Living-unrelated Donor Research Articles

V01-01 UTILITY OF 3-D MODELING IN COMPLEX UPPER TRACT RECONSTRUCTION: ROBOTIC-ASSISTED URETEROPELVICOSTOMY OF NATIVE URETER TO TRANSPLANT RENAL PELVIS

You have accessJournal of UrologyCME1 Apr 2023V01-01 UTILITY OF 3-D MODELING IN COMPLEX UPPER TRACT RECONSTRUCTION: ROBOTIC-ASSISTED URETEROPELVICOSTOMY OF NATIVE URETER TO TRANSPLANT RENAL PELVIS Bridget L. Findlay, Jayson P. Kemble, Elizabeth N. Bearrick, Katherine T. Anderson, and Boyd R. Viers Bridget L. FindlayBridget L. Findlay More articles by this author , Jayson P. KembleJayson P. Kemble More articles by this author , Elizabeth N. BearrickElizabeth N. Bearrick More articles by this author , Katherine T. AndersonKatherine T. Anderson More articles by this author , and Boyd R. ViersBoyd R. Viers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003221.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: 3-D models have been used successfully in oncologic planning, however there are limited data supporting their use and efficacy in complex genitourinary reconstructive cases. Due to complex and variable regional anatomy with transplant vasculature and collecting system, surgical planning requires an individualized approach based on anatomic relationships. Herein, we aim to illustrate the novel utility of 3-D modeling in surgical planning for complex upper tract reconstruction, and to describe an alternative approach to transplant proximal ureteral stricture reconstruction. METHODS: The index patient is a 17-year-old male with a history of bilateral grade 4 vesicoureteral reflux (VUR) who developed end stage renal disease despite ureteroneocystostomies in childhood. He underwent a living-unrelated donor renal transplantation in November 2021, complicated by a focal proximal ureteral stricture. His anatomy was further complicated due to prior ligation of his native distal right ureter and intraperitoneal location of his transplant kidney. Therefore, a 3-D printed anatomical model was created to aid in surgical planning. RESULTS: The 3-D model highlighted a complex trajectory of the proximal transplant ureter and area of stricture directly posterior to the renal hilar vessels. Additionally, the native right ureter ligation was noted distal to the transplant renal pelvis and was not amenable for use in reconstruction. Given these anatomic considerations, the patient underwent an uncomplicated robotic-assisted ureteropelvicostomy between his native left proximal ureter and transplant renal pelvis. Total robotic operative time was 2 hours 17 minutes. He was dismissed on postoperative day (POD) 1 with a creatinine nadir near his post-transplant baseline level at 10-week follow-up. CONCLUSIONS: 3-D printed models have utility in select cases with complex anatomy. These models facilitate accurate regional and spatial anatomy of critical structures to enable effective operative planning. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e79 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bridget L. Findlay More articles by this author Jayson P. Kemble More articles by this author Elizabeth N. Bearrick More articles by this author Katherine T. Anderson More articles by this author Boyd R. Viers More articles by this author Expand All Advertisement PDF downloadLoading ...

Utility of 3D Modeling in Complex Upper Tract Reconstruction: Robot-Assisted Ureteropelvicostomy of Native Ureter to Transplant Renal Pelvis

Clinical History: The case is a 17-year-old boy with a history of bilateral grade 4 vesicoureteral reflux and end-stage renal disease who underwent a living-unrelated donor renal transplantation in November 2021. He presented in June 2022 with vague abdominal pain and creatinine 4.3 mg/dL. Physical Examination: Transplant biopsy showed no evidence of acute rejection. Antegrade nephrostogram at the time of nephrostomy tube placement demonstrated hydronephrosis and a focal stricture of the proximal transplant ureter. His anatomy was further complicated because of prior ligation of his native distal right ureter at the time of transplant and intraperitoneal location of his transplant kidney through a peritoneal window. Diagnosis: Focal proximal stricture of transplant ureter. Intervention: Given the complex anatomy, a 3D-printed anatomical model was created to facilitate surgical planning. The 3D model highlighted a complex trajectory of the proximal ureter and strictured segment directly posterior to the transplant hilar vessels. In addition, the transplant kidney was directly overlying the dome of the bladder because of its intraperitoneal location. Given these anatomic considerations, the patient underwent an uncomplicated robot-assisted ureteropelvicostomy between his native left ureter and transplant renal pelvis. Follow-Up/Outcomes: Total robotic operative time was 2 hours 17 minutes. He was dismissed on postoperative day 1 with a creatinine nadir equivalent to his post-transplant baseline at 10-week follow-up. 3D-printed models have utility in select cases with complex anatomy. These models facilitate accurate regional and spatial anatomy of critical structures to enable effective operative planning. No competing financial interests exist. Patient consent statement: Patient consented to the use of nonidentifiable intraoperative photography and video recording for the purpose of medical education and publication in professional journals. Source of 3D model: Mayo clinic 3D Anatomic Modeling Laboratory. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. No funding was received for this article. Music: All music was from Pixabay.com, royalty free. Runtime of video: 04 mins 58 secs

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<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<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.

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.

A Prospective Comparative Study from India between Living Genetically Related and Unrelated Donor Renal Transplants

Background: India has a significant backlog in terms of renal transplant waiting lists, and progress of deceased donor transplant is limited by social and cultural hurdles. Newer strategies in living donation are needed. Materials and Methods: A prospective comparative study was conducted at our tertiary hospital over 3 years, between living related donor (LRD) and living unrelated donor (LURD) renal transplant outcomes, chiefly acute rejection and graft dysfunction. Confounding variables and outcome parameters such as mortality, hospital stay &gt;21 days, and complications were recorded for 6 months. Results: LRD (n = 78) and LURD (n = 42) groups differed significantly in median recipient age (25 [22–34] vs. 40 [33–50] years; P &lt; 0.001) and human leukocyte antigen (HLA) mismatches &gt;3 (3/78 [3.8%] vs. 32/78 [76.2%]; P &lt; 0.001, respectively). Yet, there was no significant difference in donor age, gender, immunosuppression, preoperative hemodialysis, nephrectomy time, or warm ischemia time. No significant difference was noted between LRD and LURD in acute rejection rate, graft dysfunction at 1 week and 6 months, mortality, hospital stay &gt;21 days, or complication rate. Among factors predictive for acute rejection, only anastomotic time had a significant association (β coefficient = 0.006 [0.001–0.010]; Pearson's coefficient “r” =0.208; P &lt; 0.01), while for early graft dysfunction, it was only mean donor nephrectomy time in minutes (β coefficient=-0.002 [−0.004–0.000]; Pearson's coefficient “r” = −0.158; P = 0.042). Conclusion: Despite differences in HLA-mismatches and age, LRD and LURD had a similar short-term outcome with respect to acute rejection and graft dysfunction. This is linked to better and standardized immunosuppression available, making it possible to expand the scope of LURD beyond spousal, within the legal and ethical boundaries.

Comparative study of the outcomes of the second kidney transplantation from the young deceased donors versus living-unrelated donors

PurposeTo compare the kidney graft function and survival in patients who had second kidney transplantation from living donors versus those who had a second transplant from young deceased donors. MethodsIn this retrospective cohort study, a total of 86 patients who underwent second kidney transplantation in Shariati hospital from 2001 until 2017 were enrolled. Baseline clinical data on the age, sex, type of kidney donor (living unrelated or deceased), duration of pretransplant dialysis, and the length of hospitalization were recorded. As the indicators of the graft function, we used the serum creatinine level and estimated glomerular filtration rate (eGFR) at time intervals during the study. The 1, 5, and 10-year graft survival rates were reported using life tables and the relative hazard ratios of the graft failure were calculated using the forward stepwise Cox proportional hazard model. ResultsForty-six of our patients were men (53.5%), with a mean ± SD age of 44.3 ± 12.3 years at the time of transplantation. The majority of the enrolled patients received the kidney from living unrelated donors (50 vs. 36 patients). In terms of serum creatinine and eGFR, at time intervals, no significant difference was found between the two recipient groups. In the living donor group, the 1, 5, and 10-year graft survival rates of the second transplant were 91% (95%CI: 73–96%), 87% (95%CI: 69–95%), and 82% (95%CI: 59–92%), and for the deceased donor group were 95% (95% CI: 69–99%), 95% (95%CI: 69–99%), and 79% (95%CI: 31–95%), respectively. ConclusionConsidering the long-term outcomes of the second kidney transplantation, in our experience, the graft function and survival, either from the living or deceased donors, were favorable; and the type of organ donation had no significant effect on the risk of graft failure.

The association of living donor source with patient and graft survival among kidney transplant recipients in the ERA-EDTA Registry - a retrospective study.

SummaryIn this study we aimed to compare patient and graft survival of kidney transplant recipients who received a kidney from a living‐related donor (LRD) or living‐unrelated donor (LUD). Adult patients in the ERA‐EDTA Registry who received their first kidney transplant in 1998–2017 were included. Ten‐year patient and graft survival were compared between LRD and LUD transplants using Cox regression analysis. In total, 14 370 patients received a kidney from a living donor. Of those, 9212 (64.1%) grafts were from a LRD, 5063 (35.2%) from a LUD and for 95 (0.7%), the donor type was unknown. Unadjusted five‐year risks of death and graft failure (including death as event) were lower for LRD transplants than for LUD grafts: 4.2% (95% confidence interval [CI]: 3.7–4.6) and 10.8% (95% CI: 10.1–11.5) versus 6.5% (95% CI: 5.7–7.4) and 12.2% (95% CI: 11.2–13.3), respectively. However, after adjusting for potential confounders, associations disappeared with hazard ratios of 0.99 (95% CI: 0.87–1.13) for patient survival and 1.03 (95% CI: 0.94–1.14) for graft survival. Unadjusted risk of death‐censored graft failure was similar, but after adjustment, it was higher for LUD transplants (1.19; 95% CI: 1.04–1.35). In conclusion, patient and graft survival of LRD and LUD kidney transplant recipients was similar, whereas death‐censored graft failure was higher in LUD. These findings confirm the importance of both living kidney donor types.

Childhood nephrotic syndrome at the University of Abuja Teaching Hospital, Abuja, Nigeria: a preliminary report supports high steroid responsiveness.

The response to steroid in childhood nephrotic syndrome (CNS) varies across geographical regions, depending on aetiology, genetics, and the underlying pathology. Recently, there is an increasing steroid responsiveness among Nigerian children with nephrotic syndrome (NS). This is the first report of CNS at the University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria, between 15th January 2016 and 30th June 2018. Prednisolone was administered to all the children with NS according to the regimen of the International Study of Kidney Disease in Children. There were 46 children aged 17 months to 18 years, including 37 males and 9 females. The peak age was 6-10 years with a mean age of 8.2 ± 4.4 years. Forty-one (89.1%) had idiopathic NS (INS). Secondary NS occurred in five (10.9%) children with hepatitis B infection, sickle cell anaemia, haemolytic-uraemic syndrome, and post-infectious glomerulonephritis (two cases). Plasmodium malariae was not seen. Overall, steroid-sensitive NS (SSNS) was seen in 34 (73.9%) and in 32 (78%) with INS. Five (16.7%) of the 30 with SSNS relapsed on follow-up. Twelve (26.1%) were resistant to steroid (steroid-resistant NS, SRNS). Renal biopsies in five SRNS revealed focal segmental glomerulosclerosis in three, minimal change lesion in one, and severe interstitial fibrosis/glomerulosclerosis in another one. Four (8.7%) children who had SRNS died. A child with SRNS is surviving on renal transplant from a living-unrelated donor. The study supports the notion that steroid responsiveness is increasing among ethnic black Nigerian children. Pre-treatment renal biopsy may be unwarranted.

Results of the kidney transplant programme at the University Clinical Centre of the Republic of Srpska from 2010 to 2018

Background: Kidney transplantation is the best treatment for patients with end-stage renal disease (ESRD). The aim of the study was to show the results of kidney transplantation performed in the University Clinical Centre of the Republic of Srpska in the period 2010-2018. Methods: This was a retrospective, 8-year observational cross-sectional study. Studied endpoints were overall patient survival, as well as graft survival rate in kidney transplant recipients. Recipient's age, gender, induction immunosuppressive therapy, the underlying cause of ESRD, the dialysis modality and post-operative complications (surgical, medical, urinary tract infections, electrolyte imbalance, and graft rejection) and their influence on the patient and graft survival rates were monitored. Results: The 30 living-donor kidney transplantations were performed, 29 living-related donor and one living-unrelated donor renal transplantation. A total of 70% of kidney recipients were male, and 30% were female. The average age of patient was 34.43 ± 8.67 years. Induction immunosuppressive regimen was prescribed to 76.7% of transplanted patients. Graft rejection occurred in 5 patients (16.7%). The 1-year, 3-year, 5-year, and 8-year patients survival rates were 100%, 100%, 96.97% and 93.33%, respectively. The 1-, 3-, 5-, and 8-year graft survival rates were 100%, 96.97%, 93.33% and 86.67%, respectively. The current mean value of glomerular filtration rate (GFR) in 25 patients with functional graft was 81.8 ± 30.3 ml/min. There was a statistically significant difference in the graft survival rate in the group with urinary tract infections (UTIs) (66.66%) compared to a group without UTIs (100%). Overall patient survival was significantly lower in the group with graft rejection (60%) compared to the group without graft rejection (92%). Kidney graft survival rate and overall patient survival have not been significantly different in terms of the studied factors (recipient's age, gender, induction immunosuppressive treatment, underlying cause of ESRD, dialysis modality, surgical or medical complications, and electrolyte imbalance). Conclusion: The results of living-donor kidney transplantation performed in the University Clinical Center of the Republic of Srpska are good in comparison with the results obtained at other centres.

Allograft and Patient Outcomes of a Tumourectomized Kidney Transplant Program

Background There is an increased utilization of marginal donor kidneys for transplantation due to the shortage of donor kidneys. Patients with a small renal cell cancer occasionally undergo radical nephrectomy, which represents an opportunity to consider the utilization of these kidneys for transplantation that would otherwise be discarded. We report the long-term outcome of kidney transplant recipients who have received kidneys from live-unrelated donors with resected small renal cell cancers of less than 3 cm. Materials & Methods The potential recipients were informed and consent was obtained before they were listed for kidney transplantation by using a kidney graft, in which a small tumor was excised. The referral was sent from urologists to transplant team when a radical nephrectomy was decided as an option for treating a renal tumor. As such, the patient was offered an option of kidney donation after radical nephrectomy and the informed consent was signed. In our structured program, the decision for partial or radical nephrectomy for management of a small renal mass was purely made between the discussion of a patient and his or her treating urologist. The selection criteria for the potential donor and recipient have been established prior to implementation. The frozen section was performed after tumor excision on bench table to ensure the margin was clear prior to transplantation. The recipients were selected as age over 60 years or age 55 with urgent need for transplantation. Results From Feb 2007 to Aug 2017, 28 patients with a small renal mass chose radical nephrectomy and were considered suitable for kidney donation after tumor excision. The tumor size was from 1 cm to 4 cm, average 2.7 cm. There were 24 malignant tumors; with most of them were Fuhrman grade I-II; and 4 benign tumors. The recipients age were from 52-80 years old; average 63 year old at the time for kidney transplantation M:F=15:13. The average warm ischemic time was 5 minutes; cold ischemic time was from 155 minutes to 340 minutes (average 275). In our cohort the follow up period was from 2-10 years, median 7 years. There was no tumor recurrence. Of recipients, 68% are alive with average age 70 years old at follow up. The average Cr level was136 mmol/L. At early phase 3 patients developed urine leakage from the tumor excision area and one patient developed pseudoaneurysm, but all recoved well after interventional management. Conclusion Transplantation of tumourectomized kidneys from patients with small renal cell cancer is associated with comparable allograft and patient outcomes. The decision of utilizing these kidneys for transplantation needs careful informed consent process, balancing the benefit of kidney transplantation and the small but potential risk of tumour recurrence. The absence of tumor recurrence in this cohort may be associated with cold perfusion, which inhibits tumor cell proliferation and clear excision of tumor on bench table.

Impact of type of donor on graft and patient survival rate in kidney transplanted patients in Iran

Introduction: End-stage renal disease (ESRD( is an increasing problem in the world. Kidney transplant is considered as preferred therapeutic method for ESRD. Options for organ transplantation include living related donor (LRD), living unrelated donor (LURD) and cadaveric donor. Objectives: This study was aimed to evaluate the effect of type of donor on graft and survival rate of patients. Patients and Methods: This study was cross-sectional, which used Meier method to calculate the patient survival rate. Additionally log-rank test was applied to compare the survival curves; analysis of variance (ANOVA) was applied to compare continuous variables and χ2 test was used to compare the data. Data were analyzed using SPSS version 19 and P values less than 0.05 was considered significant. Results: The mean duration of follow-up in LRD, LURD and cadaveric recipients were 60.37±34.2, 79.17±33 and 61.17±34 months respectively. Five-year survival, in LRD was 100 months, in LURD recipients was 87±0.01 months, and in cadaveric recipients was 91±0.03 months. The mean survival of graft in LRD, LURD and cadaveric recipients were 115.5±3.1, 103.27±1.2 and 102.15±4.5 months, respectively. Log-rank test showed a significant difference between graft survival in recipients (P=0.038). Conclusion: The results showed that LRD is one of the factors affecting graft survival. Hence, graft survival rate showed high length among patients who their graft was from LRD compared to LURD and cadaveric.

Liver transplantation for neonatal‐onset citrullinemia

Citrullinemia or ASS deficiency in its classical form presents in the neonatal period with poor feeding, hyperammonemia, encephalopathy, seizures, and if untreated can be fatal. Despite advances in medical therapy, neurocognitive outcomes remain suboptimal. LT has emerged as a potential management option. A retrospective single-center review identified 7 children with a median age of 1.1years (range, 0.6-5.8) at referral. Five children presented clinically, and 2 were treated prospectively from birth due to positive family history. All patients received standard medical and dietary therapy prior to LT. The indications for LT were frequent metabolic decompensations in 4, elective in 2, and ALF in 1. The median age at LT was 2.4years (range, 1.3-6.5). Five patients received 6 left lateral segment grafts, one a live unrelated donor left lateral segment as an APOLT graft, and one a cadaveric whole liver graft as APOLT. One child required retransplantation due to hepatic artery thrombosis. Graft and patient survival were 86% and 100%, respectively. Median follow-up is 3.1years (range, 0.1-4.1), and the median age at follow-up is 5.5years (range, 4.0-9.8). There have been no metabolic decompensations in 6 children, while 1 patient (with APOLT) developed asymptomatic hyperammonemia with no clinical or histological signs of liver injury, requiring additional medical therapy. Our medium-term experience following LT in citrullinemia is favorable, demonstrating a positive transformation of the clinical phenotype.

Pediatric Renal Transplantation in Oman: A Single-center Experience.

This study sought to report 22 years experience in pediatric kidney transplantation in Oman. Electronic charts of all Omani children below 13 years of age who received a kidney transplant from January 1994 to December 2015 were reviewed. Data collected included patient demographics, etiology of end-stage kidney disease, modality and duration of dialysis, donor type, complication of kidney transplantation (including surgical complications, infections, graft rejection) graft and patient survival, and duration of follow-up. During the study period transplantation from 27 living related donors (LRDs), 42 living unrelated donors (LURDs), also referred to as commercial transplant, and one deceased donor were performed. The median age at transplantation was nine years for both groups. The most common primary diagnosis was congenital anomalies of the kidney and urinary tract in 32.8% of patients followed by familial nephrotic syndrome in 20.0% and polycystic kidney disease in 18.5%. Almost half the patients were on hemodialysis before transplantation, 35.7% were on peritoneal dialysis, and 14.2% received preemptive renal transplantation. Children who received LURD kidneys had high surgical complications (42.8%) compared to the LRDs group (17.8%). Five patients from LURDs group had early graft nephrectomy and four patients developed non-graft function or delayed graft function. In addition, patients in the LURDs group had a higher incidence of hypertension and acute rejection. Graft and patient survival were both better in the LRDs than the LURDs group. Although our pediatric kidney transplant program is a young program it has had successful patient outcomes comparable to international programs. Our study provides evidence that in addition to legal and ethical issues with commercial transplant, it also carries significantly higher morbidity and reduced graft and patient 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.

Annual Data for Kidney Transplant Services in Kuwait (2015).

Renal transplant services have been provided by the Hamed Al-Essa Organ Transplant Center in Ibn Sina Hospital since 1979 for Kuwaitis and non-Kuwaiti citizens residing in Kuwait. We aimed to monitor the activity and outcome of annual renal transplants in 2015. Data on transplant patients were collected from hospital records from January 1, 2015, through December 31, 2015, at Ibn Sina Hospital. Eighty-one patients underwent a renal transplant in Kuwait in 2015; 46 patients (56.8%) were male and 35 (43.2%) were female. Of these 81 patients, 24 (29.6%) received a kidney from a deceased donor, 19 (23.5%) received a kidney from a living-unrelated donor, and 38 (46.9%) received a kidney from a living-related donor. Thirty-four patients (41.98%) who were highly sensitized immunologically underwent successful desensitization before transplant according the local protocol; 13 (38.2%) of these patients were male and 21 (61.8%) were female. Two patients (2.47%) experienced acute rejection within the first week after transplant. One diabetic female patient underwent a successful simultaneous deceased-donor kidney and pancreas transplant. Seventy-nine patients who underwent a transplant outside of Kuwait in 2015 were added to the follow-up list; 62 (78%) of these patients were male and 17 (22%) were female. Of these 79 patients, 31 patients (39%) received a kidney from a living-related donor, 45 (57%) received a kidney from a living-unrelated donor, and 3 (4%) received a kidney from a deceased donor. In addition, 303 patients were assessed for fitness for kidney transplant; 204 (67.3%) of these patients were male and 99 (32.7%) were female. Eight (2.6%) patients were not placed on the waiting list for a kidney transplant for medical reasons. A total of 81 patients underwent a renal transplant in Kuwait in 2015, only 2 (2.47%) of whom experienced acute rejection in the first week after transplant.

Impact of Donor Source on the Outcome of Live Donor Kidney Transplantation: A Single Center Experience.

BackgroundRenal transplantation is the ideal method for management of end-stage renal disease. The use of living donors for renal transplantation was critical for early development in the field and preceded the use of cadaveric donors. Most donors are related genetically to the recipients, like a parent, a child, or a sibling of the recipient, but there are an increasing percentage of cases where donors are genetically unrelated like spouses, friends, or altruistic individuals. Donor shortages constitute the major barrier for kidney transplantation, and much effort has been made to increase the supply of living donors. The impact of donor source on the outcome of renal transplantation is not adequately studied in our country.ObjectivesThe aim of the study was to evaluate the impact of donor source on the outcome of live donor kidney transplantation.Patients and MethodsFrom March 1976 to December 2013, the number of patients that underwent living renal transplantation sharing at least one HLA haplotype with their donors was 2,485. We divided these patients into two groups: (1) 2,075 kidney transplant recipients (1,554 or 74.9% male and 521 or 25.1% female) for whom the donors were living related, (2) 410 kidney transplant recipients (297 or 72.4% male and 113 or 27.6% female) for whom the donors were living unrelated. All patients received immunosuppressive therapy, consisting of a calcineurin inhibitor, mycophenolate mofetil, or azathioprine and prednisolone. We compared acute rejection and complication rates, as well as long-term graft and patient survival of both groups. Demographic characteristics were compared using the chi-square test. Graft survival and patient survival were calculated using the Kaplan-Meier method.ResultsThe percentages of patients with acute vascular rejection were significantly higher in the unrelated group, while percentages of patients with no rejection were significantly higher in the related group, but there were no significant differences regarding patient and graft survivals between both groups.ConclusionsKidney transplant recipients who received their grafts either from live related donors or live unrelated donors had comparable patient and graft survival outcomes.

Living Unrelated Versus Related Kidney Transplantation: A 25-Year Experience with 3716 Cases.

To evaluate the results of transplantation from living unrelated donors (LURD) versus living related donors (LRD) with a long term follow-up of 25-30 years. From 1984 to 2015, a total of3716 kidney transplantations (411 LRDs and 3305 LURDs) were enrolled to the study. Long-term survival of grafts and patients as well as the association between relation state and patients or grafts surveillance were the outcomes. A total of 3716 live donor kidney transplants (LRD, n = 411; LURD, n = 3305) were carried out over this period. The mean age of donors was 28 ± 54 years in the LURD group and 34.4 ± 11.7 years in LRD (P < . 001), while the mean age of the recipients was 35.6 ± 15.6 years and 27.6 ± 10.1 years for the two groups, respectively. Donor age was the only statistically significant predictor of graft survival rate (hazard ratio = 1.021, 95% confidence interval: 1.012-1.031). Between 1984 and 2015, patient survival and graft survival improved significantly also patient survival and graft survival was similar in LURDs compared with LRDs. It seems that the outcome of LURD and LRD is comparable in terms of patient and graft survival. Therefore, transplants from LURDs may be proposed as an acceptable management for patients with end stage renal disease.

Recurrent membranoproliferative glomerulonephritis type I after kidney transplantation: a 17-year single-center experience.

Most previously published studies of patients with membranoproliferative glomerulonephritis type I are small or have short follow-up period. We report the outcome of a fairly large cohort of patients followed up for nearly 10 years. Retrospective cohort study. Graft survival, recurrence rate and risk factors for recurrence were analyzed for 43 patients transplanted between the years 1995 and 2012. At a mean overall follow-up of 118 ± 61 months (median, 127.8; range, 4.9-217), 12 patients lost their graft (28%). Death-censored actuarial 15-year graft survival rate was 56%. Membranoproliferative glomerulonephritis recurred in eight patients (19%) at a median time of 15.4 months (range, 4.4-70 months). Recurrence led to graft loss in seven patients (88%) within a median of 11.6 months (range, 1.3-54 months) from diagnosis. Median graft survival was 30.5 months for recurrence (range, 7-86). Actuarial 15-year graft survival was 71% for nonrecurrent. The risk for recurrence was higher for patients with human leukocyte antigen (HLA) B49 (odds ratio, 16.9; 95% confidence interval, 1.1-246; P=0.038) and HLA DR4 (odds ratio, 15.9; 95% confidence interval, 1.07-237; P=0.044) alleles. A trend toward increased risk was found with shorter duration of dialysis before transplantation. Four of 16 (25%) living-related versus none of the living-unrelated donors' recipients recurred. The HLA B49, acute tubular necrosis after transplantation, previous transplantations, and Arab origin were all associated with decreased graft and patient survival. Patients without recurrence in the first years should expect an excellent graft survival. Nonrelated living donors should be preferred. The HLA B49 and DR4 alleles may increase the risk for recurrence.

Kidney transplantation from living donors: Comparison of outcomes between live unrelated and live related donor renal transplants.

Kidney transplantation from living donors: Comparison of outcomes between live unrelated and live related donor renal transplants.

Impact of donor kidney function and donor age on poor outcome of living‐unrelated kidney transplantation (KT) in comparison with living‐related KT

Living-unrelated donors (LURD) have been widely used for kidney transplantation (KT). We retrospectively reviewed 779 patients who underwent living-donor KT from 2000 to 2012, to compare outcomes of 264 KT from LURD and 515 from living-related donors (LRD), and to identify risk factors for living KT. Median follow-up was 67months. Mean donor age, total human leukocyte antigen (HLA) mismatches, and HLA-DR mismatches were higher, and mean estimated glomerular filtration rate (eGFR) was lower in LURD. Acute rejection (AR)-free survival (p=0.018) and graft survival (p=0.025) were lower for LURD than LRD, whereas patient survival rate was comparable. Cox regression analysis showed HLA-DR mismatches (OR 1.75 for one mismatch; OR 2.19 for two mismatches), recipient age≤42yr, and donor age>50yr were significant risk factors for acute rejection. For graft survival, AR and donor eGFR (OR 1.90, p=0.035) were significant. We also identified significant impact of recipient age>50yr and diabetes for patient survival. However, KT from LURD was not a significant risk factor for AR (p=0.368), graft survival (p=0.205), and patient survival (p=0.836). Our data suggest that donor eGFR and donor age are independent risk factors for clinical outcomes of living KT, which can be related with poor outcome of KT from LURD.