Vascular Access Perspectives in Patients After Kidney Transplantation

Introduction: More attention has been paid to the influence of arteriovenous fistula (AVF) on the cardiovascular system. In renal transplant recipients, some beneficial effect of an elective vascular access (VA) ligation was observed in patients with a high AVF flow. However, this strategy is not widely accepted and is in contradiction to the rule of vasculature preservation for possible future access. The aim of our study is to elucidate the vascular access function and VA perspective in the kidney transplantation (KTx) population.Materials and Methods: KTx patients with a stable graft function were recruited to participate in this single center observational study (NCT04478968). The measurement of VA flow and vessel mapping for future vascular access was performed by a color Doppler ultrasound. The study group included 99 (63%) males and 58 (37%) females; the median age was 57 (IQR 48–64) years. The median time from the transplantation to the baseline visit was 94 (IQR 61–149) months. Median serum creatinine concentration was 1.36 (IQR 1.13–1.67) mg/dl.Results: Functioning VA was found in 83 out of 157 (52.9%) patients. The sites were as follows: snuffbox in six (7.2%), wrist in 41 (49.4%), distal forearm in 18 (21.7%), middle or proximal forearm in eight (9.6%), upper-arm AV graft in one (1.2%), and upper-arm AVFs in nine (10.8%) patients, respectively. Blood flow ranged from 248 to 7,830 ml/min; the median was 1,134 ml/min. From the transplantation to the study visit, 66 (44.6%) patients experienced access loss. Spontaneous thrombosis was the most common, and it occurred in 60 (90.9%) patients. The surgical closure of VA was performed only in six (4%) patients of the study group with a functioning VA at the time of transplantation. Access loss occurred within the 1st year after KTx in 33 (50%) patients. Majority (50 out of 83, 60.2%) of the patients with an active VA had options to create a snuffbox or wrist AVF on the contralateral extremity. In a group of 74 patients without a functioning VA, the creation of a snuffbox or wrist AVF on the non-dominant and dominant extremity was possible in seven (9.2%) and 40 (52.6%) patients, respectively. In 10 (13.1%) patients, the possibilities were limited only to the upper-arm or proximal forearm VA on both sides. Access ligation was considered by 15 out of 83 (18.1%) patients with a patent VA.Conclusions: In the majority of the patients, vascular access blood flow was below the threshold of the negative cardiovascular effect of vascular access. Creation of a distal AVF is a protective measure to avoid a high flow and preserve the vessels for future access. The approach to VA should be individualized and adjusted to the patient's profile.

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Characteristics of B-lymphocyte subpopulations in renal transplant recipients

Transplantologiya The Russian Journal of Transplantation ◽

10.23873/2074-0506-2021-13-2-141-150 ◽

2021 ◽

Vol 13 (2) ◽

pp. 141-150

Author(s):

S. V. Zybleva ◽

S. L. Zyblev

Keyword(s):

Kidney Transplantation ◽

B Lymphocytes ◽

B Lymphocyte ◽

Graft Function ◽

Lymphocyte Subpopulations ◽

Cell Subpopulation ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Graft Dysfunction ◽

Allograft Function

Introduction. The presence of multiple subsets of B-cells with specific regulatory functions capable of modulating inflammatory responses havebeen detected. Most of the studies of Bregs function were carried out in the context of autoimmune and infectious diseases, whereas the objective of this research was to study the characteristics of the main, activated and tolerogenic subpopulations of B lymphocytes in patients who underwent kidney transplantation. Objective. To study the indices of B-lymphocyte subpopulations and determine their role in the development of immunological tolerance after kidney transplantation.Material and methods. We have examined 197 recipients who underwent kidney transplantation. We determined B lymphocyte subpopulation levels (CD19+IgD+CD27+ and CD19+IgD-CD27+) before transplantation, on the 1st, 3rd, 7th and 30th days after the transplantation. Allograft function was assessed on day 7 with the division of patients into two groups: with primary graft function and graft dysfunction.Results and discussion. Significant differences were revealed between the groups of recipients over three months in the following cell subpopulation levels CD19+IgD+CD27+ and CD19+IgD-CD27+. During the first 7 days, lower levels of these subpopulations were associated with satisfactory allograft function. However, by the 90th day after surgery, an increase in CD19+IgD+CD27+ B lymphocytes was noted in the group of patients with graft dysfunction.Conclusions. Low levels of not-switched (CD19+IgD+CD27+) and switched (CD19+IgD-CD27+) memory В lymphocytes in the peripheral blood of kidney transplant recipients are associated with a favorable postoperative course. We have found that on the 3rd post-transplant day, the relative level of non-switched memory B lymphocytes (CD19+IgD+CD27+) exceeding or equal to 11.47%, and the level of switched memory B lymphocytes (CD19+IgD-CD27+) exceeding or equal to 20.74% might predict the development of early renal graft dysfunction with a sensitivity and specificity of 88.40% and 84.30% for the former parameter and of 88.70% and 82.40% for the latter one, respectively.

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Evaluation of vascular access before kidney transplantation in patients with successful kidney transplantation

Journal of Renal Injury Prevention ◽

10.15171/jrip.2019.10 ◽

2018 ◽

Vol 8 (1) ◽

pp. 50-53

Author(s):

Mohsen Mohammad Rahimi ◽

Mansour Alizadeh ◽

Nima Naghdi-seded ◽

Rohollah Valizadeh ◽

Amir Jamei ◽

...

Keyword(s):

Heart Failure ◽

Blood Flow ◽

Kidney Transplantation ◽

Kidney Transplant ◽

Vascular Access ◽

Historical Cohort ◽

Related Information ◽

The Status ◽

Successful Transplantation ◽

Low Incidence

Introduction: The status of embedded fistula before kidney transplant is one of the problems in patients after kidney transplant and without correct management, surely it can lead to severe complications. The vascular access of arteriovenous fistula (AVF) and its possible complications can be found using the registered data in patients who had undergone successful kidney transplant. This information may be useful to prevent possible complications in future. Objectives: This study was aimed to determine the status of vascular access before kidney transplant in patients with successful transplantation in Urmia city, Iran. Patients and Methods: This study was a historical cohort conducted on 201 patients from March 2009 to March 2012 who had undergone vascular access before kidney transplant. The related information about complications and functions of fistula were extracted from available records. Results: According to results, the patients were divided into four groups regarding fistula function including 104 patients (51.7%) with functional fistula after kidney transplant, 49 patients (24.4%) with spontaneously closed fistula, 37 patients (18.4%) with closed fistula through surgery and 11 patients (5.5%) with reduced blood flow of fistula. Conclusion: Despite the low incidence of heart failure in functional vascular access after successful renal transplantation, these patients should be followed up by cardiologists to avoid complications. Generally, closing vascular accesses after successful transplantation is not necessary.

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Urinary NGAL Ratio Is Not a Sensitive Biomarker for Monitoring Acute Tubular Injury in Kidney Transplant Patients: NGAL and ATI in Renal Transplant Patients

Journal of Transplantation ◽

10.1155/2012/563404 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

Jessica K. Kaufeld ◽

Wilfried Gwinner ◽

Irina Scheffner ◽

Hermann G. Haller ◽

Mario Schiffer

Keyword(s):

Kidney Transplantation ◽

Renal Transplant ◽

Clinical Laboratory ◽

Graft Function ◽

Renal Transplant Recipients ◽

Urinary Ngal ◽

Tubular Injury ◽

Icu Patients ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Transplant Patients

Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is known to predict the prolonged delayed graft function after kidney transplantation. We examined the relation of uNGAL with histological findings of acute tubular injury (ATI). Analyses were made in biopsies taken at 6 weeks, 3 months, and 6 months after kidney transplantation. uNGAL was measured in the spot urines, normalized to urinary creatinine excretion, and correlated to biopsy findings and clinical, laboratory, and demographic variables. Controls included healthy individuals, individuals after kidney donation and ICU patients with acute kidney failure. Renal transplant recipients without ATI did not display elevated uNGAL levels compared to the healthy controls. Transplant patients with ATI had a higher uNGAL excretion at 6 weeks than patients without ATI (27,435 versus 13,605 ng/g;P=0.031). This increase in uNGAL was minor compared to ICU patients with acute renal failure (2.05×106 ng/g). Patients with repeated findings of ATI or severe ATI did not have higher urinary NGAL levels compared to those with only one ATI finding or moderate ATI. Female recipient gender and urinary tract infection were identified as potential confounders. uNGAL has a relation with histological signs of acute tubular injury. The usability of this biomarker in renal allograft recipients is limited because of the low sensitivity.

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Elevated plasma free thiols are associated with early and one-year graft function in renal transplant recipients

PLoS ONE ◽

10.1371/journal.pone.0255930 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255930

Author(s):

Marie B. Nielsen ◽

Bente Jespersen ◽

Henrik Birn ◽

Nicoline V. Krogstrup ◽

Arno R. Bourgonje ◽

...

Keyword(s):

Oxidative Stress ◽

Kidney Transplantation ◽

Plasma Levels ◽

Graft Function ◽

Renal Transplant Recipients ◽

Kidney Graft ◽

Ischaemia Reperfusion Injury ◽

Free Thiol ◽

One Year ◽

Randomised Controlled

Background Reduced free thiols in plasma are indicative of oxidative stress, which is an important contributor to ischaemia-reperfusion injury (IRI) in kidney transplantation leading to kidney damage and possibly delayed graft function (DGF). In a post-hoc, exploratory analysis of the randomised controlled CONTEXT trial, we investigated whether higher (i.e. less oxidised) plasma levels of free thiols as a biomarker of reduced oxidative stress are associated with a better initial graft function or a higher GFR. Methods Free thiol levels were measured in plasma at baseline, 30 and 90 minutes after reperfusion of the kidney as well as at Day 1, Day 5 and twelve months after kidney transplantation in 217 patients from the CONTEXT study. Free thiol levels were compared to the kidney graft function measured as the estimated time to a 50% reduction in plasma creatinine (tCr50), the risk of DGF and measured GFR (mGFR) at Day 5 and twelve months after transplantation. Results Higher levels of free thiols at Day 1 and Day 5 are associated with higher mGFR at Day 5 (p<0.001, r2adj. = 0.16; p<0.001, r2adj. = 0.25), as well as with mGFR at twelve months (p<0.001, r2adj. = 0.20; p<0.001, r2adj. = 0.16). However, plasma levels of free thiols at 30 minutes and 90 minutes, but not Day 1, were significantly higher among patients experiencing DGF. Conclusion Higher levels of plasma free thiols at Day 1 and Day 5, which are reflective of lower levels of oxidative stress, are associated with better early and late graft function in recipients of a kidney graft from deceased donors. Trial registration ClinicalTrials.gov Identifier: NCT01395719.

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Neutrophil-lymphocyte ratio and creatinine reduction ratio predict good early graft function among adult cadaveric donor renal transplant recipients. Single institution series

Polish Journal of Surgery ◽

10.5604/01.3001.0011.7499 ◽

2018 ◽

Vol 90 (2) ◽

pp. 28-33 ◽

Cited By ~ 4

Author(s):

Piotr Hogendorf ◽

Anna Suska ◽

Aleksander Skulimowski ◽

Joanna Rut ◽

Monika Grochowska ◽

...

Keyword(s):

Kidney Transplantation ◽

Ischemia Reperfusion Injury ◽

Ischemia Reperfusion ◽

Univariate Analysis ◽

Graft Function ◽

Delayed Graft Function ◽

Renal Transplant Recipients ◽

Kidney Graft ◽

Post Transplantation ◽

Neutrophil Lymphocyte Ratio

Background Delayed graft function (DGF) is a common complication following kidney transplantation and is associated with ischemia-reperfusion injury (IRI). Lymphocytes contribute to the pathogenesis of IRI and ischemia-reperfusion related delayed graft function Materials and Methods 135 Caucasian patients received a kidney graft from deceased heart-beating organ donors. We divided patients into 2 groups- patients with the eGFR>=30 on the 21st day post-transplantation (n=36) and patients with the eGFR<30 on the 21st day post-transplantation (n=99) to assess kidney graft function. We measured the serum creatinine levels on 1st and 2nd post-transplant day and preoperative levels of monocytes, lymphocytes, platelets and neutrophils and their ratios. Results We have found statistically significant differences between the eGFR<30 and the eGFR>=30 groups in the average lnLymphocytes (0,36 +/-0,6 vs -0,016 +/-0,74 respectively p=0,004) lnNLR ( 1,27 +/-0,92 vs. 1,73+/-1,08 p=0,016) lnLMR (1,01 +/-0,57 vs. 0,73 +/-0,64 p=0,02), lnPLR (4,97 +/-0,55 vs. 5,26 +/- 0,67 p=0,023) and CCR2% (-20,20 +/- 21,55 vs. -4,29 +/- 29,62 p=0,004 . On univariate analysis, factors of lnLymphocytes >=0,22 (OR=0,331 95%CI 0,151-0,728 p=0,006), lnLMR>=1,4 (OR=0,255 95%CI 0,072-0,903 p=0,034) were associated with worse graft function while lnNLR>=1,05 (OR=2,653 95%CI 1,158-6,078 p=0,021), lnPLR>=5,15 (OR=2,536 95%CI 1,155-5,566 p=0,02) and CRR2 (OR=3,286 95% CI 1,359-7,944 p=0,008) indicated better graft function Conclusion Higher absolute lymphocyte count (lnLymphocytes) and lnLMR as well as lower lnNLR and lnPLR were associated with lower eGFR on the 21st day after kidney transplantation. On multivariate analysis CRR2 in combination with either lnLymphocytes, lnNLR or lnPLR improved the accuracy of detecting patients with poor graft function.

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