scholarly journals Living unrelated donor kidney transplantation: A fourteen-year experience

2010 ◽  
Vol 67 (12) ◽  
pp. 998-1002 ◽  
Author(s):  
Ljiljana Ignjatovic ◽  
Dragan Jovanovic ◽  
Goran Kronja ◽  
Aleksandar Dujic ◽  
Mihailo Maric ◽  
...  
Keyword(s):  
Graft Function ◽  
Control Group ◽  
Unrelated Donor ◽  
Organ Shortage ◽  
Hla Matching ◽  
Group I ◽  
Kidney Transplantations ◽  
Stage Renal Disease ◽  
End Stage

Background. In countries without a national organization for retrieval and distribution of organs of the deceased donors, problem of organ shortage is still not resolved. In order to increase the number of kidney transplantations we started with the program of living unrelated - spousal donors. The aim of this study was to compare treatment outcome and renal graft function in patients receiving the graft from spousal and those receiving ghe graft from living related donors. Method. We retrospectively identified 14 patients who received renal allograft from spousal donors between 1996 and 2009 (group I). The control group consisted of 14 patients who got graft from related donor retrieved from the database and matched than with respect to sex, age, kidney disease, immunological and viral pretransplant status, the initial method of the end stage renal disease treatment and ABO compatibility. In the follow-up period of 41 ? 38 months we recorded immunosuppressive therapy, surgical complications, episodes of acute rejection, CMV infection and graft function, assessed by serum creatinine levels at the beginning and in the end of the follow-up period. All patients had pretransplant negative cross-match. In ABO incompatible patients pretransplant isoagglutinine titer was zero. Results. The patients with a spousal donor had worse HLA matching. There were no significant differences between the groups in surgical, infective, immunological complications and graft function. Two patients from the group I returned to hemodialysis after 82 and 22 months due to serious comorbidities. Conclusion. In spite of the worse HLA matching, graft survival and function of renal grafts from spousal donors were as good as those retrieved from related donors.

Successful Male Rabbit Whole Kidney Decellularization For Tissue Engineering

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Naglaa Medhat Abou-Rabia ◽  
Gehan Khalaf Megahed ◽  
Sara Abdel Gawad Elsebay ◽  
Elsayed Ayat Abdelnaby
Keyword(s):  
Sodium Dodecyl ◽  
Complete Removal ◽  
Rabbit Kidney ◽  
Control Group ◽  
Post Transplantation ◽  
Male Rabbit ◽  
Group I ◽  
Transplantation Complications ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Renal transplantation represents the only cure for end stage renal disease. Shortage of donated organs, immune compatibility and post-transplantation complications urges the search for another radical and revolutionary treatment . Whole kidney decellularization is a promising technique, hopefully offering a threedimensional natural kidney scaffold for engineering a patient’s compatible kidney after recellularization with patient’s own cells. The current study aimed at successfully decellularizing the male rabbit kidney while preserving the histological profile of the kidney decellularized extracellular matrix. Materials and Methods Kidneys of ten male New Zealand White Rabbits weighing (1000- 1500 gm) were harvested and sorted into two groups. Control Group I included the ten right kidneys. Decellularization Group II included the ten left kidneys; harvested carefully and kept frozen until decellularization. They were decellularized using 0.5% sodium dodecyl sulfate for 5-6 hours. Kidneys from both groups were processed similarly for histological examination. Results Decellularized kidney Scaffolds showed complete removal of cellular materials. Meanwhile, the structural profile of the decellularized kidney scaffolds was apparently well preserved. Conclusion The current study yielded an efficient decellularization of male rabbit kidney paving the way for future kidney recellularization.

scholarly journals Living unrelated (commercial) renal transplantation in children.

1998 ◽  
Vol 9 (6) ◽  
pp. 1100-1103
Author(s):  
Y Frishberg ◽  
S Feinstein ◽  
A Drukker
Keyword(s):  
Renal Transplantation ◽  
Waiting Times ◽  
Graft Function ◽  
Best Interest ◽  
Cadaveric Renal Transplantation ◽  
Arab Children ◽  
Calculated Creatinine Clearance ◽  
Stage Renal Disease ◽  
End Stage

Long waiting times for cadaveric renal transplantation has led the frustrated parents of Arab children with end-stage renal disease treated in our center to seek commercial renal transplantation (CRT) outside Israel. During the past 3 yr, 18 children, aged 13 +/- 1 yr, underwent CRT in one center in Iraq. Post-CRT follow-up was 20.2 +/- 2.5 mo. Immediate complications (abroad) included: death on the day of surgery (n = 1) and vascular thrombotic events requiring removal of a previously functioning graft (n = 2). There was a high incidence of urologic problems, mainly as a result of inadequate uretero-vesical anastomosis. Calculated creatinine clearance at 6, 12, 18, 24, and 30 mo was 84.7 +/- 6.4, 91.0 +/- 6.8, 90.8 +/- 6.2, 82.5 +/- 9.5, and 77.7 +/- 8.2 ml/min per 1.73 m2 respectively, representing excellent graft function in 13 patients and slightly compromised function in two children. One- and two-year patient survival was 94.4%, with a graft survival of 83.3%. CRT in these Arab children had a favorable outcome despite severe early postoperative complications. Graft function at follow-up was comparable to cadaveric renal transplantation in Israel. This may reflect a propensity for healthy young adult donors. Despite these results, the authors oppose and discourage the practice of CRT on legal and ethical grounds. Not to provide follow-up care in this specific group of patients would not have been in their best interest.

scholarly journals Endovascular mechanical thrombectomy and stenting in a case of central vein thrombosis

2021 ◽  
Vol 14 (2) ◽  
pp. e236508
Author(s):  
Rajesh Vijayvergiya ◽  
Navjyot Kaur ◽  
Saroj K Sahoo ◽  
Ashish Sharma
Keyword(s):  
Mechanical Thrombectomy ◽  
Transluminal Angioplasty ◽  
Brachiocephalic Vein ◽  
Central Vein ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Vein Stenosis

Central vein stenosis and thrombosis are frequent in patients on haemodialysis for end-stage renal disease. Its management includes anticoagulation, systemic or catheter-directed thrombolysis, mechanical thrombectomy and percutaneous transluminal angioplasty (PTA). Use of mechanical thrombectomy in central vein thrombosis has been scarcely reported. We hereby report a case of right brachiocephalic vein thrombosis with underlying stenosis, which was successfully treated by mechanical thrombectomy followed by PTA and stenting. The patient had a favourable 10 months of follow-up.

Coronary sinus catalase and ceruloplasmin levels predict all-cause mortality in patients with end-stage heart failure awaiting heart transplantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W Szczurek ◽  
M Gasior ◽  
M Skrzypek ◽  
G Kubiak ◽  
A Kuczaj ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Coronary Sinus ◽  
Public Institution ◽  
Funding Source ◽  
Organ Shortage ◽  
Number Of Patients ◽  
End Stage ◽  
Medical University

Abstract   Background, As a consequence of the worldwide increase in life expectancy and due to significant progress in the pharmacological and interventional treatment of heart failure (HF), the proportion of patients that reach an advanced phase of disease is steadily growing. Hence, more and more numerous group of patients is qualified to the heart transplantation (HT), whereas the number of potential heart donors has remained invariable since years. It contributes to deepening in disproportion between the demand for organs which can possibly be transplanted and number of patients awaiting on the HT list. Therefore, accurate identification of patients who are most likely to benefit from HT is imperative due to an organ shortage and perioperative complications. Purpose The aim of this study was to identify the factors associated with reduced survival during a 1.5-year follow-up in patients with end-stage HF awating HT. Method We propectively analysed 85 adult patients with end-stage HF, who were accepted for HT at our institution between 2015 and 2016. During right heart catheterization, 10 ml of coronary sinus blood was additionally collected to determine the panel of oxidative stress markers. Oxidative-antioxidant balance markers included glutathione reductase (GR), glutathione peroxidase (GPx), glutathione transferase (GST), superoxide dismutase (SOD) and its mitochondrial isoenzyme (MnSOD) and cytoplasmic (Cu/ZnSOD), catalase (CAT), malondialdehyde (MDA), hydroperoxides lipid (LPH), lipofuscin (LPS), sulfhydryl groups (SH-), ceruloplasmin (CR). The study protocol was approved by the ethics committee of the Medical University of Silesia in Katowice. The endpoint of the study was mortality from any cause during a 1.5 years follow-up. Results The median age of the patients was 53.0 (43.0–56.0) years and 90.6% of them were male. All included patients were treated optimally in accordance with the guidelines of the European Society of Cardiology. Mortality rate during the follow-up period was 40%. Multivariate logistic regression analysis showed that ceruloplasmin (odds ratio [OR] = 0.745 [0.565–0.981], p=0.0363), catalase (OR = 0.950 [0.915–0.98], p=0.0076), as well as high creatinine levels (OR = 1.071 [1.002–1.144], p=0.0422) were risk factors for death during 1.5 year follow-up. Conclusions Coronary sinus lower ceruloplasmin and catalase levels, as well as higher creatinine level are independently associated with death during 1.5 year follow-up. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of SIlesia, Katowice, POland

scholarly journals Discontinuation of Passive Immunization Is Safe after Liver Transplantation for Combined HBV/HDV Infection

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 904
Author(s):  
Ramin Raul Ossami Saidy ◽  
Irina Sud ◽  
Franziska Eurich ◽  
Mustafa Aydin ◽  
Maximilian Paul Postel ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Overall Survival ◽  
Hepatitis B ◽  
Graft Function ◽  
Passive Immunization ◽  
Standard Regimen ◽  
Long Term Follow Up ◽  
Hdv Infection ◽  
End Stage

Patients after LT due to combined HBV/HDV infection are considered to be high-risk patients for recurrence of hepatitis B and D. To date, life-long prophylaxis with hepatitis B immunoglobulin (HBIG) and replication control with nucleos(t)ide analogs (NA) remains standard. We examined the course of 36 patients that underwent liver transplantation from 1989 to 2020 for combined HBV/HDV-associated end-stage liver disease in this retrospective study. Seventeen patients eventually discontinued HBIG therapy for various reasons. Their graft function, histopathological findings from routine liver biopsies and overall survival were compared with those that received an unaltered NA-based standard regimen combined with HBIG. The median follow-up was 204 and 227 months, respectively. The recurrence of HBV was 25% and did not differ between the groups of standard reinfection prophylaxis NA/HBIG (21.1%) and HBIG discontinuation (29.4%); (p = 0.56). No significant differences were found regarding the clinical course or histopathological aspects of liver tissue damage (inflammation, fibrosis, steatosis) between these two groups. Overall, and adjusted survival did not differ between the groups. Discontinuation of HBIG in stable patients after LT for combined HBV/HDV did not lead to impaired overall survival or higher recurrence rate of HBV/HDV infection in this long-term follow-up. Therefore, the recommendation of the duration of HBG administration must be questioned. The earliest time of discontinuation remains unclear.

scholarly journals Living Kidney Donation: Practical Considerations on Setting Up a Program

2021 ◽  
Vol 2 (1) ◽  
pp. 75-86
Author(s):  
Maria Irene Bellini ◽  
Vito Cantisani ◽  
Augusto Lauro ◽  
Vito D’Andrea
Keyword(s):  
Good Practice ◽  
Kidney Donation ◽  
Living Kidney Donation ◽  
Exchange Programs ◽  
Paired Exchange ◽  
Stage Renal Disease ◽  
End Stage ◽  
Additional Value ◽  
Work Up

Living kidney donation represents the best treatment for end stage renal disease patients, with the potentiality to pre-emptively address kidney failure and significantly expand the organ pool. Unfortunately, there is still limited knowledge about this underutilized resource. The present review aims to describe the general principles for the establishment, organization, and oversight of a successful living kidney transplantation program, highlighting recommendation for good practice and the work up of donor selection, in view of potential short- and long-terms risks, as well as the additional value of kidney paired exchange programs. The need for donor registries is also discussed, as well as the importance of lifelong follow up.

scholarly journals Vasculitis ANCA: Alternativas de tratamiento y las expectativas en los pacientes

2021 ◽  
pp. 1-2
Author(s):  
Carolina Aguilar-Martínez 
Keyword(s):  
Systematic Review ◽  
Cox Regression ◽  
Meta Analysis ◽  
Significant Risk ◽  
Limiting Factor ◽  
Significant Survival ◽  
Stage Renal Disease ◽  
End Stage ◽  
Immunosuppression Therapy

<b>Background:</b> The benefits of treating anti-neutrophil cytoplasmic autoantibody-associated vasculitis (AAV) in advancing age remains unclear with most published studies defining elderly as ≥65 years. This study aims to determine outcomes of induction immunosuppression in patients aged ≥75 years. <b>Methods:</b> A cohort of patients aged ≥75 years with a diagnosis of AAV between 2006 and 2018 was constructed from 2 centres. Follow-up was to 2 years or death. Analysis included multivariable Cox regression to compare mortality and end-stage renal disease (ESRD) based on receipt of induction immunosuppression therapy with either cyclophosphamide or rituximab. A systematic review of outcome studies was subsequently undertaken amongst this patient group through Pubmed, Cochrane and Embase databases from inception until October 16, 2019. <b>Results:</b> Sixty-seven patients were identified. Mean age was 79 ± 2.9 years and 82% (<i>n</i> = 55) received induction immunosuppression. Following systematic review, 4 studies were eligible for inclusion, yielding a combined total of 290 patients inclusive of our cohort. The aggregated 1-year mortality irrespective of treatment was 31% (95% CI 25–36%). Within our cohort, induction immunosuppression therapy was associated with a significantly lower 2-year mortality risk (hazard ratio [HR] 0.29 [95% CI 0.09–0.93]). The pooled HR by meta-analysis confirmed this with a significant risk reduction for death (HR 0.31 [95% CI 0.16–0.57], <i>I</i><sup>2</sup> = 0%). Treated patients had a lower pooled rate of ESRD, but was not statistically significant (HR 0.71 [95% CI 0.15–3.35]). <b>Conclusion:</b> This meta-analysis suggests that patients ≥75 years with AAV do benefit from induction immunosuppression with a significant survival benefit. Age alone should not be a limiting factor when considering treatment.

scholarly journals Conversion from calcineurin inhibitors to sirolimus of recipients with chronic kidney graft disease grade iii for a period 2003-2011

2013 ◽  
Vol 70 (9) ◽  
pp. 848-853 ◽  
Author(s):  
Ljiljana Ignjatovic ◽  
Rajko Hrvacevic ◽  
Dragan Jovanovic ◽  
Zoran Kovacevic ◽  
Neven Vavic ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Immunosuppressive Therapy ◽  
Graft Function ◽  
Solid Organ Transplantation ◽  
Calcineurin Inhibitors ◽  
Solid Organ ◽  
Kidney Graft ◽  
Group I ◽  
Grade Iii

Background/Aim. Tremendous breakthrough in solid organ transplantation was made with the introduction of calcineurin inhibitors (CNI). At the same time, they are potentially nephrotoxic drugs with influence on onset and progression of renal graft failure. The aim of this study was to evaluate the outcome of a conversion from CNIbased immunosuppressive protocol to sirolimus (SRL) in recipients with graft in chronic kidney disease (CKD) grade III and proteinuria below 500 mg/day. Methods. In the period 2003-2011 24 patients (6 famale and 18 male), mean age 41 ? 12.2 years, on triple immunosuppressive therapy: steroids, antiproliferative drug [mycophenolate mofetil (MMF) or azathiopirine (AZA)] and CNI were switched from CNI to SRL and followe-up for 76 ? 13 months. Nine patients (the group I) had early postransplant conversion after 4 ? 3 months and 15 patients (the group II) late conversion after 46 ? 29 months. During the regular outpatient controls we followed graft function through the serum creatinine and glomerular filtration rate (GFR), proteinuria, lipidemia and side effects. Results. Thirty days after conversion, in all the patients GFR, proteinuria and lipidemia were insignificantly increased. In the first two post-conversion months all the patients had at least one urinary or respiratory infection, and 10 patients reactivated cytomegalovirus (CMV) infection or disease, and they were successfully treated with standard therapy. After 21 ? 11 months 15 patients from both groups discontinued SRL therapy due to reconversion to CNI (10 patients) and double immunosuppressive therapy (3 patients), return to hemodialysis (1 patient) and death (1 patient). Nine patients were still on SRL therapy. By the end of the follow-up they significantly improved GFR (from 53.2 ? 12.7 to 69 ? 15 mL/min), while the increase in proteinuria (from 265 ? 239 to 530.6 ? 416.7 mg/day) and lipidemia (cholesterol from 4.71 ? 0.98 to 5.61 ? 1.6 mmol/L and triglycerides from 2.04 ? 1.18 to 2.1 ? 0.72 mmol/L) were not significant. They were stable during the whole follow-up period. Ten patients were reconverted from SRL to CNI due to the abrupt increase of proteinuria (from 298 ? 232 to 1639 ? 1641/mg day in 7 patients), rapid growth of multiple ovarian cysts (2 patients) and operative treatment of persisted hematoma (1 patient). Thirty days after reconversion they were stable with an insignificant decrease in GFR (from 56.10 ? 28.09 to 47 ? 21 mL/min) and significantly improved proteinuria (from 1639 ? 1641 to 529 ? 688 mg/day). By the end of the follow-up these patients showed nonsignificant increase in the serum creatinine (from 172 ? 88 to 202 ? 91 mmol/L), decrease in GFR (from 56.10 ? 28.09 to 47 ? 21 mL/day) and increased proteinuria (from 528.9 ? 688 to 850 ? 1083 mg/min). Conclusion. In this small descriptive study, conversion from CNI to SRL was followed by an increased incidence of infections and consecutive 25-50% dose reduction in the second antiproliferative agent (AZA, MMF), with a possible influence on the development of glomerulopathy in some patients, which was the major reason for discontinuation of SRL therapy in the 7 (29%) patients. Nine (37.5%) of the patients experienced the greatest benefit of CIN to SRL conversion without serious post-conversion complications.

Vascular access types in patients starting hemodialysis after failed kidney transplant: does close nephrology follow-up matter?

2016 ◽  
Vol 18 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Naveed Ul Haq ◽  
Mohamed Said Abdelsalam ◽  
Mohammed Mahdi Althaf ◽  
Abdulrahman Ali Khormi ◽  
Hassan Al Harbi ◽  
...  
Keyword(s):  
Vascular Access ◽  
Clinic Visit ◽  
Study Data ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Early Referral ◽  
Period Data ◽  
Stage Renal Disease ◽  
End Stage

Background Native arteriovenous fistulae (AVFs) are preferred while central venous catheters (CVCs) are least suitable vascular access (VA) in patients requiring hemodialysis (HD). Unfortunately, around 80% of patients start HD with CVCs. Late referral to nephrologist is thought to be a factor responsible for this. We retrospectively analyzed the types of VA at HD initiation in renal transplant recipients followed by nephrologists with failed transplant. If early referral to nephrologist improves AVF use, these patients should have higher prevalence of AVF at HD initiation. Methods All patients who failed their kidney transplants from January 2002 to April 2013 were included in the study. Data regarding planning of VA by nephrologist, documented discussion about renal replacement therapy (RRT), estimated glomerular filtration rate (eGFR) at 6 months and last clinic visit before HD initiation, time of VA referral, and subsequent VA at dialysis initiation were gathered and analyzed. Results Eighty-three patients failed their transplants during study period. Data were inaccessible in six patients. Eleven patients started peritoneal dialysis (PD) while 66 started HD. Thirty-two had previous functioning VA while 34 needed VA. There were 11/34 patients (32%) with eGFR <15 mL/min at six months while 21/34 (61%) had eGFR <15 mL/min at last clinic visit before HD initiation. Only 11/34 (32%) had documented RRT discussion, 8/34 (24%) had VA referral, and 7/34 (21%) had vein mapping. A total of 30/34 (88.3%) started HD with CVC while 4/34 (11.3%) started HD with AVF (p<0.0001). Conclusions Early referral to nephrologist by itself may not improve VA care amongst patient with end-stage renal disease.

scholarly journals Laparoscopic-Assisted Recipient Nephrectomy and Recipient Kidney Procurement during Orthotopic Living-Related Kidney Transplantation

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Dimitri Mikhalski ◽  
Karl Martin Wissing ◽  
Renaud Bollens ◽  
Daniel Abramowicz ◽  
Vincent Donckier ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Antiphospholipid Antibodies ◽  
Graft Function ◽  
Renal Vessels ◽  
Short Period ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage ◽  
Living Related ◽  
Laparoscopic Assisted

Advanced atherosclerosis or thrombosis of iliac vessels can constitute an absolute contraindication for heterotopic kidney transplantation. We report the case of a 42-year-old women with end-stage renal disease due to lupus nephritis and a history of bilateral thrombosis of iliac arteries caused by antiphospholipid antibodies. Occlusion had been treated by the bilateral placement of wall stents which precluded vascular anastomosis. The patient was transplanted with a right kidney procured by laparoscopic nephrectomy from her HLA semi-identical sister. The recipient had left nephrectomy after laparoscopical transperitoneal dissection. The donor kidney was orthotopically transplanted with end-to-end anastomosis of graft vessels to native renal vessels and of the graft and native ureter. Although, the patient received full anticoagulation because of a cardiac valve and antiphospholipid antibodies, she had no postoperative complication in spite of a short period of delayed graft function. Serum creatinine levels three months after transplantation were at 1.0 mg/dl. Our case documents that orthotopical transplantation of laparoscopically procured living donor kidneys at the site of recipient nephrectomy is a feasible procedure in patients with surgical contraindication of standard heterotopic kidney transplantation.

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