Evanescing renal allograft cortical necrosis from living donor renal transplantation: A lesson learned over two decades |
| |
| Institution: | 1. Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India;2. Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India;3. Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India;1. Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran;2. Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran;3. Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran;4. Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran;5. Department of General Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran;6. Department of Immunology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran;1. Department of Gastroenterology, The 940th Hospital of Joint Service Logistics Support Force of Chinese People''s Liberation Army, Lanzhou 730050, Gansu, China;2. The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, Gansu, China;1. Surgical Nursing Division, Nursing Department, Health Sciences High School, Istanbul Nisantasi University, Istanbul, Turkey;2. Surgical Nursing Division, Nursing Department, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey;1. Joint Trauma Center, PLA 371 Center Hospital, Department of Orthopedics, 371 Hospital, Xinxiang Medical University, Xinxiang 453003, PR China;2. Department of Digestive System, PLA 371 Center Hospital, Xinxiang Medical University, Xinxiang 453003, PR China |
| |
| Abstract: | BackgroundRenal graft cortical necrosis (GCN) is a catastrophic cause of graft failure. We evaluated the incidence, causes, management, and outcome of GCN across two decades from our center.MethodsThis is a retrospective analysis of transplant patients who had biopsy-proven GCN transplanted between 2000 and 2020. The clinical details, immunological workup, induction, maintenance regimen, causes of cortical necrosis, and the outcomes were compared between the first period 2000–2012, and the second period 2013–2020, when Flow cytometric and Luminex based crossmatch were included in the workup plan.ResultsAmong 2333 live ABO-compatible renal transplants, 37 (0.015%) patients (36 patients between 2000 and 2012 and 1 between 2013 and 2020) developed GCN (60% had diffuse and 40% patchy GCN) at a median of 8 days after transplantation.Twenty-six (60%) received ATG, 4 received plasmapheresis and ATG (10.8%) as antirejection therapy. The cyclosporine-based regimen was associated with a higher risk of GCN (RR 2.54; 95% CI 1.26 to 5.12, p = 0.009), whereas tacrolimus-based therapy had a lower risk (RR 0.39; 95% CI 0.19 to 0.79, p = 0.009). The introduction of flow cytometry and DSA assay has significantly decreased the incidence of acute rejection and GCN. Only one patient had GCN during the 2013–2020 period because of graft's mucormycosis. Twenty-five (67.56%) patients had no recovery, and 12 (32.43%) had partial recovery of graft function.ConclusionGCN is mainly associated with rejection, and cyclosporin-based maintenance regimen had a higher incidence. The remarkable decrease in GCN after 2012 onwards could be attributed to the use of Flowcytometry, Luminex-based DSA assays, and tacrolimus-based regimens. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
