Renal Transplant Pathology: Demographic Features and Histopathological Analysis of the Causes of Graft Dysfunction

Background. Renal transplant has emerged as a preferred treatment modality in cases of end-stage renal disease; however, a small percentage of cases suffer from graft dysfunction. Aim. To evaluate the renal transplant biopsies and analyze the various causes of graft dysfunction. Materials and Methods. 163 renal transplant biopsies, reported between 2014 and 2019 and who fulfilled the inclusion criteria, were evaluated with respect to demographics, clinical, histological, and immunohistochemical features. Results. Of 163 patients, 26 (16%) were females and 137 (84%) were males with a mean age of 34 ± 7 years. 53 (32.5%) cases were of rejection (ABMR and TCMR), 1 (0.6%) was borderline, 15 were of IFTA, and rest of 94 cases (57.7%) belonged to the others category. SCr (serum creatinine) in cases of rejection was 3.85 ± 0.55 mg/dl. Causes of early graft dysfunction included active ABMR (7.1 ± 4.7 months), acute TCMR (5.5 months), and acute tubular necrosis (after 6 ± 2.2 months of transplant) while the causes of late rejection were CNIT and IFTA (34 ± 4.7 and 35 ± 7.8 months, respectively). Conclusion. Renal graft dysfunction still remains a concerning area for both clinicians and patients. Biopsy remains the gold standard for diagnosing the exact cause of graft dysfunction and in planning further management.

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Comparison of Renal Transplant Scintigraphy With Renal Resistance Index for Prediction of Early Graft Dysfunction and Evaluation of Acute Tubular Necrosis and Acute Rejection

Clinical Nuclear Medicine ◽

10.1097/rlu.0000000000000271 ◽

2013 ◽

Vol 38 (12) ◽

pp. 931-935 ◽

Cited By ~ 16

Author(s):

Bulent Yazici ◽

Ayse Yazici ◽

Aylin Oral ◽

Aysegül Akgün ◽

Huseyin Toz

Keyword(s):

Renal Transplant ◽

Acute Rejection ◽

Acute Tubular Necrosis ◽

Resistance Index ◽

Graft Dysfunction ◽

Tubular Necrosis ◽

Renal Resistance Index ◽

Early Graft ◽

Early Graft Dysfunction

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BK Virus Associated Nephropathy, a Cause of Early Renal Allograft Dysfunction: A Single Centre Study

Kathmandu University Medical Journal ◽

10.3126/kumj.v13i2.16787 ◽

2017 ◽

Vol 13 (2) ◽

pp. 140-145

Author(s):

S. Shrestha ◽

P.G. Kerr ◽

J. Kanellis ◽

K.R. Polkinghorne ◽

F. Brown ◽

...

Keyword(s):

Renal Transplant ◽

De Novo ◽

Bk Virus ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Graft Dysfunction ◽

Early Graft ◽

The Mean ◽

The Difference ◽

Early Graft Dysfunction

Background BK virus associated nephropathy (BKVN) is an important cause of early graft dysfunction in renal transplant recipients. The present study was carried out to determine the burden of BKVN in a single renal transplant centre in Australia.Method A retrospective analysis of de novo renal transplant recipients from 2010 to 2013 was performed to identify biopsy proven BKVN. Estimated glomerular filtration rate (eGFR) was compared at baseline, at BKVN diagnosis and 3 and 12 months post-diagnosis.Result Of the 317 de novo renal transplants recipients in the study period, 20 (6.3%) developed BKVN. The mean age was 54.8 ± 13.1 years and 13 (65%) were male. The mean time from transplant to BKVN was 8.7 ± 6.7 months with 17 (85%) diagnosed within 12 months. Four recipients each were diagnosed BKVN on 3 and 12 month surveillance biopsy. Six (30%) had normal eGFR at diagnosis. Mean eGFR at diagnosis was 38.8 ± 19.2 ml/min/1.73 m2, which was significantly lower (p < 0.01) than that at baseline (50.3 ± 16.4 ml/min/1.73 m2). eGFR improved numerically at 3 and 12 months post-diagnosis, however the difference was not significant. One patient had graft failure, 19 months after diagnosis.Conclusion BKVN generally occurs in first post-transplant year and is an important cause of early graft dysfunction. Surveillance biopsy helps in detecting subclinical BKVN.

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Cytomegalovirus infection and unusual early graft dysfunction in a renal transplant recipient

Journal of Global Infectious Diseases ◽

10.4103/0974-777x.52990 ◽

2009 ◽

Vol 1 (1) ◽

pp. 77

Author(s):

Suzan Sanavi ◽

Ahad Ghods ◽

Reza Afshar

Keyword(s):

Renal Transplant ◽

Transplant Recipient ◽

Renal Transplant Recipient ◽

Cytomegalovirus Infection ◽

Graft Dysfunction ◽

Early Graft ◽

Early Graft Dysfunction

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Renal transplant from infant and neonatal donors is a feasible option for the treatment of end-stage renal disease but is associated with increased early graft loss

American Journal of Transplantation ◽

10.1111/ajt.15006 ◽

2018 ◽

Vol 18 (11) ◽

pp. 2679-2688 ◽

Cited By ~ 7

Author(s):

Imeshi Wijetunga ◽

Clare Ecuyer ◽

Sonsoles Martinez-Lopez ◽

Muhammad Jameel ◽

Richard J. Baker ◽

...

Keyword(s):

Renal Transplant ◽

Renal Disease ◽

End Stage Renal Disease ◽

Graft Loss ◽

Feasible Option ◽

Early Graft ◽

Stage Renal Disease ◽

End Stage

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Pretransplantation hemodialysis strategy influences early renal graft function.

Journal of the American Society of Nephrology ◽

10.1681/asn.v93473 ◽

1998 ◽

Vol 9 (3) ◽

pp. 473-481 ◽

Cited By ~ 1

Author(s):

A A Van Loo ◽

R C Vanholder ◽

P R Bernaert ◽

F E Vermassen ◽

M Van der Vennet ◽

...

Keyword(s):

Renal Failure ◽

Renal Function ◽

Kidney Transplantation ◽

Graft Function ◽

Graft Dysfunction ◽

Urinary Volume ◽

Renal Graft ◽

Functional Differences ◽

Early Graft ◽

Early Graft Dysfunction

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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Providers’ View on the First Kidney Transplantation Center in Ethiopia: Experience From Past to Present

Health Services Research and Managerial Epidemiology ◽

10.1177/23333928211018335 ◽

2021 ◽

Vol 8 ◽

pp. 233339282110183

Author(s):

Tariku Shimels ◽

Abrham Getachew ◽

Mekdim Tadesse ◽

Alison Thompson

Keyword(s):

Kidney Transplantation ◽

Renal Transplant ◽

Health Care Providers ◽

Study Data ◽

Care Providers ◽

Transplant Center ◽

Transplantation Center ◽

Stage Renal Disease ◽

End Stage

Introduction: Transplantation is the optimal management for patients with end-stage renal disease. In Ethiopia, the first national kidney transplantation center was opened at St. Paul’s Hospital Millennium Medical College in September 2015. The aim of this study was to explore providers’ views and experiences of the past to present at this center. Methods: A qualitative study design was employed from 1st November to 15th December, 2019. To ensure that appropriate informants would provide rich study data, 8 health care providers and top management members were purposefully chosen for in-depth interviews. A maximum variation sampling method was considered to include a representative sample of informants. Interviews were digitally audio-recorded, and transcribed verbatim. Transcribed data was coded and analyzed using Qualitative Data Analysis (QDA) Minor Lite software and Microsoft-Excel. Result: The participants (5 males and 3 females) approached were from different departments of the renal transplant center, and the main hospital. Eight main themes and 18 sub-themes were generated initially from all interviews totaling to 109 index codes. Further evaluation and recoding retained 5 main themes, and 14 sub-themes. The main themes are; challenges experienced during and after launching the center, commitment, sympathy and satisfaction, outcomes of renal transplant, actions to improve the quality of service, and how the transplant center should operate. Providers claim that they discharge their responsibilities through proper commitment and compassion, paying no attention to incentive packages. They also explained that renal transplantation would have all the outcomes related to economic, humanistic and clinical facets. Conclusion and Recommendation: A multitude of challenges were faced during and after the establishment of the first renal transplant center in Ethiopia. Providers discharge their responsibility through a proper compassion for patients. Concerned stakeholders should actively collaborate to improve the quality of renal transplant services in the center.

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