Donor Renal Transplantation Research Articles

Multi-Omics Exploration of the Role of PTGS2 as a Hub Gene in Ferroptosis Within the Artery of Takayasu Arteritis.

Takayasu arteritis (TAK) is an autoimmune disease affecting the aorta and its branches. Despite anti-inflammatory treatments, some patients require surgical vascular reconstruction due to rapid disease progression. The mechanisms behind persistent inflammation are unclear due to a lack of arterial samples. This study explores ferroptosis in TAK using high-throughput and single-cell transcriptomics. Transcriptomic data were collected from 8 TAK patients (2 for single cell RNA-seq and 6 for bulk RNA-seq) and 8 renal transplant donors, with single-cell data from 3 public carotid artery samples for control. Bioinformatic analysis was performed to identify ferroptosis-related genes in inflamed arteries. We identified 1526 differentially expressed genes and 46 ferroptosis-related genes, with 6 genes including PTGS2 and HIF1A as hub genes. Single-cell analysis of 27,828 cells revealed increased M1-like macrophages, with PTGS2highly expressed in these cells. Enrichment analysis indicated NF-κB signal pathway involvement. PTGS2 is a core ferroptosis-related gene in TAK vascular inflammation, highly expressed in M1-like macrophages, potentially upregulated via the IL1B-NF-κB pathway.

Identification of the novel HLA-B*49:01:01:22 allele in an Indian renal transplant donor by next generation sequencing.

HLA-B*49:01:01:22 differs from HLA-B*49:01:01:01 by a single nucleotide C->G change in intron 5 at gDNA 2451.

HLA Genotype Imputation Results in Largely Accurate Epitope Mismatch Risk Categorization Across Racial Groups.

Biomarkers that predict posttransplant alloimmunity could lead to improved long-term graft survival. Evaluation of the number of mismatched epitopes between donor and recipient HLA proteins, termed molecular mismatch analysis, has emerged as an approach to classify transplant recipients as having high, intermediate, or low risk of graft rejection. When high-resolution genotypes are unavailable, molecular mismatch analysis requires algorithmic assignment, or imputation, of a high-resolution genotyping. Although imputation introduces inaccuracies in molecular mismatch analyses, it is unclear whether these inaccuracies would impact the clinical risk assessment for graft rejection. Using renal transplant patients and donors from our center, we constructed cohorts of surrogate donor-recipient pairs with high-resolution and low-resolution HLA genotyping that were racially concordant or discordant. We systemically assessed the impact of imputation on molecular mismatch analysis for cohorts of 180-200 donor-recipient pairs for each of 4 major racial groups. We also evaluated the effect of imputation for a racially diverse validation cohort of 35 real-world renal transplant pairs. In the surrogate donor-recipient cohorts, imputation preserved the molecular mismatch risk category for 90.5%-99.6% of racially concordant donor-recipient pairs and 92.5%-100% of racially discordant pairs. In the validation cohort, which comprised 72% racially discordant pairs, we found that imputation preserved the molecular mismatch risk category for 97.1% of pairs. Overall, these data demonstrate that imputation preserves the molecular mismatch risk assessment in the vast majority of cases and provides evidence supporting imputation in the performance of molecular mismatch analysis for clinical assessment.

Renal artery stenosis increases the risk of incident atrial fibrillation and cardiovascular events incorporating death

Abstract Background Renal artery stenosis (RAS) remains an under-recognized clinical risk factor for cardiovascular complications. Its long-term impact on AF arrhythmogenesis is unclear. Objective To investigate the role of RAS on incident AF and related adverse cardiovascular events Methods We performed a retrospective cohort study that comprised 100 patients with ultrasonographically-confirmed atherosclerotic RAS, and 50 age- and sex-matched controls who were healthy renal transplant donors (age 52.6 ±5.6 vs 50.1 ±10.7years, women 59% vs 70%). Incident AF was ascertained from clinical records. Primary endpoint was defined as the composite of incident AF, myocardial infarction, unstable angina, heart failure, ischemic stroke, peripheral arterial disease, end-stage renal failure, and cardiovascular death. Results Over a follow-up duration of 4818 ± 2751 days, RAS was significantly associated with incident AF (9.4% versus 0%, P=0.025). Kaplan-Meier analyses showed that RAS was associated with reduced incident AF event-free survival (Log-rank Mantel-Cox=4.6 P=0.032, Figure). Multivariable logistic regression showed that after adjustment for potential confounders (including age, sex, smoking, alcohol use, history of hypertension, diabetes mellitus, myocardial infarction, heart failure, ischemic stroke, renal function and serum low-density lipoprotein level), RAS was independently associated with substantially increased risk of the primary endpoint (OR=27.8, 95%CI [2.3 – 333.9], P=0.009), Conclusions RAS is an important and under-recognized independent risk factor for AF and cardiovascular events incorporating death. Its pathophysiological implications with a view to potential interventions need to be further explored.

Urinary Epidermal Growth Factor Level as a Noninvasive Indicator of Tubular Repair in Patients with Acute Kidney Injury.

Epidermal growth factor (EGF), an essential factor for the proliferation and survival of renal tubular cells, is expressed by distal tubules and normally excreted via urine. Previous studies in rats demonstrated that acute tubular injury reduces urinary EGF levels. However, it is unclear whether urinary EGF is a suitable monitoring marker of tubular repair status after acute kidney injury (AKI) in humans. To address this question, we measured serum and urinary EGF in patients with AKI (n = 99) using ELISA and investigated whether urinary EGF levels were associated with the severity of tubular injury and renal prognosis. Urinary EGF was abundant in healthy controls but showed a significant decrease in AKI patients (14,522 ± 2190 pg/mL vs. 3201 ± 459.7 pg/mL, p < 0.05). The urinary EGF level in patients with renal AKI was notably lower than that in patients with pre-renal AKI. Furthermore, the urinary EGF level in patients with AKI stage 3 was significantly lower than that in patients with AKI stage 1. Urinary EGF levels were negatively correlated with urinary β-2MG and serum creatinine levels but positively correlated with hemoglobin levels and eGFR. Urinary EGF was not significantly correlated with urinary NAG, α-1MG, L-FABP, NGAL, KIM-1, or urinary protein concentrations. No significant correlation was observed between serum and urinary EGF levels, suggesting that urinary EGF is derived from the renal tubules rather than the blood. In living renal transplantation donors, the urinary EGF/Cr ratio was approximately half the preoperative urinary EGF/Cr ratio after unilateral nephrectomy. Collectively, these data suggest that urinary EGF is a suitable noninvasive indicator of not only the volume of functional normal renal tubules but also the status of tubular repair after AKI.

Accuracy of eGFR Equation for Predicting Glomeruloar Filtration Rate in Potential Living Kidney Donor

This Descriptive Cross-Sectional Study, involving 201 patients, conducted at Sindh Institute of Urology and Transplantation (SIUT) Karachi, Pakistan after approval from institute research board. The estimated Glomerular Filtration Rate (eGFR) was calculated using the appropriate equation. Participants were instructed to collect their urine over a 24-hour period in a container devoid of any additives or preservatives. The collected urine specimens were subsequently sent to the institutional laboratory for analysis, with GFR determined based on 24-hour urine creatinine clearance to ensure accuracy. All data collected during the study period were meticulously entered into a predefined proforma, which was then electronically stored and utilized for research purposes.&#x0D; Results: Mean ± SD of age was 33.30±9.12 years. Out of 201 patients, 124 (61.7%) were male while 77 (38.3%) were female. In distribution of accuracy of eGFR by CKD-EPI equation, accuracy of (Cr-Cys) equation was noted as 60 (29.9%), (Cys) as 47 (23.4%) while accuracy of CKD- EPI (PK) equation was documented as 96 (47.8%).&#x0D; Conclusion: It is to be concluded that accuracy of CKD-EPI is closer to 24 -h urinary creatinine clearance in the calculation of eGFR. However, none of the eGFR formulas can be used in renal transplant donors because of their low accuracy, and 24-h urine creatinine clearance should be used for evaluation of the GFR in this population.

Analysis of risk factors and prognosis of diarrhea after renal transplantation.

Diarrhea is a prevalent complication after renal transplantation. To examine the risk factors for diarrhea after renal transplantation, evaluate their combined predictive values, and analyze the prognosis. Clinical data of patients who underwent allogeneic renal transplantation in the Second People's Hospital of Shanxi Province from January 2019 to March 2020 were retrospectively analyzed, cases were screened and grouped, independent risk factors for diarrhea after renal transplantation were analyzed by univariate analysis and multivariate analysis, and their predictive value was evaluated by receiver operating characteristic (ROC) curve. The survival time of recipient grafts in diarrhea and non-diarrhea groups were evaluated by Kaplan-Meier and log-rank test. We included 166 recipients in the study and the incidence of diarrhea was 25.9%; univariate and logistic regression multivariate analyses revealed that independent risk factors for diarrhea in recipients were that the type of renal transplant donor was DCD (donation after circulatory death), immunity induction was onducted with basiliximab + antithymocyte globulin (ATG), and ATG alone, the type of mycophenolic acid (MPA) used was mycophenolate mofetil capsules, and delayed graft function (DGF) occurred after transplantation. The ROC curve indicated that the combination of the four factors had good accuracy in predicting the occurrence of diarrhea in recipients. The graft survival rate two years after the operation in the diarrhea group was significantly lower than that in the non-diarrhea group. Diarrhea affected the two-year survival rate of the graft. The type of donor, immunity induction scheme, and the type of MPA and DGF were independent risk factors for diarrhea in recipients, and the combination of the four factors had good prognostic prediction value.

Analysis of Human Leukocyte Antigen Frequency among Renal Transplant Recipients and Donors in Nepal

ABSTRACT Background and Objectives: Kidney transplants are effective for advanced renal failure, but graft rejection can occur when the recipient’s immune system misidentifies the kidney as a foreign object. Human leukocyte antigen (HLA), a component of the host’s immunological defense system, acts as a barrier to graft rejection. Selecting potential kidney recipients and donors for transplantation requires careful consideration of histocompatibility for the HLA-A, HLA-B, and HLA-DRB1 antigens. Mismatches between donors and recipients prolong transplant therapy, leading to lower graft survival and higher mortality. The objective of the study was to analyze HLA-A, HLA-B, and HLA-DRB1 antigens frequency in live-related renal transplant recipients and donors visiting the Department of Histocompatibility and Immunopathology at the National Public Health Laboratory, Teku, Kathmandu, Nepal. Methods: A retrospective study was conducted by using data from 104 renal transplant recipients and donors whose samples had previously been collected, processed, and analyzed to identify the Class I loci (HLA-A and HLA-B) and Class II loci (DRB1) between November 2021 and February 2024. Results: The study found that the majority of donors were female, and the majority of recipients were male. In this study, 10, 17, and 12 different HLA-A, B, and DRB1 alleles were found in recipients and donors. Alleles found more frequently are A*11 (25.00%), A*24 (23.08%), sB*15 (22.60%), B*35 (12.98%), DRB1*15 (22.60%), and DRB1*12 (21.63%). Conclusions: The study suggests that both donors and recipients of renal transplants in Nepal have a diverse HLA antigen distribution, which could aid in selecting a genetically closer group as potential matched donors for transplant recipients.

Opportunistic screening for osteopathy with routine abdominal computed tomography scan in chronic pancreatitis

Background and aimsLumbar vertebral bone attenuation, measured in Hounsfield units (HU) can indirectly indicate the bone mineral density (BMD). The aim of this study is to determine the optimal HU threshold on abdominal computed tomography (CT) scans to detect osteopathy in patients with chronic pancreatitis (CP). MethodsThis cross-sectional study included patients with CP who underwent CT scans to measure HU at L1 to L4 vertebrae. The mean lumbar vertebral attenuation of female renal transplant donors, aged 20–30 years was utilized to calculate the T-scoreHU of all patients at each vertebral level. Receiver operator characteristic analysis was used to determine the HU and T-scoreHU for diagnosis of osteopathy in patients with CP. Dual-energy X-ray absorptiometry value was used to categorize osteopenia and osteoporosis. ResultsA total of 175 patients (mean age, 34.5 ± 10.9 years; 72 % males) and 33 female renal transplant donors (mean age, 28 ± 2.4 years) were included. A threshold HU value 212 or T scoreHU of −1.80 at L1 vertebra was found to have a 78 % sensitivity and 70 % specificity for differentiating between osteoporosis and non-osteoporosis (osteopenia and normal BMD). Similarly, a threshold HU value of 254 or a T-scoreHU of −0.46 at L1 vertebra had 78 % sensitivity and 71 % specificity for distinguishing between normal and low BMD (osteoporosis and osteopenia). ConclusionAbdominal CT images, which are routinely performed in chronic pancreatitis, can be used for opportunistic screening of osteoporosis and osteopenia without additional cost or radiation exposure.

Accuracy-Based Glomerular Filtration Rate Assessment by Plasma Iohexol Clearance in Kidney Transplant Donors.

An accurate measurement of the glomerular filtration rate (GFR) is essential for detecting renal insufficiency in living kidney donors. Iohexol is a "near-ideal" exogenous filtration marker for GFR measurements that has attracted increasing interest in clinical practice because it is non-toxic, non-radioactive, readily available, and easy to measure. In this study, we aimed to set up a laboratory test to conveniently assess the plasma clearance of iohexol in living kidney donors. A workflow was established in the institution's infusion clinic to administer iohexol and to collect three timed blood samples from renal transplant donors. Iohexol was thereafter measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The serum proteins were precipitated and the supernatant containing iohexol was diluted prior to the LC-MS/MS analysis. The LC-MS/MS method was developed on a Thermo Vanquish UHPLC coupled with a TSQ Endura triple quadruple mass spectrometer with a total run time of 2.5 min. The analytical performance of the method was assessed. The LC-MS/MS method demonstrated a good analytical performance. To calculate the iohexol clearance rate and the GFR, automated data integration and a result calculation were accomplished by using a custom Python script. Automated result reporting was achieved using a laboratory informatics system (LIS) vendor's direct media interface. We developed and implemented a laboratory test to assess the plasma clearance of iohexol. A workflow was established in the hospital to reliably measure the GFR in living kidney donors, with a potential to be further expanded into other areas where an accurate GFR measurement is needed.

How Does Surgeons' Autonomic Physiology Vary Intraoperatively?: A Real-time Study of Cardiac Reactivity.

To measure the physiological responses of surgical team members under varying levels of intraoperative risk. Measurement of intraoperative physiological responses provides insight into how operation complexity, phase of surgery, and surgeon seniority impact stress. Autonomic nervous system responses (interbeat intervals, IBIs) were measured continuously during different surgical operations of various complexity. The study investigated whether professional role (eg attending surgeon), operative risk (high vs. low), and type of primary operator (attending surgeon vs. resident) impacted IBI reactivity. Physiological synchrony captured the degree of correspondence between individuals' physiological responses at any given time point. A total of 10,005 observations of IBI reactivity were recorded in 26 participants during 16 high-risk (renal transplant and laparoscopic donor nephrectomy) and low-risk (arteriovenous fistula formation) operations. Attending surgeons showed greater IBI reactivity (faster heart rate) than residents and nurses during high-risk operations and while actively operating (Ps<0.001). Residents showed lower reactivity during high-risk (relative to low-risk) operations (P<0.001) and similar reactivity regardless of whether they or the attending surgeon was operating (P=0.10). Nurses responded similarly during low-risk and high-risk operations (P=0.102) but were more reactive when the resident was operating compared to when the attending surgeon was the primary operator (P<0.001). In high-risk operations, attending surgeons had negative physiological covariation with residents and nurses (P<0.001). In low-risk operations, only attending surgeons and nurses were synchronized (P<0.001). Attending surgeons' physiological responses were well-calibrated to operative demands. Residents' and nurses' responses were not callibrated to the same extent. This suggests that risk sensitivity is an adaptive response to stress that surgeons acquire.

#3737 RENAL RESERVE IN LIVING KIDNEY DONORS: THE HIDDEN ROLE OF OVERWEIGHT

Abstract Background and Aims Renal reserve (RR) is the capacity to increase glomerular filtration rate (GFR) under certain stimuli such as obesity, hyperglycaemia, metabolic syndrome, etc. The importance of the presence or absence of RR is unknown. We investigated the prevalence and factors associated with RR in a group of living donors for renal transplantation. Method We investigated RR before donation in 52 living kidney donors. GFR was measured by iohexol clearance before and after the stimulation of RR by endovenous amino acid infusion. The presence of RR was defined as an increase greater than 10% of basal GFR. According with the presence or absence of RR, subjects were grouped in those without RR; with RR and using RR. The latter was defined as the lack of increase in GFR after stimulation in patients with GFR &amp;gt; 100 mL/min. GFR was unadjusted to body surface area (BSA). The characteristics of these three groups were evaluated. Results 13 (25%) had no RR, 24 (46%) had RR and 15 (29%) were using RR. Subjects without RR was predominantly female (92%) with lower BSA and BMI than those with RR or using RR (BMI: 22 ± 3 vs 28 ± 3 and 29 ± 4, p &amp;lt; 0.005); also had a lower GFR than the other groups (84 ± 10 vs 95 ± 14 and 131 ± 22, p &amp;lt; 0.005). Subjects with RR or using RR had more frequently metabolic syndrome traits i.e. prediabetes than those without RR. Finally, subject using RR present larger kidney length than the other groups (right kidney: 11.3 ± 0.8 vs 10.3 ± 0.36 and 10.4 ± 0.8, p &amp;lt; 0.005; left kidney: 11.8 ± 0.5 vs 10.4 ± 0.6 and 10.7 ± 0.7, p &amp;lt; 0.005). No differences were observed regarding dyslipidaemia and arterial hypertension. Conclusion overweight and prediabetes may be factors that stimulate RR in a healthy population such as living kidney donors. Future implications of these factors, particularly after donation both in donors and recipients, deserve attention.

Biostatistical Analysis of Relation between HLA-A/B and HLA-DR Eplet Mismatches and Renal Graft Outcome

Abstract: Despite all the clinical interventions that happened during the last 2 decades, the unavailability of a potent donor for renal transplantation remains a concern in the field of transplantation immunology. Recent studies promise the establishment of an effective clinical method to find a potent renal transplant donor, in the near future. Combining the use of molecular techniques with biostatistical methods can be a great tool for clinicians in choosing a potent donor. The present study was conducted from a cohort of 1144 (n=572 pair) renal transplant recipients and their donors to analyse eplet matches and mismatches. Initial observation of increased serum creatinine level which ranged from 2.0 to 21.0 mg/dL in patients treated for end-stage renal disease implied a single event of graft rejection. The statistical correlation between eplet mismatches and graft survival was observed to be significant with P value 0.003. A value of -0.215 at 0.01 significance showed the positive linear correlation between the increased numbers of HLA DR eplet mismatches towards chronic renal graft rejection. The correlation coefficient of -0.888 observed between the number of HLA DR eplet mismatches and days of graft survival clearly implies the effect of increased HLA DR eplet mismatch delayed graft rejection. The study gives an idea on the minimization of class II HLA DR eplet mismatches to decreased frequency of graft rejection as indicated by increased survival rate.

Evaluation of the ability of human induced nephron progenitor cells to form chimeric renal organoids using mouse embryonic renal progenitor cells

The number of patients with end-stage renal failure is increasing annually worldwide and the problem is compounded by a shortage of renal transplantation donors. In our previous research, we have shown that transplantation of renal progenitor cells into the nephrogenic region of heterologous fetuses can induce the development of nephrons. We have also developed transgenic mice in which specific renal progenitor cells can be removed by drugs. By combining these two technologies, we have succeeded in generating human-mouse chimeric kidneys in fetal mice. We hope to apply these technologies to regenerative medicine. The quality of nephron progenitor cells (NPCs) derived from human pluripotent stem cells is important for the generation of chimeric kidneys, but there is currently no simple evaluation system for the chimerogenic potential of human NPCs. In this study, we focused on the fact that the re-aggregation of mouse renal progenitor cells can be used for nephron formation, even when merged into single cells. First, we examined the conditions under which nephron formation is likely to occur in mice during re-aggregation. Next, to improve the differentiation potential of human NPCs derived from pluripotent stem cells, NPCs were sorted using Integrin subunit alpha 8 (ITGA8). Finally, we demonstrated chimera formation between different species by mixing mouse cells with purified, selectively-induced human NPCs under optimum conditions. We observed these chimeric organoids at different time points to learn about these human-mouse chimeric structures at various stages of renal development. We found that the rate of chimera formation was affected by the purity of the human NPCs and the cell ratios used. We demonstrated that chimeric nephrons can be generated using a simple model, even between distant species. We believe that this admixture of human and mouse renal progenitor cells is a promising technology with potential application for the evaluation of the chimera formation abilities of NPCs.

MP31-15 BY DONOR FACTOR COMPARISON OF PRE-TRANSPLANT CT VOLUMETRY AND RENAL DYNAMIC SCINTIGRAPHY IN PREDICTING POST-TRANSPLANT RENAL FUNCTION IN LIVING RENAL TRANSPLANT DONORS

You have accessJournal of UrologyCME1 Apr 2023MP31-15 BY DONOR FACTOR COMPARISON OF PRE-TRANSPLANT CT VOLUMETRY AND RENAL DYNAMIC SCINTIGRAPHY IN PREDICTING POST-TRANSPLANT RENAL FUNCTION IN LIVING RENAL TRANSPLANT DONORS Hirohito Naito, Nobufumi Ueda, Tomoko Honda, Iori Matsuda, Yu Osaki, Yoichiro Tohi, Yuki Matsuoka, Takuma Kato, Homare Okazoe, Rikiya Taoka, and Mikio Sugimoto Hirohito NaitoHirohito Naito More articles by this author , Nobufumi UedaNobufumi Ueda More articles by this author , Tomoko HondaTomoko Honda More articles by this author , Iori MatsudaIori Matsuda More articles by this author , Yu OsakiYu Osaki More articles by this author , Yoichiro TohiYoichiro Tohi More articles by this author , Yuki MatsuokaYuki Matsuoka More articles by this author , Takuma KatoTakuma Kato More articles by this author , Homare OkazoeHomare Okazoe More articles by this author , Rikiya TaokaRikiya Taoka More articles by this author , and Mikio SugimotoMikio Sugimoto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003264.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal dynamic scintigraphy (RDS) is used to evaluate renal function in donors, and the utility of CT volumetry (CTV) has recently been reported. Both techniques can be discordant, and it is not clear which test is more useful in which patients. To evaluated the correlation between predicted renal function by both examination and post-transplant renal function. Patient factors affecting the usefulness of both examinations were evaluated. METHODS: Of 117 renal transplant donors who underwent renal transplantation at our institution between April 30, 2008 and April 30, 2022, 113 patients who underwent RDS and CT prior to transplantation were included. Correlation coefficients and regression equations were obtained from post-transplant estimated GFR (eGFR) and pre-transplant residual renal function calculated from RDS and CTV, respectively. The difference between the post-transplant eGFR and the predicted eGFR from each regression equations were obtained for each case, and the examination with smaller difference was defined as the useful test for that case. Multiple logistic regression analysis using factor including age, sex, BMI, serum creatinine, blood pressure, and presence of diabetes mellitus, which are commonly evaluated before transplantation, was performed to determine factors affecting the usefulness of both examinations. RESULTS: The correlation coefficients between pre-transplant residual renal function calculated from RDS and CTV and post-transplant eGFR were 0.742 and 0.794. The median difference between predicted eGFR and post-transplant eGFR obtained from both regression equations was 3.97 and 3.19 ml/min/1.73 m2, and multiple logistic regression analysis showed that CTV was significantly more useful in patients with higher BMI (p<0.05). CONCLUSIONS: Pre-transplant residual renal function calculated from by RDS and CTV were both positively correlated with post-transplant renal function. The results suggest that CTV is more useful than RDS in patients with high BMI. Source of Funding: No funding is needed for this study © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e435 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hirohito Naito More articles by this author Nobufumi Ueda More articles by this author Tomoko Honda More articles by this author Iori Matsuda More articles by this author Yu Osaki More articles by this author Yoichiro Tohi More articles by this author Yuki Matsuoka More articles by this author Takuma Kato More articles by this author Homare Okazoe More articles by this author Rikiya Taoka More articles by this author Mikio Sugimoto More articles by this author Expand All Advertisement PDF downloadLoading ...

Medical complications after live donor kidney transplantation: An experience from tertiary care hospital of south Punjab, Pakistan.

Objective: To determine the frequency of medical complications after renal transplantation in recipients. Study Design: Prospective Cohort study. Setting: Nephrology Unit, Bahawal Victoria Hospital, Bahawalpur. Period: December 2018 to March 2022. Material &amp; Methods: All patients undergoing renal transplant during the study period were included. Patients unwilling to be part of this study or losing follow-ups were excluded. At the time of enrollment, all patients underwent pre-transplant work-up and routine investigations. Baseline characteristics of renal transplant recipients and donors were noted while frequency of post renal transplant medical complications was also noted. Results: In a total of 39 renal transplant recipients, 32 (82.1%) were male while the mean age was 30.31±7.21 years. Mean duration of dialysis before transplantation was 6.81±5.15 months (ranging between 0-24 months). Mean age of the live donors was 35.90±9.36 years. Mean duration of follow up was 26.15±11.62 months. Renal graft dysfunction was reported in 10 (25.6%) patients. Most common medical complications reported in post-transplantation period were sepsis 19 (48.7%), anemia 19(48.7%), secondary polycythemia 10 (25.6%), CMV infection 4 (10.3%) and new onset diabetes mellitus 3 (7.7%). Mortality was reported in 2 (5.1%) renal transplant recipients and the cause of mortality in both those patients was sepsis. Conclusion: Medical complications are common after renal transplantation. Sepsis being more common in 1st6-months post-transplant period. Early recognition and management of these complications is essential for decreasing mortality and morbidity of patients.

Standardized Reporting on the Preoperative CT Assessment of Potential Living Renal Transplant Donors: Can We Create a Universal Report Standard to Meet the Needs of Transplant Urologists?

Purpose: Determine whether standardized template reporting for the preoperative assessment of potential living renal transplant donors improves the comprehensiveness of radiology reports to meet the needs of urologists performing renal transplants. Methods: Urologist and radiologist stakeholders from renal transplant centres in our province ratified a standardized reporting template for evaluation of potential renal donors. Three centres (A, B, and C) were designated "intervention" groups. Centre D was the control group, given employment of a site-specific standardized template prior to study commencement. Up to 100 consecutive CT scan reports per centre, pre- and post-implementation of standardized reporting, were evaluated for reporting specific outcome measures. Results: At baseline, all intervention groups demonstrated poor reporting of urologist-desired outcome measures. Centre A discussed 5/13 variables (38%), Centre B discussed 6/13 variables (46%), and Centre C only discussed 1/13 variables (8%) with ≥90% reliability. The control group exhibited consistent reporting, with 11/13 variables (85%) reported at ≥90% reliability. All institutions in the intervention group exhibited excellent compliance to structured reporting post-template implementation (Centres A = 95%, B = 100%, and C = 77%, respectively). Additionally, all intervention centres demonstrated a significant improvement in the comprehensiveness of reports post-template implementation, with statistically significant increases in the reporting of all variables under-reported at baseline (P > .01). Conclusion: Standardized templates across our province for CT scans of potential renal donors promote completeness of reports. Radiologists can reliably provide our surgical colleagues with needed preoperative anatomy and incidental findings, helping to determine suitable transplant donors and reduce potential complications associated with organ retrieval.

Duplicated inferior vena cava in live-related renal transplant donor nephrectomy

Evaluation for prospective donors in live-related renal transplantation poses many challenges. Anatomical anomalies are no longer considered red flags as long as the functionality is maintained. Vascular anomalies increase difficulty during live donor nephrectomy. We herein report a case of live donor nephrectomy in a donor with a duplicated left-sided inferior vena cava (IVC). Adequate length of the left renal vein was got by taking a cuff off the duplicated IVC. The postoperative period was uneventful. Duplicated IVC is not a contraindication for left donor nephrectomy and detailed preoperative imaging helps in delineating and planning such cases.

Latent Tuberculosis Infection in Potential Renal Transplant Recipients and Live Donors in a Tertiary Level Transplant Center in Nepal

Background: Active tuberculosis in transplant recipients can result from latent infection with Mycobacterium Tuberculosis in the transplant recipients, donor tissue, or de novo post-transplant infection. This study aimed to determine the prevalence of latent tuberculosis infection in potential renal transplant recipients and live donors at a tertiary-level transplant center.&#x0D; Materials and Methods: This observational study was conducted from July to October 2020 among 72 potential kidney transplant recipients and their potential donors from the Department of Nephrology, Tribhuvan University Teaching Hospital. The biochemical parameters and health behaviors were measured to find the association with latent tuberculosis infection.&#x0D; Results: The prevalence of latent tuberculosis infection according to Mycobacterium tuberculosis-specific interferon-gamma release assays was 20.8% in potential recipients and 16.6% in potential donors, whereas the prevalence with tuberculin skin test was 9.7% in potential recipients and 33.3% in potential donors. Low levels of hemoglobin, calcium, albumin, vitamin D and history of smoking were associated with the development of latent tuberculosis infection among potential recipients. Alcohol drinking was significantly associated with the development of latent tuberculosis infection among donors.&#x0D; Conclusion: Potential renal transplant recipients and donors have a significant burden of latent tuberculosis in the pre-transplantation phase. Diagnosis and treatment of latent tuberculosis before transplantation can prevent ominous complications.

QuantiFERON cytomegalovirus assay for evaluation of CMV reactivity among renal transplant recipient and donor in Bangladesh

Farnaz Nobi, Amit Bari, Nura Afza Salma Begum, Tasnuva Sarah Kashem, Mohammad Shakib Uz-Zaman Arefin, Shoeb Nomany, Mitali Rahman, Niyoti Akhter, Eshaba Yousuf, Harun Ur Rashid. Korean J Transplant 2022;36:250. https://doi.org/10.4285/ATW2022.F-3896