scholarly journals Analysis of complications after living-related kidney transplantation: a single-center experience

2021 ◽  
Vol 13 (1) ◽  
pp. 63-73
Author(s):  
F. A. Khadjibaev ◽  
V. Kh. Sharipova ◽  
P. K. Sultanov
Keyword(s):  
Kidney Transplantation ◽  
Postoperative Complications ◽  
Renal Transplant ◽  
Graft Rejection ◽  
Hypovolemic Shock ◽  
Diagnosis And Treatment ◽  
Research Centre ◽  
Main Role ◽  
Renal Graft ◽  
Transplanted Kidney

Background. The one-year renal graft survival rates have grown to 93.4% for transplantation from cadaveric and 97.2% from living donors. Early detection and elimination of complications after kidney transplantation improve these figures.The study purpose was to develop an algorithm for the diagnosis and treatment tactics of postoperative complications after kidney transplantation by reviewing literature data and analyzing the results of our own experience.Material and methods. The study included 75 patients who underwent kidney transplantation from a living donor at the Republican Research Centre of Emergency Medicine from March 2018 to December 2019.Results. The original authors' algorithm developed for the diagnosis and treatment of complications after kidney transplantation covers all postoperative complications that lead to renal transplant dysfunction. It is based on assessing the symptoms that typically occur in a specific complication. The main instrumental methods in the diagnosis of postoperative complications are ultrasound and radiological investigational techniques. The biopsy has the main role in diagnosing a graft rejection. Among 75 patients after kidney transplantation, 23 (30.6%) developed various early postoperative complications, including both surgical and immunological ones. Renal graft dysfunction was eliminated in 17 (73.9%) of 23 patients. The loss of a transplanted kidney was associated with the death of 7 recipients (9.3%). The causes of death were pulmonary embolism in 2 (2.7%) cases, infection and sepsis as a result of immunosuppression in 2 (2.7%) cases, hypovolemic shock in 2 (2.7%) cases, and acute ischemic stroke in 1 (1.3%) case. Two recipients underwent renal transplant nephrectomy. The cause of nephrectomy was graft rejection and bleeding from the renal artery. A oneyear survival rate was 90.7%. The proposed treatment and diagnostic algorithm showed a 95.7% diagnostic value in identifying the complications, and 91.3% of the therapeutic effect in coping with a renal transplant dysfunction.Conclusions. Early treatment of revealed complications allows saving the transplanted kidney function. Step-bystep differential diagnosis of complications after kidney transplantation, according to the proposed algorithm, allows choosing the treatment tactics based on complication pathogenesis.

Enhancement of Apoptosis-Related Gene Expression in Human Renal Graft Rejection

2000 ◽  
Vol 6 (S2) ◽  
pp. 626-627
Author(s):  
P. Y. Lau ◽  
J. Papadimitriou ◽  
C. Drachenberg ◽  
M. R. Weir ◽  
C. Wei
Keyword(s):  
Gene Expression ◽  
Kidney Transplantation ◽  
Graft Rejection ◽  
Human Kidney ◽  
Renal Tissue ◽  
Related Gene ◽  
Renal Graft ◽  
Normal Human ◽  
Apoptosis Related Gene ◽  
Renal Graft Rejection

Apoptosis or programmed cell death is involved in many diseases include end-stage renal failure. Apoptosis-related genes include both stimulate genes and inhibitory gene of apoptosis. The genes which stimulate apoptosis include p53 and p21-WAF. The genes which inhibit apoptosis include bcl-2 gene family. The mechanisms of apoptosis include p53-dependend pathway and p53- independent pathway. We hypothesized that apoptosis-related genes may activate in renal graft rejection after kidney transplantation. Therefore, the present study was designed to investigate apoptosis-related gene expression and localization by immunohistochemical staining (IHCS) in human renal tissues with graft rejection and compare with that in normal human renal tissue.Human renal biopsy (n=5) were obtained after kidney transplantation with mild and moderate renal rejection. Normal human kidney biopsy was obtained during nephrectomy. P53, p21-WAF and Bcl-2 levels in renal tissue were determined by IHCS. The results of IHCS was evaluated by IHCS staining density scores (0, no staining; 1, minimal staining; 2, mild staining; 3, moderate staining; and 4, strong staining).

scholarly journals Diagnostic Role of Dopplerography of Renal Vessels in Patients with Late Dysfunction of the Transplanted Kidney

2021 ◽  
pp. 203-208
Author(s):  
Yakymenko Volodymyr Viktorovych
Keyword(s):  
Blood Flow ◽  
Kidney Transplantation ◽  
Renal Transplant ◽  
Glomerular Filtration ◽  
Non Invasive ◽  
Transplanted Kidney ◽  
Renal Vessels ◽  
Diagnostic Role ◽  
Cadaveric Kidney

Aims: Search for non-invasive methods for diagnosing late transplant kidney dysfunction, which can improve control and monitor the condition of the kidney transplant, characterization diagnostic role of dopplerography of renal vessels in patients with late dysfunction of the transplanted kidney. Study design:  When conducting dopplerometry, blood flow indices were analyzed from 3 to 6 cycles of heart contractions, followed by an averaged indicator. In addition, the linear blood flow velocity was assessed separately from the renal vein. Place and Duration of Study: For the period 2016-2017 Ultrasound of an allopod was performed in 60 recipients of RT (RENAL TRANSPLANT) in the late postoperative period. Methodology: The average age of the patients was 38.89 ± 1.52 years. There were 34 men (56.6 7%), 26 women (43.33%). All patients were divided into two groups: patients with preserved function and patients with RT (RENAL TRANSPLANT) dysfunction. Related kidney transplantation (RRT) was performed in 55.0% of patients, in 45.0% - cadaveric kidney transplantation (CKP). The groups were comparable in the main clinical and demographic parameters. Results: The reverse dynamics was observed when examining the level of the renal filtration function indicator, the estimated glomerular filtration rate (SKF) - at a TAMX level of more than 15 cm/sec, glomerular filtration was 51.18 ± 1.93 (47.32-55.04) ml/min (p <0.01), and with a decrease in TAMX of less than 15 cm/sec, the level of SKF decreased significantly, more than twice, to the level of 25.40 ± 2.19 (21.02-29.78) ml/min <0.001). Conclusion: The determination of dopplerographic parameters for TP with preserved and especially with impaired depuration function with a direct assessment of TAMX opens up wide opportunities in non-invasive assessment of RT (RENAL TRANSPLANT) changes, identification of developing complications, as well as improved transplant survival.

Enhancement of Natriuretic Peptides in Rejected Human Renal Graft

2000 ◽  
Vol 6 (S2) ◽  
pp. 602-603
Author(s):  
H. Song ◽  
J. Papadimitriou ◽  
C. Drachenberg ◽  
M. R. Weir ◽  
C. Wei
Keyword(s):  
Kidney Transplantation ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Graft Rejection ◽  
Tissue Level ◽  
Renal Tissue ◽  
Compensatory Mechanism ◽  
Renal Vasoconstriction ◽  
Renal Graft ◽  
Renal Graft Rejection

Natriuretic peptides include atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and C-type natriuretic peptide (CNP). ANP, BNP and CNP are structure related but genetic distinct 1 natriuretic peptide family. ANP and BNP are cardiac cell origin and CNP are endothelial cell and kidney origin. Natriuretic peptides have potent vasoactive and natriuretic actions through generation of cGMP. On the other hand, renal graft rejection is major problem after kidney transplantation with severe renal damage and renal vasoconstriction. We hypothesized that renal tissue level of natriuretic peptides increase in renal graft rejection through compensatory mechanism. Therefore, the present study was designed to determine the expression of natriuretic peptides by immunohistochemical staining (IHCS) in human renal tissue with rejection and compare with normal renal tissue.Human renal biopsy (n=5) were obtained after kidney transplantation with mild and moderate renal rejection. Normal kidney biopsy was obtained during nephrectomy. ANP, BNP and CNP levels in renal tissue were determined by IHCS.

Increasing Nitric Oxide Synthase in Human Renal Graft Rejection after Kidney Transplantation

2000 ◽  
Vol 6 (S2) ◽  
pp. 616-617
Author(s):  
K. Seta ◽  
J. Papadimitriou ◽  
C. Drachenberg ◽  
M. R. Weir ◽  
C. Wei
Keyword(s):  
Nitric Oxide ◽  
Kidney Transplantation ◽  
Nitric Oxide Synthase ◽  
Graft Rejection ◽  
Renal Damage ◽  
Renal Tissue ◽  
Renal Vasoconstriction ◽  
Renal Graft ◽  
Oxide Synthase ◽  
Renal Graft Rejection

Nitric oxide (NO) is a potent endothelial-drived vasorelaxing factor and may involved in salt sensitive hypertension and renal damage. Nitric oxide is produced from L-arginine by activation of nitric oxide synthase (NOS). Three NOS has been identified which are brain NOS (bNOS), inducible NOS (iNOS) and endothelial NOS (eNOS). On the other hand, renal graft rejection is major problem after kidney transplantation with severe renal damage and renal vasoconstriction. While NOS has been reported localized in human and animal kidney, the status of three NOS in human renal tissue with rejection remains poorly defined. Therefore, the present study was designed to determine the expression of bNOS, iNOS and eNOS by immunohistochemical staining (IHCS) in human renal tissue with rejection and compared with that in normal human renal tissue.Human renal biopsy (n=5) were obtained after kidney transplantation with mild and moderate renal rejection. Normal kidney biopsy was obtained during nephrectomy.

Thrombotic microangiopathy after kidney transplantation: causes, clinical specifics and outcomes

2020 ◽  
Vol 48 (3) ◽  
pp. 177-186
Author(s):  
E. I. Prokopenko ◽  
E. O. Shcherbakova ◽  
R. O. Kantaria ◽  
V. A. Stepanov
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplant ◽  
Graft Survival ◽  
Thrombotic Microangiopathy ◽  
De Novo ◽  
Renal Transplant Recipients ◽  
Post Transplant ◽  
Antibody Mediated Rejection ◽  
Renal Graft ◽  
Kidney Transplantations

Background: Thrombotic microangiopathy (TMA) is a clinical and morphological phenomenon characterized by specific microvascular injury, microangiopathic hemolytic anemia, and damage of various target organs. TMA after kidney transplantation (post-renal transplant TMA) is a serious complication affecting the recipient and graft survival.Aim: To analyze the timing, causes, specifics of the clinical course and outcomes of TMA in renal transplant recipients.Materials and methods: This one-center study was based on a comprehensive examination and follow-up of 697 patients who had undergone 728 kidney transplantations (KT) from deceased donors in 2003–2019. Post-transplant TMA of the renal graft was confirmed morphologically in all cases.Results: We identified 32 episodes of post-transplant TMA in 32 patients; thus, the incidence of TMA was 4.4%. All cases developed after KT de novo; no recurrent TMA was observed. TMA was systemic in 37.5% and locally renal in 62.5% of the patients. The median time to the development of post-transplant TMA was 0.55 (range, 0.1 to 51.6) months. The patients with TMA did not differ from those without by gender, age, body mass index, underlying disorders, type and duration of dialysis before KT, protocols of immunosuppressive therapy, incidence of surgical, urological, infectious, cardiovascular and oncological complications. The patients with TMA were significantly more likely to have graft rejection (25.0% vs 11.2%, p = 0.035) and a never-functioning transplant (28.1% vs 4.9%, p < 0.001). The presence of TMA negatively affected the transplantation outcomes. The cumulative 1-year graft survival in the patients without and with TMA was 91% and 44%, respectively, whereas their 5-year survival rates were 68% and 25% (p < 0.001). The leading causes of TMA were: donor pathology (31.2%), antibody-mediated rejection (28.1%), and cyclosporine/tacrolimus nephrotoxicity (21.9%); the proportion of other causes was 18.8%. A combination of TMA etiological factors was identified in 68.7% of the recipients. The recipients with of calcineurin inhibitors nephrotoxicity had a more favorable prognosis compared to those with other causes of TMA.Conclusion: Post-renal transplant TMA is an infrequent but serious complication that worsens the graft survival and often is life-threatening for recipients. In most cases, TMA develops in the early post-operative period; however, it can occur any time thereafter. To improve the outcome of TMA, early diagnosis is necessary based on clinical suspicion and a prompt biopsy of the renal graft with suspected TMA. Treatment should be started quickly with consideration of the cause of the complication.

scholarly journals Polyomaviruria in Renal Transplant Patients Is Not Correlated to the Cold Ischemia Period or to Rejection Episodes

2000 ◽  
Vol 38 (1) ◽  
pp. 406-407
Author(s):  
P. Priftakis ◽  
G. Bogdanovic ◽  
G. Tyden ◽  
T. Dalianis
Keyword(s):  
Renal Transplant ◽  
Graft Rejection ◽  
Cold Ischemia ◽  
Renal Graft ◽  
Transplant Patients ◽  
Renal Grafts ◽  
Renal Transplant Patients ◽  
Cadaver Donor

ABSTRACT Polyomaviruria was observed in one-third of all renal transplant patients, irrespective of whether their renal grafts came from a living or cadaver donor, and was not correlated to graft rejection episodes. This suggests that the renal graft ischemia period is not the major cause of polyomavirus reactivation and that reactivation of polyomavirus is not a dominant cause of graft rejection.

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 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.

scholarly journals Development of strangulation ileus associated with the ureter of the transplanted kidney 18 years after kidney transplantation

2021 ◽  
Author(s):  
Toshihiro Shimizu ◽  
Saki Katano ◽  
Sho Nishida ◽  
Yoshitaka Kinoshita ◽  
Takahiro Shinzato ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Transplanted Kidney ◽  
Strangulation Ileus
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