scholarly journals Surgical considerations in paediatric kidney transplantation: an update

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Thilina Gunawardena ◽  
Hemant Sharma ◽  
Ajay Kumar Sharma ◽  
Sanjay Mehra
Keyword(s):  
Kidney Transplantation ◽  
Urinary Tract ◽  
Growth And Development ◽  
Age Group ◽  
Small Child ◽  
First Line ◽  
End Stage Kidney Disease ◽  
Immunosuppressive Medication ◽  
End Stage ◽  
Paediatric Transplantation

Abstract Background Kidney transplantation has established itself as the most appropriate mode of renal replacement therapy for the majority with end-stage kidney disease. Although at present this is applicable for children as well as adults, a few decades back kidney transplantation was not considered a first-line option in children. This was due to inferior outcomes following transplantation in this age group compared to that of adults. These poor results were attributed to challenges in paediatric transplantation such as the shortage of suitable donors, technical difficulties in performing a sound vascular anastomosis and the adverse effects of immunosuppressive medication on growth and development. However, current patient and graft-centred outcomes after paediatric transplantation equal or surpass that of adults. The advances in evaluation and management of specific surgical concerns in children who undergo transplantation, such as pre-transplant native nephrectomy, correction of congenital anomalies of the urinary tract, placement of an adult-sized kidney in a small child and minimizing the risk of allograft thrombosis, have contributed immensely for these remarkable outcomes. Conclusions In this review, we aim to discuss surgical factors that can be considered unique for children undergoing kidney transplantation. We believe that an updated knowledge on these issues will be invaluable for transplant clinicians, who are dealing with paediatric kidney transplantation.

Trajectories of glomerular filtration rate and progression to end stage kidney disease after kidney transplantation

2021 ◽  
Vol 99 (1) ◽  
pp. 186-197 ◽  
Author(s):  
Marc Raynaud ◽  
Olivier Aubert ◽  
Peter P. Reese ◽  
Yassine Bouatou ◽  
Maarten Naesens ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Kidney Transplantation ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
End Stage Kidney Disease ◽  
End Stage

scholarly journals FUNCTIONAL INDEPENDENCE, ACCESS TO KIDNEY TRANSPLANTATION, AND WAITLIST MORTALITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S494-S495
Author(s):  
Nadia M Chu ◽  
Stephanie Sison ◽  
Abimereki Muzaale ◽  
Christine Haugen ◽  
Jacqueline Garonzik Wang ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Disease ◽  
Activities Of Daily Living ◽  
Competing Risks ◽  
Mortality Risk ◽  
Daily Living ◽  
Functional Independence ◽  
End Stage Kidney Disease ◽  
End Stage ◽  
Waitlist Mortality

Abstract Although functional independence is a health priority for patients with advanced CKD, 50% of those who progress to end-stage kidney disease (ESKD) develop difficulties carrying-out essential day-to-day activities. Functional independence is not routinely assessed at kidney transplant (KT) evaluation; therefore, it is unclear what percentage of candidates are functionally independent and whether independence is associated with access to KT and waitlist mortality. We studied a prospective cohort of 3,168 ESKD participants (1/2009-6/2018) who self-reported functional independence in basic Activities of Daily Living (ADL) and more complex Instrumental Activities of Daily Living (IADL). We estimated adjusted associations between functional independence (separately) and listing (Cox), waitlist mortality (competing risks), and transplant rates (Poisson). At evaluation, 92.4% were independent in ADLs, but only 68.5% were independent in IADLs. Functionally independent participants had a higher chance of listing for KT (ADL:aHR=1.55,95%CI:1.30-1.87; IADL:aHR=1.39,95%CI 1.26-1.52). Among KT candidates, ADL independence was associated with lower waitlist mortality risk (SHR=0.66,95%CI:0.44-0.98) and higher rate of KT (IRR=1.58,95%CI:1.12-2.22); the same was not observed for IADL independence (SHR=0.86,95%CI:0.65-1.12; IRR=1.01,95%CI:0.97-1.19). ADL independence was associated with better KT access and lower waitlist mortality; clinicians should screen KT candidates for ADL independence, and identify interventions to maintain independence to improve waitlist outcomes.

SO061SEX DIFFERENCES IN MORTALITY AMONG PEOPLE WITH END-STAGE KIDNEY DISEASE: DO WOMEN ALWAYS LIVE LONGER?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nicole De La Mata ◽  
Grace Macleod ◽  
Patrick Kelly ◽  
Brenda Rosales ◽  
Philip Masson ◽  
...  
Keyword(s):  
Sex Differences ◽  
Kidney Transplantation ◽  
General Population ◽  
Excess Mortality ◽  
Relative Survival ◽  
Average Life ◽  
End Stage Kidney Disease ◽  
Life Years ◽  
Life Years Lost ◽  
End Stage

Abstract Background and Aims Female life expectancies consistently exceed males in the general population. Yet, this survival advantage may not persist in the presence of a chronic disease due to sex-based differences or healthcare inequities. We aimed to explore sex differences in survival among people with end-stage kidney disease (ESKD) compared to the general population. Method We included the entire ESKD population in Australia, 1980-2013 and New Zealand, 1988-2012 from the Australian and New Zealand Dialysis and Transplant Registry. These were linked to national death registers to ascertain deaths and their causes. We estimated relative measures of survival, including standardized mortality ratios (SMR), cumulative relative survival and expected life years lost, using general population data (adjusting for country, age, sex and calendar year) to account for background mortality. Results Of the 60,823 ESKD patients, there were 25,042 females (41%) and 35,781 males (59%). Overall 34,417 deaths occurred over the 368,719 person-years of follow-up where a similar proportion of females (57%) and males (56%) died. While mortality sex differences within the ESKD population were minor, once compared to the general population female ESKD patients had greater excess deaths, worse relative survival and greater life years lost compared to male ESKD patients. Female ESKD patients had 12 times (SMR:11.5; 95%CI:11.3-11.7) and males had 7 times (SMR:6.7; 95%CI:6.7-6.8) the expected deaths, with the greatest sex disparity among younger ages and from cardiovascular disease. Relative survival was consistently lower in females (0.57, 95%CI:0.57-0.58 in males vs 0.54, 95%CI:0.54-0.55 in females at 5 years), where the excess mortality was 9% higher (95%CI:7-12%) in female ESKD patients (Fig 1A), adjusting for year and age. The average life years lost for female ESKD patients was 4-5 years greater than male ESKD patients (Average life years lost 25.9 years, 95%CI:25.1-26.7 in males and 31.4 years, 95%CI:30.5-32.1 in females aged 15 years at ESKD) (Fig 1B). Kidney transplantation reduced the sex differences in excess mortality, with similar relative survival (p=0.42; Fig 1C) and average life years lost reduced to 3-4 years for females (Fig 1D). Conclusion The impact of ESKD is more profound for women than men with greater excess mortality, however kidney transplantation attenuates these differences. Our findings show that chronic diseases and sex can compound to produce worse outcomes where women lose their survival advantage in the presence of ESKD.

scholarly journals CLINICAL CASE OF ABO INCOMPATIBLEKIDNEYTRANSPLANTATTHE О. SHALIMOV’S NATIONAL INSTITUTE OFSURGERYAND TRANSPLANTOLOGYIN UKRAINE

2015 ◽  
pp. 45-48
Author(s):  
R. Zograbian ◽  
V. Zakordonets ◽  
A. Malik ◽  
O. Zakrutko ◽  
L. Tarasenko
Keyword(s):  
Kidney Transplantation ◽  
End Stage Kidney Disease ◽  
Successful Case ◽  
Increased Risk ◽  
The Family ◽  
Related Donor ◽  
Cadaveric Organ ◽  
End Stage ◽  
Living Related ◽  
Living Related Donor

Kidney transplantation is the gold standard for treating end - stage kidney disease. But the lack of cadaveric organ donation in Ukraine makes this operation available only for patients with living related donor. The absence of ABO - compatible living donor in the family is found in 20 - 30% of cases. This is the case for ABO - incompatible transplantation, but it is associated with an increased risk of acute rejection and requires special pre - transplant management. The article describes the first in Ukraine successful case of ABO - incompatible kidney transplantation in A.A. Shalimov’s National Institute of Surgery and Transplantology.

scholarly journals Critical study of Haritakyadi Yoga in Mutrakricchra (Urinary Tract Infection) - A Review

2021 ◽  
Vol 12 (4) ◽  
pp. 787-791
Author(s):  
Katkar Rahul ◽  
Upadhyay Prem Shanker
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Growth And Development ◽  
Recurrent Infection ◽  
Common Type ◽  
Renal Diseases ◽  
Critical Study ◽  
Tract Infections ◽  
End Stage ◽  
Cardinal Symptom

Urinary tract infections (UTI), the second most common type of infection. It is one of the most serious health problem affecting millions of people each year. UTI have been considered a risk factor for the development of end stage renal diseases in children. It is of greatest concern as recurrent infection of UTI can threat to the normal course of growth and development of children. The term Mutrakricchra comes under the disorders of Mutravaha Strotas. ‘Dukhen mutra pravritti’ (Difficulty while micturition-disurea) is cardinal symptom of Mutrakricchra vyadhi. Due to nidana sevana, doshas gets vitiated by their own causes and they enters in basti (Urinary bladder) and produce srotorodha, sankocha and kshobha at mutra marga which further causes Basti pradesh shotha and produce pain and difficulty while passing urine. Ayurveda has significant remedy in the management of Mutrakricchra. Haritakyadi yoga is one of the Ayurvedic formulation used in treatment of Mutrakricchra by means of Shamana chikitsa. Conclusion: Effect of ‘Haritakyadi Yoga’ was seems to be significant in reducing symptoms of Mutrakricchra as well as decreases possibility of drug resistance and recurrence of UTI.

scholarly journals Long-term outcomes of patients with end-stage kidney disease due to membranoproliferative glomerulonephritis: an ANZDATA registry study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Gregory J. Wilson ◽  
Yeoungjee Cho ◽  
Armando Teixiera-Pinto ◽  
Nicole Isbel ◽  
Scott Campbell ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Disease ◽  
Membranoproliferative Glomerulonephritis ◽  
Patient Survival ◽  
Disease Recurrence ◽  
Allograft Survival ◽  
End Stage Kidney Disease ◽  
Kidney Replacement Therapy ◽  
Allograft Loss ◽  
End Stage

Abstract Background Membranoproliferative glomerulonephritis (MPGN) is an uncommon cause of end stage kidney disease (ESKD) and the clinical outcomes of patients with MPGN who commence kidney replacement therapy have not been comprehensively studied. Methods All adult patients with ESKD due to glomerulonephritis commencing kidney replacement therapy in Australia and New Zealand from January 1, 1996 to December 31, 2016 were reviewed. Patients with ESKD due to MPGN were compared to patients with other forms of glomerulonephritis. Patient survival on dialysis and following kidney transplantation, kidney recovery on dialysis, time to transplantation, allograft survival, death-censored allograft survival and disease recurrence post-transplant were compared between the two groups using Kaplan Meier survival curves and Cox proportional hazards regression. Results Of 56,481 patients included, 456 (0.8%) had MPGN and 12,660 (22.4%) had another form of glomerulonephritis. Five-year patient survival on dialysis and following kidney transplantation were similar between patients with ESKD from MPGN and other forms of glomerulonephritis (Dialysis: 59% vs. 62% p = 0.61; Transplant: 93% vs. 93%, p = 0.49). Compared to patients with other forms of glomerulonephritis, patients with MPGN had significantly poorer 5-year allograft survival (70% vs. 81% respectively, p = 0.02) and death censored allograft survival (74% vs. 87%, respectively; p < 0.01). The risk of disease recurrence was significantly higher in patients with MPGN compared to patients with other glomerulonephritidites (18% vs. 5%; p < 0.01). In patients with MPGN who had allograft loss, patients with MPGN recurrence had a significantly shorter time to allograft loss compared to patients with MPGN who had allograft loss due to any other cause (median time to allograft loss 3.2 years vs. 4.4 years, p < 0.01). Conclusions Compared with other forms of glomerulonephritis, patients with MPGN experienced comparable rates of survival on dialysis and following kidney transplantation, but significantly higher rates of allograft loss due to disease recurrence.

scholarly journals Pre-emptive versus non pre-emptive kidney transplantation for end-stage kidney disease

2018 ◽  
Author(s):  
Camila Olarte Parra ◽  
Cedric Van de Bruaene ◽  
Laurens Weynants ◽  
Evi V Nagler ◽  
Alexandra McAleenan ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Disease ◽  
End Stage Kidney Disease ◽  
End Stage
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