Renal transplantation in old recipients from expanded criteria donors selected by kidney biopsy

Background

In Spain, the number of ideal kidney transplant donors has fallen, with at the same time an increase in the number of older recipients on the waiting list.

Aim

To analyze the results of expanded criteria cadaveric donor kidney transplants into older recipients using grafts selected by kidney biopsy.

Patients and methods

We studied 360 kidney transplant recipients who had been followed to December 2009: 180 in the study group and 180 in a control group composed of younger patients who received grafts from non-expanded criteria donors between 1999 and 2006. A paraffin-embedded kidney biopsy was evaluated by the percentages of sclerosed glomeruli, arteriolar hyalinosis, intimal wall thickening, interstitial fibrosis, and tubular atrophy.

Results

Significant differences were observed in donor age (63.50 ± 5.46 vs 31.90 ± 13.29 years; P < .001) and recipient age (58.40 ± 8.80 vs 40.71 ± 13.23 years; P < .001). Donor renal function was significantly worse among the expanded criteria group (90.80 vs 108.11 mL/min/1.73 m²; P = .006), remaining so over time in the recipient (at 1 year: 42.08 vs 63.71 [P < .001]; at 3 years: 41.25 vs 62.31 [P < .001], and at 7 years: 38.17 vs 64.18 [P < .001]). Censored 7-year graft survivals were 73% versus 87% (P < .001) with similar patient survivals (90.5% vs 95%; P = .39).

Conclusions

Selection of expanded criteria donors by kidney biopsy resulted in good renal function as well as graft and patient survivals at 7 years in older recipients.     

Early prediction of new-onset diabetes mellitus by fifth-day fasting plasma glucose, pulse pressure, and proteinuria

Renal transplant recipients are at high risk of cardiovascular disease (CVD). New-onset diabetes mellitus after transplantation (NODAT) contributes to the risk of CVD, reducing graft and patient survival. To improve outcome of kidney transplant recipients, it is of great interest to identify those patients who will develop NODAT. The aim of our study was to explore the predictive value of fifth-day fasting plasma glucose (FPG), third-month proteinuria, and pulse pressure (PP) for NODAT development. We analyzed 282 non-previously-diabetic kidney transplants in our center. Fifth-day FPG, PP, and third-month 24-hour proteinuria were collected. NODAT was defined at month 12 according to the “consensus guidelines”: symptoms of diabetes plus casual glucose concentrations ≥ 200 mg/dL or FPG ≥ 126 mg/dL. Some 46 patients (16.3%) developed NODAT at month 12. Fifth-day FPG (133 ± 35 vs 108 ± 16 mg/dL, P < .001) and PP (57 ± 17 vs 49 ± 15 mm Hg, P = .007) were significantly higher in patients at risk for NODAT, but there was no difference in third-month proteinuria (652 ± 959 vs 472 ± 1336 mg, P = .390). A multivariate regression model showed an increased risk for NODAT associated with recipient age, body mass index, smoking habit, and a fifth-day FPG ≥ 126 mg/dL (relative risk 4.784, 95% confidence interval 2.121-10.788, P = .0002). The negative predictive value of a fifth-day FPG ≥ 126 mg/dL for predicting 1-year NODAT was 89.4%. Fifth-day FPG was independently related to NODAT development. The detection of a fifth-day FPG ≥ 126 mg/dL increases the risk of suffering NODAT more than 4 times. Fifth-day FPG < 126 mg/dL allows us to identify a transplant population with a low risk (near 10%) for NODAT.     

Risk factors for early hemorrhagic and thrombotic complications after kidney transplantation

Introduction

Clotting disturbances resulting from chronic renal failure do not remit immediately after successful kidney transplantation (KTx). Hemorrhagic and thrombotic complications after KTx increase the risk of transplanted kidney loss. The aim of the study was to analyze the influence of clotting system disturbances and applied antithrombotic prophylaxis on the development of hemorrhagic and thrombotic complications among KTx patients in the early postoperative period.

Materials and methods

Sixty seven KTx patients underwent measurement of plasma activated partial thromboplastin time (APTT); international normalized ratio; fibrinogen and D-dimer concentration; activity of antitrombin III; protein C and S, VIII, IX; and von Willebrand factors, as well as platelet counts.

Results

A perigraft hematoma developed in 25.4% patients, of whom 4.5% required reoperation. Lower antithrombin III activity (96.2 ± 27.6 vs 112.3 ± 17.4, P = .02) on postoperative day (POD) 7 and higher fibrinogen concentration (4.41 ± 2.03 vs 3.35 ± 0.87, P = .01) and platelet count (269.8 ± 117.5 vs 215.8 ± 64.8, P = .03) on POD 14 were noted in recipients with a hematoma compared to those free of this complication. A perigraft hematoma developed in 57.9% patients undergoing antithrombotic prophylaxis and in 12.5% without this treatment (P = .0002). Among patients receiving unfractionated heparin, we observed extension of APTT on POD 1 (45.9 ± 53.2 vs 30.9 ± 7.5 seconds, P = .04), higher von Willebrand factor activity on POD 7 (348.8 ± 122.2 vs 218.5 ± 125.5, P = .02), and higher D-dimer concentrations POD 7 and 14 (1662 ± 894 vs 757 ± 708, P = .002 and 1614 ± 1372 vs 672 ± 532, P = .003, respectively). No significant differences were observed as regards to analyzed parameters between patients receiving low-molecular-weight heparin versus those not receiving antithrombotic prophylaxis.

Conclusions

Disturbances in analyzed parameters of hemostasis did not increase the risk of hemorrhagic and thrombotic complications in the early period after KTx. Antithrombotic prophylaxis increases the risk of hemorrhagic complications and should be introduced only for selected renal transplant recipients.     

Hesperidin stimulates cystic fibrosis transmembrane conductance regulator-mediated chloride secretion and ciliary beat frequency in sinonasal epithelium

Objective

Pharmacologic agents designed to promote mucociliary clearance (MCC) in chronic rhinosinusitis (CRS) represent a novel therapeutic strategy. The objectives of the present study were to investigate whether the natural bioflavonoid hesperidin 1) increases transepithelial chloride (Cl^-) secretion in vitro and in vivo, 2) enhances ciliary beat frequency (CBF), and 3) exerts its mechanistic effects through cAMP/PKA-dependent pathways.

Study Design

In vitro and in vivo study.

Setting

Laboratory.

Subjects and Methods

Transepithelial Cl^- transport (Ussing chamber) and CBF were investigated in primary murine nasal septal (MNSE) and human sinonasal epithelial (HSNE) cultures. In vivo activity was measured using the murine nasal potential difference (NPD) assay, cystic fibrosis transmembrane conductance regulator (CFTR) R-domain phosphorylation, and cAMP levels were investigated to rule out a cAMP/PKA-dependent mechanism of activation.

Results

Hesperidin significantly increased CFTR-mediated Cl^- transport (change in short-circuit current, ΔI_SC) in both MNSE (13.51 ± 0.77 vs 4.4 ± 0.66 [control]; P < 0.05) and HSNE (12.28 ± 1.08 vs 0.69 ± 0.32 [control]; P < 0.05). Cl^- transport across in vivo murine nasal epithelium was also significantly enhanced with hesperidin (-2.3 ± 1.0 vs -0.8 ± 0.8 mV [control], P < 0.05). There was no increase in cellular cAMP or phosphorylation of the CFTR R-domain. Hesperidin significantly increased CBF (ratio of pretreatment to post-treatment) with both basal (1.31 ± 0.07 vs 0.93 ± 0.06 [control]; P < 0.05), apical (1.72 ± 0.09 vs 1.40 ± 0.07 [control]; P < 0.05), and basal + apical delivery (2.26 ± 0.18 vs 1.60 ± 0.21, respectively; P < 0.05).

Conclusion

Our in vitro and in vivo investigations provide strong support for future testing of this robust Cl^- secretagogue and CBF activator in human clinical trials for CRS.     

Pharmacokinetics of once- versus twice-daily tacrolimus formulations in kidney transplant patients receiving expanded criteria deceased donor organs: a single-center, randomized study

Background

Noncompliance to immunosuppressive treatment is 1 of the risk factors for kidney graft loss. The once-daily, prolonged-release tacrolimus formulation may improve treatment adherence. We sought to compare the pharmacokinetics of both tacrolimus formulations in older de novo recipients of a cadaveric renal transplant from an expanded-criteria donor.

Patients and Methods

This randomized study included 27 patients (14 on once daily prolonged-release formulation [QD] and 13, on the twice-daily formulation [BID]), who were treated with 0.1 mg/kg per day of tacrolimus (target blood level, 5-8 ng/mL) mycophenolate mofetil prednisone and basiliximab induction.

Results

At 24 hours, incombination with the blood levels were 4.70 ± 2.50 versus 4.70 ± 3.04 ng/mL (P = NS). There were no significant differences in the AUC_0-24 of tacrolimus (QD/BID) at 3 days (300.8 ± 60.15 vs 287.7 ± 125.78 ng.h/mL) or 21 days (303.05 ± 99.79 vs 275.26 ± 75.37 ng.h/mL), nor in blood levels (ng/mL) at 1 month (8.76 ± 2.46 vs 8.8 ± 1.89), 3 months (7.30 ± 1.72 vs 8.80 ± 1.89) and 6 months (7.19 ± 1.89 vs 6.60 ± 1.71). At 3 days, there was a strong correlation between AUC_0-24 and C_min both for tacrolimus QD (r = .872) and BID (r = 1.0). The incidences of acute rejection episodes were: 0% versus 16.6%; graft survivals, 100% versus 92.3% (P = NS); and patient survivals, both 100%.

Conclusion

For older de novo recipients of kidneys from expanded criteria donors tacrolimus QD is comparable to the same dose in the BID formulation with similar at least short-term transplant outcomes.     

Prevalence of the Metabolic Syndrome in Kidney Transplantation

Objectives

We investigated the prevalence of the metabolic syndrome (MS) in kidney transplantation patients and assessed its development based on plasma adiponectin levels and the results of an oral glucose tolerance test (OGTT).

Methods

We performed a cross-sectional study of 94 recipients with stable graft function who underwent kidney transplantation between January 1999 and October 2008. The presence of MS was determined using National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria with body mass index (BMI) used in place of waist circumference. In addition, we measured plasma adiponectin level and performed a 75-g oral GTT.

Results

Fourteen (14.9 %) recipients suffered from MS for a mean period of 46.7 months (range, 1-106) after transplantation. BMI at the time of transplantation was significantly greater in the MS group (23.4 ± 3.24 vs 20.1 ± 2.50; P < .0001), whereas plasma adiponectin level was significantly lower (11.95 ± 5.13 vs 17.71 ± 8.47; P = .0158). The insulinogenic index values were similar, whereas the homeostatic model assessment of insulin resistance was greater in the MS group (2.598 ± 1.918 vs 1.340 ± 0.934; P = .0002).

Conclusion

The level of adiponectin, which was lower in kidney transplant recipients who developed MS, was negatively correlated with insulin sensitivity. We concluded that a low adiponectin level may correlate with the prevalence of MS in kidney transplantation in association with impaired insulin sensitivity.     

Early postoperative spectral Doppler parameters of renal transplants: the effect of donor and recipient factors

Background

The objective of this study was to explore the donor and recipient factors related to the spectral Doppler parameters of the transplant kidney in the early posttransplantation period.

Methods

This retrospective study included 76 patients who underwent renal transplantation assessed using Doppler ultrasonography (US) on the first postoperative day. We compared spectral Doppler parameters (peak systolic velocity [PSV] and resistive index [RI]) of the segmental artery of the transplant kidney according to the type of renal transplant, level of serum creatinine (SCr) of donor prior to organ donation, and donor/recipient age.

Results

RI was significantly higher in deceased-donor kidney transplantation (DDKT) as compared with living-donor kidney transplantation (LDKT; 0.73 ± 0.10 vs 0.66 ± 0.11; P = .007). In the DDKT recipients, multivariate analysis showed donor SCr was the only factor affecting PSV (P = .023), whereas recipient age was the only factor affecting RI (P = .035). In the LDKT recipients, multivariate analysis showed recipient age was the only factor affecting both PSV (P = .009) and RI (P = .018).

Conclusion

Spectral Doppler parameters in the early posttransplantation period are related to the type of renal transplant, donor renal function, and recipient age. These factors should be taken into consideration when interpreting the results of spectral Doppler US.     

Impact of early lymph node procurement to facilitate histocompatibility testing on long-term cadaveric kidney graft survival

Background

Prolonged cold ischemia time (CIT) is a clinically important causes of delayed graft function (DGF) after kidney transplantation. As DGF has been previously shown to have a deleterious influence on long-term graft survival, in the present study we analyzed the impact of early lymph node (LN) procurement on CIT, HLA mismatches, and long-term kidney graft outcome.

Materials and Methods

We evaluated 394 consecutive cadaveric procedures performed from 2001 to 2006, including 289 recipients, in whom LN were obtained before kidney procurement seeking to shorten the total time for HLA typing and crossmatch procedures.

Results

During 58 ± 6 months, 24 patients died (918 [8.3%] in the early and 6 [5.7%] in late procurement group, P = ns) and 52 lost their kidney grafts (31 [10.7%] vs 21 [20%]; P = .025). Early procurement of LN performed in 73.4% of all kidney graft recipients shortened CIT by almost 7 hours (22.9 vs 16.1 hours; P < .001), with a nonsignificantly lower incidence of DGF (32.2% vs 41.0%; P = .13). However, a Cox proportional hazards regression model revealed that early procurement reduced the risk of death-censored kidney graft loss by roughly 40% (log-rank, P = .013).

Conclusion

Early LN procurement in significantly shorten CIT and subsequently reduced the risk of long-term kidney graft loss.     

Significant Decrease in Glomerular Filtration Rate at 5 Years Posttransplantation in the Recipients of Live Donor Kidneys 50 Years of Age or Older

Introduction

Age is an established predictor of renal failure among recipients of cadaveric transplants; however, the impact of donor age on recipient glomerular filtration rate (GFR) among living donor kidney (LDK) transplantations is not well established.

Methods

We retrospectively analyzed recipient posttransplantation GFR at 12, 36, and 60 months among 315 LDK allograft recipients. The impact of donor age was assessed on the recipient estimated GFR (eGFR) using multivariate linear regression stratified according to donor age <50 years (n = 246) and ≥50 years (n = 69).

Results

Whites comprised the majority of both donors and recipients (77%). The majority (58.4%) of donors were female. Mean age (± SD) of the donors was 41.0 ± 10.2 years (range, 20-65 years). The mean age and body mass index (BMI) of the recipients were 43.3 ± 12.4 years and 26.0 ± 4.9, respectively. There was no statistically significant difference in the rejection rate between the 2 groups (P = .571). Mean eGFR at 12 months in the younger group was 63.3 ± 23.7 compared with 54.8 ± 19.7 in the older group (P = .015). Similarly, a significant difference was observed at the end of 36 months and 60 months of follow-up (61.5 ± 23.1 vs 49.4 ± 18.9, and 59.4 ± 23.0 vs 45.3 ± 20.8, respectively; both P = .001). Donor age was a statistically significant predictor of eGFR throughout the study period (P < .05).

Conclusion

Donor age predicts recipient renal function after living kidney transplantation and needs to be evaluated through a larger prospective investigation.     

Timing of Conversion to Mammalian Target of Rapamycin Inhibitors Is Crucial in Liver Transplant Recipients With Impaired Renal Function at Transplantation

Background

Renal dysfunction, primarily related to long-term use of calcineurin inhibitor-based immunosuppression, is the most common complication after liver transplantation.

Objective

To evaluate whether liver transplant recipients with impaired kidney function at transplantation can benefit from early conversion to mammalian target of rapamycin inhibitor therapy (mTORi) compared with patients with late induction of mTORi-based therapy.

Materials and Methods

Between 2003 and 2008, therapy was changed to an mTORi-based regimen in 57 patients. Patients were divided into 4 groups: group 1, early conversion (≤3 months after orthotopic liver transplantation) to mTORi therapy, and with impaired perioperative renal function; group 2, early conversion to mTORi therapy, and with normal perioperative renal function; group 3, late conversion to mTORi therapy, and with impaired perioperative renal function; and group 4, late conversion to mTORi therapy, and with normal perioperative renal function.

Results

One month after conversion, the mean (SD) increase in calculated glomerular filtration rate in groups 1 (early conversion) and 3 (late conversion) was comparable: 8 (9) mL/min vs 7 (10) mL/min. At month 3, the increase in calculated glomerular filtration rate between groups 1 and 3 was significant (15 [11] mL/min vs 9 [15] mL/min; P = .04), an effect that persisted at month 6 (16 [12] mL/min vs 10 [12] mL/min; P = .05) and month 12 (22 [14] mL/min vs 12 [15] mL/min; P = .04).

Conclusion

In liver transplant recipients with perioperatively impaired renal function, early conversion to mTORi therapy should be performed because this approach seems to be more effective in improving long-term renal function.     

Risk Factors for Urinary Tract Infections During the First Year After Kidney Transplantation

Introduction

Urinary tract infections (UTI) have been reported to occur with frequencies ranging from 30% to 60% in kidney transplant recipients during the first year posttransplantation. UTI is the main cause of infectious complications in this period. The objective of this study was to evaluate the incidence of UTI, during the first year posttransplantation and to identify the risk factors associated with its development, as well as its impact on graft function.

Patients and Methods

This retrospective cohort study had as a primary outcome the development of UTI, defined as the presence of more than 100,000 colony-forming units (CFU) of a pathogenic organism by mL of urine. The univariate analysis was performed with chi-square test for categorical variables and Student t test for continuous ones metrics. We performed multivariate analysis with logistic regression. P < .05 was considered statistically significant.

Results

We studied 176 kidney transplant recipients, including 54.5% of male gender and with an overall average age of 37 ± 12 years. The UTI incidence was of 35.8% (n = 63). The bacterium most frequently found in urine cultures was Escherichia coli (n = 46). In this study, the risk factors that were independently associated with UTI development were age, female gender, days of bladder catheterization, genitourinary anatomic alterations, and UTI during 1 month prior to kidney transplantation.

Conclusion

This type of study makes it possible to identify risk factors and to formulate strategies focused on particular risk factors.     

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.     

Calcineurin inhibitor-free immunosuppression using everolimus (Certican) after heart transplantation: 2 years' follow-up from the University Hospital Münster

Background

Everolimus is a proliferation-signal inhibitor which was introduced for heart transplant recipients in 2004. To date, there are only sparse data about long-term calcineurin inhibitor (CNI)-free immunosuppression using everolimus.

Methods

After heart transplantation, patients receiving everolimus were consecutively enrolled. Reasons for switching to everolimus were side effects of CNI immunosuppression, such as deterioration of kidney function and recurrent rejection episodes. All 60 patients underwent standardized switching protocols, 42 patients completed 24-month follow-up. Blood was sampled for lipid status, renal function, routine controls, and levels of immunosuppressive agents. On days 0, 14, and 28, and then every 3 months, echocardiography and physical examination were performed.

Results

After switching to everolimus, most patients recovered from the side effects. Renal function improved significantly after 24 months (creatinine, 2.1 ± 0.6 vs 1.8 ± 1 mg/dL; P < .001; creatinine clearance, 41.8 ± 22 vs 48.6 ± 21.8 mL/min; P < .001). Median blood pressure increased from 120.0/75.0 mm Hg at baseline to 123.8/80.0 mm Hg at month 24 (P values .008 and .003 for systolic and diastolic pressures, respectively). Tremor, peripheral edema, hirsutism, and gingival hyperplasia markedly improved. Levels of interleukin-6 were stable between baseline and 24-month levels. Temporary adverse events occurred in 8 patients [13.3%: interstitial pneumonia (n = 2), skin disorders (n = 2); reactivated hepatitis B (n = 1), and fever of unknown origin (n = 3)].

Conclusion

CNI-free immunosuppression using everolimus is safe, with excellent efficacy in maintenance of heart transplant recipients. Arterial hypertension and renal function significantly improved. CNI-induced side effects, such as tremor, peripheral edema, hirsutism, and gingival hyperplasia, markedly improved in most patients.     

A switch from conventional twice-daily tacrolimus to once-daily extended-release tacrolimus in stable kidney transplant recipients

Background

Extended-release tacrolimus (TAC-ER) was developed to provide a more convenient treatment compliance and improve safety by avoiding toxic peak levels. We prospectively evaluated the safety and effectiveness of a 1:1 dose switch from twice-daily tacrolimus to once-daily TAC-ER in stable kidney transplant recipients and assessed their satisfaction with the regimen.

Patients and methods

Tacrolimus was switched to TAC-ER (1:1 dose) in 12 kidney transplant recipients with stable renal function from March 2010 to August 2011. The posttransplantation follow-up period was 7.6 ± 4.3 years (range 1.5-13.2 years). No patient had diabetes mellitus in this group. We evaluated the tacrolimus trough levels, serum creatinine, potassium, glucose, glycohemoglobin (HbA1c), and urine protein concentrations once a month from 6 months prior to 1 year after switching. A satisfaction survey for TAC-ER treatment was performed 3 months after the switch. The questionnaire included administration compliance questions such as “forget to take less often,” “easy to carry,” “easy to store,” and “general satisfaction.”

Results

After the switch to TAC-ER, we observed a quick and sustained 25% decrease in TAC trough levels from 4.8 ± 1.0 to 3.6 ± 0.8 (P = .0002). No significant differences in serum creatinine, potassium, glucose, HbA1c, or urine protein concentration were observed during the 14.6 ± 2.6 months' follow-up period. No recipient experienced acute rejection. The satisfaction survey demonstrated that the stable kidney transplant recipients were satisfied with the switch.

Conclusions

A switch from twice-daily tacrolimus to once-daily TAC-ER (1:1 dose) was safe and effective. TAC-ER can improve treatment compliance in stable kidney transplant recipients.     

Selection of live-related liver transplantation candidates

Purpose

Living donor liver transplantation (LR) is an important alternative for children. We compared our outcomes of LR and cadaveric (CAD) graft recipients, with attention to the pediatric end-stage liver disease (PELD) score and perioperative morbidity and mortality to identify appropriate candidates for LR.

Methods

Our transplant database and electronic medical records were searched for demographics and outcome measures.

Results

From 2000 to 2008, 81 children underwent liver transplantation from 37 LR and 44 CAD donors. There were no significant differences in graft or overall survival at 3 months or 1 year. The LR group was significantly younger (4.46 ± 5.2 years vs 7.41 ± 6.6 years; P = .03) and had a significantly lower PELD score (12.7 ± 13 vs 22 ± 12; P = .001) at the time of transplantation. Ten patients were transplanted for unresectable tumor in the LR group vs 4 CAD (P = .03). Significantly fewer LR recipients required return to the operating room in the first 30 days posttransplant (13.9% vs 34.1%; P = .03). The LR recipients had a higher rate of biliary stricture requiring reoperation (22.2% vs 2.3%; P = .005).

Conclusions

The LR liver transplantation is highly selected for patients with a parent donor who will need transplant but do not yet have a high PELD score. A lower PELD score at operation may have contributed to the lower incidence of postoperative complications requiring reoperation.     

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.     

Autosomal-Dominant Polycystic Kidney Disease and Kidney Transplantation: Experience of a Single Center

Background

Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary disease that frequently leads to end-stage renal disease and is a common indication for kidney transplantation. We sought to evaluate the demographic characteristics, graft and patient survival, and some posttransplantation complications among ADPKD recipients.

Methods

This retrospective study included 445 renal transplant recipients, among whom 48 had ADPKD. We excluded patients with pretransplantation diabetes mellitus. We evaluated patient and graft survivals as well as posttransplantation complications.

Results

There was no difference between the 2 groups with respect to demographic or transplant characteristics, except for older age among the ADPKD group (51.2 ± 8.6 years vs 44 ± 13.1 years; P < .001). We also observed no significant difference with regard to immediate graft function, immunological graft, or patient survival. Although not significant, there was a lower incidence of proteinuria and a greater number of acute rejections among ADPKD patients. As for posttransplantation complications, there was no difference regarding the prevalence of hypertension, but there was more erythrocytosis among the ADPKD group. The incidence of posttransplantation diabetes mellitus was significantly greater in ADPKD patients (33.3% vs 17.1%; P = .009), and remained significant after adjusting for confounding variables by multivariate analysis with an adjusted odds ratio of 2.3 (95% confidence interval, 1.008-5.136; P = .048).

Conclusion

Our results suggested that ADPKD patients display a greater incidence of diabetes mellitus posttransplantation; ADPKD emerged as an independent predictor for this complication.     

Percentages of water, muscle, and bone decrease and lipid increases in early period after successful kidney transplantation: a body composition analysis

Background

Successful kidney transplantation (KT) can theoretically reconstitute body composition of a patient with chronic kidney disease (CKD). However, the practical changes have not been well documented. We evaluated changes in body composition among candidates before and 1 year after KT.

Methods

We enrolled 37 male and 18 female kidney recipients eligible for comparison of their body mass index (BMI), body composition, and lipid metabolism before and 1 year after KT. Twenty-one patients had been induced with a calcineurin inhibitor, mycophenolate mofetil, steroid, and basiliximab, and 34 others underwent steroid withdrawal on postoperative day 3. The body composition was analyzed using bioelectrical impedance. We also analyzed changes in BMI and lipid profiles.

Results

There was no significant change in BMI (21.4 ± 3.1 vs 21.7 ± 3.5 kg/m²). Regarding body composition, the water level decreased significantly (61.2 ± 4.9% vs 58.3 ± 5.3%; P < .05). In contrast, fat significantly increased (16.4 ± 6.7% vs 20.3 ± 7.1%; P < .05). More interestingly, successful KT significantly decreased the muscle and bone mass at 1 year after KT (37.3 ± 5.1% vs 34.8 ± 4.7%; 16.3 ± 2.1% vs 15.2 ± 2.1%; respectively; P < .05). Serum lipid profiles of total cholesterol, low-density lipoprotein cholesterol, and triglyceride worsened after KT. Comparing the 2 protocols, there was no difference in any item.

Conclusions

Care must be taken even after successful KT to avoid dyslipidemia, which is a risk factor for cardiovascular disease. Well programmed dietary and/or exercise protocols to prevent muscle atrophy and fat gain should be considered even after successful KT.     

Donor-dependent risk factors for early surgical complications after simultaneous pancreas-kidney transplantation

Introduction

The success of simultaneous pancreas-kidney transplantation (SPK) depends in a large degree on avoidance of surgical complications in the early postoperative period. The aim of the study was to analyze the Pre-procurement Pancreas Allocation Suitability Score (P-PASS) and the deceased donor parameters included within it as risk factors for early surgical complications after SPK.

Material and Methods

Forty-six consecutive donors whose kidney and pancreas were simultaneously transplanted were included in the study.

Results

Donor age was older among recipients who lost their pancreatic grafts: 30.4 ± 6.9 versus 24.1 ± 6.9 years. Donor age was also older among recipients who lost their pancreatic grafts or died compared with those discharged with a functioning graft: 29.3 ± 5.7 versus 24.0 ± 6.9 years. Donor body mass index (BMI) was higher among patients who died compared with those who were discharged: 25.3 ± 1.1 versus 23.2 ± 2.5 kg/m². P-PASS was higher in patients who lost their pancreatic grafts (17.6 ± 2.1 vs 15.2 ± 1.8) or died (15.3 ± 1.9 vs 17.2 ± 1.9), or lost pancreatic graft or died (15.2 ± 1.8 vs 17.0 ± 2.2) or with intra-abdominal infections (IAI; 17.1 ± 1.7 vs 15.0 ± 1.8). The incidence of donors ≥30 years old was higher among recipients with IAI (45.4% vs 14.3%; P = .04). An higher rate of donors with P-PASS >16 was revealed among patients who lost their pancreatic grafts (26.7% vs 3.2%), died (26.7% vs 3.2%), lost the pancreatic graft or died (33.3% vs 6.4%), or experienced IAI (46.7% vs 9.7%). Multivariate logistic regression analysis revealed P-PASS (odds ratio 2.57; P = .014) and serum sodium (odds ration, 0.91; P = .048) to be important predictors of IAI development.

Conclusion

Older age and higher BMI among deceased donors increased the risk of IAI, pancreatic graft loss, or recipient death after SPK. Transplantation of a pancreas from a donor with a low P-PASS score was associated with a lower risk of surgical complications after SPK.