Hypothermic Machine Perfusion in DCD Kidney Transplantation: A Single Center Experience

2015 ◽  
Vol 96 (2) ◽  
pp. 148-151 ◽  
Author(s):  
Liyu Yao ◽  
Honglan Zhou ◽  
Yuantao Wang ◽  
Gang Wang ◽  
Weigang Wang ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Function ◽  
Postoperative Recovery ◽  
Donation After Cardiac Death ◽  
Machine Perfusion ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Single Center Experience ◽  
Hypothermic Machine Perfusion ◽  
Significant Difference

Introduction: Donation after cardiac death (DCD) began in 2011 after the program hosted by the First Affiliated Hospital of Sun Yat-sen University in China. The aim of this study is to report on our experience regarding the method of preserving donated kidneys for DCD kidney transplantation. Material and Methods: A total of 37 donors and 73 primary kidney transplant recipients during the period 2011-2014 in the Urology Center of the First Hospital of Jilin University were enrolled in the study. Recipients were assigned to traditional static cold storage (SCS) group and hypothermic machine perfusion (HMP) group based on the preservation environment of donated kidneys after organ harvest. Clinical data were collected for each group. Result: The HMP group had a lower rate of delayed graft function (DGF), better postoperative recovery and kidney function compared with that of SCS group. There is no significant difference in postoperative rejection incidence between the 2 groups. Conclusions: DCD kidneys stored by hypothermic machine contribute to a lower rate of DGF and promoted the rehabilitation progress.

Comparison between kidney and liver transplant recipients admitted to a referral center regarding coronavirus-2019 manifestations in the Northeast of Iran during three peaks of pandemic

2021 ◽  
Vol 17 ◽  
Author(s):  
Mohsen Aliakbarian ◽  
Rozita Khodashahi ◽  
Mahin Ghorban Sabbagh ◽  
Hamid Reza Naderi ◽  
Mandana Khodashahi ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
High Risk ◽  
Liver Transplant ◽  
Severe Infection ◽  
Clinical Findings ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cross Sectional ◽  
Significant Difference ◽  
Liver Transplant Recipients

Background: Transplant recipients are at high risk for severe Coronavirus disease-2019 (COVID-19). Transplant recipients are immune-compromised individuals at high risk for severe infection. This study aimed to compare the presentations and outcomes of liver and kidney transplant recipients who were infected with COVID-19 in the Iranian population. Methods: This cross-sectional study was conducted at Imam Reza and Montaserieh Hospitals affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, between 2020 and 2021. In general, 52 patients were selected and divided into two groups of the kidney (n=28) and liver (n=24) transplantation. Two groups were compared in terms of demographic characteristics and clinical findings. Results: Of 52 patients, severe COVID-19 infection was reported in 61% of the patients. There was no significant difference between the two groups in terms of symptoms, except for cough (χ2=8.09; P=0.004), clinical condition, and laboratory symptoms, except for creatinine (Z=14; P<0.005), alkaline phosphatase (Z=4.55; P=0.03), total bilirubin (Z=8.93; P=0.03), and partial thromboplastin time (Z=5.97; P=0.01). There was no relationship between the outcome and the use of immunosuppressive medications (P>0.05). All patients with kidney transplantation survived, while two cases in the liver transplantation group failed to survive (χ2=2.42; P=0.11). Conclusion: The mortality rate was higher in the liver transplant recipients, compared to the patients who underwent kidney transplantation.

scholarly journals A Retrospective Propensity Score Matched Analysis Reveals Superiority of Hypothermic Machine Perfusion over Static Cold Storage in Deceased Donor Kidney Transplantation

2020 ◽  
Vol 9 (7) ◽  
pp. 2311
Author(s):  
Silvia Gasteiger ◽  
Valeria Berchtold ◽  
Claudia Bösmüller ◽  
Lucie Dostal ◽  
Hanno Ulmer ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Propensity Score ◽  
Graft Survival ◽  
Cold Storage ◽  
Strong Predictor ◽  
Graft Function ◽  
Machine Perfusion ◽  
Hypothermic Machine Perfusion ◽  
Increased Risk ◽  
Matching Criteria

Hypothermic machine perfusion (HMP) has been introduced as an alternative to static cold storage (SCS) in kidney transplantation, but its true benefit in the clinical routine remains incompletely understood. The aim of this study was to assess the effect of HMP vs. SCS in kidney transplantation. All kidney transplants performed between 08/2015 and 12/2019 (n = 347) were propensity score (PS) matched for cold ischemia time (CIT), extended criteria donor (ECD), gender mismatch, cytomegalovirus (CMV) mismatch, re-transplantation and Eurotransplant (ET) senior program. A total of 103 HMP and 103 SCS instances fitted the matching criteria. Prior to PS matching, the CIT was longer in the HMP group (17.5 h vs. 13.3 h; p < 0.001), while the delayed graft function (DGF) rates were 29.8% and 32.3% in HMP and SCS, respectively. In the PS matched groups, the DGF rate was 64.1% in SCS vs. 31.1% following HMP: equivalent to a 51.5% reduction of the DGF rate (OR 0.485, 95% CI 0.318–0.740). DGF was associated with decreased 1- and 3-year graft survival (100% and 96.3% vs. 90.8% and 86.7%, p = 0.001 and p = 0.008) or a 4.1-fold increased risk of graft failure (HR = 4.108; 95% CI: 1.336–12.631; p = 0.014). HMP significantly reduces DGF in kidney transplantation. DGF remains a strong predictor of graft survival.

P1728FUROSEMIDE STRESS TEST PREDICTS DISCHARGE SERUM CREATININE AFTER KIDNEY TRANSPLANTATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Armando Coca ◽  
Guadalupe Tabernero ◽  
Carlos Arias-Cabrales ◽  
Jimmy Reinaldo Sanchez Gil ◽  
Jose Antonio Menacho Miguel ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Serum Creatinine ◽  
Stress Test ◽  
Graft Function ◽  
Deceased Donor ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
Deceased Donor Kidney Transplant

Abstract Background and Aims Acute tubular necrosis is a common complication after kidney transplantation and is closely related to delayed graft function (DGF) and slower graft function recovery after surgery. The furosemide stress test (FST) uses a standardized dose of furosemide to evaluate the integrity of the renal tubule and determine which patients have developed severe tubular damage. We aimed to apply the FST to a sample of incident deceased-donor kidney transplant recipients and describe its association with DGF and serum creatinine (SCr) at discharge. Method Single-center prospective observational study of deceased-donor kidney transplant recipients. The FST, a standardized bolus dose of furosemide (1.5 mg/kg) was administered between the 3rd and 5th day after surgery. Patients were excluded if, during that time period, they presented evidence of active bleeding, obstructive uropathy or volume depletion. Urine output (UO) 60 and 120 min after FST was registered. To reduce the risk of hypovolemia, each ml of UO produced for six hours after FST was replaced with 1 ml of normal saline. Results 25 patients were included in the study. Mean 2h FST UO was 1012±570 ml. Demographic and clinical data are summarized in Table 1. Subjects that suffered DGF had a significantly lower 2h FST UO (534 vs 1164 ml; P=0.015). In adjusted linear regression analysis only a 2h FST UO&lt;1000 ml (β=0.906; 95%CI: 0.04-1.772; P=0.041) and DGF (β=1.592; 95%CI: 0.488-2.696; P=0.008) were independent predictors of SCr at discharge (model adjusted for recipient age, cold ischemia time, number of HLA mismatches, donor SCr and donor hypertension). Conclusion Recipients with a 2h FST UO &lt;1000 ml suffered DGF more frequently. FST and DGF were independent predictors of SCr at discharge. A standardized FST could help clinicians distinguish patients with more severe tubular dysfunction and higher risk of DGF.

MO999COMPARISON OF BASILIXIMAB VS NO INDUCTION ON 12-MONTHS RENAL FUNCTION IN KIDNEY TRANSPLANT RECIPIENTS IN THE TACROLIMUS ERA

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Zdenek Lys ◽  
Ivo Valkovsky ◽  
Pavel Havranek ◽  
Jarmila Dedochova ◽  
Jana Polaskova ◽  
...  
Keyword(s):  
Renal Function ◽  
Kidney Transplantation ◽  
Serum Creatinine ◽  
Kidney Transplant ◽  
Interleukin 2 ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Median Serum ◽  
Transplant Center

Abstract Background and Aims IL2-RA (Interleukin 2 receptor antagonist) are recommended for the induction immunosuppression of kidney transplant recipients in patients with low/standard immunological risk. Studies showing the effectiveness of these substances have often been performed in patients taking cyclosporine. We aimed to find out whether the same results would be obtained with the more effective tacrolimus in an immunosuppressive regimen. Method Induction immunosuppression using IL2-RA basiliximab in all patients undergoing kidney transplantation has been routinely used in our transplant center since April 1, 2018. We retrospectively compared outcomes of kidney transplantation of the last 40 patients before introduction of induction and the first 40 patients after the induction (monitored period of analysis is June 2017 to January 2019). All patients in each group received baseline immunosuppression of tacrolimus, corticosteroid and mycophenolate. We selected patients with low immunological risk (1st transplant, panel reactive antibodies up to 20%, without donor specific antibodies, donation after brain death) in both groups and evaluated their renal outcomes (serum creatinine and estimated glomerular filtration rate/eGFR) at 12 months after transplantation. Results Patients in the groups withnout and with basiliximab induction were of comparable age (51.9 years vs. 54.7) and with similar retransplantation rate (20%). The 1-year survival of patients and kidneys was the same (97.4% patient survival and 92.1% renal survival). Renal transplant function at 12 months was analyzed in 21 patients without and 19 patients with basiliximab induction with low baseline immunological risk. The patients who received basiliximab inductive immunosuppression had better graft function 12 months compared to patients without basiliximab administration: median serum creatinine level 112 µmol/L vs. 127 µmol/L (P=0.047) and eGFR 0.85 ml/s vs. 0.77 ml/s (P=0.347). Better renal function was also shown in the subgroup of patients older than 65 years. Conclusion At our transplant center, the introduction of basiliximab induction in patients at low immunological risk led to improved graft function in the short term despite the growing subpopulation of geriatric patients.

Pulmonary functions in kidney transplant recipients: Single centre observational study

2021 ◽  
Vol 9 (5) ◽  
pp. 3986-3991
Author(s):  
Harda Shah ◽  
◽  
Nehal Shah ◽  
Keyword(s):  
Kidney Transplantation ◽  
Waist Circumference ◽  
Pulmonary Function ◽  
Kidney Transplant ◽  
Physical Inactivity ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
High Waist Circumference ◽  
Pulmonary Functions

Background: Kidney transplantation in India is steadily increasing with advancement in medicines and surgical expertise. Subjects with kidney disease have spectrum of pulmonary pathologies but little is known regarding status on pulmonary function after kidney transplantation. Method: 149 kidney transplant recipients between 18 to 60 years of age, having stable graft function and more than 6months of post-transplant duration were included in the study. Forced vital capacity (FVC), forced expiratory volume in first second (FEV1), the ratio of FEV1/FVC and peak expiratory flow rate (PEFR) were evaluated. Result: 11 (7.4%) had a restrictive ventilatory impairment, none had obstructive lung function. FEV1 and FVC were lower among subjects with high waist circumference, over weight and obese. FEV1/FVC ratio were lower in subjects with comorbidities or physical inactivity. Conclusion: Restrictive lung functions present in few kidney transplant recipients. High waist circumference, over weight, obesity, comorbidity and physical inactivity alters pulmonary functions in kidney transplant recipients. KEY WORDS: Kidney transplantation, pulmonary function test, anthropometry, physical activity, comorbidity.

scholarly journals P1717OUTCOMES OF INCREASED INTRA-ABDOMINAL PRESSURE AFTER KIDNEY TRANSPLANTATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Armando Coca ◽  
Carlos Arias-Cabrales ◽  
Maria José Pérez-Sáez ◽  
Pablo Gonzalez ◽  
Isabel Acosta-Ochoa ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Failure ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Donation After Cardiac Death ◽  
Abdominal Pressure ◽  
Kidney Transplant Recipients ◽  
Abdominal Hypertension ◽  
History Of ◽  
Recipient Age

Abstract Background and Aims Increased intra-abdominal pressure (IAP) is commonly found among post-surgical patients and can induce organ dysfunction. However, its prevalence and impact after kidney transplantation have not been adequately described. We aimed to study the prevalence of increased IAP after kidney transplantation and its consequences on transplant outcomes. Method IAP was prospectively measured in 121 kidney transplant recipients every 8h during the first 72h after surgery using the urinary bladder technique (UnoMeter Abdo-Pressure kit). Mean IAP values during the first 24h (24h-IAP) were used in this analysis. Grading of intra-abdominal hypertension was defined according to WSACS guidelines. Patients were followed for at least 12 months or until graft failure or death. The study was approved by the local ethics committee and informed consent was obtained in all cases. Results 24h-IAP was 12.6±3.5 mmHg. 84.2% of subjects presented with intra-abdominal hypertension during the first 72h after kidney transplantation. Body mass index (OR: 1.35, 95% CI 1.12-1.63; P=0.002), male sex (OR: 3.34, 95% CI 1.1-10.3; P=0.032) and hemodialysis as renal replacement therapy before transplantation (OR: 4.35, 95% CI 1.32-14.4; P=0.016) were independent determinants of intra-abdominal hypertension. IAP was an independent risk factor for delayed graft function (*model adjusted for recipient age, sex, history of previous kidney transplants, recipient comorbidities, donor terminal serum creatinine and comorbidities, number of HLA mismatches &gt;4, cold ischemia time and donation after cardiac death status), graft failure and death (**model adjusted for all variables included in the previous model plus delayed graft failure) (Figure). Conclusion Increased IAP was highly common after transplant surgery and was associated with higher rates of delayed graft function, graft failure and death. Routine IAP monitoring should be considered after transplantation to facilitate early identification of complications and initiation of the appropriate treatment to stop its effects.

scholarly journals Pretransplant Serum Uromodulin and Its Association with Delayed Graft Function Following Kidney Transplantation—A Prospective Cohort Study

2021 ◽  
Vol 10 (12) ◽  
pp. 2586
Author(s):  
Stephan Kemmner ◽  
Christopher Holzmann-Littig ◽  
Helene Sandberger ◽  
Quirin Bachmann ◽  
Flora Haberfellner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Operating Characteristics ◽  
Lower Odds ◽  
Increased Risk

Delayed graft function (DGF) following kidney transplantation is associated with increased risk of graft failure, but biomarkers to predict DGF are scarce. We evaluated serum uromodulin (sUMOD), a potential marker for tubular integrity with immunomodulatory capacities, in kidney transplant recipients and its association with DGF. We included 239 kidney transplant recipients and measured sUMOD pretransplant and on postoperative Day 1 (POD1) as independent variables. The primary outcome was DGF, defined as need for dialysis within one week after transplantation. In total, 64 patients (27%) experienced DGF. In multivariable logistic regression analysis adjusting for recipient, donor and transplant associated risk factors each 10 ng/mL higher pretransplant sUMOD was associated with 47% lower odds for DGF (odds ratio (OR) 0.53, 95% confidence interval (95%-CI) 0.30–0.82). When categorizing pretransplant sUMOD into quartiles, the quartile with the lowest values had 4.4-fold higher odds for DGF compared to the highest quartile (OR 4.41, 95%-CI 1.54–13.93). Adding pretransplant sUMOD to a model containing established risk factors for DGF in multivariable receiver-operating-characteristics (ROC) curve analysis, the area-under-the-curve improved from 0.786 [95%-CI 0.723–0.848] to 0.813 [95%-CI 0.755–0.871, p = 0.05]. SUMOD on POD1 was not associated with DGF. In conclusion, higher pretransplant sUMOD was independently associated with lower odds for DGF, potentially serving as a non-invasive marker to stratify patients according to their risk for developing DGF early in the setting of kidney transplantation.

scholarly journals Predictive Score Model for Delayed Graft Function Based on Hypothermic Machine Perfusion Variables in Kidney Transplantation

2018 ◽  
Vol 131 (22) ◽  
pp. 2651-2657 ◽  
Author(s):  
Chen-Guang Ding ◽  
Yang Li ◽  
Xiao-Hui Tian ◽  
Xiao-Jun Hu ◽  
Pu-Xun Tian ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Predictive Score ◽  
Machine Perfusion ◽  
Hypothermic Machine Perfusion ◽  
Score Model

scholarly journals Incidence of malignancy after pediatric kidney transplantation: a single-center experience over the past three decades in Japan

2021 ◽  
Author(s):  
Yujiro Aoki ◽  
Hiroyuki Satoh ◽  
Yuko Hamasaki ◽  
Riku Hamada ◽  
Ryoko Harada ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Malignant Schwannoma ◽  
Solid Cancer ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplantation ◽  
Pediatric Kidney Transplantation ◽  
Barr Virus ◽  
Single Center Experience ◽  
Epstein Barr

Abstract Background Malignancy after kidney transplantation (KT) is one of the most serious post-transplant complications. This study aimed to investigate the incidence, type, and outcomes of malignancy after pediatric KT. Methods We performed a retrospective cohort study on pediatric kidney transplant recipients aged 18 years or younger who received their first transplant between 1975 and 2009. Results Among the 375 children who underwent KT, 212 were male (56.5%) and 163 were female (43.5%) (median age at KT, 9.6 years [interquartile range {IQR}] 5.8–12.9 years). The incidence of malignancy was 5.6% (n = 21). The cumulative incidences of cancer were 0.8%, 2.5%, 2.8%, 4.2%, 5.5%, and 15.6% at 1, 5, 10, 15, 20, and 30 years post-transplantation, respectively. Of 375 patients, 12 (3.2%) had solid cancer and nine (2.4%) had lymphoproliferative malignancy. The median age at the first malignancy was 21.3 years (IQR 11.5–33.3 years). The median times from transplant to diagnosis were 22.3 years (IQR 12.3–26.6 years) for solid cancer and 2.2 years (IQR 0.6–2.8) for lymphoproliferative malignancies. During follow-up, five recipients died due to malignancy. The causes of death were hepatocellular carcinoma in one patient, squamous cell carcinoma in the transplanted kidney in one patient, malignant schwannoma in one patient, and Epstein-Barr virus-related lymphoma in two patients. The mortality rate was 0.79 per 1000 person-years (95% confidence interval 0.38, 1.85). Conclusions Early diagnosis and treatment of malignancies in transplant recipients is an important challenge. Therefore, enhanced surveillance and continued vigilance for malignancy following KT are necessary.

scholarly journals Cigarette Smoking and Its Hazards in Kidney Transplantation

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Muhammad Abdul Mabood Khalil ◽  
Jackson Tan ◽  
Said Khamis ◽  
Muhammad AshhadUllah Khalil ◽  
Rabeea Azmat ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Kidney Transplantation ◽  
Cigarette Smoking ◽  
Glomerular Filtration ◽  
Kidney Transplant ◽  
Filtration Rate ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Kidney Donors

Cigarette smoking affects many organs. It causes vasoconstriction through activation of sympathetic nervous system which leads to elevation of blood pressure and reduction in glomerular filtration rate and filtration pressure. It also causes thickening of renal arterioles. Cigarette smoking increases the risk of microalbuminuria and accelerates progression of microalbuminuria to macroalbuminuria. Furthermore, it causes rapid loss of glomerular filtration rate in chronic kidney disease patients. After kidney donation, these factors may be injurious to the solitary kidney. Kidney donors with history of cigarette smoking are prone to develop perioperative complications, pneumonia, and wound infection. Postkidney transplantation various stressors including warm and cold ischemia time, delayed graft function, and exposure to calcineurin inhibitors may result in poor graft function. Continuation of cigarette smoking in kidney transplant recipients will add further risk. In this review, we will specifically discuss the effects of cigarette smoking on normal kidneys, live kidney donors, and kidney transplant recipients. This will include adverse effects of cigarette smoking on graft and patient survival, cardiovascular events, rejection, infections, and cancers in kidney transplant recipients. Lastly, the impact of kidney transplantation on behavior and smoking cessation will also be discussed.

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