Preemptive Kidney Transplantation of Living Related or Unrelated Donor–Recipient Combinations

AbstractIdiopathic forms of Focal Segmental Glomerulosclerosis (FSGS) are caused by circulating permeability factors, which can lead to early recurrence of FSGS and kidney failure after kidney transplantation. In the past three decades, many research endeavors were undertaken to identify these unknown factors. Even though some potential candidates have been recently discussed in the literature, “the” actual factor remains elusive. Therefore, there is an increased demand in FSGS research for the use of novel technologies that allow us to study FSGS from a yet unexplored angle. Here, we report the successful treatment of recurrent FSGS in a patient after living-related kidney transplantation by removal of circulating factors with CytoSorb apheresis. Interestingly, the classical published circulating factors were all in normal range in this patient but early disease recurrence in the transplant kidney and immediate response to CytoSorb apheresis were still suggestive for pathogenic circulating factors. To proof the functional effects of the patient’s serum on podocytes and the glomerular filtration barrier we used a podocyte cell culture model and a proteinuria model in zebrafish to detect pathogenic effects on the podocytes actin cytoskeleton inducing a functional phenotype and podocyte effacement. We then performed Raman spectroscopy in the < 50 kDa serum fraction, on cultured podocytes treated with the FSGS serum and in kidney biopsies of the same patient at the time of transplantation and at the time of disease recurrence. The analysis revealed changes in podocyte metabolome induced by the FSGS serum as well as in focal glomerular and parietal epithelial cell regions in the FSGS biopsy. Several altered Raman spectra were identified in the fractionated serum and metabolome analysis by mass spectrometry detected lipid profiles in the FSGS serum, which were supported by disturbances in the Raman spectra. Our novel innovative analysis reveals changed lipid metabolome profiles associated with idiopathic FSGS that might reflect a new subtype of the disease.

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Laparoscopic-Assisted Recipient Nephrectomy and Recipient Kidney Procurement during Orthotopic Living-Related Kidney Transplantation

Case Reports in Transplantation ◽

10.1155/2011/153493 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Dimitri Mikhalski ◽

Karl Martin Wissing ◽

Renaud Bollens ◽

Daniel Abramowicz ◽

Vincent Donckier ◽

...

Keyword(s):

Kidney Transplantation ◽

Antiphospholipid Antibodies ◽

Graft Function ◽

Renal Vessels ◽

Short Period ◽

History Of ◽

Stage Renal Disease ◽

End Stage ◽

Living Related ◽

Laparoscopic Assisted

Advanced atherosclerosis or thrombosis of iliac vessels can constitute an absolute contraindication for heterotopic kidney transplantation. We report the case of a 42-year-old women with end-stage renal disease due to lupus nephritis and a history of bilateral thrombosis of iliac arteries caused by antiphospholipid antibodies. Occlusion had been treated by the bilateral placement of wall stents which precluded vascular anastomosis. The patient was transplanted with a right kidney procured by laparoscopic nephrectomy from her HLA semi-identical sister. The recipient had left nephrectomy after laparoscopical transperitoneal dissection. The donor kidney was orthotopically transplanted with end-to-end anastomosis of graft vessels to native renal vessels and of the graft and native ureter. Although, the patient received full anticoagulation because of a cardiac valve and antiphospholipid antibodies, she had no postoperative complication in spite of a short period of delayed graft function. Serum creatinine levels three months after transplantation were at 1.0 mg/dl. Our case documents that orthotopical transplantation of laparoscopically procured living donor kidneys at the site of recipient nephrectomy is a feasible procedure in patients with surgical contraindication of standard heterotopic kidney transplantation.

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Long-Term Results of Donor-Specific Blood Transfusion with Cyclosporine in Living Related Kidney Transplantation

Nephron ◽

10.1159/000045975 ◽

2001 ◽

Vol 88 (2) ◽

pp. 144-148 ◽

Cited By ~ 7

Author(s):

M. Otsuka ◽

K. Yuzawa ◽

Y. Takada ◽

H. Taniguchi ◽

K. Todoroki ◽

...

Keyword(s):

Kidney Transplantation ◽

Blood Transfusion ◽

Long Term Results ◽

Living Related

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Living-Unrelated Donor Renal Transplantation: An Alternative to Living-Related Donor Transplantation?

Annals of The Royal College of Surgeons of England ◽

10.1308/003588408x261636 ◽

2008 ◽

Vol 90 (3) ◽

pp. 247-250 ◽

Cited By ~ 21

Author(s):

Nadeem Ahmad ◽

Kamran Ahmed ◽

Mohammad Shamim Khan ◽

Francis Calder ◽

Nizam Mamode ◽

...

Keyword(s):

Graft Survival ◽

Rejection Rate ◽

Unrelated Donor ◽

Hla Matching ◽

Estimated Gfr ◽

Live Donor Kidney ◽

Related Donor ◽

Living Related ◽

Living Related Donor ◽

Patient And Graft Survival

INTRODUCTION An increasing number of living-unrelated, kidney donor transplants are being performed in our unit. We present a comparison of living-unrelated (LURD) and living-related donor (LRD) renal transplant outcomes and analyse influencing factors. PATIENTS AND METHODS We retrospectively analysed the outcome of all living-donor renal transplants performed at our centre from 1993 to 2004. The parameters studied included patient and graft survival, functioning status of grafts (determined by estimated GFR) at last follow-up and any rejection episodes. Multivariate analysis was performed for recipient and donor age, ethnicity, HLA matching and re-transplants. RESULTS A total of 322 live donor kidney transplants (LRD, n = 261; LURD, n = 61) were carried out over this period. Mean recipient age was 28 ± 16 years in the LRD group and 48 ± 12 years in LURD, while mean age of the donors was 43 ± 11 years and 48 ± 10 years, respectively. Caucasians constituted 80% of all the living donors. Amongst LRD, parents were the commonest (58%) donors followed by siblings (35%). In LURD, 80% were spouses. A total of 33 grafts failed, 30 in LRD (11%) and 3 in LURD (5%). Thirteen patients died, 11 (4.2%) in LRD (7 with functioning graft) and 2 (3.3%) in LURD (1 with functioning graft). Acute rejections occurred in 41% recipients in LRD and 35% in LURD (P = 0.37). Estimated GFR was lower in LURD than in LRD (49 ± 14 versus 59 ± 29 ml/min/1.73 m2; P = 0.032). One- and 3-year patient survival for LRD and LURD was 98.7% and 96.3% and 97.7% and 95%, respectively (P = 0.75). One- and 3-year graft survival was equivalent at 94.8% and 92.3% for LRD, and 98.4% and 93.7% for LURD, respectively (P = 0.18). CONCLUSIONS Outcome of LRD and LURD is comparable in terms of patient and graft survival, acute rejection rate and estimated GFR despite differences in demographics, HLA matching and re-transplants of recipients.

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Living-related kidney transplantation with catheterizable urinary conduit in prune belly syndrome: A case report

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2018.08.022 ◽

2018 ◽

Vol 51 ◽

pp. 150-153 ◽

Cited By ~ 1

Author(s):

Taro Banno ◽

Yoichi Kakuta ◽

Kohei Unagami ◽

Akiko Sakoda ◽

Masayoshi Okumi ◽

...

Keyword(s):

Kidney Transplantation ◽

Case Report ◽

Prune Belly Syndrome ◽

Prune Belly ◽

Living Related

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Kidney transplantation from living related donors aged more than 60 years: a single center experience

Renal Failure ◽

10.3109/0886022x.2013.823873 ◽

2013 ◽

Vol 35 (9) ◽

pp. 1251-1254 ◽

Cited By ~ 4

Author(s):

Yifu Li ◽

Jun Li ◽

Qian Fu ◽

Lizhong Chen ◽

Jiguang Fei ◽

...

Keyword(s):

Kidney Transplantation ◽

Single Center ◽

Single Center Experience ◽

Living Related

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Analysis of donor selection for living related kidney transplantation and their postoperative outcome

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0206193l ◽

2002 ◽

Vol 130 (5-6) ◽

pp. 193-197

Author(s):

Visnja Lezaic ◽

Ljubica Djukanovic ◽

Dragana Radivojevic-Djokic ◽

Radmila Blagojevic-Lazic ◽

Stojanka Ristic ◽

...

Keyword(s):

Kidney Transplantation ◽

Selection Procedure ◽

Postoperative Outcome ◽

Careful Examination ◽

Family Relation ◽

Abo Incompatibility ◽

Living Donor Transplantation ◽

Kidney Transplantations ◽

Living Related ◽

Drop Outs

Lack of cadaveric organs for transplantation resulted in increased number of living related kidney donors examinations and consequent transplantations in our Department. Donor procedure, selection, drop-outs and final results for living related donors (LRD) were retrospectively analyzed in this paper. Between 1987 and 1994 202 potential LRD were examined. Most of them were females (59%) and about 30% were older than 60 years. The family relation between LRD and recipients were: parents (95%), siblings (3%), grandmother grandfather (1.5%) and uncle (0.5%). Potential LRD were informed on risks advantages and procedure of living donor transplantation. After primary information 26% of potential LRD gave up further examinations. Following immunological and clinical evaluations 48% of LRD actually donated a kidney. The other 26% were excluded during the selection procedure. High immunological risks including ABO incompatibility, HLA mismatches and positive cross match test were the reasons for drop outs of 35 potential LRD (17%). Five more donors were excluded for medical reasons: one because of low creatinine clearance and four because of neoplasms, discovered during examination (kidney, laryngeal, lung). Fourteen transplantation were not realized due to different recipient reasons: 5 of them had clinical contraindications, two died and in 7 cadaveric kidney transplantations were performed. Mild hypertension, coronary disease and diabetes mellitus type 2 were presented in 5 LRD accepted for transplantation. Five more had to be operated before donation (abdominal or urological operation). Early complications after donor nephrectomy were acute renal failure, stress ulcus, pleuropneumonia in three and thromboflebitis in two donors. In conclusion, although kidney transplantation from LRD is highly successful careful examination during selection procedure is indispensable.

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