Cases Of Kidney Transplantation Research Articles

Desensitization Therapy in Kidney Transplantation Cases with Positive Baseline Complement-Dependent Cytotoxicity Crossmatch and High Donor-Specific Antibodies

Objective: The objective of the study is to assess the graft and patient outcome after desensitization in human leukocyte antigen incompatible kidney transplantation (KT) with positive baseline complement-dependent cytotoxic (CDC) crossmatch and high mean fluorescein intensity (MFI) of donor-specific antibodies (DSA). Methods: This was a retrospective study conducted at Jaypee Hospital, Noida. This study included highly sensitized patients who were transplanted with positive CDC and DSA >10,000 MFI for single antigen or >5000 MFI for multiple donor antigens. The patient's renal outcomes were documented. The desensitization protocol consisted of rituximab, therapeutic plasma exchanges (TPE), and thymoglobulin. Results: A total of five patients who had positive CDC crossmatch with very high level of preformed DSA underwent KT. Three patients had end-stage renal disease due to diabetic kidney disease while other two due to autosomal dominant polycystic kidney disease and chronic glomerulonephritis. All the patients were on dialysis. The MFI by Luminex single antigen bead assay for Class I varied from 1657 to 23440 and for Class II varied from undetectable to 11120. The mean number of pretransplant TPE sessions given per patient was 7.8 ± 2.68 and posttransplant TPE sessions per patient was 0.8 ± 0.45. The mean follow-up period was 308.2 days. Mean creatinine on the day of discharge was 0.58 ± 0.17 mg/dL. None of the patients had any postoperative infections or rejections. Conclusion: The current report showed favorable short-term patient and graft outcomes post-KT without any postoperative infections or rejections with desensitization therapy comprising of rituximab, TPE, and thymoglobulin induction.

Трансплантация почки от Covid-19-инфицированного трупного донора: каковы последствия для реципиентов?

In recent months, with the spread of COVID 19, the number of kidney transplants from deceased donors has declined significantly in most countries. One of the reasons is the possibility of infection of the recipient with SARS-CoV-2. Determining the risk of transmission of COVID 19 with a donor organ is very important for developing a kidney transplantation policy during a pandemic.We present cases of kidney transplantation from COVID 19 positive deceased donor to two dialysis patients in single center. Deceased donor: a 45 years old man with diabetes, who had a major hemorrhagic stroke resulting in brain death. He had normal urine output and serum creatinine level for last 24 hours before kidney harvesting. For a few hours after organ harvesting, the donor was diagnosed COVID 19 (retrospective nasopharyngeal swab rRT-PCR which was confirmed by morphological examination and RNA-PCR of specimens from the trachea and bronchus). Recipient 1: a 49 years old man with polycystic kidney disease had been on hemodialysis for 28 months. He was in urgent list because of problems with vascular access. So non identical ABO (0-donor, B-recipient) kidney transplantation from this deceased donor was done in May 2020. Recipient 2: a 45 years old man with polycystic kidney disease on continuous ambulatory peritoneal dialysis (CAPD). was registered on urgent waiting list because of low transport capacity of peritoneum. Kidney transplantation from the same deceased donor was done at the same time. In both cases we completely abandoned any antilymphocytic agents for induction, despite non ABO identical transplantation in one of the recipients and the delayed graft function. Both patients received only basic immunosuppression, including tacrolimus, methylprednisolone and a mycophenolic acid.In first case cold ischemia time was 22 hours. The recipient had delayed graft function with increasing of urine output on day 8 post-transplant. No other deviations from the usual course were seen during hospital stay. The patient was discharge from hospital with serum creatinine level 122 mkmol/L. The cold ischemia time was 21 hours in another patient. Graft function was immediate with a decrease serum creatinine to 92.5 mkmol/L at discharge. Both patients had no febrile and no other symptoms of acute respiratory disease during all hospital stay. No abnormalities on chest X-ray were seen. No serum anti-SARS-CoV-2 IgM and IgG were detected before and during 6 weeks after surgery. Repeated nasopharyngeal swabs rRT-PCR were negative during all the period. Both recipients were discharged for 5 weeks after surgery to prevent out-of-hospital contamination of COVID 19, which would be difficult to differentiate from transmission infection. After 9 months both patients are doing well with no clinical or laboratory signs of COVID-19.Today we have no evidence of the possibility of transmission of COVID-19 from a SARS-Cov-2 positive donor to a kidney recipient. We also have no reason to suspect kidney damage by COVID-19 in a deceased donor at normal serum creatinine level. Avoiding the use of anti-lymphocyte drugs for induction of immunosuppression may also reduce the risk of developing COVID19 after transplantation. A careful collection and analysis of such dates is necessary to develop modern practical recommendations for transplant centers.

COVID-19 Infection in Children with Kidney Transplantation in Iran: A Case Series

Introduction: Since mid-April 2020, infection with coronavirus disease of 2019 (COVID-19) has affected more than 2 million people worldwide. Little is known about the effects of COVID-19 infection on kidney transplant patients treated with immunosuppressive (IS) drugs. Case Presentation: Here, we report three Iranian pediatric kidney transplantation cases who acquired COVID-19 infection and were admitted to Hazrat Ali Asghar Hospital in Tehran, Iran, in March-April 2020 (first wave). They were treated with prednisolone, cyclosporine, and cellcept. All of them had gastrointestinal symptoms, and one patient also had respiratory symptoms. In two patients who had only gastrointestinal symptoms, chest radiographies were considered normal. They did not need the intensive care unit (ICU), ventilator respiratory support, and dialysis due to a temporary increase in serum creatinine and no change in urine volume. Cellcept was stopped and other medications continued. The patient, who had pulmonary and gastrointestinal symptoms, expressed more severe manifestations that led to ICU admission and dialysis. Prednisolone was increased to a stress dose and the other drugs were discontinued. Conclusions: Pulmonary manifestations significantly worsen the prognosis compared to gastrointestinal manifestations in pediatric kidney transplants with COVID-19.

A Donor With Green Kidneys—To Transplant or Not to Transplant: A Case Report

A Donor With Green Kidneys—To Transplant or Not to Transplant: A Case Report

Single-center experience of organ transplant practice during the COVID-19 epidemic.

SummaryIn order to safely carry out organ donation transplants during the outbreak of coronavirus disease 2019 (COVID‐19), we have formulated strict procedures in place for organ donation and transplantation. We retrospectively analyzed our transplantation work from January 20 to May 5, 2020, to discuss whether organ transplantation can be carried out safely during the epidemic period. From January 20 to May 5, 43 cases of donation were carried out in our hospital, and the utilization rate of liver, kidney, heart, lung, and pancreas donations was more than 90%. Forty‐one cases of liver transplantation and 84 cases of kidney transplantation were performed. No graft loss or recipient death occurred within one month after kidney transplantation, and one patient (2.4%) died after liver transplantation. There was no significant difference in the length of hospital stay compared with that during the same period in the previous three years. More importantly, COVID‐19 infection did not occur among healthcare providers, donors, patients, or their accompanying families in our center. Under the premise of correct protection, it is safe and feasible to carry out organ transplantation during the epidemic period. Our experience during the outbreak might provide a clinical reference for countries facing COVID‐19 worldwide.

Robot-assisted kidney transplantation is a safe alternative approach for morbidly obese patients with end-stage renal disease.

Many centres deny obese patients with a body mass index (BMI)>35 access to kidney transplantation due to increased intraoperative and postoperative complications. From August 2017 to December 2019, 73 consecutive cases of kidney transplantation in morbidly obese patients were enrolled at a single university at the initiation of a robotic transplant surgery program. Outcomes of patients who underwent robotic assisted kidney transplant (RAKT) were compared to frequency-matched patients undergoing open kidney transplant (OKT). A total of 24 morbidly obese patients successfully underwent RAKT, and 49 obese patients received an OKT. The RAKT group developed fewer surgical site infections (SSI) than the OKT group. Graft function, creatinine, and glomerular filtration rate (GFR) were similar between groups 1year after surgery. Graft and patient survival were 100% for both groups. RAKT offers a safe alternative for morbidly obese patients, who may otherwise be denied access to OKT.

Posttransplant de novo donor specific HLA antibody monitoring and clinical outcomes: a single-center experience

Objectives: Despite the improvements in early-term outcomes of kidney transplantation, late-term graft failure still remained as a critical problem. De novo donor specific antibodies (DSA) developing against direct human leukocyte antigens (HLA) are the significant risk factors for shortened graft survival in the previously non-sensitized cases. The purpose of this study is to evaluate the clinical outcomes of de novo DSA development in the kidney transplant cases. Methods: The present study included 121 (alive/cadaver: 106/15) of 148 (alive/cadaver: 125/23) cases who were not previously sensitized (PRA and DSA negative) and undergone kidney transplantation between August 2012-January 2018. DSAs of the cases without expected declines in creatinine levels in the polyclinic follow-ups and postoperative early-term were evaluated. Renal biopsy was performed in the cases encountered with >2000 mean fluorescence intensity (MFI) de novo DSA against HLA-A, HLA-B, HLA-DR. Treatment protocol of plasmapheresis+intravenous immunoglobulin (IVIG)+rituximab (in the cases without clinical response) was administered in the cases with antibody-mediated rejection (AMR) detected by renal biopsy. In addition, the presence of de novo non-DSA was also evaluated in the cases. The presence of de novo was encountered by identifying the specificities of anti-HLA antibody specificities using Luminex single antigen beads in the recipient serum. Results: De novo DSA (antibodies against HLA-A, HLA-B, HLA-DR and HLA-DQ) were monitored in 23 cases. DQ positivity was detected in 10 cases. MFI values were > 4000 and 2000-4000 in 8 and 2 cases, respectively. De novo non-DSA was found in 19 cases. Biopsy was performed in 8 cases due to the development of MFI > 2000 de novo DSA against HLA-A, HLA-B and HLA-DR and the findings of acute humoral rejection (AHR) were encountered in 2 cases. Additionally, acute humoral rejection was diagnosed in 1 case that developed de novo non-DSA. Two cases were diagnosed with AHR by biopsy although no de novo DSA or non-DSA developed and renal graft loss occurred in these two cases. Conclusions: The fact that routine DSA monitoring in all the cases provided no significant contribution to the outcomes of our study may contribute to the debates on the necessity of DSA monitoring in the patients with low immunological risk.

POS-710 KIDNEY TRANSPLANT RECIPIENTS WITH A PRETRANSPLANTATION CANCER HISTORY

Pretransplant malignancy (PTM) in remission has long been considered a relative contraindication for organ transplantation due to the heightened risk of cancer recurrence associated with immunosuppression used after transplantation. In recent years, older patients are being accepted for transplantation. The purpose of this study was to investigate overall and cause-specific mortality in kidney transplant patients with a history of malignancy, to evaluate overall survival and cancer-related outcomes. We conducted a retrospective descriptive study collecting all cases of kidney transplanted patient with cancer history in the nephrology department over a period of forty years A total of three patients with cancer history underwent a kidney transplantation Case 1. A 56-year-old man underwent kidney transplantation because of bilateral nephrectomy. Right nephrectomy indicated in front of non-functional lithiasis kidney and a left nephrectomy indicated in front of vesical tumor invasion. Sixteen years before the transplant he was diagnosed as having a vesical tumor GII PT1. During his nine years of follow up he has had an episode of urinary infection, an episode of rejection and an episode of endocarditis. There has been no recurrence of malignancy. Case 2. A 45-year-old women underwent kidney transplantation because of vascular nephropathy. Two years before the transplant she underwent a thyroidectomy as treatment of papillary thyroid carcinoma and since then he has been considered cured. During her three years of follow up she has had an episode of rejection, an episode of urinary infection, a serous cystadenoma after one year of transplantation indicated the switch by sirolimus and cortico-induced diabetes. There has been no recurrence of malignancy. Case 3. A 65-year-old women underwent kidney transplantation because of chronic glomerular nephropathy. Eleven years before the transplant she underwent a radical mastectomy followed by hormonal therapy as treatment for breast cancer. During her five years of follow up she has had many episode of urinary infection, cortico-induced diabetes and an episode of ischemic cerebrovascular accident. There has been no recurrence of malignancy. Our findings indicate that there is no significant morbidity from recurrence cancer and no development of secondary type of cancers in pre-existing malignancies. But we must be careful about risk of rejection. The factors that should be considered in each individual case are the type and extent of cancer and the duration between diagnosis and the proposed transplant.

A Single-Center, Cross-Sectional Study of Children with Steroid-Resistant Nephrotic Syndrome in Southern China.

Introduction. We conducted a cross-sectional study on children with steroid-resistant nephrotic syndrome (SRNS) in a single center in Southern China. Methods. A total of 166 SRNS cases in the Paediatric Nephrology Center of the First Affiliated Hospital of Sun Yat-Sen University from September 1, 2006, to August 31, 2016 were retrospectively analysed. The inclusion criteria were: 1) age ≤ 14 years, 2) diagnosed with SRNS, and 3) without purpura nephritis, immunoglobulin A nephropathy, lupus nephritis, or another secondary nephritis. Incidences of primary/ late steroid-resistance and curative effects were analysed. Results. The median follow-up time was 4.64 (2.64 to 8.11) years. There were 67 cases of complete remission (CR) (40.36%), 46 cases of partial remission (PR) (27.71%), 31 cases of no remission (NR) (18.67%), 18 cases of end-stage renal disease (ESRD, 10.84%, including 7 cases of kidney transplantation), and 4 cases of death due to hematoma and severe infection after renal biopsy; renal failure after progression to ESRD; sepsis during glucocorticoid (GC) + Cyclosporine A (CsA) treatment; and multiple organ failure at the onset of disease, respectively. For the 8 cases with gene mutation, unnecessary drug treatment should be reduced due to their low responsiveness to immunosuppressive treatment. Female, patients with hematuria, primary steroid-resistance (PSR) type and histopathologic focal segmental glomerulosclerosis (FSGS) were more likely to have higher ESRD rate. Subgroup analysis of ESRD suggested that female patients and patients with PSR type were more likely to develop ESRD. Cox-regression analysis showed that female (HR = 3.04, 95% CI: 1.18 to 7.86; P < .05), without hematuria (HR = 0.36, 95% CI: 0.14 to 0.91; P < .05), and LSR type (HR = 0.17, 95% CI: 0.04 to 0.74; P < .05) were significantly associated with ESRD. Kaplan-Meier survival analysis also showed the same trends. Conclusion. Of the 166 SRNS cases, 68.07% of patients achieved CR or PR, 18.67% of cases had NR, 10.84% of cases developed ESRD, and 2.41% of patients died during follow-up. Female gender, hematuria, and PSR type were positively associated with ESRD.

Extraperitoneal Laparoscopic Kidney Transplantation: Preliminary Clinical Experiences from China.

To report on the pioneering clinical experiences of six cases of extraperitoneal laparoscopic kidney transplantation in China. For the first time in clinical practice, a customised, controllable double-circulation cooling device was used to protect the transplanted kidney. Of the six patients, two underwent an allograft renal transplantation because they had been diagnosed with uraemia and were on maintenance haemodialysis. The other four patients underwent kidney autotransplantation because of a central renal tumour. The extraperitoneal laparoscopic kidney transplantations were successfully completed between 2017 and 2018. The operative time for the two patients undergoing the allograft transplantation was 3-3.5h. The time for venous anastomosis was approximately 53-65min, and the time for arterial anastomosis was approximately 25-30min. The creatinine level was 90-80μmol/L after surgery. The operative time of the four patients who underwent autotransplantation was 9.4-17.5h. The times of venous and arterial anastomosis were 58-90min and 35-48min, respectively. The follow-up B-mode ultrasound after surgery showed good blood supply in the spared nephron. A renal graft was removed from one patient 6months after surgery because of renal atrophy and dysfunction caused by poor blood supply. Five patients (two undergoing allografting and three undergoing autografting) completed the 12-month follow-up, and their renal graft function was good. Extraperitoneal laparoscopic kidney transplantation, either allograft or autologous transplantation, is a safe and feasible procedure with a good chance of survival for the transplanted kidney. A customised cooling device is effective and practical during laparoscopic kidney transplantation.

Is Kidney Transplantation From a COVID-19–Positive Deceased Donor Safe for the Recipient?

IntroductionIn recent months, the number of kidney transplants from deceased donors has declined significantly. One of the reasons is the possibility of infection of the recipient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Determining the risk of transmission of coronavirus disease 2019 (COVID-19) with a donor organ is very important for developing a kidney transplantation policy during a pandemic. Materials and methodWe present cases of kidney transplantation from COVID-19–positive deceased donors to 2 dialysis patients 49 and 45 years old. One of them was on hemodialysis for 28 months; the other received continuous ambulatory peritoneal dialysis (CAPD). Both patients received only basic immunosuppression, including tacrolimus, methylprednisolone, and mycophenolic acid. No antilymphocyte agents were used for induction therapy. ResultsCold ischemia time was 22 and 21 hours, respectively. One recipient had delayed graft function with increasing of urine output on day 8; another had immediate function.Both patients had no febrile and no other symptoms of acute respiratory disease during their hospital stay. No abnormalities on the chest x-ray were seen. No serum anti-SARS-CoV-2 IgM and IgG were detected before and during 6 weeks after surgery. Repeated nasopharyngeal swabs real-time reverse transcription polymerase chain reaction (rRT-PCR) were negative during the period. Both recipients were discharged 5 weeks after surgery with serum creatinine levels of 122 and 91 mcmol/L, respectively. ConclusionToday we have no evidence of the possibility of transmission of COVID-19 from a SARS-CoV-2 positive donor to a kidney recipient. We also have no reason to suspect kidney damage by COVID-19 in a deceased donor at normal serum creatinine level.

Results of the 50 First Cases of Robotic assisted Kidney Transplantation compared with Matched-pair Open Cases- A Retrospective Cohort Study

Results of the 50 First Cases of Robotic assisted Kidney Transplantation compared with Matched-pair Open Cases- A Retrospective Cohort Study

Clinical effect analysis of 146 cases of ipsilateral simultaneous pancreas and kidney transplantation

Objective: To investigate the clinical effect of ipsilateral simultaneous pancreas and kidney transplantation (SPK). Methods: A total of 146 cases of SPK surgeries completed in the Second Affiliated Hospital of Guangzhou Medical University from September 2016 to June 2020 were selected to summarize the outcome, curative effect and complications of the operation. Results: The patients were followed up for 1 to 45 months. Good clinical results were obtained in 146 patients. Renal function indicators suggest that on the 7th day after operation, the serum creatinine returned to normal level [142.4 (108.6, 213.4)μmol/L]. The index of pancreatic function decreased to the normal level as expected. The level of blood amylase was 160.5(109.3, 249.8) U/L within 7 days after operation, and then decreased. The trend of urinary amylase was similar to that of blood amylase, which was 240(121.0, 370.0) U/L 7 days after operation, and glycosylated hemoglobin decreased to the normal level (5.8%±1.4%) 1 month after operation. The main medical complications were infection including pulmonary infection (26.03%, 38/146), urinary tract infection (26.03%,38/146), and abdominal infection (4.79%,7/146), acute rejection including renal graft rejection (5.8%,8/146), pancreas/duodenum rejection (18.49%,27/146), and renal graft combined pancreatic graft rejeciton (6.85%,10/146), as well as gastrointestinal bleeding (30.82%,45/146), of which 5 cases were severe bleeding (3.42%, 5/146). The main surgical complications were poor incision healing (10.27%, 15/146), serious surgical complications including arteriovenous thrombosis of the transplanted pancreas (2.05%, 3/146) and intestinal leakage (0.68%,1/146). The 1-year and 3-year patient, renal and pancreatic survival rates were both 92.5%, 91.5% and 89.5%, respectively, and despite the death, the 1-year, 3-year transplanted kidney survival rate was both 99.3%, and 95% for the the 1-year, 3-year pancreas survival rate. Conclusion: Strict preoperative evaluation of the function of large organs, reasonable surgical methods, perioperative anticoagulation, and prompt diagnosis of complications can achieve good clinical results for patients with SPK.

Technique Description and Outcomes of Robotic Transvaginal-Assisted Living Donor Kidney Transplantation

Objective: The aim of the study was to describe the surgical technique of totally robotic kidney transplantation with transvaginal insertion and to assess its safety and feasibility. Methods: It is a prospective analysis of the first 5 cases of robotic kidney transplantation with transvaginal insertion. Robotic-assisted kidney transplantation was performed after transvaginal insertion of a living donor kidney graft. Donor’s and recipient’s characteristics, intraoperative variables, postoperative complications, and surgical outcomes were assessed. Results: The median operative time was 220 min. Mean rewarming ischemia time of 53 min, with immediate diuresis. No intraoperative complications were observed. Mean hospitalization period was 9 days, with mean Cr of 1.5 mg/dL at discharge. Conclusions: Robotic kidney transplantation with transvaginal insertion is feasible and safe. A greater number of procedures are required to confirm the results of this new technique.

Early Experience of Kidney Transplantation in a New Center

Objective: Kidney transplantation is one of the most important treatments in end-stage renal disease (ESRD). We aimed to share our experiences in 60 (57 deceased donors, 3 living donors) kidney transplantation cases performed in our center between July 2017 and August 2020. Material and methods: The demographic data of 60 patients with kidney transplantation performed in our kidney transplant center were evaluated in terms of causes and duration of renal failure human leucocyte antigen (HLA) tissue compatibility, immunosuppressive protocol used, antimicrobial agents, rejection status, graft loss, patient loss, postoperative surgical complications. Results: 57 of our kidney transplants were made from deceased donors and 3 from living donors. The mean age of the patients was 44.66 (23-68) years. Kidney transplantation was performed in 8 patients (13.33%) in the preemptive period. The mean number of mismatches in kidney transplants was 3.95 (2-5) and the mean duration of renal replacement therapy (RRT) was 54.73 (0-270) months. While the mean follow-up period after transplantation was 18.86 (2-37) months, it was observed that the mean cold ischemia time was 742.8 (60-1080) minutes. Serum creatinine levels of 56 patients with functional grafts at the end of the first month 1.39 (0.5-4.9) mg/dL, 54 patients at the end of the sixth month, creatinine levels 1.29 (0.56-5.9) mg/dL, The creatinine levels of the 52 patients as of October 2020 were 1.37 (0.75-5.16) mg/dL. As surgical complications, hematoma developed in 5 patients (8.33%) and lymphocele in 3 patients (5%). Early graft loss developed in one patient with renal artery embolism and two patients with renal vein thrombosis, while chronic rejection developed in two patients. We performed a deceased kidney transplant again 14 months later in a patient who developed graft loss in the early period due to renal vein thrombosis. The kidney inserted later is functional in the 10th postoperative month. One of our patients died due to rhino-orbital mucor mycosis in the postoperative 2nd month, and one patient due to the development of sepsis due to infection in the hip prosthesis in the postoperative 6th month, while another patient died due to myocardial infarction in the postoperative 2nd month. Conclusion: As a result, our kidney transplant center is in development. Our results obtained from 60 kidney transplants, almost all of which were performed from deceased donors, seem to be compatible with the literature. More detailed results can be obtained with the long-term follow-up results and the increase in the number of living donor transplants.

Autologous stem cell transplantation following simultaneous liver and kidney transplantation in severe amyloid light chain amyloidosis associated with multiple myeloma: a case report

IntroductionThe involvement of vital organs in multiple myeloma (MM) with systemic amyloid light-chain (AL) amyloidosis can lead to acute organ failure. In this case, the fear of recurrence or progression of multiple myeloma often excludes those patients from undergoing organ transplantation. Nevertheless, clinically fit patients might benefit from a different therapeutic approach. This case presentation might highlight this particular unmet need and strengthen a different treatment approach.Case presentationTo our knowledge, we present the first case of successful simultaneous liver and kidney transplantation, followed by autologous stem cell transplantation in a 60-year-old Caucasian male patient suffering from MM (Durie-Salmon stage IIB; ISS-stage: III, RISS stage: III) with primary AL amyloidosis. Chemotherapy treatment led to end-stage kidney disease requiring dialysis. Liver failure also occurred after at least three cycles of CyBorD (bortezomib, cyclophosphamide, and dexamethasone) of induction therapy with a good hematologic response. Over three years after the initial diagnosis, the patient is reportedly showing an excellent quality of life and a complete remission.Discussion and ConclusionWe conclude that kidney and liver transplantation followed by autologous stem cell transplantation can be a treatment option for a selected group of patients with MM if AL amyloidosis is leading. In the end, the remission assessment by IMWG response criteria displayed a complete remission of MM together with complete reconstitution of organ functions (liver & renal function) as long as upfront clinical evaluation excludes significant cardiac involvement and other severe co-morbidities.

Clinical outcomes of the first 300 cases of kidney transplantation: a single-center retrospective cohort study

BackgroundKidney transplantation (KT) is regarded as the most effective treatment for end-stage renal disease. The annual number of KT cases in South Korea has increased rapidly as more centers are implementing a transplantation program. The objective of this study was to determine clinical outcomes of the first 300 consecutive cases of KT in a single center.MethodsClinical data of 300 cases of KT at Seoul National University Bundang Hospital from January 2004 to March 2018 were obtained from a prospectively collected database and retrospectively reviewed.ResultsThe mean age of patients was 47.7±12.9 years, and 59% of patients were male. There were 225 living donors and 75 deceased donors. A total of 42 cases were from ABO-incompatible donors. During a mean follow-up of 68.6±43.5 months, 38 patients (12.7%) experienced rejection. The most common cause was acute T-cell mediated rejection (9.0%). Eighteen patients experienced graft loss. One-year and 5-year death-censored graft survival rates were 99% and 96.6%, respectively. One-year and 5-year patient survival rates were 98.3% and 96.6%, respectively. Multivariate analysis revealed that graft weight-to-recipient weight ratio and rejection were significant factors affecting graft survival.ConclusionsThis single-center review demonstrates clinical outcomes comparable to other major centers. Such good outcomes were obtained by good patient selection, dedicated transplant physicians, and adequate use of immunosuppressive therapy.

Pediatric kidney transplantation in China: an analysis from the IPNA Global Kidney Replacement Therapy Registry.

The International Pediatric Nephrology Association (IPNA) Global Kidney Replacement Therapy (KRT) Registry was established to evaluate the incidence and outcomes of kidney replacement therapy (dialysis and transplantation) provided to children worldwide. Analysis of registry data for separate regions is feasible. Three centers located in Shanghai, Guangzhou, and Zhengzhou, which have the greatest number of pediatric kidney transplantation cases in China, participated in this analysis of transplant data. Data were registered by each center for patients under the age of 19years who received a single-organ kidney transplant for the first time between 2011 and 2018. In total, 415 patients (59.8% male) aged 1.4-18.7 (median 12.1) years were followed for 0.3-97.1 (median 27.7) months. The number of kidney transplants increased from a total of 129 during 2011-2014 to 286 cases during 2015-2018. 85.8% of patients received the transplanted kidney from a pediatric (age < 19years) donor, and deceased donors accounted for 94% of all donors. 8.0% of grafts were lost. One and 5-year patient survival rates were 97.6% and 95.5%, respectively. The major cause of death was infection (7/14). Similar graft and patient survival rates were observed for organs from pediatric and adult donors in 6-11 and 12-18year recipient age groups, whereas recipients < 6years showed inferior patient and graft survival. Pediatric kidney transplantation shows favorable short-term and medium-term outcomes in China. Our experience supports use of pediatric donors in pediatric kidney transplantation, but attention directed to the outcome of recipients aged under 6 is necessary. Graphical abstract.

Global Dialysis Perspective: Vietnam.

Vietnam is one of the most populated Southeast Asian countries, with a population of around 97 million people in 2018 (1). Three kinds of RRT, including hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation, are currently available in Vietnam; they service a total of about 36,000 patients, but this only accounts for about one third of the estimated ESKD population in need of dialysis across the country. The purpose of this article is to give a broad overview of some key aspects of RRT and nephrology in Vietnam. HD has been available in Vietnam since 1968. Initially, it was only used to treat acute kidney failure. During that period, only the Travenol Drake-Willock machine was used. Starting from 1996, with the initiation of the national insurance reimbursement system, a remarkable development in dialysis was seen throughout the country, with the number of patients on maintenance hemodialysis (MHD) steeply increasing. MHD has become the most common type of dialysis and has been available in many Vietnamese cities and provinces since then (2). Although little is known about the actual number of patients with ESKD in need of dialysis in the general population, it is estimated to be >100,000 persons. However, only about one third of them (approximately 30,000 patients) are actually on MHD all over the country. Although this proportion is still very low compared with the estimated demand, all dialysis facilities are frequently overwhelmed and have to operate up to four 4-hour shifts per day; home dialysis is not available yet in Vietnam. All dialyzers are capillary type, mainly low flux, and they are reused six times in total to compensate for the low reimbursement of only $25 per session. We import all dialysis machines and dialyzers from various foreign brands, such as Nipro (Japan), B. Braun, and Fresenius (Germany), …

ACCOMPLISHMENT OF ISCHEMIA-FREE KIDNEY TRANSPLANTATION USING NORMOTHERMIC MACHINE PERFUSION

Background: Ischemia-reperfusion injury (IRI) has been considered an inevitable event in organ transplantation since the first successful kidney transplant was performed in 1954. To avoid IRI, we have established a novel procedure called ischemia-free organ transplantation. Here, we describe the first case of ischemia-free kidney transplantation (IFKT). Materials and Methods: The kidney graft was donated by a 19-year-old brain dead donor. The recipient was a 47-year-old man with end-stage diabetic nephropathy. The graft was procured, preserved and implanted without cessation of blood supply using normothermic machine perfusion. Results: The graft appearance, perfusion flow and urine production suggested the kidney was functioning well during the whole procedure. The creatinine dropped rapidly to normal range within three days post-transplantation. The levels of serum renal injury markers were low post-transplantation. No rejection, vascular or infectious complications occurred. The patient had an uneventful recovery. Conclusion: This paper marks the first case of IFKT in humans. This innovation might offer a unique solution to optimize transplant outcomes in kidney transplantation.