Indications For Renal Transplantation Research Articles

Outcomes of and indications for renal transplantation in patients with von Hippel Lindau disease

Introduction and objectiveVon Hippel-Lindau (VHL) is a hereditary cancer syndrome characterized by bilateral, multifocal renal masses. The cumulative impact of extirpative surgery can depreciate renal function and render patients anephric. In the larger end-stage renal disease population, renal transplant offers both excellent quality of life and functional renal replacement. This case control study aims to examine and compare oncologic and functional outcomes of patients who have undergone renal transplant as renal replacement therapy (RRT) to those who remain anephric. MethodsPatient charts were retrospectively reviewed of patients with germline testing confirmed VHL between 1980 and 2022 for transplant, all prior surgical history (within and outside the NCI), renal function and graft outcomes. Overall survival (OS) was determined from years after radical nephrectomy, and graft time was defined as years of graft function from initial transplant until failure or patient death. Graft survival was determined as time between transplant(s) to last follow up. Kaplan-Meier analysis was conducted to compare graft times of anephric VHL patients to those with transplanted kidneys. ResultsA total of 23 VHLD patients were identified as either anephric or candidates for transplant. Out of this cohort, 11 total VHLD received 12 total kidney grafts. Median wait time from nephrectomy to transplant was 22.6 months (IQR: 1.02–40.25 months). Median age at transplant was 32 years (IQR: 23–54 years). OS at 5 and 10 years of anephric patients who did not receive a transplant was 33% and 16.7%, respectively. OS rates of the transplant cohort at 10, 15, and 20 years were 91%, 78%, and 58% years, respectively. Median graft time was 161 months (IQR: 56–214 months). Graft survival at 10, 15, and 20 years was 69.8%, 69.8%, and 26.2%, respectively. ConclusionsWe demonstrate that transplant recipients have decreased mortality with no difference in cancer recurrence compared to those who do not receive renal transplant for RRT. This data can aid in informing providers of the optimal window for early RRT planning in VHL, while also improving patient counseling.

Obstructive Nephropathy in Children – A Review

Obstructive nephropathy is any affection of the urinary tract characterized by impairment of urine flow through the tract and which, if left untreated, will cause progressive renal damage. Causes in children are congenital or acquired. Congenital causes are pelvi-ureteric junction obstructions, posterior urethral valves (PUV), urethral atresia, phimosis and meatal stenosis. The acquired causes are calculi, post-traumatic and post-inflammatory strictures and meatal stenosis. There are some manifestations like prune-belly syndrome, hydronephrosis and renal failure. Diagnostic investigations include ultrasonography, intravenous urography, cystography and renography. Advanced technologies have impacted on the treatment of the different lesions such as utero vesico-amniotic shunt and endoscopic valve ablation for PUV and minimally invasive techniques for urolithiasis. Nephrectomy may be indicated in a unilateral damaged kidney. Sometimes treatment may fail because of pretreatment irreversible renal damage. Such as end-stage renal failure is an indication for renal transplantation. So, proper treatment is essential to prevent end-stage renal failure.
 Bangladesh Med J. 2017 Sep; 46 (3): 107-113

Indications for renal transplantation in children: What a pediatrician should know ?

Renal transplantation is the best modality of treatment for end stage renal disease in children when compared to chronic dialysis. The growth, development and quality of life in these children are significantly better after transplantation. There has been a marked increase in the number of children undergoing renal transplantation in the recent years. The short term graft survival rates have increased with improved immunosuppression, but the long term outcome is still poor due to chronic graft rejection and opportunistic infections. In developing countries renal transplantation is not accessible to many children due to economic issues, lack of expertise and the absence of a strong deceased donor program. This article is a brief review of the indications and other aspects of pre-operative evaluation of pediatric renal transplant recipients.

O-19 Incidence and risk factors of adverse events during immunosuppressive therapy after renal transplantation in children

Background Transplantation has become an important treatment option in children with end-stage renal dis-ease. In the last decades progress in immunosuppressive treatment options and surgical techniques have reduced the frequency of acute rejection, graft loss and mortality. However, adverse events occur in patients treated with immunosuppressive therapy. These adverse events are well described for adults but few data are available for children. Our objective was to describe the frequency of adverse events (AEs) under different immunosuppres-sive regimen including either ciclosporin or tacrolimus in children after renal transplantation. Secondary objectives include comparison of AEs with known adverse drug re-actions (ADRs) as described in the Summary of Product Characteristics. Furthermore, risk factors for AEs will be examined. Methods Children receiving a renal transplant at our institution between 2002 to 2015 were included in the study. Initial immunosuppression was obtained by thy-moglobulin or monoclonal antibody, calcineurin inhib-itors (tacrolimus or ciclosporin), mycophenolate mofetil, and corticoids. AEs reported after transplantation were collected from medical reports and coded using Med-DRA (version 19.1). Descriptive statistical analyses were performed using SAS 9.4. Data were stratified by tacrolim-us or ciclosporin treatment schedule at the time of the AE. Results A total of 164 children fulfilled the inclusion cri-teria. Finally, complete medical records were available for 125 children (53 girls and 72 boys). The median age was 12 (2 – 19) years old. The indication for renal transplan-tation included congenital, familial and genetic disorders for 61% of the patients and renal and urinary disorders for 39% (including 30% of nephritis). The median time of observation until last follow up was 2.7 (0.6–4.3) years. Initially, 91 patients were treated with tacrolimus and 34 with ciclosporin. During the observation period 6 patients switched from tacrolimus to ciclosporin and 14 switched from ciclosporin to tacrolimus. A total of 1520 AEs were reported. For patients receiving tacrolimus 1122 AEs (233.6 person-years of exposure) were reported and 372 AEs (71.4 person-years of expo-sure) for those treated with ciclosporin. Twenty-six AEs were reported in patients not receiving any calcineurin inhibitor. The most frequent medical AEs reported for pa-tients treated with tacrolimus and ciclosporin by system organ class were renal and urinary disorders (0.3 vs 0.3 AEs per person-year of exposure), infections (0.3 vs 0.4 AEs per person-year of exposure), vascular disorders (0.2 vs 0.3 AEs per person-year of exposure) and gastrointestinal disor-ders (0.2 vs 0.2 AEs per person-year of exposure). For 46 patients at least one episode of transplant rejection was reported. Conclusion This study describes AEs up to 4 years after renal transplantation in children treated with immuno-suppressive therapy. Our findings will contribute to the understanding of the benefit-risk balance of immuno-suppressive therapy following renal transplantation in children.

A Case of Living-Donor Renal Transplantation for Chronic Renal Failure Caused by Secondary Amyloidosis

In Japan, amyloidosis is a rare cause of renal failure and of renal transplantation. We treated a patient who underwent a renal transplantation because of chronic renal failure caused by secondary amyloidosis with a good result. The patient was a 50-year-old woman who was diagnosed with secondary amyloidosis and an amyloid kidney. She underwent living donor renal transplantation after about 7 years of hemodialysis. During the 3-year posttransplantation period, she maintained good allograft function with a serum creatinine level about 1.2 mg/dL. Because of amyloidosis is a systemic disease, amyloid kidney patients often experience fatal complications, so the indications for renal transplantation in amyloid patients are still controversial. But if the patient's general condition is good, renal transplantation can be an effective therapy for patients with kidney failure caused by amyloidosis.

Anaesthesia for kidney transplantation

In 1954, Joseph Murray performed the first successful renal transplantation on identical twins. Due to improvements in immunosuppressant medication and surgical techniques in the past decades, the organ survival rate has increased significantly. A study comparing kidney recipients, patients on the waiting list and patients on dialysis showed a significant reduction in mortality in the patients that have been transplanted.1 The kidney donor pool has been expanded and even marginal organs are being transplanted, as they provide survival benefit in comparison to dialysis.2,3 The indication for renal transplantation was extended to older patients with worse medical prognosis than before.4 Particularly the recipients in the Eurotransplant Senior Program “old-for-old” require an individualised intra- and postoperative management by the attending anaesthetist.5

Renal Function Outcomes in Patients Treated With Nephron Sparing Surgery for Bilateral Wilms Tumor

Management of bilateral Wilms tumor represents a particular challenge in the consideration of long-term renal function for affected patients. Aggressive surgical resection to prevent recurrence must be balanced with the desire to preserve renal function. We evaluated our institutional experience with nephrological outcomes in patients treated with nephron sparing surgery for bilateral Wilms tumor. We identified all patients with synchronous bilateral Wilms tumors presenting to St. Jude Children's Research Hospital between October 1987 and February 2004. We also included patients with Wilms tumor involving a solitary kidney presenting during the same period. A total of 17 patients were identified who underwent nephron sparing surgery, including 16 with bilateral tumors and 1 with tumor in a solitary kidney. Institutional review board approval was obtained to retrospectively review records and analyze outcomes based on long-term renal function, hypertension, proteinuria, need for dialysis and indications for renal transplantation. Eight of the 17 patients initially underwent bilateral nephron sparing surgery and 9 initially underwent a combination of nephrectomy and contralateral nephron sparing surgery. Two patients were eventually rendered anephric following further resections secondary to local recurrence. Before the initiation of therapy all patients had normal baseline creatinine clearance, which was calculated using the Schwartz formula. At a median followup from diagnosis of 72 months (range 15 to 207) 1 patient had renal insufficiency and another 3 had renal failure requiring dialysis. One of the 3 patients on dialysis died of metastatic Wilms and 2 await renal transplantation. None of the remaining patients had evidence of proteinuria. Ten of the 17 patients (58.8%) had hypertension at diagnosis and 9 (52.9%) required antihypertensive medications at the most recent followup. The overall survival rate in this group of patients was 88.2% with no evidence of disease in survivors at the most recent followup. When combined with adjuvant radiation and/or chemotherapy, nephron sparing surgery provides an opportunity to preserve renal function, while maintaining excellent long-term oncological outcomes for patients with bilateral Wilms tumor.

Obstructive uropathy in childhood: A review

Background: Obstructive uropathy is any affection of the urinary tract characterized by impairment of urine flow through the tract and which, if left untreated, will cause progressive renal damage. Aim: To present an update on obstructive uropathy in children with emphasis on the situation in Nigeria. Methods: Contemporary information on the management of obstructive uropathy was obtained by searching the Medline and adding information from the authors\' experience. Results: Obstructive uropathy causes renal impairment in all age groups. The causes in children may be congenital or acquired. The congenital causes include pelvi-ureteric junction obstructions, posterior urethral valves (PUV), urethral atresia, phimosis and meatal stenosis. Associated anomalies include imperforate anus and vertebral malformations. Acquired causes include calculi, post-traumatic and post-inflammatory strictures and meatal stenosis. Some specific manifestations are prune-belly syndrome, hydronephrosis and renal failure. Diagnostic investigations include ultrasonography, intravenous urography, cystography and renography. Recent technological advances have impacted on the treatment of the different lesions. These include in utero vesico-amniotic shunt and endoscopic valve ablation for PUV and minimally invasive techniques for urolithiasis. Nephrectomy may be indicated in a unilateral damaged kidney. Not all lesions require treatment. Criteria to select patients for treatment require definition. Occasionally treatment fails because of pretreatment irreversible renal damage. The resulting end-stage renal failure is an indication for renal transplantation. Conclusion: Obstructive uropathy is an important cause of renal impairment. Contemporary advances in the management are yet to become available in developing countries. Compromise treatment options therefore prevail. Adequate treatment is essential to prevent end-stage renal failure. Port Harcourt Medical Journal Vol. 1 (3) 2007: pp. 137-144

Nephrologie: Nierentransplantation

Renal transplantation is currently the best option for renal replacement therapy. Quality of life will improve and lifetime will extend compared to patients staying on dialysis. New findings in the fields of pathogenesis, diagnostics and treatment make renal transplantation an effective standard procedure. In Germany, there is an imbalance between available donor kidneys and recipients. The increasing waiting time is a challenge in the treatment of patients suffering from end-stage renal disease. In the last few years great efforts were undertaken to expand the donor pool. Problems are the unreadiness for organ donation on the one hand and extended indication for renal transplantation on the other hand. Transplantation of so-called marginal organs will implicate new problems. A main focus of further research is the chronic allograft nephropathy. Advances in the field of immunosuppressive treatment lead to better results in organ and patient survival. Individualization of immunosuppression becomes one of the most important points. New markers are necessary for monitoring. The aftercare in the transplant center in close collaboration with nephrologists and family doctors is essential for a successful transplantation.

Acquired cystic disease of the kidney: an indication for renal transplantation?

Comparaison de 45 malades porteurs d'un rein transplante fonctionnant bien (1 a 14 ans) et 100 malades traites par dialyse (1 a 21 ans). La maladie kystique acquise est observee dans les reins natifs de 18 des malades porteurs d'un greffon (jamais dans le greffon) et chez 63 des malades traites par dialyse. La maladie polykystique acquise progresse au cours de la dialyse et non apres transplantation

REACTIVITY OF AUTOLYMPHOCYTOTOXIC ANTIBODIES FROM DIALYSIS PATIENTS WITH LYMPHOCYTES FROM CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) PATIENTS

Autolymphocytotoxic antibodies are found commonly in dialysis patients and these autoantibodies may be directed against T and B lymphocytes or just B lymphocytes. However, these autoantibodies react with a low frequency or not at all against chronic lymphocytic leukemia cells, and are not absorbed by autologous erythrocytes. Thus, a number of positive crossmatches between donor and recipient may be attributable to autoantibodies. Six renal transplants have been carried out in the presence of such a positive crossmatch against donor B lymphocytes, including one against donor T lymphocytes, with a successful graft outcome. Thus, the indications for renal transplantation in the presence of a positive crossmatch between donor and recipient are becoming better defined.