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Sample records for adult kidney transplant

  1. Pediatric versus adult kidney transplantation activity in Arab countries

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    Bassam Saeed

    2013-01-01

    Full Text Available The objective of this study was to evaluate the current activity of pediatric versus adult kidney transplantation activity in the Arab world. A questionnaire was mailed to all kidney transplant centers in Arab countries to collect data on the kidney transplant activity in a recent single year. Three thousand three hundred and nine kidney transplants were performed in one year, with a transplant rate of 9.5 per million populations (PMP; 298 were performed for children with a pediatric kidney transplant (PKT rate of 0.87 PMP, which is much lower than that of developed countries where it mostly ranges from 5 to 10. The pediatric share of all transplants is 9%, which is twice as high as that of European children. Kidney transplant programs in most Arab countries rely exclusively on living donors as there is a severe shortage of deceased donors. 93.5% of all transplants, combined adult and pediatric, were from living donors. Deceased transplant activity in Arab countries accounts for 14-31% of all transplants in the three countries with deceased donor programs. Of the 212 adult and pediatric transplants that were performed from deceased donors in eight countries, only 29 cases were for pediatric recipients. Deceased PKT is available in the Kingdom of Saudi Arabia (KSA, Tunisia and Kuwait. Surprisingly, the PKT share was not better in the countries with higher overall kidney transplant rate and or in those where deceased transplant was available. PKT is still inactive in most Arab countries and mostly relies on living donors. The lack of well-developed deceased donor programs is the main issue to be addressed.

  2. Presymptomatic testing for adult onset polycystic kidney disease in at-risk kidney transplant donors.

    Science.gov (United States)

    Hannig, V L; Hopkins, J R; Johnson, H K; Phillips, J A; Reeders, S T

    1991-09-15

    Autosomal dominant adult-onset polycystic kidney disease (ADPKD) is estimated to have an incidence of 1/1,000 and accounts for approximately 10% of all end-stage renal disease in the United States. While relatives are attractive as renal donors due to their availability and the improved transplant success associated with living-related donors, they may coincidentally be at risk for ADPKD. Accurate presymptomatic testing for at-risk potential donors is critical for both the donor and the recipient. We report here 2 families in which presymptomatic testing for ADPKD was accomplished by DNA linkage analysis on several potential renal donors prior to transplant. This resulted in the protection of both donors and recipients by preventing the transplantation of a kidney affected by ADPKD. Thorough counseling prior to DNA analysis (including discussion of accuracy and possible testing outcomes of presymptomatic diagnosis of ADPKD, diagnosis of noncarrier status, false paternity, and non-informative study) was essential to provide informed consent and preserve confidentiality within the family. Confidentiality for potential donors found presymptomatically to be affected (with a 94% or greater probability) was especially difficult to maintain.

  3. The Pharmacogenetics of Tacrolimus in Corticosteroid-Sparse Pediatric and Adult Kidney Transplant Recipients

    DEFF Research Database (Denmark)

    Madsen, Mads Juul; Bergmann, Troels K; Brøsen, Kim

    2017-01-01

    INTRODUCTION: Tacrolimus is a calcineurin inhibitor used as an immunosuppressant drug in solid organ transplantation, and is mainly metabolized by cytochrome P450 (CYP) 3A4 and CYP3A5. Studies have shown an association between the CYP3A5 genotype and tacrolimus dose-adjusted trough concentrations......>A, POR*28 and CYP3A4*22 and dose-adjusted tacrolimus trough concentrations in a primarily corticosteroid-free (>85%) population of Danish pediatric and adult kidney transplant recipients. METHODS: Seventy-two patients receiving treatment with oral tacrolimus were genotyped using real-time polymerase......>A, POR*28, or CYP3A4*22. An association between the PPARA c.209-1003G>A genotype and an increased number of infections with cytomegalovirus (CMV) within the first year was identified (p transplantation were on target...

  4. Barriers to kidney transplantation among adult Sudanese patients on maintenance hemodialysis in dialysis units in Khartoum state

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    Hisham H Abdelwahab

    2013-01-01

    Full Text Available Kidney transplantation remains the preferred modality of treatment for patients with end-stage renal disease. In Sudan, kidney transplantation accounted for 28% of the total provided renal replacement therapies. A cross-sectional, hospital-based study was conducted in hemodialysis (HD units in Khartoum State during the period from September 2010 to January 2011. It aimed to determine the main reasons for the currently low renal transplantation rate. Data were obtained by direct interviewing using a specifically pre-coded and pre-tested questionnaire following a pilot study. A total of 462 adult HD patients were randomly selected from the various HD units in Khartoum State; these patients accounted for 16.9% of the total HD population in Khartoum State. The mean age of the study patients was 48.5 ± 23.6 years and 312 (67.5% were males. Upon interviewing, only 316 patients (68.4% said that they had been counseled for kidney transplantation. One hundred and twenty-two patients (26.4% were on the active transplant list; of these, 50% preferred to have their kidney transplantation performed abroad, mostly due to the availability of commercial transplantation and/or a presumed better outcome. The low renal transplantation rate was due to financial constraints in 112 patients (24.2%, lack of medical fitness in 97 patients (21% and absence of a suitable kidney donor in 92 patients (20%, while 56 patients (12% were still having misperceptions regarding transplantation and preferred to continue on dialysis. To improve the kidney transplantation rate in Khartoum State, the Sudan program for organ transplantation is expected to take more initiatives to promote and improve the outcome of kidney transplants inside the country and, accordingly, regain the patients′ confidence on the health system.

  5. Cuba's kidney transplantation program.

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    Mármol, Alexander; Pérez, Alexis; Pérez de Prado, Juan C; Fernández-Vega, Silvia; Gutiérrez, Francisco; Arce, Sergio

    2010-10-01

    The first kidney transplant in Cuba was performed on 24 February 1970, using a cadaveric donor. In 1979, living donor kidney transplantation began between first-degree relatives. A total of 2775 patients are enrolled in renal replacement therapy in 47 hospitals across the country, 1440 of whom are awaiting kidney transplantation. Organs for the kidney program are procured in 63 accredited hospitals equipped for multidisciplinary management of brain death. Accordingly, over 90% of transplanted kidneys are from cadaveric donors. Identification of potential recipients is carried out through a national, computerized program that affords all patients the same opportunity regardless of distance from a transplant center, and selection of the most suitable candidate is based primarily on HLA compatibility. KEYWORDS Chronic renal failure, kidney transplantation.

  6. Kidney transplantation after liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Li-Yang Wu; Hang Liu; Wei Liu; Han Li; Xiao-Dong Zhang

    2016-01-01

    Kidney transplantation after liver transplanta-tion (KALT) offers longer survival and a better quality of life to liver transplantation recipients who develop chronic renal failure. This article aimed to discuss the efifcacy and safety of KALT compared with other treatments. The medical records of 5 patients who had undergone KALT were retrospectively studied, together with a literature review of studies. Three of them developed chronic renal failure after liver transplanta-tion because of calcineurin inhibitor (CNI)-induced neph-rotoxicity, while the others had lupus nephritis or non-CNI drug-induced nephrotoxicity. No mortality was observed in the 5 patients. Three KALT cases showed good prognoses, maintaining a normal serum creatinine level during entire follow-up period. Chronic rejection occurred in the other two patients, and a kidney graft was removed from one of them. Our data suggested that KALT is a good alternative to dialysis for liver transplantation recipients. The cases also indicate that KALT can be performed with good long-term survival.

  7. Kidney Transplantation in Iran

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    Behzad Einollahi

    2010-03-01

    Full Text Available Kidney transplantation in patients with end stage renal diseaseis preferred to dialysis because transplantation provides a betterquality of life and improved survival. However, the gapbetween the supply and demand for a renal allograft is wideningand the waiting time is increasing. Iranian protocol, a controlledtransplant program supported by the government forliving unrelated donors, was initiated for solving the problemof organ shortage. Although this system might experiencechallenges, clearly it has advantages over other organ procurementsystems primarily that thousands in need do not diewhile waiting for a compatible donor.In the present review I discuss the history of renal transplantationin Iran, "Iranian model" protocol, the situation ofIran’s kidney transplantation from either living or deceaseddonors compared with the Middle East countries, and our experiencesof unrelated renal transplantation.

  8. Kidney Transplantation in Iran

    OpenAIRE

    2010-01-01

    Kidney transplantation in patients with end stage renal diseaseis preferred to dialysis because transplantation provides a betterquality of life and improved survival. However, the gapbetween the supply and demand for a renal allograft is wideningand the waiting time is increasing. Iranian protocol, a controlledtransplant program supported by the government forliving unrelated donors, was initiated for solving the problemof organ shortage. Although this system might experiencechallenges, clea...

  9. Everolimus in kidney transplantation

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    Cooper JE

    2011-07-01

    Full Text Available James E Cooper¹, Uwe Christians², Alexander C Wiseman¹¹Division of Renal Diseases and Hypertension, Transplant Center, ²iC42 Integrated Solutions in Systems Biology for Clinical Research and Development, University of Colorado Denver, Aurora, CO, USAAbstract: Everolimus is a novel target of rapamycin (mTOR-I analog that has recently been approved in combination with cyclosporine A and steroids for use in the prevention of organ rejection in kidney transplant recipients. Compared with rapamycin, everolimus is characterized by a shorter half-life and improved bioavailability. Prior to US Food and Drug Administration approval, a number of Phase II and III clinical trials were undertaken to evaluate the effectiveness of everolimus in combination with calcineurin inhibitors for preventing acute rejection and promoting allograft survival in kidney transplant recipients. In this report, we review the pharmacokinetic properties of everolimus, the clinical efficacy studies that led to its approval for use in kidney transplantation, as well as reported data on patient safety and tolerability associated with its use.Keywords: mTOR inhibitors, kidney transplantation, everolimus

  10. Pregnancy and kidney transplantation.

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    Josephson, Michelle A; McKay, Dianne B

    2011-01-01

    Despite decades of experience with child bearing in women with kidney transplants, these pregnancies remain high risk with an increased prevalence of hypertension and pre-eclampsia. Infertility, common in women with end-stage renal disease, is rapidly restored after transplant although pregnancy rates appear lower in transplant recipients than the general public. Many unanswered questions exist, some old questions such as what is the optimal timing of pregnancy after transplant, whether breast feeding is safe, the long-term impact if any on the offspring, and whether pregnancy negatively affects the kidney graft; and some new questions such as whether to modify immunosuppression in a patient taking a mycophenolic acid-containing drug, whether kidney donation has a deleterious impact on future pregnancies, whether to use erythropoietin-stimulating agents, and the role of BK virus. Counseling about contraception and pregnancy after transplant should be initiated during the pretransplant evaluation process. It is important because of the rapid restoration of fertility that occurs after transplant as well as the many risks and unanswered questions that remain.

  11. Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model.

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    Jones-Hughes, Tracey; Snowsill, Tristan; Haasova, Marcela; Coelho, Helen; Crathorne, Louise; Cooper, Chris; Mujica-Mota, Ruben; Peters, Jaime; Varley-Campbell, Jo; Huxley, Nicola; Moore, Jason; Allwood, Matt; Lowe, Jenny; Hyde, Chris; Hoyle, Martin; Bond, Mary; Anderson, Rob

    2016-01-01

    BACKGROUND End-stage renal disease is a long-term irreversible decline in kidney function requiring renal replacement therapy: kidney transplantation, haemodialysis or peritoneal dialysis. The preferred option is kidney transplantation, followed by immunosuppressive therapy (induction and maintenance therapy) to reduce the risk of kidney rejection and prolong graft survival. OBJECTIVES To review and update the evidence for the clinical effectiveness and cost-effectiveness of basiliximab (BAS) (Simulect(®), Novartis Pharmaceuticals UK Ltd) and rabbit anti-human thymocyte immunoglobulin (rATG) (Thymoglobulin(®), Sanofi) as induction therapy, and immediate-release tacrolimus (TAC) (Adoport(®), Sandoz; Capexion(®), Mylan; Modigraf(®), Astellas Pharma; Perixis(®), Accord Healthcare; Prograf(®), Astellas Pharma; Tacni(®), Teva; Vivadex(®), Dexcel Pharma), prolonged-release tacrolimus (Advagraf(®) Astellas Pharma), belatacept (BEL) (Nulojix(®), Bristol-Myers Squibb), mycophenolate mofetil (MMF) (Arzip(®), Zentiva; CellCept(®), Roche Products; Myfenax(®), Teva), mycophenolate sodium (MPS) (Myfortic(®), Novartis Pharmaceuticals UK Ltd), sirolimus (SRL) (Rapamune(®), Pfizer) and everolimus (EVL) (Certican(®), Novartis) as maintenance therapy in adult renal transplantation. METHODS Clinical effectiveness searches were conducted until 18 November 2014 in MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Central Register of Controlled Trials (via Wiley Online Library) and Web of Science (via ISI), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment (The Cochrane Library via Wiley Online Library) and Health Management Information Consortium (via Ovid). Cost-effectiveness searches were conducted until 18 November 2014 using a costs or economic literature search filter in MEDLINE (via Ovid), EMBASE (via Ovid), NHS Economic Evaluation Database (via Wiley Online Library), Web of Science (via ISI

  12. ABO-Incompatible Kidney Transplantation

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    Morath, Christian; Zeier, Martin; Döhler, Bernd; Opelz, Gerhard; Süsal, Caner

    2017-01-01

    ABO-incompatible (ABOi) kidney transplantation has long been considered a contraindication to successful kidney transplantation. During the last 25 years, increasing organ shortage enforced the development of strategies to overcome the ABO antibody barrier. In the meantime, ABOi kidney transplantation has become a routine procedure with death-censored graft survival rates comparable to the rates in compatible transplantations. Desensitization is usually achieved by apheresis and B cell-depleting therapies that are accompanied by powerful immunosuppression. Anti-A/B antibodies are aimed to be below a certain threshold at the time of ABOi kidney transplantation and during the first 2 weeks after surgery. Thereafter, even a rebound of anti-A/B antibodies does not appear to harm the kidney transplant, a phenomenon that is called accommodation, but is poorly understood. There is still concern, however, that infectious complications such as viral disease, Pneumocystis jirovecii pneumonia, and severe urinary tract infections are increased after ABOi transplantations. Recent data from the Collaborative Transplant Study show that during the first year after kidney transplantation, one additional patient death from an infectious complication occurs in 100 ABOi kidney transplant recipients. Herein, we review the recent evidence on ABOi kidney transplantation with a focus on desensitization strategies and respective outcomes. PMID:28321223

  13. Trasplante renal Kidney transplant

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    P. Martín

    2006-08-01

    Full Text Available El trasplante renal es la terapia de elección para la mayoría de las causas de insuficiencia renal crónica terminal porque mejora la calidad de vida y la supervivencia frente a la diálisis. El trasplante renal de donante vivo es una excelente alternativa para el paciente joven en situación de prediálisis porque ofrece mejores resultados. El tratamiento inmunosupresor debe ser individualizado buscando la sinergia inmunosupresora y el mejor perfil de seguridad, y debe adaptarse a las diferentes etapas del trasplante renal. En el seguimiento del trasplante renal hay que tener muy en cuenta los factores de riesgo cardiovascular y los tumores puesto que la muerte del paciente con injerto funcionante es la segunda causa de pérdida del injerto tras el primer año del trasplante. La función alterada del injerto es un factor de mortalidad cardiovascular independiente que requerirá seguimiento y control de todas sus complicaciones para retrasar la entrada en diálisis.The kidney transplant is the therapy of choice for the majority of the causes of chronic terminal kidney insufficiency, because it improves the quality of life and survival in comparison with dialysis. A kidney transplant from a live donor is an excellent alternative for the young patient in a state of pre-dialysis because it offers the best results. Immunosuppressive treatment must be individualised, seeking immunosuppressive synergy and the best safety profile, and must be adapted to the different stages of the kidney transplant. In the follow-up to the kidney transplant, cardiovascular risk factors and tumours must be especially taken into account, given that the death of the patient with a working graft is the second cause of loss of the graft following the first year of the transplant. The altered function of the graft is a factor of independent cardiovascular mortality that will require follow-up and the control of all its complications to postpone the entrance in dialysis.

  14. ABO-incompatible kidney transplantation

    DEFF Research Database (Denmark)

    Schousboe, Karoline; Titlestad, Kjell; Baudier, Francois;

    2010-01-01

    INTRODUCTION: Kidney transplantation is the optimal treatment for many patients with end-stage renal disease (ESRD). Due to shortage of donor kidneys in Denmark, there is a need to expand the possibilities for donation. At the Odense University Hospital (OUH), we have introduced ABO......-incompatible kidney transplantation. We used antigenspecific immunoadsorptions to remove blood group antibodies and anti-CD20 antibody (rituximab) to inhibit the antibody production. The aim of introducing the ABO-incompatible kidney transplantation at the OUH was to increase the rate of living donor kidney...... transplantation without increasing rejection or mortality rates. MATERIAL AND METHODS: Retrospective evaluation. Eleven patients received ABO-incompatible kidney transplantation. The patients were followed for 3-26 months. RESULTS: One patient had an antibody-mediated rejection, one patient suffered T...

  15. Vitamin D status in children and adolescents with kidney transplants

    DEFF Research Database (Denmark)

    Brodersen, Louise Aarup; Nielsen, Pia Rude; Thiesson, Helle Charlotte;

    2011-01-01

    Brodersen LA, Nielsen PR, Thiesson HC, Marckmann P. Vitamin D status in children and adolescents with kidney transplants. Pediatr Transplantation 2011: 15: 384-389. © 2011 John Wiley & Sons A/S. Abstract:  Hypovitaminosis D is highly prevalent in adult kidney-transplanted patients. The knowledge...

  16. Epididymis microlithiasis and semen abnormalities in young adult kidney transplant recipients.

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    Bozzini, G; Lunelli, L; Berlingheri, M; Groppali, E; Carmignani, L

    2013-10-01

    Microlithiasis of the epididymis is a rare ultrasound finding in the general population, but the incidence of calcifications in various organs of patients with end-stage renal disease (ESRD) is extremely high. The aim of this study was to describe epididymal microlithiasis in 22 previously dialysed patients who received kidney transplantations at a median age of 19 years (range 9-30). The patients underwent scrotum ultrasonography, semen analysis and laboratory tests (renal function, sexual hormones, Ca, P and PTH) and were administered the International Index of Erectile Function questionnaire. Seventeen presented calcifications of the epididymis, two of whom had concomitant testicular calcifications; a further three patients had isolated testicular calcifications without epididymis involvement. It was not possible to investigate the fertility of all of the patients but 12 of the 13 whose semen was analysed showed abnormalities: five were azoospermic and seven oligospermic with various degrees of morphological anomalies. To the best of our knowledge, these are the first published data concerning the prevalence of epididymal calcifications in young dialysed patients undergoing renal transplantation. Epididymal microlithiasis and infertility were common findings and so performing a spermiogram and preserving semen before ESRD for future paternity may be good advice in this selected population.

  17. Cancer rates after kidney transplantation

    DEFF Research Database (Denmark)

    Sodemann, Ulrik; Bistrup, Claus; Marckmann, Peter

    2011-01-01

    Previous studies demonstrated a 3-5-fold increased cancer risk in kidney allograft recipients compared with the general population. Our aim was to estimate cancer frequencies among kidney allograft recipients who were transplanted in 1997-2000 and who were immunosuppressed according to a more...

  18. VASCULAR COMPLICATIONS AFTER KIDNEY TRANSPLANTATION

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    M. Sh. Khubutia

    2013-01-01

    Full Text Available Aim: evaluation of the incidence and the pattern of vessel complications, efficacy of the prophylactic anticoagulation therapy after kidney transplantation. Materials and methods. From March 2007 till January 2013 421 patients: 230 men (54,6% and 191 women (45,4%; mean age 43,07 ± 11,62 undergone 429 kidney transplantations in the department of pancreas and kidney transplantation of the Scientific-Research Institute of Emergency Care named after N.V. Sklifosovsky. In order to evaluate the condition and the function of the kidney transplant ultrasound investigation (daily andacquisition(weekly wereused. In cases of kidney dysfunction and assumption of vessel complications we used computerized tomography. Besides, we used daily analysis of biochemical and clinical parameters of blood and urine. Results. The most common vessel complication was the thrombosis of the microvasculature of the kidney transplant due to acute humoral and combined rejection resistant to antirejection therapy (n = 9; 2,1%; in 4 cases there was a breakage of the transplant due to the acute rejection and the urgent transplantatectomy in an effort to save the patient; thrombosis of the transplantat artery occurred in 1 case (0,23%; we observed 2 cases (0,46% of the artery stenosis and 2 cases (0,46% of venous thrombosis. Conclusion. Summary frequency of vessel complications in our clinic, including thrombosis due to rejection, was 3,49%. It fully corresponds with data obtained from the global medical community. The incidence of great vessel thrombosis was less than 1% which indicates the adequate prophylactic anticoagulation therapy. For the benefit of early diacrisis of complications Doppler sonography is needed. In case of assumption of vessel complications urgent acquisition, computerized tomography and/ or angiography are to be held. 

  19. Dual kidney transplantation: case report.

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    Vidas, Zeljko; Kocman, Branislav; Knotek, Mladen; Skegro, Dinko

    2010-06-01

    Chronic shortage of kidney transplants worldwide has led to the use of organs from so called marginal or borderline donors, now termed "expanded-criteria donors". There has been an emerging practice of dual kidney transplantation (DKT) to compensate for sub optimal nephron mass of such kidneys. We performed DKT in "Merkur" University Hospital in August 2005. The donor was a 72-year old female with a history of long-term hypertension, aneurysm of the posterior cerebral artery, cerebrovascular insult (CVI), and with normal creatinine values and kidney function at the time of explantation. Initial biopsy of donor kidneys revealed acute tubular damage, with connective changes in 22% and 11% of glomeruli in the left and the right kidney, respectively. The recipient was a 60-year old male diagnosed with the IgA nephropathy on the last biopsy in 1999, and on dialysis since November 2003. Postoperative course was uneventful without any surgical complications. A triple immunosuppressive protocol was used. On follow-up ultrasonography 4 years posttransplantation both kidneys appeared of normal size and parenchymal pattern and with no signs of dilatation of the canal system, and color Doppler examination demonstrated normal flow in both kidneys. In conclusion, the use of DKT ie. donors by the expanded-criteria will continue to increase, and further studies of the results will, with no doubt, support this method.

  20. Transplantation of horseshoe kidney en bloc.

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    Nahas, W C; Hakim, N S; Mazzucchi, E; Antonopoulos, L M; Eltayar, A R; Labruzzo, C; Chocair, P R; Arap, S

    2000-01-01

    Horseshoe kidney is probably the most common renal fusion anomaly. With the continuous donor shortage, transplant surgeons tend to accept donors previously considered unsuitable. We present a successful case of en bloc horseshoe kidney transplant in a single recipient. The literature is reviewed. The use of horseshoe kidneys in transplantation is recommended in selected cases.

  1. KIDNEY TRANSPLANT URODYNAMICS: NEUROPHYSIOLOGIC CONSIDERATIONS

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    V. B. Berdichevskiy

    2014-01-01

    Full Text Available By analyzing data from the literature and the results of own clinical the authors suggest the presence of its own physiological rhythmogenesis motility of the urinary system to ensure its functional viability after denervation in the process of donor kidney recоvery and its transplantation to the recipient. 

  2. Geographic determinants of access to pediatric deceased donor kidney transplantation.

    Science.gov (United States)

    Reese, Peter P; Hwang, Hojun; Potluri, Vishnu; Abt, Peter L; Shults, Justine; Amaral, Sandra

    2014-04-01

    Children receive priority in the allocation of deceased donor kidneys for transplantation in the United States, but because allocation begins locally, geographic differences in population and organ supply may enable variation in pediatric access to transplantation. We assembled a cohort of 3764 individual listings for pediatric kidney transplantation in 2005-2010. For each donor service area, we assigned a category of short (270 days) median waiting time and calculated the ratio of pediatric-quality kidneys to pediatric candidates and the percentage of these kidneys locally diverted to adults. We used multivariable Cox regression analyses to examine the association between donor service area characteristics and time to deceased donor kidney transplantation. The Kaplan-Meier estimate of median waiting time to transplantation was 284 days (95% confidence interval, 263 to 300 days) and varied from 14 to 1313 days across donor service areas. Overall, 29% of pediatric-quality kidneys were locally diverted to adults. Compared with areas with short waiting times, areas with long waiting times had a lower ratio of pediatric-quality kidneys to candidates (3.1 versus 5.9; Preference areas with ≥5:1 kidneys/candidates; Ppediatric deceased donor kidney transplantation exists and is highly associated with local supply and demand factors. Future organ allocation policy should address this geographic inequity.

  3. [The experience of kidney transplantation at the Donetsk transplantation center].

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    Serniak, P S; Denisov, V K; Zakharov, V V; Oleshchenko, N D; Guba, G B; Rodin, I N; Chernobrivtsev, P A; Derkach, I A

    1999-01-01

    In Donetskiy transplantational centre during the period from 1986 to 1996 yr were conducted 305 operations of the kidney transplantation from the cadaveric and living donor. Kidney transplantation permits to achieve higher level of rehabilitation than while application of hemodialysis and must become the method of choice in treatment of terminal stage of chronic renal insufficiency. Considering large demand for the organs transplantation in Ukraine it is necessary to create an economically substantiated programme "Transplantation of organs".

  4. Intermediate-Term Outcomes of Dual Adult versus Single-Kidney Transplantation: Evolution of a Surgical Technique

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    Ana K. Islam

    2016-01-01

    Full Text Available Background. Acceptance of dual kidney transplantation (DKT has proven difficult, due to surgical complexity and concerns regarding long-term outcomes. We herein present a standard technique for ipsilateral DKT and compare outcomes to single-kidney transplant (SKT recipients. Methods. A retrospective single-center comparison of DKT and SKT performed between February 2007 and July 2013. Results. Of 516 deceased donor kidney transplants, 29 were DKT and 487 were SKT. Mean follow-up was 43 ± 67 months. DKT recipients were older and more likely than SKT recipients to receive an extended criteria graft (p<0.001. For DKT versus SKT, the rates of delayed graft function (10.3 versus 9.2% and acute rejection (20.7 versus 22.4% were equivalent (p = ns. A higher than expected urologic complication rate in the DKT cohort (14 versus 2%, p<0.01 was reduced through modification of the ureteral anastomosis. Graft survival was equivalent between DKT and SKT groups (p = ns with actuarial 3-year DKT patient and graft survivals of 100% and 93%. At 3 years, the groups had similar renal function (p = ns. Conclusions. By utilizing extended criteria donor organs as DKT, the donor pool was enlarged while providing excellent patient and graft survival. The DKT urologic complication rate was reduced by modification of the ureteral anastomosis.

  5. Intermediate-Term Outcomes of Dual Adult versus Single-Kidney Transplantation: Evolution of a Surgical Technique.

    Science.gov (United States)

    Islam, Ana K; Knight, Richard J; Mayer, Wesley A; Hollander, Adam B; Patel, Samir; Teeter, Larry D; Graviss, Edward A; Saharia, Ashish; Podder, Hemangshu; Asham, Emad H; Gaber, A Osama

    2016-01-01

    Background. Acceptance of dual kidney transplantation (DKT) has proven difficult, due to surgical complexity and concerns regarding long-term outcomes. We herein present a standard technique for ipsilateral DKT and compare outcomes to single-kidney transplant (SKT) recipients. Methods. A retrospective single-center comparison of DKT and SKT performed between February 2007 and July 2013. Results. Of 516 deceased donor kidney transplants, 29 were DKT and 487 were SKT. Mean follow-up was 43 ± 67 months. DKT recipients were older and more likely than SKT recipients to receive an extended criteria graft (p < 0.001). For DKT versus SKT, the rates of delayed graft function (10.3 versus 9.2%) and acute rejection (20.7 versus 22.4%) were equivalent (p = ns). A higher than expected urologic complication rate in the DKT cohort (14 versus 2%, p < 0.01) was reduced through modification of the ureteral anastomosis. Graft survival was equivalent between DKT and SKT groups (p = ns) with actuarial 3-year DKT patient and graft survivals of 100% and 93%. At 3 years, the groups had similar renal function (p = ns). Conclusions. By utilizing extended criteria donor organs as DKT, the donor pool was enlarged while providing excellent patient and graft survival. The DKT urologic complication rate was reduced by modification of the ureteral anastomosis.

  6. Longitudinal measurement of physical activity following kidney transplantation.

    NARCIS (Netherlands)

    Dontje, M.L.; Greef, M.H. de; Krijnen, W.P.; Corpeleijn, E.; Kok, T.; Bakker, S.J.; Stolk, R.P.; Schans, C.P. van der

    2014-01-01

    purpose of this longitudinal observational study was to (i) examine the change of daily physical activity in 28 adult kidney transplant recipients over the first 12 months following transplantation; and (ii) to examine the change in metabolic characteristics and renal function. Accelerometer-based d

  7. Four decades of kidney transplantation in Cuba.

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    Alfonzo, Jorge P

    2013-01-01

    This article describes the background, beginnings, development, evolution and outcomes of kidney transplantation in Cuba. Nephrology as a medical specialty in Cuba began in 1962 and was formalized in 1966. Conditions were created to implement renal replacement therapy (including transplants), bring nephrology care to the entire country and train human resources who would assume this responsibility, making Cuba one of the first countries with a comprehensive program for renal patient care. After three unsuccessful cadaveric-donor kidney transplantations in 1968-69, the ensuing history of kidney transplantation can be summarized in the following three stages. 1970-1975: In January 1970, cadaveric-donor kidney transplantation began at the Nephrology Institute. That year, 17 kidney transplantations were performed; four of these patients lived with functional kidneys for 15-25 years; 10-year graft survival was 23.5% (Kaplan-Meier survival curve); HLA typing began in 1974. By December 1975, 170 grafts had been done in three hospitals. 1976-1985: Seven transplantation centers performed 893 grafts during this period. HLA-DR typing was introduced in 1976 and the National Histocompatibility Laboratory Network was founded in 1978. The first related living-donor kidney transplantation was done in 1979. 1986-2011: The National Kidney Transplantation Coordinating Center and the National Kidney Transplantation Program were created in 1986; the first combined kidney-pancreas transplantation was performed the same year. In 1990, cyclosporine and the Cuban monoclonal antibody IOR-T3 were introduced for immunosuppression to prevent rejection, as were other Cuban products (hepatitis B vaccine and recombinant human erythropoietin) for transplant patients. By December 2011, the cumulative number of transplants was 4636 (384 from related living donors). With over 40 years of experience, kidney transplantation is now well established in Cuba; it is free and universally accessible, on the

  8. Kidney temperature course during living organ procurement and transplantation

    NARCIS (Netherlands)

    Kuipers, Thomas G J; Hellegering, J; El Moumni, M; Krikke, C; Haveman, J W; Berger, Stefan P.; Leuvenink, Henri G; Pol, Robert A

    2016-01-01

    Little is known about the actual kidney graft temperature during the 2nd warm ischemia time (WIT2). We aimed to determine the actual temperature course of the WIT2, with emphasis on the 15°C metabolic threshold. Data of 152 consecutive adult living donor kidney transplantations were collected. The m

  9. When Your Child Needs a Kidney Transplant

    Science.gov (United States)

    ... live as they did before developing kidney failure. Different Types of Kidney Transplants There are two kinds of ... So it's vital for parents to communicate the importance of taking all medicines as directed. Be there for your child to ...

  10. Vitamin D status in kidney transplant patients

    DEFF Research Database (Denmark)

    Ewers, Bettina; Gasbjerg, Ane; Moelgaard, Christian

    2008-01-01

    BACKGROUND: A high prevalence of vitamin D insufficiency has been found in the general population and in patients with chronic kidney disease. OBJECTIVE: The aim was to examine vitamin D status and determinants and metabolic correlates of serum 25-hydroxyvitamin D in a population of adult Danish...... kidney transplant patients. DESIGN: This was a cross-sectional study of 173 adult kidney transplant patients with a mean (+/-SD) age of 53.4 +/- 11.7 y and a median graft age of 7.4 y (interquartile range: 3.3-12.7 y). Serum concentrations of intact parathyroid hormone (S-PTH), 25-hydroxyvitamin D [S-25......(OH)D], and 1,25-dihydroxyvitamin D [S-1,25(OH)(2)D] were measured. Dietary and supplementary intake of vitamin D, avoidance of solar ultraviolet B exposure, and selected lifestyle factors were assessed in a subgroup (n = 97). RESULTS: Fifty-one percent of the patients had vitamin D insufficiency [S...

  11. Exploratory Study of Total and Free Prednisolone Plasma Exposure and Cushingoid Appearance, Quality of Life and Biochemical Toxicity in Adult Male Kidney Transplant Recipients

    DEFF Research Database (Denmark)

    Bergmann, Troels K; Isbel, Nicole M; Ostini, Remo

    2015-01-01

    associated with free prednisolone plasma exposure with a Spearman correlation coefficient of 0.30 (p value 0.02). The correlation coefficient was 0.24 (p value 0.08) for neck to upper arm circumference ratio and free prednisolone plasma exposure. The clinical Cushingoid phenotype as determined by the Visual...... of 54 years and median time post-transplantation of 75 months. Median prednisolone dose was 5 mg. Mean area under the plasma concentration-time curve was 2390 nmol h/L (±580) (SD) and 175 nmol h/L (±78) for total and free prednisolone, respectively. Waist to upper arm circumference ratio was positively...... with total or free prednisolone exposure. CONCLUSIONS: There is a positive correlation between free prednisolone plasma exposure and waist to upper arm circumference ratio in adult male kidney transplant recipients on low maintenance prednisolone doses. There is no significant association between total...

  12. Innate immune functions in kidney transplantation

    NARCIS (Netherlands)

    Berger, Stefan Philip

    2009-01-01

    The innate immune system plays an important role in solid organ transplantation. This thesis focuses on the role of the lectin pathway of complement activation in kidney and simultaneous pancreas-kidney transplantation (SPKT) and describes the role of properdin in tubular complement activation and c

  13. Diabetes Mellitus in the Transplanted Kidney

    Directory of Open Access Journals (Sweden)

    Vasil ePeev

    2014-08-01

    Full Text Available Diabetes mellitus (DM is the most common cause of chronic kidney disease (CKD and end stage renal disease (ESRD. New onset diabetes mellitus after transplant (NODAT has been described in approximately 30 percent of non-diabetic kidney transplant recipients many years post transplantation. DM in patients with kidney transplantation constitutes a major comorbidity, and has significant impact on the patients and allografts’ outcome. In addition to the major comorbidity and mortality that result from cardiovascular and other DM complications, long standing DM after kidney transplant has significant pathological injury to the allograft, which results in lowering the allografts and the patients’ survivals. In spite of the cumulative body of data on diabetic nephropathy (DN in the native kidney, there has been very limited data on the DN in the transplanted kidney. In this review, we will shed the light on the risk factors that lead to the development of NODAT. We will also describe the impact of DM on the transplanted kidney, and the outcome of kidney transplant recipients with NODAT. Additionally, we will present the most acceptable data on management of NODAT.

  14. Kidney Transplantation in the Diabetic Patient

    Directory of Open Access Journals (Sweden)

    María José Pérez-Sáez

    2015-06-01

    Full Text Available Diabetes mellitus is one of the most important causes of chronic kidney disease (CKD. In patients with advanced diabetic kidney disease, kidney transplantation (KT with or without a pancreas transplant is the treatment of choice. We aimed to review current data regarding kidney and pancreas transplant options in patients with both type 1 and 2 diabetes and the outcomes of different treatment modalities. In general, pancreas transplantation is associated with long-term survival advantages despite an increased short-term morbidity and mortality risk. This applies to simultaneous pancreas kidney transplantation or pancreas after KT compared to KT alone (either living donor or deceased. Other factors as living donor availability, comorbidities, and expected waiting time have to be considered whens electing one transplant modality, rather than a clear benefit in survival of one strategy vs. others. In selected type 2 diabetic patients, data support cautious utilization of simultaneous pancreas kidney transplantation when a living kidney donor is not an option. Pancreas and kidney transplantation seems to be the treatment of choice for most type 1 diabetic and selected type 2 diabetic patients.

  15. Optical Coherence Tomography in Kidney Transplantation

    Science.gov (United States)

    Andrews, Peter M.; Wierwille, Jeremiah; Chen, Yu

    End-stage renal disease (ESRD) is associated with both high mortality rates and an enormous economic burden [1]. The preferred treatment option for ESRD that can extend patients' lives and improve their quality of life is kidney transplantation. However, organ shortages continue to pose a major problem in kidney transplantation. Most kidneys for transplantation come from heart-beating cadavers. Although non-heart-beating cadavers represent a potentially large pool of donor kidneys, these kidneys are not often used due to the unknown extent of damage to the renal tubules (i.e., acute tubular necrosis or "ATN") induced by ischemia (i.e., lack of blood flow). Also, ischemic insult suffered by kidneys awaiting transplantation frequently causes ATN that leads to varying degrees of delayed graft function (DGF) after transplantation. Finally, ATN represents a significant risk for eventual graft and patient survival [2, 3] and can be difficult to discern from rejection. In present clinical practice, there is no reliable real-time test to determine the viability of donor kidneys and whether or not donor kidneys might exhibit ATN. Therefore, there is a critical need for an objective and reliable real-time test to predict ATN to use these organs safely and utilize the donor pool optimally. In this review, we provided preliminary data indicating that OCT can be used to predict the post-transplant function of kidneys used in transplantation.

  16. Transplantation of infant kidneys - the surgical technique en bloc and transplant position variation: A case report

    Directory of Open Access Journals (Sweden)

    Popović Vladan

    2015-01-01

    Full Text Available Introduction. Due to the ever-present lack of kidney transplant grafts, more and more organs obtained from the so-called “marginal donors” group are accepted, which can provide suboptimal effect of transplantation, depending on their characteristics and/or implantation techniques. Case report. We presented a case with successful variation of kidney position with modified approach of kidney transplantation from an infant to an adult female patient with normal postoperative recovery. Urethral anastomosis was performed without antireflux procedure and this has not led to the development of reflux disease at an early stage. Conclusion. The position of a pair of kidneys proved to be satisfactory despite the growth of the kidney to the expected size and relatively small pelvis. There were no problems with venous stasis and kidney function from the very beginning was good.

  17. Kidney regeneration and repair after transplantation

    NARCIS (Netherlands)

    M. Franquesa (Marcella); M. Flaquer (Maria); J.M. Cruzado; J. Grinyo (Josep)

    2013-01-01

    textabstractPURPOSE OF REVIEW: To briefly show which are the mechanisms and cell types involved in kidney regeneration and describe some of the therapies currently under study in regenerative medicine for kidney transplantation. RECENT FINDINGS: The kidney contains cell progenitors that under specif

  18. Immediate re-transplantation following early kidney transplant thrombosis.

    LENUS (Irish Health Repository)

    Phelan, Paul J

    2012-02-01

    Allograft thrombosis is a devastating early complication of renal transplantation that ultimately leads to allograft loss. We report here on our experience of nine cases of immediate re-transplantation following early kidney transplant thrombosis at a single centre between January 1990 and June 2009. The mean age was 42.9 years at time of transplant. For seven patients, the allograft thrombosis was their first kidney transplant and seven of the nine cases had a deceased donor transplant. The initial transplants functioned for a mean of 1.67 days and the patients received a second allograft at a mean of 3.1 days after graft failure. All of the re-transplants worked immediately. Four allografts failed after a mean of 52.5 months (2-155 months). Two of these died with a functioning allograft, one failed owing to chronic allograft nephropathy and one owing to persistent acute cellular rejection. The remaining five patients still have a functioning allograft after a mean of 101.8 months (7-187 months). One year allograft and patient survival after re-transplantation were 87.5% and 100% respectively (after 5 years, both were 57%). Immediate re-transplantation following early kidney transplant thrombosis can be a success. It may be considered in selected cases after allograft thrombosis.

  19. Immediate re-transplantation following early kidney transplant thrombosis.

    LENUS (Irish Health Repository)

    Phelan, Paul J

    2011-08-01

    Allograft thrombosis is a devastating early complication of renal transplantation that ultimately leads to allograft loss. We report here on our experience of nine cases of immediate re-transplantation following early kidney transplant thrombosis at a single centre between January 1990 and June 2009. The mean age was 42.9 years at time of transplant. For seven patients, the allograft thrombosis was their first kidney transplant and seven of the nine cases had a deceased donor transplant. The initial transplants functioned for a mean of 1.67 days and the patients received a second allograft at a mean of 3.1 days after graft failure. All of the re-transplants worked immediately. Four allografts failed after a mean of 52.5 months (2-155 months). Two of these died with a functioning allograft, one failed owing to chronic allograft nephropathy and one owing to persistent acute cellular rejection. The remaining five patients still have a functioning allograft after a mean of 101.8 months (7-187 months). One year allograft and patient survival after re-transplantation were 87.5% and 100% respectively (after 5 years, both were 57%). Immediate re-transplantation following early kidney transplant thrombosis can be a success. It may be considered in selected cases after allograft thrombosis.

  20. Dual kidney transplantation with organs from extended criteria cadaveric donors.

    LENUS (Irish Health Repository)

    D'Arcy, Frank T

    2009-10-01

    The critical shortage of kidneys available for transplantation has led to alternate strategies to expand the pool. Transplantation of the 2 kidneys into a single recipient using organs suboptimal for single kidney transplantation was suggested. We assessed results in 24 grafts allocated for dual kidney transplantation vs those in a control group of 44 designated for single kidney transplantation. Each group underwent pretransplant biopsy and recipients were age matched.

  1. 成人间活体肝肾联合移植一例体会%The experience in one case of adult-to-adult combined liver-kidney transplantation from the same living donor

    Institute of Scientific and Technical Information of China (English)

    朱志军; 崔子林; 王智平; 张雅敏; 沈中阳

    2013-01-01

    Objective To summarize the experience in one case of adult-to-adult combined liver-kidney transplantation.Method In Sep.2007,one case of adult-to-adult liver-kidney transplantation from the same living donor was performed on a patient with liver cirrhosis (liver failure decompensation) and chronic renal failure (uremia).There was a donation of the right liver with the middle hepatic vein and right kidney in the same time from the living donor.The piggyback liver transplantation and ectopic kidney transplantation were performed for the recipient.Basiliximab and methylprednisolone were given for immune induction therapy in operation.Tacrolimus,MMF and prednisone were given for anti-rejection.There were hepatoprotective treatment,anti-infection treatment and nutritional support for the donor and recipient after operation.The follow-up period has now been more than five years.Result The donor and the patient were smooth in the perioperative period.The liver and kidney function of the donor is well so far.There was no significant influence on quality of life of the donor.The transplanted liver and kidney function of the recipient is well so far.There were no significant complications for the recipient.Conclusion The living liver-kidney transplantation is an effective means for the treatment of liver and kidney failure.The safety can be ensured for the donors that donate the right liver and one kidney simultaneously.%目的 总结活体肝肾联合移植1例的体会.方法 2007年9月对1例乙型肝炎后肝硬化(失代偿期)合并慢性肾功能衰竭(尿毒症期)的患者施行了成人间亲属活体肝肾联合移植.切取供者带肝中静脉的右半肝和右侧肾脏,受者手术采用背驮式肝移植及异位肾移植.受者给予巴利昔单抗联合他克莫司+吗替麦考酚酯+甲泼尼龙的方案抗排斥反应,供、受者术后加强护肝治疗、抗感染治疗和营养支持治疗.结果 供、受者均顺利渡过围手术期,术后肝、

  2. The Global Role of Kidney Transplantation

    Directory of Open Access Journals (Sweden)

    Guillermo Garcia Garcia

    2012-01-01

    Full Text Available World Kidney Day on March 8 th 2012 provides a chance to reflect on the success of kidney transplantation as a therapy for end stage kidney disease that surpasses dialysis treatments both for the quality and quantity of life that it provides and for its cost effectiveness. Anything that is both cheaper and better, but is not actually the dominant therapy, must have other drawbacks that prevent replacement of all dialysis treatment by transplantation. The barriers to universal transplantation as the therapy for end stage kidney disease include the economic limitations which, in some countries place transplantation, appropriately, at a lower priority than public health fundamentals such as clean water, sanitation and vaccination. Even in high income countries the technical challenges of surgery and the consequences of immunosuppression restrict the number of suitable recipients, but the major finite restrictions on kidney transplantation rates are the shortage of donated organs and the limited medical, surgical and nursing workforces with the required expertise. These problems have solutions which involve the full range of societal, professional, governmental and political environments. World Kidney Day is a call to deliver transplantation therapy to the one million people a year who have a right to benefit.

  3. The Global Role of Kidney Transplantation

    Institute of Scientific and Technical Information of China (English)

    Guillermo Garcia Garcia; Paul Harden; Jeremy Chapman

    2012-01-01

    World Kidney Day on March 8th 2012 provides a chance to reflect on the success of kidney transplantation as a therapy for end stage kidney disease that surpasses dialysis treatments both for the quality and quantity of life that it provides and for its cost effectiveness.Anything that is both cheaper and better,but is not actually the dominant therapy,must have other drawbacks that prevent replacement of all dialysis treatment by transplantation.The barriers to universal transplantation as the therapy for end stage kidney disease include the economic limitations which,in some countries place transplantation,appropriately,at a lower priority than public health fundamentals such as clean water,sanitation and vaccination.Even in high income countries the technical challenges of surgery and the consequences of immunosuppression restrict the number of suitable recipients,but the major finite restrictions on kidney transplantation rates are the shortage of donated organs and the limited medical,surgical and nursing workforces with the required expertise.These problems have solutions which involve the full range of societal,professional,governmental and political environments.World Kidney Day is a call to deliver transplantation therapy to the one million people a year who have a right to benefit.

  4. Dissection of the adult zebrafish kidney.

    Science.gov (United States)

    Gerlach, Gary F; Schrader, Lauran N; Wingert, Rebecca A

    2011-08-29

    Researchers working in the burgeoning field of adult stem cell biology seek to understand the signals that regulate the behavior and function of stem cells during normal homeostasis and disease states. The understanding of adult stem cells has broad reaching implications for the future of regenerative medicine. For example, better knowledge about adult stem cell biology can facilitate the design of therapeutic strategies in which organs are triggered to heal themselves or even the creation of methods for growing organs in vitro that can be transplanted into humans. The zebrafish has become a powerful animal model for the study of vertebrate cell biology. There has been extensive documentation and analysis of embryonic development in the zebrafish. Only recently have scientists sought to document adult anatomy and surgical dissection techniques, as there has been a progressive movement within the zebrafish community to broaden the applications of this research organism to adult studies. For example, there are expanding interests in using zebrafish to investigate the biology of adult stem cell populations and make sophisticated adult models of diseases such as cancer. Historically, isolation of the zebrafish adult kidney has been instrumental for studying hematopoiesis, as the kidney is the anatomical location of blood cell production in fish. The kidney is composed of nephron functional units found in arborized arrangements, surrounded by hematopoietic tissue that is dispersed throughout the intervening spaces. The hematopoietic component consists of hematopoietic stem cells (HSCs) and their progeny that inhabit the kidney until they terminally differentiate. In addition, it is now appreciated that a group of renal stem/progenitor cells (RPCs) also inhabit the zebrafish kidney organ and enable both kidney regeneration and growth, as observed in other fish species. In light of this new discovery, the zebrafish kidney is one organ that houses the location of two

  5. [Current status and development of kidney transplantation].

    Science.gov (United States)

    Kirste, G

    1993-01-01

    Since the first successful procedure in 1954 kidney transplantation has become a standard therapy of end stage renal disease. The knowledge of immunoregulation and immune response of the body has enabled people to recognize acute rejection of organs. HLA-testing and organ exchange on basis of HLA-compatibility are extremely important for a successful kidney transplantation. A shortage of organs is limiting the further increase of transplantations. Chronic rejection is in most cases the reason for late graft failure. Further investigations to develop new immunosuppressive drugs and to clarify immunological processes underlying chronic rejections are necessary in the future.

  6. Outcomes of shipped live donor kidney transplants compared with traditional living donor kidney transplants.

    Science.gov (United States)

    Treat, Eric G; Miller, Eric T; Kwan, Lorna; Connor, Sarah E; Maliski, Sally L; Hicks, Elisabeth M; Williams, Kristen C; Whitted, Lauren A; Gritsch, Hans A; McGuire, Suzanne M; Mone, Thomas D; Veale, Jeffrey L

    2014-11-01

    The disparity between kidney transplant candidates and donors necessitates innovations to increase organ availability. Transporting kidneys allows for living donors and recipients to undergo surgery with a familiar transplant team, city, friends, and family. The effect of shipping kidneys and prolonged cold ischemia time (CIT) with living donor transplantation outcomes is not clearly known. This retrospective matched (age, gender, race, and year of procedure) cohort study compared allograft outcomes for shipped live donor kidney transplants and nonshipped living donor kidney transplants. Fifty-seven shipped live donor kidneys were transplanted from 31 institutions in 26 cities. The mean shipping distance was 1634 miles (range 123-2811) with mean CIT of 12.1 ± 2.8 h. The incidence of delayed graft function in the shipped cohort was 1.8% (1/57) compared to 0% (0/57) in the nonshipped cohort. The 1-year allograft survival was 98% in both cohorts. There were no significant differences between the mean serum creatinine values or the rates of serum creatinine decline in the immediate postoperative period even after adjusted for gender and differences in recipient and donor BMI. Despite prolonged CITs, outcomes for shipped live donor kidney transplants were similar when compared to matched nonshipped living donor kidney transplants.

  7. Cancer risk and mortality after kidney transplantation

    DEFF Research Database (Denmark)

    Engberg, Henriette; Wehberg, Sonja; Bistrup, Claus;

    2016-01-01

    to examine whether post-transplant cancer and all-cause mortality differed between Danish renal transplantation centres using standard immunosuppressive protocols including steroids (Centres 2, 3, 4) or a steroid-free protocol (Centre 1). The Danish Nephrology Registry, the Danish Civil Registration System......BACKGROUND: Kidney recipients receive immunosuppression to prevent graft rejection, and long-term outcomes such as post-transplant cancer and mortality may vary according to the different protocols of immunosuppression. METHODS: A national register-based historical cohort study was conducted......, the Danish National Cancer Registry and the Danish National Patient Register were used. A historical cohort of 1450 kidney recipients transplanted in 1995-2005 was followed up with respect to post-transplant cancer and death until 31 December 2011. RESULTS: Compared with Center 1 the adjusted post...

  8. Metallothionein in rabbit kidneys preserved for transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Elinder, C.G.; Lundgren, G.; Nordberg, M.; Palm, B.; Piscator, M.

    1984-03-01

    Thirteen rabbits were given cadmium injections to achieve cadmium concentrations in kidney cortex ranging from 0.05 to 1 mmole Cd/kg wet weight. Another four animals served as controls. One kidney from each animal was frozen directly to -70/sup 0/C whereas the other kidney was kept for 24 hr at +4/sup 0/C in a preservative (Sachs' solution) to simulate conditions for preservation of human donor kidneys before transplantation. Protein binding of cadmium, zinc and copper in kidney homogenates and the concentration of metallothionein (MT) were measured in the kidney that was frozen directly and in the kidney that had been preserved. No gross differences in either the protein binding of cadmium, zinc and copper or in the MT content were seen between the directly frozen and preserved kidney from the same animal. This indicates that MT is not rapidly broken down in rabbit kidneys which have been preserved similarly to human donor kidneys for 24 hr in a standard preservative solution prior to a transplantation. 27 references, 3 figures, 1 table.

  9. Metallothionein in rabbit kidneys preserved for transplantation.

    Science.gov (United States)

    Elinder, C G; Lundgren, G; Nordberg, M; Palm, B; Piscator, M

    1984-03-01

    Thirteen rabbits were given repeated cadmium injections to achieve cadmium concentrations in kidney cortex ranging from 0.05 to 1 mmole Cd/kg wet weight. Another four animals served as controls. One kidney from each animal was frozen directly to -70 degrees C whereas the other kidney was kept for 24 hr at +4 degrees C in a preservative (Sachs' solution) to simulate conditions for preservation of human donor kidneys before transplantation. Protein binding of cadmium, zinc and copper in kidney homogenates and the concentration of metallothionein (MT) were measured in the kidney that was frozen directly and in the kidney that had been preserved. No gross differences in either the protein binding of cadmium, zinc and copper or in the MT content were seen between the directly frozen and preserved kidneys from the same animal. This indicates that MT is not rapidly broken down in rabbit kidneys which have been preserved similarly to human donor kidneys for 24 hr in a standard preservative solution prior to a transplantation.

  10. Urological Complications in Kidney Transplantation

    NARCIS (Netherlands)

    I.K.B. Slagt (Inez)

    2015-01-01

    markdownabstract__Abstract__ The kidney is an essential organ that plays an crucial role in acid-base balance, sodium and potassium balance, calcium metabolism, regulation of blood pressure, red blood cell synthesis and excretion of metabolites. Kidney diseases may result in kidney failure with the

  11. Transplanting Kidneys from Deceased Donors With Severe Acute Kidney Injury.

    Science.gov (United States)

    Heilman, R L; Smith, M L; Kurian, S M; Huskey, J; Batra, R K; Chakkera, H A; Katariya, N N; Khamash, H; Moss, A; Salomon, D R; Reddy, K S

    2015-08-01

    Our aim was to determine outcomes with transplanting kidneys from deceased donors with acute kidney injury, defined as a donor with terminal serum creatinine ≥2.0 mg/dL, or a donor requiring acute renal replacement therapy. We included all patients who received deceased donor kidney transplant from June 2004 to October 2013. There were 162 AKI donor transplant recipients (21% of deceased donor transplants): 139 in the standard criteria donor (SCD) and 23 in the expanded criteria donor (ECD) cohort. 71% of the AKI donors had stage 3 (severe AKI), based on acute kidney injury network (AKIN) staging. Protocol biopsies were done at 1, 4, and 12 months posttransplant. One and four month formalin-fixed paraffin embedded (FFPE) biopsies from 48 patients (24 AKI donors, 24 non-AKI) underwent global gene expression profiling using DNA microarrays (96 arrays). DGF was more common in the AKI group but eGFR, graft survival at 1 year and proportion with IF/TA>2 at 1 year were similar for the two groups. At 1 month, there were 898 differentially expressed genes in the AKI group (p-value kidneys from deceased donors with AKI is safe and has excellent outcomes.

  12. [Kidney donors and kidney transplantation in the elderly].

    Science.gov (United States)

    Giessing, M; Conrad, S; Schönberger, B; Huland, H; Budde, K; Neumayer, H-H; Loening, S A

    2004-08-01

    The likelihood of terminal renal insufficiency escalates with age, increasing the risk of dying as a patient requiring dialysis. In 1999, Eurotransplant initiated the Eurotransplant Senior Programm (ESP), in which the kidneys of old donors (>64 years) are allocated to recipients 64 years and older. Allocation does not take HLA-matching into account and is performed regionally only according to blood-group-compatibility to keep the storage time short. As a consequence of the short ischemic time, and thus reduced non-immunological damage to the anyways susceptible old kidney, graft-function and graft-survival in the ESP are very good. The results of the initial 5 years of this program show that it successfully utilizes more kidneys from old donors and that more old recipients are being transplanted, with a satisfactory graft-function. Increased donor- and/or recipient age require a thorough evaluation to exclude malignant and other diseases. Furthermore, short term controls on the waiting list and following kidney transplantation are prerequisites for successful transplantation in the aged recipient. If this is guaranteed, kidney transplantation in the old recipient-even with old donor organs-is a good alternative to the morbidity of a prolonged dialysis. Nevertheless, the role of HLA-matching should be reconsidered to reduce rejections.

  13. Protein-Based Urine Test Predicts Kidney Transplant Outcomes

    Science.gov (United States)

    ... News Releases News Release Thursday, August 22, 2013 Protein-based urine test predicts kidney transplant outcomes NIH- ... supporting development of noninvasive tests. Levels of a protein in the urine of kidney transplant recipients can ...

  14. Weight, Gender Appear to Play Part in Kidney Transplant Success

    Science.gov (United States)

    ... Gender Appear to Play Part in Kidney Transplant Success Study found the closer the match between donor ... differences between donors and recipients can affect the success of kidney transplants, a new study says. Researchers ...

  15. Cardiovascular morbidity and mortality after kidney transplantation

    OpenAIRE

    Stoumpos, Sokratis; Jardine, Alan G.; Mark, Patrick B.

    2014-01-01

    Kidney transplantation is the optimal treatment for patients with end stage renal disease (ESRD) who would otherwise require dialysis. Patients with ESRD are at dramatically increased cardiovascular (CV) risk compared to the general population. As well as improving quality of life, successful transplantation accords major benefits by reducing cardiovascular risk in these patients. Worldwide, cardiovascular disease remains the leading cause of death with a functioning graft and therefore is a ...

  16. Pregnancy management of women with kidney transplantation

    OpenAIRE

    Kovács, Dávid ágoston; Szabó, László; Jenei, Katalin; Fedor, Roland; Zádori, Gergely; Zsom, Lajos; Kabai, Krisztina; Záhonyi, Anita; Asztalos, László; Nemes, Balázs

    2015-01-01

    Women with renal disease, besides many dysfunctions, face increasing infertility and high-risk pregnancy due to uremia and changes of the hormonal functions. After renal transplantation, sexual dysfunction improves, providing the possibility of successful pregnancy for women of childbearing age. However, kidney transplanted patients are high-risk pregnant patients with increased maternal and fetal risks, and the graft also may be compromised during pregnancy; most studies report on several su...

  17. Plasma adiponectin before and after kidney transplantation

    DEFF Research Database (Denmark)

    Idorn, Thomas; Hornum, Mads; Bjerre, Mette;

    2012-01-01

    The role of plasma adiponectin (ADPN) in patients with impaired kidney function and following kidney transplantation (Tx) is debated. We aimed to: (i) determine whether pretransplant ADPN level is an independent risk factor for deterioration of glucose tolerance including development of new......-onset diabetes mellitus after Tx, (ii) describe which parameters that influence the ADPN concentration before and after Tx. Fifty-seven nondiabetic kidney allograft recipients and 40 nondiabetic uraemic patients were included. The Tx group was examined at baseline and 3 and 12 months after Tx. The uraemic...... analysis, whereas an ordinal logistic regression analysis revealed no predictive characteristic of ADPN for aggravation of the glucose tolerance after Tx. In conclusion, kidney transplantation is accompanied by a significant reduction in ADPN concentration. Several factors determine the ADPN concentration...

  18. Pregnancy management of women with kidney transplantation.

    Science.gov (United States)

    Kovács, Dávid Ágoston; Szabó, László; Jenei, Katalin; Fedor, Roland; Zádori, Gergely; Zsom, Lajos; Kabai, Krisztina; Záhonyi, Anita; Asztalos, László; Nemes, Balázs

    2015-12-01

    Women with renal disease, besides many dysfunctions, face increasing infertility and high-risk pregnancy due to uremia and changes of the hormonal functions. After renal transplantation, sexual dysfunction improves, providing the possibility of successful pregnancy for women of childbearing age. However, kidney transplanted patients are high-risk pregnant patients with increased maternal and fetal risks, and the graft also may be compromised during pregnancy; most studies report on several successive deliveries due to multidisciplinary team management. In clinical practice, the graft is rarely affected during the period of gestation. Fetal development disorders are also rare although preterm delivery and intrauterine growth retardation are common. For now, several studies and clinical investigations proved that, under multidisciplinary control, kidney transplanted female patients are also possible to have safe pregnancy and successful delivery. There are conflicting data in the literature about the prevention of complications and the timing of pregnancy. Herein, we would like to present some experience of our centre. A total of 847 kidney transplantations have been performed between June 1993 and December 2013 with 163 childbearing aged females (18-45 years) in our center. We report on three kidney transplanted patients who have given birth to healthy newborns. In our practice, severe complications have not been observed.

  19. Pregnancy management of women with kidney transplantation

    Science.gov (United States)

    Kovács, Dávid ágoston; Szabó, László; Jenei, Katalin; Fedor, Roland; Zádori, Gergely; Zsom, Lajos; Kabai, Krisztina; Záhonyi, Anita; Asztalos, László; Nemes, Balázs

    2015-01-01

    Women with renal disease, besides many dysfunctions, face increasing infertility and high-risk pregnancy due to uremia and changes of the hormonal functions. After renal transplantation, sexual dysfunction improves, providing the possibility of successful pregnancy for women of childbearing age. However, kidney transplanted patients are high-risk pregnant patients with increased maternal and fetal risks, and the graft also may be compromised during pregnancy; most studies report on several successive deliveries due to multidisciplinary team management. In clinical practice, the graft is rarely affected during the period of gestation. Fetal development disorders are also rare although preterm delivery and intrauterine growth retardation are common. For now, several studies and clinical investigations proved that, under multidisciplinary control, kidney transplanted female patients are also possible to have safe pregnancy and successful delivery. There are conflicting data in the literature about the prevention of complications and the timing of pregnancy. Herein, we would like to present some experience of our centre. A total of 847 kidney transplantations have been performed between June 1993 and December 2013 with 163 childbearing aged females (18–45 years) in our center. We report on three kidney transplanted patients who have given birth to healthy newborns. In our practice, severe complications have not been observed. PMID:26767122

  20. [The kidney transplantation from the ABO-incompatible donors].

    Science.gov (United States)

    Goriaĭnov, V A; Kaabak, M M; Babenko, N N; Shishlo, L A; Morozova, M M; Ragimov, A A; Dashkova, N G; Salimov, É L

    2012-01-01

    The experience of 28 allotransplantations of ABO-incompatible kidneys was compared with the treatment results of 38 ABO-compatible renal transplantations. The transplanted kidney function, morphological changes of the transplanted kidney and the comparative analysis of actuary survival in both groups showed no significant difference. The results of the study prove the validity of the kidney transplantation from the ABO-incompatible donors.

  1. SURGICAL OPTIMIZATION OF KIDNEY TRANSPLANTATION FROM ELDER DONOR

    Directory of Open Access Journals (Sweden)

    S. F. Bagnenko

    2011-01-01

    Full Text Available Article provides elaborated method of kidney grafts quality evaluation by virtue of hypothermic perfusion data and express biopsy results. 27 kidney transplantation in older age recipients group were carried out from elder kidney donors. 7 of them were double kidney transplantation. First results of transplantation in elder recipients were compared with 31 transplant procedures in young recipients from optimal donor. To day 90 there were no significant differences in creatinine level between the study and comparison group. 

  2. Cancer risk with alemtuzumab following kidney transplantation.

    Science.gov (United States)

    Puttarajappa, C; Yabes, J; Bei, L; Shah, N; Bernardo, J; McCauley, J; Basu, A; Tan, H; Shapiro, R; Unruh, M; Wu, C

    2013-01-01

    Alemtuzumab has been employed for induction therapy in kidney transplantation with low rates of acute rejection and excellent graft and patient survival. Antibody induction therapy has been linked to increased vulnerability to cancer. Data regarding malignancy rates with alemtuzumab are limited. We studied 1350 kidney transplant recipients (between 2001 and 2009) at the University of Pittsburgh Starzl Transplant Institute, for post-transplant de novo and recurrent malignancy, excluding non-melanoma skin cancer, among patients receiving alemtuzumab, thymoglobulin, and no induction therapies. Of the 1350 patients, 1002 (74.2%) received alemtuzumab, 205 (15.2%) received thymoglobulin, and 122 (9%) received no induction therapy. After excluding cancers occurring within 60 d post-transplantation, 43 (3.25%) malignancies were observed during a median follow-up time of 4.0 yr. The incidence of malignancy was 5.4% (1.09 per 100 patient-years [PY]) with thymoglobulin, 2.8% (0.74 per 100 PY) with alemtuzumab, and 3.3% (0.66 per 100 PY) with no induction (across all groups; p = 0.2342, thymoglobulin vs. alemtuzumab; p = 0.008). Thus, with the exception of non-melanoma skin cancer which we did not evaluate, alemtuzumab induction was not associated with increased cancer incidence post-kidney transplantation when compared to no induction therapy and was associated with lower cancer incidence when compared to thymoglobulin.

  3. Urinary tract infection in kidney transplant recipients.

    Science.gov (United States)

    Chacón-Mora, Natalia; Pachón Díaz, Jerónimo; Cordero Matía, Elisa

    2016-04-21

    Infectious complications remain a major cause of morbidity and mortality among transplant recipients. Urinary tract infection (UTI) is the most common infectious complication in kidney transplant recipients with a reported incidence from 25% to 75%, varies widely likely due to differences in definition, diagnostic criteria, study design, and length of observation. We sought reviews the incidence and importance of urinary tract infection on graft survival, the microbiology with special emphasis on multidrug resistant microorganisms, the therapeutic management of UTI and the prophylaxis of recurrent UTI among solid organ transplant recipients, highlighting the need for prospective clinical trials to unify the clinical management in this population.

  4. Calciphylaxis following kidney transplantation: a case report

    Directory of Open Access Journals (Sweden)

    Hanvesakul Rajesh

    2009-11-01

    Full Text Available Abstract Introduction Calciphylaxis occurring after kidney transplantation is rare and rarely reported. It results in chronic non-healing wounds and is associated with a poor prognosis and is often fatal. We present a case of proximal lower limb calciphylaxis that occurred early after kidney transplantation. The patient had no classic associated risk factors. He had previously had a total parathyroidectomy but had normal serum calcium-phosphate product and parathyroid hormone levels. The clinical outcome of this case was favorable and highlights some fundamental issues relating to management. Case presentation A 70-year-old British Caucasian man with end-stage renal failure secondary to IgA nephropathy presented six months post kidney transplantation with cutaneous calciphylaxis lesions involving the medial aspect of the thigh bilaterally. Conclusion To the best of our knowledge, this is the first reported case of rapid onset cutaneous calciphylaxis occurring soon after kidney transplantation that was associated with a favorable outcome. Cutaneous calciphylaxis lesions should be promptly managed with meticulous wound care, antimicrobial therapy and the correction of calcium-phosphate product where indicated.

  5. Transitional Care and Adherence of Adolescents and Young Adults After Kidney Transplantation in Germany and Austria: A Binational Observatory Census Within the TRANSNephro Trial.

    Science.gov (United States)

    Kreuzer, Martin; Prüfe, Jenny; Oldhafer, Martina; Bethe, Dirk; Dierks, Marie-Luise; Müther, Silvia; Thumfart, Julia; Hoppe, Bernd; Büscher, Anja; Rascher, Wolfgang; Hansen, Matthias; Pohl, Martin; Kemper, Markus J; Drube, Jens; Rieger, Susanne; John, Ulrike; Taylan, Christina; Dittrich, Katalin; Hollenbach, Sabine; Klaus, Günter; Fehrenbach, Henry; Kranz, Birgitta; Montoya, Carmen; Lange-Sperandio, Bärbel; Ruckenbrodt, Bettina; Billing, Heiko; Staude, Hagen; Heindl-Rusai, Krisztina; Brunkhorst, Reinhard; Pape, Lars

    2015-12-01

    Transition from child to adult-oriented care is widely regarded a challenging period for young people with kidney transplants and is associated with a high risk of graft failure. We analyzed the existing transition structures in Germany and Austria using a questionnaire and retrospective data of 119 patients transferred in 2011 to 2012. Most centers (73%) confirmed agreements on the transition procedure. Patients' age at transfer was subject to regulation in 73% (18 years). Median age at transition was 18.3 years (16.5-36.7). Median serum creatinine increased from 123 to 132 μmol/L over the 12 month observation period before transfer (P = 0.002). A total of 25/119 patients showed increased creatinine ≥ 20% just before transfer. Biopsy proven rejection was found in 10/119 patients. Three patients lost their graft due to chronic graft nephropathy.Mean coefficient of variation (CoV%) of immunosuppression levels was 0.20 ± 0.1. Increased creatinine levels ≥ 20% just before transfer were less frequently seen in patients with CoV < 0.20 (P = 0.007). The majority of pediatric nephrology centers have internal agreements on transitional care. More than half of the patients had CoV of immunosuppression trough levels consistent with good adherence. Although, 20% of the patients showed increase in serum creatinine close to transfer.

  6. Acute rejection episodes after kidney transplantation

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    Hamida Fethi

    2009-01-01

    Full Text Available Acute rejection episodes (AREs are a major determinant of renal allograft survival. The incorporation of new immunosuppressive agents explains, at least partially, the improvement seen in the results of transplantation in recent years. The objectives of this study are to analyze the incidence and severity of AREs, their risk factors and their influence on graft and patient survival. We retrospectively studied 280 kidney transplants performed in adults at the Charles Nicolle Hospital, Tunis, between 1986 and 2004. The diagnosis of ARE was based on clinical data and response to treatment. Allograft biopsies were performed in ten cases. The treatment of AREs consisted of pulse methylprednisolone and anti-thymocyte globulin. There were 186 males (66.4% and 94 females (33.6%, and their mean age was 31 ± 8.9 years. Overall, the 280 study patients experienced a total of 113 AREs. Of them, 85 had only one ARE, 28 had two to three and none had more than three AREs. A total of 68 AREs were completely re-versible, 42 were partially reversible while three could not be reversed with treatment. The mean inci-dence of AREs was 40.4%. The incidence was > 45% between 1986 and 1997, decreased to 20.5% between 1998 and 2000 and to 9% between 2001 and 2004. Graft survival rates in patients with and without AREs were respectively 91% and 93% at three years, 82% and 90% at five years and 73% and 83% at 10 years. We found a decrease in the incidence of AREs in recent years in our study patients, and this was related to the introduction of sensitized cross-match and the newer immunosuppressive agents, particularly MMF. Additionally, AREs had a deleterious impact on late graft survival in our study population.

  7. OCULAR PATHOLOGY IN PATIENTS AFTER KIDNEY TRANSPLANTATION

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    L. K. Moshetova

    2011-01-01

    Full Text Available Structural changes in eyes are present in all patients with chronic kidney disease. A study to detect ocular patho- logy in patients with end-stage chronic renal failure after kidney transplantation in the early and late postopera- tive period compared with patients receiving replacement therapy with hemodialysis. Revealed that in the early post-transplant period in recipients of kidneyas in patients on hemodialysis, continued angioretinopatiya, 40% of patients had «dry eye syndrome». In the delayed post-transplant period, patients showed significant impro- vement in the retina and retinal vessels, the improvement of spatial-temporal parameters of visual perception. However, a decrease of visual acuity on the background of the development of posterior subcapsular cataract caused by prolonged corticosteroid, and an increased incidence of viral and bacterial conjunctivitis. 

  8. Thoracic radiology in kidney and liver transplantation.

    Science.gov (United States)

    Fishman, Joel E; Rabkin, John M

    2002-04-01

    Renal transplantation accounts for more than half of all solid organ transplants performed in the U.S., and the liver is the second most commonly transplanted solid organ. Although abdominal imaging procedures are commonplace in these patients, there has been relatively little attention paid to thoracic imaging applications. Preoperative imaging is crucial to aid in the exclusion of infectious or malignant disease. In the perioperative time period, thoracic imaging focuses both on standard intensive care unit care, including monitoring devices and their complications, and on the early infections that can occur. Postoperative management is divided into three time periods, and the principles governing the occurrence of infections and malignancies are reviewed. Anatomic and pathologic aspects unique to kidney and liver transplantation patients are also discussed.

  9. Early monitoring of the human polyomavirus BK replication and sequencing analysis in a cohort of adult kidney transplant patients treated with basiliximab

    Directory of Open Access Journals (Sweden)

    Mischitelli Monica

    2011-08-01

    Full Text Available Abstract Background Nowadays, better immunosuppressors have decreased the rates of acute rejection in kidney transplantation, but have also led to the emergence of BKV-associated nephropathy (BKVAN. Therefore, we prospectively investigated BKV load in plasma and urine samples in a cohort of kidney transplants, receiving basiliximab combined with a mycophenolate mofetil-based triple immunotherapy, to evaluate the difference between BKV replication during the first 3 months post-transplantation, characterized by the non-depleting action of basiliximab, versus the second 3 months, in which the maintenance therapy acts alone. We also performed sequencing analysis to assess whether a particular BKV subtype/subgroup or transcriptional control region (TCR variants were present. Methods We monitored BK viruria and viremia by quantitative polymerase chain reaction (Q-PCR at 12 hours (Tx, 1 (T1, 3 (T2 and 6 (T3 months post-transplantation among 60 kidney transplant patients. Sequencing analysis was performed by nested-PCR with specific primers for TCR and VP1 regions. Data were statistically analyzed using χ2 test and Student's t-test. Results BKV was detected at Tx in 4/60 urine and in 16/60 plasma, with median viral loads of 3,70 log GEq/mL and 3,79 log GEq/mL, respectively, followed by a significant increase of both BKV-positive transplants (32/60 and median values of viruria (5,78 log GEq/mL and viremia (4,52 log GEq/mL at T2. Conversely, a significantly decrease of patients with viruria and viremia (17/60 was observed at T3, together with a reduction of the median urinary and plasma viral loads (4,09 log GEq/mL and 4,00 log GEq/mL, respectively. BKV TCR sequence analysis always showed the presence of archetypal sequences, with a few single-nucleotide substitutions and one nucleotide insertion that, interestingly, were all representative of the particular subtypes/subgroups we identified by VP1 sequencing analysis: I/b-2 and IV/c-2. Conclusions Our

  10. Renal cancer in kidney transplanted patients.

    Science.gov (United States)

    Frascà, Giovanni M; Sandrini, Silvio; Cosmai, Laura; Porta, Camillo; Asch, William; Santoni, Matteo; Salviani, Chiara; D'Errico, Antonia; Malvi, Deborah; Balestra, Emilio; Gallieni, Maurizio

    2015-12-01

    Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90% of cases and the graft in 10 %. In addition to general risk factors, malignancy susceptibility may be influenced by immunosuppressive therapy, the use of calcineurin inhibitors (CNI) as compared with mammalian target of rapamycin inhibitors, and the length of dialysis treatment. Acquired cystic kidney disease may increase the risk for renal cancer after transplantation, while autosomal dominant polycystic kidney disease does not seem to predispose to cancer development. Annual ultrasound evaluation seems appropriate in patients with congenital or acquired cystic disease or even a single cyst in native kidneys, and every 2 years in patients older than 60 years if they were on dialysis for more than 5 years before transplantation. Immunosuppression should be lowered in patients who develop renal cancer, by reduction or withdrawal of CNI. Although more evidence is still needed, it seems reasonable to shift patients from CNI to everolimus or sirolimus if not already treated with one of these drugs, with due caution in subjects with chronic allograft nephropathy.

  11. [Calcification in nonfunctioning transplanted kidneys].

    Science.gov (United States)

    Peces, R; Sánchez, R J; Fernández, E J; Peces, C

    2007-01-01

    Failed renal allografts often are left in situ in patients who revert to chronic dialysis therapy or who undergo retransplantation. These organs may be the site of massive calcification despite their lack of physiological function. Calcification of an endstage renal allograft is sometimes found incidentally. We report here two patients who developed extensive calcification of the renal graft, one was on chronic hemodialysis and the other had a second renal transplantation with normal renal function. The precise pathogenesis of calcification and the factors which determine its tissue localization are unclear. Factors postulated to promote the development of metastatic calcification include an elevated calcium phosphate product, severe secondary hyperparathyroidism, aluminium toxicity and duration of dialytic therapy. In some cases local factors related with the chronic inflammatory rejection process are probably involved as well. However, the exact relative contribution of these factors remains unresolved. Unless specific clinical indications are present, transplant nephrectomy is not necessary for calcified end-stage renal allografts.

  12. The case for pancreas after kidney transplantation.

    Science.gov (United States)

    Fridell, Jonathan A; Mangus, Richard S; Hollinger, Edward F; Taber, Tim E; Goble, Michelle L; Mohler, Elaine; Milgrom, Martin L; Powelson, John A

    2009-01-01

    Pancreas after kidney (PAK) transplantation has historically demonstrated inferior pancreas allograft survival compared to simultaneous pancreas and kidney (SPK) transplantation. Under our current immunosuppression protocol, we have noted excellent outcomes and rare immunological graft loss. The goal of this study was to compare pancreas allograft survival in PAK and SPK recipients using this regimen. This was a single center retrospective review of all SPK and PAK transplants performed between January 2003 and November 2007. All transplants were performed with systemic venous drainage and enteric exocrine drainage. Immunosuppression included induction with rabbit anti-thymocyte globulin (thymoglobulin), early steroid withdrawal, and maintenance with tacrolimus and sirolimus or mycophenolate mofetil. Study end points included graft and patient survival and immunosuppression related complications. Transplants included PAK 61 (30%) and SPK 142 (70%). One-yr patient survival was PAK 98% and SPK 95% (p = 0.44) and pancreas graft survival was PAK 95% and SPK 90% (p = 0.28). Acute cellular rejection was uncommon with 2% requiring treatment in each group. Survival for PAK using thymoglobulin induction, early steroid withdrawal and tacrolimus-based immunosuppression is at least comparable to SPK and should be pursued in the recipient with a potential living donor.

  13. BK Virus in Recipients of Kidney Transplants.

    Science.gov (United States)

    Hendrix, Kelly M

    2014-01-01

    Since its discovery in 1971, the BK virus, a human polyomavirus, has emerged as a significant cause of renal dysfunction and transplant graft loss in kidney transplant recipients. Improved screening methods have been effective in assisting in the early identification of the virus, and thus, prompt intervention to prevent the progression of the disease. Treatment options for the virus are limited; therefore, lowering immunosuppressive medications should be considered the first line of treatment. Current adjunctive therapies are not guaranteed to control the viral activity and may have limited therapeutic value.

  14. Arterial flow regulator enables transplantation and growth of human fetal kidneys in rats.

    Science.gov (United States)

    Chang, N K; Gu, J; Gu, S; Osorio, R W; Concepcion, W; Gu, E

    2015-06-01

    Here we introduce a novel method of transplanting human fetal kidneys into adult rats. To overcome the technical challenges of fetal-to-adult organ transplantation, we devised an arterial flow regulator (AFR), consisting of a volume adjustable saline-filled cuff, which enables low-pressure human fetal kidneys to be transplanted into high-pressure adult rat hosts. By incrementally withdrawing saline from the AFR over time, blood flow entering the human fetal kidney was gradually increased until full blood flow was restored 30 days after transplantation. Human fetal kidneys were shown to dramatically increase in size and function. Moreover, rats which had all native renal mass removed 30 days after successful transplantation of the human fetal kidney were shown to have a mean survival time of 122 days compared to 3 days for control rats that underwent bilateral nephrectomy without a prior human fetal kidney transplant. These in vivo human fetal kidney models may serve as powerful platforms for drug testing and discovery.

  15. Chronic Disease and Childhood Development: Kidney Disease and Transplantation.

    Science.gov (United States)

    Klein, Susan D.; Simmons, Roberta G.

    As part of a larger study of transplantation and chronic disease and the family, 124 children (10-18 years old) who were chronically ill with kidney disease (n=72) or were a year or more post-transplant (n=52) were included in a study focusing on the effects of chronic kidney disease and transplantation on children's psychosocial development. Ss…

  16. Strongyloides stercoralis infection in kidney transplant recipients.

    Science.gov (United States)

    Abdalhamid, Baha A; Al Abadi, Abdul Naser M; Al Saghier, Mohammed I; Joudeh, Amani A; Shorman, Mahmoud A; Amr, Samir S

    2015-01-01

    Strongyloides stercoralis is an uncommon infection in Saudi Arabia. It can establish latency and cause an autoinfection in humans that lasts for years. The infection can get reactivated during immunosuppression and can result in a life-threatening Strongyloides hyperinfection syndrome. We present three cases of renal transplant recipients who developed Strongyloides infection following transplantation. A bronchoalveolar lavage specimen, a duodenal biopsy and/or a stool specimen from these patients revealed evidence of S. stercoralis larvae. The first two patients received kidneys from the same deceased donor, a native of Bangladesh, an area that is highly endemic for S. stercoralis. The data suggest that the first two cases might be donor derived. High-risk donors and recipients should be screened for Strongyloides infection to initiate treatment before transplantation thus reducing morbidity and mortality.

  17. Fatal cutaneous mucormycosis after kidney transplant.

    Science.gov (United States)

    Davuodi, Setareh; Manshadi, Seyed Ali Dehghan; Salehi, Mohammad Reza; Yazdi, Farhad; Khazravi, Mona; Fazli, Jafar Taghizade

    2015-02-01

    Mucormycosis is an uncommon opportunistic infection that is caused by Mucorales from the Zygomycetes class. Patients with severe immunodeficiency admitted to the hospital are at greatest risk for developing this infection. Mucormycosis usually is transmitted in humans by inhalation or inoculation of spores in the skin or mucous membranes. A 66-year-old man developed a surgical wound infection at 1 week after kidney transplant that did not improve despite broad-spectrum antibiotics and debridement. He was transferred to our hospital 45 days after transplant and had fever and a large purulent wound that was surrounded by a black necrotizing margin. Immunosuppressive drugs were discontinued and the dosage of prednisolone was decreased. Massive debridement was performed but was incomplete because he had full-thickness abdominal wall necrosis. Histopathology showed broad fungal hyphae without septation, consistent with the diagnosis of mucormycosis. Despite antifungal therapy with amphotericin B and additional debridement, the patient died of septic shock at 52 days after kidney transplant. Cutaneous fungal infections should be considered in the differential diagnosis of any nonhealing infected wound that does not respond to broad-spectrum antibiotics, especially in patients with predisposing risk factors such as transplant.

  18. Update on laparoscopic/robotic kidney transplant: a literature review

    Directory of Open Access Journals (Sweden)

    He B

    2013-09-01

    Full Text Available Bulang He,1,2 Jeffrey M Hamdorf2 1Liver and Kidney Transplant Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia; 2School of Surgery, The University of Western Australia, Perth, WA, Australia Aims: The aim of this paper was to review the current status of laparoscopic/robotic kidney transplant and evaluate its feasibility and safety in comparison with conventional standard "open" kidney transplant. Methods: An electronic search of PubMed, Embase, and the Cochrane library database was performed to identify the papers between January 1980 and June 2013 that reported on laparoscopic/robotic kidney transplantation. The terms "laparoscopic kidney/renal transplant" and "robotic kidney/renal transplant (transplantation" were used. Cross-referencing was also used to find the further publications. Only English language reports were selected and accepted for descriptive analysis. Results: A total of 17 papers and abstracts were retrieved. There were two case-control studies of small volume. High-level evidence comparing the safety and efficacy of laparoscopic/robotic kidney transplant with conventional open kidney transplant was not available at the time of this review. Conclusion: The limited published data have suggested that laparoscopic/robotic kidney transplant may offer the advantages of less pain, better cosmesis, possible shorter hospital stay, and fewer wound complications, without compromising graft function. Accordingly, some immunosuppressive agents, such as sirolimus, might be able to be commenced earlier, after laparoscopic/robotic kidney transplant. The techniques are various at this early stage. A uniformed operative technique may be established in the near future. With refinement of laparoscopic devices, this technique may be widely employed. Further studies will be needed to demonstrate the advantages of laparoscopic/robotic kidney transplant over the conventional open kidney transplant. Keywords: laparoscopic surgery, robotic

  19. Kidney transplant in diabetic patients: modalities, indications and results

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    Rangel Érika B

    2009-08-01

    Full Text Available Abstract Background Diabetes is a disease of increasing worldwide prevalence and is the main cause of chronic renal failure. Type 1 diabetic patients with chronic renal failure have the following therapy options: kidney transplant from a living donor, pancreas after kidney transplant, simultaneous pancreas-kidney transplant, or awaiting a deceased donor kidney transplant. For type 2 diabetic patients, only kidney transplant from deceased or living donors are recommended. Patient survival after kidney transplant has been improving for all age ranges in comparison to the dialysis therapy. The main causes of mortality after transplant are cardiovascular and cerebrovascular events, infections and neoplasias. Five-year patient survival for type 2 diabetic patients is lower than the non-diabetics' because they are older and have higher body mass index on the occasion of the transplant and both pre- and posttransplant cardiovascular diseases prevalences. The increased postransplant cardiovascular mortality in these patients is attributed to the presence of well-known risk factors, such as insulin resistance, higher triglycerides values, lower HDL-cholesterol values, abnormalities in fibrinolysis and coagulation and endothelial dysfunction. In type 1 diabetic patients, simultaneous pancreas-kidney transplant is associated with lower prevalence of vascular diseases, including acute myocardial infarction, stroke and amputation in comparison to isolated kidney transplant and dialysis therapy. Conclusion Type 1 and 2 diabetic patients present higher survival rates after transplant in comparison to the dialysis therapy, although the prevalence of cardiovascular events and infectious complications remain higher than in the general population.

  20. En bloc transplantation of horseshoe kidney in Korea

    Science.gov (United States)

    Bang, Jun Bae; Lee, Jae Myeong; Oh, Chang-Kwon; Lee, Kyo Won; Park, Jae Berm; Kim, Sung Joo

    2017-01-01

    Transplantation of the horseshoe kidney can be performed en bloc or split into 2 grafts according to the vascular anomaly and the existence of the urinary collecting system in isthmus. From 2011 to 2014, there were 3 horseshoe kidney transplantations in Korea and transplantations were performed at 2 different centers. The transplantations were carried out successfully for all recipients without complications. All recipients have shown good graft kidney function after transplantation. No severe complication was revealed during follow-up period. We described the surgical technique used in the en bloc method to overcome various vascular anomalies and difficulties in choosing cannulation site and postoperative complications. En bloc transplantation of a horseshoe kidney is a useful strategy for patients with end-stage renal disease, and can provide favorable outcomes compared to the transplantation of a normal kidney.

  1. Recurrence of primary hyperoxaluria: An avoidable catastrophe following kidney transplant

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    Madiwale C

    2008-01-01

    Full Text Available Primary hyperoxaluria is a rare autosomal recessive disease due to deficiency of an oxalate-metabolizing liver enzyme, which results in nephrolithiasis and renal failure. Concomitant liver and kidney transplant is recommended as isolated kidney transplant is inevitably complicated by recurrence of the disease. We present a 25-year-old man with end-stage nephrolithiatic renal disease who underwent bilateral nephrectomy, followed by kidney transplantation. There was progressive worsening of kidney function two weeks post transplant. Review of nephrectomy and transplant kidney biopsy showed abundant calcium oxalate crystals and further workup revealed hyperoxaluria, which was previously unsuspected. Later he developed fever, breathlessness, hemiparesis and died 10 weeks after transplant. Autopsy revealed multi-organ deposits of oxalate crystals as well as widespread zygomycosis. This case emphasizes the need for careful pre-transplant evaluation of patients with renal calculus disease in order to exclude primary hyperoxaluria.

  2. [Kidney transplant in patients with HIV infection].

    Science.gov (United States)

    Bossini, Nicola; Sandrini, Silvio; Valerio, Francesca

    2012-01-01

    Until recently, human immunodeficiency virus (HIV) infection was an absolute contraindication to solid organ transplantation because it was feared that the anti-rejection therapy could result in accelerated HIV disease. At the end of the 1990s it became clear that HIV infection, once deemed a fatal disease, could be effectively turned into a chronic condition by the use of highly active antiretroviral therapy. Since then, the mortality rate from opportunistic infections has decreased dramatically, while liver and renal insufficiency have become the major causes of morbidity and mortality in these patients in the long term. A growing number of HIV patients develop end-stage renal disease secondary to immune-mediated glomerulonephritis, HIV-associated nephropathy, nephrotoxic effects induced by antiretroviral medication, or diabetic and vascular nephropathy, and therefore need maintenance dialysis. For this reason we have to reconsider kidney transplant as a possible treatment option. During the last decade, the results of many studies have shown that transplantation can be safe and effective as long as the HIV infection is effectively controlled by antiretroviral therapy. The short- and medium-term patient and graft survival rates in HIV-positive transplant recipients are comparable with those of the overall transplant population, but the incidence of acute rejection episodes is higher. The main clinical problem in the management of HIV-positive transplant recipients originates from the interference between immunosuppressive regimens and antiretroviral drugs. Thus, a close collaboration between infectious disease specialists and nephrologists is mandatory in order to optimize transplantation programs in these patients.

  3. The perception of sleep quality in kidney transplant patients during the first year of transplantation

    OpenAIRE

    Dnyelle Souza Silva; Elisangela dos Santos Prado Andrade; Rosilene Motta Elias; Elias David-Neto; William Carlos Nahas; Manuel Carlos Martins de Castro; Maria Cristina Ribeiro Castro

    2012-01-01

    OBJECTIVE: Poor sleep quality is one of the factors that adversely affects patient quality of life after kidney transplantation, and sleep disorders represent a significant cardiovascular risk factor. The objective of this study was to investigate the prevalence of changes in sleep quality and their outcomes in kidney transplant recipients and analyze the variables affecting sleep quality in the first years after renal transplantation. METHODS: Kidney transplant recipients were evaluated at t...

  4. Progress in pancreas transplantation and combined pancreas-kidney transplantation

    Institute of Scientific and Technical Information of China (English)

    Chang-Sheng Ming; Zhong-Hua Klaus Chen

    2007-01-01

    BACKGROUND:Pancreas transplantation (PT) has proved effective but it is associated with a high risk of surgical complications and technical failure. Duct management and venous drainage are identiifed as major issues. Improvements in immunosuppression and prophylaxis greatly have contributed to surgical progress. DATA SOURCES: A literature search of the PubMed database (1996-2005) was conducted and research articles on PT reviewed. RESULTS: More than 23 000 PTs have been performed throughout the world. The majority (83%) were performed in combination with kidney transplantation [simultaneous pancreas-kidney transplantation (SPK)]. Pancreas graft survival rates at one year were 85% for 2001-2003 SPK cases, 79% for pancreas after kidney transplantation (PAK) cases, and 76% for pancreas transplantation alone (PTA) cases. For the 1999-2003 cases, enteric drainage was done in 79% of the SPK cases and bladder drainage in 21%. Patient survival rates, pancreas and kidney graft survival rates, and pancreas graft immunological failure rates did not differ signiifcantly in enteric versus bladder drainage cases. All the available data fail to demonstrate a deifnitive advantage of portal drainage over systemic drainage. From 1993 to 2002, the use of rabbit antithymocyte globulin increased from 0 to 37%;the use of daclizumab increased from 0 to 16%;and the use of basiliximab increased from 0 to 25%. In 1993, 98%of SPK recipients received cyclosporine;but this was decreased to 9% in 2002. Tacrolimus (FK506) usage has increased from 0 (1993) to 87%(2002) of SPK recipients. Sirolimus (SIR) usage has increased from 0 (1993) to 18%(2002) of SPK recipients. CONCLUSIONS: PT remains an effective therapy for treatment of type Ⅰ diabetes mellitus. Enteric drainage is currently predominant in SPK, but bladder drainage is still largely used. Portal drainage is as safe as systemic drainage, but there is still no convincing evidence about whether it is immunologically or metabolically

  5. Acute Kidney Disease After Liver and Heart Transplantation.

    Science.gov (United States)

    Rossi, Ana P; Vella, John P

    2016-03-01

    After transplantation of nonrenal solid organs, an acute decline in kidney function develops in the majority of patients. In addition, a significant number of nonrenal solid organ transplant recipients develop chronic kidney disease, and some develop end-stage renal disease, requiring renal replacement therapy. The incidence varies depending on the transplanted organ. Acute kidney injury after nonrenal solid organ transplantation is associated with prolonged length of stay, cost, increased risk of death, de novo chronic kidney disease, and end-stage renal disease. This overview focuses on the risk factors for posttransplant acute kidney injury after liver and heart transplantation, integrating discussion of proteinuria and chronic kidney disease with emphasis on pathogenesis, histopathology, and management including the use of mechanistic target of rapamycin inhibition and costimulatory blockade.

  6. Successful 4th kidney transplantation: a case report from Iran.

    Science.gov (United States)

    Nourbala, Mohammad Hossein; Ghadian, Alireza; Einollahi, Behzad; Azarabadi, Mehdi

    2013-05-21

    Kidney transplantation is generally considered the best option for most patients with end-stage renal disease requiring renal replacement therapy, even for patients with graft failure. Here, we describe a case of a 49-year-old man who received his 1st kidney transplant the United Kingdom from his brother when he was 18 years old in. Thirty-one year after the first transplant, he underwent successful 4th living-unrelated kidney transplantation with no serious complications at our transplant center. He continued to have excellent allograft function and his latest serum creatinine 33 months after his 4th transplant was 1.2 mg/dL. To our knowledge, this is the first case of 4th kidney transplantation from Iran.

  7. Bilateral native nephrectomy for refractory hypertension in kidney transplant and kidney pancreas transplant patients

    Directory of Open Access Journals (Sweden)

    Mark J. Lerman

    2015-01-01

    We found laparoscopic bilateral native nephrectomy to be beneficial in renal and simultaneous kidney pancreas transplant patients with severe and refractory hypertension. Our patients with better baseline renal allograft function at time of nephrectomy received the most benefit. No decrease in allograft function could be attributed to acute rejection.

  8. METABOLIC ACIDOSIS--AN UNDERESTIMATED PROBLEM AFTER KIDNEY TRANSPLANTATION?.

    Science.gov (United States)

    Katalinić, Lea; Blaslov, Kristina; Đanić-Hadžibegović, Ana; Gellineo, Lana; Kes, Petar; Jelaković, Bojan; Basić-Jukić, Nikolina

    2015-12-01

    Despite prolonged survival and better quality of life as compared to dialysis, kidney transplantation frequently presents with a complex set of medical issues that require intensive management to protect graft function. Metabolic acidosis has an impact on several metabolic complications such as mineral and muscle metabolism, nutritional status and anemia. It may also have an effect on graft function, possibly through the stimulation of adaptive mechanisms aimed at maintaining acid-base homeostasis. We investigated current practice in the evaluation of metabolic acidosis at one of the largest transplant centers in the Eurotransplant region. Adult renal transplant recipients having received allograft from January 2011 to August 2012 were included in the investigation. We recorded the frequency of measuring the parameters of venous blood gas analysis, as well as creatinine and urea levels, creatinine clearance, proteinuria, calcium, phosphate and potassium blood levels, body mass index and the time spent on dialysis prior to kidney transplantation. Out of 203 patients who had received renal allograft at our institution during the observed period, 191 (124 males and 67 females, age range from 18 to 77 years) were enrolled in the study. Of these, only 92 (48.167%) patients had parameters of venous blood gas analysis measured at some time after kidney transplantation. Acid-base status was determined more often in males (77 males vs. 22 females, p = 0.001). Patients with pH/blood gas analysis performed were found to have significantly higher creatinine and urea levels and significantly lower creatinine clearance (p Metabolic acidosis is a very important clinical issue that needs to be monitored in every transplant recipient. Its effects on graft function, nutritional status, anemia and bone mass are complex but can be successfully managed. Our study showed metabolic acidosis to be linked with significantly higher creatinine and urea levels, decreased creatinine clearance

  9. Immunologic monitoring in kidney transplant recipients

    Directory of Open Access Journals (Sweden)

    Natavudh Townamchai

    2013-06-01

    Full Text Available Transplant biopsy has always been the gold standard for assessing the immune response to a kidney allograft (Chandraker A: Diagnostic techniques in the work-up of renal allograft dysfunction—an update. Curr Opin Nephrol Hypertens 8:723–728, 1999. A biopsy is not without risk and is unable to predict rejection and is only diagnostic once rejection has already occurred. However, in the past two decades, we have seen an expansion in assays that can potentially put an end to the “drug level” era, which until now has been one of the few tools available to clinicians for monitoring the immune response. A better understanding of the mechanisms of rejection and tolerance, and technological advances has led to the development of new noninvasive methods to monitor the immune response. In this article, we discuss these new methods and their potential uses in renal transplant recipients.

  10. Current status of pediatric kidney transplantation in China: data analysis of Chinese Scientific Registry of Kidney Transplantation

    Institute of Scientific and Technical Information of China (English)

    Liu Longshan; Zhang Huanxi; Fu Qian; Chen Liping; Sun Chuanhou; Xiong Yunyi; Shi Bingyi

    2014-01-01

    Background Kidney transplantation (KTx) is the primary therapy for children with renal failure.Unlike KTx in adult patients,it is commonly agreed that pediatric KTx in China is far behind that of America.There has been no systematic analysis of Chinese pediatric KTx reported.This study aimed to demonstrate the current status of pediatric KTx in China.Methods Registry data of pediatric KTx (1983-2012) from Chinese Scientific Registry of Kidney Transplantation (CSRKT) were retrospectively analyzed.Results There were 851 pediatric KTx from 102 transplant units.The recipients were (15.4±2.5) years of age,93.9% of who were over 10 years old.Chronic glomerulonephritis and pyelonephritis accounted for 75.6% of recognized primary diseases.Allografts were from deceased donors (72.2%) or living donation (27.7%).The patient survival for 1,3,5,and 10 years was 96.9%,94.2%,92.3%,and 92.3% and the graft survival was 94.6%,91.4%,86.3%,and 79.2%,respectively.The majority of post-transplant complications were acute rejection and infections.Annual transplant reached the peak in 2008 (n=114),and decreased sharply in 2006 (n=41) and 2010 (n=57).The percentage of pediatric KTx in total KTx was highest in 2007 (1.95%) and decreased to trough level in 2010 (1.0%).Living donation increased by 32.5-folds from 2004 to 2008 and then decreased by 86.6% till 2010.The percentage of living donation in pediatric or total KTx dynamically changed in a similar manner,while living donation ratio in pediatric KTx was much higher.Conclusions Kidney transplant can provide long-term benefits to pediatric recipients.Rejection and infections are worthy of concern during follow-up.Pediatric kidney transplant in China is very much lagging behind that in developed countries.Living donation played an important role in its development in the past decades.New strategies for implementation are encouraged to increase the priority of uremic children in organ allocation so as to

  11. [Effectiveness of antibiotic therapy in pyelonephritis after kidney transplantation].

    Science.gov (United States)

    Vasina, T A; Kutasova, I V; Lobanova, E D

    1981-04-01

    Determination of bacteriuria, leucocyturia, active leucocytes and Sternheimer-Malbin's cells in patients with transplanted kidneys during the postoperative period provided identification of pyelonephritis in the transplanted kidney. E. coli, Proteus, Staphylococcus, P. aeruginosa and microbial associations were the main causative agents of pyelonephritis in such patients. The majority of the causative agents were polyresistant to antibiotics. Investigation of the microbial sensitivity to antibiotics and determination of their levels in the patients promote development of rational schemes for the treatment of pyelonephritis. Early identification of pyelonephritis of the transplanted kidney and its timely treatment with antibiotics allow avoiding destruction of the transplanted organ and promote its normal functioning.

  12. Reversible compensatory hypertrophy in transplanted brown Norway rat kidneys.

    Science.gov (United States)

    Churchill, M; Churchill, P C; Schwartz, M; Bidani, A; McDonald, F

    1991-07-01

    Recently we described methods for optimizing the function of transplanted rat kidneys. In unilaterally nephrectomized recipients, one week after surgery, the left transplanted kidney was identical to the right native kidney with respect to wet weight and the clearances of inulin and para-aminohippuric acid (PAH). The goals of the present experiments were first, to extend the post-surgery period to three weeks (sufficient to allow hypertrophic changes), and second, to study function of transplanted hypertrophied kidneys. Genetically identical Brown Norway rats were used as donor and recipients. Three weeks after transplanting a normal kidney into a unilaterally-nephrectomized recipient, the transplanted kidney had a normal plasma flow and was identical to the contralateral native kidney with respect to wet weight and the clearances of inulin and PAH. Three weeks after transplanting a normal kidney into a bilaterally-nephrectomized recipient, the wet weight, inulin and PAH clearances, and plasma flow of the transplanted kidney were all higher than control, and not significantly different from those observed in unilaterally-nephrectomized control rats. Thus, transplanted and native kidneys exhibited the same degree of compensatory hypertrophy. Hypertrophied donor kidneys (that is, the donor rat had been unilaterally-nephrectomized three weeks previously) remained hypertrophied in bilaterally-nephrectomized recipients, but in unilaterally-nephrectomized recipients, they regressed towards normal (that is, the values of wet weight, inulin and PAH clearances and plasma flow were significantly less than those in rats with only one kidney) while the contralateral native kidney remained normal (values of wet weight and inulin and PAH clearances were not different from control).(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Protocol of the KTFT-TALK study to reduce racial disparities in kidney transplant evaluation and living donor kidney transplantation.

    Science.gov (United States)

    Bornemann, Kellee; Croswell, Emilee; Abaye, Menna; Bryce, Cindy L; Chang, Chung-Chou H; Good, Deborah S; Freehling Heiles, Cathleen A; Dew, Mary Amanda; Boulware, L Ebony; Tevar, Amit D; Myaskovsky, Larissa

    2017-02-01

    Living donor kidney transplantation (LDKT) is the optimal treatment for end-stage kidney disease (ESKD). The evaluation process for a kidney transplant is complex, time consuming, and burdensome to the ESKD patient. Also, race disparities exist in rates of transplant evaluation completion, transplantation, and LDKT. In December 2012 our transplant center implemented a streamlined, one-day evaluation process, dubbed Kidney Transplant Fast Track (KTFT). This paper describes the protocol of a two-part study to evaluate the effectiveness of KTFT at increasing transplant rates (compared to historical controls) and the TALK intervention (Talking About Live Kidney Donation) at increasing LDKT during KTFT. All participants will receive the KTFT evaluation as part of their usual care. Participants will be randomly assigned to TALK versus no-TALK conditions. Patients will undergo interviews at pre-transplant work-up and transplant evaluation. Transplant status will be tracked via medical records. Our aims are to: (1) test the efficacy and cost effectiveness of the KTFT in reducing time to complete kidney transplant evaluation, and increasing kidney transplant rates relative to standard evaluation practices; (2) test whether TALK increases rates of LDKT during KTFT; and (3) determine whether engaging in a streamlined and coordinated-care evaluation experience within the transplant center reduces negative perceptions of the healthcare system. The results of this two-pronged approach will help pave the way for other transplant centers to implement a fast-track system at their sites, improve quality of care by transplanting a larger number of vulnerable patients, and address stark race/ethnic disparities in rates of LDKT.

  14. Longitudinal measurement of physical activity following kidney transplantation.

    Science.gov (United States)

    Dontje, M L; de Greef, M H G; Krijnen, W P; Corpeleijn, E; Kok, T; Bakker, S J L; Stolk, R P; van der Schans, C P

    2014-04-01

    The purpose of this longitudinal observational study was to (i) examine the change of daily physical activity in 28 adult kidney transplant recipients over the first 12 months following transplantation; and (ii) to examine the change in metabolic characteristics and renal function. Accelerometer-based daily physical activity and metabolic- and clinical characteristics were measured at six wk (T1), three months (T2), six months (T3) and 12 months (T4) following transplantation. Linear mixed effect analyses showed an increase in steps/d (T1 = 6326 ± 2906; T4 = 7562 ± 3785; F = 3.52; p = 0.02), but one yr after transplantation only 25% achieved the recommended 10 000 steps/d. There was no significant increase in minutes per day spent on moderate-to-vigorous intensity physical activity (T1 = 80.4 ± 63.6; T4 = 93.2 ± 55.1; F = 1.71; p = 0.17). Body mass index increased over time (T1 = 25.4 ± 3.2; T4 = 27.2 ± 3.8; F = 12.62; p physical activity, the majority did not meet the recommended levels of physical activity after one yr. In addition to the weight gain, this may result in negative health consequences. Therefore, it is important to develop strategies to support kidney transplant recipients to comply with healthy lifestyle recommendations, including regular physical activity.

  15. AB32. Sexuality after kidney transplantation

    Science.gov (United States)

    Zhang, Xiaodong

    2014-01-01

    Introduction Kidney transplantation is the treatment of choice for persons with ESRD, and in general, KTx recipients have increased survival rates and enjoy overall better QOL than those on dialysis However, one thing of QOL that does not seem to improve post-transplant is sexuality. In fact, one study found that sexuality was the only aspect of QOL that did not improve after transplantation. Roughly, 50% of males and at least the same percent of females. Sexuality is important to QOL and is considered a basic human right and an important component of general health by WHO. Sexuality is a central aspect of being human throughout life. Encompassing Related causes, difficulties with sexuality and sexual functioning are most likely a result of both psychological and physiological factors, side effects of required medications, weight gain, hirsutism, and loss of sexually attractive following KTx, post-transplant complications and/or comorbid conditions. Hypertension and depression require medications. Almost all transplant recipients have or will eventually develop one or more comorbid conditions (diabetes) or experience side effects from treatments (pretransplant dialysis) or medications that can have a negative effect on their sexuality or sexual functioning Publications The first studies that examined sexuality among persons with ESRD were done in the 1970s. Retrospectively compare their sexual functioning levels. One of the largest of these early studies, conducted by Levy, was a nationwide survey of 519 persons belonging to the National Association of Patients on Hemodialysis and Transplantation. Three sexual functioning questions. There are 48% of men and 26% of women reported the development of or worsening of a sexual dysfunction as their ESRD progressed. And 35% of males and 25% of females reported a worsening of sexual function at the start of HD. 59% of all male HD patients and 43% of all male KTx recipients considered themselves to be partially or totally

  16. Geographic Determinants of Access to Pediatric Deceased Donor Kidney Transplantation

    OpenAIRE

    Reese, Peter P; Hwang, Hojun; Potluri, Vishnu; Abt, Peter L.; Shults, Justine; Amaral, Sandra

    2014-01-01

    Children receive priority in the allocation of deceased donor kidneys for transplantation in the United States, but because allocation begins locally, geographic differences in population and organ supply may enable variation in pediatric access to transplantation. We assembled a cohort of 3764 individual listings for pediatric kidney transplantation in 2005–2010. For each donor service area, we assigned a category of short (270 days) median waiting time and calculated the ratio of pediatric-...

  17. Low predictive value of positive transplant perfusion fluid cultures for diagnosing postoperative infections in kidney and kidney-pancreas transplantation.

    LENUS (Irish Health Repository)

    Cotter, Meaghan P

    2012-12-01

    Infection following transplantation is a cause of morbidity and mortality. Perfusion fluid (PF) used to preserve organs between recovery and transplantation represents a medium suitable for the growth of microbes. We evaluated the relevance of positive growth from PF sampled before the implantation of kidney or kidney-pancreas (KP) allografts.

  18. Concurrent validity of kidney transplant questionnaire in US renal transplant recipients

    Directory of Open Access Journals (Sweden)

    Chisholm-Burns MA

    2011-10-01

    Full Text Available Marie A Chisholm-Burns1,2, Steven R Erickson3, Christina A Spivey1, Rainer WG Gruessner2, Bruce Kaplan4 1Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ; 2Department of Surgery, University of Arizona College of Medicine, Tucson, AZ; 3Department of Clinical Sciences, University of Michigan College of Pharmacy, Ann Arbor, MI; 4Department of Medicine, The University of Arizona College of Medicine Tucson, AZ, USA Background: Valid instrumentation in the assessment of health-related quality of life (HQoL in renal transplant recipients is critical to identifying particular nuances and determinants of HQoL in this population. Therefore, the validity of disease-specific instruments to measure HQoL in renal transplant recipients, such as the Kidney Transplant Questionnaire (KTQ, needs further investigation. The objective of this study was to assess the concurrent validity of the KTQ in adult US renal transplant recipients using the well established SF-12 Health Survey version 2 (SF-12v2 as the comparison instrument. Methods: One hundred and fourteen renal transplant recipients met the following inclusion criteria for this study, ie, were at least 21 years of age, more than two years post-transplant, and receiving immunosuppressant therapy. Subjects were asked to complete a series of HQoL instruments, ie, the KTQ and the SF-12v2 (physical component summary [PCS-12] and mental component summary [MCS-12]. Descriptive statistics were calculated, and correlational analyses were conducted to examine the concurrent validity of the HQoL instruments. Results: Among 100 participants (87.7% response rate, the majority of participants were male (52%, had deceased donor transplants (63%, and received Medicare benefits (84%. PCS-12 was positively correlated with three of five KTQ subscales (P < 0.05, ie, KTQ-physical (r = 0.43, KTQ-fatigue (r = 0.42, and KTQ-uncertainty/fear (r = 0.2. MCS-12 was positively correlated

  19. Strategies to reduce clinical inertia in hypertensive kidney transplant recipients

    OpenAIRE

    Panek Romauld; Kiberd James; Kiberd Bryce

    2007-01-01

    Abstract Background Many kidney transplant recipients have hypertension. Elevated systolic blood pressures are associated with lower patient and kidney allograft survival. Methods This retrospective analysis examined the prevalence of clinical inertia (failure to initiate or increase therapy) in the treatment of hypertension before and after the introduction of an automated device (BpTRU) in the kidney transplant clinic. Results Historically only 36% (49/134) of patients were prescribed a cha...

  20. Gut microbiota and tacrolimus dosing in kidney transplantation.

    Directory of Open Access Journals (Sweden)

    John R Lee

    Full Text Available Tacrolimus dosing to establish therapeutic levels in recipients of organ transplants is a challenging task because of much interpatient and intrapatient variability in drug absorption, metabolism, and disposition. In view of the reported impact of gut microbial species on drug metabolism, we investigated the relationship between the gut microbiota and tacrolimus dosing requirements in this pilot study of adult kidney transplant recipients. Serial fecal specimens were collected during the first month of transplantation from 19 kidney transplant recipients who either required a 50% increase from initial tacrolimus dosing during the first month of transplantation (Dose Escalation Group, n=5 or did not require such an increase (Dose Stable Group, n=14. We characterized bacterial composition in the fecal specimens by deep sequencing of the PCR amplified 16S rRNA V4-V5 region and we investigated the hypothesis that gut microbial composition is associated with tacrolimus dosing requirements. Initial tacrolimus dosing was similar in the Dose Escalation Group and in the Stable Group (4.2 ± 1.1 mg/day vs. 3.8 ± 0.8 mg/day, respectively, P=0.61, two-way between-group ANOVA using contrasts but became higher in the Dose Escalation Group than in the Dose Stable Group by the end of the first transplantation month (9.6 ± 2.4 mg/day vs. 3.3 ± 1.5 mg/day, respectively, P<0.001. Our systematic characterization of the gut microbial composition identified that fecal Faecalibacterium prausnitzii abundance in the first week of transplantation was 11.8% in the Dose Escalation Group and 0.8% in the Dose Stable Group (P=0.002, Wilcoxon Rank Sum test, P<0.05 after Benjamini-Hochberg correction for multiple hypotheses. Fecal Faecalibacterium prausnitzii abundance in the first week of transplantation was positively correlated with future tacrolimus dosing at 1 month (R=0.57, P=0.01 and had a coefficient ± standard error of 1.0 ± 0.6 (P=0.08 after multivariable linear

  1. Clinical Practice of Steroid Avoidance in Pediatric Kidney Transplantation.

    Science.gov (United States)

    Nehus, E; Liu, C; Hooper, D K; Macaluso, M; Kim, M-O

    2015-08-01

    Steroid-avoidance protocols have recently gained popularity in pediatric kidney transplantation. We investigated the clinical practice of steroid avoidance among 9494 kidney transplant recipients at 124 transplant centers between 2000 and 2012 in the Organ Procurement and Transplantation Network database. The practice of steroid avoidance increased during the study period and demonstrated significant variability among transplant centers. From 2008 to 2012, 39% of transplant centers used steroid avoidance in avoidance in 10-40% of transplant recipients, and 40% of transplant centers used steroid avoidance in >40% of discharged patients. Children receiving steroid avoidance more frequently received induction with lymphocyte-depleting agents. Repeat kidney transplants were the least likely to receive steroid avoidance. Children who received a deceased donor kidney, underwent pretransplant dialysis, were highly sensitized, or had glomerular kidney disease or delayed graft function were also less likely to receive steroid avoidance. The variation in practice between centers remained highly significant (p avoidance among transplant centers remain unexplained and may reflect uncertainty about the safety and efficacy of steroid-avoidance protocols.

  2. A simultaneous liver-kidney transplant recipient with IgA nephropathy limited to native kidneys and BK virus nephropathy limited to the transplant kidney.

    Science.gov (United States)

    Ujire, Manasa P; Curry, Michael P; Stillman, Isaac E; Hanto, Douglas W; Mandelbrot, Didier A

    2013-08-01

    Immunoglobulin A (IgA) deposition in the native kidneys of patients with liver disease is well described. Secondary IgA nephropathy usually is thought to be benign, but hematuria, proteinuria, and loss of kidney function have been reported in this context. BK virus nephropathy is an important cause of kidney transplant loss; however, BK virus nephropathy is rare in the native kidneys of patients who underwent transplantation of other organs. We report the case of a patient with alcohol-related end-stage liver disease and chronic kidney disease with hematuria who underwent simultaneous liver-kidney transplantation. His kidney function decreased over the course of several weeks posttransplantation. Biopsy of the transplant kidney showed BK virus nephropathy, but no IgA deposits. In contrast, biopsy of the native kidneys showed IgA deposits, but no BK virus nephropathy. To our knowledge, this is the first reported case of a simultaneous liver-kidney transplantation wherein both the native and transplant kidneys were biopsied posttransplantation and showed exclusively different pathologies. These findings confirm the predilection of BK virus nephropathy for transplant rather than native kidneys.

  3. Kidney temperature course during living organ procurement and transplantation.

    Science.gov (United States)

    Kuipers, Thomas G J; Hellegering, Joyce; El Moumni, Mostafa; Krikke, Christina; Haveman, Jan Willem; Berger, Stefan P; Leuvenink, Henri G; Pol, Robert A

    2017-02-01

    Little is known about the actual kidney graft temperature during the 2nd warm ischemia time (WIT2). We aimed to determine the actual temperature course of the WIT2, with emphasis on the 15 °C metabolic threshold. Data of 152 consecutive adult living donor kidney transplantations were collected. The mean WIT2 was 41.3 ± 10.1 (SD) minutes with a temperature of 5.4 °C at baseline which gradually increased to 13.7, 17.4, and 20.2 °C after 10, 20, and 30 min, respectively. The percentage of kidneys with a temperature of 15 °C or higher was 81.2% after 20 min and 97.5% after 30 min. Duration of surgery (95% CI: -0.017 to -0.002, P = 0.02), multiple veins (95% CI: 0.0003-2.720, P = 0.05) and WIT2 (95% CI: 0.016-0.099, P = 0.006) were associated with a rapid temperature increase. No correlation could be determined between a rapid temperature rise and diminished graft function. This study showed a rapid increase in kidney temperature during WIT2, wherein the 15 °C threshold was reached within 20 min in more than 80% of the patients.

  4. Commercial kidney transplantation is an important risk factor in long-term kidney allograft survival.

    Science.gov (United States)

    Prasad, G V Ramesh; Ananth, Sailesh; Palepu, Sneha; Huang, Michael; Nash, Michelle M; Zaltzman, Jeffrey S

    2016-05-01

    Transplant tourism, a form of transplant commercialization, has resulted in serious short-term adverse outcomes that explain reduced short-term kidney allograft survival. However, the nature of longer-term outcomes in commercial kidney transplant recipients is less clear. To study this further, we identified 69 Canadian commercial transplant recipients of 72 kidney allografts transplanted during 1998 to 2013 who reported to our transplant center for follow-up care. Their outcomes to 8 years post-transplant were compared with 702 domestic living donor and 827 deceased donor transplant recipients during this period using Kaplan-Meier survival plots and multivariate Cox regression analysis. Among many complications, notable specific events included hepatitis B or C seroconversion (7 patients), active hepatitis and/or fulminant hepatic failure (4 patients), pulmonary tuberculosis (2 patients), and a type A dissecting aortic aneurysm. Commercial transplantation was independently associated with significantly reduced death-censored kidney allograft survival (hazard ratio 3.69, 95% confidence interval 1.88-7.25) along with significantly delayed graft function and eGFR 30 ml/min/1.73 m(2) or less at 3 months post-transplant. Thus, commercial transplantation represents an important risk factor for long-term kidney allograft loss. Concerted arguments and efforts using adverse recipient outcomes among the main premises are still required in order to eradicate transplant commercialization.

  5. The Impact of Method on Kidney Graft and Patient Survival in Kidney-Pancreas Transplantations for Type I Diabetes Mellitus

    OpenAIRE

    Dinckan, Ayhan; Aliosmanoglu, Ibrahim; Kocak, Huseyin; Mesci, Ayhan; Altunbas, Hasan; Gurkan, Alihan

    2015-01-01

    Patients who develop end-stage renal disease (ESRD) associated with Type I Diabetes Mellitus may receive kidney alone (KA) transplantation, simultaneous pancreas-kidney (SPK) transplantation, or a pancreas after kidney (PAK) transplantation. The goal of this study is to examine the long-term impact of pancreas transplantation on kidney graft and patient survival rates. A total of 85 transplantation cases, consisting of 30 that received living donor KA, 21 that received SPK, and 34 that receiv...

  6. Challenging immunosuppression treatment in lung transplant recipients with kidney failure.

    Science.gov (United States)

    Högerle, Benjamin A; Kohli, Neeraj; Habibi-Parker, Kirsty; Lyster, Haifa; Reed, Anna; Carby, Martin; Zeriouh, Mohamed; Weymann, Alexander; Simon, André R; Sabashnikov, Anton; Popov, Aron-Frederik; Soresi, Simona

    2016-03-01

    Kidney failure after lung transplantation is a risk factor for chronic kidney disease. Calcineurin inhibitors are immunosuppressants which play a major role in terms of postoperative kidney failure after lung transplantation. We report our preliminary experience with the anti-interleukin-2 monoclonal antibody Basiliximab utilized as a "calcineurin inhibitor-free window" in the setting of early postoperative kidney failure after lung transplantation. Between 2012 and 2015 nine lung transplant patients who developed kidney failure for more than 14 days were included. Basiliximab was administrated in three doses (Day 0, 4, and 20) whilst Tacrolimus was discontinued or reduced to maintain a serum level between 2 and 4 ng/mL. Baseline glomerular filtration rate pre transplant was normal for all patients. Seven patients completely recovered from kidney failure (67%, mean eGFR pre and post Basiliximab: 42.3 mL/min/1.73 m(2) and 69 mL/min/1.73 m(2)) and were switched back on Tacrolimus. Only one of these patients still needs ongoing renal replacement therapy. Two patients showed no recovery from kidney failure and did not survive. Basiliximab might be a safe and feasible therapeutical option in patients which are affected by calcineurin inhibitor-related kidney failure in the early post lung transplant period. Further studies are necessary to confirm our preliminary results.

  7. The interaction of the international society concerning kidney transplants--a consideration of diseased kidney transplants in Japan and transplant tourism over the world.

    Science.gov (United States)

    Kokubo, Asako

    2009-04-01

    In November 2006 in Japan, it was detected that there were 41 cases that diseased kidneys were harvested from patients and then were transplanted to other renal failure patients. This "Diseased kidney transplant" was prohibited in Japan since 2007 because of a lot of problems. On the other hand, in Japan, although there are about 12,000 patients on a waiting list for a transplant, only 10% of those get a transplant. Recently it appears that some patients have gone overseas for kidney transplants (transplant tourism). Concerning the background of transplant tourism, the issues are three points following. First, globalization caused recipients to go abroad easier and faster. Second, transnational law is difficult to institutionalize. Third, there is economical gap in not only international but also domestic. We should discuss again diseased kidney transplant in not only professionals but also in Japanese civilized society.

  8. Allograft loss from acute Page kidney secondary to trauma after kidney transplantation

    Science.gov (United States)

    Takahashi, Kazuhiro; Prashar, Rohini; Putchakayala, Krishna G; Kane, William J; Denny, Jason E; Kim, Dean Y; Malinzak, Lauren E

    2017-01-01

    We report a rare case of allograft loss from acute Page kidney secondary to trauma that occurred 12 years after kidney transplantation. A 67-year-old Caucasian male with a past surgical history of kidney transplant presented to the emergency department at a local hospital with left lower abdominal tenderness. He recalled that his cat, which weighs 15 lbs, jumped on his abdomen 7 d prior. On physical examination, a small tender mass was noticed at the incisional site of the kidney transplant. He was producing a normal amount of urine without hematuria. His serum creatinine level was slightly elevated from his baseline. Computer tomography revealed a large subscapular hematoma around the transplant kidney. The patient was observed to have renal trauma grade II at the hospital over a period of three days, and he was finally transferred to a transplant center after his urine output significantly decreased. Doppler ultrasound demonstrated an extensive peri-allograft hypoechoic area and abnormal waveforms with absent arterial diastolic flow and a patent renal vein. Despite surgical decompression, the allograft failed to respond appropriately due to the delay in surgical intervention. This is the third reported case of allograft loss from acute Page kidney following kidney transplantation. This case reinforces that kidney care differs if the kidney is solitary or a transplant. Early recognition and aggressive treatments are mandatory, especially in a case with Doppler signs that are suggestive of compression. PMID:28280700

  9. Ethics, Justice and the Sale of Kidneys for Transplantation Purposes

    Directory of Open Access Journals (Sweden)

    M Slabbert

    2010-08-01

    Full Text Available Living kidney donor transplantations are complex; add to that financial compensation to the donor and one enters an ethical maze. Debates on whether the buying and selling of kidneys should be allowed are mainly between utilitarians, deontologists and virtue ethicists as legal transplants are more common in the Western world. The pros and cons of each theory in relation to the sale of human organs are analysed, after which the foundational principles for all bio-ethical judgments; beneficence, non-maleficence, autonomy and justice are also scrutinised in seeking to justify the sale of human kidneys for transplantation purposes in a country with a human rights culture.

  10. Nocardiosis in a Kidney-Pancreas Transplant

    Directory of Open Access Journals (Sweden)

    I. Fontana

    2010-01-01

    Full Text Available 34-year-old man with chronic renal and pancreas failure in complicated diabetic disease received a kidney-pancreas transplantation. On the 32nd postoperative day, an acute kidney rejection occurred and resolved with OKT3 therapy. The patient also presented refractory urinary infection by E. Fecalis and M. Morganii, and a focal bronchopneumonia in the right-basal lobe resolved with elective chemotherapy. During the 50th post-operative day, an intense soft tissue inflammation localized in the first left metatarsal-phalangeal articulation occurred (Figure 1 followed by an abscess with a cutaneous fistula and extension to the almost totality of foot area. The radiological exam revealed a small osteo-lacunar image localized in the proximal phalanx head of the first finger foot. From the cultural examination of the purulent material, N. Asteroides was identified. An amoxicillin-based treatment was started and continued for three months, with the complete resolution of infection This case is reported for its rarity in our casuistry, and for its difficult differential diagnosis with other potentially serious infections.

  11. Gastrointestinal surgical emergencies following kidney transplantation.

    Science.gov (United States)

    Bardaxoglou, E; Maddern, G; Ruso, L; Siriser, F; Campion, J P; Le Pogamp, P; Catheline, J M; Launois, B

    1993-05-01

    This study reports major gastrointestinal complications in a group of 416 patients following kidney transplantation. Three hundred and ninety-nine patients received a cadaveric kidney while the other 17 received a living related organ. The immunosuppressive regimen changed somewhat during the course of the study but included azathioprine, prednisolone, antilymphocyte globulin, and cyclosporin. Perforations occurred in the colon (n = 6), small bowel (n = 4), duodenum (n = 2), stomach (n = 1), and esophagus (n = 1). There were five cases of acute pancreatitis, four of upper gastrointestinal and two of lower intestinal hemorrhage, two of acute appendicitis, one of acute cholecystitis, one postoperative mesenteric infarction, and two small bowel obstructions. Fifty percent of the complications occurred while patients were being given high-dose immunosuppression to manage either the early postoperative period or episodes of acute rejection. Ten percent of the complications had an iatrogenic cause. Of the 31 patients affected, 10 (30%) died as a direct result of their gastrointestinal complication. This high mortality appears to be related to the effects of the immunosuppression and the associated response to sepsis. Reduction of these complications can be achieved by improved surgical management, preventive measures, prompt diagnosis, and a reduced immunosuppressive protocol.

  12. Combined Kidney-Liver, Heart-Liver, and Kidney-Pancreas Transplantations from a Single Deceased Donor

    Directory of Open Access Journals (Sweden)

    Matteo Ravaioli

    2012-01-01

    Full Text Available Splitting the liver for two adults to increase the donor pool is still a debated issue, especially for combined organ transplantation. We described a case of liver-splitting procedure for two adults, which was successful even in the presence of combined organ transplantation. Three adult combined organ transplantations from one deceased donor were performed, with, use of split liver grafts in two patients: a combined heart-right split liver, a left kidney-left split liver, and a right kidney-pancreas transplantation. Despite a not perfect match between the graft type and recipient, the prevention of small-for-size syndrome by ligature of the splenic artery, and/or hemiportocaval shunt in the patient receiving the left split liver, and the maximal reduction of ischemia time were the main factors contributing to the success of the procedure. This is the first report of combined heart and split liver in two adults which may suggest new strategies for organ transplantations.

  13. [Three cases of de novo multiple myeloma after kidney transplantation].

    Science.gov (United States)

    Nieto-Ríos, John Fredy; Zuluaga, Mónica; Serna, Lina María; Aristizábal, Arbey; Ocampo-Kohn, Catalina; Gálvez, Kenny Mauricio; Flórez, Adriana Alejandra; Zuluaga, Gustavo

    2016-12-01

    Light chain-associated kidney compromise is frequent in patients with monoclonal gammopathies; it affects the glomeruli or the tubules, and its most common cause is multiple myeloma. It may develop after a kidney transplant due to recurrence of a preexisting multiple myeloma or it can be a de novo disease manifesting as graft dysfunction and proteinuria. A kidney biopsy is always necessary to confirm the diagnosis.We describe three cases of kidney graft dysfunction due to multiple myeloma in patients without presence of the disease before the transplant.

  14. Liver-kidney transplantation to cure atypical hemolytic uremic syndrome.

    Science.gov (United States)

    Saland, Jeffrey M; Ruggenenti, Piero; Remuzzi, Giuseppe

    2009-05-01

    Atypical hemolytic uremic syndrome is often associated with mutations in genes encoding complement regulatory proteins and secondary disorders of complement regulation. Progression to kidney failure and recurrence with graft loss after kidney transplantation are frequent. The most common mutation is in the gene encoding complement factor H. Combined liver-kidney transplantation may correct this complement abnormality and prevent recurrence when the defect involves genes encoding circulating proteins that are synthesized in the liver, such as factor H or I. Good outcomes have been reported when surgery is associated with intensified plasma therapy. A consensus conference to establish treatment guidelines for atypical hemolytic uremic syndrome was held in Bergamo in December 2007. The recommendations in this article are the result of combined clinical experience, shared research expertise, and a review of the literature and registry information. This statement defines groups in which isolated kidney transplantation is extremely unlikely to be successful and a combined liver-kidney transplant is recommended and also defines those for whom kidney transplant remains a viable option. Although combined liver-kidney or isolated liver transplantation is the preferred therapeutic option in many cases, the gravity of risk associated with the procedure has not been eliminated completely, and assessment of risk and benefit requires careful and individual attention.

  15. Cicletanine-induced hyponatremia and hypokalemia in kidney transplant patients

    Directory of Open Access Journals (Sweden)

    Eun Young Choi

    2016-09-01

    Conclusion: We demonstrate that cicletanine may induce hyponatremia or hypokalemia in kidney transplant patients. Hyponatremia is more frequently associated with cicletanine than hypokalemia, and extended use of cicletanine may increase the risk of hyponatremia.

  16. Preemptive kidney transplantation--a team experience in Uruguay.

    Science.gov (United States)

    González-Martínez, F; Curi, L; González-Carballido, G; Núñez, N; Manzo, L; Kurdián, M; Larre Borges, P; Nin, M; Orihuela, S

    2014-11-01

    Kidney transplantation is the best treatment for end-stage chronic renal disease. In Uruguay, the prevalence of patients on dialysis is 757 patients per millon inhabitants, plus 316 alive with a functioning renal graft. We install a preemptive renal transplantation program. Twenty-five patients received grafts without dialysis from 2004 to 2013, 5 receiving their 2nd transplantation and 17 from cadaveric donors, with 7.4 ± 7.7 months in the waiting list. At 24 months, patients' survival rate was 100% and the grafts' 97%, with a serum creatinine of 1.4 ± 0.6 mg%. The developed programs of dialysis and renal health care contributed install our preemptive kidney transplantation. Kidney transplantation should be proposed to selected patients with chronic renal failure as primary therapy of substitution of renal function.

  17. Combined heart-kidney transplantation after total artificial heart insertion.

    Science.gov (United States)

    Ruzza, A; Czer, L S C; Ihnken, K A; Sasevich, M; Trento, A; Ramzy, D; Esmailian, F; Moriguchi, J; Kobashigawa, J; Arabia, F

    2015-01-01

    We present the first single-center report of 2 consecutive cases of combined heart and kidney transplantation after insertion of a total artificial heart (TAH). Both patients had advanced heart failure and developed dialysis-dependent renal failure after implantation of the TAH. The 2 patients underwent successful heart and kidney transplantation, with restoration of normal heart and kidney function. On the basis of this limited experience, we consider TAH a safe and feasible option for bridging carefully selected patients with heart and kidney failure to combined heart and kidney transplantation. Recent FDA approval of the Freedom driver may allow outpatient management at substantial cost savings. The TAH, by virtue of its capability of providing pulsatile flow at 6 to 10 L/min, may be the mechanical circulatory support device most likely to recover patients with marginal renal function and advanced heart failure.

  18. Combined liver and kidney transplantation in Guangzhou, China

    Institute of Scientific and Technical Information of China (English)

    Xiao-Feng Zhu; Xiao-Shun He; Gui-Hua Chen; Li-Zhong Chen; Chang-Xi Wang; Jie-Fu Huang

    2007-01-01

    BACKGROUND:When liver or kidney transplant can respectively cure end-stage liver or kidney disease, neither hepatic graft nor renal transplant alone can be used as a radical therapy for diseases which involve both liver and kidney. Combined liver and kidney transplantation commenced late in China, and the number of transplants has been limited. This study was designed to assess the effects of simultaneous combined liver and kidney transplantation (SLKT) on end-stage liver and kidney diseases. METHODS:Fifteen patients who had received SLKT from 1996 to 2006 in the First Afifliated Hospital of Sun Yat-Sen University were reviewed. They included 5 patients with polycystic liver and kidney, 5 patients with hepatic cirrhosis and renal failure, and 5 patients with fulminant hepatic failure and hepatorenal syndrome (11 men and 4 women; average age 43.5 years). All patients had combined liver and kidney transplantation. RESULTS:The 5 patients with polycystic liver and kidney have survived for more than one year after SLKT, and the longest survival has been 5 years. Three of the 5 patients with hepatic cirrhosis and renal failure have survived more than two years; one died perioperatively and the other died from recurrence of hepatitis B 18 months after the operation. Three of the 5 patients with fulminant hepatic failure and hepatorenal syndrome have survived for two years, and 2 died of multiple organ failure during the operation.CONCLUSIONS:SLKT is an effective therapy for end-stage liver and kidney disease but the indications of SLKT for hepatorenal syndrome should be strict. SLKT may immunologically protect the renal graft.

  19. Comparison of Minimal Skin Incision Technique in Living Kidney Transplantation and Conventional Kidney Transplantation

    Institute of Scientific and Technical Information of China (English)

    Sang-Dong Kim; Ji-II Kim; In-Sung Moon; Sun-Cheol Park

    2016-01-01

    Background:Recently,the most common incision for kidney transplantation (KT) is an inverted J-shaped incision known as the "hockey-stick." However,demands for minimally invasive surgery in KT are increasing as in other various fields of surgery.Hence,we evaluated whether there is difference between minimal skin incision technique in kidney transplantation (MIKT) and conventional KT (CKT).Methods:Between June 2006 and March 2013,a total of 452 living kidney transplant patients were enrolled.The MIKT group included 17 young unmarried women whose body mass index was <25 kg/m2 and had no anatomic variation.The CKT group included 435 patients.The MIKT operation technique restricted to the 10 cm-sized skin incision in the lower right abdomen from laterally below the anterior superior iliac spine to the midline just above the pubis was performed.We compared the baseline clinical characteristics and postoperative results between two groups.For proper comparison,propensity score matching was implemented.Results:There was no difference in graft function,survival,and postoperative complication rate between MIKT and CKT groups (all P > 0.05).The 5-year graft survival was 92.3% and 85.7% in MIKT and CKT groups,respectively (P =0.786).Conclusions:Our results indicated that MIKT showed more favorable cosmetic results,and there were no statistical differences in various postoperative factors including graft function,survival,and complications compared with CKT.Hence,we suggested that MIKT is an appropriate method for selected patients in living KT.

  20. Epidemiology of infections in kidney transplant recipients - data miner's approach.

    Science.gov (United States)

    Wojciuk, Bartosz; Myślak, Marek; Pabisiak, Krzysztof; Ciechanowski, Kazimierz; Giedrys-Kalemba, Stefania

    2015-06-01

    Infections remain a frequent complication following organ transplantation. Agents present within the general population remain common in recurrent infections among renal transplant recipients. Data mining methodology has become a promising source of information about patterns in the organ transplant recipient population. The aim of the study was to use data mining to describe the factors influencing single and recurrent infections in kidney transplant recipients. A group of 159 recipients who underwent kidney transplantation between 2005 and 2008 was analysed. RapidMiner and Statistica softwares were used to create decision tree models based on CART Quinlan and C&RT algorithms. There were 171 microbiologically confirmed episodes among 67 recipients (41%), and 191 separate species isolations were performed. Over 50% of the infected patients underwent two or more infectious episodes. Two classification decision tree models were created. The following features were enabled to differentiate the groups with single or recurrent infections: the duration of cold ischaemia, the post-transplant hospitalization period, the cause of chronic kidney disease and pathogens. The post-transplant hospitalization period and the length of cold ischaemia appear to be the principal parameters differentiating the subpopulations analysed. These coexisting factors, connected with recurrent infections in kidney transplant recipients, resemble a network which requires an advanced analysis to support the traditional statistics.

  1. Increasing access to kidney transplantation in countries with limited resources: the Indian experience with kidney paired donation.

    Science.gov (United States)

    Kute, Vivek B; Vanikar, Aruna V; Shah, Pankaj R; Gumber, Manoj R; Patel, Himanshu V; Engineer, Divyesh P; Modi, Pranjal R; Shah, Veena R; Trivedi, Hargovind L

    2014-10-01

    According to the Indian chronic kidney disease registry, in 2010 only 2% of end stage kidney disease patients were managed with kidney transplantation, 37% were managed with dialysis and 61% were treated conservatively without renal replacement therapy. In countries like India, where a well-organized deceased donor kidney transplantation program is not available, living donor kidney transplantation is the major source of organs for kidney transplantation. The most common reason to decline a donor for directed living donation is ABO incompatibility, which eliminates up to one third of the potential living donor pool. Because access to transplantation with human leukocyte antigen (HLA)-desensitization protocols and ABO incompatible transplantation is very limited due to high costs and increased risk of infections from more intense immunosuppression, kidney paired donation (KPD) promises hope to a growing number of end stage kidney disease patients. KPD is a rapidly growing and cost-effective living donor kidney transplantation strategy for patients who are incompatible with their healthy, willing living donor. In principle, KPD is feasible for any centre that performs living donor kidney transplantation. In transplant centres with a large living donor kidney transplantation program KPD does not require extra infrastructure, decreases waiting time, avoids transplant tourism and prevents commercial trafficking. Although KPD is still underutilized in India, it has been performed more frequently in recent times. To substantially increase donor pool and transplant rates, transplant centres should work together towards a national KPD program and frame a uniform acceptable allocation policy.

  2. Giardia lamblia infection after pancreas-kidney transplantation.

    Science.gov (United States)

    Kristensen, Ann Abkjaer; Horneland, Rune; Birn, Henrik; Svensson, My

    2016-01-18

    Infection is a common complication of solid organ transplantation. It is associated with an increased risk of acute cellular rejection and loss of graft function. The most common infections are due to bacteria and viruses, including transmission of cytomegalovirus from donor to recipient. In the past years, an increasing number of parasitic infections have been documented in transplant recipients. We describe the first reported case of intestinal Giardia lamblia transmission following simultaneous pancreas and kidney transplantation.

  3. [Hilarein, a patient education game for kidney transplant patients].

    Science.gov (United States)

    Césarini, Carole; Callens, Cécile

    2013-03-01

    At Nice university hospital, an educational board game has been designed by the kidney transplant team for patients suffering from kidney failure. Hilarein is a tool to support therapeutic education which demonstrates that it is possible to learn while having fun.

  4. [The combined transplantation of the pancreatoduodenal complex and kidney].

    Science.gov (United States)

    Kaabak, M M; Zokoev, A K; Babenko, N N

    2013-01-01

    Patients with diabetic nephropathy comprise up to 30% of dialisis population. The treatment optimum for these patients remains the transplantation of pancreas and kidney. There were no successful attempts in Russia so long ago as the end of the previous century. The issue analyses the experience of the SCS (where the first successful transplantation of kidney-pancreas complex was conducted) and other Russian institutes, where the problem is elaborated. Flaws and advantages of the used operative methods of pancreas and Β-cells transplantation; early and long-term results are thoroughly discussed.

  5. Do kidney histology lesions predict long-term kidney function after liver transplantation?

    Science.gov (United States)

    Kamar, Nassim; Maaroufi, Chakib; Guilbeau-Frugier, Céline; Servais, Aude; Meas-Yedid, Vannary; Tack, Ivan; Thervet, Eric; Cointault, Olivier; Esposito, Laure; Guitard, Joelle; Lavayssière, Laurence; Panterne, Clarisse; Muscari, Fabrice; Bureau, Christophe; Rostaing, Lionel

    2012-01-01

    Histological renal lesions observed after liver transplantation are complex, multifactorial, and interrelated. The aims of this study were to determine whether kidney lesions observed at five yr after liver transplantation can predict long-term kidney function. Ninety-nine liver transplant patients receiving calcineurin inhibitor (CNI)-based immunosuppression, who had undergone a kidney biopsy at 60±48 months post-transplant, were included in this follow-up study. Kidney biopsies were scored according to the Banff classification. Estimated glomerular filtration rate (eGFR) was assessed at last follow-up, that is, 109±48 months after liver transplantation. eGFR decreased from 92±33 mL/min at transplantation to 63±19 mL/min after six months, to 57±17 mL/min at the kidney biopsy, to 54±24 mL/min at last follow-up (p<0.0001). At last follow-up, only three patients required renal replacement therapy. After the kidney biopsy, 13 patients were converted from CNIs to mammalian target of rapamycin inhibitors, but no significant improvement in eGFR was observed after conversion. Elevated eGFR at six months post-transplant and a lower fibrous intimal thickening score (cv) observed at five yr post-transplant were the two independent predictive factors for eGFR≥60 mL/min at nine yr post-transplant. Long-term kidney function seems to be predicted by the kidney vascular lesions.

  6. Parainfluenza 3 Infections Early After Kidney or Simultaneous Pancreas-Kidney Transplantation.

    Science.gov (United States)

    Helanterä, I; Anttila, V-J; Loginov, R; Lempinen, M

    2017-03-01

    Parainfluenza virus (PIV) can cause serious infections after hematopoietic stem cell or lung transplantation. Limited data exist about PIV infections after kidney transplantation. We describe an outbreak of PIV-3 in a transplant unit. During the outbreak, 45 patients were treated on the ward for postoperative care after kidney or simultaneous pancreas-kidney (SPK) transplantation. Overall, 29 patients were tested for respiratory viruses (12 patients with respiratory symptoms, 17 asymptomatic exposed patients) from nasopharyngeal swabs using polymerase chain reaction. PIV-3 infection was confirmed in 12 patients. One patient remained asymptomatic. In others, symptoms were mostly mild upper respiratory tract symptoms and subsided within a few days with symptomatic treatment. Two patients suffered from lower respiratory tract symptoms (dyspnea, hypoxemia, pulmonary infiltrates in chest computed tomography) and required supplemental oxygen. Four of six SPK patients and eight of 39 of kidney transplant patients were infected with PIV (p = 0.04). In patients with follow-up tests, PIV-3 shedding was still detected 11-16 days after diagnosis. Despite rapid isolation of symptomatic patients, PIV-3 findings were diagnosed within 24 days, and the outbreak ceased only after closing the transplant ward temporarily. In conclusion, PIV-3 infections early after kidney or SPK transplantation were mostly mild. PIV-3 easily infected immunosuppressed transplant recipients, with prolonged viral shedding.

  7. Different techniques of vessel reconstruction during kidney transplantation

    Directory of Open Access Journals (Sweden)

    Tomić Aleksandar

    2015-01-01

    Full Text Available Background/Aim. Multiple renal arteries (MRAs represent a surgical challenge by the difficulty in performing anastomoses, bleeding and stenosis. MRAs should be preserved and special attention should be paid to accessory polar arteries. All renal arteries (RAs must be reconstructed and prepared for safe anastomosis. The paper decribed the different techniques of vessel reconstruction during kidney transplantation including important steps within recovery of organs, preparation and implantation. Methods. In a 16-year period (1996-2012 of kidney transplantation in the Military Medical Academy, Belgrade, a total of 310 living donors and 44 human cadaver kidney transplantations were performed, of which 28 (8% kidneys had two or more RAs. Results. All the transplanted kidneys had immediate function. We repaired 20 cases of donor kidneys with 2 arteries, 4 cases with three RAs, one case with 4 RAs, one case with 4 RAs and renal vein reconstruction, one case with 3 arteries and additional polytetrafluoroethylene (PTFE graft reconstruction, one case with transected renal artery and reconstruction with 5 cm long deceased donor external iliac artery. There were no major complications and graft failure. At a minimum of 1-year follow-up, all the patients showed normal renal function. Conclusion. Donor kidney transplantation on a contralateral side and “end-to-end” anastomosis of the renal artery to the internal iliac artery (IIA is our standard procedure with satisfactory results. Renal artery reconstruction and anastomosis with IIA is a safe and highly efficient procedure and kidneys with MRAs are not contraindicated for transplantation. A surgical team should be fully competent to remove cadaveric abdominal organs to avoid accidental injuries of organs vessels.

  8. [New possibilities in kidney transplantation from live unrelated donors].

    Science.gov (United States)

    Bosković, S

    1990-01-01

    The kidney transplantation, as a method of medical treatment, could not be developed faster in our country for many years. A number of demands for transplantation grows much faster than our modest capability. The similar, but in a rather smaller degree, this problem occurs in some other countries in the world. The main cause is: the organization of corpse collecting and the conservatism of doctors. The latter problem, in the countries of western hemisphere, is surpassed more easily by a doctor codex and a legal obligation that involves doctors actively in this process, which is not the case in our country. The organization of corpse collecting in some states of the USA is highly developed, but however it does not give sufficient number of organs for the cadaveric transplantation. New, additional possibilities are found: the taking of even organs (kidneys) from alive unrelated donors, spouses, which excludes the possibility of greed and gives, only in the USA, about 1.500 additional alive transplantations per year. The complementary medical attitude towards the increasing of number of cadaveric transplantations is: considerably freely taking of kidneys from cadavers without tissue compatibility, only with the compatibility of blood groups of ABO system. Since the immunological criteria, in our country, are very intensified by the Zagreb immunology group, e.g. from 75-100% for alive transplantation, or the minimum of 50% tissue compatibility for cadaveric transplantation, this old-fashioned attitude has considerably lowered the number of transplantations in our country.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Heart transplantation in adults with congenital heart disease.

    Science.gov (United States)

    Houyel, Lucile; To-Dumortier, Ngoc-Tram; Lepers, Yannick; Petit, Jérôme; Roussin, Régine; Ly, Mohamed; Lebret, Emmanuel; Fadel, Elie; Hörer, Jürgen; Hascoët, Sébastien

    2017-02-22

    With the advances in congenital cardiac surgery and postoperative care, an increasing number of children with complex congenital heart disease now reach adulthood. There are already more adults than children living with a congenital heart defect, including patients with complex congenital heart defects. Among these adults with congenital heart disease, a significant number will develop ventricular dysfunction over time. Heart failure accounts for 26-42% of deaths in adults with congenital heart defects. Heart transplantation, or heart-lung transplantation in Eisenmenger syndrome, then becomes the ultimate therapeutic possibility for these patients. This population is deemed to be at high risk of mortality after heart transplantation, although their long-term survival is similar to that of patients transplanted for other reasons. Indeed, heart transplantation in adults with congenital heart disease is often challenging, because of several potential problems: complex cardiac and vascular anatomy, multiple previous palliative and corrective surgeries, and effects on other organs (kidney, liver, lungs) of long-standing cardiac dysfunction or cyanosis, with frequent elevation of pulmonary vascular resistance. In this review, we focus on the specific problems relating to heart and heart-lung transplantation in this population, revisit the indications/contraindications, and update the long-term outcomes.

  10. International kidney paired donation transplantations to increase kidney transplant of O group and highly sensitized patient: First report from India

    Science.gov (United States)

    Kute, Vivek B; Patel, Himanshu V; Shah, Pankaj R; Modi, Pranjal R; Shah, Veena R; Rizvi, Sayyed J; Pal, Bipin C; Shah, Priya S; Wakhare, Pavan S; Shinde, Saiprasad G; Ghodela, Vijay A; Varyani, Umesh T; Patel, Minaxi H; Trivedi, Varsha B; Trivedi, Hargovind L

    2017-01-01

    AIM To report the first international living related two way kidney paired donation (KPD) transplantation from India which occurred on 17th February 2015 after legal permission from authorization committee. METHODS Donor recipient pairs were from Portugal and India who were highly sensitized and ABO incompatible with their spouse respectively. The two donor recipient pairs had negative lymphocyte cross-matching, flow cross-match and donor specific antibody in two way kidney exchange with the intended KPD donor. Local KPD options were fully explored for Indian patient prior to embarking on international KPD. RESULTS Both pairs underwent simultaneous uneventful kidney transplant surgeries and creatinine was 1 mg/dL on tacrolimus based immunosuppression at 11 mo follow up. The uniqueness of these transplantations was that they are first international KPD transplantations in our center. CONCLUSION International KPD will increases quality and quantity of living donor kidney transplantation. This could be an important step to solving the kidney shortage with additional benefit of reduced costs, improved quality and increased access for difficult to match incompatible pairs like O blood group patient with non-O donor and sensitized patient. To the best of our knowledge this is first international KPD transplantation from India. PMID:28280697

  11. Ethical issues in kidney transplantation – reflections from Nigeria

    Directory of Open Access Journals (Sweden)

    Joseph Olusesan Fadare

    2010-11-01

    Full Text Available Joseph Olusesan Fadare1, Babatunde L Salako21Department of Medicine, Kogi State Specialist Hospital, Lokoja; 2Department of Medicine, University of Ibadan, Ibadan, NigeriaAbstract: Organ transplantation has become a life-saving procedure for many disease conditions hitherto considered incurable. Kidney transplantation, now the treatment of choice for end-stage renal disease, is the commonest solid organ transplantation carried out in the world at the moment and it is the only solid organ transplantation done in Nigeria. This procedure, in addition to prolonging lives, also provides better quality of life and is evaluated as cost-effective, because it makes more resources available to other sectors of the economy. Organ transplantation in general and kidney transplantation in particular are fraught with ethical issues and dilemmas worldwide. Some of the ethical issues arising in the setting of developing countries like Nigeria may differ from those in countries where this procedure is established. Informed consent of the donor and the recipient is a major requirement for both organ donation and transplantation. Regarding donation, the ethical issues may differ depending on the type of organ donation, ie, whether it is living-related, living-unrelated, cadaveric, or from brain-dead individuals. Commodification of organs is identified as an ethical dilemma, and arguments for and against this practice are put forward here. Confidentiality of donor information, fairness and equity in donor selection, and access to kidney transplantation when needed are also discussed. Finally, the issue of safety of organ harvesting for the donor and of the transplantation process itself, and the possible long-term consequences for both parties are investigated.Keywords: kidney transplantation, ethical issues, developing countries, Nigeria

  12. Malignancies after kidney transplantation: Hong Kong renal registry.

    Science.gov (United States)

    Cheung, C Y; Lam, M F; Chu, K H; Chow, K M; Tsang, K Y; Yuen, S K; Wong, P N; Chan, S K; Leung, K T; Chan, C K; Ho, Y W; Chau, K F

    2012-11-01

    Manystudies have shown that kidney transplant recipients have a higher incidence of cancers when compared with general population. However, most data on the posttransplant malignancies (PTM) are derived from Western literature and large population-based studies are rare. There is also lack of information about the posttransplant cancer-specific mortality rate. We conducted a population-based study of 4895 kidney transplants between 1972 and 2011, with data from the Hong Kong Renal Registry. Patterns of cancer incidence and mortality in our kidney transplant recipients were compared with those of the general population using standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) respectively. With 40 246 person-years of follow-up, 299 PTM was diagnosed. The SIR of all cancers was 2.94 (female 3.58 and male 2.58). Non-Hodgkin lymphoma (NHL), kidney, and bladder cancers had the highest SIRs. The overall SMR was 2.3 (female 3.4 and male 1.7) and the highest SMR was NHL. The patterns of PTM differ among countries. Increases in cancer incidence can now translate into similar increases in cancer mortality. NHL is important in our kidney transplant recipients. Strategies in cancer screening in selected patient groups are needed to improve transplant outcomes.

  13. Changing Paradigms in the Management of Rejection in Kidney Transplantation

    Science.gov (United States)

    Maier, Mirela; Takano, Tomoko; Sapir-Pichhadze, Ruth

    2017-01-01

    Purpose of review: P4 medicine denotes an evolving field of medicine encompassing predictive, preventive, personalized, and participatory medicine. Using the example of kidney allograft rejection because of donor-recipient incompatibility in human leukocyte antigens, this review outlines P4 medicine’s relevance to the various stages of the kidney transplant cycle. Sources of information: A search for English articles was conducted in Medline via OvidSP (up to August 18, 2016) using a combination of subject headings (MeSH) and free text in titles, abstracts, and author keywords for the concepts kidney transplantation and P4 medicine. The electronic database search was expanded further on particular subject headings. Findings: Available histocompatibility methods exemplify current applications of the predictive and preventive domains of P4 medicine in kidney transplant recipients’ care. Pharmacogenomics are discussed as means to facilitate personalized immunosuppression regimens and promotion of active patient participation as a means to improve adherence. Limitations: For simplicity, this review focuses on rejection. P4 medicine, however, should more broadly address health concerns in kidney transplant recipients, including competing outcomes such as infections, malignancies, and cardiovascular disease. This review highlights how biomarkers to evaluate these competing outcomes warrant validation and standardization prior to their incorporation into clinical practice. Implications: Consideration of all 4 domains of the P4 medicine framework when caring for and/or studying kidney transplant recipients has the potential of increasing therapeutic efficiency, minimizing adverse effects, decreasing health care costs, and maximizing wellness. Technologies to gauge immune competency, immunosuppression requirements, and early/reversible immune-mediated injuries are required to optimize kidney transplant care. PMID:28270929

  14. Research of combined liver-kidney transplantation model in rats

    Institute of Scientific and Technical Information of China (English)

    Jiageng Zhu; Jun Li; Ruipeng Jia; Jianghao Su; Mingshun Shen; Zhigang Cao

    2007-01-01

    Objective: To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods: SD rats served as both donors and recipients. 4℃ sodium lactate Ringer's was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava (IVC) inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results: Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion: This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.

  15. A case of Ramsay Hunt syndrome diagnosed after kidney transplantation

    Directory of Open Access Journals (Sweden)

    Yoo Min Park

    2015-12-01

    Full Text Available We report the first case of Ramsay Hunt syndrome (RHS diagnosed after kidney transplantation in Korea. RHS is a disease caused by latent varicella-zoster characterized to involve geniculate ganglion of the seventh cranial nerve. Patients who have undergone kidney transplantation can be easily affected by viral infections because of their immune-compromised status. A 35-year-old man with hypertensive end-stage renal disease underwent kidney transplantation. Two months after surgery, the recipient was diagnosed with RHS and treated with antivirals and steroids. However, after using the antiviral agents for the recommended duration, facial paralysis occurred as a new presentation and he required further treatment. Otalgia and periauricular vesicles improved, but the facial palsy remained.

  16. Adult stem-like cells in kidney

    Institute of Scientific and Technical Information of China (English)

    Keiichi Hishikawa; Osamu Takase; Masahiro Yoshikawa; Taro Tsujimura; Masaomi Nangaku; Tsuyoshi Takato

    2015-01-01

    Human pluripotent cells are promising for treatmentfor kidney diseases, but the protocols for derivationof kidney cell types are still controversial. Kidneytissue regeneration is well confirmed in several lowervertebrates such as fish, and the repair of nephronsafter tubular damages is commonly observed after renalinjury. Even in adult mammal kidney, renal progenitorcell or system is reportedly presents suggesting thatadult stem-like cells in kidney can be practical clinicaltargets for kidney diseases. However, it is still unclearif kidney stem cells or stem-like cells exist or not. Ingeneral, stemness is defined by several factors suchas self-renewal capacity, multi-lineage potency andcharacteristic gene expression profiles. The definiteuse of stemness may be obstacle to understand kidneyregeneration, and here we describe the recent broadfindings of kidney regeneration and the cells thatcontribute regeneration.

  17. [Atypical mycobacterial infection after kidney transplant: two clinical cases].

    Science.gov (United States)

    Mele, Alessandra Antonia; Bilancio, G; Luciani, Remo; Bellizzi, Vincenzo; Palladino, Giuseppe

    2013-01-01

    Infections are an important cause of morbidity and mortality during kidney transplant. In areas where tuberculosis is not endemic, Mycobacteria other than tuberculosis (MOOT), also known as 'atypical' Mycobacteria, are more frequently involved in mycobacterial infections than M. tuberculosis. The incidence of MOOT infection in renal transplant recipients ranges from 0.16 to 0.38 percent. This low rate of reported incidence is, however, often due to delay in diagnosis and lack of therapeutic protocols. Further difficulty is caused by the interaction of antimycobacterial drugs with the post-transplant immunosuppressive regimen, necessitating close monitoring of plasma concentrations and careful dose modification. We present two cases of Mycobacterium Chelonae infection in kidney transplant recipients which differ in both clinical presentation and pharmacological approach.

  18. Post-transplant lymphoproliferative disorder following kidney transplantation

    DEFF Research Database (Denmark)

    Maksten, Eva Futtrup; Vase, Maja Ølholm; Kampmann, Jan;

    2016-01-01

    to identify possible PTLDs. Candidate PTLDs underwent histopathological review and classification. Seventy PTLD cases were identified in 2175 transplantations (3.2%). The incidence rate (IR) after first transplantation was 5.4 cases per 1000 patient-years (95% CI: 4.0-7.3). Most PTLDs were monomorphic (58...

  19. Transplantation of Kidneys From Donors With Acute Kidney Injury: Friend or Foe?

    Science.gov (United States)

    Boffa, C; van de Leemkolk, F; Curnow, E; Homan van der Heide, J; Gilbert, J; Sharples, E; Ploeg, R J

    2017-02-01

    The gap between supply and demand in kidney transplantation has led to increased use of marginal kidneys; however, kidneys with acute kidney injury are often declined/discarded. To determine whether this policy is justified, we analyzed outcomes of donor kidneys with acute kidney injury (AKI) in a large UK cohort. A retrospective analysis of the UK Transplant Registry evaluated deceased donors between 2003 and 2013. Donors were classified as no AKI, or AKI stage 1-3 according to Acute Kidney Injury Network (AKIN) criteria. Relationship of AKI with delayed graft function/primary nonfunction (DGF/PNF), estimated glomerular filtration rate (eGFR), and graft-survival at 90 days and 1 year was analyzed. There were 11 219 kidneys (1869 [17%] with AKI) included. Graft failure at 1 year is greater for donors with AKI than for those without (graft survival 89% vs. 91%, p = 0.02; odds ratio (OR) 1.20 [95% confidence interval (CI): 1.03-1.41]). DGF rates increase with donor AKI stage (p kidneys (9% vs. 4%, p = 0.04) Analysis of association between AKI and recipient eGFR suggests a risk of inferior eGFR with AKI versus no AKI (p kidneys from donors with AKI. We conclude that AKI stage 1 or 2 kidneys should be used; however, caution is advised for AKI stage 3 donors.

  20. Lymphocyte Activation Markers in Pediatric Kidney Transplant Recipients

    OpenAIRE

    Fatina I Fadel; Elghoroury, Eman A.; Elshamaa, Manal F.; Bazaraa, Hafez M; Salah, Doaa M.; Kassem, Neemat M. A.; Ibrahim, Mona H.; El-Saaid, Gamila S.; Nasr, Soha A.; Koura, Hala M.

    2015-01-01

    Background and objectives: The role of CD4+CD25+ T regulatory cells (Tregs) in immune tolerance in experimental transplantation is very important but the clinical significance of circulating Tregs in the peripheral blood is undetermined. We evaluated the association between the frequency of T cell activation markers CD25 and CD71 and clinical parameters that may affect the level of these T cell markers. Methods: In 47peditric kidney transplant (KT) recipients and 20 healthy controls, the freq...

  1. Comparing Three Data Mining Methods to Predict Kidney Transplant Survival

    Science.gov (United States)

    Shahmoradi, Leila; Langarizadeh, Mostafa; Pourmand, Gholamreza; fard, Ziba Aghsaei; Borhani, Alireza

    2016-01-01

    Introduction: One of the most important complications of post-transplant is rejection. Analyzing survival is one of the areas of medical prognosis and data mining, as an effective approach, has the capacity of analyzing and estimating outcomes in advance through discovering appropriate models among data. The present study aims at comparing the effectiveness of C5.0 algorithms, neural network and C&RTree to predict kidney transplant survival before transplant. Method: To detect factors effective in predicting transplant survival, information needs analysis was performed via a researcher-made questionnaire. A checklist was prepared and data of 513 kidney disease patient files were extracted from Sina Urology Research Center. Following CRISP methodology for data mining, IBM SPSS Modeler 14.2, C5.0, C&RTree algorithms and neural network were used. Results: Body Mass Index (BMI), cause of renal dysfunction and duration of dialysis were evaluated in all three models as the most effective factors in transplant survival. C5.0 algorithm with the highest validity (96.77%) was the first in estimating kidney transplant survival in patients followed by C&RTree (83.7%) and neural network (79.5%) models. Conclusion: Among the three models, C5.0 algorithm was the top model with high validity that confirms its strength in predicting survival. The most effective kidney transplant survival factors were detected in this study; therefore, duration of transplant survival (year) can be determined considering the regulations set for a new sample with specific characteristics. PMID:28163356

  2. Seatbelt injury resulting in functional loss of a transplanted kidney.

    Science.gov (United States)

    McHugh, Patrick P; Clifford, Timothy M; Johnston, Thomas D; Banerjee, Ambar S; Gedaly, Roberto; Jeon, Hoonbae; Ranjan, Dinesh

    2008-09-01

    The transplanted kidney, lying heterotopically in the iliac fossa, is especially vulnerable to damage from blunt trauma, particularly compression by vehicle seatbelt. We present a case wherein a functioning renal allograft lying in the right iliac fossa was severely injured by seatbelt compression, resulting in significant functional compromise and eventual loss. The patient later underwent successful retransplantation with a second living donor kidney. Management of injured renal transplant recipients requires appreciation of mechanisms likely to cause damage to the graft, as well as familiarity with available treatment options, both surgical and nonsurgical. As functional life spans of renal allografts improve, this type of injury will most likely be encountered with increasing frequency.

  3. New-onset diabetes mellitus after kidney transplantation in Denmark

    DEFF Research Database (Denmark)

    Hornum, Mads; Jørgensen, Kaj Anker; Hansen, Jesper Melchior;

    2010-01-01

    Background and objectives: This study aimed to investigate the development of new-onset diabetes mellitus (NODM) in a prospective study of 97 nondiabetic uremic patients. Design, setting, participants, & measurements: Included were 57 kidney recipients (Tx group, age 39 13 years) and 40 uremic...... patients remaining on the waiting list for kidney transplantation (uremic controls, age 47 11 years). All were examined at baseline before possible transplantation and after 12 months. The prevalence of diabetes, prediabetes, insulin sensitivity index (ISI), and insulin secretion index (Isecr) were...

  4. Type 4 renal tubular acidosis in a kidney transplant recipient

    Directory of Open Access Journals (Sweden)

    Manjunath Kulkarni

    2016-02-01

    Full Text Available We report a case of a 66-year-old diabetic patient who presented with muscle weakness 2 weeks after kidney transplantation. Her immunosuppressive regimen included tacrolimus, mycophenolate mofetil, and steroids. She was found to have hyperkalemia and normal anion gap metabolic acidosis. Tacrolimus levels were in therapeutic range. All other drugs such as beta blockers and trimethoprim – sulfamethoxazole were stopped. She did not respond to routine antikalemic measures. Further evaluation revealed type 4 renal tubular acidosis. Serum potassium levels returned to normal after starting sodium bicarbonate and fludrocortisone therapy. Though hyperkalemia is common in kidney transplant recipients, determining exact cause can guide specific treatment.

  5. Type 4 renal tubular acidosis in a kidney transplant recipient.

    Science.gov (United States)

    Kulkarni, Manjunath

    2016-02-01

    We report a case of a 66-year-old diabetic patient who presented with muscle weakness 2 weeks after kidney transplantation. Her immunosuppressive regimen included tacrolimus, mycophenolate mofetil, and steroids. She was found to have hyperkalemia and normal anion gap metabolic acidosis. Tacrolimus levels were in therapeutic range. All other drugs such as beta blockers and trimethoprim - sulfamethoxazole were stopped. She did not respond to routine antikalemic measures. Further evaluation revealed type 4 renal tubular acidosis. Serum potassium levels returned to normal after starting sodium bicarbonate and fludrocortisone therapy. Though hyperkalemia is common in kidney transplant recipients, determining exact cause can guide specific treatment.

  6. SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION: EARLY POSTOPERATIVE COMPLICATIONS

    Directory of Open Access Journals (Sweden)

    M.Sh. Khubutia

    2014-01-01

    Full Text Available Aim: evaluation of the incidence of early postoperative complications after simultaneous pancreas-kidney transplantation.Materials and methods. The analysis of early postoperative complications after simultaneous pancreas-kidney transplantation is presented in the paper, the most rational diagnostic algorithms, non-surgical and surgical complications’ treatment; the outcomes of the SPKT are reported.Results. 15,6% of patients experienced surgical complications, 12,5% – immunological complications, 12,5% – infectious complications, 6,25% – complications of the immunosuppressive therapy. 1-year patient survival after SPKT was 91,4%; pancreas graft survival – 85,7%; kidney graft survival – 88,6%.Conclusion. The incidence of early postoperative complications after simultaneous pancreas-kidney transplantation remains signifi cant in spite of progressive improvement of simultaneous pancreas-kidney transplantation due to surgical technique improvement, introduction of new antibacterial and immunosuppressive agents. Data, we recovered, fully correspond to the data obtained from the global medical community.

  7. SURGICAL TECHNIQUE, SHORT- AND LONG-TERM RESULTS OF THE HORSESHOE KIDNEY TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    Sh. R. Galeev

    2015-01-01

    Full Text Available The experience of horseshoe kidney transplant operations is significantly restricted. Transplant surgeons often refuse to use horseshoe kidney due to a number of serious abnormalities of vessels and upper urinary tract in these organs. However, the constant shortage of donor organs and an increase in patients on the waiting list for kidney transplantation make us reconsider our approach to the selection of donor organs. The aim of this work was to demonstrate our result of horseshoe kidney transplantation

  8. Two cases of combined liver-kidney transplantation

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objectives To report the clinical experiences of srmultaneous hepatorenal transplantation. Methods We performed simultaneous hepatorenal transplantation in one patient with liver cirrhosis of hepatitis B and uremia of chronic nephritis on February 1,1999 and one patient with liver cirrhosis of hepatitis B complicated by hepatorenal syndrome on March 12, 1999.The donors were heart arrest cases. Rapid multiple organ harvesting techniques and UW solution infusion in situ were used. Liver and kidney transplantation were orthotopic and ordinary methods, respectively. Immunosuppressive drugs consisted of cyclosporine, Cellcept, ALG and sortstso steroids. Lamividine was used os day 50 and day 40 postoparation, respectively. Results Both transplanted organs rapidly achieved normal function postoperation and the patients recovered well but suffered mild kidney rejection day 110 postopemtion in No 1 patient. In No 2 patient, acute renal function failure, mental symptoms, muscle spasm,cerebral artery thrombosis, inhalation poeumonia and chronic liver graft rejection ensured sequentially but were controlled.The patients have survived for more than nine and eight months, respectively, with normal life quality. Conclusions Combined hepatorenal transplant is a radical treatment method for liver and kidney function failure and requires more comprehensive techniques than isolated single organ transplantation.Preventing the recurrence of hepatitis B by oral lamividine may be a kdy to long-term survival.

  9. Eleven cases of solitary kidney transplantation from pediatric donor after controlled circulatory death into adult recipient%低龄心脏停跳供者单个肾脏成人移植11例

    Institute of Scientific and Technical Information of China (English)

    袁清; 张雷; 王立明; 曾力; 周梅生; 朱有华; 李劲东; 陈忠华

    2010-01-01

    目的 总结符合脑死亡诊断标准的低龄患儿心脏停跳后供肾应用于成人移植的处理经验.方法 心跳停止后单个供肾患儿6例,月龄49~106(75.35±22.8)个月,体质量16.6~37.8(23.9±8.4)kg.受者11例,平均年龄(28.2±7.9)岁,体质量(46.9±4.2)kg.单个供肾植入受者右侧髂窝.手术方法同成人尸肾移植.术中开始单/多克隆抗体加甲泼尼龙诱导治疗,术后常规环孢素或他克莫司、霉酚酸酯、泼尼松三联免疫抑制剂治疗.结果 受者肾功能均恢复正常,其中出现移植肾功能延迟恢复3例.术后移植肾增大明显,灌注后和移植后1周移植肾长径分别为(70.6±5.5)和(86.1±6.9)mm(P<0.001),之后移植肾持续缓慢增大,至术后12个月移植肾长径为(104.5±8.8)mm.平均随访时间(21.8±9.5)个月,1年人/肾存活率均为100%.结论 低龄心跳停止供者单个供肾植入低体重的成人受者,可以成功维持受者正常肾功能,1年人/肾存活率与成人尸肾移植无显著差异.%Objective To summarize the experience of single kidney from pediatric donors after controlled circulatory death transplanted into adult patients.Methods A retrospective single-center review of all adult recipients who received a single pediatric kidney from controlled cardiac deceased donor≤9-year old between January 2006 and March 2008.All donors were diagnosed as brain death and their parents signed the agreement of donation.Patients were observed for 5 to 15 min before cardiac death was declared and the organ-donation process initiated.The mean age and weight were(75.3±22.8)months and(23.9±8.4)kg of the pediatric donors,and(28.2±7.9)years and(46.9±4.2)kg of the aduh recipients.Single kidneys with more than 6cm in length were implanted into the right iliac fossa of recipients through same surgical procedures as in adult cadaveric renal transplantation.Immunosuppression consisted of induction therapy with poly/mono-clone immunoglobulin begun in the

  10. The investigation of correlation between Iminoral concentration and neurotoxic levels after kidney transplantation

    Directory of Open Access Journals (Sweden)

    Zahra Tolou-Ghamari

    2015-01-01

    Full Text Available Background: Neurotoxicity side effects related to cyclosporine kinetics could lead to dysfunction of kidney graft and patient outcome after transplantation. The aim of this study was evidence-based pharmacotherapy of kidney transplant recipients and to investigate neurotoxic levels of Iminoral. Materials and Methods: The results of 2239 cyclosporine trough levels obtained from 743 patients were studied. Seventy-five adult kidney recipients who received Iminoral were studied for neurotoxicity symptoms. Demographic, clinical, hematology and biochemical data were recorded in d-base and analyzed using SPSS application for windows. Results: The mean value related to cyclosporine C 0 was 246.3 μg/l. In the 48% the signs of neurotoxicity such as tremor and headache were noted, but only in 9% the levels of cyclosporine C 0 were >400 μg/l. Further studies on 75 patients showed that the incidence of neurotoxic side effects were as follows: Tremor in 35, headache in 24 and anxiety in 34 recipients of kidney. The prescribed drug regimens from the day of transplant in most patients were based on mycophenolic acid or cellcept, pulse therapy using methylprednisolone (daily from kidney transplant up to 3 days after transplant, cyclosporine or Iminoral plus other drugs related to each individual. Administrations of ganciclovir, thymoglobulin, clotrimazol and prednisolone were also distinguished with immunosuppressant-based therapy simultaneously. Conclusion: Evidence-based study related to pharmacotherapy of Iminoral showed that clinical presentation related to neurotoxic side effects such as tremor, headache and anxiety might be due to many factors such as polypharmacy. Planning immunosuppression to individual patients based on programmed therapeutic Iminoral monitoring, avoiding polypharmacy in terms of removal or drug minimization and focusing on first week after transplant seem to be a realistic option.

  11. Koilocytes in urinary cytology in a patient with kidney transplant.

    Science.gov (United States)

    Altamirano, Eugenia; Drut, Ricardo

    2008-05-01

    We are reporting the case of a 17-year-old girl with kidney transplant under immunosuppressive treatment. Evidences of transplant malfunction led to urinary cytology to rule out BKV infection. The smears showed the presence of koilocytes. Gynecologic examination revealed numerous condylomatous lesions in the vulva, vagina, and cervix. PAP smears showed cells with moderate to severe koilocytic dysplasia. PCR performed on material retrieved from both the smears showed HPV18 DNA sequences. Koilocytes have rarely been documented in urinary cytologic examination. Since post-transplant immunosuppressed patients are prone to develop florid and extensive HPV infections, urinary cytology may prove useful for routine search of cells with this virus cytopathic effect.

  12. The impact of kidney transplantation on insulin sensitivity

    DEFF Research Database (Denmark)

    Jørgensen, Morten B; Hornum, Mads; van Hall, Gerrit

    2017-01-01

    OBJECTIVE: To investigate the impact of kidney transplantation (KTx) on insulin sensitivity affecting glucose metabolism. METHODS: Nine non-diabetic patients awaiting living donor KTx were examined prior to transplantation with an oral glucose tolerance test and a 3h hyperinsulinaemic euglycaemic...... as mean [range]. RESULTS: Two patients had pre-transplant prediabetes whereas all others had normal glucose tolerance. After KTx, average glucose infusion rate to maintain euglycaemia during clamp declined significantly from 15.1 [9.1 - 23.7] to 9.8 [2.8 - 14.6] μmol kg(-1) min(-1) (P

  13. Kidney and liver transplantation in children with fibrocystic liver-kidney disease: data from the US Scientific Registry of Transplant Recipients: 1990-2010.

    Science.gov (United States)

    Wen, Jessica W; Furth, Susan L; Ruebner, Rebecca L

    2014-11-01

    The natural history and survival of children with fibrocystic liver-kidney disease undergoing solid organ transplantation have infrequently been described. We report outcomes in a cohort of US children with fibrocystic liver-kidney disease receiving solid organ transplants over 20 yr. Retrospective cohort study of pediatric transplant recipients with diagnoses of fibrocystic liver-kidney disease from 1/1990 to 3/2010, using data from the SRTR. Subjects were categorized by the first transplanted organ: LT, KT, or SLK. Primary outcomes were death, re-transplant, transplant of the alternate organ, or initiation of dialysis. Seven hundred and sixteen subjects were transplanted in this period. Median age at first transplant was 9.7 yr. Of the LT, 14 (19%) required a second liver transplant at median of 0.2 yr, and five (7%) required kidney transplant or dialysis at a median of 9.0 yr. Of the KT, 188 (31%) required a second kidney transplant or dialysis at a median of 5.9 yr. Twenty-nine (5%) subsequently received liver transplant at a median of 6.0 yr. Among patients in this registry, far more children underwent kidney than liver transplants. The risk of subsequently needing transplantation of an alternate organ was low.

  14. Change of Cyclosporine Absorption over the Time after Kidney Transplantation

    Science.gov (United States)

    Einollahi, Behzad; Teimoori, Mojtaba; Rostami, Zohreh

    2012-01-01

    Background Although the immunosuppressant cyclosporine (CsA) is widely used after kidney transplantation over the long term, there is still no firm consensus on the best way to monitor of CsA blood levels. Objectives Cyclosporine (CsA) assay is critical for the management of renal transplant recipients due to inter– and intra–patient variation in CsA absorption and metabolism. Patients and Methods: In a retrospective cross sectional study, blood levels of CsA (through and 2 hours post dose) measured at least 5 times during 3 years post transplantation, in 7702 kidney transplant recipients from different transplant center of Tehran, IR Iran between 2008 and 2012. Cyclosporine absorption (CA) calculated C2/C0 ratio. Results CA had a significant correlation with allograft function (P = 0.000, r =.0.285), this correlation was stronger than its relationship with C0 and C2 blood levels (P = 0.000 and P = 0.000 as well as r = 0.033 and r = 0.090, respectively). In univariate analysis during different times after transplantation, C0 and C2 blood levels significantly decreased over three years follow up (P = 0.000), (P = 0.000); While, CA reversely increases over the time (P = 0.000). In linear regression model overall CA levels had correlation with lower age of recipient (P = 0.02), hypokalemia (P = 0.001), higher level of creatinine (P = 0.02) and triglyceride (P = 0.001). Conclusions The present study shows that CsA absorption changes trough the post-transplant time and appears to increases over time in long–term period after kidney transplantation. PMID:23573469

  15. Predictors of perceived health status in patients after kidney transplantation

    NARCIS (Netherlands)

    Rosenberger, J.; van Dijk, J.P.; Nagyova, I.; Zezula, I.; Geckova, A.M.; Roland, R.; van den Heuvel, W.J.A.; Groothoff, J.W.

    2006-01-01

    Background. Patients after kidney transplantation have decreased mortality, morbidity and better quality of life compared to people on dialysis. Major efforts are being directed towards research into graft and patient survival. Research into quality of life is less intensive. The aim of this study w

  16. Sexual dysfunction after simultaneous pancreas-kidney transplantation

    DEFF Research Database (Denmark)

    Jürgensen, J S; Ulrich, C; Hörstrup, J H;

    2008-01-01

    Simultaneous pancreas-kidney transplantation (SPK) is the treatment of choice for patients with type 1 diabetes mellitus and end-stage renal disease (ESRD) because it improves survival, is cost-effective, and can mitigate secondary complications of diabetes. Patient-reported outcomes...

  17. Pretransplant identification of acute rejection risk following kidney transplantation

    NARCIS (Netherlands)

    Y. Lebranchu (Yvon); C.C. Baan (Carla); L. Biancone (Luigi); C. Legendre (Christophe); J.M. Morales (José Maria); L. Naesens; O. Thomusch (Oliver); P. Friend (Peter)

    2014-01-01

    textabstractLack of an accepted definition for 'high immunological risk' hampers individualization of immunosuppressive therapy after kidney transplantation. For recipient-related risk factors for acute rejection, the most compelling evidence points to younger age and African American ethnicity. Rec

  18. DCD kidney transplantation: results and measures to improve outcome.

    NARCIS (Netherlands)

    Hoogland, E.R.; Snoeijs, M.G.; Heurn, L.W.E. van

    2010-01-01

    PURPOSE OF REVIEW: The purpose of the present review is to describe the current kidney preservation techniques for donors after cardiac death and to give insight in new developments that may reduce warm ischemia times and therefore improve graft function after transplantation. RECENT FINDINGS: There

  19. Recurrence of Acute Page Kidney in a Renal Transplant Allograft

    Science.gov (United States)

    Zayas, Carlos; Mulloy, Laura; Jagadeesan, Muralidharan

    2016-01-01

    Acute Page Kidney (APK) phenomenon is a rare cause of secondary hypertension, mediated by activation of renin-angiotensin-aldosterone system (RAAS). Timely intervention is of great importance to prevent any end organ damage from hypertension. We present a unique case of three episodes of APK in the same renal transplant allograft. PMID:27725836

  20. Recurrence of Acute Page Kidney in a Renal Transplant Allograft

    Directory of Open Access Journals (Sweden)

    Rajan Kapoor

    2016-01-01

    Full Text Available Acute Page Kidney (APK phenomenon is a rare cause of secondary hypertension, mediated by activation of renin-angiotensin-aldosterone system (RAAS. Timely intervention is of great importance to prevent any end organ damage from hypertension. We present a unique case of three episodes of APK in the same renal transplant allograft.

  1. Recurrence of Acute Page Kidney in a Renal Transplant Allograft.

    Science.gov (United States)

    Kapoor, Rajan; Zayas, Carlos; Mulloy, Laura; Jagadeesan, Muralidharan

    2016-01-01

    Acute Page Kidney (APK) phenomenon is a rare cause of secondary hypertension, mediated by activation of renin-angiotensin-aldosterone system (RAAS). Timely intervention is of great importance to prevent any end organ damage from hypertension. We present a unique case of three episodes of APK in the same renal transplant allograft.

  2. URETERO-VESICAL ANASTOMOTIC COMPLICATIONS AFTER KIDNEY TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    S. V. Shkodkin

    2011-01-01

    Full Text Available This article presents statistical analysis of vesico-ureteric reflux and uretero-vesical obstruction incidence after kidney transplantation depending on technique mode. In this item prevalence of chronic pyelonephritis and spe- cies of causative agent data are analyzed. The necessity of effective methods to accomplish the uretero-vesical anastomosis is suggested. 

  3. Predictors and consequences of fatigue in prevalent kidney transplant recipients

    NARCIS (Netherlands)

    W. Chan; J.A. Bosch; D. Jones; O. Kaur; N. Inston; S. Moore; A. McClean; P.G. McTernan; L. Harper; A.C. Phillips; R. Borrows

    2013-01-01

    Background: Fatigue has been underinvestigated in stable kidney transplant recipients (KTRs). The objectives of this study were to investigate the nature, severity, prevalence, and clinical awareness of fatigue in medically stable KTRs, examine the impact of fatigue on quality of life (QoL), and exp

  4. Gordonia terrae kidney graft abscess in a renal transplant patient.

    Science.gov (United States)

    Nicodemo, A C; Odongo, F C A; Doi, A M; Sampaio, J L M

    2014-08-01

    We present the first report, to our knowledge, of a renal abscess cause by an infection from Gordonia terrae in a kidney transplant patient. The patient simultaneously had pulmonary tuberculosis and a perirenal allograft abscess caused by G. terrae. After treatment with imipenem, in addition to anti-tuberculous drugs, the patient was cured.

  5. Kidney transplantation procedures in rats: assessments, complications, and management.

    Science.gov (United States)

    Pahlavan, Payam S; Smallegange, Corry; Adams, Michael A; Schumacher, Martin

    2006-01-01

    Kidney transplantation in rats is an experimental model often used for the development of general microsurgical or transplantation techniques, for immunologic studies, and for analyzing transplant-associated long-term arterial blood-pressure changes. The aim of the present study was to analyze different surgical techniques of kidney transplantation in rats, with emphasis on minimizing surgical complications and establishing guidelines for their prevention and management. Complications were categorized into general (e.g., core body temperature drop, ischemic time) and surgically related vascular and urinary tract complications. In conclusion, a significant reduction of the complication rate in renal transplantation in rats can be achieved by placing the animal on a heating pad at an appropriate temperature. To reduce the risk of vascular thrombosis, ice-cold saline with heparin and careful flushing of the donor kidneys are recommended. Vascular complications can be avoided by performing "end-to-end" anastomosis techniques. The use of stents and cannulas in the urinary tract is associated with a high risk of urinary tract obstruction, and therefore is not recommended.

  6. Impact of vitamin D status and obesity on C-reactive protein in kidney-transplant patients

    DEFF Research Database (Denmark)

    Ewers, B.; Gasbjerg, A.; Zerahn, B.;

    2008-01-01

    Objective: We examined whether vitamin D status and obesity are associated with low-grade systemic inflammation, as assessed by serum concentrations of C-reactive protein (CRP) in an adult population of kidney-transplant patients. Design: This was a single-center, cross-sectional study. Setting a...... was found. Fat mass correlated positively with CRP, suggesting that obesity may increase the risk of cardiovascular disease and chronic allograft rejection in kidney-transplant patients. (C) 2008 by the National Kidney Foundation, Inc Udgivelsesdato: 2008/5......Objective: We examined whether vitamin D status and obesity are associated with low-grade systemic inflammation, as assessed by serum concentrations of C-reactive protein (CRP) in an adult population of kidney-transplant patients. Design: This was a single-center, cross-sectional study. Setting...... and Patients: Data were collected between December 2005 and April 2006 from 161 adult (aged >18 years) kidney-transplant patients (mean age, 53.1 years; SD, 11.5 years; females/males, 78/83), with a median kidney-graft age of 7.0 years and serum CRP levels :Vitamin D status was assessed...

  7. Black markets, transplant kidneys and interpersonal coercion

    Science.gov (United States)

    Taylor, J S

    2006-01-01

    One of the most common arguments against legalising markets in human kidneys is that this would result in the widespread misuse that is present in the black market becoming more prevalent. In particular, it is argued that if such markets were to be legalised, this would lead to an increase in the number of people being coerced into selling their kidneys. Moreover, such coercion would occur even if markets in kidneys were regulated, for those subject to such coercion would not be able to avail themselves of the legal protections that regulation would afford them. Despite the initial plausibility of this argument, there are three reasons to reject it. Firstly, the advantages of legalising markets in human kidneys would probably outweigh its possible disadvantages. Secondly, if it is believed that no such coercion can ever be tolerated, markets in only those human kidneys that fail to do away with coercion should be condemned. Finally, if coercion is genuinely opposed, then legalising kidney markets should be supported rather than opposed, for more people would be coerced (ie, into not selling) were such markets to be prohibited. PMID:17145908

  8. Transplantation of Horseshoe Kidney from Living, Genetically Unrelated Donor

    Directory of Open Access Journals (Sweden)

    Kazuro Kikkawa

    2015-01-01

    Full Text Available We report a case of renal transplantation using a horseshoe kidney from a living, genetically unrelated donor. The recipient was a 60-year-old man with diabetic nephropathy, and the donor was the 63-year-old wife of the recipient with a horseshoe kidney free of complications. Computed tomography showed two renal arteries and one renal vein on the left side, and the isthmus was perfused by several accessory arteries and veins. To demarcate the boundary of the isthmus, the left renal artery was ligated and cannulated for in situ perfusion. Furthermore, the isthmus was clamped, and the boundary of the isthmus was confirmed. The kidney was divided at the left margin of the perfused boundary. The cut ends of the isthmus were closed by sutures. The left kidney was transplanted into the right iliac fossa of the recipient. Asymptomatic fluid collection occurred on the cut surface at the isthmus of the donor, and this fluid decreased in due course. On the other hand, the recipient experienced no surgical complication or rejection, while maintaining serum creatinine levels of 2.00–2.20 mg/dL over a 22-month follow-up period. Horseshoe kidneys may be used for transplantation in selected cases after a detailed preoperative evaluation.

  9. Contrast-enhanced MR angiography in patients after kidney transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Huber, A.; Heuck, A.; Scheidler, J.; Holzknecht, N.; Baur, A.; Reiser, M. [Klinikum Grosshadern, Muenchen (Germany). Radiologische Klinik und Poliklinik; Stangl, M.; Theodorakis, J.; Illner, W.-D.; Land, W. [Dept. of Transplant Surgery, Klinikum Grosshadern, Muenchen (Germany)

    2001-12-01

    The aim of this study was to investigate the value of a contrast-enhanced 3D MR angiography in detecting postoperative vascular complications after kidney transplantation in comparison with digital subtraction angiography (DSA). Forty-one patients who underwent a kidney transplantation were examined with MR angiography and DSA. Contrast-enhanced MR angiography was performed as a dynamic measurement with one precontrast and three postcontrast measurements. Maximum intensity projection reconstructions were performed for all postcontrast data sets after DSA. The results were evaluated by two independent observers who were unaware of the DSA results. Twenty-three hemodynamically significant arterial stenoses were identified with DSA in the iliac arteries (n=7), the renal allograft arteries (n=12), and in their first branches (n=4). For a patient-based analysis the sensitivity and specificity, respectively, for observer 1 were 100 and 97%, and for observer 2, 100 and 93%. Respective data were 100 and 100% after a consensus evaluation by two observers. Complications involving the renal veins were detected in 2 cases and perfusion defects of the kidney parenchyma were detected in 4 cases. Contrast-enhanced MR angiography is a reliable method in identifying postoperative arterial stenoses after kidney transplantation. In addition, dynamic MR angiography can be helpful in detecting venous complications and perfusion defects in kidney allografts. (orig.)

  10. Radiology of kidney transplants; Radiodiagnostik der Transplantatniere

    Energy Technology Data Exchange (ETDEWEB)

    Schenk, J.P.; Hansmann, J.; Hallscheidt, P.; Weingard, K.; Leutloff, C.U.; Duex, M.; Richter, G.M.; Kaufmann, G.W. [Heidelberg Univ. (Germany). Abt. Radiodiagnostik; Wiesel, M. [Universitaetsklinik Heidelberg (Germany). Urologische Klinik und Poliklinik

    1999-05-01

    Diagnostic imaging after renal transplantation is of high importance in the differential diagnosis of peri- and postoperative complications. Sonography with color duplex imaging is the method of choice in the diagnosis of acute transplant rejection. MRI is an additional method in the diagnosis of transplant dysfunktion especially in diagnosis of perirenal fluid collections. MR angiography and MR urography are noninvasive diagnostic modalities with the potential to replace angiography and pyelography. Angiography, complemented by carbon dioxide angiography, still is the gold standard in the diagnosis of transplant artery stenosis. (orig.) [Deutsch] Die bildgebende Diagnostik nach Nierentransplantation hat einen hohen Stellenwert in der Differentialdiagnostik peri- und postoperativer Komplikationen. Die Sonographie mit Doppler- und Farbduplexsonographie ist die Methode der ersten Wahl in der Diagnostik der akuten Transplantatabstossung. Die MRT kann als zusaetzliche Methode in der Diagnostik der akuten Transplantatdysfunktion und insbesondere bei unklarer perirenaler Fluessigkeitsansammlung nach Transplantation eingesetzt werden. MR-Angiographie und MR-Urographie sind ergaenzende nichtinvasive Methoden, welche die Angiographie (DSA) und Pyelographie zunehmend ersetzen koennen. Die Angiographie, ergaenzt durch die CO{sub 2}-Angiographie, ist weiterhin der Goldstandard in der Diagnostik von Transplantatarterienstenosen. (orig.)

  11. Dyslipidemia After Kidney Transplantation and Correlation With Cyclosporine Level

    Directory of Open Access Journals (Sweden)

    Hosseini

    2013-06-01

    Full Text Available Background Dyslipidemia after kidney transplantation is a frequent finding and is multifactorial. Immunosuppressive agents such as cyclosporine (CsA can cause hypercholesterolemia. Objectives As there were few reports with conflicting evidence on whether CsA related dyslipidemia is dose related and that CsA monitoring assays (trough level, C0, or two hour post dose level, C2 is a better predictor for dyslipidemia development; hence, the current study, in a large sample size, was designed to answer these questions. 3. Patients and Methods In the current retrospective cross sectional study, 1391 kidney transplant recipients were enrolled. All patients received CsA plus mycophenolatemofetile or azathioprine and prednisolone. Serum creatinine, CsA blood levels and lipid profile were measured after 12-14 h fasting. Mann-Whitney and Kruskal-Wallis, Pearson`s test and logistic regression were used for data analyses. Results Mean age of 1391studied population was 38.7 ± 15 years old. Hypercholesterolemia and hypertriglyceridemia were observed in 58.9% and 86.6%, respectively and they were more significantly detected in cadaveric kidney transplantation. Dyslipidemia had weak correlation with age of recipient, serum creatinine, C0 and C2 levels of CsA. At logistic regression, serum creatinine was the only risk factor for hypercholesterolemia development after kidney transplantation (OR = 1.6, CI 95%: 1.4 -1.8. Conclusions Dyslipidemia is a common finding after kidney transplantation and has no correlation with CsA level. According to conflicting data on the precise effect of different factors in inducing dyslipidemia, prospective large sample size studies should consider better control of dyslipidemia.

  12. OCULAR SYPHILIS IN A KIDNEY TRANSPLANT RECIPIENT

    Science.gov (United States)

    ROMAO, Elen A.; BOLELLA, Valdes R.; NARDIN, Maria Estela P.; HABIB-SIMAO, Maria Lucia; FURTADO, João Marcelo; MOYSES-NETO, Miguel

    2016-01-01

    We present a case of ocular syphilis after a renal transplantation involving progressive vision loss without clinically identifiable ocular disease. Electroretinography showed signs of ischemia, especially in the internal retina. A serological test was positive for syphilis. Lumbar puncture revealed lymphocytic meningitis and a positive serologic test for syphilis in the cerebrospinal fluid. The patient was treated with penicillin, and had a quick vision improvement. In the case of transplant recipients, clinicians should always consider the diagnosis of ocular syphilis in cases with unexplained visual acuity decrement, as this condition may cause serious complications if not treated. PMID:27253748

  13. Rituximab: An emerging therapeutic agent for kidney transplantation

    Directory of Open Access Journals (Sweden)

    Joseph Kahwaji

    2009-10-01

    summary, we will make recommendations based on existing literature and our extensive experience at Cedars-Sinai Medical Center for using rituximab in renal transplantation.Keywords: kidney transplant, rituximab, desensitization, rejection, review

  14. Kidneys at higher risk of discard: expanding the role of dual kidney transplantation.

    Science.gov (United States)

    Tanriover, B; Mohan, S; Cohen, D J; Radhakrishnan, J; Nickolas, T L; Stone, P W; Tsapepas, D S; Crew, R J; Dube, G K; Sandoval, P R; Samstein, B; Dogan, E; Gaston, R S; Tanriover, J N; Ratner, L E; Hardy, M A

    2014-02-01

    Half of the recovered expanded criteria donor (ECD) kidneys are discarded in the United States. A new kidney allocation system offers kidneys at higher risk of discard, Kidney Donor Profile Index (KDPI)>85%, to a wider geographic area to promote broader sharing and expedite utilization. Dual kidney transplantation (DKT) based on the KDPI is a potential option to streamline allocation of kidneys which otherwise would have been discarded. To assess the clinical utility of the KDPI in kidneys at higher risk of discard, we analyzed the OPTN/UNOS Registry that included the deceased donor kidneys recovered between 2002 and 2012. The primary outcomes were allograft survival, patient survival and discard rate based on different KDPI categories (90%). Kidneys with KDPI>90% were associated with increased odds of discard (OR=1.99, 95% CI 1.74-2.29) compared to ones with KDPI90% were associated with lower overall allograft failure (HR=0.74, 95% CI 0.62-0.89) and better patient survival (HR=0.79, 95% CI 0.64-0.98) compared to single ECD kidneys with KDPI>90%. Kidneys at higher risk of discard may be offered in the up-front allocation system as a DKT. Further modeling and simulation studies are required to determine a reasonable KDPI cutoff percentile.

  15. THE ROLE OF PRE-TRANSPLANT AND DE NOVO ALLOANTIBODIES IN KIDNEY TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    A. I. Sushkov

    2011-01-01

    Full Text Available Kidney transplant recipients may have pre-transplant alloantibodies or develop de novo anti-HLA and non- HLA antibodies after transplantation. Although these antibodies may be donor-specific or non-donor-specific, their presence may increase the risk for acute and chronic rejection, thereby decreasing allograft survival. The introduction of high sensitive and specific methods to detect anti-HLA antibodies, both before and after trans- plantation, will help to define transplant recipients who might be at increased risk for early or late allograft failure. Moreover, knowledge of alloantibody status before transplantation may help to guide the appropriate use of immunomodulatory agents and plasmapheresis to remove anti-HLA antibodies or downregulate their production. The review focuses on the associations between renal graft outcome and pre-transplant and de novo alloantibodies. 

  16. Twenty-year survivors of kidney transplantation.

    LENUS (Irish Health Repository)

    Traynor, C

    2012-12-01

    There have been few studies of patients with renal allografts functioning for more than 20 years. We sought to identify clinical factors associated with ultra long-term (>20 year) renal allograft survival and to describe the clinical features of these patients. We performed a retrospective analysis of the Irish Renal Transplant Database and included 1174 transplants in 1002 patients. There were 255 (21.74%) patients with graft function for 20 years or more. Multivariate analysis identified recipient age (HR 1.01, CI 1.01-1.02), gender (male HR 1.25, CI 1.08-1.45), acute rejection (HR 1.26, CI 1.09-1.45) and transplant type (living related donor vs. deceased donor) (HR 0.52, CI 0.40-0.66) as significantly associated with long-term graft loss. Median serum creatinine was 115 μmol\\/L. The 5-year graft survival in 20-year survivors was 74.7%. The mean age at death was 62.7 years (±10.6). The most common causes of death were cardiovascular disease and malignancy. The two major causes of graft loss were death (with function) and interstitial fibrosis\\/tubular atrophy. Comorbidities included skin cancer (36.1%), coronary heart disease (17.3%) and other malignancies (14.5%). This study identifies factors associated with long-term allograft survival and a high rate of morbidity and early mortality in long-term transplant recipients.

  17. Death from cancer: a sobering truth for patients with kidney transplants.

    Science.gov (United States)

    Wong, Germaine; Chapman, Jeremy R; Craig, Jonathan C

    2014-06-01

    Cancer is a major cause of morbidity among those with kidney transplants. Farrugia et al. examined the overall and site-specific risk of cancer death among kidney transplant recipients. Cancer outcomes, particularly for those with a history of cancer prior to transplantation, are poor. The overall risk of death attributed to cancer in patients with kidney transplants is increased at least tenfold over that in cancer patients in the general population.

  18. Renal Structural Changes after Kidney Allograft Transplantation

    NARCIS (Netherlands)

    Bakker, R.C.

    2005-01-01

    In vitro studies done on human proximal tubular epithelial cells showed no direct cytotoxicity of cyclosporine A. The 15-year results of an open randomized trial comparing cyclosporine withdrawal and conversion to azathioprine with continued cyclosporine treatment after kidney allograft transplantat

  19. Plasma adiponectin before and after kidney transplantation

    DEFF Research Database (Denmark)

    Idorn, Thomas; Hornum, Mads; Bjerre, Mette

    2012-01-01

    control group was examined twice, separated by 12 months. ADPN levels declined significantly following Tx (P filtration rate (eGFR) increased (P ... before and after Tx including kidney function, insulin resistance, use of immunosuppressive agents and BMI. Pretransplant ADPN level did not predict development of new-onset diabetes mellitus or even deterioration of the glucose tolerance following Tx....

  20. Polycythemia after kidney transplantation: influence of the native kidneys on the production of hemoglobin.

    Science.gov (United States)

    Ianhex, L E; Da Fonseca, J A; Chocair, P R; Maspes, V; Sabbaga, E

    1977-01-01

    3 patients with renal transplantation who developed polycythemia presented normalization of the hemoglobin levels immediately after nephrectomy of the native kidneys. This observation induced the authors to study the role of the native kidneys in the genesis of polycythemia in recipients of renal allografts. Comparison was made among 32 patients submitted to renal transplantation, with maintenance of native kidneys (group I) and among 31 under the same conditions, but without the native kidneys (group II). Both groups were comparable according to age, sex, rejection crisis incidence and immunosuppressive therapy. It was observed that the hemoglobin levels of group I were significantly higher (p less than 0.05 to p less than 0.005) than those observed in group II, from the 3rd to the 30th posttransplantation month, becoming comparable from the 36th to the 54th months. The hemoglobin production, measured by the kinetics of labeled iron (59Fe), was higher in patients of group I. The authors concluded that the native kidneys are responsible for the observed polycythemia after a kidney transplantation.

  1. CINACALCET IMPROVES BONE DENSITY IN POST KIDNEY TRANSPLANT HYPERPARATHYROIDISM

    Science.gov (United States)

    Cho, ME; Duan, Z; Chamberlain, CE; Reynolds, JC; Ring, MS; Wright, EC; Mannon, RB

    2010-01-01

    The recent availability of cinacalcet has provided a possible alternative to parathyroidectomy in kidney transplant patients with persistent hyperparathyroidism, but its effect on bone mass density (BMD) is unknown. From our database containing 163 kidney transplants performed at our center from 1999-2007, we compared recipients who received cinacalcet for persistent hypercalcemia and hyperparathyroidism following renal tx (n=8; CIN) with up to 2 other post tx patients matched for age, sex, race, and graft function (n=15; CON). The outcome of the study was BMD changes from baseline to 12, 24, and 36 months post renal tx. Repeated Measures Mixed model was used to assess the difference of BMD change between two groups. Cinacalcet therapy was started at a median of 9 months (range; 1, 24 months) post tx with a mean dose 56±29 mg/d (mean duration; 1.6 years, range; 1, 2.1). Cinacalcet therapy was associated with significant reduction of serum calcium compared to control. Cinacalcet therapy was associated with greater BMD increase at the hip over the 36-month post transplant period. Cinacalcet was well tolerated. Our results suggest that cinacalcet may have a small but favorable effect on bone density following kidney transplantation. PMID:21094814

  2. Fasting ramadan in kidney transplant patients is safe

    Directory of Open Access Journals (Sweden)

    Boobes Yousef

    2009-01-01

    Full Text Available Muslims with renal transplant often ask their doctors whether fasting Ramadan is safe. Scanty studies have addressed this question. This prospective study was undertaken to identify any clinical or biological changes with Muslim fasting. 22 kidney transplant patients with stable kidney functions, who were transplanted for more than one year, and voluntarily chose to fast during Ramadan in 1425 H (October-November 2004, were studied. Total of 22 subjects (10 men and 12 women with a mean age of 47 ± 11.6 years were studied. Full clinical and biological assessment was done before during and after the month of Ramadan fasting. Medications were taken in two divided doses at sunset (time of breaking the fast and pre dawn (before the fast. None of the patients experienced any undue fatigue, or symptoms. Body weight, blood pressure, kidney function tests, blood sugar, lipid profile, and cyclosporine levels remained stable. In conclusion it is safe for renal transplant recipients of more than one year and having stable graft function to fast during the month of Ramadan; however caution is advised for moderate to severe impaired renal function.

  3. Pharmacokinetic study of mycophenolic acid in Iranian kidney transplant patients

    Directory of Open Access Journals (Sweden)

    Saeed Rezaee

    2013-02-01

    Full Text Available Background: The purpose of this study was to characterize the pharmacokinetic parameters of mycophenolic acid (MPA in Iranian kidney transplant patients. Methods: Plasma MPA concentration of mycophenolate mofetile (MMF 1 gram two times a day was measured in 21 Iranian kidney transplant recipients receiving treatment. Patients who entered the study had been transplanted for more than 3 months and their drug level was supposed to be at steady state. MMF concentration was measured with high-performance liquid chromatography (HPLC. Results: The plasma MPA concentration-time curve was characterized by an early sharp peak at about 1 hour postdose. The mean Area Under Curve (AUC, Cmax and Tmax were 47.0±18.3 µg.h/ml, 18.6±8.5 µg/ml and 1.0±0.5 hours respectively. Conclusion: The plasma MPA concentration-time curve pattern of Iranian patients was similar and consistent with previously reported profiles in other populations taking the same dose. Keywords: Mycophenolate mofetil, Mycophenolic acid, Pharmacokinetics, Area Under Curve, Kidney transplantation

  4. Aspirin resistance as cardiovascular risk after kidney transplantation

    Science.gov (United States)

    Sandor, Barbara; Varga, Adam; Rabai, Miklos; Toth, Andras; Papp, Judit; Toth, Kalman; Szakaly, Peter

    2014-05-01

    International surveys have shown that the leading cause of death after kidney transplantation has cardiovascular origin with a prevalence of 35-40%. As a preventive strategy these patients receive aspirin (ASA) therapy, even though their rate of aspirin resistance is still unknown. In our study, platelet aggregation measurements were performed between 2009 and 2012 investigating the laboratory effect of low-dose aspirin (100 mg) treatment using a CARAT TX4 optical aggregometer. ASA therapy was considered clinically effective in case of low ( i.e., below 40%) epinephrine-induced (10 μM) platelet aggregation index. Rate of aspirin resistance, morbidity and mortality data of kidney transplanted patients (n = 255, mean age: 49 ± 12 years) were compared to a patient population with cardio- and cerebrovascular diseases (n = 346, mean age: 52.6 ± 11 years). Rate of aspirin resistance was significantly higher in the renal transplantation group (RT) compared to the positive control group (PC) (35.9% vs. 25.6%, p aspirin resistance contributes to the high cardiovascular mortality after kidney transplantation.

  5. The Critically Ill Kidney Transplant Recipient: A Narrative Review.

    Science.gov (United States)

    Canet, Emmanuel; Zafrani, Lara; Azoulay, Élie

    2016-06-01

    Kidney transplantation is the most common solid organ transplantation performed worldwide. Up to 6% of kidney transplant recipients experience a life-threatening complication that requires ICU admission, chiefly in the late posttransplantation period (≥ 6 months). Acute respiratory failure and septic shock are the main reasons for ICU admission. Cardiac pulmonary edema, bacterial pneumonia, acute graft pyelonephritis, and bloodstream infections account for the vast majority of diagnoses in the ICU. Pneumocystis jirovecii pneumonia is the most common opportunistic infection, and one-half of the patients so infected require mechanical ventilation. The incidence of cytomegalovirus visceral infections in the era of preemptive therapy has dramatically decreased. Drug-related neutropenia, sirolimus-related pneumonitis, and posterior reversible encephalopathy syndrome are among the most common immunosuppression-associated toxic effects. Importantly, the impact of critical illness on graft function is worrisome. Throughout the ICU stay, acute kidney injury is common, and about 40% of the recipients require renal replacement therapy. One-half of the patients are discharged alive and free from dialysis. Hospital mortality can reach 30% and correlates with acute illness severity and reason for ICU admission. Transplant characteristics are not predictors of short-term survival. Graft survival depends on pre-ICU graft function, disease severity, and renal toxicity of ICU investigations and treatments.

  6. A Prospective Cohort Study of Mineral Metabolism After Kidney Transplantation

    Science.gov (United States)

    Wolf, Myles; Weir, Matthew R.; Kopyt, Nelson; Mannon, Roslyn B.; Von Visger, Jon; Deng, Hongjie; Yue, Susan; Vincenti, Flavio

    2016-01-01

    Background Kidney transplantation corrects or improves many complications of chronic kidney disease, but its impact on disordered mineral metabolism is incompletely understood. Methods We performed a multicenter, prospective, observational cohort study of 246 kidney transplant recipients in the United States to investigate the evolution of mineral metabolism from pretransplant through the first year after transplantation. Participants were enrolled into 2 strata defined by their pretransplant levels of parathyroid hormone (PTH), low PTH (>65 to ≤300 pg/mL; n = 112), and high PTH (>300 pg/mL; n = 134) and underwent repeated, longitudinal testing for mineral metabolites. Results The prevalence of posttransplant, persistent hyperparathyroidism (PTH >65 pg/mL) was 89.5%, 86.8%, 83.1%, and 86.2%, at months 3, 6, 9, and 12, respectively, among participants who remained untreated with cinacalcet, vitamin D sterols, or parathyroidectomy. The results did not differ across the low and high PTH strata, and rates of persistent hyperparathyroidism remained higher than 40% when defined using a higher PTH threshold greater than 130 pg/mL. Rates of hypercalcemia peaked at 48% at week 8 in the high PTH stratum and then steadily decreased through month 12. Rates of hypophosphatemia (<2.5 mg/dL) peaked at week 2 and then progressively decreased through month 12. Levels of intact fibroblast growth factor 23 decreased rapidly during the first 3 months after transplantation in both PTH strata and remained less than 40 pg/mL thereafter. Conclusions Persistent hyperparathyroidism is common after kidney transplantation. Further studies should determine if persistent hyperparathyroidism or its treatment influences long-term posttransplantation clinical outcomes. PMID:26177089

  7. Ultrasonic microbubble contrast agents and the transplant kidney

    Energy Technology Data Exchange (ETDEWEB)

    Kay, D.H., E-mail: davidhkay@doctors.org.u [Department of Radiology, Western Infirmary, Glasgow (United Kingdom); Mazonakis, M.; Geddes, C. [Department of Renal Medicine, Western Infirmary, Glasgow (United Kingdom); Baxter, G. [Department of Radiology, Western Infirmary, Glasgow (United Kingdom)

    2009-11-15

    Aim: To evaluate the potential application of microbubble agents in the immediate post-transplant period, by studying contrast uptake and washout, and to correlate these values with clinical indices, and thus, assess the potential prognostic value of this technique. Materials and methods: The study group comprised 20 consecutive renal transplant patients within 7 days of transplantation. Sonovue was administered as an intravenous bolus with continuous imaging of the transplant kidney at low mechanical index (MI) for 1 min post-injection. These data were analysed off-line by two observers, and time intensity curves (TIC) for the upper, mid, and lower poles constructed. Within each pole, a region of interest (5 mm square) was placed over the cortex, medullary pyramid, and interlobar artery, resulting in a total of nine TIC for each patient. TIC parameters included the arrival time (AT), time to peak (TTP), peak intensity (Max), gradient of the slope (M), and the area under curve (AUC). Results: For both observers there was good agreement for all values measured from the cortex and medulla, but poor interobserver correlation for the vascular values. In addition, there was only agreement for these values in the upper and mid-pole of the transplant with poor agreement for the lower pole values. The mid-pole of the transplant kidney was chosen as the point of measurement for subsequent studies. Mid-pole values were correlated with clinical data and outcome over the 3-month post-transplant period. Renal microbubble perfusion correlated with the transplant estimated glomerular filtration rate (eGFR) at 3 months post-transplantation (p = 0.016). Discussion: In conclusion, this is the first study to confirm reproducibility of the Sonovue TIC data in transplant patients and to quantify regional variation and perfusion. The statistically significant estimates of transplant perfusion may be of future benefit to transplant recipients and potentially utilized as a prognostic tool

  8. Are There Inequities in Treatment of End-Stage Renal Disease in Sweden? A Longitudinal Register-Based Study on Socioeconomic Status-Related Access to Kidney Transplantation

    Science.gov (United States)

    Zhang, Ye; Jarl, Johan; Gerdtham, Ulf-G.

    2017-01-01

    Socioeconomic status-related factors have been associated with access to kidney transplantation, yet few studies have investigated both individual income and education as determinates of access to kidney transplantation. Therefore, this study aims to explore the effects of both individual income and education on access to kidney transplantation, controlling for both medical and non-medical factors. We linked the Swedish Renal Register to national registers for a sample of adult patients who started Renal Replacement Therapy (RRT) in Sweden between 1 January 1995, and 31 December 2013. Using uni- and multivariate logistic models, we studied the association between pre-RRT income and education and likelihood of receiving kidney transplantation. For non-pre-emptive transplantation patients, we also used multivariate Cox proportional hazards regression analysis to assess the association between treatment and socioeconomic factors. Among the 16,215 patients in the sample, 27% had received kidney transplantation by the end of 2013. After adjusting for covariates, the highest income group had more than three times the chance of accessing kidney transplantation compared with patients in the lowest income group (odds ratio (OR): 3.22; 95% confidence interval (CI): 2.73–3.80). Patients with college education had more than three times higher chance of access to kidney transplantation compared with patients with mandatory education (OR: 3.18; 95% CI: 2.77–3.66). Neither living in the county of the transplantation center nor gender was shown to have any effect on the likelihood of receiving kidney transplantation. For non-pre-emptive transplantation patients, the results from Cox models were similar with what we got from logistic models. Sensitive analyses showed that results were not sensitive to different conditions. Overall, socioeconomic status-related inequities exist in access to kidney transplantation in Sweden. Additional studies are needed to explore the possible

  9. 中国三类心死亡遗体器官捐献成人供肾移植术后的临床病理分析%Clinicopathologic Characteristics of Renal Transplant Recipients Whose Transplant Kidneys were from Adult Donors after C-Ⅲ Donation of Cardiac Death

    Institute of Scientific and Technical Information of China (English)

    龚亮; 聂峰; 孙煦勇; 彭红波

    2016-01-01

    Objective To study the clinicopathologic features of renal transplant recipients whose transplant kidneys were from adult donors after C - Ⅲ donation of cardiac death(DCD),to provide a reference for clinical practice. Methods 32 renal transplant recipients who were treated in 458th Hospital of PLA and 303th Hospital of PLA from September 2011 to May 2014,were selected as study subjects,their transplant kidneys were from donors after C - Ⅲ DCD,36 cases underwent needle biopsy of transplant kidney or received pathological examination after transplant nephrectomy,the pathological results were determined by two pathologic doctors with secondary senior positions according to the 2007 Banff system of working classification of renal allograft pathology. 40 renal transplant recipients who were treated in 458th Hospital of PLA and 303th Hospital of PLA during the same period,were selected as control subjects,their kidneys were from cadaver donors,40 cases underwent needle biopsy of transplant kidney. Incidences of acute tubular necrosis( ATN),tacrolimus( Tac)toxicity damage,acute rejection (AR),chronic rejection(CR),new/ relapse nephropathy,tubular atrophy and interstitial fibrosis were compared between two groups. Results 32 DCD renal transplant recipients were treated with triple drug therapy( Tac + mycophenolate mofetil +prednisone). Pathological findings,Visual inspection:The biopsy specimens were gray fine strip organization,the length was between 0. 8 cm and 1. 5 cm,the diameter was about 0. 1 cm,the transplant kidneys showed normal shape and size,the structure of medulla and cortex was clear,renal pelvic mucosa was smooth and no expansion was observed,no thrombosis was found in renal hilum blood vessels,narrow and expansion of the ureter were not found. Microscopic examination:1 case had fewer number of glomerulus,and the other 35 cases were qualified. 19 cases had minor glomerular abnormalities,14 cases had glomerulosclerosis,13 cases had extravasated blood

  10. Pretransplant identification of acute rejection risk following kidney transplantation.

    Science.gov (United States)

    Lebranchu, Yvon; Baan, Carla; Biancone, Luigi; Legendre, Christophe; Morales, José Maria; Naesens, Maarten; Thomusch, Oliver; Friend, Peter

    2014-02-01

    Lack of an accepted definition for 'high immunological risk' hampers individualization of immunosuppressive therapy after kidney transplantation. For recipient-related risk factors for acute rejection, the most compelling evidence points to younger age and African American ethnicity. Recipient gender, body mass, previous transplantation, and concomitant infection or disease do not appear to be influential. Deceased donation now has only a minor effect on rejection risk, but older donor age remains a significant predictor. Conventional immunological markers (human leukocyte antigen [HLA] mismatching, pretransplant anti-HLA alloantibodies, and panel reactive antibodies) are being reassessed in light of growing understanding about the role of donor-specific antibodies (DSA). At the time of transplant, delayed graft function is one of the most clear-cut risk factors for acute rejection. Extended cold ischemia time (≥ 24 h) may also play a contributory role. While it is not yet possible to establish conclusively the relative contribution of different risk factors for acute rejection after kidney transplantation, the available data point to variables that should be taken into account at the time of transplant. Together, these offer a realistic basis for planning an appropriate immunosuppression regimen in individual patients.

  11. Cholelithiasis in patients on the kidney transplant waiting list

    Directory of Open Access Journals (Sweden)

    André Thiago Scandiuzzi Brito

    2010-01-01

    Full Text Available OBJECTIVES: To evaluate the prevalence of cholecystopathy in chronic renal patients awaiting kidney transplants. INTRODUCTION: The prevalence and management of cholelithiasis in renal transplant patients is not well established. METHODS: A total of 342 chronic renal failure patients on the waiting list for a kidney transplant were studied. Patients were evaluated for the presence of cholelithiasis and related symptoms, previous cholecystectomies and other abdominal surgeries, time on dialysis, and general data (gender, age, number of pregnancies, and body mass index. RESULTS: Cholelithiasis was found in 41 out of 342 patients (12%. Twelve of these patients, all symptomatic, had previously undergone cholecystectomies. Five out of 29 patients who had not undergone surgery were symptomatic. Overall, 17 patients (41.5% were symptomatic. Their mean age was 54 (range 32-74 years old; 61% were female, and their mean body mass index was 25.4. Nineteen (76% out of 25 women had previously been pregnant, with an average of 3.6 pregnancies per woman. CONCLUSIONS: The frequency of cholelithiasis was similar to that reported in the literature for the general population. However, the high frequency of symptomatic patients points toward an indication of routine pre-transplant cholecystectomy to avoid serious post-transplant complications.

  12. Kidney transplantation from donors with hepatitis C infection.

    Science.gov (United States)

    Veroux, Massimiliano; Corona, Daniela; Sinagra, Nunziata; Giaquinta, Alessia; Zerbo, Domenico; Ekser, Burcin; Giuffrida, Giuseppe; Caglià, Pietro; Gula, Riccardo; Ardita, Vincenzo; Veroux, Pierfrancesco

    2014-03-21

    The increasing demand for organ donors to supply the increasing number of patients on kidney waiting lists has led to most transplant centers developing protocols that allow safe utilization from donors with special clinical situations which previously were regarded as contraindications. Deceased donors with previous hepatitis C infection may represent a safe resource to expand the donor pool. When allocated to serology-matched recipients, kidney transplantation from donors with hepatitis C may result in an excellent short-term outcome and a significant reduction of time on the waiting list. Special care must be dedicated to the pre-transplant evaluation of potential candidates, particularly with regard to liver functionality and evidence of liver histological damage, such as cirrhosis, that could be a contraindication to transplantation. Pre-transplant antiviral therapy could be useful to reduce the viral load and to improve the long-term results, which may be affected by the progression of liver disease in the recipients. An accurate selection of both donor and recipient is mandatory to achieve a satisfactory long-term outcome.

  13. Impact of vitamin D status and obesity on C-reactive protein in kidney-transplant patients

    DEFF Research Database (Denmark)

    Ewers, Bettina; Gasbjerg, Ane; Zerahn, Bo;

    2008-01-01

    OBJECTIVE: We examined whether vitamin D status and obesity are associated with low-grade systemic inflammation, as assessed by serum concentrations of C-reactive protein (CRP) in an adult population of kidney-transplant patients. DESIGN: This was a single-center, cross-sectional study. SETTING A...... was found. Fat mass correlated positively with CRP, suggesting that obesity may increase the risk of cardiovascular disease and chronic allograft rejection in kidney-transplant patients.......OBJECTIVE: We examined whether vitamin D status and obesity are associated with low-grade systemic inflammation, as assessed by serum concentrations of C-reactive protein (CRP) in an adult population of kidney-transplant patients. DESIGN: This was a single-center, cross-sectional study. SETTING...... AND PATIENTS: Data were collected between December 2005 and April 2006 from 161 adult (aged >18 years) kidney-transplant patients (mean age, 53.1 years; SD, 11.5 years; females/males, 78/83), with a median kidney-graft age of 7.0 years and serum CRP levels Vitamin D status was assessed...

  14. Characterization of vaginal lactobacilli in women after kidney transplantation.

    Science.gov (United States)

    Martirosian, G; Radosz-Komoniewska, H; Pietrzak, B; Ekiel, A; Kamiński, P; Aptekorz, M; Doleżych, H; Samulska, E; Jóźwiak, J

    2012-04-01

    Limited number of publications described vaginal microflora after kidney transplantation. Our PubMed search revealed only 18 publications including words "vaginal bacteria & kidney transplant" in the period of 1978-2011. The aim of this study was to characterize lactobacilli isolated from vaginal swabs of women after kidney transplantation, compared with healthy women. Eighteen renal transplant recipients (mean age 36.1) and 20 healthy women (mean age 36.0) were evaluated. Lactobacilli were cultured on MRS and Columbia blood agars. Biochemical identification with API 50 CHL (bioMerieux, Marcy L'Etoile, France) and multiplex PCR according to Song et al. was performed. Lactobacilli were tested for production of H(2)O(2). Minimal inhibitory concentrations (MICs) of selected antimicrobial agents were determined with E-tests (bioMerieux, Marcy L'Etoile, France) and interpreted with CLSI and EUCAST criteria. No bacterial vaginosis was found among studied women. Two strains of group I were identified as Lactobacillus delbrueckii; 18 strains as Lactobacillus gasseri and 15 strains as Lactobacillus crispatus. Only 3 strains from group II were not identified by species-specific mPCR. Group IV was represented with 2 unidentified strains. Vaginal lactobacilli isolated from healthy women represented more homogenous group compared with heterogenous renal transplant recipients. Biochemical identification of lactobacilli by API 50 CHL kits was concordant with mPCR results only in 7 cases (17.5%), all 7 strains were identified as L. crispatus. Majority (93%) of lactobacilli were H(2)O(2) producers. All isolated lactobacilli (100%) demonstrated high resistance to metronidazole (MIC > 256 μg/ml). Only 2 strains resistant to vancomycin (MICs: 32 and 256 μg/ml respectively), in the study and control group, and one to moxifloxacin (MIC = 32 μg/ml), were found. Resistance to metronidazole and vancomycin was concordant in CLSI and EUCAST (2010) criteria. Although significant

  15. Statins in chronic kidney disease and kidney transplantation.

    Science.gov (United States)

    Kassimatis, Theodoros I; Goldsmith, David J A

    2014-10-01

    HMG-CoA reductase inhibitors (statins) have been shown to improve cardiovascular (CV) outcomes in the general population as well as in patients with cardiovascular disease (CVD). Statins' beneficial effects have been attributed to both cholesterol-lowering and cholesterol-independent "pleiotropic" properties. By their pleiotropic effects statins have been shown to reduce inflammation, alleviate oxidative stress, modify the immunologic responses, improve endothelial function and suppress platelet aggregation. Patients with chronic kidney disease (CKD) exhibit an enormous increase in CVD rates even from early CKD stages. As considerable differences exist in dyslipidemia characteristics and the pathogenesis of CVD in CKD, statins' CV benefits in CKD patients (including those with a kidney graft) should not be considered unequivocal. Indeed, accumulating clinical evidence suggests that statins exert diverse effects on dialysis and non-dialysis CKD patients. Therefore, it seems that statins improve CV outcomes in non-dialysis patients whereas exert little (if any) benefit in the dialysis population. It has also been proposed that dyslipidemia might play a causative role or even accelerate renal injury. Moreover, ample experimental evidence suggests that statins ameliorate renal damage. However, a high quality randomized controlled trial (RCT) and metaanalyses do not support a beneficial role of statins in renal outcomes in terms of proteinuria reduction or retardation of glomerular filtration rate (GFR) decline.

  16. The role of an interdisciplinary transplant team on living donation kidney transplantation program.

    Science.gov (United States)

    Fonouni, H; Golriz, M; Mehrabi, A; Oweira, H; Schmied, B M; Müller, S A; Jarahian, P; Tahmasbi Rad, M; Esmaeilzadeh, M; Tönshoff, B; Weitz, J; Büchler, M W; Zeier, M; Schmidt, J

    2010-01-01

    During the last decades, the disparity between the organ supply and the demand for kidney transplantation in Europe has led to consider living donors as a more acceptable option. In the last 7 years, we have established an interdisciplinary supporting transplant team to increase the rate of living donation. After 2001, the new interdisciplinary transplant team consisted of a transplant surgeon, a nephrologist, a pediatrician, a radiologist, a psychologist, a transplant coordinator, and a transplant nurse. We performed a prospective analysis to examine the effect of implementing this team on our living donation program. Demographic data, the annual number of procedures, the duration of waiting, and the cold ischemia time were evaluated among brain-dead and living donors. From January 2002 until December 2008, the number of patients who were annually on the waiting list increased 42% (from 377 to 536 patients). Consequently, the number of the total kidney transplants increased from 81 to 120 with an annual median of 98 cases. By implementing the interdisciplinary transplant team, a significant increase of living kidney donors was observed: from 18 to 42 cases; median = 27). In the last 7 years, a total number of 796 kidney transplants have been performed: 567 from brain-dead and 229 from living donors. In 2001, the waiting list times for recipients who received grafts from brain-dead versus living donors were 1356 versus 615 days respectively. Compared with 2008, the duration on the waiting list decreased significantly for patients receiving a living donor graft, whereas there was a slight increase for the patients in the brain-dead group: brain death versus living donors: 1407 versus 305 days. The interdisciplinary approach has also reduced the cold ischemia time for the living donor recipients: 3 hours and 42 minutes in 2001 versus 2 hours and 50 minutes in 2008. During the last years, by implementing an interdisciplinary transplant team, supporting living donor

  17. Cytomegalovirus Infection following Kidney Transplantation: a Multicenter Study of 3065 Cases

    OpenAIRE

    2012-01-01

    Background: Cytomegalovirus (CMV) infection is a common complication following kidney transplantation. Objective: To assess the incidence and risk factors of CMV infection among renal transplant recipients. Methods: In a retrospective multicenter study, 3065 renal transplant recipients from 17 transplant centers of Iran were studied between April 2008 and January 2011. Kidney transplant patients were routinely monitored by sequential blood samples drawn for use in the CMV-pp65 antigenemia ass...

  18. Imaging of transplanted kidney. Imagerie du rein transplante

    Energy Technology Data Exchange (ETDEWEB)

    Helenon, O.; Attlan, E.; Correas, J.M.; Chabriais, J.; Souissi, M.; Hanna, S.; Legendre, C.; Kreis, H.; Moreau, J.F. (Hopital Necker, 75 - Paris (FR))

    1991-01-01

    The evolution of transplantation entails multiple complications, whose frequency and severity depend on the conditions of sampling and the quality of conservation, the grafting technique, the immunosuppressant treatment and the quality of surveillance. The latter has been significantly improved by the progress of imaging, which has allowed improving the prognosis of renal transplantation. Imaging is used for the diagnosis, surveillance and, in some cases, the treatment of these complications. Among the modern imaging techniques, color Doppler is a non-aggressive technique which currently ranks first for the screening of pedicular and peripheral vascular complications. The role of MRI is still ill-defined. While the initial results demonstrated its poor specificity, the use of paramagnetic contrast media provides a remarkable diagnostic effectiveness in case of peripheral necrosis. The lack of diagnostic specificity of imaging for medical complications most often confines its use to the follow-up of evolution. Thus renal biopsy remains the key examination for the diagnosis of immunological, ischemic or toxic complications. Ultrasound plays an essential part in the screening of urological complications, for which the diagnosis and assessment are based on plain radiological examinations. The indications of CT, which are defined according to ultrasound findings, are limited to the study of postoperative fluid collections and infectious complications. Arteriography remains essential for some selected indications, such as the study of the vascular pedicle. Intraoperative radiology plays an important part in the diagnosis and treatment of urological complications, the treatment of arterial stenoses and the drainage of some postoperative fluid collections. 34 figs.

  19. Appraisal of transplant-related stressors, coping strategies, and psychosocial adjustment following kidney transplantation.

    Science.gov (United States)

    Pisanti, Renato; Lombardo, Caterina; Luszczynska, Aleksandra; Poli, Luca; Bennardi, Linda; Giordanengo, Luca; Berloco, Pasquale Bartolomeo; Violani, Cristiano

    2016-11-09

    This study examined the relations between appraisal of transplant-related stressors, coping, and adjustment dimensions following kidney transplantation (KT). Two models were tested: (1) the main effects model proposing that stress appraisal and coping strategies are directly associated with adjustment dimensions; and (2) the moderating model of stress proposing that each coping strategy interacts with stress appraisal. Importantly, there is a lack of research examining the two models simultaneously among recipients of solid organ transplantation. A total of 174 KT recipients completed the questionnaires. Predictors of post-transplant adjustment included appraisal of transplant-related stressors and coping strategies (task-, emotion-, and avoidance-focused). Adjustment dimensions were psychological distress, worries about the transplant, feelings of guilt, fear of disclosure of transplant, adherence, and responsibility for the functioning of the new organ. The main and moderating effects were tested with regression analyses. Appraisal of transplant-related stressors and emotion-oriented coping were related to all adjustment dimensions, except of adherence and responsibility. Task-oriented coping was positively related to responsibility. Avoidance-oriented coping was negatively correlated with adherence. Only 1 out of 18 hypothesized interactive terms was significant, yielding a synergistic interaction between appraisal of transplant-related stressors and emotion-oriented coping on the sense of guilt. The findings have the potential to inform interventions promoting psychosocial adjustment among KT recipients.

  20. Alemtuzumab induction therapy in highly sensitized kidney transplant recipients

    Institute of Scientific and Technical Information of China (English)

    L(U) Tie-ming; YANG Shun-liang; WU Wei-zhen; TAN Jian-ming

    2011-01-01

    Background Immunosuppression for immunologically high-risk kidney transplant patients usually involves antithymocyte globulin induction with triple drug maintenance therapy. Alemtuzumab, a humanized anti-CD52 antibody,was expected to be a promising induction therapy agent for kidney transplantation. However, currently no consensus is available about its efficacy and safety. This study aimed to evaluate the efficacy and safety of alemtuzumab as immune induction therapy in highly sensitized kidney transplant recipients.Methods In this prospective, open-label, randomized, controlled trial, we enrolled 23 highly immunological risk patients (panel reactive antibody >20%). They were divided into two groups: alemtuzumab group (trial group) and anti-thymocyte globulin (ATG) group (control group). Patients in the alemtuzumab group received intravenous alemtuzumab (15 mg) as a single dose before reperfusion. At the 24th hour post-operation, another dosage of alemtuzumab (15 mg) was given.The control group received a bolus of rabbit ATG (9 mg/kg), which was given 2 hours before kidney transplantation and lasted until the removal of vascular clamps when the anastomoses were completed. Maintenance immunosuppression in both groups comprised standard triple therapy consisting of tacrolimus, prednisone, and mycophenolate mofetil (MMF).Acute rejection (AR) and infection episodes were recorded, and kidney function was monitored during a 2-year follow-up.χ2 test, t test and Kaplan-Meier analysis were performed with SPSS17.0 software.Results Median follow-up was 338 days. In both the alemtuzumab group and ATG group, creatinine and blood urea nitrogen values in surviving recipients were similar (P >0.05). White blood cell counts were significantly reduced in the alemtuzumab group for the most time points up to 6 months (P <0.05). One patient receiving alemtuzumab died for acute myocardial infarction at the 65th day post-operation. Two ATG patients died for severe pulmonary

  1. Vaginal tuberculosis in an elderly kidney transplant recipient

    Directory of Open Access Journals (Sweden)

    Nemati Eghlim

    2009-01-01

    Full Text Available Female genital tuberculosis (FGTB is extremely rare in post-menopausal women. A 59-year-old woman developed vaginal tuberculosis one year after receiving a kidney transplant from a living donor. Her complaints included abdominal pain, fever, and weight loss. Furthermore, her tu-berculin skin test was negative. She was successfully treated with quadruple anti-TB therapy for 6 months.

  2. Ethical considerations on kidney transplantation from living donors.

    Science.gov (United States)

    Bruzzone, P; Pretagostini, R; Poli, L; Rossi, M; Berloco, P B

    2005-01-01

    Kidney transplantation from living donors is widely performed all over the world. Living nephrectomy for transplantation has no direct advantage for the donor other than increased self-esteem, but at least remains an extremely safe procedure, with a worldwide overall mortality rate of 0.03%. This theoretical risk to the donor seems to be justified by the socioeconomic advantages and increased quality of life of the recipient, especially in selected cases, such as pediatric patients, when living donor kidney transplantation can be performed in a preuremic phase, avoiding the psychological and physical stress of dialysis, which in children is not well tolerated and cannot prevent retarded growth. According to the Ethical Council of the Transplantation Society, commercialism must be prevented, not only for ethical but also medical reasons. The risks are too high not only for the donors, but also for the recipients, as a consequence of poor donor screening and evaluation with consequent transmission of human immunodeficiency virus or other infectious agents, as well as inappropriate medical and surgical management of donors and also of recipients, who are often discharged too early. Most public or private insurance companies are considering kidney donation a safe procedure without long-term impairment and, therefore, do not increase the premium, whereas recipient insurance of course should cover hospital fees for the donors. "Rewarded gifting" or other financial incentives to compensate for the inconvenience and loss of income related to the donation are not advisable, at least in our opinion. Our center does not perform anonymous living organ donation or "cross-over" transplantation.

  3. Anesthesia Management in Aortic Dissection in Patients Undergoing Kidney Transplant.

    Science.gov (United States)

    Ucar, Muharrem; Erdil, Feray; Sanlı, Mukadder; Aydogan, Mustafa Said; Durmus, Mahmut

    2016-04-01

    Kidney transplant is a last resort to increase the life expectancy and quality of life in patients with renal failure. Aortic dissection is a disease that requires emergency intervention; it is characterized by sudden life-threatening back or abdominal pain. In the case described, constant chest pain that increased with respiration was present on examination of a 28-year-old man (85 kg, 173 cm) who presented at our emergency department complaining of severe back pain. He had undergone a kidney transplant in 2004 from his mother (live donor). He was diagnosed with acute Type II aortic dissection and was scheduled for emergent surgery. Because there were no surgical or anesthetic complications, the patient with 79 and 89 minutes aortic cross-clamping and cardiopulmonary bypass durations was sent, intubated, to intensive care unit. When nephrotoxic agents are avoided and blood flow is stabilized, cardiovascular surgery with cardio-pulmonary bypass may be performed seamlessly in patients who have undergone a kidney transplant.

  4. Heart transplantation in adult congenital heart disease.

    Science.gov (United States)

    Burchill, Luke J

    2016-12-01

    Heart failure (HF) in adult congenital heart disease (ACHD) is vastly different to that observed in acquired heart disease. Unlike acquired HF in which pharmacological strategies are the cornerstone for protecting and improving ventricular function, ACHD-related HF relies heavily upon structural and other interventions to achieve these aims. patients with ACHD constitute a small percentage of the total adult heart transplant population (∼3%), although the number of ACHD heart transplant recipients is growing rapidly with a 40% increase over the last two decades. The worldwide experience to date has confirmed heart transplantation as an effective life-extending treatment option in carefully selected patients with ACHD with end-stage cardiac disease. Opportunities for improving outcomes in patients with ACHD-related HF include (i) earlier recognition and referral to centres with combined expertise in ACHD and HF, (ii) increased awareness of arrhythmia and sudden cardiac death risk in this population, (iii) greater collaboration between HF and ACHD specialists at the time of heart transplant assessment, (iv) expert surgical planning to reduce ischaemic time and bleeding risk at the time of transplant, (v) tailored immunosuppression in the post-transplant period and (vi) development and validation of ACHD-specific risk scores to predict mortality and guide patient selection. The purpose of this article is to review current approaches to diagnosing and treating advanced HF in patients with ACHD including indications, contraindications and clinical outcomes after heart transplantation.

  5. Interleukin-10 and posttransplant lymphoproliferative disorder after kidney transplantation

    DEFF Research Database (Denmark)

    Birkeland, S.A.; Bendtzen, K.; Moller, B.;

    1999-01-01

    Background. Posttransplant lymphoproliferative disorder (PTLD) is a life-threatening complication of transplantation, which comprises a morphologically and clinically heterogeneous spectrum of B-lymphocyte diseases. Risk factors include primary or reactivated Epstein-Barr virus (EBV) infection...... to the development of PTLD in three kidney transplanted patients. The study now includes nine patients that could be followed before and/or after the occurrence of lymphoma, Methods. Nine patients with lymphomas (eight PTLDs and one Hodgkin's disease) were diagnosed among 268 consecutive renal transplantations (1990...... human recombinant IL-10 was employed; the assay is specific for human natural and viral IL-10, Results, Three patients experienced primary EBV infection, five reactivated EBV infections, and one did not change EBV status. Three patients had a fulminant course and died with EBV-associated PTLD; confirmed...

  6. Microsporidia Infection in a Mexican Kidney Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Oscar Xavier Hernández-Rodríguez

    2012-01-01

    Full Text Available Microorganisms of the microsporidia group are obligated intracellular protozoa that belong to the phylum Microspora; currently they are considered to be related or belong to the fungi reign. It is considered an opportunistic infection in humans, and 14 species belonging to 8 different genera have been described. Immunocompromized patients such as those infected with human immunodeficiency virus (HIV, also HIV serum-negative asymptomatic patients, with poor hygienic conditions, and recipients of bone marrow or solid organ transplantation are susceptible to develop deinfection. Sixty transplanted patients with renal microsporidia infection have been reported worldwide. The aim of this paper is to inform about the 2nd case of kidney transplant and microsporidia infection documented in Mexico.

  7. Compatibility and kidney transplantation: the way to go.

    Science.gov (United States)

    Doxiadis, Ilias I N

    2012-01-01

    Long lasting debates in the past questioned the relevance of any sort of compatibility in post mortal kidney transplantation. It is for no say that fully compatible transplants have the highest chances for a long patient and graft survival. In the present report the use of HLA-DR as a representative of the Major Histocompatibility Complex class II genes in the allocation of organs is discussed. The major arguments are the easiness to offer to patients a compatible graft in a relatively short waiting time, an increase in graft survival, the less sensitization during the transplantation period, and the lower waiting time for a retransplant. Even if the number of organ donors remains the same a lowering of the mean waiting time is expected because of the longer period of graft survival.

  8. Vitamin D: a new player in kidney transplantation?

    Science.gov (United States)

    Ponticelli, Claudio; Sala, Gabriele

    2014-10-01

    Vitamin D is a hormone with pleiotropic effects. It mainly regulates calcium and phosphate metabolism through interactions with FGF23 and its receptor klotho. In addition, it has been shown that Vitamin D also regulates the immune response and has protective effects from cardiovascular disease, cancer and infections. Most renal transplant recipients have overt Vitamin D deficiency, a condition that may be associated with a decline in graft function and other complications. After kidney transplantation, elevated levels of FGF23 may predict increased risks of death and allograft loss. Theoretically, an optimal Vitamin D supplementation might favor operational tolerance and protect transplant recipients from the triad cardiovascular disease-cancer-infection. However, more solid data are needed to confirm this and to set the optimal level of serum Vitamin D supplementation in order to attain the best clinical outcome.

  9. Pregnancy after kidney transplantation: high rates of maternal complications

    Directory of Open Access Journals (Sweden)

    Cristina Candido

    Full Text Available Abstract Introduction: Women regain fertility a few time after renal transplantation. However, viability of pregnancy and maternal complications are still unclear. Objective: To describe the outcomes of pregnancies in kidney transplanted patients, focusing on maternal complications. Methods: Retrospective study of pregnancies in kidney transplanted patients between 2004 and 2014, followed up 12 months after delivery. Each pregnancy was considered an event. Results: There were 53 pregnancies in 36 patients. Mean age was 28 ± 5years. Pregnancy occurred 4.4 ± 3.0 years post-transplant. Immunosuppression before conception was tacrolimus, azathioprine, and prednisone in 74% of the cases. There were 15% miscarriages in the 1st trimester and 8% in 2nd trimester. In 41% of the cases, it was necessary to induce labor. From all births, 22% were premature and 17% very premature. There were 5% stillbirths and 5% of neonatal deaths. De novo proteinuria occurred in 60%, urinary tract infection in 23%, preeclampsia in 11%, acute rejection in 6%, and graft loss in 2% of the cases. It was observed a significant increase in creatinine at preconception comparing to 3rd trimester and follow-up (1.17 vs. 1.46 vs. 1.59 mg/dL, p < 0.001. Conclusion: Although the sample is limited, the number of miscarriages was higher than in the general population, with high rates of maternal complications. Sustained increase of creatinine suggests increased risk of graft loss in long-term.

  10. Native kidney post-transplant lymphoproliferative disorder in a non-renal transplant patient.

    Science.gov (United States)

    Araya, Carlos E; Mehta, Mansi B; González-Peralta, Regino P; Hunger, Stephen P; Dharnidharka, Vikas R

    2009-06-01

    PTLD is an important post-transplant complication. Although PTLD affects kidney allografts after renal transplantation, it has not been reported in native kidneys of other solid organ recipients. Herein, we report a child who underwent an orthotropic liver transplant for cryptogenic cholestatic hepatitis and developed fever, generalized lymphadenopathy, chronic EBV viremia, and lymphatic PTLD. Subsequently, she also developed gross hematuria and nephrotic range proteinuria. Kidney histology revealed EBV-positive mononuclear infiltrates within the renal parenchyma consistent with PTLD. Electron microscopy examination demonstrated subepithelial electron-dense deposits consistent with a membranous glomerulopathy pattern. The PTLD was successfully treated with reduced immunosuppression and cyclic cyclophosphamide, rituximab, and prednisone, but the renal disease progressed to end-stage renal failure within two yr. Repeat kidney histology showed chronic nephropathy and membranous glomerulopathy without PTLD infiltrates or detectable EBV staining, although chronic viremia persisted. To our knowledge, this is the first such child to be reported and highlights the importance of remaining vigilant for renal PTLD even in non-kidney organ recipients.

  11. [Color-Doppler semiology in transplanted kidney].

    Science.gov (United States)

    Rivolta, R; Castagnone, D; Burdick, L; Mandelli, C; Mangiarotti, R

    1993-05-01

    Color-encoded duplex ultrasonography (CEDU) makes a more accurate technique in kidney graft monitoring by combining real-time US with pulsed Doppler studies of renal vasculature. It is a non-invasive and easy technique. Suitable to study the whole renal artery and vein, CEDU also allows the qualitative and quantitative assessment of the intrarenal vasculature and therefore the easy diagnosis of such vessel dysfunctions as arteriovenous fistulas following biopsy. Moreover, Doppler spectral analysis can be used to distinguish among different causes of renal allograft dysfunction--i.e. rejection, cyclosporine nephrotoxicity or acute tubular necrosis. The value of the resistive index for the differential diagnosis is discussed. CEDU allows a more reliable measurement of renal blood flow thanks to the more precise evaluation of renal artery diameter and mean flow velocity.

  12. Hyperuricemia beyond 1 year after kidney transplantation in pediatric patients: Prevalence and risk factors

    Science.gov (United States)

    Einollahi, B.; Einollahi, H.; Rostami, Z.

    2012-01-01

    Hyperuricemia is frequent among adult renal transplant recipients; however, data among pediatric kidney recipients are scarce. This study is designed to estimate the prevalence and risk factors of late post-transplant hyperuricemia in pediatric recipients. A retrospective observational multicenter study on 179 pediatric renal recipients (5–18 years) was conducted between April 2008 and January 2011 from five kidney transplant centers of Tehran, Iran. All recipients were followed up for more than 1 year (5.9 ±3.3 years) after transplantation. A total of 17686 blood samples were obtained for serum uric acid (SUA). The normal range of SUA was defined as SUA 1.86–5.93 mg/dl for children between 2 and 15 years in both genders; 2.40–5.70 mg/dl for girls aged >15 years; 3.40–7.0 mg/dl for boys aged >15 and more than 6 and 7 mg/dl in boys and girls older than 15 years old. The median age of the children was 13 years. Male recipients were more popular than female (male/female 59/41%). Hyperuricemia was detected in 50.2% of patients. Mean SUA concentration was 5.9±1.7 mg/dl and mean SUA concentration in hyperuricemic patients was 7.7±1.2 mg/dl. While at multivariate logistic regression elevated serum creatinine concentration (P<0.001) and the time span after renal transplantation (P=0.02) had impact on late post-transplant hyperuricemia. High cyclosporine level (C0 and C2) was not risk factor for huperuricemia. Late post-transplant hyperuricemia was found in about half of pediatric renal recipients, and was associated with impaired renal allograft function. PMID:23162272

  13. Functional cardiovascular reserve predicts survival pre-kidney and post-kidney transplantation.

    Science.gov (United States)

    Ting, Stephen M S; Iqbal, Hasan; Kanji, Hemali; Hamborg, Thomas; Aldridge, Nicolas; Krishnan, Nithya; Imray, Chris H E; Banerjee, Prithwish; Bland, Rosemary; Higgins, Robert; Zehnder, Daniel

    2014-01-01

    Exercise intolerance is an important comorbidity in patients with CKD. Anaerobic threshold (AT) determines the upper limits of aerobic exercise and is a measure of cardiovascular reserve. This study investigated the prognostic capacity of AT on survival in patients with advanced CKD and the effect of kidney transplantation on survival in those with reduced cardiovascular reserve. Using cardiopulmonary exercise testing, cardiovascular reserve was evaluated in 240 patients who were waitlisted for kidney transplantation between 2008 and 2010, and patients were followed for ≤5 years. Survival time was the primary endpoint. Cumulative survival for the entire cohort was 72.6% (24 deaths), with cardiovascular events being the most common cause of death (54.2%). According to Kaplan-Meier estimates, patients with AT ratio, 4.48; 95% confidence interval, 1.78 to 11.38; P=0.002). Survival did not differ significantly among patients with AT ≥40%, with one death in the nontransplanted group and no deaths in the transplanted group. In summary, this is the first prospective study to demonstrate a significant association of AT, as the objective index of cardiovascular reserve, with survival in patients with advanced CKD. High-risk patients with reduced cardiovascular reserve had a better survival rate after receiving a kidney transplant.

  14. Outcomes for kidney transplants at the National University Health System: comparison with overseas transplants.

    Science.gov (United States)

    Vathsala, Anantharaman

    2010-01-01

    The 5-year and 10-year graft survivals for 186 deceased donor (DD) transplants performed at National University Health System (NUHS) were 79.9% and 58.4% respectively. 5-year and 10-year patient survivals for DD transplants performed at NUHS were 94.2% and 83.4%. The 5-year and 10-year graft survivals for 128 living donor (LD) transplants performed at NUHS were 90.2% and 72% respectively. 5-year and 10-year patient survivals for DD transplants performed at NUHS were 98.6% and 95.1%. The projected graft half lives were 14.6 and 20.6 years for DD and LD transplants respectively. These results compare favorably with the 10-year survival rates of 40% and 58% for DD and LD grafts reported by the United States Renal Data System (USRDS) in 2010. The younger age and the lower prevalence of diabetes and HLAmismatch in the DD and LD transplant study populations, in comparison to the USRDS population and perhaps better access and compliance to maintenance immunosuppression, could have contributed to these excellent outcomes. The 5-year and 10-year graft survivals for 162 transplants receiving what were likely deceased donor kidneys from China were 89.2% and 69.2% respectively. Although these survivals were apparently better than that for DD performed at NUHS, the advantage for China Tx disappeared when DD with primary non function or vascular thrombosis were excluded from analysis. The 5-year and 10-year patient survivals for 30 transplants receiving live non-related transplants from India were 82.3% and 60.1%. Both groups were considered to have received commercial transplants based on various aspects of history from the patients. Among those receiving China_Tx or India Tx, there were a disproportionate number of males and Chinese; and a significant proportion underwent pre-emptive transplant or transplant after only a short period of dialysis. Prevalence of post-transplant hepatitis B was significantly higher among China_Tx than their DD counterparts (7.7% vs. 1.2%, P = 0

  15. Cryptococcosis in kidney transplant recipients in a Chinese university hospital and a review of published cases

    Directory of Open Access Journals (Sweden)

    Ya-li Yang

    2014-09-01

    Conclusions: Cryptococcosis is a serious infection among kidney transplant recipients in mainland China. It has unique characteristics, such as a relatively long time to onset after kidney transplantation, and diverse clinical manifestations. Treatment with intrathecal injection of amphotericin B is considered effective for central nervous system involvement. The findings of this study also highlight the urgent need for multicenter, prospective, and multidisciplinary clinical studies and education on cryptococcosis in kidney transplant recipients in China.

  16. Ethical aspects of using "marginal" kidneys for transplant.

    Science.gov (United States)

    Berardinelli, L; Raiteri, M; Costantino, B

    1996-01-01

    The continuing demand for transplantable organs leads to ongoing debates about organ procurement, even with arguments in favour of xenotransplantation as a valid alternative. This article examines the management of kidneys with major anatomical anomalies, almost one-quarter of those available for transplantation in our experience: the decision-making is considered from a scientific and an ethical standpoint. Surgical techniques include primary revascularization (PR) and/or bench-top reconstructions (BR). The results, examined for 1311 normal grafts (Group I) and 362 grafts presenting major anatomical anomalies (Group II), all transplanted for the first time, showed almost the same rates of failures due to surgical causes in these two groups. No operative mortality was associated with any of the vascular techniques, BR being easier and safer than PR. Graft survival at 1 year is the same for Group I and Group II (85% versus 84%, respectively). An ethical allocation system ought to take into account the experience of the transplant surgeon for maximizing outcome and minimizing cost and risk for transplantation.

  17. Shortened Length of Stay Improves Financial Outcomes in Living Donor Kidney Transplantation

    Science.gov (United States)

    Villa, Manuel; Siskind, Eric; Sameyah, Emil; Alex, Asha; Blum, Mark; Tyrell, Richard; Fana, Melissa; Mishler, Marni; Godwin, Andrew; Kuncewitch, Michael; Alexander, Mohini; Israel, Ezra; Bhaskaran, Madhu; Calderon, Kellie; Jhaveri, Kenar D.; Sachdeva, Mala; Bellucci, Alessandro; Mattana, Joseph; Fishbane, Steven; Coppa, Gene; Molmenti, Ernesto

    2013-01-01

    Kidney transplantation is the preferred clinical and most cost-effective option for end-stage renal disease. Significant advances have taken place in the care of the transplant patients with improvements in clinical outcomes. The optimization of the costs of transplantation has been a constant goal as well. We present herein the impact in financial outcomes of a shortened length of stay after kidney transplant. PMID:24436592

  18. Psychological rejection of the transplanted organ and graft dysfunction in kidney transplant patients

    Directory of Open Access Journals (Sweden)

    Látos M

    2016-06-01

    Full Text Available Melinda Látos,1 György Lázár,1 Zoltán Horváth,1 Victoria Wittmann,1 Edit Szederkényi,1 Zoltán Hódi,1 Pál Szenohradszky,1 Márta Csabai2 1Department of Surgery, Faculty of Medicine, 2Psychology Institute, University of Szeged, Szeged, Hungary Abstract: Interdisciplinary studies suggest that the mental representations of the transplanted organ may have a significant effect on the healing process. The objective of this study was to examine the representations of the transplanted organ and their relationship with emotional and mood factors, illness perceptions, and the functioning of the transplanted organ. One hundred and sixty-four kidney transplant patients were assessed using the Spielberger Anxiety Inventory, the Beck’s Depression Scale, the Posttraumatic Growth Inventory, the Brief Illness Perception Questionnaire, and the Transplanted Organ Questionnaire. Medical parameters were collected from the routine clinical blood tests (serum creatinine and estimated glomerular filtration rate levels and biopsy results. Our most outstanding results suggest that kidney-transplanted patients’ illness representations are associated with health outcomes. The Transplanted Organ Questionnaire “psychological rejection” subscale was connected with higher serum creatinine and estimated glomerular filtration rate levels. Logistic regression analysis showed that psychological rejection subscale, Brief Illness Perception Questionnaire, and Posttraumatic Growth Questionnaire total scores were associated with graft rejection. These results may serve as a basis for the development of complex treatment interventions, which could help patients to cope with the bio-psycho-social challenges of integrating the new organ as part of their body and self. Keywords: anxiety, depression, illness representations, posttraumatic growth, psychological rejection, renal transplantation

  19. ABO-incompatible living-donor pediatric kidney transplantation in Japan

    Directory of Open Access Journals (Sweden)

    Atsushi Aikawa

    2014-01-01

    Full Text Available The Japanese ABO-Incompatible Transplantation Committee officially collected and analyzed data on pediatric ABO-incompatible living-donor kidney transplantation in July 2012. The age of a child was defined as <16 years, and 89 children who had undergone ABO-incompatible living-donor kidney transplantation from 1989 to 2011 were entered in a registry. These data were presented as the Japanese registry of pediatric ABO-incompatible living-donor kidney transplantation at the regional meetings of the International Pediatric Transplantation Association (IPTA in Nagoya in September 2012 and in Sao Paulo in November 2012.

  20. New Organ Allocation System for Combined Liver-Kidney Transplants and the Availability of Kidneys for Transplant to Patients with Stage 4-5 CKD.

    Science.gov (United States)

    Asch, William S; Bia, Margaret J

    2016-12-27

    A new proposal has been created for establishing medical criteria for organ allocation in recipients receiving simultaneous liver-kidney transplants. In this article, we describe the new policy, elaborate on the points of greatest controversy, and offer a perspective on the policy going forward. Although we applaud the fact that simultaneous liver-kidney transplant activity will now be monitored and appreciate the creation of medical criteria for allocation in simultaneous liver-kidney transplants, we argue that some of the criteria proposed, especially those for allocating a kidney to a liver recipient with AKI, are too liberal. We call on the nephrology community to follow the consequences of this new policy and push for a re-examination of the longstanding policy of allocating kidneys to multiorgan transplant recipients before all other candidates. The charge to protect our system of equitable organ allocation is very challenging, but it is a challenge that we must embrace.

  1. Electrolytes Disturbance and Cyclosporine Blood Levels among Kidney Transplant Recipients

    Science.gov (United States)

    Einollahi, B.; Nemati, E.; Rostami, Z.; Teimoori, M.; Ghadian, A. R.

    2012-01-01

    Background: Kidney transplantation is associated with various biochemical abnormalities such as changes in serum blood level of sodium (Na), potassium (K), calcium (Ca), and phosphorous (P). Although cyclosporine (CsA) is used commonly, the prevalence of its side effects, including electrolytes disturbance, is not well understood. Objective: To find the prevalence of electrolytes disturbance and its relation to CsA blood levels. Methods: In a retrospective study, 3308 kidney transplant recipients transplanted between 2008 and 2011 were studied. We evaluated the relation between serum Ca, P, Na, K and CsA trough (C0) and 2-hour post-dose (C2) levels. Results: The mean±SD age of recipients was 37±15 years; 63% of patients were male. Overall, C2 levels had correlation with Ca blood level (p=0.018; OR: 1.13, 95%CI: 1.02–1.25), C0 levels had also correlation with blood levels of P and Cr (p<0.001; OR: 1.83, 95% CI: 1.59–2.11). Conclusion: Electrolyte disturbances are prevalent. Higher serum levels of CsA can worsen the allograft function by disturbing the serum P and Ca levels. PMID:25013642

  2. Improved results in high risk cadaveric kidney transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Toledo-Pereyra, L.H.; Baskin, S.; McNichol, L.; Edford, G.; Whitten, J.; Allaben, R.

    1980-01-01

    In general, cadaver kidney transplantation survival remains at 40-50% for the first year after transplantation. To compare the beneficial effect of a new immunosuppressive protocol to standard therapy (azathioprine and prednisone), we have studied 30 high risk first cadaveric renal allograft recipients who were randomly selected before (Group A, n.15) and after (Group B, n.15) 10/79. At 12 mos, actuarial graft survival of Group B is 75% compared to 46% in Group A. Actuarial patient survival for Group B is 94% for one year compared to 60% in Group A. We feel that these improved results are related to basic changes in our immunosuppressive protocol. These changes consist of: 1. Low doses of azathioprine and prednisolone (less than 1 mg/kg) with rapid reduction to very low levels (less than 0.3 mg/kg); 2. ALG administration at 30 mg/kg/day for 14 times; 3. Rapid placement (one month) on alternate day steroid therapy; 4. Elimination of steroids for the treatment of rejection; 5. Use of ALG (20 mg/kg/day for 10 days) for the treatment of rejection; 6. Use of ALG combined with modified lymph node irradiation for third rejection episodes; and 7. Long-term intermittent ALG administration provided that kidney function continues to be normal. The best immunosuppressive protocol is clearly the one associated with less morbidity and improved quality of life after transplantation. Our current protocol (Group B) provides the best results.

  3. Renal Vein Reconstruction for Harvesting Injury in Kidney Transplantation

    Directory of Open Access Journals (Sweden)

    Birkan Bozkurt

    2014-03-01

    Full Text Available Kidney transplantation is the best treatment choice in the end-stage renal disease. In the renal transplantation, renal vein damage or shortness which occurs during cadaveric or living donor nephrectomy causes technical difficulties for surgeons. The lack of the donors already especially cadaveric, the acquirement of the graft, gets very much importance. In this report, it is aimed to share the clinical experiment by which it seen, how anastomosis can become appropriate by using the renal vein which is damaged in the way that anastomosis cannot be done anyway by using cadaveric vena cava graft. The renal vein brought to length for anostomosis which is repaired by using cadaveric vena cava graft, is anastomosed successfully by becoming an end-to-side of the external iliac vein of the recipient. Vascular anastomoses are applied easily in technique. The time of the warm ischemia was under 2 hours and the kidney was functional in the post-operative period. Renal vein trombosis was not observed. The renal vein damage occured during cadaveric or living donor nephrectomy, can be repaired by some methods. In the kidneys in which vein requirement is done, the success rates are rather high although acute tubular necrosis and delayed function can be seen more.

  4. A case of tacrolimus-induced encephalopathy after kidney transplantation

    Directory of Open Access Journals (Sweden)

    Myoung Uk Kim

    2011-01-01

    Full Text Available We present a case of tacrolimus-induced encephalopathy after successful kidney transplantation. An 11-year-old girl presented with sudden onset of neurologic symptoms, hypertension, and psychiatric symptoms, with normal kidney function, after kidney transplantation. The symptoms improved after cessation of tacrolimus. Magnetic resonance imaging (MRI showed acute infarction of the middle cerebral artery (MCA territory in the right frontal lobe. Three days later, she had normal mental function and maintained normal blood pressure with left hemiparesis. Follow-up MRI was performed on D19, showing new infarct lesions at both cerebral hemispheres. Ten days later, MRI showed further improvement, but brain single photon emission computed tomography (SPECT showed mild reduction of uptake in both the anterior cingulate gyrus and the left thalamus. One month after onset of symptoms, angiography showed complete resolution of stenosis. However, presenting as a mild fine motor disability of both hands and mild dysarthria, what had been atrophy at both centrum semiovale at 4 months now showed progression to encephalomalacia. There are two points of interest in this case. First, encephalopathy occurred after administration of tacrolimus and improved after discontinuation of the drug. Second, the development of right-side hemiplegia could not be explained by conventional MRI; but through diffusion tensor imaging (DTI and diffusion tensor tractography (DTT of white matter tract, visualization was possible.

  5. Evaluation of renographic and metabolic parameters in human kidney transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez, A. [Barcelone, Univ. (Spain). Lab. of Biophysics and Bioengineering; Vigues, F.; Franco, E. [Hospital of Bellvitge, Bellvitge (Spain). Service of Urology; Puchal, R. [Hospital of Bellvitge, Bellvitge (Spain). Service of Nuclear Medicine; Bartrons, R.; Ambrosio, S. [Barcelona, Univ. (Spain). Faculty of Odontology, Laboratory of Biochemistry

    1997-03-01

    Background: the aim of this work is to demonstrate that the value of the mean transit time (MTT) obtained from the {sup 99m}Tc-MAG3 renogram deconvolution is related to the levels of adenine nucleotides determined in cortical biopsies from transplanted kidneys. Methods: the functional state was estimated by means of the MTT and the initial height (HO) of the renal retention function obtained from the {sup 99m}Tc-MAG3 renogram deconvolution and by the measure of adenine nucleotides obtained from biopsies. We studied 30 kidney graft recipients, 25 normal functioning grafts (NFG) and 5 with acute tubular necrosis (ATN). Results: the MTT is significantly longer for ATN (p<0.001). The initial uptake values (HO) are significantly lower for ATN (p<0.001). The sum of adenine nucleotides (SAN) is significantly greater for NFG than for ATN (p<0.001). The values of the MTT seem to reflect the energy state of the cells in transplanted kidney. Conclusion: the analysis of MTT may be indicative of the functional metabolic recovery and thus it may be predictive of the renal graft function at least in the same extent than the biochemical analysis of a cortical renal biopsy immediately after blood reperfusion of the tissue.

  6. Cancer Incidence among Heart, Kidney, and Liver Transplant Recipients in Taiwan.

    Directory of Open Access Journals (Sweden)

    Kwai-Fong Lee

    Full Text Available Population-based evidence of the relative risk of cancer among heart, kidney, and liver transplant recipients from Asia is lacking. The Taiwan National Health Insurance Research Database was used to conduct a population-based cohort study of transplant recipients (n = 5396, comprising 801 heart, 2847 kidney, and 1748 liver transplant recipients between 2001 and 2012. Standardized incidence ratios and Cox regression models were used. Compared with the general population, the risk of cancer increased 3.8-fold after heart transplantation, 4.1-fold after kidney transplantation and 4.6-fold after liver transplantation. Cancer occurrence showed considerable variation according to transplanted organs. The most common cancers in all transplant patients were cancers of the head and neck, liver, bladder, and kidney and non-Hodgkin lymphoma. Male recipients had an increased risk of cancers of the head and neck and liver, and female kidney recipients had a significant risk of bladder and kidney cancer. The adjusted hazard ratio for any cancer in all recipients was higher in liver transplant recipients compared with that in heart transplant recipients (hazard ratio = 1.5, P = .04. Cancer occurrence varied considerably and posttransplant cancer screening should be performed routinely according to transplanted organ and sex.

  7. Kidney transplantation in immunologically high-risk patients.

    Science.gov (United States)

    Keven, K; Sengul, S; Celebi, Z K; Tuzuner, A; Yalcin, F; Duman, T; Tutkak, H

    2013-04-01

    An increased number of sensitized patients await kidney transplantation (KTx). Sensitization has a major impact on patient mortality and morbidity due to prolonged waiting time and may preclude live donor transplantation. However, recent reports have shown that KTx can be performed successfully using novel immunosuppressive protocols. This study presents our experience with patients displaying donor-specific antibody (DSA) (+). We enrolled 5 lymphocyte cross-match (LCM) negative (complement-dependent cytotoxicity) and panel-reactive antibody (PRA) plus DSA-positive patients mean fluorescein intensity [MFI] > 1000) who underwent living kidney donor procedures. All subjects were females and their mean age was 36.7 years. In our protocol, we started mycophenolate mofetil (2 g/d), tacrolimus (0.01 mg/kg) and prednisolone (0.5 mg/kg) on day -6. We performed 2 sessions of total plasma exchange (TPE) with albumin replacement and administered 2 doses of IVIG (5 g/d). On day -1, we added rituximab (200 mg). On the operation day and on day +4, the patients received doses of basiliximab. Serum samples were taken on days -6, 0, and 30 as well as at 1 year after transplantation. All patients displayed immediate graft function. Mean basal DSA titer was 5624 MFI. After desensitization, the MFI titers decreased at the time of transplantation to 2753 MFI, and were 2564 MFI at the 1st month and 802 MFI at 1st year. Three patients experienced acute rejection episodes (60%). After treatment for rejection, the average follow-up was 17 months and last creatinine levels were 0.6-0.8 mg/dL (minimum-maximum). In conclusion, KTx can be succesfully performed in sensitized patients displaying DSA. However, there seems to be a greater acute rejection risk. There is no consensus regarding adequate doses of IVIG or plasmapheresis treatments; furthermore, more studies are needed to clarify the safe MFI titer of the DSA.

  8. Endothelial activation, lymphangiogenesis, and humoral rejection of kidney transplants.

    Science.gov (United States)

    Phillips, Sharon; Kapp, Meghan; Crowe, Deborah; Garces, Jorge; Fogo, Agnes B; Giannico, Giovanna A

    2016-05-01

    Antibody-mediated rejection (ABMR) is implicated in 45% of renal allograft failure and 57% of late allograft dysfunction. Peritubular capillary C4d is a specific but insensitive marker of ABMR. The 2013 Banff Conference ABMR revised criteria included C4d-negative ABMR with evidence of endothelial-antibody interaction. We hypothesized that endothelial activation and lymphangiogenesis are increased with C4d-negative ABMR and correlate with intragraft T-regulatory cells and T-helper 17. Seventy-four renal transplant biopsies were selected to include (a) ABMR with C4d Banff scores ≥2 (n = 35), (b) variable microvascular injury and C4d score 0-1 (n = 24), and (c) variable microvascular injury and C4d score = 0 (n = 15). Controls included normal preimplantation donor kidneys (n = 5). Immunohistochemistry for endothelial activation (P- and E-selectins [SEL]), lymphangiogenesis (D2-40), T-regulatory cells (FOXP3), and T-helper 17 (STAT3) was performed. Microvessel and inflammatory infiltrate density was assessed morphometrically in interstitium and peritubular capillaries. All transplants had significantly higher microvessel and lymph vessel density compared with normal. Increased expression of markers of endothelial activation predicted transplant glomerulopathy (P-SEL, P = .003). Increased P-SEL and D2-40 were associated with longer interval from transplant to biopsy (P = .005). All 3 markers were associated with increased interstitial fibrosis, tubular atrophy, and graft failure (P-SEL, P < .001; E-SEL, P = .0011; D2-40, P = .012). There was no association with the intragraft FOXP3/STAT3 ratio. We conclude that endothelial activation and lymphangiogenesis could represent a late response to injury leading to fibrosis and progression of kidney damage, and are independent of the intragraft FOXP3/STAT3 ratio. Our findings support the therapeutic potential of specifically targeting endothelial activation.

  9. Functional assessment of transplanted kidneys with magnetic resonance imaging

    Institute of Scientific and Technical Information of China (English)

    Yu-Ting; Wang; Ying-Chun; Li; Long-Lin; Yin; Hong; Pu; Jia-Yuan; Chen

    2015-01-01

    Kidney transplantation has emerged as the treatment of choice for many patients with end-stage renal disease, which is a significant cause of morbidity and mortality. Given the shortage of clinically available donor kidneys and the significant incidence of allograft dysfunction, a noninvasive and accurate assessment of the allograft renal function is critical for postoperative management. Prompt diagnosis of graft dysfunction facilitates clinical intervention of kidneys with salvageable function. New advances in magnetic resonance imaging(MRI) technology have enabled the calculation of various renal parameters that were previously not feasible to measure noninvasively. Diffusion-weighted imaging provides information on renal diffusion and perfusion simultaneously, with quantification by the apparent diffusion coefficient, the decrease of which reflects renal function impairment. Diffusion-tensor imaging accounts for the directionality of molecular motion and measures fractional anisotropy of the kidneys. Blood oxygen level-dependent MR evaluates intrarenal oxygen bioavailability, generating the parameter of R2*(reflecting the concentration of deoxyhemoglobin). A decrease in R2* could happen during acute rejection. MR nephro-urography/renography demonstrates structural data depicting urinary tract obstructions and functional data regarding the glomerular filtration and blood flow. MR angiography details the transplant vasculature and is particularly suitable for detecting vascular complications, with good correlation with digital subtraction angiography. Other functional MRI technologies, such as arterial spin labeling and MR spectroscopy, are showing additional promise. This review highlights MRI as a comprehensive modality to diagnose a variety of etiologies of graft dysfunction, including prerenal(e.g., renal vasculature), renal(intrinsic causes) and postrenal(e.g., obstruction of the collecting system) etiologies.

  10. A developmentally plastic adult mouse kidney cell line spontaneously generates multiple adult kidney structures

    Energy Technology Data Exchange (ETDEWEB)

    Webb, Carol F., E-mail: carol-webb@omrf.org [Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (United States); Immunobiology and Cancer Research, Oklahoma Medical Research Foundation, Oklahoma City, OK (United States); Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (United States); Ratliff, Michelle L., E-mail: michelle-ratliff@omrf.org [Immunobiology and Cancer Research, Oklahoma Medical Research Foundation, Oklahoma City, OK (United States); Powell, Rebecca, E-mail: rebeccapowell@gmail.com [Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (United States); Wirsig-Wiechmann, Celeste R., E-mail: celeste-wirsig@ouhsc.edu [Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (United States); Lakiza, Olga, E-mail: olga-lakiza@ouhsc.edu [Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (United States); Obara, Tomoko, E-mail: tomoko-obara@ouhsc.edu [Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (United States)

    2015-08-07

    Despite exciting new possibilities for regenerative therapy posed by the ability to induce pluripotent stem cells, recapitulation of three-dimensional kidneys for repair or replacement has not been possible. ARID3a-deficient mouse tissues generated multipotent, developmentally plastic cells. Therefore, we assessed the adult mouse ARID3a−/− kidney cell line, KKPS5, which expresses renal progenitor surface markers as an alternative cell source for modeling kidney development. Remarkably, these cells spontaneously developed into multicellular nephron-like structures in vitro, and engrafted into immunocompromised medaka mesonephros, where they formed mouse nephron structures. These data implicate KKPS5 cells as a new model system for studying kidney development. - Highlights: • An ARID3a-deficient mouse kidney cell line expresses multiple progenitor markers. • This cell line spontaneously forms multiple nephron-like structures in vitro. • This cell line formed mouse kidney structures in immunocompromised medaka fish kidneys. • Our data identify a novel model system for studying kidney development.

  11. Pre-transplant levels of ficolin-3 are associated with kidney graft survival

    DEFF Research Database (Denmark)

    Bay, Jakob T; Hein, Estrid; Sørensen, Søren S;

    2013-01-01

    Ficolin-3 is an initiator of the lectin complement pathway. The complement system is a mediator of the pathophysiology of graft rejection in kidney transplantation, but the role of ficolin-3 in this process is unknown. Using a prospective study design, 527 kidney transplanted patients were includ...

  12. The Natural History of Clinical Operational Tolerance After Kidney Transplantation Through Twenty-Seven Cases

    NARCIS (Netherlands)

    Brouard, S.; Pallier, A.; Renaudin, K.; Foucher, Y.; Danger, R.; Devys, A.; Cesbron, A.; Guillot-Guegen, C.; Ashton-Chess, J.; Roux, S. le; Harb, J.; Roussey, G.; Subra, J.F.; Villemain, F.; Legendre, C.; Bemelman, F.J.; Orlando, G.; Garnier, A.; Jambon, H.; Monies De Sagazan, H. le; Braun, L.; Noel, C.; Pillebout, E.; Moal, M.C.; Cantarell, C.; Hoitsma, A.J.; Ranbant, M.; Testa, A.; Soulillou, J.P.; Giral, M.

    2012-01-01

    We report here on a European cohort of 27 kidney transplant recipients displaying operational tolerance, compared to two cohorts of matched kidney transplant recipients under immunosuppression and patients who stopped immunosuppressive drugs and presented with rejection. We report that a lower propo

  13. Concordance of outcomes of pairs of kidneys transplanted into different recipients.

    LENUS (Irish Health Repository)

    Traynor, Carol

    2012-09-01

    Kidney transplant outcomes are influenced by donor characteristics, including age and gender. Additional donor factors, both genetic and environmental, also influence graft outcome. We aim to assess the strength of donor factors in determining kidney transplant outcomes by comparing paired kidneys from a single donor transplanted into different recipients. We conducted a retrospective cohort study of outcomes of pairs of deceased donor kidneys transplanted in our centre between 1992 and 2008. We examined the relationship within pairs for eGFR at 1 year and at 5 years post-transplant using Spearman\\'s Correlation and the concordance of pairs of transplant kidneys with respect to the occurrence of acute rejection and delayed graft function (DGF). A total of 652 recipient pairs were analysed. Spearman\\'s correlation for eGFR was 0.36 at 1 year and 0.36 at 5 years post-transplant. The incidence of DGF was 11%. The odds ratio of DGF occurring if the contralateral kidney had DGF was 5.99 (95% CI, 3.19-11.25). There is a significant degree of relationship within pairs of kidneys transplanted from the same donor for serum creatinine at 1 year and 5 years post-transplant and also for the occurrence of delayed graft function.

  14. Pancreatic autoantibodies after pancreas-kidney transplantation - do they matter?

    Science.gov (United States)

    Martins, La Salete; Henriques, Antonio C; Fonseca, Isabel M; Rodrigues, Anabela S; Oliverira, José C; Dores, Jorge M; Dias, Leonidio S; Cabrita, Antonio M; Silva, José D; Noronha, Irene L

    2014-04-01

    Type 1 diabetes recurrence has been documented in simultaneous pancreas-kidney transplants (SPKT), but this diagnosis may be underestimated. Antibody monitoring is the most simple, noninvasive, screening test for pancreas autoimmune activity. However, the impact of the positive autoimmune markers on pancreas graft function remains controversial. In our cohort of 105 SPKT, we studied the cases with positive pancreatic autoantibodies. They were immunosuppressed with antithymocyte globulin, tacrolimus, mycophenolate, and steroids. The persistence or reappearance of these autoantibodies after SPKT and factors associated with their evolution and with graft outcome were analyzed. Pancreatic autoantibodies were prospectively monitored. Serum samples were collected before transplantation and at least once per year thereafter. At the end of the follow-up (maximum 138 months), 43.8% of patients were positive (from pre-transplant or after recurrence) for at least one autoantibody - the positive group. Antiglutamic acid decarboxylase was the most prevalent (31.4%), followed by anti-insulin (8.6%) and anti-islet cell autoantibodies (3.8%). Bivariate analysis showed that the positive group had higher fasting glucose, higher glycated hemoglobin (HbA1c), lower C-peptide levels, and a higher number of HLA-matches. Analyzing the sample divided into four groups according to pre-/post-transplant autoantibodies profile, the negative/positive group tended to present the higher HbA1c values. Multivariate analysis confirmed the significant association between pancreas autoimmunity and HbA1c and C-peptide levels. Positivity for these autoantibodies pre-transplantation did not influence pancreas survival. The unfavorable glycemic profile observed in the autoantibody-positive SPKT is a matter of concern, which deserves further attention.

  15. Recurrence of focal segmental glomerulosclerosis in the transplanted kidney.

    Science.gov (United States)

    Leumann, E P; Briner, J; Donckerwolcke, R A; Kuijten, R; Largiadèr, F

    1980-01-01

    The clinical and renal biopsy findings in 3 patients with recurrent focal and segmental glomerulosclerosis (FSG) are reported, as well as the results of a survey among 17 European centers totaling 27 kidney-transplanted children with FSG. From these 27 patients, 10 had recurrent FSG. The duration of the original disease was less than 3 years in 9 of them. In contrast, this rapid progression of the disease was observed in only 7 of 17 patients in the group without recurrences. Heavy proteinuria was noted within the 1st day, or week, in all but 2 patients where it was detected at 3 and 7 weeks. All developed the nephrotic syndrome. From the 10 kidneys (mostly from cadaver donors) which functioned for more than 1 month, 5 were lost 2--24 months after transplantation because of recurrence (3 patients) or infection (2 patients). It appears that the risk of recurrence can best be predicted by the duration of the original disease: 50% or more if the duration was short (less than 3 years), and only 10--20% when the duration was longer.

  16. Severe Necrotizing Adenovirus Tubulointerstitial Nephritis in a Kidney Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Ravi Parasuraman

    2013-01-01

    Full Text Available Adenoviruses (AdV are emerging pathogens with a prevalence of 11% viruria and 6.5% viremia in kidney transplant recipients. Although AdV infection is common, interstitial nephritis (ADVIN is rare with only 13 biopsy proven cases reported in the literature. We report a case of severe ADVIN with characteristic histological features that includes severe necrotizing granulomatous lesion with widespread tubular basement membrane rupture and hyperchromatic smudgy intranuclear inclusions in the tubular epithelial cells. The patient was asymptomatic at presentation, and the high AdV viral load (quantitative PCR>2,000,000 copies/mL in the urine and 646,642 copies/mL in the serum confirmed the diagnosis. The patient showed excellent response to a combination of immunosuppression reduction, intravenous cidofovir, and immunoglobulin therapy resulting in complete resolution of infection and recovery of allograft function. Awareness of characteristic biopsy findings may help to clinch the diagnosis early which is essential since the disseminated infection is associated with high mortality of 18% in kidney transplant recipients. Cidofovir is considered the agent of choice for AdV infection in immunocompromised despite lack of randomized trials, and the addition of intravenous immunoglobulin may aid in resolution of infection while help prevention of rejection.

  17. [Recurrence of segmental and focal glomerulosclerosis in transplanted kidneys].

    Science.gov (United States)

    Chocair, P R; Noronha, I L; Ianhez, L E; Arap, S; Sabbaga, E

    1989-01-01

    The course of 16 patients with segmental and focal glomerulosclerosis (SFGS) with kidney transplantation is reported. Ten out of 16 (group I) had the diagnosis histologically confirmed in their native kidneys. In 6 (group II) the diagnosis was suggested by the early development of SFGS in the graft and was considered a recurrence of the baseline disease. The recurrence (in group I) was 40% and the main clinical parameter was proteinuria, in nephrotic level, with early development in all cases (less than 60 days). In those patients who had an early development of the baseline disease (less than 4 years) the recurrence was greater, observed in 5 out of 8 grafts with 3 grafts lost due to the recurrence of focal glomerulosclerosis. On the other hand, the patients whose baseline disease had a longer period of development presented a better course of the recurrent glomerulosclerosis and no grafts were lost in this cases. We believe that renal transplantation of a live donor must be avoided in those patients with quick developing SFGS.

  18. Improvement of cardiac function after kidney transplantation with dilated cardiomyopathy and long dialysis vintage.

    Science.gov (United States)

    Mimura, Imari; Kawarazaki, Hiroo; Momose, Toshimitsu; Shibagaki, Yugo; Fujita, Toshiro

    2009-12-01

    Patients with long dialysis vintage have low cardiac output for various reasons. Although kidney transplantation is known to improve cardiac mortality, patients are sometimes evaluated as contraindicated for transplantation because of cardiac risk. We successfully performed kidney transplantation for a patient with a long dialysis vintage and dilated cardiomyopathy. Sequential (123)I-metaiodobenzylguanidine ((123)I-MIBG) scintigraphy suggested that amelioration of uraemia improved cardiac function. Kidney transplantation for patients with severely impaired cardiac function is safe and effective under careful perioperative monitoring irrespective of dialysis vintage. Sequential (123)I-MIBG scintigraphy can be used as an evaluation tool for the improvement in cardiac function.

  19. Kidney Transplant in a 26-Year-Old Nigerian Patient with Sickle Cell Nephropathy

    Directory of Open Access Journals (Sweden)

    U. H. Okafor

    2012-01-01

    Full Text Available Sickle cell nephropathy (SCN is a common complication of sickle cell disease (SCD. It has variable presentation, ranging from hyposthenuria to end-stage renal disease (ESRD. Management of ESRD in SCD patients is froth with multiple challenges which has potential to impact negatively the outcome of the patient. Kidney transplant is the preferred renal replacement therapy in these patients. The objective of this case study is to report kidney transplant in a Nigerian young man with sickle cell nephropathy and to highlight the outcome and the challenges to kidney transplant in this patient. The index case is a 26-years-old sickle cell disease patient with ESRD complicated with cardiovascular, pulmonary, immunological, and infective challenges. These conditions were controlled, and the patient had a successful live-related kidney transplant. Kidney transplant is a viable option for sickle cell disease patients with ESRD.

  20. Impact of graft mass on the clinical outcome of kidney transplants.

    Science.gov (United States)

    Giral, Magali; Nguyen, Jean Michel; Karam, Georges; Kessler, Michelle; Hurault de Ligny, Bruno; Buchler, Mattias; Bayle, François; Meyer, Carole; Foucher, Yohann; Martin, Marie Laure; Daguin, Pascal; Soulillou, Jean Paul

    2005-01-01

    The effect of nephronic mass reduction of kidney transplants has not been analyzed specifically in a large cohort. Transplant injuries in cadaver kidney graft may have led to an underestimation of the magnitude of this factor. The aim of this study was to analyze the consequences of kidney mass reduction on transplantation outcome. The weights of 1142 kidney grafts were collected prospectively immediately before grafting. Donors and recipients /=4 g/kg). Next, using a Cox model analysis, it was shown that the risk of having a proteinuria >0.5 g/kg was significantly increased for the low DKW/RBW ratios /=4 g/kg (P < 0.001). In cadaver transplant recipients, graft mass has a rapid impact on graft filtration rate and proteinuria. Avoiding major kidney/recipient inadequacy should have a significant influence on long-term transplant function.

  1. Injury to a transplanted kidney during caesarean section: a case report.

    Science.gov (United States)

    Shrestha, Badri Man; Throssell, David; McKane, William; Raftery, Andrew Thomas

    2007-06-01

    As fertility is restored after renal transplant, more female recipients of a renal transplant successfully complete pregnancies that are safe for the mother, the fetus, and the renal allograft. Although the transplanted kidney lies in one of the iliac fossae, normal vaginal delivery is not impeded by this positioning. Caesarean section is indicated in many scenarios, primarily for obstetric reasons, particularly when the transplanted kidney lies in a position where it could be injured. Here, we report our experiences managing a rare instance of injury to a transplanted kidney during caesarean section and discuss the relevant aspects of its management. To our knowledge, this is the first report in the English literature of an injury to a transplanted kidney during caesarean section.

  2. Early Hospital Readmission After Simultaneous Pancreas-Kidney Transplantation: Patient and Center-Level Factors.

    Science.gov (United States)

    King, E A; Kucirka, L M; McAdams-DeMarco, M A; Massie, A B; Al Ammary, F; Ahmed, R; Grams, M E; Segev, D L

    2016-02-01

    Early hospital readmission is associated with increased morbidity, mortality, and cost. Following simultaneous pancreas-kidney transplantation, rates of readmission and risk factors for readmission are unknown. We used United States Renal Data System data to study 3643 adult primary first-time simultaneous pancreas-kidney recipients from December 1, 1999 to October 31, 2011. Early hospital readmission was any hospitalization within 30 days of discharge. Modified Poisson regression was used to determine the association between readmission and patient-level factors. Empirical Bayes statistics were used to determine the variation attributable to center-level factors. The incidence of readmission was 55.5%. Each decade increase in age was associated with an 11% lower risk of readmission to age 40, beyond which there was no association. Donor African-American race was associated with a 13% higher risk of readmission. Each day increase in length of stay was associated with a 2% higher risk of readmission until 14 days, beyond which each day increase was associated with a 1% reduction in the risk of readmission. Center-level factors were not associated with readmission. The high incidence of early hospital readmission following simultaneous pancreas-kidney transplant may reflect clinical complexity rather than poor quality of care.

  3. Skin and kidney histological changes in graft-versus-host disease (GVHD) after kidney transplantation.

    Science.gov (United States)

    Pintar, Tadeja; Alessiani, Mario; Pleskovič, Alojz; Pleskovič, Aleš; Zorc-Pleskovič, Ruda; Milutinović, Aleksandra

    2011-05-01

    Kidney transplantation (Ktx) is generally performed during end stage renal disease due to a loss of the kidneys' ability to filter wastes from the circulatory system. Acute graft-versus-host disease (GVHD) after Ktx is a life-threatening complication that progresses to organ failure, systemic complications, and death. The current study evaluated the significance of histologic findings of GVHD as obtained from skin biopsies following Ktx in swine. A swine model of Ktx with tacrolimus-based immunosuppression was used to assess possible correlations between acute-graft-cellular rejection and skin histological findings for prediction of GVHD. Animals were divided into a Ktx treatment group or a control group with no Ktx and skin and kidney biopsies were histologically assessed at postoperative days 0, 15, 30, 45 and 60. Skin samples were analyzed and classified from grade 1 to 4 of skin GVHD and the major histopathological changes of kidney acute cellular rejection were described using Banff's score system. We observed a significant linear correlation between the histological grading values of skin biopsy changes and the histological grading values of kidney biopsies (Kendall's tau_b=0.993) in the Ktx experimental group. No histological changes were observed in controls. Our findings demonstrate the diagnostic value of staging skin GVHD after Ktx and suggest it's future utility for monitoring long term Ktx-induced changes.

  4. Simultaneous Native Nephrectomy and Kidney Transplantation in Patients With Autosomal Dominant Polycystic Kidney Disease.

    Directory of Open Access Journals (Sweden)

    Massimiliano Veroux

    Full Text Available To evaluate the feasibility of simultaneous unilateral nephrectomy with kidney transplantation and to determine the effect of this procedure on perioperative morbidity and mortality and graft and patient survival.Between January 2000 and May 2015, 145 patients with autosomal dominant polycystic kidney disease (ADPKD underwent kidney transplantation. Of those, 40 (27.5% underwent concurrent ipsilateral native nephrectomy (group NT. Patients in group NT were compared with patients with ADPKD not undergoing concurrent nephrectomy (group NT- and asymptomatic patients undergoing pretransplant nephrectomy (group PNT.The average follow-up was 66 months. The graft survival rate at 1 and 5 years was 95% and 87.5% versus 93% and 76.2% in the NT and NT- groups, respectively (P = .903 and P = .544, respectively; 1-year patient survival was 100% for NT and 97% for NT- patients (P = .288, whereas 5-year patient survival was 100% and 92% for NT and NT- groups, respectively (P = .128. After propensity score matching (34 patients per group no significant differences were observed in 1-year (97.1% in NT and 94.1%; P = 1 and 5-year (88.2% in NT and 91.2% in NT-; P = 1 graft survival, and in 1-year (100% for both groups; P = 1 and 5-year (100% in NT and 94.1% in NT-; P = 1 patient survival. Perioperative mortality was 0% among NT and 1.2% among NT- patients, whereas perioperative surgical complications were similar in both groups. One- and 5-year graft and patient survival were similar between the NT and PNT groups, but patients in the PNT group had significantly lower levels of hemoglobin and residual diuresis volumes at the time of transplant. Moreover, PNT patients had a longer pretransplant dialysis and a longer time on the waiting list.Simultaneous unilateral nephrectomy does not have a negative effect on patient and graft survival in patients with ADPKD and is associated with low morbidity. Pretransplant nephrectomy should be restricted only to highly

  5. Access to kidney transplantation: outcomes of the non-referred

    Directory of Open Access Journals (Sweden)

    AlBugami Meteb M

    2012-12-01

    Full Text Available Abstract Background There is a concern that some, especially older people, are not referred and could benefit from transplantation. Methods We retrospectively examined consecutive incident end stage renal disease (ESRD patients at our center from January 2006 to December 2009. At ESRD start, patients were classified into those with or without contraindications using Canadian eligibility criteria. Based on referral for transplantation, patients were grouped as CANDIDATE (no contraindication and referred, NEITHER (no contraindication and not referred and CONTRAINDICATION. The Charlson Comorbidity Index (CCI was used to assess comorbidity burden. Results Of the 437 patients, 133 (30.4% were CANDIDATE (mean age 50 and CCI 3.0, 59 (13.5% were NEITHER (age 76 and CCI 4.4, and 245 (56.1% were CONTRAINDICATION (age 65 and CCI 5.5. Age was the best discriminator between NEITHER and CANDIDATES (c-statistic 0.96, P P Conclusions There exists a relatively small population of incident patients not referred who have no contraindications. These are older patients with significant comorbidity who have a small window of opportunity for kidney transplantation.

  6. Establishment of a sensitized canine model for kidney transplantation

    Institute of Scientific and Technical Information of China (English)

    XIE Sen; XIA Sui-sheng; TANG Li-gong; CHENG Jun; CHEN Zhi-shui; ZHENG Shan-gen

    2005-01-01

    Objective:To establish a sensitized canine model for kidney transplantation. Methods:12 male dogs were averagely grouped as donors and recipients. A small number of donor canine lymphocytes was infused into different anatomic locations of a paired canine recipient for each time and which was repeated weekly. Specific immune sensitization was monitored by means of Complement Dependent Cytotoxicity (CDC) and Mixed Lymphocyte Culture (MLC) test. When CDC test conversed to be positive and MLC test showed a significant proliferation of reactive lymphocytes of canine recipients, the right kidneys of the paired dogs were excised and transplanted to each other concurrently. Injury of renal allograft function was scheduled determined by ECT dynamic kidney photography and pathologic investigation. Results :CDC test usually conversed to be positive and reactive lymphocytes of canine recipients were also observed to be proliferated significantly in MLC test after 3 to 4 times of canine donor lymphocyte infusions. Renal allograft function deterioration occurred 4 d post-operatively in 4 of 6 canine recipients, in contrast to none in control dogs. Pathologic changes suggested antibody-mediated rejection (delayed) or acute rejection in 3 excised renal allograft of sensitized dogs. Seven days after operation, all sensitized dogs had lost graft function, pathologic changes of which showed that the renal allografts were seriously rejected. 2 of 3 dogs in control group were also acutely rejected. Conclusion:A convenient method by means of repeated stimulation of canine lymphocyte may induce specific immune sensitization in canine recipients. Renal allografts in sensitized dogs will be earlier rejected and result in a more deteriorated graft function.

  7. Multifocal phaeohyphomycosis caused by Exophiala xenobiotica in a kidney transplant recipient.

    Science.gov (United States)

    Palmisano, A; Morio, F; Le Pape, P; Degli Antoni, A M; Ricci, R; Zucchi, A; Vaglio, A; Piotti, G; Antoniotti, R; Cremaschi, E; Buzio, C; Maggiore, U

    2015-04-01

    In recent years, black fungi have been increasingly reported as causing opportunistic infections after solid organ transplantation. Here, we report a case of insidious, relentless, and multifocal Exophiala xenobiotica infection in a kidney transplant recipient that eventually required multiple surgical excisions along with oral and intravenous antifungal combination therapy using liposomal amphotericin B and posaconazole. We compare the present case with all previously reported cases of Exophiala infection after kidney transplantation.

  8. Late antibody-mediated rejection after ABO-incompatible kidney transplantation during Gram-negative sepsis

    NARCIS (Netherlands)

    A. de Weerd (Annelies); A.G. Vonk (Alieke); H. van der Hoek (Hans); M. van Groningen (Marian); W. Weimar (Willem); M.G.H. Betjes (Michiel); M. Agteren (Madelon)

    2014-01-01

    textabstractBackground: The major challenge in ABO-incompatible transplantation is to minimize antibody-mediated rejection. Effective reduction of the anti-ABO blood group antibodies at the time of transplantation has made ABO-incompatible kidney transplantation a growing practice in our hospital an

  9. Efficacy and safety of febuxostat in the treatment of hyperuricemia in stable kidney transplant recipients

    Directory of Open Access Journals (Sweden)

    Sofue T

    2014-02-01

    Full Text Available Tadashi Sofue,1 Masashi Inui,2 Taiga Hara,1 Yoko Nishijima,1 Kumiko Moriwaki,1 Yushi Hayashida,3 Nobufumi Ueda,3 Akira Nishiyama,4 Yoshiyuki Kakehi,3 Masakazu Kohno1 1Division of Nephrology and Dialysis, Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University, Kagawa, 2Department of Urology, Tokyo Women's Medical University, Tokyo, 3Department of Urology, 4Department of Pharmacology, Kagawa University, Kagawa, Japan Background: Post-transplant hyperuricemia (PTHU, defined as serum uric acid concentration ≥7.0 mg/dL or need for treatment with allopurinol or benzbromarone, reduces long-term allograft survival in kidney transplant recipients. Febuxostat, a new nonpurine selective xanthine oxidase inhibitor, is well tolerated in patients with moderate renal impairment. However, its efficacy and safety in kidney recipients with PTHU is unclear. We therefore assessed the efficacy and safety of febuxostat in stable kidney transplant recipients with PTHU. Methods: Of 93 stable adult kidney transplant recipients, 51 were diagnosed with PTHU (PTHU group and 42 were not (NPTHU group. Of the 51 patients with PTHU, 26 were treated with febuxostat (FX group and 25 were not (NFX group, at the discretion of each attending physician. One-year changes in serum uric acid concentrations, rates of achievement of target uric acid (<6.0 mg/dL, estimated glomerular filtration rates in allografts, and adverse events were retrospectively analyzed in the FX, NFX, and NPTHU groups. Results: The FX group showed significantly greater decreases in serum uric acid (-2.0±1.1 mg/dL versus 0.0±0.8 mg/dL per year, P<0.01 and tended to show a higher rate of achieving target uric acid levels (50% versus 24%; odds ratio 3.17 [95% confidence interval 0.96–10.5], P=0.08 than the NFX group. Although baseline allograft estimated glomerular filtration rates tended to be lower in the FX group than in the NFX group (40±14 mL/min/1.73 m2 versus 47±19 mL/min/1.73 m2

  10. Dialysis patients refusing kidney transplantation: data from the Slovenian Renal Replacement Therapy Registry.

    Science.gov (United States)

    Buturović-Ponikvar, Jadranka; Gubenšek, Jakob; Arnol, Miha; Bren, Andrej; Kandus, Aljoša; Ponikvar, Rafael

    2011-06-01

    Kidney transplantation is considered the best renal replacement therapy (RRT) for patients with end-stage renal disease; nevertheless, some dialysis patients refuse to be transplanted. The aim of our registry-based, cross-sectional study was to compare kidney transplant candidates to dialysis patients refusing transplantation. Data were collected from the Slovenian Renal Replacement Therapy Registry database, as of 31 December 2008. Demographic and some RRT data were compared between the groups. There were 1448 dialysis patients, of whom 1343 were treated by hemodialysis and 105 by peritoneal dialysis (PD); 132 (9%) were on the waiting list for transplantation, 208 (14%) were preparing for enrollment (altogether 340 [23%] dialysis patients were kidney transplant candidates); 200 (13.7%) patients were reported to refuse transplantation, all ≤ 65 years of age; 345 (24%) were not enrolled due to medical contraindications, 482 (33%) due to age, and 82 (6%) due to other or unknown reasons. No significant difference was found in age, gender, or presence of diabetes between kidney transplant candidates vs. patients refusing transplantation (mean age 50.5 ± 13.9 vs. 51.3 ± 9.6 years, males 61% vs. 63%, diabetics 18% vs. 17%). The proportion of patients ≤ 65 years old who were refusing transplantation was 28% (187/661) for hemodialysis and 17% (13/79) for PD patients (P = 0.03). There is a considerable group of dialysis patients in Slovenia refusing kidney transplantation. Compared to the kidney transplant candidates, they are similar in age, gender and prevalence of diabetes. Patients treated by peritoneal dialysis refuse kidney transplantation less often than hemodialysis patients.

  11. A Review of Transplantation Practice of the Urologic Organs: Is It Only Achievable for the Kidney?

    Science.gov (United States)

    Donati-Bourne, Jack; Roberts, Harry W; Rajjoub, Yaseen; Coleman, Robert A

    2015-01-01

    Transplantation is a viable treatment option for failure of most major organs. Within urology, transplantation of the kidney and ureter are well documented; however, evidence supporting transplantation of other urologic organs is limited. Failure of these organs carries significant morbidity, and transplantation may have a role in management. This article reviews the knowledge, research, and literature surrounding transplantation of each of the urologic organs. Transplantation of the penis, testicle, urethra, vas deferens, and bladder is discussed. Transplantation attempts have been made individually with each of these organs. Penile transplantation has only been performed once in a human. Testicular transplantation research was intertwined with unethical lucrative pursuits. Interest in urethra, bladder, and vas deferens transplantation has decreased as a result of successful surgical reconstructive techniques. Despite years of effort, transplantations of the penis, testicle, urethra, vas deferens, and bladder are not established in current practice. Recent research has shifted toward techniques of reconstruction, tissue engineering, and regenerative medicine.

  12. The effects of discontinuing cinacalcet at the time of kidney transplantation

    Science.gov (United States)

    Jadoul, Michel; Baños, Ana; Zani, Valter J.; Hercz, Gavril

    2010-01-01

    Background. The calcimimetic, cinacalcet, is approved for treating secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) on dialysis. Biochemical profiles and clinical outcomes in patients discontinuing cinacalcet at kidney transplantation have not been previously described. Methods. We performed a retrospective observational study evaluating post-transplant biochemical profiles and clinical outcomes in patients who had enrolled in phase 2 or 3 randomized, placebo-controlled studies of cinacalcet before receiving a kidney transplant. Results. The study included 28 former cinacalcet and 10 former placebo patients. Post-kidney transplant, there were no obvious differences between the two groups in levels of serum intact parathyroid hormone, calcium or phosphorus. One patient in each group underwent post-transplant parathyroidectomy. Kidney transplant failure was apparent in one former cinacalcet-treated patient (4%) and three former placebo patients (30%). The duration of hospitalization (mean ± standard error) immediately post-transplant in these two groups was 2.3 ± 0.3 and 3.4 ± 0.8 weeks, respectively. Conclusions. Using cinacalcet to treat SHPT in patients with CKD awaiting kidney transplantation does not appear to modify SHPT-related post-transplant biochemical profiles, or clinical outcomes, compared with placebo. PMID:20090879

  13. Great expectations? Pre-transplant quality of life expectations and distress after kidney transplantation : A prospective study

    NARCIS (Netherlands)

    Schulz, Torben; Niesing, Jan; van der Heide, Jaap J. Homan; Westerhuis, Ralf; Ploeg, Rutger J.; Ranchor, Adelita V.

    2014-01-01

    ObjectivesPrevious research suggests that prior to kidney transplantation, patients overestimate their post-transplant quality of life (QoL). The current study aimed to corroborate these findings, identify determinants of QoL overestimation, examine its association with subsequent distress, and clar

  14. The evolution of nonimmune histological injury and its clinical relevance in adult-sized kidney grafts in pediatric recipients.

    Science.gov (United States)

    Naesens, M; Kambham, N; Concepcion, W; Salvatierra, O; Sarwal, M

    2007-11-01

    To describe the evolution, risk factors and impact of nonimmune histological injury after pediatric kidney transplantation, we analyzed 245 renal allograft protocol biopsies taken regularly from the time of transplantation to 2 years thereafter in 81 consecutive rejection-free pediatric recipients of an adult-sized kidney. Isometric tubular vacuolization was present early after transplantation was not progressive, and was associated with higher tacrolimus pre-dose trough levels. Chronic tubulo-interstitial damage and tubular microcalcifications were already noted at 3 months, were progressive and had a greater association with small recipient size, male donor gender, higher donor age and female recipient gender, but not with tacrolimus exposure. Renal function assessment showed that older recipients had a significant increase in absolute glomerular filtration rate with time after transplantation, which differed from small recipients who showed no increase. It is concluded that progressive, functionally relevant, nonimmune injury is detected early after adult-sized kidney transplantation in pediatric recipients. Renal graft ischemia associated with the donor-recipient size discrepancy appears to be a greater risk factor for this chronic histological injury, suggesting that the exploration of additional therapeutic approaches to increase allograft perfusion could further extend the graft survival benefit of adult-sized kidneys transplanted into small children.

  15. Native kidney function after renal transplantation combined with other solid organs in preemptive patients.

    Science.gov (United States)

    Mosconi, G; Panicali, L; Persici, E; Conte, D; Cappuccilli, M L; Cuna, V; Capelli, I; Todeschini, P; D'Arcangelo, G Liviano; Stefoni, S

    2010-05-01

    Kidney transplantations combined with other solid organs are progressively increasing in number. There are no guidelines regarding the nephrologic indications for combined transplantations, namely liver-kidney (LKT), or heart-kidney (HKT), in preemptive patients with chronic kidney failure who are not on regular dialysis therapy. The objective of this study was to assess the functional contribution of the native kidneys after preemptive kidney transplantation combined with other solid organs. From 2004, 9 patients (aged 50.3 +/- 8.5 years) with chronic kidney failure (creatinine 2.5 +/- 1.0 mg/dL) caused by polycystic kidney disease (n = 4), vascular nephropathy (n = 2), interstitial nephropathy (n = 1), glomerulonephritis (n = 1), or end-stage kidney disease (n = 1), underwent combined transplantations (8 LKT, 1 HKT). A scintigraphic functional study (Tc-99DMSA or Tc-99mMAG3), was performed at 4 +/- 3 months after transplantation to evaluate the functional contribution of both the native kidneys and the graft. All patients were given immunosuppressive drugs, including a calcineurin inhibitor (tacrolimus/or cyclosporine). At the time of scintigraphy, renal function in all patients was 1.3 +/- 0.3 mg/dL. The functional contribution of the transplanted kidneys was on average 77 +/- 18%. Only in 1 patient was the contribution of the graft organic nephropathy. In light of our experience, a creatinine clearance transplantation. Close clinical and instrumental assessment pretransplant is essential before proceeding with a combined transplant program to exclude functional forms and to optimize the use of organs.

  16. The impact and treatment of obesity in kidney transplant candidates and recipients

    OpenAIRE

    2015-01-01

    The prevalence of obesity in patients with chronic kidney failure and renal transplant candidates has paralleled the epidemic in the general population. The associated risks of surgical complications and long-term cardiovascular death are significant: most transplant centers consider obesity a relative contra-indication for transplant. Few studies have focused on conservative weight loss strategies in transplant patients. Studies using administrative databases have found that only a minority ...

  17. Successful Transplantation of a Split Crossed Fused Ectopic Kidney into a Patient with End-Stage Renal Disease

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    Kristin L. Mekeel

    2010-01-01

    Full Text Available Potential donors with congenital renal anomalies but normal renal function are often overlooked because of a possible increase in technical difficulty and complications associated with the surgery. However, as the waiting list for a deceased donor kidney transplant continues to grow, it is important to consider these kidneys for potential transplant. This paper describes the procurement of a crossed fused ectopic kidney, and subsequent parenchymal transection prior to transplantation as part of a combined simultaneous kidney pancreas transplant. The transplant was uncomplicated, and the graft had immediate function. The patient is now two years from transplant with excellent function.

  18. The pregnancy rate and live birth rate after kidney transplantation: a single-center experience.

    Science.gov (United States)

    Fontana, I; Santori, G; Fazio, F; Valente, U

    2012-09-01

    Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD). Kidney transplantation recipients live longer and have better quality of life than patients on dialysis. Hypothalamic gonadal dysfunction in females who have ESRD may be reversed within the first few months after kidney transplantation, such as the ability to have children. Despite thousands of successful pregnancies in transplantation recipients, there is limited information about it. In this study, we evaluated the pregnancy rates and live birth rates in women (n = 133) who underwent kidney transplantation in our center from 1983 to 2010. Recipients of a second kidney transplantation and recipients of multiorgan transplantations were excluded. We observed 33 pregnancies with 11 live births (33.3%), 12 spontaneous abortions (36.36%), and 10 therapeutic abortions (30.3%). The pregnancy rate was 18%. The live birth rate was 33.3%. Therapeutic abortions were 36.3%, and the pregnancies resulting in fetal loss were 30.3%. The pregnancies were identified in 32 women. The majority of women (n = 32; 96.9%) had a single pregnancy, whereas 1 woman (3.1%) had two pregnancies. In our series, the pregnancy rates for kidney transplantation recipients were markedly lower and decreased more rapidly than those reported in the general population.

  19. Pharmacokinetics of mycophenolic acid in Chinese kidney transplant patients

    Institute of Scientific and Technical Information of China (English)

    LU Xiao-yang; HUANG Hong-feng; SHENG-TU Jian-zhong; LIU Jian

    2005-01-01

    To assess the influence ofcyclosporin A (CsA) and tacrolimus (FK506) on mycophenolic acid (MPA) and correlation analysis of the pharmacokinetic parameters and patient characteristics, clinical outcome in Chinese kidney transplant recipients,the pharmacokinetics of 1000 mg mycophenolate mofetil (MMF) twice daily was measured by high-performance liquid chromatography (HPLC). PKS (Pharmaceutical Kinetics Software) 1.0.2 software package was used for the calculation of pharmarespectively. The level of AUC(0-12) in the FK506 group was significantly higher than that in the CsA group. MPA appeared not to be affected by renal function. MPA AUC(0-12) showed statistically significant difference according to the patient's gender.

  20. Outcomes and predictive factors of pediatric kidney transplants: an analysis of the Thai Transplant Registry.

    Science.gov (United States)

    Rianthavorn, Pornpimol; Kerr, Stephen J; Lumpaopong, Adisorn; Jiravuttipong, Apichat; Pattaragarn, Anirut; Tangnararatchakit, Kanchana; Avihingsanon, Yingyos; Thirakupt, Prapaipim; Sumethkul, Vasant

    2013-03-01

    As universal coverage for pediatric kidney transplantation (KT) was introduced in Thailand in 2008, the number of recipients has been increasing. We evaluated predictive factors for graft failure to understand how to improve clinical outcomes in these children. Using data obtained from the National Transplant registry, we assessed the risk of graft failure using the Kaplan-Meier method and Cox proportional hazards regression. Altogether, 201 recipients aged <21 yr at the time of KT were studied. Living donors (LD) were significantly older than deceased donor (DD). Mean cold ischemia time of DD was 17 h. The mean donor glomerular filtration rate (GFR) was 84.0 mL/min/1.73 m(2) . Induction immunosuppressive therapy was administered more frequently in DD than in LDKT. Delayed graft function (DGF) occurred in 36 transplants. Over 719 person years of follow-up, 42 graft failures occurred. Graft survival at one, three, and five yr post-transplant were 95%, 88% and 76%, respectively. Two factors independently predicted graft failure in multivariate analysis. The hazard ratios for graft failure in patients with DGF and in patients with donor GFR of ≤30 mL/min/1.73 m(2) were 2.5 and 9.7, respectively. Pediatric recipients should receive the first priority for allografts from young DD with a good GFR, and DGF should be meticulously prevented.

  1. Baseline donor chronic renal injury confers the same transplant survival disadvantage for DCD and DBD kidneys.

    Science.gov (United States)

    Kosmoliaptsis, V; Salji, M; Bardsley, V; Chen, Y; Thiru, S; Griffiths, M H; Copley, H C; Saeb-Parsy, K; Bradley, J A; Torpey, N; Pettigrew, G J

    2015-03-01

    Histological assessment of baseline chronic kidney injury may discriminate kidneys that are suitable for transplantation, but has not been validated for appraisal of donation after circulatory death (DCD) kidneys. 'Time-zero' biopsies for 371 consecutive, solitary, deceased-donor kidneys transplanted at our center between 2006 and 2010 (65.5% DCD, 34.5% donation after brain death [DBD]) were reviewed and baseline chronic degenerative injury scored using Remuzzi's classification. High scores correlated with donor age and extended criteria donors (42% of donors), but the spectrum of scores was similar for DCD and DBD kidneys. Transplant outcomes for kidneys scoring from 0 to 4 were comparable (1 and 3 year graft survival 95% and 92%), but were much poorer for kidneys scoring ≥5, with 1 year graft survival only 73%, and 12.5% suffering primary nonfunction. Critically, high Remuzzi scores conferred the same survival disadvantage for DCD and DBD kidneys. On multi-variable regression analysis, time-zero biopsy score was the only independent predictor for graft survival, whereas one-year graft estimated glomerular filtration rate (eGFR) correlated with donor age and biopsy score. In conclusion, the relationship between severity of chronic kidney injury and transplant outcome is similar for DCD and DBD kidneys. Kidneys with Remuzzi scores of ≤4 can be implanted singly with acceptable results.

  2. Myoglobin cast nephropathy in a kidney transplant patient with normal creatine kinase.

    Science.gov (United States)

    Oliveira da Fonseca, Elissa; Jittirat, Arksarapuk; Birdwell, Kelly A; Fogo, Agnes B

    2015-04-01

    Delayed graft function in kidney transplant recipients is a known complication associated with increased risk of acute rejection and reduced transplant survival after 1 year. There are multiple risk factors, including prolonged cold ischemia time, donor age, and cause of donor's death. Major causes of delayed graft function are acute kidney injury in the donor, often from prolonged terminal ischemia, reflected by acute tubular injury in the recipient. However, the differential diagnosis of delayed graft function includes acute rejection, recurrence of the primary glomerular diseases, and other less commonly encountered conditions. A transplant kidney biopsy usually is required to elucidate the correct cause and initiate the right treatment, which is crucial for transplant survival. We report a case of a transplant recipient who developed delayed graft function due to an uncommon cause. After correct diagnosis, the patient's transplant function improved.

  3. The kidney transplant experience at Hospital de Especialidades, Centro Médico Nacional de Occidente, IMSS, Guadalajara México.

    Science.gov (United States)

    Monteón, Francisco J; Gómez, Benjamin; Valdespino, Carlos; Chávez, Salvador; Sandoval, Mario; Flores, Antonio; Herrera, Roberto; Ramos, Francisco; Hernandez, Alfonso; Camarena, José L; Páez, Hugo; Ramírez, José; Nieves, Juan J; Bassols, Angel; Rosales, Guillermo; Romero, Omar; Paredes, Graciela; Andrade, Jorge; Ruelas, Sara; Contreras, Ana M

    2003-01-01

    A total of 1,356 kidney transplants has been performed in the Hospital de Especialidades del Centro Médico Nacional de Occidente, IMSS, in Guadalajara Mexico, including 935 in the past 8 years. This represents an important increase of this activity in our country. Of the total transplants, 1,218 (90%) were from living donors and only 138 (10%) were from cadaveric donors, a number that we hope to increase. Most recipients were young adults, with an average age of 31 years old. The overall one-year graft and patient survival rates for living-donor kidney recipients were 90% and 82%, and for cadaveric kidney recipients they were 80% and 70%, respectively. Acute rejections occurred in 17% and chronic allograft nephropathy was diagnosed in 7% of our kidney transplant recipients. The main cause of patient death was infection, frequently invasive CMV. Cardiovascular complications were a relatively infrequent cause of death as has been seen in other international series. Hepatitis B and C have been widley studied. Hepatitis C is the most prevalent viral infection in our population. Both living and cadaveric donors in our series were young, which may explain the good results. We have had very few complications among living donors and no mortality. Two donors developed chronic renal insufficiency after the kidney donation (0.001%). This excellent safety record reflects the experience of our team. We hope to increase the number of cadaveric transplant donors with the renewed interest in enlarging the transplantation programs in Mexico while maintaining our high percentage of living donors in order to benefit more patients.

  4. Transplante renal em pacientes infectados pelo HIV Kidney transplantation in HIV infected patients

    Directory of Open Access Journals (Sweden)

    Carina Nilsen Moreno

    2011-02-01

    HIV-positive patients with end stage chronic kidney disease requiring dialysis is progressively growing. Kidney transplantation, previously considered as absolute contraindication for HIV-infected patients is currently, in the HAART era, considered a possible treatment alternative. Concerns for the effects of immunosuppressive drugs in these patients and the possible effects on progression of HIV disease, in addition to the risk of opportunistic infections and cancer development are widely discussed. Clinical experience in the HAART era shows that use of immunosuppressive drugs does not adversely affect HIV-seropositive patients. Furthermore, several transplant centers have reported improved patient and graft outcomes for kidney transplant recipients infected with HIV. In summary, results obtained so far are encouraging, supporting that renal transplantation, following specific selection criteria, can be considered an alternative of renal replacement therapy in HIV-infected patients.

  5. Rituximab induction therapy in highly sensitized kidney transplant recipients

    Institute of Scientific and Technical Information of China (English)

    YIN Hang; WAN Hao; HU Xiao-peng; LI Xiao-bei; WANG Wei; LIU Hang; REN Liang; ZHANG Xiao-dong

    2011-01-01

    Background The number of highly sensitized patients is rising, and sensitization can lead to renal transplant failure.The present study aimed to investigate the safety and efficacy of renal transplantation following induction therapy with rituximab in highly sensitized kidney transplant recipients.Methods Seven highly sensitized kidney transplant recipients who underwent rituximab therapy from December 2008 to December 2009 were retrospectively analyzed. There were 3 men and 4 women, with a mean age of 38.5 years (range, 21-47 years). The duration of hemodialysis was 3-12 months, with a mean duration of 11 months. For 4 patients,this was the second transplant; the previous graft survival time was 2-11 years, with a mean survival time of 5.8 years. All the female recipients had history of multiple pregnancies, and all patients had previously received blood transfusions. All donors were men, with a mean age of 32.5 years (range, 25-37 years). In 2 of the 7 patients, both class I and class II of panel reactive antibody were high; the remaining 5 patients showed either high in class I or in class II of panel reactive antibody. The mean panel reactive antibody value was 31% for class I and 51% for class II respectively. The donors and the recipients had the same blood type, with low lymphocyte cytotoxicity ranging from 2% to 5%. The human leukocyte antigen (HLA) mismatch numbers were from 2 to 4. All patients received tacrolimus (0.1 mg·kg-1·d-1) and mycophenolate mofetil (750 mg twice per day) orally 3 days prior to surgery. All patients received a single dose of 600 mg rituximab (375 mg/m2) infusion on the day before surgery and polyclonal antibody (antithymocyte globulin) on the day of surgery.Postoperative creatinine, creatinine clearance rate, and occurrence of rejection by pathological biopsy confirmation were monitored.Results No patient had delayed graft function after surgery. Two patients had acute rejection, one on day 7 and the other on day 13 post

  6. Gene Expression Profiling on Acute Rejected Transplant Kidneys with Microarray

    Institute of Scientific and Technical Information of China (English)

    Deping LI; Kang WANG; Yong DAI; Tianyu LV

    2008-01-01

    To investigate the gene expression profiles in acute allograft rejection of renal trans- plantation, and identify the markers for the early diagnosis of acute rejection, heterotopic kidney transplantation was performed by using F344 or Lewis donors and Lewis recipients. No immunosup- pressant was used. Renal grafts were harvested on days 3, 7, and 14. A commercial microarray was used to measure gene expression levels in day-7 grafts. The expression levels of 48 genes were up-regulated in the allograft in comparison with the isograft control, and interferon-y-induced GTPase gene was most significantly up-regulated in allografts. It is concluded that a variety of pathways are involved in organ transplant rejection which is dynamic and non-balanced. IFN-inducible genes, such as IGTP, may play an important role in the rejection. A lot of important factors involved in acute re- jection are unnecessary but sufficient conditions for the rejection. We are led to conclude that it is virtually impossible to make an early diagnosis based on a single gene marker, but it could he achieved on the basis of a set of markers.

  7. [Living kidney transplantation. A comparison of Scandinavian countries and Germany].

    Science.gov (United States)

    Lück, R; Schrem, H; Neipp, M; Nashan, B; Klempnauer, J

    2003-06-01

    The discussion of compensating for shortages of cadaveric donation with increased living donation often reveals differences between the Scandinavian countries and Germany. Possible adoption of Scandinavian structures to improve the rate of living donations in Germany warrants analysis of the actual differences between these two regions. Close examination reveals that significantly higher rates of living donation are achieved only in Sweden and Norway. In Norway, a frequently postulated negative effect on cadaveric donation due to very high rates of living donation could not be confirmed. In contrast to Germany and as a consequence of Norwegian geography, kidney transplantation has been regarded in Norway as the first-line therapy for endstage renal disease for more than 35 years. Living donation has since been actively pursued and is traditionally the transplantation of first choice. In Germany, living donation is still regarded as the second choice after cadaveric donation, due to legal regulations. Significant improvements in living donation frequencies could be achieved there by adopting the active Norwegian approach to living donor identification.

  8. DIFFERENCE OF REJECTION IN SINGLE VERSUS COMBINED PANCREAS AND KIDNEY TRANSPLANTATION IN RATS

    Institute of Scientific and Technical Information of China (English)

    朱预; 肖毅; 乔海泉; 姜洪池; 代文杰

    2000-01-01

    Objective. To investigate the difference of rejection in single versus combined pancreas and kidney transplantation in rats. Methods. Allograft models including simultaneous pancreas and kidney(SPK) transplant and pancreas or kidney transplant alone were established in SD-Wistar rats, rejections of pancreas and kidney in different models were com-pared morphologically and functionally. Results. Mean survival time (MST) of pancreas was significantly prolonged in SPK than in pancreas transplant alone (PTA) (11.5 days vs. 9.2 days, P <0.05). Incidence of interstitial pancreatic rejection at grade Ⅱ and grade Ⅲ was much obvious in PTA than in SPK (42.9% vs. 12.5% at grade Ⅱ and 28.6% vs 6.3% at grade Ⅲ , P<0.05). No significant difference was found in MST between SPK and kidney transplant alone(KTA). Administration of cyclesporine A prolonged the MST of pancreas and kidney, without altering the tendency stated above. Condusions. In SPK, the function of pancreas is protected by kidney hence the severity of rejection is reduced, whereas the function of kidney is not protected by pancreas. It suggests that different organs differ in immunoaller-gization and immunoregulation, and immune response tend to attack organs with greater immunoactivity, those organs with minor one could be protected. Cyclesporine A is effective on prolonging the MST of pancreas and kidney.

  9. DIFFERENCE OF REJECTION IN SINGLE VERSUS COMBINED PANCREAS AND KIDNEY TRANSPLANTATION IN RATS

    Institute of Scientific and Technical Information of China (English)

    乔海泉; 姜洪池; 代文杰; 朱预; 肖毅

    2000-01-01

    Objective. To investigate the difference of rejection in single versus combined pancreas and kidney transplantation in rats. Methods. All ograft models including simultaneous pancreas and kidney(SPK)transplant and pancreas or kidney transplant alone were established in SD-Wistar rats, rejections of pancreas and kidney in different models were com pared morphologically and functionally. Results. Mean survival time (MST)of pancreas was significantly prolonged in SPK than in pancreas transplant alone(PTA)( 11.5 days vs. 9.2 days, P < 0.05). Incidence of interstitial pancreatic rejection at grade Ⅱ and grade Ⅲ was much obvious in PTA than in SPK(42.9% vs. 12.5% at grade Ⅱ and 28.6% vs 6.3% at grade Ⅲ , P < 0.05). No significant difference was found in MST between SPK and kidney transplant alone(KTA). Administration of cyclosporine A prolonged the MS T of pancreas and kidney, without altering the tendency stated above. Conclusions. In SPK, the function of pancreas is protected by kidney hence the severity of rejection is reduced, whereas the function of kidney is not protected by pancreas. It suggests that different organs differ in immunoaller gization and immunoregula tion, and immune response tend to attack organs with greater immunoactivity, those organs with minor one could be protected. Cyclosporine A is effective on prolonging the MST of pancreas and kidney.

  10. Improved Left Ventricular Structure and Function After Successful Kidney Transplantation

    Directory of Open Access Journals (Sweden)

    Bernd Hewing

    2016-10-01

    Full Text Available Background/Aims: Cardiac changes observed in chronic kidney disease patients are of multifactorial origin including chronic uremia, hemodynamics or inflammation. Restoration of renal function by kidney transplantation (KTX may reverse cardiac changes. Novel echocardiographic methods such as speckle tracking echocardiography (STE allow early and sensitive detection of subtle changes of cardiac parameters. We evaluated changes of cardiac structure and function after KTX by advanced echocardiographic modalities. Methods: Thirty-one KTX recipients (female n=11 were evaluated by medical examination, laboratory testing and echocardiography before and after KTX (median follow-up 19 months. Left ventricular (LV and right ventricular (RV diameters and function were assessed by echocardiographic standard parameters. Longitudinal 2D strain of the LV (GLPS and left atrium (LA was determined by 2D STE. Results: After KTX, median serum creatinine level was 1.3 mg/dl (IQR, 1.2-1.5. Systolic blood pressure decreased significantly after KTX. Echocardiography showed a significant reduction in LV end-diastolic septal and posterior wall thickness and LV mass index after KTX, which was accompanied by an improvement of GLPS. There were no relevant changes in parameters of LA (reservoir, conduit or contractile function, LV diastolic or RV function after KTX. Conclusion: LV hypertrophy reversed after successful KTX and was accompanied by an improvement in longitudinal LV function as assessed by STE. Diastolic function and STE-derived LA function parameters did not change significantly after KTX.

  11. Simultaneous pancreas–kidney transplant for type I diabetes with renal failure: Anaesthetic considerations

    Directory of Open Access Journals (Sweden)

    Lakshmi Kumar

    2016-01-01

    Full Text Available Pancreatic grafts have been successfully used in patients with diabetes and are combined with kidney transplantation in patients with renal failure. The propagation of awareness in organ donation in India has increased the donor pool of transplantable organs in the last few years making multi visceral transplants feasible in our country. We present the anaesthetic management of a 32-year-old male with diabetes mellitus and end-stage renal failure who was successfully managed with a combined pancreas and kidney transplantation.

  12. Complex kidneys for complex patients: the risk associated with transplantation of kidneys with multiple arteries into obese patients.

    Science.gov (United States)

    Nath, J; Mastoridis, S; van Dellen, D; Guy, A J; McGrogan, D G; Krishnan, H; Pattenden, C; Inston, N G; Ready, A R

    2015-03-01

    Conflicting evidence surrounds clinical outcomes in obese individuals after transplantation; nonetheless, many are denied the opportunity to receive a transplant. Allografts with complex vascular anatomy are regularly used in both deceased and living donor settings. We established the risk of transplanting kidneys with multiple renal arteries into obese recipients. A retrospective analysis of data from 1095 patients undergoing renal transplantation between January 2004 and July 2013 at a single centre was conducted. Of these, 24.2% were obese (body mass index >30 kg/m(2)), whereas 25.1% of kidneys transplanted had multiple arteries, thereby making the transplantation of kidneys of complex anatomy into obese recipients a relatively common clinical occurrence. Vessel multiplicity was associated with inferior 1-year graft survival (85.8.% vs 92.1%, P = .004). Obese patients had worse 1-graft survival compared to those of normal BMI (86.8% vs 93.8%, P = .001). The risk of vascular complications and of graft loss within a year after transplantation were greater when grafts with multiple arteries were transplanted into obese recipients as compared to their nonobese counterparts (RR 2.00, CI 95% 1.07-3.65, and RR 1.95, CI 95% 1.02-3.65). Additionally, obese patients faced significantly higher risk of graft loss if receiving a kidney with multiple arteries compared to one of normal anatomy (RR 1.97, 95% CI 1.02-3.72). Thus, obese patients receiving complex anatomy kidneys face poorer outcomes, which should be considered when allocating organs, seeking consent, and arranging for aftercare.

  13. Intracardiac Thrombosis during Adult Liver Transplantation

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    Marina Moguilevitch

    2013-01-01

    Full Text Available Intracardiac thrombosis (ICT and pulmonary embolism (PE during adult liver transplantation are rare but potentially lethal complications. They are often overlooked because of significant diagnostic challenges. The combination of hemodynamic compromise and transesophageal echocardiography (TEE findings allows for correct diagnosis. A large variety of putative risk factors for ICT and PE have been suggested, but these events are considered to be multifactorial. There are different proposed treatment modalities for these devastating complications. Unfortunately, in spite of growing knowledge in this area, intraoperative and postoperative mortalities remain very high. The retrospective nature of the study of these events makes the case reports extremely valuable.

  14. Estimating the risks of acquiring a kidney abroad: a meta-analysis of complications following participation in transplant tourism.

    Science.gov (United States)

    Anker, Ashley E; Feeley, Thomas H

    2012-01-01

    A meta-analysis of odds ratios comparing the risks of participating in transplant tourism by acquiring a kidney abroad to the risks associated with domestic kidney transplant was undertaken. Comparison across 12 medical outcomes indicates transplant tourists are significantly more likely to contract cytomegalovirus, hepatitis B, HIV, post-transplantation diabetes mellitus, and wound infection than those receiving domestic kidney transplant. Results also indicate that domestic kidney transplant recipients experience significantly higher one-yr patient- and graft-survival rates. Analyses are supplemented by independent comparisons of outcomes and provide practitioners with weighted estimates of the proportion of transplant recipients experiencing 15 medical outcomes. Practitioners are encouraged to caution patients of the medical risks associated with transplant tourism. Despite the illegal and unethical nature of transplant tourism, additional efforts are indicated to eliminate the organ trade and to educate wait-listed patients about the risks of transplant tourism.

  15. Mycophenolic acid formulations in adult renal transplantation – update on efficacy and tolerability

    Directory of Open Access Journals (Sweden)

    Déla Golshayan

    2009-04-01

    Full Text Available Déla Golshayan1,2, M Pascual2, Bruno Vogt11Service of Nephrology and Hypertension, 2Transplantation Centre and Transplantation Immunopathology Laboratory, Department of Medicine, Centre Hospitalier Universitaire Vaudois (CHUV, Lausanne University, 1011 Lausanne, SwitzerlandAbstract: The description more than 30 years ago of the role of de novo purine synthesis in T and B lymphocytes clonal proliferation opened the possibility for selective immunosuppression by targeting specific enzymatic pathways. Mycophenolic acid (MPA blocks the key enzyme inosine monophosphate dehydrogenase and the production of guanosine nucleotides required for DNA synthesis. Two MPA formulations are currently used in clinical transplantation as part of the maintenance immunosuppressive regimen. Mycophenolate mofetil (MMF was the first MPA agent to be approved for the prevention of acute rejection following renal transplantation, in combination with cyclosporine and steroids. Enteric-coated mycophenolate sodium (EC-MPS is an alternative MPA formulation available in clinical transplantation. In this review, we will discuss the clinical trials that have evaluated the efficacy and safety of MPA in adult kidney transplantation for the prevention of acute rejection and their use in new combination regimens aiming at minimizing calcineurin inhibitor toxicity and chronic allograft nephropathy. We will also discuss MPA pharmacokinetics and the rationale for therapeutic drug monitoring in optimizing the balance between efficacy and safety in individual patients.Keywords: kidney transplantation, immunosuppression, mycophenolic acid, mycophenolate mofetil, enteric-coated mycophenolate sodium, acute rejection, chronic allograft nephropathy

  16. Medical nutrition therapy in chronic kidney disease; from dialysis to transplant: A case report

    Directory of Open Access Journals (Sweden)

    Gabriela Leal-Escobar

    2016-01-01

    Full Text Available Chronic kidney disease has direct implications in nutritional status, causing anorexia and muscular catabolism. These situations are frequent in kidney renal replacement therapy in which nutritional disorders and inflammatory mechanisms associated with therapy often lead to the development of protein-energy wasting. Nutrition therapy has shown an adequate therapeutic strategy to prevent and treat metabolic alterations, reducing surgical and nutritional complication risks in kidney transplantation patients. The current case reports nutritional intervention on a continuous ambulatory peritoneal dialysis patient who was subsequently prescribed to automatic peritoneal dialysis and, finally, kidney transplant from a living donor.

  17. Results of kidney transplantation in relation to HLA-A, B, DR matching and quality of donor organ.

    Science.gov (United States)

    Lenhard, V; Dreikorn, K; Röhl, L

    1980-01-01

    The influence of HLA compatibility as well as immediate postoperative function on survival rates was investigated in 203 cadaver kidney transplants. HLA compatibility, especially DR compatibility, improved transplant survival significantly. A direct correlation was found between primary transplant function and long-term results. HLA compatibility and quality of the donor organ had a cumulative effect on kidney transplant survival. Our results are a further indication that besides HLA compatibility, optimal quality of donor organs has crucial significance for the results of transplantation.

  18. Incidence of Malignancy after Living Kidney Transplantation: A Multicenter Study from Iran

    Science.gov (United States)

    Einollahi, Behzad; Rostami, Zohreh; Nourbala, Mohammad Hossein; Lessan-Pezeshki, Mahboob; Simforoosh, Naser; Nemati, Eghlim; Pourfarziani, Vahid; Beiraghdar, Fatemeh; Nafar, Mohsen; Pour-Reza-Gholi, Fatemeh; Mazdeh, Mitra Mahdavi; Amini, Manochehr; Ahmadpour, Pedram; Makhdoomi, Khadijeh; Ghafari, Ali; Ardalan, Mohammad Reza; Khosroshahi, Hamid Taebi; Oliaei, Farshid; Shahidi, Shahrzad; Abbaszadeh, Shahin; Fatahi, Mohammad Reza; Hiedari, Fatemeh; Makhlogh, Atehieh; Azmandian, Jalal; Samimagham, Hamid Reza; Shahbazian, Heshmatollah; Nazemian, Fatemeh; Naghibi, Massih; Khosravi, Masoud; Monfared, Ali; Mosavi, Seyed Majid; Ahmadi, Javad; Jalalzadeh, Mojgan

    2012-01-01

    Malignancy is a common complication after renal transplantation. However, limited data are available on post-transplant malignancy in living kidney transplantation. Therefore, we made a plan to evaluate the incidence and types of malignancies, association with the main risk factors and patient survival in a large population of living kidney transplantation. We conducted a large retrospective multicenter study on 12525 renal recipients, accounting for up to 59% of all kidney transplantation in Iran during 22 years follow up period. All information was collected from observation of individual notes or computerized records for transplant patients. Two hundred and sixty-six biopsy-proven malignancies were collected from 16 Transplant Centers in Iran; 26 different type of malignancy categorized in 5 groups were detected. The mean age of patients was 46.2±12.9 years, mean age at tumor diagnosis was 50.8±13.2 years and average time between transplantation and detection of malignancy was 50.0±48.4 months. Overall tumor incidence in recipients was 2%. Kaposis' sarcoma was the most common type of tumor. The overall mean survival time was 117.1 months (95% CI: 104.9-129.3). In multivariate analysis, the only independent risk factor associated with mortality was type of malignancy. This study revealed the lowest malignancy incidence in living unrelated kidney transplantation. PMID:22712025

  19. Incidence of Malignancy after Living Kidney Transplantation: A Multicenter Study from Iran

    Directory of Open Access Journals (Sweden)

    Behzad Einollahi, Zohreh Rostami, Mohammad Hossein Nourbala, Mahboob Lessan-Pezeshki, Naser Simforoosh, Eghlim Nemati, Vahid Pourfarziani, Fatemeh Beiraghdar, Mohsen Nafar, Fatemeh Pour-Reza-Gholi, Mitra Mahdavi Mazdeh, Manochehr Amini, Pedram Ahmadpour,

    2012-01-01

    Full Text Available Malignancy is a common complication after renal transplantation. However, limited data are available on post-transplant malignancy in living kidney transplantation. Therefore, we made a plan to evaluate the incidence and types of malignancies, association with the main risk factors and patient survival in a large population of living kidney transplantation. We conducted a large retrospective multicenter study on 12525 renal recipients, accounting for up to 59% of all kidney transplantation in Iran during 22 years follow up period. All information was collected from observation of individual notes or computerized records for transplant patients. Two hundred and sixty-six biopsy-proven malignancies were collected from 16 Transplant Centers in Iran; 26 different type of malignancy categorized in 5 groups were detected. The mean age of patients was 46.2±12.9 years, mean age at tumor diagnosis was 50.8±13.2 years and average time between transplantation and detection of malignancy was 50.0±48.4 months. Overall tumor incidence in recipients was 2%. Kaposis' sarcoma was the most common type of tumor. The overall mean survival time was 117.1 months (95% CI: 104.9-129.3. In multivariate analysis, the only independent risk factor associated with mortality was type of malignancy. This study revealed the lowest malignancy incidence in living unrelated kidney transplantation.

  20. Big Data, Predictive Analytics, and Quality Improvement in Kidney Transplantation: A Proof of Concept.

    Science.gov (United States)

    Srinivas, T R; Taber, D J; Su, Z; Zhang, J; Mour, G; Northrup, D; Tripathi, A; Marsden, J E; Moran, W P; Mauldin, P D

    2017-03-01

    We sought proof of concept of a Big Data Solution incorporating longitudinal structured and unstructured patient-level data from electronic health records (EHR) to predict graft loss (GL) and mortality. For a quality improvement initiative, GL and mortality prediction models were constructed using baseline and follow-up data (0-90 days posttransplant; structured and unstructured for 1-year models; data up to 1 year for 3-year models) on adult solitary kidney transplant recipients transplanted during 2007-2015 as follows: Model 1: United Network for Organ Sharing (UNOS) data; Model 2: UNOS & Transplant Database (Tx Database) data; Model 3: UNOS, Tx Database & EHR comorbidity data; and Model 4: UNOS, Tx Database, EHR data, Posttransplant trajectory data, and unstructured data. A 10% 3-year GL rate was observed among 891 patients (2007-2015). Layering of data sources improved model performance; Model 1: area under the curve (AUC), 0.66; (95% confidence interval [CI]: 0.60, 0.72); Model 2: AUC, 0.68; (95% CI: 0.61-0.74); Model 3: AUC, 0.72; (95% CI: 0.66-077); Model 4: AUC, 0.84, (95 % CI: 0.79-0.89). One-year GL (AUC, 0.87; Model 4) and 3-year mortality (AUC, 0.84; Model 4) models performed similarly. A Big Data approach significantly adds efficacy to GL and mortality prediction models and is EHR deployable to optimize outcomes.

  1. Abnormal bone and mineral metabolism in kidney transplant patients--a review

    DEFF Research Database (Denmark)

    Sprague, S.M.; Belozeroff, V.; Danese, M.D.

    2008-01-01

    for English language articles published between January 1990 and October 2006 that contained Medical Subject Headings and key words related to secondary or persistent hyperparathyroidism and kidney transplant. RESULTS: Parathyroid hormone levels decreased significantly during the first 3 months after......BACKGROUND/AIMS: Abnormal bone and mineral metabolism is common in patients with kidney failure and often persists after successful kidney transplant. METHODS: To better understand the natural history of this disease in transplant patients, we reviewed the literature by searching MEDLINE...... transplant but typically stabilized at elevated values after 1 year. Calcium tended to increase after transplant and then stabilize at the higher end of the normal range within 2 months. Phosphorus decreased rapidly to within or below normal levels after surgery and hypophosphatemia, if present, resolved...

  2. Hypertension and obesity after pediatric kidney transplantation: management based on pathophysiology: A mini review

    Directory of Open Access Journals (Sweden)

    Eunice G John

    2014-01-01

    Full Text Available Hypertension after pediatric renal transplant is a common and important risk factor for graft loss and patient survival. The mechanism of post kidney transplant hypertension is complex and multifactorial. Control of blood pressure in renal transplant patients is important but often times blood pressures remain uncontrolled. The management of hypertension and obesity in pediatric kidney transplant patients is based on the pathophysiology. Compared to the general pediatric hypertensive population, special attention needs to be focused on the additional impact of immunosuppressive medications side effects and interactions, recurrent disease, and donor and recipient comorbidities such as obesity on blood pressure control with thoughtful consideration of the risk of graft failure. In general, there is a need for prospective studies in pediatric kidney transplant patients to understand the pathophysiology of hypertension and obesity and the appropriate approach to achieve a balance between the primary need to avoid rejection and the need to lower blood pressure and prevent obesity.

  3. En-Bloc Transplant of the Liver, Kidney and Pancreas: Experience from a Latin American Transplant Center

    Science.gov (United States)

    Caicedo, Luis A.; Villegas, Jorge I.; Serrano, Oscar; Millán, Mauricio; Sepúlveda, Mauricio; Jiménez, Diego; García, Jairo; Posada, Juan G.; Mesa, Liliana; Duran, Carlos; Schweineberg, Johanna; Dávalos, Diana; Manzi, Eliana; Sabogal, Angie; Aristizabal, Ana María; Echeverri, Gabriel J.

    2017-01-01

    Case series Patient: Male, 38 • Male, 48 Final Diagnosis: En-bloc transplantation (liver, kidney, pancreas) Symptoms: Encephalopathy • adynamia • ascites • asthenia Medication: — Clinical Procedure: En-bloc transplantation Specialty: Transplantology Objective: Unusual setting of medical care Background: En-bloc transplantation is a surgical procedure in which multiple organs are transplanted simultaneously. It has some similarities with multi-organ transplantation but offers certain advantages. This report highlights the experience of our interdisciplinary group regarding the treatment and follow-up of patients who received en-bloc transplantation, with the aim of encouraging the development of this surgical technique. Case Report: The first case is a 38-year-old patient with type 1 diabetes mellitus, liver cirrhosis, and chronic kidney failure who received an en-bloc transplant of the liver, pancreas, and kidney with no intraoperative complications. He had a prolonged hospital stay due to anemia and systemic inflammatory response syndrome, which were resolved successfully. At follow-up, he had no requirement for insulin or for dialysis, or for new interventions. The second case describes a 48-year-old patient with type 2 diabetes mellitus, renal failure, and liver cirrhosis who received an en-bloc transplant of the liver, pancreas, and kidney with no complications. During the postoperative period, the patient suffered a possible episode of acute tubular necrosis, which evolved towards improvement, with a tendency to normal metabolic and renal functioning, with no additional events. The patient is currently in follow-up and is insulin-independent. Conclusions: En-bloc transplantation is a safe procedure, which is technically simple and which achieves excellent results. This procedure is indicated in patients with end-stage renal disease, cirrhosis, and diabetes mellitus that is difficult to control. PMID:28148909

  4. Cytomegalovirus Infection following Kidney Transplantation: a Multicenter Study of 3065 Cases

    Science.gov (United States)

    Einollahi, B.

    2012-01-01

    Background: Cytomegalovirus (CMV) infection is a common complication following kidney transplantation. Objective: To assess the incidence and risk factors of CMV infection among renal transplant recipients. Methods: In a retrospective multicenter study, 3065 renal transplant recipients from 17 transplant centers of Iran were studied between April 2008 and January 2011. Kidney transplant patients were routinely monitored by sequential blood samples drawn for use in the CMV-pp65 antigenemia assay, and for hematological and biochemistry tests. Results: 63% of studied patients were males; the mean±SD age of participants was 38±15 years. The majority of cases (81%) received a kidney from a living unrelated donor (LURD), 9% from living related donor (LRD), and 10% from deceased donors. 671 patients experienced CMV viremia. The incidence of CMV infection was 21.9% (95% CI: 20.4%–23.4%). The rate was higher in the first 6 months after transplantation (p<0.001); in recipients with higher level of cyclosporine (p<0.001); in those with lower hemoglobin concentration (p=0.02); patients with elevated ALT (p<0.001); those with increased fasting blood sugar (p=0.005); recipients with dyslipidemia (p<0.05); deceased kidney recipients (p=0.006); and patients with kidney graft impairment (p=0.01). In multivariate regression analysis, time since kidney transplantation (p<0.001) and renal allograft failure (p<0.001) were the only risk factors associated with CMV infection. Conclusions: CMV infection was a common complication in the first 6 months of kidney transplantation, particularly among patients with kidney graft impairment. PMID:25013626

  5. Tumor-resected kidney transplant – a quality of life survey

    Directory of Open Access Journals (Sweden)

    Sundararajan S

    2016-05-01

    Full Text Available Siva Sundararajan,1 Bulang He,1,2 Luc Delriviere,1,2 1WA Liver and Kidney Surgical Transplant Service, Department of General Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia; 2School of Surgery, The University of Western Australia, Perth, WA, Australia Background: To overcome the organ shortage, a program to use kidney grafts after excision of a small renal tumor (tumor resected kidney [TRK] was implemented in February 2007. All recipients were over 55 years old according to the selection criteria. The aim of this study is to assess the quality of life after kidney transplant in this cohort. Methods: From February 2007 to July 2013, 27 patients received a kidney graft after excision of the small kidney tumor. All patients were given the modified 36-Item Short Form Survey (SF-36 questionnaire with additional information regarding concerns about tumor recurrence and whether they would choose TRK transplantation or prefer to stay on dialysis if they have an option again. Results: Of them, 20 returned the completed questionnaire. There is no tumor recurrence on a mean follow-up of 38 months. The mean scores in all eight domains of the SF-36 were higher posttransplantation. The differences were statistically significant. Ninety-five percent of recipients would prefer to have TRK transplantation rather than remain on dialysis. Eighty percent of patients had no or minimal concerns regarding tumor recurrence. Conclusion: The patients who had kidney transplantation by using the graft after excision of a small tumor have achieved excellent quality of life. It is an important alternative for the solution of organ shortage in kidney transplantation. The concern of tumor recurrence is minimal. Performing a further study is worthwhile, with prospective data collection and a control group. Keywords: quality of life, kidney transplant, tumor, small renal cell carcinoma

  6. Recurrent urinary tract infections in kidney transplant recipients.

    Science.gov (United States)

    Silva, C; Afonso, N; Macário, F; Alves, R; Mota, A

    2013-04-01

    Urinary tract infection (UTI) constitutes the most frequent infection among kidney transplantation (KT) patients. The epidemiology and specific risk factors for recurrent UTI after KT have not been well studied. The aim of this work was to assess the incidence, pathogenic spectrum, and risk factors for recurrent post-KT UTI. This observational, cross-sectional study included all patients admitted to our transplantation department with a diagnosis of post-KT UTI from January 2010 to December 2011. Recurring post-KT UTI was defined as ≥ 2 UTIs in 6 months or ≥ 3 UTIs in 12 months. Factors associated with recurrent post-KT UTI were assessed using logistic regression analysis. The 154 patients were diagnosed with 315 episodes of post-KT UTI (28.6%), with recurrent post-KT UTI among 72% of cases. Most recurrent UTIs (73.6%) occurred during the first year after KT. Klebsiella species was the most common isolated pathogen (53.2%), being a serious problem for multidrug-resistance (odds ratio [OR], 13; 95% confidence interval [CI] 5.9-28.6; P recurrent post-KT UTI. KT recipient demographics and characteristics, factors related to KT and urologic complications, did not differ significantly between patients with versus without recurrent post-KT UTI. In conclusion, in a unit where recurrent post-KT UTI incidence was 72% and Klebsiella species was the prevailing uropathogen, nosocomial infection and multidrug-resistant bacteria appeared to be independent predictive factors for recurrent post-KT UTI.

  7. Cystatin C enhances GFR estimating Equations in Kidney Transplant Recipients

    Science.gov (United States)

    Kukla, Aleksandra; Issa, Naim; Jackson, Scott; Spong, Richard; Foster, Meredith C.; Matas, Arthur J.; Mauer, Michael S.; Eckfeldt, John H.; Ibrahim, Hassan N.

    2014-01-01

    Background The glomerular filtration rate (GFR) estimating equation incorporating both cystatin C and creatinine perform better than those using creatinine or cystatin C alone in patients with reduced GFR. Whether this equation performs well in kidney transplant recipients cross-sectionally, and more importantly, over time has not been addressed. Methods We analyzed four GFR estimating equations in participants of the Angiotensin II Blockade for Chronic Allograft Nephropathy Trial (NCT 00067990): Chronic Kidney Disease Epidemiology Collaboration equations based on serum cystatin C and creatinine (eGFR (CKD-EPI-Creat+CysC)), cystatin C alone (eGFR (CKD-EPI-CysC)), creatinine alone (eGFR (CKD-EPI-Creat)) and the Modification of Diet in Renal Disease study equation (eGFR(MDRD)). Iothalamate GFR served as a standard (mGFR). Results mGFR, serum creatinine, and cystatin C shortly after transplant were 56.1 ± 17.0 mL/min/1.73 m2, 1.2 ± 0.4 mg/dL, and 1.2 ± 0.3 mg/L respectively. eGFR (CKD-EPI-Creat+CysC) was most precise (R2=0.50) but slightly more biased than eGFR (MDRD); 9.0 ± 12.7 ml/min/1.73m2 vs. 6.4 ± 15.8 ml/min/1.73m2, respectively. This improved precision was most evident in recipients with mGFR >60 ml/min/1.73m2. For relative accuracy, eGFR (MDRD) and eGFR (CKD-EPI-Creat+CysC) had the highest percentage of estimates falling within 30% of mGFR; 75.8% and 68.9%, respectively. Longitudinally, equations incorporating cystatin C most closely paralleled the change in mGFR. Conclusion eGFR (CKD-EPI-Creat+CysC) is more precise and reflects GFR change over time reasonably well. eGFR (MDRD) had superior performance in recipients with mGFR between 30–60 ml/min/1.73m2. PMID:24457184

  8. Development of the National Kidney Transplantation Program in Uruguay.

    Science.gov (United States)

    González-Martínez, F; Orihuela, S; Alvarez, I; Dibello, N; Curi, L; Nin, M; Wimber, E; Mizraji, R; Bengochea, M; González, G; Manzo, L; Toledo, R; Silva, W; Chopitea, Á; Lopez, D; Balboa, O; Porto, D; Noboa, O

    2015-10-01

    The first kidney transplantation (KT) in Uruguay was performed in 1969. We report the rates of KT and survival of patients and grafts up to December 2014. The country has a surface of 176,215 km(2) and a population of 3,286,314 inhabitants (18.6 inhabitants per km(2)). Till December 31, 2014, 1,940 KT have been performed in Uruguay (41.8 pmp that year); 90.4% of them were from cadaveric donors (CD). Median age of recipients (R) was 44 ± 14 years; R older than 55 years increased from 0 to 27% during the period. Our pre-emptive KT program started in 2007. Optimal donors (D) decreased from 65.2% to 35.5%, and D older than 45 years old increased from 9% to 37%. Trauma as cause of death decreased from 49% to 32% and stroke as cause of death increased from 25% to 39%. Patient survival rates at 1, 5, and 8 years were 93%, 87%, and 78%, respectively for KT performed between 1980 and 1989; they were 98%, 93%, and 89%, respectively, for KT performed between 1990 and1999; they were 97%, 91%, and 90%, respectively, for KT performed between 2000 and 2010. In December 2013, there were 1098 patients pmp in renal replacement therapy, 758 pmp in dialysis, and 340 pmp (30.9%) with a functioning graft. Our national KT program is mainly based (90.6%) on cadaveric donation. Epidemiological changes in the characteristics of R and D followed the changes in aging that occurred in the general population and the dialysis population. The survival rates from patients and kidneys are similar to those reported by the European and the American registries.

  9. Living unrelated donor kidney transplantation: A fourteen-year experience

    Directory of Open Access Journals (Sweden)

    Ignjatović Ljiljana

    2010-01-01

    Full Text Available Background. In countries without a national organization for retrieval and distribution of organs of the deceased donors, problem of organ shortage is still not resolved. In order to increase the number of kidney transplantations we started with the program of living unrelated - spousal donors. The aim of this study was to compare treatment outcome and renal graft function in patients receiving the graft from spousal and those receiving ghe graft from living related donors. Method. We retrospectively identified 14 patients who received renal allograft from spousal donors between 1996 and 2009 (group I. The control group consisted of 14 patients who got graft from related donor retrieved from the database and matched than with respect to sex, age, kidney disease, immunological and viral pretransplant status, the initial method of the end stage renal disease treatment and ABO compatibility. In the follow-up period of 41 ± 38 months we recorded immunosuppressive therapy, surgical complications, episodes of acute rejection, CMV infection and graft function, assessed by serum creatinine levels at the beginning and in the end of the follow-up period. All patients had pretransplant negative cross-match. In ABO incompatible patients pretransplant isoagglutinine titer was zero. Results. The patients with a spousal donor had worse HLA matching. There were no significant differences between the groups in surgical, infective, immunological complications and graft function. Two patients from the group I returned to hemodialysis after 82 and 22 months due to serious comorbidities. Conclusion. In spite of the worse HLA matching, graft survival and function of renal grafts from spousal donors were as good as those retrieved from related donors.

  10. 42 CFR 413.202 - Organ procurement organization (OPO) cost for kidneys sent to foreign countries or transplanted...

    Science.gov (United States)

    2010-10-01

    ... kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries. 413.202... (OPO) cost for kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries. An OPO's total costs for all kidneys is reduced by the costs associated with procuring...

  11. Successful simultaneous pancreas kidney transplantation from living-related donor against positive cross-match.

    Science.gov (United States)

    Sammartino, Cinzia; Pham, Thuy; Panaro, Fabrizio; Bogetti, Diego; Jarzembowski, Tomasz; Sankary, Howard; Morelli, Nicola; Testa, Giuliano; Benedetti, Enrico

    2004-01-01

    A positive pretransplant flow cytometry cross-match (FC-XM) allows precise identification of high-risk recipients vulnerable to hyperacute or accelerated rejection after transplantation. Living donor kidney transplant recipient candidates with positive cross-match have been successfully treated with a combination of plasmapheresis (therapeutic plasma exchange, TPEX) and intravenous immunoglobulin (IVIG), achieving conversion to negative cross-match and successful transplant. We report the first successful case of simultaneous pancreas kidney transplant (SPKT) from a living donor (LD) performed against an initially positive FC-XM, converted to negative using a protocol based on TPEX and IVIG in combination with antiCD20 monoclonal antibody. This strategy of overcoming the cross-match barriers in living donation may offer a chance of successful transplantation to highly sensitized candidates for SPKT, for whom cadaveric transplant is difficult to achieve.

  12. Immune modulation and graft protection by gene therapy in kidney transplantation

    NARCIS (Netherlands)

    Sandovici, Maria; Deelman, Leo E.; de Zeeuw, Dick; van Goor, Harry; Henning, Robert H.

    2008-01-01

    Kidney transplantation represents the therapy of choice for many patients with end-stage renal disease. However, the success of renal engraftment is hindered by a number of factors, the most important of which being adverse effects of systemic immunosuppressive therapy, chronic transplant dysfunctio

  13. Sleep apnea in kidney transplant patients: Clinical correlates and comparison with pretransplant patients

    Directory of Open Access Journals (Sweden)

    Rasha Daabis

    2012-10-01

    Conclusion: SA is as highly prevalent in Tx as in WL patients. Moreover, this high prevalence in the transplant patients could be a consequence of declining renal function. In addition, we propose that sleep apnea is a new risk factor for hypertension and cardiovascular events in kidney-transplanted patients.

  14. How important is the duration of the brain death period for the outcome in kidney transplantation?

    NARCIS (Netherlands)

    Nijboer, Willemijn N.; Moers, Cyril; Leuvenink, Henri G. D.; Ploeg, Rutger J.

    2011-01-01

    P>In kidney transplantation, graft survival using grafts from donation after brain death (DBD) donors is inferior to results after living donation. However, little is known about the effect of the duration of brain death (BDdur) on outcome after transplantation. This is a retrospective Organ Procure

  15. Disseminated Rhodococcus equi infection in a kidney transplant patient without initial pulmonary involvement

    NARCIS (Netherlands)

    Rahamat-Langendoen, Janette C.; van Meurs, Matijs; Zijlstra, Jan G.; Lo-Ten-Foe, Jerome R.

    2009-01-01

    Rhodococcus equi is increasingly recognized as an opportunistic pathogen in solid organ transplant recipients. Primary pulmonary involvement is the most common finding. We report a case of a 42-year-old female kidney transplant recipient who developed multiple disseminated abscesses caused by R. equ

  16. MAIN PATHOGENETIC MECHANISMS IN URINARY TRACT INFECTIONS AND UROSEPSIS AFTER ALLOGENIC KIDNEY TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    M. Krstić

    2011-01-01

    Full Text Available This review presents recent data on urinary tract infections and urosepsis after allogeneic kidney transplantation. Urosepsis is an extremely serious complication in these patients. Differentiated approach to early etiological, pa- thogenetic diagnosis still remains a priority problem of modern transplantation, as mortality in urosepsis remains high and is at least 60%. 

  17. Donor-estimated GFR as an appropriate criterion for allocation of ECD kidneys into single or dual kidney transplantation.

    Science.gov (United States)

    Snanoudj, R; Rabant, M; Timsit, M O; Karras, A; Savoye, E; Tricot, L; Loupy, A; Hiesse, C; Zuber, J; Kreis, H; Martinez, F; Thervet, E; Méjean, A; Lebret, T; Legendre, C; Delahousse, M

    2009-11-01

    It has been suggested that dual kidney transplantation (DKT) improves outcomes for expanded criteria donor (ECD) kidneys. However, no criteria for allocation to single or dual transplantation have been assessed prospectively. The strategy of DKT remains underused and potentially eligible kidneys are frequently discarded. We prospectively compared 81 DKT and 70 single kidney transplant (SKT) receiving grafts from ECD donors aged >65 years, allocated according to donor estimated glomerular filtration rate (eGFR): DKT if eGFR between 30 and 60 mL/min, SKT if eGFR greater than 60 mL/min. Patient and graft survival were similar in the two groups. In the DKT group, 13/81 patients lost one of their two kidneys due to hemorrhage, arterial or venous thrombosis. Mean eGFR at month 12 was similar in the DKT and SKT groups (47.8 mL/min and 46.4 mL/min, respectively). Simulated allocation of kidneys according to criteria based on day 0 donor parameters such as those described by Remuzzi et al., Andres et al. and UNOS, did not indicate an improvement in 12-month eGFR compared to our allocation based on donor eGFR.

  18. Pregnancy after kidney transplantation: when is the best time? = Gravidez após transplante renal: qual o momento ideal?

    Directory of Open Access Journals (Sweden)

    Gustavo Falcão Gama

    2012-10-01

    Full Text Available The authors report a case of a patient underwent kidney transplantation that went through an unplanned pregnancy, at 41 years old, as well as the implications for both mother and fetus.Os autores relatam o caso de uma paciente submetida à transplante renal que evoluiu com uma gravidez não planejada, aos 41 anos de idade, bem como suas implicações para o binômio mãe e feto.

  19. Incidence of cardiovascular events after kidney transplantation and cardiovascular risk scores: study protocol

    Directory of Open Access Journals (Sweden)

    Lorenzo-Aguiar Dolores

    2011-01-01

    Full Text Available Abstract Background Cardiovascular disease (CVD is the major cause of death after renal transplantation. Not only conventional CVD risk factors, but also transplant-specific risk factors can influence the development of CVD in kidney transplant recipients. The main objective of this study will be to determine the incidence of post-transplant CVD after renal transplantation and related factors. A secondary objective will be to examine the ability of standard cardiovascular risk scores (Framingham, Regicor, SCORE, and DORICA to predict post-transplantation cardiovascular events in renal transplant recipients, and to develop a new score for predicting the risk of CVD after kidney transplantation. Methods/Design Observational prospective cohort study of all kidney transplant recipients in the A Coruña Hospital (Spain in the period 1981-2008 (2059 transplants corresponding to 1794 patients. The variables included will be: donor and recipient characteristics, chronic kidney disease-related risk factors, pre-transplant and post-transplant cardiovascular risk factors, routine biochemistry, and immunosuppressive, antihypertensive and lipid-lowering treatment. The events studied in the follow-up will be: patient and graft survival, acute rejection episodes and cardiovascular events (myocardial infarction, invasive coronary artery therapy, cerebral vascular events, new-onset angina, congestive heart failure, rhythm disturbances and peripheral vascular disease. Four cardiovascular risk scores were calculated at the time of transplantation: the Framingham score, the European Systematic Coronary Risk Evaluation (SCORE equation, and the REGICOR (Registre Gironí del COR (Gerona Heart Registry, and DORICA (Dyslipidemia, Obesity, and Cardiovascular Risk functions. The cumulative incidence of cardiovascular events will be analyzed by competing risk survival methods. The clinical relevance of different variables will be calculated using the ARR (Absolute Risk

  20. Acute ischemic injury to the renal microvasculature in human kidney transplantation.

    NARCIS (Netherlands)

    Snoeijs, M.G.; Vink, H.; Voesten, N.; Christiaans, M.H.; Daemen, J.W.; Peppelenbosch, A.G.; Tordoir, J.H.; Peutz-Kootstra, C.J.; Buurman, W.A.; Schurink, G.W.; Heurn, L.W.E. van

    2010-01-01

    Increased understanding of the pathophysiology of ischemic acute kidney injury in renal transplantation may lead to novel therapies that improve early graft function. Therefore, we studied the renal microcirculation in ischemically injured kidneys from donors after cardiac death (DCD) and in living

  1. Kidney transplantation in a patient with absent right common iliac artery and congenital renal abnormalities

    Directory of Open Access Journals (Sweden)

    Clifton Ming Tay

    2015-01-01

    Conclusion: Kidney transplantation in such cases is safe and we recommend routine pre-operative imaging of patients known to have congenital genitourniary abnormalities. The kidney should be implanted heterotopically to the contralateral side of the vascular anomaly and care must be taken to preserve vascular supply to the lower limbs.

  2. Increasing kidney transplantation in Britain: the importance of donor cards, public opinion and medical practice.

    Science.gov (United States)

    Lewis, A; Snell, M

    1986-01-01

    The Department of Health and Social Security has recently spent over three-quarters of a million pounds advertising the merits of kidney donor cards. The advertising campaign stresses that carrying signed cards requesting the removal of kidneys and other organs after death both increases the number of kidneys available and increases the number of kidney transplants that actually take place. This paper examines the relative success of the kidney donor card campaign in Britain and the nature of the relationship between a more widespread distribution of donor cards and the frequency of kidney transplantation. This is done in two main ways: Through a review of the evidence detailing public support expressed in the media and from social surveys (including original empirical work conducted at Bath University). By an analysis of previously unpublished statistical evidence made available by the Department of Health and Social Security. The paper concludes that the battle for public sympathy towards kidney donation has largely been won and the kidney donor card campaign has been a success. However these success perhaps deflect attention away from more important issues in the transplant equation, as the link between card carrying and increased transplantation is neither direct nor simple.

  3. Strategies to increase the donor pool and access to kidney transplantation: an international perspective

    DEFF Research Database (Denmark)

    Maggiore, U.; Oberbauer, R.; Pascual, J.

    2015-01-01

    In this position article, DESCARTES (Developing Education Science and Care for Renal Transplantation in European States) board members describe the current strategies aimed at expanding living and deceased donor kidney pools. The article focuses on the recent progress in desensitization and kidney...

  4. Outcomes of combined liver-kidney transplantation in children: analysis of the scientific registry of transplant recipients.

    Science.gov (United States)

    Calinescu, A M; Wildhaber, B E; Poncet, A; Toso, C; McLin, V A

    2014-12-01

    Combined liver-kidney transplantation (CLKT) in children is uncommon and outcomes have not been well defined. Using the Scientific Registry of Transplant Recipients, data were analyzed on 152 primary pediatric CLKTs performed from October 1987 to February 2011, to determine their outcome in the largest series reported to date. Patient survival was 86.8%, 82.1% and 78.9% at 1, 5 and 10 years, liver graft survival was 81.9%, 76.5% and 72.6%, and kidney graft survival was 83.4%, 76.5% and 66.8%. By way of comparison, the Registry was queried for pediatric patient survival following isolated liver transplantation (LT) during the same time frame: 86.7%, 81.2% and 77.4% and following isolated kidney transplant (KT): 98.2%, 95.4% and 90% at 1, 5 and 10 years. In patients having undergone CLKT, primary hyperoxaluria was associated with reduced patient (p = 0.01), liver graft (p = 0.01) and kidney graft survival (p = 0.01). Furthermore, graft outcome following CLKT improved over the past decade (p = 0.04 for liver, p = 0.02 for kidney), but this did not translate into improved patient outcome (p = 0.2). All in all, our results confirmed that survival following LT was less than following KT, and that CLKT offered similar patient survival to isolated LT.

  5. Impact of simultaneous pancreas-kidney transplantation: patients’ perspectives

    Science.gov (United States)

    Isla Pera, P; Moncho Vasallo, J; Guasch Andreu, O; Ricart Brulles, MJ; Torras Rabasa, A

    2012-01-01

    Background: Few qualitative studies of simultaneous pancreas-kidney transplantation (SPK Tx) have been published. The aims of this study were to explore from the perspective of patients, the experience of living with diabetes mellitus type 1 (T1DM), suffering from complications, and undergoing SPK Tx with good outcome; and to determine the impact of SPK Tx on patients and their social and cultural environment. Methods: We performed a focused ethnographic study. Twenty patients were interviewed. Data were analyzed using content analysis and constant comparison following the method proposed by Miles and Huberman. Results: A functioning SPK Tx allowed renal replacement therapy and insulin to be discontinued. To describe their new situation, patients used words and phrases such as “miracle”, “being reborn” or “coming back to life”. Although the complications of T1DM, its surgery and treatment, and associated psychological problems did not disappear after SPK Tx, these were minimized when compared with the pretransplantation situation. Conclusion: For patients, SPK Tx represents a recovery of their health and autonomy despite remaining problems associated with the complications of T1DM and SPK Tx. The understanding of patients’ existential framework and their experience of disease are key factors for planning new intervention and improvement strategies. PMID:22936846

  6. Growth, chronic kidney disease and pediatric kidney transplantation: is it useful to use recombinant growth hormone in Colombian children with renal transplant?

    Science.gov (United States)

    Castañeda, D A; López, L F; Ovalle, D F; Buitrago, J; Rodríguez, D; Lozano, E

    2011-11-01

    Kidney transplantation has become the best treatment for children with chronic kidney disease (CKD). In recent times, knowledge concerning the effect of CKD and kidney transplantation over the normal growth rate has increased; now it is known that 40% of children with CKD do not reach the expected height for age. Growth retardation has been associated with the type of nephropathy, metabolic and endocrine disorders that are secondary to kidney disease, immunosuppressive therapy with glucocorticoids, and suboptimal function of renal allograft. Nowadays, we know better the role of the growth hormone/insulin-like growth factor 1 axis in growth retardation we can see it in children with CKD or recipients of renal allograft. Several studies have shown that administration of recombinant growth hormone (rhGH) has a positive effect on the longitudinal growth of children and teenagers who have received a kidney transplant. On the other hand, there have been reported side effects associated with using rhGH; however, these are not statistically significant. In this article, we show a small review about growth in children with CKD and/or recipients of renal allografts the growth pattern of three children who were known by the Transplant Group of National University of Colombia, and the results obtained with the use of rhGH in one of these cases. We want to show the possibility of achieving a secure use of rhGH in children with CKD and its use as a therapeutic option for treating the growth retardation in children with kidney transplantation, and set out the need of typifying the growth pattern of Colombian children with CKD and/or who are recipients of renal allografts through multicenter studies to propose and analyze the inclusion of rhGH in the therapeutic scheme of Colombian children with these two medical conditions. rhGH could be a useful tool for treating children with CKD or kidney transplantation who have not reached the expected longitudinal growth for age. However

  7. Contrast-induced acute kidney injury in kidney transplant recipients: A systematic review and meta-analysis

    Science.gov (United States)

    Cheungpasitporn, Wisit; Thongprayoon, Charat; Mao, Michael A; Mao, Shennen A; D'Costa, Matthew R; Kittanamongkolchai, Wonngarm; Kashani, Kianoush B

    2017-01-01

    AIM To evaluate the incidence of contrast-induced acute kidney injury (CIAKI) in kidney transplant recipients. METHODS A literature search was performed using MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from the inception of the databases through July 2016. Studies assessing the incidence of CIAKI in kidney transplant recipients were included. We applied a random-effects model to estimate the incidence of CIAKI. RESULTS Six studies of 431 kidney transplant recipients were included in the analyses to assess the incidence of CIAKI in kidney transplant recipients. The estimated incidence of CIAKI and CIAKI-requiring dialysis were 9.6% (95%CI: 4.5%-16.3%) and 0.4% (95%CI: 0.0%-1.2%), respectively. A sensitivity analysis limited only to the studies that used low-osmolar or iso-osmolar contrast showed the estimated incidence of CIAKI was 8.0% (95%CI: 3.5%-14.2%). The estimated incidences of CIAKI in recipients who received contrast media with cardiac catheterization, other types of angiogram, and CT scan were 16.1% (95%CI: 6.6%-28.4%), 10.1% (95%CI: 4.2%-18.0%), and 6.1% (95%CI: 1.8%-12.4%), respectively. No graft losses were reported within 30 d post-contrast media administration. However, data on the effects of CIAKI on long-term graft function were limited. CONCLUSION The estimated incidence of CIAKI in kidney transplant recipients is 9.6%. The risk stratification should be considered based on allograft function, indication, and type of procedure.

  8. Urinary neutrophil gelatinase-associated lipocalin is a biomarker of delayed graft function after kidney transplantation

    Directory of Open Access Journals (Sweden)

    Capelli I

    2017-01-01

    Full Text Available Irene Capelli, Olga Baraldi, Giorgia Comai, Elisa Sala, Maria Cappuccilli, Chiara Donadei, Vania Cuna, Maria Laura Angelini, Gabriele Donati, Gaetano La Manna Department of Experimental Diagnostic and Specialty Medicine (DIMES, Nephrology, Dialysis and Renal Transplant Unit, St Orsola Hospital, University of Bologna, Bologna, Italy Background: Acute kidney injury occurring after kidney transplantation frequently leads to delayed graft function with detrimental long-term effects on graft survival. Neutrophil gelatinase-associated lipocalin (NGAL has been validated as a biomarker for posttransplant acute kidney injury. This observational study aimed to assess the effectiveness of urinary NGAL as a predictive marker of delayed graft function.Materials and methods: Forty-three consecutive patients who received renal transplant were included in the study. Urine samples were collected before transplant (if available and at days 1, 3, 7, 14, and 30 after transplant, and urinary NGAL levels were quantified by enzyme-linked immunosorbent assay.Results: Urinary NGAL progressively decreased after transplant in patients with both delayed and immediate graft function. However, urinary NGAL concentration remained significantly higher in the presence of delayed graft function in the first 14 days after transplant. The area under the receiver operating characteristic curve showed that the ability of urinary NGAL to predict delayed graft function was accurate at 1st and 3rd days after transplant.Conclusion: The relative decrease of urinary NGAL concentration rather than its absolute value may be relevant to predict delayed graft function after renal transplant. In particular, urinary NGAL area under the curve for 3 days seems to be a more valuable parameter of decision making in the early posttransplant period. Keywords: area under the curve, delayed graft function, immediate graft function, kidney transplant, NGAL, acute kidney injury

  9. Conversion of calcineurin inhibitors with mammalian target of rapamycin inhibitors after kidney transplant.

    Science.gov (United States)

    Nikoueinejad, Hassan; Soleimani, Alireza; Mirshafiey, Abbas; Amirzargar, Aliakbar; Sarrafnejad, Abdolfattah; Kamkar, Ideh; Einollahi, Behzad

    2013-02-01

    One way to overcome chronic allograft nephropathy induced by calcineurin inhibitors in immunosuppression protocols for organ transplants is to replace such inhibitors with mammalian target of rapamycin inhibitors, which are not clinically nephrotoxic because they have better renal function. If patients tolerate replacement, there could be a clear preference for mammalian target of rapamycin inhibitors as a maintenance immunosuppressant after renal transplant. This replacement could be sufficient if it were used for a certain time after calcineurin inhibitors. This review considers the conversion effects of calcineurin inhibitors with mammalian target of rapamycin inhibitors from the view point of kidney function during different periods after a kidney transplant.

  10. Exaggerated natriuresis in adult polycystic kidney disease.

    Science.gov (United States)

    Danielsen, H; Nielsen, A H; Pedersen, E B; Herlevsen, P; Kornerup, H J; Posborg, V

    1986-01-01

    Angiotensin II (AII), aldosterone (Aldo) arginine vasopressin (AVP) in plasma, serum osmolality (Sosm), and renal sodium excretion (UNaV) were studied before and after infusion of hypertonic sodium chloride solution in 20 patients with adult polycystic kidney disease (PKD) with normal or moderately reduced creatinine clearance (Ccr) and in 10 healthy control subjects. UNaV increased after sodium loading in all, significantly more in the PKD patients. AII and Aldo were normal before sodium loading and suppressed after saline in PKD patients and controls. The increase in VNaV correlated with Aldo in patients but not in controls. AVP before loading was increased in hypertensive PKD patients with reduced Ccr, but not in normotensive patients with normal Ccr. After hypertonic saline, Sosm increased to the same degree both in PKD and control subjects, but AVP increased more in those with PKD. The exaggerated natriuresis of PKD is probably not explained by a change in the activity of the renin-angiotensin-aldosterone system. The enhanced response of AVP to osmotic stimuli in PKD may be a compensatory reaction to a reduced renal tubular effect of AVP.

  11. New treatment for hepatitis C in chronic kidney disease, dialysis, and transplant.

    Science.gov (United States)

    Fabrizi, Fabrizio; Martin, Paul; Messa, Piergiorgio

    2016-05-01

    The evidence that chronic hepatitis C plays a detrimental role in survival among patients on maintenance dialysis or renal transplant recipients promotes the antiviral treatment of hepatitis C virus (HCV) among chronic kidney disease patients. Also, it seems that HCV infection is associated with an increased risk of developing chronic kidney disease in the adult general population. Interferon-based regimens have provided limited efficacy and safety among chronic kidney disease patients, whereas the advent of the new direct-acting antivirals for the treatment of hepatitis C (launched over the past 5 years) has given the opportunity to reach sustained virologic response rates of 90% for many patient groups. Unfortunately, poor information exists regarding the antiviral treatment of hepatitis C in the chronic kidney disease population. The first published data on the treatment of hepatitis C among patients with chronic kidney disease (stage 4-5) and HCV genotype 1 regard the grazoprevir (NS3/4A protease inhibitor) and elbasvir (NS5A inhibitor) combination; excellent efficacy (sustained viral response, 94.3%; 115/122) and safety have been achieved. Preliminary evidence on the combined treatment of sofosbuvir (NS5B inhibitor) and simeprevir (NS3/4A inhibitor) has given a viral response of 89%, but the size of the study group (n = 38 patients with end-stage renal disease) was small. Some phase 2 and 3 clinical trials based on other antiviral combinations (3D regimen, sofosbuvir/ledipasvir, or other sofosbuvir-containing approaches) are ongoing. Thus, the antiviral regimens based on direct-acting antivirals promise to play a pivotal role in the eradication of hepatitis C among kidney disease patients. Direct-acting antivirals are very expensive; in an era of cost containment this is a crucial point either in developed and developing countries. Adverse drug reactions resulting from concomitantly administered medications are another ongoing concern for patients undergoing

  12. Exocrine contamination impairs implantation of pancreatic islets transplanted beneath the kidney capsule.

    Science.gov (United States)

    Gray, D W; Sutton, R; McShane, P; Peters, M; Morris, P J

    1988-11-01

    The effect of exocrine contamination on islets implanted under the kidney capsule has been studied by histological examination of pure or exocrine-contamination human, monkey, or rat islets transplanted to the kidney capsule of the nude rat, monkey, or rat, respectively. Exocrine contamination resulted in an appearance suggestive of impaired islet implantation, due to tissue necrosis and subsequent fibrosis. The effect of exocrine contamination was examined quantitatively in a rat islet isograft model in which handpicked DA rat islets were transplanted under the kidney capsule of normal DA rats. The islets were either pure or deliberately recontaminated with exocrine tissue (50 or 90% contamination). Four hundred pure islets were placed under one kidney capsule and 400 islets (of similar size and from the same islet preparation) were contaminated and then placed under the contralateral kidney capsule. After 2 weeks the kidneys were removed and extracted for insulin content. The insulin content of kidneys bearing islets contaminated by either 50 or 90% exocrine tissue was significantly reduced when compared to the contralateral kidney bearing pure islets. These findings support the view that exocrine contamination of islets resulted in impaired islet implantation when transplanted to a confined site such as the kidney subcapsule.

  13. Recovery of Chronic Dialysis Hypotension After Kidney Transplantation: A Case Report

    Directory of Open Access Journals (Sweden)

    Mustafa YAPRAK

    2014-01-01

    Full Text Available Chronic dialysis hypotension is described as low systolic blood pressure (<100 mmHg during interdialytic period. The presence of low predialysis systolic blood pressure, typically <110 mmHg, is signifi cantly associated with increased mortality. Kidney transplantation is the preferred model of renal replacement therapy in the treatment of end-stage renal disease (ESRD as it improves quality of life and survival. In this article, a long-term hemodialysis (HD patient with chronic hypotension improved after kidney transplantation is presented. A 39-year-old male patient received a deceased donor kidney transplant. The patient was on HD for 23 years. The patient had suffered from chronic persistent hypotension for the last 8 years. Blood pressure was 70/50 mmHg before dialysis and 60/40 mmHg after dialysis. In the post-transplant period, blood pressure was maintained above 110/70 mmHg by intermittent infusion of dopamine. Hypotension was improved after 24 days and dopamine was discontinued. Various etiologies may cause chronic hypotension in patients receiving long-term HD treatment. Kidney transplantation may improve survival and quality of life by correcting hypotension in these patients. Therefore kidney transplantation should not be avoided as renal replacement therapy in ESRD patients with hypotension.

  14. Endovascular Repair of Abdominal Aortic Aneurysms in the Presence of a Transplanted Kidney

    Energy Technology Data Exchange (ETDEWEB)

    Silverberg, Daniel, E-mail: silverberg-d@msn.com; Yalon, Tal; Halak, Moshe [The Chaim Sheba Medical Center, The Department of Vascular Surgery (Israel)

    2015-08-15

    PurposeTo present our experience performing endovascular repair of abdominal aortic aneurysms in kidney transplanted patients.MethodsA retrospective review of all patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) performed at our institution from 2007 to 2014. We identified all patients who had previously undergone a kidney transplant. Data collected included: comorbidities, preoperative imaging modalities, indication for surgery, stent graft configurations, pre- and postoperative renal function, perioperative complications, and survival rates.ResultsA total of 267 EVARs were performed. Six (2 %) had a transplanted kidney. Mean age was 74 (range, 64–82) years; five were males. Mean time from transplantation to EVAR was 7.5 (range, 2–12) years. Five underwent preoperative planning with noncontrast modalities only. Devices used included bifurcated (n = 3), aortouniiliac (n = 2), and tube (n = 1) stent grafts. Technical success was achieved in all patients. None experienced deterioration in renal function. Median follow-up was 39 (range, 6–51) months. Four patients were alive at the time of the study. Two patients expired during the period of follow-up from unrelated causes.ConclusionsEVAR is an effective modality for the management of AAAs in the coexistence of a transplanted kidney. It can be performed with minimal morbidity and mortality without harming the transplanted kidney. Special consideration should be given to device configuration to minimize damage to the renal graft.

  15. Collectin Liver 1 and Collectin Kidney 1 of the Lectin Complement Pathway Are Associated With Mortality After Kidney Transplantation

    DEFF Research Database (Denmark)

    Smedbråten, J; Sagedal, S; Åsberg, A;

    2017-01-01

    Kidney transplanted patients still have significantly higher mortality compared with the general population. The innate immune system may play an important role during periods, with suppression of the adaptive immune system. In the present study, two soluble pattern recognition molecules of the i...

  16. Acute myeloid leukemia after kidney transplantation: a case report and literature review

    Directory of Open Access Journals (Sweden)

    Francesca Cardarelli

    Full Text Available Abstract The incidence of malignancy is greater in kidney transplant recipients compared to the general population, though the higher risk is not equally distributed to all types of cancers. In face of the increased longevity of renal transplant recipients, certain cancers, such as acute leukemias, are becoming more prevalent. Acute myeloid leukemia (AML typically presents with cytopenias and infections, both common findings after kidney transplantation. Therefore, the diagnosis of AML may be initially overlooked in these patients. We report the case of a 33-year-old man who presented with fever, pancytopenia and acute worsening of his renal allograft function 9 years after a living unrelated kidney transplant. After initial negative infectious work-up, a kidney biopsy revealed C4d-positive antibody-mediated rejection in combination with scattered atypical inflammatory cells. A subsequent bone marrow biopsy confirmed AML. He underwent successful induction chemotherapy with daunorubucin and cytarabine and ultimately achieved a complete remission. However, he developed a Page kidney with worsening renal function and abdominal pain three weeks after biopsy in the setting of chemotherapy-induced thrombocytopenia. Herein, we discuss the prevalence, risk factors, presentation and management of leukemia after kidney transplantation.

  17. Kidney transplantation process in Brazil represented in business process modeling notation.

    Science.gov (United States)

    Peres Penteado, A; Molina Cohrs, F; Diniz Hummel, A; Erbs, J; Maciel, R F; Feijó Ortolani, C L; de Aguiar Roza, B; Torres Pisa, I

    2015-05-01

    Kidney transplantation is considered to be the best treatment for people with chronic kidney failure, because it improves the patients' quality of life and increases their length of survival compared with patients undergoing dialysis. The kidney transplantation process in Brazil is defined through laws, decrees, ordinances, and resolutions, but there is no visual representation of this process. The aim of this study was to analyze official documents to construct a representation of the kidney transplantation process in Brazil with the use of business process modeling notation (BPMN). The methodology for this study was based on an exploratory observational study, document analysis, and construction of process diagrams with the use of BPMN. Two rounds of validations by specialists were conducted. The result includes the kidney transplantation process in Brazil representation with the use of BPMN. We analyzed 2 digital documents that resulted in 2 processes with 45 total of activities and events, 6 organizations involved, and 6 different stages of the process. The constructed representation makes it easier to understand the rules for the business of kidney transplantation and can be used by the health care professionals involved in the various activities within this process. Construction of a representation with language appropriate for the Brazilian lay public is underway.

  18. The relation between serum testosterone levels and cardiovascular risk factors in patients with kidney transplantation

    Directory of Open Access Journals (Sweden)

    Hulya Colak

    2014-01-01

    Full Text Available The objective of the study is to evaluate the relationship between serum testos-terone levels and cardiovascular risk factors (CVRF in patients after kidney transplantation and with chronic kidney disease (CKD. Seventy-five male patients, aged between 18 and 68 years, who had kidney transplantation at least six months earlier, were enrolled into the study. Only renal transplant recipients and CKD patients with a creatinine level of 0.05. Serum testosterone levels were independent risk factors affecting IVC collapse index, systolic BP and LA. m-TORi and CNIs drugs might have no negative effect on serum testosterone levels, and improvement of the serum testosterone levels after transplantation might have a positive contribution on cardiac risk factors.

  19. [Organization and results of cadaver kidney transplantation from 1969 to 1973 (author's transl)].

    Science.gov (United States)

    Crosnier, J

    1975-01-01

    France transplant was founded in order to organize rationally the cadaver kidneys transport and transplantation with is omogenous compatibility tests. 2143 hemodialysis patients have been presently (1-9-72) treated in 82 dialysis center in France; 964 of them are in the France Transplant waiting list. According with recent laws, nervous function cessation is synonimous of death. That made possible, by good resuscitation techniques, to maintain a good level of circulation and oxigenation of organs. Family permit is required for this purpose. 17 medical transporttion staffs are at work in 12 France towns and cooperate with 12 typing laboratoires working with the same techniques and reagents. One permanent secretariat in Paris is always telex connected with all staffs and mantains a continuous up to date patients waiting list. 415 cadaver kidneys were transplanted, 255 in the same town and 160 trabsported from a town another. A significative rise in cold ischemia times happened recently because of the increasing number of transported kidneys.

  20. Erythropoietin-mediated protection in kidney transplantation : Nonerythropoietic EPO derivatives improve function without increasing risk of cardiovascular events

    NARCIS (Netherlands)

    van Rijt, Willem G; van Goor, Harry; Ploeg, Rutger J; Leuvenink, Henri G D

    2014-01-01

    The protective, nonerythropoietic effects of erythropoietin (EPO) have become evident in preclinical models in renal ischaemia/reperfusion injury and kidney transplantation. However, four recently published clinical trials using high-dose EPO treatment following renal transplantation did not reveal

  1. Living-Donor Kidney Transplantation: Reducing Financial Barriers to Live Kidney Donation--Recommendations from a Consensus Conference.

    Science.gov (United States)

    Tushla, Lara; Rudow, Dianne LaPointe; Milton, Jennifer; Rodrigue, James R; Schold, Jesse D; Hays, Rebecca

    2015-09-01

    Live-donor kidney transplantation (LDKT) is the best treatment for eligible people with late-stage kidney disease. Despite this, living kidney donation rates have declined in the United States in recent years. A potential source of this decline is the financial impact on potential and actual living kidney donors (LKDs). Recent evidence indicates that the economic climate may be associated with the decline in LDKT and that there are nontrivial financial ramifications for some LKDs. In June 2014, the American Society of Transplantation's Live Donor Community of Practice convened a Consensus Conference on Best Practices in Live Kidney Donation. The conference included transplant professionals, patients, and other key stakeholders (with the financial support of 10 other organizations) and sought to identify best practices, knowledge gaps, and opportunities pertaining to living kidney donation. This workgroup was tasked with exploring systemic and financial barriers to living kidney donation. The workgroup reviewed literature that assessed the financial effect of living kidney donation, analyzed employment and insurance factors, discussed international models for addressing direct and indirect costs faced by LKDs, and summarized current available resources. The workgroup developed the following series of recommendations to reduce financial and systemic barriers and achieve financial neutrality for LKDs: (1) allocate resources for standardized reimbursement of LKDs' lost wages and incidental costs; (2) pass legislation to offer employment and insurability protections to LKDs; (3) create an LKD financial toolkit to provide standardized, vetted education to donors and providers about options to maximize donor coverage and minimize financial effect within the current climate; and (4) promote further research to identify systemic barriers to living donation and LDKT to ensure the creation of mitigation strategies.

  2. Combined Bone Marrow and Kidney Transplantation for the Induction of Specific Tolerance

    Directory of Open Access Journals (Sweden)

    Yi-Bin Chen

    2016-01-01

    Full Text Available The induction of specific tolerance, in order to avoid the detrimental effects of lifelong systemic immunosuppressive therapy after organ transplantation, has been considered the “Holy Grail” of transplantation. Experimentally, tolerance has been achieved through clonal deletion, through costimulatory blockade, through the induction or infusion of regulatory T-cells, and through the establishment of hematopoietic chimerism following donor bone marrow transplantation. The focus of this review is how tolerance has been achieved following combined bone marrow and kidney transplantation. Preclinical models of combined bone marrow and kidney transplantation have shown that tolerance can be achieved through either transient or sustained hematopoietic chimerism. Combined transplants for patients with multiple myeloma have shown that organ tolerance and prolonged disease remissions can be accomplished with such an approach. Similarly, multiple clinical strategies for achieving tolerance in patients without an underlying malignancy have been described, in the context of either transient or durable mixed chimerism or sustained full donor hematopoiesis. To expand the chimerism approach to deceased donor transplants, a delayed tolerance approach, which will involve organ transplantation with conventional immunosuppression followed months later by bone marrow transplantation, has been successful in a primate model. As combined bone marrow and organ transplantation become safer and increasingly successful, the achievement of specific tolerance may become more widely applicable.

  3. Maintenance immunosuppression with mycophenolate mofetil and corticosteroids in pediatric kidney transplantation: temporary benefit but not without risk.

    NARCIS (Netherlands)

    Cransberg, K.; Cornelissen, M.; Lilien, M.; Hoeck, K. van; Davin, J.C.; Nauta, J.

    2007-01-01

    BACKGROUND: Aiming at reducing cyclosporine toxicity, we investigated safety and efficacy of mycophenolate mofetil (MMF) as an immunosuppressive drug in pediatric kidney transplantation compared with cyclosporine (CsA), both in combination with corticosteroids. METHODS: One year after kidney transpl

  4. The Impact of Chronic Obstructive Pulmonary Disease and Smoking on Mortality and Kidney Transplantation in End-Stage Kidney Disease.

    LENUS (Irish Health Repository)

    Kent, Brian D

    2012-09-07

    Background: Chronic obstructive pulmonary disease (COPD) and tobacco use are leading causes of morbidity and mortality. The prevalence and clinical impact of COPD on mortality and kidney transplantation among patients who begin dialysis therapy is unclear. Methods: We explored the clinical impact of COPD and continued tobacco use on overall mortality and kidney transplantation in a national cohort study of US dialysis patients. National data on all dialysis patients (n = 769,984), incident between May 1995 and December 2004 and followed until October 31, 2006, were analyzed from the United States Renal Data System. Prevalence and period trends were determined while multivariable Cox regression evaluated relative hazard ratios (RR) for death and kidney transplantation. Results: The prevalence of COPD was 7.5% overall and increased from 6.7 to 8.1% from 1995-2004. COPD correlated significantly with older age, cardiovascular conditions, cancer, malnutrition, poor functional status, and tobacco use. Adjusted mortality risks were significantly higher for patients with COPD (RR = 1.20, 95% CI 1.18-1.21), especially among current smokers (RR = 1.28, 95% CI 1.25-1.32), and varied inversely with advancing age. In contrast, the adjusted risks of kidney transplantation were significantly lower for patients with COPD (RR = 0.47, 95% CI 0.41-0.54, for smokers and RR = 0.54, 95% CI 0.50-0.58, for non-smokers) than without COPD [RR = 0.72, 95% CI 0.70-0.75, for smokers and RR = 1.00 for non-smokers (referent category)]. Conclusions: Patients with COPD who begin dialysis therapy in the US experience higher mortality and lower rates of kidney transplantation, outcomes that are far worse among current smokers.

  5. Improvement in kidney transplantation in the Balkans after the Istanbul Declaration: where do we stand today?

    Science.gov (United States)

    Spasovski, Goce; Busic, Mirela; Delmonico, Francis

    2016-02-01

    Due to the limited access to kidney transplantation (KTx) in developing countries, desperate patients have engaged in the purchase and sale of kidneys. In 2004, the World Health Assembly urged member states to protect the poor and vulnerable from being exploited through practices of illegal organ trafficking that had become widespread throughout the world. In 2008, the international transplant community convened a summit of transplant professionals, legal experts and ethicists to combat organ trafficking, transplant tourism and transplant commercialism that resulted in the Declaration of Istanbul (DOI). The South-Eastern Europe Health Network (SEEHN) represents a nine country multigovernmental collaboration on health systems. The Regional Health Development Centre on Organ Donation and Transplant Medicine (RHDC) was established in 2011 in Croatia to facilitate cooperation among south-eastern European countries to improve organ transplantation within the Balkan region. Since 2011, a collaboration between the RHDC, the Custodian Group of the DOI (DICG) and SEEHN professionals has enhanced strategic planning and definition of country-specific action plan priorities on organ donation and transplantation. Data of kidney transplantation provided in this report show a significant increase in transplantation activities in a 4-year period in Macedonia, Moldova, Bosnia and Hercegovina, Romania and Montenegro. The success of the donation and transplantation programmes was influenced by the engagement of key professionals and the establishment of organizational infrastructure with the implementation of an appropriate funding model. In conclusion, the DOI has provided an ethical framework for engagement of health professionals from south-eastern European countries. The newly established SEEHN RHDC as a technical coordinating body greatly contributed in building institutional capacity and strengthening regional collaboration between health authorities and professionals within

  6. Impact of very early high doses of recombinant erythropoietin on anemia and allograft function in de novo kidney-transplant patients.

    Science.gov (United States)

    Kamar, Nassim; Reboux, Anne-Hélène; Cointault, Olivier; Esposito, Laure; Cardeau-Desangles, Isabelle; Lavayssière, Laurence; Guitard, Joëlle; Wéclawiak, Hugo; Rostaing, Lionel

    2010-03-01

    After kidney transplantation, occurrence of anemia in the early post-transplant period (50 years, being a recipient aged >50 years, not treated for hypertension at pretransplant, and no post-transplant ESA therapy. High doses of ESA within the first month of kidney transplantation have no impact on anemia or renal function by 1 month post-transplant.

  7. Pre-transplant dialysis modality does not influence short- or long-term outcome in kidney transplant recipients: analysis of paired kidneys from the same deceased donor.

    Science.gov (United States)

    Dipalma, Teresa; Fernández-Ruiz, Mario; Praga, Manuel; Polanco, Natalia; González, Esther; Gutiérrez-Solis, Elena; Gutiérrez, Eduardo; Andrés, Amado

    2016-09-01

    Previous studies have reported contradictory results regarding the effect of pre-transplant dialysis modality on the outcomes after kidney transplantation (KT). To minimize the confounding effect of donor-related variables, we performed a donor-matched retrospective comparison of 160 patients that received only one modality of pre-transplant dialysis (peritoneal dialysis [PD] and hemodialysis [HD] in 80 patients each) and that subsequently underwent KT at our center between January 1990 and December 2007. Cox regression models were used to evaluate the association between pre-transplant dialysis modality and primary study outcomes (death-censored graft survival and patient survival). To control for imbalances in recipient-related baseline characteristics, we performed additional adjustments for the propensity score (PS) for receiving pre-transplant PD (versus HD). There were no significant differences according to pre-transplant dialysis modality in death-censored graft survival (PS-adjusted hazard ratio [aHR]: 0.65; 95% confidence interval [95% CI]: 0.25-1.68) or patient survival (aHR: 0.58; 95% CI: 0.13-2.68). There were no differences in 10-year graft function or in the incidence of post-transplant complications either, except for a higher risk of lymphocele in patients undergoing PD (odds ratio: 4.31; 95% CI: 1.15-16.21). In conclusion, pre-transplant dialysis modality in KT recipients does not impact short- or long-term graft outcomes or patient survival.

  8. Sarcoidosis in native and transplanted kidneys: incidence, pathologic findings, and clinical course.

    Directory of Open Access Journals (Sweden)

    Serena M Bagnasco

    Full Text Available Renal involvement by sarcoidosis in native and transplanted kidneys classically presents as non caseating granulomatous interstitial nephritis. However, the incidence of sarcoidosis in native and transplant kidney biopsies, its frequency as a cause of end stage renal disease and its recurrence in renal allograft are not well defined, which prompted this study. The electronic medical records and the pathology findings in native and transplant kidney biopsies reviewed at the Johns Hopkins Hospital from 1/1/2000 to 6/30/2011 were searched. A total of 51 patients with a diagnosis of sarcoidosis and renal abnormalities requiring a native kidney biopsy were identified. Granulomatous interstitial nephritis, consistent with renal sarcoidosis was identified in kidney biopsies from 19 of these subjects (37%. This is equivalent to a frequency of 0.18% of this diagnosis in a total of 10,023 biopsies from native kidney reviewed at our institution. Follow-up information was available in 10 patients with biopsy-proven renal sarcoidosis: 6 responded to treatment with prednisone, one progressed to end stage renal disease. Renal sarcoidosis was the primary cause of end stage renal disease in only 2 out of 2,331 transplants performed. Only one biopsy-proven recurrence of sarcoidosis granulomatous interstitial nephritis was identified.Renal involvement by sarcoidosis in the form of granulomatous interstitial nephritis was a rare finding in biopsies from native kidneys reviewed at our center, and was found to be a rare cause of end stage renal disease. However, our observations indicate that recurrence of sarcoid granulomatous inflammation may occur in the transplanted kidney of patients with sarcoidosis as the original kidney disease.

  9. The Realities of Living With a Transplanted Kidney: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Valizadeh Zare

    2015-07-01

    Full Text Available Background The life with a transplanted organ is different from that before transplantation and is associated with unknown factors. Understanding and acceptance of real experiences as well as training and planning to manage them can reduce stress and anxiety. Because there is no study about it, this study was conducted to explore experiences of these patients. Objectives The purpose of this study was to explore realities about living with a transplanted kidney. Patients and Methods In this qualitative study, 10 patients with transplanted kidney were selected by purposive sampling from a list of transplant recipients in two referral and specialized hospitals in Mashhad and Ahvaz cities, Iran, in 2014. Data were collected through semi-structured interviews and field note, which were analyzed according to content analysis method. Results four main categories with 10 subcategories emerged as follows: perception of conditional life (health dependence on the maintenance of the transplanted kidney and continuation of life dependence on the consumption of medications, persistence of problems (necessity of medicine consumption, necessity to follow a dietary regime, transplant rejection, constant stress, necessity to be followed up for treatment, and marriage-related issues, being different (being different from before transplantation and from others, and change in attitude towards life (transplantation as a rebirth and feeling of relief. Conclusions The results showed that although transplantation can make a positive change in the lives of patients with chronic kidney disease, it leads to emergence of factors that if understood and correctly addressed, can lead to a realistic look at the new treatment.

  10. The tacrolimus metabolism rate influences renal function after kidney transplantation.

    Directory of Open Access Journals (Sweden)

    Gerold Thölking

    Full Text Available The effective calcineurin inhibitor (CNI tacrolimus (Tac is an integral part of the standard immunosuppressive regimen after renal transplantation (RTx. However, as a potent CNI it has nephrotoxic potential leading to impaired renal function in some cases. Therefore, it is of high clinical impact to identify factors which can predict who is endangered to develop CNI toxicity. We hypothesized that the Tac metabolism rate expressed as the blood concentration normalized by the dose (C/D ratio is such a simple predictor. Therefore, we analyzed the impact of the C/D ratio on kidney function after RTx. Renal function was analyzed 1, 2, 3, 6, 12 and 24 months after RTx in 248 patients with an immunosuppressive regimen including basiliximab, tacrolimus, mycophenolate mofetil and prednisolone. According to keep the approach simple, patients were split into three C/D groups: fast, intermediate and slow metabolizers. Notably, compared with slow metabolizers fast metabolizers of Tac showed significantly lower estimated glomerular filtration rate (eGFR values at all the time points analyzed. Moreover, fast metabolizers underwent more indication renal biopsies (p = 0.006 which revealed a higher incidence of CNI nephrotoxicity (p = 0.015 and BK nephropathy (p = 0.024 in this group. We herein identified the C/D ratio as an easy calculable risk factor for the development of CNI nephrotoxicity and BK nephropathy after RTx. We propose that the simple C/D ratio should be taken into account early in patient's risk management strategies.

  11. Interventional radiology procedures in adult patients who underwent liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Roberto Miraglia; Luigi Maruzzelli; Settimo Caruso; Mariapina Milazzo; Gianluca Marrone; Giuseppe Mamone; Vincenzo Carollo; Salvatore Gruttadauria; Angelo Luca; Bruno Gridelli

    2009-01-01

    Interventional radiology has acquired a key role in every liver transplantation (LT) program by treating the majority of vascular and non-vascular post-transplant complications, improving graft and patient survival and avoiding, in the majority of cases, surgical revision and/or re-transplantation. The aim of this paper is to review indications, technical consideration, results achievable and potential complications of interventional radiology procedures after deceased donor LT and living related adult LT.

  12. 9. The Contribution of Animal Experiments to Kidney Transplantation

    OpenAIRE

    2016-01-01

    Haemodialysis is life-saving and curative in acute renal failure. By reversing the build-up of metabolic products normally excreted by a functioning kidney, dialysis enables the temporarily affected kidneys to heal and resume normal function. In chronic renal failure however, the burden of regular dialysis is necessary unless a healthy kidney from a donor can be grafted. Chronic Renal Failure Chronic renal failure (CRF) due to glomerulonephritis, pyelonephritis or polycystic kidney disease is...

  13. Serum Anti-Müllerian Hormone Concentration in Young Women with Chronic Kidney Disease on Hemodialysis, and After Successful Kidney Transplantation

    OpenAIRE

    Ewelina Sikora-Grabka; Marcin Adamczak; Piotr Kuczera; Magdalena Szotowska; Paweł Madej; Andrzej Wiecek

    2016-01-01

    Background/Aims: In women with chronic kidney disease (CKD) fertility abnormalities occur frequently. Anti-Müllerian hormone (AMH) inhibits excessive recruitment of primordial follicles. The aim of the study was to evaluate the serum AMH concentration in women on hemodialysis and after kidney transplantation (KTx). Methods: 46 hemodialysed women and 14 with CKD about to undergo kidney transplantation were enrolled into the study. The control group consisted of 40 healthy women. In all subject...

  14. The kidney as a reservoir for HIV-1 after renal transplantation.

    Science.gov (United States)

    Canaud, Guillaume; Dejucq-Rainsford, Nathalie; Avettand-Fenoël, Véronique; Viard, Jean-Paul; Anglicheau, Dany; Bienaimé, Frank; Muorah, Mordi; Galmiche, Louise; Gribouval, Olivier; Noël, Laure-Helene; Satie, Anne-Pascale; Martinez, Frank; Sberro-Soussan, Rebecca; Scemla, Anne; Gubler, Marie-Claire; Friedlander, Gérard; Antignac, Corinne; Timsit, Marc-Olivier; Onetti Muda, Andrea; Terzi, Fabiola; Rouzioux, Christine; Legendre, Christophe

    2014-02-01

    Since the recent publication of data showing favorable outcomes for patients with HIV-1 and ESRD, kidney transplantation has become a therapeutic option in this population. However, reports have documented unexplained reduced allograft survival in these patients. We hypothesized that the unrecognized infection of the transplanted kidney by HIV-1 can compromise long-term allograft function. Using electron microscopy and molecular biology, we examined protocol renal transplant biopsies from 19 recipients with HIV-1 who did not have detectable levels of plasma HIV-1 RNA at transplantation. We found that HIV-1 infected the kidney allograft in 68% of these patients. Notably, HIV-1 infection was detected in either podocytes predominately (38% of recipients) or tubular cells only (62% of recipients). Podocyte infection associated with podocyte apoptosis and loss of differentiation markers as well as a faster decline in allograft function compared with tubular cell infection. In allografts with tubular cell infection, epithelial cells of the proximal convoluted tubules frequently contained abnormal mitochondria, and both patients who developed features of subclinical acute cellular rejection had allografts with tubular cell infection. Finally, we provide a novel noninvasive test for determining HIV-1 infection of the kidney allograft by measuring HIV-1 DNA and RNA levels in patients' urine. In conclusion, HIV-1 can infect kidney allografts after transplantation despite undetectable viremia, and this infection might influence graft outcome.

  15. The Kidney as a Reservoir for HIV-1 after Renal Transplantation

    Science.gov (United States)

    Dejucq-Rainsford, Nathalie; Avettand-Fenoël, Véronique; Viard, Jean-Paul; Anglicheau, Dany; Bienaimé, Frank; Muorah, Mordi; Galmiche, Louise; Gribouval, Olivier; Noël, Laure-Helene; Satie, Anne-Pascale; Martinez, Frank; Sberro-Soussan, Rebecca; Scemla, Anne; Gubler, Marie-Claire; Friedlander, Gérard; Antignac, Corinne; Timsit, Marc-Olivier; Onetti Muda, Andrea; Terzi, Fabiola; Rouzioux, Christine; Legendre, Christophe

    2014-01-01

    Since the recent publication of data showing favorable outcomes for patients with HIV-1 and ESRD, kidney transplantation has become a therapeutic option in this population. However, reports have documented unexplained reduced allograft survival in these patients. We hypothesized that the unrecognized infection of the transplanted kidney by HIV-1 can compromise long-term allograft function. Using electron microscopy and molecular biology, we examined protocol renal transplant biopsies from 19 recipients with HIV-1 who did not have detectable levels of plasma HIV-1 RNA at transplantation. We found that HIV-1 infected the kidney allograft in 68% of these patients. Notably, HIV-1 infection was detected in either podocytes predominately (38% of recipients) or tubular cells only (62% of recipients). Podocyte infection associated with podocyte apoptosis and loss of differentiation markers as well as a faster decline in allograft function compared with tubular cell infection. In allografts with tubular cell infection, epithelial cells of the proximal convoluted tubules frequently contained abnormal mitochondria, and both patients who developed features of subclinical acute cellular rejection had allografts with tubular cell infection. Finally, we provide a novel noninvasive test for determining HIV-1 infection of the kidney allograft by measuring HIV-1 DNA and RNA levels in patients’ urine. In conclusion, HIV-1 can infect kidney allografts after transplantation despite undetectable viremia, and this infection might influence graft outcome. PMID:24309185

  16. Sodium nitrite protects against kidney injury induced by brain death and improves post-transplant function.

    Science.gov (United States)

    Kelpke, Stacey S; Chen, Bo; Bradley, Kelley M; Teng, Xinjun; Chumley, Phillip; Brandon, Angela; Yancey, Brett; Moore, Brandon; Head, Hughston; Viera, Liliana; Thompson, John A; Crossman, David K; Bray, Molly S; Eckhoff, Devin E; Agarwal, Anupam; Patel, Rakesh P

    2012-08-01

    Renal injury induced by brain death is characterized by ischemia and inflammation, and limiting it is a therapeutic goal that could improve outcomes in kidney transplantation. Brain death resulted in decreased circulating nitrite levels and increased infiltrating inflammatory cell infiltration into the kidney. Since nitrite stimulates nitric oxide signaling in ischemic tissues, we tested whether nitrite therapy was beneficial in a rat model of brain death followed by kidney transplantation. Nitrite, administered over 2 h of brain death, blunted the increased inflammation without affecting brain death-induced alterations in hemodynamics. Kidneys were transplanted after 2 h of brain death and renal function followed over 7 days. Allografts collected from nitrite-treated brain-dead rats showed significant improvement in function over the first 2 to 4 days after transplantation compared with untreated brain-dead animals. Gene microarray analysis after 2 h of brain death without or with nitrite therapy showed that the latter significantly altered the expression of about 400 genes. Ingenuity Pathway Analysis indicated that multiple signaling pathways were affected by nitrite, including those related to hypoxia, transcription, and genes related to humoral immune responses. Thus, nitrite therapy attenuates brain death-induced renal injury by regulating responses to ischemia and inflammation, ultimately leading to better post-transplant kidney function.

  17. Assessment of postoperative perfusion with contrast-enhanced ultrasonography in kidney transplantation.

    Science.gov (United States)

    Wang, Xiangzhu; Yu, Zexing; Guo, Ruijun; Yin, Hang; Hu, Xiaopeng

    2015-01-01

    The aim of this study was to use contrast-enhanced ultrasound (CEUS) to evaluate renal perfusion after kidney transplantation and investigate the clinical significance of CEUS in monitoring postoperative renal perfusion. Thirty-five patients who underwent kidney transplantations were included in this study and divided into two groups-normal and abnormal-based on their serum creatinine (SCr) levels. Conventional ultrasound and CEUS were used to monitor renal perfusion after kidney transplantation. The differences in the results between the two groups were then compared. Color doppler ultrasonography showed that there were significant differences in the resistance index (RI) and the pulsatility index (PI) of the interlobar artery between the groups. Furthermore, CEUS indicated a significant difference between the two groups regarding the slope rate of the cortical ascending curve (A1), the medullary ascending curve (A2), and the derived peak intensity (DPI1). CEUS precisely showed the characteristics of microcirculation in renal parenchyma after kidney transplantation. It also detected changes in the microcirculation, which was a new method of evaluating tissue perfusion in transplanted kidneys.

  18. Prevention of infection in adult travelers after solid organ transplantation.

    Science.gov (United States)

    Kotton, Camille Nelson; Ryan, Edward T; Fishman, Jay A

    2005-01-01

    Increasing numbers of solid organ transplant recipients are traveling to the developing world. Many of these individuals either do not seek or do not receive optimal medical care prior to travel. This review considers risks of international travel to adult solid organ transplant recipients and the use of vaccines and prophylactic agents in this population.

  19. 肾移植联合成人胰岛细胞移植治疗糖尿病肾病七例报告%Simultaneous adult islet-kidney transplantation in 7 patients of type 1 diabetes mellitus with end-stage renal failure

    Institute of Scientific and Technical Information of China (English)

    谭建明; 蔡锦全; 杨顺良; 吴卫真; 郭君其; 黄梁浒; 王庆华; 吴志贤; 陈津

    2009-01-01

    Objective To establish a new technique of isolating pancreatic islet of langerhans and glueoeortieoid-free immunosuppressive regimen and to evaluate the clinical efficacy and safety of simultaneous adult islet-kidney transplantation in the treatment of type 1 diabetes mellitus with endstage renal failure.Methods Pancreases were stored using the"2-layer method"of the oxygenated perfluoroehemieal and UW solution.The pancreases were digested by Liberase collagenase enzyme and purified using continuous gradients of Ficoll-diatrizoic acid on a refrigerated COBE 2991 centrifuge to separate the islets.Cadaver kidney was transplanted by conventional method and cultured islets were infused by surgical approach to the liver via portal vaseulature using glucocorticoid-free immunosuppressive regimen.Clinical metabolic data such as blood glucose,dose of insulin,C-peptide,HbAlc,liver function and renal function,were determined and compared with the pre-transplant data.ResuitsIslets of langerhans were isolated successfully in 23 pancreases.The average islet yield was 300000 islet equivalents(IEQ).Islet purity and viability were 91.6%,94.6%,respectively.The stimulation index as assessing function of human islet was 3.16 and etiology results in vivo were negative.Twelve islet transplant infusions were carried out in 7 patients after kidney transplantation.Three recipients received 2 islet infusions,1 patient had 3 transplants,and 3 patients received 1 transplant only.The average islet mass for infusion was 1 1 820 IEQ/kg.The immunosuppressive regimen glucocorticoid.During 18 months to 3 yearg follow-up,4 recipients had insulin independence,the dosage of insulin decreased by 70%in 3 patients.The level of blood glucose and H bAlc,liver and renal function were normal throughout follow-up period.C-peptide of all patients was positive after islet transplantation.No adverse effects and complications related to islet infusion procedure were found.Conclusions New technique has proved tO be

  20. Pharmaceutical management of hepatitis B and C in liver and kidney transplant recipients

    Institute of Scientific and Technical Information of China (English)

    Chrysoula; Pipili; Evangelos; Cholongitas

    2015-01-01

    The combination of hepatitis B immune globulin with entecavir or tenofovir(at least for a certain period of time) seems to be the most reasonable prophylaxis against recurrent hepatitis B after liver transplantation. Entecavir represents an attractive option for treatment of na?ve kidney transplant recipients, because of its high efficacy and the low rates of resistance. However antiviral treatment should be individualized in the view of kidney function and the previous resistance. To date, new captivating therapeutic strategies could make interferon-free regimens viable for treatment of hepatitis C virus positive liver transplant recipients. The recent combinations of sofosbuvir with simeprevir or daclatasvir or ledipasvir plus/minus ribavirin have boosted the on treatment and sustained virological response to rates approaching 100% within liver transplant recipients with recurrent chronic hepatitis C(CHC). Preliminary data showed that the second generation direct oral antivirals could result to high treatment rates of recurrent CHC in kidney transplant recipients as well. Ongoing studies will clarify the optimal treatment of recurrent CHC in kidney transplant recipients.

  1. Atypical Hemolytic Uremic Syndrome post Kidney Transplantation: Two Case Reports and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Sami eAlasfar

    2014-12-01

    Full Text Available Atypical hemolytic uremic syndrome (aHUS is a rare disorder characterized by over-activation and dysregulation of the alternative complement pathway. Its estimated prevalence is 1-2 per million. The disease is characterized by thrombotic microangiopathy, which causes anemia, thrombocytopenia, and acute renal failure. aHUS has more severe course compared to typical (Infection-induced HUS and is frequently characterized by relapses that leads to end stage renal disease (ESRD. For a long time, kidney transplantation for these patients was contraindicated because of high rate of recurrence and subsequent renal graft loss. The post-kidney transplantation recurrence rate largely depends on the pathogenetic mechanisms involved. However, over the past several years, advancements in the understanding and therapeutics of aHUS have allowed successful kidney transplantation in these patients. Eculizumab, which is a complement C5 antibody that inhibits complement factor 5a (C5a and subsequent formation of the membrane attack complex, has been used in prevention and treatment of post-transplant aHUS recurrence. In this paper, we present two new cases of aHUS patients who underwent successful kidney transplantation in our center with the use of prophylactic and maintenance eculizumab therapy that have not been published before. The purpose of reporting these two cases is to emphasize the importance of using eculizumab as a prophylactic therapy to prevent aHUS recurrence post transplant in high-risk patients. We will also review the current understanding of the genetics of aHUS, the pathogenesis of its recurrence after kidney transplantation, and strategies for prevention and treatment of post-transplant aHUS recurrence.

  2. De Novo Renal Cell Carcinoma in a Kidney Allograft 20 Years after Transplant

    Directory of Open Access Journals (Sweden)

    Masataka Banshodani

    2015-01-01

    Full Text Available Renal cell carcinoma (RCC in a kidney allograft is rare. We report the successful diagnosis and treatment of a de novo RCC in a nonfunctioning kidney transplant 20 years after engraftment. A 54-year-old man received a kidney transplant from his mother when he was 34 years old. After 10 years, chronic rejection resulted in graft failure, and the patient became hemodialysis-dependent. Intravenous contrast-enhanced computed tomography (CT for the evaluation of gastrointestinal symptoms revealed a solid 13 mm tumor in the kidney graft. The tumor was confirmed on ultrasound examination. This tumor had not been detected on a surveillance noncontrast CT scan. Needle biopsy showed that the tumor was an RCC. Allograft nephrectomy was performed. Pathological examination showed that the tumor was a Fuhrman Grade 2 RCC. XY-fluorescence hybridization analysis of the RCC showed that the tumor cells were of donor origin. One year after the surgery, the patient is alive and has no evidence of tumor recurrence. Regardless of whether a kidney transplant is functioning, it should periodically be imaged for RCC throughout the recipient’s lifetime. In our experience, ultrasonography or CT with intravenous contrast is better than CT without contrast for the detection of tumor in a nonfunctioning kidney transplant.

  3. Prevalence of Bacterial Urinary Tract Infections in Patients before and after of Kidney Transplantation

    Directory of Open Access Journals (Sweden)

    Esmaeili, R.

    2014-06-01

    Full Text Available Background and Objective: Urinary tract infections and bacteremia are the major problems in renal transplant patients, which are mostly due to immunesuppressive regimens, surgery, and exposure to the germs in hospital. The aim of this study was to determine the prevalence of bacterial agents in the blood and urine samples of kidney transplant candidates. Material and Methods: In this one-year-long study, thirty-three renal transplant candidates were assessed for urine and blood cultures. One urine and blood samples from each patient before transplantation and three samples after transplantation were collected. The Samples, using standard microbiological methods, were investigated and infectious organisms identified. Results: In 133 urine samples, Escherichia coli (20.5%, Enterobacter spp. (5.3%, Klebsiella spp. (3 % and Staphylococcus epidermidis (1.5% were isolated. In the blood samples, Enterobacter spp. (9.1%, Escherichia coli (6.8%, Staphylococcus epidermidis (3.8% and Klebsiella spp. (0.8% were isolated. Conclusion: The results indicate that urinary tract infection was high in patients with transplanted kidney, and E. coli is the most common cause of this infection. Keywords: Kidney Transplantation; Bacterial infections; Urinary Tract and Blood Infections; Escherichia Coli

  4. Barriers to live donor kidney transplants in the pediatric population: A single-center experience.

    Science.gov (United States)

    Taormina, Shibany P; Galloway, Matthew P; Jain, Amrish

    2017-03-01

    A decrease in live donor pediatric kidney transplants has occurred in the United States. This study investigates barriers that may influence access to live donor kidney transplants in children. Retrospective chart review was conducted for 91 children (69% male, mean age 11.9 years) who underwent pretransplant workup from 2005 to 2015 at an urban pediatric hospital. Fifty-four percent were African American, 32% Caucasian, 8% Arabic, 3% Hispanic, and 3% Others. Government-sponsored insurance (Medicaid/Medicare) was utilized by 73%, and 54% had dual caregivers. Only nine of 68 kidney transplants were live donor transplants. Live donor transplants (11%) were significantly (P=.008) lower than deceased donor transplants (59%) in African Americans. Private insurance was reported by 56% of live donor recipients and 25% of deceased donor recipients. Among live donor recipients, 78% were from dual caregiver families. Caregiver, health-related, financial, and religious/cultural barriers to live donor transplants were reported, several of which may be amenable to positive intervention.

  5. Celebrities and spiritual gurus: Comparing two biographical accounts of kidney transplantation and recovery

    Directory of Open Access Journals (Sweden)

    Rose Richards

    2015-02-01

    Full Text Available Background: As a kidney transplant recipient I have long been exposed to a shortage of renal narratives and to a dominant theme in those that exist: transplant as restitution or redemption. My lived experience has, however, shown me that post-transplant life is more complex. Even after transplantation, chronic kidney disease requires lifelong health care with varying degrees of impairment, resulting in ongoing liminality for those who experience it. Nonetheless, as atransplant recipient I find the restitution or redemptive narrative pervasive and difficult to escape.Objective: I examined two seemingly very dissimilar insider renal biographies, JanetHermans’s Perfect match: A kidney transplant reveals the ultimate second chance, and Steven Cojocaru’s Glamour, interrupted: How I became the best-dressed patient in Hollywood, to explore how the narrators treat chronic kidney disease and transplantation.Methods: In addition to a close textual reading of the biographies, I used my own experience of meaning-making to problematize concepts around restitution or redemptive narratives.Results: I found that the two biographies are, despite appearances and despite the attempts of one author to escape the redemptive form, very much the same type of narrative. The accounts end with the transplant, as is common, but the recipients’ lives continue after this, as they learn to live with their transplants, and this is not addressed.Conclusions: Emphasising restitution or redemption might prevent an understanding ofpost-transplant liminality that has unique characteristics. The narrator evading this narrative form must come to terms with a changed identity and, sometimes, fight to evade the pervasive narratives others impose.

  6. VITA-D: Cholecalciferol substitution in vitamin D deficient kidney transplant recipients: A randomized, placebo-controlled study to evaluate the post-transplant outcome

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    Thiem Ursula

    2009-05-01

    Full Text Available Abstract Background Vitamin D does not only regulate calcium homeostasis but also plays an important role as an immune modulator. It influences the immune system through the induction of immune shifts and regulatory cells resulting in immunologic tolerance. As such, vitamin D is thought to exert beneficial effects within the transplant setting, especially in kidney transplant recipients, considering the high prevalence of vitamin D deficiency in kidney transplant recipients. Methods/Design The VITA-D study, a randomized, placebo-controlled, double-blind study with two parallel groups including a total of 200 kidney transplant recipients, is designed to investigate the immunomodulatory and renoprotective effects of cholecalciferol (vitamin D3 within the transplant setting. Kidney transplant recipients found to have vitamin D deficiency defined as 25-hydroxyvitamin D3 The objective is to evaluate the influence of vitamin D3 substitution in vitamin D deficient kidney transplant recipients on the post-transplant outcome. As a primary endpoint glomerular filtration rate calculated with the MDRD formula (modification of diet in renal disease one year after kidney transplantation will be evaluated. Incidence of acute rejection episodes, and the number and severity of infections (analyzed by means of C-reactive protein within the first year after transplantation will be monitored as well. As a secondary endpoint the influence of vitamin D3 on bone mineral density within the first year post-transplant will be assessed. Three DXA analyses will be performed, one within the first four weeks post-transplant, one five months and one twelve months after kidney transplantation. Trial Registration ClinicalTrials.gov NCT00752401

  7. Successful three-way kidney paired donation transplantation: The first Indian report.

    Science.gov (United States)

    Kute, V B; Gumber, M R; Shah, P R; Patel, H V; Vanikar, A V; Modi, P R; Shah, V R; Trivedi, H L

    2014-01-01

    Providing transplantation opportunities for patients with incompatible live donors through kidney paired donation (KPD) is an important strategy for easing the crisis in organ availability. KPD is can overcome the barriers when the only living potential donors are deemed unsuitable owing to an incompatibility of blood type, of human leukocyte antigen cross-match, or both. In KPD, the incompatibility problems with two donor recipient pairs can be solved by exchanging donors. In the absence of well-organized deceased donor program, or transplantation with desensitization protocol and ABO incompatible transplantation, living donor KPD promises hope to the growing number of patients suffering from end-stage renal disease in India. We report our first successful three-way KPD transplantation from India. In an era of organ shortage, this approach is relevant to encourage wider participation from KPD donors and transplant centers to prevent commercial transplantation.

  8. Protection of the Transplant Kidney from Preservation Injury by Inhibition of Matrix Metalloproteinases.

    Directory of Open Access Journals (Sweden)

    Michael A J Moser

    Full Text Available Matrix metalloproteinases (MMPs, particularly MMP-2 and MMP-9, play an important role in ischemic injury to the heart, yet it is not known if these MMPs are involved in the injury that occurs to the transplant kidney. We therefore studied the pharmacologic protection of transplant kidneys during machine cold perfusion.Human kidney perfusates were analyzed for the presence of injury markers such as cytochrome c oxidase, lactate dehydrogenase, and neutrophil-gelatinase associated lipocalin (NGAL, and MMP-2 and MMP-9 were measured. The effects of MMP inhibitors MMP-2 siRNA and doxycycline were studied in an animal model of donation after circulatory determination of death (DCDD.Markers of injury were present in all analyzed perfusates, with higher levels seen in perfusates from human kidneys donated after controlled DCDD compared to brain death and in perfusate from kidneys with delayed graft function. When rat kidneys were perfused at 4°C for 22 hours with the addition of MMP inhibitors, this resulted in markedly reduced levels of MMP-2, MMP-9 and analyzed injury markers.Based on our study, MMPs are involved in preservation injury and the supplementation of preservation solution with MMP inhibitors is a potential novel strategy in protecting the transplant kidney from preservation injury.

  9. Non-Integrated Information and Communication Technologies in the Kidney Transplantation Process in Brazil.

    Science.gov (United States)

    Peres Penteado, Alissa; Fábio Maciel, Rafael; Erbs, João; Feijó Ortolani, Cristina Lucia; Aguiar Roza, Bartira; Torres Pisa, Ivan

    2015-01-01

    The entire kidney transplantation process in Brazil is defined through laws, decrees, ordinances, and resolutions, but there is no defined theoretical map describing this process. From this representation it's possible to perform analysis, such as the identification of bottlenecks and information and communication technologies (ICTs) that support this process. The aim of this study was to analyze and represent the kidney transplantation workflow using business process modeling notation (BPMN) and then to identify the ICTs involved in the process. This study was conducted in eight steps, including document analysis and professional evaluation. The results include the BPMN model of the kidney transplantation process in Brazil and the identification of ICTs. We discovered that there are great delays in the process due to there being many different ICTs involved, which can cause information to be poorly integrated.

  10. A systems-based approach to managing blood pressure in children following kidney transplantation.

    Science.gov (United States)

    Hooper, David K; Mitsnefes, Mark

    2016-10-01

    Hypertension is one of the most common and well-known complications following kidney transplantation in children. Yet, despite numerous available therapies many pediatric kidney transplant recipients continue to have poorly controlled blood pressure, suggesting that traditional approaches to blood pressure management in this population might be inadequate. Over the last two decades, the Chronic Care Model has been developed to improve chronic illness outcomes through delivery system design and clinical information systems that support patient self-management and provider decision-making. In this educational review we discuss key elements of managing blood pressure following pediatric kidney transplantation and suggest ways that they may be reliably implemented into clinical practice using principles from the Chronic Care Model.

  11. Chronic diarrhea due to duodenal candidiasis in a patient with a history of kidney transplantation.

    Science.gov (United States)

    Nouri-Majalan, Nader; Moghaddasi, Sarasadat; Qane, Mohammad Davud; Shefaie, Farzane; Masoumi Dehshiri, Roghayyeh; Amirbaigy, Mohammad Kassem; Baghbanian, Mahmoud

    2014-11-01

    Candida infection in the small intestine is uncommon. We report an unusual case of duodenal candidiasis that presented as chronic diarrhea in a patient who had previously undergone kidney transplantation. A 60-year-old man presented with profuse watery diarrhea that had lasted 6 months 13 years after kidney transplantation. Upper gastrointestinal endoscopy results indicated candidiasis within the esophagus and duodenum. Biopsy results revealed active duodenitis with hyphal and yeast forms of Candida overlying the duodenal epithelium in periodic acid Schiff staining. The patient was successfully treated with fluconazole. After 6 months of follow-up, the patient had no complaint of diarrhea. Duodenal candidiasis may be the result of chronic diarrhea in patients with a history of kidney transplantation.

  12. Short-and long-term outcomes of kidney transplants with kidneys lavaged by retrograde perfusion technique

    Institute of Scientific and Technical Information of China (English)

    Xiu-Wu Han; Xiao-Dong Zhang; Yong Wang; Xi-Quan Tian; Jian-Wen Wang; Bu-He Amin; Wei Yan

    2015-01-01

    Objective: To evaluate the clinical safety and efficacy of the retrograde perfusion technique in kidney transplantation.Methods: Between January 2001 and June 2011, 24 cases of kidney transplantation with kidneys perfused using the retrograde perfusion technique due to renal artery variations or injury were selected as the observation group (retrograde perfussion roup, RP group).Twenty-two cases of kidney transplantation via conventional perfusion were chosen as the control group (antegrade perfussion group, AP group).There were no statistically significant differences in donor data between the two groups.Cold ischemia time, warm ischemia time, renal perfusion time, amount of perfusion fluid, acute renal tubular necrosis, wound infection, urinary fistula, graft kidney function, and the 1-year, 3-year, and 5-year survival rates for the grafted kidney in both groups were observed and recorded.Results: The kidney perfusion time was shorter in the RP group than that in the AP group (3.14 ± 1.00 vs.5.02 ± 1.15 min, P =0.030).There were 10 cases of acute renal tubule necrosis in the RP group and 5 in the AP group.The length of hospital stay was 40 ± 14 d in the RP group and 25 ± 12 d in the AP group.The follow-up time was 3.5-8.5 years (mean 6.25 years).The 1-, 3-, and 5-year survival rates for the grafted kidney were 95.8%, 75.5%, and 65.5% in the RP group and 97.1%, 82.5%, and 68.4% in the AP group, respectively (P>0.05).Conclusions: This study indicates that retrograde perfusion is safe and practicable for cadaveric kidney harvesting and can be regarded as a better alternative or remedial measure for a poorly perfused kidney due to vascular deformity or injury.Copyright 2015, Chinese Medical Association Production.Production and hosting by Elsevier B.V.on behalf of KeAi Communications Co., Ltd.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).

  13. Vitamin D Levels After Kidney Transplantation and the Risk of Cytomegalovirus Infection

    Directory of Open Access Journals (Sweden)

    Saber

    2015-11-01

    Full Text Available Background Some studies reported an association between low levels of vitamin D and the risk of infections, especially viral infections. Kidney transplant patients are at risk of opportunistic infections; however, no study has been conducted on the association between vitamin D levels and the risk of CMV infection. Objectives The aim of this study was to compare the level of vitamin D in two groups of patients with and without CMV infection within four months after the transplantation. Moreover, we aimed to find a relation between vitamin D level, before and after transplantation in each group. Patients and Methods; This prospective cohort study was conducted in Baqiyatallah hospital in Tehran in 2013. A total of 82 kidney transplant patients were enrolled and vitamin D levels were measured in them before transplantation. The kidney transplant patients had been followed up for four months and monitored for the presence of cytomegalovirus antigen (CMV Ag in their blood. In patients with positive CMV Ag, vitamin D level was measured again when they became positive but in other patients it was measured at the end of follow-up; at the end, characteristics of patients and vitamin D levels were compared between the two groups. Results Of all, 40 patients were CMV Ag positive and 42 patients were negative. In most patients transplanted organs were taken from cadaver (66% and the most common type of dialysis was hemodialysis (92%. Most participants did not undergo antithymocyte globulin therapy (69% and pulse corticosteroid therapy (83%. Vitamin D level before transplantation was 17.2 ± 11.6 ng/mL. In patients with positive results or at the end of follow-up in patients without CMV Ag, vitamin D level was 16.3 ± 11.4 ng/mL. Only 11% of kidney transplant patients, within four months after transplantation, had a normal level of vitamin D (> 30 ng/mL. There was no significant difference between the two groups for patients’ characteristics (P > 0

  14. Primary hyperoxaluria in an adult male: A rare cause of end-stage kidney disease yet potentially fatal if misdiagnosed

    Directory of Open Access Journals (Sweden)

    Kamel El-Reshaid

    2016-01-01

    Full Text Available Primary hyperoxaluria is an autosomal recessive disorder due to a deficiency in the activity of the peroxisomal hepatic enzyme alanine-glyoxylate aminotransferase. It is a common cause of urolithiasis and end-stage kidney disease in children contrary to the adult phenotypic presentation which is considered a mild disorder with occasional urolithiasis. In this case report, we describe a 25-year-old man who presented with advanced and irreversible kidney failure within three months following strenuous physical training in the police academy. He had nephrocalcinosis and stones in one kidney. Diagnosis was confirmed by establishing the existence of extensive tubular and interstitial crystal deposition in his kidneys and molecular genetic testing. The case illustrates the need to establish an early diagnosis of this disorder to prevent the need for combined liver and kidney transplantation.

  15. Prevention and treatment of atypical haemolytic uremic syndrome after kidney transplantation.

    Science.gov (United States)

    Okumi, Masayoshi; Tanabe, Kazunari

    2016-07-01

    Atypical haemolytic uraemic syndrome is a rare disorder characterized by an over-activated, dysregulated alternative complement pathway due to genetic mutation and environmental triggers. Atypical haemolytic uraemic syndrome is a serious, life-threatening disease characterized by thrombotic microangiopathy, which causes haemolytic anaemia, thrombocytopaenia, and acute renal failure. Since recurrences of atypical haemolytic uraemic syndrome frequently lead to end-stage kidney disease even in renal allografts, kidney transplantation for patients with end-stage kidney disease secondary to atypical haemolytic uraemic syndrome has long been contraindicated. However, over the past several years, advancements in the management of atypical haemolytic uraemic syndrome have allowed successful kidney transplantation in these patients. The key factor of this success is eculizumab, a humanized anti-C5 monoclonal antibody, which inhibits terminal membrane-attack complex formation and thrombotic microangiopathy progression. In the setting of kidney transplantation, there are different possible triggers of post-transplant atypical haemolytic uraemic syndrome recurrence, such as brain-death related injury, ischaemia-reperfusion injury, infections, the use of immunosuppressive drugs, and rejection. Principal strategies are to prevent endothelial damage that could potentially activate alternative complement pathway activation and subsequently lead to atypical haemolytic uraemic syndrome recurrence in kidney allograft. Published data shows that prophylactic eculizumab therapy is highly effective for the prevention of post-transplant atypical haemolytic uraemic syndrome recurrence, and prompt treatment with eculizumab as soon as recurrence is diagnosed is important to maintain renal allograft function. Further study to determine the optimal dosing and duration of prophylactic therapy and treatment of post-transplant atypical haemolytic uraemic syndrome recurrence is needed.

  16. Differences in perceived health status between kidney transplant recipients and dialyzed patients are based mainly on the selection process

    NARCIS (Netherlands)

    Rosenberger, Jaroslav; van Dijk, Jitse P.; Prihodova, Lucia; Majernikova, Maria; Nagyova, Iveta; Geckova, Andrea Madarasova; Roland, Robert; van den Heuvel, Wim J. A.; Groothoff, Johan W.

    2010-01-01

    Kidney transplantation offers longer survival, less morbidity and lower costs than dialysis. It is also believed to improve quality of life. The aim of this study was to compare prospectively the perceived health status (PHS) of dialyzed patients on a waiting list with kidney transplant recipients a

  17. DETECTION OF CYTOMEGALOVIRUS(CMV) IMMEDIATE EARLY ANTIGEN IN KIDNEY BIOPSIES AND TRANSPLANT NEPHRECTOMIES

    Institute of Scientific and Technical Information of China (English)

    燕航; 薛武军; 田普训; 郭奇; 何晓丽

    2004-01-01

    Objective To investigate the relationship between CMV infection and renal allograft rejection. Methods 39 kidney biopsies and transplant nephrectomies were collected and investigated for CMV immediate early antigen by immunohistochemistry. Results In 14 out of 39 tissue specimens CMV immediate early antigen were found. 8 biopsies from normal donor kidneys were negative; only 1 (10%) in 10 tissue specimens with early stage acute rejection was positive; 5(55.6%) in 9 biopsies with late stage acute rejection and 8 (66.7%) in 12 tissue blocks with chronic rejection were positive. Compared with normal kidney tissues, the infections in tissues with early stage acute rejection didn't increase obviously, but increased obviously in kidney tissue specimens with late stage rejection and with chronic rejection (P<0.05). Conclusion CMV infection appears to contribute to late stage acute rejection and chronic rejection after renal transplantation.

  18. Reproduction in women with end-stage renal disease and effect of kidney transplantation.

    Science.gov (United States)

    Ghazizadeh, Shirin; Lessan-Pezeshki, Mahboob

    2007-07-01

    Menstrual problem is common among women with chronic kidney disease, and patients with end-stage renal disease usually have amenorrhea. The rate of pregnancy in women on dialysis is low. Fetal survival in this population has improved, with half of such pregnancies resulting in delivery of a live infant. However, prematurity remains common and accounts for the low-birth weight of these infants. Intensifying hemodialysis by increasing the frequency of treatments is associated with longer gestation and increased likelihood of a successful pregnancy. Intense hemodialysis also improves the control of maternal intravascular volume and reduces the risk of hypotension due to excessive ultrafiltration. Women with chronic kidney disease tend to experience decreased libido and reduced ability to reach orgasm. Sexual difficulties in uremic patients are often worsened by hemodialysis, with a lowered frequency of intercourse, reduced sexual desire, and an increased incidence of sexual failure. There have been ongoing improvements in survival and quality of life after kidney transplantation. In most patients, sexual desire increases significantly after successful transplantation; however, improvement in the frequency of sexual activity and the overall sexual satisfaction is not as high as that in sexual desire. These have been accompanied by an improvement in reproductive function. Pregnancy success rate exceeds 90% after the first trimester in women with kidney transplant. Contraceptive counseling should be provided before transplantation, because ovulatory cycles may begin within 1 to 2 months after transplantation in women with functioning grafts. Breastfeeding is discouraged for patients taking any immunosuppressive drugs.

  19. Diabetes Mellitus and Prediabetes on Kidney Transplant Waiting List- Prevalence, Metabolic Phenotyping and Risk Stratification Approach.

    Directory of Open Access Journals (Sweden)

    Martina Guthoff

    Full Text Available Despite a significant prognostic impact, little is known about disturbances in glucose metabolism among kidney transplant candidates. We assess the prevalence of diabetes mellitus (DM and prediabetes on kidney transplant waiting list, its underlying pathophysiology and propose an approach for individual risk stratification.All patients on active kidney transplant waiting list of a large European university hospital transplant center were metabolically phenotyped.Of 138 patients, 76 (55% had disturbances in glucose metabolism. 22% of patients had known DM, 3% were newly diagnosed. 30% were detected to have prediabetes. Insulin sensitivity and-secretion indices allowed for identification of underlying pathophysiology and risk factors. Age independently affected insulin secretion, resulting in a relative risk for prediabetes of 2.95 (95%CI 1.38-4.83 with a cut-off at 48 years. Body mass index independently affected insulin sensitivity as a continuous variable.The prevalence of DM or prediabetes on kidney transplant waiting list is as high as 55%, with more than one third of patients previously undiagnosed. Oral glucose tolerance test is mandatory to detect all patients at risk. Metabolic phenotyping allows for differentiation of underlying pathophysiology and provides a basis for early individual risk stratification and specific intervention to improve patient and allograft outcome.

  20. The Cost-Effectiveness of Using Payment to Increase Living Donor Kidneys for Transplantation

    Science.gov (United States)

    Barnieh, Lianne; Gill, John S.; Klarenbach, Scott

    2013-01-01

    Summary Background and objectives For eligible candidates, transplantation is considered the optimal treatment compared with dialysis for patients with ESRD. The growing number of patients with ESRD requires new strategies to increase the pool of potential donors. Design, setting, participants, & measurements Using decision analysis modeling, this study compared a strategy of paying living kidney donors to waitlisted recipients on dialysis with the current organ donation system. In the base case estimate, this study assumed that the number of donors would increase by 5% with a payment of $10,000. Quality of life estimates, resource use, and costs (2010 Canadian dollars) were based on the best available published data. Results Compared with the current organ donation system, a strategy of increasing the number of kidneys for transplantation by 5% by paying living donors $10,000 has an incremental cost-savings of $340 and a gain of 0.11 quality-adjusted life years. Increasing the number of kidneys for transplantation by 10% and 20% would translate into incremental cost-savings of $1640 and $4030 and incremental quality-adjusted life years gain of 0.21 and 0.39, respectively. Conclusion Although the impact is uncertain, this model suggests that a strategy of paying living donors to increase the number of kidneys available for transplantation could be cost-effective, even with a transplant rate increase of only 5%. Future work needs to examine the feasibility, legal policy, ethics, and public perception of a strategy to pay living donors. PMID:24158797

  1. Establishment of a Model of Combined Pancreas-Kidney Transplantation in Pig

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective To establish a model of combined pancreas-kidney transplantation in pig. Methods A renoportal end-to-end anastomoses between the left renal vein and the distal end of portal vein were performed. Only two vascular end-to-side anastomoses between the donor portal vein and recipient inferior vena cava, and between the donor aortic segment including the celiac, superior mesenteric, and left renal arteries and recipient abdominal aorta were constructed. Pancreas exocrine drainage was established with duodenocystostomy. The ureterostomosis of the graft was performed. Results Satisfactory results were obtained in 11 pigs. Conclusion The method for combined pancreas-kidney transplantation was reliable.

  2. Which genetic determinants should be considered for tacrolimus dose optimization in kidney transplantation?

    DEFF Research Database (Denmark)

    Bruckmueller, H; Werk, Anneke Nina; Renders, Lutz

    2014-01-01

    BACKGROUND:: Tacrolimus is established as immunosuppressant after kidney transplantation. Polymorphism of the cytochrome P450 3A5 (CYP3A5) gene contributes significantly to tacrolimus dose requirements. Recently, CYP3A4*22 was reported to additionally affect tacrolimus pharmacokinetics (PK). In a...... remains essential in clinical care of kidney transplant patients. Genotyping of CYP3A5 and CYP3A4, however, could facilitate rapid dose finding to adapt the appropriate immunosuppressant dose, whereas other genetic factors had only little or no effect....

  3. Medical management of the kidney transplant recipient: a practical approach for the primary care provider.

    Science.gov (United States)

    Pedraza, Fernando; Roth, David

    2014-12-01

    Kidney transplant recipients (KTRs) commonly present with complex medical issues that are best managed jointly by both their primary care physician and the kidney transplant center. Hypertension, diabetes, dyslipidemias, and obesity are frequently present in the KTR population and the successful management of these comorbidities is essential in achieving excellent posttransplant outcomes. Cardiovascular disease is the leading cause of mortality in KTRs, and interventions that mitigate the risk factors that contribute to these adverse outcomes are an important part of the long-term management of a KTR.

  4. Oncologic issues and kidney transplantation: a review of frequency, mortality, and screening.

    Science.gov (United States)

    Asch, William S; Bia, Margaret J

    2014-01-01

    Kidney transplant recipients are at increased risk for development of malignancy compared with the general population, and malignancies occur at an earlier age. This increased risk, as expressed by the standard incidence ratio (SIR), varies widely, but it is highest in malignancies triggered by oncogenic viruses. For other cancers, this increased risk is the direct consequence of immunosuppressants promoting tumor growth and lowering immune system tumor surveillance. In this review, we briefly discuss the common malignancies with increased risk after kidney transplantation, explore the pros and cons associated with screening, and summarize current prevention and treatment recommendations.

  5. Cardiac imaging for the assessment of patients being evaluated for kidney or liver transplantation.

    Science.gov (United States)

    Parikh, Kalindi; Appis, Andrew; Doukky, Rami

    2015-04-01

    Cardiac risk assessment prior to kidney and liver transplantation is controversial. Given the paucity of available organs, selecting appropriate recipients with favorable short- and long-term cardiovascular risk profile is crucial. Using noninvasive cardiac imaging tools to guide cardiovascular risk assessment and management can also be challenging and controversial. In this article, we address the burden of coronary artery disease among kidney and liver transplant candidates and review the literature pertaining to the diagnostic accuracy and the prognostic value of noninvasive cardiac imaging techniques in this population.

  6. Clinical experience with kidney transplantation in patients older than 65 years

    Institute of Scientific and Technical Information of China (English)

    YU Li-xin; LIU Xiao-you; DENG Wen-feng; YE Gui-rong; MIAO Yun; YAO Bing

    2002-01-01

    Objective:To explore the peculiarities of kidney transplantation in elderly patients and define the perioperative managements. Methods: The clinical data of kidney transplantation in 29 patients older than 65years were reviewed, the eldest being 84 years old and the mean age 68. 1 years. Results: Four episodes of acute rejection (13. 80%) were encountered. FK506 toxicity occurred in one case (3.40%) and lung infection in another (3.40%), who (along with the former 4 patients) all were cured subsequently. In one case, the kidney graft was removed for thrombogenesis of the renal artery. The 1- and 3-year patients/grafts survival of 100% and 96.5% respectively was achieved, with the longest survival exceeding 5 years. Conclusions:Old age was not the absolute contraindication for kidney transplantation. Strict observance of the indications of kidney transplantation and donor selection with well-matched tissue-typing are crucial in elderly patients.Adequate application of immunosuppressants and effective long-term follow-up are also major factors for long-term allograft survival.

  7. Combined heart and kidney transplantation: an effective therapeutic option--report of six cases.

    Science.gov (United States)

    Colucci, V; Quaini, E; Magnani, P; Colombo, T; De Carlis, L; Grassi, M; Merli, M; Pellegrini, A

    1997-10-01

    Six cases of combined heart and kidney transplantation with organs from the same donor are reported. All six patients suffered from primary end-stage kidney disease, two chronic glomerulonephritis, two glomerulosclerosis, one chronic pyelonephritis and one with unknown etiology. Four patients were undergoing hemodialysis. Three patients had the diagnosis of ischemic heart disease, one dilated cardiomyopathy secondary to congenital heart disease, two idiopathic dilated cardiomyopathy. Five were males and one female. Ages ranged from 38 to 54 years. On-site or short-distance young donors with normal renal function and good cardiac function necessitating low inotropic support were selected. ABO compatibility was used exclusively. Orthotopic heart transplantation was performed first. During cardiopulmonary bypass, hemofiltration was used in four cases. Kidney transplantation was performed immediately after the closure of the chest. Diuresis was immediate in all cases. No cardiac rejection was documented at EMB. Renal function normalized within few days with no signs of kidney rejection. All six patients are alive and well with normal cardiac and renal function at a mean follow-up of 43 months. Patients and donors selection associated with a proper surgical strategy and prompt immunosuppressive therapy administration make the combined heart and kidney transplantation an effective therapeutic option.

  8. Chronic kidney disease in an adult with propionic acidemia.

    Science.gov (United States)

    Vernon, H J; Bagnasco, S; Hamosh, A; Sperati, C J

    2014-01-01

    We report an adult male with classic propionic acidemia (PA) who developed chronic kidney disease in the third decade of his life. This diagnosis was recognized by an increasing serum creatinine and confirmed by reduced glomerular filtration on a (99m)Tc-diethylenetriamine pentaacetate (DTPA) scan. Histopathology of the kidney showed moderate glomerulo- and tubulointerstitial fibrosis with very segmental mesangial IgA deposits. This is the second reported case of kidney disease in an individual with propionic acidemia possibly indicating that chronic kidney disease may be a late-stage complication of propionic acidemia. Additionally, this is the first description of the histopathology of kidney disease in an individual with propionic acidemia. As more cases emerge, the clinical course and spectrum of renal pathology in this disorder will be better defined.

  9. Dual Kidney Allocation Score: A Novel Algorithm Utilizing Expanded Donor Criteria for the Allocation of Dual Kidneys in Adults.

    Science.gov (United States)

    Johnson, Adam P; Price, Thea P; Lieby, Benjamin; Doria, Cataldo

    2016-09-08

    BACKGROUND Dual kidney transplantation (DKT) of expanded-criteria donors is a cost-intensive procedure that aims to increase the pool of available deceased organ donors and has demonstrated equivalent outcomes to expanded-criteria single kidney transplantation (eSKT). The objective of this study was to develop an allocation score based on predicted graft survival from historical dual and single kidney donors. MATERIAL AND METHODS We analyzed United Network for Organ Sharing (UNOS) data for 1547 DKT and 26 381 eSKT performed between January 1994 and September 2013. We utilized multivariable Cox regression to identify variables independently associated with graft survival in dual and single kidney transplantations. We then derived a weighted multivariable product score from calculated hazard ratios to model the benefit of transplantation as dual kidneys. RESULTS Of 36 donor variables known at the time of listing, 13 were significantly associated with graft survival. The derived dual allocation score demonstrated good internal validity with strong correlation to improved survival in dual kidney transplants. Donors with scores less than 2.1 transplanted as dual kidneys had a worsened median survival of 594 days (24%, p-value 0.031) and donors with scores greater than 3.9 had improved median survival of 1107 days (71%, p-value 0.002). There were 17 733 eSKT (67%) and 1051 DKT (67%) with scores in between these values and no differences in survival (p-values 0.676 and 0.185). CONCLUSIONS We have derived a dual kidney allocation score (DKAS) with good internal validity. Future prospective studies will be required to demonstrate external validity, but this score may help to standardize organ allocation for dual kidney transplantation.

  10. OSAKA Trial: A Randomized, Controlled Trial Comparing Tacrolimus QD and BD in Kidney Transplantation

    Science.gov (United States)

    Albano, Laetitia; Banas, Bernhard; Klempnauer, Juergen L.; Glyda, Maciej; Viklicky, Ondrej; Kamar, Nassim

    2013-01-01

    Background The once-daily (QD), prolonged-release formulation of tacrolimus has been shown to improve adherence versus twice-daily (BD) tacrolimus. Treatment nonadherence in transplant recipients has been associated with poor graft outcomes. Methods This open-label, parallel-group study randomized adults with end-stage renal disease undergoing primary kidney transplantation or retransplantation to an initial dose of tacrolimus BD 0.2 mg/kg per day (Arm 1; n=309), QD 0.2 mg/kg per day (Arm 2; n=302), QD 0.3 mg/kg per day (Arm 3; n=304) all with mycophenolate mofetil and corticosteroids (tapered) over 24 weeks, or tacrolimus QD 0.2 mg/kg per day with mycophenolate mofetil, basiliximab, and corticosteroids given only perioperatively (Arm 4; n=283). The primary composite endpoint (efficacy failure; per protocol set) was defined as graft loss, biopsy-confirmed acute rejection, or graft dysfunction at week 24. Graft dysfunction was defined as estimated glomerular filtration rate Modification of Diet in Renal Disease-4 formula of less than 40 mL/min/1.73 m2. The prespecified noninferiority margin was 12.5%. Results The per protocol set included 976 patients: 237, 263, 246, and 230 patients in Arms 1 to 4, respectively. Noninferiority of the composite endpoint was demonstrated for Arm 2 versus Arm 1; Kaplan–Meier estimates of efficacy failure were 42.2% and 40.6%, respectively (difference, −1.6%; 95% confidence interval [CI], −12.2% to 9.0%). Noninferiority to Arm 1 was not confirmed for Arm 3 (difference, −3.5%; 95% CI, −13.6% to 6.6%) or Arm 4 (difference, −7.1%; 95% CI, −16.1% to 1.9%). Graft dysfunction (estimated glomerular filtration rate <40 mL/min/1.73 m2) was the main determinant of composite-endpoint efficacy failure across all arms. Conclusions In patients representative of the European kidney transplant population, tacrolimus QD-based immunosuppression (0.2 mg/kg/day), without induction, showed similar efficacy to 0.2 mg/kg per day tacrolimus BD

  11. [Impact of end-stage renal disease and kidney transplantation on the reproductive system].

    Science.gov (United States)

    Delesalle, A-S; Robin, G; Provôt, F; Dewailly, D; Leroy-Billiard, M; Peigné, M

    2015-01-01

    Chronic renal failure leads to many metabolic disorders affecting reproductive function. For men, hypergonadotropic hypogonadism, hyperprolactinemia, spermatic alterations, decreased libido and erectile dysfunction are described. Kidney transplantation improves sperm parameters and hormonal function within 2 years. But sperm alterations may persist with the use of immunosuppressive drugs. In women, hypothalamic-pituitary-ovarian axis dysfunction due to chronic renal failure results in menstrual irregularities, anovulation and infertility. After kidney transplantation, regular menstruations usually start 1 to 12 months after transplantation. Fertility can be restored but luteal insufficiency can persist. Moreover, 4 to 20% of women with renal transplantation suffer from premature ovarian failure syndrome. In some cases, assisted reproductive technologies can be required and imply risks of ovarian hyperstimulation syndrome and must be performed with caution. Pregnancy risks for mother, fetus and transplant are added to assisted reproductive technologies ones. Only 7 authors have described assisted reproductive technologies for patients with kidney transplantation. No cases of haemodialysis patients have been described yet. So, assisted reproductive technologies management requires a multidisciplinary approach with obstetrics, nephrology and reproductive medicine teams' agreement.

  12. Difficulties in diagnosing acute kidney injury post liver transplantation using serum creatinine based diagnostic criteria

    Institute of Scientific and Technical Information of China (English)

    Banwari; Agarwal; Andrew; Davenport

    2014-01-01

    Renal function in patients with advanced cirrhosis is an important prognostic factor for survival both prior to and following liver transplantation. The importance of renal function is reflected by the introduction of the model for end stage liver disease(MELD) score, which includes serum creatinine. The MELD score has been shown to predict the short term risk of death for transplant wait listed patients and is currently used by many countries to allocate liver transplants on the basis of severity of underlying illness. Changes in serum creatinine are also used to stage acute kidney injury. However prior to liver transplantation the serum creatinine typically over estimates underlying renal function, particularly when a colorimetric Jaffe based assay is used, and paradoxically then under estimates renal function post liver transplantation, particularly when immunophyllins are started early as part of transplant immunosuppression. As acute kidney injury is defined by changes in serum creatinine, this potentially leads to over estimation of the incidence and severity of acute kidney injury in the immediate post-operative period.

  13. Waning of vaccine-induced immunity to measles in kidney transplanted children.

    Science.gov (United States)

    Rocca, Salvatore; Santilli, Veronica; Cotugno, Nicola; Concato, Carlo; Manno, Emma Concetta; Nocentini, Giulia; Macchiarulo, Giulia; Cancrini, Caterina; Finocchi, Andrea; Guzzo, Isabella; Dello Strologo, Luca; Palma, Paolo

    2016-09-01

    Vaccine-preventable diseases are a significant cause of morbidity and mortality in solid organ transplant recipients who undergo immunosuppression after transplantation. Data on immune responses and long-term maintenance after vaccinations in such population are still limited.We cross-sectionally evaluated the maintenance of immune response to measles vaccine in kidney transplanted children on immunosuppressive therapy. Measles-specific enzyme-linked immunosorbent assay and B-cell enzyme-linked immunosorbent spot were performed in 74 kidney transplant patients (Tps) and in 23 healthy controls (HCs) previously vaccinated and tested for humoral protection against measles. The quality of measles antibody response was measured by avidity test. B-cell phenotype, investigated via flow cytometry, was further correlated to the ability of Tps to maintain protective humoral responses to measles over time.We observed the loss of vaccine-induced immunity against measles in 19% of Tps. Nonseroprotected children showed signs of impaired B-cell distribution as well as immune senescence and lower antibody avidity. We further reported as time elapsed between vaccination and transplantation, as well as the vaccine administration during dialysis are clinical factors affecting the maintenance of the immune memory response against measles.Tps present both quantitative and qualitative alterations in the maintenance of protective immunity to measles vaccine. Prospective studies are needed to optimize the vaccination schedules in kidney transplant recipients in order to increase the immunization coverage over time in this population.

  14. Racial and Ethnic Disparities in Graft and Patient Survival Among Elderly Kidney Transplant Recipients

    Science.gov (United States)

    Ilori, Titilayo O.; Adedinsewo, Demilade A.; Odewole, Oluwaseun; Enofe, Nosayaba; Ojo, Akinlolu; McClellan, William; Patzer, Rachel E.

    2015-01-01

    Background/Objectives The rise in the number of elderly kidney transplant recipients over the past decade makes it increasingly important to understand factors affecting post-transplant outcomes in this population. Our objective was to investigate the racial/ethnic differences in graft and patient survival among elderly kidney transplant recipients. Design Retrospective Cohort. Setting & Participants All first-time, kidney-only transplant recipients ≥60 years of age at transplantation in the United Network for Organ Sharing (UNOS) database, transplanted between July 1996 and October 2010, N=44,013. Measurements Time to graft failure and death obtained from the UNOS database and linkage to the Social Security Death Index. Neighborhood poverty from 2000 U.S. Census geographic data. Results Of the 44,013 recipients in the sample, 20% were African American, 63% non-Hispanic white, 11% Hispanic, 5% Asian and the rest “other racial groups”. In adjusted Cox models, we found that compared to whites, African Americans were more likely to experience graft failure (HR: 1.23, 95%CI: 1.15, 1.32), while Hispanics, (HR: 0.77, 95%CI: 0.70, 0.85) and Asians (HR: 0.70, 95%CI: 0.61, 0.81) were less likely to experience graft failure. Secondly, compared to whites, African Americans (HR: 0.84, 95%CI: 0.80, 0.88), Hispanics (HR: 0.68, 95%CI: 0.64, 0.72), and Asians (HR: 0.62, 95%CI: 0.57, 0.68) all were less likely to die after renal transplantation. Conclusion Elderly African Americans are at increased risk of graft failure compared to white transplant recipients, but survive longer after transplantation. Asians have the highest patient and graft survival followed by the Hispanics. Further studies are needed to assess additional factors affecting graft and patient survival including outcomes such as quality of life. PMID:26660200

  15. Kidney and Pancreatic Extramedullary Relapse in Adult Acute Lymphoblastic Leukemia: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Leslie Skeith

    2013-01-01

    Full Text Available Extramedullary relapse of acute lymphoblastic leukemia (ALL is rare and has been primarily reported in pediatric patients or hematopoietic stem cell transplant recipients. We report a case of a 62-year-old woman who presented with relapsed ALL involving her kidneys, pancreas, and bone marrow 2 years after completing chemotherapy with a standard ALL protocol. Unfortunately, her extramedullary disease progressed despite treatment. To the best of our knowledge, this is the first reported case of extramedullary relapse of B-cell ALL to the kidneys and pancreas occurring in an adult patient who had not previously undergone a hematopoietic stem cell transplant. A literature review of kidney and pancreatic extramedullary relapse in ALL is also included.

  16. Exploring risk factors of non-adherence to immunosuppressive medication in kidney transplant recipients : improving methodology & reorienting research goals

    OpenAIRE

    Denhaerynck, Kris

    2006-01-01

    8.1. Background and aim of the research program Non-adherence to the immunosuppressive therapy is an important issue in kidney transplant patients. About 20% of the kidney transplant patients are non-adherent to the immunosuppressive regimen. Non-adherence contributes to 20% of late acute rejection episodes and 16% of the graft losses, and results in a decreased number of quality adjusted life years. A strategy to increase long-term successful outcome after transplantation i...

  17. Effect of donor age and parent-to-child transplant on living-related donor kidney transplantation: a single center's experience of 236 cases.

    Science.gov (United States)

    Qiu, Jiang; Wang, Changxi; Liang, Xianwei; Chen, Guodong; Huang, Gang; Fu, Qian; Chen, Lizhong

    2015-07-01

    To study the impact of parent-to-child transplant and older donor age on recipients' post-transplant creatinine levels, a total of 236 patients who received living donor kidney transplantation were evaluated for kidney viability based on creatinine (Cr) level. Of the 236 pairings, 113 (48%) were parent-to-child followed by sibling transplants (66, 30%). Recipient Cr levels were significantly higher at 6 months and 3 years post-transplant in the parent-to-child transplants compared to other donor-recipient relationships. In addition, donor age (average age: 44.1 ± 11.5; range: 19-66) contributed to higher recipient post-transplant Cr levels (p parent-to-child transplant and older donor significantly increased the risk of elevated post-transplant Cr levels in recipients with an estimated odds ratios ranging from 3.46 (95% CI: 1.71-6.98) at 6 months to 8.04 (3.14-20.56) at 3 years post-transplant. Donor age significantly affected transplant survival as measured by higher recipient post-transplant Cr levels. In addition, parent-to-child transplant pairings, along with older donor age, significantly increased the risk of elevated post-transplant Cr levels in recipients.

  18. Donor selection for renal transplantation : a study on mixed lymphocyte reactions and kidney allograft survival in unimmunosuppressed dogs

    NARCIS (Netherlands)

    A.B. Bijnen (Bart)

    1978-01-01

    textabstractThe prime cause of failure of a transplanted kidney is immunological rejection of the graft. Graft rejection will not occur, when the transplanted organ is obtained from a donor which is genetically identical to the recipient (isogenic transplant). Graft rejection can always occur, when

  19. Changes in biochemical parameters on the first day after kidney transplantation: risk factors for nosocomial infection?

    Institute of Scientific and Technical Information of China (English)

    YANG Yi; REN Liang; ZHANG Yong; LIU Hang; CAO Bin; ZHANG Xiao-dong

    2010-01-01

    Background Nosocomial infection in early post-transplantation period is a tough problem for kidney transplantation. Few reports have explored the relations between biochemical parameters and nosocomial infection in kidney transplantation. This retrospective study was carried out to describe the characteristics of nosocomial infection in the very early period of kidney transplantation and to determine the risk factors in biochemical parameters and their alterations. Methods Patients who underwent their first kidney transplantation from January 2001 to March 2009 in Beijing Chao-Yang Hospital were recruited and the nosocomial infectious episodes were collected for this study. Gender, age, donor type, delayed graft function (DGF) and biochemical parameters such as serum uric acid, lipids files and albumin on day 0 (before transplantation) and day 1 (24 hours after transplantation) and their changes were analyzed with Logistic regression models for nosocomial infection. Results A total of 405 patients (315 men and 90 women) were involved in this study. There were 80 patients experiencing 113 infection episodes and 105 strains of microorganism were indentified. In univariate analysis, there were significant differences in DGF, albumin on day 0, lipoprotein (a) (Lp(a)) on day 1, change in low density lipoprotein-cholesterol (LDL-C, day 1-day 0) and change in uric acid (day 1-day 0) between nosocomial infection patients and noninfectious patients (P<0.05). In multivariate analysis, change in uric acid (day 1-day 0) (Off 5.139, 95% Cl 1.176-22.465, P<0.05), change in LDL-C (day 1-day 0) {OR4.179, 95% Cl 1.375-12.703, P<0.05) and DGF (Of? 14.409, 95% Cl 1.603-129.522, P<0.05) were identified as independent risk factors for nosocomial infection in kidney transplantation. Conclusions Most nosocomial infections in early postoperative period of kidney transplantation are bacterial, especially with Gram-negative bacteria. The most common infection sites are respiratory tract

  20. Affecting Factors of Arterial Stiffness in Living Related Kidney Transplant Recipients

    Directory of Open Access Journals (Sweden)

    Serpil Ergülü EŞMEN

    2011-05-01

    Full Text Available Arterial stiffness might be affected by several factors including recipient as well as donors. In this study, we aimed to evaluate arterial stiffness in living related kidney transplant recipients before and after transplantation. We enrolled 47 living related kidney recipients and pulse wave velocity (PWV was determined before and after transplantation. Donor renal arterial biopsy, recipient iliac artery samples were taken during the operation and PWV was also determined for the donors. Forty-seven patients completed the study. Post-transplantation follow-up duration was 18.5±5.7 months. Before transplantation, the mean PWV 8.1±1.4 m/sec and it was 7.5±2.0 m/sec after the transplantation (p=0.014. The patients were divided into two groups as with (30 patients and without (17 patients a PWV decrease. Recipient age, gender, CRP, PTH, lipids, and blood pressures were not significantly different between the groups. The recipient body mass index was higher in patients with a PWV decrease. Donor-related factors were not different between the groups. We found that blood pressure and LDL cholesterol levels in recipients were associated with a decrease in PWV after the transplantation. In conclusion, donor-related factors do not seem to have an impact on arterial stiffness in recipients. Pretransplant BMI and posttransplant blood pressure and LDL cholesterol levels were associated with a decrease in PWV.

  1. [Living donor liver transplantation in adults].

    Science.gov (United States)

    Neumann, U P; Neuhaus, P; Schmeding, M

    2010-09-01

    The worldwide shortage of adequate donor organs implies that living donor liver transplantation represents a valuable alternative to cadaveric transplantation. In addition to the complex surgical procedure the correct identification of eligible donors and recipients plays a decisive role in living donor liver transplantation. Donor safety must be of ultimate priority and overrules all other aspects involved. In contrast to the slightly receding numbers in Europe and North America, in recent years Asian programs have enjoyed constantly increasing living donor activity. The experience of the past 15 years has clearly demonstrated that technical challenges of both bile duct anastomosis and venous outflow of the graft significantly influence postoperative outcome. While short-term in-hospital morbidity remains increased compared to cadaveric transplantation, long-term survival of both graft and patient are comparable or even better than in deceased donor transplantation. Especially for patients expecting long waiting times under the MELD allocation system, living donor liver transplantation offers an excellent therapeutic alternative. Expanding the so-called "Milan criteria" for HCC patients with the option for living donor liver transplantation is currently being controversially debated.

  2. Incidence, Predictors, and Associated Outcomes of Prostatism after Kidney Transplantation

    OpenAIRE

    2009-01-01

    Background and objectives: Renal transplantation is increasingly performed in elderly patients, and the incidence of benign prostatic hyperplasia (BPH) increases with age. Anuric males on dialysis may have occult BPH and not develop obstructive symptoms until urine flow is restored after transplantation. If left untreated, BPH poses a risk for numerous complications, including acute urinary retention (AUR), recurrent urinary tract infections (UTI), and renal failure. The authors hypothesized ...

  3. Hafnia alvei Urosepsis in a Kidney Transplant Patient

    OpenAIRE

    Mario Stanic; Edgar Meusburger; Gabriele Hartmann; Karl Lhotta

    2015-01-01

    Hafnia alvei, a gram-negative facultative anaerobic, rod-shaped bacterium, is a rare cause of infection in humans. We report on a renal transplant patient who developed H. alvei pyelonephritis and urosepsis. The source of infection remains enigmatic but is most likely the intestinal tract. Appropriate antibiotic therapy with cefepime followed by oral ciprofloxacin brought about rapid resolution of symptoms and complete recovery. H. alvei may cause severe infection in transplant patients with...

  4. Creatinine and cytokines plasma levels related to HLA compatibility in kidney transplant patients

    Directory of Open Access Journals (Sweden)

    Lorraine V. Alves

    2015-10-01

    Full Text Available ABSTRACTIntroduction:The success of kidney transplantation depends on prevention of organ rejection by the recipient’s immune system, which recognizes alloantigens present in transplanted tissue. Human leukocyte antigen (HLA typing is one of the tests used in pre-renal transplantation and represents one of the most important factors for a successful procedure.Objective:The present study evaluated creatinine and cytokines plasma levels in kidney transplant patients according to pre-transplant HLA typing.Methods:We assessed 40 renal transplanted patients selected in two transplant centers in Belo Horizonte (MG.Results:Patients were distributed into three groups according to HLA compatibility and, through statistical analysis, the group with more than three matches (H3 was found to have significantly lower post-transplant creatinine levels, compared to groups with three or fewer matches (H2 and H1, respectively. The median plasma levels of cytokines interleukin 6 (IL-6, tumor necrosis factor alpha (TNF-α, and interleukin 10 (IL-10 were evaluated according to the number of matches. Pro-inflammatory cytokines (IL-6 and TNF-α were significantly higher in groups with lower HLA compatibility. On the other hand, the regulatory cytokine IL-10 had significantly higher plasma levels in the group with greater compatibility between donor and recipient.Conclusion:These findings allow us to infer that pre-transplant HLA typing of donors and recipients can influence post-transplant renal graft function and may contribute to the development and choice of new treatment strategies.

  5. Association between pre-transplant dialysis modality and patient and graft survival after kidney transplantation

    DEFF Research Database (Denmark)

    Kramer, Anneke; Jager, Kitty J; Fogarty, Damian G;

    2012-01-01

    Previous studies have found inconsistent associations between pre-transplant dialysis modality and subsequent post-transplant survival. We aimed to examine this relationship using the instrumental variable method and to compare the results with standard Cox regression.......Previous studies have found inconsistent associations between pre-transplant dialysis modality and subsequent post-transplant survival. We aimed to examine this relationship using the instrumental variable method and to compare the results with standard Cox regression....

  6. 77 FR 49447 - Endpoints for Clinical Trials in Kidney Transplantation; Public Workshop

    Science.gov (United States)

    2012-08-16

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Endpoints for Clinical Trials in Kidney Transplantation; Public Workshop AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public workshop. The Food and Drug Administration (FDA) is announcing...

  7. Calcineurin inhibitor sparing with mycophenolate in kidney transplantation: a systematic review and meta-analysis.

    LENUS (Irish Health Repository)

    Moore, Jason

    2009-02-27

    Limiting the exposure of kidney transplant recipients to calcineurin inhibitors (CNIs) has potential merit, but there is no clear consensus on the utility of current strategies. In an attempt to aid clarification, we conducted a systematic review and meta-analysis of randomized trials that assessed CNI sparing (minimization or elimination) with mycophenolate as sole adjunctive immunosuppression.

  8. [Serendipity, beneficial error, and chance in the development of kidney transplantation].

    Science.gov (United States)

    Kinnaert, P

    2011-01-01

    Serendipity played an essential role in two major developments of organ transplantation: the method of continuous hypothermic perfusion of the kidney and the introduction of ciclosporin in the clinical setting. An erroneous reasoning lead to the creation of an efficient preservation fluid: Collins's solution. However, these investigations would have failed without the open-mindedness and the tenacity of the clinicians.

  9. The Current State of Pancreas-kidney Transplantation in China: The Indications, Surgical Techniques and Outcome

    Institute of Scientific and Technical Information of China (English)

    Changsheng MING; Nianqiao GONG; Xiaoping CHEN

    2009-01-01

    ference in survival and graft function between type 1 and type 2 DM recipients was noted. It is concluded that pancreas-kidney transplantation is an effective way for the treatment of type 1 DM and some type 2 DM complicated with uremia.

  10. Treatment of urinary lithiasis following kidney transplantation with extracorporeal shock-wave lithotripsy

    Institute of Scientific and Technical Information of China (English)

    LI Sha-dan; WANG Qing-tang; CHEN Wei-guo

    2011-01-01

    Background The incidence of urinary lithiasis following kidney transplantation is very low, and decision-supporting data are not available. The aim of this study was to review the diagnosis and treatment of urinary lithiasis following kidney transplantation, which is of realistic significance to reduce urinary lithiasis following kidney transplantation, prolong the survival of renal allografts.Methods The incidence, diagnosis and treatment of urinary lithiasis in ten patients following kidney transplantation were analyzed retrospectively. Seven out of these patients had stones sized approximately 0.4-1.1 cm, and they were treated with low-voltage, low-frequency extracorporeal shock-wave lithotripsy (ESWL). Two patients had stones sized <0.3 cm and they underwent cystoscopy and ureteroscopy. The ureteral catheter endoscopes were inserted in a retrograde manner to mobilize stones repeatedly. After elimination of obstruction, a ureteral double J stent was indwelt.One patient had a pelvic stone (1.2 cm), which was removed surgically.Results The major clinical manifestations were hematuria, oliguria or anuria. Some patients were asymptomatic and they were diagnosed through laboratory tests and imaging examinations, e.g., ultrasonography. After elimination of obstruction, subjective symptoms disappeared in all patients, and the function of renal allografts recovered. A six-month follow-up indicated no remnant stones or lithiasis relapse.Conclusions The diagnosis and treatment of renal allograft lithiasis are challenging. After prompt and appropriate treatment, the prognosis was satisfactory, and permanent renal functional impairment did not occur in most patients.

  11. Mycophenolate mofetil: safety and efficacy in the prophylaxis of acute kidney transplantation rejection

    Directory of Open Access Journals (Sweden)

    Pranav Dalal

    2009-01-01

    Full Text Available Pranav Dalal1, Monica Grafals2, Darshika Chhabra2, Lorenzo Gallon21Department of Medicine, Mount Sinai Hospital, Chicago, USA; 2Northwestern University–Feinberg School of Medicine, Chicago, USAAbstract: Mycophenolate mofetil (MMF, a prodrug of mycophenolic acid (MPA, is an inhibitor of inosine monophosphate dehydrogenase (IMPDH. It preferentially inhibits denovo pathway of guanosine nucleotide synthesis in T and B-lymphocytes and prevents their proliferation, thereby suppresses both cell mediated and humoral immune responses. Clinical trials in kidney transplant recipients have shown the efficacy of MMF in reducing the incidence and severity of acute rejection episodes. It also improves long term graft function as well as graft and patient survival in kidney transplant recipients. MMF is useful as a component of toxicity sparing regimens to reduce or avoid exposure of steroids or calcineurin inhibitor (CNI. Enteric-coated mycophenolate sodium (EC-MPS can be used as an alternative immunosuppressive agent in kidney transplant recipients with efficacy and safety profile similar to MMF.Keywords: mycophenolate mofetil, kidney transplantation, acute rejection, toxicity sparing

  12. Risk and prognosis of bacteremia and fungemia among first-time kidney transplant recipients

    DEFF Research Database (Denmark)

    Skov Dalgaard, Lars; Nørgaard, Mette; Povlsen, Johan Vestergaard;

    2016-01-01

    BACKGROUND: Bacterial infections are common complications in kidney transplant recipients (KTRs). Little is known about incidence rates of bacteremia and fungemia (BAF) in KTRs. METHODS: In this population-based cohort study, we used medical and administrative registries to identify episodes of BAF...

  13. Hepatocellular carcinoma after kidney transplantation: analysis of Hong Kong Renal Registry.

    Science.gov (United States)

    Cheung, Chi Yuen; Lam, Man Fai; Chow, Kai Ming; Lee, William; Cheng, Yuk Lun; Yuen, Sze Kit; Wong, Ping Nam; Mo, Ka Leung; Leung, Kay Tai; Wong, Sze Ho; Ho, Yiu Wing; Chau, Ka Foon

    2014-07-01

    Kidney transplant recipients have increased risk of cancers when compared with the general population. Hepatocellular carcinoma (HCC) is extremely important in Asia where hepatitis B virus (HBV) infection is endemic. The aim is to study the epidemiological and clinical aspects of all de novo HCC in our kidney transplant recipients. Moreover, various preventive strategies which may help to optimize the outcome will also be discussed. A retrospective review of all patients who developed HCC after kidney transplantation between May 1972 and December 2011 in Hong Kong, based on the data from Hong Kong Renal Registry. After a follow-up period of 40,246 person-years, 20 patients (males 15: females 5) developed HCC. The annual incidence was 49.7/100,000 persons per year. Among them, 16 were HBV carriers, 2 were hepatitis C (HCV) carriers and 2 had HBV and HCV co-infection. Presence of HBV infection was associated with 78-fold higher risk for HCC development. Majority (85%) were asymptomatic when HCC was diagnosed by ultrasound or alpha-fetoprotein surveillance. All patients diagnosed by surveillance received active treatment while 2/3 of symptomatic patients could only receive symptomatic care and died rapidly. In conclusion, HBV infection is the major etiological factor for HCC development in kidney transplant recipients in HBV endemic areas. Regular HCC surveillance appeared to be able to detect early stage cancers which are amenable to treatment and offer the best hope of cure.

  14. Former Smoking Is a Risk Factor for Chronic Kidney Disease After Lung Transplantation

    NARCIS (Netherlands)

    Hellemons, M. E.; Agarwal, P. K.; van der Bij, W.; Verschuuren, E. A. M.; Postmus, D.; Erasmus, M. E.; Navis, G. J.; Bakker, S. J. L.

    2011-01-01

    Chronic kidney disease (CKD) is a common complication after lung transplantation (LTx). Smoking is a risk factor for many diseases, including CKD. Smoking cessation for >6 months is required for LTx enlistment. However, the impact of smoking history on CKD development after LTx remains unclear. We i

  15. Prevalence of Overweight and Obesity in Kidney Transplant Patients

    OpenAIRE

    Vida Mohammadi; Sahar Keshtkar-Aghababaee

    2014-01-01

    While obesity is a disorder that itself is global nowadays, it is also considered as risk factor of some disorders such as hypertension and type 2 diabetes. Furthermore, metabolic syndrome and obesity are involved in pathology of chronic kidney disease.

  16. IMPORTANCE OF RESEARCH HLA ANTIBODIES CLASS I AND II, AND MICA ANTIBODIES IN KIDNEY TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    M. Sh. Khubutia

    2011-01-01

    Full Text Available The purpose of this study was to investigate the occurrence of HLA and MICA antibodies in patients from the waiting list for kidney transplantation and their influence on the course of post-transplant period. Determination of HLA antibodies class I and II, and MICA antibodies was performed on a platform of Luminex (xMAP-tech- nology using sets LABScreen ONE LAMBDA (U.S.. A total of 156 patients from the waiting list for kidney transplantation. Revealed the presence of HLA and MICA antibodies in the serum of 31.4% of patients. Regraf- ted patients increased the content of antibodies to the antigens of HLA system was noted in 88.2% of cases, 47% met the combination of antibodies to the I, II classes and MICA. In patients awaiting first kidney transplantation, HLA and MICA antibodies were determined in 23.7% of cases. The presence of pretransplant HLA and MICA antibodies had a significant influence on the course of post-transplant period. Patients with the presence of HLA and MICA in 50% of cases delayed graft function. Sessions of plasmapheresis can reduce the concentration of HLA and MICA antibodies on average by 61.1%. 

  17. Marginal living donor in kidney transplantation: experience in a Chinese single center

    Institute of Scientific and Technical Information of China (English)

    LI Gang; WANG Yun-peng; MA Lu-lin; ZHANG Jing; ZHANG Hong-xian; HUANG Yi; HOU Xiao-fei

    2013-01-01

    Background Living donor kidney transplantation is becoming popular in China,whereas,in clinical situations,some kidney donors may be sub-optimal,namely marginal living donor.The present study aimed to evaluate the safety and efficacy of marginal living donor kidney transplantation in a Chinese single center.Methods Between January 2001 and December 2009,888 kidney transplantations were performed in our center; 149were living donor kidney transplantations.The living donors and recipients were followed up regularly after the operation.Of the living donors,30 donors were marginal,who were older than 60 years or suffered from kidney anomaly or some benign diseases.Among the non-marginal living kidney transplantations,58 donors and recipients had complete perioperative and follow-up data.We compared the marginal and non-marginal living donor kidney transplantations with regard to donor age,follow-up period,donor's serum creatinine at the last follow-up,recipient's serum creatinine at the last follow-up,and graft survival at the last follow-up.Results The mean age of donors in the marginal and non-marginal living donors were (55±9) (37-66) and (43±12) (30-59) years.The mean follow-up times of the marginal and non-marginal groups were (26.4±13.4) months and (28.8±14.8)months.The donor and recipient serum creatinine levels at the last follow-up were (1.16±0.20) mg/dl and (1.30±0.24) mg/dl in the marginal group,and (1.12±0.32) mg/dl and (1.34±0.32) mg/dl in the non-marginal group.Three recipients in the marginal group and five recipients in the non-marginal group had acute rejection episodes during the first year.Actuarial 3-year graft survival was 96.7% in the marginal group and 100% in the non-marginal group.No significant differences were detected between the two groups with regard to these data.Conclusion Utilization of highly selective marginal living donors can be a safe,feasible,and effective way for the treatment of patients with end stage renal disease.

  18. Simultaneous BK Polyomavirus (BKPyV)-associated nephropathy and hemorrhagic cystitis after living donor kidney transplantation.

    Science.gov (United States)

    Helanterä, Ilkka; Hirsch, Hans H; Wernli, Marion; Ortiz, Fernanda; Lempinen, Marko; Räisänen-Sokolowski, Anne; Auvinen, Eeva; Mannonen, Laura; Lautenschlager, Irmeli

    2016-03-01

    BK polyomavirus (BKPyV) commonly reactivates after kidney transplantation, and can cause polyomavirus-associated nephropathy (PyVAN), whereas after allogeneic stem cell transplantation the most frequent manifestation of BKPyV is polyomavirus-associated hemorrhagic cystitis (PyVHC). Despite high-level BKPyV replication in both, the pathogenesis and manifestation of both BKPyV entities appears to differ substantially. We describe an unusual case of simultaneous PyVAN and PyVHC presenting with acute symptoms in a BKPyV-IgG positive recipient eight months after kidney transplantation from a haploidentical living donor, who was BKPyV-IgG negative. Symptoms of cystitis and viremia subsided rapidly after reduction of immunosuppression.

  19. Adult-to-Adult Living Donor Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Shimul A Shah

    2006-01-01

    Full Text Available The present review outlines the principles of living donor liver transplantation, donor workup, procedure and outcomes. Living donation offers a solution to the growing gap between the need for liver transplants and the limited availability of deceased donor organs. With a multidisciplinary team focused on donor safety and experienced surgeons capable of performing complex resection/reconstruction procedures, donor morbidity is low and recipient outcomes are comparable with results of deceased donor transplantation.

  20. LAPAROSCOPIC RECONSTRUCTION OF THE URINARY TRACT IN PATIENTS WITH URETERAL STRICTURE AFTER KIDNEY TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    D. V. Perlin

    2013-01-01

    Full Text Available Aim. Ureteral obstruction secondary to ischemia is the most common urologic complication of kidney trans- plantation. Pyeloureteral anastomosis with recipient ureter has shown most satisfactory long-term results in its management. Existing urinary infection and immunosupression determine the high risk of wound complications. We have experience more than 50 reconstructive procedures of urinary tract after kidney transplantation by open surgery during 25 years. Till last time this procedure has been performed through open surgery. Method. We used pyeloureteral anastomosis with recipient ureter in two patients with ureteral stricture after kidney transplantation by laparoscopic approach. The operations lasted 215 and 275 min respectively. In both cases the surgery was per- formed after percutaneous nephrostomy because of deterioration of transplanted kidney function. Internal stent was indwelled laparoscopicaly. No drain tube was left. Results. The nephrostomy tubes were removed after 10 and 7 days respectively. The stents were removed after 27 and 20 days respectively. No complications were seen during the surgery and postoperative period. Now serum creatinine level is 0.12 mmol/l and 0.15 mmol/l after 15 and 12 months after surgery respectively. Conclusion. In spite of some difficulties related with topographic land- marks and severe tissues fibrosis after transplantation laparoscopic pyeloureterostomy in transplanted kidney is safe and feasible procedure. The main advantage is absence of risk of most serious complications related with wound infection in immune compromised patients. Moreover, early recovery to usual activity and diet facilita- tes to prevent pulmonary infections and to normalize intestinal absorbability of the immunosuppressive drugs. 

  1. Comparative Assessment of Quality of Life in Hemodialysis and Kidney Transplant Patients

    Directory of Open Access Journals (Sweden)

    A Abbaszadeh

    2010-12-01

    Full Text Available Introduction: Quality of life(QOL is a state of complete physical, mental, social and spiritual well-being and may be affected by sociodemographic variables, chronic illnesses, psychiatric and physical conditions. End stage renal diseases and treatments lead to many problems in patients including physical, mental and socioeconomic problems thus affecting their overall QOL. This study evaluated and compared QOL in hemodialysis and kidney transplant patients. Methods: In a descriptive analytic study, SF36 questionnaire was used to examine QOL in 120 patients (60 hemodialysis and 60 kidney transplant patients in Kerman. Results: The mean QOL score in hemodialysis patients was 49.83±17.56, while in kidney transplant patients, it was 60.95±16.60. Although difference between the two groups was significant (p≤o.o5, the difference in three dimensions pain, physical and social function was not significant (p≥0.05. In hemodialysis patients, minimum score was in vitality dimension and maximum score in physical function. In kidney transplant patients, minimum score was in general health and maximum score was in role limitation due to physical problem dimension. Conclusion: Although QOL in both groups is lower than public communities, kidney transplantation can improve QOL, especially in role restriction due to physical problems. Based on results, it seems that age, blood creatinine levels and personal perception are the most important factors affecting QOL of hemodialysis patients and only creatinine levels and personal perception can be modified. So, in this group of patients, by maintaining creatinine levels and assuring dialysis quality, QOL can be improved. On the other hand, recognition of patient’s defiance mechanisms can improve adaptation and life satisfaction.

  2. Living Related Donor Kidney Transplantation in Libya: A Single Center Experience

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    Elusta Ahmed

    2008-01-01

    Full Text Available The aim of this study is to report the experience from a single center in Libya, on the prevailing live-related kidney transplantation program. The results of three years work on kidney transplantation at the Tripoli Central Hospital (National Organ Transplant Program in Libya were evaluated. The transplant program was launched on 17 th August, 2004 and 135 patients have been transplanted since then till 17 th August, 2007. All donors and recipients were screened thoroughly prior to transplant and monitored closely in the post-transplant period. Our immuno-suppressive protocol was cyclosporine-based. Among the 135 accepted pairs, donors and reci-pients were genetically-related in 133 cases (98.5% and emotionally-related in two others. The mean donor age was 37 ± 9.5 years (range 18-56 years and recipient age 37 ± 13.6 years (range 7-67 years. There were 95 males (70.4% and 40 females (29.6% among the recipients while among the donors, there were 102 males (75.6% and 33 females (24.4%. Delayed graft function was seen in three patients (2.2%, acute rejection in six (4.4%, post-transplant urinary tract infection in six (4.4%, pneumonia in three (2.2%, ureteric kink in two (1.5% and urine leak in four (3.0%. Graft survival at 36 months was 93.3% while patient survival at the same period was 96.3%. This report indicates that the results of our transplant program are good and comparable with other international programs.

  3. Mortality Prediction after the First Year of Kidney Transplantation: An Observational Study on Two European Cohorts.

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    Marine Lorent

    Full Text Available After the first year post transplantation, prognostic mortality scores in kidney transplant recipients can be useful for personalizing medical management. We developed a new prognostic score based on 5 parameters and computable at 1-year post transplantation. The outcome was the time between the first anniversary of the transplantation and the patient's death with a functioning graft. Afterwards, we appraised the prognostic capacities of this score by estimating time-dependent Receiver Operating Characteristic (ROC curves from two prospective and multicentric European cohorts: the DIVAT (Données Informatisées et VAlidées en Transplantation cohort composed of patients transplanted between 2000 and 2012 in 6 French centers; and the STCS (Swiss Transplant Cohort Study cohort composed of patients transplanted between 2008 and 2012 in 6 Swiss centers. We also compared the results with those of two existing scoring systems: one from Spain (Hernandez et al. and one from the United States (the Recipient Risk Score, RRS, Baskin-Bey et al.. From the DIVAT validation cohort and for a prognostic time at 10 years, the new prognostic score (AUC = 0.78, 95%CI = [0.69, 0.85] seemed to present significantly higher prognostic capacities than the scoring system proposed by Hernandez et al. (p = 0.04 and tended to perform better than the initial RRS (p = 0.10. By using the Swiss cohort, the RRS and the the new prognostic score had comparable prognostic capacities at 4 years (AUC = 0.77 and 0.76 respectively, p = 0.31. In addition to the current available scores related to the risk to return in dialysis, we recommend to further study the use of the score we propose or the RRS for a more efficient personalized follow-up of kidney transplant recipients.

  4. Obesity in kidney transplant recipients: association with decline in glomerular filtration rate.

    Science.gov (United States)

    Moreira, Thaís Rodrigues; Bassani, Tayron; de Souza, Gizele; Manfro, Roberto Ceratti; Gonçalves, Luiz Felipe Santos

    2013-10-01

    In this study we aimed to evaluate the influence of obesity in kidney and patient survival and graft function. Retrospective cohort study of kidney transplant recipients performed between 2001 and 2009. The body mass index was calculated at time of transplantation, one and five years after. The main outcomes studied were incidence of delayed graft function, new onset diabetes after transplantation, patient and graft survival, and glomerular filtration rate. The prevalence of obesity and overweight patients were 10.7% and 26.8% respectively, with an increase to 16.9% and 32.5% one year after transplantation. Underweight and obese recipients presented a higher incidence of early graft loss. The incidence of new onset diabetes after transplantation was significantly higher at one and five years in overweight or obese recipients at baseline. Overweight and obese recipients presented significantly lower estimated glomerular filtration rate at five years posttransplantation (p = 0.002). In the Kaplan-Meier analyses no statistically significant differences in patients or grafts survivals were observed. Obese patients have a higher rate of early graft failure and a higher new onset diabetes after transplantation incidence. Also, the finding of decreased glomerular filtration rate is worrisome and perhaps longer follow-up will reveal more graft failures and patients deaths in the group of obese recipients.

  5. Human papilloma virus infection in female kidney transplant recipients

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    Shirin Ghazizadeh

    2011-01-01

    Full Text Available The objective of this study was to evaluate the incidence of genital human papilloma virus (HPV infection and cervical intra-epithelial lesions in transplanted patients. Cervical Papanicolaou (Pap smear/HPV test and colposcopic examinations were performed in 58 patients who were candidates for renal transplant surgery; these tests were repeated one year later. Their age range was 26-53 years (mean, 37.2 years. Hypertension was the most common cause of renal insufficiency (34.4%, while in 41.4% of the patients, the causative pathology was unknown. In 24.1% of the patients, there was no history of dialysis, i.e. they had pre-emptive transplantation. The mean duration of marriage (years since first intercourse was 16.2 years (range, 1-35. Coitus interruptus was the most common contraceptive method used (37.9%, followed by tubal ligation and condom (10.3% and 6.9%, respectively. All patients had negative Pap tests and normal gynecologic exam before undergoing transplantation. The Pap test remained normal after transplant surgery, although the HPV test became positive in four patients (6.9%. There were five cases of white epithelium on colposcopy, but biopsy showed normal metaplasia. Two cases of extensive anogenital warts were treated by CO 2 laser, and one patient had recurrent warts, which responded well to second laser surgery. None of the study patients had squamous intra-epithelial lesions (SIL or vulvar intra-epithelial neoplasia. Our study suggests that screening with HPV and Pap test should be performed before transplant surgery and should be repeated at regular intervals in order to avoid irreversible situations such as high-grade SILs, which are difficult to treat. Avoiding high-risk sexual relations in this group of patients is highly recommended.

  6. Hafnia alvei Urosepsis in a Kidney Transplant Patient.

    Science.gov (United States)

    Stanic, Mario; Meusburger, Edgar; Hartmann, Gabriele; Lhotta, Karl

    2015-01-01

    Hafnia alvei, a gram-negative facultative anaerobic, rod-shaped bacterium, is a rare cause of infection in humans. We report on a renal transplant patient who developed H. alvei pyelonephritis and urosepsis. The source of infection remains enigmatic but is most likely the intestinal tract. Appropriate antibiotic therapy with cefepime followed by oral ciprofloxacin brought about rapid resolution of symptoms and complete recovery. H. alvei may cause severe infection in transplant patients without predisposing factors such as hospitalization, invasive procedures, or antibiotic treatment.

  7. Hafnia alvei Urosepsis in a Kidney Transplant Patient

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    Mario Stanic

    2015-01-01

    Full Text Available Hafnia alvei, a gram-negative facultative anaerobic, rod-shaped bacterium, is a rare cause of infection in humans. We report on a renal transplant patient who developed H. alvei pyelonephritis and urosepsis. The source of infection remains enigmatic but is most likely the intestinal tract. Appropriate antibiotic therapy with cefepime followed by oral ciprofloxacin brought about rapid resolution of symptoms and complete recovery. H. alvei may cause severe infection in transplant patients without predisposing factors such as hospitalization, invasive procedures, or antibiotic treatment.

  8. Liver regeneration after living donor transplantation: adult-to-adult living donor liver transplantation cohort study.

    Science.gov (United States)

    Olthoff, Kim M; Emond, Jean C; Shearon, Tempie H; Everson, Greg; Baker, Talia B; Fisher, Robert A; Freise, Chris E; Gillespie, Brenda W; Everhart, James E

    2015-01-01

    Adult-to-adult living donors and recipients were studied to characterize patterns of liver growth and identify associated factors in a multicenter study. Three hundred and fifty donors and 353 recipients in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) receiving transplants between March 2003 and February 2010 were included. Potential predictors of 3-month liver volume included total and standard liver volumes (TLV and SLV), Model for End-Stage Liver Disease (MELD) score (in recipients), the remnant and graft size, remnant-to-donor and graft-to-recipient weight ratios (RDWR and GRWR), remnant/TLV, and graft/SLV. Among donors, 3-month absolute growth was 676 ± 251 g (mean ± SD), and percentage reconstitution was 80% ± 13%. Among recipients, GRWR was 1.3% ± 0.4% (8 Graft weight was 60% ± 13% of SLV. Three-month absolute growth was 549 ± 267 g, and percentage reconstitution was 93% ± 18%. Predictors of greater 3-month liver volume included larger patient size (donors and recipients), larger graft volume (recipients), and larger TLV (donors). Donors with the smallest remnant/TLV ratios had larger than expected growth but also had higher postoperative bilirubin and international normalized ratio at 7 and 30 days. In a combined donor-recipient analysis, donors had smaller 3-month liver volumes than recipients adjusted for patient size, remnant or graft volume, and TLV or SLV (P = 0.004). Recipient graft failure in the first 90 days was predicted by poor graft function at day 7 (HR = 4.50, P = 0.001) but not by GRWR or graft fraction (P > 0.90 for each). Both donors and recipients had rapid yet incomplete restoration of tissue mass in the first 3 months, and this confirmed previous reports. Recipients achieved a greater percentage of expected total volume. Patient size and recipient graft volume significantly influenced 3-month volumes. Importantly, donor liver volume is a critical predictor

  9. Intestinal perforation after combined liver-kidney transplantation for a case of congenital polycystic disease

    Institute of Scientific and Technical Information of China (English)

    Tao Peng; Bin Chen; Qin Zhong; Min-Yi Wei; Min-Hao Peng; Le-Qun Li; Yao-Liang Deng; Ding-Hua Yang; Bang-Yu Lu; Xi-Gang Chen; Ya Guo; Kai-Yin Xiao

    2004-01-01

    AIM: To highlight the intestinal perforation (IP), an uncommon and catastrophic complication after combined liver-kidney transplantation.METHODS: Combined liver-kidney transplantation (LKTx) with left kidney excision and a cyst fenestration procedure on the right kidney were performed on a case of 46-year-old female with congenital polycystic disease (CPCD). RFSULTS: Two sites of IP were noted 40-50 cm proximal to ileocecal area during emergent laparotomy 10 d postoperatively.Despite aggressive surgical and medical management, disease progressed toward a fatal outcome due to sepsis and multiple organ failure 11 d later. CONCLUSION: Long duration of operation without venovenous bypass, overdose of steroid together with postoperative volume excess may all contribute to the risk of idiopathic multiple IPs. Microbiology and pathology inspections suggested that the infected cyst of the fenestrated kidney might be one reason for the fatal intra-peritoneal infection. Thus for the CPCD patients who seem to be very susceptible to infectious complications, any sign of suspected renal-infection found before or during LKTx is indication for the excision of original kidney. And the intensity of immunosuppression therapy should be controlled cautiously.

  10. The influence of warm ischemia elimination on kidney injury during transplantation – clinical and molecular study

    Science.gov (United States)

    Kamińska, Dorota; Kościelska-Kasprzak, Katarzyna; Chudoba, Paweł; Hałoń, Agnieszka; Mazanowska, Oktawia; Gomółkiewicz, Agnieszka; Dzięgiel, Piotr; Drulis-Fajdasz, Dominika; Myszka, Marta; Lepiesza, Agnieszka; Polak, Wojciech; Boratyńska, Maria; Klinger, Marian

    2016-01-01

    Kidney surface cooling was used during implantation to assess the effect of warm ischemia elimination on allograft function, histological changes and immune-related gene expression. 23 recipients were randomly assigned to a group operated on with kidney surface cooling during implantation (ice bag technique, IBT group), and the other 23 recipients receiving the contralateral kidney from the same donor were operated on with a standard technique. Three consecutive kidney core biopsies were obtained during the transplantation procedure: after organ recovery, after cold ischemia and after reperfusion. Gene expression levels were determined using low-density arrays (Format 32, TaqMan). The IBT group showed a significantly lower rate of detrimental events (delayed graft function and/or acute rejection, p = 0.015) as well as higher glomerular filtration rate on day 14 (p = 0.026). A greater decrease of MMP9 and LCN2 gene expression was seen in the IBT group during total ischemia (p = 0.003 and p = 0.018). Elimination of second warm ischemia reduced the number of detrimental events after kidney transplantation, and thus had influence on the short-term but not long-term allograft function. Surface cooling of the kidney during vascular anastomosis may reduce some detrimental effects of immune activation resulting from both brain death and ischemia-reperfusion injury. PMID:27808277

  11. Warts in a cohort of Danish kidney transplanted patients

    DEFF Research Database (Denmark)

    Zachariae, Claus; Sand, Carsten; Hansen, Jesper Melchior;

    2012-01-01

    with the Dermatology Life Quality Index (DLQI). Of 740 patients with a functioning renal allograft and were free of dialysis who were surveyed, 568 returned the questionnaires. Patients were asked about general health issues, with a focus on transplantation history, cutaneous warts and whether they had ever had...

  12. Implication of thymoglobulin in kidney transplant patients: review article

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    Sudabeh Alatab

    2015-11-01

    Full Text Available Thymoglobulin is a purified polyclonal immunoglobulin that has been used widely over the last decades in the prevention and treatment of rejection following renal transplantation. This immunoglobulin works against human thymocytes. Since thymoglobulin does not contain the nephrotoxic properties therefore it can be used in induction therapy especially in patients with higher risk of graft rejection such as patients who receive graft from cadavers. Recent research showed also its beneficial role in cross-match-positive transplantation, a role that is mediated through conjunction with inhibitors of terminal complement activation. This immunoglobulin has also been used for treatment of rejection following renal transplantation. Thymoglobulin can have various effects on various Immune system cells including T cells, B cells and also plasma cells. Thymoglobulin also affects the Tcell surface antigens, natural killer-cell antigens, B cell antigens, plasma cell antigens, adhesion molecules and chemokine receptors. Diverse effects of thymoglobulin on the immune system includes: T cell depletion, induce apoptosis in B cell lineage and interference with dendritic cell functional properties. Thymoglobulin can cause acute complications, delayed complications as well as infectious complications. Acute reaction events includes: anaphylaxis, fever, chills, dyspnea, nausea, vomiting and diarrhea. Thymoglobulin also induces cytokine release syndrome manifested by high grade fevers and chills and treated by steroid therapy. Delayed reactions events usually present as serum sickness and infections. Infectious complications are more important and include cytomegalovirus (CMV infection, sepsis, candidiasis, herpes simplex and urinary infections. Thymoglobulin can also induce cytokine release syndrome. It has been thought that thymoglobulin increases the risk of post-transplant lymphoproliferative disorder (PTLD, however, debate still exists whether such an

  13. [A higher place on the waiting list for kidney transplantation after earlier donation: a matter of give and take].

    Science.gov (United States)

    Hoitsma, Andries J

    2011-01-01

    In May 2011 the Dutch Health Council released an advice regarding living kidney donors who developed end-stage renal disease (ESRD) after donation. These donors with ESRD will have a high priority when they are on the waiting list for kidney transplantation. With this new rule the former donors will be transplanted within 6 weeks and transplantation can preferably be performed preemptively. It is expected that this measure shall prolong the waiting list for a donor kidney for the remaining patients with end stage renal disease by 6 days at most, on a total average waiting period of 4 years.

  14. Donor-derived Strongyloides stercoralis hyperinfection syndrome after simultaneous kidney/pancreas transplantation

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    A. Galiano

    2016-10-01

    Full Text Available Most cases of strongyloidiasis associated with solid organ transplantation have been due to the reactivation of a latent infection in the recipient as a result of the immunosuppressive therapy; however, donor-derived infections are becoming increasingly frequent. The case of a patient who nearly died of a Strongyloides stercoralis hyperinfection after receiving simultaneous kidney/pancreas transplants is described herein. No specific parasitological tests were performed pre-transplantation, despite the fact that both the recipient and the donor originated from endemic areas. Serological analysis of the donor's serum performed retrospectively revealed the origin of the infection, which if it had been done beforehand would have prevented the serious complications. Current practice guidelines need to be updated to incorporate immunological and molecular techniques for the rapid screening of Strongyloides prior to transplantation, and empirical treatment with ivermectin should be applied systematically when there is the slightest risk of infection in the donor or recipient.

  15. Increased prevalence of malnutrition and reduced lean body mass in overweight/obese kidney transplant recipients

    Directory of Open Access Journals (Sweden)

    Sylwia Małgorzewicz

    2012-06-01

    Full Text Available Overweight and obesity are common in subjects after kidney transplantation. On the other hand, features of malnutrition are also frequently recognized in this group of patients. The aim of the study was to evaluate the prevalence of both abnormalities in a cohort of stable kidney recipients and to assess whether obesity precludes malnutrition in transplanted patients. We also investigated associations between the nutritional status, graft function and adipokines concentrations. The study was performed in 80 prevalent kidney transplant patients and in a control group which consisted of 23 healthy volunteers. Body composition (% of fat, lean body mass (LBM, water content was measured by multifrequency bioelectrical impedance (Body Composition Manager. Nutritional status was determined by a 7–point Subjective Global Assessment (SGA, anthropometric measurements and s-albumin concentration. C–reactive protein (CRP, Il–6 and plasminogen activator inhibitor–1 (PAI–1 were used as markers of inflammatory status. Concentration of leptin, adiponectin and visfatin were measured by ELISA. Results: Mean age was 52.4±13.9 years (45 men and 35 women. Diabetes mellitus was present in 29% (n=23 of them. Mean time after transplantation (transplantation vintage was 82.5±56.5 months (median=73 months. Mean eGFR was 41.7±14.9 ml/min (4 points MDRD, BMI was 25.7±4.2. Overweight was present in 41% of the patients and obesity in 14%. On the basis of SGA evaluation, signs of malnutrition were observed in 48% of the subjects. Malnutrition was present in 64% (21/33 of the overweight patients and in 91% (10/11 of the obese patients. Transplantation vintage was directly associated with fat mass and inversely associated with LBM. Malnourished patients (SGA had a longer transplantation vintage. Adiponectin levels were significantly lower in transplanted patients as compared to controls. In multivariate analysis, leptin was an independent predictor of serum

  16. The role of hepcidin-25 in kidney transplantation

    NARCIS (Netherlands)

    Chan, W.; Ward, D.G.; McClean, A.; Bosch, J.A.; Jones, D.; Kaur, O.; Drayson, M.; Whitelegg, A.; Iqbal, T.; McTernan, P.G.; Tselepis, C.; Borrows, R.

    2013-01-01

    Background: Hepcidin-25 is a peptide hormone involved in iron absorption and homeostasis and found at increased serum levels in conditions involving systemic inflammation, renal dysfunction, and increased adiposity. Hepcidin may play a role in the pathogenesis of anemia, but its role in kidney trans

  17. Proteinuria and function loss in native and transplanted kidneys

    NARCIS (Netherlands)

    Koop, Klaas

    2009-01-01

    “Bones can break, muscles can atrophy, glands can loaf, even the brain can go to sleep, without immediately endangering our survival, but when the kidneys fail to manufacture the proper kind of blood neither bone, muscle, gland nor brain can carry on”. This quote from Homer Smith's book 'From Fish t

  18. Prevalence of Overweight and Obesity in Kidney Transplant Patients

    Directory of Open Access Journals (Sweden)

    Vida Mohammadi

    2014-08-01

    Full Text Available While obesity is a disorder that itself is global nowadays, it is also considered as risk factor of some disorders such as hypertension and type 2 diabetes. Furthermore, metabolic syndrome and obesity are involved in pathology of chronic kidney disease.

  19. Generic Drugs - Decreasing Costs and Room for Increased Number of Kidney Transplantations.

    Science.gov (United States)

    Spasovski, Goce

    2015-01-01

    Kidney transplantation is the best treatment option in comparison to dialysis, although patients are obliged to receive life-long medical treatment with immunosuppressive drugs (ISDs) for prevention of the graft rejection. Such immunosuppressive treatment may be costly and associated with multiple adverse effects. Since costs are viewed as one of the major constraints for the increasing number of transplantation, the use of generic ISDs may decrease the overall cost of transplantation and raise the possibility for its further development. An ideal ISD should have the security margin between toxic and therapeutic dose, and prevent development of acute or chronic rejection of the transplanted kidney. This is particularly important for drugs with a "narrow therapeutical index" (NTI), where small differences in dose or concentration lead to dose and concentration-dependent, serious therapeutic failures and/or adverse drug reactions. The NTI generic drug is approved if within 90%-112% of the area under the curve of the original product the pharmacokinetics fulfills the strict criteria of pharmaceutical equivalence and bioequivalence. Every generic has to be proven to be bioequivalent to the innovator product, and not to other generic products because of the possible generic "drift". Thus, the generic ISDs may be economically attractive, but theoretically, they may pose a risk to transplant patients. Such risks may be reduced if a long-term clinical studies showing cost-effectiveness of generic ISDs in de novo and prevalent transplant patients for every new generic ISD are performed. In conclusion, the increased number of solid organ transplantation goes in line with the increased health care expenditure for ISDs. The generic immunosuppressants could be a possible solution if safely substituted for innovator products or other generic drug of choice. The substantial cost reduction needs to be redirected into organ donation initiatives so that more patients can benefit

  20. Simultaneous pancreas and kidney transplantation with concurrent allograft nephrectomy for recipients with prior renal transplants lost to BK virus nephropathy: two case reports.

    Science.gov (United States)

    Kubal, S; Powelson, J A; Taber, T E; Goble, M L; Fridell, J A

    2010-01-01

    Candidacy for retransplantation after allograft loss due to BK virus-associated nephropathy (BKVN) with or without allograft nephrectomy is controversial. This report describes 2 renal transplant recipients who lost their grafts to BKVN and subsequently underwent simultaneous kidney and pancreas transplantation with allograft nephrectomy.

  1. Dosing of Enteric-Coated Mycophenolate Sodium Under Routine Conditions: An Observational, Multicenter Study in Kidney Transplantation.

    Science.gov (United States)

    Albano, Laetitia; Buchler, Matthias; Cantarovich, Diego; Cassuto, Elisabeth; Cointault, Olivier; Mazouz, Hakim; Vetromile, Fernando; Lecuyer, Aurélie; Tindel, Malka; Kamar, Nassim

    2016-04-28

    BACKGROUND Dosing of enteric-coated mycophenolate sodium (EC-MPS) should be adjusted to reflect concomitant immunosuppression, but it is largely undocumented whether such modifications are carried out during routine clinical practice. MATERIAL AND METHODS MyLIFE was an observational study of adult kidney-only or kidney-pancreas transplant patients starting -EC-MPS at 33 French transplant centers. Data were collected at first EC-MPS dose and 6 months later. The primary objective was to describe initial EC-MPS dosing according to concomitant immunosuppression. RESULTS There were 461 patients analyzed (174 started EC-MPS by month 1 post-transplant ['de novo'] and 287 started EC-MPS >1 month post-transplant ['maintenance']), receiving cyclosporine (CsA) (n=76), tacrolimus (n=363), or a mammalian target of rapamycin (mTOR) inhibitor (n=22). Mean (SD) starting dose was 1130 (511) mg/day, 1006 (441) mg/day, and 769 (300) mg/day in the CsA, tacrolimus, and mTOR inhibitor groups, respectively (p=0.003). In the de novo subpopulation, the starting dose was 1440 mg/day in 66.7% (14/21) of CsA-treated patients and 71.9% (110/153) of tacrolimus-treated patients, with an intensified dose of 2160 mg/day in 28.6% (6/21) and 8.5% (13/153), respectively. There was a non-significant trend to a higher rate of biopsy-proven acute rejection in patients receiving CsA versus tacrolimus or an mTOR inhibitor (p=0.082). Adverse events with a suspected relation to EC-MPS occurred in 21.0%, 23.1%, and 9.1% of the CsA, tacrolimus, and mTOR inhibitor subpopulations, respectively. CONCLUSIONS EC-MPS is usually initiated at the dose recommended for de novo CsA-treated kidney transplant patients, then titrated downwards as required. An early intensified regimen is not used frequently. The EC-MPS dose is modified in <20% of de novo patients to account for concomitant tacrolimus therapy instead of CsA administration.

  2. Hemodialysis vintage, black ethnicity, and pretransplantation antidonor cellular immunity in kidney transplant recipients.

    Science.gov (United States)

    Augustine, Joshua J; Poggio, Emilio D; Clemente, Michael; Aeder, Mark I; Bodziak, Kenneth A; Schulak, James A; Heeger, Peter S; Hricik, Donald E

    2007-05-01

    Prolonged exposure to dialysis before transplantation and black ethnicity are known risk factors for acute rejection and graft loss in kidney transplant recipients. Because the strength of the primed antidonor T cell repertoire before transplantation also is associated with rejection and graft dysfunction, this study sought to determine whether hemodialysis (HD) vintage and/or black ethnicity affected donor-directed T cell immunity. An enzyme-linked immunosorbent spot (ELISPOT) assay was used to measure the frequency of peripheral T cells that expressed IFN-gamma in response to donor stimulator cells before transplantation in 100 kidney recipients. Acute rejection occurred in 38% of ELISPOT (+) patients versus 14% of ELISPOT (-) patients (P = 0.008). The median (HD) vintage was 46 mo (0 to 125 mo) in ELISPOT (+) patients versus 24 mo (0 to 276 mo) in ELISPOT (-) patients (P = 0.009). Black recipients had a greater median HD vintage (55 versus 14 mo in nonblack recipients; P vintage remained a significant positive correlate with an ELISPOT (+) result (odds ratio per year of HD 1.3; P = 0.003). These data suggest that the risk for developing cross-reactive antidonor T cell immunity increases with longer HD vintage, providing an explanation for the previously observed relationship between increased dialysis exposure and worse posttransplantation outcome. Longer HD vintage may also explain the increased T cell alloreactivity that previously was observed in black kidney recipients.

  3. Inadequacy of Cardiovascular Risk Factor Management in Chronic Kidney Transplantation -- Evidence from the FAVORIT Study

    Science.gov (United States)

    Carpenter, Myra A.; Weir, Matthew R.; Adey, Deborah B.; House, Andrew A.; Bostom, Andrew G.; Kusek, John W.

    2015-01-01

    Background Kidney transplant recipients (KTRs) have increased risk for cardiovascular disease (CVD). Our objective is to describe the prevalence of CVD risk factors applying standard criteria and use of CVD risk factor lowering medications in contemporary KTRs. Methods The Folic Acid for Vascular Outcome Reduction in Transplantation study enrolled and collected medication data on 4,107 KTRs with elevated homocysteine and stable graft function an average of 5 years post-transplant. Results CVD risk factors were common (hypertension or use of blood pressure lowering medication in 92%, borderline or elevated LDL or use of lipid-lowering agent in 66%, history of diabetes mellitus in 41%, and obesity in 38%); prevalent CVD was reported in 20% of study participants. National Kidney Foundation blood pressure (BP) guidelines (BP < 130/80 mm Hg) were not met by 69% of participants. Uncontrolled hypertension (BP of 140/90 mm Hg or higher) was present in 44% of those taking anti-hypertension medication; 18% of participants had borderline or elevated LDL, of which 60% were untreated, and 31% of the participants with prevalent CVD were not using an anti-platelet agent. Conclusion There is opportunity to improve treatment and control of traditional CVD risk factors in kidney transplant recipients. PMID:22775763

  4. Recurrent Psoriasis After Introduction of Belatacept in 2 Kidney Transplant Recipients.

    Science.gov (United States)

    Cicora, Federico; Roberti, Javier

    2016-06-01

    Organ transplant recipients may have skin diseases as a result of immunosuppression, but psoriasis is reported infrequently. This skin condition may be induced by immunosuppression imbalance. We present 2 cases of recurrent psoriasis in 2 kidney transplant patients with belatacept-based immunosuppressive regimens. Two years after transplant, upon suspicion of calcineurin inhibitor neurotoxicity in the first patient, tacrolimus was replaced with belatacept. The patient's neurological signs resolved but the patient presented with skin lesions compatible with psoriatic plaques, successfully treated with betamethasone dipropionate and hydrocortisone. The second patient had a history of obesity and dyslipidemia, left foot amputation, and psoriasis. He received a kidney transplant, and maintenance immunosuppression included prednisone, mycophenolate mofetil, and belatacept. At posttransplant month 15, the patient presented with cutaneous erythematosus, maculopapular, and desquamative lesions compatible with psoriasis, treated with betamethasone dipropionate. The belatacept-based immunosuppressive regimens were maintained and psoriasis resolved. Psoriasis is a potential complication in kidney recipients that may recur when belatacept is used and/or tacrolimus is withdrawn as it could have happened in the first patient. The characteristics of the second case may suggest that belatacept might not have been the inciting agent. Good results were obtained with topical treatment.

  5. Evaluation of Immunosuppressive Activity of Demethylzeylasteral in a Beagle Dog Kidney Transplantation Model.

    Science.gov (United States)

    An, Huimin; Zhu, Yu; Xu, Wenping; Liu, Yujun; Zhang, Jianping; Lin, Zongming

    2015-12-01

    Several monomers isolated from Tripterygium wilfordii Hook f. (Celastraceae) have attracted worldwide interest. In this study, we established a simple and reliable kidney transplantation model in beagle dog to evaluate the immunosuppressive activity of demethylzeylasteral (T-96), an immunosuppressive monomer isolated from the root xylem of T. wilfordii. Recipient and donor male beagle dogs were obtained from two different breeders to ensure MHC mismatching. All dogs were randomly divided into six groups following kidney transplantation, and different doses of T-96 or cyclosporine A (CsA) were administered to each group during 14 days of observation. The results showed that T-96 alone at a dosage of 10 or 20 mg/kg/day prolonged graft survival up to 10.83 ± 1.47 or 11.17 ± 1.47 days. A combination of T-96 and CsA significantly prolonged the survival time to 13.33 ± 1.75 days. The results demonstrated that T-96 can inhibit acute rejection in kidney transplantation, and the inhibitory effect of T-96 was enhanced when combined with CsA, which suggests the possible use in organ transplantation to prevent immune rejection.

  6. Cumulative Doses of T-Cell Depleting Antibody and Cancer Risk after Kidney Transplantation.

    Directory of Open Access Journals (Sweden)

    Jenny H C Chen

    Full Text Available T-cell depleting antibody is associated with an increased risk of cancer after kidney transplantation, but a dose-dependent relationship has not been established. This study aimed to determine the association between cumulative doses of T-cell depleting antibody and the risk of cancer after kidney transplantation. Using data from the Australian and New Zealand Dialysis and Transplant Registry between 1997-2012, we assessed the risk of incident cancer and cumulative doses of T-cell depleting antibody using adjusted Cox regression models. Of the 503 kidney transplant recipients with 2835 person-years of follow-up, 276 (55%, 209 (41% and 18 (4% patients received T-cell depleting antibody for induction, rejection or induction and rejection respectively. The overall cancer incidence rate was 1,118 cancers per 100,000 patient-years, with 975, 1093 and 1377 cancers per 100,000 patient-years among those who had received 1-5 doses, 6-10 doses and >10 doses, respectively. There was no association between cumulative doses of T cell depleting antibody and risk of incident cancer (1-5: referent, 6-10: adjusted hazard ratio (HR 1.19, 95%CI 0.48-2.95, >10: HR 1.42, 95%CI 0.50-4.02, p = 0.801. This lack of association is contradictory to our hypothesis and is likely attributed to the low event rates resulting in insufficient power to detect significant differences.

  7. Post-transplant development of C1q-positive HLA antibodies and kidney graft survival.

    Science.gov (United States)

    Piazza, Antonina; Poggi, Elvira; Ozzella, Giuseppina; Adorno, Domenico

    2013-01-01

    The development of de novo human leukocyte antigen (HLA) donor specific antibodies (DSA), detected by both cytotoxic or solid phase assays, was considered the major risk factor for allograft failure in kidney transplantation. However, it was shown that not all patients with persistent production of DSA suffered loss of their grafts. Modified Luminex-Single Antigen assays, able to identify C1q-fixing antibodies, represent a new strategy in assessing the clinical relevance of detected DSA. This study demonstrated that C1q-fixing capability of de novo DSA is a clinically relevant marker of worse outcome and inferior graft survival in kidney transplantation. In fact, our findings evidenced a very low graft survival only in the patients who developed DSA able to fix C1q during post-transplant course, while patients producing C1q-negative DSA had good graft survival, which was comparable to that found in our previous study for DSA-negative patients. Moreover, anti-HLA class II antibodies had a higher incidence than anti-HLA class I, and the ability to fix C1q was significantly more frequent among anti-DQ DSA than anti-DR DSA. Monitoring of de novo C1q-DSA production represents a useful, non-invasive tool for risk stratification and prediction of graft outcome in kidney transplantation.

  8. THE FIRST RUSSIAN EXPERIENCE OF ABO-INCOMPATIBLE KIDNEY TRANSPLANTATION WITH ANTIGEN-SPECIFIC IMMUNOADSORPTION

    Directory of Open Access Journals (Sweden)

    Y. G. Moysyuk

    2011-01-01

    Full Text Available We report the first Russian experience of successful ABO-incompatible kidney transplantation using anti-CD20 + IA + IvIg pretransplant conditioning protocol and tacrolimus + MMF + steroids as maintenance immunosuppression. IA procedures were performed on reusable columns ABO-Adsopak® (POCARD Ltd. Moscow, Russia. IA treatments following the administration of rituximab efficiently lowered the immunoglobulin M (IgM and G (IgG anti-A/B antibodies titers in all patients. The transplantation could be performed in all cases and the kidneys showed primary function. Unfortunately, the biopsy-proven clinical antibody-mediated rejection (AMR occurred in one case. Episo- de of AMR was successfully reversed. On 6, 4 and 2 months follow-up, serum creatinine levels were 117, 127 and 87 μmol/l, respectively. We consider ABO-incompatible transplantation as a safe and promising procedure in particu- lar cases for those patients having related but ABO-incompatible donors. Given the shortage of donor organs ABO- incompatible living donor kidney transplantation may become a treatment of choice for many patients. 

  9. Hypertension after bilateral kidney irradiation in young and adult rats

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    Jongejan, H.T.; van der Kogel, A.J.; Provoost, A.P.; Molenaar, J.C.

    1987-09-01

    The mechanism of a rise in blood pressure after kidney irradiation is unclear but most likely of renal origin. We have investigated the role of the renin-angiotensin system and dietary salt restriction in the development of systolic hypertension after bilateral kidney irradiation in young and adult rats. Three to 12 months after a single X-ray dose of 7.5 or 12.5 Gy to both kidneys of young and adult rats, the systolic blood pressure (SBP) and plasma renin concentration (PRC) were measured regularly. A single X-ray dose of 12.5 Gy caused a moderate rise in SBP and a slight reduction in PRC in both young and adult rats. A dose of 7.5 Gy did not significantly alter the SBP or PRC during the follow-up period of 1 year. In a second experiment, the kidneys of young rats received an X-ray dose of 20 Gy. Subsequently, rats were kept on a standard diet (110 mmol sodium/kg) or a sodium-poor diet (10 mmol sodium/kg). On both diets, SBP started to rise rapidly 3 months after kidney irradiation. Sodium balance studies carried out at that time revealed an increased sodium retention in the irradiated rats compared to controls on the same diet. In rats on a low sodium intake, there was neither a delay nor an alleviation in the development of hypertension. Compared to controls, the PRC tended to be lower in irradiated rats up to 4 months after irradiation. Subsequently, malignant hypertension developed in all 20 Gy rats, resulting in pressure natriuresis, stimulating the renin-angiotensin system. Our findings indicated that hypertension after bilateral kidney irradiation was not primarily the result of an activation of the renin-angiotensin system. Although there were some indications that sodium retention played a role, dietary sodium restriction did not influence the development of hypertension.

  10. A new data-driven model for post-transplant antibody dynamics in high risk kidney transplantation.

    Science.gov (United States)

    Zhang, Yan; Briggs, David; Lowe, David; Mitchell, Daniel; Daga, Sunil; Krishnan, Nithya; Higgins, Robert; Khovanova, Natasha

    2017-02-01

    The dynamics of donor specific human leukocyte antigen antibodies during early stage after kidney transplantation are of great clinical interest as these antibodies are considered to be associated with short and long term clinical outcomes. The limited number of antibody time series and their diverse patterns have made the task of modelling difficult. Focusing on one typical post-transplant dynamic pattern with rapid falls and stable settling levels, a novel data-driven model has been developed for the first time. A variational Bayesian inference method has been applied to select the best model and learn its parameters for 39 time series from two groups of graft recipients, i.e. patients with and without acute antibody-mediated rejection (AMR) episodes. Linear and nonlinear dynamic models of different order were attempted to fit the time series, and the third order linear model provided the best description of the common features in both groups. Both deterministic and stochastic parameters are found to be significantly different in the AMR and no-AMR groups showing that the time series in the AMR group have significantly higher frequency of oscillations and faster dissipation rates. This research may potentially lead to better understanding of the immunological mechanisms involved in kidney transplantation.

  11. Linezolid-induced interstitial nephritis in a kidney-transplant patient.

    Science.gov (United States)

    Esposito, L; Kamar, N; Guilbeau-Frugier, C; Mehrenberger, M; Modesto, A; Rostaing, L

    2007-11-01

    Linezolid is a recent oral antibiotic used in drug-resistant Gram-positive cocci infections. Herein, we report on the first case of linezolid-related acute renal failure in a kidney-transplant patient. A 60-year-old male having autosomic polycystic kidney disease with liver involvement, on cyclosporin A, mycophenolate mofetil and very low dose prednisolone, presented with an Enterococcus faecium abscess of a huge liver cyst, which was treated by percutaneous drainage and linezolid therapy. Eight days after starting linezolid, he presented with acute renal failure, i.e. serum creatinine increased from 136- 221 micromol/l, associated with mild hypereosinophilia, anemia and thrombocytopenia. There was no skin rash, arthralgia, eosinophiluria or proteinuria. The transplant kidney biopsy, performed 15 days after the beginning of linezolid therapy, showed interstitial nephritis and focal tubular atrophy. After linezolid withdrawal and increasing prednisolone daily dose to 20 mg/d, within a few days, serum creatinine had decreased; after 2 and 4 weeks post linezolid withdrawal, his serum creatinine was 166 and 159 micromol/l, respectively. Because of the potential side effects of linezolid, i.e. myelosuppression and possibly nephrotoxicity, we recommend close monitoring of these parameters when linezolid therapy is attempted in kidney transplant patients.

  12. Double-J Versus External Ureteral Stents in Kidney Transplantation: A Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    Vogel

    2015-07-01

    Full Text Available Background Kidney transplantation has long been recognized as the best available therapy for end stage kidney disease. Objectives This study aimed to compare outcomes of double-J versus percutaneous ureteral stent placement in renal transplantation. Patients and Methods A retrospective analysis was performed on data of renal transplantations performed at our institution in a 12-month period. In this period, external and double-J stents were used in parallel. Length of hospital stay and stent-associated complications were evaluated. Results In 76 kidney transplants, 43 external (group 1 and 33 double-J (group 2 urinary stents were used. No significant difference was observed in the number of urinary tract infections, ureteric stenosis or necrosis. The mean overall length of hospital stay was comparable in both groups (20.7 days in group 1 vs 19.3 days in group 2, P = 0.533. For patients without immunological complications, the hospital stay was significantly reduced using double-J stents (12.9 days in group 1, 10.8 days in group 2, P = 0.018. Leakage of the ureteroneocystostomy occurred in 6 out of 43 patients in group 1 (13.9%. No case of anastomotic insufficiency was observed in group 2 (P = 0.035. Macrohematuria was detected in 13 out of the 43 patients in group 1 (30.2%, compared to 3 out of 33 patients in group 2 (9.1%; P = 0.045. Conclusions This nonrandomized comparison of stent types in kidney transplantation supports the use of prophylactic double-J stents in terms of decreased ureteric complications and reduced length of hospital stay.

  13. Atypical hemolytic uremic syndrome diagnosed four years after ABO-incompatible kidney transplantation.

    Science.gov (United States)

    Kawaguchi, Keiko; Kawanishi, Kunio; Sato, Masayo; Itabashi, Mitsuyo; Fujii, Akiko; Kanetsuna, Yukiko; Huchinoue, Shouhei; Ohashi, Ryuji; Koike, Junki; Honda, Kazuho; Nagashima, Yoji; Nitta, Kosaku

    2015-07-01

    Atypical hemolytic uremic syndrome (aHUS) in allograft kidney transplantation is caused by various factors including rejection, infection, and immunosuppressive drugs. We present a case of a 32 year old woman with aHUS four years after an ABO-incompatible kidney transplantation from a living relative. The primary cause of end-stage renal disease was unknown; however, IgA nephropathy (IgAN) was suspected from her clinical course. She underwent pre-emptive kidney transplantation from her 60 year old mother. The allograft preserved good renal function [serum creatinine (sCr) level 110-130 μmol/L] until a sudden attack of abdominal pain four years after transplant, with acute renal failure (sCr level, 385.3 μmol/L), decreasing platelet count, and hemolytic anemia with schizocytes. On allograft biopsy, there was thrombotic microangiopathy in the glomeruli, with a cellular crescent formation and mesangial IgA and C3 deposition. Microvascular inflammation, such as glomerulitis, peritubular capillaritis, and arteriole endarteritis were also detected. A disintegrin-like and metalloproteinase with thrombospondin type 1 motifs 13 (ADAMTS13) did not decrease and Shiga toxin was not detected. Donor-specific antibodies or autoantibodies, including anti-neutrophil cytoplasmic antibody and anti-glomerular basement membrane (anti-GBM) antibody, were negative. The patient was diagnosed with aHUS and received three sessions of plasmapheresis and methylprednisolone pulse therapy, followed by oral methylprednisolone (0.25-0.5 mg/kg) instead of tacrolimus. She temporarily required hemodialysis (sCr level, 658.3 μmol/L). Thereafter, her sCr level improved to 284.5 μmol/L without dialysis therapy. This case is clinically considered as aHUS after kidney transplantation, associated with various factors, including rejection, glomerulonephritis, and toxicity from drugs such as tacrolimus.

  14. First Canadian Case Report of Kidney Transplantation From an HIV-Positive Donor to an HIV-Positive Recipient

    Science.gov (United States)

    Ambaraghassi, Georges; Cardinal, Héloïse; Corsilli, Daniel; Fortin, Claude; Fortin, Marie-Chantal; Martel-Laferrière, Valérie; Malaise, Jacques; Pâquet, Michel R.; Rouleau, Danielle

    2017-01-01

    Rationale: Kidney transplantation has become standard of care for carefully selected patients living with human immunodeficiency virus (HIV) and end-stage renal disease (ESRD) in the highly active antiretroviral therapy (HAART) era. American and European prospective cohort studies have reported similar patient and graft survival compared with HIV-negative kidney transplant recipients. Despite an increased rate of acute rejection, partially due to drug interactions, HIV immunovirologic parameter generally remains under control during immunosuppression. A few cases of kidney transplantation between HIV-infected patients were done in South Africa and showed favorable results. No cases of kidney transplantation from an HIV-positive donor in Canada have previously been reported. Presenting concerns of the patient: A 60-year-old Canadian man with HIV infection presented in 2007 with symptoms compatible with acute renal failure secondary to IgA nephropathy. Chronic kidney disease resulted after the acute episode. Diagnoses: Hemodialysis was started in 2012. The patient was referred for a kidney transplantation evaluation. Interventions: The patient underwent kidney transplantation from an HIV-positive donor in January 2016. The recipient’s antiretroviral regimen consisted of abacavir, lamivudine, and dolutegravir. No drug interactions have been reported between these antiretrovirals and the maintenance immunosuppressive regimen used. Outcomes: The outcome at 7 months post transplantation was excellent, with good graft function and adequate control of HIV replication, in the absence of opportunistic infections at a time when immunosuppression is at its highest intensity. No acute rejection was reported. An episode of bacteremic graft pyelonephritis due to Enterococcus faecalis was successfully treated after transplantation. Novel finding: With careful selection of patient, kidney transplantation between HIV-infected patients is a viable option. The use of antiretroviral

  15. Sleep apnea is not associated with worse outcomes in kidney transplant recipients

    Science.gov (United States)

    Fornadi, Katalin; Ronai, Katalin Zsuzsanna; Turanyi, Csilla Zita; Malavade, Tushar S.; Shapiro, Colin Michael; Novak, Marta; Mucsi, Istvan; Molnar, Miklos Z.

    2014-01-01

    Obstructive sleep apnea(OSA) is one of the most common sleep disorders in kidney transplant recipients, however its long-term consequences have only rarely been investigated. Here, we hypothesized that the presence of OSA would be associated with higher risk of mortality and faster decline of graft function in kidney transplant recipients. In a prospective cohort study 100 prevalent kidney transplant recipients who underwent one-night polysomnography at baseline and were followed for a median 75 months. Generalized linear mixed-effects models and Cox regression models were used to assess the association between OSA and the rate of progression of chronic kidney disease(CKD) and mortality. The estimated slopes of estimated glomerular filtration rate(eGFR) in patients with and without OSA were compared using a two-stage model of eGFR change including only OSA as a variable. In this model patients with OSA (eGFR versus time was −0.93 ml/min/1.73 m2/yr(95%CI:−1.75 to−0.11) had a similar slope as compared to patients without OSA(eGFR versus time was −1.24 ml/min/1.73 m2/yr(95%CI: −1.67 to −0.81). In unadjusted Cox proportional regression analyses OSA was not associated with higher all-cause mortality risk (Hazard Ratio(HR) = 1.20; 95% Confidence Interval(CI): 0.50–2.85). No association was found between the presence of OSA and the rate of progression of CKD or all-cause mortality in prevalent kidney transplant recipients. PMID:25384581

  16. Outcomes of Cardiac Surgery in Patients With Previous Solid Organ Transplantation (Kidney, Liver, and Pancreas).

    Science.gov (United States)

    Vargo, Patrick R; Schiltz, Nicholas K; Johnston, Douglas R; Smedira, Nicholas G; Moazami, Nader; Blackstone, Eugene H; Soltesz, Edward G

    2015-12-15

    A growing number of solid organ transplant survivors require surgery for cardiac disease. We examined the effect of having a previous transplant on outcomes after cardiac surgery in these patients from a population-based perspective. Of 1,709,735 patients who underwent coronary artery bypass grafting, valve, or thoracic aorta surgery from 2004 to 2008 in the Nationwide Inpatient Sample, 3,535 patients (0.21%) had a previous organ transplant (2,712 kidney, 738 liver, 300 pancreas). Multivariate logistic regression analysis and propensity score matching were used to determine the effect of a previous solid organ transplant on outcomes. In-hospital mortality rate was 7% for patients who underwent transplantation versus 4% for patients who did not undergo transplantation (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.16 to 2.38). Patients who underwent transplantation were at an increased risk for acute renal failure (OR 1.62, CI 1.36 to 1.94) and blood transfusions (OR 1.63, CI 1.36 to 1.95). Median length of stay was longer (10 vs 9 days), with greater median total charges ($111,362 vs $102,221; both p mortality after cardiac surgery. Renal protective strategies and bleeding control should be stressed to mitigate complications.

  17. Clinical outcomes of kidney transplants on patients with end-stage renal disease secondary to lupus nephritis, polycystic kidney disease and diabetic nephropathy

    Science.gov (United States)

    Nieto-Ríos, John Fredy; Builes-Rodriguez, Sheila Alexandra; Restrepo-Correa, Ricardo Cesar; Aristizabal-Alzate, Arbey; Ocampo-Kohn, Catalina; Serna-Campuzano, Angélica; Cardona-Díaz, Natalia; Giraldo-Ramirez, Nelson Darío; Zuluaga-Valencia, Gustavo Adolfo

    2016-01-01

    Background: Patients with lupus nephritis could progress to end-stage renal disease (10-22%); hence, kidney transplants should be considered as the treatment of choice for these patients. Objective: To evaluate the clinical outcomes after kidney transplants in patients with chronic kidney diseases secondary to lupus nephritis, polycystic kidney disease and diabetes nephropathy at Pablo Tobon Uribe Hospital. Methods: A descriptive and retrospective study performed at one kidney transplant center between 2005 and 2013. Results: A total of 136 patients, 27 with lupus nephritis (19.9%), 31 with polycystic kidney disease (22.8%) and 78 with diabetes nephropathy (57.4%), were included in the study. The graft survivals after one, three and five years were 96.3%, 82.5% and 82.5% for lupus nephritis; 90%, 86% and 76.5% for polycystic kidney disease and 91.7%, 80.3% and 67.9% for diabetes nephropathy, respectively, with no significant differences (p= 0.488); the rate of lupus nephritis recurrence was 0.94%/person-year. The etiology of lupus vs diabetes vs polycystic disease was not a risk factor for a decreased time of graft survival (Hazard ratio: 1.43; 95% CI: 0.52-3.93). Conclusion: Kidney transplant patients with end stage renal disease secondary to lupus nephritis has similar graft and patient survival success rates to patients with other kidney diseases. The complication rate and risk of recurrence for lupus nephritis are low. Kidney transplants should be considered as the treatment of choice for patients with end stage renal disease secondary to lupus nephritis. PMID:27226665

  18. [The use of a synthetic vascular artificial prosthesis or arterial homograft in cases of patients with the arteriosclerosis and terminal insufficiency of kidney cured by the kidney transplantation].

    Science.gov (United States)

    Pupka, Artur; Blocher, Dariusz; Staniszewski, Tomasz; Płonek, Tomasz; Bogdan, Justyna

    2009-01-01

    Arterial transplantations were practiced in the vascular surgery since the beginning of her formation but without successes in the distant observation. Transplantation of a kidney is a routine conduct in the treatment of the decadent incapacity of a kidney. The dissertation concerns a use of arterial allografts kept using a method of a cold ischaemia in the protective liquid or synthetic vascular dacron artificial limbs or PTFE used as arterial foot-bridges at patients with the atherosclerotic obstruction aortal-pelvic, treated with the kidney transplantation. The arterial transplant is created from the aorta, arteria iliacas common and externa, femoral arteries common and superficial. A tissue material is kept using the method of the cold ischaemia and practical as the aortal foot-bridge-femoral or aortal-two-femoral at classified earlier patients being subjecteds to transfusion. The other way of a transplantation of a kidney at patients with the arteriosclerosis is the realization earlier or one-temporarily the vascular foot-bridge with use of the synthetic artificial limb. It seems that vascular artificial limbs about enlarged resistance on the contagion should be used in such a case. Sonographic examinations with duplex doppler and angiography are performed in all cases. The analysis of such cures can make a creation of the most profitable algorithm of the conduct possible in cases of patients suffering from ischaemia of lower limbs and requiring a transplantation of a kidney because of its incapacity.

  19. Kidney transplant artery stenosis. Interrelationship between blood pressure, kidney function, renin-aldosterone system and body sodium content.

    Science.gov (United States)

    Kornerup, H J; Pedersen, E B; Fjeldborg, O

    1977-01-01

    Among 9 hypertensive recipients with kidney transplant artery stenosis (KTAS) evidence of increased activity of the renin system was present in 3. Surgical repair of KTAS in 4 recipients resulted in an increase in renal plasma flow and glomerular filtration rate associated with a decrease in exchangeable sodium and blood pressure. Peripheral plasma renin and aldosterone values were normal before and after operation in all. It is suggested that sodium retention may counterbalance increased activity of the renin system in KTAS. Preoperative determinations of plasma renin do not predict the effect of surgical repair of KTAS on hypertension.

  20. Prevalence and risk factors of hyperuricemia among kidney transplant recipients.

    Science.gov (United States)

    Einollahi, B; Einollahi, H; Nafar, M; Rostami, Z

    2013-05-01

    Hyperuricemia is common in renal transplant patients (RTRs), especially those on cyclosporine (CsA)-based therapy. We conducted a retrospective study to determine the prevalence of hyperuricemia and its risk factors among RTRs. A total of 17,686 blood samples were obtained from 4,217 RTRs between April 2008 and January 2011. Hyperuricemia was defined as an uric acid level of ≥7.0 mg/dl in men and of ≥6 mg/dl in women that persisted for at least two consecutive tests. Majority (68.2%) of RTRs were normouricemic. Hyperuricemia was more frequent in younger and female RTRs. On multivariate logistic regression, we found high trough level of cyclosporine to be a risk factor for hyperuricemia. In addition, female gender, impaired renal function, and dyslipidemia (hypercholesterolemia, hypertriglyceridemia, and elevated LDL) were also associated with higher probability of hyperuricemia. Hyperuricemia is a common complication after renal transplantation. Risk factors implicated in post-transplant hyperuricemia include high trough level of cyclosporine, female gender, renal allograft dysfunction, and dyslipidemia.

  1. Sustained pyridoxine response in primary hyperoxaluria type 1 recipients of kidney alone transplant.

    Science.gov (United States)

    Lorenz, E C; Lieske, J C; Seide, B M; Meek, A M; Olson, J B; Bergstralh, E J; Milliner, D S

    2014-06-01

    Combined liver kidney transplant is the preferred transplant option for most patients with primary hyperoxaluria type 1 (PH1) given that it removes the hepatic source of oxalate production and improves renal allograft survival. However, PH1 patients homozygous for the G170R mutation can develop normal urine oxalate levels with pyridoxine therapy and may be candidates for kidney alone transplant (KTx). We examined the efficacy of pyridoxine therapy following KTx in five patients homozygous for G170R transplanted between September 1999 and July 2013. All patients were maintained on pyridoxine posttransplant. Median age at transplant was 39 years (range 33-67 years). Median follow-up posttransplant was 8.5 years (range 0.2-13.9 years). At the end of follow-up, four grafts were functioning. One graft failed 13.9 years posttransplant due to recurrent oxalate nephropathy following an acute medical illness. After tissue oxalate stores had cleared, posttransplant urine oxalate levels were pyridoxine therapy following KTx. Therefore, pyridoxine combined with KTx should be considered for PH1 patients with a homozygous G170R mutation.

  2. De novo minimal change disease after ABO-incompatible kidney transplantation.

    Science.gov (United States)

    Mochizuki, Yasushi; Iwata, Takahisa; Nishikido, Masaharu; Uramatsu, Tadashi; Sakai, Hideki; Taguchi, Takashi

    2012-07-01

    We report the clinical and pathological findings of a case of de novo minimal change disease (MCD) after ABO-incompatible living kidney transplantation. A 62-yr-old man with end-stage renal disease associated with type I diabetes received ABO-incompatible kidney transplantation from his 58-yr-old wife. Although allograft function was excellent immediately after surgery, massive proteinuria (35 g/d) appeared on post-transplantation day 5. After the allograft biopsy taken on post-transplantation day 6, he was treated with 12 cycles of plasma exchange, but the nephrotic-range proteinuria showed no remission. The biopsy specimen showed no significant pathological findings on light microscopy, but electron microscopy showed diffuse effacement of podocyte foot processes. Based on the diagnosis of de novo MCD, the patient received intravenous methylprednisolone pulse therapy, followed by high-dose steroid maintenance therapy. The steroid therapy induced complete remission of nephrotic syndrome and stable allograft function immediately, which was also maintained at one yr after the transplantation.

  3. Small-for-size syndrome in adult-to-adult living-related liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Salvatore; Gruttadauria; Duilio; Pagano; Angelo; Luca; Bruno; Gridelli

    2010-01-01

    Small-for-size syndrome (SFSS) in adult-to-adult living-related donor liver transplantation (LRLT) remains the greatest limiting factor for the expansion of segmental liver transplantation from either cadaveric or living donors. Portal hyperperfusion, venous pathology, and the arterial buffer response signif icantly contribute to clinical and histopathological manifestations of SFSS. Here, we review the technical aspects of surgical and radiological procedures developed to treat SFSS in LRLT, along with the...

  4. EARLY ALLOGRAFT DYSFUNCTION AND ACUTE KIDNEY INJURY AFTER LIVER TRANSPLANTATION: DEFINITIONS, RISK FACTORS AND CLINICAL SIGNIFICANCE

    Directory of Open Access Journals (Sweden)

    L. Y. Moysyuk

    2012-01-01

    Full Text Available This review discusses issues related to intensive care in recipients of transplanted liver in the early postoperative period, with an emphasis on contemporary conditions and attitudes that are specific for this group of patients. Early allograft dysfunction (EAD requires immediate diagnosis and appropriate treatment in case. The causes of the EAD and therapeutic tactics are discussed. Acute kidney injury (AKI and renal failure are common in patients after transplantation. We consider etiology, risk factors, diagnosis and treatment guidelines for AKI. The negative impact of EAD and AKI on the grafts survival and recipients is demonstrated. 

  5. Acute Cerebral Infarction after FK 506 Administration in a Kidney Transplantation Recipient: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Ji Kyung; Byun, Woo Mok; Kim, Jae Woon [Yeungnam University College of Medicine, Daegu (Korea, Republic of)

    2011-02-15

    FK506 is widely used as a potent immunosuppressive agent following organ transplantation. However, the use of FK506 is associated with a wide spectrum of neurotoxicity. FK506-induced cerebral infarctions have rarely been reported. We report here on a case of the acute cerebral infarction caused by vasospasm after FK506 administration in a kidney transplantation recipient. There were areas with increased signal intensity on the diffusion-weighted image. The areas showing increased signal intensity on the diffusion- and T2-weighted images demonstrated decreased signal intensity on the apparent diffusion coefficient mapping. MR angiography showed diffuse stenosis in both the anterior and middle cerebral arteries

  6. APOL1 genotype and kidney transplantation outcomes from deceased African American donors

    Science.gov (United States)

    Freedman, Barry I.; Pastan, Stephen O.; Israni, Ajay K.; Schladt, David; Julian, Bruce A.; Gautreaux, Michael D.; Hauptfeld, Vera; Bray, Robert A.; Gebel, Howard M.; Kirk, Allan D.; Gaston, Robert S.; Rogers, Jeffrey; Farney, Alan C.; Orlando, Giuseppe; Stratta, Robert J.; Mohan, Sumit; Ma, Lijun; Langefeld, Carl D.; Bowden, Donald W.; Hicks, Pamela J.; Palmer, Nicholette D.; Palanisamy, Amudha; Reeves-Daniel, Amber M.; Brown, W. Mark; Divers, Jasmin

    2015-01-01

    Background Two apolipoprotein L1 gene (APOL1) renal-risk variants in donors and African American (AA) recipient race are associated with worse allograft survival in deceased-donor kidney transplantation (DDKT) from AA donors. To detect other factors impacting allograft survival from deceased AA kidney donors, APOL1 renal-risk variants were genotyped in additional AA kidney donors. Methods APOL1 genotypes were linked to outcomes in 478 newly analyzed DDKTs in the Scientific Registry of Transplant Recipients. Multivariate analyses accounting for recipient age, sex, race, panel reactive antibody level, HLA match, cold ischemia time, donor age, and expanded-criteria donation were performed. These 478 transplantations and 675 DDKTs from a prior report were jointly analyzed. Results Fully-adjusted analyses limited to the new 478 DDKTs replicated shorter renal allograft survival in recipients of APOL1-two-renal-risk-variant kidneys (HR 2.00; p=0.03). Combined analysis of 1153 DDKTs from AA donors revealed donor APOL1 high-risk genotype (HR 2.05; p=3×10−4), older donor age (HR 1.18; p=0.05), and younger recipient age (HR 0.70; p=0.001) adversely impacted allograft survival. Although prolonged allograft survival was seen in many recipients of APOL1-two-renal-risk-variant kidneys, follow-up serum creatinine concentrations were higher than in recipients of zero/one APOL1-renal-risk variant kidneys. A competing risk analysis revealed that APOL1 impacted renal allograft survival, but not recipient survival. Interactions between donor age and APOL1 genotype on renal allograft survival were non-significant. Conclusions Shorter renal allograft survival is reproducibly observed after DDKT from APOL1-two-renal-risk-variant donors. Younger recipient age and older donor age have independent adverse effects on renal allograft survival. PMID:26566060

  7. Distinguishing internal property from external property in kidney transplantation.

    Science.gov (United States)

    Prasad, G V Ramesh

    2016-08-01

    What determines the ownership of human body parts? In this paper, I argue that this question can be informed by an exploration of the cognitive distinction between property external to the human body such as houses, cars or land, and internal property such as organs that are located within anatomical body confines. Each type of property has distinct brain representations and possibly different effects on the sense of self. This distinction may help explain the divergence in post-donation outcomes seen in different kidney donor populations. Poor outcomes in some types of kidney donors may be due not only to a failure in their proper selection by standard medical testing or post-donation care but may also be a manifestation of differing effects on sense of self resulting from transfer of their internal property. Because a kidney is internal property, a hypothesis worth exploring is that those who experience good outcomes post-donation experience dopaminergic activation and a feeling of reward, while those experiencing bad outcomes are instead overcoming cortisol or adrenergic-based stress or fear responses without a corresponding feeling of reward, disrupting of their sense of self. Discussions about the rules for internal property transfer must be based not only on values and laws designed to govern external property but also on cognitive science-based facts, values and judgments that discussions of external property do not presently accommodate. Any future system of rules for governing organ distribution requires a framework different from that of external property to prevent harm to living kidney donors.

  8. Sequential and simultaneous revascularization in adult orthotopic piggyback liver transplantation

    NARCIS (Netherlands)

    Polak, WG; Miyamoto, S; Nemes, BA; Peeters, PMJG; de Jong, KP; Porte, RJ; Slooff, MJH

    2005-01-01

    The aim of the study was to assess whether there is a difference in outcome after sequential or simultaneous revascularization during orthotopic liver transplantation (OLT) in terms of patient and graft survival, mortality, morbidity, and liver function. The study population consisted of 102 adult p

  9. Transplantation with positive complement-dependent microcytotoxicity crossmatch in contemporary kidney transplantation: Practice patterns and associated outcomes

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    Ralph J Graff

    2012-01-01

    Full Text Available We analyzed clinical factors and graft survival associated with complement-dependent microcytotoxicity (CDC crossmatch (XM positive (+ kidney transplants in 1995 to 2009 United Network of Sharing (UNOS registry data. CDCXM negative (- transplants were selected from centers and years in which at least one CDCXM+ transplant was performed at a given center in a given year. CDCXM+ and CDCXM- results were compared with bivariate and multivariate survival analysis. Our observations are as follows: (1 The risk of graft loss with CDCXM+ vs. CDCXM- results was markedly lower than the risk observed historically, e.g., living donor (LD-CDCXM+ absolute all-cause graft survival reductions were 0.7% at 24 hours (P=0.007, 2.9% at one year (P <0.0001, 3.7% at five years (P<0.0001; deceased donor (DD-CDCXM+ absolute graft survival reductions were 0.7% at 24 hours (P=0.02, 3.5% at one year (P <0.0001, 2.7% at five years (P=0.0009. On covariate adjustment, the only significant association of CDCXM+ vs. CDCXM- results was with one-year graft loss risk: LD aHR 1.44 (95% CI 1.05-1.96, DD aHR 1.33 (CI 1.10-1.61. (2 CDCXM+ transplantation was more commonly performed among groups disadvantaged with respect to transplant access, including sensitized, previously transplanted women and black recipients. (3 In CDCXM+ recipients, there was a high percentage of flow cytometry (FC XM- and autoXM+ results. After removing these groups, outcomes with CDCXM+ results were relatively good. (4 CDCXM+/FCXM+ vs. CDCXM-/FCXM- graft loss risk was observed only in LD recipients transplanted at centers performing fewer than 10 such transplants during the study period: 11.0% reduction (P<0.0001 and aHR of 2.86 (CI 1.18-6.94 at one year; 14.7% reduction (P<0.0001 and aHR of 1.77 (CI 0.88-3.58 at five years. Although using CDCXM+ as a contraindication to transplantation has been associated with virtual elimination of hyperacute rejection, the negative effect of a CDCXM+ in contemporary

  10. Pregnancy after kidney transplantation: when is the best time? - 10.4025/actascihealthsci.v34ispec.10554

    Directory of Open Access Journals (Sweden)

    Gustavo Falcão Gama

    2012-12-01

    Full Text Available The authors report a case of a patient underwent kidney transplantation that went through an unplanned pregnancy, at 41 years old, as well as the implications for both mother and fetus.  

  11. [Kidney transplant patients without social protection in health: what do patients say about the economic hardships and impact?].

    Science.gov (United States)

    Mercado-Martínez, Francisco Javier; Hernández-Ibarra, Eduardo; Ascencio-Mera, Carlos D; Díaz-Medina, Blanca A; Padilla-Altamira, Cesar; Kierans, Ciara

    2014-10-01

    Kidney transplant is the optimal treatment for renal disease according to biomedical criteria, but the technology is highly expensive. The aim of this article was to examine the economic hardships experienced by kidney transplant patients and the impact on their lives, specifically when they lack social protection in health. The article reports on a qualitative study conducted in Mexico. Twenty-one kidney transplant patients participated. Semi-structured interviews were performed and submitted to content analysis. Patients experience extreme economic hardship due to the high cost of renal therapies, particularly medicines. Such economic problems adversely affect their condition, since many patients report difficulties in maintaining their immunosuppressant medication, attending medical appointments, and curtailing household expenditures, further aggravated by loss of earnings. In conclusion, kidney transplantation is associated with patients' impoverishment when they lack social protection in health. A protection system is urgently needed for this group.

  12. Renal artery stenosis in kidney transplants: assessment of the risk factors

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    Ghabili K

    2011-08-01

    Full Text Available Jalal Etemadi1, Khosro Rahbar2, Ali Nobakht Haghighi2, Nazila Bagheri2, Kianoosh Falaknazi2, Mohammad Reza Ardalan1, Kamyar Ghabili3, Mohammadali M Shoja31Department of Nephrology, Dialysis and Transplantation, Tabriz University of Medical Sciences, Tabriz, 2Department of Nephrology, Shaheed Beheshti University of Medical Sciences, Tehran, 3Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IranBackground: Transplant renal artery stenosis (TRAS is an important cause of hypertension and renal allograft dysfunction occurring in kidney transplant recipients. However, conflicting predisposing risk factors for TRAS have been reported in the literature.Objective: The aim of the present study was to assess the potential correlation between possible risk factors and TRAS in a group of living donor renal transplant recipients 1 year after the renal transplantation.Methods: We evaluated the presence of renal artery stenosis in 16 recipients who presented with refractory hypertension and/or allograft dysfunction 1 year after renal transplantation. Screening for TRAS was made by magnetic resonance angiography and diagnosis was confirmed by conventional renal angiography. Age, gender, history of acute rejection, plasma lipid profile, serum creatinine, blood urea nitrogen, serum uric acid, calcium phosphate (CaPO4 product, alkaline phosphatase, fasting blood sugar, hemoglobin, and albumin were compared between the TRAS and non-TRAS groups.Results: Of 16 kidney transplant recipients, TRAS was diagnosed in three patients (two men and one woman. High levels of calcium, phosphorous, CaPO4 product, and low-density lipoprotein (LDL cholesterol were significantly correlated with the risk of TRAS 1 year after renal transplantation (P < 0.05. Serum level of uric acid tended to have a significant correlation (P = 0.051.Conclusion: Correlation between high CaPO4 product, LDL cholesterol, and perhaps uric acid and TRAS in living

  13. Non-melanoma skin cancer in Portuguese kidney transplant recipients - incidence and risk factors*

    Science.gov (United States)

    Pinho, André; Gouveia, Miguel; Cardoso, José Carlos; Xavier, Maria Manuel; Vieira, Ricardo; Alves, Rui

    2016-01-01

    Background Cancer is currently among the three leading causes of death after solid organ transplantation and its incidence is increasing. Non-melanoma skin cancer - squamous cell carcinoma and basal cell carcinoma - is the most common malignancy found in kidney transplant recipients (KTRs). The incidence of non-melanoma skin cancer in KTRs has not been extensively studied in Portugal. Objectives To determine the incidence of non-melanoma skin cancer in KTRs from the largest Portuguese kidney transplant unit; and to study risk factors for non-melanoma skin cancer. Methods Retrospective analysis of clinical records of KTRs referred for the first time for a dermatology consultation between 2004 and 2013. A case-control study was performed on KTRs with and without non-melanoma skin cancer. Results We included 288 KTRs with a median age at transplantation of 47 years, a male gender predominance (66%) and a median transplant duration of 3.67 years. One fourth (n=71) of KTRs developed 131 non-melanoma skin cancers, including 69 (53%) squamous cell carcinomas and 62 (47%) basal cell carcinomas (ratio squamous cell carcinoma: basal cell carcinoma 1.11), with a mean of 1.85 neoplasms per patient. Forty percent of invasive squamous cell carcinomas involved at least two clinical or histological high-risk features. The following factors were associated with a higher risk of non-melanoma skin cancer: an older age at transplantation and at the first consultation, a longer transplant duration and the presence of actinic keratosis. KTRs treated with azathioprine were 2.85 times more likely to develop non-melanoma skin cancer (p=0.01). Conclusion Non-melanoma skin cancer was a common reason for dermatology consultation in Portuguese KTRs. It is imperative for KTRs to have access to specialized dermatology consultation for early referral and treatment of skin malignancies. PMID:27579740

  14. Staged microvascular anastomosis training program for novices:transplantation of both kidneys from one rat donor

    Institute of Scientific and Technical Information of China (English)

    Zhou Shoujun; Li Enchun; He Jun; Weng Guobin; Yuan Hexing; Hou Jianquan

    2014-01-01

    Background Rat renal transplantation is an essential experimental model and requires greater microsurgical skills.Thus,training novices to perform quick and reliable microvascular anastomosis is of vital importance for rat renal transplantation.In this study,we developed and evaluated a staged microvascular anastomosis training program for novices,harvesting and transplanting both kidneys from one rat donor.Methods Five trainees without any prior microsurgical experience underwent a training program in which the goals were staged according to difficulty.Each trainee had to achieve satisfactory results as evaluated by a mentor before entering the next stage.Rat renal transplantation was accomplished by end-to-end technique with a bladder patch.In the intensive rat renal transplantation stage,the trainees required an average of 20 independent attempts at isotransplantation as final training assessment.Results After 2 months of intensive practice,all trainees had achieved stable and reproducible rat renal transplantation,with a satisfactory survival rate of 85.9% at postoperative Day 7.The total mean operative time was 78.0 minutes and the mean hot ischemia time was 26.2 minutes.With experience increasing,the operative time for each trainee showed a decreasing trend,from 90-100 minutes to 60-70 minutes.After 20 cases,the mean operative time of the trainees was not statistically significantly different from that of the mentor.Conclusion Harvesting and transplanting both kidneys from one rat donor after a staged microvascular anastomosis training program is feasible for novices without any prior microsurgical skills.

  15. The outcome of living related kidney transplantation with multiple renal arteries

    Directory of Open Access Journals (Sweden)

    Hafiz Shahzad Ashraf

    2013-01-01

    Full Text Available The aim of our study was to compare the surgical complications and short-term outcome of renal transplants with single and multiple renal artery grafts. We reviewed the records of 105 kidney transplantations performed consecutively at our institution from July 2006 to May 2010. The data of 33 (31.4% renal transplants with multiple arteries were compared with the 72 transplants with single artery (68.6%, and the incidence of surgical complications, post-transplant hypertension, acute tubular necrosis, acute graft rejection, mean creatinine level, and patient and graft survival was analyzed. We further subdivided the study recipients into three groups: group A (n = 72 with one-renal-artery allografts and one-artery anastomosis, group B (n = 6 with mul-tiple-artery allografts with single-artery anastomosis, and group C (n = 27 with multiple-artery allografts with multiple arterial anasatomosis, and compared their outcome. No significant diffe-rences were observed among the recipients of all the three groups regarding early vascular and urological complications, post-transplant hypertension, acute tubular necrosis, acute rejection, creatinine level, and graft and patient survival. The mean cold ischemia time in groups B and C was significantly higher (P <0.05. One patient in group A developed renal vein thrombosis resulting in graft nephrectomy. None of the patients with multiple renal arteries developed either vascular or urological complications. In conclusion, kidney transplantation using grafts with mul-tiple renal arteries is equally safe as using grafts with single renal artery, regarding vascular, urological complications, as well as patient and graft survival.

  16. Combined Lung-Kidney Transplantation: An Analysis of the UNOS/OPTN Database.

    Science.gov (United States)

    Reich, Heidi J; Chan, Joshua L; Czer, Lawrence S C; Mirocha, James; Annamalai, Alagappan A; Cheng, Wen; Jordan, Stanley C; Chaux, George; Ramzy, Danny

    2015-10-01

    Poor outcomes after thoracic transplantation with concurrent renal dysfunction are well described: without transplantation or with thoracic-only transplantation, patients face unacceptably high mortality. Outcomes after combined lung-kidney transplantation (LKT) remain largely uninvestigated. The United Network for Organ Sharing/Organ Procurement and Transplantation Network database was queried to identify all LKTs, lung transplantations (LTs), and kidney transplantations (KTs) performed in the United States from 1995 to 2013. Survival was calculated using the Kaplan-Meier method and compared using log-rank tests or Cox regression models. Thirty-one LKTs were performed. Mean recipient age was 45.4 ± 13.5 years; 48.3 per cent were male. Retransplantation for graft failure was the leading indication for LT (n = 13) and the most common renal indication was calcineurin inhibitor nephrotoxicity (n = 11). Mean lung allocation score was 46.6 ± 14.4, mean creatinine was 3.7 ± 2.8 g/dL, and glomerular filtration rate was 23.1 (interquartile range 11.9, 38.3) mL/min/1.7 m(2), and 11 (35.5%) were dialysis dependent. Patient survival after LKT was 92.9 per cent, 71.0 per cent, and 71.0 per cent at one month, six months, and one year, with a median survival of 95.2 months. One- and five-year survival after LKT, 71.0 per cent and 59.9 per cent, were similar to LT (n = 23,913), 81.7 per cent and 51.4 per cent (P = 0.061 and 0.55), and inferior to KT (n = 175,269), 94.9 per cent and 82.8 per cent (P < 0.0001), respectively. Patient survival after LKT was similar to isolated LT, and these results suggest that LKT is a feasible therapeutic option for LT candidates with significant renal dysfunction.

  17. Recipient Related Prognostic Factors for Graft Survival after Kidney Transplantation. A Single Center Experience

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    Alina Daciana ELEC

    2012-09-01

    Full Text Available Background and Aim. Advanced chronic kidney disease (CKD severely impairs life expectancy and quality of life in affected patients. Considering its benefits, renal transplantation currently represents the optimal treatment solution for end stage kidney disease patients. Pre-transplant assessment aims to maximize the graft and patient survival by identifying potential factors influencing the post-transplant outcome. The aim of this study has been to analyze recipient related prognostic factors bearing an impact on graft survival. Material and Methods. We analyzed the graft outcomes of 426 renal transplantations performed at the Clinical Institute of Urology and Renal Transplantation of Cluj-Napoca, between January 2004 and December 2008. Variables related to recipient and to potential donor/recipient prognostic factors were studied using univariate and multivariate analysis. Results. Graft survivals at 1, 3, 5 and 7 years were 94.01%, 88.37%, 82.51% and 78.10%, respectively. Chronic rejection (41.11% and death with a functioning graft (18.88% were the main causes of graft loss. In uni and multivariate analysis the recipient related variables found to influence the renal graft outcome were: peritoneal dialysis, pre transplant residual diuresis, grade I hypertension, severe iliac vessel atheromatosis, ischemic heart disease, stroke history, dyslipidemia and denutrition. The worst graft outcomes have been found for recipients on peritoneal dialysis, with anuria, hypotension, severe iliac atheromatosis, ischemic heart disease, stroke history, dyslipidemia and a poor nutritional status. Conclusion. The type of dialysis, the pre transplant residual diuresis, recipient arterial blood pressure, iliac vessel atheromatosis, ischemic heart disease, stroke history, dyslipidemia and denutrition significantly influence graft survival.

  18. TCC in Transplant Ureter--When and When Not to Preserve the Transplant Kidney.

    Science.gov (United States)

    Olsburgh, J; Zakri, R H; Horsfield, C; Collins, R; Fairweather, J; O'Donnell, P; Koffman, G

    2016-02-01

    We present four cases of transitional cell carcinoma of the transplant ureter (TCCtu). In three cases, localized tumor resection and a variety of reconstructive techniques were possible. Transplant nephrectomy with cystectomy was performed as a secondary treatment in one locally excised case. Transplant nephroureterectomy was performed as primary treatment in one case. The role of oncogenic viruses and genetic fingerprinting to determine the origin of TCCtu are described. Our cases and a systematic literature review illustrate the surgical, nephrological, and oncological challenges of this uncommon but important condition.

  19. The Impact of Amlodipine on Gingival Enlargement After Kidney Transplantation

    Science.gov (United States)

    Rostami, Zohreh; Einollahi, Behzad; Einollahi, Mohammad Javad; lessan, Simin

    2012-01-01

    Abstract Background: Although cyclosporine (CsA) and calcium channel blockers (CCBs) parallel to each other may provoke gingival enlargement (GE), there are few considerations about combined effects of CsA and CCBs on gingival tissues. Objectives: This study aimed to determine prevalence of GE among renal transplant recipients and to compare its occurrence in patients who received only CsA and those who were on CsA and amlodipine. Patients and Methods: We conducted a prospective randomized case-control trial including 213 renal transplant recipients between February 2010 and August 2010. They were randomly divided into two groups including control group (on continuous treatment with CsA alone; n = 112) and trial group (treated with combined CsA and amlodipine; n = 101). Buccal, lingual, and inter-proximal membranes at last 12 anterior teeth were assessed for GE and packet depth (PD) using Gingival Index of McGaw and others, and Packet Index of Turesky–Gilmore–Glickman, respectively. Results: Marked GE was observed in 26 patients (25.7%) in trial group and only in 4 individuals (3.6%) in control group (P = 0.000). In logistic regression analysis, obese (OR = 3, P = 0.04), older (OR = 2.8, P = 0.03), and female (OR = 1.3, P = 0.03) recipients as well as who received high dose amlodipine (OR = 4.4, P = 0.000) were at risk for marked GE. Conclusions: There is a strong correlation between GE, in particular marked GE, and combination therapy with CsA and amlodipine in transplant patients compared to those treated by CsA alone. We suggest CsA dose reduction may restrain this adverse effect. PMID:23573487

  20. Measuring cyclosporine in whole blood in kidney transplantation

    OpenAIRE

    Bottini,P.V.; Alves-Cunha,F.A.; Moda,M.A.; Souza,M.I.; Garlipp, C.R.

    1998-01-01

    INTRODUÇÃO E OBJETIVOS: Ciclosporina A é uma droga imunossupressora potente e efetiva no combate à rejeição de órgãos transplantados. No presente estudo, os autores avaliaram o emprego de um imunoensaio monoclonal com fluorescência polarizada (FPIAm), como um método alternativo ao radioimunoensaio (RIA) para determinação dos níveis de ciclosporina em sangue total. MATERIAL E MÉTODOS: Amostras de sangue de 65 pacientes submetidos a transplante renal foram colhidas em frascos com EDTA 12 horas ...

  1. Immunosuppressive therapy for kidney transplantation in children and adolescents: systematic review and economic evaluation.

    Science.gov (United States)

    Haasova, Marcela; Snowsill, Tristan; Jones-Hughes, Tracey; Crathorne, Louise; Cooper, Chris; Varley-Campbell, Jo; Mujica-Mota, Ruben; Coelho, Helen; Huxley, Nicola; Lowe, Jenny; Dudley, Jan; Marks, Stephen; Hyde, Chris; Bond, Mary; Anderson, Rob

    2016-01-01

    BACKGROUND End-stage renal disease is a long-term irreversible decline in kidney function requiring kidney transplantation, haemodialysis or peritoneal dialysis. The preferred option is kidney transplantation followed by induction and maintenance immunosuppressive therapy to reduce the risk of kidney rejection and prolong graft survival. OBJECTIVES To systematically review and update the evidence for the clinical effectiveness and cost-effectiveness of basiliximab (BAS) (Simulect,(®) Novartis Pharmaceuticals) and rabbit antihuman thymocyte immunoglobulin (Thymoglobuline,(®) Sanofi) as induction therapy and immediate-release tacrolimus [Adoport(®) (Sandoz); Capexion(®) (Mylan); Modigraf(®) (Astellas Pharma); Perixis(®) (Accord Healthcare); Prograf(®) (Astellas Pharma); Tacni(®) (Teva); Vivadex(®) (Dexcel Pharma)], prolonged-release tacrolimus (Advagraf,(®) Astellas Pharma); belatacept (BEL) (Nulojix,(®) Bristol-Myers Squibb), mycophenolate mofetil (MMF) [Arzip(®) (Zentiva), CellCept(®) (Roche Products), Myfenax(®) (Teva), generic MMF is manufactured by Accord Healthcare, Actavis, Arrow Pharmaceuticals, Dr Reddy's Laboratories, Mylan, Sandoz and Wockhardt], mycophenolate sodium, sirolimus (Rapamune,(®) Pfizer) and everolimus (Certican,(®) Novartis Pharmaceuticals) as maintenance therapy in children and adolescents undergoing renal transplantation. DATA SOURCES Clinical effectiveness searches were conducted to 7 January 2015 in MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Central Register of Controlled Trials (via Wiley Online Library) and Web of Science [via Institute for Scientific Information (ISI)], Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment (HTA) (The Cochrane Library via Wiley Online Library) and Health Management Information Consortium (via Ovid). Cost-effectiveness searches were conducted to 15 January 2015 using a costs or economic literature search filter in MEDLINE

  2. Treatment of Severe Post-kidney-transplant Lung Infection by Integrative Chinese and Western Medicine

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective: To explore treatments of severe post-kidney-transplant lung infection by integrative Chinese and Western medicine (ICWM), in order to elevate the curing rate as well as to lower the death rate. Methods: Based on conventional ways of Western medical treatments of 18 cases of severe post-kidney-transplant lung infection, such as putting the patients in single individual ward, antibiotics to prevent infection, respiratory machines, blood filtration, nutritional support, steroids, and maintaining electrolytes balance, we applied integrated Chinese medicinal treatments, like altering conventional prescription "pneumonia Ⅲ ", and conducted clinical observation of effectiveness, and indexes including white blood cell (WBC), neutrophilic granulocyte, blood urea nitrogen (BUN), blood creatinine (Cr), etc. Results: Of the 18cases studied, 7 were already cured, 8 proved the treatment effective, 3 died. All clinical indexes had statistically significant changes compared with those of before treatment (P<0.01). Conclusion: ICWM can increase curing rate and lower death rate.

  3. Tubulovillous Adenoma in the Bladder in a Dual Pancreas-Kidney Transplant Patient

    Science.gov (United States)

    Remondini, Taylor; Van Zyl, Stephan; Bismar, Tarek A.; Yilmaz, Serdar

    2017-01-01

    Abstract Background: A rare report of a tubulovillous adenoma arising in the setting of a dual pancreas-kidney transplant patient. Case Presentation: This adenoma was discovered in a 60-year-old male with a dual pancreas-kidney transplant that presented with urinary retention and gross hematuria. Management of this patient required both transurethral resection of the tumor as well as a laparotomy after recurrence. Follow-up with cystoscopy has shown no further recurrence of the tumor. Conclusion: This case adds to the few cases documented of adenomas arising in bladders augmented with gastrointestinal tract tissue. The tumor may reflect growth from donor duodenal graft tissue, however, the metaplasia of urothelial tissue cannot be fully ruled out. Based on this case, our understanding of these rare tumors and their clinical course is deepened. PMID:28265591

  4. Donor-specific antibodies accelerate arteriosclerosis after kidney transplantation.

    Science.gov (United States)

    Hill, Gary S; Nochy, Dominique; Bruneval, Patrick; Duong van Huyen, J P; Glotz, Denis; Suberbielle, Caroline; Zuber, Julien; Anglicheau, Dany; Empana, Jean-Philippe; Legendre, Christophe; Loupy, Alexandre

    2011-05-01

    In biopsies of renal allografts, arteriosclerosis is often more severe than expected based on the age of the donor, even without a history of rejection vasculitis. To determine whether preformed donor-specific antibodies (DSAs) may contribute to the severity of arteriosclerosis, we examined protocol biopsies from patients with (n=40) or without (n=59) DSA after excluding those with any evidence of vasculitis. Among DSA-positive patients, arteriosclerosis significantly progressed between month 3 and month 12 after transplant (mean Banff cv score 0.65 ± 0.11 to 1.12 ± 0.10, P=0.014); in contrast, among DSA-negative patients, we did not detect a statistically significant progression during the same timeframe (mean Banff cv score 0.65 ± 0.11 to 0.81 ± 0.10, P=not significant). Available biopsies at later time points supported a rate of progression of arteriosclerosis in DSA-negative patients that was approximately one third that in DSA-positive patients. Accelerated arteriosclerosis was significantly associated with peritubular capillary leukocytic infiltration, glomerulitis, subclinical antibody-mediated rejection, and interstitial inflammation. In conclusion, these data support the hypothesis that donor-specific antibodies dramatically accelerate post-transplant progression of arteriosclerosis.

  5. Irreversible Unilateral Gynecomastia in a Cadaveric Kidney Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Kenan TURGUTALP

    2015-12-01

    Full Text Available Gynecomastia (GM is a benign condition characterized by enlargement of the male breast, which is attributed to proliferation of the glandular tissue and local fat deposition. We present here a case with unilateral GM that gradually developed after cadaveric renal transplantation. A 37-year-old man who underwent renal transplantation in 2010 was admitted to our center with complaints of unilateral right-sided GM. There was no nipple discharge, pain or redness in the affected breast. His graft was functioning well. His medications consisted of Cyclosporine (CsA at a dose of 200 mg/d, mycophenolic acid at a dose of 2000 mg/d, prednisolone at a dose of 5 mg/d, doxazosin 8 mg/d, and metoprolol 50 mg/d. CsA-induced GM was considered, and CsA was switched to sirolimus. After two months, GM regression was not observed. Fine needle aspiration of a right breast mass revealed a benign condition. Estrogen and progesterone receptor was strongly positive on microscopic examination of the tissue. GM is a rare condition that is generally caused by CsA treatment. However, GM may persist after the discontinuation of CsA.

  6. Anaesthesia for laparoscopic kidney transplantation: Influence of Trendelenburg position and CO 2 pneumoperitoneum on cardiovascular, respiratory and renal function

    Directory of Open Access Journals (Sweden)

    Beena Kandarp Parikh

    2013-01-01

    Full Text Available Background: Laparoscopic donor nephrectomy is a routine practice since 1995. Until now, the recipient has always undergone open surgery for transplantation. In our institute, laparoscopic kidney transplantation (LKT started in 2010. To facilitate this surgery, the patient must be in steep Trendelenburg position for a long duration. Hence, we decided to study the effect of CO2 pnuemoperitoneum and Trendelenburg position in chronic renal failure (CRF patients undergoing LKT. Methods: A total of 20 adult CRF patients having mean age of 31.7±10.36 years and body mass index 19.65±3.41 kg/m 2 without significant coronary artery disease were selected for the procedure. Cardiovascular parameters heart rate (HR, mean arterial pressure (MAP, Central venous pressure (CVP and respiratory parameters (ETCO 2 , peak airway pressure were noted at the time of induction, after induction, 15 min after creation of pnuemoperitoneum, 30 min after Trendelenburg position, 15 min after decompression of pnuemoperitonuem and after extubation. Arterial blood gas analysis was carried out after induction, 15 min after creation of pnuemoperitoneum, 30 min after Trendelenburg position and 15 min after clamp release. Total duration of surgery, anastomosis time, time for the establishment of urine output and total urine output were noted. Serum creatinine on the 1 st and 7 th post-operative day were recorded. Results: Significant increase in HR was observed after creation of CO 2 pneumoperitoneum and just before extubation. Significant increase in the MAP and CVP was noted after creation of pneumoperitoneum and after giving Trendelenburg position. No significant rise in the ETCO 2 and PaCO 2 was observed. Significant increase in the base deficit was observed after the clamp release, but none of the patients required correction. Conclusion: LKT performed in steep Trendelenburg position with CO 2 pneumoperitoneum significantly influenced cardiovascular and respiratory

  7. Glomerulocystic kidney disease in an adult with enlarged kidneys: a case report and review of the literature.

    Science.gov (United States)

    Obata, Y; Furusu, A; Miyazaki, M; Nishino, T; Kawazu, T; Kanamoto, Y; Nishikido, M; Taguchi, T; Kohno, S

    2011-02-01

    We report the case of a 31-year-old male with enlarged kidneys and glomerulocystic kidney disease (GCKD). The patient had no family history of renal disease or other diseases. On initial presentation he complained of poor eyesight, and hypertensive retinopathy and elevated serum creatinine (5.0 mg/dl) were found at that time. Renal biopsy showed cystic dilatation of Bowman's capsule and atrophy of the glomerular tuft. Thus, an adult case of sporadic GCKD was diagnosed. Based on previous reports, kidney size in patients with adult type GCKD varies from small to large. Our patient's kidneys are the largest ever reported (right kidney was 22 cm×10 cm, left kidney was 19 cm×10 cm). A review of the literature dealing with sporadic adult GCKD suggested that it is difficult to diagnose this disease early in its course.

  8. Pure red cell aplasia in a simultaneous pancreas-kidney transplantation patient: inside the erythroblast

    Directory of Open Access Journals (Sweden)

    Francesca Labbadia

    2012-09-01

    Full Text Available A case of pure red cell aplasia in a simultaneous kidney-pancreas transplant recipient on immunosuppressive therapy is reported here. The patient presented with anemia unresponsive to erythropoietin treatment. Bone marrow cytomorphology was highly suggestive of parvovirus pure red cell aplasia, which was confirmed with serology and polymerase chain reaction positive for parvovirus B19 DNA in peripheral blood. After the administration of intravenous immunoglobulin the anemia improved with a rising number of the reticulocytes.

  9. SUCCESSFUL ABO-INCOMPATIBLE KIDNEY TRANSPLANTATION FROM LIVING-RELATED DONOR IN HIGH-SENSITIZED PATIENT

    Directory of Open Access Journals (Sweden)

    A. I. Sushkov

    2012-01-01

    Full Text Available This case report describes a patient initially found to have an extremely high anti-B IgM (1:1024 and IgG (1:512 titres.Additionally, patient had previous diseased donor kidney transplantation and high level of anti-HLA panel- reactive antibodies (60%. We focused on immunological monitoring during the pretransplant conditioning and posttransplant period. 

  10. More than skin deep? Potential nicotinamide treatment applications in chronic kidney transplant recipients

    OpenAIRE

    Bostom, Andrew G.; Merhi, Basma; Walker, Joanna; Robinson-Bostom, Leslie

    2016-01-01

    Non-melanoma cutaneous carcinomas, or skin cancers, predominantly squamous cell carcinomas (SCCs), are the most common malignancies occurring in kidney transplant recipients (KTRs). Squamous cell carcinoma risk is dramatically elevated in KTRs, occurring at rates of up 45-250 times those reported in general populations. New non-melanoma skin cancers in KTRs with a prior non-melanoma skin cancer also develop at 3-times the rate reported in non-KTRs with the same clinical history. The unique ag...

  11. Tamm-Horsfall protein in urine after uninephrectomy/transplantation in kidney donors and their recipients

    DEFF Research Database (Denmark)

    Torffvit, O; Kamper, A L; Strandgaard, S

    1997-01-01

    Tamm-Horsfall protein (THP) is a large glycoprotein with unknown physiological function synthesized in the thick ascending limb of the loop of Henle. Urinary THP has recently been suggested as being suitable for monitoring the functional state of transplanted kidneys. In the present study...... days after uninephrectomy (p p ... in the recipients but the difference was not significant. The correlation between excretion rate of THP and GFR was significant (r = 0.66; p

  12. Congenital hepatic fibrosis, liver cell carcinoma and adult polycystic kidneys.

    Science.gov (United States)

    Manes, J L; Kissane, J M; Valdes, A J

    1977-06-01

    In reviewing the literature, we found no liver cell carcinoma (LCC) or well-documented adult polycystic kidneys (APK) associated with congenital hepatic fibrosis (CHF). We report a 69-year-old man with CHF, LCC, APK, duplication cyst of distal portion of stomach, two calcified splenic artery aneurysms, myocardial fibrosis and muscular hypertrophy of esophagus. The LCC was grossly predunculated and microscopically showed prominent fibrosis and hyaline intracytoplasmic inclusions in the tumor cells.

  13. Reviewing the pathogenesis of antibody-mediated rejection and renal graft pathology after kidney transplantation.

    Science.gov (United States)

    Morozumi, Kunio; Takeda, Asami; Otsuka, Yasuhiro; Horike, Keiji; Gotoh, Norihiko; Narumi, Shunji; Watarai, Yoshihiko; Kobayashi, Takaaki

    2016-07-01

    The clinicopathological context of rejection after kidney transplantation was well recognized. Banff conferences greatly contributed to elucidate the pathogenesis and to establish the pathologic criteria of rejection after kidney transplantation. The most important current problem of renal transplantation is de novo donor-specific antibody (DSA) production leading chronic rejection and graft loss. Microvascular inflammation is considered as a reliable pathological marker for antibody-mediated rejection (AMR) in the presence of DSA. Electron microscopic study allowed us to evaluate early changes in peritubular capillaries in T-lymphocyte mediated rejection and transition to antibody-mediated rejection. Severe endothelial injuries with edema and activated lymphocyte invaded into subendothelial space with early multi-layering of peritubular capillary basement membrane suggest T-lymphocyte mediated rejection induce an unbounded chain of antibody-mediated rejection. The risk factors of AMR after ABO-incompatible kidney transplantation are important issues. Anti-ABO blood type antibody titre of IgG excess 32-fold before transplant operation is the only predictable factor for acute AMR. Characteristics of chronic active antibody-mediated rejection (CAAMR) are one of the most important problems. Light microscopic findings and C4d stain of peritubular capillary and glomerular capillary are useful diagnostic criteria of CAAMR. Microvascular inflammation, double contour of glomerular capillary and thickening of peritubular capillary basement are good predictive factors of the presence of de novo DSA. C4d stain of linear glomerular capillary is a more sensitive marker for CAAMR than positive C4d of peritubular capillary. Early and sensitive diagnostic attempts of diagnosing CAAMR are pivotal to prevent chronic graft failure.

  14. HLA-G expression in the peripheral blood of live kidney transplant recipients

    Institute of Scientific and Technical Information of China (English)

    XIAO Li; ZHOU Wen-qiang; SHI Bing-yi; FENG Kai; HE Xiu-yun; WEI Yu-xiang; GAO Yu

    2013-01-01

    Background The human leukocyte antigen-G (HLA-G) has been considered to be an important tolerogeneic molecule playing an essential role in maternal-fetal tolerance,upregulated in the context of transplantation,malignancy,and inflammation,and has been correlated with various clinical outcomes.The aim of this study was to investigate the clinical relevance of the expression of membrane HLA-G (mHLA-G),intracellular HLA-G (iHLA-G),and soluble HLA-G (sHLA-G) in the peripheral blood of live kidney transplant recipients.Methods We compared the expression of the three HLA-G isoforms in three groups,healthy donors (n=20),recipients with acute rejection (n=19),and functioning transplants (n=30).Flow cytometry was used to detect the expression of mHLA-G and iHLA-G in the T lymphocytes of peripheral blood from subjects in the three groups.Enzyme-linked immunosorbent assays were used to detect sHLA-G in the plasma from the three groups.Results There were no significant differences in mHLA-G and intracellular HLA-G among the three groups,but the sHLA-G plasma level was higher in the functioning group than in the acute rejection or healthy group.We found a subset of CD4+HLA-G+ and CD8+HLA-G+T lymphocytes with low rates of mHLA-G expression in the peripheral blood of kidney transplantation recipients.Intracellular expression of HLA-G was detected in T lymphocytes.However,there was no correlation between acute rejection and the mHLA-G or intracellular HLA-G expression.Conclusion sHLA-G was the major isoform in the peripheral blood of live kidney transplant recipients and high sHLA-G levels were associated with allograft acceptance.

  15. Intestinal fungal and parasitic infections in kidney transplant recipients: A multi-center study

    Directory of Open Access Journals (Sweden)

    Afsoon Emami Naeini

    2012-01-01

    Full Text Available Kidney transplant recipients are susceptible to various infections due to the use of immunosuppressive drugs. The present study was performed as studies on the prevalence of intes-tinal fungal and parasitic infections in kidney transplant recipients are limited. A total of 150 kidney transplant recipients and 225 matched immunocompetent outpatients, who were referred to the laboratory of Noor Hospital, Isfahan, were studied. After recording demographic characte-ristics, direct test and specific laboratory cultures were carried out on the stool specimens. Patients were instructed on sanitary rules and, during each medical visit, they were reminded of the same. The overall prevalence of intestinal parasitic and fungal infections was 33.3% and 58.7%, respec-tively, in transplant recipients and 20% and 51%, respectively, in the control group; the difference was not statistically significant. The most prevalent intestinal parasite was Entameba coli, which was seen in 9.3% of the study patients and 6.7% of the controls. The most prevalent fungus was Candida sp., which was seen in 22% of the study patients and 24.4% of the control group. Co-existing infection with two or more fungi was seen in 14.8% and 3.4% in the case and control groups, respectively; P <0.001. Interestingly, there was no significant difference in the prevalence of infection by a single organism between the two groups. However, co-existing infection with two or more species was more prevalent in transplant recipients. We conclude that further investigations are needed to evaluate the pathogenesis of infection with these microorganisms.

  16. The impact of the israeli transplantation law on the socio-demographic profile of living kidney donors.

    Science.gov (United States)

    Boas, H; Mor, E; Michowitz, R; Rozen-Zvi, B; Rahamimov, R

    2015-04-01

    The Israeli transplantation law of 2008 stipulated that organ trading is a criminal offense, and banned the reimbursement of such transplants by insurance companies, thus decreasing dramatically transplant tourism from Israel. We evaluated the law's impact on the number and the socio-demographic features of 575 consecutive living donors, transplanted in the largest Israeli transplantation center, spanning 5 years prior to 5 years after the law's implementation. Living kidney donations increased from 3.5 ± 1.5 donations per month in the pre-law period to 6.1 ± 2.4 per month post-law (p trading in accordance with Istanbul Declaration, was associated with an increase in local transplantation activity, mainly from related living kidney donors, and a change in the profile of unrelated donors into an older, higher educated, white collar population.

  17. Adjuvant Ciprofloxacin for Persistent BK Polyomavirus Infection in Kidney Transplant Recipients

    Directory of Open Access Journals (Sweden)

    David Arroyo

    2014-01-01

    Full Text Available Background. BK virus (BKV infection is a common complication following kidney transplantation. Immunosuppression reduction is the cornerstone of treatment while adjuvant drugs have been tried in small uncontrolled studies. We sought to examine our center’s experience with the use of ciprofloxacin in patients with persistent BKV infection. Methods. Retrospective evaluation of the effect of a 30-day ciprofloxacin course (250 mg twice daily on BKV infection in kidney transplant recipients who had been diagnosed with BK viruria ≥106 copies/mL and viremia ≥500 copies/mL and in whom the infection did not resolve after immunosuppression reduction and/or treatment with other adjuvant agents. BKV in plasma and urine was evaluated after 3 months following treatment with ciprofloxacin. Results. Nine kidney transplant recipients received ciprofloxacin at a median of 130 days following the initial reduction in immunosuppression. Three patients showed complete viral clearance and another 3 had a ≥50% decrease in plasma viral load. No serious adverse events secondary to ciprofloxacin were reported and no grafts were lost due to BKV up to 1 year after treatment. Conclusion. Ciprofloxacin may be a useful therapy for persistent BKV infection despite conventional treatment. Randomized trials are required to evaluate the potential benefit of this adjuvant therapy.

  18. Two cases of kidney transplantation-associated thrombotic microangiopathy successfully treated with eculizumab.

    Science.gov (United States)

    Ikeda, Takashi; Okumi, Masayoshi; Unagami, Kohei; Kanzawa, Taichi; Sawada, Anri; Kawanishi, Kunio; Omoto, Kazuya; Ishida, Hideki; Tanabe, Kazunari

    2016-07-01

    Transplantation-associated thrombotic microangiopathy (TA-TMA) is relatively rare and requires immediate intervention to avoid irreversible organ damage or death; however, consensus regarding the treatment approach is lacking. Atypical haemolytic uraemic syndrome (aHUS) is a rare disease caused by dysregulation of the alternative complement pathway resulting in TMA. aHUS is histologically similar to TA-TMA; approximately 60% of TA-TMA patients have complement dysregulation. Eculizumab, a humanized anti-C5 monoclonal antibody, inhibits terminal membrane-attack complex formation and TMA progression. Eculizumab has been successfully used to treat aHUS post-transplant. We present two cases of kidney TA-TMA due to unknown causes, suspected antibody-mediated rejection, or calcineurin inhibitor (CNI)-related toxicity that developed on day 1 or 2 post-kidney transplantation. Low platelet count and haemoglobin level with red cell fragments were detected. Despite steroid pulse, plasma exchange (PE), and intravenous immunoglobulin therapy, TA-TMA did not improve; therefore, eculizumab was administered despite no genetic testing. Laboratory data, including renal function, improved immediately. TA-TMA treatment primarily involves PE initiation or CNI discontinuation; eculizumab can be used to safely treat TA-TMA and then be ceased in the short term. Therefore, eculizumab administration might be beneficial for kidney TA-TMA as early as the diagnosis of refractory to PE.

  19. Improved detection reveals active β-papillomavirus infection in skin lesions from kidney transplant recipients.

    Science.gov (United States)

    Borgogna, Cinzia; Lanfredini, Simone; Peretti, Alberto; De Andrea, Marco; Zavattaro, Elisa; Colombo, Enrico; Quaglia, Marco; Boldorini, Renzo; Miglio, Umberto; Doorbar, John; Bavinck, Jan N Bouwes; Quint, Koen D; de Koning, Maurits N C; Landolfo, Santo; Gariglio, Marisa

    2014-08-01

    The aim of this study was to determine whether detection of β-HPV gene products, as defined in epidermodysplasia verruciformis skin cancer, could also be observed in lesions from kidney transplant recipients alongside the viral DNA. A total of 111 samples, corresponding to 79 skin lesions abscised from 17 kidney transplant recipients, have been analyzed. The initial PCR analysis demonstrated that β-HPV-DNA was highly present in our tumor series (85%). Using a combination of antibodies raised against the E4 and L1 proteins of the β-genotypes, we were able to visualize productive infection in 4 out of 19 actinic keratoses, and in the pathological borders of 1 out of 14 squamous cell carcinomas and 1 out of 31 basal cell carcinomas. Increased expressi