scholarly journals Comparative analysis of kidney transplant costs related to recovery of renal function after the procedure

2021 ◽  
Author(s):  
Raquel Martins e Quinino ◽  
Fabiana Agena ◽  
Flávio Jota de Paula ◽  
William Carlos Nahas ◽  
Elias David-Neto
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Kidney Transplant ◽  
Kidney Function ◽  
Hospital Costs ◽  
Graft Function ◽  
Function Recovery ◽  
Deceased Donors ◽  
Group D ◽  
Transplant Procedure

Abstract Introduction: The number of kidney transplants (KTx) is increasing in Brazil and, consequently, the costs of this procedure increase the country's health budget. We retrospectively evaluated the data of kidney transplant procedures until hospital discharge, according to kidney function recovery after the procedure. Methods: Retrospective analysis of the non-sensitized, 1st KTx from deceased donors performed between Jan/2010 to Dec/2017. Results: Out of the 1300 KTx from deceased donors performed in this period, 730 patients were studied and divided into 3 groups: Immediate Renal Function (IRF) - decrease in serum creatinine ≥ 10% on two consecutive days; Delayed Graft Function (DGF) - decrease in serum creatinine <10% on two consecutive days, without the need for dialysis, and Dialysis (D) - need for dialysis during the first week. Patients in group D stayed longer in the hospital compared to DGF and IRF (21, 11 and 8 days respectively, p < 0.001). More D patients (21%) were admitted to the ICU and performed a greater number of laboratory tests (p < 0.001) and renal biopsies (p < 0.001), in addition to receiving a higher amount of immunosuppressants. Total hospital costs were higher in group D and DGF compared to IRF (U$ 7.021,48; U$ 3.603,42 and U$ 2.642,37 respectively, p < 0.001). Conclusion: The costs of the transplant procedure is impacted by the recovery of kidney function after the transplant. The reimbursement for each of these different kidney function outcomes should be individualized in order to cover their real costs.

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.

scholarly journals Outcomes in Living Donor Kidney Transplantation: The Role of Donor’s Kidney Function

2021 ◽  
pp. 1-11
Author(s):  
Massimo Torreggiani ◽  
Ciro Esposito ◽  
Elena Martinelli ◽  
Thomas Jouve ◽  
Antoine Chatrenet ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Kidney Function ◽  
Living Donor ◽  
Graft Function ◽  
Kidney Graft ◽  
Donor Kidney ◽  
Transplant Center ◽  
Function Correlation ◽  
End Stage ◽  
Living Donor Kidney

<b><i>Introduction:</i></b> Living donor kidney transplant (LDKT) is one of the best therapeutic options for end-stage kidney disease (ESKD). Guidelines identify different estimated glomerular filtration rate (eGFR) thresholds to determine the eligibility of donors. The aim of our study was to evaluate whether pretransplant donor eGFR was associated with kidney function in the recipient. <b><i>Methods:</i></b> We retrospectively studied LDKT recipients who received a kidney graft between September 1, 2005, and June 30, 2016 in the same transplant center in France and that had eGFR data available at 3, 12, 24, and 36 months posttransplant. <b><i>Results:</i></b> We studied 90 donor-recipient pairs. The average age at time of transplant was 51.47 ± 10.95 for donors and 43.04 ± 13.52 years for recipients. Donors’ average eGFR was 91.99 ± 15.37 mL/min/1.73 m<sup>2</sup>. Donor’s age and eGFR were significantly correlated (<i>p</i> &#x3c; 0.0001, <i>r</i><sup>2</sup> 0.023). Donor’s age and eGFR significantly correlated with recipient’s eGFR at 3, 12, and 24 months posttransplant (age: <i>p</i> &#x3c; 0.001 at all intervals; eGFR <i>p</i> = 0.001, 0.003, and 0.016, respectively); at 36 months, only donor’s age significantly correlated with recipient’s eGFR. BMI, gender match, and year of kidney transplant did not correlate with graft function. In the multivariable analyses, donor’s eGFR and donor’s age were found to be associated with graft function; correlation with eGFR was lost at 36 months; and donor’s age retained a strong correlation with graft function at all intervals (<i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Donor’s eGFR and age are strong predictors of recipient’s kidney function at 3 years. We suggest that donor’s eGFR should be clinically balanced with other determinants of kidney function and in particular with age.

THE EFFECT OF SPIRONOLACTONE ON SERUM ELECTROLYTES AND RENAL FUNCTION TESTS IN PATIENTS WITH SEVERE CHRONIC HEART FAILURE

2021 ◽  
Vol 74 (10) ◽  
pp. 2460-2462
Author(s):  
Seher Abdurasool Almedeny ◽  
Jabbar Yasir AL- Mayah ◽  
Mohanmed S. Abdulzahra ◽  
Najah R. Hadi
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Serum Creatinine ◽  
Kidney Function ◽  
Serum Potassium ◽  
Control Group ◽  
Kidney Function Tests ◽  
Serum Electrolytes ◽  
Function Tests ◽  
Renal Function Tests

The aim: To evaluate the effect of single daily 25 mg of spironolactone on serum electrolytes and kidney function tests in patients with severe chronic left sided heart failure. Materials and methods: 60 patients with severe chronic left sided heart failure were enrolled in this study and they were divided in to 2 equal groups’ one group with standard therapy of HF and the other with spironolactone in a dose of 25 mg / day, as an additive therapy to the standard one. Serum electrolytes and kidney function tests were assessed at the beginning of the study and after 3 months. Results: A significant increment in serum potassium (p<0.05) was observed in the spironolactone group after 3 months treatment, while no significant reduction in serum sodium (p>0.05) and no significant increase in serum creatinine and blood urea (p>0.05) was noticed in the same group, control group showed no significant changes (p>0.05), in both serum electrolytes (S.K and S.Na) and renal function tests (S.C and B.U). Conclusions: Spironolactone caused a significant elevation of serum potassium level but this elevation is still with the clinically accepted ranges when low dose of spironolactone is used and with intact renal function. Serum creatinine level was not significantly increased with 25 mgl day of spironolactone. We conclude that Renal function tests namely blood urea and serum Creatinine, and serum potassium should be closely monitored in patients on spironolactone therapy especially those patients who use ACEI and ARBs in addition.

FP784LONG TERM GRAFT FUNCTION IN KIDNEY TRANSPLANT RECIPIENTS OF DECEASED DONORS WITH ACUTE KIDNEY INJURY

2019 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Reinis Lulle ◽  
Gritane Klinta ◽  
Asare Lasma ◽  
Jushinskis Janis ◽  
Malcevs Aleksandrs ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Transplant ◽  
Graft Function ◽  
Kidney Injury ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Deceased Donors

P1644SAPS AND EPTS SCORES AS PREDICTORS OF RENAL FUNCTION IN RECENT RENAL TRANSPLANTATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jimmy Reinaldo Sanchez Gil ◽  
Armando Coca ◽  
Guadalupe Rodriguez Portela ◽  
Carmen Aller Aparicio ◽  
Alicia Mendiluce
Keyword(s):  
Renal Function ◽  
Renal Transplantation ◽  
Serum Creatinine ◽  
Roc Curve ◽  
Graft Function ◽  
Risk Scores ◽  
Critical Care Units ◽  
Saps Ii ◽  
Combined Use ◽  
The Us

Abstract Background and Aims The risk scores used in Critical Care Units estimate the severity and mortality of patients. The SAPS (Simplified Acute Physiologic Score) and its SAPS II and SAPS III variants calculate the severity by collecting the values recorded in the first 24 hours. The EPTS (Estimated Post-Transplant-Survival) is used as a reference for the allocation of organs in the US by the OPTN. The objective is to determine its use in recent renal transplant units as estimator of subsequent renal function, in services where patients move from the operating room to a nephrological intermediate care unit. Method The SAPS (II and III) and OPTN scores were applied in 87 (N = 87) consecutive renal transplanted patients. The point value of each of the scales was evaluated with the creatinine values at hospital discharge, and one month after the transplant. The scores obtained on the SAPS scales were divided as follows (SAPSIIA &lt;20 points, SAPSIIB ≥20 points) (SAPSIII A &lt;30 points, SAPSIIIB ≥30 points). In the EPTS scale, two cut-off points were used to divide the groups (20% Score; EPTS-IA ≤20%, EPTS-IB&gt; 20%), (Score 40%; EPTS-IIA ≤40%, EPTS -IIB&gt; 40). The sérum creatinine means of each of the groups were compared. Data were analyzed with SPSS 20.0.0 Results Significant differences were found in serum creatinine levels in renal function at the first month of transplantation in the SAPS II groups (SAPS IIA 1.38 mg / dl, SAPS IIB 1.79 mg / dl; P = 0.017 95% CI). With an area under the ROC curve of 0.65 (P = 0.017 95% CI). In the SAPS III groups no significant differences were found. In the EPTS scales, there were also significant differences in creatinine one month after the transplant in the group with a score of 40% (EPTS-IIA ≤40% 1.42 mg / dl, EPTS-IIB&gt; 40 1.81 mg / dl; P = 0.024 95% CI) With an Area under the ROC curve of 0.64 (P = 0.037 95% CI). Conclusion The SAPSII and EPTS scores can be a useful tool in estimating renal function one month after renal transplantation, giving a prognosis of renal graft function. The combined use of these scales together with other functional graft tests could have an important relevance in the management and follow-up of recent renal transplantation. Other studies with larger sample sizes are necessary to establish the appropriate cut-off points for the scales.

173: Delayed Graft Function (DGF) in HIV+ Kidney Transplant Recipients Predicts Worse Long-Term Renal Function

2010 ◽  
Vol 55 (4) ◽  
pp. B75
Author(s):  
Lissa Levin ◽  
Gregory Malat ◽  
Mohit Gupta ◽  
Muhammad Saeed ◽  
Snehankita Kulkarni ◽  
...  
Keyword(s):  
Renal Function ◽  
Kidney Transplant ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

scholarly journals The association of two single-nucleotide polymorphisms of the FOXP3 gene (rs3761548 and rs3761547) with renal allograft function and survival in kidney transplant recipients

2020 ◽  
Vol 7 (2) ◽  
pp. e21-e21
Author(s):  
Vahideh Ebrahimzadeh Attari ◽  
Seyed Sadroddin Rasi Hashemi ◽  
Solmaz Oloufi ◽  
Leili Aghebati Maleki ◽  
Dariush Shanehbandi ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Kidney Transplant ◽  
Creatinine Level ◽  
Kidney Function ◽  
Renal Allograft ◽  
Regulatory Protein ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Allograft Function

Introduction: The FOXP3 protein is an immune regulatory protein that specifically maintains the function and differentiation of regulatory T cells (Tregs) and prevents autoimmunity. Variations in FOXP3 gene may alter its function and also the immune response. Objectives: The present study was conducted to investigate the association of the FOXP3 gene polymorphisms -3499 A/G and -3279 A/C with renal allograft function and survival in kidney transplant recipients. Patients and Methods: In this cross-sectional study, 150 eligible kidney transplant recipients were evaluated. Kidney function was evaluated at three- and five-year post-transplant using serum creatinine level and glomerular filtration rate as indicators. Genotyping of the study participants was performed using the PCR– restriction fragment length polymorphism method. Results: The frequencies of AA, AG, and GG genotypes of the -3499 A/G polymorphism were 62.42%, 29.53%, and 8.05%, respectively. For the -3279 A/C polymorphism, the frequencies of the AA, AC, and CC genotypes were 21.33%, 32%, and 46.67%, respectively. The mean ± SD of serum creatinine level, three and five years after transplantation were 1.70 ± 1.58 and 1.87 ± 1.94, respectively. Serum creatinine level and kidney function did not show any significant association with these polymorphisms. Conclusion: In the present study, only 10% of participants experienced episodes of severe kidney dysfunction and we did not find any significant association between kidney function and the subjects’ genotypes. Further epidemiologic studies with greater sample sizes may be needed to clarify this association.

scholarly journals P1601COMPLEMENT MEMBRANE ATTACK COMPLEX DURING THE FIRST WEEK AFTER KIDNEY TRANSPLANTATION AS SEVERITY BIOMARKER TO DELAYED GRAFT FUNCTION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Carlos Arias-Cabrales ◽  
Marta Riera ◽  
Maria José Pérez-Sáez ◽  
Javier Gimeno ◽  
Carla Burballa ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Complement Activation ◽  
Graft Function ◽  
Membrane Attack Complex ◽  
Factor H ◽  
Delayed Graft Function ◽  
Positive Staining ◽  
Complement Factor ◽  
Protocol Biopsies

Abstract Background and Aims Ischemia-reperfusion (I/R) damage is a relevant cause of delayed graft function (DGF). Complement activation is involved in experimental I/R injury, but few data are available about the expression of the complement cascade final component -membrane attack complex (MAC)- and I/R injury in KT patients. We studied the dynamics of membrane attack complex (MAC) as plasma fraction (pMAC) and the histological deposit pattern of C3b, complement factor H (FH) and MAC in DGF patients. Method We evaluated pMAC levels in 59 recipients, 38 with immediate graft function and 21 without serum creatinine decreased at day 7 (DGF). pMAC was measured at admission for KT (day 0) and 7 days after KT (day 7). Sandwich ELISAs were used to measure MAC. Additionally, we performed imunohistoquimical stained for MAC, C3b and kidney biopsies (KB) with DGF (n=12) and a control group of one-year protocol biopsies without damage (n=4) Results Patients in the DGF group were older, more frequently diabetics and received kidneys from older donors and more frequently controlled cardio-circulatory death type. Day0 and day7 post-KT pMAC levels were similar in non-DGF patients 5902±3049 mAu/L vs 6178±2882 mAu/L; p=0.686). However, patients with DGF showed a significant increase of pMAC levels between day0 and day7 (6621±2202 mAu/L vs 9625±4142 mAu/L; p=0.006. Figure 1 Percentage pMAC levels increase (Δ0-7 pMAC%) discriminative assessment analyzed by ROC curve showed a good discriminative value for DGF with an AUC of 0.78; p&lt;0.001 (sensitivity 81%, specificity 66% by cut-off point of 5%). In patients with DGF longer than ten days, we found more frequently patients with a Δ0-7 pMAC &gt;5% (83% vs 17% Δ0-7 pMAC &lt;5% ; p=0.003).Patients with DGF showed renal function at 3 and 6 months, but worse renal function 1 year after KT (serum creatinine 1.78±0.61 vs 1.35±0.30 mg/dl in non-DGF patients). DGF patients with Δ0-7 pMAC &gt;5% displayed worse renal function 1 and 2 year after KT compared to DGF patients with Δ0-7 pMAC &lt;5%. MAC, C3b and FH stains were observed in tubular epithelial cells basal membrane. DGF-kidney biopsies showed more frequently high-intensity stain for MAC and FH than controls, without differences to C3b stain. DGF-kidney biopsies also showed a higher number of tubules with positive stain and larger perimeter of tubules with positive stains for MAC, C3b and FH than the controls. Figure 2. Among the 12 patients with DGF-biopsies, three (25%) never recovered renal function, all of them presented Δ0-7 pMAC &gt;5% and intense, diffuse and positive staining in more than 50% of tubular perimeter for MAC, FH and C3b Conclusion Complement activation during peritrasplant period could be related with the severity of graft injury and the presence of DGF. Therefore, the determination of MAC levels could be useful to identify patients with possible complement dependent graft injury that might benefit from complement inhibitor therapies

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