Lower Graft Survival Rates Research Articles

Risk Factors and Hazards of Recipient-Area Perifollicular Erythema After Hair Transplantation: A Multicenter Retrospective Cohort Study.

Recipient-area perifollicular erythema (RPE) may delay graft growth after hair transplantation. However, there is currently a lack of observational clinical studies of RPE. To study the clinical features and risk factors associated with RPE while analyzing its correlation with graft growth. We conducted a multicenter retrospective cohort study between June 2020 and January 2023. A total of 1090 participants were included, 178 (16.33%) showed mild RPE, 56 (5.14%) showed moderate RPE, and 10 (0.92%) showed severe RPE. Patients with RPE had severe hair shaft shedding (P<0.001) and a lower survival rate (P<0.001) of grafts. Logistic regression analysis showed that folliculitis is a significant risk factor for mild RPE (OR 6.061, 95% CI 3.343-10.991, P<0.001) and moderate RPE (OR 3.397, 95% CI 1.299-8.882, P=0.013). Besides, untimely first postoperative hair washing was associated with the development of moderate RPE (OR 0.724, 95% CI 0.553-0.947, P=0.018) and severe RPE (OR 1.553, 95% CI 1.156-2.086, P=0.003). RPE is a postoperative complication closely related to high hair shaft shedding proportion and low graft survival rate. Both postoperative folliculitis and untimely first postoperative hair washing may induce the occurrence of RPE. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Progress of Degradable Synthetic Polymers in Adipose Tissue Engineering-A Review

Breast cancer stands as the foremost prevalent malignancy affecting women worldwide. The restoration of soft tissue volume is often necessary in cases of soft tissue loss, such as burn defects, surgical area defects, or posttumor resection defects, particularly in breast cancers. Conventional surgeries interventions, such as flap transplantation, can result in various complications and malformations, while prosthesis implantation may not be suitable due to skin weakness caused by radiation therapy. Autologous fat transplantation to the breast exhibits limited efficacy due to the unpredictable of resorption and low graft survival rates. Tissue engineering has emerged as a promising field offering novel therapeutic possibilities in regenerative medicine over the past two decades. Extensive exploration has been conducted on synthetic materials for adipose tissue engineering applications. This review delineates the current advancements and future directions in adipose tissue engineering strategies, cell applications, adipogenesismechanisms, and key factors, while focusing on the utilization of degradable synthetic polymers and the integration of 3D printing technologies.

Evaluation of grafting performances in Persian walnut affected by grafting methods and covering materials in Mugu district, Nepal

Walnut carries a great potential for cultivation in the high hills of Nepal, including the Mugu district. However, progress has not been as expected. Low graft survival rate and poor grafting practices account for inadequate number of quality saplings and consequently unreasonable price for successful ones. In this context, a field-based research was conducted in a two-factorial Randomized complete block design (RCBD) at Chhayanath Rara, 03, Mugu, to determine the suitable grafting method and covering material for grafting in walnut. Four different grafting methods viz. Tongue, saddle, cleft, and splice along with sawdust and grafting tape as graft covers were employed as treatments. The tongue grafting method yielded the highest callused rate (68.07%) and the highest graft take rate (48.07%). Similarly, sawdust used as a graft cover produced the most promising results on both the callused rate (56.37%) and the graft take rate (44.27%). Furthermore, the use of sawdust cover was found to have a greater callus quality (2.78) compared to that of using a grafting tape. No statistical differences were obtained in saleable plant rate and days to bud burst as a result of either of the factors. Apart from callus quality, the interaction between the two factors did not produce considerable variation in any of the variables. Hence, this study suggests the application of the tongue grafting method, along with the use of sawdust as a graft cover for enhanced grafting performance in agro-climatic zones similar to Mugu.

Effect of Posterior Tibial Slopes on Graft Survival Rates at 10 Years After Primary Single-Bundle Posterior Cruciate Ligament Reconstruction

Background: Recent biomechanical studies have reported that stress on the posterior cruciate ligament (PCL) graft increases as the posterior tibial slope (PTS) decreases (flattened) in knees with single-bundle (SB) and double-bundle PCL reconstruction. Clinical studies of SB PCL reconstruction have shown that a flattened PTS is associated with a lesser reduction in posterior tibial translation. There is no long-term study on the clinical outcomes and graft survival rates of SB PCL reconstruction based on the medial and lateral PTSs measured on magnetic resonance imaging. Hypothesis: Flattened medial and lateral PTSs are associated with poor clinical outcomes and graft survival rates at a minimum 10-year follow-up after SB PCL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: In this cohort study, we retrospectively reviewed 46 patients (mean age, 28.8 ± 9.9 years) who underwent primary SB PCL reconstruction between 2000 and 2009. They were followed up for a minimum of 10 years. The medial and lateral PTSs were measured on preoperative magnetic resonance imaging. As a previous study reported that a steeper medial or lateral PTS showed a higher risk of anterior tibial translation at thresholds of 5.6° and 3.8°, respectively, the patients were divided into 2 groups based on the cutoff values of both the medial (≤5.6° vs >5.6°) and lateral (≤3.8° vs >3.8°) PTSs. Clinical scores (International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity score), radiological outcomes (side-to-side difference [SSD] on stress radiography and osteoarthritis progression), and graft survival rates were compared between the groups at the last follow-up. Results: All clinical scores and the progression of osteoarthritis demonstrated no significant difference between the 2 subgroups of both the medial and lateral PTS groups. The mean SSD on stress radiography after SB PCL reconstruction was significantly greater in patients with a medial PTS ≤5.6° than in patients with a medial PTS >5.6° (8.4 ± 3.9 vs 5.1 ± 2.9 mm, respectively; P = .030), while the lateral PTS subgroups after SB PCL reconstruction demonstrated no significant difference. The minimum 10-year graft survival rate was significantly lower in patients with a medial PTS ≤5.6° (68.4% vs 92.6%, respectively; P = .029) and a lateral PTS ≤3.8° (50.0% vs 91.7%, respectively; P = .001). Conclusion: A flattened medial PTS (≤5.6°) was associated with an increased SSD on stress radiography, and both flattened medial (≤5.6°) and lateral (≤3.8°) PTSs resulted in lower graft survival rates at a minimum 10-year follow-up after primary SB PCL reconstruction.

Preoperative CD52 Level Predicts Graft Survival following Kidney Transplantation.

Several factors have been reported to affect graft survival following kidney transplantation. CD52 molecules may increase T cell proliferation and activation, which may contribute to acute graft rejection and graft survival. In the current study, we studied the possible value of preoperative CD52 levels in predicting graft survival following renal transplantation. Ninety-six patients with end-stage renal disease who had kidney transplantation were included in the study from our prospective cohort. Blood samples were taken one day before surgery, and plasma CD52 levels were measured using ELISA (Cloud-Clone Corp., Houston, TX, USA). Acute rejection, acute tubular necrosis, delayed graft function, graft loss, BK infection, cytomegalovirus infection, and graft survival were evaluated. The mean age of recipients was 50.08 ± 12.82 years, and 64.6% were male. The incidence of delayed graft function, acute rejection, graft loss (p < 0.01), BK virus infection, and serum creatinine levels were significantly higher in recipients with high preoperative CD52 levels six months after transplantation (p < 0.05). Kaplan-Meier analysis revealed that three-year graft survival was significantly higher in patients with low preoperative CD52 levels (p < 0.0001). Univariate and multivariate Cox regression analyses showed that serum creatinine levels (hazard ratio [HR] = 1.7, p < 0.05), acute rejection (HR = 2.919, p < 0.05), and preoperative CD52 levels (HR = 3.114, p < 0.05) were independent prognostic factors for graft survival after kidney transplantation. We showed that high preoperative CD52 levels are associated with higher rates of acute rejection, delayed graft function, and BK virus infection and lower rates of graft survival after kidney transplantation.

Hyperbaric Oxygen Improves the Survival and Angiogenesis of Fat Grafts after Autologous Fat Transplantation.

Objective Currently, autologous fat transplantation (AFT) still has a low graft survival rate. Elevation of the AFT graft survival rate is a challenge. This study investigated the effect of hyperbaric oxygen (HBO) on AFT. Methods Twelve adult male SD rats were randomly divided into two groups after AFT: the control group (n = 6) and the HBO group (n = 6). The rats were killed at 7, 14, and 28 days after transplantation to take the transplanted adipose tissues. The volume and weight of the tissues were detected. The pathological changes in the adipose tissues were observed after H&E staining. Microvessel density and levels of transforming growth factor- (TGF-) β, tumor necrosis factor- (TNF-) α, and malondialdehyde (MDA) in the transplanted adipose tissues were measured with CD31 immunohistochemical stain, ELISA, and biochemical reagents, respectively. Additionally, the protein expression levels of vascular endothelial growth factor- (VEGF-) A and platelet-derived growth factor- (PDGF) A in the adipose tissues were detected by Western blot. Results HBO significantly preserved the volume and weight of the transplanted adipose tissue (p < 0.01) and maintained the pathological structure of the transplanted adipose tissue. HBO therapy was effective in reducing inflammatory factor (TGF-β and TNF-α) levels and oxidative stress (MDA) in the transplanted adipose tissue (p < 0.01) and significantly increased the level of CD31 and angiogenesis-related factors including VEGF-A and PDGF-A (p < 0.01) to promote angiogenesis. Conclusion HBO therapy regulated the immune response of fat grafts, stimulated their angiogenesis, and ultimately promoted their survival after AFT.

De novo donor-specific HLA antibodies reduce graft survival rates and increase the risk of kidney transplant rejection: A single-center retrospective study

BackgroundWe investigated the impact of de novo donor-specific anti-human leukocyte antigen antibodies (dnDSAs) on long-term death-censored graft survival and renal allograft rejection in kidney transplant recipients. MethodsThe sample for this retrospective cohort study comprised 121 recipients of kidney transplants with negative complement-dependent cytotoxicity crossmatches to their deceased donors. Recipients were divided into two groups: dnDSAs+ (n = 31) and dnDSAs- (n = 90). We evaluated rejection and long-term graft survival rates in the recipients along with pathologic changes in the transplanted kidneys. ResultsDnDSAs were identified in 31/121 patients (25.6%). The graft survival rate in the dnDSAs+ group was 87.1% (27/31) and that of the dnDSAs- group was 97.8% (88/90). The dnDSAs+ group had lower graft survival rates than patients without dnDSAs (p = 0.007). There was no difference in the graft survival rates between patients with high DSA mean fluorescence intensity (≥4000) and those with low intensity (<4000) (p = 0.669). There was also no difference in the graft survival rates of patients with HLA class I, II, and I + II dnDSAs (p = 0.571). The presence of dnDSA in serum was associated with a higher incidence of antibody- and T-cell–mediated rejection (p < 0.0001). Banff scores for arterial fibrointimal and arteriolar hyalin, thickening as well as C4d deposition differed for the dnDSAs+ and dnDSAs- groups (p < 0.05). ConclusionDnDSAs were found to be associated with decreased long-term graft survival rates and increased rejection rates, often accompanied by C4d deposition.

Immunological Risk Factors in Paediatric Kidney Transplantation.

PurposeThe aim of this study was to identify factors impacting recipient sensitization rates and paediatric renal transplant patient outcomes.Patients and MethodsFor this purpose, a retrospective analysis of 143 paediatric renal transplants was carried out. This included the evaluation of patient’s and donor’s demographic data, HLA mismatches, immunosuppressive therapy, rejection episodes, panel reactive antibody (PRA) and post-transplant lymphoproliferative disease (PTLD).ResultsThe mean patient age at the point of transplant receival was 11.5 years with a mean follow up time of 9.33±5.05 years. It was noted that graft survival rates for donors over 59 years had the worst outcome. HLA match did not show statistically significant influence on graft outcome. Graft survival for more than one biopsy-proven rejection was also significantly shorter (p=0.008). PRA were found in 28% of the recipient’s post-transplantation and showed association with lower graft survival rates (p<0.001). In the present study, 22.7% (5/22) of the patients with EBV infections presented a PTLD.ConclusionIn conclusion, good graft survival with reduced sensitization for future transplantations and minimize the risk of PTLD, can be ensured through a balance between donor age, HLA match and condition of the recipient should be sought. Furthermore, paediatric patients should preferably receive organs from donors between the age of 10 and 59. EBV infection could be a relevant factor for developing PTLD.

Sixteen-Year Cohort of Liver Transplantation in the National Health System in Brazil: Analysis of Immunosuppression Maintenance Therapies.

ObjectiveTo evaluate factors related to liver graft survival with a focus on immunosuppressive schemes based on calcineurin inhibitors (tacrolimus or cyclosporine).MethodologyThis study was carried out through an open cohort constructed by deterministic and probabilistic matching through three databases of the SUS with assessment of liver graft survival from 2000 to 2015 in Brazil. From this first cohort, a second cohort was constructed by pairing 1: 1 to more precisely assess the effect of the immunosuppressive scheme on graft survival. The Kaplan-Meier method and was used to estimate the probability of survival. Cox’s model of proportional risks was used to assess factors related to graft loss.ResultWe found 12,687 patients in the Full cohort and 470 patients in the Matched cohort. The overall graft survival rates at 1, 5, 10, and 16 years were 72.6, 63.3, 52.8, and 45.3%, respectively. Patients younger had a longer graft survival than older ones. In the Full cohort, male patients had a higher survival rate than female ones. Therapeutic schemes based on tacrolimus were more prevalent and had a better survival rate when compared to schemes that used cyclosporine. Tacrolimus without association with antiproliferative agents or rapamycin inhibitors was the therapeutic scheme associated with greater survival rate in both cohorts (HR = 0.81, 95% CI = 0.72–0.91), (HR = 0.50, 95% CI = 0.30–0.85). In addition, white-skinned patients had longer survival rate in both cohorts (HR = 0.55, 95% CI = 0.50–0.61 and HR = 0.50, 95% CI = 0.34–0.75). On the other hand, patients who a greater time ratio without using an immunosuppressant had lower graft survival rate (HR = 6.46, 95% CI = 5.05–8.27 and HR = 6.57, 95% CI = 2.66–16.22).ConclusionThis 16-year cohort showed that the older age and the greater time ratio without using an immunosuppressant are risk factors for liver graft loss. White-skinned patients and tacrolimus-based regimens, especially tacrolimus without other immunosuppressants, are factors of better prognosis to the graft.

Preventive Vaccinations of Respiratory Infections during Lung Transplantation

Relevance. Lung transplantation is recognized as a method of treating terminal stages of lung disease when the drug therapy resource has been exhausted. In addition to the lack of material for transplantation, a serious problem of lung transplantation is the low graft survival rate. The main reasons are infections and primary allograft failure. Aims. To consider the current state of the use of vaccine prophylaxis in the integrated management of patients before and after lung transplantation. Conclusions The prevention of respiratory infections in adult candidates for organ transplantation and recipients is recommended and included in many clinical protocols and recommendations, however, they are based mainly on studies performed on healthy individuals, and are poorly supported by the results obtained in the study of individuals who underwent complete internal organ transplantation. Also, the effectiveness of vaccination remains unexplored, taking into account the individual characteristics of the immune system and the state of population immunity in relation to vaccine-preventable infections.

Cell-Assisted Lipotransfer for Cosmetic Breast Augmentation: Supportive Use of Adipose-Derived Stem/Stromal Cells.

Lipoinjection is a promising treatment but has some problems, such as unpredictability and a low rate of graft survival due to partial necrosis. To overcome the problems with lipoinjection, the authors developed a novel strategy known as cellassisted lipotransfer (CAL). In CAL, autologous adiposederived stem (stromal) cells (ASCs) are used in combination with lipoinjection. A stromal vascular fraction (SVF) containing ASCs is freshly isolated from half of the aspirated fat and recombined with the other half. This process converts relatively ASC-poor aspirated fat to ASC-rich fat. This report presents the findings for 40 patients who underwent CAL for cosmetic breast augmentation. Final breast volume showed augmentation by 100 to 200 ml after a mean fat amount of 270 ml was injected. Postoperative atrophy of injected fat was minimal and did not change substantially after 2 months. Cyst formation or microcalcification was detected in four patients. Almost all the patients were satisfied with the soft and natural-appearing augmentation. The preliminary results suggest that CAL is effective and safe for soft tissue augmentation and superior to conventional lipoinjection. Additional study is necessary to evaluate the efficacy of this technique further.

Concomitant Thrombotic Microangiopathy and Rejection in a Recent Kidney Transplant: A Case Study

Thrombotic microangiopathy (TMA) is an uncommon, life-threatening complication that adversely affects kidney transplant recipient and allograft survival. Post-transplantation TMA can occur as recurrence of the primary TMA or as a de novo condition. The latter can be triggered by numerous factors post-transplantation including calcineurin inhibitors, certain infections and antibody-mediated rejection. Rejection-associated TMAs carry a significantly lower graft survival rate compared with post-transplant TMAs that are not associated with rejection. In this case report, we present a rare case of rejection-associated TMA in a recently transplanted renal allograft that was managed in Al-Hada Armed Forces Hospital. Despite the poor expected outcome of this condition; the patient was successfully treated after early initiation of medical interventions. Transplantation teams may face many challenges managing such a combination of medical conditions, which may halt pursuing appropriate diagnostic and therapeutic measures in a timely fashion. This article highlights some of these challenges for better understanding of such a complex condition.

Effect of Obesity on Clinical Outcomes of Kidney Transplant Patients

PurposeCorrelating with the obesity epidemic, the number of obese transplant candidates is increasing. This study was designed to evaluate the effect of obesity on the survival of our kidney transplant recipients. MethodsAmong 1033 kidney transplants performed during the last 7.5 years in our center, 750 adult recipients were transplanted from living donors and were evaluated, and 561 of them were included in the study. Demographic and clinical data were collected. Body mass index (BMI) values at the time of transplant and post-transplant during the first year, the presence of delayed graft function, hospitalization duration, number of readmissions within the first year post-transplant, presence of post-transplant diabetes mellitus (PTDM) and cardiovascular disease, and graft and patient survival rates at 1, 3, and 5 years were investigated. ResultsObesity (BMI >30) was observed in 148 (19.7%) at the time of the transplant (initial obesity) and in 174 (23.2%) recipients at post-transplant first year. Initial obesity was not only found to be correlated with delayed wound healing (P = .03), increased hospitalization duration (P = .03), number of readmissions within the first year (P = .04), presence of PTDM (P = .02), and cardiovascular disease (P = .03) but also with lower graft survival rate (P = .04) at the first year. On the other hand, obesity at post-transplant the first year was associated with lower 3- and 5-year grafts (P = .04 and P = .03, respectively) and 5-year patient (P = .03) survival rates. ConclusionObesity should not be considered as a contraindication for kidney transplantation; however, to achieve better results, certain precautions should be taken pre- and postoperatively.

A New Risk Stratification Score for Deceased Donor Kidneys in Korea

Organ shortages have led to expansions in the criteria for deceased donors. Although the expanded criteria donor (ECD)/standard criteria donor (SCD) dichotomous criteria have been useful for making decisions about accepting organ offers, several studies reported that these criteria are too simple to predict prognosis sufficiently. The Kidney Donor Risk Index (KDRI) is based on 10 donor factors, therefore providing a finely granulated evaluation of donor kidney quality. Kidney Donor Profile Index (KDPI) that was derived from KDRI, was newly adopted as an alternative to ECD/SCD in the US. However, the KDPI based on US data may not have similar prognostic values in other countries. Here, we developed a Korean risk stratification score for deceased donor kidney using data obtained from the KONOS (Korean Network for Organ Sharing) and KOTRY (Korean Organ Transplantation RegistrY), and investigated its prognostic values. We analyzed 5,524 first-time, deceased donor adult kidney transplants between 2000 and 2016. A Cox regression model was used to find out independent risk factors among donor and transplant-related factors for graft failure, adjusted for recipient characteristics. There were 426 deaths and 483 graft loss during median follow-up of 49 months. The mean age of donors were 44 years old, and 32% of donor were females. Nine hundred seventeen donors had history of hypertension, and the cause of death was cerebrovascular event in 2,597 donors. Fifty-three donated organ after cardiac death, and mean cold ischemic time was 322 minutes. Twenty-three percent belonged to ECD. Median KDRI was 1.18 and KDPI was 67. A New Korean Kidney Donor Risk Index (K-KDRI) includes 6 donor and transplant factors, each found to be independently associated with graft failure: donor age, weight, history of diabetes, serum creatinine, cerebrovascular cause of death, and HLA mismatch. Median K- KDRI was 1.5. A New Korean Kidney Donor Profile Index (K-KDPI) is a remapping of the K-KDRI onto a cumulative percentage scale. The lowest K-KDPI group (<20%) showed better graft survival than the higher K-KDPI groups (20-80%, ≥80%, respectively) (p<0.001). Even within the ECD group, higher K-KDPI values were significantly associated with lower graft survival rate. In contrast, in the same K-KDPI group, there was no difference in graft survival rate between ECD and SCD. These data suggested that K-KDPI is a better prognostic tool for graft outcomes than the previous ECD/SCD criteria. The new K-KDPI criteria based on the Korean data are expected to give better information about graft prognosis and assist decision making for deceased donor kidney utilization in Korea. KONOS (Korean Network for Organ Sharing). KOTRY (Korean Organ Transplantation Registry).

Outcomes of Trabeculectomy and Glaucoma Drainage Devices for Elevated Intraocular Pressure After Penetrating Keratoplasty.

To assess and compare the outcomes of trabeculectomy with and without antimetabolites (AMs) and glaucoma drainage devices (GDDs) in the management of elevated intraocular pressure (IOP) after penetrating keratoplasty (PK). Data of 84 eyes of 81 patients who underwent trabeculectomy (12 eyes without an AM and 42 eyes with an AM) or GDD implantation (30 eyes) after PK were reviewed retrospectively. The main outcome measures were IOP control, corneal graft survival, and postoperative ocular complications. At the final visit, IOP success (<22 mm Hg) was 58.3% in trabeculectomy alone, 64.3% in trabeculectomy with an AM (TrabAM), and 86.7% in GDD groups (P = 0.047). The median time from surgery to IOP failure was 1 month after trabeculectomy alone, 13 months after TrabAM, and 20 months after GDD implantation (P = 0.042). The cumulative probability of IOP success rates at 1 and 3 years postoperatively was as follows: 66.7% and 57.1% in trabeculectomy alone, 80.6% and 64.8% in TrabAM, and 92.3% and 84.6 in GDD groups (P = 0.063). The cumulative probability of corneal graft survival rates at 1 and 3 years postoperatively was as follows: 70.0% and 60.0% in trabeculectomy alone, 76.7% and 67.7% in TrabAM, and 65.8% and 52.6% in GDD groups (P = 0.549). GDDs are more successful than trabeculectomy in controlling IOP in eyes that have undergone PK, but they tend to have low corneal graft survival rates. Trabeculectomy without an AM has limited success and may be considered in a limited number of patients with a low risk for bleb failure.

Procedee în chirurgia plastică a ţesuturilor moi. De la grefe de ţesut adipos la celule stem

Although significant progress has been made in recent years in plastic and reconstructive surgery procedures, there are still many issues to be solved. Thus, autologous fat transplantation is one of the promising treatments for soft tissue augmentation and facial rejuvenation, due to the lack of incisional scarring and complications associated with foreign materials. However, unpredictable problems and a low rate of graft survival due to partial necrosis occur. Recent research has led to the development of new adipose tissue transplantation techniques, with promising results, without establishing a standard protocol.

PMD64 - EFFICACY OF THE MICA ANTIBODY FOR TRANSPLANT PATIENTS

MICA antibody identification is a test performed on transplant patients to check for the presence of donor-specific MICA for the purpose of predicting the incidence of organ rejection among transplant patients. The purpose of this assessment was to evaluate the effectiveness. The literature search was performed using 8domestic research databases and 3core databases. A total of 9papers that remained. Each of the stages from literature search to application of selection criteria and data extraction was independently by 2researcher. The SIGN was used for the quality assessment. There were 5studies reporting on the medical results of kidney transplant patients. 2of the studies reported no significant differences in the graft survival rate and incidence of organ rejection(p=.67). However, 3studies reported a low graft survival rate and a significantly lower incidence of organ rejection in MICA(-)patients compared to the MICA (+)patients. There were 3studies reporting of heart transplant patients. 2studies reported an incidence of organ rejection of 23.1~62.5% and 1study reported a 5~10year graft survival rate of 94.7%(p=ns). There was one study reporting of lung transplant patients. The incidence of organ rejection was reported to be 42.0%(p=ns). MICA Identification lacked clinical effectiveness for the following reasons: i)there were no significant differences in the graft survival rate and incidence of organ rejection; ii)it is difficult to determine whether the different results for the graft survival rate and incidence of organ rejection reported; iii)the results cannot be generalized as it is probable that they will change in case of including all the patients fitting the description; iv)kidney transplantation is presently performed even if the results of the histocompatibility test of the donor and the patient do not conform to each other; v)heart and lung transplantations are performed based on anatomical compatibility without a histocompatibility test.

Urological complications, vesicoureteral reflux, and long-term graft survival rate after pediatric kidney transplantation.

To describe a single-center experience with kidney transplantation and then study some donor and recipient features that may impact on graft survival and urological complication rates. We reviewed our database searching for pediatric patients who underwent kidney transplantation from August 1985 through November 2012. Preoperative data and postoperative complications were recorded. Graft survival rates were analyzed and compared based on the type of donor, donor's age from deceased donors, and recipients' ESRD cause. Kaplan-Meier curves with log rank and Wilcoxon tests were used to perform the comparisons. There were 305 pediatric kidney transplants. The mean recipient's age was 11.7 yr. The mean follow-up was 11.0 yr. Arterial and venous thrombosis rates were 1.6% and 2.3%, respectively, while urinary fistula and symptomatic vesicoureteral reflux were diagnosed in 2.9% and 3.6% of cases, respectively. Deceased kidney transplantation had a lower graft survival rate than living kidney transplantation (log rank, p = 0.005). Donor's age (p = 0.420) and ESRD cause (p = 0.679) were not significantly related to graft survival rate. In long-term follow-up, type of donor, but not donor's age, impacts on graft survival rate. ESRD cause has no impact on graft survival rate, showing that well-evaluated recipients may have good outcomes.

Geographic Variation in Cold Ischemia Time: Kidney vs. Liver Transplantation in the United States, 2003-2011.

BackgroundRegional variations in kidney and liver transplant outcomes have been reported, but their causes remain largely unknown. This study investigated variations in kidney and liver cold ischemia times (CITs) across organ procurement organizations (OPO) as potential causes of variations in transplant outcomes.MethodsThis retrospective study analyzed the Standard Transplant Analysis and Research data of deceased donor kidney (n = 61,335) and liver (n = 39,285) transplants performed between 2003 and 2011. The CIT variations between the 2 types of organs were examined and compared. Factors associated with CIT were explored using multivariable regressions. Spearman rank tests were used to associate CIT with graft failure at the OPO level.ResultsSignificant CIT variations were found across OPOs for both organs (P < 0.05). The variation was particularly large for kidney CIT. Those OPOs with longer average kidney CIT were likely to have a lower graft survival rate (P = 0.01). For liver, this association was insignificant (P = 0.23). The regression analysis revealed sharp contrasts between the factors associated with kidney and liver CITs. High-risk kidney transplant recipients and marginal kidneys were associated with longer average CIT. The reverse was true for liver transplants.ConclusionsLarge variations in kidney CIT compared to liver CIT may indicate that there is a room to reduce kidney CIT. Reducing kidney CIT through managerial improvements could be a cost-effective way to improve the current transplant system.

Progression of urinary protein excretion after kidney transplantation: A marker for poor long-term prognosis

IntroductionPost-transplantation proteinuria is a risk factor for graft failure. A progressive decline in renal graft function is a predictor for mortality in kidney transplant patients. ObjectivesTo assess the development and the progression of urinary protein excretion (UPE) in the first year post-transplant in recipients of kidney transplants and its effect on patient and graft outcomes. Materials and methodsWe analysed 1815 patients with 24-h UPE measurements available at 3 and 12 months post-transplant. Patients were divided based on their UPE level: below 300mg, 300–1000mg and over 1000mg (at 3 and 12 months), and changes over time were analysed. ResultsAt 3 months, 65.7% had UPE below 300mg/24h, 29.6% 300–1000mg/24h and 4.7% over 1000mg/24h. At one year, 71.6% had UPE below 300mg/24h, 24.1% 300–1000mg/24h and 4.4% over 1000mg/24h.In 208 patients (12%), the UPE progressed, in 1233 (70.5%) it remained stable and in 306 (17.5%) an improvement was observed.We found that the level of UPE influenced graft survival, particularly if a progression occurred.Recipient's age and renal function at one year were found to be predictive factors for mortality, while proteinuria and renal function were predictive factors for graft survival. ConclusionsProteinuria after transplantation, essentially when it progresses, is a marker of a poor prognosis and a predictor for graft survival. Progression of proteinuria is associated with poorer renal function and lower graft survival rates.