1-year Creatinine Research Articles

Modified Ileal Conduit for Pelvic Lipomatosis: Technique Description and Outcome

Introduction: The aim of this study was to present the surgical technique and clinical outcomes of modified ileal conduit for pelvic lipomatosis (PL). Methods: From 2020 to 2022, we prospectively enrolled 9 patients with PL undergoing modified ileal conduit. The patient characteristics, perioperative variables, and follow-up outcomes as well as the description of surgical technique were reported. Results: All 9 patients successfully completed the operation. Two patients had perioperative complications of Clavien-Dindo grade I. The mean operation time and bleeding volumes were 253 ± 51.4 min and 238.9 ± 196.9 mL, with a mean postoperative follow-up time of 13.0 ± 5.6 months. The postoperative 3-month and 1-year creatinine values were significantly decreased versus the preoperative (p = 0.006 and p = 0.024). The postoperative 3-month and 1-year estimated glomerular filtration rate values were significantly increased compared with those before operation (p = 0.0002 and p = 0.018). The separation value of left renal pelvis collection system after operation was significantly reduced compared with preoperative evaluation (p = 0.023 at 3 months and p = 0.042 at 1 year) and so was the right side (p = 0.019 and p = 0.023). Conclusion: Modified ileal conduit is safe and feasible for PL. A large sample cohort with long-term follow-up is needed to evaluate the clinical outcomes of PL.

Comparison of the Effects of Indobufen and Aspirin in Older Patients with Coronary Artery Disease After Coronary Drug-Eluting Stent Implantation: A Prospective Randomized Single-Center Study.

After coronary drug-eluting stent (DES) implantation, dual antiplatelet therapy (DAPT, usually aspirin in combination with a P2Y12 inhibitor) is necessary. However, older patients are prone to aspirin intolerance or resistance. Indobufen has been reported as an ideal alternative to aspirin. To evaluate the clinical efficacy and safety of indobufen-based DAPT in this population, a total of 251 older patients (aged ≥65 years) undergoing coronary DES implantation in a tertiary healthcare facility in Quzhou, China, were enrolled, of which 110 received indobufen-based DAPT and 141 received aspirin-based DAPT. Baseline data, adverse reactions, adverse events, angina attacks, and repeated revascularization during 1-year follow-up were collected. At 1-year follow-up, creatinine, and left ventricular ejection fraction levels in the indobufen group were higher than those in the aspirin group, whereas estimated glomerular filtration rate levels were lower than those in the aspirin group. No significant difference in the incidence of adverse reactions or adverse events was found between the two groups. At 1-year follow-up, the incidence of angina in the indobufen group was significantly lower than that in the aspirin group, and the repeated revascularization rate was lower than that in the aspirin group. Indobufen-based DAPT was beneficial in avoiding repeated revascularizations (odds ratio 0.433, 95% CI 0.229-0.821, P = 0.010). These findings highlight that, for older patients who underwent coronary DES implantation, indobufen-based DAPT may be a better choice, which can effectively improve patients' symptoms and prognosis. However, application to older patients with potential renal insufficiency requires caution.

A novel acute kidney injury scoring system for renal and clinical outcomes in pediatric heart transplant patients.

The development of acute kidney injury (AKI) has been associated with worse outcomes in children after heart transplantation. Our study compares the application of a cumulative six-point Kidney Diseases Improving Global Outcomes (KDIGO) AKI scoring system, utilizing both creatinine and urine output criteria that we term as the AKI-6 criteria, to traditional AKI staging as a predictor for clinical and renal outcomes in the pediatric heart transplant recipients. We conducted a retrospective single-center chart review on 155 pediatric patients who underwent heart transplantation from May 2014 to December 2021. The primary independent variable was the presence of severe AKI. Severe AKI by KDIGO was defined as Stage ≥2, whereas severe AKI by AKI-6 was defined as cumulative scores ≥4 or Stage 3 AKI based on either KDIGO criterion alone. Primary outcomes included actuarial survival and renal dysfunction by 1-year post-transplant, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 . In total, 140 (90%) patients developed AKI; 98 (63%) patients developed severe AKI by KDIGO, and 60 (39%) by AKI-6. Severe AKI by AKI-6 was associated with worse actuarial survival following heart transplantation compared with KDIGO (p = 0.01). Of the 143 patients with 1-year creatinine data, 6 (11%) patients out of 54 with severe AKI by AKI-6 had evidence of renal dysfunction (p = 0.01), compared with 6 (7%) patients out of 88 by KDIGO (p = 0.3). AKI-6 scoring provides greater prognostic utility for actuarial survival and renal dysfunction by 1-year post-heart transplantation in pediatric patients than traditional KDIGO staging.

Broad organ acceptance and equitable access to early kidney transplantation.

Broad organ acceptance can increase early kidney transplantation (KTX) within <1-year of dialysis initiation while improving access inequity. Single-center data of adult isolated deceased-donor KTX recipients between 2013 and 2020 were stratified into three 2.5-year periods before-, early after-, and late after our center's deceased-donor organ acceptance practice change, excluding a 6-month implementation period. Outcomes were assessed within five recipient subgroups based on demographic and clinical characteristics. Of 704 recipients, the frequency of early KTX was 22% pre-change, 36% early post-change, and 34% late post-change. Given similar post-change frequencies of early KTX, post-change eras were combined to improve analytic power of subgroup analyses. After the organ acceptance practice change (vs. pre-change), the likelihood of early KTX increased variably within historically underserved groups, including recipients who were older (37%-39%, p=.859), Black (10%-21%, p=.136), female (21%-37%, p=.034), diabetic (13%-32%, p=.010), and BMI≥35kg/m2 (20%-34%, p=.007). Despite the practice change, Black recipients continued to experience less early KTX compared to non-Black recipients. The likelihood of delayed graft function was significantly increased (p<.001), and 1-year creatinine was significantly higher (p<.001) post-practice change, but between-era risk-adjusted death-censored graft survival was similar. Transition to broader donor acceptance was associated with more early KTXs among historically underserved patient subgroups. However, the effect was non-significant among Black recipients, suggesting the need for additional strategies to impact early transplant access for this population. Studies of broad organ acceptance are needed to examine both access and outcomes.

Relationship between donated kidney volume determined by ultrasound adjusted for clinical factors and 1-month and 1-year creatinine clearance: A retrospective study.

Graft volume as a surrogate of nephron numbers correlates with allograft function. The primary aim of this study was to correlate renal volume determined by ultrasound, adjusted to recipient clinical parameters in order to determine post-transplant renal function at the end of the first year. A total of 140 patients were enrolled in this study, including 75 males, with a total mean age of 41.2±13.5 years. Clinical data of all donors and recipients undergoing kidney transplantation at our institution between 2003 and 2019 were reviewed. The volume of transplanted kidney was measured by ultrasonography on the fifth day after the operation and correlated with recipients' clinical parameters and then adjusted with first-month and first-year post-transplantation creatinine clearance. The mean allograft volume measured using ultrasonography was 175.0±37.2 mL. Absolute donor kidney volume had a non-significant correlation with creatinine clearance at 1 month and at 1 year after transplantation. The kidney volume/recipient body weight ratio had a positive, and significant, correlation with creatinine clearance at 1 month and at 1 year after transplantation (r = 0.326, p<0.001, and r=0.183, p=0.038, respectively). Our data demonstrated that 12-month creatinine clearance is influenced by ratio of donated kidney volume/recipient body weight.

242.3: Is Kidney Time-Zero Biopsy Useful to Predict Graft Function at 1-Year?

Introduction: Clinical and histological characteristics of donors are known to influence graft outcome after kidney transplantation. One of the most common reasons for donor kidney discard is unfavorable histology on procurement biopsies. Many centers perform time-zero biopsies (Bx0), although there is no consensus about the histological findings significance or its association with post-transplant biopsies results. We aim to determine if findings in Bx0 could predict the allograft function at 1-year after transplantation. Methods: Adult kidney-transplant patients from October 2014 to December 2020 with Bx0, post-transplant biopsy performed and at least 1-year follow-up were included. Recipient’s gender and age, clinical donor characteristics, histological findings in Bx0 and post-transplant biopsies and 1-year creatinine levels were analyzed using SPSS® V.25. Results: During the analyzed period 138 kidney transplants were performed. Bx0 was performed in 68 (49%) patients, and of those, 60 patients (88%) had at least one post-transplant biopsy. Mean age was 46 ± 14-year-old and 37 (54%) were male. Fifty-three patients (78%) received a kidney from deceased donor and 15 (22%) from living donor. Donor mean age was 43 ± 13-year-old. Fourteen (20%) had hypertension and the mean body mass index (BMI) was 27.3 ± 5.1 kg/m2. Donor’s mean serum creatinine before procurement surgery was 1.14 ± 0.53 mg/dL and the mean cold ischemia time (CIT) was 17:21 ± 9:40hs. Bx0 histological findings were: acute tubular necrosis (ATN) in 62 biopsies (19%), glomerulosclerosis (GS) in 40 (59%) and interstitial fibrosis and tubular atrophy (IFTA) in 41 (60%), with a mean of 6 ± 9% and 5 ± 7% respectively; 15 (22%) had arteriolar hyaline thickening. A risk factor for allograft GS was donor’s age >43-year-old (OR 4.4 95%IC 1.7 – 11.7 p= 0.000). In addition, we found that donor’s age >43-year-old and history of hypertension were risk factors for IFTA (OR 3.7 95%CI 1.6 – 8.8 p= 0.000 and OR 2.57 95%CI 1.4 – 4.4 p= 0.004 respectively). The mean of 1-year serum creatinine was 1.8 ± 1.6 mg/dL. Clinical and pathological parameter effects on 1-year serum creatinine are shown in table 1. The risk factors for worse outcomes in terms of 1-year serum creatinine are shown in table 2. We also found that GS and IFTA persist in post-transplant biopsies in 85% and 100% of patients respectively. Conclusion: We have found that not only donor age and hypertension are risk factors for pathological findings in Bx0 but also those findings impact negatively on 1-year serum creatinine.

Donor-Recipient Matching to Optimize the Utility of High Kidney Donor Profile Index Kidneys

BackgroundIn December 2014, the Kidney Donor Profile Index (KDPI) was developed to give more precise information on donor kidney quality. Kidneys with KDPI scores ≥ 85 (K ≥ 85) have been reported to have inferior outcomes to kidneys with KDPI scores < 85. MethodsAfter the implementation of the new Kidney Allocation System, we developed a protocol to evaluate K ≥ 85 use. We analyzed the safety and efficacy of our institutional criteria and evaluated post-transplant outcomes. K ≥ 85 recipients were stratified based on their 1-year creatinine and estimated glomerular filtration rates to elucidate characteristics associated with serum creatinine < 1.7 mg/dL or estimated glomerular filtration rates ≤ 45 mL/min/1.73 m2. ResultsFrom December 2014 to December 2019, 304 deceased donor kidney transplants were performed at Hartford Hospital; 58 (19%) were K ≥ 85 with an average KDPI of 91%. There were 4 graft losses; 2 were death censored. Prolonged cold ischemia time and black recipient race were associated with inferior recipient graft function at 1 year. ConclusionsHigh KDPI kidney use requires a multifaceted evaluation that takes into account donor and recipient characteristics for an ideal match. We have identified several characteristics that may predict optimal post-transplant kidney function.

PREDICTING KIDNEY FUNCTION AFTER HIGH KDPI KIDNEY TRANSPLANTATION: A COMPARISON OF EXPECTED VS. OBSERVED GLOMERULAR FILTRATION RATE IN A LARGE COHORT OF KDPI &gt;85 KIDNEY TRANSPLANT RECIPIENTS

Purpose: Renal function after transplantation is dependent on a combination of viable donor nephron mass and the adaptation of recipient glomerular filtration. Although previous studies have assessed post-transplant kidney function from living and standard criteria deceased donor kidney transplant recipients, no study has sought to calculate kidney function following high KDPI (KDPI>85) kidney transplantation. Methods: From December 2014 to July 2019, 58 kidney transplants with KDPI>85 were performed at Hartford Hospital. Using the modified Glomerular Filtration Rate Cockcroft and Gault equation (CG-GFR) expected serum creatinine (ExpSCr) at one year was calculated and compared to observed serum creatinine (ObsSCr). Bland-Altman analysis was performed to assess concordance between ExpSCr and ObsSCr. Bias (mean difference between ExpSCr and ObsSCr) and limits of agreement with their 95% confidence intervals were determined.Results: Among 58 high KDPI kidney transplants, the average KDPI was 91±4%. The donor age was 61±6 years, 57% were male with an average BMI of 31.5±8.0 kg/m2. Of the donor cohort, 82% had a history of hypertension, 40% diabetes, 59% died of cardiovascular causes, and 30% donated after cardiac death. Of the recipient cohort, the average age was 63±8 years, 69% were male with a BMI of 29.4±5.1 kg/m2. More than half of the recipients (69%) were male; 45% self-identified as Caucasian, 31% African American, 17% Hispanic and 7% Other; and 50% and 90% had a pre-transplant diagnosis of diabetes and hypertension, respectively. Delayed graft function was observed in 53% of recipients. The 1-year death-censored graft and patient was survival was 95.7% and 91.5% (n=47), respectively. The 6-month and 1-year creatinine for the cohort were 1.86±1.18 (n=49) and 1.68±0.52 mg/dL (n=41), respectively. According to the CG-GFR, the ExpSCr at the first post-transplant year was 1.33±0.47 mg/dL. The average lowest ObsSCr was 1.32±0.47 mg/dL. The bias of expected and ObsSCr and ExpSCr of this cohort of high KDPI kidney transplant recipients was 0.01 mg/dL.Conclusion: Current models for predicting kidney function after living and standard criteria deceased donors accurately predict post-transplant kidney function in high KDPI kidney transplantation. Further research is necessary to identify mitigating risk factors to achieve the optimal donor-recipient match and best possible post-transplant kidney function for high KDPI kidneys.

Unspecified live kidney donation by urological patients.

BACKGROUNDIndividuals with benign kidney disorders undergoing nephrectomy have three possibilities: Autotransplantation, with a certain risk of complications, but without a clear benefit; discarding the kidney; or living kidney donation.AIMTo investigate whether patients with benign kidney disorders and a medical indication for nephrectomy are suitable as unspecified live kidney donors.METHODSWe searched all clinical data from 1994-2019 for unspecified donors and their transplant recipients (n = 160). Nine of these 160 donors had pre-existing kidney disorders necessitating nephrectomy and had decided to donate their kidney anonymously after discussing the possibility of kidney donation. We studied the clinical course of these nine donating patients and their transplant recipients.RESULTSSeven of nine donating patients indicated unbearable loin pain as the main complaint, one donating patient refused ureterocutaneostomy and one had two aneurysms of the renal artery. Postoperatively, seven donating patients described absence of pain and one a significant reduction after the nephrectomy. The average 1-year creatinine level in the donating patients was 88 µmol/L and after a median of 6.9 years the average creatinine level was 86.6 µmol/L. In the transplant recipients, one major complication occurred which led to death and in one transplant recipient graft function failed to normalize at first but has been stable for nine years now. Currently, all transplant recipients are off dialysis.CONCLUSIONOur data show that patients undergoing nephrectomy as part of treatment in selected kidney disorders can function as live kidney donors.

Effect of preservation solutions for static cold storage on kidney transplantation outcomes: A National Registry Study.

This study aimed to evaluate how 5 preservation solutions for static cold storage affected kidney transplant outcomes. It included all first single kidney transplants during 2010-2014 from donations after brain death in the French national transplant registry, excluding preemptive transplants and transplants of kidneys preserved with a hypothermic perfusion machine. The effects of each preservation solution on delayed graft function (DGF) and 1-year transplant failure were evaluated with hierarchical multivariable logistic regression models. The study finally included 7640 transplanted kidneys: 3473 (45.5%) preserved with Institut Georges Lopez-1 solution (IGL-1), 773 (10.1%) with University of Wisconsin solution, 731 (9.6%) with Solution de Conservation des Organes et Tissus (SCOT, organ and tissue preservation solution), 2215 (29.0%) with Celsior, and 448 (5.9%) with histidine-tryptophan-ketoglutarate. Primary nonfunction rates did not differ by solution. After adjustment for donor, recipient, and transplant characteristics, the DGF risk was significantly lower with IGL-1 than with all other solutions (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.48-0.64). Conversely, SCOT was associated with a DGF risk significantly higher than the other solutions (OR 2.69, 95% CI 2.21-3.27) and triple that of IGL-1 (OR 3.37, 95% CI 2.72-4.16). One year after transplantation, the transplant failure rate did not differ significantly by preservation solution. The difference between the groups for 1-year mean creatinine clearance was not clinically relevant.

Renal function between Tenofovir and Entecavir in post-liver transplanted hepatitis B patients.

Introduction: Tenofovir, Nucleotide analogue polymerase inhibitor is already accepted as effective and tolerable drug for treatment of hepatitis B virus (HBV) as much as entecavir. There are some concerns about nephrotoxicity of tenofovir in patients with end-stage liver disease or liver recipients. We retrospectively investigated the renal function of tenofovir compare to entecavir in liver recipients with HBV. Method: Among 468 patients with HBV who were underwent liver transplantation at Samsung Medical Center between 2008 January to 2015 December, tenofovir (n=37) treated group was matched with entecavir (n=132) group. (1:4, matching variables=age, pre-operative HBV DNA, eGFR, CTP score) Baseline characteristics and 1, 2, 3 year follow up eGFR & creatinine levels after operation were compared between both group using GEE(Generalized estimating equation) analysis. Risk factors lowering eGFR value are also reviewed with univariate & multivariate analysis. Result: Among baseline characteristics, age, pre-operative creatinine, eGFR and hepatic encephalopathy score showed statistical difference between tenofovir (n=39) and entecavir (n=429) group before propensity score matching. After matching, there was no statistical difference in pre-operative characteristics. Post-operative 1-year eGFR showed no statistical difference from pre-operative eGFR in both group. Post-operative 2-year eGFR (5.25 ml/min/1.73m2 decrease, p=0.04) and 3-year eGFR (7.43ml/min/1.73m2 decreased, p=0.02) showed a little decreased from pre-operative eGFR, but there was no statistical difference and interaction between tenofovir and entecavir group (p=0.42). Post-operative 1-year creatinine (0.28mg/dl decreased, p=0.02) and 2-year creatinine (0.24mg/dl decreased, p=0.049) showed improvement. 3-year creatinine showed decrease by 20mg/dl without statistical difference (p=0.10) from pre-operative creatinine. There was also no statistical difference and interaction between both group (p=0.38) for creatinine change. Conclusion: Tenofovir does not induce renal dysfunction in liver transplant patients with HBV compared to entecavir. The safety and renal dysfunction in tenofovir after liver transplantation will be investigated in the further studies.

Outcomes of donation after circulatory death kidneys undergoing hypothermic machine perfusion following static cold storage: A UK population-based cohort study.

Evidence is currently lacking regarding the outcomes of kidneys undergoing hypothermic machine perfusion (HMP) in patients in the United Kingdom. Using the National Health Service Blood and Transplant database, the authors compared outcomes for recipients of single-organ donation after circulatory death (DCD) kidneys preserved with HMP with those preserved using only static cold storage (SCS). Between 2007 and 2015, HMP was used in 19.1% (864/4,529) of kidneys. Rates of delayed graft function (DGF) were significantly lower in organs preserved with HMP than for organs preserved with SCS (34.2% vs 42.0%, P<.001), despite a slightly longer cold ischemic time (median: 14.8 vs 14.1hours, P<.001). Multivariable analysis found the effect of preservation modality to remain significant, with HMP organs having a significantly lower rate of DGF (odds ratio 0.65, 95% confidence interval 0.53-0.80, P<.001) and significantly shorter times to DGF resolution (average: 6.1 vs 7.4days, P=.003) than SCS organs. The patient (P=.313) and graft (P=.263) survival rates were similar in the 2 preservation groups. HMP was associated with a marginal functional benefit in 1-year creatinine values (P=.044), with adjusted averages of 1.36mg/dL (HMP) versus 1.40mg/dL (SCS). This study supports the use of HMP and aids decision-making over its instigation, which may improve short-term patient outcomes.

Right retroperitoneoscopic living donor nephrectomy does not increase surgical complications in the recipient and leads to excellent long-term outcome.

Right-sided retroperitoneoscopic living donor nephrectomy (LDN) has been shown to be safe for the donor but it is unknown whether the short renal vein is associated with complications or an impaired long-term outcome in the recipient. In this retrospective cohort study, consecutive transplant recipients after retroperitoneoscopic LDN were enrolled. Complications occurring within 1 year were classified according to the Clavien-Dindo Classification for Surgical Complications and analysed using multivariable logistic regression. Predictors of 1-year creatinine clearance were analysed with multivariable linear regression. Cox proportional hazard models were used to analyse graft survival. Of the 251 recipients, 193 (77%) received a left kidney and 58 (23%) a right kidney. Surgical complications of Clavien-Dindo grade 3 or higher were comparable in recipients of right and left kidneys (33% vs 29%, odds ratio 0.98, 95% confidence interval [CI] 0.50, 1.94). The occurrence of a surgical complication had a significant impact on creatinine clearance at 1 year (decrease of 6 ml/min/m2, p = 0.016). Vascular complications in right kidneys were more common but were all corrected without impact on graft survival. One-year graft-survival was similar in recipients of right (98.3%) and left (96.9%) kidneys, as was creatinine clearance one year after transplantation (mean difference 3.3 ml/min/m2, 95% CI -1.5, 8.1; p = 0.175). After a median follow-up of 5 years, neither the side (hazard ratio 1.56, 95% CI 0.67, 3.63) nor surgical complications (hazard ratio 1.44, 95% CI 0.65, 3.19) were associated with graft failure. Right retroperitoneoscopic LDN does not compromise the outcome of transplantation. Surgical complications, long-term graft function and graft survival were comparable in right and left kidneys.

Safety and Efficacy of Alemtuzumab Induction in Highly Sensitized Pediatric Renal Transplant Recipients.

Studies show that alemtuzumab, a potent lymphocyte-depleting agent, is well tolerated in pediatric renal transplantation. We report on the use of alemtuzumab induction in highly HLA sensitized (HS) pediatric kidney transplant patients. Fifty pediatric renal transplants were performed from 1/2009-12/2014. 15 HS patients received IVIG (2 g/kg ×2 doses)/rituximab (375 mg/m ×1) for desensitization with alemtuzumab induction (15-30 mg, 1 dose, subcutaneous), whereas 35 nonsensitized patients received anti-IL-2R. Graft survival and infections were compared between 2 groups. All HS patients had received a prior transplant and were older with lower risk for viral infections due to serostatus. Patient survival was 100%, and graft outcomes were similar with mean 1-year creatinine of 1.03 ± 0.45 versus 0.99 ± 0.6 (P = 0.48). Although a higher incidence of acute cellular rejection was seen in HS patients receiving alemtuzumab (P = 0.001), there was a nonsignificant difference in antibody-mediated rejection. White blood cell and absolute lymphocyte count were significantly lower in alemtuzumab group at 30 days (P < 0.0001) and at 1 year (P = 0.026 and P = 0.001), respectively. There was no significant difference in bacterial, viral, or fungal infections after transplant. Alemtuzumab induction with desensitization led to nearly equivalent graft survival and functional outcomes in HS pediatric patients as nonsensitized patients receiving anti-IL-2R induction. With this small sample size, we observed significant reduction of white blood cell and absolute lymphocyte count up to 1 year posttransplant. The risk of infection was comparable between the 2 groups; however, patients who received alemtuzumab were older and at lower risk of viral infection due to serostatus.

Long Term Outcomes of Kidney Transplant: Characteristics of Recipients with 20 or More Years of Graft Survival

Objective: Kidney transplant survival in the first year after transplantation has significantly improved, although long-term results are less encouraging. In recent years the pressure on the scientific community on the need to refine methods to discover the possible factors that can predict graft survival after 10, 20 years or more after transplantation is increased. Few previous studies have evaluated patient and laboratory characteristics associated with optimal long-term graft survival. The objective of this study was to identify possible factors associated with the survival of the transplanted kidney in the very long term. Methods: We retrospectively studied adults who had received first-time, single kidney transplants between 1967 and 1991 at S. Orsola Hospital in Kidney Transplant Centre in Bologna. We compared the clinical, immunological, and laboratory profile of patients whose grafts were still functioning ≥ 20 years after kidney transplantation to those whose transplants survived <20 years. Results: We identified 111 patients (24.5%) who received transplants with a functioning graft for 20 or more years after transplantation. Female gender, living donor, younger donor age, shorter delayed graft function duration (DGF), lower one-year creatinine and higher one-year eGFR predicted ≥ 20-year functional graft survival in the univariate analyses. In the multivariate analysis, only female gender, shorter DGF duration and 1-year creatinine and eGFR remained as significant predictors of graft survival ≥ 20 years. Conclusions: To our knowledge, this is the first report of 20-year graft survival being associated with one-year renal function. Accordingly, efforts should be targeted to preserving graft function in the first year after kidney transplantation. In addition we have identified a population of long-term kidney transplants survivors who will be the subject of further studies in order to clarify mechanism of immunological tolerance to transplant.

Expanded criteria donor and donation after circulatory death renal allografts in the West of Scotland: Their place in the kidney allocation process

IntroductionDue to the rising disparity between demand and availability, organs from expanded criteria donors (ECD) and donors after determination of circulatory death (DCD) are increasingly used. The purpose of this study was to report outcomes in recipients of ECD and DCD renal allografts from a single centre. MethodsA retrospective analysis from a single centre for all renal transplants performed between 2001 and 2010 inclusive was undertaken. SCD (standard criteria donor) and ECD organs were compared, as were DCD and DBD (donation after determination of brain stem death) organs. Baseline data and predefined standard transplant outcomes were collected and compared using appropriate statistical tests. P < 0.05 was defined as significant. Results729 renal transplants were performed. Comparing ECD to SCD organs, there was a significant difference in graft survival between groups (logrank for trend, p = 0.032) with ECD organs doing worse than SCD organs. Short-term outcomes showed a similar disparity with a higher 1-year post-transplant creatinine and delayed graft function (DGF) rate in ECD grafts. Nevertheless, outcomes were still clinically acceptable. When comparing DCD to DBD organs, no such differences were apparent, with DCD organs appearing to perform at least as well as DBD organs. In our cohort, unlike some previous studies, DGF rates were similar in both DCD and DBD groups. ConclusionsAlthough ECD organs perform less well than SCD organs, outcomes are still acceptable and our results support their continuing use. When considering DCD organs, our data support the view that they should no longer be necessarily regarded as marginal grafts. Our low DGF rates are perhaps explained by local factors contributing to a short CIT.

Early Excellent Outcomes of Flow Cross-Match Negative Kidney Transplant Recipients With Pre-Formed IgG DSA, C1q Negative With or Without Peri-Operative IVIg Infusion.

It is not clear if patients with a negative cross-match but with DSA need additional therapy at the time of transplant to prevent an amnestic reaction that could lead to early AMR. Based on our experience with a high dose IVIg desensitization program, we have conducted a stepwise deletion of peri-operative IVIg according to the DSA MFI. Intervention: All patients received ATG induction and triple therapy maintenance immunosuppression with tac, MMF and steroids. All patients were T and B flow cross-match compatible. The first 10 pts had at least one current DSA with a MFI > 1000. They received IVIg 2G/Kg at the time of Tx and 3 weeks later. The threshold to received IVIg was increased to 1500 MFI for the next 10 pts and subsequently to 2000 MFI (3 pts thus far). All patients were monitored post Tx for DSA with single antigen bead immunoassay for IgG and C1q. We compared the outcomes at 1 year of pts who received the IVIg and those who didn't according to the titration scheme. Results: From 4/08 to 9/13, thirty-two patients were treated according to this protocol. Twenty three patients with DSA MFI > 1000 received IVIg (group1) and 9 patients with MFI < 2000 did not receive IVIg (group2). Patient and graft survival were 100% at 1 year in both groups. Only one graft was lost in group 1, five years post-Tx after 2 years lost to follow-up. There were no episodes of cellular or humoral rejection in either group. Of group 1, 16/23 became DSA negative post Tx at least for 1 year, 6 remained DSA IgG positive and 1 intermittently became DSA IgG and C1q positive. In group 2: 8/9 became DSA negative, one pt remained DSA IgG. The 1-year creatinine was 1.37 ± 0.49 for group1 (n=20) and 1.06 ± 0.33 (n=9) for group 2. In conclusion, recipients of kidney transplant with negative flow cross-match but with IgG DSA up to MFI of 1500 may not need peri-operative IVIg to prevent early AMR. We are currently pursuing our evaluation with increasing MFI cut off. DISCLOSURES:Tyan, D.: Other, One Lambda, licensed product.

Outcome of Single Pediatric Deceased Donor Renal Transplantation to Adult Kidney Transplant Recipients

Introduction: In times of organ shortage more kidneys were transplanted in ‘expanded criteria kidney' programs. This study examines the outcome of adult kidney recipients from pediatric donors. Materials and Methods: This single-center retrospective analysis evaluated eight adult patients who received a kidney from a deceased pediatric donor (age 5-17) between 06/2000 and 09/2011. Results: The median donor age was 14 years (range 5-17). The median recipient age was 49 years (range 25-57). The median cold ischemia time was 13.3 h (range 4.3-20.1), while the median warm ischemia time was 53 min (range 42-60). The median follow-up was 35.8 months (range 7-142). Acute rejection was observed in 50.0% of cases. The median HLA mismatch was 2.0. The median 1-year creatinine level was 0.95 mg/dl, the uncensored 1-year graft survival was 75.0% and the 3-year graft survival 62.5%, respectively. No recipient died within the follow-up period. As severe surgical complications, one stenosis of the renal artery and one lymphocele needing surgical revision were observed. Conclusions: Renal transplantation of a deceased single pediatric donor to an adult recipient can be performed safely and shows a good outcome. Wherever feasible, single pediatric kidney transplantation can double the number of recipients over an ‘en-bloc' transplantation. The price for a single pediatric kidney transplant may be a higher vascular complication rate and a higher rejection risk. Despite the higher risks, transplantation of a single pediatric donor kidney should be performed when accomplishable.

Even Mild Renal Insufficiency Is a Risk for Mortality after Heart Transplant

Purpose Renal failure has been a consistent risk factor for mortality after heart transplantation. From the ISHLT Registry approximately one third of patients have an abnormal creatinine after heart transplantation. There has been concern that development of even mild renal insufficiency in the first year after transplant may portend poor outcome. We reviewed our experience in patients with mild renal insufficiency at 1 year after heart transplantation for long-term outcome. Methods and Materials Between 1994-2010, we evaluated 384 heart transplant patients with serum creatinine Results Patients with mild renal insufficiency (creatinine 1.2-1.5mg/dl) at one year after transplant had significantly lower survival compared to patients with normal creatinine (84% vs 91%, p=0.026). There was no difference in 1-year rejection or 5-year freedom from CAV or NF-MACE between groups. ( Table ) Upon multivariate analysis,creatinine (up to 1.5mg/dl)was an independent risk factor for 5-year mortality (HR 4.3, p=0.027). Conclusions Mild renal insufficiency up to serum creatinine of 1.5mg/dl at one year post heart transplant appears to be a risk factor for 5-year mortality. Avoiding any renal impairment in first year after transplant appears to be paramount. Outcomes Creatinine ≤1.1 at 1-Year (N=206) Creatinine 1.2-1.5 at 1-Year (N=178) p-value 5-Year Actuarial Survival 91% 84% 0.026 5-Year Freedom from CAV 76% 74% 0.654 5-Year Freedom from NF-MACE 91% 92% 0.764 1-Year Freedom from Any-Treated Rejection 80% 84% 0.296

Role of insulin resistance indices in predicting new-onset diabetes after kidney transplantation

New-onset diabetes mellitus (NODAT) is a serious complication following renal transplantation. In this cohort study, we studied 118 nondiabetic renal transplant recipients to examine whether indices of insulin resistance and secretion calculated before transplantation and at 3months post-transplantation are associated with the development of NODAT within 1year. We also analysed the long-term impact of early diagnosed NODAT. Insulin indices were calculated using homeostasis model assessment (HOMA) and McAuley's Index. NODAT was diagnosed using fasting plasma glucose. Median follow-up was 11years. The cumulative incidence of NODAT at 1year was 37%. By logistic regression, recipient age (per year) was the only significant pretransplant predictor of NODAT (OR 1.04, CI 1.009-1.072), while age (OR 1.04, CI 1.005-1.084) and impaired fasting glucose (OR 2.97, CI 1.009-8.733) were significant predictors at 3months. Pretransplant and 3-month insulin resistance and secretion indices did not predict NODAT. All-cause mortality was significantly higher in recipients developing NODAT within 1year compared with those remaining nondiabetic (44% vs. 22%, log-rank P=0.008). By Cox's regression analysis, age (HR 1.075, CI 1.042-1.110), 1-year creatinine (HR 1.007, CI 1.004-1.010) and NODAT within 3months (HR 2.4, CI 1.2-4.9) were independent predictors of death. In conclusion, NODAT developing early after renal transplantation was associated with poor long-term patient survival. Insulin indices calculated pretransplantation using HOMA and McAuley's Index did not predict NODAT.