Arterial Embolization of Polycystic Kidneys for Heterotopic Transplantation

2022 ◽  
pp. 152660282110677
Author(s):  
Del Tatto Benjamin ◽  
Gogeneata Ioan ◽  
Ohana Mickael ◽  
Fabien Thaveau ◽  
Caillard Sophie ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Arterial Embolization ◽  
Volume Reduction ◽  
Invasive Technique ◽  
Kidney Volume ◽  
Kidney Transplant Recipients ◽  
Polycystic Kidney ◽  
Polycystic Kidneys ◽  
Mortality And Morbidity ◽  
First Choice

Introduction: The purpose of this study was to evaluate the efficacy of polycystic kidney embolization, performed to reduce kidney volume before heterotopic kidney transplantation, as this technique could be an alternative to pretransplant nephrectomy. Materials and Methods: All patients who underwent pretransplant embolization of polycystic kidneys were included in a prospective register from June 2014 to February 2020. All patients underwent computed tomography (CT) scan with volumetric reconstruction (OsiriX, Bernex, Switzerland) before embolization and were then followed up at 3 and 6 months after embolization. Primary outcome was percentage of kidney volume reduction. Secondary outcomes were 30 day mortality and morbidity. Results: Thirty-one embolizations performed on 29 patients (medium age = 55.6; 62.1% male) were included between June 2014 and February 2020. All patients were under dialysis before embolization (9 peritoneal dialysis and 20 hemodialysis). Technical success was observed in 96.8% of cases. Mean procedural time was 65 minutes (range = 35–106 minutes) and mean length of in-hospital stay was 3.8 days (range = 3–6 days). A volume reduction allowing a kidney transplant was obtained for 28 patients (96.5%). The mean volume reduction was 39.9% (range = 6.01–68.2). The main observed complication was postembolization pain in 10 cases (32.2%). One patient needed complementary nephrectomy due to insufficient volume reduction. Twenty-three patients (79.3%) received renal transplant during follow-up with a mean delay of 19.5 month (range = 4–54). Conclusion: Polycystic kidney embolization is an effective and safe minimally invasive technique. It can be proposed as the first-choice technique for kidney transplant recipients as an alternative to pretransplantation nephrectomy.

scholarly journals Management of Pneumocystis jirovecii Pneumonia in Kidney Transplantation to Prevent Further Outbreak

2015 ◽  
Vol 9s1 ◽  
pp. CCRPM.S23317 ◽  
Author(s):  
Norihiko Goto ◽  
Kenta Futamura ◽  
Manabu Okada ◽  
Takayuki Yamamoto ◽  
Makoto Tsujita ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Respiratory Failure ◽  
Kidney Transplant ◽  
Eradication Rate ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Delay In Diagnosis ◽  
First Choice

The outbreak of Pneumocystis jirovecii pneumonia (PJP) among kidney transplant recipients is emerging worldwide. It is important to control nosocomial PJP infection. A delay in diagnosis and treatment increases the number of reservoir patients and the number of cases of respiratory failure and death. Owing to the large number of kidney transplant recipients compared to other types of organ transplantation, there are greater opportunities for them to share the same time and space. Although the use of trimethoprim-sulfamethoxazole (TMP-SMX) as first choice in PJP prophylaxis is valuable for PJP that develops from infections by trophic forms, it cannot prevent or clear colonization, in which cysts are dominant. Colonization of P. jirovecii is cleared by macrophages. While recent immunosuppressive therapies have decreased the rate of rejection, over-suppressed macrophages caused by the higher levels of immunosuppression may decrease the eradication rate of colonization. Once a PJP cluster enters these populations, which are gathered in one place and uniformly undergoing immunosuppressive therapy for kidney transplantation, an outbreak can occur easily. Quick actions for PJP patients, other recipients, and medical staff of transplant centers are required. In future, lifelong prophylaxis may be required even in kidney transplant recipients.

scholarly journals Glucose and Lipid Metabolism Abnormalities among Patients with Autosomal Dominant Polycystic Kidney Disease

2019 ◽  
Vol 44 (6) ◽  
pp. 1416-1422 ◽  
Author(s):  
Magda Fliszkiewicz ◽  
Mariusz Niemczyk ◽  
Andrzej Kulesza ◽  
Anna Łabuś ◽  
Leszek Pączek
Keyword(s):  
Kidney Disease ◽  
Renal Disease ◽  
Kidney Transplant ◽  
Polycystic Kidney Disease ◽  
Autosomal Dominant ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Polycystic Kidney ◽  
Cross Sectional ◽  
Autosomal Dominant Polycystic Kidney

Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is the most prevalent monogenic renal disease with a prevalence of 1:1,000 births and it is the 4th most common cause of dialysis-dependent end-stage renal disease (ESDR). Recent reports suggest an association between APDKD and metabolic derangements, particularly impaired glucose metabolism. Methods: In this cross-sectional study we analyzed data obtained from case records of 189 patients with ADPKD, including kidney transplant recipients, managed in an outpatient department. Results: The mean BMI was 25.4 ± 3.9; 25.25 before and 27.7 after transplan­tation. A fasting glucose level above 100 mg/dL (5.6 mmol/L) was observed in 60 patients (29%) – 27% without transplantation and 41% kidney transplant recipients. Diabetes mellitus was diagnosed in 17 patients (8.9%), including 3 (2.3%) without a history of transplantation and 14 (24.1%) after kidney transplantation (p < 0.01). We observed dyslipidemia in 30% and hyperuricemia in 53% of patients. Conclusion: Demonstrated metabolic abnormalities should be considered in maintenance of ADPKD patients, including kidney transplant recipients.

scholarly journals Uneventful case of COVID-19 in a kidney transplant recipient

2020 ◽  
Vol 13 (7) ◽  
pp. e237427
Author(s):  
Victor Dahl Mathiasen ◽  
Søren Jensen-Fangel ◽  
Karin Skov ◽  
Steffen Leth
Keyword(s):  
Immunosuppressive Therapy ◽  
Kidney Transplant ◽  
Low Dose ◽  
Autosomal Dominant ◽  
Kidney Transplant Recipient ◽  
Antiviral Agents ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Polycystic Kidney ◽  
Autosomal Dominant Polycystic Kidney

Kidney transplant recipients have been reported at a particularly high risk of severe COVID-19 illness due to chronic immunosuppression and coexisting conditions. Yet, here we describe a remarkably mild case of COVID-19 in a 62-year-old female who had a kidney transplantation 10 years earlier due to autosomal dominant polycystic kidney disease. The patient was admitted for 1 day; immunosuppressive therapy with tacrolimus and low-dose prednisolone was continued; and the patient recovered successfully without the use of antiviral agents or oxygen therapy. The case demonstrates that kidney transplant recipients are not necessarily severely affected by COVID-19. Withdrawal of immunosuppressive therapy could be associated with poorer outcomes and should not be implemented thoughtlessly.

scholarly journals Mortality and Morbidity in Kidney Transplant Recipients With a Failing Graft: A Matched Cohort Study

2020 ◽  
Vol 7 ◽  
pp. 205435812090867
Author(s):  
Ngan N. Lam ◽  
Devon J. Boyne ◽  
Robert R. Quinn ◽  
Peter C. Austin ◽  
Brenda R. Hemmelgarn ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kidney Transplant ◽  
Adverse Outcomes ◽  
Similar Degree ◽  
Matched Cohort ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Mortality And Morbidity ◽  
History Of ◽  
Residual Confounding

Background: Due to their history of renal disease and exposure to immunosuppression, kidney transplant recipients with a failing graft may be at higher risk of adverse outcomes compared to nontransplant controls. Understanding the burden of disease in transplant recipients may inform treatment decisions of people whose native kidneys are failing and may be eligible for a transplant. Objective: To compare mortality and morbidity in kidney transplant recipients with a failing graft to matched nontransplant controls. Design: Retrospective cohort study. Setting: Alberta, Canada. Patients: Kidney transplant recipients with a failing graft were identified as having at least 2 estimated glomerular filtration rate (eGFR) measurements between 15-30 mL/min/1.73 m2 (90-365 days apart). We also identified nontransplant controls with a similar degree of kidney dysfunction. Measurements: Mortality and hospitalization. Methods: We propensity-score matched 520 kidney transplant recipients with a failing graft to 520 nontransplant controls. Results: The median age of the matched cohort was 57 years and 40% were women. Compared to matched nontransplant controls, recipients with a failing graft had a higher hazard of death (hazard ratio, 1.54; 95% confidence interval [CI], 1.28-1.85; p < .001) and a higher rate of all-cause hospitalization (rate ratio, 1.67; 95% CI, 1.42-1.97; p < .001). Kidney transplant recipients also had a higher rate of several cause-specific hospitalizations including genitourinary, cardiovascular, and infectious causes. Limitations: Observational design with the risk of residual confounding. Conclusions: A failing kidney transplant is associated with an increased burden of mortality and morbidity beyond chronic kidney disease. This information may assist the discussion of prognosis in kidney transplant recipients with a failing graft and the design of strategies to minimize risks.

scholarly journals Management of Immunosuppression in Kidney Transplant Recipients Who Develop Malignancy

2019 ◽  
Vol 8 (12) ◽  
pp. 2189 ◽  
Author(s):  
Danwen Yang ◽  
Natanong Thamcharoen ◽  
Francesca Cardarelli
Keyword(s):  
Kidney Transplant ◽  
Graft Survival ◽  
Graft Function ◽  
Calcineurin Inhibitors ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Mortality And Morbidity ◽  
Transplant Patients ◽  
Risk Of Cancer ◽  
The Impact

The risk of cancer increases after transplantation. However, the consensus on immunosuppression (IS) adjustment after diagnosis of malignancy is lacking. Our study aims to assess the impact of IS adjustment on mortality of post-kidney transplant patients and allograft outcomes. We retrospectively reviewed the data in our center of 110 subjects. Our results showed IS dose adjustment was not statistically associated with mortality risk (HR 1.94, 95%CI 0.85–4.41, p = 0.12), and chemotherapy was the only factor that was significantly related to mortality (HR 2.3, 95%CI 1.21–4.35, p = 0.01). IS reduction was not statistically associated with worsening graft function (OR 3.8, 95%CI 0.77–18.71, p = 0.10), nor with graft survival (SHR 4.46, 95%CI 0.58–34.48, p = 0.15) after variables adjustment. Creatinine at cancer diagnosis and history of rejection were both negatively associated with graft survival (SHR 1.72, 95%CI 1.28–2.30, p < 0.01 and SHR 3.44, 95%CI 1.25–9.49, p = 0.02). Reduction of both mycophenolate and calcineurin inhibitors was associated with worsening graft function and lower graft survival in subgroup analysis (OR 6.14, 95%CI 1.14–33.15, p = 0.04; HR 17.97, 95%CI 1.81–178.78, p = 0.01). In summary, cancer causes high mortality and morbidity in kidney transplant recipients; the importance of cancer screening should be emphasized.

Arterial embolization of polycystic kidneys as current alternative to nephrectomy before kidney transplant

2021 ◽  
Vol 79 ◽  
pp. S497-S498
Author(s):  
F. Gómez Palomo ◽  
S. Luján Marco ◽  
A. Bernal Gómez ◽  
J. Martínez Rodrigo ◽  
E. Broseta Rico
Keyword(s):  
Kidney Transplant ◽  
Arterial Embolization ◽  
Polycystic Kidneys ◽  
Current Alternative

Unilateral nephrectomy versus renal arterial embolization and technique survival in peritoneal dialysis patients with autosomal dominant polycystic kidney disease

2019 ◽  
Vol 35 (2) ◽  
pp. 320-327
Author(s):  
Malika Pierre ◽  
Karine Moreau ◽  
Antoine Braconnier ◽  
Lukshe Kanagaratnam ◽  
Célia Lessore De Sainte Foy ◽  
...  
Keyword(s):  
Renal Artery ◽  
Autosomal Dominant ◽  
Arterial Embolization ◽  
Volume Reduction ◽  
Renal Volume ◽  
Polycystic Kidney ◽  
Artery Embolization ◽  
Technique Survival ◽  
Renal Artery Embolization ◽  
Autosomal Dominant Polycystic Kidney

Abstract Background Autosomal dominant polycystic kidney disease (ADPKD) is a common genetic disorder associated with progressive enlargement of the kidneys and liver. ADPKD patients may require renal volume reduction, especially before renal transplantation. The standard treatment is unilateral nephrectomy. However, surgery incurs a risk of blood transfusion and alloimmunization. Furthermore, when patients are treated with peritoneal dialysis (PD), surgery is associated with an increased risk of temporary or definitive switch to haemodialysis (HD). Unilateral renal arterial embolization can be used as an alternative approach to nephrectomy. Methods We performed a multicentre retrospective study to compare the technique of survival of PD after transcatheter renal artery embolization with that of nephrectomy in an ADPKD population. We included ADPKD patients treated with PD submitted to renal volume reduction by either surgery or arterial embolization. Secondary objectives were to compare the frequency and duration of a temporary switch to HD in both groups and the impact of the procedure on PD adequacy parameters. Results More than 700 patient files from 12 centres were screened. Only 37 patients met the inclusion criteria (i.e. treated with PD at the time of renal volume reduction) and were included in the study (21 embolized and 16 nephrectomized). Permanent switch to HD was observed in 6 embolized patients (28.6%) versus 11 nephrectomized patients (68.8%) (P = 0.0001). Renal artery embolization was associated with better technique survival: subdistribution hazard ratio (SHR) 0.29 [95% confidence interval (CI) 0.12–0.75; P = 0.01]. By multivariate analysis, renal volume reduction by embolization and male gender were associated with a decreased risk of switching to HD. After embolization, a decrease in PD adequacy parameters was observed but no embolized patients required temporary HD; the duration of hospitalization was significantly lower [5 days [interquartile range (IQR) 4.0–6.0] in the embolization group versus 8.5 days (IQR 6.0–11.0) in the surgery group. Conclusions Transcatheter renal artery embolization yields better technique survival of PD in ADPKD patients requiring renal volume reduction.

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