Skip directly to content

PubMed Kidney Transplant

Subscribe to PubMed Kidney Transplant feed PubMed Kidney Transplant
NCBI: db=pubmed; Term=kidney transplant
Updated: 7 min 39 sec ago

Epidemiology and Morbidity of Epstein-Barr Virus Infection in Pediatric Renal Transplant Recipients: A Multicenter, Prospective Study.

Tue, 10/09/2012 - 11:58
Related Articles

Epidemiology and Morbidity of Epstein-Barr Virus Infection in Pediatric Renal Transplant Recipients: A Multicenter, Prospective Study.

Clin Infect Dis. 2012 Oct 5;

Authors: Höcker B, Fickenscher H, Delecluse HJ, Böhm S, Küsters U, Schnitzler P, Pohl M, John U, Kemper MJ, Fehrenbach H, Wigger M, Holder M, Schröder M, Billing H, Fichtner A, Feneberg R, Sander A, Köpf-Shakib S, Süsal C, Tönshoff B

Abstract
Background. The epidemiology and morbidity of Epstein-Barr virus (EBV) infection in pediatric renal transplant recipients have been characterized insufficiently.Methods. In a prospective, multicenter study among 106 pediatric kidney allograft recipients, aged 11.4±5.9 years, we investigated the epidemiology of EBV infection, the relationship between EBV load, EBV serology and EBV-related morbidity (PTLD or symptomatic EBV infection defined as flu-like symptoms or infectious mononucleosis).Results. EBV primary infection occurred in 27 of 43 (63%) seronegative, and reactivation/reinfection in 28 of 63 (44%) seropositive patients. There was no association between the degree or duration of EBV load and EBV-related morbidity: The vast majority (17 of 18 (94%) patients) with a high, persistent EBV load remained PTLD-free throughout a follow-up of 5.0±1.3 years, while 2 of 3 (66%) patients with EBV-related PTLD exhibited only a low EBV load beforehand. Eight of 18 (44%) patients with a high, persistent EBV load remained asymptomatic during a follow-up of 5.3±2.9 years. Multivariate analysis identified the EBV high-risk (D+/R-) serostatus (OR 7.07, P<.05), the presence of HLA-DR7 (OR 5.65, P<.05), and the intensity of the immunosuppressive therapy, (OR 1.53, P<.01) as independent risk factors for the development of a symptomatic EBV infection.Conclusions. Presence of EBV high-risk seroconstellation, HLA-DR7, and intensity of immunosuppressive therapy are significant risk factors for a symptomatic EBV infection, while there is no close association between the degree or duration of EBV load and EBV-related morbidity.

PMID: 23042966 [PubMed - as supplied by publisher]

One hundred consecutive kidney transplantations with simultaneous ipsilateral nephrectomy in patients with autosomal dominant polycystic kidney disease.

Tue, 10/09/2012 - 11:58
Related Articles

One hundred consecutive kidney transplantations with simultaneous ipsilateral nephrectomy in patients with autosomal dominant polycystic kidney disease.

Nephrol Dial Transplant. 2012 Oct 4;

Authors: Neeff HP, Pisarski P, Tittelbach-Helmrich D, Karajanev K, Neumann HP, Hopt UT, Drognitz O

Abstract
Purpose.Surgical management of autosomal dominant polycystic kidney disease (ADPKD) in patients awaiting renal transplantation is a challenging task.METHODS: From 1998 to 2009, a total of 100 consecutive renal transplantations with simultaneous unilateral nephrectomy were performed in 59 men and 41 women with ADPKD and end-stage renal failure. About 38% received kidney allografts from living donors. The ipsilateral polycystic kidney was removed at the time of renal transplantation. Immunosuppressive therapy was not modified. Cold ischaemia time was 155 (38-204 min) versus 910 min (95-2760 min) for living versus deceased donor transplantation. Mean weight of removed kidneys was 2002 g (414-8850 g). Mean follow-up was 3.0 years (0.8-10.0 years).RESULTS: Overall patient and graft survival were 97 and 96% at 1 year and 93 and 80% at 5 years, respectively. Serum creatinine at current follow-up was 1.49 (0.8-2.8) mg/dL. Surgical complications, which might be associated with simultaneous nephrectomy requiring re-operation, occurred in 12% (lymphocele 4%, hernia 4%, post-operative haematoma or bleeding 4%). None of the patients died peri-operatively.CONCLUSION: Renal transplantation with simultaneous unilateral nephrectomy in ADPKD is a reasonable procedure for patients suffering from massively enlarged native kidneys.

PMID: 23042709 [PubMed - as supplied by publisher]

Education and counseling of renal transplant recipients.

Tue, 10/09/2012 - 11:58
Related Articles

Education and counseling of renal transplant recipients.

J Nephrol. 2012 Oct 5;:0

Authors: Ponticelli C, Graziani G

Abstract
A large number of factors can influence the clinical outcome of kidney transplant recipients, but the active role of the patient to prevent the possible complications related to transplant and its treatment is often neglected. Poor adherence to prescriptions is frequent in transplant recipients and represents a major contributor to the development of graft failure, cardiovascular disease, infection and/or malignancy. Smoking can render the patient more susceptible to cancer, cardiovascular disease and infection, and can also impair renal allograft function. The risk of malignancy is increased in transplant recipients. Therefore screening for cancer is of paramount importance. Measures that can enable prevention or early detection of cancer include self-exams and screening, physical activity, avoidance of smoking and sun exposure, and a diet rich in fruits and vegetables but limited in fats, red meats, salt and alcohol. Regular exercise can help to prevent cardiovascular disease, diabetes, obesity, osteoporosis and even some forms of cancer. Thus regular exercise is recommended. Yet, too many transplant patients remain sedentary. Weight gain is common in renal allograft recipients and may be associated with hypertension, hyperlipidemia and/or glucose intolerance or overt diabetes. To prevent these complications, patients should follow diet regimens based on low fat and normal/low caloric intake. Small amounts of alcohol may be permitted in view of its potential cardioprotective effect, but a large consumption of alcohol can be responsible for devastating side effects. Last but not least, abidance by hygienic measures may help in preventing cardiovascular and infectious complications.

PMID: 23042431 [PubMed - as supplied by publisher]

Update in HIV infection in organ transplantation.

Tue, 10/09/2012 - 11:58
Related Articles

Update in HIV infection in organ transplantation.

Curr Opin Organ Transplant. 2012 Oct 4;

Authors: Grossi PA

Abstract
PURPOSE OF REVIEW: With reductions in AIDS-related mortality, patients with HIV infection are dying and experiencing significant morbidity from end-stage organ disease. However, patients infected with HIV have traditionally been excluded from organ transplantation. Recent advances have had a significant impact on the potential transplant candidacy of these patients. This review will highlight the major issues associated with transplantation in individuals who are infected with HIV. RECENT FINDINGS: Recently published studies showing promising preliminary outcomes among transplant recipients with HIV infection, suggest that it is not any more justifiable to deny transplantation based solely on HIV-infection status. These studies consistently describe stable HIV disease following liver and kidney transplantation. Furthermore, combined pancreas-kidney, heart, and lung transplantation has been successfully reported, although in a much smaller number of patients. Despite these scientific and policy advances, many healthcare providers and patients remain unaware of ongoing progress in this field. SUMMARY: The experience with organ transplantation in HIV-infected patients is evolving and successful outcomes have been observed when specific criteria are used to select candidates.

PMID: 23042207 [PubMed - as supplied by publisher]

Steroid-free chronic immunosuppression in renal transplantation.

Tue, 10/09/2012 - 11:58
Related Articles

Steroid-free chronic immunosuppression in renal transplantation.

Curr Opin Nephrol Hypertens. 2012 Oct 4;

Authors: Steiner RW

Abstract
PURPOSE OF REVIEW: Over the past two decades, steroid-free immunosuppression has become more widespread, but improvements in long-term kidney transplant survival have been modest, mandating scrutiny of our chronic regimens. RECENT FINDINGS: Current studies and commentary cautiously conclude that steroid-free regimens in low-risk patients seem acceptable for up to 5 years, although most studies are shorter. Patients who will develop chronic rejection cannot be identified prospectively and usually return to steroids. One center continues to report long-term steroid-free results that are comparable to or better than national Scientific Registry of Renal Transplant Recipients (SRTR) outcomes, even with 'older' drugs cyclosporine and azathioprine, reaffirming the need for well designed prospective studies. Some authorities question whether minimal side effects with current regimens justify steroid elimination. In low-risk populations, 'steroid-type' studies probably would suggest no short-term benefit of tacrolimus over cyclosporine, or mycophenolate over azathioprine. SUMMARY: The data justifying steroid-free immunosuppression continue to be suboptimal. A larger question is whether to treat an entire population at medical risk or just the higher-risk subgroup that declares itself in the short term. 'Subgroup therapy' might well produce the same quandaries if applied to other accepted transplant immunosuppression.

PMID: 23042028 [PubMed - as supplied by publisher]

Do protocol transplant biopsies improve kidney transplant outcomes?

Tue, 10/09/2012 - 11:58
Related Articles

Do protocol transplant biopsies improve kidney transplant outcomes?

Curr Opin Nephrol Hypertens. 2012 Oct 4;

Authors: Chapman JR

Abstract
PURPOSE OF REVIEW: The research undertaken on 'protocol' renal transplant biopsies has provided a rich, if not the richest, approach to better understanding of the immune and nonimmune impacts upon the transplant. The purpose of this review is to detail how the direct benefit to the patient also lies in these renamed 'surveillance' biopsies. RECENT FINDINGS: Undertaken at fixed time points after transplantation, biopsy provides individual diagnoses with which the clinician can vary immunosuppression both in intensity and in the type of agent used to modify pathological processes early in their course. Initial nonfunction from acute tubular necrosis, subclinical cellular and humoral rejection, calcineurin inhibitor nephrotoxicity, BK virus nephropathy and recurrent glomerulonephritis are all important diagnoses for which early intervention provides better therapeutic outcomes than delaying until they are clinically evident. SUMMARY: This review provides the recent evidence that has convinced many transplant units to embark upon surveillance programmes for their patients in order to individualize their immunosuppression and thus gain better outcomes.

PMID: 23042026 [PubMed - as supplied by publisher]

Characteristics of Congenital Hepatic Fibrosis in a Large Cohort of Patients with Autosomal Recessive Polycystic Kidney Disease.

Tue, 10/09/2012 - 11:58
Related Articles

Characteristics of Congenital Hepatic Fibrosis in a Large Cohort of Patients with Autosomal Recessive Polycystic Kidney Disease.

Gastroenterology. 2012 Oct 3;

Authors: Gunay-Aygun M, Font-Montgomery E, Lukose L, Gerstein MT, Piwnica-Worms K, Choyke P, Daryanani KT, Turkbey B, Fischer R, Bernardini I, Sincan M, Zhao X, Sandler NG, Roque A, Douek DC, Graf J, Huizing M, Bryant JC, Mohan P, Gahl WA, Heller T

Abstract
BACKGROUND & AIMS:: Autosomal recessive polycystic kidney disease (ARPKD), the most common ciliopathy of childhood, is characterized by congenital hepatic fibrosis (CHF) and progressive cystic degeneration of kidneys. We aimed to describe CHF in patients with ARPKD, confirmed by detection of mutations in polycystic kidney and hepatic disease ( PKHD1). METHODS:: Patients with ARPKD and CHF were evaluated at the US National Institutes of Health from 2003 through 2009. We analyzed clinical, molecular, and imaging data from 73 patients (ages 1 to 56 y; average of 12.7 ±13.1 y), with kidney and liver involvement (based on clinical, imaging, or biopsy analyses) and mutations in PKHD1. RESULTS:: Initial symptoms were liver related in 26% of patients, others presented with kidney disease. One patient underwent liver and kidney transplantation; 10 others received kidney transplants. Four presented with cholangitis and 1 with variceal bleeding. Sixty nine percent had enlarged left lobes on magnetic resonance imaging, 92 % had increased liver echogenicity upon ultrasound analysis and 65% had splenomegaly. Splenomegaly started early in life; 60 % of children younger than 5 years had enlarged spleens. Spleen volume had an inverse correlation with platelet count and prothrombin time, but not with serum albumin. Platelet count was the best predictor of spleen volume (area under the curve=0.88905) and spleen length corrected for patient's height correlated inversely with platelet count (R(2)=0.42, p<0.0001). Spleen volume did not correlate with renal function or type of PKHD1mutation. Twenty-two of 31 patients who underwent endoscopy were found to have varices. Five had variceal bleeding and 2 had portosystemic shunts. Forty percent had Caroli's syndrome and 30 % had isolated dilated common bile duct. CONCLUSIONS:: Platelet count is the best predictor of the severity of portal hypertension, which is early-onset but underdiagnosed in ARPKD. Seventy percent of ARPKD patients have biliary abnormalities. Kidney and liver disease are independent; variability in severity is not explainable by type of PKHD1mutation. ClinicalTrials.gov number, NCT00068224.

PMID: 23041322 [PubMed - as supplied by publisher]

Early-outgrowth bone marrow cells attenuate renal injury and dysfunction via an antioxidant effect in a mouse model of type 2 diabetes.

Tue, 10/09/2012 - 11:58
Related Articles

Early-outgrowth bone marrow cells attenuate renal injury and dysfunction via an antioxidant effect in a mouse model of type 2 diabetes.

Diabetes. 2012 Aug;61(8):2114-25

Authors: Zhang Y, Yuen DA, Advani A, Thai K, Advani SL, Kepecs D, Kabir MG, Connelly KA, Gilbert RE

Abstract
Cell therapy has been extensively investigated in heart disease but less so in the kidney. We considered whether cell therapy also might be useful in diabetic kidney disease. Cognizant of the likely need for autologous cell therapy in humans, we sought to assess the efficacy of donor cells derived from both healthy and diabetic animals. Eight-week-old db/db mice were randomized to receive a single intravenous injection of PBS or 0.5 × 10(6) early-outgrowth cells (EOCs) from db/m or db/db mice. Effects were assessed 4 weeks after cell infusion. Untreated db/db mice developed mesangial matrix expansion and tubular epithelial cell apoptosis in association with increased reactive oxygen species (ROS) and overexpression of thioredoxin interacting protein (TxnIP). Without affecting blood glucose or blood pressure, EOCs not only attenuated mesangial and peritubular matrix expansion, as well as tubular apoptosis, but also diminished ROS and TxnIP overexpression in the kidney of db/db mice. EOCs derived from both diabetic db/db and nondiabetic db/m mice were equally effective in ameliorating kidney injury and oxidative stress. The similarly beneficial effects of cells from healthy and diabetic donors highlight the potential of autologous cell therapy in the related clinical setting.

PMID: 22596053 [PubMed - indexed for MEDLINE]

Self-kidney transplantation in takayasu arteritis.

Sat, 10/06/2012 - 12:37

Self-kidney transplantation in takayasu arteritis.

Transplantation. 2012 Oct 15;94(7):e47-9

Authors: Di Luccio GM, Lopes de Souza SA, Lopes FP, da Silva LF, da Fonseca LM, Gutfilen B

PMID: 23038632 [PubMed - in process]

Recovery from AKI and Short- and Long-Term Outcomes after Lung Transplantation.

Sat, 10/06/2012 - 12:37

Recovery from AKI and Short- and Long-Term Outcomes after Lung Transplantation.

Clin J Am Soc Nephrol. 2012 Oct 4;

Authors: Wehbe E, Duncan AE, Dar G, Budev M, Stephany B

Abstract
BACKGROUND AND OBJECTIVES: Patients with AKI after lung transplantation are at increased risk for CKD and death. Whether patients who completely recover from AKI have improved long-term outcome compared with patients who do not completely recover remains unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study retrospectively evaluated data on 657 patients who underwent lung transplantation from 1997 to 2009. Outcomes analyzed were the incidence of renal recovery after AKI and the association of this recovery with short- and long-term mortality. AKI was defined by an absolute increase in serum creatinine of ≥0.3 mg/dl or a percent increase in serum creatinine of ≥50% from baseline at any time during the first 2 weeks after transplantation. RESULTS: Four hundred twenty-four (65%) patients experienced AKI in the first 2 weeks after transplantation. Of these patients, complete renal recovery occurred in 142 (33%) patients. The incidence of in-hospital complications was similar between patients who recovered renal function and patients without recovery. At 1 year, the cumulative incidence of CKD was 14% and 22% (P=0.10) and patient survival rate was 81% and 76% (P=0.20) in patients with complete recovery from AKI and patients without recovery, respectively. Patients with completely recovered AKI had similar risk-adjusted long-term mortality compared with patients who did not recover (hazard ratio [95% confidence interval]=1.42 [1.15-2.05] versus 1.53 [1.01-2.00]). CONCLUSIONS: Patients who recover completely from early AKI after lung transplantation have a similar risk for CKD and long-term mortality compared with patients who do not recover.

PMID: 23037982 [PubMed - as supplied by publisher]

Impact of Tacrolimus-Sirolimus Maintenance Immunosuppression on Proteinuria and Kidney Function in Pancreas Transplant Alone Recipients.

Sat, 10/06/2012 - 12:37

Impact of Tacrolimus-Sirolimus Maintenance Immunosuppression on Proteinuria and Kidney Function in Pancreas Transplant Alone Recipients.

Transplantation. 2012 Oct 3;

Authors: Kandula P, Fridell J, Taber TE, Sharfuddin A, Yaqub MS, Phillips CL, Chen J, Mujtaba M

Abstract
BACKGROUND: Nephrotoxicity is a major complication with immunosuppression regimens used in transplantation. Calcineurin inhibitor-sparing or reduction regimens using sirolimus (SRL) have shown variable success in kidney transplantation. There is limited data on the role of SRL on native kidney function in pancreas transplantation. METHODS: All patients undergoing pancreas transplantation from 2003 to 2010 were enrolled in this study (n=65). Patient demographic characteristics were identified and divided into two groups: those receiving tacrolimus (Tac) in combination with mycophenolate mofetil (MMF) and those maintained on a regimen of Tac and SRL with or without MMF. The slopes for estimated glomerular filtration rate (eGFR), serum creatinine level (sCr), and proteinuria changes over time were assessed between groups. Urine protein and creatinine ratio (uPr/uCr) was used to assess proteinuria. RESULTS: There was no difference in baseline demographic characteristics. Patients were followed for a median of 3 years. Baseline sCr and eGFR were similar between groups. Differences in uPr/uCr and rate of change in sCr and eGFR were not significant between the groups overall or for any specific time. There was worsening of sCr, eGFR, and uPr/uCr within the groups over the period of study. There were no significant differences when groups were split by age or gender or when the SRL group was split further based on MMF inclusion. CONCLUSIONS: Our study findings suggest that using a Tac-SRL regimen in patients with pancreas alone transplantation is a safe approach and may not lead to worsening proteinuria and kidney function when compared with regimens using Tac with MMF.

PMID: 23037007 [PubMed - as supplied by publisher]

Identification of goat mammary stem/progenitor cells.

Sat, 10/06/2012 - 12:37
Related Articles

Identification of goat mammary stem/progenitor cells.

Biol Reprod. 2012 Apr;86(4):117

Authors: Prpar S, Martignani E, Dovc P, Baratta M

Abstract
Goat mammary gland epithelial cells have been used to establish primary and permanent cell lines, but to date, no data have been available regarding mammary stem cells (MaSCs) in this species. The detection and characterization of goat MaSCs is an important task for a better understanding of the cyclic character of mammary gland development, which will also offer the potential for manipulation of lactation yield and persistency. The objective of the present study was to demonstrate that a subpopulation of goat MaSCs resides in the goat mammary gland. Mammary tissue from lactating Saanen goats (Capra hircus) was dissociated and processed to a single-cell suspension. Using an in vitro colony-forming assay, we demonstrated that distinct colony types, which expressed specific lineage markers, arose from unipotent progenitors. Using two different growth media, we showed that the frequencies of caprine clonogenic progenitors differed according to growth conditions. Goat epithelial cells were transplanted under the kidney capsule of nonobese diabetic/severe combined immunodeficient (NOD/SCID) mice, where they formed organized, bilayered structures. Our results indicate the presence of goat MaSCs in the caprine mammary gland. To our knowledge, these data represent the first description of the tissue hierarchy of the goat mammary gland and demonstrate the regenerative potential of adult goat MaSCs.

PMID: 22238284 [PubMed - indexed for MEDLINE]

Distant metastases to nasal cavities and paranasal sinuses case series.

Tue, 10/02/2012 - 11:09

Distant metastases to nasal cavities and paranasal sinuses case series.

Indian J Otolaryngol Head Neck Surg. 2011 Oct;63(4):349-52

Authors: Azarpira N, Ashraf MJ, Khademi B, Asadi N

Abstract
Metastatic tumors to the nasal cavity and paranasal sinuses are far less common than primary cancer in this location. Review of the 2004-2010 pathology records of patients with sinonasal malignancy, revealed three cases with distant metastases to this region from primary sites in kidney, prostate and breast. The clinical presentation, histopathological findings and clinical outcome is presented for each patient. Metastases to the nose and paranasal sinuses usually respond poorly to treatment and have a poor prognosis. This report highlights the importance of suspecting metastases in patients with a previous history of malignancy. Therefore, thorough history and clinical evaluation is mandatory in any known/treated case of cancer.

PMID: 23024940 [PubMed - in process]

Attitudes Toward Strategies to Increase Organ Donation: Views of the General Public and Health Professionals.

Tue, 10/02/2012 - 11:09

Attitudes Toward Strategies to Increase Organ Donation: Views of the General Public and Health Professionals.

Clin J Am Soc Nephrol. 2012 Sep 27;

Authors: Barnieh L, Klarenbach S, Gill JS, Caulfield T, Manns B

Abstract
BACKGROUND AND OBJECTIVE: The acceptability of financial incentives for organ donation is contentious. This study sought to determine (1) the acceptability of expense reimbursement or financial incentives by the general public, health professionals involved with organ donation and transplantation, and those with or affected by kidney disease and (2) for the public, whether financial incentives would alter their willingness to consider donation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Web-based survey administered to members of the Canadian public, health professionals, and people with or affected by kidney disease asking questions regarding acceptability of strategies to increase living and deceased kidney donation and willingness to donate a kidney under various financial incentives. RESULTS: Responses were collected from 2004 members of the Canadian public October 11-18, 2011; responses from health professionals (n=339) and people with or affected by kidney disease (n=268) were collected during a 4-week period commencing October 11, 2011. Acceptability of one or more financial incentives to increase deceased and living donation was noted in >70% and 40% of all groups, respectively. Support for monetary payment for living donors was 45%, 14%, and 27% for the public, health professionals, and people with or affected by kidney disease, respectively. Overall, reimbursement of funeral expenses for deceased donors and a tax break for living donors were the most acceptable. CONCLUSION: The general public views regulated financial incentives for living and deceased donation to be acceptable. Future research needs to examine the impact of financial incentives on rates of deceased and living donors.

PMID: 23024166 [PubMed - as supplied by publisher]

Kidney transplantation and enzyme replacement therapy in patients with Fabry disease.

Tue, 10/02/2012 - 11:09

Kidney transplantation and enzyme replacement therapy in patients with Fabry disease.

J Nephrol. 2012 Sep 19;:0

Authors: Cybulla M, Kurschat C, West M, Nicholls K, Torras J, Sunder-Plassmann G, Feriozzi S

Abstract
During Fabry disease, progressive glycosphingolipid deposition in the kidney causes gradual deterioration of renal function with proteinuria, uremia and hypertension. This results in end-stage renal disease (ESRD) which is one of the leading causes of morbidity and premature mortality in affected patients. Given the excellent graft and patient survival generally nowadays, kidney transplantation is the first choice to correct renal dysfunction and improve the overall prognosis of patients with renal failure because of Fabry disease. The benefit of enzyme-replacement therapy (ERT) in kidney transplanted Fabry patients has been controversially discussed and long-term trials focusing on the effectiveness of agalsidase in this patient population are needed.

PMID: 23023720 [PubMed - as supplied by publisher]

[PREPARE: Cross-sectional study on management of chronic kidney disease by nephrologists before dialysis in France.]

Tue, 10/02/2012 - 11:09

[PREPARE: Cross-sectional study on management of chronic kidney disease by nephrologists before dialysis in France.]

Nephrol Ther. 2012 Sep 27;

Authors: Daugas E, Dussol B, Henri P, Joly D, Juillard L, Michaut P, Mourad G, Stroumza P, Touam M

Abstract
There are few epidemiologic data on Chronic Kidney Disease management before replacement therapy. The two objectives of the PREPARE study were (1) to describe the characteristics of these patients and accordance to clinical practice guidelines (2) to study nephrologists preference for renal replacement therapy in case of progression to end stage renal disease. PREPARE is a non-interventional cross-sectional study. All the French nephrologists had been solicited to collect information about CKD outpatients not on dialysis, not transplanted, with glomerular filtration rate lower than 60mL/min/1,73m(2), followed on any day between 23 and 27 November 2009. Three hundred and eight investigators included 2089 patients, 59% of them were male, they were on average 69 years old, 15, 37 and 48% had respectively a CKD stage V, stage IV and stage III, the nephropathy was the most often (43%) vascular. The most frequently reported cardiovascular risk factors were hypertension (88%), hypercholesterolemia (53%), diabetes (37%). The average time between diagnosis of nephropathy and the first nephrology consultation was too long 1,5 years. The implementation measures of nephroprotection and treatment of complications of CKD were generally satisfactory. However, preparation for replacement therapy was often too late, haemodialysis was more likely scheduled instead of peritoneal dialysis and without preparation for renal transplantation. PREPARE can therefore highlight the qualities of the current management of CKD by nephrologists in France. Nevertheless, PREPARE also shows weaknesses in preparation for replacement therapy. One can suggest that they could be reduced by systematic access of patients with risk of progression to stage V, as soon as the stage IV, to structured multidisciplinary care.

PMID: 23022292 [PubMed - as supplied by publisher]

[Current indications of azathioprine in nephrology.]

Tue, 10/02/2012 - 11:09

[Current indications of azathioprine in nephrology.]

Nephrol Ther. 2012 Sep 27;

Authors: Ladrière M

Abstract
Azathioprine is an immunosuppressive agent belonging to the antimetabolite family whose action blocks purine synthesis. It inhibits lymphocyte proliferation. In recent years, several trials have clarified the role of this compound used for three main indications: lupus glomerulonephritis, necrotizing vasculitis associated with antineutrophil cytoplasmic antibodies and renal involvement, and kidney transplantation. This review of the literature details practical conditions for the use of azathioprine in these three situations.

PMID: 23022291 [PubMed - as supplied by publisher]

Urologic Complications and Postoperative Vesicoureteral Reflux Following Pediatric Kidney Transplantation.

Tue, 10/02/2012 - 11:09

Urologic Complications and Postoperative Vesicoureteral Reflux Following Pediatric Kidney Transplantation.

J Urol. 2012 Sep 25;

Authors: Routh JC, Yu RN, Kozinn SI, Nguyen HT, Borer JG

Abstract
PURPOSE: Ureteral complications of renal transplant (RTX) can dramatically impact renal outcomes. Our objective was to determine if complications are associated with pre-existing genitourinary pathology or in those receiving a deceased donor (DD) allograft. MATERIALS AND METHODS: We retrospectively reviewed all patients undergoing RTX at our institution from 2000-2010. We abstracted patient demographic details, donor type [living (LD) vs DD], ESRD etiology, reimplant technique, stent use, pre- and postoperative imaging, history of lower genitourinary pathology, and post-complication management. RESULTS: A total of 211 kidneys were transplanted into 206 patients (mean age 13.7 years, mean follow-up 4.6 years). Most patients underwent extravesical UNC (89%) without stenting (97%); half (47%) were LD. Pre-existing urologic pathology was present in 34%. Postoperative obstruction or extravasation occurred in 16 (7.6%), 15 of which were acute. Complications were not associated with donor type, pre-existing urologic pathology other than posterior urethral valves, surgical technique, ESRD etiology, or patient age. However, posterior urethral valves (PUV) or other pre-existing GU pathology was not associated with an increased likelihood of GU complications. PUV was associated with development of postoperative VUR (odds ratio 6.7, p=0.004) but was not associated with stent placement, surgical technique, donor type, or ESRD etiology. CONCLUSIONS: Patients with PUV undergoing RTX are at increased risk of postoperative VUR but not of other acute surgical complications. Donor type, ESRD etiology, surgical technique, and patient age were not associated with increased complications.

PMID: 23022008 [PubMed - as supplied by publisher]

Impact of parathyroidectomy on allograft outcomes in kidney transplantation.

Tue, 10/02/2012 - 11:09

Impact of parathyroidectomy on allograft outcomes in kidney transplantation.

Transpl Int. 2012 Sep 29;

Authors: Jeon HJ, Kim YJ, Kwon HY, Koo TY, Baek SH, Kim HJ, Huh WS, Huh KH, Kim MS, Kim YS, Park SK, Ahn C, Yang J

Abstract
We performed retrospective, multi-center study of the impacts of parathyroidectomy (PTX) after or before kidney transplantation on allograft outcomes. A total of 63 patients who underwent PTX after kidney transplantation were identified. Deterioration in eGFR by more than 25% at 1 month after PTX occurred in 20% of the patients. The baseline eGFR was significantly lower in impairment group than nonimpairment group [adjusted odds ratio (OR) 0.87, 95% confidence interval (CI) 0.77-0.99, P = 0.033]. Low iPTH concentration after PTX was also a significant risk factor for the renal impairment (OR 0.96, CI 0.94-0.99, P = 0.009). A total of 37 patients who underwent PTX before transplantation were identified. Thirty-six percent of the patients had persistent hyperparathyroidism by 1 year after transplantation. A high iPTH level before PTX was a significant risk factor for persistent post-transplant hyperparathyroidism (adjusted OR 1.002, CI 1.000-1.005, P = 0.039). Finally, eGFR values during the first 5 years after transplantation were significantly lower in the patients who underwent PTX at less than 1 year after transplantation, than the pretransplant PTX patients (P = 0.032). As PTX after kidney transplantation has a risk of deterioration of allograft function, pretransplant PTX should be considered for patients with severe hyperparathyroidism, who could undergo post-transplant PTX.

PMID: 23020185 [PubMed - as supplied by publisher]

[Renal transplantation program at the Centenario Hospital Miguel Hidalgo in Aguascalientes, Mexico].

Tue, 10/02/2012 - 11:09
Related Articles

[Renal transplantation program at the Centenario Hospital Miguel Hidalgo in Aguascalientes, Mexico].

Rev Invest Clin. 2011 Sep;63 Suppl 1:30-7

Authors: Reyes-Acevedo R, Romo-Franco L, Delgadillo-Castañeda R, Orozco-Lozano I, Melchor-Romo M, Gil-Guzmán E, Lupercio-Luévano S, Cervantes S, Dávila I, Chew-Wong A

Abstract
INTRODUCTION: Miguel Hidalgo Hospital in Aguascalientes is dependent from the Federal Secretary of Health and operates in integrity with State health system in Aguascalientes. It capacity is based on 132 censored beds and 71 no censored beds. Is considered a specialty hospital in the region of Bajío. Renal transplant program activity was initiated in 1990 and gives care for adult and pediatric population.
MATERIAL AND METHODS: Retrospective, comparative and longitudinal study to describe and analyze our experience. Data base and clinical charts of renal transplant recipients were reviewed. Age, gender, date of transplant, etiology of renal disease, type of donor, HLA compatibility and PRA, immunosuppressive therapy, acute rejection, serum creatinina, graft loss and mortality were registered. Statistical analysis included 2, unpaired Student T test and Kaplan-Meier survival analysis with Log Rank test. Cox Analysis was also done.
RESULTS: 1050 renal transplants were done from November 1990 to June 2011. 50 were excluded because follow-up was not longer than 3 months. 1000 consecutive renal transplant patients from January 1995 to June 2011 were included for analysis. Patients were divided in 2 groups: group A transplanted January 1995 to December 2004; group B transplanted January 2005 to June 2011. Etiology for end stage renal disease is unknown in 61% of cases, 11% developed renal disease to diabetes mellitus. 93% patient survival was observed at median follow-up and 84.9% graft survival at median follow-up (6 years). Biopsy proven acute rejection in group A 19.9 vs. 10% in group B. Two haplotype matching shows 92% graft survival. Diabetic patients exhibit 73% graft survival vs. other as hypertension (87%). PRA >0 and serum creatinine > 2.0 mg/dL increase risk for graft loss according to Cox analysis. CONCLUSION. Results are comparable to international data. Importance of developing regional transplant centers is emphasized.

PMID: 22916608 [PubMed - indexed for MEDLINE]

Pages