scholarly journals Trapianto renale da donatore vivente

2021 ◽  
Vol 33 ◽  
pp. 34-38
Author(s):  
Aris Tsalouchos ◽  
Maurizio Salvadori
Keyword(s):  
Kidney Failure ◽  
Living Donor ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Primary Hyperoxaluria ◽  
Kidney Donor ◽  
Living Kidney Donor ◽  
Uremic Syndrome ◽  
End Stage ◽  
Cadaveric Donors ◽  
Donor Transplant

Kidney transplant is the best therapy to manage end-stage kidney failure. The main barriers limiting this therapy are scarcity of cadaveric donors and the comorbidities of the patients with end-stage kidney failure, which prevent the transplant. Living kidney donor transplant makes it possible to obviate the problem of scarcity of cadaveric donor organs and also presents better results than those of cadaveric transplant. The principal indication of living kidney donor transplant is preemptive transplant. This allows the patient to avoid the complications of dialysis and it has also been demonstrated that it has better results than the transplant done after dialysis has been initiated. Priority indications of living donor transplant are also twins and HLA identical siblings. We also have very favorable conditions when the donor is young and male. On the contrary, the living donor transplant will have worse results if the donors are over 60-65 years and the recipients are young, and this can be a relative contraindication. There is an absolute contraindication for the living donation when the recipient has diseases with high risk of aggressive relapse in the grafts: focal and segmental hyalinosis that had early relapse in the first transplant; atypical hemolytic uremic syndrome due to deficit or malfunction of the complement regulatory proteins; early development of glomerulonephritis due to anti-glomerular basement membrane antibody in patients with Alport syndrome; primary hyperoxaluria. Extreme caution should also be taken in the evaluation of the kidney donors. The risks of developing renal failure or other complications are low if an adequate pre-donation evaluation has been made according to the international guidelines.

scholarly journals Has the UK living kidney donor population changed over time? A cross-sectional descriptive analysis of the UK living donor registry between 2006 and 2017

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e033906
Author(s):  
Phillippa K Bailey ◽  
Katie Wong ◽  
Matthew Robb ◽  
Lisa Burnapp ◽  
Alistair Rogers ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Kidney Failure ◽  
Living Donor ◽  
Kidney Donor ◽  
Living Kidney Donor ◽  
Cross Sectional ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
The Uk ◽  
Over Time

BackgroundA living-donor kidney transplant is the best treatment for most people with kidney failure. Population cohort studies have shown that lifetime living kidney donor risk is modified by sex, age, ethnicity, body mass index (BMI), comorbidity and relationship to the recipient.ObjectivesWe investigated whether the UK population of living kidney donors has changed over time, investigating changes in donor demographics.DesignWe undertook a cross-sectional analysis of the UK living kidney donor registry between January 2006 to December 2017. Data were available on living donor sex, age, ethnicity, BMI, hypertension and relationship to recipient.SettingUK living donor registry.Participants11 651 consecutive living kidney donors from January 2006 to December 2017.Outcome measuresLiving kidney donor demographic characteristics (sex, age, ethnicity, BMI and relationship to the transplant recipient) were compared across years of donation activity. Donor characteristics were also compared across different ethnic groups.ResultsOver the study period, the mean age of donors increased (from 45.8 to 48.7 years, p<0.001), but this change appears to have been limited to the White population of donors. Black donors were younger than White donors, and a greater proportion were siblings of their intended recipient and male. The proportion of non-genetically related non-partner donations increased over the 12-year period of analysis (p value for linear trend=0.002).ConclusionsThe increasing age of white living kidney donors in the UK has implications for recipient and donor outcomes. Despite an increase in the number of black, Asian and minority ethnic individuals waitlisted for a kidney transplant, there has been no increase in the ethnic diversity of UK living kidney donors. Black donors in the UK may be at a much greater risk of developing kidney failure due to accumulated risks: whether these risks are being communicated needs to be investigated.

Ethical Issues Surrounding High-Risk Kidney Recipients: Implications for the Living Donor

2007 ◽  
Vol 17 (3) ◽  
pp. 180-182 ◽  
Author(s):  
Jerome F. O'Hara ◽  
Katrina Bramstedt ◽  
Stewart Flechner ◽  
David Goldfarb
Keyword(s):  
Informed Consent ◽  
High Risk ◽  
Ethical Issues ◽  
Family Members ◽  
Transplant Recipients ◽  
Kidney Donor ◽  
Living Kidney Donor ◽  
Kidney Recipients ◽  
Medical Issues ◽  
Donor Transplant

Evaulating patients for living kidney donor transplantation involving a recipient with significant medical issues can create an ethical debate about whether to proceed with surgery. Donors must be informed of the surgical risk to proceed with donating a kidney and their decision must be a voluntary one. A detailed informed consent should be obtained from high-risk living kidney donor transplant recipients as well as donors and family members after the high perioperative risk potential has been explained to them. In addition, family members need to be informed of and acknowledge that a living kidney donor transplant recipient with pretransplant extrarenal morbidity has a higher risk of a serious adverse outcome event such as graft failure or recipient death. We review 2 cases involving living kidney donor transplant recipients with significant comorbidity and discuss ethical considerations, donor risk, and the need for an extended informed consent.

Metabolic Syndrome, a Real Barrier for Living Kidney Donor Transplant

2020 ◽  
Vol 52 (4) ◽  
pp. 1072-1076
Author(s):  
L.R. López y López ◽  
J. Martínez González ◽  
J. Bahena Méndez ◽  
D. Espinoza-Peralta ◽  
N.P. Campos Nolasco ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Kidney Donor ◽  
Living Kidney Donor ◽  
Donor Transplant

scholarly journals Evaluation of the Medically Complex Living Kidney Donor

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Yasar Caliskan ◽  
Alaattin Yildiz
Keyword(s):  
Living Donor ◽  
Viral Infections ◽  
Evaluation Process ◽  
Living Donors ◽  
Stone Disease ◽  
Organ Shortage ◽  
Kidney Donor ◽  
Living Kidney Donor ◽  
Living Donor Transplantation ◽  
History Of

Due to organ shortage and difficulties for availability of cadaveric donors, living donor transplantation is an important choice for having allograft. Live donor surgery is elective and easier to organize prior to starting dialysis thereby permitting preemptive transplantation as compared to cadaveric transplantation. Because of superior results with living kidney transplantation, efforts including the usage of “Medically complex living donors” are made to increase the availability of organs for donation. The term “Complex living donor” is probably preferred for all suboptimal donors where decision-making is a problem due to lack of sound medical data or consensus guidelines. Donors with advanced age, obesity, asymptomatic microhematuria, proteinuria, hypertension, renal stone disease, history of malignancy and with chronic viral infections consist of this complex living donors. This medical complex living donors requires careful evaluation for future renal risk. In this review we would like to present the major issues in the evaluation process of medically complex living kidney donor.

scholarly journals Acute Progression of Adult-Onset Atypical Hemolytic-Uremic Syndrome due to CFH Mutation: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Bartlomiej Posnik ◽  
Dorota Sikorska ◽  
Krzysztof Hoppe ◽  
Krzysztof Schwermer ◽  
Krzysztof Pawlaczyk ◽  
...  
Keyword(s):  
Hemolytic Uremic Syndrome ◽  
Late Onset ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Genetic Mutation ◽  
Current Data ◽  
Factor H ◽  
Rapid Progression ◽  
Uremic Syndrome ◽  
Stage Renal Disease ◽  
End Stage

Atypical hemolytic-uremic syndrome (aHUS), unlike typical HUS, is not due to bacteria but rather to an idiopathic or genetic cause that promotes dysregulation of the alternative complement pathway. It leads to hemolytic anemia, thrombocytopenia, and renal impairment. Although aHUS secondary to a genetic mutation is relatively rare, when occurring due to a mutation in Factor H (CFH), it usually presents with younger onset and has a more severe course, which in the majority ends with end-stage renal failure. Paradoxically to most available data, our case features acute aHUS due to a CFH mutation with late onset (38-year-old) and rapid progression to end-stage renal disease. Due to current data indicating a high risk of graft failure in such patients, the diagnosis of aHUS secondary to a genetic cause has disqualified our patient from a living (family) donor renal transplantation and left her with no other option but to begin permanent renal replacement therapy.

scholarly journals Lifetime end-stage kidney disease risk estimation in living kidney donor candidates remains a challenge

2017 ◽  
Vol 31 (1) ◽  
pp. 118-120 ◽  
Author(s):  
Darren Lee ◽  
John B. Whitlam ◽  
Natasha Cook ◽  
Momena Manzoor ◽  
Geoff Harley ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Disease Risk ◽  
Risk Estimation ◽  
Kidney Donor ◽  
End Stage Kidney Disease ◽  
Living Kidney Donor ◽  
End Stage

scholarly journals Atypical Hemolytic Uremic Syndrome Successfully Treated with Eculizumab

2020 ◽  
Vol 95 (2) ◽  
pp. 124-128
Author(s):  
Jung Hyun Kim ◽  
Won Kyung Han ◽  
Yu Bum Choi ◽  
Hyung Jong Kim ◽  
Jisu Oh ◽  
...  
Keyword(s):  
Hemolytic Uremic Syndrome ◽  
End Stage Renal Disease ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Delayed Diagnosis ◽  
Membrane Attack Complex ◽  
Acute Renal Injury ◽  
Humanized Monoclonal Antibody ◽  
Uremic Syndrome ◽  
Stage Renal Disease ◽  
End Stage

Atypical hemolytic uremic syndrome (aHUS) is a rare syndrome characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury, which results from uncontrolled complement activation. Delayed diagnosis and treatment of aHUS may result in end-stage renal disease (ESRD) and an associated dependence on dialysis. In extreme cases, it may cause death due to multi-organ failure. Eculizumab, a humanized monoclonal antibody against C5, inhibits the formation of the terminal membrane attack complex and is used to treat aHUS. Here, we report a 46-year-old male patient who suffered from aHUS relapse, despite prior treatment with repeated plasma exchange and hemodialysis. Eculizumab therapy improved his hematologic findings without use of hemodialysis.

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