Incidentally Discovered Yellowish Lesions in a Renal Graft From a Deceased Donor

Delayed renal graft function (DGF) is a frequent complication with negative impact on the course of early post-transplantation period. The data concerning the impact on the late results are contradictory. This study describes results of 5-year follow-up of 248 recipients after deceased donor renal transplantation. All patients were divided into two groups: with delayed graft function (DGF, n = 53) and immediate graft function, considered as the control group (IGF, n = 195). We evaluated factors that were associated with development of DGF and its impact on the survival of graft and recipient, and frequency of acute rejections and chronic dysfunctions. The rate of observed DGF was 21.4%. Its development was associated with the following factors: age of recipient and their weight, age of donor and their body mass index, high frequency of asystole/hypotension in donors prior to organ explantation (P < 0.05 for all), and longer time of cold ischemia (P = 0.058). The DGF group had higher rate of acute rejections (P < 0.001), and also lower 1.5 and 5-year graft survival and 1.5-year patient survival (P < 0.05 for all). The conclusion is that DGF has negative impact on the survival of renal grafts and patients, especially during the first 1.5 years after transplantation.

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Mannitol and renal graft injury in patients undergoing deceased donor renal transplantation – A randomized controlled clinical trial

10.21203/rs.2.24370/v2 ◽

2020 ◽

Author(s):

Christian Reiterer ◽

Karin Hu ◽

Samir Sljivic ◽

Markus Falkner von Sonnenburg ◽

Edith Fleischmann ◽

...

Keyword(s):

Renal Transplantation ◽

Mixed Model ◽

Linear Mixed Model ◽

Deceased Donor ◽

Renal Tissue ◽

Serum Biomarkers ◽

Controlled Clinical Trial ◽

Renal Transplant Recipients ◽

Renal Graft ◽

Before And After

Abstract Background Ischaemia/reperfusion (I/R) injury is associated with renal tissue damage during deceased donor renal transplantation. Evidence is weak regarding the effect of mannitol attenuating I/R injury during graft reperfusion in renal transplant recipients. We tested the effect of mannitol to reduce renal graft injury represented by 16 serum biomarkers, which are involved in different relevant pathophysiological pathways. Our primary outcome were differences in biomarker concentrations between the mannitol and the placebo group 24 hours after graft reperfusion. Additionally, to account for biomarker concentrations before transplantation, a linear mixed model was applied. Methods 34 patients undergoing deceased donor renal transplantation were randomly assigned at the Medical University of Vienna to receive either 20% mannitol or 0.9% NaCl placebo solution before and after graft reperfusion. 16 serum biomarkers (MMP1, CHI3L1, CCL2, MMP8, HGF, GH, FGF23, Tie2, VCAM1, TNFR1, IGFBP7, IL18, NGAL, Endostatin, CystC, KIM1) were measured preoperatively and 24 hours after graft reperfusion using Luminex assays and ELISA. Results 16 patients in each group were analysed. Tie2 differed 24 hours after graft reperfusion between both groups ( p = 0.011). Change of log2 transformed concentration levels over time differed significantly in four biomarkers (VCAM1,Endostatin, KIM1, GH; p=0.007; p = 0.013; p = 0.004; p = 0.033; respectively) out of 16 between both groups. Conclusion Our study showed insufficient effects of mannitol on I/R injury in patients undergoing deceased renal transplantation. Thus, we do not support the routinely use of mannitol to attenuate I/R injury.

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Mannitol and renal graft injury in patients undergoing deceased donor renal transplantation – a randomized controlled clinical trial

BMC Nephrology ◽

10.1186/s12882-020-01961-z ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Christian Reiterer ◽

Karin Hu ◽

Samir Sljivic ◽

Markus Falkner von Sonnenburg ◽

Edith Fleischmann ◽

...

Keyword(s):

Clinical Trial ◽

Renal Transplantation ◽

Deceased Donor ◽

Controlled Clinical Trial ◽

Randomized Controlled Clinical Trial ◽

Renal Graft ◽

Randomized Controlled

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Mannitol and renal graft injury in patients undergoing deceased donor renal transplantation – A randomized controlled clinical trial

10.21203/rs.2.24370/v1 ◽

2020 ◽

Author(s):

Christian Reiterer ◽

Karin Hu ◽

Samir Sljivic ◽

Markus Falkner von Sonnenburg ◽

Edith Fleischmann ◽

...

Keyword(s):

Renal Transplantation ◽

Mixed Model ◽

Linear Mixed Model ◽

Deceased Donor ◽

Renal Tissue ◽

Serum Biomarkers ◽

Controlled Clinical Trial ◽

Renal Transplant Recipients ◽

Renal Graft ◽

Before And After

Abstract BackgroundIschaemia/reperfusion (I/R) injury is associated with renal tissue damage during deceased donor renal transplantation. Evidence is weak regarding the effect of mannitol attenuating I/R injury during graft reperfusion in renal transplant recipients. We tested the effect of mannitol to reduce renal graft injury represented by 16 serum biomarkers, which are involved in different relevant pathophysiological pathways. Our primary outcome were differences in biomarker concentrations between the mannitol and the placebo group 24 hours after graft reperfusion. Additionally, to account for biomarker concentrations before transplantation, a linear mixed model was applied.Methods4 patients undergoing deceased donor renal transplantation were randomly assigned at the Medical University of Vienna to receive either 20% mannitol or 0.9% NaCl placebo solution before and after graft reperfusion. 16 serum biomarkers (MMP1, CHI3L1, CCL2, MMP8, HGF, GH, FGF23, Tie2, VCAM1, TNFR1, IGFBP7, IL18, NGAL, Endostatin, CystC, KIM1) were measured preoperatively and 24 hours after graft reperfusion using Luminex assays and ELISA.Results16 patients in each group were analysed. Tie2 differed 24 hours after graft reperfusion between both groups (p = 0.011). Change of log2 transformed concentration levels over time differed significantly in four biomarkers (VCAM1,Endostatin, KIM1, GH; p=0.007; p = 0.013; p = 0.004; p = 0.033; respectively) out of 16 between both groups.ConclusionOur study showed insufficient effects of mannitol on I/R injury in patients undergoing deceased renal transplantation. Thus, we do not support the routinely use of mannitol to attenuate I/R injury.

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Identification of Risk Factors for Vascular Thrombosis May Reduce Early Renal Graft Loss: A Review of Recent Literature

Journal of Transplantation ◽

10.1155/2012/793461 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 44

Author(s):

Anna Krarup Keller ◽

Troels Munch Jorgensen ◽

Bente Jespersen

Keyword(s):

Risk Factors ◽

Graft Loss ◽

Significant Risk ◽

Deceased Donor ◽

Hemodynamic Instability ◽

Kidney Graft ◽

Thrombotic Risk ◽

Vascular Thrombosis ◽

Renal Graft ◽

Early Graft

Renal graft survival has improved over the past years, mainly owing to better immunosuppression. Vascular thrombosis, though rare, therefore accounts for up to one third of early graft loss. We assess current literature on transplantation, identify thrombosis risk factors, and discuss means of avoiding thrombotic events and saving thrombosed grafts. The incidence of arterial thrombosis was reported to 0.2–7.5% and venous thrombosis 0.1–8.2%, with the highest incidence among children and infants, and the lowest in living donor reports. The most significant risk factors for developing thrombosis were donor-age below 6 or above 60 years, or recipient-age below 5-6 years, per- or postoperative hemodynamic instability, peritoneal dialysis, diabetic nephropathy, a history of thrombosis, deceased donor, or >24 hours cold ischemia. Multiple arteries were not a risk factor, and a right kidney graft was most often reported not to be. Given the thrombosed kidney graft is diagnosed in time, salvage is possible by urgent reoperation and thrombectomy. Despite meticulous attentions to reduce thrombotic risk factors, thrombosis cannot be entirely prevented and means to an early detection of this complication is desirable in order to save the kidneys through prompt reoperation. Microdialysis may be a new tool for this.

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