophagosome decreased，LC3- Ⅱ expression decreased，and p62，p-p85 and p-AKT increased. Conclusion The rhEPO treatment can mitigate simulated ischemia-reperfusion injury in hepatocytes via increasing phosphorylation of PI3K/AKT and decreasing autophagic cell death.