Graft Survival In Group Research Articles

KIDNEY TRANSPLANTATION IN PEDIATRIC PATIENTS WITH LOWER URINARY TRACT DYSFUNCTION

Introduction: Approximately 30 % of children with end stage renal disease have lower urinary tract dysfunction which can have deleterious influence on kidney transplantation (KTx). The aim of the study is to present single center long-term outcome of kidney transplantation in pediatric recipients with bladder dysfunction. Material and Method: Between 2000 and 2018 there were 752 KTx performed in our center. Within them there were 545 KTx into normal bladder and 207 KTx in patients with bladder dysfunction (130 KTx into native dysfunctional bladder and 77 KTx into urinary diversion). Surgical complications rate, urinary tract infections rate and graft survival in groups of patients transplanted into normal bladder, dysfunctional bladder and urinary diversion were compared. Results: Surgical complications were higher in group of recipients with dysfunctional bladder and urinary diversion in comparison to recipients with normal bladder (33% vs 28% vs 20%). Urinary tract infecions rate was significantly higher in groups of recipients with dysfunctional bladder and urinary diversion in comparison to recipients with normal bladder (57% vs 59% vs 18%). Graft loss was 18.5 % versus 9 % versus 17.9% in groups of recipients with dysfunctional bladder, urinary diversion, and normal bladder, respectively. The major cause of graft failure in each group was chronic rejection. Conclusions: Kidney transplantation in children with lower urinary tract dysfunction and end-stage renal failure offers good long-term results. Urinary tract infections are the most common complications in these patients. The major cause of graft loss is chronic rejecion.

Is Systemic Heparinization Necessary during Living Donor Hepatectomy?

Systemic heparinization has traditionally been performed during living donor hepatectomy (LDH) at most transplant centers because of the possibility of graft vascular thrombosis. However, no consensus on the use of systemic heparinization during LDH has yet emerged. The aims of the present study were to compare donor and recipient outcomes with reference to systemic heparinization and to determine whether or not systemic heparin needs to be administered to living donors. Via a retrospective review, we analyzed the outcomes of 175 LDHs performed at our institution from January 2011 to December 2014; 79 donors received systemic heparinization (group I), whereas 96 did not, but the liver graft was flushed with a heparinized perfusate (group II). The mean follow-up period was 60.6 ± 24.6 months for group I and 47.1 ± 13.5 months for group II. Patient demographics, intraoperative parameters, postoperative complications, and survival rates were compared between the two groups. The overall complication rates in donors did not differ significantly between the two groups, but postoperative bleeding requiring red blood cell transfusions in donors occurred more frequently in group I versus group II (7.6% versus 1.0%, P = 0.028). The incidences of graft vascular thrombosis were similar in the two groups, and no graft loss caused by vascular thrombosis was evident during the early postoperative period. The incidence of biliary stricture in recipients was not higher in donors who did not receive systemic heparin (5.1% versus 8.3%, P = 0.394). Moreover, the 1-,3-,and 5-year graft survival rates in the group I and group II were 87.1%, 84.5%, 81.9% and 96.9%, 94.7%, 93.6%, respectively and so overall graft survival in group II was higher than that in group I (p=0.018). In conclusion, the omission of systemic heparinization during LDH is both feasible and safe, with no adverse effects on donor or recipient outcomes.

Outcomes of Kidney Transplantation in Patients Exposed to Hepatitis B Virus: Analysis by Phase of Infection

BackgroundIn kidney transplant recipients (KTRs) with hepatitis B virus (HBV) infection, immunosuppression may increase viral replication with increased risk for liver disease progression and HBV-related kidney diseases, factors that could adversely influence graft and patient outcomes. We aimed to analyze the impact of different phases of HBV infection on the outcomes in KTRs. MethodsUsing the Organ Procurement and Transplant Network/United Network for Organ Sharing database, we selected adult KTRs from 2001 to 2011 who received peri-operative antibody induction followed by calcineurin inhibitor/mycophenolate mofetil maintenance with/without steroid. The cohort was divided into 4 groups, based on the presence/absence of hepatitis B surface antigen (HBsAg) and core antibody (HBcAb) at the time of transplantation: group 1: HBsAg+/HBcAb− (acute infection); group 2: HBsAg+/HBcAb+ (developing immune response); group 3; HBsAg−/HBcAb+ (resolving infection); and group 4: HBsAg−/HBcAb− (HBV-naive). Graft and patient survivals were compared among the groups in a multivariate Cox model. ResultsAdjusted overall graft (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.90–1.10; P = .58) and patient (HR, 0.95; 95% CI, 0.83–1.09; P = .52) survival rates were similar between groups 1 and 2, with inferior death-censored graft survival in group 1 (HR, 0.83; 95% CI, 0.71–0.98; P = .02). Adjusted over all graft (HR, 1.0; 95% CI, 0.90–1.00; P = .46) and patient (HR, 1.03; 95% CI, 0.90–1.10; P = .10) survival rates were similar between groups 3 and 4, and death-censored graft survival trended inferior in group 3 (HR, 0.97; 95% CI, 0.90–1.00; P = .05). ConclusionsOur analysis supports a practice of delaying kidney transplantation in HBV-infected patients until they develop an immune response and preferably until the infection is cleared.

BELATACEPT IN RENAL TRANSPLANTATION

Belatacept is a novel immunosuppressive agent that inhibits T-cell activation by blocking CD28 signaling pa- thway. It was developed based on abatacept (CTLA-4Ig), the fi rst recombinant immunoglobulin fusion protein which contains extracellular part of CTLA-4 molecule and Fc domain of IgG. First clinical trials have shown the comparable patient and graft survival in group of kidney recipients with belatacept-based maintenance im- munosuppressive therapy versus Cyclosporin A-based therapy. Advantages observed with belatacept include superior glomerular fi ltration rate and improved cardiovascular risk pro fi le. Belatacept is a potential option for maintenance immunosuppressive therapy without calcineurin inhibitors. Concerns associated with belatacept use are higher rates of acute cellular rejection episodes and post-transplant lymphoproliferative disorder cases.

Outcome of patients undergoing right lobe living donor liver transplantation with small-for-size grafts

To investigate the outcome of living donor liver transplantation (LDLT) recipients transplanted with small-for-size grafts (SFSGs). Between November 2001 and December 2010, 196 patients underwent LDLT with right lobe liver grafts at our center. Recipients were divided into 2 treatment groups: group A with an actuarial graft-to-recipient weight ratio (aGRWR) < 0.8% (n = 45) and group B with an aGRWR ≥ 0.8% (n = 151). We evaluated serum liver function markers within 4 wk after transplantation. We also retrospectively evaluated the outcomes of these patients for potential effects related to the recipients, the donors and the transplantation procedures based upon a review of their medical records. Small-for-size syndrome (SFSS) developed in 7 of 45 patients (15.56%) in group A and 9 of 151 patients (5.96%) in group B (P = 0.080). The levels of alanine aminotransferase and aspartate aminotransferase in group A were higher than those in group B during early period after transplantation, albeit not significantly. The cumulative 1-, 3- and 5-year liver graft survival rates were 82.22%, 71.11% and 71.11% for group A and 81.46%, 76.82%, and 75.50% for group B patients, respectively (P = 0.623). However, univariate analysis of risk factors associated with graft survival in group A demonstrated that the occurrence of SFSS after LDLT was the only significant risk factor affecting graft survival (P < 0.001). Furthermore, multivariate analysis of our data did not identify any additional significant risk factors accounting for poor graft survival. Our study suggests that LDLT recipients with an aGRWR < 0.8% may have liver graft outcomes comparable to those who received larger size grafts. Further studies are required to ascertain the safety of using SFSGs.

Impact of renal graft nephrectomy on second kidney transplant survival

To determine the impact of non-functional renal graft nephrectomy on second kidney transplantation survival. We performed a retrospective study on patients managed in our department from April 1989 to April 2011. We compared the number of acute graft rejections and graft survival between patients undergoing second transplantation with (Group I) or without (Group II) prior graft nephrectomy. A total of ninety-one patients received a second renal graft: 43 underwent graft nephrectomy and 48 kept their non-functional renal graft. There were 5 episodes of acute graft rejection in Group I and 12 in Group II (p = 0.3). Six (13.9 %) grafts failed in Group I and eight (16.6 %) in Group II. Five and 10 years actuarial graft survival in Group I were, respectively, 91 and 85 %, while in Group II were 82.7 % and 69 % (p = 0.2). PRA level and number of acute rejection episodes did not have a statistically significant influence on graft survival, whether the patient had a nephrectomy or not (p = 0.2). Nephrectomy of a failed allograft did not significantly improve the survival of a subsequent graft. Graft nephrectomy should be indicated in case of graft-related pain or a chronic inflammation syndrome.

Graft and Patient Survival After Liver Transplantation of Patients With Cirrhosis Due to Alcohol and Hepatitis C: Comparison to Alcoholic Cirrhosis and Hepatitis C Cirrhosis

Background and Aim: Graft and patient survival after liver transplantation (LT) is poor for hepatitis C virus (HCV) cirrhosis compared to alcoholic cirrhosis (AC). Data on outcome after LT for cirrhotics due to HCV and alcohol are limited. We compared post LT course of patients transplanted for HCV cirrhosis, alcoholic cirrhosis, and cirrhosis due to alcohol and HCV. Methods and Results: United Network for Organ Sharing data (1991-2010) was used to select study population of adult cirrhotics who have undergone first LT for either HCV cirrhosis (group I), alcoholic cirrhosis (group II) or cirrhosis due to alcohol and HCV (group III). Kaplan Meier survival estimates compared graft and patient survival. Results: Of 88368 LT, 19125 (23%), 9926 (12%), 4869 (5%) were performed for group I, II, and III respectively. Three groups were different for recipient (age, gender, race, MELD score, CMV status, and warm ischemia time) and donor (age, gender, race, heart beating status, infection, CMV +ve, HCV +ve, and donor risk index) characteristics. Proportion of recipients on ventilator, on dialysis, being diabetic, with TIPS, having simultaneous kidney transplant, with previous abdominal surgery, with history of portal vein thrombosis, and with HCC were also different across the groups. Five year graft and patient survival for group III were similar to group I (63% vs. 64%; P=0.33 and 69% vs. 70%; P=0.67 respectively) and worse than group II (63% vs. 69%; P<0.0001 and 69% vs. 73%; P=0.0003 respectively). On Cox proportional hazard regression analysis, group was an independent predictor for graft and patient survival after adjusting for recipient and donor characteristics. Graft survival for group III was similar to group I (HR 1.03 [0.97-1.09]) and worse than group II (1.27 [1.191.35]). Patient survival for group III was worse than group I (HR 1.09 [1.02-1.15]) and group II (HR1.27 [1.19-1.36]). Proportion of deaths in groups I, II, and III due to denovo tumors were 10% vs. 15% vs. 11% respectively (group III vs. I; P=0.09 and group III vs. II; P=0.004) and due to metabolic complications were 11% vs. 17% vs. 13% respectively (group III vs. I; P=0.19 and group III vs. II; P=0.001). Proportion of graft loss due to recurrent hepatitis in groups I, II, and III were 41% vs. 7% vs. 36% respectively (group III vs. I; P=0.014 and group III vs. II; P<0.0001). Conclusions: Graft survival of patients undergoing LT for cirrhosis secondary to HCV and alcohol is similar to patients with HCV cirrhosis and worse than AC. Patient survival after LT for patients with cirrhosis due to alcohol and HCV is worse compared to AC and HCV cirrhosis. Strategies to improve antiHCV regimens, screening for tumors, and manage metabolic problems are needed for patients undergoing LT for cirrhosis due to alcohol and HCV.

The Graft Outcomes of Living Donor Renal Transplantation according to Gender, Age, and BMI Matching between Donors and Recipients

Background: Despite significant advances in immunosuppression, supportive therapies, and operative skills, several factors still compromise long-term graft survival of patients who undergo renal transplantation. This study was designed to evaluate the risk factors influencing graft outcomes of living donor renal transplantation. We matched the recipient and donor age, gender, and body mass index (BMI). Methods: A total of 527 living renal transplantations were evaluated. The patients were divided into matching groups by donor and recipient age; group 1 (50≤/; 2, 50≤/＜50; 3, ＜50/50≤; 4, ＜50/＜50), gender (A, female/female; B, female/male; C, male/female; D, male/male), and BMI ratio (recipient/donor) (I, ＜0.8; II, 0.8≤/＜1.3; III, 1.3≤). We compared 1, 3, 5, and 10 year graft survival and analyzed the donor and recipient variables of age, HLA matching, and acute rejection. Results: The risk factors affecting long-term graft survival were recipient gender, acute rejection rate, and HLA-AB matching. In the groups divided according to donor and recipient age, no statistical difference was observed among the groups, but the 3–5 yr graft survival of group 1 (94.1/86.9%) was much higher than group 2 (86.5/75.6%). In the groups divided according to donor and recipient gender, graft survival in group C was higher than that in the other groups. No statistical difference in acute rejection or graft survival were observed in the groups with different BMI ratios. Conclusions: Meticulous preoperative donor and recipient matching for living renal transplantation may improve graft survival and expand the donor and recipient pool.

Can Preemptive Kidney Transplantation Guarantee Longer Graft Survival in Living-Donor Kidney Transplantation? Single-Center Study

IntroductionThe benefit of preemptive kidney transplantation (KTx) for graft survival compared with nonpreemptive KTx is controversial. ObjectiveTo analyze the influence of preemptive KTx on graft survival. Patients and MethodsThe study included 476 of 531 patients who had undergone living-donor KTx between January 2000 and June 2007. Pediatric patients and those who had previously undergone KTx were excluded. Recipients were divided into 2 groups; group 1 included 413 patients (86.8%) who received grafts after institution of maintenance dialysis, and group 2 included 63 patients (13.2%) who underwent preemptive KTx. ResultsDonor type and HLA mismatch demonstrated significant differences between the 2 groups. Group 1 had more living donors and fewer HLA mismatches. Warm ischemia time in group 2 was significantly shorter than in group 1. The serum creatinine concentration in group 1 on postoperative day 7 was significantly higher than in group 2. Five- and 10-year graft survival in groups 1 and 2, respectively, were 95.3% and 81.3% vs 92.9% and 92.9%. Graft survival was not significant insofar as duration and method of dialysis. At our institution, independent risk factors for graft survival in living-donor KTx are primary end-stage renal disease, acute cellular rejection episodes, and recipient age. ConclusionWe observed no benefit on graft survival in recipients of living-donor KTx insofar as whether they had undergone previous dialysis.

Even a single, remotely positive post-transplant alloantibody test correlates with increased chronic allograft nephropathy and graft loss after kidney transplantation

AbstractBackground: Chronic renal allograft loss is considered as immunologically mediated when donor-specific alloantibodies are detected. However, remotely detected alloantibodies with lack of detection more proximate to graft loss occurrence may obscure the humoral association with graft damage.Methods: We retrospectively reviewed 609 patients multiply tested post-transplant for detectable alloantibodies and correlated their results with clinical outcomes.Results: Most patients had no detectable post-transplant alloantibodies (Group 1, n = 393), some converted from nondetectable to detectable alloantibodies (Group 2, n = 97), some always had detectable post-transplant alloantibodies (Group 3, n = 69), and some demonstrated alloantibodies that subsequently became undetectable (Group 4, n = 50). The incidence of death-censored graft survival for Group 4 patients was similar to Group 2 and 3 patients, and greater than Group 1 patients. Further, interstitial fibrosis/tubularatrophy (IF/TA) free survival was significantly worse (p=0.018) for Group 4 versus Group 1 recipients. Also, Group 4 versus Group 1 IF/TA-free survival was worse when recipients were regrouped based solely on anti-HLA class II (p=0.006), but not anti-HLA class I (p=ns) antibodies.Conclusions: Detectable anti-HLA antibodies, even remotely, post-transplant identifies recipients at greater risk for IF/TA associated graft loss when compared to patients without detectable alloantibodies.

20-Year Follow-Up Results of a Randomized Controlled Trial Comparing Antilymphocyte Globulin Induction to No Induction in Renal Transplant Patients

The purpose of this study was to determine the impact of antilymphocyte globulin (ALG)-induction on long-term outcomes of postrenal transplantation. Between January 1985 and January 1986, 123 consecutive renal transplants from deceased donors were performed at a single institution. Patients were randomized into two groups: group 1 (n=63, 40+/-10 year) received cyclosporine (CsA), prednisone, and azathioprine; and group 2 (n=60, 36+/-9 year) received ALG-induction, CsA, and prednisone and delayed initiation (45-90 days posttransplantation) of azathioprine if the CsA dose was less than 4 mg/kg per day. Target CsA trough levels were 150 to 250 ng/mL. Cytomegalovirus prophylaxis was not used. Human leukocyte antigen matching (2.4+/-1.1 vs. 2.6+/-1.2) and cold ischemia time (38+/-8 hr vs. 39+/-9 hr) did not differ. The incidence of acute rejection was lower in group 2 (28% vs. 75%, P<0.0001). The incidence of cytomegalovirus infection was 10% in group 1 and 18% in group 2 (P=0.41). The incidence of cancer was 22.2% in group 1 and 11.7% in group 2 (P=0.53) and the incidence of lymphoma did not differ (3% vs. 5%, P=0.77). Patient and graft survival in groups 1 and 2 at 1, 10, and 20 years were 100%/79% vs. 100%/93%, 83%/56% vs. 88%/51%, and 64%/43% vs. 54%/47%, respectively (log-rank test, P=0.18 and P=0.078). The use of ALG-induction resulted in a lower incidence of acute rejection and improved graft survival during the first year postrenal transplantation. Patient and graft survival at 20-year follow-up was not affected by ALG-induction.

Does nephrectomy of failed allograft influence graft survival after re-transplantation?

The aim of the study was to determine the effect of removal of a failed kidney allograft on the outcome of subsequent transplant. Retrospective analytical study comparing graft survival for patients (1993-2005) who had previous graft nephrectomy with those who had not. Of 89 patients with kidney re-transplants, 68 had had a transplant nephrectomy (Group I) while 21 had retained failed grafts (Group II). There was no significant difference in the two groups in the PRA level at the time of re-transplantation (37% versus 29%). Mean follow-up was 47 months. Acute rejections in Group I were 49.1% and in Group II, 31.2% (P = 0.20). Twenty (29%) grafts failed in Group I and four (19%) in Group II. One, three and five years' actuarial graft survival in Group I was 83.8%, 76% and 66.2%, while in Group II, it was 94.7%, 86.8% and 69.5%, respectively (P = 0.66). Five-year actuarial patient survival in Groups I and II was 94.1% and 87.5%, respectively (P = 0.69). Multivariate analysis showed that PRA level significantly influenced graft survival independent of nephrectomy (P = 0.04). Nephrectomy of a failed allograft does not seem to significantly influence the survival of a subsequent graft.

Mycophenolate Mofetil: Ten Years' Experience of a Renal Transplant Unit

Mycophenolate mofetil (MMF) use in renal transplantation has allowed a significant decrease in early acute rejection rates. We retrospectively evaluated the incidence of acute rejection episodes, renal function at the first year posttransplant, patient and graft survivals, cytomegalovirus (CMV) infection rate, influence of the degree of sensitization, and number of MHC antigen mismatches on graft survival in two groups of patients receiving either MMF or azathioprine. Group 1 included 149 patients receiving cyclosporine, MMF, and prednisolone; group 2 included 191 patients receiving cyclosporine, azathioprine, and prednisolone. The two groups did not differ in terms of age, sex, degree of sensitization (expressed as percentage of antibodies reactive to panel), MHC mismatch number, cold ischemia time, donor age, or anti-thymocyte globulin induction. In group 1 (MMF) there was a significant decrease in early acute rejection rate (19% vs 57%, P < .0001), longer graft survival at 10 years (92% vs 75%, P = .006), and higher rate of CMV infection (22% vs 12%, P = .004). Renal function at the first year posttransplant and patient survival during follow-up did not differ between the groups. The degree of sensitization influenced graft survival in group 2. The number of MHC mismatches did not influence graft survival in either group. With MMF, there was a significant reduction in early acute rejection rate, a significant increase in graft survival at 10-year follow-up, and diminished impact of the degree of sensitization on graft survival.

The Role of Graft and Host Accommodation in a Hamster-to-Rat Cardiac Transplantation Model

We evaluated the importance and mechanism of graft and host accommodation in hamster-to-rat cardiac xenotransplantation models. To evaluate graft accommodation, accommodated hamster grafts (Group 2) were transplanted to naïve host rats treated with FK506, and compared with naïve hamster grafts (Group 1). To evaluate host accommodation, three groups were evaluated: naive hamster hearts were transplanted to naïve hosts treated with FK506 (Group 3: 0.5 mg/kg, Group 4: 1.0 mg/kg) and splenectomy, and compared with accommodating hosts (Group 5) with FK506 0.5 mg/kg and splenectomy. We examined graft survival, histopathology, antihamster antibodies and B-1 cells in blood. Graft survival in Group 2 (3.4+/-0.9 days) was not significantly different from that in Group 1 (2.8+/-0.4 days). Graft survival in Groups 4 and 5 (>30 days) was significantly prolonged compared with that in Group 3 (6.0+/-0.7 days). Histopathology of Groups 1-3 showed humoral rejection, whereas Groups 4 and 5 showed normal histology and expression of protective genes. In Groups 1-3, antihamster immunoglobulin (Ig) M and B-1 cells increased significantly compared to Groups 4 and 5, where IgM and B-1 cells remained low or were reduced. Host accommodation was more important than graft accommodation. Accommodating grafts expressing protective genes were rejected with an elevation of both IgM and B-1 cells. In accommodated hosts, both IgM and B-1 cells decreased, suggesting that B-1 cells may be responsible for the production of antihamster antibodies. These results suggest that sufficient suppression of B-1 cells, resulting in decreased titers of antihamster antibodies, may play an important role in host accommodation.

A randomized trial of thymoglobulin vs. alemtuzumab (with lower dose maintenance immunosuppression) vs. daclizumab in renal transplantation at 24 months of follow‐up

A long-term prospective randomized trial evaluating alemtuzumab, a humanized anti-CD52 monoclonal antibody, in a predominantly non-Caucasian population has yet to be reported. Ninety deceased donor (DD) first renal transplant recipients were randomized into three different antibody induction groups: group A, thymoglobulin (Thymo); group B, alemtuzumab; group C, daclizumab (Dac). In groups A and C, the target trough levels of tacrolimus were 8-10 ng/mL, mycophenolate mofetil (MMF) 1 g administered twice daily, and maintenance methylprednisolone. In group B, target tacrolimus trough levels were 4-7 ng/mL, 500 mg MMF administered twice-daily, without methylprednisolone. African-Americans and Hispanics comprised more than 50% in each group. A minimum follow-up of 27 months showed no overall group differences in patient or graft survival (p = 0.89 and 0.66), but a trend towards worse death-censored graft survival in group B (p = 0.05). Acute rejection rates were not significantly different: six (20%), seven (23%), and seven (23%) in groups A, B, and C, respectively. The incidence of chronic allograft nephropathy was higher in group B than in A and C (p = 0.008). The mean calculated creatinine clearance at 24 months was 81.1 +/- 5.5, 64.4 +/- 4.5, and 80.7 +/- 5.7 in groups A, B, and C, respectively (p = 0.01 for B vs. average of A and C). In this randomized 27-month minimum follow-up trial of predominantly non-Caucasian DD renal transplant recipients with alemtuzumab induction, lower maintenance tacrolimus, MMF, and steroid avoidance appear less effective than either Thymo or Dac with higher maintenance immunosuppression.

Outcome of Renal Transplantation with Multiple Versus Single Renal Arteries After Laparoscopic Live Donor Nephrectomy: A Comparative Study

To compare donor morbidity and recipient outcomes in patients with a single artery versus multiple arteries undergoing laparoscopic donor nephrectomy. A total of 303 consecutive laparoscopic donor nephrectomies were performed. Data from the group with multiple arteries (n = 27) (group I) were compared with those from the groups with single renal artery (n = 245) (group IIA) and early branching renal artery resulting in two artery recipient anastomoses (n = 31) (group IIB), in terms of donor and recipient outcomes. Laparoscopic donor nephrectomy was technically successful in all 303 patients without need for open conversion. The graft retrieval time was higher in group I and group IIB compared with group IIA (3.9 +/- 1.4 and 3.9 +/- 0.8 versus 3.5 +/- 1.0 minutes). Similarly, warm ischemia time was significantly higher in groups I and IIB versus group IIA (7.2 +/- 1.9 and 6.7 +/- 1.9 versus 5.6 +/- 1.8 minutes). Creatinine level at day 1 was higher in group I compared with group IIA (2.4 +/- 1.4 versus 1.9 +/- 0.7 mg/dL). However, there was no significant difference in creatinine levels at 1 month and 1 year among the three groups. Overall graft survival in groups I, IIA, and IIB was 92%, 94.4%, and 94%, respectively. Laparoscopic donor nephrectomy in the presence of multiple renal arteries is feasible and safe. Additionally, long-term graft survival and graft function at 1 month and 1 year are not adversely impacted by the presence of multiple renal arteries in grafts procured laparoscopically.

Beneficial Effects of Simultaneous Treatment With 15-deoxyspergualin and Monoclonal Antibodies to CD45RB and CD154 on Murine Islet Transplantation Recipients

Treatment of transplant recipients with either 15-deoxyspergualin (DSG) or monoclonal antibodies (mAbs) to T-cell proteins CD45RB and CD154 (a two-signal blockade) has been shown to prolong islet graft survival. Therefore, we investigated the combined effect of DSG, anti-CD45RB, and anti-CD154 in murine islet model. Chemically induced diabetic C57BL/6 mice underwent allografting with islets from BALB/c mice or xenografting with rat islets. After transplantation, they were treated with either DSG, the two-signal blockade, or both (the triple treatment). The tolerogenic effects of the posttransplant treatments were measured with an intraperitoneal glucose tolerance test (IPGTT), immunohistology, enzyme-linked immunosorbent assays, and flow cytometry. Blood glucose profiles measured after glucose challenges were improved in all islet recipients. Enhancement of xenograft survival in triple-treated groups was not statistically significant (P = 0.08), compared to graft survival in group received only the two-signal blockade. However, 15 days after transplantation, xenografts in the triple-treated group showed a significant decrease in the proportion of CD4, CD8, and CD4CD45RB T-cells, and in the expression of interleukin-10 and interferon-gamma, relative to grafts in the other treatment groups. In addition, reduced infiltration of the xenografts by CD3 T-cells was observed in groups that had received either the two-signal blockade or the triple treatment. With long-term (>248 days) xenografts, only those in the triple-treated group were free of inflammatory infiltrates. These grafts also exhibited larger islet clusters and contained more insulin- and glucagon-positive cells, relative to grafts in the other treatment groups. Triple treatment has a beneficial effect in murine islet xenotransplantation.

Use of Marginal Donors in Kidney Transplantation: Our Experience

The use of elderly donors has been advocated to expand the organ donor pool because of increased needs and the organ shortage. The aim of this study was to analyze whether the use of elderly donors and marginal kidneys affected the outcome of renal transplantations. Herein we presented data on 126 kidney transplantations performed from January 1996 to September 2003 using 32 marginal donors (group A) and 94 ideal donors (group B). We analyzed the medical and surgical complications and the graft survivals at a median follow-up of 18 months. Medical and surgical complications occurred in 22% and 5% versus 7% and 4% in groups A and B, respectively. The mean cold ischemia time and the mean age were greater for patients undergoing kidney transplantations from marginal donors. No differences were observed in graft survival in groups A and B. In conclusion, our data suggested that with an appropriate strategy and a correct selection of patients, marginal kidneys can be safely used to decrease the gap between demand and supply.

The impact of sex and age matching for long-term graft survival in living donor renal transplantation

Background Deficient functional renal mass leads to progressive renal injury owing to the detrimental effects of glomerular hyperfiltration. Therefore, renal transplant mass is an important determinant of outcome. Materials and methods We retrospectively analyzed 614 living donor renal transplantations performed from 1979 to 2002. Patients were divided into 4 groups according to donor-recipient gender differences: group 1 (male to male), group 2 (male to female), group 3 (female to male), and group 4 (female to female). We analyzed the clinical and immunological data to compare the 4 groups with respect to long-term graft survival, age gender, acute rejection episodes an HLA matching. We used the Kaplan-Meier method with the log-rank test to assess graft survival. Results The actuarial graft survival rate was 86.24% at 5 years for donors younger than 50 years of age compared with 73.15% for those older than 50 years ( P = .0000). The graft survival from younger donors than recipients was 85.23% at 5 years compared with 80.35% for older donors ( P = .0213). The graft survival of group 3 (female donor to male recipient) was 75.12% at 5 years compared with 85.72%, 85.33%, and 83.16% for groups 1, 2, and 4, respectively ( P = .0165). The main parameters significantly associated with graft survival were donor age ( P = .0000), acute rejection episode ( P = .0000), donor gender ( P = .0215). HLA-DR matching ( P = .0516), and donor and recipient age matching ( P = .0213). Conclusions The results suggest that the sex and age matching between donors and recipients should be considered as a criterion in the choice of donor and recipient pairs for living donor renal transplantation.

IMPROVED RESULTS WITH SELECTIVE USE OF SPLENECTOMY AND ANTI-CD20 FOR POSITIVE CROSSMATCH TRANSPLANTS

O71 Aims: Thirty percent of the kidney transplant waiting list is sensitized to HLA molecules. These patients endure disproportionately long waiting times and inferior graft survival. Many of these patients have a live donor who has been excluded due to a positive crossmatch (+XM). Methods: A total of 63 renal transplants were performed during the study period (2/1998 – 2/2004) utilizing our plasmapheresis/low dose CMVIg (PP/CMVIg) protocol. The first 41 patients (Group 1) were preconditioned with a one-size-fits-all protocol using PP/CMVIg and standard immunosuppression. Results from this group were compared to the most recent 22 patients for whom the therapeutic plan was individualized to match the level of risk of graft loss. Results: Mean follow-up times for Groups 1 and 2 were 30.1 ± 21.1 months and 7.1 ± 3.2 months, respectively. Death-censored graft survival for Group 1 was 87.8%. Group 2 patients who were determined to be at high risk for graft loss (wide breadth of HLA reactivity, previous transplants and early graft losses, multiple repeat mismatches, rising or rebounding donor specific antibody titers) underwent enhanced preconditioning therapy with splenectomy and/or anti-CD20 therapy. Death-censored graft survival in Group 2 was 100%. Of the graft losses in Group 1, immunologic graft loss accounted for 4 of the 5 events. Current serum creatinine levels in Group 1 and 2 are 1.9 ± 1.8 and 1.1 ± 0.4. Overall patient survival in Group 1 and Group 2 is 87.8% and 100%. Three patients in Group 1 died with a functioning graft. Conclusions: Lower rates of graft loss can be achieved in patients preconditioned for a +XM with their donor when the treatment plan is crafted to match the immunologic risk of the recipient. Transplantation, Volume 78, Number 2, July 27, 2004