Cadaveric Kidney Transplantation Research Articles

A Questionnaire Survey in Kidney Transplant Outpatients: Factors Associated with Good Self-Management

It is very important for outpatients who have had a kidney transplant to take care of themselves after discharge. However, outpatients have limited access to medical care by hospital staff after discharge; therefore, medical staff are unaware of the patient’s living conditions, and the uncertainties and problems that they encounter related to self-management. We conducted a questionnaire survey among 161 of 200 outpatients who received kidney transplants to investigate their recognition and actual practice of daily self-management. To determine the characteristics of adherent outpatients, we divided patients into two groups (the adherent and non-adherent group) and compared them. The Chi-squared test was conducted to test the equality of proportions among the groups, and then multiple logistic regression analysis was used to explore the factors significantly associated with regularly taking medicine or failing to take medicine. As a result of the logistic regression model using demographic factors as independent factors, the periods after transplantation (2 - 5 and 5 - 10 years) and living-donor kidney transplantation or cadaveric kidney transplantation were selected as significant factors associated with good self-management. As a whole, 68.3% of the 145 patients were correctly predicted using the model. The results of this study suggest that in the short period after transplantation (2 - 5 years), cadaveric kidney transplantation and that the patient has a job are significant factors associated with good self-management. Behind these results, a unique Japanese concept, “amae”, could be found. Therefore, medical knowledge and techniques as well as cultural background should be studied.

OUTCOME OF LIVING KIDNEY DONORS ACCORDING TO NATIONAL DATA OF TURKISH ORGAN AND TISSUE INFORMATION SYSTEM

Live kidney transplantation has several advantages than cadaveric-kidney transplantation and is still frequently performed. When assessed in terms of donor consent and religious concepts, there is a negative relationship between these terms and live kidney transplantation. However, there is little information about renal disease, social and psychological problems of donors after donation.

Meningitis Simultaneuously Due to Cryptococcus neoformans and Mycobacterium tuberculosis in a Inmunosupressed Patient

A 51-year-old white female patient was admitted to our Intensive Care Unit, who was originally referred from Nephrology department due to neurological impairment. She had crhonic renal failure and was being treated with immunosuppressants (tacrolimus and prednisone) because she had undergone a cadaveric kidney transplantation in the past. The previous week she had been discharged after being treated for tuberculosis but she developed new symtoms including nausea, vomiting and hepatotoxicity due to the antituberculous treatment, which had to be finally stopped. Her abdominal simptomatology improved, however, she developed neurological impairment, refractory headache and tremors. On admission her temperature was 37.5oC and Glasgow coma score 13.

Urinary monocyte chemoattractant protein-1 levels and interstitial changes in the renal cortex and their relationship with loss of renal function in renal transplant patients with delayed graft function.

BackgroundInflammatory cell infiltration and residual areas of fibrosis in kidneys after renal transplantation can lead to functional abnormalities with long-term implications.ObjectivesThe aim of this study was to determine urinary monocyte chemoattractant protein-1 (uMCP-1) levels, relative cortical interstitial area (RCIA), and cortical tubulointerstitial macrophage infiltration in renal transplant patients with delayed graft function (DGF) and their possible correlation with graft outcome.DesignPatients were followed after biopsies for one year, and their renal function and structure were evaluated, as well as parameters of inflammatory process.SettingClinical Hospital of the School of Medicine of Ribeirão Preto.PatientsTwenty-two cadaveric kidney transplant recipients with DGF were followed for one year.MeasurementsRenal function, RCIA, macrophages infiltration and uMCP-1 levels were evaluated.MethodsRenal function was evaluated by plasma creatinine levels. RCIA was determined by morphometry. Immunohistochemical staining of macrophages was performed using an anti-CD68 monoclonal antibody. uMCP-1 levels were determined using a human MCP-1/CCL2 immunoassay kit.ResultsThere was a significant increase in uMCP-1 levels in transplant patients compared with controls (p < 0.001). RCIA was 7.1% (6.4 to 9.2; median and 25th to 75th percentiles) in controls and 37.1% (28.1 to 43.7) in patients with kidney transplants (p < 0.001). The patients who presented with a higher RCIA in the first biopsy showed higher levels of plasma creatinine one year after transplantation (r = 0.44; p < 0.05). The number of tubulointerstitial macrophages per 0.10 mm2 grid field was higher in the renal cortex of transplant patients compared with the controls (19.4 (9.0 to 47.1) vs. 2.5 (1.8 to 3.4), p < 0.001). There was also a positive correlation between the RCIA and the number of tubulointerstitial macrophages in the renal cortex of these patients (r = 0.49; p < 0.001).LimitationsThe number of patients studied was relatively small and may not be reflecting outcomes over a larger spectrum of kidney cadaveric transplants.ConclusionsOur results demonstrate increased levels of uMCP-1 in transplant patients with DGF, in addition to increased tubulointerstitial macrophage infiltration and RCIA, which could predict the outcome of renal function in these patients.

Transplantation through the ages

Historical development of transplantation was going slowly in all parts of the world, following technological progress in general. At the crossing of the 18th and 19th century the first big steps in the field of transplantation were made, when Franz Reisinger was the first who transplanted cornea from an animal to an animal. Successful skin transplantations were made at the beginning of the 20th century; at the same time, surgical techniques of vascular anastomoses were developed, enabling technically successful transplantations of whole organs. At the end of the Second World War the first successful cadaveric kidney transplantation was made, and the first transplantation of this organ from a living donor was performed in 1956. A liver was transplanted for the first time in 1963, and a heart in 1967. Since then, transplantation has become a part of routine health care in developed countries, thanks to technological progress and efforts in promoting organ and tissue donation. Development of transplantation medicine in Serbia was a couple of decades late and annual transplantation rate still does not meet the needs of the population. It is expected that the development of this area of medicine in Serbia will be intense in the future.

Current state of cadaveric kidney transplantation in Kanagawa Prefecture

Current state of cadaveric kidney transplantation in Kanagawa Prefecture

RESULTS OF THE CADAVERIC KIDNEY TRANSPLANTATIONS ACCORDING TO NATIONAL DATA OF TURKISH ORGAN AND TISSUE INFORMATION SYSTEM

Cadaveric kidney transplantation is performed according to a patient list formed by matching and point score in our country. Demand for renal transplantation can not be met by the number of cadavers introduced to the system because of the increase in number of patients with chronic renal failure who require renal transplantation.

Different techniques of vessel reconstruction during kidney transplantation.

Multiple renal arteries (MRAs) represent a surgical challenge by the difficulty in performing anastomoses, bleeding and stenosis. MRAs should be preserved and special attention should be paid to accessory polar arteries. All renal arteries (RAs) must be reconstructed and prepared for safe anastomosis. The paper decribed the different techniques of vessel reconstruction during kidney transplantation including important steps within recovery of organs, preparation and implantation. In a 16-year period (1996-2012) of kidney transplantation in the Military Medical Academy, Belgrade, a total of 310 living donors and 44 human cadaver kidney transplantations were performed, of which 28 (8%) kidneys had two or more RAs. All the transplanted kidneys had immediate function. We repaired 20 cases of donor kidneys with 2 arteries, 4 cases with three RAs, one case with 4 RAs, one case with 4 RAs and renal vein reconstruction, one case with 3 arteries and additional polytetrafluoroethylene (PTFE) graft reconstruction, one case with transected renal artery and reconstruction with 5 cm long deceased donor external iliac artery. There were no major complications and graft failure. At a minimum of 1-year follow-up, all the patients showed normal renal function. Donor kidney transplantation on a contralateral side and "end-to-end" anastomosis of the renal artery to the internal iliac artery (IA) is our standard procedure with satisfactory results. Renal artery reconstruction and anastomosis with IIA is a safe and highly efficient procedure and kidneys with MRAs are not contraindicated for transplantation. A surgical team should be fully competent to remove cadaveric abdominal organs to avoid accidental injuries of organs vessels.

Comparison of Cadaveric Kidney Transplantation From In-center and External Center Donors

IntroductionRenal transplantation is the best treatment modality for end-stage renal disease. We investigated the effects of donor source on renal allograft and patient survival in deceased donor transplants. MethodsWe analyzed retrospectively 190 cadaver kidney transplants performed in our center from January 2000 to December 2009. Of these, 136 kidneys were harvested in our transplantation center and 54 were from external donors. Primary outcome of graft survival was assessed with the Kaplan–Meier method and the significance of possible variables was determined with the Cox proportional hazard model. ResultsThere was no difference between groups in the age of donor and recipient, recipient body mass index, duration of dialysis, or panel reactive antibody >30%. Twenty recipients lost their grafts (14 from external donors and 6 from internal donors). Graft survival at 1, 3, and 5 years was 99.2%, 97.3%, and 95.5% for in-center donors and 98.1%, 88.9%, and 86.2% for external donor transplants (P = .01). There was no difference in patient survival rates between the groups. Acute rejection episodes (hazard ratio [HR], 13.2; P < .001) and external hospital donor (HR, 9.3; P = .008) were independent factors associated with failure. Higher age of recipient was associated with increased patient death rate (HR, 1.2; P = .02). ConclusionGraft survival of cadaveric transplants from in-center donors was better than that of transplants from external center donors. Acute rejection episodes and location of harvest were significant factors for graft survival. Further study is needed to evaluate the effects of center-level factors on allograft outcomes.

Does Presumed Consent Save Lives? Evidence from Europe.

One policy tool that could affect organ donation rates is legislative defaults. In this study, we examine how presumed consent impacts cadaveric donations and kidney transplantations, using a panel dataset from the EU-27 countries plus Croatia in the period 2000-2010. We find that presumed consent countries have 28% to 32% higher cadaveric donation and 27% to 31% higher kidney transplant rates in comparison to informed consent countries, after accounting for potential confounding factors. After studying willingness to donate one's organs and registering preferences for organ donation, we find that presumed consent could increase cadaveric donation rates, because people fail to register their preferences and many have no preference for organ donation.

Dialysis Chains and Placement on the Waiting List for a Cadaveric Kidney Transplant

The proliferation of multi-unit for-profit dialysis chains in the ESRD industry has raised concerns for patient quality of care including access to renal transplantation therapy (RTT). The effect of dialysis facility chain status on RTT is unknown. Data from the United States Renal Data System were used to identify 4,465 dialysis facilities and 56,714 dialysis patients who started hemodialysis in 2006. Patients were followed from initiation of hemodialysis in 2006 to placement on the renal transplant waiting list or to December 31, 2009. The role of dialysis facility chain status (affiliation, size, and ownership) on placement on the renal transplant waiting list was evaluated by multi-level mixed-effect regression models that account for clustering within facilities. Patients from for-profit chain facilities, compared to nonprofit chain facilities, were 13% (95% CI 0.77-0.98) less likely to be waitlisted. In contrast, among nonchains, facility ownership did not influence likelihood of being waitlisted. There was also a marginally significant difference in waiting list placement by chain size: large chains compared with mid or small chains were 8% (95% CI 0.84-1.00) less likely to place patients on the waiting list. After adjustment for patient and facility characteristics, dialysis facility chain affiliation (chain-affiliated or not) was not found to be independently associated with the likelihood of placement on the transplant waitlist. Dialysis chain affiliation expands previously observed ownership-related differences in placement on the waiting list. For-profit ownership of dialysis chain facilities appears to be a significant impediment to access to renal transplants.

Black esophagus in the early kidney post-transplant period.

A 65-year-old man with end-stage renal disease secondary to nephroangiosclerosis on hemodialysis was admitted to undergo a cadaveric kidney transplant. He had a previous history of moderate-to-severe aortic stenosis. Twenty-four hours after surgery, the patient developed an acute pulmonary oedema followed by cardiac arrest. Advanced cardiopulmonary resuscitation and aggressive fluid removal through extracorporeal ultrafiltration were performed, resulting in a successful recovery and no apparent neurological consequences. A transesophageal echocardiography revealed the progression of the aortic stenosis to a critical stage. Balloon aortic valvuloplasty was performed as a bridge therapy to a transcatheter aortic valve replacement.

Nutrition care and exercise: An effect on muscle and fat metabolism in dialysed and transplant patients with obesity

s / Nutrition 30 (2014) 1222–1224 1224 response in the concentration range from LOQ to 55 ng for CH and LOQ to 114 ng for 7-OCH. The response factors (in relation to 5-alpha-cholestane) were 0.206 and 0.142 for CH and for 7-OCH, respectively. System and method precisions were sufficient, repeatability of retention time was less than 1 %, repeatability of injection was less than 15%; the repeatability of the whole procedure for cholesterol was 15.8%. Conclusion: The method of SPE separation of cholesterol and its oxidized products form fat matrices followed by GC-MS was adopted and optimized and working characteristics were evaluated. The method is precise, linear and sufficiently sensitive to determine oxysterols in both food and biological materials. Our future work will be focus on applying this method to the evaluation of oxysterols in fish, meat and vegetable dishes created under different types of culinary conditions (frying, baking, roasting). NUTRITION CARE AND EXERCISE: AN EFFECT ON MUSCLE AND FAT METABOLISM IN DIALYSED AND TRANSPLANT PATIENTS WITH OBESITY V. Teplan , I. Kr alov a-Lesn a , A. Mahrov a , M. H ajek , J. Racek , M. Stollov a 1 Dept of Nephrol, Transplant Centre, Inst Clin Exp Medicine, Prague Cardiovascular research centre, Prague, Czech Republic 3 Faculty of Physical Educ and Sport, Charles Univ Prague, Czech Republic Dept of Magnetic Resonance Imaging,Ist Clin Exper Medicine, Prague Dept of Biochem, Charles Univ Pilsen, Czech Republic Rationale: Vascular lesions during long-term dialysis pose a major limitation for organ transplantation. Endothelial progenitor cells (EPC) play important role in the integrity of vascular endothelium and may be integrated into endothelial cells. Recently, there have been studies documenting the beneficial effect of regular physical activity and nutrition on EPC count and onmuscle and fat metabolism in dialyzed and renal transplant patients. The aim of prospective randomized study was to assess the relationship between peripheral EPC, plasma asymmetric dimethylarginine (ADMA), adipocytokines, visceral fat and fat in muscle mass examined by magnetic resonance spectroscopy (MRS) in dialysed (pre-transplant) and transplant patients before and after exercise training and nutritional management. Methods: We monitored 65 patients before (on dialysis) and 6 months after first cadaveric kidney transplantation (Group I). Intervention involved controlled exercise regimen (Rikli Jones, HRQOL SF36-Bref) and nutritional care. Control Group II consisted of 63 non-exercising transplant patients with standard diet matched in age, BMI, HLA typisation, dialysis management, history of cardiovascular disease and immunosuppressive regimen. Nutritional management in Group I consisted of modified medium protein and energy diet (0.8-1.0g/kg and 35 kcal/kg iBW/day supplemented with mixture of keto,hydroxyand L-amino acids/100mg/kg iBW/day). EPC count in peripheral blood, laboratory examination and MRS were performed before and at month 6 after kidney transplantation. Results: After six months period, significant differences were found in EPC, ADMA, adiponectin and visfatin, (ttest, ANOVA all p < 0.01) in Group I. MRS examinations confirmed reducing of extracellular muscle fat from abdominal and calf muscle area after exercise training (p<0.01).This effect was not found in patients with body/fat weight gain.Renal function was stabilized during follow-up and all patients with rejection were excluded. Conclusion: Regular exercise training and nutritional care were associated with increase of EPC and adiponectin, decrease of ADMA and reducing of fat in muscles in non-obese patients examined by MRS in Group I. This regimen may decrease the vascular risk after organ transplantation and remarkable influence patient s well-being. The study was supported by Project MZO NT 13139-3/2012 awarded by the Internal Grant Agency of the Czech Republic.

The Impact of Interleukin 12B (1188A>C), Interleukin 16 (-295T>C), and Interleukin 18 (607C>A, 137G>C) Gene Polymorphisms on Long-Term Renal Transplant Function and Recipient Outcomes

BackgroundInflammatory mediators play an important role in kidney graft outcome. The cytokine and chemokine gene polymorphisms are associated with variable production, activity, expression, or ligand-receptor affinity. Genetic variation in the DNA sequence of the interleukin 12B (IL12B), interleukin 16 (IL16), and interleukin 18 (IL18) genes may lead to altered cytokine production and activity. These variations can lead to changes in individual patient outcomes after kidney transplantation. It is known that polymorphisms of interleukins have an influence on inflammatory diseases, eg, Crohn's disease, diabetes, and asthma. AimThe aim of this study was to evaluate the correlation between IL12B, IL16, and IL18 gene polymorphisms with delayed graft function (DGF), acute rejection episodes (AR), and chronic rejection episodes (CR). Materials and MethodsA total of 267 (38.6% women, 61.4% men) recipients were included in the study. Cadaveric kidney transplantations were performed at the Department of General Surgery and Transplantation. Polymerase chain reaction was used to determine gene polymorphisms of IL12B (rs3212227), IL16 (4778889), and IL18 (rs1946518, rs187238) in 2 mL of serum. Statistical significance (P < .05) was analyzed by logit regression, ANOVA and odds ratio (OR) of χ2 with Yates correction (95% confidence interval). ResultsRegression analysis revealed no significance between AR/DGF/CR and IL-2B, IL16, IL18rs1946518, and IL18-rs187238 (P > .05). The CR group, AA vs CC genotype of IL18 (rs1946518), had an OR = 2.35 (P = .04). AR and DGF groups had no significance in OR. ConclusionsThere was no statistical significance between IL12B, IL16, and IL18 (rs187238) gene polymorphisms and kidney graft outcome after transplantation. Presence of AA genotype (IL18–rs1946518) is connected with a 2.35 times higher risk of CR occurrence.

ACUTE BACTERIAL TUBULOINTERSTITIAL NEPHRITIS OF RENAL ALLOGRAFT COMPLICATED BY SEPTIC SHOCK

Herein we present the clinical case, which demonstrates the dif fi culties of the differential diagnosis of renal allograft damage. The importance of using of modern methods of diagnosis and treatment of urinary system in- fection after cadaveric kidney transplantation: computed tomography, graft tissue biopsy and timely application of the extracorporeal endotoxin selective adsorption are emphasized.

Gender Disparity in Indian Renal Transplantation

Background: Gender disparities are a major ethical concern in renal donation and transplantation. Relatively few Indian studies, each limited by small sample sizes, have investigated the problem of gender disparities in renal transplantation. Methods: A retrospective, cross-sectional study was conducted using data collected from kidney transplantation centers in Kerala, a southern state of India, to analyze the gender disparity in kidney donation and transplantation. Data were collected on gender, age, and relationship of the donor to the recipient. Results: Among 592 related cases, 74.2% of donors were female and 25.8% male (p <.0001). In the case of recipients, 76.2% were male and 23.8% female (p <.0001). Among 110 unrelated donors, 30.9% were female and 69.1% male (p <.0001), while the recipients were 78.2% male and 21.8% female (p <.0001). The number of cadaver kidney transplantations (six) was too small for analysis. Conclusion: The study found that the majority of living-related donors are family members (first-degree relatives) of the affected patients, with a definite female gender disparity among donors and recipients, more pronounced than reported in other studies. This disparity was absent in the case of living-unrelated donors, however. Existing practices in the organ transplantation process should be reviewed in order to eliminate the donor gender disparity in India. Kidney transplantation registries and organ matching systems at the national, state, and district levels are necessary for accountability and regulation of the transplantation process in India.

The Impact of Donor Factors on Early Graft Function in Kidney Transplantation From Donation After Cardiac Death

Donation after cardiac death (DCD) has the potential to significantly increase the number of organ donors. In this study, we investigate the influence of several donor parameters on the early graft function in kidney transplantation from DCD donors. We performed 58 kidney transplantations from DCD donors. Recipients were divided into 2 groups according to their graft function: normal graft function (NGF), patients who became be free of hemodialysis within 14 days post-transplantation) and delayed graft function (DGF) group, patients who required hemodialysis for longer than 15 days after transplantation). We compared donor age, sex, cause of death, warm and total ischemic time, duration of anuria (urine volume < 10 mL/h), and low blood pressure (systolic blood pressure < 60 mm Hg), usage of catecholamine and vasopressin, serum creatinine on the day of admission and graft retrieval, serum sodium concentration, and body temperature between 2 groups. The number of recipients in NGF and DGF group was 41 and 17. Univariate analysis revealed that duration of anuria (<24 vs ≥24 hours) and usage of catecholamine significantly influenced graft function. Duration of anuria was an independent risk factor for early graft function by multivariate analysis. In cadaveric kidney transplantation from DCD donors, there was a trend to poorer early graft function with donors who suffered from anuria for longer than 24 hours before kidney retrieval.

In Cadaver kidney Recipients, Autologous Bone Marrow Stem Cell Transplantation Significantly Improve Graft Function, Short-term Outcome

Background: Renal transplantation is the best choose in the end stage renal disease (ESRD), and acute rejection and graft dysfunction remain major challenges in the worldwide, even with the advent of new immunosuppressive drugs. The novel cell-based anti-rejection treatments have been studied by using different stem cell sources. In this study, transplantation of autologous-bone-marrow-derived-total-nucleated-cells is used to improve the cadaver kidney graft function. Methods: 18 ESRD patients, which candidate for cadaver kidney transplantation, were divided in two groups (group A and B) and there was no significant difference (male, female, age, weight, type of dialysis) between two groups. The two kidney of one cadaver were transplanted to two recipients. Before transplantation, randomly, autologous-bone-marrow aspiration was done for one recipient, and then the transplantation was done for both of recipients. The total-nucleated-cells were separated and infused intravenously during and after the transplantation, respectively. In post transplantation, 6 hours diuresis, delay graft function (DGF), creatinine (1 week, 2 weeks and 3 months), cyclosporine (2 weeks) and cold ischemia were measured in bone-marrow-treated group (A: 9 patients) and non-bone-marrow-treated group (B: 9 patients). Results: A significant increase in diuresis, a significant decrease in DGF, a significant decrease (1 week and 2 weeks) and marginally significant decrease (3 month) in creatinine, no significant difference in cyclosporine blood level (2 weeks), operation time and cold ischemia were seen in group A in comparison to group B. 2 patients had CMV infection in group B, but none in group A. Conclusion: The transplantation of autologous-bone-marrow-cells in cadaver kidney recipient is safe and significantly decreases early graft dysfunction. Further clinical trial is needed to confirm these promising results. Keywords: Bone marrow, Delayed graft function, Kidney transplantation, Stem cell.

Comparison of depression between kidney transplant recipients from live donors with cadavers in hospitals of Mashhad University of Medical Sciences

Abstract Background & aim: Kidney transplant surgery may impact various aspects of the life and results in individual and psychological problems. Receiving a kidney from a cadaver donor is associated with beliefs related to death of donor and with recipient’s survival. The aim of this study was to compare the rate of depression in patients receiving kidney from living donors with cadaveric donor kidney transplant ,patients that were referred to nephrology clinics in hospitals of Mashhad University of Medical Sciences in 2010. Materials & methods: A descriptive – comparative design was used. The sample of the study consisted of 60 patients receiving kidney from living donors and 60 cadaveric kidney transplantation attended to nephrology clinics in hospitals of Mashhad University of Medical Sciences. Data were collected by a demographic questionnaire and Beck depression Inventory. The reliability of this test was evaluated with test-retest and Pearson correlation test was 0. 95. Data were analyzed with SPSS software (version 13). Finding: Depression scores in living kidney transplantation group were 11. 6±5. 7 , and in the cadaveric group was 16. 4±9. 4. Independent t-test showed a significant difference between two groups scores of depression (P . [January 24, 2010] Pascazio L et al, (2010) Anxiety, depression and emotional profile in renal transplant recipients and healthy subjects: A comparative study. Transplantation Proceedings. 42(9) 3586-3590 Pawar A et al «Cognitive and emotional effects of renal transplantation»,1 January 2006, [on line] . [3 Apr 2010]. Perez S-G et al (2008) Influence of the psychological state of relatives on the quality of life ofpatients at 1 year after transplantation. Transplantation Proceeding. 40(9)3109-11. Rezaei R et al (2009)[ Comparison of body image in hemodialysis patients with kidney transplant patients]. payesh Quarterly . 8(3) 279-287. (Persian). Sayin A et al (2007) Quality of life in hemodialysis, peritoneal dialysis, and transplantation patients. Transplantation Proceeding. 39(10) 3047-3053. Shah VS, et at (2006) Qualify of life and psychosocial factors in renal transplant Recipients. Transplantation Proceedings. 38(5) 1283-1285. Sugawara H et al (2008) Paradoxical depression in renal transplant recipient. Transplantation Proceeding. 40(10) 3448-3450. Szeifert L et al(2010) Symptoms of depression in kidney transplantations: A cross-sectional study. American Journal of Kidney Diseases (AJKD). 55(1)132-140. Toimamueang U et al (2003) Stress and coping strategies among renal transplant candidates in a stress and coping strategies among renal transplant candidates in a Thai medical center. Transplant Proceedings. 35(1) 292-3. Virzi A, et al (2007) Depression and quality of life in living related renal transplantation. Transplantation Proceedings. 39(6) 1791-1793. Weng LC, et al (2006) Effects of self-efficacy, self-care behaviors on depressive symptom of Taiwanese kidney transplant recipients. Journal of Clinical Nursing, 17(13) 1786-1794.

Plasma and urine renalase levels and activity during the recovery of renal function in kidney transplant recipients

Renalase is a recently described enzyme secreted by the kidney into both plasma and urine, where it was suggested to degrade catecholamines contributing to blood pressure control. While there is a controversy regarding the relationship between renal function and plasma renalase levels, there is virtually no data in humans on plasma renalase activity as well as on both urine renalase levels and activity. We prospectively examined the time course of plasma and urine renalase levels and activity in 26 end-stage renal disease (ESRD) patients receiving a cadaver kidney transplant (cadaver kidney recipients [CKR]) before surgery and during the recovery of renal function up to day 90 post transplant. The relationship with sympathetic and renal dopaminergic activities was also evaluated. The recovery of renal function in CKR closely predicted decreases in plasma renalase levels (r = 0.88; P < 0.0001), urine renalase levels (r = 0.75; P < 0.0001) and urine renalase activity (r = 0.56; P < 0.03), but did not predict changes in plasma renalase activity (r = -0.02; NS). Plasma norepinephrine levels positively correlated with plasma renalase levels (r = 0.64, P < 0.002) as well as with urine renalase levels and activity (r = 0.47 P < 0.02; r = 0.71, P < 0.0005, respectively) and negatively correlated with plasma renalase activity (r = -0.57, P < 0.002). By contrast, plasma epinephrine levels positively correlated with plasma renalase activity (r = 0.67, P < 0.0001) and negatively correlated with plasma renalase levels (r = -0.62, P < 0.003). A significant negative relationship was observed between urine dopamine output and urine renalase levels (r = -0.48; P < 0.03) but not with urine renalase activity (r = -0.33, NS). We conclude that plasma and urine renalase levels closely depend on renal function and sympathetic nervous system activity. It is suggested that epinephrine-mediated activation of circulating renalase may occur in renal transplant recipients with good recovery of renal function. The increase in plasma renalase activity observed in ESRD patients and renal transplant recipients can be explained on the basis of reduced inhibition of the circulating enzyme.