scholarly journals Transplantation of expanded criteria kidney grafts to elderly recipients in the N.V. Sklifosovsky Research Institute for Emergency Medicine

2018 ◽  
Vol 10 (3) ◽  
pp. 175-184
Author(s):  
N. V. Shmarina ◽  
I. V. Dmitriev ◽  
B. Z. Khubutiya ◽  
A. V. Pinchuk
Keyword(s):  
Kidney Transplantation ◽  
Graft Loss ◽  
Survival Rates ◽  
Graft Function ◽  
Donor Organ ◽  
Group I ◽  
Function Recovery ◽  
Elderly Recipients ◽  
Organ Quality ◽  
Expanded Criteria

Introduction:The expansion of the criteria for donor organ retrieval contributes to an increase in the number of kidney transplantations to elderly recipients; but in view of reduced requirements to donor organ quality, a further analysis of transplantation outcomes is needed. The aim was to analyze and compare the outcomes of kidney transplantation to elderly patients depending on the donor organ quality.Material and methods.The study was based on the analysis of the kidney transplantation outcomes in 61 elderly recipients, including 51 transplantations performed from expanded criteria donors (group 1), and other 10 from standard donors (group 2). Based on clinical, laboratory, histological, and instrumental diagnostic data, we compared the graft function recovery rates, graft/recipient survival rates, the causes of graft loss in the early posttransplant period.Results:Patients of group I had significantly higher delayed graft function rates (37.3% vs. 10%), graft non-function rates (15.7% vs. 0%), and lower early posttransplant survival rates (72.5% vs. 100%). Graft function recovery rate was 58.8% in group I, and 100% in the patients of group II. The most common cause of the graft loss and the renal graft removals performed in the early posttransplant period was the poor graft quality due to the donor's existing pathology.Conclusion.The study demonstrated a statistically significant deterioration of the initial graft function, significantly increased graft non-function rates, and decreased graft survival rates in the early posttransplant period in the elderly recipients after kidney transplantation from expanded criteria donors.

scholarly journals Graft function and pregnancy outcomes after kidney transplantation

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Anke Schwarz ◽  
Roland Schmitt ◽  
Gunilla Einecke ◽  
Frieder Keller ◽  
Ulrike Bode ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Pregnancy Outcomes ◽  
Fetal Death ◽  
Graft Loss ◽  
Graft Function ◽  
Trial Registration ◽  
Control Group ◽  
Kaplan Meier ◽  
Egfr Decline

Abstract Background After kidney transplantation, pregnancy and graft function may have a reciprocal interaction. We evaluated the influence of graft function on the course of pregnancy and vice versa. Methods We performed a retrospective observational study of 92 pregnancies beyond the first trimester in 67 women after renal transplantation from 1972 to 2019. Pre-pregnancy eGFR was correlated with outcome parameters; graft function was evaluated by Kaplan Meier analysis. The course of graft function in 28 women who became pregnant after kidney transplantation with an eGFR of < 50 mL/min/1.73m2 was compared to a control group of 79 non-pregnant women after kidney transplantation during a comparable time period and with a matched basal graft function. Results Live births were 90.5% (fetal death n = 9). Maternal complications of pregnancy were preeclampsia 24% (graft loss 1, fetal death 3), graft rejection 5.4% (graft loss 1), hemolytic uremic syndrome 2% (graft loss 1, fetal death 1), maternal hemorrhage 2% (fetal death 1), urinary obstruction 10%, and cesarian section. (76%). Fetal complications were low gestational age (34.44 ± 5.02 weeks) and low birth weight (2322.26 ± 781.98 g). Mean pre-pregnancy eGFR was 59.39 ± 17.62 mL/min/1.73m2 (15% of cases < 40 mL/min/1.73m2). Pre-pregnancy eGFR correlated with gestation week at delivery (R = 0.393, p = 0.01) and with percent eGFR decline during pregnancy (R = 0.243, p = 0.04). Pregnancy-related eGFR decline was inversely correlated with the time from end of pregnancy to chronic graft failure or maternal death (R = -0.47, p = 0.001). Kaplan Meier curves comparing women with pre-pregnancy eGFR of ≥ 50 to < 50 mL/min showed a significantly longer post-pregnancy graft survival in the higher eGFR group (p = 0.04). Women after kidney transplantation who became pregnant with a low eGFR of > 25 to < 50 mL/min/1.73m2 had a marked decline of renal function compared to a matched non-pregnant control group (eGFR decline in percent of basal eGFR 19.34 ± 22.10%, n = 28, versus 2.61 ± 10.95%, n = 79, p < 0.0001). Conclusions After renal transplantation, pre-pregnancy graft function has a key role for pregnancy outcomes and graft function. In women with a low pre-pregnancy eGFR, pregnancy per se has a deleterious influence on graft function. Trial registration Since this was a retrospective observational case series and written consent of the patients was obtained for publication, according to our ethics’ board the analysis was exempt from IRB approval. Clinical Trial Registration was not done. The study protocol was approved by the Ethics Committee of Hannover Medical School, Chairman Prof. Dr. H. D. Troeger, Hannover, December 12, 2015 (IRB No. 2995–2015).

scholarly journals Kidney transplantation in Kazakhstan: the burden of organ shortage

2021 ◽  
Vol 23 (2) ◽  
pp. 36-40
Author(s):  
S. A. Abdugafarov ◽  
M. N. Assykbayev ◽  
D. J. Saparbay
Keyword(s):  
Kidney Transplantation ◽  
Kidney Disease ◽  
Kidney Transplant ◽  
Survival Rates ◽  
Graft Function ◽  
Deceased Donor ◽  
Organ Shortage ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
End Stage

Kidney transplantation has been the best replacement therapy for end-stage kidney disease for over 60 years. The Republican Coordination Center for Transplantation reports that as of January 29, 2020, there were 2675 people on the kidney transplant waiting list in the Republic of Kazakhstan. The issue of deceased donation in Kazakhstan is problematic for various reasons. Over the past couple of years, the already low rates of deceased donors have fallen by more than 2 times.Objective: to objectively assess the effectiveness of deceased-donor kidney transplant in order to indicate the need for development of cadaveric donation and reduce the number of patients in the transplant waitlist.Materials and methods. Fifty-two kidney transplants from a deceased donor were performed at the National Research Oncology Center (NROC) from 2010 to 2020. The age group of recipients ranged from 20 to 75 years old. In most cases, end-stage chronic renal failure resulted in chronic glomerulonephritis (76%), pyelonephritis (1.9%), polycystic kidney disease (9.6%) and diabetic nephropathy (11.5%).Results. The 1-year and 5-year survival rates were 96% and 86%, respectively. There was delayed graft function in 13 of cases. In one case (1.92%), there was intraoperative hyperacute rejection of the kidney transplant that could not be treated with high doses of glucocorticosteroids; the kidney graft was removed. Two patients (3.8%) in the early postoperative period, on days 2 and 7 after surgery, developed a clinic of acute renal transplant rejection; after the rejection crisis was stopped by drug therapy, graft function was restored. One patient (1.92%) died as a result of bilateral pneumonia, which led to sepsis and death.Conclusion. Graft and recipient survival rates after deceased-donor kidney are comparable to those after living-donor kidney transplantation. The solution to the problems of increasing the number of deceased organ transplants should not rest entirely on the shoulders of transplant doctors; this task must also be addressed at the government level with constant propaganda to explain to the citizens the need for a deceased organ donation program.

Kidney transplantation after rescue allocation—meticulous selection yields the chance for excellent outcome

2020 ◽  
Author(s):  
Volker Assfalg ◽  
Svea Misselwitz ◽  
Lutz Renders ◽  
Norbert Hüser ◽  
Alexander Novotny ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Patient Survival ◽  
Graft Function ◽  
Outcome Data ◽  
Organ Donors ◽  
Excellent Outcome ◽  
Expanded Criteria Donor ◽  
History Of ◽  
Criteria Catalogue ◽  
Expanded Criteria

Abstract Background The small number of organ donors forces transplant centres to consider potentially suboptimal kidneys for transplantation. Eurotransplant established an algorithm for rescue allocation (RA) of kidneys repeatedly declined or not allocated within 5 h after procurement. Data on the outcomes and benefits of RA are scarce to date. Methods We conducted a retrospective 8-year analysis of transplant outcomes of RA offers based on our in-house criteria catalogue for acceptance and decline of organs and potential recipients. Results RA donors and recipients were both older compared with standard allocation (SA). RA donors more frequently had a history of hypertension, diabetes or fulfilled expanded criteria donor key parameters. RA recipients had poorer human leucocyte antigen (HLA) matches and longer cold ischaemia times (CITs). However, waiting time was shorter and delayed graft function, primary non-function and biopsy-proven rejections were comparable to SA. Five-year graft and patient survival after RA were similar to SA. In multivariate models accounting for confounding factors, graft survival and mortality after RA and SA were comparable as well. Conclusions Facing relevant comorbidities and rapid deterioration with the risk of being removed from the waiting list, kidney transplantation after RA was identified to allow for earlier transplantation with excellent outcome. Data from this survey propose not to reject categorically organs from multimorbid donors with older age and a history of hypertension or diabetes to aim for the best possible HLA matching and to carefully calculate overall expected CIT.

Dispelling the myth of Asian homogeneity: Improved outcomes of Chinese Americans after kidney transplantation

2018 ◽  
Vol 3 ◽  
pp. 5-9
Author(s):  
Farah Karipineni ◽  
Afshin Parsikia ◽  
PoNan Chang ◽  
John Pang ◽  
Stalin Campos ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Patient Survival ◽  
Graft Loss ◽  
Graft Function ◽  
Chinese Americans ◽  
The United States ◽  
Chinese Patients ◽  
One Year ◽  
Patient And Graft Survival

Objectives: Asians represent the fastest growing ethnic group in the United States. Despite significant diversity within the group, many transplant studies treat Asians as a homogeneous entity. We compared patient and graft survival among major Asian eth- nicities to determine whether any subgroup has superior out- comes. Methods: We conducted a retrospective analysis of kidney trans- plants on Asian and White patients between 2001 and 2012. Co- variates included gender, age, comorbidities, and donor category. Primary outcomes included one-year patient and graft survival. Secondary outcomes included delayed graft function (DGF) and rejection as cause of graft loss and death. Results: Ninety-one Asian patients were identified. Due to the large proportion of Chinese patients (n=37), we grouped other Asians into one entity (n=54) for statistical comparison among Chinese, other Asians, and Whites (n=346). Chinese subjects had significantly lower body mass index (BMI) (p=0.001) and had the lowest proportion of living donors (p>0.001). Patient survival was highest in our Chinese cohort (p>0.001)Discussion: Our study confirms outcome differences among Asian subgroups in kidney transplantation. Chinese demonstrate better patient survival at one year than Whites and non-Chinese Asians despite fewer live donors. Lower BMI scores may partly explain this. Larger, long-term studies are needed to elucidate outcome disparities among Asian subgroups

scholarly journals Functional MRI detects perfusion impairment in renal allografts with delayed graft function

2015 ◽  
Vol 308 (12) ◽  
pp. F1444-F1451 ◽  
Author(s):  
Katja Hueper ◽  
Faikah Gueler ◽  
Jan Hinrich Bräsen ◽  
Marcel Gutberlet ◽  
Mi-Sun Jang ◽  
...  
Keyword(s):  
Renal Function ◽  
Kidney Transplantation ◽  
Functional Mri ◽  
Graft Loss ◽  
Graft Function ◽  
Resistance Index ◽  
Deceased Donor ◽  
Renal Perfusion ◽  
Delayed Graft Function ◽  
Renal Outcome

Delayed graft function (DGF) after kidney transplantation is not uncommon, and it is associated with long-term allograft impairment. Our aim was to compare renal perfusion changes measured with noninvasive functional MRI in patients early after kidney transplantation to renal function and allograft histology in biopsy samples. Forty-six patients underwent MRI 4–11 days after transplantation. Contrast-free MRI renal perfusion images were acquired using an arterial spin labeling technique. Renal function was assessed by estimated glomerular filtration rate (eGFR), and renal biopsies were performed when indicated within 5 days of MRI. Twenty-six of 46 patients had DGF. Of these, nine patients had acute rejection (including borderline), and eight had other changes (e.g., tubular injury or glomerulosclerosis). Renal perfusion was significantly lower in the DGF group compared with the group with good allograft function (231 ± 15 vs. 331 ± 15 ml·min−1·100 g−1, P < 0.001). Living donor allografts exhibited significantly higher perfusion values compared with deceased donor allografts ( P < 0.001). Renal perfusion significantly correlated with eGFR ( r = 0.64, P < 0.001), resistance index ( r = −0.57, P < 0.001), and cold ischemia time ( r = −0.48, P < 0.01). Furthermore, renal perfusion impairment early after transplantation predicted inferior renal outcome and graft loss. In conclusion, noninvasive functional MRI detects renal perfusion impairment early after kidney transplantation in patients with DGF.

scholarly journals Prediction of Kidney Transplant Outcome Based On Different DGF Definitions In Chinese Deceased Donation

2019 ◽  
Author(s):  
Xiao-jun Hu ◽  
Jin Zheng ◽  
Yang Li ◽  
Xiao-hui Tian ◽  
Pu-xun Tian ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Loss ◽  
Graft Function ◽  
Reduction Rate ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Transplant Outcome ◽  
Transplantation Surgery ◽  
Relationship Of

Abstract Background Delayed graft function (DGF) is an important complication of kidney transplantation and can be diagnosed according to different definitions. DGF has been proven to be associated with the long-term outcome of kidney transplantation surgery. However, the best DGF definition for predicting renal transplant outcomes in Chinese donations after cardiac death (DCDs) remains to be determined. Method A total of 182 DCD kidney transplants from January 2015 to December 2015 in the First Affiliated Hospital of Xi’an Jiaotong University were diagnosed with DGF according to 6 different DGF definitions. The relationship of the DGF definitions to the three-year graft loss (GL) and 12-month estimated glomerular filtration rate (eGFR) posttransplantation was compared. Results The incidence of DGF varied from 5.01% to 50.89% according to the different DGF diagnoses. All DGF definitions were significantly associated with three-year GL and had considerable predictive power for a poorer transplant outcome. None of the DGF definitions were significantly better than the dialysis-based DGF definition. Conclusion DGF was a independent risk factor for poorer transplant outcome. In the Chinese DCD population, no definitions were superior to the universally accepted one, namely, the need for hemodialysis in the first week posttransplantation. Combination of need for hemodialysis within the first week and 48h serum creatinine reduction rate has a better predictive value for graft loss.

Kidney Transplantation From Hepatitis B Surface Antigen (HBsAg)–Positive Living Donors to HBsAg-Negative Recipients: Clinical Outcomes at a High-Volume Center in China

2020 ◽  
Author(s):  
Xian-ding Wang ◽  
Jin-peng Liu ◽  
Tu-run Song ◽  
Zhong-li Huang ◽  
Yu Fan ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Hepatitis B ◽  
Surface Antigen ◽  
Hepatitis B Surface Antigen ◽  
Graft Loss ◽  
Graft Function ◽  
Living Donors ◽  
Hbv Dna ◽  
Control Group ◽  
Hbv Transmission

Abstract Background Data on kidney transplantation (KTx) from hepatitis B surface antigen (HBsAg)–positive (HBsAg+) donors to HBsAg-negative (HBsAg−) recipients [D(HBsAg+)/R(HBsAg-)] are limited. We aimed to report the outcomes of D(HBsAg+)/R(HBsAg−) KTx in recipients with or without hepatitis B surface antibody (HBsAb). Methods Eighty-three D(HBsAg+)/R(HBsAg−) living KTx cases were retrospectively identified. The 384 cases of KTx from hepatitis B core antibody–positive (HBcAb+) living donors to HBcAb-negative (HBcAb−) recipients [D(HBcAb+)/R(HBcAb−)] were used as the control group. The primary endpoint was posttransplant HBsAg status change from negative to postive (-− →+). Results Before KTx, 24 donors (28.9%) in the D(HBsAg+)/R(HBsAg−) group were hepatitis B virus (HBV) DNA positive, and 20 recipients were HBsAb−. All 83 D(HBsAg+)/R(HBsAg−) recipients received HBV prophylaxis, while no D(HBcAb+)/R(HBcAb−) recipients received prophylaxis. After a median follow-up of 36 months (range, 6–106) and 36 months (range, 4–107) for the D(HBsAg+)/R(HBsAg−) and D(HBcAb+)/R(HBcAb−) groups, respectively, 2 of 83 (2.41%) D(HBsAg+)/R(HBsAg−) recipients and 1 of 384 (0.26%) D(HBcAb+)/R(HBcAb−) became HBsAg+, accompanied by HBV DNA-positive (P = .083). The 3 recipients with HBsAg−→+ were exclusively HBsAb−/HBcAb− before KTx. Recipient deaths were more frequent in the D(HBsAg+)/R(HBsAg−) group (6.02% vs 1.04%, P = .011), while liver and graft function, rejection, infection, and graft loss were not significantly different. In univariate analyses, pretransplant HBsAb−/HBcAb− combination in the D(HBsAg+)/R(HBsAg−) recipients carried a significantly higher risk of HBsAg−→+, HBV DNA−→+, and death. Conclusions Living D(HBsAg+)/R(HBsAg−) KTx in HBsAb+ recipients provides excellent graft and patient survivals without HBV transmission. HBV transmission risks should be more balanced with respect to benefits of D(HBsAg+)/R(HBsAg−) KTx in HBsAb-/HBcAb− candidates.

scholarly journals Dual kidney transplantation offers a safe and effective way to use kidneys from deceased donors older than 70 years

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Kyo Won Lee ◽  
Jae Berm Park ◽  
So Ra Cha ◽  
Seo Hee Lee ◽  
Young Jae Chung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Transplantation ◽  
Serum Creatinine ◽  
Survival Rates ◽  
Donor Pool ◽  
Expanded Criteria ◽  
Deceased Donors ◽  
Expanded Criteria Donors ◽  
Single Kidney

Abstract Purpose Dual kidney transplantation (DKT) offers a way to extend the use of kidneys from expanded criteria donors (ECDs). Here, we compared the outcomes of DKT with those of single kidney transplantation from standard criteria donors (SCDs) and ECDs. Methods In 2014, we began performing DKT using both kidneys from deceased donors greater than 70 years of age with one of two risk factors: serum creatinine (sCr) level over 3.0 mg/dl or eGFR under 30 ml/min. By 2017, we had performed 15 DKTs. We compared the outcomes of the 15 DKT recipients with those of 124 patients who received a kidney from an SCD and 80 patients who received a kidney from an ECD. Results Compared with ECDs and SCDs, DKT donors were older, had a higher diabetes burden, and a higher sCr level (p < 0.01, < 0.01, and 0.03, respectively). DKT recipients were also older and had a higher diabetes burden than recipients of kidneys from ECDs and SCDs (p < 0.01, both). DKT recipients had a lower nadir sCr and shorter duration to nadir sCr than single ECD KT recipients (p < 0.01and 0.04, respectively). Conclusions The survival rates of DKT grafts were compatible with those of single KT grafts. Therefore, DKT may be considered a suitable an option to expand the donor pool.

Obesity: An Independent Predictor of Morbidity and Graft Loss after Kidney Transplantation

2020 ◽  
Vol 51 (8) ◽  
pp. 615-623 ◽  
Author(s):  
Fahad Aziz ◽  
Anand Ramadorai ◽  
Sandesh Parajuli ◽  
Neetika Garg ◽  
Maha Mohamed ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Serum Creatinine ◽  
Surgical Complications ◽  
Hospital Readmission ◽  
Cox Regression ◽  
Graft Loss ◽  
Graft Function ◽  
High Body Mass Index ◽  
Kidney Transplant Recipients ◽  
Grade Iii

Background: There is conflicting information on current medical and surgical complications associated with high body mass index (BMI) after kidney transplantation. Methods: In a single-center observational study, we analyzed the 5-year outcomes of all consecutive primary kidney transplant recipients between 2010 and 2015 based on BMI at the time of transplant. Results: There were 1,467 patients included in this study, distributed in the following groups based on BMI: underweight (n = 32, 2.2%), normal (n = 407, 27.7%), overweight (n = 477, 32.5%), grade I obesity (n = 387, 26.4%), grade II obesity (n = 155, 10.6%), and grade III obesity (n = 9, 0.6%). Obesity was associated with an increased incidence of delayed graft function (p = 0.008), length of stay (LOS, p = 0.03), 30-day surgical re-exploration (p = 0.02), and hospital readmission (p < 0.0001). Obesity was also associated with higher 1-year serum creatinine (p = 0.03) and increased 5-year incidence of cardiac events (p < 0.0001) and congestive heart failure (p < 0.0001). Multivariable Cox regression analyses determined grade III obesity (HR = 5.84, 95% CI: 1.40–24.36, p = 0.01), LOS >4 days (HR = 1.94, 95% CI: 1.19–3.18, p = 0.008), hospital readmission (HR = 2.25, 95% CI: 1.20–4.22, p = 0.01), 1-year serum creatinine >1.5 (HR = 1.95, 95% CI: 1.20–3.18, p = 0.007), and proteinuria (UPC) >1 g/g (HR = 1.85, 95% CI: 1.06–3.24, p = 0.03) as independent predictors of death-censored graft failure. Conclusion: In the current era of renal transplant care, obesity is common, and high BMI remains associated with significant medical and surgical complications after transplant.

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