Use of simulect can reduce the incidence of acute rejection and demonstrates with superior 3-year patient and graft survival rates in renal transplantation

Background

Acute rejection is a major cause of graft loss in renal transplantation. Because the highest risk for acute rejection is in the first month posttransplantation, improved prophylaxis could be most beneficial in this period. Simulect administration provides 30 to 45 days of immunoprophylaxis against acute rejection during the critical period after transplantation.

Objectives

We sought to assess the incidence of acute rejection episodes and the safety and tolerability of Simulect plus Neoral immunosuppression. Patient and graft survival rates up to 3 years posttransplantation were evaluated.

Method

Forty-one transplant recipients received Simulect by intravenous infusion of an initial 20-mg dose on the day of renal transplantation and a second 20-mg dose on day 4 posttransplant. All renal recipients received immunosuppression with Neoral and steroid.

Results

There were eight cases (19.5%) of acute rejection within 1 year. The rejection episodes were easily reversed with steroid pulse therapy in seven patients except for graft loss. The 1-, 2-, and 3-year graft survival rates were 95%, 93%, and 88%, respectively. Overall, the 3-year patient survival rate was 100%.

Conclusions

Simulect in combination with Neoral and steroid-reduced the incidence of acute rejection without an increase in adverse events. The low incidence and severity of acute rejection may have led to the superior 3-year patient and graft survival rates in renal transplantation.     

Cardiovascular Risk Profile in Kidney Transplant Recipients Treated With Two Immunosuppressive Regimens: Tacrolimus and Mycophenolate Mofetil Versus Everolimus and Low-Dose Cyclosporine

Objective

The aim of this prospective study was to compare the cardiovascular risk (CVR) profile in patients treated with 2 different immunosuppressive regimens: tacrolimus and mycophenolate mofetil (TAC) compared with everolimus and low-dose cyclosporine (EVL).

Patients and Methods

Sixty consecutive renal transplant recipients prospectively assigned to TAC (n = 30) or to EVL (n = 30) were followed for 6 months. TAC group immunosuppression consisted of basiliximab, tacrolimus, mycophenolate mofetil (MMF), and steroid. EVL group immunosuppression consisted of basiliximab, everolimus, and low doses of cyclosporine and steroid. Main CVR factors analyzed were: hypertension, dyslipidemia, posttransplant diabetes mellitus, and weight gain.

Results

Six months posttransplantation, patients in the EVL group showed significantly higher mean serum cholesterol (P < .003) and serum triglyceride levels (P < .027), as well as a greater number of patients were receiving statin treatment (P < .05). Mean systolic blood pressure, mean diastolic blood pressure, number of patients treated for hypertension, number of antihypertensive medications prescribed per patient, posttransplant weight gain, and posttransplant diabetes mellitus were not significantly different among the EVL and TAC groups after 1, 3, and 6 months posttransplantation.

Conclusions

This study showed that at 6 months posttransplantation, patients on EVL displayed significantly greater dyslipidemia with respect to the TAC group. A longer follow-up will be necessary to discover whether the presence of everolimus in the immunosuppressive regimen provides significant benefits for the CVR of renal transplant recipients.     

Erectile Dysfunction in Living Donor Kidney Transplant Recipients Associated With Chronic Hepatitis B Infection

Objectives

The objectives of this study were to investigate the prevalence of erectile dysfunction (ED) among living donor kidney transplant (LDKT) recipients associated with chronic hepatitis B infection in China and to assess the effect of successful LDKT to improve ED.

Materials and Methods

From January 2006 to May 2009, erectile function of 26 LDKT recipients associated with chronic hepatitis B infection (Group 1) was evaluated predialysis, during dialysis, and at 6 months posttransplantation using the International Index of Erectile Function, version 5 (IIEF-5). We enrolled 61 age-matched LDKT recipients without hepatitis B/C infection as a control group (Group 2).

Results

The prevalences of ED in Group 1 at predialysis, on dialysis, and 6 months posttransplantation were 23.1%, 80.7%, and 65.3%, respectively. Among Group 2, it was 4.9%, 72.1%, and 41.0%, respectively. The difference in ED between groups was significant at predialysis (P = .031) and 6 months posttransplantation (P = .037). Compared with the dialysis stage, the prevalence of ED at 6 months posttransplantation was significantly decreased in Group 2 (72.1% vs 41.0%; P = .001), but it was not significantly difference from Group 1 (80.7% vs 65.3%; P = .211).

Conclusions

The incidence of ED among hepatitis B recipients was higher than among hepatitis B/C-negative patients at the predialysis and posttransplantation stages. Kidney transplantation is a key treatment to reduce the prevalence of ED among hepatitis B/C-negative recipients, but not those with hepatitis B.     

Similar Early Complication Rate in Simultaneous Pancreas and Kidney Recipients on Tacrolimus/Mycophenolate Mofetil Versus Tacrolimus/Sirolimus Immunosuppressive Regimens

Introduction

We compared the incidence of severe complications among 123 consecutive simultaneous pancreas and kidney (SPK) recipients randomized for treatment either with tacrolimus plus mycophenolate mofetil (MMF) or tacrolimus plus sirolimus during their initial postoperative hospital stay.

Methods

Patients with type 1 diabetes mellitus (T1DM) and renal failure with no age limit who underwent SPK were randomly assigned to tacrolimus/sirolimus or tacrolimus/MMF immunosuppressive protocols. We analyzed the rate of adverse events that led to death, graft loss, operative revision, or prolonged hospital stay.

Results

From 2002 to 2009, 62 recipients were included in the MMF and 61 in the Rapamycin (Rapa) groups. More than 2/3 of recipients suffered from at least 1 complication: 74% MMF and 77 % Rapa group (P > .05). No patient died in the MMF and 3 in the Rapa group (P = .11). Pancreas graftectomy was performed in 13% of the MMF group and in 5% of the Rapa group (P = .20). Ten of 62 recipients in the MMF and 13/61 in the Rapa group required operative treatment of wound infections (P = .49). There were no differences in the rates of gastrointestinal bleeding (11% and 8%), kidney lymphocele (6% and 5%), ileus (1.6% both), pancreatic leak (1.6% both), or ureteral leak (0 and 3%) between the groups.

Conclusion

We did not observe a difference in the rate of severe postoperative complications between groups. With the use of extraperitoneal placement of the pancreatic graft, fluid collections and wound infections remain the most frequent albeit curable postoperative complications.     

Predictive value of the charlson comorbidity index in kidney transplantation

Background

Nonimmunologic factors have been recently implicated in worse outcomes after kidney transplantation, producing a need to predict the operative risk among kidney recipients. We assessed the predictive value of the Charlson comorbidity index (CCI) among kidney transplant recipients.

Methods

A retrospective study of 223 first deceased-donor kidney transplantations performed from 2000 to 2007 evaluated the role of comorbidities.

Results

About 50% of recipients displayed >1 comorbid condition before transplantation; the most frequently reported was diabetes mellitus. Increasing CCI scores significantly affected graft and patient survivals. Crude analysis showed a significant association between CCI >1 and risk of death (hazard ratio [HR], 3.87; 95% confidence interval [CI], 1.06-14.06; P = .04). After adjustment for several covariates, high CCI values remained significantly predictive of posttransplantation outcomes with a HR for death of (12.53; 95% CI, 1.9-82.68; P = .009).

Conclusions

Our predictive model showed a strong association of CCI and patient survival even after adjustment for several clinical covariates. CCI may be used to evaluate patients referred for kidney transplantation who display a significant burden of comorbid conditions that increase the risk of premature death or graft loss.     

Serial Soluble CD30 Measurements as a Predictor of Kidney Graft Outcome

Background

High levels of soluble CD30 (sCD30), a marker for T-helper 2-type cytokine-producing T cells, pre or post-renal transplantation serves as a useful predictor of acute rejection episodes. Over the course of 1-year, we evaluated the accuracy of serial sCD30 tests to predict acute rejection episodes versus other pathologies that affect graft outcomes.

Patients and methods

Fifty renal transplant recipients were randomly selected to examine sCD30 on days 0, 3, 5, 7, 14, and 21 followed by 1, 3, 6, and 12 months. The results were analyzed for development of an acute rejection episode, acute tubular necrosis (ATN), or other pathology as well as the graft outcome at 1 year.

Results

Compared with pretransplantation sCD30, there was a significant reduction in the average sCD30 immediately posttransplantation from day 3 onward (P < .0001). Patients were divided into four groups: (1) uncomplicated courses (56%); (2) acute rejection episodes (18%); (3) ATN (16%); and (4) other diagnoses (10%). There was a significant reduction in sCD30 immediately posttransplantation for groups 1, 2, and 3 (P < .0001, .004, and .002 respectively) unlike group 4 (P = .387). Patients who developed an acute rejection episode after 1 month showed higher pretransplantation sCD30 values than these who displayed rejection before 1 month (P = .019). All groups experienced significant improvement in graft function over 1-year follow-up without any significant differences.

Conclusion

Though a significant drop of sCD30 posttransplantation was recorded, serial measurements of sCD30 did not show a difference among subjects who displayed acute rejection episodes, ATN, or other diagnoses.     

First Year Renal Function as a Predictor of Kidney Allograft Outcome

Background

Several factors are known to have detrimental effects on kidney allograft function in the first year posttransplantation, which has been reported to be an important factor influencing long-term graft survival.

Objectives

The objectives of this study were to evaluate risk factors for lower estimated glomerular filtration rate (eGFR) at 3 and 12 months posttransplantation and analyze the influence of first year allograft function on graft and patient survivals.

Patients

We performed a retrospective review of the clinical data from 433 cadaveric donor kidney transplantations in adults performed in our unit from May 1989 to May 2007.

Results

Donor female gender and nontraumatic cause of death, panel-reactive antibody (PRA) titer ≥50%, acute rejection episodes, and delayed graft function (DGF) were significant risk factors for a decreased eGFR at one year posttransplantation. Recipient and donor age showed negative correlations with eGFR at 3 and 12 months. A logistic regression model showed acute rejection episodes, DGF, donor age ≥55 years, donor female gender, and nontraumatic cause of donor death to be independent adverse risk factors for eGFR <60 mL/min at 3 and 12 months. Lower eGFRs at 3 and 12 months were associated with poorer allograft survival when data were censored for death with a functioning graft and patient survival. Multivariate analysis revealed that PRA titer ≥50%, acute rejection episodes, and eGFR <30mL/min at 12 months had adverse effects on allograft survival.

Conclusion

Several factors influence kidney allograft function in the first year after transplantation. Kidney allograft function at 12 months predicted long-term graft survival.     

Complications of Transplantation of Kidneys From Expanded-Criteria Donors

Background

Organ shortage is the primary barrier to kidney transplantation. To maximize organ use, organs from expanded-criteria donors (ECDs) have been used increasingly. Expanded-criteria donors are defined as individuals older than 60 years or older than 50 years with at least 2 of the following risk factors: hypertension, stroke as the cause of death, or serum creatinine concentration greater than 1.5 mg/dL.

Objective

To assess the incidence of complications posttransplantation in ECD kidneys compared with kidneys from standard-criteria cadaveric donors (SCDs).

Patients and Methods

One hundred seventy-two patients received cadaveric renal transplants between January 1, 2006, and August 31, 2008. Donor and recipient data were collected, as well as patient and graft survival and immediate, delayed, or slow graft function. Complication rates for lymphocele, urinary leak, thrombosis, hematoma, urinary tract infection, and cytomegalovirus infection were recorded. Follow-up was for 3 to 35 months, ending on November 30, 2008.

Results

Overall, mean 1-year graft survival was 86.9%, and mean creatinine concentration was 1.58 mg/dL. One incidence of primary nonfunction (0.6%) was observed. More than 25% of transplanted kidneys were from ECDs. No significant differences were noted in postoperative complications between recipients of ECD or SCD organs.

Conclusion

The rate of complications in recipients of ECD and SCD kidneys is comparable.     

Graft Outcome and Mycophenolic Acid Trough Level Monitoring in Kidney Transplantation

Background

Large inter- and intrapatient variabilities have been observed in the pharmacokinetics of mycophenolic acid (MPA). As a consequence, the efficacy and safety of mycophenolate mofetil (MMF) may be optimized with individualized doses based on therapeutic drug monitoring.

Materials and Methods

In this retrospective study we analyzed; 7536 12-hour trough MPA samples obtained during the first year posttransplantation among 314 kidney recipients treated with tacrolimus, MMF, and corticosteroids.

Results

Despite taking similar MMF doses, patients with delayed graft function (DGF) showed lower 12-hour trough MPA levels than patients without DGF 1.4 ± 0.1 vs 2.1 ± 0.1 μg/mL; P = .001). There was a significant correlation between 12-hour trough MPA levels and creatinine clearance (r = .32; P < .001). Logistic regression analysis showed that creatinine clearance was a predictive factor of adequate 12-hour trough MPA levels (>1.6 μg/mL) at 7 days posttransplantation. Twelve-hour trough MPA levels at 7 days posttransplantation were lower among patients who developed an acute rejecton episode (1.5 ± 0.1 vs 2.1 ± 0.1 μg/mL; P < .001), whereas those with gastrointestinal side effects showed high levels (4.1 ± 0.5 μg/mL).

Conclusions

In patients with delayed or poor graft function, MMF doses greater than 2 g/d may be necessary to achieve adequate MPA levels. Therapeutic drug monitoring of MPA may be useful to prevent acute rejection episodes or toxicity.     

Incidence and Importance of De Novo Diabetes Mellitus After Heart Transplantation

Introduction

Diabetes mellitus is one of the main metabolic complications after heart transplantation. The aims of our study were to determine the incidence and factors that determine the appearance of posttransplantation diabetes mellitus (PTDM) and its prognostic value.

Materials and methods

We performed a retrospective study of all heart transplant recipients in our hospital from January 1993 to December 2005, including 116 patients with prolonged monitoring with 59-month median follow-up. We divided the patients into two groups, according to whether they had de novo diabetes (group 1) or no diabetes (group 2).

Results

Patients with PTDM were significantly older, with a median difference (MD) of 5.4 years (95% confidence interval [CI], 1.53-9.28) and a greater body mass index (MD, 3.37 kg/m²; 95% CI, 1.68-5.06). Moreover, a greater percentage of patients in group 1 had ischemia compared to other etiologies. However, no significant differences were observed regarding other cardiovascular risk factors. PTDM was associated with a greater incidence of posttransplant hypertension (51.6% in group 1 vs 48.4% in group 2, P = .08) and posttransplant renal failure (59.5% in group 1 vs 40.5% in group 2, P = .001). However, no differences were observed in overall survival.

Conclusions

Age, overweight, and ischemic origin of cardiopathy were the main risk factors for the development of PTDM in our population. Although no differences were observed in survival rates, PTDM was associated with a greater incidence of hypertension and renal insufficiency, which may have long-term influences on patient survival.     

Wound Complications After Kidney Transplantation in Nondiabetic Patients

Introduction

Impaired wound healing represents a common operative complication after kidney transplantation. This problem seems to be affected by factors related to surgical technique, drugs, and patient/graft peculiarities.

Patients and Methods

From January 2000 to December 2007, 350 consecutive kidney transplantations were performed in a population of nondiabetic patients. We evaluated the influence of various factors on impaired wound healing.

Results

Among 350 kidney transplantation patients, we observed 54 cases (15.43%) of impaired healing of the surgical incision: 36 (10.29%) with first level and 18 (5.14%) with second level wound complications. Factors related to complications were overweight and delayed graft function. Cyclosporine and tacrolimus had similar effects. However, all patients developing second level complications showed more risk factors. In our experience, postoperative lymphocele did not occur as an unique factor but became a significant risk factor when associated with another one. Patients who did not have reconstruction of the muscle layers showed a greater incidence of incisional complications.

Conclusion

Impaired healing of the surgical incision more or less seriously influenced outcomes of transplanted patients. This complication was common and usually related to the presence of more than one risk factor.     

Recipient and perioperative risk factors associated with liver transplant graft outcomes

Background

Orthotopic Liver transplantation (OLT) is currently considered to be the ultimate form of therapy for most patients with end-stage liver diseases. The identification of recipient and various perioperative factors that may affect the graft outcomes is critical. This study sought to analyze the preoperative and perioperative factors associated with graft outcomes in our institute.

Methods

This retrospective study of liver transplanted patients from January 2002 to December 2009 determined the incidence of 2 forms of primary dysfunction (PDF): Primary nonfunction (PNF) and initial poor function (IPF).

Results

The 97 posttransplant patients included in the study had an average age of 52.74 years. The majority of indications for OLT were hepatitis B and/or C cirrhosis, alcoholic cirrhosis, and hepatocellular carcinoma. The incidence of PDF was 31.9% (31/97) with 7.2% (7/97) PNF and 24.7% (24/97) IPF. Additionally, we observed 68.1% (66/97) to display immediate function (IF). Warm ischemic time (WIT) and operative time were significantly longer in the PDF compared with the IF group. The logistic regression model showed a WIT of >45 minutes to be a risk factor leading to PDF (odds ratio, 11.74; P < .05). An operative time of >6 hours and operative blood loss of >2 L were possible risk factors.

Conclusion

Prolonged WIT (>45 minutes) was the only significant risk factor among other established parameters for graft function. Nevertheless, reduced operative times and blood loss may improve the outcomes of OLT.     

The role of obesity in kidney transplantation outcome

Background

The number of obese kidney transplant candidates has been growing. However, there are conflicting results regarding to the effect of obesity on kidney transplantation outcome. The aim of this study was to investigate the association between the body mass index (BMI) and graft survival by using continuous versus categoric BMI values as an independent risk factor in renal transplantation.

Methods

We retrospectively reviewed 376 kidney transplant recipients to evaluate graft and patient survivals between normal-weight, overweight, and obese patients at the time of transplantation, considering BMI as a categoric variable.

Results

Obese patients were more likely to be male and older than normal-weight recipients (P = .021; P = .002; respectively). Graft loss was significantly higher among obese compared with nonobese recipients. Obese patients displayed significantly lower survival compared with nonobese subjects at 1 year (76.9% vs 35.3%; P = .024) and 3 years (46.2% vs 11.8%; P = .035).

Conclusions

Obesity may represent an independent risk factor for graft loss and patient death. Careful patient selection with pretransplantation weight reduction is mandatory to reduce the rate of early posttransplantation complications and to improve long-term outcomes.     

Influence of Single-Nucleotide Polymorphisms on C-Reactive Protein Levels in Chronic Kidney Disease Before and After Kidney Transplantation

Introduction

We sought to evaluate 2 single-nucleotide polymorphisms (SNPs) in the C-reactive protein (CRP) gene promoter region for their effects on CRP levels in chronic kidney disease (CKD) patients before and after a successful kidney transplantation.

Methods

Fifty CKD patients were evaluated before and at the first and second years after the graft. Two SNPs were studied, a bi-allelic (G→A) at the −409 and a tri-allelic (C→T→A) variation at the −390 position in the CRP gene.

Results

All patients presented the −409GG genotype. At the −390 position, the “A” allele was not found; there were 15 “CC” patients, 11 “TT” patients, and 24 “CT” patients. CRP levels were different among patients with various genotypes (P < .019). Also the presence of the allele “T” was sufficient to determine differences in CRP levels both in pretransplantation (P = .045) and at 1 year posttransplantation (P = .011), but not at the second year (P = .448).

Conclusion

SNPs at the −390 position of the CRP gene promoter region influence CRP basal levels in such a way that the “C” allele correlated with the lowest and the “T” with the highest. We did not observe this influence in our patients at the second year posttransplantation.     

Impact of Clinical Condition at Restarting Dialysis on Outcome After Kidney Allograft Loss: A Single-Center Experience

Background

The purpose of this paper was to determine the impact of the clinical condition of the patient at the restart of dialysis on long-term survival after renal graft loss.

Methods

We performed an analysis of 110 patients with renal allograft failure compared with 115 hemodialysis patients without kidney transplantation.

Results

There was a relatively high glomerular filtration rate, low serum albumin, and greater prevalence of infection among graft loss patients compared with the never-transplanted patients. Patient survival after allograft loss was significantly lower than that of never-transplanted patients (P = .024) with 63.4% patients succumbing in the first 3 months. Serum hepatitis B virus (HBV) positivity, cardiovascular disease (CVD) and malnutrition were independent risk factors for graft loss patient upon COX regression analysis.

Conclusions

Serum HBV positive, complicated with CVD and malnutrition were independent risk factors for the graft loss among patients who restarted hemodialysis. More attention should be paid to treat complications of transplant recipients in K/DOQI 4 and 5 stages.     

Kidney transplantation using expanded criteria donors in Korea

Background

Use of expanded criteria donor (ECD) grafts seeks to solve the organ shortage. We investigated the current status of donor selection and transplantation outcomes.

Methods

We retrospectively analyzed 791 kidney transplantations performed between 1997 and 2009. An expanded criteria deceased donor (ECDD) was defined as an individual who fulfilled the United Network for Organ Sharing criteria or, the Nyberg criteria. An expanded criteria living donor (ECLD) was determined by fulfillment of 1 or more of 5 criteria.

Results

Deceased and living donor kidney transplantations were performed in 228 (28.8%) and 563 (71.2%) cases, respectively. Forty-three cases (18.9%) belonged to the ECDDs. The ECDD group showed a lower posttransplantation 1-year estimated glomerular filtration rate (eGFR) than that of the standard criteria deceased donor (SCDD) group (70.7 ± 19.2 vs 48.6 ± 11.5; P < .001). The ECDDs were allocated to older recipients or recipients with more HLA mismatches than SCDDs. The number of ECLD cases was 173 (30.7%). The proportions of each medical abnormality of living donors were as follows: age older than 60 years (0.5%), hypertension (2.5%), obesity (2.1%), low eGFR (25.9%), proteinuria (0%), and microscopic hematuria (1.4%). The ECLD group showed a lower posttransplantation 1-year eGFR than that of the standard criteria living donor (SCLD) group (66.9 ± 16.0 vs 58.3 ± 11.2; P < .001). Graft survival was not different among the donor types (P = .518).

Conclusions

eCDs were 27.3% of the total kidney donors. Posttransplantation 1-year eGFR was lower in the ECD group. However, there was no difference in the graft survival among the different donor types.     

Third and Fourth Kidney Transplant: Still a Reasonable Option

Introduction

At present, a second kidney transplant is considered an established therapeutic option for patients who have lost a previous graft. Second transplants show similar graft survival as first transplants. A debate exists about the benefit of submitting the patient to a third or fourth renal transplant, or to maintain dialysis.

Objective

We sought to analyze graft and patient survivals as well as associated variables and surgical complications of third and fourth transplantations.

Material and Methods

From July 1985 to December 2008, we performed 74 third and 8 fourth transplantations among 2763 cases. We prospectively collected the variables of age, gender, graft origin, hyperimmunization, time on dialysis, location, bench surgery, acute rejection episodes, graft survival, and operative complications.

Results

Third and fourth trasplantations were performed in 49 men and 33 women, with an overall mean age of 40.26 years who were on dialysis for an average of 126.89 months before transplantation. Mean graft survivals of their first and second grafts were 35.6 and 50.1 months, respectively. Acute or chronic rejection was reason for renal failure in 71% and 75% of cases, respectively. Patient survivals at 1 and 5 years were 92.7% and 90.6%, for third and both 85.7% for the fourth transplantation. The third and fourth transplantations showed 1- and 5-year graft survivals of 88% and 76.4% and 71.4% and 42.9%, respectively. Sixty-eight cases underwent cadaveric donor and 14 living donor (mean age, 42.1 years) transplantations. Nine patients were hyperimmunized.In 60 cases, we used the left kidney. Orthotopic kidney transplantation was performed in 15 cases; heterotopic transplant to the right iliac fossa in 40 and in the left iliac fossa in 17 cases. Arterial bench surgery was necessary in 6 cases and venous in 3. We performed 3 hepatorenal and 1 cardiorenal transplantation. The complications included 29 cases (35.4%) of postoperative acute tubular necrosis, 14 of acute rejection episodes (17.1%); 12 of perirenal hematoma (14.6%); 1 urinary fistula (1.2%); 4 lymphocele (4.9%); 2 ureteral stenosis (2.4%); variables arterial kink requiring surgery (1.2%), and 1 venous thrombosis with graft loss (1.2%). The 4 patients who died in the perioperative period succumbed to intravascular disseminated coagulation (n = 1) cardiac failure (n = 2), and septic shock (n = 1). Induction antibody therapy, hyperimmunized status, or operative complications were not independent prognostic factors for patient or graft survival.

Conclusions

Third or fourth renal transplantations constitute a valid therapeutic option with reasonable short- and long-term patient and graft survivals. Although orthotopic kidney transplantation was used in selected patients, we preferred an iliac fossa approach for most.     

Risk Factors for Septic Complications in Kidney Transplant Recipients

Introduction

Septic complications following kidney transplantation are a leading cause of therapeutic failure. An early diagnosis may protect the recipient from the severe consequences of sepsis. We sought to determine the risk factors influencing the occurrence of septic complications among kidney transplant recipients.

Materials and methods

The 146 potential donors included in the study were evaluated for brain stem death criteria. Supportive management included mechanical ventilation to normocapnia, rewarming, as well as fluid and electrolyte replacement. Dopamine infusions and desaminovasopressin were titrated to predetermined mean arterial pressure (MAP). Central venous pressure (CVP) was maintained at 8 to 11 mm Hg. Hemodynamic data were acquired by the thermodilution method prior to organ procurement: MAP, CVP, pulmonary capillary wedge pressure (PCWP), and systemic vascular resistance index (SVRI). Recipient data included age, gender, period of prior hemodialysis, panel reactive antibodies, cold ischemia time, and cause of renal insufficiency. The 232 kidney recipients were examined for occurrence of septic complications including septicemia, pneumonia, peritonitis, or graft infection.

Results

Kidney transplants from donors with MAP < 70 mm Hg and SVRI < 1200 dyne × s/cm⁵ × m² showed a significantly higher occurrence of septic complications in recipients (P < .05) where mortality rate was also significantly greater (P < .01).

Conclusions

MAP < 70 mm Hg and SVRI < 1200 dyne × s/cm⁵ × m² among organ donors predicted greater occurrence of septic complications and increased mortality among kidney transplant recipients.     

Importance of Renal Mass on Graft Function Outcome After 12 Months of Cadaveric Donor Kidney Transplantation

Background

Few studies have measured cadaveric kidney weight to investigate its relation to recipient kidney function related to it. The aim of this study was to evaluate kidney weight (cadaveric donor) and its relationship to creatinine clearance (CrCl) after 12 months posttransplantation.

Methods

We evaluated 81 renal transplantation recipients from cadaveric donors. We collected donor and recipient demographic, clinical and anthropometric data. Data about kidney weight were obtained through kidney measurement using an electronic machine at the moment of transplantation.

Results

The mean kidney weight was 201.4 ± 10.2 g (200.5 ± 11.6 g in women and 210.3 ± 14.1 g in men). Kidney weight correlated with CrCl at 12 months (0.001). The CrCl at 12 months showed a significant correlation of graft weight/recipient weight ratio (P < .01).

Conclusion

The cadaveric donor kidney weight significantly influenced the CrCl at 12 months after transplantation.