scholarly journals Five-year experience with donation after cardiac death kidney transplantation in a Canadian transplant program: Factors affecting outcomes

2012 ◽  
Vol 6 (6) ◽  
pp. 448 ◽  
Author(s):  
Michael Moser ◽  
Michael Sharpe ◽  
Corinne Weernink ◽  
Harrison Brown ◽  
Thomas McGregor ◽  
...  
Keyword(s):  
Renal Function ◽  
Kidney Transplantation ◽  
Creatinine Clearance ◽  
Urine Output ◽  
Cardiac Death ◽  
Donation After Cardiac Death ◽  
Ischemic Time ◽  
Transplant Program ◽  
Daily Urine ◽  
Daily Urine Output

Background: Donation after cardiac death (DCD) has led to an increase of up to 40% in the number of kidney transplants in some programs. Unfortunately, the increase in warm ischemic time results in higher rates of delayed graft function (DGF). The purpose of our study was to examine our initial 5-year experience with DCD kidney transplantation and to determine the factors involved in early postoperative function and function at 1 year.Methods: This retrospective study included a review of the recipient and donor charts of 63 DCD kidneys retrieved and transplanted by the London Multi-Organ Transplant Program between July 2006 and October 2011. Comparisons were carried out between our early (n=31, July 2006 to January 2009) and our recent experience (n=32, March 2009 to October 2011). DGF and creatinine clearance at 3, 7 and 365 days were examined with regression analyses.Results: DGF was seen in 65% of transplanted kidneys. Mean creatinine clearance (CrCl) at 1 year was 66.7 mL/min. Low pre-transplant recipient daily urine output was the most statistically significant predictor of DGF in multivariate analysis (p < 0.001). In comparisons between our early and more recent results, improvements were noted in time from asystole to flush (16.0 vs. 12.0 minutes, p = 0.003), while cold ischemic time increased (464 vs.725 minutes, p = 0.006). Experience contributed to a significant reduction in hospital length of stay (16 vs. 13 days, p = 0.035) and improved early renal function (CrCl at 3 days 7.8 vs. 11.9 mL/min, p = 0.027). The use of machine cold perfusion and higher recipient preoperative daily urine output predicted improved early renal function, while increasing donor age predicted poorer funcion at 1 year.Discussion: Despite early DGF, our results justify the continued transplantation of kidneys from DCD donors.

scholarly journals Prolonged warm ischemia time leads to severe renal dysfunction of donation-after-cardiac death kidney grafts

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peter Urbanellis ◽  
Laura Mazilescu ◽  
Dagmar Kollmann ◽  
Ivan Linares-Cervantes ◽  
J. Moritz Kaths ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Renal Dysfunction ◽  
Serum Potassium ◽  
Urine Output ◽  
Cardiac Death ◽  
Elevated Serum ◽  
Graft Function ◽  
Donation After Cardiac Death ◽  
Large Animal

AbstractKidney transplantation with grafts procured after donation-after-cardiac death (DCD) has led to an increase in incidence of delayed graft function (DGF). It is thought that the warm ischemic (WI) insult encountered during DCD procurement is the cause of this finding, although few studies have been designed to definitely demonstrate this causation in a transplantation setting. Here, we use a large animal renal transplantation model to study the effects of prolonged WI during procurement on post-transplantation renal function. Kidneys from 30 kg-Yorkshire pigs were procured following increasing WI times of 0 min (Heart-Beating Donor), 30 min, 60 min, 90 min, and 120 min (n = 3–6 per group) to mimic DCD. Following 8 h of static cold storage and autotransplantation, animals were followed for 7-days. Significant renal dysfunction (SRD), resembling clinical DGF, was defined as the development of oliguria < 500 mL in 24 h from POD3-4 along with POD4 serum potassium > 6.0 mmol/L. Increasing WI times resulted in incremental elevation of post-operative serum creatinine that peaked later. DCD120min grafts had the highest and latest elevation of serum creatinine compared to all groups (POD5: 19.0 ± 1.1 mg/dL, p < 0.05). All surviving animals in this group had POD4 24 h urine output < 500 cc (mean 235 ± 172 mL) and elevated serum potassium (7.2 ± 1.1 mmol/L). Only animals in the DCD120min group fulfilled our criteria of SRD (p = 0.003), and their renal function improved by POD7 with 24 h urine output > 500 mL and POD7 serum potassium < 6.0 mmol/L distinguishing this state from primary non-function. In a transplantation survival model, this work demonstrates that prolonging WI time similar to that which occurs in DCD conditions contributes to the development of SRD that resembles clinical DGF.

P1097INITIATING MAINTENANCE HAEMODIALYSIS USING INCREMENTAL HAEMODIALYSIS REGIME - A SINGLE CENTRE EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Tijana Azasevac ◽  
Violeta Knezevic ◽  
Sonja Golubović ◽  
Bojana Ljubiä&#x8d;iä‡ ◽  
Mira Markovic ◽  
...  
Keyword(s):  
Body Composition ◽  
Urine Output ◽  
Urine Volume ◽  
Group Versus ◽  
Obstructive Nephropathy ◽  
Intradialytic Hypotension ◽  
Full Dose ◽  
Fluid Status ◽  
Daily Urine ◽  
Daily Urine Output

Abstract Background and Aims Most patients with end stage renal disease (ESRD) initiate maintenance dialysis in three times per week regime irrespectively of residual kidney function (RKF). Incremental haemodialysis (IHD) showed benefits of starting and maintaining patients on less than three times per week regime, most importantly preserving urine volume output (UVO) and RKF. The aim of this study was to assess the main differences between a group of patients initiating dialysis once-weekly (1xHD) and twice-weekly (2xHD), to evaluate time to dialysis regime change, UVO and patients volume status at the end of study period. Method Patients with ESRD who started haemodialysis through the planned IHD (once-weekly and twice-weekly) and were undergoing IHD for at least 4 months (M) were enrolled (n=44) in the study. Study was conducted from January 2016 to December 2019 at dialysis department of our hospital. Patients were divided into two groups: 1xHD (20 pts) and 2xHD (24 pts). They were excluded from the study at the end of study period or earlier if they transitioned to thrice-weekly haemodialysis or died. Patients fluid status and body composition was assessed using results derived from bioimpedance measurements performed using Body Composition Monitor device. Results The 1xHD pts were younger (66,8±11,6 versus 67,4±10 years: P&gt;0.05) and weighed less (74,4±14,7 versus 75,5±11,9 kg, p&gt;0,05) with lower BMI. In both groups there were more males (60% versus 62,5%: P&gt;0,05). The most common cause of ESRD in both groups was nephrosclerosis (45% in 1xHD versus 47,1% in 2xHD, p&gt;0,05), followed by diabetic nephropathy (30% versus 20,8%, p&gt;0,05), obstructive nephropathy (10% versus 8,3%, p&gt;0,05), multiple myeloma (10% versus 8,3%, p&gt;0,05), glomerulonephritis (5% versus 8,3%, p&gt;0,05) and others in 2xHD group (12,5%; polycystic kidney disease and chronic interstitial nephritis). The estimated glomerular filtration rate of all patients at the time of HD initiation was 7,5±2,2 ml/min/1.73m2 (8,2±2,8 in 1xHD group versus 6,9±1,48 ml/ min/1.73m2 in 2xHD group, p&gt;0,05). Baseline daily urine output was similar, 1826,6±344,6 ml/day in 1xHD and 1772,2±343,8 ml/day in 2xHD group (p&gt;0,05). Patients in 1xHD concluded the study after mean period of 13,4 M (min 4 M, max 35 M). At the end of study period only three patients (15%) continued receiving dialysis once-weekly (mean 14,5 M, min 7 M, max 19 M), 12 pts (60%) transitioned to twice-weekly dialysis regime after 2 to 6 M (mean 3,1 M) and continued to receive this dialysis regime until the end of study period. Four pts (20%) transitioned to full-dose dialysis (mean 18,2 M, 11-24 M). Most of the patients in 2xHD group (17; 70,8%) concluded study in the same dialysis regime (mean 20,4 M, 4-24 M), 7 pts (29%) transitioned to full-dose dialysis (mean 12,6 M, 5-21 M) and one patient transitioned to once-weekly HD (8M). At the end of study daily urine output was 1463,1±317,5 in 1xHD versus 1321,1±309,1 ml/day in 2xHD group (p&gt;0,05). Results of assessment of fluid status and body composition at the end of study are in Table 1. We evaluated nutritional status at the end of study: total protein 57,4±8,9 g/l in 1xHD versus 62,8±5,3 g/l in 2xHD, albumin 36,9±10,6 versus 37,6±4,4 g/l, total cholesterol 4,1±1,6 versus 4,4±1,3 mmol/l, triglycerides 1,3±0,8 versus 1,7±0,7 mmol/l (p&gt;0,05 for all parameters). At the end of the study 70% of patients treated with IHD maintained renal function that was sufficient to continue IHD regime with overall survival rate 90% in 1xHD group and 87,5% in 2xHD group. Conclusion IHD, in carefully selected patients with good compliance, provides preservation of UVO and RKF, thus delaying transition to full-dose dialysis and avoiding complications of dialysis, such as intradialytic hypotension and vascular access failure. This type of dialysis is individualized treatment that obtains easier adaptation to dialysis and better quality of life.

Definitions of Warm Ischemic Time When Using Controlled Donation After Cardiac Death Lung Donors

2008 ◽  
Vol 86 (12) ◽  
pp. 1702-1706 ◽  
Author(s):  
Bronwyn J. Levvey ◽  
Glen P. Westall ◽  
Tom Kotsimbos ◽  
Trevor J. Williams ◽  
Gregory I. Snell
Keyword(s):  
Cardiac Death ◽  
Donation After Cardiac Death ◽  
Ischemic Time ◽  
Warm Ischemic Time

Association of Carnitine Deficiency in Indian Continuous Ambulatory Peritoneal Dialysis Patients with Anemia, Erythropoietin Use, Residual Renal Function, and Diabetes Mellitus

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 235-238
Author(s):  
S. Ramalakshmi ◽  
Bjoe Baben ◽  
Ben S. Ashok ◽  
V. Jayanthi ◽  
Nancy Leslie ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Residual Renal Function ◽  
Carnitine Deficiency ◽  
Free Carnitine ◽  
Dialysis Patients ◽  
Carnitine Level ◽  
Daily Urine ◽  
The Mean ◽  
Daily Urine Output

♦ In the present study, we aimed to determine levels of free carnitine in hemodialysis (HD) and peritoneal dialysis (PD) patients in India and to correlate carnitine deficiency with various clinical parameters. ♦ Patients on HD and PD at two tertiary care centers were selected for the study. Baseline data were obtained, and a free carnitine analysis was performed. Carnitine deficiency was defined as a free carnitine level of less than 40 μmol/L. ♦ The total number of study patients was 96 (77 on HD, 19 on PD). In the PD group, the mean age was 56 years, with 26.3% of the patients being vegan, 47.4% having diabetes, and 57.9% having a daily urine output of <500 mL. The mean carnitine level in that group was 38.9 μmol/L, and 68.4% of the patients had a carnitine deficiency. A Pearson correlation test failed to show any association of carnitine level with parameters such as anemia, use of erythropoietin, non-vegetarian diet, diabetes, and hypertension. In the HD group, the mean age was 45 years, with 22% of the patients being vegan, 23% having diabetes, and 45.5% having a daily urine output of <500 mL. The mean carnitine level in the group was 38.2 μmol/L, and 64.3% of the patients had a carnitine deficiency. Residual renal function and duration of dialysis were different in HD patients with and without carnitine deficiency. Carnitine levels in the HD group correlated positively and statistically significantly with the presence of diabetes and hypertension. ♦ Conclusion This study is the first demonstration that Indian dialysis patients have carnitine deficiency.

Comparison of Kidney Function Between Donation After Cardiac Death and Donation After Brain Death Kidney Transplantation

2013 ◽  
Vol 96 (3) ◽  
pp. 274-281 ◽  
Author(s):  
Hani M. Wadei ◽  
Michael G. Heckman ◽  
Bhupendra Rawal ◽  
C. Burcin Taner ◽  
Waleed Farahat ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Brain Death ◽  
Kidney Function ◽  
Cardiac Death ◽  
Donation After Cardiac Death ◽  
Donation After Brain Death
Sign in / Sign up

Export Citation Format

Share Document