Donor Cause Of Death Research Articles

Donor Risk Index Does Not Predict Graft Survival After Pancreas Transplantation in Brazil

BackgroundPancreas donor risk index (DRI) was developed by using large multicenter American data to predict the risk of adverse outcomes in pancreas transplantation based on donor and technical/logistical characteristics. AimThe goal of this study was to evaluate the usefulness of the DRI in predicting graft survival in a Brazilian population of pancreas transplant recipients. MethodWe conducted a retrospective analysis of the 570 procedures performed by the same surgical team between 1996 and 2011. Because of the lack of sufficient data for the calculation of DRI values, only 154 cases were studied (27%), of which 105 underwent simultaneous pancreas-kidney transplantation, 33 underwent pancreas after kidney transplantation, and 16 underwent pancreas transplantation alone. Donor cause of death was classified as cerebrovascular accident (CVA) and non-CVA. Graft origin was divided into three groups: local, if the graft was obtained in the metropolitan area of the city of São Paulo; regional, if collected in other cities of the state of São Paulo; and national, if obtained outside the state. ResultsLogistic regression analysis did not find a statistically significant association between DRI values and 1-year graft survival (odds ratio = 0.676; 95% confidence interval 0.152 to 3.014; P = .60). One-year graft survival calculated by the Kaplan-Meier method was 89.8% in transplants with DRI ≤ 1, 77.9% in those with 1 < DRI < 1.5, and 93.3% in those with DRI ≥ 1.5 (P = .106). ConclusionThe pancreas DRI model did not prove effective in predicting pancreas graft survival in a Brazilian sample of recipients.

“Hanging Donors”: Are We Still Skeptical About the Lungs?

BackgroundSuicidal hanging may cause compression of the neck blood vessels and the airway leading, to hypoxic brain damage caused by cerebral ischemia and respiratory distress. Hanging engenders global tissue hypoxia, particularly affecting the lungs as the result of pulmonary edema and barotrauma. There is scant evidence about outcomes of transplantation with the use of lungs from “hanging donors.” This study evaluates the outcomes of lung transplantations (LTx) that use organs from this group. MethodsWe retrospectively analyzed lung “organ offers” and LTx at our center between January 2007 and November 2013. The outcomes of LTx with lungs from donors with hanging as the cause of death (“hanging group”) were compared with those with donors having other causes of death (control group), with the use of an unadjusted model as well as propensity score matching. ResultsLTx (n = 302) were performed during this period and were grouped on the basis of the cause of death in donors: the hanging group (n = 8) and the control group (n = 294). No statistically significant difference was found in the donor characteristics except for the incidence of cardiac arrest, which was significantly higher in hanging donors. Preoperative characteristics in recipients in both groups were comparable. Intra-operative and post-LTx variables including PaO2/FiO2 ratios, duration of mechanical ventilation, and intensive care unit and hospital stays were comparable. One-year and 3-year survival rates were also comparable in both groups. Two recipients in the hanging group required extracorporeal life support after LTx and could not survive. ConclusionsSuicidal hanging is a relatively rare cause of death for potential organ donors. Because it does not appear to negatively affect outcomes after LTx, it should not be considered per se a contraindication for lung donation. A word of caution is necessary until we gather larger experience with lungs from hanging donors.

Outcomes of kidneys utilized from deceased donors with severe acute kidney injury.

Significant numbers of kidneys are discarded due to raised terminal creatinine of the donor. To determine long-term outcomes of kidneys utilized from donors with severe acute kidney injury (AKI). In this retrospective study, we included all patients who received kidneys from deceased donors between years 2000 and 2012. AKI was defined according to the acute kidney injury network (AKIN) classification. The primary outcomes were patient and graft survival and secondary outcomes were renal function at different time points, delayed graft function, acute rejection and length of hospital stay. Two hundred and eighty-four recipients received kidneys from 261 deceased donors. One hundred and fourteen patients (40%) received kidneys from the donors with AKI. Forty-two patients received kidneys from the donors with severe AKI (AKIN-3 category). Mean age of the donor and recipient was 36 and 37 years, respectively. Main cause of death in donors was road traffic accident (34%) followed by cerebrovascular accident (33%). Terminal creatinine was 85 and 262 μmol/l in non-AKI and AKI groups, respectively (P < 0.001). Significantly more patients in the AKI group had delayed graft function (P = 0.006), prolonged hospital stay (P < 0.001) and high creatinine at discharge (P = 0.002). However, acute rejection rates (P = 0.25), 1-, 5- and 10-year graft survival (P = 0.57) and patient survival (P = 0.77) were not different between AKI and non-AKI groups. The outcomes in the AKIN-3 category were comparable with the non-AKI group. This study has shown favorable long-term outcomes of kidneys utilized from donors with severe AKI. This study may encourage healthcare professionals to consider accepting such kidneys.

Is it Safe to Use Lungs from 'Hanging Donors' for Transplantation?

Objectives: Suicidal hanging may cause compression of the neck blood vessels and the airway leading to hypoxic brain damage due to cerebral ischemia and respiratory distress. Hanging, in addition to global tissue hypoxia, affects particularly the lungs due to pulmonary edema and barotrauma. There is little evidence in literature about outcomes of transplantation utilizing the lungs from 'hanging donors'. This study evaluates the outcome of lung transplantation (LTx) utilizing organs from this group. Methods: Retrospective analysis of lung offers and LTx between 01.2007 and 11.2013 with hanging as cause of death was performed. The outcomes of LTx utilizing the lungs from donors with hanging as cause of death (hanging group) were compared with those with donors with other causes of death (control group) using unadjusted model as well as propensity score matching. Results: 302 LTx were performed during this period and were grouped depending on the cause of death in donors - hanging group (n = 8) and control group (n = 294). To minimize the potential effects of selection bias on patient characteristics, we performed an additional analysis using one-to-three propensity score matching with 32 patients remaining for the analysis. The matching was performed based on donor and recipient characteristics which were statistically different between the two groups in the unadjusted analysis: presence of cardiac arrest and recipient age. Additionally, further clinically important variables such as donor gender, age, type of donation (DBD/DCD), and utilization of EVLP as well as recipient gender and primary diagnosis were used for calculation of propensity scores. After propensity score matching, there were no statistically significant differences in PaO2/FiO2 ratio on arrival at ICU as well as 24, 48 and 72 hours postoperatively. Ventilation duration, ICU and hospital length of stay, need for postoperative ECMO and incidence of BOS were also similar between 'hanging' and control group. Overall cumulative survival was not statistically different with 85.9% versus 75% in control and 'hanging' group, respectively (Log Rank (Mantel-Cox) p = 0.368) at 1 year which was continued at 3 years. Conclusions: Suicidal hanging is a relatively rare cause of death for potential organ donors. As it does not seem to negatively affect outcomes after LTx, it should not be considered as a contraindication for lung donation by itself.

Mortality in Kidney Transplantation

It’s a retrospective study whose aim was to evaluate the incidence and the mortality in a popula-tion including 329 patients who received first kidney transplants from a living donor in 269 cases and cadaveric donor in 60 cases at Internal Medicine A department between June 1986 and December 2003. Aetiologies of mortality in our kidney transplant recipients were determined. There were 157 males and 75 females having an average age of 30.8 years. After a period of follow-up of 5.64 years, 51 patients (21.98%) died. Aetiologies of mortality were multiple and were known in approximately 98% of cases. Infections were observed in 25 cases. Cancer was observed in 7 cases (13.72%). Patient survival was not affected by gender, donor age or cause of donor death. Infections represent the major cause of mortality in our patients even many years after kidney transplantation. The maximum of death occurred in the 8th year after kidney transplantation.

Heart transplantation using allografts from older donors: Multicenter study results

The lengthy waiting time for heart transplantation is associated with high mortality. To increase the number of donors, new strategies have emerged, including the use of hearts from donors ≥50 years old. However, this practice remains controversial. The aim of this study was to evaluate outcomes of patients receiving heart transplants from older donors. We retrospectively analyzed 2,102 consecutive heart transplants in 8 Spanish hospitals from 1998 to 2010. Acute and overall mortality were compared in patients with grafts from donors ≥50 years old versus grafts from younger donors. There were 1,758 (84%) transplanted grafts from donors < 50 years old (Group I) and 344 (16%) from donors ≥50 years old (Group II). Group I had more male donors than Group II (71% vs. 57%, p = 0.0001). The incidence of cardiovascular risk factors was higher in older donors. There were no differences in acute mortality or acute rejection episodes between the 2 groups. Global mortality was higher in Group II (rate ratio, 1.40; 95% confidence interval, 1.18-1.67; p = 0.001) than in Group I. After adjusting for donor cause of death, donor smoking history, recipient age, induction therapy, and cyclosporine therapy, the differences lost significance. Group II had a higher incidence of coronary allograft vasculopathy at 5 years (rate ratio, 1.67; 95% confidence interval, 1.22-2.27; p = 0.001). There were no differences in acute and overall mortality after adjusting for confounding factors. However, there was a midterm increased risk of coronary allograft vasculopathy with the use of older donors. Careful selection of recipients and close monitoring of coronary allograft vasculopathy are warranted in these patients.

Endophthalmitis After Penetrating Keratoplasty

To determine the incidence of endophthalmitis after penetrating keratoplasty (PK) and patient and donor risk factors. Retrospective cohort study using national transplant registry data. All corneal transplant recipients (n = 11 320) registered on the United Kingdom Transplant Registry undergoing their first PK between April 1999 and December 2006. Patients who developed endophthalmitis were identified on the transplant registry. In addition, cases where the fellow cornea from the same donor had been transplanted were included. Clinical information regarding donor and recipient characteristics, surgical details, and postoperative outcomes were collected and analyzed. In cases where endophthalmitis was reported, the diagnosis was verified by a follow-up supplementary questionnaire to the surgeon. Logistic regression was used to investigate differences in the factors associated with the development of endophthalmitis. Incidence of endophthalmitis and graft survival. The overall incidence of endophthalmitis occurring after primary PK in the UK was 0.67%. The incidence of endophthalmitis occurring within 6 weeks of surgery was 0.16%. Graft survival after endophthalmitis was 27% (95% confidence interval, 16-38) at 5 years, with a mean best-corrected visual acuity of 1.13 (logarithm of the minimum angle of resolution) for surviving grafts. Factors associated with endophthalmitis were donor cause of death (infection), high-risk cases, and indication for corneal transplantation. Endophthalmitis remains a serious issue, with those affected having reduced graft survival and poor visual outcomes. Management of the identified recipient and donor risk factors are important to reduce endophthalmitis risk. In particular, the increased incidence of endophthalmitis when the donor dies of infection requires further explanation and review of current donor eye retrieval and eye bank practices. The delayed presentation of endophthalmitis cases also raises questions regarding possible sequestration of microbes within the corneal tissue and the effect of antimicrobials in storage media.

Use of the Donor Lung After Asphyxiation or Drowning: Effect on Lung Transplant Recipients

With the relative paucity of acceptable donors for lung transplantation, criteria for extended donor consideration are being explored. We sought to evaluate the suitability of donors whose cause of death was asphyxiation or drowning (A/D) as a potential option to enlarge the donor pool. We queried the United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research registry for lung transplantation from 1987 to 2010 to assess associations between cause of death and recipient survival using the Kaplan-Meier method. To adjust for potential confounders, we used a Cox proportional hazards model and a logistic regression model to evaluate incidence of rejection within the first year. There were 18,250 adult primary lung transplantations performed, with 309 A/D donors. There was no difference in survival between groups (log-rank, p = 0.52). There were no differences in demographics, length of stay, airway dehiscence, lung allocation score (LAS), orischemic time in univariate analysis (all p > 0.05). The A/D lung recipients had fewer deaths from pulmonary causes (5.8% versus 9.5%; p= 0.02). Proportional hazards analysis was significant for double lung transplantation (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.8-0.9), height difference (HR, 1.002; 95% CI, 1.00-1.003), donor age greater than 50 years (HR, 0.89; 95% CI, 0.83-0.96), and recipient age greater than 55 years (HR, 0.8; 95% CI, 0.76-0.84). A/D cause of death did not impact survival in multivariate analysis. A/D as a donor cause of death was not associated with poor long-term survival or incidence of rejection in the first year after transplantation. Donor cause of death by A/D, when carefully evaluated and selected, should not automatically exclude the organ from transplant consideration. These results provide important justification for potentially broadening the donor pool safely.

Early Hospital Readmissions After Liver Transplantation.

Background. Early hospital readmission (EHR) is associated with increased morbidity, mortality, and cost. In liver transplantation (LT), rates of EHR are unknown. It is unclear if recipient and transplant factors increase EHR risk. Until now, national data enabling characterization of EHR after LT were unavailable. Methods. We created a novel linkage between UNOS and Medicare claims data for 13,981 liver recipients (2003-2008). EHR was defined as hospitalization within 30 days of initial discharge. Logistic regression was used to determine the association between EHR and 18 recipient (age, sex, race, BMI, MELD, HCV+, diabetes, hypertension, prior abdominal surgery, cause of liver failure, dialysis prior to transplant, hospitalization prior to transplant, ICU prior to transplant, life support prior to transplant, encephalopathy, portal vein thrombosis, ascites, and portal bleed requiring transfusion within 48 hours of transplant) and 7 transplant (donor service area (DSA), donation after cardiac death (DCD), donor age, donor cause of death, status 1a, split or partial explant, and year of transplant) factors. Results. Unadjusted rates of EHR by transplant center ranged from 0-35.2%, with an overall rate of 18.9%.Figure: No Caption available.EHR rates have increased since 2003: 2006 (OR 1.35; 95%CI 1.14, 1.60), 2007 (OR 1.61; 95%CI 1.36, 1.90), and 2008 (OR 1.75; 95%CI 1.47, 2.09). In a multivariate model, EHR was associated with female gender (OR 1.31; 95%CI 1.18, 1.45), underweight at time of transplant (OR 1.50; 95%CI1.06, 2.11), diabetes (OR 1.32; 95%CI 1.18, 1.46), previous abdominal surgery (OR1.19; 95%CI 1.08, 1.31), and local DSA transplants (OR1.15; 95%CI 1.02, 1.30). Some factors associated with graft and patient survival, such as African American race, MELD, national DSA, and DCD, were not statistically significantly associated with EHR. Conclusions. Approximately 1/5 of liver recipients are readmitted within 30 days of discharge following LT, with a wide range across transplant centers. We identified a number of patient-level risk factors for EHR; a better understanding of which patients are at risk may improve discharge planning and outpatient monitoring after LT.

Impact of immunosuppression treatment on the improvement in graft survival after deceased donor renal transplantation: a long-term cohort study.

We analyzed graft half-life and attrition rates in 1045 adult deceased donor kidney transplants from 1986-2001, with follow-up to 2011, grouped in two periods (1986-95 vs. 1996-01) according to immunosuppression. The Kaplan-Meier curve showed a significant increase in graft survival during 1996-2001. The uncensored real graft half-life was 10.25 years in 1986-95 and the actuarial was 14.58 years in 1996-2001 (P&lt;0.001). The attrition rates showed a significantly greater graft loss in 1986-95, even excluding the first year from the analysis. The decline in renal function was significantly less pronounced in 1996-2001, indicating better preservation of renal function, despite the increase in donor age and stroke as the cause of donor death. The parsimonious Cox multivariate model showed donor age, acute rejection, panel reactive antibody, cold ischemia time and delayed graft function were significantly associated with a higher risk of graft loss. In contrast, the risk of graft loss fell by 21% in 1996-2001 compared with 1986-95. A similar reduction (25%) was observed when MMF treatment was entered into the multivariate model instead of study period. Long-term graft survival improved significantly in 1996-2001 compared to 1986-1995 despite older donor age. Modern immunosuppression could have contributed to the improved kidney transplant outcome.

Donor and tissue profile of a community eye bank in Eastern India.

Purpose:The purpose of this study is to analyze the donor and tissue profile of a community eye bank in Eastern India.Materials and Methods:Eye bank records were analyzed for the period July 2007-June 2011. Variables analyzed included donor demographics (age, gender, and ethnicity), donor cause of death, consent for recovery, death-to-preservation interval, preservation-to-utilization interval, endothelial cell density (ECD), corneal suitability for transplantation, and corneal tissue utilization.Results:During this study period, 743 corneal tissues were retrieved from 373 donors (male:female = 263:110). The mean age of donors was 52 ± 21 years (range: 3-95 years). The most common donor age group was 41-50 and 71-80 years. Most of the donors belonged to one religious faith (99%). The most common causes of death were cardiorespiratory failure (34%) followed by road traffic accident (30%). Majority donors were motivated (n = 320; 86%), and remaining (n = 53; 14%) were voluntary. Most of the consents were given by sons or daughters of the deceased (45%) followed by siblings (18%). Mean death-to-preservation interval was 3.9 ± 1.9 h. Mean preservation-to-utilization interval was 56.0 ± 24.4 h. The mean ECD of donor corneal tissue was 2857 ± 551 cells/mm2 and the median value was 2898 cells/mm2. Of harvested corneas 556 (75%) corneal tissues were utilized. The most common causes of nonutilization were septicemia in donor (n = 56; 30%) and poor quality of tissue (n = 55; 30%).Conclusions:Although, there is significant corneal tissue utilization, there is a need for increased awareness among people in order to augment voluntary donations.

The effect of arginine vasopressin on organ donor procurement and lung function

BackgroundHormone replacement therapy (HRT) is becoming more common when managing brain-dead donors. Arginine vasopressin (AVP) is associated with benefits but is not consistently used. We hypothesize that AVP is associated with the maintenance of lung function and successful recovery in donors and enhanced lung graft performance in recipients. MethodsThe Organ Procurement and Transplantation Network database was used. Study donors were those treated with HRT and procured from January 1, 2009 to June 30, 2011. AVP (+) and AVP (−) donors were compared. Donor lung function, the rate of successful lung procurement, and the incidence of graft failure in recipients were studied. ResultsThere were 12,322 donors included, of which 7686 received AVP (62.4%). Cerebrovascular accident (4722 [38.3%]) was the most common cause of donor death. There was a significant increase in high yield (≥4 organs) (51.0% versus 39.3%, <0.001), mean number of organs (3.75 versus 3.33, <0.001), and rate of successful lung recovery (26.3% versus 20.5%, <0.001) with AVP. Lung function was preserved to a greater degree in donors receiving AVP. Adjusting the significant factors, AVP was independently associated with lung procurement (1.220 [1.114–1.336], <0.001). The incidence of early graft failure was not changed. ConclusionsAVP with HRT is associated with the maintenance of lung function and a significant increase in successful organ recovery in donors without untoward effects in the recipient. AVP should be universally adopted as a component of HRT in the management of donors with neurologic death.

A preliminary descriptive analysis of Corneal Transplant Registry of National Eye Bank in India

To describe and analyze the Corneal Transplant Registry of National Eye Bank and also evaluate graft outcomes in India. All patients who underwent corneal transplant at our center within six months of setting up of Corneal Transplant Registry and installation of database at National Eye Bank were included in the study. The established database was analyzed for utilization, donor and recipient details and graft outcomes. Outcome was assessed at the end of one year follow up. The influence of various donor and recipient factors affecting outcome were evaluated. Visual outcome was analyzed in terms of shift in visual handicap category. Statistical tests like analysis of variance, Kruskal-Wallis test and Chi square tests were applied for determination of clinical significance wherever required. 326 corneas were received from 168 donors; of these, 234 (71.7%) were utilized for transplantation. Out of 177 patients with adequate (one year) follow up (75.6% patients), optical corneal replacement was performed in106 patients and therapeutic keratoplasty in71. 78% (82/106) patients in the optical group retained clear grafts at the end of follow up. 59.7% (49 of 82) of patients who attained clear grafts belonged to visual disability category 3 or worse pre-operatively. 59.1% of these achieved BCVA of ≥6/60 at the end of follow up; thus shifting up their visual handicap category. Primary graft failure was found to be associated with full thickness keratoplasty and not with lamellar procedures (p<0.05) and occurred in 4.2% patients (5) with optical corneal replacement whereas 7.5% patients (8) developed secondary graft failure. Age of donor (p=0.54), death enucleation time (p>0.05), cause of donor death (p=0.15), type of surgical procedures (p=0.538) and indication for surgery did not have any significant effect on outcome. 76% patients who underwent therapeutic graft achieved elimination of corneal infection. The development of corneal graft registry established an effective means to evaluate our corneal transplantation services. Outcomes of sight restoring corneal transplants performed were comparable to results of graft registries from developed nations.

Donors' characteristics and impact on outcomes in pediatric heart transplant recipients

Organ availability and acceptability limit pediatric HTx. What characteristics define an unacceptable or high-risk pediatric donor remains unclear. The purpose of this study was to characterize a large cohort of pediatric donors and determine the donor risk factors, including cumulative risk, that affect recipient survival. Data from the PHTS, a prospective multicenter study, were used to examine the impact of donor factors on the outcomes of patients listed <18yr of age who received a HTx between 1993 and 2009. Donor data were available for 3149 of 3156 HTx (99.8%). Donor cause of death, need for inotropes, or CPR did not affect survival outcomes (p=0.05). Ischemic time also did not have an impact on overall recipient survival; however, longer ischemic times negatively impacted one-yr post-transplant survival (p<0.0001). There was no impact of cumulative risk factors on survival (p=0.8). Although used in a minority of cases, hormonal therapy in the donor positively impacted survival (p=0.03). In multivariate analysis, the only donor factor associated with decreased survival was smaller donor BSA, the other factors being related to the recipient characteristics. When analyzed by recipient age, there were no donor-related factors that affected survival for those who received a transplant at <6months of age. Longer ischemic time (p<0.0001) and greater age difference between the recipient and donor (p=0.0098) were donor-related factors impacting early-phase survival for recipients who received a graft at ≥10yr of age. Factors perceived to define a marginal or high-risk pediatric heart donor including inotrope use, CPR and donor cause of death may have less impact on outcomes than previously thought. Longer ischemic times did impact oneyr, but not overall survival, and this impact was much greater with older donors. Parameters for accepting a donor heart can potentially be expanded, especially in the infant age group, but strong consideration should always be given to the interaction between ischemic time and donor age.

The difficulty in defining extended donor criteria for liver grafts: the Eurotransplant experience

Donor criteria for liver grafts have been expanded because of organ shortage. Currently, no exact definitions for extended donor grafts have been established. The aim of this study was to analyze the impact of donor-specific risk factors, independent of recipient characteristics. In collaboration with Eurotransplant and European Liver Transplant Register, solely donor-specific parameters were correlated with 1-year survival following liver transplantation. Analyses of 4701 donors between 2000 and 2005 resulted in the development of a nomogram to estimate graft survival for available grafts. Predictions by nomogram were compared to those by Donor Risk Index (DRI). In the multivariate analysis, cold ischemic time (CIT), highest sodium, cause of donor death, γ-glutamyl transferase (γ-GT), and donor sex (female) were statistically significant factors for 3months; CIT, γ-GT, and cause of donor death for 12-month survival. The median DRI of this study population was 1.45 (Q1: 1.17; Q3: 1.67). The agreement between the nomogram and DRI was weak (kappa=0.23). Several donor-specific risk factors were identified for early survival after liver transplantation. The provided nomogram will support quick organ quality assessment. Nevertheless, this study showed the difficulties of determining an exact definition of extended criteria donors.

Donor Predictors of Allograft Use and Recipient Outcomes After Heart Transplantation

Despite a national organ-donor shortage and a growing population of patients with end-stage heart disease, the acceptance rate of donor hearts for transplantation is low. We sought to identify donor predictors of allograft nonuse, and to determine whether these predictors are in fact associated with adverse recipient post-transplant outcomes. We studied a cohort of 1872 potential organ donors managed by the California Transplant Donor Network from 2001 to 2008. Forty-five percent of available allografts were accepted for heart transplantation. Donor predictors of allograft nonuse included age >50 years, female sex, death attributable to cerebrovascular accident, hypertension, diabetes mellitus, a positive troponin assay, left-ventricular dysfunction and regional wall motion abnormalities, and left-ventricular hypertrophy. For hearts that were transplanted, only donor cause of death was associated with prolonged recipient hospitalization post-transplant, and only donor diabetes mellitus was predictive of increased recipient mortality. Whereas there are many donor predictors of allograft discard in the current era, these characteristics seem to have little effect on recipient outcomes when the hearts are transplanted. Our results suggest that more liberal use of cardiac allografts with relative contraindications may be warranted.

Influence of the First Graft Nephrectomy in the Evolution of Second Kidney Transplant

Introduction: Nephrectomy is usually specified after the loss of a graft when there are signs of intolerance or resistance to erythropoietin. However, the influence of the first graft nephrectomy in the evolution of the second graft is less known. Materials and methods: We conducted a multicenter study of all second transplants performed between January 2001 and December 2005 in 15 centers in our country. Were analyzed: Data from the first graft (donor and recipient age, pretransplant antibody(Ac) titres, rejection acute rate, acute tubular necrosis(ATN), immunosupression, causes of graft loss) Indication of nephrectomy, second transplant data (pretransplant Ac title, acute rejection rate, inmunospresión, ATN, yearly development of proteinuria and renal function and patient and graft survival. The minimum follow-up period is 5 years Results: The sample consists of 525 patients who received a second kidney transplant, 243 had been nephrectomized, in 25 had been performed an embolization and 258 continued with the first graft. The indication for nephrectomy / embolization was 31.5% for graft intolerance in 38.16% by early nephrectomy and required rest from other causes.No nephrectomy for resistance to erythropoietin were made. In the first graft did not find significant differences in donor age, the title of Ac at transplantation, acute rejection rate or frequency of ATN among patients with or without nephrectomy. The duration of first graft was 31.8 months in patients nephrectomized and 94.9 in which nephrectomy was not required. The waiting time for the second transplant was higher in patients nephrectomized (33 vs 23 months, p< 0,01) In the second graft did not find significant differences in donor age, cause of donor death, recipient age or number of HLA incompatibilities in patients with or without prior nephrectomy. The nephrectomized patients had a significantly higher second pretransplant Ac (15.7 vs. 11.8%, p < 0.001), increased frequency of NTA (54% vs. 39%, p < 0.001) and higher rate of acute rejection (24, 7 vs. 17.1%, p < 0.001), as well as more frequently required the use of induction therapy (55 vs 41%, p < 0.01). There were no significant differences in patient survival or graft survival after 5 years of follow-up Conclusions: Nephrectomy was performed in 50.9% of grafts lost. It is indicated by early nephrectomy and graft intolerance syndrome. It is associated with: Increased waiting on dialysis, increased pre-second transplant antibodies, more NTA, more acute rejection, further immunosuppression. No impact on graft and patient survival was observed at 5 years of follow-up.

Influence of the First Graft Nephrectomy in the Evolution of Second Kidney Transplant

Introduction: Nephrectomy is usually specified after the loss of a graft when there are signs of intolerance or resistance to erythropoietin. However, the influence of the first graft nephrectomy in the evolution of the second graft is less known. Materials and methods: We conducted a multicenter study of all second transplants performed between January 2001 and December 2005 in 15 centers in our country. Were analyzed: Data from the first graft (donor and recipient age, pretransplant antibody(Ac) titres, rejection acute rate, acute tubular necrosis(ATN), immunosupression, causes of graft loss) Indication of nephrectomy, second transplant data (pretransplant Ac title, acute rejection rate, inmunospresión, ATN, yearly development of proteinuria and renal function and patient and graft survival. The minimum follow-up period is 5 years Results: The sample consists of 525 patients who received a second kidney transplant, 243 had been nephrectomized, in 25 had been performed an embolization and 258 continued with the first graft. The indication for nephrectomy/embolization was 31.5% for graft intolerance in 38.16% by early nephrectomy and required rest from other causes.No nephrectomy for resistance to erythropoietin were made. In the first graft did not find significant differences in donor age, the title of Ac at transplantation, acute rejection rate or frequency of ATN among patients with or without nephrectomy. The duration of first graft was 31.8 months in patients nephrectomized and 94.9 in which nephrectomy was not required. The waiting time for the second transplant was higher in patients nephrectomized (33 vs 23 months, p< 0,01) In the second graft did not find significant differences in donor age, cause of donor death, recipient age or number of HLA incompatibilities in patients with or without prior nephrectomy. The nephrectomized patients had a significantly higher second pretransplant Ac (15.7 vs. 11.8%, p < 0.001), increased frequency of NTA (54% vs. 39%, p < 0.001) and higher rate of acute rejection (24, 7 vs. 17.1%, p < 0.001), as well as more frequently required the use of induction therapy (55 vs 41%, p < 0.01). There were no significant differences in patient survival or graft survival after 5 years of follow-up Conclusions: Nephrectomy was performed in 50.9% of grafts lost. It is indicated by early nephrectomy and graft intolerance syndrome. It is associated with: Increased waiting on dialysis, increased pre-second transplant antibodies, more NTA, more acute rejection, further immunosuppression. No impact on graft and patient survival was observed at 5 years of follow-up.

Peripancreatic Fluid Collections after Simultaneous Pancreas-Kidney Transplantation: A Multivariate Risk Factor Analysis

Introduction: Peripancreatic Fluid Collections (PPFCs) are a serious complication after simultaneous kidney-pancreas transplantation (SPKTx), and literature is sparse on the associated risk factors (RF). Methods: Retrospective single centre study for all consecutive primary SKPTx performed between 12/08/1996 and 10/10/2011. Univariate risk factor (RF) analysis was followed by multivariate analysis using binary logistic regression analysis to derive the significant associations of PPFCs. Results: Of 223 SPKTx performed during the study period, 58% were systemic enteric drained, and 42% systemic bladder drained. PPFCs were seen in 36 (16%) cases, all in the early post-operative period (13% in bladder drained and 19% in enteric drained SPKTx, p=NS). Patients with PPFCs had significantly lower 1yr (78% PPFC vs. 92% non-PPFC) and 5 yr (68% PPFC vs. 85% non-PPFC, all p< 0.05) pancreas allograft survival compared to the non-PPFC group (n=186). There was no significant difference in the kidney (87% at 5 yrs) or patient survival (96% at 5 yrs). A pancreatic enzyme leak was seen in 56%, with confirmed duodenal stump leak in 22% of the PPFCs. ‘Graft Pancreatitis» was seen in a significantly greater proportion of patients with PPFC compared to the non-PPFCs (30% vs. 11%, P< 0/0001). Univariate analysis showed the following to be significant RFs associated with the development of PPFCs: mean donor age > 30 yrs (82% vs. 51%), mean donor BMI > 30 (12% vs. 4%) and donor cause of death from CVA (67% vs. 50%, all p< 0.05). Binary logistic regression analysis showed donor age > 30 yr to be a significant association with development of PPFC: (p=0.03, OR 3.4, CI 1.1-10.5), and a trend of association was seen for donor BMI > 30 (OR 2.5, p=0.1) and cold ischemia time > 12 hrs (OR 1.5, p=0.3). There was no association seen with use of donation after cardiac death organs, recipient BMI, age or gender, or bladder vs. enteric drainage or HLA mismatch. Subgroup analysis showed that cases of PPFC who lost the pancreas graft (n=12) had a significantly greater proportion of pancreatic enzyme leaks (83% vs. 42%, p< 0.01), and slightly higher female recipients (67% vs. 38%, p=0.09) compared to those with those cases of PPFC with surviving pancreas allografts (n=24). Conclusion: Donor factors such as older age and higher BMI carry a higher risk for development of peri-pancreatic fluid collections. The immediate cause of these collections is mainly related to pancreatic enzyme leak and ‘graft pancreatitis». Pancreatic allograft loss associated with peripancreatic fluid collection is greater in female recipients and if the collections are due to pancreatic enzyme leak.

Deceased Donors Renal Transplantation from Older Donors to Increase the Donor Pool

Background: Use of kidneys from donors aged 70 years and older is controversial. The organ shortage has led many transplant centers to accept kidneys from old, suboptimal deceased donors, and make increasing use of old-for-old allocation systems. We herein describe our institutional experience with outcomes of transplanting deceased-donor kidneys from older donors(>70 years). Material and methods: Between June 2004 and September 2011, twenty deceased donor renal transplants (DDRTx) were performed at our center using grafts from deceased donor 70 years and older. Kidneys allocated to dual or single grafting according to pre-transplant biopsy. Mean age of recipients was 47.60 ± 11.38 years, 13 were males. Mean donor age was 76.49 ± 4.9 years; 10 were males. Commonest cause of donor death was cerebrovascular/road traffic accidents. Mean dialysis duration pre-transplantation was 19.5 ± 6.5 months. Mean HLA match was 1 ± 0.8. Most common recipient diseases leading to ESRD were chronic glomerulonephritis(25%), diabetes(20%), and hypertension(20%). Post-transplant immunosuppression consisted of a calcineurin inhibitor-based regimen. Results: Over a mean follow-up of 2.8 ± 1.7 years, patient and graft survival rates were 75 % (n=15) and 80 % (n=16), respectively, with a mean serum creatinine of 1.78 ± 0.56 mg/dL; 20% of patients had biopsy-proven acute rejection episodes. A total of 25% (n=5) patients were died, mainly due to infections. Patient and graft survival, rejection and infection rates were similar in older and young donors RTx groups (p < 0.05). Conclusion: DDRTx from older donors achieves acceptable graft function with patient/graft survival, provided that organs allocated to dual or single grafting according to pre-transplant biopsy, encouraging the use of this approach even in low-income countries.