Relationship of hemoglobin levels with outcomes in deceased donor kidney transplant: a retrospective cohort study / Relação dos níveis de hemoglobina com desfechos em transplante renal de doador falecido: um estudo de coorte retrospectivo

ABSTRACT Introduction: Anemia is frequent in patients undergoing replacement therapy for kidney failure. Anemia in the pre- and post-transplantation period might be related to kidney transplant outcomes. The current study therefore sought to assess the relationship between anemia, delayed allograft function (DGF), chronic kidney allograft dysfunction (CAD), and death from any cause following kidney transplantation from a deceased donor. Methods: This was a retrospective study with 206 kidney transplant patients of deceased donors. We analyzed deceased donors' and kidney transplant patients' demographic data. Moreover, we compared biochemical parameters, anemia status, and medicines between DGF and non-DGF groups. Afterward, we performed a multivariate analysis. We also evaluated outcomes, such as CAD within one year and death in ten years. Results: We observed a lower frequency of pre-transplant hemoglobin concentration (Hb) but higher frequency of donor-serum creatinine and red blood transfusion within one week after transplantation in the group with DGF. In addition, there was an independent association between Hb concentration before transplantation and DGF [OR 0.252, 95%CI: 0.159-0.401; p < 0.001]. There was also an association between Hb concentration after six months of kidney transplantation and both CAD [OR 0.798, 95% CI: 0.687-0.926; p = 0.003] and death from any cause. Conclusion: An association was found between pre-transplantation anemia and DGF and between anemia six months after transplantation and both CAD and death by any cause. Thus, anemia before or after transplantation affects the outcomes for patients who have undergone kidney transplantation from a deceased donor.

RESUMO Introdução: A anemia é frequente em pacientes submetidos à terapia substitutiva para insuficiência renal. A anemia nos períodos pré e pós-transplante pode estar relacionada aos desfechos do transplante renal. Portanto, o presente estudo buscou avaliar a relação entre anemia, função retardada do enxerto (FRE), disfunção crônica do enxerto renal (DCE) e óbito por qualquer causa após transplante renal de doador falecido. Métodos: Este foi um estudo retrospectivo com 206 pacientes transplantados renais de doadores falecidos. Analisamos dados demográficos de doadores falecidos e pacientes transplantados renais. Além disso, comparamos parâmetros bioquímicos, status de anemia e medicamentos entre os grupos FRE e não-FRE. Posteriormente, realizamos uma análise multivariada. Também avaliamos desfechos, como DCE em um ano e óbito em dez anos. Resultados: Observamos menor frequência de concentração de hemoglobina (Hb) pré-transplante, mas maior frequência de creatinina sérica do doador e transfusão de hemácias no período de uma semana após o transplante no grupo FRE. Além disso, houve associação independente entre a concentração de Hb antes do transplante e a FRE [OR 0,252; IC 95%: 0,159-0,401; p < 0,001]. Houve também associação entre a concentração de Hb após seis meses de transplante renal e ambos, DCE [OR 0,798; IC95%: 0,687-0,926; p = 0,003] e óbito por qualquer causa. Conclusão: Encontrou-se uma associação entre anemia pré-transplante e FRE e entre anemia seis meses após o transplante e ambos, DCE e óbito por qualquer causa. Assim, a anemia antes ou após o transplante afeta os desfechos de pacientes que foram submetidos a transplante renal de doador falecido.

Clinical efficacy of adult kidney transplantation from unilateral pediatric donor kidney / 器官移植

Objective To evaluate the clinical efficacy of adult kidney transplantation from unilateral pediatric donor kidney. Methods Clinical data of pediatric donors (n=10) and adult recipients (n=19) undergoing kidney transplantation were retrospectively analyzed. The changes of renal function, liver function and the maximal diameters of the kidney allografts were compared at 1, 7, 14, 28, 60 d after operation. The short-term survival and incidence of postoperative complications of the recipients were analyzed. Results Ten donors included 6 males and 4 females, aged (7±3) years old, with a body mass index (BMI) of (16.3±3.8) kg/m2. All donors were donation after brain death followed by cardiac death. Among 19 recipients, 12 were males and 7 were females, aged (34±12) years old, with a BMI of (20.3±1.3) kg/m2.An oblique incision was created in the lower right abdomen of the recipients. The arteries and veins of donor kidney were anastomosed with the external iliac arteries and veins of the recipients. The ureter of donor kidney was anastomosed with the bladder of the recipients. After anastomosis, the kidney was placed and fixed in the right iliac fossa. The serum creatinine and blood urea nitrogen levels of the recipients were decreased at 1 week after kidney transplantation, and restored to normal range at postoperative 2 weeks. All parameters related to liver function were normal after operation. At postoperative 1 month, the maximal diameters of the kidney allografts were (9.5±0.3) cm on average, which basically reached those of normal adults. The 1-year survival rate of 19 recipients was 95%. One recipient died from pulmonary infection after ineffective treatment. Two recipients developed rejection, and 1 recipient experienced urinary system infection, who were healed after corresponding treatment. Conclusions Adult kidney transplantation from unilateral pediatric donor kidney is safe, feasible and effective, which can be utilized to enlarge the source of donor kidneys.

Correlation between anti-angiotensin type 1 receptor antibody and prognosis of sensitized renal transplant recipients / 中华器官移植杂志

Objective To evaluate the correlation between anti-angiotensin type 1 receptor (AT1R) antibody and the prognosis of HLA-positive sensitized renal transplant recipients.Methods Forty-three HLA-positive sensitized recipients positive for AT1R antibodies were tested.HLA antibodies were tested by Lurninex-based single antigen beads assay.AT1R antibody was detected by ELISA.The patients were divided into two groups according to AT1R antibody level:AT1R-AA positive group (AT1R-AA ≥9 U/mL,n =12) and AT1R-AA negative group (AT1R-AA＜9 U/mL,n =31).We also analyzed the rate of rejection and allograft loss,HLA antibodies level,kidney function,kidney survival and patients' survival,etc.Results The rate of allograft loss in the AT1RAA positive group and the AT1R-AA negative group was 41.7％ (5/12) and 9.6％ (3/31)respectively (P =0.02).The rate of AMR in the AT1R-AA positive group and the AT1R-AA negative group was 25％ (3/12) and 0.0％ (0/31) respectively (P =0.03).Meanwhile,the one-yearpatients' survival in the AT1R-AA positive group was lower than in the AT1R-AA negative group (P＜0.05).There was no significant association between AT1R-AA (mean AT1R-AA =8.7 U/mL)and MFI (mean MFI =9119).AT1R antibody was one of risk factors to acute antibody-mediated rejection and kidney allograft loss for sensitized recipients.Conclusion The rate of allograft loss in the AT1R-AA positive group and the AT1R-AA negative group was 41.7％ (5/12) and 9.6％ (3/31)respectively (P =0.02).The rate of AMR in the AT1R-AA positive group and the AT1R-AA negative group was 25％ (3/12) and 0.0％ (0/31) respectively (P =0.03).Meanwhile,the one-yearpatients' survival in the AT1R-AA positive group was lower than in the AT1R-AA negative group (P ＜0.05).There was no significant association between AT1R-AA (mean AT1R-AA =8.7 U/mL)and MFI (mean MFI =9119).AT1R antibody was one of risk factors to acute antibody-mediated rejection and kidney allograft loss for sensitized recipients.

De Novo AL Amyloidosis in a Renal Allograft / 대한내과학회지

Amyloidosis is characterized by the extracellular deposition of amyloid in various tissues and organs, particularly the kidney and heart. The estimated incidence of systemic amyloidosis is at least 8 per million population per year. However, few cases of systemic amyloidosis in renal allografts have been reported. A stable renal transplant recipient was admitted with proteinuria and dyspnea on exertion. The M-peak was found on serum and urine protein electrophoresis, and lambda (λ) dominance was confirmed by serum and urine free-light-chain test. The patient was diagnosed with systemic amyloidosis of a renal allograft, by allograft biopsy, at 22 years after renal transplantation. We report a case of AL amyloidosis in a stable renal allograft and review the medical literature.

Collapsing Glomerulopathy in Renal Allograft: Case Report / 대한이식학회지

Collapsing glomerulopathy (CG) is a recently described form of focal segmental glomerulosclerosis (FSGS) which was defined by renal pathology findings. CG is characterized by severe proteinuria and rapid progressive decline of renal function clinically. We experienced one case of CG in renal allograft. 24 year-old male recipient was admitted for evaluation of proteinuria (5.08 g/day) and increment of serum creatinine level at post-transplant 150 days. The graft biopsy was taken and the pathology specimen demonstrated a typical characteristics of CG such as glomerular capillary collapse, visceral epithelial hypercellularity, deposition of immunoglobulin/C3 and variable degree of tubulointerstitial injury. The patient was negative for HIV infection before transplantation and at the time of biopsy diagnosis. No specific treatment for CG was performed. The patient progressed to the graft failure and returned to hemodialysis 84 days after biopsy. In conclusion, recognition of CG by graft biopsy is important because it is a lesion with a high risk for rapid progression to graft failure.

Correlation of Pathologic Staging by Banff Criteria with Rejection Reversal and Graft Outcome in Acute Renal Allograft Rejection / 대한이식학회지

PURPOSE: Acute renal allograft rejection is known to be an important prognostic factor of long-term graft survival. The purpose of this study was to make a treatment discipline in acute renal allograft rejection by finding any relationship between Banff classification of acute rejection and response to treatment and long term graft survival. MATERIALS AND METHODS: Thirty-eight cases histopathologically diagnosed as acute rejection were included in this study. The grade of acute rejection was classified according to Banff criteria (1997). Response to treatment was classified into three groups; complete (>75% reduction in serum creatinine increment), partial (25-75% reduction), and no response (>25% reduction). RESULT: Mean age of the patients at the time of biopsy was 32.3 years and male to female ratio was 25:13. The mean interval between renal transplantation and rejection episode was 4.9 months. Mild, moderate and severe rejection according to Banff classification was 15, 15 and 8 cases respectively. Antirejection therapy with steroid pulse was initiated in all cases, antilymphocyte globulins (ALG or OKT3) in 19 cases and tacrolimus rescue therapy in one. All patients except for two (93%) with mild or moderate rejection showed complete or partial response, whereas responsiveness was noted only in three cases (38%) with severe rejection (p>0.01). 66.7% of cases with mild rejection showed complete response to steroid pulse therapy; 40% with moderate rejection; 0% with severe rejection (p=0.01). Patients with severe rejection had much poorer long term graft survival than with mild or moderate rejection (p=0.01). CONCLUSION: These results suggest that Banff classification of renal allograft rejection could be used as an indicator of treatment responsiveness and graft prognosis. They also suggest that a more intensive anti-rejection therapy should be recommended in high grade rejections.