scholarly journals Evaluation of vascular access before kidney transplantation in patients with successful kidney transplantation

2018 ◽  
Vol 8 (1) ◽  
pp. 50-53
Author(s):  
Mohsen Mohammad Rahimi ◽  
Mansour Alizadeh ◽  
Nima Naghdi-seded ◽  
Rohollah Valizadeh ◽  
Amir Jamei ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Vascular Access ◽  
Historical Cohort ◽  
Related Information ◽  
The Status ◽  
Successful Transplantation ◽  
Low Incidence

Introduction: The status of embedded fistula before kidney transplant is one of the problems in patients after kidney transplant and without correct management, surely it can lead to severe complications. The vascular access of arteriovenous fistula (AVF) and its possible complications can be found using the registered data in patients who had undergone successful kidney transplant. This information may be useful to prevent possible complications in future. Objectives: This study was aimed to determine the status of vascular access before kidney transplant in patients with successful transplantation in Urmia city, Iran. Patients and Methods: This study was a historical cohort conducted on 201 patients from March 2009 to March 2012 who had undergone vascular access before kidney transplant. The related information about complications and functions of fistula were extracted from available records. Results: According to results, the patients were divided into four groups regarding fistula function including 104 patients (51.7%) with functional fistula after kidney transplant, 49 patients (24.4%) with spontaneously closed fistula, 37 patients (18.4%) with closed fistula through surgery and 11 patients (5.5%) with reduced blood flow of fistula. Conclusion: Despite the low incidence of heart failure in functional vascular access after successful renal transplantation, these patients should be followed up by cardiologists to avoid complications. Generally, closing vascular accesses after successful transplantation is not necessary.

scholarly journals Vascular Access Perspectives in Patients After Kidney Transplantation

2021 ◽  
Vol 8 ◽  
Author(s):  
Krzysztof Letachowicz ◽  
Mirosław Banasik ◽  
Anna Królicka ◽  
Oktawia Mazanowska ◽  
Tomasz Gołębiowski ◽  
...  
Keyword(s):  
Blood Flow ◽  
Kidney Transplantation ◽  
Vascular Access ◽  
Graft Function ◽  
Protective Measure ◽  
Study Group ◽  
Renal Transplant Recipients ◽  
Upper Arm ◽  
Surgical Closure ◽  
Proximal Forearm

Introduction: More attention has been paid to the influence of arteriovenous fistula (AVF) on the cardiovascular system. In renal transplant recipients, some beneficial effect of an elective vascular access (VA) ligation was observed in patients with a high AVF flow. However, this strategy is not widely accepted and is in contradiction to the rule of vasculature preservation for possible future access. The aim of our study is to elucidate the vascular access function and VA perspective in the kidney transplantation (KTx) population.Materials and Methods: KTx patients with a stable graft function were recruited to participate in this single center observational study (NCT04478968). The measurement of VA flow and vessel mapping for future vascular access was performed by a color Doppler ultrasound. The study group included 99 (63%) males and 58 (37%) females; the median age was 57 (IQR 48–64) years. The median time from the transplantation to the baseline visit was 94 (IQR 61–149) months. Median serum creatinine concentration was 1.36 (IQR 1.13–1.67) mg/dl.Results: Functioning VA was found in 83 out of 157 (52.9%) patients. The sites were as follows: snuffbox in six (7.2%), wrist in 41 (49.4%), distal forearm in 18 (21.7%), middle or proximal forearm in eight (9.6%), upper-arm AV graft in one (1.2%), and upper-arm AVFs in nine (10.8%) patients, respectively. Blood flow ranged from 248 to 7,830 ml/min; the median was 1,134 ml/min. From the transplantation to the study visit, 66 (44.6%) patients experienced access loss. Spontaneous thrombosis was the most common, and it occurred in 60 (90.9%) patients. The surgical closure of VA was performed only in six (4%) patients of the study group with a functioning VA at the time of transplantation. Access loss occurred within the 1st year after KTx in 33 (50%) patients. Majority (50 out of 83, 60.2%) of the patients with an active VA had options to create a snuffbox or wrist AVF on the contralateral extremity. In a group of 74 patients without a functioning VA, the creation of a snuffbox or wrist AVF on the non-dominant and dominant extremity was possible in seven (9.2%) and 40 (52.6%) patients, respectively. In 10 (13.1%) patients, the possibilities were limited only to the upper-arm or proximal forearm VA on both sides. Access ligation was considered by 15 out of 83 (18.1%) patients with a patent VA.Conclusions: In the majority of the patients, vascular access blood flow was below the threshold of the negative cardiovascular effect of vascular access. Creation of a distal AVF is a protective measure to avoid a high flow and preserve the vessels for future access. The approach to VA should be individualized and adjusted to the patient's profile.

scholarly journals Factors Affecting the Long-Term Survival of Kidney Transplanta-tion in Northeastern of Iran between 2000 and 2015

2021 ◽  
Author(s):  
Rasoul Alimi ◽  
Maryam Hami ◽  
Monavar Afzalaghaee ◽  
Fatemeh Nazemian ◽  
Mahmood Mahmoodi ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Survival Rate ◽  
Kidney Transplant ◽  
Cox Regression ◽  
Historical Cohort ◽  
Term Survival ◽  
Long Term Survival ◽  
Effective Factors ◽  
Transplant Survival

Background: Graft and patient survival are of great importance after transplantation. This study aimed to determine the long-term survival rate of kidney transplantation and its effective factors among transplanted patients in Mashhad transplantation centers in northeastern Iran. Methods: Overall, 618 kidney transplant recipients were examined in different transplantation centers during the years from 2000 to 2015 in a historical cohort study. The Kaplan-Meier method and the Log-rank test were used to calculate the survival rate of the kidney transplant, and to check the difference between survival curves respectively. Modeling of effective factors in survival rate was performed using Cox regression model. Results: Overall, 1, 3, 5, 7, 10, and 15-year survival rate of kidney transplantation were 99%, 98%, 97%, 93%, 88 and 70% respectively. The adjusted hazard ratio indicated that variables such as recipient age >40 yr [HR=0.22, 95% CI=(0.071,0.691)], serum creatinine after transplantation >1.6 Mg/dl [HR=3.03, 95% CI=(1.284,7.125)], history of hypertension [HR=6.70, 95% CI=(2.746,16.348)], and BMI [HR (normal weight versus underweight)=0.26, 95% CI=(0.088,0.761), HR (over weight versus underweight)=0.13,95% CI=(0.038,0.442)] were significant factors on kidney transplant survival rate. Conclusion: The short-term transplant survival rate was good in transplant patients. What's more, through a consideration of variables such as age, creatinine serum after transplantation, history hypertension and body mass index, as well as proper planning to control their effect, it is possible to improve the long-term graft survival rate.

scholarly journals P1355NEW SURGICAL TECHNIQUE TO CONTROL EXCESS VASCULAR ACCESS BLOOD FLOW

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
KIYOSHI IKEDA
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Cardiac Function ◽  
Vascular Access ◽  
Shortness Of Breath ◽  
Dialysis Patients ◽  
New Device ◽  
Surgical Method ◽  
Patients With Heart Failure ◽  
One Year

Abstract Background and Aims During dialysis, if blood flow rate increases above 1500ml/min. there is an increase in pulsation and a high possibility of heart failure. In the long run, it can cause valvular disease and arrhythmia. In EDTA 2015, we presented a method of blood flow suppression for dialysis patients who had heart failure caused by excessive blood flow. However, within one year, 30% of the cases had relapsed. To solve this problem, we were able to prevent the recurrence of excess blood flow through improvement measures with a new device. Report including theoretical mechanisms. During vascular access excessive shunt blood flow creates a heavy load on cardiac function. Performing blood flow control surgery on dialysis patients with heart failure symptoms improves said function. Depending on the surgical method, it may recur. For this reason, we devised a surgical method that theoretically considers recurrence suppression. Method Clinical symptoms before surgery were based on trial hemodialysis patients with significant arrhythmia and shortness of breath at the time of exertion (6 males 4 females) using EPTFE of 4mm in diameter and 4cm in length or more replaced veins extended from anastomosis. (As shown in Poiseuille's law, it is necessary to replace veins with a shunt of smaller diameter but longer length than the vein being replaced.) The point of insertion at the anastomosis portion of the artery is 4mm. In order to connect to the larger section of the vein to the other end, it is cut diagonally to make the connection secure. During the operation, blood flow was monitored using ultrasound. The central side of the tibia artery was also tied off in some cases to control blood flow. Results Blood flow was reduced to 787 ml/min immediately after surgery from 1970ml/min before surgery, 1007ml after 6 months, and 721 ml/min after one year. Symptoms of arrhythmia disappeared in two patients during surgery and in all cases shortness of breath during exertion disappeared the day after surgery. Cardiac index improved three months after surgery in three cases. In none of the cases did we observe the complete rekindling of blood flow after one year. The average blood flow was less than 63% of the rate before surgery. Conclusion Replacement of 4cm or more length sections of veins with a 4mm diameter graft was useful in improving cardiac function in dialysis patients with heart failure.

P1332VASCULAR ACCESS IN OLDER ADULTS: MOSCOW REGION REGISTER ANALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Aleksei Zulkarnaev ◽  
Vadim Stepanov ◽  
Andrey Vatazin ◽  
Ewgenii Strugaylo ◽  
Natalia Fominykh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Older Adults ◽  
Blood Flow ◽  
General Population ◽  
Elderly Patients ◽  
Vascular Access ◽  
Significant Risk ◽  
Younger Patients ◽  
Risk Of Death

Abstract Background and Aims For many years we observed aging of HD population: the proportion older adults is increasing. These patients have extremely low kidney transplantation rate, so vascular access is not a temporary option, but an important factor until the end of life. At the same time in older adults life expectancy is lower and the risks of cardiovascular events are much higher than in the general population of HD patients. We analyzed the results of providing elderly patients with vascular access. Method The study included 618 patients (age ≥ 65) from the Moscow region CKD patients register. Results With the current practice, only about 60% of elderly patients begin HD within a year after the AVF creation (taking into account competing events) - fig. 1. The proportion of patients with brachiocephalic AVF was significantly higher than in younger patients: 41,3% vs. 16,4%. It is known that proximal AVF have a much greater tendency to increase the volume blood flow (and therefore – cardiopulmonary recirculation) than distal. Thus, elderly patients begin HD with a more adverse comorbid background. Therefore, elderly patients have an additional risk factor - the onset of HD after 65 years – fig 2. Paradoxically, but according to our data, patients who started HD after 65 years had a worse prognosis than patients who reached 65 while already on HD. At the same time, the onset of HD with CVC with the subsequent successful conversion to AVF was not associated with a significant increase in the risk of death («CVC-AVF» factor). Only if CVC remained the only vascular access («CVC» factor), the risk of death is increase significantly. This is indirect evidence in favor of the fact that in elderly patients, the AVF must be created closer to the expected start of HD. In adjusted model, the significant risk factors also were diabetes, systemic diseases (factor «Other») and comorbidity (CIRS score), but not age. Among patients who started HD with CVC, all patients received functional AVF or died within 11 months – fig. 3. Infections occur with the same frequency (CVC-AVF vs. AVF) and clinical manifestations of central venous insufficiency do not have time to occur during the expected life period in most patients: incidence rate ratio IRR 1.21 [0.91; 1.31] and IRR 1.11 [0.93; 1.19], respectively. Is a conversion of AVF to CVC can improve the outcomes in older adults? In some patients probably - yes. Since many elderly patients initially have heart failure and a reduced cardiac output (CO), the potential for compensating of AVF blood flow (Qa) is significantly less than in younger patients. We found that this leads to the fact that in the elderly, at a lower Qa value, a greater value of cardiopulmonary recirculation is noted. Even with a Qa value of 1.0-1.2 l/min, the Qa/CO value can reach ≈ 25%, which is associated with a significant risk of death. But there is good news: in the older adults some criteria are more informative than in the general population of HD patients: AUC-ROC of ejection fraction (EF), estimated pulmonary artery systolic pressure (ePASP) and Qa/CO – 0.821, 0.804 and 0.846, respectively vs. 0.654, 0.726 and 0.764. The bad news: the decision to convert from a functional AVF to a CVC is a very difficult choice. Specific indications are still not determined. We believe that it is necessary to consider the conversion from AVF to CVC in a case of decompensated heart failure, with EF<30-33% or ePASP>50-55 or Qa/CO>20-25%, if the reduction of Qa does not improve these parameters. In this case, conversion from CVC to AVF may improve the prognosis. Older patients require more careful monitoring than younger patients. Conclusion 1. The start of HD with CVC is not a problem in case of subsequent successful conversion to AVF. 2. The most important risk factors is comorbidity, starting of HD after 65 years, diabetes and only then - vascular access type. 3. Given all the facts, in the older adults we tend to create an AVF closer to start of HD than in the general HD population.

scholarly journals The Association of Long-Functioning Hemodialysis Vascular Access with Prevalence of Left Ventricular Hypertrophy in Kidney Transplant Recipients

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Aureliusz Kolonko ◽  
Agata Kujawa-Szewieczek ◽  
Magdalena Szotowska ◽  
Piotr Kuczera ◽  
Jerzy Chudek ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Left Ventricular Hypertrophy ◽  
Kidney Transplant ◽  
Vascular Access ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Kidney Graft ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Hemodialysis Vascular Access

Left ventricular hypertrophy (LVH) is frequently observed in chronic dialysis patients and is also highly prevalent in kidney transplant recipients. This study evaluates the impact of long-functioning hemodialysis vascular access on LVH in single center cohort of kidney transplant recipients. 162 patients at 8.7 ± 1.8 years after kidney transplantation were enrolled. Echocardiography, carotid ultrasound, and assessment of pulse wave velocity were performed. LVH was defined based on left ventricular mass (LVM) indexed for body surface area (BSA) and height2.7. There were 67 patients with and 95 without patent vascular access. Both study groups were comparable with respect to gender, age, duration of dialysis therapy, and time after transplantation, kidney graft function, and cardiovascular comorbidities. Patients with patent vascular access were characterized by significantly elevated LVM and significantly greater percentage of LVH, based on LVMI/BSA (66.7 versus 48.4%,P=0.02). OR for LVH in patients with patent vascular access was 2.39 (1.19–4.76),P=0.01. Regression analyses confirmed an independent contribution of patent vascular access to higher LVM and increased prevalence of LVH. We concluded that long-lasting patent hemodialysis vascular access after kidney transplantation is associated with the increased prevalence of LVH in kidney transplant recipients.

Myocardial Blood Flow Response to Pacing Tachycardia and to Dipyridamole Infusion in Patients With Dilated Cardiomyopathy Without Overt Heart Failure

Circulation ◽  
1995 ◽  
Vol 92 (4) ◽  
pp. 796-804 ◽  
Author(s):  
Danilo Neglia ◽  
Oberdan Parodi ◽  
Michela Gallopin ◽  
Gianmario Sambuceti ◽  
Assuero Giorgetti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Myocardial Blood Flow ◽  
Dilated Cardiomyopathy ◽  
Blood Flow Response ◽  
Flow Response

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 High Prevalence of Three Potyviruses Infecting Cucurbits in Oklahoma and Phylogenetic Analysis of Cucurbit Aphid-Borne Yellows Virus Isolated from Pumpkins

Pathogens ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 53
Author(s):  
Vivek Khanal ◽  
Harrington Wells ◽  
Akhtar Ali
Keyword(s):  
Phylogenetic Analysis ◽  
Mosaic Virus ◽  
Zucchini Yellow Mosaic Virus ◽  
Yellow Mosaic Virus ◽  
Watermelon Mosaic Virus ◽  
High Prevalence ◽  
The Us ◽  
Close Relationship ◽  
The Status ◽  
Low Incidence

Field information about viruses infecting crops is fundamental for understanding the severity of the effects they cause in plants. To determine the status of cucurbit viruses, surveys were conducted for three consecutive years (2016–2018) in different agricultural districts of Oklahoma. A total of 1331 leaf samples from >90 fields were randomly collected from both symptomatic and asymptomatic cucurbit plants across 11 counties. All samples were tested with the dot-immunobinding assay (DIBA) against the antisera of 10 known viruses. Samples infected with papaya ringspot virus (PRSV-W), watermelon mosaic virus (WMV), zucchini yellow mosaic virus (ZYMV), and cucurbit aphid-borne-yellows virus (CABYV) were also tested by RT-PCR. Of the 10 viruses, PRSV-W was the most widespread, with an overall prevalence of 59.1%, present in all 11 counties, followed by ZYMV (27.6%), in 10 counties, and WMV (20.7%), in seven counties, while the remaining viruses were present sporadically with low incidence. Approximately 42% of the infected samples were positive, with more than one virus indicating a high proportion of mixed infections. CABYV was detected for the first time in Oklahoma, and the phylogenetic analysis of the first complete genome sequence of a CABYV isolate (BL-4) from the US showed a close relationship with Asian isolates.

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.

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