Living-related Donor Kidney Transplantation Research Articles

Prophylactic Sclerotherapy for Lymphatic Complications After Living Donor Renal Transplant: A Single-Center Experience.

Lymphocele formation after kidney transplant is a common complication that causes significant morbidity. In this study, we aimed to evaluate the safety and effectiveness of intraoperative prophylactic povidone-iodine sclerotherapy through the closed suction drain to prevent lymphocele after kidney transplant. In this retrospective comparative single-institution study, we compared patients who underwent intraoperative prophylactic povidone-iodine sclerotherapy through the closed suction drain (group A) with patients who did not receive sclerotherapy (group B). Patients were treated between September 2017 and July 2023. Atthe end of the kidney transplant surgery, after the closure of the external oblique muscle layer and before skin closure, 10 mL of 10% povidone-iodine in 40 mL of normal saline were instilled via the closed suction drain and dwelled in the cavity for 30 minutes. During the study period, 300 living-related donor kidney transplants were performed. Prophylactic povidone-iodine sclerotherapy was performed in 150 patients (50%).We noted a significantly lower incidence of lymphorrhea and lymphocele in group A. On postoperative days 1 and 5, we noted a significant reduction in drain output in group A (P < .001). One patient in group A and 5 patients in group B required ultrasonography-guideddrainage andpovidone-iodine sclerotherapy. No sclerotherapy-related complications were reported after a median follow-up of 16 months (range, 3-29 months). Intraoperative prophylactic povidoneiodine sclerotherapy appears to be an easy, safe, and effective procedure for preventing lymphatic complications after living donor kidney transplant.

Unrelated versus related living-donor kidney transplantation is associated with higher acute rejection rate but similar graft survival Running title: Outcomes in living-donor kidney transplantation

Kidney transplantation (KT) from living donors has been shown to have multiple benefits compared with that from deceased donors. We sought to compare significant graft outcomes, namely acute rejection (AR), graft function, and survival, between transplant recipients who received a kidney from a living-related donor (LRD) and from a living unrelated donor (LURD). Our cohort comprised 198 donor and recipient pairs undergoing living-donor KT at our center over 10 years. LRD recipients were compared with LURD recipients according to demographic and clinical characteristics, transplant variables (including immunosuppression), graft function, survival, and AR rate. The estimated glomerular filtration rate (eGFR) was similar in both groups over the follow-up time, of 60-65 mL/min (p&lt;0.05 over a 10-year period). Censored graft survival was similar between LRD and LURD recipients (96.9% vs. 98.0% at 5 years and 87.8% vs. 79.4% at 10 years, respectively; p=0.837). LURD recipients had a higher incidence of AR, although LURD recipient status was not an independent risk factor for AR. Multivariate analysis showed that human leukocyte antigen (HLA) -DR mismatch (MM) was an independent predictor of AR (hazard ratio [HR] 2.256, p&lt;0.05). HLA-A and HLA-B MM did not affect the AR HR between the groups. Graft function and censored-death survival rates were similar between the LURD and LRD KT recipients. HLA-DR MM was an independent risk factor for AR.

Renal Cell Carcinoma in Transplanted Kidney: A Case Report and Literature Review

Introduction: The incidence of renal cell carcinoma in the transplanted kidney is extremely rare. Case report: A 42-year-old female underwent a living-related donor kidney transplant from her 60-year-old mother due to glomerulonephritis leading to end-stage renal disease. Ultrasonography, nine years after transplantation, revealed a lower pole renal tumor in the renal graft with a suspicious image of malignant neoplasm on computed tomography. The patient underwent partial nephrectomy and histological analysis revealed clear cell carcinoma. Final considerations: After one year of follow-up, serum creatinine levels are normal and there are no signs of metastasis or tumor recurrence.

Biologically Unrelated Living Donor for Kidney Transplantation Associated With Higher Acute Rejection Rate but With Similar Graft Survival of a Related Living Donor.

Kidney transplantation (KT) from living donors has been shown to have multiple benefits compared to those from deceased donors. We sought to compare significant graft outcomes, namely acute rejection (AR), graft function, and survival between transplant recipients who received a kidney from living related donor (LRD) and living unrelated donor (LURD). Our cohort comprised 198 donor and recipient pairs undergoing living-donor KT at our center over 10 years. The LRD recipients were compared with LURD recipients according to demographic and clinical characteristics, transplant variables (including immunosuppression), graft function, survival, and AR rate. The estimated glomerular filtration rate (eGFR) was similar in both groups over the follow-up time i.e.,60-65 mL/min (p>0.05 over 10 years). Censored graft survival was similar between LRD and LURD recipients (96.9% vs. 98.0% at five years and 87.8% vs. 79.4% at 10 years, respectively; p=0.837). The LURD recipients had a higher incidence of AR, although LURD recipient status was not an independent risk factor for AR.Multivariate analysis showed that human leukocyte antigen (HLA)-DR mismatch (MM) was an independent predictor of AR (hazard ratio (HR) 2.256, p<0.05). Both HLA-A and HLA-B MM did not affect the AR HR between the groups. Graft function and censored graft survival rates were similar between LURD and LRD KT recipients in our study. The AR was higher in LURD recipients, although the LURD recipient status was not an independent risk factor for AR. The HLA-DR MM was an independent predictor of AR, while HLA-A and HLA-B MM did not affect AR HR between groups of patients.

Retrospective Analysis of the Comparison Between Single Renal Artery Versus Multiple Renal Arteries in Living Donor Kidney Transplant: Does It Affect the Outcome?

There is an increased risk of vascular complications in kidney transplant for allografts with multiple renal arteries versus a single renal artery. We compared the clinical outcomes of living donor kidney transplant recipients who received allografts with a single renal artery versus multiple renal arteries. This retrospective analysis included all living-related donor kidney transplants that were performed by a single skilled urologist. All donor nephrectomies were performed by open method. The left kidney was preferred over the right for donor nephrectomy, except in cases of vascular problems or other contraindications, for which the right kidney was preferred. In most of the cases, kidneys were placed in the right iliac fossa for transplant by an extraperitoneal approach. Of 97 living donor kidney transplants, 82 had a single renal artery (group 1) and 15 had multiple renal arteries (group 2). Patients ranged in age from 18 to 76 years old. Recipient ages (33.00 vs 29.46 years) and baseline serum creatinine values (8.61 vs 8.82 mg/dL) were comparable in groups 1 and 2 (P > .05). However, mean operative time and total ischemia time were significantly higher in the multiple renal artery group (221 and 53.45 minutes, respectively) compared with the single renal artery group (202 and 77.6 minutes, respectively). Graft survival at 1 year was 95.12% in the single renal artery group and 93.33% in the multiple renal artery group. Patient survival at 1 year was 96.34% in the single renal artery group and 93.33% in the multiple renal artery group. The safety of kidney transplants of allografts with multiple renal arteries is equal to the safety of transplants of allografts with a single renal artery in terms of vascular complications and acute tubular necrosis, as well as patient and graft survival.

Outcome of ABO Blood Type–Incompatible Living-Related Donor Kidney Transplantation Under a Contemporary Immunosuppression Strategy in Japan

BackgroundBecause of the serious donor shortage in Japan, there is an increasing need for ABO blood type–incompatible kidney transplantation (ABOi-KT) in living-related donor kidney transplantation. We evaluated the outcomes of ABOi-KT performed at our hospitals using a contemporary immunosuppression strategy with low-dose rituximab. Patients and MethodsBetween June 2006 and April 2019, 107 patients underwent living-related donor kidney transplantation at our hospitals. The patients were divided into ABO-compatible (ABOc) and ABOi groups. The basic immunosuppression regimen differed between the 2 groups in the use of low-dose rituximab and therapeutic apheresis in the ABOi group. We compared graft survival, patient survival, rejection, viral infection, and posttransplant renal function between the 2 groups. ResultsOf 107 recipients, 37 (35%) underwent ABOi-KT. The 5-year graft survival rates in the ABOc and ABOi group were 91% and 100%, respectively. The Kaplan-Meier analyses showed no difference in graft survival (P = .168) or patient survival (P = .873) between the groups. Biopsy-proven rejection in the ABOc and ABOi groups was observed in 13 (19%) and 7 (19%) patients, respectively (P = .965), and viral infection was observed in 21 (30%) and 10 (27%) patients (P = .747), respectively. Renal function by estimated glomerular filtration rate from 1 week to 5 years after transplantation was similar in both groups. ConclusionsThe outcomes of ABOi-KT with low-dose rituximab were comparable with those of ABOc-KT at our hospitals. ABOi-KT with proper immunosuppression may be an option to help resolve the severe donor shortage in Japan.

Impact of One-Year Serum Creatinine on Long-term Renal Graft Survival in a Living-Related Renal Transplant Program.

This study was carried out to determine the impact of one-year posttransplant serum creatinine (SCr) levels on the long-term outcomes of living-related donor kidney transplants. A retrospective cohort study included 773 adult living-related renal transplant recipients from 2010 to 2012, with a minimum follow-up period of five years. Demographics and posttransplantation follow-up data including immunosuppression regimens, rejection episodes, and survival rates were evaluated. Patients were divided into four cohorts (G1, G2, G3, and G4 based on SCr at the end of the 1st year: G1, SCr <88.4 μ mol/L; G2, 88.5≤ SCr ≤ 132.6 μmol/L; G3, 132.7≤ SCr ≤176.8 mol/L; and G4, SCr ≥176.9 μ mol/L). Comparisons between the groups used the Chi-square test for qualitative parameters and analysis of variance for continuous variables. Five-year graft survival for G1 was 98% as compared to 76% in G4 (P <0.001). Recipients of G4 encountered more acute rejection episodes in 21% of the cases as compared to 7.3% in G1 (P = 0.001). Donors were older in G4 (42.07 ± 10.4 years) as compared to G1 (30.1 ± 8.5 years) (P = 0.001). A third of the donors in G1 were HLA identical as compared to 7% in G4. Prediction of long-term graft survival is possible by the SCr level at one year post transplant. This can be of great importance, especially to identify those patients who require close monitoring in follow-up. Donor age, HLA, and acute rejection impact SCr at one year and hence graft outcome.

Retrospective genetic analysis illustrates the spectrum of autosomal Alport syndrome in a case of living-related donor kidney transplantation

BackgroundKidney transplantation is the treatment of choice in end-stage renal disease due to Alport syndrome (AS). However, the chances of finding an adequate living-related donor in AS are much worse compared to non-heritable conditions. Successful cases of related living-donor transplantation mostly refer to X-linked AS but are rarely reported in genetically confirmed autosomal AS.Case presentationWe describe the outcome of an exceptional AB0-incompatible kidney donation from father to son in a family with altered COL4A3. While decision-making was based on extensive clinical donor evaluation prior to transplantation, we analyzed the underlying genetic background in retrospect and associated these findings with the phenotype in all available family members. While biallelic COL4A3 variants caused autosomal recessive AS (ARAS) in the son (recipient), heterozygous family members, including the father (donor), showed minimal renal involvement and high-frequency sensorineural hearing impairment later in life indicating mild autosomal dominant Alport syndrome (ADAS). The recipient’s successful participation in the European and World Transplant Games is a testament to the positive outcome of transplantation.ConclusionsIn summary, living-related donor transplantation may be successful in autosomal AS, provided that thorough clinical and genetic evaluation of potential donors is performed. However, unrelated kidney transplantation should be given priority upon unpredictable genetic risk. Individual genetic variant interpretation is an important component of personalized donor assessment and will help to better predict genetic risk in the future.

A Decade of Live Related Donor Kidney Transplant: Experience in a Tertiary Care Hospital of Bangladesh

Background: Kidney transplantation is the preferred treatment for end stage kidney disease (ESKD). Live related donor kidney transplant was started in BIRDEM General Hospital, Bangladesh, on 6th November 2004. The aim of this study was to share our last 10 years’ experience of live related donor kidney transplant.Methods: A questionnaire was formed and data were collected from the hospital records. We retrospectively evaluated patients’ clinical and laboratory findings.Results: A total of 111 live related donor kidney transplants were performed from 2004 to 2014. Male:female was 2.3:1. The mean age of the recipients was 37.45 ± 10.58 years. The causes of ESKD were chronic glomerulonephritis (CGN) (52, 46.9%), diabetes mellitus (DM) (31, 27.9%), hypertension (26, 23.4%), chronic pyelonephritis (1, 0.9%) and obstructive nephropathy (1, 0.9%). Pre-emptive transplantation was done in 4 (3.6%) patients. Patients on continuous ambulatory peritoneal dialysis and haemodialysis were 2 (1.8%) and 105 (94.6%) respectively. Most of the donors were siblings (55.9%). Majority (64.9%) had an uncomplicated recovery. The commonest complication during post-transplant hospital stay was infection (27.0%), mostly urinary tract infection (21.6%). Surgical failure was experienced in 1 (0.9%) and acute rejection was noted in 2 (1.8%) patients. Other complications were renal vein thrombosis (1, 0.9%), haemolytic uremic syndrome (1, 0.9%), acute tubular necrosis (1, 0.9%), peri-renal collection (1, 0.9%), pericardial effusion (1, 0.9%) and clot retention in urinary bladder (2, 1.8%). Mean post-transplant hospital stay was 12.39 ± 4.27 days. Mean duration from surgery to normalization of serum creatinine was 5.75 ± 4.15 days. During discharge, 71.2% patients had normal renal function (RF) with mean serum creatinine 1.03 ± 0.15 mg/dl and 26.1% patients had gradually improving RF with mean serum creatinine 2.01 ± 1.04 mg/dl. As induction, 61 (55%) patients received basiliximab and as maintenance therapy all patients received oral prednisolone, calcinurine inhibitor and mycophenolate. In the first year of transplant, 49.5% patients suffered from infections, of which urinary tract infection was the commonest (55.9%). Incidence of chronic allograft nephropathy in CGN, DM and hypertension patients were 25%, 19.4% and 23.1% respectively. Graft survival at 1 year, 3 years and 5 years was 94.06%, 85.88% and 77.27% respectively. Patient survival at 1 year, 3 years and 5 years was 98.1%, 88.24% and 84.09% respectively.Conclusions: Our results are comparable or in some aspects, even better in comparison to other centers of both developing and developed world. In a center of a developing country with limited facility and resource, these achievements are encouraging.Birdem Med J 2018; 8(3): 198-202

Higher Incidence of Renal Allograft Glomerulonephritis in Living-Related Donor Kidney Transplantation

Glomerulonephritis recurrence has emerged as one of the leading causes of allograft loss. We aimed to investigate the effect of living-related and deceased donation on the incidence of renal allograft glomerulonephritis and its effect on renal allograft survival. MethodsAdult renal allograft recipients with primary glomerulonephritis were enrolled. Transplantation date was from Feb 2004 to Dec 2015. Exclusion criteria included combined organ transplantation, structural abnormality, diabetic nephropathy, hypertension nephropathy, obstructive nephropathy, and primary uric acid nephropathy. The incidence of biopsy-proven allograft glomerulonephritis was compared between the living-related donor group and the deceased donor group. Graft survival was assessed with Kaplan-Meier method, and Cox proportional hazard model was used to evaluate the effect of posttransplant glomerulonephritis on graft outcome. ResultsThere were 525 living-related donor kidney transplant recipients (LRKTx) and 456 deceased donor kidney transplant recipients (DDKTx) enrolled. The incidence of IgA nephropathy was 8.8% in the LRKTx group and 1.3% in the DDKTx group (P < .001); the incidence of focal segmental glomerulosclerosis (FSGS) was 3.8% in the LRKTx group and 1.5% in the DDKTx group (P = .03). FSGS increased the risk of graft failure compared with non-FSGS (hazard ratio [HR], 3.703 [1.459–9.397]; P = .006). IgA nephropathy increased the risk of graft failure by over 5 times 5 years after kidney transplantation compared with non-IgA nephropathy, but it did not affect early allograft survival (HR for ≥5 years, 6.139; 95% CI, 1.766–21.345; P = .004; HR for <5 years, 0.385 [0.053–2.814]; P = .35). ConclusionsHigher incidence of IgA nephropathy and FSGS in renal allograft was observed in living-related donor kidney transplantation compared with deceased donor kidney transplantation. De novo or recurrent IgA nephropathy and FSGS impaired long-term renal allograft survival.

Comparison of Clinical Outcomes Between Spousal and Living-related Donor Kidney Transplantation in Mainland China: A Single-center Experience

Shortage of donors still is the major obstacle for kidney transplantation. Living-related donors are the major resource of kidney transplantation at present. To expand the donor pool, spousal-donor kidney transplantation as one of the types of living-unrelated donors has been used to alleviate the organ shortage. A total of 116 living-kidney transplantations were retrospectively analyzed. We classified these recipients into two groups: a spousal-donor group (n = 50) and a living-related donor group (n = 66), and analyzed the outcome of transplantation. The Kaplan–Meier method was used for survival analysis with the log-rank test. The occurrence of delayed graft function and biopsy-proven acute rejection showed no significant difference between the two groups. Serum creatinine values at different times after transplantation in recipients with functioning grafts were similar in the two groups. Kaplan-Meier 3-year patient and graft survival rates were, respectively, 98% and 94% for the spousal donor group, and 98.5% and 95.5% for living-related donor group without significant difference. The demonstration of similar patient and graft survival of spousal-donor kidney transplantation compared with living-related donor kidney transplantation has made spousal-donor kidney transplantation an acceptable alternative for donor supply.

Cytomegalovirus pneumonia after living-related donor kidney transplantation : the experiences of one single center within 10 years

Objective To report one-center experience on diagnosis and treatment of cytomegalovirus (CMV) pneumonia in recipients after living-related donor kidney transplantation (LDKT). Methods The clinical and follow-up data of 168 recipients after LDKT from April 2005 to September 2014 were analyzed retrospectively. We analyzed the general information, clinical manifestation, treatment and outcomes of 34 recipients who were diagnosed as CMV pneumonia. Of the 34 patients, 26 were male and 8 were female. The average age were 32.0 years old. Thirty-four patients developed CMV pneumonia between 12 to 402 days with an average of (91.7±60.8) days post-transplant. It was (6.4±3.7) d(range 1-14 d) from the onset of illness to seeking medical intervention. All cases presented with fever, 18 cases with dyspnea, 11 cases with cough and 6 cases with myalgia or fatigue. The highest temperature was (38.8±0.5)℃ (range 38.0-40.0℃). Leukocyte count was (10.5±4.4)×109/L, elevated in 18 cases, normal in 14 cases, reduced in 2 cases. Quantitative polymerase chain reaction(PCR) assay for CMV DNA was (9.3-15.8)×103 copies/ml for active CMV infection. Chest X ray or CT of all cases demonstrated patchy shadow or interstitial pneumonia. The etiological examination showed that 12 cases were complicated with other microorganism, including 8 cases with Pneumocystis carinii, 3 cases with Streptococcus A, 3 cases with Neisseria, 3 cases with candida albicans, 2 cases with klebsiella pneumoniae, Staphylococcus aureus, enterococcus faecium, Pseudomonas aeruginosa varied 1 case. Results In antiviral therapy, patients were treated by introvenous ganciclovir 5 mg/kg every 12 h for 14-21d and then 5 mg/kg every day. Glucocorticoid treatment included intravenous methylprednisolone 200 mg/kg for 3-5 d, then gradually reduced to 160 mg/kg for 3-5 d, 120 mg/kg for 3 d, 80 mg/kg for 3 d, 40 mg/kg for 3-5 d, until to the original oral dose. Early application of broad-spectrum antibiotics was to prevent bacterial infection, and routine application of compound sulfamethoxazole to prevent Pneumocystis carinii pneumonia. Treatment options were adjusted according to periodic bacteria and fungal culture in blood, urine or sputum, and effective anti bacterial, viral or fungal treatment was selected. After administration of antiviral therapy, methylprednisolone, treatment for other microorganism, as well as adjusted immunosuppressive drugs, 30 cases were cured. The total course of the pneumonia lasted for (28.5±9.4) days on average. However, 4 patients complicated with other microorganism died of severe pneumonia and acute respiratory distress syndrome(ARDS). Conclusion CMV infection was a common complication of living-related donor kidney transplantation. CMV infection often complicated with other microbial infections, and became one of the causes of death after renal transplantation. Early diagnosis, early antiviral therapy combined with effective anti bacterial, fungal treatment would improve the survival of kidney transplant recipients. Key words: Cytomegalovirus; Kidney transplantation; Living donors; Pneumonia

Effect of donor age and parent-to-child transplant on living-related donor kidney transplantation: a single center's experience of 236 cases

To study the impact of parent-to-child transplant and older donor age on recipients' post-transplant creatinine levels, a total of 236 patients who received living donor kidney transplantation were evaluated for kidney viability based on creatinine (Cr) level. Of the 236 pairings, 113 (48%) were parent-to-child followed by sibling transplants (66, 30%). Recipient Cr levels were significantly higher at 6 months and 3 years post-transplant in the parent-to-child transplants compared to other donor–recipient relationships. In addition, donor age (average age: 44.1 ± 11.5; range: 19–66) contributed to higher recipient post-transplant Cr levels (p < 0.01). Pre-transplant donor and recipient Cr levels tended to result in higher post-transplant Cr levels in recipients (p < 0.05). Multivariate logistic regression analysis revealed that the presence of both parent-to-child transplant and older donor significantly increased the risk of elevated post-transplant Cr levels in recipients with an estimated odds ratios ranging from 3.46 (95% CI: 1.71–6.98) at 6 months to 8.04 (3.14–20.56) at 3 years post-transplant. Donor age significantly affected transplant survival as measured by higher recipient post-transplant Cr levels. In addition, parent-to-child transplant pairings, along with older donor age, significantly increased the risk of elevated post-transplant Cr levels in recipients.

Homocysteine Levels After Nitrous Oxide Anesthesia for Living-Related Donor Renal Transplantation: A Randomized, Controlled, Double-Blind Study

BackgroundNitrous oxide anesthesia increases postoperative homocysteine concentrations. Renal transplantation candidates present with higher homocysteine levels than patients with no renal disease. We designed this study to investigate if homocysteine levels are higher in subjects receiving nitrous oxide for renal transplantation compared with subjects undergoing nitrous oxide free anesthesia. MethodsData from 59 patients scheduled for living-related donor renal transplantation surgery were analyzed in this randomized, controlled, blinded, parallel-group, longitudinal trial. Patients were assigned to receive general anesthesia with (flowmeter was set at 2 L/min nitrous oxide and 1 L/min oxygen) or without nitrous oxide (2 L/min air and 1 L/min oxygen). We evaluated levels of total homocysteine and known determinants, including creatinine, folate, vitamin B12, albumin, and lipids. We evaluated factor V and von Willebrand factor (vWF) to determine endothelial dysfunction and creatinine kinase myocardial band (CKMB)-mass, troponin T to show myocardial ischemia preoperatively in the holding area (T1), after discontinuation of anesthetic gases (T2), and 24 hours after induction (T3). ResultsCompared with baseline, homocysteine concentrations significantly decreased both in the nitrous oxide (22.3 ± 16.3 vs 11.8 ± 9.9; P < .00001) and nitrous oxide-free groups (21.5 ± 15.3 vs 8.0 ± 5.7; P < .0001) at postoperative hour 24. The nitrous oxide group had significantly higher mean plasma homocysteine concentrations than the nitrous oxide-free group (P = .021). The actual homocysteine difference between groups was 3.8 μmol/L. ConclusionThis study shows that homocysteine levels markedly decrease within 24 hours after living-related donor kidney transplantation. Patients receiving nitrous oxide have a lesser reduction, but this finding is unlikely to have a clinical relevance.

Cyclosporine A and tacrolimus combined with enteric-coated mycophenolate sodium influence the plasma mycophenolic acid concentration - a randomised controlled trial in Chinese live related donor kidney transplant recipients

To observe the different concentrations of mycophenolic acid (MPA) during the early post-transplant phase for various combinations of cyclosporine A (CsA) and tacrolimus (Tac) with enteric-coated mycophenolate sodium (EC-MPS). A total of 42 Chinese adults receiving live related donor kidney transplants were studied. All received a triple immunosuppressive regimen of EC-MPS, CsA/Tac and corticosteroids and were divided randomly into CsA (n=21) and Tac (n=21) combination groups. The dosage of EC-MPS was the same (1440mg/day) in the two groups. The MPA concentration was evaluated with an enzyme-multiplied immunoassay technique (EMIT) and the pharmacokinetic characteristics were investigated in both groups. The mean maximum plasma concentrations (Cmax ) of MPA in the CsA and Tac groups were 11.365±9.522 and 9.748±7.523μg/ml, respectively (p=0.137). The maximum times to Cmax (Tmax ) were 2.54±1.53 and 2.67±1.08h, respectively (p=0.341). The mean MPA 12-h areas under the curve (MPA-AUC0-12h ) were 59.463±16.252 and 77.535±33.615μgh/ml (p=0.003) and the mean residence times (MRT) were 3.71±0.829 and 3.928±0.923h (p=0.038). Combined with the same EC-MPS dosage (1440mg/day), the MPA-AUC0-12 of the Tac group was higher than that of the CsA group, and the Tac group had a longer MRT after kidney transplantation. Our data indicate that the concentration of MPA should be monitored in clinical therapy when EC-MPS is combined with different calcineurin inhibitors to reduce acute allograft rejection and avoid adverse events.

Living-related donor kidney transplantation in Jehovah’s Witness patient: the importance of EPO preconditioning

Living-related donor kidney transplantation in Jehovah’s Witness patient: the importance of EPO preconditioning

Near-infrared spectroscopy as continuous real-time monitoring for kidney graft perfusion

Near-infrared spectroscopy (NIRS) is a non-invasive technique designed to study regional oxygenation (rSO(2)) by measuring the absorption of chromophores. This study investigated the role of NIRS in the real-time monitoring of kidney graft perfusion for 72 h post-transplantation. Consecutive children undergoing living related donor (LRD) or deceased donor (DD) kidney transplantation (KTP) were prospectively enrolled between April 2010 and August 2011. Renal rSO(2) values were registered continuously for 3 days and correlated with hourly urine output, serum creatinine, and urinary neutrophil gelatinase-associated lipocalin (u-NGAL). Twenty-four children were included, 6 underwent LRD and 18 DD KTP. Median age was 12.5 years (interquartile range [IQR] 3.5-16.6) and median body weight was 37 kg (IQR 13-49.7). Four patients experienced delayed graft function (DGF). Renal Doppler ultrasound showed normal vascularization patterns in all children. Median basal renal rSO(2) value was 68.8 % (IQR 59.3-76.2), significantly lower than the end-of-period result (83.6 %; IQR 79.2-90.4; p < 0.0001). Renal rSO(2) values showed significant correlation with serum creatinine (rs = -0.62; p < 0.05) and estimated glomerular filtration rate (eGFR) (rs = 0.64; p < 0.05). No correlation was shown between rSO(2) and diuresis. Increased rSO(2) was also found in patients who experienced DGF. u-NGAL exhibited a trend toward a decrease from baseline in both DD and LRD KTPs, with a strong negative correlation with rSO(2). rSO(2) assessed by NIRS strongly correlates with common markers of kidney graft function and perfusion, allowing continuous real-time monitoring of blood flow in renal grafts.

Long term follow up of congenital thrombotic thrombocytopenic purpura (Upshaw-Schulman syndrome) on hemodialysis for 19 years: a case report

BackgroundThrombotic thrombocytopenic purpura (TTP) is frequently associated with renal abnormalities, but there have been few reports about renal abnormalities in patients with hereditary TTP. In particular, little is known about the long-term prognosis of patients with childhood-onset congenital TTP.Case presentationWe report a Japanese patient with congenital TTP (Upshaw–Schulman syndrome) who was followed for 19 years after initiation of hemodialysis when he was 22 years old. At the age of 6 years, the first episode of purpura, thrombocytopenia, and proteinuria occurred without any precipitating cause. He underwent living-related donor kidney transplantation from his mother, but the graft failed after 5 months due to recurrence of TTP. Even after resection of the transplanted kidney and resumption of regular hemodialysis, TTP became refractory to infusion of fresh frozen plasma (FFP). Therefore, splenectomy was performed and his disease remained in remission for 10 years. However, TTP recurred at the age of 39 years. Plasma activity of ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type I domain 13) was less than 3%, while ADAMTS13 inhibitor was not detected (< 0.5 Bethesda units/mL). The patient died suddenly after hemodialysis at the age of 41 years. Subsequent genetic analysis of this patient and his parents revealed two different heterozygous mutations of ADAMTS13, including a missense mutation in exon 26 (c.T3650C causing p.I1217T) inherited from his father and a missense mutation in exon 21 (c.G2723A causing p.C908Y) inherited from his mother. The former mutation has not been detected before in Japan, while the latter mutation is common in Japan. A retrospective review showed that serum C3 levels were consistently low while C4 levels were normal during follow-up, and C3 decreased much further during each episode of TTP.ConclusionCongenital TTP was diagnosed from the clinical, biochemical, and genetic findings. Infusion of FFP controlled each thrombotic episode, but the effect was limited and of short duration. Review of the complement profile in this patient suggested that a persistently low serum C3 level might be associated with refractory TTP and a worse renal prognosis.

V2155 ROBOTIC-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR A 7CM MASS IN A RENAL ALLOGRAFT

Treatment options for a suspicious renal mass in a re-nal allograft include radical nephrectomy or nephron-sparing surgery (NSS). To our knowledge robotic-assisted laparoscopic partial nephrectomy (RPN) astreatment for a renal mass in a transplant kidney hasnot been previously reported. We report the case ofRPN for a 7-cm renal mass in a transplanted kidney. A35-year-old female with reflux nephropathy receiveda living-related donor kidney transplant in 1986. At24 years after transplantation she had a 7-cm BosniakIII cystic mass of the allograft detected on comput-erized tomography (CT) scan. Preoperative creatininewas 2.2 mg/dL with an estimated glomerular filtrationrate (eGFR) of 25 mL/min/1.73 m

Outcome of Kidney Transplantation in Patients with Antiphospholipid Antibodies: A Case Series

Abstract 1230 Background:Thrombotic and obstetric complications occur in association with antiphospholipid antibodies (aPL), as do intrarenal vascular changes in primary and secondary APS. There are a limited number of studies reporting the outcome of patients with aPL receiving kidney allografts. Materials & Methods:A retrospective chart review of patients who underwent kidney transplantation in our institution between 2005 and 2010 (inclusive) was performed. Patients who had at least 1 positive aPL at the time of transplantation were identified, their demographic, immediate and long-term outcome details obtained including any aPL related complications (thrombotic episodes including intrarenal vascular complications). Comparison was made with a control group consisting of transplant recipients not known to have aPL, matched for age, sex, transplant type and year of transplant. Results:884 patients underwent kidney transplantation between 2005 and 2010. 87 patients were screened for aPL(9.8%), 41 patients with aPL were identified(4.6%), 34 patients had a lupus anticoagulant, 1 had anti-cardiolipin antibodies and 6 both lupus anticoagulant and anti-cardiolipin antibodies. Long-term follow up was available for 31 patients. 25/31 patients were found to have persistent aPL (25/31 had repeated aPL screening). Patients included 17 males, 24 females, mean age 42 (range 19–61) years). 14 patients were known to have persistent aPL prior to transplantation and 5 of these were receiving long-term anticoagulation because of a history of thrombosis prior to renal transplant. 3 of the 27 patients not known to have persistent aPL prior to transplantation had a history of thrombosis prior to renal transplant; none of these were receiving long-term anticoagulation.13 patients had aPL in association with other autoimmune disease (SLE). 30 patients had screening for other thrombophilic disorders performed. Other risk factors included hypercholesterolaemia, hypertension and cigarette smoking.The table below summarises short and long-term aPL related complications.25 patients had a cadaveric transplant, 2 had live unrelated donor transplants and 14 had live-related donor kidney transplants. Immediate thrombotic complications in patients with aPL included 4 patients who had graft failure due to renal vessel thrombosis resulting in graft excision because of ischaemia of the transplanted organ and 2 had a lower limb DVT (receiving perioperative thromboprophylaxis with aspirin, n=6) compared to 1 patient in the control group who experienced a lower limb DVT(significantly higher in patients with aPL compared to controls p=0.03).Of the patients for whom long term follow up was available, long-term thrombotic complications were significantly higher in patients with aPL compared to controls (5/31 patients with aPL compared to 0/31 controls, p=0.02). Complications included fatal PE in 1 patient (on warfarin with subtherapeutic INR), bowel ischaemia secondary to mesenteric artery occlusion in another (on aspirin), and 1 patient had graft failure 9 months following transplant due to thrombotic microangiopathy (commenced on warfarin 6 months post transplant due to persistent aPL). Renal artery stenosis occurred in 2 patients (both receiving aspirin).Year of transp-lantNumber receiving periop TP*, (TP agent)Number of aPL related graft failuresNumber of non- aPL related graft failuresImmediate large vessel thrombosisNumber receiving long term thromboprophylaxis/ number with available long term follow up information (TP agent)Long term thrombotic complications20053/4 3 aspirin 1 no TP0102/3 2 aspirin1 mesenteric vein thrombosis 1 renal artery stenosis20065/5 4 aspirin 1 ufh0115/5 2 aspirin 3 warfarin1 fatal PE 1 TMA renal graft2007878 5 aspirin, 3 ufh/lmwh 1 no TP2 (renal vessel thrombosis)013/6 1 aspirin 2 warfarin1 renal artery stenosis20084/5 3 aspirin 1 asp/ufh combined 1 ufh1(renal vessel thrombosis)004/5 4 aspirin020098/12 2 aspirin 4 asp/ufh combined 2 ufh/lmwh 4 no TP1(renal vessel thrombosis)007/6 6 aspirin 1 warfarin020107/7 3 aspirin 1 asp/ufh combined 3 ufh/lmwh0007/5 3 aspirin 4 warfarin0Total33/41 22 aspirin 11 ufh/lmwh 6 no TP42229/31 19 aspirin 10 warfarin5/31Conclusions: There is a high risk of thrombotic complications in patients with aPL who are undergoing renal allograft. These patients should be considered for perioperative and longterm thromboprophylaxis. Disclosures:No relevant conflicts of interest to declare.