MO970GRAFT OUTCOME AFTER ACUTE REJECTION: A CASE CONTROL STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Safa Fattoum ◽  
Mohamed Mongi Bacha ◽  
Tasnim Mosbahhi ◽  
Nesrine Braiek ◽  
Ezzedine Abderrahim ◽  
...  
Keyword(s):  
Acute Rejection ◽  
Graft Survival ◽  
Functional Recovery ◽  
Graft Function ◽  
Early Period ◽  
Transplant Patients ◽  
Graft Outcome ◽  
Group A ◽  
Group B ◽  
Over Time

Abstract Background and Aims Although Acute rejection (AR) is a complication associated with the early period after kidney transplantation (KT), its complications are mostly seen after a long term. The aim of this study was to evaluate graft outcome after AR. Method It was a longitudinal, retrospective, analytical study including kidney transplant patients followed up in our department between 1986 and 2019. Our population was divided in 2 groups: group A (129 KT complicated by at least one episode of AR) and group B (491 KT not complicated by AR). Results AR was responsible of immediate loss of 2 grafts. Chronic graft dyfonction was more frequent in group A (44,1% versus 17,4%, p<0,0001). Creatininemia levels were significantly higher at 3, 6 months, 1 year and 2 years (respectively p =0,0113 ; <0,0001 ; 0,0003 and 0,0172) after KT. The percentage of patients having creatinine levels > 130 µmol/l was higher in group A at 3, 6 months, 1 year, 2 years, 3 years and 5 years (respectively p =0,0186 ; 0,001 ; <0,0001 ; 0,0115 ; 0,0073 and 0,0255). Graft survival was better in group B (p<0,0001). In group A, AR recurrence was responsible of a worser survival (p<0,0001). Over time, graft survival improved in the 2 groups. Complete functional recovery survival was similar to graft with no rejection but with impared graft function. The worst graft survival was noted if the functional recovery was absent. Conclusion Even if graft outcome after AR has improved over time, its deleterious effect is still inevitable. So AR must be prevented in order to enhance graft outcome.

scholarly journals P1619OUTCOME OF HIGH DONOR-RECIPIENT AGE GAP IN LIVE-DONOR RENAL TRANSPLANTS IN TACROLIMUS ERA

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hatem Kaies Ibrahim Elsayed Ali ◽  
Ahmed Daoud ◽  
Karim Soliman ◽  
Mahmoud Mohamed ◽  
Asam Murtaza
Keyword(s):  
Renal Transplant ◽  
Acute Rejection ◽  
Graft Survival ◽  
Age Difference ◽  
Live Donor ◽  
Renal Transplants ◽  
Transplant Patients ◽  
Age Gap ◽  
Group A ◽  
Recipient Age

Abstract Background and Aims High donor-recipient age gap among deceased-donor renal transplant patients leads to worse outcomes. However, the impact of this gap among live-donor renal transplants is unclear. The aim of this study is to assess the effect of this age gap on graft survival and acute rejection rates among renal transplants in tacrolimus era. Method 14390 live-donor renal transplant patients who received a single organ transplant, had no previous renal transplants, discharged on tacrolimus-based immunotherapy and were registered in the Organ Procurement Transplantation Network from January 2000 till June 2017 were included in the study. Donor–recipient age difference was divided into 5 groups; group A (difference <−10,n=4375), group B (difference from -10 to 10,n=7229), group C (difference between 10-20, n=861), group D ( difference between 20–29, n=1406) and group E (difference ≥30 years, n=519). Poisson regression analysis was used to assess effect of age gap on acute rejection rates. Kaplan-Meier survival curves and Cox hazard regression analysis were used to assess this effect on graft survival. Results Regarding graft survival, groups with age difference ≥30 years and between 20-29 years showed a significantly higher risk of graft loss when compared to group with age difference <−10 (HR equals 4.6 and 3.8 respectively). Groups with age difference between 10 to 20 years and between -10 to 10 years showed no significant difference in graft survival when compared to same group (HR equals 1.03 and 0.95 respectively). Groups B,C,D,E were not associated with increased risk of acute rejection episodes when compared to group A (IRR=1.001, 1.001, 1.022, 1.027 respectively). Conclusion Donor-recipient age difference up to 20 years has similar renal transplant outcomes to those receiving kidneys from younger donors and therefore, should not be precluded from paired kidney donation programs. The donor-recipient age difference above 20 years is associated with worse outcomes in terms of graft survival.

Living versus deceased kidney transplantation: Comparison of complications

2021 ◽  
pp. 039156032199354
Author(s):  
Ali Mohammad Fakhr Yasseri ◽  
Farshad Namdari ◽  
Shahram Gooran ◽  
Ayat Ahmadi ◽  
Sanaz Dehghani ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Graft Function ◽  
Living Donors ◽  
Delayed Graft Function ◽  
P Value ◽  
Living Donor Transplantation ◽  
Group A ◽  
Deceased Donors ◽  
Group B

Introduction: It is assumed that the outcome of kidney transplantation from living donors is more favorable than deceased donors. However, over the years there has been an overall improvement in transplant survival from both living and deceased donors. In this article we have evaluated and compared the most recent results in living and deceased donor kidney transplantations. Patients and Methods: Four hundred and forty six patients underwent kidney transplantation in our center from September 2009 to March 2014. The patients divided in two groups living (group A) and deceased (group B) donor transplantation groups. The patients were followed until September 2016. Acute rejection, graft survival, delayed graft function, renal artery thrombosis, graft nephrectomy, ureterocutaneous fistula, postoperative hypertension, mortality, hospital stay, hyperlipidemia, post transplantation diabetes and lymphocele rate measured and compared in two groups. Results: Most variables were not different between the two groups except lymphocele and delayed graft function. Lymphocele was more prevalent in group A (13.8% vs 3.1%, p-value = 0.02) and delayed graft function results were more desirable in living donor transplantation group (group B). Conclusion: Although, delayed graft function was less common in transplantation from living donors, short, and long term graft survival was not significantly different in this study.

MO1000MAINTENANCE IMMUNOSUPPRESSIVE THERAPY IN PREVENTION OF ACUTE REJECTION AFTER KIDNEY TRANSPLANTATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Safa Fattoum ◽  
Mohamed Mongi Bacha ◽  
Tasnim Mosbehi ◽  
Nesrine Braiek ◽  
Ezzedine Abderrzhim ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Acute Rejection ◽  
Low Dose ◽  
Immunosuppressive Treatment ◽  
Calcineurin Inhibitors ◽  
Transplant Patients ◽  
Group A ◽  
Kidney Transplant Patients ◽  
Group B

Abstract Background and Aims Acute rejection (AR) is a redoubtable immunological complication after kidney transplantation (KT). Maintenance immunosuppressive treatment (IS) is a corner stone in prevention of AR. The aim of this study was to define the role of different maintenance IS in preventing AR. Method It was a longitudinal, retrospective, analytical study including kidney transplant patients followed up in our department between 1986 and 2019. Our population was divided in 2 groups: group A (129 KT complicated by at least one episode of AR) and group B (491 KT not complicated by AR). Results All patients received low dose of corticosteroids (CS) in their IS. Calcineurin inhibitors (CI) were not prescribed in first intention in 33,3% of groups A patients versus 13,2% in group B. Cyclosporin A (CsA) was prescribed in first intention in 57,4% of group A patients versus 45,7% in group B. Tacrolimus was prescribed in first intention in 9,3% of group A patients versus 41,1% in group B (p<0,0001). All patients received Atimetabolite (AM) in their IS. In first intention, Azathioprin was prescribed in 73,6 % of group A patients and Mycophenolate Mofetil (MMF) was prescribed in 78,6% of group B patients (<0,0001). In first intention, maintenance IS consisted in low dose corticosteroids (CS) associated with AM in 13,5% of our patients. CI was associated to CS and AM in 86,5% of patients. Tritherapy was significantly more used than biotherapy in group A (p<0,0001). Different associations used were CS+Aza, CS+MMF, CS+AZA+CsA, CS+MMF+CsA or CS+MMF+ Tac. From group A, 74,8% of patients received CS+AZA or Cs+AZA+CsA. And from group B, 75,8% of patients received CS+MMF+CsA or CS+MMF+Tac. Conclusion Maintenance IS therapy must be well chosen according to immunological risk in order to prevent AR.

MO982COMPARISON OF BASILIXIMAB AND R-ATG  ON ACUTE REJECTION RISK IN HIGH IMMUNOLOGICAL RISK RENAL TRANSPLANT RECIPIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Hatem Kaies Ibrahim Elsayed Ali ◽  
Mahmoud Mohamed ◽  
Nithya Krishnan ◽  
Shafi Malik
Keyword(s):  
Mycophenolate Mofetil ◽  
Renal Transplant ◽  
Acute Rejection ◽  
Lower Risk ◽  
Living Donor ◽  
Graft Function ◽  
Deceased Donor ◽  
Transplant Recipients ◽  
Group A ◽  
Group B

Abstract Background and Aims High Panel Reactive Antibody (PRA) level has been widely accepted as a marker for acute rejection risk following kidney transplantation. PRA>/= 20% is considered a high immunological risk renal transplant. The aim of our study was to assess the risk of acute rejection in kidney transplant recipients (KTR) following Basiliximab induction compared to Rabbit Anti-Thymocyte Globulin (R-ATG) maintained on tacrolimus and mycophenolate mofetil maintenance immunotherapy. Method This was a retrospective observational cohort study using data from the United States Organ Procurement and Transplantation Network, all KTR’s with PRA =/> 20%, who were maintained on tacrolimus and mycophenolate mofetil between September 2017 and September 2019 were included. Follow-up was until September 2020. Data included recipient factors (age, sex, ethnicity, diabetes, body mass index), transplant factors (delayed graft function, cold ischemia time, number of previous transplants, panel reactive antibodies, HLA-mismatches, induction therapy, maintenance immunotherapy and donor factors (donor type, donor age). The cohort were divided into 2 groups; living and deceased donor renal transplants. The groups were further divided by PRA level, each group was divided into 3 subgroups: Group A (low PRA level: PRA range from 20% to 49%), Group B (moderate PRA level: PRA range from 50% to 79%), and Group C (High PRA level: PRA range from 80% to 100%). Multivariable logistic regression models were constructed to assess the effect of induction therapies (Basiliximab versus R-ATG) on acute rejection episodes at 6 months post-transplant. The multivariable model was adjusted for recipient, donor and transplant factors mentioned above. Results Among living donor KTR’s, there was no difference between Basiliximab and R-ATG in acute rejection episodes in any of the three groups, Group A (low PRA level, n=717, OR=1.17, P=0.79, 95%CI:0.34-3.95), Group B (moderate PRA level, n=618, OR=1.51, P=0.58, 95%CI:0.33-6.92) and Group C (high PRA level, n=401, OR=1.17, P=0.85, 95%CI:0.21-6.56) respectively. In contrast, among deceased donor KTR’s R-ATG was associated with lower risk of rejection compared to Basiliximab in all three groups, group A (low PRA level, n=1895, OR=0.52, P=0.03, 95%CI: 0.28-0.94), group B (moderate PRA level, n=1618, OR=0.41, P<0.01, 95%CI: 0.22-0.78) and group C (high PRA level, n=3973, P<0.01, 95%CI: 0.28-0.70). Conclusion This study shows that risk of acute rejection is no different with Basilximab induction compared to R-ATG in high immunological risk living-donor KTR’s at all levels of PRA in the current tacrolimus-mycophenolate mofetil immunosuppression era. However, risk of acute rejection seems to be lower in deceased donor KTR’s having R-ATG induction at all levels of PRA. Delayed graft function is a risk factor for acute rejection, our models did not adjust for dose of R-ATG which may explain the lower risk seen in deceased donor KTR’s, data was not available on donor specific antibodies. In summary, Basiliximab induction has similar acute rejection rates as R-ATG in living donor KTR’s whereas in deceased donor KTR’s R-ATG was found to be better.

P1661EVOLUTION OF RENAL FUNCTION IN RENAL TRANSPLANTED DONORS PATIENTS IN ASYSTOLE TYPE II. IS THERE A CORRELATION BETWEEN HISTOPATHOLOGY PARAMETERS OF THE DONOR BIOPSY AND THE GRAFT SURVIVAL? EXPERIENCE IN OUR CENTER

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Cristina Andrades Gómez ◽  
Francisco Manuel González Roncero ◽  
Alejandro Suárez Benjumea ◽  
Blanca Gascó Martos ◽  
Carmen González Corvillo ◽  
...  
Keyword(s):  
Renal Function ◽  
Acute Rejection ◽  
Brain Death ◽  
Graft Survival ◽  
Graft Function ◽  
Type Ii ◽  
Blood Group A ◽  
Group A ◽  
Donor Biopsy

Abstract Background and Aims With the aim of increasing the number of kidney transplant donors (RT), the use of organs from cadaver donors in asystole (DA) type II of Maastricht has been enhanced in recent years.The important ischemia that this type of donation entails makes it especially complex, resulting in a higher incidence of delayed renal function and non-primary graft function, compared to the TR from donor in brain death.We present our experience with the Mastricht DA type II TR since the beginning of our program in 2013 Method 108 patients with type II performed between January 2010 and June 2019, median follow-up 30 months. Results : mean age of the donor 42 years, 65% blood group A, mean Cr at the first month of 3 mg/dl, at the 3rd month of 1.9 mg/dl and currently 1.6 mg/dl. Mean ange of the receptor 46 years, time on dialysis 30 months, 1st transplant all, except 1. PRAc pre TR was < 25%, initial immunosuppression with thymoglobulin, steroids, mycophenolate, and delayed introduction of tacrolimus. 10% never function; 73.5% delayed renal function. 7.2% acute rejection. Survivors of the 1st, 3rd and 5th year recipients are 98%, 98% and 86% respectively. In a innovative way, it has been registered the correlation between histopathology parameters of the donor biopsy and the graft survival. Conclusion RT with type II DA has more incidence of delayd renal function and non-primarygraft function, however results in survival and kidney function in our center are very acceptable, comparable to donors in brain death.

Anterior approach levator plication for congenital ptosis, absorpable versus non absorpable sutures

2021 ◽  
pp. 112067212110053
Author(s):  
Moustafa Salamah ◽  
Ashraf Mahrous Eid ◽  
Hani Albialy ◽  
Sherif Sharaf EL Deen
Keyword(s):  
Randomized Study ◽  
Early Postoperative Period ◽  
Polyglactin 910 ◽  
Exclusion Criteria ◽  
Congenital Ptosis ◽  
History Of ◽  
Group A ◽  
Group B ◽  
Over Time

Purpose: To compare the efficacy of two different suture types in levator plication for correction of congenital ptosis. Subjects and methods: Prospective comparative interventional randomized study involving 42 eyes of 42 patients aged more than 6 years with congenital ptosis and good levator action. The exclusion criteria were as follows: bilateral ptosis, history of previous surgery, fair or poor levator action, and associated other ocular diseases. Patients were randomized into group A, in which double-armed 5/0 polyester Ethibond were used, and group B, in which double-armed 5/0 Coated Vicryl® (polyglactin 910) suture material we used. Outcomes including eyelid height and stability of eyelid height over time were compared with follow-up data. The MRD was 4.05 ± 0.36 mm and 3.95 ± 0.34 after 1 week for both groups A and B, respectively. At the end of study follow up period (24 weeks), the MRD was 3.60 ± 0.42 mm in group A, and 2.52 ± 0.85 mm in group B. Conclusion: No difference in eyelid height between two groups in early postoperative period, but the postoperative eyelid height was more stable over time in the 5/0 polyester Ethibond group (group A) than in the 5/0 Coated Vicryl® (polyglactin 910) group (group B).

scholarly journals The influence of previous arthroscopic treatment on subsequent primary total knee arthroplasty: the comparison between bilateral knees of the same patient

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kuishuai Xu ◽  
Liang Zhang ◽  
Rui Shen ◽  
Cailin Wang ◽  
Tianyu Li ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Functional Recovery ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Arthroscopic Treatment ◽  
Functional Scores ◽  
Group A ◽  
Vas Scores ◽  
Total Knee ◽  
Group B

Abstract Background To explore whether previous arthroscopic knee surgery affects future total knee arthroplasty (TKA) results or not. Methods A total of 56 patients with the previous arthroscopic treatment on one knee underwent subsequent bilateral total knee arthroplasty in our hospital from September 2012 to July 2018. Data on each patient were collected in regards to changes in postoperative clinical and functional scores, various other scores, as well as postoperative functional recovery and complications. We defined the knees with a previous arthroscopic history as group A, and the counter side as group B. The Knee Society clinical score, functional scores, range of motion (ROM), finger joint size (FJS), visual analogue scale (VAS) scores were assessed before and after surgery. Using the Kolmogorov-Smirnov Test to test the normality of continuous variables, and the chi-square test to compare the rate of reoperation and complications between two groups. For all statistical comparisons, P < 0.05 was considered significant. Results There were no statistically significance differences found in postoperative Knee Society clinical scores and functional scores between group A and group B, as well as in ROM, FJS, VAS scores and local complications. Conclusion There were no statistically significant differences found in postoperative functional recovery and complications in patients, who underwent total knee arthroplasty with previous knee arthroscopy.

MO941CLINICAL OUTCOMES IN KIDNEY RE-TRANSPLANTATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Clara Pardinhas ◽  
Rita Leal ◽  
Francisco Caramelo ◽  
Teofilo Yan ◽  
Carolina Figueiredo ◽  
...  
Keyword(s):  
Acute Rejection ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Graft Failure ◽  
Graft Function ◽  
Delayed Graft Function ◽  
First Year ◽  
Kidney Transplant Recipients ◽  
Post Transplant

Abstract Background and Aims As kidney transplants are growing in absolute numbers, so are patients with failed allografts and thus potential candidates for re-transplantation. Re-transplantation is challenging due to immunological barriers, surgical difficulties and clinical complexities but it has been proven that successful second transplantation improves life expectancy over dialysis. It is important to evaluate re-transplantation outcomes since 20% of patients on the waiting list are waiting for a second graft. Our aim was to compare major clinical outcomes such as acute rejection, graft and patient survival, between patients receiving a first or a second kidney transplant. Method We performed a retrospective study, that included 1552 patients submitted to a first (N=1443, 93%) or a second kidney transplant (N=109, 7%), between January 2008 and December 2018. Patients with more than 2 grafts or multi-organ transplant were excluded. Demographic, clinical and histocompatibility characteristics of both groups were registered from our unit database and compared. Delayed graft function was defined has the need of dialysis in the first week post-transplant. All acute rejection episodes were biopsy proven, according to Banff 2017 criteria. Follow-up time was defined at 1st June 2020 for functioning grafts or at graft failure (including death with a functioning graft). Results Recipients of a second graft were significantly younger (43 ±12 vs 50 ± 13 years old, p&lt;0.001) and there were significantly fewer expanded-criteria donors in the second transplant group (31.5% vs 57.5%, p&lt;0.001). The waiting time for a second graft was longer (63±50 vs 48±29 months, p=0.011). HLA mismatch was similar for both groups but PRA was significantly higher for second KT patients (21.6±25% versus 3±9%; p&lt;0.001). All patients submitted to a second KT had thymoglobulin as induction therapy compared to 16% of the first KT group (p&lt;0.001). We found no difference in primary dysfunction or delayed graft function between groups. Acute rejection was significantly more frequent in second kidney transplant recipients (19% vs 5%, p&lt;0.001), being 10 acute cellular rejections, 7 were antibody mediated and 3 were borderline changes. For the majority of the patients (85%), acute rejection occurred in the first-year post-transplant. Death censored graft failure occurred in 236 (16.4%) patients with first kidney transplant and 25 (23%) patients with a second graft, p=0.08. Survival analysis showed similar graft survival for both groups (log-rank p=0.392). We found no difference in patients’ mortality at follow up for both groups. Conclusion Although second graft patients presented more episodes of biopsy proven acute rejection, especially at the first-year post-transplant, we found no differences in death censored graft survival or patients’ mortality for patients with a second kidney transplant. Second transplants should be offered to patients whenever feasible.

Diagnostic significance of some urinary enzymes for detecting acute rejection crises in renal-transplant recipients: alanine aminopeptidase, alkaline phosphatase, gamma-glutamyltransferase, N-acetyl-beta-D-glucosaminidase, and lysozyme.

1986 ◽  
Vol 32 (10) ◽  
pp. 1807-1811 ◽  
Author(s):  
K Jung ◽  
J Diego ◽  
V Strobelt ◽  
D Scholz ◽  
G Schreiber
Keyword(s):  
Alkaline Phosphatase ◽  
Renal Transplant ◽  
Acute Rejection ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Urinary Enzymes ◽  
Gamma Glutamyltransferase ◽  
Alanine Aminopeptidase ◽  
Group A ◽  
Group B

Abstract We compared the diagnostic validity of five urinary enzymes--alanine aminopeptidase (EC 3.4.11.2), alkaline phosphatase (EC 3.1.3.1), gamma-glutamyltransferase (EC 2.3.2.2), N-acetyl-beta-D-glucosaminidase (EC 3.2.1.30), and lysozyme (EC 3.2.1.17)--as indicators of acute rejection crises in renal-transplant recipients. In 82 patients (group A), the excretion of each of these five enzymes was measured daily from transplantation until discharge from hospital. In another 69 patients (group B), enzyme determinations were made when the patient came for regular checkups (about every four to eight weeks). We used an "activity ratio" (the activity measured at a particular time compared with the activity on the preceding determination) value of 1.5 as the decision point. In group A, use of this discrimination point for alanine aminopeptidase, gamma-glutamyltransferase, and N-acetyl-beta-D-glucosaminidase yielded a specificity and sensitivity of about 90%. In group B, only alanine aminopeptidase had a greater diagnostic sensitivity than creatinine alone. Evidently, measurement of alanine aminopeptidase can be a helpful indicator of acute rejection crises, when interpreted in combination with other available relevant clinical, biochemical, and immunological data.

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