scholarly journals Intermediate-Term Outcomes of Dual Adult versus Single-Kidney Transplantation: Evolution of a Surgical Technique

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Ana K. Islam ◽  
Richard J. Knight ◽  
Wesley A. Mayer ◽  
Adam B. Hollander ◽  
Samir Patel ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Complication Rate ◽  
Graft Function ◽  
Standard Technique ◽  
Deceased Donor ◽  
Donor Pool ◽  
Urologic Complication ◽  
Surgical Complexity ◽  
Single Kidney

Background. Acceptance of dual kidney transplantation (DKT) has proven difficult, due to surgical complexity and concerns regarding long-term outcomes. We herein present a standard technique for ipsilateral DKT and compare outcomes to single-kidney transplant (SKT) recipients.Methods. A retrospective single-center comparison of DKT and SKT performed between February 2007 and July 2013.Results. Of 516 deceased donor kidney transplants, 29 were DKT and 487 were SKT. Mean follow-up was 43 ± 67 months. DKT recipients were older and more likely than SKT recipients to receive an extended criteria graft (p<0.001). For DKT versus SKT, the rates of delayed graft function (10.3 versus 9.2%) and acute rejection (20.7 versus 22.4%) were equivalent (p= ns). A higher than expected urologic complication rate in the DKT cohort (14 versus 2%,p<0.01) was reduced through modification of the ureteral anastomosis. Graft survival was equivalent between DKT and SKT groups (p= ns) with actuarial 3-year DKT patient and graft survivals of 100% and 93%. At 3 years, the groups had similar renal function (p= ns).Conclusions. By utilizing extended criteria donor organs as DKT, the donor pool was enlarged while providing excellent patient and graft survival. The DKT urologic complication rate was reduced by modification of the ureteral anastomosis.

scholarly journals Predictors and one-year outcomes of patients with delayed graft function after deceased donor kidney transplantation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Rao Chen ◽  
Haifeng Wang ◽  
Lei Song ◽  
Jianfei Hou ◽  
Jiawei Peng ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Graft Function ◽  
Deceased Donor ◽  
Donor Kidney ◽  
Ischemic Time ◽  
Deceased Donor Kidney ◽  
One Year ◽  
Donor Kidney Transplantation ◽  
Deceased Donor Kidney Transplantation

Abstract Background Delayed graft function (DGF) is closely associated with the use of marginal donated kidneys due to deficits during transplantation and in recipients. We aimed to predict the incidence of DGF and evaluate its effect on graft survival. Methods This retrospective study on kidney transplantation was conducted from January 1, 2018, to December 31, 2019, at the Second Xiangya Hospital of Central South University. We classified recipients whose operations were performed in different years into training and validation cohorts and used data from the training cohort to analyze predictors of DGF. A nomogram was then constructed to predict the likelihood of DGF based on these predictors. Results The incidence rate of DGF was 16.92%. Binary logistic regression analysis showed correlations between the incidence of DGF and cold ischemic time (CIT), warm ischemic time (WIT), terminal serum creatine (Scr) concentration, duration of pretransplant dialysis, primary cause of donor death, and usage of LifePort. The internal accuracy of the nomogram was 83.12%. One-year graft survival rates were 93.59 and 99.74%, respectively, for the groups with and without DGF (P < 0.05). Conclusion The nomogram established in this study showed good accuracy in predicting DGF after deceased donor kidney transplantation; additionally, DGF decreased one-year graft survival.

scholarly journals Long-term effects of delayed graft function duration on function and survival of deceased donor kidney transplants

2019 ◽  
Vol 41 (2) ◽  
pp. 231-241 ◽  
Author(s):  
Mateus Swarovsky Helfer ◽  
Jeferson de Castro Pompeo ◽  
Otávio Roberto Silva Costa ◽  
Alessandra Rosa Vicari ◽  
Adriana Reginato Ribeiro ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Graft Function ◽  
Deceased Donor ◽  
Delayed Graft Function ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
Donor Kidney Transplantation ◽  
Deceased Donor Kidney Transplantation

Abstract Introduction: Delayed graft function (DGF) is a frequent complication after deceased donor kidney transplantation with an impact on the prognosis of the transplant. Despite this, long-term impact of DGF on graft function after deceased donor kidney transplantation has not been properly evaluated. Objective: The main objective of this study was to evaluate risk factors for DGF and the impact of its occurrence and length on graft survival and function. Methods: A retrospective cohort study was performed in 517 kidney transplant recipients who received a deceased donor organ between January 2008 and December 2013. Results: The incidence of DGF was 69.3% and it was independently associated with donor's final serum creatinine and age, cold ischemia time, use of antibody induction therapy and recipient's diabetes mellitus. The occurrence of DGF was also associated with a higher incidence of Banff ≥ 1A grade acute rejection (P = 0.017), lower graft function up to six years after transplantation and lower death-censored graft survival at 1 and 5 years (P < 0.05). DGF period longer than 14 days was associated with higher incidence of death-censored graft loss (P = 0.038) and poorer graft function (P < 0.001). No differences were found in patient survival. Conclusions: The occurrence of DGF has a long-lasting detrimental impact on graft function and survival and this impact is even more pronounced when DGF lasts longer than two weeks.

scholarly journals Predictors and One-year Outcomes of Patients with Delayed Graft Function after Deceased Donor Kidney Transplantation

2020 ◽  
Author(s):  
Rao Chen ◽  
Haifeng Wang ◽  
Jianfei Hou ◽  
Helong Dai ◽  
Longkai Peng
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Graft Function ◽  
Deceased Donor ◽  
Donor Kidney ◽  
Ischemic Time ◽  
Deceased Donor Kidney ◽  
One Year ◽  
Donor Kidney Transplantation ◽  
Deceased Donor Kidney Transplantation

Abstract Objective:Delayed graft function (DGF) is closely associated with the use of marginal donated kidneys due to deficits during transplantation and in recipients. We aimed to predict the incidence of DGF and evaluate its effect on graft survival.Methods:This retrospective study on kidney transplantation was conducted from January 1, 2018, to May 31, 2019, in the Second Xiangya Hospital of Central South University. We classified recipients into training and validation cohorts and used data from the training cohort to analyze the predictors of DGF. A nomogram was then constructed to predict the likelihood of DGF based on these predictors.Results:The incidence rate of DGF is 24.73%. Binary logistic regression analysis showed correlations between the incidence of DGF and cold ischemic time (CIT), warm ischemic time (WIT), donor body mass index (BMI), duration of pretransplant dialysis, diabetic donor, primary cause of donor death, and terminal serum creatinine concentration. The internal accuracy of the nomogram was 85.78%. One-year graft survival rates were 100% and 94.74%, respectively, for the groups with and without DGF (P<0.05).Conclusion:The nomogram established in this study showed good accuracy in predicting DGF after deceased donor kidney transplantation; additionally, DGF decreased one-year graft survival.

scholarly journals Influence of Multiple Donor Renal Arteries on the Outcome and Graft Survival in Deceased Donor Kidney Transplantation

2021 ◽  
Vol 10 (19) ◽  
pp. 4395
Author(s):  
Uwe Scheuermann ◽  
Sebastian Rademacher ◽  
Tristan Wagner ◽  
Andri Lederer ◽  
Hans-Michael Hau ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Artery ◽  
Graft Survival ◽  
Graft Function ◽  
Deceased Donor ◽  
Renal Arteries ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Arterial Anastomosis

Aim: Complex arterial reconstruction in kidney transplantation (KT) using kidneys from deceased donors (DD) warrants additional study since little is known about the effects on the mid- and long-term outcome and graft survival. Methods: A total of 451 patients receiving deceased donor KT in our department between 1993 and 2017 were included in our study. Patients were divided into three groups according to the number of arteries and anastomosis: (A) 1 renal artery, 1 arterial anastomosis (N = 369); (B) >1 renal artery, 1 arterial anastomosis (N = 47); and (C) >1 renal artery, >1 arterial anastomosis (N = 35). Furthermore, the influence of localization of the arterial anastomosis (common iliac artery (CIA), versus non-CIA) was analyzed. Clinicopathological characteristics, outcome, and graft and patient survival of all groups were compared retrospectively. Results: With growing vascular complexity, the time of warm ischemia increased significantly (groups A, B, and C: 40 ± 19 min, 45 ± 19 min, and 50 ± 17 min, respectively; p = 0.006). Furthermore, the duration of operation was prolonged, although this did not reach significance (groups A, B, and C: 175 ± 98 min, 180 ± 35 min, and 210 ± 43 min, respectively; p = 0.352). There were no significant differences regarding surgical complications, post-transplant kidney function (delayed graft function, initial non-function, episodes of acute rejection), or long-term graft survival. Regarding the localization of the arterial anastomosis, non-CIA was an independent prognostic factor for deep vein thrombosis in multivariate analysis (CIA versus non-CIA: OR 11.551; 95% CI, 1.218–109.554; p = 0.033). Conclusion: Multiple-donor renal arteries should not be considered a contraindication to deceased KT, as morbidity rates and long-term outcomes seem to be comparable with grafts with single arteries and less complex anastomoses.

scholarly journals Predictors and One-year Outcomes of Patients with Delayed Graft Function after Deceased Donor Kidney Transplantation

2020 ◽  
Author(s):  
Rao Chen ◽  
Haifeng Wang ◽  
Lei Song ◽  
Jianfei Hou ◽  
Jiawei Peng ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Graft Function ◽  
Deceased Donor ◽  
Donor Kidney ◽  
Ischemic Time ◽  
Deceased Donor Kidney ◽  
One Year ◽  
Donor Kidney Transplantation ◽  
Deceased Donor Kidney Transplantation

Abstract Background:Delayed graft function (DGF) is closely associated with the use of marginal donated kidneys due to deficits during transplantation and in recipients. We aimed to predict the incidence of DGF and evaluate its effect on graft survival.Methods:This retrospective study on kidney transplantation was conducted from January 1, 2018, to December 31, 2019, at the Second Xiangya Hospital of Central South University. We classified recipients whose operations were performed in different years into training and validation cohorts and used data from the training cohort to analyze predictors of DGF. A nomogram was then constructed to predict the likelihood of DGF based on these predictors.Results:The incidence rate of DGF was 16.92%. Binary logistic regression analysis showed correlations between the incidence of DGF and cold ischemic time (CIT), warm ischemic time (WIT), terminal serum creatine (Scr) concentration,, duration of pretransplant dialysis, primary cause of donor death, and usage of LifePort . The internal accuracy of the nomogram was 83.12%. One-year graft survival rates were 93.59% and 99.74%, respectively, for the groups with and without DGF (P<0.05).Conclusion:The nomogram established in this study showed good accuracy in predicting DGF after deceased donor kidney transplantation; additionally, DGF decreased one-year graft survival.

scholarly journals Safety and effectiveness of kidney transplantation using a donation after brain death donor with acute kidney injury: a retrospective cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kyeong Deok Kim ◽  
Kyo Won Lee ◽  
Sang Jin Kim ◽  
Okjoo Lee ◽  
Manuel Lim ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Transplantation ◽  
Brain Death ◽  
Graft Survival ◽  
Low Dose ◽  
Kidney Injury ◽  
Induction Agent ◽  
Donor Pool ◽  
Donation After Brain Death

AbstractThe use of kidneys from donation after brain death (DBD) donors with acute kidney injury (AKI) is a strategy to expand the donor pool. The aim of this study was to evaluate how kidney transplantation (KT) from a donor with AKI affects long-term graft survival in various situations. All patients who underwent KT from DBD donors between June 2003 and April 2016 were retrospectively reviewed. The KDIGO (Kidney Disease: Improving Global Outcomes) criteria were used to classify donor AKI. The cohort included 376 donors (no AKI group, n = 117 [31.1%]; AKI group n = 259 [68.9%]). Death-censored graft survival was similar according to the presence of AKI, AKI severity, and the AKI trend (p = 0.929, p = 0.077, and p = 0.658, respectively). Patients whose donors had AKI who received using low dose (1.5 mg/kg for three days) rabbit anti-thymocyte globulin (r-ATG) as the induction agent had significantly superior death-censored graft survival compared with patients in that group who received basiliximab (p = 0.039). AKI in DBD donors did not affect long-term death-censored graft survival. Low-dose r-ATG may be considered as an induction immunosuppression in recipients receiving kidneys with AKI because it showed better graft survival than basiliximab.

scholarly journals Gene Expression Profile in Delay Graft Function: Inflammatory Markers Are Associated with Recipient and Donor Risk Factors

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Diego Guerrieri ◽  
Luis Re ◽  
Jorgelina Petroni ◽  
Nella Ambrosi ◽  
Roxana E. Pilotti ◽  
...  
Keyword(s):  
Gene Expression ◽  
Risk Factors ◽  
Kidney Transplantation ◽  
Inflammatory Markers ◽  
Graft Function ◽  
Deceased Donor ◽  
Specific Pattern ◽  
Inflammatory Gene Expression ◽  
Inflammatory Gene ◽  
Recipient Age

Background.Delayed graft function (DGF) remains an important problem after kidney transplantation and reduced long-term graft survival of the transplanted organ. The aim of the present study was to determine if the development of DGF was associated with a specific pattern of inflammatory gene expression in expanded criteria of deceased donor kidney transplantation. Also, we explored the presence of correlations between DGF risk factors and the profile that was found.Methods.Seven days after kidney transplant, a cDNA microarray was performed on biopsies of graft from patients with and without DGF. Data was confirmed by real-time PCR. Correlations were performed between inflammatory gene expression and clinical risk factors.Results.From a total of 84 genes analyzed, 58 genes were upregulated while only 1 gene was downregulated in patients with DGF compared with no DGF (P=0.01). The most relevant genes fold changes observed was IFNA1, IL-10, IL-1F7, IL-1R1, HMOX-1, and TGF-β. The results were confirmed for IFNA1, IL-1R1, HMOX-1 and TGF-β. A correlation was observed between TGF-β, donor age, and preablation creatinine, but not body mass index (BMI). Also, TGF-βshowed an association with recipient age, while IFNA1 correlated with recipient BMI. Furthermore, TGF-β, IFNA1 and HMOX-1 correlated with several posttransplant kidney function markers, such as diuresis, ultrasound Doppler, and glycemia.Conclusions.Overall, the present study shows that DGF is associated with inflammatory markers, which are correlated with donor and recipient DGF risk factors.

scholarly journals Aggravation of fibrin deposition and microthrombus formation within the graft during kidney transplantation

2021 ◽  
Author(s):  
Tamar A.J. van den Berg ◽  
Marius C. van den Heuvel ◽  
Janneke Wiersema-Buist ◽  
Jelle Adelmeijer ◽  
Gertrude J. Nieuwenhuijs-Moeke ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Living Donor ◽  
Graft Function ◽  
Deceased Donor ◽  
Potential Difference ◽  
Fibrin Deposition ◽  
Peritubular Capillaries ◽  
Deposition Intensity

Abstract In kidney transplantation, microthrombi and fibrin deposition may lead to local perfusion disorders and subsequently poor initial graft function. Microthrombi are often regarded as donor-derived. However, the incidence, time of development, and potential difference between living donor kidneys (LDK) and deceased donor kidneys(DDK), remains unclear. Two open-needle biopsies, taken at preimplantation and after reperfusion, were obtained from 17 LDK and 28 DDK transplanted between 2005 and 2008. Paraffin-embedded sections were immunohistochemically stained with anti-fibrinogen antibody. Fibrin deposition intensity in peritubular capillaries(PTC) and glomeruli was categorized as negative, weak, moderate or strong and the number of microthrombi/mm2 was quantified. Reperfusion biopsies showed more fibrin deposition (20–100% moderate/strong, p < 0.001) and more microthrombi/mm2 (0.97 ± 1.12 vs. 0.28 ± 0.53, p < 0.01) than preimplantation biopsies. In addition, more microthrombi/mm2 (0.38 ± 0.61 vs. 0.09 ± 0.22, p = 0.02) and stronger fibrin intensity in glomeruli (28% vs. 0%, p < 0.01) and PTC (14% vs. 0%, p = 0.02) were observed in preimplantation DDK than LDK biopsies. After reperfusion, microthrombi/mm2 were comparable (p = 0.23) for LDK (0.09 ± 0.22 to 0.76 ± 0.49, p = 0.03) and DDK (0.38 ± 0.61 to 0.90 ± 1.11, p = 0.07). Upon reperfusion, there is an aggravation of microthrombus formation and fibrin deposition within the graft. The prominent increase of microthrombi in LDK indicates that they are not merely donor-derived.

Timing of Kidney Clamping and Deceased Donor Kidney Transplant Outcomes

2021 ◽  
pp. CJN.03290321
Author(s):  
Simon Ville ◽  
Marine Lorent ◽  
Clarisse Kerleau ◽  
Anders Asberg ◽  
Christophe Legendre ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Survival ◽  
Ischemia Reperfusion ◽  
Multivariable Analysis ◽  
Graft Function ◽  
Deceased Donor ◽  
Kidney Graft ◽  
Kidney Transplant Recipients ◽  
Heart Beating ◽  
Deceased Donor Kidney Transplant

BackgroundThe recognition that metabolism and immune function are regulated by an endogenous molecular clock generating circadian rhythms suggests that the magnitude of ischemia-reperfusion and subsequent inflammation on kidney transplantation, could be affected by the time of the day. MethodsAccordingly, we evaluated 5026 first kidney transplant recipients from deceased heart-beating donors. In a cause-specific multivariable analysis, we compare delayed graft function (DGF) and graft survival according to the time of kidney clamping and declamping. Participants were divided into clamping between midnight and noon (AM clamping group, 65%) or clamping between noon and midnight (PM clamping group, 35%), and similarly, AM declamping or PM declamping (25% / 75%). ResultsDGF occurred among 550 participants (27%) with AM clamping and 339 (34%) with PM clamping (adjusted OR = 0.81, 95%CI: 0.67 to 0.98, p= 0.03). No significant association of clamping time with overall death censored graft survival was observed (HR = 0.92, 95%CI: 0.77 to 1.10, p= 0.37). No significant association of declamping time with DGF or graft survival was observed. ConclusionsClamping between midnight and noon was associated with a lower incidence of DGF whilst the declamping time was not associated with kidney graft outcomes.

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