Recovery of Graft Function Early Posttransplant Determines Long-Term Graft Survival in Deceased Donor Renal Transplants

Introduction

Because kidneys show remarkable resilience and can recover function, we examined the impact on long-term graft survival in deceased donor renal transplants of both immediate graft function (IGF) and the rate of renal function recovery over the first 3 months after transplantation.

Methods

We included all cadaveric renal transplants from 1990 to 2007 (n = 583). Delayed graft function (DGF) was defined as the need for dialysis in the first 7 days posttransplant. Slow graft function (SGF) and IGF were defined by serum creatinine falls of <20% or >20% in the first 24 hours posttransplant respectively. Recovery of renal function was expressed as either the best creatinine clearance (CrCl) in the first 3 months post-renal transplantation (BCrCl-3mos) as calculated using the Cockcroft-Gault formula or as a percentage of actual versus expected value (as calculated from the donors' CrCl at procurement).

Results

There were 140 (23.6%) subjects who received extended criteria donor (ECD) organs. The overall graft survival at 1 and 5 years was 87.8% and 74%, respectively. The 5-year graft survivals for patients with IGF, SGF, and DGF were 85%, 76%, and 54%, respectively (P < .02). ECD kidneys showed twice the DGF rate (49% vs 23%, P < .001). BCrCl-3mos of <30 mL/min displayed a 5-year graft survival of 34%; 30 to 39 mL/min, 72%; 40 to 49 mL/min, 85%; and >50 mL/min, 82% (P < .001). Similarly, a recovery within 90% of expected CrCl in the first 3 months posttransplant correlated with 5-year graft survival of 81%; a recovery of 70% to 90%, with 65%; and a recovery of <70%, with 51% (P < .001).

Conclusion

Early graft function in the first 3 months showed a significant impact on long-term graft survival after deceased donor renal transplantation.     

Stem cell factor, interleukin-16, and interleukin-2 receptor alpha are predictive biomarkers for delayed and slow graft function

Introduction

Delayed graft function (DGF) and slow graft function (SGF) due to ischemic and reperfusion injury (IRI) are common complications of deceased donor kidney transplantation. We tested whether a panel of serum and urine cytokines represent early biomarkers for DGF and SGF.

Methods

We collected serum and urine samples from 61 patients 48 hours posttransplantation and used a multiplex enzyme-linked immunosorbent assay (ELISA) technique to measure levels of 23 cytokines. Fourteen patients developed poor graft function (PGF), with 6 having DGF and 8 with SGF.

Results

Area under receiver operation characteristics curve (AUC) demonstrated the following: serum levels of SCF (0.88) and interleukin (IL) 16 (0.74).

Conclusions

This study showed that a select panel of cytokines measured early post kidney transplantation may predict poor graft function.     

Impact of Slow and Delayed Graft Function on Kidney Graft Survival Between Various Subgroups Among Renal Transplant Patients

Objective

Renal allografts with excellent graft function show good long-term outcomes, while grafts with delayed function have been associated with poor long-term survivals, although few reports have analyzed outcomes among these groups. We compared first-week postoperative graft function among renal transplant patients to analyze the impact of slow graft function (SGF) and delayed graft function (DGF) on graft survival.

Materials and Methods

Renal transplantations were performed from 362 unrelated, 46 related, and 163 deceased donors. Kidney transplant patients were divided into 3 groups according to their initial graft function. First-week dialyzed patients formed the DGF group. Nondialyzed patients were divided into a SGF or an excellent graft function (EGF) cohort according to whether the serum creatinine at day 7 was higher vs lower than 2.5 mg/dL, respectively.

Results

Of the 570 renal transplant recipients, DGF was observed in 39 patients (6.8%), SGF in 64 (11.2%), and EGF in 467 (81.8%). There was no significant difference in SGF vs DGF between patients who received kidneys from unrelated vs related living or deceased donors. Graft survival was worse among the DGF than the SGF or EGF patients, with no significant difference between the last 2 groups. The 6-month graft survivals were 74%, 93%, and 96%; the 3-year graft survivals were 70%, 88%, and 90%, respectively (P < .001).

Conclusions

We observed a similar impact of EGF and SGF on kidney graft survival. Kidney transplant recipients who developed DGF showed worse graft survival than those with EGF or SGF.     

Effects of ischemia and reperfusion injury on long-term graft function

Background

The clinical manifestation of ischemia/reperfusion injury in renal transplantation is delayed graft function (DGF), which is associated with an increase in acute rejection episodes (ARE), costs, and difficulties in immunosuppressive management. We sought to evaluated the DGF impact after renal transplant.

Methods

We evaluated a group of 628 patients undergoing deceased donor renal transplantation between 2002 and 2005 at 3 Brazilians institutions to define the main DGF characteristics.

Results

DGF incidence was 56.8%, being associated with elderly donors (P = .02), longer time on dialysis (P = .001), and greater cold ischemia time (CIT; P = .001). Upon multivariate analysis, time on dialysis >5 years increased DGF risk by 42% (P = .02) and CIT >24 hours increased it by 57% (P = .008). In contrast, DGF was associated with an higher incidence of ARE: 27.7% in DGF versus 18.4% in IGF patients (P = .047). The ARE risk was 46% higher among individuals with DGF (P = .02), 44% among patients >45 years old (P < .001), 50% among those with >5 years of dialysis time (P = .02), and 47% lower among the who were prescribed mycophenolate instead of azathioprine (P < .001). Patients with DGF showed worse 1-year graft function (54.6 ± 20.3 vs 59.6 ± 19.4 mL/min; P = .004), particularly those with ARE (55.5 ± 19.3 vs 60.7 ± 20.4; P = .009). One-year graft survival was 88.5% among DGF versus 94.0% among non-DGF patients.

Conclusion

The high incidence of DGF was mainly associated with a prolonged CIT. There was a relationship between DGF and ARE, as well as with a negative influence on long-term graft function.     

Delayed kidney allograft function after simultaneous pancreas-kidney transplantation

Background

Simultaneous pancreas-kidney transplantation (SPKT) is one of the treatments for insulin-dependent chronic renal failure patients.

Methods

One-year patient and kidney allograft survival rates of 150 patients undergoing SPKT were subjected to Cox regression and Kaplan-Meier analyses. Uni- and multivariate methods identified risk factors involved in allograft and patient survival.

Results

One-year patient and kidney allograft survival rates were 82% and 80%, respectively. Delayed graft function (DGF) (P = .001; hazard ratio [HR]5.41) and acute kidney rejection episodes (P = .016; HR 3.36) were related to 1 year patient survival as well as intra-abdominal infection (IAI) rates. (IAI). One-year kidney allograft survival was related to DGF (P = .013; odds ratio [OR] 3.39), acute rejection (P = .001; OR 4.74), and IAI (P = .003, OR 6.29). DGF was related to a time on dialysis >27 months (P = .046; OR 2.59), cold kidney ischemia time >14 hours (P = .027; OR 2.94), donor age >25 years (P = .03; OR 2.82), and donor serum sodium concentration >155 mEq/L (P < .0001; OR 1.09). Female kidney to male recipient in 17% of the cases did not increase the risk of DGF. We observed an important correlation between donor serum sodium and creatinine (P < .0001), which suggested undertreatment of diabetes insipidus secondary to brain death.

Conclusions

DGF, acute rejection, and IAI were the main determinants of survival after SPKT. Improving the care of deceased donors may reduce DGF occurrence.     

Preemptive kidney transplantation: experience in two centers

Introduction

End-stage renal disease (ESRD) is a prevalent, important cause of death. Transplantation increases survival and improves the quality of life of patients with ESRD while long-term dialysis is related to poor outcomes even among patients who undergo subsequent transplantations.

Objectives

To compare the advantages of preemptive procedures with kidney transplants among patients on renal replacement therapy.

Methods

This retrospective study was performed in two Córdoba city transplantation centers. Patients were divided into three groups: preemptive kidney transplant (PKT), patients on hemodialysis who received living donor kidney transplants (LDT), and subjects who received grafts from deceased donors (DDT). Serum creatinine, delayed graft function (DGF), subclinical rejection, and interstitial fibrosis/tubular atrophy (IF/TA) were evaluated at 6 months.

Results

Eighty patients were included: PKT (n = 28), LDT (n = 27), DDT (n = 25) mean age 29, 30, and 35 years, respectively. Women predominated among PKT and men in the other groups. In all groups, cyclosporine was the calcineurin inhibitor mostly used. Creatinine at 6 months was lower in the living donor groups (1.26 mg/dL PKT and 1.32 mg/dL LDT; P = NS) in relation to the deceased donor group (1.96 mg/dL; P < .05). DDT had the highest rate of DGF: 44% DDT versus 11.5% LDT vs 0% PKT (P < .05). Subclinical rejection was significantly lower among preemptive transplantations: PKT 7.6% versus LDT 18.5% versus DDT 24% (P < .05). IF/TA was higher in transplants from deceased donors: PKT 11.1%; LDT 11.5%; DDT 32%.

Conclusions

Preemptive kidney transplantation offered the advantages of a lower creatinine, no DGF, as well as a reduced incidence of subclinical rejection and chronic allograft nephropathy at 6 months posttransplantation.     

Delayed Graft Function in Renal Transplant Recipients: Risk Factors and Impact on 1-Year Graft Function: A Single Center Analysis

Delayed graft function (DGF), a frequent complication after kidney transplantation, occurs among about 60% of recipients of kidneys from deceased donors. DGF has a multifactorial etiology. It is characterized by acute tubular necrosis (ATN) upon biopsy. In this study we sought to identify among a group of recipients of kidneys from deceased donors, the incidence, risk factors, and impacts on patient and graft survivals of DGF.

Materials and Methods

We retrospectively analyzed medical records from renal transplant recipients aged >18 years who received a deceased donor kidney graft between January 2003 and December 2006. Kidneys lost during the first week posttransplantation were excluded from this series.

Results

Among 165 transplants, 111 (67%) displayed DGF, defined as the need for dialysis during the first week posttransplantation. The incidence of DGF was higher among patients with a cold ischemia time (CIT) > 24 hours: 85% vs 60%, DGF vs no DGF (P < .05), as well as for grafts from older donors. After 1-year follow-up, the DGF group showed worse graft function (serum creatinine 1.6 ± 0.7 vs 1.3 ± 0.4 mg/dL; P < .05) as well as a greater incidence of graft loss.

Conclusion

Prolonged cold ischemia and older donor age were associated with a greater incidence of DGF in this series, leading to prolonged hospitalization, increased risk for an acute rejection episode, and reduced graft function and survival after 1 year.     

The Risk Factors of Delayed Graft Function and Comparison of Clinical Outcomes After Deceased Donor Kidney Transplantation: Single-Center Study

Introduction

The aim of this study was to analyze risk factors for delayed graft function (DGF) after deceased donor kidney transplantation and to compare the clinical outcomes of non-DGF versus DGF recipients.

Patients and methods

From January 2004 to June 2008, 75/154 kidneys were transplanted into 74 recipients. We classified the recipients into two groups: group 1 (n = 61) without DGF and group 2 (n = 13) with DGF.

Results

On univariate analysis, recipient age (P = .048) cause of brain death (traumatic brain injury vs disease, P = .016), blood urea nitrogen (P = .002), serum creatinine (P = .001), arterial pH (P = .019), and serum sodium level (P = .012) just before organ procurement showed significant differences. On multivariate analysis, the cause of brain death (P = .015, hazard ratio [HR]: 7.086), the terminal serum creatinine ≥1.5 mg/dL before organ procurement (P = .007, HR: 10.132), and recipient age over ≥50 years (P = .021, HR: 7.767) were independent risk factors for the development of DGF. Graft failures occurred among 5/74 recipients with 5-year graft survivals between group 1 and group 2 of 91.7% and 84.6%, respectively. Patient death occurred in five cases, most by due to infection. The 5-year patient survival between groups 1 and 2 were 93.9% and 84.6%, respectively (P = .106).

Conclusion

The independent risk factors for DGF were the cause of brain death, the terminal creatinine level, and the recipient age. In deceased donor kidney transplantation, DGF may have less effect on long-term patient and graft survivals.     

Impact of Recipient and Donor Nonimmunologic Factors on the Outcome of Deceased Donor Kidney Transplantation

Objective

To study the influence of nonimmunologic factors on the outcome of extended criteria deceased donor (DD) kidney transplants.

Method

This is a retrospective study of DD transplantation carried out from January 1, 2003 to December 31, 2007, to investigate the impact on graft survival and function of donor renal function at retrieval, cold ischemia time (CIT), delayed graft function (DGF), acute rejection episodes (ARE), age, and weight of donors and recipients, transplant center activities, cause of donor death, donor-recipient gender pairing and size of the donating intensive care unit (ICU).

Results

At retrieval, the frequency of donors with a creatinine clearance <60 mL/min, using the Cockcroft-Gault formula, and age >40 years were 31.7% and 32%, respectively. CIT > 24 hours, DGF, and ARE occurred in 27.1%, 33.4%, and 16.5% of cases, respectively. The overall 1- and 5-year graft and patient survival rates were 88% and 79.8% and 96.6% and 92.3%, respectively. The graft function was inferior with occurrences of ARE (P = .0001), DGF (P = .0001), CIT > 20 hours (P = .005), nontraumatic the donor death (P = .022), and donor ICUs bed capacity <20 (P = .03). The odds ratio (OR) for graft loss with DGF, ARE, and donors right kidneys were 7.74 (95% confidence interval [CI] 6-13.4; P = .0001), 4.47 (95% CI, 2.6-7.6; P = .0001) and 1.7 (95% CI, 1-2.8; P = .045), respectively. Graft function was not influenced by donor renal function at retrieval, donor weight, or donor- recipient gender pairings.

Conclusion

CIT and ARE had an impact on both graft survival and function. DGF and cerebrovascular accidents as the cause of donor death negatively affected graft function during follow-up. ICU center experience had a positive impact on graft survival. Patient survival was affected by recipient age >50 years and female to male donation versus other gender pairings. Neither donor age nor acute terminal rise in the donor serum creatinine affected graft function or survival, or patient mortality.     

Delayed graft function and long-term outcome in kidney transplantation

Background

There are still many controversies about the impact of delayed graft function (DGF) on kidney transplantation outcome. The aims of this study were to define factors associated with DGF and to ascertain the relative impact of DGF on kidney transplantation outcome, both in the early postoperative period and in long-term follow-up.

Patients and Methods

Four hundred kidney transplant recipients were reviewed to assess the clinical impact of DGF on long-term outcome.

Results

The overall prevalence of DGF was 24.3%. DGF was significantly associated with increasing recipient and donor age, duration of dialysis, and cold ischemia time. Patients with DGF displayed a significantly worse graft (P = .005) and patient (P < .001) survival compared with recipients with immediate function.

Conclusion

DGF is a frequent complication of renal transplantation and may be associated with a reduced graft and even patient survival. Strategies to prevent graft injury and, more specifically, DGF may be an important clue to provide a better long-term outcome in kidney transplantation.     

Evaluation of Epstein-Barr virus load in saliva before and after renal transplantation

Introduction

Posttransplant lymphoproliferative disorders (PTLD) arising in solid organ transplant patients show a strong correlation with Epstein-Barr virus (EBV) infection. The aim of our study was to evaluate the frequency of EBV DNA levels before and after transplantation among saliva samples of Iranian kidney transplant patients.

Materials and Methods

In 40 kidney transplant recipients and their healthy donors, we evaluated the EBV DNA levels in saliva samples by quantitative polymerase chain reaction method using samples obtained 1 hour before transplantation surgery. In addition, 3 months after transplantation we evaluated EBV DNA levels in recipients for comparison with preoperative levels. Exclusion criteria included hepatitis B, hepatitis C, and human T-cell leukemia virus infections before transplantation as well as HIV-positive patients under highly active antiretroviral therapy, graft rejection requiring dialysis and active viral infection of oral cavity.

Results

Before renal transplantation, there was no significant difference in saliva EBV DNA levels between kidney donor and recipient patients (P = .8). The levels increased significantly to 67.6% in the recipient group after transplantation (P = .01).

Conclusion

We observed that EBV was more frequently present in the oral mucosa after renal transplantation. Thus, we can follow these patients for EBV infection using saliva examinations as a simple screening method.     

Early renal transplantation after donor renal angiography affects initial graft function

Background

Renal angiography of a living donor is a common radiologic examination before transplantation. However, the contrast agent used during this procedure can cause contrast nephropathy. There are insufficient data regarding whether this radiocontrast exposure detoriates renal function and survival after transplantation. In this study, we analyzed the effects of radiocontrast exposure to donors before transplant surgery on the incidence of delayed graft function (DGF) and on the outcomes of recipients at 1 year posttransplantation.

Methods

We divided 80 living donor transplantations according to the duration between the renal angiography and the transplantation procedure: Group 1 as early transplantation at ≤20 days (n = 42) versus group 2 of late transplantation at ≥20 days (n = 38). We retrospectively collected acute rejection episodes and graft survival at 1 year, monthly serum creatinine values of, DGF, proteinuria at 1 month, GFR at posttransplant day 3 month 1, and 1 year.

Results

There were 10 group 1 recipients (23.8%) and 2 group 2 (5.3%) subjects who experienced ≥1 acute rejection episode in the 1st posttransplant year (P = .02); 1 patient in each group experienced graft loss at 1 year (P = .941). DGF was observed in 9 (22%) versus 1 patient (2.6%) in group 2 (P = .009). Posttransplant day 3 creatinine values were significantly higher (P = .005) with significantly lower GFR values (P = .043) in group 1. However, creatinine and GFR levels were similar at 1 month and 1 year. Month 1 proteinuria levels were significantly higher in group 1 (P = .014). There was a significant negative correlation between renal angiography time and month 1 proteinuria (P = .014).

Conclusions

Early renal transplantation (within 2 weeks after renal angiography) in living kidney donors can detoriate initial graft function and cause DGF.     

Infective Complications Associated With Ureteral Stents in Renal Transplant Recipients

Objective

Stenting of the ureter is commonly performed during renal transplantation to avoid early complications. However, it predisposes to infections that may pose a significant threat to the graft and patient. Our study sought to investigate the incidence of infections associated with stents in renal transplant recipients.

Patients and Methods

A retrospective analysis of 100 consecutive renal transplant recipients performed over 1 year with 6 months follow-up.

Results

The median recipient age was 46 years (range, 19-71 years). Among the study group, 75 patients received an organ from deceased donor and 25 from live donor. In our study, there were 79 patients with a stent (ST) and 18 without a stent (WOST); 3 patients who required nephrectomy were excluded from the study. There were 2 ureteric stenoses that occurred following stent removal: 1 required surgical correction and 1 was treated radiologically. There were no cases of urinary leak. The incidence of urinary tract infection (UTI) was significantly greater among ST compared with WOST subjects (71% vs 39%; P = .02). New episodes of UTI following removal of the stent were more common among patients who had experienced infections while having a stent compared with infection-free stented patients (54% vs 30%; P = .04).

Conclusions

A ureteric stent may help to reduce early postoperative complications (leak and stricture), but increased the likelihood of UTI. Infection while having a ureteric stent was associated with a high recurrence rate of UTI even after stent removal.     

Delayed Graft Function Has an Equally Bad Impact on Deceased Donor Renal Graft Survival in Both Standard Criteria Donors and Expanded Criteria Donors

Introduction

The use of expanded criteria donors (ECDs) is still limited because of inferior graft survival compared to standard criteria donors (SCDs). We assessed the impact of immediate graft function (IGF) on renal graft survival among recipients of SCD and ECD grafts to determine whether these kidneys performed equally well under “ideal” conditions favoring IGF.

Methods

We included all cadaveric renal transplants performed from 1990 to 2002 (n = 335). Delayed graft function (DGF) was defined as the need for dialysis in the first 7 days posttransplant. Slow graft function (SGF) and IGF were defined as a serum creatinine fall by <20% versus >20% in the first 24 hours posttransplant, respectively. Non-death censored actual graft survivals are reported herein.

Results

Seventy-two of the 335 subjects (21.5%) received organs from ECDs and displayed IGF in 54.7%, SGF 16.2%, and DGF 29.1%. Among SCDs, the SGF and DGF rates were 15.3% and 23.4%, respectively. In ECD, the SGF and DGF rates were 19.4% and 50% (P < .02). Actual graft survivals at 1 and 5 years was 86.3% and 70.4%, respectively. Patients with IGF had higher actual graft survival at 5 years compared to SGF and DGF (83.5% vs 74.1% vs 45.4%). DGF had an equally bad impact on actual 5-year graft survival in SCDs and ECDs (42.6% vs 50%).

Conclusion

DGF has a strong detrimental impact on 5-year graft survival. There is a higher rate of DGF in ECD versus SCD kidneys. The detrimental impact on 5-year actual graft survival is equal in SCD and ECD kidneys. Minimizing DGF should be our goal.     

Living or Deceased Donor Kidney Transplantation: A Comparison of Results and Survival Rates Among Iranian Patients

Objective

Kidney transplantation is the selective treatment of end-stage renal disease. Although most previous studies have concluded that living kidney donation achieves better graft survival, some factors may limit this type of donation. This study investigated the survival rates of living and deceased donor kidney transplantations among Iranian patients.

Materials and Methods

The records of kidney transplantations up to year 2005 were used to compare 50 deceased (group I) with 50 living donor transplants (group II). The recipients were matched by transplantation time. We used SPSS version 15 software to analyze the data.

Results

Group I patients included 28 males and 22 females of mean age of 38 ± 13 years, while 26 males and 24 females in group II had a mean age of 34.6 ± 14 years. The rejection and graft nephrectomy rates were significantly higher among group I than group II (P = .01, P = .02). The first-year graft survival was higher in group II (P = .001). The graft survival was significantly lower in recipients who needed a biopsy or dialysis (P = .006 and P = .02, respectively) and higher among those who had a urine volume >4200 mL within the first 24 hours after transplantation (P = .003). Patient survivals were not significantly different between the groups.

Conclusion

Living donor kidney transplantations showed higher graft survival and lower acute rejection rates compared with those from deceased donors.     

Dialysis as a bridge therapy to renal transplantation: comparison of graft outcomes according to mode of dialysis treatment

Background

Renal transplantation is the ideal renal replacement therapy in patients with end-stage renal disease. It was unclear whether a difference in dialysis modality influences outcomes after kidney transplantation. Therefore, we evaluated the influence of dialysis modality.

Methods

We compared various clinical and laboratory parameters of 70 peritoneal dialysis (PD) and 180 hemodialysis (HD) patients (n = 250), including 91 females and an overall age 36.7 ± 9.7 years who underwent transplantation between 2000 and 2008 to evaluate factors affecting delayed graft function (DGF) and of transplant graft failure.

Results

Overall graft survival was 82% at 3 and 75% at 5 years. Among HD patients, 16% displayed DGF, versus 12% of PD patients. Multivariate analysis showed that factors affecting DGF were: mode of dialysis (relative risk [RR] = 1.39, 95% confidence interval (CI): 1.35-1.43; P < .01); parathyroid hormone (RR = 0.32, 95% CI: 0.30-0.34, P < .05), C-reative protein (RR = 1.03, 95% CI: 0.97-1.09; P < .05), hemoglobin levels (RR = .75, 95% CI: 0.72-0.79; P < .05). At 3 and 5 years follow-up, PD patients' showed fewer graft failures than HD patients (14% vs 20%; P < .05 and 17% vs 28%; P < .05).

Conclusion

Early graft function rates were better for PD than for HD patients. Inflammation and anemia should be carefully investigated and corrected to achieve better graft function.     

Impact of Continuous Value of Body Mass Index on Graft Loss in Overweight Patients

Introduction

High body mass index (BMI) is associated with increased cardiovascular mortality and risk of progression to end-stage renal disease both among the general population and among renal transplant patients. However, in the latter condition no unequivocal studies have been reported in the literature. The aim of our study was to investigate continuous versus categorical values of BMI (World Health Organization classification) as an independent risk factor in renal transplantation.

Patients and methods

We retrospectively studied 194 renal transplant patients (128 males and 66 females) whose mean age at transplant was 43.9 years. They had 5 years follow-up. To investigate the association between BMI and graft survival, we performed univariate and multivariate analyses using the Cox regression model. This model was adjusted both for classical covariates (age, gender, time on dialysis, HLA mismatches, donor status) and other covariates as delayed graft function (DGF), acute rejection episodes (AR), and chronic allograft nephropathy (CAN), which are universally recognized to be predictors of graft loss as evidenced by a need for dialysis treatments.

Results

At the time of transplantation, the BMI averaged 24.4 ± 2.65 kg/m². Upon univariate analysis, age (P = .049), BMI (P = .005), DGF (P = .009), ARE (P < .0001), and CAN (P = .001) were significantly related to poor transplant outcomes. Upon multivariate analysis, only the BMI value, considered as continuous value (P = .013), DGF (P = .030), and ARE (P < .0001) were significantly related to graft loss.

Conclusions

BMI as a continuous value represented an independent risk factor for renal transplant loss at 5 years. Correction of pretransplant body weight both in overweight (25 ≤ BMI ≤ 30) and normal-weight patients is essential to avoid graft loss.     

The value of pre-emptive therapy for cytomegalovirus after liver transplantation

Background

Cytomegalovirus (CMV) infections are among the most common infections following liver transplantation. The main preventive methods for CMV infections are universal prophylaxis and pre-emptive therapy. In our study, we adopted a pre-emptive strategy in a higth-risk group of donor CMV-positive (D+)/recipient CMV-negative (R−) casses. We investigated whether this strategy was safe and effective to prevent CMV disease.

Methods

One hundred fifty-nine liver transplantation recipients who underwent over a 15-year period were retrospectively analyzed after follow-up for at least 6 months (mean, 63 months). Weekly quantitative polymerase chain reaction (PCR) measurements were performed to detect viral DNA. No CMV drug prophylaxis was given: antiviral CMV therapy was initiated when the PCR for CMV-DNA was >400 copies/mL.

Results

Fifty-one of 159 liver transplant recipients enrolled in the study received antiviral therapy. High-risk patients (D+/R−) developed CMV infections significantly more often than D−/R− serostatus (P = .005). CMV disease was diagnosed in 12% of CMV-positive patients. Independent of serostatus in 14 cases (27.5%) virological recurrence of CMV infection occurred after primary treatment. Survival analysis showed no significant difference between patients with versus without CMV infection (P = .950). No relationship could be found between transplant rejection and CMV infection (P = .349).

Conclusion

Our results showed that a pre-emptive strategy to prevent CMV disease was possible, even among the serological high-risk group. Only 12% of cases with CMV infection went on to manifest CMV disease with organ involvement. Survival curves were similar among patients with versus without CMV infections.     

Risk factors for immediate anemia in renal transplant recipients: a single-center experience

Background

Although endogenous erythropoietin secretion returns via the renal allograft a few hours following successful engraftment, anemia is a common early or late complication. In addition, anemia is a risk factor for ischemic heart disease and graft loss. We sought to determine risk factors for and the prevalence of severe anemia immediately posttransplantation (PTA).

Methods

This cross-sectional retrospective study performed between 2006 and 2009 enrolled 864 adult subjects of mean age 40.7 ± 13.8 (range = 6-75) years. On the basis of The World Health Organization criteria, a hemoglobin (Hb) level less than 11 g/dL for men and less than 10 g/dL for women was defined as severe anemia.

Results

Severe anemia occurred frequently (62.7%) among these patients whose most common underlying disease was hypertension 311 (58.2%). Their mean Hb level was 9.9 ± 1.8 g/dL at the time of hospital discharge, namely, almost 2 weeks after transplantation. More than 90% (n = 778) of subjects received a kidney from a living donor. Immediate severe anemia associated with delayed graft function (DGF; P = .01), antithymocyte globulin (ATG)/antilymphocyte globulin (ALG) administration (P = .000), acute rejection (P = .000), recipient gender (P = .000), cold ischemic time (P = .01), pretransplant Hb (P = .000), posttransplant creatinine (P = .001), and acute rejection episodes (P = .000). Upon logistic regression analysis donor age (P = .04, confidence interval [CI] = 0.7-0.9), recipient female gender (P = .009, CI = 0.08-0.7), and ATG/ALG use (P = .009, CI = 1.7-43.4) showed significant effects to cause severe PTA.

Conclusion

Immediate anemia after renal transplantation is a consequence of poor renal function. In addition, ATG/ALG use and DGF can induce severe PTA, which may play roles in ischemic heart disease and graft loss.     

Comparison of Outcomes of Living and Deceased Donor Kidney Grafts Surviving Longer Than 5 Years in Korea

Background

It is generally recognized that living donor kidney transplantation (LDKT) grafts are superior to deceased donor kidney transplantation (DDKT) grafts. We compared survival and functional outcomes of LDKT and DDKT grafts.

Methods

Among 1000 kidneys transplanted from 1995 to 2008, we selected grafts surviving >5 years, excluding pediatric, multi-organ transplantation, and retransplantations (n = 454).

Results

There were 179 kidneys from deceased donors and 275 from living donors. Recipients showed no difference in age, gender, or cause of renal failure. Donors were younger in the DDKT group (30.6 vs 38.5 years; P < .05). There were more male donors in the DDKT group (73.2% vs 54.5%; P < .05). Deceased donors showed a greater mean number of HLA mismatches (4.2 vs 2.7; P < .05). Death-censored graft survival at 10 years showed no difference (DDKT 88.9% vs LDKT 88.9%; P = .99). Mean serum creatinine at 5 years was 1.41 mg/dL for DDKT and 1.44 mg/dL for LDKT (P = .75). Mean estimated glomerular filtration rate at 5 years was 67.8 mL/min/1.73 m² for DDKT and 62.1 mL/min/1.73 m² for LDKT (P = .23). Twenty-three DDKT grafts (12.8%) and 47 LDKT grafts (17.1%) experienced acute rejection episodes (P = .22). DDKT recipients showed more cases of viral and bacterial infections compared with LDKT recipients (viral, 11.7% vs 2.2% [P < .05]; bacterial, 21.8% vs 7.3% [P < .05]).

Conclusion

Among kidney grafts surviving >5 years, there was no difference in survival or serum creatinine levels at 5 and 10 years between DDKT and LDKT grafts.