scholarly journals Practices and Results of Two Years Service from a single UK Renal Transplant Center

2010 ◽  
Vol 49 (177) ◽  
Author(s):  
P C Shrestha ◽  
J Dominguez-Escrig ◽  
B Gowardhan ◽  
D Rix ◽  
D Talbot
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Graft Function ◽  
Rejection Rate ◽  
Definitive Treatment ◽  
Team Approach ◽  
Developed Country ◽  
Set Up ◽  
One Year ◽  
End Stage

INTRODUCTION: End stage renal failure is a common condition requiring renal replacement therapy in the form of haemodialysis or peritoneal dialysis as a short-term measure with renal transplantation as a more definitive treatment option. The aim of this study was to evaluate the set up of arenal transplant unit in a developed country and compare its results with other centers of the world. METHODS: A retrospective observational study was conducted to see the results of two years activities of a well known renal transplant unit in the United Kingdom. A description of the setup of a renal transplant unit has been made and its results have been discussed. RESULTS: Of the total patients, who had transplants in the renal transplant unit in year 2006 and 2007, 209 were renal, 14 were simultaneous kidneypancreas and two were pancreas after kidney transplants. Our one year graft survival rate was 93%, delayed graft function was 15%, early rejection rate was 11% and mortality rate was 3% in one year follow up. CONCLUSIONS: To attain good results in renal transplantation surgery, a multi-disciplinary team approach is crucial. Our set up is an example where the results are comparable to published and unpublished data from other established units world-wide. Keywords: complications, immunosuppression, renal transplant.

scholarly journals INFECTIONS DURING FIRST YEAR OF RENAL TRANSPLANTATION: ETIOLOGY, RISK FACTORS AND OUTCOME

2020 ◽  
pp. 1-3
Author(s):  
Amit Katyal ◽  
M.M. Bahadur
Keyword(s):  
Diabetes Mellitus ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Graft Function ◽  
Western World ◽  
First Year ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Major Infection ◽  
One Year

Background: Renal transplantation is the best treatment in managing end stage renal disease patients.However infections in these patients remain the leading cause of morbidity and mortality[1].Various factors like age, co-morbid infections like Hepatitis C infection and presence of Diabetes Mellitus,play a role in development of these infections.In developing country like ours, the spectrum of infection is likely to be different from the western world[2]. There is paucity of data on this aspect.There exists a conflict in literature regarding the predisposition to these infections and their impact on graft outcome. Aims & Objectives : This study proposes to analyse the predisposing factors,spectrum of infections in renal transplant recipients and their impact on graft function. Materials & Methods : Hundred renal transplant patients who received transplant between 01 Jan 2015 to Dec 2015 were prospectively followed for a period of one year for development of a major infection. All patients underwent thorough evaluation with complete blood count, urine and blood cultures, Radiological investigations and invasive investigations were done on case to case basis to achieve an etiological diagnosis. Special investigations were done when clinically indicated and infections were diagnosed based on established criteria. Those patients who had evidence of graft dysfunction were subjected to kidney biopsy.Descriptive analysis was done for all variables statistical analysis was done using paired/unpaired T test.A p value of < o.o5 was considered significant. Results: 68 patients (68%) had 138 episodes of infection (i.e. 2.02/patient)[3]. There were 42%episodes of bacterial infections,29% of viral infections,8.7% of fungal,7.1% tubercular and 14.4% had miscellaneous infection.There was no significant correlation between development of infection and variables like Diabetes Mellitus, age and HCV infection. There was significant increase in creatinine value at the end of one year,in the patients of infection(p value0.003),which on comparison with the non infected group was not significant(p >0.05). Conclusion: Nearly 68% of transplant recipients had an episode of major infection in the first year of transplantation.The majority of infection were bacterial(42%); and the dominant amongst them, was UTI. Graft survival was not inferior in these patients,at the end of one year.

Management of a ureteric stricture post ureteroileal anastomosis of a renal transplant

2021 ◽  
Vol 14 (6) ◽  
pp. e242763
Author(s):  
James P Ryan ◽  
Diarmuid Declan Sugrue ◽  
Niall F Davis ◽  
Ponnusamy Mohan
Keyword(s):  
Renal Transplant ◽  
Graft Function ◽  
Psoas Muscle ◽  
Team Approach ◽  
Tissue Mass ◽  
Urine Leak ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage ◽  
Living Related

A 58-year-old woman with a prior radical cystectomy and ileal conduit underwent a living-related donor renal transplant for end-stage renal disease secondary to autoimmune glomerulonephritis. She subsequently developed an ischaemic stricture of the transplant ureter. A successful ureteropyelostomy was performed with the native right ureter anastomosed to the pelvis of the renal transplant. She presented to the emergency department 18 months later feeling unwell and with raised inflammatory markers. Imaging demonstrated a large soft tissue mass over the right psoas muscle and hydronephrosis of the native right kidney. A nephrostomy and nephrostogram of the native right kidney diagnosed a urine leak from the native right kidney and she underwent an open right native nephrectomy. She recovered well postoperatively and continues to have excellent graft function. Renal transplantation in an abnormal urinary tract carries a high risk of complications. A multidisciplinary team approach is essential in offering the most appropriate treatment and ensuring good graft function is preserved.

scholarly journals Deceased Donor Renal Transplantation Combined with Bilateral Nephrectomy in a Patient with Tuberous Sclerosis and Renal Failure

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
R. Novotny ◽  
J. Chlupac ◽  
T. Marada ◽  
S. Bloudickova-Rajnochova ◽  
H. Vavrinova ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Tuberous Sclerosis ◽  
Kidney Transplant ◽  
Graft Function ◽  
Waiting List ◽  
Definitive Treatment ◽  
Kidney Graft ◽  
Bilateral Nephrectomy ◽  
Midline Laparotomy ◽  
The Right

Introduction. A 27-year-old female patient with known tuberous sclerosis complex (TSC), polycystic kidneys with multiple large bilateral angiomyolipomas, and failing renal functions with prehemodialysis values (urea: 19 mmol/L; creatinine: 317 μmol/L; CKD-EPI 0,27) was admitted to our department for pre-renal transplant evaluation. The patient was placed on the transplant waiting list as the living donor did not pass pretransplant workup and was subsequently contraindicated. Patient was placed on the “cadaverous kidney transplant waiting list”. Method. Computed tomography angiography revealed symptomatic PSA in the right kidney angiomyolipoma (AML). The patient underwent urgent transarterial embolisation of the PSA’s feeding vessel in the right kidney AML. Based on the “kidney transplant waiting list” order patient underwent a bilateral nephrectomy combined with transperitoneal renal allotransplantation of a cadaverous kidney graft through midline laparotomy, appendectomy, and cholecystectomy. Results. Postoperative period was complicated by delayed graft function caused by acute tubular necrosis requiring postoperative hemodialysis. The patient was discharged on the 17th postoperative day with a good renal graft function. Patient’s follow-up is currently 23 months with good graft function (urea: 9 mmol/L; creatinine: 100 μmol/L). Conclusion. Renal transplantation combined with radical nephrectomy provides a definitive treatment for TSC renal manifestations.

scholarly journals Improved survival with renal transplantation for end-stage renal disease due to granulomatosis with polyangiitis: data from the United States Renal Data System

2018 ◽  
Vol 77 (9) ◽  
pp. 1333-1338 ◽  
Author(s):  
Zachary S Wallace ◽  
Rachel Wallwork ◽  
Yuqing Zhang ◽  
Na Lu ◽  
Frank Cortazar ◽  
...  
Keyword(s):  
United States ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
End Stage Renal Disease ◽  
Granulomatosis With Polyangiitis ◽  
The United States ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Stage Renal Disease ◽  
End Stage

BackgroundRenal transplantation is the optimal treatment for selected patients with end-stage renal disease (ESRD). However, the survival benefit of renal transplantation among patients with ESRD attributed to granulomatosis with polyangiitis (GPA) is unknown.MethodsWe identified patients from the United States Renal Data System with ESRD due to GPA (ESRD-GPA) between 1995 and 2014. We restricted our analysis to waitlisted subjects to evaluate the impact of transplantation on mortality. We followed patients until death or the end of follow-up. We compared the relative risk (RR) of all-cause and cause-specific mortality in patients who received a transplant versus non-transplanted patients using a pooled logistic regression model with transplantation as a time-varying exposure.ResultsDuring the study period, 1525 patients were waitlisted and 946 received a renal transplant. Receiving a renal transplant was associated with a 70% reduction in the risk of all-cause mortality in multivariable-adjusted analyses (RR=0.30, 95% CI 0.25 to 0.37), largely attributed to a 90% reduction in the risk of death due to cardiovascular disease (CVD) (RR=0.10, 95% 0.06–0.16).DiscussionRenal transplantation is associated with a significant decrease in all-cause mortality among patients with ESRD attributed to GPA, largely due to a decrease in the risk of death to CVD. Prompt referral for transplantation is critical to optimise outcomes for this patient population.

scholarly journals Perioperative factors associated with delayed graft function in renal transplant patients

2018 ◽  
Vol 40 (4) ◽  
pp. 360-365
Author(s):  
Milton Halyson Benevides de Freitas ◽  
Luciana Cavalcanti Lima ◽  
Tania Cursino de Menezes Couceiro ◽  
Wilton Bernadino da Silva ◽  
João Marcelo de Andrade ◽  
...  
Keyword(s):  
Risk Factor ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Cold Ischemia Time ◽  
Cold Ischemia ◽  
Factors Associated ◽  
Combined Anesthesia ◽  
Anesthesia Technique

ABSTRACT Introduction: Successful renal transplant and consequent good graft function depend on a good surgical technique, an anesthetic that ensures the hemodynamic stability of the receiver, and appropriate conditions of graft and recipient. Several factors can interfere with the perfusion of the graft and compromise its viability. The objective of this study was to evaluate perioperative factors associated with delayed graft function (DGF) in renal transplantation patients. Methods: This is a historical cohort study of patients who underwent renal transplantation between 2011 and 2013. Three hundred and ten transplants were analyzed. DGF was defined as the need for dialysis during the first week post-transplant. Logistic regression with a stepwise technique was used to build statistical models. Results: Multivariate analysis revealed the following risk factor for DGF: combined anesthesia technique (OR = 3.81, 95%CI, 1.71 to 9.19), a fluid regimen < 50 mL·kg-1 (OR = 3.71, 95%CI, 1.68 to 8.61), dialysis for more than 60 months (OR = 4.77, 95%CI, 1.93 to 12.80), basiliximab (OR = 3.34, 95%CI, 1.14 to 10.48), cold ischemia time > 12 hour (OR = 5.26, 95%CI, 2.62 to 11.31), living donor (OR = 0.19, 95%CI, 0.02 to 0.65), and early diuresis (OR = 0.02, 95%CI, 0.008 to 0.059). The accuracy of this model was 92.6%, calculated using the area under the ROC curve. The incidence of DGF in the study population was 76.1%. Conclusions: Combined anesthesia technique, dialysis for more than 60 months, basiliximab, and cold ischemia time > 12 hours are risk factor for DGF, while liberal fluid regimens and kidneys from living donors are protective factors.

scholarly journals Anesthesia management of renal transplantation: A retrospective analysis

2021 ◽  
Vol 8 (2) ◽  
pp. 172-178
Author(s):  
Pradeep Tiwari ◽  
Aarti Kulkarni ◽  
Shraddha Mathkar
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Renal Disease ◽  
Retrospective Analysis ◽  
End Stage Renal Disease ◽  
Anesthesia Management ◽  
Co Morbidity ◽  
Stage Renal Disease ◽  
End Stage ◽  
Preoperative Patient

Transplantation provides a near normal life and excellent rehabilitation compared to dialysis and is preferred method of treatment for end stage renal disease patients. After ethics committee approval, a retrospective analysis of recipients of renal transplantation was done at our hospital from January 2010 to December 2014. Preoperative patient status, fluid management, hemodynamic parameters, anesthesia management, and perioperative complications were recorded and analyzed.Total 100 patients were recorded, 92% living and 8% were cadaveric related transplant. 92% were done electively. Most common co-morbidity recorded was hypertension in 49% patients. Predominant cause of end stage renal disease was chronic glomerulonephritis (41%). General anesthesia was technique of choice in all patients, 27 also received epidural. Invasive blood pressure monitoring was done in 3 patients with cardiac co-morbidities. 15% patients required blood transfusion. CVP maintained &#62; 12 mmHg and maximum at de-clamping. Mean arterial pressure maintained above 95 mmHg. Ionotropic support required in 2 patients. 76% patients were transfused with only crystalloid (NS and/or RL) while 24 patients received a combination of both crystalloid and colloid. 97% patients were extubated postoperatively while 3% required ventilator support. Recovery time with desflurane was significantly less as compared to other inhalational agents. One patient died postoperatively. Recent advances in surgical techniques, anesthesia management and immunosuppressive drugs have made renal transplantation safe and predictable. Preoperative patient optimization, intraoperative physiological stability and postoperative care of renal transplant patients have contributed to the success of renal transplant program in our hospital.

scholarly journals Electroconvulsive Therapy in a Renal Transplantation Patient: A Rare Combination of Disease and Treatment

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Giovanni Malaty ◽  
Kerilyn Godbe ◽  
Mehdi Elmouchtari ◽  
Gurjot Malhi ◽  
Justin White ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Renal Disease ◽  
Electroconvulsive Therapy ◽  
End Stage Renal Disease ◽  
Psychotic Symptoms ◽  
Safety And Efficacy ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage

The safety and efficacy of electroconvulsive therapy (ECT) for the treatment of psychiatric disorders have been demonstrated in a wide variety of patients, including postoperative patients and those who are pregnant. While several reports highlight the safety of this treatment in heart and liver transplantation patients, there is a relative lack of literature detailing the safety profile of ECT in an individual with recent kidney transplantation. Here, we explore the case of a patient with a recent renal transplant secondary to diabetes-related end-stage renal disease (ESRD) who underwent a successful course of ECT treatment. A 57-year-old Caucasian male with a past psychiatric history of schizoaffective disorder, bipolar type, and a past medical history of end-stage renal disease with recent right renal transplantation was admitted to the inpatient psychiatry unit. The admission was via a temporary detention order (TDO) for suicidality and auditory hallucinations promoting self-harm. The patient’s depressive and delusional history was well-documented and had been refractory to several courses of psychotherapeutic and pharmacologic management. Electroconvulsive therapy was subsequently initiated and was well-tolerated. Treatments progressively alleviated his depressive and psychotic symptoms and did not adversely affect the function of his transplanted kidney, which was closely monitored throughout the treatment process. This case demonstrated the safety and efficacy of ECT treatment in an individual with recent renal transplant and may prompt further trials into establishing safety and efficacy in larger study populations.

scholarly journals Clinical and genetic risk factors for new-onset diabetes mellitus after transplantation (NODAT) in major transplant centres in Malaysia

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Rhanye Mac Guad ◽  
Andrew W. Taylor-Robinson ◽  
Yuan Seng Wu ◽  
Siew Hua Gan ◽  
Nur Lisa Zaharan ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Blood Glucose ◽  
Renal Transplant ◽  
Fasting Blood Glucose ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Increased Risk ◽  
Daily Dose ◽  
One Year ◽  
New Onset

Abstract Background New-onset diabetes after transplantation (NODAT) is associated with reduced patient and graft survival. This study examined the clinical and selected genetic factors associated with NODAT among renal-transplanted Malaysian patients. Methods This study included 168 non-diabetic patients (58% males, 69% of Chinese ethnicity) who received renal transplantation between 1st January 1994 to 31st December 2014, and were followed up in two major renal transplant centres in Malaysia. Fasting blood glucose levels were used to diagnose NODAT in patients who received renal transplantation within 1 year. Two single nucleotide polymorphisms (SNPs), namely; rs1494558 (interleukin-7 receptor, IL-7R) and rs2232365 (mannose-binding leptin-2, MBL2) were selected and genotyped using Sequenom MassArray platform. Cox proportional hazard regression analyses were used to examine the risk of developing NODAT according to the different demographics and clinical covariates, utilizing four time-points (one-month, three-months, six-months, one-year) post-transplant. Results Seventeen per cent of patients (n = 29, 55% males, 69% Chinese) were found to have developed NODAT within one-year of renal transplantation based on their fasting blood glucose levels. NODAT patients had renal transplantation at an older age compared to non-NODAT (39.3 ± 13.4 vs 33.9 ± 11.8 years, p = 0.03). In multivariate analysis, renal-transplanted patients who received a higher daily dose of cyclosporine (mg) were associated with increased risk of NODAT (Hazard ratio (HR) =1.01 per mg increase in dose, 95% confidence interval (CI) 1.00–1.01, p = 0.002). Other demographic (gender, ethnicities, age at transplant) and clinical factors (primary kidney disease, type of donor, place of transplant, type of calcineurin inhibitors, duration of dialysis pre-transplant, BMI, creatinine levels, and daily doses of tacrolimus and prednisolone) were not found to be significantly associated with risk of NODAT. GA genotype of rs1494558 (HR = 3.15 95% CI 1.26, 7.86) and AG genotype of rs2232365 (HR = 2.57 95% CI 1.07, 6.18) were associated with increased risk of NODAT as compared to AA genotypes. Conclusion The daily dose of cyclosporine and SNPs of IL-7R (rs1494558) and MBL2 (rs2232365) genes are significantly associated with the development of NODAT in the Malaysian renal transplant population.

Sign in / Sign up

Export Citation Format

Share Document