Cadaveric Kidney Research Articles

My Journey Through a Kidney Transplant Procedure.

My Journey Through a Kidney Transplant Procedure James Moran Polycystic Kidney Disease is hereditary. My grandmother died at home before dialysis was readily available. My mother, uncle, and great aunt all had dialysis treatments for extended periods of time and eventually died. My uncle was most fortunate in that he had a heart attack while on dialysis. My mother and great aunt suffered through the disease before it consumed them. The magic age for adult onset PKD requiring dialysis is in the early fifties. First diagnosed at age 25, I watched my creatinine levels increase over the years and knew what awaited me. I was 52 when my nephrologist said it was time for me to have the surgical procedure to attach a vein to an artery in my left arm. This arteriovenous fistula is the access point for dialysis. He said that I would probably need dialysis within about three months. It was about one year more before I really needed it. Even though it was an eventuality we had expected for over 25 years, my wife said: “I thought we had more time.” I considered myself fortunate to have dialysis available and so close. The center was about ten minutes from my house. The 5:30 AM appointment time was not my first choice, but it did enable me to continue working and still have evenings at home with my family. The initial few months are called the “honeymoon” period. Things were going well, I was tolerating the treatments, and I felt better. Why would I need a transplant? I attended a pre-transplant session at a hospital at my wife’s insistence. I really had reservations about the process. Except for the out-patient AV fistula surgery, I had not been “under the knife” and never had a hospital stay. A pre-transplant session at a different hospital was even more graphic and made me less enthusiastic. Eventually, dialysis became more difficult and I felt more fatigued. It was more disruptive and vacations always created scheduling issues. Both hospitals as well as the dialysis team, encouraged me to look for a live donor. They suggested that I contact family members and friends to tell them I was in need of a kidney donor. My oldest son who was 21 at the time offered immediately without being asked. Personally, I felt reluctant to put someone else at risk for me even though they assured me that the donor would remain safe and my outcome would be better. I reluctantly placed myself on the transplant list and received dialysis for about four years before a cadaver kidney became available. The story of the call from the transplant clinic was interesting. My transplant surgeon had told me that I would need a bilateral nephrectomy because my polycystic kidneys were large and infected. He said that they needed to be removed before the transplant, but the removal should be delayed until I was closer to the top of the transplant list as it would add extra stress on my body. After about three years on dialysis, I received my first call. I declined the kidney and scheduled the nephrectomy. This surgery was difficult and I was in a lot of pain. The following year was brutal while I waited for the next call. Without my native kidneys, I was no longer producing urine and I had severe limitations on fluid intake. This was most unbearable during hot summer days. The long wait between the first and second calls was exacerbated by a nearby transplant center being closed as people transferred their wait time to the center on which I was listed. In the ideal scenario, I would have received a call soon after the nephrectomy had healed. The second call came while I was on a Boy Scout camping trip. I had been involved in Boy Scouts for 25 years in varying capacities but many as Scout-master and frequently camping. I probably spent several hundred nights in a tent. On this trip, I had no cell signal inside the camp. My wife received the call at home and, after failing to reach me, drove to our camp and walked...

194-LB: Tacrolimus-Induced Hyperglycemic Emergencies in Posttransplant Patients—A Case Series

Introduction: Tacrolimus is effective immunosuppressant in posttransplant patients. It inhibits calcineurin and prevents T cell activation. Post-transplantation diabetes mellitus (PTDM) is a well-established adverse effect of tacrolimus. We report the rare occurrences of DKA and hyperosmolar hyperglycemia syndrome respectively in 2 patients on tacrolimus after renal transplants. Description Case 1: A 25 year old obese (BMI 37.7 kg/m2) black female with no history of DM received a live donor kidney transplant. She was on mycophenolate 720 mg po bid, tacrolimus 7 mg po bid, and prednisone 5 mg daily. Eleven weeks after transplant she presented with polyuria and polydipsia and was admitted for DKA. Labs revealed glucose 1000 mg/dL (74-106) , HCO3 7.0 meq/L (21-32) , beta-hydroxybutyric acid 8.4 mg/dL (0.2 - 2.8) , tacrolimus trough levels 19.6 ng/mL (4.1 - 10.7) . Her A1c was 10.6% compared to 5.3% pre-transplant. Case 2: A 50 year old obese (BMI 35.6 kg/m2) black female with no prior history of DM received a cadaveric kidney transplant due to ESRD. Patient was on mycophenolate 360 mg bid, and tacrolimus 8 mg bid. She was admitted to hospital for HHS 9 weeks later. Labs revealed a glucose 940 mg/dL, serum osmolality 341 msom/kg (275-295) , HCO3 22 mmol/L, tacrolimus trough levels 12.1 ng/mL. Her A1c was 8.7% compared to 5.3% pre-transplant. Discussion: Our 2 patients with no history of DM developed hyperglycemic emergencies within 3 months of receiving kidney transplants and initiating tacrolimus. Both responded well to IV fluids and insulin and were transitioned to SQ insulin by discharge. Risk factors for post-transplant de novo DKA and HHS common to both patients were African American ethnicity, high BMI, and tacrolimus treatment with elevated trough levels. Tacrolimus inhibits insulin secretion and is linked to increased rates of PTDM, which is often reversible with tacrolimus dosage reduction. Both of our patients were prescribed tacrolimus at reduced dosage and were scheduled for outpatient Endocrine clinic evaluation to determine whether they should continue insulin treatment. Disclosure S. Gupta: None. D. Lovre: Other Relationship; AstraZeneca, Bayer AG, Novo Nordisk. R. Galagan: None.

The Anatomy of Renal Arteries in Adults

Abstract Detailed extraparenhymal renal hilar dissection was performed on 110 fixed cadaveric kidneys (60 from male cadavers and 50 from female cadavers). We analyzed the number of renal arteries, angles between renal arteries and abdominal aorta, length and diameter of the renal arteries. Multiple renal arteries were present in 20.9% of cases, with a slightly higher incidence on the right side (21.8%: 20.0%). The angle between the aorta and the RRA varied from 30° to 100° with a mean of 64.1°, while the angle between the abdominal aorta and the LRA was 40° to 115°, with a mean of 67.3°. The external caliber of the RRA at the point of origin from the abdominal aorta was 5 mm to 9.1 mm, with a mean of 6.8 mm. The same caliber of the LRA was 3.7 to 9.6 mm with a mean of 7.0 mm. The average length of the renal artery from the point of origin from the abdominal aorta to the branching point was 36.2 mm for the right renal artery and 30.7 mm for the left renal artery. The average length of the renal artery from the point of origin from the abdominal aorta to the renal hilum was 65.1 mm for the right one and 54.7 mm for the left one. Knowledge of the number of renal arteries, their mode of entry into the kidney, the angles they build with the abdominal aorta, their diameter and length has practical applications in interventional radiology and surgery of the kidney and its environment.

Successful Treatment of Transplanted Kidney Patient with 100% Lung Damage Caused by COVID-19 Bilateral Pneumonia: a Clinical Case

Background. The new SARS-CoV-2 coronavirus infection is understudied; despite its worldwide prevalence, case reports of organ transplant recipients are rare.Aim. A dynamics evaluation and treatment outcome improvement in a transplanted cadaveric kidney patient with 100% parenchymal lung damage caused by SARS-CoV-2 coronavirus bilateral pneumonia.Materials and methods. We describe a successful treatment case of a transplant kidney patient having the new coronavirus infection (COVID-19) (of 03.12.2020). COVID-19 pneumonia was diagnosed on day 7 of the early post-transplant period. On day 14, the patient was admitted to an infectious ward and transferred to intensive care upon disease aggravation. Despite ongoing treatment, pulmonary parenchymal lesion reached 100% in CT scan on 24.12.2020. The patient was transferred to Surgery Unit No. 3 for further therapy on 11.01.2021 upon revealing a clinical improvement, positive laboratory dynamics and SARS-CoV-2-negative smear PCR tests. The patient was discharged for outpatient treatment on day 10.Results and discussion. No evidence of focal infiltrative pulmonary change was detected in control chest CT after 4 months. Within 5 months since discharge, there were observed a general well-being improvement, 98% oxygen saturation, absent oedema, satisfactory transplanted kidney function.Conclusion. Post-kidney-transplant patients are particularly susceptible to infection due to inherent chronic immunosuppression. The presented case of a kidney transplant patient having a favourable COVID-19 outcome demonstrates the efficacy of a timely treatment.

MO1005: Analysis of Expression of Immune System Genes that are Responsible for Activation and Inhibition of T-Cell Immune Response in Renal Transplant Recipients after Extracorporeal Photochemotherapy

Abstract BACKGROUND AND AIMS Due to the increasing need for kidney transplantation, there is a demand for new methods of preventing rejection of the transplant based on the mechanisms of natural regulation of the immune response. Extracorporeal photopheresis (ECP) is one of these technologies whose clinical efficacy in the prevention and treatment of acute renal transplant rejection has been confirmed by many studies, but the mechanism of its effect has not been fully understood. Characterization of the genes responsible for the activation and inhibition of the immune response during ECP is an important step towards the modification of immunosuppressive therapy. The aim of this study was to analyze the changes in the expression level of the genes responsible for the activation and inhibition of the T-cell response in the recipients of the renal graft after ECP. METHOD An open cohort randomized trial was conducted with 20 patients who underwent a single group cadaver kidney transplantation from an unrelated donor. The recipients of the compared groups received standard immunosuppressive therapy and the same therapy in combination with ECP procedures, according to the study protocol. Each recipient of the main group received 15 sessions of ECP within 6 months. The level of gene expression was analyzed by real-time RT-PCR. Comparison of the study groups was carried out at point 1 (1st–4th day) and 2 (30th day). RESULTS The analysis of clinical data did not show statistically significant clinical differences, but in the specific consideration of each pair of cases, the tendency to some improvement in the transplant organ engraftment rate in the early terms after the transplant, and better survival of the graft and the recipient was revealed. For instance, patients of the main group revealed no transplant rejection by clinical laboratory signs as well as the results of histological examination of biopsy specimens. In the comparison group, acute graft rejection was clinically diagnosed and was confirmed by histological examination as humoral type rejection. The level of expression of genes involved in immune response regulation (CD28, CTLA4, PDL1 and FOXP3) and cytokine genes (TNFA, IL1, IL2, IL10 and IFNG) in the studied groups was determined. A decrease in the level of expression of the genes for the proinflammatory cytokines IL1, IL2 and IFNG was noted by the 30th day after transplantation. At the same time, the expression of the genes PDL1 and FOXP3, which regulate the development of the regulatory response, significantly increased by the 30th day after transplantation. Correlations of the level of gene expression with the presence/absence of rejection episodes have not been established. To assess the effect of the ECP on these gene expression, a comparison was made of the level sof transcript representation of patients receiving standard immunotherapy and immunotherapy in combination with ECP, and a significant increase in the expression of PDL1 and FOXP3 genes (Fig. 1A and B) was found in the group of patients who underwent ECP procedures (P = .0009 and .0013, respectively). CONCLUSION According to the results of comparative analysis, the level of expression of pro-inflammatory cytokines' genes IL1, IL2 and IFNG decreased to the 30th day after transplantation. A 30-day comparison between groups shows an increase in the expression level of the PDL1 and FOXP3 genes. Increased expression of these genes may be associated with the activation of regulatory T-cells and the development of peripheral tolerance and can become a criterion for the modification of immunosuppressive therapy.

MP14-04 IN VIVO AND BENCH TESTING OF A CONCEPT SINGLE USE URETEROSCOPE BSC COMPARED TO REFERENCE SINGLE USE AND REUSABLE URETEROSCOPES

You have accessJournal of UrologyCME1 May 2022MP14-04 IN VIVO AND BENCH TESTING OF A CONCEPT SINGLE USE URETEROSCOPE BSC COMPARED TO REFERENCE SINGLE USE AND REUSABLE URETEROSCOPES Naeem Bhojani, Nabil Shalabi, K. F. Victor Wong, Roman Herout, Alina Reicherz, and Ben H. Chew Naeem BhojaniNaeem Bhojani More articles by this author , Nabil ShalabiNabil Shalabi More articles by this author , K. F. Victor WongK. F. Victor Wong More articles by this author , Roman HeroutRoman Herout More articles by this author , Alina ReicherzAlina Reicherz More articles by this author , and Ben H. ChewBen H. Chew More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002543.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The introduction of the first single use ureteroscope over 5 years ago established a new paradigm in the surgical management of kidney stone disease and since then several new single use ureteroscopes have been developed. Furthermore, improvements in chip technology, resolution and maneuverability have been employed in this newer generation of single use ureteroscopes. This study sought to objectively test if a concept single use ureteroscope (Boston Scientific, USA, concept device, not available for sale) with pressure monitoring technology is able to achieve comparable optical performance and maneuverability as reference single use and reusable ureteroscopes. METHODS: We bench tested 3 single-use ureteroscopes, 1 reusable ureteroscope and the new concept Boston Scientific single-use ureteroscope with pressure monitoring technology. All scopes were brand new. Optical characteristics as well as manoeuverability were compared. Resolution was measured using a 1951 USAF 3x3 inch, positive Resolution Target at distances of 10mm, 20mm and 30mm using 5 different solutions. Field of view was measured. Manoeuverability and visualization was measured in cadaveric kidneys and 2 anesthetized farm pigs. Finally, pressure studies using a pressure sensing calibrator (ElveFlow OB1 Pressure Controller) was used to determine accuracy of the BSC concept device. RESULTS: The 365 micron laser fiber significantly decreased deflection for all scopes (Fig 1) and resolution significantly decreased for most scopes with increasing distance (Fig 2). Field of view of the BSC concept scope was found to be wider than all other scopes (Fig 3). Manoeuverability of scopes was found to be comparable. Notably, pressure readings from the concept scope and the pressure sensing calibrator strongly corelated with each other (r=0.9983) (Fig 4). CONCLUSIONS: In this non-clinical study, concept ureteroscope with pressure monitoring technology was found to achieve comparable optical performance and maneuverability as the reference single use and reusable ureteroscopes. In regard to the pressure measurement capability, the readings from the concept single use flexible ureteroscope were comparable to the pressure sensing calibrator. Source of Funding: This work was supported by Boston Scientific Inc © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e232 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naeem Bhojani More articles by this author Nabil Shalabi More articles by this author K. F. Victor Wong More articles by this author Roman Herout More articles by this author Alina Reicherz More articles by this author Ben H. Chew More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP32-02 DEVELOPMENT OF AN AUTOMATED IRRIGATION SYSTEM SYNCHRONIZED WITH AN ULTRA-MINIATURE FIBER-OPTIC PRESSURE SENSOR FOR REGULATING INTRAPELVIC PRESSURE DURING URETEROSCOPY: AN EX VIVO PRECLINICAL STUDY

You have accessJournal of UrologyCME1 May 2022MP32-02 DEVELOPMENT OF AN AUTOMATED IRRIGATION SYSTEM SYNCHRONIZED WITH AN ULTRA-MINIATURE FIBER-OPTIC PRESSURE SENSOR FOR REGULATING INTRAPELVIC PRESSURE DURING URETEROSCOPY: AN EX VIVO PRECLINICAL STUDY Takashi Yoshida, Tadao Matsunaga, Noriko Tsuruoka, Hidefumi Kinoshita, and Youichi Haga Takashi YoshidaTakashi Yoshida More articles by this author , Tadao MatsunagaTadao Matsunaga More articles by this author , Noriko TsuruokaNoriko Tsuruoka More articles by this author , Hidefumi KinoshitaHidefumi Kinoshita More articles by this author , and Youichi HagaYouichi Haga More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002581.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although irrigation flow is essential for maintaining clear visibility and a safe surgical field during flexible ureteroscopy (f-URS), increased intrapelvic pressure (IPP) can be associated with pyelovenous or pyelocaliceal backflow, leading to the risk of febrile urinary tract infection and sepsis postoperatively. This study aimed to assess the feasibility of our automated irrigation system synchronized with an ultra-miniature fiber-optic pressure sensor for regulating IPP in the preclinical setting. METHODS: A fresh cadaveric porcine kidney was used. A 6Fr nephrostomy catheter attached to a pressure transducer and the tip of the 10/12Fr ureteral access sheath (UAS) were placed on the renal pelvis of this model. A fiber-optic pressure sensor, which consisted of a diaphragm pressure sensor (Φ250 μm) and a 2-m optic fiber (Φ140 μm), was set in the working channel of a ureteroscope. The correlation of measured IPP between the fiber-optic pressure sensor and the pressure transducer was assessed. Further, we investigated whether an automatic system could accurately regulate IPP during f-URS. RESULTS: High correlations between the two sensors at each irrigation pressure value (60, 100, 120, and 180 mbar) were observed (all, r=>0.7, p <0.001), likewise when performing bolus irrigation (r=0.98, 95% CI 0.97-0.98, p <0.001). When changing the IPP set value from 5 to 20 mmHg or 20 to 5 mmHg, this automated irrigation system smoothly regulated IPP without overshooting. During the f-URS procedure, although a great change in pressure was observed after insertion or removal of the ureteroscope in the UAS, IPP was immediately and accurately regulated by this system when reaching the renal pelvis. CONCLUSIONS: We developed a new automated irrigation system using an ultra-miniature fiber-optic pressure sensor for controlling IPP during ureteroscopy. This system was a prototype for preclinical use; however, it was feasible and facilitated safety optimization via IPP regulation during f-URS. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e531 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takashi Yoshida More articles by this author Tadao Matsunaga More articles by this author Noriko Tsuruoka More articles by this author Hidefumi Kinoshita More articles by this author Youichi Haga More articles by this author Expand All Advertisement PDF DownloadLoading ...

Successful surgical correction of ascending aortic dissection in a kidney transplant patient

Cardiovascular disease is the leading cause of death in patients with a transplanted kidney and in graft loss. We present the first clinical case of successful surgical correction of ascending aortic dissection (DeBakey type I) in a young patient with a functioning kidney graft. The patient underwent the first cadaveric kidney transplantation (KTx), which was complicated by acute humoral rejection and suboptimal graft function. High blood pressure, anemia, elevated blood levels of triglycerides, phosphorus, parathyroid hormone, and uric acid were recorded. A repeat KTx was performed five years later; the patient’s condition and kidney function were satisfactory. Three years later,the patient started experiencing severe pain along the thoracic and lumbar spine; his blood creatinine level was 408 μmol/L. Computed tomography and echocardiography diagnosed DeBakey type I aortic dissection (AD) with critical narrowing of the true aortic lumen at certain levels, dissection of aortic branches. Aortic resection surgery with prosthetic replacement of the ascending aorta according to David procedure with reimplantation of coronary artery orifices according to Kouchoukos technique, prosthetic replacement of the aortic arch with debranching of brachiocephalic artery and left common carotid artery were successfully performed as planned under endotracheal anesthesia, cardiopulmonary bypass and selective pharmacological cold cardioplegia. The peculiarities of the course, possible causes and outcomes of surgical correction of thoracic AD in the patient are discussed.

Malignancy Prevalence in the Dialyzed Population and in Waitlisted Potential Kidney Transplant Recipients

Malignancy is the second cause of death in the dialyzed population. However, data on the prevalence of cancer are very scarce. Kidney transplantation improves quality of life, prolongs survival, and is cost-effective but bears some serious complications including malignancy. Therefore, active screening for cancer is of utmost importance. The aim of this study was to assess the prevalence of malignancy in dialyzed patients in relation to status on the on the waiting list and type of dialysis. This cross-sectional study was conducted in 108 hemodialyzed patients (mean age 65 years, 47 women) and 47 peritoneally dialyzed patients (mean age 51 years, 25 women). Among the population studied, 20 patients were actively waitlisted, including 14 peritoneal dialysis patients. Patients who had been active on the cadaver kidney waiting list and not listed did not differ in regard to sex, dialysis vintage, and causes of end-stage renal failure, but were significantly younger. Among hemodialysis patients, 24 of them had a history of malignancy and 10 in the peritoneal dialysis population. The most common were renal cell carcinoma in 6, breast cancer in 4, lung cancer in 3, prostate cancer in 3, hepatocellular cancer in 2, colorectal cancer in 2, esophageal cancer in 2, and others 14. In waitlisted patients, only 2 hemodialysis patients had a history of malignancy. Waitlisted patients represent a very selected and healthier dialyzed population. Malignancy has become a more common comorbidity in dialyzed patients, which may have important clinical implication regarding therapy. Guidelines for cancer screening in potential transplant recipients should be developed, as nowadays there are scarcity of data in this matter.

V39 - Training in transplantation - the development of a porcine cadaveric kidney retrieval course

V39 - Training in transplantation - the development of a porcine cadaveric kidney retrieval course

Laparoscopic hand-assisted donor heminephrectomy in living donor with horseshoe kidney. Case study

Report of our clinical case of laparoscopic hand-assisted donor heminephrectomy in living donor with horseshoe kidney (Horseshoe kidne) has a good innovation in donor kidney retrieval technique and particularly in case of congenital anomalies. Kidney transplantation is a “gold standard” of treatment of chronic kidney disease in terminal stage. Nowadays there is a strong deficit of donor organs. Due to undeveloped cadaveric kidney transplantation we always try to accept donors with different anatomic particularities. In our practice we perform traditionally laparoscopic hand-assisted donor nephrectomy either in case of single artery and vein or multiple vessels. This case is a report of kidney transplantation from 65 –years old woman for her 39-years old son with end-stage renal disease (ESRD). Technical challenge was due to that donor had a Horseshoe kidne with parenchymal isthmus, with 4 arteries on right half and 2 arteries on the left with retrocaval position of the latters. We performed literature review for similar cases and found out that usually open laparotomy was performed in this patients. So we decided not to change the familiar for us technique in this case also. Donor underwent laparoscopic hand-assisted donor heminephrectomy with subsequent successful implantation of graft and immediate function.

Spontaneous esophageal hematoma after kidney transplantation

Spontaneous esophageal hematoma is an extremely rare pathological condition, diagnosed mainly in patients with coagulopathy. We present the rarest case report of spontaneous esophageal hematoma, which occurred on the 5th day after allogeneic cadaveric kidney transplantation in a 53-year-old woman. Early diagnosis and treatment helped to achieve complete hematoma regression without complications.

Deep learning segmentation of glomeruli on kidney donor frozen sections.

Purpose: Recent advances in computational image analysis offer the opportunity to develop automatic quantification of histologic parameters as aid tools for practicing pathologists. We aim to develop deep learning (DL) models to quantify nonsclerotic and sclerotic glomeruli on frozen sections from donor kidney biopsies. Approach: A total of 258 whole slide images (WSI) from cadaveric donor kidney biopsies performed at our institution ( ) and at external institutions ( ) were used in this study. WSIs from our institution were divided at the patient level into training and validation datasets (ratio: 0.8:0.2), and external WSIs were used as an independent testing dataset. Nonsclerotic ( ) and sclerotic ( ) glomeruli were manually annotated by study pathologists on all WSIs. A nine-layer convolutional neural network based on the common U-Net architecture was developed and tested for the segmentation of nonsclerotic and sclerotic glomeruli. DL-derived, manual segmentation, and reported glomerular count (standard of care) were compared. Results: The average Dice similarity coefficient testing was 0.90 and 0.83. And the , recall, and precision scores were 0.93, 0.96, and 0.90, and 0.87, 0.93, and 0.81, for nonsclerotic and sclerotic glomeruli, respectively. DL-derived and manual segmentation-derived glomerular counts were comparable, but statistically different from reported glomerular count. Conclusions: DL segmentation is a feasible and robust approach for automatic quantification of glomeruli. We represent the first step toward new protocols for the evaluation of donor kidney biopsies.

Role of the macula densa sodium glucose cotransporter type 1-neuronal nitric oxide synthase-tubuloglomerular feedback pathway in diabetic hyperfiltration

An increase of glomerular filtration rate (GFR) is a common observation in early diabetes and is considered a key risk factor for subsequent kidney injury. However, the mechanisms underlying diabetic hyperfiltration have not been fully clarified. Here, we tested the hypothesis that macula densa neuronal nitric oxide synthase (NOS1) is upregulated via sodium glucose cotransporter type 1 (SGLT1) in diabetes, which then inhibits tubuloglomerular feedback (TGF) promoting glomerular hyperfiltration. Therefore, we examined changes in cortical NOS1 expression and phosphorylation, nitric oxide production in the macula densa, TGF response, and GFR during the early stage of insulin-deficient (Akita) diabetes in wild-type and macula densa-specific NOS1 knockout mice. A set of sophisticated techniques including microperfusion of juxtaglomerular apparatus invitro, micropuncture of kidney tubules invivo, and clearance kinetics of plasma fluorescent-sinistrin were employed. Complementary studies tested the role of SGLT1 in SGLT1 knockout mice and explored NOS1 expression and phosphorylation in kidney biopsies of cadaveric donors. Diabetic mice had upregulated macula densa NOS1, inhibited TGF and elevated GFR. Macula densa-selective NOS1 knockout attenuated the diabetes-induced TGF inhibition and GFR elevation. Additionally, deletion of SGLT1 prevented the upregulation of macula densa NOS1 and attenuated inhibition of TGF in diabetic mice. Furthermore, the expression and phosphorylation levels of NOS1 were increased in cadaveric kidneys of diabetics and positively correlated with blood glucose as well as estimated GFR in the donors. Thus, our findings demonstrate that the macula densa SGLT1-NOS1-TGF pathway plays a crucial role in the control of GFR in diabetes.

20 años de experiencia en trasplante renal en bloque de donantes pediátricos en receptores adultos

BackgroundEn bloc kidney transplantation from pediatric donors into adult recipients increases the donor pool. However, this surgical procedure is not widely performed in many transplant centers. To evaluate the long-term outcomes of bloc kidney transplantation from pediatric donors into adult recipients in a single center. Material and methodsRetrospective analysis of 42 patients who received pediatric cadaveric bloc kidney transplantation in our center since 1999. Median follow-up period was 73 months (5-233) in which renal function tests were taken and complications registered. ResultsWe have performed 42 bloc kidney transplantation from pediatric donors into adult recipients in our center. The recipients’ age was 44.1±11.8 years. Pediatric donors were 22.4±14.7 months old and weighted 11.3±3.6kg. Cold ischemia time was 15.7±4.5hours. During a median follow-up of 73 months, 35 patients (83.3%) had graft survival with excellent function (first-year serum creatinine levels of 0.99±0.25mg/dl). There were 7graft losses (16.7%) in the immediate postoperative period (4 cases of vascular thrombosis, one anastomosis dehiscence and 2cortical necrosis). ConclusionsThe pediatric en bloc renal graft transplantation into adults is a safe technique with excellent medium- to long-term functional performance. The vast majority of significant complications leading to graft loss were reported in the immediate postoperative period. A good selection of donors and recipients as well as an adequate surgical technique are essential to minimize the occurrence of adverse events.

Diagnostic Role of Dopplerography of Renal Vessels in Patients with Late Dysfunction of the Transplanted Kidney

Aims: Search for non-invasive methods for diagnosing late transplant kidney dysfunction, which can improve control and monitor the condition of the kidney transplant, characterization diagnostic role of dopplerography of renal vessels in patients with late dysfunction of the transplanted kidney.&#x0D; Study design: When conducting dopplerometry, blood flow indices were analyzed from 3 to 6 cycles of heart contractions, followed by an averaged indicator. In addition, the linear blood flow velocity was assessed separately from the renal vein.&#x0D; Place and Duration of Study: For the period 2016-2017 Ultrasound of an allopod was performed in 60 recipients of RT (RENAL TRANSPLANT) in the late postoperative period.&#x0D; Methodology: The average age of the patients was 38.89 ± 1.52 years. There were 34 men (56.6 7%), 26 women (43.33%). All patients were divided into two groups: patients with preserved function and patients with RT (RENAL TRANSPLANT) dysfunction. Related kidney transplantation (RRT) was performed in 55.0% of patients, in 45.0% - cadaveric kidney transplantation (CKP). The groups were comparable in the main clinical and demographic parameters.&#x0D; Results: The reverse dynamics was observed when examining the level of the renal filtration function indicator, the estimated glomerular filtration rate (SKF) - at a TAMX level of more than 15 cm/sec, glomerular filtration was 51.18 ± 1.93 (47.32-55.04) ml/min (p &lt;0.01), and with a decrease in TAMX of less than 15 cm/sec, the level of SKF decreased significantly, more than twice, to the level of 25.40 ± 2.19 (21.02-29.78) ml/min &lt;0.001).&#x0D; Conclusion: The determination of dopplerographic parameters for TP with preserved and especially with impaired depuration function with a direct assessment of TAMX opens up wide opportunities in non-invasive assessment of RT (RENAL TRANSPLANT) changes, identification of developing complications, as well as improved transplant survival.

ОСОБЕННОСТИ ВЫПОЛНЕНИЯ ТРАНСПЛАНТАЦИИ ТРУПНОЙ ПОЧКИ

Purpose of the study: Reducing the risk of early postoperative complications associated with the disorder of the blood supply to the donor’s ureter while carrying out the transplantation of a cadaveric kidney. Material and methods: The analysis of a complicated course of the postoperative period, associated with the peculiarities of the blood supply to the donor’s ureter, was carried out for 20 out of 410 (4.9%) patients with chronic renal failure, who had the cadaveric kidney transplanted in Brest regional clinical hospital from 2011 to 2020. Results: A technique of determining the anatomical benchmarks indicating the location of the vessels that feed the donor’s ureter has been developed. Mastering specific technical methods used during the preparation of the renal allograph and its implantation, made it possible to reduce the number of urological complications after kidney transplantation by more than 2 times, and the number of cases of postoperative necrosis of the ureter by 4 times. Conclusions: The proposed surgical techniques make it possible to reduce the risk of postoperative complications associated with the violation of the blood supply of the donor’s ureter while transplanting the cadaveric kidney.

What Has Changed with the Implementation of National Cadaveric Kidney Allocation Policy in Turkey?

What Has Changed with the Implementation of National Cadaveric Kidney Allocation Policy in Turkey?

Cadaveric kidney allotransplantation at Krasnoyarsk Regional Clinical Hospital

Objective: to evaluate the early and long-term outcomes of cadaveric kidney allotransplantation (CKAT) based on a retrospective analysis of 71 cases treated at Krasnoyarsk Regional Clinical Hospital (KRCH).Materials and methods. From March 2014 to June 2019, 71 kidney transplants were performed at KRCH – 42 (59.15%) men and 29 (40.85%) women. The age of the patients varied from 20 to 59 years (mean age 39.6 ± 8.14 years). The causes of end-stage chronic kidney disease which subsequently led to CKAT were chronic glomerulonephritis, chronic tubulointerstitial nephritis, hypertensive nephropathy (HN), diabetic nephropathy resulting from type I diabetes (DN), nephropathy of mixed genesis (HN + DN), vesicoureteral reflux, congenital angiodysplasia of the kidneys, and Alport syndrome. The mean number of HLA mismatches was 4.5 ± 0.9.Results. Hospitalization lasted for an average of 34.05 ± 9.56 days. Primary function was observed in 32 (45.08%) patients, while 39 (54.92%) cases had delayed function. Post-transplant complications were noted in 23 (32.39%) patients, of whom 12 (16.9%) had early post-transplant complications, while 15 (21.13%) encountered complications in the late post-transplant period. The most frequently diagnosed were immunological, infectious, and urological complications. Vascular, surgical, oncological, and other complications were less frequent. The annual graft survival rate was 87.3%. Patient survival rate was 95.77%. One (1.4%) and 2 (2.81%) patients died in the early and late post-transplant periods, respectively. Hospital mortality – 1 case (1.4%).Conclusion. Kidney transplantation is the most effective treatment for patients with irreversible chronic kidney disease. About 87.33% of transplants were found to be effective. However, 32.39% of patients had postoperative complications. The vast majority of complications were reversible and were corrected conservatively or surgically. Nevertheless, graft loss occurred in 12.67% of cases. The success of transplantation depends on a number of factors related to both the donor and the recipient, as well as the immunological status and surgical technique. A personalized approach to recipients helps to reduce postoperative complications, prevent nephrotoxicity and rejection reactions.

Does Transportation Mean Transplantation? Impact of New Airline Routes on Sharing of Cadaveric Kidneys

Every year, nearly 5,000 patients die while waiting for kidney transplants, and yet an estimated 3,500 procured kidneys are discarded. Such a polarized coexistence of dire scarcity and massive wastefulness has been mainly driven by insufficient pooling of cadaveric kidneys across geographic regions. Although numerous policy initiatives are aimed at broadening organ pooling, they rarely account for a key friction—efficient airline transportation, ideally direct flights, is necessary for long-distance sharing, because of the time-sensitive nature of kidney transplantation. Conceivably, transplant centers may be reluctant to accept kidney offers from far-off locations without direct flights. In this paper, we estimate the effect of the introduction of new airline routes on broader kidney sharing. By merging the U.S. airline transportation and kidney transplantation data sets, we create a unique sample tracking (1) the evolution of airline routes connecting all the U.S. airports and (2) kidney transplants between donors and recipients connected by these airports. We estimate the introduction of a new airline route increases the number of shared kidneys by 7.3%. We also find a net increase in the total number of kidney transplants and a decrease in the organ discard rate with the introduction of new routes. Notably, the posttransplant survival rate remains largely unchanged, although average travel distance increases after the introduction of new airline routes. Our results are robust to alternative empirical specifications and have important implications for improving access to the U.S. organ transplantation system. This paper was accepted by Vishal Gaur, operations management.