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1.
Results of Transplantation of Kidneys Procured From Donors After Brain Death Aged 60 Years and Older
S. Franczyk D. Skrabaka E. Jędrusik J. Ziaja A. Kolonko R. Świder S. Sekta J. Czerwiński A.J. Owczarek M. Durlik A. Więcek L. Cierpka R. Król 《Transplantation proceedings》2018,50(6):1674-1679
Objective
To analyze results of transplantation of kidneys procured from donors after brain death aged 60 years and older (hereafter denoted by “≥60”) compared to kidneys procured from donors after brain death aged 40–59 years (hereafter denoted by “40–59”) in medium-term follow-up period, and to assess factors that affect recipient and kidney graft survival.Material and methods
92 transplant recipients of kidneys procured from donors after brain death ≥60 were enrolled into the study. The control group were 363 recipients of kidneys procured from donors after brain death 40–59.Results
Mean values of serum creatinine were higher in recipients of kidneys procured from donors after brain death ≥60 compared to control after 3 years: 168.2 ± 57.5 (n = 59) vs 147.9 ± 65.7 (n = 294), P < .05; and after 5 years: 196.2 ± 95.3 (n = 38) vs 157.3 ± 80.0 μmol/L (n = 211), P < .01. Restricted mean recipient survival time was 56.4 (95% confidence interval: 55.0–57.8) and 52.0 (48.0–56.1) months, P < .05; and kidney graft survival time was 51.6 (49.6–53.5) and 43.9 (39.0–48.9) months, P < .01 in recipients who received kidneys from donors after brain death 40–59 and from donors after brain death ≥60 respectively. In Cox regression, donor death due to cardiovascular disease proved to be the factor increasing risk of kidney graft loss (hazard ratio 1.553, P < .001).Conclusions
The survival and function of kidneys procured from donors after brain death ≥60 at medium-term follow-up remain worse compared to kidneys procured from donors after brain death 40–59, and the donor dependent risk factor of kidney graft loss is cardiovascular disease, which caused donor death. 相似文献2.
K.J. Ko Y.H. Kim K.H. Kwon M.H. Kim K.W. Jun J.K. Hwang S.D. Kim S.C. Park J.I. Kim S.S. Yun I.S. Moon 《Transplantation proceedings》2018,50(10):3222-3227
Purpose
The use of expanded-criteria deceased-donor (ECD) kidneys must be evaluated within the objective perspective of critical organ shortage and graft function and survival. In this study, we aimed to compare the clinical outcomes of ECD reliance with concurrent use of ideal-criteria deceased donors (IDDs) and non-ECDs in adult renal transplantation.Methods
Between February 2000 and December 2015, we analyzed 405 deceased-donor renal transplants, specifically 129 grafts (31.9%) from ECDs, 233 grafts (57.5%) from non-ECDs, and 43 grafts (10.6%) from IDDs. ECDs were classified according to the United Network for Organ Sharing guidelines, while an IDD was defined as a younger person (10–39 years of age) with no medical risk factors who died from a traumatic head injury. Donor and recipient risk factors were separately analyzed and correlated with recipient graft function, and survival was evaluated.Results
ECDs were older (56.8 ± 6.3 years); showed increased incidence of hypertension, diabetes, and cerebrovascular brain death; and had a higher pre-retrieval serum creatinine level than the other groups. ECD kidney recipients were also older (50.6 ± 9.8 years), had a shorter waiting time (P = .031), and demonstrated a low frequency of re-transplantation (P = .028). Long-term renal function followed longitudinally was lower in ECD kidney recipients until five years after transplantation, while the glomerular filtration rate (GFR) level at 7 and 10 years did not differ significantly among the groups (P = .074 and .262, respectively). There were no significant differences in terms of graft survival (P = .394) or patient survival (P = .737) among the groups.Conclusions
Although the long-term renal function followed longitudinally was lower in ECD kidney recipients, the use of renal grafts from ECDs is an acceptable method to resolve the disparity of critical organ shortage. However, the classification of the high-risk group should be updated with consideration given to differences in regional characteristics. 相似文献3.
M. Jankowska I. Kuźmiuk-Glembin P. Skonieczny A. Dębska-Ślizień 《Transplantation proceedings》2018,50(6):1863-1867
Introduction
Patients with autosomal dominant polycystic kidney disease (ADPKD) represent about 10% of kidney transplant recipients (KTR) and have unique needs regarding acceptance for this procedure. Whether native kidney nephrectomy (NKN) affects kidney transplantation (KT) outcomes remains a matter of debate, and more data is needed to establish a standard approach to KTR with ADPKD.Aim
To analyze the prevalence, timing, and short- and long-term outcomes of NKN in a cohort of ADPKD recipients in a single institution.Method
Retrospective, observational study.Results
In the years 1993 to 2016 we identified 162 KTR with ADPKD; of those, 149 had known NKN status. A high proportion of ADPKD KTR (n = 72) underwent NKN, the majority of which (69.4%) were performed before KT. There was no difference in short-term and long-term transplantation outcomes (including death, graft loss, delayed graft function, acute rejection, bacterial and cytomegalovirus [CMV] infection, and post-transplant diabetes mellitus) between NKN and non-NKN groups in a median of 98 months of follow-up. However, we found a significant difference in time on a waiting list, which was longer in the NKN group vs non-NKN.Conclusions
There is a need for a consensus regarding indications and timing for NKN in recipients with ADPKD. The systematic acquisition, sharing, and analysis of accessible data on NKN between institutions is an important step toward meeting this need. In our cohort, we found no impact of the NKN procedure on KT impact. However, undergoing NKN significantly prolonged the time on the waiting list. 相似文献4.
M. Magott-Procelewska K. Madziarska M. Boratynska P. Chudoba A. Lepiesza O. Mazanowska S. Zmonarski M. Madziarski K. Hap M. Klinger 《Transplantation proceedings》2018,50(6):1701-1704
Background
The long-term burden of higher donor age on graft function and survival after kidney transplantation remains uncertain. Because both recipient and donor characteristics have evolved and the general population age is on the increase, we looked at the causes of kidney graft outcome.Aim
The aim of this study was to evaluate the impact of different clinical parameters on long-term outcome of older-donor kidney transplantation. This retrospective study included 345 adult patients (58 patients received kidney from donors at least 55 years old) transplanted between January 1993 and December 2005 and were followed in one center throughout the post-transplant course (median, 9.4 years). Data included recipient and donor age, cold ischemia time, delayed graft function, panel reactive antibodies, HLA mismatch, time on dialysis, graft function at different time points, uric acid level, proteinuria, immunosuppression, and biopsy-proven rejection.Results
Improvement of estimated glomerular filtration rate at 36 months after transplantation was a good prognostic factor for long-term kidney function. Higher donor age decreased the chance for improvement of kidney function by 2.8% per year of life (P = .0244). Hyperuricemia was found in 46% of the study population; estimated glomerular filtration rate less than 50 mL/min/1.72 m2 was associated with hyperuricaemia. A higher uric acid level was associated with inferior kidney function in recipient of older kidneys. Graft failure occurred late (median, 6.3 years post-transplantation) in 26 (44.8%) of older-donor recipients and in 87 (30.3%) of the remaining patients.Conclusions
Our results suggest an important association between older donor age and decreased allograft function in kidney recipients with elevated uric acid level. Recipients of older kidneys with normal uric acid level presented satisfactory outcomes. 相似文献5.
E. Ferreira J. Costa C. Romãozinho L. Santos F. Macário C. Bastos R. Alves A. Figueiredo 《Transplantation proceedings》2017,49(4):770-776
Background
Organ shortage has prompted the use of expanded-criteria donors (ECDs). Our objective was to compare long-term outcomes of kidney transplants from ECDs with those from concurrent standard-criteria donors (SCDs). In addition, we evaluated variables associated with graft survival in both groups.Methods
We retrospectively reviewed all 617 deceased-donor kidney transplantations performed from 2005 to 2009 in our department. The population was divided according to donor status into ECD or SCD. Patients were followed until 5 years after transplantation, death, graft failure, or loss to follow-up.Results
We transplanted 150 deceased-donor kidneys from ECDs and 467 from SCDs. ECD were older, more frequently women, had a lower pre-retrieval glomerular filtration rate, and more frequently died due to cerebrovascular accident. ECD recipients were older, presented a lower proportion of black race, more frequently were on hemodialysis, and presented a higher rate of first kidney transplants. Mean glomerular filtration rate was consistently lower in the ECD group. Patient and graft survivals were lower in the ECD group, but statistical significance was present only in graft survival censored for death with a functioning graft at 3 years and graft survival noncensored for death with a functioning graft at 5 years. Younger recipient ages, longer time on dialysis, acute rejection episodes, and glomerular filtration rate at 1 year after transplantation were independent risk factors for lower graft survival.Conclusions
Transplantation with the use of ECD kidneys provide quite satisfactory patient and graft survival rates despite their poorer long-term outcomes. 相似文献6.
Y. Nakamura Y. Kihara T. Yokoyama O. Konno H. Iwamoto 《Transplantation proceedings》2018,50(8):2404-2411
Background
To increase the number of cadaveric kidney transplants in Japan, it is necessary to proactively use organs from all donors. Since the revision of the Organ Transplant Law, the number of organ donors after cardiac death (DCD) has decreased but the number of organ donors after brain death (DBD) has increased; however, the number of donor organs and awareness of cadaveric transplantation have increased.Methods
At our institution, 28 patients underwent cadaveric kidney transplantation from January 2001 to December 2016. These patients were classified into 2 groups according to DBD or DCD. Furthermore, 10 patients received transplants from expanded criteria donors (ECD) and 18 received them from standard criteria donors (SCD).Results
Kidney graft survival and engraftment were observed for all patients. There were no significant differences in renal function at 6 months for DBD and DCD transplant recipients. Renal function at 1, 3, and 5 years and serum creatinine levels were better for the ECD group. Renal function at 5 years after transplantation was significantly better for the SCD group than for the ECD group; however, there was no difference in delayed graft function between the SCD and ECD groups. Comparisons of the 3 groups showed good renal function for transplants from DBDs, but there was no significant difference in survival rates.Conclusions
Results were good for all patients. There were no significant differences in outcomes of our patients who received transplants from ECD or SCD. 相似文献7.
Liver Transplant Recipients With End-Stage Renal Disease Largely Benefit From Kidney Transplantation
T. Yunhua Z. Qiang J. Lipeng H. Shanzhou Z. Zebin J. Fei Z. Zhiheng W. Linhe J. Weiqiang W. Dongping G. Zhiyong H. Xiaoshun 《Transplantation proceedings》2018,50(1):202-210
Background
The incidence of end-stage renal disease (ESRD) after liver transplant (LT) has increased. The actual benefit of kidney transplantation (KT) is not completely understood in LT recipients with ESRD.Methods
We analyzed Scientific Registry of Transplant Recipients data for all KT candidates with prior LT from 1998 to 2014; the benefits of KT relative to remaining on dialysis were compared by means of multivariate Cox proportional hazards regression analysis.Results
The number of these KT candidates with prior LT has tripled from 98 in 1998 to 323 in 2015; LT recipients with ESRD remaining on dialysis have a 2.5-times increase in the risk of liver graft failure and a 3.6-times increase in the risk of patient death compared with these patients receiving KT. The adjusted liver graft and patient survival rates after donors from donation after cardiac death or expanded-criteria donor kidney transplantation were significantly higher than in patients remaining on dialysis in LT recipients with ESRD.Conclusions
The number of referrals to KT with prior LT is increasing at a rapid rate. Remaining on dialysis in LT recipients with ESRD has profound increased risks of liver graft failure and patient death in comparison to receiving a KT. LT recipients with ESRD can benefit from expanded-criteria donor and donation after cardiac death kidney transplantation. 相似文献8.
A. Kleinsteuber F. Halleck D. Khadzhynov A. Staeck L. Lehner M. Duerr P. Glander D. Schmidt K. Budde O. Staeck 《Transplantation proceedings》2018,50(10):3232-3241
Background
Outcomes of patients with end-stage renal disease are mainly affected by their comorbidities. Detailed data evaluating the impact of pre-transplant comorbidities on long-term outcome after kidney transplantation are largely missing.Methods
In a long-term retrospective analysis, we investigated 839 deceased donor kidney transplant recipients (KTRs) who received transplants between 1999 and 2014. The prevalence and impact of the most relevant comorbidities were studied in detail.Results
At the time of transplantation, 25% of KTRs had coronary artery disease (CAD), 16% had diabetes mellitus (DM), 11% had peripheral arterial disease (PAD), 8% had chronic heart failure (CHF), and 7% had cerebrovascular disease (CVD). KTRs with pre-existing CAD, DM, PAD, and CHF showed a significantly inferior patient survival. Multivariate analysis adjusting for all relevant factors and comorbidities confirmed CAD as most hazardous independent risk factor for premature death (hazard ratio [HR] 1.70; P = .002). A multivariate analysis revealed CHF and PAD as independent risk factors for death censored graft loss (HR 2.20; P = .003 and HR 1.80; P = .013). Diabetes was independently and significantly associated with T-cell- (HR 1.46; P = .020) and antibody-mediated rejections (HR 2.27; P = .030).Conclusions
Detailed quantification of the impact of pre-transplant comorbidities may facilitate the evaluation of transplant candidates, guide post-transplant follow-up, and may help to further refine prediction algorithms and allocation systems. 相似文献9.
D. Cucchiari J. Rovira D. Paredes P. Ventura-Aguiar A. Sanchez-Escuredo M. Solé R. Adalia F. Oppenheimer F. Diekmann I. Revuelta 《Transplantation proceedings》2017,49(10):2260-2264
Background
Systemic inflammation affects kidney function in a wide range of diseases. Even in kidney transplant recipients, higher levels of C-reactive protein (CRP) are invariably associated with both worse short- and long-term graft outcomes. However, little is known about systemic inflammation in kidney donors and, notably, brain death causes a strong systemic inflammatory response.Objective
To analyze the role of systemic inflammation of brain-dead donors on short-term kidney graft outcomes (ie, delayed graft function [DGF], defined as the need of dialysis during the first week after transplantation).Materials and methods
Retrospective analysis of clinical and biochemical characteristics of all brain-dead kidney donors generated in the Hospital Clínic of Barcelona in the 2006 to 2015 period (n = 194). Donors who were tested for CRP in the 24 hours before BD declaration were included (n = 97, 50% of initial population). Clinical and biochemical features of their respective recipients (n = 165) were analyzed, comparing recipients who developed DGF (n = 30) with recipients who did not (n = 135).Results
Donors whose recipients later developed DGF had much higher CRP values (10.58 [5.1-18.21] vs 4.81 [1.42-12.2] mg/dL, P = .025). Other characteristics associated with the development of DGF were renal biopsy score and recipient dialysis vintage (P = .025 and P = .002, respectively). In logistic regression analysis, PCR maintained significance in the non–expanded criteria donor (ECD) group (odds ratio [OR], 1.102; P = .027), but it lost significance in the ECD group (P = .67).Conclusions
Terminal donor CRP was associated with DGF in kidney transplant recipients and proved to be mostly significant in younger donors. 相似文献10.
N. Nakamura M. Tanaka M. Tsukamoto Y. Shimano M. Yasuhira J. Ashikari 《Transplantation proceedings》2017,49(1):16-25
Background
Kidneys from non–heart-beating donors are thought to be marginal, and careful evaluation is required. Mass analyzed data are limited, and each transplant surgeon must evaluate these organs on the basis of their own experience.Methods
We analyzed the data of 589 kidneys used for kidney transplantation from 304 non–heart-beating donors from January 2002 through December 2013 at the Japan Organ Transplant Network West Japan Division. The age of the donors, cause of death, and total ischemic time of more than 24 hours were factors that influenced the graft survival of the organs.Results
On the other hand, the final serum creatinine level before donation (maximum, 12.4 mg/dL), the presence and duration of anuria (maximum, 92 hours), and the presence of cannulation did not influence the graft survival rate.Conclusions
In multivariate analysis of Cox proportional hazards regression analysis, graft survival was significantly related to the age of the donor (over 70 years of age), cause of death (atherosclerotic disease), and total ischemic time of more than 24 hours. 相似文献11.
Y. Xiong J. Jiang H. Zhang Q. Fu R. Deng J. Li L. Liu X. Yuan X. He C. Wang 《Transplantation proceedings》2018,50(8):2412-2415
Objectives
To compare the clinical outcome of kidney transplantation from living-related and deceased donors.Patients and methods
Consecutive adult kidney transplants from living-related or deceased donors from February 2004 to December 2015 in a single center were enrolled for retrospective analysis. Estimated glomerular filtration rate (eGFR) was compared with linear mixed models controlling the effect of repeated measurement at different time points.Results
There were 536 living-related and 524 deceased donor kidney transplants enrolled. The 1-year, 3-year, and 5-year graft survival rates were 98.8%, 98.5% and 97.2% in living-related kidney transplantation (KTx), and 94.9%, 91.3% and 91.3% in deceased donor KTx (log-rank, P < .001). A significantly higher incidence of delayed graft function (DGF) was observed in deceased donor KTx (20.6% vs 2.6%, P < .001). eGFR in deceased donor KTx was significantly higher than that in living-related KTx (68.0 ± 23.7 vs 64.7 ± 17.9 mL/min/1.73 m2 at 1 year postoperation, 70.1 ± 23.3 vs 64.3 ± 19.3 mL/min/1.73 m2 at 2 years postoperation, and 72.5 ± 26.2 vs 65.2 ± 20.4 mL/min/1.73 m2 at 3 years postoperation; P < .001). The donor age was significantly higher in living-related KTx group (47.5 ± 11.0 vs 31.1 ± 14.4 years, P < .001).Conclusion
Living-related graft survival is superior to deceased graft survival at this center, while better 5-year renal allograft function is obtained in deceased donor KTx patients, which may be attributable to the higher age of living-related donors. 相似文献12.
I. Woźniak A. Kolonko J. Chudek Ł. Nowak M. Farnik A. Więcek 《Transplantation proceedings》2018,50(6):1896-1899
Background
Kidney transplant recipients are frequently treated for other medical conditions and experience polypharmacy. The aim of our study was to evaluate quality of life in relation to medicines' burden in these patients.Methods
We studied 136 unselected patients with mean post-transplant time of 7.2 ± 4.6 years. Quality of life was evaluated using a validated Polish version of the Kidney Disease Quality of Life–Short Form questionnaire. Data concerning the type (generic name) and number of currently prescribed medications were collected by interview survey. The participants were divided into 3 groups: group 1, patients with a maximum of 4 different medications (n = 37); group 2, patients with 4 to 9 medications (n = 76); and group 3, patients receiving at least 10 different medications (n = 23).Results
The number of medicines taken regularly ranged from 2 to 16. Patients with ≥10 drugs had the highest body mass index and lowest estimated glomerular filtration rate. Patients treated with ≥10 drugs, compared to patients from the 2 other groups, had presented lower subscales results concerning the physical functioning (65.9 vs 84.5 in group 1 and 83.4 in group 2, P < .001 for both comparisons), pain (57.2 vs 82.7 and 76.5, respectively, P < .001 for both), social function (66.8 vs 82.1 and 80.4, respectively, P = .04 for both), and energy/fatigue (54.8 vs 67.7, P = .03 and 65.4, P < .05). Multivariate regression analysis revealed that the number of drugs independently influenced physical functioning, pain, and social function subscales.Conclusions
Polypharmacy is associated with lower quality of life in patients after successful kidney transplantation. The negative impact of polypharmacy is particularly seen regarding physical functioning and pain severity. 相似文献13.
14.
N. Arpornsujaritkun S. Jirasiritham P. Pootracool W. Tirapanich G. Gesprasert B. Sakulchairungrueng P. Wiwattanathum S. Leelaudomlipi S. Sriphojanart 《Transplantation proceedings》2018,50(8):2461-2464
Background
Dual kidney transplants (DKTs) from expanded criteria donors (ECDs) have been performed in our hospital since 2014. We needed to review our clinical outcome and update criteria to selected ECDs for DKTs.Materials and Methods
Between January 2014 and December 2016, 4 DKTs and 269 deceased donor kidney transplants were performed. The outcome of DKTs was reviewed. The literature was reviewed for surgical technique and indication for DKT.Results
Four DKTs were performed between 2014 and 2016. One-year graft survival rate was 100%. One patient developed delayed graft function. No morbidity or mortality occurred.Conclusions
DKTs in our center were safe and had good outcome with optimized selected criteria. DKT can improve the rate of kidney transplant in a developing country. 相似文献15.
T. Matsuyama H. Ushigome M. Osaka K. Masuda S. Harada T. Nakamura S. Nobori T. Iida N. Yoshimura 《Transplantation proceedings》2018,50(10):3228-3231
Background
The rising demand for living renal donors has led to the recruitment of older donors. Findings vary, but these grafts appear to survive as long as grafts from standard criteria deceased and expanded criteria deceased donors. We investigated the effects of donor age ≥65 years and the presence or absence of donor antihypertensive therapy on patient condition 1 year after transplantation, and retrospectively examined 1-year (273 patients), 3-year (217 patients), and 5-year (140 patients) patient and graft survival.Methods
We divided 273 donor-recipient pairs into Group Y (donor age <65 years, n = 224) and Group O (donor age ≥65 years, n = 49). Group O was subdivided into donors receiving treatment for hypertension (subgroup O-1, n = 16) and those not receiving treatment for hypertension (subgroup O-2, n = 33). We compared results of 1 hour post-transplant biopsies and looked at a small number of 1 year post-transplant biopsies.Results
Although a significantly larger percentage of recipients from younger donors were undergoing preemptive transplantation, and the incidence of arteriosclerosis was significantly higher in the Group O kidneys, there were no significant differences between the 2 groups in terms of patient or graft survival at 1, 3, or 5 years; serum creatinine levels; or number of episodes of acute rejection. The presence or absence of donor antihypertensive treatment had no effect.Conclusions
We found that donor age ≥65, with or without antihypertensive treatment, had no effect on graft or patient survival. 相似文献16.
H. Mursawa S. Hatakeyama H. Yamamoto Y. Tanaka O. Soma T. Matsumoto T. Yoneyama Y. Hashimoto T. Koie T. Fujita R. Murakami H. Saitoh T. Suzuki S. Narumi C. Ohyama 《Transplantation proceedings》2018,50(1):145-149
Purpose
Pre-emptive kidney transplantation (PKT) is expected to improve graft and cardiovascular event-free survival compared with standard kidney transplantation. Aortic calcification is reported to be closely associated with renal dysfunction and cardiovascular events; however, its implication in PKT recipients remains incompletely explored. This aim of this study was to evaluate whether PKT confers a protective effect on aortic calcification, renal function, graft survival, and cardiovascular event-free survival.Methods
One hundred adult patients who underwent renal transplantation between January 1996 and March 2016 at Hirosaki University Hospital and Oyokyo Kidney Research Institute were included. Among them, 19 underwent PKT and 81 patients underwent pretransplant dialysis. We retrospectively compared pretransplant and post-transplant aortic calcification index (ACI), renal function (estimated glomerular filtration rate [eGFR]), and graft and cardiovascular event-free survivals between the 2 groups.Results
The median age of this cohort was 45 years. Preoperative ACI was significantly lower in PKT recipients. There were no significant differences between the 2 groups regarding postoperative eGFR, graft survival, and cardiovascular event-free survival. However, the ACI progression rate (ΔACI/y) was significantly lower in PKT recipients than in those who underwent pretransplant dialysis. Higher ACI was significantly associated with poor cardiovascular event-free survival.Conclusions
PKT is beneficial in that it contributes to the slow progression of after transplantation. Although we could not observe significant differences in graft and cardiovascular event-free survivals between the 2 groups, slow progression of aortic calcification showed a potential to decrease cardiovascular events in PKT recipients during long-term follow-up. 相似文献17.
T. Inoue M. Saito S. Narita K. Numakura H. Tsuruta A. Maeno N. Tsuchiya S. Satoh T. Habuchi 《Transplantation proceedings》2017,49(8):1786-1790
Objectives
Using a strategy of placing a surgical drain after kidney transplantation, the duration of a lymphatic fluid leakage and prevalence of a symptomatic lymphocele were retrospectively analyzed. The risk factors for persistent lymphatic fluid leakage or asymptomatic lymphocele were evaluated using multivariate analysis to estimate the origin of the lymphatic fluid leakage.Materials and methods
Patients with persistent lymphatic fluid leakage and symptomatic lymphocele were defined as those with lymphatic fluid drainage >50 mL for more than 15 days and those who required a percutaneous drainage of the lymphocele, respectively.Results
Persistent lymphatic fluid leakage and symptomatic lymphocele were observed in 40 (16.4%) and 10 (4.1%) of a total of 244 patients, respectively. The maximum durations of lymphatic fluid drainage from the initial drain tube and the second drainage of the symptomatic lymphocele were 48 and 28 days, respectively. Anastomosis of the graft artery to the external iliac artery was an independent risk factor to predict persistent lymphatic fluid leakage or symptomatic lymphocele after kidney transplantation (odds = 2.597, P = .008).Conclusion
The findings of the study suggest that the lymphatic fluid originates from the recipient's iliac lymph trunk rather than from the graft kidney. 相似文献18.
Introduction
Kidneys from acute kidney injury (AKI) donors are used for kidney transplantation. However, different Acute Kidney Injury Network (AKIN) criteria may show varying results after transplantation. We investigated the clinical outcomes in kidney transplantation from deceased donors with AKI as defined by the AKIN criteria at a single center.Methods
We retrospectively reviewed the medical records of 101 consecutive deceased donors and kidney transplantation recipients from March 2009 to June 2015 in a single center. Donor and recipient clinical characteristics with creatinine level, delayed graft function, estimated glomerular filtration rate (eGFR), rejection, and graft survival were investigated.Results
Of the 101 deceased donor kidneys, AKI occurred in 64 (63.4%) deceased donors. No differences in eGFR and serum creatinine level were found according to AKIN criteria. However, the AKIN stage 3 group had a slightly decreased kidney function without statistical significance. In the older AKI donor group, creatinine level was significantly higher than in other groups at 1 month (P = .015). No differences were found between the 2 groups in patient survival, graft survival, or rejection-free survival (P = .359, P = .568, and P = .717, respectively).Conclusions
Kidney transplantation from deceased donors with AKI showed comparable outcomes despite high rates of delayed graft function. AKIN stage 3 donors and aged-deceased donors with AKI showed a slightly reduced renal function without statistical significance; hence, use from donors with AKI needs to be considered to expand donor pools, but caution should be taken for AKIN stage 3 donors and aged donors with AKI. 相似文献19.
M. Bejic S. Déglise J.P. Venetz G. Nseir C. Dubuis F. Saucy X. Berard J.Y. Meuwly J.M. Corpataux 《Transplantation proceedings》2018,50(10):3192-3198
Background
The treatment of choice in end-stage renal disease is transplantation. Hemodynamic disturbances can evoke graft loss, while early ultrasound identification of vascular problems improves outcome. The aim of this study was to identify differences in postoperative complications with and without systematic intraoperative Doppler ultrasound use.Methods
The primary outcome was the postoperative rate of complications and the secondary aim was to find a predictive resistance index cut-off value, which would show where surgical reintervention was necessary. Over a 10-year period, 108 renal transplants were performed from living donors at our institution. In group 1 (n = 67), intraoperative duplex ultrasound and intraparenchymatous resistance index measurements assessed patients, while in group 2 (n = 41), no ultrasound was performed.Results
There were no intergroup differences in the overall postoperative complication rate or in benefit to graft or patient survival with Doppler use. However, significantly more vascular complications (10% vs 0%, P = .02) and more acute rejections (37% vs 10%) occurred in group 2 than in group 1. Therefore, an intraoperative cut-off value of the resistance index 0.5 was proposed to justify immediate surgical revision.Conclusions
This is the first report demonstrating benefits of systematic intraoperative Doppler ultrasound on postoperative complications in renal transplantation from living donors. Our results support surgical revision with a resistance index <0.5. 相似文献20.
D. Bartoszek O. Mazanowska K. Kościelska-Kasprzak D. Kamińska A. Lepiesza P. Chudoba M. Myszka M. Żabińska M. Klinger 《Transplantation proceedings》2018,50(6):1697-1700
Complement activation is considered one of the mediators of renal ischemia-reperfusion injury. Elevated levels of C5b-9, C3a, and C5a are detected in sera of deceased kidney donors. The goal of the study was to characterize the functional activity of complement pathways in donor sera and to assess their influence on transplant outcome.