Early Renal Outcomes Research Articles

Early Renal Outcomes Following Heart Transplantation Using Organs Procured After Circulatory Death.

Transplantation using hearts obtained through donation after circulatory death (DCD) is increasing, but data on recipient renal outcomes are limited. Patients at a single institution who underwent heart transplantation using organs procured through DCD or donation after brain death (DBD) from April 2016 to August 2022 were included in this retrospective cohort study. Hemodynamic measures were collected via right heart catheterization performed 1 week after transplantation. Posttransplantation renal outcomes included estimated glomerular filtration rate at 1 week, 4 weeks, and 16 weeks, and the incidence of acute kidney injury (AKI) and renal replacement therapy within 1 week. The analysis included 225 patients (55 recipients of DCD). Baseline characteristics were comparable between recipients of DCD and DBD. Renal outcomes within 1 week posttransplantation in recipients of DCD were similar to recipients of DBD, including percent change in estimated glomerular filtration rate (-37.9% [-58.6 to -6.2] versus -31.9% [-52.4 to -9.9]; P=0.91), incidence of AKI (47.3% versus 46.5%; P>0.99) and incidence of renal replacement therapy (3.6% versus 4.7%; P>0.99). Recipients of DCD with AKI within 1 week ("early AKI") did not recover to baseline estimated glomerular filtration rate (75.8 [60.2-91.3] mL/min per 1.73 m2) by week 16 (59.3 [46.9-73.6] mL/min per 1.73 m2; P=0.002), whereas recipients without early AKI exhibited comparable estimated glomerular filtration rate to baseline by week 4 (84.5 [70.8-98.5] mL/min per 1.73 m2; P=0.084). Similar trends were observed in recipients of DBD. Recipients of DCD demonstrated similar renal outcomes compared with recipients of DBD, supporting the ongoing use of DCD transplantation. Early AKI was associated with persistent renal dysfunction for recipients of both DCD and DBD.

(398) Favorable Impact of Hypothermic Machine Perfusion (HMP) on Early Renal Outcomes in Patients Undergoing Heart Transplantation Using Prolonged (6-8 Hour) Donor Hearts

(398) Favorable Impact of Hypothermic Machine Perfusion (HMP) on Early Renal Outcomes in Patients Undergoing Heart Transplantation Using Prolonged (6-8 Hour) Donor Hearts

(275) Early Renal Outcomes Following Cardiac Transplantation Using Organs Procured after Circulatory Death

(275) Early Renal Outcomes Following Cardiac Transplantation Using Organs Procured after Circulatory Death

Excessive positive fluid balance has a negative effect on short-term renal outcomes after kidney transplantation

Background: Optimized postoperative fluid management is important in maintaining early allograft function after kidney trans plantation (KT). However, there is still no clear guidance on how to treat fluid after KT. In this study, we investigated the effect of fluid balance on postoperative allograft function. Methods: Recipients underwent KT between March 2012 and August 2018 were included and their medical records were re viewed retrospectively. We calculated fluid balance, which is the difference between total input and output during 3 days after KT, and analyzed the change of estimated glomerular filtration rate (eGFR) according to fluid balance. Results: A total of 178 patients were included, except those with delayed graft function or urine output less than 2,000 mL on the first day after KT. Among them, 116 received kidneys from living donors and 62 from deceased donors. The total fluid balance up to day 3 was 4,236.9±2,830.4 mL. Old age, high body mass index (BMI), excessive positive fluid balance of recipient and high final creatinine of donor were significantly associated with low eGFR at 1 week. In addition, age, BMI, and fluid balance predict ed 1-month eGFR. In multivariate analysis, an excessive positive fluid balance was an independent factor to predict low 1-week eGFR (P=0.031). In particular, this positive correlation was evident in the living donor KT recipients, suggesting that excessive positive fluid balance at early postoperative period can delay functional recovery of the transplanted kidney, regardless of donor kidney status. Conclusions: We have demonstrated that excessive positive fluid balance can negatively affect early graft function after KT. Therefore proper fluid management strategies based on volume conditions may provide new therapeutic opportunities to im prove early renal outcomes after KT.

EXCESSIVE POSITIVE FLUID BALANCE HAS A NEGATIVE EFFECT ON SHORT-TERM RENAL OUTCOMES AFTER KIDNEY TRANSPLANTATION

Background: Optimized postoperative fluid management is important in maintaining early allograft function after kidney trans plantation (KT). However, there is still no clear guidance on how to treat fluid after KT. In this study, we investigated the effect of fluid balance on postoperative allograft function. Methods: Recipients underwent KT between March 2012 and August 2018 were included and their medical records were re viewed retrospectively. We calculated fluid balance, which is the difference between total input and output during 3 days after KT, and analyzed the change of estimated glomerular filtration rate (eGFR) according to fluid balance. Results: A total of 178 patients were included, except those with delayed graft function or urine output less than 2,000 mL on the first day after KT. Among them, 116 received kidneys from living donors and 62 from deceased donors. The total fluid balance up to day 3 was 4,236.9±2,830.4 mL. Old age, high body mass index (BMI), excessive positive fluid balance of recipient and high final creatinine of donor were significantly associated with low eGFR at 1 week. In addition, age, BMI, and fluid balance predict ed 1-month eGFR. In multivariate analysis, an excessive positive fluid balance was an independent factor to predict low 1-week eGFR (P=0.031). In particular, this positive correlation was evident in the living donor KT recipients, suggesting that excessive positive fluid balance at early postoperative period can delay functional recovery of the transplanted kidney, regardless of donor kidney status. Conclusions: We have demonstrated that excessive positive fluid balance can negatively affect early graft function after KT. Therefore proper fluid management strategies based on volume conditions may provide new therapeutic opportunities to im prove early renal outcomes after KT.

Characterization and outcome following Puumala virus infection: a retrospective analysis of 75 cases

Infection with the Puumala virus (PUUV), which belongs to the Hantavirus family, is a common but often neglected cause of acute kidney injury (AKI) in endemic areas of Europe. The objective of the present study was to systematically analyse clinical presentation and renal outcomes following PUUV infection. In a retrospective study, we analysed data from 75 patients who were admitted to two large hospitals in Germany over an 8-year period and who tested positive for PUUV infection. Clinical and laboratory data were collected from patient files; creatinine levels before admission and during follow-up were obtained from phone calls. Patients were between 16 and 82 years old (average +/- SD, 40.4 +/- 13.4) with a male to female ratio of 2.5:1. They showed a wide variety of clinical presentations with renal failure being the cause of admission in only 50%. AKI developed in 95% of patients who showed maximum creatinine levels of 4.3 +/- 0.3 mg/dl. Four patients required temporary dialysis, and one patient died from pulmonary complications. Thrombocytopaenia (137 +/- 11 x 10(3)/microl) was present in almost all cases, and elevated levels of lactate dehydrogenase (LDH) and C-reactive protein (CRP) were observed in 57 and 100% of patients, respectively. Urinalysis revealed mild to nephrotic proteinuria in 85%, which was often associated with haemoglobinuria. All patients showed full recovery of renal function and return to pre-existing normal serum creatinine levels. In a majority of cases, PUUV infection results in thrombocytopenic AKI. Fever is a requirement for diagnosis, while elevated LDH and CRP values are also frequently observed. Overall, early renal outcomes were excellent.

A single center comparison of long-term outcomes of renal allografts procured laparoscopically versus historic controls procured by the open approach

We have previously reported that renal allografts procured by the laparoscopic live donor nephrectomy (lapNx) demonstrate worse early renal outcomes but noninferior 1-year renal function as compared to those procured by the standard open nephrectomy (openNx). We undertook this study to examine whether the apparent early dysfunction will impair long-term renal allograft survival. We retrospectively updated the status of the first 132 consecutive adult left lapNx recipients at our center and the preceding 99 adult openNx recipients. With a mean follow-up of 5.8+/-2.0 years in lapNx and 8.7+/-3.3 years in openNx, we found that death-censored renal allograft survival was identical on univariate and multivariate analysis. Patient survival was worse (log rank P-value=0.048) in lapNx, but this finding did not persist in multivariate analysis. Combined graft-patient survival as well as 1-year mean serum creatinine levels were similar on univariate and multivariate analyses. We conclude that, despite having suffered early renal dysfunction, the lapNx cohort of renal allograft recipients enjoys similar long-term renal allograft survival as compared to openNx.

OUTCOMES OF RECIPIENTS OF RENAL ALLOGRAFTS HARVESTED BY LAPAROSCOPIC TECHNIQUE: IS THERE A LEARNING CURVE?

327 We previously reported that early recipient renal function was inferior with transplant laparoscopic donor nephrectomy (lapNx) as compared to standard open nephrectomy. We now examine our accumulating experience with lapNx to assess whether we have overcome problems that may produce early renal parenchymal injury. Methods: The experience of 252 consecutive adult recipients lapNx allografts from living donors between 3/27/96 and 9/25/98 was retrospectively reviewed. Patients were divided into four groups of 63 based on the quartiles of the date of the transplant procedure (Q1-Q4, from earliest to most recent). Serum creatinines (SCr) were obtained from our computerized database, and need for hemodialysis (HD) during first postoperative week was determined based on billing records. Results: Comparison by Pearson chi-square analyses showed no differences among the groups with regard to recipient age, race or sex; donor age, race or sex; or frequency of zero HLA-AB/DR mismatches. Later quartiles were more likely to receive mycophenolate mofetil and tacrolimus (FK) versus cyclosorine, and they were less likely to receive antilymphocye induction. During Q2, we began to introduce FK preoperatively at 0.2 mg/kg/day. During Q4, the dose of pre-op FK induction decreased to 0.1 mg/kg/day due to excessive early nephrotoxicity of the higher dose. (Table)TableOne-way ANOVA and chi-square analyses revealed no significant trends in these outcomes among the groups. Likewise, comparing Q1 with Q4 by unpaired student's t-test or chi-square revealed no significant differences. Since we decreased FK induction doses, no patients have required HD and SCr has improved at 1 wk (2.31 +/− 0.1 and 1.82 +/− 0.18 mg/dl pre- and post-change, respectively; p=0.029) and 1 mo (1.87 +/− 0.1 and 1.48 +/− 0.1 mg/dl, p=0.001). Conclusion: During our center's extensive experience with the lapNx, we have demonstrated no significant changes in early renal outcomes despite increased early exposure to nephrotoxic effects of FK. We expect that lowering the doses of FK induction will unmask the benefits of improvement in harvest technique.