Formative Usability of the Kidneytime Online Live Donor Kidney Transplant Education Tool Among Transplant Candidates

Background Web-based education may be a powerful tool to support transplant candidates’ learning and communication about live donor kidney transplantation. Few educational interventions are web-based and have education sharing for living donor transplant as a primary goal. Methods Through user-centered design and iterative usability testing, we developed a web platform, called KidneyTIME, to support an educational intervention for adult transplant candidates. KidneyTIME delivers animated videos to improve candidate knowledge, motivation, and self-efficacy to pursue living donor transplantation and to promote outreach through video sharing. The animated-video educational content was previously produced by the researchers. We conducted a formative usability evaluation of the KidneyTIME web platform to enable users to find, view, and share the previously produced videos. A total of 30 kidney transplant candidates were involved in 4 rounds of testing at one transplant center, with amendments made after each round. Results Transplant candidates were predominantly White non-Hispanic; 47% had incomes <$30 000 and >43% had vision or motor impairment. Readability, navigation, and failure to find videos were the main usability issues identified. Substantial improvements were found in the usability of most functions after implementing certain features, such as enlarging text and buttons, enhancing contrast, and simplifying presentation. Participants reported that the intervention was user friendly and easy to navigate. Conclusion Considering feedback from a wide spectrum of users has improved the usability of KidneyTIME. A salient concern for End stage kidney disease populations is ensuring online accessibility despite vision and motor impairments.

Polyuria after Renal Transplantation: A Case Report and Review of Literature

Polyuria is defined as a urine output (UOP) of more than 3 litres per day in adults or 2 l/m2/day in children. Polyuria is common following live donor kidney transplantation (LDKT). This case report and review describes a 32-year-old male with chronic kidney disease who underwent LDKT. The donor was his brother. He had polyuria in the postoperative period with the maximum urine flow rate of 3700 ml/hr and the first 24-hour urine output of 42 litres. He was managed with intravenous crystalloid solutions guided by the central venous pressure and the mean arterial pressure. Electrolytes were replaced with potassium chloride, calcium gluconate and magnesium sulfate. He made an uneventful recovery. The Polyuria improved without any pharmacological interventions. Therefore, guided fluid and electrolyte administration is the key to the successful management of post-transplant polyuria.

MO973PRE-IMPLANTATION BIOPSY FINDINGS AND IMPACT ON LIVE DONOR KIDNEY TRANSPLANT RECIPIENT OUTCOMES - A SINGLE CENTRE STUDY

Background and Aims Live donor kidney transplantation remains the mainstay of renal replacement therapy in Sri Lanka. The basic universal pre surgical investigations, human leucocyte antigen (HLA) matching and cross matching are routinely performed, however due to high rates chronic kidney disease (CKD) as well as increasing numbers of, chronic kidney disease unknown etiology (CKDu) in Sri Lanka, there is a possibility of subclinical kidney disease being present in donor kidneys which go undiagnosed. A study of pre-implantation biopsy along with follow-up outcomes of kidney transplant recipients is conducted to identify presence of subclinical kidney disease in a Sri Lankan cohort of patients. Method We collected thirty three (33) live donor pre-implantation biopsies during 4 consecutive months in 2020 as well as 1 month follow-up data. This is part of an ongoing follow-up study which is conducted at National Hospital, Kandy, Sri Lanka. Results Thirty three (33) live donor recipients and their pre-implantation renal biopsy samples were studied. The mean age of the study participants’ was 37.6 (SD 12.5, range 13 - 59) years. A predominant number of male patients were in the sample (n=21, 63.6%). Underlying aetiology of end stage renal disease (ESRD), was predominantly due to chronic hypertension (39.3%; n=13) and diabetic kidney disease (21.2%, n=7) accounting for nearly 60% of the study participants. Among the 33 live donors 1st degree, 2nd degree and non-relative donors were 54.4% (n=18), 18.2% (n=6) and 27.3% (n=9) respectively. Pre-implantation renal biopsy results reported 36.4% (n=12) with abnormal biopsy findings including chronic interstitial nephritis (n=4, 12.1%), interstitial fibrosis (n=6, 18.18%) and acute tubular necrosis (n=2, 6%). Follow-up revealed delayed graft function occurring in 18.2% (n=6) of recipients with 50% (n=3) of them showing abnormalities in the pre-operative donor biopsy sample. At one month follow-up, 48.5% (n=16) reported complications which included graft failure 3% (n=1), all-cause mortality 3% (n=1), acute rejection 39.4% (n=13) and infections 24.2% (n=8). Overall, 37.5% (n=6) of these recipients had abnormal donor biopsy findings, however no significant statistical association was identified. Conclusion Our study identified subclinical kidney disease in donor kidneys despite standard pre-transplant screening. Even though, statistically not significant, recipients with abnormal pre-implantation biopsy findings had adverse short term post-transplant complications.

MO965THE EFFECT OF DEGREE OF HUMAN LEUCOCYTE ANTIGEN MISMATCH AMONG LIVE-DONOR KIDNEY TRANSPLANT RECIPIENTS

Background and Aims There is a strong evidence of importance of HLA matching in kidney transplantation and associations between HLA-DR mismatches and rejection, transplant glomerulopathy, graft failure, and death with functioning graft following kidney transplantation. Our aim is to evaluate the effect of degree of HLA mismatch on transplant outcome among live donor kidney transplant recepients. Method The current study is a retrospective cohort study which was performed in Urology and Nephrology Center, Mansoura University, Egypt. The study included 2200 kidney transplant recipients who underwent renal transplantation between March 1976 and August 2019. The patients were divided into 3 main groups according to the degree of HLA mismatch: Group I: 0, 1, 2 HLA mismatch (568 patients). Group II: 3 , 4 HLA mismatch (1462 patients). Group III: 5 HLA mismatch (170 patients Results Demographic and medical characteristics were comparable among the 3 groups. Transplantation from unrelated donors was more frequent among group III (p value: 0.001). Ischemia time was comparable and over 90% of the patients had immediate diuresis.The degree of HLA mismatch affected the choice of induction therapy as lymphocyte depleting agent (ATG) was used more frequently in group III while basliximab was used more frequently in group I (p value: 0.001). Patients in group I were maintained on dual immunosuppressive protocols more frequently than the other 2 groups where triple immunosuppressive protocols were commonly used (p value: 0.02).Tacrolimus-based protocol was used more among group I while cyclosporine-based regimen was frequently used among group III (p value: 0.002, 0.001 respectively). acute rejection episodes were more frequent with group II and III. (p value: 0.001). Chronic rejection was revealed in graft biopsies of group II and III more than group I (p value: 0.046). Incidence of post-transplant Hypertension and Diabetes mellitus was higher in group III (p value: 0.004, 0.016 respectively). Median serum creatinine after 1 year follow up didn't differ significantly between the studied groups. However, serum creatinine was higher in group III after 2, 3, 4 and 5 years post transplantation (p value: 0.006) with subsequent lower creatinine clearance (p value: 0.036). The majority of patients were alive with functioning graft at last follow-up especially in group I with statistically significant difference among the 3 groups (p value: 0.001). More patients were alive with failed graft at last follow up in group III than in the other 2 groups with statistically significant difference (p value: 0.003). There was comparable percent of patients among the 3 groups were died either with functioning or with failed graft. On the other hand the 5, 10 and 15 years graft and patient survival showed statistical significant difference among the 3 groups with better survival for group I (p value: 0.04, 0.001) Conclusion The degree of mismatch affected the choice of immunosuppressive regimen. Higher HLA mismatch was associated with higher incidence of diabetes and hypertension and lower patient and graft survival.

Living-Related Donor Kidney Transplant in a Patient With Single Ventricle and Fontan Circulation

The hemodynamic profile of the Fontan circulation presents challenges that raise questions about candidacy for organ transplantation. We report a case of a 24-year-old male with double-inlet right ventricle and aortic atresia, who suffered bilateral renal cortical necrosis due to neonatal cardiovascular shock, received a live-donor kidney transplant from his mother at age 17, and has diminished yet stable renal function seven years posttransplant.