Impact of Pretransplant Body Mass Index on Early Kidney Graft Function

Background

An increase in the number of obese patients on transplantation waiting lists can be observed. There are conflicting results regarding the influence of body mass index (BMI) on graft function.

Methods

We performed a single-center, retrospective study of 859 adult patients who received a renal graft from deceased donors. BMI (kg/m²) was calculated from patients' height and weight at the time of transplantation. Kidney recipients were subgrouped into 4 groups, according to their BMI: Groups A (<18.5; n = 57), B (18.6–24.9; n = 565), C (25–29.9; n = 198) and D (>30; n = 39). Primary or delayed graft function (DGF), acute rejection (AR) episodes, and number of reoperations, graft function expressed by glomerular filtration rate (GFR) and serum creatinine concentration and number of graft loss as well as the recipient's death were analyzed. The follow-up period was 1 year.

Results

Obese patients' grafts do not develop any function more frequently in comparison with their nonobese counterparts (P < .0001; odds ratio [OR], 32.364; 95% CI, 2.174–941.422). Other aspects of the procedure were analyzed to confirm that thesis: Cold ischemia time and number of HLA mismatches affect the frequency of AR (OR, 1.0182 [P = .0029] and OR, 1.1496 [P = .0147], respectively); moreover, donor median creatinine serum concentration (P = .00004) and cold ischemia time (P = .00019) are related to delayed graft function. BMI did not influence the incidence of DGF (P = .08, OR; 1.167; 95% CI, 0.562–2.409), the number of AR episodes (P > .1; OR, 1.745; 95% CI, 0.846–3.575), number of reoperations, GFR (P = .22–.92), or creatinine concentration (P = .09). Number of graft losses (P = .12; OR, 1.8; 95% CI, 0.770–4.184) or patient deaths (P = .216; OR, 3.69; 95% CI, 0.153–36.444) were not influenced.

Conclusion

Greater recipient BMI at the time of transplantation has a significant influence on the incidence of primary graft failure.     

The Impact of Intraoperative Graft Blood Flow Measurement on Early Graft Function

BackgroundThe aim of this study is to evaluate the impact of intraoperative allograft vascular flow on early kidney graft function.MethodsA total of 159 patients underwent kidney transplantation from January 2017 to March 2022 at Linkou Chang Gung Memorial Hospital. Graft arterial and venous blood flow was measured separately with a transient time flowmeter (Transonic HT353; Transonic Systems, Inc, Ithaca, NY, United States) after ureteroneocystostomy. The early outcomes, including the postoperative creatinine level, were analyzed accordingly.ResultsThere were 83 males and 76 females, with a mean age of 44.5 years. The mean graft arterial flow measured was 480.6 mL/min, and the mean venous flow was 506.2 mL/min. Delayed graft function (DGF) incidence was 36.5%, 32.5%, and 40.8% in total, living, and deceased donor groups, respectively. Living donor and deceased donor kidney transplantation were analyzed separately. In the DGF subgroup, there were lower graft venous flows, higher body mass index (BMI), and more male patients in the living kidney transplant group. Similarly, the deceased donor kidney transplantation group with delayed graft function tended to have higher body height, higher body weight, higher BMI, and more diabetes mellitus. The multivariate analysis showed that lower graft venous blood flow (odds ratio [OR] = 0.995, P = .008) and higher BMI (OR = 1.144, P = .042) were significantly correlated with delayed graft function in living donor kidney transplantations. In the deceased donor group, a multivariate analysis of risk factors showed that BMI had a significant correlation with delayed graft function (OR = 1.41, P = .039).ConclusionsGraft venous blood flow was significantly associated with delayed graft function in living donor kidney transplantation, and high BMI was correlated with DGF in all patients receiving kidney transplantation.     

Retrospective Analysis of the Kidney Donor Profile Index to Predict Patient and Graft Survival at 5 Years Posttransplantation in a Colombian Cohort

BackgroundThe Kidney Donor Profile Index (KDPI) has been used to predict patient and graft outcomes in deceased donor kidney transplantation. We aimed to evaluate the impact of KDPI on transplantation major outcomes applied to a Colombian cohort.MethodsWe retrospectively assessed 260 adult patients who underwent kidney transplantation (KT) from January 2011 to June 2014 at our center and compared their KDPIs with graft and patient outcomes at 5 years posttransplantation. Kaplan-Meier survival method and Cox analysis were fitted to analyze the impact of the 3 KDPI categories on graft and patient outcomes.ResultsA total of 18.4% of transplants were from donors with a KDPI ≥75%. There was a significant decrement in renal function with increasing KDPI at 5 years posttransplantation (P < .05). The final model indicates that donor diabetes was associated with elevated risk for graft loss (hazard ratio [HR], 6.5; 95% confidence interval [CI] 1.35-31.8; P = .019) at 5 years posttransplantation. Recipient age (HR, 2.3; 95% CI, 1.1-4.5; P = .001), diabetes status (HR, 2.17; CI, 1.04-5.5; P = .003), dialysis duration (HR, 1.08; 95% CI, 1.00-1.16; P = .003), and operating room time (HR, 1.47; 95% CI, 1.02-2.12; P = .003) were associated with elevated risk for death at 5 years posttransplantation. KDPI categories were not significantly associated with graft loss or death.ConclusionsWe found limited KDPI power to predict graft and patient survival when applied to a Latin American population in Colombia. Our findings highlight the importance of analyzing the application of KDPI in different populations. Therefore, our findings may not be generalizable to other regions outside of Colombia.     

Factors That Influence Delayed Graft Function in Kidney Transplants: A Single-Center Paired Kidney Analysis

BackgroundThe risk factors associated with delayed graft function (DGF) and its impact in kidney transplant (KTx) outcomes remains controversial; it is possible that donor renal characteristics influence the initial graft function in KTx.ObjectiveEvaluate risk factors associated with DGF and its impact in KTx outcomes.MethodsOne hundred six mate KTx mate recipients performed in a single center were grouped according to the presence or absence of DGF.ResultsDonors were predominantly men (58%); 70% were standard criteria type, with a mean Kidney Donor Profile Index (KDPI) of 62% ± 28%, median age of 42 ± 15 and presenting hospitalization time of 6 ± 5 days. KTx recipients presented an overall DGF rate of 82%, lasting 12 ± 7 days. Pairs presenting DGF were older than pairs without DGF (P = .008), while cold ischemia time (CIT) was significantly shorter in the group without DGF compared to those presenting DGF (P = .003). The KDPI of the KTx pairs was significantly higher in pairs with DGF versus without DGF (P = .04). No statistically significant differences in 1 year allograft and patient survival were observed. Recipient age (odds ratio = 6.3, confidence interval = 1.5–25.8; P = .009) and CIT (odds ratio = 4.6, confidence interval = 1.2–17.7; P = .002) were significantly associated with DGF.ConclusionThis study suggests that recipient age, cold ischemic time, and KDPI are factors associated with DGF. In addition, DGF had no impact on 1-year renal function, allograft, and patient survival. In the transplant conditions of our country, Brazil, CIT seems to represent an important variable to be managed, and the aim should be to reduce this factor as much as possible.     

Rate,Factors, and Outcome of Delayed Graft Function After Kidney Transplantation of Deceased Donors

BackgroundDelayed graft function (DGF) is a frequent complication after kidney transplantation affecting long-term outcome.Patients and methodsA total of 525 consecutive recipients (age 54.2 ± 13.4 years, 33% female) of kidneys from deceased donors transplanted between 2005 and 2012 were retrospectively examined. DGF was defined as the need of dialysis within the first week after transplantation.ResultsDGF developed in 21.1% (n = 111). Factors associated with DGF (P ≤ .035, respectively) were recipient body mass index, C-reactive protein of the recipient, residual diuresis, cold ischemia time, donor age, and diuresis in the first hour after transplantation. Median duration of DGF was 16 (2-66) days. Patients after DGF had a significantly lower GFR compared with recipients without DGF either after 3 (32.9 ± 16.5 vs 46.3 ± 18.4 mL/min/1.73 m²) or after 12 months (38.9 ± 19.3 vs 48.6 ± 20.4 mL/min/1.73 m², P < .001, resp.). During DGF, 12.4% developed BANFF II and 18.0% BANFF I rejection, 20.2% had signs of transplant glomerulitis (first biopsy), and 16.2% (n = 18) remained on dialysis.ConclusionDGF affects 1 out of 5 kidney transplants from deceased donors. Minimizing modifiable risk factors, in particular immunologic risk, may ameliorate the incidence and outcome of DGF. The outcome of DGF depends mainly on the diagnosis of any rejection and worsens upon detection of transplant glomerulitis and pronounced interstitial fibrosis and tubular atrophy (IFTA).     

Incidence,Risk Factors,and Outcomes of Delayed Graft Function in Deceased Donor Kidney Transplantation

ObjectiveDelayed graft function (DGF) is the most significant complication of a cadaveric kidney transplant. We aim to evaluate the predictable risk factors of DGF and its effects on the recipient and graft survival.MethodFrom January 2014 to December 2017, the medical records from 62 patients who received a kidney transplant from a deceased donor were retrospectively reviewed. We classified recipients into 2 groups. The risk factors of DGF associated with donor, recipient, and transplant procedures were analyzed. DGF's effects on the graft survival were examined.ResultsThe incidence rate of DGF was 43.5%. Older ages of donors, marginal donors (n = 15), length of stay in the intensive care unit, and terminal serum creatinine concentrations were observed to be statistically significant compared to recipients without DGF (P < .5). The ratio of serum creatinine concentrations before/after brain death was found to be significant for the groups with DGF (P < .05). Cold ischemia time (CIT) was examined as the most significant risk factor on DGF (P = .001). One-year patient survival rates were 94.5% and 92.3%, and graft survival rates were 92.1% and 87.5% (P = .05), respectively, for the groups with and without DGF.ConclusionOlder ages of donors, occurrence of acute kidney injury, its grade just before harvesting, and long duration of CIT are the most important risk factors for DGF. Brain death management, shortening the time between brain death and harvesting, and also shortening the duration of CIT can decrease the risk of DGF and can increase the graft survival.     

A Risk Index for Living Donor Kidney Transplantation

Choosing between multiple living kidney donors, or evaluating offers in kidney paired donation, can be challenging because no metric currently exists for living donor quality. Furthermore, some deceased donor (DD) kidneys can result in better outcomes than some living donor kidneys, yet there is no way to compare them on the same scale. To better inform clinical decision‐making, we created a living kidney donor profile index (LKDPI) on the same scale as the DD KDPI, using Cox regression and adjusting for recipient characteristics. Donor age over 50 (hazard ratio [HR] per 10 years = _1.151.24_1.33), elevated BMI (HR per 10 units = _1.011.09_1.16), African‐American race (HR = _1.151.25_1.37), cigarette use (HR = _1.091.16_1.23), as well as ABO incompatibility (HR = _1.031.27_1.58), HLA B (HR = _1.031.08_1.14) mismatches, and DR (HR = _1.041.09_1.15) mismatches were associated with greater risk of graft loss after living donor transplantation (all p < 0.05). Median (interquartile range) LKDPI score was 13 (1–27); 24.2% of donors had LKDPI < 0 (less risk than any DD kidney), and 4.4% of donors had LKDPI > 50 (more risk than the median DD kidney). The LKDPI is a useful tool for comparing living donor kidneys to each other and to deceased donor kidneys.     

Total Cell-Free DNA as a Noninvasive Biomarker of a Delayed Graft Function After Kidney Transplantation From Donors After Cardiac Death

BackgroundBecause of the organ shortage, donation after cardiac death (DCD) kidney transplantation (KTx) is an alternative way of achieving KTx using brain-dead donors (BDs). Although the prognosis of DCD-KTx is improving, the graft suffers from delayed graft function (DGF), the management of which is essential. With progress in understanding the characteristics of cell-free DNA (CF-DNA), we consider plasma total CF-DNA (tCF-DNA) to be a useful biomarker for predicting DGF in DCD-KTx.Study Design and MethodConsecutive patients from living donors (LDs; n = 9), BDs (n = 8), or DCD donors (n = 13) were enrolled. Plasma samples were collected after KTx and on postoperative days 3 and 5. CF-DNA was isolated, and tCF-DNA was quantified using the TapeStation 2200 software program.ResultsThe tCF-DNA levels after BD-KTx and DCD-KTx were higher than those after LD-KTx (LD, 78 ± 27 (ng/mL); BD, 99 ± 20; DCD, 150 ± 23); the difference between DCD-KTx and LD-KTx was statistically significant (P < .05). The tCF-DNA levels declined at postoperative day 5 (LD, 45 ± 10; BD, 51 ± 11; DCD, 66 ± 13). tCF-DNA levels were significantly increased in patients with DGF after KTx (DGF, 139 ± 22; immediate function, 91 ± 18; P < .05). The tCF-DNA level was correlated with the duration of DGF (r = 0.5825, P < .05).ConclusionAlthough the mechanism underlying DNA release from transplanted grafts into the recipient circulation remains unclear, cell death by apoptosis or necrosis and the active secretion of the immune system may play important roles in DGF. These data suggest that monitoring tCF-DNA may help predict graft recovery after DCD-KTx.     

Effect of Delayed Graft Function on the Outcome and Allograft Survival of Kidney Transplanted Patients from a Deceased Donor

BackgroundIn kidney transplantation (KT), delayed graft function (DGF) is a significant early complication observed in the first week. The study aimed to investigate the impact of DGF on the outcome, allograft, and patient survival after KT with organs from deceased donors.MethodsThis retrospective study was conducted using 304 KT patients who received an organ from deceased donors from 2008 to 2018. The patients were divided into 2 groups, DGF positive (DGF⁺) and DGF negative (DGF^–). The database containing the clinical, laboratory, and immunologic information of donors and recipients was statistically analyzed using the SSPS program.ResultsIn this study, 189 (62.17%) were DGF⁺ and 115 (37.83%) were DGF^–. Until 6 months after KT, the estimate glomerular filtration rate was better in group DGF^–, but it was similar between the groups during 10-year follow-up. Graft losses were higher in DGF⁺ group than in the DGF^– (P = .046). The serum creatinine level was persistently higher in DGF⁺ group until the sixth month (P ≤ .05). Allograft survival rates were better in patients who were DGF^– (P = .033). Those who had DGF for more than 15 days had a worse graft survival (P = .003), but in 10 year follow-up, patient survival rates were similar (P = .705).ConclusionDGF⁺ patients were associated with dialysis time before KT, ischemia time, and the donors’ clinical status, such as age, organ quality, and serum creatinine. All these factors had a great impact on graft survival but not on patient survival.     

Risk factors for and outcomes of delayed graft function in live donor kidney transplantation – a retrospective study

Delayed graft function (DGF) in deceased donor kidney transplantation is associated with worse outcomes. DGF has been less well studied in live donor transplantation. We aimed to examine the risk factors for DGF, and associations between DGF and short‐ and long‐term outcomes in live donor kidney transplant recipients. Using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, we included live donor kidney transplants performed in Australia and New Zealand over 2004–2015 and excluded pediatric recipients (n = 440), pathological donors (n = 97), grafts that failed in the first week (as a proxy for primary non function; n = 38), and grafts with missing DGF data (n = 46). We used multivariable logistic regression to identify the risk factors for DGF and the association between DGF and rejection at 6 months; Cox proportional hazards models to examine the relationship between DGF and patient and graft survival; and linear regression to examine the association between DGF and eGFR at 1 year. DGF occurred in 77 (2.3%) of 3358 transplants. Risk factors for DGF included right‐sided kidney [odds ratio (OR) 2.00 (95% CI 1.18, 3.40)], donor BMI [OR 1.06 per kg/m² (95% CI 1.01, 1.12)]; increasing time on dialysis and total ischemic time [OR 1.09 per hour (1.00, 1.17)]. DGF was associated with increased risk of rejection at 6 months [OR 2.37 (95% CI 1.41, 3.97)], worse patient survival [HR 2.14 (95% CI 1.21, 3.80)] and graft survival [HR 1.98 (95% CI 1.27, 3.10)], and worse renal function at 1 year [Coefficient ‐9.57 (95% CI ?13.5, ?5.64)]. DGF is uncommon after live donor kidney transplantation, but associated with significantly worse outcomes. The only modifiable risk factors identified were kidney side and total ischemic time.     

Incidence,Risk Factors,and Outcomes of Delayed Graft Function in Deceased Donor Kidney Transplantation in a Brazilian Center

Background

A high incidence of delayed graft function (DGF) after deceased donor kidney transplantation occurs in Brazil. The reasons for such have not been adequately studied.

Methods

We performed a retrospective cohort study of 346 kidney transplant recipients from deceased donors. DGF risk factors related to the recipient, donor, and transplantation surgery were analyzed and correlated with graft outcomes. A logistic regression analysis was used to identify independent risk factors and patient and graft survival were assessed using Kaplan-Meier curves.

Results

The incidence of DGF was 70.8% (245 cases). Our final model of multivariate analysis showed that DGF is associated (P < .05) with donor final serum creatinine (relative risk [RR], 1.84; 95% confidence interval [CI], 1.26–2.70), donor age (RR, 1.02 [1.0–1.033]), receiving a kidney from national offer (RR, 2.44 [1.06–5.59]), and need for antibody induction (RR, 2.87 [1.33–6.18]). Outcomes that were associated with DGF were longer length of hospital stay (32.5 ± 20.5 vs 18.8 ± 16.3 days; P = .01), higher incidence of acute rejection (37.8 vs 12.9%; P < .01), worse graft survival at 1 year (83.5% vs 93.9%; P < .01), and higher levels of serum creatinine at 3, 6, and 12 months (P < .05). There was no difference in patient survival and the occurrence of acute rejection did not influence the survival of patients or grafts.

Conclusion

DGF was associated with higher donor final serum creatinine, donor age, receiving a kidney from the national supply, and need for antibody induction. Most importantly, DGF was associated with worse outcomes.     

High Perirenal Fat Volume Affect Negatively Renal Function in Living Renal Transplantation

ObjectiveWe aimed to investigate the effect of perirenal fat volume (PFV) on graft functions by calculating the PFV of donor kidney with routine computed tomography before renal transplantation.MethodsFrom May 2019 to December 2020, a total of 54 living donors and recipients who met the criteria for kidney donor were included in the study. Left donor nephrectomy was performed to all donors. Data of age, sex, body mass index (BMI), PFV of the donors, estimated glomerular filtration rate (eGFR), and serum creatinine measurement data of the recipients were recorded. Serum creatinine and eGFR of the recipients were recorded at the 12th month controls. The patients were sorted into 2 groups (G) according to their GFR values. G1, GFR <60 mL/min/1.73 m²; G2, GFR ≥ 60 mL/min/1.73 m².ResultsThere was no difference in terms of recipient sex, recipient age, donor sex, recipient BMI, and donor BMI between the 2 groups. The mean of PFV was higher in G1 and was statistically significant (P= 0.01). The ability of the donor BMI and PFV to predict G2 was evaluated by receiver operating characteristic curve analysis. It was determined that PFV predicted G2 to be statistically significant. In the multivariate logistic regression analysis, PFV (odds ratio = 0.988, 95% GA = 0.977-0.999, P = 0.03) was found as an independent predictor of G2.ConclusionsIn conclusion, our study showed PFV as an independent risk factor for low eGFR, revealing that the previously documented relevance of increased BMI with a low eGFR can be partially explained by PFV.     

Outcomes of Expanded-Criteria Deceased Donor Kidney Transplantation in a Single Center

Background

In an effort to expand the deceased donor pool, transplant centers have accepted expanded-criteria donors as appropriate for many of the patients in the deceased donor pool. We investigated expanded-criteria deceased donor kidney transplantation and compared the outcomes of kidney transplantation according to donor types.

Methods

We retrospectively analyzed 88 kidney transplantations performed between June 2006 and December 2012. We divided the patient into 4 groups: SCDD, standard-criteria deceased donor; ECDD, expanded-criteria deceased donor; ECMO, donor under extracorporeal membrane oxygenation support; living donor.

Results

Deceased and living donor kidney transplantations were performed in 52 (59.1%) and 36 (40.9%) cases, respectively. Among deceased donors, 31 (35.2%) were standard-criteria donors and 14 cases (15.9%) were expanded-criteria donors. Seven (8.0%) donors were under extracorporeal membrane oxygenation support. Mean follow-up was 26.1 ± 20 months. Average number of HLA mismatches among the donor types was 3.39, 3.07, 3.0, and 2.94 in SCDD, ECDD, ECMO, and living donor groups, respectively (P = .708). Delayed graft function occurred in 2 (6.9%), 3 (21.4%), 3 (42.9%), and 3 (8.3%) patients in the SCDD, ECDD, ECMO, and living donor groups, respectively (P = .043). Episodes of acute rejection within a year occurred in 14 (45.2%), 2 (14.3%), 1 (14.3%), and 6 (16.7%) patients in the SCDD, ECDD, ECMO, and living donor groups, respectively (P = .029). Renal functions after kidney transplantation at 3 months, 6 months, 9 months, and 1 year were not significantly different according to donor types. Graft survival was not different among the different donor types (87.1%, 92.8%, 85.7%, 91.7% in SCDD, ECDD, ECMO, and living donor groups, respectively; P = .67). Patient survival was not different among the different donor types (87.1%, 92.9%, 100%, 97.2% in SCDD, ECDD, ECMO, and living donor group, respectively; P = .36).

Conclusion

The use of expanded-criteria deceased donor had no impact on graft or patient survival after kidney transplantation.     

Comparison of Survival in Recipients of Marginal and Standard Cadaveric Donor Kidneys

BackgroundRenal transplantation is the main treatment for end-stage renal disease and has rapidly increased in number over the past 3 decades, leading to an increasing need for organs. The disparity between organ access and the number of patients on the waiting list has led transplant surgeons to use marginal cadaveric donors. As a consequence, the concept of “marginal cadaveric kidney donor” has been developed.MethodsWe retrospectively evaluated 120 patients who received kidneys from cadaveric donors between September 2009 and August 2021. The donors were divided into standard and marginal cadaveric donors, and their age, sex, cause of death, criteria of acceptance as marginal donors, and Kidney Donor Profile Index (KDPI) were recordedResultsThe donors included 69 men and 51 women, with a mean age of 52.9 ± 16.8 years. There were 52 standard donors and 68 marginal donors. Graft and donor survival were compared based on the KDPI values of the donors, and were respectively found to be higher in those with a KDPI of 0 to 60 than in those with a KDPI of 81 to 100 (P = .011 and .039, respectively). There was no significant difference between those with a KDPI of 61 to 80 and the other groups.ConclusionsExpanded criteria donor organs, which offer greater survival benefits than hemodialysis, can be used safely to meet the increasing need for donors. Expanded criteria donor organs should thus be considered a valuable alternative in this patient group.     

The Safety and Efficacy of the Anterior Approach Total Hip Arthroplasty as per Body Mass Index

BackgroundObesity is associated with component malpositioning and increased revision risk after total hip arthroplasty (THA). With anterior approaches (AAs) becoming increasingly popular, the goal of this study was to assess whether clinical outcome post-AA-THA is affected by body mass index (BMI).MethodsThis multicenter, multisurgeon, consecutive case series used a prospective database of 1,784 AA-THAs (1,597 patients) through bikini (n = 1,172) or standard (n = 612) incisions. Mean age was 63 years (range, 20-94 years) and there were 57.5% women, who had a mean follow-up of 2.7 years (range, 2.0-4.1 years). Patients were classified into the following BMI groups: normal (BMI < 25.0; n = 572); overweight (BMI: 25.0-29.9; n = 739); obese (BMI: 30.0-34.9; n = 330); and severely obese (BMI ≥ 35.0; n = 143). Outcomes evaluated included hip reconstruction (inclination/anteversion and leg-length, complications, and revision rates) and patient-reported outcomes including Oxford Hip Scores (OHS).ResultsMean postoperative leg-length difference was 2.0 mm (range: ?17.5 to 39.0) with a mean cup inclination of 34.8° (range, 14.0-58.0°) and anteversion of 20.3° (range, 8.0-38.6°). Radiographic measurements were similar between BMI groups (P = .1-.7). Complication and revision rates were 2.5% and 1.7%, respectively. The most common complications were fracture (0.7%), periprosthetic joint infection (PJI) (0.5%), and dislocation (0.5%). There was no difference in dislocation (P = .885) or fracture rates (P = .588) between BMI groups. There was a higher rate of wound complications (1.8%; P = .053) and PJIs (2.1%; P = .029) among obese and severely obese patients. Wound complications were less common among obese patients with the ‘bikini’ incision (odds ratio 2.7). Preoperative OHS was worse among the severely obese (P < .001), which showed similar improvements (Change in OHS; P = .144).ConclusionAA-THA is a credible option for obese patients, with low dislocation or fracture risk and excellent ability to reconstruct the hip, leading to comparable functional improvements among BMI groups. Obese patients have a higher risk of PJIs. Bikini incision for AA-THA can help minimize the risk of wound complications.     

Higher Renal Allograft Function in Deceased-Donor Kidney Transplantation Rather Than in Living-Related Kidney Transplantation

Objectives

To compare the clinical outcome of kidney transplantation from living-related and deceased donors.

Quality Assessment of Donor Kidneys and the Tendency of Kidney Acceptance: A Single-Center Experience

PurposeThe increasing age of donors and the increasing tendency of comorbidities requires an extension in acceptance criteria. In this review, the tendency for acceptance and refusal was analyzed by examining reasons for declining donor kidneys at the kidney transplantation center in Debrecen. This analysis aimed to assess the quality of donor kidneys and indicate why two-thirds of donated organs were refused.MethodOur center in Debrecen received 535 kidney offers (based on exclusion criteria) between November 2016 and August 2019, which were retrospectively analyzed. Donor kidneys were evaluated using expanded criteria donor, kidney donor profile index (KDPI), and kidney donor risk index criteria systems.ResultsThirty-five percent (n = 189) of the kidneys offered to the center in Debrecen had been approved in advance, and later 63% (n = 119) were transplanted. Using the KDPI system, 41% of donors had a KDPI above 85, of which 23% were accepted, while acceptance of kidneys with a KDPI of 0 to 35 was around 70%.When examining causes of donor kidney refusal, 90% of the organs had donor quality problems, 13% had logistical cause (long cold ischemic time, large age difference between donor and recipient), and 10.5% had immunologic cause. In 13% of cases, the refusal of donor organs was due to the coexistence of several problems.ConclusionOur data showed that high-risk donor organs were being refused in our center; however, they are being transplanted at a higher rate in other Eurotransplant centers. The decision to refuse or accept donor organs depends on several factors, including expected waiting time, patient's clinical characteristics, and quality of life.     

Effect of Pretransplant Body Mass Index on Kidney Transplant Recipient and Graft Long-term Survival

BackgroundThe aim of the study was to assess the influence of pretransplant body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) to the graft and patient 5- and 10-year survival.MethodsOur study group consisted of 706 patients who received their kidney transplant after the year 2000.ResultsAlmost half, 51.9% (n = 372) of the patients had BMI < 25, and 47.6% (n = 336) had BMI ≥ 25. Patients who were overweight or obese were significantly older than other groups (P = .01). The 5-year recipient survival was significantly better in the BMI < 25 group (n = 291, 79.5%) than the BMI ≥ 25 group (n = 238, 70.2%, P < .05). In addition, 10-year recipient survival was better in the BMI < 25 group (n = 175, 47.8%) compared with the BMI ≥ 25 group (n = 127, 37.5%, P < .05). Similarly, 5-year graft survival was better in the BMI < 25 group (66.9%, n = 242) compared with the BMI ≥ 25 group (61.1%, n = 204, P < .05). However, 10-year graft survival was not statistically significant (P = .08). Regarding the impact of diabetes on survival, we found patients with diabetes mellitus to have worse survival in all groups (P = .009).ConclusionsRecipient graft survival was affected by diabetes mellitus independently from being overweight. In the current study, we demonstrated that pretransplant obesity or being overweight affects recipient and graft short-term survival, but long-term comparison of patients who were overweight or obese with patients with normal BMI revealed minimal recipient survival differences and in graft survival analysis no difference. Although in many studies obesity and being overweight predict a bad outcome for kidney transplant recipient survival, our research did not fully confirm it. Diabetes mellitus had worse outcome in all patients groups.     

Factors of Acute Kidney Injury Donors Affecting Outcomes of Kidney Transplantation From Deceased Donors

BackgroundThis study aimed to investigate the outcomes of kidney transplantation (KT) from deceased acute kidney injury (AKI) donors and analyzed the factors affecting these outcomes.MethodsAll patients who underwent KT from deceased donors at our institution from 1998 to 2016 were retrospectively reviewed. Recipients were divided into the AKI and non-AKI donor groups. We analyzed delayed graft function (DGF), serum creatinine levels at 1 month and 1 year after KT, cold ischemia time, donors’ initial and terminal serum creatinine levels, Kidney Donor Profile Index, and patient and graft survival in each group.ResultsOf 181 recipients, 30 received kidneys from 21 AKI donors, whereas the remaining 151 received kidneys from donors without AKI. DGF more frequently developed in the AKI donor group than in the non-AKI donor group (40% vs 7.28%; P = .001). Allograft functions at 1 month and 1 year after KT did not differ between the AKI and non-AKI donor groups (1 month: P = .469; 1 year: P = .691). Factors affecting DGF were recipient weight and donor AKI. Recipient factors affecting graft function at 1 year were recipient height, length of hospital stay, serum creatinine levels at 1 month and 6 months, and biopsy-proven acute rejection. Older donor age was the only donor factor that affected graft function at 1 year.ConclusionKT from deceased AKI donors showed a higher DGF rate but favorable patient and graft survival and graft functions. Donor AKI and recipient weight affected DGF, and only older donor age affected graft function at 1 year.