Cadaveric Kidney Research Articles

The impact of apoptosis and inflammation gene polymorphisms on transplanted kidney function

The progressive deterioration of kidney allograft function leads in most cases to transplant failure. Polymorphisms in genes encoding for inflammatory and apoptosis molecules may be one possible explanation for interindividual differences in kidney transplant outcomes. The objective of our work was to identify the possible effect of interleukin 6 (IL-6), transforming growth factor beta 1 (TGFB1), and Fas on graft function. A case-control study was carried out to assess potential associations between polymorphisms in inflammation- and apoptosis-related genes and the risk for chronic impairment of kidney graft function. The study included 376 cadaveric kidney recipients, 256 of them with stable graft function and 120 who experienced renal deterioration during the follow-up period of 2.6 ± 1.4 years. Genotyping of IL-6/G-174C, TGFB1/L10P, TGFB1/R25P, and Fas/G-670A polymorphisms was performed by PCR-RFLP and direct sequencing. Considering the single IL-6, TGFB1, and Fas polymorphisms, we found similar allelic and genotype frequencies between the 2 groups. To test the hypothesis of mutual effects of polymorphisms, multiple logistic regression was performed incorporating data for all the possible dual genotypic associations. The association of IL-6 high producer and Fas low producer genotype resulted in a protective effect against graft dysfunction (OR=0.79; 95% C.I.=0.72-0.86). This study did not find significant associations of apoptosis and inflammation gene polymorphisms with transplanted kidney function in Italian renal transplant recipients. However, our data seem to indicate that the carriage of IL-6 high producer/Fas low producer genotype has a protective effect against graft function loss.

A public opinion survey: is presumed consent the answer to kidney shortage in Hong Kong?

ObjectiveTo project the impact of an opt-out system (presuming consent) in Hong Kong on the likelihood that a potential donor donates his or her kidneys after death and the likelihood...

Artificially Positive Crossmatches Not Leading to the Refusal of Kidney Donations due to the Usage of Adequate Diagnostic Tools

Allografting patients with human leukocyte antigens (HLA) which are recognized by preformed antibodies constitutes the main cause for hyper-acute or acute rejections. In order to select recipients without these donor-specific antibodies, the complement-dependent cytotoxicity crossmatch (CDC-CM) assay was developed as a standard procedure about forty years ago. The negative outcome of pretransplant crossmatching represents the most important requirement for a successful kidney graft survival. The artificially positive outcomes of CDC-based crossmatches due to the underlying disease Systemic Lupus Erythematosus (SLE), however, may lead to the unjustified refusal of adequate kidney grafts. Two prospective female recipients destined for a living as well as for a cadaver kidney donation, respectively, exhibited positive CDC-based crossmatch outcomes although for both patients no historical immunizing events were known. Furthermore, solid phase-based screening or antibody differentiation analyses never led to positive results. Immediate reruns of the CDC-based crossmatch assays using the alternative antibody monitoring system (AMS-)crossmatch ELISA resulted in unequivocally negative outcomes. Consequently both transplantations were performed without any immunological complications for the hitherto follow-up time of 25 and 28 months, respectively. We here show two case reports demonstrating an alternative methodical approach to circumvent CDC-based artefacts and point to the urgent need to substitute the CDC-based crossmatch procedure at least for special groups of patients.

Living and cadaver donor transplant programs in the maghreb

In the Maghreb, organ failure constitutes a major public health problem, especially given the increasing number of patients with chronic renal failure and the high cost of care. In this study, we attempted to seek the recommendations, through a questionnaire, of various officials related to organ transplantation as well as leaders of ethics committees and religious groups in different countries of the Maghreb. The objective was to improve the rate of organ donation and transplantation. We received 36 replies (62%) within the prescribed time limit. In our survey, 83% of the respondents felt that living donor transplantation should be promoted initially, followed gradually by measures to increase cadaver donor transplantation to achieve a target of about 30 transplants with cadaver kidney donors per million inhabitants. To expand the donor pool, 83% of the respondents proposed to expand the family circle to include the spouse and in laws. To improve the cadaver donation activity, one should improve the organizational aspects to ensure at least 50 renal transplantations per year (100%) and provide material motivation to the treatment team proportional to the activity of organ donation and transplantation. Finally, 93% of the respondents suggested suitable moral motivation of the donors.

MitoQ Blunts Mitochondrial and Renal Damage during Cold Preservation of Porcine Kidneys

Cold preservation has greatly facilitated the use of cadaveric kidneys for transplantation but damage occurs during the preservation episode. It is well established that oxidant production increases during cold renal preservation and mitochondria are a key target for injury. Our laboratory has demonstrated that cold storage of renal cells and rat kidneys leads to increased mitochondrial superoxide levels and mitochondrial electron transport chain damage, and that addition of Mitoquinone (MitoQ) to the preservation solutions blunted this injury. In order to better translate animal studies, the inclusion of large animal models is necessary to develop safe preclinical protocols. Therefore, we tested the hypothesis that addition of MitoQ to cold storage solution preserves mitochondrial function by decreasing oxidative stress, leading to less renal tubular damage during cold preservation of porcine kidneys employing a standard criteria donor model. Results showed that cold storage significantly induced oxidative stress (nitrotyrosine), renal tubular damage, and cell death. Using High Resolution Respirometry and fresh porcine kidney biopsies to assess mitochondrial function we showed that MitoQ significantly improved complex II/III respiration of the electron transport chain following 24 hours of cold storage. In addition, MitoQ blunted oxidative stress, renal tubular damage, and cell death after 48 hours. These results suggested that MitoQ decreased oxidative stress, tubular damage and cell death by improving mitochondrial function during cold storage. Therefore this compound should be considered as an integral part of organ preservation solution prior to transplantation.

A Case of Acute Antibody Mediated Rejection Developing after Pretreatment with Rituximab and Plasma Exchange in a Cadaveric Kidney Recipient of High PRA

Rejection is the major cause of graft failure, and if the injury to the tubules and glomeruli is severe, the kidney may not be recovered. It is therefore important to diagnose acute rejection as soon as possible to institute rescue therapy. PRA (panel reactive antibody) tests before and after the transplant, is used as a method to gauge whether or not cross-reactivity. High PRA means a likelihood of acute rejection and the recipient of high PRA is needed for adequate pretreatment for kidney transplantation but in cadaveric kidney transplant there is no sufficient time and chance to desensitization. We report a successful renal transplant outcome in a 47-yr-old-woman with high PRA levels (class I 97.5%, class II 36.7%). The cross match was negative on CDC(ELISA) and flowcytometric method. Plasma exchange was performed on recipient before transplantation (fresh frozen plasma replacement, 1.3 plasma volume) and immediately after plasma exchange she was given rituximab 200mg. She received basiliximab and methyl prednisolone induction therapy and was maintained on steroids, mycophenolate mofetil and tacrolimus. Graft function was normal immediately after transplantation but decreased urinary output and elevated serum creatinine was noted on POD 5. She was underwent hemodialysis four times. Renal biopsy was performed on POD 6. Graft biopsy revealed acute cellular rejection (type IIa) simultaneous with antibody mediated rejection (type III). On 9 - 13 days after transplantation, plasma exchange (fresh frozen plasma replacement, 1.3 plasma volume) once every other day and steroid pulse therapy was performed 3 times. After the normalization of urinary output and serum creatinine, the patient was discharged and currently being follow-up. In conclusion, immunologically careful preparation and pretransplant treatment may be needed on the negative cross match in cadaveric kidney recipient of high levels of PRA.

A Tale of Five Kidneys and One Heart Transplants

Background: Idiopathic focal segmental glomerulosclerosis (FSGS) recurrence occurs in 20-30% of first renal transplant recipients and >80% after a re-transplant after a previous recurrence. Relapse often means graft failure. Case report: A 40-yr-old white female with primary, idiopathic FSGS diagnosed at the age of five years underwent a paired living donor kidney transplantation (her husband having blood group incompatibility). She had already received 4 previous kidney transplants at the age of 9 (mother's kidney), 11, 18 and 32 (cadaver kidneys) years old, the last one simultaneously with a heart transplant. Nephrotic syndrome was immediately diagnosed after the first, third and fourth transplantation, with consequent graft failure secondary to FSGS recurrence (histologically documented) at 6 months, 10 years and 7 years, respectively. The second transplant was lost 24-hour after surgery due to unclear reasons. Considering her past medical history, and the presence of a donor-specific antibody (DSA) (anti-DQ7, MFI 10,500) against the swapped donor (positive B-cell flow cytometry crossmatch, negative CDC crossmatch), we implemented a desensitization/preventive protocol including: plasmapheresis at day -7, -5, -4, -3 and -1 before the transplant; rituximab (375 mg/m2) at days -3, +4, +17; IVIg 1 g/kg at day -1, +1, +2, +3, +4 and +16; and occlusion of native renal arteries. Basiliximab was used for induction, and maintenance immunosuppression consisted of cyclosporine (doses adjusted to maintain C2 levels between 700-800 ng/ml), mycophenolate mofetil (2 g/die) and prednisone (5 mg/day). Serum creatinine was 0.4 mg/dl on day +3. The hightest value of proteinuria was 1.283 g/24h on day 3; the next values reduced progressively and proteinuria was 0.224 g/24h at discharge. The patient was discharged on p.o.d. 18. After 7 months of follow-up, the patient has normal renal function (creatinine level of 0.7 mg/dl), no proteinuria, and a very low titer anti-DQ7 antibody (MFI 1,800). Conclusion: This case reflects the possibility to perform a succesful fifth renal transplant in a patient with FSGS and DSA with a new immunosuppressive and surgical approach.

Donor Derived IgA Nephropathy Disappeared after Kidney Transplantation: A Case Report

IgA nephropathy is the most common cause of primary glomerulonephritis in developed world. Approximately 40 to 50 percent of IgA nephropathy patients are presented with gross hematuria, while another 30 to 40 percent only experience microscopic hematruia and/or mild proteinuria, which are detected incidentally on a routine examination. Herein we report a case in which cadaveric donor kidneys were highly suspected of IgA nephropathy by allograft biopsies after renal transplantations. This pathological condition was well tolerated without any difficulties throughout the post-operative course. Moreover, with immunosuppressant therapies, IgA nephropathy was resolved at the six-month follow-up biopsies. Material and method: The donor was 51-year-old male with no significant underlying health problem who became brain-dead after a traumatic head injury. Pre-transplantation serum creatinine was 1.35 mg/dL and urine analysis showed microscopic hematuria and mild proteinuria. Urine output was well-maintained. The kidneys were transplanted without any surgical issues to two end-stage renal disease patients. Results: Post-transplant course of both recipients was uneventful. The creatinine level of the first recipient was continuously decreased from 17.6 mg/dL and was maintained at around 1.3mg/dL. However, the second recipient's creatinine level decreased down slowly to just around 2.3mg/ dL at one month after renal transplant. Renal allograft biopsy from the second recipient was done and the findings of the immunofluorescence microscopy and electron microscopy were compatible with IgA nephropathy rather than CNI toxicity or rejection. Allograft biopsy from the other kidney of the same donor was recommended to determine whether IgA nephropathy had come from the donor or occurred as de novo disease. Interestingly, the other allograft biopsy also showed the same finding, as being compatible with IgA nephropathy. We decided to maintain the same immunosuppresants - taclorimus, MMF, and steroid - for subclinical IgA nephropathy. Follow-up allograft biopsies were both done after six months and IgA nephropathy was resolved. Both kidneys have been maintaining good function for more than two years without any complications. Conclusion: IgA nephropathy is common and asymptomatic in large portion. Therefore, it could be detected incidentally after renal transplant. Maintenance of immunosuppressants might be enough as a treatment option for subclinical IgA nephropathy of renal allograft.

Acute Antibody-Mediated Rejection of the Kidney Transplant

Introduction: Acute humoral rejection occurs in 20% of renal transplant patients. Its prognosis is worse than when it comes to cellular rejection, and it is refractory to conventional immunosuppressive therapy. C4d deposition in peritubular capillaries of the kidney transplant has shown as a sensitive diagnostic marker of acute antibody mediated rejection, which correlates with the presence of circulating donor specific antibodies. Aim of this work was to demonstrate our experiences with therapy and medical treatment results of kidney transplant patients with antibody mediated acute rejection. Patients and methods: Eight kidney transplant patients in whom the acute humoral rejection appeared have been analyzed, out of which four men and four women. The rejection has been proven by biopsy of the kidney transplant and/or the existence of donor specific antibodies. The average age of the patients was 39±14,3 years. The average duration of hemodialysis treatment was 5,9±5 years. In four patients the primary renal disease was glomerulonephritis, pyelonephritis in two, and endemic nephropathy, as well as nephronopthisis in one patient. All patients were subjected to cadaveric kidney transplantation. Three of them had already been transplanted before. In three patients humoral rejection appeared in a month after the operation (4-18 days), and in other five patients in 1-12 years. Results: Two patients were treated with plasmapheresis and intravenous immunoglobulin dose of 2g per kg of body weight in addition to the other means of immunosuppressive therapy. The other six patients were treated only with 2 g per kg of intravenous immunoglobulin together with the other means of immunosuppressive therapy. In seven patients the function of the kidney transplant recovered after the therapy, while in one patient recovery did not occur. Therefore the remaining patient has been subjected to hemodialysis treatment. The average values of serum creatinine (in seven patients) a month after the therapy ranged from 73 μmol/L do 279 μmol/L. In three patients in which the crisis appeared during the first month, a complete recovery of kidney transplant function occured. In six months all of the seven patients had stable transplant function. Conclusion: From the above results, a conclusion can be drawn that the acute hunoral rejection can be treated efficiently in case it is diagnosed on time and treated adequately.

Impact of Machine Perfusion Parameters on Renal Graft Outcomes

Introduction: The aim of the study is to evaluate the machine perfusion parameters as decision making tool in discarding cadaveric kidneys. Methods: Data was collected for all the kidneys preserved with Machine Perfusion (MP) from May 2008 till January 2012. Kidneys were perfused with KPS1 using Life port machine. Machine perfusion parameters were downloaded from Organ Recovery System data station and clinical data was retrieved from prospectively maintained database. Results are expressed as means and percentages. P values were calculated by Chi-square test or Fisher's Exact test as appropriate (< 0.05 is considered statistically significant). Results: A total of 138 kidneys were machine perfused during the study period. Of these 14 were discarded; 2 for renal cell cancer, 3 for vascular injury and 9 for poor perfusion parameters (high resistance, low flow). 124 kidneys were implanted, 13 of them were implanted in seven pairs of dual kidneys whilst the rest were implanted as single grafts. 44 DBD and 80 DCD kidneys were machine perfused. The mean resistance at the termination of perfusion (TR) in both the groups was similar 0.27 vs. 0.26 respectively. Based on resistance the kidneys were divided into three groups Group I: TR < 0.4 (n=106), Group 2: TR = 0.4 to -0.6 (n=12), Group 3: TR ≥ 0.6 (n=6). Primary function (PF) was 57, 58 and 50 % in the three groups respectively (p=1.000). DGF rate was 37.7% (p=0.765), 41.7% (p=0.677) and 50.0% (p=1.000) in group 1, 2 and 3 respectively. Only one PNF was observed in Group 1. One year graft survival (GS) was 92.5%, 91.7% and 83.3%. When graft outcomes were compared to the duration of machine perfusion (table1) and the MP proportion of CIT (table 2), no differences were detected.Table: No Caption available.Table: No Caption available.Conclusion: High resistance values, duration of MP and proportion of MP as function of total CIT do not impact on graft outcome. High resistance values on machine perfusion should not be used as standalone guide to discard kidneysion (table1) and the MP proportion of CIT (table 2), no differences were detected.

Comparison of Time on the Cadaveric Kidney Donor Waitlist Versus Time on the Kidney Paired Donation Registry in the Australian Program

Comparison of Time on the Cadaveric Kidney Donor Waitlist Versus Time on the Kidney Paired Donation Registry in the Australian Program

Old DCD Kidneys to Old Recipients Have An Excellent Outcome; Have We Found the Solution for the Old Patients on the Waiting List?

Introduction: Controlled DCD kidneys represent a valuable source of kidney transplants and in UK represent up to 30% cadaveric kidney transplants. Traditionally DCD kidneys for older donors were either not retrieved or their offer rejected due to fears of marginal renal reserve and very high primary non function (PNF). Older recipients over the age of 65 years represent more than 25% of the total transplant waiting list in our centre. On the basis of that we expanded significantly the acceptance criteria for DCD kidney donors so they now represent 60% of our cadaveric program and 40% of our overall program. Aim and Methods: The aim of this study is to present the preliminary results of the program of transplanting older donor (>60 years old) DCD kidneys to older (>60 years old) recipients to see if it is an appropriate use of these extra resource of organs. Results: In a 2 years period there were 125 DCD donors. Out of them 42 (34% of DCD) were from donors over 60 years old and were transplanted in recipients over 60. Median age of those donors was 69 (range 61-80) years (with 30 of those donors over 65), whereas the median recipient age was 68 (range 60-80) years. Median follow up was 6.5 months. The delayed graft function (DGF; defined as need for dialysis in the first week) was seen in 23 patients (55%) and it lasted a mean of 7.5 days. There was 1 case of PNF (2.4%) and 2 cases of graft failure, one at 3 months due to poor function and one at 6 months. There was 1 sudden cardiac death at home in a 70 years old patient with a GFR of 41at 3 months post transplant. There were 2 acute rejections (5%). MDRD GFR was as follows: Table 1This compares favourably with the 1 year MDRD GFR in all DCD recipients (irrespective of donor or recipient age) of 46 ml/min/1.73m2. Conclusion: Older DCD donors represent an excellent source of transplant kidneys. They have a low PNF, a low rejection rate and a good (at least) short term survival when transplanted in older recipients. The one year kidney function of these kidneys in old recipients is as good as the one year results of all DCD kidneys irrespective of donor and recipient age. Our preliminary results support the use of those ‘marginal’ kidneys in this recipient group.

Donors Older than 70 Years Old Are a Good Source of Cadaveric Kidney Transplants, a Fifteen Years Experience

Donors Older than 70 Years Old Are a Good Source of Cadaveric Kidney Transplants, a Fifteen Years Experience

Campath Induction Significantly Influences Cadaveric Kidney Graft Morphology on 1 and 3 Year Protocol Biopsies

Campath Induction Significantly Influences Cadaveric Kidney Graft Morphology on 1 and 3 Year Protocol Biopsies

Donors Older than 70 Years Old Are a Good Source of Cadaveric Kidney Transplants, a Fifteen Years Experience

Introduction: Due to a significant organ shortage and an increasingly older population, the use of older deceased donors (DD) for kidney transplantation (KT) has increased worldwide. According to UNOS, donors 65 and older represented 5.8% of kidney transplant in 2011 vs 1.9% in 1990. In Canada this number is even higher due to a significantly older population. In this study, we examine graft survival and graft function for DD 70 and older when compared to younger ones. Methods: Patients who underwent a DDKT (n=816) at our institution from 1996 to 2011 were reviewed. DD were divided have into younger (n=775) and 70 and older (n=41). Demographics, death-censored graft survival, graft function subdivided into delayed graft function (DGF), slow graft function (SGF) and normal graft function (NGF) and transplant characteristics(pump, cold and warm ischemia) were collected. Statistical analysis was done using ANOVA for demographics, COX and Kaplan Mayer for survival, logistic regression for graft function and Chi-square or Fisher's exact tests for univarite analysis. Results: Recipient's age was higher in the older (61.7) vs. the younger (51.9) group (p-value< 0.000). Transplant characteristics were similar among groups. The Kaplan-Mayer graft at 1, 5, 10 and 15 years was 97.7%, 88.4%, 79.8% and 71.8% respectively for the younger vs 97.5%, 77.1% and 65.9% for the 70 and older group. After correcting for recipient age, sex and transplant characteristics the survival hazard ratio (HR) was 2.02(95% CI 1.03-3.94,p-value=0.038) in the older vs the younger DD. In a sub-analysis, survival was similar in those aged between 60 and 70 and those older than 70 with a HR of 1.14 (95% CI 0.56-2.35,p-value=0.716). The risk ratio (RR) of DGF in the older group was 1.93 times that in the younger group with a 95%CI1.35-2.80 (p-value=0.004). However the risk of DGF was comparable in those aged between 60 and 70 and those older than 70 (RR1.49,95%CI 0.96-2.27,p-value=0.093). The risks of SGF and NGF were comparable among the younger and older groups.Figure: [Kaplan Meier Survival Estimate]Conclusion: Donors aged 70 and older had a lower death censored graft survival, when compared to younger donors however survival is similar to that of donors aged 60 to 70, as well as DGF. With the scarcity of organs available and rising age of recipients, donors 70 and older could potentially be an important source of cadaveric kidneys.

Comparison of Time on the Cadaveric Kidney Donor Waitlist Versus Time on the Kidney Paired Donation Registry in the Australian Program

Introduction: A kidney paired donation (KPD) program can help patients who have a blood group or HLA incompatible live donor to find an immunologically suitable donor. However, a small number of patients in the pool and a high level of sensitization may prevent them to find suitable matches in a KPD program. The aim of this analysis was to compare waiting time for a KPD match to the waiting time on the deceased donor waitlist (DDWL) and the occurrence of matching in the DDWL for patients who were registered in both programs. Methods: In Australia DDWL patients are matched to potential deceased donors based on HLA antigen matching rules and time on dialysis, with a national priority listing for those with peak PRA >80%. In the KPD program matching is based on acceptable mismatches excluding donors from matching to recipients with DSA >2000 MFI for any class I or II antibodies, ignoring HLA antigen matching. Data on first dialysis, number of matches in the DDWL, entry into the KPD program and KPD match and transplant dates were assessed in 26 KPD recipients in the Australian program. Results: HLA-incompatibility accounted for 90% of the 53 patients in the KPD registry and 58% had a cPRA >75%. Of the 26 patients who received a KPD transplant, 5 were pre-emptive recipients and 21 were recipients who were listed in the DDWL. Time on dialysis was 808±646days (maximum 2003 days) in patients on the DDWL. Time on dialysis was longer for patients with PRA 50-75% compared to >75% (1199±684 vs 575±497days, P< 0.001). Of patients on the DDWL 10 had never been matched with a deceased donor (waiting time 345±237days) and 11 had been matched on average 3±5 times (waiting time 1227±615days, P< 0.0001 vs. never matched) and 3 of these patients had been matched >13 times each. In those patients transplantation was not undertaken because of positive crossmatch. After being registered in the KPD program patients who progressed to KPD transplant had been listed on average for 95±68days (P< 0.0001 compared to time on DDWL) with a range of 13-294days. Conclusion: Our data suggest that in sensitized patients allocation based on HLA-antigen matching is ineffective and is associated with frequent positive XM results. KPD allocation using an approach based on acceptable mismatches is effective in identifying suitable live donors for some recipients within a relatively short time-frame.

No Effect of Bilateral Nephrectomy Prior to Kidney Transplant on the Resistive Indices Measured in the Kidney Graft

Introduction: The cirrhotic kidney is the cause of symphathetic nervous system activation leading to the increased vascular resistance and, in consequence, to arterial hypertension. The impact of unilateral and bilateral nephrectomy before kidney transplantation on the intrarenal resistance in the kidney graft was not assessed. The aim of this study is to analyse the value of intrarenal resistance parameters measured by Doppler ultrasound in the transplanted kidney in nephrectomized or non-nephrectomized kidney transplant recipients. Methods: 561 consecutive first cadaveric kidney graft recipients transplanted from 1998 to 2010 were analyzed. Patients with primary graft nonfunction and acute rejection episodes within an early posttransplant period were excluded from the study. 35 patients after bilateral (B) and 43 patients after unilateral (U) nephrectomy performed prior to transplant were identified. We analyzed both pulsatility (PI) and resistance (RI) indices in the kidney graft measured by Doppler sonography before the discharge from the hospital [at mean 22 (95%CI 21-25) posttransplant day]. Results: Neither bilateral nor unilateral nephrectomy had the influence on both PI and RI values. The mean PI and RI values were 1.51±0.39 and 0.75±0.08 in B, 1.52±0.39 and 0.76±0.09 in U and 1.47±0.41 and 0.74±0.08 in non-nephrectomized patients, respectively. Both PI and RI were correlated with recipient's but not donor's age. There was no difference in recipient's and donor's age, BMI between study groups. The prevalence of hypertension in the follow-up period after transplantation was significantly lower in B group (72% vs. 89% in non-nephrectomized patients). Conclusion: Bilateral nephrectomy prior to transplantation decreases the prevalence of posttransplant hypertension but does not affect the intrarenal vascular resistance measured in the kidney graft.

Nutritional Status and Intrarenal Resistive Indices after Kidney Transplantation

Background: Accumulation of adipose tissue is an important factor known to initiate and accelerate the development of atherosclerosis. On the other hand, intrarenal resistive indices are associated with age, surrogates of atherosclerosis (intima-media thickness, pulse wave velocity, ankle-brachial blood pressure index) and past cardiovascular episodes in kidney transplant patients. The aim of this study is to analyze the influence of nutritional status on intrarenal resistive parameters measured by Doppler ultrasound in an early period after kidney transplantation. Methods: 552 consecutive first cadaveric kidney graft recipients transplanted from 1998 to 2010 were analyzed. Patients with primary graft nonfunction and acute rejection episodes within an early posttransplant period were excluded from the study. Nutritional status was scored according to WHO criteria. Both pulsatility (PI) and resistance (RI) indices in the kidney graft were measured by Doppler sonography twice: at 2-4 day after transplant and before the patient's discharge from the hospital [at mean 22 (95%CI 21-23) posttransplant day]. Results: There was 30 underweight (UW), 295 normal weight (NW), 188 overweight (OW) and 39 obese (OB) in the analyzed group. In both measurements PI and RI values were significantly higher (p< 0.02) in obese than in underweight and normal weight patients. In the first measurement, PI and RI were as followed: UW 1.57 (1.32-1.82) and 0.76 (0.71-0.81); NW 1.60 (1.53-1.67) and 0.79 (0.77-0.80); OW 1.68 (1.59-1.76) and 0.82 (0.80-0.84); OB 2.02 (1.81-2.23) and 0.87 (0.84-0.91), respectively. While, in the second measurement they were: UW 1.35 (1.27-1.43) and 0.71 (0.69-0.73); NW 1.43 (1.39-1.48) and 0.73 (0.72-0.74); OW 1.53 (1.47-1.59) and 0.75 (0.74-0.76); OB 1.70 (1.51-1.88) and 0.79 (0.76-0.81), respectively. In the multiple regression analysis, the influence of BMI on PI and RI values was independent of diabetes mellitus comorbidity and the recipient's age. Conclusions: 1. Obesity is associated with increased vascular resistance within the kidney graft. 2. Nutritional status has to be taken under consideration in the proper interpretation of intrarenal Doppler measurements in these patients.

Ambulatory Blood Pressure Monitoring in Kidney Transplant Patients: RETENAL Study

Hypertension is common following renal transplantation, affecting up to 80% of transplant recipients. It is generally accepted that hypertension is associated with poor graft survival and reduced life expectancy, contributing to increased cardiovascular risk factors and mortality rates. The aim of the study was to compare the blood pressure (BP) control in kidney transplant patients through the use of ambulatory BP monitoring (ABMP) versus office BP measurements (oBP). A multicenter, cross-sectional, observational study was conducted in 30 nephrology/kidney transplant units. Eligible patients included hypertensive cadaveric kidney transplant recipients aged <70 years, with a functioning kidney for at least 1 year and with an estimated glomerular filtration ≥30 mL/min/1.73 m2 and a serum creatinine < 2.5 mg/dL. Recorded data included demographic characteristics, oBP, and ABPM and labroatory investigations. The 868 patients showed a mean recipient age of was 53.2 ± 11.6 years and mean follow-up after transplantation, 5.5 ± 2.8 years. Mean systolic and diastolic oBP were 140.2 ± 18 and 80.4 ± 10 mm Hg, respectively. Seventy-six percent of patients had oBP higher than or equal to 130/80 mm Hg. Mean 24 hour ABPM were 131.5 ± 14 and 77.4 ± 8.7 mm Hg for systolic and diastolic BP, respectively. Using the ABPM, we observed that 36.5% of subjects were controlled (mean 24-hour BP < 130/85 mm Hg). The two methods (oBP and ABPM) showed significant agreement. After ABPM, 65% of patients diagnosed as true controlled hypertension were considered to have white-coat RH. In clinical practice ABPM may help for better adjustment of drugs for adequate BP control.

Impact of Machine Perfusion Parameters on Renal Graft Outcomes

Introduction: The aim of the study is to evaluate the machine perfusion parameters as decision making tool in discarding cadaveric kidneys. Methods: Data was collected for all the kidneys preserved with Machine Perfusion (MP) from May 2008 till January 2012. Kidneys were perfused with KPS1 using Life port machine. Machine perfusion parameters were downloaded from Organ Recovery System data station and clinical data was retrieved from prospectively maintained database. Results are expressed as means and percentages. P values were calculated by Chi-square test or Fisher's Exact test as appropriate (< 0.05 is considered statistically significant). Results: A total of 138 kidneys were machine perfused during the study period. Of these 14 were discarded; 2 for renal cell cancer, 3 for vascular injury and 9 for poor perfusion parameters (high resistance, low flow). 124 kidneys were implanted, 13 of them were implanted in seven pairs of dual kidneys whilst the rest were implanted as single grafts. 44 DBD and 80 DCD kidneys were machine perfused. The mean resistance at the termination of perfusion (TR) in both the groups was similar 0.27 vs. 0.26 respectively. Based on resistance the kidneys were divided into three groups Group I: TR < 0.4 (n=106), Group 2: TR = 0.4 to -0.6 (n=12), Group 3: TR > 0.6 (n=6). Primary function (PF) was 57, 58 and 50 % in the three groups respectively (p=1.000). DGF rate was 37.7% (p=0.765), 41.7% (p=0.677) and 50.0% (p=1.000) in group 1, 2 and 3 respectively. Only one PNF was observed in Group 1. One year graft survival (GS) was 92.5%, 91.7% and 83.3%. When graft outcomes were compared to the duration of machine perfusion (table1) and the MP proportion of CIT (table 2), no differences were detected.Table: No Caption available.Table: No Caption available.Conclusion: High resistance values, duration of MP and proportion of MP as function of total CIT do not impact on graft outcome. High resistance values on machine perfusion should not be used as stand-alone guide to discard kidneysion (table1) and the MP proportion of CIT (table 2), no differences were detected.