Cases Of Delayed Graft Function Research Articles

Application value of ultrasonic contrast imaging and ultrasonic parameters in post-transplant renal surgery.

Utilize VUEBOX quantitative analysis software to perform quantitative analysis dynamic ultrasound contrast images of post-transplant renal patients were assessed quantitatively five parameters of ultrasonic contrast and two-dimensional ultrasound are examined to explore their six value in Diagnosing Renal Graft Dysfunction. A retrospective analysis was conducted on 73 post-transplant renal patients who underwent ultrasound contrast examinations at Yiyang Central Hospital from July 2022 to December 2023, They were diagnosed clinically and pathologically. Based on pathological and clinical diagnostic results, the patients were divided into three groups: 47 cases in the stable renal function group, 18 cases in the acute rejection (AR) group, and 8 cases in the delayed graft function (DGF) group. All patients underwent routine ultrasound and ultrasound contrast examinations post-transplantation. By comprehensively assessing renal function test results, clinical course, and pathological findings, differences in ultrasonic contrast quantitative parameters were analyzed. Additionally, ROC curves were constructed to evaluate the diagnostic efficacy of ultrasound contrast in discriminating between transplant renal rejection reactions and delayed renal function recovery. Statistically significant differences in characteristics, such as renal segmental artery resistance index, were observed among the stable renal function group, AR group, and DGF group (all P < 0.05), while peak systolic velocity showed no statistical significance (P > 0.05). Differences in cortical time to peak (TTP), medullary time to peak(TTP), main renal artery rise time (RT), main renal artery(TTP), and main renal artery fall time (FT) were statistically significant among the stable renal function group, AR group, and DGF group (P < 0.05). ROC curve analysis demonstrated that the accuracy of quantitative parameters for the DGF group and AR group was as follows: Renal artery TTP = Renal artery RT > Renal artery FT > Medulla TTP > Cortex TTP (with respective area under the curve values of 0.828, 0.828, 0.758, 0.742, 0.719). Among these, Renal artery TTP and Renal artery RT exhibited larger AUC values, with sensitivities of 87.5% each and specificities of 81.2 and 87.5%, respectively. There are discernible differences in VUEBOX quantitative parameters between post-transplant AR and DGF cases, thereby providing imaging references for diagnosing of acute rejection and functional impairment following renal transplantation.

PD45-05 STEP-BY-STEP DEVELOPMENT OF A COLD ISCHEMIA DEVICE FOR OPEN AND ROBOT-ASSISTED RENAL TRANSPLANTATION

You have accessJournal of UrologyRenal Transplantation & Vascular Surgery II (PD45)1 Sep 2021PD45-05 STEP-BY-STEP DEVELOPMENT OF A COLD ISCHEMIA DEVICE FOR OPEN AND ROBOT-ASSISTED RENAL TRANSPLANTATION Angelo Territo, Matteo Fontana, Andrea Gallioli, Alberto Piana, Pietro Diana, José Maria Gaya, Jorge Huguet, Pavel Gavrilov, Oscar Rodriguez Faba, Alex Mottrie, Carme Facundo, Lluís Guirado, Joan Palou, and Alberto Breda Angelo TerritoAngelo Territo More articles by this author , Matteo FontanaMatteo Fontana More articles by this author , Andrea GallioliAndrea Gallioli More articles by this author , Alberto PianaAlberto Piana More articles by this author , Pietro DianaPietro Diana More articles by this author , José Maria GayaJosé Maria Gaya More articles by this author , Jorge HuguetJorge Huguet More articles by this author , Pavel GavrilovPavel Gavrilov More articles by this author , Oscar Rodriguez FabaOscar Rodriguez Faba More articles by this author , Alex MottrieAlex Mottrie More articles by this author , Carme FacundoCarme Facundo More articles by this author , Lluís GuiradoLluís Guirado More articles by this author , Joan PalouJoan Palou More articles by this author , and Alberto BredaAlberto Breda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002059.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rewarming time can be associated with delayed graft function (DGF) due to ischemia/reperfusion damage. In both open kidney transplantation (OKT) and robotic assisted kidney transplantation (RAKT), ice slush is used to maintain graft temperature (GT) (target <20°C), preventing its impairment due to the rewarming time. This cooling technique is not able to keep a constant, equal temperature over the entire graft surface and can potentially provoke local or systemic hypothermia. The aim of a cold ischemia device (CID) is to maintain a constant low temperature of the entire graft while performing vascular anastomosis. METHODS: In IDEAL phase 1, CID was developed with bioengineers from GRENA Ltd. It consists of 2 layers of a thin film sealed to create a circuit, through which saline could flow in a closed system thanks to silicone tubes connected to a peristaltic pump and saline reservoir. CID was tested in the dry lab to determine whether it could keep a kidney at a constant low temperature, using 15 porcine kidneys: in 5 the device was used (group 1), in 5 a gauze jacket filled with ice slush was used (group 2), and in 5 no covering was used (group 3). The three groups of kidneys were introduced into a closed box with a predetermined temperature of 37.5°C, simulating the temperature of the abdominal cavity (38°C). The temperature was evaluated at scheduled timepoints from T0 (baseline) to T11 (50th minute). In phase 2a, CID was evaluated in porcine model (in-vivo) undergoing OKT and RAKT. In phase 2b, CID was tested in patients undergoing OKT and RAKT from living donors, monitoring GT with a thermal probe. Surgical procedures were performed according to standard technique. RESULTS: In IDEAL phase 1, CID proved able to maintain a low GT (<20°C) and was superior to both the gauze jacket filled with ice slush and no covering (p=0.002). In IDEAL phase 2a, CID allowed maintenance of a low and constant GT during both OKT (n=3) and RAKT (n=3), with a mean temperature at T11 of 10.8°C (SD 0.2) and 14.9°C (SD 0.1), respectively. In IDEAL phase 2b, demonstrated that both OKT (n=2) and RAKT (n=3) can be performed using CID in a clinical setting. In both approaches, GT never exceeded 20°C, with mean temperatures of 15.7°C and 18.3°C in OKT and RAKT, respectively. In all 5 cases, surgical times using CID were similar to the conventional approach. All (n=5) patients were discharged at post-op day 7; no cases of DGF were recorded. CONCLUSIONS: CID showed to keep a constant low GT in both OKT and RAKT. In terms of maneuverability and feasibility, it allows to perform vascular anastomosis within a satisfactory length of time. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e744-e744 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angelo Territo More articles by this author Matteo Fontana More articles by this author Andrea Gallioli More articles by this author Alberto Piana More articles by this author Pietro Diana More articles by this author José Maria Gaya More articles by this author Jorge Huguet More articles by this author Pavel Gavrilov More articles by this author Oscar Rodriguez Faba More articles by this author Alex Mottrie More articles by this author Carme Facundo More articles by this author Lluís Guirado More articles by this author Joan Palou More articles by this author Alberto Breda More articles by this author Expand All Advertisement Loading ...

Can pre-implantation biopsies predict renal allograft function in pediatric renal transplant recipients?

Objectives:To determine the utility of pre-implantation renal biopsy (PIB) to predict renal allograft outcomes.Methods:This is a retrospective review of all patients that underwent PIB from January 2003 to December 2011 at the Great Ormond Street Hospital for Children in London, United Kingdom. Thirty-two male patients (56%) aged 1.5-16 years (median: 10.2) at the time of transplantation were included in the study and followed-up for 33 (6-78) months. The results were compared with 33 controls.Results:The PIB showed normal histopathological findings in 13 patients (41%), mild chronic vascular changes in 8 (25%), focal tubular atrophy in one, moderate to severe chronic vascular change in 3, mild to moderate acute tubular damage in 6, and tissue was inadequate in one subject. Delayed graft function (DGF) was observed in 3 patients; 2 with vascular changes in PIB, and one with normal histopathological findings. Two subjects with PIB changes lost their grafts. The estimated glomerular filtration rate at 3-, and 6-months post-transplantation was lower in children with abnormal PIB changes compared with those with normal PIB. There was one case of DGF in the control group, and 4 children lost their grafts including the one with DGF.Conclusion:Pre-implantation renal biopsy can provide important baseline information of the graft with implications on subsequent medical treatment for pediatric renal transplant recipients.

Can Abdominal Surgical History Be Preventing Factors of the Hand Assisted Laparoscopic Left Nephrectomy for Living Donor Kidney Transplantation?

Background As a surgical procedure for the donor of the living related kidney transplantation, hand assisted laparoscopic nephrectomy is widely performed. It is a feasible and safe method, but sometimes thought to be inappropriate especially for donors with abdominal surgical histories because of adhesion. Purpose The efficacy of hand assisted laparoscopic living donor left nephrectomy (HALDLN) for such living related donors were investigated comparing with donors without abdominal surgeries. Patients and methods 361 donors for living related kidney transplantation between January 2009 and March 2013 were investigated retrospectively. Operative result including operative time, blood loss, warm ischemic time and open conversion was reviewed. And as for graft quality, the length of renal artery, vein, ureter, time to initial urination, delayed graft function cases were also investigated. Results In 361 donors, 358 donors were performed HALDLN. 3 donors were performed open nephrectomy. In 358 donors, 17 donors had abdominal surgical histories. 341 donors had no abdominal surgical histories (non- abdominal surgical history group) and were compared with the donors with abdominal surgical histories (abdominal surgical history group). There no significant difference in these factors between these two groups. But open conversion was done for only one donor of non-abdominal surgical group because of the uncontrollable bleeding. Delayed graft function due to nephrectomy was not found in this study. Conclusion HALDN is a feasible and safe method for the living related donors even with abdominal surgical histories.

Association of CTLA-4 Gene Polymorphism with End-Stage Renal Disease and Renal Allograft Outcome

Cytotoxic T-lymphocyte antigen 4 (CTLA-4) is upregulated in effector-T-cells after activation that may alter signal transduction and subsequently cytokine production. The present study was designed to investigate the impact of CTLA-4+49 A>G (rs231775), -318 C>T (rs5742909), -658 C>T (rs11571317), -1147 C>T (rs16840252), -1661 A>G (rs4553808), +6230 A>G (rs3087243) SNPs, and microsatellite (AT)n repeat polymorphism among end-stage renal disease (ESRD), acute allograft rejection (AR), and delayed graft function (DGF) cases. In this regard, 350 ESRD patients and 350 controls were included. Polymerase chain reaction (PCR)-restriction fragment length polymorphism analysis method was used for genotyping of CTLA-4 SNPs, while PCR-polyacrylamide gel electrophoresis method was adopted for studying CTLA4 (AT)n polymorphism. The mutant genotype GG of CTLA-4+49A>G,+6230 A>G, and longer alleles of (AT)n repeats polymorphisms were risk associated with ESRD, AR, and DGF cases. The distribution of haplotype+49G:+6230G and GCTTGG (constructed by using 6 studied SNPs) showed risk association for ESRD, DGF, and AR cases. Further, linkage analysis demonstrated strong to moderate linkage disequilibrium in our study populations. The meta-analysis also revealed risk associations for AR cases against GG genotype of CTLA-4+49A>G SNP, while CTLA-4 -318C>T polymorphism showed no correlation against TT genotype among AR cases. Subsequently, no correlation was established against the CTLA-4 -318C>T, -658 C>T, -1147 C>T, and -1661 A>G SNPs in the promoter region. Survival analysis revealed risk associations against GG genotype of CTLA-4+49A>G, +6230 A>G SNP's with overall survival (OS), and higher hazard for the OS. These results suggested that CTLA-4 variants might be involved in susceptibility to ESRD, AR, and DGF.