Living-donor Recipients Research Articles

Long-Term Results of Kidney Transplantation in the Elderly: Comparison between Different Donor Settings.

With scarce organ supply, a selection of suitable elderly candidates for transplant is needed, as well as auditing the long-term outcomes after transplant. We conducted an observational cohort study among our patient cohort >60 years old with a long follow up. (1). Patients and Methods: We used our database to study the results after transplant for 593 patients >60 years old who underwent a transplant between 2000–2017. The outcome was compared between live donor (LD; n = 257) recipients, an old-to-old (OTO, n = 215) group using an extended criteria donor (ECD) kidney, and a young-to-old (YTO, n = 123) group using a standard-criteria donor. The Kaplan−Meir method was used to calculate the patient and graft survival and Cox regression analysis in order to find risk factors associated with death. (2). Results: The 5- and 10-year patient survival was significantly better in the LD group (92.7% and 66.9%) compared with the OTO group (73.3% and 42.8%) and YTO group (70.9% and 40.6%) (p < 0.0001). The 5- and 10-year graft survival rates were 90.3% and 68.5% (LD), 61.7% and 30.9% (OTO), and 64.1% and 39.9%, respectively (YTO group; p < 0.0001 between the LD and the two DD groups). There was no difference in outcome between patients in their 60’s and their 70’s. Factors associated with mortality included: age (HR-1.060), DM (HR-1.773), IHD (HR-1.510), and LD/DD (HR-2.865). (3). Conclusions: Our 17-years of experience seems to justify the rational of an old-to-old allocation policy in the elderly population. Live-donor transplant should be encouraged whenever possible. Each individual decision of elderly candidates for transplant should be based on the patient’s comorbidity and predicted life expectancy.

ABO‐incompatible kidney transplantation in perspective of deceased donor transplantation and induction strategies: a propensity‐matched analysis

SummaryKidney transplant candidates are blood group incompatible with roughly one out of three potential living donors. We compared outcomes after ABO‐incompatible (ABOi) kidney transplantation with matched ABO‐compatible (ABOc) living and deceased donor transplantation and analyzed different induction regimens. We performed a retrospective study with propensity matching and compared patient and death‐censored graft survival after ABOi versus ABOc living donor and deceased donor kidney transplantation in a nationwide registry from 2006 till 2019. 296 ABOi were compared with 1184 center and propensity‐matched ABOc living donor and 1184 deceased donor recipients (matching: recipient age, sex, blood group, and PRA). Patient survival was better compared with deceased donor [hazard ratio (HR) for death of HR 0.69 (0.49–0.96)] and non‐significantly different from ABOc living donor recipients [HR 1.28 (0.90–1.81)]. Rate of graft failure was higher compared with ABOc living donor transplantation [HR 2.63 (1.72–4.01)]. Rejection occurred in 47% of 140 rituximab versus 22% of 50 rituximab/basiliximab, and 4% of 92 alemtuzumab‐treated recipients (P < 0.001). ABOi kidney transplantation is superior to deceased donor transplantation. Rejection rate and graft failure are higher compared with matched ABOc living donor transplantation, underscoring the need for further studies into risk stratification and induction therapy [NTR7587, www.trialregister.nl].

Donor-Derived Human Parvovirus B19 Infection in Kidney Transplantation.

BackgroundDonor-derived human parvovirus B19 (B19V) infections are rarely reported. Thus, its incidence in kidney transplantation is still unknown due to lack of surveillance studies. Similarly, whether the donor needs to be routinely screened for B19V and whether the kidneys from those with B19V DNAemia could be accepted also remain unknown.MethodsThis retrospective study aims to evaluate the donor-derived B19V infections occurring in 823 living and 1,225 deceased donor kidney transplantations from January 2016 to December 2020. The serum viral load of living donors and their corresponding recipients was evaluated before and after transplantation. Meanwhile, for the deceased donor kidney transplantation, the serum viral load of recipients was only tested after transplantation; if recipients of a deceased donor subsequently developed B19V infection, the serum viral load of recipients and their corresponding donors before transplantation would then be further traced.ResultsA total of 15 living donors were B19V DNAemia positive before the donation, of which B19V DNAemia occurred in three corresponding recipients. In deceased donor kidney transplantation, DNAemia occurred simultaneously in 18 recipients and their corresponding nine donors. A progressive decline in hemoglobin and reticulocyte count could be observed in one living donor recipient and other 11 deceased donor recipients, which were all well controlled by treatment eventually.ConclusionThe incidence of donor-derived B19V infection was 0.4% and 1.5% in living and deceased kidney transplantations, respectively. B19V was seemingly unnecessary to be routinely screened for the donor. Moreover, kidneys of the donors with B19V infection were acceptable.

In Situ Pre-Treatment of Vascularized Composite Allografts With a Targeted Complement Inhibitor Protects Against Brain Death and Ischemia Reperfusion Induced Injuries.

IntroductionDonor brain death (BD) is an unavoidable component of vascularized composite allograft (VCA) transplantation and a key contributor to ischemia-reperfusion injury (IRI). Complement is activated and deposited within solid organ grafts as a consequence of BD and has been shown to exacerbate IRI, although the role of BD and complement in VCA and the role it plays in IRI and VCA rejection has not been studied.MethodsBD was induced in Balb/c donors, and the VCA perfused prior to graft procurement with UW solution supplemented with or without CR2-Crry, a C3 convertase complement inhibitor that binds at sites of complement activation, such as that induced on the endothelium by induction of BD. Following perfusion, donor VCAs were cold stored for 6 hours before transplantation into C57BL/6 recipients. Donor VCAs from living donors (LD) were also procured and stored. Analyses included CR2-Crry graft binding, complement activation, toxicity, injury/inflammation, graft gene expression and survival.ResultsCompared to LD VCAs, BD donor VCAs had exacerbated IRI and rejected earlier. Following pretransplant in-situ perfusion of the donor graft, CR2-Crry bound within the graft and was retained post-transplantation. CR2-Crry treatment significantly reduced complement deposition, inflammation and IRI as compared to vehicle-treated BD donors. Treatment of BD donor VCAs with CR2-Crry led to an injury profile not dissimilar to that seen in recipients of LD VCAs.ConclusionPre-coating a VCA with CR2-Crry in a clinically relevant treatment paradigm provides localized, and therefore minimally immunosuppressive, protection from the complement-mediated effects of BD induced exacerbated IRI.

Donor Morbidity Is Equivalent Between Right and Left Hepatectomy for Living Liver Donation: A Meta-Analysis.

Maximizing liver graft volume benefits the living donor liver recipient. Whether maximizing graft volume negatively impacts living donor recovery and outcomes remains controversial. Patient randomization between right and left hepatectomy has not been possible due to anatomic constraints; however, a number of published, nonrandomized observational studies summarize donor outcomes between 2 anatomic living donor hepatectomies. This meta-analysis compares donor-specific outcomes after right versus left living donor hepatectomy. Systematic searches were performed via PubMed, Cochrane, ResearchGate, and Google Scholar databases to identify relevant studies between January 2005 and November 2019. The primary outcomes compared overall morbidity and incidence of severe complications (Clavien-Dindo >III) between right and left hepatectomy in donors after liver donation. Random effects meta-analysis was performed to derive summary risk estimates of outcomes. A total of 33 studies (3 prospective and 30 retrospective cohort) were used to identify 7649 pooled patients (5993 right hepatectomy and 1027 left hepatectomy). Proportion of donors who developed postoperative complications did not significantly differ after right hepatectomy (0.33; 95% confidence interval [CI], 0.27-0.40) and left hepatectomy (0.23; 95% CI, 0.17-0.29; P=0.19). The overall risk ratio (RR) did not differ between right and left hepatectomy (RR, 1.16; 95% CI, 0.83-1.63; P=0.36). The relative risk for a donor to develop severe complications showed no differences by hepatectomy side (Incidence rate ratio, 0.97; 95% CI, 0.67-1.40; P=0.86). There is no evidence that the overall morbidity differs between right and left lobe donors. Publication bias reflects institutional and surgeon variation. A prospective, standardized, multi-institutional study would help quantify the burden of donor complications after liver donation.

Focal Segmental Glomerulosclerosis and Recurrence in Living Donor Recipients.

PurposeFocal segmental glomerulosclerosis (FSGS) is a common cause for end-stage renal disease that can recur in the graft after kidney transplantation. The incidence of FSGS recurrence is reported in up to 47% of patients, predisposing those to possible poorer transplantation outcomes. Hence, we examined the incidence of FSGS recurrence and the effect on graft outcome in our patient cohort of living donor kidney transplantations (LDKT).Patients and MethodsWe analyzed 194 adult patients who received a LDKT between 2011 and 2017 of which 22 (11%) had FSGS as underlying disease. Demographic data and clinical outcomes, especially regarding recurrence of FSGS, were evaluated.ResultsFSGS recurrence was identified in three (14%) patients within three months after transplantation, of whom two patients (9%) lost their graft. There was no significant difference in graft survival comparing FSGS to other reasons for end-stage renal disease.ConclusionIncidence of FSGS recurrence in the present patient cohort was within the range reported in the literature and comparatively low. Our data support LDKT as a treatment option in patients with end-stage renal disease due to FSGS.

PCSK9 and inflammatory biomarkers in the early post kidney transplantation period.

Various biomarkers have been studied in the early post-kidney transplantation (post-KTx) period in order to identify potential therapeutic targets for improving long-term graft survival. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a biomarker that has recently gained interest in cardiovascular disease but its role still remains to be defined post-KTx. We prospectively evaluated the levels of PCSK9, interleukin (IL)-6, WBC and C-reactive protein in seventy-three hemodialysis patients undergoing KTx, at 3 time-points; pre-transplantation (day 0) and at 1 and 6-months post-KTx. All data were also analyzed according to donor-type (living or deceased) and compared with hemodialysis patients on transplant waiting list. At Day 0 there was no difference in WBC, CRP, IL-6 and PCSK9 levels between patients scheduled for transplantation and those who remained on hemodialysis. In transplanted patients WBC, CRP and IL-6 levels were significantly reduced early post-KTx [logIL-6 Day 0: 0.68 (0.33, 0.85) vs. 1-month: 0.57 (0.37, 0.75) vs. 6-months: 0.50 (0.32, 0.69) pg/ml, p=0.01], while PCSK9 levels were significantly increased (Day 0: 199.8±63.0 vs. 1-month: 276.2±79.4 vs. 6-months: 245.9±62.5 ng/ml, p<0.001). In contrast, no change of WBC, CRP, IL-6 and PCSK9 levels was observed in hemodialysis patients on follow-up (p=NS for all). Between living-donor and deceased-donor recipients, analysis showed reduced CRP and increased PCSK9 levels in both groups (p<0.05 for all), while IL-6 levels were reduced in living-donor and increased in deceased-donor recipients 1-month post-KTx. PCSK9 levels were not correlated with renal function, delayed graft function, rejection episodes or inflammatory biomarkers. PCSK9 levels were increased post-KTx independently from renal function and inflammatory biomarkers, in both living and deceased-donor recipients.

MO973PRE-IMPLANTATION BIOPSY FINDINGS AND IMPACT ON LIVE DONOR KIDNEY TRANSPLANT RECIPIENT OUTCOMES - A SINGLE CENTRE STUDY

Abstract Background and Aims Live donor kidney transplantation remains the mainstay of renal replacement therapy in Sri Lanka. The basic universal pre surgical investigations, human leucocyte antigen (HLA) matching and cross matching are routinely performed, however due to high rates chronic kidney disease (CKD) as well as increasing numbers of, chronic kidney disease unknown etiology (CKDu) in Sri Lanka, there is a possibility of subclinical kidney disease being present in donor kidneys which go undiagnosed. A study of pre-implantation biopsy along with follow-up outcomes of kidney transplant recipients is conducted to identify presence of subclinical kidney disease in a Sri Lankan cohort of patients. Method We collected thirty three (33) live donor pre-implantation biopsies during 4 consecutive months in 2020 as well as 1 month follow-up data. This is part of an ongoing follow-up study which is conducted at National Hospital, Kandy, Sri Lanka. Results Thirty three (33) live donor recipients and their pre-implantation renal biopsy samples were studied. The mean age of the study participants’ was 37.6 (SD 12.5, range 13 - 59) years. A predominant number of male patients were in the sample (n=21, 63.6%). Underlying aetiology of end stage renal disease (ESRD), was predominantly due to chronic hypertension (39.3%; n=13) and diabetic kidney disease (21.2%, n=7) accounting for nearly 60% of the study participants. Among the 33 live donors 1st degree, 2nd degree and non-relative donors were 54.4% (n=18), 18.2% (n=6) and 27.3% (n=9) respectively. Pre-implantation renal biopsy results reported 36.4% (n=12) with abnormal biopsy findings including chronic interstitial nephritis (n=4, 12.1%), interstitial fibrosis (n=6, 18.18%) and acute tubular necrosis (n=2, 6%). Follow-up revealed delayed graft function occurring in 18.2% (n=6) of recipients with 50% (n=3) of them showing abnormalities in the pre-operative donor biopsy sample. At one month follow-up, 48.5% (n=16) reported complications which included graft failure 3% (n=1), all-cause mortality 3% (n=1), acute rejection 39.4% (n=13) and infections 24.2% (n=8). Overall, 37.5% (n=6) of these recipients had abnormal donor biopsy findings, however no significant statistical association was identified. Conclusion Our study identified subclinical kidney disease in donor kidneys despite standard pre-transplant screening. Even though, statistically not significant, recipients with abnormal pre-implantation biopsy findings had adverse short term post-transplant complications.

Analyzing Association Rules for Graft Failure Following Deceased and Live Donor Kidney Transplantation.

This paper investigates the clinical attributes that contribute to kidney graft failure following live and deceased donor transplantation using an association rule mining approach. The generated rules are used to analyze the distinctive co-occurrence of attributes for those with or without all-cause graft failure. Analysis of a kidney transplantation dataset acquired from the Scientific Registry of Transplant Recipients that included over 95000 deceased and live donor recipients over 5-years was performed. Using an association rule mining approach, we were able to confirm established risk factors for graft loss after live and deceased donor transplantation and identify novel combinations of factors that may have implications for clinical care and risk prediction post kidney transplantation. Using lift as the metric to evaluate association rules, our results indicate that advanced recipient age (i.e. over 60 years), end stage kidney disease due to diabetes, the presence of recipient peripheral vascular disease and recipient coronary artery disease have a high likelihood of graft failure within 5 years after transplantation.

Changes in quality of life (QoL) and other patient-reported outcome measures (PROMs) in living-donor and deceased-donor kidney transplant recipients and those awaiting transplantation in the UK ATTOM programme: a longitudinal cohort questionnaire survey with additional qualitative interviews

ObjectiveTo examine quality of life (QoL) and other patient-reported outcome measures (PROMs) in kidney transplant recipients and those awaiting transplantation.DesignLongitudinal cohort questionnaire surveys and qualitative semi-structured interviews using thematic analysis...

POS-750 THROMBOEMBOLISM IN KIDNEY TRANSPLANT RECIPIENTS: PREVALENCE AND OUTCOMES OVER 13 YEARS

Thromboembolism is more common in kidney transplant recipients(KTR) than the general population. As the number of studies evaluating arterial andvenous thromboembolism (VTE) in KTR are very scarce, the magnitude and the riskfactors are undefined. Thromboprophylaxis poses a challenge as the risk ofthrombosis must be balanced against the risk of bleeding. It was a retrospective analysis of 2124 patients of age more than 18 yearsold, who had undergone kidney transplantation between January 2007 to December 2019. A VTE was defined as a radiographically diagnosed pulmonary embolism (PE)or deep venous thrombosis (DVT) with or without clinical symptoms. No patient wasgiven chemoprophylaxis. The primary outcome was to assess prevalence of the VTEepisode. Secondary outcomes were assessment of the timing of occurrence of thethromboembolic events after transplantation, determining the risk factors, estimationof rate of recurrence after thromboprophylaxis withdrawal, and outcomes. Multipleorgan transplant recipients and early graft loss due to vascular complications werenot included in the study. Of 2124 patients, 67 (3.1%) patients were found to have VTE (1 deceased-donor and 66 living donor recipients). 70 percent of patients were male. The median follow-up was 3.9 years (range 6 months -13 years). The mean age at transplantation was 42 years (± 10). A total of 75 VTE events were recorded. Twenty events were asymptomatic. No episode of VTE was recorded in the first-month post-transplantation. Four patients experienced a recurrence of VTE. 52 cases were diagnosed with lower limb DVT, 5 cases were upper limb DVT, 6 cases with pulmonary embolism, 2 cases were cerebral venous sinus thrombosis and 2 cases were of iliofemoral thrombosis. Cytomegalovirus infection and cancer were found to be related to higher chances of VTE. No increased risk of VTE was observed among patients receiving cyclosporine, a mammalian target of rapamycin inhibitors. The risk was not affected by the patient’s age, obesity, primary etiology of end-stage renal disease, prior dialysis modality, or acute rejections. The over-all estimated 5-year graft survival of the VTE group was 70.3%. The data suggest that kidney transplant surgery is a moderate risk for. Chemoprophylaxis should be considered in patients with hypercoagulable disease states at the time of transplant. Further prospective studies are needed to further describe the risk of VTE in KTRs.

Organ integration in kidney transplant patients – Results of a KTx360° substudy

ObjectiveOrgan transplantation is the treatment of choice for patients with end-stage organ disease. From early on, the psychological perspective on integrating the organ has been of interest. As quantitative studies on organ integration are scarce, we aimed at evaluating this aspect in a large sample of kidney transplant (KTx) recipients. MethodsFor this cross-sectional study, 684 patients after KTx were recruited within the structured post-transplant care program KTx360°. To measure organ integration and donor relationship, a previously developed and published questionnaire (FOSP), generated explicitly for this purpose, was used. Associations with sociodemographic, medical, donation-specific, and psychological variables were investigated. ResultsOverall, more than 90% of the patients perceived the transplant as part of themselves; however, a small minority reported perceiving it as a foreign object. Frequent thoughts about the donor and the belief of having adopted some of the donor's traits were common (52% and 14%, respectively), specifically in living donor recipients. Higher anxiety and depression scores and reduced kidney functioning were associated with less ideal organ integration, while a more extended period since KTx and more perceived social support correlated with better organ integration. No association between organ integration and adherence, as well as organ integration and cognitive functioning, could be found. ConclusionOrgan integration and donor relationship were unproblematic in most KTx patients. However, offering psychosocial support to those struggling with organ integration and donor relationship is crucial from a clinical perspective.

OPTN/SRTR 2019 Annual Data Report: Kidney

Despite the ongoing severe shortage of available kidney grafts relative to candidates in need, data from 2019 reveal some promising trends. After remaining relatively stagnant for many years, the number of kidney transplants has increased each year since 2015, reaching the highest annual count to date of 24,273 in 2019. The number of patients waiting for a kidney transplant in the United States was relatively stable, despite an increase in the number of new candidates added in 2019 and a decrease in patients removed from the waiting list owing to death or deteriorating medical condition. However, these encouraging trends are tempered by ongoing challenges. Nationwide, only a quarter of waitlisted patients receive a deceased-donor kidney transplant within 5 years, and this proportion varies dramatically by donation service area, from 15.5% to 67.8%. The non-utilization (discard) rate of recovered organs remains at 20.1%, despite adramatic decline in the discard of organs from hepatitis C-positive donors. Non-utilization rates remain particularly high for Kidney Donor Profile Index ≥85% kidneys and kidneys from which a biopsy specimen was obtained. While the number of living-donor transplants increased again in 2019, only a small proportion of the waiting list receives living-donor transplants each year, and racial disparities in living-donor transplant access persist. As both graft and patient survival continue to improve incrementally, the total number of living kidney transplant recipients with a functioning graft is anticipated to exceed 250,000 in the next 1-2 years. Over the past decade, the total number of pediatric kidney transplants performed has remained stable. Despite numerous efforts, living donor kidney transplant remains low among pediatric recipients with continued racial disparities among recipients. Congenital anomalies of the kidney and urinary tract remain the leading cause of kidney disease. While most deceased donor recipients receive a kidney from a donor with KDPI less than 35%, the majority of pediatric recipients had four or more HLA mismatches. Graft survival continues to improve with superior outcomes for living donor recipients.

救急科専門医を核とした医療チームによる急性肝不全診療体制の有効性(Multi–disciplinary treatment for acute liver failure that includes emergency and critical care physicians: A team approach)

要旨【目的】大阪大学医学部附属病院（以下，阪大病院）では，急性肝不全（acute liver failure: ALF）に対して救急医を含む診療チーム［肝炎ワーキンググループ（以下，WG）］による診療を行っており，WGにおける救急医の役割と今後の課題を明らかにすることを目的とした。【対象】WGが診療したALF（疑いを含む）165症例について，後方視的に検討を行った。【結果】165症例のうち95症例を阪大病院に収容し，うち，83症例が高度救命救急センター（以下，救命C）に入院となった。非昏睡型ALF 28症例，昏睡型ALF 48症例，その他19症例であり，それぞれの救命率は，89.2%，64.6%，42.1%であった。非昏睡型ALFに生体肝移植が1例，脳死肝移植が2例実施され，いずれも救命された。昏睡型ALFに対しては29症例に肝移植が実施（生体24症例，脳死5症例）され，21症例が救命された。生体肝移植が行われた24症例は全例が救命Cに入院しており，その移植までのICU管理実施期間の中央値は4日間（IQR：2–5.5）であった。【結語】WGは集中治療と並行して肝移植の適応評価と準備を行い，迅速に移植医療への移行が可能となっていた。このWG内で救急医は集中治療の適応と実践において中心的な役割を果たしていた。救急医を含むWGによるチーム医療はALF患者の予後の改善に寄与すると考える。

Living Donor-Recipient Pair Matching for Liver Transplant via Ternary Tree Representation With Cascade Incremental Learning.

Visual understanding of liver vessels anatomy between the living donor-recipient (LDR) pair can assist surgeons to optimize transplant planning by avoiding non-targeted arteries which can cause severe complications. We propose to visually analyze the anatomical variants of the liver vessels anatomy to maximize similarity for finding a suitable Living Donor-Recipient (LDR) pair. Liver vessels are segmented from computed tomography angiography (CTA) volumes by employing a cascade incremental learning (CIL) model. Our CIL architecture is able to find optimal solutions, which we use to update the model with liver vessel CTA images. A novel ternary tree based algorithm is proposed to map all the possible liver vessel variants into their respective tree topologies. The tree topologies of the recipient's and donor's liver vessels are then used for an appropriate matching. The proposed algorithm utilizes a set of defined vessel tree variants which are updated to maintain the maximum matching options by leveraging the accurate segmentation results of the vessels derived from the incremental learning ability of the CIL. We introduce a novel concept of in-order digital string based comparison to match the geometry of two anatomically varied trees. Experiments through visual illustrations and quantitative analysis demonstrated the effectiveness of our approach compared to state-of-the-art.

Risk factors for delayed graft function and their impact on graft outcomes in live donor kidney transplantation.

Delayed graft function (DGF) is a manifestation of acute kidney injury uniquely framed within the transplant process and a predictor of poor long-term graft function1. It is less common in the setting of living donor (LD) kidney transplantation. However, the detrimental impact of DGF on graft survival is more pronounced in LD2. To study the effects of DGF in the setting of LD kidney transplantation. We performed a retrospective analysis of LD kidney transplantations performed between 2010 and 2018 in the UNOS/OPTN database for DGF and its effect on graft survival. A total of 42,736 LD recipients were identified, of whom 1115 (2.6%) developed DGF. Recipient dialysis status, male gender, diabetes, end-stage renal disease, donor age, right donor nephrectomy, panel reactive antibodies, HLA mismatch, and cold ischemia time were independent predictors of DGF. Three-year graft survival in patients with and without DGF was 89% and 95%, respectively. DGF was the greatest predictor of graft failure at three years (hazard ratio = 1.766, 95% CI: 1.514-2.059, P = 0.001) and was associated with higher rates of rejection (9% vs. 6.28%, P = 0.0003). Among patients with DGF, the graft survival rates with and without rejection were not different. DGF is a major determinant of poor graft functional outcomes, independent of rejection.

Long-Term Outcomes in 831 Kidney Transplant Recipients with 20 Years of Graft Function

An understanding of long-term outcomes for kidney transplant(KTx) recipients who survive with graft function beyond a specific time posttransplant is the first step in creating protocols to optimize care for current and improve outcomes for future recipients. We studied 831KTx recipients-580 living donor(LD); 251 deceased donor(DD)—with graft survival(GS) &gt;20 years. For primary LD recipients, 25-year patient survival(PS) was 83%; 35-year, 59%. Their 25-year death-censored graft survival(DCGS) was 89%; 35-year, 72%. DD recipients had lower PS(P&lt;0.01), DCGS(P&lt;0.01). After 20 years, two major causes of graft loss(GL) were death with function(DwF)(58%, LD; 58%, DD) and interstitial fibrosis and tubular atrophy(IFTA)(22%, LD; 23%, DD). Two major causes of DwF were cancer(31%, LD; 31%, DD) and cardiovascular disease(CVD)(19%, LD;17%, DD). Per multivariate analysis(MVA), risk factors for GL after 20 years in pre–calcineurin inhibitor(CNI) era were human leukocyte antigen(HLA) mismatches &gt;3 antigens, pretransplant type 1 diabetes mellitus(DM1); in CNI era, a history of rejection, female gender. New comorbidities after 20 years were common: CVD(13%, non-DM1;18%, DM1), infections(27%, non-DM1;37%, DM1), 20-29 years posttransplant. Cancer after 20 years included: nonmelanotic skin cancer,22%; solid organ,7%; post-transplant lymphoproliferative disease(PTLD),2%. To improve long-term outcomes, clinical trials on prevention, recognition, and treatment of new comorbidities are needed.

Infection complication rate in kidney transplanted patient in Mongolia in last 3 years

Background: Infection remains a significant cause of morbidity and mortality in renal transplant recipients. In Mongolia, mean cause of kidney graft dysfunction is infection. Methods: We studied a total of 72 patients who underwent a kidney transplant from 2017 to 2019. Demographic data was inves tigated as follows: age, sex, region from transplant center, body mass index, bacteriology culture post-kidney transplantation of early period (1-6 months) and late period (more than 6 months), epidermal growth factor receptor, induction and maintenance immunosuppressive medication, number of hospitalization, surgical complication, vaccination, etc. Results: Overall mean age of subjects was 34.6±3.5 years; females were 14 (19.4%) and males were 58 (80.6%). With living donor recipients were 59 (81.9%), deceased donor recipients were 13 (18.1%). Region location from transplantation center was 40 pa tients (55.6%) living in Ulaanbaatar City and 32 patients (44.4%) living so far from Ulaanbaatar in region. The number of early-peri od infection complications was 81 bacterial (98.8%) and one virus (1.2%). From bacterial infections, urine tract infections were 26 (32.1%), respiratory infections were 52 (64.2%), and tuberculosis, pyodermatitis, pneumonia, and cytomegalovirus infection were one (1.2%), respectively. From late-period 67 infections, 64 (95.5%) were bacterial, three (4.5%) were virus infections, and from all this 23 (35.9%) were urine tract, 32 (50.0%) were respiratory, four (6.3%) were pyodermatitis, and H1N3 virus etiology pneumo nia, herpes zoster, varicella zoster were one (1.5%), respectively. From all of 72 infected patient, graft loss was one patient. Main bacterial etiology in both periods was Escherichia coli, Klebsiella pneumoniae extended-spectrum β-lactamases, etc. Number of hospitalization in infected 26 patients was 46. Conclusions: Infection complications in Mongolia for post-kidney transplant are still common, particularly urinary tract infec tions.

Practice patterns of dialysis access and outcomes in patients wait-listed early for kidney transplantation

BackgroundEarly kidney transplantation (KT) is the best option for patients with end-stage kidney disease, but little is known about dialysis access strategy in this context. We studied practice patterns of dialysis access and how they relate with outcomes in adults wait-listed early for KT according to the intended donor source.MethodsThis study from the REIN registry (2002–2014) included 9331 incident dialysis patients (age 18–69) wait-listed for KT before or by 6 months after starting dialysis: 8342 candidates for deceased-donor KT and 989 for living-donor KT. Subdistribution hazard ratios (SHR) of KT and death associated with hemodialysis by catheter or peritoneal dialysis compared with arteriovenous (AV) access were estimated with Fine and Gray models.ResultsLiving-donor candidates used pretransplant peritoneal dialysis at rates similar to deceased-donor KT candidates, but had significantly more frequent catheter than AV access for hemodialysis (adjusted OR 1.25; 95%CI 1.09–1.43). Over a median follow-up of 43 (IQR: 23–67) months, 6063 patients received transplants and 305 died before KT. Median duration of pretransplant dialysis was 15 (7–27) months for deceased-donor recipients and 9 (5–15) for living-donor recipients. Catheter use in deceased-donor candidates was associated with a lower SHR for KT (0.88, 95%CI 0.82–0.94) and a higher SHR for death (1.53, 95%CI 1.14–2.04). Only five deaths occurred in living-donor candidates, three of them with catheter use.ConclusionsPretransplant dialysis duration may be quite long even when planned with a living donor. Advantages from protecting these patients from AV fistula creation must be carefully evaluated against catheter-related risks.

Cognitive Function in Liver Transplant Recipients Who Survived More Than 6 Months.

Current research in the areas of liver transplant and cognitive function has primarily examined cognitive changes from pre- to 1-year posttransplant, resulting in an insufficient understanding of cognitive trajectory beyond early periods of transplant and its impact on self-management. This study aimed (1) to describe global and domain-specific cognitive function in liver transplant recipients who survived more than 6 months after transplant and (2) to describe patient and clinical characteristics of recipients with impaired global and/or domain-specific cognitive function. Further, this study explored the potential relationships between cognitive function and self-management by examining differences in cognitive function by levels of self-management. This secondary data analysis included 107 adult liver transplant recipients, who had a functioning transplant for at least 6 months. Data of cognitive function, demographic and clinical characteristics, and self-management were extracted for this study. T tests, Mann-Whitney tests, and Kruskal-Wallis tests were used to examine differences in cognitive function by variables. More than half of the recipients had global cognitive impairment. Significant differences were found in global and domain-specific cognitive function. Older, male, married, or deceased donor recipients had lower cognitive test scores than younger, female, single, or living donor recipients. There were no significant differences in global and domain-specific cognitive function by time since transplant and levels of self-management. Future longitudinal studies should examine the long-term trajectory of cognitive function posttransplant. Other factors such as caregivers' participation in self-management should be accounted for in future studies when examining the relationship between cognitive function and self-management.