scholarly journals Does the Presence of Renal Vascular Variation in the Renal Allograft Determine the Outcome of Renal Transplantation? Experience from the National Kidney Transplantation Center, Ethiopia

2021 ◽  
Author(s):  
Habtamu Wondmagegn ◽  
Abinet Gebremickael ◽  
Mahteme Bekele ◽  
Mala George ◽  
Teshale Fikadu ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Medical Records ◽  
Vascular Anatomy ◽  
Renal Allografts ◽  
Vascular Variations ◽  
Significant Difference ◽  
Transplantation Center ◽  
Renal Vascular

Abstract Background: Renal transplantation is the treatment of choice for people who suffer from end stage renal disease. Renal vascular anatomy is known for presenting a wide range of variations. Kidneys with variant renal vascular anatomy when used as a graft appear to be a potential risk factor that could impair the outcome of kidney transplantation. Information on renal vascular variations and its implication in the surgical outcome of renal transplantation has not been well studied. Hence, the present study was aimed to evaluate the outcomes of transplantation of renal allografts with variant renal vasculature as compared to allografts without renal vascular variation in the national kidney transplantation center of Ethiopia.Methods: A health institution based cross-sectional study was conducted. A retrospective review of the medical records of kidney recipients was performed. A total of 120 renal transplant recipient’s medical records were evaluated. Chi-square test and Independent t test was used to compare the surgical outcomes of renal transplantation. Graft survival was expressed using Kaplan-Meier curves, and was compared using the log-rank test. P values less than 0.05 was considered as statistically significant. Result: Evaluation of the renal transplant outcomes did not have shown a significant difference in the postoperative complication rate, rate of delayed graft function (DGF), creatinine clearance levels at 1 , 6, or 12 months postoperatively, and 1-year graft survival among recipients of allografts with and without renal vascular variations. However, operation time and the length of hospital stay were significantly longer among recipients of allografts with variant vasculature.Conclusion: No significant difference was noted in the outcomes of transplantation of renal allografts with and without vascular variations. Hence, renal allografts with vascular variations are safe to be recruited for transplantation as to this study.

scholarly journals Providers’ View on the First Kidney Transplantation Center in Ethiopia: Experience From Past to Present

2021 ◽  
Vol 8 ◽  
pp. 233339282110183
Author(s):  
Tariku Shimels ◽  
Abrham Getachew ◽  
Mekdim Tadesse ◽  
Alison Thompson
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplant ◽  
Health Care Providers ◽  
Study Data ◽  
Care Providers ◽  
Transplant Center ◽  
Transplantation Center ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Transplantation is the optimal management for patients with end-stage renal disease. In Ethiopia, the first national kidney transplantation center was opened at St. Paul’s Hospital Millennium Medical College in September 2015. The aim of this study was to explore providers’ views and experiences of the past to present at this center. Methods: A qualitative study design was employed from 1st November to 15th December, 2019. To ensure that appropriate informants would provide rich study data, 8 health care providers and top management members were purposefully chosen for in-depth interviews. A maximum variation sampling method was considered to include a representative sample of informants. Interviews were digitally audio-recorded, and transcribed verbatim. Transcribed data was coded and analyzed using Qualitative Data Analysis (QDA) Minor Lite software and Microsoft-Excel. Result: The participants (5 males and 3 females) approached were from different departments of the renal transplant center, and the main hospital. Eight main themes and 18 sub-themes were generated initially from all interviews totaling to 109 index codes. Further evaluation and recoding retained 5 main themes, and 14 sub-themes. The main themes are; challenges experienced during and after launching the center, commitment, sympathy and satisfaction, outcomes of renal transplant, actions to improve the quality of service, and how the transplant center should operate. Providers claim that they discharge their responsibilities through proper commitment and compassion, paying no attention to incentive packages. They also explained that renal transplantation would have all the outcomes related to economic, humanistic and clinical facets. Conclusion and Recommendation: A multitude of challenges were faced during and after the establishment of the first renal transplant center in Ethiopia. Providers discharge their responsibility through a proper compassion for patients. Concerned stakeholders should actively collaborate to improve the quality of renal transplant services in the center.

scholarly journals Donor genetic variants in interleukin-6 and interleukin-6 receptor associate with biopsy-proven rejection following kidney transplantation.

2021 ◽  
Author(s):  
Felix Poppelaars ◽  
Mariana Gaya da Costa ◽  
Siawosh K. Eskandari ◽  
Jeffrey Damman ◽  
Marc A. Seelen
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Interleukin 6 ◽  
Medical Center ◽  
Organ Donors ◽  
Nucleotide Polymorphisms ◽  
Increased Risk ◽  
Major Player ◽  
The Impact

Rejection after kidney transplantation remains an important cause of allograft failure that markedly impacts morbidity. Cytokines are a major player in rejection, and we, therefore, explored the impact of interleukin-6 (IL6) and IL-6 receptor (IL6R) gene polymorphisms on the occurrence of rejection after renal transplantation. We performed an observational cohort study analyzing both donor and recipient DNA in 1,271 renal transplant-pairs from the University Medical Center Groningen in The Netherlands and associated single nucleotide polymorphisms (SNPs) with biopsy-proven rejection after kidney transplantation. The C-allele of the IL6R SNP (Asp358Ala: rs2228145 A>C, formerly rs8192284) in donor kidneys conferred a reduced risk of rejection following renal transplantation (HR 0.78 per C-allele; 95%-CI 0.67-0.90; P=0.001). On the other hand, the C-allele of the IL6 SNP (at position-174 in the promoter; rs1800795 G>C) in donor kidneys was associated with an increased risk of rejection for male organ donors (HR per C-allele 1.31; 95%-CI 1.08-1.58; P=0.0006), but not female organ donors (P=0.33). In contrast, neither the IL6 nor IL6R SNP in the recipient showed an association with renal transplant rejection. In conclusion, donor IL6 and IL6R genotypes but not recipient genotypes represent an independent prognostic marker for biopsy-proven renal allograft rejection.

P1763TUBERCULOSIS IN RENAL TRANSPLANT RECEPIENTS - DO RITUXIMAB AND OTHER IMMUNOSUPRESSION HAVE A ROLE?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Anupma Kaul ◽  
Dharmendra Bhaduria ◽  
Narayan Prasad ◽  
Amit Gupta
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Immunosuppressive Agents ◽  
Induction Agent ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Transplant Patients ◽  
Significant Difference ◽  
High Prevalence ◽  
Mean Time

Abstract Background and Aims Rituximab is an anti CD 20 agent used widely in renal transplant recipients. Its use is associated with various infections;however, its association with Tuberculosis (TB) is not well established and has not been studied in post renal transplantation patients. Method This is a single centre, retrospective analysis of 56 renal transplant recipients who received rituximab for various reasons and 287 post renal transplant patients who did not receive rituximab during the study period from January 2013 to June 2017. The association between use of rituximab and incidence of TB was studied. Other factors associated with tuberculosis were also investigated. Results Baseline characteristics were similar in both the groups. Mean time for occurrence of TB was 18.4 + 10.6 months after renal transplantation. Rituximab use was not significantly associated with tuberculosis or any other infection. Higher number of rejection episodes (60% vs 32.72%, p=0.029) was the only factor associated with greater incidence of TB. However, no specific type of rejection was associated with tuberculosis. Use of plasmapheresis in post transplant period for treatment of humoral rejections was associated with significantly higher incidence of TB (33.33% vs 13.41%, p=0.031), however when pre- transplant plasmapheresis was also considered, there was no significant difference. The choice of induction agent was not associated with higher incidence of TB. Conclusion Use of rituximab is not associated with higher incidence of TB when compared to other immunosuppressive agents. Routine screening and prophylaxis may not be advisable especially in a country like India with high prevalence of TB; as it will further delay transplantation and may adversely affect the outcome of the patients.

scholarly journals Analysis of Factors Affecting Employment Status of Kidney Transplant Recipients in Selected European Union Member States

2021 ◽  
Vol 18 (19) ◽  
pp. 10284
Author(s):  
Elzbieta Wlodarczyk ◽  
Ondřej Viklický ◽  
Klemens Budde ◽  
Marie Kolářová ◽  
Leon Bergfeld ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Employment Status ◽  
Professional Activity ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Sf 36

Despite an increasing quality of life after renal transplantation, the number of recipients undertaking paid professional work remains relatively low. Employment after kidney transplantation became a new important marker of clinically significant health recovery. Furthermore, for social and economic reasons, returning to work and participation in social life may be considered as an objective parameter that demonstrate the effectiveness of transplantation. The objectives of the following study were to evaluate the factors that determine resuming paid work after renal transplantation, to assess a patient’s decision about returning to professional activity by comparative analysis of renal transplant recipients from Poland, Czech Republic and Germany, and to identify groups of patients exposed to professional exclusion in those EU countries. Five hundred renal transplant recipients from three EU countries were included into the study. The two main research methods used in the study were the SF-36 questionnaire, constructed and validated to assess the quality of life after kidney transplantation and a questionnaire constructed for the purposes of this study. Multifactorial analysis identified several risk factors associated with professional exclusions after kidney transplantation, namely young or advanced age, female gender, lack of education, place of residence in rural areas, long period of illness, and lack of occupational activity before transplantation. Despite the high standards of social care and rehabilitation support, patients in Germany failed to take up professional activity after kidney transplantation in more cases than those in Poland and Czech Republic. Surprisingly, the objective function of the kidney (creatinine level) and the multidimensional assessment of quality of life (SF-36 survey) did not have a significant association with the employment status after renal transplantation.

Management of Tumor Necrosis Factor α Inhibitor Therapy After Renal Transplantation: A Comparative Analysis and Associated Outcomes

2018 ◽  
Vol 53 (3) ◽  
pp. 268-275 ◽  
Author(s):  
Caroline S. Quinn ◽  
Margaret R. Jorgenson ◽  
Jillian L. Descourouez ◽  
Brenda L. Muth ◽  
Brad C. Astor ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Tumor Necrosis Factor ◽  
Inflammatory Disease ◽  
Tumor Necrosis ◽  
Tumor Necrosis Factor Α ◽  
Renal Transplant Recipients ◽  
Significant Difference ◽  
Factor Α ◽  
Necrosis Factor

Background: Biologic agents inhibiting the tumor necrosis factor α pathway (TNFα-Is) are used to treat systemic inflammatory diseases. The best management of these agents after renal transplantation is unknown. Objective: Evaluate peritransplant use of TNFα-Is and associated outcomes. Methods: Retrospective, single-center study of adult renal-transplant-recipients (RTRs) transplanted between 1/1/1998-12/31/2017, who received TNFα-Is for inflammatory disease prior to transplant. Qualifying patients were divided into 2 cohorts: patients who resumed TNFα-Is after transplant and those who did not. Outcomes were evaluated. Results: A total of 5256 renal transplants occurred in the study window; 14 patients met inclusion criteria. Primary indication for TNFα-I was Crohn’s-disease (CD; 57.1%). Infliximab was utilized most frequently (50%). Seven RTRs resumed TNFα-I posttransplant; mean time to resumption of 10.6±4.35 months (median=6 months), 85.7% for CD. Immunosuppression was modified in 2 patients (28.6%) in response to restarting TNFα-I therapy. Seven RTRs did not resume TNFα-Is following transplant; the majority of these had rheumatic diseases. There was no significant difference in time to first bacterial or fungal infection, rejection, or patient survival between the 2 groups. Last measured estimated glomerular-filtration-rate was similar between groups (TNFα-I: 41 ± 14.2 vs 48.6 ± 8.6, P = 0.25). No patient had cytomegalovirus infection; however, 42.8% of each cohort had documented BK virus infection. Malignancy occurred more frequently in the cohort that resumed TNFα-Is (42.8% vs 14.3%, P = 0.24); however, this was not statistically significant. Conclusion and Relevance: TNFα-I therapy prior to renal-transplant is relatively uncommon. The decision to continue therapy after transplant must balance risks of infection and malignancy against inflammatory disease recurrence. A multidisciplinary treatment approach is necessary as use of TNFα-I affects immunosuppressive management and appears to affect transplant outcomes. Future studies are needed to further clarify the role of TNFα-I therapy use in RTRs with inflammatory disorders focusing on its correlation with both BK and malignancy.

scholarly journals P1327STATUS OF AV FISTULA AFTER SUCCESSFUL RENAL TRANSPLANT ; A SINGLE CENTRE STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Pratim Sengupta ◽  
Tarpan Sasmal ◽  
Sumanta Biswas
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Blood Transfusion ◽  
Operative Time ◽  
Spontaneous Closure ◽  
Renal Transplant Recipients ◽  
Fistula Closure ◽  
Av Fistula ◽  
Significant Difference ◽  
Large Aneurysm

Abstract Background and Aims Functioning AV-Fistula is considered the Achilles hill of ESRD patients. After successful renal transplantation considering the risk of graft failure or recurrence of disease all attempts are made to preserve the functional AV fistula except few clinical situations like high output cardiac failure, steal phenomenon or large aneurysm with risk of rupture where voluntary closure of AVF is preferred. Even with care and attention a significant number of AV-Fistula closes spontaneously. In this retrospective study we analyzed the fate of AVF after successful renal transplantation. Method The medical records 800 renal transplant recipients in last 15 years were analyzed with the objective to find out the outcome of AVF after transplant. Data were systematically charted and analyzed by SPSS V.23.01 Results Out of 800 renal transplantation in last 15 years, excluding patients on CAPD or temporary catheter or AVgraft; 680 patients data were finally analyzed. Out of this 680 functioning AVF, 86 patients lost follow up and hence status of AVF could not be retrieved. Among rest 594 recipients, AV fistula was closed spontaneously in 184 cases (31.1%), and only 5 patients required planned AVF closure due to large aneurysm (2 cases), trauma and impending rupture (2 cases), cosmetic reason (1 cases). Incidence of spontaneous fistula closure was significantly higher among females than male recipients (p=0.001). Majority (62%) of the spontaneous closure occurred immediate post transplant period (within 7 days after transplant) and rest 26.4% within 1month and 9.2% in between 1 and 4 month. Only 2.4% fistula closed after 4 month of transplant. In the Tacrolimus era there is no significant difference in the rate of spontaneous closure with the patients who received cyclosporine (p=0.78). However among patient who received injectable cyclosporine the spontaneous closure was significantly higher (p=0.001). Factors which could be attributable to the rate of closure are, need of peripheral cannulation in perioperative period in the fistula arm (r2=0.89), operative time more than 2and half hr (r2=0.78), more than 2 unit of blood transfusion (r2=0.85) during operation and dialysis vintage through AVF less than 6 month (r2=0.77). There was no observed difference in rate of spontaneous closure among patients who received induction and who don’t (p=0.08). In subgroup analysis among induction with basiliximab or thymoglobulin there was no significant difference in spontaneous fistula closure (p=0.07). Conclusion Spontaneous closure of AV fistula observed in 31.1% patients with successful renal transplantation. It is more common in female recipients and 97.6% of spontaneous closure takes place within 4month of transplant. The factors which are attributable for spontaneous closure are cannulation in the fistula arm, injectable cyclosporine use, operative time more than 2and half hr, blood transfusion more than 2 units, during operation.

scholarly journals Donor genetic variants in interleukin-6 and interleukin-6 receptor associate with biopsy-proven rejection following kidney transplantation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Felix Poppelaars ◽  
Mariana Gaya da Costa ◽  
Siawosh K. Eskandari ◽  
Jeffrey Damman ◽  
Marc A. Seelen
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Interleukin 6 ◽  
Medical Center ◽  
Organ Donors ◽  
Nucleotide Polymorphisms ◽  
Increased Risk ◽  
Major Player ◽  
The Impact

AbstractRejection after kidney transplantation remains an important cause of allograft failure that markedly impacts morbidity. Cytokines are a major player in rejection, and we, therefore, explored the impact of interleukin-6 (IL6) and IL-6 receptor (IL6R) gene polymorphisms on the occurrence of rejection after renal transplantation. We performed an observational cohort study analyzing both donor and recipient DNA in 1271 renal transplant‐pairs from the University Medical Center Groningen in The Netherlands and associated single nucleotide polymorphisms (SNPs) with biopsy-proven rejection after kidney transplantation. The C-allele of the IL6R SNP (Asp358Ala; rs2228145 A > C, formerly rs8192284) in donor kidneys conferred a reduced risk of rejection following renal transplantation (HR 0.78 per C-allele; 95%-CI 0.67–0.90; P = 0.001). On the other hand, the C-allele of the IL6 SNP (at position-174 in the promoter; rs1800795 G > C) in donor kidneys was associated with an increased risk of rejection for male organ donors (HR per C-allele 1.31; 95%-CI 1.08–1.58; P = 0.0006), but not female organ donors (P = 0.33). In contrast, neither the IL6 nor IL6R SNP in the recipient showed an association with renal transplant rejection. In conclusion, donor IL6 and IL6R genotypes but not recipient genotypes represent an independent prognostic marker for biopsy-proven renal allograft rejection.

scholarly journals Early Post-transplant Renal Functions Predict Incidence of Acute Rejection in Kidney Transplantation

2020 ◽  
pp. 45-56
Author(s):  
Khulud Alhelal ◽  
Wejdan Almutairi ◽  
Yousef Al-Rajhi ◽  
Rakan Khalid Alfouzan ◽  
Senthilvel Vasudevan ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Acute Rejection ◽  
Serum Creatinine ◽  
Normal Level ◽  
Potassium Level ◽  
Post Transplant ◽  
Transplant Patients

Objectives: After renal transplantation, a remarkable improvement of impaired patient’s kidney function is often observed. Preserving improved kidney function ensures long-term renal allograft survival. However, there are different risk factors; the acute rejection is the major risk factor. Therefore, the aim of the present study was to examine renal function within the first six months as independent variables in predicting long-term survival and incidence of acute rejection. Methods: Fifty-three patients who underwent kidney transplantation in 2016 and 2017 in King Abdulaziz Medical City- National Guard were evaluated consecutively1 and 2-month pre-transplant up to six months’ post-transplant. Time course of changes in kidney functions; measurements of serum creatinine (Scr), blood urea nitrogen(BUN), albumin, calcium, sodium and potassium were recorded. Estimated glomerular filtration rate (eGFR) and anion gap (AGAP) were also reported. In addition, age, anthropometric factors and causes of ESRD were analyzed. Results: Lower level of calcium was observed in 40% of patient’s two-month pre-transplantation and 69% of patients one month before. Normalization of calcium was achieved in all patients starting from second month post-transplantation. All patients presented elevated serum potassium level in pre-transplant months, however, renal transplant normalize potassium level starting from first month. A remarkable higher level of serum BUN was observed in all pre-transplant patients followed by dramatically decreased after renal transplant for first four months and remain in normal level starting from month 5. Likewise, serum creatinine was highly elevated in all pre-transplant patients. A profound reduction in serum creatinine started from month 1 post-transplant and normalizes at month 4. Moreover, both eGFR and AGAP were kept in normal level immediately after renal transplantation. All patients with early acute rejection during mean follow-up period have a remarkable elevated level of serum creatinine and profound decrease in eGFR starting from first month. While a significant higher level of serum BUN observed in fifth month only and serum albumin in third month. Conclusion: Significant elevation of serum creatinine and reduction in eGFR starting from first month were associated with post-transplanted patients with early acute rejection. The clinical use of eGFR and serum creatinine may aid in predicting incidence of early acute rejection.

scholarly journals Renal transplantation at the Singapore General Hospital: a miracle in the making over 50 years

2020 ◽  
Vol 29 (4) ◽  
pp. 245-251
Author(s):  
Terence Kee Yi Shern
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
General Hospital ◽  
Organ Transplant ◽  
Kidney Donation ◽  
Kidney Donor ◽  
Human Organ ◽  
Singapore General Hospital ◽  
Donor Transplant

Background: This paper documents the history of the renal transplant programme at Singapore General Hospital. Renal transplantation in Singapore was born out of a necessity to offer a cheaper alternative to the expensive and scarce dialysis treatments in the 1970s. As a result, the first deceased kidney donor transplant was performed in 1970 at what Singapore General Hospital was then called ‘the Outram General Hospital’. However, deceased donation rates were dismal and prompted the start of a living kidney donor transplant programme in 1976 at Singapore General Hospital. Unfortunately, the prevalent population of patients with end-stage renal failure rapidly grew while kidney donation rates remain poor despite active efforts to raise awareness and even importing unwanted kidneys from other countries. Discussion: As a result, an opting-out legislation called the Human Organ Transplant Act was introduced in 1987 and increased the rate of deceased kidney donor transplantation in Singapore. Over the next two decades, access to kidney transplantation was further expanded with the introduction of living unrelated kidney donor transplantation and laparoscopic donor nephrectomy. In the past 10 years, there have been further advances in kidney transplantation with the introduction of newer immunosuppressive agents and technologies to perform incompatible kidney transplantation. The Human Organ Transplant Act has also been amended to allow the use of older deceased donors and permit paired kidney donor exchanges. Conclusion: Despite these many advances, kidney donation rates remain low and are even declining. This would certainly be the major challenge for the renal transplant programme in the next 50 years to come.

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