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Sample records for living renal transplantation

  1. The Iranian model of living renal transplantation.

    PubMed

    Mahdavi-Mazdeh, Mitra

    2012-09-01

    Organ shortage for transplantation remains a worldwide serious problem for kidney patients with end-stage renal failure, and several countries have tried different models to address this issue. Iran has 20 years of experience with one such model that involves the active role of the government and charity foundations. Patients with a desperate demand for a kidney have given rise to a black market of brokers and other forms of organ commercialism only accessible to those with sufficient financial resources. The current Iranian model has enabled most of the Iranian kidney transplant candidates, irrespective of socioeconomic class, to have access to kidney transplantation. The Iranian government has committed a large budget through funding hospital and staff at the Ministry of Health and Medical Education by supporting the brain death donation (BDD) program or redirecting part of the budget of living unrelated renal donation (LURD) to the BDD program. It has been shown that it did not prevent the development and progression of a BDD program. However, the LURD program is characterized by several controversial procedures (e.g., confrontation of donor and recipient at the end of the evaluation procedure along with some financial interactions) that should be ethically reviewed. Operational weaknesses such as the lack of a registration system and long-term follow-up of the donors are identified as the 'Achilles heel of the model'. PMID:22673884

  2. [Renal transplantation from living donor in Italy and Europe].

    PubMed

    Frascà, Giovanni M; Gaffi, G; Taruscia, D; D'Arezzo, M; Benozzi, L; Sagripanti, S

    2009-01-01

    Renal transplantation from a living donor shows a better graft and patient survival when compared with cadaver donor grafts. Moreover, since surgery can be planned in advance when a living donor is available, the time spent on dialysis while awaiting transplantation can be greatly reduced and dialysis treatment can be completely avoided in some cases. Only few risks for the donor have been reported as a consequence of nephrectomy, both in the short and long term. Nevertheless, despite these advantages, the number of living donor renal transplants carried out in Europe each year varies greatly from country to country and is particularly low in Spain and Italy. Several factors account for these differences, mainly the effectiveness of the organ procurement system, which could make people reluctant to living donation, and doctors' and patients' limited knowledge about living donor transplants. Nephrologists have the responsibility to identify patients eligible for transplant early in the course of the disease, and to inform them and their relatives about living donor transplantation, enabling them to make informed choices among the various treatment options in end-stage renal disease. PMID:19644833

  3. Ethical issues relating to renal transplantation from prediabetic living donor

    PubMed Central

    2014-01-01

    Background In Mexico, diabetes mellitus is the main cause of end − stage kidney disease, and some patients may be transplant candidates. Organ supply is limited because of cultural issues. And, there is a lack of standardized clinical guidelines regarding organ donation. These issues highlight the tension surrounding the fact that living donors are being selected despite being prediabetic. This article presents, examines and discusses using the principles of non-maleficience, autonomy, justice and the constitutionally guaranteed right to health, the ethical considerations that arise from considering a prediabetic person as a potential kidney donor. Discussion Diabetes is an absolute contraindication for donating a kidney. However, the transplant protocols most frequently used in Mexico do not consider prediabetes as exclusion criteria. In prediabetic persons there are well known metabolic alterations that may compromise the long − term outcomes of the transplant if such donors are accepted. Even so, many of them are finally included because there are not enough donor candidates. Both, families and hospitals face the need to rapidly accept prediabetic donors before the clinical conditions of the recipient and the evolution of the disease exclude him/her as a transplant candidate; however, when using a kidney potentially damaged by prediabetes, neither the donor’s nor the recipient’s long term health is usually considered. Considering the ethical implication as well as the clinical and epidemiological evidence, we conclude that prediabetic persons are not suitable candidates for kidney donation. This recommendation should be taken into consideration by Mexican health institutions who should rewrite their transplant protocols. Summary We argue that the decision to use a kidney from a living donor known to be pre-diabetic or from those persons with family history of T2DM, obesity, hypertension, or renal failure, should be considered unethical in Mexico

  4. [Use of related live donors in renal transplantation].

    PubMed

    Broyer, M

    1996-06-01

    Collecting pertinent information is first step in assessing the use of living-related kidneys for transplantation. Current bioethics legislation in France limits kidney donation to first-degree family members and spouses in emergency situations. Severe penalties are inflicted for use of other donors or sale of organs. Further valuable information can be obtained from reports in the literature on complications in donors and on the advantages of living donor organs. The proportion of live donors in France is small (3.5% from 1984 through 1993) indicating that transplantation teams prefer cadaver organs except in pediatric cases. The proportion of live donor organs transplanted in northern Europe and North America is much higher. A quick survey of French teams show that opinions and practices vary. Questions still under debate include how to guarantee freedom to refuse or accept, a freedom directly related to correct information. Several propositions have been made in an attempt to harmonize management. First, an information sheet could be distributed during the early discussions, outlining the advantages and disadvantages of live organ donation. A list of complementary examinations could also be established to identify possible contraindications for nephrectomy and define exclusion criteria. A similar procedure adopted by all transplantation teams could be based on these propositions presented in the appendix. Potential donors could then benefit from uniform protection. PMID:8685149

  5. Ethical aspects of renal transplantation from living donors.

    PubMed

    Bruzzone, P; Berloco, P B

    2007-01-01

    Kidney transplantation from living donors is widely performed all over the world. Living nephrectomy for transplantation has no direct advantages for the donor other than increased self-esteem, but it at least remains an extremely safe procedure, with a worldwide overall mortality of 0.03%. This theoretical risk for the donor seems to be justified by the socioeconomic advantages and increased quality of life of the recipient, especially in selected cases, such as pediatric patients, when living donor kidney transplantation can be performed in a preuremic phase, avoiding the psychological and physical stress of dialysis, which in children is not well tolerated and cannot prevent retarded growth. According to the Ethical Council of the Transplantation Society, commercialism must be effectively prevented, not only for ethical but also medical reasons. The risks are too high, not only for the donors, but also for the recipients, as a consequence of poor donor screening and evaluation with consequent transmission of human immunodeficiency virus (HIV) or other infective agents, as well as of inappropriate medical and surgical management of donors and also recipients, who are often discharged too early. Most public or private insurance companies consider kidney donation a safe procedure without long-term impairment and therefore do not increase the premium, whereas recipient insurance of course should cover hospital fees for the donors. "Rewarded gifting" or other financial incentives to compensate for the inconvenience and loss of income related to the donation are not advisable, at least in our opinion. Our Center does not perform anonymous living organ donation or "cross-over" transplantation. PMID:17692612

  6. [Living unrelated renal transplantation in an eldery couple: a case report].

    PubMed

    Saito, Jun; Namba, Yukiomi; Hatano, Koji; Imamura, Ryoichi; Ichimaru, Naotsugu; Miyagawa, Yasushi; Tsujihata, Masao; Tsujimura, Akira; Nishimura, Kazuo; Nonomura, Norio; Takahara, Shiro; Okuyama, Akihiko

    2006-07-01

    We present a 60-year-old female who underwent living unrelated renal transplantation from her 62-year-old husband. The primary immunosuppression consisted of tacrolimus, mycophenolate mofetil and steroid. We did not recognize any rejection in a histopathological study. The total ischemic time to carry out anastomosis of the two renal arteries was 121 minutes. After hemodialysis 5 times for acute tubular necrosis, her renal function improved. She was discharged on the 33rd postoperative day when her serum cretinine level was 1.0 mg/dl. The graft function was stable at 6 months after transplantation. We discussed living unrelated renal transplantation in the elderly population in Japan. PMID:16910589

  7. Living Related Donor Renal Transplant in Human Immunodeficiency Virus Infected Patient: Case Reports from Tertiary Care Hospital in Western India

    PubMed Central

    Dalal, Sonal; Patel, Atul K; Patel, Ketan K; Shukla, Ketan D; Darji, Prakash

    2014-01-01

    Renal transplantation (TX) in human immunodeficiency virus (HIV) infected patients with end stage renal disease (ESRD) is increasingly performed in developed countries in the era of antiretroviral therapy (ART). Management of HIV infected patients during and post-transplant is very complex and challenging due to drug interaction, infection risk and associated co-infections. We described our experience with living related donor renal TX in three HIV infected patients. PMID:25191053

  8. Living related donor renal transplant in human immunodeficiency virus infected patient: case reports from tertiary care hospital in Western India.

    PubMed

    Dalal, Sonal; Patel, Atul K; Patel, Ketan K; Shukla, Ketan D; Darji, Prakash

    2014-07-01

    Renal transplantation (TX) in human immunodeficiency virus (HIV) infected patients with end stage renal disease (ESRD) is increasingly performed in developed countries in the era of antiretroviral therapy (ART). Management of HIV infected patients during and post-transplant is very complex and challenging due to drug interaction, infection risk and associated co-infections. We described our experience with living related donor renal TX in three HIV infected patients. PMID:25191053

  9. Ethics and commerce in live donor renal transplantation: classification of the issues.

    PubMed

    Daar, A S; Salahudeen, A K; Pingle, A; Woods, H F

    1990-06-01

    Renal transplantation is now very successful. A shortage of kidneys continues to be a problem. Attempts to increase the supply have recently led to unethical practices, but the issues in the discussion of the ethics need clarification. We propose a classification that we believe will help to achieve this for living donor renal transplantation. This can be considered under five categories: (1) living-related donation; (2) emotionally related donation; (3) altruistic donation; (4) "rewarded" gifting; and (5) rampant commercialism. Ethical issues for categories 1, 2, and 3 are either esoteric or have been resolved. Category 4 needs further discussion and elucidation and should be the area of concentration. Category 5 we perceive to be unethical. PMID:2349705

  10. [Commentary on 'Ethical issues in living renal transplantation'].

    PubMed

    Spinsanti, S

    2006-01-01

    Legalizing kidney market: ethics considerations. The paper by E A Friedman and A L Friedman, advocating suitable kidney sale legislation, recently published in Kidney International, has aroused some controversy among the Italian Society of Nephrology Mailing List members (ML-SIN). A previous article reviewed the main issues and summarized Italian nephrologists' opinions. Generally speaking, ML-SIN participants were critical towards this proposal; the most widespread opinion was that trade of organs for transplant purposes is unethical and that Friedman's legislative suggestion is unlikely to succeed in Italy. To complete discussion, we report also the opinion of an authoritative Ethics expert. PMID:17123265

  11. [Promoting Living Kidney Transplantation].

    PubMed

    Lin, Chiu-Chu

    2016-04-01

    Kidney transplantation is the best approach for treating patients with end stage renal disease, offering patients the best chance of returning to normal health. While the techniques used in kidney transplantation surgery are mature and highly successful, there is a severe shortage of donor organs. Statistics show a serious imbalance between organ donations and patients on the waiting list for organ transplantation. Moreover, evidence from empirical studies has shown a better transplantation outcome for patients who receive living donor transplantation than for those who receive organs from cadavers. Although using relatives as donors offers an effective way to reduce the problem of organ shortage, this strategy faces many challenges and many other factors affect the promotion of living donor transplantation. This article elaborates how cultural and psychological factors, kidney transplantation awareness, and ethics and laws impact upon living kidney donations and then proposes coping strategies for promoting living kidney transplantation. PMID:27026555

  12. Endovascular Repair of Renal Artery Anastomotic Pseudoaneurysm Following Living Donor Kidney Transplant.

    PubMed

    Patil, Vivek V; Roytman, Michelle; Ames, Scott; Beckerman, William; Lookstein, Robert A

    2015-12-01

    Renal artery anastomotic pseudoaneurysms, an uncommon complication of transplantation, may result in aneurysm rupture and loss of allograft. We report the case of 50-year-old female with back pain 3 weeks post renal transplantation. CT scan revealed transplant renal artery anastomotic pseudoaneurysm arising from anastomosis of two renal arteries joined together to form a single renal artery that was joined to the aorta. Successful endovascular treatment was achieved with covered stents, resulting in preserved renal function. Follow-up ultrasound at one-day post procedure and CT at 2 months revealed satisfactory renal perfusion with no pseudoaneurysm. Endovascular treatment of transplant renal artery pseudoaneurysms with covered stent and ostial flare balloon technology may be preferred in patients with extensive prior pelvic surgery, as illustrated in this case. PMID:26037091

  13. Depression and self-report disclosure after live related donor and cadaver renal transplants.

    PubMed

    Schlebusch, L; Pillay, B J; Louw, J

    1989-05-20

    Important psychological reactions are associated with renal transplantation in general. Differences in psychological adjustment between recipients of kidneys from cadavers (CRs) and recipients of kidneys from live related donors (LRRs), however, have been poorly researched. In this study 10 LRRs (mean age 35,7 years; mean number of years after transplant 4,5) were compared with 30 CRs (mean age 38,6 years; mean number of years after transplant 5,3). The prevalence of depression and self-disclosed stress-inducing factors which might have affected long-term psychological adjustment after the transplant were investigated. The psychological status of each patient was assessed by means of a clinical interview, a mental status examination, the Beck Depression Inventory and a self-report questionnaire. There were found to be no long-term statistically significant differences between the LRR and CR groups in terms of the prevalence of depression, although 20% of the patients overall were depressed to varying degrees. The CR group was more concerned about the psychological and personal characteristics of the donors and their families than the LRR group, who expressed concern about the future well-being of the donors. Many members of both groups expressed having experienced both fear of graft rejection, before and immediately after the transplant, and anxiety, which decreased with time. The therapeutic value of a positive psychological climate in the renal unit and of supportive family relationships was confirmed for both groups. In comparison with their existence while on dialysis, most of the patients, irrespective of donor type, ultimately enjoyed an enhanced quality of life. PMID:2658140

  14. A Double Blind Randomized Clinical Trial of Remote Ischemic Conditioning in Live Donor Renal Transplantation

    PubMed Central

    Nicholson, Michael L.; Pattenden, Clare J.; Barlow, Adam D.; Hunter, James P.; Lee, Gwyn; Hosgood, Sarah A.

    2015-01-01

    Abstract Ischemic conditioning involves the delivery of short cycles of reversible ischemic injury in order to induce protection against subsequent more prolonged ischemia. This randomized controlled trial was designed to determine the safety and efficacy of remote ischemic conditioning (RC) in live donor kidney transplantation. This prospective randomized clinical trial, 80 patients undergoing live donor kidney transplantation were randomly assigned in a 1:1 ratio to either RC or to a control group. RC consisted of cycles of lower limb ischemia induced by an arterial tourniquet cuff placed around the patient's thigh. In the RC treatment group, the cuff was inflated to 200 mm Hg or systolic pressure +25 mm Hg for 4 cycles of 5 min ischemia followed by 5 min reperfusion. In the control group, the blood pressure cuff was inflated to 25 mm Hg. Patients and medical staff were blinded to treatment allocation. The primary end-point was renal function measured by estimated glomerular filtration rate (eGFR) at 1 and 3 months posttransplant. Donor and recipient demographics were similar in both groups (P < 0.05). There were no significant differences in eGFR at 1 month (control 52 ± 14 vs RC 54 ± 17 mL/min; P = 0.686) or 3 months (control 50 ± 14 vs RC 49 ± 18 mL/min; P = 0.678) between the control and RC treatment groups. The RC technique did not cause any serious adverse effects. RC, using the protocol described here, did not improve renal function after live donor kidney transplantation. PMID:26252316

  15. Outcomes of Living Donor Liver Transplantation Alone for Patients on Maintenance Renal Replacement Therapy in Japan

    PubMed Central

    Eguchi, Susumu; Furukawa, Hiroyuki; Uemoto, Shinji; Umeshita, Koji; Imamura, Hajime; Soyama, Akihiko; Shimamura, Tsuyoshi; Isaji, Shuji; Ogura, Yasuhiro; Egawa, Hiroto; Kawachi, Shigeyuki; Kasahara, Mureo; Nagano, Hiroaki; Ku, Yonson; Ohdan, Hideki; Maehara, Yoshihiko; Sato, Shuntaro; Inomata, Yukihiro

    2016-01-01

    Background Because simultaneous liver and kidney transplantation has been limited as a standard practice because of a severe shortage of deceased donors in Japan, living donor (LD) liver transplantation alone (LTA) is indicated in most recipients with maintenance renal replacement therapy (MRRT). Methods A retrospective nationwide survey of LD LTA was performed for liver transplant patients on MRRT. The characteristics of donors and recipients, postoperative complications, survival rate, and causes of death were analyzed. Results In the adult cases (n = 28), the overall survival rate at 1 year and 5 years were 66.1% and 57.3%, respectively. When compared with those adults without MRRT (n = 237), it was significantly worse. In the 7 pediatric cases, the overall survival rate at 1 and 5 years were both 83.3%. Three adult recipients died of nonaneurysm cerebral hemorrhage after 1 year and 1 adult recipient died of acute heart failure after 7 months. In adult recipients with MRRT, graft weight versus standard liver volume, and duration and blood loss in LTA surgery were associated with poor outcomes after LD LTA. Multivariate analysis revealed that MRRT was highest hazard ratio on patient survival after LD LTA. Conclusions Early post-LD LTA mortality was higher in patients with MRRT than in those without MRRT with characteristic causes. Smaller grafts for size and a complicated surgery were associated with poor outcome after LD LTA. Thus, LD LTA in adult patients on MRRT should be carefully treated with meticulous postoperative management and follow-up.

  16. [Renal transplantation: ethical issues].

    PubMed

    Mamzer-Bruneel, Marie-France; Laforêt, Emmanuelle Grand; Kreis, Henri; Thervet, Éric; Martinez, Frank; Snanoudj, Renaud; Hervé, Christian; Legendre, Christophe

    2012-12-01

    One of the most significant advances in medicine during the last 50 years is the development of organ transplantation. In the context of chronic kidney diseases, renal transplantation offers patients a better clinical outcome than other treatment options. However, the benefits of organ transplantation have not been maximized due to an inadequate supply of organs for transplantation. Despite the establishment of elaborate legal rules for organs procurement, both on deceased and living donors in numerous countries, ethical concerns remain. Most of them are consequences of the strategies implemented or proposed to address the so-called organ shortage. The involvement of society in these complex problems is crucial as numerous questions emerge: could actual state of organ procurement change? Is it possible and/or realistic to increase the number of organs, with respects to living donors or deceased persons? Is the shortage an indicator to limit the use of kidney transplantation? How do we maintain efficiency and justice, in this context. PMID:23168353

  17. Mineral Metabolism in European Children Living with a Renal Transplant: A European Society for Paediatric Nephrology/European Renal Association–European Dialysis and Transplant Association Registry Study

    PubMed Central

    Bonthuis, Marjolein; Busutti, Marco; Jager, Kitty J.; Baiko, Sergey; Bakkaloğlu, Sevcan; Battelino, Nina; Gaydarova, Maria; Gianoglio, Bruno; Parvex, Paloma; Gomes, Clara; Heaf, James G.; Podracka, Ludmila; Kuzmanovska, Dafina; Molchanova, Maria S.; Pankratenko, Tatiana E.; Papachristou, Fotios; Reusz, György; Sanahuja, Maria José; Shroff, Rukshana; Groothoff, Jaap W.; Schaefer, Franz; Verrina, Enrico

    2015-01-01

    Background and objectives Data on mineral metabolism in pediatric renal transplant recipients largely arise from small single-center studies. In adult patients, abnormal mineral levels are related to a higher risk of graft failure. This study used data from the European Society for Paediatric Nephrology/European Renal Association–European Dialysis and Transplant Association Registry to study the prevalence and potential determinants of mineral abnormalities, as well as the predictive value of a disturbed mineral level on graft survival in a large cohort of European pediatric renal transplant recipients. Design, setting, participants, & measurements This study included 1237 children (0–17 years) from 10 European countries, who had serum calcium, phosphorus, and parathyroid hormone measurements from 2000 onward. Abnormalities of mineral metabolism were defined according to European guidelines on prevention and treatment of renal osteodystrophy in children on chronic renal failure. Results Abnormal serum phosphorus levels were observed in 25% (14% hypophosphatemia and 11% hyperphosphatemia), altered serum calcium in 30% (19% hypocalcemia, 11% hypercalcemia), and hyperparathyroidism in 41% of the patients. A longer time since transplantation was associated with a lower risk of having mineral levels above target range. Serum phosphorus levels were inversely associated with eGFR, and levels above the recommended targets were associated with a higher risk of graft failure independently of eGFR. Conclusions Abnormalities in mineral metabolism are common after pediatric renal transplantation in Europe and are associated with graft dysfunction. PMID:25710805

  18. Living donor transplant options in end-stage renal disease patients with ABO incompatibility

    PubMed Central

    Waigankar, Santosh S.; Kamat, Madhav H.; Joshi, Shriram; Gandhi, Bhupendra V.; Bahadur, Madan; Deshpande, Rushi V.

    2013-01-01

    Introduction: The options available to CKD 5 patients with donor shortage due to incompatibilities is to either get enlisted in cadaver transplant program or opt for three other alternatives viz; ABO-incompatible transplant (ABO-I), ABO-incompatible transplant with Rituximab (ABO-R) or paired-kidney exchange transplant (PKE). At our institute we have performed ABO-I, ABO-R and PKE transplants and we are presenting the results of these transplants performed at our institution. Here, we report our experiences of living donor kidney transplantation in highly sensitized patients. Objective: To review the options available to CKD 5 patients with incompatible donor. Materials and Methods: Between January 2008 and June 2011, 7 PKE, 26 ABO-I and 7 ABO-R transplants were carried out at our institute. Evaluation of both the recipients and donors involved biochemical, serological and radiological investigations. In case of PKE, recipients were operated simultaneously in different operation theaters. In ABO-I splenectomy was done while in ABO-R was given. Post-transplant the recipient management protocol remained the same. Expenditure following each transplant was calculated. Results: The graft and patient survival of ABO-I, ABO-R and PKE transplants 12-18 months after transplant were 78.9%:80%, 85.7%:85.7% and 100%:100%, respectively. Conclusions: The inclusion of Rituximab in the transplant protocol appears promising. The existing donor shortage could be addressed by encouraging other options like PKE. The limiting factor for ABO-R and PKE transplants is time and cost, respectively. The decision depends on the informed consent between the patient and the nephrologists. PMID:23956512

  19. Opportunistic infections (non-cytomegalovirus) in live related renal transplant recipients

    PubMed Central

    Vinod, P. B.; Sharma, Raj Kumar

    2009-01-01

    The purpose of review was increasing number of opportunistic infections with use of newer immunosuppression and difficulty in diagnosis and management of such patients. For this review, MEDLINE database was searched from 2000 to 2006 with the keywords of opportunistic infections in renal transplantation. Opportunistic infection is a serious clinical complication in patients receiving immunosuppressive therapy after kidney transplantation. The two major factors for successful renal transplantation are better control of rejection and better prevention and treatment of infection. In renal allograft recipient, immunosuppressive drug therapy is the major cause of immunocompromised status and occurrence of infections, which arise most commonly as a result of invasion by endogenous opportunists. The opportunistic infections with varicella zoster viruses, parvovirus B-19, polyomavirus, nocardia and mucormycosis in immunosuppressed patients were present with severe complications that are reviewed in this article. As a result of use of strong immunosuppressive drugs like tacrolimus, mycophenolate mofetyl and antirejection therapy with antithymocyte globulins, these infections are now seen frequently, so they should always be included in differential diagnostic consideration. New diagnostic procedures and new treatment strategies are required to allow early detection and successful treatment of opportunistic infections in kidney transplant recipients. PMID:19672339

  20. Malignancy after renal transplantation.

    PubMed

    Zeier, Martin; Hartschuh, Wolfgang; Wiesel, Manfred; Lehnert, Thomas; Ritz, Eberhard

    2002-01-01

    Malignancy following renal transplantation is an important medical problem during the long-term follow-up. The overall incidence of malignancy at this time is 3 to 5 times higher than in the general population. The most common malignancies are lymphoproliferative disorders (early after transplantation) and skin carcinomas (late after transplantation). The type of malignancy is different in various countries and dependent on genetic and environmental factors. Another important confounder for risk of malignancy after renal transplantation is the type of immunosuppression. Previous use of cytotoxic drugs (eg, cyclophosphamide) or a history of analgesic abuse are additional risk factors. Malignancy may even be transplanted by the graft. Previous cancer treatment in a uremic patient on the transplant waiting list is of great importance in relation to waiting time and postmalignancy screening. Finally, every dialysis patient on the waiting list should undergo a regular screening program before and after renal transplantation to detect a potentially malignant tumor in an early stage. In addition to specific oncological treatment, managing a malignancy after renal transplantation should include modification of immunosuppression. PMID:11774131

  1. The short-term impact of protocol biopsies in a live-related renal transplant program using tacrolimus based immunosuppression.

    PubMed

    Guleria, S; Jain, S; Dinda, A K; Mahajan, S; Gupta, S; Mehra, N K

    2013-07-01

    The aim of the study was to assess the impact of protocol biopsies in a live-related renal transplant program using tacrolimus-based immunosuppression in the short term. Eighty-three live-related transplant recipients were randomly allocated to protocol biopsy group (Group I, n = 40) and a control group (Group II, n = 43). Other immunosuppressants in these groups consisted of either mycophenolate mofetil or azathioprine and steroids. Protocol biopsies were conducted in biopsy group at 1, 6, and 12 months post-transplant. The non-biopsy group was followed by serial serum creatinine and biopsies in them were conducted as and when clinically indicated. Both groups were analyzed at 12 months with respect to graft function and survival. The two groups were similar with respect to age, number of dialysis pre-operatively, tacrolimus levels, induction therapy, donor age, and donor glomerular filtration rate. Forty protocol biopsies were conducted at 1 month, 31 at 6 months, and 26 at 12 months. The prevalence of sub-clinical rejection at 1, 6, and 12 months in these biopsies was 17.5%, 11.2%, and 10.3%, respectively. The prevalence of calcineurin inhibitor toxicity during same period was 15%, 15.5%, and 14.4%, respectively. The cumulative rejection rate in Group I and Group II at 12-month follow-up was 10.3% and 11.3% (P = 0.78), respectively, and cumulative calcineurin inhibitor toxicity at 12 months was 14.4% and 9.3% (P = 0.59), respectively, were not statistically significant. There was no difference in graft survival and function at 1 year. Protocol biopsies have a limited role in a well-matched renal transplant program with tacrolimus-based immunosuppression in the short term. However, the long-term impact of protocol biopsies needs further evaluation. PMID:23960339

  2. Tofacitinab in Renal Transplantation

    PubMed Central

    Zand, Martin S.

    2013-01-01

    Tofacitinib (tositinib, CP-690,550) is a small molecule inhibitor of Janus associated kinases, primarily JAK3 and JAK2, which inhibits cytokine signaling through the IL-2Rγ chain. In this article, we review the mechanism of action of tofacitinib, and pre-clinical and clinical data regarding its use in solid organ transplantation thus far. It is hoped that tofacitinib may form the basis for calcineurin-free immunosuppression, improving renal function while eliminating calcineurin inhibitor renal toxicity. Current studies suggest that tofacitinib is an effective immunosuppressive agent for renal transplantation, but it's use in current protocols carries an increased risk of CMV, BK, and EBV viral infection, anemia and leukopenia, and post-transplant lymphoproliferative disorder. PMID:23849222

  3. Ligation of left renal vein as a salvage procedure for splenorenal shunt after living donor liver transplantation: a case report.

    PubMed

    Cho, S Y; Kim, S H; Lee, K W; Park, S J; Han, S-S; Kim, Y-K

    2009-12-01

    We describe a case of recovered portal flow by ligation of the left renal vein (LRV) as a salvage procedure for a spontaneous splenorenal shunt (SRS) occurring the next day after right liver living donor transplantation (LDLT). Doppler ultrasonography showed normal graft portal venous flow immediately after LDLT, but nearly total diversion of portal flow into the existing splenorenal shunt was observed on the next day. Portal flow normalized after ligation of the LRV by relaparotomy. The patient recovered fully without complication and was discharged on the 17th postoperative day. He remains well at 14 months after the operation, returning to his previous occupation. This case was neither associated with acute rejection nor with small-for-size graft, which may increase intrahepatic vascular resistance, causing portal flow steal through shunts. Even though patients with preoperative SRS show normal portal flow immediately after transplantation, close monitoring is necessary for a possible decrease or loss of portal flow. If portal flow becomes insufficient, ligation of LRV as a salvage procedure is an important option that can be considered even after transplantation. PMID:20005377

  4. The renal scan in pregnant renal transplant patients

    SciTech Connect

    Goldstein, H.A.; Ziessman, H.A.; Fahey, F.H.; Collea, J.V.; Alijani, M.R.; Helfrich, G.B.

    1985-05-01

    With the greater frequency of renal transplant surgery, more female pts are becoming pregnant and carrying to term. In the renal allograft blood vessels and ureter may be compressed resulting in impaired renal function and/or, hypertension. Toxemia of pregnancy is seen more frequently than normal. Radionuclide renal scan monitoring may be of significant value in this high risk obstetrical pt. After being maintained during the pregnancy, renal function may also deteriorate in the post partum period. 5 pregnant renal transplant pts who delivered live babies had renal studies with Tc-99m DTPA to assess allograft perfusion and function. No transplanted kidney was lost during or after pregnancy as a result of pregnancy. No congenital anomalies were associated with transplant management. 7 studies were performed on these 5 pts. The 7 scans all showed the uterus/placenta. The bladder was always distorted. The transplanted kidney was rotated to a more vertical position in 3 pts. The radiation dose to the fetus is calculated at 0.024 rad/mCi administered. This study demonstrates the anatomic and physiologic alterations expected in the transplanted kidney during pregnancy when evaluated by renal scan and that the radiation burden may be acceptable in management of these pts.

  5. Blood disorders typically associated with renal transplantation

    PubMed Central

    Yang, Yu; Yu, Bo; Chen, Yun

    2015-01-01

    Renal transplantation has become one of the most common surgical procedures performed to replace a diseased kidney with a healthy kidney from a donor. It can help patients with kidney failure live decades longer. However, renal transplantation also faces a risk of developing various blood disorders. The blood disorders typically associated with renal transplantation can be divided into two main categories: (1) Common disorders including post-transplant anemia (PTA), post-transplant lymphoproliferative disorder (PTLD), post-transplant erythrocytosis (PTE), and post-transplant cytopenias (PTC, leukopenia/neutropenia, thrombocytopenia, and pancytopenia); and (2) Uncommon but serious disorders including hemophagocytic syndrome (HPS), thrombotic microangiopathy (TMA), therapy-related myelodysplasia (t-MDS), and therapy-related acute myeloid leukemia (t-AML). Although many etiological factors involve the development of post-transplant blood disorders, immunosuppressive agents, and viral infections could be the two major contributors to most blood disorders and cause hematological abnormalities and immunodeficiency by suppressing hematopoietic function of bone marrow. Hematological abnormalities and immunodeficiency will result in severe clinical outcomes in renal transplant recipients. Understanding how blood disorders develop will help cure these life-threatening complications. A potential therapeutic strategy against post-transplant blood disorders should focus on tapering immunosuppression or replacing myelotoxic immunosuppressive drugs with lower toxic alternatives, recognizing and treating promptly the etiological virus, bacteria, or protozoan, restoring both hematopoietic function of bone marrow and normal blood counts, and improving kidney graft survival. PMID:25853131

  6. Blood disorders typically associated with renal transplantation.

    PubMed

    Yang, Yu; Yu, Bo; Chen, Yun

    2015-01-01

    Renal transplantation has become one of the most common surgical procedures performed to replace a diseased kidney with a healthy kidney from a donor. It can help patients with kidney failure live decades longer. However, renal transplantation also faces a risk of developing various blood disorders. The blood disorders typically associated with renal transplantation can be divided into two main categories: (1) Common disorders including post-transplant anemia (PTA), post-transplant lymphoproliferative disorder (PTLD), post-transplant erythrocytosis (PTE), and post-transplant cytopenias (PTC, leukopenia/neutropenia, thrombocytopenia, and pancytopenia); and (2) Uncommon but serious disorders including hemophagocytic syndrome (HPS), thrombotic microangiopathy (TMA), therapy-related myelodysplasia (t-MDS), and therapy-related acute myeloid leukemia (t-AML). Although many etiological factors involve the development of post-transplant blood disorders, immunosuppressive agents, and viral infections could be the two major contributors to most blood disorders and cause hematological abnormalities and immunodeficiency by suppressing hematopoietic function of bone marrow. Hematological abnormalities and immunodeficiency will result in severe clinical outcomes in renal transplant recipients. Understanding how blood disorders develop will help cure these life-threatening complications. A potential therapeutic strategy against post-transplant blood disorders should focus on tapering immunosuppression or replacing myelotoxic immunosuppressive drugs with lower toxic alternatives, recognizing and treating promptly the etiological virus, bacteria, or protozoan, restoring both hematopoietic function of bone marrow and normal blood counts, and improving kidney graft survival. PMID:25853131

  7. Presurgical Pulmonary Evaluation in Renal Transplant Patients

    PubMed Central

    Sahni, Sonu; Molmenti, Ernesto; Bhaskaran, Madhu C.; Ali, Nicole; Basu, Amit; Talwar, Arunabh

    2014-01-01

    Patients with chronic renal failure (CRF) due to various mechanisms are prone to significant pulmonary comorbidities. With the improvements in renal replacement therapy (RRT), patients with CRF are now expected to live longer, and thus may develop complications in the lung from these processes. The preferred treatment of CRF is kidney transplantation and patients who are selected to undergo transplant must have a thorough preoperative pulmonary evaluation to assess pulmonary status and to determine risk of postoperative pulmonary complications. A MEDLINE®/PubMed® search was performed to identify all articles outlining the course of pre-surgical pulmonary evaluation with an emphasis on patients with CRF who have been selected for renal transplant. Literature review concluded that in addition to generic pre-surgical evaluation, renal transplant patients must also undergo a full cardiopulmonary and sleep evaluation to investigate possible existing pulmonary pathologies. Presence of any risk factor should then be aggressively managed or treated prior to surgery. PMID:25599047

  8. Renal transplantation in Mapuche people.

    PubMed

    Ardiles, R; Beltrán, R; Jerez, V; Droguett, M A; Mezzano, S; Ardiles, L

    2008-04-01

    Previous studies have demonstrated higher concentrations of some histocompatibility antigens in Mapuche people compared with non-Mapuche Chileans in the renal transplantation program. With the aim of evaluating whether those antigenic differences might induce differences in the outcomes of renal transplantation among patients belonging to that ethnic group, we reviewed HLA studies and at least 6 months follow-up of all patients with a first kidney transplant between 1980 and 2006. The 248 patients had a mean age of 37.6 years, 40% were females, and 48% had living related donors. The mean kidney follow-up was 90 months and patient follow-up was 106 months. Thirty-nine patients (16%) were classified as Mapuche, according to their surnames, including 16 women with overall mean age of 34.5 years, and 14 had been transplanted from a living related donor. Mapuche patients received organs with better HLA matching expressed as number of identities (3.4 +/- 0.1 versus 2.8 +/- 0.1 among non-Mapuche; P < .05), and the proportion receiving organs with > or = 3 compatibilities was significantly higher (Mapuche 38% versus non-Mapuche 22%; P < .05). Kaplan-Meier survival curves showed nonsignificant differences in kidney survival: 86% at 5 years and 68% at 10 years in Mapuche; and 83% and 65%, respectively, for non-Mapuche. Patient survival rates were 97% at 5 years and 86% at 10 years in the Mapuche group versus 91% and 79%, respectively, in the non-Mapuche group; both results were not significantly different. Our results showed similar outcomes of kidney and patient survivals among Mapuche people even when they received organs with better HLA matches. PMID:18454999

  9. Successful renal transplantation in primary hyperoxaluria.

    PubMed Central

    O'Regan, P.; Constable, A. R.; Joekes, A. M.; Kasidas, G. P.; Rose, G. A.

    1980-01-01

    A successful live related renal transplant in a 29-year-old male patient with Type 1 primary hyperoxaluria, who remains well 32 months postoperatively, is described. The plasma oxalate and exchangeable oxalate pool before transplantation were 160 mumol/1 and 4429 mumol respectively. Since the transplant these have been greatly reduced although they remain elevated above the normal by a factor of 2. Pyridoxine therapy and the avoidance of oxalate-rich foods have been effective in maintaining these reduced levels and the 24-hr urinary oxalate excretion has also been maintained close to normal levels on this regime. After review of the previously reported transplants in patients with well documented primary hyperoxaluria and from the experience with this patient, the following guidelines for successful renal transplantation in primary hyperoxaluria are suggested: transplants should only be carried out in those who have shown a response to adequate pyrodoxine therapy; frequent haemodialysis pre-operatively and during periods of oliguria postoperatively is necessary; oxalate-rich foods should be avoided and a high fluid intake should be maintained after transplantation. If these guidelines are followed there is no contra-indicatin to live related renal transplants in primary hyperoxaluric patients. Images Fig. 1 Fig. 2 PMID:7001421

  10. [Drug eruption during living-donor renal transplantation in which it was difficult to identify the causative drug: a case report].

    PubMed

    Hashimoto, Kazuyoshi; Ozawa, Yoshiki; Tsurutani, Ai; Kobayashi, Tomoharu; Kojima, Keimei; Mannami, Makoto

    2010-06-01

    A 59-year-old man with renal failure given oral medication for the symptoms associated with it had no drug allergies before surgery. The patient received 8 units of FFP for a surgery of gastric tumor. The stomach tumor was benign, and living-donor renal transplantation was performed. After the living-donor transplantation, extensive reddening and swelling were observed over the patient's entire body. Anaphylaxis due to drug allergy was considered, and the patient's course was monitored. The flare and swelling tended to regress, and after about 3 hours they were resolved. The following day the drugs used intraoperatively were tested, but it was difficult to identify any allergy-inducing drugs. Ultimately, the FFP was suspected as the cause, and the patient appeared to have been saved by the methylprednisolone used as an immunosuppressive agent. PMID:20560384

  11. When less is more--case report of successful renal transplantation from a living unrelated donor to a high-risk female recipient.

    PubMed

    Lewandowska, D; Gałązka, Z; Pazik, J; Szmidt, J; Durlik, M

    2014-10-01

    Qualification for kidney transplantation for patients with a long history of renal replacement therapy and numerous medical complications requires individual analysis of all contraindications and limitations as well as advantages of the procedure. In this case report, we analyze the qualification process and posttransplantation course of a 28-year-old female patient with end-stage renal failure due to reflux nephropathy, treated with renal replacement therapy since early childhood, who received her second kidney transplant with glomerular filtration rate <40 mL/min/1.73 m(2) from a living, unrelated donor in 2009. Despite the high risk of immunological and surgical complications, transplanting organs of borderline excretory capacity, and no human leukocyte antigen matching, significant health benefits were achieved. Procurement of a kidney with borderline filtering function reduces the risk of potential negative consequences of impaired remnant filtration in the living donor. Following the principle of procuring a kidney with worse parameters from the living donors, it is necessary to perform an examination evaluating the function of each kidney. Procurement of a kidney with significantly worse parameters requires an individual assessment of benefits for the recipient. PMID:25380953

  12. Outcome of glomerulonephritis in live-donor renal transplant recipients: A single-centre experience

    PubMed Central

    Akl, Ahmed Ibrahim; Adel, Hany; Rahim, Mona Abdel; Wafa, Ehab Wahba; Shokeir, Ahmed A.

    2015-01-01

    Objectives To investigate the frequency and risk factors affecting the incidence of post-transplantation glomerulonephritis (GN) and the impact of GN on the survival of the graft and the patient. Patients and methods Patients were classified based on histological findings into three groups. Graft survival was ascertained using the Kaplan–Meier method and significance calculated using log-rank tests. For multivariate analysis the Cox model was used. Results Transplant glomerulopathy was the most prevalent glomerular disease in our series followed by recurrent GN and lastly de novo GN. In all, 50% of the de novo GN group had diabetes. The worst graft outcomes were in the recurrent GN group (P = 0.044). Multivariate analysis revealed ageing of the graft and mammalian target of rapamycin (mTOR) immunosuppression as risk factors for development of GN. While, the age of the recipient and donor, anti-lymphocyte globulin induction therapy, and acute rejection were risk factors for poor graft outcomes. Conclusions GN is an important issue after transplantation. Tracking the incidence and progression of histological findings in the graft may help to guide proper management and improve graft outcome. PMID:26609451

  13. Renal transplantation in infants.

    PubMed

    Jalanko, Hannu; Mattila, Ilkka; Holmberg, Christer

    2016-05-01

    Renal transplantation (RTx) has become an accepted mode of therapy in infants with severe renal failure. The major indications are structural abnormalities of the urinary tract, congenital nephrotic syndrome, polycystic diseases, and neonatal kidney injury. Assessment of these infants needs expertise and time as well as active treatment before RTx to ensure optimal growth and development, and to avoid complications that could lead to permanent neurological defects. RTx can be performed already in infants weighing around 5 kg, but most operations occur in infants with a weight of 10 kg or more. Perioperative management focuses on adequate perfusion of the allograft and avoidance of thrombotic and other surgical complications. Important long-term issues include rejections, infections, graft function, growth, bone health, metabolic problems, neurocognitive development, adherence to medication, pubertal maturation, and quality of life. The overall outcome of infant RTx has dramatically improved, with long-term patient and graft survivals of over 90 and 80 %, respectively. PMID:26115617

  14. A four-drug combination therapy consisting of low-dose tacrolimus, low-dose mycophenolate mofetil, corticosteroids, and mizoribine in living donor renal transplantation: A randomized study

    PubMed Central

    Yan, Tian-zhong; Wu, Xiao-qiang; Rong, Lu

    2016-01-01

    Objective: We compared a three-drug combination therapy (control group) consisting of tacrolimus, mycophenolate mofetil, and corticosteroids in living donor renal transplantation with a four-drug combination therapy (study group), in which the doses of tacrolimus and mycophenolate mofetil were halved and the immunosuppressive drug mizoribine was added, in order to determine whether the incidence rates of acute rejection after transplantation between the study group and the control group are similar, whether the study group regimen prevents the occurrence of calcineurin inhibitor–induced renal damage, and whether the study group regimen prevents adverse effects such as diarrhea caused by mycophenolate mofetil. Methods: We investigated the incidence of acute rejection, serum creatinine levels, and estimated glomerular filtration rate and the incidence of adverse effects such as diarrhea. Results: There was no significant difference between the two groups in the incidence of acute rejection. Renal function (estimated glomerular filtration rate and serum creatinine) was maintained in the control group whereas in the study group renal function gradually improved, with a statistical difference observed at 12 months. The incidence of gastrointestinal symptoms including diarrhea was significantly higher in the control group than in the study group. There was no significant difference in the incidence of cytomegalovirus infection and other adverse effects. Conclusion: These results suggest the study group therapy is an effective regimen in preventing acute rejection and the deterioration of renal function. These results also show this therapy can reduce the incidence of adverse effects such as gastrointestinal symptoms. PMID:27231549

  15. Invasive Fungal Infections after Renal Transplantation

    PubMed Central

    Ezzatzadegan, S.; Chen, S.; Chapman, J. R.

    2012-01-01

    Background: Invasive fungal infection (IFI) is a leading cause of infection-related mortality among kidney allograft recipients.  Objective: To estimate the incidence and etiology of systemic fungal infection in renal allograft recipients in Sydney transplant facility. Methods: 471 kidney recipients, transplanted between 2000 and 2010 at the Westmead Hospital renal transplantation center, Sydney, Australia, were retrospectively surveyed. Results: IFI developed in 10 (2.1%) of 471 patients. With a mean±SD new kidney transplants per year of 42.9±13, the mean±SD incidence of IFI was 0.9±0.6 for each year of transplantation. 4 patients had received kidneys from living donors and 7 from cadavers with a mean±SD age of 50.5±14 years. The mean time to IFI was 33 months after transplantation with majority within the first 2 years. Cryptococcus neoformans was responsible for 50% of episodes (n=5) followed by Aspergillus fumigatus (n=3), and Pseudallescheria boydii (n=3); there was a single case of mucurmycosis. Lungs (n=5) followed by meninges (n=4) and skin (n=3) were the most commonly involved sites. Conclusion: IFI remains a major concern in renal transplantation. A high index of suspicion is required for early diagnosis and treatment to reduce the mortality. In this regard, appropriate diagnostic tests are necessary, particularly for C. neoformans. PMID:25013619

  16. Challenges in renal transplantation in Yemen.

    PubMed

    El-Nono, Ibrahiem H; Telha, Khaled A; Al-Alimy, Gamil M; Ghilan, Abdulilah M; Abu Asba, Nagieb W; Al-Zkri, Abdo M; Al-Adimi, Abdulilah M; Al-Ba'adani, Tawfiq H

    2015-01-01

    Background Renal replacement therapy was first introduced in Yemen in 1978 in the form of hemodialysis. Twenty years later, the first renal transplantation was performed. Kidney transplantations were started in socially and financially challenging circumstances in Yemen in 1998. A structured program was established and has been functioning regularly since 2005. A pediatric transplantation program was started in 2011. Material and Methods This was a prospective study of 181 transplants performed at the Urology and Nephrology Center between May 1998 and 2012. All transplants were from living related donors. The immunosuppressive protocol consisted initially of double therapy with steroid and mycophenolate mofetil (MMF). Subsequently, triple therapy with addition of a calcineurin inhibitor was introduced. Primary graft function was achieved in 176 (97.2%) recipients. Results Cold ischemia time was 48-68 min. Episodes of acute rejection in 12 patients were treated with high-dose steroids. Anti-thymocyte globulin (ATG) was used in cases of vascular or steroid-resistant rejection in 2 patients. The post-transplant complications, either surgical or medical, were comparable to those recorded in the literature. Conclusions Renal transplantation is a good achievement in our country. The patients and graft survival rates are comparable to other reports. PMID:25683097

  17. Future challenges in renal transplantation.

    PubMed

    Whalen, H; Clancy, M; Jardine, A

    2012-02-01

    There is a worldwide increase in the incidence of end-stage renal disease. Renal transplantation has been shown to be cost effective, prolong survival and provide a better quality of life in comparison to dialysis. Consequently, there has been a steady increase in demand for organs leading to a shortage of available kidneys, and an increase in transplant waiting lists. Renal transplantation is therefore an expanding field with a number of unique future challenges to address. This article outlines strategies that may be employed to expand organ supply in order to meet increased demand. The ethical issues surrounding this are also summarized. Furthermore, we highlight techniques with the potential to minimize peri-transplant injury to the kidney on its journey from donor to recipient. Current and potential future management strategies to optimize graft and patient survival are also discussed. PMID:22361673

  18. Pediatric renal transplantation: a single center experience.

    PubMed

    Kavaz, A; Özçakar, Z B; Bulum, B; Tüzüner, A; Keven, K; Şengül, Ş; Ekim, M; Yalçınkaya, F

    2013-04-01

    Renal transplantation is the treatment of choice for children with end-stage renal disease. The aim of this study was to evaluate retrospectively of our 37 pediatric renal allograft recipients, including 20 boys and 17 girls from July 2007 to August 2012. The overall mean age at transplantation was 12.16 ± 4.25 years. Three patients (8.1%) were transplanted preemptively; two were ABO-incompatible transplantations. The majority of recipients received living donor grafts (81%). The mean duration of follow-up was 25.10 ± 14.95 months. Seven acute rejection episodes were observed in 6 patients (16.2%). Eleven recipients developed serious viral infections: cytomegalovirus (n = 8), parvovirus (n = 2), BK virus (polyoma hominis 1) (n = 2), or Ebstein-Barr virus (n = 1). Three patients died; one from posttransplant lymphoproliferative disease, one from primary disease recurrence with infection, and one from sepsis. In conclusion, kidney transplantation is the treatment of choice for end-stage renal disease. Infection was the major concern after this procedure. PMID:23622586

  19. Treatment of Autonomous Hyperparathyroidism in Post Renal Transplant Recipients

    ClinicalTrials.gov

    2015-12-23

    Chronic Allograft Nephropathy; Chronic Kidney Disease; Chronic Renal Failure; Disordered Mineral Metabolism; End Stage Renal Disease; Hyperparathyroidism; Hypophosphatemia; Kidney Disease; Kidney Transplantation; Post Renal Transplantation

  20. Intestinal transplantation: living related.

    PubMed

    Pollard, S G

    1997-01-01

    The use of live donors in intestinal transplantation could potentially both reduce the severity of rejection responses against this highly immunogenic organ by better tissue matching and also reduce cold ischaemia times. These two advantages over cadaveric grafts could preserve mucosal integrity and reduce the risk of systemic sepsis from bacterial translocation. The disadvantages of live donation are the inherent risk to the donor and the compromise of using a shorter graft. Although only a handful of such cases have been performed, the success rate has been high and this is a therapeutic modality which should be explored further. PMID:9536535

  1. [Great moments in renal transplantation].

    PubMed

    Ghossain, Antoine

    2015-01-01

    A selective review of some great moments in renal transplantation experienced or witnessed with some of the great architects of this epic. The path was strewn with hazards, sometimes halts or changes of attitude that harmed or helped some patients. PMID:26591188

  2. Severe Legionnaire's disease caused by Legionella longbeachae in a long-term renal transplant patient: the importance of safe living strategies after transplantation.

    PubMed

    Wright, A J; Humar, A; Gourishankar, S; Bernard, K; Kumar, D

    2012-08-01

    Legionella species are intracellular gram-negative bacilli that require specific culture media for growth. Transplant recipients with impaired cellular immunity are at particular risk for infection with this pathogen. Most human disease is caused by Legionella pneumophila; disease caused by non-L. pneumophila species is reported mainly in immunosuppressed patients with the exception of Legionella longbeachae. L. longbeachae is a common cause of Legionnaires' disease in Australia and New Zealand, and is associated with exposure to potting soil. We report the case of a patient, 26 years post kidney transplant, who presented with severe and rapidly progressive respiratory illness. L. longbeachae serogroup 1 was isolated from respiratory cultures. Further investigation revealed that she had significant soil exposure before the onset of illness. We highlight the importance of following safe living strategies to prevent exposure-related illness even in long-term transplant recipients. PMID:22686947

  3. Renal dysfunction associated with liver transplantation.

    PubMed Central

    Jindal, R. M.; Popescu, I.

    1995-01-01

    It has been known for some time that a variety of liver diseases affect kidney function, but renal dysfunction associated with orthotopic liver transplantation has received scant attention. Although the mechanisms mediating these abnormalities are incompletely defined, advances in the understanding of renal pathophysiology after liver transplantation have made it possible to develop new treatment strategies. Aggressive and early intervention to diagnose and treat renal complications associated with liver transplantation should be the goal for transplant centres. PMID:7479462

  4. PREGNANCY AND RENAL TRANSPLANTATION.

    PubMed

    Atallah, David; El Kassis, Nadine; Salameh, Charbel; Safi, Joelle; Bejjani, Lina; Lutfallah, Fouad; Ghaname, Wadih; Moukarzel, Maroun

    2015-01-01

    Pregnancy is common nowadays in kidney transplant female patients because of medical and surgical advances. However, pregnancy is a high risk one in these patients. Fertility is rapidly restored after the transplantation; thus, contraception is a good option in the first year. Adding to that, pregnancy can endanger the allograft function in the presence of hypertension, a moderate to severe kidney disease and proteinuria. Medical complications are more prevalent in kidney transplant population, such as infections, gestational hypertension and diabetes and anemia. Low birth weight infants and premature delivery are two other major concerns in this population. Acute rejection of the allograft is another major complication that can be avoided with close monitoring of the graft and convenient immunosuppression. Immunosuppressive drugs must be continued during pregnancy except for mycophenolic acid and sirolimus that can be teratogen. Delivery of kidney transplant patients should be vaginal and spontaneous. Cesarean section should be reserved for obstetrical indications. Prophylactic antibiotics should be administered for every invasive procedure. Patients treated with corticosteroids can breastfeed their babies. Kidney donating women can have a safe pregnancy but with a slight risk of gestational diabetes and hypertension. In summary, a multidisciplinary medical team should follow pregnant kidney transplant patients in a tertiary center. International and national registries are a must to collect data concerning this particular high-risk population in order to solve unanswered questions. PMID:26591192

  5. [Immune tolerance after renal transplantation].

    PubMed

    Krajewska, Magdalena; Weyde, Wacław; Klinger, Marian

    2006-01-01

    Progress in immunosuppressive therapy has improved short-term survival of renal allografts by decreasing the frequency of acute rejections. However, the long-term survival of renal grafts has not improved. Transplanted kidneys are lost in the late period after transplantation as a result of vasculopathy and chronic rejection. Immunological tolerance means the lack of immunological activity towards certain antigens while the response towards others remains correct. The induction of immunological tolerance of donor antigens (transplant tolerance) is examined intensively to work out treatment methods which will allow prevention of chronic allograft rejection. The paper includes an overview of current knowledge on allograft tolerance. Immune response to alloantigens is described and the mechanisms of immunological tolerance induction (including clonal deletion, anergy connected with the microchimerism phenomenon, and active suppression caused by regulatory lymphocytes) are characterized. The role of dendritic cells in the process of inducing and maintaining tolerance is highlighted. Tolerance-inducing strategies in renal transplant recipients and clinically applied evaluation methods are presented. At present, optimizing recipient matching is used to decrease the risk of graft rejection. Hopefully, gene therapy will be possible in the near future. However, before introducing such a procedure into clinical studies, optimal therapy conditions and risk evaluation must be defined in tests on animals. PMID:16552396

  6. Current status of renal transplantation.

    PubMed Central

    Suranyi, M. G.; Hall, B. M.

    1990-01-01

    The success rate of renal transplantation has improved considerably during the past decade, with substantial improvements in both graft and patient survival. The quality of graft function, however, and not graft survival alone is increasingly determining the standards by which transplantation outcome is being judged. As the demand for kidney transplants continues to rise and transplants are being offered to an ever-increasing number of patients, organs are being sought from new supply pools and efforts are being made to use current resources more efficiently. Improvements in clinical management have allowed short-term complications such as infection and rejection to be better prevented or better diagnosed and treated. Fundamental advances in the understanding of the immunologic processes underlying both allograft rejection and acceptance and the introduction of new immunosuppressive agents have allowed a better use of drug therapy and have moved the goal of acquired transplant tolerance closer to attainment. With improved initial transplant success rates, the long-term transplantation outcome is becoming more important. The role of tissue matching in preventing chronic rejection is becoming more appreciated, and the long-term risks of malignancy, arteriosclerosis, and chronic rejection are being better recognized and managed. PMID:2191502

  7. Renal transplantation across ABO barrier

    PubMed Central

    Gupta, P. N.; Pokhariyal, S.; Bansal, S.; Jain, S.; Saxena, V.; Sharma, R.; Jain, M.; Jha, P.; Sethi, S. K.; Ghosh, P.; Tewari, A.; Ahlawat, R.; Kher, V.

    2013-01-01

    In India, patients without a compatible blood group donor are usually excluded from renal transplantation. For young patients, it is a difficult therapeutic choice to stay on long-term dialysis. We describe the case of a 19-year-old male patient who had blood group O +ve and had no compatible donor in the family. His mother was B +ve and was willing to donate. The patient had an initial anti-B antibody titer of 1:512 and underwent antibody depletion with plasmapheresis (11 sessions) and intravenous immunoglobulin (IVIG) 100 mg/kg after every plasmapheresis. He also received rituximab 500 mg for 3 days prior to transplant and was induced with basiliximab. At the time of transplant, his anti-B titers were <1:8. Post-operatively, he required four sessions of plasmapheresis and IVIG as his titers rebounded to 1:64. The titers then spontaneously subsided to <1:16 and have stayed at the same level for 6 months post-transplant. The patient continues to have normal renal function with a creatinine of 1.4 mg/dl% and has had no episodes of rejection. PMID:23814422

  8. Multi-State Survival Analysis in Renal Transplantation Recipients

    PubMed Central

    MIRZAEE, Moghaddameh; MOHAMMAD, Kazem; MAHMOODI, Mahmood; ZERAATI, Hojjat; EBADZADEH, Mohammad-Reza; ETMINAN, Abbas; FAZELI, Faramarz; DEHGHANI FIROUZABADI, Mohammad Hasan; SATTARY, Hossein; HAGHPARAST, Mahdiyeh; RAHIMI FOROUSHANI, Abbas

    2014-01-01

    Abstract Background Renal transplantation is a therapy for end-stage renal disease. During the study of recipients’ survival after renal transplantation, there are some events as intermediate events that not only affect the recipients’ survival but also events which are affected by various factors. The aim of this study was to handle these intermediate events in order to identify factors that affect recipients’ survival by using multi-state models. Methods This retrospective cohort study included 405 renal transplant patients from Afzalipour Hospital, Kerman, Iran, from 2004 to 2010. The survival time of these recipients was determined after transplantation and the effect of various factors on the death hazard with and without renal allograft failure and hazard of renal allograft failure was studied by using multi-state models. Results During 4.06 years (median) of follow-up; 28 (6.9%) recipients died and allograft failure occurred in 51 (12.6%) recipients. Based on the results of multi-state model, receiving a living kidney transplantation decreased the hazard of renal allograft failure (HR=0.38; 95% CI: 0.17- 0.87), pre-transplant hypertension (HR=2.94; 95% CI: 1.54- 5.63) and serum creatinine levels >1.6 upon discharge from the hospital (HR=7.38; 95% CI: 3.87- 7.08) increased the hazard of renal allograft failure. Receiving living kidney transplantation decreased the hazard of death directly (HR=0.18; 95% CI: 0.04- 0.93). Conclusion It was concluded that the effect of donor type, pre-transplant hypertension and having serum creatinine >1.6 upon discharge from the hospital was significant on hazard of renal allograft failure. The only variable that had a direct significant effect on hazard of death was donor type. PMID:25988091

  9. Changing of the guard? A glance at the surgical representation in the Canadian renal transplantation community

    PubMed Central

    McGregor, Tom; Bjazevic, Jennifer; Patel, Premal; Koulack, Joshua

    2016-01-01

    Introduction: Renal transplant is the gold standard treatment for end-stage renal disease (ESRD), and the prevalence of both ESRD and renal transplant has been steadily increasing over the past decade. However, involvement of urology in renal transplant has been declining. We examine the current state of urology involvement in renal transplant programs across Canada. Methods: A telephone survey of all surgical transplant centres in Canada was performed. Information regarding the number of transplant surgeons, their individual training background, and their involvement in specific procedures, including open and laparoscopic living donor nephrectomy, deceased donor nephrectomy, and recipient renal transplant were collected. Results: There are 59 Canadian transplant surgeons, including 27 (46%) who completed a urology residency and 32 (54%) with a general surgery background. With regards to procedures performed, 58 (98%) perform recipient renal transplant surgery, 36 (61%) perform laparoscopic donor nephrectomy, and 17 (29%) perform open donor nephrectomy. There was no significant difference in the number of surgeons that perform renal recipient surgery, laparoscopic or open donor nephrectomies, and deceased donor nephrectomies between surgeons of the two different training backgrounds. Conclusions: The role of urology in Canadian renal transplant has declined significantly over the past decade. Given the medical and surgical complexity of renal transplant, along with the growing need for renal transplants, a multidisciplinary team approach is imperative. Strong urology involvement with the transplant team is crucial for optimal care of these complex patients. PMID:26858788

  10. Cognitive and emotional effects of renal transplantation

    PubMed Central

    Pawar, A.A.; Rathod, J.; Chaudhury, S.; Saxena, S.K.; Saldanha, D.; Ryali, V.S.S.R.; Srivastava, K.

    2006-01-01

    Background: Recent studies have shown a high prevalence of depression and cognitive changes in patients with end-stage renal disease (ERSD) and renal transplant recipients. There are few data available on the cognitive and emotional changes in patients undergoing renal transplantation in India. Aim: To evaluate the changes in cognitive profile and depression in renal transplant recipients. Methods: Thirty consecutive patients undergoing renal transplantation were evaluated 1 month before and 3 months after successful renal transplant with Beck Depression Inventory (BDI), Weschler Adult Performance Intelligence Scale (WAPIS), Luria Nebraska Neuropsychological battery (LNNB) and Life satisfaction scale. Results: Our study revealed an 86.7% prevalence of depression in ESRD patients as compared to 56.7% in post renal transplant patients. Analysis of neurocognitive functions on LNNB did not reveal any significant impairment. Furthermore, analysis of the Life satisfaction scale revealed most of the patients scored high satisfaction levels despite the stress of their disease. Results on WAPIS brought out significant improvement in intelligence quotient (IQ) after renal transplantation. Conclusion: Successful renal transplant is associated with improvement in depression, IQ and life satisfaction. PMID:20703410

  11. Renal transplantation in developing countries.

    PubMed

    Rizvi, S Adibul Hasan; Naqvi, S A Anwar; Hussain, Zafar; Hashmi, Altaf; Akhtar, Fazal; Hussain, Manzoor; Ahmed, Ejaz; Zafar, M Naqi; Hafiz, Saleem; Muzaffar, Rana; Jawad, Fatema

    2003-02-01

    Healthcare in developing countries less funded than developed nations (0.8 to 4% vs. 10 to 15%, respectively), and must contend against approximately 1/3 of the population living below the poverty line ($1US/day), poor literacy (58% males/29% females), and less access to potable water and basic sanitation. Cultural and societal constraints combine with these economic obstacles to translate into poor transplantation activity. Donor shortage is a universal problem. Paid donation comprises 50% of all transplants in Pakistan. Post-transplant infections are a major problem in developing countries, with 15% developing tuberculosis, 30% cytomegalovirus, and nearly 50% bacterial infections. The solutions to these problems may seem simplistic: alleviate poverty, educate the general population, and expand the transplant programs in public sector hospitals where commerce is less likely to play a major role. The SIUT model of funding in a community-government partnership has increased the number of transplantations and patient and organ survival substantially. Over the last 15 years, it has operated by complete financial transparency, public audit and accountability. The scheme has proven effective and currently 110 transplants/year are performed, with free after care and immunosuppressive drugs. Confidence has been built in the community, with strong donations of money, equipment and medicines. We believe this model could be sustained in other developing nations. PMID:12864884

  12. Challenges in pediatric renal transplantation

    PubMed Central

    Peruzzi, Licia; Amore, Alessandro; Coppo, Rosanna

    2014-01-01

    Transplantation in children is the best option to treat renal failure. Over the last 25 years the improvements in therapy have dramatically reduced the risk of early acute rejection and graft loss, however the long term results in terms of graft survival and morbidity still require search for new immunosuppressive regimens. Tolerance of the graft and minimization of side effects are the challenges for improving the outcome of children with a grafted kidney. Notwithstanding the difficulties in settling in children large multicenter trials to derive statistically useful data, many important contributions in the last years brought important modifications in the immunosuppressive therapy, including minimization protocols of steroids and calcineurin inhibitors and new induction drugs. New methods for diagnosis of anti HLA antibodies and some new protocols to improve both chance and outcome of transplantation in immunized subjects represent area of ongoing research of extreme interest for children. PMID:25540732

  13. Neurocognitive functions in pediatric renal transplant patients.

    PubMed

    Gulleroglu, K; Baskin, E; Bayrakci, U S; Aydogan, M; Alehan, F; Kantar, A; Karakayali, F; Moray, G; Haberal, M

    2013-01-01

    Neurocognitive dysfunction is one of the major complications of chronic renal failure (CRF). Uremic state during CRF encompasses a wide spectrum of neurobehavioral and neurological disturbances. Recent studies showed that the pathophysiology of neurocognitive dysfunction in CRF is related to plasma levels of uremic solutes. Successful renal transplantation improves renal, metabolic, and endocrine functions and the quality of life. The aim of our study was to determine the state of neurocognitive function in pediatric renal transplant recipients. We prospectively performed a neurological examination and neuropsychological test battery (Bender-Gestalt Test, Cancellation Test, and Visual and Auditory Number Assay Test) in 20 pediatric renal transplant recipients between 6 and 16 years of age. Twenty healthy children and 20 children with CRF were included in the study as the control groups. Mean age of the renal transplant recipients was 13.50 ± 3.40 years old. Mean evaluation time after transplantation was 2.0 ± 0.5 years. Bender-Gestalt Test result was abnormal in 40% of patients. The results of the Cancellation Test and the Visual and Auditory Number Assay Test showed significant decline in pediatric renal transplant patients when compared with the control. We found that neurocognitive dysfunction was frequent in pediatric renal transplantation patients. Awareness of this potential problem may be helpful for early recognition and treatment. Our findings suggest that periodic neurocognitive assessments may be indicated in transplant recipients. PMID:24314945

  14. Growth in pediatric renal transplant recipients.

    PubMed

    Vasudevan, A; Phadke, K

    2007-04-01

    One of the fundamental challenges in managing pediatric renal transplant recipient is to ensure normal growth and development. The goal of renal transplant is not just to prolong life but to optimize quality of life. Short stature during childhood may be associated with academic underachievement and development of comorbidities such as attention deficit hyperactivity disorder, learning disability, and mood disorders. The most important factors affecting growth are use of corticosteroids, allograft function, and age and height deficit at the time of transplant. Aggressive conservative management of chronic renal failure and early use of growth hormone therapy will help in optimizing height at time of transplant. Early transplant, steroid minimization or withdrawal, and growth hormone therapy will help in achieving normal adult height in a majority of renal post transplant population. Steroid avoidance to achieve good growth still needs to be validated. PMID:17445590

  15. [Kidney transplant from living donors in children?].

    PubMed

    Ginevri, Fabrizio; Dello Strologo, Luca; Guzzo, Isabella; Belingheri, Mirco; Ghio, Luciana

    2011-01-01

    A living-donor kidney transplant offers a child at the terminal stages of renal disease better functional recovery and quality of life than an organ from a deceased donor. Before starting the procedure for a living-donor transplant, however, it is necessary to establish if it is really safe. There are diseases, such as focal segmental glomerulosclerosis, atypical HUS and membranoproliferative glomerulonephritis with dense deposits, for which living donation is not recommended given the high incidence of recurrence of the disease but also the frequent loss of the graft. Regarding the selection of the donor, an increased risk of acute rejection has been reported for donors older than 60-65 years and a worsening of the renal outcome if the donor's weight is equal to or less than the recipient's. Finally, it is necessary to take into consideration that complications may arise in the donor both in the perioperative period and in the long term. In conclusion, kidney transplant from a living donor is a natural choice within the pediatric setting. The parents, usually young and highly motivated to donate, are the ideal donors. However, although the risks associated with donation are minimal, they are not totally absent, and consequently it is mandatory to follow standardized procedures according to the guidelines issued by the Centro Nazionale Trapianti. PMID:21341241

  16. Demodicosis in Renal Transplant Recipients.

    PubMed

    Chovatiya, R J; Colegio, O R

    2016-02-01

    Solid organ transplant recipients have an increased incidence of skin infections resulting from immunosuppression. Common pathogens include herpes simplex virus, varicella zoster virus, Gram-positive bacteria and dermatophytes; however, the contribution of multicellular parasitic organisms to dermatologic disease in this population remains less studied. Demodex folliculorum and brevis are commensal mites that reside on human skin. Proliferation of Demodex mites, or demodicosis, is associated with rosacea and rosacea-like disorders, particularly in immunocompromised populations, although their ability to cause disease is still the subject of debate. We present a case series of four renal transplant recipients with the singular chief complaint of acne rosacea who we diagnosed with demodicosis. Although one of the four patients showed complete resolution following initial antiparasitic therapy, the other three required subsequent antibacterial treatment to fully resolve their lesions. We suggest that demodicosis may be more prevalent than once thought in solid organ transplant recipients and showed that Demodex-associated acne rosacea can be effectively treated in this population. PMID:26431451

  17. Colchicine myoneuropathy in a renal transplant patient.

    PubMed

    Dupont, Peter; Hunt, Ian; Goldberg, Lawrence; Warrens, Anthony

    2002-07-01

    Colchicine is widely employed for the treatment of gout in renal transplant patients where NSAIDs are contra-indicated and allopurinol prophylaxis is often avoided due to concomitant azathioprine immunosuppression. We report here a case of colchicine-induced myoneuropathy in a renal transplant recipient. Our patient had myalgia, muscle weakness, elevated creatine kinase levels, myopathic changes on electromyography and peripheral neuropathy. Withdrawal of colchicine resulted in recovery within 4 weeks. Renal transplant recipients are likely to be at greater risk of colchicine-induced myoneuropathy due to the unique concurrence of risk factors predisposing to toxicity in such patients. These risk factors include the high incidence of gout in this population, widespread use of colchicine as first-line therapy, impaired renal function and concomitant cyclosporin treatment. The diagnosis should be considered in any renal transplant recipient receiving the drug who develops myopathy. Prompt withdrawal of colchicine therapy should result in rapid clinical and biochemical improvement. PMID:12122515

  18. Living Donor Liver Transplantation

    MedlinePlus

    ... around the scar. The bulges can usually be fixed with surgery. During your medical exam, ask the ... to find out if the donor's blood type matches the recipient’s blood type. Next, the transplant team ...

  19. Cortical necrosis in a renal transplant

    SciTech Connect

    Blumhardt, R.; Growcock, G.; Lasher, J.C.

    1983-07-01

    The /sup 99m/Tc-DTPA renogram is a well extabished noninvasive method for evaluating and following transplanted kidneys. The examination is useful in distinguishing rejection from acute tubular necrosis as well as demonstrating several less common complications such as vascular occlusion, urinary extravasation, obstruction, and lymphocele. A previously unreported condition involving a transplant kidney (i.e., renal cortical necrosis) is described which was diagnosed with renal scintigraphy in combination with sonography.

  20. Psychosocial aspects of dialysis and renal transplant.

    PubMed

    Haq, I; Zainulabdin, F; Naqvi, A; Rizvi, A H; Ahmed, S H

    1991-05-01

    Keeping in view our socio cultural millieu, the psychological aspects of twenty renal transplants recipients and equal number of patients on dialysis were studied. Socio psychiatric profile in the dialysis and transplanted patients revealed that the frequency of anxiety, depression and hypochondriasis was significantly less (P less than 0.01) in the transplanted group. On Bender Gestalt Scale the transplanted group achieved normal status in significantly higher (P less than 0.05) number compared to the dialysis patients. It was concluded that transplanted patients showed marked improvement in social functioning, psychological symptoms and enduring personality traits compared to patients on maintenance dialysis. PMID:1861361

  1. Fungal infections in renal transplant patients.

    PubMed

    Khan, Asif; El-Charabaty, Elie; El-Sayegh, Suzanne

    2015-06-01

    Organ transplantation has always been considered to be the standard therapeutic interventions in patients with end-stage organ failure. In 2008, more than 29,000 organ transplants were performed in US. Survival rates among transplant recipients have greatly improved due to better understanding of transplant biology and more effective immunosuppressive agents. After transplant, the extent of the immune response is influenced by the amount of interleukin 2 (IL-2) being produced by the T-helper cells. Transplant immunosuppressive therapy primarily targets T cell-mediated graft rejection. Calcineurin inhibitor, which includes cyclosporine, pimecrolimus and tacrolimus, impairs calcineurin-induced up-regulation of IL-2 expression, resulting in increased susceptibility to invasive fungal diseases. This immunosuppressive state allows infectious complication, leading to a high mortality rate. Currently, overall mortality due to invasive fungal infections (IFIs) in solid organ transplant recipients ranges between 25% and 80%. The risk of IFI following renal transplant is associated with the dosage of immunosuppressive agents given, environmental factors and post-transplant duration. Most fungal infections occur in the first 6 months after transplant because of the use of numerous immunosuppressors. Candida spp. and Cryptococcus spp. are the yeasts most frequently isolated, while most frequent filamentous fungi (molds) isolated are Aspergillus spp. The symptoms of systemic fungal infections are non-specific and early detection of fungal infections and proper therapy are important in improving survival and reducing mortality. This article will provide an insight on the risk factors and clinical presentation, compare variation in treatment of IFIs in renal transplant patients, and evaluate the role of prophylactic therapy in this group of patients. We also report the course and management of two renal transplant recipients admitted to Staten Island University Hospital, both of

  2. Fungal Infections in Renal Transplant Patients

    PubMed Central

    Khan, Asif; El-Charabaty, Elie; El-Sayegh, Suzanne

    2015-01-01

    Organ transplantation has always been considered to be the standard therapeutic interventions in patients with end-stage organ failure. In 2008, more than 29,000 organ transplants were performed in US. Survival rates among transplant recipients have greatly improved due to better understanding of transplant biology and more effective immunosuppressive agents. After transplant, the extent of the immune response is influenced by the amount of interleukin 2 (IL-2) being produced by the T-helper cells. Transplant immunosuppressive therapy primarily targets T cell-mediated graft rejection. Calcineurin inhibitor, which includes cyclosporine, pimecrolimus and tacrolimus, impairs calcineurin-induced up-regulation of IL-2 expression, resulting in increased susceptibility to invasive fungal diseases. This immunosuppressive state allows infectious complication, leading to a high mortality rate. Currently, overall mortality due to invasive fungal infections (IFIs) in solid organ transplant recipients ranges between 25% and 80%. The risk of IFI following renal transplant is associated with the dosage of immunosuppressive agents given, environmental factors and post-transplant duration. Most fungal infections occur in the first 6 months after transplant because of the use of numerous immunosuppressors. Candida spp. and Cryptococcus spp. are the yeasts most frequently isolated, while most frequent filamentous fungi (molds) isolated are Aspergillus spp. The symptoms of systemic fungal infections are non-specific and early detection of fungal infections and proper therapy are important in improving survival and reducing mortality. This article will provide an insight on the risk factors and clinical presentation, compare variation in treatment of IFIs in renal transplant patients, and evaluate the role of prophylactic therapy in this group of patients. We also report the course and management of two renal transplant recipients admitted to Staten Island University Hospital, both of

  3. Living donor kidney transplantation in patients with hereditary nephropathies.

    PubMed

    Niaudet, Patrick

    2010-12-01

    Patients with some hereditary nephropathies-including autosomal dominant polycystic kidney disease (ADPKD), Fabry disease and Alport syndrome-can progress to end-stage renal disease (ESRD) and are candidates for kidney transplantation. When considering whether a potential living donor is appropriate for a particular patient, clinicians should be aware of the increased risk of adverse outcomes for the donor and the recipient. Renal transplantation from a living related donor is not contraindicated in most nephropathies that have an autosomal recessive mode of inheritance (for example, autosomal recessive polycystic kidney disease and cystinosis). Renal transplant recipients with ADPKD, however, should only receive a kidney from a related donor if the disease has been excluded in the donor by imaging and/or genetic testing. Potential living related donors for patients with Alport syndrome should be evaluated carefully for the presence of microhematuria and microalbuminuria before a decision is made to perform transplantation, and mothers or heterozygous sisters of affected male recipients with X-linked Alport syndrome should be informed about the possible long-term increased risk of renal dysfunction associated with donation. Most patients with atypical hemolytic uremic syndrome should not receive a kidney transplant from a living donor because there is a high risk of disease recurrence and graft loss. PMID:20877305

  4. A renal transplantation model for developing countries.

    PubMed

    Rizvi, S A H; Naqvi, S A A; Zafar, M N; Hussain, Z; Hashmi, A; Hussain, M; Akhtar, S F; Ahmed, E; Aziz, T; Sultan, G; Sultan, S; Mehdi, S H; Lal, M; Ali, B; Mubarak, M; Faiq, S M

    2011-11-01

    The estimated incidence of end-stage renal disease (ESRD) in Pakistan is 100 per million population. Paucity and high costs of renal replacement therapy allows only 10% to get dialysis and 4-5% transplants. Our center, a government organization, started a dialysis and transplant program in 1980s where all services were provided free of charge to all patients. It was based on the concept of community government partnership funded by both partners. The guiding principles were equity, transparency, accountability and development of all facilities under one roof. This partnership has sustained itself for 30 years with an annual budget of $25 million in 2009. Daily 600 patients are dialyzed and weekly 10-12 receive transplants. One- and 5-year graft survival of 3000 transplants is 92% and 85%, respectively. The institute became a focus of transplantation in Pakistan and played a vital role in the campaign against transplant tourism and in promulgation of transplant law of 2007, and also helped to increase altruistic transplants in the country. This model emphasizes that in developing countries specialized centers in government sector are necessary for transplantation to progress and community support can make it available to the common man. PMID:21883911

  5. Dental management of people with renal disease and renal transplants.

    PubMed

    Ferguson, C A; Whyman, R A

    1998-09-01

    Chronic renal failure is the result of progressive loss of functioning nephrons leading to loss of renal function and accumulation of excretory products. Loss of the regulatory and excretory functions of the kidneys causes oral manifestations and multiple complications which have implications for dental care. Dental management of patients with renal failure and renal transplants involves consideration of specific haematological and cardiovascular effects, and implications for the prescribing and use of pharmaceuticals. It also requires the dentist to appreciate the potential for involvement of multiple organ systems in the disease process and the implications this has for dental care. The orofacial manifestations of chronic renal failure are secondary to systemic manifestations and are not specific to the diagnosis of end-stage renal disease. PMID:9775650

  6. Renal scans in pregnant transplant patients

    SciTech Connect

    Goldstein, H.A.; Ziessman, H.A.; Fahey, F.H.; Collea, J.V.; Alijani, M.R.; Helfrich, G.B.

    1988-08-01

    This study demonstrates the normal technetium-99m diethylenetriaminepentaacetic acid ((/sup 99m/Tc)DTPA) renal scan in pregnant patients with transplanted kidneys. Five pregnant renal transplant patients had seven (/sup 99m/Tc)DTPA renal studies to assess allograft perfusion and function. All scans showed the uteroplacental complex. The bladder was always compressed and distorted. The transplanted kidney was frequently rotated to a more vertical position. In all patients allograft flow and function were maintained. There was calyceal retention on all studies and ureteral retention activity in three of five patients. Using the MIRD formalism, the total radiation absorbed dose to the fetus was calculated to be 271 mrad. This radiation exposure is well within NRCP limits for the fetus of radiation workers and an acceptable low risk in the management of these high risk obstetric patients.

  7. Simultaneous pancreatic-renal transplant scintigraphy

    SciTech Connect

    Shulkin, B.L.; Dafoe, D.C.; Wahl, R.L.

    1986-12-01

    99mTc-DTPA scintigraphy was evaluated in seven patients as a technique to assess perfusion of the transplanted pancreas and kidney. Such scans provide high-quality images of both organs in both the flow phase and later phases. The radionuclide is readily available and its brief effective half-life allows repeated evaluations at short intervals. /sup 131/I-hippuran, the major radiopharmaceutical for renal transplant scintigraphy, does not allow visualization of the transplanted pancreas or evaluation of its blood supply. Although the blood glucose is a gross indicator of the function of the pancreatic allograft, pancreatic scintigraphy with 99mTc-DTPA in one case was capable of detecting graft dysfunction before elevation of the blood glucose occurred. While additional studies will be necessary to determine the predictive value of this test, 99mTc-DTPA is valuable for pancreatic-renal transplant evaluation.

  8. PARACOCCIDIOIDOMYCOSIS IN A RENAL TRANSPLANT RECIPIENT

    PubMed Central

    GÓES, Heliana Freitas de Oliveira; DURÃES, Sandra Maria Barbosa; LIMA, Caren dos Santos; de SOUZA, Mariana Boechat; VILAR, Enoi Aparecida Guedes; DALSTON, Marcos Olivier

    2016-01-01

    Paracoccidioidomycosis (PCM) is the most common endemic mycosis in Latin America. The etiological agents, which comprise two species, Paracoccidioides brasiliensis and P. lutzii, are thermodimorphic fungi that usually affect previously healthy adults. They primarily involve the lungs and then disseminate to other organs. Such mycosis is rare in organ transplant recipients; there have been only three cases reported in literature, until now. We report a case of PCM in a renal transplant recipient with an unusual dermatological presentation. PMID:26910451

  9. Contrast-enhanced three-dimensional fast-spoiled gradient magnetic resonance angiography of the renal arteries for potential living renal transplant donors: a comparative study with digital subtraction angiography.

    PubMed

    Al-Saeed, O; Ismail, M; Sheikh, M; Al-Moosawi, M; Al-Khawari, H

    2005-06-01

    Preoperative assessment of the arterial anatomy of prospective renal donors is essential. Various non-invasive techniques are used for such evaluation. We conducted this study using contrast-enhanced 3-D fast-spoiled gradient (CE 3-D FSPGR) magnetic resonance angiography (MRA) on a 1.0 Tesla magnet, for preoperative definition of the renal arteries. Forty-five preoperative living renal donors underwent CE 3-D FSPGR MRA of the renal vessels and the results were compared with conventional digital subtraction angiography (DSA). The renal vascular anatomy, both normal and with variations, was satisfactorily defined in all 45 cases with CE 3-D FSPGR MRA. Fifteen cases showed an accessory or aberrant arterial supply. A small aneurysm was shown in one case. All cases compared well with conventional DSA. Our study revealed that CE 3-D FSPGR MRA on a lower field strength magnet is accurate in defining the renal vascular anatomy and its variations. PMID:15932463

  10. Risk factors for lung diseases after renal transplantation

    PubMed Central

    Pencheva, Ventsislava P.; Petrova, Daniela S.; Genov, Diyan K.; Georgiev, Ognian B.

    2015-01-01

    Background: Lung diseases are one of the major causes of morbidity and mortality after renal transplantation. The aim of the study is to define the risk factors for infectious and noninfectious pulmonary complications in kidney transplant patients. Materials and Methods: We prospectively studied 267 patients after renal transplantation. The kidney recipients were followed-up for the development of pulmonary complications for a period of 7 years. Different noninvasive and invasive diagnostic tests were used in cases suspected of lung disease. Results: The risk factors associated with the development of pulmonary complications were diabetes mellitus (odds ratio [OR] = 4.60; P = 0.001), arterial hypertension (OR = 1.95; P = 0.015), living related donor (OR = 2.69; P = 0.004), therapy for acute graft rejection (OR = 2.06; P = 0.038), immunosuppressive regimens that includes mycophenolate (OR = 2.40; P = 0.011), azathioprine (OR = 2.25; P = 0.023), and tacrolimus (OR = 1.83; P = 0.041). The only factor associated with the lower risk of complications was a positive serology test for Cytomegalovirus of the recipient before transplantation (OR = 0.1412; P = 0.001). Conclusion: The risk factors can be used to identify patients at increased risk for posttransplant lung diseases. Monitoring of higher-risk patients allow timely diagnosis and early adequate treatment and can reduce the morbidity and mortality after renal transplantation. PMID:26958045

  11. Preemptive Renal Transplantation-The Best Treatment Option for Terminal Chronic Renal Failure.

    PubMed

    Arze Aimaretti, L; Arze, S

    2016-03-01

    Renal transplantation is the best therapeutic option for end-stage chronic renal disease. Assuming that it is more advisable if performed early, we aimed to show the clinical, social, and economic advantages in 70% of our patients who were dialyzed only for a short period. For this purpose, we retrospectively collected data over 28 years in 142 kidney transplants performed in patients with <6 weeks on dialysis. 66% of our patients were 30-60 years old; 98% of the patients had living donors. At transplantation, 64% of our patients had no public support; however, 64% of them returned to work and got health insurance 2 months later. Full rehabilitation was achieved in all cases, including integration to the family, return to full-time work, school and university, sports, and reproduction. Immunosuppression consisted of 3 drugs, including steroids, cyclosporine, and azathioprine or mycophenolate. The cost in the 1st year, including patient and donor evaluation, surgery, immunosuppression, and follow-up, was $13,300 USD versus $22,320 for hemodialysis. We conclude that preemptive renal transplantation with <6 weeks on dialysis is the best therapeutic option for end-stage renal failure, especially in developing countries such as Bolivia, where until last year, full public support for renal replacement therapy was unavailable. PMID:27110013

  12. Laparoscopic donor nephrectomy: impact on an established renal transplant program.

    PubMed

    Shafizadeh, S; McEvoy, J R; Murray, C; Baillie, G M; Ashcraft, E; Sill, T; Rogers, J; Baliga, P; Rajagopolan, P R; Chavin, K

    2000-12-01

    The current disparity of viable organs and patients in need of a transplant has been an impetus for innovative measures. Live donor renal transplantation offers significant advantages compared with cadaveric donor transplantation: increased graft and patient survival, diminution in incidence of delayed graft function, acute tubular necrosis (ATN), and reduction in waiting time. Notwithstanding these gains live donors continue to be underutilized and account for only approximately one quarter of all renal transplants performed in the United States. It has been felt that inherent disincentives to live donation have slowed its growth. These include degree and duration of postoperative pain and convalescence, child care concerns, cosmetic concerns, and time until return to full activities and employment. In an attempt to curtail the disincentives to live donation, laparoscopic live donation (laparoscopic donor nephrectomy; LDN) was developed. The purpose of this study was to compare the results of our first 25 laparoscopic nephrectomies (performed over a 10-month period from September 1998 through July 1999) with the previous 25 standard open donor nephrectomies (ODNs) completed over the past 3 years. We conducted a retrospective review of all donor nephrectomies and recipient pairs performed over the past 3 years. End points included sex, operative time, length of stay, immediate and long-term renal function, and willingness to donate. There were no differences in demographics of the ODN versus the LDN group. The average length of stay was 2.48+/-0.72 days for the LDN versus 4.08+/-0.28 days for the ODN. ODN and LDN have comparable short- and long-term function with no delayed graft function and no complications. Growth of living donor transplant has increased from 16 per cent of all kidney transplants performed in 1995 to 23 per cent in 1999. We conclude that LDN is a viable alternative to the standard donor operation. LDN has had a positive impact on the donor pool

  13. [Liver transplants from living donors].

    PubMed

    Rogiers, X; Danninger, F; Malagó, M; Knoefel, W T; Gundlach, M; Bassas, A; Burdelski, M; Broelsch, C E

    1996-03-01

    In this article the authors discuss the advantages of Living Related Liver Transplantation (LRLT), criteria for the selection of donors and the standard operation technique. Among a total of 241 liver transplantation (LTx), 42 LRLT were performed at the University of Hamburg between October 1, 1991 and December 19, 1994. The body weight of recipients for LRLT ranged from 4,6 to 39 kg, with 64,2% having less than 10 kg. The volume of the donor left lateral liver lobe ranged from 100 cc to 350 cc. The average one year survival rate among electively operated patients-status 3-4 (UNOS 1995 classification) was 86.7%, two year survival rate 83.3%. The main advantages of LRLT are consired the following: 1. Absence of mortality on the waiting list, 2. Optimal timing of the transplantation (elective procedure, patient in a good condition), 3. Excellent organ (no primary non function), 4. A possible immunologic advantage, 5. Relief of the waiting list for cadaveric organs, 6. Psychological benefit for the family, 7. Cost effectiveness. Potential candidates for living donation with more than one cardiovascular risk factors were excluded. Social and psychological reasons leading to rejection of candidates were as follows: unstable family structure, expected professional or financial difficulties after living donation or withdrawal from consent. LRLT gives parents of a child with TLD a chance to avoid the risk of death on the waiting list or primary non function of the graft. LRLT has therefore established an important place in pediatric liver transplantation. PMID:8768973

  14. The feasibility and applications of non-invasive cardiac output monitoring, thromboelastography and transit-time flow measurement in living-related renal transplantation surgery: results of a prospective pilot observational study

    PubMed Central

    2014-01-01

    Introduction Delayed graft function (DGF) remains a significant and detrimental postoperative phenomenon following living-related renal allograft transplantation, with a published incidence of up to 15%. Early therapeutic vasodilatory interventions have been shown to improve DGF, and modifications to immunosuppressive regimens may subsequently lessen its impact. This pilot study assesses the potential applicability of perioperative non-invasive cardiac output monitoring (NICOM), transit-time flow monitoring (TTFM) of the transplant renal artery and pre-/perioperative thromboelastography (TEG) in the early prediction of DGF and perioperative complications. Methods Ten consecutive living-related renal allograft recipients were studied. Non-invasive cardiac output monitoring commenced immediately following induction of anaesthesia and was maintained throughout the perioperative period. Doppler-based TTFM was performed during natural haemostatic pauses in the transplant surgery: immediately following graft reperfusion and following ureteric implantation. Central venous blood sampling for TEG was performed following induction of anaesthesia and during abdominal closure. Results A single incidence of DGF was seen within the studied cohort and one intra-operative (thrombotic) complication noted. NICOM confirmed a predictable trend of increased cardiac index (CI) following allograft reperfusion (mean CI - clamped: 3.17 ± 0.29 L/min/m2, post-reperfusion: 3.50 ± 0.35 L/min/m2; P < 0.05) mediated by a significant reduction in total peripheral resistance. Reduced TTFM at the point of allograft reperfusion (227 ml/min c.f. mean; 411 ml/min (95% CI: 358 to 465)) was identified in a subject who experienced intra-operative transplant renal artery thrombosis. TEG data exhibited significant reductions in clot lysis (LY30 (%): pre-op: 1.0 (0.29 to 1.71), post reperfusion 0.33 (0.15 to 0.80); P = 0.02) and a trend towards increased clot initiation following

  15. Deceased donor renal transplantation and the disruptive effect of commercial transplants: the experience of Oman.

    PubMed

    Mohsin, N; Al-Busaidy, Q; Al-Marhuby, H; Al-Lawati, J; Daar, A S

    2014-01-01

    The Oman Renal Transplantation Program was established in 1988 as a joint venture between Sultan Qaboos University and the Ministry of Health. It began with both living related donor (LRD) and deceased donor (DD) transplants. Over the next nine years, while the LRD programme progressed relatively well, there were only thirteen DD transplants. Two of the DD kidneys were obtained from overseas via an active collaboration with the Euro-transplant organisation, and one DD kidney was obtained from Saudi Arabia within the Gulf Cooperative Council exchange programme. The rest of the DD kidneys were obtained in Oman. The Omani DD programme, although it was a pioneering effort in the Gulf region at the time, was not entirely sustainable. In this paper we focus on the challenges we encountered. Among the major challenges was the absence of resources to establish a dedicated DD programme and particularly the failure to develop a cadre of dedicated transplant coordinators. PMID:25160966

  16. Transplant Trajectory and Relational Experience Within Living Kidney Dyads.

    PubMed

    Ummel, Deborah; Achille, Marie

    2016-01-01

    Living kidney donation is considered common practice across most Westernized countries. While extensive research has documented the experience of living donors, few studies have addressed the perspective of recipients, and even fewer have examined the experience of donor and recipient as an interactive dyad. In this study, our aim was to examine the reciprocal influence between donors and recipients across the transplantation process. We recruited a homogeneous sample of 10 donors and recipients, who were interviewed individually. Data were analyzed using interpretative phenomenological analysis. The presentation of results follows the stages of the transplantation process: the disease experience, the experience of offering and accepting a kidney, the screening period, the surgery, and the post-transplantation period. Results are discussed within the framework of Mauss's gift exchange theory, social roles, and altruism. This comprehensive description of the dyadic experience provides a way to frame and understand psychosocial aspects and relational implications of living renal transplantation. PMID:25700284

  17. Acoustic Radiation Force Impulse Measurement in Renal Transplantation

    PubMed Central

    Lee, Juhan; Oh, Young Taik; Joo, Dong Jin; Ma, Bo Gyoung; Lee, A-lan; Lee, Jae Geun; Song, Seung Hwan; Kim, Seung Up; Jung, Dae Chul; Chung, Yong Eun; Kim, Yu Seun

    2015-01-01

    Abstract Interstitial fibrosis and tubular atrophy (IF/TA) is a common cause of kidney allograft loss. Several noninvasive techniques developed to assess tissue fibrosis are widely used to examine the liver. However, relatively few studies have investigated the use of elastographic methods to assess transplanted kidneys. The aim of this study was to explore the clinical implications of the acoustic radiation force impulse (ARFI) technique in renal transplant patients. A total of 91 patients who underwent living donor renal transplantation between September 2010 and January 2013 were included in this prospective study. Shear wave velocity (SWV) was measured by ARFI at baseline and predetermined time points (1 week and 6 and 12 months after transplantation). Protocol biopsies were performed at 12 months. Instead of reflecting IF/TA, SWVs were found to be related to time elapsed after transplantation. Mean SWV increased continuously during the first postoperative year (P < 0.001). In addition, mixed model analysis showed no correlation existed between SWV and serum creatinine (r = −0.2426, P = 0.0771). There was also no evidence of a relationship between IF/TA and serum creatinine (odds ratio [OR] = 1.220, P = 0.7648). Furthermore, SWV temporal patterns were dependent on the kidney weight to body weight ratio (KW/BW). In patients with a KW/BW <3.5 g/kg, mean SWV continuously increased for 12 months, whereas it decreased after 6 months in those with a KW/BW ≥3.5 g/kg. No significant correlation was observed between SWV and IF/TA or renal dysfunction. However, SWV was found to be related to the time after transplantation. Renal hemodynamics influenced by KW/BW might impact SWV values. PMID:26426636

  18. Abdominal aortic aneurysmectomy in renal transplant patients.

    PubMed Central

    Lacombe, M

    1986-01-01

    Five patients who had undergone renal transplantation 3 months to 23 years ago were operated on successfully for an abdominal aortic aneurysm. In the first case, dating from 1973, the kidney was protected by general hypothermia. In the remaining patients, no measure was used to protect the kidney. Only one patient showed a moderate increase of blood creatinine in the postoperative period; renal function returned to normal in 15 days. All five patients have normal renal function 6 months to 11 years after aortic repair. Results obtained in this series show that protection of the transplant during aortic surgery is not necessary, provided adequate surgical technique is used. Such a technique is described in detail. Its use simplifies surgical treatment of such lesions and avoids the complex procedures employed in the seven previously published cases. Images FIGS. 1A and B. FIGS. 2A and B. FIGS. 3A and B. FIGS. 4A and B. FIGS. 5A and B. PMID:3510592

  19. The Cost and Utility of Renal Transplantation in Malaysia

    PubMed Central

    Bavanandan, Sunita; Yap, Yok-Chin; Ahmad, Ghazali; Wong, Hin-Seng; Azmi, Soraya; Goh, Adrian

    2015-01-01

    Background Kidney transplantation is the optimal therapy for the majority of patients with end-stage renal disease. However, the cost and health outcomes of transplantation have not been assessed in a middle-income nation with a low volume of transplantation, such as Malaysia. Aim and Methods This study used microcosting methods to determine the cost and health outcomes of living and deceased donor kidney transplantation in adult and pediatric recipients. The perspective used was from the Ministry of Health Malaysia. Cost-effectiveness measures were cost per life year (LY) and cost per quality-adjusted LYs. The time horizon was the lifetime of the transplant recipient from transplant to death. Results Records of 206 KT recipients (118 adults and 88 children) were obtained for microcosting. In adults, discounted cost per LY was US $8609(Malaysian Ringgit [RM]29 482) and US $13 209(RM45 234) for living-donor kidney transplant (LKT) and deceased donor kidney transplant (DKT), respectively, whereas in children, it was US $10 485(RM35 905) and US $14 985(RM51 317), respectively. Cost per quality-adjusted LY in adults was US $8826 (RM30 224) for LKT and US $13 592(RM46 546) for DKT. Total lifetime discounted costs of adult transplants were US $119 702 (RM409 921) for LKT, US $147 152 (RM503 922) for DKT. Total costs for pediatric transplants were US $154 841(RM530 252) and US $159 313(RM545 566) for the 2 categories respectively. Conclusions Both LKT and DKT are economically favorable for Malaysian adult and pediatric patients with ESRD and result in improvement in quality of life. PMID:27500211

  20. Human Leukocyte Antigen Alleles and Cytomegalovirus Infection After Renal Transplantation

    PubMed Central

    Futohi, Farzaneh; Saber, Azadeh; Nemati, Eglim; Einollahi, Behzad; Rostami, Zohre

    2015-01-01

    Background: Several studies have been conducted on the relationship between a number of human leukocyte antigen (HLA) alleles and cytomegalovirus infection (CMV), in kidney transplant recipients, after transplantation. However, only a limited number of HLAs have been investigated, so far, and the results have been contradictory. Objectives: This study aimed to investigate the relationship between 59 HLA alleles and the CMV infection, in transplant recipients, after kidney transplantation. Patients and Methods: This retrospective cohort study was conducted on 200 patients, receiving a kidney transplant, in Baqiyatallah Hospital, in Tehran, during 2013. Throughout a one-year follow-up of kidney transplant recipients, in case of detecting the CMV antigen in patients’ blood, at any time, they were placed in the group of patients with CMV infection, whereas, if no CMV-specific antigen was developed, over a year, patients were placed in the group of patients without CMV infection, after transplantation. This study investigated the relationship between CMV infection in kidney transplant recipients and 59 HLA alleles, including 14 HLA-A, 28 HLA-B, and 17 HLA-DRB1 cases. Results: Of all participants, 104 patients (52%) were diagnosed with CMV infection. There was no significant difference between the two groups, with and without CMV infection, in terms of patient’s characteristics. The CMV infection, in patients receiving a transplanted organ from deceased donor, was significantly more prevalent than in those receiving kidney transplant from living donor (63% vs. 39%, respectively, P = 0.001). Recipients with HLA-B44 were more infected with CMV compared with patients without this allele (80% vs. 50%, respectively, P = 0.024); on the contrary, kidney recipients with HLA-DRB1-1 were less infected with CMV than patients without this allele (31% vs. 55%, respectively, P = 0.020). There was no significant relationship between CMV infection and other HLA alleles. Results of

  1. Living donor transplant: wider selection criteria.

    PubMed

    Splendiani, G; Cipriani, S; Valeri, M; Torlone, N; Vega, A; Tullio, T; Condò, S; Dominijanni, S; Casciani, C U

    2004-04-01

    The availability of cadaveric donor organs is insufficient for actual needs. The organ demand increases by 20% per year. Living donor transplant (LDT) may be a valid therapeutical alternative provided one uses proper criteria. LDT provides many advantages, like improved patient and organ survival, short waiting time, and the possibility to carefully plan the procedure. Potential risks include perioperative mortality and renal dysfunction in the kidney donor. At present, kidney LDTs in Italy represent 8% of the total, with an organ survival rate of 97% after 1 year (vs 93% for cadaveric transplants) and donors mortality rate of almost null. Most LDTs are performed from kinsmen. Presently, law no. 458, 26 June 1967, is in force in Italy for kidney LDT and law no. 453, 16 December 1999, for liver LDT. The foundations of LDT are, of course, the recipient's condition, the donor's motivation, and the altruism of the donation. It is desirable that in the future an increasing number of LDT be performed, supported by a careful, widespread health education regarding organ donation from living subjects and by the possibility to obtain insurance for the donor, which has been considered but never provided by actual laws. PMID:15110560

  2. Anemia in pediatric renal transplant recipients.

    PubMed

    Kausman, Joshua Yehuda; Powell, Harley Robert; Jones, Colin Lindsay

    2004-05-01

    The aim of this study was to establish the prevalence of anemia in stable pediatric renal transplant recipients and to examine the association of anemia with renal function, immunosuppressants, angiotensin converting enzyme inhibitors, and growth, as well as iron, vitamin B(12), and folate stores. This is a cross-sectional study of the 50 renal transplant recipients currently followed at our center. Patient data were collected regarding hematological parameters, growth, medications, renal function, underlying renal disease, delayed graft function, episodes of rejection, and iron or erythropoietin therapy post transplantation. The mean hemoglobin level (Hb) was 110 g/l and the overall prevalence of anemia was 60%, including 30% who were severely anemic (Hb<100 g/l). There was a high rate of iron deficiency (34%) and serum iron was the parameter of iron metabolism most closely associated with anemia. Hb in patients with low serum iron was 90.7 g/l versus 114.4 g/l in those with normal serum iron ( P<0.01). Both univariate and multiple linear regression determined tacrolimus dose and creatinine clearance to be significant factors associated with anemia. Tacrolimus dose correlated with a 10 g/l reduction in Hb for every increase of tacrolimus dose of 0.054 mg/kg per day ( P=0.001). The dose of mycophenolate was positively correlated with Hb, but this was likely to be confounded by our practice of dose reduction in the setting of anemia. Angiotensin converting enzyme inhibitor use was not associated with anemia. Severely anemic patients tended to be shorter, with a mean Z-score for height of -1.8 compared with -0.9 for those with normal Hb ( P=0.02). Anemia is a significant and common problem in pediatric renal transplant patients. Deteriorating renal function is an important cause, but other factors like iron deficiency and immunosuppression are involved. Definition of iron deficiency is difficult and serum iron may be a valuable indicator. Medication doses

  3. [Living donor transplantation. Surgical complications].

    PubMed

    Karam, Georges

    2008-02-01

    Although nephrectomy by open surgery is the most used technique for the extraction of kidney transplants in the living donor, nephrectomy under laparaoscopy is increasingly practiced. Laparoscopic nephrectomy is less invasive and performed under videoscopy control, after insufflation of the peritoneal cavity. Three to four incisions are done in order to enter the surgical instruments. The kidney is extracted through a horizontal sus-pubic incision. The exposition is either exclusively transperitoneal, retroperitoneal or hand assisted. The advantages of laparoscopy are esthetical, financial due to a shorter hospitalisation and a quicker recovery, as well a confort for the donor. The disadvantages are a longer warm ischemia time and possibly a higher risk of delayed graft function. Randomised studies having compared laparoscopy and open surgery in the living donor have not find any significant difference regarding the per- and perioperative in the complications. PMID:18160357

  4. Renal cancer in kidney transplanted patients.

    PubMed

    Frascà, Giovanni M; Sandrini, Silvio; Cosmai, Laura; Porta, Camillo; Asch, William; Santoni, Matteo; Salviani, Chiara; D'Errico, Antonia; Malvi, Deborah; Balestra, Emilio; Gallieni, Maurizio

    2015-12-01

    Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90% of cases and the graft in 10 %. In addition to general risk factors, malignancy susceptibility may be influenced by immunosuppressive therapy, the use of calcineurin inhibitors (CNI) as compared with mammalian target of rapamycin inhibitors, and the length of dialysis treatment. Acquired cystic kidney disease may increase the risk for renal cancer after transplantation, while autosomal dominant polycystic kidney disease does not seem to predispose to cancer development. Annual ultrasound evaluation seems appropriate in patients with congenital or acquired cystic disease or even a single cyst in native kidneys, and every 2 years in patients older than 60 years if they were on dialysis for more than 5 years before transplantation. Immunosuppression should be lowered in patients who develop renal cancer, by reduction or withdrawal of CNI. Although more evidence is still needed, it seems reasonable to shift patients from CNI to everolimus or sirolimus if not already treated with one of these drugs, with due caution in subjects with chronic allograft nephropathy. PMID:26202137

  5. Challenges of valve surgeries in post-renal transplant patients

    PubMed Central

    Ahmad, Tanveer; Kishore, Kolkebaile Sadanand; Maheshwarappa, Nandakumar Neralakere; Pasarad, Ashwini Kumar

    2015-01-01

    Renal transplantation remains a mainstay of therapy for the end-stage renal disease. Cardiac disease has a high prevalence in this patient population. Cardiovascular disease remains the leading cause of death among kidney transplantation patients. The cardiac disease accounts for 43% of all-cause mortality among dialysis patients and for ≈38% of all-cause mortality after transplantation. In this article, we review the factors and outcomes associated with valve surgeries in renal transplant recipients and evaluate the strategy for open heart surgery after renal transplantation performed. PMID:26440255

  6. Cold Storage Exacerbates Renal and Mitochondrial Dysfunction Following Transplantation

    PubMed Central

    Shrum, S; MacMillan-Crow, LA; Parajuli, N

    2016-01-01

    Long-term renal function is compromised in patients receiving deceased donor kidneys which require cold storage exposure prior to transplantation. It is well established that extended cold storage induces renal damage and several labs, including our own, have demonstrated renal mitochondrial damage after cold storage alone. However, to our knowledge, few studies have assessed renal and mitochondrial function after transplantation of rat kidneys exposed to short-term (4 hr) cold storage compared to transplant without cold storage (autotransplantation). Our data reveal that cold storage plus transplantation exacerbated renal and mitochondrial dysfunction when compared to autotransplantation alone. PMID:27066594

  7. Ethical evaluation of risks related to living donor transplantation programs.

    PubMed

    Panocchia, N; Bossola, M; Silvestri, P; Midolo, E; Teleman, A A; Tazza, L; Sacchini, D; Minacori, R; Di Pietro, M L; Spagnolo, A G

    2013-09-01

    The shortage of available cadaveric organs for transplantation and the growing demand has incresed live donation. To increase the number of transplantations from living donors, programs have been implemented to coordinate donations in direct or indirect form (cross-over, paired, and domino chain). Living donors with complex medical conditions are accepted by several transplantation programs. In this way, the number of transplants from living has exceeded that from cadaver donors in several European countries. No mortality has been reported in the case of lung, pancreas, or intestinal Living donations, but the perioperative complications range from 15% to 30% for pancreas and lung donors. In living kidney donors, the perioperative mortality is 3 per 10,000. Their frequency of end-stage renal disease does not exceed the United States rate for the general population. However, long-term follow-up studies of living donors for kidney transplantations have several limitations. The frequency of complications in live donor liver transplantation is 40%, of these, 48% are possibly life-threatening according to the Clavien classification. Residual disability, liver failure, or death has occurred in 1% of cases. The changes in live donor acceptance criteria raise ethical issues, in particular, the physician's role in evaluating and accepting the risks taken by the living donor. Some workers argue to set aside medical paternalism on behalf of the principle of donor autonomy. In this way the medical rule "primum non nocere" is overcome. Transplantation centers should reason beyond the shortage of organs and think in terms of the care for both donor and recipient. PMID:24034000

  8. [Serum beta 2 microglobulin (beta 2M) following renal transplantation].

    PubMed

    Pacheco-Silva, A; Nishida, S K; Silva, M S; Ramos, O L; Azjen, H; Pereira, A B

    1994-01-01

    Although there was an important improvement in graft and patient survival the last 10 years, graft rejection continues to be a major barrier to the success of renal transplantation. Identification of a laboratory test that could help to diagnose graft rejection would facilitate the management of renal transplanted patients. PURPOSE--To evaluate the utility of monitoring serum beta 2M in recently transplanted patients. METHODS--We daily determined serum beta 2M levels in 20 receptors of renal grafts (10 from living related and 10 from cadaveric donors) and compared them to their clinical and laboratory evolution. RESULTS--Eight patients who presented immediate good renal function following grafting and did not have rejection had a mean serum beta 2M of 3.7 mg/L on the 4th day post transplant. The sensitivity of the test for the diagnosis of acute rejection was 87.5%, but the specificity was only 46%. Patients who presented acute tubular necrosis (ATN) without rejection had a progressive decrease in their serum levels of beta 2M, while their serum creatinine changed as they were dialyzed. In contrast, patients with ATN and concomitance of acute rejection or CSA nephrotoxicity presented elevated beta 2M and creatinine serum levels. CONCLUSION--Daily monitoring of serum beta 2M does not improve the ability to diagnose acute rejection in patients with good renal function. However, serum beta 2M levels seemed to be useful in diagnosing acute rejection or CSA nephrotoxicity in patients with ATN. PMID:7787867

  9. Transmission of toxoplasmosis by renal transplant.

    PubMed

    Mejia, G; Leiderman, E; Builes, M; Henao, J; Arbelaez, M; Arango, J L; Borrero, J

    1983-05-01

    Two renal allograft recipients who had received their organs from the same cadaver donor developed acute toxoplasmosis shortly after transplantation. Neither of the recipients had serologic evidence of previous exposure to Toxoplasma gondii at the time of surgery, but the donor had a positive indirect fluorescent antibody test. One of the recipients died during the fourth week, and multiorgan involvement with toxoplasmosis was demonstrated at autopsy. No evidence of the parasite could be found in the transplanted kidney. In the second recipient the disease was suspected, serologically demonstrated, and successfully treated. We concluded that toxoplasmosis was transmitted by the donor's kidneys, although this mode of transmission was not completely proven. PMID:6342373

  10. Urinary tract infections in renal transplant recipients.

    PubMed

    Alangaden, George

    2007-11-01

    Urinary tract infection (UTI) is the most common infectious complication after renal transplantation. Although Escherichia coli remains the most common cause of UTI, Enterococcus spp and drug-resistant Enterobacteriaceae have emerged as important uropathogens in these patients. As a result, symptomatic UTIs warrant pathogen-specific antibiotic therapy guided by culture and susceptibility data. In the early transplant period, prophylaxis of UTI with trimethoprim-sulfamethoxazole is generally effective. Until the natural history and optimal management of asymptomatic bacteruria are better defined, therapy of asymptomatic bacteruria is generally unnecessary. PMID:17999883

  11. Neurologic complications following pediatric renal transplantation.

    PubMed

    Ghosh, Partha S; Kwon, Charles; Klein, Melanie; Corder, Julie; Ghosh, Debabrata

    2014-06-01

    We reviewed neurologic complications after renal transplantation in children over a 20-year period. Neurologic complications were classified as early (within 3 months) and delayed (beyond 3 months). Of 115 children, 10 (8.7%) had complications. Early complications were found in 4.35% of patients: seizures in 4 (posterior reversible leukoencephalopathy syndrome due to immunosuppressant toxicity, sepsis/presumed meningitis, and indeterminate) and headaches in 1. One patient with seizures received levetiracetam for 6 months and 1 with headaches received amitriptyline prophylaxis. Late complications were noted in 4.35% of patients: seizures in 3 (posterior reversible leukoencephalopathy syndrome due to hypertension, hypertensive encephalopathy), headaches in 2, and tremors in 1. Two patients with seizures were treated with anti-epilepsy medications; 1 with migraine received cyproheptadine prophylaxis. Neurologic complications develop in children after renal transplantation. Seizures due to posterior reversible leukoencephalopathy syndrome were the commonest complication. Early detection and appropriate management of these complications is important. PMID:23752071

  12. Parasitic infection in renal transplant recipients.

    PubMed

    Valar, C; Keitel, E; Dal Prá, R L; Gnatta, D; Santos, A F; Bianco, P D; Sukiennik, T C T; Pegas, K L; Bittar, A E; Oliveira, K T; Garcia, V D

    2007-03-01

    The purpose of this study was to evaluate the prevalence of symptomatic parasitic infections in adult renal transplant recipients. We retrospectively analyzed a sample of 657 adult renal transplant recipients performed from January 2001 to December 2005 for immunosuppression protocol, clinical manifestations, parasite diagnosis, treatments, and outcomes. The prevalence of symptomatic parasitosis infections was 2.4% (16/657). None of the infected patients received cyclosporine in their immunosuppression protocol. Most of the infections were caused by Strongyloids stercoralis (n = 11), followed by Giardia lamblia (n = 3), Toxoplasma gondii (n = 1), and Trypanosoma cruzi: (n = 1). Strongyloides stercoralis was the most frequent agent, causing three cases of hyperinfection including one fatal case. With the new immunosuppressive regimes there must be a suspicion of parasitic infection to avoid the diagnostic delay that can be fatal. Strategies, including empiric treatment for S. stercoralis, must be considered. PMID:17362759

  13. Asymptomatic hyperuricemia following renal transplantation

    PubMed Central

    Bellomo, Gianni

    2015-01-01

    Evidence is accumulating indicating a role for uric acid in the genesis and progression of kidney disease, and a few studies are beginning to show a possible beneficial effect of urate-lowering therapy. Whether this holds true for renal allograft recipients is not clear. In this short review evidence from epidemiological as well as intervention studies is summarized and discussed, with some practical considerations presented at the end. PMID:26167455

  14. Asymptomatic hyperuricemia following renal transplantation.

    PubMed

    Bellomo, Gianni

    2015-07-01

    Evidence is accumulating indicating a role for uric acid in the genesis and progression of kidney disease, and a few studies are beginning to show a possible beneficial effect of urate-lowering therapy. Whether this holds true for renal allograft recipients is not clear. In this short review evidence from epidemiological as well as intervention studies is summarized and discussed, with some practical considerations presented at the end. PMID:26167455

  15. Whooping cough in a renal transplant recipient.

    PubMed

    Garbiras, M; Shabaka, A; Calvo, N; Martin, L; Moreno, M A; Lopez de la Manzanara, V; Sanchez-Fructuoso, A I

    2016-04-01

    Whooping cough is a respiratory infection with a severity that varies with age, immune status, and probably with other factors such as the degree of exposure and the virulence of the organism. The most frequent microorganism responsible for whooping cough is Bordetella pertussis. We present the case of a 62-year-old renal transplant recipient presenting with typical and severe manifestations of whooping cough caused by B. pertussis. PMID:26808962

  16. Living vs. deceased donor liver transplantation provides comparable recovery of renal function in patients with hepatorenal syndrome: a matched case-control study.

    PubMed

    Goldaracena, N; Marquez, M; Selzner, N; Spetzler, V N; Cattral, M S; Greig, P D; Lilly, L; McGilvray, I D; Levy, G A; Ghanekar, A; Renner, E L; Grant, D R; Selzner, M

    2014-12-01

    Outcomes of living versus deceased donor liver transplantation in patients with chronic liver disease and hepatorenal syndrome (HRS) was compared using a matched pair study design. Thirty patients with HRS receiving a live donor liver transplantation (LDLT) and 90 HRS patients receiving a full graft deceased donor liver transplantation (DDLT) were compared. LDLT versus DDLT of patients with HRS was associated with decreased peak aspartate aminotransferase levels (339 ± 214 vs. 935 ± 1253 U/L; p = 0.0001), and similar 7-day bilirubin (8.42 ± 7.89 vs. 6.95 ± 7.13 mg/dL; p = 0.35), and international normalized ratio levels (1.93 ± 0.62 vs. 1.78 ± 0.78; p = 0.314). LDLT vs. DDLT had a decreased intensive care unit (2 [1-39] vs. 4 [0-93] days; p = 0.004), and hospital stay (17 [4-313] vs. 26 [0-126] days; p = 0.016) and a similar incidence of overall postoperative complications (20% vs. 27%; p = 0.62). No difference was detected between LDLT and DDLT patients regarding graft survival at 1 (80% vs. 82%), at 3 (69% vs. 76%) and 5 years (65% vs. 76%) (p = 0.63), as well as patient survival at 1 (83% vs. 82%), 3 (72% vs. 77%) and 5 years (72% vs. 77%) (p = 0.93). The incidence of chronic kidney disease post-LT (10% vs. 6%; p = 0.4) was similar between both groups. LDLT results in identical long-term outcome when compared with DDLT in patients with HRS. PMID:25277134

  17. Pyelo-ureteral necrosis after renal transplantation.

    PubMed

    Spasovski, Goce B; Masin-Spasovska, Jelka; Stavridis, Sotir; Saiti, Skender; Lekovski, Ljupco

    2008-01-01

    Because of the limited chance of receiving a kidney transplant (for several well-known reasons), a lot of desperate dialysis patients procure an unrelated donor kidney transplant against all medical advice. This type of renal paid transplantation is associated with many surgical complications and invasive opportunistic infections that increase the morbidity and mortality in this group of transplant recipients. In this report, we describe a case of a 22-year-old girl with a segmental infarction of the graft lower pole and a complete pyelo-ureteral necrosis as a consequence of some vascular damage, complicated by a pathohistological finding of an invasive candidiasis. Despite the successful surgical pyelovesical anastomosis and the good recovery of the patient and the kidney, long-term prognosis remains poor. The lack of information from the transplanting center regarding both donor and recipient and the associated, unacceptable risks on the graft and patient survival in unrelated, paid transplant recipients reinforce the standpoint that this practice should be abandoned. PMID:18204913

  18. Cardiovascular disease in renal transplant recipients.

    PubMed

    McQuarrie, Emily P; Fellström, Bengt C; Holdaas, Hallvard; Jardine, Alan G

    2010-05-01

    Renal transplant recipients have a markedly increased risk of premature cardiovascular disease (CVD) compared with the general population, although considerably lower than that of patients receiving maintenance haemodialysis. CVD in transplant recipients is poorly characterised and differs from the nonrenal population, with a much higher proportion of fatal to nonfatal cardiac events. In addition to traditional ischaemic heart disease risk factors such as age, gender, diabetes and smoking, there are additional factors to consider in this population such as the importance of hypertension, left ventricular hypertrophy and uraemic cardiomyopathy. There are factors specific to transplantation such immunosuppressive therapies and graft dysfunction which contribute to this altered risk profile. However, understanding and treatment is limited by the absence of large randomised intervention trials addressing risk factor modification, with the exception of the ALERT study. The approach to managing these patients should begin early and be multifactorial in nature. PMID:20586909

  19. Changes in leucocyte migration after renal transplantation

    PubMed Central

    Smith, M. G. M.; Eddleston, A. L. W. F.; Dominguez, J. A.; Evans, D. B.; Bewick, M.; Williams, Roger

    1969-01-01

    The leucocyte migration test, an in-vitro measure of cellular immunity, has been used to follow the changes in cell-mediated hypersensitivity to kidney and histocompatibility antigens in three patients after renal transplantation. Inhibition of leucocyte migration, indicating strong sensitization to the antigens used, occurred in each patient, starting five to seven days after transplantation. Satisfactory renal function had not been established in any of the patients at this time. In one case inhibition of leucocyte migration persisted almost continuously until the 24th day and was associated with poor renal function proved histologically to be due to rejection. Treatment with increased dosage of prednisone was associated with a rapid reversion to normal of the migration index and improvement in renal function. Later, inhibition of migration occurred again, and shortly afterwards the graft ceased to function. In the other two cases the migration index became normal without alteration in immunosuppressive therapy and a satisfactory diuresis followed. It is suggested that this simple test should prove useful in the specific diagnosis of rejection and in control of immunosuppressive therapy. ImagesFig. 3Fig. 4 PMID:4899455

  20. [Cytomegalovirus and BK polyomavirus infection after renal transplantation].

    PubMed

    De Paolis, P; Gervasio, E; Tedesco, M; Favaro', A; Iappelli, M; Di Giulio, S

    2009-01-01

    Cytomegalovirus (CMV) and BK polyomavirus (BKV) infections have been described in a high percentage of renal transplant patients and are known to cause various complications in renal transplantation. They are closely related to immunosuppressive therapy and implicated in the progression of graft failure. This review focuses on the clinical aspects of CMV and BKV infection after renal transplantation, optimal monitoring, and recent preventive measures and interventions to improve graft function and recipient survival. PMID:19382094

  1. Noncompliance in children with renal transplants.

    PubMed

    Korsch, B M; Fine, R N; Negrete, V F

    1978-06-01

    Fourteen patients (13 of them adolescents) interrupted immunosuppressive treatment following renal transplantation. Twelve were girls and two were boys. Six subsequently lost their allografts and eight had impaired renal function. Noncompliance was suspected when diminution in cushingoid features, unexplained weight loss, or changes in renal function occurred. Noncompliance was comfirmed by interview with psychosocial staff. Available psychosocial data from family interview and personality test obtained earlier as part of systematic follow-up study were analyzed to explore the reasons for noncompliance. Non compliant patient families had lower incomes, more fatherless households, and comunication difficulties within the family and with the medical establishment. Using a stepwise discriminant analysis, a discriminant function was derived which selected 13 of 14 noncompliant patients. Noncompliance may be a preventable cause of allograft failure. These data can aid in identifying high-risk patients and planning intervention programs. PMID:353683

  2. Serum lipid pattern unifies following renal transplantation in children.

    PubMed

    Müller, Thomas; Koeppe, Silvie; Arbeiter, Klaus; Luckner, Doris; Salzer, Urike; Balzar, Egon; Aufricht, Christoph

    2003-09-01

    Hyperlipidemia is a common problem in solid organ transplant recipients. In this study we evaluated the role of pre-transplant renal replacement therapy on early and late changes of serum lipid levels in children following renal transplantation. In 46 children with chronic renal failure (median age 10.3 years) and 12 children with heart failure (median age 5.0 years), cholesterol and triglycerides were measured before and during follow-up after transplantation. Children with renal failure had significantly higher serum lipids than controls ( n=34, median age 9.2 years) and patients with heart failure. Pre transplantation, cholesterol and triglycerides were significantly lower in the hemodialysis than in the peritoneal dialysis population, whereas conservatively treated children had intermediate levels. After transplantation, serum cholesterol converged towards a mean level of 208 mg/dl and triglyceride levels converged towards a uniform level of 195 mg/dl at 9 months post transplant. The ratio of cholesterol/high-density lipoprotein significantly decreased from 4.7 to 3.8. The pattern of "post-transplant hyperlipidemia" was similar in both renal and cardiac allograft recipients. Hence, the early post-transplant changes of serum lipid pattern are markedly dependent on the mode of pre-transplant renal replacement therapy. Later, serum lipid levels were no longer influenced by prior renal replacement therapy and showed a new pattern of "post-transplant hyperlipidemia" in all children. PMID:12883978

  3. Commercial renal transplantation: A risky venture? A single Canadian centre experience

    PubMed Central

    Kapoor, Anil; Kwan, Kevin G.; Whelan, J. Paul

    2011-01-01

    Background: Canada, akin to other developed nations, faces the growing challenges of end-stage renal disease (ESRD). Even with expanded donor criteria for renal transplantation (the treatment of choice for ESRD), the supply of kidneys is outpaced by the escalating demand. Remuneration for kidney donation is proscribed in Canada. Without an option of living-related transplantation (biological or emotional donors), patients often struggle with long waiting lists for deceased donor transplantation. Accordingly, many patients are now opting for more expedient avenues to obtaining a renal transplant. Through commercial organ retrieval programs, from living and deceased donors, patients are travelling outside Canada to have the procedure performed. Methods: Between September 2001 and July 2007, 10 patients (7 males, 3 females) underwent commercial renal transplantation outside Canada. We describe the clinical outcomes of these patients managed postoperatively at our single Canadian transplant centre. Results: Six living unrelated and 4 deceased donor renal transplantations were performed on these 10 patients (mean age 49.5 years). All procedures were performed in developing countries and the postoperative complications were subsequently treated at our centre. The mean post-transplant serum creatinine was 142 μmol/L. The average follow-up time was 29.8 months (range: 3 to 73 months). One patient required a transplant nephrectomy secondary to fungemia and subsequently died. One patient had a failed transplant and has currently resumed hemodialysis. Acute rejection was seen in 5 patients with 3 of these patients requiring re-initiation of hemodialysis. Only 1 patient had an uncomplicated course after surgery. Discussion: Despite the kidney trade being a milieu of corruption and commercialization, and the high risk of unconventional complications, patients returning to Canada after commercial renal transplantation are the new reality. Patients are often arriving without any

  4. Adipocytokines in renal transplant recipients

    PubMed Central

    Nagy, Kristof; Nagaraju, Shankar Prasad; Rhee, Connie M.; Mathe, Zoltan; Molnar, Miklos Z.

    2016-01-01

    In the last two decades, perceptions about the role of body fat have changed. Adipocytes modulate endocrine and immune homeostasis by synthesizing hundreds of hormones, known as adipocytokines. Many studies have been investigating the influences and effects of these adipocytokines and suggest that they are modulated by the nutritional and immunologic milieu. Kidney transplant recipients (KTRs) are a unique and relevant population in which the function of adipocytokines can be examined, given their altered nutritional and immune status and subsequent dysregulation of adipocytokine metabolism. In this review, we summarize the recent findings about four specific adipocytokines and their respective roles in KTRs. We decided to evaluate the most widely described adipocytokines, including leptin, adiponectin, visfatin and resistin. Increasing evidence suggests that these adipocytokines may lead to cardiovascular events and metabolic changes in the general population and may also increase mortality and graft loss rate in KTRs. In addition, we present findings on the interrelationship between serum adipocytokine levels and nutritional and immunologic status, and mechanisms by which adipocytokines modulate morbidity and outcomes in KTRs. PMID:27274819

  5. Adipocytokines in renal transplant recipients.

    PubMed

    Nagy, Kristof; Nagaraju, Shankar Prasad; Rhee, Connie M; Mathe, Zoltan; Molnar, Miklos Z

    2016-06-01

    In the last two decades, perceptions about the role of body fat have changed. Adipocytes modulate endocrine and immune homeostasis by synthesizing hundreds of hormones, known as adipocytokines. Many studies have been investigating the influences and effects of these adipocytokines and suggest that they are modulated by the nutritional and immunologic milieu. Kidney transplant recipients (KTRs) are a unique and relevant population in which the function of adipocytokines can be examined, given their altered nutritional and immune status and subsequent dysregulation of adipocytokine metabolism. In this review, we summarize the recent findings about four specific adipocytokines and their respective roles in KTRs. We decided to evaluate the most widely described adipocytokines, including leptin, adiponectin, visfatin and resistin. Increasing evidence suggests that these adipocytokines may lead to cardiovascular events and metabolic changes in the general population and may also increase mortality and graft loss rate in KTRs. In addition, we present findings on the interrelationship between serum adipocytokine levels and nutritional and immunologic status, and mechanisms by which adipocytokines modulate morbidity and outcomes in KTRs. PMID:27274819

  6. [Renal transplantation without maintenance immunosuppression. Identical twins and kidney transplantation following a successful bone marrow graft].

    PubMed

    Hadi, Riad Abdel; Thomé, Gustavo Gomes; Ribeiro, Adriana Reginato; Manfro, Roberto Ceratti

    2015-01-01

    Renal transplantation without maintenance immunosuppression has been sporadically reported in the literature. The cases include non-adherent patients who discontinued their immunosuppressive medications, transplantation between identical twins, kidney transplantation after a successful bone marrow graft from the same donor and simultaneous bone marrow and kidney transplantation for the treatment of multiple myeloma with associated renal failure. There are also ongoing clinical trials designed to induce donor specific transplant tolerance with infusion of hematopoietic cells from the same kidney donor. Here we describe two cases of renal transplantation without immunosuppression as examples of situations described above. PMID:26154652

  7. Outcomes of Renal Transplantation in Brunei Darussalam over a Twenty-Year Period (1993–2012)

    PubMed Central

    Khalil, Muhammad Abdul Mabood; Tan, Si Yen; Ahmed, Dalinatul; Zinna, Shaukat; Chong, William

    2014-01-01

    Objectives. Brunei Darussalam has a high prevalence and incidence of end stage renal disease (ESRD). Up until 2012, all renal transplantations were performed in overseas centres, either as government-sponsored (living-related transplantation) or as self-sponsored (commercialized transplantation) ones. We hypothesize that graft and patient survival of Brunei renal transplant patients are on a par with international standards. Materials and Methods. Data of all renal transplant patients in Brunei were analysed over a twenty-year period from registry records and case notes. Comparative survival data from other countries were obtained from PubMed-listed literature. Results. A total of 49 transplantation procedures were performed in foreign centres between 1993 and 2012. 29 were government-sponsored and 20 were self-sponsored transplantations. The 5- and 10-year overall patient survival rates were 93.3% and 90.1%, respectively. The 5- and 10-year overall graft survival rates were 91.1% and 81.2%. There is no difference in the survival outcomes of government-sponsored and self-sponsored patients. Living-related (government-sponsored) and commercialised (self-sponsored) grafts had equivalent survival to those reported in the literature. Conclusion. Our survival data was on par with those achieved in many countries. We hope to use this information to convince local stakeholders and patients to favour transplantation as the preferred modality of RRT. PMID:25478205

  8. Ethical and legal issues in renal transplantation in Nigeria.

    PubMed

    Ajayi, S O; Raji, Y; Salako, B L

    2016-01-01

    With the increasing number of patients being offered kidney transplantation by many centers in the developing world, it is not unexpected that there would be attendant ethical and legal issues even when the selection process for transplantation seems medically justified. Because of the inadequate infrastructure for hemodialysis and peritoneal dialysis, coupled with the challenges of logistics for maintenance dialysis, transplantation would seem to be the best option for patients with end-stage renal failure, even in developed economies where these can easily be tackled. The main issues here revolve around incentives for donors, organ trade and trafficking and the economics of eliminating the waiting list and the criminal activities of organ trans-plantation. In the developing world, with the current level of corruption and poverty, there is a need to redouble efforts to monitor transplant activities. Professional bodies should take the lead in this regard. Furthermore, there is a need for governments to engage in public consultation and community awareness concerning organ donation in living and deceased persons. PMID:26787578

  9. Living donor liver transplantation in India

    PubMed Central

    2016-01-01

    Liver transplantation is currently in its golden period in India. The number of transplants being performed and the steady increase in the new programs that have emerged over the last decade is a testimony to it. The growth was not smooth, especially in the early years. But a multipronged approach in developing infrastructure and the involvement of multidisciplinary teams in the management of transplant patients has had a major positive impact on the outcome and as a result a positive impetus to the growth of this specialty in India. To date, the majority of transplants performed in India are live donor liver transplants. Deceased donation is more sporadic and concentrated in a couple of regions. With phenomenal increase in transplant activity in India, there is huge potential for streamlining data sharing among programs in India and with the rest of the world to ultimately benefit the transplant community. PMID:27115006

  10. Ambulatory blood pressure monitoring in renal transplantation: should ABPM be routinely performed in renal transplant patients?

    PubMed

    Covic, Adrian; Segall, Liviu; Goldsmith, David J A

    2003-12-15

    In renal transplant recipients, hypertension is common and associated with increased cardiovascular and allograft rejection risks. Ambulatory blood pressure monitoring is required for its accurate diagnosis and adequate treatment, as it clearly offers several advantages over office or casual blood pressure measurements. First, it correlates better with target-organ damage and with cardiovascular mortality. Second, ambulatory blood pressure monitoring can eliminate "white coat" hypertension. Most important is the identification of nocturnal hypertension, an independent cardiovascular risk factor. A circadian nondipping pattern is often found in renal transplant recipients, most probably resulting from cyclosporine A and persistent fluid overload in the early posttransplant phase (approximately 70% prevalence), but reflecting an underlying renal (parenchymal or vascular) allograft disease when persistent (approximately 25% prevalence) beyond the first year posttransplant. PMID:14702541

  11. Subclinical Rejection in Renal Transplantation: Reappraised.

    PubMed

    Mehta, Rajil; Sood, Puneet; Hariharan, Sundaram

    2016-08-01

    Short-term outcomes in renal transplantation have improved significantly in the past few years. However, the improvement in long-term outcomes has been modest. The reasons for graft failure beyond the first year of transplantation have been attributed to several different factors. We believe that subclinical rejection (SCR) may be 1 of the factors that contribute to graft loss in the long run. We also believe that there are data to suggest that SCR leads to progressive fibrosis and loss of graft function. This has been demonstrated even in patients who have mild degrees of subclinical inflammation. This review outlines the major studies that have been published on this important topic. It also outlines potential risk factors for the development of SCR. The current approach and diagnostic methods are discussed as well as their pros and cons. Newer noninvasive methods of diagnosis as well as molecular diagnostics and their merits and shortcomings are also discussed in some depth. Thus, the proposed state of the art review on SCR will create a renewed interest at all levels including transplant clinicians, transplant researchers, pharmaceutical industries as well as regulatory organizations. PMID:26985747

  12. Robotic renal transplantation: first European case.

    PubMed

    Boggi, Ugo; Vistoli, Fabio; Signori, Stefano; D'Imporzano, Simone; Amorese, Gabriella; Consani, Giovanni; Guarracino, Fabio; Melfi, Franca; Mussi, Alfredo; Mosca, Franco

    2011-02-01

    A kidney from a 56-year-old mother was transplanted to her 37-year-old daughter laparoscopically using the daVinci HDSi surgical system. The kidney was introduced into the abdomen through a 7-cm suprapubic incision used also for the uretero-vescical anastomosis. Vascular anastomoses were carried out through a total of three additional ports. Surgery lasted 154 min, including 51 min of warm ischemia of the graft. Urine production started immediately after graft reperfusion. Renal function remains optimal at the longest follow-up of 3 months. The technique employed in this case is discussed in comparison with the only other two contemporary experiences, both from the USA. Furthermore, possible advantages and disadvantages of robotics in kidney transplantation are discussed extensively. We conclude that the daVinci surgical system allows the performance of kidney transplantation under optimal operative conditions. Further experience is needed, but it is likely that solid organ transplantation will not remain immune to robotics. PMID:21091963

  13. Gout in pediatric renal transplant recipients.

    PubMed

    Trück, Johannes; Laube, Guido F; von Vigier, Rodo O; Goetschel, Philippe

    2010-12-01

    Clinical gout has rarely been described after pediatric renal transplantation (RTx), although asymptomatic hyperuricemia is common in these patients. We describe three male pediatric patients who presented with gouty arthritis 7-8.5 years following RTx. Since receiving allopurinol, all patients had been free of gouty symptoms. To prevent severe bone marrow depletion, the dosage of azathioprine, an immunosupressant drug, was reduced by 50% to prevent interaction with allopurinol. Because atypical presentation of gout can occur, a high index of suspicion is needed to allow appropriate diagnosis of this disease in patients with skeletal pain after RTx. PMID:20640905

  14. Cutaneous alternariosis in a renal transplant recipient.

    PubMed

    Essabbah, Nawel; Gorsane, Imen; Youssef, Monia; Hadhri, Rym; Aloui, Sabra; Gorcii, Mohamed; Ali, Hichem Bel Hadj; Chemli, Zeineb; Babba, Hammouda; El May, Mezri; Zili, Jameleddine; Zakhama, Abdelfatteh; Skhiri, Habib

    2014-05-01

    Alternariosis is a fungal infection that is usually described in immunocompromised patients. We report a case of cutaneous alternariosis in a renal transplant recipient caused by Alternaria tenuissima. The diagnosis was supported by histopathologic (ie, yeastlike cells, filamentous structures) and mycologic findings from a cutaneous biopsy. Cutaneous lesions regressed 1 month following a decrease in the dosage of immunosuppressive therapy. The patient also was treated with intravenous amphotericin B followed by oral fluconazole without improvement. Cryotherapy remarkably accelerated healing of the lesions. PMID:24897135

  15. Renal allograft transplant recipient with ruptured hydatid native kidney.

    PubMed

    Bhat, Riyaz Ahmad; Wani, Imtiyaz; Khan, Imran; Wani, Muzaffar

    2014-07-01

    Echinococcosis of the kidneys in a renal transplant recipient is extremely rare and its occurrence being related to immunosuppression is a possibility which needs further characterisation. Ruptured renal hydatid in a renal transplant recipient is not reported so far to our best knowledge. We present a 42-year-old renal allograft receipient who presented one year after transplant with left flank pain, palpable left lumbar mass and gross hydatiduria. Investigations revealed a ruptured native hydatid kidney. Patient was managed with a combination of chemotherapy and left native nephrectomy and discharged in a satisfactory condition. PMID:25125908

  16. Non-invasive cardiac investigations in patients awaiting renal transplantation.

    PubMed Central

    Langford, E J; de Belder, A J; Cairns, H; Hendry, B M; Wainwright, R J

    1997-01-01

    Patients with chronic renal failure undergoing renal transplantation have a high prevalence of cardiovascular disease. Invasive investigation may identify those at risk of cardiac death during or after renal transplantation, but which patients should undergo cardiac catheterization is currently not clear. In 95 patients awaiting renal transplantation we assessed the ability of echocardiography and exercise electrocardiography to identify patients at risk of cardiac death. Echocardiography identified impaired left ventricular (LV) systolic function in 20%, severe in 8%. Of the patients with severe LV dysfunction, 25% died before transplantation. Of those undergoing exercise electrocardiography, 44% did not achieve 85% of maximum predicted heart rate. No coronary artery disease requiring intervention was identified by exercise testing. These findings indicate that echocardiography, but not exercise electrocardiography, should be part of the assessment for renal transplantation. PMID:9135610

  17. Interventional radiology in living donor liver transplant

    PubMed Central

    Cheng, Yu-Fan; Ou, Hsin-You; Yu, Chun-Yen; Tsang, Leo Leung-Chit; Huang, Tung-Liang; Chen, Tai-Yi; Hsu, Hsien-Wen; Concerjero, Allan M; Wang, Chih-Chi; Wang, Shih-Ho; Lin, Tsan-Shiun; Liu, Yueh-Wei; Yong, Chee-Chien; Lin, Yu-Hung; Lin, Chih-Che; Chiu, King-Wah; Jawan, Bruno; Eng, Hock-Liew; Chen, Chao-Long

    2014-01-01

    The shortage of deceased donor liver grafts led to the use of living donor liver transplant (LDLT). Patients who undergo LDLT have a higher risk of complications than those who undergo deceased donor liver transplantation (LT). Interventional radiology has acquired a key role in every LT program by treating the majority of vascular and non-vascular post-transplant complications, improving graft and patient survival and avoiding, in the majority of cases, surgical revision and/or re-transplant. The aim of this paper is to review indications, diagnostic modalities, technical considerations, achievements and potential complications of interventional radiology procedures after LDLT. PMID:24876742

  18. In vivo regeneration of renal vessels post whole decellularized kidneys transplantation

    PubMed Central

    Lin, KeZhi; Yu, YaLing; Zhao, LiNa; Chu, TingGang; Wu, LiZhi; Alkhawaji, Ali; Li, MiaoZhong; Shao, YingKuan; Li, Ting; Lou, XinFa; Chen, ShiXin; Tang, MaoLin; Mei, Jin

    2015-01-01

    Nearly 50 million patients in China live with end-stage renal disease (ESRD), and only about 4000 patients may receive kidney transplantation. The purpose of this study was to investigate regeneration of renal vessels post whole decellularized kidneys transplantation in vivo. We decellularized kidneys of donor rats by perfusing a detergent through the abdominal aorta, yielding feasible extracellular matrix, confirmed for acellularity before transplantation. Based on the concept of using the body as a bioreactor, we orthotopically transplanted the kidney and ureter scaffolds in recipient rats, and found the regeneration of vessels including artery and vein in the renal sinus following a spontaneous recanalization. Although the findings only represent an initial step toward the ultimate goal of the generation of fully functional kidneys in vivo, these findings suggest that the body itself, as the bioreactor, is a viable strategy for kidney regeneration. PMID:26575172

  19. Cardiovascular risk factors following renal transplant

    PubMed Central

    Neale, Jill; Smith, Alice C

    2015-01-01

    Kidney transplantation is the gold-standard treatment for many patients with end-stage renal disease. Renal transplant recipients (RTRs) remain at an increased risk of fatal and non-fatal cardiovascular (CV) events compared to the general population, although rates are lower than those patients on maintenance haemodialysis. Death with a functioning graft is most commonly due to cardiovascular disease (CVD) and therefore this remains an important therapeutic target to prevent graft failure. Conventional CV risk factors such as diabetes, hypertension and renal dysfunction remain a major influence on CVD in RTRs. However it is now recognised that the morbidity and mortality from CVD are not entirely accounted for by these traditional risk-factors. Immunosuppression medications exert a deleterious effect on many of these well-recognised contributors to CVD and are known to exacerbate the probability of developing diabetes, graft dysfunction and hypertension which can all lead on to CVD. Non-traditional CV risk factors such as inflammation and anaemia have been strongly linked to increased CV events in RTRs and should be considered alongside those which are classified as conventional. This review summarises what is known about risk-factors for CVD in RTRs and how, through identification of those which are modifiable, outcomes can be improved. The overall CV risk in RTRs is likely to be multifactorial and a complex interaction between the multiple traditional and non-traditional factors; further studies are required to determine how these may be modified to enhance survival and quality of life in this unique population. PMID:26722646

  20. Clinical role of the renal transplant biopsy

    PubMed Central

    Williams, Winfred W.; Taheri, Diana; Tolkoff-Rubin, Nina; Colvin, Robert B.

    2013-01-01

    Percutaneous needle core biopsy is the definitive procedure by which essential diagnostic and prognostic information on acute and chronic renal allograft dysfunction is obtained. The diagnostic value of the information so obtained has endured for over three decades and has proven crucially important in shaping strategies for therapeutic intervention. This Review provides a broad outline of the utility of performing kidney graft biopsies after transplantation, highlighting the relevance of biopsy findings in the immediate and early post-transplant period (from days to weeks after implantation), the first post-transplant year, and the late period (beyond the first year). We focus on how biopsy findings change over time, and the wide variety of pathological features that characterize the major clinical diagnoses facing the clinician. This article also includes a discussion of acute cellular and humoral rejection, the toxic effects of calcineurin inhibitors, and the widely varying etiologies and characteristics of chronic lesions. Emerging technologies based on gene expression analyses and proteomics, the in situ detection of functionally relevant molecules, and new bioinformatic approaches that hold the promise of improving diagnostic precision and developing new, refined molecular pathways for therapeutic intervention are also presented. PMID:22231130

  1. Living-donor kidney transplantation: a review of the current practices for the live donor.

    PubMed

    Davis, Connie L; Delmonico, Francis L

    2005-07-01

    The first successful living-donor kidney transplant was performed 50 yr ago. Since then, in a relatively brief period of medical history, living kidney transplantation has become the preferred treatment for those with ESRD. Organ replacement from either a live or a deceased donor is preferable to dialysis therapy because transplantation provides a better quality of life and improved survival. The advantages of live versus deceased donor transplantation now are readily apparent as it affords earlier transplantation and the best long-term survival. Live kidney donation has also been fostered by the technical advance of laparoscopic nephrectomy and immunologic maneuvers that can overcome biologic obstacles such as HLA disparity and ABO or cross-match incompatibility. Congressional legislation has provided an important model to remove financial disincentives to being a live donor. Federal employees now are afforded paid leave and coverage for travel expenses. Candidates for renal transplantation are aware of these developments, and they have become less hesitant to ask family members, spouses, or friends to become live kidney donors. Living donation as practiced for the past 50 yr has been safe with minimal immediate and long-term risk for the donor. However, the future experience may not be the same as our society is becoming increasingly obese and developing associated health problems. In this environment, predicting medical futures is less precise than in the past. Even so, isolated abnormalities such as obesity and in some instances hypertension are no longer considered absolute contraindications to donation. These and other medical risks bring additional responsibility in such circumstances to track the unknown consequences of a live-donor nephrectomy. PMID:15930096

  2. Prednisolone protein binding in renal transplant patients.

    PubMed Central

    Reece, P A; Disney, A P; Stafford, I; Shastry, J C

    1985-01-01

    Prednisolone pharmacokinetics and protein binding characteristics were studied in 10 renal transplant patients with various degrees of renal function (serum creatinine: 80-380 mumol/l) who received their usual oral maintenance dose of prednisolone (0.18 +/- 0.04 mg/kg). Plasma was assayed for prednisolone and hydrocortisone by h.p.l.c. and free prednisolone concentrations were determined in each sample by a rapid ultrafiltration technique. Free prednisolone area under curve (AUCu) ranged from 101 to 436 ng ml-1 h and was 6.3 to 15.0% of total prednisolone AUC. The fraction AUCu/AUC was closely related to serum albumin and creatinine concentrations determined at the time of study (multilinear regression correlation coefficient r2 = 0.830, P less than 0.0001); elevated serum creatinine and low albumin concentrations were associated with a higher % free. These results suggest that much of the variability in prednisolone protein binding could be attributed to inter-patient variability in serum albumin and creatinine concentrations. Total prednisolone concentrations would be potentially misleading in any comparisons made between patient groups with different renal function. PMID:3899153

  3. [Percutaneous Nephrolithotripsy for Renal Transplant Lithiasis: A Case Report].

    PubMed

    Oida, Takeshi; Kanemitsu, Toshiyuki; Hayashi, Tetsuya; Fujimoto, Nobumasa; Koide, Takuo

    2016-02-01

    A 54-year-old man was introduced to our hospital for follow-up examinations after renal transplantation. At the initial visit, a 25 mm renal transplant stone was noted, which had enlarged to 32 mm at an examination 1 year later. We first attempted transurethral lithotripsy (TUL), but failed due to ureteral stricture. However, we could completely remove the stone in 2 sessions of percutaneous nephrolithotripsy (PNL). The incidence of urinary lithiasis after renal transplantation ranges from 0.17-1.8%, for which PNL and TUL are frequently used. Although considered to be accompanied with risks of bleeding, bowel injury, and renal dysfunction, PNL is effective for urinary lithiasis after renal transplantation. TUL is less invasive, but access may be difficult when the ureter has an unusual course or ureteral stricture exists, as in our patient. PMID:27018408

  4. Endovascular repair of a transplant renal artery anastomotic pseudoaneurysm using the snorkel technique.

    PubMed

    Che, Haijie; Men, Changping; Yang, Mu; Zhang, Juwen; Chen, Ping; Yong, Jun

    2014-10-01

    Renal artery pseudoaneurysms after renal transplantation are extremely uncommon and are able to cause severe complications such as aneurysm rupture or renal allograft loss. Treatment often leads to transplant nephrectomy. We successfully treated a transplant renal artery pseudoaneurysm with covered stents, which resulted in well-preserved renal function. PMID:23993437

  5. Living donor liver transplantation in Europe

    PubMed Central

    Capobianco, Ivan; Panaro, Fabrizio; Di Francesco, Fabrizio; Troisi, Roberto; Sainz-Barriga, Mauricio; Muiesan, Paolo; Königsrainer, Alfred; Testa, Giuliano

    2016-01-01

    Living donor liver transplantation (LDLT) sparked significant interest in Europe when the first reports of its success from USA and Asia were made public. Many transplant programs initiated LDLT and some of them especially in Germany and Belgium became a point of reference for many patients and important contributors to the advancement of the field. After the initial enthusiasm, most of the European programs stopped performing LDLT and today the overall European activity is concentrated in a few centers and the number of living donor liver transplants is only a single digit fraction of the overall number of liver transplants performed. In this paper we analyse the present European activities and highlight the European contribution to the advancement of the field of LDLT. PMID:27115011

  6. Hyperinfection strongyloidiasis in renal transplant recipients.

    PubMed

    Khuroo, Mehnaaz S

    2014-01-01

    Strongyloidiasis is infection caused by the nematode Strongyloides stercoralis. Chronic uncomplicated strongyloidiasis is known to occur in immunocompetent individuals while hyperinfection and dissemination occurs in selective immunosuppressed hosts particularly those on corticosteroid therapy. We report two cases of hyperinfection strongyloidiasis in renal transplant recipients and document endoscopic and pathological changes in the involved small bowel. One patient presented with features of dehydration and malnutrition while another developed ileal obstruction and strangulation, requiring bowel resection. Oesophagogastroduodenoscopy showed erythematous and thickened duodenal mucosal folds. Histopathological examination of duodenal biopsies revealed S. stercoralis worms, larvae and eggs embedded in mucosa and submucosa. Wet mount stool preparation showed filariform larvae of S. stercoralis in both cases. Patients were managed with anthelmintic therapy (ivermectin/albendazole) and concurrent reduction of immunosuppression. Both patients had uneventful recovery. Complicated strongyloidiasis should be suspected in immunocompromised hosts who present with abdominal pain, vomiting and diarrhoea, particularly in endemic areas. PMID:25150235

  7. Hyperinfection strongyloidiasis in renal transplant recipients

    PubMed Central

    Khuroo, Mehnaaz S

    2014-01-01

    Strongyloidiasis is infection caused by the nematode Strongyloides stercoralis. Chronic uncomplicated strongyloidiasis is known to occur in immunocompetent individuals while hyperinfection and dissemination occurs in selective immunosuppressed hosts particularly those on corticosteroid therapy. We report two cases of hyperinfection strongyloidiasis in renal transplant recipients and document endoscopic and pathological changes in the involved small bowel. One patient presented with features of dehydration and malnutrition while another developed ileal obstruction and strangulation, requiring bowel resection. Oesophagogastroduodenoscopy showed erythematous and thickened duodenal mucosal folds. Histopathological examination of duodenal biopsies revealed S. stercoralis worms, larvae and eggs embedded in mucosa and submucosa. Wet mount stool preparation showed filariform larvae of S. stercoralis in both cases. Patients were managed with anthelmintic therapy (ivermectin/albendazole) and concurrent reduction of immunosuppression. Both patients had uneventful recovery. Complicated strongyloidiasis should be suspected in immunocompromised hosts who present with abdominal pain, vomiting and diarrhoea, particularly in endemic areas. PMID:25150235

  8. [Perioperative management of patients for living-donor liver transplantation].

    PubMed

    Matsumoto, Atsuhiro; Fujino, Yuji

    2014-05-01

    Living-donor liver transplantation has become a standard and effective treatment for end stage liver disease patients. As a result of remarkable progress in immunosuppressive drugs, surgical device, anesthetics, and appropriate perioperative management, liver-transplanted patients may experience fewer complications, shorter length of ICU stay, and a better overall outcome. However, unexpected perioperative complications remain substantial. Therefore, we take care in several points in perioperative period. First, we should appropriately evaluate general preoperative conditions, such as coagulopathy, ascites, respiratory and renal function. Second, we need to maintain hemodynamic stabilization, electrolyte balance, correction of coagulopathy and prevention of portal hypertention during operation. And third, in postoperative period we should perform strict monitoring and focus on infection prophylaxis, early weaning from mechanical ventilation, appropriate administration of fluid and transfusion, maintaining renal function and preservation of graft function. Appropriate knowledge and understanding of perioperative management in liver transplantation are required to improve patient's outcome. Furthermore, it is important for performing liver transplantation to boost mutual understanding and trust in the medical team including health-care providers. PMID:24864574

  9. Feasibility and Acceptability of the TALK Social Worker Intervention to Improve Live Kidney Transplantation

    ERIC Educational Resources Information Center

    DePasquale, Nicole; Hill-Briggs, Felicia; Darrell, Linda; Boyer, LaPricia Lewis; Ephraim, Patti; Boulware, L. Ebony

    2012-01-01

    Live kidney transplantation (LKT) is underused by patients with end-stage renal disease. Easily implementable and effective interventions to improve patients' early consideration of LKT are needed. The Talking About Live Kidney Donation (TALK) social worker intervention (SWI) improved consideration and pursuit of LKT among patients with…

  10. FSGS Recurrence in Adults after Renal Transplantation

    PubMed Central

    Rudnicki, Michael

    2016-01-01

    Recurrence of focal segmental glomerulosclerosis (FSGS) in the allograft occurs in 30–50% of patients, and it is associated with poor renal allograft survival. Major risk factors for recurrence are younger age at diagnosis, rapid progression to end-stage renal disease, white race, and the loss of previous allografts due to recurrence. Recent data support the hypothesis that circulating permeability factors play a crucial role in podocyte injury and progression of FSGS. Due to lack of controlled trials, the management of recurrent FSGS is inconsistent and highly empirical. Prophylactic and perioperative treatment with plasmapheresis and high-dose (intravenous) cyclosporine represent the main cornerstones of immunosuppressive therapy. In recent years, therapy with rituximab has shown promising results. Despite evidence of activation of the renin-angiotensin system (RAS) in recurrent FSGS and its association with progression, only limited data exist on the renoprotective role of RAS blockade in this setting. Further well designed studies are needed on pathogenesis risk factors and therapeutical options in FSGS and its recurrence after transplantation. PMID:27144163

  11. Integrated dialysis and renal transplantation: small is beautiful.

    PubMed Central

    Nicholls, A J; Catto, G R; Edward, N; Engeset, J; Logie, J R; Macleod, M

    1980-01-01

    Many patients in Britain with chronic renal failure suitable for renal replacement treatment die because not enough treatment facilities are available. Moreover, the number of renal transplants performed is insufficient to meet even present needs, so the number of patients on dialysis is rising. The integrated dialysis and transplant unit in Aberdeen, which has a population base much smaller than the average British unit, meets community needs for dialysis and transplantation. The problem of harvesting cadaver kidneys has been solved; the present supply has not only enabled the number of patients on dialysis to remain stable but has resulted in a net export of kidneys. The Aberdeen unit shows how estimated needs for chronic dialysis and renal transplantation may be met. PMID:6992935

  12. Selective Embolization of Large Symptomatic Iatrogenic Renal Transplant Arteriovenous Fistula

    SciTech Connect

    Barley, Fay L.; Kessel, David Nicholson, Tony; Robertson, Iain

    2006-12-15

    We report on the successful treatment of hypertension by occlusion of a large iatrogenic renal transplant arteriovenous fistula using detachable embolization coils with concomitant flow reduction by occlusion balloon in two patients.

  13. [Cost of a renal transplant: medico-economic analysis of the amount reimbursed by the French national health program to finance renal transplantation].

    PubMed

    Sainsaulieu, Yoël; Sambuc, Cléa; Logerot, Hélène; Bongiovanni, Isabelle; Couchoud, Cécile

    2014-07-01

    Successful organ transplantation relies on several ancillary activities such as the identification of a compatible donor, organ allocation and procurement and the coordination of the transplant process. No existing study of the overall costs, in France, of these additional transplantation activities could be identified. This study determines the total additional costs of ancillary transplantation activities by comparing the costs of kidney transplantations with living donors against those using deceased donors. The data used are drawn from the 2013 public healthcare tariff calculations, PMSI recorded activity and transplant activity in 2012 as assessed and reported by the Agence de la biomédecine. The results show that, in 2012, additional transplant costs varied from 13835.44 € to 20050.67 € for a deceased donor and were 13601.66 € for a living donor. In conclusion, this study demonstrates that all the costs covered by National Health Insurance need to be taken into account in the economic impact evaluation of renal transplantation and during the development of this national priority activity. PMID:24985351

  14. Association of renal adenocarcinoma and BK virus nephropathy post transplantation.

    PubMed

    Kausman, Joshua Yehuda; Somers, Gino Rene; Francis, David Michael; Jones, Colin Lindsay

    2004-04-01

    While most BK virus infections are asymptomatic, immunosuppression has been associated with BK virus reactivation and impaired graft function or ureteric ulceration in renal transplant patients and hemorrhagic cystitis in bone marrow transplant patients. Oncogenicity is also postulated and this is the first report of a child with a carcinoma of the donor renal pelvis following BK virus allograft nephropathy. Removal of the primary tumor and cessation of immunosuppression led to regression of secondary tumors and a return to health. PMID:14986088

  15. Renal Transplantation by Automatic Anastomotic Device in a Porcine Model.

    PubMed

    Lo Monte, Attilio Ignazio; Damiano, Giuseppe; Palumbo, Vincenzo Davide; Spinelli, Gabriele; Buscemi, Giuseppe

    2015-10-01

    Automatic vascular staplers for vascular anastomoses in kidney transplantation may dramatically reduce the operative time and, in particular, warm ischemia time, thus increasing the outcome of transplantation. Ten pigs underwent kidney auto-transplantation by automatic anastomotic device. Kidneys were collected by laparotomy with selective ligations at the renal hilum and perfused with cold storage solution. To overcome the shortage in length of renal hilum, a tract of the internal jugular vein was harvested to increase the length of the vessels. The anastomoses were totally performed by the use of the anastomotic device. On 10 kidney transplants, nine were successful and no complications occurred. Renal resistive indexes showed a slight increase in the immediate postoperative period returning normal at 10 days of follow-up. We demonstrated the possibility to perform renal vascular anastomoses by means of an automatic anastomotic device. This instrument developed for coronary bypass surgery by virtue of the small caliber of the vessels could be adopted on a larger scale for renal transplantation. The reduced warm ischemia time needed for anastomosis may help to achieve a better outcome for the graft and expand the pool of marginal donors in renal transplantation. PMID:25900063

  16. Living donor liver transplantation in the USA

    PubMed Central

    Testa, Giuliano

    2016-01-01

    Living donor liver transplant (LDLT) accounts for a small volume of the transplants in the USA. Due to the current liver allocation system based on the model for end-stage liver disease (MELD), LDLT has a unique role in providing life-saving transplantation for patients with low MELD scores and significant complications from portal hypertension, as well as select patients with hepatocellular carcinoma (HCC). Donor safety is paramount and has been a topic of much discussion in the transplant community as well as the general media. The donor risk appears to be low overall, with a favorable long-term quality of life. The latest trend has been a gradual shift from right-lobe grafts to left-lobe grafts to reduce donor risk, provided that the left lobe can provide adequate liver volume for the recipient. PMID:27115007

  17. Diffuse parenchymal form of malakoplakia in renal transplant recipient: a case report.

    PubMed

    Keitel, Elizete; Pêgas, Karla Lais; do Nascimento Bittar, Antonio Eduardo; dos Santos, Auri Ferreira; da Cas Porto, Francisco; Cambruzzi, Eduardo

    2014-06-01

    Malakoplakia is an unusual chronic inflammatory disease related to prior urinary tract infection. It is characterized by the presence of macrophages with foamy cytoplasm exhibiting larger PAS positive inclusions that stain for calcium and iron. Malakoplakia affects renal allograft and is associated with severe morbidity. Herein, the authors report a new case of renal graft malakoplakia in a 23-year-old female patient. The patient received a living-related donor renal transplantation with a high immunological risk. Plasmapheresis and intravenous immunoglobulin (i.v. Ig) treatment, pre- and post-transplant, and induction with rabbit anti-thymocyte globulins were used due to presence of donor specific antibodies and positive B cross match by flow cytometry. The patient had an early urinary tract infection with a good outcome. On Day 36 post-transplant (PO), the patient returned to the clinic with fever, graft pain and acute renal dysfunction leading to hemodialysis. Escherichia coli (E. coli) was present in the blood and urine culture. At the time, the renal biopsy revealed numerous sheets of macrophages with foamy, eosinophilic cytoplasm showing several PAS positive granules and large inclusions that stained strongly with hematoxylin, calcium (von Kossa method) and iron (Prussian blue). The patient was diagnosed with malakoplakia related to a kidney transplant. Despite prolonged treatment with antibiotics, determined by a susceptibility test, the patient did not recover renal function and remained on dialysis. PMID:23195831

  18. Post-renal Transplantation de novo Renal Cell Carcinoma in a Middle-aged Man.

    PubMed

    Pandya, V K; Sutariya, H C

    2016-01-01

    Renal cell carcinoma is usually seen in the native kidney but may be seen in the renal allograft. We report a rare case of renal cell carcinoma in a 56-year-old renal allograft recipient who was transplanted for end-stage renal disease induced by analgesic nephropathy. This complication developed after 13 years of renal transplantation. Patient was investigated for hematuria and abdominal pain with a normal renal function. Computed tomography depicted a mass sized 9.0×7.3×6.8 cm that involved the upper pole of the transplant. There was no metastasis. The patient underwent radical allograft nephrectomy for the carcinoma that had extended up to the renal hilum. Histopathological examination revealed Furhman grade-1, clear cell variant, stage pT2 N0 M0. In the last visit, the patient was on maintenance hemodialysis via arterio-venous fistula and planned for cadaveric renal transplantation. Computed tomography could facilitate early diagnosis and proper management of patients with post-renal allograft renal cell carcinoma. PMID:26889374

  19. Post-renal Transplantation de novo Renal Cell Carcinoma in a Middle-aged Man

    PubMed Central

    Pandya, V. K.; Sutariya, H. C.

    2016-01-01

    Renal cell carcinoma is usually seen in the native kidney but may be seen in the renal allograft. We report a rare case of renal cell carcinoma in a 56-year-old renal allograft recipient who was transplanted for end-stage renal disease induced by analgesic nephropathy. This complication developed after 13 years of renal transplantation. Patient was investigated for hematuria and abdominal pain with a normal renal function. Computed tomography depicted a mass sized 9.0×7.3×6.8 cm that involved the upper pole of the transplant. There was no metastasis. The patient underwent radical allograft nephrectomy for the carcinoma that had extended up to the renal hilum. Histopathological examination revealed Furhman grade-1, clear cell variant, stage pT2 N0 M0. In the last visit, the patient was on maintenance hemodialysis via arterio-venous fistula and planned for cadaveric renal transplantation. Computed tomography could facilitate early diagnosis and proper management of patients with post-renal allograft renal cell carcinoma. PMID:26889374

  20. The management of urological complications in renal transplant patients.

    PubMed

    Al-Shaer, M B; Al-Midani, A

    2005-01-01

    To determine the incidence and management of urological complications after live-donor renal transplantations at our center, we studied the medical records of 122 patients who underwent live kidney transplantation with a stented Lich-Gregoire anastomosis for ureteric reimplantation. The overall incidence of urological complications was 7.3 %. The early complications included four cases of ureteric stenosis, two cases of urinary leaks (one vesical fistula and one ureterovesical fistula) and one case of lymphocele causing ureteric obstruction. On the other hand, the late complications (> 6 months after surgery) included two cases of vesicoureteral reflux. No graft was lost and there was no urinary complication-related mortality. There was no association with recipient age, related or non-related donor or cold ischemic time. The urinary complications were mostly caused by ureteral ischemia and extrinsic compression by lymphocele; the stent caused vesicular fistula in one patient and clot anuria caused ureteral obstruction in another. In conclusion, the Lich-Gregoire technique has low complication rate and technical ease to perform compared with Barry's extravesical technique. PMID:18202495

  1. Renal cell carcinoma in a transplanted kidney: MR imaging findings.

    PubMed

    Leonardou, Polytimi; Semelka, Richard C; Mastropasqua, Maria; Kanematsu, Masayuki; Woosley, John T

    2003-07-01

    We report the MR findings of a 42-year-old man who developed renal cell carcinoma in an allograft kidney, 10 years after transplantation. The lower pole of the transplant kidney showed a solid lesion which was well shown on the post gadolinium fat suppressed images as a heterogeneously enhancing 2 cm mass lesion. PMID:12915202

  2. Living Donor Kidney Transplant Surgery

    MedlinePlus Videos and Cool Tools

    ... more than 100 caregiving sites, including seven acute care hospitals, four advanced imaging centers, seven nursing homes, ... screen and open the door to informed medical care. “OR-Live,” the vision of improving health. Good ...

  3. Cutting Edge: Immunological consequences and trafficking of human regulatory macrophages administered to renal transplant recipients.

    PubMed

    Hutchinson, James A; Riquelme, Paloma; Sawitzki, Birgit; Tomiuk, Stefan; Miqueu, Patrick; Zuhayra, Maaz; Oberg, Hans H; Pascher, Andreas; Lützen, Ulf; Janssen, Uwe; Broichhausen, Christiane; Renders, Lutz; Thaiss, Friedrich; Scheuermann, Ernst; Henze, Eberhard; Volk, Hans-Dieter; Chatenoud, Lucienne; Lechler, Robert I; Wood, Kathryn J; Kabelitz, Dieter; Schlitt, Hans J; Geissler, Edward K; Fändrich, Fred

    2011-09-01

    Regulatory macrophages (M regs) were administered to two living-donor renal transplant recipients. Both patients were minimized to low-dose tacrolimus monotherapy within 24 wk of transplantation and subsequently maintained excellent graft function. After central venous administration, most M regs remained viable and were seen to traffic from the pulmonary vasculature via the blood to liver, spleen, and bone marrow. By 1 y posttransplantation, both patients displayed patterns of peripheral blood gene expression converging upon the IOT-RISET signature. Furthermore, both patients maintained levels of peripheral blood FOXP3 and TOAG-1 mRNA expression within the range consistent with nonrejection. It is concluded that M regs warrant further study as a potential immune-conditioning therapy for use in solid-organ transplantation. The results of this work are being used to inform the design of The ONE Study, a multinational clinical trial of immunomodulatory cell therapy in renal transplantation. PMID:21804023

  4. Late renal dysfunction in adult survivors of bone marrow transplantation

    SciTech Connect

    Lawton, C.A.; Cohen, E.P.; Barber-Derus, S.W.; Murray, K.J.; Ash, R.C.; Casper, J.T.; Moulder, J.E. )

    1991-06-01

    Until recently long-term renal toxicity has not been considered a major late complication of bone marrow transplantation (BMT). Late renal dysfunction has been described in a pediatric population status post-BMT which was attributable to the radiation in the preparatory regimen. A thorough review of adults with this type of late renal dysfunction has not previously been described. Fourteen of 103 evaluable adult patients undergoing allogeneic (96) or autologous (7) bone marrow transplantation, predominantly for leukemia and lymphomas, at the Medical College of Wisconsin (Milwaukee, WI) have had a syndrome of renal insufficiency characterized by increased serum creatinine, decreased glomerular filtration rate, anemia, and hypertension. This syndrome developed at a median of 9 months (range, 4.5 to 26 months) posttransplantation in the absence of specific identifiable causes. The cumulative probability of having this renal dysfunction is 20% at 1 year. Renal biopsies performed on seven of these cases showed the endothelium widely separated from the basement membrane, extreme thickening of the glomerular basement membrane, and microthrombi. Previous chemotherapy, antibiotics, and antifungals as well as cyclosporin may add to and possibly potentiate a primary chemoradiation marrow transplant renal injury, but this clinical syndrome is most analogous to clinical and experimental models of radiation nephritis. This late marrow transplant-associated nephritis should be recognized as a potentially limiting factor in the use of some intensive chemoradiation conditioning regimens used for BMT. Some selective attenuation of the radiation to the kidneys may decrease the incidence of this renal dysfunction.

  5. Incidence of Malignancy after Living Kidney Transplantation: A Multicenter Study from Iran

    PubMed Central

    Einollahi, Behzad; Rostami, Zohreh; Nourbala, Mohammad Hossein; Lessan-Pezeshki, Mahboob; Simforoosh, Naser; Nemati, Eghlim; Pourfarziani, Vahid; Beiraghdar, Fatemeh; Nafar, Mohsen; Pour-Reza-Gholi, Fatemeh; Mazdeh, Mitra Mahdavi; Amini, Manochehr; Ahmadpour, Pedram; Makhdoomi, Khadijeh; Ghafari, Ali; Ardalan, Mohammad Reza; Khosroshahi, Hamid Taebi; Oliaei, Farshid; Shahidi, Shahrzad; Abbaszadeh, Shahin; Fatahi, Mohammad Reza; Hiedari, Fatemeh; Makhlogh, Atehieh; Azmandian, Jalal; Samimagham, Hamid Reza; Shahbazian, Heshmatollah; Nazemian, Fatemeh; Naghibi, Massih; Khosravi, Masoud; Monfared, Ali; Mosavi, Seyed Majid; Ahmadi, Javad; Jalalzadeh, Mojgan

    2012-01-01

    Malignancy is a common complication after renal transplantation. However, limited data are available on post-transplant malignancy in living kidney transplantation. Therefore, we made a plan to evaluate the incidence and types of malignancies, association with the main risk factors and patient survival in a large population of living kidney transplantation. We conducted a large retrospective multicenter study on 12525 renal recipients, accounting for up to 59% of all kidney transplantation in Iran during 22 years follow up period. All information was collected from observation of individual notes or computerized records for transplant patients. Two hundred and sixty-six biopsy-proven malignancies were collected from 16 Transplant Centers in Iran; 26 different type of malignancy categorized in 5 groups were detected. The mean age of patients was 46.2±12.9 years, mean age at tumor diagnosis was 50.8±13.2 years and average time between transplantation and detection of malignancy was 50.0±48.4 months. Overall tumor incidence in recipients was 2%. Kaposis' sarcoma was the most common type of tumor. The overall mean survival time was 117.1 months (95% CI: 104.9-129.3). In multivariate analysis, the only independent risk factor associated with mortality was type of malignancy. This study revealed the lowest malignancy incidence in living unrelated kidney transplantation. PMID:22712025

  6. [Living-donor kidney transplantation in the European countries and in North America (2001-2009)].

    PubMed

    Tuppin, Philippe; Hiesse, Christian; Caillé, Yvanie; Kessler, Michèle

    2011-12-01

    In front of kidney transplants shortage, the alternative of living donor renal transplantation is discussed. The purpose of this work is to compare, in 16 European countries and of North America having a consequent activity, the levels of living donor renal transplantation activities and their possible impact on kidney shortage, usually reported in a fragmented and punctual way. In 2009 and in spite of a light growth, the French rate of 3,5 living donor kidney transplantation per million people (pmp) was one of the weakest just before Italy and Finland. Numerous countries exceeded the rate of 14 pmp. Others as Spain and Portugal know a regular growth while their transplant activity was mainly based on brain dead donor. This growth is also observed in Germany and in Austria. France, in spite of an increase of kidney transplantation activity, had a high level of kidney shortage (2,7 patients registered on the waiting list in 2009 for one kidney transplant) before Italy which has low rate of living kidney transplant activity, Portugal, with a recent growth of transplant activity, but also the United States with high incidence of end stage renal disease and the United Kingdom which has a low rate of brain dead donors. For these last ones, France have one of the highest rates but it seems to reach a ceiling for 3 years. This report should lead a real strategy of the transplant from kidney living donor with a support for the healthcare professionals, the information of the general public, the patients and their family. PMID:21317057

  7. Influence of Socio-Economic Inequalities on Access to Renal Transplantation and Survival of Patients with End-Stage Renal Disease

    PubMed Central

    Kihal-Talantikite, Wahida; Vigneau, Cécile; Deguen, Séverine; Siebert, Muriel; Couchoud, Cécile; Bayat, Sahar

    2016-01-01

    Background Public and scientific concerns about the social gradient of end-stage renal disease and access to renal replacement therapies are increasing. This study investigated the influence of social inequalities on the (i) access to renal transplant waiting list, (ii) access to renal transplantation and (iii) patients’ survival. Methods All incident adult patients with end-stage renal disease who lived in Bretagne, a French region, and started dialysis during the 2004–2009 period were geocoded in census-blocks. To each census-block was assigned a level of neighborhood deprivation and a degree of urbanization. Cox proportional hazards models were used to identify factors associated with each study outcome. Results Patients living in neighborhoods with low level of deprivation had more chance to be placed on the waiting list and less risk of death (HR = 1.40 95%CI: [1.1–1.7]; HR = 0.82 95%CI: [0.7–0.98]), but this association did not remain after adjustment for the patients’ clinical features. The likelihood of receiving renal transplantation after being waitlisted was not associated with neighborhood deprivation in univariate and multivariate analyses. Conclusions In a mixed rural and urban French region, patients living in deprived or advantaged neighborhoods had the same chance to be placed on the waiting list and to undergo renal transplantation. They also showed the same mortality risk, when their clinical features were taken into account. PMID:27082113

  8. Commercial cadaveric renal transplant: an ethical rather than medical issue.

    PubMed

    Sun, Chiao-Yin; Lee, Chin-Chan; Chang, Chiz-Tzung; Hung, Cheng-Chih; Wu, Mai-Szu

    2006-01-01

    Donor organ shortage is a universal problem. The organ source has been extended to controversial death-penalty outlaws in certain countries. It was claimed that commercial transplant had a worse short-term clinical outcome. The aim of this study is to investigate the long-term outcome of patients receiving commercial cadaveric renal transplant. Seventy-five renal transplant recipients receiving long-term follow-up were included. Thirty-one patients received overseas commercial cadaveric transplant. Forty-four patients had legal domestic transplant in Taiwan. The age of the patients receiving the commercial cadaveric transplant was significantly older than those with legal domestic transplant (commerical vs. legal: 46.1 +/- 11.4 vs. 35.6 +/- 9.0 yr old, p < 0.001). The renal function estimated by creatinine and 1/creatinine up to eight yr showed no significant difference between the two groups. The graft survivals of the two groups were not different. The mortality rate between the two groups was comparable in 10 yr (91.1% in domestic and 88.9% in overseas). There was no significant difference in de novo viral hepatitis, cytomegalovirus infection, and acute rejection. The clinical outcome of overseas commercial cadaveric transplant was not different from the domestic legal transplant. To stop the unethical procedure, ethnicity and humanity are the major concerns. PMID:16824152

  9. Use of Kidneys with Small Renal Tumors for Transplantation.

    PubMed

    Lugo-Baruqui, Alejandro; Guerra, Giselle; Arocha, Adriana; Burke, George W; Ciancio, Gaetano

    2016-01-01

    Population of patients with end-stage renal disease increases every day. There is a vast difference in the number of patients on the waiting list for a kidney transplant, and the number of donors and the gap increases every year. The use of more marginal organs can increase the donor pool. These organs include the kidneys with small renal cell carcinomas (RCTC). There has been a number of reports in the literature about the use of these grafts for renal transplant after tumor excision and reconstruction. These grafts have been reported to be used with good renal function outcomes without an increased risk for malignancy recurrences. We present the collection of evidence for the use of kidneys with RCC for transplantation, technique used for surgical resection, and reconstruction as well as insights on the recommendations for the use of these grafts. PMID:26695405

  10. Living-donor liver transplantation: current perspective.

    PubMed

    Lobritto, Steven; Kato, Tomoaki; Emond, Jean

    2012-11-01

    The disparity between the number of available deceased liver donors and the number of patients awaiting transplantation continues to be an ongoing issue predisposing to death on the liver transplant waiting list. Deceased donor shortage strategies including the use of extended donor-criteria deceased donor grafts, split liver transplants, and organs harvested after cardiac death have fallen short of organ demand. Efforts to raise donor awareness are ongoing, but the course has been arduous to date. Living donor transplantation is a means to access an unlimited donor organ supply and offers potential advantages to deceased donation. Donor safety remains paramount demanding improvements and innovations in both the donor and recipient operations to ensure superior outcomes. The specialty operation is best preformed at centers with specific expertise and shuttling of select patients to these centers supported by third party payers is critical. Training future surgeons at centers with this specific experience can help disseminate this technology to improve local availability. Ongoing research in immunosuppression minimization, withdrawal and tolerance induction may make living donation a desired first-line operation rather than a necessary albeit less-desirable option. This chapter summarizes the progress of living liver donation and its potential applications. PMID:23397534

  11. Two papillary renal cell carcinomas of different origin following renal transplantation (Case report).

    PubMed

    Gerth, Hans-Ulrich; Pohlen, Michele; Thoennissen, Nils-Heinrich; Suwelack, Barbara; Pavenstädt, Hermann-Josef; Störkel, Stefan; Abbas, Mahmoud; Spieker, Tilmann; Thölking, Gerold

    2012-07-01

    Papillary renal cell carcinoma (PRCC) is a rare malignant tumor entity compared to common clear cell renal carcinoma. In the present study, we report a patient who was diagnosed with PRCC twice and successfully treated each time following renal transplantation. The first PRCC was located in the left native kidney two years following transplantation, and the second PRCC was diagnosed in the allograft 13 years following transplantation. The two tumors were completely removed by surgery in stage I of the disease with sufficient conservation of the allograft function. Notably, the tumors had a different origin as indicated by the microsatellite analysis, which reflects the exceptional course of the case. Risk factors for PRCC were identified in our patient. We concluded that high-risk candidates for malignancies in renal transplant recipients should receive shorter ultrasonic screening intervals, which may facilitate early tumor detection and improve outcome rates. PMID:22807965

  12. Live birth after ovarian tissue transplant

    NASA Astrophysics Data System (ADS)

    Lee, D. M.; Yeoman, R. R.; Battaglia, D. E.; Stouffer, R. L.; Zelinski-Wooten, M. B.; Fanton, J. W.; Wolf, D. P.

    2004-03-01

    Radiation and high-dose chemotherapy may render women with cancer prematurely sterile, a side-effect that would be avoided if ovarian tissue that had been removed before treatment could be made to function afterwards. Live offspring have been produced from transplanted ovarian tissue in mice and sheep but not in monkeys or humans, although sex steroid hormones are still secreted. Here we describe the successful transplantation of fresh ovarian tissue to a different site in a monkey, which has led to the birth of a healthy female after oocyte production, fertilization and transfer to a surrogate mother. The ectopically grafted tissue functions without surgical connection to major blood vessels and sets the stage for the transplantation of cryopreserved ovarian tissue in humans.

  13. The value of living donor liver transplantation.

    PubMed

    Yang, Xiaoli; Gong, Junhua; Gong, JianPing

    2012-12-31

    Living donor liver transplantation (LDLT) is a very successful procedure that develops liver resources in case of worldwide shortages. As the technology has developed so much in the past 2 decades, LDLT has the same good prognosis as DDLT. However, LDLT still has lots of ethical & technical problems. It causes great psychiatric, physical and psychosocial harm to donors. Also, it has some negative effects on society by providing a platform for organ trade. Therefore, there is much controversy about the social value of LDLT. After review of recent papers, we find much progress can be made in inspiring the public to become organ donors and creating donation model new to improve the consent rate for solid organ donation from deceased donors. That is the key strategy for increasing the liver supply. With this serious shortage of organs, liver donor transplantation still has its advantages, but we should not place all our hopes on LDLT to increase the liver supply. We all need to try our best to increase donor awareness and promote organ donor registration--when cadaver organs could meet the needs for liver transplantation, living donor liver transplants would not be necessary. PMID:23274332

  14. Tailoring tacrolimus-based immunotherapy in renal transplantation.

    PubMed

    Yang, Harold C

    2003-05-01

    Tacrolimus is a cornerstone immunosuppressive agent in renal transplantation and compared with cyclosporin, its use is associated with a reduced incidence of acute rejection. Optimizing immunosuppressive management in the early post-transplant period is important for achieving long-term graft function and survival. In attempts to improve the long-term outcomes of renal transplantation further, tacrolimus has been combined with two novel immunosuppressive agents, mycophenolate mofetil (MMF) and sirolimus, with encouraging results in terms of patient and graft survival, acute rejection rates and renal graft function. Tacrolimus in combination with MMF adjunctive therapy showed significantly better graft survival in patients with delayed graft function, fewer episodes of corticosteroid-resistant rejection and better renal function at the 3-year follow-up compared with cyclosporin microemulsion plus MMF immunosuppression. A tacrolimus plus MMF regimen was also effective for renal transplant recipients at our centre in Pennsylvania, resulting in excellent survival and rejection rates at 1 year post-transplantation. The 3-month results of a US multicentre study comparing tacrolimus in combination with either MMF or sirolimus showed these two treatment regimens to be equivalent in terms of patient and graft survival, delayed graft function, the incidence of biopsy-confirmed acute rejection and renal graft function, although differences were apparent in terms of acute tubular necrosis and hyperlipidaemia. In conclusion, the development of a new immunosuppressive regimen in renal transplantation should take account of factors that influence graft function, both in the short and long term, as a way of optimizing individual maintenance therapy. PMID:12738759

  15. Unrelated renal transplantation: an ethical enigma.

    PubMed

    Aggarwal, Gaurav; Adhikary, Samiran

    2016-01-01

    End-stage renal disease (ESRD) is a condition better discussed than suffered. People suffering from ESRD are at a disadvantage not only financially, but also emotionally and in terms of the quality of their lives. The majority of their productive time is spent in hospital, on dialysis machines, or in the search for a suitable kidney donor, so that they may be able to improve upon the quality of their remaining lifespan. Only a "lucky few" are able to find a suitable matching donor, be it living (related) or a cadaver, whilst the others are left to fend for themselves. As the supply fails to cope with the demand, people go to the extent of exploring the pool of "unrelated donors". Though not legalised yet, this is one domain yet to be explored in its entirety, both on humanitarian as well as ethical grounds. Our current work hopes to highlight this scenario and also provides a few options that may well become "ethically acceptable" in the not-so-far future. PMID:27178491

  16. Hematopoietic Cell and Renal Transplantation in Plasma Cell Dyscrasia Patients.

    PubMed

    Baraldi, Olga; Grandinetti, Valeria; Donati, Gabriele; Comai, Giorgia; Battaglino, Giuseppe; Cuna, Vania; Capelli, Irene; Sala, Elisa; La Manna, Gaetano

    2016-01-01

    Gammopathies, multiple myeloma, and amyloidosis are plasma dyscrasias characterized by clonal proliferation and immunoglobulin overproduction. Renal impairment is the most common and serious complication with an incidence of 20-30% patients at the diagnosis. Kidney transplant has not been considered feasible in the presence of plasma dyscrasias because the immunosuppressive therapy may increase the risk of neoplasia progression, and paraproteins may affect the graft. However, recent advances in clinical management of multiple myeloma and other gammopathies allow considering kidney transplant as a possible alternative to dialysis. Numerous evidence indicates the direct relationship between hematological remission and renal function restoring. The combination of kidney and hematopoietic cell transplant has been reported as a promising approach to reestablish end-organ function and effectively treat the underlying disease. This review describes current protocols used to perform kidney transplantation in patients with plasma dyscrasias. PMID:26160700

  17. Paediatric obesity and renal transplantation: current challenges and solutions.

    PubMed

    Terrace, John D; Oniscu, Gabriel C

    2016-04-01

    The increased incidence of obesity in the paediatric population poses significant challenges to renal transplantation. Whilst the body mass index appears to be widely used as a measure of obesity in adults, there are no standardised definitions in the paediatric population, making comparative analyses difficult. In the paediatric transplant population, obesity is associated with an increased incidence of surgical complications, diabetes, hyperlipidaemia and cardiovascular morbidity, leading to diminished graft function and impacting patient and graft survival. Management of obesity in renal transplantation requires multiple interventions starting with life-style and behavioural modification combined with medical and possibly surgical therapies, representing a unique challenge in the childhood setting. In this review we discuss the current challenges of obesity and potential solutions in the setting of paediatric transplantation. PMID:26018121

  18. Management of children after renal transplantation: highlights for general pediatricians

    PubMed Central

    Giglia, Lucy; Chan, Howard; Chan, Anthony K.

    2012-01-01

    The number of children undergoing successful renal transplantations has been increasing steadily and as a result; general pediatricians are now more likely to encounter children with a kidney allograft in their practice. Although the medical care immediately after transplantation is mostly provided by transplant teams, more and more outpatient care will eventually be performed at the patient’s local community. Medical care from general pediatricians is particularly important, especially for children who are residing far from transplant centers. As these children require prolong immunosuppressive therapies and are susceptible to various specific clinical problems, it is imperative for their primary care providers and pediatricians to be knowledgeable about their specific needs and be competent in providing care. This article highlights the roles and common practice related issues that pertain to general pediatricians in the care of pediatric renal allograft recipients. PMID:26835261

  19. Practice recommendations for the monitoring of renal function in pediatric non-renal organ transplant recipients.

    PubMed

    Filler, Guido; Melk, Anette; Marks, Stephen D

    2016-05-01

    The management of non-renal pediatric solid organ transplant recipients has become complex over the last decade with innovations in immunosuppression and surgical techniques. Post-transplantation follow-up is essential to ensure that children have functioning allografts for as long as possible. CKD is highly prevalent in these patients, often under recognized, and has a profound impact on patient survival. These practice recommendations focus on the early detection and management of hypertension, proteinuria, and renal dysfunction in non-renal pediatric solid organ transplant recipients. We present seven practice recommendations. Renal function should be monitored regularly in organ transplant recipients, utilizing assessment of serum creatinine and cystatin C. GFR should be calculated using the new Schwartz formula. Transplant physicians should also monitor blood pressure using automated oscillometric devices and confirm repeated abnormal measures with manual blood pressure readings and ambulatory 24-h blood pressure monitoring. Proteinuria and microalbuminuria should also be assessed regularly. Referrals to a pediatric nephrologist should be made for non-renal organ transplant recipients with repeated blood pressures >95th percentile using the Fourth Task Force reference intervals, microalbumin/creatinine ratio >32.5 mg/g (3.7 mg/mmol) creatinine on repeated testing and/or GFR <90 mL/min/1.73 m(2) . PMID:26917052

  20. Concomitant administration of cyclosporin and ketoconazole in renal transplant recipients.

    PubMed

    First, M R; Schroeder, T J; Weiskittel, P; Myre, S A; Alexander, J W; Pesce, A J

    1989-11-18

    18 renal transplant recipients receiving cyclosporin, prednisone, and azathioprine were given ketoconazole, a potent inhibitor of the cytochrome P-450 enzyme system. Within a month ketoconazole-induced blockade of cyclosporin metabolism allowed a significant reduction (451 vs 106 mg/day; 77%) of the mean dose of cyclosporin without altering cyclosporin whole blood trough levels, although maximum blood levels were almost halved. This dose reduction was maintained in patients followed up for up to 13 months. Renal and hepatic function were unchanged after the addition of ketoconazole. This drug interaction has the potential to reduce dramatically expenditure on cyclosporin in transplant recipients. PMID:2572912

  1. Digital processing of histopathological aspects in renal transplantation

    NASA Astrophysics Data System (ADS)

    de Albuquerque Araujo, Arnaldo; de Andrade, Marcos C.; Bambirra, Eduardo A.; dos Santos, A. M. M.

    1993-07-01

    We describe here our initial experience with the digital image processing of histopathological aspects from multiple renal biopsies of transplanted kidney in a patient treated with Cyclosporine (CsA), a powerful immunosupressor drug whose use has improved the chances of a successful vascularized organ transplantation (Tx). Unfortunately, CsA promotes morphological alterations to the glomerular structure of the kidneys. To characterize this process, glomeruli, tufts, and lumen areas distributions are measured. The results are presented in form of graphics.

  2. The medical management of renal artery stenosis in transplant recipients.

    PubMed

    Jachuck, S J; Wilkinson, R; Uldall, P R; Elliott, R W; Taylor, R M; Hacking, P M

    1979-01-01

    The investigation, management and clinical course of 12 patients developing stenosis of the renal artery following transplantation are described. The possible aetiology of the three arteriographic patterns of stenosis is discussed. Surgical correction of graft arterial stenosis is difficult and may lead to graft loss, whereas the outcome with antihypertensive drug treatment with or without anticoagulants is good. Surgery should only be contemplated if medical treatment is failing or if renal function is deteriorating. PMID:369641

  3. Renal

    MedlinePlus

    ... term "renal" refers to the kidney. For example, renal failure means kidney failure. Related topics: Kidney disease Kidney disease - diet Kidney failure Kidney function tests Renal scan Kidney transplant

  4. Recent advance in living donor liver transplantation.

    PubMed

    Hashikura, Yasuhiko; Kawasaki, Seiji; Miyagawa, Shinichi; Terada, Masaru; Ikegami, Toshihiko; Nakazawa, Yuichi; Urata, Koichi; Chisuwa, Hisanao; Ogino, Shiro; Makuuchi, Masatoshi

    2002-02-01

    Living donor liver transplantation (LDLT)has been performed in more than 2000 cases around the world. This procedure is considered to have certain advantages over cadaveric liver transplantation, because detailed preoperative evaluation of the donor liver is possible and superior graft quality is available. The indication has recently been widened to include adult patients. The results of LDLT have been reported to be very good. In this article,several considerations on LDLT,including living donor selection and application to adult patients, are discussed. Between June 1990 and March 2001, 143 patients underwent LDLT at Shinshu University Hospital. During this period, 160 patients were determined to be candidates for liver transplantation in our institution, and 185 candidates were evaluated as potential donors for these patients. Thirty-eight of 185 donor candidates were excluded for reasons including liver dysfunction and withdrawal of consent. The recipients included 60 adults, 50 (83%) of whom are currently alive. Taking into account the worldwide shortage of cadaveric organ donation,the importance of LDLT will probably never diminish. This procedure should be established on the basis of profound consideration of donor safety as well as accumulated expertise of hepatobiliary surgery. PMID:11865355

  5. Can patients with schizophrenia undergo renal transplantation with success?

    PubMed

    Bouhlel, Saoussen

    2014-05-01

    We report a case of a 41-year-old man suffering from paranoid schizophrenia. The patient has been consulting in our psychiatric hospital since he was 29 years old. Eight years later, he developed kidney failure and required peritoneal dialysis. After more than two years, the nephrology team indicated a renal transplantation and his brother suggested giving his kidney. There were no obstacles for transplantation in the immune and histological compatibilities; the psychiatric staff decided to check the patient's compliance with medication. The patient was compliant to all his medications and to the salt-free diet after the transplant operation. Few weeks later, he developed steroid-induced diabetes. Through the last two years, he had psychotic exacerbations with major anxiety and fear of losing the transplant. These relapses were managed by increasing doses of antipsychotics without need for hospitalization. At the present time, three years after transplantation, the nephrologists are decreasing the immunosuppressive agents and the steroids. The renal function is optimum and the diabetes is stabilized. This case exemplifies the potential for schizophrenic patients to undergo renal transplantation and to comply with follow-up medical care through a close cooperation between the patient's family, the psychiatric staff and the nephrology team. PMID:24821159

  6. Renal Sinus Lipomatosis in Transplanted Kidneys: An Unusual Clinical Case

    PubMed Central

    Apicella, Luca; Vallone, Gianfranco; Vitale, Sossio; Garofalo, Gianluca; Russo, Luigi; Gallo, Riccardo; Federico, Stefano; Sabbatini, Massimo

    2011-01-01

    Renal sinus lipomatosis (RSL) represents an abnormal proliferation of the adipose tissue surrounding the renal pelvis of uncertain origin, associated with aging, obesity, steroid excess, infections, and calculosis. It represents a rare complication in transplanted kidneys, and, despite the accurate and prolonged radiological followup of transplanted organs, only a few cases of RSL have been described in graft recipients, with no remarkable effects on renal function. The diagnosis relies on ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT), and, finally, percutaneous biopsy. We describe the case of an extensive RSL in a 38-year-old renal transplant recipient, diagnosed by ultrasonography and computed tomography. The patient underwent a radiologic study because of an acute, asymptomatic renal impairment, that led to the diagnosis of a RSL of unusual dimensions, associated with a discrete hydronephrosis. Paradoxically, after a short course of steroids, the recovery of renal function and the partial resolution of calyceal dilatation were observed. The rarity of this affection, the need of a differential diagnosis with fat-containing tumors, and the possibility of parenchymal inflammation associated with RSL, potentially responsive to steroids, are also discussed. PMID:23213599

  7. Living donor liver transplantation in Egypt

    PubMed Central

    Marwan, Ibrahim

    2016-01-01

    In Egypt there is no doubt that chronic liver diseases are a major health concern. Hepatitis C virus (HCV) prevalence among the 15−59 years age group is estimated to be 14.7%. The high prevalence of chronic liver diseases has led to increasing numbers of Egyptian patients suffering from end stage liver disease (ESLD), necessitating liver transplantation (LT). We reviewed the evolution of LT in Egypt and the current status. A single center was chosen as an example to review the survival and mortality rates. To date, deceased donor liver transplantation (DDLT) has not been implemented in any program though Egyptian Parliament approved the law in 2010. Living donor liver transplantation (LDLT) seemed to be the only logical choice to save many patients who are in desperate need for LT. By that time, there was increase in number of centers doing LDLT (13 centers) and increase in number of LDLT cases [2,400] with improvement of the results. Donor mortality rate is 1.66 per 1,000 donors; this comprised four donors in the Egyptian series. The exact recipient survival is not accurately known however, and the one-year, three-year and five-year survival were 73.17%, 70.83% and 64.16% respectively in the International Medical Center (IMC) in a series of 145 adult to adult living donor liver transplantation (AALDLT) cases. There was no donor mortality in this series. LDLT are now routinely and successfully performed in Egypt with reasonable donor and recipient outcomes. Organ shortage remains the biggest hurdle facing the increasing need for LT. Although LDLT had reasonable outcomes, it carries considerable risks to healthy donors. For example, it lacks cadaveric back up, and is not feasible for all patients. The initial success in LDLT should drive efforts to increase the people awareness about deceased organ donation in Egypt. PMID:27115003

  8. Living donor liver transplantation in Egypt.

    PubMed

    Amer, Khaled E; Marwan, Ibrahim

    2016-04-01

    In Egypt there is no doubt that chronic liver diseases are a major health concern. Hepatitis C virus (HCV) prevalence among the 15-59 years age group is estimated to be 14.7%. The high prevalence of chronic liver diseases has led to increasing numbers of Egyptian patients suffering from end stage liver disease (ESLD), necessitating liver transplantation (LT). We reviewed the evolution of LT in Egypt and the current status. A single center was chosen as an example to review the survival and mortality rates. To date, deceased donor liver transplantation (DDLT) has not been implemented in any program though Egyptian Parliament approved the law in 2010. Living donor liver transplantation (LDLT) seemed to be the only logical choice to save many patients who are in desperate need for LT. By that time, there was increase in number of centers doing LDLT (13 centers) and increase in number of LDLT cases [2,400] with improvement of the results. Donor mortality rate is 1.66 per 1,000 donors; this comprised four donors in the Egyptian series. The exact recipient survival is not accurately known however, and the one-year, three-year and five-year survival were 73.17%, 70.83% and 64.16% respectively in the International Medical Center (IMC) in a series of 145 adult to adult living donor liver transplantation (AALDLT) cases. There was no donor mortality in this series. LDLT are now routinely and successfully performed in Egypt with reasonable donor and recipient outcomes. Organ shortage remains the biggest hurdle facing the increasing need for LT. Although LDLT had reasonable outcomes, it carries considerable risks to healthy donors. For example, it lacks cadaveric back up, and is not feasible for all patients. The initial success in LDLT should drive efforts to increase the people awareness about deceased organ donation in Egypt. PMID:27115003

  9. Hyperaluminemia associated with liver transplantation and acute renal failure.

    PubMed

    Erasmus, R T; Kusnir, J; Stevenson, W C; Lobo, P; Herman, M M; Wills, M R; Savory, J

    1995-08-01

    Iatrogenic aluminium toxicity is reported in a patient who underwent an orthotopic liver transplant and who had concomitant renal failure requiring hemodialysis. Following transplantation the patient developed a metabolic encephalopathy with only mildly elevated blood ammonia concentrations. During the period following transplantation the patient received massive infusions of albumin and was on oral feeding (vivonexten), both of which contained aluminium, as did the dialysis fluid. Hyperaluminemia and profoundly elevated liver tissue aluminium concentrations were observed. Treatment with desferrioxamine, a trivalent ion chelator, decreased the plasma aluminium concentrations with an improvement in the patient's mental status. PMID:7579738

  10. Menstruation. A hazard in radionuclide renal transplant evaluation

    SciTech Connect

    Orzel, J.A.; Jaffers, G.J.

    1986-06-01

    Serial Tc-99m DTPA studies were performed to evaluate renal transplant blood flow and function in a 34-year-old woman. A hypervascular pelvic mass with increased blood pool activity was intermittently identified. This hypervascular lesion suggested a pathologic condition of the pelvis, and its blood pool simulated bladder activity, confusing interpretation of renal function. This perplexing vascular lesion was the uterus, with varying degrees of blood flow and blood pool activity depending on the timing of the renal study in relation to the menstrual cycle.

  11. Cavitary lung lesion 6 years after renal transplantation.

    PubMed

    Subbiah, Arun Kumar; Arava, Sudheer; Bagchi, Soumita; Madan, Karan; Das, Chandan J; Agarwal, Sanjay Kumar

    2016-06-24

    The differential diagnoses of a cavitary lung lesion in renal transplant recipients would include infection, malignancy and less commonly inflammatory diseases. Bacterial infection, Tuberculosis, Nocardiosis, fungal infections like Aspergillosis and Cryptococcosis need to be considered in these patients. Pulmonary cryptococcosis usually presents 16-21 mo after transplantation, more frequently in patients who have a high level of cumulative immunosuppression. Here we discuss an interesting patient who never received any induction/anti-rejection therapy but developed both BK virus nephropathy as well as severe pulmonary Cryptococcal infection after remaining stable for 6 years after transplantation. This case highlights the risk of serious opportunistic infections even in apparently low immunologic risk transplant recipients many years after transplantation. PMID:27358792

  12. Cavitary lung lesion 6 years after renal transplantation

    PubMed Central

    Subbiah, Arun Kumar; Arava, Sudheer; Bagchi, Soumita; Madan, Karan; Das, Chandan J; Agarwal, Sanjay Kumar

    2016-01-01

    The differential diagnoses of a cavitary lung lesion in renal transplant recipients would include infection, malignancy and less commonly inflammatory diseases. Bacterial infection, Tuberculosis, Nocardiosis, fungal infections like Aspergillosis and Cryptococcosis need to be considered in these patients. Pulmonary cryptococcosis usually presents 16-21 mo after transplantation, more frequently in patients who have a high level of cumulative immunosuppression. Here we discuss an interesting patient who never received any induction/anti-rejection therapy but developed both BK virus nephropathy as well as severe pulmonary Cryptococcal infection after remaining stable for 6 years after transplantation. This case highlights the risk of serious opportunistic infections even in apparently low immunologic risk transplant recipients many years after transplantation. PMID:27358792

  13. Vitamin D Status and Outcomes After Renal Transplantation

    PubMed Central

    Girard, Delphine; Anglicheau, Dany; Canaud, Guillaume; Souberbielle, Jean Claude; Kreis, Henri; Noël, Laure Hélène; Friedlander, Gérard; Elie, Caroline; Legendre, Christophe; Prié, Dominique

    2013-01-01

    Kidney transplant recipients usually have low vitamin D levels, especially in the early posttransplantation period, but the association between vitamin D status with renal outcomes is not well described in this population. Here, we studied a prospective cohort of 634 kidney recipients who underwent transplantation at a single institution between January 2005 and June 2010. In this cohort, low 25-hydroxyvitamin D concentrations 3 months after transplantation did not predict early death or graft loss but were independently associated with lower measured GFR at 12 months (P=0.001) and higher risk for interstitial fibrosis and tubular atrophy (P=0.01). In contrast, levels of calcium, phosphorus, calcitriol, parathyroid hormone, or fibroblast growth factor-23 were not consistently associated with any of the studied outcomes. In conclusion, low 25-hydroxyvitamin D concentration measured 3 months after transplantation is an independent risk factor for interstitial fibrosis progression and is associated with a lower GFR 1 year after transplantation. PMID:23539758

  14. Results of cataract surgery in renal transplantation and hemodialysis patients

    PubMed Central

    Luo, Li-Hua; Xiong, Shi-Hong; Wang, Yan-Ling

    2015-01-01

    AIM To compare the effect of cataract surgery in renal transplantation and hemodialysis patients. METHODS We evaluated 51 eyes of 31 renal transplantation patients, 41 eyes of 29 hemodialysis patients and 45 eyes of 32 normal control patients who received phacoemulsification and intraocular lens (IOL) implantation from January, 2000 to August, 2014 in the Beijing Friendship Hospital. Each individual underwent a blood routine and a kidney function examination. Routine ophthalmologic examination included best-corrected visual acuity (BCVA), a slit-lamp examination to detect cataract type, determination of intraocular pressure, a corneal endothelial count, and fundus examination. All patients received phacoemulsification and an IOL implantation. RESULTS For the types of cataract in the three groups, transplantation group was significantly different from normal control group (P=0.04), the most kind is posterior subcapsular cataract (PSC) in transplantation group 33 (64.7%), hemodialysis group had no significantly difference from normal control group (P=0.43), and the difference between transplantation group and hemodialysis group also had significantly difference (P=0.02). For postoperative BCVA in the three groups, transplantation group had significantly difference from normal control group (P=0.03), hemodialysis group was significantly different from normal control group (P=0.00), and the difference between transplantation group and hemodialysis group also had significantly difference (P=0.00). The multiple linear regression equation is Y=0.007 hemoglobin (Hb)-0.000233 serum creatinine (Cr), R2=0.898. Postoperative fundus examination showed that hemorrhage, exudation, and macular degeneration were greater in the hemodialysis group. CONCLUSION This study showed that the PSC was more in the renal transplantation patients. BCVA was better and fundus lesions were less frequent in the renal transplantation group than in the hemodialysis group after cataract surgery. The

  15. Why are cadaveric renal transplants so hard to find in Japan? An analysis of economic and attitudinal aspects.

    PubMed

    Ohi, G; Hasegawa, T; Kumano, H; Kai, I; Takenaga, N; Taguchi, Y; Saito, H; Ino, T

    1986-01-01

    In view of the fact that in Japan treatment of end-stage renal disease depends disproportionately heavily on hemodialysis and almost negligible on transplants from cadaveric donors (hemodialysis 44.4/100,000; renal transplants 0.31/100,000 per year; cadaveric renal transplants 0.11/100,000 per year (1983 data)), we analysed the cost-effectiveness of hemodialysis and renal transplantation, predicted economic gains under expected changes in variables and described attitudes of the Japanese hampering cadaveric renal transplantation. Adjusted life expectancy of transplant recipients (live and cadaveric combined) under the current technical conditions is longer than that of those on hemodialysis (18.3 vs. 14.7 years) and the cost per year for maintaining the transplant is approximately one third of hemodialysis ($12,000 vs $32,000). If the proportion of cadaveric transplant recipients would increase to the levels of the USA (hemodialysis 30.8/100,000; transplants 2.6/100,000 per year; cadaveric transplants 1.9/100,000 per year (1983 data)) along with improvement in graft survival rate, the life expectancy for transplant recipients in Japan could increase by 2 years, thus reducing the annual cost even further. The current number of patients starting hemodialysis (11,500 cases per year) coupled with their life expectancy predicts the number of patients on hemodialysis to reach equilibrium at around 174,000 in a decade (Japanese population 110 million). Based on current price, their annual cost will be about 5.3 billion dollars. Medical expenditure of this magnitude for such a small fraction of people is expected to become an increasingly strong economic incentive for cadaveric renal transplantation. A review of studies on Japanese attitudes toward cadaveric renal transplantation in both urban and rural areas shows that approximately 60% are in favor of donating their kidney after death, though with the majority of cases the donation is contingent upon agreement of their

  16. Phomopsis bougainvilleicola prepatellar bursitis in a renal transplant recipient

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Pre-patellar bursitis is typically a monomicrobial bacterial infection. Rarely is a fungal cause identified. We describe a 61 year-old man who had received a renal transplant 21 months prior to presentation whose synovial fluid and surgical specimens grew Phomopsis bougainvilleicola, a pycnidial coe...

  17. Cladophialophora bantiana osteomyelitis in a renal transplant patient.

    PubMed

    Desmet, Stefanie; Smets, Liesbeth; Lagrou, Katrien; Derdelinckx, Inge; Neyt, Jeroen; Maertens, Johan; Sciot, Raf; Demaerel, Philip; Bammens, Bert

    2016-06-01

    Cladophialophora bantiana is a neurotropic dematiaceous fungus which rarely causes disseminated disease. We report a case of proven C. bantiana osteomyelitis in a renal transplant recipient, complicated with probable cerebral disease. Stable disease was reached after combined antifungal therapies, immune enhancement and amputation of the infected lower limb. PMID:27595060

  18. Transplant renal artery stenosis: clinical manifestations, diagnosis and therapy.

    PubMed

    Chen, Wei; Kayler, Liise K; Zand, Martin S; Muttana, Renu; Chernyak, Victoria; DeBoccardo, Graciela O

    2015-02-01

    Transplant renal artery stenosis (TRAS) is a well-recognized vascular complication after kidney transplant. It occurs most frequently in the first 6 months after kidney transplant, and is one of the major causes of graft loss and premature death in transplant recipients. Renal hypoperfusion occurring in TRAS results in activation of the renin-angiotensin-aldosterone system; patients usually present with worsening or refractory hypertension, fluid retention and often allograft dysfunction. Flash pulmonary edema can develop in patients with critical bilateral renal artery stenosis or renal artery stenosis in a solitary kidney, and this unique clinical entity has been named Pickering Syndrome. Prompt diagnosis and treatment of TRAS can prevent allograft damage and systemic sequelae. Duplex sonography is the most commonly used screening tool, whereas angiography provides the definitive diagnosis. Percutaneous transluminal angioplasty with stent placement can be performed during angiography if a lesion is identified, and it is generally the first-line therapy for TRAS. However, there is no randomized controlled trial examining the efficacy and safety of percutaneous transluminal angioplasty compared with medical therapy alone or surgical intervention. PMID:25713713

  19. Socioeconomic deprivation and barriers to live-donor kidney transplantation: a qualitative study of deceased-donor kidney transplant recipients

    PubMed Central

    Bailey, Phillippa K; Ben-Shlomo, Yoav; Tomson, Charles R V; Owen-Smith, Amanda

    2016-01-01

    Objectives Socioeconomically deprived individuals with renal disease are less likely to receive a live-donor kidney transplant than less-deprived individuals. This qualitative study aimed to identify reasons for the observed socioeconomic disparity in live-donor kidney transplantation. Design A qualitative study using face-to-face in-depth semistructured interviews. Setting A UK tertiary renal referral hospital and transplant centre. Participants Purposive sampling was used to select deceased-donor transplant recipients from areas of high socioeconomic deprivation (SED) (19 participants), followed by a low SED comparison group (13 participants), aiming for maximum diversity in terms of age, gender, ethnicity, primary renal disease and previous renal replacement therapy. Methods Participants were interviewed following their routine transplant clinic review. Interviews were digitally audio-recorded and transcribed verbatim. Transcripts were coded using NVivo software and analysed using the constant comparison method described in Grounded Theory. Results Themes common and distinct to each socioeconomic group emerged. 6 themes appeared to distinguish between individuals from areas of high and low SED. 4 themes were distinct to participants from areas of high SED: (1) Passivity, (2) Disempowerment, (3) Lack of social support and (4) Short-term focus. 2 themes were distinct to the low SED group: (1) Financial concerns and (2) Location of donor. Conclusions Several of the emerging themes from the high SED individuals relate to an individual's lack of confidence and skill in managing their health and healthcare; themes that are in keeping with low levels of patient activation. Inadequate empowerment of socioeconomically deprived individuals by healthcare practitioners was also described. Financial concerns did not emerge as a barrier from interviews with the high SED group. Interventions aiming to redress the observed socioeconomic inequity should be targeted at both

  20. Acoustic Radiation Force Impulse Measurement in Renal Transplantation: A Prospective, Longitudinal Study With Protocol Biopsies.

    PubMed

    Lee, Juhan; Oh, Young Taik; Joo, Dong Jin; Ma, Bo Gyoung; Lee, A-lan; Lee, Jae Geun; Song, Seung Hwan; Kim, Seung Up; Jung, Dae Chul; Chung, Yong Eun; Kim, Yu Seun

    2015-09-01

    Interstitial fibrosis and tubular atrophy (IF/TA) is a common cause of kidney allograft loss. Several noninvasive techniques developed to assess tissue fibrosis are widely used to examine the liver. However, relatively few studies have investigated the use of elastographic methods to assess transplanted kidneys. The aim of this study was to explore the clinical implications of the acoustic radiation force impulse (ARFI) technique in renal transplant patients. A total of 91 patients who underwent living donor renal transplantation between September 2010 and January 2013 were included in this prospective study. Shear wave velocity (SWV) was measured by ARFI at baseline and predetermined time points (1 week and 6 and 12 months after transplantation). Protocol biopsies were performed at 12 months. Instead of reflecting IF/TA, SWVs were found to be related to time elapsed after transplantation. Mean SWV increased continuously during the first postoperative year (P < 0.001). In addition, mixed model analysis showed no correlation existed between SWV and serum creatinine (r = -0.2426, P = 0.0771). There was also no evidence of a relationship between IF/TA and serum creatinine (odds ratio [OR] = 1.220, P = 0.7648). Furthermore, SWV temporal patterns were dependent on the kidney weight to body weight ratio (KW/BW). In patients with a KW/BW < 3.5 g/kg, mean SWV continuously increased for 12 months, whereas it decreased after 6 months in those with a KW/BW ≥ 3.5 g/kg.No significant correlation was observed between SWV and IF/TA or renal dysfunction. However, SWV was found to be related to the time after transplantation. Renal hemodynamics influenced by KW/BW might impact SWV values. PMID:26426636

  1. Dental management of patients before and after renal transplantation.

    PubMed

    Georgakopoulou, Eleni A; Achtari, Marina D; Afentoulide, Niki

    2011-01-01

    The number of patients who are long-term survivors of renal transplantation increases rapidly, and proportionally increases the demand of quality dental care for this group of patients. All the transplant patients are on potent immunosupressants and also some of them may suffer from other systemic diseases, so their dental management is a challenge for any dentist. This article is an update of the current relevant literature and is aimed to summarize the key points of dental care for renal transplant patients, since no specific guidelines exist. The research for relevant references took place by using Pubmed database, as well as information published by accredited medical societies and health services both in Greece and abroad. PMID:22362336

  2. Genes and beans: pharmacogenomics of renal transplant.

    PubMed

    Murray, Brian; Hawes, Emily; Lee, Ruth-Ann; Watson, Robert; Roederer, Mary W

    2013-05-01

    Advances in the management of patients after solid organ transplantation have led to dramatic decreases in rates of acute rejection, but long-term graft and patient survival have remained unchanged. Individualized therapy after transplant will ideally provide adequate immunosuppression while limiting the adverse effects of drug therapy that significantly impact graft survival. Therapeutic drug monitoring represents the best approximation of individualized drug therapy in transplant at this time; however, obtaining pharmacogenomic data in transplant patients has the potential to enhance our current practice. Polymorphisms of target genes that impact pharmacokinetics have been identified for most immunosuppressants, including tacrolimus, cyclosporine, mycophenolate, azathioprine and sirolimus. In the future, pre-emptive assessment of a patient's genetic profile may inform drug selection and provide information on specific doses that will improve efficacy and limit toxicity. PMID:23651025

  3. The first identical twin renal transplant.

    PubMed

    Ellis, Harold

    2015-03-01

    There is no doubt that it was the work of one man, Alexis Carrel, which laid the foundations of modern organ transplantation. Working first in his native city of Lyons, then in Chicago and finally at the Rockefeller Institute New York, he developed the techniques of successful anastomosis of blood vessels, using extremely fine silk sutures and tiny needles. As early as 1892, he successfully grafted a kidney into the neck of a dog. He was soon able to demonstrate that, although a dog's kidney transplanted into its own neck could survive, even when the opposite kidney was excised, transplant of a kidney to another animal would fail after a few days. Further experiments included transplantation of other organs, including ovary, thyroid, lower limb and heart. In 1914 he wrote to fellow Nobel Prize winning Swiss surgeon, Theodor Kocher about his experiments; "Concerning homoplastic transplantation (from one animal to another) of organs such as the kidney, I have never found positive results to continue after a few months, whereas ir autoplastic transplants the results were always positive. The biological side of the question has to be investigated very much more and we must find out by what means to prevent the reaction of the organism against a new organ" (my italics). This, in fact, was going to occupy the next half century of worldwide research! PMID:26016284

  4. Renal artery embolization for managing uncontrolled hypertension in a kidney transplant candidate

    PubMed Central

    Alhamid, Naji; Alterky, Hani; Othman, Mohammad Imad

    2013-01-01

    We report a case of pre-operative bilateral renal artery embolization to control the resistant and malignant hypertension in a patient prepared for kidney transplantation. A 34-year-old man with end-stage renal disease as a result of the focal segmental glomerulosclerosis and uncontrolled hypertension that precluded the transplantation surgery and the patient's post-transplant blood pressure and the renal function remained within normal limits following the transplant for 6 months of follow-up. PMID:23984264

  5. Pediatric live-donor kidney transplantation in Mansoura Urology & Nephrology Center: a 28-year perspective.

    PubMed

    El-Husseini, Amr A; Foda, Mohamed A; Bakr, Mohamed A; Shokeir, Ahmed A; Sobh, Mohamed A; Ghoneim, Mohamed A

    2006-10-01

    Our objective was to evaluate our overall experience in pediatric renal transplantation. Between March 1976 and March 2004, 1,600 live-donor kidney transplantations were carried out in our center; 216 of the patients were 18 years old or younger (mean age 12.9 years). There were 136 male patients and 80 female patients. The commonest causes of end-stage renal disease (ESRD) were renal dysplasia (22%), nephrotic syndrome (20%), hereditary nephritis (16%), and obstructive uropathy (16%). Of the donors, 94% were one-haplotype matched and the rest were identical. Pre-emptive transplantation was performed in 51 (23%) patients. Triple-therapy immunosuppression (prednisone + cyclosporine + azathioprine) was used in 78.2% of transplants. Rejection-free recipients constituted 47.7%. Hypertension (62%) was the commonest complication. A substantial proportion of patients (48%) were short, with height standard deviation score (SDS) less than -1.88. The overall infection rate was high, and the majority (53%) of infections were bacterial. The graft survival at 1 year, 5 years and 10 years were 93.4%, 73.3% and 48.2%, respectively, while the patients' survival at 1, 5 and 10 years were 97.6%, 87.8% and 75.3%, respectively. Despite long-term success results of pediatric renal transplantation in a developing country, there is a risk of significant morbidity. PMID:16791608

  6. Successful endovascular treatment of transplant intrarenal artery stenosis in renal transplant recipients: Two case reports.

    PubMed

    Koukoulaki, Maria; Brountzos, Elias; Loukopoulos, Ioannis; Pomoni, Maria; Antypa, Eleni; Vougas, Vasileios; Drakopoulos, Spiros

    2015-06-24

    Transplant renal artery stenosis (TRAS) is a relatively rare complication after renal transplantation. The site of the surgical anastomosis is most commonly involved, but sites both proximal and distal to the anastomosis may occur, as well. Angioplasty is the gold standard for the treatment of the stenosis, especially for intrarenal lesions. We report two cases of intrarenal TRAS and successful management with angioplasty without stent placement. Both patients were male, 44 and 55 years old respectively, and they presented with elevated blood pressure or serum creatinine within three months after transplantation. Subsequently, they have undergone angioplasty balloon dilatation with normalization of blood pressure and serum creatinine returning to baseline level. Percutaneous transluminal balloon renal angioplasty is a safe and effective method for the treatment of the intrarenal TRAS. PMID:26131408

  7. Invasive filamentous fungal infections associated with renal transplant tourism.

    PubMed

    Shoham, S; Hinestrosa, F; Moore, J; O'Donnell, S; Ruiz, M; Light, J

    2010-08-01

    'Transplant tourism,' the practice of traveling abroad to acquire an organ, has emerged as an issue in kidney transplantation. We treated a patient who developed invasive aspergillosis of the allograft vascular anastomosis after receiving a kidney transplant in Pakistan, prompting us to review the literature of invasive mycoses among commercial organ transplant recipients. We reviewed all published cases of infections in solid organ transplant recipients who bought their organs abroad and analyzed these reports for invasive fungal infections. Including the new case reported here, 19 cases of invasive fungal infections post commercial kidney transplant occurring in 17 patients were analyzed. Infecting organisms were Aspergillus species (12/19; 63%), Zygomycetes (5/19; 26%), and other fungi (2/19; 5%). Invasive mold infections were present at the transplanted graft in 6/17 patients (35%) with graft loss or death in 13/17 (76%) of patients and overall mortality (10/17) 59%. Invasive fungal infections, frequently originating at the graft site, have emerged as a devastating complication of commercial renal transplant and are associated with high rates of graft loss and death. PMID:20163566

  8. Recurrent Glomerulonephritis after Renal Transplantation: An Unsolved Problem

    PubMed Central

    Golgert, William A.; Appel, Gerald B.; Hariharan, Sundaram

    2008-01-01

    Background and objectives: Despite advances in prevention of acute rejection and improved short- and long-term kidney graft survival, recurrent glomerulonephritis remains problematic and poorly characterized. This study analyzed prevalence and outcome of recurrent glomerulonephritis from various registries. Design, setting, participants, & measurements: Definition, classification, and limitations in evaluating epidemiology of native and recurrent glomerulonephritis are discussed. Epidemiology of native glomerulonephritis as the cause of end-stage renal failure and subsequent recurrence of individual glomerulonephritis was evaluated using data from various registries, and pathogenesis of individual glomerulonephritis is discussed. Results: Analysis of data from transplant registries revealed that glomerulonephritis is an important cause of end-stage renal disease in white and pediatric recipients; however, glomerulonephritis as the cause of end-stage renal disease is not characterized well in black recipients, and many of them are perhaps labeled to have hypertensive nephrosclerosis as the cause of renal disease without renal biopsy. A systematic approach toward urinalysis after transplantation and utility of immunofluorescence and electron microscopic examination of renal biopsy tissues will identify the true prevalence of recurrent glomerulonephritis. Data on recurrent glomerulonephritis should be compiled by either using registry analysis or pooling data from multiple centers. This will provide true data on prevalence and outcome and could potentially initiate translational research studies. Conclusions: The understanding of the pathogenesis of recurrent glomerulonephritis is critical to optimize prevention as well as to treat individual recurrent glomerulonephritis, which can enhance long-term graft survival. PMID:18272827

  9. Evidence for a need to mandate kidney transplant living donor registries.

    PubMed

    Emara, Mahmoud; Ragheb, Ahmed; Hassan, Abubaker; Shoker, Ahmed

    2008-01-01

    Kidney disease is a global public health problem of growing proportions. Currently the best treatment for end-stage renal failure is transplantation. Living organ donation remains a complex ethical, moral and medical issue. It is based on a premise that kidney donation is associated with short-term minimal risks to harm the donor, and is outweighed by the definite advantages to the recipient. A growing number of patients with end-stage renal disease and shortage of kidney donors poses a pressing need to expand the criteria needed to accept kidney donors. The current donor registries are structured and are driven to expand donor pool. As living kidney donation is not without risks, more attention should be given to protect the donor health. After kidney donation, mild to moderate renal insufficiency may occur. Renal insufficiency, even mild, is associated with increased risks of hypertension, proteinuria and cardiovascular morbidity. We, therefore, foresee a need to mandate the establishment of renal transplant donor registries at all transplanting programs as a prerequisite to protect the long-term well being of kidney donors. These registries can collect the database necessary to develop standards of practice and guidelines for future kidney donation. PMID:18549448

  10. Obstetric and long-term kidney outcomes in renal transplant recipients: a 40-yr single-center study.

    PubMed

    Stoumpos, Sokratis; McNeill, Susan H; Gorrie, Morag; Mark, Patrick B; Brennand, Janet E; Geddes, Colin C; Deighan, Christopher J

    2016-06-01

    Female renal transplant recipients of childbearing age may ask what the outcomes are for pregnancy and whether pregnancy will affect graft function. We analyzed obstetric and transplant outcomes among renal transplant recipients in our center who have been pregnant between 1973 and 2013. A case-cohort study was performed identifying 83 pairs of pregnant and non-pregnant controls matched for sex, age, transplant vintage, and creatinine. There were 138 pregnancies reported from 89 renal transplant recipients. There were live births in 74% of pregnancies with high prevalence of prematurity (61%), low birth weight (52%), and pre-eclampsia (14%). Lower eGFR (OR 0.98; p = 0.05) and higher uPCR (OR 1.86; p = 0.02) at conception were independent predictors for poor composite obstetric outcome. Lower eGFR (OR 0.98; p = 0.04), higher uPCR (OR 1.50; p = 0.04), and live organ donation (OR 0.35; p = 0.02) were predictors of ≥20% loss of eGFR between immediately pre-pregnancy and one yr after delivery. There was no difference in eGFR at one, five, and 10 yr in pregnant women compared with non-pregnant controls and a pregnancy was not associated with poorer 10-yr transplant or 20-yr patient survival. Despite high rates of obstetric complications, most women had successful pregnancies with good long-term transplant function. PMID:26992458

  11. Young aboriginals are less likely to receive a renal transplant: a Canadian national study

    PubMed Central

    2013-01-01

    Background Previous studies have demonstrated Aboriginals are less likely to receive a renal transplant in comparison to Caucasians however whether this applies to the entire population or specific subsets remains unclear. We examined the effect of age on renal transplantation in Aboriginals. Methods Data on 30,688 dialysis (Aboriginal 2,361, Caucasian 28, 327) patients obtained between Jan. 2000 and Dec. 2009 were included in the final analysis. Racial status was self-reported. Cox proportional hazards, the Fine and Grey sub-distribution method and Poisson regression were used to determine the association between race, age and transplantation. Results In comparison to Caucasians, Aboriginals were less likely to receive a renal transplant (Adjusted HR 0.66 95% CI 0.57-0.77, P < 0.0001) however after stratification by age and treating death as a competing outcome, the effect was more predominant in younger Aboriginals (Age 18–40: 20.6% aboriginals vs. 48.3% Caucasians transplanted; aHR 0.50(0.39-0.61), p < 0.0001, Age 41–50: 10.2% aboriginals vs. 33.9% Caucasians transplanted; aHR 0.46(0.32-0.64), p = 0.005, Age 51–60: 8.2% aboriginals vs. 19.5% Caucasians transplanted; aHR0.65(0.49-0.88), p = 0.01, Age >60: 2.7% aboriginals vs. 2.6% Caucasians transplanted; aHR 1.21(0.76-1.91), P = 0.4, Age X race interaction p < 0.0001). Both living and deceased donor transplants were lower in Aboriginals under the age of 60 compared to Caucasians. Conclusion Younger Aboriginals are less likely to receive a renal transplant compared to their Caucasian counterparts, even after adjustment for comorbidity. Determination of the reasons behind these discrepancies and interventions specifically targeting the Aboriginal population are warranted. PMID:23317294

  12. [Nursing needs of renal transplanted adolescents, a descriptive cross sectional study in a Swiss hospital].

    PubMed

    Kleinknecht, Michael; Neuhaus, Thomas J; Landolt, Markus A

    2009-06-01

    Various studies have demonstrated that the five-year graft survival of adolescents after renal transplantation is significantly lower than in children. This may be due to poor adherence to the post-transplant regime in adolescents. It has been shown that nurses can provide support to renal transplanted adolescents with positive effects on their adherence. The aim of this descriptive cross-sectional study was to gain knowledge about important topics of nurses' support to adolescent renal transplant patients. Twenty-seven adolescents between the ages of 12 and 18 years were interviewed and given a questionnaire based on a focus group discussion. Each of the provided 43 topics was rated on its importance. Results showed that responses corresponding to the judgment "very important" ranged from 20 % to 100 %. Information about illness and therapy was given highest priority, followed by the provision of support services as well as information and the support of planning and managing the personal way of living. These topics can be seen as a set of relevant variables that may be used for focused assessment, and for planning of nursing interventions. With regard to clinical practice it is necessary to develop nursing strategies and patient and family education programs based on the results of this study. PMID:19496030

  13. Living unrelated-commercial-kidney transplantation: when there is no chance to survive.

    PubMed

    Sever, Mehmet Sukru

    2006-10-01

    Transplantation is the best treatment of end-stage renal disease (ESRD); however, organ shortage is a reality. Deceased donor organ donation is inadequate; hence, the number of patients on the waiting lists is increasing progressively. Since many ESRD patients do not have living genetically related donors, living unrelated transplantation is considered. These transplantations offer excellent graft and patient survival rates if practiced in conventional situations, while the results are not so favorable or even poor in unconventional transplantations, which mostly take place in developing countries. Ethical aspects of living unrelated transplantation are more complicated than the medical side due to concern of commercialization. Making payment to the donors has been considered strictly as nonethical by many authors, while some others suggest reopening previous debates for kidney sales. The latter claim that if exploitation of donors is avoided, the reward (or payment) to the donor can be morally justified. Apart from these controversies, it is uniformly accepted that commercial transplantation is certainly unethical when brokers are involved or the aim is just profit for transplant physicians, because the main reason in favor of organ sales is improving the quality of life of the patients and the donors, not the brokers or the physicians. All these theoretical ethical arguments in the Western countries turn out to become vital concerns in developing countries, because transplantation is the cheapest renal replacement therapy. Recently, it has been suggested that organ shortage problems can partly be solved by establishing controlled donor compensation programs in these countries, which may also prevent exploitation of the donors. However, it is impossible to suggest a uniform solution for all countries because of deep differences in economical status as well as social and cultural values. Thus, every country should build its own ethical standards for commercial

  14. Delayed Graft Function 5 Months After Living Donor Kidney Transplantation

    PubMed Central

    Schulz, Tim; Pries, Alexandra; Kapischke, Matthias

    2016-01-01

    Patient: Female, 59 Final Diagnosis: Delayed kidney graft function Symptoms: — Medication: — Clinical Procedure: Living donor kidney transplantation Specialty: Transplantology Objective: Unusual clinical course Background: Delayed graft function is a clinical term to describe the failure of the transplanted kidney to function immediately after transplantation. Case Report: A 59-year-old woman suffered from a rare case of delayed graft function lasting 148 days after unrelated living donor kidney transplantation. Until now, 15 years after transplantation, organ function is still good, with serum creatinine levels about 1.4 to 2.0 mg/dl. Conclusions: Even after prolonged graft dysfunction, good graft function can be achieved. PMID:26915643

  15. Inflammatory Cutaneous Diseases in Renal Transplant Recipients

    PubMed Central

    Savoia, Paola; Cavaliere, Giovanni; Zavattaro, Elisa; Veronese, Federica; Fava, Paolo

    2016-01-01

    Kidney transplant recipients frequently suffer from skin infections and malignancies, possibly due to the effects of long-term immunosuppressive therapy. While the relationships between immunosuppression and these pathological conditions have been widely investigated, little is known about the relative incidence and characteristics of inflammatory skin diseases in this type of patient. In this study, we analyze the incidence of a number of inflammatory cutaneous diseases in a cohort of patients who underwent kidney transplantation. Although our study shows a relatively low incidence of these pathologies in transplanted patients—in agreement with the general action of immunosuppressant therapies in reducing inflammation—we scored a different efficacy of the various immunosuppressive regimens on inflammatory and autoimmune skin diseases. This information can be key for designing immunosuppressive regimens and devising accurate follow-up protocols. PMID:27548160

  16. Viral Infection in Renal Transplant Recipients

    PubMed Central

    Cukuranovic, Jovana; Ugrenovic, Sladjana; Jovanovic, Ivan; Visnjic, Milan; Stefanovic, Vladisav

    2012-01-01

    Viruses are among the most common causes of opportunistic infection after transplantation. The risk for viral infection is a function of the specific virus encountered, the intensity of immune suppression used to prevent graft rejection, and other host factors governing susceptibility. Although cytomegalovirus is the most common opportunistic pathogen seen in transplant recipients, numerous other viruses have also affected outcomes. In some cases, preventive measures such as pretransplant screening, prophylactic antiviral therapy, or posttransplant viral monitoring may limit the impact of these infections. Recent advances in laboratory monitoring and antiviral therapy have improved outcomes. Studies of viral latency, reactivation, and the cellular effects of viral infection will provide clues for future strategies in prevention and treatment of viral infections. This paper will summarize the major viral infections seen following transplant and discuss strategies for prevention and management of these potential pathogens. PMID:22654630

  17. Early diagnosis of acute postoperative renal transplant rejection

    SciTech Connect

    Tisdale, P.L.; Collier, B.D.; Kauffman, H.M.; Adams, M.B.; Isitman, A.T.; Hellman, R.S.; Rao, S.A.; Joestgen, T.; Krohn, L.

    1985-05-01

    A prospective evaluation of In-111 labeled autologous platelet scintigraphy for the early diagnosis of acute postoperative renal transplant rejection was undertaken. To date, 28 consecutive patients between 7 and 14 days post-op have been injected with 500..mu..Ci of In-111 platelets followed by imaging at 24 and 48 hours. Activity within the renal transplant exceeding activity in the adjacent iliac vessels was considered to be evidence of rejection, and both chemical evidence and clinical impression of rejection at 5 days after completion of imaging was accepted as proof of ongoing or incipient rejection at the time of scintigraphy. In addition, to visual inspection, independent quantitative analysis compared the area-normalized activity over the transplant with the adjacent iliac vessels (normal <1.0). For 5 patients, positive In-111 scintigraphy was present before convincing clinical evidence of rejection. In-111 platelet scintigraphy is useful not only to confirm the clinical diagnosis of rejection but also to establish the early, pre-clinical diagnosis of incipient acute postoperative renal transplant rejection.

  18. Survival Benefit of Statins in Hemodialysis Patients Awaiting Renal Transplantation.

    PubMed

    Aftab, Waqas; Gazallo, Juliana; Motabar, Ali; Varadrajan, Padmini; Deedwania, Prakash C; Pai, Ramdas G

    2015-06-01

    End-stage renal disease (ESRD) patients have extraordinarily high cardiovascular risk and mortality, yet the benefit of statins in this population remains unclear based on the randomized trials. We investigated the prognostic value of statins in a large, pure cohort of prospectively recruited patients with ESRD awaiting renal transplantation, and being followed up in a dedicated cardiac clinic. We prospectively collected demographic, clinical, laboratory, and pharmacological data on 423 consecutive ESRD patients on hemodialysis awaiting renal transplantation. Survival analysis was performed as a function of statin therapy. The baseline characteristics were as follows: age 57 ± 11 years, males 64%, diabetes mellitus in 68%, known coronary artery disease in 30%, left ventricular (LV) ejection fraction 61 ± 11%. Over a mean follow-up of 2 years, there were 43 deaths. Adjusted for age, gender, hypertension, body mass index, diabetes mellitus, coronary artery disease, smoking, and treatment with angiotensin converting enzyme inhibitor, β blocker, and antiplatelet medications, statin use was a predictor of lower mortality (hazard ratio 0.30, 95% confidence interval 0.11-0.79, p = 0.01). This beneficial effect of statin was supported by propensity score analysis (p = 0.02) and was consistent across all clinical subgroups. The benefit of statins seemed to be greater in those with LV hypertrophy and smoking. Statin therapy in hemodialysis patients awaiting renal transplant is independently associated with better survival supporting its use in this high-risk population. PMID:26060381

  19. Antiviral treatment for chronic hepatitis B in renal transplant patients

    PubMed Central

    Ridruejo, Ezequiel

    2015-01-01

    Chronic hepatitis B infection is frequent in renal transplant patients. It negatively impacts long term outcomes reducing graft and patient survival. Current guidelines clearly define who needs treatment, when to start, what is the first line therapy, how to monitor treatment response, when to stop, and how patients must be controlled for its safety. There is some data showing a favorable safety and efficacy profile of nucleos(t)ide analogue (NUC) treatment in the renal transplant setting. Entecavir, a drug without major signs of nephrotoxicity, appears to be the first option for NUC naïve patients and tenofovir remains the preferred choice for patients with previous resistance to lamivudine or any other NUC. Renal transplant recipients under antiHBV therapy should be monitored for its efficacy against HBV but also for its safety with a close renal monitoring. Studies including a large number of patients with long term treatment and follow up are still needed to better demonstrate the safety and efficacy of newer NUCs in this population. PMID:25729474

  20. Improved renal ischemia tolerance in females influences kidney transplantation outcomes

    PubMed Central

    Aufhauser, David D.; Wang, Zhonglin; Murken, Douglas R.; Bhatti, Tricia R.; Wang, Yanfeng; Ge, Guanghui; Redfield, Robert R.; Abt, Peter L.; Wang, Liqing; Reese, Peter P.; Hancock, Wayne W.; Levine, Matthew H.

    2016-01-01

    Experimentally, females show an improved ability to recover from ischemia-reperfusion injury (IRI) compared with males; however, this sex-dependent response is less established in humans. Here, we developed a series of murine renal ischemia and transplant models to investigate sex-specific effects on recovery after IRI. We found that IRI tolerance is profoundly increased in female mice compared with that observed in male mice and discovered an intermediate phenotype after neutering of either sex. Transplantation of adult kidneys from either sex into a recipient of the opposite sex followed by ischemia at a remote time resulted in ischemia recovery that reflected the sex of the recipient, not the donor, revealing that the host sex determines recovery. Likewise, renal IRI was exacerbated in female estrogen receptor α–KO mice, while female mice receiving supplemental estrogen before ischemia were protected. We examined data from the United Network for Organ Sharing (UNOS) to determine whether there is an association between sex and delayed graft function (DGF) in patients who received deceased donor renal transplants. A multivariable logistic regression analysis determined that there was a greater association with DGF in male recipients than in female recipients. Together, our results demonstrate that sex affects renal IRI tolerance in mice and humans and indicate that estrogen administration has potential as a therapeutic intervention to clinically improve ischemia tolerance. PMID:27088798

  1. Is living kidney donation the answer to the economic problem of end-stage renal disease?

    PubMed

    Klarenbach, Scott; Barnieh, Lianne; Gill, John

    2009-09-01

    The escalating number and cost of treating patients with end-stage renal disease is a considerable economic concern for health care systems and societies globally. Compared with dialysis, kidney transplantation leads to improved patient survival and quality of life, as well as cost savings to the health payer. Despite efforts to increase kidney transplantation, the gap between supply and demand continues to grow. In this article we explore the economic consideration of both living and deceased transplantation. Although living kidney donation has several advantages from an economic perspective, efforts to increase both deceased and living donation are required. Strategies to increase kidney donation are underfunded, and even costly strategies are likely to lead to net health care savings. However, demonstration of efficacy of these strategies is required to ensure efficient use of resources. PMID:19751899

  2. Wait List Death and Survival Benefit of Kidney Transplantation among Non-renal Transplant Recipients

    PubMed Central

    Cassuto, James R.; Reese, Peter P.; Sonnad, Seema; Bloom, Roy D.; Levine, Matthew H.; Naji, Ali; Abt, Peter

    2010-01-01

    The disparity between the number of patients waiting for kidney transplantation and the limited supply of kidney allografts has renewed interest in the benefit from kidney transplantation experienced by different groups. This study evaluated kidney transplant survival benefit in prior non-renal transplant recipients (kidney after liver, KALi; lung, KALu; heart, KAH) compared to primary isolated (KA1) or repeat isolated kidney (KA2) transplant. Multivariable Cox regression models were fit using UNOS data for patients wait listed and transplanted from 1995–2008. Compared to KA1, the risk of death on the wait list was lower for KA2 (p<0.001;HR=0.84;CI=0.81–0.88), but substantially higher for KALu (p<0.001;HR=3.80;CI=3.08–4.69), KAH (p<0.001;HR=1.92;CI=1.66–2.22), and KALi (p<0.001;HR=2.69;CI=2.46–2.95). Following kidney transplant, patient survival was greatest for KA1, similar among KA2, KALi, KAH, and inferior for KALu. Compared to the entire wait list, renal transplantation was associated with a survival benefit among all groups except KALu (p=0.017;HR=1.61;CI=1.09–2.38), where post-transplant survival was inferior to the wait list population. Recipients of KA1 kidney transplantation have the greatest post-transplant survival and compared to the overall kidney wait list, the greatest survival benefit. PMID:20977641

  3. Maintenance pharmacological immunosuppressive strategies in renal transplantation.

    PubMed Central

    Vella, J. P.; Sayegh, M. H.

    1997-01-01

    Current maintenance immunosuppressive regimens for transplantation are based on three classes of drugs: corticosteroids, immunophilin-binding agents (eg, cyclosporin and tacrolimus), and antimetabolites (eg, azathioprine and mycophenolate). Drugs from the various classes inhibit the immune system at different points and are thus synergistic when used in combination. PMID:9338020

  4. Urinary tract infection in renal transplantation

    PubMed Central

    Giessing, Markus

    2012-01-01

    Introduction Urinary tract infection (UTI), especially recurrent UTI, is a common problem, occurring in >75% of kidney transplant (KTX) recipients. UTI degrades the health-related quality of life and can impair graft function, potentially reducing graft and patient survival. As urologists are often involved in treating UTI after KTX, previous reports were searched to elucidate underlying causes, risk factors and treatment options, as well as recommendations for prophylaxis of UTI after KTX. Methods Pubmed/Medline was searched and international guidelines and recommendations for prevention and treatment of UTI after KTX were also assessed. Results Most studies on UTI after KTX have a small sample, and are descriptive and retrospective. Many transplant- and recipient-related risk factors have been identified. While asymptomatic bacteriuria is often treated, even though some studies advise against it, symptomatic UTI should be treated empirically after collecting urine for microbiological analysis, to avoid the development of transplant pyelonephritis with a high chance of urosepsis. The duration of treatment has not been determined in studies and recommendations refer to the treatment of complicated UTI in the non-transplant population. Prophylaxis has not been the focus of studies either. Conclusion UTI after KTX is still largely an under-represented field of study, despite many recipients developing UTI after KTX. Prospective studies on this topic are urgently needed. PMID:26558020

  5. Epstein-Barr virus-positive multiple myeloma following an ABO incompatible second renal transplantation

    PubMed Central

    Kirushnan, B.; Subbarao, B.; Prabhu, P.

    2016-01-01

    ABO incompatible kidney transplant recipients receive higher dose of immunosuppression. Previous data indicate that the incidence of malignancy is not higher in these patients. Compared to the general population, renal transplant recipients are at 4.4-fold higher risk of developing myeloma. We describe a case of posttransplant multiple myeloma in an ABO incompatible renal transplant recipient of a second graft. PMID:27512301

  6. Epstein-Barr virus-positive multiple myeloma following an ABO incompatible second renal transplantation.

    PubMed

    Kirushnan, B; Subbarao, B; Prabhu, P

    2016-01-01

    ABO incompatible kidney transplant recipients receive higher dose of immunosuppression. Previous data indicate that the incidence of malignancy is not higher in these patients. Compared to the general population, renal transplant recipients are at 4.4-fold higher risk of developing myeloma. We describe a case of posttransplant multiple myeloma in an ABO incompatible renal transplant recipient of a second graft. PMID:27512301

  7. Ex vivo reconstruction of the donor renal artery in renal transplantation: a case-control study.

    PubMed

    McLoughlin, Louise C; Davis, Niall F; Dowling, Catherine M; Power, Richard E; Mohan, Ponnusamy; Hickey, David P; Smyth, Gordon P; Eng, Molly M P; Little, Dilly M

    2014-05-01

    Transplantation of renal allografts with anatomic variability or injured vasculature poses a challenge to the transplanting surgeon but can be salvaged for transplantation with ex vivo bench reconstruction of the vasculature. We investigated whether renal allograft function is impaired in these reconstructed allografts; compared to the donor-matched, un-reconstructed allograft. Reconstructed allografts were transplanted into 60 patients at our institution between 1986 and 2012. A control group was selected from the matched pair of the recipient in deceased donor transplantation. We found no significant difference in the overall graft and patient survival rates (P = 1.0, P = 0.178). Serum creatinine levels were not significantly higher in the study group at 1, 3 and 12 months postoperatively. There were two cases of vascular thrombosis in the study group that were not related to the ex vivo reconstruction. A significantly greater proportion of reconstructed patients were investigated with a colour duplex ultrasound postoperatively (0.007). Although we have demonstrated a higher index of suspicion of transplant failure in patients with a reconstructed allograft, this practice has proven to be a safe and useful technique with equivocal outcome when compared to normal grafts; increasing the organ pool available for transplantation. PMID:24851246

  8. Type 4 renal tubular acidosis in a kidney transplant recipient.

    PubMed

    Kulkarni, Manjunath

    2016-02-01

    We report a case of a 66-year-old diabetic patient who presented with muscle weakness 2 weeks after kidney transplantation. Her immunosuppressive regimen included tacrolimus, mycophenolate mofetil, and steroids. She was found to have hyperkalemia and normal anion gap metabolic acidosis. Tacrolimus levels were in therapeutic range. All other drugs such as beta blockers and trimethoprim - sulfamethoxazole were stopped. She did not respond to routine antikalemic measures. Further evaluation revealed type 4 renal tubular acidosis. Serum potassium levels returned to normal after starting sodium bicarbonate and fludrocortisone therapy. Though hyperkalemia is common in kidney transplant recipients, determining exact cause can guide specific treatment. PMID:27105603

  9. Living donor kidney transplantation: "beauty and the beast"!

    PubMed

    Danovitch, Gabriel M

    2013-01-01

    The report by Terasaki and colleagues in 1995 that the outcomes of spousal and biologically unrelated transplants were essentially the same as for 1-haplotype matched living related transplants changed the course of clinical transplantation. This article, entitled metaphorically "Beauty and the Beast", describes the dramatic change in the practice of living donor transplantation that followed. In the ensuing two decades, biologically unrelated living donor transplantation became commonplace in the developed world and reached its apotheosis in cross-country living donor paired exchange programs that have made transplantation accessible to many whose donors were deemed "incompatible". Such exchanges can indeed be thought of as a "thing of beauty". Sadly, the same observation was abused to exploit vulnerable donors, and the "beast" in the form of transplant tourism became a feature of transplantation in the developing world. The responsibility of the transplant community to protect the welfare of living donors and their recipients and the key role of trust in the evaluation of living donors is discussed. PMID:25095511

  10. [Severe infectious keratitis in renal transplant patient: a case report].

    PubMed

    Limaiem, Rim; Mnasri, Heni; El Maazi, Abir; Ammari, Hela; Chaabouni, Afif; Mghaieth, Fatma; El Matri, Leila

    2009-07-01

    Keratitis occurring in renal transplant patients are often severe, with difficult management. We describe the case of a renal transplant patient, 44 year-old man, with history of recurrent herpetic keratitis, which developed an impending corneal perforation. Conjunctival smear showed the presence of amoebic cysts. Anti-amoebic treatment was undertaken in addition with oral aciclovir, and a therapeutic penetrating keratoplasty was performed. An ulceration of the graft occurred within five months. Ocular samples showed the presence of Candida albicans. Despite aggressive antifungal therapy, he required a second therapeutic penetrating keratoplasty for graft perforation. One month later, we noted a recurrence of the ulcer with corneal thinning which evolved to perforation. PMID:19345628

  11. Cutaneous Alternariasis in a Patient With Renal Transplant

    PubMed Central

    Demirci, Mustafa; Baran, Nurten; Uzum, Atilla; Calli, Aylin Orgen; Gul-Yurtsever, Sureyya; Demirdal, Tuna

    2015-01-01

    Introduction: Alternaria is a common saprophyte, which is usually not pathogenic in humans. Generally, local wounds infections of Alternaria occur with presence of immunosuppression factors such as HIV infection and renal transplant patients. Case Presentation: We reported a case of wound infection induced by Alternaria spp. in a renal transplant patients. The main interest in this case was the rareness of the cutaneous alternariasis, its clinical aspects and good response to therapy. Recognition of Alternaria spp. as potential opportunistic pathogens is important for differential diagnosis of dermatological lesions, such as granulomatous or ulcerative lesions in immunocompromised patients. Conclusions: Alternariasis or similar cases may be increased due to the increased number of immunosuppressed patients. From this point of view, skin lesions in these patients must be planned and microbiologically evaluated considering the molds. PMID:26060568

  12. Rhodococcal lung abscess in a renal transplant recipient

    PubMed Central

    Wong, Koh-Wei; Thevarajah, Bharathan

    2012-01-01

    Summary Background: Rhodococcus species are relatively rare human pathogens, but are being increasingly recognized as causes of infection especially in immunosuppressed patients. Case Report: We present a case of Rhodococcus lung abscess in a patient 10 months post-cadaveric renal transplant, successfully treated with a combination of antibiotics. She required a prolonged course of oral antibiotics for 6 months. She did not require surgical intervention. Chest X-rays and CT thorax showed complete resolution of the initial lesion. We also review the medical literature related to Rhodococcus infection in patients with renal transplantation. Rhodococcus infection should be considered as in the differential diagnosis of immunosuppressed patients who present with lung abscess/mass. Conclusions: A literature review indicates this is a potentially fatal condition with disseminated sepsis/abscesses. PMID:23569526

  13. Pityriasis versicolor on penile shaft in a renal transplant recipient.

    PubMed

    Ryu, Han-Won; Cho, Jae-We; Lee, Kyu-Suk

    2012-08-01

    Pityriasis versicolor is a superficial infection of the stratum corneum, which is caused by the Malassezia species. Tge Malassezia species consist of 12 subspecies, including M. furfur, M. pachydermatis, M. symphodialis and M. globasa. The Malassezia species are classified as a normal flora, particularly in the sebum rich areas of the skin, and they convert from saprophytic yeast to parasitic mycelial morpholgic form to cause clinical disease. But majorities of their distributions are in the upper back, the neck, the thighs, and the forearm, and not in the penis. It is well known that the renal transplant patients, who take immunosuppressive agents, have impairment in the protective cell mediated immunity. Thus, they are more susceptible to infectious diseases, such as a fungal infection. Therefore, clinical manifestations show higher incidence of disease, but they mostly occur in an expected distribution. We here report a case of pityriasis versicolor in a renal transplant recipient on penile shaft, which is an unusual area. PMID:22879720

  14. Risk factors and outcome of stroke in renal transplant recipients.

    PubMed

    Findlay, Mark D; Thomson, Peter C; MacIsaac, Rachael; Jardine, Alan G; Patel, Rajan K; Stevens, Kathryn K; Rutherford, Elaine; Clancy, Marc; Geddes, Colin C; Dawson, Jesse; Mark, Patrick B

    2016-08-01

    Stroke incidence is high in end-stage renal disease, and risk factors differ between the dialysis and general populations. However, risk factors and outcomes following renal transplantation remain unclear. We analyzed all adult patients with a functioning renal transplant from 01/01/2007 to 12/31/2012. Data were extracted from the electronic patient record. Variables associated with stroke were identified by survival analyses; demographic, clinical, and imaging and laboratory variables were assessed and case fatality determined. Follow-up was until 05/12/2013. A total of 956 patients were identified (median age 40.1 years, 59.9% male). Atrial fibrillation (AF) prevalence was 9.2%, and 38.2% received a transplant during follow-up. A total of 26 (2.7%) experienced a stroke during 4409 patient-years of follow-up (84.6% ischemic). Stroke incidence was 5.96/1000 patient-years. Factors associated with stroke on regression analysis were prior stroke, diabetes, age, systolic hypertension, and hemoglobin. Atrial fibrillation was associated with time to stroke (P<0.001). Warfarin did not associate with ischemic stroke risk in those with AF. Fatality was 19.2% at 7, 23.1% at 28, and 42.3% at 365 days after stroke. Patients with a functioning renal transplant have a high stroke incidence and case fatality. Unlike those on hemodialysis, risk factors are similar to the general population. We did not demonstrate benefit from warfarin use in those with AF. PMID:27218240

  15. Protocol of a cluster randomized trial of an educational intervention to increase knowledge of living donor kidney transplant among potential transplant candidates

    PubMed Central

    2013-01-01

    Background The best treatment option for end-stage renal disease is usually a transplant, preferably a live donor kidney transplant (LDKT). The most effective ways to educate kidney transplant candidates about the risks, benefits, and process of LDKT remain unknown. Methods/design We report the protocol of the Enhancing Living Donor Kidney Transplant Education (ELITE) Study, a cluster randomized trial of an educational intervention to be implemented during initial transplant evaluation at a large, suburban U.S. transplant center. Five hundred potential transplant candidates are cluster randomized (by date of visit) to receive either: (1) standard-of-care (“usual”) transplant education, or (2) intensive education that is based upon the Explore Transplant series of educational materials. Intensive transplant education includes viewing an educational video about LDKT, receiving print education, and meeting with a transplant educator. The primary outcome consists of knowledge of the benefits, risks, and process of LDKT, assessed one week after the transplant evaluation. As a secondary outcome, knowledge and understanding of LDKT are assessed 3 months after the evaluation. Additional secondary outcomes, assessed one week and 3 months after the evaluation, include readiness, self-efficacy, and decisional balance regarding transplant and LDKT, with differences assessed by race. Although the unit of randomization is the date of the transplant evaluation visit, the unit of analysis will be the individual potential transplant candidate. Discussion The ELITE Study will help to determine how education in a transplant center can best be designed to help Black and non-Black patients learn about the option of LDKT. Trial registration Clinicaltrials.gov number NCT01261910 PMID:24245948

  16. Slope Estimation of Covariates that Influence Renal Outcome following Renal Transplant Adjusting for Informative Right Censoring

    PubMed Central

    Jaffa, Miran A.; Jaffa, Ayad A; Lipsitz, Stuart R.

    2015-01-01

    A new statistical model is proposed to estimate population and individual slopes that are adjusted for covariates and informative right censoring. Individual slopes are assumed to have a mean that depends on the population slope for the covariates. The number of observations for each individual is modeled as a truncated discrete distribution with mean dependent on the individual subjects' slopes. Our simulation study results indicated that the associated bias and mean squared errors for the proposed model were comparable to those associated with the model that only adjusts for informative right censoring. The proposed model was illustrated using renal transplant dataset to estimate population slopes for covariates that could impact the outcome of renal function following renal transplantation. PMID:25729124

  17. Eligibility for renal transplantation: a Moroccan interregional survey.

    PubMed

    Kabbali, Nadia; Mikou, Souad; El Bardai, Ghita; Najdi, Adil; Ezziani, Meriem; Batta, Fatima Zahra; El Pardiya, Nada Tazi; El Fadil, Chadia; El Hassani, Aniss; Arrayhani, Mohamed; Houssaini, Tarik Sqalli

    2015-01-01

    In the treatment of end-stage renal disease, kidney transplantation (KT) is the best and most cost-effective alternative with regard to both prognosis and quality of life. To identify the proportion and the characteristics of kidney transplant candidates who can be considered eligible, a total of 2066 hemodialysis patients were investigated as part of the ARTEMIS (Attitude toward Renal Transplantation and Eligibility among dialysis patients in a Moroccan Interregional Survey) study. We investigated all patients receiving hemodialysis in the 39 centers of four Moroccan departments. The mean age was 52.9 years and the mean duration of hemodialysis was 55.3 months. Fifty-eight percent of our patients were considered eligible for KT; 18.2% had an absolute contraindication and 23.8% had one or more relative contraindications. When compared with eligible patients (n = 1200) in the univariate analysis, those ineligible were significantly older (61 years vs. 51, P < 0.0001), had no residual diuresis (59.8% vs. 49.1%, P < 0.0001), were more often diabetic (25.1% vs. 11.9%, P < 0.0001) and hypertensive (54.5% vs. 45.8%, P < 0.0001), and their median dialysis duration was longer (61 months vs. 51, P < 0.0001). In the multivariate models, eligibility remained associated with young age, less term of dialysis and residual diuresis. Adequate control of cardiovascular risk factors before dialysis and early referral for transplantation might help to improve eligibility of the renal transplant candidates. PMID:25579741

  18. ACE inhibition in the treatment of children after renal transplantation.

    PubMed

    Arbeiter, Klaus; Pichler, Andrea; Stemberger, Regina; Mueller, Thomas; Ruffingshofer, Dagmar; Vargha, Regina; Balzar, Egon; Aufricht, Christoph

    2004-02-01

    Currently, there are no data available on long-term effects of angiotensin-converting enzyme inhibitors (ACE-I) on graft function in children after renal transplantation. We therefore analyzed all children who were transplanted at our institution between 1989 and 1998 and followed for at least 2 years. Those treated with ACE-I, mainly because of failure of other antihypertensive medications, were compared to those without ACE-I. The ACE-I-treated children ( n=19) showed significantly better blood pressure control during the 1st year of follow-up ( p<0.05). In children with chronic allograft dysfunction ( n=8), treatment with ACE-I stabilized graft function, with improvement in creatinine clearance in 50% ( p<0.01). Serum potassium and hemoglobin levels remained stable. One patient discontinued ACE-I because of renal artery stenosis. Taken together, ACE-I were effective and safe in the treatment of hypertension in children following renal transplantation. Children with chronic allograft dysfunction experienced a stabilizing effect on graft function. PMID:14673630

  19. Thirty-seven years of renal transplantation in Oregon.

    PubMed

    Barry, J M; Lemmers, M J; Conlin, M J; Norman, D J; Bennett, W M; Meyer, M M; DeMattos, A; Wetzsteon, P; Johnson-Tomanka, M; Seely, M

    1996-01-01

    What we accomplish today as a matter of routine was only imagined by a few 4 decades ago. The journey from that first successful kidney transplant in the 1950s to the multidisciplinary, multiorgan transplant program of today has been a fascinating one. Although we attribute our current results to careful recipient selection and preparation, improvements in organ procurement and preservation, refinement of surgical techniques, improvement in histocompatibility techniques and organ sharing, improvements in immunosuppression and infection control, and careful monitoring of recipients, we and our patients have benefited from significant contributions from our colleagues in government and the law. The 4 that come to mind are the provision of near-universal insurance coverage for end stage renal disease patients in 1972 under the Medicare program, the passage of brain death laws in the mid 1970s, the passage of the National Transplant Act in 1984, and the passage of the Oregon required request law in 1985. PMID:9286571

  20. Recurrence and Treatment after Renal Transplantation in Children with FSGS.

    PubMed

    Kang, Hee Gyung; Ha, Il-Soo; Cheong, Hae Il

    2016-01-01

    Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage renal disease and a common pathologic diagnosis of idiopathic nephrotic syndrome (NS), especially in steroid-resistant cases. FSGS is known to recur after kidney transplantation, frequently followed by graft loss. However, not all patients with FSGS suffer from recurrence after kidney transplantation, and genetic and secondary FSGS have a negligible risk of recurrence. Furthermore, many cases of recurrence achieve remission with the current management of recurrence (intensive plasmapheresis/immunosuppression, including rituximab), and other promising agents are being evaluated. Therefore, a pathologic diagnosis of FSGS itself should not cause postponement of allograft kidney transplantation. For patients with a high risk of recurrence who presented with classical symptoms of NS, that is, severe edema, proteinuria, and hypoalbuminemia, close monitoring of proteinuria is necessary, followed by immediate, intensive treatment for recurrence. PMID:27213154

  1. Recurrence and Treatment after Renal Transplantation in Children with FSGS

    PubMed Central

    Ha, Il-Soo

    2016-01-01

    Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage renal disease and a common pathologic diagnosis of idiopathic nephrotic syndrome (NS), especially in steroid-resistant cases. FSGS is known to recur after kidney transplantation, frequently followed by graft loss. However, not all patients with FSGS suffer from recurrence after kidney transplantation, and genetic and secondary FSGS have a negligible risk of recurrence. Furthermore, many cases of recurrence achieve remission with the current management of recurrence (intensive plasmapheresis/immunosuppression, including rituximab), and other promising agents are being evaluated. Therefore, a pathologic diagnosis of FSGS itself should not cause postponement of allograft kidney transplantation. For patients with a high risk of recurrence who presented with classical symptoms of NS, that is, severe edema, proteinuria, and hypoalbuminemia, close monitoring of proteinuria is necessary, followed by immediate, intensive treatment for recurrence. PMID:27213154

  2. [Cryptosporidium parvum Gastroenteritis in a Patient with Renal Transplantation].

    PubMed

    Çetinkaya, Ülfet; Dursun, İsmail; Kuk, Salih; Şahin, İzzet; Yazar, Süleyman

    2015-09-01

    In this study, a case who starting abundant watery diarrhea on the 14th day of renal transplantation is presented. Stool sample was analyzed for Cryptosporidium spp. by carbol fuchsin staining method, copro-ELISA and nested polimeraze chain reaction (PCR). From sample found positive by Carbol-fuchsin staining method and Copro-ELISA, DNA sequence analysis was performed, gel-purified from amplicon obtained by nested PCR. As a result of DNA sequence analysis was determined to be Cryptosporidium parvum. Although C. parvum is a rare causative agent of gastroenteritis it can be cause serious clinical diarrhea solid organ transplantation patient. As a result, also C.parvum must be considered as a causative agent of diarrhea occurring after organ transplantation. PMID:26470932

  3. Laparoscopic cholecystectomy in a renal transplant recipient.

    PubMed

    Hudson, H M; Hakaim, A G; Birkett, D H

    1992-01-01

    Laparoscopic cholecystectomy is a viable and safe alternative for the treatment of symptomatic gallstones and biliary colic. As surgeons gain more experience with this procedure, contraindications become fewer and indications increase. Well-documented advantages of this approach include less patient discomfort, less surgical scarring, and earlier return to employment. Not previously discussed in the literature, however, are the additional advantages that this procedure holds for a specific subset of patients--namely, those patients that have undergone successful organ transplantation and are receiving immunosuppressive drugs. We report a case of a laparoscopic cholecystectomy in such a patient. PMID:1387737

  4. Pretransplant renal dysfunction predicts poorer outcome in liver transplantation.

    PubMed

    Lafayette, R A; Paré, G; Schmid, C H; King, A J; Rohrer, R J; Nasraway, S A

    1997-09-01

    The postoperative courses of 115 liver transplant recipients were reviewed to monitor for outcomes of acute renal failure and mortality. An analysis of baseline (preoperative) variables with particular attention to baseline renal function was accomplished to establish predictive variables for a complicated postoperative course. Acute renal failure requiring dialysis occurred in 27 cases (23%) and was associated with a prolonged ICU stay, greater infectious complications, greater hospital charges and a high mortality rate (46 +/- 11% vs. 9 +/- 3%) as compared to patients who did not experience acute renal failure. Death occurred in 20 patients (17%) overall prior to discharge. In order to assess the contribution of renal function, the population was divided arbitrarily into two groups based on preoperative serum creatinine. Group 1 (n = 50) had a preoperative serum creatinine < 1.0 mg/dl (mean +/- SD = 2.2 +/- 0.2 mg/dl) and Group 2 (n = 65) had a preoperative serum creatinine < or = 1.0 mg/dl (0.7 +/- 0.1 mg/dl). The groups experienced similar operative courses. Group 1 patients experienced significantly longer ICU stays (18 +/- 3 vs. 10 +/- 2 days), higher rates of acute renal failure requiring dialysis (52 +/- 7 vs. 5 +/- 2%), higher hospital charges (231,454 +/- 17,088 vs. 178,755 +/- 14,744 $, US) and a greatly increased mortality rate (32 +/- 1 vs. 6 +/- 1%), as compared to Group 2 patients. A multifactorial regression analysis demonstrated that of all pretransplant factors analyzed, elevation in the serum creatinine was significantly associated and was the strongest predictor of both outcomes: acute renal failure requiring dialysis (ROC = 0.89) and death (ROC = 0.83). The presence or absence of hepatorenal syndrome did not influence the results of this analysis. This study demonstrates that cirrhotic patients with renal dysfunction, as indicated by an elevated serum creatinine, experience a poor surgical outcome following liver transplantation. These patients

  5. Primary disease recurrence—effects on paediatric renal transplantation outcomes.

    PubMed

    Bacchetta, Justine; Cochat, Pierre

    2015-06-01

    Primary disease recurrence after renal transplantation is mainly diagnosed by examination of biopsy samples, but can also be associated with clinical symptoms. In some patients, recurrence can lead to graft loss (7-8% of all graft losses). Primary disease recurrence is generally associated with a high risk of graft loss in patients with focal segmental glomerulosclerosis, membranous proliferative glomerulonephritis, primary hyperoxaluria or atypical haemolytic uraemic syndrome. By contrast, disease recurrence is associated with a limited risk of graft loss in patients with IgA nephropathy, renal involvement associated with Henoch-Schönlein purpura, antineutrophil cytoplasmic antibody-associated glomerulonephritis or lupus nephritis. The presence of systemic diseases that affect the kidneys, such as sickle cell anaemia and diabetes mellitus, also increases the risk of delayed graft loss. This Review provides an overview of the epidemiology, pathophysiology and management of primary disease recurrence in paediatric renal graft recipients, and describes the overall effect on graft survival of each of the primary diseases listed above. With appropriate management, few paediatric patients should be excluded from renal transplantation programmes because of an increased risk of recurrence. PMID:25917555

  6. ABO incompatible renal transplants: Good or bad?

    PubMed Central

    Muramatsu, Masaki; Gonzalez, Hector Daniel; Cacciola, Roberto; Aikawa, Atsushi; Yaqoob, Magdi M; Puliatti, Carmelo

    2014-01-01

    ABO incompatible kidney transplantation (ABOi-KT) was previously considered to be an absolute contraindication for patients with end-stage kidney disease (ESKD) due to hyperacute rejection related to blood type barrier. Since the first successful series of ABOi-KT was reported, ABOi-KT is performed increasingly all over the world. ABOi-KT has led to an expanded donor pool and reduced the number of patients with ESKD awaiting deceased kidney transplantation (KT). Intensified immunosuppression and immunological understanding has helped to shape current desensitization protocols. Consequently, in recent years, ABOi-KT outcome is comparable to ABO compatible KT (ABOc-KT). However, many questions still remain unanswered. In ABOi-KT, there is an additional residual immunological risk that may lead to allograft damage, despite using current diverse but usually intensified immunosuppressive protocols at the expense of increasing risk of infection and possibly malignancy. Notably, in ABOi-KT, desensitization and antibody reduction therapies have increased the cost of KT. Reassuringly, there has been an evolution in ABOi-KT leading to a simplification of protocols over the last decade. This review provides an overview of the history, outcome, protocol, advantages and disadvantages in ABOi-KT, and focuses on whether ABOi-KT should be recommended as a therapeutic option of KT in the future. PMID:24669364

  7. Endovascular Repair of Abdominal Aortic Aneurysm in a Patient with Renal Transplant

    SciTech Connect

    Rao, M.; Arya, N. Lee, B.; Hannon, R.J.; Loan, W.; Soong, C.V.

    2004-09-15

    Patients with functioning renal transplant who develop abdominal aortic aneurysm can safely be treated with endovascular repair. Endovascular repair of aneurysm avoids renal ischemia associated with cross-clamping of aorta.

  8. Pediatric renal transplantation: 13 years of experience--report from the Chilean Cooperative Multicenter Group.

    PubMed

    Rosati, P; Pinto, V; Delucchi, A; Salas, P; Cano, F; Zambrano, P; Lagos, E; Rodriguez, E; Hevia, P; Ramirez, K; Quiero, X; Azócar, M; Rodriguez, S; Aguiló, J; Varela, M; Ferrario, M; Ramirez, R; Palacios, J M; Turu, I; Jimenez, O; Godoy, J; Gaete, J; Maluenda, X; Villegas, R

    2005-04-01

    Between 1989 and 2002, 178 renal transplants were performed in 168 pediatric patients in Chile. The mean age was 10.9 +/- 3.7 years (range 1 to 17.9). End-state renal disease etiologies were: congenital renal hypoplasia/dysplasia, chronic glomerulonephritis, and reflux nephropathy. Seventy received a graft from a living donor (LD), and 108 from a cadaveric donor (CD). Only 9% received antibody induction. Acute rejection episodes were reported in 76 patients: 38% in LD recipients and 48% in CD recipients (P = NS). One-, 3-, and 5-year graft survivals were 88%, 84%, and 76%, respectively, for LD and 86%, 79%, and 68% for CD recipients. Actuarial graft survival was significantly better among those patients with serum creatinine < 1 mg/dL at 1 year posttransplant compared with those with creatinine > 1 mg/dL (P < .05). The graft survival rate has improved from the first period (1989 to 1996) to the second period (1997 to 2002); (P = .05). Patient survival rates at 1, 3, and 5 years were 98%, 98%, and 98%, respectively, for LD, and 95%, 94%, and 94% for CD. Global height/age Z-score decreased from -0.7 at birth to -1.5 when dialysis started, and to -2.4 at the time of transplantation. The Z-score height/age at 1, 3, and 5 years posttransplantation was -2.25, -2.24, and -2.5. No significant differences were observed in transplant outcomes comparing patients younger than 7 years with those older ones. In conclusion, pediatric renal transplant has been performed in Chile with acceptable morbidity. The patient and graft survivals are similar to the reported international experience. In the last period there was a significant improvement in graft survival. PMID:15866676

  9. Liver regeneration after living donor transplant

    PubMed Central

    Olthoff, Kim M.; Emond, Jean C.; Shearon, Tempie H.; Everson, Greg; Baker, Talia B.; Fisher, Robert A.; Freise, Chris E.; Gillespie, Brenda W.; Everhart, James E.

    2014-01-01

    Background & Aims Adult-to-adult living donors and recipients were studied to characterize patterns of liver growth and identify associated factors in a multicenter study. Methods 350 donors and 353 recipients in A2ALL (Adult to Adult Living Donor Liver Transplantation Cohort Study) transplanted between March 2003 and February 2010 were included. Potential predictors of 3-month liver volume included total and standard liver volumes (TLV, SLV), the model for end-stage liver disease (MELD) score (in recipients), remnant and graft size, remnant to donor and graft to recipient weight ratio (RDWR, GRWR), remnant/TLV, and graft/SLV. Results Among donors, 3-month absolute growth was 676±251g (mean± SD) and percent reconstitution was 80%±13%. Among recipients, GRWR was 1.3%±0.4% (8<0.8%). Graft weight was 60%±13% of SLV. Three-month absolute growth was 549±267g and percent reconstitution was 93%±18%. Predictors of greater 3-month liver volume included larger patient size (donors, recipients), larger graft volume (recipients), and larger TLV (donors). Donors with the smallest remnant/TLV ratios had larger than expected growth, but also had higher postoperative bilirubin and international normalized ratio at 7 and 30 days. In a combined donor-recipient analysis, donors had smaller 3-month liver volumes than recipients adjusted for patient size, remnant or graft volume, and TLV or SLV (p=0.004). Recipient graft failure in the first 90 days was predicted by poor graft function at day 7 (HR=4.50, p=0.001), but not by GRWR or graft fraction (p>0.90 for each). Conclusions Both donors and recipients had rapid yet incomplete restoration of tissue mass in the first 3 months, confirming previous reports. Recipients achieved a greater percentage of expected total volume. Patient size and recipient graft volume significantly influenced 3 month volumes. Importantly, donor liver volume is a critical predictor of the rate of regeneration, and donor remnant fraction impacts post

  10. Determinants of graft survival in pediatric and adolescent live donor kidney transplant recipients: a single center experience.

    PubMed

    El-Husseini, Amr A; Foda, Mohamed A; Shokeir, Ahmed A; Shehab El-Din, Ahmed B; Sobh, Mohamed A; Ghoneim, Mohamed A

    2005-12-01

    To study the independent determinants of graft survival among pediatric and adolescent live donor kidney transplant recipients. Between March 1976 and March 2004, 1600 live donor kidney transplants were carried out in our center. Of them 284 were 20 yr old or younger (mean age 13.1 yr, ranging from 5 to 20 yr). Evaluation of the possible variables that may affect graft survival were carried out using univariate and multivariate analyses. Studied factors included age, gender, relation between donor and recipient, original kidney disease, ABO blood group, pretransplant blood transfusion, human leukocyte antigen (HLA) matching, pretransplant dialysis, height standard deviation score (SDS), pretransplant hypertension, cold ischemia time, number of renal arteries, ureteral anastomosis, time to diuresis, time of transplantation, occurrence of acute tubular necrosis (ATN), primary and secondary immunosuppression, total dose of steroids in the first 3 months, development of acute rejection and post-transplant hypertension. Using univariate analysis, the significant predictors for graft survival were HLA matching, type of primary urinary recontinuity, time to diuresis, ATN, acute rejection and post-transplant hypertension. The multivariate analysis restricted the significance to acute rejection and post-transplant hypertension. The independent determinants of graft survival in live-donor pediatric and adolescent renal transplant recipients are acute rejection and post-transplant hypertension. PMID:16269048

  11. Can pre-implantation biopsies predict renal allograft function in pediatric renal transplant recipients?

    PubMed Central

    Kari, Jameela A.; Ma, Alison L.; Dufek, Stephanie; Mohamed, Ismail; Mamode, Nizam; Sebire, Neil J.; Marks, Stephen D.

    2015-01-01

    Objectives: To determine the utility of pre-implantation renal biopsy (PIB) to predict renal allograft outcomes. Methods: This is a retrospective review of all patients that underwent PIB from January 2003 to December 2011 at the Great Ormond Street Hospital for Children in London, United Kingdom. Thirty-two male patients (56%) aged 1.5-16 years (median: 10.2) at the time of transplantation were included in the study and followed-up for 33 (6-78) months. The results were compared with 33 controls. Results: The PIB showed normal histopathological findings in 13 patients (41%), mild chronic vascular changes in 8 (25%), focal tubular atrophy in one, moderate to severe chronic vascular change in 3, mild to moderate acute tubular damage in 6, and tissue was inadequate in one subject. Delayed graft function (DGF) was observed in 3 patients; 2 with vascular changes in PIB, and one with normal histopathological findings. Two subjects with PIB changes lost their grafts. The estimated glomerular filtration rate at 3-, and 6-months post-transplantation was lower in children with abnormal PIB changes compared with those with normal PIB. There was one case of DGF in the control group, and 4 children lost their grafts including the one with DGF. Conclusion: Pre-implantation renal biopsy can provide important baseline information of the graft with implications on subsequent medical treatment for pediatric renal transplant recipients. PMID:26593162

  12. Renal transplantation in Nepal: the first year's experience.

    PubMed

    Chalise, Pawan R; Shah, Dibya S; Sharma, Uttam K; Gyawali, Prem R; Shrestha, Guna K; Joshi, Bhola R; Kafle, Mukunda P; Sigdel, Mahesh; Raut, Kanak B; Francis, David

    2010-05-01

    A successful renal transplantation service was started in Nepal at the Tribhuvan University Teaching Hospital in August 2008, and a continuing regular service is being provided currently to needy people. We report here our experience in thirty five end stage renal disease patients who received kidneys from close relatives during a one year period. The mean age of donors was 46.7 years. Seventeen (49%) donations were from parents, 13 (37%) from spouses, four (11%) between siblings and one (3%) between mother and daughter in law. Although the left kidney was given preference, right sided donor nephrectomy was needed in five (14%) cases. Six (17%) donors had minor postoperative problems. The mean age of recipients was 33.2 years, four (11%) of whom had pre-emptive renal transplantation. Recipients were immunosuppressed with dacluzimab, prednisolone, mycophenalate, and cyclosporine or tacrolimus. The average time taken for graft implantation was 137 minutes. The mean cold ischemia time and second warm ischemia time were 133 and 36 minutes respectively. Four (11%) patients developed urinary tract infection, three (9%) had significant hematuria, one (3%) developed a peri-transplant abscess, and one (3%) had ureteric ischemia and urine leak which required re-exploration in the early post-operative period. Four patients (11%) developed acute rejection of which three were cell-mediated rejection and one was antibody-mediated. There were two (6%) deaths, one due to transplant-related sepsis and the other due to subarachnoid hemorrhage following rupture of a posterior communicating artery aneurysm. No kidney has been lost otherwise. PMID:20427894

  13. Mining the human urine proteome for monitoring renal transplant injury.

    PubMed

    Sigdel, Tara K; Gao, Yuqian; He, Jintang; Wang, Anyou; Nicora, Carrie D; Fillmore, Thomas L; Shi, Tujin; Webb-Robertson, Bobbie-Jo; Smith, Richard D; Qian, Wei-Jun; Salvatierra, Oscar; Camp, David G; Sarwal, Minnie M

    2016-06-01

    The human urinary proteome provides an assessment of kidney injury with specific biomarkers for different kidney injury phenotypes. In an effort to fully map and decipher changes in the urine proteome and peptidome after kidney transplantation, renal allograft biopsy matched urine samples were collected from 396 kidney transplant recipients. Centralized and blinded histology data from paired graft biopsies was used to classify urine samples into diagnostic categories of acute rejection, chronic allograft nephropathy, BK virus nephritis, and stable graft. A total of 245 urine samples were analyzed by liquid chromatography-mass spectrometry using isobaric Tags for Relative and Absolute Quantitation (iTRAQ) reagents. From a group of over 900 proteins identified in transplant injury, a set of 131 peptides were assessed by selected reaction monitoring for their significance in accurately segregating organ injury causation and pathology in an independent cohort of 151 urine samples. Ultimately, a minimal set of 35 proteins were identified for their ability to segregate the 3 major transplant injury clinical groups, comprising the final panel of 11 urinary peptides for acute rejection (93% area under the curve [AUC]), 12 urinary peptides for chronic allograft nephropathy (99% AUC), and 12 urinary peptides for BK virus nephritis (83% AUC). Thus, urinary proteome discovery and targeted validation can identify urine protein panels for rapid and noninvasive differentiation of different causes of kidney transplant injury, without the requirement of an invasive biopsy. PMID:27165815

  14. Epidemiology of urinary infections in renal transplant recipients.

    PubMed

    Valera, B; Gentil, M A; Cabello, V; Fijo, J; Cordero, E; Cisneros, J M

    2006-10-01

    Urinary tract infection (UTI) remains a significant cause of infectious complications in renal transplant recipients. We evaluated prospectively all the UTIs in 161 kidney recipients transplanted between July 2003 and July 2005. All patients received prophylaxis with sulfadoxine-pyrimethamine. We excluded asymptomatic bacteriuria. Forty-one patients (25%) suffered at least one UTI episode. Ninety-two episodes of infection were confirmed with an incidence rate of 97 UTI episodes per 100 patient-years. The most common clinical features were uncomplicated acute bacterial cystitis, 71 episodes (77%), and acute pyelonephritis, 21 episodes (23%). Microbiological isolation was confirmed in 58 episodes (63%). Bacterial infections were the most frequent etiologies: gram-negative bacilli in 52 (90%), gram-positive cocci in 4 (7%), fungal in 2 (3%), and one viral BK virus (2%) infection. The causative microorganisms were E. coli as the principal isolated agent in 41 cases (71%), including 10 (24%) that were extended-spectrum betalactamases (ESBLEC). All episodes showed a favorable course. The survival rate of the graft at the end of the study period was 90.7%, and the survival rate of the transplant recipients was 97.5%. The incidence of UTI in transplant patients who received antibiotic prophylaxis was high. E. coli (ESBLEC) was the main agent isolated. Uncomplicated UTI, the most frequent post transplantation infection, showed a good prognosis. PMID:17097953

  15. Evaluation of Heparin Anticoagulation Protocols in Post–Renal Transplant Recipients (EHAP-PoRT Study)

    PubMed Central

    Ng, Joan Chung Yan; Leung, Marianna; Landsberg, David

    2016-01-01

    thromboplastin time were above target. A larger proportion of deceased-donor transplant recipients who had major bleeding were taking antiplatelet agents, relative to living-donor transplant recipients. Conclusion: Therapeutic use of heparin increased the risk of bleeding among renal transplant recipients, but there were no cases of thrombosis. Prophylactic use of heparin did not increase the risk of bleeding and prevented proportionately more cases of thrombosis relative to no anticoagulation; this result supports the continued use of prophylaxis. PMID:27168632

  16. The knowledge, awareness, and acceptability of renal transplantation among patients with end-stage renal disease in Ibadan, Nigeria.

    PubMed

    Takure, A O; Jinadu, Y O; Adebayo, S A; Shittu, O B; Salako, B L; Kadiri, S

    2016-01-01

    Renal transplantation is well established in the USA, Europe, India, and South Africa. However, it is still in its infancy in Nigeria. The objective of our study is to determine the knowledge, awareness, and acceptability of renal transplant among patients with end-stage renal disease (ESRD) and the factors which are responsible for the low level of transplantation in Ibadan, Nigeria. A 15-item pilot-tested questionnaire was administered to willing patients with ESRD seen at the medical outpatient clinic of the University Teaching Hospital, from January to December 2011. There was 81% participation rate of the respondents. Exactly 90.1% had formal education and 44% earned <50,000 naira per month. Seventy-nine percent of respondents was aware of renal transplantation, 70.4% would recommend it to others, and 66.7% accepted renal transplantation; 77.8% would maintain a close relationship with their donors. About 61.7% considered it very expensive, while 33.3% did not know the cost for transplantation. Of the reason for the low level of kidney transplantation in Nigeria, 39.5% had no idea and in 27.2% of the respondents, the fear of death by potential donors may be responsible. Eleven percent of responded that recipients had no money for kidney transplantation and another 11% thought the potential donors would like to be paid for donating their kidneys. Most of the respondents with ESRD were knowledgeable, aware of, and accepted renal transplantation as the next step to treat chronic renal failure. However, majority of these patients could not afford the cost for renal transplantation. PMID:27424696

  17. Applying best practices to designing patient education for patients with end-stage renal disease pursuing kidney transplant

    PubMed Central

    Skelton, Stacy L.; Waterman, Amy D.; Davis, LaShara A.; Peipert, John D.; Fish, Anne F.

    2015-01-01

    Despite the known benefits of kidney transplant, less than 30% of the 615000 patients living with end-stage renal disease (ESRD) in the United States have received a transplant. More than 100000 people are presently on the transplant waiting list. Although the shortage of kidneys for transplant remains a critical factor in explaining lower transplant rates, another important and modifiable factor is patients’ lack of comprehensive education about transplant. The purpose of this article is to provide an overview of known best practices from the broader literature that can be used as an evidence base to design improved education for ESRD patients pursuing a kidney transplant. Best practices in chronic disease education generally reveal that education that is individually tailored, understandable for patients with low health literacy, and culturally competent is most beneficial. Effective education helps patients navigate the complex health care process successfully. Recommendations for how to incorporate these best practices into transplant education design are described. Providing more ESRD patients with transplant education that encompasses these best practices may improve their ability to make informed health care decisions and increase the numbers of patients interested in pursuing transplant. PMID:25758805

  18. Management of severe pancreatitis in renal transplant recipients.

    PubMed Central

    Slakey, D P; Johnson, C P; Cziperle, D J; Roza, A M; Wittmann, D H; Gray, D W; Roake, J A; Britton, J; Morris, P J; Adams, M B

    1997-01-01

    OBJECTIVE: The authors determine if any aspects of the treatment of renal transplant patients with pancreatitis were of particular benefit with regard to graft and patient survival. BACKGROUND: The incidence of pancreatitis in renal transplant patients is low (1%-2%), but the mortality of the disease approaches 100%. Although several descriptive reports have been published, there is no consensus-regarding management. METHODS: The authors conduct a retrospective chart review. RESULTS: Twenty-one patients were identified with posttransplant pancreatitis (1.3% incidence). The cause of pancreatitis was presumed to be maintenance immunosuppression in all cases. Patients were classified by dynamic computed tomography (CT) scans having 1) mild/edematous disease (4 patients), 2) localized abscess or pseudocyst (6 patients), or 3) severe disease (11 patients). Patients with mild/edematous pancreatitis did well with medical management. The six patients with localized abscess or pseudocyst were successfully treated with standard operative intervention. Of the 11 patients with severe disease, 6 had several days of intensive medical management before operation, and all died. The other five patients underwent early operative intervention based principally on CT scan findings, and all survived. The latter group had multiple operations and four of five had functioning renal allografts at discharge. CONCLUSION: The severity of pancreatitis in the posttranplant patients may be difficult to assess by clinical criteria. Dynamic CT scanning is, therefore, essential in defining the extent of disease. Early, and perhaps repeated, operations may be lifesaving in those patients having CT scan findings of severe pancreatitis. PMID:9065299

  19. Ethical perspectives on living donor organ transplantation in Asia.

    PubMed

    Concejero, Allan M; Chen, Chao-Long

    2009-12-01

    Live donors are a continuing source of organ grafts for solid organ transplantation in Asia. Ethical issues surrounding the development of living donor organ transplantation in Eastern countries are different from those in Western countries. Donor safety is still the paramount concern in any donor operation. Issues on organ trafficking remain societal concerns in low-income nations. Religion, cultural background, economic prerogatives, and timely legislation contribute to the social acceptance and maturation of organ donation. PMID:19938130

  20. Recurrent and de novo disease after renal transplantation: a report from the Renal Allograft Disease Registry.

    PubMed

    Hariharan, Sundaram; Savin, Virginia J

    2004-08-01

    Recurrent and de novo disease is an increasing problem and is known to negatively impact transplant graft survival. Immunosuppressive medications have not had an impact on the prevalence of recurrent and de novo disease. Renal Allograft Disease Registry (RADR) was established to study the prevalence, impact and risk factors for the development of recurrent and de novo disease. Retrospective and prospective study on recurrent disease is discussed in this manuscript. PMID:15265160

  1. Evaluation of psychiatric issues in renal transplant setting

    PubMed Central

    Naqvi, R.

    2015-01-01

    Chronic illnesses can cause wide range of personality and behavioral disorders and require appropriate evaluation. Poor patient compliance with prescribed medications and other aspects of management can affect the outcome towards undesirable situation. The setting of renal transplantation presents a broad spectrum of problems and consequences. People involved (patients, their families or treating physicians) have lifelong commitment with evaluation and implementation of measures towards resolving the issues. Psychiatric evaluation is part of this scenario, which starts with evaluation of organ recipient along with donor and family as whole, right from time of diagnosis of end organ failure to transplant and then lifelong. This review highlights common issues faced at different stages of this lengthy pathway. PMID:26664203

  2. Evaluation of psychiatric issues in renal transplant setting.

    PubMed

    Naqvi, R

    2015-01-01

    Chronic illnesses can cause wide range of personality and behavioral disorders and require appropriate evaluation. Poor patient compliance with prescribed medications and other aspects of management can affect the outcome towards undesirable situation. The setting of renal transplantation presents a broad spectrum of problems and consequences. People involved (patients, their families or treating physicians) have lifelong commitment with evaluation and implementation of measures towards resolving the issues. Psychiatric evaluation is part of this scenario, which starts with evaluation of organ recipient along with donor and family as whole, right from time of diagnosis of end organ failure to transplant and then lifelong. This review highlights common issues faced at different stages of this lengthy pathway. PMID:26664203

  3. Transition from gastrostomy to oral feeding following renal transplantation.

    PubMed

    Pugh, Pearl; Watson, Alan R

    2006-01-01

    Feeding through a gastrostomy button (GB) provides benefits to the families of children on chronic dialysis. But data on the transition to oral feeding following renal transplantation--especially in children under 2--is scarce. Here, we report our experience of more than 14 years in 22 children who were GB fed at under 5 years of age (median age: 1.66 years; range: 0.25-4.25 years). We excluded 6 children from the analysis of transition following transplantation because of factors precluding early return to oral feeding--specifically, cognitive impairment and a tongue tie. We compared 10 children who commenced GB feeding at less than 2 years (group 1) with those who commenced at 2-5 years (group 2, n = 6). All 16 children made the transition to normal oral feeding by 10 months post transplantation. Median duration of GB feeding post-transplant in group 1 was 0.3 years (range: 0.1-1.0 years) as compared with 0.2 years (range: 0-0.3 years) in group 2 (p = 0.2). Children with normal cognition and no other precluding factors who have a GB inserted at less than 2 years of age can make a successful transition from GB to oral feeding with no significant delay. Family support should be individualized during this period of potential anxiety. PMID:16983960

  4. A simple and accurate grading system for orthoiodohippurate renal scans in the assessment of post-transplant renal function

    SciTech Connect

    Zaki, S.K.; Bretan, P.N.; Go, R.T.; Rehm, P.K.; Streem, S.B.; Novick, A.C. )

    1990-06-01

    Orthoiodohippurate renal scanning has proved to be a reliable, noninvasive method for the evaluation and followup of renal allograft function. However, a standardized system for grading renal function with this test is not available. We propose a simple grading system to distinguish the different functional phases of hippurate scanning in renal transplant recipients. This grading system was studied in 138 patients who were evaluated 1 week after renal transplantation. There was a significant correlation between the isotope renographic functional grade and clinical correlates of allograft function such as the serum creatinine level (p = 0.0001), blood urea nitrogen level (p = 0.0001), urine output (p = 0.005) and need for hemodialysis (p = 0.007). We recommend this grading system as a simple and accurate method to interpret orthoiodohippurate renal scans in the evaluation and followup of renal allograft recipients.

  5. Cyclosporin-erythromycin interaction in renal transplant patients.

    PubMed Central

    Gupta, S K; Bakran, A; Johnson, R W; Rowland, M

    1989-01-01

    1. The interaction between cyclosporin (CyA) and erythromycin was studied in renal transplant patients following oral and intravenous administration of CyA. 2. Blood and plasma CyA concentrations and blood concentrations of metabolite 17 were measured by h.p.l.c. 3. Erythromycin produced almost a two-fold increase in bioavailability, from 36% to 60%; with a small (13%) decrease in clearance of CyA. 4. The metabolite 17 data further support the postulate that erythromycin increases the absorption of CyA rather than inhibits its metabolism, as generally believed. PMID:2655690

  6. Scintigraphic assessment of perivesical urinary extravasation following renal transplantation

    SciTech Connect

    Bushnell, D.L.; Wilson, D.G.; Lieberman, L.M.

    1984-02-01

    Radionuclide scintigraphy is a safe and accurate means of detecting postoperative urologic complications in renal transplant recipients. Early identification of urinary leakage coupled with aggressive intervention significantly reduces the associated morbidity and mortality. Perivesical extravasate may be difficult to distinguish from adjacent or nearby bladder activity on scintiscan. Clarification of actual bladder contour and determination of its exact location within the pelvis may resolve such uncertainties. We describe imaging techniques that define the anatomic extent of the bladder and demonstrate our scintigraphic assessment of perivesical extravasation.

  7. Confusion after starting citalopram in a renal transplant patient

    PubMed Central

    Sran, Hersharan; Phanish, Mysore K

    2013-01-01

    The UK NICE (National Institute for Clinical Excellence) guidelines on management of depression in adults recommends use of selective serotonin re-uptake inhibitor (SSRI) as a first choice agent. Citalopram, an SSRI antidepressant, is a preferred antidepressant in those patients with concomitant chronic physical health problems. Hyponatraemia because of syndrome of inappropriate antiduretic hormone secrection has been reported with SSRI antidepressants but is usually mild and responds to fluid restriction and cessation of the drug. We report a case of severe hyponatraemia because of citalopram in a renal transplant patient who required treatment with hypertonic (3%) saline, with a good outcome avoiding any neurological complications. PMID:23843413

  8. Babesiosis and hemophagocytic syndrome in an asplenic renal transplant recipient.

    PubMed

    Slovut, D P; Benedetti, E; Matas, A J

    1996-08-27

    Babesiosis is a malaria-like illness transmitted by the tick Ixodes dammini. The disease is endemic to the Northeast coastal region and parts of the Midwest. Symptoms-which include fever, anemia, elevated liver function tests, and hemoglobinuria-may be especially severe in asplenic or immunocompromised patients. In rare cases, infection with Babesia may be associated with marked pancytopenia. Bone marrow biopsy may reveal hemophagocytosis and marrow histiocytosis. We report a severe case of babesiosis and hemophagocytic syndrome in an asplenic renal transplant patient. PMID:8781622

  9. Disseminated mucormycosis with myocardial involvement in a renal transplant recipient.

    PubMed

    Nam, Y; Jung, J; Park, S S; Kim, S J; Shin, S J; Choi, J H; Kim, M; Yoon, H E

    2015-12-01

    We report the case of a renal transplant recipient with pulmonary and splenic mucormycosis whose demise was accelerated by a myocardial abscess. Once pulmonary and splenic mucormycosis was diagnosed, liposomal amphotericin B was started and immunosuppressant treatments were discontinued. The pulmonary cavities regressed during treatment, but new myocardial and peri-allograft abscesses developed. The myocardial abscess diffusely infiltrated the left ventricular wall and was associated with akinesia, which led to sudden cardiac arrest. This case demonstrates a rare manifestation of mucormycosis and highlights the fatality and invasiveness of this infection. PMID:26538076

  10. Extracorporeal membrane oxygenation after living-related liver transplant.

    PubMed

    Gedik, Ender; Çelik, Muhammet Reha; Otan, Emrah; Dişli, Olcay Murat; Erdil, Nevzat; Bayındır, Yaşar; Kutlu, Ramazan; Yılmaz, Sezai

    2015-04-01

    Various types of extracorporeal membrane oxygenation methods have been used in liver transplant operations. The main indications are portopulmonary or hepatopulmonary syndromes and other cardiorespiratory failure syndromes that are refractory to conventional therapy. There is little literature available about extracorporeal membrane oxygenation, especially after liver transplant. We describe our experience with 2 patients who had living-related liver transplant. A 69-year-old woman had refractory aspergillosis pneumonia and underwent pumpless extracorporeal lung assist therapy 4 weeks after liver transplant. An 8-month-old boy with biliary atresia underwent urgent liver transplant; he received venoarterial extracorporeal membrane oxygenation therapy on postoperative day 1. Despite our unsuccessful experience with 2 patients, extracorporeal membrane oxygenation and pumpless extracorporeal lung assist therapy for liver transplant patients may improve prognosis in selected cases. PMID:25894176

  11. Ipsilateral leg swelling after renal transplantation as an alarming sign of Iliac vein stenosis

    PubMed Central

    Kim, Ju Hyeon; Bae, Seong Man; Park, Su-Kil

    2014-01-01

    Iliac vein stenosis is a rare vascular complication of renal transplantation that may compromise allograft function if not recognized and corrected in a timely fashion. Because chronic venous stenosis may remain undiagnosed for several years, a high index of suspicion should be maintained until diagnosing this rare disease. A 56-year-old renal transplant recipient presented with unilateral leg swelling and renal dysfunction 16 years after transplantation. Computed tomography excluded deep vein thrombosis and revealed tight iliac vein stenosis on the side of the renal transplant. Following angiographic confirmation of the stenosis, endovascular treatment was successfully performed with a purposefully designed, self-expanding, venous stent. Ipsilateral leg swelling is an alarming sign for the diagnosis of iliac vein stenosis after renal transplantation. Percutaneous intervention with venous stent placement seems to be a safe and effective treatment of this rare condition. PMID:26885480

  12. Renal transplantation in autosomal dominant polycystic kidney disease.

    PubMed

    Kanaan, Nada; Devuyst, Olivier; Pirson, Yves

    2014-08-01

    In patients with autosomal dominant polycystic kidney disease (ADPKD) evaluated for kidney transplantation, issues related to native nephrectomy, cystic liver involvement, screening for intracranial aneurysms and living-related kidney donation deserve special consideration. Prophylactic native nephrectomy is restricted to patients with a history of cyst infection or recurrent haemorrhage or to those in whom space must be made to implant the graft. Patients with liver involvement require pretransplant imaging. Selection of patients for pretransplant screening of intracranial aneurysms should follow the general recommendations for patients with ADPKD. In living related-donor candidates aged <30 years and at-risk of ADPKD, molecular genetic testing should be carried out when ultrasonography and MRI findings are normal or equivocal. After kidney transplantation, patient and graft survival rates are excellent and the volume of native kidneys decreases. However, liver cysts continue to grow and treatment with a somatostatin analogue should be considered in patients with massive cyst involvement. Cerebrovascular events have a marginal effect on post-transplant morbidity and mortality. An increased risk of new-onset diabetes mellitus and nonmelanoma skin cancers has been reported, but several studies have challenged these findings. Finally, no data currently support the preferential use of mammalian target of rapamycin inhibitors as immunosuppressive agents in transplant recipients with ADPKD. PMID:24935705

  13. Shotgun Proteomics Identifies Proteins Specific for Acute Renal Transplant Rejection

    SciTech Connect

    Sigdel, Tara K.; Kaushal, Amit; Gritsenko, Marina A.; Norbeck, Angela D.; Qian, Weijun; Xiao, Wenzhong; Camp, David G.; Smith, Richard D.; Sarwal, Minnie M.

    2010-01-04

    Acute rejection (AR) remains the primary risk factor for renal transplant outcome; development of non-invasive diagnostic biomarkers for AR is an unmet need. We used shotgun proteomics using LC-MS/MS and ELISA to analyze a set of 92 urine samples, from patients with AR, stable grafts (STA), proteinuria (NS), and healthy controls (HC). A total of 1446 urinary proteins were identified along with a number of NS specific, renal transplantation specific and AR specific proteins. Relative abundance of identified urinary proteins was measured by protein-level spectral counts adopting a weighted fold-change statistic, assigning increased weight for more frequently observed proteins. We have identified alterations in a number of specific urinary proteins in AR, primarily relating to MHC antigens, the complement cascade and extra-cellular matrix proteins. A subset of proteins (UMOD, SERPINF1 and CD44), have been further cross-validated by ELISA in an independent set of urine samples, for significant differences in the abundance of these urinary proteins in AR. This label-free, semi-quantitative approach for sampling the urinary proteome in normal and disease states provides a robust and sensitive method for detection of urinary proteins for serial, non-invasive clinical monitoring for graft rejection after

  14. Increased intestinal permeability during cytomegalovirus infection in renal transplant recipients.

    PubMed

    de Maar, E F; Kleibeuker, J H; Boersma-van Ek, W; The, T H; van Son, W J

    1996-01-01

    Cytomegalovirus (CMV) infections in renal transplant recipients can affect the gastrointestinal tract, but significant clinical manifestations are seldom seen. We hypothesize that subclinical involvement of the gastrointestinal tract may be quite frequent during CMV infection. In order to study this, we measured intestinal permeability by calculating the urinary lactulose mannitol (LM) excretion ratio after oral administration of lactulose and mannitol (normal < 0.030) in patients with symptomatic and asymptomatic CMV infection. A total of 111 patients were enrolled in the study, 104 of whom were tested on postoperative day (POD) 10. Twenty-nine patients developed CMV infection, 12 of whom could be studied with the permeability test (median POD 40). Another nine patients without CMV infection were also studied at day 40 and served as controls. The LM ratio increased significantly during CMV infection compared to measurements before active infection (median 0.060 vs. 0.030, P < 0.01) and was significantly higher during the infection than in the control group (median 0.007, P < 0.01). No correlation could be found between the LM ratio and viral load, humoral response to the virus, or symptomatology of infection. We conclude that an increased intestinal permeability is found in a substantial number of patients with an active, albeit asymptomatic, CMV infection after renal transplantation. Pathophysiological mechanisms and clinical implications remain speculative but will be subject to further study. PMID:8914238

  15. Chronic Renal Transplant Rejection and Possible Anti-Proliferative Drug Targets.

    PubMed

    Bhatti, Adnan Bashir; Usman, Muhammad

    2015-01-01

    The global prevalence of renal transplants is increasing with time, and renal transplantation is the only definite treatment for end-stage renal disease. We have limited the acute and late acute rejection of kidney allografts, but the long-term survival of renal tissues still remains a difficult and unanswered question as most of the renal transplants undergo failure within a decade of their transplantation. Among various histopathological changes that signify chronic allograft nephropathy (CAN), tubular atrophy, fibrous thickening of the arteries, fibrosis of the kidney interstitium, and glomerulosclerosis are the most important. Moreover, these structural changes are followed by a decline in the kidney function as well. The underlying mechanism that triggers the long-term rejection of renal transplants involves both humoral and cell-mediated immunity. T cells, with their related cytokines, cause tissue damage. In addition, CD 20+ B cells and their antibodies play an important role in the long-term graft rejection. Other risk factors that predispose a recipient to long-term graft rejection include HLA-mismatching, acute episodes of graft rejection, mismatch in donor-recipient age, and smoking. The purpose of this review article is the analyze current literature and find different anti-proliferative agents that can suppress the immune system and can thus contribute to the long-term survival of renal transplants. The findings of this review paper can be helpful in understanding the long-term survival of renal transplants and various ways to improve it. PMID:26677426

  16. Chronic Renal Transplant Rejection and Possible Anti-Proliferative Drug Targets

    PubMed Central

    Usman, Muhammad

    2015-01-01

    The global prevalence of renal transplants is increasing with time, and renal transplantation is the only definite treatment for end-stage renal disease. We have limited the acute and late acute rejection of kidney allografts, but the long-term survival of renal tissues still remains a difficult and unanswered question as most of the renal transplants undergo failure within a decade of their transplantation. Among various histopathological changes that signify chronic allograft nephropathy (CAN), tubular atrophy, fibrous thickening of the arteries, fibrosis of the kidney interstitium, and glomerulosclerosis are the most important. Moreover, these structural changes are followed by a decline in the kidney function as well. The underlying mechanism that triggers the long-term rejection of renal transplants involves both humoral and cell-mediated immunity. T cells, with their related cytokines, cause tissue damage. In addition, CD 20+ B cells and their antibodies play an important role in the long-term graft rejection. Other risk factors that predispose a recipient to long-term graft rejection include HLA-mismatching, acute episodes of graft rejection, mismatch in donor-recipient age, and smoking. The purpose of this review article is the analyze current literature and find different anti-proliferative agents that can suppress the immune system and can thus contribute to the long-term survival of renal transplants. The findings of this review paper can be helpful in understanding the long-term survival of renal transplants and various ways to improve it. PMID:26677426

  17. Recruitment of renal transplant patients into patrolling police roles using orthotic shields

    PubMed Central

    Levene, Sara; Levene, Charlotte Amy; Makanjuola, David; Rajakariar, Ravi

    2014-01-01

    Renal allografts are transplanted to an anatomically unnatural site where they are exposed to trauma, and may fail if damaged. Individuals with renal allografts have been excluded from patrolling police roles as these often necessitate confrontation. We describe two patients with renal allografts who have been recruited by the Metropolitan Police Service, using bespoke orthotic shields to protect the grafts. PMID:24879727

  18. Medication therapy management and adherence among US renal transplant recipients

    PubMed Central

    Chisholm-Burns, Marie A; Spivey, Christina A; Tolley, Elizabeth A; Kaplan, Erin K

    2016-01-01

    Background Medication therapy management (MTM) services among patient populations with a range of disease states have improved adherence rates. However, no published studies have examined the impact of Medicare Part D MTM eligibility on renal transplant recipients’ (RTRs) immunosuppressant therapy (IST) adherence. This study’s purpose was therefore, to determine the effects of Medicare Part D MTM on IST adherence among adult RTRs at 12 months posttransplant. Methods Cross-sectional analyses were performed on Medicare Parts A, B, and D claims and transplant follow-up data reported in the United States Renal Data System. The sample included adult RTRs who were transplanted between 2006 and 2011, had graft survival for 12 months, were enrolled in Part D, and were prescribed tacrolimus. IST adherence was measured by medication possession ratio for tacrolimus. MTM eligibility was determined using criteria established by the Centers for Medicare and Medicaid Services. Descriptive statistics were calculated. Adherence was modeled using multiple logistic regression. Results In all, 17,181 RTRs were included. The majority of the sample were male (59.1%), and 42% were MTM-eligible. Mean medication possession ratio was 0.91±0.17 (mean ± standard deviation), with 16.83% having a medication possession ratio of <0.80. MTM eligibility, sex, age, and number of prescription drugs were significantly associated with adherence in the full model (P<0.05). MTM-eligible RTRs were more likely to be adherent than those who were not MTM-eligible (odds ratio =1.13, 95% confidence interval 1.02–1.26, P=0.02). Conclusion The findings provide evidence that access to MTM services increases IST adherence among RTRs. PMID:27175070

  19. Conversion to everolimus in liver transplant patients with renal dysfunction.

    PubMed

    Pérez, T; Segovia, R; Castro, L; Roblero, J P; Estela, R

    2011-01-01

    Calcineurin inhibitor (CNI) immunosuppressive therapy post-liver transplantation (OLT) is important to reduce graft rejection episodes. However, these drugs show important side effects, particularly renal dysfunction (RDF). Changing from CNI to a nonnephrotoxic drug, as mammalian target of rapamycin (mTOR) inhibitor may solve the problem. Our objective was to evaluate renal function (RF) among liver transplant patients initially receiving CNI, among whom the patients with RDF were converted completely or partially to an mTOR inhibitor like everolimus (EVE). We performed a prospective study in liver transplant patients from 2000 to 2009. Creatinine levels and creatinine clearances (Cockroft-Gault) expressed as mean values ± standard deviations were measured pre- and postswitch for comparisons using Wilcoxon nonparametric tests. Six patients were converted fully or partially to EVE. Their mean age at the moment of introducing the new therapy was 52.2 ± 13.6 years (range = 28-60). Immunosuppression time prior to switching from CNI to EVE was 23.8 ± 26.6 months (range = 6-70). Postconversion follow-up was 25.8 ± 16.5 months (range = 8-42). All patients showed improvement in RF. The creatinine level improvement was significant (P = .03) namely, from a mean of 2.26 ± 0.49 to 1.21 ± 0.57 mg/dL. Glomerular filtration rate improved from a mean of 40 ± 15.13 to 72.60 ± 17.3 mL/min/m(2) (P = .03). Conversion from CNI to EVE improved creatinine concentrations and creatinine clearances with long-term effects free of graft rejection. PMID:21839260

  20. Commercial living non-related organ transplantation: a viewpoint from a developed country.

    PubMed

    Hoyer, Peter F

    2006-10-01

    In developed countries, the use of living unrelated donors is restricted to purely altruistic donors who have a close and emotional relationship with the recipients. By law, commercial transplantation is illegal. Increasing shortness of donors, the excellent results of kidney transplants from spousal and living unrelated donors as well as the very low risk for the donor has been used as an argument for paid organ donation. Arguments in favour are the relief of donor-organ shortage, short waiting times for renal transplantation, economic benefits for the donor as well as the economic benefits for society by reducing the costs of dialysis by more transplants. Major arguments against are exploitation of the donor, coercion, and a growing black market. Despite the fact that different societies have different norms or reproaches that we are failing our patients and accept the death of thousands, kidney trade has created an environment of corruption and commercialisation, which brings even the cadaver transplant program into disrepute. However, denying the existence of paid organ donation does not contribute to solve the problem. A public discussion about consequences of changing ethics and human rights, rather than pragmatic solutions, is needed. PMID:16810510

  1. Peliosis hepatis complicated by portal hypertension following renal transplantation.

    PubMed

    Yu, Chia-Ying; Chang, Liang-Che; Chen, Li-Wei; Lee, Tsung-Shih; Chien, Rong-Nan; Hsieh, Ming-Fang; Chiang, Kun-Chun

    2014-03-01

    Peliosis hepatis (PH) is a vascular lesion of the liver that mimics a hepatic tumor. PH is often associated with underlying conditions, such as chronic infection and tumor malignancies, or with the use of anabolic steroids, immunosuppressive drugs, and oral contraceptives. Most patients with PH are asymptomatic, but some present with abdominal distension and pain. In some cases, PH may induce intraperitoneal hemorrhage and portal hypertension. This study analyzed a 46-year-old male who received a transplanted kidney nine years prior and had undergone long-term immunosuppressive therapy following the renal transplantation. The patient experienced progressive abdominal distention and pain in the six months prior to this study. Initially, imaging studies revealed multiple liver tumor-like abnormalities, which were determined to be PH by pathological analysis. Because the hepatic lesions were progressively enlarged, the patient suffered from complications related to portal hypertension, such as intense ascites and esophageal varices bleeding. Although the patient was scheduled to undergo liver transplantation, he suffered hepatic failure and died prior to availability of a donor organ. PMID:24605041

  2. Use of local allograft irradiation following renal transplantation

    SciTech Connect

    Halperin, E.C.; Delmonico, F.L.; Nelson, P.W.; Shipley, W.U.; Cosimi, A.B.

    1984-07-01

    Over a 10 year period, 67 recipients of 71 renal allografts received graft irradiation following the diagnosis of rejection. The majority of kidneys were treated with a total dose of 600 rad, 150 rad per fraction, in 4 daily fractions. Fifty-three kidneys were irradiated following the failure of standard systemic immunosuppression and maximally tolerated antirejection measures to reverse an episode of acute rejection. Twenty-two (42%) of these allografts were noted to have stable (i.e. no deterioration) or improved function 1 month following the treatment with irradiation. Eleven (21%) of these allografts maintained function 1 year following transplantation. Biopsies were obtained of 41 allografts. Of the 24 renal allografts with predominantly cellular rejection, 10 (42%) had the process reversed or stabilized at 1 month following irradiation. Five (21%) of these allografts were functioning at 1 year following irradiation. Rejection was reversed or stabilized in 6 of 17 (35%) allografts at 1 month when the histologic features of renal biopsy suggested predominantly vascular rejection. Local graft irradiation has helped maintain a limited number of allografts in patients whose rejection has failed to respond to systemic immunosuppression. Irradiation may also benefit patients with ongoing rejection in whom further systemic immunosuppression is contra-indicated.

  3. Living paid organ transplantation results in unacceptably high recipient morbidity and mortality.

    PubMed

    Inston, N G; Gill, D; Al-Hakim, A; Ready, A R

    2005-03-01

    The ethical debate surrounding the payment of living unrelated donors continues despite very little evidence regarding the outcome. The aim of this audit was to identify the scale of the problem and assess the results of patients undergoing these procedures. The large Indo-Asian population within our region has a high demand for renal replacement therapy and transplantation. These patients have a limited chance of receiving a transplant for several reasons and some resort to traveling abroad, against medical advice, to procure an unrelated donor kidney transplant. Following an initial audit in our region, a national audit was conducted within the UK. A total of 23 patients were identified, all of whom had done so against medical advice. Mortality from causes directly related to transplantation was high in this group (35%), as was graft loss. The overall rate of successful transplants was only 44% (overall graft loss was 56%) in the short term. The information regarding both donor and recipient, provided from the transplanting center, was inadequate in all cases. These results, which almost certainly represent an underestimate of an ongoing situation, reinforce the standpoint that organ trading is associated with unacceptable risks and poor outcomes. The basis of this trade in organs is based on monetary rather than clinical criteria and such exploitation of both donor and recipient lead us to conclude that this practice cannot be endorsed and even the most desperate dialysis patients should be reminded of the unacceptable risks involved in this practice. PMID:15848456

  4. Organ Transplants from Living Donors – Halachic Aspects*

    PubMed Central

    Halperin, Mordechai

    2011-01-01

    This manuscript is a survey of the halachic attitudes toward organ transplant procedures from a living donor which can be defined as life-saving procedures for the recipient or at least life-prolonging procedures. Three fundamental problems concerning the halachic aspects of such transplantation are discussed in detail: the danger to the donor, donation under coercion, and the sale of organs and tissues. The terms “halacha” and “Jewish law” are defined in the introduction. PMID:23908800

  5. Assessment of Potential Live Kidney Donors and Computed Tomographic Renal Angiograms at Christchurch Hospital

    PubMed Central

    Mark, Stephen; Armstrong, Sarah; McGregor, David

    2016-01-01

    Aims. To examine the outcome of potential live kidney donors (PLKD) assessment program at Christchurch Hospital and, also, to review findings of Computed Tomographic (CT) renal angiograms that led to exclusion in the surgical assessment. Methods. Clinical data was obtained from the database of kidney transplants, Proton. Radiological investigations were reviewed using the hospital database, Éclair. The transplant coordinator was interviewed to clarify information about PLKD who did not proceed to surgery, and a consultant radiologist was interviewed to explain unfavorable findings on CT renal angiograms. Results. 162 PLKD were identified during the period January 04–June 08. Of those, 65 (40%) proceeded to have nephrectomy, 15 were accepted and planned to proceed to surgery, 13 were awaiting further assessment, and 69 (42.5%) did not proceed to nephrectomy. Of the 162 PLKD, 142 (88%) were directed donors. The proportion of altruistic PLKD who opted out was significantly higher than that of directed PLKD (45% versus 7%, P = 0.00004). Conclusions. This audit demonstrated a positive experience of live kidney donation at Christchurch Hospital. CT renal angiogram can potentially detect incidental or controversial pathologies in the kidney and the surrounding structures. Altruistic donation remains controversial with higher rates of opting out. PMID:27034659

  6. Evaluation of Bleeding Rates in Renal Transplant Patients on Therapeutic Intravenous Heparin

    PubMed Central

    Ringenberg, Theresa; Desanto, Heather; Opsha, Yekaterina; Costello, Jennifer; Schiller, Daryl

    2013-01-01

    Background: It is unknown whether coagulation properties differ between renal transplant and nontransplant patients. Objective: To assess whether renal transplant patients on intravenous (IV) heparin, titrated to therapeutic activated partial thromboplastin times (aPPT; 56-93 seconds), experienced a higher rate of bleeding compared to nontransplant patients. Methods: Twenty-nine renal transplant and 29 nontransplant patients receiving IV heparin for a deep vein thrombosis, pulmonary embolism, atrial fibrillation, or acute coronary syndrome were randomly identified through a retrospective chart review. Results: Renal transplant patients had higher bleeding rates on IV heparin therapy compared to nontransplant patients (31% vs 6.9%, respectively; P = .041). Renal transplant patients experienced a drop in hemoglobin of at least 1 g/dL or the need for a transfusion more often then nontransplant patients (69% vs 45%, respectively; P = .111), although the difference was not statistically significant. Conclusions: Further research is necessary to identify the factors contributing to increased rates of bleeding in renal transplant patients on IV heparin and to determine the ideal aPTT to appropriately balance anticoagulation in renal transplant patients. PMID:24474835

  7. Managing new-onset gout in pediatric renal transplant recipients: when, how, to what extent.

    PubMed

    Assadi, Farahnak

    2013-01-01

    Hyperuricemia and gout are common among adult renal transplant recipients, but it is rarely reported following pediatric renal transplantations. Treating gout in pediatric kidney transplant recipients presents clinical challenges to the management of both immunosuppressive regimen and hyperuricemia for their effects on serum uric acid levels, renal function and drug interactions. Most renal transplant recipients have a relative impairment of renal clearance of urate due to abnormalities in renal transport, explaining the association of hyperuricemia and decreased glomerular filtration rate. Risk factors for the development of gout include impaired renal function, hypertension, heart failure and diabetes mellitus. Calcineurin inhibitors, particularly cyclosporine, are the most important risk factor for gout in transplant recipients and should not be used in pediatric renal transplant recipients. Diuretic therapy increases the risk of gout by causing extracellular volume contraction with consequent enhancement of proximal tubular reabsorption. Corticosteroids are increasingly replacing nonsteroidal antiinflammatory drugs and colchicine for the treatment of acute gout flares because they have little effect on kidney function. Proper management is aimed at lowering serum uric acid level below 6.0 mg/dL with xanthine oxidase inhibitors such as allopurinol or febuxostat. Allopurinol and mycophenolate mofetil are safer to use in combination than are allopurinol and azathioprine. Febuxostat is an alternative to allopurinol in patients with allopurinol intolerance or hypersensitivity. Pegloticase is indicated for patients with severe gout in whom allopurinol and febuxostat have not been effective or tolerated. PMID:22941874

  8. The Tacrolimus Metabolism Rate Influences Renal Function after Kidney Transplantation

    PubMed Central

    Thölking, Gerold; Fortmann, Christian; Koch, Raphael; Gerth, Hans Ulrich; Pabst, Dirk; Pavenstädt, Hermann; Kabar, Iyad; Hüsing, Anna; Wolters, Heiner

    2014-01-01

    The effective calcineurin inhibitor (CNI) tacrolimus (Tac) is an integral part of the standard immunosuppressive regimen after renal transplantation (RTx). However, as a potent CNI it has nephrotoxic potential leading to impaired renal function in some cases. Therefore, it is of high clinical impact to identify factors which can predict who is endangered to develop CNI toxicity. We hypothesized that the Tac metabolism rate expressed as the blood concentration normalized by the dose (C/D ratio) is such a simple predictor. Therefore, we analyzed the impact of the C/D ratio on kidney function after RTx. Renal function was analyzed 1, 2, 3, 6, 12 and 24 months after RTx in 248 patients with an immunosuppressive regimen including basiliximab, tacrolimus, mycophenolate mofetil and prednisolone. According to keep the approach simple, patients were split into three C/D groups: fast, intermediate and slow metabolizers. Notably, compared with slow metabolizers fast metabolizers of Tac showed significantly lower estimated glomerular filtration rate (eGFR) values at all the time points analyzed. Moreover, fast metabolizers underwent more indication renal biopsies (p = 0.006) which revealed a higher incidence of CNI nephrotoxicity (p = 0.015) and BK nephropathy (p = 0.024) in this group. We herein identified the C/D ratio as an easy calculable risk factor for the development of CNI nephrotoxicity and BK nephropathy after RTx. We propose that the simple C/D ratio should be taken into account early in patient’s risk management strategies. PMID:25340655

  9. The tacrolimus metabolism rate influences renal function after kidney transplantation.

    PubMed

    Thölking, Gerold; Fortmann, Christian; Koch, Raphael; Gerth, Hans Ulrich; Pabst, Dirk; Pavenstädt, Hermann; Kabar, Iyad; Hüsing, Anna; Wolters, Heiner; Reuter, Stefan; Suwelack, Barbara

    2014-01-01

    The effective calcineurin inhibitor (CNI) tacrolimus (Tac) is an integral part of the standard immunosuppressive regimen after renal transplantation (RTx). However, as a potent CNI it has nephrotoxic potential leading to impaired renal function in some cases. Therefore, it is of high clinical impact to identify factors which can predict who is endangered to develop CNI toxicity. We hypothesized that the Tac metabolism rate expressed as the blood concentration normalized by the dose (C/D ratio) is such a simple predictor. Therefore, we analyzed the impact of the C/D ratio on kidney function after RTx. Renal function was analyzed 1, 2, 3, 6, 12 and 24 months after RTx in 248 patients with an immunosuppressive regimen including basiliximab, tacrolimus, mycophenolate mofetil and prednisolone. According to keep the approach simple, patients were split into three C/D groups: fast, intermediate and slow metabolizers. Notably, compared with slow metabolizers fast metabolizers of Tac showed significantly lower estimated glomerular filtration rate (eGFR) values at all the time points analyzed. Moreover, fast metabolizers underwent more indication renal biopsies (p = 0.006) which revealed a higher incidence of CNI nephrotoxicity (p = 0.015) and BK nephropathy (p = 0.024) in this group. We herein identified the C/D ratio as an easy calculable risk factor for the development of CNI nephrotoxicity and BK nephropathy after RTx. We propose that the simple C/D ratio should be taken into account early in patient's risk management strategies. PMID:25340655

  10. Plasma homocysteine concentration changes after renal transplantation in children.

    PubMed

    Merouani, Aicha; Delvin, Edgar E; Genest, Jacques; Rozen, Rima; Lambert, Marie

    2002-07-01

    Hyperhomocysteinemia, a risk factor for vascular disease, is found in children as well as in 80% of adult patients with end-stage renal disease. The aim of this study was to assess the changes in plasma homocysteine concentrations after renal transplantation (RT). Plasma homocysteine, vitamin B(12), and folate concentrations were prospectively measured in six patients at three points, before and post transplantation (6 months, 4 years), and compared with controls using standardized scores (Z score) for each of these parameters. Folic acid supplementation was introduced after the evaluation at 6 months. Patients had elevated median plasma homocysteine Z scores during dialysis (4.12). When assessed at 6 months and 4 years, median plasma homocysteine Z scores were, respectively, 2.35 and 0.29. Median folate Z scores were 1.89 during dialysis, -0.26 at 6 months, and 3.26 at 4 years post RT. Median vitamin B(12) Z score was 2.12 during dialysis, 0.58 at 6 months, and -0.07 at 4 years post RT. Glomerular filtration rate (GFR) improved after RT, with median GFR of 84.5 ml/min per 1.73 m(2) at 6 months. This stabilized to a value of 70.5 ml/min per 1.73 m(2) at 4 years. When comparing values before and after RT at 6 months, changes were observed only for GFR ( P<0.03) and vitamin B(12) ( P<0.05). There were no changes in plasma homocysteine, folate, and serum albumin. At 4 years, a significant decrease in plasma homocysteine was observed ( P<0.05) with increased GFR ( P<0.03). No significant changes were observed in plasma albumin, folate, and vitamin B(12) concentrations. In conclusion, elevated plasma homocysteine in children during dialysis persists after RT despite a significant improvement in renal function. However, normalization was attained when patients were supplemented with folic acid. Further controlled studies are required to evaluate the determinants and treatment of elevated plasma homocysteine in pediatric transplant patients. PMID:12172766

  11. Quality of sleep and health-related quality of life in renal transplant recipients

    PubMed Central

    Liu, Hong-Xia; Lin, Jun; Lin, Xiao-Hong; Wallace, Linda; Teng, Sha; Zhang, Shu-Ping; Hao, Yu-Fang

    2015-01-01

    Aims and objectives: The purpose of this study was to examine the sleep quality and health-related quality of life (HRQOL) in patients after renal transplantation and to explore the relationship between the quality of sleep and the HRQOL. Background: Sleep disorders are still an important clinical problem after renal transplantation. Previous studies mainly focused on patients’ sleep quality before kidney transplant. More studies are needed to document sleep quality after renal transplantation. Design: A cross-sectional design was used in this study. Methods: A convenience sample of renal transplant recipients was recruited at an outpatient transplant clinic of a general hospital in Beijing, China. The Pittsburgh Sleep Quality Index (PSQI) was used to measure quality of sleep. The Medical Outcomes Study 36-item Short Form (MOS SF-36) was used to measure health-related quality of life. Results: The average PSQI score of the 204 renal transplant recipients was 5.81±3.52, significantly lower than the norm. Fifty (24.5%) recipients were classified as having poor sleep quality (global PSQI > 7). The mean scores of renal transplant recipients for SF-36 Mental Component Summary (MCS) and Physical Component Summary (PCS) were 47.57±6.71 and 48.26±9.66 respectively. Compared with residents in Sichuan province, recipients’ scores for SF-36 dimensions were statistically lower except the dimension of mental health. SF-36 scores of poor sleepers (PSQI > 7) were significantly lower than the good sleepers (PSQI ≤ 7) in both the MCS and PCS. Significant differences exist between the groups in physical function, bodily pain, vitality, and mental health dimensions. Conclusions: Sleep quality and HRQOL of patients after renal transplantation were lower than the norm. Poor sleep is associated with lower HRQOL. Relevance to clinical practice: Health professionals need to pay attention to sleep quality and HRQOL in renal transplant recipients and take appropriate measures to

  12. Living Donor Kidney Transplantation: Improving Education Outside of Transplant Centers about Live Donor Transplantation—Recommendations from a Consensus Conference

    PubMed Central

    Morgievich, Marie; Cohen, David J.; Butt, Zeeshan; Chakkera, Harini A.; Lindower, Carrie; Hays, Rebecca E.; Hiller, Janet M.; Lentine, Krista L.; Matas, Arthur J.; Poggio, Emilio D.; Rees, Michael A.; Rodrigue, James R.; LaPointe Rudow, Dianne

    2015-01-01

    Living donor kidney transplantation (LDKT) offers better quality of life and clinical outcomes, including patient survival, compared with remaining on dialysis or receiving a deceased donor kidney transplant. Although LDKT education within transplant centers for both potential recipients and living donors is very important, outreach and education to kidney patients in settings other than transplant centers and to the general public is also critical to increase access to this highly beneficial treatment. In June 2014, the American Society of Transplantation’s Live Donor Community of Practice, with the support of 10 additional sponsors, convened a consensus conference to determine best practices in LDKT, including a workgroup focused on developing a set of recommendations for optimizing outreach and LDKT education outside of transplant centers. Members of this workgroup performed a structured literature review, conducted teleconference meetings, and met in person at the 2-day conference. Their efforts resulted in consensus around the following recommendations. First, preemptive transplantation should be promoted through increased LDKT education by primary care physicians and community nephrologists. Second, dialysis providers should be trained to educate their own patients about LDKT and deceased donor kidney transplantation. Third, partnerships between community organizations, organ procurement organizations, religious organizations, and transplant centers should be fostered to support transplantation. Fourth, use of technology should be improved or expanded to better educate kidney patients and their support networks. Fifth, LDKT education and outreach should be improved for kidney patients in rural areas. Finally, a consensus-driven, evidence-based public message about LDKT should be developed. Discussion of the effect and potential for implementation around each recommendation is featured, particularly regarding reducing racial and socioeconomic disparities in

  13. Renal blood flow transit time in the study of renal transplants

    SciTech Connect

    Sfakianakis, G.; Ihmeidan, I.; Kyriakides, G.; Martinez, B.; Hourani, M.; Miller, J.; Serafini, A.

    1985-05-01

    Radio-hippurate scintigraphy has been used to study renal transplant function because of its unique advantages over other noninvasive methods. Despite a great sensitivity in diagnosing the existence of a functional problem the test lacks in specificity. In an effort to differentiate between acute tubular necrosis (ATN) and graft rejection (RJ) the authors preceded hippurate scintigraphy by measurements of renal flow transit time (TT). After an intravenous injection of 8 mCi of Tc-99m-sulfur-colloid flow curves from the kidney and the abdominal aorta in 1 sec intervals for 1 min were obtained. Renal transit time was mathematically calculated and corrected for bolus and circulatory differences by dividing it with the corresponding Aortic TT (corrected Renal TT(cRTT). Radiohippuran (O-I-131-Hippurate), 150 ..mu..Ci was injected subsequently and of the different computer generated parameters the 30 min net cortical residual (% of the peak) activity (Hippuran Residual Activity, HRA) was found more sensitive and reproducible for comparisons. Results of documented cases showed a statistically significant difference. Uncomplicated cases (usually on antirejection therapy) showed a tendency to increasing the cRTTs with time (not significantly) but their HRAs were significantly lower than in ATN and RJ (p< 0.001).

  14. Successful pregnancy following single blastocyst transfer in a renal transplant recipient

    PubMed Central

    Muthuvel, V. Arun; Ravindran, Manipriya; Chander, Aravind; Veluswamy, Chandralekha

    2016-01-01

    Numerous spontaneous pregnancies have been reported in renal transplant recipients; however, only a few pregnancies after the use of assisted reproductive techniques. The authors report a case of renal transplant recipient with secondary infertility who delivered a healthy baby without any complications. The report highlights the importance of minimal stimulation protocol during ovarian stimulation, single embryo transfer, and the need for multispecialty care for these patients. To the best of the authors' knowledge, the present report is the first such case from India and also the second in the world to report a blastocyst transfer among renal transplant recipients. PMID:27110079

  15. BK Nephritis and Venous Thrombosis in Renal Transplant Recipient Detected by 111In Leukocyte Imaging.

    PubMed

    Pucar, Darko; Klein, Kandace; Corley, James; Williams, Hadyn T

    2015-07-01

    Three months after deceased donor kidney transplant, a patient who presented with proteinuric renal dysfunction and fever of undetermined origin was found to have BK viruria by quantitative polymerase chain reaction analysis. An ¹¹¹In leukocyte scan showed increased renal transplant uptake consistent with nephritis and linear uptake in the knee. Venous duplex ultrasound revealed acute occlusive thrombosis in the superficial right lesser saphenous vein in the area of increased radiolabeled leukocyte uptake. This ¹¹¹In leukocyte scan performed for fever of undetermined origin demonstrated findings of BK nephritis in a renal transplant patient and associated acute venous thrombosis related to leukocyte colonization. PMID:26018698

  16. Evaluation of renal vascular anatomy in live renal donors: Role of multi detector computed tomography

    PubMed Central

    Pandya, Vaidehi Kumudchandra; Patel, Alpeshkumar Shakerlal; Sutariya, Harsh Chandrakant; Gandhi, Shruti Pradipkumar

    2016-01-01

    Background: Evaluation of renal vascular variations is important in renal donors to avoid vascular complications during surgery. Venous variations, mainly resulting from the errors of the embryological development, are frequently observed. Aim: This retrospective cross-sectional study aimed to investigate the renal vascular variants with multidetector computed tomography (MDCT) angiography to provide valuable information for surgery and its correlations with surgical findings. Materials and Methods: A total of 200 patients underwent MDCT angiography as a routine work up for live renal donors. The number, course, and drainage patterns of the renal veins were retrospectively observed from the scans. Anomalies of renal veins and inferior vena cava (IVC) were recorded and classified. Multiplanar reformations (MPRs), maximum intensity projections, and volume rendering were used for analysis. The results obtained were correlated surgically. Results: In the present study, out of 200 healthy donors, the standard pattern of drainage of renal veins was observed in only 67% of donors on the right side and 92% of donors on the left side. Supernumerary renal veins in the form of dual and triple renal veins were seen on the right side in about 32.5% of donors (dual right renal veins in 30.5% cases and triple right renal veins in 2.5% cases). Variations on the left side were classified into four groups: supernumerary, retro-aortic, circumaortic, and plexiform left renal veins in 1%, 2.5%, 4%, 0.5%, cases respectively. Conclusions: Developmental variations in renal veins can be easily detected on computed tomography scan, which can go unnoticed and can pose a fatal threat during major surgeries such as donor nephrectomies in otherwise healthy donors if undiagnosed. PMID:27453646

  17. Prevalence of Hypercalcaemia in a Renal Transplant Population: A Single Centre Study

    PubMed Central

    Coates, P. Toby; Barbara, Jeffrey; Hakendorf, Paul; Karim, Nazmul

    2016-01-01

    Introduction. Postrenal transplant bone disease is a significant problem. Factors influencing postrenal transplant bone status include high dose acute and low dose long-term steroid use, persistent hypercalcaemia, and graft failure. In this study, we aimed to determine the prevalence of hypercalcaemia and to evaluate the risk factors for postrenal transplant hypercalcaemia in long-term renal transplant patients at our centre. Methods. This is a biochemical audit in which we studied renal transplant recipients from the Central Northern Adelaide Renal Transplant Services, South Australia. Inclusion criteria include kidney transplant patients with functioning graft since 1971 and at least 3 months after transplantation at the time of analysis. Hypercalcaemia was defined as persistently elevated serum corrected calcium greater than or equal to 2.56 mmol/L for three consecutive months. Results. 679 renal transplant recipients with a functioning graft were studied and 101 were hypercalcaemic between March 2011 and June 2011 (15%). 60% of the hypercalcaemic patients were male and 40% were female, with chronic glomerulonephritis (39%) being the commonest cause of their end stage kidney disease (ESKD). Prevalence was similar in those that had haemodialysis and peritoneal dialysis pretransplantation. Hypercalcaemia in the renal transplant population was not secondary to suboptimal allograft function but secondary to pretransplantation hyperparathyroidism with persistent high parathyroid hormone (PTH) levels after transplantation. Conclusion. There is a high prevalence of hypercalcaemia (15%) in renal transplant recipients. The predominant cause for hypercalcaemia is pretransplantation hyperparathyroidism. The magnitude of pretransplantation hyperparathyroidism is the major determinant for long-term parathyroid function rather than graft function or pretransplantation duration on dialysis or mode of dialysis. PMID:27493801

  18. [Living donors for kidney transplantation: ethical and legal challenges].

    PubMed

    Mamzer-Bruneel, Marie-France; Fournier, Catherine; Legendre, Christophe

    2010-05-01

    Living donor kidney transplantation has developed very heterogeneously worldwide despite excellent results and without taking into account the context of global organ shortage. Such a heterogeneity highlights persistent ethical issues, whereas organ trafficking is emerging as an organized transplant tourism reinforcing the need for strong national legal frameworks. Despite its powerful regulation system, which ensures standardization, transparency and accountability of support for donation, France remains reluctant to enlarge the circle of legal donors, whereas it would be the first step to give a greater role to living organ donation. PMID:20510152

  19. Hepatitis E-associated encephalopathy in a renal transplant recipient

    PubMed Central

    de Vries, Marijke A; Samijn, Johnny P A; de Man, Rob; Boots, Johannes M M

    2014-01-01

    Hepatitis E virus genotype 3 is not rare in developed countries, and may cause chronic hepatitis in immunocompromised patients. This may not only lead to abnormalities in liver test and malaise, but to severe neurological symptoms as well. In this case, chronic hepatitis E infection caused encephalopathy, an atactic gait, Lhermitte's sign, incomplete bladder emptying and peripheral sensory neuropathy in a renal transplant recipient. The diagnosis was not performed until years after the onset of first symptoms and several months after the onset of neurological symptoms. If treated adequately, viral load can be reduced in over two-thirds of patients and neurological symptoms are often resolved. More widespread knowledge about this virus and its extrahepatic manifestations may lead to a quicker diagnosis, and may limit pathology. Serological screening should be added to standard pretransplant virological screening, so that, in the future, patients without antibodies could be vaccinated. PMID:24789162

  20. The Bioethics and Utility of Selling Kidneys for Renal Transplantation

    PubMed Central

    Berman, Elisheva; Lipschutz, Jonathan M.; Bloom, Roy D.; Lipschutz, Joshua H.

    2008-01-01

    In the fifty years since kidney transplantation was first performed, this procedure has evolved from a highly speculative biomedical endeavor to a medically viable and often standard course of therapy (1). Long-term survival is markedly improved among patients who receive a kidney compared with patients who remain on the waiting list for such an organ (2). As outcomes have improved and more clinical indications have emerged, the number of people awaiting transplantation has grown significantly. In stark contrast to the robust expansion of the waiting list, the number of available deceased donors has remained relatively constant over the last several years (1). The current mechanism for procuring kidneys relies on voluntary donations by the general public, with the primary motivation being altruism. However, in light of the ever-increasing waiting list, it is the authors’ belief that the current system needs to be revised if supply is ever going to meet demand. In response to this critical organ shortage, different programs have been developed in an attempt to increase organ donation. At present, however, no solution to the problem has emerged. This paper begins by outlining the scope of the problem and current legislation governing the procurement of transplantable organs/tissues in the United States. It continues with an overview of different proposals to increase supply. It concludes by exploring some of the controversy surrounding the proposal to increase donation using financial incentives. Though the following discussion certainly has implications for other transplantable organs, this paper will focus on kidney transplantation because the waiting list for kidneys is by far the longest of all the solid organs; and, as it carries the smallest risk to living donors, is the least ethically problematic. PMID:18589084

  1. Lower Respiratory Tract Infection in a Renal Transplant Recipient: Do not Forget Metapneumovirus

    PubMed Central

    Noel, N.; Rammaert, B.; Zuber, J.; Sayre, N.; Mamzer-Bruneel, M. F.; Leruez-Ville, M.; Mascard, L.; Lecuit, M.; Lortholary, O.

    2012-01-01

    Human metapneumovirus (hMPV) is emerging as a cause of a severe respiratory tract infection in immunocompromised patients. hMPV pneumonia has only been seldom reported in nonpulmonary solid organ transplanted patients, such as renal transplant recipients. We report here a case of a 39-year-old patient presenting with fever, cough, and interstitial opacities on CT scan diagnosed as a nonsevere hMPV pneumonia 11 years after a renal transplantation. Infection resolved spontaneously. Differential diagnosis with Pneumocystis pneumonia was discussed. We review the medical literature and discuss clinical presentation and detection methods that can be proposed in solid organ transplant recipients. PMID:23213611

  2. Simultaneous pancreas-kidney transplant for type I diabetes with renal failure: Anaesthetic considerations.

    PubMed

    Kumar, Lakshmi; Surendran, Sudhindran; Kesavan, Rajesh; Menon, Ramachandran Narayana

    2016-02-01

    Pancreatic grafts have been successfully used in patients with diabetes and are combined with kidney transplantation in patients with renal failure. The propagation of awareness in organ donation in India has increased the donor pool of transplantable organs in the last few years making multi visceral transplants feasible in our country. We present the anaesthetic management of a 32-year-old male with diabetes mellitus and end-stage renal failure who was successfully managed with a combined pancreas and kidney transplantation. PMID:27013753

  3. Endothelial progenitor cells and asymmetric dimethylarginine after renal transplantation.

    PubMed

    Teplan, Vladimír; Mahrová, Andrea; Králová-Lesná, Ivana; Racek, Jaroslav; Valkovský, Ivo; Štollová, Milena

    2015-03-01

    Levels of the endogenous nitric oxide synthase inhibitor asymmetrical dimethylarginine (ADMA) are elevated and endothelial progenitor cells (EPCs) decreased in patients undergoing renal transplantation (Tx) and may contribute to cardiovascular complications. In this study, we tested the hypothesis that elevated ADMA and decreased EPC can be positively influenced with regular physical exercise early after Tx. Blood samples for analysis of ADMA and EPC were obtained from randomly selected 64 patients after Tx who agreed to participate in a supervised aerobic exercise program for 6 months (group I). Samples were collected before the training began, 1 month after surgery (with stabilized renal function), and at 6 months after initiation. Sixty-two age, sex, human leukocyte antigens (HLA) typing, duration of previous dialysis, history of cardiovascular disease, and immunosupression regimen-matched transplant patients who did not exercise regularly were examined as controls (group II). There were no differences in ADMA levels and EPC count between both groups before the training program began. After 6 months of exercise, ADMA concentration in the group I decreased (3.50 ± 0.45 vs. 2.11 ± 0.35 μmol/L; P < .01) and was also lower comparing with group II (2.11 ± 0.23 vs. 3.25 ± 0.35 μmol/L; P < .01). In the same period, EPC cells increased from 2.085 ± 650 cells/mL versus 3.991 ± 560 cells/mL, P < .01 in group I; but in group II, changes were nonsignificant (P = .11). Blood lipids, HbA1c, insulin, and systolic blood pressure were also affected by the training program. Elevated ADMA level and decreased EPC count were significantly influenced by early regular exercise in patients after Tx. PMID:25576240

  4. [Meningoencephalitis caused by West Nile virus in a renal transplant recipient].

    PubMed

    Ertilav, Muhittin; Ozkul, Aykut; Zeytinoğlu, Ayşın; Sen, Sait; Sipahi, Savaş; Töz, Hüseyin; Kitiş, Omer; Eraslan, Cenk

    2014-10-01

    West Nile virus (WNV) infection which is asymptomatic or mild in normal population, it may cause serious clinical conditions leading to death in eldery and immunosupressed patients. The virus is mainly transmitted by mosquito bites, however transfusion, transplantation, transplasental and nosocomial ways have also been reported to be responsible for viral transmission. It is known that WNV may cause life-threatining conditions such as central nervous system (CNS) infections especially in bone marrow and solid organ transplant recipients. In this report, the first case of WNV encephalitis in an immunosuppressed patient with renal transplant in Turkey was presented. A 25-year-old male patient admitted to our hospital with the complaints of generalized myalgia, nausea and vomiting, after the 24. day of renal transplantation from a live donor. Since he developed diffuse tonic clonic seizures during his follow up, he was diagnosed as meningoencephalitis with the results of cranial magnetic resonance imaging (MR) and cerebrospinal fluid (CSF) biochemistry. Bacterial and fungal cultures of blood and CSF yielded negative results. CMV antigenemia test and CMV IgM in blood, and nucleic acid tests for CMV, EBV, HSV-1/2, VZV, HHV-6, enterovirus and parvovirus in CSF were also negative. However, WNV RNA was detected in CSF by an in-house reverse transcriptase (RT) nested PCR method. The sequence analysis (GenBank BLAST) of the virus showed that it had 99% similarity with Lineage-1 WNV strains. To define the transmission way of the virus to the recipient, WNV-RNA was searched in the renal biopsy sample and found negative by RT nested PCR. The clinical condition of the patient was improved with supportive therapy and by the de-escalation of immunosuppressive drugs [Mycophenolate mofetil (MMF; 1 g/day), cyclosporin (1 mg/kg/day)]. However WNV meningoencephalitis recurred one month later. The patient presented with fever, myalgia, confusions, leukocytosis, anemia, and repeating WNV

  5. Incipient renal transplant dysfunction associates with tubular syndecan-1 expression and shedding.

    PubMed

    Adepu, Saritha; Rosman, Colin W K; Dam, Wendy; van Dijk, Marcory C R F; Navis, Gerjan; van Goor, Harry; Bakker, Stephan J L; van den Born, Jacob

    2015-07-15

    Syndecan-1 is a transmembrane heparan sulfate proteoglycan involved in regenerative growth and cellular adhesion. We hypothesized that the induction of tubular syndecan-1 is a repair response to incipient renal damage in apparently stable, uncomplicated renal transplant recipients. We quantified tubular syndecan-1 in unselected renal protocol biopsies taken 1 yr after transplantation. Spearman rank correlation analysis revealed an inverse correlation between tubular syndecan-1 expression and creatinine clearance at the time of biopsy (r = -0.483, P < 0.03). In a larger panel of protocol and indication biopsies from renal transplant recipients, tubular syndecan-1 correlated with tubular proliferation marker Ki67 (r = 0.518, P < 0.0001). In a rat renal transplantation model, 2 mo after transplantation, mRNA expression of syndecan-1 and its major sheddase, A disintegrin and metalloproteinase-17, were upregulated (both P < 0.03). Since shed syndecan-1 might end up in the circulation, in a stable cross-sectional human renal transplant population (n = 510), we measured plasma syndecan-1. By multivariate regression analysis, we showed robust independent associations of plasma syndecan-1 with renal (plasma creatinine and plasma urea) and endothelial function parameters (plasma VEGF-A, all P < 0.01). By various approaches, we were not able to localize syndecan-1 in vessel wall or endothelial cells, which makes shedding of syndecan-1 from the endothelial glycocalyx unlikely. Our data suggest that early damage in transplanted kidneys induces repair mechanisms within the graft, namely, tubular syndecan-1 expression for tubular regeneration and VEGF production for endothelial repair. Elevated plasma syndecan-1 levels in renal transplantation patients might be interpreted as repair/survival factor related to loss of tubular and endothelial function in transplanted kidneys. PMID:25972509

  6. Urinary Tract Infection among Renal Transplant Recipients in Yemen

    PubMed Central

    Gondos, Adnan S.; Al-Moyed, Khaled A.; Al-Robasi, Abdul Baki A.; Al-Shamahy, Hassan A.; Alyousefi, Naelah A.

    2015-01-01

    Urinary tract infection (UTI) is the most common complication following kidney transplantation (KT), which could result in losing the graft. This study aims to identify the prevalence of bacterial UTI among KT recipients in Yemen and to determine the predisposing factors associated with post renal transplantation UTI. A cross sectional study included of 150 patients, who underwent KT was conducted between June 2010 and January 2011. A Morning mid-stream urine specimen was collected for culture and antibiotic susceptibility test from each recipient. Bacterial UTI was found in 50 patients (33.3%). The prevalence among females 40.3% was higher than males 29%. The UTI was higher in the age group between 41–50 years with a percentage of 28% and this result was statistically significant. Predisposing factors as diabetes mellitus, vesicoureteral reflux, neurogenic bladder and polycystic kidney showed significant association. High relative risks were found for polycystic kidney = 13.5 and neurogenic bladder = 13.5. The most prevalent bacteria to cause UTI was Escherichia coli represent 44%, followed by Staphylococcus saprophyticus 34%. Amikacin was the most effective antibiotic against gram-negative isolates while Ciprofloxacin was the most effective antibiotic against Staphylococcus saprophyticus. In conclusion, there is high prevalence of bacterial UTI among KT recipients in Yemen. Diabetes mellitus, vesicoureteral reflux, neurogenic bladder, polycystic kidney and calculi were the main predisposing factors. PMID:26657128

  7. Mycobacterium haemophilum Masquerading as Leprosy in a Renal Transplant Patient.

    PubMed

    Copeland, Nathanial K; Arora, Navin S; Ferguson, Tomas M

    2013-01-01

    Opportunistic infections following immunosuppression in solid organ transplant (SOT) patients are common complications with the skin being a common sight of infection. Nontuberculous mycobacteria (NTM) are rare but potential causes of skin infection in SOT patients. We present a case of an adult male immunosuppressed following renal transplantation who presented with an asymptomatic rash for several months. The patient's skin eruption consisted of erythematous papules and plaques coalescing into an annular formation. After failure of the initial empiric therapy, a punch biopsy was performed that demonstrated nerve involvement suspicious for Mycobacterium leprae. However, culture of the biopsy specimen grew acid-fast bacilli that were subsequently identified as M. haemophilum. His rash improved after a prolonged course of clarithromycin and ciprofloxacin. Both organisms are potential causes of opportunistic skin infections and can be difficult to distinguish with similar predilection for skin and other biochemical and genetic similarities. Ultimately they can be distinguished with culture as M. haemophilum will grow in culture and M. leprae will not. This case was unique due to nerve involvement on biopsy which is classically seen on biopsies of leprosy. PMID:24369511

  8. Renal transplantation in 22 children with nephropathic cystinosis.

    PubMed

    Ehrich, J H; Brodehl, J; Byrd, D I; Hossfeld, S; Hoyer, P F; Leipert, K P; Offner, G; Wolff, G

    1991-11-01

    In 1989, 22 children (11 boys, 11 girls aged 8-23 years) with nephropathic cystinosis, who had received a total of 28 renal allografts over the previous 14 years, were reviewed. Nineteen were alive, of whom 17 had functioning grafts 5 months to 13 years after transplantation. The mean serum creatinine level in these 17 was 135 mumol/l. Patient and graft survival did not differ from non-cystinotic children. Persistent hypothyroidism was found in 3 patients, transient diabetes mellitus in 1, severely disturbed vision in 1 and brain atrophy in 11. Arterial hypertension was present in 16 patients. Growth retardation was universal, although in 4 patients on cyclosporin A post-transplant catch-up growth occurred. Five patients over 15 years completed puberty. Readjustment in terms of school performance was good but was less good for psychosocial development. None of the patients had ever been treated with cystine-depleting agents; the data will therefore provide a historical control group with which to compare the results from a group treated with these agents. PMID:1768583

  9. Intra-corporeal robotic renal auto-transplantation

    PubMed Central

    Lee, Jason Y.; Alzahrani, Tarek; Ordon, Michael

    2015-01-01

    Renal auto-transplantation (RATx) is a suitable option for managing patients with long upper ureteric or pan-ureteric strictures. The current gold standard approach to RATx is a laparoscopic nephrectomy followed by open auto-transplantation. The advent of robotic-assisted laparoscopic surgery has allowed us to apply minimally-invasive techniques to ever-more complex surgical procedures. We present the case of a 38-year-old patient referred to our institution for management of a failed laparoscopic pyeloplasty resulting in a long upper ureteric stricture with complete ureteric obstruction. After complete evaluation, RATx was determined as a suitable management option. Completely intracorporeal right RATx was performed robotically with intraperitoneal cold perfusion. Total operative time was 6.5 hours, with total ischemia time of only 79 minutes (4 minutes warm ischemia, 48 minutes cold ischemia, 27 minutes re-warming time), comparable to the gold standard approach for RATx. To our knowledge, this is the first reported case of a completely intracorporeal robotic RATx in Canada. PMID:26664514

  10. Urinary Tract Infection among Renal Transplant Recipients in Yemen.

    PubMed

    Gondos, Adnan S; Al-Moyed, Khaled A; Al-Robasi, Abdul Baki A; Al-Shamahy, Hassan A; Alyousefi, Naelah A

    2015-01-01

    Urinary tract infection (UTI) is the most common complication following kidney transplantation (KT), which could result in losing the graft. This study aims to identify the prevalence of bacterial UTI among KT recipients in Yemen and to determine the predisposing factors associated with post renal transplantation UTI. A cross sectional study included of 150 patients, who underwent KT was conducted between June 2010 and January 2011. A Morning mid-stream urine specimen was collected for culture and antibiotic susceptibility test from each recipient. Bacterial UTI was found in 50 patients (33.3%). The prevalence among females 40.3% was higher than males 29%. The UTI was higher in the age group between 41-50 years with a percentage of 28% and this result was statistically significant. Predisposing factors as diabetes mellitus, vesicoureteral reflux, neurogenic bladder and polycystic kidney showed significant association. High relative risks were found for polycystic kidney = 13.5 and neurogenic bladder = 13.5. The most prevalent bacteria to cause UTI was Escherichia coli represent 44%, followed by Staphylococcus saprophyticus 34%. Amikacin was the most effective antibiotic against gram-negative isolates while Ciprofloxacin was the most effective antibiotic against Staphylococcus saprophyticus. In conclusion, there is high prevalence of bacterial UTI among KT recipients in Yemen. Diabetes mellitus, vesicoureteral reflux, neurogenic bladder, polycystic kidney and calculi were the main predisposing factors. PMID:26657128

  11. ABO-incompatible renal transplantation in developing world - crossing the immunological (and mental) barrier.

    PubMed

    Jha, P K; Bansal, S B; Sethi, S K; Jain, M; Sharma, R; Nandwani, A; Phanish, M K; Duggal, R; Tiwari, A K; Ghosh, P; Ahlawat, R; Kher, V

    2016-01-01

    ABO incompatibility has been considered as an important immunological barrier for renal transplantation. With the advent of effective preconditioning protocols, it is now possible to do renal transplants across ABO barrier. We hereby present a single center retrospective analysis of all consecutive ABOi renal transplants performed from November 2011 to August 2014. Preconditioning protocol consisted of rituximab, plasmapheresis and intravenous immunoglobulin (IVIG) and maintenance immunosuppression consisted of tacrolimus, mycophenolate sodium, and prednisolone. The outcome of these ABOi transplants was compared with all other consecutive ABO-compatible (ABOc) renal transplants performed during same time. Twenty ABOi renal transplants were performed during the study period. Anti-blood group antibody titer varied from 1:2 to 1:512. Patient and graft survival was comparable between ABOi and ABOc groups. Biopsy proven acute rejection rate was 15% in ABOi group, which was similar to ABOc group (16.29%). There were no antibody-mediated rejections in ABOi group. The infection rate was also comparable. We conclude that the short-term outcome of ABOi and ABOc transplants is comparable. ABOi transplants should be promoted in developing countries to expand the donor pool. PMID:27051135

  12. Self-reported sleep disturbances in renal transplant recipients

    PubMed Central

    2013-01-01

    Background Poor sleep quality (SQ) and daytime sleepiness (DS) are common in renal transplant (RTx) recipients; however, related data are rare. This study describes the prevalence and frequency of self-reported sleep disturbances in RTx recipients. Methods This cross-sectional study included 249 RTx recipients transplanted at three Swiss transplant centers. All had reported poor SQ and / or DS in a previous study. With the Survey of Sleep (SOS) self-report questionnaire, we screened for sleep and health habits, sleep history, main sleep problems and sleep-related disturbances. To determine a basis for preliminary sleep diagnoses according to the International Classification of Sleep Disorders (ICSD), 164 subjects were interviewed (48 in person, 116 via telephone and 85 refused). Descriptive statistics were used to analyze the data and to determine the frequencies and prevalences of specific sleep disorders. Results The sample had a mean age of 59.1 ± 11.6 years (60.2% male); mean time since Tx was 11.1 ± 7.0 years. The most frequent sleep problem was difficulty staying asleep (49.4%), followed by problems falling asleep (32.1%). The most prevalent sleep disturbance was the need to urinate (62.9%), and 27% reported reduced daytime functionality. Interview data showed that most suffered from the first ICSD category: insomnias. Conclusion Though often disregarded in RTx recipients, sleep is an essential factor of wellbeing. Our findings show high prevalences and incidences of insomnias, with negative impacts on daytime functionality. This indicates a need for further research on the clinical consequences of sleep disturbances and the benefits of insomnia treatment in RTx recipients. PMID:24112372

  13. Neuropsychologic side-effects of tacrolimus in pediatric renal transplantation.

    PubMed

    Kemper, Markus J; Spartà, Giuseppina; Laube, Guido F; Miozzari, Marco; Neuhaus, Thomas J

    2003-04-01

    Calcineurin inhibition with tacrolimus has been used after renal transplantation (RTPL) as rescue therapy for insufficient immunological control or if cyclosporin A (CSA) toxicity occurred. Neurologic side-effects occur but are rare in children, usually presenting as tremor; however, serious complications, e.g. the posterior leukoencephalopathy syndrome are also documented. Twenty children (10 girls) were switched to tacrolimus: 11 (55%) for immunological reasons (n = 9: steroid-resistant rejection; n = 2: recurrent rejections) and nine for CSA side-effects. Tacrolimus was started at a median of 8 wk (range 10 d to 8.7 yr) after RTPL and was continued for a median of 2.5 yr (range 5 wk to 4.6 yr). Renal function significantly improved over a period of 12 months following conversion to tacrolimus (glomerular filtration rate 56 +/- 19 vs. 66 +/- 16 mL/min/1.73 m2; p < 0.03; n = 13). Fifteen of 20 (75%) patients tolerated tacrolimus well. The most frequent side-effects were neuropsychological and behavioral symptoms in three children, ranging from anorexia nervosa-like symptoms with weight loss, amenorrhea, depression and school problems to severe insomnia and to aggressive and anxious behavior in one child. Only the latter child was exposed to toxic tacrolimus blood levels. All side-effects were fully reversible after discontinuation of tacrolimus. In conclusion, tacrolimus had a beneficial effect on renal function and was well tolerated in the majority of pediatric patients. However, neuropsychologic and behavioral side-effects are important and maybe underrecognized in children. PMID:12709079

  14. Recurrence of proteinuria following renal transplantation in congenital nephrotic syndrome of the Finnish type.

    PubMed

    Srivastava, Tarak; Garola, Robert E; Kestila, Marjo; Tryggvason, Karl; Ruotsalainen, Vesa; Sharma, Mukut; Savin, Virginia J; Jalanko, Hannu; Warady, Bradley A

    2006-05-01

    We report a Caucasian boy of Italian descent with congenital nephrotic syndrome of the Finnish type (NPHS1, CNF, MIM 256300) who developed recurrence of proteinuria and hypoalbuminemia on the seventh post-operative day following living related renal transplantation from his paternal aunt. The allograft biopsy was normal except for effacement of podocyte foot processes on electron microscopy. He was treated by the substitution of mycophenolate mofetil with cyclophosphamide for 12 weeks, in addition to cyclosporine, prednisone and daclizumab. His proteinuria resolved quickly following the initiation of cyclophosphamide treatment, and he remains in remission 4 years after receiving his transplant. His native and allograft kidneys were evaluated for nephrin expression by immunohistochemistry, DNA analysis for the NPHS1 mutation, serum for the presence of auto-antibodies to nephrin by both enzyme-linked immunosorbent assay (ELISA) and fetal glomeruli immunofluorescence assay, and serum for glomerular permeability to albumin (Palb) activity using a functional in vitro assay for Palb. Nephrin expression was completely absent in the native kidney, while it was decreased in the allograft compared with normal. DNA analysis of the NPHS1 gene revealed mutations 3248G>T and 3250delG in exon 24, causing G1083V and 1084Vfs, respectively, inherited from his father, and 3478C>T in exon 27, that leads to R1160X, inherited from his mother. Serum was negative for auto-antibodies to nephrin. Interestingly, the Palb activity was increased at the time of recurrence of proteinuria following transplantation (Palb 0.73+/-0.10) and remained elevated when retested more than 3 years later (Palb 0.54+/-0.09). This is the first report of increased Palb activity in recurrence of proteinuria following transplantation in NPHS1. We speculate the role of increased Palb activity in the recurrence of proteinuria following transplantation in NPHS1. PMID:16518627

  15. Randomized trial of tacrolimus versus cyclosporin microemulsion in renal transplantation.

    PubMed

    Trompeter, Richard; Filler, Guido; Webb, Nicholas J A; Watson, Alan R; Milford, David V; Tyden, Gunnar; Grenda, Ryszard; Janda, Jan; Hughes, David; Ehrich, Jochen H H; Klare, Bernd; Zacchello, Graziella; Bjorn Brekke, Inge; McGraw, Mary; Perner, Ferenc; Ghio, Lucian; Balzar, Egon; Friman, Styrbjörn; Gusmano, Rosanna; Stolpe, Jochen

    2002-03-01

    This study was undertaken to compare the efficacy and safety of tacrolimus (Tac) with the microemulsion formulation of cyclosporin (CyA) in children undergoing renal transplantation. A 6-month, randomized, prospective, open, parallel group study with an open extension phase was conducted in 18 centers from nine European countries. In total, 196 pediatric patients (<18 years) were randomly assigned (1:1) to receive either Tac ( n=103) or CyA microemulsion ( n=93) administered concomitantly with azathioprine and corticosteroids. The primary endpoint was incidence and time to first acute rejection. Baseline characteristics were comparable between treatment groups. Tac therapy resulted in a significantly lower incidence of acute rejection (36.9%) compared with CyA therapy (59.1%) ( P=0.003). The incidence of corticosteroid-resistant rejection was also significantly lower in the Tac group compared with the CyA group (7.8% vs. 25.8%, P=0.001). The differences were also significant for biopsy-confirmed acute rejection (16.5% vs. 39.8%, P<0.001). At 1 year, patient survival was similar (96.1% vs. 96.6%), while 10 grafts were lost in the Tac group compared with 17 graft losses in the CyA group ( P=0.06). At 1 year, mean glomerular filtration rate (Schwartz estimate) was significantly higher in the Tac group (62+/-20 ml/min per 1.73 m(2), n=84) than in the CyA group (56+/-21 ml/min per 1.73 m(2), n=74, P=0.03). The most frequent adverse events during the first 6 months were hypertension (68.9% vs. 61.3%), hypomagnesemia (34.0% vs. 12.9%, P=0.001), and urinary tract infection (29.1% vs. 33.3%). Statistically significant differences ( P<0.05) were observed for diarrhea (13.6% vs. 3.2%), hypertrichosis (0.0% vs. 7.5%), flu syndrome (0.0% vs. 5.4%), and gum hyperplasia (0.0% vs. 5.4%). In previously non-diabetic children, the incidence of long-term (>30 days) insulin use was 3.0% (Tac) and 2.2% (CyA). Post-transplant lymphoproliferative disease was observed in 1 patient in the

  16. Interventions for impaired bladders in paediatric renal transplant recipients with lower urinary tract dysfunction.

    PubMed

    Al-Khudairi, Naji; Riley, Paul; Desai, Divyesh Y; Reid, Christopher; Marks, Stephen D; Mamode, Nizam

    2013-04-01

    Dysfunctional bladders in paediatric patients were thought to be a contraindication for renal transplantation, but advances in surgical techniques have meant that surgical correction can allow safe transplantation. This study compares the outcomes of renal transplantation for different interventions, and the timing of such interventions, in relation to transplantation. We identified all paediatric renal transplant recipients with LUTD that received intervention for their impaired bladders at two hospitals between 2002 and 2010. Outcome measures included patient and graft survival, perioperative complications, UTI incidence, acute rejection episodes and serum creatinine levels. A total of 288 allografts were transplanted, 77 were in 75 children with LUTD, of which 46 received intervention. Patient survival was 100% in the intervention group and 97% in the nonintervention group (P = 0.815). Death-censored graft survival was 96% and 100% respectively (P = 0.688). In the groups receiving intervention pretransplant or post-transplant, graft survival rates were 95% and 100% respectively (P = 0.476). The follow-up serum creatinine levels were higher in the pretransplant intervention group (P < 0.001). Interventions for dysfunctional bladders can be performed safely in paediatric renal transplant recipients. The mode of intervention and timing of intervention, in relation to transplant, do not influence outcomes if guided by careful assessment and investigation. PMID:23350943

  17. The role of commercial non-related living kidney transplants.

    PubMed

    Friedlaender, Michael M

    2003-01-01

    The motivation for dialysis patients to seek early, even pre-emptive, kidney transplantation from living donors is discussed. In most countries both the waiting time and the numbers of patients awaiting kidney transplantation are increasing. Local geopolitics in Jerusalem have produced a unique window to observe present transplant practices which include widespread international marketing of kidneys from paid living donors. These have been subject of media admonitions and total rejection by professional organizations. In a modern world, traditional medical paternalism to both donors and patients should be balanced by rights for individual autonomy. Since patients, donors and medical professionals are already participating in illicit organ trading, is it not time for us to seriously consider the ethical and logistic implications of legalizing financial remuneration for kidney donation? PMID:14733294

  18. Living Related Liver Transplantation in an Infant with Neonatal Hemochromatosis

    PubMed Central

    Choi, Shin Jie; Choi, Jong Sub; Chun, Peter; Yoo, Jung Kyung; Moon, Jin Soo; Kim, Woo Sun; Kang, Gyeong Hoon; Yi, Nam-Joon

    2016-01-01

    Neonatal hemochromatosis (NH) is a severe neonatal liver injury that is confirmed by extra-hepatic iron accumulation. Although a recent study described treating NH with exchange transfusions and intravenous immunoglobulin, liver transplantation should be considered for patients with severe liver failure that does not respond to other medical treatment. Herein, we report the case of a two-month-old female infant who presented with persistent ascites and hyperbilirubinemia. Her laboratory findings demonstrated severe coagulopathy, high indirect and direct bilirubin levels, and high ferritin levels. Abdominal magnetic resonance imaging presented low signal intensity in the liver on T2-weighted images, suggesting iron deposition. The infant was diagnosed with NH as a result of the clinical findings and after congenital infection and metabolic diseases were excluded. The infant was successfully treated with a living-donor liver transplantation. Living related liver transplantation should be considered as a treatment option for NH in infants. PMID:27437193

  19. Living Related Liver Transplantation in an Infant with Neonatal Hemochromatosis.

    PubMed

    Choi, Shin Jie; Choi, Jong Sub; Chun, Peter; Yoo, Jung Kyung; Moon, Jin Soo; Ko, Jae Sung; Kim, Woo Sun; Kang, Gyeong Hoon; Yi, Nam-Joon

    2016-06-01

    Neonatal hemochromatosis (NH) is a severe neonatal liver injury that is confirmed by extra-hepatic iron accumulation. Although a recent study described treating NH with exchange transfusions and intravenous immunoglobulin, liver transplantation should be considered for patients with severe liver failure that does not respond to other medical treatment. Herein, we report the case of a two-month-old female infant who presented with persistent ascites and hyperbilirubinemia. Her laboratory findings demonstrated severe coagulopathy, high indirect and direct bilirubin levels, and high ferritin levels. Abdominal magnetic resonance imaging presented low signal intensity in the liver on T2-weighted images, suggesting iron deposition. The infant was diagnosed with NH as a result of the clinical findings and after congenital infection and metabolic diseases were excluded. The infant was successfully treated with a living-donor liver transplantation. Living related liver transplantation should be considered as a treatment option for NH in infants. PMID:27437193

  20. Risk Factors for the Development of BK Virus Nephropathy in Renal Transplant Recipients.

    PubMed

    Pai, D; Mann, D M; Malik, A; Hoover, D R; Fyfe, B; Mann, R A

    2015-10-01

    The BK polyoma virus has, in recent years, become a significant cause of renal allograft dysfunction and failure. Among 260 adult kidney transplant recipients, those with biopsy-proven BK virus nephropathy (BKVN) were compared with those without BKVN with regard to gender, age, race, rejection episodes, time on dialysis, number of organs transplanted, HLA match, live donor versus deceased donor, cold ischemia time, delayed graft function, cytomegalovirus (CMV) serostatus of donor and recipient, induction therapy, and maintenance immunosuppression. Episodes of rejection (35.7% of patients with BKVN vs 8.5% of patients without BKVN; P = .01), transplantation of >1 organ (35.7% of patients with BKVN vs 9.0% of patients without BKVN; P = .01), positive CMV serology in both donor and recipient (71.4% of patients with BKVN vs 41.1% of patients without BKVN; P = .03), and a greater cumulative dose of daclizumab use at the time of induction (2.24 ± 0.05 mg/kg in patients with BKVN vs 2.03 ± 0.14 mg/kg in patients without BKVN; P = .04) were statistically significant risk factors for the development of BKVN. Those who developed BKVN received a higher mean cumulative dose of rabbit antithymoglobulin for induction therapy, but that difference failed to achieve statistical significance (P = .07). PMID:26518952

  1. Acute hepatitis C infection in a renal transplant recipient: primacy of the liver or kidney?

    PubMed Central

    Althaf, Mohammed Mahdi; Abdelsalam, Mohamed Said; Rashwan, Mohamed; Nadri, Quaid

    2014-01-01

    We present a case where a renal transplant recipient contracted chronic hepatitis C virus (HCV) infection post-transplantation. The disease progressed and deteriorated leading to fibrosing cholestatic hepatitis that mandated treatment. Treatment with pegylated interferon α-2a and ribavirin was successful in salvaging the liver and eradicating the virus but as a consequence lead to treatment-resistant acute rejection and loss of the renal allograft. PMID:24907214

  2. Infective endocarditis and meningitis due to Scedosporium prolificans in a renal transplant recipient.

    PubMed

    Uno, Kenji; Kasahara, Kei; Kutsuna, Satoshi; Katanami, Yuichi; Yamamoto, Yoshifumi; Maeda, Koichi; Konishi, Mitsuru; Ogawa, Taku; Yoneda, Tatsuo; Yoshida, Katsunori; Kimura, Hiroshi; Mikasa, Keiichi

    2014-02-01

    Scedosporium prolificans is a ubiquitous filamentous fungi that may cause disseminated diseases in neutropenic patients with hematological malignancies. We report a fatal case of renal transplant recipient who developed both infective endocarditis and meningitis due to S. prolificans during treatment with micafungin and itraconazole for chronic necrotizing aspergillosis. Breakthrough Scedosporium infection should be considered among differential diagnosis of invasive fungal diseases in patients with renal transplant recipients receiving antifungal agents. PMID:24462439

  3. Liver Transplantation for Metabolic Liver Disease: Experience at a Living Donor Dominant Liver Transplantation Center

    PubMed Central

    Kim, Jun Suk; Oh, Seak Hee; Kim, Hyun Jin; Cho, Jin Min; Yoo, Han-Wook; Namgoong, Jung-Man; Kim, Dae Yeon; Kim, Ki-Hun; Hwang, Shin; Lee, Sung-Gyu

    2015-01-01

    Purpose Metabolic liver disease (MLD) often progresses to life-threatening conditions. This study intends to describe the outcomes of liver transplantation (LTx) for MLD at a living donor-dominant transplantation center where potentially heterozygous carrier grafts are employed. Methods We retrospectively evaluated the medical records of 54 patients with MLD who underwent LTx between November 1995 and February 2012 at Asan Medical Center in Seoul, Korea. The cumulative graft and patient survival rates were analyzed according to patient age, and living or deceased donor LTx. Recurrence of the original disease was also investigated. Results The post-transplant cumulative patient survival rates at one, five, and 10 years were 90.7%, 87.5% and 87.5%, and the graft survival rates were 88.8%, 85.5%, and 85.5%, respectively. There were no differences in the patient survival rates according to the recipient age, human leukocyte antigen matching, and living or deceased donor LTx. There were also no differences in the patient survival rates between the MLD and the non-MLD groups for children. Recurrence of the original metabolic disease was not observed in any patient during the follow-up period. Conclusion Our results suggest that the living donor-dominant transplantation program is well-tolerated in MLD without recurrence of the original MLD using all types of transplantation. PMID:25866733

  4. Laparoscopic versus conventional live donor nephrectomy: experience in a community transplant program.

    PubMed

    Hawasli, A; Boutt, A; Cousins, G; Schervish, E; Oh, H

    2001-04-01

    Fifty-nine consecutive patients underwent live donor nephrectomy for transplantation. Twenty-nine patients (Group I) had open kidney procurement, and 30 patients (Group II) had laparoscopic procurement. The mean operative time in Group I was 2:30 hours (range 1:55-2:59), whereas in Group II it was 3:01 hours (1:54-5:21). All kidneys functioned immediately after transplantation. The average warm ischemia time was not calculated in Group I; it was 3.9 minutes (2-15) in Group II. Intraoperative complications occurred in two patients in Group II. One patient had bleeding from an accessory renal artery. The second patient had a tear in the splenic capsule. No ureteral complications occurred in either group. Postoperatively one patient in Group I developed incisional hernia, one developed pneumothorax, and two developed atelectasis. In Group II one patient developed pancreatitis, one developed flank ecchymosis, and two had suprapubic wound hematomas. Using the laparoscopic approach the hospital stay decreased from 4.1 to 1.27 days (69%) (P < 0.001) and return to work decreased from 28.4 to 14.8 days (49%) (P < 0.01). Live donation increased by 67 per cent. We conclude that the laparoscopic procurement of kidneys for transplantation compares well with the open method. It offers several advantages that may increase the living donor pool. PMID:11308000

  5. The effect of the American Heart Association step one diet on hyperlipidemia following renal transplantation.

    PubMed

    Moore, R A; Callahan, M F; Cody, M; Adams, P L; Litchford, M; Buckner, K; Galloway, J

    1990-01-01

    Cardiovascular disease is a frequent cause of morbidity and mortality following renal transplantation. The percentage of deaths due to ischemic cardiovascular disease and cerebrovascular accidents nearly equals that caused by infection among patients receiving their first transplant, according to data from the European Dialysis and Transplant Association Registry. Hypercholesterolemia is a risk factor for cardiovascular disease frequently identified following renal transplantation, and diets low in fat and cholesterol have been suggested as treatment. Previous studies have not reported the response of LDL cholesterol to dietary treatment, and it is this form of cholesterol that is most closely related to cardiovascular disease. The American Heart Association has provided nutritionists with guidelines for the treatment of hyperlipidemic patients which include the Step One Diet. Previous dietary studies of renal transplant recipients have allowed a slightly higher intake of fat than that currently recommended by the AHA. We wondered if an easily reproducible diet well known to nutritionists such as the AHA Step One Diet would be effective in lowering cholesterol levels in hyperlipidemic renal transplant recipients. The purpose of our study was not to define the mechanisms of posttransplant hyperlipidemia, but rather to assess the effectiveness of dietary intervention on hyperlipidemia following renal transplantation. PMID:2301029

  6. An association between antibodies specific for endothelial cells and renal transplant failure.

    PubMed

    Perrey, C; Brenchley, P E; Johnson, R W; Martin, S

    1998-06-01

    Human leucocyte antigen (HLA)-specific antibodies, present at the time of transplant, cause renal transplant rejection but cases of rejection of HLA-identical renal transplants indicate that antibodies to non-HLA antigens may also be detrimental. There is increasing evidence that antibodies to antigens present on endothelial cells and monocytes, and on endothelial cells alone, are associated with transplant rejection. We investigated 105 patients with failed renal transplants for the presence of endothelial cell reactive antibodies and compared them with 94 successful transplant patients to determine the role of non-HLA antibodies in transplant failure. Patient sera were tested by enzyme-linked immunoabsorbent assay (ELISA) using as a target fixed cells either from the endothelial/epithelial cell line EAHy.926 or primary cultures of human umbilical vein endothelial cells. Antibody binding was detected using an alkaline phosphatase-conjugated anti-human immunoglobulin G (IgG) antibody. Fourteen of the 105 failed transplant patients had endothelial cell-reactive antibodies as compared with only three of the 94 patients with successful transplants (Fisher's exact test, p = 0.02). Antibody-positive sera were absorbed with the epithelial cell line A549 to remove antibodies directed against the epithelial component of EAHy.926 and with a pool of lymphoblastoid cell line cells to remove HLA-specific antibodies. Absorption did not reduce antibody activity showing the antibodies to be directed against endothelial cell determinants. Antibody-positive sera were also tested by flow cytometry against the monocyte cell line THP-1 and 13 of the 14 patients were negative. In conclusion, we have demonstrated the presence of IgG antibodies directed against endothelial cell determinants in renal transplant recipients in association with renal transplant failure. PMID:9777698

  7. Organ transplantation and replacement

    SciTech Connect

    Cerilli, G.J.

    1988-01-01

    This book contains 49 chapters. Some of the titles are: Molecular, Genetic, and Clinical Aspects of the HLA System; The Normal Immune Response; Significance of the ABO Antigen System; The Role of Dialysis in the Management of End-Stage Renal Disease; Access for Dialysis; Patient Selection for Renal Transplantation; The Living Donor in Kidney Transplantation; and Kidney Preservation by Cold Storage.

  8. Kidney transplantation as treatment for end stage renal disease.

    PubMed

    Santiago-Delpín, Eduardo

    2011-01-01

    Within this review the author presents what kidney transplantation can and cannot do; it's state of the art; experience in Puerto Rico; major problems, obstacles and pitfalls; and the cutting edge of clinical transplantation and of transplantation immunology. PMID:23210334

  9. Family caregivers' burden, quality of life, and health following patients' renal transplantation.

    PubMed

    Wicks, M N; Milstead, E J; Hathaway, D K; Cetingok, M

    1998-09-01

    Improved quality of life and physical functioning among renal transplant recipients have been documented; however, little of the literature has addressed the effects of transplantation on family caregivers. The purpose of this exploratory descriptive study was to characterize the level of subjective burden, quality of life, and self-rated health of caregivers who assist family members prior to transplantation as well as at 6 months following. The study sample included 19 caregivers of 19 renal transplant recipients. In general, caregiver burden, quality of life, and self-rated health did not improve following patients' transplants. In addition, 9 of 19 family caregivers reported increased burden. Because much of healthcare is family-based and greater reliance on family support seems inevitable, further studies are needed to examine the impact of transplantation on the family as well as the impact of the family on patients' posttransplant outcomes. PMID:9866547

  10. An Insight Into the Immunologic Events and Risk Assessment in Renal Transplantation

    PubMed Central

    Khan, Asif; Nasr, Patricia; El-Charabaty, Elie; El-Sayegh, Suzanne

    2016-01-01

    Organ transplantation has always been considered to be the optimal therapeutic intervention in patients with end-stage organ failure. In the US, approximately 615,000 patients are diagnosed with end-stage renal disease and less than 30% have received a kidney transplant. One of the crucial drawbacks in successful renal transplantation is allograft rejection. Survival rates among transplant recipients have greatly improved due to better understanding of transplant biology and more effective immunosuppressive agents. Post-transplant immune monitoring and optimization of the immunosuppressive therapy using non-invasive biomarkers can effectively predict impending graft rejection and may spare the need for renal biopsy. This article provides an insight into the immunomodulations of renal transplant recipients. It depicts the immune system including several types of kidney rejection and reviews the biomarkers that may serve in near future, as surveillance tools for graft monitoring. Finally, a summary on the main immunosuppressive drugs used in kidney transplant both in the induction and maintenance phases is also covered. PMID:27081421

  11. A case of invasive cytomegalovirus duodenitis in an immunosuppressed patient 15 months after renal transplantation.

    PubMed

    Kazanji, N; Davila, F; Manickam, P; Wang, Y; Bossory, L

    2015-06-01

    Cytomegalovirus (CMV) remains one of the most important infections in kidney transplantation. Only a handful of images have been reported in the literature thus far. We present classic pathologic and gross images of CMV duodenitis in an immunosuppressed patient more than one year post-renal transplantation. PMID:25582982

  12. Calcineurin activity in tacrolimus-treated renal transplant patients early after and 5 years after transplantation.

    PubMed

    Mortensen, D M; Koefoed-Nielsen, P B; Jørgensen, K A

    2006-10-01

    The pharmacodynamic (PD) action of tacrolimus (FK) within the T-cell is inhibition of calcineurin phosphatase (CaN). Determination of CaN activity provides us with an important PD marker. Eleven renal transplant patients treated with FK were investigated on day 14 following transplantation and 5 years later. Blood samples drawn before as well as 1, 2, 3, and 4 hours after oral intake of FK were analyzed for CaN activity and blood FK concentrations. Twenty healthy subjects had one blood sample drawn for CaN activity, which was measured as the release of (32)P from a phosphorylated peptide. Radioactivity of (32)P was quantitated by liquid scintillation counting with the results converted to units of CaN utilizing a calibration curve. On day 14, we observed significant inhibition of CaN activity at T:1, 2, and 3 compared with the predose level (P = .002; P = .015; P = .015). Furthermore, all measured CaN activities were significantly different from those observed in healthy nonmedicated subjects. In contrast, at 5 years posttransplant only the CaN activity at T:2 was significantly inhibited compared with the predose level (P = .02). Additionally, all CaN activities at this time were not significantly different from CaN activities in the healthy subjects. We were not able to demonstrate individual CaN activity profiles in the patients. The lack of CaN inhibition at 5 years after transplantation despite relevant drug concentrations, probably reflected the lower drug dose used long after transplantation. This result raises the question of whether CaN inhibition is necessary to hold graft function and whether FK possess CaN-independent mechanisms of action. PMID:17098028

  13. Urothelial carcinoma of the allograft kidney developed in a renal transplant patient

    PubMed Central

    Gökçe, Mehmet İlker; Kocaay, Akın Fırat; Aktürk, Serkan; Tüzüner, Acar

    2016-01-01

    Renal transplantation is the best option in the treatment of end-stage renal disease However these patients are under the risk of developing malignancies particularly due to effects of immune supression. These malignancies tend to be more agressive compared to the general population. Here, we present a case of urothelial carcinoma develoing in the ureter of allograft kidney.

  14. Spectrum of biliary complications following live donor liver transplantation

    PubMed Central

    Simoes, Priya; Kesar, Varun; Ahmad, Jawad

    2015-01-01

    Liver transplantation is the optimal treatment for many patients with advanced liver disease, including decompensated cirrhosis, hepatocellular carcinoma and acute liver failure. Organ shortage is the main determinant of death on the waiting list and hence living donor liver transplantation (LDLT) assumes importance. Biliary complications are the most common post operative morbidity after LDLT and occur due to anatomical and technical reasons. They include biliary leaks, strictures and cast formation and occur in the recipient as well as the donor. The types of biliary complications after LDLT along with their etiology, presenting features, diagnosis and endoscopic and surgical management are discussed. PMID:26207167

  15. Ethical considerations on kidney transplantation from living donors.

    PubMed

    Bruzzone, P; Pretagostini, R; Poli, L; Rossi, M; Berloco, P B

    2005-01-01

    Kidney transplantation from living donors is widely performed all over the world. Living nephrectomy for transplantation has no direct advantage for the donor other than increased self-esteem, but at least remains an extremely safe procedure, with a worldwide overall mortality rate of 0.03%. This theoretical risk to the donor seems to be justified by the socioeconomic advantages and increased quality of life of the recipient, especially in selected cases, such as pediatric patients, when living donor kidney transplantation can be performed in a preuremic phase, avoiding the psychological and physical stress of dialysis, which in children is not well tolerated and cannot prevent retarded growth. According to the Ethical Council of the Transplantation Society, commercialism must be prevented, not only for ethical but also medical reasons. The risks are too high not only for the donors, but also for the recipients, as a consequence of poor donor screening and evaluation with consequent transmission of human immunodeficiency virus or other infectious agents, as well as inappropriate medical and surgical management of donors and also of recipients, who are often discharged too early. Most public or private insurance companies are considering kidney donation a safe procedure without long-term impairment and, therefore, do not increase the premium, whereas recipient insurance of course should cover hospital fees for the donors. "Rewarded gifting" or other financial incentives to compensate for the inconvenience and loss of income related to the donation are not advisable, at least in our opinion. Our center does not perform anonymous living organ donation or "cross-over" transplantation. PMID:16182701

  16. Medication Adherence and Treatment Satisfaction Among Renal Transplant Recipients.

    PubMed

    Alkatheri, Abdulmalik A; Albekairy, Abdulkareem M; Jarab, Anan; Bustami, Rami; Khalidi, Nabil; Alshaya, Abdulrahman; Bin Saleh, Khalid; Alraddadi, Sultan; Alharbi, Shmeylan; Vasudevan, Senthilvel; Alsayyari, Abdullah; Qandil, Amjad M

    2016-01-01

    BACKGROUND Evidence suggests that patients who are more satisfied with their treatment show better adherence with the prescribed therapy. Although there is valuable data about medication adherence among renal transplant recipients (RTRs), there is a limited literature about their treatment satisfaction and its relation to adherence. The aim of the present study was to investigate factors that can predict medication adherence and to explore the relationship between treatment satisfaction and medication adherence in renal transplant recipients. MATERIAL AND METHODS Adult RTRs were included in the study using convenient sampling. The participants were asked to complete the 8-item Morisky Medication Adherence Scale (MMAS-8) and Treatment Satisfaction Scale TSQM 1.4 in addition to several socio-demographic and treatment-related data. The results were statistically analyzed using univariate and multivariate logistic regression modelling in a stepwise procedure. RESULTS A total of 151 RTRs were included in the study, of which 52 were classified as adherent (34%). Univariate analysis showed that, in comparison with non-adherent RTRs, the adherent group demonstrated significantly higher satisfaction scores in the domains of convenience (96.6±8.7 vs. 85.3±19.3), side effects (95.9±14.1 vs. 82.6±24.1), and global satisfaction (93.4±9.8 vs. 86.7±16.7), while they had marginally higher satisfaction scores in the effectiveness domain (90.4±11.6 vs. 86.5±14.5). Results from multiple logistic regression showed that higher likelihood of adherence was significantly associated with increased satisfaction score in the convenience domain [AOR=1.76, 95% CI=(1.21, 2.55); p=0.003] and marginally related to increased satisfaction scores in the side effects domain [AOR=1.31, 95% CI=(0.99, 1.74); p=0.061]. Male RTRs were significantly more likely to be adherent than female RTRs [AOR=2.23, 95% CI=(1.02, 4.84); p=0.043]. CONCLUSIONS Although the adherence rate among RTRs is relatively

  17. ABO-incompatible living donor kidney transplantation without post-transplant therapeutic plasma exchange.

    PubMed

    Yabu, Julie M; Fontaine, Magali J

    2015-12-01

    Blood group incompatibility remains a significant barrier to kidney transplantation. Approximately, one-third of donors are blood group incompatible with their intended recipient. Options for these donor-recipient pairs include blood group incompatible transplantation or kidney paired donation. However, the optimal protocol for blood group incompatible transplantation is unknown. Protocols differ in techniques to remove ABO antibodies, titer targets, and immunosuppression regimens. In addition, the mechanisms of graft accommodation to blood group antigens remain poorly understood. We describe a blood group incompatible protocol using pretransplant therapeutic plasma exchange (TPE), high-dose intravenous immunoglobulin, and rituximab in addition to prednisone, mycophenolate mofetil, and tacrolimus. In this protocol, we do not exclude patients based on a high initial titer and do not implement post-transplant TPE. All 16 patients who underwent this protocol received a living donor transplant with 100% patient and graft survival, and no reported episodes of antibody-mediated rejection to date with a median follow-up of 2.6 years (range 0.75-4.7 years). We conclude that blood group incompatible transplantation can be achieved without post-transplant TPE. PMID:25739580

  18. Risk of Post-Lung Transplant Renal Dysfunction in Adults With Cystic Fibrosis

    PubMed Central

    Mayer-Hamblett, Nicole; Aitken, Moira L.; Goss, Christopher H.

    2012-01-01

    Background: Cystic fibrosis (CF) is one of the leading indications for lung transplantation. The incidence and pre-lung transplant risk factors for posttransplant renal dysfunction in the CF population remain undefined. Methods: We conducted a cohort study using adults (≥ 18 years old) in the CF Foundation Patient Registry from 2000 to 2008 to determine the incidence of post-lung transplant renal dysfunction, defined by an estimated glomerular filtration rate of < 60 mL/min/1.73 m2. Multivariable Cox proportional hazards modeling was used to identify independent pretransplant risk factors for post-lung transplant renal dysfunction. Results: The study cohort included 993 adult lung transplant recipients with CF, with a median follow-up of 2 years. During the study period, 311 individuals developed renal dysfunction, with a 2-year risk of 35% (95% CI, 32%-39%). Risk of posttransplant renal dysfunction increased substantially with increasing age (25 to < 35 years vs 18 to < 25 years: hazard ratio [HR], 1.60; 95% CI, 1.15-2.23; vs ≥ 35 years: HR, 2.45; 95% CI, 1.73-3.47) and female sex (HR, 1.56; 95% CI, 1.22-1.99). CF-related diabetes requiring insulin therapy (HR, 1.30; 95% CI, 1.02-1.67) and pretransplant renal function impairment (estimated glomerular filtration rate, 60-90 mL/min/m2 vs > 90 mL/min/m2: HR, 1.58; 95% CI, 1.19-2.12) also increased the risk of posttransplant renal dysfunction. Conclusions: Renal dysfunction is common following lung transplant in the adult CF population. Increased age, female sex, CF-related diabetes requiring insulin, and pretransplant renal impairment are significant risk factors. PMID:22222189

  19. Atypical Presentation of Herpes Zoster Duplex Bilateralis in a Renal Transplanted Patient.

    PubMed

    Gouveia, Ana Isabel; Borges-Costa, João; Soares-Almeida, Luís; Santana, Alice; Guerra, José

    2013-01-01

    Viral infections in renal transplant patients are an important cause of morbidity and mortality. In most cases, the clinical presentation of herpes zoster allows the diagnosis to be made only by history and physical examination. However, patients who are immunosuppressed may have uncommon presentations, and require a high index of suspicion and additional diagnostic testing for proper management. We report a rare presentation of herpes zoster duplex bilateralis involving symmetrical dermatomes over the lower limbs occurring in a woman with a recent history of renal transplantation. The skin lesions were also atypical representing a diagnostic challenge. This infection should be part of differential diagnosis of cutaneous manifestations in organ transplant recipients. PMID:27429257

  20. Atypical Presentation of Herpes Zoster Duplex Bilateralis in a Renal Transplanted Patient

    PubMed Central

    Gouveia, Ana Isabel; Borges-Costa, João; Soares-Almeida, Luís; Santana, Alice; Guerra, José

    2013-01-01

    Viral infections in renal transplant patients are an important cause of morbidity and mortality. In most cases, the clinical presentation of herpes zoster allows the diagnosis to be made only by history and physical examination. However, patients who are immunosuppressed may have uncommon presentations, and require a high index of suspicion and additional diagnostic testing for proper management. We report a rare presentation of herpes zoster duplex bilateralis involving symmetrical dermatomes over the lower limbs occurring in a woman with a recent history of renal transplantation. The skin lesions were also atypical representing a diagnostic challenge. This infection should be part of differential diagnosis of cutaneous manifestations in organ transplant recipients. PMID:27429257

  1. Living donor liver transplantation in Brazil-current state.

    PubMed

    Andraus, Wellington; Canedo, Bernardo F; D'Alburquerque, Luiz A C

    2016-04-01

    Currently in Brazil, living donor liver transplantation (LDLT) represents 8.5% of liver transplantation (LT), being the majority pediatric one. Up to now, according to Brazilian Organ Transplantation Association (ABTO) annual report, 2,086 procedures have been done nationwide, most of them in southeast and south regions. Based on national centers reports, biliary complication is the most common recipient postoperative complication (14.5-20.6%), followed by hepatic artery thrombosis (3.1-10.7%) and portal vein thrombosis (2.3-9.1%). Patient and graft overall 5-y survival correspond to 76% and 74%, respectively. Regarding the donor, morbidity rate ranges from 12.4% to 28.3%, with a national mortality rate of 0.14%. In conclusion, Brazilian LDLT programs enhance international experience that this is a feasible and safe procedure, as well as an excellent alternative strategy to overcome organs shortage. PMID:27115012

  2. Living donor liver transplantation in Brazil—current state

    PubMed Central

    Andraus, Wellington; D’Alburquerque, Luiz A. C.

    2016-01-01

    Currently in Brazil, living donor liver transplantation (LDLT) represents 8.5% of liver transplantation (LT), being the majority pediatric one. Up to now, according to Brazilian Organ Transplantation Association (ABTO) annual report, 2,086 procedures have been done nationwide, most of them in southeast and south regions. Based on national centers reports, biliary complication is the most common recipient postoperative complication (14.5–20.6%), followed by hepatic artery thrombosis (3.1–10.7%) and portal vein thrombosis (2.3–9.1%). Patient and graft overall 5-y survival correspond to 76% and 74%, respectively. Regarding the donor, morbidity rate ranges from 12.4% to 28.3%, with a national mortality rate of 0.14%. In conclusion, Brazilian LDLT programs enhance international experience that this is a feasible and safe procedure, as well as an excellent alternative strategy to overcome organs shortage. PMID:27115012

  3. Successful Endovascular Repair of Ruptured Abdominal Aortic Aneurysm in a Renal Transplant Recipient

    SciTech Connect

    Kaskarelis, Ioannis S. Koukoulaki, Maria; Lappas, Ioannis; Karkatzia, Fani; Dimopoulos, Nikitas; Filias, Vasilios; Bellenis, Ion; Vougas, Vasilios; Drakopoulos, Spiros

    2006-04-15

    A renal transplant recipient presented in the early post-transplantation period with rupture of an abdominal aortic aneurysm. The high mortality rate of the surgical repair of ruptured aneurysm in addition to the concern of preserving the renal graft prompted us to seek alternative approaches, such as repairing the aneurysm by means of endovascular techniques. The ruptured aneurysm was confirmed by performing computed tomography and digital angiography and thereafter was successfully repaired by endovascular stenting technique (Talent stent-graft), which seems to be a safe and effective method of preserving a renal graft.

  4. Outpatient percutaneous nephrolithotomy in a renal transplant patient: World’s first case

    PubMed Central

    McAlpine, Kristen; Leveridge, Michael J.; Beiko, Darren

    2015-01-01

    Percutaneous nephrolithotomy (PCNL) is an established safe and effective surgical treatment option for renal calculi in renal allografts. The advent of tubeless PCNL has led to reports of ambulatory or outpatient PCNL. This case report describes the successful outpatient management of a 49-year-old female with a symptomatic renal pelvic calculus in her transplanted kidney. Tubeless PCNL successfully removed the stone, free of complication, and the patient was discharged 2 hours and 17 minutes after the procedure in stable condition with minimal pain. This is, to the best of our knowledge, the first successful case of outpatient tubeless PCNL in a transplanted kidney. PMID:26029308

  5. Organ transplantation from donors (cadaveric or living) with a history of malignancy: review of the literature.

    PubMed

    Zhang, Sheng; Yuan, Jin; Li, Wei; Ye, Qifa

    2014-10-01

    The evolution of organ transplantation has resulted in extended lifespan as well as better life quality of patients with end-stage diseases, which in turn causes an increased demand for organs. The persistent organ shortage requires a careful reconsideration of potential donors (living or cadaveric) that have current or historical malignancies. Donors with low-grade skin tumors, carcinomas in situ of the uterine cervix, and primary central nervous system (CNS) tumors can be considered as potential donors for recipients dying on wait list longing for organ transplantation. Recently, transplant centers have turned to other types of malignancies including low grade renal cell carcinoma, prostate, ureteral, endometrial and breast cancer, and favorable outcomes have been shown in such innovations. When considering donors with a history of malignancy, general biologic behavior of the tumor type, histology and stage at the time of diagnosis, and the length of disease-free interval should be considered (Transplantation 2002;74(12):1657-1663). With the review of literatures, we illustrate the organ utilization from donors with malignancies all around the world since earlier times and give some suggestions for decision making under the circumstance of whether to choose those marginal donors or not on the basis of reviewed literatures. PMID:25135838

  6. Economic Evaluation of Pharmacogenetic Tests in Patients Subjected to Renal Transplantation: A Review of Literature

    PubMed Central

    Rancic, Nemanja; Dragojevic-Simic, Viktorija; Vavic, Neven; Kovacevic, Aleksandra; Segrt, Zoran; Djordjevic, Natasa

    2016-01-01

    Renal transplantation is the treatment of choice for the patients with end-stage renal failure. Genetic factors, among others, can influence variability in response to immunosuppressive drugs. Nowadays, due to restrictive health resources, the question arises whether routine pharmacogenetic analyses should be done in the renal transplant recipients or not. The aim of this literature review was to present the up-to-date information considering the economic feasibility of pharmacogenetic testing in patients subjected to renal transplantation. The organization United Network for Organ Sharing in the US estimated that total costs per renal transplant concerning these analyses were $334,300 in 2014. Pharmacogenetic testing prior to treatment initiation could be helpful to predict and assess treatment response and the risks for adverse drug reactions. This kind of testing before treatment initiation seems to be one of the most promising applications of pharmacokinetics. Although pharmacogenetic tests were found to be a cost-effective or cost-saving strategy in many cases, some authors represent another opinion. However, if the real costs of renal transplantation are recognized, the application of these tests in the standard daily practice could be considered more realistic, which additionally emphasizes the importance of future studies assessing their cost effectiveness.

  7. Outpatient parenteral antibiotic therapy in a renal transplant population: A single-center experience.

    PubMed

    Harrison, Jade; Hossain, Mohammad Ayaz; Morsy, Mohamed; Ghazanfar, Abbas

    2015-11-01

    Outpatient parenteral antimicrobial therapy (OPAT) is a well-established method in medical specialties. Its use in renal transplant recipients has not been thoroughly explored. No guidelines within this patient subset exist. This study describes OPAT outcomes within a UK teaching hospital renal transplant population. Renal function, mapped by estimated glomerular filtration rate (eGFR), and clinical response to infection were collected retrospectively. A total of 635 antimicrobial episodes were administered to nine renal transplant patients over 12 discrete OPAT courses during the study period. Eleven of 12 OPAT courses (91.67%) produced a clinical improvement in infection. One course was terminated due to immunosuppressive-related neutropenia. No patient required admission due to failure of OPAT or adverse events. There was no significant change in graft function throughout the OPAT courses compared with baseline renal function (ANOVA, P = 0.06). One minor line infection was reported. This was treated conservatively and did not interrupt the OPAT. OPAT is safe and clinically effective in our renal transplant recipients with no significant deterioration in eGFR. The incidence of adverse events, specifically line complications, was lower in our population than those reported in the literature. Future work should develop OPAT guidelines designed for transplant recipients to outline the degree of monitoring required. PMID:26586048

  8. Summary of the British Transplantation Society UK Guidelines for Living Donor Liver Transplantation.

    PubMed

    Manas, Derek; Burnapp, Lisa; Andrews, Peter Antony

    2016-06-01

    The British Transplantation Society Guidelines for Living Donor Liver Transplantation was published in July 2015 and is the first national guideline in the field of living donor liver transplantation. The guideline aims to review the evidence relating to the evaluation process of both recipient and donor candidates; address the moral and ethical issues surrounding the procedure; outline the technical aspects of the procedure, including the middle hepatic vein controversy and the "small for size syndrome"; review donor and recipient outcomes and complications including donor mortality; and examine evidence relating to the advantages and disadvantages of living donor liver transplantation. In line with previous guidelines published by the BTS, the guideline has used the Grading of Recommendations Assessment, Development and Evaluation system to rate the strength of evidence and recommendations. This article summarizes the Statements of Recommendation contained in the guideline, which provide a framework for the delivery of living liver donation in the United Kingdom and may be of wide international interest. It is recommended that the full guideline document is consulted for details of the relevant references and evidence base. This may be accessed at http://www.bts.org.uk/BTS/Guidelines_Standards/Current/BTS/Guidelines_Standards/Current_Guidelines.aspx?hkey=e285ca32-5920-4613-ac08-fa9fd90915b5. PMID:26950721

  9. Accurate diagnosis of renal transplant rejection by indium-111 platelet imaging despite postoperative cyclosporin therapy

    SciTech Connect

    Collier, B.D.; Adams, M.B.; Kauffman, H.M.; Trembath, L.; Hoffmann, R.G.; Tisdale, P.L.; Rao, S.A.; Hellman, R.S.; Isitman, A.T.

    1988-08-01

    Previous reports indicate that In-111 platelet scintigraphy (IPS) is a reliable test for the early diagnosis of acute post-operative renal transplant rejection (TR). However, the recent introduction of cyclosporin for post-transplantation immunosuppression requires that the diagnostic efficacy of IPS once again be established. Therefore, a prospective IPS study of 73 post-operative renal transplant recipients was conducted. Fourty-nine patients received cyclosporin and 24 patients did not receive this drug. Between these two patient groups, there were no significant differences in the diagnostic sensitivities (0.86 vs 0.80) and specificities (0.93 vs 0.84) with which TR was identified. We conclude that during the first two weeks following renal transplantation the cyclosporin treatment regimen used at our institution does not limit the reliability of IPS as a test for TR.

  10. Post renal transplant pure red cell aplasia—is tacrolimus a culprit?

    PubMed Central

    Patil, Malagouda R.; Choudhury, Arpita Roy; Chohwanglim, Manong; Divyaveer, Smita; Mahajan, Chetan; Pandey, Rajendra

    2016-01-01

    Anemia is not uncommon in the post-renal transplant period and has been reported in up to 40% of renal transplant recipients. It is commonly due to drugs and infections. While post-transplantation anemia is usually due to graft dysfunction and drugs such as mycophenolate and cotrimoxazole, tacrolimus is an uncommon cause. Tacrolimus is usually not believed to be significantly myelosuppressive, but it can cause anemia due to thrombotic microangiopathy. A literature review shows a very small number of reported cases of pure red cell aplasia (PRCA) where tacrolimus seemed to be a causative agent. We report a case series of three renal transplant recipients who were on tacrolimus and presented with chronic transfusion requiring anemia due to PRCA. PMID:27478605

  11. Acute renal failure after cardiac transplantation: a case report and review of the literature.

    PubMed Central

    Cruz, D. N.; Perazella, M. A.

    1996-01-01

    Acute renal failure (ARF) is a relatively frequent complication associated with heart transplantation. It develops in the first few days postoperatively and is characterized by oliguria with laboratory and urinary indices typical of pre-renal azotemia. Cyclosporine, especially with higher doses, is one of the many factors which play an integral part in the nephrotoxicity following cardiac transplant. Poor preoperative renal function and perioperative hemodynamic compromise may also contribute to ARF. The actual incidence of ARF now encountered by transplant centers may be lower than previously reported, the result of lower cyclosporine doses. Currently, management is entirely supportive, but novel therapeutic approaches with atrial natriuretic peptide-like substances are being explored. A case illustrating the typical clinical presentation of ARF after heart transplant will be presented and the clinical features will be reviewed. PMID:9381741

  12. Post renal transplant pure red cell aplasia-is tacrolimus a culprit?

    PubMed

    Patil, Malagouda R; Choudhury, Arpita Roy; Chohwanglim, Manong; Divyaveer, Smita; Mahajan, Chetan; Pandey, Rajendra

    2016-08-01

    Anemia is not uncommon in the post-renal transplant period and has been reported in up to 40% of renal transplant recipients. It is commonly due to drugs and infections. While post-transplantation anemia is usually due to graft dysfunction and drugs such as mycophenolate and cotrimoxazole, tacrolimus is an uncommon cause. Tacrolimus is usually not believed to be significantly myelosuppressive, but it can cause anemia due to thrombotic microangiopathy. A literature review shows a very small number of reported cases of pure red cell aplasia (PRCA) where tacrolimus seemed to be a causative agent. We report a case series of three renal transplant recipients who were on tacrolimus and presented with chronic transfusion requiring anemia due to PRCA. PMID:27478605

  13. Unilateral recurrent pleural effusion in a renal transplant patient.

    PubMed

    Binnani, Pooja; Gupta, Ruchi; Kedia, Nikhil; Bahadur, M M

    2012-01-01

    Pleural effusion is a frequent complication in patients undergoing hemodialysis (HD). We report a patient on HD with a novel cause of recurrent unilateral pleural effusion. A 45-year-old female patient on long-term maintenance HD presented to us with recurrent unilateral pleural effusion. She had a history of poor quality dialysis, severe anemia and severe hypertension. Despite correcting these factors and even after undergoing successful renal transplantation, she continued to have recurrent effusion. Left upper extremity venography demonstrated severe stenosis of the subclavian vein and an increased venous flow in the ipsilateral arteriovenous (AV) fistula. Ligation of the AV fistula led to dramatic resolution of the pleural effusion. Hemodialysis patients who develop unexplained pleural effusions ipsilateral to a functioning AV fistula should be investigated for stenosis in the brachiocephalic vein, particularly those patients who have had previous catheterizations of the jugular or subclavian veins on the same side as the effusion. Correcting the stenosis by venous angioplasty and/or ligation of the ipsilateral fistula can dramatically resolve the pleural effusion. A high index of suspicion is required to diagnose this complication for meaningful intervention. PMID:22237229

  14. Induction therapy in renal transplantation : an overview of current developments.

    PubMed

    Ciancio, Gaetano; Burke, George W; Miller, Joshua

    2007-01-01

    An overview of the past 10 years of clinical renal transplantation would include progress in the development of new induction protocols (non-depleting versus depleting monoclonal and polyclonal antibodies, plasmapheresis and intravenous immunoglobulins) designed to reduce the incidence and severity of rejection and adverse effects as well as improve long-term graft and patient survival. These modalities have been introduced primarily to reduce the incidence of acute rejection episodes leading to early graft loss, decrease the need for higher toxic doses of maintenance immunosuppressive drugs, such as calcineurin inhibitors, and possibly aid in the pursuit of the goal of achieving immunological tolerance and the avoidance of all long-term immunosuppressive therapy. What has resulted during the past 20 years as the use of induction agents has become more popular is the concurrent improvement in detection and treatment of acute and chronic infectious (primarily viral), and opportunistic and quasi-malignant disease accompanying the use of these agents and, therefore, their increase in popularity. However, the overall cost of therapy and the long-term results of protocols in which these agents have been used have not resulted in a definitive benefit thus far, because of the lack of sufficient numbers of defined randomised, long-term studies and the continuing introduction of newer protocols based on even more recent advances. The specific agents used for induction therapy to date, and the rationale for their introduction and mechanisms of action are discussed in this review. PMID:18062717

  15. Opportunistic fungal and bacterial infection in the renal transplant recipient.

    PubMed

    Tolkoff-Rubin, N E; Rubin, R H

    1992-06-01

    The risk of opportunistic infection in the renal transplant recipient is determined by the interaction between two factors: the epidemiologic exposures the individual encounters within the community and the hospital and a complex function termed the net state of immunosuppression. There are two general categories of opportunistic fungal infection in this patient population: (1) disseminated primary or reactivation infection with one of the geographically restricted systemic mycoses (histoplasmosis, coccidioidomycosis, blastomycosis, and paracoccidioidomycosis) and (2) opportunistic infection with fungal species that rarely cause invasive infection in the normal host (Aspergillus species, Candida species, Cryptococcus neoformans, and the Mucoraceae), with these last usually being acquired within the hospital environment. Newly available azole compounds, fluconazole and itraconazole, are exciting new alternatives to amphotericin in the treatment of at least some of these infections. The three most important forms of opportunistic bacterial infections are those due to Listeria monocytogenes, Nocardia asteroides, and a variety of mycobacterial species. Clinical diseases with these first two are effectively prevented by low-dose trimethoprim-sulfamethoxazole prophylaxis. There are two cardinal therapeutic rules to be followed by clinicians in dealing with these infections: prevention is better than treatment; when treatment is required, however, the major determinant of the success of therapy is the rapidity with which the diagnosis is made and effective therapy is initiated. PMID:1498286

  16. Demand for evaluation of vaccination antibody titers in children considered for renal transplantation.

    PubMed

    Prelog, M; Pohl, M; Ermisch, B; Fuchshuber, A; Huzly, D; Jungraithmayr, Th; Forster, J; Zimmerhackl, L B

    2007-02-01

    Vaccinations are recommended for achieving protection against vaccine-preventable infections in solid-organ transplant recipients. In order to evaluate the protection at the time of renal transplantation, the antibody titers against measles, mumps, rubella, varicella, hepatitis B, diphtheria, and tetanus were determined in 35 children one month prior to transplantation. Only 26% of patients on dialysis listed for transplantation showed protective antibodies against all tested pathogens. Particularly, low protection was found for hepatitis B. Children younger than four yr showed significantly lower protective antibody titers compared with older children for almost all vaccines. Children who completed vaccination in the last six months to six yr prior to renal transplantation showed higher rates of protective antibody titers against all pathogens compared with children who had vaccination more than six yr before transplantation. Preventive strategies in children with chronic renal failure include repeated measurements of serum antibodies and appropriate revaccination if titers decline. Our results underline the demand for continuous surveillance of specific antibody titers against vaccine-preventable diseases in the risk group of renal transplant recipients. PMID:17239126

  17. Pulmonary function in chronic renal failure: effects of dialysis and transplantation.

    PubMed Central

    Bush, A; Gabriel, R

    1991-01-01

    Many possible pulmonary complications of renal disease have been described, but little is known of their physiological importance or the effects on them of different forms of renal replacement therapy. Four groups were recruited, each containing 20 patients. The groups consisted of patients with chronic renal failure before dialysis (group 1); patients receiving continuous ambulatory peritoneal dialysis, never having received a transplant (group 2); patients receiving haemodialysis, never having received a transplant (group 3); and patients after their first successful cadaveric renal transplant (group 4). All were attending the same regional dialysis and transplant unit. None was known to have clinically important lung or chest wall disease. Flow-volume loops were recorded before and after 400 micrograms of salbutamol, and plethysmographic lung volumes and airway conductance and single breath carbon monoxide transfer factor were measured. Only nine of 80 patients had normal lung function. The reductions in spirometric values were minor. Whole lung carbon monoxide transfer factor was reduced in all groups (mean % predicted with 95% confidence intervals: group 1 81.7% (74-89%); group 2 69.7% (62-77%); group 3 87.5% (80-96%); group 4 82.5% (78-87%]. The values were significantly lower in those having continuous ambulatory peritoneal dialysis (group 2). Residual volume was reduced significantly in the group who had undergone renal transplantation (85.7%, 77-94%). There was no correlation between these changes and smoking habit, age, duration or severity of renal failure, duration of treatment, or biochemical derangement. It is concluded that abnormal lung function is common in renal disease. The main change is a reduction in carbon monoxide transfer that persists after transplantation. The likeliest explanation is that subclinical pulmonary oedema progresses to fibrosis before transplantation. The fibrosis may worsen further to cause the reduced residual volume in the

  18. The International Liver Transplant Society Guideline on Living Liver Donation.

    PubMed

    Miller, Charles M; Durand, Francois; Heimbach, Julie K; Kim-Schluger, Leona; Lee, Sung-Gyu; Lerut, Jan; Lo, Chung-Mau; Quintini, Cristiano; Pomfret, Elizabeth Anne

    2016-06-01

    The following guideline represents the position of the International Liver Transplantation Society (ILTS) on key preoperative, operative, and postoperative aspects surrounding living liver donation. These recommendations were developed from experts in the field from around the world. The authors conducted an analysis of the National Library of Medicine indexed literature on "living donor liver transplantation" [Medline search] using Grading of Recommendations Assessment, Development and Evaluation methodology. Writing was guided by the ILTS Policy on the Development and Use of Practice Guidelines (www.ilts.org). ILTS members, and many more nonmembers, were invited to comment. Recommendations have been based on information available at the time of final submission (March 2016). The lack of randomized controlled trials in this field to date is acknowledged and is reflected in the grading of evidence. Intended for use by physicians, these recommendations support specific approaches to the diagnostic, therapeutic, and preventive aspects of care. PMID:27120453

  19. Living donor liver transplantation in polycystic liver disease.

    PubMed

    Mekeel, Kristin L; Moss, Adyr A; Reddy, Kunam S; Douglas, David D; Vargas, Hugo E; Carey, Elizabeth J; Byrne, Thomas J; Harrison, M E; Rakela, Jorge; Mulligan, David C

    2008-05-01

    In the current Model for End-Stage Liver Disease system, patients with polycystic liver disease (PCLD) who have a poor quality of life secondary to their massive hepatomegaly are no longer competitive for a deceased donor liver transplant if their liver function is well preserved. Traditionally, a caval resection has been advocated in these patients because of the difficulty of the hepatectomy with hepatomegaly, which makes living donation impossible. This series looks at 3 patients who underwent a caval sparing hepatectomy and subsequent living donor liver transplantation (LDLT) for PCLD. Graft and patient survival was 100%, and there were few complications in either donors or recipients. LDLT is an ideal option for patients with PCLD and preserved liver function but poor quality of life. PMID:18433036

  20. Fractionated total lymphoid irradiation as preparative immunosuppression in high risk renal transplantation: clinical and immunological studies

    SciTech Connect

    Najarian, J.S.; Ferguson, R.M.; Sutherland, D.E.; Slavin, S.; Kim, T.; Kersey, J.; Simmons, R.S.

    1982-10-01

    Twenty-two patients at high risk to reject renal allografts have been treated with fractionated total lymphoid irradiation (FTLI) prior to transplantation of primary (2), secondary (16) or teritary (4) renal allografts. All patients undergoing retransplantation had rapidly rejected previous grafts. At 24 months following transplantation, 72% of grafts were functioning in the TLI group compared with a 38% graft function in an historical control group of recipients receiving secondary or tertiary grafts and treated with conventional immunosuppression. Important variables in determining success of transplantation following fractionated TLI include the dose of TLI, the interval from radiation to transplantation, and maintenance, post-transplant immunosuppressive therapy. Optimal results were achieved with 2500 rads delivered in 100 rad fractions followed by transplantation within two weeks, and a tapering prednisone schedule and maintenance azathioprine post-transplantation. Seventeen patients had significant complications of the radiation treatment and there was one death, prior to transplantation, associated with pneumonitis. In vitro assessment of immune function demonstrated marked peripheral T cell depletion and loss of in vitro responsiveness to mitogen and allogeneic stimulation following FTLI. The administration of donor bone marrow at the time of transplantation did not produce chimerism. The results suggest that when properly utilized FTLI can produce effective adjunctive immunosuppression for clinical transplantation.

  1. Fractionated total lymphoid irradiation as preparative immunosuppression in high risk renal transplantation

    SciTech Connect

    Najarian, J.S.; Ferguson, R.M.; Sutherland, D.E.; Slavin, S.; Kim, T.; Kersey, J.; Simmons, R.L.

    1982-10-01

    Twenty-two patients at high risk to reject renal allografts have been treated with fractionated total lymphoid irradiation (FTLI) prior to transplantation of primary (2), secondary (16) or tertiary (4) renal allografts. All patients undergoing retransplantation had rapidly rejected previous grafts. At 24 months following transplantation, 72% of grafts were functioning in the TLI group compared with a 38% graft function in an historical control group of recipients receiving secondary or tertiary grafts and treated with conventional immunosuppression. Important variables in determining success of transplantation following fractionated TLI include the dose of TLI, the interval from radiation to transplantation, and maintenance post-transplant immunosuppressive therapy. Optimal results were achieved with 2500 rads delivered in 100 rad fractions followed by transplantation within two weeks, and a tapering prednisone schedule and maintenance azathioprine post-transplantation. Seventeen patients had significant complications of the radiation treatment and there was one death, prior to transplantation, associated with pneumonitis. In vitro assessment of immune function demonstrated marked peripheral T cell depletion and loss of in vitro responsiveness to mitogen and allogeneic stimulation following FTLI. The administration of donor bone marrow at the time of transplantation did not produce chimerism. The results suggest that when properly utilized FTLI can produce effective adjunctive immunosuppression for clinical transplantation.

  2. Pancreas Transplantation From Living Donors: A Single Center Experience of 20 Cases.

    PubMed

    Choi, J Y; Jung, J H; Kwon, H; Shin, S; Kim, Y H; Han, D J

    2016-08-01

    Living donor pancreas transplantation (LDPT) has several advantages over deceased donor pancreas transplantation (DDPT), including better HLA matching, shorter ischemic time, and shorter waiting time. It remains an attractive option for diabetes mellitus (DM) patients with end stage renal disease. We reviewed 20 cases of LDPT performed in Asan Medical Center between October 1992 and March 2015. Six cases (30%) were pancreas transplantation alone (PTA), and the rest (70%) were simultaneous pancreas and kidney transplantation (SPK). Relations of donor and recipient were parents in 7 (35%), siblings in 6 (30%), spouse in 6 (30%), and cousin in 1 (5%). Graft survival in SPK at 1, 3, 5, and 10 years was 91.7%, 83.3%, 83.3%, and 83.3%, respectively, and that in PTA recipients was 50%, 33.3%, 16.7%, and 16.7%, respectively (p = 0.005). Causes of graft failure in SPK were thrombosis (one case), and rejection (one case), whereas those in PTA were noncompliance (two cases), thrombosis (one case), reflux pancreatitis (one case), and chronic rejection (one case). In terms of pancreas exocrine drainage, two grafts (25%) maintained their function in bladder drainage, while all grafts maintained in enteric drainage p < 0.05). Seven (35%) donors experienced minor pancreatic juice leakage and one underwent reoperation due to postoperative hematoma. Most donors maintained normoglycemia and normal renal function. However, two donors developed DM (at 1 and 90 months postdonation), and were treated with oral hypoglycemic agents. Graft survival in PTA recipients was poorer than in SPK due to poor compliance and bladder drainage-related problems. The surgical and metabolic complication rates of donors can be minimized by applying strict donor criteria. Therefore, LDPT with enteric drainage is an acceptable treatment for SPK. PMID:26833623

  3. Recent advances in renal interstitial fibrosis and tubular atrophy after kidney transplantation

    PubMed Central

    2014-01-01

    Although kidney transplantation has been an important means for the treatment of patients with end stage of renal disease, the long-term survival rate of the renal allograft remains a challenge. The cause of late renal allograft loss, once known as chronic allograft nephropathy, has been renamed “interstitial fibrosis and tubular atrophy” (IF/TA) to reflect the histologic pattern seen on biopsy. The mechanisms leading to IF/TA in the transplanted kidney include inflammation, activation of renal fibroblasts, and deposition of extracellular matrix proteins. Identifying the mediators and factors that trigger IF/TA may be useful in early diagnosis and development of novel therapeutic strategies for improving long-term renal allograft survival and patient outcomes. In this review, we highlight the recent advances in our understanding of IF/TA from three aspects: pathogenesis, diagnosis, and treatment. PMID:25285155

  4. Multiple Brain Abscesses Due to Phialemonium in a Renal Transplant Recipient: First Case Report in the Literature.

    PubMed

    Aydın, Mehtap; Özçelik, Ümit; Çevik, Halime; Çınar, Özlem; Evren, Ebru; Demirağ, Alp

    2015-11-01

    Fungal brain abscesses are a rare but serious complication in transplant recipients. Phialemonium organisms are rare causes of invasive mold infections. Here, we present the first case of a renal transplant recipient with multiple brain abscesses caused by Phialemonium infection A. A 51-year-old female kidney transplant recipient was admitted with pneumonia of an unknown cause and treated with empiric intravenous antibiotics. Her treatment was uneventful, and she was discharged 1010 days later. After 5 days, she was readmitted with fever, cerebral palsy, and speech disorder. The patient had undergone living-donor renal transplant 7 months earlier. A cranial computed tomography and magnetic resonance imaging were performed for a possible cerebrovascular pathology. The magnetic resonance imaging scan showed multiple brain abscesses located at the left parietal, frontal and occipital lobes; right parietal and occipital lobes; right basal ganglia; and left cerebellum. The patient received meropenem, linezolid, sulfamethoxazole and trimethoprim, and AmBisome for probable pathogenic infection, and immunosuppressive agents dosage was reduced increasingly immunosuppressed. We identified Phialemonium in cerebrospinal fluid culture. The patient received voriconazole 200 mg twice daily. Lesions could not be drained due to lack of capsula formation. The patient died on the 30th day of antifungal therapy. Phialemonium organisms, although a rare cause of fungal infections, are associated with a high mortality rate in immunocompromised patients. To our knowledge, this is the first case report in the literature describing multiple brain abscesses due to Phialemonium in a transplant recipient. Clinicians recipient should be alert about these rare opportunistic fungi in the differential diagnosis of brain abscess, and bronchoscopy and bronchoalveolar lavage are recommended for transplant patients when they are admitted with pneumonia exclude fungal infections. PMID:26640919

  5. Association of interleukin 18-607A/C and -137C/G polymorphisms with oxidative stress in renal transplant recipients.

    PubMed

    Davran, Fatih; Yilmaz, Vural Taner; Erdem, Bilge Karatoy; Gultekin, Meral; Suleymanlar, Gultekin; Akbas, Halide

    2016-06-01

    Objectives IL-18 mediates various inflammatory and oxidative responses including renal injury, fibrosis, and graft rejection. It has been reported that the promoter -607 and -137 polymorphisms of IL-18 influence the level of IL-18. This prospective observational study investigated the association between oxidative stress with IL-18-607 and -137 polymorphisms in renal transplant recipients. Patients and methods This study included 75 renal transplant recipients (28 female, 47 male) from living-related donors. Blood samples were collected immediately before and after transplantation at day 7 and month 1. Serum IL-18, creatinine, cystatin C, CRP, and oxidative stress markers (TOS, TAC) were measured. The Oxidative Stress Index (OSI) was calculated. Polymorphisms of the promoter region of the IL-18 gene, IL18-607A/C, and -137C/G were determined by analysis of a "real-time PCR/Melting curve". Results Serum creatinine, cystatin C, CRP, IL-18, TOS, and OSI levels significantly decreased after transplantation. Post-transplant levels of serum TAC and estimated GFR demonstrated consistent significant increases. Serum IL-18 levels were significantly higher in patients with IL-18-137 GG and IL-18-607 CC genotypes before transplantation. Conclusion Our results indicate that the IL-18-137 GG and -607 CC genotypes contribute to higher IL-18 levels; however, the influence of these polymorphisms on oxidative stress has not been observed. PMID:26983036

  6. Tolerance Induction in HLA Disparate Living Donor Kidney Transplantation by Donor Stem Cell Infusion: durable chimerism predicts outcome1

    PubMed Central

    Leventhal, Joseph; Abecassis, Michael; Miller, Joshua; Gallon, Lorenzo; Tollerud, David; Elliott, Mary Jane; Bozulic, Larry D.; Houston, Chris; Sustento-Reodica, Nedjema; Ildstad, Suzanne T.

    2012-01-01

    Background We recently reported that durable chimerism can be safely established in mismatched kidney recipients through nonmyeloablative conditioning followed by infusion of a facilitating cell (FC)-based hematopoietic stem cell transplant termed FCRx. Here we provide intermediate-term follow-up on this phase 2 trial. Methods Fifteen HLA mismatched living donor renal transplant recipients underwent low intensity conditioning (fludarabine, cyclophosphamide, 200cGyTBI), received a living donor kidney transplant on day 0, then infusion of cryopreserved FCRx on day +1. Maintenance immunosuppression(IS),consisting of tacrolimus and mycophenolate, was weaned over one year. Results All but one patient demonstrated peripheral blood macrochimerism post-transplantation. Engraftment failure occurred in a highly sensitized (PRA of52%) recipient. Chimerism was lost in 3patients at 2, 3, and 6 months post transplantation. Two of these subjects had received either a reduced cell dose or incomplete conditioning; the other 2 had PRA >20%. All demonstrated donor-specific hyporesponsiveness and were weaned from full dose immunosuppression. Complete immunosuppression withdrawal at one year post-transplant was successful in all patients with durable chimerism. There has been no GVHD or engraftment syndrome. Renal transplant loss occurred in 1 patient who developed sepsis following an atypical viral infection. Two subjects with only transient chimerism demonstrated subclinical rejection on protocol biopsy despite donor-specific hyporesponsiveness. Conclusions Low intensity conditioning plus FCRx safely achieved durable chimerism in mismatched allograft recipients. Sensitization represents an obstacle to successful induction of chimerism. Sustained T cell chimerism is a more robust biomarker of tolerance than donor-specific hyporeactivity. PMID:23222893

  7. Desmopressin use prior to renal transplant biopsy—does it fit?

    PubMed Central

    Anandagoda, Nelomi; Jayawardene, Satish; Macdougall, Iain C.; Shah, Sapna

    2014-01-01

    Desmopressin acetate (DDAVP), a selective agonist of type 2 vasopressin receptors, is sometimes used prior to percutaneous renal biopsy to reduce the risk of bleeding complications. DDAVP increases free water reabsorption in renal collecting ducts, potentially leading to water intoxication or dilutional hyponatraemia. We present two cases, where DDAVP was used prior to percutaneous renal transplant biopsy and was associated with severe hyponatraemia and neurological sequelae. With DDAVP being advocated in many centres prior to percutaneous renal biopsy, these cases highlight the need for increased awareness regarding side effects. In this report, we provide suggestions on strategies to minimize hyponatraemia in this context. PMID:25859381

  8. Cyclosporine dose reduction by ketoconazole administration in renal transplant recipients.

    PubMed

    First, M R; Schroeder, T J; Alexander, J W; Stephens, G W; Weiskittel, P; Myre, S A; Pesce, A J

    1991-02-01

    Cyclosporine metabolism occurs in the liver via hepatic cytochrome P-450 microsomal enzymes. Ketoconazole, an imidazole derivative, has been shown to inhibit the cytochrome P-450 enzyme system. Thirty-six renal transplant recipients receiving cyclosporine as part of a triple immunosuppressive drug regimen were started on 200 mg/day of oral ketoconazole. The dose of cyclosporine was reduced by 70% at the start of ketoconazole; this dose reduction was based on our previous experience with concomitant cyclosporine-ketoconazole therapy. Ketoconazole was started in patients who had been on cyclosporine for between 10 days and 74 months. The mean cyclosporine dose was 420 mg/day (5.9 mg/kg/day) before starting ketoconazole and 66 mg/day (0.9 mg/kg/day) one year after the addition of ketoconazole; this represents a cyclosporine dose reduction of 84.7% (P less than 0.0001). The mean trough whole-blood cyclosporine concentrations measured by HPLC, were 130 ng/mL preketoconazole and 149 ng/mL after 1 year of combination therapy. Mean serum creatinine and BUN levels were unchanged before and during ketoconazole administration, and no changes in liver function tests were noted. Cyclosporine pharmacokinetics were performed before and after at least three weeks of ketoconazole. Hourly whole-blood samples were measured by HPLC (parent cyclosporine only) and TDX (parent + metabolites). Combination therapy resulted in decreases in the maximum blood concentration and the steady-state volume of distribution divided by the fractional absorption, and increases in mean residence time and the parent-to-parent plus metabolite ratio (calculated by dividing the HPLC by the TDX value). The addition of ketoconazole to cyclosporine-treated patients resulted in a significant inhibition of cyclosporine metabolism and decrease in the dosage. There was minimal nephrotoxicity, and only four rejection episodes occurred on combined therapy. The concomitant administration of the two drugs was well

  9. Recurrence of light chain deposit disease after renal allograft transplantation: potential role of rituximab?

    PubMed

    Kuypers, Dirk R J; Lerut, Evelyne; Claes, Kathleen; Evenepoel, Pieter; Vanrenterghem, Yves

    2007-04-01

    Light chain deposit disease (LCDD) is a monoclonal plasma cell disorder characterized by tissue deposition of nonamyloid immunoglobulin light chains, predominantly kappa chains, causing renal insufficiency. LCDD reoccurs almost invariably after renal grafting, leading to early graft loss, usually within a time span of months to years. We describe a female patient with LCDD who lost her first living donor graft after 1 year due to extensive recurrence of kappa chain deposition. Rituximab was administered on the seventh day after her second transplantation with a graft from a deceased donor, in order to prevent early recurrence of LCDD. The 2-year protocol biopsy - similarly to the completely normal 1-year protocol biopsy - revealed persistent absence of light chain deposition on light microscopy but immunohistochemical staining and electron microscopy showed very mild recurrence of light chain deposits. A second 4-week course of rituximab was repeated because of these electron microscopic findings. Subsequently, free kappa light chain concentration decreased from 693 to 74 mg/l and remained low 4 months after completion of therapy. Rituximab could be considered for delaying early LCDD recurrence in patients in whom treatment of the underlying bone marrow disorder failed or is contraindicated, but maintenance therapy is apparently necessary to consolidate this response. PMID:17326779

  10. Human leukocyte antigens in indigenous (mapuche) people in a regional renal transplantation program in chile.

    PubMed

    Droguett, M A; Oyarzún, M J; Alruiz, P; Jerez, V; Mezzano, S; Ardiles, L

    2005-10-01

    An active regional transplantation program established in the southern region of Chile has allowed the incorporation of ethnic minorities particularly Mapuche living in this geographic area in the development of a histocompatibility database. To identify possible differences in the human leukocyte (HLA) antigen distribution in Chilean Mapuche compared with non-Mapuche, we reviewed 442 HLA tissue-typing studies. Seventy-eight of 309 recipients (25%) and 18 of 133 donors (13%) were Mapuche. Among recipients, Mapuche people showed a significantly higher frequency of the HLA antigens, A28, B16, DR4, and DR8, and a lower one for A19, B15, and DR1 (P < .05) compared with non-Mapuche individuals. A particularly higher frequency of the haplotype A28, -B16, -DR4 was also evidenced in Mapuche. Besides, these recipients showed a higher frequency of the allele -DR4 when compared with Mapuche donors. A greater frequency of some histocompatibility antigens in patients with chronic renal disease might be attributed to allelic concentration due to a high index of endogamy, but a possible association with the development of progressive renal disease cannot be ignored, especially when a higher prevalence of DR4 was observed among Mapuche recipients. PMID:16298598

  11. Longitudinal renal function in pediatric heart transplant recipients: 20-years experience.

    PubMed

    Gupta, Punkaj; Rettiganti, Mallikarjuna; Gossett, Jeffrey M; Gardner, Megan; Bryant, Janet C; Noel, Tommy R; Knecht, Kenneth R

    2015-03-01

    This study was initiated to assess the temporal trends of renal function, and define risk factors associated with worsening renal function in pediatric heart transplant recipients in the immediate post-operative period. We performed a single-center retrospective study in children ≤18 yr receiving OHT (1993-2012). The AKIN's validated, three-tiered AKI staging system was used to categorize the degree of WRF. One hundred sixty-four patients qualified for inclusion. Forty-seven patients (28%) were classified as having WRF after OHT. Nineteen patients (11%) required dialysis after heart transplantation. There was a sustained and steady improvement in renal function in children following heart transplantation in all age groups, irrespective of underlying disease process. The significant factors associated with risk of WRF included body surface area (OR: 1.89 for 0.5 unit increase, 95% CI: 1.29-2.76, p = 0.001) and use of ECMO prior to and/or after heart transplantation (OR: 3.50, 95% CI: 1.51-8.13, p = 0.004). Use of VAD prior to heart transplantation was not associated with WRF (OR: 0.50, 95% CI: 0.17-1.51, p = 0.22). On the basis of these data, we demonstrate that worsening renal function improves early after orthotopic heart transplantation. PMID:25484128

  12. Complement inhibition as a novel strategy in renal transplantation

    PubMed Central

    Drage, M; Watson, C; Nicholson, M; Sacks, S

    2013-01-01

    Affiliated to the Association of Surgeons in Training and the British Transplantation Society, the Carrel Club is the transplant trainee surgical society. The Carrel Club held a joint meeting with the Chapter of Transplant Surgeons, a subsidiary organisation of the British Transplantation Society, at the Manchester Hilton Hotel on 31 January and 1 February 2013. As part of the meeting, ten abstracts were presented. A selection is printed below. The winner of the Best Presentation award was Mr Mownah.

  13. Vascular Multiplicity Should Not Be a Contra-Indication for Live Kidney Donation and Transplantation

    PubMed Central

    van Bruggen, Mark; Kimenai, Hendrikus J. A. N.; Tran, Thi C. K.; Terkivatan, Türkan; Betjes, Michiel G. H.; IJzermans, Jan N. M.; Dor, Frank J. M. F.

    2016-01-01

    Background Whether vascular multiplicity should be considered as contraindication and therefore ‘extended donor criterion’ is still under debate. Methods Data from all live kidney donors from 2006–2013 (n = 951) was retrospectively reviewed. Vascular anatomy as imaged by MRA, CTA or other modalities was compared with intraoperative findings. Furthermore, the influence of vascular multiplicity on outcome of donors and recipients was studied. Results In 237 out of 951 donors (25%), vascular multiplicity was present. CTA had the highest accuracy levels regarding vascular anatomy assessment. Regarding outcome of donors with vascular multiplicity, warm ischemia time (WIT) and skin-to-skin time were significantly longer if arterial multiplicity (AM) was present (5.1 vs. 4.0 mins and 202 vs. 178 mins). Skin-to-skin time was significantly longer, and complication rates were higher in donors with venous multiplicity (203 vs. 180 mins and 17.2% vs. 8.4%). Outcome of renal transplant recipients showed a significantly increased WIT (30 vs. 26.7 minutes), higher rate of DGF (13.9% vs. 6.9%) and lower rate of BPAR (6.9% vs. 13.9%) in patients receiving a kidney with AM compared to kidneys with singular anatomy. Conclusions We conclude that vascular multiplicity should not be a contra-indication, since it has little impact on clinical outcome in the donor as well as in renal transplant recipients. PMID:27077904

  14. Laboratory use of hepcidin in renal transplant recipients

    PubMed Central

    Šimetić, Lucija; Zibar, Lada

    2016-01-01

    Hepcidin is a small peptide with a critical role in cellular iron homeostasis, as it regulates utilization of stored iron and antimicrobial defense in inflammation (bacterial and fungal). Since it was isolated in 2000, and especially in the last decade, numerous studies aimed to evaluate the clinical use of plasma and urine hepcidin as a marker of anemia, especially anemia of chronic disease and post-transplant anemia (PTA). Hepcidin regulation is delicately tuned by two inflammatory pathways activated by interleukin-6 (IL-6) and bone morphogenic proteins (BMPs) and iron regulated pathway sensitive to circulating transferin-iron (TR-Fe) complex. BMP-mediated pathway and TR-Fe sensitive pathway seem to be connected by hemojuveline, a BMP co-factor that interacts with transferine receptor 2 (TRF2) in cases of high TR-Fe circulatory concentration. In addition to these regulatory mechanisms other regulators and signaling pathways are being extensively researched.
Hepcidin has been identified as an important contributor to morbidity and mortality in end stage renal disease (ESRD) but no such association has jet been found in case of PTA. However, there is an association between higher doses of erythropoiesis-stimulating agents (ESA) and mortality in the posttransplant period and the assumption that hepcidin might play a role in ESA resistance in PTA. Thus the review’s main goal was to summarize papers published on the association of hepcidin with PTA, give up-to-date information on hepcidin regulation and on potential therapeutics that optimize hepcidin regulation. We also compared the performances of tests for hepcidin determination and reviewed research on immunosuppressants’ (IS) effect on hepcidin concentration. PMID:26981017

  15. Living donor liver transplantation in Taiwan-challenges beyond surgery.

    PubMed

    Pillai, Vinod G; Chen, Chao-Long

    2016-04-01

    Taiwan has a high prevalence of hepatitis B and C viral infections, and consequently a high burden of chronic liver diseases. Liver transplantation (LT) began in Taiwan in 1984, and living donor liver transplantation (LDLT) in 1994. Education and collaboration between physicians on a national and international scale were important factors in the development of transplantation in East Asia. Technical innovations in donor hepatectomy, vascular and biliary reconstruction, and interventional radiology, perioperative management of transplant patients and development of associated specialties have enabled achievement of excellent results after both adult and pediatric LDLT. The establishment of rigorous protocols to withstand strict medico-legal scrutiny, combined with technical excellence has contributed to excellent surgical outcomes. The socioeconomic development of Taiwan and the first nationwide hepatitis B vaccination program in the world have also contributed to the decrease in disease burden and improvement of quality of healthcare. This article examines the factors enabling the development of LT in Taiwan, the innovations that have contributed to excellent outcomes, and indicates the future prospects of LDLT in Taiwan. PMID:27115009

  16. Living donor liver transplantation in Taiwan—challenges beyond surgery

    PubMed Central

    Pillai, Vinod G.

    2016-01-01

    Taiwan has a high prevalence of hepatitis B and C viral infections, and consequently a high burden of chronic liver diseases. Liver transplantation (LT) began in Taiwan in 1984, and living donor liver transplantation (LDLT) in 1994. Education and collaboration between physicians on a national and international scale were important factors in the development of transplantation in East Asia. Technical innovations in donor hepatectomy, vascular and biliary reconstruction, and interventional radiology, perioperative management of transplant patients and development of associated specialties have enabled achievement of excellent results after both adult and pediatric LDLT. The establishment of rigorous protocols to withstand strict medico-legal scrutiny, combined with technical excellence has contributed to excellent surgical outcomes. The socioeconomic development of Taiwan and the first nationwide hepatitis B vaccination program in the world have also contributed to the decrease in disease burden and improvement of quality of healthcare. This article examines the factors enabling the development of LT in Taiwan, the innovations that have contributed to excellent outcomes, and indicates the future prospects of LDLT in Taiwan. PMID:27115009

  17. Hispanic/Latino Disparities in Living Donor Kidney Transplantation: Role of a Culturally Competent Transplant Program

    PubMed Central

    Gordon, Elisa J.; Lee, Jungwha; Kang, Raymond; Ladner, Daniela P.; Skaro, Anton I.; Holl, Jane L.; French, Dustin D.; Abecassis, Michael M.; Caicedo, Juan Carlos

    2015-01-01

    Background Hispanic Americans face disparities in access to kidney transplantation, particularly living donor kidney transplantation (LDKT). This study compared characteristics of LDKT recipients before and after implementing the Hispanic Kidney Transplant Program (HKTP) at Northwestern Medicines (NM) and other centers. Methods The NM HKTP, initiated in December 2006, delivers culturally and linguistically competent and congruent care. Program-specific data were used to compare the mean ratios of Hispanic to non-Hispanic white LDKTs between pre-HKTP (2001-2006) and post-HKTP (2008-2013), and to compare the characteristics of NM's adult LDKT patients between pre-HKTP and post-HKTP. The same ratio was calculated for transplant centers in regions with a significant Hispanic population (≥25%) and performing in the top tertile of total LDKT volume in the pre-HKTP period. The number of Hispanic and non-Hispanic white patients added to the waiting list were compared between pre-HKTP (2001-2006) and post-HKTP (2008-2013) as a proxy for increased patient referrals and a pathway by which the HKTP may increase LDKTs. Results The ratio of Hispanic to non-Hispanic white LDKTs significantly increased by 70% after the implementation of NM's HKTP (pre-HKTP mean = 0.20, post-HKTP mean = 0.34; P= 0.001). None of the other transplant centers experienced a similar increase in their ratio of Hispanic to non-Hispanic white LDKTs. The NM waiting list additions grew by 91% among Hispanics, but grew only 4% for non-Hispanic whites. Conclusions These data suggest that the development and implementation of a culturally congruent transplant program can positively affect Hispanic LDKT and thereby reduce Hispanics disparities in LDKT rates. Further studies are needed to prospectively evaluate the generalizability of implementing such culturally competent interventions at other transplant programs. PMID:27500229

  18. Pulmonary nocardiosis due to Nocardia farcinica in a renal transplant recipient.

    PubMed

    Gowrinath, K; Baig, Waqas Wahid; Prabhu, Attur Ravindra; Chawla, Kiran; Bairy, Indira

    2009-01-01

    Nocardia farcinica is an infrequent cause of nocardiosis among the renal transplant recipients and it has not been reported so far from India. We report a case of pulmonary nocardiosis due to N. farcinica in a 32-year-old woman with hypothyroidism and post-renal transplant status, currently on immunosuppressive therapy (prednisolone, azathioprine and tacrolimus). The N. farcinica isolate was susceptible to trimethoprim-sulfamethoxazole (TMP-SMZ), linezolid, imipenem, gentamicin but resistant to ceftriaxone, ciprofloxacin, tobramycin, erythromycin, amoxycillin-clavulanic acid and tetracycline. Treatment with TMP-SMZ and linezolid resulted in marked clinico-radiological improvement but after two weeks both of the drugs had to be stopped due to severe pancytopenia as adverse effect of their use. Currently, the patient is on imipenem and remains stable after four weeks of treatment. In N. farcinica infections, multi antibiotic resistance and toxicity of some specific drugs enhances the risk of therapeutic failure in renal transplant recipients. PMID:20073376

  19. Comparison of magnetic resonance imaging and radionuclide imaging in the evaluation of renal transplant failure

    SciTech Connect

    Goldsmith, M.S.; Tanasescu, D.E.; Waxman, A.D.; Crues, J.V. III

    1988-04-01

    Magnetic resonance imaging (MRI) was compared with radionuclide scintigraphy (RNS) in 16 patients with renal transplants undergoing renal failure to determine which modality could best discriminate between rejection, acute tubular necrosis (ATN), and cyclosporin nephrotoxicity (CN). Although all rejecting transplants had reduced corticomedullary differentiation (CMD) on T1-weighted MR images, four of five cases of ATN had appearances that could not be distinguished from rejection. A normal CMD suggests nonrejection, but diminished CMD is nonspecific. Tc-99m DTPA/I-131 hippuran RNS was superior to MRI in differentiating rejection from ATN. Although ATN and CN have similar RNS patterns, this distinction can usually be made based on the clinical time course. Other potential uses of MRI in the evaluation of the renal transplants are discussed.

  20. Medication adherence and older renal transplant patients' perceptions of electronic medication monitoring.

    PubMed

    Russell, Cynthia L; Owens, Sarah; Hamburger, Karen Q; Thompson, Denise A; Leach, Rebecca R; Cetingok, Muammer; Hathaway, Donna; Conn, Vicki S; Ashbaugh, Catherine; Peace, Leanne; Madsen, Richard; Winsett, Rebecca P; Wakefield, Mark R

    2009-10-01

    This study evaluated older renal transplant recipients' perceptions of electronic medication monitoring and the influence of these perceptions on medication adherence. A sample of 73 older adult renal transplant recipients who used the Medication Event Monitoring System (MEMS(®)) TrackCaps for 12 months provided their perceptions of device use. Participants perceived that the MEMS had a neutral effect on their medication-taking routine (65%), believed the MEMS was practical (56%), and could not describe any instances in which using the MEMS was difficult (56%). No significant difference in medication adherence was found between those who perceived the MEMS's influence negatively/neutrally and those who perceived the MEMS positively (p = 0.22). Medication adherence data from older adult renal transplant recipients can be used regardless of their perceptions of the MEMS's influence on their medication taking without biasing medication adherence data. PMID:19772223

  1. Asymptomatic Cecal Perforation in a Renal Transplant Recipient After Sodium Polystyrene Sulfonate Administration.

    PubMed

    Singla, Montish; Shikha, Deep; Lee, Sunggeun; Baumstein, Donald; Chaudhari, Ashok; Carbajal, Roger

    2016-01-01

    Sodium polystyrene sulfonate (SPS) is a medication commonly used for the treatment of hyperkalemia. There have been many cases of colonic necrosis and perforation associated with administration of SPS. There are very few such cases reported in renal transplant patients. We present a case of renal transplant recipient who developed cecal perforation after a single oral dose of SPS. She had no signs or symptoms suggestive of intestinal perforation and was incidentally diagnosed with it on abdominal imaging performed to find cause of acute blood loss anemia. This case underlines the importance of recognizing this severe and potentially life-threatening complication associated with SPS. The clinicians should also consider renal/solid organ transplant and immunosuppression as potential risk factors. PMID:25415544

  2. [Late presentation of an extrarenal pseudoaneurysm in a renal transplant patient: CT and color Doppler US findings (case report)].

    PubMed

    Düşünceli, Ebru; Atasoy, Cetin; Fitoz, Suat; Yağci, Cemil

    2004-12-01

    Vascular complications associated with renal transplants are a significant cause of graft dysfunction or failure. The most common complications are arterial and venous stenoses/thromboses, intrarenal and extrarenal arteriovenous fistulas, and pseudoaneurysms. In this case report, an extremely rare complication following renal transplantation, an extrarenal pseudoaneurysm, is presented with CT, gray scale, and color Doppler US findings. PMID:15611918

  3. Feelings of living donors about adult-to-adult living donor liver transplantation.

    PubMed

    Kusakabe, Tomoko; Irie, Shinji; Ito, Naomi; Kazuma, Keiko

    2008-01-01

    This study investigated the feelings of living donors about adult-to-adult liver transplantation. We interviewed 18 donors about their feelings before and after transplantation using semistructured interviews and then conducted a content analysis of their responses. Before transplantation, many donors reported that they wanted recipients to live for the donor or his or her family, and there was no one else to donate. Many donors were not anxious, did not feel coerced, and did not consider donation dangerous. Some reported being excited at facing a new experience. Some said they would not mind whatever happens. Others were anxious or unsure about the operation. Diagnostic testing and preoperative blood banking were painful. Donors experienced increasing stress just before the operation. After transplantation, some donors verbalized feeling more grateful to others and that they gained maturity. Throughout the process, donors were concerned about their recipients. Our results suggest that donors might act for themselves or their family. It is important to recognize the varied responses of donors' feelings toward liver transplant recipients. PMID:18708830

  4. Psycho-social outcome of parents and young children after renal transplantation.

    PubMed

    Douglas, J E; Hulson, B; Trompeter, R S

    1998-01-01

    This cross-sectional study aims to assess whether renal transplantation in children under the age of 6 years has an effect on the child's later behaviour and eating and whether this outcome is related to differences in the levels of stress and coping skills shown by the parents. In this small sample of 14 children aged under 8 years, renal transplantation in the pre-school age range did not have any marked adverse effect on the children's emotional or behavioural state. The children's severe eating problems dramatically improved after transplant. Long-term, early tube-feeding does not impair the development of normal feeding patterns in these children. Parental stress levels were not elevated in the post-transplant period and parents tended to use passive coping strategies to manage the chronic illness in their child. PMID:9468781

  5. Travel-related disseminated Penicillium marneffei infection in a renal transplant patient.

    PubMed

    Hart, J; Dyer, J R; Clark, B M; McLellan, D G; Perera, S; Ferrari, P

    2012-08-01

    Penicillium marneffei is a thermally dimorphic fungus that causes severe human immunodeficiency virus-related opportunistic infection in endemic areas of Southeast Asia and has rarely been reported in solid organ transplant (SOT) recipients. We report here the case of an Australian renal transplant patient who presented with disseminated P. marneffei infection shortly after a 10-day holiday to Vietnam, and review all previously published cases of penicilliosis associated with renal transplantation. This is the first reported case, to our knowledge, of P. marneffei infection in an SOT recipient acquired during travel to an endemic country, and highlights the importance of an accurate travel history when opportunistic infection is suspected, as well as giving appropriate health advice to transplant patients who travel. PMID:22188555

  6. Toll-Like Receptor Family Polymorphisms Are Associated with Primary Renal Diseases but Not with Renal Outcomes Following Kidney Transplantation

    PubMed Central

    Damman, Jeffrey; Leuvenink, Henri G. D.; van Goor, Harry; Hillebrands, Jan-Luuk; Hepkema, Bouke G.; Snieder, Harold; van den Born, Jacob; de Borst, Martin H.; Bakker, Stephan J. L.; Navis, Gerjan J.; Ploeg, Rutger J.; Florquin, Sandrine; Seelen, Marc; Leemans, Jaklien C.

    2015-01-01

    Toll-like receptors (TLRs) play a crucial role in innate- and adaptive immunity. The TLR pathways were shown to play key functional roles in experimental acute and chronic kidney injury, including the allo-immune response after experimental renal transplantation. Data about the precise impact of TLRs and their negative regulators on human renal transplant outcomes however are limited and contradictory. We studied twelve non-synonymous single nucleotide polymorphisms (SNPs) of which eleven in TLR1-8 and one in SIGIRR in a final cohort comprising 1116 matching donors and recipients. TLR3 p.Leu412Phe and SIGIRR p.Gln312Arg significantly deviated from Hardy-Weinberg equilibrium and were excluded. The frequency distribution of the minor alleles of the remaining 10 TLR variants were compared between patients with end-stage renal disease (recipients) and controls (kidney donors) in a case-control study. Secondly, the associations between the minor allele frequency of the TLR variants and delayed graft function, biopsy-proven acute rejection and death-censored graft failure after transplantation were investigated with Cox regression. Carrier frequencies of the minor alleles of TLR1 p.His305Leu (OR = 4.79, 95% CI = 2.35–9.75, P = 0.0002), TLR1 p.Asn248Ser (OR = 1.26, 95% CI = 1.07–1.47, P = 0.04) and TLR8 p.Met1Val (OR = 1.37, 95% CI = 1.14–1.64, P = 0.008) were significantly higher in patients with ESRD, with little specificity for the underlying renal disease entity (adjusted for age, gender and donor-recipient relatedness). The minor allele frequency of none of the TLR variants significantly associated with the surrogate and definite outcomes, even when multivariable models were created that could account for TLR gene redundancy. In conclusion, genetic variants in TLR genes were associated with the prevalence of ESRD but not renal transplant outcomes. Therefore, our data suggests that specific TLR signaling routes might play a role in the final common pathway of

  7. The development and current status of minimally invasive surgery to manage urological complications after renal transplantation

    PubMed Central

    Sabnis, Ravindra B.; Singh, Abhishek G.; Ganpule, Arvind P.; Chhabra, Jaspreet S.; Tak, Gopal R.; Shah, Jaimin H.

    2016-01-01

    Introduction: In the past, urological complications after renal transplantation were associated with significant morbidity. With the development and application of endourological procedures, it is now possible to manage these cases with minimally invasive techniques. Materials and Methods: A MEDLINE search for articles published in English using key words for the management of urological complications after renal transplantation was undertaken. Forty articles were selected and reviewed. Results: The incidence of urological complications postrenal transplantation was reported to be 2–13%. Ureteric leaks occurred in up to 8.6%, and 55% were managed endourologically. The incidence of lymphocele was as high as 20%, and less that 12% of the cases required treatment. Ureteric stricture was the most common complication, and endourological management was successful in 50–70%. The occurrence of complicated vesicoureteral reflux was 4.5%, and 90% of low-grade reflux cases were successfully treated with deflux injections. Stones and obstructive voiding dysfunction occurred in about 1% of kidney transplant recipients. Conclusion: Minimally invasive techniques have a critical role in the management of urological complications after renal transplantation. Urinary leakage should be managed with complete decompression. Percutaneous drainage should be the first line of treatment for lymphocele that is symptomatic or causing ureteric obstruction. Laparoscopic lymphocele deroofing is successful in aspiration-resistant cases. Deflux is highly successful for the management of complicated low-grade kidney transplant reflux. The principles of stone management in a native solitary kidney are applied to the transplanted kidney. Early identification and treatment of bladder outlet obstruction after renal transplantation can prevent urinary leakage and obstructive uropathy. PMID:27555675

  8. Hepatitis C virus related lymphoproliferative disorder in a renal transplant recipient.

    PubMed

    Aravindan, A N; Moger, Venkatesh; Sakhuja, Vinay; Kohli, Harbir S; Varma, Neelam; Jha, Vivekanand

    2006-01-01

    Posttransplant lymphoproliferative disorders (PTLD) are commonly caused by Ebstein-Barr Virus infection. The role of hepatitis C virus (HCV) in the genesis of lymphomas has been recognized recently. We report a HCV infected renal transplant recipient who developed PTLD 11 months after transplantation. Reduction of immunosuppression led to disappearance of viremia and clearance of PTLD. This is the first such report in the world literature. PMID:16868710

  9. [A preemptive combined liver-kidney transplantation in Aalpha fibrinogen chain renal amyloidosis].

    PubMed

    Delabre, Jean-Philippe; Pageaux, Georges-Philippe; Le Quellec, Alain; Raynaud, Pierre; Grateau, Gilles; Mourad, Georges

    2009-04-01

    The predominant cause of hereditary renal amyloidosis is a mutation of the fibrinogen Aalpha chain (AFib), the most common being the E526V mutation. The evolution towards terminal renal insufficiency is constant and raises the question of renal transplantation and the risk of recurrence. We describe the case of a Portuguese woman with the E526V mutation without any renal or hepatic history in her family which developed a nephrotic syndrome at the age of 35, followed by stage 5 renal insufficiency. Because of the risk of recurrence of amyloidosis on its transplant, we carried out a combined transplantation liver-kidney despite the absence of clinical or biological hepatic abnormalities. Four years later, the result is excellent and there is no sign of the disease on the new organs. This successful experience as well as the five other published cases of combined liver-kidney transplantation in Aalpha fibrinogen chain amyloidosis, demonstrates the feasibility and efficacy of this treatment in AFib amyloidosis. PMID:19013120

  10. Methods in renal research: kidney transplantation in the rat.

    PubMed

    Tillou, Xavier; Howden, Brian O; Kanellis, John; Nikolic-Paterson, David J; Ma, Frank Y

    2016-06-01

    Kidney transplantation in small animals has been crucial in the development of anti-rejection therapies. While there is no substitute for a skilled microsurgeon, there are many aspects of the transplant procedure that can be modified to optimize the reproducibility and utility of the technique. This article provides a detailed description, including video recording, of orthotopic kidney transplantation in the rat. The key variables in the technique are also discussed. PMID:26648592

  11. Anorexia nervosa in a pediatric renal transplant recipient and its reversal with cyclosporine.

    PubMed

    Okechuku, Gyongyi; Boulos, Andrew K; Herman, Lettie; Upadhyay, Kiran

    2015-05-01

    We report a 16-yr-old female who developed AN within a month after renal transplantation and its resolution after switching from tacrolimus to cyclosporine. Her initial maintenance immunosuppressive regimen after renal transplantation consisted of tacrolimus, mycophenolate, and steroid. She had 7 kg weight loss within the first month of transplant with subsequent 10, 12, 17, and 19 kg loss after three, five, seven, and nine months of transplant, respectively. Besides weight loss and disturbances in body image, the patient developed alopecia, bradycardia, and persistent secondary amenorrhea. Upon switching to cyclosporine from tacrolimus nine months after transplant, she started regaining weight with 5 kg gain within two months and 10 kg after four months. She restarted her menstrual cycle, alopecia and bradycardia resolved, and her body image disturbance improved. Here, we describe a very unusual neuropsychiatric side effect of tacrolimus and its resolution with another calcineurin inhibitor, cyclosporine, in an adolescent renal transplant recipient. PMID:25661468

  12. Epstein-Barr virus DNA load and seroconversion in pediatric renal transplantation with tacrolimus immunosuppression.

    PubMed

    Suzuki, Toshiaki; Ikezumi, Yohei; Okubo, Soichiro; Uchiyama, Makoto; Takahashi, Kota; Shiraga, Hiroshi; Hattori, Motoshi

    2007-11-01

    EBV infection is one of major complications arising in pediatric patients who have undergone renal transplantation. A strong correlation between the grade of immunosuppression and the development of PTLD, one of the most severe EBV-associated diseases, has been recognized. In this study, we monitored the serologic profile in conjunction with peripheral blood EBV-DNA load of 32 children who underwent renal transplantation with tacrolimus as an immunosuppressant. Six patients were EBV-seronegative (EBV-) before the transplantation, and the mean DNA load in the EBV- group was significantly higher than that in the EBV-seropositive (EBV+) group. Seroconversion occurred in five of these patients in a mean period of 22 weeks after the transplantation. The EBV-DNA load in the EBV+ group was maintained at a low level for a year, whereas it increased rapidly to over 1 x 10(5) copies/mL in two patients in the EBV- group three to seven months after the transplantation, which corresponds to the timing of seroconversion, and one of them developed PTLD. These observations suggest that the close monitoring of the EBV-DNA load, along with longitudinal observation of seroconversion, is essential in pediatric renal transplantation, particularly for younger children who are more likely to be EVB-. PMID:17910652

  13. [Impact of end-stage renal disease and kidney transplantation on the reproductive system].

    PubMed

    Delesalle, A-S; Robin, G; Provôt, F; Dewailly, D; Leroy-Billiard, M; Peigné, M

    2015-01-01

    Chronic renal failure leads to many metabolic disorders affecting reproductive function. For men, hypergonadotropic hypogonadism, hyperprolactinemia, spermatic alterations, decreased libido and erectile dysfunction are described. Kidney transplantation improves sperm parameters and hormonal function within 2 years. But sperm alterations may persist with the use of immunosuppressive drugs. In women, hypothalamic-pituitary-ovarian axis dysfunction due to chronic renal failure results in menstrual irregularities, anovulation and infertility. After kidney transplantation, regular menstruations usually start 1 to 12 months after transplantation. Fertility can be restored but luteal insufficiency can persist. Moreover, 4 to 20% of women with renal transplantation suffer from premature ovarian failure syndrome. In some cases, assisted reproductive technologies can be required and imply risks of ovarian hyperstimulation syndrome and must be performed with caution. Pregnancy risks for mother, fetus and transplant are added to assisted reproductive technologies ones. Only 7 authors have described assisted reproductive technologies for patients with kidney transplantation. No cases of haemodialysis patients have been described yet. So, assisted reproductive technologies management requires a multidisciplinary approach with obstetrics, nephrology and reproductive medicine teams' agreement. PMID:25530544

  14. In-111-labeled leukocytes in the diagnosis of rejection and cytomegalovirus infection in renal transplant patients

    SciTech Connect

    Forstrom, L.A.; Loken, M.K.; Cook, A.; Chandler, R.; McCullough, J.

    1981-04-01

    Indium-111-labelled (In-111) leukocytes have been shown to be useful in the localization of inflammatory processes, including renal transplant rejection. Using previously reported labelling methods, 63 studies with this agent have been performed in 53 renal transplant patients. Indications for study included suspected rejection or cytomegalovirus (CMV) infection. Studies were performed in 33 men and 20 women, with ages ranging from 6 to 68 years. Autologous cells were normally used for labeling, although leukocytes obtained from ABO-compatible donors were used in three subjects. Rectilinear scanner and/or scintillation camera images were obtained at 24 hours after intravenous administration of 0.1 to 0.6 mCi of In-111 leukocytes. There was abnormal uptake of In-111-leukocytes in the transplanted kidney in 11 of 15 cases of rejection. In three additional cases of increased transplant uptake, CMV infection was present in two. Abnormal lung uptake was present in 13 of 14 patients with CMV infection. In four additional cases, increased lung uptake was associated with other pulmonary inflammatory disease. Increased lung activity was not seen in patients with uncomplicated transplant rejection. These results suggest that In-111-leukocyte imaging may be useful in the differential diagnosis of rejection versus CMV infection in renal transplant patients.

  15. In-111-labeled leukocytes in the diagnosis of rejection and cytomegalovirus infection in renal transplant patients

    SciTech Connect

    Forstrom, L.A.; Loken, M.K.; Cook, A.; Chandler, R.; McCullough, J.

    1981-04-01

    Indium-111-labeled (In-111) leukocytes have been shown to be useful in the localization of inflammatory processes, including renal transplant rejection. Using previously reported labeling methods, 63 studies with this agent have been performed in 53 renal transplant patients. Indications for study included suspected rejection or cytomegalovirus (CMV) infection. Studies were performed in 33 men and 20 women, with ages ranging from 6 to 68 years. Autologous cells were normally used for labeling, although leukocytes obtained from ABO-compatible donors were used in three subjects. Rectilinear scanner and/or scintillation camera images were obtained at 24 hours after intravenous administration of 0.1 to 0.6 mCi of In-111-leukocytes. There was abnormal uptake of In-111-leukocytes in the transplanted kidney in 11 of 15 cases of rejection. In three additional cases of increased transplant uptake, CMV infection was present in two. Abnormal lung uptake was present in 13 of 14 patients with CMV infection. In four additional cases, increased lung uptake was associated with other pulmonary inflammatory disease. Increased lung activity was not seen in patients with uncomplicated transplant rejection. These results suggest that In-111-leukocyte imaging may be useful in the differential diagnosis of rejection versus CMV infection in renal transplant patients.

  16. Update on the treatment of focal segmental glomerulosclerosis in renal transplantation

    PubMed Central

    Messina, Maria; Gallo, Ester; Mella, Alberto; Pagani, Fabiola; Biancone, Luigi

    2016-01-01

    Focal segmental glomerulosclerosis (FSGS) represents one of the most severe glomerular diseases, with frequent progression to end-stage renal disease and a high rate of recurrence in renal allografts (30%-50%). Recurrent FSGS portends a negative outcome, with the hazard ratio of graft failure being two-fold higher then that of other glomerulonephritis. Two patterns of clinical presentations are observed: Early recurrence, which is characterized by massive proteinuria within hours to days after implantation of the renal graft, and late recurrence, which occurs several months or years after the transplantation. Many clinical conditions have been recognized as risk factors for recurrence, including younger age, rapid progression of the disease to end-stage renal disease on native kidneys, and loss of previous renal allografts due to recurrence. However, much less is known about the incidence and risk factors of the so-called “de novo” type of FSGS, for which sufferers are transplanted patients without disease on native kidneys; but, rapid development of allograft failure is frequently observed. Management of both forms is challenging, and none of the approaches proposed to date have been demonstrated as consistently beneficial or effective. In the present review we report an update on the available therapeutic strategies for FSGS in renal transplantation within the context of a critical overview of the current literature. PMID:27011905

  17. Length of time on dialysis prior to renal transplantation is a critical factor affecting patient survival after allografting.

    PubMed

    West, J C; Bisordi, J E; Squiers, E C; Latsha, R; Miller, J; Kelley, S E

    1992-01-01

    Within the past year at our transplant center we have had the experience of performing renal allografts in two patients older than 65 years, each of whom had been on hemodialysis more than 10 years. Both resulted in patient mortality within 90 days of transplant (one due to myocardial infarction, the other due to visceral ischemia with infarction). This prompted us to review retrospectively our own data (n = 204) and the national (UNOS) data (n = 10,971) regarding transplant outcome, patient age, and length of time on dialysis prior to renal transplantation. This review revealed that patient mortality after transplant increased with the length of end-stage renal disease (dialysis, regardless of type) independent of age, the greatest mortality occurring within the first 6 months of transplant (and not thereafter); graft survival was similar for all age cohorts analyzed. Our review of the literature reveals a paucity of articles pertaining to post-transplant mortality and length of time on dialysis prior to transplant. Our results indicate the following possible conclusions. (1) The length of time of end-stage renal disease therapy prior to renal transplantation is a significant and independent risk factor for post-transplant mortality. (2) Higher priority should be given to this factor when formulating strategies for allocation of scarce resources. (3) Patients on dialysis for extended periods of time who are elderly may be at particularly high risk. (4) Patients being considered for renal transplant should be informed of their individual risk factors for mortality post-transplant based on length of ESRD therapy. (5) Renal transplantation should be considered as early as possible in patients with ESRD (or imminent ESRD). PMID:14621760

  18. Management issues in post living donor liver transplant biliary strictures.

    PubMed

    Wadhawan, Manav; Kumar, Ajay

    2016-04-01

    Biliary complications are common after living donor liver transplant (LDLT) although with advancements in surgical understanding and techniques, the incidence is decreasing. Biliary strictures are more common than leaks. Endoscopic retrograde cholangiopancreatography (ERCP) is the first line modality of treatment of post LDLT biliary strictures with a technical success rate of 75%-80%. Most of ERCP failures are successfully treated by percutaneous transhepatic biliary drainage (PTBD) and rendezvous technique. A minority of patients may require surgical correction. ERCP for these strictures is technically more challenging than routine as well post deceased donor strictures. Biliary strictures may increase the morbidity of a liver transplant recipient, but the mortality is similar to those with or without strictures. Post transplant strictures are short segment and soft, requiring only a few session of ERCP before complete dilatation. Long-term outcome of patients with biliary stricture is similar to those without stricture. With the introduction of new generation cholangioscopes, ERCP success rate may increase, obviating the need for PTBD and surgery in these patients. PMID:27057304

  19. Management issues in post living donor liver transplant biliary strictures

    PubMed Central

    Wadhawan, Manav; Kumar, Ajay

    2016-01-01

    Biliary complications are common after living donor liver transplant (LDLT) although with advancements in surgical understanding and techniques, the incidence is decreasing. Biliary strictures are more common than leaks. Endoscopic retrograde cholangiopancreatography (ERCP) is the first line modality of treatment of post LDLT biliary strictures with a technical success rate of 75%-80%. Most of ERCP failures are successfully treated by percutaneous transhepatic biliary drainage (PTBD) and rendezvous technique. A minority of patients may require surgical correction. ERCP for these strictures is technically more challenging than routine as well post deceased donor strictures. Biliary strictures may increase the morbidity of a liver transplant recipient, but the mortality is similar to those with or without strictures. Post transplant strictures are short segment and soft, requiring only a few session of ERCP before complete dilatation. Long-term outcome of patients with biliary stricture is similar to those without stricture. With the introduction of new generation cholangioscopes, ERCP success rate may increase, obviating the need for PTBD and surgery in these patients. PMID:27057304

  20. Living donor liver transplantation in the absence of inferior vena cava: a case report.

    PubMed

    Hatipoglu, S; Olmez, A; Ozgor, D; Kayaalp, C; Yilmaz, S

    2012-01-01

    Because of difficulties in the supply of cadaveric organs, of living donor liver transplantations are performed in increasing numbers. Congenital hepatic fibrosis associated with fibrosis and atrophy of the inferior vena cava were present in a potential recipient of living donor liver transplantation. This case report documented living donor liver transplantation as a treatment modality for a patient with absence of the inferior vena cava due to chronic liver failure. PMID:22841266

  1. Renal transplantation in patients with hepatitis C virus antibody. A long national experience

    PubMed Central

    Morales, Jose María; Marcén, Roberto; Andres, Amado; Domínguez-Gil, Beatriz; Campistol, Josep María; Gallego, Roberto; Gutierrez, Alex; Gentil, Miguel Angel; Oppenheimer, Federico; Samaniego, María Luz; Muñoz-Robles, Jorge; Serón, Daniel

    2010-01-01

    Background. Renal transplantation is the best therapy for patients with hepatitis C virus (HCV) infection with end-stage renal disease. Patient and graft survival are lower in the long term compared with HCV-negative patients. The current study evaluated the results of renal transplantation in Spain in a long period (1990–2002), focusing on graft failure. Methods. Data on the Spanish Chronic Allograft Nephropathy Study Group including 4304 renal transplant recipients, 587 of them with HCV antibody, were used to estimate graft and patient survival at 4 years with multivariate Cox models. Results. Among recipients alive with graft function 1 year post-transplant, the 4-year graft survival was 92.8% in the whole group; this was significantly better in HCV-negative vs HCV-positive patients (94.4% vs 89.5%, P < 0.005). Notably, HCV patients showed more acute rejection, a higher degree of proteinuria accompanied by a diminution of renal function, more graft biopsies and lesions of de novo glomerulonephritis and transplant glomerulopathy. Serum creatinine and proteinuria at 1 year, acute rejection, HCV positivity and systolic blood pressure were independent risk factors for graft loss. Patient survival was 96.3% in the whole group, showing a significant difference between HCV-negative vs HCV-positive patients (96.6% vs 94.5%, P < 0.05). Serum creatinine and diastolic blood pressure at 1 year, HCV positivity and recipient age were independent risk factors for patient death. Conclusions. Renal transplantation is an effective therapy for HCV-positive patients with good survival but inferior than results obtained in HCV-negative patients in the short term. Notably, HCV-associated renal damage appears early with proteinuria, elevated serum creatinine showing chronic allograft nephropathy, transplant glomerulopathy and, less frequently, HCV-associated de novo glomerulonephritis. We suggest that HCV infection should be recognized as a true risk factor for graft failure, and

  2. Tacrolimus Versus Cyclosporine as Primary Immunosuppressant After Renal Transplantation: A Meta-Analysis and Economics Evaluation.

    PubMed

    Liu, Jin-Yu; You, Ru-Xu; Guo, Min; Zeng, Lu; Zhou, Pu; Zhu, Lan; Xu, Gang; Li, Juan; Liu, Dong

    2016-01-01

    Tacrolimus and cyclosporine are the major immunosuppressants for renal transplantation. Several studies have compared these 2 drugs, but the outcomes were not consistent. The aim of this study was to evaluate the efficacy, safety, and pharmacoeconomics of cyclosporine and tacrolimus in the treatment of renal transplantation and provide evidence for the selection of essential drugs. Trials were identified through a computerized literature search of PubMed, EMBASE, Cochrane Controlled Trials Register, Cochrane Renal Group Specialized Register of randomized controlled trials, and Chinese Biomedical database. Two independent reviewers assessed trials for eligibility and quality and then extracted data. Data were extracted for patient and graft mortality, acute rejection, and adverse events. Dichotomous outcomes were reported as relative risk with 95% confidence intervals. A decision tree model was populated with data from a literature review and used to estimate costs and quality-adjusted life years gained and incremental cost-effectiveness. Altogether, 6137 patients from 27 randomized controlled trials were included. The results of our analysis were that tacrolimus reduced the risks after renal transplantation of patient mortality, graft loss, acute rejection, and hypercholesterolemia. Nevertheless, tacrolimus increased the risk of new-onset diabetes. Pharmacoeconomic analysis showed that tacrolimus represented a more cost-effective treatment than does cyclosporine for the prevention of adverse events following renal transplant. Tacrolimus is an effective and safe immunosuppressive agent and it may be more cost-effective than cyclosporine for the primary prevention of graft rejection in renal transplant recipients. However, new-onset diabetes should be closely monitored during the medication period. PMID:25299636

  3. Educating Prospective Kidney Transplant Recipients and Living Donors about Living Donation: Practical and Theoretical Recommendations for Increasing Living Donation Rates

    PubMed Central

    Waterman, Amy D.; Robbins, Mark L.; Peipert, John D.

    2016-01-01

    A promising strategy for increasing living donor kidney transplant (LDKT) rates is improving education about living donation for both prospective kidney transplant recipients and living donors to help overcome the proven knowledge, psychological, and socioeconomic barriers to LDKT. A recent Consensus Conference on Best Practices in Live Kidney Donation recommended that comprehensive LDKT education be made available to patients at all stages of chronic kidney disease (CKD). However, in considering how to implement this recommendation across different healthcare learning environments, the current lack of available guidance regarding how to design, deliver, and measure the efficacy of LDKT education programs is notable. In the current article, we provide an overview of how one behavior change theory, the Transtheoretical Model of Behavior Change, can guide the delivery of LDKT education for patients at various stages of CKD and readiness for LDKT. We also discuss the importance of creating educational programs for both potential kidney transplant recipients and living donors, and identify key priorities for educational research to reduce racial disparities in LDKT and increase LDKT rates. PMID:27347475

  4. An alternative tool for intraoperative assessment of renal vasculature after revascularization of a transplanted kidney.

    PubMed

    Sawada, Tokihiko; Solly, Mizrahi; Kita, Junji; Shimoda, Mitsugi; Kubota, Keiichi

    2010-06-01

    Intraoperative assessment of flow in the renal artery and vein after reconstruction is a crucial matter in kidney transplantation. Conventional Doppler ultrasound detects blood flow only in a limited area. The authors report a newly developed device that noninvasively visualizes the condition of perfusion of an entire allograft at one time from any angle and also clearly detects the state of anastomosis of the renal vessels. This near-infrared camera system provides the opportunity for the intraoperative assessment of the vasculature of renal allografts. PMID:20409513

  5. Living Kidney Donor Transplantation in a Resource-limited Country: The Ivory Coast Experience.

    PubMed

    Ackoundou-N'Guessan, C; Hoang, A D; Ben Abdallah, T; Gnionsahe, D A; Dollo, I; Ripoche, C; Coulibaly, N; Aye, D Y; N'Guessan, F Y; Diby Kouame, B; Guei, C M; Tia, M W; Amekoudji, Y; Lagou, D A

    2015-01-01

    Renal transplantation that offers a good quality of life still is not performed by the majority of countries of black Africa. We started a pilot project of renal transplantation in Ivory Coast 2 years ago. The present paper reports the preliminary results, difficulties related to the program, and perspectives regarding its expansion. Ten living related kidney transplantations have been performed over a 2-year period. Recipients and their respective donors were male. The mean age of the recipients was 42.8 years (22-57), and the mean age of the donors was 29.4 years (22-43). The mean number of mismatches was 3.2 (0-6). None was immunized. Recipients and donors were all EBV IgG positive and CMV IgG positive. All but 1 case were induced with basiliximab. The mean graft and patient survival time was 16.6 months (6-26). The mean cold ischemic time was 2.27 hours (1-3.32). The mean serum creatinine at discharge was 241.87 μmol/L (115.18-1063.2), at 6 months was 117.20 μmol/l (95.6-139.9), at 12 months was 104.55 μmol/L (62.02-132.9), and at 24 months was 104.55 μmol/L (62.02-132.9). The mean cyclosporine through level (C0) at 6 months was 137.57 ng/mL (70-366), at 12 months was 117.33 ng/mL (62-197), and at 24 months was 78 ng/mL. The mean cyclosporine 2-hour post-administration concentration levels (C2) at 6 months was 764.9 ng/mL (430-1421), at 12 months was 937.17 ng/mL (483-1292), and at 24 months was 690.66 ng/mL (488-853). Main complications were sepsis, adenovirus hemorrhagic cystitis, new-onset diabetes after transplantation, delayed graft function, polycythemia, and cytomegalovirus infection. No clinical rejection was diagnosed over the 2-year period. Patient and graft survival was 100% at a mean post-transplantation time of approximately 16.6 months. PMID:26293016

  6. Comparison of Minimal Skin Incision Technique in Living Kidney Transplantation and Conventional Kidney Transplantation

    PubMed Central

    Kim, Sang-Dong; Kim, Ji-Il; Moon, In-Sung; Park, Sun-Cheol

    2016-01-01

    Background: Recently, the most common incision for kidney transplantation (KT) is an inverted J-shaped incision known as the “hockey-stick.” However, demands for minimally invasive surgery in KT are increasing as in other various fields of surgery. Hence, we evaluated whether there is difference between minimal skin incision technique in kidney transplantation (MIKT) and conventional KT (CKT). Methods: Between June 2006 and March 2013, a total of 452 living kidney transplant patients were enrolled. The MIKT group included 17 young unmarried women whose body mass index was <25 kg/m2 and had no anatomic variation. The CKT group included 435 patients. The MIKT operation technique restricted to the 10 cm-sized skin incision in the lower right abdomen from laterally below the anterior superior iliac spine to the midline just above the pubis was performed. We compared the baseline clinical characteristics and postoperative results between two groups. For proper comparison, propensity score matching was implemented. Results: There was no difference in graft function, survival, and postoperative complication rate between MIKT and CKT groups (all P > 0.05). The 5-year graft survival was 92.3% and 85.7% in MIKT and CKT groups, respectively (P = 0.786). Conclusions: Our results indicated that MIKT showed more favorable cosmetic results, and there were no statistical differences in various postoperative factors including graft function, survival, and complications compared with CKT. Hence, we suggested that MIKT is an appropriate method for selected patients in living KT. PMID:27064035

  7. Latin American Dialysis and Transplant Registry: 2008 prevalence and incidence of end-stage renal disease and correlation with socioeconomic indexes.

    PubMed

    Cusumano, Ana M; Garcia-Garcia, Guillermo; Gonzalez-Bedat, Maria C; Marinovich, Sergio; Lugon, Jocemir; Poblete-Badal, Hugo; Elgueta, Susana; Gomez, Rafael; Hernandez-Fonseca, Fabio; Almaguer, Miguel; Rodriguez-Manzano, Sandra; Freire, Nelly; Luna-Guerra, Jorge; Rodriguez, Gaspar; Bochicchio, Tommaso; Cuero, Cesar; Cuevas, Dario; Pereda, Carlos; Carlini, Raul

    2013-05-01

    In 2008, 563,294,000 people were living in Latin America (LA), of which 6.6% were older than 65. The region is going through a fast demographic and epidemiologic transition process, in the context of an improvement in socio-economic indices. The Latin American Dialysis and Renal Transplant Registry has collected data since 1991, through an annual survey completed by 20 affiliated National Societies. Renal replacement treatment (RRT) prevalence and incidence showed an increase year by year. The prevalence rate (in all modalities) correlated with the World Bank country classification by income and the epidemiologic transition stage the countries were experiencing. RRT prevalence and kidney transplantation rates correlated significantly with gross national income (GNI), health expenditure in constant dollars (HeExp), % older than 65, life expectancy at birth, and % of the population living in urban settings. Kidney transplantation increased also, year by year, with more than 50% of transplants performed using kidneys from deceased donors. Double transplants were performed in six countries. RRT prevalence and incidence increased in LA, and are associated with indexes reflecting higher and more evenly distributed national wealth (GNI and HeExp), and the stage of demographic and epidemiological transition. PMID:25018980

  8. [Principles of dietotherapy in patients with long-term renal transplantation].

    PubMed

    Sharafetdinov, Kh Kh; Plotnikova, O A; Alekseeva, R I; Zuglova, E A; Kaganov, B S; Kandidova, I E

    2009-01-01

    In this review role of clinical nutrition of the some components of dietotherapy in correction metabolic parameters and in decrease of complication risk (cardiovascular disease, type 2 diabetes, osteoporosis and other) in patients with long-term renal transplantation is discussed. PMID:20387684

  9. Outcome of kidney transplantation for renal amyloidosis:a single-center experience.

    PubMed

    Celik, A; Saglam, F; Dolek, D; Sifil, A; Soylu, A; Cavdar, C; Temizkan, A; Bora, S; Gulay, H; Camsari, T

    2006-03-01

    The aim of this retrospective study was to investigate the results of kidney transplantation in patients with renal amyloidosis. We analyzed the results of renal transplantation in 13 amyloidotic transplant recipients compared with those in a control group of 13 nonamyloidotic patients. While the etiology of amyloidosis was rheumatoid arthritis in one patient, in all of the others it was secondary to familial Mediterranean fever. Acute rejection episodes developed once in six and twice in one patient. The renal function in these patients was improved by antirejection treatment. Chronic rejection did not develop in any patient. However six patients (46%) died due to various complications despite functional grafts. The others are still being followed with well-functioning grafts. Among the control group, acute and chronic rejection were diagnosed in three and two patients, respectively: one patient returned to hemodialysis after 26 months of transplantation, while the others are still alive with functional grafts. There was no death in the control group. The 5- and 10-year actuarial patient survival rates of the amyloidosis and control groups were 52.2%, 26.6%, and 100%, 100%, respectively (P = .002). However, the graft survivals of the amyloidosis versus control groups were 100%, 100%, versus 87.5%, 87.5, respectively (P = .47). In conclusion, we observed a high rate of early mortality among recipients with amyloidosis associated with infectious complications. Moreover, patient survivals were lower among amyloidotic renal recipients. PMID:16549141

  10. Development of bladder tumour containing HPV type 11 DNA after renal transplantation.

    PubMed

    Querci della Rovere, G; Oliver, R T; McCance, D J; Castro, J E

    1988-07-01

    We report a case of bladder cancer developing in a patient after renal transplantation in whom it was possible to demonstrate DNA evidence for infection of the tumour with HPV Type 11. The significance of the observation is discussed in relation to the hypothesis that immunosurveillance can control the development of malignancy. PMID:2841992

  11. Acute venous thrombosis of a renal transplant: early detection with color Doppler sonography.

    PubMed

    Danse, E; Malaise, J; Mourad, M; Cosyns, J P

    2009-01-01

    The observation of a recent case of an acute venous thrombosis of a renal transplant is the opportunity to review and present the role of color Doppler sonography for the early detection of such a severe and uncommon complication. PMID:19534237

  12. Continuous ambulatory peritoneal dialysis and renal transplantation: a five year experience.

    PubMed Central

    Donnelly, P K; Lennard, T W; Proud, G; Taylor, R M; Henderson, R; Fletcher, K; Elliott, W; Ward, M K; Wilkinson, R

    1985-01-01

    Continuous ambulatory peritoneal dialysis is a new and increasingly popular method of routine dialysis, but its effect on renal transplantation is uncertain. A non-randomised comparison was made of the outcome of grafting in patients who had been treated before transplantation with continuous ambulatory peritoneal dialysis with that in patients treated with haemodialysis. During the five years, 1979-84, after continuous ambulatory peritoneal dialysis was introduced to Newcastle upon Tyne 220 patients have received transplants after either continuous ambulatory peritoneal dialysis (61 patients) or haemodialysis (159 patients). During follow up no significant differences occurred in survival of patients or grafts between the two treatment groups. One year after transplantation the percentages of survivors who had received continuous ambulatory peritoneal dialysis and haemodialysis were 88% and 91% respectively, and overall graft survival was 66% and 72%, respectively. A multiple regression model was used to allow for differences among patients--for example, duration of dialysis and number of preoperative transfusions--on the survival of grafts. When only first cadaver grafts were considered (in 152 patients) graft survival (non-immunological failures excluded) was not significantly different between the patients treated with continuous ambulatory peritoneal dialysis and haemodialysis. Continuous ambulatory peritoneal dialysis is not a risk factor in renal transplantation, and its continued use in treatment of potential renal graft recipients is recommended. PMID:3931765

  13. Cost-effectiveness of kidney transplantation compared with chronic dialysis in end-stage renal disease.

    PubMed

    Rosselli, Diego; Rueda, Juan-David; Diaz, Carlos Eduardo

    2015-01-01

    To estimate the costs and effectiveness measured in quality-adjusted life years (QALY) of kidney transplantation compared with dialysis in adults suffering from end-stage renal disease from the perspective of the Colombian healthcare system, we designed a Markov model with monthly cycles over a five-year time horizon and eight transitional states, including death as an absorbing state. Transition probabilities were obtained from international registries, costs from different local sources [case studies, official tariffs (ISS 2001 + 35%) for procedures and SISMED for medications]. Data were validated by an expert panel and we performed univariate, multivariate and probabilistic sensitivity analyses. Effectiveness indicators were months of life gained, months of dialysis averted and deaths prevented. The annual discount rate was 3% and the cost-utility threshold (willingness to pay) was three times gross domestic product (GDP) = USD 20,000 per QALY. The costs were adopted in US dollars (USD) using the 2012 average exchange rate (1 USD = COP$ 1798). The discounted average total cost for five years was USD 76,718 for transplantation and USD 76,891 for dialysis, with utilities 2.98 and 2.10 QALY, respectively. Additionally, renal transplantation represented 6.9 months gained, 35 months in dialysis averted per patient and one death averted for each of the five patients transplanted in five years. We conclude that renal transplantation improves the overall survival rates and quality of life and is a cost-saving alternative compared with dialysis. PMID:26178546

  14. Gender Disparities in Access to Pediatric Renal Transplantation in Europe: Data From the ESPN/ERA-EDTA Registry.

    PubMed

    Hogan, J; Couchoud, C; Bonthuis, M; Groothoff, J W; Jager, K J; Schaefer, F; Van Stralen, K J

    2016-07-01

    Inequalities between genders in access to transplantation have been demonstrated. We aimed to validate this gender inequality in a large pediatric population and to investigate its causes. This cohort study included 6454 patients starting renal replacement therapy before 18 years old, in 35 countries participating in the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry. We used cumulative incidence competing risk and proportional hazards frailty models to study the time to receive a transplant and hierarchical logistic regression to investigate access to preemptive transplantation. Girls had a slower access to renal transplantation because of a 23% lower probability of receiving preemptive transplantation. We found a longer follow-up time before renal replacement therapy in boys compared with girls despite a similar estimated glomerular filtration rate at first appointment. Girls tend to progress faster toward end-stage renal disease than boys, which may contribute to a shorter time available for pretransplantation workup. Overall, medical factors explained only 70% of the gender difference. In Europe, girls have less access to preemptive transplantation for reasons that are only partially related to medical factors. Nonmedical factors such as patient motivation and parent and physician attitudes toward transplantation and organ donation may contribute to this inequality. Our study should raise awareness for the management of girls with renal diseases. PMID:26783738

  15. Invasive gastric mucormycosis and cytomegalovirus infection in an ABO incompatible renal transplant recipient.

    PubMed

    Nandwani, A; Jha, P K; Duggal, R; Kher, V

    2015-01-01

    Opportunistic infections are common in immunocompromised patients, such as solid organ transplant recipients. Both fungal and viral infections in posttransplant period increase morbidity and mortality. Cytomegalovirus (CMV) remains one of the most important pathogens. CMV disease may manifest as a nonspecific febrile syndrome or tissue-invasive infections. Zygomycosis is a rare infection, usually presents in rhino-cerebral, pulmonary and disseminated forms; gastrointestinal (GI) tract being a rare site of involvement. Newer techniques for early diagnosis and efficient therapies are essential for a better outcome of the disease; however, mortality rate remains high despite aggressive therapy. We report a renal transplant recipient, who developed gastric mucormycosis along with tissue invasive CMV disease, within 4 weeks of renal transplant and was diagnosed on the basis of upper GI endoscopy and gastric biopsy. The patient succumbed to the infection in spite of gastrectomy, antifungal and antiviral therapy. PMID:26664215

  16. The standard of urological consultation of patients qualified for renal transplant - a review.

    PubMed

    Antoniewicz, Artur Andrzej; Zapała, Łukasz; Bogucki, Arkadiusz; Małecki, Robert

    2015-01-01

    Urological consultation is an important step in the procedure of a patient's preparation before placing him/her on a waiting list for a renal transplant. Urological work-up aims to diagnose, treat, and optimize any preexisting urological disease. In the present paper we present the review of the literature together with the authors' conclusions based on literature and their experience. There is not enough data in current literature and urology manuals on the adequate sequence of the urological management with patients qualified for renal transplant and the literature needs an update. This study presents the crucial steps of the qualification and emphasizes the urge for a more standardized urological approach in patients qualified for a kidney transplantation. PMID:26568885

  17. A Rare Reason of Ileus in Renal Transplant Patients With Peritoneal Dialysis History: Encapsulated Peritoneal Sclerosis.

    PubMed

    Gökçe, Ali Murat; Özel, Leyla; İbişoğlu, Sevinç; Ata, Pınar; Şahin, Gülizar; Gücün, Murat; Kara, V Melih; Özdemir, Ebru; Titiz, M İzzet

    2015-12-01

    Encapsulating peritoneal sclerosis is a rare complication of long-term peritoneal dialysis ranging from moderate inflammation of peritoneal structures to severe sclerosing peritonitis and encapsulating peritoneal sclerosis. Complicated it, ileus may occur during or after peritoneal dialysis treatment or after kidney transplant. We sought to evaluate 3 posttransplant encapsulating peritoneal sclerosis through clinical presentation, radiologic findings, and outcomes. We analyzed 3 renal transplant patients with symptoms of encapsulating peritoneal sclerosis admitted posttransplant to our hospital with ileus between 2012 and 2013. Conservative treatment was applied to the patients whenever necessary to avoid surgery. One patient improved with medical therapy. Surgical treatment was delayed and we decided it as a last resort, in 2 cases with no response to conservative treatment for a long time. Finally, patients with peritoneal dialysis history should be searched carefully before renal transplant for intermittent bowel obstruction story. PMID:25343532

  18. The standard of urological consultation of patients qualified for renal transplant – a review

    PubMed Central

    Antoniewicz, Artur Andrzej; Bogucki, Arkadiusz; Małecki, Robert

    2015-01-01

    Urological consultation is an important step in the procedure of a patient's preparation before placing him/her on a waiting list for a renal transplant. Urological work-up aims to diagnose, treat, and optimize any preexisting urological disease. In the present paper we present the review of the literature together with the authors’ conclusions based on literature and their experience. There is not enough data in current literature and urology manuals on the adequate sequence of the urological management with patients qualified for renal transplant and the literature needs an update. This study presents the crucial steps of the qualification and emphasizes the urge for a more standardized urological approach in patients qualified for a kidney transplantation. PMID:26568885

  19. Surgical techniques and innovations in living related liver transplantation.

    PubMed Central

    Tanaka, K; Uemoto, S; Tokunaga, Y; Fujita, S; Sano, K; Nishizawa, T; Sawada, H; Shirahase, I; Kim, H J; Yamaoka, Y

    1993-01-01

    The authors successfully performed a series of 33 living related liver transplantations (LRLT) on children (15 males and 18 females, ranging from 7 months to 15 years of age) from June 1990 to May 1992, with the informed consent of their parents and the approval of the Ethics Committee of Kyoto University. Before operation, six of the children required intensive care, another 14 were hospitalized, and 13 were homebound. Donors (12 paternal and 21 maternal) were selected solely from the parents of the recipients on the basis of ABO blood group and graft/recipient size matching determined by computed tomography scanning. Procurement of graft was performed using ultrasonic aspirator and bipolar electrocautery without blood vessel clamping and without graft manipulation. All donors subsequently had normal liver function and returned to normal life. The left lateral segment (16 cases), left lobe (16 cases), or right lobe (one case) were used as grafts. The partial liver graft was transplanted into the recipient who underwent total hepatectomy with preservation of the inferior vena cava using a vascular side clamp. Twenty-seven of 33 recipients are alive and well with the original graft and have normal liver function. The patient survival rate was 89% (24/27) in elective cases and 50% (3/6) in emergent cases. The other six recipients had functioning grafts but died of extrahepatic complications. Complications of the graft were minimal in all cases. Hepatic vein stenosis, which occurred three times in two cases, was successfully treated by balloon dilatation. In cases with sclerotic portal vein, the authors anastomosed the portal vein of the graft to the confluence of the splenic vein and the superior mesenteric vein without a vascular graft, after experiencing a case of vascular graft thrombosis. After hepatic artery thrombosis occurred in one of the initial seven recipients whose arterial anastomosis was done with surgical loupe, microsurgery was introduced for hepatic

  20. A Risk Index for Living Donor Kidney Transplantation.

    PubMed

    Massie, A B; Leanza, J; Fahmy, L M; Chow, E K H; Desai, N M; Luo, X; King, E A; Bowring, M G; Segev, D L

    2016-07-01

    Choosing between multiple living kidney donors, or evaluating offers in kidney paired donation, can be challenging because no metric currently exists for living donor quality. Furthermore, some deceased donor (DD) kidneys can result in better outcomes than some living donor kidneys, yet there is no way to compare them on the same scale. To better inform clinical decision-making, we created a living kidney donor profile index (LKDPI) on the same scale as the DD KDPI, using Cox regression and adjusting for recipient characteristics. Donor age over 50 (hazard ratio [HR] per 10 years = 1.15 1.241.33 ), elevated BMI (HR per 10 units = 1.01 1.091.16 ), African-American race (HR = 1.15 1.251.37 ), cigarette use (HR = 1.09 1.161.23 ), as well as ABO incompatibility (HR = 1.03 1.271.58 ), HLA B (HR = 1.03 1.081.14 ) mismatches, and DR (HR = 1.04 1.091.15 ) mismatches were associated with greater risk of graft loss after living donor transplantation (all p < 0.05). Median (interquartile range) LKDPI score was 13 (1-27); 24.2% of donors had LKDPI < 0 (less risk than any DD kidney), and 4.4% of donors had LKDPI > 50 (more risk than the median DD kidney). The LKDPI is a useful tool for comparing living donor kidneys to each other and to deceased donor kidneys. PMID:26752290

  1. Malignancies in a renal transplant population: The St. Michael's Hospital experience

    PubMed Central

    Saleeb, R.; Faragalla, H.; Yousef, G. M.; Stewart, R.; Streutker, C. J.

    2016-01-01

    Introduction: Previous publications have shown an increased incidence of various malignancies amongst renal transplant populations. The objective of this study was to analyze the rate and types of malignancies occurring in the St. Michael's Hospital renal transplant population and to determine whether our results were comparable to those previously published. Methods: After approval by the hospital's research ethic board, review of the records and pathology of the 1584 patients in the renal transplant clinic database patients was performed. The reports dated back to the year 1970. Results: Amongst the 1584 renal transplant patients, 106 patients with 132 dysplastic and malignant posttransplant lesions were identified. The highest incidence amid the malignancies was in nonmelanoma skin malignancies squamous cell carcinoma (SCC), basal cell carcinoma, and Kaposi sarcoma, with a total of 32 patients having 54 separate tumors (2.02% of all patients, 43.2% of tumors). Following skin tumors in incidence were genitourinary (28 tumors), gastrointestinal tract (GIT) lesions (8 adenocarcinomas, 14 dysplastic lesions, 1 low grade neuroendocrine tumor/carcinoid), posttransplant lymphoproliferative disorders (PTLDs) (10 cases), gynecologic (6 carcinomas), cervical/anal/vulvar dysplasia and invasive (SCCs) (4), and thyroid (3 papillary tumors). Nine patients had tumors of multiple sites/types. With respect to outcome, 14 patients died of malignancy, with the highest mortality being in the GIT malignancies (six patients). Second in mortality were the PTLD and skin tumor groups. Discussion: Information on the incidence and outcome of various malignancies in renal transplant patients is important in designing guidelines for the follow-up of these patients regarding tumor screening and prevention. The rate of malignancies in our group is comparable to that reported in other centers. PMID:27141185

  2. Pill burden does not influence compliance with oral medication in recipients of renal transplant

    PubMed Central

    Adhikari, Uma Rani; Taraphder, Abhijit; Hazra, Avijit; Das, Tapas

    2016-01-01

    Objectives: Insights about the predictors of noncompliance are key to develop compliance enhancing strategy in a given therapeutic situation. Renal transplantation is a critical surgical procedure that imposes a large medication burden on patients. There is a suspicion that the large pill burden may lead to noncompliance. Our objective was to ascertain the influence of pill burden on medication compliance in renal transplant patients in the Indian sociocultural context. Methods: A longitudinal observational study was conducted in two Tertiary Care Hospitals in Kolkata running renal transplant program – one each from the government and private sectors. Totally 120 literate adult transplant recipients were recruited through purposive sampling and followed up at 3 months intervals for 1 year. Data were collected through interview and review of prescriptions and medical records. Results: Data of 110 subjects were analyzed. The pill burden was high – ranging from 10-21 (median 14) at first visit shortly after discharge to 7–22 (median 11) at last visit at 12 months in the government sector; corresponding figures in the private sector were 14–32 (median 21) and 10–28 (median 17). Pill burden increased with age. Only 60.91% of the patients were fully compliant until 1 year after transplantation. The rate of immunosuppressant noncompliance was 27.78% in government sector and 25.00% in private sector. There was no significant association between median pill burden and medication compliance. Satisfaction with caregiver support was associated with better immunosuppressant compliance. Conclusions: Noncompliance in renal transplant recipients is likely to be multifactorial. Contrary to popular belief, pill burden was not a major determinant of noncompliant behavior. PMID:26997717

  3. Pharmacokinetics and target attainment of mycophenolate in pediatric renal transplant patients.

    PubMed

    Martial, Lisa C; Jacobs, Bart A W; Cornelissen, Elisabeth A M; de Haan, Anton F J; Koch, Birgit C P; Burger, David M; Aarnoutse, Rob E; Schreuder, Michiel F; Brüggemann, Roger J M

    2016-06-01

    MPA is an immunosuppressive agent used to prevent graft rejection after renal transplantation. MPA shows considerable inter- and intraindividual variability in exposure in children and has a defined therapeutic window, and TDM is applied to individualize therapy. We aimed to study the exposure to MPA measured as the AUC in pediatric renal transplant patients, to identify factors influencing exposure and to assess target attainment. Children transplanted between 1998 and 2014 in a single center were included. Two groups were identified: Group 1 (AUC <3 wk post-transplantation) and Group 2 (AUC >18 months post-transplantation). Therapeutic targets were set at: AUC0-12h of 30-60 mg h/L. A total of 39 children were included in Group 1 (median age 13.3 yr) vs. 14 in Group 2 (median age 13.4 yr). AUC0-12h was 29.7 mg h/L in Group 1 and 56.6 mg h/L in Group 2, despite a lower dosage in Group 2 (584 and 426 mg/m(2) , respectively). About 46% of patients reached the target AUC0-12h in Group 1. Time since transplantation and serum creatinine were significantly associated with MPA exposure (p < 0.001), explaining 36% of the variability. Individualization of the mycophenolate dose by more intense and more early TDM could improve target attainment. PMID:26923724

  4. A case of kidney transplantation using donation after circulatory death with renal calculi

    PubMed Central

    Gao, Baoshan; Zhang, Kun; Guo, Chunjie; Wang, Weigang; Wang, Gang; Wang, Yuantao; Yao, Liyu; Fu, Yaowen; Zhou, Honglan

    2015-01-01

    Donation after circulatory death (DCD) supplies a big percentage of the organ source pool. Compared to living-related donations, donor kidneys from DCD are commonly with lower quality since they inevitably suffer from hypoxia, hypotension, and inadequate organ perfusion during the progression to circulatory arrest. The current case presents a 44-year-old male donor with wide range subarachnoid hemorrhage and multiple skull fracture from a car accident. Multiple stones were detected in his right kidney. We performed a modified ex vivo pyelolithotomy and ureteroscopy on the bench to render a stone-free allograft. We also improved the donor kidney with hypothermic/perfusion preservation machine before renal transplantation. The recipient showed no complications during the first two-month post-operational follow-up. Such a donor kidney with stones may probably be discarded by conventional perspective. Yet, the combination of the ex vivo bench-surgery technique and hypothermic oxygenation/perfusion makes it a qualified donor kidney. Thus we have demonstrated a promising way of saving borderline qualified DCD donor kidneys. PMID:26885172

  5. Low-dose tacrolimus combined with donor-derived mesenchymal stem cells after renal transplantation: a prospective, non-randomized study

    PubMed Central

    Pan, Guang-hui; Chen, Zheng; Xu, Lu; Zhu, Jing-hui; Xiang, Peng; Ma, Jun-jie; Peng, Yan-wen; Li, Guang-hui; Chen, Xiao-yong; Fang, Jia-li; Guo, Yu-he; Zhang, Lei; Liu, Long-shan

    2016-01-01

    Calcineurin inhibitors, including tacrolimus, are largely responsible for advances in allotransplantation. However, the nephrotoxicity associated with these immunosuppressants impairs patients' long-term survival after renal allograft. Therefore, novel regimens that minimize or even eliminate calcineurin inhibitors could improve transplantation outcomes. In this pilot study, we investigated the use of low-dose tacrolimus in combination with mesenchymal stem cells (MSCs), which are immunosuppressive and prolong allograft survival in experimental organ transplant models. Donor-derived, bone marrow MSCs combined with a sparing dose of tacrolimus (0.04-0.05 mg/kg/day) were administered to 16 de novo living-related kidney transplant recipients; 16 other patients received a standard dose of tacrolimus (0.07-0.08 mg/kg/day). The safety of MSC infusion, acute rejection, graft function, graft survival, and patient survival were evaluated over ≥24 months following kidney transplantation. All patients survived and had stable renal function at the 24 month follow-up. The combination of low-dose tacrolimus and MSCs was as effective as standard dose tacrolimus in maintaining graft survival at least 2 years after transplantation. In addition, both groups had similar urea, urine protein, urinary RBC, urinary WBC, 24-h urine protein, and creatinine clearance rates from 7 days to 24 months after transplantation. Furthermore, no differences in the proportion of lymphocytes, CD19, CD3, CD34, CD38, and natural killer cells were detected between the control and experimental groups. None of the MSC recipients experienced immediate or long-term toxicity from the treatment. This preliminary data suggests that the addition of MSCs permits the use of lower dosages of nephrotoxic calcineurin inhibitors following renal transplantation. PMID:26933811

  6. [Applying Mishel's Uncertainty Theory to the Care of a Patient After Living-Donor Kidney Transplantation: A Care Experience].

    PubMed

    Fang, Ting-Nien; Lin, Chiu-Chu

    2016-02-01

    Kidney transplantation greatly benefits end-stage renal disease patients, as they no longer must bear the torment of hemodialysis. However, the effectiveness of living-donor kidney transplantation is often negatively impacted by various complications, which patients may learn to control through related self-care strategies. However, lack of information on these complications and related strategies may lead to feelings of uncertainty and worries over the prognosis. This article discusses a nursing experience with a patient who underwent living-donor kidney transplantation and who suffered from immense uncertainty and prognosis-related worry. Based on the assessment framework of Mishel's uncertainty theory, the authors identified the cause of the subject's uncertainty and offered thorough information regarding post-transplant care. During the period of care, the subject gained self-care knowledge and skills. Furthermore, he learned to apply self-recording, a technique that enabled him to self-monitor the progress of his disease progress, which reduced his sense of insecurity significantly. Ultimately, the subject turned uncertainty into motivation in order to actively participate in his treatment and to maintain optimum health status. PMID:26813071

  7. Vascular management during live donor nephrectomy: an online survey among transplant surgeons.

    PubMed

    Janki, S; Verver, D; Klop, K W J; Friedman, A L; Peters, T G; Ratner, L E; Ijzermans, J N M; Dor, F J M F

    2015-06-01

    In 2006, a survey from the American Society of Transplant Surgeons disclosed significant and sometimes fatal hemorrhagic events in live donor nephrectomies (LDN) related to failure of clips, leading to the contraindication of the Weck® Hem-o-lok® clip for control of the renal artery during LDN. A survey regarding vascular control techniques, their perceived safety ratings and their failures was sent to 645 European Society for Organ Transplantation members who profiled their profession as "surgeon" and selected "kidney" as organ type. Two hundred forty-three (41%) members responded, of whom 171 (63.3%) independently perform LDN. Their responses were analyzed. For arterial and venous vascular control, the GIA™ and TA™stapler are used most frequently, and were rated the safest. Of the 121 reported hemorrhagic events, slippage and dislodgement of clips occurred at least 58 times, while stapler malfunction occurred at least 40 times. One donor death from hemorrhage related to clip dysfunction was reported. Hemorrhagic complications of LDN with fatal and non-fatal outcomes still occur. Strikingly, many surgeons do not use the vascular closing technique that they consider most safe. Failure of non-transfixion techniques is associated with greater risks for the donor. Control of major vessels in LDN must employ transfixion techniques for optimal donor safety. PMID:25833120

  8. Management of Ureteral Strictures in Renal Transplants by Antegrade Balloon Dilatation and Temporary Internal Stenting

    SciTech Connect

    Yong, Audrey Alice; Ball, Simon Thomas; Pelling, Marc X.; Gedroyc, Wladyslaw Michal Witold; Morgan, Robert Anthony

    1999-09-15

    Purpose: To evaluate the efficacy of percutaneous balloon dilatation and temporary internal stenting in the treatment of transplant ureteral strictures. Methods: Nine patients presenting with obstructed renal transplants were treated by antegrade nephrostomy insertion, ureteroplasty, and temporary internal stenting. Following stent removal, patients were divided into two groups for analysis according to whether the obstruction occurred less than (group A) or more than (group B) 3 months following transplantation. Results: All procedures were technically successful. In group A (n= 6), all patients were successfully treated by one or two dilatations with stenting. In group B (n= 3), two patients were successfully treated by one dilatation with stenting. Overall, eight patients (89%) have had their primary or secondary stent removed successfully at a mean interval of 97.5 days after insertion, and remain well at a mean follow-up interval of 22 months. Conclusion: Balloon dilatation and temporary internal stenting is a useful method for treating transplant ureteral strictures.

  9. Renal Transplantation in Systemic Lupus Erythematosus: Outcome and Prognostic Factors in 50 Cases from a Single Centre

    PubMed Central

    Cairoli, Ernesto; Sanchez-Marcos, Carolina; Espinosa, Gerard; Glucksmann, Constanza; Ercilla, Guadalupe; Oppenheimer, Federico; Cervera, Ricard

    2014-01-01

    Background. End-stage renal disease (ESRD) is an important cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Objectives. To analyze the outcome and prognostic factors of renal transplantation in patients with ESRD due to SLE from January 1986 to December 2013 in a single center. Results. Fifty renal transplantations were performed in 40 SLE patients (32 female (80%), mean age at transplantation 36 ± 10.4 years). The most frequent lupus nephropathy was type IV (72.2%). Graft failure occurred in a total of 15 (30%) transplantations and the causes of graft failure were chronic allograft nephropathy (n = 12), acute rejection (n = 2), and chronic humoral rejection (1). The death-censored graft survival rates were 93.9% at 1 year, 81.5% at 5 years, and 67.6% at the end of study. The presence of deceased donor allograft (P = 0.007) and positive anti-HCV antibodies (P = 0.001) negatively influence the survival of the renal transplant. The patient survival rate was 91.4% at the end of the study. Recurrence of lupus nephritis in renal allograft was observed in one patient. Conclusion. Renal transplantation is a good alternative for renal replacement therapy in patients with SLE. In our cohort, the presence of anti-HCV antibodies and the type of donor source were related to the development of graft failure. PMID:25013800

  10. Mesenchymal stromal cells in renal transplantation: opportunities and challenges.

    PubMed

    Casiraghi, Federica; Perico, Norberto; Cortinovis, Monica; Remuzzi, Giuseppe

    2016-04-01

    Lifelong immunosuppressive therapy is essential to prevent allograft rejection in transplant recipients. Long-term, nonspecific immunosuppression can, however, result in life-threatening complications and fail to prevent chronic graft rejection. Bone marrow (BM)-derived multipotent mesenchymal stromal cells (MSCs) have emerged as a potential candidate for cell-based therapy to modulate the immune response in organ transplantation. These cells can repair tissue after injury and downregulate many of the effector functions of immune cells that participate in the alloimmune response, converting them into regulatory cells. The findings of preclinical and initial clinical studies support the potential tolerance-inducing effects of MSCs and highlight the unanticipated complexity of MSC therapy in kidney transplantation. In animal models of transplantation MSCs promote donor-specific tolerance through the generation of regulatory T cells and antigen-presenting cells. In some settings, however, MSCs can acquire proinflammatory properties and contribute to allograft dysfunction. The available data from small clinical studies suggest that cell infusion is safe and well tolerated by kidney transplant recipients. Ongoing and future trials will provide evidence regarding the long-term safety of MSC therapy and determine the optimum cell source (either autologous or allogeneic) and infusion protocol to achieve operational tolerance in kidney transplant recipients. These studies will also provide additional evidence regarding the risks and benefits of MSC infusion and will hopefully offer definitive answers to the important questions of when, where, how many and which types of MSCs should be infused to fully exploit their immunomodulatory, pro-tolerogenic and tissue-repairing properties. PMID:26853275

  11. Evidence that matching for HLA antigens significantly increases transplant survival in 1001 renal transplants performed in the northwest region of England.

    PubMed

    Dyer, P A; Johnson, R W; Martin, S; Bakran, A; Gokal, R; Harris, R; Mallick, N P; Manos, J; Orr, W M; Pearson, R C

    1989-07-01

    In the 20-year period from March 1968 to March 1988, 860 patients received 1001 renal transplants in the Northwestern Regional Renal Transplant Unit at Manchester Royal Infirmary. Through a continuing policy of avoiding mismatches for HLA antigens and lymphocytotoxic antibody crossmatching, transplant survival rates were found to correlate with the degree of HLA-A and B antigen mismatching from 1968 to 1978 and with HLA-B and DR antigen mismatching from 1979 to 1988. Mismatching for HLA-B and DR antigens was also found to correlate with transplant survival in highly sensitized patients and in patients transplanted since 1981, the "cyclosporine era." Recipients who were HLA-DR1 positive were found to have the highest graft survival compared to recipients negative for this antigen. In contrast, HLA-DR3 positive recipients had the poorest outcome. Transplants from HLA-DRw6 positive donors showed higher transplant survival rates than donor kidneys positive for any other HLA-DR antigen. A correlation of transplant survival with HLA-B and DR mismatching was seen whether kidneys were collected within our region or received through the UK Transplant Service. We conclude that avoidance of mismatching for HLA-B and DR antigens confers high transplant survival rates (91.1% at 5 years for 0 HLA-B and DR mismatches), and in order to achieve this rate for most recipients exchange of donor kidneys between transplant centers will be essential. PMID:2665219

  12. Hodgkin lymphoma post-transplant lymphoproliferative disorder following pediatric renal transplant: serial imaging with F-18 FDG PET/CT.

    PubMed

    Makis, William; Lisbona, Robert; Derbekyan, Vilma

    2010-09-01

    Post-transplant lymphoproliferative disorder (PTLD) occurs in 1.2% of pediatric renal transplant patients, and is frequently Epstein-Barr Virus mediated. Hodgkin Lymphoma PTLD is the rarest of the 4 types of PTLDs recognized by the World Health Organization, with an incidence of <4% of all PTLD patients. It has a distinct clinical course and treatment from all other types of PTLD. This is a case of a 16-year-old girl who had a renal transplant in 2000 due to Moya Moya disease. Her first F-18 FDG PET/CT done in 2006 showed mildly FDG-avid mediastinal adenopathy (histologically nonspecific reactive nodes), however in 2009, after presenting with fevers, a repeat PET/CT showed extensive intensely FDG-avid disease. Biopsy of a supraclavicular node identified Hodgkin Lymphoma PTLD. The patient was treated with chemotherapy and reimaged, showing excellent response to therapy. In contrast, classic PTLD is treated by withdrawal of immunosuppression and administration of Rituximab. F-18 FDG PET/CT is known to be very useful in the staging and monitoring of response to therapy in the setting of classic PTLD. In this case, serial F-18 FDG PET/CT scans proved very useful in the evaluation and follow-up of the rare and distinct Hodgkin Lymphoma PTLD subtype. PMID:20706047

  13. Retrospective screening for lymphocyte-dependent antibody in recipients of renal transplants.

    PubMed Central

    Williams, K A; Morris, P J

    1977-01-01

    Pretransplant sera from thirty-two patients who had received cadaveric renal transplants were screened retrospectively for lymphocyte-dependent antibody (LDA). An 18-hr 51Cr-release assay, using neat serum and an effector: target ratio of 10:1 was employed, each serum being screened against 10 normal target cells. Ten per cent of all reactions tested were positive, compared with 2% when ten normal sera were screened in the same way. No relationship between the presence of LDA pregraft, and the subsequent course of the renal allograft, was apparent in the group as a whole. Patients who had received blood transfusions and who developed LDA before transplantation, had marginally worse graft courses than transfused patients who did not develop LDA, but the difference was not significant. Eight male patients who had never been transfused, nevertheless were found to have LDA. Twelve patients were screened postoperatively for LDA, but only five out of 433 sera tested were positive. It appears that pregraft LDA do not influence the course of a subsequent renal transplant, nor does the appearance of LDA after transplantation allow prediction of acute rejection episodes, PMID:321162

  14. Percutaneous Therapy of Ureteral Obstructions and Leak After Renal Transplantation: Long-Term Results

    SciTech Connect

    Aytekin, Cueneyt Boyvat, Fatih; Harman, Ali; Ozyer, Umut; Colak, Turan; Haberal, Mehmet

    2007-11-15

    The purpose of this study was to evaluate the long-term outcome of percutaneous therapy of ureteral complications after renal transplantation. Between January 2000 and June 2006 we percutaneously treated 26 renal transplant patients with ureteral obstruction (n=19) and leak (n=7). Obstructions were classified as early (<2 months after transplantation) or late (>2 months). Patients with leak were treated with nephro-ureteral catheter placement and subsequent double-J stenting. Balloon dilatation, stent placement, and basket extraction were used to treat ureteral obstructions. Patients were followed with ultrasonography. No major procedure-related complication occurred. The mean follow-up time was 34.3 months (range: 6 to 74 months). Initial clinical success was achieved in all 19 patients with obstruction and 6 of 7 patients with leak. Four of 9 early obstructions and 4 of 10 late obstructions recurred during the follow-up. All recurrences were initially managed again with percutaneous methods, including cutting balloon technique and metallic stent placement. Although there was no recurrence in patients with successfully treated leak, stricture was seen at the previous leak site in two patients. These strictures were also successfully managed percutaneously. We conclude that in the treatment of ureteral obstruction and leak following renal transplantation, percutaneous therapy is an effective alternative to surgery. However, further interventions are usually needed to maintain long-term patency.

  15. Urinary tract infections following renal transplantation: a single-center experience.

    PubMed

    Barbouch, Samia; Cherif, Mejda; Ounissi, Mondher; Karoui, Cyrine; Mzoughi, Sonia; Hamida, Fethi Ben; Abderrahim, Ezeddine; Bozouita, Abdellatif; Abdalla, Taiebben; Kheder, Adel

    2012-11-01

    Urinary tract infection (UTI) is the most frequent infectious complication among renal transplant recipients and a frequent cause of bacteremia, sepsis and acute graft failure. To evaluate the incidence, risk factors, type of pathogens and long-term effect of UTIs on graft and patient survivals in our center, we performed a retrospective cohort study reviewing the medical records of patients who received a renal transplant at our center from June 1986 to December 2009, excluding patients who lost their grafts in the first month due to arterial or veins thrombosis and acute antibody-mediated rejection. We studied 393 kidney-transplanted recipients; at least one UTI occurred in 221 (53.69%) patients during the follow-up period. The most frequent pathogens isolated in urine culture were Escherichia coli (n = 39, 18.4%) and Klebsiella pneumonia (n = 31, 14.6%). When patients with UTIs were compared with those without UTIs, female gender and use of mycophenolate mofetil or azathioprine seemed to be risk factors for UTIs on univariate analysis. However, female gender was the only independent risk factor on multivariate analysis RR = 1.964 (1.202-3.207), P = 0.007. This study confirmed that UTIs remain a major problem in renal transplant recipients, and female gender was the only independent risk factor. PMID:23168875

  16. Urological complications of renal transplantation: the impact of double J ureteric stents.

    PubMed Central

    Nicholson, M. L.; Veitch, P. S.; Donnelly, P. K.; Bell, P. R.

    1991-01-01

    In a 10 year series of 350 consecutive renal transplant operations, the overall urological complication rate was 7.7%. During this period double J stents were introduced and were used either in the treatment of actual urological complications or as a prophylactic measure to protect ureters which had been damaged at retrieval. A total of 34 double J stents were used in 33 patients. The indications were: ureteric obstruction (n = 13), urinary leak (n = 5), short transplant ureter anastomosed using an extravesical ureteroneocystostomy (n = 10) and ureteric injury at the time of organ retrieval (n = 6). Thirty-two double J stents were inserted at open operation and two were inserted by an antegrade method after percutaneous nephrostomy. Improvement in renal function occurred in 16 out of the 18 cases of urological complications. No kidneys were lost and there were no deaths as a direct result of these complications. In a number of cases the insertion of a double J stent was the only treatment, thus eliminating the need for more complex surgery. All 16 patients who had a ureteric stent inserted as a prophylactic measure at the time of transplantation made uncomplicated postoperative recoveries. Urinary tract infection was relatively common (27%) after double J stent insertion, but other complications were rare. In conclusion, double J stents have proved to be a useful adjunct in the management of renal transplant related urological complications. PMID:1929136

  17. Graft survival rate of renal transplantation during a period of 10 years in Iran

    PubMed Central

    Shahbazi, Fatemeh; Ranjbaran, Mehdi; Karami-far, Simin; Soori, Hamid; Manesh, Hadi Jafari

    2015-01-01

    Background: Kidney transplantation is a preferred treatment for many patients with end-stage renal disease (ESRD) and is far more profitable than hemodialysis. Analyzing renal transplantation data can help to evaluate the effectiveness of transplantation interventions. The aim of this study was to determine the organ survival rate after kidney transplantation during a period of 10 years (March 2001-March 2011) among transplanted patients in Arak, Markazi Province, Iran. Materials and Methods: In this historical cohort study, all recipients of kidney transplantation from Arak, Markazi Province, Iran who had medical records in Valiasr Hospital and “charity for kidney patients” of Arak, Markazi Province, Iran during a period of 10 years from March 2001 to March 2011 were included. Data collected by using checklists were completed from patients’ hospital records. Kaplan-Meier method was used to determine the graft cumulative survival rate, log-rank test to compare survival curves in subgroups, and Cox regression model to define the hazard ratio and for ruling out the intervening factors. Statistical analysis was conducted by Statistical Package for the Social Sciences (SPSS) 20 and Stata 11. Results: Mean duration of follow-up was 55.43 ± 42.02 months. By using the Kaplan-Meier method, the cumulative probability of graft survival at 1, 3, 5, 7, and 10 years was 99.1, 97.7, 94.3, 85.7, and 62.1%, respectively. The number of dialysis by controlling the effect of other variables had a significant association with the risk of graft failure [hazard ratios and 95% confidence interval (CI): 1.47 (1.02-2.13)]. Conclusion: This study showed that the graft survival rate was satisfactory in this community and was similar to the results of single-center studies in the world. Dialysis time after transplantation was a significant predictor of survival in the recipients of kidney transplantation that should be considered. PMID:26941807

  18. Safety and Efficacy Endpoints for Mesenchymal Stromal Cell Therapy in Renal Transplant Recipients

    PubMed Central

    Bank, J. R.; Rabelink, T. J.; de Fijter, J. W.; Reinders, M. E. J.

    2015-01-01

    Despite excellent short-term graft survival after renal transplantation, the long-term graft outcome remains compromised. It has become evident that a combination of sustained alloreactivity and calcineurin-inhibitor- (CNI-) related nephrotoxicity results in fibrosis and consequently dysfunction of the graft. New immunosuppressive regimens that can minimize or eliminate side effects, while maintaining efficacy, are required to improve long-term graft survival. In this perspective mesenchymal stromal cells (MSCs) are an interesting candidate, since MSCs have immunosuppressive and regenerative properties. The first clinical trials with MSCs in renal transplantation showed safety and feasibility and displayed promising results. Recently, the first phase II studies have been started. One of the most difficult and challenging aspects in those early phase trials is to define accurate endpoints that can measure safety and efficacy of MSC treatment. Since both graft losses and acute rejection rates declined, alternative surrogate markers such as renal function, histological findings, and immunological markers are used to measure efficacy and to provide mechanistic insight. In this review, we will discuss the current status of MSCs in renal transplantation with a focus on the endpoints used in the different experimental and clinical studies. PMID:26258149

  19. A prospective study on treatment of hypercholesterolemia with lovastatin in renal transplant patients receiving cyclosporine.

    PubMed

    Cheung, A K; DeVault, G A; Gregory, M C

    1993-06-01

    Hypercholesterolemia occurs commonly in renal transplant recipients and may contribute to the high cardiovascular morbidity and mortality in these patients. Although an effective hypolipidemic agent, lovastatin has been associated with rhabdomyolysis and acute renal failure in patients on cyclosporin A (CsA). In this study, lovastatin was administered at 10 mg/day for 8 wk followed by 20 mg/day for 12 wk to six renal transplant recipients who were receiving CsA concomitantly. The 10-mg/day dose was effective, but an additional lipid-lowering effect was seen with the 20-mg/day dose. Both serum total cholesterol and low-density lipoprotein cholesterol levels decreased by 27% at the end of the 20 wk of lovastatin administration. Serum high-density lipoprotein cholesterol and triglyceride levels remained unchanged. No significant clinical or laboratory adverse effects were observed, including muscular symptoms, ophthalmologic abnormalities, or alterations in serum creatine kinase, urea nitrogen, creatinine, transaminases, and CsA levels. Peak and trough plasma concentrations of active lovastatin were comparable to those reported in normal subjects receiving a higher lovastatin dose without CsA. It was concluded that the administration of low-dose (10 to 20 mg/day) lovastatin to renal transplant recipients receiving concomitant CsA can be safe and effective in lowering serum cholesterol. PMID:8338920

  20. Renal pathology in hematopoietic cell transplant recipients: a contemporary biopsy, nephrectomy, and autopsy series.

    PubMed

    Brinkerhoff, Brian T; Houghton, Donald C; Troxell, Megan L

    2016-06-01

    Renal injury in hematopoietic cell transplant recipients may be related to a combination of factors including chemotherapy, radiation, infection, immunosuppressive agents, ischemia, and graft-versus-host disease, and can involve glomerular, tubulointerstitial, and vascular structures. We reviewed renal pathology from 67 patients at a single institution (2009-2014), including 14 patients with biopsy for clinical dysfunction, 6 patients with surgical kidney resection for other causes, and 47 autopsy patients. Kidney specimens frequently contained multiple histopathologic abnormalities. Thrombotic microangiopathy, membranous nephropathy, minimal change disease, and focal segmental glomerulosclerosis were the most common glomerular findings. Pathologies not previously reported in the hematopoietic cell transplant setting included collapsing glomerulopathy, antiglomerular basement membrane disease, fibrillary glomerulonephritis, and in the case of two surgical resections distinctive cellular segmental glomerular lesions that defied classification. Kidney specimens frequently demonstrated acute tubular injury, interstitial fibrosis, arteriolar hyaline, and arteriosclerosis. Other kidney findings at autopsy included leukemia and amyloid (both recurrent), diabetic nephropathy, bacterial infection, fungal invasion, and silver deposition along glomerular and tubular basement membranes. Also in the autopsy cohort, C4d immunohistochemistry demonstrated unexpected membranous nephropathy in two patients, yet C4d also colocalized with arteriolar hyaline. This retrospective hematopoietic cell transplant cohort illustrates multifaceted renal injury in patients with renal dysfunction, as well as in patients without clinically recognized kidney injury. PMID:27015134

  1. Karyopherins: potential biological elements involved in the delayed graft function in renal transplant recipients

    PubMed Central

    2014-01-01

    Background Immediately after renal transplantation, patients experience rapid and significant improvement of their clinical conditions and undergo considerable systemic and cellular modifications. However, some patients present a slow recovery of the renal function commonly defined as delayed graft function (DGF). Although clinically well characterized, the molecular mechanisms underlying this condition are not totally defined, thus, we are currently missing specific clinical markers to predict and to make early diagnosis of this event. Methods We investigated, using a pathway analysis approach, the transcriptomic profile of peripheral blood mononuclear cells (PBMC) from renal transplant recipients with DGF and with early graft function (EGF), before (T0) and 24 hours (T24) after transplantation. Results Bioinformatics/statistical analysis showed that 15 pathways (8 up-regulated and 7 down-regulated) and 11 pathways (5 up-regulated and 6 down-regulated) were able to identify DGF patients at T0 and T24, respectively. Interestingly, the most up-regulated pathway at both time points was NLS-bearing substrate import into nucleus, which includes genes encoding for several subtypes of karyopherins, a group of proteins involved in nucleocytoplasmic transport. Signal transducers and activators of transcription (STAT) utilize karyopherins-alpha (KPNA) for their passage from cytoplasm into the nucleus. In vitro functional analysis demonstrated that in PBMCs of DGF patients, there was a significant KPNA-mediated nuclear translocation of the phosphorylated form of STAT3 (pSTAT3) after short-time stimulation (2 and 5 minutes) with interleukin-6. Conclusions Our study suggests the involvement, immediately before transplantation, of karyopherin-mediated nuclear transport in the onset and development of DGF. Additionally, it reveals that karyopherins could be good candidates as potential DGF predictive clinical biomarkers and targets for pharmacological interventions in renal

  2. [Postbiopsy giant pseudoaneurysm in renal transplant: treatment with embolization].

    PubMed

    Zaragozano Guillén, R; García Díez, A I; Cobos Hernández, M V; Yagüe Romeo, D

    1998-03-01

    Pseudoaneurism in renal grafts is a well known complication of the percutaneous biopsy. Colour Doppler has been shown to be the choice technique for their diagnosis and subsequent control, the most effective treatment being embolization. This paper presents an unusual form of pseudoaneurism in terms of its size (up to 8 cm diameter) in a renal graft, following performance of a percutaneous biopsy with automatic needle. The findings of the colour Doppler study and the angiography are shown and discussed, as well as the treatment by embolization with metal spirals which achieved the stable, complete occlusion of the lesion after six months control. PMID:9616940

  3. Excellent long term patient and renal allograft survival after ABO-incompatible kidney transplantation: Experience of one center

    PubMed Central

    Melexopoulou, Christina; Marinaki, Smaragdi; Liapis, George; Skalioti, Chrysanthi; Gavalaki, Maria; Zavos, George; Boletis, John N

    2015-01-01

    AIM: To investigate the long-term results of ABO-incompatible (ABOi) kidney transplantation in a single center in Greece. METHODS: Thirty consecutive ABOi kidney transplantations were performed from June 2005 to December 2013. All patients received rituximab one month prior to transplantation. Immunoadsorption therapy was performed for the removal of anti-A/B IgG antibodies until the titer was ≤ 1:16. Additional apheresis sessions were performed post-operatively. Intravenous immunoglobulin and oral immunosuppression consisting of tacrolimus (TAC) in combination with either everolimus or mycophenolate acid was administered. We compared the long term results of our ABOi group to those of a matched group of 30 ABO compatible (ABOc) living kidney recipients with similar baseline characteristics. The ABOc recipients received an immunosuppressive regimen consisting of TAC and mycophenolate acid. All patients in both groups received induction therapy with Basiliximab or Daclizumab, whereas corticosteroids were instituted on the day of surgery. During the follow-up period, indication biopsies were performed and interpreted by an experienced nephropathologist. The parameters we analyzed included the following: Donor/recipient age, gender, blood type, human leukocyte antigen mismatches, panel reactive antibodies, primary cause of renal failure, mean time on dialysis, immunosuppressive regimen, patient survival, graft outcome, incidence of rejections, surgical and infectious complications. RESULTS: The mean follow-up period was 6 years (range 1 to 9 years). A mean of 5.0 ± 3.0 (range 0-14) pre-transplant immunoadsorptions were required in order to reach the target titer. Patient survival in ABOi group in comparison to ABOc group at 1, 3, 5 and 8 years did not differ significantly (100% vs 100%, 96% vs 100%, 92% vs 100% and 92% vs 100%, P = ns). Additionally, graft survival was similar in the two groups at the same time points (100% vs 100%, 96% vs 96%, 92% vs 96% and 81

  4. Mediastinal mass and pericardial tamponade in a renal transplant recipient: A rare case of nocardia infection

    PubMed Central

    Salazar, Maria Nieva; Wray, Dannah; Denlinger, Chadrick; Srinivas, Titte; Thomas, Beje; Posadas, Aurora

    2013-01-01

    Patient: Female, 30 Final Diagnosis: Nocardiosis Symptoms: Cardiac tamponade • cough • dyspnea • hoarseness • mediastinal mass • pericardial effusion • short of breath Medication: — Clinical Procedure: — Specialty: Transplantology Objective: Rare disease Background: Nocardia infections can complicate solid organ transplantation. The usual clinical presentations include pulmonary infiltrates with or without cavitation and subcutaneous and brain abscesses. We report an unusual case of nocardia infection in a kidney transplant recipient that presented as mediastinal mass and was associated with pericardial tamponade. Case Report: A 30 year old African American renal transplant recipient presented with cough, hoarseness and shortness of breath nine months after kidney transplantation. She received basiliximab perioperatively and her maintenance immunosuppression included tacrolimus, mycophenolate mofetil and prednisone. Computed tomography (CT) showed a large mediastinal mass with a large pericardial effusion. An echocardiogram revealed collapse of the right ventricle consistent with tamponade. We performed emergent pericardiocentesis to treat the tamponade. A mediastinoscopic biopsy of the mediastinal mass was done to establish a diagnosis. The mediastinal biopsy confirmed the growth of Nocardia. After 2 weeks of imipenem and 6 weeks of linezolid, there was marked radiographic improvement in the size of the mediastinal mass. Conclusions: We report a rare case of a large mediastinal mass associated with pericardial tamponade from nocardia infection in a renal transplant recipient. An invasive approach may be necessary to obtain tissue diagnosis to direct treatment in these cases. Prompt and appropriate medical therapy leads to marked radiographic improvement. PMID:23940824

  5. Acute Renal Failure - A Serious Complication in Patients After Kidney Transplantation.

    PubMed

    Basta-Jovanovic, G; Bogdanovic, Lj; Radunovic, M; Prostran, M; Naumovic, R; Simic-Ogrizovic, S; Radojevic-Skodric, S

    2016-01-01

    Free radical-mediated injury releases proinflammatory cytokines and activates innate immunity. It has been suggested that the early innate response and the ischemic tissue damage play roles in the development of adaptive responses, which may lead to acute kidney rejection. Various durations of hypothermic kidney storage before transplantation add to ischemic tissue damage. The final stage of ischemic injury occurs during reperfusion that develops hours or days after the initial insult. Repair and regeneration processes occur together with cellular apoptosis, autophagy and necrosis and a favorable outcome is expected if regeneration prevails. Along the entire transplantation time course, there is a great demand for novel immune and nonimmune injury biomarkers. The use of these markers can be of great help in the monitoring of kidney injury in potential kidney donors, where acute kidney damage can be overlooked, in predicting acute transplant dysfunction during the early post-transplant periods, or in predicting chronic changes in long term followup. Numerous investigations have demonstrated that biomarkers that have the highest predictive value in acute kidney injury include NGAL, Cystatin C, KIM-1, IL-18, and L-FABP. Most investigations show that the ideal biomarker to fulfill all the needs in renal transplant has not been identified yet. Although, in many animal models, new biomarkers are emerging for predicting acute and chronic allograft damage, in human allograft analysis they are still not routinely accepted and renal biopsy still remains the gold standard. PMID:27498898

  6. Probing transplant and living donor candidates about their participation in organ vending.

    PubMed

    Bramstedt, Katrina A

    2010-09-01

    The selling of human organs for transplant is illegal in the United States and in most countries; however, such transactions still occur. Transplant hospitals and their personnel have multiple ethical duties, including (1) protecting the safety of their living donors and transplant recipients and (2) protecting the integrity of living donation and transplantation as clinical practices. To date, few psychosocial screening tools exist that pertain specifically to a person's risk or intent of pursuing organ vending (buying or selling). This article presents a series of transplant ethics case consultations that spawned the creation of a set of behavioral prompts for teams to probe with regard to organ vending when screening candidates about their suitability for participation as living donors or transplant recipients. PMID:20929116

  7. Day-of-surgery rejection of donors in living donor liver transplantation

    PubMed Central

    Hegab, Bassem; Abdelfattah, Mohamed Rabei; Azzam, Ayman; Mohamed, Hazem; Hamoudi, Waleed Al; Alkhail, Faisal Aba; Bahili, Hamad Al; Khalaf, Hatem; Sofayan, Mohammed Al; Sebayel, Mohammed Al

    2012-01-01

    AIM: To study diagnostic laparoscopy as a tool for excluding donors on the day of surgery in living donor liver transplantation (LDLT). METHODS: This study analyzed prospectively collected data from all potential donors for LDLT. All of the donors were subjected to a three-step donor evaluation protocol at our institution. Step one consisted of a clinical and social evaluation, including a liver profile, hepatitis markers, a renal profile, a complete blood count, and an abdominal ultrasound with Doppler. Step two involved tests to exclude liver diseases and to evaluate the donor’s serological status. This step also included a radiological evaluation of the biliary anatomy and liver vascular anatomy using magnetic resonance cholangiopancreatography and a computed tomography (CT) angiogram, respectively. A CT volumetric study was used to calculate the volume of the liver parenchyma. Step three included an ultrasound-guided liver biopsy. Between November 2002 and May 2009, sixty-nine potential living donors were assessed by open exploration prior to harvesting the planned part of the liver. Between the end of May 2009 and October 2010, 30 potential living donors were assessed laparoscopically to determine whether to proceed with the abdominal incision to harvest part of the liver for donation. RESULTS: Ninety-nine living donor liver transplants were attempted at our center between November 2002 and October 2010. Twelve of these procedures were aborted on the day of surgery (12.1%) due to donor findings, and eighty-seven were completed (87.9%). These 87 liver transplants were divided into the following groups: Group A, which included 65 transplants that were performed between November 2002 and May 2009, and Group B, which included 22 transplants that were performed between the end of May 2009 and October 2010. The demographic data for the two groups of donors were found to match; moreover, no significant difference was observed between the two groups of donors with

  8. Renal transplantation in a patient with chronic granulomatous disease: case report.

    PubMed

    Caliskan, B; Yazici, H; Gulluoglu, M; Caliskan, Y; Turkmen, A; Sever, M S

    2015-01-01

    Chronic granulomatous disease (CGD) is a genetic disease caused by structural mutations in the enzyme NADPH oxidase that results in severe immunodeficiency. End-stage renal disease occurs in this patient population and is attributed to various factors, including infections, amyloidosis, and nephrotoxic anti-infective agents. In this report, we present our experience in transplantation for a patient with CGD complicated by isolated hepatic tuberculosis abscess. The course of the case demonstrates the absolute requirements for a multidisciplinary and compulsive approach before, during, and after transplantation. This case report also highlights the unexpectedly benign effects of immunosuppressive therapy in this patient population. PMID:25480525

  9. Renal denervation of the native kidneys for drug-resistant hypertension after kidney transplantation

    PubMed Central

    Dobrowolski, Linn C.; Bemelman, Frederike J.; ten Berge, Ineke J.M.; van den Born, Bert-Jan H.; Reekers, Jim A.; Krediet, C.T. Paul

    2015-01-01

    There is a strong rationale for renal denervation (RDN) of the native kidneys in kidney transplant recipients with treatment-resistant hypertension. We present a patient with a stable graft function, who underwent RDN for posttransplant therapy-resistant hypertension (24-h ambulatory blood pressure measurement (ABPM) 143/89 mmHg, while compliantly using five different antihypertensive agents). After RDN, BP measurements and orthostatic complaints required withdrawal of two antihypertensive agents and halving a third. At 6 months, ABPM was 134/84 mmHg and allograft function remained unchanged. This case calls for designing well-designed prospective studies on RDN in kidney transplant recipients. PMID:25713714

  10. Renal denervation of the native kidneys for drug-resistant hypertension after kidney transplantation.

    PubMed

    Dobrowolski, Linn C; Bemelman, Frederike J; Ten Berge, Ineke J M; van den Born, Bert-Jan H; Reekers, Jim A; Krediet, C T Paul

    2015-02-01

    There is a strong rationale for renal denervation (RDN) of the native kidneys in kidney transplant recipients with treatment-resistant hypertension. We present a patient with a stable graft function, who underwent RDN for posttransplant therapy-resistant hypertension (24-h ambulatory blood pressure measurement (ABPM) 143/89 mmHg, while compliantly using five different antihypertensive agents). After RDN, BP measurements and orthostatic complaints required withdrawal of two antihypertensive agents and halving a third. At 6 months, ABPM was 134/84 mmHg and allograft function remained unchanged. This case calls for designing well-designed prospective studies on RDN in kidney transplant recipients. PMID:25713714

  11. Risk Factors for Graft Failure and Death following Geriatric Renal Transplantation

    PubMed Central

    Cho, Hyungjin; Yu, Hoon; Shin, Eunhye; Kim, Young Hoon; Park, Su-Kil; Jo, Min-Woo

    2016-01-01

    Background Population aging is a major health concern in Asian countries and it has affected the age distribution of patients with end-stage renal disease (ESRD). As a consequence, the need for kidney transplantation in the geriatric population has increased, but the shortage of donors is an obstacle for geriatric renal transplantation. The aim of this study was to evaluate risk factors for graft failure and death in geriatric renal transplantation. Methods Kidney transplantations performed in a tertiary hospital in South Korea from May 1995 to December 2014 were retrospectively reviewed. Recipients younger than 60 years of age or who underwent other organ transplantations were excluded. The Kaplan-Meier method was used to assess patient and graft survival. A Cox regression analysis was used to evaluate risk factors for graft failure and patient death. Results A total of 229 kidney transplantation patients were included. Graft survival at 1, 5, and 10 years were 93.2%, 82.9%, and 61.2% respectively. Patient survival at 1, 5, and 10 years were 94.6%, 86.9%, and 68.8%, respectively. According to the Cox multivariate analysis, ABO incompatibility (hazard ratio [HR] 3.91, p < 0.002), DGF (HR 3.544, p < 0.004), CMV infection (HR 2.244, p < 0.011), and HBV infection (HR 6.349, p < 0.015) were independent risk factors for graft survival. Recipient age (HR 1.128, p < 0.024), ABO incompatibility (HR 3.014, p < 0.025), CMV infection (HR 2.532, p < 0.010), and the number of HLA mismatches (HR 1.425, p < 0.007) were independent risk factors for patient death. Conclusion Kidney transplantation in the geriatric population showed good clinical outcomes. ABO incompatibility, DGF, CMV infection, and HBV infection were risk factors for graft failure and the recipient age, ABO incompatibility, CMV infection, and the number of HLA mismatches were risk factors for patient death in geriatric renal transplantation. PMID:27074003

  12. Analysis of Donor Motivations in Living Donor Liver Transplantation

    PubMed Central

    Abdeldayem, Hesham; Kashkoush, Samy; Hegab, Bassem Soliman; Aziz, Amr; Shoreem, Hany; Saleh, Shereef

    2014-01-01

    Objectives: The introduction of the living donor liver transplantation (LDLT) in Egypt as in elsewhere, has raised important psychological conflicts and ethical questions. The objective of this study was to get better understanding of the potential donors’ motives toward LDLT. Methods: This study was conducted on consecutive 193 living-liver donors who underwent partial hepatectomy as donors for LDLT during the period between April 2003 and January 2013, at the National Liver Institute Menoufeyia University, Egypt. Potential donors were thoroughly evaluated preoperatively through a screening questionnaire and interviews as regard their demographic data, relationship to the potential recipient, and motives toward proceeding to surgery. They were assured that the information shared between them and the transplant center is confidential. Results: The donors’ mean age was 25.53 ± 6.39 years with a range of 18–45 years. Males represented 64.7% and females were 35.3%. The most common donors (32.1%, n = 62) were sons and daughters to their parents (sons: n = 43, daughters: n = 19) while parents to their offsprings represent 15% (mothers: n = 21, fathers: n = 8). Brothers and sisters represent 16.5% (brothers: n = 22, sisters: n = 10). Nephews and nieces giving their uncles or aunts were 14%. The number of wives donating to their husbands was 11 (5.7%). Interestingly, there was no single husband who donated his wife. Among the remaining donors, there were 11 cousins and 1 uncle. Unrelated donors were 20 (10.4%). Several factors seemed to contribute to motivation for donation: the seriousness of the potential recipient condition, the relationship and personal history of the donor to the potential recipient, the religious beliefs, the trust in the health care system, and family dynamics and obligations. Conclusion: Absolute absence of coercion on the living-liver donor’s motives may not be realistic because of the serious

  13. Tuberculosis of the arterio-venous graft in a renal transplant recipient.

    PubMed

    Alalawi, Fakhriya; Alhadari, Amna; Railey, M J; Alrukhaimi, Mona

    2012-09-01

    A 44-year-old Pakistani lady with end-stage renal disease secondary to rapidly proliferative glomerulonephritis underwent successful renal transplantation. Three years later, she was referred to the surgeon with an abscess in the axillary region at the site of a previous arterio-venous (AV) graft. She underwent repeated incision and drainage of the abscess, which was constantly recurring. Nine months later, she presented with a tender swelling at the site of the AV graft with purulent discharge. The graft was removed; culture and histology confirmed the presence of tuberculosis (TB). This patient presents a rare case of TB infection in the AV graft. PMID:22982915

  14. Endovascular management of renal transplant dysfunction secondary to hemodynamic effects related to ipsilateral femoral arteriovenous graft.

    PubMed

    Salsamendi, Jason; Pereira, Keith; Quintana, David; Bleicher, Drew; Tabbara, Marwan; Goldstein, Michael; Narayanan, Govindarajan

    2016-01-01

    Hemodialysis access options become complex in long-term treatment for patients with renal disease, while awaiting renal transplantation (RT). Once upper extremity sites are exhausted, lower extremities are used. RT is preferably in the contralateral iliac fossa, rarely ipsilateral. In current literature, RT dysfunction secondary to the hemodynamic effects of an ipsilateral femoral arteriovenous graft (AVG) has been rarely described. To our knowledge, AVG ligation is the only published technique for hemodynamic correction of an ipsilateral AVG. We present a simple, potentially reversible endovascular approach to manage the hemodynamic effects of an AVG, without potentially permanently losing future AVG access. PMID:26899147

  15. Single-center assessment of nutritional counseling in preventing excessive weight gain in pediatric renal transplants recipients.

    PubMed

    Cameron, Camilla; Krmar, Rafael T

    2016-05-01

    Post-transplantation obesity is a common complication that is associated with a higher risk for decreased allograft function and hypertension. However, the role of diet intervention on reducing post-transplantation obesity is relatively unknown. We investigated the clinical relevance of dietary counseling on the prevalence of overweight/obesity during the first two yr following renal transplantation. The computerized patient records of 42 recipients (31 males) aged 6.3 ± 4.8 yr at transplantation were reviewed. All patients systematically underwent yearly dietary assessment/counseling (motivational interviewing technique) and measurement of renal function and ABPM. At transplantation, 14.2% of patients were overweight/obese, which increased to 42.8% by two yr post-transplantation (p = 0.004). The majority of patients experienced a significant increase in BMI SDS during the first six months post-transplantation that remained sustained throughout the duration of the follow-up period (p = 0.001). By two yr post-transplantation, there were no observable differences between patients classified as having normal BMI or being overweight/obese with regard to renal function and controlled hypertension. The application of yearly tailored dietary assessment/counseling had a poor effect on preventing post-transplantation weight gain, suggesting the need for more comprehensive interventions to reduce post-transplant obesity. PMID:26787256

  16. Transplantation tolerance mediated by suppressor T cells and suppressive antibody in a recipient of a renal transplant.

    PubMed

    Suzuki, S; Mizuochi, I; Sada, M; Amemiya, H

    1985-10-01

    This is a report of a patient who underwent cadaveric renal transplantation in spite of the presence of three HLA-A, B and two DR antigen mismatches between the recipient and donor. The recipient received more than 20 units of blood before transplantation. The crossmatch between the recipient's serum and the T and B cells of the donor was negative. The patient exhibited hepatic dysfunction from the early posttransplant period, which eventually led to discontinuation of azathioprine or Bredinin at one year posttransplantation. Thereafter, only betamethasone was administered once every 3 days. The patients has maintained good renal function for more than one year following withdrawal of the immunosuppressants. It appeared that transplantation tolerance was established in this patient. Therefore, we examined the mechanisms sustaining the tolerance. Both nylon-wool-adherent, alloantigen-specific suppressor T cells and nonadherent, nonspecific suppressor T cells were observed in the lymphocytes of the patient after transplantation. It was also shown that suppressive antibody was present in the serum directed toward the clone of autologous lymphocytes that reacted with the mixed lymphocyte reaction (MLR) antigen of the donor. In the inhibition test against various types of MLR antigens using this suppressive antibody, it was found that the reaction against the donor cells was suppressed when the responding cells shared the same class I antigen with the recipient. When the stimulating cells had the class II antigen of the donor, the reaction of the specific responding cells was also inhibited. These inhibiting effects were only seen when the responding cells were pretreated with the antibody, but not when stimulating cells were pretreated. PMID:2413592

  17. Spontaneous regression of initially elevated peak systolic velocity in renal transplant artery.

    PubMed

    Brabrand, Knut; Holdaas, Hallvard; Gunther, Anne; Midtvedt, Karsten

    2011-06-01

    There is limited knowledge about the incidence, clinical implication and spontaneous course of transplant renal artery stenosis detected early after renal transplantation. We performed Doppler ultrasound examination of the transplant artery(s) 2 months after transplantation in 98 consecutive patients and peak systolic velocity (PSV) was measured. All patients with an elevated PSV ≥1.8 m/s were reexamined 20 months later and clinical data were followed for 3 years. At the initial examination 2 months after transplantation 15 recipients had a PSV ≥1.8 m/s, mean value for PSV 2.5 (1.8-3.6) m/s, whereas 83 recipients had a normal PSV of 1.3 (0.7-1.7) m/s (P<0.01). At baseline there were no statistical significant differences in clinical parameters between the high PSV versus normal PSV recipients. Twenty (15-28) months after transplantation 14 patients with initial elevated PSV were re-examined. There was an overall mean reduction in PSV of 0.5 (-0.7 to 1.2) m/s from 2.4 (1.8-3.4) m/s to 1.9 (1.2-3.1) m/s (P=0.02). Detection of a high PSV early after transplantation did not affect graft function or blood pressure 3 years after engraftment. We conclude that a high PSV, at 2 months after engraftment, seems to be more of an 'incidental finding' that should be re-challenged and carefully interpreted. PMID:21332581

  18. Socioeconomic rehabilitation of successful renal transplant patients and impact of funding source: Indian scenario

    PubMed Central

    Kapoor, Rakesh; Sharma, Raj Kumar; Srivastava, Aneesh; Kapoor, Rohit; Arora, Sohrab; Sureka, Sanjoy Kumar

    2015-01-01

    Introduction: Socio-economic rehabilitation is an important outcome parameter in successful renal transplant recipients, particularly in developing countries with low income patients who often depend on extraneous sources to fund their surgery costs. We studied the socioeconomic rehabilitation and changes in socioeconomic status (SES) of successful renal allograft recipients among Indian patients and its correlation with their source of funding for the surgery. Materials and Method: A cross-sectional, questionnaire-based study was conducted on 183 patients between January 2010 to January 2013. Patients with follow up of at least 1 year after successful renal transplant were included. During interview, two questionnaires were administered, one related to the SES including source of funding before transplantation and another one relating to the same at time of interview. Changes in SES were categorized as improvement, stable and deterioration if post-transplant SES score increased >5%, increased or decreased by <5% and decreased >5% of pre-transplant value, respectively. Results: In this cohort, 97 (52.7%), 67 (36.4%) and 19 (10.3%) patients were non-funded (self-funded), one-time funded and continuous funded, respectively. Fifty-six (30.4%) recipients had improvement in SES, whereas 89 (48.4%) and 38 (20.7%) recipients had deterioration and stable SES. Improvement in SES was seen in 68% patients with continuous funding support whereas, in only 36% and 12% patients with non-funded and onetime funding support (P = 0.001) respectively. Significant correlation was found (R = 0.715) between baseline socioeconomic strata and changes in SES after transplant. 70% of the patients with upper and upper middle class status had improving SES. Patients with middle class, lower middle and lower class had deterioration of SES after transplant in 47.4%, 79.6% and 66.7% patients, respectively. Conclusions: Most of the recipients from middle and lower social strata, which included

  19. Evidence for Kidney Rejection after Combined Bone Marrow and Renal Transplantation Despite Ongoing Whole-blood Chimerism in Rhesus Macaques

    PubMed Central

    Ramakrishnan, Swetha K; Page, Andrew; Farris, Alton B.; Singh, Karnail; Leopardi, Frank; Hamby, Kelly; Sen, Sharon; Polnett, Aneesah; Deane, Taylor; Song, Mingqing; Stempora, Linda; Strobert, Elizabeth; Kirk, Allan D.; Larsen, Christian P.; Kean, Leslie S.

    2012-01-01

    Although there is evidence linking hematopoietic chimerism-induction and solid organ transplant tolerance, the mechanistic requirements for chimerism-induced tolerance are not clearly elucidated. To address this, we used an MHC-defined primate model to determine the impact of impermanent, T cell-poor, mixed-chimerism on renal allograft survival. We compared two cohorts: one receiving a bone marrow + renal transplant (“BMT/renal”) and one receiving only a renal transplant. Both cohorts received maintenance immunosuppression with CD28/CD40-directed costimulation blockade and sirolimus. As previously demonstrated, this transplant strategy consistently induced compartmentalized donor chimerism, (significant whole-blood chimerism, lacking T cell chimerism). This chimerism was not sufficient to prolong renal allograft acceptance: the BMT/renal mean survival time (MST, 76 days) was not significantly different than the renal transplant alone MST (85 days, p= 0. 46), with histopathology documenting T-cell mediated rejection. Flow cytometric analysis revealed significant enrichment for CD28-/CD95+ CD4+ and CD8+ Tem cells in the rejected kidney, suggesting a link between CD28-negative Tem and costimulation blockade-resistant rejection. These results suggest that in some settings, transient T cell-poor chimerism is not sufficient to induce tolerance to a concurrently placed renal allograft and that the presence of this chimerism per se is not an independent biomarker to identify tolerance. PMID:22642491

  20. Costs of Treatment after Renal Transplantation: Is it Worth to Pay More?

    PubMed

    Salamzadeh, Jamshid; Foroutan, Naghmeh; Jamshidi, Hamid Reza; Rasekh, Hamid Reza; Rajabzadeh Gatari, Ali; Foroutan, Arash; Nafar, Mohsen

    2014-01-01

    The primary aim of the study was to estimate costs of treatment for the first year after renal transplantation from the perspective of health insurance organizations in Iran. An Excel-based and a Monte Carlo model were developed to determine the treatment costs of current clinical practice in renal transplantation therapy (RTT). Inputs were derived from Ministry of Health and insurance organizations database, hospital and pharmacy records, clinical trials and local and international literature. According to the model, there were almost 17,000 patients receiving RTT in Iran, out of which about 2,200 patients underwent the operation within the study year (2011 - 2012; n = 2,200) The estimated first year total treatment cost after renal transplantation was almost $14,000,000. These costs corresponded to annual total cost per patient of almost $6500 for the payers. Renal transplantation therapy is almost fully reimbursed by government in Iran. However, regarding new expensive medicines, cost of medical expenditure is rapidly growing and becoming quite unaffordable for the government; therefore, out-of-pocket (OOP) payments are dramatically increasing over time. In order to improve reimbursement policy making under pressure of current budget constraints, the present study is providing decision makers with practical tools make it possible for them to easily compare budgetary impact of the current therapy strategy with the future financial consequences of purchasing newly proposed medicines. In other words having estimation of the current budget spending on RTT would help policy makers in making efficient resource allocation and decrease quite high OOP expenditures. PMID:24734080

  1. Curious Case of Photo-distributed Verrucae in a Renal Transplant Patient: Report of Three Cases

    PubMed Central

    Deb, Samujjala; Bhat, P Ishwara; Thomas, Naveen

    2016-01-01

    Viral warts are a common lesion found in patients who have undergone a renal transplant. The occurrence of verrucae also depends on the choice of immunosuppressant and posttransplant time interval. The presence of viral warts only on sun-exposed parts of the body is extremely uncommon and rarely reported. It might also influence the choice of treatment since these warts are often resistant to treatment. PMID:27512193

  2. Transplantation of a horseshoe kidney from a living donor: Case report, long term outcome and donor safety

    PubMed Central

    Justo-Janeiro, Jaime Manuel; Orozco, Eduardo Prado; Reyes, Francisco J.Roberto Enríquez; de la Rosa Paredes, René; de Lara Cisneros, Luis G.Vázquez; Espinosa, Alfonso Lozano; Naylor, Jesús Mier

    2015-01-01

    Introduction The use of a horseshoe kidney in renal transplant remains controversial, when it is found in the evaluation of a living donor, anatomical, surgical and ethical issues are involved. Presentation of Case An uncomplicated horseshoe kidney was detected in a 51-year-old woman who was the only suitable donor for her 30-year-old son. Kidneys were fused in the inferior pole and no vascular or urinary abnormalities were detected during imaging evaluation. The surgical procedure was approved by the hospital transplant committee. A laparotomy was performed by means of a medial upper incision. The isthmus of the kidney was divided using a harmonic scalpel and the left segment was used; it had 2 arteries too distant to create a common one, thus anastomosed separately. The renal vein was side-to-side anastomosed to the right external iliac vein and a Lich-Gregoir ureteral implant was made. There were no intraoperative or postoperative complications in the donor who currently remains asymptomatic. Recipient developed a delayed graft function (DGF), and was discharged on the 12th day after surgery. After 24 months of surgery, renal function has remained stable with a serum creatinine of 128 μmol/L (1.45 mg/dL). Discussion There are 7 reports of a horseshoe kidney from living donors in 8 patients without morbidity and a good long term outcome of all recipients. Conclusion If we anticipate a low operative risk and there is a suitable anatomy, we may consider the use of horseshoe kidneys from living donors a viable alternative. PMID:26299249

  3. Adult Living Donor Liver Transplantation Across ABO-Incompatibility

    PubMed Central

    Lee, Chen-Fang; Cheng, Chih-Hsien; Wang, Yu-Chao; Soong, Ruey-Shyang; Wu, Tsung-Han; Chou, Hong-Shiue; Wu, Ting-Jung; Chan, Kun-Ming; Lee, Ching-Song; Lee, Wei-Chen

    2015-01-01

    Abstract The objective of this study was to evaluate the results of adult ABO-incompatible living donor liver transplantation (LDLT). ABO-incompatible LDLT is an aggressive treatment that crosses the blood-typing barrier for saving lives from liver diseases. Although graft and patient survival have been improved recently by various treatments, the results of adult ABO-incompatible LDLT require further evaluation. Two regimens were designed based on isoagglutinin IgG and IgM titers and the time course of immunological reactions at this institute. When isoagglutinin IgG and IgM titers were ≤64, liver transplantation was directly performed and rituximab (375 mg/m2) was administrated on postoperative day 1 (regimen I). When isoagglutinin titers were >64, rituximab (375 mg/m2) was administered preoperatively with or without plasmapheresis and boosted on postoperative day 1 (regimen II). Immunosuppression was achieved by administration of mycophenolate mofetil, tacrolimus, and steroids. Forty-six adult ABO-incompatible and 340 ABO-compatible LDLTs were performed from 2006 to 2013. The Model for End-Stage Liver Disease scores for ABO-incompatible recipients ranged from 7 to 40, with a median of 14. The graft-to-recipient weight ratio ranged from 0.61% to 1.61% with a median of 0.91%. The 1-, 3-, and 5-year survival rates were 81.7%, 75.7%, and 71.0%, respectively, for ABO-incompatible LDLT recipients, compared to 81.0%, 75.2%, and 71.5% for ABO-C recipients (P = 0.912). The biliary complication rate was higher in ABO-incompatible LDLT recipients than in the ABO-compatible recipients (50.0% vs 29.7%, P = 0.009). In the rituximab era, the blood type barrier can be crossed to achieve adult ABO-incompatible LDLT with survival rates comparable to those of ABO-compatible LDLT, but with more biliary complications. PMID:26496313

  4. Adult Living Donor Liver Transplantation Across ABO-Incompatibility.

    PubMed

    Lee, Chen-Fang; Cheng, Chih-Hsien; Wang, Yu-Chao; Soong, Ruey-Shyang; Wu, Tsung-Han; Chou, Hong-Shiue; Wu, Ting-Jung; Chan, Kun-Ming; Lee, Ching-Song; Lee, Wei-Chen

    2015-10-01

    The objective of this study was to evaluate the results of adult ABO-incompatible living donor liver transplantation (LDLT).ABO-incompatible LDLT is an aggressive treatment that crosses the blood-typing barrier for saving lives from liver diseases. Although graft and patient survival have been improved recently by various treatments, the results of adult ABO-incompatible LDLT require further evaluation.Two regimens were designed based on isoagglutinin IgG and IgM titers and the time course of immunological reactions at this institute. When isoagglutinin IgG and IgM titers were ≤64, liver transplantation was directly performed and rituximab (375 mg/m) was administrated on postoperative day 1 (regimen I). When isoagglutinin titers were >64, rituximab (375 mg/m) was administered preoperatively with or without plasmapheresis and boosted on postoperative day 1 (regimen II). Immunosuppression was achieved by administration of mycophenolate mofetil, tacrolimus, and steroids.Forty-six adult ABO-incompatible and 340 ABO-compatible LDLTs were performed from 2006 to 2013. The Model for End-Stage Liver Disease scores for ABO-incompatible recipients ranged from 7 to 40, with a median of 14. The graft-to-recipient weight ratio ranged from 0.61% to 1.61% with a median of 0.91%. The 1-, 3-, and 5-year survival rates were 81.7%, 75.7%, and 71.0%, respectively, for ABO-incompatible LDLT recipients, compared to 81.0%, 75.2%, and 71.5% for ABO-C recipients (P = 0.912). The biliary complication rate was higher in ABO-incompatible LDLT recipients than in the ABO-compatible recipients (50.0% vs 29.7%, P = 0.009).In the rituximab era, the blood type barrier can be crossed to achieve adult ABO-incompatible LDLT with survival rates comparable to those of ABO-compatible LDLT, but with more biliary complications. PMID:26496313

  5. A rare case of cytomegalovirus, scedosporium apiospermum and mycobacterium tuberculosis in a renal transplant recipient

    PubMed Central

    2014-01-01

    Background Renal transplant recipients are at high risk of developing multiple infections, often concomitantly because of their immunocompromised status. Post renal transplant infections are often elusive and require extensive evaluation for proper diagnosis and treatment. A high index of suspicion is required and an attempt should be made to confirm the microbiological diagnosis from each site involved to rule out multiple infections. Case presentation We report a 50-year-old female, a renal allograft recipient who presented with left hemiplegia, esophageal ulcers and fever 3 months after her transplant. Esophageal biopsy revealed Cytomegalovirus (CMV) inclusions and the whole blood quantitative CMV polymerase chain reaction (PCR) was positive. Neuroimaging showed a brain abscess, stereotactic biopsy from which revealed Scedosporium apiospermum on fungal culture. Her tacrolimus and mycophenolate were stopped and she was managed with intravenous ganciclovir and voriconazole. With these measures, she showed marked improvement in her general and neurological condition. Two months later, she developed recurrence of fever with dry cough. Radiological investigation revealed a cavitating lung lesion, a needle aspiration from which demonstrated acid-fast bacilli. She was started on antituberculous treatment. With these measures, she recovered completely and maintained good graft function despite being on only prednisolone 10 mg once a day. Conclusion Although CMV disease is not uncommon in the first three months post transplant, Scedosporium is a rare cause of brain abscess. On the other hand, tuberculosis is common in transplant recipients, especially in developing countries, like India. However, this is the first case report of occurrence of these three infections in the same patient, demonstrating the importance of a good microbiological work-up from each site involved in immunosuppressed subjects. PMID:24885965

  6. Graft Loss Due to Percutaneous Sclerotherapy of a Lymphocele Using Acetic Acid After Renal Transplantation

    SciTech Connect

    Adani, Gian Luigi Baccarani, Umberto; Bresadola, Vittorio; Lorenzin, Dario; Montanaro, Domenico; Risaliti, Andrea; Terrosu, Giovanni; Sponza, Massimo; Bresadola, Fabrizio

    2005-12-15

    Development of lymphoceles after renal transplantation is a well-described complication that occurs in up to 40% of recipients. The gold standard approach for the treatment of symptomatic cases is not well defined yet. Management options include simple aspiration, marsupialization by a laparotomy or laparoscopy, and percutaneous sclerotherapy using different chemical agents. Those approaches can be associated, and they depend on type, dimension, and localization of the lymphocele. Percutaneous sclerotherapy is considered to be less invasive than the surgical approach; it can be used safely and effectively, with low morbidity, in huge, rapidly accumulating lymphoceles. Moreover, this approach is highly successful, and the complication rate is acceptable; the major drawback is a recurrence rate close to 20%. We herewith report a renal transplant case in which the patient developed a symptomatic lymphocele that was initially treated by ultrasound-guided percutaneous sclerotherapy with ethanol and thereafter using acetic acid for early recurrence. A few hours after injection of acetic acid in the lymphatic cavity, the patient started to complain of acute pain localized to the renal graft and fever. An ultrasound of the abdomen revealed thrombosis of the renal vein and artery. The patient was immediately taken to the operating room, where the diagnosis of vascular thrombosis was confirmed and the graft was urgently explanted. In conclusion, we strongly suggest avoiding the use of acetic acid as a slerosating agent for the percutaneous treatment of post-renal transplant lymphocele because, based on our experience, it could be complicated by vascular thrombosis of the kidney, ending in graft loss.

  7. Living related liver transplantation. Why this option has been discarded in a pediatric liver transplant program in Chile.

    PubMed

    Uribe, M; Buckel, E; Ferrario, M; Godoy, J; González, G; Ceresa, S; Hunter, B; Cavallieri, S; Berwart, F; Blanco, A; Smok, G; Calabrán, L; Herzog, C; Santander, M T

    2005-10-01

    Living related living transplantation (LRLT) has opened new possibilities for planning transplantation in better conditions for children with emergency situations and chronic liver diseases. Since we began the LRLT program in 1999, we have performed 57 pediatric liver transplants, 17 (29.8%) using living related donors (LRD). The aim of this study was to analyze the reasons why LRD were discarded as a therapeutic option. All pediatric patients were prospectively included in our Microsoft Excel database that was reviewed for obtaining information about causes why the LRLT could not be done. LRLT was proposed in 28 cases and performed in 17 (60.7%). The reasons for LRD rejection were: parent's fear of surgical complications in four cases; drug abuse in two; a mother without family support; medical reasons in two; and only one, due to anatomical reasons and in one case, cadaveric graft transplantation was performed while completing the father's evaluation. From these eleven cases, the indications for liver transplant were acute liver failure (ALF) in seven, biliary atresia in three, and Alagille syndrome in one. Nine were transplanted with cadaveric organs, but two patients with ALF died awaiting a liver. Efforts should be made to clarify the advantages and the disadvantages of LRD in each case, allowing parents to make a free, well-informed decision. PMID:16298600

  8. Lymphomatoid granulomatosis treated successfully with rituximab in a renal transplant patient.

    PubMed

    Castrale, Cindy; El Haggan, Wael; Chapon, Françoise; Reman, Oumedaly; Lobbedez, Thierry; Ryckelynck, Jean Philippe; Hurault de Ligny, Bruno

    2011-01-01

    Lymphomatoid granulomatosis (LYG) in renal transplant recipients is rare multisystemic angiocentric lymphoproliferative disorder with significant malignant potential. Here, we describe LYG in a 70-year-old renal allograft recipient who, 4 years after transplantation, on tacrolimus and mycophenolate mofetil and prednisone maintenance immunosuppression, complained of low-grade fever, persistent headache and gait disturbance. The MRI of the brain revealed diffuse periventricular cerebral and cerebellar contrast-enhanced lesions. The CT scan of the thorax showed multiple pulmonary nodular opacities in both lung fields. The patient was diagnosed LYG based on the cerebral biopsy showing perivascular infiltration of CD20-positive B-lymphocytes with granulomatous lesions and immunofluorescence staining with anti-EBV antibodies. With careful reduction of the immunossuppression combined with the use of rituximab, our patient showed a complete disappearance of LYG, and she is clinically well more than 4 years after the diagnosis, with good kidney function. No recurrence has been observed by radiological imaging until now. This is the first report of a durable (>4 years) complete remission of LYG after treatment with rituximab in renal transplantation. PMID:21559262

  9. [The therapeutic drug monitoring network server of tacrolimus for Chinese renal transplant patients].

    PubMed

    Deng, Chen-Hui; Zhang, Guan-Min; Bi, Shan-Shan; Zhou, Tian-Yan; Lu, Wei

    2011-07-01

    This study is to develop a therapeutic drug monitoring (TDM) network server of tacrolimus for Chinese renal transplant patients, which can facilitate doctor to manage patients' information and provide three levels of predictions. Database management system MySQL was employed to build and manage the database of patients and doctors' information, and hypertext mark-up language (HTML) and Java server pages (JSP) technology were employed to construct network server for database management. Based on the population pharmacokinetic model of tacrolimus for Chinese renal transplant patients, above program languages were used to construct the population prediction and subpopulation prediction modules. Based on Bayesian principle and maximization of the posterior probability function, an objective function was established, and minimized by an optimization algorithm to estimate patient's individual pharmacokinetic parameters. It is proved that the network server has the basic functions for database management and three levels of prediction to aid doctor to optimize the regimen of tacrolimus for Chinese renal transplant patients. PMID:22010353

  10. Incidence and outcome of transplant renal artery stenosis: single center experience.

    PubMed

    Polak, W G; Jezior, D; Garcarek, J; Chudoba, P; Patrzałek, D; Boratyńska, M; Szyber, P; Klinger, M

    2006-01-01

    Since the incidence of transplant renal artery stenosis (TRAS) in renal allografts varies from 1% to 23%, we sought to examine its incidence, to analyze treatment options, and to ascertain its outcomes. Retrospective analysis of 793 kidney allograft recipients transplanted between 1996 and 2004 revealed an incidence of 0.9% (n = 7). Time from kidney transplantation to the first symptoms varied from 1 week to 3 years (median, 4 months). Three patients experiences refractory hypertension and six patients developed allograft dysfunction. Screening color Doppler ultrasonography showed hemodynamic changes in six patients with the definitive diagnosis confirmed by angiography in all patients. One patient with an anastomotic stenosis was treated with a surgical operation and six patients, percutaneous transluminal angioplasty (PTA), with stenting in three cases. Both surgical as well as PTA treatment were successful in all but one patient, who underwent PTA alone, developed chronic renal insufficiency necessitating hemodialysis and finally lost his allograft. In the other patients all symptoms resolved after treatment and the patients are doing well with functioning allografts. Although TRAS was an uncommon complication, if recognized promptly it could be treated by surgery or PTA with a high success rate. PMID:16504683

  11. Comparison between valganciclovir and aciclovir/valaciclovir for CMV prophylaxis in pediatric renal transplantation.

    PubMed

    Fila, M; Dechartes, A; Maisin, A; Dossier, C; Zhao, W; Deschênes, G; Baudouin, V

    2015-01-01

    Prophylaxis has dramatically decreased the occurrence of cytomegalovirus (CMV) infection after renal transplantation. Optimal regimens of treatment remain controversial, especially in pediatric recipients. The aim of this study was to evaluate the effectiveness of valganciclovir (VGC) versus aciclovir/valaciclovir (ACV) in a pediatric renal transplant population. Data from 101 renal transplantations were retrospectively analyzed. Except those with R-/Dstatus, all patients received prophylaxis either with ACV, n = 39 or VGC, n = 38. Incidences of positive CMV antigenemia and disease, as well as the delay in relation to the prophylaxis, were collected during at least 12 months after the end of treatment. Positive CMV antigenemia was reported in 34 patients (ACV: 16, VGC: 16, no prophylaxis: 2). CMV disease occurred in 15 patients (ACV: 5; VGC: 8) (ns). For the majority of patients under VGC, positive CMV antigenemia occurred within the year following the withdrawal of prophylaxis (VGC: 14; ACV: 5, P <0.05), whereas it occurred during prophylaxis in 11 patients under ACV versus two under VGC (P <0.05). The over-all incidence of positive CMV antigenemia was similar between ACV and VGC prophylaxis. However, VGC was more efficient to prevent early CMV infection while patients treated with ACV had less CMV infection or disease after the end of the prophylaxis. PMID:26022014

  12. Exogenous Lipocalin 2 Ameliorates Acute Rejection in a Mouse Model of Renal Transplantation

    PubMed Central

    Ashraf, M. I.; Schwelberger, H. G.; Brendel, K. A.; Feurle, J.; Andrassy, J.; Kotsch, K.; Regele, H.; Pratschke, J.; Maier, H. T.

    2016-01-01

    Abstract Lipocalin 2 (Lcn2) is rapidly produced by damaged nephron epithelia and is one of the most promising new markers of renal injury, delayed graft function and acute allograft rejection (AR); however, the functional importance of Lcn2 in renal transplantation is largely unknown. To understand the role of Lcn2 in renal AR, kidneys from Balb/c mice were transplanted into C57Bl/6 mice and vice versa and analyzed for morphological and physiological outcomes of AR at posttransplantation days 3, 5, and 7. The allografts showed a steady increase in intensity of interstitial infiltration, tubulitis and periarterial aggregation of lymphocytes associated with a substantial elevation in serum levels of creatinine, urea and Lcn2. Perioperative administration of recombinant Lcn2:siderophore:Fe complex (rLcn2) to recipients resulted in functional and morphological amelioration of the allograft at day 7 almost as efficiently as daily immunosuppression with cyclosporine A (CsA). No significant differences were observed in various donor–recipient combinations (C57Bl/6 wild‐type and Lcn2−/−, Balb/c donors and recipients). Histochemical analyses of the allografts showed reduced cell death in recipients treated with rLcn2 or CsA. These results demonstrate that Lcn2 plays an important role in reducing the extent of kidney AR and indicate the therapeutic potential of Lcn2 in transplantation. PMID:26595644

  13. [Incidence and management of anemia in renal transplantation: an observational-French study].

    PubMed

    Choukroun, Gabriel; Deray, Gilbert; Glotz, Denis; Lebranchu, Yvon; Dussol, Bertrand; Bourbigot, Bernard; Lefrançois, Nicole; Cassuto-Viguier, Elisabeth; Toupance, Olivier; Hacen, Chafik; Lang, Philippe; Mazouz, Hakim; Martinez, Franck

    2008-12-01

    The management of anemia after kidney transplantation remains poorly explored. The Management of Anemia in French Kidney Transplant Patients (MATRIX) study is an observational study conducted in 10 academic hospitals among kidney-transplant patients designed to evaluate the prevalence, associated factors and management of post-transplant anemia. Over two consecutive weeks, 418 recipients (males: 248; age: 50.8+/-12.7 years) were included, all were transplanted for more than six months. Mean serum creatinine (Scr) was 152+/-67 micromol/l and mean hemoglobin (Hb) was 12.4+/-1.8 g/dl (males: 12.8+/-1.9 g/dl; females 11.9+/-1.6 g/dl). Irrespective of the delay following transplantation, 23% of patients (n=95) were severely anemic (Hb < or = 11 g/dl). Eighteen percent of the patients received an antianemic treatment (10% oral iron, 7% erythropoiesis stimulating agents (ESA), 4% folic acid) and only 35% of the severely anemic patients were actually treated (n=33). A significantly-negative correlation was observed between eGFR and Hb levels (R= -0.347, p<0.02). Ninety-six percent of the 193 patients transplanted for more than six months and a Scr greater than 150 micromol/l (n=185) suffered at least one comorbidity (89% hypertension, 32% hypercholesterolemia, 13% diabetes); this group represent the second cohort. Seventy-four percent of them were treated with mycophenolate mofetil, 16% with azathioprine, and 62% with an ACEI or angiotensin II receptor antagonists. Since the transplantation, 127 patients (66%) have been anemic (Hb < or = 11 g/dl) and 58% (n=112) were treated (iron and/or ESA, respectively 81 and 55%). Among the patients not treated for anemia, 74% had an Hb level below 12g/dl. ESA-treated patients received a mean dose of 8500 UI+/-2800 per week. Anemia is under-diagnosed and under-treated in renal-transplant recipients, despite its high prevalence. As expected, a correlation between renal function and Hb levels was observed, as in CKD patients. Prospective

  14. Pathologic findings of renal biopsy were a helpful diagnostic clue of stenosis of the iliac segment proximal to the transplant renal artery: a case report.

    PubMed

    Aoyama, H; Saigo, K; Hasegawa, M; Akutsu, N; Maruyama, M; Otsuki, K; Matsumoto, I; Kawaguchi, T; Kitamura, H; Asano, T; Kenmochi, T; Itou, T; Matsubara, H

    2014-01-01

    Common iliac artery stenosis after renal transplantation is a rare complication; it can occur in the course of hypertension and renal dysfunction. We report a case of suspected renal allograft rejection with iliac artery stenosis proximal to a transplanted kidney. A 52-year-old man with a history of cadaveric kidney transplantation 26 years previously underwent a second cadaveric kidney transplantation in the left iliac fossa because of graft failure 3 years before. In June 2012, the patient had progressive renal dysfunction. In July, a percutaneous needle biopsy was taken, and it showed no rejection; however, his renal function continued to get worse through September. A percutaneous allograft renal biopsy was performed under ultrasound guidance and showed hyperplasia of the juxtaglomerular apparatus and renin granules. Magnetic resonance angiography was used to evaluate the arteries in the pelvis and showed left common iliac artery stenosis, and a stent was placed. After percutaneous intervention, the patient's ankle brachial pressure index was within the normal range and the allograft function had improved. PMID:24656037

  15. Technical adjunct for abdominal aortic aneurysm repair in patient with renal transplant.

    PubMed

    Rizzo, Anna R; Sirignano, Pasqualino; Capoccia, Laura; Menna, Danilo; Ippoliti, Francesco; Speziale, Francesco

    2014-10-01

    One of the most discussed issues in abdominal aortic surgery in kidney-transplanted patients is represented by organ protection during aortic cross-clamping. We report the case of a kidney-transplanted woman who underwent surgical correction for an abdominal aortic aneurysm after she refused any endovascular approach. To maintain kidney perfusion, during surgical aortic reconstruction, a biopump was chosen. Nowadays, abdominal aortic aneurysm endovascular repair, when feasible, allows avoiding cross-clamping-related renal ischemia, although a potential risk for contrast-induced nephrotoxicity still exists. When open surgical repair is chosen, several different techniques to protect the transplanted organ have been proposed, with different potential advantages and results. In the case we reported, the use of biopump allowed an effective protection from ischemia, minimizing perioperative stress and complications. PMID:24531028

  16. Case of early-disseminated Rhizopus microsporus var. microsporus mucormycosis in a renal transplant patient

    PubMed Central

    Sharma, Dikshya; Dahal, Kumud; Pathak, Bandana; Dahal, Udip

    2016-01-01

    Mucormycosis is a rare infection caused by the ubiquitous filamentous fungi of the order Mucorales and class Zygomycetes. These species are vasotropic, causing rapid onset of tissue infarctions and necrosis and subsequent thrombosis by invading vascular bed. The disease spectrum ranges from involvement of skin, sinuses, lung, and brain to disseminated and mostly fatal infections, especially in immunocompromised hosts. Here, we present a case of a fatal disseminated mucormycosis in a 56-year-old female who had deceased donor renal allograft transplantation ~2 weeks prior to presentation. She presented with shortness of breath and dry cough. Despite being on broad-spectrum antibiotics/antifungals and proper management by transplant, infectious disease, and primary team, she died within 3 weeks of admission. Autopsy showed disseminated mucormycosis of lungs and thyroid. Disseminated infection within 2 weeks of solid organ transplantation in this patient was one of the rare features of mucormycosis. PMID:27354831

  17. Cytomegalovirus infection in renal transplantation: clinical aspects, management and the perspectives

    PubMed Central

    Requião-Moura, Lúcio Roberto; de Matos, Ana Cristina Carvalho; Pacheco-Silva, Alvaro

    2015-01-01

    Cytomegalovirus infection is one of most frequent infectious complications after renal transplantation, and can be classified as primo-infection, when the transmission occurs through the graft, or reactivation, when the recipient is cytomegalovirus seropositive. After transplantation, cytomegalovirus can appear as an infection, when the patient presents with evidence of viral replication without symptoms or disease, which has two clinical spectra: typical viral syndrome or invasive disease, which is a less common form. Their effects can be classified as direct, while the disease is developed, or indirect, with an increase of acute rejection and chronic allograft dysfunction risks. Diagnosis must be made based on viremia by one of the standardized methods: antigenemia or PCR, which is more sensitive. The risk factors related to infection after transplantation are the serologic matching (positive donor and negative recipient) and anti-lymphocyte antibody drugs. One of the strategies to reduce risk of disease should be chosen for patients at high risk: preemptive treatment or universal prophylaxis. Recent clinical research has described ganciclovir resistance as an emergent problem in management of cytomegalovirus infection. Two types of mutation that cause resistance were described: UL97 (most frequent) and UL54. Today, sophisticated methods of immunologic monitoring to detect specific T-cell clones against cytomegalovirus are used in clinical practice to improve the management of high-risk patients after renal transplantation. PMID:25993081

  18. Cutaneous alternariosis in a renal transplant recipient: a case report and literature review.

    PubMed

    Hsu, Chia-Chi; Chang, Shen-Shin; Lee, Po-Chang; Chao, Sheau-Chiou

    2015-01-01

    Organ transplant recipients under immunosuppressive therapy have a highly increased risk of acquiring unusual opportunistic infections. Diagnosis of the etiology of infection may be difficult in clinical manifestations, which need further histological and biological investigations. We recently treated a male renal transplant recipient with a cutaneous phaeohyphomycosis due to Alternaria species. The diagnosis was based on microscopy and culture of the skin lesions. Treatment with oral itraconazole for 5 weeks was ineffective, then clinical improvement was achieved by combination of amphotericin B wet-packing and systemic antifungal therapy with oral voriconazole. Alternaria species are ubiquitous plant-inhabiting saprobes, which are increasingly associated with opportunistic phaeohyphomycosis in immunocompromised individuals. To the best of our knowledge, this is the second case report noting sporotrichoid pattern as the manifestation of cutaneous alternariosis. In this context, we reviewed recent renal-transplant-related cutaneous alternariosis reported in the English-language literature during 1995 to 2011 to summarize its clinical features and outcomes, and to guide clinicians in the care of kidney transplant patients with cutaneous alternariosis. PMID:25554667

  19. Acute bacterial sternoclavicular osteomyelitis in a long-term renal transplant recipient

    PubMed Central

    Dounousi, Evangelia; Duni, Anila; Xiromeriti, Sofia; Pappas, Charalambos; Siamopoulos, Kostas C

    2016-01-01

    Kidney transplantation is the treatment of choice for a significant number of patients with end-stage renal disease. Although immunosuppression therapy improves graft and patient’s survival, it is a major risk factor for infection following kidney transplantation altering clinical manifestations of the infectious diseases and complicating both the diagnosis and management of renal transplant recipients (RTRs). Existing literature is very limited regarding osteomyelitis in RTRs. Sternoclavicular osteomyelitis is rare and has been mainly reported after contiguous spread of infection or direct traumatic seeding of the bacteria. We present an interesting case of acute, bacterial sternoclavicular osteomyelitis in a long-term RTR. Blood cultures were positive for Streptococcus mitis, while the portal entry site was not identified. Magnetic resonance imaging of the sternoclavicluar region and a three-phase bone scan were positive for sternoclavicular osteomyelitis. Eventually, the patient was successfully treated with Daptomycin as monotherapy. In the presence of immunosuppression, the transplant physician should always remain alert for opportunistic pathogens or unusual location of osteomyelitis. PMID:27358791

  20. Acute bacterial sternoclavicular osteomyelitis in a long-term renal transplant recipient.

    PubMed

    Dounousi, Evangelia; Duni, Anila; Xiromeriti, Sofia; Pappas, Charalambos; Siamopoulos, Kostas C

    2016-06-24

    Kidney transplantation is the treatment of choice for a significant number of patients with end-stage renal disease. Although immunosuppression therapy improves graft and patient's survival, it is a major risk factor for infection following kidney transplantation altering clinical manifestations of the infectious diseases and complicating both the diagnosis and management of renal transplant recipients (RTRs). Existing literature is very limited regarding osteomyelitis in RTRs. Sternoclavicular osteomyelitis is rare and has been mainly reported after contiguous spread of infection or direct traumatic seeding of the bacteria. We present an interesting case of acute, bacterial sternoclavicular osteomyelitis in a long-term RTR. Blood cultures were positive for Streptococcus mitis, while the portal entry site was not identified. Magnetic resonance imaging of the sternoclavicluar region and a three-phase bone scan were positive for sternoclavicular osteomyelitis. Eventually, the patient was successfully treated with Daptomycin as monotherapy. In the presence of immunosuppression, the transplant physician should always remain alert for opportunistic pathogens or unusual location of osteomyelitis. PMID:27358791

  1. Lymphatic disorders after renal transplantation: new insights for an old complication

    PubMed Central

    Ranghino, Andrea; Segoloni, Giuseppe Paolo; Lasaponara, Fedele; Biancone, Luigi

    2015-01-01

    In renal transplanted patients, lymphoceles and lymphorrhea are well-known lymphatic complications. Surgical damage of the lymphatics of the graft during the procurement and of the lymphatic around the iliac vessels of the recipients has been associated with development of lymphatic complications. However, lymphatic complications may be related to medical factors such as diabetes, obesity, blood coagulation abnormalities, anticoagulation prophylaxis, high dose of diuretics, delay in graft function and immunosuppressive drugs. Consistently, immunosuppression regimens based on the use of mTOR inhibitors, especially in association with steroids and immediately after transplantation, has been associated with a high risk to develop lymphocele or lymphorrhea. In addition, several studies have demonstrated the association between rejection episodes and lymphatic complications. However, before the discovery of reliable markers of lymphatic vessels, the pathogenic mechanisms underlining the development of lymphatic complications during rejection and the influence of mTOR inhibitors remained not fully understood. The recent findings on the lymphatic systems of either native or transplanted kidneys together with the advances achieved on lymphangiogenesis shared some lights on the pathogenesis of lymphatic complications after renal transplantation. In this review, we describe the surgical and medical causes of lymphatic complications focusing on the rejection and immunosuppressive drugs as causes of lymphatic complications. PMID:26413290

  2. Optimal management of distal ureteric strictures following renal transplantation: a systematic review.

    PubMed

    Kwong, Justin; Schiefer, Danielle; Aboalsamh, Ghaleb; Archambault, Jason; Luke, Patrick P; Sener, Alp

    2016-05-01

    Our objective was to define optimal management of distal ureteric strictures following renal transplantation. A systematic review on PubMed identified 34 articles (385 patients). Primary endpoints were success rates and complications of specific primary and secondary treatments (following failure of primary treatment). Among primary treatments (n = 303), the open approach had 85.4% success (95% CI 72.5-93.1) and the endourological approach had 64.3% success (95% CI 58.3-69.9). Among secondary treatments (n = 82), the open approach had 93.1% success (95% CI 77.0-99.2) and the endourological approach had 75.5% success (95% CI 62.3-85.2). The most common primary open treatment was ureteric reimplantation (n = 33, 81.8% success, 95% CI 65.2-91.8). The most common primary endourological treatment was dilation (n = 133, 58.6% success, 95% CI 50.1-66.7). Fourteen complications, including death (4 weeks post-op) and graft loss (12 days post-op), followed endourological treatment. One complication followed open treatment. This is the first systematic review to examine the success rates and complications of specific treatments for distal ureteric strictures following renal transplantation. Our review indicates that open management has higher success rates and fewer complications than endourological management as a primary and secondary treatment for post-transplant distal ureteric strictures. We also outline a post-transplant ureteric stricture evaluation and treatment algorithm. PMID:26895782

  3. Incidence and risk factors for early renal dysfunction after liver transplantation

    PubMed Central

    Wiesen, Patricia; Massion, Paul B; Joris, Jean; Detry, Olivier; Damas, Pierre

    2016-01-01

    AIM: To determine renal dysfunction post liver transplantation, its incidence and risk factors in patients from a Belgian University Hospital. METHODS: Orthotopic liver transplantations performed from January 2006 until September 2012 were retrospectively reviewed (n = 187). Patients with no renal replacement therapy (RRT) before transplantation were classified into four groups according to their highest creatinine plasma level during the first postoperative week. The first group had a peak creatinine level below 12 mg/L, the second group between 12 and 20 mg/L, the third group between 20 and 35 mg/L, and the fourth above 35 mg/L. In addition, patients who needed RRT during the first week after transplantation were also classified into the fourth group. Perioperative parameters were recorded as risk factors, namely age, sex, body mass index (BMI), length of preoperative hospital stay, prior bacterial infection within one month, preoperative ascites, preoperative treatment with β-blocker, angiotensin-converting enzyme inhibitor or non steroidal anti-inflammatory drugs, preoperative creatinine and bilirubin levels, donor status (cardiac death or brain death), postoperative lactate level, need for intraoperative vasopressive drugs, surgical revision, mechanical ventilation for more than 24 h, postoperative bilirubin and transaminase peak levels, postoperative hemoglobin level, amount of perioperative blood transfusions and type of immunosuppression. Univariate and multivariate analysis were performed using logistic ordinal regression method. Post hoc analysis of the hemostatic agent used was also done. RESULTS: There were 78 patients in group 1 (41.7%), 46 in group 2 (24.6%), 38 in group 3 (20.3%) and 25 in group 4 (13.4%). Twenty patients required RRT: 13 (7%) during the first week after transplantation. Using univariate analysis, the severity of renal dysfunction was correlated with presence of ascites and prior bacterial infection, preoperative bilirubin, urea and

  4. Renal aspergillosis after liver transplantation: Clinical and imaging manifestations in two cases

    PubMed Central

    Meng, Xiao-Chun; Jiang, Ting; Yi, Shu-Hong; Xie, Pei-Yi; Guo, Yue-Fei; Quan, Li; Zhou, Jing; Zhu, Kang-Shun; Shan, Hong

    2014-01-01

    Renal aspergillosis (RAsp) is a rare complication in liver transplant (LT) recipients. Here we report RAsp in two LT recipients. In both patients, RAsp occurred more than 90 d after allogenetic orthotropic LT, and all the clinical findings were unspecific. RAsp involved unilateral kidney in Case one and bilateral kidneys in Case two. Both computed tomography (CT) and magnetic resonance imaging (MRI) revealed renal abscesses, with progressively enhanced walls and separations and unenhanced alveolate areas after contrast agent administration. On unenhanced CT images they showed inhomogeneous hypo-attenuation. On fat-suppressed T2-weighted images (T2WIs), the walls and separations of the abscesses showed slightly low signal intensity and the central parts of the lesions showed slightly high signal intensity. Both on CT and MRI, there were some hints of renal infarction or chronic ischemia. Both cases were treated by radical nephrectomy followed by adjuvant antifungal treatment. They all recovered well. PMID:25561822

  5. Acute renal transplant rejection in children: assessment by Duplex Doppler sonography.

    PubMed

    Vergesslich, K A; Khoss, A E; Balzar, E; Schwaighofer, B; Ponhold, W

    1988-01-01

    Over a two year period 74 consecutive Duplex Doppler scans were performed in 23 children with renal allografts and were compared to the Doppler sonographic findings in orthotopic kidneys of 25 age matched healthy controls. The Doppler waveforms of renal arterial flow were analyzed qualitatively assessing systolic and diastolic flow amplitudes, for quantitation the Pourcelot index (PI) was used. There was no variation between the Doppler waveforms in recipients with normal allograft function and healthy controls. In 12 patients with biopsy proven acute rejection a decrease or absence of the diastolic flow amplitude was noted, resulting in increased pulsatility of the Doppler waveform. The mean PI in acute rejection differed significantly from the mean PI in normal allograft function. Duplex Doppler sonography is a useful imaging modality in the differentiation between acute rejection and normal allograft function and should therefore be integrated in the screening of children after renal transplantation. PMID:3054768

  6. Limitations of indium-111 leukocyte scanning in febrile renal transplant patients

    SciTech Connect

    Sebrechts, C.; Biberstein, M.; Klein, J.L.; Witztum, K.F.

    1986-04-01

    Indium-111-labeled leukocyte scanning was evaluated as a technique for investigating possible abscess as the cause of fever in 10 renal allograft recipients under therapy for rejection, acute tubular necrosis, or urinary infection. The usefulness of the method in this setting was found to be limited by marked nonspecificity of renal, pulmonary, and other focal leukocyte accumulation. Although wound infections were correctly identified, false-positive scans resulted in multiple nonproductive consultations and radiologic procedures (some invasive) and contributed to the decision to perform one negative exploratory laparotomy. Such generalized nonspecificity in this patient population is in distinct contrast to the experience with this diagnostic test in nontransplant patients, and has not previously been reported. Possible explanations and implications of these findings are discussed. Consequently, great caution is recommended in the use of indium-111 leukocyte scans to diagnose infection in febrile renal transplant patients who present in a similar clinical setting.

  7. A review of current status of living donor liver transplantation.

    PubMed

    Park, Gil-Chun; Song, Gi-Won; Moon, Deok-Bog; Lee, Sung-Gyu

    2016-04-01

    Living donor liver transplantation (LDLT) has become an inevitable procedure in Asia due to its shortage of deceased donor under the influence of the religion and native cultures. Through a broad variety of experience, LDLT has been evolved and extended its indication. Although there have been many surgical and ethical efforts to prevent donor risk, concerns of donor's safety still are remaining questions due to its strict selection criteria. Therefore, dual grafts LDLT or ABO incompatible (ABO-I) LDLT may be effective means in its application and safety aspect. Many Asian LDLT centers have pointed out the useful extended criteria of LDLT for hepatocellular carcinoma (HCC), but the applicability of extended criteria should be validated and standardized by worldwide prospective studies based on the Milan criteria. Recent struggling efforts have been reported to surmount extensive portal vein thrombosis and Budd-Chiari syndrome which were previously contraindicated to LDLT. There is no doubt that LDLT is a surely complicated therapy to be performed successfully and requires devoted efforts by surgeons and co-workers. Nonetheless, comprehensive increasing understandings of partial graft LT and improvements of surgical techniques with challenges to obstacles in LDLT will make its prosperity with satisfactory outcomes. PMID:27115004

  8. A review of current status of living donor liver transplantation

    PubMed Central

    Park, Gil-Chun; Song, Gi-Won; Moon, Deok-Bog

    2016-01-01

    Living donor liver transplantation (LDLT) has become an inevitable procedure in Asia due to its shortage of deceased donor under the influence of the religion and native cultures. Through a broad variety of experience, LDLT has been evolved and extended its indication. Although there have been many surgical and ethical efforts to prevent donor risk, concerns of donor’s safety still are remaining questions due to its strict selection criteria. Therefore, dual grafts LDLT or ABO incompatible (ABO-I) LDLT may be effective means in its application and safety aspect. Many Asian LDLT centers have pointed out the useful extended criteria of LDLT for hepatocellular carcinoma (HCC), but the applicability of extended criteria should be validated and standardized by worldwide prospective studies based on the Milan criteria. Recent struggling efforts have been reported to surmount extensive portal vein thrombosis and Budd-Chiari syndrome which were previously contraindicated to LDLT. There is no doubt that LDLT is a surely complicated therapy to be performed successfully and requires devoted efforts by surgeons and co-workers. Nonetheless, comprehensive increasing understandings of partial graft LT and improvements of surgical techniques with challenges to obstacles in LDLT will make its prosperity with satisfactory outcomes. PMID:27115004

  9. Functional and histological improvement after everolimus rescue of chronic allograft dysfunction in renal transplant recipients

    PubMed Central

    Chow, Kai Ming; Szeto, Cheuk Chun; Lai, Fernand Mac-Moune; Luk, Cathy Choi-Wan; Kwan, Bonnie Ching-Ha; Leung, Chi Bon; Li, Philip Kam-Tao

    2015-01-01

    Background We tested the strategy of mTOR inhibitors with calcineurin inhibitor minimization in renal transplant recipients with known chronic allograft dysfunction. Methods In this open-label, single-arm study, renal transplant patients were recruited after biopsy-confirmed chronic allograft dysfunction in the absence of acute rejection episode within 2 months, with proteinuria <0.8 g/day, and serum creatinine <220 μmol/L or estimated glomerular filtration rate >40 mL/min/1.73 m2. They were converted to everolimus (aiming for trough everolimus level 3–8 ng/mL) with cyclosporine minimization, to assess the effect on renal function, rate of glomerular filtration rate decline, and longitudinal transplant biopsy at 12 months. Results Seventeen Chinese patients (median transplant duration, 4.2 years) were recruited; no patients discontinued study medication. The mean slope of the glomerular filtration rate over time was −4.31±6.65 mL/min/1.73 m2 per year in the year before everolimus, as compared with 1.29±5.84 mL/min/1.73 m2 per year in the 12 months of everolimus therapy, a difference of 5.61 mL/min/1.73 m2 per year (95% confidence interval [CI], 0.40–10.8) favoring everolimus therapy (P=0.036). Serial renal biopsy histology showed significant decrease of tubular atrophy (15.7%±11.3% versus 7.1%±7.3%, P=0.005) and interstitial fibrosis (14.8%±11.5% versus 7.2%±8.2%, P=0.013). Intrarenal expression of TGF-β1 mRNA showed a nonsignificant decrease after everolimus treatment. Conclusion In renal transplant recipients with biopsy-confirmed chronic allograft dysfunction, we found a significant beneficial effect of everolimus rescue therapy and calcineurin inhibitor minimization strategy on the improvement of glomerular filtration rate decline rate. In secondary analysis, everolimus was shown to slow down the disease progression by reducing the tubular atrophy and interstitial fibrosis scoring. PMID:26056462

  10. Perioperative management of living-donor liver transplantation for methylmalonic acidemia.

    PubMed

    Baba, Chiaki; Kasahara, Mureo; Kogure, Yasuhiro; Kasuya, Shugo; Ito, Sukeyuki; Tamura, Takako; Fukuda, Akinari; Horikawa, Reiko; Suzuki, Yasuyuki

    2016-07-01

    Methymalonic acidemia (MMA) is a hereditary metabolic disorder characterized by a defect of the methylmalonyl-CoA mutase that breaks down propionate. The efficacy of liver transplantation for MMA was recently reported. However, the anesthetic management of liver transplant for MMA is not clear. The aim of this article is to describe an anesthetic management algorithm of liver transplant for MMA by reviewing our cases of liver transplant for MMA. Fourteen patients received a liver transplant; three cases showed metabolic decompensation during the transplant and two of the patients died. In the two patients who expired, propofol was used for maintenance anesthesia and preoperative continuous hemodiafiltration was used to reduce plasma methylmalonic acid level in one case, and to control severe metabolic decompensation before transplant for the other case. Their renal function was also worse than others and they were already experiencing metabolic decompensation before induction of anesthesia. Based on our experience of these 14 cases, we have established an anesthetic algorithm for patients with MMA undergoing liver transplant or other procedures. There are three important points in our experience: propofol should be avoided, dextrose infusion therapy should be continued to prevent metabolic decompensation, and liver transplant or other procedures should be avoided during metabolic decompensation. PMID:27221384

  11. Successful technical and clinical outcome using a second generation balloon expandable coronary stent for transplant renal artery stenosis: Our experience.

    PubMed

    Salsamendi, Jason; Pereira, Keith; Baker, Reginald; Bhatia, Shivank S; Narayanan, Govindarajan

    2015-10-01

    Transplant renal artery stenosis (TRAS) is a vascular complication frequently seen because of increase in the number of renal transplantations. Early diagnosis and management is essential to optimize a proper graft function. Currently, the endovascular treatment of TRAS using angioplasty and/or stenting is considered the treatment of choice with the advantage that it does not preclude subsequent surgical correction. Treatment of TRAS with the use of stents, particularly in tortuous transplant renal anatomy presents a unique challenge to an interventional radiologist. In this study, we present three cases from our practice highlighting the use of a balloon-expandable Multi-Link RX Ultra coronary stent system (Abbott Laboratories, Abbott Park, Illinois, USA) for treating high grade focal stenosis along very tortuous renal arterial segments. Cobalt-Chromium alloy stent scaffold provides excellent radial force, whereas the flexible stent design conforms to the vessel course allowing for optimal stent alignment. PMID:26629289

  12. Successful technical and clinical outcome using a second generation balloon expandable coronary stent for transplant renal artery stenosis: Our experience

    PubMed Central

    Salsamendi, Jason; Pereira, Keith; Baker, Reginald; Bhatia, Shivank S; Narayanan, Govindarajan

    2015-01-01

    Transplant renal artery stenosis (TRAS) is a vascular complication frequently seen because of increase in the number of renal transplantations. Early diagnosis and management is essential to optimize a proper graft function. Currently, the endovascular treatment of TRAS using angioplasty and/or stenting is considered the treatment of choice with the advantage that it does not preclude subsequent surgical correction. Treatment of TRAS with the use of stents, particularly in tortuous transplant renal anatomy presents a unique challenge to an interventional radiologist. In this study, we present three cases from our practice highlighting the use of a balloon-expandable Multi-Link RX Ultra coronary stent system (Abbott Laboratories, Abbott Park, Illinois, USA) for treating high grade focal stenosis along very tortuous renal arterial segments. Cobalt–Chromium alloy stent scaffold provides excellent radial force, whereas the flexible stent design conforms to the vessel course allowing for optimal stent alignment. PMID:26629289

  13. Acute Rejection Associated with Donor-Specific Anti-MICA Antibody in a Highly Sensitized Pediatric Renal Transplant Recipient

    PubMed Central

    Narayan, Shoba; Tsai, Eileen W.; Zhang, Qiuheng; Wallace, William D.; Reed, Elaine F.; Ettenger, Robert B.

    2013-01-01

    Allograft rejection in HLA identical transplant recipients and in patients without detectable donor specific anti-HLA antibodies has lead to the identification of non-HLA antigens as targets of the alloimmune response. Major Histocompatibility Complex class I-related chain A (MICA) antigen has been recognized as an important non-HLA target in renal transplantation. Recent studies have shown that anti-MICA antibodies are associated with acute renal allograft rejection and failure. Current cross match procedures using donor lymphocytes fail to detect MICA antibodies. Transplant candidates are not routinely tested for pre-sensitization to MICA antigens nor are transplant donors typed for MICA alleles. Optimal classification and treatment of acute rejection associated with MICA antibody remains unknown. In this case report, we are the first to describe the clinical course and treatment of donor specific MICA antibody associated with both Banff type II A acute cellular rejection (ACR) and antibody mediated rejection (AMR) in a highly sensitized pediatric renal re-transplant recipient. This case also emphasizes the importance of pre-transplant screening for donor specific MICA antibody especially in highly sensitized renal transplant patients.. PMID:21199204

  14. Excellent uricosuric efficacy of benzbromarone in cyclosporin-A-treated renal transplant patients: a prospective study.

    PubMed

    Zürcher, R M; Bock, H A; Thiel, G

    1994-01-01

    Patients on cyclosporin A (CsA) often develop hyperuricaemia and gout. In transplant patients the use of uricosuric drugs for treating hyperuricaemia may be preferable to allopurinol because of the known interaction of the latter with azathioprine. We therefore prospectively studied the uricosuric efficacy of 100 mg benzbromarone (Bbr;Desuric) daily in 25 CsA-treated renal transplant patients with stable graft function and hyperuricaemia (> 359 mumol/l for females, > 491 mumol/l for males). Benzbromarone decreased plasma uric acid from 579 + 18 mumol/l to 313 +/- 24 mumol/l (mean +/- SEM; P < 0.0001) and thereby normalized plasma uric acid in 21 of 25 patients. The remaining four patients had creatinine clearances between 21 and 25 ml/min, the lowest of the entire study group. Mean fractional clearance of uric acid increased from 5.4 +/- 0.4% to 17.2 +/- 1.0% (P < 0.001). The relative decrease of plasma uric acid closely correlated with baseline creatinine clearance (r = 0.67; P < 0.001). CsA trough values were not influenced. None of the patients experienced any significant side-effects. As an unexpected find-ing, urinary uric acid excretion increased from 2082 +/- 175 mumol/24 h to 3233 +/- 232 mumol/24 h after 4 weeks' treatment with benzbromarone. In conclusion, benzbromarone normalized plasma uric acid in all CsA-treated renal transplant recipients with a creatinine clearance > 25 ml/min. Due to its excellent efficacy and lack of significant side-effects, benzbromarone appears to be preferable to allopurinol in CsA-treated renal transplant recipients with a creatinine clearance over 25 ml/min. PMID:8090336

  15. Minimization vs tailoring: Where do we stand with personalized immunosuppression during renal transplantation in 2015?

    PubMed Central

    Zsom, Lajos; Wagner, László; Fülöp, Tibor

    2015-01-01

    The introduction of novel immunosuppressive agents over the last two decades and the improvement of our diagnostic tools for early detection of antibody-mediated injury offer us an opportunity, if not a mandate, to better match the immunosuppression needs of the individual patients with side effects of the therapy. However, immunosuppressive regimens in the majority of programs remain mostly protocol-driven, with relatively little inter-program heterogeneity in certain areas of the world. Emerging data showing different outcomes with a particular immunosuppressive strategy in populations with varying immunological risks underscore a real potential for “personalized medicine” in renal transplantation. Studies demonstrating marked differences in the adverse-effect profiles of individual drugs including the risk for viral infections, malignancy and renal toxicity call for a paradigm shift away from a “one size fits all” approach to an individually tailored immunosuppressive therapy for renal transplant recipients, assisted by both screening for predictors of graft loss and paying close attention to dose or class-related adverse effects. Our paper explores some of the opportunities during the care of these patients. Potential areas of improvements may include: (1) a thorough assessment of immunological and metabolic risk profile of each renal transplant recipient; (2) screening for predictors of graft loss and early signs of antibody-mediated rejection with donor-specific antibodies, protocol biopsies and proteinuria (including close follow up of adverse effects with dose adjustments or conversions as necessary); and (3) increased awareness of the possible link between poor tolerance of a given drug at a given dose and non-adherence with the prescribed regimen. Altogether, these considerations may enable the most effective use of the drugs we already have. PMID:26421259

  16. Immunosuppressive agents and metabolic factors of cardiovascular risk in renal transplant recipients.

    PubMed

    Sessa, A; Esposito, A; Giliberti, A; Iavicoli, G; Costa, C; Bergallo, M; Lettieri, E; Rossano, R; Capuano, M

    2009-05-01

    Cardiovascular disease (CVD) accounts for 35% to 50% of deaths among renal transplant recipients. Beside the atherogenic risk factors related to hemodialysis, renal function, and use of immunosuppressive agents, other relevant risk factors for CVD include acute rejection episodes, microalbuminuria (muAlb), diabetes, arterial hypertension, lipid disorders, inflammatory triggers, hyperhomocysteinemia, anemia, erythrocytosis, obesity, and hyperuricemia. We studied the prevalence of risk factors and the impact of various drugs on CVD among 103 renal transplant recipients with measured glomerular filtration rates showing values >45 mL/min. We measured uric acid, triglycerides (TG), low-density lipoprotein (LDL)/high-density lipoprotein (HDL) LDL/HDL ratio, homocysteine (HOMO), insulin resistance, muAlb, C-reactive protein (CRP), and fibrinogen. Subsequently, patients were divided into 8 groups based on the immunosuppressive protocol to evaluate its impact on CVD risk factors. Insulin resistance and hyperhomocysteinemia were present in >2/3 of patients. Considering the impact of protocols, the combination of cyclosporine (CsA) + everolimus (EVL) resulted in the most favorable profile in terms of reduction of hyperuricemia, hyperlipidemia, and hyperhomocysteinemia. Insulin resistance tended to be more frequent among patients treated with protocols including calcineurin inhibitors (CNI) and steroids. The prevalence of hyperhomocyteinemia was similar among patients on CsA and on tacrolimus (Tac). Sirolimus (SRL) was associated with higher levels of HOMO. The combination of CNI and proliferative signal inhibitors (PSI) seemed to be the most promising one to reduce the impact of CVD risk factors. The reduction in CVD morbidity can improve expectancy and quality of life, as well as graft function and survival among renal transplant patients. PMID:19460510

  17. Benefits and Complications of Removing Ureteral Stent Based on the Elapsed Time After Renal Transplantation Surgery

    PubMed Central

    Dadkhah, Farid; Yari, Hassan; Ali Asgari, Majid; Fallahnezhad, Mohammad Hossein; Tavoosian, Ali; Ghadian, Alireza

    2016-01-01

    Background The most important surgical complications of renal transplantation are stenosis and obstruction of anastomosis of the ureter to the bladder. Although the routine use of the ureteral stents to prevent such complications seems rational, the optimal time to keep the ureteral stent is still controversial. Objectives This study presents the benefits and complications of removing the ureteral stent based on the elapsed time after the surgery. Patients and Methods All patients who underwent kidney transplantation between May 2011 and August 2014 in Modarres hospital, Tehran, Iran, were enrolled in the study. The patients were classified into three groups. The ureteral stent was removed 10, 20, and 30 days after the transplantation in these groups. Results A total of 529 patients underwent kidney transplant surgery in our center. Urologic complications among the three groups consisting of hydronephrosis, urinoma and collection did not have statistically significant differences. Conclusions Ureteral stent can be picked up with no increased risk of urologic complications at shorter intervals after the kidney transplantation surgery. PMID:27231685

  18. Left Lateral Sectionectomy of the Native Liver and Combined Living-Related Liver–Kidney Transplantation for Primary Hyperoxaluria Type 1

    PubMed Central

    Chen, Guo-Yong; Wei, Si-Dong; Zou, Zhong-Wu; Tang, Gao-Feng; Sun, Jian-Jun; Zhou, Shao-Tang

    2015-01-01

    Abstract Primary hyperoxaluria type I (PH1), the most severe form of primary hyperoxalurias, is a liver disease of the metabolic defect in glyoxylate detoxification that can be corrected by liver transplantation. A 21-year-old man presented to our center after 4 months of regular hemodialysis for kidney failure caused by nephrolithiasis. A diagnosis of PH1 was confirmed by mutations of the AGXT gene. Left lateral sectionectomy of the native liver was performed; and auxiliary partial orthotopic liver transplantation (APOLT) and kidney transplantation were carried out synchronously using a living donor. After transplantation, the patient's plasma oxalate and creatinine levels substantially decreased and the patient recovered well with good dual grafts function. APOLT and kidney transplantation can compensate the liver deficient in liver enzyme production and aid the renal elimination of oxalate, thus serving as an effective treatment option for patients with PH1. In conclusion, left lateral sectionectomy of the native liver and combined living-related liver–kidney transplantation can be a surgical option for PH1. PMID:26252291

  19. Single-center experience in pediatric renal transplantation using thymoglobulin induction and steroid minimization.

    PubMed

    Warejko, Jillian K; Hmiel, S Paul

    2014-12-01

    Our center has offered thymoglobulin induction with steroid minimization to our pediatric renal transplant patients for the last 10 yr. Steroid minimization or avoidance has shown favorable results in survival, kidney function, and growth in previous studies of pediatric patients. We report our experience with this protocol over the past 10 yr with respect to patient/graft survival, acute rejection episodes, renal function, linear growth, bone density, cardiovascular risk factors, and opportunistic infections. A retrospective chart review was performed for pediatric renal transplant patients on the steroid-minimized protocol between January 2002 and December 2011 on an intention to treat basis. Patient demographics, height, weight, serum creatinine, iGFR, biopsies, and survival data were collected. Height and weight z-scores were calculated with EpiInfo 7, using the CDC 2000 growth charts. Survival was calculated using Kaplan-Meier analysis. eGFR was calculated using the original and modified Schwartz equations. Forty-four pediatric patients were identified, aged 13 months to 19 yr. Five-yr survival was 95.5% for males and 94.4% for females. Only five patients had biopsy-proven ACR, two of which were at more than 12 months post-transplantation. Height delta z-scores from transplant to one, three, and five yr were 0.34, 0.38, and 0.79, respectively. Weight delta z-scores from transplant to one, three, and five yr were 0.87, 0.79, and 0.84, respectively. Mean original Schwartz eGFR was 84.3 ± 15.8 mL/min/1.73 m(2) , modified Schwartz eGFR was 59.3 ± 11.5 mL/min/1.73 m(2) , and iGFR was 64.2 ± 8.5 mL/min/1.73 m(2) at three yr. Of 18 subjects who had a bone density exam, none had a z-score less than -2 on DEXA exam at one-yr post-transplantation. Fifty-one percent of patients were on antihypertensives at the time of transplant compared with 43% at one-yr post-transplantation. Three yr post-transplantation, the average LDL was <100 mg/dL, and

  20. Impact of Drug Therapy, Radiation Dose, and Dose Rate on Renal Toxicity Following Bone Marrow Transplantation

    SciTech Connect

    Cheng, Jonathan C.; Schultheiss, Timothy E. Wong, Jeffrey Y.C.

    2008-08-01

    Purpose: To demonstrate a radiation dose response and to determine the dosimetric and chemotherapeutic factors that influence the incidence of late renal toxicity following total body irradiation (TBI). Methods and Materials: A comprehensive retrospective review was performed of articles reporting late renal toxicity, along with renal dose, fractionation, dose rate, chemotherapy regimens, and potential nephrotoxic agents. In the final analysis, 12 articles (n = 1,108 patients), consisting of 24 distinct TBI/chemotherapy conditioning regimens were included. Regimens were divided into three subgroups: adults (age {>=}18 years), children (age <18 years), and mixed population (both adults and children). Multivariate logistic regression was performed to identify dosimetric and chemotherapeutic factors significantly associated with late renal complications. Results: Individual analysis was performed on each population subgroup. For the purely adult population, the only significant variable was total dose. For the mixed population, the significant variables included total dose, dose rate, and the use of fludarabine. For the pediatric population, only the use of cyclosporin or teniposide was significant; no dose response was noted. A logistic model was generated with the exclusion of the pediatric population because of its lack of dose response. This model yielded the following significant variables: total dose, dose rate, and number of fractions. Conclusion: A dose response for renal damage after TBI was identified. Fractionation and low dose rates are factors to consider when delivering TBI to patients undergoing bone marrow transplantation. Drug therapy also has a major impact on kidney function and can modify the dose-response function.

  1. The Association between Marine n-3 Polyunsaturated Fatty Acid Levels and Survival after Renal Transplantation

    PubMed Central

    Jenssen, Trond; Hartmann, Anders; Diep, Lien M.; Dahle, Dag O.; Reisæter, Anna V.; Bjerve, Kristian S.; Christensen, Jeppe H.; Schmidt, Erik B.; Svensson, My

    2015-01-01

    Background and objectives Several studies have reported beneficial cardiovascular effects of marine n-3 polyunsaturated fatty acids. To date, no large studies have investigated the potential benefits of marine n-3 polyunsaturated fatty acids in recipients of renal transplants. Design, setting, participants, & measurements In this observational cohort study of 1990 Norwegian recipients of renal transplants transplanted between 1999 and 2011, associations between marine n-3 polyunsaturated fatty acid levels and mortality were investigated by stratified analysis and multivariable Cox proportional hazard regression analysis adjusting for traditional and transplant-specific mortality risk factors. Marine n-3 polyunsaturated fatty acid levels in plasma phospholipids were measured by gas chromatography in a stable phase 10 weeks after transplantation. Results There were 406 deaths (20.4%) during a median follow-up period of 6.8 years. Mortality rates were lower in patients with high marine n-3 polyunsaturated fatty acid levels (≥7.95 weight percentage) compared with low levels (<7.95 weight percentage) for all age categories (pooled mortality rate ratio estimate, 0.69; 95% confidence interval, 0.57 to 0.85). When divided into quartiles according to marine n-3 polyunsaturated fatty acid levels, patients in the upper quartile compared with the lower quartile had a 56% lower risk of death (adjusted hazard ratio, 0.44; 95% confidence interval, 0.26 to 0.75) using multivariable Cox proportional hazard regression analysis. There was a lower hazard ratio for death from cardiovascular disease with high levels of marine n-3 polyunsaturated fatty acid and a lower hazard ratio for death from infectious disease with high levels of the marine n-3 polyunsaturated fatty acid eicosapentaenoic acid, whereas there was no association between total or individual marine n-3 polyunsaturated fatty acid levels and cancer mortality. Conclusions Higher plasma phospholipid marine n-3

  2. Conversion from Tacrolimus to Cyclosporine A Improves Glucose Tolerance in HCV-Positive Renal Transplant Recipients

    PubMed Central

    Handisurya, Ammon; Kerscher, Corinna; Tura, Andrea; Herkner, Harald; Payer, Berit Anna; Mandorfer, Mattias; Werzowa, Johannes; Winnicki, Wolfgang; Reiberger, Thomas; Kautzky-Willer, Alexandra; Pacini, Giovanni; Säemann, Marcus; Schmidt, Alice

    2016-01-01

    Background Calcineurin-inhibitors and hepatitis C virus (HCV) infection increase the risk of post-transplant diabetes mellitus. Chronic HCV infection promotes insulin resistance rather than beta-cell dysfunction. The objective was to elucidate whether a conversion from tacrolimus to cyclosporine A affects fasting and/or dynamic insulin sensitivity, insulin secretion or all in HCV-positive renal transplant recipients. Methods In this prospective, single-center study 10 HCV-positive renal transplant recipients underwent 2h-75g-oral glucose tolerance tests before and three months after the conversion of immunosuppression from tacrolimus to cyclosporine A. Established oral glucose tolerance test-based parameters of fasting and dynamic insulin sensitivity and insulin secretion were calculated. Data are expressed as median (IQR). Results After conversion, both fasting and challenged glucose levels decreased significantly. This was mainly attributable to a significant amelioration of post-prandial dynamic glucose sensitivity as measured by the oral glucose sensitivity-index OGIS [422.17 (370.82–441.92) vs. 468.80 (414.27–488.57) mL/min/m2, p = 0.005), which also resulted in significant improvements of the disposition index (p = 0.017) and adaptation index (p = 0.017) as markers of overall glucose tolerance and beta-cell function. Fasting insulin sensitivity (p = 0.721), insulinogenic index as marker of first-phase insulin secretion [0.064 (0.032–0.106) vs. 0.083 (0.054–0.144) nmol/mmol, p = 0.093) and hepatic insulin extraction (p = 0.646) remained unaltered. No changes of plasma HCV-RNA levels (p = 0.285) or liver stiffness (hepatic fibrosis and necroinflammation, p = 0.463) were observed after the conversion of immunosuppression. Conclusions HCV-positive renal transplant recipients show significantly improved glucose-stimulated insulin sensitivity and overall glucose tolerance after conversion from tacrolimus to cyclosporine A. Considering the HCV

  3. Consensus, Dilemmas, and Challenges in Living Donor Liver Transplantation in Latin America.

    PubMed

    Salvalaggio, Paolo R; Seda Neto, João; Alves, Jefferson Andre; Fonseca, Eduardo A; Carneiro de Albuquerque, Luiz; Andraus, Wellington; Massarollo, Paulo B; Duro Garcia, Valter; Maurette, Rafael J; Ruf, Andrés E; Pacheco-Moreira, Lucio F; Caicedo Rusca, Luis A; Osorio, Veronica Botero; Matamoros, Maria Amalia; Varela-Fascinetto, Gustavo; Jarufe, Nicolas P

    2016-06-01

    We reviewed the history, volume, outcomes, uniqueness, and challenges of living donor liver transplantation (LDLT) in Latin America. We used the data from the Latin American and Caribbean Transplant Society, local transplant societies, and opinions from local transplant experts. There are more than 160 active liver transplant teams in Latin America, but only 30 centers have used LDLT in the past 2 years. In 2014, 226 LDLTs were done in the region (8.5% of liver transplant activities). Living donor liver transplantation is mainly restricted to pediatric patients. Adult-to-adult LDLT activities decreased after the implementation of the model for end-stage liver disease score and a concomitant increase on the rate of deceased donors per million population. Posttransplant outcome analysis is not mandatory, transparent or regulated in most countries. More experienced teams have outcomes comparable to international expert centers, but donor and recipient morbidity might be underreported. Latin America lags behind in terms of the number of adult LDLT and the rate of living donor utilization in comparison with other continents with similar donation rates. Local alliances and collaborations with major transplant centers in the developed world will contribute to the development of LDLT in Latin America. PMID:27203583

  4. Pharmacokinetic modeling of enterohepatic circulation of mycophenolic acid in renal transplant recipients.

    PubMed

    Colom, Helena; Lloberas, Núria; Andreu, Franc; Caldés, Ana; Torras, Joan; Oppenheimer, Federico; Sanchez-Plumed, Jaime; Gentil, Miguel A; Kuypers, Dirk R; Brunet, Mercè; Ekberg, Henrik; Grinyó, Josep M

    2014-06-01

    Several factors contribute to mycophenolic acid (MPA) between-patient variability. Here we characterize the metabolic pathways of MPA and quantify the effect of combining genetic polymorphism of multidrug-resistant-associated protein-2, demographics, biochemical covariates, co-medication (cyclosporine (CsA) vs. macrolides), and renal function on MPA, 7-O-MPA-glucuronide (MPAG), and acyl-glucuronide (AcMPAG) disposition, in renal transplant recipients, after mycophenolate mofetil. Complete pharmacokinetic profiles from 56 patients (five occasions) were analyzed. Enterohepatic circulation was modeled by transport of MPAG to the absorption site. This transport significantly decreased with increasing CsA trough concentrations (CtroughCsA). MPAG and AcMPAG plasma clearances significantly decreased with renal function. No significant influence of multidrug-resistant-associated protein-2 C24T single-nucleotide polymorphism was found. The model adequately predicted the increase in MPAG/AcMPAG exposures in CsA and macrolide patients with decreased renal function. This resulted in higher MPA exposures in macrolide patients versus