Impact of renal graft volume in the renal function of patients who undergo kidney transplantation

The influence of the pretransplantation hemodialysis strategy on early renal graft function was evaluated in 44 patients receiving hemodialysis in the 24 h preceding kidney transplantation and in 13 patients receiving hemodialysis more than 24 h before transplantation. The patients dialyzed less than 24 h before transplantation were stratified according to treatment with or without complement-activating dialyzers (cuprophane, bioincompatible membrane [BICM] versus polysulfone, biocompatible membrane [BCM]) and with or without ultrafiltration (UF). Serum creatinine (Scr) at days 0, 2, 5, 10, and 30, the time for Scr to decrease 50% (T1/2Scr), the incidence of acute renal failure (ARF; defined as urinary volume < 500 ml/d and/or necessity for posttransplantation hemodialysis), and early graft dysfunction (defined as T1/2Scr > 3.5 d) were registered. Scr was higher in BCM- versus BICM-treated patients (P < 0.0001 by variance analysis) and in patients receiving UF versus those receiving no UF (P = 0.0009). T1/2Scr was higher in treatment with BICM versus BCM (7.4 +/- 7.9 versus 3.1 +/- 2.9 d; P < 0.05) and UF versus no UF (7.1 +/- 7.7 versus 2.7 +/- 2.0 d; P < 0.01). The evolution of Scr was markedly more favorable in the patient group treated with BCM without UF (T1/2Scr 1.7 +/- 0.8 d) compared with the group treated with BICM and UF (T1/2Scr 9.3 +/- 9.1 d; P < 0.01). The remaining groups (BICM without UF and BCM with UF) showed intermediate results. The incidence of ARF and early graft dysfunction was higher in the group on BICM with UF compared to BCM without UF. Functional differences persisted up to 1 mo after transplantation. Patients who underwent dialysis with UF more than 24 h before transplantation had a more beneficial evolution of renal function parameters than those who were dialyzed with UF less than 24 h before transplantation. In conclusion, the use of BICM and the application of UF within 24 h before kidney transplantation enhance the risk of posttransplantation ARF and early graft dysfunction.

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TRANSPLANT TOURISM - OUTCOMES OF UNITED STATES RESIDENTS WHO UNDERGO KIDNEY TRANSPLANTATION OVERSEAS.

Transplantation Journal ◽

10.1097/00007890-200607152-00474 ◽

2006 ◽

Vol 82 (Suppl 2) ◽

pp. 226

Author(s):

&NA;

Keyword(s):

United States ◽

Kidney Transplantation ◽

Transplant Tourism ◽

Undergo Kidney Transplantation

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A Kidney Transplant Recipient with Recurrent Henoch-Schönlein Purpura Nephritis Successfully Treated with Steroid Pulse Therapy and Epipharyngeal Abrasive Therapy

Nephron ◽

10.1159/000511166 ◽

2020 ◽

pp. 1-5

Author(s):

Mika Fujimoto ◽

Kan Katayama ◽

Kouhei Nishikawa ◽

Shoko Mizoguchi ◽

Keiko Oda ◽

...

Keyword(s):

Renal Function ◽

Kidney Transplantation ◽

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Pulse Therapy ◽

Steroid Pulse Therapy ◽

Steroid Pulse ◽

Schonlein Purpura ◽

Purpura Nephritis

There is no specific treatment for recurrent Henoch-Schönlein purpura nephritis (HSPN) in a transplanted kidney. We herein report a case of a kidney transplant recipient with recurrent HSPN that was successfully treated with steroid pulse therapy and epipharyngeal abrasive therapy (EAT). A 39-year-old Japanese man developed HSPN 4 years ago and had to start hemodialysis after 2 months despite receiving steroid pulse therapy followed by oral prednisolone, plasma exchange therapy, and cyclophosphamide pulse therapy. He had undergone tonsillectomy 3 years earlier in the hopes of achieving a better outcome of a planned kidney transplantation and received a living-donor kidney transplantation from his mother 1 year earlier. Although there were no abnormalities in the renal function or urinalysis 2 months after transplantation, a routine kidney allograft biopsy revealed evidence of mesangial proliferation and cellular crescent formation. Mesangial deposition for IgA and C3 was noted, and he was diagnosed with recurrent HSPN histologically. Since the renal function and urinalysis findings deteriorated 5 months after transplantation, 2 courses of steroid pulse therapy were performed but were ineffective. EAT using 0.5% zinc chloride solution once per day was combined with the third course of steroid pulse therapy, as there were signs of chronic epipharyngitis. His renal function recovered 3 months after daily EAT and has been stable for 1.5 years since transplantation. Daily EAT continued for >3 months might be a suitable strategy for treating recurrent HSPN in cases of kidney transplantation.

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