Cadaveric Donor Renal Transplantation Research Articles

Salvage of a Transplanted Kidney following Immediate Renal Artery Narrowing

Renal transplantation is considered the preferred treatment method for chronic renal failure. Early graft failure caused by transplant renal artery narrowing/stenosis is a common vascular complication after kidney transplantation. The classic symptoms include refractory hypertension, a decline in graft function, and fluid retention. Color Doppler sonography plays an important role in the diagnosis of renal artery narrowing; however, allograft artery angiography remains the gold standard. We report on a case of cadaveric donor renal transplantation, wherein the urine output markedly decreased within 7 h of transplantation due to renal arterial narrowing and the efforts that were made to salvage the kidney.

#4973 PATHOGENIC ROLE OF D313Y MUTATION IN FABRY DISEASE

Abstract Background and Aims Fabry disease (FD) is a multisystem lysosomal storage disorder caused by mutations in the GLA gene. The significance of the mutation p.D313Y in the GLA gene is under debate. Our aim is to evaluated the pathogenic role of the D313Y. Method For clinical FD phenotype a 60-year-old woman (index case) with cadaveric donor renal transplantation and unknown cause of renal disease was undergoing genetic investigation. She reported D313Y as single variant in the GLA gene. A prospective analysis of clinical manifestation, genetic and biochemical (lyso-GB3 and enzyme activity) data was performed in all her brothers, sisters and sons. Data were assessed as part of routine follow-up visits. Results Genotype information of our index case was: nucleotide change c.937G>T, exon 6 involved, amino acid change p.Asp313Tyr, HGMD accession CM930335, mutation type missense. In our cohort comprising n.9 family members: n°5 (55%, n°3 females, n°3 males age range 45-60) had the p.D313Y mutation. In nobody the biomarker lyso-Gb3 was elevated. Two brothers (age range of 40-50 y) died for acute cardiovascular attack before genetic investivagation was performed. The 5 family members showed the following clinical features: 2 hypertension and cardiac hypertrophy (2M, 44/61y); our index case renal failure, LVH and bruning pains; 2F with burning pains (49/46y). Enzyme replacement therapy (ERT) was started in our index case. Annual routine visits are performed in the others. Conclusion D313Y mutation seems to correlate with clinically rilevant symptoms (mainly cardiovascular and renal) compatible with FD, also without lyso-Gb3 elevation. ERT might be considered as therapeutic option not only in patients with already organ involvement, but also in paucisymptomatic to prevent disease progression.

CARDIOVASCULAR COMPLICATIONS AFTER CADAVERIC RENAL TRANSPLANTATION

Objective: Renal transplantation is the treatment for end-stage renal disease. Cadaveric donor renal transplantation (CDRT) is still uncommon in Tunisia, constituting less than 20% of total renal transplants. The aim of our study was to evaluate the results and cardiovascular complications in our center Design and method: A retrospective analysis of 30 CDRT was performed between November 1995 and December 2018. Data analysis included. age, gender, cold ischemia time, graft function graft function, dialysis requirements dialysis requirements, rejection episodes rejection, infectious episodes, new onset diabetes after transplantation (NODAT), hypertension and cardiovascular events Results: Thirty patients underwent CDRT among 172 renal transplants performed in our unit. Among the donors, there were 23 males and 7 females, with a mean age of 32 ± 9 years. All transplants were blood group compatible with 3 HLA matches in the majority of cases (45%). The mean age of the recipients was 34 ± 9 years. Chronic glomerulonephritis (40%) and chronic chronic interstitial nephropathy (32%) represented the main type of native renal disease. 88.5% of the patients were hemodialysis before transplantation and the median time to transplantation on dialysis was dialysis was eight years. The mean nadir of creatinine was 108 ± 27 μmol/l. Two biopsies showed acute tubular injury, four patients had acute rejection and two patients had allograft nephropathy allograft nephropathy with one case of segmental and focal hyalinosis. segmental and focal hyalinosis. The major infectious complication was a cytomegalovirus cytomegalovirus infection (33.3%) followed by a urinary tract infection (23.8%). Regarding metabolic complications metabolic complications, NODAT and hypertension were observed in three and four patients respectively. Two patients presented an acute coronary syndrome treated with medical therapy. Five patients returned to dialysis. The rest (57.7%) have been followed up regularly in our consultation so far over a period of 87 months (range 16-209 months). Conclusions: CDRT is not common in our center, but the analysis shows good results and provides encouraging data that support broadening the criteria for potential donors eligible for organ donation especially in the face of increasing organ shortages. Cardiovascular complications are not as common

Influence of double J stent in the complications of ureterovesical anastomosis during kidney transplantation

IntroductionComplications arising from ureterovesical anastomosis in kidney transplantation have an important influence on the success of the procedure. The most serious and frequent complications are fistula and stenosis of the ureterovesical junction. The placement of double J stents in anastomosis is currently recommended to reduce these complications. ObjectiveThe aim of the study is to evaluate whether the placement of a DJ stent affects complications of anastomosis. Material and MethodsRetrospective analysis of 697 patients treated with cadaveric donor renal transplant in our center from 1999 to 2018 was performed. Results were compared according to double J stent placement and the surgical technique employed for anastomosis. ResultsTransplantation was performed without DJ placement in 51.7% of the patients, compared to 48.3% who were treated with DJ stent placement. The most commonly used technique was Lich-Gregoir. Ureterovesical fistula occurred in 5% of cases, and ureterovesical stenosis in 4.2%. DJ stent behaved as a protective factor for ureterovesical fistula but did not significantly influence the development of stenosis. The Taguchi technique greatly increased the risk of developing both ureterovesical fistula and stenosis. The incidence of stenosis and fistula was significantly higher when the Taguchi technique was combined with no DJ stent placement. ConclusionDJ stent placement acts as a protective factor for ureterovesical stenosis complications. The results of our study seem to agree with current literature.

Influencia del catéter doble J en las complicaciones de la anastomosis vesicoureteral realizada durante el trasplante renal

IntroductionComplications arising from ureterovesical anastomosis in kidney transplantation have an important influence on the success of the procedure. The most serious and frequent complications are fistula and stenosis of the ureterovesical junction. The placement of double J stents in anastomosis is currently recommended to reduce these complications. ObjectiveThe aim of the study is to evaluate whether the placement of a DJ stent affects complications of anastomosis. Material and methodsRetrospective analysis of 697 patients treated with cadaveric donor renal transplant in our center from 1999 to 2018 was performed. Results were compared according to double J stent placement and the surgical technique employed for anastomosis. ResultsTransplantation was performed without DJ placement in 51.7% of the patients, compared to 48.3% who were treated with DJ stent placement. The most commonly used technique was Lich-Gregoir. Ureterovesical fistula occurred in 5% of cases, and ureterovesical stenosis in 4.2%. DJ stent behaved as a protective factor for ureterovesical fistula but did not significantly influence the development of stenosis. The Taguchi technique greatly increased the risk of developing both ureterovesical fistula and stenosis. The incidence of stenosis and fistula was significantly higher when the Taguchi technique was combined with no DJ stent placement. ConclusionDJ stent placement acts as a protective factor for ureterovesical stenosis complications. The results of our study seem to agree with current literature.

Volatile agents and renal transplantation

Living donor and cadaveric donor renal transplantation have received a significant interest. During the procedure, both volatile agents and total intravenous anesthesia are used.

Anesthesia Management for Kidney Transplant Recipient in Patient with Kyphoscoliosis

Kyphoscoliosis is one of the manifestations of renal bone disease due to End stage renal disease (ESRD). Chronic renal failure patients usually present with comorbidities like hypertension, Diabetes, Dyslipedidemias, however, the risk of renal transplant increases multifold when the patient also suffers with respiratory problems. Herein we provide a patient of ESRD with severe kyphoscoliosis having severe pulmonary and systemic hypertension posted for emergency cadaveric donor renal transplantation which was successfully performed under general anesthesia with invasive Monitoring.

Perioperative management of adult cadaveric and live donor renal transplantation in the UK: a survey of national practice

BackgroundThere is a limited evidence base and no national consensus regarding the perioperative management of patients undergoing renal transplantation. We developed an electronic survey to capture an overview of renal transplant perioperative practice across UK renal transplant centres and determine the need for future guidelines on patient management. MethodsA 29-question survey was developed to encompass the entire renal transplant perioperative pathway and input was sought from clinicians with expertise in renal transplant surgery, anaesthesia, nephrology and intensive care. The survey was sent to lead renal anaesthetists at each of the 23 transplant centres across the UK. ResultsA 96% response rate was achieved with 22 out of 23 centres returning complete responses. There was limited evidence of guideline-based approaches to preoperative workup. Questions regarding intraoperative fluid management, blood pressure targets, vasopressor administration and central venous pressure (CVP) monitoring identified a broad range of practice. Of note, the routine use of goal-directed fluid therapy based on cardiac output estimation was reported in six (27.3%) centres, while nine centres (40.9%) continue to target a specific CVP intraoperatively. In all, 12 (54.5%) centres perform transversus abdominis plane blocks with fentanyl-based patient-controlled analgesia as the most common mode of postoperative analgesia. A single centre reported a renal transplant-specific Enhanced Recovery after Surgery programme for cadaveric organ recipients. ConclusionsThis questionnaire highlighted a high degree of heterogeneity in current UK practice as regards the perioperative management of renal transplant recipients. Development of evidence-based national consensus guidelines to standardize the perioperative care of these patients is recommended in order to improve patient outcomes and focus areas of future research.

Pancreas transplant imaging: how I do it.

Pancreas transplantation aims to restore physiologic normoglycemia in diabetic patients with glomerulopathy and avoid or delay the onset of diabetic retinopathy and arteriopathy. Simultaneous pancreas-kidney transplant is the most common approach, using a cadaveric pancreas donation in conjunction with either cadaveric or live donor renal transplant. Alternative techniques include pancreas after kidney transplant, in which the pancreas transplant is performed some years after renal transplant. Pancreas transplant alone is utilized rarely in diabetic patients with compensated renal function. Pancreas grafts have vascular and enteric connections that vary in their anatomic approach, and understanding of this is critical for imaging with ultrasonography, computed tomography, or magnetic resonance imaging. Imaging techniques are directed to display the pancreatic transplant arterial and venous vasculature, parenchyma, and intestinal drainage pathway. Critical vascular information includes venous thrombosis (partial or complete), arterial occlusion, or aneurysm. Parenchymal abnormalities are nonspecific and occur in pancreatitis, graft rejection, and subsequent graft ischemia. Peripancreatic fluid collections include hematoma/seroma, pseudocyst, and abscess. The latter two are related to pancreatitis, duct disruption, or leak from the duodenojejunostomy. An understanding of transplant anatomy and complications will lead to appropriate use of imaging techniques to diagnose or exclude important complications.

Virtual Crossmatch in Kidney Transplantation

BackgroundThe Luminex Single-Antigen Beads (LSA) assay allows an accurate detection and characterization of preexisting donor-specific antibodies (DSA) in kidney transplant candidates. But the ability of LSA to detect quite low levels of antibodies makes it hard to correctly predict crossmatch results in donor selection. In this study we retrospectively analyzed the accuracy of our virtual crossmatch (v-XM) protocol, which was used for selection of potential kidney transplant recipients, in predicting the results of actual crossmatch (a-XM) in cadaver-donor renal transplantation. We also investigated correlation between negative a-XM results and strength/specificity of preformed DSA. MethodsThe correlation between negative v-XMs and a-XMs performed in 2007–2012 at the Regional Transplant Center of the Lazio Region, Italy, was analyzed. In carrying out v-XM, the donor HLA molecules against which patients showed LSA-detected DSA with normalized mean fluorescence intensity (MFI) ≥5,000 were considered to be “unacceptable DSA,” and LSA-DSA showing MFI <5,000 were defined as “acceptable DSA.” All cadaver donors had been typed for HLA-A, -B, -DR, and -DQB molecules by sequence-specific primer methods. On the basis of a negative v-XM, we performed 507 a-XMs between serum samples from 256 renal transplant candidates and T/B lymphocytes from 302 cadaver donors with the use of both complement-dependent cytotoxicity (CDC) and flow cytometry (FC) methods. ResultsThe v-XM negative results showed good correlation with both CDC and FC a-XMs (97% and 90%, respectively). The sensitivity of v-XM was 100%; this high value was related to the lack of false-negative DSA results. The limited specificity with both techniques (CDC-XM, 74%; FC-XM, 79%) was due to the presence of “acceptable” and/or anti-DQA/DPB DSA in some patient sera used to perform the a-XMs. During the study period, 171 (67%) of the 256 sensitized patients received a kidney transplant: 30% of these had “acceptable DSA” and/or anti-DQA/DPB DSA. No antibody-mediated rejection due to preformed HLA-DSA was observed. ConclusionsOur v-XM protocol showed high sensitivity in predicting donor-recipient immunologic compatibility. The results of this study also demonstrated the importance of evaluating DSA strength for implementing v-XM results in the selection of kidney transplant recipients. Moreover, the finding of anti-DQA/DPB DSA, especially in serum samples that gave positive results with the use of both CDC and FC a-XMs, highlights the importance of defining all of the donor HLA molecules to perform an accurate v-XM.

Evaluation of Number of Renal Arteries in Live Related Renal Donors by CT Angiography and Conventional Angiography

Renal transplantation represents the best available replacement treatment for patients with end stage renal disease patients than performing dialysis, and living donor transplantation has been shown to offer better graft survival than cadaver donor renal transplantation. It was demonstrated that kidneys from living, unrelated donors succeed as well as kidneys obtained from brothers and sisters who share half of the tissue matching antigens with kidney recipients. The study was carried out at department of Angiography, Sindh Institute of Urology and Transplantation (SIUT) from January 2009 to September 2011. A total of 30 patients were included in the study. Informed consent was taken from all patients. Result demonstrates a total of 115 renal arteries in 60 kidneys of donors were depicted at CT angiography (CTA). Only 57 of kidneys showed more than one or multiple arteries, 52 of these had two renal arteries, and 6 had three renal arteries.

A Case of Delayed Recovery from Antibody-Mediated Rejection

Antibody-mediated rejection (ABMR) in kidney transplant recipients is mediated by donor-specific antibodies. It is the major cause of graft failure in noncompliant patients and is associated with reduced long-term graft survival. We present a case of delayed recovery of renal function despite aggressive therapy after acute ABMR. A 49-year-old male on triple-drug maintenance immunosuppression (prednisolone, cyclosporine, and azathioprine), who underwent cadaveric donor renal transplantation 14 years earlier, visited our clinic with a serum creatinine level (SCr) of 1.9 mg/dL. The kidney biopsy revealed acute ABMR with diffuse C4d immunopositivity. We started steroid pulse therapy and bortezomib with plasmapheresis. Nevertheless, the SCr increased. Consequently, antithymocyte globulin (ATG) and intravenous immunoglobulin were administered. The SCr increased further to 4.1 mg/dL. Therefore, we performed a second kidney biopsy, which showed no change. Finally, we used rituximab. Fortunately, the SCr decreased gradually and returned to baseline. (Korean J Med 2014;86:237-241)

Monitoring of CD3+ T-Cell Count in Patients Receiving Antithymocyte Globulin Induction After Cadaveric Renal Transplantation

AimAlthough antithymocyte globulin (ATG) has been used for years, its ideal dose and administration period is obscure. Herein, we sought to use the CD3+ cell count to detect the optimal ATG dosage. Material and MethodsTwenty-one patients who underwent cadaveric donor renal transplantation from January 2009 to January 2012 received a 1 mg/kg ATG initial dose at the time of the operation. Patients were randomized into 2 cohorts. Group 1 (n = 11) received ATG according to the clinical and total lymphocyte count and group 2 (n = 10), the dose was tailored according to the CD3+ cell count. We compared the total and daily ATG dosages, ATG administration period, side effects of ATG, the number of days to a serum creatinine level <2 mg/dL, graft function at 3 months, acute rejection episodes, infection rates, costs of CD3+ analysis, and ATG amounts. ResultsBoth groups showed similar gender, age, and human leukocyte antigen matching data. There was no difference in presensitizing events or panel-reactive antibody class 1 and 2 levels. The number of days to a serum creatinine level of <2 mg/dL was 11 ± 1.5 for group 1 versus 10.4 ± 0.8 for group 2 (P = .45). Between groups 1 and 2, there was a significant difference between the mean total (P = .031) and mean daily ATG dosages (P = .006). We used a total dose of 3800 mg ATG for group 1 and 2200 mg for group 2 and for the group 2 who underwent 43 CD3+ cell counts. The expenditure per patient was 20% higher among group 1 than group 2. ConclusionDetermination of appropriate ATG dosages by CD3+ cell counts was useful, reliable, and cost effective.

Costo-utilidad del trasplante renal frente a la hemodiálisis, en el tratamiento de la insuficiencia renal crónica terminal en un hospital peruano

Objectives. To assess and compare the cost utility of the cadaveric donor renal transplant (CDRT) at the Hospital Nacional Guillermo Almenara Irigoyen between 2000 to 2001, against haemodialysis (HD), 5 years after treatment initiation. Materials and Methods. A cost utility study design was used, which evaluated every patient continuing treatment after 5 years of having the CDRT done, and 2 controls consisting in patients having received HD for 5 years, matched by age, sex and disease duration. The costs of each procedure and their Quality-adjusted life years (QALY´s) were evaluated using the questionnaire of quality of life SF-36v2TM, finally calculating the cost utility (CU) and incremental cost utility (ICU) ratios. Results. Fifty-eight CDRT were performed between 2000-1. Five years later, 17 (29%) patients died and only 27 (47%) continued the treatment after CDRT. Out of the 31 patients (53%) having treatment failures, 26% rejected the transplant, 55% presented a complication and 19% were irregular. The mean SF-36v2TM scores obtained by the CDRT and HD patients were 95±12 and 87±18 points, respectively. The QALYs obtained by the CDRT and HD groups were 251 and 229 points, respectively; the CU ratios for the CDRT and HD were USD 11,984 and USD 9,243; and the ICU ratio for the period was USD 40,669. Conclusions. CDRTs performed during the years 2000-1 at the HNGAI, were 5 years later surprisingly less cost effective than the HD and CDRT´s performed at year 2000 had a lower incremental cost utility ratio that those performed the 2001, probably because of the highest rate of irregular treatment.

Costo-utilidad del trasplante renal frente a la hemodiálisis en el tratamiento de la insuficiencia renal crónica terminal en un hospital peruano

To assess and compare the cost utility of the cadaveric donor renal transplant (CDRT) at the Hospital Nacional Guillermo Almenara Irigoyen between 2000 to 2001, against haemodialysis (HD), 5 years after treatment initiation. A cost utility study design was used, which evaluated every patient continuing treatment after 5 years of having the CDRT done, and 2 controls consisting in patients having received HD for 5 years, matched by age, sex and disease duration. The costs of each procedure and their Quality-adjusted life years (QALY´s) were evaluated using the questionnaire of quality of life SF-36v2(TM), finally calculating the cost utility (CU) and incremental cost utility (ICU) ratios. Fifty-eight CDRT were performed between 2000-1. Five years later, 17 (29%) patients died and only 27 (47%) continued the treatment after CDRT. Out of the 31 patients (53%) having treatment failures, 26% rejected the transplant, 55% presented a complication and 19% were irregular. The mean SF-36v2(TM) scores obtained by the CDRT and HD patients were 95±12 and 87±18 points, respectively. The QALYs obtained by the CDRT and HD groups were 251 and 229 points, respectively; the CU ratios for the CDRT and HD were USD 11,984 and USD 9,243; and the ICU ratio for the period was USD 40,669. CDRTs performed during the years 2000-1 at the HNGAI, were 5 years later surprisingly less cost effective than the HD and CDRT´s performed at year 2000 had a lower incremental cost utility ratio that those performed the 2001, probably because of the highest rate of irregular treatment.

Quality of Life After Laparoscopic Donor Nephrectomy

ObjectivesDistinct from cadaveric donor renal transplantation, living donor renal transplantation has many benefits for the recipient, such as a shorter waiting time as well as longer patient and graft survivals. But, there is no potential physical benefit for the donors. Many studies have shown that laparoscopic donor nephrectomy (LDN) resulted in a lower complication rate and shorter hospital stay compared with an open donor nephrectomy. The present study was performed to analyze the quality of life (QoL) among patients who underwent LDN. Materials and MethodsFrom November 2005 to December 2008, 14 patients who underwent LDN were enrolled in this study. We assessed the QoL of these patients before versus 3 months after the operation using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), which were expressed as a Physical Component Summary and a Mental Component Summary. We analyzed the association between QoL and donor age, gender, relationship to the recipient, and renal function. ResultsThe Physical Component Summaries showed a significant decrease from the values before kidney donation (92.9 ± 5.0) to 3 months thereafter (80.4 ± 16.6; P = .004). In addition, the Mental Component Summaries were also significantly decreased from 84.2 ± 10.2 to 76.8 ± 19.2 (P = .012). However, the changes of QoL were not significantly associated with donor age, gender, relationship to the recipient, or renal function after kidney donation. ConclusionThis study revealed that kidney donation had negative impacts on donor QoL after LDN although renal function was well preserved. The QoL of a potential living donor must be evaluated carefully before transplantation.

Outcomes of Renal Transplants from Spousal Donors: 25 Years of Experience at Our Center

Objectives Many transplantation teams have attempted renal transplants from living unrelated kidney donors, as well as from cadaveric and living related kidney donors. In this study, we evaluated the results for renal transplants from spousal donors at our center. Methods We retrospectively analyzed renal transplant patients from spousal donors from 1983 to 2008. A total of 25 patients who underwent a cadaveric donor renal transplant from 1983 to 2008 were also studied as a control group. Patients were evaluated regarding patient and graft survival at 1 and 5 years of follow-up. Acute rejection, delayed graft function, infections, and late complications were recorded. Results Thirty-eight male, spousal transplant recipients (group 1), 21 female, spousal transplant recipients (group 2), and 25 cadaveric donor transplant recipients were included this study. Graft survival rates were 96% in group 1 and 100% in group 2 (p=0.76) at 1-year follow-up. Patient survival rates in group 1 and 2 were both 100% at 1-year follow-up. Graft survival rates were 80% in group 1 and 100% in group 2 (p=0.12) at 5-year follow-up. Patient survival rates were 90% in group 1 and 100% in group 2 (p=0.56) at 5-year follow-up. Acute rejection rates were 10% (group 1) and 33% (group 2) (p=0.03); delayed graft function rates were 0% (group 1) and 10% (group 2) (p=0.05); infection rates were 16% (group 1) and 5% (group 2) (p=0.21) as early period posttransplant complications. Conclusion Results for transplants between spouses in our groups were comparable to those previously reported in the literature. Acute rejection rates were mildly higher in female recipients than in the male recipients due to pre-sensitization arising from previous pregnancies; however, long-term patient and graft survival rates were not significantly different between female and male recipients.

Organ and Tissue Donation Knowledge Among Intensive Care Unit Nurses

Introduction Increased cadaveric donation may be achieved by improving medical staff education to enhance consent rates. This study was designed to examine the critical items that influence nurse knowledge regarding the concepts of brain death and the attitudes toward cadaveric donor renal transplantation. These findings may be useful to evaluate future progress in education. Subjects and methods A 31-item questionnaire was distributed to 418 nurses in 24 intensive care units (ICUs) in our hospitals. In addition to initial data regarding age, sex, and marital status, knowledge about donation was evaluated by eight questions. The first four questions pertained to judical and legal knowledge, the second two to economic knowledge, and the last two to concepts of brain death. Results Three hundred and two women and 116 men participated in this study. Their mean age was 31.98 years (range = 22–55 years). Two hundred fifty-six (61.2%) of them were married. Three hundred sixteen (75.6%) expressed favorable attitudes regarding cadaveric donation. The major reason for their consent was humanity, and the major reason for their disagreement was “body respect.” Of the 418 nurses, 105 (25.1%) stated positive attitudes toward living kidney donation. Conclusion The legal definition of death and the medical definition of death should be uniform in the view of society. To make all medical staff favor cadaveric renal transplantation, they should agree on a definition of death. It was observed that the relatively high rate of misinterpretation of the brain-death concept among respondents negatively affected nurses attitudes toward cadaveric renal transplant. It was concluded that the “concept of brain death” and the “preferences of transplant over other treatment modalities” are the two items that need further attention in educational programs for nurses.

Results of renal transplantation in low-weight children

Purpose Recipient age and weight are considered as risk factors for graft failure. The objective of this study is to review the characteristics and results of cadaveric donor renal transplants (CDRTs) in children weighing less than 12 Kg. Material and Methods 8 CDRTs were performed in 7 children weighing less than 12 Kg (3 males and 4 females) between 1990 and 2005. Grafts were placed extraperitoneally, in the iliac fossa, in all patients, and intravascular volume was expanded during the perioperative period. Renal function was assessed using the Glomerular Filtration Rate (GFR), obtained using the Schwartz formula, and graft survival curve was calculated using the Kaplan-Meier analysis. Primary pathology of the end-stage renal disease (ESRD), donor age and cold isquemia were analized. Results There was a 100% survival rate for patients in the sample. Graft survival rate was 87.5% at 1 year, dropping to 75% at 5 years. Six children still had a functioning graft after a mean follow-up time of 5.5 years. Conclusions Renal Transplantation (RT) may be performed with satisfactory results for the patient as well as the graft, in children weighing less than 12 Kg.

Immunosuppression With Generic Tacrolimus and Mycophenolate Mofetil in Renal Transplant Recipients: Preliminary Report in Chile

The association of tacrolimus (TAC) and mycophenolate mofetil (MMF) in renal transplant patients has diminished the incidence of acute rejection. We evaluated the use of generic TAC and MMF as primary immunosuppression in 6 living related (LR) and 11 cadaveric (C) donor renal transplant recipients (9 men, 8 women) of mean age 37 ± 12 years (range, 17–56 years) between May 2006 and June 2007. From day 0 all patients received TAC, MMF, and prednisone without antibody induction. They were followed for the development of acute rejection, graft loss, side effects, and mortality. Mean follow-up was 7.6 months (range, 2–15 months). No biopsy-proven acute rejection episodes, graft loss, or recipient deaths were observed. Creatinine levels at the end of the study were 1.90 ± 1.0 mg/dL (range, 0.62–4.25 mg/dL for C recipients and 1.19 ± 0.15 mg/dL (range, 0.91–1.35 mg/dL) for LR recipients. Mean systolic and diastolic blood pressures were 130/73 mm Hg with 12 patients (70.5%) on antihypertensive therapy with calcium antagonists and beta-blockers. Mean (range) of total cholesterol, triglycerides, and glucose were 172 (110–244) mg/dL, 139 (69–277) mg/dL, and 89 (63–129) mg/dL, respectively. MMF was suspended in 1 patient due to diarrhea and 1 other because of leukopenia. We observed that generic TAC and MMF yielded effective and safe immunosuppression in terms of mortality, biopsy-proven acute rejection, and graft loss with a low incidence of adverse effects during the study period.