scholarly journals Standard work-up of the low-risk kidney transplant candidate: a European expert survey of the ERA-EDTA Developing Education Science and Care for Renal Transplantation in European States Working Group

2019 ◽  
Vol 34 (9) ◽  
pp. 1605-1611 ◽  
Author(s):  
Umberto Maggiore ◽  
Daniel Abramowicz ◽  
Klemens Budde ◽  
Marta Crespo ◽  
Christophe Mariat ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Kidney Transplant ◽  
Working Group ◽  
Young Patients ◽  
Geographical Location ◽  
Diagnostic Procedures ◽  
Low Risk ◽  
Education Science ◽  
Work Up

Abstract Background Existing guidelines on the evaluation and preparation of recipients for kidney transplantation target the entire spectrum of patients with end-stage renal disease. Within the ERA-EDTA Developing Education Science and Care for Renal Transplantation in European States (DESCARTES) Working Group, it was proposed that in a subset of relatively young patients (<40 years) without significant comorbidities (such as diabetes or cardiovascular disease), the work-up for transplantation could be restricted to a small set of tests. Methods Aiming for agreement between transplant centres across Europe, we surveyed the opinion of 80 transplant professionals from 11 European states on the composition of a minimal work-up. Results We show that there is a wide agreement among European experts that the work-up for kidney transplantation of the low-risk candidate, as opposed to the standard risk candidate, could include a limited number of investigations. However, there is some disagreement regarding the small number of diagnostic procedures, which is related to geographical location within Europe and the professional background of respondents. Conclusions Based on the results of the survey, published guidelines and expert meetings by the DESCARTES Working Group, we have formulated a proposal for the work-up of low-risk kidney transplant candidates.

scholarly journals The history of renal transplantation in Canada

2020 ◽  
Vol 14 (12) ◽  
Author(s):  
Max Alexander Levine ◽  
Joseph L. Chin ◽  
Andrew Rasmussen ◽  
Alp Sener ◽  
Patrick Luke
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Kidney Transplant ◽  
Professional Group ◽  
History Of ◽  
The Impact

While the urologist’s involvement in kidney transplantation varies from center to center and country to country, urologists remain integral to many programs across Canada. From the early days of kidney transplant to contemporary times, the leadership, vision, and skillset of Canadian urologists have helped progress the field. In this review of Canadian urologists’ role in kidney transplantation, the achievements of this professional group are highlighted and celebrated. Original contributors to the field, as well as notable achievements are highlighted, with a focus on the impact of Canadian urologists.

scholarly journals La terapia immunosoppressiva nel trapianto di rene

2019 ◽  
Vol 31 (3) ◽  
pp. 192-196
Author(s):  
Aris Tsalouchos ◽  
Maurizio Salvadori
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Acute Rejection ◽  
Immunosuppressive Therapy ◽  
Kidney Transplant ◽  
Induction Therapy ◽  
Immunosuppressive Agents ◽  
Oral Prednisone ◽  
Kidney Transplant Recipients ◽  
Optimal Maintenance

Immunosuppressive therapy in renal transplantation Immunosuppressive therapy in renal transplantation can be distinguished in induction therapy and maintenance therapy. Induction therapy is an intense immunosuppressive therapy administered at the time of kidney transplantation to reduce the risk of acute allograft rejection. In general, the induction immunosuppressive strategies used at kidney transplant centers fall into one of these two categories. One strategy relies upon high doses of conventional immunosuppressive agents, while the other utilizes antibodies directed against T-cell antigens in combination with lower doses of conventional agents. Maintenance immunosuppressive therapy is administered to almost all kidney transplant recipients to help prevent acute rejection and loss of the renal allograft. Although an adequate level of immunosuppression is required to dampen the immune response to the allograft, the level of chronic immunosuppression is decreased over time (as the risk of acute rejection decreases) to help lower the overall risk of infection and malignancy; these risks directly correlate with the degree of overall immunosuppression. The optimal maintenance immunosuppressive therapy in kidney transplantation is not established. The major immunosuppressive agents that are available in various combination regimens are glucocorticoids (primarily oral prednisone), azathioprine, mycophenolate mofetil (MMF), enteric-coated mycophenolate sodium (EC-MPS), cyclosporine (in non-modified or modified [microemulsion] form), Tacrolimus, everolimus, rapamycin (sirolimus), and Belatacept.

scholarly journals P1786THE HIGHWAY TO KIDNEY TRANSPLANTATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Daènne Scheuter-van Oers ◽  
Ton Kooij van ◽  
Renske Schelfhout ◽  
René Dorpel van den
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Treatment Options ◽  
General Information ◽  
Test Procedures ◽  
Potential Donor ◽  
Transplant Centre ◽  
Nurse Coordinator ◽  
Close Cooperation ◽  
Work Up

Abstract Background and Aims Close cooperation between nephrologist, nurse coördinator and social workers in a large non academic hospital. By timely starting the process of education and examinations we have increased the possibilities of pre-emptive transplantation Method When a patiënt needs to be informed about renal replacement therapy, the digital program is used by the nephrologist to inform all necessary disciplines involved. They each will make an appointment within the given time slot with te patient. At first the social worker start the education process, preferably, in the home situation. General information about the procedures and actions to be taken in the coming period, is given to the patient and his family/friends. They support patients in making difficult dicisions. Secondly, the nurse coordinator in the process, gives information about all options in renal transplantation and gives an explanation about the test procedures which are necessary to decide if patients are able te receive a kidney and donors are appropriate candidates. In case of availability of a potential donor, information is directly given about living donation and the procedure can directly be started. The nurse coordinator ensures that the patient and potential donor complete all required tests in the shortest time possible in their own hospital. The close cooperation consists of daily deliberation between all disciplines and quickly changing the process of a patient or donor when needed. The progress is reported in the digital file and everyone involved will be informed. Results From 2013 until 2020 516 patients entered the program. 575 donors ( for 348 recipients) entered the program. 191 couples have been approved ans presented for transplantation of which 87 couples have been transplanted, 61 couples have been put on hold because of a stabilised kidney function. 40 couples are still in the work up program. 44 recipients were not transplantable due to medical/psychological reasons. The median work up time of the procedure of the recipients was 260 days from start of the process to transfer tot he transplant centre. (2017) Various patient/medical retarding factors are discribed. The median work up time fort he donors was 191 days (2017) days from start of the process to transfer tot the transplant centre. Various donor/medical retarding factors are discribed. Conclusion Patients and family are well informed about the treatment options, with a special attention for kidney transplantation. The efficient work up program in the patients treating hospital, results in a significant improvement of the possibility of pre-emptive renal transplantation, or otherwise, patients are earlier registered on the waiting list.

Renal transplantation

2021 ◽  
pp. 689-740
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Surgical Procedure ◽  
Long Term Outcomes ◽  
Chronic Graft Dysfunction ◽  
Short And Long Term ◽  
Stage Renal Disease ◽  
End Stage ◽  
Work Up

Kidney transplantation is the optimal treatment for end stage renal disease. However, there are risks both from early complications directly related to the surgical procedure, and from longer-term complications resulting from the effects of immunosuppression. This chapter describes the transplant process from the evaluation of patients with renal failure for suitability for transplantation, through the surgical procedure itself, the early and late management of recipients, and the management of the complications that can arise, including acute and chronic graft dysfunction, infection, malignancy, and cardiovascular disease. It also covers the short- and long-term outcomes of kidney transplantation. Since live kidney donors have become an increasingly important source of kidneys for renal transplantation, it also describes the work-up process for potential live donors and the long-term outcomes following donation. Finally, combined kidney/pancreas transplantation is included separately and includes a discussion around the selection and evaluation recipients, the surgical procedure, short- and long-term complications, and the outcomes.

Abstract 15511: A Negative Tachycardic-induced Stress Test Predicts Against Myocardial Infarction at 30 Days Post Renal Transplantation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nicholas J Montarello ◽  
Tania Salehi ◽  
Alex P Bate ◽  
Patrick T Coates ◽  
Matthew I Worthley
Keyword(s):  
Myocardial Infarction ◽  
Renal Transplantation ◽  
Kidney Transplant ◽  
Stress Test ◽  
Low Risk ◽  
Kidney Transplant Recipients ◽  
Post Transplantation ◽  
Assessment Protocol ◽  
Induced Stress ◽  
Asymptomatic Patients

Background: Cardiovascular (CV) events remain a major cause of death in kidney transplant recipients and an accurate CV risk assessment is required prior to a patient being placed on an active transplant wait-list. Determining the optimal protocol and non-invasive test modality for CV work-up remains contentious. The aim of this study was to assess the CV assessment protocol used within a single centre. Methods: We conducted a retrospective analysis on the rates of myocardial infarction (MI) and CV death at 30 days post renal transplantation in patients who had been processed through the CV assessment pathway at the Central Northern Adelaide Renal and Transplantation Service over a 5-year period. This protocol does not require asymptomatic patients under the age of 45, who are non-smokers, have no history of diabetes mellitus, and have been dialysis dependent for less than 24 months, to undergo objective testing for coronary artery disease (CAD) prior to listing. For all other asymptomatic patients, a tachycardic-induced stress test is required. The primary endpoint was the composite of MI and CV death at 30 days post renal transplantation. Results: Between January 2015 and December 2019, 380 patients received kidney only transplants: 79 patients (20.8%) were deemed low-risk and placed on the active transplant list without further CV assessment; 270 patients (71.1%) underwent a tachycardic-induced stress test; 31 patients (8.1%) proceeded directly to ICA. In the five-year study period, a total of three patients (0.8%) experienced a MI at 30 days post transplantation. None of these occurred in the ‘low-risk’ or ‘tachycardic-induced stress test’ cohorts. There were no CV deaths at 30 days post transplantation in the entire cohort. Conclusions: Our review has validated tachycardic-induced cardiac stress testing in predicting MI following kidney transplant surgery. Patients with a valid negative tachycardic-induced stress test went on to have transplantation with no 30-day MI or CV death, supporting the listing without the need for invasive coronary testing. Similarly, we demonstrated that no preliminary testing is required for asymptomatic patients under 45 if they do not smoke or have diabetes, and if they have been dialysis dependent for less than 24 months.

scholarly journals Current Pharmacological Intervention and Medical Management for Diabetic Kidney Transplant Recipients

Pharmaceutics ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 413
Author(s):  
Theerawut Klangjareonchai ◽  
Natsuki Eguchi ◽  
Ekamol Tantisattamo ◽  
Antoney J. Ferrey ◽  
Uttam Reddy ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Pharmacological Intervention ◽  
Diabetic Patients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Kidney Allograft ◽  
Post Transplant ◽  
Glucose Management

Hyperglycemia after kidney transplantation is common in both diabetic and non-diabetic patients. Both pretransplant and post-transplant diabetes mellitus are associated with increased kidney allograft failure and mortality. Glucose management may be challenging for kidney transplant recipients. The pathophysiology and pattern of hyperglycemia in patients following kidney transplantation is different from those with type 2 diabetes mellitus. In patients with pre-existing and post-transplant diabetes mellitus, there is limited data on the management of hyperglycemia after kidney transplantation. The following article discusses the nomenclature and diagnosis of pre- and post-transplant diabetes mellitus, the impact of transplant-related hyperglycemia on patient and kidney allograft outcomes, risk factors and potential pathogenic mechanisms of hyperglycemia after kidney transplantation, glucose management before and after transplantation, and modalities for prevention of post-transplant diabetes mellitus.

scholarly journals Effects of renal transplantation on erectile dysfunction: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Irham Arif Rahman ◽  
Nur Rasyid ◽  
Ponco Birowo ◽  
Widi Atmoko
Keyword(s):  
Systematic Review ◽  
Erectile Dysfunction ◽  
Kidney Transplantation ◽  
Renal Transplantation ◽  
End Stage Renal Disease ◽  
Erectile Function ◽  
Meta Analysis ◽  
Post Transplantation ◽  
Stage Renal Disease ◽  
End Stage

AbstractErectile dysfunction (ED) is a major global health burden commonly observed in patients with end-stage renal disease (ESRD). Although renal transplantation improves the problem in some patients, it persists in ≈20–50% of recipients. Studies regarding the effects of kidney transplantation on ED present contradictory findings. We performed a systematic review to summarise the effects of kidney transplantation on ED. A systematic literature search was performed across PubMed, Cochrane, and Scopus databases in April 2020. We included all prospective studies that investigated the pre and posttransplant international index of erectile function (IIEF-5) scores in recipients with ED. Data search in PubMed and Google Scholar produced 1326 articles; eight were systematically reviewed with a total of 448 subjects. Meta-analysis of IIEF-5 scores showed significant improvements between pre and post transplantation. Our findings confirm that renal transplantation improves erectile function. Furthermore, transplantation also increases testosterone level. However, the evidence is limited because of the small number of studies. Further studies are required to investigate the effects of renal transplantation on erectile function.

scholarly journals Abdominal Panniculectomy Can Simplify Kidney Transplantation in Obese Patients

2021 ◽  
pp. 1-8
Author(s):  
Dominik Promny ◽  
Theresa Hauck ◽  
Aijia Cai ◽  
Andreas Arkudas ◽  
Katharina Heller ◽  
...  
Keyword(s):  
Wound Healing ◽  
Kidney Transplantation ◽  
Postoperative Complications ◽  
Kidney Transplant ◽  
Interdisciplinary Approach ◽  
Wound Complications ◽  
Obese Patients ◽  
Patient Cohort ◽  
Transplant Candidates ◽  
Stage Renal Disease

<b><i>Background:</i></b> Obesity is frequently present in patients suffering from end-stage renal disease (ESRD). However, overweight kidney transplant candidates are a challenge for the transplant surgeon. Obese patients tend to develop a large abdominal panniculus after weight loss creating an area predisposed to wound-healing disorders. Due to concerns about graft survival and postoperative complications after kidney transplantation, obese patients are often refused in this selective patient cohort. The study aimed to analyze the effect of panniculectomies on postoperative complications and transplant candidacy in an interdisciplinary setting. <b><i>Methods:</i></b> A retrospective database review of 10 cases of abdominal panniculectomies performed in patients with ESRD prior to kidney transplantation was conducted. <b><i>Results:</i></b> The median body mass index was 35.2 kg/m<sup>2</sup> (range 28.5–53.0 kg/m<sup>2</sup>) at first transplant-assessment versus 31.0 kg/m<sup>2</sup> (range 28.0–34.4 kg/m<sup>2</sup>) at panniculectomy, and 31.6 kg/m<sup>2</sup> (range 30.3–32.4 kg/m<sup>2</sup>) at kidney transplantation. We observed no major postoperative complications following panniculectomy and minor wound-healing complications in 2 patients. All aside from 1 patient became active transplant candidates 6 weeks after panniculectomy. No posttransplant wound complications occurred in the transplanted patients. <b><i>Conclusion:</i></b> Abdominal panniculectomy is feasible in patients suffering ESRD with no major postoperative complications, thus converting previously ineligible patients into kidney transplant candidates. An interdisciplinary approach is advisable in this selective patient cohort.

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

Nephron ◽  
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 &#x3e;3 months might be a suitable strategy for treating recurrent HSPN in cases of kidney transplantation.

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