Performance of Renal Allografts Perfused With Verapamil-Treated Perfusion Solution

Verapamil has been used in perfusion solution to improve kidney performance, but evidence was anecdotal, and no research has been reported on recipient outcomes. Our organization began a program to evaluate Verapamil’s effect on pump performance, transplant rate, and recipient outcomes. One kidney in a pair was treated with Verapamil and one with standard perfusion. Donor inclusion criteria were age 18 or older and both kidneys were placed on the pump. The laterality of the treated kidney was changed every month to reduce bias. From January 1, 2020 to June 30, 2020, 88 kidneys were evaluated. Of those, 21 donors had both kidneys transplanted to different recipients, so for those 42 kidneys, recipient outcomes were evaluated. Small improvements in pump performance were observed in the Verapamil-treated kidneys and more were transplanted. No clinical differences were found in recipients between the Verapamil-treated and standard perfused kidneys. A larger cohort is needed to determine whether differences are significant.

Chronic Active Antibody-Mediated Rejection Is Associated With the Upregulation of Interstitial But Not Glomerular Transcripts

Molecular assessment of renal allografts has already been suggested in antibody-mediated rejection (ABMR), but little is known about the gene transcript patterns in particular renal compartments. We used laser capture microdissection coupled with quantitative RT-PCR to distinguish the transcript patterns in the glomeruli and tubulointerstitium of kidney allografts in sensitized retransplant recipients at high risk of ABMR. The expressions of 13 genes were quantified in biopsies with acute active ABMR, chronic active ABMR, acute tubular necrosis (ATN), and normal findings. The transcripts were either compartment specific (TGFB1 in the glomeruli and HAVCR1 and IGHG1 in the tubulointerstitium), ABMR specific (GNLY), or follow-up specific (CXCL10 and CX3CR1). The transcriptional profiles of early acute ABMR shared similarities with ATN. The transcripts of CXCL10 and TGFB1 increased in the glomeruli in both acute ABMR and chronic active ABMR. Chronic active ABMR was associated with the upregulation of most genes (SH2D1B, CX3CR1, IGHG1, MS4A1, C5, CD46, and TGFB1) in the tubulointerstitium. In this study, we show distinct gene expression patterns in specific renal compartments reflecting cellular infiltration observed by conventional histology. In comparison with active ABMR, chronic active ABMR is associated with increased transcripts of tubulointerstitial origin.

Does the Presence of Renal Vascular Variation in the Renal Allograft Determine the Outcome of Renal Transplantation? Experience from the National Kidney Transplantation Center, Ethiopia

Background: Renal transplantation is the treatment of choice for people who suffer from end stage renal disease. Renal vascular anatomy is known for presenting a wide range of variations. Kidneys with variant renal vascular anatomy when used as a graft appear to be a potential risk factor that could impair the outcome of kidney transplantation. Information on renal vascular variations and its implication in the surgical outcome of renal transplantation has not been well studied. Hence, the present study was aimed to evaluate the outcomes of transplantation of renal allografts with variant renal vasculature as compared to allografts without renal vascular variation in the national kidney transplantation center of Ethiopia.Methods: A health institution based cross-sectional study was conducted. A retrospective review of the medical records of kidney recipients was performed. A total of 120 renal transplant recipient’s medical records were evaluated. Chi-square test and Independent t test was used to compare the surgical outcomes of renal transplantation. Graft survival was expressed using Kaplan-Meier curves, and was compared using the log-rank test. P values less than 0.05 was considered as statistically significant. Result: Evaluation of the renal transplant outcomes did not have shown a significant difference in the postoperative complication rate, rate of delayed graft function (DGF), creatinine clearance levels at 1 , 6, or 12 months postoperatively, and 1-year graft survival among recipients of allografts with and without renal vascular variations. However, operation time and the length of hospital stay were significantly longer among recipients of allografts with variant vasculature.Conclusion: No significant difference was noted in the outcomes of transplantation of renal allografts with and without vascular variations. Hence, renal allografts with vascular variations are safe to be recruited for transplantation as to this study.

Innate-like self-reactive B cells infiltrate human renal allografts during transplant rejection

Intrarenal B cells in human renal allografts indicate transplant recipients with a poor prognosis, but how these cells contribute to rejection is unclear. Here we show using single-cell RNA sequencing that intrarenal class-switched B cells have an innate cell transcriptional state resembling mouse peritoneal B1 or B-innate (Bin) cells. Antibodies generated by Bin cells do not bind donor-specific antigens nor are they enriched for reactivity to ubiquitously expressed self-antigens. Rather, Bin cells frequently express antibodies reactive with either renal-specific or inflammation-associated antigens. Furthermore, local antigens can drive Bin cell proliferation and differentiation into plasma cells expressing self-reactive antibodies. These data show a mechanism of human inflammation in which a breach in organ-restricted tolerance by infiltrating innate-like B cells drives local tissue destruction.

Clinical Outcomes Following Single vs. Multiple Vessel Living-Donor Kidney Transplantation: A Retrospective Comparison of 210 Patients

Background: The use of living-donor kidney allografts with multiple vessels continues to rise in order to increase the donor pool. This requires surgeons to pursue vascular reconstructions more often, which has previously been associated with a higher risk of developing early post-transplant complications. We therefore wanted to investigate the prognostic role of using living-donor renal allografts with a single artery (SA) vs. multiple arteries (MA) at the time of transplant.Methods: We retrospectively analyzed a cohort of 210 consecutive living-donor kidney transplants performed between January, 2008 and March, 2019, and compared the incidence of developing postoperative complications and other clinical outcomes between SA vs. MA recipients.Results: No differences were observed between SA (N = 161) and MA (N = 49) kidneys in terms of the incidence of developing a postoperative (or surgical) complication, a urologic complication, hospital length of stay, delayed graft function, estimated glomerular filtration rate at 3 or 12 mo post-transplant, and graft survival.Conclusions: The use of live-kidney allografts with MA requiring vascular reconstruction shows excellent clinical outcomes and does not increase the risk of developing postoperative complications or other adverse outcomes when compared with SA renal allografts.