Outcomes of arteriovenous fistula for hemodialysis in octogenarian population

Vascular ◽  
2018 ◽  
Vol 26 (5) ◽  
pp. 509-514 ◽  
Author(s):  
Cemal Kocaaslan ◽  
Tamer Kehlibar ◽  
Mehmet Yilmaz ◽  
Mehmet E Mehmetoglu ◽  
Rafet Gunay ◽  
...  
Keyword(s):  
Survival Rate ◽  
Arteriovenous Fistula ◽  
Patient Survival ◽  
Treated Patient ◽  
Survival Rates ◽  
Venous Aneurysm ◽  
Absolute Contraindication ◽  
Kaplan Meier ◽  
Stage Renal Disease ◽  
End Stage

Introduction Guidelines have been recommending the use of arteriovenous fistula among the hemodialysis population, but no clear conclusion has emerged with regard to the adequate access type in octogenarians. In this paper, the outcomes of arteriovenous fistula in octogenarian cohort were presented for death-censored cumulative patency rate, complications, and patients’ survival rate. Methods A retrospective review of 88 consecutive arteriovenous fistula interventions in 70 octogenarian patients were performed at one referral institution between January 2010 and June 2014. The patients’ records were analyzed and postoperative complications were documented. Death-censored cumulative arteriovenous fistula patency rates were calculated, and Kaplan–Meier method was used to analyze patient survival for 24 months. Findings: Eighty-eight arteriovenous fistula constructions and six salvage procedures were performed in 70 octogenarians. Fifty-four (61.3%) forearm and 34 (38.7%) upper arm fistulas were created. All types of fistulas had 6-, 12-, 18-, and 24-month death-censored cumulative patency rates of 63.6%, 58.3%, 48.8%, and 41.4%, respectively. The primary failure rate was 40.9%. A total of 15 complications were documented as edema, hematoma/bleeding, infection, distal ischemia, and venous aneurysm, all of which had been treated. Patient survival rates for 12 and 24 months were 68.5% and 58.5%, respectively. Discussion and conclusion: This analysis regarding arteriovenous fistula in octogenarian end-stage renal disease patients figured out equal death-censored cumulative patency compared to nonelderly, and two-year survival rate was acceptable. This study strengthens the argument that arteriovenous fistula should be the best proper choice in selected octogenarians; older age only should not be considered as an absolute contraindication for arteriovenous fistula creation in octogenarians; and patient-based approach should be applied.

Title: Efficacy of Tacrolimus as Maintenance Therapy after Cyclophosphamide for Treating Antineutrophil Cytoplasmic Antibody-associated Vasculitis

2021 ◽  
Author(s):  
Jung Yoon Pyo ◽  
Lucy Eunju Lee ◽  
Sung Soo Ahn ◽  
Jason Jungsik Song ◽  
Yong-Beom Park ◽  
...  
Keyword(s):  
Survival Rate ◽  
Maintenance Therapy ◽  
End Stage Renal Disease ◽  
Medical Records ◽  
Survival Rates ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background: Azathioprine, methotrexate, or rituximab is used for the maintenance therapy of antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Although the efficacy of tacrolimus (TAC) in various autoimmune diseases has been demonstrated, there have been few reports on the efficacy of TAC in AAV. We investigated the efficacy of TAC as maintenance therapy for AAV and compared its efficacy with that of AZA.Methods: We retrospectively analyzed the medical records of 81 AAV patients who received cyclophosphamide (CYC) as induction therapy and AZA or TAC as maintenance therapy. All-cause death, relapse, and progression to end-stage renal disease (ESRD) were analyzed.Results: Among 81 AAV patients, 69 patients received AZA alone, 6 patients received TAC alone, and 6 patients received TAC after AZA for maintenance therapy. Overall, 11 patients (13.6%) died, 30 patients (37.0%) experienced relapse, and 16 patients (19.8%) progressed to ESRD during a median of 33.8 months. No significant differences were observed in cumulative patients’, relapse-free, and ESRD-free survival rates between patients administered AZA alone and TAC alone. There were no significant differences in the cumulative patients’ and relapse-free survival rate between patients who received AZA alone and TAC after AZA. However, the cumulative ESRD-free survival rate was lower in patients who received TAC after AZA than in those who received AZA alone (P = 0.027). Conclusions: Patients who received TAC as maintenance therapy showed a higher incidence of ESRD than those who received AZA, but this might be attributed to the lack of efficacy of AZA rather than the low ESRD prevention effect of TAC.

Arteriovenous Fistulas for Hemodialysis Created using a Long-Term Absorbable Suture: A Safe Solution and a Measure to Minimize Myointimal Hyperplasia

2005 ◽  
Vol 6 (4) ◽  
pp. 171-176 ◽  
Author(s):  
S. Occhionorelli ◽  
D. De Tullio ◽  
D. Pellegrini ◽  
S. Ascanelli ◽  
G. Resta ◽  
...  
Keyword(s):  
Survival Rates ◽  
Absorbable Suture ◽  
Trimethylene Carbonate ◽  
Arteriovenous Fistulas ◽  
Vascular Walls ◽  
Kaplan Meier ◽  
Surgical Suture ◽  
Stage Renal Disease ◽  
End Stage

Background/aims The goal of the therapeutic management of patients affected by end-stage renal disease (ESRD) is to maintain the vascular access (VA) as long as possible. Myointimal hyperplasia development in the vascular walls of arteriovenous fistulas (AVFs) is considered one of the most important factors responsible for procedure failure. These alterations could be linked to hemodynamic changes in the anastomosis and to the presence of the surgical suture itself. We report our preliminary experience, discussing the use and the possible benefits of an absorbable suture in polyglycolide trimethylene carbonate (PTC) in AVF creation. Methods Seventy-four AVFs were created as primary access for hemodialysis (HD), using PTC, over 4 years. Age, gender, ESRD etiology, artery and vein preoperative diameters, AVF survival outcome, and the number of AVFs created per year were recorded. The Kaplan-Meier method was used to analyze AVF survival rates. Results No dehiscences, pseudoaneurysms, or failures in the “critical” period related to PTC absorption were recorded. Kaplan-Meier analysis was used to evaluate AVF survival; 12-month primary AVF survival (74.33%) and AVF failure (25.67%) rates, 9 “early” (8.22%) and 10 “late” failures (13.51%), and a 360-day mean survival were found. Conclusions Our data indicate that PTC, a well known and widely used material for sutures in vascular surgery, is safe and effective in AVF creation. Potential advantages of PTC sutures are represented by a reduced myointimal hyperplasia formation in the AVF vascular walls, prolonging the AVF lifespan and avoiding re-interventions.

scholarly journals P1703RESULTS OF RENAL TRANSPLANTATION IN PATIENTS WITH RHEUMATIC DISEASES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mariya Likhavets ◽  
Konstantin Chyzh ◽  
Aleh Kalachyk ◽  
Nikolay Soroka
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Renal Transplantation ◽  
Survival Rate ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
End Stage Renal Disease ◽  
Patient Survival ◽  
Systemic Lupus ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Rheumatic diseases often involve the kidneys and it might lead to chronic kidney disease (CKD). In its final stage it must be treated with renal replacement methods such as dialysis (hemodialysis or peritoneal dialysis) or renal transplantation. Kidney transplantation is the preferred and most cost-effective treatment for the end-stage renal disease, it offers a better quality of life than dialysis. The most common types of renal pathology in rheumatic diseases include glomerular (systemic lupus erythematosus), vascular (ANCA-associated vasculitides) and tubulointerstitial (goat) diseases. According to a research conducted in 2010 at the Minsk Rheumatological Department, 25% of patients had clinical or laboratory features of CKD. The aims were to reveal the most frequent rheumatic diseases affecting the kidneys and evaluate the post-transplant period in these patients. Method 94 medical case were studied retrospectively. All these patients had the end-stage renal disease with GFR of <15 ml/min/1.73m2 and underwent renal transplantation between January 2011 and September 2019. Results A retrospective study of 94 kidney transplant patients was conducted on renal transplantation centers in Belarus. Among the patients that underwent renal transplantation from January 2011 till September 2019, the percentage of recipients with rheumatic diseases was 3.64%. The majority of the recipients (52 %) were females. The mean age was 44.36 years (range, 16-78 years). Of the sample, 90% of kidney allografts were received from brain-dead donors, whereas only 10% of recipients got a new kidney from living-donors. Systemic lupus erythematosus was the most common causative disease in patients with rheumatic diseases (31 cases, 33%) followed by goat (28 cases, 30%) and secondary amyloidosis (17 cases, 18%) that complicated the course of rheumatoid arthritis and seronegative spondylarthritis. The remaining part of patients suffered from ANCA-associated vasculitides (10 cases, 10.6%), anti-glomerular basement membrane disease (6 cases, 6.4%), and single cases were represented by progressive systemic sclerosis and antiphospholipid syndrome (2%). In the post-transplant period, the most common complications were arterial hypertension (38%), anemia (20%), infectious diseases (27%), among them the most frequent were urinary tract infection (20%) and cytomegalovirus infection (7%). The 1-year allograft survival rate was 86%, the 5-year rate was about 82%. The main reasons for failed outcomes were acute renal allograft rejection, postoperative complications and infection. The patient survival rate after 1 and 5 years after transplantation was 93% and 86%, respectively. Infectious diseases (44%) such as nosocomial pneumonia, sepsis and cardiovascular disease (33%) are still the two most important reasons of death. Conclusion 1. The most common rheumatic diseases causing the end-stage renal disease are systemic lupus erythematosus (33%), goat (30%), rheumatoid arthritis, and seronegative spondylarthritis that lead to secondary amyloidosis (18%). 2. The 1-year allograft survival rate was 86%, the 5-year rate was about 82%, the patient survival rate after 1 and 5 years after transplantation was 93% and 86%, respectively. 3. The survival of patients with rheumatic diseases who underwent renal transplantation is comparable to patient survival after transplantation with another kidney pathology. 4. The main causes of death following renal transplantation are infectious and cardiovascular complications. Acute renal allograft rejection, postoperative complications, and infection are the main reasons of allograft failure.

scholarly journals EVALUATIONOFRENAL REPLACEMENT THERAPYQUALITY IN UKRAINE: TIME FOR ACTIONS

2015 ◽  
pp. 3-12
Author(s):  
Mykola Kolesnyk ◽  
Nadiya Kozlyuk
Keyword(s):  
Cox Regression ◽  
Patient Survival ◽  
International Perspective ◽  
Soviet Period ◽  
Kaplan Meier ◽  
Home Based ◽  
The Status ◽  
Stage Renal Disease ◽  
End Stage

Background. Little is known about the status of renal replacement therapy (RRT) in the post-Soviet period of Ukraine. We therefore investigated the epidemiology and treatment outcomes of RRT in Ukrainian patients and put the results into an international perspective. Methods. Data from the Ukrainian National Renal Registry for patients on RRT between 1 January 2010 and 31 December 2012 were selected. We calculated the incidence and prevalence of RRT per million population (pmp) and the 3-, 12- and 24-month patient survival using the Kaplan— Meier method and Cox regression Results. There were 5985prevalent patients on RRT on 31 December 2012 (131,2 pmp). Mean age was 46,5 ± 13,8 years, 56% were men and 74% received haemodialysis (HD), while peritoneal dialysis and kidney transplantation both represented 13%. The most common cause of end-stage renal disease was glomerulonephritis (51%), while only 12% had diabetes. In 2012, 1129 patients started dialysis (incidence 24,8 pmp), with 80% on HD. Mean age was 48 ± 14 years, 58% were men and 20% had diabetes. Three, 12- and 24-month patient survival on dialysis was 95,1%, 86,0% and 76,4%, respectively. The transplant rate in 2012 was 2,1 pmp. Conclusions. The incidence and prevalence of RRT and the transplantation rate in Ukraine are among the lowest in Europe, suggesting that the need for RRT is not being met. Strategies to reduce the RRT deficit include the development and improvement of transplantation and home-based dialysis programs. Further evaluation of the quality of Ukrainian RRT care is needed.

scholarly journals Morbidity and Mortality Associated with Hemodialysis Versus Peritoneal Dialysis in Patients with End Stage Renal Disease Caused By Sickle Cell Disease

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 488-488
Author(s):  
Miriam Kwarteng-Siaw ◽  
Mahyar Heydarpour ◽  
Olesya Baker ◽  
Kevin Tucker ◽  
Maureen Achebe
Keyword(s):  
Survival Rates ◽  
Dialysis Initiation ◽  
Advisory Committees ◽  
Patient Demographics ◽  
Kaplan Meier ◽  
Younger Age ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background: End stage renal disease (ESRD) is a common complication of sickle cell disease (SCD), contributing to 14% mortality. Most patients with ESRD are managed with dialysis. The relative risk of mortality in hemodialysis (HD) versus peritoneal dialysis (PD) may be influenced by the primary cause of ESRD (Vonesh et al, 2004). The purpose of this study is to compare patients with ESRD primarily caused by SCD (SCD-ESRD) to non-SCD-ESRD controls and to evaluate the association of dialysis type with mortality and hospitalization in SCD-ESRD patients. Methods: This was a retrospective study of SCD-ESRD patients newly initiated on dialysis in the United States Renal Data System between January 1, 2006 and December 31, 2013. SCD-ESRD patients were identified by ICD-9 codes. A sample of 5% of African Americans with incident ESRD caused by conditions other than SCD (non-SCD-ESRD cohort) initiated within the same timeframe were randomly selected as controls. Patient demographics, comorbidities, and dialysis type were compared between SCD and controls. Patient demographics, clinical characteristics, and outcomes were compared between HD and PD patients in the SCD-ESRD cohort. Chi-square, t-test, and Wilcoxon rank sum tests were used for comparative analysis. Survival times were estimated by Kaplan Meier curve and compared using log rank test. Results: 768 SCD-ESRD and 12,402 non-SCD-ESRD patients were included in analysis. SCD-ESRD patients started dialysis at a younger age (44±12.9 vs 58.6±15.4 years; p<0.001), were more likely to be unemployed (44% vs 29.7%; p<0.001) and have Medicaid insurance (55% vs 33%; p<0.001). Most common comorbidities in SCD-ESRD patients were hypertension (71%) and congestive heart failure (26%) and in controls were hypertension (89.3%) and diabetes (61.3%). SCD-ESRD patients had twice the odds of being initiated on PD compared to controls (11.3% vs 5.7%, OR 2.11, p<0.001). Demographics, comorbidities, laboratory values, access to nephrology care prior to dialysis initiation, survival, hospitalization, and kidney transplantation of HD and PD patients in the SCD-ESRD cohort are shown in Table 1. Kaplan Meier survival plot is shown in Figure 1. PD patients were more likely to be female, have full time employment and employer insurance, be students, have lower glomerular filtration rate, and have congestive heart failure as a comorbidity. They were also 1.6 and 1.9 times more likely to have been seen by a nephrologist and received erythropoietin prior to dialysis initiation respectively (p<0.001). PD patients had significantly better survival rates at year 1 (88.5% vs 75.9%, p=0.01). Survival rates were still higher in PD patients at years 3 and 5 although not statistically significant. HD and PD patients were hospitalized equally within a year of dialysis initiation however, HD patients had more intensive care unit (ICU) stays (p=0.003) and ~1.5 times the number of hospitalizations per person. More PD patients had been informed about (90.8% vs 80.47%, p=0.019) and listed for (42.5% vs 19.1%, p<0.001) transplant although no patients in this study had undergone a kidney transplant within the 5 year follow up. Discussion: SCD-ESRD patients in this study were more likely to be started on PD compared to non-SCD-ESRD patients. This could be explained by the younger age of SCD-ESRD patients as younger individuals are more likely to be started on PD in the general ESRD literature. SCD-ESRD patients started on PD had better survival and hospitalization outcomes particularly within the first year of dialysis initiation when mortality and morbidity is known to be high in ESRD. These results suggest a survival benefit of PD over HD in SCD-ESRD patients. This could perhaps be explained by decreased likelihood of vaso-occlusive events due to less fluid shifts and thus hematocrit fluctuations in the PD group (Boyle et al, 2016). A limitation of our study is that we do not have data on the possibility of individuals switching dialysis modalities (crossovers) over the course of follow up that could bias survival rates in either direction. A next step would be to look at the same outcomes in individuals who switch. Moreover, a prospective observational study or randomized control trial could further evaluate differential survival rates in HD versus PD initiation in SCD and inform guidelines in SCD-ESRD care. Acknowledgement: Support was provided to MKS by the Minority Resident Hematology Award Program. Figure 1 Figure 1. Disclosures Achebe: Pharmacosmos: Membership on an entity's Board of Directors or advisory committees; Fulcrum Therapeutics: Consultancy; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees.

The Japanese National Registry Data on Pediatric Capd Patients: A Ten-Year Experience a Report of the Study Group of Pediatric Pd Conference

1996 ◽  
Vol 16 (3) ◽  
pp. 269-275 ◽  
Author(s):  
Masataka Honda ◽  
Kikuo Litaka ◽  
Hiroshi Kawaguchi ◽  
Sakurako Hoshii ◽  
Shunji Akashi ◽  
...  
Keyword(s):  
Survival Rate ◽  
Survival Rates ◽  
National Registry ◽  
Older Children ◽  
Catheter Survival ◽  
Technique Survival ◽  
High Infection ◽  
Stage Renal Disease ◽  
End Stage ◽  
National Registry Data

Objective Over the past 10 years, we have collected data on pediatric patients less than 16 years of age from the National Registry of CAPD (continuous ambulatory peritoneal dialysis). We present our experience with this population. Design The database details the patient number, age, weight, height, outcome, cause of death, reason for terminating CAPD therapy, peritonitis, and catheter survival. Patients Of the 434 patients (239 males, 195 females), 37 patients (8.5%) were under 1 year of age and 164 patients (37.8%) were under 6 years of age. About half of the patients were less than 20 kg in weight, clearly indicating that CAPD was the treatment of choice in young children. The duration on CAPD for these patients was less than 2 years for 233 patients (54%), and was 5 years or more in 48 patients (11%). Results The outcome of the total patient population of 434 as of M ay, 1991, is as follows 229 patients (52.8%) were being successfully treated with CAPD, 47 patients (10.8%) died, and 78 patients (18.0%) received a kidney transplantation. The patient survival rate was 85.6% at 3 years and 81.7% at 5 years. The technique survival rate was 74.9% at 3 years and 63.5% at 5 years. The rate of peritonitis was one episode over 28.6 patient-months. The mean catheter duration was 1.68 years. Peritonitis rate, catheter survival rate, and the rate of tunnel infection were worse in children less than 6 years of age than in older children. Conclusion The excellent patient and technique survival rates indicate that CAPD is an effective treatment for children with end-stage renal disease in Japan. The high infection rates in younger children indicate that extra careful management is needed for this young age group.

MO528INFLUENCE OF CARDIOVASCULAR DISEASES ON SURVIVAL RATES IN DIALYSIS PATIENTS IN A COHORT OF THE UZBEK POPULATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Olimkhon Sharapov ◽  
Sherzod Abdullaev
Keyword(s):  
Survival Rate ◽  
Cardiovascular Diseases ◽  
Mortality Rate ◽  
Survival Rates ◽  
Dialysis Patients ◽  
Cardiovascular Comorbidity ◽  
Kaplan Meier ◽  
N 93 ◽  
End Stage ◽  
To Receive

Abstract Background and Aims The mortality rate of patients on hemodialysis is 6.3-8.2 times higher than in the general population. The presence of cardiovascular comorbidity worsens the prognosis and survival in this category of patients. According to various sources, the mortality rate in patients with CVD is 3 times higher than in patients without CVD. The aim of our study was to study the effect of comorbidity of the CVD on survival in patients with end-stage CKD receiving programmed hemodialysis among the population of Uzbekistan. Method We conducted a multicenter prospective cohort study of 165 patients among the Uzbek population. The study took place in 3 different dialysis centers in the country for 30 months (from January 2018 to July 2020). All patients received programmed hemodialysis due to ESRD. All patients were of Uzbek nationality, there were 90 men, 75 women. The average age was 48.1 ± 14.1 years. The duration of hemodialysis at the time of inclusion of patients in the study ranged from 6 to 165 months. The main primary diseases were glomerulonephritis (46%), diabetes mellitus (27%) and urolithiasis (8%). 56% (n = 92) of patients (52 men and 40 women) had CVD and 44% (n = 73) of patients (38 men and 35 women) had no CVD. The main CVDs were hypertension, coronary heart disease, heart failure and various arrhythmias. All patients were observed during the observation period, at the end of which the outcome was noted: patients either died or continued to receive hemodialysis. The survival rate was determined using the Kaplan-Meier method. The 95% confidence interval was determined using the Greenwood method. Results After 30 months of follow-up, 43.6% (n = 72) of all observed patients died, 56.4% (n = 93) patients survived (of which 11 underwent kidney transplantation). The average age of the deceased (53.6 ± 1.6) was significantly higher than that of patients continuing to receive HD (45.6 ± 1.5). The average duration of hemodialysis in survivors (33.0 ± 5.4) was higher than in the dead (28.6 ± 3.9). The study of the further fate of patients, depending on the presence or absence of cardiovascular diseases, showed that among the deceased patients, 68.1% (n = 49) of patients were patients who had CVD, while among those who survived, 53.7% ( n = 44) had no CVS pathologies. Among those continuing to receive programmed hemodialysis, there were 31.7% more patients without CVD than among patients with diagnosed CVD. In dialysis patients with CVD who died within the period of 30 months of prospective observation was 39.6% higher than in patients without CVD. The survival rate of patients with CVD was 0.44 [95% CI 0.34-0.55], while in patients without CVD it was 0.67 [95% CI 0.55-0.78]. Conclusion The concomitant pathology of the cardiovascular system affects the survival rate of patients with end-stage CKD on hemodialysis. Dialysis patients of the population of Uzbekistan who do not have concomitant cardiovascular pathology have a 33% higher survival rate than patients without CVD.

Kidney transplantation in the extremely elderly from extremely aged deceased donors: a kidney for each age

2020 ◽  
Vol 35 (4) ◽  
pp. 687-696
Author(s):  
Jimena Cabrera ◽  
Mario Fernández-Ruiz ◽  
Hernando Trujillo ◽  
Esther González ◽  
María Molina ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Cox Regression ◽  
Patient Survival ◽  
Incidence Rates ◽  
Allocation Policy ◽  
Recipient Age ◽  
Deceased Donors ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Advances in life expectancy have led to an increase in the number of elderly people with end-stage renal disease (ESRD). Scarce information is available on the outcomes of kidney transplantation (KT) in extremely elderly patients based on an allocation policy prioritizing donor–recipient age matching. Methods We included recipients ≥75 years that underwent KT from similarly aged deceased donors at our institution between 2002 and 2015. Determinants of death-censored graft and patient survival were assessed by Cox regression. Results We included 138 recipients with a median follow-up of 38.8 months. Median (interquartile range) age of recipients and donors was 77.5 (76.3–79.7) and 77.0 years (74.7–79.0), with 22.5% of donors ≥80 years. Primary graft non-function occurred in 8.0% (11/138) of patients. Cumulative incidence rates for post-transplant infection and biopsy-proven acute rejection (BPAR) were 70.3% (97/138) and 15.2% (21/138), respectively. One- and 5-year patient survival were 82.1 and 60.1%, respectively, whereas the corresponding rates for death-censored graft survival were 95.6 and 93.1%. Infection was the leading cause of death (46.0% of fatal cases). The occurrence of BPAR was associated with lower 1-year patient survival [hazard ratio (HR) = 4.21, 95% confidence interval (CI) 1.64–10.82; P = 0.003]. Diabetic nephropathy was the only factor predicting 5-year death-censored graft survival (HR = 4.82, 95% CI 1.08–21.56; P = 0.040). Conclusions ESRD patients ≥75 years can access KT and remain dialysis free for their remaining lifespan by using grafts from extremely aged deceased donors, yielding encouraging results in terms of recipient and graft survival.

Renal transplantation in the first year of life: the treatment of choice for infants with end-stage renal disease.

1992 ◽  
Vol 2 (12) ◽  
pp. S228
Author(s):  
J S Najarian ◽  
P S Almond ◽  
M Mauer ◽  
B Chavers ◽  
T Nevins ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Transplantation ◽  
Survival Rate ◽  
Living Donor ◽  
Patient Survival ◽  
First Year ◽  
End Stage Renal Failure ◽  
End Stage ◽  
First Year Of Life ◽  
Patient Survival Rate

The treatment of choice for end-stage renal failure within the first year of life is controversial. Between September 1970 and February 1991, we performed 28 kidney transplants (27 primary, 1 retransplant, 23 living donor, 5 cadaver) in infants less than 1 yr of age (mean, 7 +/- 2 months; range, 6 wk to 12 months). The 1-yr patient survival rate for living donor recipients was 100% versus 20% for cadaver recipients (P = 0.0001). The 1-yr graft survival rate for living donor recipients was 96% versus 20% for cadaver recipients (P = 0.001). The 1-yr patient survival rate for cyclosporin A (CSA) recipients (N = 12) was 100% versus 75% for non-CSA recipients (P = 0.03). The 1-yr graft survival rate for CSA recipients was 92% versus 75% for non-CSA recipients (P = 0.08). There was no difference in the number of rejection episodes or serum creatinine levels in CSA versus non-CSA recipients. Compared with pretransplant values, the mean posttransplant standard deviation scores (SDS) for height (N = 18), weight (N = 22), and head circumference (N = 8) improved: height SDS from -1.9 to -1.5 (not significant); weight SDS from -2.5 to 0.6 (P less than 0.0005); head circumference SDS from -2.0 to -0.7 (P = 0.01). Because no other renal replacement therapy can match these results, we conclude that renal transplantation is the treatment of choice for infants with end-stage renal failure.

Sign in / Sign up

Export Citation Format

Share Document